A Communitywide Collaboration to Increase Enrollment, Retention, and Success in Evidence-Based Lifestyle-Change Programs in Racial and Ethnic Minority Populations.

PURPOSE AND OBJECTIVES: Chronic diseases (eg, diabetes, hypertension) are the leading causes of death in the US and disproportionally affect racial and ethnic minority populations. This disparity is partially due to the unequal burden of unmet social needs that stem from several factors, including racism. INTERVENTION APPROACH: The Alliance is a collaboration among health care, public health, and community organizations formed to improve referral, enrollment, and successful completion of evidence-based lifestyle-change programs, particularly among Black people. The Alliance built 1) a system to assess and address social barriers through the screening and referral process and 2) a training center for frontline staff (eg, community health workers). EVALUATION METHODS: From January 2020 through September 2022, we conducted an evaluation that included both quantitative and qualitative methods. We developed an electronic database to make referrals and track key barriers to participation. Additionally, we conducted a focus group among frontline staff (N = 15) to understand the challenges in making referrals and discussing, documenting, and addressing barriers to participation. We used surveys that collected quantitative and open-ended qualitative responses to evaluate the training center and to understand perceptions of training modules as well as the skills gained. RESULTS: Frontline staff engaged with 6,036 people, of whom 847 (14%) were referred to a lifestyle-change program from January 2020 through September 2022. Of those referred, 257 (30%) were eligible and enrolled in a program. Food access and unreliable internet were the most common barriers to participation. Thirteen of 15 frontline staff participated in trainings, and, on average, trainees completed 4.2 trainings and gained several skills (eg, ability to monitor personal bias, de-escalate a crisis, educate on mental health, understand community and environmental factors). IMPLICATIONS FOR PUBLIC HEALTH: The Alliance is an example of how health care, public health, and community partners can work together to increase enrollment in lifestyle-change programs of residents disproportionately affected by chronic diseases. Lessons learned from implementation and evaluation can inform other complex partnerships to improve public health.

Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States: Development and Psychometric Properties of a New Measure.

CONTEXT: Fostering evidence-based decision making (EBDM) within local public health departments and among local health department (LHD) practitioners is crucial for the successful translation of research into public health practice to prevent and control chronic disease. OBJECTIVE: The purpose of this study was to identify organizational supports for EBDM within LHDs and determine psychometric properties of a measure of organizational supports for EBDM in LHDs. DESIGN: Cross-sectional, observation study. SETTING: Local public health departments in the United States. PARTICIPANTS: Local health department practitioners (N = 376) across the United States participated in the study. MAIN OUTCOME MEASURES: Local health department practitioners completed a survey containing 27 items about organizational supports for EBDM. Most items were adapted from previously developed surveys, and input from researchers and practitioners guided survey development. Confirmatory factor analysis was used to test and refine the psychometric properties of the measure. RESULTS: The final solution included 6 factors of 22 items: awareness of EBDM (3 items), capacity for EBDM (7 items), resources availability (3 items), evaluation capacity (3 items), EBDM climate cultivation (3 items), and partnerships to support EBDM (3 items). This factor solution achieved acceptable fit (eg, Comparative Fit Index = 0.965). Logistic regression models showed positive relationships between the 6 factors and the number of evidence-based interventions delivered. CONCLUSIONS: This study identified important organizational supports for EBDM within LHDs. Results of this study can be used to understand and enhance organizational processes and structures to support EBDM to improve LHD performance and population health. Strong measures are important for understanding how LHDs support EBDM, evaluating interventions to improve LHD capacity, and to guide programmatic and policy efforts within LHDs.

Development of a Survey to Assess Local Health Department Organizational Processes and Infrastructure for Supporting Obesity Prevention.

Local health departments (LHDs) have an important function in controlling the growing epidemic of obesity in the United States. Data are needed to gain insight into the existence of routine functions and structures of LHDs that support and sustain obesity prevention efforts. The purpose of this study was to develop and examine the reliability of measures to assess foundational LHD organizational processes and functions specific to obesity prevention. Survey measures were developed using a stratified, random sample of US LHDs to assess supportive organizational processes and infrastructure for obesity prevention representing different domains. Data were analyzed using weighted κ and intraclass correlation coefficient for assessing test-retest reliability. Most items and summary indices in the majority of survey domains had moderate/substantial or almost perfect reliability. The overall findings support this survey instrument to be a reliable measurement tool for a large number of processes and functions that comprise obesity prevention-related capacity in LHDs.

The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study.

BACKGROUND: Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population's health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments. METHODS: In a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination. RESULTS: Slightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received. CONCLUSIONS: There is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.

Importance of scientific resources among local public health practitioners.

OBJECTIVES: We examined the perceived importance of scientific resources for decision-making among local health department (LHD) practitioners in the United States. METHODS: We used data from LHD practitioners (n = 849). Respondents ranked important decision-making resources, methods for learning about public health research, and academic journal use. We calculated descriptive statistics and used logistic regression to measure associations of individual and LHD characteristics with importance of scientific resources. RESULTS: Systematic reviews of scientific literature (24.7%) were most frequently ranked as important among scientific resources, followed by scientific reports (15.9%), general literature review articles (6.5%), and 1 or a few scientific studies (4.8%). Graduate-level education (adjusted odds ratios [AORs] = 1.7-3.5), larger LHD size (AORs = 2.0-3.5), and leadership support (AOR = 1.6; 95% confidence interval = 1.1, 2.3) were associated with a higher ranking of importance of scientific resources. CONCLUSIONS: Graduate training, larger LHD size, and leadership that supports a culture of evidence-based decision-making may increase the likelihood of practitioners viewing scientific resources as important. Targeting communication channels that practitioners view as important can also guide research dissemination strategies.

State practitioner insights into local public health challenges and opportunities in obesity prevention: a qualitative study.

INTRODUCTION: The extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs' success in obesity prevention. METHODS: From June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations. RESULTS: Main themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process. CONCLUSIONS: These findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state-local relationship, especially in centralized states.

Sustainability Planning for a Community Network to Increase Participation in Evidence-Based Lifestyle Change Programs: A Mixed-Methods Approach.

Community-based chronic disease prevention programs can have long-term, broad public health benefits. Yet, only 40 to 60% of evidence-based health programs are sustained. Using established frameworks and evidence-based tools to characterize sustainability allows programs to develop structures and processes to leverage resources effectively to sustain effective program activities and systems. This study used a mixed-methods, partner-engaged approach to identify barriers and facilitators to sustaining a community network (the Alliance program) aimed to increase participation in evidence-based lifestyle change programs delivered in the community. Surveys and qualitative interviews were conducted with the Alliance partners based on the Program Sustainability Assessment Tool and Consolidated Framework for Implementation Research. Overall, partners felt Alliance had a high capacity for sustainability. Strategic planning, communication, and partnerships were areas partners prioritized to improve the potential for sustaining the program. Results informed the co-development of a sustainability action plan. This paper furthers our understanding of factors critical for the sustainability of community-based programs for chronic disease prevention and health equity and presents a process for developing action plans to build sustainability capacity.

Designing for dissemination among public health researchers: findings from a national survey in the United States.

OBJECTIVES: We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement. METHODS: In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States. RESULTS: In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process. CONCLUSIONS: The current data and the existing literature suggest considerable room for improvement in designing for dissemination.

State legislators' work on public health-related issues: what influences priorities?

CONTEXT: Policies are an effective way to influence population health and prevent disease. Unfortunately, public health research is often not well translated for policy audiences. Furthermore, researchers seeking to influence policy face an incomplete understanding of what influences legislators' decisions regarding which issues will receive their limited time and focus. OBJECTIVE: The objective of this analysis was to examine various factors that may influence state legislators' decisions about which health issues they address. DESIGN: Cross-sectional analysis of data collected from a randomized trial. SETTING: State legislatures. PARTICIPANTS: State-level legislators. MAIN OUTCOME MEASURE(S): Measures included a rating of the influence of various factors on health policy priorities. A 7-point scale was used to measure political ideology on social and fiscal issues. Standard demographic questions were included on age, gender, and level of education. RESULTS: Seventy-five legislators completed surveys. Sixty-three percent were aged 55 years or older, and 76% male. When they were asked to rate factors according to importance in determining what health issues to work on, the top-rated factor was constituents' needs or opinions followed by evidence of scientific effectiveness. Ratings were also examined by subgroups. CONCLUSIONS: These findings point to several important applications for public health practitioners and researchers. Because legislators value constituents' opinions, it is critical to inform and educate constituents about public health issues as well as policy options that may be effective in addressing problems. The results also highlight the importance of public health researchers and practitioners improving dissemination efforts to ensure that evidence-based scientific information is shared with policymakers in an effective and timely manner.

Systems science methods in public health: dynamics, networks, and agents.

Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time, and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies in which these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity.

Where is obesity prevention on the map?: distribution and predictors of local health department prevention activities in relation to county-level obesity prevalence in the United States.

CONTEXT: The system of local health departments (LHDs) in the United States has the potential to advance a locally oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. OBJECTIVE: This study examines the extent to which LHDs across the United States have responded to local levels of obesity by examining the association between jurisdiction-level obesity prevalence and the existence of obesity prevention programs. DESIGN: Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n = 2300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. SETTING: Two thousand three hundred local health department jurisdictions defined with respect to county boundaries. PARTICIPANTS: Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. MAIN OUTCOME MEASURES: Likelihood of having obesity prevention activities and association with area-level obesity prevalence. RESULTS: The existence of obesity prevention activities was not associated with the prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. CONCLUSIONS: This article identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance.

Combined Effect of Lead Exposure and Allostatic Load on Cardiovascular Disease Mortality-A Preliminary Study.

This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008 linked to 1999-2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

Development of a measurement tool to assess local public health implementation climate and capacity for equity-oriented practice: Application to obesity prevention in a local public health system.

OBJECTIVE: The objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities. METHODS: We developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability. RESULTS: Measures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong internal push (67%) was often accompanied by limited external political (25%) and community support (40%). Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice. Frequently identified (>70%) training needs included improving skills in applying frameworks, assessment methods, and evaluating collaborations around equity. CONCLUSION: We developed a theory-based, practitioner-informed questionnaire to assess capacity for equity-oriented practice and identify opportunities for capacity building in local public health departments to engage in effective change toward health equity.

Understanding evidence-based public health policy.

Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.

Developing a Survey Tool to Assess Implementation of Evidence-Based Chronic Disease Prevention in Public Health Settings Across Four Countries.

Background: Understanding the contextual factors that influence the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) interventions in public health settings across countries could inform strategies to support the dissemination and implementation of EBCDP interventions globally and more effectively prevent chronic diseases. A survey tool to use across diverse countries is lacking. This study describes the development and reliability testing of a survey tool to assess the stage of dissemination, multi-level contextual factors, and individual and agency characteristics that influence the dissemination and implementation of EBCDP interventions in Australia, Brazil, China, and the United States. Methods: Development of the 26-question survey included, a narrative literature review of extant measures in EBCDP; qualitative interviews with 50 chronic disease prevention practitioners in Australia, Brazil, China, and the United States; review by an expert panel of researchers in EBCDP; and test-retest reliability assessment. Results: A convenience sample of practitioners working in chronic disease prevention in each country completed the survey twice (N = 165). Overall, this tool produced good to moderately reliable responses. Generally, reliability of responses was higher among practitioners from Australia and the United States than China and Brazil. Conclusions: Reliability findings inform the adaptation and further development of this tool. Revisions to four questions are recommended before use in China and revisions to two questions before use in Brazil. This survey tool can contribute toward an improved understanding of the contextual factors that public health practitioners in Australia, Brazil, China, and the United States face in their daily chronic disease prevention work related to the dissemination and implementation of EBCDP interventions. This understanding is necessary for the creation of multi-level strategies and policies that promote evidence-based decision-making and effective prevention of chronic diseases on a more global scale.

All-Cause 30-Day Mortality After Surgical Treatment for Head and Neck Squamous Cell Carcinoma in the United States.

OBJECTIVES: Thirty-day (30-day) mortality, a common posttreatment quality metric, is yet to be described following surgery for head and neck squamous cell carcinoma (HNSCC). This study aimed to measure 30-day postoperative mortality in HNSCC and describe clinical/nonclinical factors associated with 30-day mortality. METHODS: In this retrospective cohort study, the National Cancer Database (2004 to 2013) was queried for eligible cases of HNSCC (n=91,858). Adult patients were included who were treated surgically with curative intent for the primary HNSCC, not missing first treatment, survival, and follow-up information. The outcome of interest was all-cause mortality within 30 days of definitive surgery. Clinical and nonclinical factors associated with all-cause 30-day postoperative mortality were estimated using a fully adjusted, multivariable logistic regression, which accounted for time-varying nature of adjuvant therapy. RESULTS: A total of 775 patients died within 30 days of definitive surgery for HNSCC (30-day mortality rate of 0.84%). Thirty-day mortality rate was however up to 2.33% (95% confidence interval [CI], 1.91%-2.75%) depending on comorbidity. In the fully adjusted model, increasing severity of comorbidity was associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: adjusted odds ratio [aOR], 1.43; 95% CI, 1.21-1.69, and of 2+ aOR, 2.55; 95% CI, 2.07-3.14). Odds of 30-day mortality were greater among Medicaid patients (aOR, 1.77; 95% CI, 1.30-2.41), and in patients in neighborhoods with little education (≥ 29% missing high school diploma: aOR, 1.35; 95% CI, 1.02-1.78). CONCLUSIONS: Patients with higher 30-day mortality were those with a greater burden of comorbidities, with little education, and covered by Medicaid.

Association between depressive symptoms and poor sleep quality among Han and Manchu ethnicities in a large, rural, Chinese population.

OBJECTIVES: To estimate the relationship between sleep quality and depression, among Han and Manchu ethnicities, in a rural Chinese population. METHODS: A sample of 8,888 adults was selected using a multistage cluster and random sampling method. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed via the Center for Epidemiological Survey, Depression Scale (CES-D). Logistic regression was conducted to assess associations between sleep quality and depression. RESULTS: The prevalence of poor sleep quality and depression in the Manchus (20.74% and 22.65%) was significantly lower than that in the Hans (29.57% and 26.25%), respectively. Depressive participants had higher odds ratios of global and all sub PSQI elements than non-depressive participants, both among the Hans and the Manchus. Additive interactions were identified between depressive symptoms and ethnicity with global and four sub-PSQI elements, including subjective sleep quality, sleep disturbance, use of sleep medication and daytime dysfunction. CONCLUSIONS: The findings revealed that the prevalence of poor sleep quality and depression among the Hans was greater than among the Manchus. Depression was associated with higher odds of poor sleep quality.

Perinatal risk factors for obstructive sleep apnea syndrome in children.

OBJECTIVE: The aim of this study was to determine whether specific perinatal factors are associated with obstructive sleep apnea syndrome (OSAS) in children. METHODS: A retrospective case-control study was conducted. All cases of OSAS were obtained from a tertiary pediatric hospital between April 2013 and April 2016. A total of 823 children who had been diagnosed with OSAS were designated as the case group, and 823 children without OSAS were selected with strict criteria to match with the case group by age, gender and body mass index. Logistic regression models were used to determine the perinatal factors associated with childhood OSAS. RESULTS: Preterm birth (adjusted odds ratio (aOR): 1.87, 95% confidence interval (CI): 1.13-3.08) and cesarean section (aOR: 1.32, 95% CI: 1.03-1.68) were significantly associated with OSAS. Exposure of the mother to smoke (aOR: 2.59, 95% CI: 1.57-4.26) was also associated with an increased risk of childhood OSAS. Mothers aged 35 years and above, performing manual labor, and living in suburban areas significantly increased the risk of childhood OSAS. Multiparous mothers decreased the risk of childhood OSAS (aOR: 0.59, 95% CI: 0.42-0.83). Maternal education, gravidity, prenatal care times, pregnancy-induced hypertension, multiple pregnancies, sex of the child and birth weight were not significantly associated with OSAS in children. CONCLUSION: Perinatal risk factors are important for predicting childhood OSAS. Our findings provide evidence regarding several potentially useful factors for recognizing OSAS in children, which could be important in diagnosis of pediatric OSAS by physicians.

Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA.

OBJECTIVE: The nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently known about use of diabetes-related EBIs among LHDs. This study used a national online survey to determine the patterns and correlates of the Centers for Disease Control and Prevention Community Guide-recommended EBIs for diabetes control in LHDs. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted to survey a stratified random sample of LHDs regarding department characteristics, respondent characteristics, evidence-based decision making within the LHD, and delivery of EBIs (directly or in collaboration) within five categories (diabetes-related, nutrition, physical activity, obesity, and tobacco). Associations between delivering EBIs and respondent and LHD characteristics and evidence-based decision making were explored using logistic regression models. RESULTS: Among 240 LHDs there was considerable variation among the EBIs delivered. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI 1.02 to 1.62)), diabetes self-management education (OR=1.32 (95% CI 1.04 to 1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI 1.05 to 1.54)). Although all organizational supports for evidence-based decision making factors were related in a positive direction, the only significant association was between evaluation capacity and identifying patients with diabetes and determining effective treatment (OR=1.54 (95% CI 1.08 to 2.19)). CONCLUSION: Supporting evidence-based decision making and increasing the implementation of these EBIs by more LHDs can help control diabetes nationwide.

Ambient particulate matter air pollution associated with acute respiratory distress syndrome in Guangzhou, China.

Limited evidence exists concerning the impact of particulate pollution on acute respiratory distress syndrome (ARDS). We examined the effects of particulate pollution on emergency ambulance dispatches (EAD) for ARDS in Guangzhou, China. Daily air pollution concentrations for PM10, PM2.5, and PM1, as well as PM2.5 chemical compositions, were available from a central air monitoring station. The association between incident ARDS and air pollution on the concurrent and previous 5 days was estimated by an over-dispersed Poisson generalized additive model controlling for meteorological factors, temporal trends, public holidays and day of the week. We identified a total of 17,002 EADs for ARDS during the study period. There were significant associations between concentrations of PM10, PM2.5, PM1, and ARDS; corresponding excess risk (ER) for an interquartile range IQR increase in 1-day lagged concentration was 5.45% [95% confidence interval (CI): 1.70%, 9.33%] for PM10 (45.4 µg/m3), 4.71% (95% CI: 1.09%, 8.46%) for PM2.5 (31.5 µg/m3), and 4.45% (95% CI: 0.81%, 8.23%) for PM1 (28.8 µg/m3), respectively. For PM2.5 chemical compositions, we found that OC, EC, sulfate and ammonium were significantly associated with ARDS. The observed effects remained even after adjusting for potentially confounding factors. This study suggests that PM10, PM2.5, and PM1, as well as chemical constituents from combustion and secondary aerosols might be important triggers of ARDS in Guangzhou.