Association between coarse particulate matter and inflammatory and hemostatic markers in a cohort of midlife women.

BACKGROUND: Exposure to particulate matter air pollution has been associated with cardiovascular disease (CVD) morbidity and mortality; however, most studies have focused on fine particulate matter (PM2.5) exposure and CVD. Coarse particulate matter (PM10-2.5) exposure has not been extensively studied, particularly for long-term exposure, and the biological mechanisms remain uncertain. METHODS: We examined the association between ambient concentrations of PM10-2.5 and inflammatory and hemostatic makers that have been linked to CVD. Annual questionnaire and clinical data were obtained from 1694 women (≥ 55 years old in 1999) enrolled in the longitudinal Study of Women's Health Across the Nation (SWAN) at six study sites from 1999 to 2004. Residential locations and the USEPA air monitoring network measurements were used to assign exposure to one-year PM10-2.5, as well as co-pollutants. Linear mixed-effects regression models were used to describe the association between PM10-2.5 exposure and markers, including demographic, health and other covariates. RESULTS: Each interquartile (4 µg/m3) increase in one-year PM10-2.5 exposure was associated with a 5.5% (95% confidence interval [CI]: 1.8, 9.4%) increase in levels of plasminogen activator inhibitor-1 (PAI-1) and 4.1% (95% CI: - 0.1, 8.6%) increase in high-sensitivity C-creative Protein (hs-CRP). Stratified analyses suggested that the association with PAI-1 was particularly strong in some subgroups, including women who were peri-menopausal, were less educated, had a body mass index lower than 25, and reported low alcohol consumption. The association between PM10-2.5 and PAI-1 remained unchanged with adjustment for PM2.5, ozone, nitrogen dioxide, and carbon monoxide. CONCLUSIONS: Long-term PM10-2.5 exposure may be associated with changes in coagulation independently from PM2.5, and thus, contribute to CVD risk in midlife women.

Temperature and hand, foot and mouth disease in California: An exploratory analysis of emergency department visits by season, 2005-2013.

BACKGROUND: For the past decade, hand, foot and mouth disease (HFMD), caused by entero and coxsackie viruses, has been spreading in Asia, particularly among children, overloading healthcare settings and creating economic hardships for parents. Recent studies have found meteorological factors, such as temperature, are associated with HFMD in Asia. However, few studies have explored the relationship in the United States, although HFMD cases have steadily increased recently. As concerns of climate change grow, we explored the association between temperature and HFMD admissions to the Emergency Department (ED) in California. METHODS: Weekly counts of HFMD for 16 California climate zones were collected from 2005 to 2013. We calculated weekly temperature for each climate zone using an inverse distance-weighting method. For each climate zone stratified by season, we conducted a time-series using Poisson regression models. We adjusted models for weekly averaged relative humidity, average number of HFMD cases in previous weeks and long-term temporal trends. Climate zone estimates were combined to obtain an overall seasonal estimate. We attempted stratified analyses by region, race/ethnicity, and sex to identify sensitive subpopulations. RESULTS: Risk of ED visits for HFMD per 1 °F increase in mean temperature during the same week increased 2.00% (95% confidence intervals 1.15, 2.86%) and 2.35% (1.38, 3.33%) during the warm and cold seasons, respectively. The coastal region showed a higher, though not statistically different, association during the cold season [3.18% (1.99, 4.39)] than the warm season [1.64% (0.47, 2.82)]. CONCLUSIONS: Our findings indicated an association between temperature and ED visits for HFMD, with variation by season and region. Thus, the causative pathogen's ability to persist in the atmosphere may vary by season. Furthermore, the mild and wet winter in the coastal region of California may contribute to different results than studies in Asia. With the onset of climate change, HFMD cases will likely grow in California, warranting further investigation on this relationship, including new populations at-risk.

Associations between ambient temperature and hepatobiliary and renal hospitalizations in California, 1999 to 2009.

BACKGROUND: High ambient temperature has been linked to a number of types of morbidity, such as cardiovascular disease and dehydration. Fewer studies have explored specifically the relationship between ambient temperature and liver, kidney, and urinary system morbidity despite known biological impacts of extreme high temperatures on those systems. OBJECTIVE: We assessed the relationship between temperature and hospitalizations related to selected renal system (urinary stones, urinary tract infections, septicemia, chronic kidney disease, and a composite of selected kidney diseases) and hepatobiliary (biliary tract disease, other liver diseases [e.g. cirrhosis], non-diabetic pancreatic disorders) ailments. METHODS: We compiled data on daily hospitalization counts for hepatobiliary and renal system diseases in California for 1999 through 2009, and matched it with meteorological data. Relationships between temperature and admissions during the warm season (May-October) were assessed at the climate zone-level cumulative over 14 days following exposure using distributed lag non-linear models, with adjustment for time trends and relative humidity, then combined using random-effects meta-regression to create statewide estimates. RESULTS: Higher mean temperatures in the warm season were associated with significant increases in renal admissions for urinary tract infection [% change per 10 °F: 7.3, 95% CI: 5.6, 9.1], septicemia [% increase: 2.9; 95% CI: 1.5, 4.3], urinary stones [% increase: 15.2; 95% CI: 10.3, 20.4], and composite kidney disease. Additionally, increased temperatures were linked to increased admissions for biliary tract disease, but lower risk of other liver diseases. Some differences in association by race/ethnicity and regional meteorology were observed. CONCLUSIONS: Exposure to higher temperatures was associated with increased risk of multiple renal system hospitalization types, with additional links to specific hepatobiliary morbidities observed.

Associations between fine particulate matter and changes in lipids/lipoproteins among midlife women.

Fine particles (PM2.5) are known to increase risks of cardiovascular diseases, but it is unclear how they affect plasma lipid levels. In this study, we examined the associations between PM2.5 exposure and lipid/lipoprotein levels from 2289 midlife women enrolled in the longitudinal Study of Women's Health Across the Nation. The average exposure to PM2.5 and gaseous co-pollutants during the prior one year, six months, 30 days, and one day were estimated for each woman based on U.S. Environmental Protection Agency ambient monitoring data. Blood samples were collected annually from 1999 to 2005 and analyzed for lipids/lipoproteins. Mixed-effect models were used to account for repeated measures for each woman, adjusted for demographic, health and behavior covariates. PM2.5 exposures, especially the long-term exposure, were negatively associated with protective lipoproteins, and positively associated with atherogenic lipoproteins. For example, each 3 µg/m3 increase of one-year PM2.5 exposure was associated with decreases of -0.7% (-1.4%, -0.1%) in high-density lipoprotein cholesterols and -0.6% (-1.1%, -0.1%) in apolipoprotein A1 (ApoA1), as well as increases of 3.8% (1.0%, 6.6%) in lipoprotein(a) and 1.4% (0.5%, 2.3%) in the ratio of apolipoprotein B (ApoB)/ApoA1. In stratified analysis, increased atherogenic lipoproteins were mainly observed in women without dyslipidemia, and both increased atherogenic lipoproteins and reduced protective lipoproteins were observed among women in perimenopause. In summary, PM2.5 exposure was associated with adverse lipid level changes, and thus, may increase cardiovascular risks in midlife women.

Association between gaseous air pollutants and inflammatory, hemostatic and lipid markers in a cohort of midlife women.

BACKGROUND: Exposures to ambient gaseous pollutants have been linked to cardiovascular diseases (CVDs), but the biological mechanisms remain uncertain. OBJECTIVES: This study examined the changes in CVD marker levels resulting from elevated exposure to ambient gaseous pollutants in midlife women. METHODS: Annual repeated measurements of several inflammatory, hemostatic and lipid makers were obtained from 2306 midlife women enrolled in the longitudinal Study of Women's Health Across the Nation (SWAN) between 1999 and 2004. Ambient carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2) data were assigned to each woman based on proximity of the monitoring station to her residential address. Short- and long-term exposures were calculated, and their associations with markers were examined using linear mixed-effects regression models, adjusted for demographic, health and other factors. RESULTS: Short-term CO exposure was associated with increased fibrinogen, i.e., every interquartile increase of average prior one-week exposure to CO was associated with 1.3% (95% CI: 0.6%, 2.0%) increase in fibrinogen. Long-term exposures to NO2 and SO2 were associated with reduced high-density lipoproteins and apolipoprotein A1, e.g., 4.0% (1.7%, 6.3%) and 4.7% (2.8%, 6.6%) decrease per interquartile increment in prior one-year average NO2 concentration, respectively. Fine particle (PM2.5) exposure confounded associations between CO/NO2 and inflammatory/hemostatic markers, while associations with lipoproteins were generally robust to PM2.5 adjustment. CONCLUSIONS: Exposures to these gas pollutants at current ambient levels may increase thrombotic potential and disrupt cholesterol metabolism, contributing to greater risk of CVDs in midlife women. Caution should be exercised in evaluating the confounding by PM2.5 exposure.

Polybrominated diphenyl ether serum concentrations in a Californian population of children, their parents, and older adults: an exposure assessment study.

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many household items. Given concerns over their potential adverse health effects, we identified predictors and evaluated temporal changes of PBDE serum concentrations. METHODS: PBDE serum concentrations were measured in young children (2-8 years old; N = 67), parents of young children (<55 years old; N = 90), and older adults (≥55 years old; N = 59) in California, with concurrent floor wipe samples collected in participants' homes in 2008-2009. We also measured serum concentrations one year later in a subset of children (N = 19) and parents (N = 42). RESULTS: PBDE serum concentrations in children were significantly higher than in adults. Floor wipe concentration is a significant predictor of serum BDE-47, 99, 100 and 154. Positive associations were observed between the intake frequency of canned meat and serum concentrations of BDE-47, 99 and 154, between canned meat entrees and BDE-154 and 209, as well as between tuna and white fish and BDE-153. The model with the floor wipe concentration and food intake frequencies explained up to 40% of the mean square prediction error of some congeners. Lower home values and renting (vs. owning) a home were associated with higher serum concentrations of BDE-47, 99 and 100. Serum concentrations measured one year apart were strongly correlated as expected (r = 0.70-0.97) with a slight decreasing trend. CONCLUSIONS: Floor wipe concentration, food intake frequency, and housing characteristics can explain 12-40% of the prediction error of PBDE serum concentrations. Decreasing temporal trends should be considered when characterizing long-term exposure.

Serum concentrations of perfluorinated compounds (PFC) among selected populations of children and adults in California.

Perfluorinated compounds (PFCs) have been widely used in industrial applications and consumer products. Their persistent nature and potential health impacts are of concern. Given the high cost of collecting serum samples, this study is to understand whether we can quantify PFC serum concentrations using factors extracted from questionnaire responses and indirect measurements, and whether a single serum measurement can be used to classify an individual's exposure over a one-year period. The study population included three demographic groups: young children (2-8 years old) (N=67), parents of young children (<55 years old) (N=90), and older adults (>55 years old) (N=59). PFC serum concentrations, house dust concentrations, and questionnaires were collected. The geometric mean of perfluorooctane sulfonic acid (PFOS) was highest for the older adults. In contrast, the geometric mean of perfluorooctanoic acid (PFOA) was highest for children. Serum concentrations of the parent and the child from the same family were moderately correlated (Spearman correlation (r)=0.26-0.79, p<0.05), indicating common sources within a family. For adults, age, having occupational exposure or having used fire extinguisher, frequencies of consuming butter/margarine, pork, canned meat entrées, tuna and white fish, freshwater fish, and whether they ate microwave popcorn were significantly positively associated with serum concentrations of individual PFCs. For children, residential dust concentrations, frequency of wearing waterproof clothes, frequency of having canned fish, hotdogs, chicken nuggets, French fries, and chips, and whether they ate microwave popcorn were significant positive predictors of individual PFC serum concentrations. In addition, the serum concentrations collected in a subset of young children (N=20) and the parents (N=42) one year later were strongly correlated (r=0.68-0.98, p<0.001) with the levels measured at the first visits, but showed a decreasing trend. Children had moderate correlation (r=0.43) between serum and dust concentrations of PFOS, indicating indoor sources contribute to exposure. In conclusion, besides food intake, occupational exposure, consumer product use, and exposure to residential dust contribute to PFC exposure. The downward temporal trend of serum concentrations reflects the reduction of PFCs use in recent years while the year-to-year correlation indicates that a single serum measurement could be an estimate of exposure relative to the population for a one-year period in epidemiology studies.

Temporal variation of residential pesticide use and comparison of two survey platforms: a longitudinal study among households with young children in Northern California.

BACKGROUND: Pesticide use patterns are essential inputs into human pesticide exposure models. Currently, data included for modeling purposes have mostly been collected in cross-sectional surveys. However, it is questionable whether responses to one-time surveys are representative of pesticide use over longer periods, which is needed for assessment of health impact. This study was designed to evaluate population-wide temporal variations and within-household variations in reported residential pesticide use patterns and to compare alternative pesticide data collection methods - web surveys versus telephone interviews. METHOD: A total of 481 households in Northern California provided up to 3 annual telephone interviews on residential pesticide use; 182 of these households provided up to 6 quarterly web surveys that covered the same topics for some of the same time periods. Information on frequency and areas of application were collected for outdoor and indoor sprays, indoor foggers, professional applications, and behind-the-neck treatments for pets. Population-wide temporal variation and within-household consistency were examined both within telephone surveys and within web surveys, and quantified using Generalized Estimating Equations and Mixed Effect Modeling. Reporting between the two methods, the telephone survey and the web survey, was also compared. RESULTS: Use prevalence of outdoor sprays across the population reported in both the annual telephone surveys and the quarterly web surveys decreased over time, as did behind-the-neck treatment of pets reported in the quarterly web survey. Similarly, frequencies of use of these products decreased in the quarterly web surveys. Indoor sprays showed no statistically significant population-wide temporal variation in either survey. Intraclass correlation coefficients indicated consistent use within a household for behind-the-neck treatment on pets and outdoor sprays but great variability for the use of indoor sprays. Indoor sprays were most consistently applied in the bathroom and kitchen. Outdoor sprays were consistently more often applied by male household members, while indoor sprays were not. The two survey approaches obtained fairly similar results on the prevalence of using pesticides, but found discrepancies in use frequencies. In addition, the number of products purchased was positively correlated with application frequency for outdoor sprays (R = 0.51, p = 0.0005) but not for indoor sprays. CONCLUSIONS: In this population, repeated surveys are necessary either to obtain a reliable estimate of the average household use of pesticides or to project potential temporal changes of pesticide use. Web surveys could collect comparable data to traditional telephone surveys for some information. However, researchers need to consider the internet acceptability among the target population and balance lower participant burden against the need for sufficiently accurate time-varying measurement, to improve subject retention in longitudinal surveys.

Indoor particle levels in small- and medium-sized commercial buildings in California.

This study monitored indoor and outdoor particle concentrations in 37 small and medium commercial buildings (SMCBs) in California with three buildings sampled on two occasions, resulting in 40 sampling days. Sampled buildings included offices, retail establishments, restaurants, dental offices, and hair salons, among others. Continuous measurements were made for both ultrafine and fine particulate matter as well as black carbon inside and outside of the building. Integrated PM(2.5), PM(2.5-10), and PM(10) samples were also collected inside and outside the building. The majority of the buildings had indoor/outdoor (I/O) particle concentration ratios less than 1.0, indicating that contributions from indoor sources are less than removal of outdoor particles. However, some of the buildings had I/O ratios greater than 1, indicating significant indoor particle sources. This was particularly true of restaurants, hair salons, and dental offices. The infiltration factor was estimated from a regression analysis of indoor and outdoor concentrations for each particle size fraction, finding lower values for ultrafine and coarse particles than for submicrometer particles, as expected. The I/O ratio of black carbon was used as a relative measure of the infiltration factor of particles among buildings, with a geometric mean of 0.62. The contribution of indoor sources to indoor particle levels was estimated for each building.

Feasibility of using web surveys to collect time-activity data.

Time-activity data are traditionally collected by telephone interviews or through paper diaries, which are time consuming and costly. As a potential alternative that may greatly save staff time, a web survey to collect time-activity data was developed and tested in this study. We collected 24-h recall web diaries from 151 parents of young children mostly under 55 years of age (who also answered for their children) and 55 older adults (≥ 55 years of age) both on a weekday and a weekend day every 3 months during an 18-month period. The performance and reliability of the web surveys collected were evaluated, including the survey-completion rate, and the percentage of surveys with unreasonable time being reported as spent sleeping and with missing reports of being in transit between locations. We also compared the web-survey data with time-activity information we collected from the same subjects in telephone interviews and found that these data sources were fairly consistent with each other. However, we observed slightly more compliance issues for the web than the telephone survey, but most of these issues could be addressed and minimized by refining some questions or the survey interface. Our study suggests that it is critical to reduce participants' burden and improve survey interface design for optimal compliance and data quality. In conclusion, web surveys are a promising method to consider for time-activity data collection.

Passive sampling methods to determine household and personal care product use.

Traditionally, use of household and personal care products has been collected through questionnaires, which is very time consuming, a burden on participants, and prone to recall bias. As part of the SUPERB Project (Study of Use of Products and Exposure-Related Behaviors), a novel platform was developed using bar codes to quickly and reliably determine what household and personal care products people have in their homes and determine the amount used over a 1-week period. We evaluated the acceptability and feasibility of our methodology in a longitudinal field study that included 47 California households, 30 with young children and 17 with an older adult. Acceptability was defined by refusal rates; feasibility was evaluated in terms of readable bar codes, useful product information in our database for all readable barcodes, and ability to find containers at both the start and end of the week. We found 63% of personal care products and 87% of the household care products had readable barcodes with 47% and 41% having sufficient data for product identification, respectively and secondly, the amount used could be determined most of the time. We present distributions for amount used by product category and compare inter- and intra-person variability. In summary, our method appears to be appropriate, acceptable, and useful for gathering information related to potential exposures stemming from the use of personal and household care products. A very low drop-out rate suggests that this methodology can be useful in longitudinal studies of exposure to household and personal care products.

Exposures to volatile organic compounds (VOCs) and associated health risks of socio-economically disadvantaged population in a "hot spot" in Camden, New Jersey.

To address disparities in health risks associated with ambient air pollution for racial/ethnic minority groups, this study characterized personal and ambient concentrations of volatile organic compounds (VOCs) in a suspected hot spot of air pollution - the Village of Waterfront South (WFS), and an urban reference community - the Copewood/Davis Streets (CDS) neighborhood in Camden, New Jersey. Both are minority-dominant, impoverished communities. We collected 24-h integrated personal air samples from 54 WFS residents and 53 CDS residents, with one sample on a weekday and one on a weekend day during the summer and winter seasons of 2004-2006. Ambient air samples from the center of each community were also collected simultaneously during personal air sampling. Toluene, ethylbenzene, and xylenes (TEX) presented higher (p < 0.05) ambient levels in WFS than in CDS, particularly during weekdays. A stronger association between personal and ambient concentrations of MTBE and TEX was found in WFS than in CDS. Fourteen to forty-two percent of the variation in personal MTBE, hexane, benzene, and TEX was explained by local outdoor air pollution. These observations indicated that local sources impacted the community air pollution and personal exposure in WFS. The estimated cancer risks resulting from two locally emitted VOCs, benzene and ethylbenzene, and non-cancer neurological and respiratory effects resulting from hexane, benzene, toluene, and xylenes exceeded the US EPA risk benchmarks in both communities. These findings emphasized the need to address disparity in health risks associated with ambient air pollution for the socio-economically disadvantaged groups. This study also demonstrated that air pollution hot spots similar to WFS can provide robust setting to investigate health effects of ambient air pollution.

Volatile organic compounds in small- and medium-sized commercial buildings in California.

While small- and medium-sized commercial buildings (SMCBs) make up 96% of the commercial buildings in the U.S., serving a large variety of uses, little information is available on indoor air quality (IAQ) in SMCBs. This study investigated 37 SMCBs distributed across different sizes, ages, uses, and regions of California. We report indoor concentrations and whole building emission rates of a suite of 30 VOCs and aldehydes in these buildings. There was a considerable range in the concentrations for each of the contaminants, especially for formaldehyde, acetaldehyde, decamethylcyclopentasiloxane, d-limonene, 2-butoxyethanol, toluene, 2,2,4-trimethylpentanediol diisobutyrate, and diethylphthalate. The cause of higher concentrations in some building categories generally corresponded to expected sources, for example, chloroform was higher in restaurants and grocery stores, and formaldehyde was higher in retail stores and offices. Factor analysis suggests sources in SMCBs include automobile/traffic, cleaning products, occupant sources, wood products/coating, and plasticizers. The comparison to health guidelines showed that formaldehyde concentrations were above the chronic RELs required by the OEHHA (9 µg/m³) in 86% of the buildings. Data collected in this study begins to fill the knowledge gap for IAQ in SMCBs and helps us understand the indoor sources of VOCs to further improve indoor air quality in SMCBs.

Residential insecticide usage in northern California homes with young children.

Residential insecticide usage and actual application details were collected in a population-based sample of 477 households residing within 22 counties in northern California with at least one child of age ≤ 5 years between January 2006 and August 2008. Structured telephone interviews were conducted collecting information on residential use of insecticides, including outdoor sprays, indoor sprays, indoor foggers, applications by professionals, and pet flea/tick control during the previous year. Interviews also covered post-treatment behaviors, which influence post-application exposure levels. Altogether, 80% of the households applied some type of insecticide in the previous year, with half of this population using two or more application methods. Of the households using insecticides, half reported applying insecticides relatively infrequently (<4 times per year), whereas 11-13% reported high frequency of use (>24 times per year). Application frequency was temperature dependent, with significantly more applications during the warmer months from May through October. Spot treatments appeared to be the most prevalent application pattern for sprays. For one out of three of the indoor applications, children played in the treated rooms on the day of the application, and for 40% of the outdoor applications, pets played in the treated area on the day of the application. These findings describing the intensity of insecticide use and accompanying behaviors in families with young children may inform future insecticide exposure modeling efforts, and ultimately, risk assessments.

Usage pattern of personal care products in California households.

Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of ∼30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderately correlated, which may impact aggregate exposures. Use frequencies observed in this study were generally in the same range as those reported in the EPA Exposure Factor Handbook, but we found differences for some individual products. Our study provides additional data on population-based usage patterns of a large collection of commonly used personal care products pertaining to several age groups and socio-demographic strata. This information will be valuable for exposure and risk assessments.

Time-location patterns of a population living in an air pollution hotspot.

This study characterized the time-location pattern of 107 residents living in air pollution hotspots, the Waterfront South and Copewood/Davis Streets communities in Camden, NJ. Most residents in the two communities are minority and impoverished individuals. Results showed that employment status played the fundamental role in determining time-location patterns of this study population, and the variations of time-location pattern by season and by day-type were partially attributed to employment status. Compared to the National Human Activity Pattern Survey, the Camden cohort spent significantly more time outdoors (3.8 hours versus 1.8 hours) and less time indoors (19.4 hours versus 20.9 hours) than the general US population, indicating a higher risk of exposure to ambient air pollution for the Camden cohort. The findings of the study are important for understanding exposure routes and sources for the socioeconomically disadvantaged subgroup and ultimately help develop effective strategies to reduce community exposure to ambient air pollution in "hotspots".