Indoor environment and tobacco smoke exposure in relation to allergic disease and lung function

Asthma and other allergy related diseases are the most common chronic diseases in childhood, and have become a major public health concern. The rapid increase in the occurrence of these diseases, especially in high-income countries, has led to the study of the role ofvarious environmental and lifestyle factors. The overall aim of this thesis was to evaluate the association between indoor environmental factors and the development of allergic diseases in childhood and adolescence, and more specifically, to study the association between tobacco smoke exposure during pre- or postnatal life as well as exposure to indoor mold or dampness and allergic diseases from birth to age 16 years. We used data from the Swedish prospective birth cohort BAMSE (N = 4089) and in study III data from BAMSE combined with four other European birth cohorts (N = 10860). We found that exposure to maternal smoking during pregnancy was associated with asthma up to adolescence, especially early-transient asthma. Additionally, exposure to high doses of maternal smoking during pregnancy (≥10 cigarettes/day) was associated with persistent asthma as well as persistent rhinoconjunctivitis up to age 16 years. Based on spirometry, exposure to maternal smoking during pregnancy was also associated with lower FEV1/FVC ratios at age 16 years. Additionally, indices from impulse oscillometry indicated increased peripheral airway resistance at age 16 years among subjects exposed to maternal smoking during pregnancy. Exposure to secondhand smoke (SHS) during infancy was associated with overall increased risks of asthma, rhinitis, and eczema up to adolescence. However, we found suggestive evidence that the association between SHS during infancy and asthma was likely driven by exposure in utero. Our findings indicate that exposure to SHS during infancy, without prior exposure to maternal smoking during pregnancy, was associated with food allergen sensitization up to age 16 years. Furthermore, exposure to SHS during infancy was associated with increased risks ofrhinitis without concomitant sensitization and eczema with concomitant sensitization. SHS exposure during other periods of childhood was not associated with the onset of asthma or rhinoconjunctivitis in adolescence. Compared with non-smokers, participants who smoked daily or occasionally tended to have reduced FEV1/FVC ratios at age 16 years, even after controlling for maternal smoking during pregnancy. Using indices from impulse oscillometry (IOS) we found increased peripheral airway resistance among adolescent smokers. These findings were corroborated when we used saliva cotinine concentrations to discriminate smokers from non-smokers. Exposure to indicators of mold or dampness during infancy were associated with increased risk of asthma up to age 16 years, as well as an increased risk of persistent asthma. We also found suggestive evidence of an association between reported mold odor or visible mold during infancy and rhinitis up to age 16 years. No association between exposure to indicators of mold or dampness and IgE sensitization was observed. In conclusion, findings from the studies included in this thesis suggest that exposure to maternal smoking during pregnancy is associated with asthma and measures of airway obstruction, such as reduced FEV1/FVC ratios, up to adolescence. Exposure to SHS during infancy seems to be associated with food allergen sensitization and rhinitis up to age 16 years. Adolescent smoking is associated with reduced FEV1/FVC ratios and increased peripheral airway resistance at age 16 years. Exposure to indicators of mold or dampness during infancy may be associated with an increased risk of asthma, and more specifically with persistent asthma up to age 16 years. The results from this thesis can be used to help inform public health policy as well as clinicians to motivate their patients to abstain from smoking. Indoor mold and dampness is a modifiable risk factor related to the onset and persistence of asthma in children and adolescence, and further research should focus on identifying the causal agents

Road traffic noise exposure and filled prescriptions for antihypertensive medication:A danish cohort study

Background: Epidemiological research on effects of transportation noise on incident hypertension is inconsistent. Objectives: We aimed to investigate whether residential road traffic noise increases the risk for hypertension. Methods: In a population-based cohort of 57,053 individuals 50–64 years of age at enrollment, we identified 21,241 individuals who fulfilled our case definition of filling ≥2 prescriptions and ≥180 defined daily doses of antihypertensive drugs (AHTs) within a year, during a mean follow-up time of 14.0 y. Residential addresses from 1987 to 2016 were obtained from national registers, and road traffic noise at the most exposed façade as well as the least exposed façade was modeled for all addresses. Analyses were conducted using Cox proportional hazards models. Results: We found no associations between the 10-y mean exposure to road traffic noise and filled prescriptions for AHTs, with incidence rate ratios (IRRs) of 0.999 [95% confidence intervals (CI): 0.980, 1.019)] per 10-dB increase in road traffic noise at the most exposed façade and of 1.001 (95% CI: 0.977, 1.026) at the least exposed façade. Interaction analyses suggested an association with road traffic noise at the least exposed façade among subpopulations of current smokers and obese individuals. Conclusion: The present study does not support an association between road traffic noise and filled prescriptions for AHTs. https://doi.org/10.1289/EHP627

Residential exposure to transportation noise in Denmark and incidence of dementia:National cohort study

OBJECTIVE: To investigate the association between long term residential exposure to road traffic and railway noise and risk of incident dementia. DESIGN: Nationwide prospective register based cohort study. SETTING: Denmark. PARTICIPANTS: 1 938 994 adults aged ≥60 years living in Denmark between 1 January 2004 and 31 December 2017. MAIN OUTCOME MEASURES: Incident cases of all cause dementia and dementia subtypes (Alzheimer’s disease, vascular dementia, and Parkinson’s disease related dementia), identified from national hospital and prescription registries. RESULTS: The study population included 103 500 participants with incident dementia, and of those, 31 219 received a diagnosis of Alzheimer’s disease, 8664 of vascular dementia, and 2192 of Parkinson’s disease related dementia. Using Cox regression models, 10 year mean exposure to road traffic and railway noise at the most (L(den)max) and least (L(den)min) exposed façades of buildings were associated with a higher risk of all cause dementia. These associations showed a general pattern of higher hazard ratios with higher noise exposure, but with a levelling off or even small declines in risk at higher noise levels. In subtype analyses, both road traffic noise and railway noise were associated with a higher risk of Alzheimer’s disease, with hazard ratios of 1.16 (95% confidence interval 1.11 to 1.22) for road L(den)max ≥65 dB compared with <45 dB, 1.27 (1.22 to 1.34) for road L(den)min ≥55 dB compared with <40 dB, 1.16 (1.10 to 1.23) for railway L(den)max ≥60 dB compared with <40 dB, and 1.24 (1.17 to 1.30) for railway L(den)min ≥50 dB compared with <40 dB. Road traffic, but not railway, noise was associated with an increased risk of vascular dementia. Results indicated associations between road traffic L(den)min and Parkinson’s disease related dementia. CONCLUSIONS: This nationwide cohort study found transportation noise to be associated with a higher risk of all cause dementia and dementia subtypes, especially Alzheimer’s disease

Long-term exposure to transportation noise and risk of incident stroke:A pooled study of nine scandinavian cohorts

BACKGROUND: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse. OBJECTIVE: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population. METHODS: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through link-age to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle con-founders, and air pollution. RESULTS: During follow-up (median = 19:5 y), 11,056 stroke cases were identified. Road traffic noise (Lden ) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for indi-vidual-and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of ≤2:5 lm (PM2:5 ) and NO2 ]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40–50 vs. ≤40 dB) (HR = 1:12; 95% CI: 0.99, 1.27), but not with higher exposure (≥50 dB, HR = 0:94; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke. DISCUSSION: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise. https://doi.org/10.1289/EHP8949

Integrated system dynamics toolbox for water resources planning.

Public mediated resource planning is quickly becoming the norm rather than the exception. Unfortunately, supporting tools are lacking that interactively engage the public in the decision-making process and integrate over the myriad values that influence water policy. In the pages of this report we document the first steps toward developing a specialized decision framework to meet this need; specifically, a modular and generic resource-planning ''toolbox''. The technical challenge lies in the integration of the disparate systems of hydrology, ecology, climate, demographics, economics, policy and law, each of which influence the supply and demand for water. Specifically, these systems, their associated processes, and most importantly the constitutive relations that link them must be identified, abstracted, and quantified. For this reason, the toolbox forms a collection of process modules and constitutive relations that the analyst can ''swap'' in and out to model the physical and social systems unique to their problem. This toolbox with all of its modules is developed within the common computational platform of system dynamics linked to a Geographical Information System (GIS). Development of this resource-planning toolbox represents an important foundational element of the proposed interagency center for Computer Aided Dispute Resolution (CADRe). The Center's mission is to manage water conflict through the application of computer-aided collaborative decision-making methods. The Center will promote the use of decision-support technologies within collaborative stakeholder processes to help stakeholders find common ground and create mutually beneficial water management solutions. The Center will also serve to develop new methods and technologies to help federal, state and local water managers find innovative and balanced solutions to the nation's most vexing water problems. The toolbox is an important step toward achieving the technology development goals of this center

Biomass fuel use and the risk of asthma in Nigerian children

Background: Biomass fuel smoke exposure contributes to respiratory infections in childhood, but its association with asthma has not been established. We studied the relationship of biomass fuel use with asthma symptoms and lung function in Nigerian children. Methods: A cross-sectional study was performed in 299 village children aged 5-11 years in North Central Nigeria. Data were collected regarding the cooking fuels used and duration of daily smoke exposure in the cooking area. Asthma symptoms were assessed with a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and lung function was assessed with spirometry. Results: The prevalence of a lifetime history of wheeze was 9.4% (95% CI: 6.3%-13.2%). Fourteen children (4.7%) had airway obstruction (FEV1/FEV6 <85%). Female subjects had lower FEV1 and FEV6 (110% and 120% percent predicted, respectively) than males (121% and 130%, respectively, P<0.001 for both differences). Advancing age was associated with a relative decline in the predicted value of FEV1 of 7.8% per year (r = -0.61; P < 0.001). Children in families that used firewood daily did not have a significantly increased likelihood of asthma-related symptoms (OR = 2.36, 95% Cl: 0.66-8.44). Similarly, airway obstruction did not differ significantly between children in households that did and did not use firewood daily (mean FEV1/FEV6 of 0.95 and 0.97, respectively; P = 0.41). Conclusion: Reported smoke exposure was not associated with an increased risk of asthma symptoms or airway obstruction. However, lifetime smoke exposure may explain the reduction in spirometric values in female subjects and with advancing age. (C) 2013 Elsevier Ltd. All rights reserved

Maternal smoking during pregnancy and early childhood and development of asthma and rhinoconjunctivitis - a MeDALL Project

BACKGROUND: The role of tobacco smoke exposure in the development and persistence of asthma and rhinoconjunctivitis through childhood into adolescence is unclear. OBJECTIVES: We assessed the associations of parental smoking from fetal life through adolescence with asthma and rhinoconjunctivitis during childhood and adolescence. METHODS: We analyzed data for 10,860 participants of five European birth cohort studies from the Mechanisms of the Development of Allergy (MeDALL) consortium. Parental smoking habits and health outcomes (early transient, persistent, and adolescent-onset asthma and rhinoconjunctivitis) were based on questionnaires covering the period from pregnancy to 14-16 y of age. Data were combined and analyzed using a one-stage and two-stage individual participant data meta-analysis. RESULTS: Overall, any maternal smoking during pregnancy tended to be associated with an increased odds of prevalent asthma [adjusted odds ratio (aOR)=1.19 (95% CI: 0.98, 1.43)], but not prevalent rhinoconjunctivitis [aOR=1.05 (95% CI: 0.90, 1.22)], during childhood and adolescence. In analyses with phenotypes related to age of onset and persistence of disease, any maternal smoking during pregnancy was associated with early transient asthma [aOR=1.79 (95% CI: 1.14, 2.83)]. Maternal smoking of ≥10 cigarettes/day during pregnancy was associated with persistent asthma [aOR=1.66 (95% CI: 1.29, 2.15)] and persistent rhinoconjunctivitis [aOR=1.55 (95% CI, 1.09, 2.20)]. Tobacco smoke exposure during fetal life, infancy, childhood, and adolescence was not associated with adolescent-onset asthma or rhinoconjunctivitis. CONCLUSIONS: Findings from this combined analysis of five European birth cohorts strengthen evidence linking early exposure to tobacco smoke with asthma during childhood and adolescence. Children with high early-life exposure were more likely than unexposed children to have early transient and persistent asthma and persistent rhinoconjunctivitis.This work was supported by Mechanisms of the Development of Allergy (MeDALL), a collaborative project done within the European Union under the Health Cooperation Work Program of the seventh Framework program (grant no. 261357). Funding: The research leading to these results has received funding from the European Community’s Seventh Framework Program [grant no. 261357 (Mechanisms of the Development of Allergy; MeDALL)]

Parental smoking and development of allergic sensitization from birth to adolescence

BACKGROUND: The relation between secondhand tobacco smoke (SHS) exposure and the development of allergic sensitization in children is unclear. The aim of this study was to determine whether maternal smoking during pregnancy and postnatal SHS exposure contributes to the development of allergic sensitization in children and adolescents up to 16 years of age. METHODS: We included 3316 children from a birth cohort followed for 16 years. SHS exposure and symptoms of allergic disease were assessed using repeated parental questionnaires. Serum immunoglobulin E against eight common inhalant and six food allergens was assessed at ages 4, 8, and 16 years with ImmunoCAP. The association between SHS exposure and sensitization was explored using logistic regression and generalized estimating equations. RESULTS: Exposure to SHS in infancy without prior exposure in utero, was associated with an excess risk of food sensitization at age 4 (OR 1.47, 95% CI 1.08-2.00), with comparable ORs at ages 8 and 16 years. In longitudinal analyses, an overall association was indicated between SHS in infancy and food sensitization up to age 16 years (OR 1.24, 95% CI 0.98-1.56). Maternal smoking during pregnancy was unrelated to sensitization up to 16 years of age. When sensitization was combined with concurrent symptoms of allergic disease, SHS in infancy was associated with an overall elevated risk of eczema with sensitization (OR 1.62, 95% CI 1.20-2.18). CONCLUSIONS: SHS exposure in infancy appears to increase the risk of sensitization to food allergens up to age 16 years as well as eczema in combination with sensitization