Summary of the workshop on methodologies for environmental public health tracking of air pollution effects

The US Centers for Disease Control and Prevention established the Environmental Public Health Tracking (EPHT) program to support state and local projects that characterize the impact of the environment on health. The projects involve compiling, linking, analyzing, and disseminating environmental and health surveillance information, thereby engaging stakeholders and guiding actions to improve public health. One of the EPHT objectives is to track the public health impact of ambient air pollution with analyses that are timely and relevant to state and local stakeholders. To address methodological issues relevant to this objective, in January 2008, government officials and researchers from the USA, Canada, and Europe gathered in Baltimore, Maryland for a 2-day workshop. Using commissioned papers and presentations on key methodological issues as well as examples of previous air pollution impact assessments, work group discussions produced a set of consensus recommendations for the EPHT program. These recommendations noted the need for data that will encourage local stakeholders to support continued progress in air pollution control. The limitations of using only local data for analyses were also noted. To improve local estimates of air pollution health impacts, methods were recommended that “borrow strength” from other evidence. An incremental approach to implementing such methods was recommended. The importance and difficulty of communicating uncertainties in local health impact assessments was emphasized, as was the need for coordination among different agencies conducting health impact assessments

Exposure to traffic pollution, acute inflammation and autonomic response in a panel of car commuters

Background Exposure to traffic pollution has been linked to numerous adverse health endpoints. Despite this, limited data examining traffic exposures during realistic commutes and acute response exists. Objectives: We conducted the Atlanta Commuters Exposures (ACE-1) Study, an extensive panel-based exposure and health study, to measure chemically-resolved in-vehicle exposures and corresponding changes in acute oxidative stress, lipid peroxidation, pulmonary and systemic inflammation and autonomic response. Methods We recruited 42 adults (21 with and 21 without asthma) to conduct two 2-h scripted highway commutes during morning rush hour in the metropolitan Atlanta area. A suite of in-vehicle particulate components were measured in the subjects’ private vehicles. Biomarker measurements were conducted before, during, and immediately after the commutes and in 3 hourly intervals after commutes. Results At measurement time points within 3 h after the commute, we observed mild to pronounced elevations relative to baseline in exhaled nitric oxide, C-reactive-protein, and exhaled malondialdehyde, indicative of pulmonary and systemic inflammation and oxidative stress initiation, as well as decreases relative to baseline levels in the time-domain heart-rate variability parameters, SDNN and rMSSD, indicative of autonomic dysfunction. We did not observe any detectable changes in lung function measurements (FEV1, FVC), the frequency-domain heart-rate variability parameter or other systemic biomarkers of vascular injury. Water soluble organic carbon was associated with changes in eNO at all post-commute time-points (p \u3c 0.0001). Conclusions Our results point to measureable changes in pulmonary and autonomic biomarkers following a scripted 2-h highway commute

Air Pollution–Associated Changes in Lung Function among Asthmatic Children in Detroit

In a longitudinal cohort study of primary-school–age children with asthma in Detroit, Michigan, we examined relationships between lung function and ambient levels of particulate matter ≤ 10 μm and ≤ 2.5 μm in diameter (PM(10) and PM(2.5)) and ozone at varying lag intervals using generalized estimating equations. Models considered effect modification by maintenance corticosteroid (CS) use and by the presence of an upper respiratory infection (URI) as recorded in a daily diary among 86 children who participated in six 2-week seasonal assessments from winter 2001 through spring 2002. Participants were predominantly African American from families with low income, and > 75% were categorized as having persistent asthma. In both single-pollutant and two-pollutant models, many regressions demonstrated associations between higher exposure to ambient pollutants and poorer lung function (increased diurnal variability and decreased lowest daily values for forced expiratory volume in 1 sec) among children using CSs but not among those not using CSs, and among children reporting URI symptoms but not among those who did not report URIs. Our findings suggest that levels of air pollutants in Detroit, which are above the current National Ambient Air Quality Standards, adversely affect lung function of susceptible asthmatic children

Framework for a Community Health Observing System for the Gulf of Mexico Region: Preparing for Future Disasters

© Copyright © 2020 Sandifer, Knapp, Lichtveld, Manley, Abramson, Caffey, Cochran, Collier, Ebi, Engel, Farrington, Finucane, Hale, Halpern, Harville, Hart, Hswen, Kirkpatrick, McEwen, Morris, Orbach, Palinkas, Partyka, Porter, Prather, Rowles, Scott, Seeman, Solo-Gabriele, Svendsen, Tincher, Trtanj, Walker, Yehuda, Yip, Yoskowitz and Singer. The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop

Characterization of personal exposures to ambient and indoor particulate matter among children with asthma in Detroit, Michigan.

The asthma prevalence among children has increased dramatically and has become a growing concern. A large body of epidemiological data has closely linked mortality and morbidity with elevated mass concentrations of ambient particulate matter (PM); many studies have also implicated PM in asthma exacerbation. To date, intensive studies in urban communities of children's exposures to PM together with detailed measures of their asthma status have not been reported. As part of Community Action Against Asthma, a community-based participatory research project in Detroit, MI, two-week seasonal measurement campaigns were conducted from 1999--2002 in which daily ambient and indoor measurements of PM2.5 and PM10 were collected at two elementary schools representing community-level exposure and exposure in the classroom, respectively. Concurrent measurements of PM2.5 and PM10 inside the homes of 20 asthmatic children, and personal measurements of PM10 for the same 20 children using personal exposure monitors, were also performed. Evaluation of the PM for mass and chemical constituents permitted characterization of the sources directly impacting the children's personal exposures, and the data collected in the multiple environments provides us with a greater basis for source comparison. The children recorded spending, on average, 16 hours at home and five hours at school which represents approximately 88% of their day. The children's mean 24-hour personal exposures to PM10 were consistently greater than the concentrations measured in the ambient environment and in the classroom. Similarly, the environments in which the children spent the most time were reflected in the elemental concentrations in the children's personal exposures. The trace element concentration observed among the children in both smoking and non-smoking households were strongly and significantly correlated to their home concentrations. The main sources of the children's PM10 mass were consistently environmental tobacco smoke, secondary sulfate, and windblown dust, which represent more than half of the source-contributed mass and explained a majority of the day-to-day variability that was observed in the mass. Mass measurements helped in characterizing the magnitude of the children's PM exposure, but the addition of elemental composition data enabled us to gain insight into the causes of elevated exposures and the sources that influenced the variability. These data will be extremely useful when ultimately evaluating potential sources that can lead to the exacerbation of asthma symptoms.Ph.D.Environmental scienceHealth and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/124344/2/3137970.pd

Tracking environmental hazards and health outcomes to inform decision-making in the United States

ObjectiveTo increase the availability and accessibility of standardized environmental health data for public health surveillance and decision-making.IntroductionIn 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges in environmental health surveillance described by the Pew Environmental Commission (1). The report cited gaps in our understanding of how the environment affects our health and attributed these gaps to a dearth of surveillance data for environmental hazards, human exposures, and health effects. The Tracking Program’s mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. Accomplishing this mission requires a range of expertise from environmental health scientists to programmers to communicators employing the best practices and latest technical advances of their disciplines. Critical to this mission, the Tracking Program must identify and prioritize what data are needed, address any gaps found, and integrate the data into the network for ongoing surveillance.MethodsThe Tracking Program identifies important environmental health topics with data challenges based on the recommendations in the Pew Commission report as well as input from federal, state, territorial, tribal, and local partners. For each topic, the first step is to formulate the key surveillance question, which includes identifying the decision-maker or end user. Next, available data are evaluated to determine if the data can answer the question and, if not, what enhancements or new data are needed. Standards are developed to establish data requirements and to ensure consistency and comparability. Standardized data are then integrated into the network at national, state, and local levels. Standardized measures are calculated to translate the data into the information needed. These measures are then publically disseminated via national, state, and local web-based portals. Data are updated annually or as they are available and new data are added regularly. All data undergo a multi-step validation process that is semi-automated, routinized, and reproducible.ResultsThe first set of nationally consistent data and measures (NCDM) was released in 2008 and covered 8 environmental health topics. Since then the NCDM have grown to cover 14 topics. Additional standardized data and measures are integrated into the national network resulting in 23 topics with standardized 450 measures (Figure). On the national network, measures can be queried via the Data Explorer, viewed in the info-by-location application, or connected to via the network’s Application Program Interface (API). On average, 15,000 and 3300 queries are run every month on the Data Explorer and the API respectfully. Additional locally relevant data are available on state and local tracking networks.Gaps in data have been addressed through standards for new data collections, models to extend available data, new methodologies for using existing data, and expansion of the utility of non-traditional public health data. For example, the program has collaborated with the Environmental Protection Agency to develop daily estimates of fine particulate matter and ozone for every county in the conterminous US and to develop the first national database of standardized radon testing data. The program also collaborated with the National Aeronautics and Space Administration and its academic partners to transform satellite data into data products for public health.The Tracking Program has analyzed the data to address important gaps in our understanding of the relationship between negative health outcomes and environmental hazards. Data have been used in epidemiologic studies to better quantify the association between fine particulate matter, ozone, wildfire smoke, and extreme heat on emergency department visits and hospitalizations. Results are translated into measures of health burden for public dissemination and can be used to inform regulatory standards and public health interventions.ConclusionsThe scope of the Tracking Program’s mission and the volume of data within the network requires the program to merge traditional public health expertise and practices with current technical and scientific advances. Data integrated into the network can be used to (1) describe temporal and spatial trends in health outcomes and potential environmental exposures, (2) identify populations most affected, (3) generate hypotheses about associations between health and environmental exposures, and (4) develop, guide, and assess the environmental public health policies and interventions aimed at reducing or eliminating health outcomes associated with environmental factors. The program continues to expand the data within the network and the applications deployed for others to access the data. Current data challenges include the need for more temporally and spatially resolved data to better understand the complex relationships between environmental hazards, health outcomes, and risk factors at a local level. National standards are in development for systematically generating, analyzing, and disseminating small area data and real-time data that will allow for comparisons between different datasets over geography and time.References1. Pew Environmental Health Tracking Project Team. America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network. Johns Hopkins School of Hygiene and Public Health, Department of Health Policy and Management; 2000