Contrasting Health Outcomes following a Severe Smoke Episode and Ambient Air Pollution in Early Life: Findings from an Australian Data Linkage Cohort Study of Hospital Utilization.

BACKGROUND: Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain. OBJECTIVE: Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care. METHODS: We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012-2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5µm (PM2.5) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient PM2.5 and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children. RESULTS: Prenatal exposure to fire-related PM2.5 was associated with ED presentations for allergies/skin rash [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.01, 1.76 per 240 µg/m3 increase]. Exposure in utero to ambient PM2.5 was associated with overall presentations (OR=1.18, 95% CI: 1.05, 1.33 per 1.4 µg/m3) and visits for infections (ED: OR=1.13, 95% CI: 0.98, 1.29; hospitalizations: OR=1.23, 95% CI: 1.00, 1.52). Exposure in infancy to fire-related PM2.5 compared to no/minimal exposure, was associated with ED presentations for respiratory (OR=1.37, 95% CI: 1.05, 1.80) and infectious conditions (any: OR=1.21, 95% CI: 0.98, 1.49; respiratory-related: OR=1.39, 95% CI: 1.05, 1.83). Early life exposure to ambient PM2.5 was associated with overall ED visits (OR=1.17, 95% CI: 1.05, 1.30 per 1.4 µg/m3 increase). DISCUSSION: Higher episodic and lower ambient concentrations of PM2.5 in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. https://doi.org/10.1289/EHP12238.

Connecting patients notified with hepatitis C to treatment (CONNECT Study): A randomized controlled trial of active case management by a health department to support primary care practitioners.

BACKGROUND: Despite subsidised access to direct-acting antivirals (DAAs), hepatitis C (HCV) treatment uptake in Australia is declining. Interventions are needed to link people living with HCV to care and treatment. We implemented and measured effectiveness of a state-wide, health department-led, enhanced case management through the primary care practitioner for all HCV notifications, aiming to encourage and support treatment commencement. METHODS: A randomised controlled trial compared enhanced case management, delivered by the health department to diagnosing clinicians, with standard of care using notifiable disease systems in Tasmania, Australia (2020-21). The intervention involved a nurse specialist contacting and providing support by telephone to primary care practitioners making an HCV notification. The primary outcome was the proportion of cases notified with chronic hepatitis C who commenced treatment within 12 weeks of notification. We allowed a 12-week extended follow-up period at the end of the study for participants with no outcomes. RESULTS: Eighty-five primary care practitioners randomised to the intervention and 86 to standard of care arms notified 111 and 115 HCV cases, respectively. The proportion of cases notified with chronic hepatitis (HCV RNA detected) commencing treatment within 12 weeks was similar between study arms (41% vs 33%; p=0·51) and after extended study follow-up (65% vs 48%; p=0·18). RNA test completion was higher in the intervention than in standard of care arm (89% vs. 78%; p=0·03), while completing pre-treatment workup for chronic patients (65% vs. 64%; p=0·93) was similar. CONCLUSION: This was the first prospective randomised study of the utility of immediate HCV notification follow-up of primary care practitioners to enhance treatment uptake using disease notification surveillance data. We demonstrated improvement in HCV RNA testing and trend toward better engagement in care, but no significant increase in treatment uptake.

The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based study.

Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods: In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings: A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55-74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation: TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding: Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.

Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life.

BACKGROUND: Due to climate change, landscape fires account for an increasing proportion of air pollution emissions, and their impacts on primary and pharmaceutical care are little understood. OBJECTIVES: To evaluate associations between exposure in two early life periods to severe levels of PM2.5 from a mine fire, background PM2.5, and primary and pharmaceutical care. METHODS: We linked records of births, general practitioner (GP) presentations and prescription dispensing for children born in the Latrobe Valley, Australia, 2012-2014, where a severe mine fire occurred in February-March 2014 in an area with otherwise low levels of ambient PM2.5. We assigned modelled exposure estimates for fire-related (cumulative over the fire and peak 24-hour average) and annual ambient PM2.5 to residential address. Associations with GP presentations and dispensing of prescribed medications in the first two years of life (exposure in utero) and in the two years post-fire (exposure in infancy) were estimated using two-pollutant quasi-Poisson regression models. RESULTS: Exposure in utero to fire-related PM2.5 was associated with an increase in systemic steroid dispensing (Cumulative: IRR = 1.11, 95%CI = 1.00-1.24 per 240 µg/m3; Peak: IRR = 1.15, 95%CI = 1.00-1.32 per 45 µg/m3), while exposure in infancy was associated with antibiotic dispensing (Cumulative: IRR = 1.05, 95%CI = 1.00-1.09; Peak: IRR = 1.06, 95%CI = 1.00-1.12). Exposure in infancy to ambient PM2.5, despite relatively low levels from a global perspective (Median = 6.1 µg/m3), was associated with an increase in antibiotics (IRR = 1.10, 95%CI = 1.01-1.19 per 1.4 µg/m3) and in GP presentations (IRR = 1.05, 95%CI = 1.00-1.11), independently from exposure to the fire. We also observed differences in associations between sexes with GP presentations (stronger in girls) and steroid skin cream dispensing (stronger in boys). DISCUSSION: Severe medium-term concentrations of PM2.5 were linked with increased pharmaceutical treatment for infections, while chronic low levels were associated with increased prescriptions dispensed for infections and primary care usage. Our findings also indicated differences between sexes.

Randomised controlled trial of active case management to link hepatitis C notifications to treatment in Tasmania, Australia: a study protocol.

INTRODUCTION: By subsidising access to direct acting antivirals (DAAs) for all people living with hepatitis C (HCV) in 2016, Australia is positioned to eliminate HCV as a public health threat. However, uptake of DAAs has declined over recent years and new initiatives are needed to engage people living with HCV in care. Active follow-up of HCV notifications by the health department to the notifying general practitioner (GP) may increase treatment uptake. In this study, we explore the impact of using hepatitis C notifications systems to engage diagnosing GPs and improve patient access to treatment. METHODS AND ANALYSIS: This study is a randomised controlled trial comparing enhanced case management of HCV notifications with standard of care. The intervention includes phone calls from a department of health (DoH) specialist HCV nurse to notifying GPs and offering HCV management support. The level of support requested by the GP was graded in complexity: level 1: HCV information only; level 2: follow-up testing advice; level 3: prescription support including linkage to specialist clinicians and level 4: direct patient contact. The study population includes all GPs in Tasmania who notified HCV diagnosis to the DoH between September 2020 and December 2021. The primary outcome is proportion of HCV cases who initiate DAAs after 12 weeks of HCV notification to the health department. Secondary outcomes are proportion of HCV notifications that complete HCV RNA testing, treatment workup and treatment completion. Multiple logistic regression modelling will explore factors associated with the primary and secondary outcomes. The sample size required to detect a significant difference for the primary outcome is 85 GPs in each arm with a two-sided alpha of 0.05% and 80% power. ETHICS AND DISSEMINATION: The study was approved by University of Tasmania's Human Research Ethics Committee (Protocol ID: 18418) on 17 December 2019. Results of the project will be presented in scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04510246. TRIAL PROGRESSION: The study commenced recruitment in September 2020 and end of study expected December 2021.

Associations between respiratory and vascular function in early childhood.

BACKGROUND AND OBJECTIVE: The link between respiratory and vascular health is well documented in adult populations. Impaired lung function is consistently associated with thicker arteries and higher incidence of cardiovascular disease. However, there are limited data on this relationship in young children and the studies that exist have focussed on populations at high risk of cardiorespiratory morbidity. We determined if an association exists between respiratory and cardiovascular function in young children and, if so, whether it is confounded by known cardiorespiratory risk factors. METHODS: Respiratory and vascular data from a prospective cohort study established to evaluate the health implications 3 years after coal mine fire smoke exposure in children aged 3-5 years were used. Respiratory function was measured using the forced oscillation technique and included resistance at 5 Hz (R5 ), reactance at 5 Hz (X5 ) and area under the reactance curve (AX). Vascular health was measured by carotid intima-media thickness (ultrasound) and pulse wave velocity (arterial tonometry). Regression analyses were used to examine the relationship between the respiratory Z-scores and cardiovascular measures. Subsequent analyses were adjusted for potential confounding by maternal smoking during pregnancy, maternal education and exposure to fine particulate matter <2.5 µm in aerodynamic diameter (PM2.5 ). RESULTS: Peripheral lung function (X5 and AX), but not respiratory system resistance (R5 ), was associated with vascular function. Adjustment for maternal smoking, maternal education and early life exposure to PM2.5 had minimal effect on these associations. CONCLUSION: These observations suggest that peripheral lung stiffness is associated with vascular stiffness and that this relationship is established early in life.

Why Tasmanian retailers stop selling tobacco and implications for tobacco control.

INTRODUCTION: The retail availability of tobacco is at odds with the health harms associated with tobacco smoking and undermines tobacco control efforts. Evidence suggests ease of access to tobacco through retail outlets contributes to smoking prevalence. OBJECTIVE: This study aimed to understand why retailers stop selling tobacco and explore possible implications for tobacco control. METHODS: The Tobacco Licensing Database maintained by the Department of Health Tasmania was used to identify and recruit past retailers who no longer held licences. Semistructured interviews were conducted to explore business demographics and the reasons they stopped selling tobacco. Interview findings were analysed using a thematic framework. RESULTS: Twenty former tobacco retailers participated, representing all business types except specialist tobacconists and large supermarkets. Retailers gave multiple reasons for ending tobacco sales, related to business considerations, security, tobacco regulations, ethics and health. Most often, the decision was business-related; health or ethical considerations were rarely a factor. Most retailers felt they played no role in mitigating tobacco-related harm. CONCLUSIONS: This study provides insights into factors that make tobacco sales unattractive or unfeasible for low-volume outlets and may inform supply-focused tobacco control policy. A campaign that emphasises the possible business benefits of ending tobacco sales in favour of other higher-margin products may support retailers to transition away from tobacco sales. The regulatory obligations of selling tobacco are disincentives and create a less favourable retail environment.

Respiratory and atopic conditions in children two to four years after the 2014 Hazelwood coalmine fire.

OBJECTIVE: To evaluate associations between exposure during early life to mine fire smoke and parent-reported indicators of respiratory and atopic illness 2-4 years later. DESIGN, SETTING: The Hazelwood coalmine fire exposed a regional Australian community to markedly increased air pollution during February - March 2014. During June 2016 - October 2018 we conducted a prospective cohort study of children from the Latrobe Valley. PARTICIPANTS: Seventy-nine children exposed to smoke in utero, 81 exposed during early childhood (0-2 years of age), and 129 children conceived after the fire (ie, unexposed). EXPOSURE: Individualised mean daily and peak 24-hour fire-attributable fine particulate matter (PM2.5 ) exposure during the fire period, based on modelled air quality and time-activity data. MAIN OUTCOME MEASURES: Parent-reported symptoms, medications use, and contacts with medical professionals, collected in monthly online diaries for 29 months, 2-4 years after the fire. RESULTS: In the in utero exposure analysis (2678 monthly diaries for 160 children exposed in utero or unexposed), each 10 µg/m3 increase in mean daily PM2.5 exposure was associated with increased reports of runny nose/cough (relative risk [RR], 1.09; 95% CI, 1.02-1.17), wheeze (RR, 1.56; 95% CI, 1.18-2.07), seeking health professional advice (RR, 1.17; 95% CI 1.06-1.29), and doctor diagnoses of upper respiratory tract infections, cold or flu (RR, 1.35; 95% CI, 1.14-1.60). Associations with peak 24-hour PM2.5 exposure were similar. In the early childhood exposure analysis (3290 diaries for 210 children exposed during early childhood, or unexposed), each 100 µg/m3 increase in peak 24-hour PM2.5 exposure was associated with increased use of asthma inhalers (RR, 1.26; 95% CI, 1.01-1.58). CONCLUSIONS: Exposure to mine fire smoke in utero was associated with increased reports by parents of respiratory infections and wheeze in their children 2-4 years later.

Adverse birth outcomes in Victoria, Australia in association with maternal exposure to low levels of ambient air pollution.

BACKGROUND: The relationship between maternal exposure to air pollution and birth outcomes is not well characterised where ambient air pollution is relatively low. OBJECTIVES: We aimed to explore the association between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and a range of birth outcomes in Victoria, Australia. Secondary aims were to explore whether obstetric conditions, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy, were effect modifiers in observed relationships. METHODS: We included all singleton births occurring in Victoria, Australia from 1st March 2012 to 31st December 2015 using routinely collected government data. Outcomes included birth weight, small for gestational age (SGA), term low birth weight (tLBW), large for gestational age (LGA), and spontaneous preterm birth (sPTB). We estimated exposure to annual ambient NO2 and PM2.5 concentrations, assigned to maternal residence at time of birth. Confounders included maternal, meteorological and temporal variables. Multivariable linear regression and log-binomial regression were used for continuous and dichotomous outcomes, respectively. RESULTS: There were 285,594 births during the study period. Average NO2 exposure was 6.0 parts per billion (ppb, median 5.6; interquartile range (IQR) 3.9) and PM2.5 was 6.9 µg/m3 (median 7.1, IQR 1.3). IQR increases in ambient NO2 and PM2.5 were associated with fetal growth restriction, including decrements in birth weight (NO2 ß -22.8 g; 95%CI -26.0, -19.7; PM2.5 ß -14.8 g; 95%CI -17.4, -12.2) and increased risk of SGA (NO2 RR 1.08; 95%CI 1.06, 1.10; PM2.5 RR 1.05; 95%CI 1.04, 1.07) and tLBW (NO2 RR 1.06; 95%CI 1.01, 1.10; PM2.5 RR 1.04; 95%CI 1.03, 1.08). Women with GDM and hypertensive disorders of pregnancy had greater decrements in birth weight in association with pollutant exposure. DISCUSSION: In this exploratory study using an annual metric of exposure, maternal exposure to low-level ambient air pollution was associated with fetal growth restriction, which carries substantial public health implications.

Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia.

The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO2 and PM2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM2.5 (1.3 µg/m3) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.

Roof cavity dust as an exposure proxy for extreme air pollution events.

Understanding exposure to air pollution during extreme events such as fire emergencies is critical for assessing their potential health impacts. However, air pollution emergencies often affect places without a network of air quality monitoring and characterising exposure retrospectively is methodologically challenging due to the complex behaviour of smoke and other air pollutants. Here we test the potential of roof cavity (attic) dust to act as a robust household-level exposure proxy, using a major air pollution event associated with a coal mine fire in the Latrobe Valley, Australia, as an illustrative study. To assess the relationship between roof cavity dust composition and mine fire exposure, we analysed the elemental and polycyclic aromatic hydrocarbon composition of roof cavity dust (<150µm) from 39 homes along a gradient of exposure to the mine fire plume. These homes were grouped into 12 zones along this exposure gradient: eight zones across Morwell, where mine fire impacts were greatest, and four in other Latrobe Valley towns at increasing distance from the fire. We identified two elements-barium and magnesium-as 'chemical markers' that show a clear and theoretically grounded relationship with the brown coal mine fire plume exposure. This relationship is robust to the influence of plausible confounders and contrasts with other, non-mine fire related elements, which showed distinct and varied distributional patterns. We conclude that targeted components of roof cavity dust can be a useful empirical marker of household exposure to severe air pollution events and their use could support epidemiological studies by providing spatially-resolved exposure estimates post-event.

Early life exposure to coal mine fire smoke emissions and altered lung function in young children.

BACKGROUND AND OBJECTIVE: Long-term respiratory risks following exposure to relatively short periods of poor air quality early in life are unknown. We aimed to evaluate the association between exposure to a 6-week episode of air pollution from a coal mine fire in children aged <2 years, and their lung function 3 years after the fire. METHODS: We conducted a prospective cohort study. Individual exposure to 24-h average and peak concentrations of particulate matter with an aerodynamic diameter <2.5 µm in diameter (PM2.5 ) during the fire were estimated using dispersion and chemical transport modelling. Lung function was measured using the forced oscillation technique (FOT), generating standardized Z-scores for resistance and reactance at a frequency of 5 Hz (Rrs5 and Xrs5 ), and area under the reactance curve (AX). We used linear regression models to assess the associations between PM2.5 exposure and lung function, adjusted for potential confounders. RESULTS: Of the 203 infants originally recruited, 84 aged 4.3 ± 0.5 years completed FOT testing. Median (interquartile range, IQR) for average and peak PM2.5 were 7.9 (6.8-16.8) and 103.4 (60.6-150.7) µg/m3 , respectively. The mean ± SD Z-scores for Rrs5 , Xrs5 and AX were 0.56 ± 0.80, -0.76 ± 0.88 and 0.72 ± 0.92, respectively. After adjustment for potential confounders including maternal smoking during pregnancy, a 10 µg/m3 increase in average PM2.5 was significantly associated with worsening AX (ß-coefficient: 0.260; 95% CI: 0.019, 0.502), while the association between a 100-µg/m3 increase in peak PM2.5 and AX was borderline (0.166; 95% CI: -0.002, 0.334). CONCLUSION: Infant exposure to coal mine fire emissions could be associated with long-term impairment of lung reactance.

Maternal exposure to fine particulate matter from a large coal mine fire is associated with gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: In 2014, the Hazelwood coal mine fire was an unprecedented event that resulted in a six-week period of poor air quality in the Latrobe Valley in regional Australia. We aimed to determine whether maternal exposure to fine particulate matter in coal mine fire smoke was associated with selected obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy and abnormal placentation. METHODS: We defined a complete cohort of pregnant women with births >20 weeks in the Latrobe Valley from March 1, 2012-Dec 31, 2015 utilising administrative perinatal data. Average and peak fine particulate matter (PM2.5) was assigned to residential address at delivery using a chemical transport model. Maternal, meteorological and temporal variables were included in final log-binomial regression models. RESULTS: 3612 singleton pregnancies were included in the analysis; 766 were exposed to the smoke event. Average maternal PM2.5 exposure was 4.4 µg/m3 (SD 7.7; IQR 2.12). Average peak PM2.5 exposure was 44.9 µg/m3 (SD 57.1; IQR 35.0). An interquartile range increase in peak PM2.5 was associated with a 16% increased likelihood of gestational diabetes mellitus (95%CI 1.09, 1.22; <0.0001). Whereas, an interquartile range increase in average PM2.5 was associated with a 7% increased likelihood of gestational diabetes mellitus (95%CI 1.03, 1.10; <0.0001). Second trimester exposure was of critical importance. No association for hypertensive disorders or abnormal placentation was observed. CONCLUSION: this is the first study to examine obstetric complications relating to a discrete smoke event. These findings may guide the public health response to future similar events.

Early life exposure to coal mine fire and tobacco smoke affect subclinical vascular function.

OBJECTIVE: To evaluate whether vascular health in young children was associated with exposure to a 6-week episode of coal mine fire smoke or environmental tobacco smoke (ETS) in a retrospective cohort study. METHODS: Three years after a coal mine fire in Victoria, Australia, we investigated the vascular health of children either in utero (n=75) or aged <2 years (postnatal exposure, n=96) at the time of the fire. The outcomes were the carotid intima-media thickness (IMT) and pulse wave velocity (PWV). The mean and peak daily particulate matter <2.5 µm in diameter (PM2.5) exposures were estimated based on their daily locations throughout the fire period. Multivariable linear regression models were used to test for associations between the fire-related PM2.5 and outcomes adjusted for relevant covariates including ETS. RESULTS: In the postnatal-exposure group, each 10 µg/m³ increase in mean PM2.5 level was independently positively associated with PWV (ß=0.116, p=0.028). When these two groups were combined, there was an association between mean PM2.5 and increased PWV in those children who had ETS exposure (ß=0.148, p=0.033) or whose mothers smoked (ß=0.151, p=0.011), but not in those not exposed to ETS or maternal smoking. CONCLUSIONS: Three years after a coal mine fire, infants aged up to 2 years at the time of exposure have increases in vascular stiffness. Although no adverse effects were observed in the in uterus exposure group, further follow-up study is needed to elucidate the long-term effects of coal mine fire smoke exposure.

The Contribution of Geogenic Particulate Matter to Lung Disease in Indigenous Children.

Indigenous children have much higher rates of ear and lung disease than non-Indigenous children, which may be related to exposure to high levels of geogenic (earth-derived) particulate matter (PM). The aim of this study was to assess the relationship between dust levels and health in Indigenous children in Western Australia (W.A.). Data were from a population-based sample of 1077 Indigenous children living in 66 remote communities of W.A. (>2,000,000 km2), with information on health outcomes derived from carer reports and hospitalisation records. Associations between dust levels and health outcomes were assessed by multivariate logistic regression in a multi-level framework. We assessed the effect of exposure to community sampled PM on epithelial cell (NuLi-1) responses to non-typeable Haemophilus influenzae (NTHi) in vitro. High dust levels were associated with increased odds of hospitalisation for upper (OR 1.77 95% CI [1.02-3.06]) and lower (OR 1.99 95% CI [1.08-3.68]) respiratory tract infections and ear disease (OR 3.06 95% CI [1.20-7.80]). Exposure to PM enhanced NTHi adhesion and invasion of epithelial cells and impaired IL-8 production. Exposure to geogenic PM may be contributing to the poor respiratory health of disadvantaged communities in arid environments where geogenic PM levels are high.

Maternal exposure to fine particulate matter from a coal mine fire and birth outcomes in Victoria, Australia.

INTRODUCTION: The Hazelwood coal mine fire was an unprecedented event in Australian history that resulted in the surrounding towns in regional Victoria being covered in plumes of smoke and ash for six weeks in 2014. Evidence concerning adverse reproductive impacts associated with maternal exposure to ambient air pollution is expanding. Gaps remain regarding the relative impact of acute changes in outdoor air quality lasting days to months, such as that resulting from coal mine fires. METHODS: Routinely collected perinatal data was used to define a complete cohort of singleton babies born within the affected region. Maternal average, and peak, fine particulate matter (PM2.5) was assigned to residential address at time of delivery using a chemical transport model. Maternal, infant, meteorological and temporal variables were adjusted for in final linear and log-binomial regression models. RESULTS: There were a total of 3591 singleton livebirths during the study period; 763 of which were in utero during the coal mine fire. Average PM2.5 exposure was 4.4 µg/m3 (median 1.9; IQR 2.1 µg/m3) and peak was 45.0 µg/m3 (median 30.4; IQR 35.1 µg/m3). There was no association between coal mine fire-attributable PM2.5 and fetal growth or gestational maturity outcomes. However, there was weak evidence that gestational diabetes mellitus was an effect modifier in the relationship between maternal PM2.5 exposure and birth weight. Babies born to exposed gestational diabetic mothers were 97 g heavier per 10 µg/m3 increase in average PM2.5 exposure (95%CI 74, 120 g). No association was observed among mothers without gestational diabetes. CONCLUSION: Maternal exposure to fine particulate matter resulting from the 2014 Hazelwood coal mine fire did not appear to adversely effect fetal maturity. However, there was weak evidence of a trophic response among babies born to exposed mothers with gestational diabetes, a possible susceptibility that requires further exploration.

Maternal exposure to short-to medium-term outdoor air pollution and obstetric and neonatal outcomes: A systematic review.

BACKGROUND: Little is known about the impacts of maternal exposure to acute episodes of outdoor air pollution, such as that resulting from wildfires, on obstetric and neonatal outcomes. This systematic review aims to synthesise the existing literature exploring the relationship between maternal exposure to short-to medium-term changes in outdoor air quality and obstetric and neonatal outcomes. METHODS: A systematic search of peer-reviewed articles using PubMed, Cochrane Library, EMBASE, ScienceDirect, Web of Science, ProQuest, GreenFILE and Scopus was conducted in January 2018 using selected search terms. Quality of included studies were assessed using the Newcastle Ottawa Scale. RESULTS: Eleven studies were included; eight assessed the impact of maternal exposure to air pollution exacerbation events, such as wildfires, oil well fires and volcanic eruptions, and three assessed the impact of improvement events, such as the 2018 Beijing Olympics and closure of industrial activities, on obstetric and neonatal outcomes. Studies were highly heterogenous in methodology. Six studies found a significant association between acute changes in air quality and markers of fetal growth restriction, while two did not. Three studies found an adverse association between acute changes in air quality and markers of gestational maturity, and one did not. CONCLUSION: Overall, there is some evidence that maternal exposure to acute changes in air quality of short-to medium-term duration increases the risk of fetal growth restriction and preterm birth. The relationship for other adverse obstetric or neonatal outcomes is less clear.

The retail availability of tobacco in Tasmania: evidence for a socio-economic and geographical gradient.

OBJECTIVES: To describe the retail availability of tobacco and to examine the association between tobacco outlet density and area-level remoteness and socio-economic status classification in Tasmania. DESIGN: Ecological cross-sectional study; analysis of tobacco retail outlet data collected by the Department of Health and Human Services (Tasmania) according to area-level (Statistical Areas Level 2) remoteness (defined by the Remoteness Structure of the Australian Statistical Geographical Standard) and socio-economic status (defined by the 2011 Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage). MAIN OUTCOME MEASURE: Tobacco retail outlet density per 1000 residents. RESULTS: On 31 December 2016, there were 1.54 tobacco retail outlets per 1000 persons. The density of outlets was 79% greater in suburbs or towns in outer regional, remote and very remote Tasmania than in inner regional Tasmania (rate ratio [RR], 1.79; 95% confidence Interval [CI], 1.29-2.50; P < 0.001). Suburbs or towns in Tasmania with the greatest socio-economic disadvantage had more than twice the number of tobacco outlets per 1000 people as areas of least disadvantage (RR, 2.30; 95% CI, 1.32-4.21; P = 0.014). CONCLUSIONS: A disproportionate concentration of tobacco retail outlets in regional and remote Tasmania and in areas of lowest socio-economic status is evident. Our findings are consistent with those of analyses in New South Wales and Western Australia. Progressive tobacco retail restrictions have been proposed as the next frontier in tobacco control. However, the intended and unintended consequences of such policies need to be investigated, particularly for socio-economically deprived and rural areas.

The pyrohealth transition: how combustion emissions have shaped health through human history.

Air pollution from landscape fires, domestic fires and fossil fuel combustion is recognized as the single most important global environmental risk factor for human mortality and is associated with a global burden of disease almost as large as that of tobacco smoking. The shift from a reliance on biomass to fossil fuels for powering economies, broadly described as the pyric transition, frames key patterns in human fire usage and landscape fire activity. These have produced distinct patters of human exposure to air pollution associated with the Agricultural and Industrial Revolutions and post-industrial the Earth global system-wide changes increasingly known as the Anthropocene. Changes in patterns of human fertility, mortality and morbidity associated with economic development have been previously described in terms of demographic, epidemiological and nutrition transitions, yet these frameworks have not explicitly considered the direct consequences of combustion emissions for human health. To address this gap, we propose a pyrohealth transition and use data from the Global Burden of Disease (GBD) collaboration to compare direct mortality impacts of emissions from landscape fires, domestic fires, fossil fuel combustion and the global epidemic of tobacco smoking. Improving human health and reducing the environmental impacts on the Earth system will require a considerable reduction in biomass and fossil fuel combustion.This article is part of the themed issue 'The interaction of fire and mankind'.