Communication channels for receiving air quality alerts among adults in the United States.

Exposure to air pollution is associated with respiratory and cardiovascular effects, particularly among people with underlying respiratory and heart disease. It is therefore important for individuals with respiratory and heart disease to be aware of air quality. However, information about the most effective communication channels for disseminating air quality alerts is limited. We assessed communication channels used for receiving air quality alerts among U.S. adults using data from the summer 2020 wave of ConsumerStyles, a nationally representative survey of U.S. adults (n = 4053). We calculated weighted percentages of respondents who received air quality alerts from six communication channels and stratified by demographic and health characteristics. We calculated weighted prevalence ratios (PRs) adjusted for sex, age, race/ethnicity, and education to assess if communication channel use varied by presence of respiratory or heart disease. Sixty-four percent of U.S. adults had heard or read about air quality alerts. Television was the most commonly reported communication channel for receiving alerts (57.5%), followed by app on mobile phone or device (30.2%) and internet or social media (26.4%). Communication channels differed most prominently by age. The proportion of adults receiving alerts from specific communication channels did not notably vary by presence of heart disease. Adults with respiratory disease more often reported receiving alerts from their doctor's office than adults without respiratory disease (PR: 3.10, 95% confidence interval: 1.49, 6.45). These findings can be used by public health officials to increase awareness of poor air quality days and improve the reach of alerts to target populations.

Trends in Clinical Severity of Hospitalized Patients With Coronavirus Disease 2019-Premier Hospital Dataset, April 2020-April 2021.

BACKGROUND: Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking. METHODS: We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden. RESULTS: Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%-85%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%-25%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden. CONCLUSIONS: Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.

Patient-Provider Discussions About Strategies to Limit Air Pollution Exposures.

INTRODUCTION: Exposure to air pollution negatively affects respiratory and cardiovascular health. The objective of this study was to describe the extent to which health professionals report talking about how to limit exposure to air pollution during periods of poor air quality with their at-risk patients. METHODS: In 2015, a total of 1,751 health professionals completed an online survey and reported whether they talk with their patients about limiting their exposure to air pollution. In 2017, these data were analyzed to assess the frequency that health professionals in primary care, pediatrics, obstetrics/gynecology, and nursing reported talking about limiting air pollution exposure with patients who have respiratory or cardiovascular diseases, were aged ≤18 years, were aged ≥65 years, or were pregnant women. Frequencies of positive responses were assessed across categories of provider- and practice-level characteristics. RESULTS: Overall, 714 (41%) respondents reported ever talking with their patients about limiting their exposure to air pollution. Thirty-four percent and 16% of providers specifically reported talking with their patients with respiratory or cardiovascular disease diagnoses, respectively. Percentages of health professionals who reported talking with their patients about limiting air pollution exposure were highest among respondents in pediatrics (56%) and lowest among respondents in obstetrics/gynecology (0%). CONCLUSIONS: Despite the well-described health effects of exposure to air pollution, the majority of respondents did not report talking with their patients about limiting their exposure to air pollution. These findings reveal clear opportunities to improve awareness about strategies to limit air pollution exposure among sensitive groups of patients and their healthcare providers.

Air Quality Awareness Among U.S. Adults With Respiratory and Heart Disease.

INTRODUCTION: Poor air quality affects respiratory and cardiovascular health. Information about health risks associated with outdoor air quality is communicated to the public using air quality alerts. This study was conducted to assess associations of existing respiratory and heart disease with three aspects of air quality awareness: awareness of air quality alerts, discussing with a health professional strategies to reduce air pollution exposure, and avoiding busy roads to reduce air pollution exposure when walking, biking, or exercising outdoors. METHODS: During 2014-2016, a total of 12,599 U.S. adults participated in summer waves of the ConsumerStyles surveys and self-reported asthma, emphysema/chronic obstructive pulmonary disease, heart disease, and each aspect of air quality awareness. In 2017, associations between each health condition and air quality awareness were estimated using log binomial and multinomial regression. RESULTS: Overall, 49% of respondents were aware of air quality alerts, 3% discussed with a health professional strategies to reduce air pollution exposure, and 27% always/usually avoided busy roads to reduce air pollution exposure. Asthma was associated with increased prevalence of awareness of air quality alerts (prevalence ratio=1.11, 95% CI=1.04, 1.20), discussing with a health professional (prevalence ratio=4.88, 95% CI=3.74, 6.37), and always/usually avoiding busy roads to reduce air pollution exposure (prevalence ratio=1.13, 95% CI=1.01, 1.27). Heart disease was not associated with air quality awareness. CONCLUSIONS: Existing respiratory disease, but not heart disease, was associated with increased air quality awareness. These findings reveal important opportunities to raise awareness of air quality alerts and behavior changes aimed at reducing air pollution exposure among adults at risk of exacerbating respiratory and heart diseases.

Audiogram notches in noise-exposed workers.

OBJECTIVES: Diagnostic criteria for noise-induced hearing loss include the audiometric notch, yet no standardized definition exists. This study tested whether objective notch metrics could match the clinical judgments of an expert panel. DESIGN: A panel of occupational physicians, otolaryngologists, and audiologists reviewed audiograms of noise-exposed workers. In a two-sample process, the panel judged whether a notch was present and whether hearing loss had progressed in a notch pattern. Quantitative notch metrics were compared against expert decisions. RESULTS: At least five of six experts agreed about notch identification in 71 and 72% of the cases in the two samples, and agreement about notch progression was 61 and 67%. Notch depth and professional specialty appeared to affect notch judgments. Despite this variability, a notch metric showed excellent agreement with expert notch consensus in each sample (94.7 and 96.6%; kappa = 0.88 and 0.92). CONCLUSIONS: Audiogram notch metrics can agree with expert clinical consensus and assist in the surveillance of noise-exposed workers.

Incidence of asthma among aluminum workers.

Exposures to respiratory irritants encountered in aluminum smelters in Europe, Australia, and New Zealand have been suggested as the cause of "potroom asthma." However, there remains disagreement in North America regarding the existence of this entity. This study was designed to assess whether asthma occurs excessively among potroom workers and if so, delineate dose-response relationships for possible causal risk factors. The asthma incidence ratio between potroom and nonpotroom workers after adjusting for smoking was 1.40. Although bivariate analyses showed a relationship between asthma incidence and exposure to total fluoride, gaseous fluoride, particulate fluoride, sulfur dioxide, and smoking, only the effects of gaseous fluoride (relative risk [RR] = 5.1) and smoking (RR = 7.7) remained significant in a multivariate model. Potroom asthma appears to occur at the studied U.S. aluminum smelters at doses within regulatory guidelines.

Hearing loss in migrant agricultural workers.

BACKGROUND: Farmers have high rates of hearing loss, yet little is known about the hearing status of migrant agricultural workers. We performed a cross-sectional survey to assess the prevalence and impact of hearing loss in this population. METHODS: One hundred fifty migrant and seasonal agricultural workers were surveyed at a series of health fairs held at migrant camps. A bilingual questionnaire included items related to hearing loss risk factors and subjective hearing difficulties. Pure tone audiometry and tympanometry were performed in a mobile testing van. RESULTS: More than half the subjects had some degree of hearing loss at audiometric frequencies between 500 and 6,000 Hz, especially in the higher frequencies. Hispanic males in the sample had significantly greater prevalence of high-frequency hearing loss compared to adults in the national Hispanic Health and Nutrition Examination Survey (HHANES). More than 35% of respondents complained of subjective difficulty hearing or understanding speech, yet no workers reported use of hearing aids. Even after adjusting for measured hearing loss, Hispanic farm workers were more likely than their English- speaking counterparts to complain of difficulty hearing or understanding speech, suggesting that language barriers could worsen the impact of hearing loss. Risk factors for hearing loss included age and abnormal tympanometry. Occupational exposures to noise from tractors and other machinery as well as pesticides were frequently reported, while use of hearing protection was rare. CONCLUSION: Hearing loss is a significant and under-recognized problem in the migrant worker population. Further preventive and treatment efforts are warranted.