NEW RESEARCH: Improved air quality leads to fewer kids developing asthma in nation’s most-polluted region

By LEIGH HOPPER, USC

PRESS COVERAGE: National Public Radio, Reuters,

Improved air quality in the Los Angeles region is linked to roughly 20 percent fewer new asthma cases in children, according to a USC study that tracked Southern California children over a 20-year period.

The findings appear in the May 21 issue of the Journal of the American Medical Association.

The research expands on the landmark USC Children’s Health Study, which found that children’s lungs had grown stronger in the previous two decades and rates of bronchitic symptoms decreased as pollution declined throughout the region.

“While the findings show a clear benefit of lower air pollution levels, there must be continued efforts to reduce pollution in our region,” said first author Erika Garcia, a postdoctoral scholar in the Department of Preventive Medicine at the Keck School of Medicine of USC. “We’re not in a place where we can stop and say, ‘Hey, we’ve arrived’.”

USC Infographic: Lower air pollution = less asthma
Graphic by Wendy Gutschow
Full study related infographic and printable PDF can be found here.

Los Angeles remains the nation’s most-polluted region, but air quality improvements between 1993 and 2006 cut nitrogen dioxide pollution by 22 percent and fine particulate matter by 36 percent.

Nitrogen dioxide can cause airway inflammation and airway hyper-responsiveness. Particulate matter — tiny particles of soot, smoke dust, etc. — can penetrate deep into the lungs and cause serious health problems.

To assess new-onset cases of asthma, USC scientists used data from 4,140 children in nine California communities: Alpine, Lake Elsinore, Lake Gregory, Long Beach, Mira Loma, Riverside, San Dimas, Santa Maria and Upland. Parents or guardians completed questionnaires regarding their children’s health. New-onset asthma was defined as a newly reported, physician-diagnosed case of asthma on an annual questionnaire during follow-up.

Researchers looked at rates of new-onset asthma alongside air pollution data collected from monitoring stations in each of those communities during three different periods: 1993-2001, 1996-2004 and 2006-2014. Using statistical methods, they separately examined four air pollutants and found that two were associated with reductions in new-onset asthma. They estimated that the nitrogen dioxide reductions achieved between 1993 and 2006 led to a 20 percent lower rate of asthma, while fine particulate matter reductions led to a 19 percent lower rate.

The findings add to the increasing scientific evidence supporting the role of air pollution in the development of new cases of asthma. Asthma is the most common chronic disease in children, affecting about 14 percent of children around the world, and a major contributing factor to missed time from school and work.

“This is encouraging news as it shows the number of new cases of asthma in children can be reduced through improvements in air quality,” said Kiros Berhane, a professor of preventive medicine at the Keck School of Medicine of USC and one of the study’s authors. “This is very likely a direct result of the science-based environmental policies that have been put in place.”

In addition to Garcia and Berhane, the study’s other authors are Talat Islam, Rob McConnell, Robert Urman, Zhanghua Chen and Frank Gilliland, all of the Department of Preventive Medicine at the Keck School of Medicine.

The research was supported by the National Institute of Environmental Health Sciences (grants P30ES007048, P01ES009581, R01ES021801, and R01ES025786), the National Heart, Lung and Blood Institute (grant R01HL118455), the United States Environmental Protection Agency (grants R826708 and RD831861), and the Hastings Foundation.

Dr. Rima Habre contributes to international panel on performance standards for low-cost air pollution sensors


Rima Habre holds an ultrafine particle monitor monitor while a plane flies overhead. Photo courtesy of Something in the Air documentary.

In June 2018, USC Environmental Health Centers exposure assessment expert Rima Habre, ScD, contributed to a two-day workshop hosted by the U.S. Environmental Protection Agency. Habre discussed essential features, design recommendations and performance targets specifically for wearable personal PM2.5 deployed in health research studies to assess personal exposures and investigate relationships with health outcomes in population studies. Dr. Habre’s presentation discussed her work in the UCLA/USC Los Angeles PRISMS center led by Dr. Alex Bui (UCLA Medical Imaging Informatics) where researchers are developing a multi-sensor informatics platform to enable mHealth studies of pediatric asthma. The platform, called BREATHE (Biomedical REAl-Time Health Evaluation for Pediatric Asthma) allows researchers to monitor environmental exposures, behaviors, medications and symptoms using Bluetooth-enabled wearable sensors in real-time and in context, to ultimately help predict and prevent asthma attacks in children. Dr. Habre’s presentation focused on ‘real-life compatibility’ design and performance needs for low-cost PM2.5 sensors deployed as part of an informatics ecosystem, including flexible wear options, battery life, communication needs, but also calibration well-suited for mobile deployments on humans moving in and across microenvironments in daily life.

Proceedings from the meeting that focused on performance targets for low cost sensors that measure fine particulate matter and ozone, are summarized in a research paper of which Habre is a co-author, published in April 2019 in the Atmospheric Environment journal.

Williams, R., Duvall, R., Kilaru, V., Hagler, G., Hassinger, L., Benedict, K., Habre, R. … Ning, Z. (2019). Deliberating performance targets workshop: Potential paths for emerging PM2.5 and O3 air sensor progress. Atmospheric Environment: X, 2, 100031. https://doi.org/10.1016/J.AEAOA.2019.100031

For more information about the workshop, including links to all presentations, click here.

Learn more about Dr. Habre’s recent research here.

Children’s Health Study featured in new book

The following article on CityLab’s website, and can be read in full on the website. The article is an excerpt from the new book Choked: Life and Breath in the Age of Air Pollution (University of Chicago Press, $27.50).

How Scientists Discovered What Dirty Air Does to Kids’ Health

BETH GARDINER APRIL 22, 2019

The landmark Children’s Health Study tracked thousands of children in California over many years—and transformed our understanding of air pollution’s harms.

Across Southern California, in school gyms and libraries and lunchrooms, the children filed in, one by one, to put their lips around a plastic tube and blow with all their might. Thousands of them, year after year, in rich neighborhoods and poor ones, from the breezy towns along the Pacific coast to the hot, smoggy valley locals know as the Inland Empire.

Erika Fields was one of them, back in the 1990s, when she was in high school at Long Beach Poly, just outside Los Angeles. Even now, she’s the kind of person who raises her hand, who steps forward when volunteers are needed, and she liked being the only one called out of her class, walking down the hall to the quiet room where the breathing machine sat on a desk. She liked, too, the sense of being part of something bigger than herself, something that might really matter in the world.

In the empty classroom, the woman from the University of Southern California would hand her a sterile mouthpiece, attached by a tube to the spirometer ready to gauge the power of her lungs. Erika would give it a couple of practice puffs to get comfortable before the one that counted. “I remember her saying ‘Push, push, push. Blow all the air out.’ And then she would show me on her laptop, and I could see on a graph where I pushed the most,” and watch the line edge downward as her breath tailed off.

After that, there was a survey to fill out, a couple of pages about her health and her family, about smoking in the home and pets and diet and exercise, and then Erika would walk back down the hall, back to her classmates and the ordinary rhythms of the school day.

She didn’t know it then, but those brief, once-a-year interruptions to her routine helped lay the foundation for insights that would ultimately change scientists’ understanding of what air pollution does to the human body. In the vast stacks of accumulating numbers—results from Erika Fields’s breath tests and thousands of others— a team of patient researchers would discern the outlines of a threat that had, until then, been hard to see.

Photo/Courtesy of the South Coast Air Quality Management District

Ed Avol was one of those scientists. He grew up breathing the foul air of 1960s L.A., and he remembers well the hacking coughs that filled the playgrounds of his childhood. An engineer by training, he worked early in his career on hospital-based studies that examined the effects of dirty air as researchers had for decades, by pumping pollution into small rooms and watching volunteers exercise inside.

The team he was part of wasn’t allowed to make conditions in their smog chambers any worse than what Angelenos would experience outdoors, but in the 1980s that still gave them plenty of latitude. The researchers would monitor subjects as they pedaled, measuring their heart rates and oxygen levels, making note of their coughing, their shortness of breath, and their red, watery eyes.

By that time, it was clear to scientists that ozone—the main ingredient in the smog that still plagues L.A. and so many other cities—had an immediate effect on those who breathed it. And the impact could be far more serious than the discomfort Avol saw so plainly: When ozone blankets a city, asthmatics wheeze, emergency room visits spike, and even in healthy people, the lungs can grow inflamed and struggle to do their job.

Read the rest of this article, including more of the history of the Children’s Health Study, and interviews from CHS investigators including Ed Avol and Jim Gauderman here on CityLab’s website.

This article from CityLab is an excerpt from the new book Choked: Life and Breath in the Age of Air Pollution (University of Chicago Press, $27.50).

“A Day in the Life” youth program participants present at annual conference

In March 2019, youth participants from the Los Angeles communities of South LA and Wilmington, along with youth organizers from their respective communities and USC Environmental Health staff presented at the annual Citizen Science Conference, held this year in Raleigh, North Carolina.

The group presented during a workshop comprised of groups from around the country: Building Collaboration and Ensuring Justice in Community-Based Participatory Research: Lessons Learned from California, South Carolina, and Michigan.

The two youth who presented have shared the following reflections about their experience presenting and attending the conference:

Ashley Lazaro, 12th grade, South Central Youth Leadership Coalition

The highlight of my trip was having the opportunity to share my story with others and being able to connect with others that were dealing with similar situations. This trip taught me to be more assertive and to stand up for myself. I learned to not feel inferior or intimidated by anyone and that my voice as a youth is powerful.

To me citizen science means science or research that is conducted by the community itself. However, I do wish it was called people’s science to be more inclusive to my immigrant community.  Citizen science gives me the opportunity to defend myself. Taking the research into my own hands gives me and my community power against big industries who try to make us feel inferior.

In the future I hope that the Day in the Life project can expand to more youth in the community. It was a helpful and fun project. Next time, people can journal their journey or it can be expanded to a week in the life. 

Ashley Lazaro, presenting at the Citizen Science Conference.

Viridia Preciado, 12th grade, Communities for a Better Environment

The highlight of my trip was exploring a new place and exploring all it had to offer. What I took away from this trip was understanding that not only my community is going through all of this environmental racism, but others around the world are going through similar things. If parts of my community have came together to fight for environmental justice, why can’t the whole world do that to get what was once stolen from us. The right to clean air, water, soil, and so much more. 

What citizen science means to me is the work and research done by individuals in our community to make that change and present it back to others to inform them. CBE may not use the term citizen science to describe our work, but it connects with our work because the community is really the ones who do all the work to mark a change in this world. 

It would be great to involve more people to really experience this great program and to fully understand what it’s like to be in their community.

Viridiana Preciado presenting at the Citizen Science conference.
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