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Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health., This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). Y.W and B.W. were supported by the China Scholarship Council (nos. 202006010044 and 202006010043); S.L. was supported by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council (no. APP2009866); Y.G. was supported by Career Development Fellowship (no. APP1163693) and Leader Fellowship (no. APP2008813) of the Australian National Health and Medical Research Council; J.K. and A.U. were supported by the Czech Science Foundation (project no. 20–28560S); N.S. was supported by the National Institute of Environmental Health Sciences-funded HERCULES Center (no. P30ES019776); Y.H. was supported by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; M.d.S.Z.S.C. and P.H.N.S. were supported by the São Paulo Research Foundation (FAPESP); H.O. and E.I. were supported by the Estonian Ministry of Education and Research (IUT34–17); J.M. was supported by a fellowship of Fundação para a Ciência e a Tecnlogia (SFRH/BPD/115112/2016); A.G. and F.S. were supported by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU’s Horizon 2020 project, Exhaustion (grant ID 820655); A.S. and F.d.D. were supported by the EU’s Horizon 2020 project, Exhaustion (grant ID 820655); V.H. was supported by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017–046); and A.T. by MCIN/AEI/10.13039/501100011033 (grant CEX2018-000794-S). Statistics South Africa kindly provided the mortality data, but had no other role in the study.

Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality association, indicating long-term adaptation to local climate. Limited evidence about the geographical variability of the MMT is available at a global scale.

Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991–2018. Across all study countries, we find that 37.0% (range 20.5–76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change., We thank the participants of the ISIMIP Health workshop in Barcelona in November 2018 where this work was discussed for the first time. This study was supported by the Medical Research Council UK (grant no. MR/M022625/1), the Natural Environment Research Council UK (grant no. NE/R009384/1) and the European Union’s Horizon 2020 Project Exhaustion (grant no. 820655). N.S. was supported by the NIEHS-funded HERCULES Center (P30ES019776). Y.H. was supported by the Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency, Japan (JPMEERF15S11412). J.J.J.K.J. was supported by Academy of Finland (grant no. 310372). V.H. was supported by the Spanish Ministry of Economy, Industry and Competitiveness (grant no. PCIN-2017-046) and the German Federal Ministry of Education and Research (grant no. 01LS1201A2). J.K. and A.U. were supported by the Czech Science Foundation (grant no. 20-28560S). J.M. was supported by the Fundação para a Ciência e a Tecnologia (FCT) (SFRH/BPD/115112/2016). S.R. and F.d.R. were supported by European Union’s Horizon 2020 Project EXHAUSTION (grant no. 820655). M.H. was supported by the Japan Science and Technology Agency as part of SICORP, grant no. JPMJSC20E4. Y.G. was supported by the Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). S.L. was support by the Early Career Fellowship of the Australian National Health and Medical Research Council (APP1109193). Y.L.L.G. was supported by the Taiwan Ministry of Science and Technology (MOST110-2918-I-002-007) as a visiting academic at the University of Sydney.

Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PMFor this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/mShort-term exposure to wildfire-related PMAustralian Research Council, Australian National HealthMedical Research Council.

Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

Summary Background Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. Methods For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000–16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. Findings 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0–2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016–1·022) for all-cause mortality, 1·017 (1·012–1·021) for cardiovascular mortality, and 1·019 (1·013–1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48–0·75) of all-cause deaths, 0·55% (0·43–0·67) of cardiovascular deaths, and 0·64% (0·50–0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period., Australian Research Council, Australian National Health & Medical Research Council.

Summary Background Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. Methods DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985–2015) and future (2020–99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. Findings The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by −0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4–10·3% in 2090–99. Interpretation This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health.

Background: Various retrospective studies report that a higher diurnal temperature range (DTR) increases mortality risk. This study projects the impact of DTR on future mortality across 445 communities in 20 countries. Methods: We first estimated the DTR-related mortality risk based on the historical daily time-series of mortality and of weather factors from 1985 to 2015. Next, we projected the excess deaths attributable to the DTR during the current (1985–2015) and future (2020–2099) periods using daily DTR series under four climate-change scenarios. We then calculated the future excess deaths based on two assumptions: warmer temperatures affect or do not affect the DTR-mortality risk. Findings: DTR was associated with excess mortality in our time-series analyses. Under the unmitigated scenario, the future average DTR is projected to increase in most countries (-0·4–1·6 °C), and the increasing pattern was more evident in the United States, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased with an increasing average temperature. Based on the positive interactive effect between DTR and temperature, the DTR-related excess deaths are projected to increase in all countries (1·4–10·3%) in 2090–2099. Interpretation: This study suggests that the DTR-related excess mortality may increase globally under climate change, and this increasing pattern may vary between countries. Our findings can contribute to both international and regional public health interventions to reduce the DTR impacts on health under climate change. Funding Statement: Ho Kim is supported by the Korea Ministry of Environment via the “Climate Change Correspondence Program” (2014001310007). Declaration of Interests: All authors report no financial relationships with commercial interests.

Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3–2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1–2.7%) to 2.7% (2.4–2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health. Keywords: Diurnal temperature range, Attributable mortality risk fraction, Time-varying effect, Climate change

There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature.We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset.In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques.Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly.The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.

BACKGROUND: There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. OBJECTIVES: We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. METHODS: In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. Cityspecific associations were summarized using meta-analytic techniques. RESULTS: Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1–3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. DISCUSSION: The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430. © 2019, Public Health Services, US Dept of Health and Human Services. All rights reserved., B.A. was supported by the UK National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Change and Health; A.G., F.S., and A.V.C. were supported by grants from the UK Medical Research Council (grant IDs: MR/M022625/1, MR/R013349/1) and from the UK Natural Environment Research Council (grant ID: NE/R009384/1); and M.L.B. was supported by Assistance Agreement No. 83587101 awarded by the U.S. Environmental Protection Agency and R01 MD012769 awarded by the U.S. National Institutes of Health. Y.G. was supported by the Career Development Fellowship of Australian National Health and Medical Research Council (APP1107107). A.T. was supported by the Japanese Society for the Promotion of Science (JSPS) Invitational Fellowships for Research in Japan (S18149). Y.L.G. was supported by NHRI-105-EMSP09 from National Health Research Institutes, Taiwan. H.O. and E.I. were supported by Ministry of Education and Research (Estonia) grant IUT34-17. J.K. and A.U. were supported by the Czech Science Foundation, grant 18-22125S. H.K., M.H., and Y.H. were supported by the Global Research Lab (#K21004000001-10A0500-00710) through the National Research Foundation of Korea. M.H. and Y.H. were supported by the Environment Research and Technology Development Fund (S-14) of the Environmental Restoration and Conservation Agency.

An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010–2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (−0.92%p/°C) and Australia (−0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population. © 2019, This study was supported by the Global Research Lab (# K21004000001-10A0500-00710 ) through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT (Information and Communication Technologies), and Future Planning. JL was supported by the National Research Foundation of Korea as NRF-SNSF Researcher Exchange Program ( NRF-2018K2A9A1A06086694 ). AG was supported by Medical Research Council UK (Grant ID: MR/M022625/1 ) and Natural Environment Research Council UK (Grant ID: NE/R009384/1 ). JK and AU were supported by the Czech Science Foundation , project no. 18-22125S . HO and EI were supported by the Estonian Ministry of Education and Research (Grant no IUT34-17 ). JJKJ and NRIR were supported by the Research Council for Health, Academy of Finland (Grant no 266314 and 310372 ). MH and YH were supported by the Environment Research and Technology Development Fund (S-14) of the Environmental Restoration and Conservation Agency . AT was supported by the Japan Society for the Promotion of Science (JSPS) Invitational Fellowships for Research in Japan ( S18149 ). Appendix A

Modern populations spend the majority of their time indoors. For the most active working age population, the fraction of time spent indoors is around 85%, whereas for small children and the sedentary elderly the figure approaches 100%. Indoor air is, of course, particularly affected by indoor sources. Nevertheless, outdoor air is a significant contributor to indoor levels of the main classical air pollutants such as ultrafine and fine particles and nitrogen oxides, and often the only source of others such as ozone and sulfur dioxide. Indoor air quality is created by complex processes that involve outdoor air, ventilation, building tightness, filtration, mixtures of pollution, occupant behaviour and indoor emission sources ranging through building materials, soil, occupants, and customer products and appliances used in the building. The literature shows convincingly that the role played by outdoor air is probably the most significant single factor at the population level. In developed countries, the building stock is relatively well insulated, affecting the air exchange rates and infiltration processes. This chapter presents an overview of recent evidence on infiltration rates of outdoor air pollution and processes that affect them.

Introduction: Evidence-based patient stratification is required to address the hetergeneity of asthma severity. Detailed physiological profiling of symptomatic patients is important and of increasing interest in airway microbiome studies. Aims and objectives: Detailed high quality physiological parameters were recorded from lung function tests in subjects included in an airway microbiome study. Subjects underwent testing in order to build individual physiological profiles and categorise the subjects into control, asthma and airway hyperresponsive groups. Methods: 48 adult subjects (17 controls, 31 patients) performed spirometry, lung volumes and diffusing capacity tests. Asthma was confirmed by significant bronchodilator response (BDR). Airway Hyperresponsiveness (AHR) was confirmed by a positive methacholine challenge test. Profiling also included end tidal carbon dioxide (etCO2), fraction of exhaled Nitric Oxide (FeNO) and skin prick allergy tests. Results: Prelimary data shows that patients were classified as asthma (15) or AHR (16). AHR was categorised into borderline (6), mild (5), moderate (5) subgroups. Significant difference in atopy status was observed in controls versus asthma/AHR groups (31.3% vs 87.5%). Largest incidence of atopy was observed in the mild and moderate hyperresponsive subgroups (100%). No significant gender differences in atopy were observed. FeNO was significantly elevated in the asthma group and the moderate AHR subgroups compared to controls (p=0.03) Conclusions: Using detailed classification there was significant separation between controls and sub categories of asthma and airway hyperresponsiveness profiles.

Introduction: Barrett’s Esophagus (BE), a condition of intestinal metaplasia of the oesophagus is associated with an increased risk of esophageal adenocarcinoma (EAC). Patients with OSA & BE share risk factors including: obesity, reflux, older age, and male gender. Patients added to a clinical database in the previous 12 months were invited to participate. Methods: Male patients (18-70 yrs) completed the following screening procedures: Anthropometric measurements; Sleep assessment: Epworth Score (ESS) & Polysomnography (AASM criteria); Prevalence of Metabolic Syndrome (MetS) was estimated with the International Diabetes Federation criteria. Results: Of the first 69 subjects screened, OSA (AHI ›5) was detected in 77% of the group with a median ESS for all subjects of 4. Moderate to Severe OSA was present in 47% of subjects with a median ESS of just 6. MetS was detected in 42% of all screened. Subjects with MetS tended to show higher: AHI (10 versus 15.4), BMI, Neck & Waist Circumference & resting blood pressure (p Conclusions: Latent or subclinical OSA was common in these patients with BE in the absence of significant daytime symptoms or excessive sleepiness. The presence of comorbid MetS correlated with more severe OSA and a worsening of several baseline medical parameters. Studies will be designed to assess the benefit of CPAP intervention in these non-sleepy subjects.

The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to hold warming well below 2 degrees C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 degrees C. The 1.5 degrees C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 degrees C) and more extreme GMT increases (3 and 4 degrees C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 degrees C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 degrees C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.

Background: Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited. Methods and findings: We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave–mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971–2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031–2080 compared with 1971–2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections. Conclusions: This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change. © 2018 Guo et al. http://creativecommons.org/licenses/by/4.0/., We thank relevant institutes/agencies who provided data on mortality and weather conditions.

Legislation controlling vehicle emissions has been credited with a general downward trend in NOx (NO2+NO) concentrations in Europe since the 1990's. However, recent studies suggest that traffic (roadside) (TR) NO2 concentrations have not decreased as expected, and in some cases increased, most likely due to the use of oxidation catalysts and particle filters in diesel vehicles (EURO III, IV, V, VI). In this study we describe the time trends in NOx, NO2 and NO concentrations in 9 European cities comparing TR and urban background (UB) monitoring locations. In each city, we collected hourly city-specific NOx, NO, and NO2 data from one TR and one UB monitoring site for each year. We describe hourly, weekly, seasonal and inter-annual patterns for periods corresponding to the implementation dates of various EURO vehicle emission standards regulating NOx emissions. The diurnal patterns in all 9 cities strongly reflected morning and evening traffic. In addition, lower weekend concentrations were observed. The NOx concentrations from the TR sites remain unchanged in the majority of the cities over the study period. When stratified by 3 time periods according to the implementation of the EURO standards, an increasing NO2/NOx ratio in 7/9 cities with time was noted. However, over the same time period the NO/NO2 ratio decreased in 8/9 cities. A permanent inversion of the NO/NO2 ratio was observed to occur in 2003 in 5/9 cities. Our analyses of temporal and diurnal patterns of NOx in European cities show reductions in concentrations consistent with reductions in primary emissions likely arising from the implementation of successive EURO standards. The generally constant or increasing NO2 concentrations in the majority of the cities assessed over the study period underline the need of further regulative measures to meet the air quality standards and consequently to minimise adverse effects on human health. The ongoing collection and analysis of pollution concentrations across the EU is recommended to monitor trends in pollutants associated with adverse health effects.

Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization.

Introduction Barrett9s Esophagus (BE), a condition of intestinal metaplasia of the oesophagus is associated with an increased risk of esophageal adenocarcinoma (EAC). Patients with OSA share risk factors with patients with BE including: obesity, reflux, older age, and male gender. Patients added to a detailed clinical database in the previous 12 months were invited to participate in this study. Methods Male patients (18 - 70 yrs old) completed the following screening procedures: Anthropometric measurements; Sleep assessment - sleep questionnaires with Epworth Score (ESS); Polysomnography (AASM criteria); Prevalence of Metabolic Syndrome (MetS) was estimated with the International Diabetes Federation criteria. Results Of the first 40 subjects screened 32 (80%) had significant OSA (AHI ›5) with 22 (53%) falling in the moderate to severe category. Subjects with OSA tended to be 10 years older (p Conclusions Subclinical OSA was common in these patients with BE in the absence of significant daytime symptoms of excessive sleepiness. The severity of OSA correlated with the severity of MetS. Studies will be designed to assess the benefit of CPAP intervention in these patients.

Background: Few studies have examined variation in the associations between heat waves and mortality in an international context. Objectives: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. Methods: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave–mortality relation over lags of 0–10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Results: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave–mortality associations, but not daily minimum temperature. Conclusions: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. Medical Research Council, UK

BACKGROUND: In many places, daily mortality has been shown to increase after days with particularly high or low temperatures, but such daily time-series studies cannot identify whether such increases reflect substantial life shortening or short-term displacement of deaths (harvesting). OBJECTIVES: To clarify this issue, we estimated the association between annual mortality and annual summaries of heat and cold in 278 locations from 12 countries. METHODS: Indices of annual heat and cold were used as predictors in regressions of annual mortality in each location, allowing for trends over time and clustering of annual count anomalies by country and pooling estimates using meta-regression. We used two indices of annual heat and cold based on preliminary standard daily analyses: a) mean annual degrees above/below minimum mortality temperature (MMT), and b) estimated fractions of deaths attributed to heat and cold. The first index was simpler and matched previous related research; the second was added because it allowed the interpretation that coefficients equal to 0 and 1 are consistent with none (0) or all (1) of the deaths attributable in daily analyses being displaced by at least 1 y. RESULTS: On average, regression coefficients of annual mortality on heat and cold mean degrees were 1.7% [95% confidence interval (CI): 0.3, 3.1] and 1.1% (95% CI: 0.6, 1.6) per degree, respectively, and daily attributable fractions were 0.8 (95% CI: 0.2, 1.3) and 1.1 (95% CI: 0.9, 1.4). The proximity of the latter coefficients to 1.0 provides evidence that most deaths found attributable to heat and cold in daily analyses were brought forward by at least 1 y. Estimates were broadly robust to alternative model assumptions. CONCLUSIONS: These results provide strong evidence that most deaths associated in daily analyses with heat and cold are displaced by at least 1 y. https://doi.org/10.1289/EHP1756.

Background: Regression of the residual sac is indicative of successful endovascular aortic aneurysm (EVAR) repair. Using color duplex ultrasound (CDU), we monitored the residual aneurysm sac following EVAR and correlated sac behavior with perioperative risk factors. Methods: Of 145 patients with EVAR, 106 (73.1%) patients between January 01, 2003, and July 01, 2010, had at least 2 consecutive postoperative scans and thus were eligible for inclusion. Mean (± standard deviation [SD]) CDU scans per person was 4.6 (±1.4). All were conducted by the same technologist using a standard protocol on the same machine. Aneurysm sac change in centimeters and percentage terms was calculated. The presence or absence of an endoleak was also recorded. Change in aneurysm sac size was correlated with preoperative risk factors. Findings: Mean sac size change at 1 month was a decrease of 0.24 cm, equating to a percentage change of 4.3%. At 7 months, the decrease was 0.59 cm (9.8%), at 12 months, 0.73 cm (12.4%), at 18 months 0.92 cm (15.8%), and at 36 months 1.0 cm (16.6%). Both univariate and multivariate analyses demonstrated that statin therapy ( P = .002) was the only risk factor variable positively associated with aneurysm regression while the presence of an endoleak was inversely related to sac reduction ( P = .01). Interpretation: Maximum aneurysmal sac reduction seems to occur in the first year following endograft implantation. Statin therapy appears to be associated with an increased likelihood of sac regression following EVAR. Further investigation of the role of statins in the biology of abdominal aortic aneurysmal disease is warranted.

Climate change enhances the vulnerability of Ireland to extreme weather events in terms of potential adverse health impacts. To examine this, the mortality impacts of heatwaves between 1981 and 2006 were analysed, with particular reference to potential differences occurring between urban and rural areas. Heatwaves were identified during five summers: 1983, 1984, 1995, 2003 and 2006. Episodes in the 1980s were seen to have had a greater impact, especially July 1983, with 115 excess deaths recorded in rural areas. Only 14 excess deaths were reported in 2006 and none in 2003. Overall, 294 excess deaths were attributed to heatwaves. Heat is a moderate but real risk in Ireland. In the future, with climate change and the ageing of the population, it may be that more severe heat episodes will result in a larger mortality burden. It is recommended that the relevance of setting up an appropriate heat prevention plan should be considered in Ireland.

Background: Barrett9s esophagus (BE) arising from chronic gastro-oesophageal reflux is the main pathologic precursor of esophageal adenocarcinoma (EAC). Features of BE in common with OSA include male sex, elevated body mass index and intra-abdominal fat. A detailed database with clinical, endoscopic, and pathologic data was established in this center and patients that were added to it in the previous 12 months were invited to participate. Aim: To determine if OSA is a common finding in patients with BE. Methods: Male volunteers were recruited from the BE database and completed the following: screening for Metabolic Syndrome (MetS), interview with questionnaires (Epworth, STOP-BANG) and a home-setup full Polysomnography. Sleep Studies were manually scored to determine the Apnoea Hypopnea Index (AHI). Results: The first 30 males to successfully complete screening procedures were included in this study. Mean: Age 41 (Range 35-69), BMI:53±6.8, Waist Circumference 103±11, Epworth Score 5±4, AHI 16±15. 80% of those screened had OSA (AHI >5): 37% Mild (n=11), 30% Moderate (n=9), 13% Severe (n=4). Excessive Daytime Sleepiness (EDS) found in 13% (n=4). Prevalence of MetS was 40% using the International Diabetes Federation definition with 92% (n=11) of MetS incidences occurring in those with OSA. Conclusion: OSA was a very common finding in this group despite the low level of reported daytime sleepiness. The incidence of MetS was twice as high as population studies. OSA is associated with increased risk of CVD and BE with the development of EAC. This raises the question as to whether CPAP will be of benefit in this cohort.

Objectives: The initial survival advantage seen with endovascular aneurysm repair (EVAR) over open repair does not persist in the long term. Pulse wave velocity (PWV) is a measure of arterial stiffness, and increased PWV is an independent risk factor for increased cardiovascular morbidity and mortality. This prospective comparative pilot study examined the effect of implantation of an aortic graft on PWV in patients undergoing open or endovascular aortic aneurysm repair. Patients and Methods: Thirty-four patients (15 open and 19 EVAR) were recruited. Patient demographics were similar in both the groups. Pulse wave velocity was calculated for all patients preoperatively and postoperatively using a standardized technique on a Philips IU22 Vascular Ultrasound machine and the results compared. Results: An increase in mean PWV following EVAR was demonstrated. The mean postprocedure PWV of 9.7 (± 4.5) cm/sec detected in the open group was significantly lower than the elevated 12.2 (± 4.5) cm/sec detected in the EVAR group. The surgical group also demonstrated a mean decrease of 0.2 (± 4.9) cm/sec in PWV following open repair compared to a mean increase of 3.3 (± 3.7) cm/sec in the EVAR group. Conclusion: EVAR patients have a significantly higher postoperative PWV measurement than those undergoing open abdominal aortic aneurysm repair. Patients who have undergone EVAR may be at a higher risk of cardiovascular morbidity in the long term. A larger scale study with a longer prospective follow-up is required.

PurposeOlder people are vulnerable to fuel poverty on the island of Ireland. This paper seeks to explore the lived experiences of older people in cold weather with a view to informing fuel poverty policy and service responses.Design/methodology/approachA postal and online survey utilising an opportunistic sample of older people living in Ireland and linked with a range of services/community and voluntary groups was undertaken in January‐April 2011. Data on the experiences of 722 older people in the cold weather of winter 2010/2011 were analysed in the context of socio‐economic, health, and housing circumstances.FindingsDuring the period of extreme cold weather half of the sample reported that they went without other household necessities due to the cost of home‐heating. In general, 62 per cent of those surveyed worried about the cost of home‐heating. Homes considered “too cold” were more likely to lack central heating and experience damp/draughts. Staying indoors, keeping the heating on, and eating hot food/drinks were common responses to cold weather but a diverse range of behaviours was observed. Associations were observed between living in a cold home and higher levels of chronic illness, falls and loneliness, and fewer social activities.Research limitations/implicationsThe sample cannot be considered nationally representative; single occupancy and social housing units were overrepresented.Originality/valueThis research found significant associations between living in a cold home/difficulty paying for heating, and aspects of ill‐health and social exclusion. While no causal association can be assumed, this phenomenon has implications for policies supporting healthy ageing.

Background. In 2004, the Irish Government introduced national legislation banning smoking in workplaces; with exemptions for “a place of residence”. This paper summarises three Irish studies of exempted premises; prisons, psychiatric hospitals and nursing homes. Methods. PM2.5 and nicotine were measured in nursing homes and psychiatric hospitals, in addition to ultrafine particles in the hospitals. In the prisons, officers (𝑛=30) completed exhaled breath Carbon Monoxide (CO) measurements. Questionnaires determined officers’ opinion on introducing smoking prohibitions in prisons. Nursing home smoking policies were examined and questionnaires completed by staff regarding workplace secondhand smoke (SHS) exposure. Findings. Ultrafine particle concentrations in psychiatric hospitals averaged 130,000 per cm3, approximately 45% higher than Dublin pub levels (85,000 per cm3) pre ban. PM2.5 levels in psychiatric hospitals (39.5 μg/m3) were similar to Dublin pubs (35.5 μg/m3) pre ban. In nursing homes permitting smoking, similar PM2.5 levels (33 μg/m3) were measured, with nicotine levels (0.57 μg/m3) four times higher than “non-smoking” nursing homes (0.13 μg/m3). In prisons, 44% of non-smoking officers exhibited exhaled breath CO criteria for light to heavy smokers. Conclusions. With SHS exposure levels in some exempted workplaces similar to Dublin pubs levels pre ban, policies ensuring full protection must be developed and implemented as a right for workers, inmates and patients.

Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever), using the Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. ISAAC is a cross-sectional self-administered questionnaire survey of randomly selected representative post-primary schools. Children aged 13–14 years were studied: 2,670 (in 1995), 2,273 (in 1998), 2,892 (in 2002–2003), and 2,805 (in 2007). Generalized linear modelling using Poisson distribution was employed to compute adjusted prevalence ratios (PR). A 39% significant increase in symptoms of severe asthma was estimated in 2007 relative to the baseline year 1995 (adjusted PR: 1.39 [95% CI: 1.14–1.69]) increasing from 12% in 1995 to 15.3% in 2007. Opposite trends were observed for allergies, showing a decline in 2007, with an initial rise. The potential explanations for such a complex disease pattern whose aetiological hypothesis is still evolving are speculative. Changing environmental factors may be a factor, for instance, an improvement in both outdoor and indoor air quality further reinforcing the hygiene hypothesis but obesity as a disease modifier must also be considered.

Second-hand smoke (SHS) is a major avoidable cause of developmental and respiratory disease and premature death among children worldwide. SHS is a ‘Class A’ carcinogen, and there is no safe level of SHS exposure. Almost 700 million children worldwide are exposed daily to SHS at home. This article reviews and summarizes evidence based on available studies that report on ‘voluntary’ home smoking restrictions and their effects on SHS exposure levels in children aged 0–17 years. All potentially relevant publications within a 10-year period (January 2000–April 2010) were identified (n = 19 full-text articles) through comprehensive database searches. In general, voluntary household smoking restrictions reported a significant reduction in childhood SHS exposure ranging between 20–50% reductions, using both self-reported and biological measures. Mandated comprehensive workplace and enclosed public smoke-free policies also suggested an apparent benefit in some specific pediatric health encounters, namely, decreased preterm birth risks and reduced emergency hospital visits owing to asthma.

Introduction. Maximum diameter of an abdominal aortic aneurysm (AAA) is the main indication for surgery. This study compared colour duplex ultrasound (CDU) and computed tomography (CT) in assessing AAA diameter.Patients and Methods. Patients were included if they had both scans performed within 90 days. Pearson’s correlation coefficient, pairedt-test, and limits of agreement (LOA) were calculated for the whole group. Subgroup analysis of small (6.5 cm) aneurysms was performed. APvalue of Results. 389 patients were included, giving 130 pairs of tests for comparison. Excellent correlation was in the whole group (r= 0.95) and in the subgroups (r= 0.94; 0.69; 0.96, resp.). Small LOA between the two imaging modalities was found in all subgroups.Conclusion. Small aneurysms can be accurately measured using CDU. CDU is preferable for small AAAs, but cannot supplant CT for planning aortic intervention.

This article has been made available through the Brunel Open Access Publishing Fund. Background: Consistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities. Methods: Census data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000–2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages ≥35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results: Post-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death. Conclusions: Overall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality.

Background and aims: Cold weather is shown to impact mortality and morbidity, with effects persisting from several days to weeks. This study aimed to assess prolonged effects of cold temperature on...

Introduction CT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy. Patients & methods Postoperative surveillance CTs and CDUS scans in the 145 patients who have undergone EVAR from 1st June 2003 to 1st July 2010 were compared for the detection of endoleak and determination of residual sac size. Results Adopting a protocol where CDUS was employed as the first line surveillance tool following EVAR would result in a reduction in the number of postoperative CTs required in 2010 from 235 to 36. Based on 2010 costings, this would equate to an estimated reduction in expenditure from €117,500 to €34,915 a saving of €82,585. CDUS had a sensitivity of 100% and a specificity of 85% in the detection of endoleaks compared to CT. The positive predictive value was 28% and negative predictive value 100%. The Pearson Coefficient correlation of 0.96 indicates a large degree of correlation between CDUS and CT when measuring residual aneurysm size following EVAR. Conclusion CDUS can replace CT as the first line surveillance tool following EVAR. This is associated with a significant reduction in the cost of surveillance without any loss of imaging accuracy.

Background and Aims: The implementation of three EU directives to reduce sulphur content in fuel was assessed for mortality impacts in 20 European cities, between 1990 and 2007 in the APHEKOM proje...

Background and Aims: Intervention studies play an important role in supporting and complementing scientific validation of results of epidemiological non-intervention studies linking air pollution a...

Background and aims: Animal studies and a few epidemiological investigations suggest a causal role of local traffic-related air pollution in the development of chronic cardiovascular pathologies su...

Numerous epidemiological studies have found a link between air pollution and health. We are reviewing a collection of published intervention studies with particular focus on studies assessing both improvements in air quality and associated health effects.Interventions, defined as events aimed at reducing air pollution or where reductions occurred as a side effect, e.g. strikes, German reunification, from the 1960s onwards were considered for inclusion. This review is not a complete record of all existing air pollution interventions. In total, 28 studies published in English were selected based on a systematic search of internet databases.Overall air pollution interventions have succeeded at improving air quality. Consistently published evidence suggests that most of these interventions have been associated with health benefits, mainly by the way of reduced cardiovascular and/or respiratory mortality and/or morbidity. The decrease in mortality from the majority of the reviewed interventions has been estimated to exceed the expected predicted figures based on the estimates from time-series studies.There is consistent evidence that decreased air pollution levels following an intervention resulted in health benefits for the assessed population.

OBJECTIVE: This study hypothesised a continual decline in current smoking prevalence over four calendar years (1995, 1998, 2002/03 and 2007) and no significant increase in second-hand-smoke (SHS) exposure levels at home after the workplace smoking ban of March 2004 (2007 versus 2002/03 survey) among Irish school children. METHODS: A modified ISAAC (International Study of Asthma and Allergies in Childhood) protocol was used. Children aged 13-14 years from randomly selected representative post-primary schools were studied: 2670 in 1995, 2273 in 1998, 2892 in 2002-2003, and 2805 in 2007. ISAAC is a cross-sectional self-administered questionnaire survey. Smoking history was self-reported. beta Coefficients (slopes) of smoking rates across the four surveys were computed. Odds ratios for smoking rates were also computed using the baseline year (1995) as the reference period. All analyses were performed using SAS software (v 9.1). RESULTS: There were significant reductions in active smoking rates between 1995 and 2007 (from 19.9% to 10.6%, respectively) resulting in 3.3% survey-to-survey reductions, with a significantly greater survey-to-survey decline among girls compared to boys (3.8% vs 2.7%, respectively). 45% of children were exposed to SHS at home in 2007. There was a statistically non-significant 2% overall decline in SHS exposure levels at home in 2007 relative to 2002/03, which was more pronounced in girls. CONCLUSIONS: The continual reduction in active smoking prevalence in children is welcome. That there was no significant increase in SHS exposure at home after the nationwide workplace smoking ban suggests that the ban did not increase smoking inside homes.