International Society For Environmental Epidemiology Research Articles

Ethics guidelines for environmental epidemiologists: 2023 revision.

Recognition of the importance to environmental epidemiology of ethical and philosophical deliberation led, in 1996, to the establishment of Ethics Guidelines for the profession. In 1999, these guidelines were adopted by the International Society for Environmental Epidemiology. The guidelines were revised in 2012 and again in 2023 to ensure continued relevance to the major issues facing the field. Comprising normative standards of professional conduct, the guidelines are structured into four subsections: (1) obligations to individuals and communities who participate in research; (2) obligations to society; (3) obligations regarding funders/sponsors and employers; and (4) obligations to colleagues. Through the 2023 revision of the Ethics Guidelines, the International Society for Environmental Epidemiology seeks to ensure the highest possible standards of transparency and accountability for the ethical conduct of environmental epidemiologists engaged in research and public health practice.

Mortality attributable to ambient fine particulate matter and nitrogen dioxide in Switzerland in 2019: Use of two-pollutant effect estimates

IntroductionAir pollution health risk assessments have traditionally used single-pollutant effect estimates for one proxy ambient air pollutant such as PM2.5. Two-pollutant effect estimates, i.e. adjusted for another correlated pollutant, theoretically enable the aggregation of pollutant-specific health effects minimizing double-counting. Our study aimed at estimating the adult mortality in Switzerland in 2019 attributable to PM2.5 from a single-pollutant effect estimate and to the sum of PM2.5 and NO2 from two-pollutant estimates; comparing the results with those from alternative global, European and Swiss effect estimates. MethodsFor the single-pollutant approach, we used a PM2.5 summary estimate of European cohorts from the project ELAPSE, recommended by the European Respiratory Society and International Society for Environmental Epidemiology (ERS-ISEE). To derive the two-pollutant effect estimates, we applied ELAPSE-based conversion factors to ERS-ISEE PM2.5 and NO2 single-pollutant effect estimates. Additionally, we used World Health Organization 2021 Air Quality Guidelines as counterfactual scenario, exposure model data from 2019 and Swiss lifetables. ResultsThe single-pollutant effect estimate for PM2.5 (1.118 [1.060; 1.179] per 10 μg/m3) resulted in 2240 deaths (21,593 years of life lost). Using our derived two-pollutant effect estimates (1.023 [1.012; 1.035] per 10 μg/m3 PM2.5 adjusted for NO2 and 1.040 [1.023; 1.058] per 10 μg/m3 NO2 adjusted for PM2.5), we found 1977 deaths (19,071 years of life lost) attributable to PM2.5 and NO2 together (23% from PM2.5). Deaths using alternative effect estimates ranged from 1042 to 5059. DiscussionEstimated premature mortality attributable to PM2.5 alone was higher than to both PM2.5 and NO2 combined. Furthermore, the proportion of deaths from PM2.5 was lower than from NO2 in the two-pollutant approach. These seemingly paradoxical results, also found in some alternative estimates, are due to statistical imprecisions of underlying correction methods. Therefore, using two-pollutant effect estimates can lead to interpretation challenges in terms of causality.

Urban Climate Policy and Action through a Health Lens-An Untapped Opportunity.

Motivated by a growing recognition of the climate emergency, reflected in the 26th Conference of the Parties (COP26), we outline untapped opportunities to improve health through ambitious climate actions in cities. Health is a primary reason for climate action yet is rarely integrated in urban climate plans as a policy goal. This is a missed opportunity to create sustainable alliances across sectors and groups, to engage a broad set of stakeholders, and to develop structural health promotion. In this statement, we first briefly review the literature on health co-benefits of urban climate change strategies and make the case for health-promoting climate action; we then describe barriers to integrating health in climate action. We found that the evidence-base is often insufficiently policy-relevant to be impactful. Research rarely integrates the complexity of real-world systems, including multiple and dynamic impacts of strategies, and consideration of how decision-making processes contend with competing interests and short-term electoral cycles. Due to siloed-thinking and restrictive funding opportunities, research often falls short of the type of evidence that would be most useful for decision-making, and research outputs can be cryptic to decision makers. As a way forward, we urge researchers and stakeholders to engage in co-production and systems thinking approaches. Partnering across sectors and disciplines is urgently needed so pathways to climate change mitigation and adaptation fully embrace their health-promoting potential and engage society towards the huge transformations needed. This commentary is endorsed by the International Society for Environmental Epidemiology (ISEE) and the International Society for Urban Health (ISUH) and accompanies a sister statement oriented towards stakeholders (published on the societies’ websites).

Scientist Civic Engagement and the US Ozone Standards in 2020

BACKGROUND AND AIM: In 2020, the United States Environmental Protection Agency (EPA) proposed to retain, without revision, its national primary and secondary ozone National Ambient Air Quality Standards (NAAQS). As exposure scientists and environmental epidemiologists, we recognized that this decision may not have reflected the most updated research on ozone and population health effects. We thus aimed to inform the EPA of the state-of-the-science through official channels. METHODS: Within the North American Chapter (NAC) of the International Society for Environmental Epidemiology (ISEE), the Policy Committee worked as a team to gather, synthesize, and communicate evidence on ozone effects on population health. For the ozone NAAQS, one member attended the oral comment sessions and led the effort to draft and submit a written comment to the EPA. RESULTS:At the ISEE NAC Policy Committee, we recognized a proposed ruling that would have affected air quality in the US. We effectively organized to engage government stakeholders and communicate the latest research on ozone and population health. These actions entered into the public record a statement aimed at a general audience on the effects of ozone along with supporting scientific articles. Such materials could be considered in a court of law if and when a decision on the ozone NAAQS is contested. CONCLUSIONS:Environmental exposure and epidemiology research have the potential to inform policy decisions. The ISEE NAC Policy Committee provides an avenue for scientists to gain experience in communicating the research implications to decision-makers. KEYWORDS: Ozone, Research translation, Science communication, Policy

Greening the International Society for Environmental Epidemiology.

Greening the International Society for Environmental Epidemiology.

CDC Addresses Non-Occupational Noise-Induced Hearing Loss.

CDC Addresses Non-Occupational Noise-Induced Hearing Loss.

The Effects of Fine Dust, Ozone, and Nitrogen Dioxide on Health.

Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 μg/m3 for fine dust particles smaller than 2.5 μm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany. This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS). Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mor- tality rises approximately 7% for every incremental long-term exposure to 5 μg/m3 PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m3 of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits. It is very important for public health that the current EU standards for rkedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.

The Fifth Conference of the International Society for Environmental Epidemiology in the Asia Chapter Region

The Fifth Conference of the International Society for Environmental Epidemiology in the Asia Chapter Region

The Role of Air Pollutants for Health - A Reply to the Expert Opinion of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS)

ZusammenfassungIn Deutschland gibt es regionale Fahrverbote für ältere Dieselfahrzeuge ohne SCR-Katalysator bei Überschreitung der Grenzwerte für NO2. Dies hat zu einer intensiven Diskussion über die Rolle der Luftschadstoffe für die Gesundheit geführt. In der Replik wird dargestellt, dass die Daten zur Wirkung von Stickstoffdioxid (NO2) und Feinstaub (PM10 und PM2,5) nicht ausreichen, um die Fahrverbote zu begründen.Für NO2 gibt es passagere Reaktionen bei unbehandelten Asthmatikern ab 500 µg/m3. Die deutschen Grenzwerte (Jahresmittelwert 40 µg/m3) fußen im Wesentlichen auf einer Metaanalyse von 9 Studien aus Innenraumbelastungen wobei nur in 4 Studien NO2 gemessen wurde. In der großen europäischen Escape-Studie von 2014 wurde kein Einfluss von NO2 auf die Mortalität gefunden.Als Surrogatparameter für andere Schadstoffe ist NO2 ebenfalls nicht mehr geeignet, da seit Einführung der Partikelfilter bei Dieselautos (etwa ab 2000) der KFZ-Anteil am Feinstaub an der Straße unter 10 % liegt. Der Feinstaub besteht im Wesentlichen aus Aufwirbelung von mineralischen, organischen Bodensubstanzen sowie Reifenabrieb und wird am stärksten durch Wetterphänomene, vor allen Dingen durch Sonneneinstrahlung beeinflusst.Die Grenzwerte für NO2 und Feinstaub werden errechnet aus epidemiologischen Beobachtungsstudien. Es findet sich zumeist eine schwache Assoziation zwischen der Konzentra-tion und zahlreichen Erkrankung sowie der Mortalität. Epidemiologische Beobachtungsstudien erlauben nur die Bildung einer Hypothese. Permanente Wiederholungen der Beobachtungsstudien betätigen nur, dass manche gefundenen Phänomene nicht zufällig sind. Eine Kausalität kann daraus nicht abgeleitet werden, da es zahlreiche Erklärungsmodelle neben dem NO2 und Feinstaub gibt. Dazu wären Interventionsstudien im Niedrigdosisbereich sowie Tierexperimente erforderlich. Diese Daten fehlen nahezu komplett bzw. sind, soweit vorhanden, allesamt negativ.Nie diskutiert wird eine starke Widerlegung der Hypothese der Gefährdung von NO2 und Feinstaub im Grenzwertbereich durch das Inhalationsrauchen. Die Raucher stellen quasi einen inhalationstoxikologischen Großversuch dar. Der Zigarettenrauch enthält sehr hohe Feinstaub-, Stickstoffmonoxid- (NO) und NO2-Konzentrationen, die vom Organismus erstaunlich gut toleriert werden. Das hängt damit zusammen, dass NO ein Naturstoff ist, der in den Zellen oder auch in den Nasennebenhöhlen in z. T. sehr hohen Konzentrationen (über 30 000 µg/m3) vorkommt. Eines der Abbauprodukte von NO ist NO2, was im Wasser zu Nitrat und Nitrit disproportioniert wird. Ein Teil von NO2 wird zur Synthese von Fettsäuren verwendet.Zigaretten haben ein Kondensat von ca. 7 – 10 mg. Nimmt man als Vergleich eine lebenslange Dauerbelastung durch Feinstaub und NO2 in den Grenzwertkonzentrationen an, müssten alle Raucher nach wenigen Tagen bis Monaten zahlreiche Erkrankungen entwickeln, die dem Feinstaub und NOx angelastet werden. Auch die Mortalität müsste drastisch erhöht sein; nahezu alle Raucher müssten bereits nach 1 packyear verstorben sein. Der Unterschied wird noch größer, wenn man die nachgewiesene Toxizität und Kanzerogenität des Zigarettenrauchs im Vergleich zu dem i. d. R. deutlich weniger gefährlichen Feinstaub an der Straße ins Verhältnis setzt.

The Fourth Conference of the International Society for Environmental Epidemiology in the Asia Chapter Region

The Fourth Conference of the International Society for Environmental Epidemiology in the Asia Chapter Region

Abstracts of the 29th Annual Scientific Conference of the International Society for Environmental Epidemiology (ISEE), 24–28 September 2017, Sydney, Australia.

The 29th Annual Scientific Conference of the International Society for Environmental Epidemiology was held 24–28 September 2017 in Sydney, Australia. The conference theme was "Healthy Places, Healthy People—Where Are the Connections?" The focus of this year's conference was the recognition that there are many differentplaces (the natural environment, the built environment, and the social environment) and many different people (the young, the old, the disadvantaged, and the marginalized), and that the connections between them may be physical, psychological, social, or political.

Offline: The Donald Trump Promise

Evidence-based medicine (EBM) has been a powerful influence on clinical practice. But one book should make even the most ardent EBM advocates pause. That book is How Doctors Think, by Jerome Groopman (Houghton Mifflin, 2007). Groopman, an oncologist, drew on the work of Daniel Kahneman and Amos Tversky (before both were made famous by Kahneman's own bestseller, Thinking, Fast and Slow). Groopman used his clinical experience to show how easy it was, despite the very best evidence, to be misled by multiple personal biases—most notably the bias of “availability”. Clinicians will often make diagnoses or decisions based on the mental availability of particular pieces of knowledge, including what might be considered as “best evidence”. Groopman punctures easy assumptions that high-quality evidence alone can improve the quality of medical care. Unless doctors are aware of their own informational biases, the possibility of false reliance on “evidence” is not only conceivable, but likely. How Doctors Think should be required reading before any prospective physician is allowed to lay a hand on a patient. Last week, at the annual Rambam Summit in Haifa, Israel, Groopman, together with Pamela Hartzband, deepened the scepticism with which we should approach EBM. Doctors are educated to believe in their scientific appreciation of evidence. But we may not have educated ourselves to appreciate the mindsets that interpose themselves between evidence and our interpretations of that evidence. Based on extensive interviews with physician colleagues, Groopman and Hartzband identified three dimensions of the medical mindset that any doctor (and patient) should be self-consciously aware of as they make clinical decisions. The three mindsets each have two extremes—maximalist/minimalist, naturalist/technologist, believer/doubter. Ask yourself. Are you the kind of doctor who wants to go as far as you can with the latest technology and who believes in the power of that technology to make a difference to the patient? Or are you the type of doctor who thinks that less is more and who is inherently sceptical about claims for new discoveries? Groopman readily admitted to being a maximalist-believer, which probably influenced his decision in the 1970s to choose haematology as a career when bone-marrow transplantation became popular. Hartzband, by contrast, is a self-confessed minimalist-doubter. Their point was that most clinical decisions lie in a grey zone—there is no single right answer for everyone. The important step is less to adhere to some abstract notion of EBM, but rather to think hard about what kind of medical mindset you have. Whether you are a maximalist-believer or a minimalist-doubter will have a larger effect on your clinical decisions than the result of any single systematic review or randomised trial. We see these mindsets at play all the time in today's scientific, evidence-informed medicine. There have been at least four US expert committees ruling on the safety and efficacy of screening mammography—with four different sets of recommendations. There have been three expert committees reviewing the evidence on screening for prostate cancer using PSA—with three different conclusions. So much for science. So much for evidence. What matters more are the mindsets of those “experts” reviewing the scientific evidence. Here is The Donald Trump Promise, according to Groopman and Hartzband. Modern scientific medicine promises the right doctor prescribing the right treatment and the right procedure for the right outcome. It's just impossible. A final word regarding Joel D Kaufman and colleagues from the University of Washington in Seattle, USA. The International Society for Environmental Epidemiology (ISEE) has awarded its prize for the Best Environmental Epidemiology Paper published in 2016 to Kaufman and coauthors' Lancet Article “Association between air pollution and coronary artery calcification within six metropolitan areas in the USA”. The multicentre team, funded by the US Environmental Protection Agency and National Institutes of Health (both targeted for cuts by President Trump), concluded that, “Increased concentrations of PM2·5 and traffic-related air pollution…in ranges commonly encountered worldwide, are associated with progression in coronary calcification, consistent with acceleration of atherosclerosis. This study supports the case for global efforts of pollution reduction in prevention of cardiovascular diseases.” Congratulations.

“Greening” conferences - Experiences from the International Society for Environmental Epidemiology (ISEE)

“Greening” conferences - Experiences from the International Society for Environmental Epidemiology (ISEE)

Abstracts of the 28th Annual Conference of the International Society for Environmental Epidemiology (ISEE), 1-4 September 2016, Rome, Italy.

The 28th annual conference of the International Society for Environmental Epidemiology was held 1 - 4 September 2016 in Rome, Italy. The conference theme was "Old and New Risks: Challenges for Environmental Epidemiology." The focus of this year's conference is current and future challenges in exposure assessment, study design, and data analyses.

Sounding the Alarm: Health in the Anthropocene.

There is growing scientific and public recognition that human actions, directly and indirectly, have profoundly changed the Earth system, in a still accelerating process, increasingly called the “Anthropocene”. Planetary transformation, including of the atmosphere, climate, ecosystems and biodiversity, has enormous implications for human health, many of which are deeply disturbing, especially in low-income settings. A few health consequences of the Anthropocene have been partially recognized, including within environmental epidemiology, but their long-term consequences remain poorly understood and greatly under-rated. For example Syria could be a “sentinel” population, giving a glimpse to a much wider dystopian future. Health-Earth is a research network, co-founded in 2014, which seeks, with other groups, to catalyse a powerful curative response by the wider health community. This paper builds on a symposium presented by Health-Earth members at the 2015 conference of the International Society for Environmental Epidemiology. It reviews and synthesizes parts of the large literature relevant to the interaction between the changing Earth system and human health. It concludes that this topic should be prominent within future environmental epidemiology and public health. Created by our species, these challenges may be soluble, but solutions require far more understanding and resources than are currently being made available.

Abstracts of the 27th Annual Conference of the International Society for Environmental Epidemiology (ISEE), 30 August-3 September 2015, Centro de Convenções Rebouças, São Paulo, Brazil.

The 27th annual conference of the International Society for Environmental Epidemiology was held 30 August-3 September 2015 in São Paulo, Brazil. The conference theme was "Addressing Environmental Health Inequalities." Sessions highlighted social determinants of health and how they can generate environmental health inequalities.

Ethics Guidelines For Environmental Epidemiologists

The International Society for Environmental Epidemiology (ISEE) Ethics and Philosophy Committee has taken an active role in supporting ethical conduct and formulating ethics guidelines. The second ...

Tony McMichael, 1942-2014.

FigureTony McMichael, who sadly died in September 2014, was an outstanding and visionary epidemiologist and public health scientist who was particularly renowned for his pioneering work on climate change and health. Tony graduated in Medicine at the University of Adelaide and then undertook a PhD in Preventive Medicine at Monash University. His work on occupational hazards at a postdoctoral position at the University of North Carolina included seminal contributions to understanding the “healthy worker effect.” Back in Australia, he made important advances to understanding the health effects of lead exposure and the epidemiology of multiple sclerosis—pointing in particular to the possible role of ultraviolet radiation exposure. Any of these major advances would have given Tony a global reputation as a leading epidemiologist, but it is for his work on climate change and health that he became best known and where his long-term legacy is greatest. His first book Planetary Overload: Global Environmental Change and the Health of the Human Species, published in 1993, is a classic. At the London School of Hygiene & Tropical Medicine (1994–2001), he took a leading role in UN Intergovernmental Panel on Climate Change and associated WHO activities focused on estimating health impacts of past and future anthropogenic climate change, as well as on epidemiologic studies that could better inform such assessments. Tony was a champion of epidemiology applied broadly to public health and also advocated that the concerns of that wider world influence the practice and scope of epidemiology. He urged that to stay relevant, epidemiology should escape the “prison” of focus just on proximate health risk factors and expand to address more distal, possibly complex, societal, and temporal influences on health and engage in projecting the health effects of large-scale environmental perturbations, notably climate change. Tony returned to Australia in 2001 as director of the National Centre for Epidemiology and Population Health and continued a leading role in epidemiology internationally, including as president of the International Society for Environmental Epidemiology 2008–2010. A Festschrift to commemorate his extraordinary career was held in 2012. An associated open-access book will appear next year. Tony was a warm and engaging friend to many and an inspirational teacher and lecturer, who will be greatly missed across the world epidemiologic and public health community.

Abstracts of the 26th Annual Conference of the International Society for Environmental Epidemiology (ISEE), 24-28 August 2014, Seattle, Washington.

The 26th annual conference of the International Society for Environmental Epidemiology was held 24-28 August 2014 in Seattle, Washington. The conference theme was "From Local to Global: Advancing Science for Policy in Environmental Health." Sessions highlighted results assessing the burden of diseases from environmental exposures and key areas related to topics of uncertainty for policy makers.

Reflections on the origins of the International Society for Environmental Epidemiology after its first 25 years.

Reflections on the origins of the International Society for Environmental Epidemiology after its first 25 years.