New Research published from the CHS: Less pollution = improvement in children’s respiratory health

Bronchitic symptoms on the decline as pollution levels drop in Los Angeles region over the past two decades  #CleanAir

PRESS COVERAGE: Press Enterprise, New York Times, U.S.News, HealthDay, United Press International, Medical News Today, Eureka Alert
JAMA Coverage:  News Release and VideoAuthor Interview Video
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A USC study that tracked Southern California children over a 20 year period has found they now have significantly fewer respiratory symptoms as a result of improved air quality.

The finding expands on the landmark USC Children’s Health Study, which a year ago reported that kids’ lungs had grown stronger over the past 20 years as pollution levels in the Los Angeles Basin declined. In the current study, USC researchers examined a health issue that makes many parents anxious while pulling at their pocketbooks: bronchitic symptoms that could land otherwise healthy children in a doctor’s office or hospital.

The research appears in the April 12, 2016 issue of the Journal of the American Medical Association.

To assess respiratory symptoms, USC scientists studied children in eight California communities and defined bronchitic symptoms over the preceding year as a daily cough for at least three consecutive months, congestion or phlegm not related to a cold, or inflammation of the mucous membranes, according to Kiros Berhane, lead author and a professor of preventive medicine at the Keck School of Medicine of USC.

“This is one of the few times that we have been able to report good news, and this is very likely a direct result of the science-­‐‑based policies that have been put in place,” Berhane said. “The message that clean air leads to better health in children should be taken seriously because it has implications for how we live and how productive we become.”

The study, published April 12 in the Journal of the American Medical Association, followed 4,602 children in three cohorts as they aged from 5 to 18. During 1993 to 2012, children and their parents from Long Beach, San Dimas, Upland, Riverside, Mira Loma, Lake Elsinore, Alpine and Santa Maria answered questionnaires about children’s health. Air quality was continuously monitored in each community.

“Because of the wide variations in ambient pollution levels among the eight California communities we analyzed, these findings are applicable to other parts of the United States and maybe other parts of the world as well,” Berhane said, adding the results could help with asthma management and the overall respiratory health of children.

How much children’s respiratory health improved

Because bronchitic symptoms are usually about four times higher in children with asthma, the scientists examined associations of air pollution reduction with bronchitic symptoms separately for kids with and without asthma. Researchers also adjusted their analyses for age, gender, race or ethnicity, secondhand tobacco smoke and presence of cockroaches in the home.

“It is important to note that while reductions in bronchitic symptoms were larger in children with asthma, they were still substantial and significant in children without asthma as well — indicating that all children have benefited from the improvement in air quality over the past 20 years,” Berhane said.

The study found that tiny particles called particulate matter 2.5 (PM 2.5) — which can penetrate deep into lungs and cause serious health problems — dropped by 47 percent from 1992 to 2011 in the study region. USC researchers were able to associate cleaner air with improved children’s respiratory health. Kids with asthma were 32 percent less likely to suffer from bronchitic symptoms, and children without asthma experienced a 21 percent reduction in these respiratory problems.

Moreover, nitrogen dioxide, which can reduce resistance to respiratory infections, decreased by 49 percent in the same two decades. USC researchers linked the drop in nitrogen dioxide with a 21 percent decrease of bronchitic symptoms in children with asthma and a 16 percent decline of bronchitic symptoms in kids without asthma.

“This type of data is important for policymaking and for how clinicians would advise their patients,” Berhane said.

The cost of asthma and sick children

About 1 in 10 children in the United States had asthma in 2009, according to the Centers for Disease Control and Prevention. Medical expenses associated with asthma amounted to $50.1 billion in 2007 and cost the nation about $3,300 per person each year.

“Changes in children’s respiratory health have a ripple effect,” Berhane said. “A child may stay home because of severe bronchitic symptoms. That could mean parents have to call in sick or arrange for a caregiver. Beyond quality of life, childhood asthma and bronchitic symptoms take a toll on children’s school attendance, parental productivity and society in general.”

Asthma is the cause for almost 2 million emergency room visits each year, according to the Asthma and Allergy Foundation of America. Each year, this respiratory condition is the reason for more than 14 million doctor visits and about 439,000 hospital stays.

Frank Gilliland, senior author and a professor of preventive medicine at Keck Medicine of USC, said the USC Children’s Health Study is a unique examination because it has been able to follow children for so many years.

“Asthma is the most common chronic disease of childhood, so the reduction of these symptoms by 16 to 32 percent is a big deal,” Gilliland said. “We studied longitudinal cohorts of children for 20 years using consistent methods and found that decreased levels of air pollutants were associated with a marked decrease in bronchitic-­‐‑related symptoms in children both with and without asthma. No other study has been able to accomplish this.”

Pollution and policy

California cities have consistently topped the American Lung Association’s annual list of most polluted cities by ozone or particulate matter pollution. Historically, Southern California has reported high levels of ambient air pollution because of emissions from vehicles, industrial sources and two of the nation’s largest ports.

“While the reduction in ambient air pollution has been observed during the past 20 years, it was most marked after 2000 and is very likely due to policies that were put in place,” Berhane said. “Even though this is very encouraging, there is still room for improvement. We must recognize that in some cases, the ozone and particulate matter levels in Southern California are still in violation of federal standards.”

Some California regulatory policies that have been implemented include the Low-Emission Vehicle Program, a risk-reduction plan for diesel fueled engines and vehicles, and pollution controls at the ports of Los Angeles and Long Beach.

For many years, environmental epidemiologists have reported adverse health effects associated with increasingly polluted air. So the ability to report that Southern California has been on the path to cleaner air and that this reduction in air pollution has led to significant improvement in children’s health is a welcome change, Gilliland said.

Berhane added: “But we must not get complacent. We expect more cars on the road, more ships at our ports and more economic activities in the region. Even if we maintain the current policies and practices in environmental protection, pollution levels could start to rise again because of more cars and economic activities. We have to stay vigilant so that we do not lose current gains in air quality and the associated improvements in our children’s health.”

USC strives to conduct research that could have a global impact. This study was supported by the National Institute of Environmental Health Sciences, the Health Effects Institute and the California Air Resources Board.

Press Release: by Zen Vuong, USC Media Relations

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Kiros Berhane, PhD; Chih-Chieh Chang, PhD; RobMcConnell, MD;W. James Gauderman, PhD; Edward Avol, MS; Ed Rapapport, MPH; Robert Urman, PhD; Fred Lurmann, MS; Frank Gilliland, MD, PhD. Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012. JAMA. 2016;315(14):1491-1501. doi:10.1001/jama.2016.3444

USC Funded by NIH/Fogarty: GEOHealth Hub for Research and Training in eastern Africa

October 8, 2015: NIH Fogarty International Center announced they are investing $21 million in partnerships between research institutions in the US and Canada  to establish Global Environmental and Occupational Health (GEOHealth) Hubs in developing countries.

Through the leadership of Dr. Kiros Berhane, Professor in the Department of Preventive Medicine at the Keck School of Medicine and Dr. Jon Samet, Distinguished Professor and Chair of the Department of Preventive Medicine in the Keck School of Medicine, USC will be partnering with Addis Ababa University (Ethiopia) for the eastern Africa portion of the work which will include air pollution monitoring work in Ethiopia, Kenya, Rwanda and Uganda. The air pollution monitoring network and surrounding work that is a part of this hub is modeled after the longitudinal Southern California Children’s Health study of which Dr. Berhane has been an investigator. The hub will have two main components dealing with training and research activities to be led by USC and Addis Ababa University (Ethiopia) respectively. The research projects will be conducted primarily by Eastern African researchers.

Media coverage:
USC Press Release here.
NIH/Fogarty PRESS RELEASE and related resources and information about the GEOHealth Hub project can be found here.

For background on this project at USC,see this blog post detailing part of the air pollution monitoring network planning process that took place back in April 2014 when Worku Tefera, researcher from Ethiopia visited USC.

GEOHealth Hub team in Ethiopia during a planning meeting in 2013.

Worku Tefera (right), Steve Howland, and Suresh Ratnam pictured on the roof of the Soto Street building at USC HSC disassembling an air pollution monitor.

Establishing a GEOHealth Hub for East Africa

L-R: Ratnam, Howland and Tefera on the roof of USC’s Soto Street Building as they disassemble an air pollution monitor.

Worku Tefera is a researcher visiting USC Environmental Health this week to learn about the types of air pollution monitoring conducted as part of the Children’s Health Study. The training will kick-start a similar air pollution monitoring network that will be set up in Addis Ababa, the capital of Ethiopia. “Pollution is boundary-less,” said Tefera, who is also studying for a PhD at USC under the direction of Dr. Frank Gilliland.

Training is being provided by USC staff Suresh Ratnam and Steve Howland and faculty members Kiros Berhane, Frank Gilliland and Scott Fruin. “It’s been a busy week” training Worku and documenting all the equipment procedures, says Ratnam.

Tefera will be bringing exposure monitoring equipment back to Ethiopia with him to begin a study, as part of the Global Environmental Health initiative of the SCEHSC and part of the global health activities of the Institute for Global Health.

Tefera is co-investigator of a planning grant from the National Institutes of Health’s Fogarty International Center designed to establish a “GEOHealth Hub for East Africa.” GEOHealth stands for “Global Environmental and Occupational Health,” with the Hub covering Ethiopia, Kenya, Uganda and Rwanda. He is also a co-investigator on a proposal with Environmental Health faculty on “Effects of Clean Cookstoves on Child Survival in Ethiopia.”

by Kiros Berhane and Carla Truax