Electronic cigarette exposures reported to the British Columbia Drug and Poison Information Centre: an observational case series.

BACKGROUND: Electronic nicotine delivery systems (ENDSs), including electronic cigarettes (e-cigarettes), are rapidly gaining popularity. The aim of this study was to use poison centre data to describe epidemiological trends in ENDS-related exposures. METHODS: We conducted an observational case series study using records containing both coded fields and free-text narratives from the British Columbia Drug and Poison Information Centre for all calls involving exposure to ENDS received from 2012 to 2017. We described trends in exposures and exposed people, as well as clinical effects. RESULTS: A total of 243 calls were recorded for 186 unique exposures to ENDS devices, e-juice, e-cigarette cartridges and other associated paraphernalia over the study period. Calls related to ENDS exposures increased nearly sixfold between 2013 and 2014 and did not decline subsequently. Exposures were most frequently documented in children aged 4 years or less (81 [43.5%]), with 58 (31.0%) in 1- and 2-year-olds. Seventy-two exposures (89%) in children aged 4 years or less were due to accidental ingestion, whereas adults aged 25 years or more called the poison centre following ENDS malfunctions (7 [23%], spills (4 [13%]) and exposure to e-juice mistaken for other substances (4 [13%]). Of the 186 exposed people, 87 (46.8%) reported symptoms. INTERPRETATION: British Columbia experienced a sixfold increase in ENDS-related calls to the provincial poison centre between 2012 and 2017, driven by ingestions in young children. Regulatory approaches aimed at minimizing children's access to ENDS, clear labelling of nicotine concentration, and packaging that reduces the likelihood of spills, product confusion and malfunction should be considered.

Residential exposure to electromagnetic fields during pregnancy and risk of child cancer: A longitudinal cohort study.

OBJECTIVE: We assessed whether exposure to electromagnetic fields during pregnancy increases the risk of childhood cancer. METHODS: We studied a retrospective cohort of 784,944 newborns in Quebec, Canada between 2006 and 2016 who were followed for cancer one decade after birth. The exposures were residential distance to the nearest high voltage power transformer station and transmission line. We determined the incidence of childhood cancer, and estimated hazard ratios and 95% confidence intervals (CI) in Cox proportional hazards regression models adjusted for maternal and birth characteristics. RESULTS: There were 1114 incident cases of cancer during 4,647,472 person-years of follow-up. Residential proximity to transformer stations was associated with a somewhat greater risk of cancer, but there was no association with transmission lines. Compared with 200 m, a distance of 80 m from a transformer station was associated with a hazard ratio of 1.08 (95% CI 0.98, 1.20) for any cancer, 1.04 (95% CI 0.88, 1.23) for hematopoietic cancer, and 1.11 (95% CI 0.99, 1.25) for solid tumours. CONCLUSIONS: Residential proximity to transformer stations is associated with a borderline risk of childhood cancer, but the absence of an association with transmission lines suggests no causal link.

Maternal proximity to extremely low frequency electromagnetic fields and risk of birth defects.

Causes of birth defects are unclear, and the association with electromagnetic fields is inconclusive. We assessed the relationship between residential proximity to extremely low frequency electromagnetic fields from power grids and risk of birth defects. We analyzed a population-based sample of 2,164,246 infants born in Quebec, Canada between 1989 and 2016. We geocoded the maternal residential postal code at delivery and computed the distance to the nearest high voltage electrical transmission line or transformer station. We used log-binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association of residential proximity to transmission lines and transformer stations with birth defects, adjusting for maternal and infant characteristics. The prevalence of birth defects within 200 m of a transmission line (579.4 per 10,000 per live births) was only slightly higher compared with distances further away (568.7 per 10,000). A similar trend was seen for transformer stations. Compared with 200 m, a distance of 50 m was not associated with the risk of birth defects for transmission lines (RR 1.00, 95% CI 1.00-1.01) and transformer stations (RR 1.01, 95% CI 1.00-1.03). There was no consistent association when we examined birth defects in different organ systems. We found no compelling evidence that residential proximity to extremely low frequency electromagnetic fields from electrical power grids increases the risk of birth defects. Women residing near electrical grids can be reassured that an effect on the risk of birth defects is unlikely.

Leveraging the Canadian Health Measures Survey for environmental health research.

Since 2007, the nationally representative, cross-sectional Canadian Health Measures Survey (CHMS) has collected detailed health and exposure data from more than 25,000 Canadians, including a wide range of chemical biomarkers analyzed in blood, urine, and environmental media. This article highlights the extent to which the CHMS dataset has been used in the peer-reviewed environmental health literature and opportunities for further expanding usage of the dataset. A literature search (2007-2018) was performed to identify peer-reviewed studies that have made substantive use of the CHMS dataset. Studies were analyzed according to the study type, data usage, populations studied, environmental health themes, citation/publication data, and institutional collaborations. A total of 51 environmental-health related CHMS studies were identified, including studies related to indoor and outdoor air quality, the built environment, and chemical and environmental tobacco smoke exposures. Health indicator data are being increasingly exploited, as is the ability to combine cycle datasets over time. Although these studies covered a range of environmental exposures, many CHMS variables remain underutilized. The CHMS dataset provides a valuable portrait of chemical exposures in Canadians of all ages, linked to a wide variety of health indicators. Many opportunities remain to exploit and expand both the use of the dataset and collaborations between Canadian agencies and domestic and international research institutions.

Blood mercury, lead and cadmium levels and determinants of exposure among newcomer South and East Asian women of reproductive age living in Vancouver, Canada.

BACKGROUND: Biomarkers of the reproductive and neuro-developmental toxicants mercury (Hg), lead (Pb) and cadmium (Cd) have been found at higher concentrations in women born outside Canada than in Canadian-born women. We measured blood Hg, Pb and Cd in women ages 19 to 45years living in greater Vancouver (Canada) within five years of their arrival from South Asia (India) or East Asia (mainland China, Hong Kong and Taiwan) and related their biomarker concentration levels with exposures and behaviors since their coming to Canada. METHODS: Participants were recruited through advertisements in relevant ethnic media, locations and groups. Concentrations of blood Hg, Pb and Cd were analyzed by inductively coupled plasma-mass spectrometry (ICP-Q-MS) and compared with population values. Biomarker concentrations were regressed against exposures and behaviors assessed by culturally-relevant questionnaire. RESULTS: The study recruited 53 South and 111 East Asian women. Median (95th percentile) blood Pb in South Asians was 1.15 (2.71) µg/dL compared with 1.01 (1.81) µg/dL in East Asians. On the other hand, blood Hg at 2.5 (7.3) µg/L was higher in East Asians compared to 0.20 (0.83) µg/L in South Asians. Blood Cd was also higher in the East Asian group: East 0.53 (1.1) µg/L; South 0.27 (0.82) µg/L. Higher blood Hg was associated with seafood consumption, dental amalgams and traditional remedies; blood Pb with home renovations, sucking on metal jewelry, and cosmetics. Blood Pb and Cd concentrations were inversely associated with dairy consumption. CONCLUSIONS: Asian women recently arrived in Vancouver had higher blood Hg, Pb and Cd concentrations than same-age Canadian women measured in a national survey. Among South Asian newcomer women of reproductive age, exposure to Cd may continue after arrival. Local exposures to Hg occur through seafood and potentially through ingestion of imported traditional remedies.

Elevated ambient temperatures and risk of neural tube defects.

OBJECTIVES: The association between ambient heat and neural tube defects has received limited attention, despite imminent climate warming this century. We sought to determine the relationship between elevated outdoor temperatures during neurogenesis and risk of neural tube defects. METHODS: We carried out a retrospective cohort study of 887 710 fetuses between 3 and 4 weeks postconception from the months of April through September for 1988-2012 in Quebec, Canada. The exposure was maximum daily temperature and the outcome presence of neural tube defects at delivery. We estimated prevalence ratios (PR) and 95% CIs for the association between maximum temperature and neural tube defects in log-binomial regression models adjusted for maternal characteristics. RESULTS: Relative to 20°C, exposure to temperatures of 30°C was associated with risk of neural tube defects on day 5 (PR 1.56, 95% CI 1.04 to 2.35) and day 6 (PR 1.49, 95% CI 1.00 to 2.21) of the 4th week postconception, during the time of neural tube closure. The trend was apparent for spina bifida and anencephalus/encephalocoele, the main subtypes of neural tube defects. Temperature during the 3rd week postconception was not associated with neural tube defects. CONCLUSIONS: Elevated ambient temperatures may be weakly associated with risk of neural tube defects during tube closure.

Respiratory hospital admissions in young children living near metal smelters, pulp mills and oil refineries in two Canadian provinces.

BACKGROUND: Industrial plants emit air pollutants like fine particles (PM2.5), sulfur dioxide (SO2) and nitrogen dioxide (NO2) that may affect the health of individuals living nearby. OBJECTIVE: To assess the effects of community exposure to air emissions of PM2.5, SO2, and NO2 from pulp mills, oil refineries, metal smelters, on respiratory hospital admissions in young children in Quebec (QC) and British Columbia (BC), Canada. METHODS: We assessed QC, BC and pooled associations between the following estimates of exposure and hospital admissions for asthma and bronchiolitis in children aged 2-4years for the years 2002-2010: i) Crude emission exposures at the residential postal codes of children, calculated by multiplying estimated daily emissions of PM2.5, SO2, or NO2 from all nearby (<7.5km) pulp mills, oil refineries, metal smelters emitting yearly ≥50t and their total emissions, by the percent of the day each postal code was downwind; ii) Daily levels of these pollutants at central ambient monitoring stations nearby the industries and the children's residences. RESULTS: Seventy-one major industries were selected between QC and BC, with a total of 2868 cases included in our analyses. More cases were exposed to emissions from major industries in QC than in BC (e.g. 2505 admissions near SO2 industrial emitters in QC vs 334 in BC), although air pollutant levels were similar. Odds ratios (ORs) for crude refinery and smelter emissions were positive in QC but more variable in BC. For example with PM2.5 in QC, ORs were 1.13 per 0.15t/day (95% CI: 1.00-1.27) and 1.03 (95% CI: 0.99-1.07) for refinery and smelter emissions, respectively. Pooled results of QC and BC for crude total SO2 emissions from all sources indicated a 1% increase (0-3%) in odds of hospital admissions per 1.50t/day increase in exposure. Associations with measured pollutant levels were only seen in BC, with SO2 and NO2. CONCLUSION: Hospital admissions for wheezing diseases in young children were associated with community exposure to industrial air pollutant emissions. Future work is needed to better assess the risk of exposure to complex mixture of air pollutants from multiple industrial sources.

Differences in lung cancer mortality trends from 1986-2012 by radon risk areas in British Columbia, Canada.

Residential exposure to radon gas is associated with increased risk of lung cancer, especially in smokers. Most evidence about the health effects of radon has been derived from meta-analyses on global epidemiologic studies, but administrative data can help public health authorities to explore the local impacts. Eighty health units in British Columbia (BC), Canada, were classified as having low, moderate, or high radon risk using more than 3,800 residential measurements. Vital statistics records were used to identify deaths due to lung cancer and to all natural causes. The annual ratio of lung cancer mortality to all natural mortality was plotted for the 1986-2012 study period for each radon classification. Visualizations were stratified by gender and by smoking prevalence. The overall ratio increased throughout the study period in high radon areas and remained stable in low and moderate radon areas. The increase was most pronounced for females, especially when plots were stratified by smoking prevalence. These limited but interesting findings confirm that radon is one risk factor for lung cancer mortality in BC and that its effects differ across gender and smoking strata. The results would be strengthened by replication, and more rigorous methods are required to assess other contributing factors.

Short-term risk of hospitalization for asthma or bronchiolitis in children living near an aluminum smelter.

Few studies have measured the effect of short-term exposure to industrial emissions on the respiratory health of children. Here we estimate the risk of hospitalization for asthma and bronchiolitis in young children associated with their recent exposure to emissions from an aluminum smelter. We used a case-crossover design to assess the risk of hospitalization, February 1999-December 2008, in relation to short-term variation in levels of exposure among children 0-4 years old living less than 7.5 km from the smelter. The percentage of hours per day that the residence of a hospitalized child was in the shadow of winds crossing the smelter was used to estimate the effect of wind-borne emissions on case and crossover days. Community-wide pollutant exposure was estimated through daily mean and daily maximum SO2 and PM2.5 concentrations measured at a fixed monitoring site near the smelter. Odds ratios (OR) were estimated using conditional logistic regressions. The risk of same-day hospitalization for asthma or bronchiolitis increased with the percentage of hours in a day that a child's residence was downwind of the smelter. For children aged 2-4 years, the OR was 1.27 (95% CI=1.03-1.56; n=103 hospitalizations), for an interquartile range (IQR) of 21% of hours being downwind. In this age group, the OR with PM2.5 daily mean levels was slightly smaller than with the hours downwind (OR: 1.22 for an IQR of 15.7 µg/m(3), 95% CI=1.03-1.44; n=94 hospitalizations). Trends were observed between hospitalizations and levels of SO2 for children 2-4 years old. Increasing short-term exposure to emissions from a Quebec aluminum smelter was associated with an increased risk of hospitalization for asthma and bronchiolitis in young children who live nearby. Estimating exposure through records of wind direction allows for the integration of exposure to all pollutants carried from the smelter stack.

How to ensure that national radon survey results are useful for public health practice.

Exposure to radon gas increases the risk of lung cancer. Preliminary national survey data collected by Health Canada indicate that approximately 10% of households exceed the recommended federal long-term guideline of 200 Bq/m3. However, results to date have been reported for large geographic areas in broad measurement categories. Given that Health Canada recommends the most rapid remediation for buildings with the highest concentrations, such reporting makes it challenging for public health authorities to target interventions to communities at the highest risk. Here we use data from a survey in British Columbia to illustrate how improved spatial resolution and more refined concentration categories would be valuable for prioritizing the use of limited public health resources. We encourage Health Canada in future to provide more specific, community-level information that can be used to inform local policy and to engage building owners in radon testing and remediation.

Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal, Quebec: a cross-sectional study.

BACKGROUND: Little attention has been devoted to the effects on children's respiratory health of exposure to sulphur dioxide (SO2) in ambient air from local industrial emissions. Most studies on the effects of SO(2) have assessed its impact as part of the regional ambient air pollutant mix. OBJECTIVE: To examine the association between exposure to stack emissions of SO(2) from petroleum refineries located in Montreal's (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby. METHODS: The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO(2) exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO(2) exposure estimates and asthma outcomes. Adjustments were made for child's age, sex, parental history of atopy and tobacco smoke exposure at home. RESULTS: The adjusted PR for the association between active asthma and SO(2) levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO(2). The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO(2) [95% CI 1.00 to 1.94]). CONCLUSIONS: Results of the present study suggest a relationship between exposure to refinery stack emissions of SO(2) and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries.

Low-level methylmercury exposure as a risk factor for neurologic abnormalities in adults.

UNLABELLED: Methylmercury is a neurotoxicant that bio-accumulates in the aquatic food chain and is present in all fish. Little is known about the effects of long-term low-dose exposure to methylmercury in adults. The aim of this study was to determine whether a dose-response relationship exists between long-term methylmercury exposure and neurological abnormalities in aboriginal Quebec Cree adults for whom fish is a dietary staple. We re-analysed data from a 1977 cross-sectional study conducted by Kofman and collaborators on a group of Quebec Cree individuals claiming ill health from local fish consumption. In the original 1977 study, 306 adult participants aged 18-82 years were assessed for methylmercury exposure. Tremor and other neurologic outcomes were assessed with a clinical examination. The investigators did not find clinical evidence of methylmercury intoxication based on an analysis of covariance. We used ordinal regression to obtain odds ratios for the relationship between total hair mercury levels and neurologic abnormalities. Hair mercury concentrations ranged from 0.5 to 46 ppm (parts per million). A 6 ppm increase in hair mercury was associated with increasing levels of tremor (OR, 2.22; 95% CI, 1.15-4.26) in adults under 40 years of age. There was no association with nine other outcomes considered, nor with tremor among older persons. Odds ratios were not influenced by gender, smoking, alcohol use, or co-morbidity. CONCLUSION: : Dose-dependent effects of methylmercury on tremor may occur below the commonly accepted 50 ppm threshold, particularly in young adults. These effects may be detectable by clinical examination. However, the results should be interpreted with caution given that alcohol use was probably under-reported and that multiple outcomes were studied.

Asthma and allergic rhinitis in Quebec children.

BACKGROUND: The Health and Social Survey of Quebec Children and Youth, conducted on representative samples of children nine, 13 and 16 years of age, provided data on the prevalence and determinants of asthma and allergic rhinitis in Quebec. OBJECTIVES: To determine the prevalence of asthma and allergic rhinitis among children in the province of Quebec and to identify the determinants of these pathologies. METHODS: Three groups of more than 1100 children aged nine, 13 and 16 years were recruited. Respiratory symptoms were documented using the International Study of Asthma and Allergies in Childhood questionnaire. Questions enquiring about family income, smoking, degree of urbanization of the child's school's location and various variables related to indoor air were also included. The comparisons of proportions were done using the chi2 test. RESULTS: The prevalence rates for reported history of asthma varied from 14% to 15% depending on the age group. The prevalence of wheezing in the past year was 7% to 8%. Asthma was the primary cause of the limitation of activities due to a health problem in nine- and 13-year-old Quebecers, and the second most common cause in 16-year-old Quebecers. The prevalence of rhinitis, rhinoconjunctivitis and reported history of hay fever increased with age, reaching 28.0%, 15.9% and 21.1%, respectively, in the 16-year-old group. The prevalence of asthma and wheezing was associated with family history and allergies, and inversely related to family income. CONCLUSIONS: The prevalence of childhood asthma is high in the province of Quebec. It is a major cause of the limitation of activities due to a health problem for young Quebecers. A family history of asthma and an atopic predisposition are important determinants in the development of asthma in Quebec.