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      Synergistic Effects of Traffic-Related Air Pollution and Exposure to Violence on Urban Asthma Etiology

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          Abstract

          Background

          Disproportionate life stress and consequent physiologic alteration (i.e., immune dysregulation) has been proposed as a major pathway linking socioeconomic position, environmental exposures, and health disparities. Asthma, for example, disproportionately affects lower-income urban communities, where air pollution and social stressors may be elevated.

          Objectives

          We aimed to examine the role of exposure to violence (ETV), as a chronic stressor, in altering susceptibility to traffic-related air pollution in asthma etiology.

          Methods

          We developed geographic information systems (GIS)–based models to retrospectively estimate residential exposures to traffic-related pollution for 413 children in a community-based pregnancy cohort, recruited in East Boston, Massachusetts, between 1987 and 1993, using monthly nitrogen dioxide measurements for 13 sites over 18 years. We merged pollution estimates with questionnaire data on lifetime ETV and examined the effects of both on childhood asthma etiology.

          Results

          Correcting for potential confounders, we found an elevated risk of asthma with a 1-SD (4.3 ppb) increase in NO 2 exposure solely among children with above-median ETV [odds ratio (OR) = 1.63; 95% confidence interval (CI), 1.14–2.33)]. Among children always living in the same community, with lesser exposure measurement error, this association was magnified (OR = 2.40; 95% CI, 1.48–3.88). Of multiple exposure periods, year-of-diagnosis NO 2 was most predictive of asthma outcomes.

          Conclusions

          We found an association between traffic-related air pollution and asthma solely among urban children exposed to violence. Future studies should consider socially patterned susceptibility, common spatial distributions of social and physical environmental factors, and potential synergies among these. Prospective assessment of physical and social exposures may help determine causal pathways and critical exposure periods.

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          Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study.

          Gerard Hoek, Bert Brunekreef, Sandra Goldbohm … (2002)
          Long-term exposure to particulate matter air pollution has been associated with increased cardiopulmonary mortality in the USA. We aimed to assess the relation between traffic-related air pollution and mortality in participants of the Netherlands Cohort study on Diet and Cancer (NLCS), an ongoing study. We investigated a random sample of 5000 people from the full cohort of the NLCS study (age 55-69 years) from 1986 to 1994. Long-term exposure to traffic-related air pollutants (black smoke and nitrogen dioxide) was estimated for the 1986 home address. Exposure was characterised with the measured regional and urban background concentration and an indicator variable for living near major roads. The association between exposure to air pollution and (cause specific) mortality was assessed with Cox's proportional hazards models, with adjustment for potential confounders. 489 (11%) of 4492 people with data died during the follow-up period. Cardiopulmonary mortality was associated with living near a major road (relative risk 1.95, 95% CI 1.09-3.52) and, less consistently, with the estimated ambient background concentration (1.34, 0.68-2.64). The relative risk for living near a major road was 1.41 (0.94-2.12) for total deaths. Non-cardiopulmonary, non-lung cancer deaths were unrelated to air pollution (1.03, 0.54-1.96 for living near a major road). Long-term exposure to traffic-related air pollution may shorten life expectancy.
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            Environmental justice: human health and environmental inequalities.

            Robert J Brulle, David Pellow (2006)
            In this review, we provide an introduction to the topics of environmental justice and environmental inequality. We provide an overview of the dimensions of unequal exposures to environmental pollution (environmental inequality), followed by a discussion of the theoretical literature that seeks to explain the origins of this phenomenon. We also consider the impact of the environmental justice movement in the United States and the role that federal and state governments have developed to address environmental inequalities. We conclude that more research is needed that links environmental inequalities with public health outcomes.
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              Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts

              Gilbert Gee, Devon C. Payne-Sturges (2004)
              Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure–disease paradigm has long suggested that differential “vulnerability” may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Environ Health Perspect
                Title: Environmental Health Perspectives
                Publisher: National Institute of Environmental Health Sciences
                ISSN (Print): 0091-6765
                Publication date (Print): August 2007
                Publication date (Electronic): 22 March 2007
                Volume: 115
                Issue: 8
                Pages: 1140-1146
                Affiliations
                [1 ] Department of Environmental Health and
                [2 ] Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
                [3 ] Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
                [4 ] Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
                [5 ] Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
                Author notes
                Address correspondence to J.E. Clougherty, Harvard School of Public Health; Department of Environmental Health, Landmark Center Room 404, P.O. Box 15677, Boston, MA 02215 USA. Telephone: (617) 384-8811. Fax: (617) 384-8859. E-mail: jcloughe@ 123456hsph.harvard.edu

                The authors declare they have no competing financial interests.

                Article
                Publisher ID: ehp0115-001140
                DOI: 10.1289/ehp.9863
                PMC ID: 1940095
                PubMed ID: 17687439
                SO-VID: dc2c85c5-1693-4107-aea3-d460267e5a88
                Copyright © This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI
                History
                Date received : 27 October 2006
                Date accepted : 22 March 2007
                Categories
                Subject: Research

                ScienceOpen disciplines: Public health
                Keywords: geographic information systems (gis),childhood asthma,social–environmental synergy,stress,exposure to violence (etv),intraurban variability,nitrogen dioxide (no2)
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: geographic information systems (gis), childhood asthma, social–environmental synergy, stress, exposure to violence (etv), intraurban variability, nitrogen dioxide (no2)

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