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Previous studies have demonstrated associations between serum levels of perfluoroalkyl substances (PFASs) and asthma or asthma related-biomarkers. However, no studies have reported a possible relationship between PFASs exposure and lung function among children. The objective of the present study is to test the association between PFASs exposure and lung function in children from a high exposure area by using a cross-sectional case-control study, which included 132 asthmatic children and 168 non-asthmatic controls recruited from 2009 to 2010 in the Genetic and Biomarkers study for Childhood Asthma. Structured questionnaires were administered face-to-face. Lung function was measured by spirometry. Linear regression models were used to examine the influence of PFASs on lung function. The results showed that asthmatics in our study had significantly higher serum PFAS concentrations than healthy controls. Logistic regression models showed a positive association between PFASs and asthma, with adjusted odds ratios (ORs) ranging from 0.99 (95% confidence interval [CI]: 0.80-1.21) to 2.76 (95% CI: 1.82-4.17). Linear regression modeling showed serum PFASs levels were significantly negatively associated with three pulmonary function measurements (forced vital capacity: FVC; forced expiratory volume in 1s: FEV1; forced expiratory flow 25-75%: FEF25-75) among children with asthma, the adjusted coefficients between lung function and PFASs exposure ranged from -0.055 (95%CI: -0.100 to -0.010) for FVC and perfluorooctane sulfonate (PFOS) to -0.223 (95%CI: -0.400 to -0.045) for FEF25-75 and perfluorooctanoic acid (PFOA). PFASs were not, however, significantly associated with pulmonary function among children without asthma. In conclusion, this study suggests that serum PFASs are associated with decreased lung function among children with asthma.

The objective of this study was to evaluate whether high levels of maternal exposure to O3, SO2, NO2, CO are related to increased risk of congenital heart defects (CHDs) in Wuhan, China. The study included mothers living in the central districts of Wuhan during pregnancy over the two-year period from June 10, 2011 to June 9, 2013. For each study participant, we assigned 1-month averages of O3, SO2, NO2 and CO exposure based on measurements obtained from the nearest exposure monitor to the living residence of mothers during their early pregnancy period. In one-pollutant model, we observed an increased risk of CHDs, ventricular septal defect (VSD), and tetralogy of fallot (TF) with increasing O3 exposure. In two-pollutant model, associations with all CHDs, VSD, and TF for O3 were generally consistent compared to the models that included only O3, with the strongest aORs observed for exposures during the third month of pregnancy. We also observed a positive association between CO exposures during the third month of pregnancy and VSD in two pollution model.Our results contribute to the small body of evidence regarding air pollution exposure and CHDs, but confirmation of these associations will be needed in future studies.

Journal is deposited in PubMed Central for public release after 2017-10-15 STUDY OBJECTIVES Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To fill this void, the current study aimed to assess the association between sleep quality and abdominal obesity in a rural Chinese population. METHODS A representative sample of 9,404 adults aged 20-93 years in northeastern China was selected between 2012 and 2013 by a multistage cluster and random sampling method. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), where a score of 6 or higher indicated sleep disorder. Abdominal obesity was measured by waist circumference (WC), with abdominal obesity defined as WC > 90 cm for men and WC > 80 cm for women. RESULTS Male participants with abdominal obesity had higher global PSQI scores in addition to higher subscores in almost all of the elements compared to normal values. The odds ratios of abdominal obesity among participants with sleep disorders were 1.64 (95% confidence interval [CI]: 1.39-1.95) and 1.14 (95% CI: 0.98-1.32) for males and females compared to the reference group. The risk in all sleep elements was significantly increased, with odds ratios ranging from 1.28 (95% CI: 1.08-1.51) to 5.81 (95% CI: 3.54-9.53) for males. The risk only in four elements was significantly increased, from 1.28 (95% CI: 1.12-1.47) to 2.27 (95% CI: 1.36-3.80) for females. CONCLUSIONS Poor sleep quality was associated with abdominal obesity in Chinese. Furthermore, effects in males were larger than those in females.

Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are two types of perfluoroalkyl substances (PFASs) commonly used in the manufacturing process of many consumer products. Both have been detected in the blood of the majority of Americans. PFASs have been shown to be associated with intermediate cardiovascular disease (CVD) outcomes such as hypertension, hyperuricemia and dyslipidemia, but their relationship with obesity, a risk factor for intermediate and advanced CVD, remains largely unexplored. In this context, we examined the associations between PFOA and PFOS levels, and Body Mass Index (BMI) and waist circumference (WC) in a representative sample (N = 5,180) of US children. Our cross-sectional sample included participants aged 12-19 years from CDC’s National Health and Nutrition Examination Survey 1999-2000, 2003-2012. PFOA and PFOS were measured in ng/mL and modeled as quartiles of exposure, where quartile 1 is the referent group across models. Overweight/obesity was defined as age-, sex-specific BMI ≥85 th percentile; abdominal obesity was defined as age-, sex-specific waist circumference ≥90 th percentile. A multivariable model adjusting for age (years), sex (male, female), race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American, other), and annual household income category (

Several recent studies have suggested that maternal exposures to air pollution and temperature extremes might contribute to low birth weight (LBW), preterm birth (PTB), and other outcomes that can adversely affect infant health. At the time the current study began, most other studies had been conducted in the United States or Europe. Dr. Zhengmin Qian proposed to extend work he had done on ambient particulate air pollution and daily mortality in Wuhan, China (Qian et al. 2010), as part of the HEIsponsored Public Health and Air Pollution in Asia program, to study adverse birth outcomes. Wuhan is the capital city of Hubei province, has a large population of about 6.4 million within the urban study area, experiences temperature extremes, and generally has higher air pollution levels than those observed in the United States and Europe, thus providing a good opportunity to explore questions about air pollution and health.Qian and colleagues planned a cohort and nested case–control design with four specific aims, examining whether increased exposures to air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) during vulnerable pregnancy periods were associated with increased rates of PTB, LBW (2500 g), or intrauterine growth retardation (IUGR, defined as having a birth weight below the 10th percentile of singleton live births in Wuhan) after adjusting for major risk factors and whether the associations were confounded by copollutant exposures, affected by residual confounding, or modified by temperature extremes, socioeconomic status (SES), or secondhand smoke (SHS) exposure. The cohort study included 95,911 births that occurred from June 10, 2011, to June 9, 2013, and met typical prespecified inclusion criteria used in other birth outcome studies. The case–control study included 3146 cases (PTB, LBW, or both, but not IUGR) and 4263 controls (matched to the cases by birth month) for whom investigators were able to complete home visits and questionnaires. The investigators obtained air pollution and daily weather data for August 2010 to June 2013 from nine monitoring stations representing background air pollution sites in seven Wuhan inner-city districts. Only two of these stations provided PM2.5 data. For the cohort study, the investigators assigned exposures to mothers according to the daily mean concentrations from the monitor nearest the residential community in which the mother lived at the time of the birth. For the case–control study, they assigned exposures based on the inverse distance weighted average of daily mean concentrations from the three nearest monitors, for all but PM2.5 for which the method was not specified. They also collected data on various factors that might confound or modify the impact of the pollutants on the adverse outcomes, including data collected in the cohort from mothers at the time of delivery and, in the case–control study, from questionnaires administered to mothers. In the case–control study, covariates representing SES (as indicated by the mother’s educational attainment and household income) and SHS exposures were of particular interest. The primary statistical analyses of the pollutant associations with PTB, LBW, and IUGR were conducted using logistic regression models. In the cohort study, exposures during the pregnancy period of interest (full term, trimesters, and selected months) were included as continuous variables. In the case–control study, the exposures were modeled as binary variables (i.e., above or below the median pollutant concentrations). Numerous sensitivity analyses were conducted.Although originally planning a nested case–control study, the investigators encountered challenges that led them to analyze the cohort and case–control studies using different ways of assigning exposures and characterizing them in their statistical models. These decisions precluded direct comparisons between the sets of results, making it difficult to answer the questions about residual confounding that nested case–control studies are designed to answer. The odds ratios from the two study designs using different exposures also have different interpretations. Still, one can ask whether the sets of findings were qualitatively consistent with each other or with those of similar studies. There were some similarities. Both studies suggested that increased PM(2.5), PM(10), CO, and O(3) exposures over the full pregnancy were associated with small increases in the odds of PTB (the case–control study also showed an association with NO2) and that increased PM(2.5) exposures were associated with significantly increased odds of LBW. However, most of the other pollutants had no effect on LBW, except CO in the cohort study and O(3) in the case–control study, both of which increased the odds of LBW. The exposures over the entire pregnancy were generally associated with decreased odds of IUGR. Adjustments for potential confounders were greatest for the delivery covariates. The investigators found no systematic association of any of these outcomes with particular trimesters or months, another result that differed from those of some other studies. They found little evidence that their main results were confounded or modified by the presence of copollutants, although with the exception of O3, most of the pollutants were highly correlated, making it difficult to disentangle the effects of individual pollutants. Could the two sets of data be analyzed in a more comparable way, as in a standard nested case–control study? At the Committee’s request, the investigators reanalyzed the case–control data using the same exposures and models as in the cohort study. The results were strikingly different from those using the inverse distance weighted exposures, modeled as binary variables — the pollutants had either no effect or an apparent beneficial effect on PTB and LBW. The Committee was not convinced by the explanations offered for these differences, leaving the reasons for them unresolved.This study set out to answer important questions about the effects of air pollution exposure on three measures of adverse birth outcomes — LBW, PTB, and IUGR — in a large cohort of mothers and newborns in Wuhan, China. Given the cohort size, high pollution levels and temperatures, and detailed covariate data, the investigators were well poised to address these questions. They sought to pattern their work on other studies of birth outcomes, were very responsive to Committee questions, and provided many additional analyses and explanations. In the Committee’s view, however, the study was unable to address with confidence several of its specific aims. Most important, the differences in results when the case–control data were analyzed with different exposure metrics remain unexplained, raising concerns about the ability to draw conclusions from subsequent analyses assessing residual confounding and effect modification by temperature extremes, SES, and SHS exposure. Consequently, any individual findings from the cohort and case–control studies should be considered suggestive rather than conclusive, and should be interpreted carefully together.

Limited evidence exists concerning the impact of particulate pollution on acute respiratory distress syndrome (ARDS). We examined the effects of particulate pollution on emergency ambulance dispatches (EAD) for ARDS in Guangzhou, China. Daily air pollution concentrations for PM10, PM2.5, and PM1, as well as PM2.5 chemical compositions, were available from a central air monitoring station. The association between incident ARDS and air pollution on the concurrent and previous 5 days was estimated by an over-dispersed Poisson generalized additive model controlling for meteorological factors, temporal trends, public holidays and day of the week. We identified a total of 17,002 EADs for ARDS during the study period. There were significant associations between concentrations of PM10, PM2.5, PM1, and ARDS; corresponding excess risk (ER) for an interquartile range IQR increase in 1-day lagged concentration was 5.45% [95% confidence interval (CI): 1.70%, 9.33%] for PM10 (45.4 μg/m3), 4.71% (95% CI: 1.09%, 8.46%) for PM2.5 (31.5 μg/m3), and 4.45% (95% CI: 0.81%, 8.23%) for PM1 (28.8 μg/m3), respectively. For PM2.5 chemical compositions, we found that OC, EC, sulfate and ammonium were significantly associated with ARDS. The observed effects remained even after adjusting for potentially confounding factors. This study suggests that PM10, PM2.5, and PM1, as well as chemical constituents from combustion and secondary aerosols might be important triggers of ARDS in Guangzhou.

This study is a nested case control study from a population-based cohort study conducted in Wuhan, China. The aim is to estimate the association between symptoms of depression during pregnancy (DDP), anxiety during pregnancy(ADP), and depression with anxiety during pregnancy (DADP) and low birth weight (LBW) and to examine the extent to which preterm birth (PTB) moderates these associations. Logistic regression analyses were used to model associations between DDP, ADP, and DADP and LBW. Models were stratified by the presence or absence of PTB to examine moderating effects. From the cohort study, 2853 had a LBW baby (cases); 5457 pregnant women served as controls. Women with DDP or ADP only were not at higher risk of having a LBW baby, but DADP was associated with increased risk of LBW (crude OR 1.41, 95% CI 1.17-1.70; adjusted OR 1.29, 95% CI 1.07-1.57), and the significant association was particularly evident between DADP and LBW in PTB, but not in full-term births. Our data suggests that DADP is related to an increased risk of LBW and that this association is most present in PTBs.

Background Substance use and crime/recidivism are irrevocably linked. We explore the nuances of this association by highlighting the prevalence, trends, and correlates of substance use dsorders in a large group of probationers/parolees. Methods We examined SUDs among probationers and parolees in the United States using data from the National Study on Drug Use and Health (NSDUH). Logistic regression models were computed to examine eight distinct outcomes: alcohol abuse, illicit drug abuse, marijuana/hashish abuse, comorbid alcohol and illicit drug abuse, alcohol dependence, illicit drug dependence, marijuana/hashish dependence, and comorbid alcohol and illicit drug dependence. Results Probationers/parolees have high prevalence rates across all SUDs categories and these trends have been relatively constant. Prevalence rates for alcohol abuse and dependence are two to six times higher than for marijuana and other illicit drug abuse and dependence. Key correlates of substance abuse for probationers/parolees include: age, gender, race/ethnicity, education, income, risk propensity, crime/violence measures, and comorbid substance abuse. Similar correlates were found for substance dependence, in addition to employment and mental health treatment. Conclusions This study indicates that SUDs are higher among probationer/parolees as compared to their non-supervised counterparts − between four and nine times higher − and these levels have changed little in recent years. Effectively responding to SUDs in this population may enhance adherence to supervision requirements, prevent recidivism, and improve public safety. We may be better served using limited funds for further development of evidence-based policies and programs, such as drug courts, which demonstrate reductions in both drug use and recidivism.

Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.

Perfluoroalkyl substances (PFASs) are a class of widely used chemicals that have been detected in the environment and general population. However, the isomer patterns in human are poorly characterized. Previous studies observed the isomer-specific maternal-fetal transfer of PFASs in human. In our current study, we first examined the profile of PFASs and isomers, including 17 linear PFASs and 10 branched PFOS/PFOA isomers by using isotopic internal standards in umbilical cord serum samples from Guangzhou, China. We collected a total of 321 of cord blood serum samples from July to October in 2013, and analyzed the PFASs concentration with isomer-specific PFASs analysis method. The results showed that 9 out of 17 PFASs (linear PFASs) were detected (>50% detection rate). Perfluorohexane sulfonate (PFHxS, median 3.87 ng/mL) was the predominant, followed by total PFOS (median 2.99 ng/mL) and total PFOA (median 1.23 ng/mL) in cord serum. In addition, 1m-, iso-, ∑3+4+5m-PFOS and iso-PFOA were the branched PFASs detected in the current study. The proportion of linear PFOS (n-PFOS) was 75.16% of ∑PFOS which was similar to the proportion of electrochemical fluorination that produces ca. 70% linear PFOS and 30% branched. On the contrary, linear PFOA (n-PFOA) accounted for 98.69% ∑PFOA in cord serum samples. Our finding indicates distinct PFASs and PFOS/PFOA isomer profile in cord serum, suggesting there might be a different exposure pathway and metabolism of PFASs.

Polyfluoroalkyl substances (PFASs) are a group of common chemicals that ubiquitously exist in wildlife and humans. However, few studies have researched the effect of PFASs on reproductive hormones in adolescents. To provide information in this regard, we recruited 225 Taiwanese adolescents aged 13–15 years from 2009 to 2010 to investigate the relationship between serum PFASs (PFOS, PFOA, PFBS, PFDA, PFDoA, PFHxA, PFHxS, PFNA and PFTA) and reproductive hormone concentrations using a cross-sectional study design. Results showed PFOS and PFTA levels were highest among the PFASs, with a median concentrations of 29.9 (interquartile range: 13.0–43.8) ng/mL and 6.0 (0.6–25.9) ng/mL in males, and a median concentrations of 28.8 (14.8–42.6) ng/mL and 4.5 (0.3–18.4) ng/mL in females. After adjustment for confounding factors, nonsignificant associations between PFASs and reproductive hormone were found except for PFNA with ln(estradiol) (β = 0.2060, 95%CI: 0.0016, 0.4105). When stratified by sex, more significant associations were found in males than in females. Among males, PFASs were negatively associated with ln(testosterone) level for PFOS (β = −0.0029, 95%CI: −0.0055, −0.0003), PFDA (β = −0.2565, 95%CI: −0.4135, −0.0994), PFHxA (β = −0.3095, 95%CI: −0.5942, −0.0248), and PFNA (β = −0.4233, 95%CI: −0.6998, −0.1467). Furthermore, male participant ln(estradiol) levels were positively associated with PFOA (β = 0.0921, 95%CI: 0.0186, 0.1656), and PFHxS (β = 0.0462, 95%CI: 0.0020, 0.0905). Among females, a significant relationship was found only for PFDoA with ln(testosterone) (β = −0.0119, 95%CI: −0.0227, −0.0010). In conclusion, this study showed higher levels of PFASs coincide with lower testosterone and higher estradiol levels, and more significant associations of PFASs with reproductive hormone were found in males than in females. Keywords: Perfluoroalkyl substances, Testosterone, Estradiol, Sex, Adolescents

To examine the racial disparity in the association between obesity and asthma in US children and adolescents.This study was based on a nationally representative, random-digit-dial sample of US households with children less than 18 years of age from the National Survey of Children's Health in 2011/2012 and 2007. The study sample included 88,668 children ages 10-17 with data on body mass index (BMI), parental reporting of asthma diagnosis, and potential confounders. Multiple logistic regression analysis was performed to estimate the crude and adjusted odds ratios stratified by child race/ethnicity.The prevalence of overweight was 15.2% and obesity was 14.1%. Self-reported asthma diagnosis was 16.7% in our study sample. Obese children were 51% more likely to have asthma compared to normal weight children after controlling for child's sex, child age, socioeconomic status, environmental tobacco smoke (ETS), and neighborhood conditions. Our study also shows that the strength of this association varied by race/ethnicity after stratification. Being male, being non-Hispanic Black or Multi-racial, below the Federal Poverty Level, ETS and having detracting neighborhood elements were also significantly associated with higher odds of having a self-reported asthma diagnosis.We observed a racial difference in the association between BMI and asthma in US children. Our findings have significant public health implications and may help public health practitioners to target children and adolescents at higher risk of prevention and intervention efforts.

Study question Is prenatal vanadium exposure associated with adverse birth outcomes? Summary answer The odds of low birthweight (LBW) are increased 2.23-fold in mothers with a urinary vanadium of ≥2.91 μg/g creatinine compared with that in mothers with a urinary vanadium of ≤1.42 μg/g creatinine. What is known already Human exposure to vanadium occurs through intake of food, water and polluted air. Vanadium has been suggested to have fetotoxicity and developmental toxicity in animal studies, and epidemiological studies have reported an association between a decrease in birthweight and vanadium exposure estimated from particulate matter. Study design, size, duration A nested case-control study involving 816 study participants (204 LBW cases and 612 matched controls) was conducted with data from the prospective Healthy Baby Cohort between 2012 and 2014 in the province of Hubei, China. Participants/materials, setting, methods Vanadium concentrations in 816 maternal urine samples collected before delivery [the median gestational age was 39 weeks (range 27-42 weeks)] were measured by inductively coupled plasma mass spectrometry. Information on the infants' birth outcomes was obtained from medical records. Conditional logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Main results and the role of chance The median urinary vanadium concentration of the cases was much higher than that of the controls (3.04 μg/g creatinine versus 1.93 μg/g creatinine). The results revealed a significant positive trend between the odds of LBW and level of maternal urinary vanadium [relative to the lowest tertile; adjusted OR = 1.69 (95% CI: 0.92, 3.10) for the medium tertile; adjusted OR = 2.23 (95% CI: 1.23, 4.05) for the highest tertile; P-trend = 0.02]. Additionally, the association was not modified by maternal age (P for heterogeneity = 0.70) or infant gender (P for heterogeneity = 0.21). Limitations, reasons for caution The maternal urine sample was collected before labor, and the maternal urinary vanadium levels measured at one point in time may not accurately reflect the vanadium burden during the entire pregnancy. Wider implications of the findings The results of this study can enrich the biological monitoring data on urinary vanadium in pregnant women; and may be evidence that vanadium may affect fetal development. Study funding/competing interests This work was supported by the National Natural Science Foundation of China (21437002, 81372959 and 81402649), the R&D Special Fund for Public Welfare Industry (Environment) (201309048) and the Fundamental Research Funds for the Central Universities, HUST (2016YXZD043). The authors have no conflicts of interest to declare.

To investigate the risk of hyperuricemia in relation to Perfluoroalkyl substances (PFASs) in children from Taiwan, 225 Taiwanese children aged 12-15 years were recruited from 2009 to 2010. Linear and logistic regression models were employed to examine the influence of PFASs on serum uric acid levels. Findings revealed that eight of ten PFASs analyses were detected in >94% of the participants' serum samples. Multivariate linear regression models revealed that perfluorooctanic acid (PFOA) was positively associated with serum uric acid levels (β = 0.1463, p

The objective of this study is to determine the impact of body weight and physical activity on the development of metabolic syndrome (MetS).We used the public use data from the Atherosclerosis Risk in Communities study. From the baseline cohort, we identified, as the study population, 9359 individuals who did not have MetS and who completed the second follow-up examination in 1993-1995.In 6 years of follow-up, 1970 individuals (25%) developed MetS. Compared with normal weight group [body mass index (BMI)25 kg/m], the odds ratios [95% confidence interval (CI)] of incident MetS were 2.81 (95% CI: 2.50-3.17) and 5.24 (95% CI: 4.50-6.12) for the overweight (BMI: 25-30 kg/m) and the obese groups (BMIor=30 kg/m), respectively. Compared with persons in the lowest quartile of leisure-time physical activity, the odds ratios (95% CI) of incident MetS were 0.80 (95% CI: 0.71-0.91) and 0.92 (95% CI: 0.81-1.04) for persons in the highest and the middle quartiles of leisure-time physical activity, respectively. Our results indicated that at any level of physical activity, there is a graded increase in the risk of incident MetS with an increase in BMI, in contrast to a lack of graded association between physical activity and the incidence of MetS in all categories of BMI.This study highlights the need to target obesity more than physical activity in preventing the development of MetS.

Context An increasing body of research has linked the geographic distribution of lead with various indicators of criminal and antisocial behavior. Objective The current study, using data from an ongoing project related to lead exposure in St. Louis City, MO, analyzed the association between aggregate blood lead levels and specific indicators violent crime within the city. Design Ecological study. Setting St. Louis, Missouri. Exposure measure Blood lead levels. Main outcome measure Official reports of violent crimes were categorized as 1) crimes involving a firearm (yes/no), 2) assault crimes (with or without a firearm), 3) robbery crimes (with or without a firearm), 4) homicides and 5) rape. Results With the exception of rape, aggregate blood-lead levels were statistically significant predictors of violent crime at the census tract level. The risk ratios for each of the outcome measures were as follows: firearm crimes 1.03 (1.03-1.04), assault crimes 1.03 (1.02-1.03), robbery crimes 1.03 (1.02-1.04), homicide 1.03 (1.01, 1.04), and rape 1.01 (0.99-1.03). Conclusions Extending prior research in St. Louis, results suggest that aggregated lead exposure at the census tract level predicted crime outcomes, even after accounting for important sociological variables. Moving forward, a more developed understanding of aggregate level crime may necessitate a shift toward studying the synergy between sociological and biological risk factors such as lead exposure.

Extreme temperatures are associated with increased daily mortality in many regions of the world (Patz and Khaliq 2002). Because human activity is likely to increase overall global average temperatures, research efforts have focused on the health effects of exposure to high temperatures and heat waves in summer. In the United States, increased mortality during high-temperature days has been extensively investigated. Semenza et al. (1996) reported that a heat wave in Chicago, Illinois, in 1995 was associated with an increase in the death rate among socially isolated people who had no air conditioning. In studies of multiple U.S. cities, similar results were reported (Curriero et al. 2002). In Europe, excess mortality during high-temperature days has also been noted. Le Tertre et al. (2006) also reported an association between the 2003 heat wave in France and increases in all causes of mortality in nine French cities. Stafoggia et al. (2006) explored vulnerability to heat-related mortality in four Italian cities: Bologna, Milan, Rome, and Turin. The populations particularly vulnerable to high summer temperatures were the elderly, women, widows and widowers, those with particular medical conditions, and those in nursing homes and health care facilities. Air pollution is also associated with increased daily mortality (Pope 2000). A large number of daily mortality time-series analyses have provided sufficiently convincing evidence that nonaccidental mortality, including cardio-pulmonary mortality, is associated with ambient particulate matter (PM) exposure in the United States (Ostro et al. 2007), Canada (Burnett et al. 2000), Rome (Forastiere et al. 2007), China (Kan et al. 2007), Korea (Lee et al. 2000), Greece (Katsouyanni et al. 1997), and Chile (Cakmak et al. 2007). The estimated effect is generally in the range of 1.0–8.0% excess deaths per 50-μg/m3 increments in 24-hr average concentrations of particulate matter ≤ 10 μm in aerodynamic diameter (PM10) (Schwartz and Zanobetti 2000). Although the independent impacts of high temperature and air pollution on daily mortality have been widely explored, few studies have examined the interaction between high temperature and air pollution (Samet et al. 1998). Investigating the effects of the synergy between air pollution and high temperature on mortality, although desirable, is difficult, because a suitable study site is not easily available. The Chinese city of Wuhan, however, provides an opportunity to examine these synergistic effects; it has been called an “oven” city because of its extremely hot summers. Previous studies in Wuhan (He et al. 1993; Qian et al. 2004) have shown high air pollution levels, with concentration ranges wider than those reported in the published literature for other locations. Therefore, we tested the hypothesis that temperature extremes modify the mortality effects of air pollution.

The change in ICD coding from ICD-9 to ICD-10 may produce inconsistencies and discontinuities in cause-specific mortality, thus impacting on effects estimates of air pollution on mortality. The current study was conducted in Wuhan, China. We examined the concordant rates and Kappa statistics using the mortality data from the year 2002 coded with both ICD-9 and ICD-10 codes and compared the estimated effects of air pollution using the Generalized Additive Model in R. We found high concordant rates (>99.3%) and Kappa statistics close to 1.0 (>0.98). Little difference was identified in the estimated effects of air pollution on daily cardiovascular, stroke, cardiac, cardiopulmonary, and respiratory mortality. This study provides evidence that, based on the wide definitions of cause-specific morality typically used in the studies of time-series air pollution mortality, the change in the ICD coding does not significantly affect the estimated effects of air pollution. Keywords: Mortality, ICD-9, ICD-10, Air pollution, Particulate matter, Sulfur dioxide, Nitrogen dioxide, Ozone

The prevalence of smoking among Chinese adolescents has dramatically increased in recent years. The purpose of this study was to examine the differences in smoking-related knowledge, attitudes, and behaviors among Chinese students in 3 types of secondary schools.This cross-sectional study was conducted among 3,957 students of seventh, eighth, and ninth grades and 2,870 student parents from 3 public, 1 factory, and 2 general-paid private secondary schools at Guangzhou in 2004. Participants were asked to complete self-administered questionnaires about sociodemographic characteristics, smoking-related family and school environments, smoking-related knowledge and attitudes, and smoking behaviors.The average scores of students' smoking-related knowledge and attitudes (higher score, more against smoking) were highest in the factory school, followed by public schools and private schools. The differences among them were statistically significantly (P.05). The lifetime smoking prevalence was also significantly different (P.001) among 3 types of schools: 35.4% in private schools, 17.4% in public schools, and 13.2% in the factory school. The prevalence of students' weekly smoking was also higher in private schools (6.2%) than in public schools (4.9%) or the factory school (4.0%). Similar disparity was observed in the prevalence of daily smoking (3.9% private, 3.5% public, and 2.7% factory). However, differences in weekly and daily smoking were not statistically significant (P.05).Compared with students in public and factory schools, those in general-paid private schools had poorer smoking-related knowledge, more supportive attitudes toward smoking, and more popular smoking behaviors. Therefore, more intensive smoking prevention programs should be implemented among them.

In Asia, limited literature has been published on the association between daily mortality and ambient air pollution. We examined the associations of daily cause-specific mortality with daily mean concentrations of particulate matter (PM) with a mass median aerodynamic diameter less than 10 microm (PM(10)) in Wuhan, China using 4 years of data (2001-2004). There are approximately 4.5 million residents in Wuhan who live in the city core area of 201 km(2) where air pollution levels are higher and pollution ranges are wider than the majority of cities in the published literature. We use quasi-likelihood estimation within the context of the generalized additive models (GAMs) (natural spline (NS) models in R) to model the natural logarithm of the expected daily death counts as a function of the predictor variables. We found consistent PM(10) effects on mortality with the strongest effects on lag 0 day. Every 10 microg/m(3) increase in PM(10) daily concentration at lag 0 day was significantly associated with an increase in non-accidental (0.36%; 95% CI 0.19-0.53%), cardiovascular (0.51%; 95% CI 0.28-0.75%), stroke (0.44%; 95% CI 0.16-0.72%), cardiac (0.49%; 95% CI 0.08-0.89%), respiratory (0.71%; 95% CI 0.20-1.23%), and cardiopulmonary (0.46%; 95% CI 0.23-0.69%). In general, these effects were stronger among the elderly (65 yearsor = 45 years) than among the young. The exploration of exposure-response relationships between PM(10) and cause-specific mortality suggests the appropriateness of assuming linear relationships, where the PM(10) concentration in Wuhan ranged from 24.8 to 477.8 microg/m(3). We conclude that there is consistent evidence of acute effects of PM(10) on cardiopulmonary mortality. A linear no threshold exposure-response relationship is suggested between PM(10) and the studied cause-specific mortality.

Objective. To identify modifiable family and school environmental factors associated with Chinese adolescent smoking behaviors including never-smoking, experimental smoking, regular smoking, and attempting to quit. Methods. A cross-sectional survey using self-reported questionnaires was conducted in Huangpu, Guangzhou in December of 2004. A total of 3957 pupils agreed to complete the questionnaires. The prevalence odds ratio (risk) of experimental smoking was compared to never-smoking, adjusting for gender and age in unconditional logistic regression analysis. The risk of regular smoking was compared to experimental smoking, and the risk of attempting quitting was analyzed in regular smokers. Results. The cigarette smoking of peers, mothers, fathers, brothers, and supervising teachers, passive smoking, and seeing someone smoking on campus increased the risk of experimental smoking vs. nonsmoking, while no-smoking signs, perceived anti-tobacco atmosphere in school, and being taught smoking-related health knowledge decreased the risk. The factors associated with regular smoking compared to experimental smoking included the smoking of peers, brothers, fathers and supervising teachers, teacher's tolerance, and passive smoking. Being taught smoking-related knowledge, perceived anti-tobacco atmosphere and no-smoking signs in school were positively associated with regular smoker's attempt to quit, while supervising teacher's smoking, parents' and teachers' tolerance could delay it. Conclusions. These modifiable family and school environmental factors as well as their interaction with gender and age should be highly considered in adolescent smoking prevention in China.

UNLABELLED Diverse indoor combustion sources contribute to the indoor air environment. To evaluate the effect of these sources on human respiratory health, we examined associations between respiratory conditions and household factors in the 2360 children's fathers (mean = 38.4 years old) and associations between lung function and household factors in 463 primary school children (mean = 8.3 years old) from Wuhan, China. Factor analysis developed new uncorrelated 'factor' variables. Unconditional logistic regression models or linear regression models, controlling for important covariates, estimated the respiratory health effects. Coal smoke derived from home heating ('heating coal smoke') was associated with high adult reporting of persistent cough, persistent phlegm, and wheeze. Cooking coal smoke was associated with physician-diagnosed adult asthma and decreased forced vital capacity (FVC), and forced expiratory volume at 1 s (FEV(1)) in children. The presence of any home cigarette smoker was associated with more reports of persistent cough, persistent phlegm, cough with phlegm, and bronchitis. Our study suggests that in Wuhan, there may be independent respiratory health effects of different indoor combustion sources and their exposure factors for these study populations. PRACTICAL IMPLICATIONS We conclude that multiple indoor air pollution sources could have adverse respiratory health effects on both children and middle-aged men in the city of Wuhan, China. These results may have implications for the Wuhan local government, the Chinese government, or other related organizations in efforts on protecting public health through regulation of indoor air pollution from indoor combustion sources.

We studied the evolution of lower respiratory symptoms at 1 month (initial) and 19 months (follow-up) after the collapse of the World Trade Center on September 11, 2001 (9/11).A total of 1588 New York police officers completed initial self-administered questionnaires. The level of 9/11 exposure and pre-9/11 health was available in 1373. Of those, 471 (426 with no pre-9/11 chronic respiratory disease) completed a follow-up telephone survey.Prevalence of cough was 43.5% at both initial and follow-up assessments, but increased were the prevalence of phlegm (14.4% to 30.7%, P0.001), shortness of breath (18.9% to 43.6%, P0.001), and wheeze (13.1% to 25.9%, P0.001). Rates of delayed-onset (present on follow-up assessment only) cough, phlegm, shortness of breath, and wheeze were 21%, 21.9%, 31.7%, and 17.3%, respectively.Most of the lower respiratory symptoms increased between 1 month and 19 months after 9/11.

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12-17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12-17 (n=197,313) and spanning the years 2002-2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004-2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012-2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.

Importance Although studies in western countries suggest that ambient air pollution is positively associated with adverse pregnancy outcomes, the upper levels of pollutant exposures have been relatively low, thus eroding confidence in the conclusions. Meanwhile, in Asia, where upper levels of exposure have been greater, there have been limited studies of the association between air pollution and adverse pregnancy outcomes. Objective The primary objective was to evaluate whether high levels of pollution, including particulate matter pollution with a mass median aerodynamic diameter of less than 2.5 μm (PM2.5) and 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) are related to increased occurrence of preterm birth (PTB). Methods We conducted a population-based study in Wuhan, China in a cohort of 95,911 live births during a two-year period from 2011 to 2013. The exposure was estimated based on daily mean concentrations of pollutants estimated using the pollutants’ measurements from the nine closest monitors. Logistic regressions were performed to determine the relationships between exposure to each of the pollutants during different pregnancy periods and PTB while controlling for key covariates. Results We found 3% (OR = 1.03; 95% CI: 1.02, 1.05), 2% (OR = 1.02; 95% CI: 1.02, 1.03), 15% (OR = 1.15; 95% CI: 1.11, 1.19), and 5% (OR = 1.05; 95% CI: 1.02, 1.07) increases in risk of PTB with each 5-μg/m3 increase in PM2.5 and PM10 concentrations, 100-μg/m3 increase in CO concentrations, and 10-μg/m3 increase in O3 concentrations, respectively. There was negligible evidence for associations for SO2 and NO2. The effects from two-pollutant models were similar to the estimated effects from single pollutant models. No critical exposure windows were identified consistently: the strongest effect for PTB was found in the second trimester for PM2.5, PM10, and CO, but for SO2 it was in the first trimester, second month, and third month. For NO2 it was in the first trimester and second month, and for O3, the third trimester. Conclusion Findings reveal an association between air pollutants and PTB. However, more toxicological studies and prospective cohort studies with improved exposure assessments are needed to establish causality related to specific pollutants.

The prevalence of macrosomia has risen markedly worldwide, including in China, during the past two decades. Few epidemiological studies, however, have investigated the risk factors for macrosomia in China. This study was designed to investigate the associations between parental anthropometric characteristics, gestational weight gain (GWG), and risk of macrosomia in China.This population-based, case-control study in Wuhan, China, included a total of 6341 subjects (870 cases and 5471 controls). Multivariable logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI).Mothers or fathers who were overweight or obese before pregnancy had an elevated risk of giving birth to a macrosomic infant compared with their normal weight counterparts. Women with GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 6.09 [95% CI 5.04, 7.35] for delivering a macrosomic infant compared with women who had GWG within the IOM recommendation. When stratified by maternal pre-pregnancy body mass index (BMI), women who were underweight or normal weight before pregnancy were observed to have a higher risk of macrosomia birth associated with greater GWG.Parental pre-pregnancy overweight/obesity and excessive GWG during pregnancy were highly associated with macrosomia. The association with GWG was most pronounced in mothers who had a normal or underweight pre-pregnancy BMI. Weight control efforts before pregnancy for mothers and fathers as well as control of maternal gain during pregnancy may reduce the risk of macrosomia.

Exposure to chromium is increasing due to environmental pollution from industrial processes. Several epidemiological studies have investigated chromium exposure and reproductive outcomes, but few studies have investigated the association of chromium exposure and low birth weight (LBW). This study was designed to investigate whether maternal exposure to chromium during pregnancy is associated with an increased risk of LBW. Chromium concentrations in maternal urine samples collected at delivery were measured in 204 LBW cases and 612 matched controls recruited between 2012 and 2014 in Hubei Province, China. Risk of LBW was associated with higher levels of chromium in maternal urine [adjusted odds ratio (OR) = 1.77 for the medium tertile, 95% confidence interval (CI): 0.95, 3.29; adjusted OR = 2.48 for the highest tertile, 95% CI: 1.33, 4.61; P trend = 0.01]. The association was more pronounced among female infants (adjusted OR = 3.67 for the highest tertile, 95% CI: 1.50, 8.97) than among male infants (adjusted OR = 1.22 for the highest tertile, 95% CI = 0.48, 3.11) (p heterogeneity = 0.06). Our findings suggest that maternal exposure to higher levels of chromium during pregnancy may potentially increase the risk of delivering LBW infants, particularly for female infants.

Though significant associations between particulate matter (PM) air pollution and cardiovascular diseases have been widely reported, it remains unclear what characteristics, such as particle size and chemical constituents, may be responsible for the effects. A time-series model was applied to examine the cardiovascular effects of particle size (for the period of 2009–2011) and chemical constituents (2007–2010) in Guangzhou, we controlled for potential confounders in the model, such as time trends, day of the week, public holidays, meteorological factors and influenza epidemic. We found significant associations of cardiovascular mortality with PM10, PM2.5 and PM1; the excess risk (ER) was 6.10% (95% CI: 1.76%, 10.64%), 6.11% (95% CI: 1.76%, 10.64%) and 6.48% (95% CI: 2.10%, 11.06%) for per IQR increase in PM10, PM2.5 and PM1 at moving averages for the current day and the previous 3 days (lag03), respectively. We did not find significant effects of PM2.5-10 and PM1-2.5. For PM2.5 constituents, we found that organic carbon, elemental carbon, sulfate, nitrate and ammonium were significantly associated with cardiovascular mortality, the corresponding ER for an IQR concentration increase at lag03 was 1.13% (95% CI: 0.10%, 2.17%), 2.77% (95% CI: 0.72%, 4.86%), 2.21% (95% CI: 1.05%, 3.38%), 1.98% (95% CI: 0.54%, 3.44%), and 3.38% (95% CI: 1.56%, 5.23%), respectively. These results were robust to adjustment of other air pollutants and they remained consistent in various sensitivity analyses by changing model parameters. Our study suggests that PM1 and constituents from combustion and secondary aerosols might be important characteristics of PM pollution associated with cardiovascular mortality in Guangzhou.

Despite the association of childhood blood pressure (BP) with hypertension later in the life course, there remains dearth of information regarding the prevalence and emergence of hypertension in children, especially in China. To investigate the current status of BP, prevalence of elevated BP and related factors in Chinese children, a cross-sectional survey in a representative sample of 9354 Chinese children 5-17 years old was conducted in seven cities in Northeastern China during 2011 and 2012. BP measurements were taken by mercury sphygmomanometer. Elevated BP in children was defined as an average diastolic BP or systolic BP that is in the 95th percentile or higher for their gender, age and height. Overall, total prevalence of elevated BP was 13.8%, and no significant difference between males and females was identified. Multivariate analyses revealed that children having a higher area of residence had a lower of elevated BP. Increased odds for elevated BP were found for individuals who were lean (odds ratio (OR)=2.12; 95% confidence interval (CI): 1.67-2.69), overweight (OR=2.05; 95% CI: 1.74-2.42), obese (OR=3.15; 95% CI: 2.70-3.68), were born with low birth weight (OR=1.26; 95%CI: 1.01-1.63), premature birth (OR=1.46; 95%CI: 1.13-1.88), and were with home coal use (OR=1.24; 95%CI: 1.02-1.52). In conclusion, elevated BP was found to be prevalent in children in urban areas of Northeast China. These results underscore the importance of implementing a package of measures aimed at reducing malleable risk for this cardiovascular condition in school-aged children in Northeast China.

Maternal exposure to ambient air pollution has increasingly been linked to congenital heart defects (CHDs). The objective of this study was to evaluate whether high levels of maternal exposure to PM2.5 and PM10 are related to increased risk of CHDs in Wuhan, China. We conducted a cohort study with a total of 105,988 live-born infants, stillbirths, and fetal deaths. The study included mothers living in the urban district of Wuhan during pregnancy over the 2-year period from 10 June 2011 to 9 June 2013. For each study participant, we assigned 1-month and 1-week averages of PM10 and PM2.5 exposure based on measurements obtained from the nearest exposure monitor to the living residence of mothers during their early pregnancy period. Logistic regression analyses were conducted to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the association between exposure to these ambient air pollutants during early pregnancy and CHDs. We observed an increased risk of CHDs, particularly ventricular septal defect (VSD), with increasing PM2.5 exposure. Using 1-week averages, we also observed significant monotonically increasing associations between PM2.5 exposure during weeks 7-10 of pregnancy and risk of VSD, with aORs ranging from 1.11 to 1.17 (95% CI: 1.02-1.20, 1.03-1.22, 1.05-1.24, and 1.08-1.26 separately) per a 10 μg/m(3) change in PM2.5 concentration. Our study contributes to the small body of knowledge regarding the association between in utero exposure to air pollution and CHDs, but confirmation of these associations will be needed in future studies.

To evaluate the potential effect of interaction between breastfeeding and environmental tobacco smoke (ETS) exposure on respiratory health, we studied 31 049 children (aged 2-14 years) from 25 districts of seven cities in northeast China. Parents of the children completed standardized questionnaires that characterized the children's histories of respiratory symptoms and illness, feeding methods, ETS exposure, and other associated risk factors. Breastfeeding was defined as having been mainly breastfed for 3 months or more. The results showed that the association of ETS exposure with childhood respiratory conditions/diseases was modified by breastfeeding, and the association for nonbreastfed children was stronger than that for breastfed children. In particular, for nonbreastfed children, the odds ratios (ORs) for the effect of current ETS exposure asthma was 1.71 (95% CI: 1.43-2.05); however, the OR for breastfed children was 1.33 (95% CI: 1.20-1.48), indicating that the interactions between breastfeeding and current ETS exposure on asthma were statistically significant (P = 0.019). When stratified by school (kindergarten vs. elementary school), breastfeeding was more protective for asthma-related symptoms among children from kindergarten. In conclusion, this study shows that breastfeeding is associated with smaller associations between ETS exposure and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of ETS.

Little information is available concerning the association between sleep quality and blood pressure (BP) in Chinese individuals. This study evaluated the association between sleep quality, as determined by the Pittsburgh sleep quality index (PSQI), and hypertension in a rural Chinese population. Using a multistage cluster and random sampling method, a representative sample of 9404 adults aged 20-93 years in northeastern China was selected from 2012 to 2013. Sleep quality was assessed by PSQI, and trained observers measured BP. A sleep disorder (SD) was diagnosed for any participant with a score of 6 or greater. Overall, 1218 male participants (25.53%) and 1261 female participants (27.22%) were defined as having SDs. Compared with the normal subjects, participants with hypertension had higher global PSQI scores and subscores in all elements. The odds ratios (ORs) of hypertension, systolic hypertension and diastolic hypertension among participants with SDs were 2.38 (95% confidence interval (CI): 2.13-2.65), 2.52 (95% CI: 2.26-2.80) and 1.93 (95% CI: 1.74-2.14) in contrast to the reference group, respectively. The risk for hypertension in poor sleepers with subscores over 0 in all of the elements was significantly increased, with ORs ranging from 1.16 (95% CI: 1.04-2.30) to 3.88 (95% CI: 1.24-12.16). The global PSQI score and its components were associated with hypertension and high BP.

Background Little information exists regarding the interaction effects of obesity with long-term air pollution exposure on cardiovascular diseases (CVDs) and stroke in areas of high pollution. The aim of the present study is to examine whether obesity modifies CVD-related associations among people living in an industrial province of northeast China. Methods We studied 24,845 Chinese adults, aged 18 to 74 years old, from three Northeastern Chinese cities in 2009 utilizing a cross-sectional study design. Body weight and height were measured by trained observers. Overweight and obesity were defined as a body mass index (BMI) between 25–29.9 and ≥ 30 kg/m 2 , respectively. Prevalence rate and related risk factors of cardiovascular and cerebrovascular diseases were investigated by a questionnaire. Three-year (2006–2008) average concentrations of particulate matter (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), and ozone (O 3 ) were measured by fixed monitoring stations. All the participants lived within 1 km of air monitoring sites. Two-level logistic regression (personal level and district-specific pollutant level) was used to examine these effects, controlling for covariates. Results We observed significant interactions between exposure and obesity on CVDs and stroke. The associations between annual pollutant concentrations and CVDs and stroke were strongest in obese subjects (OR 1.15–1.47 for stroke, 1.33–1.59 for CVDs), less strong in overweight subjects (OR 1.22–1.35 for stroke, 1.07–1.13 for CVDs), and weakest in normal weight subjects (OR ranged from 0.98–1.01 for stroke, 0.93–1.15 for CVDs). When stratified by gender, these interactions were significant only in women. Conclusions Study findings indicate that being overweight and obese may enhance the effects of air pollution on the prevalence of CVDs and stroke in Northeastern metropolitan China. Further studies will be needed to investigate the temporality of BMI relative to exposure and onset of disease.

Human milk is a unique biological matrix that can be used to estimate exposures in both the mother and the breastfed infant. In addition, the presence of environmental chemicals in human milk may act as a sentinel for exposures to a broader population. Several factors play a role in determining the quantity of chemicals transferred to milk and, subsequently, to the breastfeeding infant, including maternal, infant, and chemical characteristics. Exposure to certain environmental chemicals during critical periods can disrupt normal infant development, yet few data exist to quantify the hazards posed by environmental chemicals in human milk. Chemicals measured in human milk may also provide insights to agents suspect in altering breast development and breast-related disease risk. Carefully designed exposure assessment and toxicokinetic studies are needed to elucidate mechanisms and establish relationships between human milk and other biologic matrices. Data from human milk biomonitoring studies can be used to inform and validate models that integrate information about chemical properties, human metabolism, and biomarker concentrations. Additional research is needed to determine the degree to which environmental chemicals enter, are present in, and are excreted from human milk, their impact on the host (mother), and the extent of their bioavailability to breastfeeding infants. This article describes how the collection and use of exposure data from human milk biomonitoring in the United States can be designed to inform future research and policy.

Concerns regarding human milk in our society are diverse, ranging from the presence of environmental chemicals to the health of breastfed infants and the economic value of breastfeeding to society. The panel convened for the Technical Workshop on Human Milk Surveillance and Biomonitoring for Environmental Chemicals in the United States, held at the Hershey Medical Center, Pennsylvania State College of Medicine, on 24–26 September 2004, considered how human milk research may contribute to environmental health initiatives to benefit society. The panel concluded that infant, maternal, and community health can benefit from studies using human milk biomonitoring. Unlike other biological specimens, human milk provides information regarding exposure of the mother and breastfed infant to environmental chemicals. Some of the health topics relevant to this field of research include disorders of growth and development in infants, cancer origins in women, and characterization of the trend of exposure to environmental...

Data collected in a large epidemiologic study were analyzed to examine respiratory health effects of residential coal use in 7058 school children living in the four Chinese cities of Chongqing, Guangzhou, Lanzhou, and Wuhan. A Scenario Evaluation Approach was used to develop two exposure variables, heating coal smoke and cooking coal smoke. Estimated lifetime exposures to heating coal smoke and cooking coal smoke were both classified into four-level ordinal scales, as follows: no reported exposure (control); lightly exposed; moderately exposed; and heavily exposed. Zero-one dummy variables were constructed for each exposure level other than the control level (total six variables). These variables were entered into the analytical model. We tested for exposure-response relationships using logistic regression models, while controlling for other relevant covariates, including an indicator variable of ambient air pollution levels. We observed monotonic and positive exposure-response relationships of exposure to heating coal smoke with modeled odds ratios (ORs) of phlegm, cough with phlegm, and bronchitis. Other health outcomes were not associated with such exposure in a monotonic exposure-response pattern. However, ORs for cough, wheeze, and asthma were all higher in the exposed groups than in the control group. We observed no consistent associations between cooking coal smoke and the examined health outcomes. We conclude that exposure to heating coal smoke could have adverse effects on children's respiratory symptoms and illnesses in these four Chinese cities.

Nonadherence to asthma medications is associated with increased emergency department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the first goal to meet after the physician and patient have decided to begin treatment. Little is known about first-fill adherence with asthma medications and the factors for no-fill.The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill.This retrospective cohort study linked electronic health records with pharmacy claims. The cohort was comprised of 2023 patients aged 18 years or older who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy copay amount. A logistic-regression model was used to determine covariates associated with first-fill.The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11).SEVERAL FACTORS ASSOCIATED WITH FAILING TO FILL AN INITIAL PRESCRIPTION FOR ASTHMA CAN BE ADDRESSED THROUGH SIMPLE INTERVENTIONS: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control.

Multiple avenues of research (e.g., criminal careers, intergenerational family transmission, and epidemiological studies) have indicated a concentration of antisocial traits and behaviors that cluster among families and within individuals in a population. The current study draws on each of these perspectives in exploring the intergenerational contours of antisocial personality disorder across multiple generations of a large-scale epidemiological sample.The analytic sample of persons meeting criteria for antisocial personality disorder (N = 1,226) was derived from waves I and II of the National Epidemiologic Survey on Alcohol and Related Conditions. Path analytic, latent class, and multinomial models were executed to describe and elucidate family histories among persons diagnosed with antisocial personality disorder.Three classes of an antisocial family tree were found: minimal family history of problem behaviors (70.3 % of sample) who were characterized by higher socioeconomic functioning, parental and progeny behavior problems (9.4 % of sample) who were characterized by criminal behaviors, psychopathology, and substance use disorders, and multigenerational history of problem behaviors (20.3 % of sample) who were characterized by alcoholism, psychopathology, and versatile criminal offending.These findings add a typology to intergenerational studies of antisocial behavior that can assist in identifying etiological and treatment factors among those for whom crime runs in the family.

Perfluorinated compounds (PFCs), such as perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA), are a family of commonly used industrial chemicals whose persistence and ubiquity in blood samples of humans and wildlife have become a growing concern. Despite PFOS and PFOA having been found in human blood and tissue samples from occupationally exposed workers and the general worldwide population, little systematic knowledge has accrued with respect to exposure levels in Uyghurs in the Sinkiang-Uighur Autonomous Region of China, which is predominantly agricultural and pastoral. Our goal was to provide background data for biological monitoring in the general population of this region. In this study, 110 self-reported healthy human serum samples were collected from nonoccupationally exposed Uyghurs volunteers and analyzed by microbore HPLC-electrospray tandem mass spectrometry. Among the 110 blood specimens, PFOS was detected in 102 samples (93 %) and ranged from the lower limit of quantification of 0.01 to 22.63 μg/L with a median of 1.93 μg/L (interquartile range 1.00–3.43 μg/L). The median was higher among males (2.39 μg/L; interquartile range 1.23–4.40 μg/L) than that among females (1.20 μg/L; interquartile range 0.83–2.77 μg/L). No significant difference was observed with respect to age. The concentration of PFOA was lower than that of PFOS and was found only in seven samples (6 %) at concentrations above the limit of quantification. This study is the first investigation to reveal serum PFOS and PFOA levels in the general population of Uyghurs. PFOS and PFOA concentrations found in the present investigation were lower than those found in recent studies consisting of subjects from different geographic locations (PFOS 5.0–44.7 μg/L, PFOA 1.5–10 μg/L).

Background Little is known about the association between air pollution and hypertension among children, and no studies report whether breastfeeding modifies this association in children. Methods Nine thousand three hundred fifty-four Chinese children, ages 5–17 years old, from 24 elementary schools and 24 middle schools in the Seven Northeastern Cities during 2012–2013 were evaluated. The weight, height, and BP were measured. Four-year average concentrations of particles with an aerodynamic diameter of ≤10μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), ozone (O 3 ), and carbon monoxide (CO) were calculated from monitoring stations. Two-level regression analysis was used to examine the effects, controlling for covariates. Results The results showed that associations existed between hypertension and pollutants. The odds ratios for hypertension ranged from 1.12 per 46.3μg/m 3 increase for O 3 (95% confidence interval [CI], 1.10–1.13) to 1.68 per 30.6μg/m 3 increase for PM 10 (95% CI, 1.53–1.86). The increases in mean diastolic BP ranged from 0.58mm Hg per 46.3μg/m 3 increase for O 3 (95% CI, 0.52–0.63mm Hg) to 2.89mm Hg per 563.4μg/m 3 increase for CO (95% CI: 2.53–3.24mm Hg). The increase in systolic BP ranged from 0.50mm Hg per 46.3μg/m 3 increase for O 3 (95% CI: 0.43–0.57mm Hg) to 2.10mm Hg per 30.6μg/m 3 increase for PM 10 (95% CI, 1.73–2.47mm Hg). Compared with children who had been breastfed, non-breastfed children exhibited consistently stronger effects. Conclusion Study findings indicate that high levels of PM 10 , SO 2 , NO 2 , O 3 , and CO are associated with increased arterial BP and hypertension among the children. Breastfeeding may reduce the risk.

The field data collection of an air pollution epidemiologic study was carried out from 1993 to 1996 in four Chinese cities of Lanzhou, Chongqing, Wuhan, and Guangzhou. In each city, an urban district and a suburban district were selected. Ambient concentrations of total suspended particles (TSP), size-fractionated particulate matter including PM2.5, PM2.5-10, and PM10, sulfur dioxide (SO2), and oxides of nitrogen (NOx) were measured in these districts. The results indicate the presence of wide inter-city and intra-city gradients in long-term ambient levels of these measured pollutants. Across the eight districts, the 1993-1996 4-year means of TSP, SO2, and NOx ranged from 198 to 659 microg/m3, from 14.6 to 331 microg/m3, and from 31.5 to 239 microg/m3, respectively, and the 1995-1996 2-year means of PM2.5, PM2.5-10, and PM10 ranged from 51.5 to 142 microg/m3, from 29.2 to 107 microg/m3, and from 80.7 to 232 microg/m3, respectively. These pollution ranges substantially extended the upper end of the pollution ranges of previous air pollution epidemiologic studies conducted in North America and Europe. In each district, significant correlations among the measured pollutants were observed for daily concentrations. However, the gradient patterns in long-term means of different pollutants were different across the eight districts. (e.g., PM2.5-10 and TSP were highest in the Lanzhou urban district, PM2.5 and PM10 were highest in the Guangzhou urban district, SO2 was highest in the Chongqing urban district, and NOx was highest in the Guangzhou urban district). In general, seasonal variations were present in the ambient concentrations with high levels often occurring in winter months. The eight districts may be classified into four district clusters based on integrated levels of all measured pollutants. These features of the ambient air pollution have important implications for epidemiological studies and may provide unique opportunities to study exposure-effects relationships in the four Chinese cities.

Crosstalk between printed circuit board (PCB) traces in switching power supplies may cause high electromagnetic interference emission. PCB layout plays an important part and a genetic algorithm (GA) is used to produce a layout with reduced crosstalk. A coupling index and a new way of representing a trace for the GA process is presented.

During the winter of 1988--1989, parents of 2,789 elementary-school students completed standardized questionnaires. The students were 5--14 y of age and were from three urban districts and one suburban district of three large Chinese cities. The 4-y average ambient levels of total suspended particles in the three cities differed greatly during the period 1985--1988: Lanzhou, 1,067 {micro}g/m{sup 3}; urban Wuhan, 406 {micro}g/m{sup 3}; Guangzhou, 296 {micro}g/m{sup 3}; and suburban Wuhan, 191 {micro}g/m{sup 3}. The authors constructed unconditional logistic-regression models to calculate odds ratios and 95% confidence intervals for prevalences of several respiratory symptoms and illnesses, adjusted for district, use of coal in the home, and parental smoking status. There was a positive and significant association between total suspended particle levels and the adjusted odds ratios for couch, phlegm, hospitalization for diseases, and pneumonia. This association was derived from only the 1,784 urban children and, therefore, the authors were unable to extrapolate it to the suburban children. The results also indicated that parental smoking status was associated with cough and phlegm, and use of coal in the home was associated only with cough prevalence.

Although several studies have documented that latitude might be an effect modifier of the association between temperature and mortality, little is known about how much latitude modifies the temperature–mortality relationship. In this study, we examined this research question using a distributed lag non-linear model and meta-regression analysis based on data from 13 large cities of eastern US from the US National Morbidity, Mortality, and Air Pollution Study. We found that cold effects lasted about 1 month while hot effects were acute and short-term. Meta-regression analysis showed that latitude modified both the cold and hot effects with statistical significance. The cold effect decreased with the latitude increment, with −0.11 % change of mortality effect for 1° increment, while the hot effect increased with the latitude increment, with 0.18 % change of mortality effect for 1° increment. This finding indicates the importance of latitude on temperature-related mortality risk, which is helpful for city to develop localized effective adaptation strategy in the context of climate change.

Objective To translate and validate the Sleep Disturbance Scale for Children (SDSC), a promising questionnaire for use among children in epidemiological studies, in Chinese children. Methods In total, 3525 children aged 5–16years were randomly selected from five primary schools in Shenyang. Internal consistency, reliability and factor analyses were undertaken to assess the construct validity of the SDSC. Results Internal consistency indicated adequate reliability (Cronbach's α =0.81). Factor analytic results indicated a six-factor solution (ie, six types of sleep disorder) based on parent-reported sleep disorder symptoms. The mean total score of the SDSC was 39.28±7.83 and 156 (4.43%) children were identified as suffering from parent-reported sleep disorder. The prevalence for each sleep type disorder ranged from 3.46% to 6.30% with the highest for sleep hyperhidrosis (SHY) and the lowest for disorders of initiating and maintaining sleep. Significant differences were found between boys and girls in the prevalence of sleep breathing disorders (6.51% vs 3.72%), SHY (8.62% vs 4.00%) and parent-reported sleep disorders (5.19% vs 3.67%). Conclusions The SDSC is reliable and useful in screening for parent-reported sleep disorders in Chinese children. Compared with other countries, parent-reported sleep disorders among Chinese elementary school children were at a relatively low level of prevalence.

Background Few studies have assessed the impact of residential home characteristics and home environmental risk factors on respiratory diseases in Chinese women. Therefore, this study sought to determine the association between residential home features, domestic pets, home renovation and other indoor environmental risk factors with respiratory health outcomes of Chinese women. Methods This cross-sectional study included a study sample of 30,780 Chinese women aged 23 to 49 from 25 districts of seven cities in Liaoning Province, Northeast China. Information on respiratory health, residential characteristics, and indoor air pollution sources was obtained by a standard questionnaire from the American Thoracic Society. Multivariable logistic regression was used to estimate prevalence odds ratios (POR) and 95% confidence interval (95%CI). Results The odds of respiratory diseases were higher for those who lived near the main road, or near ambient air pollution sources. Pet-keeping was associated with increased odds of chronic bronchitis (POR = 1.40; 95%CI: 1.09–1.81) and doctor-diagnosed asthma (POR = 2.07; 95%CI: 1.18–3.64). Additionally, humidifier use was associated with increased odds of chronic bronchitis (POR = 1.44; 95%CI: 1.07–1.94). Home renovation in recent 2 years was associated with increased likelihood of allergic rhinitis (POR = 1.39; 95%CI 1.17–1.64). Conclusion Home renovation and residential home environmental risk factors were associated with an increased likelihood of respiratory morbidity among Chinese women.

The authors regret the misspelling of co-author ‘Kahee A. Mohammed’. The authors would like to apologise for any inconvenience caused.

Although the health effects of ambient ozone have been widely assessed, their tempo-spatial variations remain unclear. We selected 20 communities (ten each from southern and northern USA) based on the US National Morbidity, Mortality, and Air Pollution Study (NMMAPS) dataset. A generalized linear model (GLM) was used to estimate the season-specific association between each 10 ppb (lag0-2 day average) increment in daily 8 h maximum ozone concentration and mortality in every community. The results showed that in the southern communities, a 10 ppb increment in ozone was linked to an increment of mortality of −0.07%, −0.17%, 0.40% and 0.27% in spring, summer, autumn and winter, respectively. For the northern communities, the excess risks (ERs) were 0.74%, 1.21%, 0.52% and −0.65% in the spring, summer, autumn and winter seasons, respectively. City-specific ozone-related mortality effects were positively related with latitude, but negatively related with seasonal average temperature in the spring, summer and autumn seasons. However, a reverse relationship was found in the winter. We concluded that there were different seasonal patterns of ozone effects on mortality between southern and northern US communities. Latitude and seasonal average temperature were identified as modifiers of the ambient ozone-related mortality risks.