Manfred Neuberger

Parental smoking and children’s respiratory health: independent effects of prenatal and postnatal exposure

Objectives: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children’s health. Uncertainties remain about the relative importance of smoking at different periods in the child’s life. We investigate this in a pooled analysis, on 53 879 children from 12 cross-sectional studies—components of the PATY study (Pollution And The Young). Methods: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, “woken by wheeze”, bronchitis, nocturnal cough, morning cough, “sensitivity to inhaled allergens” and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. Results: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. Conclusions: Adverse effects of both pre- and postnatal parental smoking on children’s respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children’s respiratory health and needs to be reduced urgently.

Reducing ambient levels of fine particulates could substantially improve health: a mortality impact assessment for 26 European cities

Recently new European policies on ambient air quality—namely, the adoption of new standards for fine particulate matter (PM2.5), have generated a broad debate about choosing the air quality standards that can best protect public health. The Apheis network estimated the number of potential premature deaths from all causes that could be prevented by reducing PM2.5 annual levels to 25 μg/m3, 20 μg/m3, 15 μg/m3 and 10 μg/m3 in 26 European cities. The various PM2.5 concentrations were chosen as different reductions based on the limit values proposed by the new European Directive, the European Parliament, the US Environmental Protection Agency and the World Health Organization, respectively. The Apheis network provided the health and exposure data used in this study. The concentration-response function (CRF) was derived from the paper by Pope et al (2002). If no direct PM2.5 measurements were available, then the PM10 measurements were converted to PM2.5 using a local or an assumed European conversion factor. We performed a sensitivity analysis using assumptions for two key factors—namely, CRF and the conversion factor for PM2.5. Specifically, using the “at least” approach, in the 26 Apheis cities with more than 40 million inhabitants, reducing annual mean levels of PM2.5 to 15 μg/m3 could lead to a reduction in the total burden of mortality among people aged 30 years and over that would be four times greater than the reduction in mortality that could be achieved by reducing PM2.5 levels to 25 μg/m3 (1.6% vs 0.4% reduction) and two times greater than a reduction to 20 μg/m3. The percentage reduction could grow by more than seven times if PM2.5 levels were reduced to 10 μg/m3 (3.0% vs 0.4%). This study shows that more stringent standards need to be adopted in Europe to protect public health, as proposed by the scientific community and the World Health Organization.

Critical Review Nicotine for the Fetus, the Infant and the Adolescent?

The recent expansion of Nicotine Replacement Therapy to pregnant women and children ignores the fact that nicotine impairs, disrupts, duplicates and/or interacts with essential physiological functions and is involved in tobacco-related carcinogenesis. The main concerns in the present context are its fetotoxicity and neuroteratogenicity that can cause cognitive, affective and behavioral disorders in children born to mothers exposed to nicotine during pregnancy, and the detrimental effects of nicotine on the growing organism. Hence, the use of nicotine, whose efficacy in treating nicotine addiction is controversial even in adults, must be strictly avoided in pregnancy, breastfeeding, childhood and adolescence.

Low levels of air pollution induce changes of lung function in a panel of schoolchildren

In search of sensitive screening parameters for assessing acute effects of ambient air pollutants in young schoolchildren, the impact of 8-h average air pollution before lung function testing was investigated by oscillatory measurements of resistance and spirometry with flow–volume loops. At a central elementary school in Linz, the capital of Upper Austria, 163 children aged 7–10 yrs underwent repeated examinations at the same time of day during 1 school year, yielding a total of 11–12 lung function tests per child. Associations to mass concentrations of particulate matter and nitrogen dioxide (NO2) measured continuously at a nearby monitoring station were tested, applying the Generalised Estimating Equations model. Reductions per 10 µg·m−3 (both for particles and for NO2) were in the magnitude of 1% for most lung function parameters. The most sensitive indicator for acute effects of combustion-related pollutants was a change in maximal expiratory flow in small airways. NO2 at concentrations below current standards reduced (in the multipollutant model) the forced expiratory volume in one second by 1.01%, maximal instantaneous forced flow when 50% of the forced vital capacity remains to be exhaled (MEF50%) by 1.99% and MEF25% by 1.96%. Peripheral resistance increased by 1.03% per 10 µg·m−3 of particulate matter with a 50% cut-off aerodynamic diameter of 2.5 μm (PM2.5). Resistance is less influenced by the childs cooperation and should be utilised more often in environmental epidemiology when screening for early signs of small airway dysfunction from urban air pollution, but cannot replace the measurement of MEF50% and MEF25%. In the basic model, the reduction of these parameters per 10 µg·m−3 was highest for NO2, followed by PM1, PM2.5 and PM10, while exposure to coarse dust (PM10–PM2.5) did not change end-expiratory flow significantly. All acute effects of urban air pollution found on the lung function of healthy pupils were evident at levels below current European limit values for nitrogen dioxide. Thus, planned reduction of nitrogen dioxide emission (Euro 5; vehicles that comply with the emission limits as defined in Directive 99/96/EC) of 20% in 2010 would seem to be insufficient.

Italy and Austria before and after study: second-hand smoke exposure in hospitality premises before and after 2 years from the introduction of the Italian smoking ban

UNLABELLED The aim of this paper was to compare nicotine concentration in 28 hospitality premises (HPs) in Florence and Belluno, Italy, where a smoking ban was introduced in 2005, and in 19 HPs in Vienna, Austria, where no anti-smoking law entered into force up to now. Airborne nicotine concentrations were measured in the same HPs in winter 2002 or 2004 (pre-ban measurements) and winter 2007 (post-ban measurements). In Florence and Belluno, medians decreased significantly (P < 0.001) from 8.86 [interquartile range (IQR): 2.41-45.07)] before the ban to 0.01 microg/m3 (IQR: 0.01-0.41) afterwards. In Austria (no smoking ban) the medians collected in winters 2004 and 2007 were, respectively, 11.00 (IQR: 2.53-30.38) and 15.76 microg/m3 (IQR: 2.22-31.93), with no significant differences. Measurements collected in winter 2007 in 28 HPs located in Naples, Turin, Milan (0.01 microg/m3; IQR: 0.01-0.16) confirmed post-ban results in Florence and Belluno. The medians of nicotine concentrations in Italy and Austria before the Italian ban translates, using the risk model of Repace and Lowery, into a lifetime excess lung cancer mortality risk for hospitality workers of 11.81 and 14.67 per 10,000, respectively. Lifetime excess lung cancer mortality risks for bar and disco-pub workers were 10-20 times higher than that calculated for restaurant workers, both in Italy and Austria. In winter 2007, it dropped to 0.01 per 10,000 in Italy, whereas in Austria it remained at the same levels. The drop of second-hand smoke exposure indicates a substantial improvement in air quality in Italian HPs even after 2 years from the ban. PRACTICAL IMPLICATIONS The nation-wide smoking ban introduced in Italy on January 10, 2005, resulted in a drop in second-hand smoke exposure in hospitality premises, whereas in Austria, where there is no similar nation-wide smoking ban, the exposure to second-hand smoke in hospitality premises remains high. Given that second-hand smoke is considered a group 1 carcinogen according to the International Agency for Research on Cancer classification, the World Health Organization Framework Convention on Tobacco Control strongly recommends the implementation of nation-wide smoke-free policies in order to improve the indoor air quality of hospitality premises and workplaces. Results from our study strongly supports this recommendation.

PM10, and children's respiratory symptoms and lung function in the PATY study

Studies of the impact of long-term exposure to outdoor air pollution on the prevalence of respiratory symptoms and lung function in children have yielded mixed results, partly related to differences in study design, exposure assessment, confounder selection and data analysis. We assembled respiratory health and exposure data for >45,000 children from comparable cross-sectional studies in 12 countries. 11 respiratory symptoms were selected, for which comparable questions were asked. Spirometry was performed in about half of the children. Exposure to air pollution was mainly characterised by annual average concentrations of particulate matter with a 50% cut-off aerodynamic diameter of 10 &mgr;m (PM10) measured at fixed sites within the study areas. Positive associations were found between the average PM10 concentration and the prevalence of phlegm (OR per 10 &mgr;g·m−3 1.15, 95% CI 1.02–1.30), hay fever (OR 1.20, 95% CI 0.99–1.46), bronchitis (OR 1.08, 95% CI 0.98–1.19), morning cough (OR 1.15, 95% CI 1.02–1.29) and nocturnal cough (OR 1.13, 95% CI 0.98–1.29). There were no associations with diagnosed asthma or asthma symptoms. PM10 was not associated with lung function across all studies combined. Our study adds to the evidence that long-term exposure to outdoor air pollution, characterised by the concentration of PM10, is associated with increased respiratory symptoms.

Blood levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin in chemical workers after chloracne and in comparison groups

SummaryNine production workers with a history of chloracne from exposure to polychlorinated dibenzo-p-dioxins (PCDDs) in 1971–1973 had a median level of 340 pg 2,3,7,8-tetrachlorodibenzo p-dioxin (TCDD) per gram blood lipid (range 98–659 pg/g) in 1990. This was significantly higher than blood levels in 4 reference subjects without chloracne and no known exposure from the same plant (median 18, range 8–28 pg/g) and in 17 external referents (median 16, range < 5–23 pg/g). We therefore consider chloracne to be a reliable indicator of heavy dioxin exposure in a cohort of herbicide production workers and will use its former presence in 159 cases as a substitute for exposure when investigating cancer morbidity and mortality in a multicenter cohort study.

Risk factors for hearing loss at different frequencies in a population of 47 388 noise‐exposed workers

Weighted regression analysis was applied to determine the dependence of the hearing thresholds of 47,388 noise-exposed workers on age, sex, noise immission level, ear disease, head injury, tinnitus, hearing protector usage, and audiometric frequency in the range from 0.5 to 6 kHz. It could be shown that the hearing thresholds at any frequency are dominated by the age of the worker and that women, after equivalent exposure conditions, hear better than men. The relative effects of sex, noise immission level, ear diseases, tinnitus, and hearing protector usage are related to the audiometric frequency. Users of hearing protectors at the last audiometric investigation hear worse than nonusers. Hearing protector usage is strongly related with the hearing threshold in the low-frequency range. The noise immission level does not noticeably affect the hearing threshold below 3 kHz. The most important frequency of the noise immission level is as expected 4 kHz. For 4 kHz, it was shown that the variables age, noise immission level, tinnitus, head injuries, and ear diseases act in a good approximation additively on the pure-tone hearing threshold.

Hearing Loss from Industrial Noise, Head Injury and Ear Disease: A Multivariate Analysis on Audiometric Examinations of 110647 Workers

From compulsory screening examinations of 260,917 noise-exposed workers standardized audiograms as well as medical and occupational histories of 110,647 workers were selected because of full-time exposure to well-defined noise greater than 85 dB (A) and analyzed by loglinear and multiple linear regression. The most important factors for prediction of pure-tone hearing loss at 4 kHz were found to be age, sex and noise immission level. For predicting speech impairment and handicap the history of ear disease, head injury and tinnitus were more important than noise immission level. Dose-response relationships are given to improve prevention and compensation of hearing loss from combined factors.

NO2 and children¡¦s respiratory symptoms in the PATY study

Objectives: NO2 is a major urban air pollutant. Previously reported associations between ambient NO2 and children’s respiratory health have been inconsistent, and independent effects of correlated pollutants hard to assess. The authors examined effects of NO2 on a spectrum of 11 respiratory symptoms, controlling for PM10 and SO2, using a large pooled dataset. Methods: Cross sectional studies were conducted in Russia, Austria, Italy, Switzerland, and the Netherlands, during 1993–99, contributing in total 23 955 children. Study-specific odds ratios for associations with ambient NO2 are estimated using logistic regressions with area-level random effects. Heterogeneity between study-specific results, and mean estimates (allowing for heterogeneity) are calculated. Results: Long term average NO2 concentrations were unrelated to prevalences of bronchitis or asthma. Associations were found for sensitivity to inhaled allergens and allergy to pets, with mean odds ratios around 1.14 per 10 μg/m3 NO2. SO2 had little confounding effect, but an initial association between NO2 and morning cough was reduced after controlling for PM10. Associations with reported allergy were not reduced by adjustment for the other pollutants. Odds ratios for allergic symptoms tended to be higher for the 9–12 year old children compared with the 6–8 year old children. Conclusions: Evidence for associations between NO2 and respiratory symptoms was robust only for inhalation allergies. NO2 most likely is acting as an indicator of traffic related air pollutants, though its direct effect cannot be ruled out. This remains important, as policies to reduce traffic related air pollution will not result in rapid reductions.