Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution.

OBJECTIVES: To identify strategies and tactics communities use to translate research into environmental health action. METHODS: We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks. RESULTS: In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation. CONCLUSIONS: CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

On the Need for Human Studies of PM Exposure Activation of the NLRP3 Inflammasome.

Particulate matter air pollution is associated with blood inflammatory biomarkers, however, the biological pathways from exposure to periferal inflammation are not well understood. We propose that the NLRP3 inflammasome is likely stimulated by ambient particulate matter, as it is by some other particles and call for more research into this pathway.

Relationship between traffic-related air pollution and inflammation biomarkers using structural equation modeling.

BACKGROUND: Evidence suggests that exposure to traffic-related air pollution (TRAP) and social stressors can increase inflammation. Given that there are many different markers of TRAP exposure, socio-economic status (SES), and inflammation, analytical approaches can leverage multiple markers to better elucidate associations. In this study, we applied structural equation modeling (SEM) to assess the association between a TRAP construct and a SES construct with an inflammation construct. METHODS: This analysis was conducted as part of the Community Assessment of Freeway Exposure and Health (CAFEH; N = 408) study. Air pollution was characterized using a spatiotemporal model of particle number concentration (PNC) combined with individual participant time-activity adjustment (TAA). TAA-PNC and proximity to highways were considered for a construct of TRAP exposure. Participant demographics on education and income for an SES construct were assessed via questionnaires. Blood samples were analyzed for high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumor necrosis factor-α receptor II (TNFRII), which were considered for the construct for inflammation. We conducted SEM and compared our findings with those obtained using generalized linear models (GLM). RESULTS: Using GLM, TAA-PNC was associated with multiple inflammation biomarkers. An IQR (10,000 particles/cm3) increase of TAA-PNC was associated with a 14 % increase in hsCRP in the GLM. Using SEM, the association between the TRAP construct and the inflammation construct was twice as large as the associations with any individual inflammation biomarker. SES had an inverse association with inflammation in all models. Using SEM to estimate the indirect effects of SES on inflammation through the TRAP construct strengthened confidence in the association of TRAP with inflammation. CONCLUSION: Our TRAP construct resulted in stronger associations with a combined construct for inflammation than with individual biomarkers, reinforcing the value of statistical approaches that combine multiple, related exposures or outcomes. Our findings are consistent with inflammatory risk from TRAP exposure.

A randomized crossover trial of HEPA air filtration to reduce cardiovascular risk for near highway residents: Methods and approach.

BACKGROUND: Near highway residents are exposed to elevated levels of traffic-related air pollution (TRAP), including ultrafine particles, which are associated with adverse health effects. The efficacy of using in-home air filtration units that reduce exposure and potentially yield health benefits has not been tested in a randomized controlled trial. METHODS: We will conduct a randomized double-blind crossover trial of portable air filtration units for 200 adults 30 years and older who live in near-highway homes in Somerville, MA, USA. We will recruit participants from 172 households. The intervention periods will be one month of true or sham filtration, followed by a one-month wash out period and then a month of the alternate intervention. The primary health outcome will be systolic blood pressure (BP); secondary outcome measures will include diastolic and central BP, C-Reactive Protein (CRP) and D-dimer. Reasons for success or failure of the intervention will be evaluated in a subset of homes using indoor/outdoor monitoring for particulate pollution, personal monitoring, size and composition of particulate pollution, tracking of time spent in the room with the filter, and interviews for qualitative feedback. RESULTS: This trial has begun recruitment and is expected to take 2-3 years to be completed. Recruitment has been particularly challenging because of additional precautions required by the COVID-19 pandemic. DISCUSSION: This study has the potential to shed light on the value of using portable air filtration in homes close to highways to reduce exposure to TRAP and whether doing so has benefits for cardiovascular health.

Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action.

Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.

Effect of Reducing Ambient Traffic-Related Air Pollution on Blood Pressure: A Randomized Crossover Trial.

Exposure to traffic-related air pollution (TRAP) may contribute to increased prevalence of hypertension and elevated blood pressure (BP) for residents of near-highway neighborhoods. Relatively few studies have investigated the effects of reducing TRAP exposure on short-term changes in BP. We assessed whether reducing indoor TRAP concentrations by using stand-alone high-efficiency particulate arrestance (HEPA) filters and limiting infiltration through doors and windows effectively prevented acute (ie, over a span of hours) increases in BP. Using a 3-period crossover design, 77 participants were randomized to attend three 2-hour-long exposure sessions separated by 1-week washout periods. Each participant was exposed to high, medium, and low TRAP concentrations in a room near an interstate highway. Particle number concentrations, black carbon concentrations, and temperature were monitored continuously. Systolic BP (SBP), diastolic BP, and heart rate were measured every 10 minutes. Outcomes were analyzed with a linear mixed model. The primary outcome was the change in SBP from 20 minutes from the start of exposure. SBP increased with exposure duration, and the amount of increase was related to the magnitude of exposure. The mean change in SBP was 0.6 mm Hg for low exposure (mean particle number and black carbon concentrations, 2500 particles/cm3 and 149 ng/m3), 1.3 mm Hg for medium exposure (mean particle number and black carbon concentrations, 11 000 particles/cm3 and 409 ng/m3), and 2.8 mm Hg for high exposure (mean particle number and black carbon concentrations, 30 000 particles/cm3 and 826 ng/m3; linear trend P=0.019). There were no statistically significant differences in the secondary outcomes, diastolic BP, or heart rate. In conclusion, reducing indoor concentrations of TRAP was effective in preventing acute increases in SBP.

Two communities, one highway and the fight for clean air: the role of political history in shaping community engagement and environmental health research translation.

BACKGROUND: This paper explores strategies to engage community stakeholders in efforts to address the effects of traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately impacted by environmental threats including emissions generated by major roadways. METHODS: Qualitative instrumental case study design was employed to examine how community-level factors in two Massachusetts communities, the City of Somerville and Boston's Chinatown neighborhood, influence the translation of research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three data sources: key informant interviews, observations and document reviews. Thematic analysis was used. RESULTS: Findings indicate political history plays a significant role in shaping community action. In Somerville, community organizers worked with city and state officials, and embraced community development strategies to engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including housing and resident displacement resulting in more opposition to local municipal leadership. CONCLUSIONS: The ISF was helpful in informing the team's thinking related to systems and structures needed to translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing framework may serve as a useful approach for examining the dynamic relationship between science, community engagement and environmental research translation. Social workers and public health professionals can advance TRAP exposure mitigation by exploring the political and social context of communities and working to bridge research and community action.

CBPR Partnerships and Near-Roadway Pollution: A Promising Strategy to Influence the Translation of Research into Practice.

Community-based participatory research (CBPR) aims to engage those traditionally left out of the research process. Partnering with community stakeholders to design, plan, implement and disseminate research can facilitate translation into practice. Using qualitative research methods, we set out to explore the policy and practice implications of a CBPR partnership focused on reducing exposure to near-roadway pollution. Key Informant interviews (n = 13) were conducted with individuals from various entities (municipal, state and private) for whom partners to the Community Assessment of Freeway Exposure and Health (CAFEH) provided technical assistance between 2013 and 2017. The findings indicate community research partnerships may have the power to inform local planning efforts. Developers and planners who the partnership consulted indicated a greater awareness of the implications of near-roadway exposure. They also described making changes in their practice based on study findings. The CAFEH partnership has demonstrated active attention to translating knowledge can influence local planning and practice, albeit with some challenges.

Association of modeled long-term personal exposure to ultrafine particles with inflammatory and coagulation biomarkers.

BACKGROUND: Long-term exposure to fine particulate matter has been linked to cardiovascular disease and systemic inflammatory responses; however, evidence is limited regarding the effects of long-term exposure to ultrafine particulate matter (UFP, <100nm). We used a cross-sectional study design to examine the association of long-term exposure to near-highway UFP with measures of systemic inflammation and coagulation. METHODS: We analyzed blood samples from 408 individuals aged 40-91years living in three near-highway and three urban background areas in and near Boston, Massachusetts. We conducted mobile monitoring of particle number concentration (PNC) in each area, and used the data to develop and validate highly resolved spatiotemporal (hourly, 20m) PNC regression models. These models were linked with participant time-activity data to determine individual time-activity adjusted (TAA) annual average PNC exposures. Multivariable regression modeling and stratification were used to assess the association between TAA-PNC and single peripheral blood measures of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor-necrosis factor alpha receptor II (TNFRII) and fibrinogen. RESULTS: After adjusting for age, sex, education, body mass index, smoking and race/ethnicity, an interquartile-range (10,000particles/cm(3)) increase in TAA-PNC had a positive non-significant association with a 14.0% (95% CI: -4.6%, 36.2%) positive difference in hsCRP, an 8.9% (95% CI: -0.4%, 10.9%) positive difference in IL-6, and a 5.1% (95% CI: -0.4%, 10.9%) positive difference in TNFRII. Stratification by race/ethnicity revealed that TAA-PNC had larger effect estimates for all three inflammatory markers and was significantly associated with hsCRP and TNFRII in white non-Hispanic, but not East Asian participants. Fibrinogen had a negative non-significant association with TAA-PNC. CONCLUSIONS: Our findings suggest an association between annual average near-highway TAA-PNC and subclinical inflammatory markers of CVD risk.

A Randomized Cross-over Air Filtration Intervention Trial for Reducing Cardiovascular Health Risks in Residents of Public Housing near a Highway.

Exposure to traffic-generated ultrafine particles (UFP; particles <100 nm) is likely a risk factor for cardiovascular disease. We conducted a trial of high-efficiency particulate arrestance (HEPA) filtration in public housing near a highway. Twenty residents in 19 apartments living <200 m from the highway participated in a randomized, double-blind crossover trial. A HEPA filter unit and a particle counter (measuring particle number concentration (PNC), a proxy for UFP) were installed in living rooms. Participants were exposed to filtered air for 21 days and unfiltered air for 21 days. Blood samples were collected and blood pressure measured at days 0, 21 and 42 after a 12-hour fasting period. Plasma was analyzed for high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha-receptor II (TNF-RII) and fibrinogen. PNC reductions ranging from 21% to 68% were recorded in 15 of the apartments. We observed no significant differences in blood pressure or three of the four biomarkers (hsCRP, fibrinogen, and TNF-RII) measured in participants after 21-day exposure to HEPA-filtered air compared to measurements after 21-day exposure to sham-filtered air. In contrast, IL-6 concentrations were significantly higher following HEPA filtration (0.668 pg/mL; CI = 0.465-0.959) compared to sham filtration. Likewise, PNC adjusted for time activity were associated with increasing IL-6 in 14- and 21-day moving averages, and PNC was associated with decreasing blood pressure in Lags 0, 1 and 2, and in a 3-day moving average. These negative associations were unexpected and could be due to a combination of factors including exposure misclassification, unsuccessful randomization (i.e., IL-6 and use of anti-inflammatory medicines), or uncontrolled confounding. Studies with greater reduction in UFP levels and larger sample sizes are needed. There also needs to be more complete assessment of resident time activity and of outdoor vs. indoor source contributions to UFP exposure. HEPA filtration remains a promising, but not fully realized intervention.

Effect of time-activity adjustment on exposure assessment for traffic-related ultrafine particles.

Exposures to ultrafine particles (<100 nm, estimated as particle number concentration, PNC) differ from ambient concentrations because of the spatial and temporal variability of both PNC and people. Our goal was to evaluate the influence of time-activity adjustment on exposure assignment and associations with blood biomarkers for a near-highway population. A regression model based on mobile monitoring and spatial and temporal variables was used to generate hourly ambient residential PNC for a full year for a subset of participants (n=140) in the Community Assessment of Freeway Exposure and Health study. We modified the ambient estimates for each hour using personal estimates of hourly time spent in five micro-environments (inside home, outside home, at work, commuting, other) as well as particle infiltration. Time-activity adjusted (TAA)-PNC values differed from residential ambient annual average (RAA)-PNC, with lower exposures predicted for participants who spent more time away from home. Employment status and distance to highway had a differential effect on TAA-PNC. We found associations of RAA-PNC with high sensitivity C-reactive protein and Interleukin-6, although exposure-response functions were non-monotonic. TAA-PNC associations had larger effect estimates and linear exposure-response functions. Our findings suggest that time-activity adjustment improves exposure assessment for air pollutants that vary greatly in space and time.

Transferability and generalizability of regression models of ultrafine particles in urban neighborhoods in the Boston area.

Land use regression (LUR) models have been used to assess air pollutant exposure, but limited evidence exists on whether location-specific LUR models are applicable to other locations (transferability) or general models are applicable to smaller areas (generalizability). We tested transferability and generalizability of spatial-temporal LUR models of hourly particle number concentration (PNC) for Boston-area (MA, U.S.A.) urban neighborhoods near Interstate 93. Four neighborhood-specific regression models and one Boston-area model were developed from mobile monitoring measurements (34-46 days/neighborhood over one year each). Transferability was tested by applying each neighborhood-specific model to the other neighborhoods; generalizability was tested by applying the Boston-area model to each neighborhood. Both the transferability and generalizability of models were tested with and without neighborhood-specific calibration. Important PNC predictors (adjusted-R(2) = 0.24-0.43) included wind speed and direction, temperature, highway traffic volume, and distance from the highway edge. Direct model transferability was poor (R(2) < 0.17). Locally-calibrated transferred models (R(2) = 0.19-0.40) and the Boston-area model (adjusted-R(2) = 0.26, range: 0.13-0.30) performed similarly to neighborhood-specific models; however, some coefficients of locally calibrated transferred models were uninterpretable. Our results show that transferability of neighborhood-specific LUR models of hourly PNC was limited, but that a general model performed acceptably in multiple areas when calibrated with local data.

Developing Community-Level Policy and Practice to Reduce Traffic-Related Air Pollution Exposure.

The literature consistently shows associations of adverse cardiovascular and pulmonary outcomes with residential proximity to highways and major roadways. Air monitoring shows that traffic-related pollutants (TRAP) are elevated within 200-400 m of these roads. Community-level tactics for reducing exposure include the following: 1) HEPA filtration; 2) Appropriate air-intake locations; 3) Sound proofing, insulation and other features; 4) Land-use buffers; 5) Vegetation or wall barriers; 6) Street-side trees, hedges and vegetation; 7) Decking over highways; 8) Urban design including placement of buildings; 9) Garden and park locations; and 10) Active travel locations, including bicycling and walking paths. A multidisciplinary design charrette was held to test the feasibility of incorporating these tactics into near-highway housing and school developments that were in the planning stages. The resulting designs successfully utilized many of the protective tactics and also led to engagement with the designers and developers of the sites. There is a need to increase awareness of TRAP in terms of building design and urban planning.

Spatial and temporal differences in traffic-related air pollution in three urban neighborhoods near an interstate highway.

Relatively few studies have characterized differences in intra- and inter-neighborhood traffic-related air pollutant (TRAP) concentrations and distance-decay gradients in along an urban highway for the purposes of exposure assessment. The goal of this work was to determine the extent to which intra- and inter-neighborhood differences in TRAP concentrations can be explained by traffic and meteorology in three pairs of neighborhoods along Interstate 93 (I-93) in the metropolitan Boston area (USA). We measured distance-decay gradients of seven TRAPs (PNC, pPAH, NO, NOX, BC, CO, PM2.5) in near-highway (<400 m) and background areas (>1 km) in Somerville, Dorchester/South Boston, Chinatown and Malden to determine whether (1) spatial patterns in concentrations and inter-pollutant correlations differ between neighborhoods, and (2) variation within and between neighborhoods can be explained by traffic and meteorology. The neighborhoods ranged in area from 0.5 to 2.3 km2. Mobile monitoring was performed over the course of one year in each pair of neighborhoods (one pair of neighborhoods per year in three successive years; 35-47 days of monitoring in each neighborhood). Pollutant levels generally increased with highway proximity, consistent with I-93 being a major source of TRAP; however, the slope and extent of the distance-decay gradients varied by neighborhood as well as by pollutant, season and time of day. Correlations among pollutants differed between neighborhoods (e.g., ρ = 0.35-0.80 between PNC and NOX and ρ = 0.11-0.60 between PNC and BC) and were generally lower in Dorchester/South Boston than in the other neighborhoods. We found that the generalizability of near-road gradients and near-highway/urban background contrasts was limited for near-highway neighborhoods in a metropolitan area with substantial local street traffic. Our findings illustrate the importance of measuring gradients of multiple pollutants under different ambient conditions in individual near-highway neighborhoods for health studies involving inter-neighborhood comparisons.

An hourly regression model for ultrafine particles in a near-highway urban area.

Estimating ultrafine particle number concentrations (PNC) near highways for exposure assessment in chronic health studies requires models capable of capturing PNC spatial and temporal variations over the course of a full year. The objectives of this work were to describe the relationship between near-highway PNC and potential predictors, and to build and validate hourly log-linear regression models. PNC was measured near Interstate 93 (I-93) in Somerville, MA using a mobile monitoring platform driven for 234 h on 43 days between August 2009 and September 2010. Compared to urban background, PNC levels were consistently elevated within 100-200 m of I-93, with gradients impacted by meteorological and traffic conditions. Temporal and spatial variables including wind speed and direction, temperature, highway traffic, and distance to I-93 and major roads contributed significantly to the full regression model. Cross-validated model R(2) values ranged from 0.38 to 0.47, with higher values achieved (0.43 to 0.53) when short-duration PNC spikes were removed. The model predicts highest PNC near major roads and on cold days with low wind speeds. The model allows estimation of hourly ambient PNC at 20-m resolution in a near-highway neighborhood.

Highway proximity associated with cardiovascular disease risk: the influence of individual-level confounders and exposure misclassification.

BACKGROUND: Elevated cardiovascular disease risk has been reported with proximity to highways or busy roadways, but proximity measures can be challenging to interpret given potential confounders and exposure error. METHODS: We conducted a cross sectional analysis of plasma levels of C-Reactive Protein (hsCRP), Interleukin-6 (IL-6), Tumor Necrosis Factor alpha receptor II (TNF-RII) and fibrinogen with distance of residence to a highway in and around Boston, Massachusetts. Distance was assigned using ortho-photo corrected parcel matching, as well as less precise approaches such as simple parcel matching and geocoding addresses to street networks. We used a combined random and convenience sample of 260 adults >40 years old. We screened a large number of individual-level variables including some infrequently collected for assessment of highway proximity, and included a subset in our final regression models. We monitored ultrafine particle (UFP) levels in the study areas to help interpret proximity measures. RESULTS: Using the orthophoto corrected geocoding, in a fully adjusted model, hsCRP and IL-6 differed by distance category relative to urban background: 43% (-16%,141%) and 49% (6%,110%) increase for 0-50 m; 7% (-39%,45%) and 41% (6%,86%) for 50-150 m; 54% (-2%,142%) and 18% (-11%,57%) for 150-250 m, and 49% (-4%, 131%) and 42% (6%, 89%) for 250-450 m. There was little evidence for association for TNF-RII or fibrinogen. Ortho-photo corrected geocoding resulted in stronger associations than traditional methods which introduced differential misclassification. Restricted analysis found the effect of proximity on biomarkers was mostly downwind from the highway or upwind where there was considerable local street traffic, consistent with patterns of monitored UFP levels. CONCLUSION: We found associations between highway proximity and both hsCRP and IL-6, with non-monotonic patterns explained partly by individual-level factors and differences between proximity and UFP concentrations. Our analyses emphasize the importance of controlling for the risk of differential exposure misclassification from geocoding error.

Positional error and time-activity patterns in near-highway proximity studies: an exposure misclassification analysis.

BACKGROUND: The growing interest in research on the health effects of near-highway air pollutants requires an assessment of potential sources of error in exposure assignment techniques that rely on residential proximity to roadways. METHODS: We compared the amount of positional error in the geocoding process for three different data sources (parcels, TIGER and StreetMap USA) to a "gold standard" residential geocoding process that used ortho-photos, large multi-building parcel layouts or large multi-unit building floor plans. The potential effect of positional error for each geocoding method was assessed as part of a proximity to highway epidemiological study in the Boston area, using all participants with complete address information (N = 703). Hourly time-activity data for the most recent workday/weekday and non-workday/weekend were collected to examine time spent in five different micro-environments (inside of home, outside of home, school/work, travel on highway, and other). Analysis included examination of whether time-activity patterns were differentially distributed either by proximity to highway or across demographic groups. RESULTS: Median positional error was significantly higher in street network geocoding (StreetMap USA = 23 m; TIGER = 22 m) than parcel geocoding (8 m). When restricted to multi-building parcels and large multi-unit building parcels, all three geocoding methods had substantial positional error (parcels = 24 m; StreetMap USA = 28 m; TIGER = 37 m). Street network geocoding also differentially introduced greater amounts of positional error in the proximity to highway study in the 0-50 m proximity category. Time spent inside home on workdays/weekdays differed significantly by demographic variables (age, employment status, educational attainment, income and race). Time-activity patterns were also significantly different when stratified by proximity to highway, with those participants residing in the 0-50 m proximity category reporting significantly more time in the school/work micro-environment on workdays/weekdays than all other distance groups. CONCLUSIONS: These findings indicate the potential for both differential and non-differential exposure misclassification due to geocoding error and time-activity patterns in studies of highway proximity. We also propose a multi-stage manual correction process to minimize positional error. Additional research is needed in other populations and geographic settings.

A community participatory study of cardiovascular health and exposure to near-highway air pollution: study design and methods.

Current literature is insufficient to make causal inferences or establish dose-response relationships for traffic-related ultrafine particles (UFPs) and cardiovascular (CV) health. The Community Assessment of Freeway Exposure and Health (CAFEH) is a cross-sectional study of the relationship between UFP and biomarkers of CV risk. CAFEH uses a community-based participatory research framework that partners university researchers with community groups and residents. Our central hypothesis is that chronic exposure to UFP is associated with changes in biomarkers. The study enrolled more than 700 residents from three near-highway neighborhoods in the Boston metropolitan area in Massachusetts, USA. All participants completed an in-home questionnaire and a subset (440+) completed an additional supplemental questionnaire and provided biomarkers. Air pollution monitoring was conducted by a mobile laboratory equipped with fast-response instruments, at fixed sites, and inside the homes of selected study participants. We seek to develop improved estimates of UFP exposure by combining spatiotemporal models of ambient UFP with data on participant time-activity and housing characteristics. Exposure estimates will then be compared with biomarker levels to ascertain associations. This article describes our study design and methods and presents preliminary findings from east Somerville, one of the three study communities.

In-home air filtration for improving cardiovascular health: lessons from a CBPR study in public housing.

BACKGROUND: Particulate air pollution, including from motor vehicles, is associated with cardiovascular disease. OBJECTIVES: To describe lessons learned from installing air filtration units in public housing apartments next to a major highway. METHODS: We reviewed experience with recruitment, retention, and acceptance of the air filtration units. RESULTS: Recruitment and retention have been challenging, but similar to other studies in public housing. Equipment noise and overheated apartments during hot weather have been notable complaints from participants. In addition, we found that families with members with Alzheimer's or mental disability were less able to tolerate the equipment. CONCLUSIONS: For this research, the primary lesson is that working closely with each participant is important. A future public health program would need to address issues of noise and heat to make the intervention more acceptable to residents.