Prenatal exposure to fine particles and polycyclic aromatic hydrocarbons and birth outcomes: a two-pollutant approach.

BACKGROUND: Previous epidemiologic studies have considered the effects of individual air pollutants on birth outcomes, whereas a multiple-pollutant approach is more relevant to public health policy. OBJECTIVES: The present study compared the observed effect sizes of prenatal fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH) (a component of PM2.5) exposures on birth outcome deficits, assessed by the single vs. two-pollutant approaches. METHODS: The study sample included 455 term infants born in Krakow to non-smoking mothers, among whom personal exposures to PM2.5 and PAH were monitored in the second trimester of pregnancy. The exposure effect estimates (unstandardized and standardized regression coefficients) on birth outcomes were determined using multivariable linear regression models, accounting for relevant covariates. RESULTS: In the single-pollutant approach, each pollutant was inversely associated with all birth outcomes. The effect size of prenatal PAH exposure on birth weight and length was twice that of PM2.5, in terms of standardized coefficients. In the two-pollutant approach, the negative effect of PM2.5 on birth weight and length, adjusted for PAH exposure, lost its significance. The standardized effect of PAH on birth weight was 10-fold stronger (ß = -0.20, p = 0.004) than that estimated for PM2.5 (ß = -0.02, p = 0.757). CONCLUSION: The results provide evidence that PAH had a greater impact on several measures of fetal development, especially birth weight, than PM2.5. Though in the single-pollutant models PM2.5 had a significant impact on birth outcomes, this effect appears to be mediated by PAH.

Seasonal variability in environmental tobacco smoke exposure in public housing developments.

The risk of tobacco smoking and second-hand smoke (SHS) exposure combined are the leading contributors to disease burden in high-income countries. Recent studies and policies are focusing on reducing exposure to SHS in multiunit housing (MUH), especially public housing. We examined seasonal patterns of SHS levels within indoor common areas located on Boston Housing Authority (BHA) properties. We measured weekly integrated and continuous fine particulate matter (PM2.5) and passive airborne nicotine in six buildings of varying building and occupant characteristics in summer 2012 and winter 2013. The average weekly indoor PM2.5 concentration across all six developments was 9.2 µg/m3, higher during winter monitoring period (10.3 µg/m3) compared with summer (8.0 µg/m3). Airborne nicotine concentrations ranged from no detection to about 5000 ng/m3 (mean 311 ng/m3). Nicotine levels were significantly higher in the winter compared with summer (620 vs. 85 ng/m3; 95% CI: 72-998). Smoking-related exposures within Boston public housing vary by season, building types, and resident smoking policy. Our results represent exposure disparities that may contribute to health disparities in low-income communities and highlight the potential importance of efforts to mitigate SHS exposures during winter when outdoor-indoor exchange rates are low and smokers may tend to stay indoors. Our findings support the use of smoke-free policy as an effective tool to eliminate SHS exposure and protect non-smokers, especially residents of MUH.

Ventilation rates and health: multidisciplinary review of the scientific literature.

UNLABELLED: The scientific literature through 2005 on the effects of ventilation rates on health in indoor environments has been reviewed by a multidisciplinary group. The group judged 27 papers published in peer-reviewed scientific journals as providing sufficient information on both ventilation rates and health effects to inform the relationship. Consistency was found across multiple investigations and different epidemiologic designs for different populations. Multiple health endpoints show similar relationships with ventilation rate. There is biological plausibility for an association of health outcomes with ventilation rates, although the literature does not provide clear evidence on particular agent(s) for the effects. Higher ventilation rates in offices, up to about 25 l/s per person, are associated with reduced prevalence of sick building syndrome (SBS) symptoms. The limited available data suggest that inflammation, respiratory infections, asthma symptoms and short-term sick leave increase with lower ventilation rates. Home ventilation rates above 0.5 air changes per hour (h(-1)) have been associated with a reduced risk of allergic manifestations among children in a Nordic climate. The need remains for more studies of the relationship between ventilation rates and health, especially in diverse climates, in locations with polluted outdoor air and in buildings other than offices. PRACTICAL IMPLICATIONS: Ventilation with outdoor air plays an important role influencing human exposures to indoor pollutants. This review and assessment indicates that increasing ventilation rates above currently adopted standards and guidelines should result in reduced prevalence of negative health outcomes. Building operators and designers should avoid low ventilation rates unless alternative effective measures, such as source control or air cleaning, are employed to limit indoor pollutant levels.

Indoor air pollution: a public health perspective.

Although official efforts to control air pollution have traditionally focused on outdoor air, it is now apparent that elevated contaminant concentrations are common inside some private and public buildings. Concerns about potential public health problems due to indoor air pollution are based on evidence that urban residents typically spend more than 90 percent of their time indoors, concentrations of some contaminants are higher indoors than outdoors, and for some pollutants personal exposures are not characterized adequately by outdoor measurements. Among the more important indoor contaminants associated with health or irritation effects are passive tobacco smoke, radon decay products, carbon monoxide, nitrogen dioxide, formaldehyde, asbestos fibers, microorganisms, and aeroallergens. Efforts to assess health risks associated with indoor air pollution are limited by insufficient information about the number of people exposed, the pattern and severity of exposures, and the health consequences of exposures. An overall strategy should be developed to investigate indoor exposures, health effects, control options, and public policy alternatives.

Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics.

OBJECTIVE: An analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area. METHODS: Nicotine concentrations were determined using passive monitors placed in homes over a one-week sampling period and air exchange rates (AER) were sampled using the perfluorocarbon tracer technique. Residents were surveyed through a questionnaire about smoking behaviour and a visual inspection was conducted to collect information on housing characteristics contributing to secondhand smoke (SHS) exposure. Using a mass balance model to account for the air exchange rate, volume of the home and sorption and re-emission of nicotine on indoor surfaces, the effective smoking rate (SR(eff)) was determined for each residence. RESULTS: Nicotine levels ranged from the limit of detection to 26.92 microg/m(3), with a mean of 2.20 microg/m(3) and median of 0.13 microg/m(3). Nicotine measurements were significantly associated with the number of smokers in the household and the number of cigarettes smoked in the home. The results of this study suggest that questionnaire reports can provide a valid estimate of residential exposure to tobacco smoke. In addition, this study found evidence that tobacco smoke contamination in low-income housing developments is not limited to homes with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming from other apartments or hallways resulted in increased levels of nicotine concentrations and SR(eff) in non-smoking homes, suggestive of SHS infiltration from neighbouring units. CONCLUSION: These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents.

Evaluating building-related symptoms using the US EPA BASE study results.

UNLABELLED: In order to develop baseline data about United States office buildings, the United States Environmental Protection Agency conducted the Building Assessment Survey Evaluation (BASE) study, a systematic survey of 100 randomly selected United States office buildings, in the 1990s. This paper analyzes the self-reported work-related symptoms and job and workplace characteristics of 4326 respondents and compares results to the National Institute for Occupational Safety and Health's (NIOSH) study of 80 'complaint' buildings. Four distinct groups of symptoms, representing 'tiredness', 'mucosal irritation', 'neuropsychological', and 'lower respiratory' conditions emerged from factor analysis of work-related symptoms. The symptom grouping is identical for both surveys. Although the prevalence of each symptom is significantly higher in the NIOSH than in the BASE sample, there is overlap of the symptom distributions. In the BASE survey, 45% of the work force reported at least one work-related health symptom; 20% reported at least three symptoms. These findings imply that it is counterproductive to dichotomize buildings into healthy vs. unhealthy; instead the prevalence of health problems related to buildings span a continuum. PRACTICAL IMPLICATIONS: These results indicate that most office buildings have occupants who report building-related symptoms. This paper provides practical guidance for the comparison of building prevalences to the BASE normative data. Work-related symptom distributions and symptom groups can improve investigators' ability to identify IEQ problems.

Shelter for the twenty-first century.

Housing for the twenty-first century will be shaped by the changes that are occurring in society. These include the demographics of the occupant, the products and materials used for construction and furnishing, and the basic use of the structure. An aging population will have different demands on design and function. The health concerns of an aging population encompass chronic degenerative diseases as well as injury. The lessons of the past must make us mindful that chronic, low-level exposures to substances can occur at home. Products and materials used in homes can release vapors that may affect immunologic and neurologic function. Manifestations of dysfunctions will be more important as our population ages and if there is a continued reliance on new chemical formulation for products used in homes and workplaces. The future portends changes in functional use of residences. Electronic communications and robotics will decentralize our work force. Manufacturing or office functions will occur at home. This will present new challenges for health and safety for both monitoring and prevention.

Buildings operations and ETS exposure.

Mechanical systems are used in buildings to provide conditioned air, dissipate thermal loads, dilute contaminants, and maintain pressure differences. The characteristics of these systems and their operations h implications for the exposures of workers to environmental tobacco smoke (ETS) and for the control of these exposures. This review describes the general features of building ventilation systems and the efficacy of ventilation for controlling contaminant concentrations. Ventilation can reduce the concentration of ETS through dilution, but central heating, ventilating, and air conditioning (HVAC) can also move air throughout a building that has been contaminated by ETS. An understanding of HVAC systems is needed to develop models for exposures of workers to ETS.

Analysis of health effects resulting from population exposures to acid precipitation precursors.

Types of available studies relevant to the quantification of air pollution health effects and their principal limitations are discussed. Assessments are provided based on review and re-analysis of previously reported data bases, synthesis of published findings, and original analysis of health data sets using new methods or recent size-specific particle mass measurements. Interim results from ongoing research activities on airborne particle health effects are presented. It is shown that preliminary results obtained from cross-sectional and time-series mortality studies appear to be consistent, indicating that particulate air pollution, even at current levels, could be of concern for public health. Throughout the paper, methodological deficiencies and remaining gaps in knowledge are identified. In particular, uncertainties associated with the reported exposure-response coefficients are assessed. Finally, by characterizing the limitations of analysis we propose various recommendations for future studies and research that will serve to further define the nature, magnitude, and uncertainties of air pollution health risks.

Problems in the estimation of human exposure to components of acid precipitation precursors.

Problems associated with estimation of human exposure to ambient air pollutants are discussed. Ideally, we would prefer to have some indication of actual dose. For most pollutants this is not presently feasible. Specific problems discussed are adequacy of outdoor monitors; the need to correct for exposures and time spent indoors; the need to have particle size distributions described and the chemistry of the particles presented. These indicate the need to develop lightweight accurate and reliable personal monitors.

Assessing exposures to inhaled complex mixtures.

In the course of daily activities, individuals spend varying amounts of time in different spaces where they are exposed to a complex mixture of gas, vapor, and particulate contaminants. The term complex is used in this paper to refer to binary mixtures as well as truly complex mixtures of three or more constituents. The diversity of the environments where pollution may occur, the number of pollutants that may be present, and the nature of the activity in the environment combine to pose a challenge to investigators of the health effects of air pollutants. This article discusses several methods of measuring or assessing exposure to complex mixture air contaminants that include time-activity assessments, personal monitoring, biomarkers of exposure, and microenvironmental models that can be employed singly or in combination in a protocol for exposure assessment. The use of nested designs, involving more intensive data collection from samples or subjects, is also considered.

Estimating the mortality impacts of particulate matter: what can be learned from between-study variability?

Epidemiologic studies of the link between particulate matter (PM) concentrations and mortality rates have yielded a range of estimates, leading to disagreement about the magnitude of the relationship and the strength of the causal connection. Previous meta-analyses of this literature have provided pooled effect estimates, but have not addressed between-study variability that may be associated with analytical models, pollution patterns, and exposed populations. To determine whether study-specific factors can explain some of the variability in the time-series studies on mortality from particulate matter [less than/equal to] 10 microm in aerodynamic diameter (PM(10)), we applied an empirical Bayes meta-analysis. We estimate that mortality rates increase on average by 0.7% per 10 microg/m(3) increase in PM(10) concentrations, with greater effects at sites with higher ratios of particulate matter [less than/equal to] 2.5 microm in aerodynamic diameter (PM(2.5))/PM(10). This finding did not change with the inclusion of a number of potential confounders and effect modifiers, although there is some evidence that PM effects are influenced by climate, housing characteristics, demographics, and the presence of sulfur dioxide and ozone. Although further analysis would be needed to determine which factors causally influence the relationship between PM(10) and mortality, these findings can help guide future epidemiologic investigations and policy decisions.

The Harvard Southern California Chronic Ozone Exposure Study: assessing ozone exposure of grade-school-age children in two Southern California communities.

The Harvard Southern California Chronic Ozone Exposure Study measured personal exposure to, and indoor and outdoor ozone concentrations of, approximately 200 elementary school children 6-12 years of age for 12 months (June 1995-May 1996). We selected two Southern California communities, Upland and several towns located in the San Bernardino mountains, because certain characteristics of those communities were believed to affect personal exposures. On 6 consecutive days during each study month, participant homes were monitored for indoor and outdoor ozone concentrations, and participating children wore a small passive ozone sampler to measure personal exposure. During each sampling period, the children recorded time-location-activity information in a diary. Ambient ozone concentration data were obtained from air quality monitoring stations in the study areas. We present ozone concentration data for the ozone season (June-September 1995 and May 1996) and the nonozone season (October 1995-April 1996). During the ozone season, outdoor and indoor concentrations and personal exposure averaged 48.2, 11.8, and 18.8 ppb in Upland and 60.1, 21.4, and 25.4 ppb in the mountain towns, respectively. During the nonozone season, outdoor and indoor concentrations and personal exposure averaged 21.1, 3.2, and 6.2 ppb in Upland, and 35.7, 2.8, and 5.7 ppb in the mountain towns, respectively. Personal exposure differed by community and sex, but not by age group.

Criteria air pollutants and toxic air pollutants.

This review presents a brief overview of the health effects and exposures of two criteria pollutants--ozone and particulate matter--and two toxic air pollutants--benzene and formaldehyde. These pollutants were selected from the six criteria pollutants and from the 189 toxic air pollutants on the basis of their prevalence in the United States, their physicochemical behavior, and the magnitude of their potential health threat. The health effects data included in this review primarily include results from epidemiologic studies; however, some findings from animal studies are also discussed when no other information is available. Health effects findings for each pollutant are related in this review to corresponding information about outdoor, indoor, and personal exposures and pollutant sources.

Acute lung function responses to ambient acid aerosol exposures in children.

We examined the relationship between lung function changes and ambient acid aerosol episodes in children attending a residential summer camp. Young females (112) performed daily spirometry, and 96 were assessed on one occasion for airway hyperresponsiveness using a methacholine bronchoprovocation test. Air quality measurements were performed on site and four distinct acid aerosol episodes were observed during the 41-day study. The maximum values observed during the 41-day study were: O3 at 143 ppb; H2SO4 at 47.7 micrograms/m3; and [H+] at 550 nmole/m3. Maximum decrements of 3.5 and 7% for FEV1 and PEF, respectively, were observed to be associated with the air pollution episodes. There was some evidence of a differential lung function response to the episodes where children with a positive response to a methacholine challenge had larger decrements compared to their nonresponsive counterparts.

Exposures to acidic aerosols.

Ambient monitoring of acid aerosols in four U.S. cities and in a rural region of southern Ontario clearly show distinct periods of strong acidity. Measurements made in Kingston, TN, and Steubenville, OH, resulted in 24-hr H+ ion concentrations exceeding 100 nmole/m3 more than 10 times during summer months. Periods of elevated acidic aerosols occur less frequently in winter months. The H+ determined during episodic conditions in southern Ontario indicates that respiratory tract deposition can exceed the effects level reported in clinical studies. Observed 12-hr H+ concentrations exceeded 550 nmole/m3 (approximately 27 micrograms/m3 H2SO4). The maximum estimated 1-hr concentration exceeded 1500 nmole/m3 for H+ ions. At these concentrations, an active child might receive more than 2000 nmole of H+ ion in 12 hr and in excess of 900 nmole during the hour when H2SO4 exceeded 50 micrograms/m3.

Particle concentrations in urban microenvironments.

Although ambient particulate matter has been associated with a range of health outcomes, the health risks for individuals depend in part on their daily activities. Information about particle mass concentrations and size distributions in indoor and outdoor microenvironments can help identify high-risk individuals and the significant contributors to personal exposure. To address these issues in an urban setting, we measured particle count concentrations in four size ranges and particulate matter (3/4) 10 microm (PM(10)) concentrations outdoors and in seven indoor microenvironments in Boston, Massachusetts. Particle counts and PM(10) concentrations were continuously measured with two light-scattering devices. Because of the autocorrelation between sequential measurements, we used linear mixed effects models with an AR-1 autoregressive correlation structure to evaluate whether differences between microenvironments were statistically significant. In general, larger particles were elevated in the vicinity of significant human activity, and smaller particles were elevated in the vicinity of combustion sources, with indoor PM(10) concentrations significantly higher than the outdoors on buses and trolleys. Statistical models demonstrated significant variability among some indoor microenvironments, with greater variability for smaller particles. These findings imply that personal exposures can depend on activity patterns and that microenvironmental concentration information can improve the accuracy of personal exposure estimation.

Fine particulate matter and polycyclic aromatic hydrocarbon concentration patterns in Roxbury, Massachusetts: a community-based GIS analysis.

Given an elevated prevalence of respiratory disease and density of pollution sources, residents of Roxbury, Massachusetts, have been interested in better understanding their exposures to air pollution. To determine whether local transportation sources contribute significantly to exposures, we conducted a community-based pilot investigation to measure concentrations of fine particulate matter (particulate matter < 2.5 microm; PM(2.5)) and particle-bound polycyclic aromatic hydrocarbons (PAHs) in Roxbury in the summer of 1999. Community members carried portable monitors on the streets in a 1-mile radius around a large bus terminal to create a geographic information system (GIS) map of concentrations and gathered data on site characteristics that could predict ambient concentrations. Both PM(2.5) and PAH concentrations were greater during morning rush hours and on weekdays. In linear mixed-effects regressions controlling for temporal autocorrelation, PAH concentrations were significantly higher with closer proximity to the bus terminal (p < 0.05), and both pollutants were elevated, but not statistically significantly so, on bus routes. Regressions on a subset of measurements for which detailed site characteristics were gathered showed higher concentrations of both pollutants on roads reported to have heavy bus traffic. Although a more comprehensive monitoring protocol would be needed to develop robust predictive functions for air pollution, our study demonstrates that pollution patterns in an urban area can be characterized with limited monitoring equipment and that university-community partnerships can yield relevant exposure information.

Dietary exposures to selected metals and pesticides.

Average daily dietary exposures to 11 contaminants were estimated for approximately 120,000 U.S. adults by combining data on annual diet, as measured by a food frequency questionnaire, with contaminant residue data for table-ready foods that were collected as part of the annual U.S. Food and Drug Administration Total Diet Study. The contaminants included in the analysis were four heavy metals (arsenic, cadmium, lead, mercury), three organophosphate pesticides (chlorpyrifos, diazinon, malathion), and four organochlorine pesticides (dieldrin, p,p'-DDE, lindane, heptachlor epoxide). Dietary exposures to these contaminants were highly variable among individuals, spanning two to three orders of magnitude. Intraindividual exposures to the metals, organophosphates, and organochlorines were estimated to be strongly correlated; Pearson's correlation coefficients ranged from 0.28 for lindane:dieldrin to 0.84 for lead:mercury. For some of the compounds (e.g., arsenic and dieldrin), a substantial fraction of the population was estimated to have dietary intakes in excess of health-based standards established by the EPA. Before use for risk assessment or epidemiologic purposes, however, the validity of the exposure estimates must be evaluated by comparison with biological indicators of chronic exposure. Because of their low detection rate in table-ready foods, the estimated distributions of exposures for dieldrin, p,p'-DDE, heptachlor epoxide, lindane, diazinon, and chlorpyrifos were found to be sensitive to assumed values for nondetect samples. Reliable estimates of the population distribution of dietary exposures to most other contaminants cannot be made currently, due to their low rate of detection in table-ready foods. Monitoring programs that use more sensitive study designs and population-based assessments for other subpopulations should be a priority for future research.

Particulate air pollution and respiratory disease in Anchorage, Alaska.

This paper examines the associations between average daily particulate matter less than 10 microns in diameter (PM10) and temperature with daily outpatient visits for respiratory disease including asthma, bronchitis, and upper respiratory illness in Anchorage, Alaska, where there are few industrial sources of air pollution. In Anchorage, PM10 is composed primarily of earth crustal material and volcanic ash. Carbon monoxide is measured only during the winter months. The number of outpatients visits for respiratory diagnoses during the period 1 May 1992 to 1 March 1994 were derived from medical insurance claims for state and municipal employees and their dependents covered by Aetna insurance. The data were filtered to reduce seasonal trends and serial autocorrelation and adjusted for day of the week. The results show that an increase of 10 micrograms/m3 in PM10 resulted in a 3-6% increase in visits for asthma and a 1-3% increase in visits for upper respiratory diseases. Winter CO concentrations were significantly associated with bronchitis and upper respiratory illness, but not with asthma. Winter CO was highly correlated with automobile exhaust emissions. These findings are consistent with the results of previous studies of particulate pollution in other urban areas and provide evidence that the coarse fraction of PM10 may affect the health of working people.