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Background: Cardiovascular diseases (CVDs), the leading cause of death worldwide, are sensitive to temperature. In light of the reported climate change trends, it is important to understand the burden of CVDs attributable to temperature, both hot and cold. The association between CVDs and temperature is region-specific, with relatively few studies focusing on low-and middle-income countries. This study investigates this association in Puducherry, a district in southern India lying on the Bay of Bengal, for the first time., Methods: Using in-hospital CVD mortality data and climate data from the Indian Meteorological Department, we analyzed the association between apparent temperature (T app ) and in-hospital CVD mortalities in Puducherry between 2011 and 2020. We used a case-crossover model with a binomial likelihood distribution combined with a distributed lag non-linear model to capture the delayed and non-linear trends over a 21-day lag period to identify the optimal temperature range for Puducherry. The results are expressed as the fraction of CVD mortalities attributable to heat and cold, defined relative to the optimal temperature. We also performed stratified analyses to explore the associations between T app and age-and-sex, grouped and considered together, and different types of CVDs. Sensitivity analyses were performed, including using a quasi-Poisson time-series approach., Results: We found that the optimal temperature range for Puducherry is between 30°C and 36°C with respect to CVDs. Both cold and hot non-optimal T app were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Cumulatively, up to 17% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to heat (9.1%) than cold (8.3%). We also found that males were more vulnerable to colder temperature; females above 60 years were more vulnerable to heat while females below 60 years were affected by both heat and cold. Mortality with cerebrovascular accidents was associated more with heat compared to cold, while ischemic heart diseases did not seem to be affected by temperature., Conclusion: Both heat and cold contribute to the burden of CVDs attributable to non-optimal temperatures in the tropical Puducherry. Our study also identified the age-and-sex and CVD type differences in temperature attributable CVD mortalities. Further studies from India could identify regional associations, inform our understanding of the health implications of climate change in India and enhance the development of regional and contextual climate-health action-plans., (© 2023. The Author(s).)

Environmental noise exposure has been shown to affect children's cognition, but the concept of cognition is multifaceted, and studies on associations with noise are still inconclusive and fragmented. We studied cognitive change within one year in 882 adolescents aged 10-17 years in response to road traffic noise exposure. Participants filled in a comprehensive questionnaire and underwent cognitive testing twice at an interval of one year. Figural and verbal memory was measured with the Intelligenz-Struktur-Test (IST), and concentration accuracy and constancy were measured with FAKT-II and d2 test. Exposure to noise and other environmental stressors were modelled for school and home location at baseline. Missing data was addressed with multiple imputation. Cross-sectional multilevel analyses and longitudinal change score analyses were performed. In cross-sectional analyses, figural memory was significantly reduced by -0.27 (95%CI -0.49,-0.04) units per 10 dB road traffic noise increase at home (L den ). Longitudinal analyses showed a significant reduction of concentration constancy Z-scores between baseline and follow-up by -0.13 (95%CI -0.25, 0.00) per 10 dB road traffic noise at home (L den ). Our study indicates that road traffic noise at home reduces cognitive performance in adolescents. Larger cohorts with longer follow-up time are needed to confirm these results., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Radiofrequency electromagnetic fields originate from a variety of wireless communication sources operating near and far from the body, making it challenging to quantify daily absorbed dose. In the framework of the prospective cohort SCAMP (Study of Cognition, Adolescents and Mobile Phones), we aimed to characterize RF-EMF dose over a 2-year period., Methods: The SCAMP cohort included 6605 children from greater London, UK at baseline (age 12.1 years; 2014-2016) and 5194 at follow-up (age 14.2; 2016-2018). We estimated the daily dose of RF-EMF to eight tissues including the whole body and whole brain, using dosimetric algorithms for the specific absorption rate transfer into the body. We considered RF-EMF dose from 12 common usage scenarios such as mobile phone calls or data transmission. We evaluated the association between sociodemographic factors (gender, ethnicity, phone ownership and socio-economic status), and the dose change between baseline and follow-up., Results: Whole body dose was estimated at an average of 170 mJ/kg/day at baseline and 178 mJ/kg/day at follow-up. Among the eight tissues considered, the right temporal lobe received the highest daily dose (baseline 1150 mJ/kg/day, follow-up 1520 mJ/kg/day). Estimated daily dose [mJ/kg/day] increased between baseline and follow-up for head and brain related tissues, but remained stable for the whole body and heart. Doses estimated at baseline and follow-up showed low correlation among the 3384 children who completed both assessments. Asian ethnicity (compared to white) and owning a bar phone or no phone (as opposed to a smartphone) were associated with lower estimated whole-body and whole-brain RF-EMF dose, while black ethnicity, a moderate/low socio-economic status (compared to high), and increasing age (at baseline) were associated with higher estimated RF-EMF dose., Conclusion: This study describes the first longitudinal exposure assessment for children in a critical period of development. Dose estimations will be used in further epidemiological analyses for the SCAMP study., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Radon is a radioactive noble gas naturally found in the earth crust that can accumulate in buildings. In addition to lung cancer, alpha particles emitted by radon may contribute to the risk of skin cancer. We evaluated the association between residential radon exposure and skin cancer mortality, over a fifteen year period, taking residential ultra-violet (UV) exposure into account., Methods: We included 4.9 million adults from the Swiss National Cohort. Hazard ratios for melanoma mortality were estimated using Cox proportional hazard models (20+ years old; follow-up 2001-2015). Long-term modelled residential radon and ambient UV exposures were assigned at baseline, and included together in the Cox models. With age as a time scale, models were adjusted for calendar time, sex, marital status, education, mother tongue, socioeconomic position, and occupational environment with potential for UV exposure. Age specific hazard ratios were derived. Effect modification, sensitivity analyses and the shape of the exposure response, as well as secondary analysis using other outcome definitions, were investigated., Results: During follow-up (average of 13.6 years), 3,979 melanoma deaths were observed. Associations declined with age, with an adjusted hazard ratio per 100 Bq/m 3 radon at age 60 of 1.10 (95% CI: 0.99, 1.23). The dose-response showed an approximate linear trend between the minimum and mean radon exposure of 75 Bq/m 3 . Having outdoor occupation significantly increased the risk of melanoma mortality associated with UV exposure compared to indoor jobs. Analysis restricted to the last five years of follow-up showed similar results compared to the main analysis. Similar associations were found for mortality from melanoma and non-melanoma skin cancer combined., Conclusion: With double the follow-up time, this study confirmed the previously observed association between residential radon exposure and melanoma and non-melanoma skin cancer mortality in Switzerland. Accumulation of radon indoors is preventable and of public health importance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

A series of human field studies demonstrated that simulated nocturnal traffic noise exposure impaired sleep quality and endothelial function, which could be significantly improved after intake of vitamin C in case of endothelial function. However, it remains unclear whether these changes follow a sex-specific pattern. Thus, we aimed to analyze the effect of simulated nocturnal train noise exposure on sleep quality, endothelial function and its associated changes after vitamin C intake, and other hemodynamic and biochemical parameters in young healthy men and women. We used data from a randomized crossover study, wherein 70 healthy volunteers (50% women) were each exposed to one control pattern (regular background noise) and two different train noise scenarios (30 or 60 train noise events per night, with average sound pressure levels of 52 and 54 dB(A), respectively, and peak sound level of 73-75 dB(A)) in their homes for three nights. After each night, participants visited the study center for the measurement of endothelial function as well as other hemodynamic and biochemical parameters. Sleep quality measured via self-report was significantly impaired after noise 30 and noise 60 nights in both men and women ( p < 0.001 vs. control). Likewise, endothelial function measured by flow-mediated dilation (FMD) was significantly impaired after noise 30 and noise 60 nights in both men and women ( p < 0.001 vs. control). While in women, vitamin C intake significantly improved FMD after both noise 30 and noise 60 study nights compared to control nights, no significant changes were observed in men. Exposure to simulated nocturnal train noise impairs sleep quality and endothelial function in both men and women, whereas a significant improvement of endothelial function after noise exposure and vitamin C intake could only be observed in women. These findings suggest for the first time that in men other mechanisms such as oxidative stress causing endothelial dysfunction may come into play.

Over the last decades, concern has arisen worldwide about the negative impacts of pesticides on the environment and human health. Exposure via dust ingestion is important for many chemicals but poorly characterized for pesticides, particularly in Africa. We investigated the spatial and temporal variations of 30 pesticides in dust and estimated the human exposure via dust ingestion, which was compared to inhalation and soil ingestion. Indoor dust samples were collected from thirty-eight households and two schools located in two agricultural regions in South Africa and were analyzed using high-performance liquid chromatography coupled to tandem mass spectrometry. We found 10 pesticides in dust, with chlorpyrifos, terbuthylazine, carbaryl, diazinon, carbendazim, and tebuconazole quantified in >50% of the samples. Over seven days, no significant temporal variations in the dust levels of individual pesticides were found. Significant spatial variations were observed for some pesticides, highlighting the importance of proximity to agricultural fields or of indoor pesticide use. For five out of the nineteen pesticides quantified in dust, air, or soil (i.e., carbendazim, chlorpyrifos, diazinon, diuron and propiconazole), human intake via dust ingestion was important (>10%) compared to inhalation or soil ingestion. Dust ingestion should therefore be considered in future human exposure assessment to pesticides.

There is a paucity of air quality data in sub-Saharan African countries to inform science driven air quality management and epidemiological studies. We investigated the use of available remote-sensing aerosol optical depth (AOD) data to develop spatially and temporally resolved models to predict daily particulate matter (PM 10 ) concentrations across four provinces of South Africa (Gauteng, Mpumalanga, KwaZulu-Natal and Western Cape) for the year 2016 in a two-staged approach. In stage 1, a Random Forest (RF) model was used to impute Multiangle Implementation of Atmospheric Correction AOD data for days where it was missing. In stage 2, the machine learner algorithms RF, Gradient Boosting and Support Vector Regression were used to model the relationship between ground-monitored PM 10 data, AOD and other spatial and temporal predictors. These were subsequently combined in an ensemble model to predict daily PM 10 concentrations at 1 km × 1 km spatial resolution across the four provinces. An out-of-bag R 2 of 0.96 was achieved for the first stage model. The stage 2 cross-validated (CV) ensemble model captured 0.84 variability in ground-monitored PM 10 with a spatial CV R 2 of 0.48 and temporal CV R 2 of 0.80. The stage 2 model indicated an optimal performance of the daily predictions when aggregated to monthly and annual means. Our results suggest that a combination of remote sensing data, chemical transport model estimates and other spatiotemporal predictors has the potential to improve air quality exposure data in South Africa's major industrial provinces. In particular, the use of a combined ensemble approach was found to be useful for this area with limited availability of air pollution ground monitoring data., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Human biomonitoring (HBM) is a crucial approach for exposure assessment, as emphasised in the European Commission's Chemicals Strategy for Sustainability (CSS). HBM can help to improve chemical policies in five major key areas: (1) assessing internal and aggregate exposure in different target populations; 2) assessing exposure to chemicals across life stages; (3) assessing combined exposure to multiple chemicals (mixtures); (4) bridging regulatory silos on aggregate exposure; and (5) enhancing the effectiveness of risk management measures. In this strategy paper we propose a vision and a strategy for the use of HBM in chemical regulations and public health policy in Europe and beyond. We outline six strategic objectives and a roadmap to further strengthen HBM approaches and increase their implementation in the regulatory risk assessment of chemicals to enhance our understanding of exposure and health impacts, enabling timely and targeted policy interventions and risk management. These strategic objectives are: 1) further development of sampling strategies and sample preparation; 2) further development of chemical-analytical HBM methods; 3) improving harmonisation throughout the HBM research life cycle; 4) further development of quality control / quality assurance throughout the HBM research life cycle; 5) obtain sustained funding and reinforcement by legislation; and 6) extend target-specific communication with scientists, policymakers, citizens and other stakeholders. HBM approaches are essential in risk assessment to address scientific, regulatory and societal challenges. HBM requires full and strong support from the scientific and regulatory domain to reach its full potential in public and occupational health assessment and in regulatory decision-making., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction). We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz-3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day. Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m 2 at home, 94 μW/m 2 at school, and 100 μW/m 2 overall. In general, restrictions at school or at home made little difference for adolescents' measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure. Total exposure to RF-EMF in adolescents living in Greater London tended to be higher compared to exposure levels reported in other European countries. This study suggests that school policies and parental restrictions are not associated with a lower RF-EMF exposure in adolescents., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Sleep problems show associations with negative outcomes in both physical and mental health in adolescents, but the associations may be reciprocal. We aimed to assess bidirectional associations between sleep problems and mental health symptoms including behavioural difficulties (internalising and externalising difficulties) and low health-related quality of life (HRQoL)., Methods: A total of 6616 adolescents (52.4% females) across Greater London completed baseline assessments when they were aged 11-12 years, and 3803 of them (57.2% females) completed follow-up assessments at aged 13-15 years. Weekday and weekend sleep duration were derived from self-reported bedtime, sleep onset latency and wake time. Sleep disturbance was assessed using a standardized sleep disturbance scale. Internalising and externalising difficulties were assessed using subscales of the Strength and Difficulties Questionnaire. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Cross-lagged structural equation modelling was used with multiple imputation to examine bidirectional associations between sleep problems and mental health symptoms., Results: Females had greater internalising difficulties, worse HRQoL and more sleep disturbance than males. Persistent insufficient weekday and weekend sleep, and sleep disturbance (i.e., at both baseline and follow-up) were associated with internalising and externalising difficulties and low HRQoL at follow-up (ORs ranged from 1.53 to 3.63). Persistent externalising difficulties and low HRQoL were also associated with insufficient weekend sleep and sleep disturbance at follow-up (ORs ranged from 1.68 to 4.25). Using continuous variables, we found bidirectional associations between weekday sleep duration and HRQoL, weekend sleep duration and externalising score, sleep quality and internalising score, and sleep quality and HRQoL. The association magnitudes were mostly similar in the two directions., Conclusions: Our study showed bidirectional associations between sleep problems and mental health symptoms during adolescence, indicating that early intervention and treatment on the first-occurring symptom may prevent the development of subsequent problems., Competing Interests: The authors have declared that they have no competing or potential conflicts of interest., (© 2022 The Authors. JCPP Advances published by John Wiley & Sons Ltdon behalf of Association for Child and Adolescent Mental Health.)

Motor vehicle exhaust is a major contributor to air pollution, and exposure to benzene or other carcinogenic components may increase cancer risks. We aimed to investigate the association between traffic-related air pollution and risk of childhood cancer in a nationwide cohort study in Switzerland. We identified incident cases from the Swiss Childhood Cancer Registry diagnosed < 16 years of age between 1990 and 2015 and linked them probabilistically with the census-based Swiss National Cohort study. We developed land use regression models to estimate annual mean ambient levels of nitrogen dioxide (NO 2 ) and benzene outside 1.4 million children's homes. We used risk-set sampling to facilitate the analysis of time-varying exposure and fitted conditional logistic regression models adjusting for neighborhood socio-economic position, level of urbanization, and background ionizing radiation. We included 2,960 cancer cases in the analyses. The adjusted hazard ratios (HR) and 95% confidence intervals for exposure to NO 2 per 10 μg/m 3 were 1.00 (95%-CI 0.88-1.13) for acute lymphoblastic leukemia (ALL) and 1.31 (95%-CI 1.00-1.71) for acute myeloid leukemia (AML). Using exposure lagged by 1 to 5 years instead of current exposure attenuated the effect for AML. The adjusted HR for exposure to benzene per 1 μg/m 3 was 1.03 (95%-CI 0.86-1.23) for ALL and 1.29 (95%-CI 0.86-1.95) for AML. We also observed increased HRs for other diagnostic groups, notably non-Hodgkin lymphoma. Our study adds to the existing evidence that exposure to traffic-related air pollution is associated with an increased risk of childhood leukemia, particularly AML., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes.

Background: Outdoor air pollution is increasingly recognised as a key threat to population health globally, with particularly high risks for urban residents. In this study, we assessed the association between residential nitrogen dioxide (NO2) exposure and children's cognitive and behavioural development using data from São Paulo Brazil, one of the largest urban agglomerations in the world., Methods: We used data from the São Paulo Western Region Birth Cohort, a longitudinal cohort study aiming to examine determinants as well as long-term implications of early childhood development. Cross-sectional data from the 72-month follow-up was analysed. Data on NO2 concentration in the study area was collected at 80 locations in 2019, and land use regression modelling was used to estimate annual NO2 concentration at children's homes. Associations between predicted NO2 exposure and children's cognitive development as well as children's behavioural problems were estimated using linear regression models adjusted for an extensive set of confounders. All results were expressed per 10 μg/m3 increase in NO2., Results: 1143 children were included in the analysis. We found no association between NO2 and children's cognitive development (beta -0.05, 95% CI [-0.20; 0.10]) or behavioural problems (beta 0.02, 95% CI [-0.80; 0.12])., Conclusion: No association between child cognition or child behaviour and NO2 was found in this cross-sectional analysis. Further research will be necessary to understand the extent to which these null results reflect a true absence of association or other statistical, biological or adaptive factors not addressed in this paper., Competing Interests: The authors have declared that no competing interests exist.

The findings of environmental noise exposure and behavioural disorders in children and adolescents are inconclusive, and longitudinal studies are scarce. We studied the response of behaviour and behavioural change within one year in a cohort of 886 adolescents in Switzerland aged 10-17 years in response to road traffic noise exposure. Participants filled in a comprehensive questionnaire at baseline and follow-up. It included the Strengths and Difficulties Questionnaire (SDQ), which measures self-rated positive and negative behaviours in five scales. We modelled road traffic noise for participants' most exposed facade at home and school addresses in various metrics (L den , L night , L day , Intermittency Ratio and Number of events). We addressed missing data with multiple imputation and performed mixed linear cross-sectional analyses and longitudinal change score analyses. In cross-sectional analyses, peer relationship problems increased by 0.15 units (95%CI: 0.02, 0.27; scale range: 0-10) per 10 dB road traffic noise increase. In longitudinal analyses, increases in SDQ scales between baseline and follow-up were not related to noise exposure. This study suggests subtle associations between road traffic noise exposure and behaviour problems in adolescents, but longer follow-up times may be needed to observe longitudinal changes., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Air pollution health risk assessments (AP-HRAs) provide a method to quantify health effects for entire populations. In Switzerland, AP-HRAs are included in Swiss assessments for Transport Externalities (STEs), ordered by public authorities since the 1990s. This study aimed to describe the differences among national and international AP-HRAs for Switzerland. Methods: We compared input data, approaches and results across AP-HRAs over time. Results and input data for each AP-HRA were expressed as a ratio compared to the most recent STE (in most cases STE-2010). Results: Substantial variation across AP-HRAs was found. For all-cause adult mortality attributed to particulate matter (the most frequent outcome-pollutant pair), the ratio in HRAs oscillated from 0.40 to 2.09 (times the STE-2010 value). Regarding input data, the ratio ranged from 0.69 to 1.26 for population exposure, from 0 to 1.81 for counterfactual scenario, from 0.96 to 1.13 for concentration-response function and from 1.03 to 1.13 for baseline health data. Conclusion: This study demonstrates that methods matter for AP-HRAs. Transparent and possibly standardized reporting of key input data and assumptions should be promoted to facilitate comparison of AP-HRAs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Castro, Röösli, de Hoogh, Kappeler, Kutlar Joss, Vienneau and Künzli.)

Little is known about personal and time-integrated exposure to past and current used pesticides in agricultural areas and within-family exposure similarities. We aimed to assess exposure to pesticides using silicone wristbands in child/guardian pairs living on farms and in villages within two agricultural areas in South Africa. Using silicone wristbands, we quantified 21 pesticides in child/guardian pairs in 38 households over six days in 2018. Levels (in ng/g wristband) of pesticides and their transformation products (12 current-use pesticides and nine organochlorine pesticides) were measured using GC-MS/MS. We assessed the correlation between pesticide levels and between household members using Spearman correlation coefficients (r s ). Multivariable generalized least squares (GLS) models, using household id as intercept, were used to determine level of agreement between household members, exposure differences between children and guardians and exposure predictors (study area, household location [farm vs. village] and household pesticide use). We detected 16 pesticides with highest detection frequencies for deltamethrin (89%), chlorpyrifos (78%), boscalid (56%), cypermethrin (55%), and p,p'-DDT (48%). Most wristbands (92%) contained two or more pesticides (median seven (range one to 12)). Children had higher concentrations than guardians for four pesticides. Correlation between the pesticide levels were in most cases moderate (rs 0.30-0.68) and stronger in children than in guardians. Five pesticides showed moderate to strong correlation between household members, with the strongest correlation for boscalid (r s 0.84). Exposure differences between the two agricultural areas were observed for chlorpyrifos, diazinon, prothiofos, cypermethrin, boscalid, p,p'-DDT and p,p'-DDE and within areas for cypermethrin. We showed that for several pesticides children had higher exposure levels than guardians. The positive correlations observed for child/guardian pairs living in the same household suggest non-occupational shared exposure pathways in these communities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To investigate the association of estimated all-day and evening whole-brain radiofrequency electromagnetic field (RF-EMF) doses with sleep disturbances and objective sleep measures in preadolescents., Methods: We included preadolescents aged 9-12 years from two population-based birth cohorts, the Dutch Generation R Study (n = 974) and the Spanish INfancia y Medio Ambiente Project (n = 868). All-day and evening overall whole-brain RF-EMF doses (mJ/kg/day) were estimated for several RF-EMF sources including mobile and Digital Enhanced Cordless Telecommunications (DECT) phone calls (named phone calls), other mobile phone uses, tablet use, laptop use (named screen activities), and far-field sources. We also estimated all-day and evening whole-brain RF-EMF doses in these three groups separately (i.e. phone calls, screen activities, and far-field). The Sleep Disturbance Scale for Children was completed by mothers to assess sleep disturbances. Wrist accelerometers together with sleep diaries were used to measure sleep characteristics objectively for 7 consecutive days., Results: All-day whole-brain RF-EMF doses were not associated with self-reported sleep disturbances and objective sleep measures. Regarding evening doses, preadolescents with high evening whole-brain RF-EMF dose from phone calls had a shorter total sleep time compared to preadolescents with zero evening whole-brain RF-EMF dose from phone calls [-11.9 min (95%CI -21.2; -2.5)]., Conclusions: Our findings suggest the evening as a potentially relevant window of RF-EMF exposure for sleep. However, we cannot exclude that observed associations are due to the activities or reasons motivating the phone calls rather than the RF-EMF exposure itself or due to chance finding., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Concerns about the possible negative impacts of current use pesticides (CUPs) for both the environment and human health have increased worldwide. However, the knowledge on the occurrence of CUPs in soil and air and the related human exposure in Africa is limited. This study investigated the presence of 30 CUPs in soil and air at two distinct agricultural sites in South Africa and estimated the human exposure and related risks to rural residents via soil ingestion and inhalation (using hazard quotients, hazard index and relative potency factors). We collected 12 soil and 14 air samples over seven days during the main pesticide application season in 2018. All samples were extracted, purified and analyzed by high-performance liquid chromatography coupled with tandem mass spectrometry. In soils, nine CUPs were found, with chlorpyrifos, carbaryl and tebuconazole having the highest concentrations (up to 63.6, 1.10 and 0.212 ng g -1 , respectively). In air, 16 CUPs were found, with carbaryl, tebuconazole and terbuthylazine having the highest levels (up to 25.0, 22.2 and 1.94 pg m -3 , respectively). Spatial differences were observed between the two sites for seven CUPs in air and two in soils. A large dominance towards the particulate phase was found for almost all CUPs, which could be related to mass transport kinetics limitations (non-equilibrium) following pesticide application. The estimated daily intake via soil ingestion and inhalation of individual pesticides ranged from 0.126 fg kg -1  day -1 (isoproturon) to 14.7 ng kg -1  day -1 (chlorpyrifos). Except for chlorpyrifos, soil ingestion generally represented a minor exposure pathway compared to inhalation (i.e. <5%). The pesticide environmental exposure largely differed between the residents of the two distinct agricultural sites in terms of levels and composition. The estimated human health risks due to soil ingestion and inhalation of pesticides were negligible although future studies should explore other relevant pathways., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

For decades pesticides have been used in agriculture, however, the occurrence of legacy organochlorine pesticides (OCPs) and current-use pesticides (CUPs) is poorly understood in Africa. This study investigates air concentrations of OCPs and CUPs in three South African agricultural areas, their spatial/seasonal variations and mixture profiles. Between 2017 and 2018, 54 polyurethane foam-disks passive air-samplers (PUF-PAS) were positioned in three agricultural areas of the Western Cape, producing mainly apples, table grapes and wheat. Within areas, 25 CUPs were measured at two sites (farm and village), and 27 OCPs at one site (farm). Kruskal-Wallis tests investigated area differences in OCPs concentrations, and linear mixed-effect models studied differences in CUPs concentrations between areas, sites and sampling rounds. In total, 20 OCPs and 16 CUPs were detected. A median of 16 OCPs and 10 CUPs were detected per sample, making a total of 11 OCPs and 24 CUPs combinations. Eight OCPs (trans-chlordane, o,p'-/p,p'-dichlorodiphenyldichloroethylene (DDE)/dichlorodiphenyltrichloroethane (DDT), endosulfan sulfate, γ-hexachlorocyclohexane and mirex) and two CUPs (carbaryl and chlorpyrifos) were quantified in all samples. p,p'-DDE (median 0.14 ng/m 3 ) and chlorpyrifos (median 0.70 ng/m 3 ) showed the highest concentrations throughout the study. Several OCPs and CUPs showed different concentrations between areas and seasons, although CUPs concentrations did not differ between sites. OCPs ratios suggest ongoing chlordane use in the region, while DDT and endosulfan contamination result from past-use. Our study revealed spatial and seasonal variations of different OCPs and CUPs combinations detected in air. Further studies are needed to investigate the potential cumulative or synergistic risks of the detected pesticides., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Death from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source., Methods: Road traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM 2.5 , adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group., Results: During a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024-1.034), 1.013 (1.010-1.017), and 1.003 (0.996-1.010) per 10 dB L den , respectively. Associations for MI mortality were a respective 1.043 (1.029-1.058), 1.020 (1.010-1.030) and 1.040 (1.020-1.060) per 10 dB L den . Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40 dB L den for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females., Conclusion: Independent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms., Objective: Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF)., Eligibility Criteria: We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language., Study Appraisal and Synthesis: Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques., (Copyright © 2021. Published by Elsevier Ltd.)

Study Objectives: During infancy, adequate sleep is crucial for physical and neurocognitive development. In adults and children, night-time noise exposure is associated with sleep disturbances. However, whether and to what extent infants' sleep is affected, is unknown. Thus, this study investigated the relationship between nocturnal transportation noise and actimetry-derived habitual sleep behavior across the first year of life., Methods: In 144 healthy infants (63 girls), nocturnal (23:00-7:00) transportation noise (i.e., road, railway, and aircraft) was modelled at the infants' individual places of residence. Using actimetry, we recorded movement patterns for 11 days in a longitudinal design at 3, 6, and 12 months of age and derived the recently proposed core sleep composites of night-time sleep duration, activity, and variability. Using linear mixed-effects models, we determined associations between noise exposure and sleep composites. Sex, gestational age, parents' highest educational level, infants' age, and the existence of siblings served as control variables., Results: In models without interactions, night-time transportation noise was unrelated to sleep composites across the first year of life (p > .16). Exploratory analyses of an interaction between noise and the existence of siblings yielded an association between night-time transportation noise and sleep duration in infants without siblings only (p = .004)., Conclusion: In our study, sleep in infants during the first year of life was relatively robust against external perturbation by night-time transportation noise. However, particularly in children without siblings increasing night-time transportation noise reduced sleep duration. This suggests that the habitual noise environment may modulate individual susceptibility to adverse effects of noise on sleep., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Noise exposure has been associated with adverse cognitive and behavioral outcomes in children, but evidence on longitudinal associations between community noise and child development in low- and middle-income countries is rare. We investigated associations between community noise and behavioral and cognitive development in preschool children in São Paulo., Methods: We linked child development data from the São Paulo Western Region Birth Cohort with average (Lden) and night-time (Lnight) community noise exposure at children's home, estimated by means of a land use regression model using various predictors (roads, schools, greenness, residential and informal settlements). Outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Regional Project on Child Development Indicators (PRIDI) at 3 years of age and the Child Behavior Checklist (CBCL) and International Development and Early Learning Assessment (IDELA) at 6 years of age. We investigated the relationship between noise exposure and development using cross-sectional and longitudinal regression models., Results: Data from 3385 children at 3 years of age and 1546 children at 6 years of age were analysed. Mean Lden and Lnight levels were 70.3 dB and 61.2 dB, respectively. In cross-sectional analyses a 10 dB increase of Lden above 70 dB was associated with a 32% increase in the odds of borderline or abnormal SDQ total difficulties score (OR = 1.32, 95% CI: 1.04; 1.68) and 0.72 standard deviation (SD) increase in the CBCL total problems z-score (95% CI: 0.55; 0.88). No cross-sectional association was found for cognitive development. In longitudinal analyses, each 10 dB increase was associated with a 0.52 SD increase in behavioral problems (95% CI: 0.28; 0.77) and a 0.27 SD decrease in cognition (95%-CI: 0.55; 0.00). Results for Lnight above 60 dB were similar., Discussion: Our findings suggest that community noise exposure above Lden of 70 dB and Lnight of 60 dB may impair behavioral and cognitive development of preschool children., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rationale: Infants born prematurely have impaired capacity to deal with oxidative stress shortly after birth. Objectives: We hypothesize that the relative impact of exposure to air pollution on lung function is higher in preterm than in term infants. Methods: In the prospective BILD (Basel-Bern Infant Lung Development) birth cohort of 254 preterm and 517 term infants, we investigated associations of particulate matter ⩽10 μm in aerodynamic diameter (PM 10 ) and nitrogen dioxide with lung function at 44 weeks' postconceptional age and exhaled markers of inflammation and oxidative stress response (fractional exhaled nitric oxide [Fe NO ]) in an explorative hypothesis-driven study design. Multilevel mixed-effects models were used and adjusted for known confounders. Measurements and Main Results: Significant associations of PM 10 during the second trimester of pregnancy with lung function and Fe NO were found in term and preterm infants. Importantly, we observed stronger positive associations in preterm infants (born 32-36 wk), with an increase of 184.9 (95% confidence interval [CI], 79.1-290.7) ml/min [Formula: see text]e per 10-μg/m 3 increase in PM 10 , than in term infants (75.3; 95% CI, 19.7-130.8 ml/min) ( p prematurity   ×   PM10 interaction  = 0.04, after multiple comparison adjustment p adj  = 0.09). Associations of PM 10 and Fe NO differed between moderate to late preterm (3.4; 95% CI, -0.1 to 6.8 ppb) and term (-0.3; 95% CI, -1.5 to 0.9 ppb) infants, and the interaction with prematurity was significant ( p prematurity   ×   PM10 interaction  = 0.006, p adj  = 0.036). Conclusions: Preterm infants showed significantly higher susceptibility even to low to moderate prenatal air pollution exposure than term infants, leading to increased impairment of postnatal lung function. Fe NO results further elucidate differences in inflammatory/oxidative stress response when comparing preterm infants with term infants.

Background: Maternal substance use and its long-term effect on the neurocognitive functions of children is a global public health issue. Despite an increase in substance use in rural areas of low to middle-income countries, research is limited in these populations., Objective: We have therefore explored the effect of maternal drinking and smoking behaviors on the neurocognitive functioning of rural school children., Method: A cross-sectional analysis on the determinants of current, past and gestational maternal alcohol use and gestational smoking on child neurocognitive functions was conducted on school-children (N = 482), embedded within the child health agricultural cohort (CapSA) study across seven schools in rural Western Cape, South Africa. Standardised neurocognitive assessment tools included the Cambridge Automated Neuropsychological Battery (CANTAB) and the KIDSCREEN-10 to measure health-related quality of life via a child questionnaire. Maternal smoking and drinking behaviour were captured using a parent/guardian questionnaire., Results: Of the 482 parents/guardians who completed the survey, 29 % reported current drinking 27 % reported past drinking and 10 % reported maternal gestational drinking, while 31 % reported gestational smoking. Significant associations were observed between past and current maternal drinking and child's reduced rapid visual processing accuracy in attention [β:-0.03; 95 % confidence interval (CI): -0.05;-0.004] and between maternal drinking during pregnancy and reduced child's spatial working memory (β: -0.59; CI: -1.02; -0.15). Heavy (>5 cigarettes per day) gestational smoking was associated with lowered child's learning in memory (β:-1.69; 95 % CI: -3.05; -0.33) and lower health-related quality of life (β: -3.41; CI: -6.64; -0.17). The odds of a child repeating a grade were 1.69 (CI: 2.81-1.02) for those exposed to maternal gestational smoking and 1.68 (CI: 3.31-0.85) for those exposed to maternal gestational drinking compared to those who were not exposed., Conclusion: The consistent negative associations across all four maternal substance use proxies, six neurocognitive health outcomes and one health symptom is suggestive of adverse health effects, warranting longitudinal follow-up. Health policies to eliminate gestational substance use are recommended., (Copyright © 2021 Elsevier B.V. All rights reserved.)

On the African continent, ongoing agriculture intensification is accompanied by the increasing use of pesticides, associated with environmental and public health concerns. Using a systematic literature review, we aimed to map current geographical research hotspots and gaps around environmental and public health risks research of agriculture pesticides in Sub-Saharan Africa (SSA). Studies were included that collected primary data on past and current-used agricultural pesticides and assessed their environmental occurrence, related knowledge, attitude and practice, human exposure, and environmental or public health risks between 2006 and 2021. We identified 391 articles covering 469 study sites in 37 countries in SSA. Five geographical research hotspots were identified: two in South Africa, two in East Africa, and one in West Africa. Despite its ban for agricultural use, organochlorine was the most studied pesticide group (60%; 86% of studies included DDT). Current-used pesticides in agriculture were studied in 54% of the study sites (including insecticides (92%), herbicides (44%), and fungicides (35%)). Environmental samples were collected in 67% of the studies (e.g., water, aquatic species, sediment, agricultural produce, and air). In 38% of the studies, human subjects were investigated. Only few studies had a longitudinal design or assessed pesticide's environmental risks; human biomarkers; dose-response in human subjects, including children and women; and interventions to reduce pesticide exposure. We established a research database that can help stakeholders to address research gaps, foster research collaboration between environmental and health dimensions, and work towards sustainable and safe agriculture systems in SSA.

Particulate matter less than or equal to 10 μm in aerodynamic diameter (PM 10 µg/m 3 ) is a priority air pollutant and one of the most widely monitored ambient air pollutants in South Africa. This study analyzed PM 10 from monitoring 44 sites across four provinces of South Africa (Gauteng, Mpumalanga, Western Cape and KwaZulu-Natal) and aimed to present spatial and temporal variation in the PM 10 concentration across the provinces. In addition, potential influencing factors of PM 10 variations around the three site categories (Residential, Industrial and Traffic) were explored. The spatial trend in daily PM 10 concentration variation shows PM 10 concentration can be 5.7 times higher than the revised 2021 World Health Organization annual PM 10 air quality guideline of 15 µg/m 3 in Gauteng province during the winter season. Temporally, the highest weekly PM 10 concentrations of 51.4 µg/m 3 , 46.8 µg/m 3 , 29.1 µg/m 3 and 25.1 µg/m 3 at Gauteng, Mpumalanga, KwaZulu-Natal and Western Cape Province were recorded during the weekdays. The study results suggest a decrease in the change of annual PM 10 levels at sites in Gauteng and Mpumalanga Provinces. An increased change in annual PM 10 levels was reported at most sites in Western Cape and KwaZulu-Natal.

Few studies have investigated the relationship between ambient air pollution and cardiorespiratory outcomes in Africa. A cross-sectional study comprising of 572 adults from four informal settlements in the Western Cape, South Africa was conducted. Participants completed a questionnaire adapted from the European Community Respiratory Health Survey, and the National Health and Nutrition Examination Survey questionnaire. Exposure estimates were previously modelled using Land-Use Regression for Particulate Matter (PM 2.5 ) and Nitrogen Dioxide (NO 2 ) at participants' homes. The median age of the participants was 40.7 years, and 88.5% were female. The median annual NO 2 level was 19.7 µg/m 3 (interquartile range [IQR: 9.6-23.7]) and the median annual PM 2.5 level was 9.7 µg/m 3 (IQR: 7.3-12.4). Logistic regression analysis was used to assess associations between outcome variables and air pollutants. An interquartile range increase of 5.12 µg/m 3 in PM 2.5 was significantly associated with an increased prevalence of self-reported chest-pain, [Odds ratio: 1.38 (95% CI: 1.06-1.80)], adjusting for NO 2 , and other covariates. The study found preliminary circumstantial evidence of an association between annual ambient PM 2.5 exposure and self-reported chest-pain (a crude proxy of angina-related pain), even at levels below the South African National Ambient Air Quality Standards.

Ambient air pollution is the leading cause of environmental mortality and morbidity worldwide. However, the individual contributions to acute mortality of traffic-related air pollutants such as nitrogen dioxide (NO 2 ) and fine particulate matter (PM 2.5 ) are still debated. We conducted a time-stratified case-crossover study for a population located around Zurich airport in Switzerland, including 24,886 adult cardiovascular deaths from the Swiss National Cohort. We estimated the risk of cause-specific cardiovascular mortality associated with daily NO 2 and PM 2.5 concentrations at home using distributed lag models up to 7 days preceding death, adjusted for daily temperature, precipitation, acute night-time aircraft noise, firework celebrations, and holidays. Cardiovascular mortality was associated with NO 2 , whereas the association with PM 2.5 disappeared upon adjustment for NO 2 . The strongest association was observed between NO 2 and ischemic stroke mortality (odds ratio = 1.55 per 10 μg/m 3 , 95% confidence intervals = 1.20-2.00). Cause-specific mortality analyses showed differences in terms of delayed effect: odds ratios were highest at 1-3 days after exposure for most outcomes but at lags of 3-5 days for heart failure. Individual vulnerabilities to NO 2 associated cardiovascular mortality also varied by cause of death, possibly highlighting the role of different behaviours and risk factors in the most susceptible groups. The risk of cardiovascular mortality was also increased on firework days and after public holidays, independent from NO 2 and PM 2.5 concentrations. This study confirms the association between ambient NO 2 , as a marker for primary emissions, and acute cardiovascular mortality in a specific setting around a major airport. Future research should clarify the role of additional air pollutants including ultra-fine particles on cardiovascular diseases to inform most efficient control measures., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits., Objectives: To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes., Methods: We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research)., Eligibility Criteria: Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included., Information Sources: We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews., Study Appraisal and Synthesis Method: Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure., Risk of Bias: The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies., Evidence Appraisal: To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies., Framework and Funding: This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population., Registration: PROSPERO CRD42021239432., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The World Health Organization (WHO) has an ongoing project to assess potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMF) in the general and working population. Here we present the protocol for a systematic review of the scientific literature on cancer hazards from exposure to RF-EMF in humans, commissioned by the WHO as part of that project., Objective: To assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to RF-EMF and risk of neoplastic diseases., Eligibility Criteria: We will include cohort and case-control studies investigating neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of handheld transceivers or RF-emitting equipment in the workplace (SR-C). While no restriction on tumour type will be applied, we will focus on selected neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C)., Information Sources: Eligible studies will be identified through Medline, Embase, and EMF-Portal., Risk-Of-Bias Assessment: We will use a tailored version of the OHAT's tool to evaluate the study's internal validity., Data Synthesis: We will consider separately studies on different tumours, neoplasm-specific risks from different exposure sources, and a given exposure-outcome pair in adults and children. When a quantitative synthesis of findings can be envisaged, the main aims of the meta-analysis will be to assess the strength of association and the shape of the exposure-response relationship; to quantify the degree of heterogeneity across studies; and explore the sources of inconsistency (if any). When a meta-analysis is judged inappropriate, we will perform a narrative synthesis, complemented by a structured tabulation of results and appropriate visual displays., Evidence Assessment: Confidence in evidence will be assessed in line with the GRADE approach., Funding: This project is supported by the World Health Organization. Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; ARPANSA as a WHO Collaborating Centre for Radiation Protection., Registration: PROSPERO CRD42021236798., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Air pollution is a major global public health problem. The situation is most severe in low- and middle-income countries, where pollution control measures and monitoring systems are largely lacking. Data to quantify the exposure to air pollution in low-income settings are scarce., Methods: In this study, land use regression models (LUR) were developed to predict the outdoor nitrogen dioxide (NO 2 ) concentration in the study area of the Western Region Birth Cohort in São Paulo. NO 2 measurements were performed for one week in winter and summer at eighty locations. Additionally, weekly measurements at one regional background location were performed over a full one-year period to create an annual prediction., Results: Three LUR models were developed (annual, summer, winter) by using a supervised stepwise linear regression method. The winter, summer and annual models explained 52 %, 75 % and 66 % of the variance (R 2 ) respectively. Cross-holdout validation tests suggest robust models. NO 2 levels ranged from 43.2 μg/m 3 to 93.4 μg/m 3 in the winter and between 28.1 μg/m 3 and 72.8 μg/m 3 in summer. Based on our annual prediction, about 67 % of the population living in the study area is exposed to NO 2 values over the WHO suggested annual guideline of 40 μg/m 3 annual average., Conclusion: In this study we were able to develop robust models to predict NO 2 residential exposure. We could show that average measures, and therefore the predictions of NO 2, in such a complex urban area are substantially high and that a major variability within the area and especially within the season is present. These findings also suggest that in general a high proportion of the population is exposed to high NO 2 levels., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In order to achieve an integrated radio-frequency electromagnetic fields (RF-EMF) dose assessment, detailed information about source-specific exposure duration and output power is needed. We developed an Integrated Exposure Model (IEM) to combine energy absorbed due to use of and exposure to RF-EMF sources and applied it to a sample of the general population to derive population RF-EMF estimates. The IEM used specific absorption rate transfer algorithms to provide RF-EMF daily dose estimates (mJ/kg/day) using source-specific attributes (e.g. output power, distance), personal characteristics and usage patterns. Information was obtained from an international survey performed in four European countries with 1755 participants. We obtained median whole-body and whole-brain doses of 183.7 and 204.4 mJ/kg/day. Main contributors to whole-brain dose were mobile phone near the head for calling (2G networks) and far-field sources, whereas the latter together with multiple other RF-EMF sources were main contributors for whole-body dose. For other anatomical sites, 2G phone calls, mobile data and far-field exposure were important contributors. The IEM provides insight into main contributors to total RF-EMF dose and, applied to an international survey, provides an estimate of population RF-dose. The IEM can be used in future epidemiological studies, risk assessments and exposure reduction strategies., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc. part of Springer Nature.)

Droughts are associated with several health effects and Africa is uniquely vulnerable. Despite this, there has been no previous review of the literature on the health effects of drought in Africa. This study systematically reviewed the epidemiological research on the association between drought and adverse health effects in Africa (2012-2019). A total of fifteen articles were included in the review after screening 1922 published (peer-reviewed) and unpublished articles. These studies were all conducted in 9 Sub-Saharan African countries. The drought-related health effects identified were on adverse nutritional health (n = 8) including malnutrition resulting in reduced body size and wasting, stunting and underweight, mortality from food insecurity, anaemia from food insecurity and nutrition-related disability from food insecurity; drought and diseases due to microbial contamination of water (n = 6) including cholera, diarrhoeal diseases, scabies, vector-borne diseases and malaria-related mortality; and drought and health behaviours (n = 1) including HIV prevention and care behaviours. The study found limited evidence of a high prevalence of malnutrition, an increased prevalence of anaemia, cholera, scabies, dengue and an increased incidence in child disabilities during periods of drought. Additionally, there was limited evidence on improved child nutritional health with improved water and sanitation access, and an increased prevalence of child wasting, stunting and underweight in drought-prone areas. No evidence of drought on other health outcomes was found. However, all the studies had more than one limitation including weak study design, a lack of comparison to a drought period, uncertainty on the onset and end of drought, lack of control for confounding, presence of contextual factors, weak outcome and/or exposure measure, small sample size and lack of generalizability. This review found weak evidence for all health outcomes measured but highlights key areas for further research and contextual factors which need to be considered for interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) is often measured with personal exposimeters, but the accuracy of measurements can be hampered as carrying the devices on-body may result in body shielding. Further, the compact design may compromise the frequency selectivity of the sensor. The aim of this study was to compare measurements obtained using a multi-band body-worn distributed-exposimeter (BWDM) with two commercially available personal exposimeters (ExpoM-RF and EmeSpy 200) under real-life conditions., Methods: The BWDM measured power density in 10 frequency bands (800, 900, 1800, 2100, 2600 MHz, DECT 1900 MHz, WiFi 2.4 GHz; with separate uplink/downlink bands for 900, 1800 and 2100 MHz); using 20 separate antennas integrated in a vest and placed on diametrically opposite locations on the body, to minimize body-shielding. RF-EMF exposure data were collected from several microenvironments (e.g. shopping areas, train stations, outdoor rural/ urban residential environments, etc.) by walking around pre-defined areas/routes in Belgium, Spain, France, the Netherlands and Switzerland. Measurements were taken every 1-4 s with the BWDM in parallel with an ExpoM-RF and an EmeSpy 200 exposimeter. We calculated medians and interquartile ranges (IQRs) and compared difference, ratios and correlations of geometric mean RF-EMF exposure levels per microenvironment as measured with the exposimeters and the BWDM., Results: Across 267 microenvironments, medians and IQR of total BWDM measured RF-EMF exposure was 0.13 (0.05-0.33) mW/m 2 . Difference: IQR of exposimeters minus BWDM exposure levels was -0.011 (-0.049 to 0.0095) mW/m 2 for the ExpoM-RF and -0.056 (-0.14 to -0.017) for the EmeSpy 200; ratios (exposimeter/BWDM) of total exposure had an IQR of 0.79 (0.55-1.1) for the ExpoM-RF and 0.29 (0.22-0.38) for the EmeSpy 200. Spearman correlations were 0.93 for the ExpoM-RF vs the BWDM and 0.96 for the EmeSpy 200 vs the BWDM., Discussion and Conclusions: Results indicate that exposimeters worn on-body provide somewhat lower total RF-EMF exposure as compared to measurements conducted with the BWDM, in line with effects from body shielding. Ranking of exposure levels of microenvironments showed high correspondence between the different device types. Our results are informative for the interpretation of existing epidemiological research results., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Since the 2003 heatwave in Europe, evidence has been rapidly increasing on the association between extreme temperature and all-cause mortality. Little is known, however, about cause-specific cardiovascular mortality, effect modification by air pollution and aircraft noise, and which population groups are the most vulnerable to extreme temperature. We conducted a time-stratified case-crossover study in Zurich, Switzerland, including all adult cardiovascular deaths between 2000 and 2015 with precise individual exposure estimates at home location. We estimated the risk of 24,884 cardiovascular deaths associated with heat and cold using distributed non-linear lag models. We investigated potential effect modification of temperature-related mortality by fine particles, nitrogen dioxide, and night-time aircraft noise and performed stratified analyses across individual and social characteristics. We found increased risk of mortality for heat (odds ratio OR = 1.28 [95% confidence interval: 1.11-1.49] for 99th percentile of daily Tmean (24 °C) versus optimum temperature at 20 °C) and cold (OR = 1.15 [0.95-1.39], 5th percentile of daily Tmean (-3 °C) versus optimum temperature at 20 °C). Heat-related mortality was particularly strong for myocardial infarctions and hypertension related deaths, and among older women (>75 years). Analysis of effect modification also indicated that older women with lower socio-economic position and education are at higher risk for heat-related mortality. PM 2.5 increased the risk of heat-related mortality for heart failure, but not all-cause cardiovascular mortality. This study provides useful information for preventing cause-specific cardiovascular temperature-related mortality in moderate climate zones comparable to Switzerland., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aims: Previous studies found increased cardiovascular mortality during hot days, while emergency hospital admissions were decreasing. We explored potential underlying reasons by analysing clinically similar cardiovascular disease groups taking into account primary, underlying and immediate causes of death., Methods and Results: We assessed associations of daytime maximum temperature in relation to cardiovascular deaths and emergency hospital admissions between 1998 and 2016 in Switzerland. We applied conditional quasi-Poisson models with non-linear distributed lag functions to estimate relative risks (RRs) of daily cardiovascular mortality and morbidity for temperature increases from the median (22°C) to the 98th percentile (32°C) of the warm season temperature distribution with 10 days of lag. Cardiovascular mortality (n = 163,856) increased for total cardiovascular disease (RR 1.13, 95% confidence interval [CI] 1.08-1.19) and the disease groups hypertension (1.18, 1.02-1.38), arrhythmia (1.29, 1.08-1.55), heart failure (1.22, 1.05-1.43) and stroke of unknown origin (1.20, 1.02-1.4). In contrast, emergency hospital admissions (n = 447,577) decreased for total cardiovascular disease (0.91, 0.88-0.94), hypertension (0.72, 0.64-0.81), heart failure (0.83, 0.76-0.9) and myocardial infarction (0.88, 0.82-0.95). Opposing heat effects were most pronounced for disease groups associated with diuretic and antihypertensive drug use, with the age group ≥75 years at highest risk., Conclusions: Volume depletion and vasodilation from heat stress plausibly explain the risk reduction of heat-related emergency hospital admissions for hypertension and heart failure. Since primary cause of death mostly refers to the underlying chronic disease, the seemingly paradoxical heat-related mortality increase can plausibly be explained by an exacerbation of heat effects by antihypertensive and diuretic drugs. Clinical guidelines should consider recommending strict therapy monitoring of such medication during heatwaves, particularly in the elderly.

Noise pollution has negative health consequences, which becomes increasingly relevant with rapid urbanization. In low- and middle-income countries research on health effects of noise is hampered by scarce exposure data and noise maps. In this study, we developed land use regression (LUR) models to assess spatial variability of community noise in the Western Region of São Paulo, Brazil.We measured outdoor noise levels continuously at 42 homes once or twice for one week in the summer and the winter season. These measurements were integrated with various geographic information system variables to develop LUR models for predicting average A-weighted (dB(A)) day-evening-night equivalent sound levels (L den ) and night sound levels (L night ). A supervised mixed linear regression analysis was conducted to test potential noise predictors for various buffer sizes and distances between home and noise source. Noise exposure levels in the study area were high with a site average L den of 69.3 dB(A) ranging from 60.3 to 82.3 dB(A), and a site average L night of 59.9 dB(A) ranging from 50.7 to 76.6 dB(A). LUR models had a good fit with a R 2 of 0.56 for L den and 0.63 for L night in a leave-one-site-out cross validation. Main predictors of noise were the inverse distance to medium roads, count of educational facilities within a 400 m buffer, mean Normalized Difference Vegetation Index (NDVI) within a 100 m buffer, residential areas within a 50 m (L den ) or 25 m (L night ) buffer and slum areas within a 400 m buffer. Our study suggests that LUR modelling with geographic predictor data is a promising and efficient approach for noise exposure assessment in low- and middle-income countries, where noise maps are not available., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep., Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents., Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep., Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect., Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships., (©Chen Shen, Iroise Dumontheil, Michael Thomas, Martin Röösli, Paul Elliott, Mireille Toledano. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.07.2021.)

This study presents a novel method for estimating the heat-attributable fractions (HAF) based on the cross-validated best temperature metric. We analyzed the association of eight temperature metrics (mean, maximum, minimum temperature, maximum temperature during daytime, minimum temperature during nighttime, and mean, maximum, and minimum apparent temperature) with mortality and performed the cross-validation method to select the best model in selected cities of Switzerland and South Korea from May to September of 1995-2015. It was observed that HAF estimated using different metrics varied by 2.69-4.09% in eight cities of Switzerland and by 0.61-0.90% in six cities of South Korea. Based on the cross-validation method, mean temperature was estimated to be the best metric, and it revealed that the HAF of Switzerland and South Korea were 3.29% and 0.72%, respectively. Furthermore, estimates of HAF were improved by selecting the best city-specific model for each city, that is, 3.34% for Switzerland and 0.78% for South Korea. To the best of our knowledge, this study is the first to observe the uncertainty of HAF estimation originated from the selection of temperature metric and to present the HAF estimation based on the cross-validation method.

Background: There is limited data on the association between diarrhoea among children aged under five years (U5D) and water use, sanitation, hygiene, and socio-economics factors in low-income communities. The study investigated U5D and the associated risk factors in the Zeekoe catchment in Cape Town, South Africa., Methods: A cross-sectional study was conducted in 707 households in six informal settlements (IS) two formal settlements (FS) (March-June 2017)., Results: Most IS households used public taps (74.4%) and shared toilets (93.0%), while FS households used piped water on premises (89.6%) and private toilets (98.3%). IS respondents had higher average hand-washing scores than those of FS (0.04 vs. -0.14, p = 0.02). The overall U5D prevalence was 15.3% (range: 8.6%-24.2%) and was higher in FS than in IS (21.2% vs. 13.4%, respectively, p = 0.01). Water storage >12 h was associated with increasing U5D (OR = 1.88, 95% CI 1.00-3.55, p = 0.05). Water treatment (OR = 0.57, 95%CI 0.34-0.97, p = 0.04), good hand-washing practices (OR = 0.59, 95%CI 0.42-0.82, p = 0.002) and Hepatitis A vaccination (OR = 0.51, 95%CI 0.28-0.9, p = 0.02) had significant preventing effects on U5D., Conclusions: The study highlights that good hygiene practice is a key intervention against U5D in informal settlements. The promotion of hand-washing, proper water storage, and hygienic breastfeeding is highly recommended.

Evidence on the relationship between lifestyle, socio-economic factors and pesticide exposure and urinary concentrations of organophosphate (OP) pesticide metabolites among children is generally incomplete. This study investigated the relationship between socio-economic factors and reported pesticide exposures and the sum of three urinary concentrations of dialkyl phosphate metabolites (DAP) among boys living in the rural areas of the Western Cape, South Africa. Data was collected during a cross-sectional study of 183 boys from three agricultural intense areas. Measurements included a questionnaire on socio-economic and pesticide exposures and urinary DAP concentrations. Most boys (70%) lived on farms with a median age of 12 years (range: 5.0-19.5 years). Children aged >14 years had lower DAP urine concentrations (median = 39.9 ng/ml; β = -68.1 ng/ml; 95% CI: -136.8, 0.6) than children aged 9 years and younger (median = 107.0 ng/ml). DAP concentrations also varied significantly with area, with concentrations in the grape farming area, Hex River Valley (median = 61.8 ng/ml; β = -52.1; 95% CI: -97.9, -6.3 ng/ml) and the wheat farming area, Piketberg (median = 72.4 ng/ml; β = -54.2; 95% CI: 98.8, -9.7 ng/ml) lower than those in the pome farming area, Grabouw (median = 79.9 ng/ml). Other weaker and non-significant associations with increased DAP levels were found with increased household income, member of household working with pesticides, living on a farm, drinking water from an open water source and eating crops from the vineyard and or garden. The study found younger age and living in and around apple and grape farms to be associated with increased urinary DAP concentrations. Additionally, there were other pesticide exposures and socio-economic and lifestyle factors that were weakly associated with elevated urinary DAP levels requiring further study. The study provided more evidence on factors associated to urinary DAP concentrations especially in developing country settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Good quality and completeness of ambient air quality monitoring data is central in supporting actions towards mitigating the impact of ambient air pollution. In South Africa, however, availability of continuous ground-level air pollution monitoring data is scarce and incomplete. To address this issue, we developed and compared different modeling approaches to impute missing daily average particulate matter (PM 10 ) data between 2010 and 2017 using spatiotemporal predictor variables. The random forest (RF) machine learning method was used to explore the relationship between average daily PM 10 concentrations and spatiotemporal predictors like meteorological, land use and source-related variables. National (8 models), provincial (32) and site-specific (44) RF models were developed to impute missing daily PM 10 data. The annual national, provincial and site-specific RF cross-validation (CV) models explained on average 78%, 70% and 55% of ground-level PM 10 concentrations, respectively. The spatial components of the national and provincial CV RF models explained on average 22% and 48%, while the temporal components of the national, provincial and site-specific CV RF models explained on average 78%, 68% and 57% of ground-level PM 10 concentrations, respectively. This study demonstrates a feasible approach based on RF to impute missing measurement data in areas where data collection is sparse and incomplete.

We welcome the updated systematic review and meta-analysis of case-control studies of mobile phone use and cancer by Choi et al [...].

Aims: It is unclear whether night-time noise events, including from aeroplanes, could trigger a cardiovascular death. In this study, we investigate the potential acute effects of aircraft noise on mortality and the specific role of different night-time exposure windows by means of a case-crossover study design., Methods and Results: We selected 24 886 cases of death from cardiovascular disease (CVD) from the Swiss National Cohort around Zürich Airport between 2000 and 2015. For night-time deaths, exposure levels 2 h preceding death were significantly associated with mortality for all causes of CVD [OR = 1.44 (1.03-2.04) for the highest exposure group (LAeq > 50 dB vs. <20 dB)]. Most consistent associations were observed for ischaemic heart diseases, myocardial infarction, heart failure, and arrhythmia. Association were more pronounced for females (P = 0.02) and for people living in areas with low road and railway background noise (P = 0.01) and in buildings constructed before 1970 (P = 0.36). We calculated a population attributable fraction of 3% in our study population., Conclusion: Our findings suggest that night-time aircraft noise can trigger acute cardiovascular mortality. The association was similar to that previously observed for long-term aircraft noise exposure., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Residential radon exposure is a major public health issue in Switzerland due to the known association between inhaled radon progeny and lung cancer. To confirm recent findings of an association with skin cancer mortality, an updated national radon model is needed. The aim of this study was to derive the best possible residential radon prediction model for subsequent epidemiological analyses. Two different radon prediction models were developed (linear regression model vs. random forest) using ca. 80,000 measurements in the Swiss Radon Database (1994-2017). A range of geographic predictors and building specific predictors were considered in the 3-D models (x,y, floor of dwelling). A five-fold modelling strategy was used to evaluate the robustness of each approach, with models developed (80% measurement locations) and validated (20%) using standard diagnostics. Random forest consistently outperformed the linear regression model, with higher Spearman's rank correlation (51% vs. 36%), validation coefficient of determination (R 2 31% vs. 15%), lower root mean square error (RMSE) and lower fractional bias. Applied to the population of 5.4 million adults in 2000, the random forest resulted in an arithmetic mean (standard deviation) of 75.5 (31.7) Bq/m 3 , and indicated a respective 16.1% and 0.1% adults with predicted radon concentrations exceeding the World Health Organization (100 Bq/m 3 ) and Swiss (300 Bq/m 3 ) reference values., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Little is known about radiofrequency electromagnetic fields (RF) from mobile technology and resulting dose in young people. We describe modeled integrated RF dose in European children and adolescents combining own mobile device use and surrounding sources., Methods: Using an integrated RF model, we estimated the daily RF dose in the brain (whole-brain, cerebellum, frontal lobe, midbrain, occipital lobe, parietal lobe, temporal lobes) and the whole-body in 8358 children (ages 8-12) and adolescents (ages 14-18) from the Netherlands, Spain, and Switzerland during 2012-2016. The integrated model estimated RF dose from near-field sources (digital enhanced communication technology (DECT) phone, mobile phone, tablet, and laptop) and far-field sources (mobile phone base stations via 3D-radiowave modeling or RF measurements)., Results: Adolescents were more frequent mobile phone users and experienced higher modeled RF doses in the whole-brain (median 330.4 mJ/kg/day) compared to children (median 81.8 mJ/kg/day). Children spent more time using tablets or laptops compared to adolescents, resulting in higher RF doses in the whole-body (median whole-body dose of 81.8 mJ/kg/day) compared to adolescents (41.9 mJ/kg/day). Among brain regions, temporal lobes received the highest RF dose (medians of 274.9 and 1786.5 mJ/kg/day in children and adolescents, respectively) followed by the frontal lobe. In most children and adolescents, calling on 2G networks was the main contributor to RF dose in the whole-brain (medians of 31.1 and 273.7 mJ/kg/day, respectively)., Conclusion: This first large study of RF dose to the brain and body of children and adolescents shows that mobile phone calls on 2G networks are the main determinants of brain dose, especially in temporal and frontal lobes, whereas whole-body doses were mostly determined by tablet and laptop use. The modeling of RF doses provides valuable input to epidemiological research and to potential risk management regarding RF exposure in young people., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To investigate the association between estimated whole-brain radiofrequency electromagnetic fields (RF-EMF) dose, using an improved integrated RF-EMF exposure model, and cognitive function in preadolescents and adolescents., Methods: Cross-sectional analysis in preadolescents aged 9-11 years and adolescents aged 17-18 years from the Dutch Amsterdam Born Children and their Development Study (n = 1664 preadolescents) and the Spanish INfancia y Medio Ambiente Project (n = 1288 preadolescents and n = 261 adolescents), two population-based birth cohort studies. Overall whole-brain RF-EMF doses (mJ/kg/day) were estimated for several RF-EMF sources together including mobile and Digital Enhanced Cordless Telecommunications phone calls (named phone calls), other mobile phone uses than calling, tablet use, laptop use (named screen activities), and far-field sources. We also estimated whole-brain RF-EMF doses in these three groups separately (i.e. phone calls, screen activities, and far-field) that lead to different patterns of RF-EMF exposure. We assessed non-verbal intelligence in the Dutch and Spanish preadolescents, information processing speed, attentional function, and cognitive flexibility in the Spanish preadolescents, and working memory and semantic fluency in the Spanish preadolescents and adolescents using validated neurocognitive tests., Results: Estimated overall whole-brain RF-EMF dose was 90.1 mJ/kg/day (interquartile range (IQR) 42.7; 164.0) in the Dutch and Spanish preadolescents and 105.1 mJ/kg/day (IQR 51.0; 295.7) in the Spanish adolescents. Higher overall estimated whole-brain RF-EMF doses from all RF-EMF sources together and from phone calls were associated with lower non-verbal intelligence score in the Dutch and Spanish preadolescents (-0.10 points, 95% CI -0.19; -0.02 per 100 mJ/kg/day increase in each exposure). However, none of the whole-brain RF-EMF doses was related to any other cognitive function outcome in the Spanish preadolescents or adolescents., Conclusions: Our results suggest that higher brain exposure to RF-EMF is related to lower non-verbal intelligence but not to other cognitive function outcomes. Given the cross-sectional nature of the study, the small effect sizes, and the unknown biological mechanisms, we cannot discard that our resultsare due to chance finding or reverse causality. Longitudinal studies on RF-EMF brain exposure and cognitive function are needed., (Copyright © 2020 Elsevier GmbH. All rights reserved.)