Survey Of The Health Of Wisconsin Research Articles

Determinants of per- and polyfluoroalkyl substances (PFAS) exposure among Wisconsin residents

BackgroundPer- and polyfluoroalkyl substances (PFAS) include thousands of manufactured compounds with growing public health concerns due to their potential for widespread human exposure and adverse health outcomes. While PFAS contamination remains a significant concern, especially from ingestion of contaminated food and water, determinants of the variability in PFAS exposure among regional and statewide populations in the United States remains unclear. ObjectivesThe objective of this study was to leverage The Survey of the Health of Wisconsin (SHOW), the only statewide representative cohort in the US, to assess and characterize the variability of PFAS exposure in a general population. MethodsThis study sample included a sub-sample of 605 adult participants from the 2014–2016 tri-annual statewide representative sample. Geometric means for PFOS, PFOA, PFNA, PFHxS, PFPeS, PFHpA, and a summed measure of 38 analyzed serum PFAS were presented by demographic, diet, behavioral, and residential characteristics. Multivariate linear regression was used to determine significant predictors of serum PFAS after adjustment. ResultsOverall, higher serum concentrations of long-chain PFAS were observed compared with short-chain PFAS. Older adults, males, and non-Hispanic White individuals had higher serum PFAS compared to younger adults, females, and non-White individuals. Eating caught fish in the past year was associated with elevated levels of several PFAS. DiscussionThis is among the first studies to characterize serum PFAS among a representative statewide sample in Wisconsin. Both short- and long-chain serum PFAS were detectable for six prominent PFAS. Age and consumption of great lakes fish were the most significant predictors of serum PFAS. State-level PFAS biomonitoring is important for identifying high risk populations and informing state public health standards and interventions, especially among those not living near known contamination sites.

Participant attrition from statewide, population-based Survey of the Health of Wisconsin into the longitudinal SHOW COVID-19 cohort

PurposeLongitudinal studies are essential for examining how social and institutional determinants of health, historical and contemporary, affect disparities in COVID-19 related outcomes. The unequal impacts of COVID-19 likely exacerbated selected attrition in longitudinal research. This study examines attrition and survey mode effects in the SHOW COVID-19 study which recruited from a statewide, representative cohort. Materials & methodsParticipants were recruited from the Survey of the Health of Wisconsin (SHOW) cohort. Online surveys, or phone interviews, were administered at three timepoints during 2020–2021. The surveys captured social, behavioral, and structural determinants of health and the lived experience. Univariate and multivariate logistic regression was used to examine predictors of participation and survey mode effects. ResultsA total of 2304 adults completed at least one COVID-19 online survey. Participants were more educated, older, and more likely to be female, married, non-Hispanic, and White compared to non-participants. Phone participants were older, less educated, and more likely be non-White, food insecure, and have co-morbidities compared to online participants. Mode effects were seen with reporting COVID-19 beliefs, loneliness, and anxiety. ConclusionThe SHOW COVID-19 cohort offers unique longitudinal data but suffered from selected attrition. Phone interview is an important mode for retention and representation.

Biomonitoring of perfluoroalkyl and polyfluoroalkyl substances (PFAS) from the Survey of the Health of Wisconsin (SHOW) 2014-2016 and comparison with the National Health and Nutrition Examination Survey (NHANES).

Per- and polyfluoroalkyl substances (PFAS) are a growing class of manufactured chemical compounds found in a variety of consumer products. PFAS are ubiquitous in the environment and were found in many humans sampled in the United States (U.S.). Yet, significant gaps in understanding statewide levels of exposure to PFAS remain. The goals of this study are to establish a baseline of exposure at the state level by measuring PFAS serum levels among a representative sample of Wisconsin residents and compare to United States National Health and Nutrition Examination Survey (NHANES). The study sample included 605 adults (18+ years of age) selected from the 2014-2016 sample of the Survey of the Health of Wisconsin (SHOW).Thirty-eight PFAS serum concentrations were measured using high-pressure liquid chromatography coupled with tandem mass spectrometric detection (HPLC-MS/MS) and geometric means were presented. Weighted geometric mean serum values of eight PFAS analytes from SHOW were compared to U.S. national levels from the NHANES 2015-2016 sample (PFOS, PFOA, PFNA, PFHxS, PFHpS, PFDA, PFUnDA), and the 2017-2018 sample for Me-PFOSA, PFHPS using the Wilcoxon rank-sum test. PFOS, PFHxS, PFHpS, PFDA, PFNA, and PFOA were detected in over 96% of SHOW participants. In general, SHOW participants had lower serum levels across all PFAS when compared to NHANES. Serum levels increased with age and were higher among males and whites. Similar trends were seen in NHANES, except non-whites had higher PFAS levels at higher percentiles in NHANES. The present study conducts biomonitoring of 38 PFAS among representative sample of residents in the state of Wisconsin. Results suggest that while the majority of Wisconsin residents tested have detectable levels of PFAS in their blood serum, they may have a lower body burden of some PFAS compared to a nationally representative sample. Older adults, males, and whites may have a higher body burden of PFAS relative to other groups, both in Wisconsin and the wider United States.

For Submission to the Journal of Community Health: Carbon Monoxide Awareness and Detector Use in the State of Wisconsin.

Carbon monoxide (CO) is a leading cause of poisoning. CO detectors are a known-effective prevention strategy, however, little is known about use of detectors or knowledge of risk. This study assessed awareness of CO poisoning risk, detector laws, and detector use among a statewide sample. Data collected from the Survey of the Health of Wisconsin (SHOW) included a CO Monitoring module added to the in-home interview for 466 participants representing unique households across Wisconsin in 2018-2019. Univariate and multivariable logistic regression models examined associations between demographic characteristics, awareness of CO laws and detector use. Less than half of households had a verified CO detector. Under 46% were aware of the detector law. Those aware had 2.82 greater odds of having a detector in the home compared to those unaware of the law. Lack of CO law awareness may lead to less frequent detector use and result in higher risk of CO poisoning. This highlights the need for CO risk and detector education to decrease poisonings.

Self-reported hearing loss is associated with poorer perceived health care access, timeliness, satisfaction, and quality: Findings from the Survey of the Health of Wisconsin

BackgroundHearing loss is a highly prevalent chronic condition impacting communication and may negatively influence patients’ health care experiences. ObjectiveDetermine associations of hearing loss with perceived health care access, timeliness, satisfaction, and quality in a representative sample of the general population. MethodsThe Survey of the Health of Wisconsin (SHOW) is a household-based examination survey that collects data from a representative sample of Wisconsin residents. SHOW participants from years 2008–2013 with data on self-reported hearing loss and health care access, timeliness, satisfaction, and quality were included in this study. Age- and sex- and multivariable-adjusted (additionally adjusted for race/ethnicity, education, marital status, public health region, smoking, chronic disease, self-reported health, and insurance coverage) logistic regression models were used to evaluate associations of hearing loss with participants’ health care experiences. Results are presented as odds ratios (OR) with corresponding 95% confidence intervals. ResultsThere were 2438 individuals (42.1% men) included in this study with an average age of 48.3 (range 21–74; standard deviation [SD] 14.4) years. The number of participants who self-reported hearing loss was 642 (26.3%). After multivariable adjustment, hearing loss was associated with increased odds of perceived difficulties with health care access (OR 1.47 [1.05, 2.05]), timeliness (OR 1.69 [1.23, 2.32]), quality (OR 2.54 [1.50, 4.32]), and satisfaction (OR 2.50 [1.51, 4.13]). ConclusionsGiven the high prevalence of hearing loss and the growing aging population, there is an urgent need to prioritize interventions to improve health care provision for individuals with hearing loss.

The Survey of the Health of Wisconsin (SHOW) Program: An Infrastructure for Advancing Population Health.

IntroductionThe Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of (1) providing a timely and accurate picture of the health of the state residents; and (2) serving as an agile resource infrastructure for ancillary studies. Today, the SHOW program continues to serve as a unique and vital population health research infrastructure for advancing public health.MethodsSHOW currently includes 5,846 adult and 980 minor participants recruited between 2008 and 2019 in four primary waves. WAVE I (2008–2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014–2016) is a triannual statewide sample of 1,957 adults (age ≥18 years) and 645 children (age 0–17). WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline surveys of 222 children in selected households. WAVEs II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV consists of 517 adults and 113 children recruited from traditionally under-represented populations in biomedical research including African Americans and Hispanics in Milwaukee, Wisconsin.Findings to DateThe SHOW resource provides unique spatially granular and timely data to examine the intersectionality of multiple social determinants and population health. SHOW includes a large biorepository and extensive health data collected in a geographically diverse urban and rural population. Over 60 studies have been published covering a broad range of topics including, urban and rural disparities in cardio-metabolic disease and cancer, objective physical activity, sleep, green-space and mental health, transcriptomics, the gut microbiome, antibiotic resistance, air pollution, concentrated animal feeding operations and heavy metal exposures.DiscussionThe SHOW cohort and resource is available for continued follow-up and ancillary studies including longitudinal public health monitoring, translational biomedical research, environmental health, aging, microbiome and COVID-19 research.

Exposure to socioenvironmental stress as a predictor of physical and mental health.

The literature demonstrates links between socioenvironmental characteristics, dysregulation of the stress response system, and PTSD, though few studies integrate these factors in one model. In a secondary analysis of cross-sectional data collected by the Survey of the Health of Wisconsin (SHOW), structural equation modeling evaluated the relationships between socioenvironmental stress, cumulative biological risk (CBR), and PTSD symptom severity. The model hypothesized that exposure to socioenvironmental stress was associated with PTSD and that this relationship is mediated by increased CBR. Indices suggest the model provided a good fit to the data and supported socioenvironmental stress and CBR as valid latent constructs. Although the association between CBR and PTSD was not found to be statistically significant in this study, socioenvironmental stress was a significant predictor of PTSD and CBR. Given the role of socioenvironmental factors on CBR and PTSD symptoms, providers need to better assess and incorporate social stressors within evaluation and treatment.

1015. Antibiotic use and indications in a community sample of adults in Wisconsin

BackgroundThere is significant inappropriate and overuse of antibiotics in the United States. We describe patterns of self-reported actual use of antibiotics and indications in Wisconsin adults.MethodsThe Survey of the Health of Wisconsin (SHOW) is an annual health study of a wide range of health determinants and outcomes among a population-based sample of residents with targeted recruitment of underrepresented minorities. In 2016, SHOW initiated WARRIOR (Winning the War on Antibiotic Resistance), an ancillary study that assessed actual antibiotic use and indications among adults. Antibiotics were grouped by pharmacologic class, and indications were grouped into clinical categories. Descriptive statistics and logistic regression were used to examine factors associated with antibiotic use.ResultsOverall, 756 adults [435 female and 321 male; mean (SD) age=54.2 (16.5)] were recruited, and 256 (33.5%) reported antibiotic use in the past year. Females (OR=1.87, 95% CI: 1.29, 2.70), people with current comorbidities or history of certain health conditions (OR=2.04, 95% CI: 1.23, 3.39), and people with a mental health or developmental condition (OR=1.93, 95% CI: 1.33, 281) were statistically significantly more likely to report antibiotic use. BMI (kg/m2) was slightly higher among antibiotic users (31.2) than nonusers (29.8; P = 0.064). Diabetes, heavy drinking, and smoking history were not correlated with antibiotic use.Top antibiotic classes used were penicillins (31%), macrolides (12%), first-generation cephalosporins (9%), tetracyclines (8%), quinolones (7%), and nitroimidazoles (3%). Top indications reported were upper respiratory infection (URI; 32.3%), dental condition or procedure (21.0%), surgery (12.6%), lower respiratory infection (11%), urinary tract, bladder, or kidney infection (7%), skin or soft-tissue infection (6%), and insect bite or insect-borne infection (6%).ConclusionAntibiotic use varies among Wisconsin adults, and certain groups are more likely to have used antibiotics in the last year. The top two reported indications for antibiotics were categories with known high rates of inappropriate (e.g., URI) and prophylactic (i.e., dental) prescribing. Further studies are needed to determine specific opportunities to reduce antibiotic use in Wisconsin.Disclosures All authors: No reported disclosures.

540. The Impact of Diet and Oral Hygiene on the Risk of Multidrug-Resistant Organism Carriage in the Mouth and Gut

BackgroundLittle is known about the relationship between oral hygiene and multidrug-resistant organism in the mouth and gut. We aimed to assess the relationship of oral hygiene and diet with multidrug-resistant organism (MDRO) carriage in the oral cavity and gut.MethodsParticipants were adults over age 18 from the 2016–2017 Survey of the Health of Wisconsin (SHOW) and its ancillary Wisconsin Microbiome Study. SHOW surveys residents of Wisconsin, collecting health determinants including a food frequency questionnaire, oral health, as well as biologic specimens. MDROs were defined as the presence of methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus, and Fluoroquinolone-resistant Gram-negative bacteria identified via culture from saliva, oral swabs, and stool samples. Statistical analysis was performed in R v3.5.1. Univariate analyses were conducted for all variables in the data set. Any variable with a P-value < 0.2 in the univariate analysis was considered for the logistic regression. Logistic regression using the glm function was done modeling MDRO carriage in either the saliva, oral swab, saliva and oral samples combined, and stool against diet, oral health, and known confounders.Results876 participants were included in the dataset with all 876 providing oral and stool samples and 784 providing saliva samples. Thirty-three patients were MDRO positive in the saliva (4.2%), 36 were positive in the oral swabs (4.1%), 55 were positive in either the saliva or oral swabs (6.3%), and 103 were positive in the stool (11.8%). In the logistic regression, consumption of whole grains was significantly associated with reduced MDRO carriage in the saliva (P = 0.046) and saliva and oral swab combined (P = 0.036) data sets (Table 1).ConclusionConsuming more whole grains was associated with a lower prevalence of MDRO carriage in the oral cavity. Higher levels of sugar consumption were associated with a higher prevalence of MDRO in the gut. Oral hygiene was not found to be associated with MDRO colonization in the mouth and a higher prevalence in the gut in this cross-sectional study. This may be due to over-reporting of hygiene practices by participants. Being positive for an MDRO in the oral cavity significantly increased the risk of MDRO carriage in the gut. Disclosures All authors: No reported disclosures.

Urban and Rural Differences in Gut Microbial Diversity

PDS 75: Microbiome, infections and respiratory effects, Johan Friso Foyer, Floor 1, August 27, 2019, 1:30 PM - 3:00 PM Background: The link between the external and internal microbiological communities on host health is an emerging area of scientific inquiry. Gut dysbiosis or the unequal balance of healthy and unhealthy microbes has been associated with numerous inflammatory, metabolic and immune disorders. Urban environments are thought to be less diverse than rural environments, but the health impacts of these differences are poorly understood. The aim of this study is to examine urban and rural factors predicting gut microbial diversity among a randomly selected population-based sample of adults. The geographically diverse sample includes unique opportunities to explore differences in both urban and rural communities in which air pollution and drinking water sources vary considerably. Methods: Participants included adults over the age of 18 from the 2016 Survey of the Health of Wisconsin (SHOW) and its ancillary microbiome study. SHOW is a general population-based health examination survey, collecting a wide range of health determinants including drinking water sources and filtration, as well as objective measurements of body habitus, and biological specimens. Residents can be linked to numerous extant data including downscaled air monitoring and drinking water source data. Data for this analysis came from participants who also submitted a stool sample and completed a microbiome survey questionnaire. Results: Using carefully adjusted models, among 466 participants, gut microbial α-diversity and richness were associated with higher income, older age, and urbanicity. Water filtration use was only associated with α-diversity among rural residents, 98% private-well users. Similarly, β-diversity was associated with water filter use for those with increasing income level. In contrast, low-level ambient-air pollution was not associated with an altered gut microbial composition in either context. Conclusion: Results suggest urban and rural sources of water and air pollution may contribute to differences in microbial diversity, additional research is needed to fully understand the health impacts.

What moves us: Subjective and objective predictors of active transportation

BackgroundThe majority of commuting trips in the United States are taken by motor vehicle. Yet, lack of regular physical activity has been identified as one of its most significant public health issues, and globally, risks due to physical inactivity are increasing. However, we believe current studies offer an unclear picture of the complex role of the environmental or psychological influences in active travel behavior across urbanicity classifications. AimsTo (1) determine an association between objective or subjective measures of the built environment and active transportation, and (2) characterize the associations within both urban and non-urban contexts among a statewide sample of 862 adults residing in Wisconsin. MethodsMultivariate logistic regression analysis of subjective data from the Survey of the Health of Wisconsin (SHOW) and data from the Wisconsin Assessment of the Social and Built Environment (WASABE), a direct observation audit tool, to test the impacts of subjective perceptions and objective built environment predictors on active transportation in both urban and rural contexts. ResultsMales, non-married, physically active individuals, those living in urban areas and with higher education levels had greater odds of using active transportation. Bicycle friendliness (aOR = 2.43; 95% CI: 1.4–4.2) and presence of non-residential destinations (aOR = 1.03; 95% CI: 1.01–1.05) were the strongest objective predictors of active transportation overall. Subjective measures were especially predictive of active transportation in non-urban areas, specifically for participants identifying presence of trails (adjusted odds = 3.71; 95% CI: 1.5–9.2) and non-residential destinations nearby (adjusted odds = 2.65; 95% CI: 0.99–7.06). ConclusionsActive transportation is associated with built environment characteristics and perceived environmental factors, but the specific predictors and strength of associations vary by context. Results suggest perceived bicycle friendliness may be important in urban areas and access to trails for walking and biking may provide important opportunities to promote active transportation in more suburban or rural areas.

Urinary lead concentration and composition of the adult gut microbiota in a cross-sectional population-based sample

BackgroundLead (Pb) is a ubiquitous environmental contaminant with an array of detrimental health effects in children and adults, including neurological and immune dysfunction. Emerging evidence suggests that Pb exposure may alter the composition of the gut microbiota, however few studies have examined this association in human populations. The purpose of this study was to examine the association between urinary Pb concentration and the composition of the adult gut microbiota in a population-based sample of adults. MethodsData used in this study were collected as part of the Survey of the Health of Wisconsin (SHOW) and its ancillary microbiome study. The SHOW is a household-based health examination survey of Wisconsin residents, collecting a variety of survey data on health determinants and outcomes, as well as objective measurements of body habitus, and biological specimens including urine. The ancillary microbiome study added additional questions and biological specimen collection, including stool, from participants age 18+. Pb concentration was analyzed in urine samples, and gut microbiota composition was assessed using DNA sequencing of the 16S rRNA V4 region, extracted from stool samples. Data processing and statistical analyses were performed in mothur, Python, R, and SAS. ResultsOf 696 participants, urinary Pb concentration was highest in those age 70+, females, those with a high school diploma or lower, current and former smokers, and those without indoor pets. In adjusted models, increasing urinary Pb levels were associated with increases in microbial α-diversity (p = 0.071) and richness (p = 0.005). Differences in microbial β-diversity were significantly associated (p = 0.003) with differences in urinary Pb level. Presence of Proteobacteria, including members of the Burkholderiales, was significantly associated with increased urinary Pb. ConclusionThese results suggest that Pb exposure is associated with differences in the composition of the adult gut microbiota in a population-based human sample. Further investigation of this association is warranted.

Residential proximity to concentrated animal feeding operations and allergic and respiratory disease

BackgroundAir emissions from concentrated animal feeding operations (CAFO) have been associated with respiratory and allergic symptoms among farm workers, primarily on swine farms. Despite the increasing prevalence of CAFOs, few studies have assessed respiratory health implications among residents living near CAFOs and few have looked at the health impacts of dairy CAFOs. ObjectivesThe goal of this study was to examine objective and subjective measures of respiratory and allergic health among rural residents living near dairy CAFOs in a general population living in the Upper Midwest of the United States. MethodsData were from the 2008–2016 Survey of the Health of Wisconsin (SHOW) cohort (n = 5338), a representative, population based sample of rural adults (age 18+). The association between distance to the nearest CAFO and the prevalence of self-reported physician-diagnosed allergies, asthma, episodes of asthma in the last 12 months, and asthma medication use was examined using logistic regression, adjusting for covariates and sampling design. Similarly, the association between distance to the nearest CAFO and lung function, measured using spirometry, was examined using multivariate linear regression. Restricted cubic splines accounted for nonlinear relationships between distance to the nearest CAFO and the aforementioned outcomes. ResultsLiving 1.5 miles from a CAFO was associated with increased odds of self-reported nasal allergies (OR = 2.08; 95% CI: 1.38, 3.14), lung allergies (OR = 2.72; 95% CI: 1.59, 4.66), asthma (OR = 2.67; 95% CI: 1.39, 5.13), asthma medication (OR = 3.31; 95% CI: 1.65 6.62), and uncontrolled asthma, reported as an asthma episode in last 12 months (OR = 2.34; 95% CI: 1.11, 4.92) when compared to living 5 miles from a CAFO. Predicted FEV1 was 7.72% (95% CI: −14.63, −0.81) lower at a residential distance 1.5 miles from a CAFO when compared with a residence distance of 3 miles from a CAFO. ConclusionsResults suggest CAFOs may be an important source of adverse air quality associated with reduced respiratory and allergic health among rural residents living in close proximity to a CAFO.

Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin.

There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07–4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64–4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10–7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.

Urinary Lead Concentration and Its Association with the Composition of the Adult Gut Microbiota

Imbalance of the gut microbiota has been linked to many adverse health outcomes including infection, and autoimmune disease. Along with its other detrimental health effects, lead (Pb) exposure may alter the composition of the gut microbiota, but this association has not been investigated in adults. This study examines the association between urinary Pb concentration and the composition of the adult gut microbiota in a non-clinical sample. Data are from the 2016 Survey of the Health of Wisconsin (SHOW) and its ancillary microbiome study. SHOW is a general population-based health survey of Wisconsin residents, collecting survey data on health determinants and outcomes, objective measurements of body habitus, and biological specimens including urine. The ancillary microbiome study collects additional survey data and biological specimens, including stool for microbiota analysis, from participants age 18&amp;#43;. Pb exposure was measured in urine and gut microbiota composition was assessed using 16S rRNA V4 region amplicon sequencing. Statistical analysis includes &amp;#945; and &amp;#946; diversity metrics, multiple linear regression and PERMANOVA adjusted for relevant confounders, and SIMPER analysis. Of 467 participants, urinary Pb concentration was highest in those age 70&amp;#43;, those with a high school diploma or less, and current smokers. Creatinine adjusted log urinary Pb concentration was associated with a significant decrease in &amp;#945;-diversity (Shannon p&amp;#61; 0.026, Inverse-Simpson p&amp;#61; 0.051) but not richness, although interactions with age, gender, diet components and smoking status were significant. &amp;#946;-diversity was significantly different between participants in quartile 4 vs. 1 of urinary Pb (Jaccard p&amp;#61;0.049), however no operational taxonomic units were significantly different between groups after correction for multiple comparisons. These novel results suggest that Pb exposure is associated with differences in the composition of the adult gut microbiota in a community-based human population.

Wisconsin microbiome study, a cross-sectional investigation of dietary fibre, microbiome composition and antibiotic-resistant organisms: rationale and methods

IntroductionPrevention of multidrug-resistant organism (MDRO) infections, such as those caused by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, fluoroquinolone-resistant Gram-negative bacteria and Clostridium difficile is crucial. Evidence suggests that dietary fibre increases...

Neighborhood Perceptions and Cumulative Impacts of Low Level Chronic Exposure to Fine Particular Matter (PM2.5) on Cardiopulmonary Health.

Adverse perceptions of neighborhood safety, aesthetics and quality including access to resources can induce stress and may make individuals more sensitive to cardiopulmonary effects of air pollution exposure. Few studies have examined neighborhood perceptions as important and modifiable non-chemical stressors of the built environment that may exacerbate effects of air pollution on cardiopulmonary health outcomes, particularly among general population based cohorts. This study examined associations between low-level chronic exposure to fine particulate matter (PM2.5) and cardiopulmonary health, and the potential mediating or modifying effects of adverse neighborhood perceptions. Using data from the Survey of the Health of Wisconsin (SHOW), 2230 non-asthmatic adults age 21–74 were included in the analyses. The overall goals of this study were to assess if individuals who experience stress from neighborhood environments in which they live were more sensitive to low levels of fine particular matter (PM2.5 μg/m3). Demographic predictors of air pollution exposure included younger age, non-White race, lower education and middle class income. After adjustments, objective lung function measures (FEV1 and FEV1 to FVC ratio) were the only cardiopulmonary health indicators significantly associated with chronic three-year annual averages of PM2.5. Among all non-asthmatics, a ten unit increase in estimated three year annual average PM2.5 exposure was significantly associated with lower forced expiratory volume (L) in one second FEV1 (β = −0.40 μg/L; 95% CI −0.45, −0.06). Among all individuals, adverse perceptions of the neighborhood built environment did not appear to statistically moderate or mediate associations. However, stratified analysis did reveal significant associations between PM2.5 and lung function (FEV1) only among individuals with negative perceptions and increased reports of neighborhood stressors. These findings included individuals who felt their neighborhoods were poorly maintained (β = −0.82; 95% CI −1.35, −0.28), experienced stress from crime (β = −0.45; 95% CI −0.94, 0.04) or reported neighborhood is not well maintained (β = −1.13, CI −2.04, −0.24). These significant associations were similar for FEV1 to FVC ratio. Multi-pronged approaches addressing both neighborhood built environment aesthetics and air pollution regulation may be necessary to protect vulnerable and susceptible individuals and reduce persistent inequalities.

Obesity, Air Pollution and Lung Function: Findings from the Survey of the Health of Wisconsin (SHOW)

Obesity, Air Pollution and Lung Function: Findings from the Survey of the Health of Wisconsin (SHOW)

Allergic disease associations with regional and localized estimates of air pollution

BackgroundExposure to multiple types of air pollution may contribute to and exacerbate allergic diseases including asthma and wheezing. However, few studies have examined chronic air pollution exposure and allergic disease outcomes among an adult population. Associations between potential estimates of annual average fine particulate matter (PM2.5), traffic related air pollution, and industrial source air emissions and three allergic disease outcomes (asthma, allergies and wheezing) were examined in a state-wide general population of adults. MethodsThe study includes a representative sample of 3381 adult Wisconsin residents who participated in the 2008–2013 Survey of the Health of Wisconsin (SHOW) program. Participant data were geographically linked to The United States Environmental Protection Agency (USEPA) Baysian space-time downscaler air pollution model for PM2.5, the United States Census roadway, and USEPA's Toxic Release Inventory data. Self-report and lung function (FEV1) estimates were used to define prevalence of asthma, allergies and wheezing symptoms. ResultsAnnual mean exposure to fine particulate matter (PM2.5) was between 6.59 and 15.14μg/m3. An increase of 5μg/m3 in the annual mean PM2.5 resulted in a 3.58 (2.36, 5.43) increase in the adjusted odds (95% CI) of having asthma. Exposure to vehicle traffic increased the odds of both current allergies [OR (95% CI)=1.35 (1.07, 1.35)] and current asthma [OR (95% CI)=1.51 (1.14, 2.00)]. Living within 300m of an Interstate roadway was associated with a 3-fold increase in the odds of asthma. Those living within 800m of an industrial site were 47% more likely to have asthma. No significant associations were seen with wheezing. ConclusionsWithin this population exposed to overall annual average levels of estimated low level chronic exposure to fine particulate matter (PM2.5) at or near 12μg/m3, the USEPA standard for air quality, significant association between both modeled PM2.5 exposure and proximity to roadways with asthma and allergies but not wheezing were found. Industrial source emissions were not associated with any allergic disease outcomes.

Food insecurity and cardiovascular health: Findings from a statewide population health survey in Wisconsin

BackgroundThe social and economic environment has become a major area of interest regarding the determinants of cardiovascular health. Among markers of economic distress, food insecurity has been found associated with metabolic disorders, dyslipidemia, and obesity, but no previous studies have examined its association with overall cardiovascular health. Methods and resultsWe conducted a cross-sectional analysis among 2935 participants in the Survey of the Health of Wisconsin (SHOW), a statewide population-based representative sample. The presence of food insecurity was determined by an affirmative answer to the question “In the last 12months, have you been concerned about having enough food for you or your family?” Cardiovascular health (CVH) was defined based on the American Heart Association Life's Simple 7 criteria and classified as “poor,” “intermediate,” or “ideal” using previously published criteria. “Good” CVH was defined as having no poor in any of the seven criteria (any amount of intermediate or ideal). Crude and adjusted odds ratios (OR) of good CVH according to presence of food insecurity were calculated using logistic regression models. Overall, food insecurity was associated with a decreased likelihood of good CVH (OR 0.53; 95% Confidence Interval 0.31 to 0.92; p=0.02). This association persisted in models controlling for age, gender, race, and urbanization. ConclusionsParticipants who were food insecure were significantly less likely to have good CVH compared to participants who were food secure. Even though this study cannot confirm causality, these results suggest that food insecurity might be one of several socio-economic barriers contributing to poor CVH.