Urban environment during pregnancy and lung function, wheezing, and asthma in school-age children. The generation R study.

The urban environment during pregnancy may influence child's respiratory health, but scarce evidence exists on systematic evaluation of multiple urban exposures (e.g., air pollution, natural spaces, noise, built environment) on children's lung function, wheezing, and asthma development. We aimed to examine the association of the urban environment during pregnancy with lung function, preschool wheezing, and school-age asthma. We included 5624 mother-child pairs participating in a population-based prospective birth cohort. We estimated 30 urban environmental exposures including air pollution, road traffic noise, traffic, green spaces, blue spaces, and built environment during pregnancy. At 10 years of age, lung function was measured by spirometry. Information on preschool wheezing and physician-diagnosed school-age asthma was obtained from multiple questionnaires. We described single-exposure associations with respiratory outcomes using an exposome-wide association study. We also identified patterns of urban exposures with hierarchical clustering on principal components analysis and examined their associations with respiratory outcomes using multivariate regression models. Single-exposure analyses showed associations of higher particulate matter (PM) with lower mid-expiratory flow (FEF25-75%) (e.g., for PM < 2.5 µm of diameter [PM2.5] z-score = -0.06 [-0.09, -0.03]) and higher forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) (e.g., for PM2.5 FEV1 0.05 [0.02, 0.08]) after correction for multiple-hypothesis testing. Cluster analysis described three patterns of urban exposures during pregnancy and showed that the cluster characterised by higher levels of air pollution, noise, walkability, street connectivity, and lower levels of natural spaces were associated with lower FEF25-75% (-0.08 [-0.17, 0.00]), and higher odds of preschool wheezing (1.21 [1.03, 1.43]). This study shows that the characteristics of the urban environment during pregnancy are of relevance to the offspring's respiratory health during childhood.

Outdoor residential noise exposure and sleep in preadolescents from two European birth cohorts.

OBJECTIVE: To examine whether outdoor residential exposure to annual average road traffic and multiple (i.e., road traffic, railway, aircraft, industry) noise levels is related with preadolescents' sleep using maternal-reported and wrist-actigraphy data in two European birth cohorts. METHODS: This cross-sectional study used data of 1245 preadolescents from the Dutch Generation R Study and 232 from the Spanish INMA-Sabadell cohort with a mean age of 12.3 years old. We used noise maps to assess average outdoor road traffic and multiple noise levels (day-evening-night noise indicator, LDEN) at each child's residential address for the year before the sleep assessment. Sleep disturbances were reported by mothers through the Sleep Disturbance Scale for Children and objectively recorded using GeneActiv wrist-actigraphy during seven subsequent days. Linear and Poisson regression models adjusted for several potential confounding variables were performed. RESULTS: The mean (SD) exposure to road traffic noise was 53.2 dB (7.3) in the Generation R Study and 61.3 dB (5.9) in the INMA-Sabadell cohort. Exposure to road traffic was related with reduced total sleep time and longer wake after sleep onset (e.g. -3.62 min (95%CI -6.87; -0.37) and 6.88 min (95%CI 1.15; 12.61) per an increase of 10 dB in road traffic noise, respectively) collected by wrist-actigraphy. We observed no association between road traffic exposure and maternal-reported sleep disturbances. Results were similar for multiple noise exposure. CONCLUSIONS: These findings indicate that sleep may be compromised for preadolescents living in areas highly exposed to outdoor residential noise. Future studies using longitudinal designs to further explore these associations during the different stages of sleep development across childhood and adolescence are warranted. Also, wrist-actigraphy measurements which provide more accurate information and may be complementary to the parental- and self-reported data should be considered.

Exposure to outdoor residential noise during pregnancy, embryonic size, fetal growth, and birth outcomes.

INTRODUCTION: Previous literature suggested that noise exposure during pregnancy was not associated with adverse birth outcomes. However, no studies evaluated the association between noise exposure and embryonic and fetal growth, or mutually assessed other urban environmental exposures such as traffic-related air pollution or natural spaces. METHODS: We included 7947 pregnant women from the Generation R Study, the Netherlands. We estimated total (road traffic, aircraft, railway, and industry), road traffic, and railway noise at the participants' home addresses during pregnancy using environmental noise maps. We estimated traffic-related air pollution using land-use regression models, greenness within a 300 m buffer using the normalized difference vegetation index, and distance to blue spaces using topographical maps at the home addresses. Embryonic size (crown-rump length) and fetal growth parameters (head circumference, femur length, and estimated fetal weight) were measured by ultrasound at several gestational ages. Information on neonatal anthropometrics at birth (head circumference, length, and weight) and adverse birth outcomes (preterm birth, low birth weight, and small for gestational age) were retrieved from medical records. RESULTS: Higher total noise exposure during pregnancy was associated with larger crown-rump length (0.07 SDS [95%CI 0.00 to 0.14]). No association was found with fetal growth parameters, neonatal anthropometrics, and adverse birth outcomes. Similar results were observed for road traffic noise exposure, while railway noise exposure was not associated with any of the outcomes. Traffic-related air pollution was not associated with crown-rump length. Total noise exposure mediated 15% of the association between exposure to greenness and smaller crown-rump length. No association was observed between distance to blue spaces and total noise exposure. CONCLUSION: Exposure to outdoor residential noise during pregnancy was associated with larger embryonic size. Moreover, a reduction of total noise exposure during pregnancy partially mediated the association between exposure to greenness and smaller embryonic size. Additional research is warranted to confirm and further understand these novel findings.

Susceptible windows of exposure to fine particulate matter and fetal growth trajectories in the Spanish INMA (INfancia y Medio Ambiente) birth cohort.

While prior studies report associations between fine particulate matter (PM2.5) exposure and fetal growth, few have explored temporally refined susceptible windows of exposure. We included 2328 women from the Spanish INMA Project from 2003 to 2008. Longitudinal growth curves were constructed for each fetus using ultrasounds from 12, 20, and 34 gestational weeks. Z-scores representing growth trajectories of biparietal diameter, femur length, abdominal circumference (AC), and estimated fetal weight (EFW) during early (0-12 weeks), mid- (12-20 weeks), and late (20-34 weeks) pregnancy were calculated. A spatio-temporal random forest model with back-extrapolation provided weekly PM2.5 exposure estimates for each woman during her pregnancy. Distributed lag non-linear models were implemented within the Bayesian hierarchical framework to identify susceptible windows of exposure for each outcome and cumulative effects [ßcum, 95% credible interval (CrI)] were aggregated across adjacent weeks. For comparison, general linear models evaluated associations between PM2.5 averaged across multi-week periods (i.e., weeks 1-11, 12-19, and 20-33) and fetal growth, mutually adjusted for exposure during each period. Results are presented as %change in z-scores per 5 µg/m3 in PM2.5, adjusted for covariates. Weeks 1-6 [ßcum = -0.77%, 95%CrI (-1.07%, -0.47%)] were identified as a susceptible window of exposure for reduced late pregnancy EFW while weeks 29-33 were positively associated with this outcome [ßcum = 0.42%, 95%CrI (0.20%, 0.64%)]. A similar pattern was observed for AC in late pregnancy. In linear regression models, PM2.5 exposure averaged across weeks 1-11 was associated with reduced late pregnancy EFW and AC; but, positive associations between PM2.5 and EFW or AC trajectories in late pregnancy were not observed. PM2.5 exposures during specific weeks may affect fetal growth differentially across pregnancy and such associations may be missed by averaging exposure across multi-week periods, highlighting the importance of temporally refined exposure estimates when studying the associations of air pollution with fetal growth.

Air pollution exposure during pregnancy and childhood, cognitive function, and emotional and behavioral problems in adolescents.

BACKGROUND: Exposure to air pollution may impact neurodevelopment during childhood, but current evidence on the association with cognitive function and mental health is inconclusive and primarily focusses on young children. Therefore, we aim to study the association of exposure to air pollution during pregnancy and childhood, with cognitive function and emotional and behavioral problems in adolescents. METHODS: We used data from 5170 participants of a birth cohort in Rotterdam, the Netherlands. Concentrations of fourteen air pollutants at participant's home addresses were estimated during pregnancy and childhood, using land use regression models. We included four cognitive domains (processing speed, working memory, fluid reasoning and verbal intelligence quotient (IQ)) and an estimated full-scale IQ. Internalizing, externalizing, and attention problems were self- and parent-reported. We used linear regression models to assess the association of each air pollutant, with cognitive function and emotional and behavioral problems, adjusting for socioeconomic status and lifestyle characteristics. Then, we performed multipollutant analyses using the Deletion/Substitution/Addition (DSA) algorithm. RESULTS: Air pollution exposure was not associated with full-scale IQ, working memory, or processing speed. Higher exposure to few air pollutants was associated with higher fluid reasoning and verbal IQ scores (e.g. 0.22 points of fluid reasoning (95%CI 0.00; 0.44) per 1 µg/m3 increase in organic carbon during pregnancy). Higher exposure to some air pollutants was also associated with less internalizing, externalizing, and attention problems (e.g. -0.27 internalizing problems (95% CI -0.52; -0.02) per each 5 ng/m3 increase in copper during pregnancy). CONCLUSIONS: Higher exposure to air pollution during pregnancy and childhood was not associated with lower cognitive function or more emotional and behavioral problems in adolescents. Based on previous literature and biological plausibility, the observed protective associations are probably explained by negative residual confounding, selection bias, or chance and do not represent a causal relationship.

Green space exposure during pregnancy and umbilical cord blood levels of liver enzymes.

Evidence has suggested better pregnancy outcomes due to exposure to greenspace; however, the studies on such an association with the level of liver enzymes in the cord blood are still nonexistent. Hence, this study investigated the relationship between exposure to greenspace during the entire pregnancy and gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in cord blood samples. We selected 150 pregnant women from our pregnancy cohort in Sabzevar, Iran (2018). Greenspace exposure was characterized based on (i) residential distance to green space, (ii) time spent in public/private green spaces, (iii) residential surrounding greenspace, (iv) visual access to greenspace, and (v) number of indoor natural pot plants at home. We developed linear regression models to investigate the adjusted associations of greenspace exposure with enzyme levels. Each one interquartile range (IQR) increase in the residential surrounding greenspace (100 m buffer) was related to a reduction of -12.58 (U/L) (95% CI -22.86, -2.29), -3.35 (U/L) (95% CI -5.50, -1.20), and -0.57 (U/L) (95% CI -1.12, -0.02) in the levels of GGT, AST, and ALT, respectively. Moreover, a similar association was observed for the time the participants spent in green spaces. A decrease in the residential distance to large green spaces was related with lower cord blood levels of AST, ALT, and GGT. Having a window with greenspace view at home was significantly related to lower AST level. The results for the indoor plant pots were not conclusive. Our findings suggested an inverse relationship between greenspace exposure during pregnancy and cord blood levels of liver enzymes. Further studies in other settings and populations are needed to confirm our findings.

Maternal exposure to air pollution during pregnancy and child's cognitive, language, and motor function: ECLIPSES study.

Prenatal exposure to air pollution, even at low levels, has been associated with negative effects on a child's neuropsychological functioning. The present work aimed to investigate the associations between prenatal exposure to air pollution on a child's cognitive, language, and motor function at 40 days of age in a highly exposed area of Spain. From the ECLIPSES study population, the present work counted 473 mother-child pairs. Traffic-related air pollution levels at home addresses during the whole pregnancy were estimated including particulate matter (PM) with an aerodynamic diameter <2.5 µm (PM2.5), <10 µm (PM10) and 2.5-10 µm (PMcoarse), PM2.5absorbance, nitrogen dioxide (NO2), other nitrogen oxides (NOx), and ozone (O3) using land-use regression models developed within ESCAPE and ELAPSE projects. Children's cognitive, language, and motor functions were assessed using the Bayley Scales of Infant Development 3rd edition (BSID-III) at around 40 days of age. Linear regression models were adjusted for maternal biological, sociodemographic and lifestyle characteristics, area deprivation index, and amount of greenness around the home's address. All air pollutants assessed, except PM2.5 absorbance, were associated with lower motor function in children, while no association was observed between prenatal exposure to air pollution and cognitive and language functions. This finding highlights the need to continue raising awareness of the population-level impact that maternal exposure to air pollution even at low levels can have on the neuropsychological functions of children.

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil.

BACKGROUND: Currently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil. METHODS: We carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability. RESULTS: We estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations. DISCUSSION: Not complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices.

Environmental noise exposure and emotional, aggressive, and attention-deficit/hyperactivity disorder-related symptoms in children from two European birth cohorts.

BACKGROUND: Environmental noise exposure is increasing but limited research has been done on the association with emotional, aggressive, and attention-deficit/hyperactivity disorder (ADHD)-related symptoms in children. OBJECTIVE: To analyze the association between prenatal and childhood environmental noise exposure and emotional, aggressive, and ADHD-related symptoms in children from two European birth cohorts. METHODS: We included 534 children from the Spanish INMA-Sabadell Project and 7424 from the Dutch Generation R Study. Average 24 h noise exposure at the participants' home address during pregnancy and childhood periods were estimated using EU maps from road traffic noise and total noise (road, aircraft, railway, and industry). Symptom outcomes were assessed using validated questionnaires: Strengths and Difficulties Questionnaire, Child Behavioral Checklist, ADHD Criteria of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition List, and Conner's Parent Rating Scale-Revised at 4, 7 and 9 years (INMA-Sabadell cohort) and 18 months, 3, 5, and 9 years (Generation R Study). Adjusted linear mixed models of prenatal and repeated childhood noise exposure with repeated symptom outcomes were run separately by cohort and overall estimates were combined with random-effects meta-analysis. RESULTS: Average prenatal and childhood road traffic noise exposure levels were 61.3 (SD 6.1) and 61.7 (SD 5.8) for INMA-Sabadell and 54.6 (SD 7.9) and 51.6 (SD 7.1) for Generation R, respectively. Prenatal and childhood road traffic noise exposure were not associated with emotional, aggressive, or ADHD-related symptoms. No heterogeneity was observed between cohorts and results were comparable for total noise exposure. CONCLUSIONS: No association was observed between prenatal or childhood road traffic or total noise exposure and symptom outcomes in children. Future studies should include a more comprehensive noise exposure assessment considering noise sensitivity and noise exposure at different settings such as work for pregnant women and school for children.

The impact of urban and transport planning on health: Assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status.

BACKGROUND: The population living in urban areas is growing rapidly. The level of exposure to adverse environmental factors is detrimental to human health and is directly related to urban and transport planning practices. OBJECTIVE: To estimate the premature mortality burden of non-compliance with international exposure guidelines for air pollution, noise, access to green space and heat for Barcelona and Madrid (Spain), and its distribution among the population by the socioeconomic status (SES). METHODS: The Urban and TranspOrt planning Health Impact Assessment (UTOPHIA) tool was applied and the attributable premature mortality due to non-compliance with recommended exposure levels was estimated. The distribution of the attributable mortality burden among the population by SES was investigated through Generalized Additive Models (GAMs) adjusting for spatial autocorrelation and a cluster analysis was performed to identify attributable mortality hot spots. RESULTS: Annually, 7.1% and 3.4% of premature mortality in Barcelona and Madrid, respectively, could be attributed to non-compliance with the international exposure recommendations for air pollution, noise, heat and access to green space. In addition, analysis by SES showed that in Barcelona lower SES areas had an overall greater attributable mortality rate, while in Madrid, the distribution of the attributable mortality burden by SES varied by exposure. CONCLUSION: This study shows the impact of environmental exposures on mortality and highlights the importance of taking integrated actions when designing cities considering the health impacts, but also the specificities of each city such as the socio-demographic context. Moreover, the high precision scale of the analysis enables the identification of environmental hazards and mortality hot spots providing a powerful tool to support priority-setting and guide policymakers towards a healthy, sustainable and just city for all of their residents.

Land-Use Change and Cardiometabolic Risk Factors in an Urbanizing Area of South India: A Population-Based Cohort Study.

BACKGROUND: Land-use changes in city fringes due to urbanization can lead to a reduction of greenspace that may reduce its associated health benefits. OBJECTIVES: We evaluated the association between changes in residential surrounding built-up land use and cardiometabolic risk factors in an urbanizing peri-urban area of south India and explored the mediating roles of air pollution, physical activity, and stress in these associations. METHODS: We analyzed data on 6,039 adults from the third follow-up of the Andhra Pradesh Children and Parent Study (APCAPS) cohort (2010-2012). We generated trajectories of change in residential surrounding built-up land use (buffer areas) from 1995-2009 (stable, slow increase, fast increase) using remote sensing data and image classification methods. We estimated associations between built-up land use trajectories and natural log-transformed blood pressure, waist circumference, triglycerides, fasting glucose, and non-high-density lipoprotein (non-HDL) cholesterol using linear mixed models. We accounted for multiple mediators and the multilevel structure of the data in mediation analyses. RESULTS: We observed positive associations between a fast increase in built-up land use within 300m of the home and all cardiometabolic risk factors. Compared with participants with stable trajectories, those with the largest increase in built-up land use had 1.5% (95% CI: 0.1, 2.9) higher systolic blood pressure, 2.4% (95% CI: 0.6, 4.3) higher diastolic blood pressure, 2.1% (95% CI: 0.5, 3.8) higher waist circumference, and 1.6% (95% CI: -0.6, 3.8) higher fasting glucose in fully adjusted models. Associations were positive, but not statistically significant, for triglycerides, fasting glucose, and non-HDL cholesterol. Physical activity and ambient particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) partially mediated the estimated associations. Associations between fast build-up and all cardiometabolic risk factors except non-HDL cholesterol were stronger in women than men. DISCUSSION: Increases in built-up land use surrounding residences were consistently associated with higher levels of cardiometabolic risk factors. Our findings support the need for better integration of health considerations in urban planning in rapidly urbanizing settings. https://doi.org/10.1289/EHP5445.

Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria.

Each year, The Economist Intelligence Unit (EIU) computes the Global Liveability Index and determines the most liveable cities around the world. Vienna, Austria, was ranked by the EIU as the most liveable city worldwide in 2018 and 2019. However, the relationship between a liveable as well as healthy and environmentally-just city has not been previously explored. To explore whether the most liveable city is also a healthy and environmentally-just one, we estimated the premature mortality burden related to non-compliance with international exposure level recommendations for physical activity (PA), air pollution (PM2.5 and NO2), road traffic noise, green space and heat for Vienna, as well as its distribution by socioeconomic status (SES). We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated the annual mortality, life expectancy (LE) and economic impact of non-compliance with exposure guidelines for the Viennese adult population ≥ 20 years. We compared current with recommended exposure levels, quantified the association between exposures and mortality and calculated attributable health impact fractions. Eight percent of premature mortality (i.e. 1239 deaths, 95% CI: 679-1784) was estimated to be attributable to non-compliance with the recommended exposure levels. Seventy-six percent of the attributable premature mortality was due to PM2.5 exposure and insufficient PA. Non-compliance also resulted in an average of 199 days of LE lost for the adult population (95% CI: 111-280) and an economic impact of 4.6 (95% CI: 2.5-6.7) billion 2015€ annually. Overall, residents of lower SES neighbourhoods faced higher risk of premature mortality due to higher exposure to NO2, road traffic noise, heat and less green space. Despite high liveability standards according to EIU definition, a considerable premature mortality burden was attributable to non-compliance with exposure recommendations, and socioeconomic inequalities were estimated. Although the exposure attributable mortality burden was lower than in other European cities and local Viennese policies favour the reduction of motorized traffic, alongside the promotion of active and public transport and urban greening, there is room for further alignment of liveability, environmental health and justice objectives.

Momentary mood response to natural outdoor environments in four European cities.

Exposure to natural outdoor environments (NOE) has been shown in population-level studies to reduce anxiety and psychological distress. This study investigated how exposure to one's everyday natural outdoor environments over one week influenced mood among residents of four European cities including Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands) and Kaunas (Lithuania). Participants (n = 368) wore a smartphone equipped with software applications to track location and mood (using mobile ecological momentary assessment (EMA) software), for seven consecutive days. We estimated random-effects ordered logistic regression models to examine the association between mood (positive and negative affect), and exposure to green space, represented by two binary variables indicating exposure versus no exposure to NOE using GPS tracking and satellite and aerial imagery, 10 and 30 min prior to participants' completing the EMA. Models were adjusted for home city, day of the week, hour of the day, EMA survey type, residential NOE exposure, and sex, age, education level, mental health status and neighbourhood socioeconomic status. In addition, we tested for heterogeneity of effect by city, sex, age, residential NOE exposure and mental health status. Within 10 min of NOE exposure, compared to non-exposure, we found that overall there was a positive relationship with positive affect (OR: 1.39, 95% CI: 1.06, 1.81) of EMA surveys, and non-significant negative association with negative affect (OR: 0.80, 95% CI: 0.58, 1.10). When stratifying, associations were consistently found for Stoke-on-Trent inhabitants and men, while findings by age group were inconsistent. Weaker and less consistent associations were found for exposure 30 min prior to EMA. Our findings support increasing evidence of psychological and mental health benefits of exposure to natural outdoor environments, especially among urban populations such as those included in our study.

Correlates of Walking for Travel in Seven European Cities: The PASTA Project.

BACKGROUND: Although walking for travel can help in reaching the daily recommended levels of physical activity, we know relatively little about the correlates of walking for travel in the European context. OBJECTIVE: Within the framework of the European Physical Activity through Sustainable Transport Approaches (PASTA) project, we aimed to explore the correlates of walking for travel in European cities. METHODS: The same protocol was applied in seven European cities. Using a web-based questionnaire, we collected information on total minutes of walking per week, individual characteristics, mobility behavior, and attitude (N=7,875). Characteristics of the built environment (the home and the work/study addresses) were determined with geographic information system (GIS)-based techniques. We conducted negative binomial regression analyses, including city as a random effect. Factor and principal component analyses were also conducted to define profiles of the different variables of interest. RESULTS: Living in high-density residential areas with richness of facilities and density of public transport stations was associated with increased walking for travel, whereas the same characteristics at the work/study area were less strongly associated with the outcome when the residential and work/study environments were entered in the model jointly. A walk-friendly social environment was associated with walking for travel. All three factors describing different opinions about walking (ranging from good to bad) were associated with increased minutes of walking per week, although the importance given to certain criteria to choose a mode of transport provided different results according to the criteria. DISCUSSION: The present study supports findings from previous research regarding the role of the built environment in the promotion of walking for travel and provides new findings to help in achieving sustainable, healthy, livable, and walkable cities. https://doi.org/10.1289/EHP4603.

When, Where, and What? Characterizing Personal PM2.5 Exposure in Periurban India by Integrating GPS, Wearable Camera, and Ambient and Personal Monitoring Data.

Evidence identifying factors that influence personal exposure to air pollutants in low- and middle-income countries is scarce. Our objective was to identify the relative contribution of the time of the day ( when?), location ( where?), and individuals' activities ( what?) to PM2.5 personal exposure in periurban South India. We conducted a panel study in which 50 participants were monitored in up to six 24-h sessions ( n = 227). We integrated data from multiple sources: continuous personal and ambient PM2.5 concentrations; questionnaire, GPS, and wearable camera data; and modeled long-term exposure at residence. Mean 24-h personal exposure was 43.8 µg/m3 (SD 24.6) for men and 39.7 µg/m3 (SD 12.0) for women. Temporal patterns in exposure varied between women (peak exposure in the morning) and men (more exposed throughout the rest of the day). Most exposure occurred at home, 67% for men and 89% for women, which was proportional to the time spent in this location. Ambient daily PM2.5 was an important predictor of 24-h personal exposure for both genders. Among men, activities predictive of higher hourly average exposure included presence near food preparation, in the kitchen, in the vicinity of smoking, or in industry. For women, predictors of exposure were largely related to cooking.

The Urban Exposome during Pregnancy and Its Socioeconomic Determinants.

BACKGROUND: The urban exposome is the set of environmental factors that are experienced in the outdoor urban environment and that may influence child development. OBJECTIVE: The authors' goal was to describe the urban exposome among European pregnant women and understand its socioeconomic determinants. METHODS: Using geographic information systems, remote sensing and spatio-temporal modeling we estimated exposure during pregnancy to 28 environmental indicators in almost 30,000 women from six population-based birth cohorts, in nine urban areas from across Europe. Exposures included meteorological factors, air pollutants, traffic noise, traffic indicators, natural space, the built environment, public transport, facilities, and walkability. Socioeconomic position (SEP), assessed at both the area and individual level, was related to the exposome through an exposome-wide association study and principal component (PC) analysis. RESULTS: Mean±standard deviation (SD) NO2 levels ranged from 13.6±5.1 µg/m3 (in Heraklion, Crete) to 43.2±11 µg/m3 (in Sabadell, Spain), mean±SD walkability score ranged from 0.22±0.04 (Kaunas, Lithuania) to 0.32±0.07 (Valencia, Spain) and mean±SD Normalized Difference Vegetation Index ranged from 0.21±0.05 in Heraklion to 0.51±0.1 in Oslo, Norway. Four PCs explained more than half of variation in the urban exposome. There was considerable heterogeneity in social patterning of the urban exposome across cities. For example, high-SEP (based on family education) women lived in greener, less noisy, and less polluted areas in Bradford, UK (0.39 higher PC1 score, 95% confidence interval (CI): 0.31, 0.47), but the reverse was observed in Oslo (-0.57 PC1 score, 95% CI: -0.73, -0.41). For most cities, effects were stronger when SEP was assessed at the area level: In Bradford, women living in high SEP areas had a 1.34 higher average PC1 score (95% CI: 1.21, 1.48). CONCLUSIONS: The urban exposome showed considerable variability across Europe. Pregnant women of low SEP were exposed to higher levels of environmental hazards in some cities, but not others, which may contribute to inequities in child health and development. https://doi.org/10.1289/EHP2862.

Development of land-use regression models for fine particles and black carbon in peri-urban South India.

Land-use regression (LUR) has been used to model local spatial variability of particulate matter in cities of high-income countries. Performance of LUR models is unknown in less urbanized areas of low-/middle-income countries (LMICs) experiencing complex sources of ambient air pollution and which typically have limited land use data. To address these concerns, we developed LUR models using satellite imagery (e.g., vegetation, urbanicity) and manually-collected data from a comprehensive built-environment survey (e.g., roads, industries, non-residential places) for a peri-urban area outside Hyderabad, India. As part of the CHAI (Cardiovascular Health effects of Air pollution in Telangana, India) project, concentrations of fine particulate matter (PM2.5) and black carbon were measured over two seasons at 23 sites. Annual mean (sd) was 34.1 (3.2) µg/m3 for PM2.5 and 2.7 (0.5) µg/m3 for black carbon. The LUR model for annual black carbon explained 78% of total variance and included both local-scale (energy supply places) and regional-scale (roads) predictors. Explained variance was 58% for annual PM2.5 and the included predictors were only regional (urbanicity, vegetation). During leave-one-out cross-validation and cross-holdout validation, only the black carbon model showed consistent performance. The LUR model for black carbon explained a substantial proportion of the spatial variability that could not be captured by simpler interpolation technique (ordinary kriging). This is the first study to develop a LUR model for ambient concentrations of PM2.5 and black carbon in a non-urban area of LMICs, supporting the applicability of the LUR approach in such settings. Our results provide insights on the added value of manually-collected built-environment data to improve the performance of LUR models in settings with limited data availability. For both pollutants, LUR models predicted substantial within-village variability, an important feature for future epidemiological studies.

Health impact assessment of cycling network expansions in European cities.

We conducted a health impact assessment (HIA) of cycling network expansions in seven European cities. We modeled the association between cycling network length and cycling mode share and estimated health impacts of the expansion of cycling networks. First, we performed a non-linear least square regression to assess the relationship between cycling network length and cycling mode share for 167 European cities. Second, we conducted a quantitative HIA for the seven cities of different scenarios (S) assessing how an expansion of the cycling network [i.e. 10% (S1); 50% (S2); 100% (S3), and all-streets (S4)] would lead to an increase in cycling mode share and estimated mortality impacts thereof. We quantified mortality impacts for changes in physical activity, air pollution and traffic incidents. Third, we conducted a cost-benefit analysis. The cycling network length was associated with a cycling mode share of up to 24.7% in European cities. The all-streets scenario (S4) produced greatest benefits through increases in cycling for London with 1,210 premature deaths (95% CI: 447-1,972) avoidable annually, followed by Rome (433; 95% CI: 170-695), Barcelona (248; 95% CI: 86-410), Vienna (146; 95% CI: 40-252), Zurich (58; 95% CI: 16-100) and Antwerp (7; 95% CI: 3-11). The largest cost-benefit ratios were found for the 10% increase in cycling networks (S1). If all 167 European cities achieved a cycling mode share of 24.7% over 10,000 premature deaths could be avoided annually. In European cities, expansions of cycling networks were associated with increases in cycling and estimated to provide health and economic benefits.

Estimated effects of air pollution and space-time-activity on cardiopulmonary outcomes in healthy adults: A repeated measures study.

BACKGROUND: Exposure to air pollution is known to affect both short and long-term outcomes of the cardiopulmonary system; however, findings on short-term outcomes have been inconsistent and often from isolated and long-term rather than coexisting and short-term exposures, and among susceptible/unhealthy rather than healthy populations. AIMS: We aimed to investigate separately the annual, daily and daily space-time-activity-weighted effect of ambient air pollution, as well as confounding or modification by other environmental (including noise) or space-time-activity (including total daily physical activity) exposures, on cardiopulmonary outcomes in healthy adults. METHODS: Participants (N=57: 54% female) had indicators of cardiopulmonary outcomes [blood pressure (BP), pulse (HR) and heart rate variability (HRV {SDNN}), and lung function (spirometry {FEV1, FVC, SUM})] measured on four different mornings (at least five days apart) in a clinical setting between 2011 and 2014. Spatiotemporal ESCAPE-LUR models were used to estimate daily and annual air pollution exposures (including PM10, PMCoarse, but not Ozone {derived from closest station}) at participant residential and occupational addresses. Participants' time-activity diaries indicated time spent at either address to allow daily space-time-activity-weighted estimates, and capture total daily physical activity (total-PA {as metabolic-equivalents-of-task, METs}), in the three days preceding health measurements. Multivariate-adjusted linear mixed-effects models (using either annual or daily estimates) were adjusted for possible environmental confounders or mediators including levels of ambient noise and greenness. Causal mediation analysis was also performed separately considering these factors as well as total-PA. All presented models are controlled by age, height, sex and season. RESULTS: An increase in 5µg/m3 of daily space-time-activity-weighted PMCoarse exposure was statistically significantly associated with a 4.1% reduction in total heart rate variability (SDNN; p=0.01), and remained robust after adjusting for suspected confounders [except for occupational-address noise (ß=-2.7, p=0.20)]. An increase in 10ppb of annual mean Ozone concentration at the residential address was statistically significantly associated with an increase in diastolic BP of 6.4mmHg (p<0.01), which lost statistical significance when substituted with daily space-time-activity-weighted estimates. As for pulmonary function, an increase in 10µg/m3 of annual mean PM10 concentration at the residential address was significantly associated with a 0.3% reduction in FVC (p<0.01) and a 0.5% reduction in SUM (p<0.04), for which again significance was lost when substituted for daily space-time-activity-weighted estimates These associations with pulmonary function remained robust after adjusting for suspected confounders, including annual Ozone, as well as total-PA and bioaerosol (pollen and fungal spore) levels (but not residential-neighborhood greenness {ß=-0.22, p=0.09; ß=-0.34, p=0.15, respectively}). Multilevel mediation analysis indicated that the proportion mediated as a direct effect on cardiopulmonary outcomes by suspected confounders (including total-PA, residential-neighborhood greenness, and occupational-address noise level) from primary exposures (including PM10, PMCoarse, and O3) was not statistically significant. CONCLUSION: Our findings suggest that increased daily space-time-activity-weighted PMCoarse exposure levels significantly adversely affect cardiac autonomic modulation (as reduced total HRV) among healthy adults. Additionally, increased annual levels at the residential address of Ozone and PM10 significantly increase diastolic blood pressure and reduce lung function, respectively, among healthy adults. These associations typically remained robust when adjusting for suspected confounders. Occupational-address noise and residential-neighborhood greenness levels, however, were seen as mediators of cardiovascular and pulmonary outcomes, respectively. Total daily physical activity was not seen as a mediator of any of the studied outcomes, which supports the promotion of active mobility within cities.

Living Close to Natural Outdoor Environments in Four European Cities: Adults' Contact with the Environments and Physical Activity.

This study investigated whether residential availability of natural outdoor environments (NOE) was associated with contact with NOE, overall physical activity and physical activity in NOE, in four different European cities using objective measures. A nested cross-sectional study was conducted in Barcelona (Spain); Stoke-on-Trent (United Kingdom); Doetinchem (The Netherlands); and Kaunas (Lithuania). Smartphones were used to collect information on the location and physical activity (overall and NOE) of around 100 residents of each city over seven days. We used Geographic Information Systems (GIS) to determine residential NOE availability (presence/absence of NOE within 300 m buffer from residence), contact with NOE (time spent in NOE), overall PA (total physical activity), NOE PA (total physical activity in NOE). Potential effect modifiers were investigated. Participants spent around 40 min in NOE and 80 min doing overall PA daily, of which 11% was in NOE. Having residential NOE availability was consistently linked with higher NOE contact during weekdays, but not to overall PA. Having residential NOE availability was related to NOE PA, especially for our Barcelona participants, people that lived in a city with low NOE availability.