The mediating role of exhaled breath condensate metabolites in the effect of particulate matter on pulmonary function in schoolchildren: A crossover intervention study.

The role played by metabolites in exhaled breath condensate (EBC) in the effect of PM on schoolchildren's pulmonary function has received little attention. Accordingly, we examined whether metabolites in EBC mediated the effect of PM10, PM2.5, and PM1 on the pulmonary function of schoolchildren at a residential primary school who had received an air-cleaner cross-over intervention. Samples of EBC were collected from a total of 60 schoolchildren and subjected to metabolomics analysis. We found that the effect of PM on six pulmonary function indicators was mediated by the following nine lipid peroxidation-related and energy metabolism-related metabolites present in EBC: 4-hydroxynonenal, arachidoyl ethanolamide, dl-pyroglutamic acid, 5-deoxy-d-glucose, myristic acid, lauric acid, linoleic acid, l-proline, and palmitic acid. However, while all nine of these metabolites mediated the effects of PM on boys' pulmonary function, only 4-hydroxynonenal, arachidoyl ethanolamide, and dl-pyroglutamic acid mediated the effects of PM on girls' pulmonary function. Overall, our results show that (1) short-term exposure to PM affected the schoolchildren's pulmonary function by causing an imbalance between lipid peroxidation and glutathione-based antioxidant activity and by perturbing energy metabolism in respiratory system and (2) there was a sex-dependent antioxidant response to PM exposure, with boys being less resistant than girls.

Estimating elemental composition of personal PM2.5 by a modeling approach in two megacities, China.

Personal exposure to PM2.5, and the elemental composition therein, may vary greatly from ambient measurements at fixed monitoring sites. Here, we characterized the differences between personal, indoor, and outdoor concentrations of PM2.5-bound elements, and predicted personal exposures to 21 PM2.5-bound elements. Personal-indoor-outdoor PM2.5 filter samples were collected for five consecutive days across two seasons from 66 healthy non-smoking retired adults in Beijing (BJ) and Nanjing (NJ), China. Personal element-specific models were developed using liner mixed effects models and evaluated by R2 and root mean square error (RMSE). The mean (SD) concentrations of personal exposures varied by element and city, ranging from 2.5 (1.4) ng/m3 for Ni in BJ to 4271.2 (1614.8) ng/m3 for S in NJ. Personal exposures to PM2.5 and most elements were significantly correlated with both indoor and outdoor (except Ni in BJ) measurements, but frequently exceeded indoor levels and fell below outdoor levels. Indoor and outdoor PM2.5 elemental concentrations were the strongest determinants of most personal elemental exposures, with RM2 ranging from 0.074 to 0.975 for indoor and from 0.078 to 0.917 for outdoor levels, respectively. Home ventilation conditions (especially window opening behavior), time-activity patterns, meteorological factors, household characteristics, and season were also key factors influencing personal exposure levels. The final models accounted for 24.2 %-94.0 % (RMSE: 0.135-0.718) of the variance in personal PM2.5 elemental exposures. By incorporating these crucial determinants, the modeling approach used here can improve PM2.5-bound elemental exposure estimates and better associate compositionally dependent PM2.5 exposures and health risks.

Effects of subchronic exposure of perfluorooctane sulfonate on cognitive function of mice and its mechanism.

Perfluorooctane sulfonate (PFOS) is an emerging persistent organic pollutant, and its potential impact on cognitive function remains unclear. We adopted the C57BL/6J mouse model to investigate the effect of PFOS on cognitive function, as well as the underlying mechanisms. Subchronic exposure was performed by administering PFOS via drinking water for 6 months (at doses of 0, 0.2, and 2.0 mg/kg/day), starting from 10.5 months old. The object recognition ability was tested at 2, 4, and 6 months of exposure, and spatial learning and memory were assessed at endpoint. The apoptosis of neurons and astrocytes in the cortex and hippocampus was analyzed, as well as the potential apoptotic signaling pathways. Our results showed that exposure to PFOS for 6 months caused a decrease in object recognition ability and a decline in learning and spatial memory. PFOS selectively increased apoptosis in neurons of the cerebral cortex and specifically activated the endoplasmic reticulum stress PERK/CHOP signaling pathway. In conclusion, our results confirmed that subchronic exposure to PFOS can lead to cognitive impairment in mice, which might be closely associated with the specific activation of an endoplasmic reticulum stress-induced pro-apoptosis pathway in the cerebral cortex neurons.

Neglected Aspects of SARS-CoV-2 Aerosol Transmission in Bathrooms of Multistory and High-Rise Buildings - Beijing Municipality, China, October 2022.

What is already known about this topic?: There is a toilet flush-soil stack-floor drain pathway of aerosol transmission in multistory and high-rise buildings, but the influencing factors are not completely clear. What is added by this report?: The poor airtightness of the connecting parts of the floor drain, as well as pressure fluctuations in the sewage pipe during toilet flushing caused by blockage of the soil stack vent, may lead to the cross-floor transmission of viral aerosols through the soil stack and floor drains. What are the implications for public health practice?: In multistory and high-rise buildings, the bathroom floor drains should be kept sealed, and floor drain connecting parts should be airtight. Furthermore, the soil stack vent should not be blocked. In this way, the cross-floor transmission of viral aerosols can be effectively reduced.

Exploring the Transmission Path, Influencing Factors and Risk of Aerosol Transmission of SARS-CoV-2 at Xi'an Xianyang International Airport.

SARS-CoV-2 genetic sequence results collected from native COVID-19 cases who waited or saw relatives off at Xi'an Xianyang International Airport were highly consistent with the imported cases. In order to explore the routes of transmission and influencing factors that may cause the transmission of SARS-CoV-2 at the airport, a field simulation experiment of aerosol diffusion was adopted based on epidemiological survey data and a detailed field investigation of airport structure and ventilation. The results showed that the inbound passengers waited for approximately 3 h in the rest area on the first level of the international arrival area (Zone E). During the period, masks were removed for eating and drinking, resulting in the viral aerosols rising from the first level to the second level with hot air. After deplaning, the inbound passengers handled the relevant procedures and passed through the corridor on the second floor. The local side wall of the corridor adopted fan coil air conditioning, combined with fresh air supply and personnel walking, resulting in airflow flowing to Zone E. After merging with diffused air containing virus aerosol from the first floor, it continued to spread upward to the connected third-layer area. There was a local suspended ceiling on the top of the third floor, but it was approximately 4 m high and connected to the corridor from Terminal 2 to Terminal 3. When the virus aerosol diffused above the Terminal 2-Terminal 3 corridor, where the temperature was low and the air diffused downward, it could cause an infection risk for people passing through the corridor. In addition, the investigation found that the exhaust pipes of the nucleic acid sampling rooms at the international arrival corridor were directly discharged outdoors without treatment. Only one exhaust pipe and poor ventilation in the bathroom in Zone E had a risk of viral aerosol diffusion. Therefore, the international arrival area should be set up alone or separated from the other areas by hard isolation to avoid the existence of communication between different areas that could cause viral aerosols to diffuse with airflow. The toilet ventilation should be increased to avoid the accumulation of viral aerosols at high concentrations. The exhaust pipes of the toilet and the nucleic acid sampling rooms should be equipped with disinfection and efficient filtration devices, and high-altitude emission should be adopted to reduce the risk of virus aerosol diffusion.

Personal exposure to PM2.5 in different microenvironments and activities for retired adults in two megacities, China.

Microenvironmental concentrations and time-activity patterns influence personal exposure to fine particulate matter (PM2.5). However, the variations and contributions of PM2.5 exposures from various microenvironments (MEs) and activities remain unclear. In this study, gravimetrically corrected real-time personal PM2.5 measurements were collected during routine activities in different MEs from 66 non-smoking retired adults. Exposure data were collected for five consecutive days over two seasons in Nanjing (NJ) and Beijing (BJ), China. Measured PM2.5 concentrations varied substantially both between and within different MEs and activities. The highest average concentrations were observed in restaurants (NJ: mean 192 µg/m3, SD 242 µg/m3; BJ: mean 91 µg/m3, SD 79 µg/m3) and were associated with sources such as passive smoking and cooking emissions. Overall, PM2.5 concentrations in different MEs and activities were moderately to highly correlated with outdoor PM2.5 concentrations (Spearman's r = 0.51-0.97) except in restaurants and during passive smoking. The at-home ME contributed approximately 85 % of the total PM2.5 exposure, corresponding to the participants spending about 87 % of their time there. The majority of household exposures occurred during sleeping, cooking, and other home-based activities. Transportation accounted for <5 % of total exposure. Our results indicate that improving indoor air quality, especially residential indoors, is important to reduce personal exposure to PM2.5.

The influencing factors of health hazards of benzo[a]pyrene in cigarette mainstream smoke: The example of one brand in Beijing.

INTRODUCTION: The study focused on the influence of tar concentrations, smoking regimen, and smoking behavior, on benzo[a]pyrene (B[a]P) emission from cigarette mainstream smoke and related health hazards to determine the key factors influencing B[a]P reduction and protection of the smoker's health. METHODS: A locally popular brand of cigarettes in Beijing was selected with tar concentrations of 1, 3, 5, 8, 10, and 11 mg/cigarette. Two different machine smoking regimens, the Canada Intense (HCI) regimen and the International Organization for Standardization (ISO) regimen, were adopted to collect the cigarette mainstream smoke. The B[a]P emission concentrations were then measured by gas chromatography and mass spectrum. RESULTS: The average B[a]P emission was 8.14-17.6 ng/cigarette for the HCI regimen and 0.92-3.46 ng/cigarette for the ISO regimen. As expected, the tar concentrations and B[a]P emissions exhibited a positive relation in both the HCI and ISO regimens, the cancer risk and non-cancer risk increased with an increase in tar concentrations for both the ISO and HCI regimens, and the smoking behavior also affected the B[a]P emissions with a tendency of VB (ventilation blocking) > HVB (half ventilation blocking) > DP (deep puff), under the same smoking regimen. Under the same conditions, the cancer risk and non-cancer risk in men were 1.19 and 1.11 times, respectively, higher than in women. CONCLUSIONS: The smoking regimen influences the B[a]P emission relatively more than the cigarette tar concentration and smoking behavior. The cancer risk and non-cancer risk are higher in men than in women that possibly due to longer smoking duration and greater smoking intensity.

Independent and Interactive Effects of Environmental Conditions on Aerosolized Surrogate SARS-CoV-2 - Beijing, China, June to September 2020.

What is already known about this topic?: Environmental factors such as temperature and humidity play important roles in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via droplets/aerosols. What is added by this report?: Higher relative humidity (61%-80%), longer spreading time (120 min), and greater dispersal distance (1 m) significantly reduced SARS-CoV-2 pseudovirus loads. There was an interaction effect between relative humidity and spreading time. What are the implications for public health practice?: The findings contribute to our understanding of the impact of environmental factors on the transmission of SARS-CoV-2 via airborne droplets/aerosols.

Air Pollution Health Impact Monitoring and Health Risk Assessment Technology and Its Application - China, 2006-2019.

Air pollution is a significant risk factor contributing to the burden of disease in China. Health risk assessment and management are important to reduce the impact of air pollution on public health. To help formulate standardized health risk assessment techniques, a series of studies were conducted from 2006 to 2019. Through systematic review, study of molecular mechanisms, epidemiological investigation, and health effect monitoring, the overall project established a monitoring and evaluation indicator system, a comprehensive information platform, software for automatic data cleaning, and standardized health risk assessment techniques. Technical specifications have been issued by the National Health Commission for promoting health risk assessments across China. This paper introduces the project, the research approach, its main research accomplishments, innovations, and public health significance, and describes directions for further research.

SARS-CoV-2 Aerosol Transmission Through Vertical Sanitary Drains in High-Rise Buildings - Shenzhen, Guangdong Province, China, March 2022.

What is already known about this topic?: Aerosol transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via sanitary pipelines in high-rise buildings is possible, however, there is a lack of experimental evidence. What is added by this report?: The field simulation experiment confirmed the existence of a vertical aerosol transmission pathway from toilet flush-soil stack-floor drains without water seal. This report provided experimental evidence for vertical aerosol transmission of clustered outbreaks on 18 floors of a 33-story residential building. What are the implications for public health practice?: The water seal on floor drains is a necessary barrier to prevent the risk of vertical aerosol transmission of infectious disease pathogens in buildings. It is necessary not only to have a U-shaped trap in the drainage pipe, but also to be filled with water regularly.

Strengthening Community Defenses to Prevent and Control the Spread of COVID-19 in China.

In light of the severity of coronavirus disease (COVID-19) around the world, it is an arduous task for China to prevent COVID-19 from being imported from abroad and proliferating domestically. The community is the first and most effective line of defense and can effectively cut off the channels of spread of the epidemic. In order to reduce risks of COVID-19 transmission in the community, it is necessary to sort out the loopholes in risk and management, as well as investigate previous epidemic transmission events in the community.

Simulation Studies Provide Evidence of Aerosol Transmission of SARS-CoV-2 in a Multi-Story Building via Air Supply, Exhaust and Sanitary Pipelines.

A cross-layer non-vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in a quarantine hotel in Guangzhou, Guangdong Province, China in June 2021. To explore the cross-layer transmission path and influencing factors of viral aerosol, we set up different scenarios to carry out simulation experiments. The results showed that the air in the polluted room can enter the corridor by opening the door to take food and move out the garbage, then mix with the fresh air taken from the outside as part of the air supply of the central air conditioning system and re-enter into different rooms on the same floor leading to the same-layer transmission. In addition, flushing the toilet after defecation and urination will produce viral aerosol that pollutes rooms on different floors through the exhaust system and the vertical drainage pipe in the bathroom, resulting in cross-layer vertical transmission, also aggravating the transmission in different rooms on the same floor after mixing with the air of the room and entering the corridor to become part of the air supply, and meanwhile, continuing to increase the cross-layer transmission through the vertical drainage pipe. Therefore, the air conditioning and ventilation system of the quarantine hotel should be operated in full fresh air mode and close the return air; the exhaust volume of the bathroom should be greater than the fresh air volume. The exhaust pipe of the bathroom should be independently set and cannot be interconnected or connected in series. The riser of the sewage and drainage pipeline of the bathroom should maintain vertical to exhaust independently and cannot be arbitrarily changed to horizontal pipe assembly.

The association between urine elements and fasting glucose levels in a community-based elderly people in Beijing.

Epidemiological studies have demonstrated that various kinds of urinary element concentrations were different between healthy, prediabetes, and diabetes patients. Meanwhile, many studies have explored the relationship between element concentration and fasting blood glucose (FBG), but the association between joint exposure to co-existing elements and FBG level has not been well understood. The study explored the associations of joint exposure to co-existing urinary elements with FBG level in a cross-sectional design. 275 retired elderly people were recruited from Beijing, China. The questionnaire survey was conducted, and biological samples were collected. The generalized linear model (GLM) and two-phase Bayesian kernel machine regression (BKMR) model were used to perform in-depth association analysis between urinary elements and FBG. The GLM analysis showed that Zn, Sr, and Cd were significantly correlated with the FBG level, under control potential confounding factors. The BKMR analysis demonstrated 8 elements (Zn, Se, Fe, Cr, Ni, Cd, Mn, and Al) had a higher influence on FBG (posterior inclusion probabilities > 0.1). Further intensive analyses result of the BKMR model indicated that the overall estimated exposure of 8 elements was positively correlated with the FBG level and was statistically significant when all creatinine-adjusted element concentrations were at their 65th percentile. Meanwhile, the BKMR analysis showed that Cd and Zn had a statistically significant association with FBG levels when other co-existing elements were controlled at different levels (25th, 50th, or 75th percentile), respectively. The results of the GLM and BKMR model were inconsistent. The BKMR model could flexibly calculate the joint exposure to co-existing elements, evaluate the possible interaction effects and nonlinear correlations. The meaningful conclusions were found that it was difficult to get by traditional methods. This study will provide methodological reference and experimental evidence for the association between joint exposure to co-existing elements and FBG in elderly people.

Wearing time and respiratory volume affect the filtration efficiency of masks against aerosols at different sizes.

Face masks are critical in preventing the spread of respiratory infections including coronavirus disease 2019 (COVID-19). Different types of masks have distinct filtration efficiencies (FEs) with differential costs and supplies. Here we reported the impact of breathing volume and wearing time on the inward and outward FEs of four different mask types (N95, surgical, single-use, and cloth masks) against various sizes of aerosols. Specifically, 1) Mask type was an important factor affecting the FEs. The FEs of N95 and surgical mask were better than those of single-use mask and cloth mask; 2) As particle size decreased, the FEs tended to reduce. The trend was significantly observed in FEs of aerosols with particle size < 1 µ m ; 3) After wearing N95 and surgical masks for 0, 2, 4, and 8 h, their FEs (%) maintained from 95.75 ± 0.09 to 100 ± 0 range. While a significant decrease in FEs were noticed for single-use masks worn for 8 h and cloth masks worn >2 h under deep breathing (30 L/min); 4) Both inward and outward FEs of N95 and surgical masks were similar, while the outward FEs of single-use and cloth masks were higher than their inward FEs; 5) The FEs under deep breathing was significantly lower than normal breathing with aerosol particle size <1 µ m. In conclusion, our results revealed that masks have a critical role in preventing the spread of aerosol particles by filtering inhalation, and FEs significantly decreased with the increasing of respiratory volume and wearing time. Deep breathing may cause increasing humidity and hence decrease FEs by increasing the airflow pressure. With the increase of wearing time, the adsorption capacity of the filter material tends to be saturated, which may reduce FEs. Findings may be used to provide information for policies regarding the proper use of masks for general public in current and future pandemics.

The impacts of continuous improvements in air quality on mortality in Beijing: A longitudinal comparative study.

There has been increasing concern about the health effects of air pollution in China, and many measures have been implemented to control air pollution. To investigate the impacts of air quality improvement on mortality from non-accidental causes (NAD), cardiovascular disease (CD), and respiratory disease (RD), a longitudinal comparative study was conducted in Beijing. This study investigated the effects of air pollutants on outcomes across five periods (stages 1-5). Health effect data from stage1-5 (1990-2013) were obtained through a systematic literature search of studies published before 2021. Daily atmospheric pollutant, meteorological, and cause-specific death data were collected to determine the effects in stage 5 (2015-2017). Poisson generalized additive models were used to analyze the associations between short-term exposure to air pollutants and mortality. Random-effects meta-analysis models were used to estimate the pooled effects at each stage. The effects of changes in air quality were analyzed through a difference-in-differences approach. Our results indicate that the absolute change of concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter≤ 10 µm (PM10) and≤ 2.5 µm (PM2.5) decreased by up to 42%, 10%, 33%, and 15% (stage 5), respectively. The effects of SO2 on deaths from CD and RD decreased by up to 2.76% and 1.43% (stage 3). The effects of NO2 on mortality from NAD, CD, and RD decreased by up to 0.39%, 0.74%, and 0.37% (stage 5). The effects of PM10 on death decreased by up to 0.11% (stage 3). The effects of PM2.5 on deaths from CD and RD decreased by up to 0.33% and 0.13% (stage 5). The results indicate that continued improvements in air quality have reduced the acute impact of air pollutants on population health.

Regulatory Approaches and Implementation of Minimally Addictive Combusted Products.

INTRODUCTION: A joint meeting was held by the World Health Organization (WHO) and the Convention Secretariat of the WHO Framework Convention on Tobacco Control to examine the potential effects of a regulatory policy to reduce nicotine in cigarettes to minimally addictive levels. This paper reviews the feasibility of and approaches to implementing a nicotine product standard. METHODS: Prior WHO reports on this topic were consulted and a systematic review of the scientific literature was conducted. The paper was reviewed by the participants at the aforementioned meeting and their feedback was incorporated. RESULTS: The nicotine dose most likely to consistently reduce smoking behavior and dependence is ≤0.4 mg nicotine/g tobacco. An immediate rather than a gradual nicotine reduction approach appears to be more beneficial. Smokers are likely to seek nicotine from alternate sources (e.g., nicotine replacement therapies, e-cigarettes) or potentially, the illegal market. As such, the availability of alternative products, as well as strong policies against illegal markets, can potentially mitigate unintended consequences. An effectively reduced nicotine regulation must be imbedded in a comprehensive and strong tobacco control program that includes public education and surveillance. Barriers and challenges to implementing a nicotine product standard exist, particularly in low-capacity countries. CONCLUSIONS: Not all countries will have the capacity to implement a regulation to reduce nicotine in cigarettes (and preferably other combusted tobacco products) to minimally addictive levels. However, for the countries that choose to implement it, such a policy could potentially dramatically reduce the burden of tobacco use. IMPLICATIONS FOR TOBACCO REGULATORY SCIENCE: Article 9 of the Framework Convention on Tobacco Control provides signatory governments the authority to implement a product standard for reducing nicotine in tobacco products to minimally addictive levels. This product standard has the potential to result in a dramatic reduction in cigarette and other combusted tobacco use and therefore, smoking-caused mortality and morbidity. This article describes the growing scientific evidence to support nicotine regulation in cigarettes, potential regulatory approaches and describes the infrastructure and tobacco control policies needed to implement a reduced nicotine product standard.

Cardiovascular benefits of air purifier in patients with stable coronary artery disease: A randomized single-blind crossover study.

Background: Exposure to PM2.5 will accelerate the progression of cardiovascular diseases. Air purifier can reduce the PM2.5 exposure and theoretically alleviate the influence of PM2.5 on patients with stable coronary artery disease (SCAD). However, few studies of the protective effect showed significant results because the interferent effects of routine medication had not been taken into account. In order to explore the actual effect on patients with SCAD, we conducted a randomized single-blind crossover air purifier intervention trial. Method: Levels of PM2.5 exposure during intervention and cardiovascular indicators (inflammation, coagulation, plaque stability, and blood lipids) after intervention were detected, meanwhile the information of drug use was obtained by questionnaire. The kinds of drug used by more than 20% of the subjects were sorted out. And the influence of these drugs on cardiovascular indicators was summarized through literature review. Based on that, the drug use was included as a variable in linear mixed effects models that used to analyze the associations between PM2.5 exposure reduction by air purifier and cardiovascular indicators. Results: The result revealed that the interpretation contribution rate of drug use was more than that of PM2.5 exposure. The level of C-reactive protein significantly decreased by 20.93% (95%CI: 6.56%, 33.10%), 23.44% (95%CI: 2.77%, 39.39%) and 24.11% (95%CI: 4.21%, 39.69%) on lag1, lag01 and lag02 respectively, while the level of high-density lipoprotein cholesterol significantly increased by 5.10% (95%CI: 0.69%, 9.05%), 3.71% (95%CI: 0.92%, 6.60%) and 6.48% (95%CI: 2.58%, 10.24%) respectively on lag0, lag1 and lag01 associated with an interquartile range decrease of 22.51 µg/m3 in PM2.5 exposure. Conclusion: The study shows positive effects of air purifier on SCAD, and also provides methodological reference for future related research.

Research on the relationship between architectural features in northeast China and vertical aerosol transmission of COVID-19.

During the COVID-19 pandemic, many buildings in northeast China have had clusters of infected cases in the vertical layout. There is speculation that vertical aerosol transmission occurs. The houses in northeast China are airtight, and range hoods may be used for a long period of time when cooking. The pathway and factors influencing vertical aerosol transmission are worth studying. To elucidate a viral aerosol transmission pathway, we selected a multistory apartment and a high-rise building in Changchun city, Jilin province, China, to conduct an in-depth investigation and on-site simulation experiments. According to epidemiological investigation information on infected cases, building structures, drainage, ventilation, etc., we used fluorescent microspheres to simulate the behaviors of infected people, such as breathing and flushing the toilet after defecation, to discharge simulated viruses and track and monitor them. The field simulation experiment confirmed the transmission of fluorescent microsphere aerosols to other rooms in two types of buildings using a vertical aerosol transmission pathway of toilet flush-sewage pipe-floor drain without a water seal. Our study showed that, in the absence of a U-shaped trap or floor drain water seal whether in a multistory apartment or high-rise residential building, there is a transmission pathway of "excretion of virus through feces-toilet flushing-sewage pipe-floor drain without water seal," which will cause the vertical transmission of viral aerosol across floors during the COVID-19 pandemic. Moreover, the negative pressure generated by turning on the range hood when closing doors and windows increase aerosol transmission. Based on this negative pressure, prevention and control measures for residential buildings in northeast China during the COVID-19 pandemic were proposed.

Is hand-to-mouth contact the main pathway of children's soil and dust intake?

Children (n = 240) between the ages of 2 and 17 years were randomly selected from three cities in China. The total amount of soil and dust (SD) on their hands was measured and ranged from 3.50-187.39 mg (median = 19.49 mg). We screened for seven elements (Ce, V, Y, Al, Ba, Sc, and Mn), and Ce levels were used to calculate hand SD by variability and soil elements. The main factors affecting SD amount were location and age group, as identified using a conditional inference tree. Hand SD and the hand SD intake rate were highest in Gansu Province, followed by Guangdong and Hubei provinces, respectively. Hand SD and the hand SD intake rate were highest among children in primary school, followed by kindergarten and secondary school, respectively. The hand SD intake rate of the three typical areas was 11.9 mg/d, which was about 26.6% of the children's soil intake rate (44.8 mg/d), indicating that hand-to-mouth contact is not the main route for children's soil intake in the three areas of China.