Southern Exposure: Lived Experiences of the COVID-19 Pandemic

The COVID-19 pandemic wreaked havoc and disrupted the lives of low-income individuals and families throughout a state in the southeast region of the U.S. Many of the disruptions were shared by all, including isolation-induced mental health issues, adjustments to safety protocols, and financial challenges. Sone lost jobs. Some left jobs to protect family members. Some had major housing issues. Those with school-age children had multiple challenges, including access, reliability, and cost of broadband to support virtual learning; the inability to maintain or return to work because of children at home; and loss of free-and reduced meals at schools. Attitudes about vaccination varied considerably, with some adamantly refusing to be vaccinated, while others acknowledged uncertainty, but hesitatingly sought the vaccines. Others were eager to be vaccinated. Despite personal exposures and familial losses, study participants demonstrated great resiliency, creating ways to keep food on the table, supporting family and friends, finding the positive in having more time with children and other family members, and continuing to search for a way forward throughout the pandemic.

Exposure to Air Pollution in Rural Malawi: Impact of Cooking Methods on Blood Pressure and Peak Expiratory Flow

We made static and personal PM2.5 measurements with a miniature monitor (RTI MicroPEM) to characterise the exposure of women cooking with wood and charcoal in indoor and outdoor locations in rural Malawi, together with measurements of blood pressure and peak expiratory flow rate (PEFR). Mean PM2.5 concentrations of 1338 and 31 µg/m3 were observed 1 m from cookstove locations during cooking with wood and charcoal, respectively. Similarly, mean personal PM2.5 exposures of 706 and 94 µg/m3 were observed during cooking with wood and charcoal, respectively. Personal exposures to PM2.5 in indoor locations were 3.3 and 1.7 times greater than exposures observed in equivalent outdoor locations for wood and charcoal, respectively. Prior to the measured exposure, six out of eight participants had PEFR observations below 80% of their expected (age and height) standardised PEFR. We observed reductions in PEFR for participants cooking with wood in indoor locations. Five out of eight participants reported breathing difficulties, coughing, and eye irritation when cooking with wood but reported that symptoms were less severe when cooking with charcoal. In conclusion, we observed that exposure to PM2.5 was substantially reduced by cooking outdoor with charcoal. As both wood and charcoal fuels are associated with negative environmental and health impacts, the adoption of high-efficiency cookstoves and less polluting sources of energy will be highly beneficial. Cooking outside whenever possible, and minimising the time spent in close proximity to stoves, may be simple interventions that could reduce the risks of exacerbation and progression of respiratory and cardiovascular diseases in Malawi.

RGC-TBRS Personal Air Pollutant Exposure versus Health Condition and Perception Pilot Study for Young Asthmatics in Hong Kong (2019/2020)

This is a report of the RGC-TBRS funded observational pilot study which examines the effects of personal exposures to three types of air pollutants, namely, PM1.0, PM2.5, and PM10, on personal health condition and perception of young asthmatics (aged 12 to 15) in Hong Kong. This is the first study to investigate the relationship between PM1.0 and FEV1 and FVC of young asthmatics in Hong Kong, based on personal exposures obtained from portable sensors. Our preliminary results show that a higher level of PM1.0, PM2.5 and PM10 would deteriorate the health conditions of young asthmatics in HK. All correlations between particulates and lung functions are significant and negative, including PM1.0 exposure vs. FEV1 (R2=12%; p=0.023), PM1.0 exposure vs. FVC (R2=15%; p=0.010), PM2.5 exposure vs. FEV1 (R2=13%; p=0.019), PM2.5 exposure vs. FVC (R2=16%; p=0.008), PM10 exposure vs. FEV1 (R2=14%; p=0.012), and PM10 exposure vs. FVC (R2=18%; p=0.005). Moreover, after accounting for covariates, including age, gender, body mass index (BMI), temperature, and relative humidity, we found a significant relationship between PM1.0 exposure vs. FVC (Coefficient=-0.1224; p=0.032), PM2.5 exposure vs. FVC (Coefficient=-0.1177; p=0.021), PM10 exposure vs. FEV1 (Coefficient=-0.0703; p=0.019), and PM10 exposure vs. FVC (Coefficient=-0.1204; p=0.006). Further, using the pilot study data, we have performed a power analysis to estimate the sample size for our follow-up main study. Based on the primary null hypothesis that personal PM exposure would not change the FEV1 and FVC of young asthmatics in HK, the lowest sample size that gives 80% power at a 5% significance level is 107. Hence, the sample size (or the total number of participated asthma subjects) expected for the follow-up longitudinal clinical study should be 125 (after adjusting for the non-compliance and withdrawal of subjects). Our pilot study has demonstrated the feasibility of research into the effects of personal air pollutant exposure on health condition and health perception. Our follow-up study will address the challenges identified in the pilot study, based on the proposed follow-up actions for subject engagement, data collection, and data analysis.

Miniaturizing wet scrubbers for aerosolized droplet capture

Particles dispersed and transmitted through the air (e.g., particulate matter pollution, bioaerosols) are ubiquitous and one of the leading causes of adverse health effects and disease transmission. A variety of sampling methods (e.g., filters, cyclones, impactors) have been developed to assess personal exposures. However, a gap still remains in the accessibility and ease-of-use of these technologies for people without experience or training in collecting airborne samples. Additionally, wet scrubbers (large non-portable industrial systems) utilize liquid sprays to remove particles from the air; the goal is to "scrub" (i.e., clean) the exhaust of industrial smoke stacks, not collect the particles for analysis. Inspired by wet scrubbers, we developed a device fundamentally different from existing portable air samplers by using aerosolized microdroplets to capture airborne particles in personal spaces (e.g., homes, offices, schools). Our aerosol-sampling device is the size of a pint of ice cream (0.5 L), can be operated without specialized training, and features a winding flow path in a supersaturated relative humidity environment enabling droplet growth. The integrated open mesofluidic channels shuttle coalesced droplets to a collection chamber for subsequent sample analysis. Here, we present the experimental demonstration of aerosol capture into water droplets. Iterative study optimized the non-linear flow manipulating baffles and enabled us to retain 83% of the aerosolized microdroplets in the confined volume of our device. As a proof-of-concept for bioaerosol capture into the liquid medium, 0.5-3 μm model particles were used to evaluate aerosol capture efficiency.

The contribution of cooking appliances and residential traffic proximity to aerosol personal exposure

Purpose Indoor and outdoor factors affect personal exposure to air pollutants. Type of cooking appliance (i.e. gas, electricity), and residential location related to traffic are such factors. This research aims to investigate the effect of cooking with gas and electric appliances, as an indoor source of aerosols, and residential traffic as outdoor sources, on personal exposures to particulate matter with an aerodynamic diameter lower than 2.5 μm (PM2.5), black carbon (BC), and ultrafine particles (UFP). Methods Forty subjects were sampled for four consecutive days measuring personal exposures to three aerosol pollutants, namely PM2.5, BC, and UFP, which were measured using personal sensors. Subjects were equally distributed into four categories according to the use of gas or electric stoves for cooking, and to residential traffic (i.e. houses located near or away from busy roads). Results/conclusion Cooking was identified as an indoor activity affecting exposure to aerosols, with mean concentrations during cooking ranging 24.7–50.0 μg/m3 (PM2.5), 1.8–4.9 μg/m3 (BC), and 1.4 × 104–4.1 × 104 particles/cm3 (UFP). This study also suggest that traffic is a dominant source of exposure to BC, since people living near busy roads are exposed to higher BC concentrations than those living further away from traffic. In contrast, the contribution of indoor sources to personal exposure to PM2.5 and UFP seems to be greater than from outdoor traffic sources. This is probably related to a combination of the type of building construction and a varying range of activities conducted indoors. It is recommended to ensure a good ventilation during cooking to minimize exposure to cooking aerosols.

Integrating User Voice in Hearing Care With Focus on Off-Duty Warfighter

ABSTRACT Introduction Noise-Induced Hearing Loss (NIHL) is a growing public health concern in the USA and globally because of the emergence of lifestyle preferences and environmental exposures to sound levels exceeding safe listening limits for extended periods of time. In the military, hearing and communication are important for survival and the Department of Defense’s Hearing Center of Excellence highlights the importance of protection from NIHL. Issuance of the World health organization safe audio listening standards along with existing U.S. federal and military standards provides a framework for developing an accessible tool for promoting safe listening. Methods An App is being proposed for an aggregated assessment of a user’s daily sound exposure, through personal audio system and ambient sources and providing tools for managing personal sound exposures. The key elements for development of App features were integration of user voice for functionalities, computations based on global standards, including military, for safe listening and alignment with regulatory standards for Apps. Results Features of the App are “Track” for audio and ambient exposures, “Compute” for real-time and cumulative exposures vs. safe listening standards, “Alert” for unsafe exposures using visual and haptic, “Inform” for personal exposures vs. safe dose, associated NIHL risk and education, “Choice” for alternatives that can be relatable to personal lifestyle, and “Share” for informing others as determined by the user. App safety is ensured by privacy and cybersecurity regulatory standards. Conclusion The overall goals of the App are to increase NIHL awareness and to empower users to improve personal listening behaviors that can potentially reduce the risk of NIHL.

Exposure contrasts associated with a liquefied petroleum gas (LPG) intervention at potential field sites for the multi-country household air pollution intervention network (HAPIN) trial in India: results from pilot phase activities in rural Tamil Nadu

Background The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial. Methods We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice – at 1 and 2 months – after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers. Results In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 [IQR:71–258] and 27 μg/m3 [IQR:20–47], while corresponding personal exposures were 75 μg/m3 [IQR:55–104] and 36 μg/m3 [IQR:26–46], respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 [IQR:49–127] at baseline and 25 μg/m3 [IQR:18–35] after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 [IQR:19–27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance. Conclusions An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs. Trial registration ClinicalTrials.Gov. NCT02944682; Prospectively registered on October 17, 2016.

Deep phenotyping meets big data: the Geoscience and hEalth Cohort COnsortium (GECCO) data to enable exposome studies in The Netherlands

Environmental exposures are increasingly investigated as possible drivers of health behaviours and disease outcomes. So-called exposome studies that aim to identify and better understand the effects of exposures on behaviours and disease risk across the life course require high-quality environmental exposure data. The Netherlands has a great variety of environmental data available, including high spatial and often temporal resolution information on urban infrastructure, physico-chemical exposures, presence and availability of community services, and others. Until recently, these environmental data were scattered and measured at varying spatial scales, impeding linkage to individual-level (cohort) data as they were not operationalised as personal exposures, that is, the exposure to a certain environmental characteristic specific for a person. Within the Geoscience and hEalth Cohort COnsortium (GECCO) and with support of the Global Geo Health Data Center (GGHDC), a platform has been set up in The Netherlands where environmental variables are centralised, operationalised as personal exposures, and used to enrich 23 cohort studies and provided to researchers upon request. We here present and detail a series of personal exposure data sets that are available within GECCO to date, covering personal exposures of all residents of The Netherlands (currently about 17 M) over the full land surface of the country, and discuss challenges and opportunities for its use now and in the near future.