Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Query Trace: Breysse P[original query] |
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Federal Research Action Plan on Recycled Tire Crumb Used on Playing Fields: Tire Crumb Rubber Characterization and Exposure Characterization Study Overview
Benson K , Irvin-Barnwell E , Ragin-Wilson A , Breysse P . J Environ Health 2019 82 (2) 28-30 As part of our continued effort to highlight innovative approaches to improve the health and environment of communities, the Journal is pleased to publish a bimonthly column from the Agency for Toxic Substances and Disease Registry (ATSDR) at the Centers for Disease Control and Prevention (CDC). ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. The purpose of this column is to inform readers of ATSDR's activities and initiatives to better understand the relationship between exposure to hazardous substances in the environment, its impact on human health, and how to protect public health. The conclusions of this column are those of the author(s) and do not necessarily represent the official position of ATSDR or CDC. Kelsey Benson is an environmental epidemiologist at ATSDR. Elizabeth Irvin-Barnwell currently serves as the acting chief of the Environmental Epidemiology Branch at ATSDR. Angela Ragin-Wilson currently serves as the acting deputy director of the Division of Toxicology and Human Health Sciences at ATSDR. Pat Breysse is the director of CDC's National Center for Environmental Health/ATSDR. |
Welcome to the AJPH supplement on Ubiquitous Lead: Risks, prevention-mitigation programs, and emerging sources of exposure
Breysse P . Am J Public Health 2022 112 S632-s634 As director of the National Center for Environmental Health (NCEH), we are committed to preventing premature death and disease among Americans attributable to current and emerging environmental health hazards. Through science and practice, we promote a healthy environment and prevent premature death, avoidable illness, and disability caused by noninfectious, nonoccupational environmental and related factors. We are especially committed to safeguarding the health of vulnerable populations—such as children, the elderly, and people with disabilities—from certain environmental hazards, such as lead exposure among children. |
Targeting coordinated federal efforts to address persistent hazardous exposures to lead
Breysse PN , Cascio WE , Geller AM , Choiniere CJ , Ammon M . Am J Public Health 2022 112 S640-s646 The Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), the US Food and Drug Administration (FDA), the US Department of Housing and Urban Development (HUD), and other federal agencies are committed to primary and secondary prevention of lead exposure and its adverse health outcomes. Updated national standards, guidance, and coordinated policies combined with abatement, enforcement, remediation, infrastructure replacement, and other lead exposure prevention projects will further reduce the presence of lead in the diets of children and their families and in the places where they live, work, learn, and play. This includes providing resources to support cleanup or removal of remaining lead exposure hazards; identifying the most vulnerable US locations to focus prevention and mitigation efforts through coordinated lead-mapping efforts; targeting blood lead surveillance, education, outreach, and training to the most vulnerable locations; and updating national standards and guidance based on the best available science. We describe how agencies are coordinating their efforts. |
Update of the Blood Lead Reference Value - United States, 2021
Ruckart PZ , Jones RL , Courtney JG , LeBlanc TT , Jackson W , Karwowski MP , Cheng PY , Allwood P , Svendsen ER , Breysse PN . MMWR Morb Mortal Wkly Rep 2021 70 (43) 1509-1512 The negative impact of lead exposure on young children and those who become pregnant is well documented but is not well known by those at highest risk from this hazard. Scientific evidence suggests that there is no known safe blood lead level (BLL), because even small amounts of lead can be harmful to a child's developing brain (1). In 2012, CDC introduced the population-based blood lead reference value (BLRV) to identify children exposed to more lead than most other children in the United States. The BLRV should be used as a guide to 1) help determine whether medical or environmental follow-up actions should be initiated for an individual child and 2) prioritize communities with the most need for primary prevention of exposure and evaluate the effectiveness of prevention efforts. The BLRV is based on the 97.5th percentile of the blood lead distribution in U.S. children aged 1-5 years from National Health and Nutrition Examination Survey (NHANES) data. NHANES is a complex, multistage survey designed to provide a nationally representative assessment of health and nutritional status of the noninstitutionalized civilian adult and child populations in the United States (2). The initial BLRV of 5 μg/dL, established in 2012, was based on data from the 2007-2008 and 2009-2010 NHANES cycles. Consistent with recommendations from a former advisory committee, this report updates CDC's BLRV in children to 3.5 μg/dL using NHANES data derived from the 2015-2016 and 2017-2018 cycles and provides helpful information to support adoption by state and local health departments, health care providers (HCPs), clinical laboratories, and others and serves as an opportunity to advance health equity and environmental justice related to preventable lead exposure. CDC recommends that public health and clinical professionals focus screening efforts on populations at high risk based on age of housing and sociodemographic risk factors. Public health and clinical professionals should collaborate to develop screening plans responsive to local conditions using local data. In the absence of such plans, universal BLL testing is recommended. In addition, jurisdictions should follow the Centers for Medicare & Medicaid Services requirement that all Medicaid-enrolled children be tested at ages 12 and 24 months or at age 24-72 months if they have not previously been screened (3). |
Per- and Polyfluoroalkyl Substances Multi-Site Study
Uzochukwu C , Weems M , Pavuk M , Bove F , Reh C , Breysse P . J Environ Health 2021 84 (3) 34-37 The article provides information on the health effects of drinking water exposed to per- and polyfluoroalkyl substances (PFAS). Topics include the Multi-Site Study (MSS) of the Health Implications of Exposure to PFAS-Contaminated Drinking Water, the establishment of pharmacokinetic modeling and historical reconstruction work groups, and the community engagement efforts to provide answers regarding the potential effects of elevated PFAS level on public health. |
Approaching climate change: The role of state and territorial health agencies
Breysse P , Dolan K , Schramm P , Plescia M . J Public Health Manag Pract 2021 27 (6) 615-617 Climate impacts on human health are an urgent public health issue. The effects of climate change are clear. During the past several years, states and territories have wrestled with extreme temperatures, historic rains and flooding, and the worst wildfire and drought conditions ever recorded. These events have become more severe, more frequent, and more costly in recent years.1 | | State and territorial health agencies (S/THAs), as well as local and tribal health departments, must be prepared for the inevitability of climate-related impacts on human health. They can take direct action in areas where they have authority, and they can help influence other policy actions that protect health. While responsibility for setting and enforcing federal environmental policy largely falls to the US Environmental Protection Agency (EPA) and other federal agencies, state and local agencies can play a significant role in advancing policy. An example of such local authority is actions taken by state governments to move toward 100% clean energy.2–5 These actions have led to more far-reaching and ambitious regulations than those established by the federal government. S/THAs can continue to take similarly bold, progressive action and work toward mitigating impacts of a changing climate based on sound science and public health impact. In this column, we outline a technical package of capacity building and policy interventions for state and territorial health officials (S/THOs) to address the range of health impacts associated with climate change. |
Randomized clinical trial of air cleaners to improve indoor air quality and COPD health: results of the Clean Air Study
Hansel NN , Putcha N , Woo H , Peng R , Diette GB , Fawzy A , Wise RA , Romero K , Davis MF , Rule AM , Eakin MN , Breysse PN , McCormack MC , Koehler K . Am J Respir Crit Care Med 2021 205 (4) 421-430 RATIONALE: Indoor particulate matter is associated with worse COPD outcomes. It remains unknown whether reductions of indoor pollutants improve respiratory morbidity. METHODS: Eligible former smokers with moderate-severe COPD received active or sham portable HEPA air cleaners and followed for six months in this blinded randomized controlled trial. The primary outcome was six-month change in Saint George's Respiratory Questionnaire (SGRQ). Secondary outcomes were exacerbation risk, respiratory symptoms, rescue medication use and 6MWD. Intention to treat analysis included all subjects and per protocol analysis included adherent participants (greater than 80% use of air cleaner). MAIN RESULTS: 116 participants were randomized of which 84.5% completed study. There was no statistically significant difference in total SGRQ score, but the active filter group had greater reduction in SGRQ symptom subscale (ß -7.7 [95% CI, -15.0 to -0.37]) and respiratory symptoms (BCSS, ß -0.8 [95% CI, -1.5 to -0.1); and lower rate of moderate exacerbations (IRR 0.32 [95% CI, 0.12-0.91]) and rescue medication use (IRR 0.54 [95% CI, 0.33-0.86]) compared to sham group (all p<0.05). In per protocol analysis, there was statistically significant difference in primary outcome between the active filter vs. sham group (SGRQ β-4.76 [95% CI, -9.2 to -0.34]) and in moderate exacerbation risk, BCSS and 6MWD. Participants spending more time indoors were more likely to have treatment benefit. CONCLUSIONS: This is the first environmental intervention study conducted among former smokers with COPD showing potential health benefits of portable HEPA air cleaners, particularly among those with greater adherence and spending a greater time indoors. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02236858. |
Heat-Related Emergency Department Visits During the Northwestern Heat Wave - United States, June 2021
Schramm PJ , Vaidyanathan A , Radhakrishnan L , Gates A , Hartnett K , Breysse P . MMWR Morb Mortal Wkly Rep 2021 70 (29) 1020-1021 Record high temperatures are occurring more frequently in the United States, and climate change is causing heat waves to become more intense (1), directly impacting human health, including heat-related illnesses and deaths. On average, approximately 700 heat-related deaths occur in the United States each year (2). In the northwestern United States, increasing temperatures are projected to cause significant adverse health effects in the coming years (3). During June 25-30, 2021, most of Oregon and Washington were under a National Weather Service excessive heat warning.* Hot conditions persisted in parts of Oregon, Washington, or Idaho through at least July 14, 2021. The record-breaking heat had the largest impact in Oregon and Washington, especially the Portland metropolitan area, with temperatures reaching 116°F (46.7°C), which is 42°F (5.6°C) hotter than the average daily maximum June temperature. |
Advancing per- and polyfluoroalkyl substances (PFAS) research: an overview of ATSDR and NCEH activities and recommendations
Rogers RD , Reh CM , Breysse P . J Expo Sci Environ Epidemiol 2021 31 (6) 1-11 The National Center for Environmental Health (NCEH), part of the Centers for Disease Control and Prevention (CDC), and the Agency for Toxic Substances and Disease Registry (ATSDR) support and conduct research advancing national, state, and local public health response to per- and polyfluoroalkyl substances (PFAS). PFAS are a group of manufactured chemicals used in industry and consumer products that persist in the environment. Given the growing evidence linking PFAS with adverse health effects in humans, NCEH and ATSDR developed a public health research framework to capture the broad range of PFAS research activities being conducted and supported by the agency to determine future research priorities and identify opportunities for interagency collaboration. The framework was conceptualized via a multidisciplinary visioning process designed to identify compelling questions and research activities that span five scientific domains: toxicology, exposure, human health, public health action, and cross-cutting priorities. This paper presents a framework, compelling questions and research activities to help NCEH and ATSDR advance scientific discovery in partnership with federal, state, and local stakeholders as part of a comprehensive public health response to PFAS contamination. |
Cardiopulmonary impact of particulate air pollution in high-risk populations: JACC State-of-the-Art Review
Newman JD , Bhatt DL , Rajagopalan S , Balmes JR , Brauer M , Breysse PN , Brown AGM , Carnethon MR , Cascio WE , Collman GW , Fine LJ , Hansel NN , Hernandez A , Hochman JS , Jerrett M , Joubert BR , Kaufman JD , Malik AO , Mensah GA , Newby DE , Peel JL , Siegel J , Siscovick D , Thompson BL , Zhang J , Brook RD . J Am Coll Cardiol 2020 76 (24) 2878-2894 Fine particulate air pollution <2.5 μm in diameter (PM(2.5)) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM(2.5) as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM(2.5) can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention. |
Association of long-term ambient ozone exposure with respiratory morbidity in smokers
Paulin LM , Gassett AJ , Alexis NE , Kirwa K , Kanner RE , Peters S , Krishnan JA , Paine R3rd , Dransfield M , Woodruff PG , Cooper CB , Barr RG , Comellas AP , Pirozzi CS , Han M , Hoffman EA , Martinez FJ , Woo H , Peng RD , Fawzy A , Putcha N , Breysse PN , Kaufman JD , Hansel NN . JAMA Intern Med 2019 180 (1) 106-115 Importance: Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history. Objective: To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. Design, Setting, and Participants: This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (>/=20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis. Exposures: The 10-year mean historical ambient ozone concentration at participants' residences estimated by cohort-specific spatiotemporal modeling. Main Outcomes and Measures: Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure. Results: A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (beta = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (beta = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (beta = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (beta = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (beta = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (beta = -2.50; 95% CI, -4.42 to -0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result. Conclusions and Relevance: This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population. |
Notes from the Field: Targeted Biomonitoring for GenX and Other Per- and Polyfluoroalkyl Substances Following Detection of Drinking Water Contamination - North Carolina, 2018
Pritchett JR , Rinsky JL , Dittman B , Christensen A , Langley R , Moore Z , Fleischauer AT , Koehler K , Calafat AM , Rogers R , Esters L , Jenkins R , Collins F , Conner D , Breysse P . MMWR Morb Mortal Wkly Rep 2019 68 (29) 647-648 In June 2017, local health departments asked the North Carolina Department of Health and Human Services (NCDHHS) to provide health information and guidance regarding 2,3,3,3,-tetrafluoro-2-(1,1,2,2,3,3,3-heptafluoropropoxy)-propanoate (GenX) and other per- and polyfluoroalkyl substances (PFAS) that had been detected in the Cape Fear River, an important drinking water source (1). PFAS are a group of man-made chemicals that have been used in industry and consumer products worldwide since the 1950s. Most PFAS do not break down in the environment and can accumulate over time, resulting in increased human exposures. Limited studies in humans have indicated that some PFAS might affect reproduction, development, and the immune system and increase the risk for certain types of cancer (2). The source of GenX and other PFAS contamination in the Cape Fear River was a PFAS chemical manufacturing facility. After further investigation, the North Carolina Department of Environmental Quality identified GenX and other PFAS in surface water, air, and private wells close to the facility. As of April 2018, 837 private wells within a 5-mile radius of the facility had been tested; 207 (25%) had GenX levels exceeding the NCDHHS provisional drinking water health goal of 140 parts per trillion (ppt),* with a maximum measured GenX concentration of 4,000 ppt. The manufacturer began providing bottled water to residents living in homes with a well that exceeded the NCDHHS provisional drinking water health goal. In August 2018, NCDHHS worked with local health departments and asked CDC to quantify GenX and other PFAS in serum and urine specimens from a convenience sample of residents near the facility. |
Lead elimination for the 21st century
Breysse PN . J Public Health Manag Pract 2019 25 S3-s4 Now is the time to eliminate lead from children’s environments. | | Lead exposure—which can inhibit brain development—poses a significant health threat to hundreds of thousands of American children.1 | | Over time, scientific evidence has accumulated and no safe level of lead for children has been identified. Why then has the elimination of lead hazards in the environment not been more of a priority for society as a whole? Lead poisoning is the longest-lasting childhood epidemic in the United States and has never been treated as one. |
Association of obesity with hearing impairment in adolescents
Scinicariello F , Carroll Y , Eichwald J , Decker J , Breysse PN . Sci Rep 2019 9 (1) 1877 Hearing loss (HL) is the third most common chronic physical condition in the United States. Obesity has become an increasingly important public health concern, as the prevalence in children, adolescents and adults has increased over the past few decades. The objectives of this study is to investigate whether obesity is associated with audiometric notches indicative of noise-induced hearing loss (NIHL), speech frequency hearing loss (SFHL), and high frequency hearing loss (HFHL) in adolescent participants of the National Health and Nutrition Examination Survey 2007-2010. The prevalence of overall audiometric notches in the adolescent population was 16.0% with higher prevalence in females than males. The prevalence of SFHL and HFHL were higher in males than females (SFHL, 7.3% vs. 5.4%, respectively; and HFHL 14.3% vs. 8.1%, respectively). Obese adolescents had a higher adjusted OR to have audiometric notches (OR = 1.93; 95% CI: 1.33-2.81) and HFHL (OR = 1.95; 95% CI: 1.19-3.21). Continued preventative efforts towards reducing obesity might also help to reduce the risk for HL and NIHL. |
The Flint Water Crisis: A coordinated public health emergency response and recovery initiative
Ruckart PZ , Ettinger AS , Hanna-Attisha M , Jones N , Davis SI , Breysse PN . J Public Health Manag Pract 2019 25 S84-s90 CONTEXT: The City of Flint was already distressed because of decades of financial decline when an estimated 140 000 individuals were exposed to lead and other contaminants in drinking water. In April 2014, Flint's drinking water source was changed from Great Lakes' Lake Huron (which was provided by the Detroit Water and Sewerage Department) to the Flint River without necessary corrosion control treatment to prevent lead release from pipes and plumbing. Lead exposure can damage children's brains and nervous systems, lead to slow growth and development, and result in learning, behavior, hearing, and speech problems. After the involvement of concerned residents and independent researchers, Flint was reconnected to the Detroit water system on October 16, 2015. A federal emergency was declared in January 2016. PROGRAM: The Centers for Disease Control and Prevention provided assistance and support for response and recovery efforts including coordinating effective health messaging; assessing lead exposure; providing guidance on blood lead screening protocols; and identifying and linking community members to appropriate follow-up services.In response to the crisis in Flint, Congress funded the Centers for Disease Control and Prevention to establish a federal advisory committee; enhance Childhood Lead Poisoning Prevention Program activities; and support a voluntary Flint lead exposure registry. The registry, funded through a grant to Michigan State University, is designed to identify eligible participants and ensure robust registry data; monitor health, child development, service utilization, and ongoing lead exposure; improve service delivery to lead-exposed individuals; and coordinate with other community and federally funded programs in Flint. The registry is also collaborating to make Flint "lead-free" and to share best practices with other communities. DISCUSSION: The Flint water crisis highlights the need for improved risk communication strategies, and environmental health infrastructure, enhanced surveillance, and primary prevention to identify and respond to environmental threats to the public's health. Collecting data is important to facilitate action and decision making to prevent lead poisoning. Partnerships can help guide innovative strategies for primary lead prevention, raise awareness, extend outreach and communication efforts, and promote a shared sense of ownership. |
Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees
Kaplan B , Sussan T , Rule A , Moon K , Grau-Perez M , Olmedo P , Chen R , Carkoglu A , Levshin V , Wang L , Watson C , Blount B , Calafat AM , Jarrett J , Caldwell K , Wang Y , Breysse P , Strickland P , Cohen J , Biswal S , Navas-Acien A . Environ Int 2019 127 495-502 INTRODUCTION: Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. METHOD: We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. RESULTS: Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. CONCLUSION: Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees. |
Age and sex differences in hearing loss association with depressive symptoms: analyses of NHANES 2011-2012
Scinicariello F , Przybyla J , Carroll Y , Eichwald J , Decker J , Breysse PN . Psychol Med 2018 49 (6) 1-7 BACKGROUND: Depression is a common and significant health problem. Hearing loss is the third most common chronic physical condition in the USA and might be a factor in depression. To determine whether hearing loss is associated with depressive symptoms in US adults ages 20-69 years. METHODS: National Health and Nutrition Examination Survey (NHANES) data (2011-2012) were used to assess the potential relationship between hearing loss and depression, in adults (20-69 years) who answered the Patient Health Questionnaire (PHQ-9) depression screening module, with pure tone audiometry measurements, and complete information on the co-variates data (n = 3316). The degree of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) were defined as slight/mild hearing loss 26-40 dB; moderate/worse hearing loss 41 dB by pure tone audiometry examination. RESULTS: Moderate/worse HFHL was statistically significantly associated with depressive symptoms (OR 1.54, 95% CL 1.04-2.27) when the analyses were conducted among all participants. Further stratification by gender and age groups found that moderate/worse HFHL (OR 3.85, 95% CL 1.39-10.65) and moderate/worse SFHL (OR 5.75, 95% CL 1.46-22.71) were associated with depressive symptoms in women ages 52-69 years. CONCLUSIONS: Moderate/worse speech frequency and HFHL are associated with depression in women ages 52-69 years, independent of other risk factors. Hearing screenings are likely to reduce delays in diagnosis and provide early opportunities for noise prevention counseling and access to hearing aids. Health professionals should be aware of depressive signs and symptoms in patients with hearing loss. |
Loud noise: Too loud, too long!
Eichwald J , Carroll Y , Breysse P . J Environ Health 2018 80 (8) 34-35 The article discusses the relationship between exposure to hazardous substances in the environment and their impact on human health and how to protect public health. Topics mentioned include a hearing loss campaign launched by the U.S. Centers for Disease Control and Prevention in February 2017, the National Health and Nutrition Examination Survey, and the 1999 Guidelines for Community Noise by the World Health Organization. |
Vital Signs: Asthma in children - United States, 2001-2016
Zahran HS , Bailey CM , Damon SA , Garbe PL , Breysse PN . MMWR Morb Mortal Wkly Rep 2018 67 (5) 149-155 BACKGROUND: Asthma is the most common chronic lung disease of childhood, affecting approximately 6 million children in the United States. Although asthma cannot be cured, most of the time, asthma symptoms can be controlled by avoiding or reducing exposure to asthma triggers (allergens and irritants) and by following recommendations for asthma education and appropriate medical care. METHODS: CDC analyzed asthma data from the 2001-2016 National Health Interview Survey for children aged 0-17 years to examine trends and demographic differences in health outcomes and health care use. RESULTS: Asthma was more prevalent among boys (9.2%) than among girls (7.4%), children aged >/=5 years (approximately 10%) than children aged <5 years (3.8%), non-Hispanic black (black) children (15.7%) and children of Puerto Rican descent (12.9%) than among non-Hispanic white (white) children (7.1%), and children living in low income families (10.5%) than among those living in families with income >/=250% of the Federal Poverty Level (FPL) (approximately 7%). Asthma prevalence among children increased from 8.7% in 2001 to 9.4% in 2010, and then decreased to 8.3% in 2016. Although not all changes were statistically significant, a similar pattern was observed among subdemographic groups studied, with the exception of Mexican/Mexican-American children, among whom asthma prevalence increased from 5.1% in 2001 to 6.5% in 2016. Among children with asthma, the percentage who had an asthma attack in the past 12 months declined significantly from 2001 to 2016. Whereas asthma prevalence was lower among children aged 0-4 years than among older children, the prevalence of asthma attacks (62.4%), emergency department or urgent care center (ED/UC) visits (31.1%), and hospitalization (10.4%) were higher among children with asthma aged 0-4 years than among those aged 12-17 years (44.8%, 9.6%, and 2.8%, respectively). During 2013, children with asthma aged 5-17 years missed 13.8 million days of school per year (2.6 days per child). Compared with 2003, in 2013, the prevalence of adverse health outcomes and health care use were significantly lower and the prevalence of having an action plan to manage asthma was higher. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Asthma remains an important public health and medical problem. The health of children with asthma can be improved by promoting asthma control strategies, including asthma trigger reduction, appropriate guidelines-based medical management, and asthma education for children, parents, and others involved in asthma care. |
Protecting young children from tobacco smoke exposure: A pilot study of Project Zero Exposure
Rosen L , Guttman N , Myers V , Brown N , Ram A , Hovell M , Breysse P , Rule A , Berkovitch M , Zucker D . Pediatrics 2018 141 S107-s117 BACKGROUND: Tobacco smoke exposure (TSE) harms children, who are often "captive smokers" in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014. METHODS: The intervention consisted of motivational interviews, child biomarker and home air quality feedback, a Web site, a video, and self-help materials. The primary outcome was child TSE as measured by hair nicotine. Secondary outcome measures were air nicotine and particulate matter, parental reports of TSE, parental smoking behavior, and TSE child protection. A single-group pre- and posttest design was used. RESULTS: Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine. CONCLUSIONS: A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions. |
24-h Nitrogen dioxide concentration is associated with cooking behaviors and an increase in rescue medication use in children with asthma
Paulin LM , Williams D'L , Peng R , Diette GB , McCormack MC , Breysse P , Hansel NN . Environ Res 2017 159 118-123 Exposure to nitrogen dioxide (NO2), a byproduct of combustion, is associated with poor asthma control in children. We sought to determine whether gas-fueled kitchen appliance use is associated with 24-h indoor NO2 concentrations and whether these concentrations are associated with asthma morbidity in children. Children aged 5-12 years old with asthma were eligible. Mean 24-h NO2 concentration was measured in the kitchen over a four-day sampling period and gas stove use was captured in time activity diaries. The relationship between stove and oven use and daily NO2 concentration was analyzed. Longitudinal analysis assessed the effect of daily NO2 exposure on symptoms, inhaler use, and lung function. Multivariate models were adjusted for age, sex, season, and maternal education. Thirty children contributed 126 participant days of sampling. Mean indoor 24-h NO2 concentration was 58(48)ppb with a median (range) of 45(12-276)ppb. All homes had gas stoves and furnaces. Each hour of kitchen appliance use was associated with an 18ppb increase in 24-h NO2 concentration. In longitudinal multivariate analysis, each ten-fold increase in previous-day NO2 was associated with increased nighttime inhaler use (OR = 4.9, p = 0.04). There were no associations between NO2 and lung function or asthma symptoms. Higher previous-day 24-h concentration of NO2 is associated with increased nighttime inhaler use in children with asthma. |
Design of the subpopulations and intermediate outcome measures in COPD (SPIROMICS) AIR study
Hansel NN , Paulin LM , Gassett AJ , Peng RD , Alexis N , Fan VS , Bleecker E , Bowler R , Comellas AP , Dransfield M , Han MK , Kim V , Krishnan JA , Pirozzi C , Cooper CB , Martinez F , Woodruff PG , Breysse PJ , Graham Barr R , Kaufman JD . BMJ Open Respir Res 2017 4 (1) e000186 Introduction Population-based epidemiological evidence suggests that exposure to ambient air pollutants increases hospitalisations and mortality from chronic obstructive pulmonary disease (COPD), but less is known about the impact of exposure to air pollutants on patient-reported outcomes, morbidity and progression of COPD. Methods and analysis The Subpopulations and Intermediate Outcome Measures in COPD (SPIROMICS) Air Pollution Study (SPIROMICS AIR) was initiated in 2013 to investigate the relation between individual-level estimates of short-term and long-term air pollution exposures, day-to-day symptom variability and disease progression in individuals with COPD. SPIROMICS AIR builds on a multicentre study of smokers with COPD, supplementing it with state-of-the-art air pollution exposure assessments of fine particulate matter, oxides of nitrogen, ozone, sulfur dioxide and black carbon. In the parent study, approximately 3000 smokers with and without airflow obstruction are being followed for up to 3 years for the identification of intermediate biomarkers which predict disease progression. Subcohorts undergo daily symptom monitoring using comprehensive daily diaries. The air monitoring and modelling methods employed in SPIROMICS AIR will provide estimates of individual exposure that incorporate residence-specific infiltration characteristics and participant-specific time-activity patterns. The overarching study aim is to understand the health effects of short-term and long-term exposures to air pollution on COPD morbidity, including exacerbation risk, patient-reported outcomes and disease progression. Ethics and dissemination The institutional review boards of all the participating institutions approved the study protocols. The results of the trial will be presented at national and international meetings and published in peer-reviewed journals. Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. |
Vital Signs: Noise-induced hearing loss among adults - United States 2011-2012
Carroll YI , Eichwald J , Scinicariello F , Hoffman HJ , Deitchman S , Radke MS , Themann CL , Breysse P . MMWR Morb Mortal Wkly Rep 2017 66 (5) 139-144 INTRODUCTION: The 2016 National Academies of Sciences report "Hearing Health Care for Adults: Priorities for Improving Access and Affordability" included a call to action for government agencies to strengthen efforts to collect, analyze, and disseminate population-based data on hearing loss in adults. METHODS: CDC analyzed the most recent available data collected both by questionnaire and audiometric tests of adult participants aged 20-69 years in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) to determine the presence of audiometric notches indicative of noise-induced hearing loss. Prevalence of both unilateral and bilateral audiometric notches and their association with sociodemographics and self-reported exposure to loud noise were calculated. RESULTS: Nearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Noise-induced hearing loss is a significant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss. |
The importance of housing for healthy populations and communities
Breysse PN , Gant JL . J Public Health Manag Pract 2017 23 (2) 204-206 In this issue, 3 articles summarize the impact of acomprehensive, multisite healthy homes initiative(New York State Healthy Neighborhoods Pro-gram [HNP]) on overall housing-related conditions,as well as asthma health outcomes and costs, andremind us of the importance of housing to healthypopulations and communities. Housing has long beenrecognized as a key health determinant.1,2As earlyas 1938, the American Public Health Association(APHA) published a book on basic principles ofhealthy housing.3More recently, the National Cen-ter for Healthy Housing, along with APHA, publishedan updated National Healthy Homes Standard.4In2009, the US Surgeon General issued aCall to Ac-tion to Promote Healthy Homesthat addressed wayshousing can affect health, highlighting the importanceof healthy homes.5This was followed in 2013 bythe release of a federal strategy,Advancing HealthyHousing: A Strategy for Action,6that includes a vi-sion statement of “Substantially reduce the numberof American homes with health and safety hazards,”and which identifies multiple actions to accelerate thecreation of healthy housing. In a 2011 analysis, theCenters for Disease Control and Prevention (CDC) es-timated that 5.2% (5.8 million) of housing units inthe United States were classified as inadequate and23.4 million housing units were considered unhealthy,based on data collected as part of the American Hous-ing Survey.6That article also identified key racial,educational, and economic disparities in access to adequate housing. While a number of specific hous-ing interventions have been shown to reduce diseaseand injury in residents, getting wide adoption of theseinterventions has proven difficult. Efforts to increaseaccess to healthy housing can have significant healthand economic impact, as highlighted in the articlespresented in this issue |
Respiratory effects of indoor heat and the interaction with air pollution in COPD
McCormack MC , Belli AJ , Waugh D , Matsui EC , Peng RD , Williams D , Paulin L , Saha A , Aloe CM , Diette GB , Breysse PN , Hansel NN . Ann Am Thorac Soc 2016 13 (12) 2125-2131 RATIONALE: There is limited evidence of the effect of exposure to heat on COPD morbidity and the interactive effect between indoor heat and air pollution has not been established. OBJECTIVES: To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature. METHODS: Sixty-nine participants with COPD were enrolled in a longitudinal cohort study and data from the 601 participant days that occurred during the warm weather season were included in the analysis. Participants completed home environmental monitoring with measurement of temperature, relative humidity, and indoor air pollutants and simultaneous daily assessment of respiratory health with questionnaires and portable spirometry. MEASUREMENTS AND MAIN RESULTS: Participants had moderate to severe COPD and spent the majority of their time indoors. Increases in maximum indoor temperature were associated with worsening of daily Breathlessness, Cough, and Sputum Scores (BCSS) and increases in rescue inhaler use. The effect was detected on the same day and lags of 1 and 2 days. The detrimental effect of temperature on these outcomes increased with higher concentrations of indoor fine particulate matter and nitrogen dioxide (p<0.05 for interaction terms). On days that participants went outdoors, increases in maximum daily outdoor temperature were associated with increases in BCSS scores after adjusting for outdoor pollution concentrations. CONCLUSIONS: For patients with COPD that spend the majority of their time indoors, indoor heat exposure during warmer months represents a modifiable environmental exposure that may contribute to respiratory morbidity. In the context of climate change, adaptive strategies that include optimization of indoor environmental conditions are needed to protect this high risk group from adverse health effects of heat. |
Exposure science in an age of rapidly changing climate: challenges and opportunities
LaKind JS , Overpeck J , Breysse PN , Backer L , Richardson SD , Sobus J , Sapkota A , Upperman CR , Jiang C , Beard CB , Brunkard JM , Bell JE , Harris R , Chretien JP , Peltier RE , Chew GL , Blount BC . J Expo Sci Environ Epidemiol 2016 26 (6) 529-538 Climate change is anticipated to alter the production, use, release, and fate of environmental chemicals, likely leading to increased uncertainty in exposure and human health risk predictions. Exposure science provides a key connection between changes in climate and associated health outcomes. The theme of the 2015 Annual Meeting of the International Society of Exposure Science-Exposures in an Evolving Environment-brought this issue to the fore. By directing attention to questions that may affect society in profound ways, exposure scientists have an opportunity to conduct "consequential science"-doing science that matters, using our tools for the greater good and to answer key policy questions, and identifying causes leading to implementation of solutions. Understanding the implications of changing exposures on public health may be one of the most consequential areas of study in which exposure scientists could currently be engaged. In this paper, we use a series of case studies to identify exposure data gaps and research paths that will enable us to capture the information necessary for understanding climate change-related human exposures and consequent health impacts. We hope that paper will focus attention on under-developed areas of exposure science that will likely have broad implications for public health. |
Blood lead levels among children aged <6 years - Flint, Michigan, 2013-2016
Kennedy C , Yard E , Dignam T , Buchanan S , Condon S , Brown MJ , Raymond J , Rogers HS , Sarisky J , de Castro R , Arias I , Breysse P . MMWR Morb Mortal Wkly Rep 2016 65 (25) 650-4 During April 25, 2014-October 15, 2015, approximately 99,000 residents of Flint, Michigan, were affected by changes in drinking water quality after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River.* Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. Adverse health effects are associated with lead exposure (1). On January 2, 2015, a water advisory was issued because of detection of high levels of trihalomethanes, byproducts of disinfectants.(dagger)(,)( section sign) Studies conducted by local and national investigators detected an increase in the prevalence of blood lead levels (BLLs) ≥5 microg/dL (the CDC reference level) among children aged <5 years living in Flint (2) and an increase in water lead levels after the water source switch (3). On October 16, 2015, the Flint water source was switched back to DWA, and residents were instructed to use filtered tap water for cooking and drinking. During that time, pregnant and breastfeeding women and children aged <6 years were advised to consume bottled water.( paragraph sign) To assess the impact on BLLs of consuming contaminated drinking water, CDC examined the distribution of BLLs ≥5 microg/dL among children aged <6 years before, during, and after the switch in water source. This analysis enabled determination of whether the odds of having BLLs ≥5 microg/dL before the switch differed from the odds during the switch to FWS (before and after the January 2, 2015, water advisory was issued), and after the switch back to DWA. Overall, among 9,422 blood lead tests in children aged <6 years, 284 (3.0%) BLLs were ≥5 microg/dL during April 25, 2013-March 16, 2016. The adjusted probability of having BLLs ≥5 microg/dL was 46% higher during the period after the switch from DWA to FWS (and before the January 2, 2015, water advisory) than during the period before the water switch to FWS. Although unrelated to lead in the water, the water advisory likely reduced tap water consumption and increased consumption of bottled water. Characterizing exposure to lead contaminated drinking water among children aged <6 years living in Flint can help guide appropriate interventions. |
Specific blood absorption parameters for 239PUO2 and 238PUO2 nanoparticles and impacts on bioassay interpretation
Cash LJ , Hoover MD , Guilmette RA , Breysse PN , Bertelli L . Radiat Prot Dosimetry 2016 173 (4) 318-324 Specific absorption parameters for239PuO2and238PuO2have been determined based on available biokinetic data from studies in rodents, and the impacts of these parameters on bioassay interpretation and dosimetry after inhalation of nanoPuO2materials have been evaluated. Calculations of activities after an acute intake of nanoparticles of239PuO2and238PuO2are compared with the corresponding calculations using standard default absorption parameters using the International Commission on Radiological Protection (ICRP) 66 respiratory tract model. Committed effective doses are also evaluated and compared. In this case, it was found that interpretation of bioassay measurements with the assumption that the biokinetic behaviour of PuO2nanoparticles is the same as that of micrometre-sized particles can result in an overprediction of the committed effective dose by two orders of magnitude. Although in this case the use of the default assumptions (5 microm AMAD, Type S) for assessing dose following inhalation exposure to airborne PuO2nanoparticles appears to be conservative, the evaluation of situations involving PuO2nanoparticles that may have different particle size and solubility properties should prudently follow the ICRP recommendation to obtain and use additional, material-specific information whenever possible. |
Impact of neighborhood biomass cooking patterns on episodic high indoor particulate matter concentrations in clean fuel homes in Dhaka, Bangladesh
Salje H , Gurley ES , Homaira N , Ram PK , Haque R , Petri W , Moss WJ , Luby SP , Breysse P , Azziz-Baumgartner E . Indoor Air 2014 24 (2) 213-20 Exposure to particulate matter (PM2.5 ) from the burning of biomass is associated with increased risk of respiratory disease. In Dhaka, Bangladesh, households that do not burn biomass often still experience high concentrations of PM2.5 , but the sources remain unexplained. We characterized the diurnal variation in the concentrations of PM2.5 in 257 households and compared the risk of experiencing high PM2.5 concentrations in biomass and non-biomass users. Indoor PM2.5 concentrations were estimated every minute over 24 h once a month from April 2009 through April 2010. We found that households that used gas or electricity experienced PM2.5 concentrations exceeding 1000 mug/m(3) for a mean of 35 min within a 24-h period compared with 66 min in biomass-burning households. In both households that used biomass and those that had no obvious source of particulate matter, the probability of PM2.5 exceeding 1000 mug/m(3) were highest during distinct morning, afternoon, and evening periods. In such densely populated settings, indoor pollution in clean fuel households may be determined by biomass used by neighbors, with the highest risk of exposure occurring during cooking periods. Community interventions to reduce biomass use may reduce exposure to high concentrations of PM2.5 in both biomass and non-biomass using households. |
Indoor exposure to particulate matter and age at first acute lower respiratory infection in a low-income urban community in Bangladesh
Gurley ES , Salje H , Homaira N , Ram PK , Haque R , Petri WA Jr , Bresee J , Moss WJ , Luby SP , Breysse P , Azziz-Baumgartner E . Am J Epidemiol 2014 179 (8) 967-73 The timing of a child's first acute lower respiratory infection (ALRI) is important, because the younger a child is when he or she experiences ALRI, the greater the risk of death. Indoor exposure to particulate matter less than or equal to 2.5 microm in diameter (PM2.5) has been associated with increased frequency of ALRI, but little is known about how it may affect the timing of a child's first ALRI. In this study, we aimed to estimate the association between a child's age at first ALRI and indoor exposure to PM2.5 in a low-income community in Dhaka, Bangladesh. We followed 257 children from birth through age 2 years to record their age at first ALRI. Between May 2009 and April 2010, we also measured indoor concentrations of PM2.5 in children's homes. We used generalized gamma distribution models to estimate the relative age at first ALRI associated with the mean number of hours in which PM2.5 concentrations exceeded 100 microg/m(3). Each hour in which PM2.5 levels exceeded 100 microg/m(3) was independently associated with a 12% decrease (95% confidence interval: 2, 21; P = 0.021) in age at first ALRI. Interventions to reduce indoor exposure to PM2.5 could increase the ages at which children experience their first ALRI in this urban community. |
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