Publications by authors named "Justin Manjourides"

45 Publications

Associations Between Work-Related Factors and Psychological Distress Among Construction Workers.

J Occup Environ Med 2021 Jul 7. Epub 2021 Jul 7.

Department of Physical Therapy, Movement, and Rehabilitation Science, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Dennerlein, Weinstein); Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Dennerlein, Manjourides); Behavioral Health Department, Reliant Medical Group, Worcester, Massachusetts (Eyllon); Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Eyllon, Manjourides, Lincoln); Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts (Eyllon, Garverich, Lincoln); Department of Anthropology and Sociology, College of Arts and Sciences, Northeastern University, Boston, Massachusetts (Vallas, Lincoln).

Objective: Identify work-related factors associated with the mental health and well-being of construction workers.

Methods: We completed eight key informant interviews, six worker focus groups, and a survey, informed by the interviews and focus groups, of 259 construction workers on five construction sites. Negative binomial regressions examined associations between psychological distress and work-related factors including safety climate, work-to-family conflict, psychological demands, social support, harassment, and job security.

Results: Three themes emerged from the interviews and focus groups, job demands and structure, social support and workplace relations, and job precarity. From the survey higher psychological demands, higher work-to-family conflict, lower supervisor support, higher discrimination, and higher likelihood of losing a job were associated with higher psychological distress. When combined into a single model job demands and work-to-family conflict remained significant.

Conclusions: Work-related factors were associated with high levels of distress.
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http://dx.doi.org/10.1097/JOM.0000000000002311DOI Listing
July 2021

Preterm birth and PM in Puerto Rico: evidence from the PROTECT birth cohort.

Environ Health 2021 Jun 11;20(1):69. Epub 2021 Jun 11.

Department of Civil and Environmental Engineering, Tufts University, Anderson Hall, 200 College Avenue, Medford, MA, 02155, USA.

Background: Preterm birth (PTB, birth before 37 weeks of gestation) has been associated with adverse health outcomes across the lifespan. Evidence on the association between PTB and prenatal exposure to air pollutants is inconsistent, and is especially lacking for ethnic/racial minority populations.

Methods: We obtained data on maternal characteristics and behaviors and PTB and other birth outcomes for women participating in the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, who lived in municipalities located along the North Coast of Puerto Rico. We assessed pre-natal PM exposures for each infant based on the nearest US Environmental Protection Agency monitor. We estimated prenatal phthalate exposures as the geometric mean of urinary measurements obtained during pregnancy. We then examined the association between PM and PTB using modified Poisson regression and assessed modification of the association by phthalate exposure levels and sociodemographic factors such as maternal age and infant gender.

Results: Among 1092 singleton births, 9.1% of infants were born preterm and 92.9% of mothers had at least a high school education. Mothers had a mean (standard deviation) age of 26.9 (5.5) years and a median (range) of 2.0 (1.0-8.0) pregnancies. Nearly all women were Hispanic white, black, or mixed race. Median (range) prenatal PM concentrations were 6.0 (3.1-19.8) μ g/m. Median (interquartile range) prenatal phthalate levels were 14.9 (8.9-26.0) and 14.5 (8.4-26.0), respectively, for di-n-butyl phthalate (DBP) and di-isobutyl phthalate (DiBP). An interquartile range increase in PM was associated with a 1.2% (95% CI 0.4, 2.1%) higher risk of PTB. There was little difference in PTB risk in strata of infant sex, mother's age, family income, history of adverse birth outcome, parity, and pre-pregnancy body mass index. Pregnancy urinary phthalate metabolite levels did not modify the PM-PTB association.

Conclusion: Among ethnic minority women in Puerto Rico, prenatal PM exposure is associated with a small but significant increase in risk of PTB.
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http://dx.doi.org/10.1186/s12940-021-00748-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196435PMC
June 2021

Associations of gestational phthalate exposure and non-nutritive suck among infants from the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) birth cohort study.

Environ Int 2021 07 16;152:106480. Epub 2021 Mar 16.

University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, Michigan, USA.

Background: Infant non-nutritive suck (NNS), or sucking on a pacifier with no nutrients being delivered, has been used as in index of brain function and has been linked to subsequent neurodevelopment. Yet, no data are available connecting NNS to environmental exposures in utero. The goal of this study was to examine the relationship between gestational exposure to phthalates (a group of chemicals found in personal care products, PVC plastics, and other products) and NNS among infants in a birth cohort study in Puerto Rico.

Methods: Urinary phthalate metabolite levels were measured in women at up to three time points in pregnancy as a measure of in utero exposure to the child. We calculated the geometric mean of each metabolite for each woman as a measure of exposure across gestation. Infants had their NNS sampled using our custom research pacifier between 4-6 (± 2 weeks) weeks of age, yielding the following NNS dependent measures: cycles/burst, frequency, amplitude, bursts/min, and cycles/min.

Results: Two hundred and eight mother-infant dyads completed this study We used multiple linear regression to assess associations between individual phthalate metabolites and NNS measurements, adjusting for infant sex, birthweight, and urinary specific gravity. An interquartile range (IQR) increase in mono carboxyisononyl phthalate across pregnancy was associated with 3.5% (95%CI: -6.2, -0.8%) lower NNS frequency and 8.9% (0.6, 17.3%) higher NNS amplitude. Similarly, an IQR increase in mono-2-ethylhexyl phthalate was also associated with 3.4% (-6.5, -0.2%) lower NNS frequency, while an IQR increase in di-2-ethylhexyl terephthalate metabolites was associated with 11.2% (2.9, 19.5%) higher NNS amplitude. Gestational exposure to phthalates may alter NNS amplitude and frequency in full-term infants. These findings indicate that the infants may be increasing their NNS amplitude to compensate for their slower NNS frequency. These preliminary findings could have important clinical implications for earlier detection of exposure-related deficits in neurofunction as well as implications for subsequent neurodevelopment and related interventions.
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http://dx.doi.org/10.1016/j.envint.2021.106480DOI Listing
July 2021

Measuring Criterion Validity of Microinteraction Ecological Momentary Assessment (Micro-EMA): Exploratory Pilot Study With Physical Activity Measurement.

JMIR Mhealth Uhealth 2021 03 10;9(3):e23391. Epub 2021 Mar 10.

Khoury College of Computer Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.

Background: Ecological momentary assessment (EMA) is an in situ method of gathering self-report on behaviors using mobile devices. In typical phone-based EMAs, participants are prompted repeatedly with multiple-choice questions, often causing participation burden. Alternatively, microinteraction EMA (micro-EMA or μEMA) is a type of EMA where all the self-report prompts are single-question surveys that can be answered using a 1-tap glanceable microinteraction conveniently on a smartwatch. Prior work suggests that μEMA may permit a substantially higher prompting rate than EMA, yielding higher response rates and lower participation burden. This is achieved by ensuring μEMA prompt questions are quick and cognitively simple to answer. However, the validity of participant responses from μEMA self-report has not yet been formally assessed.

Objective: In this pilot study, we explored the criterion validity of μEMA self-report on a smartwatch, using physical activity (PA) assessment as an example behavior of interest.

Methods: A total of 17 participants answered 72 μEMA prompts each day for 1 week using a custom-built μEMA smartwatch app. At each prompt, they self-reported whether they were doing sedentary, light/standing, moderate/walking, or vigorous activities by tapping on the smartwatch screen. Responses were compared with a research-grade activity monitor worn on the dominant ankle simultaneously (and continuously) measuring PA.

Results: Participants had an 87.01% (5226/6006) μEMA completion rate and a 74.00% (5226/7062) compliance rate taking an average of only 5.4 (SD 1.5) seconds to answer a prompt. When comparing μEMA responses with the activity monitor, we observed significantly higher (P<.001) momentary PA levels on the activity monitor when participants self-reported engaging in moderate+vigorous activities compared with sedentary or light/standing activities. The same comparison did not yield any significant differences in momentary PA levels as recorded by the activity monitor when the μEMA responses were randomly generated (ie, simulating careless taps on the smartwatch).

Conclusions: For PA measurement, high-frequency μEMA self-report could be used to capture information that appears consistent with that of a research-grade continuous sensor for sedentary, light, and moderate+vigorous activity, suggesting criterion validity. The preliminary results show that participants were not carelessly answering μEMA prompts by randomly tapping on the smartwatch but were reporting their true behavior at that moment. However, more research is needed to examine the criterion validity of μEMA when measuring vigorous activities.
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http://dx.doi.org/10.2196/23391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991987PMC
March 2021

Should we adjust for delivery hospital in studies of air pollution and pregnancy outcomes?

Environ Epidemiol 2019 Oct 14;3(5):e064. Epub 2019 Oct 14.

Departments of Epidemiology.

In conducting a study of ambient air pollution and pregnancy outcome in New York City, we identified delivery hospital as a potential confounder, given its association with both maternal residence and therefore air pollution exposure, and with clinical practices and as a potential marker of outcome misclassification in the coding of pregnancy complications. Motivated by evidence that adjustment for delivery hospital affected associations between air pollution and pregnancy outcome, we undertook a detailed empirical examination of the role of delivery hospital that warrants consideration by others addressing this topic.

Methods: In a study of air pollution and pregnancy outcome, we identified births from 2008 to 2010 to residents of New York City and, after restrictions, included 238,960 in the analysis. Air pollution exposure estimates for ambient fine particles (PM) and nitrogen dioxide (NO) were derived from a community-wide exposure study and assigned based on geocoded maternal residence. We examined the impact of adjusting for delivery hospital and explored the relationship between delivery hospital and both exposure and pregnancy outcomes.

Results: Statistical adjustment for delivery hospital markedly attenuated the relationship of air pollution with birth weight and gestational hypertension, with smaller effects on preterm birth and preeclampsia. Delivery hospital was associated with estimated maternal air pollution levels after adjusting for individual-level patient characteristics, more strongly for PM than for NO. Delivery hospital predicted pregnancy outcome after adjustment for individual attributes, with larger hospitals and those that managed a greater volume of complicated cases having lower birth weight, more medically indicated preterm births, and more diagnosed gestational hypertension. Evaluation through the use of directed acyclic graphs illustrates the potential for adjustment for hospital to reduce residual spatial confounding, but also indicates the possibility of introducing bias through adjustment of a mediator.

Conclusions: Based on these results, delivery hospital warrants closer consideration in studies of air pollution and other spatial factors in relation to pregnancy outcomes. The possibility of confounding by delivery hospital needs to be balanced with the risk of adjusting for a mediator of the air pollution-pregnancy outcome association in studies of this type.
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http://dx.doi.org/10.1097/EE9.0000000000000064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608891PMC
October 2019

Comparison of censoring assumptions to reduce bias in tuberculosis treatment cohort analyses.

PLoS One 2020 19;15(10):e0240297. Epub 2020 Oct 19.

Dept. Health Sciences, Northeastern University, Boston, MA, United States of America.

Objective: Observational tuberculosis cohort studies are often limited by a lack of long-term data characterizing survival beyond the initial treatment outcome. Though Cox proportional hazards models are often applied to these data, differential risk of long-term survival, dependent on the initial treatment outcome, can lead to violations of model assumptions. We evaluate the performance of two alternate censoring approaches on reducing bias in treatment effect estimates.

Design: We simulate a typical multidrug-resistant tuberculosis cohort study and use Cox proportional hazards models to assess the relationship of an aggressive treatment regimen with hazard of death. We compare three assumptions regarding censored observations to determine which produces least biased treatment effect estimates: conventional non-informative censoring, an extension of short-term survival informed by literature, and incorporation of predicted long-term vital status.

Results: The treatment regimen's protective effect on death is consistently underestimated by the conventional censoring method, up to 7.6%. Models using the two alternative censoring techniques produce treatment effect estimates consistently stronger and less biased than the conventional method, underestimating the treatment effect by less than 2.4% across all scenarios.

Conclusions: When model assumptions are violated, alternative censoring techniques can more accurately estimate associations between treatment and long-term survival. In multidrug-resistant tuberculosis cohort analyses, this bias reduction may yield more accurate and, larger effect estimates. This bias reduction can be achieved through use of standard statistical procedures with a simple re-coding of the censoring indicator.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240297PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571697PMC
December 2020

Cohort profile: Center for Research on Early Childhood Exposure and Development in Puerto Rico.

BMJ Open 2020 07 19;10(7):e036389. Epub 2020 Jul 19.

Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA.

Purpose: Puerto Rican children experience high rates of asthma and obesity. Further, infants born in Puerto Rico are more at risk for being born prematurely compared with infants on the mainland USA. Environmental exposures from multiple sources during critical periods of child development, potentially modified by psychosocial factors, may contribute to these adverse health outcomes. To date, most studies investigating the health effects of environmental factors on infant and child health have focused on single or individual exposures.

Participants: Infants currently in gestation whose mother is enrolled in Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, and infants and children already born to mothers who participated in the PROTECT study.

Findings To Date: Data collection and processing remains ongoing. Demographic data have been collected on 437 mother-child pairs. Birth outcomes are available for 420 infants, neurodevelopmental outcomes have been collected on 319 children. Concentrations of parabens and phenols in maternal spot urine samples have been measured from 386 mothers. Center for Research on Early Childhood Exposure and Development mothers have significantly higher urinary concentrations of dichlorophenols, triclosan and triclocarban, but lower levels of several parabens compared with reference values from a similar population drawn from the National Health and Nutrition Examination Survey.

Future Plans: Data will continue to be collected through recruitment of new births with a target of 600 children. Seven scheduled follow-up visits with existing and new participants are planned. Further, our research team continues to work with healthcare providers, paediatricians and early intervention providers to support parent's ability to access early intervention services for participants.
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http://dx.doi.org/10.1136/bmjopen-2019-036389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371225PMC
July 2020

Designing a Participatory Total Worker Health Organizational Intervention for Commercial Construction Subcontractors to Improve Worker Safety, Health, and Well-Being: The "ARM for Subs" Trial.

Int J Environ Res Public Health 2020 07 15;17(14). Epub 2020 Jul 15.

Harvard Center for Work, Health, and Well-Being, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

Evidence supports organizational interventions as being effective for improving worker safety, health and well-being; however, there is a paucity of evidence-based interventions for subcontracting companies in commercial construction. A theory-driven approach supplemented by formative research through key stakeholder interviews and focus groups and an iterative vetting process with stakeholders, resulted in the development of an intervention for subcontractors in the commercial construction industry. We piloted the intervention in one subcontracting commercial construction company. We used these findings to adapt and finalize the intervention design to be tested in a future large-scale trial. There were several key findings from the formative research, including challenges faced by companies and assets that should be considered in the intervention design. This resulted in a communication infrastructure company-based, continual improvement, participatory intervention design, consisting of a needs assessment and report, committee-led prioritization, action planning and implementation, and worker communication/feedback cycle. The pilot contributed to the final intervention design with modifications made with respect to timing, implementation support, capacity building, adaptability and sustainability. The use of a theory-driven participatory approach to developing an integrated organizational intervention for commercial construction subcontracting companies was important and necessary. It allowed us to consider the empirical evidence and relevant theories and tailor these to meet the needs of our target population. This study gives pragmatic insight into the early development of a complex intervention, with practical experience of how we adapted our intervention at each stage. This intervention will be tested in a future randomized trial.
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http://dx.doi.org/10.3390/ijerph17145093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400451PMC
July 2020

Associations between a safety prequalification survey and worker safety experiences on commercial construction sites.

Am J Ind Med 2020 09 9;63(9):766-773. Epub 2020 Jun 9.

Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.

Background: While assessment of subcontractors' safety performance during project bidding processes are common in commercial construction, the validation of organizational surveys used in these processes is largely absent.

Methods: As part of a larger research project called Assessment of Contractor Safety (ACES), we designed and tested through a cross-sectional study, a 63-item organizational survey assessing subcontractors' leading indicators of safety performance. We administered the ACES Survey to 43 subcontractors on 24 construction sites. Concurrently, we captured the safety climate of 1426 workers on these sites through worker surveys, as well as injury rates, for the duration of the project.

Results: At the worksite level, higher average ACES scores were associated with higher worker safety climate scores (P < .01) and lower rates of injury involving days away (P < .001). Within subcontracting companies, no associations were observed between ACES and worker safety climate scores and injuries.

Conclusions: These results suggest the overall and collective importance of the construction project and its worksite in mediating worker experiences, perhaps somewhat independent of the individual subcontractor level.
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http://dx.doi.org/10.1002/ajim.23143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641207PMC
September 2020

Low birth weight and PM in Puerto Rico.

Environ Epidemiol 2019 Aug;3(4)

Department of Civil and Environmental Engineering, Tufts University, Medford, MA.

Background: Low birth weight (LBW) has been associated with adverse health outcomes across the lifespan. Among ethnic/racial minority populations, few studies have examined the association between LBW (<2,500 or ≥2,500 g) and prenatal exposure to air pollution, a key modifiable environmental risk factor.

Methods: We examined the association between LBW and prenatal exposure to PM in a Hispanic and black population in Puerto Rico between 1999 and 2013, adjusting for individual and municipality-level confounders. We used modified Poisson regression to estimate the association and performed sensitivity analyses treating birth weight as continuous or polychotomous. In secondary analyses, we applied a 2-stage mixed effects model suitable for longitudinally measured exposures and binary outcomes.

Results: Among 332,129 total and 275,814 term births, 12.2% and 6.3% of infants had LBW, respectively. Eighty-eight percent of mothers were Hispanic. Mean (SD) PM concentrations declined from 9.9 (1.7) μg/m in 1999 to 6.1 (1.1) μg/m in 2013. Mean birth weights dropped to 3,044 g in 2010 and rose steadily afterward. Among term births, a SD increase in PM was associated with a 3.2% (95% CI = -1.0%, 6.3%) higher risk of LBW. First (risk ratio, 1.02; 95% CI = 1.00, 1.04) and second (1.02; 95% CI = 1.01, 1.05) trimester exposures were associated with increased LBW risk. In a 2-stage approach that longitudinally modeled monthly prenatal exposure levels, a standard deviation increase in average PM was associated with higher risk of LBW (odds ratio, 1.04; 95% CI = 1.01, 1.08).

Conclusions: In Puerto Rico, LBW is associated with prenatal PM exposure.
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http://dx.doi.org/10.1097/EE9.0000000000000058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039618PMC
August 2019

The impact of long-term PM exposure on specific causes of death: exposure-response curves and effect modification among 53 million U.S. Medicare beneficiaries.

Environ Health 2020 02 17;19(1):20. Epub 2020 Feb 17.

Department of Civil & Environmental Engineering, Tufts University, Medford, MA, USA.

Background: The shape of the exposure-response curve for long-term ambient fine particulate (PM) exposure and cause-specific mortality is poorly understood, especially for rural populations and underrepresented minorities.

Methods: We used hybrid machine learning and Cox proportional hazard models to assess the association of long-term PM exposures on specific causes of death for 53 million U.S. Medicare beneficiaries (aged ≥65) from 2000 to 2008. Models included strata for age, sex, race, and ZIP code and controlled for neighborhood socio-economic status (SES) in our main analyses, with approximately 4 billion person-months of follow-up, and additionally for warm season average of 1-h daily maximum ozone exposures in a sensitivity analysis. The impact of non-traffic PM on mortality was examined using two stage models of PM and nitrogen dioxide (NO).

Results: A 10 μg /m increase in 12-month average PM prior to death was associated with a 5% increase in all-cause mortality, as well as an 8.8, 5.6, and 2.5% increase in all cardiovascular disease (CVD)-, all respiratory-, and all cancer deaths, respectively, in age, gender, race, ZIP code, and SES-adjusted models. PM exposures, however, were not associated with lung cancer mortality. Results were not sensitive to control for ozone exposures. PM-mortality associations for CVD- and respiratory-related causes were positive and significant for beneficiaries irrespective of their sex, race, age, SES and urbanicity, with no evidence of a lower threshold for response or of lower Risk Ratios (RRs) at low PM levels. Associations between PM and CVD and respiratory mortality were linear and were higher for younger, Black and urban beneficiaries, but were largely similar by SES. Risks associated with non-traffic PM were lower than that for all PM and were null for respiratory and lung cancer-related deaths.

Conclusions: PM was associated with mortality from CVD, respiratory, and all cancer, but not lung cancer. PM-associated risks of CVD and respiratory mortality were similar across PM levels, with no evidence of a threshold. Blacks, urban, and younger beneficiaries were most vulnerable to the long-term impacts of PM on mortality.
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http://dx.doi.org/10.1186/s12940-020-00575-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026980PMC
February 2020

Corrections for measurement error due to delayed onset of illness for case-crossover designs.

Biometrics 2020 09 28;76(3):963-972. Epub 2019 Nov 28.

Department of Epidemiology, Brown University, Providence, 02912, Rhode Island.

Epidemiologic studies of the short-term effects of ambient particulate matter (PM) on the risk of acute cardiovascular or cerebrovascular events often use data from administrative databases in which only the date of hospitalization is known. A common study design for analyzing such data is the case-crossover design, in which exposure at a time when a patient experiences an event is compared to exposure at times when the patient did not experience an event within a case-control paradigm. However, the time of true event onset may precede hospitalization by hours or days, which can yield attenuated effect estimates. In this article, we consider a marginal likelihood estimator, a regression calibration estimator, and a conditional score estimator, as well as parametric bootstrap versions of each, to correct for this bias. All considered approaches require validation data on the distribution of the delay times. We compare the performance of the approaches in realistic scenarios via simulation, and apply the methods to analyze data from a Boston-area study of the association between ambient air pollution and acute stroke onset. Based on both simulation and the case study, we conclude that a two-stage regression calibration estimator with a parametric bootstrap bias correction is an effective method for correcting bias in health effect estimates arising from delayed onset in a case-crossover study.
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http://dx.doi.org/10.1111/biom.13173DOI Listing
September 2020

Daily ambient temperature is associated with biomarkers of kidney injury in older Americans.

Environ Res 2019 12 1;179(Pt A):108790. Epub 2019 Oct 1.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.

Background: Increases in ambient temperature have recently been associated with increased emergency department visits and hospital admissions for acute renal failure. However, potential biological mechanisms through which short-term ambient temperature affects kidney function are not known.

Methods: We used multiple regression models to evaluate the association between 1- and 3-day average, ambient temperature levels and two biomarkers of kidney injury (neutrophil gelatinase-associated lipocalin (NGAL) and adiponectin), among 3377 individuals over 57 years of age enrolled in the National Social Life, Health, and Aging Project. Ambient temperature was estimated on a 6-km grid covering the conterminous United States using ambient temperature measurements obtained from the National Climatic Data Center (NCDC). NGAL and adiponectin levels were measured from whole blood collected for each participant. All health effect models were adjusted for a number of demographics, socioeconomic, health behavior, medical history variables, with non-linear exposure-response relationships examined using natural cubic splines.

Results: The relationship between 1- and 3-day average temperature and both NGAL and adiponectin levels was significant and non-linear, with largely null associations below 10 °C, and positive association for temperatures >10 °C. In fully adjusted, linear multiple regression models restricted to >10 °C, NGAL and adiponectin levels increased by 1.89% (95% CI: 0.77, 3.91) and 2.51% (95% CI: 1.34, 3.69), respectively, for a 1 °C increase in daily average temperature. Additionally, every 1 °C increase in temperature over 10 °C was associated with a 1.83% increased odds of having plasma NGAL levels consistent with acute kidney injury (>150 μg/L).

Conclusions: In a cohort of older men and women in the United States, our study is the first to observe that short-term ambient temperature exposures were significantly associated with biomarkers of kidney injury. These associations suggest that ambient temperature exposures could be an important risk factor for renal pathology.
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http://dx.doi.org/10.1016/j.envres.2019.108790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893879PMC
December 2019

Long-term ozone exposures and cause-specific mortality in a US Medicare cohort.

J Expo Sci Environ Epidemiol 2020 07 16;30(4):650-658. Epub 2019 Apr 16.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.

We examined the association of long-term, daily 1-h maximum O (ozone) exposures on cause-specific mortality for 22.2 million US Medicare beneficiaries between 2000-2008. We modeled the association between O and mortality using age-gender-race stratified log-linear regression models, adjusted for state of residence. We examined confounding by (1) adjusting for PM (particles with aerodynamic diameters <2.5 μm) and NO (nitrogen dioxide) exposures, temperature, and neighborhood-level characteristics and behaviors, and (2) decomposing O into its temporal and spatio-temporal components and comparing estimated risk ratios. We also examined sensitivity of our results to alternate exposure measures based on warm-season 8-h daily maximum and 24-h average exposures. We found increased risks from long-term O exposures to be strongest and most consistent for mortality from respiratory disease (1.030, 95% CI: 1.027, 1.034) (including COPD (chronic obstructive pulmonary disease)), CHF (congestive heart failure), and lung cancer (1.015, 95% CI: 1.010, 1.020), with no evidence of confounding by PM, NO, and temperature and with results similar across O exposure measures. While significant, associations between long-term O exposures and CVD (cardiovascular)-related mortality (1.005, 95% CI: 1.003, 1.007) were confounded by PM and varied with the exposure measure, with associations no longer significantly positive when warm-season 8-h maximum or 24-h average O was used to assess exposures. In this large study, we provide strong evidence that O exposure is associated with mortality from respiratory-related causes and for the first-time, lung cancer, but raise questions regarding O-related impacts on CVD mortality. Our findings demonstrate the need to further identify potential confounders.
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http://dx.doi.org/10.1038/s41370-019-0135-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197379PMC
July 2020

Testing the associations between leading and lagging indicators in a contractor safety pre-qualification database.

Am J Ind Med 2019 04 6;62(4):317-324. Epub 2019 Feb 6.

Department of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.

Background: Safety prequalification assessing contractors' safety management systems and safety programs lack validation in predicting construction worker injuries.

Methods: Safety assessments of leading indicators from 2198 construction contractors, including Safety Management Systems (SMS), Safety Programs (e.g., falls, hearing protection), and Special Elements (drug testing, return to work) scales as well as the history of citations from the Occupational Safety and Health Administration (OSHA) were compared to contractors' lagging indicators of recordable injury case rates (RC) and rates of injuries involving days away, restricted, or transferred (DART).

Results: Increased SMS scores were related to lower injury rates. Each one-point increase in SMS values was associated with 34% reduced odds of a recordable case rate greater than zero (Odds ratio (OR): 0.66, 95% Confidence Interval (CI): (0.57, 0.79)), and a 9% reduced recordable case rate, if one occurs (Risk Ratio (RR): 0.91, 95% CI: (0.88, 0.94)). A one-point increase in SMS was associated with 28% reduced odds of a DART (OR = 0.72, 95%CI (0.56, 0.91)), and 9% reduced DART rate, if one occurs (RR = 0.91, 95%CI (0.87, 0.95)). Safety programs did not show consistent associations with injury outcomes. Having additional Special Elements related to drug and alcohol programs was associated with lower injury rates while the Special Element related to return to work showed no consistent associations with injury. Having more OSHA Citations was associated with lower injury rates for companies with injuries.

Conclusions: These results support pre-qualification methods based on SMS and suggest the need for safety management systems in contractors.
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http://dx.doi.org/10.1002/ajim.22951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666568PMC
April 2019

Long-term NO exposures and cause-specific mortality in American older adults.

Environ Int 2019 03 9;124:10-15. Epub 2019 Jan 9.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States.

Background: The impact of long-term exposure to nitrogen dioxide (NO) on cause-specific mortality is poorly understood.

Objective: To assess mortality risks associated with long-term NO exposure and evaluate confounding of this association.

Methods: We examined the association between 12-month moving average NO exposure and cause-specific mortality in 14.1 million US Medicare beneficiaries between 2000 and 2008. Associations were examined using age, gender, and race-stratified and state-adjusted Poisson regression models. We assessed the potential for confounding by PM and behavioral covariates and unmeasured confounding by decomposing NO into its spatial and spatio-temporal components.

Results: We found significant associations between 12-month NO exposure and increased mortality from all-causes [risk ratio (RR): 1.052; 95% CI: 1.051, 1.054; per 10 ppb], cardiovascular (CVD) (1.133; 95% CI: 1.130, 1.137) and respiratory disease (1.050; 95% CI: 1.044, 1.056), all cancers (1.021; 95% CI: 1.017, 1.025), ischemic heart disease (IHD) (1.221; 95% CI: 1.217, 1.226), cerebrovascular (CBV) disease (1.092; 95% CI: 1.085, 1.100), and for the first time pneumonia (1.275; 95% CI: 1.263, 1.287). Associations generally remained positive and statistically significant after adjustment for PM and behavioral factors.

Conclusions: Our findings provide additional evidence of the increased risk posed by long-term NO exposures on increased mortality from all-causes, CVD, respiratory disease, IHD, CBV, and cancer and provide new evidence of their impact on mortality from pneumonia. Unmeasured confounding of these associations was present, however, demonstrating the need to understand sources of this confounding.
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http://dx.doi.org/10.1016/j.envint.2018.12.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123874PMC
March 2019

Close proximity to roadway and urbanicity associated with mental ill-health in older adults.

Sci Total Environ 2019 Mar 15;658:854-860. Epub 2018 Dec 15.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02153, United States of America. Electronic address:

Evidence for the association between built environment and mental ill health, especially in older population where mental ill health is common, remains inconclusive. We examined the association of roadway distance and urbanicity, measured as percentage of urban land use within 1 km from participants' residence, with mental ill-health in a longitudinal study of community-dwelling older adults in the United States between 2005 and 2006 and 2011-2012. We evaluated perceived stress, depression and anxiety symptoms using the Cohen's Perceived Stress Scale, the Center for Epidemiological Studies - Depression, and the Hospital Anxiety and Depression Scale - anxiety subscale, respectively. Increment in roadway distance was significantly associated with -0.03 point (95% CI: -0.05, -0.01) change in depressive score, with loneliness and PM partially mediating the observed associations. Age, gender, race/ethnicity, and physical activity significantly modified the distance-depression association. Anxiety was inversely associated with roadway distance (-0.02; 95% CI: -0.03, 0.00), though the associations became insignificant upon adjusting for road traffic or noise. Urbanicity was significantly associated with 0.29 (95% CI: 0.10, 0.57) point increase in depressive symptoms in multivariable model; the association was partly mediated by loneliness, physical activity, social support and air pollution. No association was found between roadway distance and perceived stress, and between urbanicity, and anxiety and perceived stress. Built environment was associated with mental ill health, partially through pathways related to air pollution and certain individual characteristics (e.g. loneliness). Our study warrants further examination of the mediation and interaction of the built environment-mental health association.
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http://dx.doi.org/10.1016/j.scitotenv.2018.12.221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004241PMC
March 2019

Use of predicted vital status to improve survival analysis of multidrug-resistant tuberculosis cohorts.

BMC Med Res Methodol 2018 12 11;18(1):166. Epub 2018 Dec 11.

Department of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.

Background: Multidrug-resistant tuberculosis (MDR-TB) cohorts often lack long-term survival data, and are summarized instead by initial treatment outcomes. When using Cox proportional hazards models to analyze these cohorts, this leads to censoring subjects at the time of the initial treatment outcome, instead of them providing full survival data. This may violate the non-informative censoring assumption of the model and may produce biased effect estimates. To address this problem, we develop a tool to predict vital status at the end of a cohort period using the initial treatment outcome and assess its ability to reduce bias in treatment effect estimates.

Methods: We derive and apply a logistic regression model to predict vital status at the end of the cohort period and modify the unobserved survival outcomes to better match the predicted survival experience of study subjects. We compare hazard ratio estimates for effect of an aggressive treatment regimen from Cox proportional hazards models using time to initial treatment outcome, predicted vital status, and true vital status at the end of the cohort period.

Results: Models fit from initial treatment outcomes underestimate treatment effects by up to 22.1%, while using predicted vital status reduced this bias by 5.4%. Models utilizing the predicted vital status produce effect estimates consistently stronger and closer to the true treatment effect than estimates produced by models using the initial treatment outcome.

Conclusions: Although studies often use initial treatment outcomes to estimate treatment effects, this may violate the non-informative censoring assumption of the Cox proportional hazards model and result in biased treatment effect estimates. Using predicted vital status at the end of the cohort period may reduce this bias in the analyses of MDR-TB treatment cohorts, yielding more accurate, and likely larger, treatment effect estimates. Further, these larger effect sizes can have downstream impacts on future study design by increasing power and reducing sample size needs.
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http://dx.doi.org/10.1186/s12874-018-0637-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290510PMC
December 2018

Fine Particle Sources and Cognitive Function in An Older Puerto Rican Cohort in Greater Boston.

Environ Epidemiol 2018 Sep;2(3)

Department of Civil and Environmental Engineering, Tufts University, Medford, MA.

Background: Puerto Ricans living in the mainland US have substantially higher rates of impairment to cognitive performance as compared to non-Hispanic Whites, with air pollutant exposures a potential risk factor. We investigated whether exposures to specific air pollution sources were associated with performance across several cognitive domains in a cohort of Puerto Rican older adults.

Objectives: To investigate the association between sources of PM and cognitive performance in each of five cognitive domains.

Methods: We obtained demographic, health, and cognitive function data for 1500 elderly participants of the Boston Puerto Rican Health Study (BPRHS). Cognitive function was assessed in each of two waves for five domains: verbal memory, recognition, mental processing, and executive and visuospatial function. To these data, we linked concentrations of fine particulate matter (PM) and its components, black carbon (BC), nickel, sulfur, and silicon, as tracers for PM from traffic, oil combustion, coal combustion, and resuspended dust, respectively. Associations between each PM component and cognitive domain were examined using linear mixed models.

Results: One year moving average exposures to BC were significantly associated with decreased verbal memory (-0.38;95% CI: -0.46,-0.30), recognition (-0.35; 95% CI: -0.46,-0.25), mental processing (-1.14; 95% CI: -1.55,-0.74), and executive function (-0.94; 95% CI: -1.31,-0.56). Similar associations were found for nickel. Associations for sulfur, and silicon, and PM were generally null, although sulfur (-0.51; 95% CI -0.75,-0.28) silicon (-0.25; 95% CI: -0.36,-0.13) and PM (-0.35; 95% CI: -0.57,-0.12) were associated with decreased recognition.

Conclusion: Long-term exposures to BC and nickel, tracers of traffic and oil combustion, respectively, were associated with decreased cognitive function across all domains, except visuospatial function.
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http://dx.doi.org/10.1097/EE9.0000000000000022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261496PMC
September 2018

A Cluster Randomized Controlled Trial of a Total Worker Health Intervention on Commercial Construction Sites.

Int J Environ Res Public Health 2018 10 25;15(11). Epub 2018 Oct 25.

Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

This study evaluated the efficacy of an integrated Total Worker Health program, "All the Right Moves", designed to target the conditions of work and workers' health behaviors through an ergonomics program combined with a worksite-based health promotion Health Week intervention. A matched-pair cluster randomized controlled trial was conducted on ten worksites (five intervention ( = 324); five control sites ( = 283)). Worker surveys were collected at all sites pre- and post- exposure at one- and six-months. Linear and logistic regression models evaluated the effect of the intervention on pain and injury, dietary and physical activity behaviors, smoking, ergonomic practices, and work limitations. Worker focus groups and manager interviews supplemented the evaluation. After controlling for matched intervention and control pairs as well as covariates, at one-month following the ergonomics program we observed a significant improvement in ergonomic practices (B = 0.20, = 0.002), and a reduction in incidences of pain and injury (OR = 0.58, = 0.012) in the intervention group. At six months, we observed differences in favor of the intervention group for a reduction in physically demanding work (B = -0.25, = 0.008), increased recreational physical activity (B = 35.2, = 0.026) and higher consumption of fruits and vegetables (B = 0.87, = 0.008). Process evaluation revealed barriers to intervention implementation fidelity and uptake, including a fissured multiemployer worksite, the itinerant nature of workers, competing production pressures, management support, and inclement weather. The All the Right Moves program had a positive impact at the individual level on the worksites with the program. For the longer term, the multi-organizational structure in the construction work environment needs to be considered to facilitate more upstream, long-term changes.
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http://dx.doi.org/10.3390/ijerph15112354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265748PMC
October 2018

Microinteraction Ecological Momentary Assessment Response Rates: Effect of Microinteractions or the Smartwatch?

Proc ACM Interact Mob Wearable Ubiquitous Technol 2017 Sep;1(3)

Northeastern University, Boston MA.

Mobile-based ecological-momentary-assessment (EMA) is an in-situ measurement methodology where an electronic device prompts a person to answer questions of research interest. EMA has a key limitation: interruption burden. Microinteraction-EMA(μEMA) may reduce burden without sacrificing high temporal density of measurement. In μEMA, all EMA prompts can be answered with 'at a glance' microinteractions. In a prior 4-week pilot study comparing standard EMA delivered on a phone (phone-EMA) vs. μEMA delivered on a smartwatch (watch-μEMA), watch-μEMA demonstrated higher response rates and lower perceived burden than phone-EMA, even when the watch-μEMA interruption rate was 8 times more than phone-EMA. A new 4-week dataset was gathered on smartwatch-based EMA (i.e., watch-EMA with 6 back-to-back, multiple-choice questions on a watch) to compare whether the high response rates of watch-μEMA previously observed were a result of using microinteractions, or due to the novelty and accessibility of the smartwatch. No statistically significant differences in compliance, completion, and first-prompt response rates were observed between phone-EMA and watch-EMA. However, watch-μEMA response rates were significantly higher than watch-EMA. This pilot suggests that (1) the high compliance and low burden previously observed in watch-μEMA is likely due to the microinteraction question technique, not simply the use of the watch versus the phone, and that (2) compliance with traditional EMA (with long surveys) may not improve simply by moving survey delivery from the phone to a smartwatch.
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http://dx.doi.org/10.1145/3130957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128356PMC
September 2017

Establishing a relationship between the effect of caffeine and duration of endurance athletic time trial events: A systematic review and meta-analysis.

J Sci Med Sport 2019 Feb 20;22(2):232-238. Epub 2018 Aug 20.

Department of Health Sciences, Northeastern University, United States.

Objectives: Caffeine has well-documented benefits on endurance athletic performance. Because of caffeine's ergogenic effects of reducing perceived fatigue, it is hypothesized that as duration of athletic event increases, so will the effect size of caffeine upon performance. This study aims to examine the relationship between duration of endurance athletic event and the effect size of caffeine compared to placebo for athletic performance.

Design: A systematic review and meta-analysis of placebo-controlled trials assessing the effects of caffeine in adults performing endurance athletic events.

Methods: We searched MedLine, Web of Science, and review article references published through March 2016. We performed meta-analyses on placebo-controlled trials to determine the effect of the duration of an endurance athletic event on the standardized mean difference (Cohen's d) between the caffeine and placebo groups for athletic performance.

Results: Forty articles including 56 unique comparison groups were included. Pooled results showed a Cohen's d of 0.33 (95% CI=0.21, 0.45; p=1.00; I=0%). The effect of the duration of athletic event was significantly associated with Cohen's d (Relative Risk: 0.005; 95% CI=0.001, 0.009; p=0.024). For a 30min increase in duration of the athletic event, Cohen's d will increase by 0.150.

Conclusions: This study is the first to report on the statistical finding that the effect size of caffeine increases along with the increasing duration of the time trial event. Endurance athletes may especially benefit from caffeine for performance enhancement.
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http://dx.doi.org/10.1016/j.jsams.2018.07.022DOI Listing
February 2019

Social and Structural Determinants of Smoking Status and Quit Attempts Among Adults Living in 12 US States, 2015.

Am J Health Promot 2019 05 2;33(4):498-506. Epub 2018 Aug 2.

4 Dana-Farber Cancer Institute, Boston, MA, USA.

Purpose: This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts.

Design: Secondary data analysis of cross-sectional data.

Setting: Data come from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), Social Context module. A national, representative sample from 12 US states (Alabama, Arkansas, Delaware, District of Columbia, Georgia, Louisiana, Minnesota, Mississippi, Missouri, Rhode Island, Tennessee, and Utah).

Participants: A total of 64 053 noninstitutionalized US adults aged ≥18 years.

Measures: Smoking status and quit attempts were outcome variables. Individual-level structural determinants (age, sex, race/ethnicity, marital status, education, and employment status) and intermediary determinants (housing insecurity, food insecurity, health insurance, binge drinking, and general health mental health) from BRFSS.

Analysis: Weighted multivariate, multinomial logistic regression.

Results: Current smoking was greater among men, respondents aged between 35 to 64 and 55 to 64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic Black, graduated college, and reported food and housing insecurity.

Conclusion: Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use and may be needed to enhance smoking cessation rates among racially diverse adults.
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http://dx.doi.org/10.1177/0890117118792827DOI Listing
May 2019

Association of neighborhood greenness with self-perceived stress, depression and anxiety symptoms in older U.S adults.

Environ Health 2018 04 16;17(1):39. Epub 2018 Apr 16.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, 02153, USA.

Background: Neighborhood environment, such as green vegetation, has been shown to play a role in coping with stress and mental ill health. Yet, epidemiological evidence of the association between greenness and mental health is inconsistent.

Methods: We examined whether living in green space is associated with self-perceived stress, depressive and anxiety symptoms in a nationally representative, longitudinal sample of community-dwelling older adults (N = 4118; aged 57-85 years) in the United States. We evaluated perceived stress, depression and anxiety symptoms using the Cohen's Perceived Stress Scale, the Center for Epidemiological Studies - Depression, and the Hospital Anxiety and Depression Scale - anxiety subscale, respectively. Greenness was assessed for each participant using the Normalized Difference Vegetation Index at 250-m resolution, as well as a buffer of 1000-m. We conducted longitudinal analyses to assess the associations between greenness and mental health upon adjusting for confounders (e.g., education), and to examine potential mediation and effect modification.

Results: An interquartile range (0.25 point) increase in contemporaneous greenness was significantly associated with 0.238 unit (95% CI: - 0.346, - 0.130) and 0.162 unit (95% CI: - 0.271, - 0.054) decrease in the perceived stress in base and multivariable models, respectively. The magnitude of the association was similar or even stronger when examining summer (- 0.161; 95% CI: - 0.295, - 0.027) and annual average of greenness (- 0.188; 95% CI: - 0.337, - 0.038), as well as greenness buffer of 1000-m. The greenness-stress association was partially mediated by physical activity (15.1% mediated), where increased greenness led to increased physical activity and less stress, and by history of respiratory diseases (- 3.8% mediated), where increased greenness led to increased respiratory disease and more stress. The association was also significantly modified by race, social support, physical function, socioeconomic status, and region. While greenness was not significantly associated with anxiety and depressive scores across all participants, significant inverse associations were found for Whites participants, and for individuals with higher socioeconomic status, who were physically active, as compared to their counterparts.

Conclusion: We found a direct association of greenness with perceived stress among older adults, and an indirect association mediated through physical activity and respiratory disease history. Our study findings warrant further examination of the mediation and modification of the greenness-mental health association.
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http://dx.doi.org/10.1186/s12940-018-0381-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902952PMC
April 2018

Associations of long-term fine particulate matter exposure with prevalent hypertension and increased blood pressure in older Americans.

Environ Res 2018 07 16;164:1-8. Epub 2018 Feb 16.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.

Background: Hypertension is a highly prevalent cardiovascular risk factor. It is possible that air pollution, also an established cardiovascular risk factor, may contribute to cardiovascular disease through increasing blood pressure. Previous studies evaluating associations between air pollution and blood pressure have had mixed results.

Methods: We examined the association between long-term (one-year moving average) air pollutant exposures, prevalent hypertension and blood pressure in 4121 older Americans (57+ years) enrolled in the National Social Life, Health, and Aging Project. We estimated exposures to PM using spatio-temporal models and used logistic regression accounting for repeated measures to evaluate the association between long-term average PM and prevalence odds of hypertension. We additionally used linear regression to evaluate the associations between air pollutants and systolic, diastolic, mean arterial, and pulse pressures. Health effect models were adjusted for a number of demographic, health and socioeconomic covariates.

Results: An inter-quartile range (3.91 μg/m) increase in the one-year moving average of PM was associated with increased: Odds of prevalent hypertension (POR 1.24, 95% CI: 1.11, 1.38), systolic blood pressure (0.93 mm Hg, 95% CI: 0.05, 1.80) and pulse pressure (0.89 mm Hg, 95% CI: 0.21, 1.58). Dose-response relationships were also observed.

Conclusions: PM was associated with increased odds of prevalent hypertension, and increased systolic pressure and pulse pressure in a cohort of older Americans. These findings add to the growing evidence that air pollution may be an important risk factor for hypertension and perturbations in blood pressure.
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http://dx.doi.org/10.1016/j.envres.2018.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911215PMC
July 2018

The Effect of Workforce Mobility on Intervention Effectiveness Estimates.

Ann Work Expo Health 2018 03;62(3):259-268

Center for Community-Based Research, Dana-Farber Cancer Institute, USA.

Background: Little is known about how mobile populations of workers may influence the ability to implement, measure, and evaluate health and safety interventions delivered at worksites.

Methods: A simulation study is used to objectively measure both precision and relative bias of six different analytic methods as a function of the amount of mobility observed in the workforce. Those six methods are then used to reanalyze a previously conducted cluster-randomized control trial involving a highly mobile workforce in the construction industry.

Results: As workforce mobility increases, relative bias in treatment effects derived from standard models to analyze cluster-randomized trials also increases. Controlling for amount of time exposed to the intervention can greatly reduce this bias. Analyzing only subsets of workers who exhibit the least amount of mobility can result in decreased precision of treatment effect estimates. We demonstrate a 59% increase in the treatment effect size from the reanalysis of the previously conducted trial.

Conclusions: When evaluating organizational interventions implemented at specific worksites by measuring perceptions and outcomes of workers present at those sites, researchers should consider the effects that the mobility of the workforce may have on the estimated treatment effects. The choice of analytic method can greatly affect both precision and accuracy of estimates.
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http://dx.doi.org/10.1093/annweh/wxx112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873524PMC
March 2018

Associations between long-term exposure to air pollution, glycosylated hemoglobin and diabetes.

Int J Hyg Environ Health 2017 10 26;220(7):1124-1132. Epub 2017 Jun 26.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States.

Background: Air pollution exposures have been shown to adversely impact health through a number of biological pathways associated with glucose metabolism. However, few studies have evaluated the associations between air pollution and glycosylated hemoglobin (HbA1c) levels. Further, no studies have evaluated these associations in US populations or investigated whether associations differ in diabetic as compared to non-diabetic populations. To address this knowledge gap, we investigated the associations between airborne fine particulate matter (PM) and nitrogen dioxide (NO) and HbA1c levels in both diabetic and non-diabetic older Americans. We also examined the impact of PM and NO on prevalent diabetes mellitus (DM) in this cohort.

Methods: We used multilevel logistic and linear regression models to evaluate the association between long-term average air pollutant levels and prevalence of DM and HbA1c levels, respectively, among 4121 older (57+ years) Americans enrolled in the National Social Life, Health, and Aging Project between 2005 and 2011. All models adjusted for age, sex, body mass index, smoking status, race, household income, education level, neighborhood socioeconomic status, geographic region, urbanicity and diabetic medication use. We estimated participant-specific exposures to PM on a six-kilometer grid covering the conterminous U.S. using spatio-temporal models, and to NO using nearest measurements from the Environmental Protection Agency's Air Quality System. HbA1c levels were measured for participants in each of two data collection waves from dried blood spots and log-transformed prior to analysis. Participants were considered diabetic if they had HbA1c values≥6.5% or reported taking diabetic medication.

Results: The prevalence of diabetes at study entry was 22.2% (n=916) and the mean HbA1c was 6.0±1.1%. Mean one-year moving average PM and NO exposures were 10.4±3.0μg/m and 13.1±7.0 ppb, respectively. An inter-quartile range (IQR, 3.9μg/m) increase in one-year moving average PM was positively associated with increased diabetes prevalence (prevalence odds ratio, POR 1.35, 95% CI: 1.19, 1.53). Similarly, an IQR (8.6 ppb) increase in NO was also significantly associated with diabetes prevalence (POR 1.27, 95% CI: 1.10, 1.48). PM (1.8%±0.6%, p<0.01) and NO (2.0%±0.7%, p<0.01) exposures were associated with higher HbA1c levels in diabetic participants, while only NO was significantly associated with HbA1c in non-diabetic participants (0.8%±0.2%, p<0.01). Significant dose response relationships were identified for both pollutants in diabetic participants and for NO in non-diabetic participants.

Conclusions/interpretations: In a cohort of older men and women in the United States, PM and NO exposures were significantly associated with prevalence of DM and increased HbA1c levels among both non-diabetic and diabetic participants. These associations suggest that air pollution could be a key risk factor for abnormal glucose metabolism and diabetes in the elderly.
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http://dx.doi.org/10.1016/j.ijheh.2017.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580354PMC
October 2017

Long-Term PM2.5 Exposure and Respiratory, Cancer, and Cardiovascular Mortality in Older US Adults.

Am J Epidemiol 2017 Oct;186(8):961-969

The impact of chronic exposure to fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5)) on respiratory disease and lung cancer mortality is poorly understood. In a cohort of 18.9 million Medicare beneficiaries (4.2 million deaths) living across the conterminous United States between 2000 and 2008, we examined the association between chronic PM2.5 exposure and cause-specific mortality. We evaluated confounding through adjustment for neighborhood behavioral covariates and decomposition of PM2.5 into 2 spatiotemporal scales. We found significantly positive associations of 12-month moving average PM2.5 exposures (per 10-μg/m3 increase) with respiratory, chronic obstructive pulmonary disease, and pneumonia mortality, with risk ratios ranging from 1.10 to 1.24. We also found significant PM2.5-associated elevated risks for cardiovascular and lung cancer mortality. Risk ratios generally increased with longer moving averages; for example, an elevation in 60-month moving average PM2.5 exposures was linked to 1.33 times the lung cancer mortality risk (95% confidence interval: 1.24, 1.40), as compared with 1.13 (95% confidence interval: 1.11, 1.15) for 12-month moving average exposures. Observed associations were robust in multivariable models, although evidence of unmeasured confounding remained. In this large cohort of US elderly, we provide important new evidence that long-term PM2.5 exposure is significantly related to increased mortality from respiratory disease, lung cancer, and cardiovascular disease.
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http://dx.doi.org/10.1093/aje/kwx166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915823PMC
October 2017

Cognitive impacts of ambient air pollution in the National Social Health and Aging Project (NSHAP) cohort.

Environ Int 2017 07 6;104:102-109. Epub 2017 Apr 6.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA. Electronic address:

Background: Pathways through which air pollution may impact cognitive function are poorly understood, particularly with regard to whether and how air pollution interacts with social and emotional factors to influence cognitive health.

Objective: To examine the association between air pollutant exposures and cognitive outcomes among older adults participating in the National Social Life, Health, and Aging Project (NSHAP) cohort study.

Methods: Measures of cognitive function, social connectedness, and physical and mental health were obtained for each NSHAP participant starting with Wave 1 of the study in 2005. Cognitive function was assessed using the Chicago Cognitive Function Measure (CCFM) for 3377 participants. Exposures to fine particles (PM) were estimated for each participant using GIS-based spatio-temporal models, and exposures to nitrogen dioxide (NO) were obtained from the nearest EPA monitors.

Results: In adjusted linear regression models, IQR increases in 1 to 7year PM exposures were associated with a 0.22 (95% CI: -0.44, -0.01) to a 0.25 (95% CI: -0.43, -0.06) point decrease in CCFM scores, equivalent to aging 1.6years, while exposures to NO were equivalent to aging 1.9years. The impacts of PM on cognition were modified by stroke, anxiety, and stress, and were mediated by depression. The impacts of NO were mediated by stress and effect modification by impaired activities of daily living for NO was found.

Conclusions: Exposures to long-term PM and NO were associated with decreased cognitive function in our cohort of older Americans, and individuals who experienced a stroke or elevated anxiety were more susceptible to the effects of PM on cognition. Additionally, mediation results suggest that PM may impact cognition through pathways related to mood disorders.
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http://dx.doi.org/10.1016/j.envint.2017.03.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022397PMC
July 2017

Erectile dysfunction and exposure to ambient Air pollution in a nationally representative cohort of older Men.

Environ Health 2017 02 17;16(1):12. Epub 2017 Feb 17.

Department of Civil and Environmental Engineering, Tufts University, 200 College Avenue, 301 Anderson Hall, Medford, MA, 02155, USA.

Background: Little is known about the association between air pollution and erectile dysfunction (ED), a disorder occurring in 64% of men over the age of 70, and to date, no studies have been published. To address this significant knowledge gap, we explored the relationship between ED and air pollution in a group of older men who were part of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort study of older Americans.

Methods: We obtained incident ED status and participant data for 412 men (age 57-85). Fine particulate matter (PM) exposures were estimated using spatio-temporal models based on participants' geocoded addresses, while nitrogen dioxide (NO) and ozone (O) concentrations were estimated using nearest measurements from the Environmental Protection Agency's Air Quality System. The association between air pollution and incident ED (newly developed in Wave 2) was examined and logistic regression models were run with adjusted models controlling for race, education, season, smoking, obesity, diabetes, depression, and median household income of census tract.

Results: We found positive, although statistically insignificant, associations between PM, NO, and O exposures and odds of incident ED for each of our examined exposure windows, including 1 to 7 year moving averages. Odds ratios (OR) for 1 and 7 year moving averages equaled 1.16 (95% CI: 0.87, 1.55) and 1.16 (95% CI: 0.92, 1.46), respectively, for an IQR increase in PM exposures. Observed associations were robust to model specifications and were not significantly modified by any of the examined risk factors for ED.

Conclusions: We found associations between PM, NO, and O exposures and odds of developing ED that did not reach nominal statistical significance, although exposures to each pollutant were consistently associated with higher odds of developing ED. While more research is needed, our findings suggest a relationship between air pollutant exposure and incident cases of ED, a common condition in older men.
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http://dx.doi.org/10.1186/s12940-017-0216-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316194PMC
February 2017
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