Women's experiences of childbirth during the COVID-19 pandemic in Lithuania.

INTRODUCTION: Childbirth experiences depend on environmental factors, the provision of qualified medical and non-medical care, and the woman's psychological well-being. Stress experienced during pregnancy and childbirth affects a woman's psychological well-being. The aim of this study was to determine the care of women who gave birth during the COVID-19 pandemic in Lithuania. METHODS: This qualitative study used an interview method to reveal women's childbirth experiences during and before the pandemic in Lithuania. The data obtained during the interview were analyzed using qualitative content analysis. Interviews were taken from 15 women who gave birth at least twice, i.e. the first time until March 2020 (but not earlier than March 2019) and gave birth again during the COVID-19 pandemic (March 2020 - January 2021). RESULTS: A total of 15 women participanted in the interviews. The experience of childbirth before the COVID-19 pandemic was seen as largely positive by women, but childbirth during the COVID-19 pandemic was mentioned as more complex and negative because of the challenges posed by the pandemic, but easier for other reasons not affected by the pandemic. The results of our study show that a higher proportion of women were satisfied with delivery care in hospitals, were happy, and praised the work of midwives and other staff, which mainly contributed to a positive experience. CONCLUSIONS: The COVID-19 pandemic posed particular challenges to women's childbirth experiences, and not enough attention was paid to mental health. The stress that was exacerbated during the pandemic period had a profound impact on the pregnant woman in Lithuania.

Association between greenery and health indicators in urban patients with symptomatic heart failure: a retrospective cohort study in Lithuania.

Urban green spaces benefit physical, mental health, and reduses the risk of cardiovascular disease. A study in Kaunas, Lithuania collected health data from 100 patients with symptomatic heart failure (HF) during 2006-2009. Residential greenness was measured by the normalized difference vegetation index (NDVI). We assessed the impact of greenness on health indicators and on changes in health markers after 6 months. Higher greenness levels based on the NDVI 1-km radius were related to higher mean values of heart rate (HR) and ejection fraction and lower left ventricular (LV) end-diastolic diameter index (LV EDDI), LV end-systolic volume (ESV), left atrium size (LAS), and right atrium size (RAS) at baseline. After 6 months, a decrease in DBP and HR and an improvement in spiroergometric parameters were associated with exposure to high levels of greenness. The long-term rehabilitation group experienced significant changes in spiroergometric indicators. The results confirm that the greenness of the residential environment can improve health indicators in patients with HF.

Relationship of trihalomethane in drinking water with hypertension and arrhythmia among young and middle-aged adults in Petropavlovsk, Kazakhstan.

There are no studies investigating the association of chlorinated drinking water with the risk of cardiovascular diseases (CVDs) among young and middle-aged adults. This study was aimed to assess the associations between trihalomethanes (THMs) in drinking water and the risk of CVDs in in the target group in Petropavlovsk, Kazakhstan. 448 dwellers of Petropavlovsk were asked about their demographic, socioeconomic, lifestyle, behavioural characteristics, and drinking water preferences. THMs exposure was assessed to each participant based on their residence address. We used multivariable logistic regression analysis to assess the risk of CVDs in young and middle-aged adults. The results showed that the risk of hypertension in the adjusted logistic regression model was increased by 68% and a 2.7-fold in the second and third THM tertiles, respectively. Participants in the second and third THM exposure tertiles had a 2.3-fold and a 4.8-fold increase in the risk of arrhythmia.

Environmental exposures in early-life and general health in childhood.

BACKGROUND: Early-life environmental exposures are suspected to be involved in the development of chronic diseases later in life. Most studies conducted so far considered single or few exposures and single-health parameter. Our study aimed to identify a childhood general health score and assess its association with a wide range of pre- and post-natal environmental exposures. METHODS: The analysis is based on 870 children (6-12 years) from six European birth cohorts participating in the Human Early-Life Exposome project. A total of 53 prenatal and 105 childhood environmental factors were considered, including lifestyle, social, urban and chemical exposures. We built a general health score by averaging three sub-scores (cardiometabolic, respiratory/allergy and mental) built from 15 health parameters. By construct, a child with a low score has a low general health status. Penalized multivariable regression through Least Absolute Shrinkage and Selection Operator (LASSO) was fitted in order to identify exposures associated with the general health score. FINDINGS: The results of LASSO show that a lower general health score was associated with maternal passive and active smoking during pregnancy and postnatal exposure to methylparaben, copper, indoor air pollutants, high intake of caffeinated drinks and few contacts with friends and family. Higher child's general health score was associated with prenatal exposure to a bluespace near residency and postnatal exposures to pets, cobalt, high intakes of vegetables and more physical activity. Against our hypotheses, postnatal exposure to organochlorine compounds and perfluorooctanoate were associated with a higher child's general health score. CONCLUSION: By using a general health score summarizing the child cardiometabolic, respiratory/allergy and mental health, this study reinforced previously suspected environmental factors associated with various child health parameters (e.g. tobacco, air pollutants) and identified new factors (e.g. pets, bluespace) warranting further investigations.

Availability, accessibility, and use of green spaces and cognitive development in primary school children.

Green spaces may have beneficial impacts on children's cognition. However, few studies explored the exposure to green spaces beyond residential areas, and their availability, accessibility and uses at the same time. The aim of the present study was to describe patterns of availability, accessibility, and uses of green spaces among primary school children and to explore how these exposure dimensions are associated with cognitive development. Exposures to green space near home, school, commuting route, and other daily activity locations were assessed for 1607 children aged 6-11 years from six birth cohorts across Europe, and included variables related to: availability (NDVI buffers: 100, 300, 500 m), potential accessibility (proximity to a major green space: linear distance; within 300 m), and use (play time in green spaces: hours/year), and the number of visits to green spaces (times/previous week). Cognition measured as fluid intelligence, inattention, and working memory was assessed by computerized tests. We performed multiple linear regression analyses on pooled and imputed data adjusted for individual and area-level confounders. Availability, accessibility, and uses of green spaces showed a social gradient that was unfavorable in more vulnerable socioeconomic groups. NDVI was associated with more playing time in green spaces, but proximity to a major green space was not. Associations between green space exposures and cognitive function outcomes were not statistically significant in our overall study population. Stratification by socioeconomic variables showed that living within 300 m of a major green space was associated with improved working memory only in children in less deprived residential areas (ß = 0.30, CI: 0.09,0.51), and that more time playing in green spaces was associated with better working memory only in children of highly educated mothers (ß per IQR increase in hour/year = 0.10; 95% CI: 0.01, 0.19). However, studying within 300 m of a major green space increased inattention scores in children in more deprived areas (ß = 15.45, 95% CI: 3.50, 27.40).

Lithuanian midwives' attitudes and actions during low-risk birth.

INTRODUCTION: This study sheds light on the attitudes and practices of Lithuanian midwives during low-risk births. The aim is to reveal how autonomous work is incorporated into daily routines, how care is oriented towards the mother, and how care is delivered before and during interventions. It highlights midwives' views on both their own and their colleagues' actions during labor, what is aimed for and what outcome is expected. METHODS: A qualitative research method was chosen. Midwives were interviewed individually in February and April 2022 by random sampling and semi-structured interviews, after the purpose of the survey was explained and their consent was given to use the information only for scientific work purposes. Midwives were recruited through social networks, sharing information about the study and its nature. All data were coded and analyzed in aggregate form. Ten midwives working in the labor ward participated in the study. RESULTS: From the midwives' point of view, every birth and its experience are unique. Midwives work together with mothers to achieve the common goal of a positive birth experience. Communication with the mother and her family, good rapport, clear information and informed decision-making are key aspects for midwives during labor. The midwife's actions must be reasonable and purposeful, with a preference for non-medicated methods of pain and stress relief. CONCLUSIONS: A low-risk birth that is within the competence of midwives is one in which there is a low likelihood of medical interventions. Midwives are encouraged to minimize the use of interventions and to provide high quality delivery care.

Association between Outdoor Air Pollution and Fatal Acute Myocardial Infarction in Lithuania between 2006 and 2015: A Time Series Design.

BACKGROUND: Air pollution has a significant effect on human health and there is a broad body of evidence showing that exposure to air pollution is associated with an increased risk of adverse health effects. The main objective of this study was to assess the association of traffic-related air pollutants with fatal AMI during the ten-year period. METHODS: The study was conducted in Kaunas city, where the WHO MONICA register included a total of 2273 adult cases of fatal AMI cases during the 10-year study period. We focused on the period between 2006 and 2015. The associations between exposure to traffic-related air pollution and the risk of fatal AMI were evaluated by using a multivariate Poisson regression model, RR presented per an increase in IQR. RESULTS: It was found that the risk of fatal AMI was significantly higher in all subjects (RR 1.06; 95% CI 1.00-1.12) and women (RR 1.12; 95% CI 1.02-1.22) when the concentration of PM10 in the ambient air was increased 5-11 days before the onset of AMI, adjusting for NO2 concentration. The effect was stronger during spring in all subjects (RR 1.12; 95% CI 1.03-1.22), in men (RR 1.13; 95% CI 1.01-1.26), in younger-aged (RR 1.15; 95% CI 1.03-1.28), and in winter in women (RR 1.24; 95% CI 1.03-1.50). CONCLUSIONS: Our findings show that ambient air pollution increases the risk of fatal AMI, and this pertains to PM10 specifically.

Exposure to natural environments during pregnancy and birth outcomes in 11 European birth cohorts.

Research suggests that maternal exposure to natural environments (i.e., green and blue spaces) promotes healthy fetal growth. However, the available evidence is heterogeneous across regions, with very few studies on the effects of blue spaces. This study evaluated associations between maternal exposure to natural environments and birth outcomes in 11 birth cohorts across nine European countries. This study, part of the LifeCycle project, was based on a total sample size of 69,683 newborns with harmonised data. For each participant, we calculated seven indicators of residential exposure to natural environments: surrounding greenspace in 100m, 300m, and 500m using Normalised Difference Vegetation Index (NDVI) buffers, distance to the nearest green space, accessibility to green space, distance to the nearest blue space, and accessibility to blue space. Measures of birth weight and small for gestational age (SGA) were extracted from hospital records. We used pooled linear and logistic regression models to estimate associations between exposure to the natural environment and birth outcomes, controlling for the relevant covariates. We evaluated the potential effect modification by socioeconomic status (SES) and region of Europe and the influence of ambient air pollution on the associations. In the pooled analyses, residential surrounding greenspace in 100m, 300m, and 500m buffer was associated with increased birth weight and lower odds for SGA. Higher residential distance to green space was associated with lower birth weight and higher odds for SGA. We observed close to null associations for accessibility to green space and exposure to blue space. We found stronger estimated magnitudes for those participants with lower educational levels, from more deprived areas, and living in the northern European region. Our associations did not change notably after adjustment for air pollution. These findings may support implementing policies to promote natural environments in our cities, starting in more deprived areas.

Motivations and barriers towards optimal physical activity level: A community-based assessment of 28 EU countries.

Regular physical activity (PA) is one of the most important determinants of a healthy lifestyle and improved physical and mental well-being. Despite the health benefits of regular PA, the studies show low levels of PA among European adolescents and adults. An increase in physical inactivity has been associated with different personal and environmental factors. This study aimed to investigate positive motivation and barriers to community-based PA. Face-to-face interviews were conducted to collect data on PA, positive motivation and barriers to PA, demographic, and socioeconomic factors. Moderate and vigorous levels of PA were assessed. Regression analysis was applied to estimate the associations for positive and negative reasons for meeting PA recommendations. Data were available for 28,031 adults with a mean age of 48.3 (SD = 18.8) and 51.8% women. Significant variations in individual characteristics were seen between different types of communities. The percentage of participants who reported achieving recommended levels of PA was the lowest in rural areas (44.3%). Regression models showed that most motivational factors had a strong positive association with meeting PA recommendations. We observed the effects of interactions between making acquaintances, having fun and the type of community on meeting PA recommendations. The effects of interactions between the type of community and barriers to PA such as price, risk of injury, disability / illness, and a lack of motivation on PA recommendations were observed. In conclusion, the motivational factors and barriers to PA are associated with the physical environment, and community-based programs and policies for encouraging PA participation are needed.

Environmentally related gender health risks: findings from citizen science cross-sectional study.

BACKGROUND: Public engagement in the research of environmental epidemiological problems is becoming an important measure to empower citizens to identify the local environmental and health problems and to explain different environmental exposures affect estimates for males and females. This HORIZON2020 CitieS-Health Kaunas Pilot study examines the relationship between urban built and social environment, health behaviors, and health in men and women. METHODS: This cross-sectional study included 1086 18-74-year-old participants residing in 11 districts of Kaunas city, Lithuania. Using GIS, we measured traffic flow, noise, NO2, PM2.5, PM10, and greenness NDVI for the participants' home addresses, determined participants' perceptions of environmental quality, linked this information with personal sociodemographic data, and used multivariate logistic regression to assess the associations with health issues (physician-diagnosed chronic disease and self-rated general health) in men and women. RESULTS: Men and women similar rated the quality of the neighborhood environment, except for air pollution and satisfaction with the public transport in the district. The traffic-related health associations were stronger for women than for men. The prevalence of poor health increased with the increasing age of men and women, yet no significant differences between gender health risks were found in the total sample. Perceived air pollution, irregular visits to green space, and chronic diseases were consistently associated with poor health risks in men and women, yet part-time jobs and low income had a higher impact on women's poor health. CONCLUSIONS: Quality of the built neighborhood, air pollution, irregular visits to the green space, and chronic disease had a joint effect on the magnitude of the prevalence of poor health in men and women. Our results suggest that decreasing air pollution and improving the urban built neighborhood supporting citizens' physical activity in green spaces, might reduce health risks for all.

Urban environment and health behaviours in children from six European countries.

BACKGROUND: Urban environmental design is increasingly considered influential for health and wellbeing, but evidence is mostly based on adults and single exposure studies. We evaluated the association between a wide range of urban environment characteristics and health behaviours in childhood. METHODS: We estimated exposure to 32 urban environment characteristics (related to the built environment, traffic, and natural spaces) for home and school addresses of 1,581 children aged 6-11 years from six European cohorts. We collected information on health behaviours including total amount of overall moderate-to-vigorous physical activity, physical activity outside school hours, active transport, sedentary behaviours and sleep duration, and developed patterns of behaviours with principal component analysis. We used an exposure-wide association study to screen all exposure-outcome associations, and the deletion-substitution-addition algorithm to build a final multi-exposure model. RESULTS: In multi-exposure models, green spaces (Normalized Difference Vegetation Index, NDVI) were positively associated with active transport, and inversely associated with sedentary time (22.71 min/day less (95 %CI -39.90, -5.51) per interquartile range increase in NDVI). Residence in densely built areas was associated with more physical activity and less sedentary time, and densely populated areas with less physical activity outside school hours and more sedentary time. Presence of a major road was associated with lower sleep duration (-4.80 min/day (95 %CI -9.11, -0.48); compared with no major road). Results for the behavioural patterns were similar. CONCLUSIONS: This multicohort study suggests that areas with more vegetation, more building density, less population density and without major roads are associated with improved health behaviours in childhood.

Short- and medium-term air pollution exposure, plasmatic protein levels and blood pressure in children.

Exposure to air pollution influences children's health, however, the biological mechanisms underlying these effects are not completely elucidated. We investigated the association between short- and medium-term outdoor air pollution exposure with protein profiles and their link with blood pressure in 1170 HELIX children aged 6-11 years. Different air pollutants (NO2, PM10, PM2.5, and PM2.5abs) were estimated based on residential and school addresses at three different windows of exposure (1-day, 1-week, and 1-year before clinical and molecular assessment). Thirty-six proteins, including adipokines, cytokines, or apolipoproteins, were measured in children's plasma using Luminex. Systolic and diastolic blood pressure (SBP and DBP) were measured following a standardized protocol. We performed an association study for each air pollutant at each location and time window and each outcome, adjusting for potential confounders. After correcting for multiple-testing, hepatocyte growth factor (HGF) and interleukin 8 (IL8) levels were positively associated with 1-week home exposure to some of the pollutants (NO2, PM10, or PM2.5). NO2 1-week home exposure was also related to higher SBP. The mediation study suggested that HGF could explain 19% of the short-term effect of NO2 on blood pressure, but other study designs are needed to prove the causal directionality between HGF and blood pressure.

Urban Environment and Health: A Cross-Sectional Study of the Influence of Environmental Quality and Physical Activity on Blood Pressure.

Few studies have examined the relation between urban built environment and the prevalence of hypertension. This cross-sectional study aimed at assessing the relationship between the environmental quality, physical activity, and stress on hypertension among citizens of Kaunas city, Lithuania. We conducted a survey of 1086 citizens residing in 11 districts to determine their perceptions of environmental quality, health behavior, and health indices. The independent variables included residential traffic flows, access to public transportation and green spaces. Dependent variables included physician-diagnosed hypertension, systolic and diastolic blood pressure, and stress level. We used multivariable logistic regression to assess the associations as odds ratios (OR). The environmental factors beneficially associated with meeting the physical activity recommendations were opportunities for walking to reach the city's green spaces and available relaxation areas. Residents of high noise level districts aged 45-64 years had a significantly higher OR of stress and a higher prevalence of hypertension when age, sex, education status, family status, and smoking were accounted for. However, meeting the physical activity recommendations had a beneficial effect on the risk of hypertension. This study provided evidence that improvement of the district-level built environment supporting citizens' physical activity might reduce the risk of hypertension.

Promoting Sustainable Mobility: A Perspective from Car and Public Transport Users.

Sustainable mobility is becoming a key factor in improving the quality of life of the residents and increasing physical activity (PA) levels. The current situation of sustainable mobility and its analysis is a first step in understanding the factors that would encourage residents to discover and choose alternative modes of travel. The present study examined the factors that encourage the choice of active modes of travel among urban adult population. Walking and cycling were analyzed as the most sustainable forms of urban mobility from the perspective of car and public transport (PT) users. Total of 902 subjects aged 18 years or older were analyzed in the study to assess commuting habits in Kaunas city, Lithuania. The majority (61.1%) of the respondents used a passenger vehicle, 28.2% used PT, and only 13.5% used active modes of travel. The results showed that safer pedestrian crossings, and comfortable paths were the most significant factors that encourage walking. A wider cycling network, and bicycle safety were the most important incentives for the promotion of cycling. Our findings show that the main factors encouraging walking and cycling among car and PT users are similar, however, the individual characteristics that determine the choice of these factors vary significantly.

The Relationship Between the Healthy Diet Index, Chronic Diseases, Obesity and Lifestyle Risk Factors Among Adults in Kaunas City, Lithuania.

A healthy and balanced diet is an important factor contributing to overall health and wellness. The aim of this study was to develop a Healthy Diet Index (HDI) score and assess its association with various chronic diseases and lifestyle risk factors. A cross-sectional survey included 1,111 adults aged 18 years and older. Information on dietary habits was collected using a questionnaire. Additional demographic, socioeconomic and lifestyle risk factors data were also collected. Sixteen food groups were used to develop the HDI score for the residents of Kaunas city, Lithuania based on the national recommendations, World Health Organization (WHO) and other guidance on a healthy diet. We used logistic regression models to assess the association of the HDI score with chronic diseases, obesity and lifestyle risk factors. We found that both males and females were lacking the optimal consumption of the base components of a healthy diet-fruits and vegetables, starchy carbohydrates, and proteins. We also observed significant associations between the HDI score and several outcomes such as hypertension, arrhythmia, physical activity, and obesity. The suggested HDI score could serve as a valuable tool in assessing and improving dietary habits beneficial for promoting health and preventing many diseases.

Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study.

Citizens' participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality and exposure to urban green spaces and the risk of hypertension. The study sample consisted of 580 participants residing in 11 districts in Kaunas city, Lithuania. Using geographic information systems (GIS), individual data on the socioeconomic status (SES) and health were linked to the participants' perceptions of the environmental quality and exposure to green spaces (NDVI). We used multivariate logistic regression to estimate associations as odds ratios (OR). Those study participants with lower education and those study participants with higher education on low incomes rated their health significantly worse. Low SES persons residing in areas with low exposure to green spaces had a significantly higher risk of hypertension when sex, age, family status, smoking, and income were accounted for (OR 1.83, 95% CI 1.01-3.36). This citizen science study provided evidence that the social environment and the quality of the built environment had a complex effect on disparities in the risk of hypertension.

Environmental Quality Perceptions and Health: A Cross-Sectional Study of Citizens of Kaunas, Lithuania.

The perception of urban environmental quality is an important contributor when identifying local problems in sustainable development and environmental planning policy. This study examined the associations between environmental and social residential characteristics, physical activity, obesity, and hypertension in Kaunas city, Lithuania. This cross-sectional study analyzed 580 citizens' demographic-, socioeconomic-, health-, and lifestyle-related factors, environmental health concerns, and environmental quality perceptions. Using Geographic Information Systems and the multivariate logistic regression, we found that the less physically active group more often presented lower than mean ratings of the quality of pathways and cycling routes (32.9% and 45.6%, p = 0.042) and only irregularly visited the natural environment. Obese participants presented poorer ratings of air pollution, the quality of pathways and cycling routes, their possibility to reach green spaces by walking, and the available relaxing areas. The environmental issues associated with hypertension were poor possibilities to reach green spaces by walking (OR 1.94, 95% CI 1.14-3.32) and the availability of relaxation areas (OR 2.30, 95% 1.34-3.95). The quality of the neighborhood and individual-level characteristics were the factors that influenced a higher prevalence of health problems at the district level. Our findings suggest that a public health policy to improve the physical and social environment of the neighborhood would have a potential to increase citizens' physical activity and health.

Early-Life Environmental Exposures and Childhood Obesity: An Exposome-Wide Approach.

BACKGROUND: Chemical and nonchemical environmental exposures are increasingly suspected to influence the development of obesity, especially during early life, but studies mostly consider single exposure groups. OBJECTIVES: Our study aimed to systematically assess the association between a wide array of early-life environmental exposures and childhood obesity, using an exposome-wide approach. METHODS: The HELIX (Human Early Life Exposome) study measured child body mass index (BMI), waist circumference, skinfold thickness, and body fat mass in 1,301 children from six European birth cohorts age 6-11 y. We estimated 77 prenatal exposures and 96 childhood exposures (cross-sectionally), including indoor and outdoor air pollutants, built environment, green spaces, tobacco smoking, and biomarkers of chemical pollutants (persistent organic pollutants, metals, phthalates, phenols, and pesticides). We used an exposure-wide association study (ExWAS) to screen all exposure-outcome associations independently and used the deletion-substitution-addition (DSA) variable selection algorithm to build a final multiexposure model. RESULTS: The prevalence of overweight and obesity combined was 28.8%. Maternal smoking was the only prenatal exposure variable associated with higher child BMI (z-score increase of 0.28, 95% confidence interval: 0.09, 0.48, for active vs. no smoking). For childhood exposures, the multiexposure model identified particulate and nitrogen dioxide air pollution inside the home, urine cotinine levels indicative of secondhand smoke exposure, and residence in more densely populated areas and in areas with fewer facilities to be associated with increased child BMI. Child blood levels of copper and cesium were associated with higher BMI, and levels of organochlorine pollutants, cobalt, and molybdenum were associated with lower BMI. Similar results were found for the other adiposity outcomes. DISCUSSION: This first comprehensive and systematic analysis of many suspected environmental obesogens strengthens evidence for an association of smoking, air pollution exposure, and characteristics of the built environment with childhood obesity risk. Cross-sectional biomarker results may suffer from reverse causality bias, whereby obesity status influenced the biomarker concentration. https://doi.org/10.1289/EHP5975.

Association between the living environment and the risk of arterial hypertension and other components of metabolic syndrome.

BACKGROUND: Metabolic syndrome (MS) is characterized by numerous metabolic risk factors. We investigated the associations between a long-term exposure to ambient air pollution and the residential distance to green spaces (GS) and major roads with the development of arterial hypertension (AH) and some components of MS. These associations were assessed among persons living in private and multi-story houses (MH). METHODS: We selected 1354 participants for the population study from MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease Program). The exposures to PM10, PM2.5, and NO2 levels were assessed by using the LUR models for Kaunas City. RESULTS: In the participants who lived in MH, the residential distance to a major road closer than 200 m and the residential exposure to PM10 and PM2.5 levels above the median were associated with a higher risk of AH (the adjusted relative risks (RRs), respectively, were 1.41(1.10-1.81), 1.19(1.01-1.42) and 1.27(1.07-1.52)). In these participants, the residential exposure to a PM10 level above the median was associated with a higher risk of reduced high density lipoprotein (RHDL) (RR = 1.46(1.05-2.05)). A negative impact of the traffic air pollutants on the incidence of AH, RHDL cholesterol and high triglyceride levels was observed only in the participants who lived in MH.