Biomonitoring of exposure to Great Lakes contaminants among licensed anglers and Burmese refugees in Western New York: Toxic metals and persistent organic pollutants, 2010-2015.

Between 2010 and 2015, the New York State Department of Health (NYSDOH) conducted a biomonitoring program to gather exposure data on Great Lakes contaminants among licensed anglers and Burmese refugees living in western New York who ate locally caught fish. Four hundred and nine adult licensed anglers and 206 adult Burmese refugees participated in this program. Participants provided blood and urine samples and completed a detailed questionnaire. Herein, we present blood metal levels (cadmium, lead, and total mercury) and serum persistent organic pollutant concentrations [polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), dichlorodiphenyldichloroethylene (DDE), and trans-nonachlor]. Multiple linear regression was applied to investigate the associations between analyte concentrations and indicators of fish consumption (locally caught fish meals, store-bought fish meals, and consuming fish/shellfish in the past week). Licensed anglers consumed a median of 16 locally caught fish meals and 22 store-bought fish meals while Burmese refugees consumed a median of 106 locally caught fish meals and 104 store-bought fish/shellfish meals in the past year. Compared to the general U.S. adult population, licensed anglers had higher blood lead and mercury levels; and Burmese refuges had higher blood cadmium, lead, and mercury, and higher serum DDE levels. Eating more locally caught fish was associated with higher blood lead, blood mercury, and serum ∑PCBs concentrations among licensed anglers. Licensed anglers and Burmese refugees who reported fish/shellfish consumption in the past week had elevated blood mercury levels compared with those who reported no consumption. Among licensed anglers, eating more store-bought fish meals was also associated with higher blood mercury levels. As part of the program, NYSDOH staff provided fish advisory outreach and education to all participants on ways to reduce their exposures, make healthier choices of fish to eat, and waters to fish from. Overall, our findings on exposure levels and fish consumption provide information to support the development and implementation of exposure reduction public health actions.

Biomonitoring of per- and polyfluoroalkyl substances in minority angler communities in central New York State.

Onondaga Lake in central New York State was listed as a Superfund site in 1994 due to industrial disposal of pollutants. A biomonitoring program was conducted to assess exposure to over 70 legacy contaminants and contaminants of emerging concern in populations disproportionately at risk for exposure residing near Onondaga Lake and to educate these communities on how to reduce exposures. The populations of focus were refugees from Burma and Bhutan and low-income, primarily African American, anglers (urban anglers). These communities consume locally caught fish for economic as well as cultural reasons and therefore may be at higher risk of exposure. This study focuses on assessment of exposure to per- and polyfluoroalkyl substances (PFAS) and associations with local fish consumption. Using respondent driven sampling, 311 refugees and 89 urban anglers were enrolled in the study. Following informed consent, study participants provided blood and urine specimens and completed a questionnaire. Percentiles of locally caught fish meals in the past 12 months by race/ethnicity groups showed that the Burmese participants of Karen ethnicity were the highest consumers, with a median of 135 meals compared to 103 meals for the other Burmese participants, 70 meals for the urban anglers, and 44 meals for the Bhutanese participants. Compared to the National Health and Nutrition Examination Survey (NHANES) 2015-16 sample of the general U.S. population, the Karen participants had markedly elevated perfluorooctane sulfonic acid (PFOS) and perfluorodecanoic acid (PFDA) levels with median serum concentrations 9.5 times greater (41.6 ng/mL vs. 4.4 ng/mL) and 26.9 times greater (2.69 ng/mL vs. 0.10 ng/mL), respectively; the other Burmese participants had moderately elevated levels of PFOS and PFDA with median serum concentrations 3.0 times greater (13.3 ng/mL vs. 4.4 ng/mL) and 7.3 greater times greater (0.73 ng/mL vs. 0.10 ng/mL), respectively; and, PFAS levels were not elevated in the Bhutanese or urban angler cohorts. Male gender was consistently the strongest predictor of PFAS exposure among all study cohorts. A positive association between local fish consumption was indicated only for PFOS among urban anglers. An association between local fish consumption and PFAS was not statistically significant among the refugee cohorts, perhaps due to the lack of 'lower-end' exposure or exposure variability. Community events were held by the program staff to present the biomonitoring results and distribute community outreach materials with visual aids specific for the study populations to promote safe fish eating.

Assessing exposures to per- and polyfluoroalkyl substances in two populations of Great Lakes Basin fish consumers in Western New York State.

BACKGROUND: Fish and other seafood are an important dietary source of per- and polyfluoroalkyl substances (PFAS) exposure in many areas of the world, and PFAS were found to be pervasive in fish from the Great Lakes area. Few studies, however, have examined the associations between Great Lakes Basin fish consumption and PFAS exposure. Many licensed anglers and Burmese refugees and immigrants residing in western New York State consume fish caught from the Great Lakes and surrounding waters, raising their risk of exposure to environmental contaminants including PFAS. The aims of this study were to: 1) present the PFAS exposure profile of the licensed anglers and Burmese refugees and 2) examine the associations between serum PFAS levels and local fish consumption. METHODS: Licensed anglers (n = 397) and Burmese participants (n = 199) provided blood samples and completed a detailed questionnaire in 2013. We measured 12 PFAS in serum. Multiple linear regression was used to assess associations between serum PFAS concentrations and self-reported consumption of fish from Great Lakes waters. RESULTS: Licensed anglers and Burmese participants reported consuming a median of 16 (IQR: 6-36) and 88 (IQR: 44-132) meals of locally caught fish in the year before sample collection, respectively (data for Burmese group restricted to 10 months of the year). Five PFAS were detected in almost all study participants (PFOS, PFOA, PFHxS, PFNA and PFDA; 97.5-100%). PFOS had the highest median serum concentration in licensed anglers (11.6 ng/mL) and the Burmese (35.6 ng/mL), approximately two and six times that of the U.S. general population, respectively. Serum levels of other PFAS in both groups were generally low and comparable to those in the general U.S. POPULATION: Among licensed anglers, Great Lakes Basin fish meals over the past year were positively associated with serum PFOS (P < 0.0001), PFDA (P < 0.0001), PFHxS (P = 0.01), and PFNA (P = 0.02) and the number of years consuming locally caught fish was positively associated with serum PFOS (P = 0.01) and PFDA (P = 0.01) levels. In the Burmese group, consuming Great Lakes Basin fish more than three times a week in the past summer was positively associated with serum PFOS (P = 0.004) and PFDA (P = 0.02) among the Burmese of non-Karen ethnicity, but not among those of Karen ethnicity, suggesting potential ethnic differences in PFAS exposure. CONCLUSIONS: Great Lakes Basin fish consumption was associated with an increase in blood concentrations of some PFAS, and especially of PFOS, among licensed anglers and Burmese refugees and immigrants in western New York State. In the Burmese population, there may be other important PFAS exposure routes related to residential history and ethnicity. Continued outreach efforts to increase fish advisory awareness and reduce exposure to contaminants are needed among these populations.

Impact of geo-imputation on epidemiologic associations in a study of outdoor air pollution and respiratory hospitalization.

Imputation of missing spatial attributes in health records may facilitate linkages to geo-referenced environmental exposures, but few studies have assessed geo-imputation impacts on epidemiologic inference. We imputed patient Census tracts in a case-crossover analysis of fine particulate matter (PM2.5) and respiratory hospitalizations in New York State (2000-2005). We observed non-significantly higher PM2.5 exposures, high accuracy of binary exposure assignment (89 to 99%), and marginally different hazard ratios (HRs) (-0.2 to 0.7%). HR differences were greater in urban versus rural areas. Given its efficiency and nominal influence on accuracy of exposure classification and measures of association, geo-imputation is a candidate method to address missing spatial attributes for health studies.

Biomonitoring of populations in Western New York at risk for exposure to Great Lakes contaminants.

The New York State Department of Health conducted the Healthy Fishing Communities Program in collaboration with the Agency for Toxic Substances and Disease Registry to assess human exposure to contaminants common to Lake Ontario, Lake Erie and surrounding rivers and waterways among populations in western New York State who eat locally caught fish. The program enrolled licensed anglers and Burmese refugees and immigrants, living near four designated Great Lakes Areas of Concern: Buffalo River, Niagara River, Eighteenmile Creek, and the Rochester Embayment. These target populations were sampled and enrolled independently into the program between February and October of 2013. A core set of contaminants were measured in blood and urine of 409 licensed anglers and 206 Burmese refugees and immigrants which included lead, cadmium, mercury, PCBs, PBDEs, organochlorine pesticides (hexachlorobenzene, mirex, DDT, DDE, and chlordane and its metabolites oxychlordane and trans-Nonachlor), and PFOS and PFOA. Biomonitoring results showed that both groups had higher geometric means for blood lead, total blood mercury, and serum PFOS compared to the 2013-2014 NHANES reference levels. The Burmese refugee group also showed higher geometric means for creatinine-adjusted urine mercury and lipid-adjusted serum DDE compared to national levels. Licensed angler participants reported eating a median of 16 locally caught fish meals in the past year. Burmese participants consumed local fish throughout the year, and most frequently in the summer (median 39 fish meals or 3 times a week). The study results provide valuable information on populations at high risk of exposure to contaminants in the Great Lakes Basin of western New York. The results provide the foundation for developing and implementing public health actions to reduce potential exposures to Great Lakes pollutants.

Projected Changes in Maternal Heat Exposure During Early Pregnancy and the Associated Congenital Heart Defect Burden in the United States.

Background More intense and longer-lasting heat events are expected in the United States as a consequence of climate change. This study aimed to project the potential changes in maternal heat exposure during early pregnancy (3-8 weeks post conception) and the associated burden of congenital heart defects ( CHD s) in the future. Methods and Results This study expanded on a prior nationwide case-control study that evaluated the association between CHD s and maternal heat exposure during early pregnancy in summer and spring. We defined multiple indicators of heat exposure, and applied published odds ratios obtained for the matching season of the baseline (1995-2005) into the projection period (2025-2035) to estimate potential changes in CHD burden throughout the United States. Increases in maternal heat exposure were projected across the United States and to be larger in the summer. The Midwest will potentially have the highest increase in summer maternal exposure to excessively hot days (3.42; 95% CI, 2.99-3.88 per pregnancy), heat event frequency (0.52; 95% CI, 0.44-0.60) and heat event duration (1.73; 95% CI, 1.49-1.97). We also found large increases in specific CHD subtypes during spring, including a 34.0% (95% CI, 4.9%-70.8%) increase in conotruncal CHD in the South and a 38.6% (95% CI , 9.9%-75.1%) increase in atrial septal defect in the Northeast. Conclusions Projected increases in maternal heat exposure could result in an increased CHD burden in certain seasons and regions of the United States.

Biomonitoring programs in Michigan, Minnesota and New York to assess human exposure to Great Lakes contaminants.

Over the past century, industrialization and urban practices have resulted in the contamination of the Great Lakes ecosystem-the world's largest surface freshwater system-that provides drinking water and recreation to more than 40 million residents. In 2010, the Great Lakes Restoration Initiative was launched to accelerate efforts to protect and restore the Great Lakes and surrounding areas. Funded by GLRI, the Agency for Toxic Substances and Disease Registry initiated the Biomonitoring of Great Lakes Populations (BGLP) program. The objective of the program is to assess human exposure to legacy and emerging contaminants in the Great Lakes by measuring the body burden of contaminants in potentially susceptible populations. The BGLP program consists of a series of cross-sectional studies carried out collaboratively with states that are funded through ATSDR. The first BGLP Program (BGLP-I) began in 2010 and was completed in September 2015 through cooperative agreements with state health departments in Michigan, Minnesota, and New York. The three state programs targeted susceptible adult populations living in designated areas of contamination. Contaminants measured in all populations include mercury, lead, mirex, hexachlorobenzene, dichlorodiphenyltrichloroethane, and selected polychlorinated biphenyl congeners. In addition, some chemicals of emerging concern, such as per- and polyfluoroalkyl substances, were measured in several populations. The biomonitoring results helped guide public health actions to mitigate chemical exposures in these vulnerable Great Lakes populations. We provide an overview of the BGLP-I program's study populations, designs, and general methods. This overview provides a lead-in for subsequent manuscripts that present human biomonitoring data for legacy and emerging contaminants in culturally diverse susceptible populations-i.e., shoreline anglers, sport anglers, American Indians, and Burmese immigrants-residing in seven areas of concern.

Accessibility of cooling centers to heat-vulnerable populations in New York State.

Introduction: Spending a few hours to cool down in a cooling center reduces the impact of heat on health. But limited or lack of accessibility of these facilities is often a barrier to their utilization. The objective of this study was to assess accessibility of the cooling centers to heat-vulnerable populations in New York State (NYS) by various modes of transportation. Methods: We estimate the proximity of 377 cooling centers to general and heat-vulnerable populations in NYS (excluding New York City (NYC)) and determine their accessibility via walking, public transportation and driving. Distances between tract populations and nearest cooling center, and between cooling centers and public transportation stops were estimated. Accessibility in four metropolitan regions was determined via public transportation while accessibility in heat-vulnerable rural areas was estimated via driving. Results: Distances to nearest cooling center ranged from 0 to 53.2 miles with only a third of NYS population within walking distance (0.5 miles) of a cooling center. About 51% of heat-vulnerable tracts were within 0.5 miles, with an average distance of 2.4 miles to the nearest cooling center. Within the four metro politan regions 80% of cooling centers within 0.5 miles of a public transportation stop. All cooling centers in heat-vulnerable tracts were accessible via public transportation. In rural heat-vulnerable tracts, driving distances averaged at about 18 miles. Conclusions: In urban areas many residents were not within walking distance of a cooling center, but most, and nearly all in the most heat-vulnerable areas, were within walking distance of public transportation to a cooling center. In rural locations distances were longer, and accessibility is a greater issue. Cooling centers can be a valuable resource for general and heat-vulnerable populations during an extreme heat event. When planning and implementing cooling centers, it is therefore important to improve accessibility and address other barriers that can hamper their utilization.

A population-based case-control study of the association between weather-related extreme heat events and orofacial clefts.

BACKGROUND: Limited epidemiologic research exists on the association between weather-related extreme heat events (EHEs) and orofacial clefts (OFCs). We estimated the associations between maternal exposure to EHEs in the summer season and OFCs in offspring and investigated the potential modifying effect of body mass index on these associations. METHODS: We conducted a population-based case-control study among mothers who participated in the National Birth Defects Prevention Study for whom at least 1 day of their first two post-conception months occurred during summer. Cases were live-born infants, stillbirths, and induced terminations with OFCs; controls were live-born infants without major birth defects. We defined EHEs using the 95th and the 90th percentiles of the daily maximum universal apparent temperature distribution. We used unconditional logistic regression with Firth's penalized likelihood method to estimate adjusted odds ratios and 95% confidence intervals, controlling for maternal sociodemographic and anthropometric variables. RESULTS: We observed no association between maternal exposure to EHEs and OFCs overall, although prolonged duration of EHEs may increase the risk of OFCs in some study sites located in the Southeast climate region. Analyses by subtypes of OFCs revealed no associations with EHEs. Modifying effect by BMI was not observed. CONCLUSIONS: We did not find a significantly increased risk of OFCs associated with maternal exposure to EHEs during the relevant window of embryogenesis. Future studies should account for maternal indoor and outdoor activities and for characteristics such as hydration and use of air conditioning that could modify the effect of EHEs on pregnant women.

Maternal ambient heat exposure during early pregnancy in summer and spring and congenital heart defects - A large US population-based, case-control study.

BACKGROUND/OBJECTIVE: Few studies have assessed the effect of ambient heat during the fetal development period on congenital heart defects (CHDs), especially in transitional seasons. We examined and compared the associations between extreme heat and CHD phenotypes in summer and spring, assessed their geographical differences, and compared different heat indicators. METHODS: We identified 5848 CHD cases and 5742 controls (without major structural defects) from the National Birth Defects Prevention Study, a US multicenter, population-based case-control study. Extreme heat events (EHEs) were defined by using the 95th (EHE95) or 90th (EHE90) percentile of daily maximum temperature and its frequency and duration during postconceptional weeks 3-8. We used a two-stage Bayesian hierarchical model to examine both regional and study-wide associations. Exposure odds ratios (ORs) were calculated using multivariate logistic regression analyses, while controlling for potential confounding factors. RESULTS: Overall, we observed no significant relationships between maternal EHE exposure and CHDs in most regions during summer. However, we found that 3-11 days of EHE90 during summer and spring was significantly associated with ventricular septal defects (VSDs) study-wide (ORs ranged: 2.17-3.24). EHE95 in spring was significantly associated with conotruncal defects and VSDs in the South (ORs: 1.23-1.78). Most EHE indicators in spring were significantly associated with increased septal defects (both VSDs and atrial septal defects (ASDs)) in the Northeast. CONCLUSION: While generally null results were found, long duration of unseasonable heat was associated with the increased risks for VSDs and ASDs, mainly in South and Northeast of the US. Further research to confirm our findings is needed.

Respondent driven sampling in a biomonitoring study of refugees from Burma in Buffalo, New York who eat Great Lakes fish.

BACKGROUND: Refugees from Burma who consume fish caught from local waterbodies have increased risk of exposure to environmental contaminants. We used respondent driven sampling (RDS) to sample this hard-to-reach population for the first Biomonitoring of Great Lakes Populations program. In the current study, we examined the interview data and assessed the effectiveness of RDS to sample the unique population. METHODS: In 2013, we used RDS to sample 205 Burmese refugees and immigrants residing in Buffalo, New York who consumed fish caught from Great Lakes waters. RDS-adjusted population estimates of sociodemographic characteristics, residential history, fish consumption related behaviors, and awareness of fish advisories were obtained. We also examined sample homophily and equilibrium to assess how well the RDS assumptions were met in the study. RESULTS: Our sample was diverse with respect to sex, age, years residing in Buffalo, years lived in a refugee camp, education, employment, and fish consumption behaviors, and each of these variables reached equilibrium by the end of recruitment. Burmese refugees in Buffalo consumed Great Lakes fish throughout the year; a majority of them consumed the fish more than two times per week during summer, and about one third ate local fish more than once per week in winter. An estimated 60% of Burmese refugees in Buffalo had heard about local fish advisories. CONCLUSIONS: RDS has the potential to be an effective methodology for sampling refugees and immigrants in conducting biomonitoring and environmental exposure assessment. Due to high fish consumption and limited awareness and knowledge of fish advisories, some refugee and immigrant populations are more susceptible to environmental contaminants. Increased awareness on local fish advisories is needed among these populations.

A Spatial Analysis of Acute Myocardial Infarction Rates in New York State in Relation to Hospitals Along State Jurisdictional Borders.

INTRODUCTION: Patients experiencing acute myocardial infarction (AMI) are likely to visit the nearest hospital providing appropriate services since timely care is a critical determinant in the treatment and progression of AMI. We comparatively examined AMI rates in border and nonborder census tracts. The New York State (NYS) Environmental Public Health Tracking (EPHT) program, in conjunction with the Statewide Planning and Research Cooperative System, will work on developing memoranda of understanding with neighboring states to be able to more comprehensively access NYS residents' out-of-state health records. OBJECTIVE: To determine whether AMI rates in the NYS border census tracts differ from AMI rates in nonborder census tracts as a preliminary exploration of the utilization of out-of-state care for acute health conditions by NYS border residents. DESIGN: We reviewed data on inpatient and emergency department visits in NYS with discharge dates from 2005 to 2014 retrospectively. We used the NYS EPHT tier 1 system database to locate hospitals. We geocoded all cases to NYS 2010 census tracts. We mapped differences between border and nonborder tracts and analyzed resulting spatial patterns. We computed tract-level AMI rates and differences between border and nonborder AMI rates. RESULTS: The age-adjusted AMI rates differed by 8.2 cases per 10 000 people (95% confidence interval, 6.94-12.60). Maps showed patterns of differences in AMI rates, especially along the NYS border with New England and other geographically closer out-of-state hospitals. CONCLUSIONS: AMI rates that were geographically closer to out-of-state hospitals were lower, suggesting that people residing in border census tracts are utilizing out-of-state care. Our study adds to literature on the geographical component of health care accessibility and utilization in the context of acute conditions such as AMI and lends impetus to access out-of-state health records to better understand health care facility access and utilization for NYS residents.

Population-based case-control study of the association between weather-related extreme heat events and neural tube defects.

BACKGROUND: Elevated body core temperature has been shown to have teratogenic effects in animal studies. Our study evaluated the association between weather-related extreme heat events (EHEs) in the summer season and neural tube defects (NTDs), and further investigated whether pregnant women with a high pregestational body mass index (BMI) have a greater risk of having a child with NTDs associated with exposure to EHE than women with a normal BMI. METHODS: We conducted a population-based case-control study among mothers of infants with NTDs and mothers of infants without major birth defects, who participated in the National Birth Defects Prevention Study and had at least 1 day of the third or fourth week postconception during summer months. EHEs were defined using the 95th and the 90th percentiles of the daily maximum universal apparent temperature. Adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression models with Firth's penalized likelihood method while controlling for other known risk factors. RESULTS: Overall, we did not observe a significant association between EHEs and NTDs. At the climate region level, consistently elevated but not statistically significant estimates were observed for at least 2 consecutive days with daily universal apparent maximum temperature above the 95th percentile of the UATmax distribution for the season, year, and weather monitoring station in New York (Northeast), North Carolina and Georgia (Southeast), and Iowa (Upper Midwest). No effect modification by BMI was observed. CONCLUSION: EHEs occurring during the relevant developmental window of embryogenesis do not appear to appreciably affect the risk of NTDs. Future studies should refine exposure assessment, and more completely account for maternal activities that may modify the effects of weather exposure. Birth Defects Research 109:1482-1493, 2017.© 2017 Wiley Periodicals, Inc.

Surveying Local Health Departments and County Emergency Management Offices on Cooling Centers as a Heat Adaptation Resource in New York State.

Local agencies in New York State (NYS) set up cooling centers to provide relief from summer-time heat especially for people with limited access to air-conditioning. We aimed to determine cooling center locations in NYS, and explore county agencies' involvement in organizing and promoting utilization of cooling centers. We conducted a survey among county health and emergency preparedness offices in NYS (excluding NYC) and explored official county websites. We identified 377 cooling centers, mostly in metropolitan areas of NYS. Although 47 % of counties listed locations online, only 29 % reported locations via survey. Radio (90 %) and internet (84 %) were popular for information dissemination. Air-conditioning was available at all indoor cooling center facilities. Cooling centers in 13 % of the counties were accessible by either public transportation or shuttles arranged by the facility. About 38 % counties do not consider cooling centers important in their region or promote informal cooling centers. More than a third of New York counties had neither cooling centers nor plans to establish a cooling center as extreme heat was not perceived as a threat in their region.

Seasonal and temperature modifications of the association between fine particulate air pollution and cardiovascular hospitalization in New York state.

It is known that extreme temperature and ambient air pollution are each independently associated with human health outcomes. However, findings from the few studies that have examined modified effects by seasons and the interaction between air pollution and temperature on health endpoints are inconsistent. This study examines the effects of short-term PM2.5 (particulate matter less than or equal to 2.5µm in aerodynamic diameter) on hospitalization for cardiovascular diseases (CVDs), its modifications by season and temperature, and whether these effects are heterogeneous across different regions in New York State (NYS). We used daily average temperature and PM2.5 concentrations as exposure indicators and performed a time series analysis with a quasi-Poisson model, controlling for possible confounders, such as time-relevant variables and dew point, for CVDs in NYS, 1991-2006. Stratification parametric models were applied to evaluate the modifying effects by seasons and temperature. Across the whole year, a 10-µg/m3 increment in PM2.5 concentration accounted for a 1.37% increase in CVDs (95% confidence interval (CI): 0.90%, 1.84%) in New York City, Long Island & Hudson. The PM2.5 effect was strongest in winter, with an additional 2.06% (95% CI: 1.33%, 2.80%) increase in CVDs observed per 10-µg/m3 increment in PM2.5. Temperature modified the PM2.5 effects on CVDs, and these modifications by temperature on PM2.5 effects on CVDs were found at low temperature days. These associations were heterogeneous across four PM2.5 concentration regions. PM2.5 was positively associated with CVD hospitalizations. The short-term PM2.5 effect varied with season and temperature levels, and stronger effects were observed in winter and at low temperature days.

Association Between Low Temperature During Winter Season and Hospitalizations for Ischemic Heart Diseases in New York State.

Most prior research investigating the health effects of extreme cold has been limited to temperature alone. Only a few studies have assessed population vulnerability and compared various weather indicators. The study described in this article intended to evaluate the effects of cold weather on hospital admissions due to ischemic heart disease, especially acute myocardial infarction (AMI), and to examine the potential interactive effects between weather factors and demographics on AMI. The authors found that extremely low universal apparent temperature in winter was associated with increased risk of AMI, especially during lag4-lag6. Certain demographic groups such as the elderly, males, people with Medicaid insurance, people living in warmer areas, and areas with high PM2.5 concentration showed higher vulnerabilities to cold-AMI effects than other groups.

Did summer weather factors affect gastrointestinal infection hospitalizations in New York State?

BACKGROUND: Gastrointestinal infections, a substantial public health problem worldwide, have been associated with single weather factors but the joint effect of multiple weather factors on gastrointestinal infections remains unclear. METHODS: We conducted a retrospective time-series analysis to investigate effects of weather conditions on hospitalizations for gastrointestinal infections (GIH) in New York State in July and August from 1991 to 2004. Applying generalized additive model (GAM), we evaluated the associations between daily GIH count and multiple weather factors including temperature, humidity, and precipitation (0-10 lag days), adjusting for long term trend, seasonality, and calendar effects. RESULTS: Maximum temperature, minimum temperature, and maximum universal apparent temperature (UAT) showed that each °C increase in temperature was significantly associated with an increase (0.70-0.96%) in daily GIH count, with the greatest impacts observed at lag 1. Extreme heat (EH: >90th percentile) (3.68% at lag 1) and precipitation (0.31% at lag 4) showed larger impacts on increases of GIH and a clear dose-response relationship for EH. Stratified analyses showed that the impacts of extreme heat on GIH tend to be greater among Hispanics, blacks, females, and those with bacterial infections. CONCLUSION: We found that high maximum and minimum temperature, UAT, precipitation, and extreme heat in summer significantly increased the risks of GIH in NYS. Our findings also suggest that bacteria might be a significant cause for GIH in the summer, and minority, female and those with bacterial infection may be more vulnerable to heat's effects on GIH.

Respiratory hospitalizations in association with fine PM and its components in New York State.

UNLABELLED: Despite observed geographic and temporal variation in particulate matter (PM)-related health morbidities, only a small number of epidemiologic studies have evaluated the relation between PM2.5 chemical constituents and respiratory disease. Most assessments are limited by inadequate spatial and temporal resolution of ambient PM measurements and/or by their approaches to examine the role of specific PM components on health outcomes. In a case-crossover analysis using daily average ambient PM2.5 total mass and species estimates derived from the Community Multiscale Air Quality (CMAQ) model and available observations, we examined the association between the chemical components of PM (including elemental and organic carbon, sulfate, nitrate, ammonium, and other remaining) and respiratory hospitalizations in New York State. We evaluated relationships between levels (low, medium, high) of PM constituent mass fractions, and assessed modification of the PM2.5-hospitalization association via models stratified by mass fractions of both primary and secondary PM components. In our results, average daily PM2.5 concentrations in New York State were generally lower than the 24-hr average National Ambient Air Quality Standard (NAAQS). Year-round analyses showed statistically significant positive associations between respiratory hospitalizations and PM2.5 total mass, sulfate, nitrate, and ammonium concentrations at multiple exposure lags (0.5-2.0% per interquartile range [IQR] increase). Primarily in the summer months, the greatest associations with respiratory hospitalizations were observed per IQR increase in the secondary species sulfate and ammonium concentrations at lags of 1-4 days (1.0-2.0%). Although there were subtle differences in associations observed between mass fraction tertiles, there was no strong evidence to support modification of the PM2.5-respiratory disease association by a particular constituent. We conclude that ambient concentrations of PM2.5 and secondary aerosols including sulfate, ammonium, and nitrate were positively associated with respiratory hospitalizations, although patterns varied by season. Exposure to specific fine PM constituents is a plausible risk factor for respiratory hospitalization in New York State. IMPLICATIONS: The association between ambient concentrations of PM2.5 components has been evaluated in only a small number of epidemiologic studies with refined spatial and temporal scale data. In New York State, fine PM and several of its constituents, including sulfate, ammonium, and nitrate, were positively associated with respiratory hospitalizations. Results suggest that PM species relationships and their influence on respiratory endpoints are complex and season dependent. Additional work is needed to better understand the relative toxicity of PM species, and to further explore the role of co-pollutant relationships and exposure prediction error on observed PM-respiratory disease associations.

Linking air pollution data and adverse birth outcomes: environmental public health tracking in New York State.

BACKGROUND: Studies investigating associations between ambient air pollution and fetal growth and gestational duration have reported inconclusive findings. OBJECTIVES: The study goal was to use the Environmental Public Health Tracking Network to describe the association between exposure to particulate matter (PM2.5) and ozone and term low birth weight (TLBW) in New York State. METHODS: Birth data for the years 2001-2006 were linked to Census data and hierarchical Bayesian modeled air pollution data. Daily 8-hour maximums for ozone and daily average PM2.5 estimates were averaged by trimester and exposure quartiles. The Environmental Public Health Tracking Academic Center for Excellence at Rutgers University partnered with New York and several other states to create a statistical program that uses logistic regression to determine the association between air pollution exposure and TLBW. RESULTS: There were no consistent dose-response relationships between the pollutants and TLBW. Ozone exposure was associated with a higher risk of TLBW only in the first trimester, but these results were not statistically significant. Exposure to the third quartile of ozone for the full gestational period had negative associations with TLBW (odds ratio = 0.86; 95% confidence interval, 0.81-0.92). CONCLUSION: Collaboration within the Environmental Public Health Tracking Network to share methods and data for research proved feasible and efficient in assessing the relationship of air pollutants to adverse birth outcomes. This study finds little evidence to support positive associations between exposure to ozone or PM2.5 and TLBW in New York State.

Comparison of patterns and knowledge of benefits and warnings of fish consumption between parents and children.

We examined generational differences in fish consumption and knowledge of benefits/warnings of fish consumption among parents and children. This cross-sectional study gathered self-administered questionnaire data, including demographics, fish consumption behavior (including specific fish species) and knowledge of fish consumption warnings and benefits. Fish were later grouped into four categories by potential mercury contamination. Descriptive statistics were conducted for all variables comparing all adults and children. Benefit/risk knowledge variables were also descriptively analyzed among parent-child pairs only. Multivariate Poisson regression was conducted on pairs to assess risk factors for children eating higher mercury fish. 421 adults and 207 children (171 adult-child pairs) participated (family response rate: 71%). Slightly more adults (97.6%) ate fish in the last year than children (92.3%); however, there was no difference between consumption of fish by category of potential mercury contamination. Both adults (44%) and children (45%) ate high-mercury fish. In 71% of parent-child pairs, both the parent and the child knew of benefits of consuming fish; only 31% knew of warnings. Parental consumption of high or moderately-high-mercury fish was related to the child's consumption of fish in the same category. Parents and children need additional education to make better choices about fish consumption. Education should target the family and include specifics about benefits and risks.