Urban air pollution and health inequities: a workshop report.

Over the past three decades, an array of legislation with attendant regulations has been implemented to enhance the quality of the environment and thereby improve the public's health. Despite the many beneficial changes that have followed, there remains a disproportionately higher prevalence of harmful environmental exposures, particularly air pollution, for certain populations. These populations most often reside in urban settings, have low socioeconomic status, and include a large proportion of ethnic minorities. The disparities between racial/ethnic minority and/or low-income populations in cities and the general population in terms of environmental exposures and related health risks have prompted the "environmental justice" or "environmental equity" movement, which strives to create cleaner environments for the most polluted communities. Achieving cleaner environments will require interventions based on scientific data specific to the populations at risk; however, research in this area has been relatively limited. To assess the current scientific information on urban air pollution and its health impacts and to help set the agenda for immediate intervention and future research, the American Lung Association organized an invited workshop on Urban Air Pollution and Health Inequities held 22-24 October 1999 in Washington, DC. This report builds on literature reviews and summarizes the discussions of working groups charged with addressing key areas relevant to air pollution and health effects in urban environments. An overview was provided of the state of the science for health impacts of air pollution and technologies available for air quality monitoring and exposure assessment. The working groups then prioritized research needs to address the knowledge gaps and developed recommendations for community interventions and public policy to begin to remedy the exposure and health inequities

How to Address Tobacco Use in Minnesota\u27s Mental Health and Substance Use Disorder Services: Tips from the Field

The American Lung Association, Upper Midwest Region, developed and facilitates the Leadership Academy Collaborative, bringing together various health care stakeholders in Minnesota to collaborate on a shared vision to reduce commercial tobacco use among people living with mental illness and/or substance use disorders. The following areas were identified as strategies that would benefit from further collective action: social norms, delivery, polic

Air pollutants exposure with respiratory symptoms and lung function among primary school children nearby heavy traffic area in Kajang

The high loading of air pollutants in heavy traffic area has urged researcher to pay greater attention as it frequently associated with significant health impact particularly among children. This study aims to determine the association between traffic-related air pollutants and respiratory health among Malay primary school children in heavy traffic area and low traffic area. A cross-sectional comparative study was carried out among Malay children in heavy traffic area (N=69, Kajang) and low traffic area (N=69, Hulu Langat) areas. Air quality monitoring was conducted in 6 primary schools which include parameters of PM10, PM2.5, ultrafine particles(UFP), nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO) and carbon dioxide (CO2). A set of standardized questionnaire was distributed to obtain respondents’ background information, exposure history and respiratory health symptoms. Spirometry test was carried out to determine the lung function of the respondents. Traffic count survey was conducted at two time intervals per day (7.00- 7.30 am and 1.00-1.30 pm). The result showed that there is a significant difference between concentration of PM10 [t=22.37; p≤0.001], PM2.5 [t=9.73; p≤0.001], UFP [Z= -3.36; p=0.001], NO2 [t=5.73; p=0.001], SO2 [t=6.88; p≤0.001] and CO2 [t=15.67; p≤0.001] in school in exposed and comparative area. Lung function abnormalities found in children in exposed area was 3 times higher than comparative area. All respiratory symptoms show significant difference between both exposed and comparative groups. All pollutants show a significant association with lung function abnormality among the respondents. The finding indicated that higher PM10 and PM2.5 will increase the FVC abnormality by 4 and 6 times of getting FVC abnormality and increase the FVC abnormality by 2 and 3 times of getting FEV1 abnormality. The finding concluded that exposures to traffic-related air pollutants, especially PM10, PM2.5 increase the risk of getting lung function abnormality and respiratory health symptoms among respondents

Small median tumor diameter at cure threshold (<20 mm) among aggressive non-small cell lung cancers in male smokers predicts both chest X-ray and CT screening outcomes in a novel simulation framework

The effectiveness of population-wide lung cancer screening strategies depends on the underlying natural course of lung cancer. We evaluate the expected stage distribution in the Mayo CT screening study under an existing simulation model of non-small cell lung cancer (NSCLC) progression calibrated to the Mayo lung project (MLP). Within a likelihood framework, we evaluate whether the probability of 5-year NSCLC survival conditional on tumor diameter at detection depends significantly on screening detection modality, namely chest X-ray and computed tomography. We describe a novel simulation framework in which tumor progression depends on cellular proliferation and mutation within a stem cell compartment of the tumor. We fit this model to randomized trial data from the MLP and produce estimates of the median radiologic size at the cure threshold. We examine the goodness of model fit with respect to radiologic tumor size and 5-year NSCLC survival among incident cancers in both the MLP and Mayo CT studies. An existing model of NSCLC progression under-predicts the number of advanced-stage incident NSCLCs among males in the Mayo CT study (p-value = 0.004). The probability of 5-year NSCLC survival conditional on tumor diameter depends significantly on detection modality (p-value = 0.0312). In our new model, selected solution sets having a median tumor diameter of 16.2ﾖ22.1 mm at cure threshold among aggressive NSCLCs predict both MLP and Mayo CT outcomes. We conclude that the median lung tumor diameter at cure threshold among aggressive NSCLCs in male smokers may be small (<20 mm)

Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review

<p>Abstract</p> <p>Background</p> <p>The primary objective was to systematically review the medical literature for instruments validated for use in epidemiological and clinical research on waterpipe smoking.</p> <p>Methods</p> <p>We searched the following databases: MEDLINE, EMBASE, and ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included papers reporting on the development and/or validation of survey instruments to measure waterpipe tobacco consumption or related concepts. Two reviewers used a standardized and pilot tested data abstraction form to collect data from each eligible study using a duplicate and independent screening process. We also determined the percentage of observational studies assessing the health effects of waterpipe tobacco smoking and the percentage of studies of prevalence of waterpipe tobacco smoking that have used validated survey instruments.</p> <p>Results</p> <p>We identified a total of five survey instruments. One instrument was designed to measure knowledge, attitudes, and waterpipe use among pregnant women and was shown to have internal consistency and content validity. Three instruments were designed to measure waterpipe tobacco consumption, two of which were reported to have face validity. The fifth instrument was designed to measure waterpipe dependence and was rigorously developed and validated. One of the studies of prevalence and none of the studies of health effects of waterpipe smoking used validated instruments.</p> <p>Conclusions</p> <p>A number of instruments for measuring the use of and dependence on waterpipe smoking exist. Future research should study content validity and cross cultural adaptation of these instruments.</p

Comparing the effectiveness of a multi-component weight loss intervention in adults with and without intellectual disabilities

&lt;p&gt;Background: The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi-component weight management programme.&lt;/p&gt; &lt;p&gt;Methods: TAKE 5 is a 16-week multi-component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m–2]. This intervention is an adaption of the weight management programme provided by the Glasgow &#38; Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty-two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.&lt;/p&gt; &lt;p&gt;Results: There were no significant differences between the groups in the amount of weight loss (median: −3.6 versus −3.8 kg, respectively, P = 0.4), change in BMI (median: −1.5 versus −1.4 kg m–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16-week intervention.&lt;/p&gt; &lt;p&gt;Conclusions: A multi-component weight loss intervention can be equally effective for adults with and without ID and obesity.&lt;/p&gt

Family-school connections and internalizing problems among children living with asthma in urban, low-income neighborhoods

Children with asthma living in urban environments are at risk for experiencing internalizing problems and difficulties at school due to social context and health-related stressors. Parent confidence and participation in the school and children’s attitudes about school were explored in association with children’s depressed mood and school anxiety. Forty-five parent—child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed that higher levels of parent confidence in the school were associated with fewer symptoms of school anxiety in children. Children’s attitudes toward school moderated the relation between parent participation in the school and children’s depressed mood. Specifically, lower levels of parent participation were associated with higher levels of depressed mood only for children with the least positive school attitudes. Although preliminary, these results suggest the importance of attending to family—school connections to optimize the school-related psychological functioning of children living with asthma in urban environments