Su Hyun Park

The Effect of Exposure to Persistent Organic Pollutants on Metabolic Health among KOREAN Children during a 1-Year Follow-Up

Previous evidence suggests the potential for adverse effects of persistent organic pollutants (POPs) on metabolic health even at low-dose exposure levels common among the general population, but there is less evidence of these associations among children. Therefore, as part of a prospective cohort study, 214 children were measured for POPs exposure. After the 1-year follow-up, we assessed the effect of circulating POPs exposure among 158 children aged 7–9 years (at baseline) on the change of metabolic components of metabolic syndrome using multiple regression analysis. In addition, we calculated the continuous metabolic syndrome (cMetS) score and assessed the variation among individuals by POPs exposure. The concentrations of marker polychlorinated biphenyls (PCBs) were significantly associated with increased change in diastolic blood pressure (BP) and triglyceride levels during a 1-year follow-up, after controlling for sex, age, household income, and change in body mass index. Total PCBs also showed a marginal association with increasing cMetS score from the baseline. Of the metabolic components, change in diastolic BP over time showed a notable association with specific PCBs, but no association with organochlorine pesticides. Here, we found that low-dose exposures to PCBs among children in the general population could negatively influence metabolic health, particularly diastolic BP. Increased disease sensitivity during childhood can continue to adulthood, thus, these results support the need for continuous assessment of the health impact of POPs.

Risks of Lung Cancer due to Radon Exposure among the Regions of Korea

Radon is likely the second most common cause of lung cancer after smoking. We estimated the lung cancer risk due to radon using common risk models. Based on national radon survey data, we estimated the population-attributable fraction (PAF) and the number of lung cancer deaths attributable to radon. The exposure-age duration (EAD) and exposure-age concentration (EAC) models were used. The regional average indoor radon concentration was 37.5 95 Bq/m3. The PAF for lung cancer was 8.3% (European Pooling Study model), 13.5% in males and 20.4% in females by EAD model, and 19.5% in males and 28.2% in females by EAC model. Due to differences in smoking by gender, the PAF of radon-induced lung cancer deaths was higher in females. In the Republic of Korea, the risk of radon is not widely recognized. Thus, information about radon health risks is important and efforts are needed to decrease the associated health problems. Graphical Abstract

Serum Levels of Persistent Organic Pollutants and Insulin Secretion among Children Age 7–9 Years: A Prospective Cohort Study

Background: Persistent organic pollutants (POPs) are endocrine disruptors and have been suggested as possible risk factors for diabetes. Few studies have been performed to investigate this association among children. Objectives: In this study, we prospectively examined the relationship between the serum concentration of POPs and glucose metabolism in children. Methods: Data were collected from the Ewha Birth & Growth Cohort Study, an ongoing birth cohort study initially constructed between 2001 and 2006. In 2010–2012, the POP concentration was measured in serum from a total of 214 children, 7–9 years of age. Using fasting glucose and insulin measurements at both baseline and the second year of follow-up, the homeostatic model assessment of beta-cell function (HOMA-β) and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Multiple linear regression analysis and a linear mixed-effects model were used to determine the relationship between POP tertiles and metabolic biomarkers. Results: Compared with the lowest tertile of total marker PCBs, participants in the third tertile had decreased HOMA-β values, after adjustment for age, sex, body mass index z-score, mother’s education, ponderal index, and history of breastfeeding (–18.94%; 95% CI: –32.97%, –1.98%). In a linear mixed model, the HOMA-β values were still lower in subjects in the highest compared with the lowest tertile of total PCBs at the 2-year follow-up period (108.3 vs. 135.0, respectively). Conclusion: The results of the study suggested that exposure to POPs among children might affect insulin secretory function, which could lead to an increased risk of developing diabetes. Citation: Park SH, Ha EH, Hong YS, Park H. 2016. Serum levels of persistent organic pollutants and insulin secretion among children age 7–9 years: a prospective cohort study. Environ Health Perspect 124:1924–1930; http://dx.doi.org/10.1289/EHP147

Patterns of electronic cigarette use and level of psychological distress.

Background Psychological distress has been correlated with higher levels of nicotine dependence. To date, the possible association between individuals’ levels of psychological distress and e-cigarette use has not been investigated, despite the dramatic growth of e-cigarette use in the US. We examined this possible association using a nationally representative sample of US adults. Methods A total of 36,697 adults from the 2014 National Health Interview Survey (NHIS) were included. The Kessler 6 scale was used to measure psychological distress. Multivariate logistic regression analysis was conducted to assess the association between level of psychological distress and e-cigarette use. Results Both e-cigarette and cigarette use varied according to level of psychological distress as well as multiple socio-demographic characteristics. In a multivariate model, psychological distress was significantly associated with the following groups: (a) exclusive e-cigarette ever-use (aOR = 3.7; 95% CI = 1.6, 8.6), (b) current dual use of e-cigarettes and cigarettes (aOR = 4.6; 95% CI = 3.1, 6.7), (c) former cigarette use and ever use of e-cigarette (aOR = 3.2; 95% CI = 2.2, 4.8) and (d) current use of cigarettes only (aOR = 2.1; 95% CI = 1.7, 2.6). Conclusion These are the first data to demonstrate that, as is true for cigarettes, e-cigarette use is associated with increased levels of psychological distress. Further large-scale, longitudinal studies are needed to determine the direction of this relationship and to evaluate the long-term positive and negative consequences of such use.

Effects of hookah smoking on indoor air quality in homes

Introduction Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke. Methods Air samples from 33 homes—11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking—were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room. Results Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different. Conclusions This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.

The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities

BackgroundThe educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels.MethodsNational census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30–44 and 45–59 years).ResultsThe PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30–44 years. However, the PAFs of suicide in younger females (30–44 years) and of cerebrovascular disease in older males (45–59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30–44 years.ConclusionsThe consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies.

Characteristics of Adults Who Switched From Cigarette Smoking to E-cigarettes

INTRODUCTION Because of the rapidly increasing use of electronic cigarettes (e-cigarettes), this study aimed to investigate the individual characteristics and state-level prevalence of U.S. adults who have switched to e-cigarettes from traditional cigarettes. METHODS Data from the 2012-2013 and 2013-2014 National Adult Tobacco Surveys were analyzed in 2016. Relative percent change in switching was estimated, and the state-specific prevalence of adults who switched to e-cigarettes from traditional cigarettes was calculated and mapped. Multivariate logistic regression was conducted to examine how switching varied by sociodemographic subgroups and region. RESULTS Overall, the number of individuals who switched from traditional cigarettes to e-cigarettes increased by approximately 100% over the 1-year interval. Significant increases were found among a number of sociodemographics and regions. Multivariate logistic regression analyses showed that young adults and those living in the South and West were more likely to switch to e-cigarettes, compared to former smokers who did not switch. Compared with current dual users, those with higher education and those who were not single were more likely to switch to e-cigarettes. The state with the highest prevalence of switching was New Mexico (7.3%), whereas Connecticut had the lowest prevalence (0.8 %) among former smokers. CONCLUSIONS There is an increase in the progression from traditional cigarette use to e-cigarette use. Further research is warranted to determine whether this change continues and facilitates cigarette smoking cessation as a possible public health benefit and opportunity to save lives rather than constitutes a potential threat to public health.

Analysis of state-specific prevalence, regional differences, and correlates of hookah use in U.S. adults, 2012-2013

Objective To investigate the state-specific prevalence, regional differences, and correlates of hookah use among U.S. adults. Methods We analyzed the most recent nationally representative data of adults from the National Adult Tobacco Survey (NATS) 2012-2013 (n = 60192). State-specific prevalence of lifetime and current hookah use was calculated and mapped. Multivariate logistic regression was performed to determine the association between sociodemographic characteristics, regional differences, and hookah use. Results Among U.S. adults (≥18 years), overall prevalence of lifetime hookah use was 12.3%, while current use was 3.9%. Mapping of state-specific prevalence revealed that the West tended to have higher rates of use, while the South tended to have lower ones. In the adjusted model, we observed that current hookah use was positively associated with younger adults, males, non-Hispanic adults, those with higher education and income statuses, being single, those living in the West, and current cigarette use. Conclusion The prevalence of hookah use varies by state, region, and sociodemographic characteristics among adults. Future research, including longitudinal studies, are needed to identify geographic and sociodemographic characteristics and trends among hookah users, investigate hookah-related health outcomes, and evaluate targeted public health efforts aimed at this emerging threat. Implications This study investigates state-level prevalence, regional differences, and sociodemographic characteristics of hookah use among U.S. adults, using the most recent NATS. Hookah use was positively associated with younger adults and those living in the West. This study adds to the understanding of the geographic and sociodemographic factors underlying hookah use, which can be used to develop much needed evidence-based regulations and programs that are responsive to the needs of different risk groups.

Comparison of Prevalence- and Smoking Impact Ratio-Based Methods of Estimating Smoking-Attributable Fractions of Deaths

Background Smoking is a major modifiable risk factor for premature mortality. Estimating the smoking-attributable burden is important for public health policy. Typically, prevalence- or smoking impact ratio (SIR)-based methods are used to derive estimates, but there is controversy over which method is more appropriate for country-specific estimates. We compared smoking-attributable fractions (SAFs) of deaths estimated by these two methods. Methods To estimate SAFs in 2012, we used several different prevalence-based approaches using no lag and 10- and 20-year lags. For the SIR-based method, we obtained lung cancer mortality rates from the Korean Cancer Prevention Study (KCPS) and from the United States-based Cancer Prevention Study-II (CPS-II). The relative risks for the diseases associated with smoking were also obtained from these cohort studies. Results For males, SAFs obtained using KCPS-derived SIRs were similar to those obtained using prevalence-based methods. For females, SAFs obtained using KCPS-derived SIRs were markedly greater than all prevalence-based SAFs. Differences in prevalence-based SAFs by time-lag period were minimal among males, but SAFs obtained using longer-lagged prevalence periods were significantly larger among females. SAFs obtained using CPS-II-based SIRs were lower than KCPS-based SAFs by >15 percentage points for most diseases, with the exceptions of lung cancer and chronic obstructive pulmonary disease. Conclusions SAFs obtained using prevalence- and SIR-based methods were similar for males. However, neither prevalence-based nor SIR-based methods resulted in precise SAFs among females. The characteristics of the study population should be carefully considered when choosing a method to estimate SAF.

Financial hardship and drug use among men who have sex with men

BackgroundLittle is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM.MethodsWe conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs).ResultsIn our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05–1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19–1.78), marijuana (aRR = 1.48; 95% CI =1.03–2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03–1.50).ConclusionsFinancial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.