Respiratory Health Outcomes Research Articles

Health Risks of Major Air Pollutants, their Drivers and Mitigation Strategies: A Review

The impact of increasing air pollution on human health and the environment is a major concern worldwide. Exposure to air pollution is one of the leading risk factors and substantially contributes to morbidity and premature mortality. This review paper aims to examine the exposure of major air pollutants (i.e., particulate matter, sulfur dioxide, oxides of nitrogen, carbon monoxide) and its association with respiratory, cardiovascular, reproductive, and genotoxic adverse health outcomes that can cause DNA damage leading to genetic mutations. The study emphasized how a better understanding of source-receptor relationships and exposure assessment methodologies can support effective air quality management planning. Hence, there is a need to augment various exposure indicators (spatial modeling, personal/area monitoring, emphasizing central/rural site measurements, etc.) to generate reliable surrogates for informed decision-making. The critical drivers of anthropogenic interference for air pollution remain urbanization, growing vehicle use, and industrialization. This requires innovative approaches, such as energy-efficient and technologically sustainable solutions to gradually replace conventional fossil fuel from primary energy mix with renewable energy. It holds the key to meet future energy challenges and minimizing air pollution emissions. Further, there is an urgent need to frame effective public policy with graded mitigation actions to reduce the adverse impact of air pollution on human health and the environment.

Linking environmental injustices in Detroit, MI to institutional racial segregation through historical federal redlining

ObjectivesTo identify the most pervasive environmental exposures driving environmental disparities today associated with historical redlining in Detroit.MethodsWe overlaid Detroit’s 1939 Home Owners’ Loan Corporation (HOLC) shapefile from the Mapping Inequality project onto the EPA EJScreen and the DOT National Transportation Noise maps to analyze differences in current demographic and environmental indicators between historically redlined (D-grade) and non-redlined neighborhoods using simple linear regression and a boosted classification tree algorithm.ResultsHistorically redlined neighborhoods in Detroit experienced significantly higher environmental hazards than non-redlined neighborhoods in the form of 12.1% (95% CI: 7.2–17.1%) higher levels of diesel particulate matter (PM), 32.2% (95% CI: 3.3–69.3%) larger traffic volumes, and 65.7% (95% CI: 8.6–152.8%) higher exposure to hazardous road noise (LEQ(24h) >70 dBA). Historically redlined neighborhoods were situated near 1.7-times (95% CI: 1.4–2.1) more hazardous waste sites and twice as many (95% CI: 1.5–2.7) risk management plan (RMP) sites than non-redlined neighborhoods. The lifetime cancer risk from inhalation of air toxics was 4.4% (95% CI: 2.9–6.6%) higher in historically redlined communities, and the risk of adverse respiratory health outcomes from air toxics was 3.9% (95% CI: 2.1–5.6%) higher. All factors considered together, among the environmental hazards considered, the most pervasive hazards in historically redlined communities are proximity to RMP sites, hazardous road noise, diesel PM, and cancer risk from air pollution.ConclusionsHistorically redlined neighborhoods may have a disproportionately higher risk of developing cancer and adverse respiratory health outcomes from air toxics. Policies targeting air and noise pollution from transportation sources, particularly from sources of diesel exhaust, in historically redlined neighborhoods may ameliorate some of the impacts of structural environmental racism from historical redlining in Detroit.

Global trends in ozone concentration and attributable mortality for urban, peri-urban, and rural areas between 2000 and 2019: a modelling study

Data on long-term trends of ozone exposure and attributable mortality across urban-rural catchment areas worldwide are scarce, especially for low-income and middle-income countries. This study aims to estimate trends in ozone concentrations and attributable mortality for urban-rural catchment areas worldwide. In this modelling study, we used a health impact function to estimate ozone concentrations and ozone-attributable chronic respiratory disease mortality for urban areas worldwide, and their surrounding peri-urban, peri-rural, and rural areas. We estimated ozone-attributable respiratory health outcomes using a modified Global Burden of Diseases, Injuries, and Risk Factors 2019 Study approach. We evaluate long-term trends with linear regressions of annual ozone concentrations and ozone-attributable mortality against time in years, and examined the influence of each health impact function input parameter to temporal changes in ozone-attributable disease burden estimates for 12 946 cities worldwide by region, from 2000 to 2019. Ozone-attributable mortality worldwide increased by 46% from 2000 (290 400 deaths [95% CI 151 800-457 600]) to 2019 (423 100 deaths [95% CI 223 200-659 400]). The fraction of global ozone-attributable mortality occurring in peri-urban areas remained unchanged from 2000 to 2019 (56%), whereas urban areas gained in their share of global ozone-attributable burden (from 35% to 37%; 54 000 more deaths). Across all cities studied, average population-weighted mean ozone concentration increased by 11% (46 parts per billion [ppb] to 51 ppb). The number of cities with concentrations above the WHO peak season ozone standard (60 μg/m3) increased from 11 568 (89%) of 12 946 cities in 2000 to 12 433 (96%) cities in 2019. Percent change in ozone-attributable mortality averaged across 11 032 cities within each region from 2000 to 2019 ranged from -62% in eastern Europe to 350% in tropical Latin America. The contribution of ozone concentrations, population size, and baseline chronic respiratory disease rates to the change in ozone-attributable mortality differed regionally. Ozone exposure is increasing worldwide, contributing to disproportionate ozone mortality in peri-urban areas and increasing ozone exposure and attributable mortality in urban areas worldwide. Reducing ozone precursor emissions in areas affecting urban and peri-urban exposure can yield substantial public health benefits. NASA Health and Air Quality Applied Sciences Team, the National Institute for Occupational Safety and Health, and the NOAA Co-operative Agreement with the Cooperative Institute for Research in Environmental Sciences.

Geographic and social economic disparities in the risk of exposure to ambient air respiratory toxicants at Oklahoma licensed early care and education facilities

BackgroundEarly life exposures to hazardous air pollutants has been associated with adverse asthma-related outcomes. Neighborhood-level social and economic factors play an essential role in the distribution of hazardous air pollutants and children spend a substantial amount of time at early care and education (ECE) facilities. While the indoor air quality of these facilities has been described, particularly for criteria air pollutants such as volatile organic compounds and particulate matter, little is known about the ambient air quality of ECE facilities. ObjectivesWe conducted a cross-sectional study to estimate the ambient air quality of Oklahoma licensed ECE facilities and to explore associations between ambient air quality and select geographic predictors. MethodsWe estimated ambient air quality using the total respiratory hazard quotient from the National Air Toxics Assessment according to the geographical location of licensed Oklahoma ECE facilities (N = 3184). We then determined whether urban and rural ECE facilities' air respiratory toxicant exposure risk differed by ECE facilities’ neighborhood-level social and economic inequities including: 1) racial-ethnic minority community, 2) neighborhood socioeconomic status, and 3) residential segregation. ResultsUrban ECE facilities in Hispanic segregated counties were five times more likely to be at risk of high air respiratory exposure, adjusted for integrated urban counties (p < 0.0001, 95% CI [3.824, 7.699]). Rural ECE facilities in African American segregated counties were nine times more likely to be at risk of high air respiratory toxicant exposure, adjusted for integrated rural counties (p < 0.0001, 95% CI [5.641, 15.928]). ConclusionWe found geographically and socially disparate patterns of higher exposures to ambient air respiratory toxicants at Oklahoma ECE facilities. Safer siting policies and interventions are needed to mitigate air respiratory toxicant exposures, which may help to reduce asthma control disparities and improve respiratory health outcomes in Oklahoma ECE facilities.

Respiratory health among adolescents living in the Highveld Air Pollution Priority Area in South Africa

BackgroundAir pollution is a global, public health emergency. The effect of living in areas with very poor air quality on adolescents’ physical health is largely unknown. The aim of this study was to investigate the prevalence of adverse respiratory health outcomes among adolescents living in a known air pollution hotspot in South Africa.MethodsAmbient air quality data from 2005 to 2019 for the two areas, Secunda and eMbalenhle, in the Highveld Air Pollution Priority Area in Mpumalanga province, South Africa were gathered and compared against national ambient air pollution standards and the World Health Organization Air Quality Guidelines. In 2019, adolescents attending schools in the areas completed a self-administered questionnaire investigating individual demographics, socio-economic status, health, medical history, and fuel type used in homes. Respiratory health illnesses assessed were doctor-diagnosed hay fever, allergies, frequent cough, wheezing, bronchitis, pneumonia and asthma. The relationship between presence (at least one) or absence (none) of self-reported respiratory illness and risk factors, e.g., fuel use at home, was explored. Logistic regression was used to estimate the odds ratio and 95% confidence interval (CI) of risk factors associated with respiratory illness adjusted for body mass index (measured by field assistants), gender, education level of both parents / guardians and socio-economic status.ResultsParticulate matter and ozone were the two pollutants most frequently exceeding national annual air quality standards in the study area. All 233 adolescent participants were between 13 and 17 years of age. Prevalence of self-reported respiratory symptoms among the participants ranged from 2% for ‘ever’ doctor-diagnosed bronchitis and pneumonia to 42% ever experiencing allergies; wheezing chest was the second most reported symptom (39%). Half (52%) of the adolescents who had respiratory illness were exposed to environmental tobacco smoke in the dwelling. There was a statistically significant difference between the presence or absence of self-reported respiratory illness based on the number of years lived in Secunda or eMbalenhle (p = 0.02). For a one-unit change in the number of years lived in an area, the odds of reporting a respiratory illness increased by a factor of 1.08 (p = 0.025, 95% CI = 1.01–1.16). This association was still statistically significant when the model was adjusted for confounders (p = 0.037).ConclusionsAdolescents living in air polluted areas experience adverse health impacts Future research should interrogate long-term exposure and health outcomes among adolescents living in the air polluted environment.

Estimation of hospital visits for respiratory diseases attributable to PM10 from vegetation fire smoke and health impacts of regulatory intervention in Upper Northern Thailand

The air quality in Upper Northern Thailand (UNT) deteriorates during seasonal vegetation fire events, causing adverse effects especially on respiratory health outcomes. This study aimed to quantitatively estimate respiratory morbidity from vegetation fire smoke exposure, and to assess the impact of a burning ban enforced in 2016 on morbidity burden in UNT. We computed daily population exposure to fire-originated PM10 and estimated its health burden during a 5-year period from 2014 to 2018 using daily fire-originated PM10 concentration and the concentration–response function for short-term exposure to PM10 from vegetation fire smoke and respiratory morbidity. In subgroups classified as children and older adults, the health burden of respiratory morbidity was estimated using specific effect coefficients from previous studies conducted in UNT. Finally, we compared the health burden of respiratory morbidity before and after burning ban enforcement. Approximately 130,000 hospital visits for respiratory diseases were estimated to be attributable to fire-originated PM10 in UNT from 2014 to 2018. This estimation accounted for 1.3% of total hospital visits for respiratory diseases during the 5-year period, and 20% of those during burning events. Age-specific estimates revealed a larger impact of PM10 in the older adult group. The number of hospital visits for respiratory diseases attributable to fire-originated PM10 decreased from 1.8% to 0.5% after the burning ban policy was implemented in the area. Our findings suggest that PM10 released from vegetation fires is a health burden in UNT. The prohibition of the burning using regulatory measure had a positive impact on respiratory morbidity in this area.

Community-Based Approach to Assess ObstructiveRespiratory Diseases and Risk in Urban African American Churches.

Asthma, and chronic obstructive pulmonary disease (COPD) are significant health problems that have disparate effects on many Americans. Misdiagnosis and underdiagnosis are common and lead to ineffective treatment and management. This study assessed the feasibility of applying a two-step case-finding technique to identify both COPD and adult asthma cases in urban African American churches. We established a community-based partnership, administered a cross-sectional survey in step one of the case-finding technique and performed spirometry testing in step two. A total of 219 surveys were completed. Provider-diagnosed asthma and COPD were reported in 26% (50/193) and 9.6% (18/187) of the sample. Probable asthma (13.9%), probable COPD (23.1%), and COPD high-risk groups (31.9%) were reported. It is feasible to establish active case-finding within the African American church community using a two-step approach to successfully identify adult asthma and COPD probable cases for early detection and treatment to reduce disparate respiratory healthoutcomes.

Ambient air pollutants and respiratory health outcomes in Tabriz and Urmia, two metropolises of Iran.

Polluted air affects human life and it is crucial to assess air pollutants to inform policy and protect human lives. In this study, we sought to assess the respiratory outcomes associated with PM10, O3, SO2, and NO2 in the Iranian population. The required data, which included concentrations of air pollutants, meteorology, and population size, were obtained from the department of environment and meteorological organizations. The validity of the data was evaluated, and appropriate calculations were conducted on the data to extract the required values and parameters for modeling (using the AirQ2.2.3). This study was conducted in two megacities of Iran (Tabriz and Urmia) with over 2 million population. The annual averages of SO2, NO2, and PM10 concentrations were 9, 73, and 43μg/m3 in Tabriz and 76, 29, and 76μg/m3 in Urmia, respectively. Excess deaths from respiratory diseases associated with PM10 and SO2 were estimated to be 33.1 and 1.2 cases in Tabriz and 31.6 and 24.7 cases in Urmia, respectively. The proportions of hospitalizations for chronic obstructive pulmonary disease (COPD) attributable to SO2 and NO2 in Tabriz were 0.07% and 1.61%, respectively, whereas they were 2.84% and 0.48% in Urmia. O3 had an annual average of 56μg/m3 in Tabriz and with 44.5 excess respiratory deaths and 42.5 excess hospital admissions for COPD, it had the greatest health impacts among the pollutants studied. Findings from this study add to the growing literature, especially from developing countries, that provides insights to help authorities and decision-makers develop and implement effective interventions to curb air pollution and save lives.

Exposure to Pesticides and Respiratory Health Outcomes in Children Residing in Imperial Valley, CA

Exposure to Pesticides and Respiratory Health Outcomes in Children Residing in Imperial Valley, CA

California wildfires: mental and physical health, unmet needs, and future directions

Background: California’s wildfires annually break records in size, fatalities, or buildings destroyed. Every year since 2017, records have been broken for deaths, structures destroyed, or area burned. The toll on mental health, respiratory conditions, and other outcomes constitutes a major public health challenge. Methods: Online surveys of households in counties affected by fires or smoke collected information about experiences during wildfires, unmet needs, and health conditions before, during and after the fires. Both a convenience sample, and a probability sample of households were recruited. One respondent replied for all household members. Lack of access to shelter, food, electricity, cell phone service, and other basic necessities was documented. Separate multinomial models were fit to the incident respiratory and mental health outcomes that occurred during and after the fires, with the goal to identify major independent predictors of symptoms in those time periods. All models hierarchically adjusted for intra-household correlations. Potential predictors included sociodemographic characteristics, cumulative PM2.5 exposure during wildfires, prior health, and fire-related experiences (evacuations; loss of home, job, loved one; etc.). Results: The sociodemographics, prior asthma, and wildfire PM2.5 exposure predicted increases in respiratory symptoms. Different factors associated with greater mental health disturbances. The study demonstrated how needs changed over time. Multivariate models showed that people of color had higher risks for respiratory symptoms, both as a direct association and through their greater prevalence of prior asthma, indicating a particularly high health burden from wildfire smoke. Conclusions: Climate change challenges epidemiology to identify specific high risk subgroups; determine factors that mediate or buffer adverse health impacts; investigate synergies across multiple extreme events/disasters or multiple health consequences; clarify differences in health risks from traffic or industrial versus wildfire air pollution; and work with communities to develop culturally appropriate protective strategies and to evaluate feasibility, effectiveness, co-benefits or negative effects of interventions.

Associations between grass pollen counts and allergen (Phl p 5) levels with respiratory allergic health outcomes

Associations between grass pollen counts and allergen (Phl p 5) levels with respiratory allergic health outcomes

Characterizing Impacts of Smoke Exposure from Prescribed Burns on Adverse Respiratory Health Outcomes in Georgia, United States, 2015-2018

Characterizing Impacts of Smoke Exposure from Prescribed Burns on Adverse Respiratory Health Outcomes in Georgia, United States, 2015-2018

Protecting playgrounds: local-scale reduction of airborne particulate matter concentrations through particulate deposition on roadside ‘tredges’ (green infrastructure)

Exposure to traffic-related particulate air pollution has been linked with excess risks for a range of cardiovascular, respiratory and neurological health outcomes; risks likely to be exacerbated in young children attending schools adjacent to highly-trafficked roads. One immediate way of reducing airborne PM concentrations at the local (i.e., near-road community) scale is installation of roadside vegetation as a means of passive pollution abatement. Roadside vegetation can decrease airborne PM concentrations, through PM deposition on leaves, but can also increase them, by impeding airflow and PM dispersion. Critical to optimizing PM removal is selection of species with high particle deposition velocity (Vd) values, currently under-parameterised in most modelling studies. Here, the measured amounts of leaf-deposited magnetic PM after roadside greening (‘tredge’) installation, and measured reductions in playground PM, particle number and black carbon concentrations demonstrate that air quality improvements by deposition can be achieved at the local, near-road, community/playground scale. PM deposition on the western red cedar tredge removed ~ 49% of BC, and ~ 46% and 26% of the traffic-sourced PM2.5 and PM1, respectively. These findings demonstrate that roadside vegetation can be designed, installed and maintained to achieve rapid, significant, cost-effective improvement of air quality by optimising PM deposition on plant leaves.

A Review of Ambient Air Pollution Exposure Assessment Methods in Determining Childhood Respiratory Health Effects in Children under Five

Various epidemiological studies have reported on air pollution exposure-related lung function decline and respiratory health effects in children. Children have increased susceptibility to ambient air pollutants as physiological and structural changes of the lung are still occurring within the first five years of life after birth. This review examines applications in air pollution exposure assessment methods when evaluating lung function and respiratory health concentration–response effects in young children, while considering the effects of critical windows of exposure. We identified 13 studies that used various methods of exposure assessment in assessing respiratory health outcomes (presence of lower respiratory tract infections, respiratory symptoms, wheezing and asthma) in children under five. The methods applied included personal monitoring (n = 1), proximity-based methods (n = 3), inverse distance weighting (n = 2), geographic weighted regression (n = 1), dispersion modeling (n = 1), satellite-based methods (n = 2) and land use regression modeling (n = 5). These studies assessed exposure and outcomes at different “windows of susceptibility”: antenatally/specific trimesters (n = 8), infancy (n = 5) and early childhood (n = 6). In most studies, the reported measures of air pollutants were noted to be below the prescribed limits, though for some, a cause–effect association was observed. It was also noted that there was very little variation in estimates between time points or trimesters of exposure, likely attributed to limitations in the selected exposure assessment method. Moderate to high correlations between trimesters were reported for most studies.

Microbiome alterations from volatile organic compounds (VOC) exposures among workers in salons primarily serving women of color

Salon workers, especially those serving an ethnically and racially diverse clientele (i.e., Black/Latina), may experience disparately high levels of workplace exposures to respiratory irritants, including volatile organic compounds (VOCs). Salon workers are also reported to have a greater risk of developing respiratory conditions compared to the general population. Emerging evidence suggests that occupational chemical exposures may alter the human microbiome and that these alterations may be an important mechanism by which workplace VOC exposures adversely impact respiratory health. This preliminary research investigated the potential effects of 28 VOC urinary biomarkers on the 16S rRNA nasal microbiome in 40 workers from salons primarily serving women of color (Black and Dominican salons) compared to office workers. Our exploratory analysis revealed significant differences in microbial composition by worker group; namely dissimilar levels of Staphylococcus species (S. epidermidis and S. aureus, specifically) in salon workers compared to office workers, and higher alpha diversity levels in workers in Dominican salons compared to workers in Black salons. Within-sample alpha diversity levels tended to be decreased with higher VOC urinary biomarker concentrations, significantly for carbon disulfide, acrolein, acrylonitrile, crotonaldehyde, and vinyl chloride biomarkers. Our research highlights that occupational exposures, particularly to chemicals like VOCs, can impact the respiratory microbiome in the vulnerable salon worker group. Further understanding of the potential effects of chemical mixtures on microbial composition may provide key insights to respiratory health and other adverse health outcomes, as well as direct prevention efforts in this largely historically understudied occupational population.

Health Outcomes in Children Associated with Prenatal and Early-Life Exposures to Air Pollution: A Narrative Review.

(1) Background: The developmental origins of health and disease (DOHaD) hypothesis links adverse fetal exposures with developmental mal-adaptations and morbidity later in life. Short- and long-term exposures to air pollutants are known contributors to health outcomes; however, the potential for developmental health effects of air pollution exposures during gestation or early-childhood have yet to be reviewed and synthesized from a DOHaD lens. The objective of this study is to summarize the literature on cardiovascular and metabolic, respiratory, allergic, and neuropsychological health outcomes, from prenatal development through early childhood, associated with early-life exposures to outdoor air pollutants, including traffic-related and wildfire-generated air pollutants. (2) Methods: We conducted a search using PubMed and the references of articles previously known to the authors. We selected papers that investigated health outcomes during fetal or childhood development in association with early-life ambient or source-specific air pollution exposure. (3) Results: The current literature reports that prenatal and early-childhood exposures to ambient and traffic-related air pollutants are associated with a range of adverse outcomes in early life, including cardiovascular and metabolic, respiratory and allergic, and neurodevelopmental outcomes. Very few studies have investigated associations between wildfire-related air pollution exposure and health outcomes during prenatal, postnatal, or childhood development. (4) Conclusion: Evidence from January 2000 to January 2022 supports a role for prenatal and early-childhood air pollution exposures adversely affecting health outcomes during development. Future studies are needed to identify both detrimental air pollutants from the exposure mixture and critical exposure time periods, investigate emerging exposure sources such as wildfire, and develop feasible interventional tools.

Retrofitting home insulation reduces incidence and severity of chronic respiratory disease.

To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference‐in‐difference model compared changes in the number of prescriptions dispensed for respiratory illness post‐ insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow‐up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow‐up: odds ratio 0.90 (95% CI: 0.86–0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96–0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99–1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.

Pollen Exposure and Cardiopulmonary Health Impacts in Adelaide, South Australia.

(1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003–2017) of data gathered in Adelaide, South Australia; (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0–17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days; (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00–1.10) to 1.25 (95% CI 1.12–1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children; (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.

Respiratory, Neurological and Other Health Outcomes among Plastic Factory Workers in Gazipur, Bangladesh

Background: Approximately three thousand plastic goods manufacturing factories (PGMF) are currently operating in Bangladesh involving numerous workers. Associated health problems of these workers are largely unknown. The key objectives of the current study were identifying plastic chemical exposures related health outcomes in these workers and comparing these outcomes before and after their joining in PGMFs. In addition, we aimed to investigate the relationships between work duration and the prevalence of health ailments among workers.&#x0D; Method: A cross-sectional study was carried out among factory workers (n=405) at six PGMFs in Gazipur district in Bangladesh. A simple random sampling method had been applied to select participants and data on their self-reported exposures to chemicals and associated respiratory, neurological, and other multiple health outcomes were collected through a validated questionnaire survey. Data were analyzed using different descriptive and inferential statistical tools. The categorical variables and continuous variables were interpreted using frequency distribution and standard deviation (SD) respectively. A Pearson chi-square (χ2) test was applied to evaluate the correlation between work duration and health outcomes. A p-value &lt;0.05 was considered significant statistically.&#x0D; Results: The average age and work duration of the workers were 25.63±6.85 and 3.49±3.53 years, respectively, implying that most workers were young, and spent over 10% of their lifetime in PGMFs work. Most common health outcomes reported by the workers were nasal discharges: 60 (14.9%), headaches: 76 (18.9%), fatigues: 112 (27.8%), losses of appetites: 108 (26.8%), urination problems: 61 (13.1%), losses of body weights: 102 (25.3%), and nervousness: 70 (17.4%). Among the common health outcomes only headache (p=0.005); fatigue (p=0.04); urination problem (p=&lt;0.0001), and nervousness (p=0.004) were significantly associated with the work duration. Furthermore, except for hypertension and tarry stool, all health outcomes among workers differ significantly before and after joining in PGMFs.&#x0D; Conclusion: This study first time identified important health outcomes of the PGMFs workers and generated baseline information on common health outcomes of the PGMFs workers in developing countries like Bangladesh. However, it might be important to identify potential causes of such health outcomes in PGMFs workers considering both biomarkers of exposures and real-time environmental samples to understand the disease pathology and to recommend mitigation measures to be taken by occupational health policymakers and practitioners in developing countries.

Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study

BackgroundWhile benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent.MethodsWe utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV1), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV1/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status.ResultsWe noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV1 and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV1 (200 m: β = 2.1, 95% CI: 0.1, 3.3; 400 m: β = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: β = 1.8, 95% CI: 0.7, 3.0; 400 m: β = 1.6, 95% CI: 0.3, 2.8; 800 m: β = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV1/FVC were non-significant except exposure at birth in the 400 m buffer (β = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function.ConclusionSensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.