Publications by authors named "Junfeng Jim Zhang"

107 Publications

The exposome in practice: an exploratory panel study of biomarkers of air pollutant exposure in Chinese people aged 60-69 years (China BAPE Study).

Environ Int 2021 Sep 12;157:106866. Epub 2021 Sep 12.

China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China. Electronic address:

The exposome overhauls conventional environmental health impact research paradigms and provides a novel methodological framework that comprehensively addresses the complex, highly dynamic interplays of exogenous exposures, endogenous exposures, and modifiable factors in humans. Holistic assessments of the adverse health effects and systematic elucidation of the mechanisms underlying environmental exposures are major scientific challenges with widespread societal implications. However, to date, few studies have comprehensively and simultaneously measured airborne pollutant exposures and explored the associated biomarkers in susceptible healthy elderly subjects, potentially resulting in the suboptimal assessment and management of health risks. To demonstrate the exposome paradigm, we describe the rationale and design of a comprehensive biomarker and biomonitoring panel study to systematically explore the association between individual airborne exposure and adverse health outcomes. We used a combination of personal monitoring for airborne pollutants, extensive human biomonitoring, advanced omics analysis, confounding information, and statistical methods. We established an exploratory panel study of Biomarkers of Air Pollutant Exposure in Chinese people aged 60-69 years (China BAPE), which included 76 healthy residents from a representative community in Jinan City, Shandong Province. During the period between September 2018 and January 2019, we conducted prospective longitudinal monitoring with a 3-day assessment every month. This project: (1) leveraged advanced tools for personal airborne exposure monitoring (external exposures); (2) comprehensively characterized biological samples for exogenous and endogenous compounds (e.g., targeted and untargeted monitoring) and multi-omics scale measurements to explore potential biomarkers and putative toxicity pathways; and (3) systematically evaluated the relationships between personal exposure to air pollutants, and novel biomarkers of exposures and effects using exposome-wide association study approaches. These findings will contribute to our understanding of the mechanisms underlying the adverse health impacts of air pollution exposures and identify potential adverse clinical outcomes that can facilitate the development of effective prevention and targeted intervention techniques.
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http://dx.doi.org/10.1016/j.envint.2021.106866DOI Listing
September 2021

The associations of nitrated polycyclic aromatic hydrocarbon exposures with plasma glucose and amino acids.

Environ Pollut 2021 Aug 10;289:117945. Epub 2021 Aug 10.

BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Peking University, Beijing, 100871, China; Center for Environment and Health, Peking University, Beijing, 100871, China. Electronic address:

Nitrated polycyclic aromatic hydrocarbons (nitro-PAHs) have been widely studied for their mutagenic and carcinogenic effects. This study aims to investigate whether exposure to nitro-PAHs is associated with biomarkers of carbohydrate metabolism, an underlying risk factor for metabolic disorder. Early morning urine and blood samples were longitudinally collected two times with a four-week interval from 43 healthy adults. Five urinary amino-PAHs (1-aminonaphthalene, 2-aminonaphthalene, 9-aminophenanthrene, 2-aminofluorene, and 1-aminopyrene) were measured as biomarkers of nitro-PAH exposures. We measured plasma concentrations of glucose and six amino acids that can regulate insulin secretion, including aspartate (Asp), glutamate (Glu), glutamine (Gln), alanine (Ala), Arginine (Arg), and ornithine (Orn). We found that increasing concentrations of 9-aminophenanthrene were significantly associated with increasing glucose levels and with decreasing Asp, Glu, Ala, and Orn levels. We estimated that 26.4 %-43.8 % of the 9-aminophenanthrene-associated increase in glucose level was mediated by Asp, Glu, and Orn. These results suggest that exposure to certain nitro-PAHs affects glucose homeostasis, partly resulting from the depletion of insulin-stimulating amino acids (Asp, Glu, and Orn).
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http://dx.doi.org/10.1016/j.envpol.2021.117945DOI Listing
August 2021

Changes in children's lung function over two decades in relation to socioeconomic, parental and household factors in Wuhan, China.

J Thorac Dis 2021 Jul;13(7):4601-4613

Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, USA.

Background: It is important to identify risk and beneficial factors for children's lung function. This study aims to ascertain potential changes in children's lung function in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning 25 years in Wuhan, the largest metropolis in central China.

Methods: In two cross-sectional studies, lung function measurements and questionnaire surveys were conducted on school-age children in 1993-1996 (Period I) and in 2018 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Demographic information, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Spirometric lung function was measured, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV), forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75), and peak expiratory flow (PEF). Wilcoxon analysis of variances was used to assess the differences in lung function indexes between Period I and Period II. Multiple linear regression models were used to estimate the association of lung function with regard to socioeconomic, parental and household factors, respectively.

Results: Significant prevalence reductions were observed for household coal use, paternal smoking and maternal asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds and breastfeeding, ventilation use during cooking, and parental education level from Period I to Period II. When adjusted for age, height, weight, sex and other factors assessed in the study, children had significant lower values of FVC, FEV, and PEF in Period II than in Period I. Enclosed kitchen was significantly associated with lower lung function in children in Period I. Urban living condition and higher maternal education level were each associated with a higher FVC, while father having no fixed income was associated with a lower FVC and a lower FEV, respectively, in Period II. In comparison with Period I, the beneficial impact of urban living and that of breastfeeding were enhanced and the detrimental effect of poor household condition was weakened in Period II.

Conclusions: Lung function was lower in 2018 than in 1993-1996 in school-age children living in Wuhan. Although improvements in urban living and household environmental conditions as well as increased breastfeeding in Period II could have contributed to increased lung function, other unmeasured risk factors may have played a more dominant role in leading to a net decrease in lung function from Period I to Period II. Future studies are needed to identify these risk factors.
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http://dx.doi.org/10.21037/jtd-21-158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339758PMC
July 2021

Household environmental factors and children's respiratory health: comparison of two cross-sectional studies over 25 years in Wuhan, China.

J Thorac Dis 2021 Jul;13(7):4589-4600

School of Energy and Environmental Engineering, Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, University of Science and Technology Beijing, Beijing, China.

Background: Over the recent decades, residential lifestyle and household environment have changed substantially with rapid development of industrialization and urbanization in China. Whether the prevalence of respiratory diseases changed is still lack of evidence. The objective of this study is to assess potential changes in children's respiratory disease prevalence and associated household environmental factors in Wuhan over a 25-year time interval.

Methods: Two cross-sectional studies in the Period 1 (1993 to 1996) and Period 2 (2017 to 2018) were compared in this research. Elementary school children in period 1 (N=2,517) and in period 2 (N=3,152) were recruited in Wuhan, China. The respiratory health condition, home environmental factors, and family socioeconomic status of each subject were acquired through questionnaire survey using the same protocols in both periods. We used the Chi-square test to analyze the difference of household environmental factors (focused on three indoor air quality determinants) and children's respiratory health condition between two periods. Logistic regression models were used to assess the impacts of household environmental determinants on children's respiratory diseases and symptoms between the two studies, by adjusting a set of covariates.

Results: The three indoor air quality determinants have reduced substantially in prevalence from period 1 to period 2: environment tobacco smoke (ETS) from 86.6% to 45.9%, household coal use from 47.6% to 4.9%, and kitchen smoke from 58.9% to 7.3%. The prevalence of certain respiratory symptoms in children significantly decreased, such as cough with colds (51.1% to 41.6%) and phlegm with colds (22.3% to 17.7%). The prevalence of asthma was 2.5% and 2.4% and that of bronchitis was 27.1% and 29.8% in both periods. Coal use was a risk factor for asthma in period 1 (OR =2.34, 95% CI: 1.30-4.23), while it was not significantly associated with prevalence of asthma in period 2 (OR =0.60, 95% CI: 0.08-4.51).

Conclusions: Household indoor air quality determinants and respiratory health condition of children in Wuhan has been improved over the last 25 years. At present, kitchen smoke is an important factor affecting the prevalence of wheeze whatever child has a cold or not and reducing exposure to ETS could be beneficial to protect children to be less likely to develop bronchitis.
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http://dx.doi.org/10.21037/jtd-20-2170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339747PMC
July 2021

Children's lung function in relation to changes in socioeconomic, nutritional, and household factors over 20 years in Lanzhou.

J Thorac Dis 2021 Jul;13(7):4574-4588

Global Health Research Center, Duke Kunshan University, Kunshan, China.

Background: Lanzhou has experienced rapid urbanization, leading to changes in socioeconomic, nutritional, and household factors. These changes may affect children's lung function.

Methods: Two cross-sectional studies of school-age children (6-13 years of age) from the urban (Chengguan) (Period 1 in 1996 with n=390; Period 2 in 2017 with n=192) and the suburban (Xigu) (Period 1 n=344; Period 2 n=492) district were conducted. Demographic information, household factors, and nutrition status were obtained via a questionnaire survey. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV) were measured in each period. Student's t-test analysis of variance was used to assess the differences in FVC and FEV between Periods 1 and 2. Generalized linear models were used to analyze the associations between questionnaire derived factors and lung function. Analyses were done separately for girls and boys.

Results: Children had significantly lower mean FEV and FVC measures in Period 2 than in Period 1. This reduction was greater in children living in the urban area than those living in the suburban area. Obese children had significantly lower lung function but this was only statistically significant in Period 1.

Conclusions: Children's lung function (FVC and FEV) were lower in 2017 than in 1996. Rapid urbanization may have contributed to the decline of lung function. Obesity may be a risk factor for impaired lung function in children living in Lanzhou and possibly elsewhere.
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http://dx.doi.org/10.21037/jtd-20-2232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339784PMC
July 2021

The effects of indoor and outdoor air pollution on the prevalence of adults' respiratory diseases in four Chinese cities: a comparison between 2017-2018 and 1993-1996.

J Thorac Dis 2021 Jul;13(7):4560-4573

Global Health Research Center, Duke Kunshan University, Kunshan, China.

Background: Over the past decades, both ambient and household air pollution have changed in several aspects, including the emission sources and the concentrations of pollutants, in many Chinese cities. It is unknown whether these changes are associated with changes in health conditions, especially given changes in other factors due to rapid economic growth.

Methods: Two cross-sectional surveys were conducted in two periods spanning more than twenty years (1993-1996 . 2017-2018) in four Chinese cities of Chongqing, Wuhan, Lanzhou, and Guangzhou. Data were collected regarding adults' respiratory disease, smoking status, education, occupation, and household characteristics. Ambient air pollution data were obtained for each study. We first used logistic regression models to construct the district-specific adjusted disease prevalences. In the second stage, first-difference regression models were employed to examine whether the change in respiratory diseases prevalences was associated with the change in outdoor air pollution and indoor air pollution surrogates.

Results: A total of 7,557 and 9,974 households were participating in Period 1 (1993-1996) and Period 2 (2017-2018), respectively. Compared to Period 1, we found substantial reductions in the ambient air pollution concentrations, and a suggestive improvement in cooking-related indoor air pollution in Period 2. We observed decreases in the district-specific covariate-adjusted prevalences of both asthma and chronic bronchitis among participants, with an average reduction of 3.6% (range: 0.0% to 24.3%). From Period 1 to Period 2, one percent decrease in the proportion of cooking with coal was associated with a 19.0% (95% CI, 0.96-37.04%) decrease in the prevalence of males' chronic bronchitis and a 1.86% (0.69-3.04%) increase in the prevalence of females' asthma. Little evidence was observed regarding the potential health benefits associated with the decreases in ambient air pollution levels.

Conclusions: The substantial reduction in household use of coal for cooking might be an important contributor to the decrease in adults' respiratory disease prevalence from 1993-1996 to 2017-2019 in four Chinese cities. Changes in this indoor air pollution source, along with other risk factors for respiratory diseases, may have masked respiratory health benefits associated with reductions in outdoor air pollution levels.
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http://dx.doi.org/10.21037/jtd-20-2121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339734PMC
July 2021

Tobacco smoking and older people amid the COVID-19 pandemic: An elephant in the room.

Age Ageing 2021 Jul 26. Epub 2021 Jul 26.

School of Public Health, The University of Hong Kong, Hong Kong, China.

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http://dx.doi.org/10.1093/ageing/afab170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344474PMC
July 2021

Malondialdehyde in dried blood spots: a biomarker of systemic lipid peroxidation linked to cardiopulmonary symptoms and risk factors.

J Thorac Dis 2021 Jun;13(6):3731-3740

Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, NC, USA.

Background: There are few oxidative biomarkers that can be used in resource-limited settings (e.g., rural Africa) where blood collection facilities are lacking. This study aims to evaluate the potential of malondialdehyde (MDA) in dried blood spots (DBS) as a useful biomarker to monitor cardiopulmonary health.

Methods: We first conducted a cross-validation comparison of matched capillary DBS, plasma, and whole venous blood collected from nine healthy volunteers for the measurement of total MDA (free + conjugated) and C-reactive protein (CRP), a well-established biomarker of systemic inflammation. Then a field study was conducted in a rural Senegal with a population of 441 women routinely exposed to severe household air pollution, examining associations of MDA and CRP levels in 882 DBS with self-reported cardiopulmonary symptoms.

Results: In the cross-validation study, CRP levels were strongly correlated across DBS, plasma, and whole blood. MDA levels were correlated between DBS and whole blood and were 1-2 orders of magnitude lower in plasma, suggesting that DBS MDA may reflect total oxidation levels in intracellular and extracellular compartments. In the field study, we observed significantly higher MDA levels in women with secondhand smoke exposure. An interquartile range increase in MDA concentration was associated with 27.0% (95% CI: 3.1-56.5%) and 21.1% (95% CI: -3.5% to 52.0%) increases in the incidence of chest tightness and breath difficulty, respectively. In contrast, CRP levels were not associated with worse outcomes or risk factors.

Conclusions: These results support the use of DBS as a convenient alternative to venous blood when MDA is measured as a biomarker for cardiopulmonary health risk.
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http://dx.doi.org/10.21037/jtd-21-604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264672PMC
June 2021

Population ageing and deaths attributable to ambient PM pollution: a global analysis of economic cost.

Lancet Planet Health 2021 06;5(6):e356-e367

Ministry of Education Key Laboratory for Earth System modeling, Department of Earth System Science, Tsinghua University, Beijing, China. Electronic address:

Background: The health impacts of ambient air pollution impose large costs on society. Although all people are exposed to air pollution, the older population (ie, those aged ≥60 years) tends to be disproportionally affected. As a result, there is growing concern about the health impacts of air pollution as many countries undergo rapid population ageing. We investigated the spatial and temporal variation in the economic cost of deaths attributable to ambient air pollution and its interaction with population ageing from 2000 to 2016 at global and regional levels.

Methods: In this global analysis, we developed an age-adjusted measure of the value of a statistical life-year (VSLY) to estimate the economic cost of deaths attributable to ambient PM pollution using Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data and country-level socioeconomic information. First, we estimated the global age-specific and cause-specific mortality and years of life lost (YLLs) attributable to PM pollution using the global exposure mortality model and global estimates of exposure at 0·1° × 0·1° (about 11 km × 11 km at the equator) resolution. Second, for each year between 2000 and 2016, we translated the YLLs within each age group into a health-related cost using a country-specific, age-adjusted measure of VSLY. Third, we decomposed the major driving factors that contributed to the temporal change in health costs related to PM. Finally, we did a sensitivity test to analyse the variability of the estimated health costs to four alternative valuation measures. We identified the uncertainty intervals (UIs) from 1000 draws of the parameters and concentration-response functions by age, cause, country, and year. All economic values are reported in 2011 purchasing power parity-adjusted US dollars. All simulations were done with R, version 3.6.0.

Findings: Globally, in 2016, PM was estimated to have caused 8·42 million (95% UI 6·50-10·52) attributable deaths, which was associated with 163·68 million (116·03-219·44) YLLs. In 2016, the global economic cost of deaths attributable to ambient PM pollution for the older population was US$2·40 trillion (1·89-2·93) accounting for 59% (59-60) of the cost for the total population ($4·09 trillion [3·19-5·05]). The economic cost per capita for the older population was $2739 (2160-3345) in 2016, which was 10 times that of the younger population (ie, those aged <60 years). By assessing the factors that contributed to economic costs, we found that increases in these factors changed the total economic cost by 77% for gross domestic product (GDP) per capita, 21% for population ageing, 16% for population growth, -41% for age-specific mortality, and -0·4% for PM exposure.

Interpretation: The economic cost of ambient PM borne by the older population almost doubled between 2000 and 2016, driven primarily by GDP growth, population ageing, and population growth. Compared with younger people, air pollution leads to disproportionately higher health costs among older people, even after accounting for their relatively shorter life expectancy and increased disability. As the world's population is ageing, the disproportionate health cost attributable to ambient PM pollution potentially widens the health inequities for older people. Countries with severe air pollution and rapid ageing rates need to take immediate actions to improve air quality. In addition, strategies aimed at enhancing health-care services, especially targeting the older population, could be beneficial for reducing the health costs of ambient air pollution.

Funding: National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Qiushi Foundation.
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http://dx.doi.org/10.1016/S2542-5196(21)00131-5DOI Listing
June 2021

DNA Methylation in Babies Born to Nonsmoking Mothers Exposed to Secondhand Smoke during Pregnancy: An Epigenome-Wide Association Study.

Environ Health Perspect 2021 May 19;129(5):57010. Epub 2021 May 19.

Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.

Background: Maternal smoking during pregnancy is related to altered DNA methylation in infant umbilical cord blood. The extent to which low levels of smoke exposure among nonsmoking pregnant women relates to offspring DNA methylation is unknown.

Objective: This study sought to evaluate relationships between maternal prenatal plasma cotinine levels and DNA methylation in umbilical cord blood in newborns using the Infinium HumanMethylation 450K BeadChip.

Methods: Participants from the Newborn Epigenetics Study cohort who reported not smoking during pregnancy had verified low levels of cotinine from maternal prenatal plasma (0 to ), and offspring epigenetic data from umbilical cord blood were included in this study (). Multivariable linear regression models were fit to the data, controlling for cell proportions, age, race, education, and parity. Estimates represent changes in response to any unit increase in exposure.

Results: Multivariable linear regression models yielded 29,049 CpGs that were differentially methylated in relation to increases in cotinine at a 5% false discovery rate. Top CpGs were within or near genes involved in neuronal functioning (, , ), carcinogenesis (, ) and inflammation (). Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses suggest cotinine was related to methylation of gene pathways controlling neuronal signaling, metabolic regulation, cell signaling and regulation, and cancer. Further, enhancers associated with transcription start sites were enriched in altered CpGs. Using an independent sample from the same study population (), bisulfite pyrosequencing was performed with infant cord blood DNA for two genes within our top 20 hits ( and ). Results from pyrosequencing replicated epigenome results for (cg17079497, , , ) but not for AGER (cg09199225; , , ).

Discussion: Secondhand smoke exposure among nonsmoking women may alter DNA methylation in regions involved in development, carcinogenesis, and neuronal functioning. These novel findings suggest that even low levels of smoke exposure during pregnancy may be sufficient to alter DNA methylation in distinct sites of mixed umbilical cord blood leukocytes in pathways that are known to be altered in cord blood from pregnant active smokers. https://doi.org/10.1289/EHP8099.
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http://dx.doi.org/10.1289/EHP8099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132610PMC
May 2021

Role of endogenous melatonin in pathophysiologic and oxidative stress responses to personal air pollutant exposures in asthmatic children.

Sci Total Environ 2021 Jun 6;773:145709. Epub 2021 Feb 6.

Nicholas School of the Environment, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Kunshan University, Kunshan, Jiangsu Province, China. Electronic address:

Background: Heightening oxidative stress and inflammation is an important pathophysiological mechanism underlying air pollution health effects in people with asthma. Melatonin can suppress oxidative stress and inflammation in pulmonary and circulatory systems. However, the role of melatonin in the oxidative stress and physiological responses to air pollution exposure has not been examined in children with asthma.

Methods: In this panel study of 43 asthmatic children (5-13 years old), each child had 4 clinic visits with a 2-week interval between two consecutive visits. At each visit, urine samples were collected and subsequently analyzed for 6-sulfatoxymelatonin (aMT6s) as a surrogate of circulating melatonin and for malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) as two biomarkers of systemic oxidative stress. At each clinic visit, children were measured for pulmonary function and fractional exhaled nitric oxide (FeNO, a marker of pulmonary inflammation). None of the children reported to have taking melatonin supplementation. Concentrations of indoor and ambient PM and ozone (O) were combined with individual time-activity data to calculate personal air pollutant exposures.

Results: We found that interquartile range increases in urinary MDA and 8-OHdG concentrations were associated with significantly increased urinary aMT6s concentrations by 73.4% (95% CI: 52.6% to 97.0%) and 41.7% (22.8% to 63.4%), respectively. Increases in daily personal exposure to O and to PM were each associated with increased urinary aMT6s concentrations. Increasing urinary aMT6s concentrations were associated with decreased FeNO and resonant frequency, indicating improved airway inflammation and lung elasticity, respectively.

Conclusion: The results suggest that systemic oxidative stress heightened by air pollution exposure may stimulate melatonin excretion as a defense mechanism to alleviate the adverse effects.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145709DOI Listing
June 2021

Inhibition of TRPA1 reduces airway inflammation and hyperresponsiveness in mice with allergic rhinitis.

FASEB J 2021 05;35(5):e21428

Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

This study was conducted to investigate whether a transient receptor potential ankyrin 1 (TRPA1) antagonist (HC-030031) can reduce airway inflammation and hyperresponsiveness in a murine allergic rhinitis (AR) model. BALB/c mice were sensitized and challenged by ovalbumin (OVA) to induce AR. HC-030031 or vehicle was administrated to mice via intraperitoneal injection prior to OVA challenges. Nose-scratching events, histopathologic alterations of the airways, and bronchial hyperresponsiveness (BHR) were assessed. Differential cells and proinflammatory cytokines in the nasal lavage (NAL) and bronchoalveolar lavage (BAL) fluid were measured. Expressions of TRPA1 in nasal mucosa were examined by immunohistochemistry. TRPA1-expressing vagal neurons were labeled by immunofluorescent staining. HC-030031-treated AR mice had markedly reduced type-2 inflammation in nasal mucosa and ameliorated-nose-scratching events than AR mice received vehicle. HC-030031 treatment also dramatically reduced leucocyte numbers and IL-8 level in the BAL fluid, inhibited lower airway remodeling and fibrosis, and nearly abolished BHR. HC-0300031 treatment significantly inhibited the upregulated number of TRPA1 expressing nasal epithelial cells and TRPA1 expressing sensory neurons, leading to downregulation of SP in both upper and lower airways. Targeting TRPA1 may represent a promising strategy for treating AR and AR-related asthma.
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http://dx.doi.org/10.1096/fj.201902627RDOI Listing
May 2021

Long-term exposure to ambient PM increase obesity risk in Chinese adults: A cross-sectional study based on a nationwide survey in China.

Sci Total Environ 2021 Jul 2;778:145812. Epub 2021 Mar 2.

Nicholas School of the Environment and Global Health Institute, Duke University, Durham, NC, USA; Duke Kunshan University, Kunshan, Jiangsu Province, China.

Certain studies suggest that air pollution could be a risk factor for obesity, but the evidence on the association between air pollution exposure and obesity in adults is limited. This study aims to examine the association between long-term exposure to fine particulate matter (PM) and obesity-related traits in Chinese adults. Thus, a cross-sectional study was conducted based on a nationally representative sample of 91, 121 adults from 31 provinces in China. Integrated the data from satellites, chemical transport model, and ground observations, annual average concentrations of PM was obtained at the township level using a machine learning method. The information on body weight, height, and waist circumference (WC) were obtained from a questionnaire survey. The general obesity and abdominal obesity status were classified based on body mass index (BMI) and WC, respectively. Logistic and multivariate linear regression models were used to examine the association between PM and obesity-related traits, along with the examination of potential effect modifications. After adjustment for covariates, a 10 μg/m increase in PM concentration was associated with 8.0% [95% confidence interval (CI): 1.0%, 10.0%] and 10% (95% CI: 9.0%, 11.0%) increases in odds for general obesity and abdominal obesity, respectively. The odds ratios associated with per 10 μg/m PM increase were significantly greater in individuals of older age (≥60 years), of Han ethnicity, with lower socioeconomic status (SES), cooking without using a ventilation device, using unclean household fuels, having near-home pollution sources, and doing no physical exercise. These findings suggest that long-term exposure to ambient PM increase obesity risk in Chinese adults. It has significant significance to reduce air pollution to reducing the burden of obesity, particularly for the susceptible populations.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145812DOI Listing
July 2021

Nitrated Polycyclic Aromatic Hydrocarbons and Arachidonic Acid Metabolisms Relevant to Cardiovascular Pathophysiology: Findings from a Panel Study in Healthy Adults.

Environ Sci Technol 2021 03 23;55(6):3867-3875. Epub 2021 Feb 23.

Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States.

Concerns on nitrated polycyclic aromatic hydrocarbons (nitro-PAHs) in the environment have mainly arisen from their mutagenic and carcinogenic effects. The objective of this study is to investigate whether nitro-PAH exposures are associated with biomarkers of cardiovascular pathophysiology. In a panel study design, urines and blood samples were collected up to four times with a 2-week interval from 89 healthy adults. We measured 1-naphthylamine, 2-naphthylamine, 9-aminophenanthrene, 2-aminofluorene, and 1-aminopyrene as biomarkers of nitro-PAH exposures. We measured three urinary metabolites of arachidonic acid (AA) including 20-hydroxyeicosatetraenoic acid (20-HETE) from the cytochrome P450 (CYP) pathway, 8-isoprostane from the nonenzymatic pathway, and 11-dehydro-thromboxane B2 (11-dhTXB) from the cyclooxygenase (COX) pathway. Urinary malondialdehyde, 8-hydroxy-2'-deoxyguanosine (8-OHdG), and 6-sulfatoxymelatonin (aMT6s) were measured to reflect systemic oxidative stress. Plasma concentrations of the soluble P-selectin and von Willebrand factor (vWF) were measured as biomarkers of platelet activation and endothelial dysfunction. We found that increased urinary concentrations of amino-PAHs were significantly associated with increased 20-HETE, 11-dhTXB, and 8-OHdG and with decreased 8-isoprostane and aMT6s. Increased amino-PAHs were positively associated with P-selectin and vWF, respectively. These results suggest that exposure to nitro-PAHs increases systemic oxidative stress and alters AA metabolism toward CYP and COX pathways, leading to an increased cardiovascular disease risk.
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http://dx.doi.org/10.1021/acs.est.0c08150DOI Listing
March 2021

Personal Exposure to PM Oxidative Potential in Association with Pulmonary Pathophysiologic Outcomes in Children with Asthma.

Environ Sci Technol 2021 03 8;55(5):3101-3111. Epub 2021 Feb 8.

Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States.

Fine particulate matter (PM) with a higher oxidative potential has been thought to be more detrimental to pulmonary health. We aim to investigate the associations between personal exposure to PM oxidative potential and pulmonary outcomes in asthmatic children. We measured each of the 43 asthmatic children 4 times for airway mechanics, lung function, airway inflammation, and asthma symptom scores. Coupling measured indoor and outdoor concentrations of PM mass, constituents, and oxidative potential with individual time-activity data, we calculated 24 h average personal exposures 0-3 days prior to a health outcome measurement. We found that increases in daily personal exposure to PM oxidative potential were significantly associated with increased small, large, and total airway resistance, increased airway impedance, decreased lung function, and worsened scores of individual asthma symptoms and the total symptom score. Among the PM constituents, organic matters largely of indoor origin contributed the greatest to PM oxidative potential. Given that the variability in PM oxidative potential was a stronger driver than PM mass for the variability in the respiratory health outcomes, it is suggested to reduce PM oxidative potential, particularly by reducing the organic matter constituent of indoor PM, as a targeted source control strategy in asthma management.
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http://dx.doi.org/10.1021/acs.est.0c06114DOI Listing
March 2021

Impacts of implementing Healthy Building guidelines for daily PM limit on premature deaths and economic losses in urban China: A population-based modeling study.

Environ Int 2021 02 2;147:106342. Epub 2021 Jan 2.

Department of Building Science, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing 100084, China. Electronic address:

Given a large fraction of people's exposure to urban PM occur indoors, reducing indoor PM levels may offer a more feasible and immediate way to save substantial lives and economic losses attributable to PM exposure. We aimed to estimate the premature mortality and economic loss reductions associated with achieving the newly established Chinese indoor air guideline and a few hypothetical indoor PM guideline values. We used outdoor PM concentrations from 1497 monitoring sites in 339 Chinese cities in 2015, coupled with a steady-state mass balance model, to estimate indoor concentrations of outdoor-infiltrated PM. Using province-specific time-activity patterns for urban residents, we estimated outdoor and indoor exposures to PM of outdoor origin. We then proceeded to use localized census-based concentration-response models and the value of statistical life estimates to calculate premature deaths and economic losses attributable to PM exposure across urban China. Finally, we estimated potentially avoidable mortality and corresponding economic losses by meeting the current 24-hour based guideline and various hypothetical indoor limits for PM. In 2015 in urban areas of mainland China, the city-specific annual mean outdoor and indoor PM concentrations ranged 9-108 μg/m and 5-56 μg/m, respectively. Indoor exposures contributed 62%-91% daily and 68%-83% annually to the total time-weighted exposures. The potential reductions in total deaths and economic losses for the scenario in which daily indoor concentrations met the current guideline of 75 μg/m, 37.5 μg/m, and 25 μg/m were 16.9 (95% CI: 0.7-62.1) thousand, 87.7 (95% CI: 9.7-197.7) thousand, and 165.5 (95% CI: 30.8-304.0) thousand, respectively. The corresponding reductions in economic losses were 5.7 (95% CI: 0.2-34.8) billion, 29.4 (95% CI: 2.4-109.6) billion, and 55.2 (95% CI: 7.7-168.0) billion US Dollars, respectively. Deaths and economic losses would be reduced exponentially within the range of 0-75 μg/m for hypothetical indoor PM limits. The findings demonstrate the effectiveness of reducing indoor concentrations of outdoor-originated PM in saving substantial lives and economic losses in China. The analysis provides quantitative evidence to support the implementation of an indoor air quality guideline or standard for PM.
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http://dx.doi.org/10.1016/j.envint.2020.106342DOI Listing
February 2021

Urinary carboxylic acid metabolites as possible novel biomarkers of exposures to alkylated polycyclic aromatic hydrocarbons.

Environ Int 2021 02 16;147:106325. Epub 2020 Dec 16.

Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, United States. Electronic address:

Previous studies have found that alkylated polycyclic aromatic hydrocarbons (alkyl-PAHs) were more abundant in petrogenic sources (e.g., crude oil and its refined products) than pyrogenic sources of incomplete combustion. While urinary hydroxylated metabolites of unsubstituted PAHs have been widely used as biomarkers of PAHs exposures, little information is available as to the occurrence of alkyl-PAH metabolites. In this study, we have detected carboxylic acid metabolites of alkyl-naphthalene (2-NAPCA) and alkyl-phenanthrene (2-PHECA) in 314 urine samples repeatedly collected from 45 Los Angeles residents before, during, and after they spent ten weeks in Beijing in summers of 2014-2017. We found that traveling from Los Angeles to Beijing led to 348% (95% CI: 243 to 485%) and 209% (95% CI: 149 to 282%) increases in 2-NAPCA and 2-PHECA concentrations, respectively, which returned to baseline levels after participants came back to Los Angeles. The concentration ratio between 2-PHECA and hydroxy-phenanthrenes was significantly (p < 0.05) lower in Beijing (median: 0.40, IQR: 0.27-0.53) than in Los Angeles (median: 0.51, IQR: 0.32-0.77), where more than 5,000 active gas and oil wells were located. From 2014 to 2017, the concentration ratio of 2-PHECA to hydroxy-phenanthrenes increased by 28.7 (95%CI: 12.3 to 47.6) %/yr in Los Angeles and 18.6 (95%CI: 7.9 to 30.3) %/yr in Beijing, likely resulted from both cities' efforts to reduce pyrogenic emissions (e.g. vehicle exhaust). These results provided indirect evidence supporting the use of 2-PHECA to hydroxy-phenanthrene ratio as an index to reflect the relative exposure contributions from petrogenic and pyrogenic sources. While our study suggested that urinary PAHCAs may be novel biomarkers of exposure to alkyl-PAHs, future studies with external exposure characterization are warranted to further validate these biomarkers.
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http://dx.doi.org/10.1016/j.envint.2020.106325DOI Listing
February 2021

The role of Hipk2-p53 pathways in arsenic-induced autistic behaviors: A translational study from rats to humans.

Environ Pollut 2020 Dec 31;267:115568. Epub 2020 Aug 31.

Department of Neurology, Children's Hospital of Fudan University, Shanghai, 201102, China. Electronic address:

Previous studies have associated the risk of autism spectrum disorder (ASD) with increased exposures to metals and metalloids such as arsenic. In this study, we used an animal-to-human translational strategy to identify key molecular changes that potentially mediated the effects of arsenic exposures on ASD development. In a previously established rat model, we have induced autistic behaviors in rat pups with gestational arsenic exposures (10 and 45 μg/L AsO in drinking water). Neuronal apoptosis and the associated epigenetic dysregulations in frontal cortex were assayed to screen potential mediating pathways, which were subsequently validated with qPCR, western blotting, and immunohistochemistry analyses. Furthermore, the identified pathway, along with serum levels of 26 elements including arsenic, were characterized in a case-control study with 21 ASD children and 21 age-matched healthy controls. In animals, we found that arsenic exposures caused difficulties of social interaction and increased stereotypic behaviors in a dose-dependent manner, accompanied by increased neuronal apoptosis and upregulation of Hipk2-p53 pathway in the frontal cortex. In humans, we found that serum levels of Hipk2 and p53 were 24.7 (95%CI: 8.5 to 43.4) % and 23.7 (95%CI: 10.5 to 38.5) % higher in ASD children than in healthy controls. ASD children had significantly higher serum levels of 15 elements, among which arsenic, silicon, strontium, and vanadium were positively associated with both Hipk2 and p53. Results from both the rat arsenic exposure and human case-control studies suggest a likely role of Hipk2-p53 pathway in ASD development induced by exposures to environmental pollutants such as arsenic.
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http://dx.doi.org/10.1016/j.envpol.2020.115568DOI Listing
December 2020

Identifying the Best Questions for Rapid Screening of Secondhand Smoke Exposure Among Children.

Nicotine Tob Res 2021 06;23(7):1217-1223

Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA.

Introduction: Many children suffer from secondhand smoke exposure (SHSe), which leads to a variety of negative health consequences. However, there is no consensus on how clinicians can best query parents for possible SHSe among children. We employed a data-driven approach to create an efficient screening tool for clinicians to quickly and correctly identify children at risk for SHSe.

Methods: Survey data from mothers and biospecimens from children were ascertained from the Neurodevelopment and Improving Children's Health following Environmental Tobacco Smoke Exposure (NICHES) study. Included were mothers and their children whose saliva were assayed for cotinine (n = 351 pairs, mean child age = 5.6 years). Elastic net regression predicting SHSe, as indicated from cotinine concentration, was conducted on available smoking-related questions and cross-validated with 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to select the most predictive items of SHSe among children (n = 1670, mean child age = 8.4 years).

Results: Answering positively to at least one of the two final items ("During the past 30 days, did you smoke cigarettes at all?" and "Has anyone, including yourself, smoked tobacco in your home in the past 7 days?") showed area under the curve = .82, and good specificity (.88) and sensitivity (.74). These results were validated with similar items in the nationally representative NHANES sample, area under the curve = .82, specificity = .78, and sensitivity = .77.

Conclusions: Our data-driven approach identified and validated two items that may be useful as a screening tool for a speedy and accurate assessment of SHSe among children.

Implications: The current study used a rigorous data-driven approach to identify questions that could reliably predict SHSe among children. Using saliva cotinine concentration levels as a gold standard for determining SHSe, our analysis employing elastic net regression identified two questions that served as good classifier for distinguishing children who might be at risk for SHSe. The two items that we validated in the current study can be readily used by clinicians, such as pediatricians, as part of screening procedures to quickly identify whether children might be at risk for SHSe.
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http://dx.doi.org/10.1093/ntr/ntaa254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186417PMC
June 2021

Trends in ambient air pollution levels and PM chemical compositions in four Chinese cities from 1995 to 2017.

J Thorac Dis 2020 Oct;12(10):6396-6410

Nicholas School of Environment & Duke Global Health Institute, Duke University, Durham, USA.

An in-depth analysis of the specific evolution of air pollution in a given city can provide a better understanding of the chronic effects of air pollution on human health. In this study, we reported trends in ambient concentrations of particulate matter (PM) and gaseous pollutants [sulfur dioxide (SO), nitrogen dioxide (NO), and ozone (O)] from 1995 to 2017 and PM composition for the period of 2000-2017 in Guangzhou, Wuhan, Chongqing, and Lanzhou. We provided socio-economic indicators to help explain the pollution trends. SO and PM (including PM and PM) concentrations showed a downward trend in recent years with the most notable reduction in SO in Chongqing and PM in Guangzhou. There was an overall flat trend for NO, while O showed an upward trend in recent years except in Lanzhou. The majority of PM mass was SO (6.0-30 µg/m) and organic carbon (6.0-38 µg/m), followed by NO (2.0-12 µg/m), elemental carbon (2.1-12 µg/m), NH (1.0-10 µg/m), K (0.2-2.0 µg/m), and Cl (0.2-1.9 µg/m). Except for secondary inorganic aerosols in Wuhan, annual average concentrations of all PM constituents showed a declining trend after 2013, corresponding to the trend of PM. The secondary sources in PM were found to be most prominent in Wuhan, while the most abundant EC and Cl in Lanzhou was attributed to the use of coal. Despite temporal and spatial variabilities across the four cities, coal combustion, traffic emissions, and secondary pollution have been the major sources of PM pollution. These trends in ambient air pollution levels and PM composition may help understand changes in health outcomes measured at different times within the time period of 1995-2017 in the four cities.
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http://dx.doi.org/10.21037/jtd-19-crh-aq-004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656343PMC
October 2020

Long-term exposure to PM2.5 and Children's lung function: a dose-based association analysis.

J Thorac Dis 2020 Oct;12(10):6379-6395

Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China.

Background: The current literature is still not consist regarding the effect of long-term exposure to PM2.5 and children's lung function, partly due to inadequate or inaccurate exposure assessment. In this study, we aim to investigate the associations between long-term exposure to PM2.5, estimated as average daily dose (ADD), and lung function in school-age children.

Methods: We recruited 684 participants of 7-12 years old from the city of Lanzhou located in northwestern China. Participants underwent spirometric tests for lung function and responded to a questionnaire survey. Detailed information about individual air exposure and personal information were collected, including length of school hours, home address, age, gender, etc. Combining the spatial distribution of PM2.5 concentrations in the past 5 years and individual time-activity data, we estimated annual ADD for 5 years preceding the lung function tests and 5-year average ADD, respectively. We used multiple linear regression models to examine the associations between ADD values and lung function, controlling for a range of individual-level covariates.

Results: The 5-year average ADD among all the participants was 50.5 µg/kg-d, with higher values estimated for children living in the urban area than the suburban area, for boys than girls, and for children whose parents received a lower education attainment. We found that a 1 μg/kg-d increment in ADD of PM2.5 was associated with a 10.49 mL (95% CI: -20.47, -0.50) decrease in forced vital capacity (FVC) and a 7.68 mL (95% CI: -15.80, -0.44) decrease in forced exploratory volume in 1 second (FEV). Among the annual ADDs estimated for the preceding 5 years, the immediate past year prior to lung function measurement had the greatest effect on lung function. The effect was greater in girls than in boys. We found no associations between annual exposure of PM2.5 (instead of ADD) and lung function when defined concentration was used as an exposure variable.

Conclusions: Long-term PM2.5 exposure, when estimated as exposure dose averaged over a year or longer, was associated with statistically significant reductions in FVC and FEV1 in children of elementary-school age. Future studies may consider the use of individual-level dose estimates (as opposed to exposure concentrations) to improve the dose-response assessment.
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http://dx.doi.org/10.21037/jtd-19-crh-aq-007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656332PMC
October 2020

Changes in children's asthma prevalence over two decades in Lanzhou: effects of socioeconomic, parental and household factors.

J Thorac Dis 2020 Oct;12(10):6365-6378

Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China.

Background: The prevalence of childhood asthma may have changed with rapid economic development. This study aims to ascertain potential changes in asthma prevalence in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning over 20 years in Lanzhou, a large northwestern city of China.

Methods: Cross-sectional studies using the same protocols were performed in Lanzhou, China in 1994-1995 (Period I) and in 2017 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Information on the presence of asthma and asthma-related symptoms of children, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Logistic regression models were used to estimate odds ratios of asthma prevalence with regard to socioeconomic, parental and household factors, respectively.

Results: Significant prevalence reductions were observed for paternal smoking, household coal use, and parental asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds, ventilation use during cooking, and parental occupation and education level after 22 years. In children, the prevalence of ever-diagnosed asthma decreased from 3.2% in period I to 1.5% in Period II (P<0.001); the prevalence of wheeze also decreased from 15.4% to 9.3% (P<0.001). Passive smoking (OR =1.531, 95% CI: 1.032-2.270) and poor household ventilation (OR =1.709, 95% CI: 1.208-2.416) were significantly associated with an increased prevalence of wheeze in Period I, whereas household mold (OR =2.112, 95% CI: 1.203-3.811) was significantly associated with prevalence of wheeze. Parental asthma history was associated with increased prevalence of asthma and asthma-related symptoms. Breastfeeding was significantly associated with reduced risk of asthma in period II children.

Conclusions: The prevalence of asthma and that of asthma-related symptoms were lower in 2017 than in 1994-1995 in school children living in Lanzhou. In 2017 with increased urbanization and industrialization, breastfeeding became a significant protective factor and household mold was a significant risk factor for asthma diagnosis and asthma-related symptoms. Promoting breastfeeding and household mold control is recommended to reduce the risk of childhood asthma in contemporary Lanzhou.
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http://dx.doi.org/10.21037/jtd-19-crh-aq-008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656413PMC
October 2020

Changes in children's respiratory morbidity and residential exposure factors over 25 years in Chongqing, China.

J Thorac Dis 2020 Oct;12(10):6356-6364

Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA.

Background: Respiratory morbidity and mortality during childhood remains a major challenge for global health. Due to the rapid economic development in Chongqing, we expect substantial temporal changes in respiratory health status and environmental risk factors in children. By leveraging a historical dataset, this study aims to assess the changes in prevalence of respiratory symptoms and diseases, residential exposure factors, and their associations in school-age children over a period of 25 years.

Methods: This study involved two cross-sectional surveys conducted in Chongqing with a 25-year interval (2017 1993). Purpose sampling was used to conduct questionnaire surveys on school-age children in both surveys. Information collected include children's respiratory health outcomes, family residential exposures, demographic information, and parental respiratory disease history. The changes of residential exposures as well as demographics were determined by chi-square test. Odds ratios were calculated to compare the prevalence of children's respiratory symptoms and diseases between the two periods. Associations between children's respiratory outcomes and exposure indicators were assessed using multivariate logistic regressions.

Results: The majority of residential exposure indicators improved in 2017, including sleep in shared room, cooking with coal, poor kitchen ventilation, cooking frequency, and parental smoking. Compared to the 1993 study, the adjusted risk for children's wheezing was lower (OR: 0.38, 95% CI: 0.29, 0.49), but the risk for bronchitis was higher (OR: 1.89, 95% CI: 1.54, 2.31) in the 2017 study. Poor kitchen ventilation and parental smoking were linked to an increased risk of children's wheezing (OR: 1.39, 95% CI: 1.02, 1.90) and bronchitis (OR: 1.51, 95% CI: 1.02, 2.21), respectively, while heating in winter was linked to an increased risk of phlegm (OR: 1.40, 95% CI: 1.03, 1.90) and wheezing (OR: 1.47, 95% CI: 1.07, 2.01) in the 1993 study. However, these residential exposure factors were no longer associated with the children's respiratory diseases in the 2017 study.

Conclusions: Our study found improvement of residential exposures in Chongqing, a decline of prevalence of children's wheezing but an increase of that of bronchitis from 1993 to 2017. Poor kitchen ventilation, heating in winter, and parental smoking were significant risk factors in the 1993 survey but, with significantly reduced prevalence in 2017, were not significantly associated with children's respiratory morbidity in the latter survey.
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http://dx.doi.org/10.21037/jtd-19-crh-aq-005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656426PMC
October 2020

Respiratory health effects of residential individual and cumulative risk factors in children living in two cities of the Pearl River Delta Region, China.

J Thorac Dis 2020 Oct;12(10):6342-6355

Key Laboratory for Urban Habitat Environmental Science and Technology, School of Environment and Energy, Peking University Shenzhen Graduate School, Shenzhen 518055, China.

Background: Indoor environment is complex, with many factors potentially interacting with each other to affect health. However, previous studies have usually focused on effect of a single factor. Assessment of the combined effects of multiple factors can help with understanding the overall health risk.

Methods: A cross-sectional study was conducted among 2,306 school children in Guangzhou and Shenzhen. Questionnaire data on respiratory symptoms and diseases were collected along with sociodemographic and residential environmental information. A subset of children (N=987) were measured for their lung function. A random forest algorithm was applied to screen the top-ranked indoor environmental exposure variables and to form a composite index for cumulative risk of indoor pollution (CRIP). Logistic regressions were conducted to analyze the independent effect of single indoor environmental risk factors and the combined effect of CRIP on children's respiratory health. Multiple linear regressions were used to examine the independent and combined effects of indoor environmental exposure on lung function.

Results: We found that home dampness and molds as well as environmental tobacco smoke (ETS) were significantly and independently associated with increased prevalence of children's respiratory symptoms and diseases and with reduced lung function. A higher CRIP level was significantly associated with increased risk of cough with cold (OR =1.37, 95% CI: 1.05-1.79) and wheeze (OR =2.71, 95% CI: 1.16-6.34). A higher CRIP level was also associated with reduced lung function measured as FVC, FEV, PEF, FEF, FEF and VC.

Conclusions: In children living in the subtropical region of the Pearl River Delta, home dampness and the presence of mold as well as ETS were individual risk factors for children's respiratory health. The composite CRIP index was associated with respiratory symptoms and lung function, suggesting the utility of this index for predicting the combined effects of multiple risk factors.
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http://dx.doi.org/10.21037/jtd.2020.03.92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656417PMC
October 2020

Effects of indoor environment and lifestyle on respiratory health of children in Chongqing, China.

J Thorac Dis 2020 Oct;12(10):6327-6341

Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA.

Background: The prevalence of certain respiratory diseases of children in China appears to be on the rise in recent decades. This study aims to explore residential environmental factors that may affect respiratory diseases and lung function of children and to assess the effects of lifestyle (diet and exercise) on lung function.

Methods: The study was conducted in Chongqing, southwest of China in June, 2017. Information on respiratory diseases was obtained from 2,126 primary school children through a family questionnaire by purposive sampling. In addition, a random sample of 771 children participating in the family-questionnaire was selected for physical measurements and lung function test as well as lifestyle questionnaire survey. Chi-square test and multivariate logistic regressions were used to analyze the relationship between indoor environment and children's respiratory diseases. The effects of indoor environment and lifestyle on lung function indices were analyzed by t-test, variance analysis, and univariate and multivariate linear regression methods.

Results: Among residential environmental factors, indoor ventilation and air circulation were significant associated with children's respiratory health outcomes. The use of air conditioning for more than 8 h/day in summer was a risk factor for asthma with an adjusted odds ratio (AOR) of 1.99, bronchitis (AOR =1.62), and allergic rhinitis (AOR =1.51). Ventilation for less than 12 h per day during summer increased the risk for allergic rhinitis (AOR =1.40). Children living in homes with an opened kitchen had the risk of developing allergic rhinitis 1.51 times higher than children living in homes with a closed kitchen. Indoor dampness and mold were significantly associated with increased risks for childhood asthma (AOR =2.16), bronchitis (AOR =1.55) and allergic rhinitis (AOR =1.55). The frequent use of hygienic incense and mosquito coils also increased the risk for asthma (AOR =2.58) and bronchitis (AOR =1.42) in children. The multiple linear regression results showed that frequent use of air fresheners reduced children's peak expiratory flow (PEF) and small airway function (FEF) after potential influencing factors were adjusted for. Analyses of lifestyle variables showed that increased lung function (FVC, FEV, FEV) was associated with increasing consumption of vegetable and fruit as well as increasing time of physical exercise.

Conclusions: This study identified the following residential risk factors for children's respiratory diseases in Chongqing: poor indoor ventilation, home dampness and mold presence, and frequent use of hygienic incense and mosquito coils. Frequent use of air fresheners is associated with reduced lung function in children. High frequency consumption of vegetables, fruits and dairy products as well as daily exercise for more than 1 hour have positive effects on children's lung development.
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http://dx.doi.org/10.21037/jtd.2020.03.102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656398PMC
October 2020

Prevalence of respiratory diseases in relation to smoking rate in adults living in four Chinese cities: a comparison between 2017-2018 and 1993-1996.

J Thorac Dis 2020 Oct;12(10):6315-6326

Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China.

Background: The sustained high prevalence of smoking in China has contributed substantially to the burden of chronic diseases, including respiratory diseases. This study compared the prevalence of smoking and respiratory diseases in Chinese adults between two time periods spanning over 25 years.

Methods: Cross-sectional surveys were performed in four Chinese cities of Chongqing, Lanzhou, Wuhan, and Guangzhou in 1993-1996 (Period 1) and in 2017-2018 (Period 2). Participants completed questionnaires asking smoking status, the presence of asthma and chronic bronchitis, education attainment and household characteristics. Logistic regression models were used to estimate the odds ratios of disease prevalence with regard to active smoking status for men and passive smoking status for women.

Results: Prevalence of asthma, prevalence of chronic bronchitis, and smoking rate, all decreased from Period 1 to Period 2. We observed strong evidence that active smoking increased prevalence for both asthma and chronic bronchitis in men during Period 1, with spatial heterogeneity and modifying effect by college-level education. Home exposure to passive smoking was associated with increased odds of having chronic bronchitis among female participants in Chongqing during Period 2, although the association was not statistically significant.

Conclusions: The prevalence for asthma and chronic bronchitis were lower in 2017-2018 compared to 25 years ago in the same four Chinese cities. Decreased smoking rate may have contribution to the improvement of these respiratory diseases. Male smokers, especially those without college-level education, showed higher prevalence of chronic bronchitis compared to nonsmokers during Period 1.
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http://dx.doi.org/10.21037/jtd-19-crh-aq-002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656329PMC
October 2020

Twenty-Four-Hour Cardiovascular Effects of Electronic Cigarettes Compared With Cigarette Smoking in Dual Users.

J Am Heart Assoc 2020 12 19;9(23):e017317. Epub 2020 Nov 19.

Clinical Pharmacology Research Program Division of Cardiology Department of Medicine University of California San Francisco CA.

Background Cardiovascular safety is an important consideration regarding the benefits versus risks of electronic cigarette use (EC) for public health. The single-use cardiovascular effects of EC have been well studied but may not reflect effects of ad libitum use throughout the day. We aimed to compare the circadian hemodynamic effects as well as 24-hour biomarkers of oxidative stress, and platelet aggregation and inflammation, with ad libitum cigarette smoking (CS) versus EC versus no tobacco product use. Methods and Results Thirty-six healthy dual CS and EC users participated in a crossover study in a confined research setting. Circadian heart rate, blood pressure and plasma nicotine levels, 24-hour urinary catecholamines, 8-isoprostane and 11-dehydro-thromboxane B2, and plasma interleukin-6 and interleukin-8 were compared in CS, EC, and no nicotine conditions. Over 24 hours, and during daytime, heart rate and blood pressure were higher in CS and EC compared with no tobacco product conditions (<0.01). Heart rate on average was higher with CS versus EC. Urinary catecholamines, 8-isoprostane, and 11-dehydro-thromboxane B2 were not significantly different, but plasma IL-6 and IL-8 were higher with both CS and EC compared with no tobacco product (<0.01). Conclusions CS and EC had similar 24-hour patterns of hemodynamic effects compared with no tobacco product, with a higher average heart rate with CS versus EC, and similar effects on biomarkers of inflammation. EC may pose some cardiovascular risk, particularly to smokers with underlying cardiovascular disease, but may also provide a harm reduction opportunity for smokers willing to switch entirely to EC. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02470754.
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http://dx.doi.org/10.1161/JAHA.120.017317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763797PMC
December 2020

Associations of ozone exposure with urinary metabolites of arachidonic acid.

Environ Int 2020 12 7;145:106154. Epub 2020 Oct 7.

Nicholas School of the Environment, Duke University, Durham, NC 27705, USA; Global Health Institute, Duke University, Durham, NC 27708, USA; Duke Kunshan University, Kunshan City, Jiangsu Province 215316, China. Electronic address:

Background: Ozone (O) exposure has been associated with biomarkers of platelet activation and oxidative stress. The metabolism of arachidonic acid (AA) plays an important role in platelet activation and oxidative stress. However, AA metabolic pathways have not been examined in relation to O and other air pollutants.

Methods: Early morning urine and fasting blood were longitudinally collected up to four times from 89 healthy adults (22-52 years old, 25 women) in Changsha City, China. We measured three urinary AA metabolites, namely 11-dehydro-Thromboxane B2 (11-dhTXB) produced from the arachidonic cyclooxygenase pathway, 20-hydroxyeicosatetraenoic acid (20-HETE) from the CYPs pathway, and 8-isoprostane from the non-enzymatic pathway. Urinary malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured as indicators of oxidative damage to lipids and DNA, respectively. We measured soluble P-selectin (sCD62p) concentrations in plasma as an indicator of platelet activation. Indoor and outdoor air pollutants were measured and combined with participants' time-activity pattern to calculate personal exposure to O, PM, NO, and SO averaged over 12-hour, 24-hour, 1-week, and 2-week periods prior to biospecimen collection, respectively. Linear mixed-effects models were used to examine the relationships of AA metabolites with air pollutant exposures, plasma sCD62p, and urinary MDA & 8-OHdG.

Results: We found that a 10% increase in 12 h and 24 h O exposure were associated with increases in urinary11-dhTXB by 1.4% (95%, 0.1% to 2.6%) and 1.3% (0.05% to 2.5%), respectively. These associations remained robust after adjusting for co-pollutant exposures. No significant associations were observed between 11-dhTXB and other pollutants or between O exposures and other AA metabolites. All the three AA metabolites were significantly and positively associated with urinary MDA and 8-OHdG, whereas only urinary 11-dhTXB was significantly and positively associated with plasma sCD62p.

Conclusions: A metabolite of AA from the cyclooxygenase pathway was positively associated with short-term O exposure, and with a plasma marker of platelet activation and two urinary markers of oxidative stress. The results suggest that O exposure may contribute to increased platelet activation and oxidative damages via altering the metabolism of AA.
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http://dx.doi.org/10.1016/j.envint.2020.106154DOI Listing
December 2020

Malondialdehyde in Nasal Fluid: A Biomarker for Monitoring Asthma Control in Relation to Air Pollution Exposure.

Environ Sci Technol 2020 09 3;54(18):11405-11413. Epub 2020 Sep 3.

Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States.

Fine particulate matter (PM) and ozone (O) may exert oxidative damage in the nose, which is hypothesized to be associated with worsened asthma symptoms. This study, hence, is to explore whether an oxidative stress biomarker, malondialdehyde (MDA) in the nasal fluid, has the potential to aid personalized asthma control. In a panel study of 43 asthmatic children, 5-13 years old, each child was measured 4 times with a 2-week interval between consecutive clinic visits. At each visit, nasal fluid and urine samples were collected, and fractional exhaled nitric oxide (FeNO) was measured as a biomarker of pulmonary inflammation. In addition to nasal MDA, urinary MDA and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured as biomarkers of systemic oxidative stress. We also assessed asthma symptoms using the Childhood Asthma-Control Test (C-ACT). We found that interquartile range (IQR) increases in 24 h average personal PM exposure (22.2-33.5 μg/m), estimated 0 to 5 days prior to a clinic visit, were associated with increased nasal MDA concentrations by 38.6-54.9%. Similarly, IQR increases in 24 h average personal O exposure (7.7-8.2 ppb) estimated 2 to 4 days prior were associated with increased nasal MDA by 22.1-69.4%. Only increased PM exposure was associated with increased FeNO. Increased nasal MDA concentration was associated with decreased total and individual C-ACT scores, indicating worsening of asthma symptoms. However, no significant associations were observed between urinary MDA or 8-OHdG and C-ACT scores. The results confirm that oxidative stress plays an important role in linking air pollution exposure and adverse respiratory health effects. These findings support that MDA in the nasal fluid may serve as a useful biomarker for monitoring asthma status, especially in relation to PM and O exposures, two known risk factors of asthma exacerbation.
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http://dx.doi.org/10.1021/acs.est.0c02558DOI Listing
September 2020
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