Associations between combined urban and lifestyle factors and respiratory health in European children.

INTRODUCTION: Previous studies identified some environmental and lifestyle factors independently associated with children respiratory health, but few focused on exposure mixture effects. This study aimed at identifying, in pregnancy and in childhood, combined urban and lifestyle environment profiles associated with respiratory health in children. METHODS: This study is based on the European Human Early-Life Exposome (HELIX) project, combining six birth cohorts. Associations between profiles of pregnancy (38 exposures) and childhood (84 exposures) urban and lifestyle factors, identified by clustering analysis, and respiratory health were estimated by regression models adjusted for confounders. RESULTS: Among the 1033 included children (mean ± standard-deviation (SD) age: 8.2 ± 1.6 years old, 47% girls) the mean ± SD forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were 99 ± 13% and 101 ± 14%, respectively, and 12%, 12% and 24% reported ever-asthma, wheezing and rhinitis, respectively. Four profiles of pregnancy exposures and four profiles of childhood exposures were identified. Compared to the reference childhood exposure profile (low exposures), two exposure profiles were associated with lower levels of FEV1. One profile was characterized by few natural spaces in the surroundings and high exposure to the built environment and road traffic. The second profile was characterized by high exposure to meteorological factors and low levels of all other exposures and was also associated with an increased risk of ever-asthma and wheezing. A pregnancy exposure profile characterized by high exposure levels to all risk factors, but a healthy maternal lifestyle, was associated with a lower risk of wheezing and rhinitis in children, compared to the reference pregnancy profile (low exposures). CONCLUSION: This comprehensive approach revealed pregnancy and childhood profiles of urban and lifestyle exposures associated with lung function and/or respiratory conditions in children. Our findings highlight the need to pursue the study of combined exposures to improve prevention strategies for multifactorial diseases such as asthma.

Long-term exposure to ambient air pollution and risk of lung cancer - A comparative analysis of incidence and mortality in four administrative cohorts in the ELAPSE study.

BACKGROUND: Studies have linked air pollution to lung cancer incidence and mortality, but few have compared these associations, which may differ due to cancer survival variations. We aimed to evaluate the association between long-term air pollution exposure and lung cancer incidence and compare findings with previous lung cancer mortality analyses within the same cohorts. METHODS: We analyzed four population-based administrative cohorts in Denmark (2000-2015), England (2011-2017), Norway (2001-2016) and Rome (2001-2015). We assessed residential exposure to annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and warm-season ozone (O3) using Europe-wide land use regression models. We used Cox proportional hazard models to evaluate cohort-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence identified using hospital admission records (English and Roman cohorts) or cancer registries (Danish and Norwegian cohorts). We evaluated the associations at low exposure levels using subset analyses and natural cubic splines. Cohort-specific HRs were pooled using random-effects meta-analyses, separately for incidence and mortality. RESULTS: Over 93,733,929 person-years of follow-up, 111,949 incident lung cancer cases occurred. Incident lung cancer was positively associated with PM2.5, NO2 and BC, and negatively associated with O3. The negative O3 association became positive after adjustment for NO2. Associations were almost identical or slightly stronger for lung cancer incidence than mortality in the same cohorts, with respective meta-analytic HRs (95% CIs) of 1.14 (1.06, 1.22) and 1.12 (1.02, 1.22) per 5 µg/m3 increase in PM2.5, and 1.10 (1.04, 1.16) and 1.09 (1.02, 1.16) per 10 µg/m3 increase in NO2. Positive associations persisted for both incidence and mortality at low pollution levels with similar magnitude. CONCLUSIONS: We found similarly elevated risks of lung cancer incidence and mortality in association with residential exposure to PM2.5, NO2 and BC in meta-analyses of four European administrative cohorts, which persisted at low pollution levels.

Agreement between self-reported and registry-based use of sleep medications and tranquilizers.

PURPOSE: The purpose of the present study was to assess the agreement between self-reported use of sleep medications and tranquilizers and dispensed hypnotics and anxiolytics. METHODS: Self-reported medication use was obtained from the population-based survey Health and Environment in Oslo (HELMILO) (2009-2010) (n = 13 019). Data on dispensed hypnotics and anxiolytics were obtained from the Norwegian Prescription Database (NorPD). As measures of validity, we calculated sensitivity and specificity using both self-reports and prescription records as the reference standard. Furthermore, we calculated Cohen's kappa. Current self-reported medication use was compared with prescription data in time windows of both 100 and 200 days preceding questionnaire completion. RESULTS: The highest sensitivity was observed for current sleep medication use in the 100-day time window (sensitivity = 0.76, 95% confidence interval [CI]: 0.74, 0.79) when using prescription records as the reference standard. Sensitivity was generally lower for tranquilizers compared with sleep medications. Cohen's kappa showed the highest agreement for the 200-day time window with substantial agreement for sleep medications (kappa = 0.64; 95% CI: 0.62, 0.67) and moderate agreement for tranquilizers (kappa = 0.45; 95% CI: 0.41, 0.48). CONCLUSIONS: The present study suggests moderate to substantial agreement between self-reported use of sleep medications and tranquilizers and dispensed drugs in a general adult population. The magnitude of agreement varied according to drug category and time window. Since self-reported and registry-based use of these drug classes does not match each other accurately, limitations of each data source should be considered when such medications are applied as the exposure or outcome in epidemiologic studies.

A Longitudinal Study of Road Traffic Noise and Body Mass Index Trajectories from Birth to 8 Years.

BACKGROUND: Being overweight constitutes a health risk, and the proportion of overweight and obese children is increasing. It has been argued that road traffic noise could be linked to adiposity through its influence on sleep and stress. Few studies, to our knowledge, have investigated whether noise and adiposity are associated. Most of them were on adults, and we are not aware of any longitudinal study using repeated measures. OBJECTIVES: The present longitudinal study investigated whether road traffic noise exposures in pregnancy (N = 6,963; obs = 22,975) or childhood (N = 6,403; obs = 14,585) were associated with body mass index (BMI) trajectories in children. METHODS: We obtained information on BMI and covariates from questionnaires used in the Norwegian Mother and Child Cohort Study, Statistics Norway, and Medical Birth Registry of Norway. We modeled road traffic noise for the most exposed façade of children's present and historical addresses at 6 time points from pregnancy to age 8. We investigated effects on BMI trajectories using repeated measures and linear mixed models. RESULTS: The results indicated that BMI curves depended on road traffic noise exposure during pregnancy, but not on exposure during childhood. Children in the highest decile of traffic noise exposure had increased BMI, with 0.35 kg/m more than children in the lowest decile, from birth to age 8 years. CONCLUSIONS: The results indicate that exposure to road traffic noise during pregnancy may be associated with children's BMI trajectories. Future studies should investigate this further, using anthropometric measures such as waist-hip ratio and skinfold thickness, in addition to BMI.

Road traffic noise and children's inattention.

BACKGROUND: An increasing number of children are exposed to road traffic noise levels that may lead to adverse effects on health and daily functioning. Childhood is a period of intense growth and brain maturation, and children may therefore be especially vulnerable to road traffic noise. The objective of the present study was to examine whether road traffic noise was associated with reported inattention symptoms in children, and whether this association was mediated by sleep duration. METHODS: This study was based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Parental reports of children's inattention at age 8 were linked to modelled levels of residential road traffic noise. We investigated the association between inattention and noise exposure during pregnancy (n = 1934), noise exposure averaged over 5 years (age 3 to 8 years; n = 1384) and noise exposure at age 8 years (n = 1384), using fractional logit response models. The participants were children from Oslo, Norway. RESULTS: An association with inattention at age 8 years was found for road traffic noise exposure at age 8 years (coef = .0083, CI = [.0012, .0154]; 1.2% point increase in inattention score per 10 dB increase in noise level), road traffic noise exposure average for the last 5 years (coef = .0090, CI = [.0016, .0164]; 1.3% point increase/10 dB), and for pregnancy road traffic noise exposure for boys (coef = .0091, CI = [.0010, .0171]), but not girls (coef = -.0021, CI = [-.0094, .0053]). Criteria for doing mediation analyses were not fulfilled. CONCLUSION: Results indicate that road traffic noise has a negative impact on children's inattention. We found no mediation by sleep duration.

Road traffic noise and registry based use of sleep medication.

BACKGROUND: Road traffic noise has been associated with adverse health effects including sleep disturbances. Use of sleep medication as an indicator of sleeping problems has rarely been explored in studies of the effects of traffic noise. Furthermore, using registry data on sleep medications provides an opportunity to study the effects of noise on sleep where attribution of sleep problems to noise is not possible. METHODS: We used questionnaire data from the population-based study Health and Environment in Oslo (HELMILO) (2009-10) (n = 13,019). Individual data on sleep medications was obtained from the Norwegian Prescription Database (NorPD). Noise levels (L night) were modeled for the most exposed façade of the building at each participant's home address. Logistic regression models adjusted for potential confounders were used to analyze the association between traffic noise and sleep medication use both for one whole year and for the summer season. The results were reported as changes in the effect estimate per 5 decibel (dB) increase in noise level. RESULTS: We observed no association between traffic noise and sleep medication use during one year [odds ratio (OR) = 1.00; 95% confidence interval (CI): 0.96, 1.04]. For sleep medication use in the summer season, there was a positive, however non-significant association (OR = 1.04; 95% CI: 0.99, 1.10). Among individuals sleeping with the bedroom window open, the association increased slightly and was borderline statistically significant (OR = 1.06; 95% CI: 1.00, 1.12). CONCLUSIONS: We found no evidence of an association between traffic noise and sleep medication use during one year. However, for the summer season, there was some suggestive evidence of an association. These findings indicate that season may play a role in the association between traffic noise and sleep, possibly because indoor traffic noise levels are likely to be higher during summer due to more frequent window opening. More studies are, however, necessary in order to confirm this.

Exposure to traffic noise and markers of obesity.

OBJECTIVES: Limited evidence suggests adverse effects of traffic noise exposure on the metabolic system. This study investigates the association between road traffic noise and obesity markers as well as the role of combined exposure to multiple sources of traffic noise. METHODS: In a cross-sectional study performed in 2002-2006, we assessed exposure to noise from road traffic, railways and aircraft at the residences of 5075 Swedish men and women, primarily from suburban and semirural areas of Stockholm County. A detailed questionnaire and medical examination provided information on markers of obesity and potential confounders. Multiple linear and logistic regression models were used to assess associations between traffic noise and body mass index (BMI), waist circumference and waist-hip ratio using WHO definitions of obesity. RESULTS: Road traffic noise was significantly related to waist circumference with a 0.21 cm (95% CI 0.01 to 0.41) increase per 5 dB(A) rise in L(den). The OR for central obesity among those exposed to road traffic noise ≥ 45 dB(A) was 1.18 (95% CI 1.03 to 1.34) in comparison to those exposed below this level. Similar results were seen for waist-hip ratio (OR 1.29; 95% CI 1.14 to 1.45) but not for BMI (OR 0.89; 95% CI 0.76 to 1.04). Central obesity was also associated with exposure to railway and aircraft noise, and a particularly high risk was seen for combined exposure to all three sources of traffic noise (OR 1.95; 95% CI 1.24 to 3.05). CONCLUSIONS: Our results suggest that traffic noise exposure can increase the risk of central obesity. Combined exposure to different sources of traffic noise may convey a particularly high risk.

Road traffic noise and markers of obesity - a population-based study.

BACKGROUND: Noise has been found to be associated with endocrine changes and cardiovascular disease. Increased cortisol levels and chronic sleep problems due to noise may increase the risk of obesity. OBJECTIVES: We investigated the relationship between road traffic noise and obesity markers. Furthermore, we explored the modifying role of noise sensitivity, noise annoyance, and sleep disturbances. METHODS: We used data from a population-based study, HUBRO (N=15,085), and its follow-up study HELMILO (N=8410) conducted in Oslo, Norway. Measurements were used to define body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and these binary outcomes: BMI≥30kg/m(2), WC≥102cm (men)/88cm (women), and WHR≥0.90 (men)/0.85 (women). Modelled levels of road traffic noise (Lden) were assigned to each participant's home address. Linear and logistic regression models were used to examine the associations. RESULTS: The results indicated no significant associations between road traffic noise and obesity markers in the total populations. However, in highly noise sensitive women (n=1106) a 10dB increase in noise level was associated with a slope (=beta) of 1.02 (95% confidence interval (CI): 1.01, 1.03) for BMI, 1.01 (CI: 1.00, 1.02) for WC, and an odds ratio (OR) of 1.24 (CI: 1.01, 1.53) for WHR ≥0.85. The associations appeared weaker in highly noise sensitive men. We found no effect modification of noise annoyance or sleep disturbances. In a sub-population with bedroom facing a road, the associations increased in men (e.g. an OR of 1.25 (CI: 0.88, 1.78) for BMI ≥30kg/m(2)), but not in women. Among long-term residents the associations increased for BMI ≥30kg/m(2) (OR of 1.07 (CI: 0.93, 1.24) in men and 1.10 (CI: 0.97, 1.26) in women), but not for the other outcomes. CONCLUSION: In an adult urban Scandinavian population, road traffic noise was positively associated with obesity markers among highly noise sensitive women. The associations appeared stronger among men with bedroom facing a street, representing a population with more accurately assigned exposure.

Road traffic noise, sleep and mental health.

This study examines the relationship between road traffic noise, self-reported sleep quality and mental health. The study is cross-sectional and based on data from a survey conducted in Oslo, Norway, in 2000. Psychological distress (Hopkins Symptom Checklist, HSCL-25) was measured along with self-reported somatic health, sleep quality, noise sensitivity and socioeconomic variables. Questionnaire data were combined with modeled estimates of noise exposure. The total study sample consisted of 2898 respondents. After adjustment for potential confounders and stratifying for sleep quality, we found a positive, but not statistically significant association between noise exposure and symptoms of psychological distress among participants with poor sleep quality (slope=0.06, 95% CI: -0.02 to 0.13, per 10 dB increase in noise exposure). In the same sleep quality group, we found a borderline statistically significant association between noise exposure and a symptom level indicating a probable mental disorder (HSCL≥1.55) (odds ratio=1.47, 95% CI: 0.99-1.98, per 10 dB increase in noise exposure). We found no association between road traffic noise and mental health among subjects reporting good and medium sleep quality. The results suggest that road traffic noise may be associated with poorer mental health among subjects with poor sleep. Individuals with poor sleep quality may be more vulnerable to effects of road traffic noise on mental health than individuals with better sleep quality.

Availability, accessibility, and use of green spaces and cognitive development in primary school children.

Green spaces may have beneficial impacts on children's cognition. However, few studies explored the exposure to green spaces beyond residential areas, and their availability, accessibility and uses at the same time. The aim of the present study was to describe patterns of availability, accessibility, and uses of green spaces among primary school children and to explore how these exposure dimensions are associated with cognitive development. Exposures to green space near home, school, commuting route, and other daily activity locations were assessed for 1607 children aged 6-11 years from six birth cohorts across Europe, and included variables related to: availability (NDVI buffers: 100, 300, 500 m), potential accessibility (proximity to a major green space: linear distance; within 300 m), and use (play time in green spaces: hours/year), and the number of visits to green spaces (times/previous week). Cognition measured as fluid intelligence, inattention, and working memory was assessed by computerized tests. We performed multiple linear regression analyses on pooled and imputed data adjusted for individual and area-level confounders. Availability, accessibility, and uses of green spaces showed a social gradient that was unfavorable in more vulnerable socioeconomic groups. NDVI was associated with more playing time in green spaces, but proximity to a major green space was not. Associations between green space exposures and cognitive function outcomes were not statistically significant in our overall study population. Stratification by socioeconomic variables showed that living within 300 m of a major green space was associated with improved working memory only in children in less deprived residential areas (ß = 0.30, CI: 0.09,0.51), and that more time playing in green spaces was associated with better working memory only in children of highly educated mothers (ß per IQR increase in hour/year = 0.10; 95% CI: 0.01, 0.19). However, studying within 300 m of a major green space increased inattention scores in children in more deprived areas (ß = 15.45, 95% CI: 3.50, 27.40).

Heritability of hearing loss.

BACKGROUND: Hearing impairment is one of the most common permanent disabilities in the western world. Although hearing ability normally declines with age, there is great individual variation in age of onset, progression, and severity, indicating that individual susceptibility plays a role. The aim of the present study was to explore the relative importance of genetic and environmental effects in the etiology of impaired hearing. METHODS: From August 1995 to June 1997, the total adult population of Nord-Trøndelag County, Norway, was invited to take part in the Nord-Trøndelag Health Study. The survey included as an integrated project the Nord-Trøndelag Hearing Loss Study with pure-tone audiometry assessment of the standard frequencies 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz on 51,574 participants aged 20 to 101 years. We obtained information from Statistics Norway identifying 11,263 sibling pairs. After age stratification, we assessed similarity in hearing thresholds between siblings using polychoric correlations. The contribution of genetic effects in hearing ability was calculated. RESULTS: The upper limit of the heritability of hearing loss was 0.36. We found little evidence for sex differences in the relative importance of genetic effects. CONCLUSIONS: There is a substantial genetic contribution to individual variation in hearing thresholds.

Prenatal and childhood exposure to air pollution and traffic and the risk of liver injury in European children.

Nonalcoholic fatty liver disease is the most prevalent pediatric chronic liver disease. Experimental studies suggest effects of air pollution and traffic exposure on liver injury. We present the first large-scale human study to evaluate associations of prenatal and childhood air pollution and traffic exposure with liver injury. METHODS: Study population included 1,102 children from the Human Early Life Exposome project. Established liver injury biomarkers, including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and cytokeratin-18, were measured in serum between ages 6-10 years. Air pollutant exposures included nitrogen dioxide, particulate matter <10 µm (PM10), and <2.5 µm. Traffic measures included traffic density on nearest road, traffic load in 100-m buffer, and inverse distance to nearest road. Exposure assignments were made to residential address during pregnancy (prenatal) and residential and school addresses in year preceding follow-up (childhood). Childhood indoor air pollutant exposures were also examined. Generalized additive models were fitted adjusting for confounders. Interactions by sex and overweight/obese status were examined. RESULTS: Prenatal and childhood exposures to air pollution and traffic were not associated with child liver injury biomarkers. There was a significant interaction between prenatal ambient PM10 and overweight/obese status for alanine aminotransferase, with stronger associations among children who were overweight/obese. There was no evidence of interaction with sex. CONCLUSION: This study found no evidence for associations between prenatal or childhood air pollution or traffic exposure with liver injury biomarkers in children. Findings suggest PM10 associations maybe higher in children who are overweight/obese, consistent with the multiple-hits hypothesis for nonalcoholic fatty liver disease pathogenesis.

Long-term low-level ambient air pollution exposure and risk of lung cancer - A pooled analysis of 7 European cohorts.

BACKGROUND/AIM: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. METHODS: The "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants' residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. RESULTS: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10-5m-1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence. CONCLUSIONS: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

Impact of hearing impairment on spousal mental health: the Nord-Trøndelag Health Study.

BACKGROUND: Previous studies indicate that hearing loss have negative emotional implications also on spouses of the hearing impaired persons. We sought to assess the relationship between hearing impairment and spousal mental health in the general population. METHODS: Pure tone audiometry and questionnaires were administered to the adult population of Nord-Trøndelag County, Norway (1996-97). In the age group between 20 and 44 years, the number of cases with hearing impairment was very low; thus, this age group was excluded from analyses. In total, 8607 couples with women over 44 years and 9530 couples with men over 44 years were identified. Associations between measured and self-reported hearing impairment and spousal self-reported symptoms of anxiety and depression, and subjective well-being were estimated. Stratified by sex and adjusting for several covariates, mental health in spouses of persons with hearing impairment was compared with that of spouses of persons with normal hearing using the general linear model. RESULTS: Audiometrically measured hearing was not significantly associated with spousal mental health. Moderate relations between self-reported hearing and spousal mental health were observed. CONCLUSION: Contrary to previous results based on self-reported hearing loss, our results based on audiometry did not indicate severe loss of mental health among spouses of persons with impaired hearing.

Linking green infrastructure to urban heat and human health risk mitigation in Oslo, Norway.

The predicted extreme temperatures of global warming are magnified in cities due to the urban heat island effect. Even if the target for average temperature increase in the Paris Climate Agreement is met, temperatures during the hottest month in a northern city like Oslo are predicted to rise by over 5 °C by 2050. We hypothesised that heat-related diagnoses for heat-sensitive citizens (75+) in Oslo are correlated to monthly air temperatures, and that green infrastructure such as tree canopy cover reduces extreme land surface temperatures and thus reduces health risk from heat exposure. Monthly air temperatures were significantly correlated to the number of skin-related diagnoses at the city level, but were unrelated to diagnoses under circulatory, nervous system, or general categories. Satellite-derived spatially-explicit measures revealed that on one of the hottest days during the summer of 2018, landscape units composed of paved, midrise or lowrise buildings gave off the most heat (39 °C), whereas units composed of complete tree canopy cover, or mixed (i.e. tree and grass) vegetation maintained temperatures of between 29 and 32 °C. Land surface temperatures were negatively correlated to tree canopy cover (R2 = 0.45) and vegetation greenness (R2 = 0.41). In a scenario in which each city tree was replaced by the most common non-tree cover in its neighbourhood, the area of Oslo exceeding a 30 °C health risk threshold during the summer would increase from 23 to 29%. Combining modelling results with population at risk at census tract level, we estimated that each tree in the city currently mitigates additional heat exposure of one heat-sensitive person by one day. Our results indicate that maintaining and restoring tree cover provides an ecosystem service of urban heat reduction. Our findings have particular relevance for health benefit estimation in urban ecosystem accounting and municipal policy decisions regarding ecosystem-based climate adaptation.

Influence of the Urban Exposome on Birth Weight.

BACKGROUND: The exposome is defined as the totality of environmental exposures from conception onwards. It calls for providing a holistic view of environmental exposures and their effects on human health by evaluating multiple environmental exposures simultaneously during critical periods of life. OBJECTIVE: We evaluated the association of the urban exposome with birth weight. METHODS: We estimated exposure to the urban exposome, including the built environment, air pollution, road traffic noise, meteorology, natural space, and road traffic (corresponding to 24 environmental indicators and 60 exposures) for nearly 32,000 pregnant women from six European birth cohorts. To evaluate associations with either continuous birth weight or term low birth weight (TLBW) risk, we primarily relied on the Deletion-Substitution-Addition (DSA) algorithm, which is an extension of the stepwise variable selection method. Second, we used an exposure-by-exposure exposome-wide association studies (ExWAS) method accounting for multiple hypotheses testing to report associations not adjusted for coexposures. RESULTS: The most consistent statistically significant associations were observed between increasing green space exposure estimated as Normalized Difference Vegetation Index (NDVI) and increased birth weight and decreased TLBW risk. Furthermore, we observed statistically significant associations among presence of public bus line, land use Shannon's Evenness Index, and traffic density and birth weight in our DSA analysis. CONCLUSION: This investigation is the first large urban exposome study of birth weight that tests many environmental urban exposures. It confirmed previously reported associations for NDVI and generated new hypotheses for a number of built-environment exposures. https://doi.org/10.1289/EHP3971.

Early-Life Environmental Exposures and Blood Pressure in Children.

BACKGROUND: Growing evidence exists about the fetal and environmental origins of hypertension, but mainly limited to single-exposure studies. The exposome has been proposed as a more holistic approach by studying many exposures simultaneously. OBJECTIVES: This study aims to evaluate the association between a wide range of prenatal and postnatal exposures and blood pressure (BP) in children. METHODS: Systolic and diastolic BP were measured among 1,277 children from the European HELIX (Human Early-Life Exposome) cohort aged 6 to 11 years. Prenatal (n = 89) and postnatal (n = 128) exposures include air pollution, built environment, meteorology, natural spaces, traffic, noise, chemicals, and lifestyles. Two methods adjusted for confounders were applied: an exposome-wide association study considering the exposures independently, and the deletion-substitution-addition algorithm considering all the exposures simultaneously. RESULTS: Decreases in systolic BP were observed with facility density (ß change for an interquartile-range increase in exposure: -1.7 mm Hg [95% confidence interval (CI): -2.5 to -0.8 mm Hg]), maternal concentrations of polychlorinated biphenyl 118 (-1.4 mm Hg [95% CI: -2.6 to -0.2 mm Hg]) and child concentrations of dichlorodiphenyldichloroethylene (DDE: -1.6 mm Hg [95% CI: -2.4 to -0.7 mm Hg]), hexachlorobenzene (-1.5 mm Hg [95% CI: -2.4 to -0.6 mm Hg]), and mono-benzyl phthalate (-0.7 mm Hg [95% CI: -1.3 to -0.1 mm Hg]), whereas increases in systolic BP were observed with outdoor temperature during pregnancy (1.6 mm Hg [95% CI: 0.2 to 2.9 mm Hg]), high fish intake during pregnancy (2.0 mm Hg [95% CI: 0.4 to 3.5 mm Hg]), maternal cotinine concentrations (1.2 mm Hg [95% CI: -0.3 to 2.8 mm Hg]), and child perfluorooctanoate concentrations (0.9 mm Hg [95% CI: 0.1 to 1.6 mm Hg]). Decreases in diastolic BP were observed with outdoor temperature at examination (-1.4 mm Hg [95% CI: -2.3 to -0.5 mm Hg]) and child DDE concentrations (-1.1 mm Hg [95% CI: -1.9 to -0.3 mm Hg]), whereas increases in diastolic BP were observed with maternal bisphenol-A concentrations (0.7 mm Hg [95% CI: 0.1 to 1.4 mm Hg]), high fish intake during pregnancy (1.2 mm Hg [95% CI: -0.2 to 2.7 mm Hg]), and child copper concentrations (0.9 mm Hg [95% CI: 0.3 to 1.6 mm Hg]). CONCLUSIONS: This study suggests that early-life exposure to several chemicals, as well as built environment and meteorological factors, may affect BP in children.

Nocturnal Road Traffic Noise Exposure and Children's Sleep Duration and Sleep Problems.

Almost half of the European Union (EU)'s population is exposed to road traffic noise above levels that constitute a health risk. Associations between road traffic noise and impaired sleep in adults have consistently been reported. Less is known about effects of noise on children's sleep. The aim of this study was to examine the association between nocturnal road traffic noise exposure and children's parental-reported sleep duration and sleep problems. The present cross-sectional study used data from The Norwegian Mother and Child Cohort Study. Parental report of children's sleep duration and sleep problems at age 7 was linked to modelled levels of residential night-time road traffic noise. The study population included 2665 children from Oslo, Norway. No association was found between road traffic noise and sleep duration in the total study population (odds ratio (OR): 1.05, 95% confidence interval (CI): [0.94, 1.17]), but a statistically significant association was observed in girls (OR: 1.21, 95% CI: [1.04, 1.41]). For sleep problems, the associations were similar (OR: 1.36, 95% CI: [0.85, 2.16]) in girls. The ORs are presented for an increase of 10 dB. The findings suggest there is an association between road traffic noise and sleep for girls, underlining the importance of protecting children against excessive noise levels.

Occupation and the risk of bothersome tinnitus: results from a prospective cohort study (HUNT).

Objectives Estimates of occupation-specific tinnitus prevalence may help identify high-risk occupations where interventions are warranted. The authors studied the effect of occupation on prevalence of bothersome tinnitus and estimated the attributable fraction due to occupation. The authors also studied how much of the effect remained after adjusting for noise exposure, education income, hearing thresholds and other risk factors. Design A prospective cohort study. Setting A health survey of the Nord-Trøndelag county of Norway. Participants A sample of the general adult population (n=49 948). Primary outcome measure The primary outcome measure is bothersome tinnitus. Results Occupation had a marked effect on tinnitus prevalence. The effect of occupation on tinnitus was reduced in men by controlling for self-reported occupational noise exposure and in women by controlling for education and income. Adding hearing loss as a predictor increased the effect of occupation somewhat. In men, age-adjusted prevalence ratios of tinnitus ranged from 1.5 (workshop mechanics) to 2.1 (crane and hoist operators) in the 10 occupations with highest tinnitus prevalence. In women, the most important contribution to the tinnitus prevalence was from the large group of occupationally inactive persons, with a prevalence ratio of 1.5. Conclusion This study found a moderate association between occupation and bothersome tinnitus.

Effects of changed aircraft noise exposure on experiential qualities of outdoor recreational areas.

The literature indicates that sound and visual stimuli interact in the impression of landscapes. This paper examines the relationship between annoyance with sound from aircraft and annoyance with other area problems (e.g., careless bicycle riding, crowding, etc.), and how changes in noise exposure influence the perceived overall recreational quality of outdoor recreational areas. A panel study (telephone interviews) conducted before and after the relocation of Norway's main airport in 1998 examined effects of decreased or increased noise exposure in nearby recreational areas (n = 591/455). Sound from aircraft annoyed the largest proportion of recreationists, except near the old airport after the change. The decrease in annoyance with sound from aircraft was accompanied by significant decreases in annoyance with most of the other area problems. Near the new airport annoyance with most factors beside sound from aircraft increased slightly, but not significantly. A relationship between aircraft noise annoyance and perceived overall recreational quality of the areas was found.