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Background For the past decade, hand, foot and mouth disease (HFMD), caused by entero and coxsackie viruses, has been spreading in Asia, particularly among children, overloading healthcare settings and creating economic hardships for parents. Recent studies have found meteorological factors, such as temperature, are associated with HFMD in Asia. However, few studies have explored the relationship in the United States, although HFMD cases have steadily increased recently. As concerns of climate change grow, we explored the association between temperature and HFMD admissions to the Emergency Department (ED) in California. Methods Weekly counts of HFMD for 16 California climate zones were collected from 2005 to 2013. We calculated weekly temperature for each climate zone using an inverse distance-weighting method. For each climate zone stratified by season, we conducted a time-series using Poisson regression models. We adjusted models for weekly averaged relative humidity, average number of HFMD cases in previous weeks and long-term temporal trends. Climate zone estimates were combined to obtain an overall seasonal estimate. We attempted stratified analyses by region, race/ethnicity, and sex to identify sensitive subpopulations. Results Risk of ED visits for HFMD per 1 °F increase in mean temperature during the same week increased 2.00% (95% confidence intervals 1.15, 2.86%) and 2.35% (1.38, 3.33%) during the warm and cold seasons, respectively. The coastal region showed a higher, though not statistically different, association during the cold season [3.18% (1.99, 4.39)] than the warm season [1.64% (0.47, 2.82)]. Conclusions Our findings indicated an association between temperature and ED visits for HFMD, with variation by season and region. Thus, the causative pathogen's ability to persist in the atmosphere may vary by season. Furthermore, the mild and wet winter in the coastal region of California may contribute to different results than studies in Asia. With the onset of climate change, HFMD cases will likely grow in California, warranting further investigation on this relationship, including new populations at-risk.

Fine particles (PM(2.5)) are known to increase risks of cardiovascular diseases, but it is unclear how they affect plasma lipid levels. In this study, we examined the associations between PM(2.5) exposure and lipid/lipoprotein levels from 2,289 midlife women enrolled in the longitudinal Study of Women’s Health Across the Nation. The average exposure to PM(2.5) and gaseous co-pollutants during the prior one year, six months, 30 days, and one day were estimated for each woman based on US Environmental Protection Agency ambient monitoring data. Blood samples were collected annually from 1999 to 2005 and analyzed for lipids/lipoproteins. Mixed-effect models were used to account for repeated measures for each woman, adjusted for demographic, health and behavior covariates. PM(2.5) exposures, especially the long-term exposure, were negatively associated with protective lipoproteins, and positively associated with atherogenic lipoproteins. For example, each 3 μg/m(3) increase of one-year PM(2.5) exposure was associated with decreases of −0.7% (−1.4%, − 0.1%) in high-density lipoprotein cholesterols and −0.6% (−1.1%, −0.1%) in apolipoprotein A1 (ApoA1), as well as increases of 3.8% (1.0%, 6.6%) in lipoprotein(a) and 1.4% (0.5%, 2.3%) in the ratio of apolipoprotein B (ApoB) / ApoA1. In stratified analysis, increased atherogenic lipoproteins were mainly observed in women without dyslipidemia, and both increased atherogenic lipoproteins and reduced protective lipoproteins were observed among women in perimenopause. In summary, PM(2.5) exposure was associated with adverse lipid level changes, and thus, may increase cardiovascular risks in midlife women.

Background: Exposures to ambient gaseous pollutants have been linked to cardiovascular diseases (CVDs), but the biological mechanisms remain uncertain. Objectives: This study examined the changes in CVD marker levels resulting from elevated exposure to ambient gaseous pollutants in midlife women. Methods: Annual repeated measurements of several inflammatory, hemostatic and lipid makers were obtained from 2306 midlife women enrolled in the longitudinal Study of Women's Health Across the Nation (SWAN) between 1999 and 2004. Ambient carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2) data were assigned to each woman based on proximity of the monitoring station to her residential address. Short- and long-term exposures were calculated, and their associations with markers were examined using linear mixed-effects regression models, adjusted for demographic, health and other factors. Results: Short-term CO exposure was associated with increased fibrinogen, i.e., every interquartile increase of average prior one-week exposure to CO was associated with 1.3% (95% CI: 0.6%, 2.0%) increase in fibrinogen. Long-term exposures to NO2 and SO2 were associated with reduced high-density lipoproteins and apolipoprotein A1, e.g., 4.0% (1.7%, 6.3%) and 4.7% (2.8%, 6.6%) decrease per interquartile increment in prior one-year average NO2 concentration, respectively. Fine particle (PM2.5) exposure confounded associations between CO/NO2 and inflammatory/hemostatic markers, while associations with lipoproteins were generally robust to PM2.5 adjustment. Conclusions: Exposures to these gas pollutants at current ambient levels may increase thrombotic potential and disrupt cholesterol metabolism, contributing to greater risk of CVDs in midlife women. Caution should be exercised in evaluating the confounding by PM2.5 exposure. Keywords: Cardiovascular, Coagulation, Fibrinolysis, Carbon monoxide, Nitrogen dioxide, Sulfur dioxide, Lipoprotein

Associations between temperature and cardiovascular (CVD) mortality have been reported, but the underlying biological mechanisms remain uncertain. We explored the association between apparent temperature and serum biomarkers for CVD. Using linear mixed effects models, we examined the relationships between residence-proximate apparent temperature (same day and 1, 7, and 30 days prior) and several inflammatory, hemostatic, and lipid biomarkers for midlife women from 1999 through 2004. Our study population consisted of 2,306 women with mean age of 51 years (±3 years) enrolled in Study of Women's Health Across the Nation (SWAN) in Chicago, Illinois; Detroit, Michigan; Los Angeles and Oakland, California; Newark, New Jersey; and Pittsburgh, Pennsylvania. Mean daily apparent temperature was calculated using temperature and relative humidity data provided by the National Climatic Data Center and the US Environmental Protection Agency, while daily data for fine particles, ozone, carbon monoxide, and nitrogen dioxide from the US Environmental Protection Agency Air Quality Data Mart were considered as confounders. All analyses were stratified by warm and cold seasons. More significant (p&nbsp

Background High ambient temperature has been linked to a number of types of morbidity, such as cardiovascular disease and dehydration. Fewer studies have explored specifically the relationship between ambient temperature and liver, kidney, and urinary system morbidity despite known biological impacts of extreme high temperatures on those systems. Objective We assessed the relationship between temperature and hospitalizations related to selected renal system (urinary stones, urinary tract infections, septicemia, chronic kidney disease, and a composite of selected kidney diseases) and hepatobiliary (biliary tract disease, other liver diseases [e.g. cirrhosis], non-diabetic pancreatic disorders) ailments. Methods We compiled data on daily hospitalization counts for hepatobiliary and renal system diseases in California for 1999 through 2009, and matched it with meteorological data. Relationships between temperature and admissions during the warm season (May–October) were assessed at the climate zone-level cumulative over 14 days following exposure using distributed lag non-linear models, with adjustment for time trends and relative humidity, then combined using random-effects meta-regression to create statewide estimates. Results Higher mean temperatures in the warm season were associated with significant increases in renal admissions for urinary tract infection [% change per 10 °F: 7.3, 95% CI: 5.6, 9.1], septicemia [% increase: 2.9; 95% CI: 1.5, 4.3], urinary stones [% increase: 15.2; 95% CI: 10.3, 20.4], and composite kidney disease. Additionally, increased temperatures were linked to increased admissions for biliary tract disease, but lower risk of other liver diseases. Some differences in association by race/ethnicity and regional meteorology were observed. Conclusions Exposure to higher temperatures was associated with increased risk of multiple renal system hospitalization types, with additional links to specific hepatobiliary morbidities observed.

To address disparities in health risks associated with ambient air pollution for racial/ethnic minority groups, this study characterized personal and ambient concentrations of volatile organic compounds (VOCs) in a suspected hot spot of air pollution – the Village of Waterfront South (WFS), and an urban reference community – the Copewood/Davis Streets (CDS) neighborhood in Camden, New Jersey. Both are minority-dominant, impoverished communities. We collected 24-h integrated personal air samples from 54 WFS residents and 53 CDS residents, with one sample on a weekday and one on a weekend day during the summer and winter seasons of 2004–2006. Ambient air samples from the center of each community were also collected simultaneously during personal air sampling. Toluene, ethylbenzene, and xylenes (TEX) presented higher (p < 0.05) ambient levels in WFS than in CDS, particularly during weekdays. A stronger association between personal and ambient concentrations of MTBE and TEX was found in WFS than in CDS. Fourteen to forty-two percent of the variation in personal MTBE, hexane, benzene, and TEX was explained by local outdoor air pollution. These observations indicated that local sources impacted the community air pollution and personal exposure in WFS. The estimated cancer risks resulting from two locally emitted VOCs, benzene and ethylbenzene, and non-cancer neurological and respiratory effects resulting from hexane, benzene, toluene, and xylenes exceeded the US EPA risk benchmarks in both communities. These findings emphasized the need to address disparity in health risks associated with ambient air pollution for the socio-economically disadvantaged groups. This study also demonstrated that air pollution hot spots similar to WFS can provide robust setting to investigate health effects of ambient air pollution.

The use of household cleaning products and air fresheners exposes people to a variety of chemicals, including some that have been shown to be irritants, potential carcinogens and endocrine disrupting compounds. In addition, some react with ambient ozone infiltrating to the indoor environment to form potentially toxic secondary pollutants. Although realistic estimates of usage patterns are necessary for modeling potential exposures in risk assessments, few studies have documented cleaning habits and product usage to characterize how they vary between households and over time. In addition, understanding within-household temporal variability of use is important to assess the reliability of exposure questionnaires used in epidemiological surveys and improve the cost-efficiency of data collection. In the SUPERB (Study of Use of Products and Exposure-Related Behavior) study, frequencies of use of eight types of household cleaning products and air fresheners and the performance of different types of cleaning tasks are collected in three annual telephone and six quarterly web-based surveys. All-purpose and glass cleaners were the products most frequently used among all products surveyed. Use frequencies differed by demographic and other household characteristics for some products. Product usage was internally consistent, with over 75% of pairwise cross-sectional correlations between product types statistically significantly different from zero. In addition, each product type was correlated with at least one cleaning habit. Frequency of cleaning product use and performing cleaning tasks did not vary by season. An examination of intra-household variability showed moderately to highly consistent usage patterns over time, with lower temporal consistency observed among products used more frequently, such as all-purpose cleaners. Frequency of household care product usage was consistent enough that in epidemiologic studies, participants can be classified, for example, into three categories on the basis of a single assessment, with only minimal misclassification.

While small- and medium-sized commercial buildings (SMCBs) make up 96% of the commercial buildings in the U.S., serving a large variety of uses, little information is available on indoor air quality (IAQ) in SMCBs. This study investigated 37 SMCBs distributed across different sizes, ages, uses, and regions of California. We report indoor concentrations and whole building emission rates of a suite of 30 VOCs and aldehydes in these buildings. There was a considerable range in the concentrations for each of the contaminants, especially for formaldehyde, acetaldehyde, decamethylcyclopentasiloxane, d-limonene, 2-butoxyethanol, toluene, 2,2,4-trimethylpentanediol diisobutyrate, and diethylphthalate. The cause of higher concentrations in some building categories generally corresponded to expected sources, for example, chloroform was higher in restaurants and grocery stores, and formaldehyde was higher in retail stores and offices. Factor analysis suggests sources in SMCBs include automobile/traffic, cleaning products, occupant sources, wood products/coating, and plasticizers. The comparison to health guidelines showed that formaldehyde concentrations were above the chronic RELs required by the OEHHA (9 μg/m³) in 86% of the buildings. Data collected in this study begins to fill the knowledge gap for IAQ in SMCBs and helps us understand the indoor sources of VOCs to further improve indoor air quality in SMCBs.

Time-activity data are traditionally collected by telephone interviews or through paper diaries, which are time consuming and costly. As a potential alternative that may greatly save staff time, a web survey to collect time-activity data was developed and tested in this study. We collected 24-h recall web diaries from 151 parents of young children mostly under 55 years of age (who also answered for their children) and 55 older adults (≥ 55 years of age) both on a weekday and a weekend day every 3 months during an 18-month period. The performance and reliability of the web surveys collected were evaluated, including the survey-completion rate, and the percentage of surveys with unreasonable time being reported as spent sleeping and with missing reports of being in transit between locations. We also compared the web-survey data with time-activity information we collected from the same subjects in telephone interviews and found that these data sources were fairly consistent with each other. However, we observed slightly more compliance issues for the web than the telephone survey, but most of these issues could be addressed and minimized by refining some questions or the survey interface. Our study suggests that it is critical to reduce participants' burden and improve survey interface design for optimal compliance and data quality. In conclusion, web surveys are a promising method to consider for time-activity data collection.

Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in furniture foam, electronics, and other home furnishings. A field study was conducted that enrolled 139 households from California, which has had more stringent flame retardant requirements than other countries and areas. The study collected passive air, floor and indoor window surface wipes, and dust samples (investigator collected using an HVS3 and vacuum cleaner) in each home. PentaBDE and BDE209 were detected in the majority of the dust samples and many floor wipe samples, but the detection in air and window wipe samples was relatively low. Concentrations of each PBDE congener in different indoor environmental media were moderately correlated, with correlation coefficients ranging between 0.42 and 0.68. Correlation coefficients with blood levels were up to 0.65 and varied between environmental media and age group. Both investigator-collected dust and floor wipes were correlated with serum levels for a wide range of congeners. These two sample types also had a relatively high fraction of samples with adequate mass for reliable quantification. In 42 homes, PBDE levels measured in the same environmental media in the same home 1year apart were statistically correlated (correlation coefficients: 0.57-0.90), with the exception of BDE209 which was not well correlated longitudinally.

Background Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many household items. Given concerns over their potential adverse health effects, we identified predictors and evaluated temporal changes of PBDE serum concentrations. Methods PBDE serum concentrations were measured in young children (2-8 years old; N = 67), parents of young children (

Perfluorinated compounds (PFCs) have been widely used in industrial applications and consumer products. Their persistent nature and potential health impacts are of concern. Given the high cost of collecting serum samples, this study is to understand whether we can quantify PFC serum concentrations using factors extracted from questionnaire responses and indirect measurements, and whether a single serum measurement can be used to classify an individual's exposure over a one-year period. The study population included three demographic groups: young children (2-8 years old) (N=67), parents of young children (55 years old) (N=59). PFC serum concentrations, house dust concentrations, and questionnaires were collected. The geometric mean of perfluorooctane sulfonic acid (PFOS) was highest for the older adults. In contrast, the geometric mean of perfluorooctanoic acid (PFOA) was highest for children. Serum concentrations of the parent and the child from the same family were moderately correlated (Spearman correlation (r)=0.26-0.79, p

This study monitored indoor and outdoor particle concentrations in 37 small and medium commercial buildings (SMCBs) in California with three buildings sampled on two occasions, resulting in 40 sampling days. Sampled buildings included offices, retail establishments, restaurants, dental offices, and hair salons, among others. Continuous measurements were made for both ultrafine and fine particulate matter as well as black carbon inside and outside of the building. Integrated PM(2.5), PM(2.5-10), and PM(10) samples were also collected inside and outside the building. The majority of the buildings had indoor/outdoor (I/O) particle concentration ratios less than 1.0, indicating that contributions from indoor sources are less than removal of outdoor particles. However, some of the buildings had I/O ratios greater than 1, indicating significant indoor particle sources. This was particularly true of restaurants, hair salons, and dental offices. The infiltration factor was estimated from a regression analysis of indoor and outdoor concentrations for each particle size fraction, finding lower values for ultrafine and coarse particles than for submicrometer particles, as expected. The I/O ratio of black carbon was used as a relative measure of the infiltration factor of particles among buildings, with a geometric mean of 0.62. The contribution of indoor sources to indoor particle levels was estimated for each building.

Traditionally, use of household and personal care products has been collected through questionnaires, which is very time consuming, a burden on participants, and prone to recall bias. As part of the SUPERB Project (Study of Use of Products and Exposure-Related Behaviors), a novel platform was developed using bar codes to quickly and reliably determine what household and personal care products people have in their homes and determine the amount used over a 1-week period. We evaluated the acceptability and feasibility of our methodology in a longitudinal field study that included 47 California households, 30 with young children and 17 with an older adult. Acceptability was defined by refusal rates; feasibility was evaluated in terms of readable bar codes, useful product information in our database for all readable barcodes, and ability to find containers at both the start and end of the week. We found 63% of personal care products and 87% of the household care products had readable barcodes with 47% and 41% having sufficient data for product identification, respectively and secondly, the amount used could be determined most of the time. We present distributions for amount used by product category and compare inter- and intra-person variability. In summary, our method appears to be appropriate, acceptable, and useful for gathering information related to potential exposures stemming from the use of personal and household care products. A very low drop-out rate suggests that this methodology can be useful in longitudinal studies of exposure to household and personal care products.

This study characterized the time-location pattern of 107 residents living in air pollution hotspots, the Waterfront South and Copewood/Davis Streets communities in Camden, NJ. Most residents in the two communities are minority and impoverished individuals. Results showed that employment status played the fundamental role in determining time-location patterns of this study population, and the variations of time-location pattern by season and by day-type were partially attributed to employment status. Compared to the National Human Activity Pattern Survey, the Camden cohort spent significantly more time outdoors (3.8 hours versus 1.8 hours) and less time indoors (19.4 hours versus 20.9 hours) than the general US population, indicating a higher risk of exposure to ambient air pollution for the Camden cohort. The findings of the study are important for understanding exposure routes and sources for the socioeconomically disadvantaged subgroup and ultimately help develop effective strategies to reduce community exposure to ambient air pollution in “hotspots”.

This study presents the Individual Based Exposure Modeling (IBEM) application of MENTOR (Modeling ENvironment for TOtal Risk studies) in a hot spot area, where there are concentrated local sources on the scale of tens to hundreds of meters, and an urban reference area in Camden, NJ, to characterize the ambient concentrations and personal exposures to benzene and toluene from local ambient sources. The emission-based ambient concentrations in the two neighborhoods were first estimated through atmospheric dispersion modeling. Subsequently, the calculated and measured ambient concentrations of benzene and toluene were separately combined with the time-activity diaries completed by the subjects as inputs to MENTOR/IBEM for estimating personal exposures resulting from ambient sources. The modeling results were then compared with the actual personal measurements collected from over 100 individuals in the field study to identify the gaps in modeling personal exposures in a hot spot. The modeled ambient concentrations of benzene and toluene were generally in agreement with the neighborhood measurements within a factor of 2, but were underestimated at the high-end percentiles. The major local contributors to the benzene ambient levels are from mobile sources, whereas mobile and stationary (point and area) sources contribute to the toluene ambient levels in the study area. This finding can be used as guidance for developing better air toxic emission inventories for characterizing, through modeling, the ambient concentrations of air toxics in the study area. The estimated percentage contributions of personal exposures from ambient sources were generally higher in the hot spot area than the urban reference area in Camden, NJ, for benzene and toluene. This finding demonstrates the hot spot characteristics of stronger local ambient source impacts on personal exposures. Non-ambient sources were also found as significant contributors to personal exposures to benzene and toluene for the population studied.

Background Pesticide use patterns are essential inputs into human pesticide exposure models. Currently, data included for modeling purposes have mostly been collected in cross-sectional surveys. However, it is questionable whether responses to one-time surveys are representative of pesticide use over longer periods, which is needed for assessment of health impact. This study was designed to evaluate population-wide temporal variations and within-household variations in reported residential pesticide use patterns and to compare alternative pesticide data collection methods – web surveys versus telephone interviews. Method A total of 481 households in Northern California provided up to 3 annual telephone interviews on residential pesticide use; 182 of these households provided up to 6 quarterly web surveys that covered the same topics for some of the same time periods. Information on frequency and areas of application were collected for outdoor and indoor sprays, indoor foggers, professional applications, and behind-the-neck treatments for pets. Population-wide temporal variation and within-household consistency were examined both within telephone surveys and within web surveys, and quantified using Generalized Estimating Equations and Mixed Effect Modeling. Reporting between the two methods, the telephone survey and the web survey, was also compared. Results Use prevalence of outdoor sprays across the population reported in both the annual telephone surveys and the quarterly web surveys decreased over time, as did behind-the-neck treatment of pets reported in the quarterly web survey. Similarly, frequencies of use of these products decreased in the quarterly web surveys. Indoor sprays showed no statistically significant population-wide temporal variation in either survey. Intraclass correlation coefficients indicated consistent use within a household for behind-the-neck treatment on pets and outdoor sprays but great variability for the use of indoor sprays. Indoor sprays were most consistently applied in the bathroom and kitchen. Outdoor sprays were consistently more often applied by male household members, while indoor sprays were not. The two survey approaches obtained fairly similar results on the prevalence of using pesticides, but found discrepancies in use frequencies. In addition, the number of products purchased was positively correlated with application frequency for outdoor sprays (R = 0.51, p = 0.0005) but not for indoor sprays. Conclusions In this population, repeated surveys are necessary either to obtain a reliable estimate of the average household use of pesticides or to project potential temporal changes of pesticide use. Web surveys could collect comparable data to traditional telephone surveys for some information. However, researchers need to consider the internet acceptability among the target population and balance lower participant burden against the need for sufficiently accurate time-varying measurement, to improve subject retention in longitudinal surveys.