Thomas Matte

Influence of variation in birth weight within normal range and within sibships on IQ at age 7 years: cohort study

Abstract Objective: To examine the relation between birth weight and measured intelligence at age 7 years in children within the normal range of birth weight and in siblings. Design: Cohort study of siblings of the same sex. Setting: 12 cities in the United States. Subjects: 3484 children of 1683 mothers in a birth cohort study during the years 1959 through 1966. The sample was restricted to children born at ≥37 weeks gestation and with birth weights of 1500-3999 g. Main outcome measure: Full scale IQ at age 7 years. Results: Mean IQ increased monotonically with birth weight in both sexes across the range of birth weight in a linear regression analysis of one randomly selected sibling per family (n= 1683) with adjustment for maternal age, race, education, socioeconomic status, and birth order. Within same sex sibling pairs, differences in birth weight were directly associated with differences in IQ in boys (812 pairs, predicted IQ difference per 100 g change in birth weight =0.50, 95% confidence interval 0.28 to 0.71) but not girls (871 pairs, 0.10, −0.09 to 0.30). The effect in boys remained after differences in birth order, maternal smoking, and head circumference were adjusted for and in an analysis restricted to children with birth weight ≥ 2500 g. Conclusion: The increase in childhood IQ with birth weight continues well into the normal birth weight range. For boys this relation holds within same sex sibships and therefore cannot be explained by confounding from family social environment. What is already known on this topic IQ at school age is linked to birth weight among low birthweight babies Some evidence suggests the association might also apply to children of normal birth weight What this study adds IQ at age 7 years is linearly related to birth weight among children of normal birth weight The relation was not due to confounding by maternal or socioeconomic factors IQ is also associated with differences in birth weight between boy sibling pairs but not girls

Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation

BACKGROUND After an increase in cigarette taxes and implementation of smoke-free workplace legislation, the New York City Department of Health and Mental Hygiene, the New York State Department of Health, and the Roswell Park Cancer Institute undertook large-scale distribution of free nicotine replacement therapy (NRT). We did a 6 month follow-up survey to assess the success of this programme in improving smoking cessation on a population basis. METHODS 34,090 eligible smokers who phoned a toll-free quitline were sent a 6-week course of nicotine patches (2 weeks each of 21 mg, 14 mg, and 7 mg per day). Brief follow-up counselling calls were attempted. At 6 months after treatment, we assessed smoking status of 1305 randomly sampled NRT recipients and a non-randomly selected comparison group of eligible smokers who, because of mailing errors, did not receive the treatment. NRT recipients were compared with local survey-derived data for heavy smokers in New York City. FINDINGS An estimated 5% of all adults in New York City who smoked ten cigarettes or more daily received NRT; most (64%) recipients were non-white, foreign-born, or resided in a low-income neighbourhood. Of individuals contacted at 6 months, more NRT recipients than comparison group members successfully quit smoking (33%vs 6%, p<0.0001), and this difference remained significant after adjustment for demographic factors and amount smoked (odds ratio 8.8, 95% CI 4.4-17.8). Highest quit rates were associated with those who were foreign born (87 [39%]), older than 65 years (40 [47%]), and smoked less than 20 cigarettes per day (116 [35%]). Those who received a counselling call were more likely to stop smoking than those who did not (246 [38%] vs 189 [27%], p=0.001). With the conservative assumption that every 6-month follow-up survey non-respondent continued to smoke, the stop rate among NRT recipients was 20%. At least 6038 successful quits were attributable to NRT receipt, and cost was 464 US dollars per quit. INTERPRETATION Easy access to cessation medication for diverse populations could help many more smokers to stop.

Fine particulate matter constituents associated with cardiovascular hospitalizations and mortality in New York City.

Background Recent time-series studies have indicated that both cardiovascular disease (CVD)mortality and hospitalizations are associated with particulate matter (PM). However, seasonal patterns of PM associations with these outcomes are not consistent, and PM components responsible for these associations have not been determined. We investigated this issue in New York City (NYC), where PM originates from regional and local combustion sources. Objective In this study, we examined the role of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) and its key chemical components on both CVD hospitalizations and on mortality in NYC. Methods We analyzed daily deaths and emergency hospitalizations for CVDs among persons ≥ 40 years of age for associations with PM2.5, its chemical components, nitrogen dioxide (NO2), carbon monoxide, and sulfur dioxide for the years 2000–2006 using a Poisson time-series model adjusting for temporal and seasonal trends, temperature effects, and day of the week. We estimated excess risks per interquartile-range increases at lags 0 through 3 days for warm (April through September) and cold (October through March) seasons. Results The CVD mortality series exhibit strong seasonal trends, whereas the CVD hospitalization series show a strong day-of-week pattern. These outcome series were not correlated with each other but were individually associated with a number of PM2.5 chemical components from regional and local sources, each with different seasonal patterns and lags. Coal-combustion–related components (e.g., selenium) were associated with CVD mortality in summer and CVD hospitalizations in winter, whereas elemental carbon and NO2 showed associations with these outcomes in both seasons. Conclusion Local combustion sources, including traffic and residual oil burning, may play a year-round role in the associations between air pollution and CVD outcomes, but transported aerosols may explain the seasonal variation in associations shown by PM2.5 mass.

Housing and health - current issues and implications for research and programs.

This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs.This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs.

Summer Heat and Mortality in New York City: How Hot Is Too Hot?

Background To assess the public health risk of heat waves and to set criteria for alerts for excessive heat, various meteorologic metrics and models are used in different jurisdictions, generally without systematic comparisons of alternatives. We report such an analysis for New York City that compared maximum heat index with alternative metrics in models to predict daily variation in warm-season natural-cause mortality from 1997 through 2006. Materials and methods We used Poisson time-series generalized linear models and generalized additive models to estimate weather–mortality relationships using various metrics, lag and averaging times, and functional forms and compared model fit. Results A model that included cubic functions of maximum heat index on the same and each of the previous 3 days provided the best fit, better than models using maximum, minimum, or average temperature, or spatial synoptic classification (SSC) of weather type. We found that goodness of fit and maximum heat index–mortality functions were similar using parametric and nonparametric models. Same-day maximum heat index was linearly related to mortality risk across its range. The slopes at lags of 1, 2, and 3 days were flat across moderate values but increased sharply between maximum heat index of 95°F and 100°F (35–38°C). SSC or other meteorologic variables added to the maximum heat index model moderately improved goodness of fit, with slightly attenuated maximum heat index–mortality functions. Conclusions In New York City, maximum heat index performed similarly to alternative and more complex metrics in estimating mortality risk during hot weather. The linear relationship supports issuing heat alerts in New York City when the heat index is forecast to exceed approximately 95–100°F. Periodic city-specific analyses using recent data are recommended to evaluate public health risks from extreme heat.

Urban Tree Canopy and Asthma, Wheeze, Rhinitis, and Allergic Sensitization to Tree Pollen in a New York City Birth Cohort

Background: Urban landscape elements, particularly trees, have the potential to affect airflow, air quality, and production of aeroallergens. Several large-scale urban tree planting projects have sought to promote respiratory health, yet evidence linking tree cover to human health is limited. Objectives: We sought to investigate the association of tree canopy cover with subsequent development of childhood asthma, wheeze, rhinitis, and allergic sensitization. Methods: Birth cohort study data were linked to detailed geographic information systems data characterizing 2001 tree canopy coverage based on LiDAR (light detection and ranging) and multispectral imagery within 0.25 km of the prenatal address. A total of 549 Dominican or African-American children born in 1998–2006 had outcome data assessed by validated questionnaire or based on IgE antibody response to specific allergens, including a tree pollen mix. Results: Tree canopy coverage did not significantly predict outcomes at 5 years of age, but was positively associated with asthma and allergic sensitization at 7 years. Adjusted risk ratios (RRs) per standard deviation of tree canopy coverage were 1.17 for asthma (95% CI: 1.02, 1.33), 1.20 for any specific allergic sensitization (95% CI: 1.05, 1.37), and 1.43 for tree pollen allergic sensitization (95% CI: 1.19, 1.72). Conclusions: Results did not support the hypothesized protective association of urban tree canopy coverage with asthma or allergy-related outcomes. Tree canopy cover near the prenatal address was associated with higher prevalence of allergic sensitization to tree pollen. Information was not available on sensitization to specific tree species or individual pollen exposures, and results may not be generalizable to other populations or geographic areas.

Monitoring intraurban spatial patterns of multiple combustion air pollutants in New York City: Design and implementation

Routine air monitoring provides data to assess urban scale temporal variation in pollution concentrations in relation to regulatory standards, but is not well suited to characterizing intraurban spatial variation in pollutant concentrations from local sources. To address these limitations and inform local control strategies, New York City developed a program to track spatial patterns of multiple air pollutants in each season of the year. Monitor locations include 150 distributed street-level sites chosen to represent a range of traffic, land-use and other characteristics. Integrated samples are collected at each distributed site for one 2-week session each season and in every 2-week period at five reference locations to track city-wide temporal variation. Pollutants sampled include PM2.5 and constituents, nitrogen oxides, black carbon, ozone (summer only) and sulfur dioxide (winter only). During the first full year of monitoring more than 95% of designed samples were completed. Agreement between colocated samples was good (absolute mean % difference 3.2–8.9%). Street-level pollutant concentrations spanned a much greater range than did concentrations at regulatory monitors, especially for oxides of nitrogen and sulfur dioxide. Monitoring to characterize intraurban spatial gradients in ambient pollution usefully complements regulatory monitoring data to inform local air quality management.

Intra-urban spatial variability in wintertime street-level concentrations of multiple combustion-related air pollutants: the New York City Community Air Survey (NYCCAS).

Although intra-urban air pollution differs by season, few monitoring networks provide adequate geographic density and year-round coverage to fully characterize seasonal patterns. Here, we report winter intra-urban monitoring and land-use regression (LUR) results from the New York City Community Air Survey (NYCCAS). Two-week integrated samples of fine particles (PM2.5), black carbon (BC), nitrogen oxides (NOx) and sulfur dioxide (SO2) were collected at 155 city-wide street-level locations during winter 2008–2009. Sites were selected using stratified random sampling, randomized across sampling sessions to minimize spatio-temporal confounding. LUR was used to identify GIS-based source indicators associated with higher concentrations. Prediction surfaces were produced using kriging with external drift. Each pollutant varied twofold or more across sites, with higher concentrations near midtown Manhattan. All pollutants were positively correlated, particularly PM2.5 and BC (Spearman’s r=0.84). Density of oil-burning boilers, total and truck traffic density, and temporality explained 84% of PM2.5 variation. Densities of total traffic, truck traffic, oil-burning boilers and industrial space, with temporality, explained 65% of BC variation. Temporality, built space, bus route location, and traffic density described 67% of nitrogen dioxide variation. Residual oil-burning units, nighttime population and temporality explained 77% of SO2 variation. Spatial variation in combustion-related pollutants in New York City was strongly associated with oil-burning and traffic density. Chronic exposure disparities and unique local sources can be identified through year-round saturation monitoring.

Noise, air pollutants and traffic: continuous measurement and correlation at a high-traffic location in New York City.

BACKGROUND Epidemiological studies have linked both noise and air pollution to common adverse health outcomes such as increased blood pressure and myocardial infarction. In urban settings, noise and air pollution share important sources, notably traffic, and several recent studies have shown spatial correlations between noise and air pollution. The temporal association between these exposures, however, has yet to be thoroughly investigated despite the importance of time series studies in air pollution epidemiology and the potential that correlations between these exposures could at least partly confound statistical associations identified in these studies. METHODS An aethelometer, for continuous elemental carbon measurement, was co-located with a continuous noise monitor near a major urban highway in New York City for six days in August 2009. Hourly elemental carbon measurements and hourly data on overall noise levels and low, medium and high frequency noise levels were collected. Hourly average concentrations of fine particles and nitrogen oxides, wind speed and direction and car, truck and bus traffic were obtained from nearby regulatory monitors. Overall temporal patterns, as well as day-night and weekday-weekend patterns, were characterized and compared for all variables. RESULTS Noise levels were correlated with car, truck, and bus traffic and with air pollutants. We observed strong day-night and weekday-weekend variation in noise and air pollutants and correlations between pollutants varied by noise frequency. Medium and high frequency noise were generally more strongly correlated with traffic and traffic-related pollutants than low frequency noise and the correlation with medium and high frequency noise was generally stronger at night. Correlations with nighttime high frequency noise were particularly high for car traffic (Spearman rho=0.84), nitric oxide (0.73) and nitrogen dioxide (0.83). Wind speed and direction mediated relationships between pollutants and noise. CONCLUSIONS Noise levels are temporally correlated with traffic and combustion pollutants and correlations are modified by the time of day, noise frequency and wind. Our results underscore the potential importance of assessing temporal variation in co-exposures to noise and air pollution in studies of the health effects of these urban pollutants.

Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment

Coastal storms can take a devastating toll on the publics health. Urban areas like New York City (NYC) may be particularly at risk, given their dense population, reliance on transportation, energy infrastructure that is vulnerable to flood damage, and high-rise residential housing, which may be hard-hit by power and utility outages. Climate change will exacerbate these risks in the coming decades. Sea levels are rising due to global warming, which will intensify storm surge. These projections make preparing for the health impacts of storms even more important. We conducted a broad review of the health impacts of US coastal storms to inform climate adaptation planning efforts, with a focus on outcomes relevant to NYC and urban coastal areas, and incorporated some lessons learned from recent experience with Superstorm Sandy. Based on the literature, indicators of health vulnerability were selected and mapped within NYC neighborhoods. Preparing for the broad range of anticipated effects of coastal storms and floods may help reduce the public health burden from these events.