Racial/ethnic disparities in the association between fine particles and respiratory hospital admissions in San Diego county, CA.

Ambient air pollution exposure is associated with exacerbating respiratory illnesses. Race/ethnicity (R/E) have been shown to influence an individual's vulnerability to environmental health risks such as fine particles (PM 2.5). This study aims to assess the R/E disparities in vulnerability to air pollution with regards to respiratory hospital admissions in San Diego County, California where most days fall below National Ambient Air Quality Standards (NAAQS) for daily PM 2.5 concentrations. Daily PM 2.5 levels were estimated at the zip code level using a spatial interpolation using inverse-distance weighting from monitor networks. The association between daily PM 2.5 levels and respiratory hospital admissions in San Diego County over a 15-year period from 1999 to 2013 was assessed with a time-series analysis using a multi-level Poisson regression model. Cochran Q tests were used to assess the effect modification of race/ethnicity on this association. Daily fine particle levels varied greatly from 1 µg/m3 to 75.86 µg/m3 (SD = 6.08 µg/m3) with the majority of days falling below 24-hour NAAQS for PM 2.5 of 35 µg/m3. For every 10 µg/m3 increase in PM 2.5 levels, Black and White individuals had higher rates (8.6% and 6.2%, respectively) of hospitalization for respiratory admissions than observed in the county as a whole (4.1%). Increases in PM 2.5 levels drive an overall increase in respiratory hospital admissions with a disparate burden of health effects by R/E group. These findings suggest an opportunity to design interventions that address the unequal burden of air pollution among vulnerable communities in San Diego County that exist even below NAAQS for daily PM 2.5 concentrations.

Defining heat waves and extreme heat events using sub-regional meteorological data to maximize benefits of early warning systems to population health.

BACKGROUND: Extreme heat events have been consistently associated with an increased risk of hospitalization for various hospital diagnoses. Classifying heat events is particularly relevant for identifying the criteria to activate early warning systems. Heat event classifications may also differ due to heterogeneity in climates among different geographic regions, which may occur at a small scale. Using local meteorological data, we identified heat waves and extreme heat events that were associated with the highest burden of excess hospitalizations within the County of San Diego and quantified discrepancies using county-level meteorological criteria. METHODS: Eighteen event classifications were created using various combinations of temperature metric, percentile, and duration for both county-level and climate zone level meteorological data within San Diego County. Propensity score matching and Poisson regressions were utilized to ascertain the association between heat wave exposure and risk of hospitalization for heat-related illness and dehydration for the 1999-2013 period. We estimated both relative and absolute risks for each heat event classification in order to identify optimal definitions of heat waves and extreme heat events for the whole city and in each climate zone to target health impacts. RESULTS: Heat-related illness differs vastly by level (county or zone-specific), definition, and risk measure. We found the county-level definitions to be systematically biased when compared to climate zone definitions with the largest discrepancy of 56 attributable hospitalizations. The relative and attributable risks were often minimally correlated, which exemplified that relative risks alone are not adequate to optimize heat waves definitions. CONCLUSIONS: Definitions based on county-level defined thresholds do not provide an accurate picture of the observed health effects and will fail to maximize the potential effectiveness of heat warning systems. Absolute rather than relative risks are a more appropriate measure to define the set of criteria to activate early warnings systems and thus maximize public health benefits.

Heat, Disparities, and Health Outcomes in San Diego County's Diverse Climate Zones.

Climate variability and change are issues of growing public health importance. Numerous studies have documented risks of extreme heat on human health in different locations around the world. Strategies to prevent heat-related morbidity and reduce disparities are possible but require improved knowledge of health outcomes during hot days at a small-scale level as important within-city variability in local weather conditions, socio-demographic composition, and access to air conditioning (AC) may exist. We analyzed hospitalization data for three unique climate regions of San Diego County alongside temperature data spanning 14 years to quantify the health impact of ambient air temperature at varying exceedance threshold levels. Within San Diego, coastal residents were more sensitive to heat than inland residents. At the coast, we detected a health impact at lower temperatures compared to inland locations for multiple disease categories including heat illness, dehydration, acute renal failure, and respiratory disease. Within the milder coastal region where access to AC is not prevalent, heat-related morbidity was higher in the subset of zip codes where AC saturation is lowest. We detected a 14.6% increase (95% confidence interval [4.5%, 24.6%]) in hospitalizations during hot weather in comparison to colder days in coastal locations where AC is less common, while no significant impact was observed in areas with higher AC saturation. Disparities in AC ownership were associated with income, race/ethnicity, and homeownership. Given that heat waves are expected to increase with climate change, understanding health impacts of heat and the role of acclimation is critical for improving outcomes in the future.

Feasibility Pilot of a Randomized Faith-Based Intervention to Reduce Secondhand Smoke Exposure Among Korean Americans.

INTRODUCTION: Interventions are needed to prevent exposure to secondhand smoke (SHS), which persists in certain immigrant enclaves, including Koreans in the United States. A faith-based and culturally acceptable intervention was developed and pilot tested in collaboration with Korean churches to address SHS exposure among people of Korean descent. METHODS: A pilot cluster randomized intervention trial was conducted with 11 Korean churches in southern California and 75 Korean adults who were exposed to SHS. Study participants received a multicomponent intervention, which consisted of motivational interviewing by telephone and educational materials tailored with related biblical messages; the intervention was bolstered by church-based group activities and environmental cues. The control group received the same type and frequency of intervention components, but the components related only to fruit and vegetable consumption. Data were collected on the feasibility of the intervention and study procedures. SHS exposure and awareness and knowledge of SHS exposure were assessed by telephone interviews at baseline and follow-up. RESULTS: At follow-up, a larger percentage of the intervention group than the control group reported correct SHS knowledge and disapproval of SHS. The intervention group's SHS exposure was reduced by 8.5 cigarettes per week (vs a reduction of 1 cigarette per week among the control group). CONCLUSIONS: Initial findings are promising for improving knowledge, attitudes, and protective behaviors surrounding SHS exposure. Results suggest that a faith-based intervention for Korean Americans who are exposed to SHS is feasible, acceptable, and potentially effective in reducing their exposure to SHS.

Longitudinal study of household smoking ban adoption among Korean Americans.

BACKGROUND: Few longitudinal studies have examined the adoption of bans on smoking in private homes. PURPOSE: This longitudinal study examined: (1) the prevalence of home smoking bans at baseline, (2) the incidence and predictors of new ban implementation by follow-up, and (3) the reasons for banning smoking and the difficulties with enforcement. METHODS: The sample consisted of 1360 adults of Korean descent residing in California who were interviewed by telephone (in English/Korean) at baseline during 2001-2002 and re-interviewed in 2006-2007. Data analyses were conducted in 2007-2008. RESULTS: The proportion of respondents with a complete household smoking ban grew from 59% at baseline to 91% by the follow-up interview. Among the 552 respondents who did not have a ban at baseline, 84% had adopted a ban by follow-up. Three baseline factors independently predicted ban adoption during the follow-up period: the presence of a nonsmoking respondent or spouse, the presence of nonsmoking family members, and respondent's belief that secondhand smoke caused lung cancer. The most highly rated reasons for banning smoking were as follows: because smoke annoys others, to protect family members, to avoid the odor, to discourage youth from smoking, and to encourage smokers to quit. Finally, respondents indicated that they would find it most difficult to ask their parent-in-law not to smoke. CONCLUSIONS: The proportion of households with smoking bans increased substantially, but households with smokers or family members who smoke remained less likely to implement bans. The importance of culturally sensitive programs to promote household bans cannot be overstated.

Home smoking restrictions among Koreans in Seoul.

The prevalence and correlates of home smoking bans in the Republic of Korea were examined using population-based data from telephone interviews with 500 Seoul adult residents in 2002. Most (97%) respondents indicated that they smoked, or that their spouse, other family member, or a regular friend smoked. Nearly all indicated that environmental tobacco smoke (ETS) is harmful. Only 19% of homes banned smoking, 65% allowed smoking anywhere, and 16% allowed smoking by special guests or in certain areas. The odds of having a full ban were significantly greater for men, married individuals, those less than 35 years or more than 50 years of age, non-smokers, individuals whose nonspouse family members did not smoke, and individuals with more sources of anti-ETS messages. Home smoking bans should be promoted by media campaigns and other tobacco control activities, because knowledge of the effects of ETS was already high.

Children's exposure to secondhand smoke at home in Seoul, Korea.

here is little information about Korean children's secondhand smoke (SHS) exposure at home. This paper examines the extent and determinants of their SHS exposure at home. A population-based random digit dial telephone survey was conducted in 2002 with 500 adults in Seoul. We analyzed data for 207 adults with children living in the household. Thirty-one percent of respondents reported children' s SHS exposure at home. The mean weekly dose was 5 cigarettes among exposed children. Multiple logistic regression results showed that children's odds of SHS exposure at home increased if the respondent or spouse smoked, if the respondent's parent smoked, if smoking was allowed in the home, and if fewer groups discouraged smoking. Stronger protective measures are urged, such as widespread increase in home smoking bans and discouragement of smoking.

Secondhand smoke exposure among nonsmoking adults in Seoul, Korea.

Despite having one of the highest smoking rates among men, information about secondhand smoke (SHS) exposure among Korean adults is lacking. This study describes SHS exposure among Korean men and women. The results were derived from a population-based, cross-sectional telephone survey conducted with 332 adult nonsmokers in Seoul. Sixty-eight percent of nonsmokers were exposed to SHS during a typical day. Exposure was most common in locations other than home and work, where 57% of respondents were exposed, compared to 26% at home and 25% at work. However, among those exposed, the greatest dose of exposure occurred at work (9 cigarettes/day), followed by at home (6 cigarettes/day). Men were more likely to be exposed to SHS at work than women. For men, lack of home smoking bans and strong belief in traditional Korean values were independently associated with SHS exposure in any location. For women, younger age, family members' smoking (non-spouse), and having fewer sources of anti-SHS messages were independently associated with SHS exposure anywhere. The results highlight the need for strong, comprehensive SHS control measures, such as a complete ban of smoking in all workplaces and public places, as well as public health campaigns to promote home smoking bans and non-smoking norms.

Environmental tobacco smoke exposure among Korean American nonsmokers in California.

Information about the extent and patterns of environmental tobacco smoke (ETS) exposure among Korean Americans is sparse, despite the population's having one of the highest male smoking rates. This paper estimates the prevalence of ETS exposure among Korean American nonsmokers in California, and identifies demographic and other characteristics associated with exposure. Data were collected during 2001-2002 from telephone interviews (in English or Korean) with 2,328 nonsmoking Korean American adults. ETS was encountered by 31% of respondents during a typical day. Exposure was most common in "other locations," where 24% of respondents were exposed, compared with 6% at home and 9% at work. Among those exposed, the greatest dose of exposure occurred at work (6 cigarettes/day) and at home (5 cigarettes/day). Women were four times more likely than men to be exposed to ETS at home (8% vs. 2%, respectively). For both men and women, the odds of exposure were greater among those who were younger, who were unmarried, and whose friends smoked. Additionally, traditional men and bicultural women had greater odds of ETS exposure than those who were more acculturated. Women who were married to smokers, had no children at home, consumed more alcohol, and had no home smoking ban also had greater likelihood of exposure. The results indicate the need for a complete ban of smoking in workplaces and in private homes to prevent exposure, particularly for women whose husbands smoke.