Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions.

BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardiovascular morbidity. We explored the relation between spatial variation in nitrogen dioxide (NO2) concentrations and cardiopulmonary hospital admissions. METHODS: This ecological study was based on hospital admissions data (2001-2004) from the National Medical Registration and general population data for the West of the Netherlands (population 4.04 million). At the 4-digit postcode area level (n=683) associations between modeled annual average outdoor NO2 concentrations and hospital admissions for respiratory and cardiovascular causes were evaluated by linear regression with the log of the postcode-specific percentage of subjects that have been admitted at least once during the study period as the dependent variable. All analyses were adjusted for differences in composition of the population of the postcode areas (age, sex, income). RESULTS: At the postcode level, positive associations were found between outdoor NO2 concentrations and hospital admission rates for asthma, chronic obstructive pulmonary disease (COPD), all cardiovascular causes, ischemic heart disease and stroke (e.g. adjusted relative risk (95% confidence interval) for the second to fourth quartile relative to the first quartile of exposure were 1.87 (1.46-2.40), 2.34 (1.83-3.01) and 2.81 (2.16-3.65) for asthma; 1.44 (1.19-1.74), 1.50 (1.24-1.82) and 1.60 (1.31-1.96) for COPD). Associations remained after additional (indirect) adjustment for smoking (COPD admission rate) and degree of urbanization. CONCLUSIONS: Our study suggests an increased risk of hospitalization for respiratory and cardiovascular causes in areas with higher levels of NO2. Our findings add to the currently limited evidence of a long-term effect of air pollution on hospitalization. The ecological design of our study is a limitation and more studies with individual data are needed to confirm our findings.

Long-term exposure to traffic-related air pollution and type 2 diabetes prevalence in a cross-sectional screening-study in the Netherlands.

BACKGROUND: Air pollution may promote type 2 diabetes by increasing adipose inflammation and insulin resistance. This study examined the relation between long-term exposure to traffic-related air pollution and type 2 diabetes prevalence among 50- to 75-year-old subjects living in Westfriesland, the Netherlands. METHODS: Participants were recruited in a cross-sectional diabetes screening-study conducted between 1998 and 2000. Exposure to traffic-related air pollution was characterized at the participants' home-address. Indicators of exposure were land use regression modeled nitrogen dioxide (NO2) concentration, distance to the nearest main road, traffic flow at the nearest main road and traffic in a 250 m circular buffer. Crude and age-, gender- and neighborhood income adjusted associations were examined by logistic regression. RESULTS: 8,018 participants were included, of whom 619 (8%) subjects had type 2 diabetes. Smoothed plots of exposure versus type 2 diabetes supported some association with traffic in a 250 m buffer (the highest three quartiles compared to the lowest also showed increased prevalence, though non-significant and not increasing with increasing quartile), but not with the other exposure metrics. Modeled NO2-concentration, distance to the nearest main road and traffic flow at the nearest main road were not associated with diabetes. Exposure-response relations seemed somewhat more pronounced for women than for men (non-significant). CONCLUSIONS: We did not find consistent associations between type 2 diabetes prevalence and exposure to traffic-related air pollution, though there were some indications for a relation with traffic in a 250 m buffer.

A front-of-pack nutrition logo: a quantitative and qualitative process evaluation in the Netherlands.

This study aimed to perform a quantitative and qualitative process evaluation of the introduction of the Choices logo, a front-of-pack nutrition logo on products with a favorable product composition, adopted by many food producers, retail and food service organizations, conditionally endorsed by the Dutch government, validated by scientists, and in the process of international dissemination. An online questionnaire was sent to adult consumers 4 months after the introduction of the logo (n = 1,032) and 1 year later (n = 1,127). Additionally, seven consumer focus groups (n = 41) were conducted to provide more insight into the questionnaire responses. Quantitative analyses showed that exposure to the logo had significantly increased. Elderly and obese respondents reported to be more in need of a logo than younger and normal-weight individuals. Women perceived the logo more attractive and credible than men did. Further qualitative analyses indicated that the logo's credibility would improve if it became known that governmental and scientific authorities support it. Elderly respondents indicated that they needed a logo due to health concerns. Consumers interested in health reported that they used the logo. Further research focusing on specific target groups, forming healthful diets, and health outcomes is needed to investigate the effectiveness of the Choices logo.