OP-001

E-POSTERS

EP-001[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Exposure to metal mixtures andneurodevelopment outcomes in 4-5-year-old
children living in Spain
N. Jimenez Redondo1, S. Díaz Coto2, P. Martinez Camblor3, M. Guxens4, M. Vrijheid4, A. Andiarena5,
A. Irizar5, I. Riaño Galan6, A. Fernández Somoano10, S. Llop7, M. Lozano7, M. R. Karagas2, J.
Vioque9, M. Carey8, A. Meharg8, C. Meharg8, K. Ralphs8, C. Mccreanor8, E. Sendra1, A. J. Signes
Pastor9
1Centro de Investigación e Innovación Agroalimentaria y Agroambiental CIAGRO. Universidad MiguelHernández de Elche.Ctra Beniel KM 3,2 03312 Orihuela (Alicante).
2Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, UnitedStates.
3Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, NH,

United States.
4ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica deBarcelona (PRBB), Barcelona, Spain.
5Health Research Institute, Biodonostia, Donostia-San Sebastian, Spain.
6Servicio de Pediatría. Endocrinología pediátrica. HUCA. Roma Avenue s/n. 33001, Oviedo. Asturias,

Spain. University Institute of Oncology of the Principality of Asturias (IUOPA) – Department ofMedicine, University of Oviedo. Julián Clavería Street s/n. 33006, Oviedo. Asturias. Spain. Institute of
Health Research of the Principality of Asturias (ISPA). Roma Avenue s/n. 33001, Oviedo. Spain. CIBER
de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
7Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-

Public Health, Valencia, Spain.
8Institute for Global Food Security, Queen’s University Belfast, School of Biological Sciences Building,

19 Chlorine Gardens, Belfast, Northern Ireland, BT9 5DL.
9Unidad de Epidemiología de la Nutrición. Universidad Miguel Hernández, Alicante, Spain. CIBER de

Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain.
10University Institute of Oncology of the Principality of Asturias (IUOPA) – Department of Medicine,

University of Oviedo. Julián Clavería Street s/n. 33006, Oviedo. Asturias. Spain. Institute of HealthResearch of the Principality of Asturias (ISPA). Roma Avenue s/n. 33001, Oviedo. Spain. CIBER de
Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.

BACKGROUND AND AIM:Humans are exposed to toxic metals/metalloids and essential elements(hereafter, “metals”) simultaneously in real-life scenarios with potential additive, synergistic or
antagonistic effects. Early life is a vulnerable window for metal exposure, with potential adverse healtheffects that may last throughout the life course. This study aims to explore the association between
metal mixture exposures and the neurodevelopment of children in Spain.
METHOD:The study population (n = 962) belonged to the INMA Project. A standardised version of the
McCarthy Scales of Children's Ability was used to assess 4-year-old children's neurodevelopment. The
concentrations of As species, Co, Cu, Mo, Pb, Se and Zn were measured in spot urine samples
adjusted for urine dilution. Principal component analysis was performed as a dimension reduction
technique to identify latent metal mixtures. The association between the metal mixtures and children'sneurodevelopment function scores was explored using multiple linear regression adjusted forconfounding factors.
RESULTS:Four principal components or metal mixtures were identified with a cumulative explained
variance of 69%. The first component comprised the essential elements Cu, Se, and Zn, as well as the
toxic metal Pb, and was linked to a decreased performance in global verbal, executive, verbal
executive, and working memory function scores. The second component, comprising urinary inorganic
As and monomethylarsonic acid concentrations, was associated with a reduced global motor and grossmotor scores. The third component gathered Mo and Co and was related to an increased function
scores in visual and verbal span, and global motor. The fourth component was generated from urinary
arsenobetaine concentrations and was related to an increased fine motor.
CONCLUSIONS:Even relatively low metal exposures, relevant to the Spanish population and others,
may impact children's neurodevelopment. Our main findings support the reduction of exposure to
toxic metals during critical windows of early life.

Keywords: mixture, heavy metals, children’s environmental health, respiratory outcomes, biomarkers
of exposure.

EP-002[Exposures » Food/nutrition]

Pro-vegetarian dietary patterns and metal
exposure in Spanish children of 4-5 years
Alejandro Oncina Canovas1, Jesús Vioque2, Gabriel Riutort3, Raquel Soler Blasco4, Amaia Iriza5,
Ziortza Barroeta5, Ana Fernández Somoano6, Adonina Tardón6, Martine Vrijheid7, Monica Guxens8,
Antonio J. Signes Pastor2
1Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-

UMH), 03010 Alicante, Spain; Unidad de Epidemiología de la Nutrición, Departamento de Salud
Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante,
Spain
2Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-

UMH), 03010 Alicante, Spain;Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública,
Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain;
CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
3Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-

Public Health, Valencia, Spain.
4CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain;

Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIOPublic Health, Valencia, Spain; Department of Nursing, Universitat de València, Valencia, Spain
5Health Research Institute, Biodonostia, Donostia-San Sebastian, Spain.
6CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain;

University Institute of Oncology of the Principality of Asturias (IUOPA) – Department of Medicine,
University of Oviedo. Julián Clavería Street s/n. 33006, Oviedo. Asturias. Spain; Institute of HealthResearch of the Principality of Asturias (ISPA). Roma Avenue s/n. 33001, Oviedo. Spain.
7CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain;

Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu
Fabra (UPF), Barcelona, Spain.
8CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain;

Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.

BACKGROUND AND AIM:Food is an important source of vital nutrients, yet it can also contain nonessential-toxic elements. Dietary patterns are a more comprehensive and accurate way to assess theoverall impact of combined food consumption. Pro-vegetarian dietary patterns (PVG) are a novel
approach to evaluate the health effects of vegetarian diets, yet their effects on children remain
unknown. Thus, we aim to examine the association between children’s adherence to three PVG dietary
patterns and exposure to essential and non-essential elements.
METHOD:The study population includes 723 children aged 4-5 years from the INfancia y Medio
Ambiente (INMA) cohort in Spain. We constructed the three PVGs (general (gPVG), healthful (hPVG)
and unhealthful (uPVG)) using dietary information from a validated Food Frequency Questionnaire.
Urinary concentrations of Co, Cu, Zn, Se, Mo, Pb, and Cd were used as exposure biomarker. Urinary
arsenic species concentrations were also measured, and the primary (PMI) and secondary (SMI)
inorganic arsenic methylation indexes calculated.
RESULTS:Higher adherence to gPVG was associated with decreased Co and Se concentrations, anincreased PMI, and reduced SMI. Increased adherence to hPVG was associated with decreased
inorganic arsenic concentration. Higher adherence to uPVG was associated with reduced Mo
concentration and SMI.

CONCLUSIONS:Ingestion of certain essential elements may be lowered with a greater adherence to a
PVG pattern, which may impair children's ability to methylate inorganic arsenic. Our findings support achildren’s nutritional adequate diet with a variety of foods from each food group.

Keywords: Heavy metals, Food and nutrition, Mixtures analysis

EP-003[Air pollution » Particulate matter]

Estimating spatiotemporally resolved PM2.5
concentration across the contiguous UnitedStates using an ensemble model
Alexandra Shtein, Joel Schwartz
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston,
Massachusetts, United States

BACKGROUND AND AIM:Spatiotemporally resolved predictions of PM2.5 concentration are essential forstudying associations between long-term and short-term exposures and adverse health outcomes in
epidemiological studies. An improved statistical ensemble modeling approach with novel covariates
was used to estimate daily 1x1 km PM2.5 concentrations across the contiguous US for the years 20002019, and 250m resolution in urban areas.
METHOD:An ensemble model was used to integrate daily PM2.5 predictions from six different baselearners: 3 tree-based machine learning models (random forests, gradient boosting machine, andextreme gradient boosting), neural networks, an ensemble of individual generalized linear model
predictors with two-way interactions, and a gaussian process approximations model. The ensemble
modeling approach aims to provide predictions with minimized root mean square error (RMSE)
compared to the base learners using a geographically weighted generalized additive model (GAM)
which fused the predictions from multiple learners by allowing the weights of each model to vary overspace. The spatial and temporal variables used as predictors within the individual base learners were:satellite-based products (aerosol optical depth (AOD), land surface temperature, vegetation indexes,
light at night, fires), human modification of land, land cover variables, meteorology, topography,
population density, modelled emissions, proximity, and density of multiple possible sources of air
pollution. The model was calibrated using daily PM2.5 measured by monitors and its performance was
evaluated using 5-folds cross validation where a random subset of monitoring sites was assigned toeach fold.
RESULTS:The 1x1 km ensemble model showed an improved cross validated performance compared tothe input base learners with an overall R2=0.74 and RMSE of 3.24 mg/m3 for the year 2010, and
RMSE for annual average of 1.34.
CONCLUSIONS:The ensemble model suggests an improved statistical approach for integrating PM2.5
concentration predictions from multiple modeling approaches.

Keywords: Air pollution modeling, ensemble modeling, machine learning, satellite-based products

EP-004[Birth and pregnancy outcomes » Birth outcomes]

The role of spatial social polarization in racialand ethnic disparities in stillbirth
Amal Rammah1, Kristina W. Whitworth2, Jasmine M. Drake3, Howard Henderson3, Elaine Symanski2
1Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas, USA
2Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas, USA &Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine,
Houston, Texas, USA
3Department of Administration of Justice, Texas Southern University, Houston, Texas, USA

BACKGROUND AND AIM:Despite evidence of the role of structural racism on disparities in adverse
birth outcomes, its impact on stillbirth has not been sufficiently explored. Thus, we examinedassociations between neighborhood-level racialized economic segregation and stillbirth in greater
Houston, TX, a racially and ethnically diverse and segregated metropolitan area.
METHOD:We abstracted information from 860,789 live birth and fetal death records (2007—2019)from the Texas Department of State Health Services, including geocoded addresses at the time ofdelivery, and used U.S. census data to generate a census-tract level measure of spatial polarization
based on race/ethnicity and income (i.e., the Index for Concentration at the Extremes; ICE), which
was categorized by tertiles (ranging from most deprived to most privileged). We employed logistic
regression with generalized estimating equations (to account for correlation between mothers residingin the same census tract), adjusted for sociodemographic characteristics, to examine the association
between the ICE and stillbirth. We stratified by race/ethnicity to inform the contribution of racialized
economic segregation on disparities in stillbirth.
RESULTS:For all mothers, there was no evidence of an association between stillbirth and living in themost deprived and racially polarized neighborhoods. However, non-Hispanic Black mothers living inthese neighborhoods had a 30% reduced odds of stillbirth (OR=0.70, 95% confidence interval (CI):0.59, 0.84) as compared to non-Hispanic Black mothers living in the most privileged neighborhoods.
Conversely, we observed positive, though not statistically significant, associations among non-Hispanic
White (OR=1.15, 95% CI: 0.90, 1.46) and Hispanic (OR=1.09, 95% CI: 0.94, 1.27) mothers living in
the most deprived neighborhoods.
CONCLUSIONS:Our finding that Black mothers living in deprived neighborhoods had lower odds ofstillbirth relative to those who reside in the most privileged neighborhoods suggests that theavailability of communal support to mothers in these communities may offset the potential effects ofstress associated with economic deprivation.

Keywords: racial disparities, segregation, spatial social polarization, structural racism,

EP-005[Chemical exposures » Mixtures]

Persistent endocrine disrupting chemicals andincident uterine leiomyomata: a mixtures
analysis
Amelia K Wesselink1, Birgit Claus Henn2, Victoria Fruh2, Ruth J Geller1, Chad M Coleman1, Samantha
Schildroth1, Traci N Bethea3, Donna D Baird4, Ganesa Wegienka5, Lauren A Wise1
1Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States ofAmerica
2Department of Environmental Health, Boston University School of Public Health, Boston, MA, UnitedStates of America
3Lombardi Cancer Center, Georgetown University, Washington, DC, United States of America
4Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle, NC,

United States of America
5Henry Ford Health System, Detroit, MI, United States of America

BACKGROUND AND AIM:Uterine leiomyomata (UL) are benign, hormone-sensitive neoplasms that cancause substantial gynecologic morbidity. Our objective was to examine the association between
biomarkers of exposure to a mixture of persistent EDCs and incident UL.
METHOD:We analyzed prospective data from the Study of Environment, Lifestyle, and Fibroids.
Participants were aged 23-35 years, had an intact uterus, resided in the Detroit, MI area, and had no
previous UL diagnosis. Participants completed a clinic visit and questionnaires at baseline (2010-2012)and every ~20 months through 10 years. The clinic visits involved blood collection and transvaginalultrasound for detection of UL. We analyzed baseline plasma samples for 34 chemicals:
polychlorinated biphenyls, polybrominated flame retardants, organochlorine pesticides, and per- andpoly-fluoroalkyl substances. Our analysis included 13 chemicals with >80% detection frequency andwas restricted to the 1,069 participants without UL at baseline. We used Bayesian kernel machine
regression (BKMR) and quantile g-computation to examine the association of the EDC mixture withincident UL, adjusting for age, education, body mass index, cigarette smoking, parity, time since lastbirth, and current depot medroxyprogesterone acetate use.
RESULTS:Thirty-one percent of participants had ultrasound detection of UL over follow-up. In BKMR
analyses, the EDC mixture was weakly inversely associated with probit of UL. This association was
driven primarily by PCB153, PCB180, p,p’-DDE, and PFDA. Alternatively, PCB138/158 was positively
associated with probit of UL. There was little evidence of interaction between chemicals. In quantile gcomputation analyses, the risk ratio for a one-quartile increase in the mixture was 0.87 (95% CI:
0.75, 1.01). PCB138/158 (positive), PCB153 (inverse), and PFDA (inverse) had the highest
contribution to the mixture effect.
CONCLUSIONS:We found a weak inverse association between biomarkers of exposure to a mixture of
persistent EDCs and incident UL, although PCB138/158 was positively associated with incident UL.

Keywords: mixtures analysis, epidemiology, chemical exposures, reproductive outcomesEP-006[Chemical exposures » PFAS]

Case-cohort study of PFAS and hematologic
malignancy risk in American Cancer Society’s
Cancer Prevention Study II Cohort
Andrea Winquist1, James M. Hodge2, W. Ryan Diver2, Lauren R. Teras2, Juan Rodriguez3, Alyssa
Troeschel4, Johnni Daniel1
1National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta,

United States
2Department of Population Science, American Cancer Society, Atlanta, United States
3National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease

Control and Prevention, Atlanta, United States
4National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta,

United States; Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta,
United States

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) have been associated withhematologic malignancies in some but not all previous studies. Many studies did not consider
histologic subtypes, yet there is evidence that risk factors for these cancers vary by subtype. We
examined associations between PFAS exposure and risk of several hematologic malignancy subtypes.
METHOD:We conducted a case-cohort study within the American Cancer Society’s prospective Cancer
Prevention Study II LifeLink cohort for which serum specimens were collected during 1998-2001 (ages≥54 years). This study included a subcohort (500 men, 499 women) randomly selected from cohort
members without prior cancer diagnoses at serum collection, and all persons with incident (after
serum collection) hematologic cancers (n=635, first malignancies only). Hematologic cancer subtypes
with at least 80 cases were analyzed separately. Concentrations of perfluorooctanoic acid,perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid
were measured in stored serum. Multivariable Cox proportional hazards regression was used toestimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between PFAS
concentrations and risk of hematologic malignancy subtypes. Models accounted for the study designand controlled for sex, age and year at blood draw, education, race/ethnicity, smoking and alcoholuse.
RESULTS:Serum PFHxS concentrations were positively associated with chronic lymphocytic
leukemia/small lymphocytic lymphoma (CLL/SLL) among men [HR (95% CI) per unit (ng/ml)
doubling: 1.34 (1.02–1.75), p=0.033] but not women. We also observed possible negative
associations between PFAS serum concentrations and other hematologic malignancy subtypes [e.g.,multiple myeloma and PFOS].
CONCLUSIONS:This study provides some evidence for different associations between PFAS andhematologic cancer risk by subtype -- a positive association between PFHxS and CLL/SLL among men,and possible negative associations between PFAS and other subtypes. Consideration of histologic types
might help clarify inconsistencies in the literature on PFAS and hematologic cancer.

Keywords: PFAS, cancer

EP-007[Neurologic and mental health outcomes » Mental health outcomes]

Air pollution exposure is associated with lower
positive affect in older women
Andrew John Petkus1, Xinhui Wang1, Susan M. Resnick2, Joshua Millstein3, Daniel P. Beavers4, MarkA. Espeland5, Margaret Gatz6, Joel D. Kaufman7, Stephen R. Rapp8, Jiu Chiuan Chen3
1Department of Neurology, University of Southern California, Los Angeles, CA, United States ofAmerica
2Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States ofAmerica
3Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

CA, United States of America
4Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC,

United States of America
5Departments of Internal Medicine and Data Science, Wake Forest School of Medicine, Winston-Salem,

NC, United States of America
6Center for Economic and Social Research, University of Southern California, Los Angeles, CA, UnitedStates of America
7Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology,

University of Washington, Seattle, WA, United States of America
8Departments of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem,

NC, United States of America

BACKGROUND AND AIM:Exposure to ambient air pollution, including PM2.5 (particulate matter <2.5μm) and NO2 (nitrogen dioxide), may increase the risk for depressive symptoms in older adulthood,the impact on specific dimensions of DS is unclear. Our previous work has linked low positive affectwith air pollution exposure and cerebrovascular and neurodegenerative diseases. Here we validated
the factor structure of a commonly used measure of depressive symptoms in a sample of older womenand examined cross-sectional associations between air pollution exposure and depressive symptom
dimensions.
METHOD:We included 2,179 women (age=73.8±3.8 years) from the Women’s Health Initiative Studyof Cognitive Aging who completed an assessment of depressive symptoms with the 15-item GeriatricDepression Scale (GDS-15) at study enrollment. Three-year average of annual mean concentrations ofambient PM2.5 (in μg/m3) and NO2 (in ppb) before this assessment were estimated at participants'
addresses via spatiotemporal models. Structural equation models (SEMs) were constructed to validate
the 3-factor solution consisting of positive affect, apathy/withdrawal, and dysphoria latent factors
identified by previous meta-analyses. Next, SEMs were constructed to examine whether exposures
were associated with each of the three latent factors adjusting for sociodemographic, lifestyle, andclinical characteristics.
RESULTS:The three-factor solution exhibited good model fit (comparative fit index=.99; Tucker-Lewis
index=.98; root mean square error or approximation=.02). Higher exposures to NO2 (β=.140 per
10.36 ppb, p=.003) and PM2.5 (β=.111 per 3.65 μg/m3, p=.009) were significantly associated withlower positive affect. The effect sizes approximated the effect of not engaging in any weekly moderate
to vigorous physical activity relative to 2-4 episodes a week (β=.135, p=.129). Exposure was not
associated with apathy/withdraw or dysphoria symptoms (all p>0.05).
CONCLUSIONS:Consistent with our previous work, air pollution exposure may contribute to reductionof positive affect. Future studies need to examine the changes in brain structures and neural networks
that underlie these associations.

Keywords: depressive symptoms, aging, air pollution, women

EP-008[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

Reference values of barium in hair samples fromchildren and adolescents in Alcalá de Henares(Spain)Anonio Peña Fernández1, María Carmen Lobo Bedmar2, Manuel Higueras3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.
3Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja, 26006

Logroño, Spain.

BACKGROUND AND AIM:Barium (Ba) is a toxic element poorly investigated in biomonitoring studies.
To suggest tentative reference values for Ba in scalp hair from schoolchildren born/living in Alcalá deHenares (Madrid Region).
METHOD:Scalp-hair was collected from 120 children (70 girls, 6-9 years-old) and 97 adolescents (68girls, 13-16 years-old) which met strict inclusion criteria. Following removal of exogenous
contamination, Ba was monitored by ICP-MS after appropriate processing to remove external
contamination. Reference values, i.e. the 95% confidence interval of the 95th population percentile(CI-PP95), were quantified using NADA package in R.
RESULTS:Levels of Ba were higher in female participants, being significantly higher in girls (pvalue=5.94E-06); data is provided as median and IQR, in g/g, for children [0.271 (0.153, 0.421) vs.
0.104 (0.066, 0.164)] and teenagers [0.323 (<0.153, 0.777) vs. 0.112 (0.021, 0.595)]. CI-PP95 areprovided for male and female for children [0.225-0.442 and 0.533-0.848] and teenagers [1.34831.803 and 1.099-2.209], respectively. Our results were slightly lower than those reported as
reference values for children and teenagers living in the Madrid Region (<0.2-1.8 g/g), which would
be logical as most of the participants were living in Madrid city that supports higher levels ofcontamination and urbanisation than Alcalá. These authors also reported significantly higher levels inhair from female participants, although they found that Ba was higher in hair from children >15 yearsold. However, levels of Ba in Alcalá schoolchildren’s hair were much lower than those reported in
populations exposed to Ba in drinking water that live close to oil industries in South Sudan (2.9-50
g/g), suggesting minimal environmental exposure to Ba in both groups monitored in Alcalá.
CONCLUSIONS:The tentative reference values for Ba in scalp hair proposed for children/adolescentsliving in Alcalá de Henares, can be used to identify individuals (male and female) who have been
exposed to this toxic element.

Keywords: human hair, barium, exposure, Spanish schoolchildren

EP-009[Exposures » Food/nutrition]

Exposure and risk assessments to caffeine inyoung university students from Leicester,
EnglandAnonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, Guillermo Torrado3, María de los Ángeles
Peña3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:To assess intake of coffee, tea, energy (ED) and related drinks in a young
population of students at De Montfort University (DMU, UK), to determine exposure and risk
assessments to caffeine.
METHOD:Comprehensive nutrient intake was collected from 111 (20.45±1.16 yrs-old; 78 female)
DMU students between 2015-16 from three major ethnic backgrounds (41 Asia, 41 Africa, 27 Europe),
using a validated variant of the Nutrition Norfolk Food Frequency Questionnaire. Questionnaires were
processed with Nutritics dietary software.
RESULTS:The dietary intake of caffeine was higher in female participants (90.483 vs. 75.579 mg/day),which could be attributed to the higher intake of coffee (104.69 vs. 65.68 g/day) and tea (161.29 vs.
106.97 g/day) in female students. In contrast, the intake of energy (88.14 vs. 63.14 g/day) andsports drinks (232.14 vs. 178.57 g/day) were higher in male participants. Although none of themshowed statistical significance maybe due to the differences in the number of participants according tosex, our results agree with recent studies that have reported a considerable increase in the intake of
EDs in young male adults. The intake of caffeine, tea and coffee did not show statistical differences
according to ethnic background. The recorded body weights with Tanita(R) were used to report the
intake of caffeine in milligrams per kilogram of body weight per day (1.408 vs. 1.057 mg/kg/day,
respectively), which were lower than the reported intake in 18-24 years-old US population (1.7mg/kg/day).
CONCLUSIONS:Although the total intake of caffeine in DMU students would be lower than the amountestablished by the FDA as safe (400 mg/day), the intake of caffeine in some participants (0.01705.8528 and 0.0209-6.6699 mg/kg/day, female and male, respectively) exceed the establishedreference range intake that can cause adverse effects (>3 mg/kg/day; cardiovascular/haematological,
neurological and psycho-behavioural effects). The intake of caffeinated beverages should be reduced
in university students.

Keywords: Caffeine intake, university students, Leicester.

EP-010[Chemical exposures » Heavy metals]

Environmental monitoring of lanthanum in wildmushrooms from urban and rural areas acrossLeicestershire (UK)
Anonio Peña-Fernández1, Tiziana Sgamma1, María Lobo-Bedmar2, Mark D. Evans1, Edna Segura3,
Manuel Higueras3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.
3Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja, 26006

Logroño, Spain.

BACKGROUND AND AIM:A monitoring study in Leicestershire’s topsoils (UK) revealed that lanthanum(La) exceeded the established soil screening level (SSL). To gain a better understanding of theenvironmental presence/distribution/risks of La by using wild mushrooms collected in the same areas.
METHOD:106 mushrooms were collected from Leicester city and Bradgate Park. Species identification
was confirmed by DNA barcoding. La was monitored by ICP-MS in cleaned/dried/homogenised
mushrooms mineralised with HNO3/H2O2 [LoD=0.533 ng/g dry weight (dw)]. La was also monitoredin 850 topsoils collected in these areas.
RESULTS:Significantly higher levels were found in mushrooms collected in the urban area (median andranges, in µg/g dw; p-value=0.04): 0.238 (0.013-10.580) vs. 0.198 (0.131-2.670), which might be
attributed to the technological uses of La in catalytic converters and phosphors. Content of La varied
between mushrooms collected across the four cardinal subareas in which Leicester city was divided (pvalue=5E-18); the lower levels were observed in mushrooms sampled in NW areas [0.146 (0.1234.866)], meanwhile the higher levels were found in those collected in the SW [1.286 (0.842-4.953)].
La also varied between major mushroom species collected (ranges, in µg/g; p-value=1E-19): Agaricus
bitorquis (edible; 0.123-0.180), Panaeolus foenisecii (poisonous; 0.298-10.580) and Mycena
citrinomarginata (0.374-8.194; unclassified), which might suggest a minimal exposure to La despite
consumption of edible wild mushrooms collected in Leicestershire. Although a similar distribution of La
was found in the topsoils, i.e. significant (p-value=0.0153) higher levels in the SW (19.621 µg/g) andlower in the NW (16.447 µg/g), no correlation was found between the content of La in mushrooms andthe respective topsoils.
CONCLUSIONS:The presence of La in wild mushrooms in Leicester was within the same ranges as
those reported in other similar European cities. Although the risks would be minimal, La presence
could contribute to the maximum level of intake of total REEs for vegetables set at 0.7 µg/g.

Keywords: Lanthanum, mushrooms, Leicester, topsoils, risks.

EP-011[Exposure assessment methods » Risk assessment]

Environmental distribution and exposure to
heavy-rare earth elements in Leicestershire (UK)
Anonio Peña-Fernández1, Manuel Higueras2, Guillermo Repetto3, Consuelo Álvarez-Herrera3, María
Llana-Ruiz-Cabello3, Sara Maisanaba3, Mark D. Evans1, María Carmen Lobo-Bedmar4
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Area of Toxicology, Universidad Pablo de Olavide, 41013 Sevilla, Spain.
4Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The aim was to determine the presence/distribution/risks to ytterbium (Yb)and lutetium (Lu), heavy-rare earths (HREEs), present in topsoils from Leicestershire (UK).
METHOD:A total of 850 samples were collected (2017-18); 26 composite samples were appropriately
prepared after mixing topsoil samples collected per park/location (18 urban, 8 rural), which were
further processed in duplicate. Both HREEs were measured in triplicate in each of the 52 composite
samples by ICP-MS. Provisional sub-chronic oral reference dose for Lu was used to determine risks.
RESULTS:Slightly higher levels of Yb [0.898 (0.492-1.142) vs. 0.828 (0.616-1.211)] and Lu [0.123(0.069-0.162) vs. 0.117 (0.084-0.182)] were found in the topsoils collected in the rural areas (datapresented as median and ranges, mg/kg), suggesting similar sources. However, Yb and Lu showed
differences according to the urban subareas and followed a similar distribution; significantly higher
medians of both elements in the NE (0.929, 0.134) and lower in the NW (0.720, 0.102), respectively(p-values=0.0209, all in mg/kg). Soil texture, specifically clay content, which can retain/absorb
HREEs, might explain the distribution found in the urban subareas, as was significantly higher intopsoils sampled in the NE than in the NW (27 vs. 18.5%). The levels of Yb and Lu were lower than
the reported background levels for UK soils by FOREGS (0.859 vs. 2.3; 0.121 vs. 0.3; mean averages
in mg/kg), suggesting minimal anthropic contamination. Moreover, the levels of Yb in the urban area
were much lower [0.859 vs. 1.9 (0.1-8.8; mean and range, in mg/kg)] than detected in London’s
topsoils. The noncarcinogenic risks quotients for ingestion (3.10E-06, 3.37E-06) and dermal contact(1.10E-07, 1.20E-07) in urban/rural areas for Lu, were lower than the threshold, respectively.
CONCLUSIONS:In general, levels of Yb and Lu would represent a minimal risk for Leicestershire’s
population, although more toxicological knowledge for Yb is needed to quantify their risks.

Keywords: Ytterbium, lutetium, Leicester, topsoils, risks.

EP-012[Exposures » Environmental disparities]

Human health risks of cerium contamination in
urban and rural soils across Leicestershire (UK)
Antonio Pena Fernandez1, Manuel Higueras2, Gurminder S. Jagdev1, Mark D. Evans1, María Carmen
Lobo Bedmar3
1Leicester School of Allied Health Sciences, Faculty of Heath & Life Sciences, De Montfort University,

Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The aim was to determine the presence, distribution and risks to cerium (Ce)in topsoils from Leicestershire (UK).
METHOD:A total of 850 samples were collected (2017-18); 26 composite samples were appropriately
prepared after mixing topsoil samples collected per park/location (18 urban, 8 rural), which were
further processed in duplicate. Ce was measured in triplicate in each of the 52 composite samples by
ICP-MS. Noncarcinogenic risks were characterised following US EPA methodologies.
RESULTS:Slightly higher levels of Ce were found in the rural area, although without significance (datapresented as median and interquartile ranges, in mg/kg): 39.825 (29.156, 51.610) vs. 38.745(35.012, 43.746), suggesting a wide dispersion of this element. The urban/rural regions were
subdivided into the four ordinal directions to study the distribution of this element. A Duncan test
showed significant differences in the presence of Ce throughout Leicester city (p=0.037;
NE>SE>SW>NE), which might be attributed to the use of fertilisers, one of the major diffuse sourcesof rare earths in soils. The median level of Ce was lower than the described in soils (5-20 cm depth)
sampled across London (50.9 mg/kg) and much lower than the described in topsoils monitored inurban parks in Beijing (82.7 mg/kg). Noncarcinogenic risks quotients for inhalation of Ce inresuspended soils (0.0248, 0.0255) were lower than the threshold for urban and rural areas,
respectively.
CONCLUSIONS:Overall, Leicester’s topsoils would be slightly less contaminated by Ce than other areasin Europe as they were lower than the described as background levels for European soils (39.2 vs.
48.2 mg/kg), and would represent a minimal risk through inhalation for the population living inLeicestershire. However, a better risk characterisation is needed due to the scarcity of toxicological
data for Ce, including understanding the fate processes Ce undergoes in the environment to inform
decontamination strategies.

Keywords: Exposure Assessment, Risk Assessment, CeriumEP-013[Exposures » Environmental disparities]

Environmental contamination and exposure to
praseodymium in Leicestershire (UK)
Antonio Peña Fernández1, Manuel Higueras2, Mark D. Evans1, María Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The aim was to determine the environmental presence and distribution ofpraseodymium (Pr) across Leicestershire’s topsoils (UK) and examine risk characterisation.
METHOD:A total of 850 samples were collected (2017-18); 26 composite samples were appropriately
prepared after mixing topsoil samples collected per park/location (18 urban, 8 rural), which were
further processed in duplicate. Pr was measured in triplicate in each of the 52 composite samples by
ICP-MS. Both areas were further subdivided into the four ordinal directions to study the distribution of
Pr. Noncarcinogenic risks were characterised following US EPA methodologies.
RESULTS:Levels of Pr were similar in both urban and rural areas, respectively (median andinterquartile ranges, in mg/kg): 4.692 (4.250, 5.152) and 4.883 (3.469, 6.126). Significant
differences were detected for the Pr monitored in the composite samples collected throughout
Leicester city (p=0.0207) and rural areas (p=0.021), which revealed different concentration patterns
NE>SW>SE>NW and SE>NE>SW>NW for each area, respectively, reflecting a wide distribution of Pr
in Leicestershire soils. The median level of Pr in both areas were lower than the background values
described for this element in European topsoils (FOREGS; 5.6 mg/kg), but were higher than thedescribed in topsoils from the industrialised town of Maribor (Slovenia; 3.13 mg/kg). Noncarcinogenic
risks quotients for ingestion (1.10E-05) and dermal contact (3.90E-07) due to Pr in urban topsoils
were lower than the threshold.
CONCLUSIONS:Although the levels of Pr in Leicestershire topsoils would be lower than those describedas background in Europe and in the Upper Continental Crust (9.1 mg/kg), further monitoring studies
would be needed to have a better understanding of the potential sources (natural/anthropic) of Pr in
Leicestershire, including agricultural practices, waste disposal, metal recycling, vehicular/industrial
emissions and urbanisation, as a slight contamination by this metal was detected in Leicester whencomparing with other industrialised towns in Europe.

Keywords: Exposures, Risk assessment, Praseodymium

EP-014[Exposures » Food/nutrition]

Dietary exposure to cerium in a young (18-23
yrs-old) population in Leicester (England)
Antonio Peña Fernández1, Mark D. Evans1, Manuel Higueras2, Edna Segura2, María Carmen Lobo
Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, SpainDepartamento de Investigación Agroambiental. IMIDRA.
Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:Although the use of cerium (Ce) is increasing in Europe due to its multiple
applications, the risks derived from chronic exposures to Ce are currently not well stablished. To
assess exposure to Ce in undergraduate students at De Montfort University (DMU, England) with a
specific focus on food intake.
METHOD:Comprehensive nutrient intake was collected from 111 (20.45 ± 1.16 yrs-old; 33 male and78 female) DMU students using a validated variant of the European Prospective Investigation into
Cancer and Nutrition Norfolk Food Frequency Questionnaire (EPIC-Norfolk FFQ). Ce was analysed in
scalp-hair voluntarily provided by 73 of these participants (58 female) by ICP-MS after appropriate
removal of exogenous contamination. The limit of detection was 0.0125 µg/g. Data was processedwith the statistical package ‘NADA’ freely available in R, as Ce was detected only in 21 hair samples.
RESULTS:The presence of Ce in hair did not show sex-dependency, possibly due to its low detection inhair from male participants [n=2; range=0.0203-0.1331, P95=0.0541, in µg/g]. Thus, Ce was
detected in 19 female participants (median and IQR, in µg/g): [0.0068 (0.0026, 0.0179)]. Ce waspositively correlated with alcohol (r=0.3436; p<0.01) and tea (r=0.2440; p<0.05) intake. However,alcohol (p-value=0.0686) and tea (p-value=0.3332) intake did not show differences due to sex in thisgroup of the population observed after performing a Mann-Whitney U test study. Large market-based
studies have reported that the highest concentrations of Ce are usually found in plant foods(vegetables, cereals, potatoes, beans). Meanwhile the intake of vegetables and pulses in the
population studied did not show sex dependency, significant differences were detected in the intake of
cereals (p-value=0.0016), although they were higher in male participants.
CONCLUSIONS:The levels of Ce found were lower than those reported in the literature, suggesting
minor environmental exposure in the population monitored.

Keywords: Exposures, Food/nutrition, CeriumEP-015[Exposures » Food/nutrition]

Biomonitoring mercury in young students
attending a British university
Antonio Peña Fernández1, Manuel Higueras2, Edna Segura2, Mark D. Evans1
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain

BACKGROUND AND AIM:Hair mercury (Hg) levels are considered a good biomarker of exposure to thispollutant. To evaluate the exposure to Hg in undergraduate De Montfort University (DMU) students.
METHOD:Nutrient intake was collected from 111 (20.45 ± 1.16 yrs-old; 33 male and 78 female) DMU
students from different ethnic backgrounds (41 Asia, 41 Africa, 27 Europe, 1 Central America and 1
Caribbean), using a validated variant of the Nutrition Norfolk Food Frequency Questionnaire (EPICNorfolk FFQ). Hg was analysed in scalp-hair provided by 73 of the participants (58 female) by ICP-MS.
RESULTS:Hg was detected in 63 hair samples (49 female; LoD=0.0310 µg/g) and were significantly
higher in male participants (p-value<0.05; data presented as mean and range, in µg/g): [0.9794(0.0891-6.6073) vs. 0.2956 (0.0443-1.6732)]. The concentrations of total-Hg are higher than themean average reported in Polish individuals aged 21-22 years-old (0.435 vs. 0.150 µg/g) but lower
than the geometric mean reported in Spanish individuals aged 18-29 years-old (0.30 vs. 1.65 µg/g).
Hg was only correlated with chocolate intake (r=-0.2957; p-value<0.05). However, chocolate intake
did not show differences due to sex in the population monitored. Similar results were observed for theintake of fish/seafood (the major source of Hg in the diet), i.e. intake did not show significance due tosex (p-value=0.826) or ethnic background (p-value=0.589). However, the intake of fish was muchhigher in male participants (72.656 vs. 53.907 g/day), which could explain the sex differences foundin total-Hg in hair.
CONCLUSIONS:Although the levels of Hg found in hair would highlight a generally lower exposure to
Hg in the population studied when comparing with other studies on populations that traditionally eat
more fish/seafood, some individuals presented higher concentrations of total-Hg than the USEPA
recommended reference level (1 μg/g), individuals that should be followed up with dietary
recommendations.

Keywords: Exposures, Food/nutrition, Exposure Assessment, Mercury

EP-016[Exposures » Other (to be specified with keywords in the keywords section)]

Environmental exposure of children to erbium in
Alcalá de Henares (Spain)
Antonio Peña Fernández1, Manuel Higueras2, Mark D. Evans1, María Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Departamento de Matemáticas y Computación, Universidad de La Rioja, Logroño, Spain
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:High-technology rare earth elements (REEs) are contaminants of emerging
concern. To determine the environmental presence and exposure to Er, a minimally studied REE intopsoils, in children born and residing in Alcalá de Henares (Spain)
METHOD:Scalp-hair was collected from 120 children (6 to 9-years-old; 70 girls). Erbium (Er) was
analysed by ICP-MS after appropriate removal of exogenous contamination using Triton X-100/bathsonication. Er was also monitored in 70/167 topsoil samples randomly sampled from different urban
parks across Alcalá.
RESULTS:The limits of detection of Er in hair and topsoils were (in µg/g): 0.00025; 0.0005). Data wasprocessed using ‘NADA’ statistical package, due to the censored data found in hair (32.5%). Levels of
Er in scalp hair was slightly higher in male participants (95th percentile and range, in µg/g): 0.00143(0.00026-0.00157) vs. 0.00103 (0.00026-0.00117). In contrast, Er was detected in all topsoil samples
monitored (median and range, in mg/kg): Er 0.93 (0.1287-1.3833), which would suggest little
anthropic input as they were within the background value range reported for soils in Spain (FOREGS;
0.3-13 mg/kg). Moreover, levels of Er in hair showed statistical significance according to zones ofresidency (p-value=1.04E-10); the mean concentration of Er was higher in children’s hair living inareas with a higher density of green areas than in those with higher number of buildings and industrial
activities, respectively (0.00073 vs. 0.00038 and 0.00043 µg/g)
CONCLUSIONS:Our results suggest that monitored child population in Alcalá de Henares have notbeen significantly exposed to Er, as the concentration was much lower than that reported in exposedchildren (0.0281 µg/g, 0-3 years-old) and adolescents hair (0.0159 µg/g; 11-15 years-old) living in
mining areas in China. However, further efforts should be carried out to determine the(eco)toxicological values of Er, to be able to characterise the risks to human health due to thiselement.

Keywords: Exposure assessment, Children's environmental health, ErbiumEP-017[Exposures » Other (to be specified with keywords in the keywords section)]

Temporal variation and carcinogenic risks toarsenic in Alcalá de Henares (Spain)
Antonio Peña Fernández1, Manuel Higueras2, M. Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Dpt. Agroenvironmental Research. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800

Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The aim was to assess a sixteen years temporal variation period on thepresence and distribution of total arsenic (As) in urban/industrial topsoils collected across Alcalá deHenares (Madrid Region, Spain), and to estimate their carcinogenic risks.
METHOD:Ninety topsoil (66 urban/24 industrial) samples collected in July 2017 were appropriately
processed/digested in a microwave system. As was analysed by ICP-MS; data was compared with
topsoils collected in the same locations in 2001 (97/22).
RESULTS:As was detected in all topsoil samples collected in both monitoring studies (LoDs=0.01 and0.07 mg/kg, respectively). A significant increase of total-As was observed for both main areas (datapresented as mean averages, in mg/kg), respectively: 5.69 vs. 4.83 (17.8%) and 7.66 vs. 6.63
(15.53%). The observed increases would be logical, as arsenic and its compounds are considered
immobile in soils, so their presence would increase over time by different anthropogenic sources thatare relevant in Alcalá, including the production of glass and ceramics, and the use of semiconductormaterials, whose production of which has increased due to the urbanisation/industrial growth that
Alcalá has experienced recently. Moreover, traffic volume would also have had a summative effect.
Significantly higher levels of As were detected in samples collected within urban (9.603 vs. 4.345,
4.561, 4.089 mg/kg; p-value=0.0006) and industrial (8.386 vs. 6.447 mg/kg; p-value=0.0133)
areas. A similar trend was found in 2001 although without significance, which could support therelevance of the industrial activities in Alcalá in the presence/distribution of this metalloid.
CONCLUSIONS:Carcinogenic risks for the population of Alcalá from the ingestion/inhalation of As in
soils and resuspended soils seem to be small (5.71E-06, 1.41E-08). However, the total content in
Alcalá’s urban soils was much higher than the established soil screening level (0.68 mg/kg) by the US
EPA for cancer risk following lifetime exposure to As in residential topsoils.

Keywords: Exposure assesment, metalloid, soil

EP-018[Exposures » Other (to be specified with keywords in the keywords section)]

Investigating the variation of boron in scalp-hairfrom three different population groups in Alcaláde Henares (Spain)
Antonio Peña Fernández1, Manuel Higueras2, M. Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Dpt. Agroenvironmental Research. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800

Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:To study the content of boron (B) in scalp hair from school children
born/living in Alcalá de Henares (Madrid Region), as B-hair analysis has been suggested as a useful
exposure tool.
METHOD:Samples were collected from 120 children (70 girls, 6-9 years-old) and 97 adolescents (68girls, 13-16 years-old) which met strict inclusion criteria to minimise factors that may affect elemental
content in hair. B was monitored by ICP-MS after appropriate removal of exogenous contamination.
Data was processed with the NADA package available in R due to high levels of censored data (89.2%,
LoD=2.679; 94.8%, LoD=3.341 in g/g, respectively).
RESULTS:Although not significant, levels of B were higher in children and female participants; data
provided as ranges and 95-percentiles in g/g, for children [overall 4.859 (2.732-7.415), males 4.061(2.732-7.373), females 4.734 (3.348-7.415)] and adolescents [overall 3.362 (3.447-4.505), males
3.469 (P97.5 value) (<3.341-3.766), females 3.410 (3.447-4.505)]. Our results are in agreementwith a previous study carried out in young adults living in the Madrid Region (20-24 years-old;range=1.33-4.86 g/g), in which higher levels of B found in females was attributed to differences in
the intake of vegetables, pulses and fruit. However, other authors have described that men would be
more tolerable to the levels of B. Moreover, it has been reported that B is ten times higher in infants
than in their mothers, which might explain the slightly higher levels of this element in children.
CONCLUSIONS:Despite the ranges of B in both Alcalá’s schoolchildren groups being within theadequate reference ranges reported in Croatian (0.771-6.510 men, 0.472–3.89 women) and Polish(<LoD-14.37) adults (all in g/g), the high levels of censored data might highlight an inadequate
intake of B in the diet that should be investigated, as B may play an important role in obesity andbone metabolism.

Keywords: human hair, boron, exposure, schoolchildren

EP-019[Exposures » Food/nutrition]

Applicability of wild mushrooms to monitor
environmental contamination of europium inLeicester, England
Antonio Peña Fernández1, Manuel Higueras2, Tziana Sgamma1, Mark D. Evans1, Edna Segura2, M.
Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Dpt. Agroenvironmental Research. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800

Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:Although the current levels of europium (Eu) in topsoils monitored acrossLeicestershire (UK) did not represent an oral/dermal toxic risk for the population, wild mushrooms
were collected in the same areas to gain a better picture of its environmental distribution and risks.
METHOD:106 mushrooms were collected from Leicester city and Bradgate Park, and species wereidentified by DNA barcoding. Eu was monitored by ICP-MS in cleaned/dried/homogenised mushrooms[LoD=0.00056 µg/g dry weight (dw)] and in 850 topsoils collected in these areas.
RESULTS:Eu concentrations were higher in mushrooms collected in urban areas, although without
significance (median and ranges, in µg/g dw): 0.0016 (0.0004-0.2891) vs. 0.0013 (0.00036-0.0529),
which might be attributed to fertilisers. However, levels of Eu varied between mushrooms collectedacross the four cardinal subareas in which the city was divided (p-value=7E-9), which might indicate
differences in urbanisation, as Eu is used in flat screen displays and optical fibres. Although acorrelation between the content of Eu in mushrooms and their respective topsoil/subareas was notfound, a similar distribution was found. Thus, significantly higher median concentrations of Eu were
found in the NE (0.0047, 0.8110) and lower in the NW (0.00087, 0.5960), in mushrooms and topsoils(all in µg/g dw and µg/g, respectively). Moreover, Eu significantly varied between the three mainmushroom species collected (ranges, in µg/g dw; p-value=7E-15): Agaricus bitorquis (edible;
0.00079-0.00706), Panaeolus foenisecii (poisonous; 0.00104-0.17146) and Mycena citrinomarginata(unclassified; 0.00123-0.07117). Moreover, Eu was only detected in 54.5% of the A. bitorquis
samples, although detected in all the other main species collected.
CONCLUSIONS:The levels of Eu found were similar/lower than those reported in other major
monitoring studies performed in other European countries, suggesting that the environmental
presence of Eu would represent a minimal risk for Leicestershire’s population, including thoseindividuals that pick up wild mushrooms for consumption.

Keywords: Europium, mushrooms, Leicester, topsoils, risks.

EP-020[Exposures » Food/nutrition]

Utility of wild soil mushrooms to monitor ceriumand characterise oral risks
Antonio Peña Fernández1, Manuel Higueras2, Tziana Sgamma1, Nazia Nazar1, Mark D Evans1, Edna
Segura2, Gurminderjeet S Jagdev1, M. Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Dpt. Agroenvironmental Research. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800

Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:A study of cerium (Ce) in urban/rural topsoils from Leicestershire (England)
showed minimal risk through inhalation for the population. Wild mushrooms were collected to identify
oral risks for Ce.
METHOD:106 mushrooms were collected from Leicester city and Bradgate Park. Species identification
was confirmed by DNA barcoding. Ce was monitored by ICP-MS in cleaned/dried/homogenised
mushrooms mineralised with HNO3/H2O2 [LoD=0.795 ng/g dry weight (dw)] and in 850 topsoils
collected in these areas. Organic matter content, pH, electric conductivity (EC) and soil textures were
determined in topsoils using standard methods.
RESULTS:Higher levels of Ce were found in mushrooms collected in urban areas (median and ranges,
in µg/g dw): 0.352 (0.019-16.260) vs. 0.198 (0.196-5.084). Moreover, lower levels were detected inmushrooms sampled in NW urban areas [0.225 (0.185-7.094)], meanwhile higher levels were found insamples collected in the SW [1.930 (1.293-7.457)]. Although a similar pattern was found in the urban
topsoils, i.e. lower levels of Ce in the NW (p=0.037; NE>SW>SE>NW), no correlation was shown withthe mushroom content. The differences observed in mushrooms could be attributed to different
factors, including the use of fertilisers, as Ce in mushrooms showed significantly negative correlation
with topsoil EC (-0.2630; significance level of 10%, p-value=0.0980). EC content (in dS/m) was
significantly higher in rural areas (0.4615 vs. 0.3404; p-value=0.0086) and higher in NW vs. NE(0.396 vs. 0.304; p-value=0.0741) urban topsoils. Ce also significantly varied between major
mushroom species collected (ranges, in µg/g): Agaricus bitorquis (edible; 0.185-0.297), Panaeolus
foenisecii (poisonous; 0.481-16.260) and Mycena citrinomarginata (unclassified; 0.557-12.256), andwere within the values reported in large monitoring studies.
CONCLUSIONS:Our results would be in line with those studies that have reported that wildmushrooms show a weak predilection to bioconcentrate Ce. The presence of Ce in wild mushrooms
would not represent a risk for the Leicester’s population.

Keywords: Cerium, mushrooms, Leicester, topsoils, risks.

EP-021[Exposures » Multi-pollutant/Multi-media]

Environmental exposure to scandium andyttrium in Leicestershire (UK)
Antonio Peña Fernández1, Manuel Higueras2, Mark D Evans1, M. Carmen Lobo Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Dpt. Agroenvironmental Research. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km, 38.2, 28800

Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The aim was to determine the presence/distribution/risks to yttrium (Y) andscandium (Sc), usually included as rare earth elements (REEs), present in topsoils from Leicestershire(UK).
METHOD:850 topsoil samples were collected (2017-18); elements were measured by ICP-MS. Areas
were further subdivided into the four ordinal directions to study distribution. Noncarcinogenic risks
were characterised for Y.
RESULTS:Sc [7.762 (4.067-12.217) vs. 5.942 (3.315-9.830)] and Y [11.586 (5.795-16.041) vs.
10.620 (7.532-16.338)] showed higher median concentrations in the topsoils collected in the rural
areas (median and ranges, all in mg/kg), although only Sc showed significance (p-value=0.0148). The
application of fungicides and fertilisers might explain partially our results, as Sc and Y tend to occur inthe same ore deposits as REEs which are associated with manufacture/use of fertilisers. Moreover,natural factors, might explain the distribution found. Thus, clay content, which can retain/absorb
REEs, was significantly higher in rural topsoils (28 vs. 22.23 %). Similar distributions were found in
urban subareas; significant higher medians (p-values=0.017) of both elements in the NE (6.516,
11.748 mg/kg) and lower in the NW (5.125, 8.855 mg/kg). However, only Y showed statisticalsignificance for the rural subareas (p-value=0.006), being much lower in topsoils sampled in the NW(6.309 mg/kg). Clay content was also significantly lower/lower in topsoils sampled in the NE, for urban
and rural subareas, respectively.
CONCLUSIONS:The mean concentrations of Sc (6.089 vs. 8.3 mg/kg) and Y (10.931 vs. 21.1 mg/kg)
in Leicestershire’s topsoils were lower than those reported in urban soils in London, and lower thanthose described as background for Sc in the UK (9.4 mg/kg), suggesting a lower contamination in
Leicestershire. The risks to Y would be minimal as noncarcinogenic risks quotients for ingestion(4.98E-03, 5.43E-03) and dermal contact (1.77E-04, 1.93E-04) in urban/rural areas, were lower than
the threshold, respectively.

Keywords: Scandium, yttrium, Leicester, topsoils, distribution

EP-022[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Environmental monitoring and risk assessments
for gadolinium in topsoils from Alcalá deHenares (Spain)
Antonio Peña-Fernández1, Manuel Higueras2, Maria Carmen Lobo-Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The global demand for gadolinium (Gd) is increasing rapidly due to its
technological uses. To study its presence, distribution and potential risks in Alcalá de Henares’s
topsoils (Spain).
METHOD:Ninety-four topsoil samples were collected in July 2017 from: urban (66), industrial (24) andpublic gardens (4). Gd was analysed by ICP-MS after acid digestion with nitric acid (69%) and
chlorhydric acid (37%). Noncarcinogenic risks were characterised following US EPA methodologies.
RESULTS:Gd was detected (LoD=0.0007 mg/kg) in all samples collected in the three areas monitored,
which respectively were (median and interquartile limits; mg/kg): 2.902 (1.908, 3.366), 3.999(3.469, 4.705), and 3.616 (3.490, 3.694). Significant (p-value=3.84E-06) higher mean concentrationsof Gd were found in the industrial and garden topsoils, which would be logical due to its
technological/industrial applications and its presence in fertilisers. Similarly, slightly higher mean
concentrations were found in the urban (3.163, 2.823, 2.568, 2.220 mg/kg; NS) and industrial (4.365
vs. 3.505 mg/kg; p-value=0.0396) areas. Our results suggest minimal anthropic input of Gd in soils in
Alcalá, as the levels were lower than the background values reported for Spanish soils [FOREGS, mean
and reference range (in mg/kg); 2.694 (0.348-4.951) vs. 5.4 (0.9-24)], and slightly lower than the
median reported for European topsoils (3.85 mg/kg). Thus, the median level of Gd was lower thanthat reported for urban topsoils from Beijing (4.46 mg/kg), suggesting some anthropic input in the
topsoils monitored in the industrial area.
CONCLUSIONS:Noncarcinogenic risks quotients for inhalation of Gd in resuspended soils (8.35E-04,
1.15E-03) were lower than the threshold for urban and rural areas, respectively, representing a minor
risk for human health. Moreover, understanding the fate processes Gd undergoes in the environmentis critical to identify interventions/techniques for the decontamination of Gd, environmental presenceof which will increase owing to its myriad of technological applications.

Keywords: Gadolinium, topsoils, presence, distribution, risks.

EP-023[Exposures » Food/nutrition]

Food intake in a sample of young university
students living in Leicester, England
Antonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, María de los Ángeles Peña3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:To assess the food intake in a young population of students at De Montfort
University (DMU, UK).
METHOD:Comprehensive nutrient intake was collected from 111 (20.45 ± 1.16 yrs-old; 78 female)
DMU students from three major ethnic backgrounds (41 Asia, 41 Africa, 27 Europe), using a validated
variant of the Nutrition Norfolk Food Frequency Questionnaire. Questionnaires were processed with
Nutritics dietary software. BMI values were calculated with the formula BMI = kg/m². Body total andvisceral fat, water, muscle and bone mass were directly obtained by a Tanita scale.
RESULTS:The total intake of protein, fat and carbohydrates was significantly higher in malecounterparts, which can explain the significant intake of energy (3064.9 vs. 2310.8 kcal/day; pvalue=0.0011) in men. According to their BMI values, 25.7% and 8.3% of this population were
overweight and obese, meanwhile 9.2% were underweight. Female participants support the highest
percentages of individuals overweight and obese; greater incidence of overweight was shown instudents from African and European background (29.3 and 33.3%), meanwhile the highest percentageof obesity was seen in European students (14.8). The highest percentages of students with normal
weight (63.4) and underweight (17.1) were observed in participants from African and Asianbackgrounds, respectively. Percentages of muscle and bone mass presented statistical differences due
to ethnic background, being higher in students from European background (49.9 and 2.6 vs. 45.3 and
2.41, 45 and 2.39, in African and Asian students, respectively).
CONCLUSIONS:The significant differences in the total fat, cereals, vegetables, pulses, and crisps andsnacks intakes might explain that at least one-third of European and African students were
overweight, meanwhile almost a quarter of European and Asian were obese, which places them atincreased health risk, highlighting the need of public health interventions that promote healthy diets inthese groups of the population.

Keywords: Food intake, diet, university students, overweight, Leicester.

EP-024[Exposures » Food/nutrition]

Exposure to praseodymium in young university
students from Leicester, England
Antonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, Maria Carmen Lobo-Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:Rare earth elements (REEs) have arisen as a public health concern due totheir numerous applications in modern societies. To assess dietary exposure to praseodymium (Pr) in
young adults (18-23 yrs-old) at De Montfort University (DMU, Leicester, England).
METHOD:Comprehensive nutrient intake data was collected from 111 (20.45 ± 1.16 yrs-old; 78
female) DMU students using a validated variant of the European Prospective Investigation into Cancer
and Nutrition Norfolk Food Frequency Questionnaire (EPIC-Norfolk FFQ). Pr was analysed in scalp-hairprovided by 73 of these participants (58 female) by ICP-MS after appropriate removal of exogenous
contamination. Data was processed with the statistical package ‘NADA’ in R due to high presence of
censored results (62%; LoD=0.0007 µg/g).
RESULTS:Pr was detected in hair from only one male participant [P95=0.0009, in µg/g], but detected
in 27 female participants (median and IQR, in µg/g): [0.00068 (0.000246, 0.00185)]. Althoughcontroversial, different authors have suggested that REEs would affect females more seriously thanmen, and young females would be more sensitive to small quantities of these elements, which could
explain our results. Pr was positively correlated with alcohol intake (r=0.251; p-value<0.05) andnegatively with crisps and snacks intake (r=-0.2381; p-value<0.05; which includes different foodproducts, e.g. crisps, ice-cream, cereal bars). The differences in the intake of these two categories
might explain the sex differences found for Pr in hair in the population monitored. Thus, the intake ofalcohol (2.282 vs. 1.790 g/day) and crisps/snacks (47.922 vs. 74.152 g/day) was higher and lower infemale participants, respectively.
CONCLUSIONS:Generally, the presence of Pr in participants’ hair was lower than than reported inenvironmentally exposed groups, and slightly lower to the reported in healthy, unexposed Chinese
women (IQR 0.0025-0.0042 µg/g), suggesting that DMU students would have shown a low exposure
to Pr.

Keywords: Pr, human hair, dietary intake, university students.

EP-025[One health » Parasitology]

Potential presence and distribution of humanrelated microsporidia in different soil types from
Makeni, Sierra Leone
Sergio Llorens-Berzosa1, Ethel Ukaegbu2, Fernando Izquierdo1, Lucrecia Acosta3, Antonio PeñaFernández4
1Facultad de Farmacia, Universidad San Pablo CEU, Urbanización Montepríncipe, Boadilla del Monte,

Madrid, Spain.
2Public Health Department. University of Makeni, Makeni, Sierra Leone.
3Área de Parasitología, Departamento de Agroquímica y Medio Ambiente, Universidad MiguelHernández de Elche, Ctra. Valencia Km 8.7, 03550 San Juan, Alicante, Spain.
4Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.

BACKGROUND AND AIM:Spores of Encephalitozoon spp., an emerging genus of microsporidia affecting
humans, were detected for the first time by our group in farm/wild animals from different recreational
areas/farms across Bombali District (Sierra Leone). To study their presence in different soil types
collected across Makeni (Sierra Leone) to gain better understanding of their presence and risks.
METHOD:A soil sample was collected from the surface (topsoils; first 3-5 cm) and subsoil (10-20 cm)
from 28 different points in Summer 2022, including: a small farm (10) and a poultry farm (3), amunicipal slaughterhouse (2) and different areas that households share with their farm animals,
mostly chickens and ducks (13). Following appropriate preconcentration methods, soil samples werescreened for the presence of Encephalitozoon spores by immunofluorescent-antibody test using a
specific monoclonal antibody (Mab) of murine origin IgG2a, patented as a diagnostic tool for
miscrosporidiasis caused by the genus Encephalitozoon.
RESULTS:Structures compatible with Encephalitozoon were found in 6 of the 28 soil samples examined(21.42%), four of them corresponding to the subsoil samples, suggesting a potential mobility of
spores within soil. Positive samples were collected in pig breeding areas (in topsoil and subsoil), one in
subsoil collected in the poultry farm and three soil samples (1 surface, 2 subsoil) collected in areas
shared by families and their farm animals.
CONCLUSIONS:Previous studies conducted in 2019 by our research team revealed a presence of
microsporidia higher than 40% in animal faecal samples collected in the same locations, mainly of thegenus Encephalitozoon, mostly of the species E. cuniculi. Owing to their zoonotic nature, animals could
play a significant role in the contamination of the soils. Although our results should be considered as
preliminary, spores could remain in these soils due to their resistance, representing a risk for the local
population.

Keywords: Microsporidia, Encephalitozoon, soil samples, Makeni, Sierra Leone.

EP-026[Exposure assessment methods » Exposure assessment-biomarkers of exposure]Presence of platinum, palladium and rhodium inchildren living in Alcalá de Henares (Spain) andthe environment
Antonio Peña-Fernández1, Manuel Higueras2, Maria Carmen Lobo-Bedmar3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Departamento de Matemáticas y Computación, Universidad de La Rioja, Logroño, Spain.
3Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:The use of automobile catalytic converters has led to concerning
concentrations of platinum (Pt), palladium (Pd) and rhodium (Rh), in urban environments. A humanand environmental monitoring programme was performed to determine the environmental presence
and exposure to these pollutants in Alcalá de Henares (Spain).
METHOD:Scalp-hair was collected from 120 children (6 to 9-years-old; 70 girls) born and residing in
Alcalá. Elements were monitored in scalp hair by ICP-MS; limits of detection (LoD) were 0.0051,
0.0007 and 0.0018 µg/g, respectively. Additionally, Pt and Rh were monitored in 97 topsoil samples
randomly sampled from different urban parks across the city after appropriate mineral digestion; LoDs
were 0.38 and 0.22 mg/kg, respectively. Data was processed in the ‘NADA’ statistical package.
RESULTS:Pd and Rh were detected in only a few of the scalp samples collected, specifically in 9.24%
and 5%, respectively, which might be attributed to the higher mobility and biological uptake rates of
Pd and Rh compared with Pt. Concentrations in µg/g were as follows (values provided as 95
percentiles and ranges), being slightly higher in boys’ hair: Pd [(0.0010, 0.00091-0.00112) vs.
(0.00076, 0.00072-0.00137)] and Rh [(0.0024, 0.00187-0.00372) vs. (<0.0018, 0.00227-0.00984)].
In contrast to hair, Pt was detected (median and IQR, in mg/kg) in 41.24% [0.27 (0.26-0.81)] and Rh
in 15.46% [0.15 (0.15-0.16)] of the topsoil samples monitored, which may suggest that the Alcalá
child population monitored has not been significantly exposed to Pd, Pt and Rh, as hair has beensuggested as an appropriate tool to measure their exposure.
CONCLUSIONS:In general, the presence of Pt and Rh Alcalá’s soils would not represent a significant
risk for the population. Human hair would be a safe and non-invasive tool to follow-up exposure tometals related with automobile catalytic converters in urban environments and identify future risks
from these contaminants.

Keywords: Platinum group elements, human hair, monitoring, Spanish children, soils.

EP-027[Exposures » Food/nutrition]

Dietary exposure to arsenic in young (18-23 yrsold) university students in Leicester, England
Antonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, Guillermo Torrado3, Mª Ángeles Peña3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:To evaluate dietary exposure to arsenic (As) in young adults (18-22 yearsold) attending De Montfort University (DMU, UK).
METHOD:Nutrient intake was collected from 111 (78 female) DMU students using a validated variantof the Nutrition Norfolk Food Frequency Questionnaire (EPIC-Norfolk FFQ). As was analysed in scalphair provided by 73 of the participants (58 female) by ICP-MS, after removal of exogenous
contamination. Owing to the percentage of censored data (61.6%; LoD=0.0196 µg/g), data wasprocessed with the NADA software available in R.
RESULTS:Levels of As were significantly higher in male participants (p <0.05; data presented as
median and IQR, in µg/g): [0.0238 (<0.0196-0.1495) vs. 0.0084 (0.0025-0.0277)]. The
concentrations of As were higher and lower than the mean averages reported in Spanish unexposed
individuals aged 20-24 years-old for men (<0.001 µg/g) and women (0.011 µg/g), respectively; andlower than the geometric mean reported in individuals aged 18-39 years-old (0.0676 vs. 0.0899 µg/g)
from Cornwall (south-west England), who were studied following reports of levels of As exceeding the
10 µg/L prescribed concentration in private water supplies. The sex differences on the concentration of
As in hair could be explained by the intake of fish/seafood (72.656 vs. 53.907 g/day; non-significant)and cereals (436.165 vs. 308.750 g/day; p-value=0.0016), which were much higher in maleparticipants. A positive and significant correlation was also found between hair As and cereals intake(r=0.252; p-value<0.05), and could explain our results as fish/seafood and rice (cereals) are foods
with the highest content in As.
CONCLUSIONS:Although the levels of As found in hair would suggest a generally low exposure to As in
the population studied, some individuals should be followed up for monitoring and dietary
recommendations, as some individuals presented levels of As (0.0199-0.610 μg/g) higher than therange suggested for chronic exposure to As (0.1-0.5 μg/g).

Keywords: As, human hair, dietary exposure, university students.

EP-028[One health » Co-infections and co-morbidities]

Trans fatty acids intake in a sample of young
university students from Leicester, England
Antonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, Mª Ángeles Peña3
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:To assess intake of trans fatty acids (TFA) in a young population of students
at De Montfort University (DMU, UK), after voluntary food product reformulation in 2011.
METHOD:Comprehensive nutrient intake was collected from 111 (20.45 ± 1.16 yrs-old; 78 female)
DMU students between 2015-16 from three major ethnic backgrounds (41 Asia, 41 Africa, 27 Europe),
using a validated variant of the Nutrition Norfolk Food Frequency Questionnaire. Questionnaires were
processed with Nutritics dietary software. BMI values were calculated with the formula BMI = kg/m2.
RESULTS:According to their BMI values, 25.7% and 8.3% of this population were overweight andobese, meanwhile 9.2% were underweight. Overweight is three times that of the national average inthis age group, 10.6%. The dietary intake of total fat (100.55 vs. 81.72 all in g/day; p-value=0.032)
and saturated (SFA; 34.73 vs. 29.84; NS), monounsaturated (MUFA; 37.54 vs. 30.42; pvalue=0.042), polyunsaturated fatty acids (PUFA; 14.61 vs. 12.91; NS) and TFA (1.58 vs 1.27; pvalue=0.017) was higher in male counterparts, which can explain the significantly higher intake ofenergy (3064.9 vs. 2310.8 kcal/day; p-value=0.0011) in men. The intake of total-fat (pvalue=0.0007), MUFA (p-value=0.0224) and PUFA (p-value=0.0012) were significantly higher instudents from Asia and Europe. However, although without significance, the higher intakes of TFA
were seen in Asian [values as mean and range (in g/day); 1.435 (0.290-5.047)] and African [1.370(0.416-3.906)] students versus European [1.232 (0.305-2.815)].
CONCLUSIONS:The dietary intake of total-fat, SFA, MUFA, PUFA and TFA were slightly higher thanthose reported in general English population (19-64 years-old). Moreover, some DMU students shownto have diets with intake of TFA above the WHO TFA limit (2.2 g/day for a 2000-calorie diet), which
could place them at increased health risk, highlighting the need of public health interventions that
promote healthy diets in these population groups.

Keywords: FTA intake, fat, university students, overweight, Leicester.

EP-029[Chemical exposures » Heavy metals]

Dietary and environmental exposure to
gadolinium in young adults from Leicester,
EnglandAntonio Peña-Fernández1, Manuel Higueras2, Edna Segura2, Mª Ángeles Peña3, Carmen LoboBedmar4
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Scientific Computation & Technological Innovation Center (SCoTIC), Universidad de La Rioja,

Logroño, Spain
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain
4Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:To assess environmental and dietary exposure to gadolinium (Gd) in young
adults at De Montfort University (DMU, Leicester, England).
METHOD:Nutrient intake was collected from 111 (18-23 years-old; 78 female) DMU students using avalidated food frequency questionnaire. Gd was analysed in scalp-hair provided by 73 of theseparticipants (58 female) by ICP-MS after appropriate removal of exogenous contamination. 450 topsoil
samples were collected per urban park across Leicester city and prepared as composite samples tomeasure Gd (LoD=0.0017 µg/g) to estimate environmental exposure. Data was processed with ‘NADA’in R, due to a high presence of censored results in hair (60.3%; LoD=0.0006 µg/g).
RESULTS:Higher levels of Gd were detected in hair from female participants although without
significance, possibly due to the low number of samples from male participants in which Gd was
detected (n=4 vs. 25); data is provided as median and IQR (in µg/g): 0.00051 (0.00021, 0.00123)
vs. 0.00033 (0.00017, 0.00065). It has been reported that young females would be more sensitive toeven small quantities of rare earths, which could explain our results. Thus, the levels of Gd found in
the urban topsoils (median=3.094 µg/g) were lower than the reported in topsoils from Beijing urban
parks (4.48 µg/g) and the Upper Continental Crust (6.1 µg/g), suggesting that Leicester would be lesscontaminated than other more industrialised cities. Gd was positively correlated with alcohol(r=0.339; p-value<0.01) and tea consumption (r=0.295; p-value<0.01). Although non-significantly
different, the higher intake of alcohol (2.28 vs. 1.79 g/day) and tea (161.29 vs. 106.97 g/day) infemale counterparts might explain the sex differences found for Gd in hair.
CONCLUSIONS:The presence of Gd in the hair samples monitored was much lower than thosereported in environmentally exposed groups living in smelting/mining areas, suggesting that DMU
students would have had a low exposure to Gd.

Keywords: Gd, human hair, dietary intake, environmental exposure, university students.

EP-030[One health » Parasitology]First detection of emerging human parasites
microsporidia in grass from recreational andurban parks from, Leicester, UK
Umar Anjum1, Lucrecia Acosta2, Mª Ángeles Peña3, Guillermo Torrado3, Antonio Peña-Fernández1
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Área de Parasitología, Departamento de Agroquímica y Medio Ambiente, Universidad MiguelHernández de Elche, Ctra. Valencia Km 8.7, 03550 San Juan, Alicante, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain

BACKGROUND AND AIM:Encephalitozoon spp. (E. intestinalis, E. hellem and E. cuniculi), emerging
microsporidian species affecting humans, were detected in water/topsoil from Leicestershire (UK). To
determine their potential presence and circulation in the grass from different parks and recreational
areas frequently visited across Leicestershire.
METHOD:190 grass samples were collected over a year (June 2017 to August 2018) to study temporalvariation, in and around Leicester. After appropriate pre-treatment to resuspend any microsporidian
spore present in the grass and avoiding soil contamination, DNA was extracted from each preconcentrated sample using the using Fast-Prep for Soil® kit. SYBR Green real-time polymerase chain
reaction technique was used for specific detection of Encephalitozoon spp., using establishedmethodologies.
RESULTS:Spores of Encephalitozoon spp. were detected in 11 (11.57%) grass samples, specifically E.
intestinalis in six samples collected from urban and rural parks (2 in Bradgate, and one in
Humberstone, Victoria, New Walk and Abbey) and E. hellem in five samples across both main areas(Bradgate, Evington, Willowbrook, Humberstone and Victoria). E. cuniculi was not detected in any of
the grass samples. Our results would indicate a low-moderate distribution of these parasites.
Moreover, Encephalitozoon spp. was also detected across the different seasons, with the highest
presence in Summer 2017 and 2018 (n=4/each season) followed by Winter 17/18 (n=2) and one inAutumn 2017, suggesting some circulation in the environment.
CONCLUSIONS:To our knowledge, this is the first report reporting the presence of Encephalitozoon
spp. in grass across Leicestershire; citizens could be exposed to these pathogens when playing sports
in these areas, or by contact of cornea with the grass. The zoonotic role of Encephalitozoon spp. andthe environmental resistance of their spores in soil, might facilitate their spread within grass. Further
genotyping studies are required to tailor appropriate public health interventions to minimise theirinfections.

Keywords: microsporidia, urban parks, zoonotic roleEP-031[Exposure assessment methods » Exposure assessment-air pollution]

Assessing the exposure to uranium and thorium
in healthy Spanish teenagers
Antonio Peña-Fernández1, Manuel Higueras2, Mª Ángeles Peña3, Guillermo Torrado3, Carmen LoboBedmar4
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
2Departamento de Matemáticas y Computación, Universidad de La Rioja, Logroño, Spain.
3Departamento de Ciencias Biomédicas, Universidad de Alcalá, Crta. Madrid-Barcelona Km, 33.6,

28871 Alcalá de Henares, Madrid, Spain
4Departamento de Investigación Agroambiental. IMIDRA. Finca el Encín, Crta. Madrid-Barcelona Km,

38.2, 28800 Alcalá de Henares, Madrid, Spain.

BACKGROUND AND AIM:To assess the exposure to uranium-238 (U) and thorium-232 (Th) in healthy
teenagers living in Alcalá de Henares (Spain).
METHOD:Scalp hair was collected from 97 adolescents (13-16 years-old; 68 girls) from Alcalá. U and
Th were monitored by ICP-MS after appropriate removal of exogenous contamination with Triton X100/sonication. Data was processed using ‘NADA’ statistical package.
RESULTS:The limits of detection in hair were (in µg/g): U (0.0018) and Th (0.0011). Levels ofcensored data were 5.4% and 35.5%, respectively. Concentrations of U and Th were significantly
higher (p-value=0.0017) and higher in female counterparts, respectively as follows (data provided as
median and IQR, in µg/g): [0.0194 (0.0059, 0.0296) vs. 0.0055 (0.0030, 0.0135)] and [0.0015(<0.0011, 0.0023) vs. 0.0014 (<0.0011, 0.0029)]. Levels of both radionuclides were slightly higher
than those reported by our group in Alcalá’s children (6-9-years-old; median for U was 0.011,
meanwhile Th was detected only in 4.2% of children), which would be in line with scientific evidence
suggesting that elemental content in hair increases with age. However, the concentrations of both
radionuclides in teenagers’ hair were much lower than those reported in exposed children aged 7-15
years-old (0.1495 µg/g) that live close to an industrial-scale gold mine in Soweto, South Africa,
suggesting minimal environmental exposure. Moreover, Th showed statistical significance according tozones of residency (p-value=0.0028), being higher in teenagers’ hair living in areas that support moreindustrial activities [0.00298 vs 0.0022 (which support high levels of traffic), 0.00171 and 0.00159µg/g].
CONCLUSIONS:Teenagers living in Alcalá have minimal exposure to both radionuclides, notrepresenting a risk for the population. Further studies should try to identify potential
environmental/dietary sources of these radionuclides in the population living in Alcalá de Henares,
especially Th, as this showed some increase with age in the population groups monitored.

Keywords: Radionuclides, uranium, human hair, monitoring, Spanish teenagers

EP-032[Methods » Toxicology]

A strategy using the fission
yeast Schizosaccharomyces pombe toinvestigate the toxic effects of environmental
chemicals
Antonio Peña-Fernández1, Consuelo Alvarez-Herrera2, Maria Llana-Ruiz-Cabello2, Sara Maisanaba2,
Guillermo Repetto2
1Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK
2Area of Toxicology, Universidad Pablo de Olavide, 41013 Sevilla, Spain

BACKGROUND AND AIM:The aim of this study was the development of a systematic strategy toinvestigate the main effects of environmental chemicals using the fission yeast Schizosaccharomyces
pombe
METHOD:The changes in the growth in liquid medium of different S. pombe mutant strains have been
compared after 16, 18 and 20 hours of exposure. Four chemical compounds with perfectly known
different mechanisms of action were applied: 1) carbendazim, that causes interference inmicrotubules, 2) hydrogen peroxide, that causes oxidative stress, 3) potassium chloride, that causes
osmotic stress and 4) hydroxyurea, that induces DNA damage. Finally, triclosan, an antibacterial andantifungal agent present in some consumer products, including toothpaste, soaps, detergents, toys,
and surgical cleaning treatments was evaluated.
RESULTS:Microtubule disruption by carbendazim was detected thanks to the sensitivity of the mph1∆
strain. Oxidative stress induced by hydrogen peroxide compromised particularly the growth in sty1∆,
sty1∆pmk1∆ and pap1∆ strains. DNA damage induced by hydroxyurea was correlated to thesensibility of the rad3∆ strain. The global detoxification and multidrug resistance were investigatedusing Pmd1, Bfr1, Mfs1 and Caf5 Schizosaccharomyces pombe deficient strains. Furthermore, theantibacterial and antifungal agent triclosan was evaluated using the alternative strategy,
demonstrating that its main mechanism of action on yeast was oxidative stress.
CONCLUSIONS:The application of a systematic strategy using several deficient strains of the fission
yeast Schizosaccharomyces pombe was useful for the investigation of the main toxic effects ofpollutants.

Keywords: Environmental chemicals, yeast, triclosan, toxicity

EP-033[Other » Other (to be specified with keywords in the keywords section)]

Associations between long-term exposure to air
pollution, noise, and body composition in theAustrian LEAD cohort
Hicran Altug1, Katherine Ogurtsova1, Caspar Schiffers2, Owat Sunanta2, Marie Kathrin Breyer3, Sylvia
Hartl3, Barbara Hoffmann1, Sarah Lucht4, Robab Breyer Kohansel5
1Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical

Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
2Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and

Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
3Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and

Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria; Department of Respiratory andPulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Vienna, Austria
4Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical

Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany: Cardinal
Health, Dublin, Ohio, USA
5Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and

Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria; Department of Respiratory andPulmonary Diseases, Vienna Healthcare Group, Clinic Hietzing, Vienna, Austria

BACKGROUND AND AIM:Air pollution and noise exposure has been linked to an increased risk ofvarious cardiometabolic diseases. However, evidence is limited regarding their potential effects onbody composition. This study aimed to investigate the associations between traffic-related air
pollution, chronic noise, and body composition.
METHOD:We used repeated measures from the LEAD (Lung, hEart, sociAl, boDy) cohort study
conducted in Vienna, Austria. Body mass index (BMI; kg/m²), fat mass index (FMI; z-score) and leanmass index (LMI; z-score) were measured using dual-energy x-ray absorptiometry (DXA) at thebaseline (t0; 2011-ongoing) and follow-up (t1; 2017-ongoing) exams. The annual concentrations ofparticulate matter (PM10) and nitrogen dioxide (NO₂) were estimated using the GRAMM/GRAL
dispersion air pollution model (2015-2021). Transportation noise was modeled for 2017 for mean
weighted 24-hour (LDEN) and night-time (LNIGHT) noise according to the European Union Directive
2002/49/EC. The participants' exposures were assigned based on their residential addresses. Linear
mixed-effects models with random participant intercepts and linear regression models stratified by age
were used for cross-sectional and longitudinal analyses, respectively. Models were adjusted forlifestyle, demographics, and co-exposure.
RESULTS:A total of 19,202 observations (nt0=12,717, nt1=6,485) from participants aged 6-86 years(mean age at t0: 41.0 years; 52.9% female; mean PM10=21 µg/m3) were analyzed. Among children,
higher PM10 exposure was cross-sectionally associated with higher FMI z-scores (0.09 (95% CI: 0.03,
0.16)) and lower LMI z-scores (-0.05 (95% CI: -0.10, -0.002) per 1.8 µg/m³). The cross-sectional
associations observed among adults were similar, albeit not significant. No associations were observed
for noise exposures. Longitudinal analyses, investigating changes in body composition over time, did
not reveal conclusive associations.
CONCLUSIONS:Air pollution exposure was cross-sectionally associated with body composition inchildren However, estimates from longitudinal analyses, while mostly positive, were not conclusive.
This study contributes to the evidence on the detrimental effects of air pollution on obesity.

Keywords: Air pollution, Obesity and metabolic disorders, NoiseEP-034[Exposure assessment methods » Exposure assessment-general]

Trajectories of non-asbestos air toxic exposure
among mesothelioma patients: A latent classmixed modeling approach
Bian Liu1, Furrina F Lee2
1Department of Population Health Science and Policy; Department of Environmental Medicine andPublic Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Bureau of Cancer Epidemiology, Division of Chronic Disease Prevention, New York State Department

of Health, Menands, NY, USA

BACKGROUND AND AIM:To examine the heterogeneous trajectories of non-asbestos air toxic exposure
among mesothelioma patients.
METHOD:Patients’ residential histories were obtained by linking mesothelioma cases diagnosed during
2011-2015 from the New York State Cancer Registry to LexisNexis administrative data and inpatient
claims data. Percentile ranking of lifetime cancer risk from inhalation of non-asbestos air toxics was
based on the National Air Toxic Assessment. To compare data across years during patient’s residential
history, yearly excess risk was calculated by dividing exposures at individual census tracts by thestate-level average and subtracting one. We used a latent class mixed model to identify distinct risk
trajectories among patients with a 15-year residential history prior to cancer diagnosis (n=909). We
further examined differences in trajectory groups by patient characteristics using bi-variate analysis
and a multinomial logistic regression model.
RESULTS:The majority of the patients were non-Hispanic White (89.7%), male (75.5%), and with
distant stage at diagnosis (64.8%). We identified 5 distinct trajectories of cancer risk: “Persistent lowrisk” (24.8%), “Increased low-risk” (24.1%), “Increased high-risk” (22.2%), “Tempered low-risk”(16.2%), and “Persistent moderate-risk” (12.8%). Patient characteristics did not differ across
trajectory groups, except for race and Hispanic ethnicity (p<0.0001). The proportion of non-Hispanic
White patients was the highest in the “Persistent low-risk” (99.6%) while the lowest in the “Increased
high-risk” (75.2%). Compared to their counterparts, non-Hispanic White patients had a significantly
lower odds of being in trajectory groups other than the “Persistent low-risk” group (all adjusted
OR<0.1, all upper 95% confidence intervals <0.7).
CONCLUSIONS:We quantified the heterogeneous experiences of cancer risks associated with ambient
air toxics among a cohort of mesothelioma patients. In addition, we found patient’s race and ethnicity
differed across the identified trajectories, likely a reflection of disparities in patients’ residential
mobility prior to their cancer diagnoses.

Keywords: Long-term exposure, Exposure Assessment, Environmental epidemiology, Cancer andcancer precursors, Environmental disparities

EP-035[Outcomes » Obesity and metabolic disorders]

Data-driven identification of epidemiologicalfactors associated with youth type 2 diabetes
and prediabetes
Bian Liu1, Catherine Mcdonough2, Yan Chak Li2, Gaurav Pandey2, Nita Vangeepuram3
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New

York, NY, USA
2Department of Genetic and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY,USA
3Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

BACKGROUND AND AIM:The prevalence of Type 2 diabetes (DM) and prediabetes (preDM) has been
increasing among youth in recent decades in the United States, prompting an emerging need forunderstanding and identifying their associated risk factors. Such efforts, however, have been hinderedby the lack of easily accessible high quality data. We aimed to build a platform to share high quality
epidemiological data to address this significant gap and facilitate youth preDM/DM research.
METHOD:Building on data from the National Health and Nutrition Examination Survey (NHANES) from1999 to 2018, we cleaned and harmonized variables relevant to preDM/DM (fasting plasma glucose
level ≥100 mg/dL and/or HbA1C ≥5.7%) for youth aged 12-19 years (n=15,149). We identified
factors associated with preDM/DM risk using bivariate statistical analyses and our Ensemble
Integration (EI) framework for multi-domain machine learning. We developed a Prediabates/diabetes
in youth ONline Dashboard (POND) to share the data and codes.
RESULTS:We extracted 95 variables potentially relevant to preDM/DM risk organized into 4 domains(socioeconomic status, health status, diet, and other lifestyle behaviors). The bivariate analyses
identified 27 significant correlates of preDM/DM, including race/ethnicity, health insurance, BMI, addedsugar intake, and screen time. Many but not all of these factors were also identified based on the EI
methodology. The EI approach also identified additional predictive variables, including some known(e.g., meat and fruit intake and family income) and less recognized factors (e.g., number of rooms inhomes and times healthcare was received in the past year).
CONCLUSIONS:Leveraging the rich information in NHANES, we built one of the largest datasets forstudying youth preDM/DM, and presented user cases of the data using complimentary statistical andmachine learning methods. Our data-sharing platform, POND, facilitates a wide range of applications
and development of youth preDM/DM studies.

Keywords: Food/nutrition, Exposures, Socio-economic factors, Environmental epidemiology

EP-036[Outcomes » Obesity and metabolic disorders]

Occupational Factors and the Risk of Chronic
Diseases among Technology Industry Workers in
Hsinchu: A Retrospective Cohort Study
Che Jui Jerry Chang1, Te Wei Lin1, Hsiao Yu Yang2
1Department of Community and Family Medicine, National Taiwan University Hospital Hsinchu Branch,

Hsinchu, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan

BACKGROUND AND AIM:Workers in the technology industry in Hsinchu are generally exposed to highstress and long working hours, and the impact on health risks is not yet known. Therefore, this project
aims to investigate the association between the risk of common chronic diseases and occupational
factors.
METHOD:A cohort study design was used to follow up the working population who attended a healthcheck program at National Taiwan University Hsin-chu Branch from 2016 to 2020. The main
explanatory variable was occupation, which was divided into three major categories: engineers,technicians, and office workers (control groups). Confounding factors included age, sex, and industry.
A generalized estimating equation (GEE) was used as a repeated measures model to investigate theeffect of occupation on risks of chronic diseases.
RESULTS:A total of 953 engineers, 40 technicians, and 303 office workers were enrolled in the study.
Common (prevalence ≥5%) chronic diseases among the participants included hyperlipidemia,
metabolic syndrome, nonalcoholic fatty liver disease (NAFLD), chronic hepatitis B, gallbladder polyps,
peptic ulcers, and urolithiasis. The engineer group had a lower risk of metabolic syndrome (odds ratio
0.658 [0.468, 0.925]) but a higher risk of NAFLD (odds ratio 1.496 [1.130, 1.981]) and the yearly
increasing risk of peptic ulcers (odds ratio 1.430 [1.318, 1.552]) was higher. The technician group hada higher yearly increasing risk of peptic ulcers (odds ratio 1.432 (1.255, 1.635)), and urolithiasis(odds ratio 1.390 [1.083, 1.783]), and the rate of kidney function decline (β -0.865 [-1.589, -0.141])
was more rapid.
CONCLUSIONS:The risks of common chronic diseases among workers in the technology industry in
Hsinchu was significantly associated with occupation, and significant time-response relationships were
found.

Keywords: Cardiovascular diseases, Occupational epidemiology, Outcomes Other

EP-037[Exposures » Occupational exposures]

Thermoregulation in response to exercising at amoderate metabolic rate when wearing personal
protective and emergency response equipment
Yi-Chun Lin, Fei-Pi Huang, Chen-Peng Chen
Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Personal protective equipment (PPE) is the last line of defense against
exposure to chemical hazards. However, the PPE ensemble applied in emergency rescue adds
significant thermal burden to their users and risks heat stress when they are used. This study
investigated the thermal stress imposed upon PPE users as a result of donning PPE used in emergency
response (Level A/B Ensemble) and in non-emergency situations (Level C/D Ensemble).
METHOD:Ten male and ten female participants wore PPE for 60 min and walked on simulated stairs at
a moderate metabolic rate (130-200 W/m²) from 21st to 35th min in a climatic chamber preset at
25°C. The heart rate and core temperature were monitored to indicate core thermoregulation inexperiment, and the skin capillary blood flow, skin moisture, transepidermal water loss, and skintemperature measured to observe heat exchange between the skin and the ambient environment. The
thermoregulatory dynamics involved in dissipating excessive metabolic heat for maintaining thermalbalance were described as change in observed thermo-physiological quantities.
RESULTS:The changes in core and skin-based thermo-physiological indicators were significantly
greater when donning Level A and B Ensemble than when wearing Level C and D. The period required
for the thermoregulatory indicators of PPE users to return to baseline lengthened as the heat stressfrom wearing PPE ensemble increased, with those for the heart rate after donning Level A and B
Ensemble being more than 25 min.
CONCLUSIONS:Significant heat stress arose from donning PPE in emergency response missions andrisked overrunning heat strain capacity of the users, even when the users were only engaged in
exercise of moderate metabolic consumption. Periodical monitoring of thermo-physiology (e.g., heart
rate and sweating rate) is recommended when using PPE to alert potential heat stress. This study was
funded by Taiwan’s National Science and Technology Council.

Keywords: exposure assessment, risk assessment, climate

EP-038[Exposures » Occupational exposures]

Thermal burden from wearing personal
protective equipment enhanced for healthcare
personnel (“Bunny Suit”) during COVID-19
pandemic
Yi-Chun Lin, Hung-Yun Jou, Chen-Peng Chen
Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:During COVID-19 pandemic, workers in medical facilities routinely used fullbody personal protective equipment (PPE) to safe-guard against potential infection. However, the heatexchange between the body and the ambient environment was reduced due to low permeability andinsulation of PPE, resulting in buildup of excess metabolic heat inside PPE and risking heat stress. This
study evaluated the generation of metabolic heat as manifested in thermoregulation due to wearing
the PPE enhanced for healthcare personnel, the “Bunny Suit.”
METHOD:A total of 16 participants (8 males and 8 females) wearing designated garments exercised ina climatic chamber preset at a temperature of 25°C, and they were observed for the time course ofchange in thermo-physiological quantities, including skin capillary blood flow (SCBF), skin moisture,and transepidermal water loss (TEWL). The maneuvers involved in the exercise, in the order of
performance, were wearing designated garments and stair-walking for 15 min (an activity of moderate
metabolic rate between 130 and 200 W/m²), removing garments (15 min), and sitting and resting (10min). The studied PPEs included Bunny Suit (Level D protective suit, medical isolation gown, N95
mask, face shield, and gloves) and Level D Ensemble (Level D suit, powered air-purifying respirator,and gloves.)
RESULTS:When stair-walking, the SCBF of the participants wearing Bunny Suit was consistently
greater than the levels determined when wearing Level D Ensemble. The difference in skin moisture
between two garment groups during exercise was insignificant. However, the TEWL determined
wearing Bunny Suit was significantly higher than those measured wearing Level D Ensemble, signalinga requirement of advanced heat dissipation when wearing the Bunny Suit.
CONCLUSIONS:When enhanced PPE are used to protect healthcare professionals, potential heat stressfrom PPE use and heat strain capacity of personnel must be evaluated and monitored to avoid thermal
hazards.

Keywords: exposure assessment, risk assessment, COVID-19

EP-039[Air pollution » Short-term exposure]

Individual susceptibility to the acute impact of
air pollution on resting heart rate among theelderly
Chi Hsien Chen1, Feipei Lai2, Yue Liang Leon Guo3
1Department of Environmental and Occupational Medicine, National Taiwan University (NTU) Collegeof medicine and NTU Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
2Department of Computer Science and Information Engineering, National Taiwan University, Taipei,

Taiwan3Department of Environmental and Occupational Medicine, National Taiwan University (NTU) Collegeof medicine and NTU Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan;
National Institute of Environmental Sciences, National Health Research Institutes, No. 35, Keyan Rd.,
Zhunan Township, Miaoli County, Taiwan; Institute of Environmental and Occupational Health
Sciences, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City, Taiwan

BACKGROUND AND AIM:Elevated resting heart rate is a significant predictor of cardiovascular disease
and all-cause mortality. This study aims to investigate the impact of air pollution on resting heart rateand individual susceptibility among elderly individuals.
METHOD:Seventy elderly individuals (>65 years old) from Datong, Zhongshan, and Wanhua districtsof Taipei City participated in the study. They completed questionnaires, blood tests, and bodycomposition measurements in May-June 2020 and wore Garmin@ smartwatches throughout the study
until early August 2020. Acute air pollution exposure was defined as the averaged lag-1-day
concentration of air pollutants from Datong, Zhongshan, and Wanhua monitoring stations. Mixedeffect modeling was used to evaluate the effect of air pollution on resting heart rate, with aninteraction term included to examine the modifying effect of individual factors.
RESULTS:Each interquartile range increase in PM2.5, PM10, NO2, CO, SO2, and non-methanehydrocarbons (NMHC) was linked to a corresponding increase of 0.20, 0.22, 0.27, 0.47, 0.19, and0.53 beats per minute in resting heart rate, respectively. Further analysis using two-pollutant
modeling and AIC/BIC criteria identified NMHC as the pollutant with the strongest association withresting heart rate. Individual factors, including genotypes of GSTP1 Ile105Val, GSTT1-null, and
GSTM1-null, inadequate control status of diabetes with HbA1c more than 7.5%, loss of a loved one in
the past year, higher blood neutrophil and monocyte percentage, and lower eosinophil percentage,
were found to enhance the exposure-response relationship.
CONCLUSIONS:Acute air pollution exposures, especially NMHC, increase resting heart rate among theelderly. Individual genotype, physiological status, and exposure to external stressors may amplify the
impact of air pollution on heart rate.

Keywords: air pollution, non-methane hydrocarbons, resting heart rate, wearable device, individual
susceptibility

EP-040[Respiratory and allergic outcomes » Allergies]

A mysterious rash outbreak over Pescadores
Islands in Taiwan Strait: an airborne caterpillar
contact dermatitis by ultrastructure mapping
Chih Hung Lee1, I Ming Lin5, Tsung Jen Hsu2, Hung Su3, Chia Hua Lin4, Yeo Wan Chiang5, Jentaie
Shiea3, Huang Chang Liao6, Sheng Chieh Kuang6, Jui Lan7
1Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
2Dermatology Clinic, Penghu, Taiwan
3Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
4Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
5Department of Materials and Optoelectronic Science, National Sun Yat-Sen University, Kaohsiung,Taiwan6Ministry of Health and Welfare Penghu Hospital, Penghu, Taiwan
7Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

BACKGROUND AND AIM:A mysterious skin rash (papular lesions) outbreak broke out for unknown
reasons in Taiwan’s Pescadores Islands mid-autumn 2021, causing much anxiety in the population
already nervous about the ongoing COVID-19 epidemic.
METHOD:We conducted a field survey for possible culprit agents. Skin samples were taken by rapidglue adhesives from the affected skin. Electron microscopy from the skin samples as well as caterpillar
seta was performed. Additional neurotransmitter analysis by mass spectrometry were conducted on
the skin samples.
RESULTS:A field survey found a large increase in caterpillars, Euproctis taiwana, in September 2021,
the warmest September in recent years. Electron microscopy performed on superficial skin samples(3-6 cells thick) of affected and healthy skin (n=5 and 3, respectively) and caterpillar setae revealed
ultrastructural similarities between setae spurs (0.15-0.2m) and tiny pits (0.2m) on affected skin as
well as similar vegetative debris (0.75m) on both setae and affected skin. Mass spectrometry showedlarge increases in tyrosine, serine, and histamine, known mediators of arthropod insult.
CONCLUSIONS:The co-occurrence of Euproctis taiwana population growth, excessive warming, strong
monsoon winds may lead to this unusual autumn outbreak late September. The lifting of COVID-19
related travel restriction against earlier that month probably exacerbated it.

Keywords: airborne caterpillar dermatitis, electron microscope, global warmingEP-041[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Urinary heavy metals and psychosocial behaviorof preschool children: a mixed exposure
analysisChing Chun Huang1, Wei Shan Chin2, Shih Chun Pan3, Jing Fang Hsu3, Yaw Huei Huang4, Yue Liang
Leon Guo5
1Environmental and Occupational Medicine, National Taiwan University Hospital Hsin-Chu Branch,

Hsin-Chu, Taiwan
2School of Nursing, College of Medicine, National Taiwan University and National Taiwan University

Hospital, Taipei, Taiwan
3National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan4Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
5Environmental and Occupational Medicine, College of Medicine, National Taiwan University andNational Taiwan University Hospital, Taipei, Taiwan

BACKGROUND AND AIM:The neurotoxic effects of certain heavy metals are well established, but only afew studies have investigated the joint effect of concurrent exposure to multiple ones. The study aims
to evaluate the association between mixed exposure to neurotoxic metals and the psychosocial
behavior of preschool children.
METHOD:Using a stratified sampling strategy, we recruited participants from 105 kindergartens in 41
townships of Taiwan and excluded those with blood lead levels ≥3.5 µg/L. The first-morning void
urines were collected and analyzed for cadmium, magnesium, arsenic, chromium, lead, and nickel
concentrations using ICP-MS. We applied the parentally reported Strengths and Difficulties
Questionnaire (SQD) and Swanson, Nolan, and Pelham IV (SNAP-IV) scales to evaluate thepsychosocial behaviors. Multiple linear regressions were utilized to evaluate the associations between
each heavy metal and the outcomes, while the mixed effect of concurrent exposure was estimated byusing a Quantile g-computation approach.
RESULTS:A total of 977 preschool children were included in the study, and the mean (SD) age was 5.7(0.7) years old. In single pollutant models, we observed adverse effects of urinary magnesium, nickel,
arsenic, and lead on the specific subsets of SDQ. Furthermore, the combined effect of the six heavy
metals significantly affected the hyperactivity/inattention symptoms (beta = 0.46, 95% CI:
0.13~0.78, with all metals increased by one quartile), and chromium and lead were the two major
effect contributors. Similar detrimental effects of the urinary cadmium and lead were also observed in
the SNAP-IV subsets, although the joint effect analysis was not significant.
CONCLUSIONS:The study provided evidence that concurrent exposure to multiple heavy metals mayexert increased risks of hyperactivity/inattention in children compared to single pollutant exposure.
Further studies are needed to verify our findings regarding mixed exposure to multiple neurotoxic
metals.

Keywords: neurotoxic metals, psychosocial behavior, children, mixed exposureEP-042[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Dietary intake of acrylamide and increased riskof mortality: evidence from the E3N Frenchprospective cohort
Chloé Marques1, Pauline Frenoy1, Alexis Elbaz1, Nasser Laouali2, Sanam Shah1, Gianluca Severi3,
Francesca Romana Mancini1
1Paris-Saclay University, UVSQ, Gustave Roussy, Inserm, "Exposome, Heredity, Cancer And Health"Team, CESP U1018, 94805, Villejuif, France
2Paris-Saclay University, UVSQ, Gustave Roussy, Inserm, "Exposome, Heredity, Cancer And Health"Team, CESP U1018, 94805, Villejuif, France; Department Of Biostatistics And Epidemiology, School Of
Public Health And Health Sciences, University Of Massachusetts At Amherst, Amherst, MA 01002, USA;
Scripps Institution Of Oceanography, University Of California, San Diego, CA, USA
3Paris-Saclay University, UVSQ, Gustave Roussy, Inserm, "Exposome, Heredity, Cancer And Health"Team, CESP U1018, 94805, Villejuif, France; Department Of Statistics, Computer Science, Applications“G. Parenti”, University Of Florence, Italy

BACKGROUND AND AIM:Acrylamide is an organic compound classified as probably carcinogenic tohumans because of sufficient evidence in animals but not in humans. Its other health risks are notentirely clear. We aimed to study the relationship between acrylamide dietary intake and mortality inthe E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) French cohort.
METHOD:We studied 72 585 women of the E3N prospective cohort, which completed a food frequency
questionnaire in 1993. The E3N food consumption database and the second French total diet study
food contamination database (based on food prepared “as consumed”) were used to estimate
participants’ acrylamide dietary intake. We estimated the associations between acrylamide dietaryintake and all-cause or cause-specific mortality using Cox proportional hazard models.
RESULTS:During the follow-up (1993-2014), we identified 6 441 deaths. The mean acrylamide dietaryintake was 32.6 µg/day, with coffee consumption as the principal contributor (48.6%). In the fully
adjusted model, we found a U-shaped association between acrylamide dietary intake and all-cause
mortality and a linear positive association with cardiovascular disease (HR for one STD increment[95%CI]: 1.11 [1.02; 1.21]), all-cancer (HR [95%CI]: 1.05 [1.01; 1.10]) and lung cancer (HR[95%CI]: 1.22 [1.09; 1.38]) mortality, while we observed no association with breast (HR [95%CI]:
0.94 [0.86; 1.03]) and colorectal (HR [95%CI]: 1.12 [0.97; 1.29]) cancer mortality. We highlighted
an interaction between acrylamide dietary intake and smoking status in the models for all-cause andall-cancer mortality: when stratifying on smoking status, associations were positive and statisticallysignificant only in current smokers.
CONCLUSIONS:This study on a large prospective cohort following more than 70 000 women for morethan 20 years suggests that a higher acrylamide dietary intake is associated with an increased risk ofmortality. Therefore, it is essential to keep reducing acrylamide formation and prevent dietary intakeof acrylamide, especially among smokers.

Keywords: environmental epidemiology, female, nutrition, mortality, long-term exposureEP-043[Chemical exposures » Fluoride]

Drinking water fluoride and hip fracture
incidence in England: Analysis of 2013-2020
data
Christopher Neurath1, Penelope Sowter2
1Research Director, American Environmental Health Studies Project (AEHSP), Lexington MA, USA
2Independent researcher, Bedford, UK

BACKGROUND AND AIM:To examine associations between drinking water fluoride concentrations andincidence rates of hip fracture for all of England using smaller area data and controlling for age, sex,ethnicity, deprivation, and water hardness.
METHOD:All data was publicly available from UK government sources. Age-standardized hip fracture
hospitalization incidence rates for the years 2013-2020 for those age 60+ years, by geographical levelof Clinical Commissioning Group (CCG). Drinking water fluoride concentration CCG average wasestimated with GIS software from published water fluoride concentration maps. Water hardness for all
CCGs was similarly obtained using GIS and published maps. Percent of population age 60+ years
considered income-deprived and percent non-White ethnicity was obtained from UK Census. Eachcovariate was chosen because previous evidence suggested associations with hip fracture risk. Linear
and spline regression models were evaluated to assess associations.
RESULTS:Mean hip fracture rate for 2013-2020 was 400 per 100,000 person-years. Spline regression
models adjusting for all four co-variates indicated non-linearity. Water fluoride concentration, water
hardness, deprivation, and percent non-White all had statistically significant associations with hip
fracture rate. Model-predicted hip fracture rate with covariates set at their mean values increased
from 378 (95%CI 361-395) to 454 (95%CI 433-474) as water fluoride increased from 0.05 to 0.7
mg/L, a range from the lowest concentrations in England to that commonly used in artificial
fluoridation. Significant interactions were found between water fluoride and percents income deprived
and non-White. Water hardness and percent non-White were protective against hip fracture.
Deprivation was associated with increased hip fracture rate.
CONCLUSIONS:Water fluoride at concentrations commonly used in artificial fluoridation (0.7 mg/L)
was associated with a significant 20% increased rate of hip fracture in older adults, compared to thelowest natural fluoride concentrations in England, controlling for age, water hardness, deprivation, andethnicity.

Keywords: hip fracture, water quality, public health, spatial statistics, environmental epidemiology

EP-044[Chemical exposures » Fluoride]

Updated dose-response assessment and metaanalysis of fluoride developmental neurotoxicity
studies rated higher quality by National
Toxicology Program
Christopher NeurathResearch Director, American Environmental Health Studies Project (AEHSP), Lexington MA, USA

BACKGROUND AND AIM:The US National Toxicology Program (NTP) updated their systematic review offluoride (F) human developmental neurotoxicity studies in 2022. In response to National Academies(NASEM) committee recommendations the present study assessed dose-response relationships in
NTP-identified studies using rigorous methods consistent with Environmental Protection Agency risk
assessments.
METHOD:Studies rated lower risk of bias (RoB) in the updated NTP review were examined using three
approaches to assess dose-response relationships and possible thresholds. The first approachassessed consistency of effect direction by comparing the number and proportion of studies finding
statistically significant adverse associations of IQ with F at mean exposures <1.5 or ≥1.5 mg/L water
F (or urine F) compared to studies finding no significant effect or a significant beneficial effect. The
second approach used subgroup meta-analysis to compare pooled estimates of studies with individuallevel IQ outcome data with mean F <1.5 compared to mean F ≥1.5 mg/L. The third approach wasmeta-regression of IQ loss at mean exposure by mean exposure for studies with individual-level data.
Linear and spline meta-regression models were assessed.
RESULTS:NTP rated 31 studies lower RoB. Over 90% of studies in both exposure ranges (<1.5 and≥1.5 mg/L F) found statistically significant adverse associations. Subgroup meta-analysis foundsimilar magnitude of effect in both exposure range subgroups, averaging -3 IQ points per 1 mg/L F forthe two subgroups. Linear meta-regression also found a statistically significant pooled effectmagnitude of -3 IQ points per 1 mg/L F. Spline meta-regression did not suggest any threshold.
CONCLUSIONS:A large number of high-quality studies consistently showed statistically significant
adverse neurocognitive effects at both higher and lower exposure levels. Three dose-response
assessment approaches were robust in finding no evidence of a safe threshold for IQ loss.

Keywords: fluoride, children's environmental health, risk assessment, environmental epidemiology,
public healthEP-045[Respiratory and allergic outcomes » Respiratory outcomes]

Pesticide exposure and respiratory healthoutcomes of avocado farmworkers in
Michoacan, Mexico
Cynthia Armendáriz Arnez1, Cecilia Alcalá2, Ana María Mora3, Maria Gabriela Rodriguez Zamora4, Asa
Bradman5, Lilian Eréndira Pacheco Magaña6, Samuel Fuhrimann7, Christian Lindh8, María José Rosa2
1Escuela Nacional de Estudios Superiores (ENES) Unidad Morelia, Universidad Nacional Autónoma deMéxico (UNAM), Mexico
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Center for Environmental Research and Community Health (CERCH), School of Public Health,

University of California, Berkeley, United States
4Escuela de Ingeniería en Seguridad Laboral e Higiene Ambiental (EISLHA), Instituto Tecnológico de

Costa Rica, Cartago, Costa Rica
5Department of Public Health, University of California, Merced, United States
6Instituto Mexicano del Seguro Social (IMSS), Michoacán, México
7Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss

TPH), Basel, Switzerland
8Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden

BACKGROUND AND AIM:There is limited epidemiologic data on the association between occupational
pesticide exposure and respiratory health. We aimed to examine the association of exposure toinsecticides, fungicides, and herbicides, individually and as a mixture, with respiratory healthoutcomes among avocado workers from Michoacán, Mexico
METHOD:We conducted a cross-sectional study of 105 avocado workers between May and August2021. We quantified 13 insecticides, fungicide, or herbicide metabolites in urine samples collectedduring two study visits (8-10 weeks apart). We collected survey data on self-reported pesticide use
during the 12 months prior to the baseline survey and estimated yearly exposure-intensity scores(EIS) using a semi-quantitative exposure algorithm. Respiratory symptoms during the 12 months prior
to the follow-up survey including wheeze, chest tightness, wheezing after exercise, and night coughwere also assessed via questionnaire. We examined associations of combined EIS and individual
urinary metabolite concentrations with respiratory health outcomes using generalized linear regression
models. Mixture effects were assessed using Bayesian Weighted Quantile Sum regression.
RESULTS:Annual combined EIS were associated with higher odds of night cough (OR: 1.02, 95% CI:
1.00, 1.04). Additionally, in individual models, higher concentrations of pyrethroid metabolites, 3phenoxybenzoic acid, cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropanecarboxylic acid (DCCA), andtrans-DCCA were associated with higher odds of night cough (OR per 2-fold increase inconcentrations: 2.04, 95% CI: 1.17, 3.76; OR: 2.52, 95% CI: 1.33, 5.25; OR: 2.56, 95% CI: 1.18,
6.02; respectively). We found similar joint mixture effects between the pesticide mixtures and higher
odds of night cough (OR: 5.02, 95% CrI: 1.36, 22.76); pyrethroids were the main contributor of the
mixture (43%).
CONCLUSIONS:Our findings indicate that exposure to pesticides, but particularly to pyrethroids, may
be associated with adverse respiratory health outcomes among avocado workers. Future directions
include examining occupational pesticide exposure and lung function within this population.

Keywords: pesticide, mixtures, respiratory health, asthma, wheezeEP-046[Exposures » Water quality]

Long-term exposure to arsenic in drinking waterand risk of cardiovascular diseases among
women living in California
Danielle N Medgyesi1, Emma Spielfogel2, Komal Bangia3, Ana Navas Acien1, Jessica M Madrigal4,
Jared A Fisher4, Rena R Jones4, Mary H Ward4, James V Lacey2, Tiffany R Sanchez1
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, New York2Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman

Research Institute of the City of Hope National Medical Center, Duarte, California
3Community and Environmental Epidemiology Research Branch, Office of Environmental Health

Hazard Assessment, Oakland, California
4Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, Rockville, Maryland

BACKGROUND AND AIM:High levels of arsenic in drinking water (wAs) have been linked to
cardiovascular disease (CVD), but risks remain uncertain at lower levels present in US community
water supplies (CWS), currently regulated at the federal-level (maximum contaminant level[MCL]=10µg/L). Our study evaluated the relationship between long-term wAs exposure and CVD riskin the California Teachers Study prospective cohort (enrolled 1995-1996).
METHOD:We computed wAs exposure as the average of annual measurements corresponding to CWS
serving participants’ residential addresses from 1995-2005 (N=94,402). CVD outcomes fromstatewide healthcare administrative records through 2018 included incident cases of stroke (n=6,919),
myocardial infarction (n=3,365), and coronary revascularization procedures (n=3,539), a proxy forsevere coronary artery disease. We estimated hazard ratios (HRs) and 95% confidence intervals(95CIs) for wAs exposure and CVD outcomes. We evaluated wAs exposure using penalized splines andcategorized at concentrations relevant to the MCL (<1, 1-<3, 3-<5, 5-<10, ≥10µg/L) and percentiles(<50th, 50th-75th, 75th-95th, ≥95th). Models were adjusted for baseline age, socioeconomic status,
race/ethnicity, BMI and smoking status. We also conducted analyses stratified by smoking status.
RESULTS:Median (75th, 95th percentiles) wAs were 0.96µg/L (1.76, 3.92). The adjusted HR (95%CI)
of wAs ≥10 vs. <1µg was 1.09 (0.87, 1.38) for any CVD outcome, 1.05 (0.78, 1.41) for stroke, 0.68
(0.40, 1.15) for myocardial infarction, and 1.64 (1.17, 2.28) for coronary revascularization
procedures. Risk of coronary revascularization procedures comparing ≥95th vs. <50th percentiles was
HR=1.14 (95%CI=0.97, 1.35), cases=169, ptrend=0.027. Among ever smokers, we found evidenceof a linear and statistically significant association between wAs and coronary revascularization
procedures (ptrend<0.01). Among never smokers, the corresponding association was non-linear andrisk was observed only ≥10µg/L (ptrend=0.73).
CONCLUSIONS:Our findings suggest long-term wAs exposure at relatively low levels in CWS could
lead to atherosclerosis that requires coronary revascularization. We observed greater susceptibility
among ever smokers.

Keywords: Water quality, Heavy metals, Environmental epidemiology, Cardiovascular diseases

EP-047[Exposure assessment methods » Exposure assessment-air pollution]

Complex interaction effects of air pollution andtemperature on blood pressure: Evidence fromthe SALIA cohort study
Dayasri Ravi1, Andreas Groll1, Tamara Schikowski2
1Department of Statistics, TU Dortmund University, Dortmund, Germany
2Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf,

Germany

BACKGROUND AND AIM:Systolic and diastolic blood pressures have always been closely associatedwith environmental factors such as temperature and air pollution. However, the interaction effectbetween these environmental factors in modeling blood pressure is often not considered. We
investigated the short-term combined effect of temperature and air pollution on blood pressure.
METHOD:We examined the blood pressure in older women from the German SALIA cohort during the
2007-2013 follow-up examination. A generalized additive model with a bivariate tensor product was
employed to capture the complex interaction effect of temperature and air pollutants such as
particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with systolic (SBP) and diastolicblood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP). The interaction wasmonitored over a lag period of up to 13 days. The estimated effects were calculated based on a cut-off
level of temperature determined by an inflection point in the graph.
RESULTS:We observed a non-linear interaction effect of environmental factors on blood pressure. On
warmer days with temperatures above 10°C, the effect of air pollutants was significantly associatedwith blood pressure. For example, a one-unit increase in PM2.5 concentration (μg/m³) was associatedwith a 0.46% (95% CI: 0.06%, 0.98%) increase in SBP, a 0.67% (95% CI: 0.17%,1.18%) increase in
DBP, and a 0.6% (95% CI: 0.15%, 1.05%) increase in MAP. We found no significant relationshipbetween air pollution and blood pressure in colder temperatures.
CONCLUSIONS:We discovered an intricate synergistic relationship between temperature and air
pollution on systolic and diastolic blood pressures. Considering the linear effect, we found a minimal
statistically significant association between air pollutants and blood pressure. However, we discovereda highly significant association when considering the non-linear interactions between temperature andair pollution.

Keywords: Air Pollution, Temperature, Modeling, Short-term exposure.

EP-048[Air pollution » Particle components]

Spatio-temporal diversity and metagenome
analysis of biological aerosols over somediscrete locations of Northeast India
Debajit Borah1, Binita Pathak2
1Department of Biotechnology, The Assam Royal Global University, Guwahati-781035, India
2Department of Physics, Dibrugarh University-786004, India; Centre for Atmospheric Studies,

Dibrugarh University-786004, India

BACKGROUND AND AIM:Human health issues due to air pollution are common issues to be addressedat the global level and biological aerosols contribute a major part to it. Even though, the Northeasternregion in India is known for its healthy air quality within the country but is reported be deteriorated inrecent times. Henceforth, the biological aerosols collected from eight discrete locations in all four
seasons in a year were characterized in terms of viable (bacterial diversity) and non-viable
components (fungal spores, animal debris, and non-biological components, particulate matters:
inhalable, thoracic, and alveolic).
METHOD:All the aerosol samples were collected using GRIMM Portable Laser Aerosol Spectrometer11.A which is capable of continuous monitoring of airborne particles as well as for measuring theparticle count distribution. The microbial diversity of the aerosol samples was analyzed by DNA-based
metagenomic approach and the culturable microbes were analyzed for their sensitivity against bradand narrow spectrum antibiotics. The living and non-living components were differentiated byfluorescence microscopic technique by using suitable fluorescence dye.
RESULTS:The non-viable (non-biological) components contributed the major part (30-89%) of thetotal components in the aerosol samples with pollens (4-20%), animal debris (1-24%), and fungal
spores (1-17%). The DNA-based metagenomic approach showed 184 bacterial (operational taxonomic
units) with 28,028 abundance count comprising 7 major phylum, 6 classes, 10 orders, 15 families, 13
genera, and 8 species in the samples collected during pre-monsoon season. Overall, 8-10% of thetotal culturable microbes during pre-monsoon season exhibited β-hemolysis which may pose apotential threat to human health.
CONCLUSIONS:This study gives a snapshot of both viable and non-viable components of aerosols
throughout a year in the selected locations and the results would be beneficial for the policymakers
and NGOs to create awareness among the people for suitable precautions to be followed.

Keywords: Particulate matter, Particle components, Microbiome, Air pollution

EP-049[Birth and pregnancy outcomes » Pregnancy outcomes]

Prenatal exposure to disinfection by-products(DBPs) through drinking water and their effects
on placental function
Dora Cserbik1, Cintia Flores2, Alexandra Paraian2, Ioar Rivas1, Payam Dadvand1, Jordi Sunyer1,
Cristina M. Villanueva1
1ISGlobal, Barcelona, Spain
2Mass Spectrometry Laboratory/Organic Pollutants, Institute of Environmental Assessment and Water

Research, IDAEA-CSIC, Barcelona, Spain

BACKGROUND AND AIM:Exposure to disinfection by-products (DBPs) and in utero have been
associated with adverse pregnancy and birth outcomes in epidemiological studies. Associations remain
unclear for the placenta that is a critical organ during pregnancy for the development of the fetus andvulnerable to environmental insults. This study aimed to comprehensively assess exposure to DBPs in
drinking water during pregnancy in the Barcelona Life Study Cohort (BiSC) as well as to estimate
associations in relation to placental function.
METHOD:A total of 1086 pregnant women living in the Barcelona Metropolitan area were recruited at
the first trimester of pregnancy and followed by surveys until delivery (2018-2021). Water ingestion
habits were ascertained at the first and third trimesters through questionnaires. Routinely monitored
DBPs (trihalomethanes, THMs) were obtained from the local public health authority for the pregnancy
period (N=183) and non-regulated DBPs were analysed in a subset. Concentrations of DBPs weremodelled based on geolocation and temporal variation to predict concentrations in the residential
water supply of each participant from conception until delivery. Association analysis and mixture
modelling are ongoing.
RESULTS:Median (Interquartile range) concentrations (μg/L) of THMs were 18.6 (7.3-27.6) for
chloroform, 9.4(5.6-12.4) for dibromochloromethane, 6.4 (2.9-10.3) for bromodichloromethane, and26.1(16.2-36.0) for bromoform. Drinking water consumed at home was bottled (64%), filtered (21%),and unfiltered (15%) tap water.
CONCLUSIONS:The study population is exposed to THMs with a significant component of brominatedspecies in drinking water, concentrations of DBPs were below the regulatory limits set by the EU
Drinking Water Directive (EU DWD 2020/2184).

Keywords: water quality, chemical exposures, pregnancy outcome

EP-050[Air pollution » Short-term exposure]

Association between Air Pollution and COVID-19
in Hanoi and Ho Chi Minh Cities in Vietnam in
2021
Duc Minh Dao1, Saori Kashima2
1Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering,

Hiroshima University, Japan
2Center for the Planetary Health and Innovation Science, IDEC Institute, Hiroshima University, JapanBACKGROUND AND AIM:Air pollution make various serve effects on respiratory diseases. However, theassociation between air pollution and COVID-19 incidents is still under debate. Particularly, studies inSoutheast Asia countries with higher annual temperatures and relative humidity, and higher air
pollution concentrations have been limited. T study aimed to explore the association between air
pollution and COVID-19 incidents in Hanoi and Ho Chi Minh cities of Vietnam.
METHOD:The interrupted time-series study design was applied. For considering the effects of the
lockdown, the study period was divided into three periods: before, during, and after the lockdown in
2021. Daily COVID-19 cases were obtained from the Vietnam Ministry of Health and Air Pollutants(PM2.5, PM10, NO2, and O3) data from the World Air Quality website respectively. The incident rate
ratios (IRR) and their 95% confidence intervals (CIs) were calculated by Poisson regression and thenegative binomial regression model.
RESULTS:Significant positive associations of PM2.5 were observed after the lockdown period in bothcities. Indeed, every 10 μg/m3 increase in the mean concentration of PM2.5, corresponds to the IRR
fluctuating from 1.101 (95% CI: 1.065 – 1.143) at Lag 0 to 1.05 (1.007 – 1.096) at Lag 6 after
lockdown period in Hanoi city. In Ho Chi Minh City, after the lockdown, IRR ranges from 1.017 (0.998– 1.037) at Lag 0 to 1.014 (0.993 – 1.035) at Lag 7. Also, significantly positive associations of PM10,
NO2, and O3 were observed in Hanoi city. Conversely, before and during the lockdown, theseassociations were not observed in both cities.
CONCLUSIONS:In countries with high air pollution, they have already suffered in health effects fromair pollution. In addition, air pollution would elevate the risks of COVID-19 incidents. The public healthinterventions such as establishing warning systems for air pollution on COVID-19 should beconsidered.

Keywords: Air pollution, COVID-19, VIETNAM 2021

EP-051[Air pollution » Particulate matter]

The Interaction Between Extreme Temperatureand PM2.5 on Mortality in Nine U.S. States
Edgar Castro, James Healy, Abbie Liu, Yaguang Wei, Anna Kosheleva, Joel Schwartz
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA

BACKGROUND AND AIM:Previous studies have shown modification of the effect of PM2.5 on all-cause
mortality by ambient temperature, but findings have been conflicted and few studies have looked
specifically at extreme temperatures (especially extreme cold). We aimed to estimate the interaction
between co-exposures to both PM2.5 and temperature extremes.
METHOD:We conducted a case-crossover study with bidirectional control sampling. We used
4,644,810 adult, non-accidental mortality records obtained from the departments of public health of 9
U.S. states, PM2.5 data from a 1-km exposure model, and temperature and relative humidity from the
1-km Daymet and 4-km gridMET surface weather models, respectively. We looked at same-day up to
the 8-day moving average of PM2.5. Extreme heat was defined as days where the minimum
temperature in a given Census tract in a given year was greater than the 99th percentile of minimum
temperature in that tract in that year. We used a similar definition for extreme cold, focusing on the
1st percentile of maximum temperature instead. We modeled the modification with an interaction
term and controlled for relative humidity. Less stringent definitions of extreme temperature were also
explored.
RESULTS:We found significant modification of effect of PM2.5 on mortality by extreme temperature.
This finding was consistent across both extremes of temperature at various cutoffs and also acrossdifferent moving averages of PM2.5. We observed the largest interactions for same-day PM2.5, withinteraction odds ratios of 1.0018 (95% CI: 1.0015, 1.0021) for both extreme heat and extreme coldfor each 5 μg m-3 increase in PM2.5. We observed the smallest interactions with the 3-day moving
average of PM2.5, with interaction odds ratios of 1.0014 (95% CI: 10011, 1.0017).
CONCLUSIONS:Exposure to extreme temperature significantly worsens the effect of PM2.5 onmortality. This finding was robust across our sensitivity analyses.

Keywords: Air pollution, climate, mortality, short-term exposureEP-052[Air pollution » Particle components]

Fine-scale Disparities in Exposure to Particulate
Matter Components in U.S. Urban Areas
Edgar Castro1, Heresh Amini2, Falco Bargagli Stoffi3, Francesca Dominici3, Joel Schwartz1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt Sinai, New

York, USA
3Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA

BACKGROUND AND AIM:Extensive work has shown that communities of color are exposed to more air
pollution than their White counterparts. However, these studies have largely used coarse measures of
air pollution and demographics, smoothing over finer-scale heterogeneities in both. Additionally, few
studies have looked at how these disparities have changed over time or at particulate mattercomponents specifically. We aimed to address these gaps by assessing particle component exposure
disparities at the Census block level over three decades in urban areas across the U.S.
METHOD:We merged the ambient concentrations of 15 different components of PM2.5 in urban areasfrom a 50-m exposure model with block-level demographic data, block group- and tract-levelsocioeconomic data, and the nearest combined statistical area (CSA) centroid from the U.S. Census
Bureau, resulting in about 4 million records per decade. We fit linear mixed effects models for eachcomponent for each decade to model how ambient concentrations varied with area-level demographics
and socioeconomics over time. We used spatiotemporally-defined clusters to account for similarities
between neighborhoods that were planned and built in the same area and time period. We additionally
included fixed effects for each CSA to account for regional differences in demographics and pollution
and conducted stratified analyses to investigate how the relationships changed by Census region.
RESULTS:We found that communities of color, especially Black and Native communities, tended to be
exposed more to particle components, though the relationships differ by component. Our stratified
analyses additionally indicated that these disparities differ by region. We found that disparities havebeen decreasing over time but are still present.
CONCLUSIONS:Our findings indicate that efforts to reduce disparities in exposure to air pollution in
the U.S. have made much progress, but disparities still persist to varying degrees across the country.

Keywords: Air pollution, big data, environmental disparities, environmental justiceEP-053[Exposure assessment methods » Exposure assessment-general]

Childhood lead exposure and source
investigation in Patna, Bihar, India: Building
deeper understanding through international
collaboration
Emily Nash1, Mary Jean Brown2, Purvi Patel3
1Pure Earth, New York, New York, USA
2Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston,

Massachusetts, USA
3National Center for Disease Control India, New Delhi, India

BACKGROUND AND AIM:Despite the well-documented impacts of lead on children, exposure to thistoxic metal remains a pressing public health issue, particularly in LMICs. Ongoing research has
revealed varied sources of exposure across different regions of the world. One source of concern inIndia are lead-acid battery (LAB) manufacturing and recycling sites; ~90% of such sites assessed in
the Indian states of Bihar and Jharkhand were found to have elevated levels of lead in soil. However,following the remediation of one such site in the city of Patna, a consistent reduction in blood leadlevels among local children was not observed. Other potential sources had been reported in India, but
their relative contribution had not yet been characterized.
METHOD:An international consortium of US- and Indian-based organizations implemented a
representative, cross-sectional population-based cluster design survey, which evaluated the blood leadlevels (BLLs) and risk factors in 135 children <6 years old in areas considered to be impacted by LAB
operations and control areas.
RESULTS:Households in proximity to LAB operations were compared to households distal to these
operations. Overall, the geometric mean (GM) BLL was 11.6 μg/dL, with ~87% of children exceeding
the WHO's threshold value of 5 μg/dL. GM BLLs of children in proximal and distal households were notsignificantly different. Lead concentrations in certain environmental media (soil and dust) weresignificantly higher in proximal households whereas concentrations in spices and turmeric specificallywere higher in distal households.
CONCLUSIONS:The results demonstrate the complexity of exposure scenarios even within a single
city. The results raised new research questions into under-studied sources such as metal cookware.
This study has prompted new research into the extent of spice adulteration across North India, andthe prevalence of elevated blood leads across Bihar, the results of which are forthcoming.

Keywords: Heavy metals, children's environmental health, exposures, multi-media, international
collaboration

EP-054[Chemical exposures » Pesticides]

Persistent Organic Pesticides and Risk ofAmyotrophic Lateral Sclerosis among National
ALS Registry Cases and Matched Controls
Evelyn O Talbott1, Angela M Malek2, Vincent C. Arena1, Fan Wu1, Todd Bear1, John E Vena2, Jeanine
Buchanich1, Caroline A. Hoffman1, Judith R Rager1
1University of Pittsburgh, School of Public Health, Pittsburgh, USA
2Medical University of South Carolina, Charleston, USA

BACKGROUND AND AIM:Neurotoxic chemicals including pesticides have been suggested in the etiology
of ALS. Studies have examined self-reported exposure to pesticides and risk of ALS; however, only
one study has considered serum levels of organochlorine pesticides (OCP) and risk of ALS. Our aim is
to examine the association of persistent OCP and ALS risk within a national sample of cases from theCenters for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry(CDC/ATSDR) National ALS Registry.
METHOD:CDC identified 280 ALS cases through their Registry and Biorepository between 2013 and2018 with survey and serum OCP with analyses performed by SGS AXYS Analytical Services Ltd(British Columbia). University of Pittsburgh received data and identified age, sex, and county-matched
controls with survey data and serum samples (N=243), measured for concentrations of 29 OCP.
Conditional logistic regression with adjustment for covariates was conducted to consider associations
between ALS risk and serum OCP levels in cases and controls.
RESULTS:Six of the OCPS with Level of Detection (LOD) ≥70% were: 4,4’-DDE, hexachlorobenzene,trans-Nonachlor, β-Endosulfan, α-Endosulfan and oxychlordane. Conditional logistic regression
controlling for smoking and education revealed α-Endosulfan and oxychlordane revealed increased riskof ALS: OR=1.04 (95%CI:1.02-1.06) and OR-1.02 (95%CI:1.00-1.04). Of nine additional OCPs ≤50% levels of detection, non-parametric analysis revealed Heptachlor significantly associated with ALS
risk (OR: 3.57,95%CI:1.5-8.5.) In the human body, chlordane impacts many areas, including thenervous system making it of particular interest to research investigating neurodegenerative diseases.
ALS risk (OR: 3.57,95% CI:1.5-8.5.)
CONCLUSIONS:Despite many OCPS were banned in 70's and 80's in the US, their use abroad and long
half-lives continue to exert possible neurotoxic health effects. β-endosulfan was not banned until 2016and heptachlor in the l988. In the human body, chlordane impacts many areas, including the nervous
system making it of particular interest to research investigating neurodegenerative diseases.

Keywords: pesticides, neurodegenerative outcomes, risk assessment

EP-055[Air pollution » Particulate matter]

Association between ambience fine particulatematter (PM10) and Skin brown Spots in Taipei
City Community
Fu Yu Chanskin health promotion research center, UNIYU Biotech Co., LTD

BACKGROUND AND AIM:There have been few epidemiological studies exploring the association
between environmental exposures and skin health in the past. As a result, the evaluation of cosmetic
efficacy and skin health risk assessment has relied heavily on toxicological data. However, a new law,
the Product Information File of Cosmetic Hygiene and Safety Act, will come into effect on July 1, 2024.
This law prohibits the use of animal test data and clinical trial data for cosmetic safety and efficacy
assessment. Therefore, this study aims to investigate the relevance of environmental exposures toskin health, which will be useful for cosmetic safety and efficacy assessment.
METHOD:Between 2018 and 2019, we recruited 456 participants in Taipei's communities (as the urbanarea), The participants were residents aged 20 to 70 years who had lived in Taipei City for more than
1 year and had no communicable diseases. The skin brown spots were measured by the VISIA 7
Imaging System device (Canfield, NJ, USA) and facial image analysis software. We estimated the levelof outdoor PM10 exposure based on participants' residential addresses by using Land Use Regression
model to estimate PM10 concentrations. We also collected information on covariates by selfadministered questionnaires. Finally, we conducted linear regression models to examine theassociation between air pollutants exposure and skin brown spots.
RESULTS:A positive and statistically significant association between PM10 exposure and skin brownspots was identified. The risk of skin brown spots increased with the score of exposure to PM10 over 1
year in Taipei community (Zscore b=1.01, 95% CI: 0.19−1.81).
CONCLUSIONS:Higher exposure to (PM10) is associated with a higher risk of skin brown Spots.

Keywords: PM10, Skin brown Spots, Skin exposureEP-056[Air pollution » Long-term exposure]

Association of long-term exposure to air
pollutants mixture and incident cardiovasculardisease in a highly polluted region of China
Fuyuan Wen1, Bingxiao Li1, Han Cao2, Pandi Li1, Yunyi Xie1, Fengxu Zhang1, Yuan Sun1, Ling Zhang1
1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University,

and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
2Department of Biostatistics, Peking University First Hospital, Beijing, China

BACKGROUND AND AIM:Despite growing evidence that links long-term air pollution exposure to
cardiovascular disease (CVD), the combined effects of air pollutants and particulate matter with anaerodynamic diameter of less than 2.5 µm (PM₂.₅) have not been studied well. The aim of this study
was to assess the association of long-term air pollutants with incident CVD and the combined effect of
the air pollutants mixture.
METHOD:A prospective cohort study was performed based on the cohort study on CHronic disease of
the Community Natural population in the Beijing-Tianjin-Hebei region (CHCN-BTH). In all, 26,851
adults were included. Three-year residential exposure to air pollutants (PM2.5, O₃, PM10, PM1, NO₂,
SO₂ and CO) and PM₂.₅ components [black carbon (BC), NH₄⁺, SO₄²⁻, NO₃⁻and organic matter (OM)]
were calculated based on well-validated models. Proportional hazards models and quantile gComputation were applied to assess the association of air pollutants and pollutant mixture with CVD,
respectively.
RESULTS:During the 56,090 person-years follow-up, 629 participants reported incident CVD. Adjusted
hazard ratios (95% confidence intervals) of CVD per interquartile range increase in O₃, PM₂.₅, PM1,
NO₂, BC, and OM concentrations were 4.521 (2.612, 7.825), 2.394 (1.830, 3.133), 2.372 (1.195,
4.705), 1.363 (1.189, 1.563), 3.836 (2.381, 6.182), and 3.066 (2.007, 4.686), respectively. In multipollutant models, the combined effect of air pollutant mixture on CVD was 2.366 (2.298, 2.436).
PM2.5 and O₃ contributed 54.3% and 44.5% of the combined effect of the air pollutant mixture,
respectively. After using PM2.5 components instead of PM₂.₅ as part of the mixture, OM drove 55.2%of the combined effect.
CONCLUSIONS:The findings indicated associations of air pollutant mixtures with CVD incidence. PM₂.₅(especially OM) and O₃ might strongly contribute to air pollutant mixtures that lead to incident CVD.

Keywords: Long-term exposure, Ozone, Particulate matter, Mixtures, Cardiovascular diseases

EP-057[Air pollution » Long-term exposure]

Joint and mediation effects of ambient air
pollutants and PM2.5 components on renal
function in China
Fuyuan Wen1, Yunyi Xie1, Bingxiao Li1, Pandi Li1, Han Qi2, Fengxu Zhang1, Yuan Sun1, Ling Zhang1
1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University,

and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
2Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University,

and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China & The National ClinicalResearch Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding
Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University,
Beijing, China.

BACKGROUND AND AIM:While growing evidence links long-term air pollution exposure with chronic
kidney disease (CKD), combined effects of pollutants mixture and multiple mediation effects ofmetabolic risk factors were rarely discussed. The study aimed to evaluate the combined effects ofpollutants mixture and multiple mediation effects of metabolic risk factors on CKD progression.
METHOD:We included 8,996 baseline CKD-free adults from the CHCN-BTH cohort study during 20172021. Three-year individual air pollutants exposure [particulate matter ≤ 2.5μm (PM₂.₅), PM10, PM1,
ozone (O₃), nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and carbon monoxide (CO)] and PM₂.₅
components [black carbon (BC), ammonium (NH₄⁺), nitrate (NO₃⁻), sulfate (SO₄²⁻) and organic
matter (OM)] were assessed using well-validated methods. Generalized linear mixed models wereapplied to examine the associations between air pollutants and CKD progression. Quantile gComputation was used to assess the combined effects of air pollutant mixtures. Causal mediation
analysis and Bayesian mediation analysis were employed to estimate the univariate and multivariate
mediation effects of metabolic risk factors.
RESULTS:During the follow-up, 399 participants had an incident of CKD progression. Interquartile
range (IQR) increases in BC [OR: 1.010 (95%CI: 1.008–1.012)], SO₄²⁻ [1.024 (1.019–1.029)] andOM [1.028 (1.023–1.033)] were robustly associated with incident CKD progression, while a protective
effect was observed for O₃ [0.965 (0.957–0.974)]. Incident CKD progression was associated with
PM₂.₅ components mixture [BC, SO₄²⁻ and OM, 1.023 (1.017–1.29)]. Univariate mediation analysis
showed that high-density lipoprotein (HDL) mediated 13.9% and 14.1% effects of O₃ and SO₄²⁻.
Fasting plasma glucose (FPG) also showed minor mediation effects of O₃, BC, SO₄²⁻ and OM (range:
2.142–3.459%). However, none of these mediation effects remained significant in Bayesian mediation
analysis.
CONCLUSIONS:The findings indicated the effect of PM₂.₅ component mixtures on CKD progression.
Metabolic risk factors might not mediate the effects of air pollutants. Further study is warranted toclarify the potential mechanism involved.

Keywords: Particulate matter, Long-term exposure, Other (chronic kidney disease), Mixtures, Other(Bayesian mediation analysis)

EP-059[Outcomes » Other (to be specified with keywords in the keywords section)]

Prevalence and factors associated with chronic
kidney disease in diabetic and hypertensive
patients
Ualison Oliveira Pontes1, Thatiana Lameira Maciel Amaral2, Cledir De Araújo Amaral3, Gina Torres
Rego Monteiro4
1Sesacre, Rio Branco, Acre
2Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Rio Branco, Brasil
3Instituto Federal do Acre, Rio Branco, Brasil
4Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, Brasil

BACKGROUND AND AIM:Chronic kidney disease (CKD) is a serious public health problem worldwide. It
is often asymptomatic in the early stages, making early diagnosis difficult. Some people are more
susceptible to developing CKD, including hypertensive and diabetic patients. In this context, theobjective of this study is to assess the prevalence and factors associated with CKD in diabetic andhypertensive patients.
METHOD:This is a survey carried out with 672 hypertensive patients and 324 diabetics, registered in
the Family Health Strategies (ESF), in the urban area of Rio Branco, Acre, in 2019. Chronic kidneydisease was defined by GFR < 60 ml/1.72m², estimated from the Chronic Kidney Disease
Epidemiology Collaboration (CKD-EPI) formula, and the presence of albuminuria > 29 mg/g. Bivariate
analyzes and logistic regression models were performed, with a significance level of 5%.
RESULTS:The prevalence of CKD in hypertensive patients was 27.3% and 40.0% in diabetics. In thelogistic regression, a statistically significant association was observed in hypertensive patients
between CKD and illiterate individuals (OR = 1.87; 95%CI 1.14; 3.07), with uncontrolled hypertension(OR = 2.38; 95%CI 1.45; 3.94) and sedentary (OR = 1.63; 95%CI 1.02; 2.60). In diabetics, thevariables evaluated lost statistical significance after adjustment.
CONCLUSIONS:The high prevalence of CKD among hypertensive and diabetic patients should be acause for concern due to the impact on quality of life and mortality. Important factors must be
addressed, such as controlling morbidities and changing unhealthy habits.
Funding: Research Support Foundation of the State of Acre (FAPAC), PPSUS – Agreement No.
837567/2016, Process No. 6068-18-0000299, Grant Term No. 032/2018.

Keywords: Cardiovascular diseases, Outcomes, Epidemiology.

EP-060[Cancer and cancer-precursors » Incidence]

Exposure to pesticides and breast cancer in thecity of Petrópolis, Brazil
Louise Moura Rezende De Carvalho, Sabrina Da Silva Santos, Gina Torres Rego Monteiro
National School of Public Health (ENSP, Escola Nacional de Saúde Pública), Rio de Janeiro – RJ, Brazil.

BACKGROUND AND AIM:Breast cancer is a public health issue worldwide and a disease which requires
prevention and control owing to its high rates of incidence and mortality, and most cases of cancer areassociated with environmental exposure, including pesticides. Since 2008, Brazil has ranked as one of
the largest users of pesticides worldwide and the city of Petropolis is a main agricultural center.
Against this background, the objective of the present study was to investigate the association between
self-reported pesticide exposure and female breast cancer, according to risk factors related to
exposure to estrogen, in women hospitalized in the city of Petropolis, a city where this relationship has
not previously been investigated.
METHOD:A hospital-based case-control study was conducted in Petrópolis city, Brazil. The study data
were obtained through interviews, and the magnitude of the association between self-reported
pesticide exposure and breast cancer was determined using unconditional logistic regression.
RESULTS:A higher estimated risk for breast cancer was found in women exposed to pesticides for 10
or more years, where this association was not statistically significant after adjusting for potential
confounders (OR = 1.40; 95% CI 0.85 – 2.49). A positive statistically significant association was
found between breast cancer and higher educational level or previous use of hormone replacement
therapy (HRT), whereas having had 2 or more pregnancies to term proved a protective factor.
CONCLUSIONS:Further studies elucidating the contribution of pesticide exposure to the developmentof breast cancer are needed, given that current findings in the literature are conflicting.

Keywords: Chemical exposures, Pesticides, Cancer and cancer precursors, Environmental
epidemiology, Female.

EP-061[Air pollution » Particulate matter]

Particulate matter characterization frombiomass-fuel usage in rural South Indian
kitchens
Gopika Indu, Shiva Nagendra S M
Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, India

BACKGROUND AND AIM:The most significant source of indoor air pollution (IAP) in rural areas remains
using unclean fuels like solid biomass for cooking activities. It releases high concentrations of air
pollutants, specifically particulate matter (PM), into the indoor air. Therefore, burning such fuels in
enclosed spaces such as small household kitchens is a major risk factor for aggravation of respiratory
diseases like chronic obstructive pulmonary disease (COPD). To understand this in detail, a monitoring
campaign was carried out in selected houses from Mysuru, Karnataka.
METHOD:Continuous real-time measurement of PM was carried out to understand its diurnal
variations. The houses were chosen to include varied cookstoves (traditional and improved) andkitchen (separate and open) configurations as well as with and without COPD patients. PM samples
were also collected from the kitchen microenvironments to study the personal exposure of the cooks.
The collected samples underwent morphological and chemical analyses to characterize themmethodically.
RESULTS:The results showed that indoor separate kitchens had 3.5 times higher PM concentrations
than open kitchens. Similarly, kitchens using improved cookstoves showed pollutant concentrations up
to 1.8 times lower than the traditional mud or concrete cookstoves commonly used in rural areas.
Cooking activities released 10-20 times higher PM concentrations. Physico-chemical characterization of
the PM samples showed higher levels of carbon, heavy metals, and toxic compounds in houses with
COPD patients.
CONCLUSIONS:Cooking using solid biomass fuels remains the central issue in rural India. The study
compares PM exposures from different cookstoves and kitchen settings as well as between houses
with and without COPD patients. The PM concentrations and analyses reveal that separate kitchensusing traditional cookstoves with biomass fuels are the worst-case scenario. These kitchen andcookstove setups must be improvised, considering exposure and the likelihood of future health issues.

Keywords: Particle components, Exposure assessment, Heavy metals, Respiratory outcomesEP-062[Exposures » Other (to be specified with keywords in the keywords section)]

Association between arsenic exposure andincidence metabolic syndrome in older Chinese
population
Haiyan Jiang1, Simei Zhang1, Yaoyao Lin1, Lin Meng1, Fanjia Guo2, Mingjuan Jin2, Jianbing Wang3,
Mengling Tang1, Kun Chen2
1Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine,

Hangzhou, China
2Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine,

Hangzhou, China
3Department of Public Health, National Clinical Research Center for Child Health of Children’s Hospital,

Zhejiang University School of Medicine, Hangzhou, China

BACKGROUND AND AIM:Growing evidences showed that heavy metals exposure may be associatedwith metabolic diseases. Nevertheless, the relationship between arsenic (As) exposure and metabolic
syndrome (MetS) in older adults is still uncertain and the underlying mechanism of its association
remains unclear. We aimed to prospectively investigate the associations of blood As exposure and its
co-exposure to other metals with incident MetS.
METHOD:The study participants included people aged 65 and above among the Yiwu Elderly Cohort.
The whole blood levels of As as well as other 13 metals were measured using the inductively coupledplasma mass spectrometry (ICP-MS) at baseline. MetS events were defined according to the criteria of
the International Diabetes Federation (IDF). Linear regression and multivariable logistic regression
models were applied to estimate the association of As with MetS. The Bayesian kernel machine
regression (BKMR) was used to explore the association of metal interactions with MetS.
RESULTS:We found a dose-dependent negative association between As and the incidence of MetS in
the restricted cubic spline curve. In the fully adjusted model, for each increase in IQR concentration ofAs, the risk of MetS increased 1.4-fold. In the logistic model, compared with the lowest quartile of As,
the highest quartile group significantly increased the risk of MetS after adjusting for potential
confounders. In the BKMR model, As was considered to be most likely associated with MetS (PIP >0.5) and we found the negative association between As and MetS risk was stronger at higher level ofiron (Fe).
CONCLUSIONS:Higher blood As was remarkably associated with the elevated incidence of MetS in
elderly Chinese population. Potential interaction effects of As and Fe on MetS may exist. Thesefindings suggested future studies should further confirm the potential role of As in MetS.

Keywords: arsenic, metabolic syndrome, iron, BKMR analysis

EP-063[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Source and health risk of antibiotic exposure of
Tibetan pregnant women in China: A
biomonitoring-based study
Yuanping Wang1, Yue Chen2, Yangzong Gesang1, Zichen Yang1, Yi Wang1, Ke Zhao1, Minghui Han1,
Chunxia Li3, Luobu Ouzhu4, Jiwei Wang1, Hexing Wang1, Qingwu Jiang1
1Key Laboratory of Public Health Safety of Ministry of Education/School of Public Health, Fudan

University, Shanghai, China
2School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario,

Canada3Obstetrics and Gynecology Department, Fukang Hospital, Affiliated Hospital of Tibet University,

Lhasa, Tibet, China
4Administrative Department, Fukang Hospital, Affiliated Hospital of Tibet University, Lhasa, Tibet,

China

BACKGROUND AND AIM:Tibetan people are one Chinese ethnic minority living in Qinghai-Tibet Plateau
with an average altitude of more than 4,500 meters. High altitude could cause a different antibiotic
exposure in terms of source and health risk, but relevant information is limited in Tibetan people.
METHOD:We investigated 476 Tibetan pregnant women in Lhasa, Tibet in 2021 and measured 30
antibiotics from five categories in urine, including 13 veterinary antibiotics (VAs), five humanantibiotics (HAs), and 12 human/veterinary antibiotics (H/VAs). Food consumption was investigated bya brief food frequency questionnaire. Health risk was assessed by hazard quotient (HQ) and hazard
index (HI) based on acceptable daily intakes (ADIs).
RESULTS:All antibiotics were overall detected in 34.7% of urine samples with the 75th percentile
concentration of 0.19 ng/mL (0.35 ug/g creatinine). HAs, VAs, and H/VAs were respectively detected
in 5.3%, 13.0%, and 25.0% of urine samples, with the 95th percentiles of 0.01 ng/mL (0.01 ug/g
creatinine), 0.50 ng/mL (0.99 ug/g creatinine), and 3.58 ng/mL (5.02 ug/g creatinine), respectively.
Maternal age, smoking of family members, and housework time were associated with detection
frequencies of HAs, VAs, or sum of all antibiotics. Pregnant women with a more frequent consumptionof fresh milk, egg, yoghourt, poultry meat, and fish had a higher detection frequency of VAs or H/VAs.
Only ciprofloxacin and tetracycline had a HQ of larger than one based on microbiological effect in
1.26% and 0.21% of pregnant women, respectively and a HI of larger than one was found in 1.47% ofpregnant women.
CONCLUSIONS:An evident antibiotic exposure from various sources was seen in Tibetan pregnant
women with some basic characteristics of pregnant women as potential predictors. Several animalderived food items were important sources of exposure to antibiotic with a fraction of pregnant womenin the health risk related to microbiological disruption of gut microbiota.

Keywords: Pharmaceuticals, Long-term exposure, Risk assessment, Pregnancy outcomesEP-064[Air pollution » Other (to be specified with keywords in the keywords section)]

Characteristics of bioaerosols in kindergarten
classrooms in Miaoli City
Hsin Hsiu Chen1, Tser Sheng Lin1, Chung Saint Lin2, Hsueh Fen Hung3
1Department of Safety, Health and Environmental Engineering, National United University, Miaoli,

Taiwan2Department of Food Science, Yuanpei University of Medical Technology, Hsinchu, Taiwan
3Department of Environmental Engineering and Health, Yuanpei University of Medical Technology,

Hsinchu, Taiwan

BACKGROUND AND AIM:Preschool children have spent probably 90% of their time indoor, thus theindoor air quality would crucially affect their health. Notably, some may spend more than 10 hours per
day in kindergarten in Taiwan due to their parents’ work pattern. Airborne bioaerosol (i.e. bacterium,
fugus) poses a high health risk for children; thus, this study aimed to investigate the airborne aerosol
in kindergarten and its potential controlling factors.
METHOD:This study utilized Anderson bioaerosol samplers to collect samples at a flow rate of 28.3
L/min for 5~10 minutes during March, 2021 to December 2022 in kindergartens located in Miaoli. In
addition, we also used simple commercialized indoor air quality (IAQ) sensors to collect some indoor
pollutants’ levels in order to estimate possible IAQ. The dominate bacteria were also identified.
RESULTS:The results indicated that the level of fugus was higher than that of bacterium in the indoor
environment; in addition, the predominant bacteria were Gram-positive bacterium. The concentrationsof fugus, total bacterium, Gram-positive bacterium, in summer were 1415 CFU/m³, 582 CFU/m³, 594
CFU/m³, respectively. The level of bacterium was associated with the level of CO₂ (p =0.034, r =0.335), whereas the level of fugus was associated with relative humidity (p =0.003, r = 0.457) andCO₂ (p =0.028, r = 0.353). The dominant bacteria were Staphylococcus spp. and Micrococcus spp.. If
U.V. or ozone was applied to inhibit the growth (or to diminish) the indoor levels of bacterium andfugus, we found the inactivation efficiencies were 72.4%, 75.6% for bacterium and 85.4%, 66.9% forfugus, respectively.
CONCLUSIONS:The application of U.V. or ozone would significantly inactivate indoor airborne
bacterium (Staphylococcus spp. and Micrococcus spp.) and fugus, therefore, can improve the IAQ for
kindergarten in terms of bioaerosol and prevent preschool children from potential health risk.

Keywords: Children's environmental health, Microbes

EP-065[Chemical exposures » Phthalates]

Association between phthalate exposure andsleep quality: results from a nationwide analysis
of pregnant women
Hwan Cheol Kim, Dirga Kumar Lamichhane
Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon,
South Korea

BACKGROUND AND AIM:Evidence linking environmental toxicants to sleep quality is growing, butthese associations during pregnancy remain unclear. In the present study, we examined association
between phthalate exposure and sleep quality among pregnant women using repeated exposure
measurements.
METHOD:Spot urine samples collected from a nationwide sample of 2,324 pregnant women at two
time points during pregnancy were analyzed for exposure biomarkers of eight phthalate metabolites.
We investigated associations between summary and individual phthalate metabolites and self-reported
sleep measures using generalized ordinal logistic regression and generalized estimating equations
models adjusted for age, body mass index, education, gestational age, income, physical activity,
smoking, occupation, chronic health condition, depression, and urinary cotinine level.
RESULTS:Multiple individual phthalates and summary measures of phthalate mixtures, including thephthalates from plastic sources (∑Plastic), di-(2-ethyhexyl) phthalate (∑DEHP), anti-androgenic
phthalates (∑AA), and all phthalate metabolites (∑Phthalates), were associated with lower sleep
efficiency. To illustrate, every 1-unit log increase in ∑AA was associated with a reduction of sleep
efficiency by 1.26% (95% confidence interval [CI]: –2.30, –0.21; q < 0.05). ∑AA and ∑Phthalates
were associated with shorter sleep duration and longer sleep latency. Associations between ∑DEHP
and ∑Plastic and sleep efficiency differed by urinary cotinine level (p-interaction < 0.01).
CONCLUSIONS:Results indicate that higher phthalate exposure may be related to low sleep efficiency,
short sleep duration, and prolonged sleep latency during pregnancy.

Keywords: Sleep, phthalates, Pittsburgh Sleep Quality Index, pregnant women

EP-066[Air pollution » Particulate matter]

Ambient particulate matter and surrounding
greenness in relation to sleep quality among
pregnant women: A nationwide cohort study
Hwan Cheol Kim, Dirga Kumar Lamichhane
Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon,
South Korea

BACKGROUND AND AIM:Both particulate air pollution and residential greenness have been shown to
be associated with sleep quality in the general population, but its influence on maternal sleep quality
during pregnancy has not been assessed. This study aimed to explore the individual and interactive
effects of exposure to particulate matter (PM) air pollution and residential greenness on sleep quality
among pregnant women.
METHOD:We analyzed 4,876 pregnant women from the Korean Children’s Environmental HealthStudy. Prenatal sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Average
concentrations of PM (PM2.5 and PM10) during pregnancy were estimated through land use
regression, and residential greenness in a 1000 m buffer around participants’ residences wasestimated based on the Normalized Difference Vegetation Index (NDVI1000-m). We used modified
Poisson regression models to estimate the effects of NDVI, PM, and their interaction on poor sleep
quality (PSQI > 5), adjusted for a range of covariates.
RESULTS:After adjustment for confounders, each 10 µg/m3 increase in PM2.5 and PM10 exposure wasassociated with higher risks of poor sleep quality (Relative Risk (RR) 1.06, 95% confidence interval(CI): 1.02, 1.11; RR 1.08 (95% CI: 1.05, 1.12), respectively), each 0.1-unit decrease in NDVI1000-m
was associated with a higher risk of poor sleep quality (RR 1.03, 95% CI: 1.01, 1.05), and theinteraction term between PM2.5 and NDVI1000-m was 1.06 (95% CI: 1.01, 1.11) with a p-value of0.010. Associations of PM with poor sleep quality differed by depressive symptoms.
CONCLUSIONS:Our study showed that exposure to PM was associated with an increased risk of poor
sleep quality, whereas residing in greener areas was associated with a lower risk of poor sleep among
pregnant women. This suggests that green space planning and air pollution control can jointly improve
the quality of sleep.

Keywords: Environment, particulate matter, pregnancy, residential greenness, sleep quality

EP-067[Chemical exposures » Mixtures]

Health effects from Hebei Spirit oil spill using
Environmental Risk Score for Oxidative Stress in
Korean residents: A HEROS study
Hyuna Jang1, Yong Min Cho3, Sang Yong Eom4, Su Ryeon Noh5, Hae Kwan Cheong6, Mina Ha2,
Myung Sook Park7, Kyung Hwa Choi2
1Department of Statistics, Sookmyung Women’s University, Seoul, Republic of Korea
2Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of

Korea
3Institute of Environmental Health, Seokyeong University, Seoul, Republic of Korea
4Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju,

Korea
5Department of Public Health and Environment, Kosin University, Busan, Korea
6Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon,

Korea
7Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea

BACKGROUND AND AIM:The Hebei Spirit spilled crude oil in the Yellow Sea of Korea, December 2007.
Oil spills are complex exposure to environmental pollutants, including metals and polycyclic aromatichydrocarbons (PAHs), which can induce oxidative stress and associated with various diseases. This
study aims to evaluate the health effects of oxidative stress from oil spills using the environmental risk
score (ERS) to measure the multiple pollutants using repeated measured data.
METHOD:Our analysis included 618 participants from a prospective cohort data generated by the
Health Effect Research on Hebei Spirit Oil Spill study (HEROS), consisting of participants who
participated to cleanup activities or lived near the oil spill site from 2009 to 2014. We used four metals
in urine (Hg and Cd) and blood (Mn and Pb), and two urinary PAHs metabolites (2-naphthol and 1hydroxypyrene) to construct multiple pollutants. As oxidative stress markers, urinary 8-hydroxy-2'deoxyguanosine and Malondialdehyde were used. We derived ERS from nine statistical models: elastic
net models, adaptive elastic net models, weighted quantile sum regression, Bayesian weighted
quantile sum regression, Bayesian kernel machine regression, Bayesian additive regression tree, andsuper learner. To evaluate and compare the performance of ERS, we performed a logistic regression
model for the oxidative stress risk group, defined as having more than 95 percentiles value in general
population for each marker, and plotted 95% confidence ellipses of ERS.
RESULTS:Levels of oxidative stress markers were significantly different depending on clean-up
activities. The performance of ERS based on super learner (ERS-SL) was the best among the ninemodels. We confirmed the odds ratio from ERS-SL was more stable than using a single pollutant andthe oxidative stress risk group had higher levels of ERS-SL than the non-risk group.
CONCLUSIONS:This study highlights the health effect of oxidative stress associated with exposure to
multiple pollutants caused by oil spills using ERS.

Keywords: Multi-pollutant, Exposure assessment-biomarkers of exposure, Mixtures analysis,
Environmental epidemiology

EP-068[Cancer and cancer-precursors » Other (to be specified with keywords in the keywords section)]

Cancer familial history and clinical-environment
interaction on benign breast diseases risks
among Brazilian womenIlce Ferreira Da Silva1, Marla Presa Raulino Schilling2, Rafaela Soares Senra Da Costa2, VivianeFerreira Esteves3, Sergio Koifman4, Cecília Vianna De Andrade3, Rosalina Jorge Koifman1
1National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
2Graduate Program of Environmental Public Health, National School of Public Health Sergio Arouca,

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
3Fernandes Figueira National Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
4in memmoriam

BACKGROUND AND AIM:A better understanding of cancer familial history role in women with benign
breast diseases could guide breast cancer high-risk surveillance. AIM: To analyze the interaction
between a family history of cancer and clinical-environment factors on BBD risks.
METHOD:This is an interaction study using a case-only approach among 353 women with breast
biopsies from two reference-hospitals in Rio de Janeiro between 2013 and 2018. Participants wereclassified according to cancer familial history (none, all cancer; breast/ovary/prostate cancer;
breast/ovary cancer; and breast cancer only). Non-conditional logistic regression was used to estimate
crude and adjusted interaction OR between clinical-environmental factors and cancer familial history,
and respective 95% confidence interval (95%CI), according to the presence of proliferation, andatypia. We estimated correlations between the age of familial cancer at diagnosis and age at BBD
diagnosis, with 95% CI, using a linear regression model.
RESULTS:For proliferative lesions, significant interaction OR (iOR) between all cancer familial history
and age ≤ 50 years (iOR=2.29;CI95%:1.09-4.79), and 1st. Pregnancy>30yo (iOR=3.19:CI95% 1.0110); while age ≤50 years interacted with familial history of breast/ovary/prostate(iOR=3.42;CI95%:1.47-7.93), breast/ovary (iOR=3.39:CI95%1.23-9.32), and breast only(iOR=2.85;CI95%:1.02-7.95). Regarding the risk of BBD with atypia, age ≤ 50 years interacted withcancer familial history of any site (iOR=14.40;CI95%:2.29-90.6), breast/ovary/prostate(iOR=14.40;CI95%:2.29-90.6), breast/ovary (iOR=11.87;CI95%:1.19-118.5), breast only(iOR=11.87;CI95%:1.19-118.5). Mother/father’s age at diagnosis of any cancer(B=0.50;95%CI:0.01–0.55) was statistically associated with proliferative BBD age.
CONCLUSIONS:The risk of proliferative BBD increased with the interaction between all cancer familial
history and age ≤50 years, and 1st. Pregnancy>30yo; and between age ≤50 years with familial
cancer history of breast/ovary/prostate, breast/ovary, and breast only. BBD with atypia risk increased
with the interaction between age ≤50 years and cancer familial history of all sites,
breast/ovary/prostate, breast/ovary, and breast only. The older the mother and father cancer
diagnosis, the older proliferative BBD women are at diagnosis.

Keywords: breast cancer, cancer precursors, familial cancer history, case-only study, clinicalenvironment interaction

EP-069[Cancer and cancer-precursors » Incidence]

Stomach cancer incidence trends in selected
Latin America populations: age, period, andbirth-cohort effects
Ilce Ferreira Da Silva1, Thayana Calixto De Oliveira2, Anne Karin Da Mota Borges3
1National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
2Graduate Program of Environmental Public Health, National School of Public Health Sergio Arouca,

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
3Health Technology Management Coordination, National Health Agency, Rio de Janeiro, Brazil

BACKGROUND AND AIM:to explore the age, period, and birth-cohort effects on stomach cancer
incidence trends during 3 decades in selected Latin American populations.
METHOD:A time-trend study was performed using Cancer Incidence in Five Continents data from highquality population-based cancer registries (PBCRs) in Latin American countries. Crude and agestandardized incidence rates (ASRs) were calculated. Time trends in ASRs were assessed using the
average annual percentage change (AAPC). Age-period-cohort effects were estimated by Poisson
regression for individuals aged between 20 and 79 years with stomach cancer informed by PBCRs from1983 to 2012 in Cali (Colombia); from 1982 to 2011 in Costa Rica; and from 1988 to 2012 for Goiania(Brazil) and Quito (Ecuador). The goodness-of-fit model was tested using the deviance of the models.
RESULTS:Decreases in age-standardized incidence rates were observed for both genders in all
populations covered by PBCRs. Age affected the rates significantly in all areas, with curve slopes
reaching peaks in the older age groups. Increased trends were observed in recent cohorts for bothgenders in Cali, and among women in Quito. In Costa Rica and Goiania, decreasing trends wereobserved among recent cohorts for both genders. The period effect showed an increased ratio rate forboth genders in Costa Rica (1997-2001), and Goiania (2003-2007), while Quito (1998-2002)
presented a decrease.
CONCLUSIONS:Despite the decreasing gastric cancer trends in the past 30 years observed for bothgenders in all studied populations, positive cohort effects were seen for both genders in Cali, andamong women in Quito, while decreasing trends were observed in Goiania and Costa Rica for recent
cohorts. The economic market opening process may have led to changes in the risk factor exposuresover successive generations. These geographic and gender variations may reflect
cultural/ethnic/gender differences and differences in dietary and smoking rate patterns.

Keywords: gastric cancer incidence, trend analysis, age-period-cohort analysis, ecological study,
Latin-America

EP-070[Cancer and cancer-precursors » Other (to be specified with keywords in the keywords section)]

Gastric cancer cases in Brazil: Clinicalenvironment profile, prevalence and associatedfactors to treatment treatment
Ilce Ferreira Da Silva1, Thayana Calixto De Oliveira2, Anne Karin Da Mota Borges3
1National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
2Graduate Program of Environmental Public Health, National School of Public Health Sergio Arouca,

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
3Health Technology Management Coordination, National Health Agency, Rio de Janeiro, Brazil

BACKGROUND AND AIM:Characterize the clinical-environment profile of hospital-based gastric cancer
cases, estimate gastric cancer treatment-delays prevalence and associated factors in Brazil from 2007
to 2017.
METHOD:This is an exploratory study of hospital-based gastric cancer cases identified at Brazilian
Hospital-based Cancer Registries from 2007 to 2017. Cases were identified at the national SIS-HBCR
database, according to the State of residency. All public cancer hospitals report cancer cases regularly,
while private cancer hospitals only report spontaneously. Days from 1st specialist appointment todiagnosis, and from diagnosis to treatment were estimated and later categorized into <30/>30 daysand ≤60/>60 days, respectively. Treatment-delay prevalences were estimated according to State ofresidency, and clinical-environment factors. Associated factors were estimated by crude and adjusted
logistic regression, with respective 95% confidential interval(95%CI).
RESULTS:From 76.157 primary gastric cancer cases, 65% were male, 28.9% were aged 60-69, 14.6%
were illiterate, 48.7% were incomplete middle school, 62% had a partner, and 48.5% lived inSoutheastern Brazil. Surgery was the main treatment(51.1%), while 43.2% of cases were diagnosed
with stage-IV, 23% stage-III, 18.9% stage-II, and 14.9% stage-0/I. Median time for diagnosis was 11days. Among those with diagnosis without treatment, treatment-delay median was 63 days, 64 days
for surgery, 62 days for chemotherapy, and 76 days for radiotherapy. Treatment-delay prevalence
was 49%, and associated factors were age >40y/o(OR=1.42;95%CI:1.19-1.71), living insoutheastern (OR=2.20;95%CI:1.96–2.47), and northern (OR=3.52;95%CI:2.91–4.26), being
illiterate (OR=2.29;95%CI:1.70–3.08), having private health-service (OR=0.80;95%CI:0.70–0.90),
stage-0/IA (OR=2.16;95CI:1.79–2.61) and IB/IIIA (OR=1.44;95%CI:1.31–1.57), receiving
radiotherapy (OR=1.40;95%CI:1.16–1.69), and chemotherapy (OR=1.13;95%CI:1.03–1.25).
CONCLUSIONS:In Brazil, hospital-based gastric cancer cases are mostly men, aged 60+, low
educated, with advanced stages. Treatment-delays were over 50% for those with a diagnosis without
treatment. Age >40y/o, living in southeastern and northern, being illiterate, having health secure,stage-0/IA and IB/IIIA, radiotherapy, and chemotherapy were independently associated withtreatment-delay.

Keywords: gastric cancer, cancer treatment delays, Socio-economic factors, environmental
disparities, epidemiology

EP-071[Chemical exposures » Pesticides]

Associations between agrichemical mixturesand childhood cancer in Nebraska counties- a
Generalized Weighted Quantile Sum Regression
based approach
Jabeen Taiba1, Cheryl Beseler1, Shannon Bartelt Hunt2, Muhammad Zahid1, Alan Kolok3, Eleanor
Rogan1
1Department of Environmental, Agricultural & Occupational Health, University of Nebraska Medical

Center, Omaha, United States
2Department of Civil and Environmental Engineering, University of Nebraska - Lincoln, Lincoln, UnitedStates3Department of Fish and Wildlife, University of Idaho, Moscow, United States

BACKGROUND AND AIM:Human exposure to agrichemical mixtures occurs frequently in agriculturally
dominant US states, including Nebraska. Nebraska's age-adjusted incidence rates (AAR) for childhood
cancers are among the highest in the US. Previous studies indicated associations between
agrichemical exposures (atrazine and nitrates) and pediatric cancer rate, assuming single pollutant
exposure with conventional statistical models. OBJECTIVES: To evaluate the joint association between
agrichemical mixtures exposure and pediatric cancer. Additionally, to identify chemicals of concern
while adjusting for social vulnerability factors.
METHOD:Agrichemical exposures at a county scale were quantified using USGS Pesticide National
Synthesis Project for Nebraska's most frequently applied pesticides from 1992 to 2014. Outcomes
were quantified using pediatric cancer diagnosed among children < 20 years of age (1992-2014) fromthe Nebraska cancer registry. We adjusted for social vulnerability factors such as race, income,
employment, and access to care, obtained from the American Community Survey 5-Year estimates.
The associations between 30 agrichemicals frequently applied in Nebraska, and pediatric cancer(including sub-types) at a county scale were assessed using the Generalized Weighted Quantile Sum
Regression (gWQS) model. The joint association model was fit assuming a Poisson distribution andusing pediatric population as an offset-term and a-priori-based social vulnerability factors ascovariates. Furthermore, we included repeated holdout validation to identify variance in our effectestimates.
RESULTS:We observed a statistically significant positive association between the 30 agrichemicals andpediatric cancer. These associations were not limited to overall cancers but also to Central Nervous
System tumors (CNS) and leukemia. The strength of associations was stronger among CNS cancers(β=0.36, CI = 0.14, 0.57) compared to overall cancer (β=0.30, CI = 0.16, 0.44) and leukemia(β=0.23, CI =0.09, 0.38). The insecticide Tefluthrin and herbicide Quizalofop contributed higher
weights to the joint association between exposure mixture and overall cancer.
CONCLUSIONS:These findings may explain the agrichemical mixture effects on childhood cancer

Keywords: chemical exposures, mixtures, pesticides, socio-economic factors, cancer

EP-072[Air pollution » Particulate matter]

Personal breathing zone concentrations of
PM2.5 among workers in different occupationalgroups at a brick kiln in Nepal
James D. Johnston1, John D. Beard1, James D. Lecheminant1, Neil E. Peterson1, Paul R. Reynolds1,
Juan A. Arroyo1, Andrew J. South1, Clifton B. Farnsworth1, Nathaniel Baxter2, Garrett Braiden1,
Gerardo Fong1, Taylor Heath1, Lindsey Layton1, James Lu1, Alisandra Olivares1, Marli Shaw1, Mariah
Taylor1, Matthew Tibbitts1, Scott C. Collingwood2
1Brigham Young University, Provo, United States of America
2University of Utah, Salt Lake City, United States of America

BACKGROUND AND AIM:Chronic obstructive pulmonary disease (COPD) is the third leading cause ofdeath globally. Brick workers in Nepal are uniquely vulnerable to developing COPD. Understanding
brick workers’ total aerosol exposures is complicated due to multiple contributing sources, including
brick kiln smoke, ambient air pollution, brick dust, and household air pollution. The objective of thisstudy was to use 24-hr breathing zone (PBZ) monitoring to characterize particulate matter less than
2.5 µm (PM2.5) exposures among brick workers across work and living microenvironments.
METHOD:In this observational, cross-sectional study, adult Nepalese brick workers (N = 48) were
sampled from five occupational groups (administration, firemaster, green brick hand molder, green
brick machine molder, top loader) at a single brick kiln in Bhaktapur, Nepal, in March 2023. PBZ
samples were collected for approximately 24 hours using RTI MicroPEMs, a miniaturized, wearable
aerosol monitor that allows for sampling of PM2.5 aerosols using both gravimetric (filter-based) andnephelometer-based (datalogged) readings. Linear regression models were used to calculate
geometric mean (GM) PM2.5 concentrations and determine whether GM PM2.5 concentrations differedby occupational group.
RESULTS:The overall GM PM2.5 concentration in the PBZ of the brick workers was 74.90 µg/m3 (95%
confidence interval [CI]: 58.85, 95.34). GM PM2.5 concentrations were significantly different (p =0.0002) among workers in the five occupational groups with administration having the lowest
concentrations (GM: 20.96 µg/m3; 95% CI: 11.51, 38.17) and green brick hand molders having thehighest concentrations (GM: 115.14 µg/m3; 95% CI: 82.35, 160.99).
CONCLUSIONS:This study improves on previous studies of brick workers in Nepal by using a larger
sample size, using PBZ sampling, and including workers in administration and top loading. Although all
five occupational groups had GM PM2.5 concentrations above the World Health Organization’s
recommendations, non-administration occupational groups had particularly high concentrations andshould be targeted for interventions.

Keywords: air pollution, particulate matter

EP-073[Cancer and cancer-precursors » Incidence]

Ambient fine particulate matter exposure andrisk of non-Hodgkin lymphoma in the NIH-AARP
Diet and Health Study
Jared A Fisher, Xiuqi Ma, Linda M Liao, Joel D Kaufman, Debra T Silverman, Rena R Jones
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD, USA

BACKGROUND AND AIM:Particulate and dust exposure has been associated with non-Hodgkin
lymphoma (NHL) in occupational settings, but studies of ambient PM2.5 are scarce. We aimed toinvestigate this association for the first time by histologic subtype.
METHOD:We estimated outdoor PM2.5 concentrations at the residential enrollment (1995-1996)
address for 451,202 participants of the NIH-AARP Diet and Health Study, a cohort located in 6 states(California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and 2 metropolitan
areas (Atlanta, Georgia, and Detroit, Michigan). We used annual estimates from a national
spatiotemporal model to assess PM2.5 concentrations for a 5-year pre-enrollment period (1990-1994).
We used Cox regression to estimate associations (hazard ratio, HR; 95% confidence interval, 95%CI)
with NHL and major histologic subtypes per interquartile range (IQR; 4.4µg/m3) increase in PM2.5,
adjusting for demographic characteristics, body mass index (BMI), smoking status and intensity, andcensus-tract median household income. We also examined models stratified by BMI and state.
RESULTS:There were 6,466 incident cases of NHL diagnosed through 2011. We found a positive andstatistically significant association with follicular lymphoma (HRIQR=1.16; 95%CI=1.02-1.31; 788
cases); associations for other subtypes were not apparent. An overall NHL association was notapparent (HRIQR=0.99; 95%CI=0.95-1.04), and no differences were observed by BMI (p-interaction>0.05). NHL risk was significantly elevated with PM2.5 levels in Pennsylvania (HRIQR=1.28;
95%CI=1.06-1.54), but a test for interaction by state was not significant (p-interaction >0.05).
CONCLUSIONS:Our findings from this large U.S. cohort indicate that PM2.5 may be associated withrisk of follicular lymphoma. Future investigations of NHL and PM2.5 should consider histologic
subtypes and examine whether differences in regional PM constituency influence risk.

Keywords: air pollution, particulate matter, Cancer and cancer precursors

EP-074[Cancer and cancer-precursors » Incidence]

Ingested nitrate and nitrite and risk of renal cell
carcinoma in the Agricultural Health Study
Jessica M. Madrigal1, Rena R. Jones1, Samantha Ammons1, Jonathan N. Hofmann1, Dale Sandler2,
Laura E. Beane Freeman1, Mary H. Ward1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
2Epidemiology Branch, Chronic Disease Epidemiology Group, National Institute of Environmental

Health Sciences, National Institutes of Health, Durham, NC, United States

BACKGROUND AND AIM:Limited studies have shown associations of ingested nitrate and nitrite withrenal cell carcinoma (RCC) incidence. We evaluated exposure from drinking water and diet and RCC
incidence in the Agricultural Health Study, a cohort of pesticide applicators and their spouses in Iowa
and North Carolina.
METHOD:For applicators and spouses, we used the enrollment water source (1993-1997; N=74,919)
to compute average nitrate concentrations in public water supplies (25% of participants) from
historical monitoring data and estimated nitrate concentrations in private wells (71%) using random
forest models. We excluded 4% using other water sources. We used Cox regression models adjusted
for age, state, body mass index, and smoking status to estimate hazard ratios (HR) and 95%
confidence intervals (CI) for nitrate exposure quintiles. Among those who completed the NCI Dietary
History Questionnaire at first follow-up (N=28,446), we calculated HRs for tertiles of daily intakes ofnutrient density-adjusted dietary nitrate and nitrite (mg/1000 kcal) and examined associations forwater nitrate stratified by median levels of red meat and vitamin C consumption, factors linked toincreased and decreased endogenous nitrosation, respectively.
RESULTS:We identified 345 RCC cases (139 with diet information) through 2019 (Iowa) and 2014
(North Carolina). Drinking water nitrate concentrations were not associated with risk (HRQ5>3.75mg/L vs. Q1<0.7mg/L=0.93, 95%CI:0.66–1.31, p-trend=0.84); associations did not vary by
red meat or vitamin C consumption. Higher dietary nitrate intake was associated with increased RCC
risk (HR T3 vs. T1=2.3, 95%CI:1.5-3.7, p-trend<0.0001). Dietary nitrite from plants but not animal
sources was associated with elevated risk (HR T3 vs. T1=1.5, 95%CI:0.95-2.4, p-trend=0.06).
CONCLUSIONS:Our study findings do not support an association between nitrate concentrations indrinking water and risk of RCC. Novel findings of increased risk among participants with higher dietarynitrate and plant nitrite consumption merit additional investigation to better understand how thesefactors may increase RCC risk.

Keywords: Incidence, Cancer and cancer precursors, Water quality, Food/nutrition, ExposuresEP-075[Omics technologies » Proteomics]

Exposure to per- and polyfluoroalkyl substancesand plasma proteomics in young adults: The
Meta-AIR study
Jiawen Carmen Chen1, Jesse A. Goodrich1, Douglas I. Walker2, Elizabeth Costello1, Jiawen Liao1,
Tanya L. Alderete3, Damaskini Valvi2, Brittney O. Baumert1, Sarah Rock1, Dean P. Jones4, Rob
Mcconnell1, Sandrah P. Eckel1, Frank D. Gilliland1, Max T. Aung1, David V. Conti1, Zhanghua Chen1,
Lida Chatzi1
1Department of Population and Public Health Sciences, University of Southern California Keck Schoolof Medicine, Los Angeles, CA, United States
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
4Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine,

Emory University, Atlanta, GA, United States

BACKGROUND AND AIM:Exposure to per- and polyfluoroalkyl substances (PFAS) has been linked withmany adverse health outcomes including cardiovascular, liver, and kidney diseases, and adverse
reproductive and developmental outcomes. However, the underlying biological activity and toxicity
information of PFAS in humans are not fully elucidated. We evaluated the associations of PFAS
exposure with the proteomics profile in young adults.
METHOD:This cross-sectional study included 137 young adults with a history of overweight or obesityfrom the Southern California Children’s Health Meta-AIR study. Plasma PFAS (i.e., PFOS, PFOA,PFHxS, PFHpS, PFNA, PFDA) were quantified using liquid-chromatography high-resolution mass
spectrometry. Plasma proteins (n=384) in cardiometabolic panel were measured utilizing theproximity extension assay. A proteome-wide association study (PWAS) examined associations of
exposure to log2 transformed individual PFAS and PFAS mixtures with 346 unique proteins using linear
regression adjusting for age, sex, race/ethnicity, and parental education. Hierarchical clustering was
performed using complete-linkage to identify protein clusters associated with PFAS. UniProtKB/SwissProt, a protein database, was used to annotate the protein functions.
RESULTS:Overall, 104 proteins were marginally associated with at least one PFAS (p<0.05).
Hierarchical clustering on the test statistics identified a cluster of PFAS down-regulated proteins and acluster of PFAS up-regulated proteins. PFAS mixtures were marginally associated with up-regulation ofnine proteins with functions of initiation of innate immune response (i.e., LBP, SPON2), proinflammation (i.e., LBP, GDF15), protein digestion (i.e., CELA3A, PRSS2), anti-apoptosis (i.e., TIMP1),
oxidative stress (i.e., GDF15), as well as with down-regulation of nine proteins with functions of
immune regulation (i.e., FCGR2A, ADGRE5), both anti-angiogenesis (i.e., COL4A1, THBS4) and proangiogenesis (i.e., NOTCH3, IL19), and neural development (i.e., NOTCH3, CNTN1).
CONCLUSIONS:PFAS exposure was associated with broad alterations of the proteomic profile in young
adults. The biological functions of these proteins provide insight on the underlying mechanisms of
PFAS toxicity on adverse health outcomes.

Keywords: per- and polyfluoroalkyl substances, PFAS, proteomics, biological processes

EP-076[Chemical exposures » Endocrine disrupting chemicals]

Thyroid hormones mediate the association
between single and mixed polycyclic aromatichydrocarbons exposure with visceral adipose
accumulation
Jintao Liu, Li Liu, Ning Wei, Xuanxuan Li, Rong Song, Jiajun Yuan, Rubing Pan, Hong Su
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University,
Hefei, Anhui 230032, China

BACKGROUND AND AIM:Polycyclic aromatic hydrocarbons (PAHs) have been reported to be associatedwith obesity-related cardiovascular risk, and visceral adiposity carries a major contribution to theobesity-induced disease burden. Therefore, exploring the effect of PAHs on visceral adipose tissue
accumulation is of great significance for early warning and targeted intervention. The present study
aimed to examine the association between PAHs exposure with visceral adiposity and further explore
the potential mediating role of thyroid hormones.
METHOD:We investigated levels of nine urinary PAHs metabolites and serum thyroid-stimulating
hormone (TSH) and free thyroxine (FT4) in 2190 adult participants in the National Health andNutrition Examination Survey (NHANES) between 2007 to 2012 and quantified their visceral adiposityand lipid accumulation status by two indicators: visceral adiposity index (VAI) and lipid accumulation
products (LAP). Multiple linear regressions were used to assess the effect of single PAHs components
on visceral adiposity. Then, we used weighted quantile sum (WQS) regression models and Bayesiankernel machine regression (BKMR) models to estimate the association of mixed PAHs exposure withvisceral adiposity. Finally, mediation analysis was used to explore the mediating role of FT4 and TSH
in this association.
RESULTS:Multiple linear regressions showed that multiple urinary PAHs metabolites were significantly
associated with both VAI and LAP after fully adjusting for covariates. The WQS indices of PAH mixtures
showed significant positive effects on VAI (0.305, 95 % CI: 0.109-0.501) and LAP (8.600, 95 % CI:
4.577-12.623). The BKMR model indicated that VAI and LAP tended to increase significantly with theconcentration of PAHs mixture. Furthermore, the mediated analysis showed that FT4 mediated theeffect of single or mixed PAHs on visceral fat.
CONCLUSIONS:In conclusion, our results suggest that PAHs exposure may increase visceral adipose
accumulation by decreasing FT4 levels.

Keywords: Mixtures, Endocrine disrupting chemicals, Obesity and metabolic disorders, Mixtures
analysis, Environmental epidemiology.

EP-077[Exposures » Environmental disparities]

Concentrated animal feeding operations(CAFOs) in relation to environmental justicemetrics and related variables in Wisconsin,
United States
Ji-Young Son, Michelle L. Bell
School of the Environment, Yale University, New Haven, USA

BACKGROUND AND AIM:The growth of concentrated animal feeding operations (CAFOs) has caused
significant environmental detriments and raised concerns regarding environmental justice with CAFOs
exposure. This study examined environmental disparities in exposure to CAFOs with several
environmental justice metrics and considered exposure intensity.
METHOD:We obtained data on permitted CAFOs (July 2021) from the Wisconsin Department of Natural
Resources. We used Census tract level variables from the 2010 Census to evaluate environmental
disparities by environmental justice metrics and related variables (i.e., percentages of Non-Hispanic
White, Non-Hispanic Black, or Hispanic; percentage living below the poverty level; median annual
household income; income inequality (Gini index); percentage with education less than high school
diploma; racial isolation (RI) for Non-Hispanic Black; and educational isolation (EI) for population
without a college degree). We assessed exposure to CAFOs as the sum of animal units (AUs) withineach Census tract and investigated exposure disparities by comparing distributions of environmental
justice metrics based on CAFO status (i.e., never, expired, or current) and Census tract-level CAFOs
exposure intensity categories (i.e., from low exposure (quartile 1) to high exposure (quartile 4)).
RESULTS:CAFOs in Wisconsin were generally located in areas with lower percentages of racial
minorities and high SES communities; however, within the areas with current CAFO exposure, areas
with high CAFOs exposure intensity had higher percentages of non-Hispanic Black and Hispanic, andlower percentages of non-Hispanic White populations compared to areas with low CAFOs exposure.
CONCLUSIONS:Our findings add to the growing body of literature on environmental disparities
associated with CAFOs exposure. These results have implication of future studies on environmental
justice and CAFOs exposure and suggest the need for further research using accurate exposure
assessment in other regions.

Keywords: Environmental justice, Disparities

EP-078[Air pollution » Particulate matter]

Evaluating PM2.5 concentrations in homes of
on-site workers at a Nepalese brickmanufacturing facility
John D. Beard1, Scott C. Collingwood2, James D. Lecheminant1, Neil E. Peterson1, Paul R. Reynolds1,
Juan A. Arroyo1, Andrew J. South1, Clifton B. Farnsworth1, Nathaniel Baxter2, Garrett Braiden1,
Gerardo Fong1, Taylor Heath1, Lindsey Layton1, James Lu1, Alisandra Olivares1, Marli Shaw1, Mariah
Taylor1, Matthew Tibbitts1, James D. Johnston1
1Brigham Young University, Provo, United States of America
2University of Utah, Salt Lake City, United States of America

BACKGROUND AND AIM:Increasing concern about air pollution and health impacts has led to thedevelopment of low-cost monitors suitable for wide-scale deployments and use by citizen scientists.
Moreover, technological advancements have reduced the size, weight, and power requirements ofdevices such that they may be readily transported in sufficient quantity into under-resourced
communities where vehicle travel to homes and mains electricity supply in the home is unavailable.
The objective of this project was to utilize the recently released AirU+ v2.2 low-cost particle sensor tomonitor indoor particulate matter less than 2.5 µm (PM2.5) aerosols pollution in the homes of two
types of brick manufacturing workers in Bhaktapur, Nepal, in March 2023.
METHOD:A subset of 48 workers who lived on-site voluntarily participated in an observational, crosssectional study investigating inhalation exposures and chronic obstructive pulmonary disease (COPD).
Workers participating in automated brick molding had a distinct home structure (n=6) that wasdifferent from the homes (n=6) of workers manually forming bricks. Stationary AirU sensors wereplaced in each workers’ homes for an average of 60.55 hours. Linear regression models were used to
calculate mean PM2.5 concentrations in the homes overall and by brick molding group.
RESULTS:The overall mean PM2.5 concentration in the homes was 139.19 µg/m3 (95% confidence
interval [CI]: 119.89, 158.50) and the PM2.5 concentrations in the homes of automated brick molders(mean: 116.82; 95% CI: 98.29, 135.34 µg/m3) were significantly different (p = 0.0034) fromconcentrations in the homes of manual brick molders (mean: 161.57; 95% CI: 143.05, 180.09µg/m3).
CONCLUSIONS:This is the first study to compare the indoor PM2.5 concentrations of these two typesof brick molding workers in Nepal. Although indoor concentrations of PM2.5 were highest in the homesof manual brick molders, interventions to lower PM2.5 concentrations in the homes of both types ofbrick molders are warranted.

Keywords: air pollution, particulate matter

EP-079[Chemical exposures » Phthalates]

Particulate matter phthalate, polycyclic aromatichydrocarbons, and toxic metal concentrations intailpipe and non-tailpipe emissions near
highways
John G Watson1, Xiaoliang Wang1, Judith C Chow1, Steven D Kohl1, Steven Sai Hang Ho1, HeejungJung2, Antony Chen3
1Desert Research Institute2University of California, Riverside
3University of Nevada, Las Vegas

BACKGROUND AND AIM:Highway emissions are large contributors to particulate matter exposures.
METHOD:PM2.5 and PM10 filter samples were collected upwind and downwind of two southern
California highways and analyzed for phthalates, potentially toxic metals, ions, organic and elemental
carbon, polycyclic aromatic hydrocarbons (PAHs), and marker species for source apportionment.
Source samples of road dusts, brake dusts, and tire dusts were also obtained, suspended, sampled
onto filters through size selective inlets, and analyzed for the same components.
RESULTS:Phthalate concentrations were as high as 4 µg/m3 and were dominated by bis(2ethylhexyl)phthalate (DEHP) followed by di-n-octyl phthalate (DnBP); these are plasticizing agentsused in some tire manufacturing. Average PAH concentrations ranged from 5.1 to 8.6 µg/m3 and were
dominated by engine exhaust contributions. Brake pads contained potentially toxic metals such ascopper, zinc, barium and lead and were enriched in ambient air near the highways. PM2.5 and PM10mass concentrations averaged 10-15 and ~30 µg/m3, respectively. The most abundant PM2.5
components were: organic matter (OM; ~30–40%), mineral dust (~25–30%), and elemental carbon(EC; ~10–15%). For PM10, mineral dust (~40–45%), OM (~25%), nitrate (~6-11%), and EC (6-8%)
were the dominant component. High correlations were found for elements with common sources, suchas markers for brake wear and road dust.
CONCLUSIONS:On average, contributions from non-tailpipe fractions (brake and tire wear) to PM2.5
exceeded those of tailpipe fractions (diesel and gasoline emissions) at one of the highways (~30% vs.
20%) while they were comparable at another highway that experienced twice the diesel traffic (15–17% vs. 15–19%). For PM10, non-tailpipe contributions were 2 – 3 times the tailpipe contributions.
Brake wear particles were more abundant than tire wear particles, though there was a higher
uncertainty in the tire wear contribution estimates.

Keywords: Air pollution, Particulate matter, Traffic-related, Particle components

EP-080[Chemical exposures » Heavy metals]

Secondary students from Callao, Peru, discovercritical points of lead contamination
Johny Ponce1, Johny Ponce2, Alexander Van Geen3, Franziska Landes3, Rafael Vargas4, Eda Palacios1,
Percy Ponce1, Jaime Languasco2
1Center for Research in Environmental Health, CREEH Peru. Lima, Peru
2Universidad Peruana Cayetano Heredia, UPCH. Lima, Peru
3Lamont-Doherty Earth Observatory of Columbia University, UC. NY, US
4Universidad Militar Nueva Granada. Bogota, Colombia

BACKGROUND AND AIM:Lead contamination is a health risk that has not been resolved and is related
to conditions of poverty, which affects the global burden of disease, so it is necessary to identify
critical points in communities exposed to lead and its risk levels.
OBJECTIVES: Establish the levels of lead contamination in Callao to establish a risk map from here.
METHOD:MATERIALS-METHODS: Surface soil samples were evaluated in the main streets andsidewalks of Callao, following the National and International Soil Sampling Standards. The samples arethen analyzed to determine the lead concentration. The lead values obtained were used in order toelaborate a risk map based on the ERSA criteria.
RESULTS:RESULTS: The risk levels for lead contamination, and supported by national andinternational regulations, were: low risk <140 mg/kg, medium risk >140 - <800mg/kg and high risk
>800mg/kg. 50% of the collected soil samples present lead values with medium risk >140 <800mg/kg and 30% with high risk >800mg/kg.
CONCLUSIONS:CONCLUSIONS: The level of risk of exposure to lead associated with contaminatedsoils in Callao has a distribution similar to that reported internationally and to the findings reported byour group in previous works. These results can be taken as an input to establish public health policies
aimed at reducing exposure to lead and preventing diseases, especially in children, pregnant womenand the elderly.

Keywords: Students, Callao, hotspots, contamination, leadEP-081[Outcomes » Other (to be specified with keywords in the keywords section)]

Occurrence and burden of burns from cooking inperi-urban Cameroon, Ghana, and Kenya: resultsfrom surveys of household cooks
Jonathan Abuga1, Gohole Arthur1, James Mwitari1, Willah Nabukwangwa1, Samuel Iddi2, Reginald
Quansah2, Theresa Tawiah3, Kwaku Poku Asante3, Judith Mangeni4, Edna Sang4, Diana Menya4,
Miranda Baame5, Emmanuel Betang5, Bertrand Hugo Mbatchou Ngahane3, Matthew Shupler6, Elisa
Puzzolo6, Daniel Pope6
1Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI),

Nairobi, Kenya
2School of Public Health, University of Ghana, Accra, Ghana
3Kintampo Health Research Centre, Kintampo, Ghana
4School of Public Health, Moi University, Eldoret, Kenya
5Douala General Hospital, Douala, Cameroon
6Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom

BACKGROUND AND AIM:Over 90% of all global burns occur in low-and-middle-income-countries,
disproportionately affecting women, who are typically the primary cooks, and children. We determined
the occurrence, severity, and causes of cooking-related burns, and assessed whether the choice ofprimary cooking fuel (biomass fuels versus liquefied petroleum gas (LPG)) impacted their prevalence.
METHOD:Cross-sectional surveys were administered to women cooking either primarily with LPG or
exclusively with biomass fuels in peri-urban communities of Kenya, Cameroon, and Ghana.
Information was collected on sociodemographics, cooking patterns, and experience of cooking-relatedburns (adult and child) in the previous 12 months. Factors contributing to the prevalence, severity,and cause of burns were assessed by fuel type using logistic regression analysis.
RESULTS:One in 10 adults (10%, 128 of 1240) and 42 in 1240 (3%) children reported experiencing aburn in the last 12 months. The self-reported occurrence of burns in adults was higher (24%) in
Cameroon than in Ghana and Kenya (3% and 3%, respectively). For children, the prevalence of burns
was similar across the three countries (4%, 3%, and 3% respectively). Among those reporting a burn,severity (scarring) was high in both adults (73%) and children (83%). The three most common causesof child burns included touching hot objects (31%), hot stoves (12%), or direct exposure to flames(14%). Choice of stove (LPG or biomass fuel) did not appear to be associated with adult burns in
Ghana and Kenya (OR=0.73 and OR=1.42 p>0.05 respectively). Children in households primarily
cooking with LPG had lower odds of experiencing burns (OR=0.30, 95%CI 0.05-1.59), although thisdid not reach statistical significance. The use of an LPG stove, however, appeared to reduce the risk ofsevere burns in children (OR=0.49, 95%CI 0.25-0.92).
CONCLUSIONS:Cooking-related burns are a frequent and debilitating issue for both adults andchildren. The experience of burns is highly context-specific.

Keywords: Outcomes, Other (cooking-related burns), Epidemiology

EP-082[Air pollution » Wildfires]

Physicochemical characterization of Canadian
Wildfire Related Air Pollution in the U.S.
Northeast
Jose Guillermo Cedeno Laurent, Hooman Parhizkar, Georgios Kelesidis, Leonardo Calderon,Constatinos Moularas, Denisa Lizonova, Philip Demokritou
Environmental and Occupational Health Sciencies Institute (EOHSI), Rutgers University

BACKGROUND AND AIM:During June 2023, the smoke from Canadian wildfires drifted into theNortheastern United States, making New York City on June 6th the most polluted city in the world.
Our objective is to provide a physicochemical characterization of the particulate wildfire pollutants bycollecting integrated and real-time measurements during the peak days of the wildfire incident.
METHOD:Mass concentration for ultrafine, fine, and coarse PM was obtained with the use of a Harvard
Compact Cascade Impactor. Size distributions were obtained with real time instrumentation (TSI
SMPS 3082; TSI APS 3321). Integrated samples were used for identification of chemical composition:
elemental analysis via ICP-MS and OC/EC analysis via FID. Multiple-Path Particle Dosimetry Modelingwas used to estimate total particle deposition in the human alveolar region for a 72-h constant
exposure period.
RESULTS:Average mass concentrations onf June 6th-7th for PM0.1, PM0.1-2.5, PM2.5-10, PM10 andabove were 95.2 μg/m3, 111.7 μg/m3, 53.4 μg/m3, and 49.8 μg/m3, respectively. Peak PM2.5
concentrations on June 7th reached 330μg/m3, with a large contribution from ultrafine particles(PM0.1 = 165μg/m3). Average particle number concentration for particles with mobility diameter<200 nm was substantially higher (Average PNC=6053) than for larger particles between 500nm –20μm (Average PNC= 854.8). Organic carbon content was predominant (OC/EC ratio = 23.6). The
relative abundance of the five most prevalent metals were Fe (48.9%), Ba(12.8%), Ti(10.8%), Mn(4.4%) and Al (4.3%). The pulmonary deposition of PM0.1 reached 1.42 mg, and a total deposition of
2.3mg for all studied size fractions.
CONCLUSIONS:The strong presence of ultrafine PM concentrations in mass and particle number
concentrations, as well as distinct PM composition is suggestive of different dose-response functions incomparison to traffic related air pollution. Toxicological studies with the collected material are ongoingand should inform further about the human health impacts of wildfire air pollution.

Keywords: wildfires, ultrafine particles, chemical composition, air pollution, climate changeEP-083[One health » Tropical health]Mapping household-scale livestock husbandry
in LMICs by animal taxon: a Bayesian prediction
model of a key infectious diseases risk factor
Josh Michael Colston1, Margaret Kosek1, Bin Fang2, Venkataraman Lakshmi2
1The University of Virginia School of Medicine
2The University of Virginia

BACKGROUND AND AIM:Around 70% of the world’s 880 million rural poor depend on traditional
animal husbandry for their livelihoods which, while having economic and health benefits, can be asource of infections through exposure to fecal contamination and respiratory pathogens. Over 60% of
human pathogens are zoonotic, and recent pandemics have resulted from the spillover of zoonotic
pathogens such as Ebola, SARS-CoV2 and Mpox yet there have been few attempts to estimate theinterface of human and domestic animal interaction at a global scale. This represents a barrier to theimproved understanding of the dynamics of endemic and emerging infectious diseases. This analysis
aimed to map the distribution of household-scale livestock husbandry in LMICs by animal taxon.
METHOD:Data on animal ownership were compiled from around 300 nationally representative,
population-based household surveys, and species were classified into ruminants, monogastrics andpoultry. A novel georeferencing methodology was implemented and a suite of time-static
environmental and demographic spatial covariates were compiled based on their hypothesized
associations with the outcome variables. Variable values were extracted at the georeferenced cluster
locations and a Bayesian Multi-level based logistic regression approach was used to model associations
and generate predictions for all LMICs at a 6km resolution. A Markov Random Field (MRF) smoothalgorithm was employed to improve spatial correlation and continuity of the prediction maps.
RESULTS:Model evaluation statistics were mixed, but weighted average recall was 0.89 formonogastric, 0.78 for ruminant and 0.74 for poultry ownership. High prevalence of poultry ownership
was predicted across the Tibetan Plateau and in pockets in the Andes, Ethiopia, and Kenya, while
ruminant ownership rates were high in parts of Amazonia, Syria and Yemen.
CONCLUSIONS:The resulting prediction maps can be used by policymakers and program planners togenerate disease burden estimates, target outbreak prevention interventions geographically andidentify hotspots of risk for zoonotic spillover.

Keywords: One Health, infectious diseases, geospatial health, zoonoses, tropical healthEP-084[Built environment » General]

Spatial variation in housing construction
material in LMICs: a Bayesian prediction modelof a key infectious diseases risk
Josh Michael Colston1, Margaret Kosek1, Bin Fang2, Venkataraman Lakshmi2
1The University of Virginia School of Medicine
2The University of Virginia

BACKGROUND AND AIM:Housing quality is a well-recognized social determinant of health. Many
infectious diseases of global concern are transmitted within and between households and features ofthe built peridomestic environment and infrastructure can promote or impede the spread of pathogens
and their insect vectors. In tropical and rural regions where vector-borne and neglected tropicaldiseases circulate, dwellings are often constructed using locally available, natural materials andtraditional techniques. Disease-causing insects and microbes are well-adapted to exploit the ecologicalniches that such buildings provide. This study modeled spatial variation in housing material types
using covariates with global coverage to map predicted coverage across LMICs.
METHOD:Data on materials used in construction of dwelling floors, walls and rooves were compiled
from 334 nationally representative, population-based household surveys, and classified into natural,
rudimentary, and finished types. A novel georeferencing methodology was developed andimplemented here for the first time. A suite of time-static environmental and demographic spatial
covariates in raster format were compiled based on their hypothesized associations with the outcome
variables. Variable values were extracted at the georeferenced cluster locations and a Bayesian Multilevel based logistic regression approach was used to model associations and generate predictions for
all LMICs at a 6km resolution. A Markov Random Field (MRF) smooth algorithm was employed to
improve spatial correlation and continuity of the prediction maps.
RESULTS:Models for wall and roof material performed better than for floors giving a precision of 0.82
for the finished category and a weighted average precision of 0.7 and 0.73 respectively. Croplandareas, urbanization, and distance to water source were important variables in all models.
CONCLUSIONS:Resulting prediction maps enable the identification of areas of low coverage ofimproved housing material across large areas of Sub-Saharan Africa, South Asia, and Amazonian
South America among others, and can be used to prioritize populations for housing improvements.

Keywords: Infectious diseases, social determinants of health, housing, global healthEP-085[Exposures » Other (to be specified with keywords in the keywords section)]

Deciduous teeth from the New Hampshire Birth
Cohort Study: Infant feeding and Pb in water
predict dentine elements
Julia Anglen Bauer1, Tracy Punshon2, Brian P. Jackson3, Felicitas B. Bidlack4, Modupe O. Coker5, Marc
G. Weisskopf6, Margaret R. Karagas1
1Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
2Department of Biological Sciences, Dartmouth College, Hanover, NH, USA
3Department of Earth Sciences, Dartmouth College, Hanover, NH, USA
4The Forsyth Institute, Cambridge, MA, USA; Department of Developmental Biology, Harvard Schoolof Dental Medicine, Boston, MA, USA
5Department of Oral Biology, Rutgers University, Newark, NJ, USA
6Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA

BACKGROUND AND AIM:To estimate associations between maternal/child characteristics, along withelements measured in home tap water during pregnancy, and element concentrations in shed
deciduous teeth.
METHOD:Our analysis included 152 mother-infant dyads followed from the second trimester throughthe end of the first postnatal year from the New Hampshire Birth Cohort Study. During pregnancy andearly infancy, we collected maternal and infant dietary and sociodemographic information via surveys,
measured metals in home tap water, and later collected naturally shed teeth from child participants
and measured weekly deposition of elements in dentine using LA-ICPMS. Multivariable linear mixed
models were used to estimate associations between predictors and tooth metal concentrations.
RESULTS:We measured 12 elements in dentine including those previously found in teeth (Ba, Mn, Pb,
Sr, Zn) and other elements potentially derived from environmental, dietary, or drinking water
exposures (Al, As, Cd, Cu, Hg, Li, and W). A doubling of Pb concentrations in water was associatedwith higher prenatal and postnatal dentine Pb [8.9% (95%CI: 3.2, 14.8%); 13% (95%CI: 5.0%,22%)]. Exclusive formula feeding was associated with higher postnatal dentine element
concentrations as compared to exclusive breast feeding at 4 months: Sr: 251% (95%CI: 54%,699%); Ba: 120% (95%CI: 32%, 268%); Li: 73% (95%CI: 13%, 166%); Al: 136% (95%CI: -6.2%,498%). A mix of formula and breast feeding was associated with higher elements but to a lesser
degree than exclusive formula feeding, suggesting a dose response: dentine Sr: 73% (95%CI: 17%,155%), Ba: 26% (95%CI: -0.6%, 60%), Li: 46.9% (95%CI: 20%, 79%); Al: 4.8% (-32%, 63%) ascompared to exclusive breastfeeding.
CONCLUSIONS:Measurement of elements in deciduous teeth provide retrospective information on
individuals exposures. Pb in home tap water and any formula use were predictors of dentine elements.

Keywords: Heavy metals, Biomarkers of exposure, Children's environmental health, Environmental
epidemiology

EP-086[Cancer and cancer-precursors » Survival]

Survival of bronchopulmonary cancers
according to radon exposure
Juliette Dessemon1, Olivia Perol2, Cécile Chauvel3, Hugo Noelle1, Thomas Coudon4, Leny Grassot4,
Nicolas Foray5, Elodie Belladame4, Jérôme Fayette6, Françoise Fournié7, Aurélie Swalduz6, Eve Marie
Neidhardt6, Pierre Saintigny8, Mayeul Tabutin9, Maxime Boussageon5, Frédéric Gomez10, Virginie
Avrillon6, Maurice Perol6, Barbara Charbotel11, Béatrice Fervers2
1Département Prévention Cancer Environnement, Centre Léon Bérard, Université de Lyon 1, 28 rue

Laennec, 69008, Lyon, France; Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, 8
Avenue Rockefeller, 69008 Lyon, France
2Département Prévention Cancer Environnement, Centre Léon Bérard, Université de Lyon 1, 28 rue

Laennec, 69008, Lyon, France; Inserm UMR1296, "Radiations: Défense, Santé, Environnement",
Centre Léon Bérard, 28 Rue Laennec, 69008 Lyon, France
3Centre for Excellence in Respiratory Pathogens, Hospices Civils de Lyon, 5, place d'Arsonval-69437

Lyon cedex 03, France; CIRI, Centre International de Recherche en Infectiologie, (Team Public Health,
Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID)), Univ Lyon, Inserm, U1111,
Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
4Département Prévention Cancer Environnement, Centre Léon Bérard, Université de Lyon 1, 28 rue

Laennec, 69008, Lyon, France
5Inserm UMR1296, "Radiations: Défense, Santé, Environnement", Centre Léon Bérard, 28 Rue

Laennec, 69008 Lyon, France
6Département de Cancérologie Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France
7Département interdisciplinaire de soins de support du patient en oncologie, Centre Léon Bérard,

69373 Lyon CEDEX 08, France
8Département de Cancérologie Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France;

Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard,
Centre de recherche en cancérologie de Lyon, 69008 Lyon, France
9Département de chirurgie cancérologique, Centre Léon Bérard, 69373 Lyon CEDEX 08, France
10Unité d’information médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France
11Université de Lyon, Université Lyon 1, Université Gustave Eiffel-Ifsttar, Umrestte, UMR T 9405,

Domaine Rockefeller, 8 Avenue Rockefeller, 69008 Lyon, France; CRPPE-Lyon, Centre Régional de
Pathologies Professionnelles et Environnementales de Lyon, Centre Hospitalier Lyon Sud, Hospices
Civils de Lyon, 69495 Pierre Bénite, France

BACKGROUND AND AIM:Radon residential exposure is estimated to be responsible of nearly 10% oflung cancers in France, making it the 2nd risk factor, after tobacco. The Auvergne-Rhône-Alpes
region, in the Southwest of France, is particularly affected by this exposure as 30% of the population
lives in areas with medium or high radon potential.
The aim of this study was to investigate the impact of radon exposure on the survival of lung cancer
patients.
METHOD:In this single-centre study conducted at the Centre Léon Berard (Lyon, France), patients witha histologically confirmed diagnosis of lung cancer, and newly managed, were prospectively included
between 2014 and 2020. The assessment of the study participants’ radon exposure was based on thegeogenic radon potential of their municipality of residence, using the zip code of residence from theirelectronic medical record. Univariate and multivariate survival analyses were carried out using a non-proportional risk survival model to consider variations in risk over time. Adjustment was made for themain prognostic factors: age at diagnosis, sex, smoking status, histology, tumour stage at diagnosis,
and presence of brain metastases.
RESULTS:A total of 1,477 patients were included in the analysis. In the multivariate analysis and after
adjustment for covariates, radon exposure was not statistically associated with survival of lung cancer
patients (HR=0.82 [0.55-1.22], HR=0.92 [0.72-1.18], HR=0.96 [0. 77-1.20] at 1, 3 and 5 years
respectively for patients residing in category 2 municipalities; HR=0.88 [0.66-1.17], HR=0.93 [0.771.12], HR=0.89 [0.75-1.05] at 1, 3 and 5 years respectively for patients residing in category 3
municipalities.
CONCLUSIONS:Although radon exposure is known to increase the risk of lung cancer, in the present
study no significant association was found between radon exposure and survival of lung cancer
patients, in univariate and multivariate studies, at 1, 3 and 5 years.

Keywords: Ionizing radiation, Cancer and cancer precursors, Survival, Environmental epidemiology

EP-087[Exposures » Environmental disparities]

Cardiovascular Health in Miramar Guayama,
Puerto Rico: Posible Case of Public Health
Justice
Karilys Del Mar Villanueva, Nancy Raquel Cardona, Carla Sofia Torres, Gabriela Vidal, Paola Rodriguez
Department of Natural Science, University of Puerto Rico, Aguadilla, Puerto Rico

BACKGROUND AND AIM:In 2016 a survey demonstrated that people who live in Miramar, Guayama
P.R. had a high probability to suffer from cardiovascular and respiratory diseases. Environmental
factors such as air pollution may be associated with these diseases. Our co-created objectives with
community leaders were: 1) To assess and categorize cardiovascular diseases in Miramar, and 2)
report back the results to the citizens of Miramar.
METHOD:From September-October 2022, a survey was designed with demographic questions andchronic/acute diseases. We collected data in November 2022 using the platform Kobo Toolbox.
Afterward, we created frequency tables and graphs using Excel. In December, results were reported
back in oral and paper format.
RESULTS:A total of 175 people completed the survey, leading to 20% of the Miramar community. The
median age for participants was 50. Most (80%) of the participants have been residents for more than
5 years, and 35% indicated suffering from cardiovascular disease and had been through many
cardiovascular-related procedures. Cardiac Arrest and Hypertension were the diseases that had moreprevalence.
CONCLUSIONS:Studies of Environmental Health indicate that particulate matter 2.5 could cause
cardiovascular and respiratory diseases, especially in elderly people. Reporting results can allow
people to advocate for environmental justice and possible behavior change. Future students should
include biological markers to assess the relationship between environmental sources and healthexposure. Acknowledgments: We appreciate the community leaders of Miramar and Santa Ana andthe support of “The Organized Community Guayamesa United for Health”. Funding: This project was
subsidized by the PR-LSAMP Scholarship.

Keywords: community health, carbon emissions

EP-088[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Multipollutant Associations Between Air
Pollution and Autism Spectrum Disorder in
California: How Sociodemographics and Region
Impact Risk.
Karl Osharkey1, Sanjali Mitra1, Seung A Paik1, Jason Su3, Ting Chow1, Beate Ritz2
1Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles,

CA 90095, USA
2Department of Epidemiology & Department of Environmental Health Sciences, Fielding School of

Public Health, University of California, Los Angeles, CA 90095, USA
3Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley,

CA 94720, USA

BACKGROUND AND AIM:Autism spectrum disorder (ASD) is a complex neurodevelopmental condition
with social, behavioral, and learning challenges, likely caused by a mix of genetic and environmental
factors. Its prevalence has surged in the US, causing significant health and economic burdens. This
study examines the link between ASD and exposure to environmental toxins like PM25, NO2, and O3,
considering sociodemographic and regional factors.
METHOD:This study employed a population-based cohort design (N = 2,376,489), utilizing 2013-2018
birth records from the California (CA) birth registry linked to ASD cases (N = 44,416) reported by the
CA Department of Developmental Services up to the end of 2022. Air pollution exposure wasascertained using a land-use regression spatiotemporal model with advanced machine learning. A
multipollutant strategy was employed to adjust for co-pollutants.
RESULTS:The prevalence of ASD for 2013-2018 births was 1.88%. This study found that in a
multipollutant model including PM2.5, NO2, and O3, a 1 interquartile range (IQR: 2.39 ug/m³)
increase in PM2.5 across pregnancy was associated with a 14.7% (95% CI: 1.13, 1.16) increased riskof ASD, while a 1 IQR (4.95 ppb) increase in NO2 was associated with a 3.1% (95% CI: 1.02, 1.05)
increased risk of ASD. Overall O3 (IQR: 5.11 ppb) was not associated with an increased risk of ASD.
Additionally, we saw interesting differences in the estimated effects of different air pollutants on ASD
by race, maternal education, neighborhood socioeconomic status, and region.
CONCLUSIONS:Results indicate that prenatal exposures to PM2.5 and NO2 are associated with ASD
incidence in CA, with results varying by key sociodemographic factors and region, suggesting thatdifferent pollutant sources or exposure profiles/mixtures may place individuals at greater risk of ASD.

Keywords: Autism Spectrum Disorder, Air Pollution, Neurodevelopment, Pregnancy

EP-089[Air pollution » Long-term exposure]

Cardiovascular and respiratory effects of longterm exposure to air pollution: A cross sectional
study in Greece
Konstantina Dimakopoulou, Aravela Stergiopoulou, Natasa Kalpourtzi, George Baltatzis, Evangelia
Samoli, Giota Touloumi, Klea Katsouyanni
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National andKapodistrian University of Athens, Athens, Greece

BACKGROUND AND AIM:We investigated the long-term effects of modeled ambient air pollutant
exposures on cardiovascular and respiratory health outcomes in the Greek National Morbidity and Risk
Factors Survey (EMENO).
METHOD:We used data collected for 5,908 residents in Greece participating in the EMENO survey in
Greece, 2015-2016. We used mean arterial pressure (MAP) based on measurements, prevalent
hypertension, myocardial, coronary and stroke event as cardiovascular outcomes, asthma, chronic
obstructive pulmonary disease, chronic bronchitis and allergic rhinitis as respiratory outcomes. Longterm exposure to nitrogen dioxide (NO2), particulate matter with a diameter equal or less than 10μm
(PM10) and ozone (O3) at the participant residential address were estimated by dispersion models for
Greece and by spatio-temporal land use regression (LUR) models for the Greater Athens Area and
Thessaloniki. Multiple linear and logistic regression was applied adjusting for potential confounders.
RESULTS:A 10 μg/m3 increase in long-term exposure of NO2 and PM10 at the participants’ residence
all over the country, was associated with an increased risk of stroke [Odds Ratio (OR): 1.14 (95%
Confidence Interval (CI):1.02, 1.29) and 1.40 (95% C.I.:1.08, 1.82), respectively]. A higher risk ofstroke was found for participants living in the 2 largest cities of Greece; for a 10 μg/m3 increase inlong-term exposure of NO2 and PM10, estimated ORs were: 1.22 (95% C.I.:1.02, 1.46) and 1.49
(95% C.I.:1.00, 2.21), respectively]. Moreover, in the 2 metropolitan areas, a 10 μg/m3 increase inlong-term exposure of NO2 and PM10 was also associated with increased MAP and increased risk ofchronic bronchitis, hypertension and asthma.
CONCLUSIONS:In a cross-sectional analysis, using predicted air pollutant concentrations at theresidence of the participants of a survey conducted in a representative population sample in Greece,
we found adverse associations of long-term exposure to NO2 and PM10 and cardiovascular andrespiratory health.

Keywords: long-term air pollution, exposure modeling, cardiovascular, respiratory, cross-sectional

EP-090[Exposures » Environmental disparities]

Characterizing social inequalities in health in
the Region of the Americas
Laura Aballay1, Camila Niclis2, Sonia Alejandra Pou2, Julia Mariel Wirtz Baker2, Eugenia Haluszka2,
Camila Ormaechea1, Stefano Staurini1, Gabriela Diaz Rousseau1, Julia Becaría Coquet1
1Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias

Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
2Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones

Científicas y Técnicas (CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina; Centro deInvestigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias Médicas,
Universidad Nacional de Córdoba, Córdoba, Argentina

BACKGROUND AND AIM:The Region of Americas is characterized by inequalities in demography,socioeconomic conditions, health systems and public policies that play a key role in shaping
epidemiological scenarios. Therefore, we aim to study the epidemiological trends of morbidity toidentify baseline socio-health scenarios of the region characterizing social inequalities in health.
METHOD:A descriptive ecological study of 27 countries in the Americas was developed using the latest
data from WHO, PAHO, UN Development Programme, GCO and OurWorldInData. The baseline sociohealth scenarios were identified using cluster analysis (Ward's method). The socio-demographic
variables studied were the percentage of elderly population, Human Development Index (HDI),
coverage of essential services, and health expenditure. Epidemiological variables included theprevalence of obesity, hypertension, and diabetes, and cancer incidence, for the 2014-2019 period.
Clusters data and socio-health characteristics were mapped using a GIS.
RESULTS:We identified 3 clusters representing different socio-health scenarios. The first one included
the Southern countries (Chile, Brazil, Argentina, Uruguay), together with the Bahamas, Costa Rica,
Cuba and Jamaica; the second cluster included North American countries (Canada and USA); and thethird included 63% of the rest. Comparative analysis of socio-demographic and epidemiologicalcharacteristics between clusters showed that the second cluster has a better socio-health situation(higher average HDI and health expenditure) and an older population, with higher burdens of obesityand cancer. We observed that the first and third clusters had similar epidemiological profiles, but thefirst one had a higher average HDI and health expenditure, while the third had a less-aged populationand the lowest average HDI.
CONCLUSIONS:Most countries in the Americas region (93%) presented a very different socio-healthscenario to the countries in the north of the continent, which presented a more favorable socioeconomic situation but higher burdens of obesity and cancer.
Grants FONCYT-PICT-2019-04594.

Keywords: socio-economic factors, environmental disparities, obesity and metabolic disorders, cancer
and cancer precursors, cardiovascular diseases

EP-091[Air pollution » Particulate matter]

Mapping residential air pollution hotspots using
freely available Energy Performance Certificatesin England and Wales
Laura J Horsfall1, Nicola Shelton2, Pia Hardelid3
1Department of Primary Care and Population Health, University College London, London, UK
2Department of Epidemiology and Public Health, University College London, London, UK
3Department of Population, Policy & Practice, UCL GOS Institute of Child Health, London, UK

BACKGROUND AND AIM:The use of solid fuel appliances (SFAs) for heating homes, particularly woodburning stoves, has increased in recent years across the Global North raising concerns on the impactof airborne emissions on human health. In 2022, SFAs are estimated to account for 25% of all PM2.5
emissions in the United Kingdom (UK) versus 12% for road transport. Identifying potential air
pollution hotspots in residential areas is challenging when existing monitoring networks are basedaround major roads.
METHOD:Since 2008, UK law has required that Energy Performance Certificates (EPCs) are issued
whenever a property changes hands. We used data on all 23 million EPCs from England and Wales to
identify SFAs hotspots. We also quantified the association between SFA prevalence, Index of Multiple
Deprivation (IMD) and Smoke Control Areas established in many towns and cities following the Great
London Smog of 1952.
RESULTS:London currently has the highest geographic concentration of SFAs at 3.8 per km2
compared with the second highest, the South East of England, at 1.8 per km2. The prevalence ofwood-burning SFAs has remained relatively stable in London at 31-44 per 1000 houses between 2008
and 2022 but increased by 57% outside of London from 71 per 1000 houses (95%CI: 70-72) to 114(95%CI: 113-114). SFAs were recorded in 12.9% (95%CI: 12.8-12.9%) of houses in the leastdeprived IMD quintile compared with 2.1% (95%CI: 2.1-2.1%) in the most deprived quintile. For
houses in Smoke Control Areas, the odds of an SFA were 52% lower (95%CI: 51-52%) than outsideof these areas.
CONCLUSIONS:Our results are consistent with appliance sales trends and smaller surveys suggestingthat affluent areas are the major contributors to PM2.5 emissions from SFAs. EPCs could help local
decision-makers target awareness campaigns and expand Smoke Control Areas to reduce air pollution
and improve population health.

Keywords: Air pollution, Big data, Spatial statistics, Built environment, Socio-economic factors (nonchemical stressors)

EP-092[Reproductive outcomes » Female reproductive outcomes]

Association of ambient PM2.5 mass and its
components with ovarian reserve in a northern
peninsular province, China: the criticalconstituent
Lihong Pang1, Wenhao Yu2, Qi Zhao2, Han Zhao1
1Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China; KeyLaboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan,
Shandong, 250012, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong,
250012, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan,
Shandong, 250012, China; Shandong Technology Innovation Center for Reproductive Health, Jinan,
Shandong, 250012, China; National Research Center for Assisted Reproductive Technology andReproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
2Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong

University, Jinan, Shandong, 250012, China

BACKGROUND AND AIM:Potential effects of PM2.5 components on ovarian reserve have not been well
explored worldwide, especially in northern China where air pollution contamination and women fertility
disorders both have been arousing substantial public concerns. Our aim was to examine theassociations of PM2.5 components and ovarian reserve in northern China.
METHOD:We included 15,102 women with serum AMH measurements between January 2015 andDecember 2019 from the Center for Reproductive Medicine, Shandong University in China.
Concentrations of PM2.5 and its five major components (0.1° × 0.1°), including sulfate (SO42-),
nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC) were assigned toeach participant’s residential address. Multivariable linear mixed effect models were performed toevaluate the associations between PM2.5 components and ovarian reserve over six exposure periods,
with constituent-residual model used to confirm the most responsible component.
RESULTS:During the exposure period from primary to small antral follicle, per interquartile range
increase in average concentration of PM2.5 mass was associated with -8.7% (95%CI: -12.3%, -4.9%)
change in AMH. The association was significant for all five components, with the effect estimate
observed largest for SO42-. The associations were more pronounced during the process from primary
to small antral follicle and among women with low educational level and living in inland areas.
CONCLUSIONS:Our findings suggest that short-term exposure to PM2.5 and its specific chemicalcomponents (particularly SO42−) was associated with ovarian reserve decline. Lower educated orinland women were more vulnerable than others.

Keywords: PM2.5 components, ovarian reserve, exposure period, anti-Müllerian hormone

EP-093[Chemical exposures » Pesticides]

Respiratory and allergic effects associated withpesticide exposure among farmworkers in Costa
Rica
María G. Rodríguez Zamora1, Samuel Fuhrimann2, Mirko S. Winkler2, Brian J. Reich3, Christian
Lindh4, Ana M. Mora5
1Escuela de Ingeniería en Seguridad Laboral e Higiene Ambiental, Instituto Tecnológico de Costa Rica,

PO Box 159-7050, Cartago, Costa Rica
2Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute,Socinstrasse 55, 4051 Basel, Switzerland. University of Basel, Peterspl. 1, 4001 Basel, Switzerland
3Department of Statistics, North Carolina State University, NC, USA; Center for Human Health and theEnvironment, North Carolina State University, NC, USA
4Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund

University, Scheelevagen 2, 22363 Lund, Sweden
5Center for Environmental Research and Community Health, School of Public Health, University ofCalifornia, Berkeley, 1995 University Avenue, Suite 265, Berkeley, CA 94720, USA

BACKGROUND AND AIM:Growing evidence suggests that pesticide exposures may contribute torespiratory symptoms, asthma, and allergies. We examined the association of exposure toinsecticides, fungicides, and herbicides with respiratory and allergic effects among farmworkers in
Costa Rica.
METHOD:We measured concentrations of 15 pesticide metabolites in urine samples collected from 299
farmworkers at one or two time points between May and August 2016. We administered participants acomputer-based questionnaire to collect information on sociodemographic factors, current pesticideuse, medical conditions, and presence of respiratory and allergic symptoms during the last 12 months(short version of the European Community Respiratory Health Survey). We implemented two-stage
Bayesian Hierarchical Models (BHM) adjusted for age and smoking status to examine exposureoutcome associations with all urinary pesticide metabolites included simultaneously.
RESULTS:Geometric mean (GSD) specific gravity-corrected urinary concentrations of 2-isopropyl-4methyl-6-hydroxypyrimidine (IMPy; metabolite of the organophosphate insecticide diazinon), boscalid5-hydroxy (BOS-OH; metabolite of the fungicide boscalid), and 4-hydroxypyrimethanil (OH-P;
metabolite of the fungicide pyrimethanil) were 0.48 ng/mL (4.24), 0.33 ng/mL (3.99), and 0.29
ng/mL (6.85), respectively. We found that higher IMPy concentrations were associated with increased
odds of asthma symptoms or medication use [adjusted OR per two-fold increase in urinary metabolite
concentrations; 95% credible interval = (1.33; 1.10, 1.61)], a higher asthma symptoms score (1.15;
1.04, 1.26), and rhinitis (1.32; 1.14, 1.52). We also observed that higher BOS-OH concentrations
were associated with increased odds of asthma symptoms or medication use (1.22; 1.00, 1.50) andthat higher OH-P concentrations were associated with increased odds of eczema (1.10; 0.99, 1.23).
Null associations of pesticide exposure with chronic bronchitis were observed.
CONCLUSIONS:Our data indicate that occupational exposure to several pesticides may be associatedwith adverse respiratory and allergic outcomes.
Funding: UNA, SNIS, Swedish Research Council (2018-05841), EAWAG, Fogarty International Center(D43TW011403).

Keywords: pesticides, respiratory outcomes, allergies, occupational epidemiology, mixtures analysis

EP-094[Built environment » Blue space]

Investigating associations of exposure to blue
spaces with natural and cause-specific mortality
in Greece using different exposure assessment
methods
Maria Iosifina Kasdagli1, Klea Katsouyanni2, Kees De Hoogh3, Sofia Zafeiratou1, Konstantina
Dimakopoulou1, Evangelia Samoli1
1Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National andKapodistrian University of Athens, Athens, Greece
2Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National andKapodistrian University of Athens, Athens, Greece & Environmental Research Group, MRC Centre forEnvironment and Health, Imperial College, United Kingdom
3Swiss Tropical and Public Health Institute, Basel, Switzerland & University of Basel, Basel,

Switzerland

BACKGROUND AND AIM:The potential health benefits of exposure to natural environments,
particularly green space, have gained widespread attention, while the effects of exposure to blue
spaces is less documented. We investigated the association of exposure to blue spaces with naturaland cause-specific mortality in Greece using an ecological study design.
METHOD:We collected socioeconomic and mortality data for 1,035 Municipal Units (MU) from the 2011
Census. To define exposure to "blue" we used the CORINE 2012 map to calculate the rate of land
cover categories associated with blue space per 10,000 people in the MU, and proximity to the coastfor MUs on the Greek coastline. We applied Poisson regression models, accounting for spatial
autocorrelation for the entire country and various geographical definitions. We assessed the sensitivityof our results to co-exposures to the air pollutants and NDVI by two-exposure models.
RESULTS:An interquartile range (IQR) increase of blue space per 10,000 was associated withdecreased risk in natural mortality (Relative Risk (RR): 0.98 (95% confidence interval (CI): 0.98,0.99), mortality due to cardiovascular and respiratory causes and diseases of the nervous system(0.98 (95% CI: 0.97, 0.99); 0.97 (95% CI: 0.95, 0.99); 0.94 (95% CI: 0.88, 1.00) respectively).
Protective associations were also detected for ischemic heart disease, COPD and cerebrovasculardisease mortality. We estimated protective associations for the distance from the coast and mortality
from the diseases of the nervous system (RR = 0.75, 95% CI: 0.61, 0.92, ≤1 km from the coast
versus >1 km). Our results were stronger in the islands, the coastline and in the rural areas andremained robust after co-exposure adjustment.
CONCLUSIONS:Our findings support the beneficial effect of exposure to blue space on mortality.
Nonetheless, additional research is required to further investigate and elucidate our results.

Keywords: Blue space, Mortality, Green Space, Air pollution

EP-095[Neurologic and mental health outcomes » Mental health outcomes]

Association of pesticide exposure withneurobehavioral outcomes among avocado
workers in Mexico
Maria José Rosa1, Cynthia Armendáriz Arnez2, Esteban Gudayol Ferré3, Manuela Prehn2, SamuelFuhrimann4, Brenda Eskenazi5, Christian H Lindh6, Ana Maria Mora5
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
2Escuela Nacional de Estudios Superiores (ENES) Unidad Morelia, Universidad Nacional Autónoma deMéxico (UNAM), Morelia, Mexico
3Facultad de Psicología, Universidad Michoacana San Nicolás de Hidalgo, Morelia, Mexico
4Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss

TPH), Basel, Switzerland
5Center for Environmental Research and Community Health (CERCH), School of Public Health,

University of California, Berkeley, Berkeley, United States
6Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund

University, Lund, Sweden

BACKGROUND AND AIM:To date, few studies have focused on the health effects of pesticide exposure
among avocado workers. We aimed to examine the association of exposure to insecticides, fungicides,
and herbicides with cognitive and mental health outcomes among avocado workers from Michoacan,
Mexico.
METHOD:We conducted a cross-sectional study of 105 avocado workers between May and August2021. We collected data on self-reported pesticide use during the 12 months prior to the baseline
survey and estimated annual exposure-intensity scores (EIS) using a semi-quantitative exposurealgorithm. We calculated average concentrations of 13 insecticide, fungicide, or herbicide metabolites
measured in urine samples collected during two study visits (8-10 weeks apart). We administered
tests from the NIH Toolbox Cognition Battery and the Brief Symptom Inventory 18 (BSI-18) to assessparticipants’ cognitive function and psychological distress, respectively. We examined individual
associations of EIS and urinary pesticide metabolites with neurobehavioral outcomes using generalized
linear regression models. We also implemented Bayesian Weighted Quantile Sum (BWQS) regression
to evaluate the association between a pesticide metabolite mixture and neurobehavioral outcomes.
RESULTS:In individual models after adjustment for multiple comparisons, higher concentrations offungicide metabolite hydroxy-tebuconazole (TEB-OH) were associated with higher anxiety (IRR=1.26,
95%CI:1.08, 1.48) and overall BS-18 scores (IRR=1.89, 95%CI:1.36, 2.75). Higher 3,5,6-trichloro-2pyridinol (TCPy) metabolite concentrations were associated with lower overall BSI-18 scores(IRR=0.69, 95%CI: 0.56, 0.85). In BWQS analyses, we found evidence of a mixture association ofurinary pesticide metabolites with higher overall BSI-18 (IRR=1.99, 95% CrI: 1.39, 2.79), anxiety(IRR=1.72, 95% CrI: 1.12, 2.55), and depression (IRR=4.60, 95% CrI: 2.19, 9.43) symptom scores.
TEB-OH and OH-T combined contributed 54%, 54%, and 40% to the mixture effect in the overall BSI18, anxiety, and depression symptom models, respectively.
CONCLUSIONS:We found that exposure to fungicides, which has been rarely studied in farmworkers,
is associated with adverse neurobehavioral outcomes among avocado workers.

Keywords: Pesticides, Mental health outcomes, Neurodegenerative outcomes, Occupational
epidemiology,

EP-096[Cancer and cancer-precursors » Incidence]

Nitrate ingestion from drinking water anddietary sources and risk of brain cancer in the
Agricultural Health Study
Mary H. Ward1, Jessica M Madrigal1, Rashmi Sinha2, Jonathan N Hofmann1, Dale Sandler3, Laura
Beane Freeman1, Rena R Jones1
1Occupational and Environmental Epidemiology Branch, National Cancer Institute, Rockville MD, USA
2Metabolic Epidemiology Branch, National Cancer Institute, Rockville MD, USA
3Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park

NC, USABACKGROUND AND AIM:N-nitroso compounds (NOC) formed from ingested nitrate/nitrite cause brain
tumors in animals. Nitrate and nitrite intakes from drinking water and diet are associated with brain
cancer in limited epidemiologic studies. We evaluated these exposures and brain cancer risk in the
Agricultural Health Study (AHS).
METHOD:The AHS is a prospective cohort of licensed pesticide applicators and their spouses in Iowa
(IA) and North Carolina (NC). Drinking water source was ascertained at enrollment (1993-1997;
N=74,919). For users of public water supplies (PWS, 25%), we linked participants’ addresses tomonitoring data for nitrate-nitrogen (NO3-N) and computed duration-specific averages. For private
well users (71%), we estimated NO3-N using random forest models based on well depth, nitrogen
inputs, soil characteristics, and other factors. Among 30,177 participants who completed the NCI
Dietary History Questionnaire (1999-2003), we assessed dietary nitrate and nitrite intakes using a
database of nitrate/nitrite in foods. Incident brain cancers were assessed from enrollment (drinking
water analyses, N=137) or first follow-up (diet analyses, N=61) through 2019 (IA) and 2014 (NC).
Adjusted hazard ratios (HRs) and 95%CI were computed using Cox regression for average drinking
water nitrate concentrations (quartiles [Q], Q4 split at 90th percentile) and tertiles (T) of dietaryintakes. We stratified by median intakes of red meat and vitamin C, factors that increase and decrease
NOC, respectively.
RESULTS:Nitrate concentrations in private wells exceeded 10mg/L NO3-N (regulatory limit, PWS) for
12% of IA and <1% of NC participants. Drinking water nitrate concentrations >7.1 mg/L NO3-N (90thpercentile) were associated with increased risk (HR=1.7, 95% CI=1.0-3.0; p-trend=0.08). We
observed some evidence of effect modification by red meat and vitamin C. There were no significant
associations with dietary nitrate and nitrite.
CONCLUSIONS:Drinking water nitrate concentrations were associated with increased risk of brain
cancer, supporting endogenously formed NOC as potential risk factors.

Keywords: cancer and cancer precursors, water quality, exposure assessment

EP-097[Air pollution » Particulate matter]

Racial and ethnic disparities between short-term
increases in ambient PM2.5 concentrations andtemperature with stillbirth among Medicaid
enrollees
Matthew Shupler1, Krista Huybrechts2, Michael Leung3, Yaguang Wei3, Joel Schwartz3, Sonia
Hernandez Diaz1, Stefania Papatheodorou1
1Department of Epidemiology, Harvard T.H. Chan School of Public Health
2Harvard Medical School, Division of Pharmacoepidemiology & Pharmacoeconomics
3Department of Environmental Health, Harvard T.H. Chan School of Public Health

BACKGROUND AND AIM:Studies examining the association between prenatal exposure to ambient fineparticulate matter (PM2.5), temperature and stillbirth risk in the US typically focus on long-term (e.g.
trimester) rather than short-term (e.g. days, weeks) exposures. Racial/ethnic heterogeneity in theeffect of short-term increases in PM2.5 or temperature on stillbirth have also been understudied.
METHOD:Within the Medicaid Analytic eXtract (MAX) dataset, 118,632 stillbirths from 2000-2014 werelinked to zip code-level average daily outdoor PM2.5 concentration and temperature. A time-stratified,case-crossover design using a distributed lag non-linear model (0 to 6-day lag) estimated the odds ofstillbirth associated with increases in exposures, with an index date set at two days prior to thestillbirth date of diagnosis. Disparities in the association by maternal race/ethnicity (Black, White,
Hispanic, Asian, American Indian) and median household income were assessed.
RESULTS:A 10 μg/m³ increase in average daily PM2.5 concentration was associated with increased
odds of stillbirth on the index date (lag 0) (1.10% (95%CI:[0.22,1.98]) through lag 3 (0.45%
95%CI:[0.01,0.89]) and over the entire lag period (lag 0–6) (3.17% 95%CI:[0.07,6.37]). The
temperature-adjusted odds of stillbirth due to PM2.5 from lag 0 to 4 days and lag 0-6 days was higher
among Black individuals (lag 0-6: 9.31% 95%CI:[3.45,15.51]) than White individuals (lag 0-6: 2.75% 95%CI:[-8.43,3.29]). Within the lowest income zip codes, a stronger association existed with
PM2.5 among Black mothers (e.g. lag 0-6: 14.13% (95%CI:[4.51,24.65]) compared with White
mothers (e.g. lag 0-6: 2.88% 95%CI:[-8.26,15.38]). A 1ºC temperature increase was not associatedwith stillbirth risk.
CONCLUSIONS:Short-term increases in PM2.5 exposures were associated with stillbirth among
Medicaid recipients, particularly Black enrollees. Racial/ethnic minorities are more vulnerable toenvironmental exposures exacerbated by climate change.

Keywords: PM2.5, temperature, stillbirth, case-crossover, short-term exposureEP-098[Air pollution » Particulate matter]Put your money where gas stoves fit: Household
air pollution measurements in sub-SaharanAfrica to prioritize locations for cooking
intervention
Matthew Shupler1, Theresa Tawiah2, Emily Nix1, Miranda Baame3, Federico Lorenzetti1, EmmanuelBetang3, Ryan Chartier4, Judith Mangeni5, Rachel Anderson De Cuevas1, Edna Sang5, Ricardo
Piedrahita6, Michael Johnson6, Daniel Wilson7, Seeba Amenga Etego2, Mieks Twumasi2, Sara Ronzi1,
Diana Menya5, Elisa Puzzolo1, Reginald Quansah8, Kwaku Poku Asante2, Daniel Pope1, Betrand
Mbatchou Ngahane3
1Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom
2Kintampo Health Research Centre, Kintampo, Ghana
3Douala General Hospital, Douala, Cameroon
4RTI International, Research Triangle Park, North Carolina, USA
5School of Public Health, Moi University, Eldoret, Kenya
6Berkeley Air Monitoring Group, Berkeley, California, USA
7Geocene Inc., Berkeley, California, USA
8School of Public Health, University of Ghana, Ghana

BACKGROUND AND AIM:Cleaner cooking fuels like liquefied petroleum gas (LPG) emit less fineparticulate matter (PM2.5) and carbon monoxide (CO) than polluting fuels (e.g. wood, charcoal). Yet,some clean cooking interventions have not achieved substantial exposure reductions.
METHOD:The CLEAN-Air(Africa) study measured 24-hour PM2.5 and CO kitchen concentrations(n=262), female cook (n=223) and child (n=119) exposures in peri-urban Kenya, Ghana and
Cameroon among households cooking primarily with LPG, wood or charcoal. Stove use monitoring wasused to derive mean ‘cooking’ and ‘non-cooking’ PM2.5 and CO levels.
RESULTS:The mean 24-hour PM2.5 kitchen concentration among households cooking with charcoal(317 μg/m3) was quintuple that among households using LPG (61 μg/m3) in Kenya, but only 2 μg/m3
higher in Ghana (56 versus 54 μg/m3, respectively). The mean CO kitchen concentration inhouseholds cooking with charcoal was twice the WHO guideline (7 ppm) in Kenya (15.81 ppm) but
below the guideline in Ghana (1.77 ppm). The mean PM2.5 kitchen concentration among households
using wood in Cameroon was four times higher while cooking (811 μg/m3) than not cooking (202μg/m3). Among households using charcoal in Ghana, the mean PM2.5 kitchen concentration was lower
when cooking (42 μg/m3) than not cooking (67 μg/m3). Mean PM2.5 cook exposures only met the
WHO interim-1 target (35 μg/m3) among LPG users staying indoors and living >10 minutes from a
road.
CONCLUSIONS:Clean cooking interventions should be prioritized in certain sub-Saharan African
communities to increase the likelihood of PM2.5 exposure reductions and associated health benefits.

Keywords: household air pollution, PM2.5, CO, LPG, cooking

EP-099[Air pollution » Oxides of nitrogen]

Short-term increases in NO2 and O3
concentrations and odds of stillbirth among U.S.
Medicaid enrollees: A time-stratified casecrossover study
Matthew Shupler1, Krista Huybrechts2, Michael Leung3, Yaguang Wei3, Joel Schwartz3, Sonia
Hernandez Diaz1, Stefania Papatheodorou1
1Department of Epidemiology, Harvard T.H. Chan School of Public Health
2Harvard Medical School, Division of Pharmacoepidemiology & Pharmacoeconomics
3Department of Environmental Health, Harvard T.H. Chan School of Public Health

BACKGROUND AND AIM:Few national studies have assessed the relationship between short-term (i.e.
day, week) increases in gaseous pollutant (nitrogen dioxide (NO2), ozone (O3)) concentrations andstillbirth risk in the US. National racial and ethnic disparities in the association between short-term
increases in gaseous pollutant concentrations and stillbirth have also not been investigated.
METHOD:Within the Medicaid Analytic eXtract (MAX) dataset, 114,799 stillbirths from 2000-2014 werelinked to zip code-level average daily outdoor NO2 and O3 concentrations. We used a time-stratified,case-crossover design to compare NO2 and O3 exposures on the case day with those the same
weekday within the calendar month. A distributed lag non-linear model was used to estimate the
distributed (lag0-lag6) and cumulative odds of stillbirth due to short-term increases in NO2 and O3
exposures, controlling for PM2.5 concentrations and temperature (individual-level confounders
controlled by design). We explored effect modification by race/ethnicity (Black, White, Hispanic, Asian,
American Indian).
RESULTS:Nationally, a short-term, 10 ppb increase in NO2 (lag0-6: -0.88 95%CI:[-2.43%,0.70%])
and 10 ppm increase in O3 concentration (lag0-6: -0.21 95%CI:[-1.35%,0.94%]) were not associatedwith stillbirth odds. Among American Indians, each 10 ppb increase in lag0-lag6 cumulative average
daily NO2 exposure was not statistically significantly associated with odds of stillbirth (7.12%
95%CI:[-9.83%,27.27%]; however, a significant association was found at lag0 (5.66%
95%CI:[0.57%,11.01%]) and lag1 (4.08% 95%CI:[0.22%,8.09%]), with the risk declining from lag0
to lag6 days. No national-level associations were found for NO2 concentrations among other racial andethnic groups, nor for short-term increases in O3 concentrations.
CONCLUSIONS:No associations between short-term increases in gaseous pollutant concentrations andstillbirth were found at a national level. However, there was suggestive evidence of an association
between short-term, single-day increases in NO2 concentrations and stillbirth risk among American
Indian Medicaid recipients, highlighting the importance of further evaluating sources of NO2 pollution
in this population.

Keywords: NO2, O3, stillbirth, case-crossover, air pollution

EP-100[Exposures » Microplastics]

A comprehensive approach to determine routesof human exposures to micro and nanoplastics
in water and health effects
Max A Zarate Bermudez1, Janie Renee Hils2, Gaston Casillas3, Michael Yeh4, Yulia Iossifova Carroll5
1Water, Food, and Environmental Health Services Branch, Division of Environmental Health Scienceand Practice, National Center for Environmental Health, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
2Water, Food, and Environmental Health Services Branch, Division of Environmental Health Scienceand Practice, National Center for Environmental Health, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
3Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Centers for

Disease Control and Prevention, Atlanta, Georgia, USA
4Emergency Management, Radiation, and Chemical Branch, Division of Environmental Health Scienceand Practice, National Center for Environmental Health, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
5Division of Environmental Health Science and Practice, National Center for Environmental Health,Centers for Disease Control and Prevention, Atlanta, Georgia, USA

BACKGROUND AND AIM:To present a comprehensive approach for conducting a systematic review(1990-2022) to determine routes of human exposures to micro and nanoplastics (M-NPs) in water andassess the potential health effects.
METHOD:We registered our protocol in PROSPERO. Searching eight databases resulted in 6,472
scientific publications. Using Covidence, we eliminated duplicates, completed screening 6,417 titles
and abstracts (stage 1) and reviewing 744 full texts (stage 2), and are finishing data extraction (stage3) of 253 publications. We developed the inclusion criteria and reasons for exclusion for stages 1 and
2, and templates for data extraction and quality assessment for stage 3. To ensure transparency andproduce reliable summaries of scientific knowledge, the inclusion of publications at each stage
required that two reviewers, working independently, arrive at the same agreement.
RESULTS:Publications selected for data extraction cover areas showing our comprehensive approach
to better understand (1) how M-NPs reach freshwater systems, drinking water treatment plants, tap
and bottled water, (2) the potential routes of human exposures to M-NPs in water, and (3) theadvances in determining the effects of M-NPs on human cells at laboratory scale. Preliminary findings
confirm that methods for sampling, sample preparation, M-NPs isolation, size and shapedetermination, and characterization are not standardized despite authors recommending this needsince mid-2010s.
CONCLUSIONS:Recently, researchers found M-NPs in blood and lungs confirming human exposure to
M-NPs, though exposure routes remain unproven. Those findings elevated the importance of human
exposures to M-NPs as a public health and environmental epidemiology issue. In the water field,
hazard identification, exposure assessment, and dose-response assessment will require the sounddetermination of human exposures to M-NPs. Thus, standardizing methods for sampling, sample
preparation, and full M-NPs characterization remains urgent. We expect that our findings willcontribute with efforts researchers are conducting to address this public health challenge.

Keywords: exposures, microplastics, environmental epidemiology, water quality

EP-101[Outcomes » Obesity and metabolic disorders]

Association of water arsenic and uranium
exposures with incident diabetes in Indigenous
US communities: The Strong Heart Study
Maya Spaur1, Marta Galvez Fernandez1, Melissa A Lombard2, Qixuan Chen3, Benjamin C Bostick4,
Ana Navas Acien1, Anne E Nigra1
1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA
2U.S. Geological Survey, New England Water Science Center, Pembroke, NH, USA
3Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
4Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA

BACKGROUND AND AIM:In the United States (US), type 2 diabetes (T2D) affects approximately 37.3
million people (11.3% of the population), with the highest burden in American Indian communities.
Toxic metal exposures have been identified as risk factors of T2D. Most studies rely on biomarkers,
which could be affected by early disease processes. Studies directly measuring metals in drinking
water in US populations have been limited. We examined the association of arsenic and uranium
exposures in community water systems (CWS) and private wells with T2D incidence in American
Indian communities to address current limitations in direct associations between metal exposures and
T2D.
METHOD:We evaluated adults in the Strong Heart Family Study (SHFS) free of T2D at baseline (20012004) and followed through 2010, with available water arsenic (N=1,737) and uranium (N=1,559)
estimates assigned by residential zip code. We used mixed effects Cox models to account forclustering by family and residential zip code, modeling the association between log-transformed
arsenic and uranium per linear and non-linear (restricted cubic splines) interquartile range (IQR)
change and the risk of T2D. We also assessed cross-sectional associations between water arsenic anduranium levels and prevalent prediabetes at baseline.
RESULTS:T2D incidence in the SHFS was 13.5% (mean follow-up 5.6 years). After adjustment for sex,
education, smoking status, body mass index, and estimated glomerular filtration rate, the hazard ratio(95% CI) of incident diabetes excluding prediabetes was 1.06 (1.02, 1.10) and 1.30 (0.79, 2.14)
comparing 75th vs. 25th percentiles of private well and CWS arsenic, respectively. Public water andprivate well uranium were not associated with incident T2D, however private well uranium was
associated with prevalent prediabetes (odds ratio = 1.28 (1.02, 1.59)).
CONCLUSIONS:Water arsenic levels were associated with T2D incidence and prediabetes prevalence.
Water uranium was associated with pre-diabetes but not with incident diabetes.

Keywords: environmental epidemiology, water quality, cardiovascular diseases

EP-102[Exposure assessment methods » Exposure assessment-general]

Construction of a scale to assess
multidimensional vulnerability to pesticides inhorticultural production in the Food Region of
Córdoba
Melisa Florencia Romero Asís, Mariana Andrea Eandi, Mariana Butinof
Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Ciudad deCórdoba, Argentina

BACKGROUND AND AIM:To identify and validate dimensions for the construction of a Socio-sanitary
Vulnerability Scale (SVS) as an input for integrated pesticide surveillance in the horticultural context of
the Food Region of Córdoba (FRC).
METHOD:A cross-sectional correlational observational study was carried out. Living conditions, workand exposure to pesticides of horticulturists of the FRC (n=198) in the period 2019-2020 weresurveyed. Variables were identified in 4 dimensions (D) to address aspects linked to vulnerability inthe horticultural context: D1 occupational exposure to pesticides (use of personal protective
equipment); D2 tracer health events (presence of symptoms, diseases and self-reported accidents);
D3 housing conditions (availability of basic services -water, electricity, drainage, sanitation-); D4
material conditions of horticultural production (land tenure, type of machinery and agricultural tools).
The variables that make up each dimension were selected from the application of principal component
factor analysis, including those with loadings greater than 0.40 in the first factor. To evaluate thereliability of the dimensions, Cronbach's α coefficient was applied, considering a score greater than
0.70 to be adequate. Stata 16 was used.
RESULTS:The set of dimensions (D1, D2, D3, D4) obtained a total score of 0.72 on Cronbach's α forthe 19 items. The individual score for the constructed scale was at D1 α=0.79; D2 α=0.73; D3, α=0.76 and D4 α=0.71.
CONCLUSIONS:The SVS promises to be a robust method for conducting epidemiological surveillance inthe horticultural context, its multidimensional nature will allow addressing the complexity of exposure
to pesticides It is planned in later stages the evaluation through a panel of experts in the subject forthe confection of the EVS.

Keywords: Pesticides, Vulnerability, Exposure, HorticultureEP-103[Exposure assessment methods » Exposure assessment-air pollution]

Realtime personal exposure and dosimetry
assessment in susceptible population
Min Ji Park, Kyung Jun Jeong, Yong Jin Lee
institute for environmental research, college of medicine, yonsei university, seoul, south korea

BACKGROUND AND AIM:Personal exposure to fine particle is reported to be determined by theconcentration of Micro-environment and time of residence at each location. Therefore, information on
time-based places of residence is considered an essential factor in estimating time-weighted exposure
to personal pollutants. Exposure at the same concentration and time is an important part of exposure
assessment because the intensity of exposure varies according to changes in breathing depending on
individual activities. Therefore, a personal exposure assessment is required that considers thecorrelation between pollutants, micro-environment, exposure period, and activity intensity that canreflect the life style of receptors.
METHOD:In this study, personal exposure assessment was conducted by selecting cohort-based
susceptible groups to check the amount of fine particle exposure. A total of 60 personal exposure
assessments were conducted with 20 residents living in the industrial complex, 20 people withcirculatory diseases, and 20 people with respiratory diseases. We conducted an exposure assessment
for 5 days per person to collect environmental exposure information and wrote a daily activity diary byhand whenever the subject moved in space to identify the Micro-environment according to the time.
The fine particle measurement used AIR HEART-P21, a light scattering portable device. Individual
activity measurements were recommended to wear an accelerometer around the waist and were notworn during showers and bedtime. Based on the measured fine particle concentration(㎍/㎥) andactivity intensity, the daily exposure amount(㎍/day) was calculated through the correlation of
respiration rate(㎥/hr) in the Korean exposure factors handbook.
RESULTS:The average fine particle daily exposure for all subjects was 110 ㎍/day, and the averagefine particle daily exposure for each cohort was 132 ㎍/day for industrial complexes, 118 ㎍/day forcirculatory diseases, and 81 ㎍/day for respiratory diseases.
CONCLUSIONS:The results of higher exposure were shown in the order of industrial complex,
circulatory, and respiratory system subjects.

Keywords: Air pollution, Particulate matterEP-104[Exposures » Environmental disparities]

Quality of Place: A Measurement Model
Ming Wen1, David Curtis2, Sara Grineski3, Dennis Wei4, Yue Zhang5
1Department of Sociology, University of Hong Kong
2Department of Family & Consumer Studies, University of Utah
3Department of Sociology, University of Utah
4Department of Geography, University of Utah
5Department of Internal Medicine, University of Utah

BACKGROUND AND AIM:Neighborhood social, economic, built, and physical environmental features
are often correlated with each other. For example, neighborhoods with lower incomes and higher
poverty rates may also have fewer community resources and more exposure to environmental hazards
such as air pollution. Similarly, neighborhoods with higher rates of crime may also have poorly
maintained buildings and streets, as well as limited access to healthy food options and otheramenities. These environmental factors can have negative impacts on physical and mental health,social well-being, and economic outcomes. That said, the relationships among different place features
may be complex. On the one hand, poverty is often associated with limited access to green spaces,
including parks. On the other hand, access to green spaces is also linked to air pollution because, inmany cities, parks are located near major roadways, which can lead to exposure to higher levels of
traffic-related air pollutants. And how these structural, physical, and built environmental features
related to social and organizational features at the place level are largely unknown. These different
aspects of “place quality” have only been studied in fragmentation. The purpose of this study is to 1)
compile a fuller list of place-based data in the United States to comprehensively measure place social,
built, and physical environmental features; 2) examine their correlations to identify the constituent
elements of place quality that are conceptually coherent and empirically clustered; and 3) investigate
the associations between the quality of place with racial and economic segregation to test the“environmental justice” framework.
METHOD:We will use data from the 2010 US census and a range of open sources and employ bothtraditional statistical methods and big data methods to examine our research questions.
RESULTS:We haven't completed data analysis here.
CONCLUSIONS:Will add here and finish a complete manuscript before the meeting.

Keywords: concentrated disadvantage, segregation, social capital, air pollution, build environmentEP-105[Air pollution » Particulate matter]

Long-term Exposure to Particulate Matter andMortality between General Population andCancer Patients in South Korea
Miyoun Shin, Sun Young Kim
Graduate School of Cancer Science and Policy, National Cancer Center

BACKGROUND AND AIM:Exposure to particulate matter (PM) has been reported as a major
environmental hazard to human health. Although many studies found the associations with mortality
and its susceptibility in patients with diabetes and heart diseases, few studies paid attention to cancer.
The aim of this study is to compare the associations between long-term exposure to PM with all-cause
and cause-specific mortality for the general population to those for cancer patients and survivors in
the Seoul Metropolitan Area, South Korea, using a population-based cohort.
METHOD:Using the National Health Insurance Services-National Sample cohort, we selected thesubjects who received health screening during 2005-2007, had full address information, and wereaged 30-80 without severe disability. We defined cause-specific mortality based on the International
Classification of Disease, 10th reversion. Individual-level long-term PM concentrations were estimatedfor the previous 5 years from each year for 2002-2015 by a previously-developed prediction model.
We performed time-dependent Cox proportional hazards model to estimate hazard ratios (HRs) and
95% confidence intervals per 10 ug/m3 increase in PM2.5 and PM10 adjusting for sociodemographic
characteristics, family history of cancer, and health behaviors.
RESULTS:Our study population of 91,017 adults include 90,092 people without cancer for 2002-2006
and 925 cancer patients and survivors. We observed significant or marginal associations with all-cause
and cardiopulmonary mortality for the general population (PM2.5: HR=1.22-1.56; PM10:1.05-1.19),
but no associations for cancer patients and survivors (PM2.5: HR=1.11-1.32; PM10: 0.90-1.01).
Although HRs for cancer and lung cancer mortality were not statistically significant, cancer patientsand survivors showed higher HRs than the general population.
CONCLUSIONS:Our findings for cancer patients and survivals suggest the susceptibility of PM effectfor cancer mortality but not for total and cardiopulmonary mortality. Future studies using an extended
population should re-examine the association.

Keywords: Particulate matter, Mortality

EP-106[Exposures » Other (to be specified with keywords in the keywords section)]

Receptor-based aggregate exposure estimation
for children’s personal care and cosmetic
products in Korea
Miyoung Lim1, Kiyoung Lee2
1Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
2Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea

BACKGROUND AND AIM:To manage the risk of consumer chemical exposure, realistic exposure
estimation through aggregate exposure from multiple consumer products are considered. Accurate
aggregate exposure assessment should be based on individual’s exposure factors. Due to children’s
product usage patterns are strongly related to the demographic characteristics, receptor-based
aggregate exposure assessment is required. The aim of this study was to estimate aggregate
exposure of parabens in multiple personal care and cosmetic products (PCCPs) by Korean children.
METHOD:We collected exposure factors of 11 PCCPs (shampoo, body wash, soap, hand wash, body
lotion, body oil, baby powder, sunscreen, lip care, nail makeup, and lip makeup) by face-to-faceinterviews. The survey was conducted to 20,000 households with children aged 0-12 years in twice,
July to October 2017 and February to March 2018. The number of subjects was determined byproportional quota sampling based on the children’s gender, age, and region distribution. Aggregate
exposures were calculated for methyl-, ethyl-, propyl- and butyl- paraben according to individuals'
exposure factor response and simultaneous PCCPs use. Children’s
RESULTS:PCCPs use rates were ranged 7.5-98.7% for 11 products. Average number of simultaneous
PCCPs use was 5.45 ± 1.43. A worst-case exposure (0.4% parabens to each PCCPs) estimatedaggregate exposures of paraben for 13.3 µg/kg-bw/day to 95th percentile population. Total 0.18% of
population (36 users) exceeded 5 mg/kg-bw/day of paraben. Total 0.02% of population exceeded
exposure safety level of 10 mg/kg-bw/day for methyl- and ethyl-paraben. The PCCPs with highest
contribution was lotion.
CONCLUSIONS:These aggregate exposure data would be useful input data for risk assessment andregulation of parabens in PCCPs for children.

Keywords: aggregate exposure, personal care products, cosmetics, children, parabenEP-107[Outcomes » Childrens environmental health]

Challenges when estimating the environmental
burden of disease for children in Germany
Myriam Tobollik1, Sarah Kienzler2, Dirk Wintermeyer2, Dietrich Plass2
1Department Environmental Medicine and Health Effects Assessment, German Environment Agency,

Berlin, Germany
2Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin,

Germany

BACKGROUND AND AIM:In most European countries, children are a comparably healthy population.
However, long-term environmental exposures, even at lower levels, starting early in life or even
before birth can negatively impact children’s health. Our aim was to estimate the environmental
burden of disease (EBD) attributable to a selected set of environmental risk factors for children aged 3
to 17 years in Germany.
METHOD:Using the EBD approach we estimated various health indicators such as disability-adjusted
life years for the selected environmental risk factors. Current exposure and health data for children
were derived from the fifth population-representative German Environmental Survey (GerES V 20142017).
RESULTS:Quantifications were performed for 5 out of 18 risk factors: secondhand smoke, Bisphenol A,
traffic noise, benzene and particulate matter. One limitation was that we hardly could use the GerES V
data for the assessments, because for several risk factors, the measured exposure levels were too low
and thus would not result in any quantifiable disease burden. However, it does not mean, that theidentified concentrations were generally uncritical. Though, it was challenging to combine exposureresponse functions identified by systematic literature searches with the survey data. For traffic noiseand particulate matter, we used other exposure data, even though they did not only focus on children
but on the general population.
CONCLUSIONS:The EBD method needs several input data, which are not readily available for childrenin Germany hampering a comprehensive overview of their EBD.

Keywords: Environmental epidemiology, Exposure assessment, Risk assessment

EP-108[Chemical exposures » Pesticides]

The situation of agricultural pesticide use andits human health hazards in Iran, A qualitative
study
Mohammad Amin Farahmandfard1, Narges Khanjani2
1Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
2Department of Medical Education, Paul Foster School of Medicine, Texas Tech University Health

Science Center El Paso, El Paso, Texas, USA

BACKGROUND AND AIM:Agricultural pesticide poisoning is a common and serious occupational hazard
for farmers in developing countries. In this study we try to explain the pattern of agricultural pesticide
use and its hazards in Iran.
METHOD:In this qualitative study, purposeful sampling was performed, and 8 farmers and 2
agriculture engineers participated in this study. Semi-structured in-depth interviews were used tocollect information. Then, qualitative theme analysis was performed.
RESULTS:Information collected about the situation of pesticide use in Iran, was categorized in four
themes. First, “No supervision on the use and distribution of pesticides”. Second, “Farmers’ knowledge
is inadequate about the hazard of pesticides and no organization is responsible for educating them”.
Third “Safety instructions are not obeyed and the hazardous effects of pesticides are frequently
observed among farmers”. Fourth, “The use of pesticides is irrationally high in Iran”.
CONCLUSIONS:Serious action should be taken to prevent the human health hazards of pesticides in
Iran, including comprehensive training programs about proper preparation, storage and use of
agricultural pesticides for farmers and pesticide retailers. Also, it is necessary to continuously
supervise pesticide sales, distribution and use in the country.

Keywords: Pesticides, Policy and Practice, Occupational ExposuresEP-109[Climate » Temperature extremes and variability]

The ascending trend of Valley Fever in El Paso,
TX, and its association with regional climate andatmospheric factors
Gabriel Ibarra Mejia1, Narges Khanjani2
1Department of Public Health Sciences, University of Texas at El Paso, El Paso, TX, USA
2Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health

Sciences Center El Paso, Texas, USA

BACKGROUND AND AIM:This study aimed to assess the trend of reported human Coccidioidomycosis(Valley Fever -VF) cases and determine the association between weather variables and the incidenceof VF in El Paso, Texas, from 2023-2022. Many studies associate the incidence of valley fever in thesouthwest US with weather and climate variables.
METHOD:We collected incidence data of Coccidioidomycosis cases from the City of El Paso Notifiable
Conditions Report from 2013 until 2022. Weather data, including monthly precipitation total, minimum
monthly temperature, average monthly temperature, and maximum monthly temperature, wasdownloaded from the National Weather Services website. The incidence data were summarized in
descriptive tables. A trend analysis was performed using a three-month centered moving averagemethod corresponding to the duration of each season, complemented with a linear regression
analysis. In addition, correlation tests were performed between the monthly weather variables and thecount of Coccidioidomycosis per month, with lags up to 18 months.
RESULTS:During this time, 246 valley fever cases were recorded in the El Paso region. The numbers
were higher in July and August and in summer and spring. The disease trend has increased (R² =0.5497), with an apparent bi-yearly seasonality effect. The number of positive cases of VF after fourmonths' lag was inversely related to total monthly precipitation (r=-0.204, p=0.028) and directly
related to maximum monthly temperature (r=0.184, p=0.046) after one month's lag. No othersignificant correlation was observed.
CONCLUSIONS:There is a current and significant rising trend in the incidence of VF in the El Paso, TX
region. Climate variables such as temperature and precipitation are likely to affect the incidence of VF
in the El Paso region; however, more investigation is needed. Moreover, promoting increased
community and healthcare provider awareness of this infection remains a crucial responsibility for
public health officials.

Keywords: Climate, Infectious diseases, Particulate matter, TemperatureEP-110[Birth and pregnancy outcomes » Birth outcomes]

Lead and Mercury untrauterine exposure andBirth weight: Birth cohort in an urban área PIPA UFRJ
Nataly Damasceno De Figueiredo1, Ana Paula Natividade Oliveira4, Monica Seefelder De Araujo3,
Volney De Magalhaes Camara3, Carmen Ildes Rodrigues Froes Asmus2
1Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Maternity School,

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Public Health, Souza
Marques Medical School, Rio de Janeiro, Brazil
2Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Medicine School,

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
3Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
4Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

BACKGROUND AND AIM:This study aimed to evaluate prenatal exposure to lead and mercury and theireffects on birth weight.
METHOD:The study population consisted of newborns delivered at the maternity-school of UFRJ
between June 2021 and July 2022. A total of 750 newborns were included. Mothers' characteristics
were obtained through a questionnaire applied at pregnancy third trimester. Lead and Mercury weremesured at umbilical cord blood samples. Pearson correlation was used to assess the correlation
between lead and mercury levels. Birth weight was evaluated based on adequacy for gestational age.
The reference values (RV) considered for lead and mercury exposure were 3.5 μg/dL and 5.0 μg/L,
respectively. The effects were measured using risk ratio (RR) and hypothesis tests.
RESULTS:The detection rate for lead and Mercury were 98.9% and 94.5%, respectvely. 2.4% (18) of
the newborns had lead blood levels above RV, and 2.3% for Hg. Lead and mercury concentrations
showed a significant positive correlation (r = 0.16, p = 0.000). Babies with mercury levels above themedian for the study population (0.8 μg/dL) had a 3.5 times higher risk of having lead levels above
the reference value for this metal (p = 0.025). Babies with lead levels above the median had a twofold higher risk compared to those with lead levels below the median (RR = 1.9, p = 0.05) of being big
for gestational age (BGA). When comparing lead concentrations above the reference value, the risk
ratio was 3.9 (p = 0.005). Mercury did not show an association when the cut-off was the reference
value; for mercury levels above the median, the risk ratio was 1.55 (p = 0.25). Baby gender,
maternal diabetes, and body mass index were considered confounding factors.
CONCLUSIONS:Higher lead concentrations were associated with an increased risk of being big for
gestational age.

Keywords: Metals exposure, metal mixture, environmental pollutants, birth weight, Birth outcomesEP-111[Methods » Methodological study design]Childhood and Environmental Pollutants Project(PIPA UFRJ): Retention Strategies in a BirthcohortNataly Damasceno De Figueiredo1, Ana Paula Natividade Oliveira4, Monica Seefelder De Araujo3,
Volney De Magalhaes Camara3, Carmen Ildes Rodrigues Froes Asmus2
1Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Maternity School,

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Public Health, Souza
Marques Medical School, Rio de Janeiro, Brazil
2Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Medicine School,

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
3Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
4Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

BACKGROUND AND AIM:A Birth Cohort is an opportunity of pollutants concentrations measurement at
different biological matrix and clinical and subclinical effects follow up at the first cycle of life. The
PIPA-UFRJ project is a longitudinal study that follow children from pregnancy to 4 years old to accessthe environmental pollutants effects on fetal and childhood development. AIM: To describe steps,
retention strategies and study progress.
METHOD:The study included babies born at UFRJ-maternity-school, which mothers had >16years old
and lived at Rio de Janeiro city. Metals, organochlorine, pyrethroids and PFOAS were analyzed atmother and baby’s samples. Outcomes: Birth, weight gain and other anthropometric outcomes,
respiratory, allergic and neurodevelopment. The planning and execution stages and strategies used forrecruitment and retention at follow-up were described.
RESULTS:The cohort recruited was accomplished from June 2021 to July 2022 and adherence rate was
80%. 907 pregnant and 844 babies were recruited. 865 (94%) blood samples and 824 (89%) urine
samples from pregnant, and 792 (94%) umbilical cord blood samples were collected. So far, 86% of
the babies have been returned at least one of the following periods (3rd, 6th, or 1st year) and 50%
had returned at the 3 moments. 846 Breast milk samples were collected (3rd and 6th month); 1580
baby urine (3rd, 6th, and 1st). Strategies: Involvement of the institution's professionals in sample
collection, with prior and ongoing training. With the mothers: welcome visit to the birth in the ward,
help with transport and snacks for the day of follow-up, small whatsapp groups of mothers, telephone
contact to accompany the baby and simulation of appointments; Active search of families via local
health unit; creation of a council of families to define strategies for approaching.
CONCLUSIONS:The study has a good adherence rate >80% and retention >86% at the end of the 1styear of follow-up.

Keywords: Birth Cohort, Environmental pollutants, Birth and pregnancy outcomes, Methodologicalstudy designEP-112[Chemical exposures » Endocrine disrupting chemicals]

Bisphenol A and Cancer: A critical review of theepidemiologic literature for hazard assessment
Neela Guha, Gwendolyn Osborne, M. Elizabeth Marder, Martha S. Sandy, Meng Sun, Nancy Firchow,
Vincent J. Cogliano
Office of Environmental Health Hazard Assessment, California Environmental Protection Agency,
Oakland, USA

BACKGROUND AND AIM:Bisphenol A (BPA) is a high production volume chemical with extensive
consumer and industrial applications. BPA is detected in the majority of the US general population,
despite a short half-life (< 6 hours) and declining exposures. We comprehensively reviewed theepidemiologic literature on the carcinogenicity of BPA and key considerations of exposure
characterization needed to interpret these studies.
METHOD:Multiple biomedical databases were searched until March 2023 for peer-reviewed
publications on BPA exposure and human cancer. Eighty-three records were identified. All analyticalepidemiologic studies were included (38 studies). Study quality evaluation included a detailed bias
assessment, using principles of systematic review. PRISMA guidelines were followed.
RESULTS:Potential for information bias posed the greatest challenge for interpreting the human cancer
studies. Reliably characterizing long-term BPA exposure was limited by use of short-term biomarkers
that reflect recent exposure and lack of longitudinal measurements to characterize temporal variation.
Urinary BPA was measured at a single time point, post-diagnosis in most studies; limitations werereverse causation and inability to capture the time window of susceptibility. Past BPA exposure
estimated via questionnaire or job exposure matrix in few studies were also limited. For most cancers,
only one study was available, with the exception of the thyroid, lung, colorectum, prostate (≤3 studieseach), and breast (13 studies). For breast cancer, the associations with BPA were inconsistent.
CONCLUSIONS:The epidemiologic evidence was inadequate to evaluate the carcinogenicity of BPA.
Limitations included unreliable estimation of long-term BPA exposure, few studies by cancer site, lackof consistency, and low exposures because all studies were conducted in the general population.
Therefore additional studies are warranted, particularly in workers highly exposed to BPA, ideally withprospective and longitudinal collection of quantitative exposure data as well as sufficient follow-up forcancer morbidity or acute endpoints in established mechanisms of carcinogenesis.

Keywords: Cancer and cancer precursors, Phenols, Environmental epidemiology, Biomarkers of
exposure, Risk assessment

EP-113[Built environment » Green space]

The association between greenery type and gut
microbiome in schizophrenia: Did all
greenspaces play the equivalent role?
Ning Wei, Xuanxuan Li, Jingtao Liu, Jiajun Yuan, Rong Song, Rubing Pan, Hong Su
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University,
Hefei, Anhui, 230032, China

BACKGROUND AND AIM:In recent years, attention has been focused on the benefit of greenspace on
mental health, and it is suggested this link may vary with the type of greenery. As more and morestudies highlighting the influence of the gut microbiome on SCZ, however, the effect of greenspace on
SCZ gut microbiome and further the effect of different greenery types on gut microbiome remain
unclear. We aim to examine if there were variations in the effects of various greenery types on the gut
microbiome in SCZ. Besides, we sink to explore important taxonomic compositions associated withdifferent greenery types.
METHOD:We recruited 243 objects with schizophrenia from Anhui Mental Health Center and collectedfecal samples for 16S rRNA sequencing. Three types of greenery coverage were calculated withdifferent circular buffers (800 m, 1500 m, 3000 m) corresponding to individual addresses. The
association between greenspace and microbiome composition was analyzed with permutational
analysis of variance (PERMANOVA). We conducted the linear regression to capture specific gut
microbiome taxa associated with greenery coverage.
RESULTS:Tree coverage was consistently associated with microbial composition in both 1500 m(R2=0.007, P=0.030) and 3000 m (R2=0.007, P=0.039). In contrast, there was no association withgrass cover in any of the buffer zones. In the regression analysis, higher tree coverage wassignificantly correlated with the relative abundance of several taxa. Among them, tree coverage waspositively associated with increased Bifidobacterium-longum (β=1.069, 95% CI: 0.419-1.720), which
was the dominant composition in the gut microbiota.
CONCLUSIONS:The relationship between greenspace and gut microbiome in schizophrenia patientsdiffered by type. Besides, “tree coverage” may present a dominant effect on the important taxonomic
composition. Our findings might provide instructive evidence for the design of urban greenspace tooptimize health and well-being in SCZ as well as the whole people.

Keywords: Green space, Microbiome, Biodiversity

EP-114[Exposure assessment methods » Exposure assessment-biomarkers of exposure]Environmental and biological monitoring: Risk
assessment for arsenic exposure throughgroundwater in a rural community of Uruguay
Paulina Pizzorno1, Mariano Cáceres1, Angela Torres1, Valery Bühl2, Nelly Mañay1
1Área Toxicología, Facultad de Química-Udelar Montevideo (11800), Uruguay2Área Química Analítica, Facultad de Química-Udelar, Montevideo (11800), Uruguay

BACKGROUND AND AIM:Arsenic in drinking water is a major health issue affecting millions of people
across the world. Arsenic is a well-known human carcinogen, and dietary exposure has been proven to
be the major source´s pathway to the human body. General population exposure to inorganic arsenic
mostly occurs through the consumption of groundwater. Those sources of drinking water often havemeasurable arsenic levels and several regions of Uruguay have shown naturally higher levels than the
WHO's maximum recommended value.
To assess human health risks, the concentration of toxicologically relevant arsenic species in urine hasoften served as a biomarker that indicates recent exposure to inorganic arsenic considering that urine
is the main route of excretion.
This work aims to assess human exposure to inorganic arsenic through groundwater in a population ina rural area near the town of San Antonio
METHOD:The studied area is a rural region with 1650 inhabitants. 33 local families were visited, andthe owners were asked to voluntarily participate in a survey providing groundwater and urine samples.
The survey consisted of personal interviews and recorded relevant data such as average liters of water
consumption per family, food intake, along with personal.
47 urine and 33 drinking groundwater samples were later refrigerated and brought to the laboratory
for arsenic determination using HG- MIP-OES.
RESULTS:Results in drinking water showed more than 97% of analyzed samples with higher levels ofarsenic than WHO´s guidelines.
Urine toxicologically relevant arsenic species concentrations results ranged from non-detect levels to
70.5μg/L which were correlated by Spearman’s correlation coefficient (r=0.35,p-Value=0.03) andreflect current exposure to this contaminant in groundwater, can be considered of moderately tohighly human health risks.
CONCLUSIONS:Consequently, these urinary arsenic levels, should be monitored in this, an others
rural areas in future environmental health surveillance programs, which are not yet implemented in
Uruguay.

Keywords: Biomarkers of exposure, Exposure assessment, Water quality, Risk assessment, Heavy
metalsEP-115[Other » Other (to be specified with keywords in the keywords section)]

A case for perinatal natural photoperiod in thedevelopmental origins of health and disease
Philip Lewis, Thomas C Erren
Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research,
University Hospital of Cologne, Germany.

BACKGROUND AND AIM:Light, and in particular daylight, is the key synchronising agent (“zeitgeber”)
for the temporal organisation of physiology, acting via the circadian timing system. Given the breadthof physiological co-governance by this system (incl. endocrine, metabolic, immunologic, growth andrepair, sleEP-wake, genetic regulation – and in all cells), it is not surprising that perturbation of this system islinked with various chronic diseases. The time-of-year (month/season) of birth has also long been
associated with various chronic diseases, in studies all across the globe. The natural daily photoperiod– important for circadian timing systems and health – is a ubiquitous factor that varies by time-ofyear and latitude and in a completely predictable manner (resolution to a day). Experiments in animalmodels demonstrate the impact of different perinatal light-dark zeitgeber paradigms on physiology
and health, including on various working parts of the circadian timing system.
METHOD:We assessed perinatal natural photoperiod metric associations with cancer, diabetes,
cardiovascular disease, depression, and chronotype (a circadian timing system marker) in later-life inhumans. These studies were conducted using the International Childhood Cancer Cohort Consortium(I4C) and the UK Biobank with study participants from across the globe. Perinatal natural photoperiod
metrics were determined using time-of-year of birth and latitude.
RESULTS:Signals of association with all outcomes studied were observed for average daily photoperiod
in the 3rd trimester of pregnancy and for the range of daily photoperiods experienced in this time
window relative to the average daily photoperiod.
CONCLUSIONS:Although size and direction of effects varied by outcome, associations wereconsistently observed and association with chronotype is compatible with the hypothesized mechanismof action (i.e., via the circadian timing system). Further studies are, of course, needed, but the casefor a role of natural photoperiod in the developmental origins of health and disease is growing.

Keywords: Light pollution, Obesity and metabolic disorders, Mental health outcomes, Cancer andcancer precursors, Cardiovascular diseases

EP-116[Neurologic and mental health outcomes » Mental health outcomes]

Establishing prediction model for psychosocialand environmental risk of postpartum
depression
Ping Shih1, Chih Da Wu2, Tung Liang Chiang3, Yue Leon Guo4
1Department of Environmental and Occupational Medicine, National Taiwan University Hospital Hsin-

Chu Branch, Hsinchu, Taiwan; Department of Environmental and Occupational Medicine, College ofMedicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
3College of Public Health, Institute of Health Policy and Management, National Taiwan University,

Taipei, Taiwan
4Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan

University (NTU) and NTU Hospital, Taipei, Taiwan; Institute of Environmental and Occupational
Health Sciences, National Taiwan University, Taipei, Taiwan; National Institute of Environmental
Health Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Postpartum depression (PPD) is a common and serious mental healthproblem for postpartum mothers. Although some modeling mechanism of PPD has been developed inrecent three years, the impact of environmental exposure factors such as air pollution has not been
included. Therefore, the study aims to development machine learning algorithm for predicting PPD
including not only social psychological but also environmental exposure factors.
METHOD:Taiwan Birth Cohort Study recruited nationally representative participants, as a result of
approximately 12% of all deliveries in 2005 using multistage stratified sampling. PPD was inquired
when their child was six months of age by face-to-face interview. Exposure to air pollution of mothers
during perinatal periods was estimated using hybrid kriging/land-use regression model based onresidential address. Including the possible psychosocial predictors, a framework of data extraction andclassification, processing, and machine learning was implemented to enable future PPD risk prediction.
RESULTS:The best-performing model uses data from the demographic characteristics, baby’s
condition, household factors as well as air pollution concentration during perinatal periods. Area under
the receiver operating characteristic curve increased from 0.65 by generalized logistic model to 0.97
and 0.81 in the development and validation datasets by bootstrap forest model. In the best
performing machine learning algorithm, exposure to PM2.5 during pregnancy remained an important
predictor for PPD.
CONCLUSIONS:Machine learning provides the ability to identify women at risk of PPD. In thealgorithms, air pollution exhibits non-negligible impact on PPD compared with other risk factors. The
results may contribute to scalable prevention and interventions, reducing negative psychologicaloutcomes.

Keywords: postpartum depression, machine learning, air pollution

EP-117[Cancer and cancer-precursors » Incidence]

Increased risk for cancer mortality observed
among female hairdressers in Brazil, 1996 2020
Rafael Junqueira Buralli1, Adeylson Guimarães Ribeiro2, Cleber Cremonese3, Armando Meyer4
1Department of Preventive Medicine, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo,

Brazil2Institute for Research and Education, Barretos Cancer Hospital, Barretos, Brazil
3Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
4Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

BACKGROUND AND AIM:Hairdressers are classified by the International Agency for Research on
Cancer as occupation exposed to probable carcinogens to humans (Group 2A) for lung and bladdercancer, but evidence is accumulating on associations with other cancers, such as oral cavity, stomach,breast, non-Hodgkin lymphoma (NHL), and leukemia. However, evidence on health effects among
Brazilian hairdressers is scarce. To better inform tailored cancer actions, we compared cancer
mortality rates among hairdressers and the general population in Brazil.
METHOD:Exploratory and comparative study on sex-specific mortality ratio of cancer and othercauses, among hairdressers and ‘other workers’ (as reference group), aged from 20-70y, withidentifiable occupation, and notified on the Brazilian Mortality Information System from 1996-2020.
Sociodemographic characteristics and mortality ratio of different types of cancer were compared.
Crude Odds Ratio (OR), and adjusted (ORADJ) for age, educational level, and ethnicity are presented
with 95% confidence intervals (CI).
RESULTS:From 1996-2020, 23,557 deaths by cancer (as primary cause) among hairdressers, and13,332,996 among all other workers (excluding hairdressers) were notified in Brazil. Hairdressers’
deaths were significantly higher among women, at younger ages, with white skin color, and withcompleted high school than other workers. Female hairdressers had significantly higher odds of dying
from cancer of digestive, respiratory, reproductive, urinary and hematological system, both in crude
and adjusted models. We highlight high ORADJ of dying for lung (1.58, 95% CI 1.42-1.75) andbladder cancer (1.74, 95% CI 1.20-2.52), alongside breast cancer (1.51, 95% CI 1.41-1.63) andacute myeloid leukemia (AML) (1.37, 95% CI 1.06-1.77). Odds of dying from liver, lymphoidleukemia, and acute lymphoid leukemia (ALL) lost significance after adjustments.
CONCLUSIONS:Higher mortality from several types of cancer among hairdressers has been observedin the Brazilian mortality system, and causal associations, such as exposures to chemicals, should be
investigated by epidemiological studies.

Keywords: Occupational exposures, cancer and cancer-precursors, mortality, chemical exposuresEP-118[Air pollution » Particulate matter]

Outdoor ultrafine particulate matter and risk oflung cancer in the Los Angeles Ultrafine PM
Study
Rena R. Jones1, Jared A. Fisher1, Sina Hasheminassab2, Joel D. Kaufman3, Neal D. Freedman4, Mary
H. Ward1, Constantinos Sioutas2, Roel Vermeulen5, Gerard Hoek5, Debra T. Silverman1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
2Department of Civil and Environmental Engineering, University of Southern California, Los Angeles,

California, USA
3Department of Environmental and Occupational Health Sciences, School of Public Health, Universityof Washington, Seattle, Washington, USA
4Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer

Institute, National Institutes of Health, Rockville, Maryland, USA
5Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University,

Utrecht, Netherlands

BACKGROUND AND AIM:Fine particulate matter (PM2.5, <2 µm in diameter) is an established cause oflung cancer, but it is unclear whether ultrafine PM (<0.1 µm), a key PM2.5 component, contributes torisk. Our objective was to investigate the U

FP-lung cancer association overall and by histologic subtype.
METHOD:The Los Angeles Ultrafine PM Study includes 45,660 participants aged 50+ in Southern
California at enrollment (1995-1996) followed through 2011 for incident lung cancer (N=1,285). We
estimated historical residential ultrafine PM concentrations via land use regression and backextrapolation. We estimated total and sex-specific associations between 10-year lagged UFP (per10,000 particles/cm3) and lung cancer overall and by histologic subtype (adenocarcinoma, squamouscell carcinoma, small cell carcinoma) in Cox models adjusted for smoking and other confounders,adjusting for PM2.5 concentrations (Spearman’s rho=0.52) as a model covariate and in crossclassified analyses. We evaluated relationships by smoking status, birth cohort, and historical duration
at the residence.
RESULTS:Ultrafine PM exposure was associated with a non-significantly increased risk of lung cancer(hazard ratio [HR]=1.02 per 10,000 particles/cm3;95% CI [0.96-1.08]). Risk of adenocarcinoma wassignificantly elevated among men (HR=1.10 [1.00-1.20]); but not women (p-interaction=0.04). A
nonsignificant association for adenocarcinoma was apparent in never-smoking (HR=1.15 [0.92-1.43])
and former smoking (HR=1.10 [0.99-1.23]) men, but weaker in current smoking men (HR=1.05[0.86-1.28]; p-interaction>0.05). Associations were strongest among men born in 1925-1930(HR=1.14 [1.01-1.27]; p-interaction=0.03) and with ≥10 years residential duration (HR=1.14 [1.011.30]; p-interaction=0.03). We observed no significant relationships for women or other disease
subtypes. Patterns were consistent when adjusting for PM2.5 and ultrafine PM associations werestronger when PM2.5 levels were low (<median) versus high (≥median).
CONCLUSIONS:Ambient UFP exposure may increase the risk of lung adenocarcinoma among men,with historical exposures contributing more than levels in recent decades. Further investigation of thedisparity in findings by sex is warranted.

Keywords: Air pollution, ultrafine particulate matter, long-term exposure, lung cancer

EP-119[Air pollution » Wildfires]

Geographic patterns in wildfire exposures andcounty-level lung cancer mortality in the UnitedStatesRichard V. Remigio1, Ian D. Buller1, Maria Kamenetsky2, Jared Fisher1, Samantha Ammons1, Jesse E.
Bell3, Neal D. Freedman4, Rena J. Jones1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
2Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute,

National Institutes of Health, Bethesda, Maryland, United States
3Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical

Center, College of Public Health
4Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer

Institute, National Institutes of Health, Bethesda, Maryland, United States

BACKGROUND AND AIM:Emissions from wildland fire plumes are composed of modified biomass
combustion by-products, including carcinogens. However, studies of the association between wildland
fire exposures and lung cancer are scant. We evaluated geographic patterns in these exposures andlung cancer mortality to explore possible associations.
METHOD:We extracted historical fire (wildfires and prescribed burns) information and satellite imagery
for the conterminous U.S. from the Monitoring Trends in Burn Severity program (1984-2001). We
derived two county-level fire exposure metrics: 1) ratio between total burned area and county area,and 2) fire density (events/100 km2). Age-adjusted, sex-specific lung cancer mortality rates at thecounty level for two 5-year periods (2011-2015 and 2016-2020) were obtained from the National
Center for Health Statistics. Lee’s L statistic for bivariate spatial association was used to identify
geographic patterns with significant associations between fire exposures and lung cancer mortality
rates.
RESULTS:There were over 6,100 wildland fires (67% were wildfires) and 7,650,000 km2 burned area
during the exposure period, with most activity in the Western U.S. states and Florida. Among females,
we observed clusters of counties where the areal-based ratio metric and lung cancer mortality rates(2011-2015) were both high across eastern Kentucky (n=17 counties, p-values: 0.009-0.03),
southwestern West Virginia (n=9, p-values: 0.009-0.01), and Florida (n=17, p-values: 0.009-0.03).
Among western counties, greater fire exposure was associated with lower lung cancer mortality(n=47, p-values: 0.009-0.03). These patterns were consistent among men, by time period, and forfire density. Our findings differed from recently published lung cancer mortality clusters associatedwith smoking prevalence.
CONCLUSIONS:Our novel analysis identified U.S. counties where wildfires might contribute to lungcancer mortality; the inverse association in some Western counties may be due to chance andrequires additional investigation. Studies with individual-level exposure-response assessments areneeded to further evaluate this relationship.

Keywords: air pollution, wildfires, cancer and cancer precursors, mortality

EP-120[Air pollution » Traffic-related]

Impact of the central London Ultra-Low Emission
Zone and toxicity-charge on adult emergency
hospital admissions: An interrupted time series
analysis
Rosemary C Chamberlain1, Bethan Davies2, John Hodsoll3, Daniela Fecht2
1Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of

Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
2Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of

Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; NIHR
Health Protection Research Unit in Chemical Radiation Threats and Hazards, School of Public Health,
Imperial College London, London, UK
3Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and

Neuroscience, Kings College London, London, UK

BACKGROUND AND AIM:The Ultra-Low Emission Zone (ULEZ) was introduced in central London, UK, in
April 2019, replacing the less stringent toxicity-charge, dating from October 2017. These interventions
have led to substantial air quality improvements, but limited evidence exists on their impact on health.
We aimed to assess these interventions’ impact on emergency hospital admissions due tocardiovascular disease, respiratory disease, and all non-accidental causes (‘all-cause’), using acontrolled interrupted time series (cITS) approach.
METHOD:National routine data on emergency hospital admissions for adult (≥15 years) residents of
the ULEZ and a control area of London were used to identify cause-specific admissions(cardiovascular: primary ICD-10 code I00-I99, respiratory: J00-J99, all-cause: A00-R99) between 6
January 2014 and 1 March 2020. cITS analysis used segmented negative binomial regression,modelling the outcomes as weekly age/sex-standardised rates, adjusting for temperature, relative
humidity, month, and public holidays. Temporal autocorrelation was accounted for using Newey-Weststandard errors. The estimands of interest were trend changes in rates between pre- and postintervention periods, with changes in the intervention area adjusted for those in the control area. The
toxicity-charge and ULEZ were modelled both as separate interventions and in combination.
RESULTS:There were trend reductions in age and sex-standardised cardiovascular (-0.19% per week,[95%CI: -0.07%, -0.31%]) and all-cause (-0.10% [-0.05%, -0.15%]) emergency admission rates in
the ULEZ relative to the control area when a single intervention point was modelled at the toxicitycharge start, and larger reductions for the ULEZ start (cardiovascular: -0.38% [-0.07%, -0.68%], allcause: -0.18% [-0.04%, -0.32%]). Respiratory admissions showed no statistically significant trendchange relative to the control area (toxicity-charge: -0.05% [-0.15%, +0.05%]).
CONCLUSIONS:These results indicate that the ULEZ/T-charge is associated with reductions in airpollution-related emergency hospital admissions, particularly those due to cardiovascular disease.
Further analysis with alternative control areas would be valuable to further test the robustness ofthese results.

Keywords: Environmental epidemiology, Policy, Respiratory outcomes, Cardiovascular diseases.

EP-121[Built environment » Green space]

Multiple pathways mediate the residential
greenspace morphology and triglyceride risk:
implications for climate change
Rubing Pan1, Weiqiang Wang2, Ning Wei1, Li Liu1, Weizhuo Yi1, Jian Song1, Jian Cheng1, Yinguang
Fan1, Hong Su1
1Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University,

Hefei, Anhui, China.
2Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China.

BACKGROUND AND AIM:Long recognized as the link between greenspaces, an essential component ofa healthy city, and cardiovascular risk factors, but little is known about how Greenpeace morphology
affects triglyceride risk.
METHOD:We included 106238 locals between the ages of 35 and 75 based on the Cardiovascular
Disease Screening Cohort in Anhui Province, China. The greenspace morphology was calculated using
high-resolution land cover data for 2020 from the World Cover Database, and triglyceride as an
outcome. Multiple linear regression model and structural equation model were used to evaluate
relationships between greenspace morphology and triglyceride risk and to investigate the potential
role of fine particulate matter (PM2.5) and heat waves in the association, respectively.
RESULTS:Overall, in residential environmental characteristic exposure, triglyceride was expected toincrease by 0.046% (95% CI: 0.040%, 0.052%) with a 1% increase in the percentage of built-up
while decrease by 0.270% (95% CI: 0.202%, 0.337%) in the percentage of greenspace. Furthermore,
the shape, connectedness, and aggregation of greenspace were inversely correlated with triglyceride
when the total greenspace was maintained, lowering to 0.605% (95% CI: 0.198%, 1.012%), 0.031%(95% CI: 0.022%, 0.039%), and 0.049% (95% CI: 0.039%, 0.058%), respectively. Likewise, theprotective effect of the shape index was higher than that of the total amount of greenspace. The
stratification results showed that urban residents benefited more from greenspace exposure.
Greenspace morphology can minimize triglyceride risk by reducing pollution and heat waves, withaggregation having the greatest effect on reducing pollutants whereas fragmentation is more efficientat reducing heatwaves.
CONCLUSIONS:Exposure to the greenspaces morphology is associated with a reduction in triglyceriderisk. The study has important practical and policy implications for early health monitoring and thespatial layout of greenspace, and will provide scientific information for healthy urban planning by
reducing unfavorable health consequences.

Keywords: Green space,Environmental epidemiology,Risk assessment, Built environment,Air pollution

EP-122[Chemical exposures » Heavy metals]

Association of arsenic exposure with diabetes
and insulin resistance in Chinese adults: China
National Human Biomonitoring (CNHBM)
Saisai Ji1, Yingli Qu1, Yidan Qiu2, Yuebin Lv1, Xiaoming Shi1
1China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental

Health, Chinese Center for Disease Control and Prevention, Beijing, China
2Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou,

Zhejiang, China

BACKGROUND AND AIM:Previous findings about the association between low-to-moderate arsenic (As)exposure and diabetes are inconsistent. Population heterogeneity and creatinine adjustment methods
may contribute for discrepancies across studies. This study aims to evaluate the associations of lowto-moderate As exposure with diabetes and insulin resistance (IR) in a representative sample ofChinese adults and in different subgroups using the covariate-adjusted standardization method tocorrect urine dilution.
METHOD:Based on 2017-2018 China National Human Biomonitoring (CNHBM), we conducted a crosssectional analysis and a case-control study. 10,510 participants were included in the cross-sectional
analysis and 972 participants were included in the case-control study with 489 with diabetes and 483
controls. Urinary total As (TAs) were analyzed as As exposure and homeostatic model assessment of
insulin resistance (HOMA-IR) was calculated. Generalized linear mixed models and RCS models wereused to assess the association of TAs levels with diabetes prevalence and HOMA-IR.
RESULTS:Of the cross-sectional population, the weighted median (interquartile range) concentrationsof creatinine-corrected TAs was 19.52 μg/L (11.36-36.61 μg/L) and the weighted prevalence ofdiabetes was 10.80%. The fully adjusted OR (95%CI) of diabetes prevalence for an interquartile range
increase in the ln-transformed TAs was 1.15 (1.06, 1.24) in the cross-sectional analysis and 1.25
(1.06, 1.46) in the case-control study. TAs was positively associated with HOMA-IR. Compared withthose in the lowest quartile, HOMA-IR of participants in the fourth quartiles of TAs increased by 2.14
(95% Cis: 0.57, 3.70). RCS models showed a positive and linear association between TAs anddiabetes. The association between TAs and diabetes varied by residence area with a greater
association in urban residents (P values for the interaction was 0.017).
CONCLUSIONS:TAs was positively associated with diabetes prevalence and HOMA-IR in the Chinese
adults. Population residing in urban area may have increased susceptibility to As-related diabetes in
China.

Keywords: Biomonitoring, Urinary arsenic, Diabetes, Insulin resistanceEP-123[Chemical exposures » Pesticides]

Exposure to DDE and BMI among adolescents in
the Teen-Longitudinal Assessment of BariatricSurgery (Teen-LABS) Study
Shudi Pan1, Bruna Rubbo1, Brittney O Baumert1, Hongxu Wang1, Sarah Rock1, Justin Ryder2, Todd
Jenkins3, Stephanie Sisley4, Xiangping Lin5, Scott Bartell6, Thomas Inge2, Stavra Xanthakos7, Zoe
Coates Fuentes5, Michele A. La Merrill8, Douglas I Walker9, David V Conti1, Rob McConnell1, Sandrah
P Eckel1, Lida Chatzi1
1Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, CA, USA
2Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H.

Lurie Children’s Hospital of Chicago, Chicago, IL, USA
3Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Department ofPediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
4Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
5Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
6Department of Environmental and Occupational Health, University of California, Irvine, CA, USA
7Division of Gastroenterology, Hepatology, Nutrition, Cincinnati Children’s Hospital Medical Center,

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
8Department of Environmental Toxicology, University of California, Davis, CA, USA
9Gangarosa Department of Environmental Health, Emory University,Atlanta, GA, USA

BACKGROUND AND AIM:Dichlorodiphenyldichloroethylene (DDE) is considered an obesogen, as it canalter the individual’s susceptibility to develop obesity. Bariatric surgery is effective in reducing weight
among adolescents with obesity. However, the mechanisms that lead to variations in the rate ofweight loss post-bariatric surgery remain unknown and could be due to environmental exposure to
DDE. We aimed to assess the impact of different levels of exposure to 4,4-DDE on body mass index(BMI) and waist circumference in a cohort of adolescents up to 5 years after bariatric surgery.
METHOD:We included 63 participants from 5 time points from the prospective multi-center TeenLongitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort. Exposure was measured in visceraladipose tissue (vAT) collected at the time of surgery and categorized into tertiles (low ≤14ng/g,
moderate 14 to 21ng/g, and high ≥21ng/g). We constructed longitudinal linear regression models toassess the interaction between exposure and time since surgery, with a random intercept forparticipant and a linear spline with a single knot at one year, adjusted for sex, age, race, and parents’income.
RESULTS:We found a dose-response relationship, with the low exposure group having a greater
reduction in BMI during the first year after bariatric surgery compared to both the moderate and highexposure groups (6.12 kg/m², 95%CI 0.62 to 12.85, and 4.38 kg/m², 95%CI 2.69 to 11.46,
respectively). BMI increased after the first year, with patients exposed to lower levels of DDE showing
a smaller increase compared to those in the higher exposure group (9.82 kg/m², 95%CI 3.16 to 16.49
for moderate, and 3.40 kg/m², 95%CI -3.74 to 10.53 for high exposure group). We observed a similar
pattern between exposure to 4,4-DDE and waist circumference.

CONCLUSIONS:Our findings suggest that exposure to 4,4-DDE could contribute to differences inweight trajectory following bariatric surgery among adolescents.

Keywords: Obesity and metabolic disorders, Environmental epidemiology, Children's environmental
healthEP-124[Chemical exposures » Heavy metals]

Association between Blood Cadmium
Concentrations and Dyslipidemia among Older
Adults: A Cross-sectional Study
Simei Zhang1, Haiyan Jiang1, Fanjia Guo2, Yaoyao Lin2, Lin Meng1, Mengling Tang1, Kun Chen2
1Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine,

Hangzhou 310058, China
2Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine,

Hangzhou 310058, China

BACKGROUND AND AIM:Dyslipidemia, defined as abnormal lipid levels, constitutes a significant risk
factor for the development of cardiovascular disease (CVD), increasing the likelihood of atherosclerosis
and related cardiovascular events. Cadmium, a toxic heavy metal, can enter the human body throughvarious channels such as air, water, and soil, accumulate within bodily tissues, and jeopardize humanhealth. The present study aims to explore the association between blood cadmium concentrations anddyslipidemia in the older population.
METHOD:A cross-sectional study was conducted among 3,326 elderly participants in Zhejiang, China.
Whole blood levels of cadmium were measured using inductively coupled plasma mass spectrometry(ICP-MS). Dyslipidemia events were defined based on total cholesterol (TC), triglyceride (TG), lowdensity lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels.
Multivariable logistic regression analysis was employed to assess the association between cadmium
levels and dyslipidemia.
RESULTS:The prevalence of dyslipidemia among the older population in China was found to be
36.49%. In logistic regression models, blood cadmium levels showed a positive correlation withdyslipidemia. When compared to the lowest quartile of blood cadmium, the odds ratio (OR) of
dyslipidemia in the highest quartile was 1.30 (95% confidence interval, CI: 1.04, 1.64) after adjustingfor multiple covariates.
CONCLUSIONS:The whole blood level of cadmium exhibited a significant association with the risk ofdyslipidemia in the older Chinese population. This finding emphasizes the importance of monitoring
and controlling environmental exposure to heavy metals and improve cardiovascular health.

Keywords: Cardiovascular diseases, Epidemiology.

EP-125[Exposures » Ionizing radiation]

Cancer risk from occupational cosmic radiation
exposure in flight attendants: A systematic
review and meta-analysis
Soojin Park, Ga Bin Lee, Haesu Jeong, So Yeon Jung, Songwon Seo
Laboratory of Radiation Health Assessment, National Radiation Emergency Medical Center, Korea
Institute of Radiological and Medical Sciences, Seoul, South Korea

BACKGROUND AND AIM:Cosmic radiation is an occupational risk factor for flight attendants (consistingof pilots and cabin crew), and recent studies of flight attendants have reported risk for several
individual cancer types. However, the findings of these studies are inconsistent and evidence of risk at
low dose radiation which is considered as the exposure level of flight attendants remains unclear. This
study aims to establish the risk of cosmic radiation exposure for cancer in flight attendants based onsummarizing studies published to date.
METHOD:We conducted a search of articles through PubMed and EMBASE with a predefined searchstrategy. The search terms included flight attendant terms, cosmic radiation terms, and cancer terms.
We selected articles that met our inclusion criteria through a screening of titles and abstracts, as well
as full-text reviews. In addition, a meta-analysis was performed to evaluate quantitative synthesis
assessment for cancer risks from the articles.
RESULTS:Of the 9,242 articles retrieved (3,466 in PubMed and 5,776 in EMBASE), a total of 50 studies
matched our inclusion criteria, excluding 2,935 duplicates. The standardized incidence or mortality
ratios (SIR or SMR) were presented in 33 articles, and most of the studies were conducted in Europe(63.6%). The pooled-SIR for all cancers was 0.84 (95% CI 0.81 to 0.87), and the pooled-SMR for all
cancers was 0.78 (95% CI 0.75 to 0.80), which was significantly lower than that of the referencegroups. In individual sites of cancer, the pooled-estimates of breast cancer (SIR=1.42), melanoma(SIR=1.40, SMR=1.53), and leukemia (SIR=1.37) were significantly higher than that of the referencegroups.
CONCLUSIONS:The pooled-estimates for all cancers were significantly decreased, indicating a possible
healthy worker effect. For a better understanding of increased pooled-estimates in several cancer
sites, an in-depth review is required with consideration of various risk factors (e.g., shift work,socioeconomic status) and cosmic radiation doses.

Keywords: Cosmic radiation, Cancer, Occupational exposure, Flight attendant, Meta-analysis

EP-126[One health » Tropical health]Children of Conflict - Paired Surveys andInteractive Exercise focused on Violence
Against Youth
Steve D. Whittaker1, Gabrielle, C. D. Myers1, Shadesia K. Greene1, Anayo M. Alladice1, Sientanicia S.
Thomas1, Jeymi J. Peets1, Zahir K. Blackett2
1Clarence Fitzroy Bryant College (CFBC), St. Kitts and Nevis
2Science Technology Research and Work Study (STRaWS) St. Kitts and Nevis

BACKGROUND AND AIM:Violence endures as a global problem. This study was designed to evaluate
the incidence and experiences of violence involving youth in the Eastern Caribbean federation of St.
Kitts-Nevis (SKN)
METHOD:Data was derived via surveys on interpersonal violence (IPV) and Violence Against Young
Women and Girls (VAYWG) as well as an interactive exercise where respondents shared perspectives
on conflict. Fifty (50) youths were recruited throughout November 2022.
RESULTS:Per the IPV survey, approximately 87.5% of respondents identified as Black and 90%
achieved a high school certificate. While most had never had a physical altercation (54%), 9 out of 10
respondents recently witnessed at least one physical fight. Approximately 30% experienced physicalabuse by a relative. Anger was perceived as a main driver for physical (42%) and verbal (67%)
assaults. Substance use was not a major promulgator of physical (19%) and verbal (25%) conflicts.
Many confrontations (44%) were attributed to miscommunication. Only half of the approximately 13%
of respondents who reported physical injuries sought medical care. At least 80% of participants
expressed feelings of fear, anger, stress, anxiety, or depression. Per the VAYWG survey, parents,
friends, classmates, strangers, and bus operators are among the most common perpetrators ofvarious forms of conflict. Young women and girls were reported to be 6.5 and 6.7 times more likely
than their male counterparts to be verbally accosted by a bus driver and a stranger, respectively.
Participants (n=29) of the interactive exercise reported that trust issues, poverty, excessive corporalpunishment, sexism, and homophobia to be major factors driving violent conflicts. All participants
agreed that these factors should be addressed.
CONCLUSIONS:Incidents of IPV including VAYWG continue to impact Eastern Caribbean youth. Whilewidely acknowledged and frequently experienced by minors and young adults, sustained solutions are
yet to be determined. Resolutions require nuanced, data-driven interventions.

Keywords: Children's environmental health, Community-engaged research, Mental health outcomes,
Socio-economic factors, Tropical healthEP-127[Climate » Temperature extremes and variability]

Prenatal heat stress and birth outcomes in
predominantly rural central Ghana
Sulemana Watara Abubakari1, Aalekhya Reddam2, Mohammed Nuhu Mujtaba1, Cascade Tuholske3,
Seyram Kaali1, Ashlinn Quinn4, Kenneth Ayuurebobi Ae Ngibise1, Blair Wylie5, Danielle Medgyesi2,
Ellen Boamah Kaali1, Andrea Baccarelli2, Oscar Agyei1, Steve Chillrud6, Kwaku Poku Asante1, Darby
Jack2, Prince Agyapong1, Alison Lee7
1Kintampo Health Research Centre, Research and Development Division, Ghana Health Service,

Kintampo North Municipality, Bono East Region, Ghana
2Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University,

New York, New York
3Department of Earth Sciences, Montana State University, Bozeman, Montana; Geospatial Core

Facility, Montana State University, Bozeman, Montana
4Berkeley Air Monitoring Group, Fort Collins, Colorado
5Dept Obstetrics/Gynecology, Columbia University Irving Medical Center, New York, New York
6Lamont-Doherty Earth Observatory of Columbia University, Palisades, New York
7Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai,

New York, NY

BACKGROUND AND AIM:Climate change is increasing exposures to higher ambient temperatures,
particularly in rural developing communities where people have limited access to indoor cooling. We
aimed to examine associations between prenatal heat and birth outcomes in rural Ghana.
METHOD:We leveraged the Ghana Randomized Air Pollution and Health Study (GRAPHS) prenatal
cohort recruited from 35 rural communities in the Bono East Region of Ghana between 2013-2015. We
assigned prenatal heat stress from conception to delivery using weekly averages of satellite-derived
daily Wet Bulb Globe Temperature (WBGT) estimates corresponding to the community of eachparticipant. We performed multivariable regression with average WBGT over pregnancy and trimester(TM) specific averages included in the same model to understand associations with birth weight,
length, head circumference, and small-for-gestational-age (SGA).
RESULTS:1,173 pregnant individuals with delivery > 28 weeks were available for analysis. Weekly
prenatal WBGT averages in the cohort ranged from 22.7-30.8°C. Extreme heat events (WBGT >30°C)
have been occurring with increasing frequency and 82% of the participants experienced > 1 extreme
heat event in pregnancy. Higher average WBGT in the second TM was associated with lower meanbirth weight (β = -36.5 g, 95% CI: -72.9, -0.2) and birth length (β = -0.32 cm, 95% CI: -0.61, -0.02)
with third TM exposure suggestive of reductions, although not reaching statistical significance. Higher
average WBGT across gestation, and in first and third TMs, were associated with increased headcircumference, possibly a head sparing effect. No significant associations with SGA or LBW wereidentified.
CONCLUSIONS:We demonstrate impacts of heat stress on newborn anthropometrics in this rural
Ghanaian population where the range of temperatures is relatively narrow. Given the link between size
at birth and future disease, it is critical to better understand how rising global temperatures impacts
newborn health, and more importantly, identify interventions to mitigate these effects.

Keywords: Wet bulb globe temperature, heat index, birth outcomes

EP-128[Air pollution » Particle components]

Spatial variation of PM2.5 component
concentrations in 23 Tokyo wards
Takehiro Michikawa1, Shinji Saito2, Ayako Yoshino3, Akinori Takami3, Seiji Sugata3, Yuji Fujitani4,
Shin Yamazaki4, Yuki Takeda5, Yuji Nishiwaki5
1Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo,

Japan; Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba,
Japan
2Tokyo Metropolitan Research Institute for Environmental Protection, Tokyo, Japan
3Regional Environment Conservation Division, National Institute for Environmental Studies, Tsukuba,

Japan
4Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
5Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo,

Japan

BACKGROUND AND AIM:In the general environment, concentrations of particulate matter with anaerodynamic diameter of less than 2.5 μm (PM2.5) show wide spatial homogeneity. However, we do
not have evidence of whether the same pattern applies to the PM2.5 components. In particular, within
big cities, such as Tokyo, with diverse pollutant sources, we cannot ignore the possibility that there
are spatial variabilities of PM2.5 component concentrations. In this study, we examined the spatial
variation of PM2.5 mass and its component concentrations in 23 Tokyo wards.
METHOD:In the fiscal year of 2021 (April 2021 to March 2022), Aerosol Chemical Speciation Analyzer(ACSA-14, Kimoto electric co. Ltd) was set and continuously measured total PM2.5 massconcentrations and its component concentrations at three monitoring sites (Ota-ku in the westernpart, Chiyoda-ku in the central part, and Koto-ku in the eastern part) within the 23 Tokyo wards. Our
measured components included black carbon (BC), water-soluble organic compounds (WSOC), nitrate,and sulphate. We estimated daily mean concentrations of total mass and each component, andsummarised the data.
RESULTS:During the study period, daily mean total PM2.5 mass concentrations were 9.9 (standard
deviation = 5.0) μg/m3 at Ota-ku, 9.7 (4.9) μg/m3 at Chiyoda-ku, and 9.5 (4.8) μg/m3 at Koto-ku,
and the average Pearson’s correlation coefficients between two sites were 0.95. Strong correlations
were also observed among the each component concentration at three sites (correlation coefficients =0.86 for OBC, 0.94 for WSOC, 0.95 for nitrate, and 0.95 for sulphate).
CONCLUSIONS:Within 23 Tokyo wards, the spatial homogeneous assumption of PM2.5 components
seemed to be generally valid.
Acknowledgements
This research was performed by the Environment Research and Technology Development Fund(JPMEERF20225M02) of the Environmental Restoration and Conservation Agency Provided by the
Ministry of Environment of Japan.

Keywords: fine particle, chemical element, spatial variation

EP-129[Omics technologies » Metabolomics]

Revealing the association between metabolic
pattern and heat stress exposure in farmers by
nuclear magnetic resonance
Ting Yu Chen1, Wan Chin Chen2, Shu Fang Hsu1, Hao Jan Liang1, Hsiao Yu Yang1, Ching Yu Lin1
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
2Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Changhua Christian Medical Foundation Changhua Christianhospital, Yunlin, Taiwan

BACKGROUND AND AIM:During the global warming era, heat stress exposure becomes a more severe
problem for heavy physical labor, especially combined with physical exertion and inadequate
hydration. The literature has revealed that heat stress can cause unknown etiology of chronic kidneydisease due to the susceptibility of the kidney. This study aims to explore the metabolic effects of heatstress and correlate it with chronic kidney disease in farmers.
METHOD:Farmers were recruited as the heat exposure group based on prolonged physical labor, andnon-farmers were recruited as the control group. The participant urine samples were collected andanalyzed by nuclear magnetic resonance (NMR) by metabolomics. Then, the multivariate analysis will
be conducted after spectral data processing to determine the variation in the metabolome between
farmers and non-farmers.
RESULTS:The 114 subjects who were 40 to 65 years old were recruited from Yunlin Christian Hospitalin our project. Numerous urinary metabolites were shown in the NMR spectrum. Metabolome variation
between farmers and non-farmers is not significant. Later, adjusting for confounders such as job
category, dehydration, and age will be conducted in addition to the typical multivariate analysis usedin metabolomics studies.
CONCLUSIONS:As global temperatures continue to rise and extreme heat events become more
frequent and intense, the adverse health effects of heat stress on farmers are expected to worsen in
the coming years. This study intends to discover molecular events of heat stress in the highly exposed
population. The information may suggest potential health effects and provide molecular informationfor early diagnosis.

Keywords: Metabolomics, Environmental epidemiology, TemperatureEP-130[Air pollution » Ozone]

Air pollution might impede ALT normalization inchronic hepatitis B patients treated with
nucleotide/nucleoside analog
Tyng Yuan Jang
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital,
Kaohsiung Medical University, Kaohsiung, Taiwan

BACKGROUND AND AIM:The biochemical response is an important indicator of prognosis in chronic
hepatitis B (CHB) patients receiving nucleotide/nucleoside analogues (NAs). The effects of air pollution
in alanine aminotransferase (ALT) normalization were elusive.
METHOD:The longitudinal study recruited 80 CHB patients with hepatitis B e-antigen (HBeAg) negative
who received NAs. ALT levels were examined at the first year of anti-HBV therapy. Normal ALT was
defined as <19 U/L for females and <30 U/L for males, and the risk factors associated with ALT
abnormality were analysed.
RESULTS:Sixteen patients (20.0%) with baseline ALT >40 U/L and 41 patients (51.6%) were ALT
abnormal (>19 U/L for females and >30 U/L for males). After 1-year NAs therapy, 75 patients(93.8%) had undetectable HBV DNA. Post-treatment ALT levels significantly decreased, compared tothe pre-treatment levels (21.3 U/L vs 30.0 U/L, respectively; P < 0.001). The proportion of patientswith normal ALT was also significantly higher after treatment, compared to the pre-treatment status ofpatients (71.2% vs 51.2%, respectively; P = 0.001). The strongest factor associated with ALT
abnormality after first year treatment with NAs was body mass index (BMI) (odds ratio[OR]/95%
confidence interval[CI]: 1.28/1.05-1.54; P=0.01). and ozone level (OR/CI: 1.11/1.02-1.22; P=0.02).
CONCLUSIONS:Among HBeAg negative CHB patients with relatively low viral load, NAs could improve
the ALT level by adjusting the confounding factors. It could also increase the proportion of ALT
normality after 1-year NAs treatment. Air pollution indeed affected the efficacy of ALT normalization.

Keywords: NAs, HBV, HBeAg negative, air pollution, ozone

EP-131[Cancer and cancer-precursors » Incidence]

Associations of outdoor air pollution and cancer
incidence in a large US prospective cohort
W. Ryan Diver1, Lauren R. Teras2, Emily L. Deubler2, Michelle C. Turner3
1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; Department of Population Science, American Cancer Society, Atlanta, GA, UnitedStates2Department of Population Science, American Cancer Society, Atlanta, GA, United States
3Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain

BACKGROUND AND AIM:Outdoor air pollution and airborne particulate matter (PM) have beenclassified as Group 1 carcinogens for lung cancer, however evidence for other cancers is limited andthe American Cancer Society (ACS) Cancer Prevention Study-II (CPS-II) has focused solely on cancer
mortality. This research examined associations of outdoor air pollutants with incidence of a range ofcancer subtypes, including less fatal cancers.
METHOD:In the ACS CPS-II Nutrition Cohort, census block-group level annual predictions of PM2.5,
PM10, PM10-2.5, NO2, O3, SO2, and CO concentrations were assigned to residential address.
Extended Cox regression estimated multivariable-adjusted hazard ratios (HR) and 95% confidence
intervals (CI) for associations of pollutant concentrations with risk of any incident cancer and at 21
cancer sites. Air pollution exposure estimates were updated annually during follow-up.
RESULTS:There were 30,959 total cancer cases identified among 108,002 participants followed from
1992-2017. PM2.5 was associated with an increased risk of lung cancer (HR per 4.1 ug/m3=1.05;
95% CI 0.99-1.10). PM10-2.5 (per 5 ug/m3) was associated with higher risks of colon (HR=1.05;
95% CI 1.00-1.11), uterine (HR=1.09; 95% CI 1.01-1.18), and cervical (HR=1.57; 95% CI 1.132.16) cancers, as was PM10. Higher NO2 was associated with increased risk of any cancer, but only
statistically significantly with lung cancer (HR per 6.3 ppb=1.05; 95% CI 1.01-1.10). SO2 wasassociated with higher risk of lung and kidney cancer. O3 was associated with increased risk ofmelanoma. CO was associated with increased risk of any cancer as well as statistically significant
associations with melanoma and uterine cancer.
CONCLUSIONS:Consistent with previous literature, multiple outdoor air pollutants were associatedwith lung cancer. Additionally, we identified novel associations with air pollutants and incidence ofseveral other cancers. These findings suggest a broader impact of air pollutants on cancer risk thanhas been previously recognized.

Keywords: air pollution, particulate matter, long-term exposureEP-132[Outcomes » Other (to be specified with keywords in the keywords section)]

Associations Between Maternal Gestational
Diabetes and Pubertal Growth in Offspring
Wen Wei Hsu1, Mei Huei Chen2, Chih Fu Wei3, Yi Ching Tung4, Ching Chun Lin5, Chien Nan Lee6, Pau
Chung Chen7
1Department of Obstetrics and Gynecology, National Taiwan University Hospital, Biopark Branch,

Hsinchu, Taiwan
2Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;

Department of Pediatrics, National Taiwan University Hospital and National Taiwan University Collegeof Medicine, Taipei, Taiwan.
3Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, U.S.A
4Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National

Taiwan University, Taipei, Taiwan
5Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
6Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
7Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Public Health, College of Public Health, National
Taiwan University, Taipei, Taiwan; National Institute of Environmental Health Sciences, National
Health Research Institutes, Miaoli, Taiwan; Department of Environmental and Occupational Medicine,National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei,
Taiwan.

BACKGROUND AND AIM:Maternal gestational diabetes mellitus (GDM) has an adverse impact onchildren’s dysmetabolic trait. Discussion about maternal GDM and children’s peripubertal healthremains limited. This study aims to determine the association of maternal gestational diabetes mellitus(GDM) and peripubertal growth of offspring.
METHOD:This is a prospective cohort study that enrolled 1,008 mother-infant pairs who received
antenatal care at single center from 2010 to 2012. In 2018, children received follow-up study which
included bone age, serum sex hormone levels, Tanner stage for breast and testes, and the penile
length follow-up. Differences in the outcomes between offspring of mothers with GDM and control
subjects were examined using Student’s t test and chi-square test. We also used multiple linear andlogistic regression models to adjust for maternal pre-gravid BMI, household income, maternal age atdelivery, and maternal menarche age.
RESULTS:There were 43 (8.9%) children born from GDM mothers, and 441 (91.1%) in the control
group. In girls, there was more advanced bone age in the GDM group (n=19) than the control group(n=205) after adjusting for potential confounding factors (0.48-year, 95% CI=0.005-0.97-year,
p=0.048). For boys, the GDM group (n=24) showed no advancement in the bone age compared withthe control group (n=236) (-0.13-year, 95% CI= -0.65-0.40). The serum sex hormone levels andsecondary sexual characteristics of children in the GDM group were comparable to those in the control
group.
CONCLUSIONS:Compared to the control group, girls with mothers diagnosed with GDM showed moreadvanced bone age at peripubertal stage. We need longer follow-up of consequent health effects
during their adolescence.

Keywords: outcomes, Obesity and metabolic disordersEP-133[Chemical exposures » Heavy metals]

Relationships between urinary uranium andcardiac geometry and left ventricularfunctioning in the Strong Heart Study
Wil Lieberman Cribbin1, Irene Martinez Morata1, Arce Domingo Relloso2, Jason Umans3, Shelley A
Cole4, Marcia O'leary5, Maria Grau Perez6, Gernot Pichler7, Richard Devereux8, Anne Nigra1, Allison
Kupsco1, Ana Navas Acien1
1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA.
2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA. Department of Chronic Diseases Epidemiology, National Center for Epidemiology,
Carlos III Health Institute, Madrid, Spain. Department of Statistics and Operations Research,
University of Valencia, Valencia, Spain.
3Georgetown-Howard Universities Center for Clinical and Translational Science Washington DC.

MedStar Health Research Institute Hyattsville Maryland, USA
4Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA.
5Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA.
6Cardiometabolic and Renal Risk Unit, Biomedical Research Institute INCLIVA, Valencia, Spain;

Department of Preventive Medicine and Microbiology, Universidad Autonoma de Madrid, Madrid,
Spain; Department of Statistics and Operations Research, University of Valencia, Valencia, Spain.
7Department of Cardiology and Karl Landsteiner Institute for Cardiovascular and Critical Care

Research, Clinic Floridsdorf, Vienna, Austria.
8Weill Cornell Medical College, New York, USA.

BACKGROUND AND AIM:Drinking water contaminated with uranium is common in the Western US,
particularly in areas near abandoned mines. Uranium is a potentially cardiotoxic non-essential
element. Measures of cardiac geometry and function are useful for capturing risk, early-detection, andprogression to clinical cardiovascular disease outcomes. We leveraged urinary uranium measures inStrong Heart Study participants from the Great Plains and the Southwest to investigate theirassociation with measures of cardiac geometry and functioning in young adults.
METHOD:Urinary uranium was measured among participants free of diabetes, cardiovascular disease,and <50 years old at baseline (2001-2003). Transthoracic echocardiography and blood pressure wasassessed at baseline and follow-up (2006-2009). We estimated mean differences in measures ofcardiac geometry and function at baseline and follow-up using linear mixed effect models with random
intercept and slope over time, accounting for family clustering.
RESULTS:Participants’ mean (SD) age was 30.8 (10.4) years; 39.3% were male. Median (IQR)
uranium levels were 0.029 (0.045) μg/g creatinine. At baseline, a 2-fold increase in urinary uranium
was positively associated with left ventricular (LV) mass index (mean difference: 0.49, 95% CI: 0.070.92), left atrial systolic diameter (0.02, 0.01-0.03), and stroke volume (0.66, 0.25-1.08) after
adjustment for age, sex, smoking status, urinary arsenic, body mass index and other cardiovascularrisk factors. At follow-up, uranium was associated with increases in left atrial diameter (0.02, 0.010.03) and pulse pressure (0.28, 0.05-0.52). Among participants in the highest tertiles of uranium andarsenic, associations were stronger at baseline and follow-up for LV mass (5.23, 2.66-7.81; 4.55,
2.06-7.05), left atrial diameter (0.14, 0.07-0.20; 0.15 0.08-0.21) and stroke volume (5.08, 2.577.58; 2.49, 0.12-4.85), respectively.

CONCLUSIONS:Preliminary findings indicate that uranium exposure may be associated with measuresof cardiac geometry and left ventricular functioning in the Strong Heart Study. Future analyses should
determine the potential long-term clinical cardiovascular effects of uranium exposure.

Keywords: Environmental epidemiology, chemical exposures, cardiovascular diseases

EP-134[Chemical exposures » General]

Selenium Status and DNA methylation in theStrong Heart Family Study
Wil Lieberman Cribbin1, Arce Domingo Relloso2, Shelley A Cole3, Karin Haack3, Marcia O'leary4, Ying
Zhang5, Jason Umans6, Walter Goessler7, Ana Navas Acien1, Allison Kupsco1
1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA.
2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA. Department of Chronic Diseases Epidemiology, National Center for Epidemiology,
Carlos III Health Institute, Madrid, Spain. Department of Statistics and Operations Research,
University of Valencia, Valencia, Spain.
3Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA.
4Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA.
5Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center,

Oklahoma City, OK, USA.
6MedStar Health Research Institute, Hyattsville, MD, USA. Georgetown-Howard Universities Center for

Clinical and Translational Science, Washington, DC, USA
7Institute of Chemistry, University of Graz, Graz, Austria.

BACKGROUND AND AIM:Selenium (Se) is a naturally occurring metalloid found in rocks and soils
throughout the United States and is an essential element for several antioxidant-related pathways.
However, Se is potentially linked to elevated diabetes risk at high concentrations. The mechanisms
behind these relationships remain unknown and there is a need to identify mechanistic biomarkers of
Se exposure to identify individuals at risk. We performed an epigenome wide association study toinvestigate the relationship between Se exposure and DNA methylation (DNAm) in a population ofAmerican Indian participants with high diabetes risk.
METHOD:Urinary Se was measured in the baseline exam (2001-2003) of the Strong Heart Family
Study (n=2325), a prospective study of cardiovascular disease among American Indian communities
in Arizona, Oklahoma, North Dakota and South Dakota. Se was analyzed by inductively coupledplasma mass spectrometry. Blood DNAm was measured using the Illumina MethylationEPIC BeadChip
Array at baseline. Epigenome-wide robust linear regressions (limma) and an elastic net regression
approach (glmnet) were performed to select differentially methylated CpG sites associated with Se.
Gene ontology enrichment analysis was performed using gometh.
RESULTS:Among 1,357 participants free of diabetes at baseline, the mean (SD) age was 55.4 (8.0)
years and 58.2% were female. The median (SD) concentration of Se was 51.81 (25.13) μg/g
creatinine. Across 788,368 CpG sites, 490 sites were retained in the elastic net approach and one site
(cg00163554) was significantly associated with Se after accounting for multiple comparisons in linear
regression (Bonferroni p-value: 0.0044). This site was annotated to the DIP2C gene. Enrichment
analysis did not yield any overrepresented gene ontology terms.
CONCLUSIONS:Preliminary findings indicate that urinary Se may be associated with specific changes
in DNAm in a sample of American Indians. Future analyses should replicate these findings in an
external cohort and investigate the mediating role of differentially methylated CpG-associated sites
with diabetes.

Keywords: Environmental epidemiology, biomarkers of exposureEP-135[Neurologic and mental health outcomes » Mental health outcomes]

Risk factors associated with transient andpersistent anxiety among pregnant women in
Shanghai, China
Xiaoning Lei1, Jiaqi Zheng2, Hong Li3, Jiuru Zhao4, Zhiwei Liu4, Ying Tian5, Yu Gao1
1Department Of Environmental Health, Shanghai Jiao Tong University School Of Medicine, Shanghai,

China
2Department Of Environmental Health, Shanghai Jiao Tong University School Of Medicine, Shanghai,

China; International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School
Of Medicine, Shanghai, China
3International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School Of

Medicine, Shanghai, China
4International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School Of

Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
5Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University Schoolof Medicine, Shanghai, China; MOE-Shanghai Key Laboratory of Children’s Environmental Health,Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

BACKGROUND AND AIM:Chronic or persistent anxiety (PA) over the course of pregnancy may lead toadverse maternal and infant outcomes. Several studies have investigated the potential contributing
factors to transient anxiety (TA) at one point in pregnancy, but little is known about PA. This study
aimed to identify the risk factors for TA and PA during pregnancy.
METHOD:Pregnant women with no history of mental illness were recruited from 2016 to 2021 basedon a Shanghai sub-cohort of the China National Birth Cohort study (CNBC). Structured survey
interviews were conducted in early pregnancy to collect the socio-demographic information, obstetricaland physical health status, and lifestyle factors. The Zung Self-Rating Anxiety Scale (SAS) was used toassess the anxiety status of pregnant women and their partners during each trimester. Separate
logistic regression models were performed to identify risk factors for TA (SAS scores ≥ 50 for only one
trimester) and PA (SAS scores ≥ 50 for at least two trimesters).
RESULTS:The prevalence of TA and PA among the total of 3456 pregnant women was 12% (n=421)
and 4.2% (n=146), respectively. Logistic regression showed that younger age, poor physical health,
low intake of vegetables, and poor sleep quality were the common factors strongly associated with TA
and PA in pregnancy. Additionally, a low intake of milk (OR = 1.314, 95% CI: 1.034 – 1.677) was the
exclusive predictor of TA. Self-pay medical insurance (OR = 1.757, 95% CI: 1.063 – 2.815) andpartner anxiety (OR = 1.053, 95% CI: 1.029 – 1.076) were unique predictor of PA.
CONCLUSIONS:Poor physical health, partner anxiety, and some socio-demographic (e.g. age andmedical insurance) and lifestyle (e.g. diet and sleep) factors may play important roles in TA or PA
during pregnancy. Identification of these risk factors may guide the development of early intervention
strategies.

Keywords: Epidemiology, Socio-economic factors, Food/nutrition

EP-136[Climate » Temperature extremes and variability]

Climate warming and chronic diseases burden:
direct gradient between heat wave annual
frequency and mortality by cerebrovascular
events in Argentina
Ximena Porcasi1, Julius Koritschoner2, Sonia Alejandra Pou4, Camila Niclis4, Maria Pilar Díaz3, Fabian
Muñoz3, Mariana Carrillo3, Mariana Butinoff3, Sonia Edith Muñoz3
1Instituto Mario Gulich (CONAE- National University of Cordoba), Falda del Carmen, Córdoba,

Argentina
2Instituto de Investigaciones en Ciencias de la Salud (INICSA), Universidad Nacional de Córdoba,

CONICET, Facultad de Ciencias Médicas, Córdoba, Argentina.
3Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias

Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
4Instituto de Investigaciones en Ciencias de la Salud (INICSA) and Centro de Investigaciones en

Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacionalde Córdoba, Córdoba, Argentina.

BACKGROUND AND AIM:Climate warming is generating new challenges in health, and little is known
about its effect on chronic diseases. The aim of this study is to characterize the spatio-temporal
pattern of heat waves in the central area of Argentina in the last decades and to assess theassociation of heat wave frequency with mortality from cerebrovascular disease (CD).
METHOD:A longitudinal study with an ecological design (2005-2019; n=26 geographical units) was
conducted in Córdoba, Argentina. Data from the European Climate data service were processed tobuild a 30-year time series of daily Maximum air temperature. Heat waves were identified annually(National Meteorological Service definition). From official mortality data, annual crude mortality rates
were estimated for CD (CIE-10 I60-I69). An autoregressive order 2 Poisson regression model was
fitted, using CD mortality rates as the outcome, and annual frequency of heat waves (0-7, 8-19, ≥20),
urban scale (big cities/middle-sized or small cities/towns) and socioeconomic stratum, as covariates.
RESULTS:Aggregated spatial patterns of heat waves were identified, their frequency ranging from 0 to
25 annually. An increasing trend in the annual number of heat waves was observed over the studied
period. The intermediate and higher categories of heat waves showed a direct effect with a clear
gradient on CD mortality rates in women (OR 1.01; p<0.047 and OR 1.04; p<0.001, respectively). In
males and females, a higher urbanization level (vs. towns) was associated inversely with CD mortality,
while an intermediate urbanization level showed increased CD mortality rates.
CONCLUSIONS:The spatial and temporal patterns of heat waves were neither homogeneous nor
constant. The effect of heat waves on CD mortality is evident only in women, perhaps given theirlonger life expectancy, considering that age is a vulnerability factor against climatic events.
Funding: FONCyT; Grant PICT-2019-04594.

Keywords: Climate, Environmental epidemiology, Temperature variability, Cardiovascular diseases,
Mortality

EP-137[Air pollution » Long-term exposure]

Associations between air pollution exposure andgait speed in older women: partial mediation by
structural brain atrophy
Xinhui Wang1, Andrew J Petkus1, Lauren E Salminen2, Joshua Millstein3, Daniel P Beavers4, Mark A
Espeland5, Meredith N Braskie6, Joshua Liu6, Paul M Thompson7, Susan M Resnick8, Joel D Kaufman9,
Jiu Chiuan Chen10
1Department of Neurology, University of Southern California, Los Angeles, CA, US
2Department of Neurology, Imaging Genetics Center, Mark and Mary Stevens Neuroimaging &Informatics Institute, University of Southern California, Marina del Rey, CA, US
3Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

CA, US
4Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC,US
5Departments of Internal Medicine and Biostatistics and Data Science, Wake Forest School of

Medicine, Winston-Salem, NC, US
6Department of Neurology, Stevens Neuroimaging and Informatics Institute, Imaging Genetics Center,

Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California,
Marina del Rey, CA, US
7Department of Neurology, Psychiatry and the Behavioral Sciences, Radiology, Psychiatry, andEngineering, Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute,
University of Southern California, Marina del Rey, CA, US
8Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, US
9Departments of Environmental & Occupational Health Sciences, Medicine (General Internal Medicine),and Epidemiology, University of Washington, Seattle, WA, US
10Departments of Population and Public Health Sciences and Neurology, University of Southern

California, Los Angeles, CA, US

BACKGROUND AND AIM:Decreased physical performance, especially slowed gait speed, is associatedwith increased risks of disability and mortality. Cortical thickness (CT) of brain regions important for
sensory, motor, and cognitive functions is implicated in gait speed. Late-life air pollution exposure isassociated with poorer physical functioning and may exert neurotoxic effects on CT. Here we
examined whether and how much of the adverse impact of exposure on gait speed was mediated by
reduced CT in older adults.
METHOD:We conducted a cohort study of community-dwelling cognitively-unimpaired women (n=484;
aged 71-87) from the Women’s Health Initiative Memory Study who had a brain MRI scan in 2005-6
and timed walk assessed in 2012-13. We estimated monthly PM₂.₅ and NO₂ exposures at residential
locations using regionalized universal kriging models and aggregated to 3-year averages before MRI
scan. Gait speed was calculated as the distance (3 or 4 meters) walked divided by the seconds used.
Brain scans were processed using FreeSurfer-v.5.3.0 to estimate CT in 34 bilateral regions parcellatedwith the Desikan-Killiany atlas. Structural Equation Models were constructed to examine mediation
effects of each CT on the association between exposure and gait speed, adjusting for sociodemographic, lifestyle, and clinical covariates, and random effects for scanner manufacturers.
RESULTS:Women exposed to higher PM₂.₅ and NO₂ had slower gait speed (βPM₂.₅=-0.072 per3.19µg/m³, p<0.001; βNO₂=-0.058 per 6.64ppb, p=0.001), equivalent to 4.2 and 3.6 years of aging,respectively. The largest mediation effects were observed in precentral, paracentral, superior frontal,
and middle temporal gyri (all p<0.01), mediating 13.9-19.3% of total PM₂.₅ effect and 19.8-29.6% of
total NO₂ effect. The remaining direct associations between exposure and gait speed remained
statistically significant.
CONCLUSIONS:In cognitively-unimpaired older women, higher exposures to PM₂.₅ and NO₂ wereassociated with slower gait speed - relationships partially mediated by the lower CT in the frontal lobe,
especially the motor cortex.

Keywords: environmental epidemiology, gait speed, cortical thickness, partial mediation

EP-138[Neurologic and mental health outcomes » Mental health outcomes]

Residential Greenness Cover and Risk of
Psychiatric Hospital Admission among US
residents
Xinye Qiu1, Yaguang Wei1, Edgar Castro1, Marc G. Weisskopf2, Joel D. Schwartz2
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston,

Massachusetts, US
2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, US& Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston,
Massachusetts, US

BACKGROUND AND AIM:Earlier evidence has indicated potential mental health benefits from exposure
to greenness. However, much evidence was generated from studies of certain age groups as well as incities. In addition, most of them focused on milder outcome measures, such as mental symptoms.
Little is known about whether it also protects more severe outcomes, such as psychiatrichospitalization. In this study, we aimed to estimate the associations between residential greenness
exposure and risk of psychiatric hospitalization among US residents.
METHOD:Psychiatric hospital admissions were extracted from the Health Cost and Utilization ProjectState Inpatient Databases, covering 14 US states (Arizona, Colorado, Delaware, Georgia, Kentucky,
Maryland, Michigan, North Carolina, New Jersey, New York, Rhode Islands, Vermont, Washington, andWisconsin). We applied zero-inflated negative binomial regressions to obtain relative risk (RR) of total
psychiatric hospitalization associated with increases in residential exposure to greenness, as measured
by Normalized Difference Vegetation Index (NDVI). NDVI was divided into quartiles before modelingwith higher quartiles indicating higher greenness cover. The analysis covered all-age residents in the
included states over 2000-2019 and a total of 10,801 unique ZIP code areas with population over 100.
Models were adjusted for temperature, precipitation, sunlight, admission year and state, andneighborhood contextual backgrounds.
RESULTS:Over the study period and among the covered areas, we identified 7,256,308 admissions
due to psychiatric disorders. Using quartile 1 as reference, NDVI quartile 2, 3, 4 were associated withan outcome RR of 0.90 (95% CI, 0.88-0.92), 0.95 (95% CI, 0.93-0.97), 1.09 (95% CI, 1.07-1.12)
respectively. The protective associations were stronger among more urbanized areas and certain
states.
CONCLUSIONS:The study suggests that living in areas with moderately higher levels of green space
may be associated with mental health benefits among US residents, including reduced risk ofpsychiatric hospital admissions as observed. This work was supported by NIH P30 ES000002.

Keywords: Long-term exposure, Mental health outcomes, Green spaceEP-139[Air pollution » Particulate matter]

Impact of fine particulate matter on latenttuberculosis infection and active tuberculosis inolder adults:a population-based multicentre
cohort study
Xu Gao1, Sifan Tian1, Tonglei Guo2, Marianthi Anna Kioumourtzoglou3, Lei Gao2
1School of Public Health, Peking University
2Chinese Academy of Medical Sciences and Peking Union Medical College
3Mailman School of Public Health, Columbia University

BACKGROUND AND AIM:Evidence showed that air pollution was associated with an increased risk oftuberculosis (TB), an infectious disease caused by bacillus Mycobacterium tuberculosis (MTB).
However, the associations of air pollution with latent TB infection (LTBI) and subsequent active TB
development have not yet been investigated to date. This study aimed to study the impact of longterm exposure to ambient particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5)
on the acquisition of LTBI and on the risk of subsequent active disease development among rural older
adults from a multicentre cohort.
METHOD:A total of 4789 older adults were included in a population-based, multicenter, prospective
cohort study (LATENTTB-NSTM) from 2013 to 2018. The level of long-term (1- to 3-year) exposure toPM2.5 for each participant was assessed by aggregating satellite-based estimates at a daily time scaleand 1 km resolution. Logistic regression and time-varying Cox proportional hazards models with
province-level random intercepts were employed to assess associations of long-term exposures toPM2.5 with the risk of LTBI and subsequent development of active TB, respectively.
RESULTS:Out of 4789 participants, 3283 were LTBI-free at baseline, among whom 2805 completed
the one-year follow-up and 127 of them developed newly identified LTBI. No significant associations
were identified between long-term exposure to PM2.5 and the risk of LTBI. And among 1506
participants with LTBI at baseline, 30 active TB cases were recorded during the 5-year follow-up.
Particularly, an increment of 5 μg/m3 in 2-year moving averaged PM2.5 was associated with a 42.7%
increased risk of active TB (HR = 1.427, 95% CI: 1.073-1.897).
CONCLUSIONS:Our findings suggest that long-term air pollution might be considered as a neglectedrisk factor for active TB development from LTBI, especially for those living in developing or lessdeveloped areas where the air quality is poor.

Keywords: air pollution, particulate matter, infectious diseases, respiratory outcomes, environmental
epidemiology

EP-140[Air pollution » Particulate matter]

Association of fine particulate matter
constituents and ozone with immunotherapy
outcomes among Non-small cell lung cancer
patients
Xu Gao1, Meijie Jiang1, Liu Bin2, Jinghui Wang2
1School of Public Health, Peking University
2Cancer Research Center, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis andThoracic Tumor Research Institute

BACKGROUND AND AIM:Short-term or long-term evidence for associations between pollutants andimmunotherapy outcomes of non-small cell lung cancer (NSCLC) patients was extensively sparse. We
aimed to comprehensively understand the impacts of air pollutants on the progress-free survival (PFS)of the patients, and to explore the key exposure windows of the pollutants.
METHOD:We selected 364 patients who diagnosed with NSCLC and treated with PD-L1 immunotherapy
at Beijing Chest Hospital from 2019 to 2022. Concentrations of main PM2.5 constituents (organic
matter (OC), black carbon (BC), nitrate (NO3−), sulfate (SO42−), and ammonium (NH4+)) and O3
were estimated using the Tracking Air Pollution in China (TAP) dataset. Multivariate Cox regression
models was adopted to estimate the effects of exposure to PM2.5, PM2.5 constituents and O3 acrossmoving-average lags on immunotherapy outcomes for NSCLC. Restricted cubic spline models wereused to evaluate potential nonlinear relationships between statistically significant pollutants andoutcomes. Stratification analyses were done by sex, age, and PD-L1.
RESULTS:The concentrations of PM2.5, SO42−, NO3−, NH4+, OM, BC, O3 on lag-1y were averaged at
39.7, 6.4, 8.8, 5.5, 9.3, 1.7 and 96.6 μg/m3, respectively. As for BC, OM and O3, significant
associations were identified at different exposure time windows. Long-term exposure to BC and OM
were associated with a higher risk, with corresponding HRs of 2.31 (1.35, 3.97), 2.66 (1.49, 4.74)
observed at lag-1y. The difference is that exposures to O3 significantly elevated risks of adverse
outcome of immunotherapy for NSCLC, with HRs of 1.47 (1.01, 2.14) at lag-21d, 1.52 (1.03, 2.26) at
lag-1m, and 1.66 (1.08, 2.55) at lag-3m. Monotonic increasing dose-response relationships wereobserved for the associations of all pollutants with risks of outcomes of immunotherapy for NSCLC.
CONCLUSIONS:Our findings suggest that long-term exposures to PM2.5, PM2.5 constituents andShort-term exposure to O3 were positively associated with increased risks of adverse outcome of
immunotherapy.

Keywords: Particulate matter, Ozone, cancer and cancer-precursors, survivalEP-141[Respiratory and allergic outcomes » Asthma]

Interactive effects of ambient temperature andnitrogen dioxide on childhood asthma in
Shanghai - a megacity in China
Yabin Hu1, Yiting Chen2, Shijian Liu1, Jianguo Tan3, Chonghuai Yan4, Yong Yin5, Shenghui Li2, Shilu
Tong6
1Department of Clinical Epidemiology and Biostatistics, Child Health Advocacy Institute, ShanghaiChildren's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
2School of Public Health, Shanghai Jiao Tong University, Shanghai, China
3Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai,

China
4MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of

Medicine, Shanghai Jiao Tong University, Shanghai, China
5Department of Respiratory Medicine, National Children's Medical Center, Shanghai Children's Medical

Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
6National Institute of Environmental Health, Chinese Centers for Disease Control and Prevention,

Beijing, China;School of Public Health, Anhui Medical University, Hefei, China;Center for Global Health,
School of Public Health, Nanjing Medical University, Nanjing, China;School of Public Health and Social
Work, Queensland University of Technology, Brisbane, QLD, Australia

BACKGROUND AND AIM:While strong evidence supports adverse effects of non-optimum ambient
temperature and nitrogen dioxide (NO₂) on childhood asthma, previous studies rarely considered theirinteractions or even the potential role of offspring sex. Therefore, we aimed to assess the overall andsex-specific interactive effects of ambient temperature and NO₂ on childhood asthma in Shanghai
under the context of climate crisis.
METHOD:This study relied on 16,605 mother-child pairs from the Shanghai Children's Allergy Study.
Self-reported questionnaires were used to obtain data on the prevalence of pediatric asthma andcovariates such as demographic, socioeconomic, and behavioral characteristics. Environmental data
including ambient temperature and NO2 were satellite derived. Binomial generalized linear models
with a logit link were carried out to evaluate the association between environmental exposure andchildren’s asthma adjusted for potential confounders, and then stratified by sex.
RESULTS:Mean exposure to ambient temperature and NO2 during three years prior the study was
17.65 ℃ and 41.27 μg/m3, respectively. Per unit increment of temperature was associated with anincreased odds ratio (OR) of childhood asthma prevalence (1.13, 95% confidence intervals, CI: 1.05,
1.21 in overall; 1.15, 95% CI: 1.05, 1.27 for males) after controlling potential confounders. There wasno such association in females. In addition, the NO2-asthma association was only found in the lowtemperature group (＜ median value) where an interquartile range increase of NO2 was associatedwith 22% increased OR (95% CI: 1.06, 1.40) for children’s asthma.
CONCLUSIONS:Both ambient temperature and NO2 seemed to be triggers of childhood asthma,
together with their interactive effects. Children were more sensitive to NO2 in cold conditions, andmales were more venerable to higher temperatures. Further research are warranted, and tailored
preventive strategies shall be proposed to protect children’s respiratory health.

Keywords: Asthma, children, interactions, nitrogen dioxide, temperatureEP-142[Air pollution » Long-term exposure]Ten-year exposures to PM2.5 and NO2 andcancer incidence in American older adults
Yaguang Wei1, Mahdieh Danesh Yazdi2, Tszshan Ma3, Edgar Castro1, Cristina Su Liu1, Xinye Qiu1,
James Healy1, Bryan N. Vu1, Cuicui Wang1, Liuhua Shi3, Joel Schwartz4
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony

Brook University, Stony Brook, NY, USA
3Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA, USA
4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Epidemiologic evidence on air pollution and major cancers other than lungcancer remains largely lacking. We aim to examine simultaneous effects of 10-year exposures to fineparticulate matter (PM2.5) and nitrogen dioxide (NO2) on the risks of breast, prostate, colorectal, andendometrial cancer.
METHOD:For each cancer, we constructed a separate cohort among the national Medicare beneficiaries
during 2000–2016. For each participant, we required a follow-up of at least 10 years, during which
there was no cancer diagnosis. After that, participants were censored at first occurrence of cancer
diagnosis, death, or end of study, whichever occurred earliest. We examined additive effects ofmoving average exposures to PM2.5 and NO2 over the year of diagnosis and previous 2 years,
previous 3 to 5 years, and previous 6 to 10 years, predicted using high-resolution spatio-temporalmodels, on the risk of first cancer diagnosis after 10 years of “cancer-free” follow-up. We used aninverse probability weighting-based additive model to perform analysis, accounting for competing riskof death.
RESULTS:The cohorts included 2.2–6.5 million subjects for different cancers. PM2.5 and NO2
exposures increased absolute risks of colorectal and prostate cancer across the 10-year exposure
window: a unit reduction in PM2.5 and NO2 would respectively prevent 705 and 95 colorectal cancers,
representing 6.2% and 0.8% of new cases per year within the cohort; a unit reduction in PM2.5 andNO2 would respectively prevent 460 and 223 prostate cancers, representing 3.4% and 1.7% of newcases per year within the cohort. Effects were considerably larger at low exposure levels. PM2.5 andNO2 were not associated with endometrial cancer risk. Evidence supported adverse effects of NO2 onbreast cancer risk but was unclear for PM2.5.
CONCLUSIONS:Long-term PM2.5 and NO2 exposures increased colorectal and prostate cancer risks.
Substantial benefits of air quality management exist through cancer prevention.

Keywords: Air pollution, Long-term exposure, Cancer and cancer-precursors, Incidence,
Methodological study designEP-143[Climate » General]

Mixture effects of air pollutants and seasonaltemperature anomalies on cardiovascularhospitalizations
Yaguang Wei1, Heresh Amini2, Xinye Qiu1, Edgar Castro1, Tingfan Jin1, Kanhua Yin3, Bryan N Vu1,
Jiangshan Zhang4, Joel Schwartz5
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
4Department of Statistics, University of California, Davis, CA, USA
5Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Although emerging evidence suggests that climate change negatively impacts
cardiovascular disease (CVD) through pathways involving worsening air quality and abnormal
temperature patterns, the joint impacts and relative importance of related exposures are largely
lacking. Our goal is to assess mixture effects of chronic exposures to air pollutants and seasonaltemperature anomalies on hospitalization risk for CVD among all-age residents in 15 U.S. states
during 2000–2016.
METHOD:Using the Health Cost and Utilization Project State Inpatient Databases, we investigatedassociations between annual exposures to mixtures of major PM2.5 components (sulfate, nitrate,
ammonium, organic carbon, and elemental carbon), ozone, nitrogen dioxide (NO2), and fluctuations of
seasonal temperature averages and standard deviations on the hospitalization risks for ischemic heartdisease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease,and all of these CVDs combined. For each outcome, we used a generalized weighted quantile sum
regression with quasi-Poisson link to examine the cumulative association between the mixture of
exposures and hospitalization risk and the contribution of each single exposure to the cumulative
association, adjusting for individual- and community-level characteristics as confounders.
RESULTS:For the combined CVD, we found that each decile increase in the levels of the mixtures
increased hospitalization risk by 7.8% (95% confidence interval: 7.3%, 8.2%). Sulfate, NO2, andnitrate contributed the most to the cumulative association. For individual CVDs, a decile increase in
the mixtures was significantly associated with increased hospitalization risks, with point estimatesranging between 6.7%–10.0%. In addition to sulfate, NO2, and nitrate, warmer-than-averagesummer temperature was another important contributor for most individual CVDs.
CONCLUSIONS:Our findings suggested that air pollution and warmer climate jointly increased the riskof cardiovascular hospitalization. Identified air pollutants suggested that combustion of fossil fuels,
traffic, and agriculture were the most detrimental sources to cardiovascular health.

Keywords: Air pollution, Mixtures, Climate, Cardiovascular diseases

EP-144[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Exposure to monocyclic aromatic hydrocarbons BTEX is associated with cardiovascular disease,dyslipidemia and leukocytosis in national US
population
Yan Su He1, Hong Qiu2, Wen Qiao Wang3, Kin Fai Ho4
1The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese

University of Hong Kong, Hong Kong, China
2Department of Clinical Nutrition, The Children’s Hospital, Zhejiang University, Hangzhou, China
3Department of Computer Science and Engineering, The Hong Kong University of Science andTechnology, Hong Kong, China.
4The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese

University of Hong Kong, Hong Kong, China; Institute of Environment, Energy and Sustainability, The
Chinese University of Hong Kong, Hong Kong, China.

BACKGROUND AND AIM:The evidence of blood benzene, toluene, ethylbenzene, and xylenes (BTEX)
on cardiovascular diseases (CVD) from epidemiological studies is insufficient. To investigate the effectsof blood BTEX on total CVD and individual CVD outcomes, as well as that on lipid profiles and whiteblood cell (WBC) count.
METHOD:We investigated the associations of blood combined and individual BTEX with CVD and its
subtypes in 17007 participants from the U.S. National Health and Nutrition Examination Survey 1999–
2018 by survey-weighted multivariate logistic regression. Weighted quantile sum model and its
extension quantile g-computation were conducted to estimate the combined effect of BTEX mixture on
CVD. Weighted multivariate linear regression was used to estimate the effects of BTEX on lipid profiles
and WBC and its five-part differential count.
RESULTS:Compared to reference quartile of BTEX mixture, adjusted odds ratio of CVD risk for people
in the highest quartile was 1.64 (95% CI: 1.23 to 2.19) with P for trend = 0.008. Positive associations
were also found for benzene, toluene, ethylbenzene, and m-/p-xylene but not for o-xylene. The above
associations demonstrated monotonically increasing exposure-response relationship. Furthermore,combined BTEX exposure was associated with congestive heart failure (CHF), angina pectoris, andheart attack; individual benzene, toluene, and ethylbenzene were associated with CHF; toluene,
ethylbenzene, and all xylene isomers were associated with angina pectoris; benzene, toluene, and oxylene were associated with heart attack. Combined and individual BTEX was positively associatedwith triglycerides, cholesterol, low density lipoprotein, and WBC and its five-part differential count, but
negatively associated with high density lipoprotein. Subgroup analyses identified modifying effects ofsmoking, drinking, exercise, BMI, hypertension, and diabetes on the associations between specific
VOCs and CVD risk.
CONCLUSIONS:Exposure to higher levels of combined and individual BTEX were associated withincreased CVD risk through dyslipidemia and leukocytosis.

Keywords: biomarkers of exposure, cardiovascular diseases, mixtures analysis, environmental
epidemiology

EP-145[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Interaction between air pollution and risk factors
for cognitive decline: a comparison study in
China and the UK cohorts
Yanxi Zeng, Weiju Zhou, John S Ji
Wanke School of Public Health, Tsinghua University, Beijing, China

BACKGROUND AND AIM:The Lancet Commission's review of risk factors for dementia and cognitive
decline in 2020 identified twelve factors, among which air pollution was recognized as a significant
contributor. However, little is known about the potential interaction effects of air pollution with otherrisk factors for cognitive decline, and their differences between countries.
METHOD:In the study, 13,186 participants aged over 45 from the China Health and Retirement
Longitudinal Study (CHARLS, 2015 wave) and 461,020 UK Biobank participants aged 37-73 (enrolled
between 2006 to 2010) were compared. The study assessed cognitive function using standardized
tests that measured specific cognitive domains. Air pollution exposure, including annual averages of
PM2.5, PM10, and NO2, was measured in both cohorts. The study utilized multivariable regression
models to analyze the direct and interaction effects of air pollutants and 11 other risk factors on
cognitive function, while adjusting for key covariates.
RESULTS:Both cohorts demonstrated a significant interaction effect between air pollution and smoking
status across most cognitive tests, but there were differences in the nature, extent, and direction of
the interaction effects observed. The CHARLS cohort revealed that the interaction between PM10 andhearing loss had a significant effect on immediate learning ability (0.21 [95%CI 0.04, 0.38]), while
NO2 had significant interaction effects with obesity on delayed learning ability (-0.22 [-0.40, -0.05]).
Conversely, the UK Biobank cohort showed that the interaction between PM2.5 and physical inactivity
had a significant effect on numeric memory (-0.04 [-0.07, -0.01]) and reaction time (0.003[0.001,0.006]). Furthermore, the magnitude of interaction effects was generally more substantial in
the CHARLS cohort compared to the UK Biobank cohort.
CONCLUSIONS:Our findings in China and the UK emphasize the need for tailored interventions thattarget multiple risk factors and address the unique risk factors and environmental exposures in
specific populations to promote healthy cognitive aging.

Keywords: Air pollution, Cognitive decline, Interaction effect, China, United Kingdom

EP-146[Air pollution » General]

Associations between long-term and short-term
air pollution and postpartum depression, andinteraction with temperature
Yi Sun1, Kathryne Headon3, Anqi Jiao2, Jeff M. Slezak4, Chantal C. Avila4, Vicki Y. Chiu4, David A.
Sacks5, John Molitor6, Tarik Benmarhnia7, Jiu Chiuan Chen8, Darios Getahun9, Jun Wu2
1Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical

College, Beijing, China.
2Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, CA, USA.
3School of Medicine, University of California, Irvine, CA, USA.
4Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
5Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine,Los Angeles, CA, USA.
6College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
7Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
8Departments of Population & Public Health Sciences and Neurology, University of Southern California,

Keck School of Medicine, Los Angeles, CA, USA.
9Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,

Pasadena, CA, USA.

BACKGROUND AND AIM:Few studies have examined the relationship between air pollution andpostpartum depression (PPD). The joint impact of air pollution and temperature on PPD remains
unexplored. We aimed to investigate the relationships between PPD and maternal exposure to longand short-term air pollution, and the interaction of air pollution and temperature.
METHOD:Clinical data were obtained from Kaiser Permanente Southern California electronic healthrecords (2008-2016). PPD ascertainment was done using ICD-codes and prescribed medications.
Monthly ambient air pollution concentrations (PM₂.₅, PM10, NO₂, and O₃) were assessed using kriging
interpolation of monitoring station data. PM₂.₅ constituents (sulfate, nitrate, ammonium, organic
matter, and black carbon) were estimated using outputs from a fine-resolution geoscience-derived
model. Multilevel Cox proportional hazard models were applied; non-PPDs were censored at the end offollow-up (one-year after delivery). Long-term exposure was defined as exposure from conception to
the date of PPD diagnosis or censoring; short-term exposure was defined as exposure during the pastmonth of the PPD diagnosis or censoring. Relative excess risks due to interactions were calculated toquantify the interactions between air pollution and temperature.
RESULTS:A total of 342,241 singleton births with 43,399 (10.5%) PPD cases were included. We
observed increased PPD risk associated with both long- and short-term air pollution, including PM₂.₅,
PM10, NO₂ and PM₂.₅ constituents. The associations were most pronounced for long-term PM10
[adjusted hazard ratio(HR) per interquartile range: 1.18, 95% confidence interval(CI):1.16–1.20] andshort-term NO₂ (HR=1.06,95%CI:1.50–1.07) among krigged pollutants, and PM₂.₅ black carbon(long-term: HR=1.34,95%CI:1.29–1.38; short-term: HR=1.24,95%CI:1.21–1.26) among PM₂.₅
constituents. We identified positive additive interactions between air pollution and maximum
temperature, suggesting that increasing maximum temperature could aggravate the increased PPD
risks associated with air pollution.

CONCLUSIONS:Exposure to long- and short-term air pollution was associated with an increased risk of
PPD. There is a synergistic effect between air pollution and high temperature on PPD.

Keywords: Pregnancy outcomes, mental health outcomes, air pollution, temperatureEP-147[Chemical exposures » PFAS]

PFAS exposure and changes in the extracellular
microRNA profile in a cohort of adolescents
undergoing bariatric surgery
Yijie Li1, Brittney O. Baumert1, Nikos Stratakis2, Jesse Goodrich1, Haotian Wu3, Hongxu Wang1,
Flemming Nielsen4, Philippe Grandjean5, Scott Bartell6, Sandrah P. Eckel1, Douglas I. Walker7,
Damaskini Valvi8, Michele A. La Merrill9, Thomas Inge10, Todd Jenkins11, Justin Ryder10, Stephanie
Sisley12, Rohit Kohli13, Stavra A. Xanthakos14, Max Aung1, Rob Mcconnell1, Andrea Baccarelli3, DavidConti1, Lida Chatzi1
1Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, USA
2Barcelona Institute of Global Health, Barcelona, Spain
3Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, USA
4Institute of Public Health, University of Southern Denmark, Odense, Denmark
5Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department ofEnvironmental Health, T.H. Chan School of Public Health, Harvard University, Boston, USA
6Department of Environmental and Occupational Health, University of California, Irvine, USA
7Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, USA
8Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, USA
9Department of Environmental Toxicology, University of California, Davis, USA
10Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA; Ann &Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
11Division of Epidemiology & Biostatistics, Cincinnati Children's Hospital Medical Center, Departmentof Pediatrics, University of Cincinnati, Cincinnati, USA
12Department of Pediatrics, Baylor College of Medicine, Houston, USA
13Division of Gastroenterology, Children’s Hospital Los Angeles, Los Angeles, USA
14Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical

Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals thatpersist in the environment and accumulate in humans, leading to adverse health effects, such as
hepatotoxicity. Little is known about the modes of action of PFAS toxicity, but one likely mechanism isalteration of microRNA (miRNA) profiles that regulate post-transcription gene expression. This study
aims to investigate associations between plasma PFAS concentrations and plasma miRNA expressionin adolescents with severe obesity undergoing bariatric surgery.
METHOD:PFAS concentrations (PFOS, PFOA, PFHxS, PFNA, PFUdA, PFHpA) were assessed in plasma
samples from 175 participants of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS)
cohort. 843 plasma miRNA were profiled using the established HTG EdgeSeq platform. We examinedassociations of individual PFAS with miRNA using linear regression after adjusting for sex, BMI, age,race, parental income, pre-surgery weight loss and geographic clinical site of surgery. We additionallyassessed PFAS mixture effects using quantile g-computation. Ingenuity Pathways Analysis (IPA) wasused to identify putative biological functions of PFAS-associated miRNA (p < 0.05).
RESULTS:In the single PFAS analysis, PFHpA exhibited the highest numbers of significant associations
with miRNA (22 upregulated, 192 downregulated, p < 0.05). Moreover, PFOS, PFOA, PFNA, PFHxS and
PFUNdA were associated with 6, 25, 3, 29 and 33 miRNA (p < 0.05), respectively. PFAS mixture wassignificantly associated with alteration in 239 miRNA levels (52 downregulated, 187 upregulated, p <0.05), but none overlapped with individual PFAS-associated miRNA. Putative targets of dysregulated
miRNA associated with PFAS mixture included pathways involved in hepatotoxicity (e.g. liver
inflammation, cirrhosis and hepatocellular carcinoma), cardiotoxicity (e.g. organismal injury andabnormalities and reproductive system disease) and nephrotoxicity (e.g renal inflammation andnephritis).
CONCLUSIONS:Altered miRNA expression could be an indicator of PFAS toxicity and a mechanistic link
between PFAS exposure and disease risk.

Keywords: Children's environmental health, Mixtures analysis, Epidemiology

EP-148[Air pollution » Particulate matter]

Long-term Exposure of Ambient PM2.5,
Particulate Constituents and Hospital
Admissions from Non-respiratory Infection
among Older Adults in the US
Yijing Feng1, Edgar Castro2, Yaguang Wei2, Francesca Dominici3, Joel Schwartz2
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, UnitedStates3Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States

BACKGROUND AND AIM:PM2.5 is known to have high immunotoxicity. Previous studies have foundthat PM2.5 was associated with increased risk of respiratory infections. Less is known about theassociation between PM2.5 and non-respiratory Infections. We investigated the association between
total PM2.5, PM2.5 constituents, source-specific PM2.5 and hospital admission from non-respiratory
infection.
METHOD:Annual ZIP code level concentration of PM2.5 and its constituents across the US between
2000-2016 were estimated from validated ensemble machine learning models. Non-negative matrix
factorization was used to obtain the concentration of source-specific PM2.5 from constituent data.
Quasi-Poisson regression models were used to investigated the association between annual ZIP codelevel total and source-specific PM2.5 and rate of hospital admission of Medicare participants from nonrespiratory infections. Using weighted-quantile-sum regression, we estimated the association between
PM2.5 mixture index and the outcome while identified the PM2.5 constituents which contributed themost in the association. All the associations were adjusted for demographics, socioeconomic status,
access to healthcare and meteorological factors.
RESULTS:Each 1ug/m3 increase is PM2.5 was associated with a 2.8% (95%CI 2.8-2.9%) increase inrate of hospital admission from non-respiratory infections. Sulfates (30.8%), Nickel (22.5%) and
Copper (15.3%) contributed the highest weights in the associations between PM2.5 mixture index andthe outcome across the 15 constituents. Each one standard error increase in PM2.5 sourced from oil
combustion, coal burning, traffic, dirt and regionally transported nitrates were associated with 14.5%(95%CI 7.7-21.9%), 18.2% (95%CI 7.2-30.3%), 20.7% (95%CI 5.6-37.9%), 9.1% (95%CI 0.318.6%) and 7.9% (95%CI 0.6-15.7%) increases in hospital admission from non-respiratory infections.
CONCLUSIONS:Long-term ZIP code level PM2.5 is associated with increased hospital admission from
non-respiratory infection among older adults, with sulfates, nickel and copper playing the mostimportant roles. This study highlighted the need for concern about the impact of air pollution on nonrespiratory infections.

Keywords: Particle components, Mixtures, Long-term exposure, Infectious diseases

EP-149[Exposure assessment methods » Risk assessment]

Influence of gender and age on overwork-related
adverse effects among employees: a crosssectional study in Taiwan
Yu Cheng Lin
Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan

BACKGROUND AND AIM:The aim of the present study was to evaluate the risk of overwork related
adverse effects (OrAEs) between women and men among different age groups in Taiwan workplaces.
METHOD:Data from employees of the companies providing occupational health services wereanalyzed. The study population consisted of 4920 employees, and the anonymous data analyzed
included employment duration, working hours, work schedules and health examination results. The
risk for OrAEs was assessed by an index, the Karo index, which is composed of thecerebrocardiovascular risk score (0-2) and the occupational risk score(0-2), with scores of 3 and 4
being categorized as at high risk for OrAEs (h-OrAEs).
RESULTS:The 4920 employees had a mean employment duration of 8.5 years and a mean age of 38.6
years. The ratio of female to male labor force participation changed with increasing age. The
prevalence rates for h-OrAEs in women and men were 9.8% and 23.3%, respectively. The peakprevalence rates for h-OrAEs were in the 40s and 50s for women and in the ages of 40s for men.
Multivariate analysis results showed that men had a 2.9-fold higher risk of h-OrAEs than women, andthe workers in their 40s had the significantly highest risk of h-OrAEs for both women and men.
CONCLUSIONS:There are significant gender differences in the risk of overwork-related adverse effects
among Taiwanese workers. The late middle-aged workers have the highest risk of overwork-related
adverse effects in both women and men.

Keywords: Overwork related adverse effects, Gender differences, Age, Cardiovascular diseases, Risk
assessment

EP-150[Chemical exposures » PFAS]

Serum Concentrations of Per andPolyfluoroalkyl Substances and Thyroid
Function Biomarkers Among Females Presenting
to a Fertility Clinic
Yu Zhang1, Vicente Mustieles2, Leah Martin1, Yang Sun1, Alexandra Hillcoat3, Xin Fang1, Zainab Bibi1,
Nicole Torres1, Ayanna Coburn Sanderson1, Olivia First1, Irene Souter4, John C. Petrozza4, Yi Xin
Wang1, Carmen Messerlian1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
2Instituto de Investigación Biosanitaria Ibs GRANADA, Spain. University of Granada, Center for

Biomedical Research (CIBM), Spain. Consortium for Biomedical Research in Epidemiology and Public
Health (CIBERESP), Spain.
3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
4Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts

General Hospital Fertility Center, Boston, MA, USA.

BACKGROUND AND AIM:This study aimed to examine the associations between serum per andpolyfluoroalkyl substances (PFAS) concentrations and their mixture with thyroid biomarkers amongfemales presenting for fertility investigation.
METHOD:Our study included 287 females seeking medically assisted reproduction at a fertility center
in Massachusetts, United States (U.S.). Non-fasting blood samples were collected at recruitment andquantified for serum concentrations of six long-alkyl chain PFAS compounds, thyroid hormones[thyroid stimulating hormones (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total
triiodothyronine (TT3), total thyroxine (TT4)], and two autoimmune antibodies [peroxidase antibody(TPOAb) and thyroglobulin antibody (TgAb)]. The ratio of FT4 to FT3 was calculated. We used
multivariable linear regressions and quantile-based g-computation to evaluate associations ofindividual PFAS and their total mixture with thyroid biomarkers, adjusting for confounders.
RESULTS:The mean (SD) age of the study participants was 34.5 (4.1) years. Most were White females(82.7%) and had graduate degrees (57.8%), and nearly half had unexplained infertility (45.9%). We
found that higher serum concentrations of four PFAS compounds, namely perfluorooctanoate (PFOA),
perfluorononanoate (PFNA), perfluorodecanoate (PFDA), perfluoroundecanoate (PFUnDA), and thetotal PFAS mixture were associated with lower TT3 levels. Specifically, each quartile increase in serum
concentrations of the total PFAS mixture was associated with a 4.45% (95% CI: -7.15%, -1.67%)
decrease in TT3. Further, we found higher serum concentrations of PFNA, PFDA, PFUnDA, and the total
PFAS mixture to be associated with a higher FT4/FT3 ratio. No associations were found for TT4, TSH,
or autoimmune antibodies.
CONCLUSIONS:In this study of females attending a fertility clinic, we found that select PFAS
compounds and the total PFAS mixture were associated with lower TT3 levels and higher FT4/FT3
ratios. Our findings suggest that PFAS induces thyroid disruption among a vulnerable population ofsubfertile females, especially among those with unexplained infertility.

Keywords: PFAS, Mixtures, Thyroid function, FemaleEP-151[Chemical exposures » Heavy metals]

Age- and sex-specific inverse associations
between blood lead levels and serum levels of αKlotho in US adult participants
Yudan Wei1, Jianmin Zhu2, Wonjun Billy Kim3
1Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA
2Department of Mathematics and Coumputer Science, Fort Valley State University, Fort Valley,

Georgia, USA
3MD Program, Mercer University School of Medicine, Macon, Georgia, USA

BACKGROUND AND AIM:Prolonged exposure to low levels of lead, a non-essential toxic metal, hasbeen associated with aging-related disorders, such as cardiovascular disease, in the general adult
population. The aim of the present study was to examine the relation between lead exposure andserum levels of soluble α-Klotho, an anti-aging hormone, in US adults.
METHOD:A nationally representative subsample of 2259 adults from ages 40-79 in the 2013-2016
National Health and Nutrition Examination Survey was analyzed for the association between blood leadlevels and serum α-Klotho levels using multiple general linear models, adjusting for potential
confounders. Age- and sex-specific analyses were further conducted. We also evaluated two othertoxic metals, cadmium and mercury, in association with α-Klotho levels for sensitivity analyses.
RESULTS:The weighted geometric mean of blood lead was 1.10 µg/dL and the weighted mean ofserum α-Klotho was 819.48 pg/mL in the study participants during 2013-2016. After adjusting forpotential confounders, lead was significantly associated with decreased serum levels of α-Klotho(regression coefficient β=-33.75; p=0.0011) in the total study population. Age- and sex-specificanalyses revealed a significant inverse association between lead and α-Klotho levels in middle-aged
adults (40-59 years) with a β of -48.20 (p=0.0013) and in males with a β=-43.94 (p=0.0003).
However, no significant association was observed in older adults (60-79 years) and in females. The
age- and sex-specific associations were stronger as compared to the total population. No statisticallysignificant associations with α-Klotho levels were observed for blood cadmium or mercury.
CONCLUSIONS:This study demonstrates an inverse relationship between blood lead levels and αKlotho in middle-aged adults and in males. Additional studies would further explore these age- andsex- specific interactions and elucidate the potential role of α-Klotho in mediating the effect of lead
exposure on aging-related disorders.

Keywords: adults, α-Klotho, blood lead levels, lead exposure, NHANES

EP-152[Air pollution » General]

Air quality in Bulgaria and policies to improve it
Jeni Nikolova Staykova1, Yuliya Dimitrova Ilieva2, Manoela Georgieva3
1Faculty of Public Health, Medical University, Sofia, Bulgaria
2MBAL Pirdop JSC, Pirdop, Bulgaria
3ATM Consulting Partners Ltd, Sofia, Bulgaria

BACKGROUND AND AIM:To study the atmospheric air pollution in Bulgaria during the last ten years.
METHOD:Data from the Environment Executive Agency, Ministry of Health and National Institute of
Statistics were used.
RESULTS:Atmospheric air pollution is extremely relevant globally, with a risk to the health and life ofpeople and the environment. In Bulgaria, the legislation on its monitoring is harmonized with theEuropean one. According to the requirements, 6 regions for assessment and management of
atmospheric air quality with 48 stationary points have been approved. The biggest problem is air
pollution with fine particulate matter (PM10 and PM2.5). In 2019, the percentage of the population,living at levels of PM10 pollution was very high – 60.8%. Excessive concentrations were found for NO2(exceeding the average day-night norm in one region), SO2 (10 exceedances were registered in oneof the points near the thermal power plant), benz(o)pyrene (exceedance in 7 out of 16 points of theaverage annual rate). The main sources of pollution are motor transport, heat energy production,
domestic heating with solid fuel, metallurgy and oil refining.
CONCLUSIONS:For a 10-year period, in recent years, a decrease in the emissions of the main
pollutants has been registered in Bulgaria. This was achieved as a result of the measures taken to
reduce national emissions, regulated in the National Program for the Improvement of Ambient Air
Quality for the period 2018-2024 and the National Program for Air Pollution Control (2020-2030). In
the period 1990-2019, the emissions of the main pollutants decreased, with the exception of PM2.5,
due to an increase in the emissions of the household. SO2 emissions decreased by 93% (mainly from
TPP). NOx emissions decreased by 66.5%, due to reduced emissions from thermal power plants andmotor transport.

Keywords: air pollution, environmental epidemiology, particulate matterEP-153[Air pollution » Particulate matter]

Driving forces of PM2.5 concentrations inmegacity Lahore: application of geographicallyand temporally weighted regression model tocity-level
Saqib Ur Rehman1, Bilal Ahmed Usmani2, Muhammad Ahmed3, Zafar Ahmed4, Zafar Fatmi5
1Department of Mathematics, University of Karachi, Pakistan.
2Section of Epidemiology & Biostatistics, Department of Community Health Sciences, Aga Khan

University, Karachi, Pakistan.
3NED University of Engineering & Technology, Karachi, Pakistan.
4Northumbria University, UK
5Section of Environmental-Occupational Health & Climate Change, Department of Community Health

Sciences, Aga Khan University, Karachi, Pakistan.

BACKGROUND AND AIM:Fine particulate matter (PM <2.5µm) is the main indicator for air pollution
which is closely linked to human health and much wider impact on environment and considered an
important impact pathway of global climate change. Accurately identifying the main drivers of PM2.5
in megacities is of great significance, as cities are the main hub of air pollution.
OBJECTIVE: The temporal and spatial heterogeneity of PM2.5 and its drivers, considering both climatechange and socioeconomic developmental conditions, has not been explored in the previous studies
especially at the city-level.
METHOD:We adopted a geographically and temporally weighted regression model (GTWR) to explore
the direction and strength of the influences of climate change and socioeconomic variables on theconcentration of PM2.5 in one of the highest polluted megacity Lahore, covering the period 1998 to
2020.
RESULTS:PM2.5 concentration steadily increased from an average of 53 to 88µg/m3 during last 20
years in Lahore city. Windspeed, relative humidity, temperature and precipitation reduce PM2.5
concentrations, with strongest to weakest influence in that order. Eastern part of the city morestrongly favorably influenced than western part of the city by the climate variables leading to higher
PM2.5 concentrations in eastern part of the city. Foreign direct investment (FDI) very strongly and
GDP moderately intensified PM2.5 concentrations. Population density strongly intensifies PM2.5
throughout the city, while road density and land use intensify the concentrations at specific locations
within the city. Less dense areas of road and land use inversely favorably influence PM2.5 in the city.
CONCLUSIONS:In the city of Lahore, PM2.5 concentrations showed strong spatial variances andcorrespond to a series of phases. Both the sources of PM2.5 and its concentration are spatiallyheterogeneous. This information at the sub-districts scale within a city may help in formulatingtargeted interventions for air pollution mitigation.

Keywords: PM2.5 concentrations, Geographically and temporally weighted regression, climaticconditions, socioeconomic determinants, spatial heterogeneity.

EP-154[Air pollution » General]

The association of prenatal ambient air pollution
with placenta epigenetic age at birthZhengting He1, Ashley Song2, Rose Schrott2, Jason Feinberg2, Kelly Bakulski3, Lisa A. Croen4, Irva
Hertz Picciotto5, Rebecca J. Schmidt5, Craig Newschaffer6, M. Daniele Fallin7, Heather Volk2, Christine
Ladd Acosta1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, UnitedStates; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, United States
2Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, UnitedStates; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, United States
3Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, UnitedStates
4Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
5Department of Public Health Sciences, School of Medicine, University of California at Davis (UCDavis), Davis, CA, United States; UC Davis MIND (Medical Investigations of Neurodevelopmental
Disorders) Institute, UC Davis, Sacramento, CA, United States
6College of Health and Human Development, Pennsylvania State University, State College, PA, UnitedStates7Rollins School of Public Health, Emory University, Atlanta, GA, United States

BACKGROUND AND AIM:Prenatal exposures to air pollutants (AP) are well-established risk factors forpreterm birth, yet evidence on implicated tissues and underlying biological mechanisms remaininconclusive. DNA methylation (DNAm) is involved in AP-induced placental alterations. DNAm-based
epigenetic age estimators are emerging biomarkers for biological age and can reflect early-life
exposures in children. We assessed associations of prenatal ambient AP with placental epigenetic age
at birth.
METHOD:Prenatal AP concentrations (NO2, O3, PM2.5, PM10) were assigned by spatial interpolations
on weekly AP data from monitoring stations proximal to maternal residence, and calculated for
exposure periods: preconception, pregnancy, which was further divided into three trimesters. Fetalside placenta DNAm data measured on Illumina Infinium HumanMethylation450 BeadChip wasavailable for 104 mother-child pairs from Early Autism Risk Longitudinal Investigation cohort.
Epigenetic age was computed using Lee’s robust placenta clock algorithm. Intrinsic epigenetic age
accelerations (IEAAs) were defined as residuals from a linear regression of epigenetic age on
chronological gestational age, adjusting for cell type proportions. We used multivariable linear
regressions to examine associations between average AP and IEAAs for each exposure period,
adjusting for study site, maternal, and child characteristics. We used weekly distributed lag models(DLMs) to examine vulnerable exposure windows.
RESULTS:Average O3 and PM10 levels during pregnancy were associated with lower IEAA at birth(β=-0.58, 95% CI: -1.11, -0.06; β=-0.80, 95% CI: -1.43, -0.18; per 10-unit AP, respectively).
Trimester-specific analyses revealed associations between average O3 and PM10 in trimester 2 with

slower IEAA (β=-0.28, 95% CI: -0.54, -0.03; β=-0.63, 95% CI: -1.10, -0.17; per 10-unit AP,
respectively). Weekly DLMs suggested associations with lower IEAA for O3 and PM10 in pregnancy
week 16-32 and 18-32, respectively.
CONCLUSIONS:Prenatal ambient AP, especially during middle to late pregnancy, was associated withdecelerated epigenetic age at birth, suggesting lower biological maturity. Findings reinforce
importance of AP exposure prevention during pregnancy.

Keywords: air pollution, epigenetic age, DNA methylation, placentaEP-155[Air pollution » Long-term exposure]Long-term exposure to air pollution andParkinson’s disease: A causal analysis based ona large prospective cohort study
Baozhuo Ai, Hualiang Lin, Zilong Zhang
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

BACKGROUND AND AIM:Current epidemiological evidence on long-term air pollution exposure andParkinson’s disease is inconsistent, and assessment of causality is particularly lacking. We aimed toinvestigate the associations between long-term air pollution exposure and Parkinson’s disease withcausal modelling approaches.
METHOD:We studied 314,482 participants from a large prospective cohort study, the UK Biobank
Study, from 2006 to 2019. Long-term exposure to ambient fine particulate matter (PM2.5) and ozone(O3) was estimated using high-resolution spatial-temporal models at each participant’s residence.
Incidence of Parkinson’s disease was identified using health administrative datasets. We used
instrumental variable models, with wind speed as the instrument, to examine the causal effects of
PM2.5 and O3 exposure on Parkinson’s disease. In addition, we used accidental death as a negative
control outcome to evaluate the potential bias due to unmeasured confounding.
RESULTS:During an average follow-up of 11.6 years, 1,924 individuals developed Parkinson’s disease.
In instrumental variable analysis, we found significant associations between PM2.5 exposure andParkinson’s disease, with a hazard ratio of 1.35 (95% confidence interval: 1.05,1.74) for one-unit
increment in the instrument. No significant associations were observed for O3 exposure. As expected,
no significant associations were found between air pollution exposure and the negative control
outcome.
CONCLUSIONS:Our findings suggest that there might be a causal association between long-term
exposure to air pollution, particularly PM2.5, and Parkinson’s disease.

Keywords: Air pollution, Parkinson's disease, prospective cohort, causal inferenceEP-156[Air pollution » Wildfires]

Factors that Influence Risk Perception of
Wildfires: A Systematic Review
Anqi Jiao1, Yuliya Danilovna Gluhova2, Keira Truong1, Suellen Hopfer3, Jun Wu1
1Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US
2Department of Anthropology and Middle Eastern Cultures, Mississippi State University, Starkville, US
3Department of Health, Society, and Behavior, Program in Public Health, University of California,

Irvine, US

BACKGROUND AND AIM:Risk perception plays an important role in developing response actions towildfires and can be influenced by a variety of factors. We aimed to conduct a systematic review tocompile a comprehensive list of factors that affect the public’s wildfire risk perception.
METHOD:We performed an online search for PubMed, ProQuest, and Web of Science databases to
identify research published between January 2000 and August 2022. Studies reporting factors related
to risk perception based on surveys were included in the review.
RESULTS:From 3,466 papers retrieved, 20 studies met our screening criteria, and 16 were conductedin the United States. Several major factors were identified as influential factors for the risk perceptionof wildfires: sociodemographic characteristics, property ownership, living environment, prior wildfirerelated experience, and wildfire-related information resources. The most common factors studied wereage, income, education, dense vegetation around the residence, and prior wildfire experience. The
associations of age and prior experience with wildfire risk perception were largely inconsistent acrosspapers, with some papers associating older age and having prior wildfire experience with lower risk
perception, while others concluded the opposite or no association at all. Other factors, such as owninga property and being able to receive wildfire-related information from different resources wereassociated with higher risk perception in most of the studies.
CONCLUSIONS:To our knowledge, this is the first review to summarize associations of factors withwildfire-related risk perception. Future studies can provide further investigations and theories to
explain inconsistent results for certain variables.

Keywords: air pollution, built environment, natural disasters, socio-economic factors, wildfires

EP-157[Air pollution » Wildfires]

A Comparison between Short-Term Respiratory
Effects of Wildfire-Related Particulate Matterand Non-Wildfire Particulate Matter: A
Systematic Review
Anqi Jiao1, Tianmei Han2, Sara Abdallah2, Wajeeha Umer1, Janina Santos2, Jun Wu1
1Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US
2Program in Public Health, University of California, Irvine, US

BACKGROUND AND AIM:The frequency and severity of wildfires have been sharply increasing due toclimate change and largely contribute to ambient particulate matter (PM) pollution. We conducted asystematic literature review on the short-term relationships between wildfire-related PM and a varietyof respiratory endpoints and compared the effects of wildfire-related PM and non-wildfire PM.
METHOD:A comprehensive online search for the literature published from January 2000 to August2022 was conducted for databases of PubMed, Web of Sciences, Scopus, and EMBASE. We applied
search terms related to wildfire smoke and respiratory health outcomes, such as lung conditions,asthma, and wheeze.
RESULTS:In total, 3,397 articles were retrieved, and 37 articles were included in this review. The
majority of studies focused on associations of wildfire-related PM less than 2.5 µm or 10 µm withhospital admissions, emergency department visits/ambulance dispatches, or mortality, with a timeseries or case-crossover study design. Studies were concentrated in the continent of the United Statesand Australia. Asthma/wheeze was the most studied specific respiratory outcome. Positive
associations of wildfire PM with various respiratory outcomes were observed in most studies, with few
studies showing non-significant or mixed associations. Some age groups (e.g., children or elders aged
> 65 years) and females were more vulnerable to wildfire smoke impacts. Most studies concluded thatwildfire-specific PM was associated with higher risks of adverse respiratory outcomes than non-wildfire
PM or stronger associations of PM pollution were observed during the wildfire period or on smoke days
related to wildfires.
CONCLUSIONS:To our knowledge, this is the first systematic review to summarize the comparison
between the short-term respiratory health effects of wildfire vs. non-wildfire PM. Further investigations
are needed to better understand the mechanisms of adverse respiratory effects of wildfire-specific PM
pollution.

Keywords: air pollution, particulate matter, respiratory outcomes, short-term exposure, wildfires

EP-158[Air pollution » Mixtures]

Maternal Exposure to Ambient Air Pollution
Mixture and Premature Rupture of Membranes:
Evidence from A Large Cohort in Southern
California
Anqi Jiao1, Yi Sun2, Chantal Avila3, Vicki Chiu3, John Molitor4, Jeff Slezak3, David Sacks5, Jiu Chiuan
Chen6, Tarik Benmarhnia7, Darios Getahun8, Jun Wu1
1Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US
2Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US; Institute of Medical Information, Chinese Academy of Medical Sciences andPeking Union Medical College, Beijing, China
3Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US
4College of Public Health and Human Sciences, Oregon State University, Corvallis, US
5Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US;

Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, US
6Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

US
7Scripps Institution of Oceanography, University of California, San Diego, US
8Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US;

Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, US

BACKGROUND AND AIM:There is minimal evidence of relationships between maternal air pollution
exposure and spontaneous premature rupture of membranes (SPROM), a critical obstetrical problem
that can significantly increase maternal and fetal mortality and morbidity. No prior study has explored
the PROM risk related to specific components of particulate matter with aerodynamic diameters of ≤2.5 µm (PM₂.₅). We examined associations between maternal exposure to nitrogen dioxide (NO₂),
ozone (O₃), PM₂.₅, PM10, and PM₂.₅ constituents and SPROM.
METHOD:A large retrospective cohort study was conducted and included 427,870 singleton live births
from Kaiser Permanente Southern California during 2008-2018. Monthly averages of NO₂, O₃ (8-hdaily maximum), PM₂.₅, and PM10 were measured using empirical Bayesian kriging based on
measurements from monitoring stations. Data on PM₂.₅ sulfate, nitrate, ammonium, organic matter,and black carbon were obtained from a fine-resolution model. A discrete time approach with pooled
logistic regressions was used to estimate associations throughout the pregnancy and based ontrimesters and gestational months. The quantile-based g-computation models were fitted to examine
the effects of 1) the air pollution mixture of four pollutants of interest and 2) the mixture of PM₂.₅
components.
RESULTS:There were 37,857 SPROM cases (8.8%) in our study population. We observed relationships
between maternal exposure to all four pollutants and SPROM. PM₂.₅ sulfate, nitrate, ammonium, andorganic matter were associated with higher SPROM risks in the single-pollutant model. Mixture
analyses demonstrated that the overall effects of the air pollution mixture and PM₂.₅ mixture in thisstudy were mainly driven by O₃ and PM₂.₅ nitrate, respectively. Underweight mothers had asignificantly higher risk of SPROM associated with NO₂.
CONCLUSIONS:Our findings add to the literature on associations between air pollution exposure and
SPROM. This is the first study reporting the impact of PM₂.₅ constituents on SPROM.

Keywords: air pollution, environmental epidemiology, mixtures analysis, multi-pollutant, pregnancy
outcomesEP-159[Methods » Environmental epidemiology]

The association between carbon monoxide andcardiovascular diseases: a systematic review
and meta-analysis
Thi Hoang Yen Nguyen1, Kun Hua Li1, How Ran Guo2
1Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng
Kung University Hospital, Tainan, Taiwan

BACKGROUND AND AIM:The leading cause of death worldwide is cardiovascular diseases (CVDs).
Many studies have demonstrated the associations between short-term carbon monoxide (CO)exposure and the occurrence of CVDs in terms of hospital admissions and mortality. However, thefindings are still inconsistent, and the risk may vary across diseases. The objective of this study was toquantify the associations between ambient short-term CO exposure and mobility and mortality CVDs,
including cerebrovascular diseases.
METHOD:We used Embase, PubMed, and Web of Science to perform a systematic review of theliterature to identify studies that reported quantitative data on the connection between CO exposure
and CVDs and were published before August 2022. Two researchers independently searched for andselected studies, extracted data, and assessed the quality. Using random-effects models, we
calculated the relative risks (RRs) and their 95% confidence intervals (CIs) for various CVDs
associated with each 1 mg/m³ increase in CO.
RESULTS:This meta-analysis included 58 articles. We found significant associations between CO
exposure and mobility of CVDs (RR = 1.080; 95% CI: 1.016－1.148; I² = 99.9%), mortality of CVDs
(RR = 1.021; 95% CI: 1.009－1.033; I² = 92.6%), mobility of stroke (RR = 1.020; 95% CI: 1.002－
1.038; I² = 48.5%), mortality of stroke (RR 1.017; 95% CI: 1.010－1.025; I² = 0.0%), mobility ofarrhythmia (RR 1.012; 95% CI: 1.007－1.017, I² = 0.0%), mobility of ischemic heart disease (RR
1.007; 95% CI: 1.004－1.010; I² = 40.1%), mobility of heart failure (RR 1.017; 95% CI: 1.011－
1.023; I² = 42.2%), and mortality of heart failure (RR 1.019; 95% CI: 1.013－1.026; I² = 19.2%).
CONCLUSIONS:Our analyses showed associations between CO exposure and CVDs, but the pooled risk
estimates varied across different disease outcomes.

Keywords: carbon monoxide, cardiovascular diseases, mortality, mobility, meta-analysis

EP-160[Outcomes » Infectious diseases]

Impact of Influenza Infection and Environmental
Factors on Sepsis
Guozhang Lin, Conglu Li, Xiaoting Jiang, Yuchen Wei, Ka Chun Chong
The Chinese University of Hong KongBACKGROUND AND AIM:The influences of influenza infections and environmental factors on sepsis
have been examined. However, no previous studies have attempted to simultaneously quantify theirimpact on sepsis. In this study, we aimed to evaluate the time-varying relationships between influenza
infection, meteorological factors, air pollutants, and sepsis using Hong Kong’s surveillance data over
14 years.
METHOD:Weekly total numbers of hospitalizations due to sepsis were obtained from all public
hospitals in Hong Kong during 1998-2011. The numbers were matched with local meteorologicalrecords and outdoor air pollutant concentrations. To describe influenza activity, type-specific and alltype influenza-like illness positive (ILI+) rates were used as proxies. Quasi-Poisson generalized
additive models were used in conjunction with distributed lag non-linear models to estimate theassociations of interest.
RESULTS:A total of 169,830 hospital admissions due to sepsis were notified in public settings during
1998-2011 in Hong Kong. The cumulative adjusted relative risk (ARR) of hospital admission due tosepsis reached 1.10 (95% CI, 1.06-1.15) when the ILI+ total rate increased from zero to 21.68 per1000 consultations, the 95th percentile. The cumulative ARR of sepsis admission was elevated to 1.19
(95% CI, 1.07-1.32) when the mean ambient temperature decreased from 24.4 °C (median) to 14.9
°C (the 5th percentile). The relationship between short-term exposure to air pollutants and sepsis
hospitalization was not found to be statistically significant.
CONCLUSIONS:Influenza activity and cold weather are risk factors of sepsis. This implies that climatechange may exacerbate the sepsis burden. Promotion of influenza vaccination may lower the risk ofsepsis, especially before the winter season.

Keywords: Infectious diseases, Environmental epidemiology, ModelingEP-161[Policy » Policy research]

The Washington State Emergency Rule toProtect Workers from Wildfire Smoke:
Assessing Stakeholder Engagement andSentiment in Labor Policy
Lilian (ziqi) Liu, Edward J. Kasner, Tania M. Busch Isaksen, Elena Austin, Nancy J. Simcox, Martin A.
Cohen, Chris Zuidema, Christopher Simpson, Edmund Seto
University of Washington

BACKGROUND AND AIM:Rulemaking across the Western USA is being enacted to increase protections
for outdoor workers during wildfire events. Success of such efforts are dependent on adoption by
workers and employers. The Washington State Department of Labor and Industries (LNI) adopted its
first seasonal emergency occupational wildfire smoke rule in July 2021.
METHOD:We used qualitative methods to analyze the sentiments expressed about this rulemaking
effort from three primary sources. 1) Public comments collected during a series of Statewide
rulemaking forums held between April and June 2021. 2) Responses to key informant interviews of
outdoor worker representatives from different industries and labor organizations. 3) Responses to an
online survey distributed to outdoor supervisors and workers’ to capture their experience with wildfire
smoke and the emergency rule (n=30).
RESULTS:Cross-cutting themes that emerged were a) appreciation for the worker health impacts ofwildfire smoke; b) debate on air quality action levels, monitoring, and data; c) challenges due toinconsistencies between different rules in adjacent states; d) issues with the practicality and feasibilityof exposure reduction strategies, including respiratory protection; e) the need to manage coexposures and cumulative risks involving COVID-19 and heat exposure; and f) concerns on rule
compliance, worker rights, and enforcement. We also observed a significant shift (p < 0.001) fromnegative to positive sentiment between the April (prior to wildfire) and June (post wildfire) meetingssuggesting recent exposure to wildfire smoke may impact rulemaking sentiment.
CONCLUSIONS:These findings highlight important common themes and concerns that impact wildfire
smoke preparedness and compliance with worker protections. Responding to these themes is likely to
improve stakeholder engagement for future permanent rulemaking efforts.

Keywords: Wildfires, Occupational exposures, Policy research, Community outreach, Researchtranslation to affect policy and practiceEP-162[Climate » Temperature extremes and variability]

Extreme Heat and Severe Maternal Morbidity inSouthern California: Evidence of Health
Disparities from a Large Pregnancy Cohort
Anqi Jiao1, Yi Sun2, Chantal Avila3, Vicki Chiu3, John Molitor4, Jeff Slezak3, David Sacks5, Jiu Chiuan
Chen6, Tarik Benmarhnia7, Darios Getahun8, Jun Wu1
1Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US
2Department of Environmental and Occupational Health, Program in Public Health, University ofCalifornia, Irvine, US; Institute of Medical Information, Chinese Academy of Medical Sciences andPeking Union Medical College, Beijing, China
3Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US
4College of Public Health and Human Sciences, Oregon State University, Corvallis, US
5Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US;

Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, US
6Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

US
7Scripps Institution of Oceanography, University of California, San Diego, US
8Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, US;

Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, US

BACKGROUND AND AIM:The rate of severe maternal morbidity (SMM) has continued to increase in the
United States. We aimed to examine if maternal exposure to extreme heat is associated with the riskof SMM.
METHOD:We conducted a retrospective cohort study and included 425,722 singleton pregnancies from
Kaiser Permanente Southern California in 2008-2018. Daily maximum temperature data at a 4 km
resolution were obtained. An extreme heat day was defined as a day with the daily maximum
temperature exceeding a certain threshold. Four percentiles (i.e., 75th, 90th, 95th, and 98th) of daily
maximum temperature during the warm season (May-September) in 2007-2018 in Southern California
were selected to define the extreme heat day. Long-term exposures included the proportions of
extreme heat days during the entire pregnancy and by trimester. Short-term exposures were
measured by 12 different heatwave exposures (combining the four thresholds with three durations,
i.e., ≥ 2, ≥ 3, and ≥ 4 consecutive days) during the last gestational week. The discrete-time approachand Cox proportional hazards model were used to estimate the long- and short-term associations
between heat exposure and SMM, respectively. Stratified analyses were conducted to examine
vulnerable subpopulations and the effectiveness of mitigation measures.
RESULTS:There were 7,767 (1.8%) SMM cases during delivery hospitalization in this study. Long-term
associations with extreme heat were detected in the entire pregnancy and each trimester. Heatwave
exposures during the last gestational week were associated with higher risks of SMM. Stronger
associations were observed in mothers who were Hispanic, with lower education or incomes, orsmokers. More green space may attenuate heat effects.
CONCLUSIONS:Long- and short-term maternal exposure to extreme heat can be associated with anincreased risk of SMM. More residential green space can be a potential mitigation strategy.

Keywords: environmental epidemiology, green space, pregnancy outcomes, socio-economic factors,
temperature extremesEP-163[Outcomes » Childrens environmental health]

A population-based analysis on the relationshipbetween air pollutants, influenza infection, andacute otitis media in children
Conglu Li1, Xiaoting Jiang1, Yuchen Wei1, Yawen Wang1, Xiang Qian Lao2, Qianying Yue1, Ka Chun
Chong1
1The Chinese University of Hong Kong
2City University of Hong KongBACKGROUND AND AIM:Acute otitis media (AOM) is the most common diagnosis for childhood acuteillness, accounting for 13.6 million pediatric office visits annually. It is currently acknowledged as abacterial complication of viral upper respiratory tract infection (URI). Other potential risk factors of
AOM aside from URI, involve exposure to environmental air pollution and cold seasons. Herein, weused territory-wide hospitalization data to investigate the relationships between meteorologicalfactors, air pollutants, influenza infection, and AOM for children observed from 1998 to 2019 in HongKong.
METHOD:Quasi-Poisson generalized additive model in conjunction with distributed-lag non-linear
model was used to elucidate the association of interest, with weekly AOM admissions for children as
the response variable and weekly influenza-like illness-positive (ILI+) rates and air pollutants (i.e.,oxidant gases, sulfur dioxide, and fine particulate matter) as predictors, while controlling formeteorological variations.
RESULTS:According to our results, there were 21,224 hospital admissions due to AOM for children
aged ≤15 years throughout a 22-year period. The cumulative adjusted relative risks (ARR) of AOM
were 1.15 (95% CI, 1.04-1.28) and 1.07 (95% CI, 0.97-1.18) at the 95th percentile concentration ofoxidant gases (65.9 ppm) and fine particulate matter (62.2 μg/m³) respectively, with reference set totheir medians of concentration. The ARRs exhibited a monotone increasing trend for all-type and typespecific ILI+ rates, indicating ILI+ Total, A/H1N1, A/H3N2, and B were all statistically significantly
associated with an increased risk of AOM.
CONCLUSIONS:Our findings suggested that policy on air pollution control and influenza vaccination forchildren need to be implemented, which might have significant implications for averting AOM inchildren.

Keywords: Environmental epidemiology, Children's environmental healthEP-164[Air pollution » Ozone]

Short-, Mid-, and Long-term Ambient Exposureof Ozone, Physical Activity, and Dyslipidemia:
Korea National Health and Nutrition Examination
SurveyTaiyue Jin1, Jeoung A Kwon2, Seyoung Kim1, Hyo Seon Kim1, Eunjeong Choi1, Minshik Rhie1, Yoonjoo
Choi1, Bohyun Park1, Bomi Park3, Byungmi Kim4
1National Cancer Control Institute, National Cancer Center, Goyang, Korea
2National Cancer Control Institute, National Cancer Center, Goyang, Korea; Institute of HealthServices Research, Yonsei University, Seoul, Korea
3Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
4National Cancer Control Institute, National Cancer Center, Goyang, Korea; Department of Cancer

Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center,
Goyang, Korea

BACKGROUND AND AIM:Evidence for the adverse health effects of ambient ozone which is one of theelevating air pollutants in Korea was limited. This study was aimed to evaluate the association ofozone exposure with dyslipidemia and examine whether the association was modified by level ofphysical activity.
METHOD:Adults enrolled in the Korea National Health and Nutrition Examination Survey (KNHANES)
2007‒2020 were included in this study (n=49,684). Short- (24-hour average), mid- (6-monthaverage), and long-term (1-year average) exposure levels of ambient ozone (ppm) were estimatedusing the Community Multiscale Air Quality models. Participants were categorized into physicallyinactive, minimally active, and active groups based on the metabolic equivalent-min/week. Multiple
logistic regression models were conducted to calculate odds ratios (ORs) and 95% confidence intervals(CIs).
RESULTS:Geometric means of ambient ozone levels were 0.0225 ppm, 0.0257 ppm, and 0.0258 ppm
for short-, mid-, and long-term exposure, respectively. Of the total participants, 15,240 (30.7%) met
the diagnosis criteria for dyslipidemia. The prevalence of dyslipidemia increased by 20% among
participants with the highest quintile of mid-term ozone exposure compared to those with the lowest
quintile (OR=1.20; 95% CI=1.05‒1.36). It showed a higher prevalence of dyslipidemia only in men(OR=1.34; 95% CI=1.13‒1.59 for 5th vs. 1st quintile). Notably, when stratified by level of physicalactivity, the positive association between mid-term ozone exposure and dyslipidemia was more
pronounced among minimally active and active participants [ORs (95% CIs) for 5th vs. 1st quintile:
1.72 (1.23‒2.41) for minimally active and 1.33 (1.04‒1.72) for active; ""p"" for interaction=0.02]. No
significant association between short- and long-term exposure to ambient ozone and dyslipidemia wasobserved.
CONCLUSIONS:Findings of this study demonstrate that 6-month average ozone exposure may belinked to dyslipidemia, and to prevent this, the additive effects of ambient ozone exposure andphysical activity should be considered.

Keywords: Air pollution, ozone, dyslipidemia, physical activity, Korea

EP-58[Outcomes » Other (to be specified with keywords in the keywords section)]

Medication adherence of hypertensive anddiabetic patients registered in the Family HealthStrategy in Acre, Brazil
Aline Fernanda Silva Sampaio1, Thatiana Lameira Maciel Amaral1, Cledir De Araújo Amaral2, Gina
Torres Rego Monteiro3
1Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Rio Branco, Brasil
2Instituto Federal do Acre, Rio Branco, Brasil
3Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, Brasil

BACKGROUND AND AIM:Therapeutic adherence of patients with chronic diseases favors the protectionof target organs, reduces cardiovascular risks and improves their quality of life. But despite thetherapeutic options and health promotion actions, adherence to long-term therapy for them is still low,
especially in developing countries. The aim of this study is analyzing the medication adherence ofhypertensive and diabetic patients registered in the Family Health Strategy in the city of Rio Branco,
Acre.
METHOD:Population-based survey in adults aged 18 years or over, with arterial hypertension (AH)
and/or diabetes mellitus (DM), of both sexes, followed up by the Family Health Strategy in Rio Branco.
Adherence was assessed by the Batalla test and the potentially associated variables by logistic
regression, with a significance level of 5%.
RESULTS:According to the Batalla test, the prevalence of adherence was 14.7% (HA) and 16.3% (DM)(p<0.001). Most participants were aware of the chronicity of the disease (HA: 71.3%; DM: 79.0%)
and understood that it can be controlled with diet and medication (HA: 96.6%; DM: 95.5 %), but inrelation to affected organs, only 20.0% of hypertensive patients and 22.7% of diabetics achieved two
or more correct answers. In the bivariate analyses, a statistically significant association was observed
between drug non-adherence and several variables for both diseases. In the multiple logistic
regression, only having health insurance (OR: 2.44) and having obesity (OR: 0.53) remained
significant for HA, while for DM the age group ≥65 years (OR: 3.30), having a health plan (OR: 4.03)
and being hypertensive (OR: 2.90) remained significant.
CONCLUSIONS:Medication adherence in hypertensive and diabetic patients is low, requiring actions
and health policies aimed at increasing adherence.
Funding: Research Support Foundation of the State of Acre (FAPAC), PPSUS – Agreement No.
837567/2016, Process No. 6068-18-0000299, Grant Term No. 032/2018.

Keywords: Cardiovascular diseases, Outcomes, Epidemiology.

FREE POSTERS

FP-001[Chemical exposures » Pesticides]

Health Risk Characterization due toOrganochlorine Pesticide Exposure, in Womenfrom Northern Mexico
Alma Carolina Rincón Rubio1, Brenda Gamboa Loira2, Ángel Mérida Ortega1, Mariano Cebrían García3,
Lizbeth López Carrillo1
1Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Morelos, México
2Facultad de Medicina, Universidad Autónoma de Yucatán, Yucatán, México & Centro de Investigación

en Salud Poblacional, Instituto Nacional de Salud Pública, Morelos, México
3Laboratorio de Toxicología de Metales y Plaguicidas, Centro de Investigación y de Estudios Avanzadosdel Instituto Politéctico Nacional, Ciudad de México, México

BACKGROUND AND AIM:To characterize the health risk from exposure to organochlorine pesticides(OCPs) in a sample of women from northern Mexico.
METHOD:Hazard quotients (HQ) for non-cancer and cancer events were determined in a sample of908 women from five states in northern Mexico (Sonora, Chihuahua, Coahuila, Nuevo León,
Tamaulipas, and Durango), calculating the relationship between the serum concentrations of OCPs andtheir respective bioequivalents reference risk values. Likewise, the percentage of cases ofcardiometabolic, reproductive, and respiratory diseases and cancers attributable to detectableconcentrations of OCPs was estimated.
RESULTS:At least 45% of the women in the study were at risk of developing a non-cancer diseasebecause of exposure to total hexachlorobenzene (HCB) and/or dichlorodiphenyltrichloroethane (DDT).
In addition, exposure levels to HCB and dichlorodiphenyltrichloroethane (DDE) may cause anincreased risk of developing cancer in at least 25% and 50% of women, respectively. It is estimatedthat HCB and p,p'-DDE are the POCs that may explain the proportion of cases of type II diabetes
mellitus (26.65% and 48.47%) and non-Hodgkin lymphoma (19.9% and 27.34%).
CONCLUSIONS:The levels of exposure to HCB, DDT, and chlordane might have deleterious effects on
the health of women in the north of Mexico.

Keywords: pesticides, long-term exposure, risk assessment

FP-002[Climate » Other (to be specified with keywords in the keywords section)]

Wildfires and the changing landscape of air
pollution-related health burden in California
Ana G Rappold1, Ruwan Thilakaratne2, Sumi Hoshiko2, Andrew Rosenburg2, Thomas Hayashi3, Joseph
Ryan Buckman2
1US Environmental Protection Agency, Office of Research and Development, USA
2California Department of Public Health, California, USA
3Sequoia Foundation, La Jolla, California, USA

BACKGROUND AND AIM:Wildfires are a growing source of fine particulate (PM2.5) pollution, but
associated trends in health burden are not well characterized.
We investigated trends and disparities in PM2.5-related cardiorespiratory health burden (asthma,
chronic obstructive pulmonary disease, and all-cause respiratory and cardiovascular emergency
department (ED) visits and hospital admissions) for all days and wildfire smoke-impacted days across
California, 2008-2016.
METHOD:Using residential ZIP code and daily PM2.5 exposures, we estimated overall- and subgroupspecific (age, gender, race/ethnicity) associations with cardiorespiratory outcomes. Health burden
trends and disparities were evaluated based on relative risk, attributable number, and attributablefraction by demographic and geographic factors and over time.
RESULTS:PM2.5-attributed burden steadily decreased, whereas the fraction attributed to wildfire
smoke varied by fire season intensity, comprising up to 15% of the annual PM2.5-burden. The highest
relative risk and PM2.5-attributed burden (92 per 100,000 people) was observed for respiratory ED
visits, accounting for 2.2% of the respiratory annual burden. Disparities in overall morbidity in theoldest age, Black, and “Other” race groups were also reflected in PM2.5-attributed burden, whereas
Asian populations had the highest risk rate in respiratory outcomes and thus the largest fraction of thetotal burden attributed to the exposure. In contrast, high wildfire-attributed burden rates in rural,central, and northern California populations occurred due to differential exposure.
CONCLUSIONS:In California, wildfires’ impact on air quality offset the public health gains achieved
through reductions in non-smoke PM. Disproportionate effects could be attributed to differences in
subpopulation susceptibility, relative risk, and differential exposure.

Keywords: wildfire smoke, cardiopulmonary health, exposure trends, health burden

FP-005[Chemical exposures » Heavy metals]

The Association of Children’s Blood Lead Levels
and Prevalence of Stunting in Tin Mining Area inIndonesia
Budi Haryanto
Department of Environmental, Faculty of Public Health, Universitas Indonesia

BACKGROUND AND AIM:Metal mining and smelting activities are regarded as major sources of heavy
metals such as lead, mercury, arsenic and cadmium in the environment and humans living at
surrounding area. Among others, lead can enter and accumulate in the human body and very
influential in children's growth and development. This study aims to assess the association between
children’s blood lead levels and stunting in a mining area in Indonesia
METHOD:A cross-sectional design was implemented by involving 193 children living surrounding Tin
Mining in Bangka Island, Indonesia. Venous blood was drawn, and blood lead level was measured by
Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Stunting status was measured byanthropometry standing height and converted to sex- and age-specific Z-scores based on World
Health Organization (WHO) growth reference. Children’s dietary was assessed using 24-hour dietary
recall method. Statistics of chi-square test and multiple-logistic regression were performed for the
analyses.
RESULTS:The geometric mean of Blood Lead Levels (BLLs) was 5.5 µg/dl (± 2.6 µg/dl; 95% CI: 5.1 5.9). The interquartile range of BLLs and height for age Z-score (HAZ) were 3.0 μg/dl and -1.5,
respectively. The data revealed that 23.3% children were stunted (HAZ < -2). The multiple logistic
regression models suggest that elevated BLLs was an independent predictor of the stunting. The odds
stunted if blood lead concentration elevated was about ten times higher [adjusted odd ration (AOR) =9.75 (95% Confidence interval (CI): 3.1 – 30.7); p<0.001] in comparison to the odds of normal BLLs.
The BLLs of children at age 2 - 9 years were found associated with stunting after controlling of
mother’s education, residence, and the intake of energy, protein, zinc, vitamin A, calcium, andphosphorus.
CONCLUSIONS:The study suggested that living at surrounding Tin Mining was dangerous for children
health and their development_

Keywords: Children, Blood Lead Levels, Stunting, Tin Mining

FP-006[One health » COVID-19]

The Environmental Surveillance in Medical
Center During the SARS-CoV-2 Omicron Variant
Pandemic
Yu Hsiang Chang1, Chi Hsin Sally Chen1, Ta Chen Su2, Chang Chuan Chan1
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan2Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

TaiwanBACKGROUND AND AIM:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing
coronavirus disease 2019 (COVID-19) has spread globally. Current epidemiological evidence illustrates
SARS-CoV-2 is spread among people by two main routes of transmission: (a) primarily throughdroplets and may be spread by fomites and contact transmission to the respiratory tract and mucous
membranes. (b) inhalation of smaller aerosol particles containing the virus. Previous studies haveshown that wards of patients with COVID-19 present the potential risk for medical care associatedtransmission through aerosols containing SARS-CoV-2. However, there is still limited information on
the characteristics of aerosols containing SARS-CoV-2 and the concentration of virus-containing
aerosols in and outside of wards. In this study, we aim to investigate whether virus-containing
aerosols are present in various areas of the medical center.
METHOD:We use cyclonic sampling devices: a two-stage cyclonic bioaerosol sampler developed byUnited States’ National Institute for Occupational Safety & Health (NIOSH) to collect air samples.
Samplers are set up in isolation wards of COVID-19 patients, nursing stations, and corridors of thesemi-contaminated areas. Air samples were continuously collected and RNA extracted from samples
underwent reverse transcription polymerase chain reaction (PCR) for SARS-CoV-2 analysis. Moreover,
we use EAQ-T17 to continuously monitor indoor air quality (IAQ) parameters during our sample
collection period, including carbon dioxide, temperature, and relative humidity.
RESULTS:Preliminary result showed that 35 of the 93 air samples in nursing station and 138 of the
342 air samples in corridor tested positive for SARS-CoV-2 RNA, while in isolation rooms, all of air
samples tested negative.
CONCLUSIONS:Based on our research, airborne is a possible route for SARS-CoV-2 transmission.

Keywords: Exposure assessment, environmental epidemiology

FP-007[Air pollution » Particulate matter]

Characterizing Winter Weather Patterns and
Pollution Sources of PM2.5 in Taipei City
Peiyuan Hsieh, Changfu Wu
Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei City,
TaiwanBACKGROUND AND AIM:Air quality is intricately linked to weather patterns. Regional factors such as
wind direction, wind speed, and dispersion conditions directly impact PM2.5 concentrations. Therefore,
categorizing weather patterns aid in studying their corresponding contributions of pollution sources.
METHOD:This study employed three online instruments to conduct monitoring of chemical species of
elements, ions, organic carbon, and elemental carbon in PM2.5 during the winter season of 20202021. The measured data were then analyzed using the Positive Matrix Factorization (PMF) model toidentify pollution sources and their contributions in Taipei City. Additionally, weather patterns with
PM2.5 concentrations exceeding 25 µg/m3 were classified using clustering techniques to investigate
the relationship between weather patterns and pollution sources.
RESULTS:The results revealed that weather patterns during periods with high PM2.5 concentrations
could be classified into three groups, each showing distinct associations with pollution sources: (1)During periods of low wind speed and poor dispersion, traffic-related pollution was significantly higher
compared to other weather patterns, with an average increase of 4.5 µg/m3; (2) Strong northeast
monsoon patterns exhibited relatively lower averaged PM2.5 concentration due to limited pollutant
accumulation within the basin compared to the other two weather patterns; (3) Weather patterns
predominantly influenced by northwest winds showed significant contributions from pollution sources
related to fuel combustion, coal combustion, and industry mixed with secondary aerosols. The PM2.5
concentration level in northwest winds pattern could reach as high as 56 µg/m3.
CONCLUSIONS:The pollution source analysis corresponding to weather patterns can serve as avaluable reference for policymakers in formulating effective PM2.5 control strategies.

Keywords: Particulate matter, Traffic-related, Particle components

FP-008[Air pollution » Short-term exposure]

Health Risk Analysis of Air Pollution and Related
Risk Factors on Residents Living near a Power
Plant in Central Taiwan
Chen Jia Fen1, Chen Cheng Xian1, Wang Shu Yi1, Chien Szu Pei1, Hsu Wan Ting1, Chiu She Yu2, Ho
Chi Chang3, Chu Wei Min4, Tsan Yu Tse4, Yu Hua Lung5, Ho Wen Chao1
1Department of Public Health, China Medical University College of Public Health, Taichung, Taiwan
2National Health Research Institutes, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei,Taiwan
4Taichung Veterans General Hospital, Taiwan
5Department of Bioenvironmental Systems Engineering, National Taiwan University, Taiwan

BACKGROUND AND AIM:Based on the rise of environmental protection awareness and theestablishment of relevant laws and regulations, the overall air pollution has shown a downward trend
in Taiwan. However, the incidence and mortality of certain diseases in certain area remains animportant public health task. This study has focused on coastal county and city near an important
power plant in central Taiwan.
METHOD:We collect the incidence and mortality of diseases from public information, as well as race,
occupation, education, economic income and living habits (smoking, drinking, and betel nut chewing),
combined with air pollution data. Generalized estimating formula (generalized estimating equations,
GEE) was used to explore the impact of various air pollutants and risk factors on health amongresidents.
RESULTS:Ambient air pollution potentially related to the incidence and mortality of respiratory,
cardiovascular and cerebrovascular disease, especially O3. The study showed that gender, education,
occupational exposure and alcohol drinking may interact with the effects.
CONCLUSIONS:Multiple exposure scenario consideration including air pollution and related risk factors
is important to assess the health effect on residents near power plant. Further study is suggested.

Keywords: Air pollution, respiratory disease, cardiovascular disease, cerebrovascular diseaseFP-009[Exposures » Food/nutrition]

The association between dietary intake, indoor
environmental status, and urinary cadmium
levels in a nationwide representative sample in
TaiwanChi Chang Ho1, Meng Shan Tsai2, Mei Huei Chen3, Yaw Huei Hwang1, Kuang Mao Chiang4, Wen Harn
Pan4, Ching Chun Lin1, Pau Chung Chen5
1Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taiwan
2Department of Environmental and Occupational Health of the School of Public Health, University ofMontreal, Canada
3Institute of Population Health Sciences, National Health Research Institutes, Taiwan
4Institute of Biomedical Sciences, Academia Sinica, Taiwan
5National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan

BACKGROUND AND AIM:Cadmium (Cd) is a toxic heavy metal that can accumulate in the human bodythrough various environmental exposures, including dietary intake. In Taiwan, higher urinary cadmium
concentrations among the general population compared with the Human Biomonitoring Guidance value(HBM-GVs) for Cd have been observed, but the primary source has not been identified. This study
aimed to investigate the association between dietary intake, indoor environmental status, and urinary
cadmium levels in a nationwide representative sample in Taiwan.
METHOD:This study collected 1,566 human urine samples from the Taiwan Human Biomonitoring
program in 2019. Individual urinary cadmium concentrations were measured and adjusted by urinary
creatinine levels. The study also used questionnaires to collect information on individuals' dietary
habits (e.g., vegetarian, lacto-o

VO-vegetarian, and general population), dietary frequency, and indoor environmental conditions (e.g.,household incense burning and use of air purifiers).
RESULTS:The results showed that 35.82% of participants (n=561) had urinary Cd concentrations
exceeding the HBM-GVs. Additionally, 4.21% of participants (n=66) were vegetarians, and 64.43%(n=1009) burned incense at home, while 23.40% (n=365) used air purifiers at home. Logistic
regression analysis, adjusted for gender, age, BMI, and other confounding factors, revealed that theodds ratio (OR) for elevated urinary Cd concentrations was 1.80 (95% CI: 1.02~3.19) for participants
who were vegetarian or lacto-o

VO-vegetarian.
CONCLUSIONS:These findings suggest that the consumption of certain foods may increase the risk ofheavy metal exposure and toxicity. The results also highlight the need for public health interventions
to raise awareness of the potential health risks associated with certain dietary habits and to promotehealthy and balanced diets

Keywords: dietary intake, indoor environmental status, urinary cadmium, human biomonitoringFP-010[Outcomes » Mortality]

Epidemiology of Sudden Unexplained Death
Syndrome among Southeast Asian Labor in
TaiwanMeng Chih Lee1, Hsiu Chuan Chen2, Chi Hua Yen3
1Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan,

College of Management, Chaoyang University of Technology, Taichung, Taiwan
2Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
3Department of Family Medicine and Community Health, Chung Shan Medical University, Taichung,TaiwanBACKGROUND AND AIM:Sudden unexplained death syndrome (SUDS), also called as sudden
unexpected nocturnal death syndrome or Asian sudden death syndrome, is a mysterious illness thatmainly attacks young healthy males from Southeast Asian countries. The cause of SUDS remains
unknown. Taiwan has started recruiting foreign workers from Southeast Asian countries since 1989,
and SUDS was found then. The purpose of this study is to determine the epidemiologicalcharacteristics of SUDS in Taiwan.
METHOD:In this case-control study, the case group (totaling 32 individuals with confirmed SUDS
symptoms) and the control group (totaling 57 individuals unaffected by SUDS but familiar with thedeceased) were collected through the Foreign Labor Death Promulgation System and in-person
interview with the controls in a three-year study period in Taiwan. Demographic information (jobstatus, period of residence in Taiwan, lifestyle, and family history of SUDS) was compiled for bothgroups. Forensic reports and toxicological examinations were included as research data.
RESULTS:The majority of deceased individuals were Thai nationals (71.9%), followed by Filipinos(25%). All were males, with an average mean age of 33.3±6.7 years (87.5%) and were employed in
Taiwan as foreign laborers. Highest rate of SUDS (87.5) occurred during sleep, significant rate (about
40.0%) were discovered during early morning hours, and a few succumbed during hospitalization.
Postmortem forensic and toxicological examinations showed nothing remarkable. Comparative datafrom case and control groups indicated that alcohol and food consumption prior to sleep appeared a
relatively important factor; risk associated with food intake was of particular significance whenmeasured by multiple logistic regression analysis (adjusted odds ratio=8.80/95% CI=2.26-34.97)
CONCLUSIONS:Food consumption prior to sleep may be a significant risk factor of SUDS. Suchfindings can be applied to prevention strategies; however, further investigation is required forcomplete verification.

Keywords: mortality, sudden unexplained death syndrome, southeast Asian labor, food, sleep

FP-011[Cancer and cancer-precursors » Incidence]

Aristolochic Acid and the Risk of Female Lung
Cancer: Population-Based Case-Control Study
Chi Jen Chen1, Yao Hsu Yang2, Ching Chun Lin3, Tzu Pin Lu4, Jin Shing Chen5, Pau Chung Chen6
1Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public

Health, Taipei, Taiwan
2Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Schoolof Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
4Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public

Health, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public
Health, Taipei, Taiwan
5Department of Surgery, National Taiwan University Hospital and National Taiwan University Collegeof Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Cancer Center, Taipei,
Taiwan6Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; Department of Public Health, National Taiwan University College of
Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan;
National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,
TaiwanBACKGROUND AND AIM:Aristolochic acid (AA) is a known human carcinogen that induces DNA adducts
and lung tumors in rodents exposed to it. As there are relatively few female smokers in Taiwan, theobjective of this study is to examine the potential risk of lung cancer in women who consume herbs
containing AA.
METHOD:A case-control study based on the population was conducted, where cases were individuals
newly diagnosed with lung cancer (ICD-9 162) between January 1, 1999, and December 31, 2013.
Logistic regression was utilized to evaluate the risk of lung cancer in relation to the total dose of AAcontaining herbs and the estimated cumulative dose of aristolochic acid.
RESULTS:The analysis revealed that certain factors significantly increased the risk of lung cancer,
including chronic obstructive pulmonary disease (OR: 1.31, 95% CI: 1.24 to 1.37), tuberculosis (OR:1.44, 95% CI: 1.26 to 1.64), pneumococcal pneumonia (OR: 2.51, 95% CI: 1.35 to 4.64), humanpapillomavirus infection (OR: 1.14, 95% CI: 1.03 to 1.26), alcohol-related disease (OR: 1.37, 95% CI:
1.05 to 1.79), hyperlipidemia (OR: 1.05, 95% CI: 1.01 to 1.10), and hormone replacement therapy(OR: 1.15, 95% CI: 1.10 to 1.20). The study also found a slightly elevated risk of lung cancer (OR:1.08, 95% CI: 1.04 to 1.12) in women taking AA-containing herbs. However, there was no significant
dose-response relationship between the estimated AA dose or herbs containing AA and female lungcancer.
CONCLUSIONS:The study found that consuming herbs containing aristolochic acid (AA) is associatedwith a slightly higher risk of developing lung cancer in women. However, the risk does not seem to bestrongly related to the amount of AA consumed. This suggests that even a small amount of AAcontaining herbs may pose a risk to women.

Keywords: Exposures, Female, Epidemiology

FP-012[Methods » Modeling]

Evaluation of sinonasal outcome test (SNOT-22)
domains in the assessment of the quality of life
in patients with nasopharyngeal carcinoma
Ching Nung Wu1, Chung Ying Lin2
1Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University

College of Medicine, Kaohsiung, Taiwan; Department of Public Health, College of Medicine, National
Cheng Kung University, Tainan, Taiwan
2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan;

Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan,
TaiwanBACKGROUND AND AIM:Few instruments are available for assessing the otorhinologic-related qualityof life (QOL) in nasopharyngeal carcinoma (NPC) patients. Therefore, we evaluated whether the 22item Sinonasal Outcome Test (SNOT-22) could be applied to these patients.
METHOD:Patients diagnosed with NPC, who had been treated with standard protocol and followed up
in our institute between 2019 and 2022, were invited to join the cross-sectional study during theirclinic visits. All participants completed the SNOT-22 and Eustachian Tube Dysfunction Questionnaire-7
once they were recruited. Confirmatory factor analysis (CFA) was performed to decide the mostsuitable model for the underlying SNOT-22 subdomains, along with various validity and reliability
tests.
RESULTS:We identified a total of 275 patients, with 84 (30.5%) women and 191 (69.5%) men. The
mean age was 54.1 years (standard deviation: 11.2). Among these patients, 171 (62.1%) were in latestages, and 260 (94.5%) received chemoradiotherapy as treatment. The median interval between
primary RT treatment and questionnaire completion was 50 months (interquartile range: 29-93). CFA
supported a five-factor model for the SNOT-22 for NPC patients, including nasal, ear/facial, sleep,
function, and emotion domains. The internal consistency and test-retest reliability of the SNOT-22
domain score were good. In addition, known-group validity was good for the SNOT-22 total score anddomain scores according to the disease recurrence status.
CONCLUSIONS:Psychometric analyses supported the reliability and validity of a five-domain SNOT-22
for assessing otorhinologic-related QOL in NPC patients.

Keywords: Cancer and cancer precursors, ModelingFP-013[Air pollution » Particulate matter]

Early-life exposure to residential black carbon
and childhood cardiometabolic health
Chloe Friedman1, Dana Dabelea2, Deborah H Glueck3, William B Allshouse4, John L Adgate4, Kayleigh
P Keller5, Sheena E Martenies6, Sheryl Magzamen7, Anne P Starling8
1Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
2Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA, Department of Pediatrics, Schoolof Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
3Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Department of Pediatrics, School of Medicine, University ofColorado Anschutz Medical Campus, Aurora, CO, USA
4Department of Environmental and Occupational Health, Colorado School of Public Health, Universityof Colorado Anschutz Medical Campus, Aurora, CO, USA
5Department of Statistics, Colorado State University, Fort Collins, CO, USA
6Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign,

Urbana, IL, USA
7Department of Environmental and Radiological Health Sciences, Colorado State University, Fort

Collins, CO, USA, Department of Epidemiology, Colorado School of Public Health, Colorado State
University, Fort Collins, CO, USA
8Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA, Department of Epidemiology,
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

BACKGROUND AND AIM:Early life exposure to air pollution, such as particulate matter ≤2.5
micrometers (PM₂.₅), may be associated with obesity and adverse cardiometabolic health outcomes inchildhood. However, the toxicity of PM₂.₅ varies according to its chemical composition. Black carbon(BC) is a constituent of PM₂.₅, but few studies have examined its impact on childhood cardiometabolic
health. Therefore, we examined relationships between prenatal and early childhood exposure to BC
and markers of adiposity and cardiometabolic health in early childhood.
METHOD:This study included 578 mother-child pairs enrolled in the Healthy Start study (2009-2014)living in the Denver-metro area. Using a spatiotemporal prediction model, we assessed average
residential black carbon levels during pregnancy and in the year prior to the early childhood follow-up
visit at approximately 5 years old. We estimated associations between prenatal and early childhood BC
and indicators of adiposity and cardiometabolic biomarkers in early childhood (mean 4.8; range, 4.0,8.3), using linear regression.
RESULTS:We found higher early childhood BC was associated with higher percent fat mass, fat massindex, insulin, and homeostatic model of assessment-insulin resistance (HOMA-IR), and lower leptin
and waist circumference at approximately 5 years old, after adjusting for covariates. For example, perinterquartile range (IQR) increase in early childhood BC (IQR, 0.48 µg/m³) there was 3.24% higher fat
mass (95% CI; 2.00, 4.48). Generally, we did not find consistent evidence of associations between
prenatal BC and cardiometabolic health outcomes in early childhood, except for an inverse association
between prenatal BC and adiponectin, an adipocyte-secreted hormone typically inversely associatedwith adiposity.
CONCLUSIONS:Higher early childhood, but not in utero, ambient concentrations of black carbon, acomponent of air pollution, were associated with greater adiposity and altered insulin homeostasis at
approximately 5 years old. Future studies should examine whether these changes persist later in life.

Keywords: Air pollution, Children's environmental health, Particulate matter, Obesity and metabolic
disordersFP-014[Air pollution » Particulate matter]

Burden of cardiovascular disease attributable tolong-term exposure to ambient PM2.5
concentration and interim target for regulationlevel
Chu Chih Chen1, Chu Chih Chen2, Yin Ru Wang1, Jhi Shin Liu1, Hsing Yi Chang1, Yue Leon Guo3, Yue
Leon Guo4, Yue Leon Guo5, Pau Chung Chen3, Pau Chung Chen4, Pau Chung Chen5
1Institute of Population Health Sciences, National Health Research Institutes, Taiwan
2Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Taiwan
3Department of Environmental and Occupational Medicine, National Taiwan University (NTU) Collegeof Medicine and NTU Hospital, Taiwan
4Institute of Environmental and Occupational Health Sciences, School of Public Health, National

Taiwan University, Taiwan
5National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan

BACKGROUND AND AIM:Environmental exposure to fine particulate matter PM2.5 is known to be
associated with many hazardous health effects, including cardiovascular diseases (CVDs). To reduce
the related health burden, it is crucial that policy-makers worldwide set regulation levels according totheir own evidence-based study outcomes.
METHOD:In this study, 117,882 CVD-free participants (≥ 30 years) of the MJ Health Database were
followed-up (median 9 years) between 2007 and 2017. We used a weight-transformation Cox
regression model for the concentration‒response function (CRF) between (5-year average) exposure
to PM2.5 and CVD incidence. A cost‒benefit analysis was proposed by the ratio of avoidable years oflife in disability (YLDs) over the mitigation cost for an optimal regulation level.
RESULTS:The CRF was heterogeneous across different areas with dissimilar PM2.5 exposure ranges.
Women and older participants were more susceptible. The avoided town/district-specific YLDs in CVD
incidence ranged from 0 to 3000 person-years due to improvement in PM2.5 concentrations between
2011 and 2019.
CONCLUSIONS:An annual PM2.5 concentration of 13 μg/m^3 would be optimal, rather than thecurrent level of 15 μg/m^3. The method may be applied to other countries for regulation levels thatare most suitable for their air pollution status and population health.

Keywords: Cardiovascular diseases, Environmental epidemiology, Long term exposure, Particulatematter, Research translation to affect policy and practiceFP-015[Exposures » Microbes/Microbiome]

Visualizing the Invisible: How Digital Images
Reveal the Impact of Surface Mold on Airborne
Fungal Levels
Chun Chieh Tseng1, Ning Huang2, Chia Jung Hsieh1, Chien Che Hung1, Yue Liang Leon Guo3
1Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan
2Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
3Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU

Hospital, Taipei, Taiwan

BACKGROUND AND AIM:Rapid monitoring of human exposure to total fungi, including air and surface
fungal profiling, is an important issue.
METHOD:In this study, we applied air and surface sampling combined with digital image quantificationof surface mold spots to evaluate the contribution of surface fungi to airborne fungal concentrations.
RESULTS:Cladosporium, Penicillium, Aspergillus, Geotrichum, and yeast often appeared in the air or
on wall surfaces during sampling. These commonly found fungal genera tend to have higher
concentrations outdoors than indoors, except for Penicillium and yeast. In addition, the surface density(fungal concentration/area) of individual fungi had no significant correlation with the airborne
concentration except for Geotrichum. However, if Aspergillus and Geotrichum presented a higher
surface ratio (>0.00035) in the total area of an indoor environment, then the concentration of these
two fungi in the air would increase significantly.
CONCLUSIONS:Our results demonstrated that the airborne concentration of indoor fungi is mainly
derived from the outdoor concentration. The higher density of surface fungi does not necessarily
contribute to a high fungal concentration in the air. Different from fungal density, the quantification of
surface fungal area is recommended to assess the risk of surface fungi propelling into the air.

Keywords: bioaerosol, fungi, surface, indoor air

FP-016[Air pollution » Particulate matter]

Risk of death from liver cancer in relation to
long-term exposure to fine particulate air
pollution in Taiwan
Shang Shyue Tsai1, Chun Yuh Yang2
1Department of Healthcare Adiministration, I-Shou University, Kaohsiuing, Taiwan
2Department of Public Health, Kaohsiung Medical University, Kaohsiuing, Taiwan

BACKGROUND AND AIM:According to the International Agency for Research on Cancer (IARC),
airborne fine particulate matter (PM2.5), which is categorized as a Group I carcinogen, was found tolead to lung cancer in humans. Hepatocellular carcinoma (HCC) is endemic in Taiwan where it is thesecond and fourth foremost cause of cancer deaths in men and women, respectively. Taiwan's
mortality rates for liver cancer vary considerably from one region to another, suggesting that theenvironment may exert some influence on deaths attributed to liver cancer. The aim of thisinvestigation was to perform an ecologic study to examine the possible link between ambient PM2.5
levels and liver cancer risk in 66 in Taiwan municipalities.
METHOD:To undertake this investigation, annual PM2.5 levels and age-standardized liver cancer
mortality rates were calculated for male and female residents of these areas from 2010 to 2019. Data
were tested using weighted-multiple regression analyses to compute adjusted risk ratio (RR)
controlling for urbanization level and physician density. Annual PM2.5 levels of each municipality weredivided into tertiles.
RESULTS:The adjusted RRs for males residing in those areas with intermediate tertile levels (21.85 to
28.21 ug/m3) and the highest tertiles levels (28.22-31.23 ug/m3) of PM2.5 were 1.29 (95% CI=1.251.46) and 1.41 (95% CI=1.36-1.46), respectively. Women in these locations shared a similar risk,
1.32 (1.25-1.40) and 1.41 (1.34-1.49), respectively.
CONCLUSIONS:Evidence indicated that PM2.5 increased risk of enhanced mortality rates with livercancer in both men and women in Taiwan.

Keywords: air pollution, PM2.5, liver cancer, mortality

FP-017[One health » COVID-19]

Citywide wastewater SARS-CoV-2 concentration
predicts the epidemic curve in Taipei City,
TaiwanChung Yen Chen1, Chang Chuan Chan2, Sui Yuan Chang3, Chi Hsin Sally Chen2, Ta Chen Su4
1National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Institute of Environmental

and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei,
Taiwan; Department of Occupational and Environmental Medicine, National Taiwan University Hospital,
Taipei, Taiwan
2Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
3Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Departmentof Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan
University, Taipei, Taiwan
4Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Occupational and Environmental Medicine, National
Taiwan University Hospital, Taipei, Taiwan

BACKGROUND AND AIM:During the pandemic, over 70 countries have incorporated wastewater
surveillance as a novel public health tool to detect unidentified cases and monitor epidemic curves.
However, it remains unresolved whether the surveillance serves as a leading, lagging, or concurrent
indicator. The aim of this study was to establish a citywide wastewater surveillance system and a
COVID-19 epidemic prediction model in Taiwan.
METHOD:Over a period of 90 days from May to August 2022, wastewater sampling, preparation, and
qRT-PCR analysis were carried out daily in the Xinyi and Neihu districts and twice a week in the other10 districts in Taipei City. Epidemic statistics were obtained from the Taiwan Centers for Disease
Control database, and daily epidemiological indicators were computed, including new case rates andlast and future x-days moving averages. Simple linear regression analysis, with and without
logarithmic transformation, was performed based on daily wastewater surveillance data in the two
districts to predict the epidemic curve. The prediction model was validated by comparing reported
epidemic indicators and model estimates for the other 10 districts with a paired sample t-test.
RESULTS:All wastewater samples from all districts were positive, with an average viral concentrationof 1,829.0±2,237.7 copies/L and an average relative signal of 17.1±16.7. Wastewater virus could bewell identified when new case rates exceeded 59.08 new cases per 100,000 population. The bestfitting model, with an R-squared value of 0.43, was a log-log model predicting future 5-day moving
average new cases with relative signals of the E gene. An increase of 1% in the latter was associatedwith an increase of about 0.53% in the former. There was no significant difference between reported
and predicted epidemic indicators for the other 10 districts.
CONCLUSIONS:Modelling with wastewater viral surveillance data is a useful supplement to forecast
epidemic trends.

Keywords: Infectious diseases, Modeling, Policy and practice, Risk assessment, Science
communication

FP-018[Air pollution » Long-term exposure]

Spatial-temporal distribution of Alzheimer’s
diseases and dementia and the risk factors: A
global Study
Cui GuoDepartment of Urban Planning and Design, the University of Hong KongBACKGROUND AND AIM:Previous studies showed that air pollution has been linked to neurologicaldiseases, but most of them focused on specific populations. Few studies examined the effects at a
global scale. This study aims to investigate the associations between long-term exposure to main air
pollution and the mortality of Alzheimer’s diseases (AD) and dementias worldwide.
METHOD:Age-standardised mortality and disability adjusted life years (DALY) of AD and dementias in
149 countries regions were collected from the Institute for Health Metrics and Evaluation in 19902019. Ambient PM2.5, NO2, and ozone were collected from different resources, including literature
review and satellite-based data. The exposure data were then aggregated into annual average values
at a country/region level. Information on covariates, including household air pollution, annual
temperature, Gross Domestic Product, prevalence of cigarette smoking, volume of alcohol drinking,prevalence of physical inactivity, mean value of vegetable and fruit intake, mean total cholesterol andprevalence of chronic diseases (i.e., hypertension and diabetes) were collected from different sources.
A linear mixed model was used to examine the associations between air pollution and AD mortality
and DALYs. Stratified analyses by age groups, sex, continents, and human development index (HDI)
were performed to assess the inequity of health effects.
RESULTS:The study found that long-term exposure to air pollution was associated with a higher risk of
AD mortality and DALYs after adjusting for various of covariates. Non-linear concentration-response
associations between air pollution and AD mortality were observed. Generally, higher risk of AD
mortality and DALYs were observed in those with older age and in countries/regions with lower level of
HDI.
CONCLUSIONS:Ambient PM2.5, NO2, and ozone are all contributed to the burden of AD and dementia
worldwide, even adjusting for household air pollution. This study highlights the urgent need tomitigate the inequity in the health effects.

Keywords: Particulate matter, Oxides of nitrogen, Ozone, Long-term exposure

FP-019[Exposure assessment methods » Exposure assessment-general]

Challenges for the exposure assessment of
ambient temperature in longitudinal cohort
studies
Diego Fano Sizgorich, Gustavo F. Gonzales
Laboratory of Endocrinology and Reproduction, Facultad de Ciencias y Filosofía, Universidad Peruana
Cayetano Heredia, Lima, Peru

BACKGROUND AND AIM:Biomonitoring of ambient temperature exposure in longitudinal cohort studies
is a difficult task, since the behavior of the person can be very dynamic across the day. Additionally,
temperature can be influenced by different factors such as construction materials of the ambient. Thisvariations should be considered when designing an appropriate method to assess the exposure. For
this reason, the present study aimed to evaluate temperature variation assessment in a two day-spanusing wearable ambient temperature monitors.
METHOD:Longitudinal descriptive study in which the ambient temperature difference between two
ambient monitors data loggers was evaluated. For this, one adult male was asked to wear one of thedata loggers which was place as a lanyard, resting at the height of the breastbone (this data logger
will be referred as Monitor 1). The other data logger was placed on a surface close to the person
position, and transported everywhere the person went (Monitor 2). The temperature was recorded
every minute. The data logger was not worn only during sleep.
RESULTS:There was a difference in the temperature recorded between the two monitors, being higher
in Monitor 1. The difference was heterogeneous, being as low as 1°C and as high as 5.5°C. Abruptchanges were observed in both monitors when the person moved from one ambient to another.
CONCLUSIONS:Ambient temperature is a complex exposure to measure since it can be affected byseveral components, meaning that there are multiple exposed temperatures and temperature changes
across a day-span, even at short time-intervals such as minutes. On the other hand, it is important tonote that humans are radiation-emitting systems, and the heat released may influence in the ambient
temperature felt by the person. If so, this should be evaluated across lifetimes and sexes given themetabolic differences in these groups.

Keywords: Exposure assessment, Temperature, Temperature variability, Methodological study designFP-020[Built environment » Green space]

Development and Application of Health
Measurement Tools and Protocols for Forest
Therapy Program through Pilot Test andQualitative Analysis
Hae Ryoung Chun1, Inhyung Cho1, Yoon Young Choi1, Geonwoo Kim2, Su Jin Park2, Sung Il Cho1
1Department of Public Health Sciences, Graduate School of Public Health, Seoul National University,

Seoul 08826, Korea
2Future Forest Strategy Department, Forest Human Service Division, National Institute of Forest

Science, Seoul 02455, Korea

BACKGROUND AND AIM:Research to verify the health promotion effect of forest healing programs isincreasing. However, since various health indicators are currently used, it is necessary to establish
standardized health measurement tools and protocols related to forest healing to investigate thehealth promotion effect continuously.
METHOD:Data were collected through about an hour of interviews with 40 interview participants andthree forest healing program operators out of 99 pilot participants using Focused Group Interviews
and in-depth Interviews. Qualitative analysis was performed using MAXQDA. Three researchers
conducted data coding and classification; the first Author and Corresponding Author conducted thefinal code classification work.
RESULTS:According to the opinions of the program participants, the terms used in mental healthmeasurement tools were not used in daily life. Still, they were difficult to respond to, or it waschallenging to answer sincerely to the repeatability of the question. In addition, the length of themental health measurement tool was not longer than expected, and the answer to the type of exercise
was complicated because the example was unclear. There were opinions that it was necessary to
introduce a health measurement tool for blood circulation and a health measurement tool that could
examine short-term health changes. In addition, it was challenging to measure group customers due
to a large number of people, and there was an opinion that it was necessary to introduce ameasurement protocol for group customers.
CONCLUSIONS:It is thought that the following research results can be referred to for the
standardization of health indicators and protocols used in forest healing programs. In addition, it isbelieved that medical-based forest healing programs can be applied through long-term health change
measurement.

Keywords: Forest bathing, forest healing, physiological effect, psychological effect, Qualitative
Research

FP-021[One health » Public health]Comparison of malnutrition levels among
adolescents in urban slums of Mumbai in preand post-COVID-19 times
Swapnali Patil1, Priya Samdarshi1, Geeta Premani1, Padukudru Anand Mahesh3, Harish Chandra
Phuleria2
1Environmental Sciences and Engineering Dept. Indian Institute of Technology Bombay, Mumbai,

India
2Environmental Sciences and Engineering Dept, Koita Centre for Digital Health, Indian Institute ofTechnology Bombay, Mumbai, India
3Respiratory Medicine Pulmonology, JSS Medical College, JSSAHER, Mysuru, India

BACKGROUND AND AIM:Adolescents have second fastest growth velocity after infancy. Children gain
up to 50% of their adult weight and skeletal mass and >20% of their adult height during adolescence.
Malnutrition among adolescents is a matter of serious concern as it is associated with immediate
impact on their learning and productivity and has transgenerational effects
AIM: To compare levels of malnutrition among adolescents in slums of Mumbai during pre and postCOVID-19 periods.
METHOD:The current study is a part of the APEAL (Longitudinal Effects of Air Pollution Exposure on
Adolescents Lungs) study a multi-centric environmental health study in India. Anthropometricparameters are measured for 571 urban slum adolescents in Mumbai in post-covid period (2022-23).
Adolescents were classified in to subgroups – stunting (height < -2SD WHO reference 2007), severestunting (< -3SD), wasting (weight for height < -2SD), severe-wasting (< -3SD), overweight (> +1SD), obese (> +2SD).
RESULTS:In urban Mumbai, 14.9% of the adolescent children are stunted with no significant
difference in between gender males (p>>0.05). This is found similar to other studies in slum of
Mumbai in pre-COVID-19 period (p>0.05). Adolescents have mean weight-for-height of 36.6 (±9.6)
kg with no significant difference between the genders (p>>0.05). One-fifth of the adolescents arewasted, of which 6.8% are severely-wasted. 10.9% of adolescents are overweight and 3.5% areobese. Male adolescents have higher percentage of severe-wasting (p=0.04) and obesity (p<0.01)
than females. Compared to pre-COVID-19 period, there is no significant difference in over-weight(p>0.05) and obese children (p>>0.05), but wasting and severe-wasting have significantly reduced(p<0.05). Body impedance analysis shows significantly higher total body, subcutaneous whole bodyand subcutaneous trunk fat among stunted adolescent than normal (p<<0.01).
CONCLUSIONS:Our data shows that COVID-19 times did not affect the malnutrition in urban
adolescents, however, higher body fat in stunted children poses risk of development of obesity.

Keywords: Adolescent malnutrition, Stunting, Wasting, Over-weight, ObeseFP-022[Exposures » Microplastics]

Public behavior and awareness of mask litter as
microplastic source in KOREA
Yeonjung Park1, Heekyung Bae2, Younghun Kim3, Jeonggue Park4
1Risk Research Team, TO21 company Limited, Seoul, South Korea; University of Seoul, Seoul, South

Korea
2Chemical Management Institute, TO21 company Limited, Seoul, South Korea
3Department of Chemical Engineering, Kwangwoon University, Seoul, South Korea
4Climate, Air Quality and Safety Research Group/Division for Environmental Risk, Korea Environment

Institute, Sejong, South Korea

BACKGROUND AND AIM:Masks are commonly used products made of plastic, and their usage has
increased rapidly since the COVID-19 pandemic. To solve the problem of plastic and microplastic
pollution caused by masks, it is necessary to raise public awareness of mask use and disposal. In thisstudy, a survey was conducted on 1,000 adults in Korea to find out the public's perception of MP
emission and mask disposal.
METHOD:By age group, people in their 20s spent the longest time wearing masks, and wearing timedecreased as they got older. Among the occupational groups, the occupation with the longest average
daily mask wearing time was 12.0 hours for station workers. Children wear masks for an average of
4.5 hours a day, compared to 6.1 hours for adults. On the other hand, the average number of masks
used by children per year is 468.2, which is higher than the average of adults (430.6 masks/year).
RESULTS:As a result of the survey on the experience of losing a mask, 38.1% of respondents had losta mask, and the average number of lost masks per year was about 33 regardless of gender. The
experience of mask loss was generally higher among younger people.
It was confirmed that the level of risk perception about the microplastics was high compared to low
understanding. Also, 55.6% of respondents said they did not know that microplastics could be
released from masks.
CONCLUSIONS:The results of mask wearing time and usage according to occupation and age groupcan be used as basic information for designing management policies for each exposure risk group. The
experience of mask loss and the results of the awareness survey on microplastics suggest the need forpolicy promotion and education for the public.

Keywords: mask litter, microplastics, public awareness, public behavior

FP-023[Air pollution » Particulate matter]

Validity of a Low-cost Particle Sensor to Assess
Real-time Indoor PM2.5 Exposure
Hsiao Hsien Leon Hsu1, Robert Wharton2, Ann Wang3, Rachel Meislin4, Vi Le3, Bian Liu1, Najla
Abdurrahman3, Andela Bianco4, Corrine Hanson5, Sonali Bose3
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
3The Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai,

New York, NY
4Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of

Medicine at Mount Sinai, New York, NY
5Department of Nutrition, University of Nebraska Medical Center, Omaha, NE

BACKGROUND AND AIM:Prenatal exposure to indoor fine particulate air pollution (PM₂.₅) has been
linked to numerous adverse birth outcomes. While prior studies have validated the performance of
low-cost sensors in laboratory or outdoor settings, only a few have examined their performance within
the context of real-world exposures. Therefore, we conducted a pilot in an ongoing pregnancy cohort
to assess the validity of low-cost particle sensors to estimate PM₂.₅ in urban indoor settings andevaluate factors contributing to discrepancies when compared with research grade PM₂.₅ monitors.
METHOD:Pregnant women in New York City were recruited early in gestation. Real-time indoor PM₂.₅
concentrations were assessed simultaneously with both DustTrak (DT) (TSI-USA, model:8530EP) and
PurpleAir (PA) (model:PA-II, Plantower-CF1 algorithm) by co-locating monitors within the home over 7
days. Temperature, humidity, and instrument-run-time were also collected via PA-II sensors. Data
was aggregated into hourly averages. We used multivariate linear models with 10-fold cross-validation
using PA measured PM₂.₅ (PA-PM₂.₅) to predict DT measured PM₂.₅ (DT-PM₂.₅). Models accounting fortemperature, relative humidity, instrument run-time, as well as potential interactions between these
affecting factors were compared.
RESULTS:Nine houses completed 1-2 distinct periods of indoor sampling. Mean PM₂.₅ concentration
ranged from 14-471 μg/m³ (SD:12-883 μg/m³). The model that included temperature, humidity,
instrument-run-time, and interaction between PA-PM₂.₅ and humidity yielded the lowest RMSE
(R²=0.93, MAE=0.2), with all adjusting covariates significantly predicting DT-PM₂.₅. Significant
interactions were also found between PA-PM₂.₅ and humidity (p<0.001). Higher runtime was alsosignificant (p<0.001) but did not interact with other variables.
CONCLUSIONS:This pilot suggests that low-cost indoor air quality sensors such as Purple Air are
adequate to estimate indoor PM₂.₅ exposure levels, especially if environmental conditions such astemperature and humidity are measured. Low-cost PM₂.₅ sensors may improve the surveillance of
health risks associated with indoor PM₂.₅ exposures, especially in future studies conducted in lowresource settings.

Keywords: Air pollution, Particulate matter, Exposure assessment, Exposures, Temperature

FP-024[Methods » Occupational epidemiology]

Developing Screening Tools for Work-relatedCases: Taking Lumbar Disc Herniation for
ExampleHsu-Li Huang1, Chi-Jen Chen2, Pau-Chung Chen3
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan

University, Taipei, Taiwan
3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences,
National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:To determine the work-relatedness of a certain disease highly relies on
occupational physicians’ judgement. Therefore, the referral mechanism from general practitioners to
occupational physicians is crucial to diagnosis of occupational diseases. Taking lumbar disc herniation(LDH) for example, this study aimed to develop a screening tool for clinical referral, which could assist
general practitioners to differentiate work-related LDH cases from non-work-related.
METHOD:Network of Occupational Diseases and Injuries Service (NODIS) was an importantsurveillance system of occupational diseases in Taiwan. From 2010 to 2018, a total of 1,421 patientsdiagnosed with LDH were reported to NODIS, and their diseases were classified as with higher orlower probability of work-relatedness by reviewers. Demographic factors and information of patients’occupation were also recorded. Logistic regression models were used to investigate the effect of eachfactor and to develop screening tools.
RESULTS:Among 1,421 confirmed LDH cases, 824 were classified as with higher probability of workrelatedness, while 597 were lower. The odds ratios for five factors in favored of higher probability ofwork-relatedness were statistically significant, including female, tenure over ten years, never stopped
working after symptoms onset, currently working part-time, and working in manufacturing or
construction industry. In our proposed screening tool, the sensitivity and positive predictive value
were 0.90 and 0.60, respectively.
CONCLUSIONS:Demographic factors indicating work-related LDH were identified. We proposed ascreening tool for work-related LDH to assist general practitioners in clinic for referral.

Keywords: Occupational exposures, ModelingFP-025[Other » Other (to be specified with keywords in the keywords section)]

Using the Health Belief Model to Explore theInfluencing Factors of Occupational Hazard
Prevention of Indigenous Laborers in Taiwan
Hung Ching I1, Yang Hsiao Yu2, Yeh Ching Ying3, Tsai Han Hui4, Chen Chiou Jong5, Wang Ming Chu6
1Institute of Labor, Occupational Safety and Health, Ministry of Labor; Institute of Environmental andOccupational Health Sciences, National Taiwan University
2Institute of Environmental and Occupational Health Sciences, National Taiwan University
3Taiwan Health and Productivity Management Association; Taipei Medical University
4Department of Exercise and Health Promotion, Chinese Culture University
5School of Safety and Health Sciences, Chang Jung Christian University
6Department of Commercial Design, Hsing Wu University

BACKGROUND AND AIM:The purpose of this study was to use the Health Belief Model (HBM) to
identify factors influencing occupational hazard prevention among Indigenous workers and the reasonsfor not receiving occupational hazard prevention courses.
METHOD:The main research objects are indigenous ethnic group laborers aged 15 and over.
Participants will fill in the questionnaire before the promotion activities for occupational hazard
prevention. Data collection is carried out by using a structured questionnaire designed based on the
HBM. The content includes: demographic information, labor status, healthy life behavior and status,
occupational safety and health measures, intention to receive education and training, as well as six
dimensions of the health belief model (perceived susceptibility, perceived seriousness, perceived
benefits, perceived barriers, action cues, and self-efficacy).
RESULTS:A total of 354 samples was collected in this study. The results of the study found that the
failure of indigenous workers to participate in relevant courses was affected by perceived barriers,
action cues and self-efficacy, especially perceived barriers. Other factors include: older age, lower
education level, shorter seniority, less physical aches and pains, non-fixed job, low income, or
perception that the workplace will not encounter hazards. Those in agriculture, forestry, fishery,
animal husbandry, manufacturing, construction engineering, accommodation and catering services are
relatively untouched.
CONCLUSIONS:From the result based on the HBM, it is recommended that the occupational hazard
prevention training courses for indigenous laborers need to be continuously strengthened, andappropriate arrangements should be made in accordance with the characteristics of indigenous
groups. According to the time and occasion, try to go deep into the tribe to hold promotional activities,
in order to reduce the occurrence of occupational accidents.

Keywords: Indigenous workers, Health Belief Model, Occupational hazard prevention

FP-026[Chemical exposures » Heavy metals]

Temporal variability of nickel levels using
repeated biomonitoring data
Jae Hee Min1, Seungho Lee1, Jung Yeon Kwon2, Young Seoub Hong1
1Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea;

Environmental Health Center, Dong-A University, Busan, Korea
2Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea

BACKGROUND AND AIM:The toxicity of nickel to humans is well known, but studies on exposure levels
related to metabolism in the human body are insufficient. We studied the distribution of nickel in threebiological tissues in the body.
METHOD:We recruited 50 healthy participants living in Busan, South Korea. Biological tissues werecollected four times in March 2020, August 2020, June 2021, and November 2021. Nickel
concentrations were analyzed using inductively coupled plasma-mass spectrometry (ICP-MS) at DongA University Environmental Health Center.
RESULTS:The results showed that the accuracy and precision of all three tissues were within ±15%,
and the geometric mean (GM) of nickel concentration in blood was high in November (blood: 1.197µg/L), and the GM of nickel concentration in serum and urine was high in March (serum: 1.146 µg/L,
urine: 1. 893 µg/L). Temporal variation had a significantly affected nickel levels in blood (p-value:
0.004), serum (p-value: <0.001), and urine (p-value: 0.001). The intraclass correlations of blood andurinary nickel were 8.05% and 6.4%, respectively. The GM of blood nickel in Italy (0.89 µg/L) was
comparable to this study (1.03 µg/L), but serum nickel in Italy (0.35 µg/L) was about a-half of thisstudy (0.69 µg/L). Urinary nickel was compared to international reference values (RV95), and noparticipants exceeded the RV95 values for Canada, France, or Germany. The correlation coefficient ofnickel concentration in the three tissues was low. This study shows that nickel levels in the body varydepending on the time of sampling and that the intra-individual correlation is greater than the interindividual correlation.
CONCLUSIONS:Therefore, future research is needed on biomarkers that can adequately reflect thelevel of nickel in the body by considering the source and route of exposure.

Keywords: Biomarkers of exposure, Environmental epidemiology, Multi-media, Risk assessment

FP-027[Exposure assessment methods » Risk assessment]

sleep hours and changes in cognitive function
considering the morningness-eveningness typeJi Eun Park1, Kyuhyun Yoon2, Eun Young Ahn1
1Korean Institute of Oriental Medicine, Daejeon, South Korea
2Institute of Health and Environment, Seoul, South Korea

BACKGROUND AND AIM:Many previous studies have investigated the association between sleep hours
and cognitive function, but few studies have considered morningness-eveningness type even though
the effect of sleep hours could be different by morningness type.
METHOD:The Korean Community health survey was used in this study. it is a cross-sectional study
and assessed sleep hours and sleep quality using PSQI. The participants were categorized into fourgroups (morningness, intermediate, eveningness, none group). The change in cognitive function wasassessed using a questionnaire.
RESULTS:More than half participants (55.6%) were classified into morningness group and 5% ofparticipants were eveningness group. The risk of cognitive decline was different by sleep hours. The
sleep hours showing the lowest risk was different between the morningness and the eveningnessgroups.
CONCLUSIONS:The result of this study showed that the proper sleep hours to lower risk of cognitive
decline might be different by individual's morningness type. Further studies investigating theassociation between sleep hours and health should consider people's morningness type.

Keywords: sleep, cognitive, morningness, chronotype, memory

FP-028[Air pollution » Long-term exposure]

Air pollution exposure and longitudinal changes
in pulmonary function in adults: A communitybased cohort study in Korea
Chan Ho Lee1, Heeseon Jang2, Mi Wha Kim3, Songhui Lee3, Jaelim Cho2, Ji Ye Jung4
1Severance Biomedical Science Institute, Yonsei Biomedical Research Institute, Yonsei University

College of Medicine, Seoul, Korea.
2Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
3Division of Pulmonary and Critical Care Medicine, Severance Hospital, Seoul, Republic of Korea
4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance

Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

BACKGROUND AND AIM:The effect of exposure to air pollutants on human health is a global publichealth concern. They adversely affect lung development and aggravate lung function. This study
investigated the effects of exposure to PM, NO2, SO2, and CO on longitudinal change in pulmonary
function in Korean adults.
METHOD:The longitudinal associations between air pollutant concentrations and pulmonary function
were analyzed by a linear mixed-effect model with an unstructured covariance matrix. A linear mixed
model included a subject-specific random intercept and random slope for time.
RESULTS:A total of 5,021 participants were included in this longitudinal study. The mean age was55.3 years and 45.6% was male. The mean FEV1/FVC ratio, FEV1 liter, FEV1 predicted, and FVC
predicted were 79.6 (4.2) %, 2.8 (0.6) L, 113.2 (14.3) %, and 105.0 (12.1) %, respectively. The
mean (SD) concentrations of PM10, PM2.5, SO2, NO2, and CO were 6.4 (0.4) μg/m3, 3.2 (0.3)μg/m3, 5.5 (0.8) ppb, 2.6 (0.5) ppb, and 59.4 (3.9) ppb, respectively. Men had higher mean values of
FEV1/FVC ratio, FEV1 predicted, and FVC predicted than women. Men had a lower mean value of FEV1
liters compared to women.
A 10-μg/m3 increase in PM10 was significantly associated with decreased FEV1/FVC ratios (β= –0.969%, p <.001), FEV1 liters (β= –0.064, p <.001), FEV1 predicted (β= –1.981 %, p <.001), and FVC
predicted (β= –0.537 %, p= 0.008). A 10-μg/m3 increase in PM2.5 was significantly associated withdecreased FEV1/FVC ratios (β= –1.791 %, p <.001), FEV1 liters (β= –0.115, p <.001), FEV1
predicted (β= –3.768 %, p <.001), and FVC predicted (β= –1.009 %, p <.001). SO2, NO2, and CO
were also significantly associated with reductions in pulmonary function, except the association
between SO2 and FEV1.
CONCLUSIONS:Air pollution exposure was associated with accelerated longitudinal change inpulmonary function in Korean adults.

Keywords: air pollutants, lung function, longitudinal

FP-029[Respiratory and allergic outcomes » Asthma]

The improvement of indoor air in households ofasthma patients through air purifier in industrial
city
Jia Lin Zhang, Pei Shih Chen
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City,
TaiwanBACKGROUND AND AIM:Xiaogang District in Kaohsiung City, Republic of China, was close to both the
Linhai Industrial Park and Kaohsiung International Airport. Households indoor air may be impacted byoutdoor pollutants emitted from industrial development. The aim of this study was to evaluate how
two different mechanisms of air purifiers improved indoor air in households of asthma patients,
including particulate matter (PM), ultrafine particles (UFPs), carbon monoxide (CO), carbon dioxide(CO2), nitrogen dioxide (NO2), sulfur dioxide (SO2), and total volatile organic compounds (TVOCs).
METHOD:We conducted a randomized, double-blind crossover study among 48 asthma patients in
Kaohsiung City, Taiwan. Asthma patients were randomized divided into 2 groups. One group was
asked to use air purifier with both Titanium dioxide Photocatalyst (PCO) and filter (including pre-filter,
activated carbon, and High-Efficiency Particulate Air) for 2 weeks, followed by 2-week washout period,
and then use PCO for additional 2 weeks. Another group was received the same intervention but inreverse order. We measured indoor air pollutants using real-time monitoring equipment, including
PM1, PM2.5, PM4, PM10, UFPs, CO, CO2, SO2, NO2, TVOCs, UFPs.
RESULTS:We observed that the concentrations of TVOCs and SO2 were significantly decreased afterusing air purifiers with PCO. For the intervention of PCO and filter, the concentrations of PM1, PM2.5,
PM4, PM10, UFPs, TVOCs, NO2, and CO were significantly decreased. In addition, air purifiers with
PCO and filter resulted in a range of 42~45% reduction in PM1, PM2.5, PM4, PM10, and 3% reductionin NO2, respectively.
CONCLUSIONS:We revealed that air purifiers with two different mechanisms improved indoor air
pollutants including particulate and gaseous pollutants. Air purifiers with both PCO and filter efficiently
reduce the particulate and gaseous pollutants. Therefore, air purifiers could be an effective control
method for improving indoor air quality, especially in high-polluted area.

Keywords: industry, household, air purifier, particulate matter, Titanium dioxide Photocatalyst

FP-030[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

A high-throughput LC-MS Method for Urinary
Transportation- and Petrochemical-Related VOC
Metabolites as Biomarkers for Exposure
Assessment
Jing Fang Hsu1, Wei Shan Chin2, Pinpin Lin1, Pau Chung Chen3, Tzu Chieh Chou4, Leon Guo3
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2School of Nursing, College of Medicine, National Taiwan University and National Taiwan University

Hospital, Taipei, Taiwan
3National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan & Institute of Environmental and Occupational Health Sciences, National Taiwan University
College of Public Health, Taipei, Taiwan & Department of Environmental and Occupational Medicine,National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
4Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Many transportation and petrochemical industries Volatile organic compounds(VOCs) are IARC group I carcinogens. Urinary VOC metabolites are valuable biomarkers for assessing
VOC exposure. This study aimed to develop and validate a method for quantitatively analyzing 12
urinary VOC metabolites as biomarkers for environmental and occupational exposure assessment. The
method was applied to urine samples from primary school students in an urban town in southern
Taiwan to evaluate the VOC exposure levels.
METHOD:An isotope-dilution electrospray ionization tandem mass spectrometry (ESI‒MS/MS) with
online sample cleanup was developed to analyze 12 urinary VOC metabolites quantitatively. The
method was validated for accuracy, sensitivity, and precision using spiked standards. In addition, theurinary VOC levels in 255 primary school students in an urban town in Tainan, Taiwan, were
evaluated.
RESULTS:The LC-MS method developed in this study demonstrated high accuracy (mean error for
spiked standards 0.1 to 17%), sensitivity (limit of detection 0.03 to 1.16 ng/mL), and precision(within- and between-run relative standard deviations 0.5 to 12.9%) for the quantitative analysis of
12 VOC metabolites in human urine samples. Application of the method to urine samples from primaryschool students in southern Taiwan revealed potentially elevated transportation- and petrochemicalrelated VOC exposure levels compared to the USA, warranting further investigation and exposure
reduction measures.
CONCLUSIONS:A high-throughput, sensitive, and accurate LC-MS method was developed andvalidated for quantitatively analyzing 12 transportation- and petrochemical-related VOC metabolites inhuman urine samples. The method was applied to urine samples from primary school students insouthern Taiwan, revealing higher VOC exposure levels compared to the USA. These results indicate aneed for further investigation and suggest that the developed method can accurately determine VOC
metabolite levels in human urine samples as biomarkers for transportation- and petrochemical-related
VOC exposure assessment.

Keywords: exposure marker, human biomonitoring, LC‒MS/MS, VOCs

FP-031[Exposures » Occupational exposures]Night-shift work and prostate cancer: a twostage dose-response meta-analysis for thecorrect risk definition
Jinyoung Moon
Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, SouthKorea

BACKGROUND AND AIM:The hypothesis of this study is night shift work exposure can increase the riskof prostate cancer. To validate this hypothesis, the author conducted a two-stage dose-response
meta-analysis with improved quality on this topic.
METHOD:The medical librarian searched PubMed, EMBASE, and the Cochrane Library on 30th
December 2022. The 7 inclusion criteria were determined and strictly applied to the selection process.
RESULTS:Finally, 11 cohort studies (12 cohort reports, total cases: 9366, and total person-years:
88238009) were included. The pooled RR of prostate cancer for 1, 10, 20, and 30 years of night shift
work exposure was 1.0126 (95% CI 1.0003-1.0251), 1.1336 (95% CI 1.0033-1.2808), 1.2850 (95%
CI 1.0066-1.6404), and 1.4566 (95% CI 1.0099-1.0251), respectively.
CONCLUSIONS:This study (ⅰ) strictly applied 7 transparent inclusion criteria, and (ⅱ) thoroughly
separated RRs from cohort studies and ORs from case-control studies and synthesized each type ofeffect estimates separately, even though the ORs from case-control studies were all excluded becauseof a high possibility of publication bias. In addition, (ⅲ) exposure dose (years of night shift work) was
clearly defined in evidence synthesis based on the years of night shift work reported in individual
studies. Finally, (ⅳ) the author applied a new two-stage dose-response meta-analysis method
reported in recent literature. Therefore, this study will be the best evidence regarding this topic, andthe results reported in this study will be the most accurate and up-to-date risk definition for prostatecancer, along with the years of night shift work exposure.

Keywords: Night shift work, Prostate cancer, Two-stage dose-response meta-analysis, Light exposure
at night, Cohort studies

FP-032[Exposures » Occupational exposures]Night shift work and colorectal cancer: a twostage dose-response meta-analysis for thecorrect risk definition
Jinyoung Moon
Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, SouthKorea

BACKGROUND AND AIM:The hypothesis of this study is night shift work exposure can increase the riskof colon/rectal cancer. To validate this hypothesis, the author conducted a two-stage dose-response
meta-analysis with improved quality on this topic.
METHOD:The medical librarian searched PubMed, EMBASE, and the Cochrane Library on 30th
December 2022. The 7 inclusion criteria were determined and strictly applied to the selection process.
RESULTS:Finally, 4 cohort studies (9 cohort reports, total cases: 4368.77, and total person-years:
253074380) and 3 case-control studies (5 case-control reports, total cases: 2517, and total controls:4919) were included. The pooled RR of colorectal cancer for 1, 10, 20, and 30 years of night shift work
exposure was 1.0023 (95% CI 0.9992-1.0055), 1.0234 (95% CI 0.9916-1.0562), 1.0473 (95% CI
0.9832-1.1155), and 1.0717 (95% CI 0.9749-1.1782), respectively. The pooled OR of colorectal
cancer for 1, 10, 20, and 30 years of night shift work exposure was 1.0268 (95% CI 0.9968-1.0578),
1.3031 (95% CI 0.9685-1.7532), 1.6980 (95% CI 0.9381-3.0737), and 2.2127 (95% CI 0.90855.3888), respectively.
CONCLUSIONS:This study (ⅰ) strictly applied 7 transparent inclusion criteria, and (ⅱ) thoroughly
separated RRs from cohort studies and ORs from case-control studies and synthesized each type ofeffect estimates separately. In addition, (ⅲ) exposure dose (years of night shift work) was clearly
defined in evidence synthesis based on the years of night shift work reported in individual studies.
Finally, (ⅳ) the author applied a new two-stage dose-response meta-analysis method reported inrecent literature. Therefore, this study will be the best evidence regarding this topic, and the results
reported in this study will be the most accurate and up-to-date risk definition for colon/rectal cancer
according to years of night shift work exposure.

Keywords: Night shift work, Colorectal cancer, Dose-response meta-analysis, Cohort studies, Casecontrol studies

FP-033[Climate » Temperature extremes and variability]

Heat Related Mortality Burden during theRecord-Breaking Summer 2022 in Europe: An
Integrated Continental Analysis
Joan Ballester1, Marcos Quijal Zamorano1, Raúl Fernando Méndez Turrubiates1, Ferran Pegenaute1,
François R. Herrmann2, Jean Marie Robine3, Xavier Basagaña1, Cathryn Tonne1, Josep Maria Antó1,
Hicham Achebak4
1ISGlobal, Barcelona, Spain
2Medical School of the University of Geneva, Geneva, Switzerland
3MMDN, University of Montpellier, Montpellier, France
4Inserm, France Cohortes, Paris, France

BACKGROUND AND AIM:The record-breaking temperatures in the summer of 2003 caused over
70,000 excess deaths in Europe. The resulting societal awareness led to the design andimplementation of adaptation strategies to protect vulnerable populations across the continent. We
here aimed to quantify the heat related mortality burden of the summer of 2022, the now hottest
season on record in Europe, and analyse it within the context of accelerated warming temperatures.
METHOD:We analysed a mortality database including 45,184,044 counts of death from 823 contiguous
regions in 35 European countries, representing their whole population of over 543 million people. We
used quasi-Poisson regression models to calculate the location-specific temperature-lag-mortality
relation in each European region, and a multivariate multilevel meta-regression analysis to pool thelocation-specific coefficients.
RESULTS:We estimate that 61,405 (95% CI 59,131-63,719) Europeans died due to the observed heat
between May 30th and September 4th. Italy (18,091 deaths; 17,375-18,703), Spain (11,234; 10,46212,009) and Germany (8,209; 7,033-9,430) were the countries with the largest heat related mortality
burden. In relative terms, the largest heat related mortality rates were found in the Mediterraneanarch, i.e. Italy (296 deaths per million, 285-306), Greece (281, 261-301), Spain (235, 219-251) andPortugal (217, 198-235). 64% more women than men died prematurely due to heat.
CONCLUSIONS:In the context of global warming, with European temperatures rising at a faster rate
than the global average, and taking into account the magnitude of heat related mortality in thecontinent, our results call for a substantial re-evaluation and strengthening of existing heatsurveillance platforms, prevention plans and long-term adaptation strategies in Europe.

Keywords: Global warming, heat related mortality, summer temperatures, heat waves, climatechange adaptation

FP-034[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

DNA methylation associated with Cadmium
exposure among the residents near vulnerable
area
Jung Yeon Kwon1, Seungho Lee2, Jae Hee Min2, Sungho Won3, Jung Woong Kim4, Young Seoub
Hong2
1Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea
2Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea;

Environmental Health Center, Dong-A University, Busan, Korea
3Department of Public Health Sciences, Seoul National University, Seoul, Korea
4Department of Life Sciences, Chung-Ang University, Seoul, Korea

BACKGROUND AND AIM:Cadmium (Cd) can cause various diseases and cancers in addition to kidneydamage. Additionally, several candidate genes have been reported based on research findings thatsuggest that cadmium exposure affects DNA methylation. Therefore, we conducted biomonitoring
survey and identified the association between DNA methylation markers and cadmium exposure
among those who lived in vulnerable area.
METHOD:From July to October 2021, blood and urine samples were collected from a total of 290
participants. Cadmium levels were determined using inductively coupled plasma-mass spectrometer.
In addition, the locations of differentially methylated regions were identified using reduced
representation bisulfite sequencing (RRBS) method. We used STATA for the general statistical analysis
and R for DNA methylation adjusting sex, age, regions, smoking and the distance from the exposuresource.
RESULTS:The geometric mean concentrations (95% CI) of blood and urinary cadmium in study
participants were 1.72 (1.59, 1.85) μg/L and 2.65 (2.44, 2.88) μg/g creatinine, respectively. And we
found a methylated region of BRD8 in blood cadmium that is associated with regulation of cancer cellproliferation and the response to chemotherapeutic compounds that destabilize the cytoskeleton or
impede proteasomal function. The significance was remained after adjusting the age effect. For
urinary cadmium, six significant methylation regions were found in all participants, corresponding to
the LMX1A, IGKV3D-7, DYSF, DNASE1L3, ADARB2, and GATA5 genes. And the significance of IGKV3D7 was remained after controlling the age over 60.
CONCLUSIONS:There were significant methylation regions according to the WHO guidance level for
Cd, the association between the genes and the level of cadmium will be investigated for the further
research.

Keywords: Environmental epidemiology, Epigenomics, Exposure assessment, Heavy metals

FP-035[Air pollution » Particulate matter]

Neighbourhood and household level socioeconomic status and its association with air
pollution exposure in Indian cities
Jyothi S Menon1, Melina Magsumbol3, Siddhartha Mandal2, Dorairaj Prabhakaran2, Poornima
Prabhakaran1
1Public Health Foundation of India, Gurugram, Haryana, India
2Center for Chronic Disease Control, New Delhi, India
3Vital Strategies, New Delhi, India

BACKGROUND AND AIM:Although recent studies indicate that the inequities in air pollution exposure
negatively affects lower socioeconomic groups, there is relatively limited evidence on how bothhousehold and neighbourhood level socioeconomic status (SES) may influence air pollution exposuresin lower and middle income settings.We evaluated the associations between household and area-level
SES metrics and exposure to particulate matter (PM2.5) in two contrasting Indian cities ‒ Delhi and
Chennai.
METHOD:We used baseline data from the Centre for cArdiometabolic Risk Reduction in South-Asiasurveillance (CARRS) study. The household level SES indicators viz. household income, education level
and wealth index score were obtained from the CAARS survey. The neighbourhood level SES was
calculated based on the ward level socio-demographic variables from the 2011 Census of India. The
daily mean PM2.5 estimates for the year 2010-2016 at a spatial resolution of 1 km x 1 km wereobtained from a hybrid exposure model. Multilevel mixed-effects models were used to understand theassociation between air pollution and SES.
RESULTS:Neighbourhoods with lower SES score were exposed to higher PM2.5 concentrations in boththe cities. An interquartile range increase in neighbourhood SES score was found to be associated with
0.54µg/m3 and 2.47µg/m3 lower annual average PM2.5 concentrations in Delhi and Chennai
respectively. The analysis indicated that in Delhi, people living in densely populated areas and sociallydisadvantaged groups were exposed to higher pollution as compared to others. In Chennai, heavily
populated areas are located closer to the coast where the pollutants are dispersed by the sea-landbreeze hence, a negative association was observed between PM2.5 levels and household density.
CONCLUSIONS:As compared to household-level SES, neighbourhood factors were observed to have astronger association with ambient PM2.5 concentrations. This signifies the importance of controllingfor neighborhood level SES factors while studying the effects of ambient air pollution on health.

Keywords: Socio-economic factors, Environmental justice, Environmental disparities

FP-036[Chemical exposures » Heavy metals]

Exposure to inorganic arsenic and hypertension
among non-diabetic Mexican women
Karla Fabiola Rangel Moreno1, Lizbeth López Carrillo1, Mariano E. Cebrián2
1Population Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
2Department of Toxicology, Center for Research and Advanced Studies of the IPN, Mexico City, Mexico

BACKGROUND AND AIM:Arsenic exposure is a serious public health problem around the world.
Ingested inorganic arsenic (iAs) is eliminated through urine as monomethylarsonic acid (MMA) anddimethylarsinic acid (DMA), which are associated with several health outcomes, for example,
hypertension (HTA); however, the epidemiological evidence is still inconclusive. Therefore, theobjective of this report is to evaluate the association between iAs exposure and metabolism withhypertension in a study sample of women without T2DM.
METHOD:We identified 150 HTA cases and 572 controls from healthy controls of a case-control study
for female breast cancer in northern Mexico, after excluding participants with diabetes diagnostic andbiological implausible values of urinary creatinine. Women were interviewed about their clinical,
reproductive, sociodemographic and lifestyle characteristics. Urinary iAs metabolites were determined
by High Performance Liquid Chromatography coupled with mass spectrometry and iAs metabolism wasassessed by metabolite percentages and ratios. Unconditional logistic regression models were used toevaluate associations.
RESULTS:Urinary total arsenic minus arsenobetaine (TAs-AsB) concentrations varied from 0.57 to
303.29 μg/L. HTA cases had significantly lower iAs and MMA concentrations (µg/L) than control
women. Cases had significantly lower %iAs and %MMA, while %DMA and second methylation index(SMI) were significantly higher than in control women. After adjusting for age, smoking and state ofresidence, HTA was significantly negative associated with %MMA, as well as significantly positive
associated with SMI. No significant associations were observed between HTA prevalence, TAs-AsB
levels and its metabolites.
CONCLUSIONS:Our findings support an association between iAs metabolism and HTA but not with
TAs-AsB concentrations. These results confirm the complex relationship between iAs metabolism andseveral diseases.

Keywords: Epidemiology, Heavy metals, Female

FP-037[Other » Other (to be specified with keywords in the keywords section)]

Gender and geographical representation ineditorial boards publishing in environmental
sciences and public health: challenging the “oldboys club”
Kim R. Van Daalen1, Sara Dada2, Alanna Barrios Ruiz3, Kai Ti Wu4, Aidan Desjardins5, Mayte Bryce
Alberti6, Alejandra Castro Varela3, Parnian Khorsand7, Ander Santamarta Zamorano8, Laura Jung9,
Grace Malolos10, Jiaqi Li11, Dominique Vervoort12, Nikita Charles Hamilton13, Poorvaprabha Patil14,
Omnia El Omrani15, Marie Clare Wangari16, Telma Sibanda17, Alexandra Phelan18, Ebele R. I. Mogo19
1British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary

Care, University of Cambridge, Cambridge, United Kingdom
2UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of

Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
3Escuela de Medicina y Ciencias de la Salud,Tecnológico de Monterrey, Monterrey, México
4Leibniz Institute for freshwater ecology and inland fisheries, Berlin, Germany
5Department of Microbiology, School of Genetics and Microbiology, Moyne Institute of Preventive

Medicine, Trinity College Dublin, Dublin, Ireland
6Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
7Women in Global Health, Washington, District of Columbia, USA
8School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
9Leipzig University, Medical Faculty, Leipzig, Germany
10College of Medicine, University of the Philippines Manila, Manila, Philippines
11University of Cambridge, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, United

Kingdom
12Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario,

Canada13NCH Strategy Group, Nassau, The Bahamas; The Department of Environmental Planning andProtection (DEPP), Nassau, Bahamas
14Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
15Faculty of Medicine, Ain Shams University, Cairo, Egypt
16Nazareth Hospital, Nairobi, Kenya
17Zimbabwe Red Cross Society, Gokwe South and North, Zimbabwe
18Center for Global Health Science & Security, Georgetown University, Washington, District ofColumbia, USA
19MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom

BACKGROUND AND AIM:Journal editors play a critical role in coordinating and shaping what is
accepted as scientific knowledge. This study aimed to explore the diversity of journal editorial boards(EB) publishing in environmental science and public health.

METHOD:Clarivate Journal Citation Reports were used to identify journals classified as Public,
Environmental, and Occupational (PEO) Health, Environmental Studies, or Environmental Sciences.
Current EB members were identified from each journal’s publicly available website between 1 Marchand 31 May 2021. Individuals’ names, EB roles, institutional affiliations, geographic locations (city,
country), and inferred gender were collected. Linear and logistic regression models were fitted tofurther assess the relationship between gender presence, low- and middle-income country (LMIC)
presence, and several journal and editor-based indicators.
RESULTS:After identifying 628 unique journals and excluding discontinued or unavailable journals, 615
journal EBs were included. In-depth analysis was conducted on 591 journals (27,772 editors) withcomplete gender and geographic data. Overall, most editors were men (65.9%), followed by women(32.9%) and non-binary/other gender minorities (0.05%). 75.5% of EBs (n=446) were composed of amajority of men (>55% men), whilst only 13.2% (n=78) demonstrated gender parity (45–55%
women/gender minorities [WGM]). 84% of editors (n = 23,280) were based in high-income countries
and only 2.5% of journals (n=15) demonstrated economic parity in their editorial boards (45–55%
editors from LMICs). None of the editors-in-chief and only 27 editors in total were women based in
low-income countries. Having WGM and LMIC-based editors-in-chief are both positively correlated tothe overall percentage of WGM (R=0.42) and overall percentage of LMIC-based (R=0.57) editors
respectively.
CONCLUSIONS:This study exposes the glaring lack of diversity in EBs in environmental science andpublic health, and discusses the power dynamics affecting the creation and dissemination ofknowledge.

Keywords: editorial boards, environmental sciences, public health, diversity, knowlege generation

FP-038[Exposures » Occupational exposures]

Coal Production Trends and Black Lung Disease
Incidence Rate In Indonesia, 2013-2021
Kurnia Ardiansyah Akbar1, Kurnia Ardiansyah Akbar2, Kraiwuth Kallawicha2
1Public Health Faculty, Jember University, Jember, Indonesia
2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

BACKGROUND AND AIM:The use of coal in the world continues to increase, resulting in countries
supplying coal products continuing to increase their production. Indonesia as the world's largest coalsupplier also seeks to increase coal production every year. The aim of this study is to see the otherperspective on occupational health of increasing coal production and its impact on black lung disease
in Indonesia.
METHOD:This research is a retrospective longitudinal study conducted on 3 coal mines in Indonesia.
The research focused on 2013-2021. Data is taken from Indonesia's national coal production data andblack lung disease data is taken based on the annual medical check-up program for coal miners in 3
coal companies in Indonesia. Rate ratios were examined for differences in rates between men andwomen workers, and annual percent change was calculated to quantify changes in incidence rates
over time.
RESULTS:Trends analysis shows that coal production in Indonesia has continued to increase at least
24,49% in the last decade from 490 million tons in 2013 and gradually increased to 610 million tons in
2021. Based on the results of X-Ray every years of coal mine workers in Indonesia, the new cases ofBlack lung disease in coal miners was found 112 (13,88%) these years, bigger than worldwide
incidence rate (8%). Male workers have a greater ratio of black lung disease in coal mining
companies. The age of workers over 40 years have an incidence rate twice (69,64%; 78 cases) that ofworkers under 40 years.
CONCLUSIONS:Increasing coal production in Indonesia results in increasing new cases of black lungdisease in Indonesia. The increase in new cases of black lung disease in Indonesia is mainly
experienced by male coal mine workers and workers over the age of 40 years.

Keywords: long-term exposure, respiratory outcomes, occupational epidemiology, occupational
exposures

FP-039[Air pollution » Particulate matter]

Decoding the Impact of Particulate Matter on
Metabolic Pathways: A Systematic Review of
Toxicological and Epidemiological Studies
Lauren Lopez, Andrea Baccarelli, Gary Miller, Vrinda Kaila
Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York,NY, United States

BACKGROUND AND AIM:The global demographic is undergoing an unprecedented shift with the
population aged 65 and over surpassing the number of children under five for the first time. This
demographic change emphasizes the health risks related to environmental exposures, particularly
PM2.5 air pollution, which has been shown to disproportionately impact older individuals. PM2.5
particles can enter the bloodstream through the respiratory system, leading to oxidative stress andsystemic inflammation. Metabolomics, the comprehensive analysis of biological metabolites, canprovide valuable insights into the effects of these changes and clarify the relationship between air
pollution, metabolic changes, and age-related diseases.
METHOD:In this review, we synthesized findings from both epidemiological and toxicological studies
using metabolomics to examine the molecular effects of PM2.5 exposure on aging populations. We
conducted a thorough examination of studies published on PubMed and Europe PMC from 2012 to2022. From an initial assessment of 484 abstracts, we selected 70 primary papers that met ourselection criteria.
RESULTS:The evidence from the selected studies suggests that exposure to PM2.5 pollution results in
cardiovascular-related metabolic disruptions and activates the sphingolipid metabolism pathway.
Furthermore, PM2.5 exposure appears to induce metabolic changes associated with oxidative stress,
inflammation, and mitochondrial dysfunction, affecting pathways such as amino acid metabolism, lipid
metabolism, energy metabolism, and nucleic acid damage/repair.
CONCLUSIONS:This review underscores the urgent need to mitigate the detrimental effects of PM2.5
air pollution on the aging population. Given the escalating environmental challenges, it is paramountto develop and apply targeted interventions and evidence-based strategies to protect the health ofolder individuals.

Keywords: Untargeted metabolomics, targeted metabolomics, PM2.5, PM10, black carbon

FP-040[Methods » Community outreach]

Inventory in ABCD mode Community Assets ofSanmin District, Kaohsiung City for Google Maps
Li Ling Chen1, Shu Ting Huang2, Wen Tsung Tsai4, Yu Ju Yeh3, Hang Ru Su4, Shian Fei Juang4
1No
2Sanmin District Second Public Health Center, Kaohsiung City.
3Social Affairs Bureau of Kaohsiung City Government
4Department of Medical Information Kaohsiung Medical University Chung-Ho Memorial Hospital

BACKGROUND AND AIM:According to the National Development Commission (2023) "Republic ofChina Population Estimates", by 2025, we will enter a "Super Aged Society". According to Hao
Guangzhong et al.'s (2019) research, it was found that all elderly people aged 65-85 have experiencein using mobile phones, and Lin et al.'s (2009) research found that the elderly want easier and clearer
media operation interfaces. In response to the needs of the elderly's daily activities and health care.
METHOD:Since October 2018, the ABCD (asset-based community development) model has been used
to classify and build community assets. The data is built on Google Maps, which reduces the memory
space of mobile phones and tablets, and can be used on various media. In addition, with theInformation Office of Zhonghe Hospital affiliated to Kaohsiung Medical University, the "Social
Participation Map" was embedded in the hospital's medical information system, and the patient's
address was linked to the "Social Participation Map" to present the community assets near thepatient's home (source), and through the doctor's simple Explain and introduce to patients and theirfamilies.
RESULTS:Users feel that it is convenient and easy to use, and it is easy to find the resources theywant to use.
CONCLUSIONS:Recording community resources on multi-media shared by many people is easy for the
public to use, and it is helpful for them to promote healthy behaviors. In addition, using google earth
multimedia, it is clear at a glance the proportion of resources in each region, which is conducive to thebalance of community distribution.

Keywords: ABCD (asset-based community development), community assets (source), Google Map,
Google earthFP-041[Cancer and cancer-precursors » Incidence]

Estimation of Burden of Abestos Related
Cancers in Taiwan
Lukas Jyuhn Hsiarn Lee1, Chung Yen Chen2, Yawen Cheng3
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University,
Taipei, Taiwan
2Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University,
Taipei, Taiwan
3Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Occupational and environmental exposure to asbestos is a crucial risk factor
for asbestos-related cancers (ARCs), including malignant mesothelioma (MM), lung cancer, laryngeal
cancer and ovarian cancer. Because of the relatively long latency period of ARCs, and a general lack ofpublic awareness, there are barriers and difficulties in recognition, and their underestimation could bea public health challenge. Few studies analyzed the trend of ARCs or evaluated their extent of underestimation in Taiwan. This study aimed to estimate the disease burden of ARCs during 2005-2017.
METHOD:Cancer cases were obtained from the Taiwan Cancer Registry, and incident case number ofMM, lung cancer, laryngeal cancer, ovarian cancer, pharyngeal cancer, gastric cancer, and colorectal
cancer were retrieved from 2005 to 2017. Healthcare utilization data were based on the National
Health Insurance (NHI) databases. The cases of ARDs attributable to asbestos were estimated using
population attributable fraction (PAF). The prevalence of asbestos exposure was estimated throughretrospective exposure assessment using worker population in various industries, and CARcinogen
EXposure (CAREX). Relative risks of the ARCs of interest were drawn from epidemiological literaturesearched in the PubMed databases.
RESULTS:PAF of MM was assumed to be 100%, and PAF of the other ARCs ranged from 0.14%(colorectal cancer) to 2.31% (lung cancer) in 2015. Estimated incident case numbers of asbestosrelated malignancies were summarized. There were about 400 cancer cases annually may be
attributable to asbestos exposure in Taiwan.
CONCLUSIONS:ARCs would impose a substantial burden on Taiwanese workers. We observed obvious
underestimation of ARCs in comparison with real-world statistics of worker’s compensation.
Collaborative efforts to increase awareness of work-related ARCs in the general public and among
clinicians are urgently needed. Appropriate health exam programs with cancer screening should bedesigned considering cost-effectiveness for workers even after retirement for early detection of ARCs.

Keywords: Cancer and cancer precursors, IncidenceFP-042[Climate » Temperature]

Predictability assessment of the firstcontinental heat-cold-health early warning
system: new avenues for human healthforecasting
Marcos Quijal Zamorano1, Desislava Petrova2, Èrica Martínez Solanas3, François R. Herrmann4, Xavier
Rodó5, Jean Marie Robine6, Hicham Achebak7, Joan Ballester2
1ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
2ISGlobal, Barcelona, Spain
3ISGlobal, Barcelona, Spain; Sub-Directorate General of Surveillance and Response to Public Health

Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain
4Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals andUniversity of Geneva, Thônex, Switzerland
5ISGlobal, Barcelona, Spain; ICREA, Barcelona, Spain
6Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France; École

Pratique des Hautes Études, Paris, France
7ISGlobal, Barcelona, Spain; Inserm, France Cohortes, Paris, France

BACKGROUND AND AIM:The increasing number of extreme climate events due to global warming
highlights the urgent need for the implementation of early warning systems directly targeting theeffects of weather phenomena on human health. Here we build the first continental heat-cold-healthearly warning system, and compare its predictability with the original weather forecasts.
METHOD:We did so by considering almost 60 million counts of all-cause mortality in 147 contiguous
NUTS regions from 16 European countries. We calculated state-of-the-art temperature-lag-mortality
models, which account for the delayed effects of daily temperatures on mortality counts. These
epidemiological associations were used to transform the daily bias-corrected forecasts of 2-meter
temperature into daily predictions of temperature related mortality. We compared the predictive skillof temperature forecasts and temperature related mortality predictions by using predictability
assessment techniques widely used in weather and climate forecasting.
RESULTS:We found that temperature forecasts can be used to issue skillful predictions of heat andcold related mortality accounting for the real impacts of temperature on human health, although thewindow of predictability was differently reduced by season and location. We also showed that thepredictability of the early warnings is to a very large extent constrained by the original weather
forecasts, and not by the epidemiological models, which means that further advancements in weather
forecasting would automatically turn into an increase in the predictability window of health early
warning systems.
CONCLUSIONS:Therefore there is a pressing need to develop new interdisciplinary research combining
weather and climate forecasting with epidemiology and social sciences, which systematically validates
the predictability of any derived early warning system. Overall, we proved that a rigorous assessmentof the predictability of early warning systems is an unavoidable requisite to generate trust among
public health authorities, and in this way, increase resilience and strengthen our early adaptation
response to climate change.

Keywords: Temperature, Mortality, Short-term exposure, Climate

FP-043[Built environment » Green space]

Linking the health of women and non-binary
residents during Covid-19 pandemic to public
spaces with natural elements, gentrification andtouristificat
Margarita Triguero Mas1, Valeria Carolina Cuenca Cuenca2, Amalia Calderón Argelich2, Blanca
Valdivia3, Sara Ortiz Escalante3, Helen V.s. Cole2
1Department of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain; Mariana

Arcaya’s research group, Department of Urban Studies and Planning at Massachusetts Institute ofTechnology (DUSP-MIT), Cambridge, United States; Barcelona Laboratory for Urban Environmental
Justice and Sustainability, Institute for Environmental Science and Technology at UniversitatAutònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès, Spain; Barcelona Institute for Global
Health (ISGlobal), Barcelona, Spain
2Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain
3Col·lectiu Punt 6, Barcelona, Spain

BACKGROUND AND AIM:Our main goal was to understand if and how – in the context of the Covid-19
pandemic – changes in use and perception of public space which have natural elements (PSNE) have
impacted the health of women and non-binary residents of Barcelona. Also, to explore how changes inprocesses such as gentrification and touristification may have impacted the use of and health benefits
from PSNE during the pandemic.
METHOD:We employed a comparative mixed methods case-study with two parts (one quantitative andone qualitative) in two neighborhoods of the city of Barcelona (Spain). For the quantitative part wecollected data from 907 residents using a questionnaire. For the qualitative part we performed twoparticipate workshop, two exploratory walks and semi-structured interviews. We interpreted theresults jointly to obtain statistically solid and context-relevant results.
RESULTS:We found that in general participants maintained or increased their use of PSNE nearby theirresidence. But in neighborhoods with low access to PSNE, spaces located outside the neighborhood
emerged as relevant.
Participants who maintained or increased their use of nearby PSNE during the Covid-19 pandemic hadaround 50% lower odds of self-reported poor general and mental health. Those who maintained orincreased their use of PSNE further away also had around 55% lower odds of reporting poor general
health. Interviewees explained that walking and meeting friends and family in PSNE helped themrelax, disconnect, and decrease their stress levels. Among participants, we found that increased
perceptions of touristification during the Covid-19 pandemic were associated with a 7% (1%, 14%)higher odds of reporting poor general health.
CONCLUSIONS:Our results add to other existing evidence indicating that contact with PSNE should bepromoted during health emergencies like the Covid-19, while paying attention to the detrimental
impacts of perceived changes to touristification.

Keywords: Green space, COVID-19, Environmental justice, Public healthFP-044[Built environment » Green space]

Perceived urban ecosystem services anddisservices in gentrifying neighborhoods:
Contrasting views between community members
and state informants
Mary Kathryn Rodgman1, Isabelle Anguelovski2, Carmen Pérez Del Pulgar3, Galia Shokry4, Melissa
Garcia Lamarca5, James J.t. Connolly6, Francesc Baró7, Margarita Triguero Mas8
1Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain
2Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; Barcelona

Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental Science andTechnology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès, Spain
3Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain; Department Environmental Politics, Helmholtz Centre for Environmental Research-UFZ, Leipzig,
Germany
4Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain; School of Environmental and Sustainability Science, Kean University, New Jersey, United Statesof America
5Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain; Polytechnic of Turin, Interuniversity Department of Regional and Urban Studies and Planning,
Turin, Italy
6Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental

Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain; School of Community and Regional Planning (SCARP), Faculty of Applied Science at Universityof British Columbia (UBC), Vancouver, Canada
7Geography and Sociology Departments at Vrije Universiteit Brussel (VUB), Brussels, Belgium;

Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute for Environmental
Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola del Vallès,
Spain
8Universitat Oberta de Catalunya, Barcelona, Spain; Mariana Arcaya’s research group, Department of

Urban Studies and Planning at Massachusetts Institute of Technology (DUSP-MIT), Cambridge, UnitedStates; Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute forEnvironmental Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola
del Vallès, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, SpainBACKGROUND AND AIM:As the world continues to become rapidly urbanized, securing quality urban
natural outdoor environments (NOE) is increasingly important. These NOE are well-known to benefit
people’s health through the provision of ecosystem services. However, NOE are also linked toecosystem disservices. In this direction, several scholars suggest that NOE may not equitably benefit
the health of all urban residents as they may be affected by processes such as gentrification. To better
understand why these health inequities persist, attention needs to be placed on how informants indifferent decision making positions perceive these NOE ecosystem services and disservices ingentrifying areas.
METHOD:We performed 153 interviews (105 to community representatives and 48 to state
informants). We analyze the ecosystem services and disservices identified by community and state
informants in seven cities with gentrifying neighborhoods, pronounced social inequalities, and where
NOE were created or improved: Amsterdam, Bristol, Cleveland, Lyon, Montreal, Philadelphia, and San
Francisco.
RESULTS:Our study shows that informants report a wide array of ecosystem disservices (and services)in relation to new and improved NOE located in cities undergoing gentrification and identified somedisservices previously under-studied (i.e. physical tiredness, low attractiveness and forced
displacement). Generally, community informants were able to identify ecosystem disservices moreclearly and richly. Our study illustrates how differences in decision making positions can impact
perceptions of ecosystem services and disservices.
CONCLUSIONS:Our study has implications for urban environmental planning decisions that will help
maximize the ecosystem services provided by urban NOE. Only if all perceived ecosystem services anddisservices are considered, will it be possible to design green just healthy cities.

Keywords: Green space, Particulate matter, Environmental disparities, Environmental justiceFP-045[Chemical exposures » Heavy metals]

Spatial distribution of arsenic in environmental
matrices and its relationship with the urinary
arsenic concentration in pregnant women from
Arica
María Pía Muñoz1, Paola Rubilar2, Marta Saavedra3, Gina Saavedra3, Ximena Cannobbio3, Verónica
Iglesias4
1Programa de Doctorado en Salud Pública, Escuela de Salud Pública, Facultad de Medicina,

Universidad de Chile, Santiago, Chile
2Centro de Epidemiología y Políticas de Salud Pública, Facultad de Medicina, Universidad delDesarrollo, Santiago, Chile
3Departamento de Salud Pública, Secretaría Regional Ministerial de Salud Arica y Parinacota, Arica,

Chile
4Programa de Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile,

Santiago, Chile

BACKGROUND AND AIM:The soils of Arica, northern Chile, contain arsenic of natural andanthropogenic origin. Here, we explore the relationship between the arsenic concentration in two
environmental matrices and the urinary arsenic concentration in pregnant women.
METHOD:Data analysis of 1,559 pregnant women from Arica city with urine arsenic concentration,
information on seafood intake, and drinking water supply sources between 2013 and 2016. For thesame years, information on urban drinking water samples' arsenic concentration (n=40) was obtained
through public reports from the local health authority. Information on soil arsenic concentration(n=394) was obtained from a study of the soil chemical quality in 2008 available on the web. RStudiosoftware was used to geocode and assign to each pregnant woman the arsenic concentration of bothmatrices according to the residence place (n=68 neighborhood units for soil; n=5 potable water
storage tanks). We estimated the proportion of urinary samples with an arsenic concentration above
the median according to the distribution of water storage tanks. Spearman's correlation was used toevaluate the relationship between urine and soil arsenic concentration.
RESULTS:The median urinary arsenic in pregnant women was 15 μg/L (IQR: 9.0–23 μg/L). After
adjusting for seafood intake and drinking water supply source, the proportion of women with urine
arsenic concentration above 15 μg/L was higher in those residing in sectors supplied by the Cerro
Chuño water storage tanks (arsenic-p95= 20 μg/L) compared to those who receive water with a lower
concentration (Prevalence ratio= 1.25; 95% CI 1.10, 1.41). Regarding soil arsenic concentration, we
accomplished not observe a correlation with the concentration of arsenic in the urine (rho= 0.08; pvalue 0.04).
CONCLUSIONS:This analysis reveals a higher arsenic concentration in the urine of pregnant women
residing in sectors with arsenic drinking water levels >10 μg/L. Continued monitoring is required.

Keywords: Exposures, Pregnancy outcomes, Spatial statistics, Water quality

FP-046[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Association between labor epidural analgesia
and autistic traits among Japanese children:
evidence from Hamamatsu Birth Cohort for
Mother and Child
Md. Shafiur Rahman1, Chieko Akinaga2, Akemi Okumura1, Tomoko Nishimura1, Kenji J Tsuchiya1
1Research Centre for Child Mental Development, Hamamatsu University School of Medicine,

Hamamatsu, Japan
2Hamamatsu University Hospital, Hamamatsu, JapanBACKGROUND AND AIM:Epidural analgesia is widely used for pain relief to women during labor,
particularly in developed countries. A previous study reported an increased risk of autism spectrum
disorder (ASD) among offspring associated with the administration of labor epidural analgesia (LEA),
while subsequent studies found no significant risk of ASD and thus the findings remain inconsistent.
Besides, whether administration of LEA is associated with autistic traits remain unknown. Therefore,
this study aimed to examine the association between LEA and autistic traits among children aged 8
years.
METHOD:This study included 810 children aged 8 years, who participated in the Hamamatsu Birth
Cohort for Mother and Child. The exposures were administration of epidural analgesia, and doses of
epidural analgesia including bupivacaine and ropivacaine. The Social Responsive Scale, Second Edition(SRS-2) was used to assess autistic traits among children at 8 years. SRS-2 total T-score, as well asT-scores for two sub-domains — restricted and repetitive behavior (RRB), and social communicationand interaction (SCI)— were calculated. Multivariate linear regression was used to estimate the βcoefficient and 95% confidence interval (CI) for the associations.
RESULTS:Out of 810 children, 51.2% were male and 50.5% were first born. Only 5% children were
exposed to LEA. Administration of LEA was not significantly associated with SRS-2 total T-score[β=0.83; 95% CI: -2.79 to 4.45], RRB score (-0.06; -3.42 to 3.29) and SCI score (0.99; -3.33 to5.30). After adjusting for child characteristics, paternal age, maternal prepregnancy and pregnancy
related covariates, the results remain materially the same. Higher dose of bupivacaine was associatedwith decreased total T-score (-1.22; -7.19 to 4.76), while higher dose of ropivacaine was associatedwith increased total T-score (3.18; -2.39 to 8.75), albeit these associations were not statisticallysignificant.
CONCLUSIONS:The present study suggest that LEA may not be associated with autistic traits among
Japanese children.

Keywords: autism spectrum disorder, autistic traits, epidural analgesia, epidural analgesia,
neurodevelopmental disorders

FP-047[Cancer and cancer-precursors » Incidence]

Association between polymorphisms of onecarbon metabolism genes and oral cancer risk
Ming Jang Su1, Shiang Fu Huang2, Ming Zhen Yu3, Chih Ching Yeh4
1Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City,

Taiwan2Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan

City, Taiwan
3School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
4School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan

BACKGROUND AND AIM:Head and Neck Cancers (HNCs) rank third among the top ten cancers for men
in Taiwan in 2020. It is well known that heavy smoking, alcohol abuse and betel quid chewing areassociated with the development of HNCs. Genetic polymorphisms involved in one-carbon metabolism(OCM) demonstrated the risk of alcohol-associated carcinogenesis, including HNCs. Previous studies
have reported that MTHFR C677T, MTHFR A1298C and MTR A2756G polymorphisms associated with
HNCs risk. However, the relationship between OCM polymorphisms and oral cancer risk in Taiwan isunclear. Therefore, we aimed to investigate the impact of OCM polymorphisms on the susceptibility oforal cancer patients.
METHOD:Oral cancer patients were recruited from the Head and Neck Surgery Department at Chang
Gung Memorial Hospital between 1999 to 2019. Controls participants were recruited from Taiwan
Biobank. SNP array analysis was processed on Axiom Genome-Wide TWB Array Plate and performedat the National Center for Genome Medicine, Academia Sinica, Taiwan.
RESULTS:This study included 496 oral cancer patients and 2302 healthy controls. Our analysis showeda statistically significant difference in education levels, occupation, alcohol drinking, cigarette smoking,betel nut chewing, tea, coffee, vegetarian and family history of oral cancer between cases andcontrols. In the MTHFR A1298C polymorphism, there was an increased risk of oral cancer in thedominant model (genotypes AC and CC vs. AA) (OR = 1.236, 95% CI = 1.015-1.505). However, after
adjusted for above mentioned significant variables, the significant association was disappeared (OR =1.047, 95% CI = 0.792-1.384). In addition, MTHFR C677T and MTR A2756G polymorphisms were notassociated with oral cancer risk.
CONCLUSIONS:Our results indicated no significant association
between MTHFR A1298C, MTHFR A1298C and MTR A2756G polymorphism with oral cancer risk.
Further evaluations for other OCM polymorphisms are recommended.

Keywords: oral cancer, one-carbon metabolism, gene polymorphisms

FP-048[Exposures » Other (to be specified with keywords in the keywords section)]

Problems experienced during caseinvestigations for children with elevated bloodlead reported to Health Protection Teams in
England, 2014-2021
Mona Dave1, Helen Crabbe2, Neelam Iqbal2, Araceli Busby3, Helen Bagnall4, Louise Coole1
1UK Field Epidemiology Training Programme
2Environmental Epidemiology Group - Radiation, Chemicals and Environmental Hazards (RCE)

Directorate, UK Health Security Agency
3North East and North Central London Health Protection Team and Chair of LEPHIS Working Group, UK

Health Security Agency
4Field Service Midlands, UK Health Security Agency

BACKGROUND AND AIM:Lead is a non-threshold contaminant with children being most vulnerable toits effects. In England, children (≤16 years) with elevated blood lead are notified via UK Health
Security Agency’s (UKHSA’s) Lead Exposure in Children Surveillance System (LEICSS) to regional
Health Protection Teams (HPTs) for case management in collaboration with other agencies. To date, adetailed review of the problems experienced during investigation has not been conducted. AIM:
Describe the problems experienced in the public health investigation and management of children withelevated blood lead reported to HPTs in England between 2014 and 2021.
METHOD:Data on problems experienced was collected using a lookback questionnaire with casemanagers and the following free-text question: “were there any specific problems or issues that arose
during the investigation and management of this case?”. Data were extracted from Select Survey anddeduplicated. A thematic analysis was conducted by applying codes to text and assigning to themes.
Multiple codes and therefore multiple themes could be assigned to one entry.
RESULTS:The completion rate for the lookback questionnaire was 74%. Overall, 241 were children
reported to HPTs for lead exposure and had a completed lookback questionnaire. A text entry to the‘problems experienced’ question was recorded for 123 records (51%) which generated 141 codes and9 themes. ‘Stakeholder engagement/response’ was the most common theme that emerged (38%)
with parent/guardian engagement most frequently cited, followed by ‘Roles and responsibilities’ (13%)
and ‘Needing additional resource’ (10%). Resources required included interpreters, expertise, andfunding. In order of frequency, the other themes that emerged were ‘Contacting stakeholders’,‘Source identification’, ‘Continuity’, ‘Safeguarding’, ‘Information errors’ and ‘Worry (parent/guardian)’.
CONCLUSIONS:Whilst multi-agency working is required for managing lead exposure cases in England,
increasing stakeholder engagement within the process through education and awareness-raising andhaving clearly defined roles and responsibilities, would support more efficient case management.

Keywords: lead (Pb) exposure, childhood, public health case management, problems

FP-049[Birth and pregnancy outcomes » Birth outcomes]

Maternal occupation and stillbirths in São Paulo,
Brazil – FetRisks study preliminary findings
Rafael Junqueira Buralli1, Lays Janaina Prazeres Marques2, Osmara Alves Viana1, Luciana Duzolina
Manfré Pastro1, Gerusa Maria Figueiredo1, Rossana Pulcineli Vieira Francisco3, Hillegonda Maria Dutilh
Novaes1, Marcia Furquim De Almeida2, Zilda Pereira Da Silva2, Mara Sandra Hoshida1, Gizelton
Pereira Alencar2, Nelson Gouveia1
1Department of Preventive Medicine, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo,

Brazil2Department of Epidemiology, School of Public Health, University of São Paulo (FSPUSP), São Paulo,

Brazil3Department of Gynecology and Obstetrics, Faculty of Medicine, University of São Paulo (FMUSP), SãoPaulo, Brazil

BACKGROUND AND AIM:Maternal occupation and work-related exposures may represent central risks
for pregnancy and childbirth outcomes, although are often overlooked. This study aimed to describe
preliminary findings of maternal occupational profile of stillbirths. Stillbirth is poorly studied and a
descriptive approach is of great interest.
METHOD:This ongoing hospital-based case-control study aims to evaluate the effect of environmental
pollution, maternal infections, access to health services, and other risk factors through interviews,
pregnancy records, biomarkers, and secondary data. Absolute and relative frequencies of the mother’smarital status, personal income, occupation, number of jobs, employment relationship, job physicalexertion, and transportation to work, as well as time worked during pregnancy, are presented.
RESULTS:The number of women included was 290. Most were married (72.1%), earned between 1-3
minimum wages (44.9%), or had no personal income (28.5%). Of these, 148 women (51.0%) worked
during pregnancy, while the rest were unemployed or housewife. Of those who worked, most had one
job (93.8%), a formal contract (56.4%), worked in a fixed place (86.3%), and went to work by public
transport (68.4%). About 30% worked more than 41 hours weekly during pregnancy, and 24.5%
declared to face physical exertion at work, especially heavy weight carrying or lifting, excessive
walking, squatting, or climbing stairs. Most frequent occupations were: service workers in hotels, andfood and beverage establishments; sales operators; cashiers; beauty and hygiene services; foodservice assistants; telemarketing operators; receptionists; and caregivers (range: 11.1% to 4.5% of
total).
CONCLUSIONS:Participants reported experiencing work-related risks during pregnancy, including longshifts, physical exertion, and physical and ergonomic hazards. Participants may be also exposed toother unrecognized risks, such as chemicals. Subsequent analyzes will include the comparison
between cases and controls, in order to estimate the effect of maternal occupation on the risk ofstillbirths in the studied population.

Keywords: Birth outcomes, Pregnancy outcomes, Occupational exposures, Children's environmental
healthFP-050[Chemical exposures » Mixtures]

Liver on Fire? Exposure to PFAS and PAHs in
Relation to Liver Function and Serum Lipids in
Firefighters (CELSPAC-FIREexpo study)
Nina Pálešová1, Léa Maitre2, Nikos Stratakis2, Katarína Řiháčková1, Aleš Pindur3, Jiří Kohoutek1, Petr
Šenk1, Martine Vrijheid2, Pavel Čupr1
1RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
2ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de

Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
3RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic; Faculty ofSports Studies, Masaryk University, Kamenice 753/5, Brno, Czech Republic; Training Centre of Fire
Rescue Service, General Directorate of Fire Rescue Service of the Czech Republic, Ministry of theInterior, Trnkova 85, Brno, Czech Republic

BACKGROUND AND AIM:Firefighting is associated with exposure to per- and polyfluoroalkyl
substances (PFAS) and polycyclic aromatic hydrocarbons (PAHs), which are suspected to affect the
cardiometabolic profile, including liver function and serum lipids. However, only a few studies haveinvestigated the impact of this specific exposure among firefighters. Our study aims to investigate theassociations between firefighters´ exposure to PFAS and PAHs and liver biomarkers and serum lipids.
METHOD:CELSPAC-FIREexpo study included professional firefighters (n=52), newly recruitedfirefighters in training (n=58), and controls (n=54). They provided exposure questionnaires and bloodand urine samples to assess their exposure to PFAS (6 compounds) and hydroxylated metabolites of
PAHs (OH-PAHs, 6 compounds), and to determine liver biomarkers (alanine aminotransferase (ALT),
gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alkaline phosphatase (ALP)and total bilirubin (BIL)) and serum lipids (total cholesterol (CHOL), low-density lipoprotein cholesterol(LDL) and triglycerides (TG)). The associations between exposure and biomarkers of liver function andserum lipids were investigated cross-sectionally using multiple linear regression (MLR) with false
discovery rate correction and Bayesian weighted quantile sum (BWQS) regression for the mixture ofcompounds. All models were adjusted for potential confounders.
RESULTS:A positive association between exposure to PFAS/OH-PAHs mixture and BIL (β=28.6%, 95%
CrI=14.6 – 45.7%) was observed in the BWQS model. When the study population was stratified, in
professional firefighters and controls the mixture showed a positive association with CHOL (β=29.5%,
CrI=10.3 – 53.6%) and LDL (β=26.7%, CrI=8.3 – 48.5%). No statistically significant associations
with individual compounds were detected using MLR.
CONCLUSIONS:Our results showed that higher exposure to PFAS/OH-PAH mixture is associated withchanges in biomarkers of cardiovascular diseases, which can result in an unfavourable cardiometabolic
profile, especially in occupationally exposed firefighters.
This project was funded by EU´s Horizon Europe (N°857340, N°857560, N°101057014), RECETOX
Research Infrastructure (N°LM2018121) and projects CETOCOEN EXCELLENCE(CZ.02.1.01/0.0/0.0/17_043/0009632) and CETOCOEN PLUS (CZ.02.1.01/0.0/0.0/15_003/0000469).

Keywords: Occupational exposures, PFAS, Cardiovascular diseases, Environmental epidemiology

FP-051[Built environment » Other (to be specified with keywords in the keywords section)]

Associations of Local Climate Zones withcardiovascular disease: findings from the USbased Nationwide Nurses’ Health Study from2000 to 2016
Pi I Debby Lin1, Meng Qi2, Steve Hankey2, Perry Hystad3, Wenwen Zhang4, Esra Suel5, Marcia
Pescador Jimenez6, Jamie Hart7, Eric B. Rimm8, Brent Coull9, Peter James10
1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care

Institute, Boston, MA, United States.
2School of Public and International Affairs, Virginia Tech, Blacksburg, VA, United States.
3College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
4Edward J. Bloustein School of Planning and Public Policy, Rutgers University, Brunswick, NJ, UnitedStates.
5The Bartlett Centre for Advanced Spatial Analysis, University College London, London, United

Kingdom.
6Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States.
7Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, UnitedStates.
8Department of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,

United States.
9Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
10Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care

Institute, Boston, MA, United States; Department of Environmental Health, Harvard T.H. Chan Schoolof Public Health, Boston, MA, United States.

BACKGROUND AND AIM:Over 80% of US population lives in urban areas, and the built environment
may influence cardiovascular diseases (CVD) by promoting physical activity and shaping exposure toenvironmental hazards. In 2012, the local climate zone (LCZ) scheme was introduced to characterizeand classify urban surface structures with consideration of micro-scale land cover (e.g. paved, lowplants, or water) and the associated physical properties. However, little is known how LCZ influences
CVD risk. Therefore, we explored the association between LCZ and CVD incidents using longitudinalcohort data.
METHOD:We followed 101,870 participants from the US-based Nurses’ Health Study from 2000 to
2016. We derived percentages of urban (compact highrise, compact midrise, compact lowrise, open
highrise, open midrise, open lowrise, large lowrise, sparsely built, heavy industry) and natural (dense
trees, scattered trees, bush or scrub, low plants, bare rock or paved, bare soil or sand, water) LCZs in
the 500m area around each residential address at biennual follow-ups. We modeled hazard ratios (HR)and 95% confidence intervals (95%CI) for fatal and nonfatal coronary heart disease (CHD), stroke,and combined CVD (CHD or stroke) by LCZ classes using time-varying Cox proportional hazards
models adjusting age, year, marital status, living-alone, occupational history, education level, smoking
history, race, and neighborhood social economic status.
RESULTS:We included 1,406,707 person-years, 3390 cases of CHD and 3636 stroke. We foundreduced risks of CVD and CHD among participants living in LCZs with higher proportion of water[HR=0.97 (95% CI: 0.95, 0.99) and HR=0.96 (0.92, 0.99), respectively, for each standard deviation
increment in the percent of LCZ-water] and elevated risks of stroke among participants living in LCZs
with higher proportions of low plants [HR=1.06 (1.03, 1.09)] and large lowrise [HR=1.03 (1.01,
1.06)].
CONCLUSIONS:Urban morphology may influence CVD risk; we will further explore these associations
considering physical activity as a mediator.

Keywords: Built environment, Local Climate Zone, Cardiovascular diseases, Environmental
epidemiology, Nurses' Health StudyFP-052[One health » Public health]Long-term quality-of-care score for predicting
the occurrence of heart failure in patients with
type 2 diabetes mellitus
Pi I Li1, Pi I Li2, How Ran Guo3, How Ran Guo4
1Department of Family Medicine, Chi Mei Medical Center
2Department of Pharmacy, Chia Nan University of Pharmacy and Science
3Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University
4Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital

BACKGROUND AND AIM:Heart failure (HF) remains a major cause of mortality, morbidity, and poor
quality of life, and diabetes mellitus (DM) is a known risk factor. To develop a long-term quality-ofcare score for predicting the occurrence of HF among patients with type 2 DM on the basis of the
hypothesis that good quality of care can reduce the risk of HF in patients with DM.
METHOD:Using Taiwan’s Longitudinal Cohort of Diabetes Patients Database and the medical charts ofa medical center, we identified incident patients diagnosed with type 2 DM from 1999 to 2003 andfollowed them until 2011. We constructed a summary quality-of-care score (with values ranging from0 to 8) with process indicators (frequencies of HbA1c and lipid profile testing and urine, foot andretinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure andHbA1c), and co-morbidity of hypertension. The associations between the score and the incidence of HF
were evaluated using Cox regression models.
RESULTS:A total of 4339 patients who had sufficient information to calculate the score were enrolled.
In comparison with participants who had scores ≤ 1, those with scores between 2 and 4 had a lower
risk of developing HF [adjusted hazard ratio (AHR) = 0.84; 95% confidence interval (95%CI): 0.661.07], and those with scores ≥ 5 had an even lower risk (AHR = 0.40; 95%CI: 0.23-0.72).
CONCLUSIONS:Management of diabetes can have an impact on clinical events in patients with HF.
Moreover, there is growing evidence suggesting that medications commonly used to treat diabetes
have the potential to decrease the occurrence of HF events. The quality-of-care score developed inthis study had a significant association with the risk of HF and thus can be applied to guiding the carefor these patients.

Keywords: quality-of-care score, heart failure, diabetes mellitus

FP-053[Outcomes » Cardiovascular diseases]

The association between indoor workplaceenvironment and heart rate variability in office
workers of an information service company
Ping Ju Hsieh1, Ta Chen Su2, Ta Chen Su3
1Department of Environmental and Occupational Medicine, National Taiwan University Hospital Yunlin

Branch, Yunlin, Taiwan
2Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

Taiwan3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Indoor air pollution is one of the greatest environmental risks to health.
Indoor air pollution–mediated systemic risk is still evolving and related to the morbidity and mortalityof various cardiovascular diseases.
METHOD:The employees of an information service company participated. Three stages healthassessments including questionnaires, heart rate variability analysis were performed from December
2019 to December 2020. Air quality monitoring devices were used to monitor air quality includingPM₂.₅, carbon dioxide, ambient temperature, and relative humidity. The apparent temperature wasused to indicate thermal comfort in workplace. The standard deviation of NN intervals, Root meansquare of the successive differences, total power, high frequency power, low frequency power areused as heart rate variability parameters. The generalized linear mixed model was used to evaluate
the association between air quality and heart rate variability.
RESULTS:Totally 1254 person-hours were used in model. After adjusting age, gender, BMI, personaldiseases, and habits, we found per IQR (12.13 μg/m³) increase in PM2.5 was positive associated withSDNN (β= 2.28 ms; 95%CI= 1.32 ~ 3.25), LF (28.29 ms²; 14.46 ~ 42.1) and TP (346.4 ms²; 183.1~ 510.1). However, per IQR (529.4 ppm) increase in carbon dioxide was negative associated withSDNN (-1.96 ms; -3.18 ~ -0.69), HF (-15.51 ms²; -29.62 ~ -0.85) and TP (-362.9 ms²; -569.4 ~ 145.9). In addition, a significant decrease in SDNN (-2.77 ms; -3.93 ~ -1.53), RMSSD (-1.16 ms; 2.03 ~ -0.23), LF (-26.7 ms²; -43.48 ~ -8.89), HF (-24.35 m²; -37.64 ~ -10.05) and TP (-471.6 ms²;
-661.8 ~ -260.4) were associated with per IQR (2.46°C ) increases in apparent temperature.
CONCLUSIONS:The study provided important evidence of decrease in HRV while working in an indoor
office environment with higher CO₂ concentration and apparent temperature. Our study verified thatair pollutants and thermal comfort are immediate environmental stressors.

Keywords: Built environment, Multi-pollutant, Temperature, Cardiovascular diseases

FP-054[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Microplastics and Autism: A plausible link
Ramel A Carlos
The Neurology Clinic, Tamuning, Guam 96913, USA

BACKGROUND AND AIM:An alarming 5-fold increase in the prevalence of Autism Spectrum Disorder(ASD) on the island of Guam from 2016 to 2022. This trend correlates with the environmental
exposure of humans, particular young children to the ubiquitous but toxic microplastics. The natureand magnitude of its impacts to developing nervous system are only beginning to be understood.
This study aims to fill the knowledge gap regarding the theoretical link of the potential neurotoxic
effects of environmental microplastics in the face of increasing prevalence of Autism on Guam byreviewing the current evidence in literature.
METHOD:Topic-focused reviews that examine the neurotoxic effects of microplastics as a potential risk
factor for development of autism was conducted to cover relevant articles in Pubmed from 2020-2023
using the combinations of this search words: Autism and Microplastics, Neurotoxicity andMicroplastics.
RESULTS:A total of 127 articles were analyzed. Only 3 articles addressed directly the link between
neurotoxicity of various microplastics on children and development of ASD symptoms. The author
reviewed 95 studies on the neurotoxic effects of microplastics on other species, including fish, mice,mollusks, nematodes, crustaceans and chicken. All studies have demonstrated neurotoxicity and mostcommon mechanisms reported include 1. induction of oxidative stress resulting to neuronal damage
and neuroinflammation, 2. inhibition of acetylcholinesterase activity, 3. altered neurotransmitterlevels, which all could lead to ASD like symptoms. Microplastics are taken up via ingestion andinhalation, which can reach systemic circulation and ultimately cross the blood brain barrier, where it
exerts its neurotoxic effects.
CONCLUSIONS:There is an increased trend of ASD on Guam, which parallel with the widespread
exposure of young children to microplastics, both of which require equal attention. There is much to
be understood about neurotoxic effects of microplastics to children’s developing brain and further
research is imperative to establish its potential linkage to ASD.

Keywords: Autism and Microplastics, Neurotoxicity and Microplastics

FP-055[Air pollution » Particulate matter]

The Need of Customized Air Quality index forEnvironmental Diseases
Se Hwa Hong1, Youhyun Park1, Dae Ryong Kang2
1Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
2Department of Precision Medicine & Biostatistics, Yonsei University Wonju College of Medicine,

Wonju, Korea

BACKGROUND AND AIM:The World Health Organization(WHO) provides recommendations for air
quality guideline levels. In Korea, the PM10 concentration standard is limited to 100㎍/㎥ per 24hours. But that does not mean it's suitable for general population. In particular, sensitive andvulnerable people may need more strict standards. This study aimed to identify the appropriate air
quality concentration for health management by environmental disease.
METHOD:This study used national population data from the National Health Insurance Service and Air
Korea data, which summarized air pollutant concentrations. The subjects were patients who werediagnosed as outpatients for environmental diseases from 2015 to 2019 and received emergency
department visits or hospitalizations after the first diagnosis. The cut-off point of PM10 for eachenvironmental disease that separates exacerbation was calculated through Maximal standardized logrank statistic. Hazard ratios were estimated for the two groups (below the cut-off point vs. above thecut-off point) using Cox proportional -hazards models.
RESULTS:The calculated cut-off points of PM10 were COPD 49, Asthma 50, Stroke 50, Arrhythmia andHeart Failure 50. The risk of exacerbation when classified based on the cut-off point for eachenvironmental disease is as follows(below the cut-off point vs. above the cut-off point). COPD:<49,
HR 0.50(95% CI 0.36-0.70); ≥49, HR 2.00(95% CI 1.42-2.81). Asthma:<50, 0.37(0.28-0.50); ≥50,
2.69(2.01-3.60). Stroke:<50, 0.48 (0.34-0.69); ≥50, 2.07(1.45-2.97). Arrhythmia and Heart
Failure:<50, 0.49( 0.31-0.77); ≥50, 2.06(1.30-3.26). The two groups divided based on the cut-off
point showed a statistically significant difference(log-rank P < 0.0001). As a result of sensitivity
analysis by vulnerable group, appropriate concentrations were different for each group.
CONCLUSIONS:The cut-off points calculated in this study indicate that the air quality index standards
designated by Korea are not suitable for particularly sensitive and vulnerable people. These results
suggest the need for a customized air quality index based on environmental diseases and individual
characteristics.

Keywords: Particulate matter, Air pollution, Long-term exposure, Big data

FP-056[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Paternal age and risk of epilepsy in theoffspring: A population-based multi-generationand sibling comparison study in Taiwan
Shi Heng Wang1, Mei-chen Lin1, Chi Shin Wu1, Pei Chun Chen2, Wesley K. Thompson3, Chun Chieh
Fan3
1National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin,

Taiwan2Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
3Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK,USA

BACKGROUND AND AIM:Whether paternal age associated with offspring’s epilepsy risk is a cause of denovo mutation as men age or just an association due to confounding factors is still unclear. We
examined whether there is an independent role of paternal age in increased risk of epilepsy inoffspring.
METHOD:A total cohort of 2,751,232 singletons born 2000-2017 was included in Taiwan;
819,371/826,087 with information on paternal/maternal grandparents were enrolled for multigeneration analyses; 1,748,382 with sibling(s) were selected for sibling-comparison. Incidence of
epilepsy was followed until 2020. Cox model was used to estimate the hazard ratio (HR) and 95%
confidence interval (CI).
RESULTS:In the total cohort, there was an increased risk of epilepsy in individuals with advanced
paternal age, e.g., the HR for paternal age ≥50= 1.36 (95% CI:1.15-1.61) compared with paternal
age 25–29, and fathers older than mothers, e.g., the HR for parental age difference ≥15= 1.29 (95%
CI:1.16–1.43). When accounting for parental age difference, advanced paternal age was not
associated with offspring’s epilepsy (HR for paternal age ≥50= 1.11, 95% CI:0.93-1.34). Multigeneration analyses showed that advanced grand-paternal age at childbirth of the parent was not
associated with offspring’s epilepsy. Sibling comparison analyses showed that younger siblings did nothave an increased risk of epilepsy.
CONCLUSIONS:These results do not support the hypothesis that de novo mutations associated withadvanced paternal age play a direct causal role in the etiology of epilepsy. Instead, familial factors
may explain the observed paternal age association with the offspring’s epilepsy risk.

Keywords: paternal age, de novo mutation, epilepsy, sibling comparison

FP-057[Neurologic and mental health outcomes » Mental health outcomes]

Living in Proximity to Petrochemical Industrial
Parks and Risk of Major Depression Disorder in
AdultsShih Chun Pan1, Wei Shan Chin2, Ching Chun Huang3, Yu Cheng Chen1, Chih Da Wu4, Chin Yu Hsu5,
Pinpin Lin1, Pau Chung Chen6, Yue Leon Guo7
1National Institute of Environmental Sciences, National Health Research Institutes, Miaoli, Taiwan
2School of Nursing, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei,

Taiwan3Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) andNTU Hospital, Taipei, Taiwan
4Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
5Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology,

New Taipei City, Taiwan
6National Institute of Environmental Sciences, National Health Research Institutes, Miaoli, Taiwan;

Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan
University, Taipei, Taiwan
7Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) andNTU Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of
Public Health, National Taiwan University, Taipei, Taiwan; National Institute of Environmental
Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Extensive investigation has suggested that exposure to environmental healththreats, such as polluting industrial activity, has harmful effects on mental health. Aim of present
study is using different surrogate indices of petrochemical industrial parks (PIPs) exposure to evaluate
the effect on the occurrence of major depressive disorder (MDD) in adults.
METHOD:We conducted a 1:1 sex and year of birth matching case-control study by using the Nation
Health Insurance Research Database (NHIRD). We included individuals without any catastrophic illness
or mental disorders, aged 20-65 years old, and living in the western part of the main island of Taiwan
as our target population. Those newly diagnosed as having MDD after 2006 as cases. Controls wereselected from those without any medical visits for mental disorders. The distance to the nearest PIPs,
probability of PIPs exposure, and benzene exposure level were used as surrogating PIPs exposure
indices. The conditional logistic regression was used to determine the odds ratios (ORs) and 95%
confidence intervals (CIs) of PIPs exposure indices and MDD.
RESULTS:In total, 252,477 MDD cases were newly diagnosed during 2006-2018. The results showedthat compared with those living in the farthest, living in proximity to PIPs were observed to have an
increased risk of MDD occurrence. Considering the prevailing wind direction, a higher probability of
PIPs exposure was also related to an increased risk of MDD. Higher benzene exposure levels having
higher risks of MDD were also found.
CONCLUSIONS:In the present study, we found that all of three surrogate PIPs exposure wasassociated with an increased risk of MDD. Living in proximity to PIPs might have adverse effects on
psychiatric health.

Keywords: Mental health outcomes, Environmental disparities, Environmental epidemiology

FP-058[Air pollution » Short-term exposure]

Association between changes in short-term air
pollution and circulatory and respiratory death
Tae Hwa Go1, Dae Ryong Kang1, Dae Ryong Kang2
1Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
2Department of Precision Medicine & Biostatistics, Yonsei University Wonju College of Medicine,

Wonju, Korea

BACKGROUND AND AIM:It is well established that short-term exposure to air pollution is associatedwith increased death from circulatory and respiratory diseases. However, most studies only consider
average air pollution concentrations and do not reflect fluctuations in air pollution concentrations overtime. Therefore, this study aims to confirm the association between short-term changes in air pollution
and death from circulatory and respiratory diseases.
METHOD:We analyzed the statistics of the cause of death in Korea in 2021, air pollution data from Air
Korea, and weather data from the Korea Meteorological Administration. Using the time-stratified casecontrol design, we selected the stratum as month and case and control as 1:2. Change groups were
estimated using trajectory analysis as air pollution data per hour. The association between air
pollution and circulatory and respiratory system deaths was confirmed through conditional logistic
regression.
RESULTS:As a result of the analysis, the risk of death from the circulatory and respiratory system washighest in the group with particulate matter≤10μm in diameter and particulate matter≤2.5μm in
diameter, and the risk of death was higher in the group with moderately increased concentrationcompared to the group with continuously low concentration. In particular, even if the average
concentration was low, the risk of death was high when the peak value was included among the daily
exposed air pollution concentrations. These results were the same in the vulnerable groups, such as
children, the elderly, and a group with a low level of education.
CONCLUSIONS:Most air pollution studies use average air pollution concentrations, but it is difficult toaccurately confirm the influence of extreme values in such cases. Reflecting the characteristics ofrepeatedly measured air pollution data, research on mortality due to air pollution changes is required.
In the future, it can also be extended through deep learning methods.

Keywords: short-term air pollution, circulatiory system death, respiratory systerm death, trajectroy

FP-059[Respiratory and allergic outcomes » Other (to be specified with keywords in the keywords section)]

Profile of High-Risk Silicosis Industries in
Taiwan---A Nationwide Analysis from 2004 to2020
Tingyao Su1, Jyuhnhsiarn Lukas Lee2, Yuying Chang2, Shunhui Chung3, Weite Wu4
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli

County, Taiwan; School of Public Health, National Defense Medical Center, Taipei City, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli

County, Taiwan
3Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, Taiwan
4National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli

County, Taiwan; Institute of Environmental and Occupational Health Sciences, National Yang Ming
Chiao Tung University, Taipei City, Taiwan

BACKGROUND AND AIM:Silicosis is a well-known non-neoplastic pulmonary fibrosis disease caused byexposure to crystalline silica in the workplace. This exposure can lead to severe and irreversible
cardio-pulmonary complications. Over the last decade, an increasing number of silicosis cases havebeen observed in the Taiwan Occupational Disease and Injury notification System (TODIS). Therefore,
there is an urgent need to identify the industries that are at risk for silicosis through evidence-based
medicine approaches, as well as to analyze the period of silicosis induction and the survival of silicosis
patients in Taiwan.
METHOD:To find silicosis cases from 2004 to 2020, this study combined the National Labor Insurance
Research Database (NLIRD) and National Health Insurance Research Database (NHIRD), which
covered more than 88.5% of workforce and 99.9% of citizens, respectively. We enrolled silicosis cases
who have been insured by the Labor Insurance for more than 6 months prior to receiving silicosis
compensation for labor insurance benefits or a diagnosis of silicosis (ICD10: J60 or ICD9: 502) wereenrolled in the analysis. The International Standard Industrial Classification of All Economic Activities(ISIC) was used in this study.
RESULTS:Based on the industry-specific incidence rates, we have identified 14 industries with highrisk for silicosis, including 5 emerging high-risk industries: (1) Materials Recovery, (2) Construction ofRoads and Railways, (3) Site Preparation, Foundation and Structure Construction, (4) LandscapeConstruction, and (5) Wholesale of Brick, Sand, Cement and Products. Among the 14 high-risk
industries, the age-standardized incidence increased from 10.0 per 100,000 persons in 2004 to 25.6 in2020 per 100,000 persons, based on the 2000 WHO World Standard Population.
CONCLUSIONS:We have observed an upward trend in silicosis cases and have identified emerging
industries with a risk of silicosis in Taiwan. Furthermore, additional field and epidemiological studies
are needed to examine these observation in detail.

Keywords: Silicosis, National Labor Insurance Research Database, National Health Insurance
Research Database.

FP-060[Birth and pregnancy outcomes » Pregnancy outcomes]

A Comprehensive Review on Social Inequalities
and Pregnancy Outcome-Identification of
Relevant Pathways and Mechanisms
Valentin Simoncic1, Séverine Deguen2, Christophe Enaux1, Stéphanie Vandentorren3, Wahida Kihal
Talantikite1
1LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100

Strasbourg, France
2Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population

Health Research Center, University of Bordeaux, 33076 Boedeaux, France
3Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population

Health Research Center, University of Bordeaux, 33076 Bordeaux, France;Santé Publique France,
French National Public Health Agency, 94410 Saint-Maurice, France.

BACKGROUND AND AIM:Scientific literature tends to support the idea that the pregnancy and healthstatus of fetuses and newborns can be affected by maternal, parental, and contextual characteristics.
In addition, a growing body of evidence reports that social determinants, measured at individual
and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies havefound social factors (including maternal age and education, marital status, pregnancy intention, andsocioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond
individual and contextual social characteristics, living environment and conditions (or "neighborhood")
emerge as important determinants in health inequalities, particularly for pregnant women.
METHOD:Using a comprehensive review, we present a conceptual framework based on the work ofboth the Commission on Social Determinants of Health and the World Health Organization (WHO),
aimed at describing the various pathways through which social characteristics can affect bothpregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic
and political context) that influence social position, as well as on intermediary determinants. We alsosuggest that social position may influence more specific intermediary health determinants; individuals
may, on the basis of their social position, experience differences in environmental exposure andvulnerability to health-compromising living conditions.
RESULTS:Our model highlights the fact that adverse birth outcomes, which inevitably lead to healthinequity, may, in turn, affect the individual social position.
CONCLUSIONS:In order to address both the inequalities that begin in utero and the disparities
observed at birth, it is important for interventions to target various unhealthy behaviors andpsychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery
availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

Keywords: birth outcomes, neighborhood, social determinants, social inequalities

FP-061[Birth and pregnancy outcomes » Pregnancy outcomes]

A Comprehensive Review on Social Inequalities
and Pregnancy Outcome-Identification of
Relevant Pathways and Mechanisms
Valentin Simoncic1, Séverine Deguen2, Christophe Enaux1, Wahida Kihal Talantikite1
1LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100

Strasbourg, France
2Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population

Health Research Center, University of Bordeaux, 33076 Boedeaux, France

BACKGROUND AND AIM:There is a growing number of international studies on the association
between ambient air pollution and adverse pregnancy outcomes, this study has been conductedfocusing to assess the variability of the critical windows of exposure of sensitivity of the fetus tonitrogen dioxide (NO2) and particular matter (PM), according to the socio-economic environment, andthe spatio-temporal practice of women of their territory during pregnancy.
METHOD:A bayesian distributed lag interaction model (BDLIM) has been performed on the association
between maternal exposure during pregnancy to nitrogen dioxide (NO2) or particular matter (PM) andthe risk of adverse birth outcomes, including low birth weight (LBW) and preterm birth (PTB), in
relation to their socio-economic environment and their weekly mobility. This approach will allow us torelate the different exposure combinations for each gestational period to the estimated adverse
pregnancy outcomes in our study area during our study period. These modeling approaches will be
implemented to identify the critical window of vulnerability during the gestational period whereenvironmental exposure is associated with an adverse pregnancy outcome.
RESULTS:The model set up will analyze in a first phase the exposure to the different pollutants NO2,
PM10, PM2.5 without taking into account the socio-economic profile and spatio-temporal practice ofthe pregnant women, then in a 2nd phase with taking into account these profiles during eachpregnancy trimester.
CONCLUSIONS:The main results suggest that increased air pollution exposure during the first and thethird trimester of pregnancy might contribute to adverse birth outcomes, especially LBW, especially forunfavorable socio-economic environments.

Keywords: birth outcomes, windows of exposure, spatio-temporal practice, social inequalities,
Bayesian distributed lag interaction models

FP-062[Exposures » Food/nutrition]

Risk assessment of plumbum for rice productsin Taiwan
Chung Jieh Wang1, Jong Yi Wang2, Wen Chao Ho1
1Department of Public Health, China Medical University, Taichung City, Taiwan
2Department of Health Services Administration, China Medical University, Taichung City, Taiwan

BACKGROUND AND AIM:It is an important issue about public health risk, such as heavy metal
pollution. Rice, one of the most common food ingredients in Taiwan snacks, may accumulate highlevels of plumbum within environmental pollution. According to the data from the International Agency
for Research on Cancer (IARC), plumbum compounds are carcinogenic to humans (Group 2A). This
study aims to focus on the risk assessment and exposure assessment of plumbum related to riceconsumption around 2005-2012 in Taiwan.
METHOD:The participants of our study were all age groups of the national representative survey. The
hazard quotient (HQ) and lifetime average daily dose (LADD) were calculated to evaluate the risk ofsystemic adverse effects of plumbum in rice (formula A and B). If the value of HQ was less than 1, itmeans it is within the acceptable range of dietary exposure. EF is exposure frequency. C was takenfrom HSU et.al 2010 (0.02ppm) and the reference dose (RfD) was taken from the Joint FAO/WHO
Expert Committee on Food Additives (JECFA). The average time (AT) and exposure duration (ED) were
set to 70 years. The values of consumption rate (CR) and body weight (BW) were obtained from
National Food Consumption Database in Taiwan.
HQ=LADD/Rfd (A)LADD= (C*CR*ED)/(BW*AT) (B)
RESULTS:The CR of >65 years old male has maximum consumption of rice (2635.53 grams). CR in
consumer only participant showed the highest was >65 year old male (mean ± SD: 524.31 ± 445.94
grams). The LADD of 6-12 year old male who had the maximum dose of rice (0.00138 mg/kg-day)
was in the acceptable range and HQ (0.055) was in the acceptable range.
CONCLUSIONS:The systemic risk of plumbum in rice as within the acceptable range, and the systemic
effect seemed to be within the acceptable exposure range. Further study is needed.

Keywords: Consumption database, Plumbum, Food risk assessment

FP-063[One health » COVID-19]

Dietary Supplement Use and Self-Reported
Symptoms among Adults Real-Time Chain
Polymerase Reaction (RT-PCR) Tested forCoronavirus 2019 (COVID-19)
Wendy N Nembhard1, Jenil R Patel2, Omobola O Oluwafemi2, Maria D Politis3, Igor Koturbash4
1Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
2Department of Epidemiology, Human Genetics, and Environmental Sciences, Dallas, USA
3Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New

York, USA
4Department of Environmental Health Sciences, University of Arkansas for Medical Sciences, Little

Rock, USABACKGROUND AND AIM:To date, no scientific evidence supports recommendations for dietary
supplement use to prevent or treat COVID-19. Moreover, US law prohibits the marketing of dietary
supplements as a treatment, prevention, or cure for any disease. However, sales of dietary
supplements promoted for immune health increased because of media/social media claims that theseproducts could confer protection against SARS-CoV-2 infection, or reduce disease or symptom severity
if infected. We investigated use of dietary supplements and reported symptoms by COVID-19 statususing population-based data.
METHOD:From March – August 2020, the University of Arkansas for Medical Sciences provided COVID19 testing to hospital patients and community members at clinics and, drive-thru or mobile sites
across Arkansas. Sociodemographic factors, COVID-19 symptoms, dietary supplement and medicationuse, and health information was collected at time of testing, and at days 7 and 14 post-testing.
Prevalence ratios (PRs) and 95% confidence intervals (CIs) for each symptom by supplement status
was calculated stratified by COVID-19 status using Poisson regression with robust variance estimation.
RESULTS:Out of 27,181 adults tested, 9.0% tested positive and 7.8% were using any supplement toprevent or treat COVID-19 at time of testing. Among supplement users 14.0% tested positive; but
among non-users only 8.7% tested positive. Those COVID-19 positive were more likely to report using
any supplement, Astragalus, multivitamins, Vitamin C, Zinc, Vitamin B/Complex/B12/B6, Elderberry,and Vitamin D than COVID-19 negative adults (PRs ranged from 1.33 to 2.58 and 95% CIs excluded1.00). No difference was observed in the PRs for self-reported symptoms at time of testing and day 7
post-testing between those who tested positive and those who tested negative.
CONCLUSIONS:Although COVID-19 positive adults were more likely to report taking dietary
supplements than those who tested negative the supplements did not appear to improve symptoms or
shorten time experiencing symptoms.

Keywords: COVID-19, food/nutrition

FP-064[Air pollution » Long-term exposure]

Socioeconomic and regional disparities in ofmortality burden long-term exposure to NO2
above the new WHO air quality guideline
Yang Zhao1, Mengcen Qian2, Chunlei Han2
1The George Institute for Global Health, University of New South Wales, Sydney, Australia
2School of Public Health and Management, Binzhou Medical University, Yantai, China

BACKGROUND AND AIM:It’s of high importance to quantify the spatial and socioeconomic variation ofmortality burden attributable to ambient nitrogen dioxide (NO2). This study aims to examine theregional and socioeconomic disparities in the mortality burden attributable to long-term exposure toambient NO2 in China.
METHOD:Regional and socioeconomic disparity in all-cause mortality burden among adult (age ≥16
years) attributable to the long-term exposure to ambient NO2 above the WHO new air quality
guideline (10 µg/m3annual mean) was estimated based on NO2 concentration and mortality data from231 Chinese cities from 2015 to 2019. Kruskal-Wallis H test was used to test the differences amonggroups. The mortality burden measurements included attributed fraction (AF), attributed deaths (AD),attributed mortality rate (AMR) and total value of statistical life lost (VSL).
RESULTS:The annual ambient NO2 concentration was 28.4 ug/m3 (standard deviation: 9.8 ug/m3) in
China from 2015 to 2019, which attributed to AF:19.2% [95% confidence interval (CI): 7.2, 29.3],
AD: 1356.3 thousand deaths (95% CI: 513.7, 2050.7), 115.5/105 (95% CI: 43.4, 176.0) AMR, andUS$958.2 billion lost. From 2015 to 2019, the ambient NO2annual concentration decreased from 28.6
ug/m3 to 26.5 ug/m3, leading to the AMR decreased from 118.7/105 (95% CI: 44.7, 180.5) to106.4/105 (95% CI: 39.6, 163.4). The cities of north region, and cities with high level of GDP per
capita (PGDP) suffered the highest mortality burden. The highest AD and economic loss were observedin the eastern region with high level of PGDP. Most of top ten cities of AF, AMR and VSL were with highlevel of urbanization.
CONCLUSIONS:There are significant regional and socioeconomic disparities in NO2 attributed mortality
burden across cities in China. This study can provide evidence for making effective mitigation policies
and local air pollution regulations for different regions in China.

Keywords: Regional disparity, long-term exposure, NO2, mortality burden

FP-065[Air pollution » Long-term exposure]

The association between air pollution exposure
and incident nonalcoholic fatty liver disease in a
Taiwan cohort
Yi Chuan Chen1, Wei Shan Chin2, Shih Chun Pan1, Chih Da Wu1, Chih Da Wu3, Yue Liang Leon Guo1,
Yue Liang Leon Guo4, Yue Liang Leon Guo5
1National Institute of Environmental Health Science, National Health Research Institutes, Miaoli

County, Taiwan
2School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
3Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
4Department of Environment and Occupational Medicine, College of Medicine, National Taiwan

University (NTU) and NTU Hospital, Taipei, Taiwan
5Graduate Institute of Environmental and Occupational Health Science, College of Public Health,National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Nonalcoholic fatty liver disease (NAFLD), strongly associated with obesity,
insulin resistance or type 2 diabetes mellitus, and dyslipidemia, exists among approximately one-thirdof general adult population. This study examined the association between long-term exposure toambient air pollution and the development of NAFLD.
METHOD:The participants were 43,153 who enrolled between 2007 and 2016 in MJ regular healthexaminations, and did not consume alcohol. The development of NAFLD was based on liver
ultrasonography, and medical history obtained from self-administered questionnaire. The exposurelevels to ambient air pollutants, including particulate matter with a ≤2.5-μm diameter (PM2.5),
nitrogen dioxide (NO2) and carbon monoxide (CO), were estimated based on participants’ residential
areas at a 50 × 50 m grid resolution by using a hybrid Kriging/land-use regression (LUR) model
executed using the XGBoost algorithm and a hybrid Kriging/LUR model, respectively. Logistic
regression with baseline covariates and average air pollution concentration during follow-up was
conducted, and smoothing splines were further performed to examine the linear association between
air pollution and NAFLD.
RESULTS:During the average follow-up period of 1.8 years, 13.6% of the participants developed
NAFLD without liver cirrhosis. After adjustments for potential covariates (e.g., age, sex, exercise, fried
food consumption, triglyceride, high-density lipoprotein cholesterol, low-density lipoproteincholesterol), NO2 and CO were found to be positively associated with the incidence of NAFLD, and CO
remained significant in the two-pollutant model. Logistic additive model with NAFLD development
against CO using smoothing spline while adjusting for the above covariates showed that CO waslinearly associated with NAFLD odds. The adjusted odds ratio of per 0.1 ppm increase in CO was 1.05
(95% confidence interval [CI] = 1.04, 1.06). The adjusted OR of per interquartile range (0.42—0.68ppm) was 1.14 (95% CI = 1.08, 1.20).
CONCLUSIONS:Our findings suggest that exposure to CO might be associated with the occurrence of
NAFLD.

Keywords: long-term exposure, particulate matter, oxides of nitrogen, carbon monoxide, fatty liverFP-066[Air pollution » Particle components]

Indoor air dust levels of polybrominateddiphenyl ethers and polybrominateddioxins/furans (PBDD/Fs) at the Southern
Taiwan Drug Administration
Yi Hung Lin1, How Ran Chao2
1Yi-Hung Lin
2How-Ran Chao

BACKGROUND AND AIM:PBDEs and PBDD/Fs are considered as emerging types of persistent organic
pollutants (POPs) that are highly toxic. Previous research has demonstrated that PBDEs can act as aprecursor to PBDD/Fs. A number of studies have shown that higher concentrations of PBDEs are foundin indoor air and dust compared to outdoor environments. In Taiwan households, the main routes ofhuman exposure to PBDEs and PBDD/Fs are through ingestion (via diet or dust) and inhalation (indoorair). However, there is limited literature available on exposure to PBDEs and PBDD/Fs in indoor
environments, particularly in pharmacies. While air conditioning systems are crucial to maintaining acontrolled environment for drugs and medicines in modern pharmacies in Taiwan, they also contributeto the accumulation of PBDEs and PBDD/Fs in the dust, medical equipment, and powders within
enclosed spaces.
METHOD:This study aims to investigate the concentrations of PBDEs and PBDD/Fs by collecting 10
dust samples from indoor pharmacies. The levels of PBDEs and PBDD/Fs will be analyzed using High
Resolution Gas Chromatography/High Resolution Mass Spectrometry (HRGC/HRMS).
RESULTS:In addition, the health risks associated with indoor environmental problems, environmental
risk assessment, and toxic effects from PBDEs and PBDD/Fs via indoor dust will be investigated. The
HQ value of BDE-209 in indoor dust was found to be 9.10×10-3, which is below the non-carcinogenic
risk threshold of 1.00, and the R value of BDE-209 is 4.46×10-8, which is also lower than the
carcinogenic risk threshold R=1×10-6.
CONCLUSIONS:The results suggest that the dust samples from pharmacies do not pose a clear noncarcinogenic or carcinogenic risk to the pharmacy staff.

Keywords: pharmacies, dust level, PBDE, PBDD/F, toxicity

FP-067[Air pollution » Particle components]

Polybrominated diphenyl ethers andpolybrominated dibenzo-p-dioxins/furans in
Taiwanese pharmacies
Yi Hung Lin1, How Ran Chao2
1Yi-Hung Lin
2How-Ran Chao

BACKGROUND AND AIM:Polybrominated diphenyl ethers (PBDEs) and polybrominated dibenzo-pdioxins/furans (PBDD/Fs) are considered as emerging compounds of persistent organic pollutants(POPs) that are highly toxic. Previous research has demonstrated that PBDEs can act as a precursor toform PBDD/Fs. A number of studies have shown that higher concentrations of PBDEs are found inindoor air and dust compared to outdoor environments.
METHOD:In Taiwan households, the main routes of human exposure to PBDEs and PBDD/Fs arethrough ingestion (via diet or dust) and inhalation (indoor air). However, there is limited literature
available on exposure to PBDEs and PBDD/Fs in indoor environments, particularly in pharmacies.
While air conditioning systems are crucial to maintaining a controlled environment for drugs andmedicines in modern pharmacies in Taiwan, they also contribute to the accumulation of PBDEs and
PBDD/Fs in the dust, medical equipment, and powders within enclosed spaces.
RESULTS:This study aims to investigate the concentrations of PBDEs and PBDD/Fs by collecting 20
dust samples from indoor pharmacies. The levels of PBDEs and PBDD/Fs will be analyzed using High
Resolution Gas Chromatography/High Resolution Mass Spectrometry. In addition, the risk
assessments associated with toxic effects from PBDEs and PBDD/Fs via indoor dust were investigated.
The HQ value of BDE-209 in indoor dust was found to be 9.10×10-3, which is below the noncarcinogenic risk threshold of 1.00, and the R value of BDE-209 is 4.46×10-8, which is also lower thanthe carcinogenic risk threshold R=1×10-6
CONCLUSIONS:The results suggest that the dust samples from pharmacies do not pose a clear noncarcinogenic or carcinogenic risk to the pharmacy staff.

Keywords: pharmacies, PBDE, PBDD/Fs, toxicity, risk healthFP-068[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Air Pollution Reduction and Brain Aging amongOlder Adults: a Community-Based Cohort study
in Taiwan
Ying Cen Lin1, Kang Chen Fan2, Chih Da Wu3, Wen Chi Pan4, Yi Fang Chuang5
1School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
2School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;

Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
3Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
4Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
5Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of

Psychiatry, Far Eastern Memorial Hospital, New Taipei, Taiwan

BACKGROUND AND AIM:Air pollution is recognized as a modifiable risk factor for dementia, and recent
evidence suggests that improving air quality could attenuate cognitive decline and reduce dementia
risk. However, studies have yet to explore the effects of improved air quality on brain structures. This
community-based cohort study examines the impact of air pollution reduction on cognitive functions
and structural brain differences among cognitively normal older adults in Taiwan.
METHOD:Four hundred and twenty cognitively normal older adults were from the Epidemiology of Mild
Cognitive Impairment study in Taiwan (EMCIT), a community-based cohort of adults aged 60 andolder in New Taipei City established in 2017. Annual concentrations of PM2.5, NO2, O3, and PM10 atparticipants’ residential addresses during the 10 years before enrollment were estimated using hybrid
kriging/land-use regression models. Each participant’s 10-year change (slope) in air pollutants wasestimated. At enrollment, participants received neuropsychological tests and brain magnetic resonanceimaging (MRI). The associations of 10-year air pollution change with cognitive functions and brain
structures were examined by linear regression models.
RESULTS:Overall, all pollutant concentrations, except O3, decreased over the 10-year period. A
greater reduction in PM2.5 was associated with better attention [b=-0.2, 95% CI: -0.38, -0.02], and agreater reduction in PM10 was associated with better attention [b=-0.22, 95% CI: -0.38, -0.08] andexecutive function [b=-0.24, 95% CI: -0.44, -0.04]. In addition, the diffusion tensor imaging analysis
revealed that a greater reduction in PM2.5 was significantly correlated with higher white matter
integrity in several white matter tracts, including anterior thalamic radiation, superior longitudinalfasciculus, inferior longitudinal fasciculus, corticospinal tract, and inferior fronto-occipital fasciculus.
CONCLUSIONS:Greater reduction in air pollution, particularly PM2.5, was associated with better
attention and attention-related white matter integrity. These results provide insight into themechanism underlying the relationship between air pollution, brain health, and cognitive aging amongolder adults.

Keywords: Air pollution, Particulate matter, Ozone, Oxides of nitrogen, Environmental epidemiology

FP-069[Birth and pregnancy outcomes » Birth outcomes]

Preterm birth and term low birth weightassociated with wildfire PM2.5: a cohort study
in New South Wales, Australia
Yiwen Zhang1, Tingting Ye1, Pei Yu1, Rongbin Xu1, Gongbo Chen1, Wenhua Yu1, Jiangning Song2,
Yuming Guo1, Shanshan Li1
1Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash

University, Melbourne, Australia
2Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash

University, Melbourne, Australia

BACKGROUND AND AIM:To evaluate the risk and burden of preterm birth/term low birth weightassociated with maternal exposure to wildfire PM2.5.
METHOD:330,884 birth records in 523 residential communities were obtained from the New South
Wales Australia during 2015−2019. Daily wildfire PM2.5 with a 0.25° × 0.25° resolution was
estimated by a machine learning technique combining 3-D chemical transport model. Cox proportional
hazards models were performed to evaluate the association between wildfire PM2.5 and preterm
birth/term low birth weight, from which attributable burdens were calculated respectively.
RESULTS:Overall, 24,034 preterm births and 7,160 term low birth weight cases were recorded,
dominating 7.3% and 2.2% of new-borns, respectively. Per one interquartile range rise in wildfire
PM2.5 was associated with 6.9% (HR: 1.069, 95% CI: 1.058–1.081) and 6.5% (HR: 1.065, 95% CI:
1.053–1.077) increased risks of preterm birth and term low birth weight, respectively. The mostsusceptible gestational window was the 2nd trimester for preterm birth whereas the 1st trimester forterm low birth weight. Additionally, 16.56% preterm births and 15.43% term low birth weight cases
were attributable to maternal exposure to wildfire PM2.5 during the full pregnancy. Male infants andmothers aged ≥ 40, experiencing temperature extremes, living in the inner region, or conceived
during spring had higher risks of preterm birth/term low birth weight associated with wildfire PM2.5.
Exposed to wildfire PM2.5, mothers with advanced age had a significant risk of preterm birth while
younger mothers were more inclined to deliver term new-borns with low birth weight. Furthermore,pregnancy-induced hypertension might enhance the risk of preterm birth associated with wildfire
PM2.5.
CONCLUSIONS:Robustly, the enhanced risk of preterm birth/term low birth weight was associatedwith maternal exposure to wildfire PM2.5. Given both higher frequency and stronger intensity of
wildfire occurrences globally, it is crucial to prioritize the health and welfare of pregnant women andinfants.

Keywords: wildfires, air pollution, environmental epidemiology

FP-070[Air pollution » Ozone]

Association of short-term exposure to ozone
with daily records of nasal and respiratory
symptoms in adolescents
Yoshiko Yoda1, Takeshi Ito2, Tomonari Masuzaki2, Junko Wakamatsu2, Masayuki Shima1
1Department of Public Health, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
2National Institute of Technology, Yuge College, Kamijima, JapanBACKGROUND AND AIM:Recently, ambient ozone concentration has increased in Japan. Many studies
have indicated the adverse effects of exposure to ozone on respiratory systems. However, the effectsof ozone exposure in daily life on healthy adolescents are not well known. We investigated theassociations of short-term exposure to ozone with daily records of nasal and respiratory symptoms inhealthy adolescents.
METHOD:A panel study was conducted from 10th May to 27th June 2022 among healthy adolescentsat a school in Yuge Island, in the Seto Island Sea, Japan. The indoor and outdoor ozone
concentrations were continuously measured. We calculated the indoor and outdoor ozone
concentrations of daily 1-hour maximum average, maximum 8-hour average, and 24-hour average.
Nasal and respiratory symptoms were recorded daily by each subject. Mixed effect models were used
to estimate the association between the ozone concentrations and daily symptoms.
RESULTS:The means±standard deviations of the daily average concentrations of outdoor and indoor
ozone were 45.4±20.1 and 44.4±20.4 ppb, respectively. The increase in outdoor daily 1-hourmaximum average ozone was associated with presence of rhinorrhea (odds ratio (OR): 1.02 [95%confidence interval (CI): 1.00 to 1.03] for an interquartile range (IQR) increase of 70 ppb). The IQR
increase (80 ppb) in indoor 1-hour maximum average ozone was associated with nasal obstruction(OR: 1.02 [95% CI: 1.00 to 1.04]). The indoor and outdoor 1-hour maximum average ozone
concentrations were also associated with cough. Alternatively, indoor and outdoor ozone
concentrations of daily maximum 8-hour average and 24-hour average were not significantly
associated with the any daily symptoms.
CONCLUSIONS:Our results suggest that short-term exposure to ozone in daily life may be associatedwith nasal and respiratory symptoms in healthy adolescents.
[Acknowledgements] This study was supported by JSPS KAKENHI grant number 21K10457.

Keywords: Ozone, Short-term exposure, Respiratory outcomesFP-071[Other » Other (to be specified with keywords in the keywords section)]

Real-time Feedback System for High Quality
Cardiopulmonary Resuscitation Training with the
AI Technology
Yu Tse Tsan1, Yu Wei Chan2, Chih Hung Chang3, Yan Heng Lin5, Han Hsuan Yang4, Yi En Chen4, Chih
Hsuan Su1, Cheng Fu Lin1, Yu Li Lin1, Che Yu Kuo1
1Division of Occupational Medicine, Department of Emergency Medicine Taichung Veterans General

Hospital Taichung, Taiwan; Occupational Injury Prevention and Rehabilitation Center, Taichung
Veterans General Hospital, Taichung City, Taiwan
2Department of Information Management Providence University Taichung, Taiwan
3Department of Computer Science and Communication Engineering Providence University Taichung,Taiwan4Everlink Occupational Medicine Clinic, Taichung City, Taiwan; Occupational Injury Prevention andRehabilitation Center, Taichung Veterans General Hospital, Taichung City, Taiwan
5Prospective Technology of Electrical Engineering and Computer Science National Chin-Yi University ofTechnology Taichung, Taiwan

BACKGROUND AND AIM:Cardiopulmonary resuscitation is a basic skill required by emergency andsevere units. To achieve effective first aid goals, precise training is required at ordinary times.
However, the results of the instructor's visual inspection often cannot allow the trainees to confirm
whether the goal of high-quality CPR training has been achieved. At present, although QCPR can
inform trainees of compression depth and speed, it is expensive and difficult to popularize. Therefore,
we use the AI edge computing module to effectively and instantly give back to the trainees'
compression quality.
METHOD:This project has successfully built (A) a standardized edge smart CPR system environment
through OpenPose human posture estimation technology. (B) Android version of the application (App).
First of all, the standardized edge smart CPR system has been built, which can judge and give realtime text and voice feedback to the trainee's posture, pressing depth, pressing frequency and pressing
position in the CPR teaching environment. In the future, we will continue to optimize the system andcomplete the Android version of the application.
RESULTS:Comparing the teacher's visual inspection with QCPR and AI real-time video feedback
system, the results show that the AI real-time video feedback system can effectively identify
compression depth, frequency, positioning, elbow angle, etc. Compared with the teacher's visualinspection, the accuracy is closer to QCPR (AUC 90%).
CONCLUSIONS:Using the AI image real-time feedback recognition system can effectively achieve thegoal of high-quality CPR training. and more widely accepted by trainees.

Keywords: Cardio-Pulmonary Resuscitation (CPR), Human Pose Estimation, Deep Learning,
Emergency Medicine, High-Quality CPR.

FP-072[Respiratory and allergic outcomes » Other (to be specified with keywords in the keywords section)]

ITIH4 involved in Hippo signaling pathwayregulated apoptosis on type 2 alveolar epithelial
cells of acute respiratory distress syndrome
Yu Xuan Shih, Hsiao Chi Chuang
School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

BACKGROUND AND AIM:Acute respiratory distress syndrome (ARDS) is a severe inflammatory lunginjury, characterized by diffuse alveolar damage and increased alveolar endothelial cell permeability.
Inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) is an anti-inflammatory protein. However, the roleof ITIH4 in the lungs and its underlying mechanisms remains unclear. This study aims to investigate
the role of ITIH4 in regulating apoptosis of type 2 alveolar epithelial cells via the Hippo signaling
pathway in ARDS.
METHOD:Alveolar epithelial cell type II (AECII) A549 cells were treated with different concentration of
ITIH4 (0, 10, 50, or 100 ng/mL) for 24 h. Next, cells were exposed to lipopolysaccharides (LPS) at 10
μg/mL for 6 hours, followed by adding ITIH4 (0, 10, 50, or 100 ng/mL) for 24 h. In addition, A549
cells were transfected with ITIH4 siRNA or DNA sequences. Expression of E-cadherin, β-catenin, ATM,
p53, SIRT1, Caspase-3, YAP, and TAZ were examined using Western Blot. The expression of YAP+ and
SPC+ cells in alveolar regions of LPS-induced ARDS mice was observed by immunofluorescencestaining.
RESULTS:We observed that the deficiency or overexpression of the ITIH4 gene could impact theactivity of downstream factors of the Hippo pathway, such as YAP and TAZ. Next, we found that ITIH4
increased the expression of E-cadherin, β-catenin, and SIRT1, reduced the expression of ATM andcaspase-3, and regulated YAP/TAZ pathway on A549 after LPS exposure (p<0.05). The
immunofluorescence staining results revealed that AECII cells in the damaged zone and severe zone
showed an upward trend in YAP expression compared to the undamaged area.
CONCLUSIONS:In summary, our findings provide evidence that ITIH4 involves in the Hippo signaling
pathway-regulated apoptosis on AECII of LPS-induced injury. This study offers a unique perspective on
the potential use of ITIH4 in future ARDS management.

Keywords: ARDS, ITIH4, Hippo pathway

FP-073[Air pollution » Traffic-related]

Effects of Long-Term Exposure to Air Pollutantson the Renal Function of Patients with Type 2
Diabetes
Yue Leon Guo1, Weishan Chin2, Yu Kang Chang3, Li Feng Huang4
1Environmental and Occupational Medicine, National Taiwan University and UTN Hospital, Institute ofEnvironmental and Occupational Health Sciences, NTU College of Public Health,
2School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
3Medical Research, Tung’s Taichung Metro Harbor Hospital, Taichung City, Taiwan
4Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan;

Department of Health Services Administration, China Medical University, Taichung; Family Medicine,
Min-Sheng General Hospital, Taoyuan; National Center for Geriatrics and Welfare Research, National
Health Research Institutes, Yunlin County, Taiwan Taiwan

BACKGROUND AND AIM:Patients with Type 2 Diabetes (T2D) often present with chronic kidneydisease (CKD). CKD development is associated with patients’ exposure to air pollutants. However, few
studies examined the effects of long-term exposure to air pollutants on the renal function of patientswith T2D. In this study, we investigated the effects air pollution exposure on renal function changes in
T2D participants.
METHOD:Between 2003 and 2005, we recruited 1,316 patients with T2D; the patients were followed
up until the end of 2012. Their baseline information regarding demographics, medical history, andbiomarker levels were obtained. Using the CKD epidemiology collaboration equations for Taiwanese
adults, we calculated the patients’ eGFRs on the basis of their blood reports (2006–2012).
Furthermore, we
obtained data regarding the monthly averages of various air pollutants, such as carbon monoxide,ozone, sulfur dioxide, nitrogen dioxide (NO2), and particulate matter (diameter of ≤2.5 μm) from 72
air-quality-monitoring stations. Applying the kriging method, we interpolated the aforementioned data
to the residential addresses of the participants. The possible correlation between air pollutants and thedecrease in patients’ eGFRs was investigated using a mixed-effects model with random intercepts.
RESULTS:This study included 989 patients (mean age, 58.8 years). The mean follow-up duration was
6.0 years with a total of 9,298 medical visits. After covariate adjustment, exposure to elevatedconcentrations of ambient NO2 was related to more rapid decrease in the eGFR of the patients with
T2D. Other significat factors for accelerated reduction o eGFR included duration of diabetes, andurinary albumin-to-creatinine ratio at the beginning of follow-up.
CONCLUSIONS:Long-term exposure to elevated NO2 levels may be related with decreased renal
function in patients with T2D. Our study serves as a reference for future studies aimed at improving
the quality of life of patients with diabetes who are exposed to air pollutants for prolonged periods.

Keywords: air pollution, NO2, traffic emission, renal function, diabetes

FP-074[One health » Public health]

Association between dry eye disease andintraocular pressure in adults: Korean National
Health and Nutrition Examination Survey 20102012 analysis
Yun Hee Choi1, Yoon Hyeong Choi1, Dong Hyun Kim2
1Department of Health and Safety Convergence Science, Korea University, Seoul, South Korea
2Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea

BACKGROUND AND AIM:Despite reporting mechanisms through which dry eye disease (DED) canpotentially affect intraocular pressure (IOP) in animal experiment studies, no epidemiological studies
have been conducted to confirm this association in large general populations. Therefore, this study
aimed to investigate the association between DED and IOP in the general adult population of South
Korea.
METHOD:This study analyzed 14,625 adults aged 19 and above who participated in the fifth Korea
National Health and Nutrition Examination Survey (KNHANES) (2010–2012). IOP was measured using
the Goldman applanation tonometry. As the correlation between the left and right eyes was very high(r=0.833), only the measurement values of the left eye were presented. We sequentially conducted
multiple linear and logistic regression analyses to investigate the association between DED and IOP as
well as high IOP (>21 mmHg) prevalence.
RESULTS:The prevalence of DED in Korean adults was found to be 8.7%, and the geometric mean of
IOP in the left eye was 13.7±1.0 mmHg. In the fully adjusted model, males with DED had significantly
lower IOP compared to males without DED (β (95% CI) = -0.074 (-0.124, -0.023)). In the overall
population, participants with DED had a significantly lower prevalence of high IOP compared toparticipants without DED (OR (95% CI) = 0.38 (0.15, 0.96)), and this trend was more pronounced inmales (OR (95% CI) = 0.15 (0.03, 0.74)).
CONCLUSIONS:The results of this study suggest that DED may affect IOP reduction among Koreanmales.

Keywords: dry eye disease, intraocular pressure, adults, KNHANES, epidemiology

FP-075[Exposures » Food/nutrition]

The association between sodium intake
assessed by 24-h urinary sodium excretion andnonalcoholic fatty liver disease in Koreans
Yun Jung Yang1, Jihye Lee2
1Department of Convergence Science, College of Medicine, Catholic Kwandong University International

St. Mary’s Hospital, Incheon 22711, Korea
2Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency,

Ulsan 44429, Korea

BACKGROUND AND AIM:High sodium intake was associated with the occurrence of NAFLD, theevidence is not yet sufficient. This study is to examine the association between sodium intake
assessed by 24-h urinary sodium excretion and the risk of NAFLD incidence.
METHOD:Using data from a Korean prospective cohort study, participants without urinary sodium
levels and with a history of NAFLD were excluded. Finally, this study included 2,782 adults (aged 4069 years. The total amount of sodium excretion in 24-h urine was estimated using Tanaka’s equations
from spot urine specimens. The participants were classified into three groups based on the levels of
estimated 24-h urinary excretion: lowest (T1), middle (T2), and highest (T3). In addition, to assess
the association of NAFLD occurrence, participants were classified into non-NAFLD (<30) and NAFLD(>36) groups based on the hepatic steatosis index.
RESULTS:During the 12-year follow-up period, NAFLD was occurred in 334 men and 725 women. In
crude analysis and multivariate analysis, the risk of NAFLD in women was significantly increased in T2
and T3 compared to T1 (OR 1.43, 95% CI 1.09-1.88; OR 1.68, 95% CI 1.29-2.20, respectively).
CONCLUSIONS:Therefore, the risk of NAFLD incidence gradually increased in women with the degreeof sodium intake. Individuals with high sodium intake showed properly counseled and monitored forrisk for NAFLD.

Keywords: nonalcoholic fatty liver disease, sodium intake, Korean Genome and Epidemiology studyFP-076[Exposures » Occupational exposures]

Artificial Stone Associated Silicosis in Taiwan: A
Systematic Review of Case Reports
Yu-Tai Hsiao1, Chun-Chi Lin2, Lih-Ming Yiin3, Hwan-Wun Liu2
1Department of Public Health, Tzu Chi University, Hualien, Taiwan; Department of Occupational

Medicine, Hualien Tzu-Chi Hospital, Hualien, Taiwan; Eastern Labor Health Service Center,
Occupational Safety and Health Administration, Ministry of Labor, Hualien, Taiwan
2Department of Occupational Medicine, Hualien Tzu-Chi Hospital, Hualien, Taiwan; Eastern Labor

Health Service Center, Occupational Safety and Health Administration, Ministry of Labor, Hualien,Taiwan3Department of Public Health, Tzu Chi University, Hualien, Taiwan

BACKGROUND AND AIM:Hundreds of silicosis cases associated with artificial stone manufacture andinstallation (commonly used for kitchen and bathroom countertops) have been reported globally forthe past ten years. These workers were found to have less exposure latency and a younger onset age
than miners or masons with silicosis; thus, the potential years of life lost was greater. Since thedetails of the industry in Taiwan are yet to be surveyed, we aim to review all domestic case reports
systematically and summarize demographic characteristics.
METHOD:Databases with PubMed, Medline, EMBASE, Google Scholar, and Airiti Library were searched
for studies published up to June 30th, 2023. Searching terms with “artificial stone or engineeredstone,” “silicosis,” and “Taiwan” were applied via English and Chinese. An additional conference paperwith two cases presented by the authors in April 2023 was added for the purpose of including all
known cases in Taiwan.
RESULTS:Six case reports were reviewed; two of them presented different courses of the disease fromthe same case. All cases were male, whose mean age when diagnosed was 36 (ranging from 30 to43), and their mean exposure years to silica dust were 6.8 (ranging from 4.5 to 9). Two cases were
foreign workers, while the others’ ethnicity was not disclosed. On the date of each publication orpresentation, three cases underwent lung transplantation, and one of them eventually died. Anothercase also died before the lung transplantation.
CONCLUSIONS:The mean age is younger and the mean exposure years are lower in Taiwan than inmost of the studies reported abroad; this may help identify similar exposure groups in Taiwan.
Further, workplace monitoring and health surveillance for the artificial stone industry are important
issues for occupational medicine and public health practitioners.

Keywords: respiratory and allergic outcomes, respiratory outcomes, occupational epidemiology

FP-077[Cancer and cancer-precursors » Incidence]

The novel terminology "discernible" undiscerned
Conclusions: A Critical Review of UNSCEAR
2020/21 Fukushima Report 2
Yutaka Hamaoka
Keio University

BACKGROUND AND AIM:On March 2022, UNSCEAR released the updated Fukushima Report. This
study examines the UNSCEAR 2020/21 Report from viewpoints of (1) risk communication, (2) qualityof literature review, and (3) consistency between analysis and description in the Report.
METHOD:A critical review of the UNSCEAR Fukushima report 2013, 2020/2021 and their Attachments
was conducted.
RESULTS:(1) The Report introduced the novel terminology “discernible” which is equivalent tostatistically enough power to detect. However, UNSCEAR's news releases and briefings do not explain
the meaning of “discernible, ” leading reporters and the general public to misinterpret "no discernible"
is "no risk." That is a serious failure in risk communication. (2) For thyroid cancers identified in
Fukushima Ultrasound Examination (TUE), the Report concludes “the excess (nip) a result of theapplication of highly sensitive ultrasound screening procedures (para. 246).” Because compared to
Chernoby where a significant increase was observed among children under 5 years after 4 years of theaccident, in Fukushima, a large part of thyroid cancer was detected in adolescents within three years.
The report missed difference in protocol of TUE in Chernobyl and Fukushima, in Chernobyl, TUE
started in the 1990s or after 4 years of the accident. On the contrary, TUE started after six month ofaccident. (3) For solid cancer (excluding melanoma and thyroid cancer), UNSCEAR's power analysis in
the Attachment A-23 indicated a lifetime increase likely to be detectable (LFR is 1.2% for 10 yrs girls
subpopulation with a statistical power of 0.80). On the contrary, the report describes, “the levels of
exposure of members of the public have been too low for the Committee to expect distinctive
increases in the incidence of breast cancer or other solid cancers (para.247 ).”CONCLUSIONS:A Critical review revealed serious problems in the UNSCEAR2020/21 Fukushima
Report. The Report must be corrected or updated accordingly.

Keywords: Thyroid cancer, radiation epidemiology, Fukushima nuclear disaster, UNSCEAR

FP-079[Exposures » Other (to be specified with keywords in the keywords section)]

Indoor Pollution Emission Characteristics of Air
Fryer and the Influence of PM2.5 Toxicity on The
Development of Caenorhabditis Elegans
Zhan Yu Huang1, How Ran Chao1, Yi Ming Kuo2
1Department of Environmental Science and Engineering, National Pingtung University of Science andTechnology, Neipu, Pingtung 91201, Taiwan
2Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical

Technology, Yongkang, Tainan 71703, Taiwan

BACKGROUND AND AIM:The purpose of this study was to examine the emission characteristics ofindoor air pollution caused by air fryers and their potential effects on human health, specifically the
impact of PM2.5.
METHOD:To achieve this, we utilized Caenorhabditis elegans (C. elegans) as an animal model due toits genetic similarity to humans. We established an in vivo model and conducted toxicity exposure
tests to evaluate lethality, reproductive toxicity, locomotor behavior, body length, and lifespan.
Analysis of body length and lifespan was used to determine the five major outcomes.
RESULTS:A statistical analysis revealed that the concentration of PM2.5 did not prove to be fatal for C.
elegans. However, there was a locomotor behaviour effect that was noticed at a dosage of 7.5 x 10-3
g/L and was significantly different from the control group. At higher concentrations of 7.5 x 10-2 μg/L
and 7.5 x 10-1 μg/L, the negative impact on the body length, locomotor behavior, and reproductive
toxicity of C. elegans was noticeable. In particular, the locomotor system of C. elegans was affected,
causing a significant reduction in locomotor behavior, body length, and reproductive capacity whencompared to the control group.
CONCLUSIONS:The air fryer generated PM2.5 at toxic concentrations can impede the development of
C. elegans and studying the organism's other physiological characteristics can provide valuable
insights for diverse research applications.

Keywords: Air fryer, Indoor air pollutants, PM2.5, C. elegans

FP-080[One health » Public health]Derivation of sex and age-specific reference
intervals for clinical chemistry analytes inhealthy Ghanaian adults
Abigail Serwaa Akoto Bawua1, Kiyoshi Ichihara2, Rosemary Keatley3, John Arko Mensah1, Patrick F.
Ayeh Kumi4, Rajiv Erasmus5, Julius Fobil1
1Department of Biological, Environmental & Occupational Health Sciences, University of Ghana Schoolof Public Health, Accra, Ghana
2Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University

Graduate School of Medicine, Ube, Japan
3Medlab Ghana Ltd., Roman Ridge, Accra, Ghana
4Department of Microbiology, University of Ghana Medical School, College of Health Sciences,

University of Ghana, Korle-Bu, Ghana
5University of Stellenbosch, Division of Chemical Pathology, Tygerberg, Cape Town, South Africa

BACKGROUND AND AIM:Clinical laboratory reference intervals (RI) are supposed to be established andverified in every country. However, few countries carry out their own RI studies due to challenges andcost involved. Ghana diagnostic laboratories rely on reference intervals provided by the manufacturersof in vitro diagnostic instruments. These RIs may have been derived from a population with different
characteristics which might not be appropriate. Hence this study aimed at establishing RIs of 40
chemistry and immunochemistry analytes for Ghanaian adults based on IFCC Committee on Reference
Intervals and Decision Limits (C-RIDL) protocol.
METHOD:A total of 501 healthy volunteers aged ≥18 years were recruited from the northern andsouthern regions of Ghana. Blood samples were analyzed with Beckman-Coulter AU480 and CentaurXP/Siemen auto-analyzers. Sources of variations of reference values (RVs) were evaluated by multiple
regression analysis (MRA). The need for partitioning RVs by sex and age was guided by the SD ratio(SDR). The RI for each analyte was derived using parametric method with application of the latent
abnormal values exclusion (LAVE) method.
RESULTS:Using SDR≥0.4 as threshold, RVs were partitioned by sex for most enzymes, creatinine, uricacid, bilirubin, immunoglobulin-M. MRA revealed age and body mass index (BMI) as major source ofvariations of many analytes. LAVE lowered the upper limits of RIs for alanine/aspartate
aminotransferase, γ-glutamyl transaminase and lipids. Exclusion of individuals with BMI≥30 further
lowered the RIs for lipids and CRP. After standardization based on value-assigned serum panel
provided by C-RIDL, Ghanaian RIs were found higher for creatine kinase, amylase, and lower foralbumin and urea compared to other collaborating countries.
CONCLUSIONS:The LAVE effect on many clinical chemistry RIs supports the need for the secondary
exclusion for reliable derivation of RIs. The differences in Ghanaian RIs compared to other countries
underscore the importance of country specific-RIs for improved clinical decision making.

Keywords: Clinical diagnosis, Reference interval, Clinical parameters,between-country differences;bias ratio; latent abnormal values exclusion method

FP-081[Cancer and cancer-precursors » Incidence]

Ambient arsenic concentration is associatedwith hepatocellular carcinoma incidece anddifferential effects exist among race/ethnicity
and sex groups
Abiodun O Oluyomi1, Omar Rosales3, Adegboyega Olayode4, Aaron P Thrift2, Hemant K Roy2, Hashem
El Serag5
1Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Gulf Coast Center for

Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA; Dan L Duncan
Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
2Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Dan L Duncan

Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
3Department of Medicine, Baylor College of Medicine, Houston, TX, USA
4Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
5Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Dan L Duncan

Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA; Clinical Epidemiology
and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E.
DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX

BACKGROUND AND AIM:Primary liver cancer has the sixth highest incidence and fourth highest cancer
mortality worldwide. In the United States, liver cancer incidence has more than tripled between 1975
to 2017 and mortality has also increased in the same time frame. Exposure to toxins or chemical
pollutants account for significant liver disease burden globally. Arsenic is known to accumulate in theliver, and several mechanisms of carcinogenesis have been proposed, however, the evidence inhuman populations is limited. A better understanding of the role of chemical risk factors in HCC isrequired. We assessed the association between ambient arsenic concentration and HCC in Texas—thestate with the highest rates of HCC in the US.
METHOD:The outcome measure is HCC incidence based on Texas Cancer Registry (TCR). Primary
exposure is census tract (neighborhood) estimate of Arsenic inhalation exposure concentrations asreported in the 2011 National Air Toxics Assessment (NATA) inventory. We measured and adjusted
the main analyses for several individual-derived and neighbood-derived characteristics. We createdseparate study subgroups based on the patients’ race/ethnicity and sex. We assessed the association
between Arsenic and HCC separately for the subgroups using the negative binomial Poisson regression(NBR) model.
RESULTS:Texas has 5,265 census tracts and TCR reported 18,235 new ≥20 years old HCC diagnoses
between 2007-2015. In our assessment of the relationship between neighborhood-level Arsenic
exposure air concentration and HCC in Texas, we observed significant differences along racial-ethnic
and sex groups while accounting for covariates. Independent association between Arsenic and HCC
was largely more evident among men versus women, and also more eviden in Not Hispanic Black,followed by NH White subgroups versus Hispanics.
CONCLUSIONS:Our finding suggests a potential inhalation pathway for Arsenic-HCC association,

though its ecological nature precludes the interpretation of a causal link. This ecological finding should
be further examined in direct association studies

Keywords: Chemical exposures, Cancer and cancer precursors, Environmental disparities,
Environmental epidemiology

FP-082[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Mixture effects of particle components on
Parkinson's disease in adults ages 40+ in the
United States from 2000 to 2016
Bryan N Vu1, Heresh Amini2, Xinye Qiu1, Yijing Feng3, Yaguang Wei1, Joel Schwartz1
1Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
2Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:More and more studies are documenting that air pollutants such as PM2.5
and ozone may have adverse effects on neurological disorders. However, few studies haveinvestigated the long-term exposure of particle components in conjunction with nitrogen dioxide andozone to assess their mixture effects on Parkinson’s disease. We aim to utilize weighted quantile sum
regression to assess the cumulative effects of five major particle components including organic carbon(OC), elemental carbon (EC), nitrate, sulfate, and ammonium, along with nitrogen dioxide and ozone,
on counts of inpatient Parkinson’s hospitalizations for adults ages 40 years and up.
METHOD:Inpatient records for Parkinson’s hospitalizations were collected from the State Inpatient
Databases which included hospitals from 12 U.S. states ranging in years from 2000 through 2016. Wealso included temperature from Daymet and variables from the U.S. census to control for socioeconomic status. All variables were aggregated to the annual level.
RESULTS:We observed an increase of 7.2% (95%CI: 6.4%,8.1%) in the number of Parkinson’s
inpatient hospitalizations each year for each decile increase of the pollutant mixture in adults ages 40
years and up. Ozone contributed the most weight to the pollutant mixture while the other 6 pollutants
carried the same relatively small weights.
CONCLUSIONS:Our results emphasize the significance of the effects of ozone on Parkinson’s disease
while also contributing to the growing body of literature on neurological disorders.

Keywords: Parkinson’s Disease, PM Components, Ozone, WQS

FP-083[Cancer and cancer-precursors » Incidence]

The relation between air pollution exposure andbreast cancer risk: a case-control study in
TaiwanChen Lee1, Wen Hung Kuo2, Chi Chang Ho1, Szu Yi Li3, Ming Yang Wang2, Ming Yang Wang4, Yen
Shen Lu3, Yen Shen Lu5, Ching Hung Lin3, Ching Hung Lin5, Ching Hung Lin6, Pau Chung Chen1, Pau
Chung Chen7, Pau Chung Chen8, Pau Chung Chen9
1Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
2Departments of Surgery, National Taiwan University Hospital, Taipei, Taiwan
3Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
4Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
5Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
6Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
7National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan8Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
9Department of Environmental and Occupational Medicine, National Taiwan University Hospital andNational Taiwan University College of Medicine, Taipei, Taiwan

BACKGROUND AND AIM:Breast cancer is the most common cancer worldwide, has surpassed lungcancer from 2018 to 2020, and Taiwan has a similar pattern. Many epidemiologic studies indicatedthat occurrence of female breast cancer might associate with body mass index (BMI), age of menarche
and menopause, pregnant and breastfeeding experience, family history, and past history. However,
the relation to environment exposure and breast cancer has been strongly suspected the major risk
factor. This study aims to investigate whether air pollution exposure and breast cancer risk areassociated.
METHOD:We had been conducted a case-control study in National Taiwan University Hospital (NTUH)
from October 2010. The participants included female volunteers with no history of malignancy orbreast disease (defined as healthy volunteers), biopsy-proven benign breast disease, or breast cancer
patients. At enrollment, the participants provided a fasting blood sample, urine sample, and completed
an assisted questionnaire. To reduce treatment-related bias, blood samples were collected before anytreatment for breast cancer was initiated. Blood samples were centrifuged immediately aftercollection, and the plasma samples were stored at 80C. The questionnaire included questions on therisk factors for breast cancer, including age, parity, breastfeeding history, BMI, smoking and drinking
habits, menopause status, education level, and family history of breast or ovarian cancer.
RESULTS:We enrolled 257 breast cancer patients as case group and 228 healthy volunteers as control
group. Air pollution included particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone,
the exposure period was estimated from 2000 to 2020.
CONCLUSIONS:We calculated odds ratios (OR) and 95% confidence intervals (CI) by conditional
logistic regression with adjustment for marital status, educational level, occupational status, personal
income, medication and area-level socio-economic indicators.

Keywords: air pollution, Breast cancer

FP-084[Cancer and cancer-precursors » Incidence]

Assessing the Relationship Between Persistent
Organic Pollutants in Adipose Tissue andFemale Breast Cancer Risk in Taiwan: A
Prioritization Study
Meng Shan Tsai1, Wen Hung Kuo2, Chi Jen Chen3, Szu Yi Li4, Yung Chun Chang5, Ming Yang Wang2,
Yen Shen Lu6, Shu Li Wang7, Ching Hung Lin8, Pau Chung Chen9
1Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
2Departments of Surgery, National Taiwan University Hospital, Taipei, Taiwan
3Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public

Health, Taipei, Taiwan
4Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
5Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan; Clinical Big Data

Research Center, Taipei Medical University Hospital, Taipei, Taiwan
6Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal

Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
7National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan; Department of Public Health, National Defense Medical Center, Taipei, Taiwan; Department of
Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan
8Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal

Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical
Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
9Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; National Institute of Environmental Health Sciences, National HealthResearch Institutes, Miaoli, Taiwan; Department of Public Health, National Taiwan University Collegeof Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

BACKGROUND AND AIM:This study aimed to explore the relationship between a mixture of persistentorganic pollutants (POPs), including polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinateddibenzofurans (PCDFs), polychlorinated biphenyls (PCBs), and various pesticides, and breast cancer(BC) risk in Taiwanese women.
METHOD:A case-control study was conducted with 73 BC patients and 27 women with biopsy-provenbenign breast disease. The participants completed a questionnaire and provided blood samples.
Adipose tissue samples were analyzed for the presence of POPs, and random forest machine learning
methods were used to predict BC risk.
RESULTS:The results showed that the concentrations of certain PCDDs, PCDFs, and PCBs weresignificantly higher in BC patients compared to controls. The most important POPs related to BC were
1,2,3,4,7,8,9-HeptaCDF, 1,2,3,7,8-PentaCDF, and 4,4'-DDD. After adjusting for covariates, 1,2,3,7,8PentaCDF, 1,2,3,4,7,8,9-HeptaCDF, and 1,2,3,7,8,9-HexaCDF were the top three most importantcomponents related to BC.
CONCLUSIONS:The study highlights the importance of considering mixtures of chemicals inunderstanding the relationship between POPs and BC risk. This information could then be used to
inform public health policies and interventions aimed at reducing the risk of breast cancer associatedwith POP exposure.

Keywords: breast cancer, persistent organic pollutants, random forest machine learning, Taiwan

FP-085[Air pollution » Short-term exposure]

Assessment of indoor air pollutants exposure of
the commuters on the platform in Taipei mass
rapid transit
Chi Yun Chu, Chin Sheng Tang, Zhi Han Lee
Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City,Taiwan

BACKGROUND AND AIM:More than 3 million passengers take Taipei mass rapid transit (MRT) systemevery work day. There is a growing concern about the air quality because of the potential effects topassengers’ health. This study aimed to investigate the impact of various environmental factors onindoor air pollutants(IAPs) exposure on the platform in MRT stations and rank their importance on theeffects of IAP levels.
METHOD:This study investigated the IAPs on the platform, including particulate matter (PM10, PM2.5,
PM1), polycyclic aromatic hydrocarbons(PAHs), volatile organic compounds (VOCs), carbon monoxide(CO) and carbon dioxide (CO2) in ten MRT stations with varying platform (underground, ground-level,
elevated), station designs (side, island, stacked island), and platform screen door (PSD) types (fullcoverage, half coverage, no coverage).
Random Forest analysis were used to evaluate the impact of environmental factors on IAPs, including
outdoor air quality, weather conditions, temperature, relative humidity (RH), rush hours, andentry/exit gates. Marginal effect plots were used to assess each variable's influence on IAPs.
RESULTS:Results showed that all IAP levels on the platform met the stipulated standards as regulated
by Taiwan’s Indoor Air Quality Management Act, with higher IAP concentrations during morning rush
hours than afternoon rush hours. The underground IAP concentrations were higher than the groundlevel and elevated stations IAP concentrations.
Temperature was positively correlated with CO2 concentrations, while RH (60-80%) was negatively
correlated with CO2 concentrations in marginal effect plots. The importance ranking revealed thattemperature, RH, station design and waiting location dominated IAP concentrations mostly.
CONCLUSIONS:Optimizing the ventilation systems could assure the indoor air quality in MRT stations
during rush hours. Thermal conditions, station design, CO2, and waiting location are the observableparameters to alert the IAPs exposure.

Keywords: Particulate matter, Exposure assessment, Traffic-related

FP-086[Outcomes » Cardiovascular diseases]

Comparison of Risks of Major Adverse
Cardiovascular Events and Mortality in patientswith Deep Vein Thrombosis and Pulmonary
Embolism
Chia Ming Chang1, Pau Chung Chen2, Ming Shun Hsieh3
1Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan; Depatrment of Emergency Medicine, College of Medicine, National Yang Ming Chiao
Tung University, Taipei, Taiwan;
2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; National Institute of Environmental Health Sciences, National HealthResearch Institutes, Miaoli, TaiwanDepartment of Environmental and Occupational Medicine, National
Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan;
3Department of Emergency Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan,

Taiwan; Depatrment of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung
University, Taipei, Taiwan

BACKGROUND AND AIM:This study aimed to evaluate the subsequent major adverse cardiovascular
events (MACEs) and mortality after patients with a new diagnosis of deep vein thrombosis (DVT) or
pulmonary embolism (PE).
METHOD:We conducted a nationwide, population-based, frequency-matching cohort study using
Taiwan’s National Health Insurance Research Database. The study cohort comprised 693 newly
diagnosed DVT patients (without PE) or PE patients (without DVT) who were frequency-matching byage, sex, urban, and index year without a diagnosis of DVT and PE in the comparison cohort. We
evaluate the subsequent major adverse cardiovascular events and mortality. Each patient case wasfollowed from 2000 to 2012. We constructed a Cox proportional hazard model and plotted KaplanMeier curves to evaluate the association between DVT, PE, MACEs, and mortality.
RESULTS:We identified 75, 67, and 51 MACEs cases in the study (DVT, PE) and comparison cohorts
during the mean follow-up period of 5.78, 5.06, and 7.18 years, respectively. After adjusting forpotential confounders, the adjusted hazard ratio (HR) for DVT was 1.48 (95% confidence interval [CI]1.01–2.16) and PE was 1.44 (95% [CI] 0.97–2.14). The mortality cases were 106, 121, and 28 in the
study (DVT, PE) and comparison cohorts, respectively. The adjusted HR for DVT was 2.91 (95% [CI]1.88– 4.5) and PE was 4.29 (95% [CI] 2.8–6.58). The survival analysis curve demonstrated both DVTor PE had an impact on the deaths.
CONCLUSIONS:Patients with DVT have a higher incidence of MACE. However, patients with PE have ahigher incidence of mortality. Either DVT or PE may increase the risk of MACE and mortality.

Keywords: Deep vein thrombosis, Pulmonary embolism, Major adverse cardiovascular event

FP-087[Other » Other (to be specified with keywords in the keywords section)]

Suicide Risk Among Low-Income Household
Members Suffering From Depression: A
Population-Based Retrospective Cohort Study
Chieh Sung1, Chi Hsiang Chung2, Fu Huang Lin2, Wu Chien Chien3, Chien An Sun4, Chang Huei Tsao5,
Daphne Yih Ng6
1Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
2School of Public Health, National Defense Medical Center, Taipei, Taiwan
3Graduate Institute of Life Sciences, Department of Medical Research, Tri-Service General Hospital,

Taipei, Taiwan
4Department of Public Health, National Defense Medical Center, Taipei, Taiwan & College of Medicine,

Fu-Jen Catholic University, Taipei, Taiwan
5Department of Microbiology & Immunology, Tri-Service General Hospital, Taipei, Taiwan
6Department of Family Medicine, Tri-Service General Hospital, Taipei, Taiwan

BACKGROUND AND AIM:Low income in depressed patients is associated with further suicide-related
risk factors. Depression and suicide risk among low-income individuals share common epidemiologicaland underlying molecular mechanisms. We hypothesized that low-income depressed patients are at ahigh risk of suicide. To test this hypothesis, we used the National Health Insurance Research Database(NHIRD) to evaluate whether depression among low-income individuals is significantly linked withsuicide.
METHOD:The present cohort study adopted data from the Taiwan National Health Insurance Program.
Total 1,936,512 patients included in the Longitudinal Health Insurance Dataset between the period
2000–2015, 771 low-income participants who had suffered from depression and 3,084 controls
matched for sex and age were selected. Cox proportional hazard regression analysis was used to
explore the hazard ratio (HR) and 95% confidence interval for the risk of depression with low income
being associated with the risk of developing psychiatric disorders during the 16 years of follow-up
period.
RESULTS:Of the low-income, depressed patients and 3,084 control participants, 60 (8,514.66 per 105
person-years) and 138 (36,269.29 per 105 person-years) developed suicidal thoughts, respectively.
The Cox regression model revealed an adjusted HR of 1.771 (95% confidence interval = 1.289–2.432,
P < 0.001) after adjusting for all the covariates. Depression among low-income individuals was
associated with Charlson Comorbidity Index (adjusted HR, 1.097; 95% confidence interval =1.004 –1.186; p=1.186). Factors of suicide methods by using Cox regression included other gases and vapors(AHR= 8.149; 95% CI=5.926–11.196, P<0.001), and cutting and piercing (AHR= 2.789; 95%
CI=2.021–3.864, P<0.001).
CONCLUSIONS:Depression with low-income are independent risk factors for suicide. Depressed
patients with low income are at higher risk of developing suicidal thoughts compared with depressed
patients that would not be characterized as low income. Among suicide methods, other gases andvapors have the highest risk. Clinicians should pay attention to income level of depressed patients.

Keywords: Depression, low income, National Health Insurance Research DatabaseFP-088[Other » Other (to be specified with keywords in the keywords section)]

Association between low-density cholesterol
and its related risk factors among young
workers in southern Taiwan
Chien Yuan Huang1, Chien Yuan Huang2
1Department of Occupational medicine, Chi-Mei Medical Center Liouying
2Department of Family Medicine, Chi-Mei Medical Center Liouying

BACKGROUND AND AIM:Low density cholesterol is highly correlated with cardiovascular diseases. In
previous studies, the prevalence of low-density cholesterol was found to be elevated among theses
years, but only few studies focus on young workers. Therefore, we conducted a study to evaluate therisk factors with low-density cholesterol among young workers in southern Taiwan.
METHOD:We recruited workers working in southern Taiwan during their routine annual healthexamination between May 1 and December 31, 2022. Participants accept blood sampling and received
anthropometric measurements. The younger worker defined by age less than 40 years old.
RESULTS:A total of 6091 workers participated in this study, and 3336 workers age less than 40 years
old. The prevalence rate of low-density cholesterol was 37.9% in total study population and 35.1% inyounger workers. We observed positive associations between low-density cholesterol and age lessthan 40 years old, body mass index (BMI), hypertension, waist, and GPT (all with p <0.05). Throughfurther analyses using logistic regressions in younger workers, we found hypertension, and waist werepredictors of low-density cholesterol. After adjusting for other factors, we found hypertension(adjusted odds ratio [AOR] =1.32, 95% confidence interval [CI]: 1.07-1.62), and waist (AOR =1.88,
95% CI: 1.59-2.21), were independent predictors of low-density cholesterol.
CONCLUSIONS:In the young workers less than 40 years old, low-density cholesterol is associated withhypertension, and waist. However, further studies still need to be constructed to clarify the association
between low-density cholesterol and possible risk factors.

Keywords: : Low density cholesterol, cardiovascular diseases, young worker

FP-089[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Prenatal Phthalate Exposure Modifies the
Genetic Impact on IQ
Chueh Chun Yeh1, Shu Li Wang2, Chia Lin Hsu3, Cheng Sheng Lee4, Yen Feng Lin3
1Center for Neuropsychiatric Research, National Health Research Institutes, Taiwan; Institute of

Molecular and Cellular Biology, National Tsing Hua University, Hsinchu, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
3Center for Neuropsychiatric Research, National Health Research Institutes, Taiwan
4Institute of Molecular and Cellular Biology, National Tsing Hua University, Hsinchu, Taiwan

BACKGROUND AND AIM:Exposure to phthalates during fetal development has a negative impact onchildren's cognitive development, with intelligence (IQ) often serving as an assessment measure. To
assess the hypothesis that prenatal phthalate exposure might interfere with the genetic influence on
IQ, we used polygenic risk score (PRS) to estimate the overall genetic contribution to children’s
cognitive ability and examine its interaction with environmental exposures to phthalates.
METHOD:Participants were 137 mother-infant pairs from the central region of the Taiwan Maternal andInfant Cohort Study. To gauge prenatal exposure, we measured phthalate metabolites, including
mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono benzyl phthalate (MBzP), mono-nbutyl phthalate (MnBP), and the sum of three metabolites of di (2-ethylhexyl) phthalate (ΣMEHP), in
the mothers' urine during the third trimester of pregnancy. IQ tests were performed for the children attheir age of 4. We applied PRS-CS method to generating PRS for IQ and educational attainment(EDU), using data from a genome-wide association study (GWAS) involving 269,867 individuals for IQ,
and GWAS results from Taiwan BioBank involving 100,000 individuals for educational attainment,
which has been considered as a proxy of cognitive ability in young adults. We then conducted multiple
linear regression analyses to examine the interaction between prenatal phthalate exposure and PRS.
RESULTS:Our study revealed a significant interaction (p=0.001) between IQ-PRS and maternal urine
MBzP concentration. Moreover, the low MBzP concentration group exhibited a stronger correlation
between IQ-PRS and IQ, compared to the high concentration group. Similar results were observed forthe interaction between EDU-PRS and MMP.
CONCLUSIONS:These findings suggest that prenatal phthalate exposure may act as an effect modifierin the relationship between genetic influence on cognitive ability and children’s IQ.

Keywords: Children's environmental health, Endocrine disrupting chemicals, Exposures, PhthalatesFP-090[Exposures » Environmental disparities]

Preliminary investigations on the mental healthimpact of socio-economic and living
environment characteristics in residents of
informal housing
Crystal Ying Chan1, Ka Hung Chan2, Becky Hoi1, Maggie Ying Yee Li1, Joyce Ho Yi Chan1, Henry Ho
Fai Sin1, Edwin Shun Kit Chung1, Eliza Lai Yi Wong1
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
2Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health;

Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United
Kingdom

BACKGROUND AND AIM:This study investigates the relationships between the socio-economic andenvironmental characteristics and the mental health outcomes of adults and children living in
subdivided flat units(SDU), a common type of informal housing where >0.21million population lives inHong Kong. These units are known for cramped living space (median floor area/capita:6.0m2,
population average:15.9m2) and poor housing quality (e.g. lack of bathroom/cooking space). Suchliving conditions may impact on the residents' mental health.
METHOD:A community-based health screening program was conducted 01.07.2021-31.01.2023 with aconvenient sample referred by non-government organizations, involving 438 caregiving dyads living in
SDUs in Hong Kong. Interviewer-administered questionnaire was used to assess socio-economic andhousing characteristics along with the Depression, Anxiety, and Stress Scale-21(DASS-21).
Multivariate logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals(CI)for DASS-21 defined depression and anxiety after adjusting for age and sex of the individuals.
RESULTS:The 438 caregiving dyads screened were predominantly middle-aged caregivers(94.3%
female, mean age[standard deviation(SD)] = 39.8[7.79]) and their children aged 13 and over (age=14.5[0.94]). These respondents lived with a median monthly household income of USD 1,600, which
is 44.5% of Hong Kong average. Sharing a residence with median per-capita floor area of 4.34m2(Interquartile range=3.90-5.57), 27.3% respondents faced moderate/severe anxiety risk and 18.4%
faced depression risk (comparing to14% and 19% in general population). Living in a residence with a
total floor area <13.0m2 is significantly associated with an increased risk of depression (OR=1.77,
p<0.05) and anxiety (1.83, p<0.01) in adults, and a non-significant elevated risk of anxiety inchildren (3.44, p=0.36). Other socio-economic/physical environment factors (e.g., household income,caregiver education, stove ownership) were not associated with the residents’ mental healthoutcomes.
CONCLUSIONS:With a larger proportion of population being affected by anxiety, the physicalattributes of the home environment could significantly influence the mental health of SDU residents.

Keywords: Community outreach, Mental health outcomes, Environmental disparities, Environmental
justiceFP-091[Exposures » Environmental disparities]

Mapping of Exposure Scenarios from Industrial
Combustion Facilities to Health Outcome
through Systematic Review
Dahee Han1, Yong Min Cho1, Ju Shin Oh1, Kyung Hwa Choi2, Moon Ju Oh3, Young Seoub Hong4
1Institute of Environmental Health, Seokyeong University, Seoul, South Korea
2Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
3Business Development and Quality Assurance Unit, Theragen Bio co., Seoungnam, South Korea
4Department of Preventive Medicine, School of Medicine, Dong-A University, Busan, South Korea

BACKGROUND AND AIM:Industrial combustion facilities emit various pollutants through their stacks
and pollute the surrounding environment. Living near those facilities can affect residents’ health. We
conducted systematic reviews of environmental vulnerable regions and integrated exposure scenarios
from emission source to health outcome into a map.
METHOD:Systematic reviews of studies on residents near smelters, incinerators, and fired power
plants were conducted separately and integrated into a map. The literature search was conductedfrom 21 June to 22 December 2021, on PubMed. Non-human studies such as environmental
concentration measurements, in-vivo, and in-vitro studies, occupational studies, review articles, booksections, and gray literatures were excluded, and years of publication were restricted from 2000 to
2021. Among 232 articles, health effects studied in more than five articles from each source wereselected. For the reviewed articles, assessments of the evidence level were carried out.
RESULTS:Following the bold lines in our map, near incinerators, persistent organic pollutants are
exposed to human and cause non-Hodgkin’s lymphoma consistently among published literatures. In
the vicinity of smelters, metal exposures are investigated and associated with renal tubular damage.
Fired power plants areas are shown to be polluted by nitrogen oxides (NOx), particulate matter (PM),and polycyclic aromatic hydrocarbons (PAHs). Among those pollutants, NOx causes a decrease inpulmonary function and PM causes lung cancer and chronic obstructive pulmonary disease. PAHs fromfired power plants are associated with delays in neurobehavior.
CONCLUSIONS:This study provided a map of exposure scenarios and evidence for priority selection to
be considered in future studies of residents’ health impact assessment near combustion facilities.
FUNDING: The Korea Environment Industry and Technology Institute through the Core Technology
Development Project for Environmental Disease Prevention and Management, funded by the Korea
Ministry of Environment (grant number 2021003320003).

Keywords: Chemical exposures, Environmental epidemiology, OutcomesFP-092[Exposures » Environmental disparities]

Particle exposure and cytotoxicity assessmentof indoor air pollution from cooking emissions ina low-income home
Eliani Ezani1, Armania Nurdin2
1Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences

Universiti Putra Malaysia, Serdang, Malaysia
2Department of Biomedical Sciences, Faculty of Medicine and Health Sciences Universiti Putra

Malaysia, Serdang, Malaysia

BACKGROUND AND AIM:This study was conducted to determine the exposure and the cytotoxic effects
of in-kitchen aerosols of PM2.5 on human lung cells.
METHOD:PM2.5 levels were measured using real-time portable monitor during cooking and noncooking days. Indoor and outdoor PM2.5 samples were collected for 24 hours simultaneously on a 37
mm polyvinyl chloride (PVC) membrane filter using a portable low-volume personal air sampler. The
samples were then extracted using methanol. MTT assay was used to determine the cytotoxic activityof indoor and outdoor PM2.5 at different concentrations (25 - 200 μg/mL) on human lung cells (MRC5) at 24 hours incubation period.
RESULTS:The average concentrations of PM2.5 were approximately 2 times higher during cooking
days compared to non-cooking days. Exposure of indoor PM2.5 on MRC-5 cells induces cytotoxicity athigher concentrations compared to control cells, but the value is not significant (p>0.05). In contrast,
exposure to outdoor PM2.5 at 100 and 200 μg/mL significantly (p<0.05) induce cell viability in MRC-5
cells compared to control cells. The indoor and outdoor PM2.5 sampling can be further optimized inorder to increase the yield of samples collection. This will allow further evaluation of the cytotoxic
activity of indoor and outdoor PM2.5 at higher concentrations (>200 μg/mL).
CONCLUSIONS:The results of the study indicate that exposure to fine particulate aerosols in the
kitchen could be a risk factor for the development of oxidative stress, but further research is needed.
The determinants of the temporal pattern of activity and the characterization of exposure need to beconsidered in a future study, especially in a low-income home-based food business.

Keywords: indoor air quality, cooking emissions, low-income neighbourhood, PM2.5, lung cancer

FP-093[Air pollution » Short-term exposure]

Assessment of Household Air Pollution
Exposure in Kampala Capital City, Uganda
Etajak Samuel Ebuut1
1Etajak Samuel Makerere University School of Public Health
2Atuyambe Lynn Makerere University School of Public Health3William Bazeyo Makerere University School of Public Heallth
4Felix Walyawula Makerere University School of Public Health
5Agnes Nyabigambo Makerere University School of Public Health

BACKGROUND AND AIM:Air pollution (AP) is a major public health problem affecting nearly all spheresof human wellbeing and affects social and economic development. Worldwide, estimated 4.3 million
people dies every year as a result of exposure to Indoor air pollution. Kampala Capital City like manyother cities in low income countries Almost the entire population (99%) breathe air that exceeds the
WHO guideline limit
METHOD:We sampled 160 Households from our previous bigger study sample 1000 East Africa Child
Health Study in urban households in 5 sub cities of Kampala Capital City Authority between March
2020 and August 2021. The Ultrasonic Personal Aerosol Sampler (UPAS) equipment is a gravimetricﬁlter-based instrument for estimating personal exposure was used to measure air pollution exposure
among children. The Teflon Filters were weighed before and after deployment at Colarado State
University.
RESULTS:The majority 84.4% (103/122) and 86.1% (105/122) of the households used Charcoal stove
unimproved for cooking lunch and dinner respectively. The average PM2.5 concentration from personal
exposure assessment among children was 5 times higher (78.7μg/m³)
CONCLUSIONS:The average PM2.5 concentration from personal exposure assessment among children
was 5 times higher (78.7μg/m³) than the WHO recommended range of 15μg/m³ as per Air Quality
Guideline 2021.

Keywords: Air pollution, Personal Exposure Assessment

FP-094[Outcomes » Obesity and metabolic disorders]

Association between organophosphate flame
retardant exposure and lipid metabolism: Data
from the 2013–2014 National Health andNutrition Examination S
Fu Jen Cheng, Hsiu Yung Pan, Chia Te Kung
Kaohsiung Chang Gung Memorial Hospital

BACKGROUND AND AIM:Organophosphate flame retardants (OPFRs) are emerging environmental
pollutants that can be detected in water, dust, and biological organisms. Certain OPFRs can disrupt
lipid metabolism in animal models and cell lines. However, the effects of OPFRs on human lipid
metabolism remain unclear.
METHOD:We included 1,580 participants (≥20 years) from the 2013–2014 National Health andNutrition Examination Survey (NHANES) to explore the relationship between OPFR exposure and lipid
metabolism biomarkers.
RESULTS:After adjusting for confounding factors, results showed that one-unit increases in the log
levels of diphenyl phosphate (DPhP) (regression coefficient = -5.755; S.E. = 2.289; p = 0.023) andlog bis-(1-chloro-2-propyl) phosphate (BCPP) (regression coefficient = -4.637; S.E. = 2.019; p =0.036) were negatively associated with the levels of total cholesterol (TC) in all participants. One-unit
increases in the levels of DPhP (regression coefficient = -2.292; S.E. = 0.802; p = 0.012), log bis(1,3dichloro-2-propyl) phosphate (BDCPP) (regression coefficient = -2.046; S.E. = 0.825; p = 0.026), andlog bis-2-chloroethyl phosphate (BCEP) (regression coefficient = -2.604; S.E. = 0.704; p = 0.002)
were negatively associated with the levels of high-density lipoprotein cholesterol (HDL-C). With
increasing quartiles of urine BDCPP levels, the mean TC levels significantly decreased in allparticipants (p value for trend=0.028), and quartile increases in the levels of DPhP (P value fortrend=0.01), BDCPP (p value for trend=0.001), and BCEP (p value for trend<0.001) were negatively
corelated with HDL-C, with approximately 5.9%, 9.9%, and 12.5% differences between the upper andlower quartiles.
CONCLUSIONS:In conclusion, DPhP, BDCPP, and BCEP were negatively related to HDL-C
concentration, whereas DPhP and BCPP levels were negatively associated with TC level. Thus,
exposure to OPFRs may interfere with lipid metabolism.

Keywords: organophosphate flame retardant, cholesterol, high-density lipoprotein cholesterol,
NHANESFP-095[Climate » Temperature extremes and variability]

The effects of extreme temperature exposure on
gestational diabetes mellitus and hypertension
Hae Ji Han1, Youngrin Kwag1, Eun Hee Ha2
1Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, SouthKorea
2Department of Environmental Medicine, School of Medicine, Graduate Program in System Health

Science and Engineering, Ewha Womans University, Seoul, Republic of Korea

BACKGROUND AND AIM:Exposure to heat stress from heatwaves and extremely cold temperature
have negative effects on mothers. However, studies on the association between extreme temperature
exposure and pregnant women are limited, especially in women with gestational diabetes mellitus andhypertension. The presence of these diseases is likely to affect the ability of the mother to adapt tothe demands of pregnancy and, as a result, may influence fetal growth and development. We
examined the association between exposure to extreme temperature and gestational diabetes mellitus
and hypertension.
METHOD:In this study, using Health Insurance Review and Assessment Service data, pregnant women
who visited the hospital from January 2015 to December 2020 were analyzed. Adjusted factors weretreatment date, treatment code, residence, mean age of mothers and crude birth rate. The exposure
period was obtained from the average temperature exposed during pregnancy. The study was verified
through regression analysis of the temperature and the number of subjects with gestational diabetes
mellitus and hypertension.
RESULTS:Our study included 370,254 subjects in total, among the subjects, 342,965 and 27,289
subjects were diagnosed with gestational diabetes mellitus and hypertension, respectively. We foundpositive associations with increase in number of subjects with gestational diabetes mellitus in factors
such as heat exposure temperature (E: 15.568, 95% CI 8.397, 22.739, p-value= 0.039), exposure
period, and environmental change. On the other hand, we found that the number of subjects withgestational hypertension significantly increased when the temperature fell to the extreme (E: -1.332,
95% CI -1.953, -0.711, p-value= 0.037).
CONCLUSIONS:Our findings suggest that maternal exposure to extreme temperature during
pregnancy is associated with endocrine disorders such as gestational diabetes mellitus andhypertension. Pregnant women should pay attention to outdoor activities and regulate thetemperature of the surrounding environment through appropriate adjustments (use air conditioners orheaters and refrain from outdoor activities).

Keywords: gestational diabetes mellitus, gestational hypertension, pregnant women, heatwaves,environmental exposure

FP-096[Air pollution » Short-term exposure]

Association of short term Particulate matter(PM 2.5) exposure with cardio-respiratory
outpatient visits in secondary hospital in North
India
Harshal Ramesh Salve1, Abhishek Jaiswal3, Surbhi Puri1, Sagnik Dey2, Anand Krishnan1
1All India Institute of Medical Sciences, New Delhi
2Indian Institute of Technology, Delhi
3ESI Hospital and Medical college, Faridabad

BACKGROUND AND AIM:Air pollution adversely affects the health of individuals, especially the mostvulnerable. We aimed to document the short-term effects of PM2.5 exposure and outpatient visits for
cardio-respiratory causes at the secondary care hospital.
METHOD:Daily outpatient visit data with cardio-respiratory disease specific diagnosis along withdemographic characteristics was collected for three years (2018–2020) hospital records in Faridabad
District of Haryana. Daily PM 2.5 exposure at patients' residence level was assessed using satellitebased PM2.5 (1-km) exposure that was calibrated against the ground-based measurements. Surface
PM2.5 concentrations were estimated by converting aerosol optical depth (AOD) from Moderate
Resolution Imaging Spectroradiometer (MODIS). Multi-variable analysis was done, including
information on demographic variables, meteorology, Normalized Difference Vegetation Index, using ageneralized linear model with Poisson’s distribution.
RESULTS:The median age of the participants visiting the OPD with respiratory complaints was 9 years(IQR: 3,26). On univariate analysis, the association between PM 2.5 values and the number of OPD
visits for respiratory complaints was not statistically significant. The model showed a significant
increase in OPD visits for cardio-respiratory causes and PM2.5 levels with a lag period of 7 days taking
into account seasonality (IRR – 1.025, p-value: 0.01). On stratified analysis, among children underfive years of age, the association was significant with a lag of zero to two days (IRR0 – 1.028, pvalue: 0.03; IRR1 – 1.034, p-value: 0.03; IRR2 – 1.034, p-value: 0.03 ).
CONCLUSIONS:An increase in PM2.5 levels is associated with an increase in outpatient visits for
cardio-respiratory causes with a lag of seven days. The effect was more immediate among children
under five years with a lag of up to two days.

Keywords: Particulate Matter, Short term exposure, Health effects

FP-097[Exposures » Food/nutrition]

Nutrition, a crucial environmental factor of
mental health outcome among nurses
Hiu Yu Natalie Tang, Beixi Li, Yuen Ting Ma, Lap Ah Tse
JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,
China

BACKGROUND AND AIM:Among all the environmental factors, eating habits, implicated nutrients,
affect mental health the most. Poor diet quality was found among nurses, as well as prevalence ofdepression symptoms compared to workers in other industries. The present study aims to examine the
dietary habits of nurses and the associated mental health outcome.
METHOD:665 nurses with current night shift work and at least 1 year of working were recruited
through Association of Hong Kong nursing staff during 29/3/2022-, 11/1/2023. Participants filled in a
structured online questionnaire which collected demographic, dietary habits, and mental healthinformation. Then food frequency questionnaire (FFQ) was used to measure food consumption
frequency and proportion. Mental health was measured by The Hospital Anxiety and Depression Scale(HADS) with 14-items. Multivariable linear regression analysis was used to examine types of food,consumption frequency and proportion in correlation to depression and anxiety.
RESULTS:Among 546 (82.1%) females and 119 (17.9%) males, the average age of participants was
33 (SD=7), 13(1.95%) received high school education or below, 126(19%) had post-secondary
education, 343(51.6%) and 183 (27.5%) received undergraduate and postgraduate education
respectively. After adjusted for the demographic variables, having fresh vegetables 2 or more times
per day negatively associated with depression (B=-3.79, p<.01) and anxiety (B=-2.6, p=.01). Having
dark green vegetables (B=-2.18, p=.03), meat (B=-2.46, p=.03) and fruit (B=2.64, p=.01) 2 or moretimes per day are negatively associated with depression. Having salted vegetables 5-6 times per week
is positively correlated with depression (B= 5.1, p=.004) and anxiety (B= 4.8, p=.005). Having darkvegetables 1-6 times per year has positive relationship with anxiety (B=7.4, p=.009).
CONCLUSIONS:Heathy dietary habits, greeter consumption on unprocessed food with rich nutrients,
especially fiber and protein, have positive effect towards mental health.

Keywords: Nutrition, mental healthFP-098[Chemical exposures » Heavy metals]

Maternal Exposure to Potentially Toxic Metals
and Birthweight: preliminary results of theDSAN-12M birth cohort in the Recôncavo
Baiano, Brazil
Homegnon Antonin Ferreol Bah1, Victor Otero Martinez2, Nathália Ribeiro Dos Santos3, Erival Amorim
Gomes Junior4, Daisy Oliveira Costa3, Elis Macêdo Pires2, João Vitor Araújo Santana2, Filipe Da Silva
Cerqueira2, José Antônio Menezes Filho5
1Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Laboratory of Toxicology,

College of Pharmacy, Federal University of Bahia, Salvador, Brazil.
2Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador, Brazil.
3Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador, Brazil;

Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador, Brazil.
4Graduate Program in Food Science, College of Pharmacy, Federal University of Bahia, Salvador,

Brazil.
5Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador, Brazil;

Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Laboratory of Toxicology,
College of Pharmacy, Federal University of Bahia, Salvador, Brazil

BACKGROUND AND AIM:We investigated i) the determinants of exposure to lead (Pb), cadmium (Cd),and manganese (Mn) in 163 pregnant women ii) and the relationship between maternal exposure to
those potentially toxic metals (PTMs) and birthweight (BW).
METHOD:Blood was collected from the pregnant women during their second trimester of pregnancy todetermine Pb (PbB) and Cd (CdB), while hair (MnH) and toenails (MnTn) were used for Mn. Metallevels were analyzed by graphite furnace atomic absorption spectrophotometry (GFAAS).
Sociodemographic data were collected using questionnaires while BW information of only 74 newborns
was available in the medical records.
RESULTS:Few participants had levels above the reference values for PbB (5.1; 95% CI: 2.1–10.1%),
and MnH or MnTn (4.3; 95% CI: 2.3–10.1%). On the other hand, 61.1(95% CI: 52.4–69.3%) had
elevated CdB levels. Low socioeconomic status, domestic waste burning, being a passive smoker,
multiparity, and renovating the house significantly increased the chances of having high levels of Mn,
Pb, and Cd. Considering the 74 dyads of mother-child at the moment, the medians (P25th–P75th) of
PbB, CdB, MnH, and MnTn, were, respectively, 0.9 (0.5–1.8) µg/dL; 0.54 (0.1–0.8) µg/L; 0.18 (0.1–0.4) µg/g and 0.65 (0.37–1.22) µg/g. The means (SD) of BW were 3,067 (426.3) and 3,442 (431)
grams, respectively, for girls and boys. MnTn presented an inverse correlation with the BW/GA ratio
for girls (rho = –0.478; p = 0.018), suggesting the effect of sex modification. Although the BW’s
correlation with CdB was not statistically significant, hierarchical linear regression (Beta = –2.08;
95%CI -4.58 to 0.41) suggested a fetotoxic effect.
CONCLUSIONS:We detected a worrying situation related to exposure to Cd. We confirmed the threat
PTM might represent and contributed to elucidating their role in inadequate fetal growth in developing
countries like Brazil.

Keywords: Socio-economic factors, Birth outcomes, Epidemiology, Female

FP-099[Outcomes » Other (to be specified with keywords in the keywords section)]

Prenatal exposure to perfluoroalkyl substancesand liver injury in 21 year-old adolescents: The
Taiwan Maternal and Infant cohort study
Hui Chen Wu1, Chien Wen Sun2, Shu Li Julie Wang2
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University
2National Health Research Institutes, Miaoli County, Taiwan

BACKGROUND AND AIM:Non-alcoholic fatty liver disease (NAFLD) is among the most common
contributors to the global burden of chronic liver disease. In addition to genetic factors, increasing
evidence suggests that environmental exposures play important roles in the development andprogression of NAFLD. Perfluoroalkyl substances (PFASs) are synthetic chemicals used for various
industrial applications and in consumer products and are widespread persistent compounds whichhave a half-life of 3-15 years in human bodies. Recent data suggest that PFASs are associated with ahigher risk of NAFLD. However, no study examined the association of prenatal exposure of PFASs withliver injury in youth. In this pilot, we aim to examine the association between PFASs exposure andbiomarker of liver injury in adolescents.
METHOD:In the Taiwan Maternal and Infant Cohort Study, we collected serum samples from pregnant
women during the third trimester and measured concentrations of 9 PFASs using a high performanceliquid chromatography system. A subsample of their children was assessed with liver steatosis using
FibroScan at age 21 (n=81). We defined NAFLD by controlled attenuation parameter (CAP) scores of≥238 dB/M in the absence of excessive alcohol use and viral hepatitis. Both alanine aminotransferase(ALT), and aspartate aminotransferase (AST) were also measured.
RESULTS:We found maternal serum perfluorohexane sulfonic acid (PFHxS) was statisticallysignificantly correlated with AST (r=0.26, p=0.02) and ALT (r=0.29, p=0.01). The mean value of
PFHxS were 1.55 (±3.43, ng/mL) and 0.81 (±1.0, ng/mL) for participants with and without NAFLD.
CONCLUSIONS:Preliminary results showed cord blood PFASs appear to associate with increased liver
injury. Prenatal exposure to PFASs may increase the risk of liver injury later in life.

Keywords: Prenatal exposure to perfluoroalkyl substances, birth cohort, adolescents, liver injury

FP-100[Chemical exposures » Mixtures]

Analysis of Cardiovascular and Respiratory
System Diagnosis Results of Some Secondary
Battery Workers in Korea
Hwayeon Lee, Yonglim Won, Junhyeok Choi, Youngjoong Park
Occupational Health Research Bureau, Occupational Safety and Health Research Institute, Ulsan,
Republic of Korea

BACKGROUND AND AIM:This survey was conducted as a preliminary survey to conduct a health caresurvey for workers at secondary battery manufacturing and regeneration sites conducted in Korea
from 2023-24. In the manufacture of lithium-based secondary batteries, harmful factors to special
health diagnosis, such as nickel, cobalt, manganese, and dichloromethane, are used. In addition,
various raw materials such as lithium, carbonate, carbon nanotubes, and the like, which are notclearly disclosed, are mixed and used. Organic compounds and dust are feared to be exposed in somemanual processes and cardiovascular and respiratory hazards, including night work.
METHOD:Six work places were selected in consideration of industries such as anode, cathode material,
electrolyte. 652 cases of special health diagnosis data that were not normally judged by the
cardiovascular system or respiratory system were analyzed.
RESULTS:The most harmful factors exposed to workers at the surveyed workplace were night work,
followed by aluminum and dichloromethane, and more than 60% of workers performed night work.
Workers exposed to cardiovascular harmful factors had significantly higher blood pressure, fastingblood sugar, and triglycerides compared to the general population group, but the rate of abdominal
circumference exceeding the standard was low. The proportion of workers who were not normal in the
respiratory system was similar to or slightly lower than that of the general population group.
CONCLUSIONS:Many of the workers are exposed to cardiovascular harmful factors along with nightwork, which is feared to increase the burden factor. Most of the processes are automated, so theconcentration of harmful factors exposed is expected to be low, but it is judged that it is necessary toevaluate workers' health effects during unstructured processes such as maintenance processes.
Through a survey on health care status, it will closely grasp the condition of workers and create healthcare guides for each industry.

Keywords: Secondary battery industry, Cardiovascular disease, Respiratory diseaseFP-101[Air pollution » Particulate matter]

Exploration of high concentration areas of finedust and biomonitoring for volatile organic
compounds among the residents
Hyun Ji Ju1, Seung Ho Lee1, Na Young Kim1, Yong Sik Hwang2, Young Seoub Hong1
1Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea;

Environmental Health Center, Dong-A University, Busan, Korea
2Silla Environmental Consulting Co., Ltd, Busan, Korea

BACKGROUND AND AIM:Busan is the second largest city in Korea, known for the port industry. Due tothe high emissions of pollutants from ships and heavy traffics, the concentration of fine dust is high inthe city. In this study, air quality data was analyzed to identify areas with high levels of fine dust in
Busan and to monitor the exposure of residents in the areas.
METHOD:Air quality data from 31 air pollution monitoring stations in Busan were collected by using
the National Ambient Air Quality Monitoring System (Air Korea). The mean concentrations and spatial
distribution were analyzed by location and year, and statistical analysis was conducted using SPSS. To
determine the concentrations of volatile organic compounds (VOCs) among residents in areas withhigh levels of fine dust, urine samples were collected and analyzed by LC-MS/MS.
RESULTS:The mean of PM10 fine dust by location for 10 years from 2011 to 2020 were 46.99 μg/m³(39.00 μg/m³ to 63.02 μg/m³). The spatial distribution showed that the western and central regions
had higher concentrations. From 2018 to 2020, the mean of PM10 was particularly high at H location,with 42.50 μg/m³. The mean of t,t-MA (trans,trans-muconic acid) and BMA (N-Acetyl-S-(benzyl)-Lcysteine) were 71.15 μg/g creatinine and 7.00 μg/g creatinine, respectively among the 400 residents
near H town, which were higher than the 4th and 5th KoNEHS (Korean National Environmental Health
Survey) reference values of 64.60 μg/g creatinine and 5.02 μg/g creatinine, respectively.
CONCLUSIONS:The western region of Busan showed a higher average concentration of PM10 fine dust
and the results of the resident monitoring survey were higher than the nationwide average value.
Continuous monitoring for the western region is needed to establish a foundation for efforts to reduce
fine dust and to monitor the health impacts on the residents.

Keywords: Long-term exposure, Chemical exposures, Other (volatile organic compounds)

FP-102[Climate » Natural disasters]

Natural hazards and critical infrastructure in the
United States
Jeonggyo Yoon, Chris C. Lim
Department of Community, Environment, and Policy, Zuckerman College of Public Health, The
University of Arizona, Tucson, Arizona, US

BACKGROUND AND AIM:Given that climate change poses a significant threat to critical infrastructure
by damaging the quality and continuity of services, and facility capacity, identifying and quantifying
the number of infrastructures at risk is needed. This study aims to evaluate the spatial patterns andquantify the percentage of multiple infrastructures at risk of climate change-related natural hazards in
the United States.
METHOD:We linked the National Risk Index Score developed by the Federal Emergency Management
Agency (FEMA) and the Homeland Infrastructure Foundation-Level Data (HIFLD) for locations ofcritical infrastructure across 5 sectors including chemicals, communications, education, energy, andpublic health. The 18 types of natural hazards considered such as avalanche, coastal flooding, cold
wave, drought, earthquake, hail, heat wave, hurricane, ice storm, landslide, lightning, riverine
flooding, strong wind, tornado, tsunami, volcanic activity, wildfire, and winter weather. The natural
hazard risk index rating (from “Very Low” to “Very High”) is calculated by multiplying expected annual
loss and social vulnerability and dividing by community resilience at the census tract level. We
visualized the infrastructure locations and calculated the percentages in the "Very High" and"Relatively High" natural hazard areas.
RESULTS:We analyzed 18 types of climate change-related natural hazards with 5 sectors of criticalinfrastructures. For example, for public health infrastructures, the number (percentages) of hospitals,
nursing homes, and urgent facilities in "Very High" and "Relatively High" coastal flooding tracts were56 (0.70%), 304 (0.67%), and 45 (0.94%); heatwave tracts were 1556 (19.56%), 7674 (17.00%),
and 635 (13.33%); and wildfire tracts were 339 (4.26%), 1476 (3.27%), and 161 (3.38%). We also
identified infrastructures at risk of multiple natural hazards. Single- and multiple-hazard risks showed
highly variable geographical patterns.
CONCLUSIONS:The identification of critical infrastructures at risk from natural hazards can inform
policymakers and public health officials in prioritizing resources for the most vulnerable areas.

Keywords: Wildfires, Spatial statistics

FP-103[Air pollution » Particulate matter]

Associations between Fine Particulate Matter
Composition and Sources with Adverse Health
Effects: A Systematic Review and Meta-Analysis
Jeonggyo Yoon1, Chris C. Lim1, George Thurston2
1Department of Community, Environment, and Policy, Zuckerman College of Public Health, The

University of Arizona, Tucson, AZ, US
2Department of Environmental Medicine, School of Medicine, New York University, New York, NY, USBACKGROUND AND AIM:Associations between fine particulate matter (PM₂.₅) exposure and healthoutcomes are well established. Constituents and sources of PM₂.₅ that are driving the PM₂.₅-healthassociations remain unclear.
METHOD:We performed a systematic literature review of an array of health outcomes (mortality,
morbidity, birth outcomes) associated with exposure to fine particulate matter constituents andsources. PubMed, Scopus, and Web of Science were searched for English-language publications using
relevant keywords. After screening and assessing the risk of bias for each study, we performed metaanalyses for each health endpoint and constituent/sources combination if the number of studies was atleast three.
RESULTS:We grouped studies according to health endpoints (e.g., cardiovascular and respiratory
diseases) and exposure length (short-term and long-term). We found that elemental carbon, organiccarbon, and sulfates were most consistently associated with health endpoints. The findings indicatethat fossil fuel combustion, such as diesel-fueled vehicles and traffic (elemental carbon, organiccarbon), as well as coal combustion (sulfates) are particularly associated with adverse human healthimpacts.
CONCLUSIONS:While more studies of PM₂.₅ constituents and source components are still needed, theavailable results of both the short- and long-term exposure studies are consistent with the conclusionthat PM₂.₅ mass derived from fossil fuel combustion, such as traffic-related and coal combustion
pollution, is of particular concern for public health. Our findings indicate a need for clean air andclimate action policies to focus on limiting PM₂.₅ pollution from fossil fuel combustion sources tomaximize the health benefits of those mitigation efforts.

Keywords: Particle components, Short-term exposure, Long-term exposure, Traffic-relatedFP-104[Air pollution » Long-term exposure]Long-term PM2.5 exposure and urticaria,
allergic conjunctivitis, and allergic rhinitis innational longitudinal cohort
Ji Hyen Lee1, Hyemin Jang2, Whanhee Lee3, Joyce Mary Kim4, Yi‐jun Kim5, Jung Won Lee1, Hae Soon
Kim1, Eunhee Ha6
1Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic ofKorea;Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
2Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of

Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul,
Republic of Korea
3School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic ofKorea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
4Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans

University, Seoul, Republic of Korea; Department of Environmental Medicine, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
5Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
6Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans

University, Seoul, Republic of Korea; Department of Environmental Medicine, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health(IESEH), College of Medicine, Ewha Womans University, Seoul, Republic of Korea

BACKGROUND AND AIM:Previous studies have suggested that air pollutants are associated withasthma development and exacerbation, but the associations between PM2.5 and the risks of urticaria,
allergic conjunctivitis, and allergic rhinitis remain inconsistent. We examined the association of longterm exposure to PM2.5 with the risk of Urticarial Rush (UR), Allergic Conjunctivitis (AC), and Allergic
Rhinitis (AR).
METHOD:We utilized the National Health Insurance Service-National Sample Cohort spanning from2002 to 2019, consisting of one million beneficiaries representative of the entire population in South
Korea. The onset of allergic diseases was the first hospital visit record with a primary diagnostic code
based on the International Classification of Disease, 10th edition codes. For PM2.5 exposure, we used
a machine learning-based ensemble prediction model to achieve a high spatial resolution of 1 km2.
We allocated the district-specific annual average concentration of PM2.5 across all 229 districts inSouth Korea. We estimated the association between PM2.5 and the onset of allergic diseases using atime-varying Cox proportional hazard model adjusted for age, sex, socioeconomic status, region, andcommunity level indicators.
RESULTS:Our study included 571,836 beneficiaries aged 18 and below at enrollment and followed until
the first onset of allergic diseases. Among the subjects, 156,577, 137,491, and 277,768 individuals
were diagnosed with UR, AC, and AR, respectively. The hazard ratios of development of allergic
diseases when annual PM2.5 concentration increased by 5μg/m³ were 1.023 (95% CI 1.011 to 1.036)
for UR, 1.035 (95% CI 1.021 to 1.048) for AC, and 1.064 (95% CI 1.055 to 1.074) for AC.
CONCLUSIONS:Long-term exposure to PM2.5 was associated with an increased incidence of urticaria,

allergic conjunctivitis, and allergic rhinitis in this national cohort. These findings can provide essential
information for preventing allergic diseases in children and adolescents.

Keywords: Air pollution, Allergies, Long-term exposure, Particulate matterFP-105[Air pollution » Long-term exposure]

Temperature Variation, Ambient PM2.5, and Allcause Mortality: A Longitudinal Cohort
Jinjian Chen1, Ka Chun Chong1, Xiangqian Lao2
1Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong

Kong SAR, China.
2Department of Biomedical Sciences, the City University of Hong Kong, Hong Kong SAR, China.

BACKGROUND AND AIM:Previous studies showed that impacts of climate change may stem from theincreasing temperature variation (TV) rather than the warmer temperature. However, most studies on
effects of TV mainly focused on the short-term exposure and they ignored the modifying effect of
PM2.5. We therefore investigated the associations of TV and ambient PM2.5 with all-cause mortality in
Taiwanese.
METHOD:We included 434,443 Taiwanese recruited during 2000-2016 with 976,913 medical
examination records. PM2.5 was estimated at each participant’s address using spatial-temporalmodels. We collected daily ground-level temperature observations from Taiwan Central Weather
Bureau. We used the inverse distance weighted method to derive averages of the daily ambient
temperature at residential addresses. We used standard deviation (TSD) and range (TR) of
temperature as the indicators of TV. A Cox regression model with time-varying covariates was applied
to examine effects of PM2.5 and annual and seasonal TV. All variables (except for sex) were treated as
time-varying variables. We also tested the interaction of PM2.5 and TV.
RESULTS:Ambient PM2.5, summer TSD, winter TR were significantly associated with all-cause
mortality. The hazard ratio (HR) per 10 μg/m3 increase in annual PM2.5 concentration was 1.264(95% CI: 1.227, 1.303). The HRs for per 1 ℃ increase in annual, summer, and winter TSD were 1.013(0.977, 1.050), 1.086 (1.035, 1.140), and 0.929 (0.886, 0.974), respectively. The HRs for 1 ℃
increase in annual, summer, and winter TR were 0.999 (0.989, 1.010), 0.998 (0.991, 1.005), and
1.017 (1.008, 1.026), respectively. Larger TV was associated with a lower risk of PM2.5 on all-cause
mortality. The long-term TV-mortality association was stronger in low and moderate PM2.5
concentration.
CONCLUSIONS:Long-term exposure to ambient PM2.5 and temperature variations were positively
associated with increased risk of mortality. Our results also suggest that temperature variation
modified the effects of PM2.5 on mortality in this Taiwan population.

Keywords: Air pollution, Long-term exposure, Temperature variability, Mortality, Risk assessment

FP-106[Birth and pregnancy outcomes » Birth outcomes]

A propensity score analysis of the relationshipbetween exposure to RF-EMF during pregnancy
and birth outcomes
Jonghyuk Choi, Hyungryul Lim, Hyunjoo Joo, Mina Ha
Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic ofKorea

BACKGROUND AND AIM:In modern society, exposure to RF-EMF is an unavoidable ubiquitous
exposure. It is not yet clear whether the use of mobile phones during pregnancy has a causal adverse
effect on birth outcomes.
METHOD:In the Korea Children's Environment and Health Study cohort, information was gathered via
a survey on mobile phone usage among 5,213 women who gave birth between 2015 and 2020. In thecase of missing mobile phone use information during pregnancy, birth outcome information andmultiple births were excluded, 4628 women were finally included in the analysis. Birth outcomes
evaluated were birth weight, birth height, ponderal index, and gestation age, preterm birth, low birthweight. Propensity scores(PS) were generated for groups with high and low mobile phone calls during
pregnancy based on the 75percentile. Variables for PS calculation were selected using generalcharacteristics and LASSO regression. Ultimately, the effects of RF-EMF on birth outcomes via mobile
phone calls were examined through propensity score matching analysis and IPTW analysis.
RESULTS:In PS matching analysis, the balances of the general characteristics of the groups with low
and high mobile phone calls were similarly distributed, ensuring comparability. The effect in the groupwith high mobile phone calls compared to low group was β=7.22(p=0.58) for birth weight,
β=0.10(p=0.28) for birth height, β=-0.02(p=0.32) for ponderal index, β=-0.05(p=0.40) for
gestational age, HR=1.02(0.95-1.10) for gestational age, OR=1.06(0.75-1.51) for preterm birth, and
OR=0.97(0.71-1.34) for low birth weight, respectively. There were no significant results in the IPTW
analysis results.
CONCLUSIONS:We did not observe evidence that prenatal mobile phone use causally affects birthoutcomes. Additional studies using specific absorption rate are needed. This work was supported by
Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by
the Korea government (MSIT) (2019-0-00102, A Study on Public Health and Safety in a Complex EMF
Environment)

Keywords: RM-EMF, mobile phone calls, birth outcome, propensity score, IPTW

FP-107[Outcomes » Obesity and metabolic disorders]Tall stature and the combination risk on kidneydamage with overweight and lifestyle among thediabetic population
Jou Yin Chen1, Yukiko Wagatsuma2
1Department of Clinical Trials and Clinical Epidemiology, Graduate School of Comprehensive Human

Sciences, University of Tsukuba, Tsukuba, Japan
2Department of Clinical Trials and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba,

Tsukuba, JapanBACKGROUND AND AIM:Height of an individual is influenced by both genetic and environmental
factors. The correlation of height with kidney disease and diabetes has been less studied. Different
body shapes may have various risks of developing diseases, but most past research has focused on
BMI rather than height. In today's society, which is filled with snacking and drinking habits, this study
aims to investigate how different height groups of patients with diabetes may be affected differently
by their snacking and drinking habits in relation to the progression of kidney function decline.
METHOD:This follow-up study was conducted in Japan with participants who underwent healthcheckups. Diabetic patients’ height, weight, and lifestyle information were recorded at baseline. Heightwas divided into two groups by the median value. Subjects were observed for about three years todetect the progression of kidney damage, which is defined as eGFR less than 60 or developing
proteinuria. Cox proportional hazard model was used for statistical analysis.
RESULTS:A total of 2380 subjects were enrolled. Combinations of drinking alcohol with overweight
showed risks for kidney damage in both low and high height groups among males (HR=1.95, Pvalue=0.049 for lower height; HR=3.15, P-value=0.003 for higher height). Among subjects of maleswith tall stature, the combination of no alcohol consumption and overweight had further significant
risk for kidney damage (HR=4.01, P-value=0.001).
CONCLUSIONS:This study found that in male diabetic populations with a tall stature, obesity andunhealthy lifestyle habits may cause a greater decline in kidney function. Although the mechanism
underlining this observation is not clear, it may be attributed to the higher levels of growth hormones,
such as insulin-like growth factor 1. Further studies are required to examine the relationship between
tall stature and kidney function decline among diabetic population.

Keywords: Epidemiology,Obesity and metabolic disorders

FP-108[Air pollution » Particulate matter]

Association between particulate matter 2.5 andmenopause in Korean women
Joyce Mary Kim1, Joyce Mary Kim2, Eunji Kim1, Eunji Kim2, Kyungah Jeong5, Eunhee Ha1, Eunhee
Ha2, Eunhee Ha3, Eunhee Ha4
1Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans

University, Seoul, Republic of Korea.
2Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul,

Republic of Korea.
3Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College ofMedicine, Seoul, Republic of Korea.
4Department of Medical Science, Ewha Womans University, College of Medicine and Ewha Medical

Research Institute, Seoul, Republic of Korea
5Department of Obstetrics and Gynecology, College of medicine, Ewha Womans University, Seoul,

Korea

BACKGROUND AND AIM:Particulate matter (PM2.5) has become a serious public health issue andaffecting women’s fertility rates worldwide. Therefore, there is a need to evaluate the risk factors
associated with menopause in order to be able to inform women of the health risks.
METHOD:We collected data from KHANES (The Korea National Health and Nutrition Examination
Survey) linked air pollution concentration data (2010–2020) by Korea Centers for Disease Control andPrevention, Ministry of Health and Welfare. The database of meteorological factors and air quality assources of exposure data were estimated using the Community Multiscale Air Quality model. The
linkage dataset was merged by three ways; administrative district, si-gun-gu (city, county, anddistrict), and geocode (in latitude and longitude coordinate units) based on the participants’ residential
address. The gross population sample for this study, comprising 88,220 participants was selected
between 2010-2020. 40,241 men were excluded from this study population leaving 47,979 women.
We employed logistic regression analyses to determine the associations between PM2.5 andmenopause after adjusting for covariates.
RESULTS:A total of 46,986 participants were included in the analysis. Additionally, menopause women
were 17,164 participants. The mean age (SD) at natural menopause was 49.10 (5.07) years. The
prevalence rate of menopause systems was found to be 37%. There was association between PM2.5
and menopause (adjusted odds ratio [aOR]: 1.007, 95% confidence interval [CI]: 1.003-1.011).
CONCLUSIONS:Therefore, the findings from this study discovered that person exposed to more
Particulate matter 2.5 was strongly related to increased risk of menopause in Korean women.

Keywords: Particulate matter, menopause, environment epidemiology

FP-109[Climate » Temperature extremes and variability]

Projection of Dengue Fever Infection Under
Climate Change: A Modelling Study
Yawen Wang1, Conglu Li1, Xiaoting Jiang1, Shi Yin2, Chao Ren2, Shi Zhao1, Yuchen Wei1, Zihao
Guo1, Ka Chun Chong1
1The Chinese University of Hong Kong
2The University of Hong KongBACKGROUND AND AIM:Climate change has accelerated dengue fever (DF) spread worldwide, andprojecting DF infection in South and Southeast Asia would help to prevent and control DF spread in
advance.
METHOD:Weekly DF cases and meteorological data in Singapore, Selangor, and Chiang Mai from 2012
to 2020 were collected. Projected monthly temperature and rainfall in 2030s, 2050s, 2070s, and2090s under low, middle, and high greenhouse gas emission scenarios (SSP126, SSP245, and
SSP585) were retrieved. The quasi-Poisson generalized additive models (GAMs) were used to assess
the association between climate and DF incidence and project DF infection risk.
RESULTS:Under SSP126, the weekly DF incidence would increase from 187 (95% confidence interval[CI]: 170-204) to 203 (95%CI: 187-221), from 748 (95%CI: 708-789) to 754 (95%CI: 719-789),
and from 18 (95%CI: 16-20) to 20 (95%CI: 17-22) in 2090s compared to 2030s in Singapore,
Selangor, and Chiang Mai, respectively. Projected DF incidence under SSP245 would increase more
apparent than under SSP126, while the most significant increase would be under SSP585. The weekly
DF incidence would increase from 191 (95% CI: 175-209) in 2030s to 381 (95%CI: 264-497) in
2090s and from 18 (95%CI: 16-20) to 43 (95%CI: 38-49) in Singapore and Chiang Mai under
SSP585, while the incidence in Selangor would peak at 2050s and then drop until 2090s. The highest
peak weekly DF incidence in a year would be 485 (95%CI: 287-686) and 112 (95%CI: 95-129) in
Singapore and Chiang Mai in 2090s under SSP585, and would be 791 (95%CI: 757-824) in 2050s
under SSP 585 in Selangor.
CONCLUSIONS:The DF infection risk will increase in the future, especially in the second half of thiscentury and under high emission scenarios. Limiting global warming is urgently needed to reduce a
potential increase in DF infection.

Keywords: Modeling, Climate, Infectious diseases

FP-110[Outcomes » Childrens environmental health]

Impact of ambient temperature, air pollutants,
and seasonal influenza on febrile seizure inchildren
Xiaoting Jiang1, Conglu Li1, Qianying Yue1, Yuchen Wei1, Yawen Wang1, Xiang Qian Lao2, Ka Chun
Chong1
1The Chinese University of Hong Kong
2City University of Hong KongBACKGROUND AND AIM:Febrile seizure is a kind of convulsion that mainly occurs among young
children. The effects of various exposome including influenza infection and external environmental
factors on febrile seizure have not been well-studied. In this study, we elucidated the relationships
between ambient temperature, air pollutants, influenza infection, and febrile seizure using 22-year
territory-wide hospitalization data in Hong Kong.
METHOD:The aggregated data were matched with the meteorological records and air pollutant
concentrations. All-type and type-specific influenza-like illness positive (ILI+) rates were used as
proxies of influenza activity. Distributed lag non-linear model in conjunction with the quasi-poisson
generalized additive model was used to examine the associations of interest.
RESULTS:According to the results, all-type influenza infections were significantly associated with anincreased risk of hospital admission due to febrile seizure (cumulative adjusted relative risk
[ARR]=1.59 at 95th percentile vs 0; 95% CI, 1.51–1.68). The effect of ILI+ A/H3N2 on febrile seizure
was more pronounced among the type-specific ILI+ rates. Low mean ambient temperature as asignificant risk factor for febrile seizure (cumulative ARR=1.50 at 5th percentile vs median; 95% CI,
1.35-1.66), while redox-weighted oxidant capacity and sulfur dioxide were not associated with febrile
seizure.
CONCLUSIONS:In conclusion, our study provided clues about the impacts of different exposome on
febrile seizure manifestation. Our results suggested that influenza vaccination for children at eligible
age could safeguard their health. Young children should be kept warm during cold weather.

Keywords: Children's environmental health, Environmental epidemiology

FP-111[Air pollution » Particle components]

Integrating Aerosol Optical Depth, Land Use
Regression, and XGBoost to Estimate the Spatial
Variation of Ions in PM2.5 across Taiwan
Kang Lo1, Yee Lin Wu2, Tang Huang Lin3, Chang Fu Wu1
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei City, Taiwan
2Department of Environmental Engineering, National Cheng Kung University, Tainan City, Taiwan
3Center for Space and Remote Sensing Research, National Central University, Taoyuan City, Taiwan

BACKGROUND AND AIM:This study utilized aerosol optical depth (AOD), land use regression (LUR)and machine learning to estimate the spatial variation of water-soluble ions (WSI) in fine particulatematter (PM2.5).
METHOD:Monthly average PM2.5 WSIs (SO42−, NO3−, NH4+, Cl−, Na+, K+, Ca2+, and Mg2+) wereobtained from 31 Taiwan EPA air quality monitoring stations in 2019. Several datasets, including landuse, road information, MODIS AOD, Himawari-8 AOD, MODIS Normalized Difference Vegetation Index(NDVI), elevation, stationary emission sources, demographic data, meteorological data, anddistribution of temples, were collected to be the predicting variables in the model. The feature
selection for each WSI was conducted with LUR. Then, Extreme Gradient Boosting (XGBoost)algorithm was applied to build multiple predicting models with the selected features for each WSI. The
model-tuning procedure was processed with Tree Parzen Estimator algorithm.
RESULTS:By incorporating XGBoost algorithm with AOD and LUR, the results demonstrated that thesemodels had good performance on predicting external datasets of SO42- (adjusted R2 = 0.69), NO3−
(adjusted R2 = 0.73), NH4+ (adjusted R2 = 0.71), and Na+ (adjusted R2 = 0.62). The other ions,
including Cl−, K+, Ca2+, and Mg2+ had the adjusted R2 <0.5.
CONCLUSIONS:This study demonstrates that integrating AOD, LUR, and XGBoost algorithm could be afeasible method to predict the spatial variation of selected WSIs in PM2.5.

Keywords: air pollution, particulate matter, spatial statistics, modelingFP-112[Chemical exposures » Endocrine disrupting chemicals]

Associations of persistent organic pollutants(POPs) with diabetes in women from the
Hispanic Community Health Study/ Study of
Latinos (HCHS/SOL)
Konstantina Tsintsifas1, Robert M Sargis2, Chibuzor Abasilim1, Tessa Day1, Sally Freels1, Martha
Daviglus3, Robert Kaplan4, Gregory A Talavera5, Jianwen Cai6, Kyeezu Kim7, Andreas Sjodin8, Mark
Davis8, Richard Jones8, Victoria Persky1, Mary E Turyk1
1Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago,

Chicago, IL, USA
2Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois at

Chicago, IL, USA;Medical Service, Jesse Brown VA Medical Center, Chicago, IL, USA
3Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx,

NY;Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
5Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego

State University, San Diego, CA, USA
6Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
7Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
8Persistent Pollutants Biomonitoring Laboratory, Centers for Disease Control and Prevention, Atlanta,

GA, USABACKGROUND AND AIM:Global diabetes prevalence has risen rapidly in recent decades. Exposure toPOPs has been identified as a possible risk factor for diabetes, but the impact on diabetes progression
and mechanisms of action are unclear. We explored associations of serum POPs with incident
prediabetes and diabetes, and changes in diabetes traits in post-menopausal Hispanic/Latino women.
METHOD:HCHS/SOL is the largest multiethnic cohort of Hispanics/Latinos in the US. Our sample
included 310 normoglycemic and 399 prediabetic women not taking medications related to diabetes or
hormones, with an average 6 years of follow-up. The effect of baseline POPs levels on progression
from 1) normoglycemia at baseline to prediabetes at follow-up (162/310) and 2) prediabetes atbaseline to diabetes at follow-up (195/399) was evaluated using multivariable Poisson regression withrobust variance analysis. The association between POPs and change scores for glycemic traits wasevaluated using linear regression. All models were adjusted for sampling design, demographic, clinicaland acculturation characteristics.
RESULTS:Progression from prediabetes to diabetes was linearly associated with p’,p’dichlorodiphenyldichloroethylene (DDE, IRR:1.39;95%CI:(1.07,1.82), hexachlorobenzene (HCB,
IRR:1.72;95%CI:(1.17,2.51) and sum polychlorinated biphenyls (PCBs, IRR:2.27;95%CI:(1.54,3.34),
and non-monotonically associated with sum dioxin-like PCBs and oxychlordane, while the association
with β-hexachlorocyclohexane (β-HCCH) was significant at the highest quartile. Mirex(IRR:0.75;95%CI:(0.59,0.94) and o’,p’-dichlorodiphenyltrichloroethylene(DDT,IRR:1.89;95%CI:(1.19,3.01) had significant linear associations for progression to prediabetes
from normoglycemia. PCBs, dioxin-like PCBs, β-HCCH, and HCB were positively, and sum
polybrominated diphenyl ethers (PBDEs) was negatively, associated with change in glycosylatedhemoglobin (HbA1c), but POPs were not related to change in HOMA-IR or HOMA-B.
CONCLUSIONS:Our findings confirm positive associations between POPs exposure and risk of diabetes.
The positive associations are mainly driven by conversion from prediabetes to diabetes, whichsuggests that effects of POPs may occur later in disease development. Further studies are needed to
identify mechanisms by which POPs affect diabetes.

Keywords: Endocrine disrupting chemicals, Female, Incidence, Pesticides

FP-113[Exposures » Occupational exposures]

Gender differences in blood cadmium
concentrations of fishers living near thermal
power plants
Mi Ji Kim1, Gyeong Ye Lee2, Ki Soo Park1
1Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University

College of Medicine, Jinju, Republic of Korea
2Center for Fishermen's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic ofKorea

BACKGROUND AND AIM:Fishers are vulnerable to heavy metal exposure in both their working andliving environments. The objective of this study is to measure the blood cadmium concentration (bCd)of fishers living near thermal power plants and to identify gender differences and factors that
contribute to elevated bCd.
METHOD:This is a cross-sectional study conducted in 2021 among residents living in the southern partof South Korea. A total of 128 fishers (73 men and 55 women) participated in the survey. The primary
outcome was bCd in ㎍/L. We used multiple regression models to analyze the association between
gender and cadmium exposure. In the statistical analysis, the bCd was log-transformed. The models
were adjusted for confounding variables, including age, occupation, fishing-related working period,
education level, economic level, smoking status, heavy alcohol use, seafood consumption, compliancescore for particulate matter protection, subjective health, and body mass index.
RESULTS:The geometric mean bCd of participants was 1.02 ㎍/L (95% confidence interval 0.94, 1.12).
The mean difference of log transformed bCd was -0.31 ㎍/L (95% CI -0.48, -0.15), which was higher
in women (p<0.001). The gender of women had a significant effect on the increase in bCd after
adjusting for several potential confounders (β=0.485, p<0.001). St

EP-wise multiple regression analysis revealed that not only gender but also smoking were related tothe increase in bCd among fishers. There was no statistically significant relationship between healthbehaviors such as seafood consumption or compliance score for particulate matter protection and theincrease in bCd.
CONCLUSIONS:Our results confirm the gender differences in bCd among fishers. Factors such as
women and smoking were found to influence the increase in bCd. In order to protect human healthfrom cadmium exposure, future investigations should focus on sex-specific factors that contribute togender differences in bCd among fishers, such as gender-specific work or genetic differences.

Keywords: Heavy metals, Occupational exposures, FemaleFP-114[Built environment » Other (to be specified with keywords in the keywords section)]Protocol for cross-sectional study ofenvironment factors and spatial distribution of
hypertension control status in Putrajaya
Mohd Zulfadli Nasir, Hayati Kadir Shahar, Siti Aisah Mokhtar
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia,
43400 Serdang, Malaysia

BACKGROUND AND AIM:Hypertension is a major public health problem in Malaysia, and controlling
hypertension is essential to prevent complications and reduce morbidity and mortality. Hypertension
control status in urban area like Putrajaya could be influenced by environmental factors, such as theavailability and distance of healthcare facilities, public green spaces, and healthy food sources.
Putrajaya is a planned city in Malaysia, where the urban environment is well-organized and could
provide an opportunity to investigate the association between environmental factors and hypertension
control status. This cross-sectional study aims to investigate the association between these factors
with the spatial distribution of hypertension control status among hypertensive patients in Putrajaya.
METHOD:A cross-sectional study was designed to select at least 108 data from list of hypertensive
patients attending primary healthcare clinics in Putrajaya, using a systematic random sampling. Data
will be extracted which includes sociodemographic information, residential address, clinicalinformation, and hypertension control status according to protocol by Ministry of Health, Malaysia. The
spatial distribution of hypertension control status will be assessed using a geographic information
system (GIS) to map the distribution of hypertensive patients and their hypertension control status.
The distribution of healthcare facility, public green space, and healthy food sources was mapped using
GIS and counter checked using a checklist from the local authority.
RESULTS:Hypertension control status and environmental exposure will be analysed descriptively.
Association between healthcare facility, public green space, healthy food and hypertension control
status will be measured using Geographical Weighted Regression (GWR).
CONCLUSIONS:The study will help to identify the association between the availability and distance of
healthcare facility, public green space, and healthy food sources with the spatial distribution of
hypertension control status in Putrajaya. The findings will provide insight and useful information todevelop effective strategies to improve hypertension control in other urban areas in Malaysia.

Keywords: Built environment, Cardiovascular diseases, Food/nutrition, Green spaceFP-115[Air pollution » Short-term exposure]Hourly PM2.5 exposure and ischaemic heartdiseases onset in Central Taiwan
Mu Jean Chen1, Shih Chan Hung2, Hung Chang Hung2, Tzu Chun Lien1, Yu Cheng Chen1
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2Nantou Hospital of the Ministry of Health and Welfare, Nantou, Taiwan

BACKGROUND AND AIM:Ischaemic heart disease (IHD) is a formidable contributor to premature
mortality and disability worldwide, intensifying the global health burden. Although studies have shown
the positive link between daily PM₂.₅ exposure and acute coronary syndrome, a research gap remains
regarding the impact of hourly PM₂.₅ exposure on IHD onset.
METHOD:We gathered measurements encompassing O₃, NO₂, SO₂, CO, PM₂.₅, temperature, andrelative humidity from the Nantou air quality station in central Taiwan, spanning 2011 to 2021. The
hourly time-series measurements underwent transferred into 0-24 hour rolling average
concentrations. Concurrently, we integrated this dataset with hourly emergency department visits(EDVs) for ischemic heart disease (IHD) from Nantou Hospital. The Quasi-Poisson generalized additivemodels and non-linear distributed models were used to explore the relationships between hourly
rolling average PM₂.₅ concentrations and EDVs for IHD, considering time lags ranging from 0 to 48
hours in both single- and multi-pollutant models.
RESULTS:This study conducted 1507 IHD EDVs, encompassing 55.7% of acute myocardial infractions,
27.9% of other acute or chronic IHD instances, and 16.4% of angina pectoris cases. Chi-square tests
revealed significant associations between IHD occurrence and variables such as season, day-nightcycles, and days of the week. Hourly rolling average PM₂.₅ exhibited positive correlations with IHD
EDVs, particularly at 17 to 22 lag hours. The 6-hour rolling average of PM₂.₅ showed robust links withIHD EDVs. A 10 μg/m3 rise in the 6-hour rolling average of PM₂.₅ was significantly associated withIHD EDVs 17 hours later, resulting in a 2.91% excess risk (95% CI: 2.36-3.46) of IHD onset.
CONCLUSIONS:This study highlights a significant link between hourly PM₂.₅ exposure and anincreased risk of acute IHD. Remarkably, even a 1-hour PM₂.₅ exposure demonstrated a notable
positive correlation with IHD EDVs. These findings emphasize the importance of addressing hourly
PM₂.₅ standards to mitigate the risks associated with IHD.

Keywords: Hourly PM2.5 standards, Ischaemic heart disease, Emergency department visits, QuasiPoisson generalized additive model, Non-linear distributed modelFP-116[Air pollution » Particulate matter]

The influence of farming activities of paddy ricecultivation on PM2.5 pollution and the incidenceof allergic symptoms
Nai Tzu Chen1, Ji Jhan Li1, Chia Ling Yeh1, Chien Cheng Jung2, Huey Jen Su1
1Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Public Health, China Medical University, Taiwan

BACKGROUND AND AIM:This study aims to compare PM2.5 pollution in the school around the rice
fields and the incidence of allergic symptoms among school students during different farming activitiesof paddy rice cultivation.
METHOD:Our study subjects were students in the second and fourth grades of an elementary schoolaround the rice fields from January to November 2022. AS-LUNG sensors were set up both outdoors
and indoors in the classrooms to monitor PM2.5 levels. Daily allergic symptoms of students, including
symptoms of the respiratory tract, nose, eyes, and skin, were investigated using an eight-day
questionnaire. The PM2.5 pollution and the frequency of allergic symptoms were compared over 7
periods, including three fallow periods (no farming activities) and four farming periods (ricetransplanting, fertilization, pesticide spraying, and harvesting).
RESULTS:The outdoor to ambient ratios of PM2.5 in the period of fertilization and harvesting werehigher than those detected in other farming periods (1.25 - 1.39 vs. 0.64 - 0.71), showing that PM2.5
pollution might be affected by farming activities. However, such influence did not further affect healthoutcomes because the incidence of 4 kinds of allergic symptoms was not significantly different among
farming periods (p>0.05). When three fallow periods were included in the comparison, the fallow
period in January had the highest frequency of respiratory symptoms when getting up in the morning
as well as symptoms of nose, eyes, and skin (0.77, 0.79, 0.81, 0.82, 0.77, and 0.78 time/periodperson)(p<0.05 for all). The level of indoor PM2.5 was also the highest in this period (21.02 μg/m3
vs. 6.03 - 18.81 μg/m3).
CONCLUSIONS:Farming activities of paddy rice cultivation could affect PM2.5 levels in the surroundingarea; PM2.5 pollution during fertilization and harvesting periods increased. However, the increase inPM2.5 pollution during fertilization and harvesting periods might not be large enough to have more
frequent allergic symptoms.

Keywords: Allergies, Children's environmental health, ExposureFP-117[Air pollution » Particulate matter]

The association between long-term exposure toambient coarse particulate matter and mortality
among dialysis patients: a nationwide cohort
study
Shih Feng Chen1, Pau Chung Chen2
1Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan

BACKGROUND AND AIM:Exposure to PM2.5 has been known to be associated with an increased risk ofmortality in dialysis patients. Sporadic studies have suggested that coarse particulate matter (PM10)
adversely affects kidney health. However, the impact of PM10 on the survival in patients with endstage renal disease remains unclear. We conducted a retrospective cohort study to explore theassociation of long-term ambient PM10 exposure with the mortality among dialysis patients.
METHOD:Data from Taiwan Air Quality-Monitoring Database and the dialysis data extracted from the
National Health Insurance Research Database were utilized for evaluation. The two databases werelinked using the postcodes of patients’ living area. We selected dialysis patients residing in areas with
ambient PM10 measurements from January 1st, 2000, and followed them up until their deaths orDecember 31st, 2013. Cox proportional hazards model was used to estimate the risk of mortality indialysis patients, with adjustments for demographic, health-related, and socioeconomic factors.
RESULTS:A cohort of 34,088 dialysis patients was formed. The adjusted hazard ratio (aHR) for
mortality per 10-μg/m3 increase of PM10 was 1.059 (95% confidence interval [CI] = 1.044–1.075).
Moreover, restricted cubic spline analysis showed a non-linear concentration-response relationshipbetween PM10 and mortality, with the lowest mortality aHR identified at a mean PM10 of 43 μg/m3,
followed by an interval of gradual aHR increase, and finally a remarkable rise of mortality risk whenmean PM10 exceeded 63 μg/m3.
CONCLUSIONS:Our study revealed a significant association between long-term ambient PM10
exposure and mortality risk among dialysis patients. Specifically, every 10-μg/m3 increase in PM10
causes a 5.9% rise in mortality risk. A non-linear concentration-response relationship between PM10
and mortality was noted, with mortality risk increasing when mean PM10 exceeded 43 μg/m3. Thesefindings strongly suggest a causal relationship between ambient PM10 and mortality among dialysis
patients.

Keywords: coarse particulate matter, dialysis patient, mortality

FP-118[One health » Public health]

The Role of Inpatients and Caregivers in a
Hospital Falls Prevention Education Program in
a Regional Teaching Hospital in Taiwan
Pei Rung Tsai1, Li Hsueh Chen1, Yu Hsia Wang1, Wei Heng Chen2, Isabella Yu Ju Hung3
1Department of Nursing, Tainan Municipal Hospital (Managed by Show Chwan Medical Care

Corporation), Tainan, Taiwan (R.O.C.)
2Department of Rehabilitation, Tainan Municipal Hospital (Managed by Show Chwan Medical Care

Corporation), Tainan, Taiwan (R.O.C.)
3Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan (R.O.C.)BACKGROUND AND AIM:Falls and fall injuries in hospitals are the most frequently reported adverse
event among inpatients. Therefore, fall Prevention was considered as an important task theme of the
Joint Commission of Taiwan. The purpose of this study was to evaluate the effectiveness of of a falls
prevention program that involve patients and caregivers participation on reducing falls in hospitals.
METHOD:This is an interventional study. The subjects were inpatients admitted to a regional teaching
hospital in south Tainan between December 2022 and February 2023. Patients were excluded if they
had impaired cognitive function or were too ill to provide informed consent. Each participant
completed a fall risk questionnaire, a falls prevention educational program, and fall related knowledge
tests. The education contained falls prevention knowledge with chart cards and booklets, transferringskills and muscle strengthening training. Pretest of the fall related knowledge was performed when thepatient admitted to the hospital, and the posttest was carried out on the day the patient discharged.
RESULTS:Total of 217 inpatients were enrolled with an average age of 60.9+20.3 years old and62.2% of male. Most patients have family or caregiver(86.6%). The fall prevention knowledge score of
posttest(96.5+8.6) was significantly higher than the pretest(88.5+14.0) of the patients(p<0.05), as
well as to the caregiver (99.0+3.7 vs 94.0+9.5). Interestingly, the male had higher score than female
both in pretest(89.3+13.1 vs 87.0+15.3) and posttest(98.0+6.1 vs 94.0+11.2). One of the reasons
might be that the male had higher education level. During the study period, there was only one fallreported and the incidence of fall was reduced to 0.046%.
CONCLUSIONS:The outcomes show that the approach of patients and caregivers participating in a fall
prevention program has the potential to be an important aspect to reduce falls and further possibly
promote patient safety.

Keywords: Outcomes, Male, Female, Incident

FP-119[Methods » Occupational epidemiology]

Work-related and personal factors inmusculoskeletal disorders among elderly
hospital cleaning workers
Po Ching Chu1, Chen Hsien Lee2, Jui Wang3
1Department of Environmental and Occupational Medicine, National Taiwan University, Taipei, Taiwan;

Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,
Taiwan2Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, Taiwan
3Health Management Center, National Taiwan University Hospital, Taipei, Taiwan

BACKGROUND AND AIM:Evidence suggests cleaning workers had high risk of musculoskeletal
disorders (MSDs). Investigations on work-related and personal factors for MSDs are limited, especiallyin elderly hospital cleaning workers. This study aimed to explore their work-related and personal
factors associated with MSDs.
METHOD:We conducted a cross-sectional study from five hospitals in northern Taiwan. The MSDs wereassessed based on the Nordic questionnaire. Sociodemographic factors and occupational hazards wereassessed. The assessment of ergonomic risk factors was based on the Guidelines for Occupational
Medical Examinations from DGUV. The logistic regression analysis was used to identify factors
associated with MSDs.
RESULTS:A total of 112 hospital cleaning workers completed the study. The majority were females(65.2%), and the average age was 68.7 years. 56.3% had any musculoskeletal symptoms during thelast twelve months, and the most prevalent location was the knee (17.3%). The most prevalentergonomic risk factor was repetition of upper limbs (19.4%), followed by flexion or twist of trunk(19.1%), and forceful movement of upper limbs (16.9%). Except for the ergonomic hazard, the mostprevalent occupational hazard was chemical (38.5%). The most prevalent medical history was trauma(18.2%), followed by MSDs (19.1%) or gastrointestinal disorders (11.8% each). For univariablelogistic regression, female sex, flexion or twist of trunk, repetition of upper limbs, forceful movementof upper limbs, kneeling or squatting, hand over the shoulder, and histories of musculoskeletal
disorders, gastrointestinal disorders were significantly associated with MSDs. Female sex (OR = 10.58,
95% CI = 2.87–39.07), hand over the shoulder (OR = 14.32, 95% CI = 2.85–71.92), history ofgastrointestinal disorders (OR = 12.13, 95% CI = 2.60–56.64) were significantly associated with
MSDs after adjustment.
CONCLUSIONS:This study implies that female, hand over the shoulder, and history of gastrointestinal
disorders were associated with MSDs. Future studies on the plausible mechanisms for associations are
warranted.

Keywords: Epidemiology, FemaleFP-120[Climate » Temperature]

Significant impacts of humid heat stress on citylevel human mortality
Qiang Guo1, Malcolm Mistry2, Xudong Zhou3, Gang Zhao3, Kanon Kino4, Bo Wen5, Kei Yoshimura3,
Yusuke Satoh6, Ivana Cvijanovic7, Yoonhee Kim8, Chris Fook Sheng Ng9, Ana M. Vicedo Cabrera10,
Antonio Gasparrini11, Masahiro Hashizume9, Taikan Oki4, Multi Country Multi City (mcc) Collaborative
Research Network12
1Department of Civil Engineering, The University of Tokyo, Tokyo, 113-0033, Japan; Institute ofIndustrial Science, The University of Tokyo, Tokyo, 153-8505, Japan
2Department of Public Health, Environments and Society, London School of Hygiene and Tropical

Medicine, London, UK; Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
3Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan
4Department of Civil Engineering, The University of Tokyo, Tokyo, 113-0033, Japan
5Climate, Air Quality Research (CARE) Unit, School of Public Health and Preventive Medicine, Monash

University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
6Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology,

Korea
7Barcelona Institute for Global Health - ISGLOBAL, Doctor Aiguader 88, 08003 Barcelona, Spain
8Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo,

Tokyo 113-0033, Japan
9Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo

113-0033, Japan
10Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
11Department of Public Health, Environments and Society, London School of Hygiene and Tropical

Medicine, London, UK; The Centre on Climate Change & Planetary Health, London School of Hygiene &Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene &Tropical Medicine, London, UK
12Multi-Country Multi-City (MCC) Collaborative Research Network

BACKGROUND AND AIM:The continuing increasing humid heat stress is believed to be a severe threat
to human survivability, and many humid heat indicators (HHIs) have been proposed to quantify its
severity. However, to date, there is a lack of established epidemiological evidence linking these HHIs
to city-level mortality. Here, we aim to examine the suitability of multiple HHIs in modeling/predicting
city-level human mortality in addition to the commonly used meteorological exposure variable airtemperature (Tair), and quantify the spatial diversity of their performances.
METHOD:To address this gap, we utilized well-established distributed lag non-linear models (DLNMs)
to assess the exposure-response associations between multiple HHIs and daily human mortality, andused supervised machine learning methods to identify the key factors influencing the lethal heat stresstype (humid vs. dry) experienced at the city level. The analysis is conducted for 739 cities from 43
countries, with state-of-the-art epidemiological and climatological datasets.
RESULTS:Our study revealed notable differences in the long-term trends and timing of hot days
among these HHIs. Using HHIs produced a more accurate predictive model for city-level mortality in
521 of the 739 cities, whose most recognizable feature is a positive correlation between the daily air
temperature and relative humidity during the warm season. Moreover, significant differences arefound in heat-related excess deaths and length of heat stress period when quantified using HHIs.

CONCLUSIONS:Our analyses have identified many locations around the world vulnerable to humid
heat stress for which HHIs are better predictors of heat-related deaths compared to commonly use
Tair. We also found that the correlation between daily Tair and relative humidity during the warm
season explains best the type of lethal heat stress experienced at the city level. Our findings provide
important insights for climate change health impact studies and the development of early warning
systems for urban heat stress.

Keywords: Climate, Mortality, Temperature, Temperature extremes, Exposure assessment

FP-121[Outcomes » Infectious diseases]

A nationwide analysis of college and university
campus wastewater based epidemiology
practices in response to coronavirus disease2019
Raeann Leal, Michael Pecolar, Sarah Teague, Cameron Rull, Deborah Sumantri, Jessica Mosher, Ryan
Sinclair, Rhonda Spencer Hwang, MengLi Lu
Loma Linda University, Loma Linda, United States

BACKGROUND AND AIM:Wastewater-Based Epidemiology (WBE) can be used as a rapid, sensitive,
and cost-efficient surveillance system for SARS-CoV-2 in cities, neighborhoods, campuses, andbuildings. Throughout natural disasters, public health emergencies, and environmental hazards,
colleges and universities have been tasked to continue operations adapting to the changes in socialand environmental pressures. The recurring question is whether or not each campus was adequately
prepared to address the COVID-19 pandemic. The project examined 176 United States (US) private
and public colleges and universities’ use of the WBE surveillance tool to monitor the COVID-19
pandemic. The data was gathered from the “COVIDPoops19 Summary of Global SARS-CoV-2
Wastewater Monitoring Efforts,” a live GIS dashboard.
METHOD:We developed a WBE scorecard (score 1-5) to measure readiness, response, and adaptability
for each academic institution. Nearly half of the institutions discontinued WBE surveillance due to lackof funding at one year of use in 2022, while others decided to stop after 75%+ of the student
population became fully vaccinated.
RESULTS:The overall scorecard analysis found that public (71.6%) and private (25.6%) schools had
similar frequency results across scoring points. For both public and private schools, 85.2% had an
Institution-Wide Goal for WBE. The project further compared the scoring of WBE efforts for regions
and states within the U.S. There were similar scores for all regions with the Northeast scoring (2.5)
the lowest for effective WBE response. The t

OP-scoring states which scored 4 out of 5 included Delaware, Louisiana, North Dakota, Oklahoma, andWisconsin.
CONCLUSIONS:WBE was successfully implemented in about 85% of colleges and universities as asurveillance technique and approximately 60% had defined follow-up actions. This public healthmeasure is worth considering outside of declared emergencies as it can also serve as a prevention tool
to monitor other pathogens of concern such as viral hepatitis and pox viruses.

Keywords: infectious disease, epidemiology, wastewater, surveillance, SARS-CoV-2

FP-122[Air pollution » Particle components]

EC/OC-Analysis coupled to Photoionization
Mass Spectrometry: A novel approach to thecomposition of particular matter for
epidemiological studies
Ralf Zimmermann1, Patrick Martens1, Hendryk Czech1, Robert Irsig2, Andreas Walte2, Sven Ehlert2,
Martin Rigler3, Judy Chow4, John Watson4, Johannes Passig1
1Chair of Analytical Chemistry and JMSC, HMGU and Universität Rostock, Rostock, Germany
2Photonion GmbH, Schwerin, Germany
3Aerosol doo, Ljubljana, Slovenia
4DRI, Reno, USA

BACKGROUND AND AIM:The Elemental-Carbon (EC) and Organic-Carbon (OC) content of ambientparticulate matter (PM) are important parameters in air pollution-oriented environmental healthstudies (epidemiology). However, the OC-fractions characterization need to be improved for modern
epidemiological studies. The novel instrumental approach Photo Ionization Mass Spectrometry (PIMS)
enables the rapid characterization of highly health relevant organic compounds such as Polycyclic
Aromatic Hydrocarbons (PAH). In this contribution a new approach for a parallel analysis of importantchemical air-toxicants during standard EC/OC-analysis of PM-loaded filters by PIMS is presented.
METHOD:For epidemiological studies, carbonaceous matter in PM often is described by theirorganic/elemental carbon content (OC/EC), as measured by Thermal-Optical Carbon Analysis (TOCA
with e.g. IMPROVE-A protocol). A PIMS-system (Photonion GmbH, PhotoTOF) is hyphenated to a
TOCA-system (Magee Inc., DRI Model 2015/2). The TOCA-PIMS combination largely extends theobtainable information and result in a fast and simple molecular analysis of the different thermal
fractions. In particular, the profile of the important, highly health-relevant, carcinogenic Polycyclic
Aromatic Hydrocarbons (PAH) is detected by Resonance-Enhanced MultiPhoton-Ionization (REMPI)
mass spectrometry (Diab et al., AMT 2015; Miersch et al. STOTEN 2019). Furthermore, the healthrelevant PM-oxidation state of the OC-fractions is measured in parallel by Electron Ionization (EI).
RESULTS:The new hyphenated TOCA-PIMS instrument is applied to many different PM sources (ship-,jet- and gasoline car- engines, biomass combustion) as well to ambient air samples. Furthermore
model-aerosols and photochemically aged emissions are investigated. The improvement of the source
apportionment-capability and the toxicant-detectability as well as the applicability foe epidemiology is
discussed. The toxicity/carcinogenicity of the PM caused by the PAH content can be evaluated by the
Toxicity Equivalent Factor-approach..
CONCLUSIONS:A novel TOCA-PIMS analyzer for rapid and sensitive description of health-relevant
parameters in the carbonaceous fractions of PM has been developed. The system is now commerciallyavailable, enabling improved epidemiological- and exposure characterization-studies.

Keywords: Air pollution, Exposure assessment, Mixtures analysis, Environmental epidemiology,
Cancer and cancer precursors

FP-123[Chemical exposures » Pesticides]

Mixture analysis of serum organochlorine
pesticides concentrations and breast cancer inwomen from Northern Mexico
Rodrigo Ugalde Resano1, Ángel Mérida Ortega1, Mariano E Cebrián García2, Lizbeth López Carrillo1
1Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
2Department of Toxicology, Center for Research and Advanced Studies of the National Polytechnic

Institute, Mexico City, Mexico

BACKGROUND AND AIM:We aimed to evaluate the association between breast cancer (BC) and serum
concentrations of organochlorine pesticide (OCP) mixtures, and to identify the main OCP contributors
within the mixtures.
METHOD:We included 767 histopathologically confirmed incident BC cases and 908 controls from a
population-based case-control study conducted from 2007 to 2011 in Northern Mexico. We obtained
information about sociodemographic, lifestyle and reproductive characteristics by in-person interviews.
Blood samples were collected from women at moment of recruitment to analyze 24 OCPs using gas
chromatography/mass spectrometry. We used Weighted Quantile Sum (WQS) regression to assess theassociation of BC and the exposure to multiple lipid corrected serum concentrations of OCPs (ng/gtotal lipid), and the contribution of each compound within the mixture. Models were adjusted by age,body mass index, years exposed to endogenous estrogens, education and total serum lipids.
RESULTS:We found a positive association between a OCP mixture and BC (OR: 2.14, 95%CI: 1.54 –2.95), where the primary contribution came from hexachlorocyclohexane (42%), endosulfan (18%)
and endosulfan sulfate (15%). On the other hand, we also identified a mixture negatively associated(OR: 0.12, 95%CI: 0.08 – 0.17), characterized by p,p’-DDE (38%), o,p’-DDE (13%), nonachlor (13%)
and p,p’-DDD (13%).
CONCLUSIONS:To our knowledge, this is the first epidemiological report that evaluates the association
between serum concentrations of OCP mixtures and BC, in which we identified two OCP mixturescontrastingly associated with this tumor. Further research is needed on the biological mechanisms of
the OCPs within the mixtures and their BC relationship. This study was supported by CONACyT (2019– 137732).

Keywords: pesticides, cancer, female, mixtures analysis

FP-124[Air pollution » Ozone]

Seasonal Variations in Mortality Risk Associatedwith Ozone Concentrations in Tokyo, Japan
Satbyul Estella Kim1, Yasushi Honda1, Masahiro Hashizume2, Chris Fook Sheng Ng2, Oka Kazutaka3,
Tatsuya Nagashima4
1Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
2Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
4Regional Environment Conservation Division, National Institute for Environmental Studies, Tsukuba,

Japan

BACKGROUND AND AIM:Ozone concentrations and their health impacts can vary throughout the year
due to various factors such as meteorological conditions and human activities. The aim of this study
was to investigate the seasonal variations in the risk of mortality associated with increases in ozone
concentrations in Tokyo, Japan (2009–2015), where current WHO regulatory standards and guidelines
are met.
METHOD:We performed time-series analyses using generalized linear models with a quasi-Poisson
family. We assessed short-term ozone-mortality associations using distributed lag linear models toaccount for delayed effects of time-varying exposures and quantify net effects over a lag period. We
controlled for time trends and utilized distributed lag non-linear models to impose more rigorous
temperature control. We explored exposure-response curves and conducted stratified analyses by
season, i.e., spring (March–May), summer (June–August), fall (September–November), and winter(December–February).
RESULTS:Ozone concentrations were highest in spring and lowest in winter. The study found thatozone was significantly and positively associated with increased mortality risk throughout all seasons
above the threshold concentration point. Specifically, the mortality risks for ozone showed a clear
pattern with positive associations during spring and summer, but no significant associations during fall
and winter.
CONCLUSIONS:Based on the findings, ozone-related health effects can be prevented by maintaining
standards substantially lower than the WHO guidelines. Furthermore, the study highlights theimportance of considering the season when implementing effective public policies to further reduce
adverse health effects.

Keywords: Ozone, Seasonality, Mortality, Time series, Health effects

FP-125[Air pollution » Long-term exposure]

Seasonal Differences in Indoor Exposure toPM2.5 and Household Characteristics inPatients with Idiopathic Pulmonary Fibrosis
Seokmin Ji1, Giryeon Bae1, Kyumin Kim1, Miyoun Shin2, Soyoung Han3, Seunghyun Cho4, Heeyoung
Yoon5, Jinwoo Song6, Sunyoung Kim7
1Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
2Department of Cancer Control and Population Health, Graduate School, National Cancer Center,

Goyang, Republic of Korea
3Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea
4Department of Exposure and Protection, Research Triangle Institute, Carolina, USA
5Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
6Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea
7Department of AI and Digital Health, Graduate School, National Cancer Center, Goyang, Republic ofKorea

BACKGROUND AND AIM:Adverse health effects of PM2.5 could be greater in susceptible populations
such as patients with chronic lung diseases, who stay long indoors for long periods of time. In
addition, indoor PM2.5 concentrations are affected by household characteristics that may vary with theseason. However, few studies have focused on indoor exposure in these patients, and even fewer have
paid attention to seasonal differences. This study aims to compare the relationships between
household characteristics and indoor PM2.5 concentrations across four seasons in patients with
idiopathic pulmonary fibrosis (IPF).
METHOD:We monitored indoor PM2.5 level in the homes of 110 patients with IPF for 5days in each of
the four seasons from September, 2021 to August, 2022. We measured PM2.5 concentrations using
the MicroPEM (RTI, USA) and interviewed each patient to obtain household characteristics, including
demographics, home environments, lifestyles, and perception to indoor air pollution. To investigate
the relationships between each household characteristic and PM2.5 concentrations by season, weapplied T-test and one-way ANOVA.
RESULTS:Although we did not find statistically significant differences in PM2.5 concentrations acrossmost household characteristics, possibly because of small sample sizes, some characteristics showed
differences in autumn and winter. In winter, PM2.5 concentrations were higher with multi-household
housing (42.2 [multi] vs. 10.2 μg/m3 [single]), floors lower than five (27.6 [<5] vs. 11.2 μg/m3[5≥]) and housing prices less than 7.6 million US dollars (56.7 [<7.6] vs. 12.9 μg/m3 [7.6≥]),compared with those without. Among all seasons, patients tended to have a positive perception forboth indoor and outdoor air pollution in autumn (60.6% [autumn] vs. 18.1% [summer] vs. 11.5%[winter] vs. 9.8% [spring]; however, average PM2.5 concentrations were higher in autumn(17.1μg/m3) than in spring (15.3μg/m3) and summer (11.2μg/m3).
CONCLUSIONS:Our findings on the first-year monitoring suggest seasonal differences in PM2.5
concentrations according to some household characteristics.

Keywords: Particulate matter, Exposure assessment-air pollution, Long-term exposure, Internal
exposome, Socio-economic factors

FP-126[Cancer and cancer-precursors » Incidence]

Analysis of the mortality rate of pancreaticcancer under multiple exposures to air pollution
and diet
Shu Yi Wang1, Jia Fen Chen1, Szu Pei Chien1, Wan Ting Hsu1, She Yu Chiu2, Chi Chang Ho3, Wei Min
Chu4, Yu Tse Tsan4, Hua Lung Yu5, Wen Chao Ho1, Pau Chung Chen6
1Department of Public Health, China Medical University College of Public Health, Taichung, Taiwan
2National Health Research Institutes, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
4Taichung Veterans General Hospital, Taiwan
5Department of Bioenvironmental Systems Engineering, National Taiwan University, Taiwan
6Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; Department of Public Health, National Taiwan University College of
Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan;
National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,
TaiwanBACKGROUND AND AIM:Until now, the cause of pancreatic cancer is unknown. It is only known thatsmoking, chronic pancreatitis, obesity, long-term diabetes, family history of pancreatic cancer, and adiet of red meats and processed meats will increase the risk of pancreatic cancer. In terms of gender,
it is the eighth and fifth leading cause of cancer death for men and women respectively. Therefore, wewould like to explore the correlation between air pollution, diet, and pancreatic cancer.
METHOD:A retrospective cohort study was used to analyze the mortality rate of pancreatic cancer
under multiple exposures to air pollution and diet in each county in Taiwan from 2005 to 2018.
RESULTS:For pancreatic cancer mortality analysis, the single pollutant model showed a significant
adverse effect in females including O3 only; in males, including PM2.5 and O3. For the model of two
pollutants, only O3 showed a significant effect on the mortality of pancreatic cancer for both genders.
For consumption data, red meat and processed meat showed no significant effect. Furthermore, when
considering multiple environmental exposures, it was found that the interaction terms of air pollutants(PM2.5 and O3) and food intake are related to increasing pancreatic cancer mortality rate in females,
but not in males.
CONCLUSIONS:For pancreatic cancer mortality analyses, multiple exposures to air pollution and dietcan be important to be considered individually and together in gender-specific way. Further study issuggested.

Keywords: pancreatic cancer, air pollution, diet

FP-127[Exposures » Microbes/Microbiome]

The impact of indoor microbiome on allergic
diseases in preschool children
Ssu Yin Chen1, Hsing Jasmine Chao2, Fang I Hsieh2, Ling Chu Chien2
1Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei,

Taiwan2School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

BACKGROUND AND AIM:In recent years, the prevalence of allergic diseases has continued to rise
globally, affecting many populations. Studies have indicated that indoor bacteria and fungi areassociated with childhood allergic rhinitis and atopic dermatitis, but few studies simultaneously
investigated the effects of indoor bacteria and fungi on allergic diseases in children. The aim of thisstudy is to characterize the distributions of bacteria and fungi in children's homes and explore thecorrelation between indoor microbiome and allergic diseases in children.
METHOD:The study subjects were recruited from a pediatric clinic at a medical center in Taipei Cityand consisted of children under the age of seven. Environmental sampling was conducted in children’s
homes to measure indoor pollutants. Next-generation sequencing was used to analyze the bacterial
and fungal microbiome in children's bed dust. Information on allergic diseases (i.e., allergic rhinitis
and atopic dermatitis), demographic data, and home environmental characteristics were collected
through questionnaires.
RESULTS:Forty percent of children have doctor-diagnosed allergic rhinitis, and 30% have doctordiagnosed atopic dermatitis. Over half of the children’s bedrooms feel damp, and 70% of thehouseholds have visible mold. The predominant bacteria found in dust on children's beds
was Staphylococcus, and the predominant fungi was Malassezia. According to the preliminary analysis,
the levels of ozone and formaldehyde were associated with children’s allergic diseases. The
relationship between microbiome and allergic diseases will be further analyzed.
CONCLUSIONS:The damp bedrooms and mold inside homes could contribute to the development of
respiratory and skin-related conditions. The presence of microbiome in children's bed dust is apotential source of allergens or irritants affecting children's health. Overall, the findings suggest aneed to improve indoor environmental quality and hygiene to reduce the health risk of preschool
children.

Keywords: Microbiome, Allergies

FP-128[Air pollution » General]

Causal association of particulate matter air
pollution (pm10) on liver cancer: Using
Multivariable Mendelian Randomization
Suhyun Lee1, Jiwoo Beak2, Sunha Jee3
1Su Hyun Lee
2Ji Woo Baek
3Sun Ha Jee

BACKGROUND AND AIM:Particulate matter air pollution (PM10) is known to increase the risk ofvarious cancer including liver cancer. In addition, both body mass index (BMI) and serum gammaglutamyl transferase (GGT) have been reported to be associated with liver cancer risk. However, but
most of them are observational studies and no causal conclusions can be drawn. Multivariable
Mendelian randomization (MVMR) was performed to investigate the causal relationship between PM10
on liver cancer.
METHOD:Two-sample MR analysis was performed using genetic markers of BMI and liver cancer
identified in the Genome Wide Association Study (GWAS) at the GIANT Consortium and UKB,
respectively. The genetic markers of serum GGT were sampled from the biobank of Japan and thegenetic markers of PM10 were sampled from the UKB. The MR-Base platform was used for analysis.
Finally, multivariable MR was performed to examine the mediating effect of PM10 on liver cancer.
RESULTS:In the univariable two-sample MR analysis, three factors which were 1) PM10 (OR=0.9995,
95% CI=0.9972-1.0018), 2) GGT (OR=1.0002, 95% CI=0.9998-1.0005), and 3) BMI (OR=1.0001,
95% CI=0.9996 -1.0006) showed a non-significant association with liver cancer. Outliers weredetected and removed through radial MR analysis, but the results of univariate two sample MR weresimilar to those before outlier removal. Finally, in the MVMR analysis that controlled for BMI and GGT,
PM10 did not show a significant causal relationship with liver cancer.
CONCLUSIONS:This study suggests that pm10 does not have a significant causal relationship with therisk of liver cancer. In the future, it seems that there should be continuous research through various
and precise data of individual exposure.

Keywords: particulate matter air pollution (PM10), body mass index, Mendelian randomization, livercancerFP-129[Air pollution » Other (to be specified with keywords in the keywords section)]

Cooking fuel during pregnancy, PM2.5
Exposures and birth outcomes of babies in
Kalutara Children’s Health Study
Sumal Nandasena1, Rajitha Wickremasinghe2, Nalini Sathiakumar3
1Regional Directorate of Health Services, Kalutara, Sri Lanka
2Faculty of Medicine, University of Kelaniya, Sri Lanka
3Late Professor, School of Public Health, University of Alabama at Birmingham, Birmingham, USA

BACKGROUND AND AIM:Exposure to indoor air pollution from biomass fuels is a major health burden
in developing countries. Birth outcomes determine the health status in later life.Aim of the study is tocompare birth outcomes among female residents in households using a mixture of cooking fuels
during pregnancy.
METHOD:Pregnant mothers (n = 475) in the third trimester of the pregnancy were recruited andfollowed up. Birth weight, occipitofrontal circumference (OFC), and length of the newborn babies wereascertained from the Child Health Development Record. The study sample was categorized into twogroups based on the cleanliness of cooking fuel (e.g., clean fuel - electricity, liquid petroleum gas vs.
unclean fuel – wood, kerosene). The kitchen PM2.5 were monitored for 24 hours in a subsample ofhouseholds, every six months over the two years since the birth of the child.
RESULTS:Primary cooking fuel in 167 (35.2%) households were clean fuel. Secondary cooking fuelwas used by 380 (80.0%) households and tertiary cooking fuel was used by 161 (33.9%) households.
There were 446 (95.1%) term babies and 23 (4.9%) pre-term babies. There were 17 (10.2%) Low
Birth weight(<2500g) babies in clean energy-using households and 44 (14.3%) in unclean clean
energy-using households as primary cooking fuel. Prematurity was less among mothers in households
using a clean primary cooking fuel (3.6%) as compared to mothers in households using an unclean
primary cooking fuel (4.9%). PM2.5 monitoring every six months and four times in a sample ofhouseholds (n = 81) showed that the PM2.5 concentration is 2-3 times higher in the unclean primary
fuel-using households.
CONCLUSIONS:Majority of the households use more than one cooking fuel (i.e., unclean or clean).
Using a mixture of fuel types reduces exposures and improves birth outcomes, but relying on 100%
clean energy would improve the birth outcomes further.

Keywords: biomass fuel, indoor air pollution, birth outcomes, low birth weightFP-130[Air pollution » General]

Effect of Ambient Air Pollution on Years of Life
Lost from Deaths due to External Causes in
Seoul, South Korea
Sun Woo Kang, Gyeong Chan Kim, Subin Jeong, Hyewon Lee
Department of Health Administration and Management, Soonchunhyang University, Asan, South Korea

BACKGROUND AND AIM:We aimed to investigate the association between short-term exposure toambient air pollution and years of life lost (YLLs) from deaths due to external causes.
METHOD:Data on daily YLLs for 2002-2021 were obtained from the Death Statistics Database of
Korean National Statistical Office. This study estimated short-term exposure to particles <10μm(PM10), particles <2.5μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide(CO), and ozone (O3). This time-series study was conducted using a generalized additive model(GAM) assuming a Gaussian distribution. We also evaluated delayed effects of ambient air pollution by
constructing lag structures up to 7 days. To explore effect modification by demographic factors (sexand age) and intention/mechanism of injury (unintentional [traffic accident, fall, others] injury andintentional injury [self-harm, assault]), we conducted stratified subgroup analyses.
RESULTS:During the study period, 78,175 deaths by external causes occurred, and the average daily
YLLs by external causes was 315.2 years. In the intentional injuries, PM2.5 (2.76; 95% CI: 0.06-5.46;
lag4), NO2 (7.25; 95% CI: 3.48-11.01; lag7), CO (3.38; 95% CI: 0.20-6.56; lag7), and O3 (5.74;
95% CI: 1.29-10.18; lag3) were associated with a significant increase of the YLLs. In the fall, PM10(0.90; 95% CI: 0.15-1.65; lag04) and O3 (1.60; 95% CI: 0.32-2.89; lag0) were associated with asignificant increase of YLLs from external causes. In the other unintentional injuries, PM10 (0.97; 95%
CI: 0.11-1.82; lag01) and PM2.5 (1.07; 95% CI: 0.06-2.08; lag1) were associated with a significant
increase of the YLLs. In the case of traffic accidents, all air pollutants showed negative association
with the YLLs.
CONCLUSIONS:Our results suggest that ambient air pollutants can cause death by external causes,
and these findings could contribute to the establishment of public health policies to manage accidental
death and reduce ambient air pollutants concentration.
(No. 2022R1C1010045)

Keywords: Air pollution, Particulate matter, Oxides of nitrogen, Ozone, Short-term exposureFP-131[Air pollution » Short-term exposure]short-term effects of air pollution on Acute
Exacerbations of Chronic Obstructive Pulmonary
Disease (AECOPD) in a population-based cohort
Sung Hwa Kim1, Jihye Lim1, Jae Hun Han1, Dae Ryong Kang2
1Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
2Department of Precision Medicine and Biostatistics, Yonsei University Wonju College of Medicine,

Wonju, Korea

BACKGROUND AND AIM:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD)
describe the condition of sudden deterioration in airway function and respiratory symptoms in COPD
patients, requiring a change in treatment. Short-term exposure to high levels of air pollution is one ofmajor impacts on respiratory illness. The purpose of this study is to reduce health care costs andimprove end-of-life care by managing short-term air pollution factors associated with AECOPD inpatients with COPD.
METHOD:This study used data that linked national population data from the National Health Insurance
Service-National Sample Cohort and Air Korea data managed by the Ministry of Environment. All
subjects were adult patients who were first diagnosed with COPD between 2015 and 2019. To
evaluate the short-term effects of exposure to air pollution (SO2, CO, NO2, PM10, PM2.5) on the
AECOPD, a nested case-control study was conducted utilizing 2,114 patients and 4,228 control
subjects who were matched at a 1:2 ratio by age group, sex, smoking type, and income. Data wereanalysed using generalized additive models (GAM).
RESULTS:We observed strong associations of CO, NO2, and PM10, PM2.5 with AECOPD on lag days 0,
1, 2, 3, and 4. The overall relative risk (95% CI) for AECOPD from exposure to four air pollutant wereas follows: 1.012 (1.003–1.023) for CO, 1.015 (1.005–1.026) for NO2, 1.015 (1.006–1.026) for
PM10, and 1.012 (1.003–1.023) for PM2.5. The similar results were obtained as in average lag (0–1,
0–2, 0–3, 0–4, 0-5 days). Additional analyzes of COPD-related disease exacerbation (pneumonia,
dyspnea, etc.) were also showed some significant.
CONCLUSIONS:Our results showed that hospital visits for AECOPD were associated with the measured
concentrations of ambient air pollutants NO2, CO, PM10, and PM2.5. Further studies are required toconfirm these associations and find their mechanisms. The indoor air measurement for the
management of COPD patients will be needed.

Keywords: air pollutant, Chronic Obstructive Pulmonary Disease, short-term effect, predictor

FP-132[Air pollution » Long-term exposure]: Associations of long-term exposure to PM2.5
and risk of cognitive impairment or dementia in
English Longitudinal Study of Ageing
Thomas Byrne, Giorgio Di Gessa, Rina So, Paola Zaninotto
Department of Epidemiology and Public health, Institute of Epidemiology and Healthcare, University
College London, London, United Kingdom.

BACKGROUND AND AIM:Although many studies have found associations between exposure to fineparticulate matter (PM2.5) and increased risk of cognitive impairment or dementia, most only
considered air pollution at one point in time. In this study, we evaluate associations between longterm exposure to PM2.5 and cognitive functioning.
METHOD:We used data from the English Longitudinal Study of Ageing, a nationally representative
sample of people aged 50 and older, living in England. The sample analysed consists of 6,331
participants successfully interviewed in 2018-2019 when cognitive functioning was evaluated and withindividual-level exposure to annual mean concentration of PM2.5 between 2010 and 2016. PM2.5 wasestimated by the Data Integration Model for Air Quality at 0.1°×0.1° spatial resolution at each
respondent’s residential address. Logistic regression models were used to estimate the association
between average exposure to PM2.5 and having either mild cognitive impairment or dementia vs no
impairment, adjusting for demographic and socioeconomic characteristics as well as area-level
deprivation, urbanicity, and region.
RESULTS:In models adjusted only for age and sex, PM2.5 averaged between 2010 and 2016 was
associated with an increased odds of cognitive impairment or dementia (OR: 1.30, 95%CI: 1.06, 1.59)
per 5 µg/m3. However, this association disappeared when adjusting for additional confounding
variables (OR: 0.90, 95%CI 0.65, 1.24).
CONCLUSIONS:Further analyses using latent profile analysis to identify different trajectories of
exposure to PM2.5 are expected to shed more light on the extent to which prolonged exposures todifferent levels of PM2.5 relate with cognitive functioning.

Keywords: Air pollution, Particulate matter, Neurodegenerative outcomes, Long-term exposure,
Epidemiology

FP-133[Neurologic and mental health outcomes » Mental health outcomes]

Air pollution and mental health in mid to older
age: results from the MRC National Survey ofHealth and Development
Thomas Canning1, Helen L Fisher2, Marcus Richards3, Anna Hansell4, John Gulliver4, Rebecca Hardy5,
Jorge Arias De La Torre6, Stephani Hatch7, Ian Mudway8, Amal R Khanolkar9, Ioannis Bakolis10
1Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and

Neuroscience, King’s College London, London, United Kingdom and Social, Genetic & Developmental
Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London,
United Kingdom
2Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King’s College London, London, United Kingdom and ESRC Centre for Society and
Mental Health, King’s College London, London, United Kingdom
3MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
4Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United

Kingdom
5Social Research Institute, University College London, London, United Kingdom and School of Sport,

Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
6Centre for Implementation Science, Health Service and Population Research Department, Institute of

Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom and CIBER
Epidemiology and Public Health (CIBERESP), Madrid, Spain and Institute of Biomedicine (IBIOMED),
University of Leon, Leon, Spain
7ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom and

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, United Kingdom
8Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College

London, London. United Kingdom and MRC Centre for Environment and Health, School of Public
Health, Faculty of Medicine, Imperial College London, London, United Kingdom
9MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom

and School of Life Course & Population Sciences, King’s College London, London, United Kingdom
10Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and

Neuroscience, King’s College London, London, United Kingdom and Centre for Implementation
Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, United Kingdom

BACKGROUND AND AIM:Existing evidence on associations between exposure to air pollution andmental health symptoms in middle to older age is limited by short exposure periods or cross-sectional
designs. We examined this association over a 25-year period in later adulthood.
METHOD:This prospective study utilised data from the MRC National Survey of Health andDevelopment (NSHD: the British 1946 birth cohort) (N=2123, 49% Male). Land-use regression models
estimated exposure to specific air pollutants using household addresses at age 43 (NO2, Black Smoke,SO2), at age 55 (PM10, NO2), and at age 60-64 years (PM2.5, PM10, NO2, NOx, PMabs, PMcoarse).
Mental health was based on the self-reported 28-item General Health Questionnaire (GHQ28) at ages
53, 60-64 and 69, and presence of depression defined by anti-depressant medication use and self-reported diagnosis at ages 53, 60-64 and 69 years.
Regression models examined the association between inter-quartile levels of air pollution exposure atages 43, 55 and 60-64 with mental health at age 69 for each pollutant separately. Longitudinal multilevel models examined associations over 25 years for NO2 and 15 years for PM10. All models
controlled for social class, area deprivation, smoking at closest timepoint to exposure, historical air
pollution exposure, and history of mental health problems.
RESULTS:None of the air pollutants showed any association with depression or continuous GHQ28score in prospective models. In fully adjusted longitudinal models, NO2 did not have any association
with GHQ28 (β=0.008; 95% CI: -0.006-0.023) or depression (OR=0.96; 95% CI: 0.85-1.07) nor did
PM10 (GHQ28: β=0.012; 95% CI: -0.004-0.027; depression: OR=1.05, 95% CI: 0.91-1.21).
CONCLUSIONS:There was no evidence in this cohort of an association between exposure to air
pollution in middle to older age and mental health outcomes. This may be due to bias in the sample
from loss to follow-up or challenges in exposure modelling over time.

Keywords: Air pollution, Environmental epidemiology, Long-term exposureFP-134[Built environment » Blue space]

Associations between residential distance togreen or blue space and hospitalization for
cardiovascular disease: a Danish Nurse Cohort
study
Yujing Li, Jiawei Zhang, Stéphane Tuffier, Zorana J. Andersen, Youn Hee Lim, Thomas Cole Hunter
1. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

BACKGROUND AND AIM:Evidence on the associations between natural surroundings andcardiovascular disease (CVD) is inconsistent. Our longitudinal study aimed to explore the associationsof residential distance to green or blue space with hospitalization for CVD using the Danish Nurse
Cohort.
METHOD:We followed 19,070 female nurses residing in Denmark from 1993/1999 to 2018. We
calculated the shortest Euclidian distance from each residential address to seven natural surrounding(zone) exposures (three green space [i.e., park, woodland, heathland] and four blue space [i.e., lake,river, coast, wetland] variables) at 2005 using GeoDanmark Vektor. We estimated associations of the
log-transformed distance with the first hospitalization of total CVD as well as stroke using Cox
proportional hazards models adjusted for potential covariates including individual-level lifestyle factors
and socioeconomic status. Additionally, we explored potential effect modification by age, smoking
status, occupational status, household income, and urbanicity level.
RESULTS:A total of 8,179 CVD incident cases over 344,084 person-years occurred. In our mainmodel, a 2.72-fold increase in distance to woodland was associated with a higher risk of stroke
incidence (HR: 1.153; 95% CI: 1.029-1.293); meanwhile, a 2.72-fold increase in distance toheathland was associated with a lower risk of incident CVD (HR: 0.975; 95% CI: 0.955-0.996).
Individuals living in the 1st quartile of proximity to a lake (distance <253 meters) experienced thelowest risk of CVD incidence among all quartiles. We observed no associations between proximity toparks, woodland, rivers, coast, or wetlands and CVD incidence. Younger individuals showed greater
benefits from proximity to natural zones.
CONCLUSIONS:Living closer to some types of green and blue space, studied for the first time by using
geographical zoning and Euclidian distance, is suggested to protect against CVD hospitalization
although the strength of association depends on specific types of natural zones and specific CVD
outcomes, warranting more research on the mechanistic pathways.

Keywords: cardiovascular diseases, green space, incidence, long-term exposureFP-135[Chemical exposures » Phthalates]

Relationships among exposure to phthalates andrenal function in Taiwanese adults
Ting Yi Lin1, Po Chin Huang2, Yuan Ting C. Lo1, Han Bin Huang1
1School of Public Health, National Defense Medical Center, Taipei, Taiwan.
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan.

BACKGROUND AND AIM:Epidemiologic studies on the association between phthalate exposure andrenal function in the general population have been heterogeneous. Therefore, the aim of this study
was to investigate the associations between phthalate exposure and biomarkers of renal function in
the adult population.
METHOD:This is a cross-sectional study. We analyzed data (n=919) from a community-based arm of
Taiwan Biobank (TWB). Urinary phthalate metabolites including mono-ethylhexyl phthalate, mono-(2ethyl-5-oxo-hexyl) phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2ethyl-5-carboxypentyl) phthalate (MECPP), mono-(2-carboxymethylhexyl) phthalate (MCMHP), monobutyl phthalate, mono-iso-butyl phthalate (MiBP), mono-benzyl phthalate (MBzP), monoethyl
phthalate (MEP), and monomethyl phthalate (MMP), as well as the sum of dibutyl phthalate (DBP)
metabolite (ΣDBPm) and di(2-ethylhexyl) phthalate (DEHP) metabolite (ΣDEHPm) molar
concentrations were calculated. Biomarkers of renal function including blood urea nitrogen (BUN), uricacid, and albumin/creatinine ratio (ACR) were assessed and estimated glomerular filtration rate(eGFR) was evaluated using the age-adjusted creatinine CKD-EPI equation (CKD-EPI40). Generalized
linear models and logistic regression models were used to examine the associations between individual
phthalate exposures and renal function biomarkers. We also used Bayesian Kernel Machine Regression(BKMR) to analyze the relationships between mixtures of phthalate exposure and renal function.
RESULTS:We found that urinary DEHP metabolites were significantly positively associated with BUN
and ACR. Urinary MEHHP, MECPP, MiBP and MEP levels were positively associated with uric acid levels.
Urinary MBzP, MEP, ΣDBPm and ΣDEHPm were negatively associated with eGFR. In addition, ΣDEHPm
levels were significantly associated with increasing odds of impaired renal function. In the BKMR
regression model, the mixture of 10 phthalate metabolites was significantly associated with BUN, uricacid, eGFR, and impaired renal function.
CONCLUSIONS:Our results suggest that exposure to environmental phthalates may be associated withadverse kidney function in the Taiwanese adult population.

Keywords: environmental epidemiology, public health, mixtures analysis

FP-136[Air pollution » Particulate matter]

Ambient PM2.5, inflammation, andprostaglandin synthesis: Evidence from apregnancy cohort in Puerto Rico
Trenton Honda1, Trenton Henry1, Laura Corlin2, Kipruto Kirwa2, Akram Alshawabkeh3, José F.
Cordero4, Carmen M. Velez Vega5, Zaira Y. Rosario Pabon6, John Meeker7, Helen Suh8
1School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, USA
2Department of Public Health, Tufts University, Medford, USA
3Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
4Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
5University of Puerto Rico Medical Campus, San Juan, Puerto Rico, USA
6Northeastern University, Boston, USA
7School of Public Health, University of Michigan, Ann Arbor, USA
8Department of Civil and Environmental Engineering, Tufts University, Medford, MA

BACKGROUND AND AIM:Prostaglandin synthesis and production is an important part of normal
physiology during pregnancy. PGF2 is a potent vasoconstrictor and regulates uterine activation
protein expression, while Prostaglandin E2 (PGE2) is involved in promoting labor. Both are also
downstream products of the arachidonic acid inflammatory pathway and are byproducts of thearachidonic acid cascade, resulting from cell membrane injury. While PM2.5 is known to impact healththrough systemic inflammation and has been associated with adverse pregnancy outcomes, how andto what extent it perturbs prostaglandin synthesis during pregnancy is unclear.
METHOD:We used linear models and generalized estimating equations to investigate associations
between PM2.5 and maternal levels of PGE2, PGF2-alpha and arachidonic acid (AA) in a cohort of
1,117 pregnant women living in Puerto Rico. Participant-specific 30-day moving average PM2.5
exposures were estimated using inverse distance weighting from Air Quality System monitors.
Biomeasures were analyzed in blood collected at study visits. Models were adjusted for gestational age
at blood draw, parity, adverse pregnancy history, age, race, education, employment status, income,marital status, exercise, pre-pregnancy body mass index, and seasonality.
RESULTS:30-day moving average PM2.5 exposure was 9.1ug/m3. Mean PGF2-alpha levels were 3.1,
3.1, and 3.9ng/mg, respectively, while mean AA level was 13.8umol/L and mean PGE2 level was 3.
nmol/L. A 10 ug/m3 increase in the 30-day moving average PM2.5 exposure was associated with anincrease in AA of 33.8% (95% CI:4.9,70.6). The same exposure was associated with an increase in
PGE2 of 53.6% (95% CI:14.7,105.6) and a decrease in PGF2-alpha of 14.7% (95% CI:-25.5,-2.3).
Statistically significant dose response relationships were observed. Mediation of the effect of PGE2 or
PGF2a was not identified through AA.
CONCLUSIONS:Our findings suggest that ambient PM2.5 is associated with elevated biomarkers of cell
membrane injury and inflammation, as well as perturbed prostaglandin synthesis during pregnancy.

Keywords: PM2.5, pregnancy, prostaglandin, inflammation

FP-137[Outcomes » Infectious diseases]

Airborne influenza virus in daycare centers
Tsai Chi Hung, Jia Lin Zhang, Yi Lien Lee, Pei Shih Chen
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City
807, Taiwan, Republic of China

BACKGROUND AND AIM:This study investigated the concentration of airborne influenza virus in
daycare centers and influence factors, such as common colds prevalence, air pollutants,
meteorological factors.
METHOD:A total of 209 air samples were collected from daycare centers in Kaohsiung and influenza
virus was analyzed using real-time quantitative polymerase chain reaction. Air pollutants andmetrological factors were measured using real-time monitoring equipment.
RESULTS:Winter had the highest positive rates of airborne influenza virus and the highest prevalenceof the common cold, followed by summer and autumn. The concentration of CO was significantly
positively correlated with airborne influenza virus. Daycare center A with natural ventilation and air
condition systems had the higher concentration of airborne influenza A virus, airborne fungi, andairborne bacteria, as well as prevalence of the common cold than those in daycare center B with amechanical ventilation system and air purifiers, while the concentrations of CO2, CO, UFPs in daycare
center A were lower than those in daycare center B.
CONCLUSIONS:We successfully detected airborne influenza virus in daycare centers, demonstratingthat aerosol sampling for influenza can provide novel epidemiological insights and inform the
management of influenza in daycare centers.

Keywords: daycare centers, infectious bioaerosols

FP-138[Outcomes » Childrens environmental health]

Impact of air pollutants from night markets on
nearby households
Tseng Guo Ping, Zhang Jia Lin, Chen Pei Shih
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City
807, Taiwan, Republic of China

BACKGROUND AND AIM:Night markets—a unique element of Asian culture—involve various cooking
methods and combustion, producing air pollutants with adverse health effects. No study examined
whether air pollutants from night markets affect indoor air quality and the lung functions of children
living in nearby households. Accordingly, we measured air pollutant concentrations and children’s lungfunctions in households located near a night market. We evaluated factors influencing indoor air
quality and children’s lung functions, including market opening hours and household distance from themarket.
METHOD:We measured concentrations of particulate matter (PM)1, PM₂.₅, PM10, carbon dioxide(CO₂), carbon monoxide (CO), nitrogen dioxide, sulfur dioxide (SO₂), ozone, total volatile organic
compound (TVOC), airborne bacteria, and fungi in 58 households near the night market by using realtime monitoring equipment; we assessed the lung functions of children in these households. The PM1,
PM₂.₅, and PM10 concentrations were significantly higher during opening hours than during nonopening hours. The lung function values for children were significantly higher in households located>595 m (median distance) from the market than in those located ≤595 m from the market (neargroup). Higher CO₂, CO, SO₂, TVOCs, and PM10 concentrations and poor lung functions in children
were observed in the near group.
RESULTS:The predicted values of VC%, FVC%, FEV1%, and FEV₃% were significantly lower in thenear group than in the far group. The concentrations of PM1, PM₂.₅, and PM10 during opening hours
were significantly higher than those during non-opening hours.
CONCLUSIONS:In conclusion, this study is the first to evaluate indoor air quality in households locatednear a night market and the lung functions of children living in such households. Furthermore, small
particles (PM1) had the highest proportion during the opening hours in both the near and far groups,
indicating the possible influence of combustion in night markets on air quality.

Keywords: night markets, particulate matter, opening hours, distance, households

FP-139[Air pollution » Long-term exposure]

The Association Between Long-term Exposure to
Ambient PM2.5 and Incident Dementia: A
Nationwide Longitudinal Cohort Study
Wei Cheng Lo1, Yi Ting Huang2, Jing Shiang Hwang3
1Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei,

Taiwan2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan

University, Taipei, Taiwan
3Institute of Statistical Science, Academia Sinica, Taipei, Taiwan

BACKGROUND AND AIM:Long-term exposure to ambient air pollution may not only lead to anincreased risk of cardiopulmonary disease, but also associate with neurotoxicity. We aimed toinvestigate the associations between long-term exposure to PM2.5 and risk of incident dementia in
Taiwan.
METHOD:A nationally representative cohort of Taiwanese participants who participated in the National
Health Interview Surveys (NHIS) 2001, 2005, 2009, and 2013 was followed until 2020 to identify any
onset of dementia. Exposure to PM2.5 was estimated using a widespread monitoring network of air
quality monitoring stations and microsensors. The study used time-dependent Cox regression models
to examine the associations between PM2.5 exposure and dementia, while adjusting for individual
characteristics and ecological covariates.
RESULTS:This study enrolled 62,694 adults from 353 towns, with a median follow-up period of 10.5
years (IQR: 7.5-14.5) and 2,935 incident cases of dementia diagnosed was during that time. Each 10
μg/m3 increase in 5-year average exposure to PM2.5 was associated with a 7.9% increased risk ofincident dementia (95% CI: 2.8, 13.4). In the effect modification analysis, vulnerable subpopulations
were identified, including those who were younger than 65 years, male, non-smokers, or without
comorbidities; they have higher hazard ratios (HRs) for the risk of dementia (p value for effectmodification <0.05). Significant geographic heterogeneity was also observed, with individuals living in
northern and western areas having a higher hazard of dementia compared to those living in theeastern area (adjusted HRs ranged from 1.11 to 1.22 for northern and western areas vs. 1.03 for theeastern area).
CONCLUSIONS:This nationwide study revealed that long-term exposure to intermediate level ofambient PM2.5 was associated with a higher risk of dementia. Our findings suggest that ambient air
pollution should be considered when attempting to reduce the burden of dementia in the aging
population of Taiwan.

Keywords: air pollution, long-term exposure, dementia

FP-140[Air pollution » Long-term exposure]

Lung Adenocarcinoma Among Non-smokers is
Linked to Visibility Degradation
Wei Chi Lin1, Ruei Hao Shie2, Chi Hsin Sally Chen1, Tzu Hsuen Yuan3, Chang Chuan Chan1
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan2Green Energy and Environment Research Laboratories, Industrial Technology Research Institute,

Hsinchu, Taiwan
3Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan

BACKGROUND AND AIM:Studies on association between lung cancer and long-term exposure to air
pollution are limited due to the unavailability of air pollution data. The study aims to investigate
association of visibility degradation with lung adenocarcinoma among non-smokers.
METHOD:Our study area, southern Taiwan, with 3.5 million people in 5.7 thousand km², wastransformed from an agricultural to an industrialized society from 1960s to 2020s. Our study data
include annual lung cancer incidence data identified using ICD-O-3 codes from C34.0-C34.9 in Taiwan
Cancer Registry (TCR) and visibility data from Taiwan Weather Bureau. Our study outcomes are
incidence of lung adenocarcinoma among non-smokers between 1997 and 2020. Our exposure forlung adenocarcinoma cases was 30-year cumulative visibility before they are identified in TCR. We
estimate exposure and outcomes by simple and multiple linear regression models at community levelby adjusting age, gender, and EGFR mutation.
RESULTS:From 1997 to 2020, a total of 21,901 lung adenocarcinoma patients were registered insouthern Taiwan. Lung adenocarcinoma incidence increased from 8.91 to 26.94 per 100,000
population from 1997 to 2020 in our study area. Their exposures of 30-years averaged visibility
declined from 14.90 to 7.39 km in the same period. Non-smokers’ lung adenocarcinoma incidence
increased from 11.32 to 17.85 per 100,000 population from 2011 to 2020. Estimates of 3.39 per
100,000 population (95% CI: 2.71-4.07, adjusted R2: 0.94) increase in lung adenocarcinoma
incidence among non-smokers are significantly associated with 1 km decrease in visibility during thisperiod. Such associations exist by using cumulative days with visibility lower than 5 km over 30-years
exposures. After controlling gender and EGFR mutation status, aggravation of visibility is significantly
associated with increase of non-smokers’ lung adenocarcinoma incidence.
CONCLUSIONS:Long-term visibility reduction is associated with increases in lung adenocarcinoma
incidence among non-smokers. Female and EGFR-mutated individuals are susceptible population to air
pollution-related lung adenocarcinoma.

Keywords: Cancer and cancer precursors, Incidence, Exposure assessment-air pollution

FP-141[Air pollution » Particulate matter]

Physical activity modifies the association
between long-term exposure to air pollution anddepression in adults
Woongbi Park1, Heesun Jang2, Jaelim Cho2, Changsoo Kim2, Changsoo Kim3, Changsoo Kim4
1Department of Public Health, Yonsei University College of Medicine
2Department of Preventive Medicine, Yonsei University College of Medicine
3Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
4Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Republic of Korea

BACKGROUND AND AIM:Mounting evidence suggests the effect of long-term air pollution exposure on
depression. However, it is unclear if physical activity modifies this effect. Therefore, this study aimed
to examine whether the association between exposure to air pollution and depression differs byphysical activity intensity in adults.
METHOD:This study included a total of 1,454 individual (556 men and 898 women) dwelling in for
cities (Seoul, Incheon, Wonju and Pyeongchang) in the Republic of Korea. Depression was defined as
the Korean version of the Geriatric Depression Scale score ≥8. Long-term concentrations of particulatematter with diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5), and nitrogen dioxide (NO2) at eachparticipant’s residential address were estimated. Physical activity intensity was categorized as inactive,
minimally active, and health enhancing physical activity (HEPA) based on metabolic equivalents(METs). Using a multivariable logistic regression model, we estimated the associations of PM10,
PM2.5, and NO2 with depression after stratification by the METs group.
RESULTS:A 1-ppb increase in NO2 was associated with an increased risk of depression in the inactive
group (odds ratio, 1.03; 95% confidence interval, 1.00−1.05), the minimally active group (1.09;
1.05−1.13), and the HEPA group (1.09; 1.03−1.15). The risk of depression associated with NO2 wassignificantly higher in the minimally active group than in the inactive group (p for interaction=0.006).
Difference in the association between the inactive and HEPA groups was not statistically significant (pfor interaction=0.06). In men, the risk of depression associated with NO2 was significantly higher inthe minimally active group than in the inactive group (p for interaction=0.047). In women, the risk ofdepression associated with NO2 did not significantly differ by the METs group.
CONCLUSIONS:We found that physical activity intensity modified the association between NO2
exposure and depression.

Keywords: Air pollution, depression, physical activity, metabolic equivalents (METs)

FP-142[Exposures » Food/nutrition]

Associations of serum vitamins with multiple
blood pressure among adults in NHANES, 2017–2018
Xinzhe Cheng, Yue Liang Guo
Institute of Environmental and Occupational Health Sciences, National Taiwan University, No. 17, XuZhou Road, Taipei 100, Taiwan

BACKGROUND AND AIM:In recent years, systemic arterial hypertension has been regarded as one of
the most substantial risk factors for all causes of mobility and mortality worldwide. Previous research
has found some correlations between single serum vitamins and blood pressure. However individual
vitamins cannot account for the occurrence and progression of the disease, it is worthwhile to study
vitamin co-exposure status and its overall effect on blood pressure.
METHOD:Therefore, we estimated the relationship between 13 vitamins and blood pressre status from1107 U.S. adults based on the National Health and Nutrition Examination Survey (NHANES), 2017–2018. We used single exposure model, weighted quintile sum (WQS) regression, and g-computation tobuild linear models, finding the overall effect of the vitamin mixture and the relatively importantcomponents of the mixture. Furthermore, we also built nonlinear regression models using Bayesiankernel machine regression (BKMR) to estimate the functional correlation between multiple vitamins
exposure and blood pressure.
RESULTS:Single expsore model showed that caroteine, crypotoxanthin, vitamin C and vitamin D had
negative effect on blood pressure, while vitamin A and vitamin E have positive effect. For overall effectestimation, among three different models, the vitamin mixture showed significant reducing effect ofsysyolic blood pressre by incresing percentile, while it had no significant effect on diastolic bloodpressure.The WQS model also demonstrated that cis and trans beta caroteine and vitamin D played asignificant role in the systolic blood pressure reduction impact. Furthermore, the dose-response
relationship between multiple vitamins and blood pressure was confirmed by the BKMR model. Same
results as the WQS models，a combined impact of the 13 vitamins was seen on blood pressure; therisk decreased with mixture levels from the 25th to the 75th percentiles.
CONCLUSIONS:Our findings demonstrated a non-linear relationship and non-additive effects between
the 13 joined vitamins and the reduction in systolic blood pressure.

Keywords: Food and nutrition; Cardiovascular diseases

FP-143[Cancer and cancer-precursors » Survival]

Segmentectomy versus Wedge Resection forstage IA Lung Adenocarcinoma – A Populationbased Study
Xu Heng Chiang1, Chih Fu Wei2, Ching Chun Lin3, Jin Shing Chen4, Pau Chung Chen5
1Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, UnitedStates3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan.
4Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
5National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan.

BACKGROUND AND AIM:Based on the existing studies, sublobar resection for early lung cancer was
not inferior to lobectomy with respect to cancer-specific survival. However, the clinical benefits andrisks of sublobar resection including segmentectomy and wedge resection have not been investigatedcomprehensively. The objective of this population-based study was to investigate whether wedge
resection is comparable to segmentectomy in patients with stage IA lung adenocarcinoma.
METHOD:The clinical stage IA lung adenocarcinoma patients were collected from Taiwan Cancer
Registry database between 2011 to 2018. The primary endpoint was lung cancer-specific survival.
Further subgroup survival analyses were conducted based on tumor size. Propensity score matching
was used to balance the baseline differences between the two groups. Survival predictors other than
the surgical procedure were also analyzed using regression model.
RESULTS:Totally, 6598 stage IA lung adenocarcinoma patients who underwent sublobar resection
between 2011 and 2018 were enrolled in this study. Of these, 2061 received segmentectomy and4537 received wedge resection. The mean age was 60.3 ± 11.7, and 66.2% were female. Most
(81.5%) were never smokers. After propensity matching, segmentectomy was associated with betterlung cancer-specific survival then wedge resection especially for 2 cm or larger in tumor size. Except
for the choice of segmentectomy, 75 year old or less, good differentiation, smaller tumor size and nonodal metastasis were also associated with better lung cancer-specific survival.
CONCLUSIONS:Segmentectomy was linked to better lung cancer-specific survival than wedge
resection, particularly for tumors 2 cm or larger. Being 75 or younger, having good differentiation,
smaller tumor size, and no nodal metastasis were also associated with better survival.

Keywords: Sublobar resection, Segmentectomy, Wedge resection, Populationa-based, Early lungadenocarcinoma

FP-144[Cancer and cancer-precursors » Incidence]

Cancer incidence in relation to residential
proximity to coal-fired power plants in Korea
Xue Han1, Jonghyuk Choi1, Hyungryul Lim1, Sanghyuk Bae2, Kyung Hwa Choi1, Mina Ha1, Ho Jang
Kwon1
1Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic of

Korea
2Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,

Republic of Korea

BACKGROUND AND AIM:Cancer is one of the main causes of death worldwide, seriously threatening
human health and life expectancy. This study aimed to investigate the relationship between cancer
incidence and living near coal-fired power plants in Korea.
METHOD:We defined the exposed group as individuals who lived within 2 km of coal-fired power
plants, while the control group consisted of those who had no residential history within 2 km of suchplants. Standardized incidence ratios (SIR) were calculated using the frequency of cancer cases in
National Health Insurance System data from 2007 to 2017. We created a retrospective cohort using
NHIS data from 2007 to 2019, and estimated hazard ratios (HRs) and 95% confidence intervals (CIs)using the Cox proportional hazard model, adjusted for age and health insurance fee.
RESULTS:The ecological study found that the risk of all cancers and all cancers excluding thyroid
cancer in exposed males was 1.11 and 1.15 times higher than in control males, respectively. For
exposed females, the risk of all cancers and all cancers excluding thyroid cancer was 1.05 and 1.06
times higher than in control females, respectively. However, in the retrospective cohort, after
adjusting for confounding factors, the risk of all cancers and all cancers excluding thyroid cancer
among exposed males was only 1.05 and 1.04 times higher than in control males, respectively.
Among females, the risk of all cancers and all cancers excluding thyroid cancer was not significantly
higher in the exposed group compared to the control group.
CONCLUSIONS:The SIR of cancer was significantly higher in the exposed group than the control
group, but this was not the case in a cohort study that adjusted for socio-economic status. Therefore,
it is crucial to consider both residential proximity to power plants and socio-economic status wheninvestigating cancer risk factors to ensure accurate conclusions.

Keywords: Cancer, SIR, HR, SES

FP-145[One health » Public health]

Impact of pregnancy on severity of injury inwomen involved in motor vehicle crashes
Ya-Hui Chang, Tsung-Hsueh Lu, Chung-Yi Li
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

BACKGROUND AND AIM:Although some studies suggest that pregnant women are at higher risk of
injury and may suffer from irreparable consequences, the impact of pregnancy on the severity of
injuries following motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate thepotential impact of pregnancy on the severity of injuries from MVCs.
METHOD:We conducted a retrospective cohort study in Taiwan between 2006 and 2017 and identified
23,559 women victims who encountered MVC during pregnancy and 94,236 age- and calendar yearat MVC matched non-pregnant women victims also involved in MVCs. Injury severity was assessedusing the Maximum Abbreviated Injury Scale (MAIS), as determined by the International Classificationof Diseases Programs for Injury Categorization in R (ICDPIC-R) program, based on the diagnosis of
medical claims within three days after MVCs. Multinomial logistic regression models were used toestimate the odds ratio and corresponding 95% CI of injury severity levels associated with pregnancy
among MVC victims.
RESULTS:Compared to non-pregnant women victims, those who were pregnant had a significantly
higher risk of both severe (aOR=1.79, 95% CI=1.54-2.08) and mild injuries (aOR=8.63, 95%
CI=8.21-9.07) following MVCs. The increased risk of severe injury was particularly evident among
pregnant women who were riding scooters (aOR=4.25, 95% CI=3.58-5.04). Additionally, pregnant
women who experienced MVC but without any injury were more likely to visit a clinic than nonpregnant MVC victims.
CONCLUSIONS:Pregnant women victims, particularly those riding scooters, who are involved in MVCs
have a higher risk of severe injury compared their non-pregnant counterparts. Our findings suggestthat women should consider avoiding riding a scooter and must use restrictive devices during
pregnancy, which would help reduce the severity of injuries sustained in the event of an MVC.

Keywords: Big data, Female, Epidemiology, Outcome, Risk assessment

FP-146[Exposures » Environmental disparities]

Socioeconomic Disparity in Associations ofExposure to NO2 with Hypertension, Diabetes
and Multimorbidity in the Floating Population
Chunlei Han1, Hongyu Li1, Yang Zhao2
1School of Public Health and Management, Binzhou Medical University, Yantai, China
2The George Institute for Global Health, University of New South Wales, Sydney, Australia

BACKGROUND AND AIM:Previous studies on the associations between air pollution exposure andchronic disease multimorbidity are limited and there is a dearth of evidence on socioeconomic
differences in the relationships among floating people. This study aims to examine the associations of
exposure to ambient NO2 with diabetes, hypertension, and multimorbidity in the floating population in
China.
METHOD:The study used the China Migrants Dynamic Survey data in 2017, including information onsocio-demographic characteristics, temperature, humidity, air pollution and other related
meteorological data. The multivariable logistic regression models were performed to examine theassociation between NO2 and chronic diseases in the floating population after adjusting for covariates.
Stratified analyses were also performed to identify whether the association varied across subgroups.
RESULTS:Overall, every 10 ug/m3 increase in annual average of NO2 exposure was associated withincreased odds of hypertension (OR=1.043, 95%CI: 1.007-1.081) and multimorbidity (OR=1.204,
95%CI: 1.094-1.324) in the floating population in China. The results suggested that there was no
significant association between NO2 and diabetes. The stratified analysis showed that there was a highhealth risk of NO2 in older adults, males, low education status and people living in the region with low
economic development in China.
CONCLUSIONS:This study suggests that NO2 exposure was associated with an increased risk ofhypertension and multimorbidity in the floating population, particularly among older people andresidents in the less-developed provinces in China. Air pollution reduction strategies should beconsidered by local policymakers for improving the migrants’ health status.

Keywords: Socioeconomic disparity, Floating population, Air pollution, Multimorbidity, NO2

FP-147[Air pollution » Long-term exposure]Long-Term Exposure to Air Pollution and the
Occurrence of Nonalcoholic Fatty Liver Disease
in Taiwan
Yi Chuan Chen1, Wei Shan Chin2, Shih Chun Pan1, Chih Da Wu1, Chih Da Wu3, Yue Liang Leon Guo1,
Yue Liang Leon Guo4, Yue Liang Leon Guo5
1National Institute of Environmental Health Science, National Health Research Institutes, Miaoli

County, Taiwan
2School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
3Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
4Department of Environment and Occupational Medicine, College of Medicine, National Taiwan

University (NTU) and NTU Hospital, Taipei, Taiwan
5Graduate Institute of Environmental and Occupational Health Science, College of Public Health,National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:This study examined the association between long-term exposure to air
pollutants and the occurrence of nonalcoholic fatty liver disease (NAFLD) by using a longitudinalcohort.
METHOD:The MJ Health Research Foundation is a medical institute that conducts regular physicalexaminations. The development of NAFLD was based on liver ultrasonography, and medical history
was obtained from the questionnaire of an MJ cohort of 44,501 participants who were enrolled
between 2007 and 2016, having 2 or more examinations, compared with cumulative exposure to air
pollutants. The exposure levels to particulate matter with a ≤2.5-μm diameter (PM2.5) and nitrogendioxide (NO2) in the participants’ residential areas at a 50 × 50 m grid resolution, were estimatedusing a hybrid Kriging/land-use regression (LUR) model executed using the XGBoost algorithm and a
hybrid Kriging/LUR model, respectively. Cox regression with time-dependent covariates was conducted
to estimate the effects of annual air pollutant exposure on NAFLD.
RESULTS:During the average follow-up period of 3.6 years, the incidence of NAFLD was 62.1 per
1,000 person-years. After mutual adjustment and adjustments for potential covariates (e.g., age, sex,diet, regular exercise), the result of two-pollutant model indicated that increased risk of NAFLD was
associated with every 10 μg/m3 increase in annual PM2.5 concentration (adjusted hazard ratio [aHR]= 1.07, 95% confidence interval [CI] = 1.02, 1.12) and every 10-ppb increase in annual NO2
concentration (aHR = 1.18, CI = 1.10, 1.25). PM2.5 and NO2 were further classified as low and highconcentrations by median, and the combination of high PM2.5 (>29.8 μg/m3) and high NO2 (>18.7ppb) was associated with incident NAFLD (aHR = 1.45, CI = 1.34, 1.56).
CONCLUSIONS:Our findings suggest that exposure to PM2.5 and NO2 might be associated with theoccurrence of NAFLD.

Keywords: Long-term exposure, Particulate matter, Oxides of nitrogen, fatty liver

FP-148[Chemical exposures » Heavy metals]

Results of Improvement of Work Environment inIndium Handling Workplaces in Korea Confirmed
by Biological Monitoring
Yonglim Won, Hwayeon Lee
Occupational Health Research Bureau, Occupational Safety and Health Research Institute, Ulsan,
Republic of Korea

BACKGROUND AND AIM:Indium is a key material used in display manufacturing. After indium lungdisease was reported in Japan in 2003, a study was conducted in Korea in 2012 to confirm lungdisease of indium handling workers. A number of workers with interstitial lung disease were identified,and based on the research results, the concentration limit of serum indium was suggested as 1.2 μg/L.
Continuous improvement of the workplace has been carried out, and from 2021, indium handlingworkers must undergo medical checkups prescribed by the law. Through the comparison of serum
indium concentration, we tried to compare the results of improvement in the working environment ofindium handling workplaces.
METHOD:After institutionalization, workers' serum indium concentrations were compared with those at
the time of the first survey in 2012. The serum indium concentrations of 3 target manufacturers, 3
display manufacturers, and 4 indium recyclers that participated in the 2012 survey were comparedwith those in 2022.
RESULTS:The average concentration of the entire comparative workplace in 2012 and 2022 was 4.8
μg/L and 0.7 μg/L, confirming that the serum indium concentration decreased after the improvementof the working environment. By industry, the indium recyclers showed the largest decline from 14.3
μg/L to 4.1 μg/L, and the target manufacturer decreased from 4.2 μg/L to 2.1 μg/L. Display
manufacturer did not show any significant change. In some workplaces or in some workers who
participated in the 2012 survey, the serum indium concentration was higher than in 2012.
CONCLUSIONS:Since the 2012 survey, until 2021 when work environment evaluation and medical
checkup were mandatory, each manufacturer has made a lot of efforts to improve the working
environment and believes that the desired results have been achieved. However, some of the small
companies still need improvement.

Keywords: Indium, Improvement of Work EnvironmentFP-149[Policy » Policy research]

The Effect of Trauma and Age on Prisoner
Disposition and Time Spent in the Emergency
Department
Young Koh1, Shaun Tay2, Jia Yin Yan2, Beng Hoong Poon2, Kevin Kuan2, Siang Hiong Goh2
1Department of Graduate Medicine, Duke-NUS Medical School, Singapore
2Department of Emergency Medicine, Changi General Hospital, Singapore

BACKGROUND AND AIM:In Singapore, epidemiological information about the health of inmates islimited. A description of inmates who present in the emergency department will serve as valuableepidemiological knowledge. This will elucidate their impact on the healthcare system and identify
potential gaps and challenges in their treatment for further future studies.
METHOD:This study is a retrospective analysis of data from the Singapore Changi General Hospitalemergency department between 1 January 2019 and 31 December 2019. All data extracted is deidentified. The duration spent in the emergency department and rate of admission are the twooutcome variables that assessed for significant associations with characteristics of the inmate
population at presentation, which include age, gender, vital signs (heart rate, systolic blood pressure,diastolic blood pressure, temperature, blood oxygen saturation), presence of blood-borne infections,involvement of trauma at presentation, and body system involved at presentation.
RESULTS:The factors found with significant associations to disposition are as follows: age, bodysystem involved at presentation, presence of blood borne illnesses, vital signs, and the MEWS. There
were significant associations to duration spent in the ED with: body system involved at presentationand the involvement of trauma at presentation. In subgroup analysis based on the presence of trauma
for the associations between the body systems involved at presentation and disposition, the absenceof trauma yielded more significant associations to disposition. In a similar subgroup analysis toduration, similar associations were seen.
CONCLUSIONS:As a preliminary retrospective cross sectional study, this study suggests that there areassociations viable for further investigation. Namely, between the clinical outcomes of disposition andduration spent at ED and the presentation factors of presence of trauma and the body system
involved.

Keywords: Epidemiology, Policy and practiceFP-150[Chemical exposures » Phthalates]

Associations of phthalate exposure with glucose
and lipid metabolism in Taiwanese adults
Yu Chi Liang1, Po Chin Huang2, Yuan Ting C. Lo1, Han Bin Huang1
1School of Public Health, National Defense Medical Center, Taipei, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

TaiwanBACKGROUND AND AIM:Previous studies regarding relationships between phthalate exposure andmetabolic effects, including glucose and lipid metabolism, were inconsistent. Therefore, we aimed toinvestigate the relationships between phthalate exposure and indicators of glucose and lipid
metabolism in the Taiwanese adult population.
METHOD:Study participants were recruited from the community-based arm of the Taiwan Biobank (n=934). Participants' daily intake (DI) and hazard index (HI) of phthalates were calculated based on theirurinary concentrations of phthalate metabolites, and the reference limit value adopted by the US EPA
for hepatotoxicity of phthalates. Indicators of glucose and lipid metabolism, including fasting glucose,
triglyceride-glucose (TyG) index, total cholesterol (TC), triglycerides (TG), high-density lipoproteincholesterol (HDL-C), and low-density lipoprotein cholesterol, were evaluated. Generalized linear
models were used to examine the associations between DI, HI of phthalate exposure with metabolic
indicators after adjustment for covariates.
RESULTS:There were three subjects whose HI_EPA exceeded 1, representing 0.4% of the total. We
found that the TyG and TG levels in the fourth quarter (Q4) group of DI_DiBP were significantly higher
than those in the first quarter (Q1) group (β = 0.071, 95% CI = 0.020, 0.121, p for trend = 0.016 for
TyG; β = 0.131, 95% CI = 0.035, 0.226, p for trend = 0.007 for TG). The TC levels in the Q4 group of
HI_EPA were significantly lower than those in the Q1 group (β = -0.042, 95% CI = -0.073, -0.010, p
for trend = 0.004 for HI_EPA). Furthermore, the HDL-C levels in the Q4 group of HI_EPA weresignificantly lower than those in the Q1 group (β = -0.046, 95% CI = -0.090, -0.002, p for trend =0.027 for HI_EPA).
CONCLUSIONS:Exposure to environmental phthalates may affect the homeostasis of glucose and lipid
metabolism in the adult population.

Keywords: Environmental epidemiology, Risk assessment

FP-151[Air pollution » Particulate matter]

Ambient air pollution and Years of Life Lost
(YLL) in Taiwan - a seasonal spatial risk analysis
Yu Hsiang Tsao1, Yu Hsiang Tsao2, Hui Min Hsieh1, Hui Min Hsieh2, Hui Min Hsieh3
1Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan.
2Department of Medical Research, Division of Biostatistics and Bioinformatic, Kaohsiung Medical

University Hospita
3Director of Center for Big Data Research, Kaohsiung Medical University

BACKGROUND AND AIM:The level of air pollution in Taiwan varies greatly in different seasons. The
reason is that the high temperature in summer in Taiwan makes the mixed layer height higher and the
air convection is strong, which helps the air pollutants to diffuse. Moreover, the southwest monsoon
brings rainfall, which achieves rain removal and effectively improves air quality; while the weather
conditions in winter are opposite to those in summer, and the height of the mixed layer is lower,
resulting in a smaller diffusion range and higher concentration of pollutants. Understanding changes inpollutant concentrations and how they affect health is an important issue of public health.
METHOD:A retrospective study design used Taiwan National Health Insurance Research Database andthe Taiwan Air Quality Monitoring Database from 2015 to 2020. The major outcome of interest was tocompare years of life lost (YLL) by area (North, Central, South, and East Taiwan). This study
presented five air pollution-related causes of death (all causes of death, malignant tumors, stroke,chronic lower respiratory diseases, and lung cancer) with trends by season. In addition to estimating
the trends of PM2.5 exposure and YLL, linear regression was used to determine the season andregional impact of PM2.5 exposure and YLL.
RESULTS:We found the all-cause death YLL was higher in the North area, followed by the South,Central and East area due to the distributions of population size and age. In addition, this study found
YLL was higher in cooler seasons among different regions, which was consistent with the concentration
distribution of PM2.5, showing the correlation.
CONCLUSIONS:This study provides evidence that YLL in Taiwan is significantly associated with
exposure to ambient air pollutants and seasonal distribution. Policies may need to vary seasonally or
regionally to have a positive impact on public health.

Keywords: PM2.5, Years of life lost (YLL), Taiwan National Health Insurance Research Database(NHIRD), Air pollution, Environmental exposureFP-152[Air pollution » Particulate matter]

Longitudinal assessment of oxidative stressmarkers and their relationship with exposure toPM2.5 and its bound metals in healthy
participants
Yuan Ting Hsu1, Ting Yao Su1, Yu Ru Wang1, Wei Jin Li1, Sheng Wen Chen2, Yu Chun Lin1, Hua Ling
Chen1, Ling Yu Ma2, Yi Shan Chou2, Yi Kai Ni2, Saou Hsing Liou1, Wei Te Wu1, Ching Huang Lai2,
Shau Ku Huang1
1Department of National Institute of Environmental Health Sciences, National Health ResearchInstitutes, Miaoli, Taiwan
2School of Public Health, National Defense Medical Center, Taipei, Taiwan

BACKGROUND AND AIM:Biomonitoring of exposure to ambient PM2.5 and its bound metals is
important in assessing the risk with better precision. We evaluated, longitudinally, a battery ofoxidative stress markers and their relationship with the exposure of PM2.5 and PM2.5-bound metals ina panel of healthy participants.
METHOD:Residence- and personal-based ambient air PM2.5 and its bound metals, as well as of lungfunction parameters, were assessed in 58 individuals (male, 39.7%). Levels of urinary oxidative stressmarkers [Nε-(hexanoyl)-lysine (HEL; an early lipid peroxidation product), 4-hydroxynonenal (4-HNE),
N7-methylguanine (N7-meG), and 8-hydroxy-2-deoxyguanosine (8-OHdG)], plasma antioxidants[superoxide dismutase (SOD) and glutathione peroxidase (GPx)], as well as urinary metals were
measured by ELISA and ICP-MS, respectively, and three repeated measurements in two-monthintervals were analyzed by Generalized Estimating Equation (GEE).
RESULTS:The study participants were never smokers (mean age, 24.3 years; mean BMI, 23.0kg/m2). After adjusting for age, BMI, sampling site, time, and vitamin supplement, levels ofresidence- and personal-based ambient air PM2.5 (βHEL=0.22, βN7-meG=0.22; βHEL=0.29; βN7meG=0.20) and its bound metals, especially V (βHEL=0.13; βN7-meG=0.12), Mn (βHEL=0.10; βN7meG=0.07) and Pb (βHEL=0.17; βN7-meG=0.10), were positively associated with HEL and N7-meG,
respectively, while the levels of urinary V (βHEL=0.12), Cr (βHEL=0.13), and Ni (βHEL=0.16) werepositively correlated with HEL, but the levels of urinary Cr (βN7-meG=-0.05) was negatively
associated with N7-meG. Although the lung function parameters in the study panel were within thenormal range, negative association of interaction (pollutant*time) was noted for PM2.5-bound As(βFEV1=-4.99, βFVC=-9.04), V (βFEV1=-4.32, βFVC=-7.40), Co (βMMF=-3.31, βPEFR=-3.29), Ni(βFVC=-6.22, βPEFR=-6.46), Pb (βFEV1=-6.47, βFVC=-7.69). In addition, negative association ofinteraction was observed for N7-meG (βFEV1=-21.35, βFVC=-18.77; βPEFR=-23.86) and SOD(βFEV1=-26.56; βFVC=-26.18; βPEFR=-16.48).
CONCLUSIONS:These results suggested that HEL and N7-meG may serve as the potential biomarkers
for the exposure to PM2.5 and its bound metals in healthy subjects.

Keywords: Air pollution, PM2.5, oxidative stress, HEL, N7-meG

FP-153[Exposome » External exposome]

An Exposure-Wide Association Study (ExWAS)
on Erectile Dysfunction
Yuki Mizuno1, Chirag J Patel2
1Department of Human Ecology, School of International Health, Graduate School of Medicine, The

University of Tokyo, Tokyo, Japan
2Department of Biomedical Informatics, Harvard Medical School, MA, USA

BACKGROUND AND AIM:Male sexual dysfunction, such as erectile dysfunction, is one of the important
aspects of reproductive health among men. Exposure to chemicals, including endocrine-disrupting
chemicals, was suggested to be an environmental determinant of the risk of erectile dysfunction;
however, the number of chemicals targeted in previous studies was limited. This study aims to
conduct the Exposure-Wide Association Study (ExWAS) on erectile dysfunction in a nationally
representative U.S. data sample.
METHOD:We performed multiple cross-sectional analyses of male adult participants in the 2001–2004
National Health and Nutrition Examination Survey. The study participants were categorized into twogroups based on the data collected by the questionnaire survey (“normal” and “erectile dysfunction”).
We primally targeted environmental chemicals as exposures in the ExWAS analysis of erectile
dysfunction. Logistic regression models adjusted for age, body mass index, and ethnicity were
performed to examine associations between erectile dysfunction and each biomarker of chemical
exposure, calculating false discovery rate for multiple testing.
RESULTS:Odds ratios significantly greater than one were observed in the associations between erectile
dysfunction and some biomarkers of exposure to chemicals, e.g., perfluorobutane sulfonic acid (polyfluoroalkyl chemicals), methamidophos (pesticides), etc. In contrast, we found several inverse
associations between erectile dysfunction and biomarkers of exposure to chemicals, including various
pesticides.
CONCLUSIONS:The current ExWAS systematically found associations between erectile dysfunction andexposure to various chemicals, including ones not previously studied. Further studies are needed toreveal the biological mechanisms of the associations discovered in this study, including investigating
the impact of co-exposure to multiple chemicals on erectile dysfunction.

Keywords: Exposome, External exposome, Exposures, Environmental epidemiology

FP-154[Other » Other (to be specified with keywords in the keywords section)]

A descriptive study of employed older people inJapan
Yumiko Ishikawa, Yuriko Takahashi
Department of Nursing, Teikyo Heisei University, Ichihara, JapanBACKGROUND AND AIM:Japan is the highest aging society in the world, and older people involved in
the active labor force to maintain the economy during the last decade. The aging workforce as a highrisk population, health-related characteristics should be described. The characteristics will becompared between retirees to working older people.
METHOD:We conducted a cross-sectional study targeting the whole community-dwelling older adults
aged ≥60 years in a town, Tochigi, Japan. Employment status was simply asked a yes/no question.
The health-related characteristics and demographic information were corrected using a selfadministered questionnaire. Differences between retirees to working older people were examinedusing chi-squared tests.
RESULTS:Of 1,921 community-dwelling older people, 1,018 completed the questionnaire (53%female, 25% working, and 49% aged between 70 to 79). 23% of working participants were also
experiencing caring for an older family member. Chi-squared tests revealed that people in theworkforce were significantly associated with good subjective health (p = 0.004). The retirees weresignificantly associated with depressive mood (p < 0.01) and regular exercise (p < 0.01), whereas no
significant differences were found for having medical conditions that required treatment (p = 0.44).
CONCLUSIONS:The working population of the elderly is expected to increase in the future. While
working is a way to stay connected to society and live an active life, public health must take care toensure that the elderly can continue to work under the management of their health and illnesses. Indepth research concerning life satisfaction, occupations, and working type such as full-time/parttimers should explore the aging workforce.

Keywords: Occupational epidemiology, Socio-economic factors, Community outreachFP-155[Cancer and cancer-precursors » Incidence]

Association between oil spill clean-up work andthyroid cancer: 11 years follow-up after theHebei Spirit oil spill
Yun Hee Choi1, Lita Kim1, Da An Huh2, Kyong Whan Moon3, Min Sung Kang4, Yong Jin Lee5
1Department of Health and Safety Convergence Science, Korea University, South Korea; BK21 FOUR

R&E Center for Learning Health System, Korea University, South Korea
2Institute of Health Sciences, Korea University, South Korea
3BK21 FOUR R&E Center for Learning Health System, Korea University, South Korea; Department of

Health and Environmental Science, Korea University, South Korea
4Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, South Korea
5Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, South Korea;

Environmental Health Center, Soonchunhyang University Cheonan Hospital, South Korea

BACKGROUND AND AIM:On December 7, 2007, an unprecedented oil spill occurred in Taean, South
Korea. Although crude oil contains chemicals that could biologically increase the risk of thyroid cancer,
there are scant reports on the association of chronic oil spill exposure with the incidence of thyroid
cancer. Therefore, we aimed to follow up on the long-term incidence of thyroid cancer due to the oilspill exposure among participants who engaged in the clean-up.
METHOD:A total of 1,798 participants who were a part of at least two surveys from the baseline
survey were tracked every two years from 2008 to 2018. At baseline, participants responded about
the number of days they participated in an oil purification operation and subsequently reported about
their cancer diagnosis. We used time-varying interval-censored proportional hazard models toestimate the hazard ratios (HRs) and 95% confidence interval (CI) between the duration of oil cleanup work and thyroid cancer.
RESULTS:During the 11-year follow-up period, 135 new all-cause cancer and 30 new thyroid cancer
patients were diagnosed. After adjusting all potential covariates, a positive association between the oilclean-up work duration and all cancer (hazard ratio (HR) and 95% confidence interval (CI) = 1.10
(1.02, 1.19)) and thyroid cancer (HR (95% CI) = 1.17 (1.00, 1.37)) were found.
CONCLUSIONS:The results of this study suggest that a longer duration of exposure to oil spill canincrease the risk of thyroid cancer.

Keywords: clean-up working, cohort study, Hebei Spirit, oil spill, thyroid cancer

FP-156[Outcomes » Cardiovascular diseases]

Lead exposure and increased blood pressureand hypertension: A systematic review andmeta-analysis
Zahra Gohari1, Michael Stewart2, Haesoo Kim1, Ellen Kirrane2, Evan Coffman2, Stephanie DeFlorioBarker2
1Oak Ridge Institute for Science and Education Research Participation Program, U.S. Environmental

Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park,
North Carolina, USA
2U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment,

Research Triangle Park, North Carolina, USA

BACKGROUND AND AIM:Exposure to lead (Pb) in the environment can occur through multiple media.
On average, blood Pb levels (BLL) have been declining over the past 50 years, but concerns remain
given that evidence indicates potential adverse health effects among those with low BLL. This analysis
aims to critically review the current epidemiologic literature and conduct a meta-analysis to provide asummary estimate of the relationship between BLL and blood pressure or hypertension incidence inchildren and adult populations.
METHOD:Following the Conduct of Systematic Reviews in Toxicology and Environmental healthResearch (COSTER) guidelines, relevant articles will be identified by searching multiple databases
using citation mapping and keyword search strings. Following a pre-defined Population, Exposure,
Comparator, Outcome, and Study design (PECOS) framework, title and abstract screening will becompleted with the assistance of machine learning software to select relevant references. Full text
screening will follow. Included articles will be further evaluated will be analyzed in a meta-analysis.
RESULTS:The preliminary search identified 61 articles, including 30 studies on BLL and bloodpressure, and 18 on BLL and hypertension incidence or prevalence among adults. Additionally, 13
studies were identified that evaluated the association between BLL or cord blood Pb and bloodpressure changes or hypertension incidence among children.
CONCLUSIONS:Taken together the evidence suggests consistent positive relationships between
increasing BLL and blood pressure. Evidence is less consistent when considering BLL and hypertension
prevalence; however, there is evidence that BLL are associated with hypertension incidence. In
contrast, there is very limited evidence of an effect of BLL or cord blood Pb and blood pressure or
hypertension in children. The results of the meta-analysis will help to summarize the effect BLL has onchanges to blood pressure and hypertension.

Keywords: Heavy metals, Other (Systematic review), Other (Lead)

FP-157[One health » COVID-19]

COVID-19 Contact Tracing in Casablanca Region
2020-2022: Review of a Moroccan Experienceand Lessons Learned
Zakia Abadane1, Mustapha Amirich2, Abdelmoula Boulamizat2, Mohamed Youbi2
1Zakia Abadane, Public Health Department, Regional Health Directorate, Casablanca, Morocco.
2Mustapha Amirich

BACKGROUND AND AIM:During the management of the COVID pandemic in Morocco, containing the
spread of COVID-19 through case investigation and contact tracing has revealed itself early as an
essential non pharmaceutical intervention to reduce mortality and morbidity during the pandemic. Our
objective is to assess the completeness and timeliness of COVID-19 contact tracing from 2020 to2022.
METHOD:This cross-sectional study examined routinely collected COVID-19 case investigation andcontact tracing data from Regional Health Department surveillance database as defined at the national
level. We focused on monitoring key process Indicators along the case investigation and contact
tracing process.
RESULTS:The capacity to conduct contact tracing varied with time, majorly impacted by contact
tracer's caseloads. Therefore, incomplete case investigation and poor follow up of contacts affected
negatively the ability to break the chain of COVID-19 transmission.
The application Wiqaytna launched on May 11, 2020, as an optional tool has helped to widen contact
identification circle, accelerate medical intervention, and optimize the testing.
CONCLUSIONS:We learned that the enhancement of contact tracers' capacity, ability and improving
community engagement as well as the incorporation of digital technology is essential to minimize therisk of transmission.

Keywords: Infectious diseases, Public health, Policy and practice.

FP-158[Birth and pregnancy outcomes » Other (to be specified with keywords in the keywords section)]

Hippo signaling pathway regulated branchingmorphogenesis of fetal lung under hypoxia
Zih An Liao, Hsiao Chi Chuang
School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.

BACKGROUND AND AIM:Hypoxia is one of the factors that cause many pathological conditions, and it
also affects embryonic development, leading to increased neonatal mortality or causing many
complications. Hippo pathway is crucial in lung morphogenesis, but how hypoxia impacts lungdevelopment through this pathway remains unknown. The aim is to explore hypoxia's effects on fetallung branching via Hippo pathway.
METHOD:Fetal lungs from 11.5 embryonic days ICR pregnant mice were cultured ex vivo under
normoxia or hypoxia (1% O2) for 3 days. Lung branching morphogenesis was assessed every 24
hours, and RNA-sequencing was performed on mouse fetal whole lungs. Normal human fetal lungfibroblast IMR-90 cells were also cultured under normoxia or hypoxia for 24 hours. We measured
biochemical analysis, including Sulforhodamine B assay, lactate dehydrogenase assay, and Interleukin
6. Also, we used western blot to determine the expression of YAP, TAZ, SOX2, SOX9, FGF10, andFGFR2.
RESULTS:Under hypoxic conditions, ex vivo mouse fetal lung branching morphogenesis was inhibited,resulting in significantly lower terminal bronchiole numbers and lung area compared to the control
group after 72 hours. RNA-sequencing analysis revealed a decrease in "in utero embryonicdevelopment" and "response to growth factor stimulus" in hypoxic fetal lungs compared to the control
group. Additionally, LDH and IL-6 increased in the hypoxic fetal lungs and IMR-90 cells. Western blot
analysis indicated that Hippo pathway was turned on after hypoxia exposure.
CONCLUSIONS:Hypoxia impairs fetal lung branching and increases inflammation and cell death in fetal
lungs and IMR-90 cells. Hypoxia may also affect YAP/TAZ and downstream signaling molecules,
delaying development and reducing regulation of cellular senescence. Pregnant women should becautious of hypoxia exposure due to its potential to cause fetal lung impairment.

Keywords: hypoxia, lung morphogenesis, hippo signaling pathway, branching morphogenesis,
alveolarization

FP-159[Air pollution » Particulate matter]

The Benefit of NASA’s Atmosphere Observing
System (AOS) Mission Lidar and Polarimeter
Observations for Health and Air Quality
Applications
Aaron Naeger1, Melanie Follette Cook3, James Campbell4, Emily Berndt2, Elizabeth Wiggins5, Jason
Tackett5, Bryan Duncan3, Andrea Portier3
1Earth System Science Center, University of Alabama in Huntsville, Huntsville, AL, United States
2NASA Marshall Space Flight Center, Huntsville, AL, United States
3NASA Goddard Space Flight Center, Huntsville, AL, United States
4U.S. Naval Research Laboratory, Monterey, CA, United States
5NASA Langley Research Center, Hampton, VA, United States

BACKGROUND AND AIM:The Atmosphere Observing System (AOS) seeks to explore fundamental
questions of how interconnections between aerosols, clouds and precipitation impact our weather andclimate, addressing real-world challenges to benefit society. AOS will provide key information toenhance the communities’ ability to improve weather and air quality forecasting today, seasonal tosub-seasonal changes in the near future, and societal challenges resulting from climate change in thedecades to come. A fundamental component of the AOS mission is ensuring that health and air quality
applications are considered to the greatest extent possible in mission design. As a result, theApplications Impact Team (AIT) was implemented to address this objective.
METHOD:We seek to maximize AOS benefit to impact decisions through early engagement in the
mission development phase in order to prepare stakeholders to apply observations as soon as AOS
mission data becomes available. The unique synergy between lidar and polarimeter instruments
onboard the AOS constellation, as well as diurnally varying observations of aerosol profiles, will
provide new opportunities to engage health and air quality stakeholders for forecasting, monitoring,
and warning of hazardous events that impact human health. Engaging with existing missions helps
identify and understand data needs, gaps and opportunities for current and future stakeholders,determine what aerosol data products are of highest value and use, and helps connect stakeholders
with current mission data that can serve as AOS proxy data.
RESULTS:We provide an overview of AOS aerosol observations relevant for health and air quality
applications, AIT activities and initiatives and how existing aerosol satellite missions and theirapplications activities can play a critical role in AOS applications development during mission design.
CONCLUSIONS:The overarching goal of the AIT is to help improve the capacity for transitioning
science to applications to make it possible to more quickly and effectively inform decisions that
directly benefit society.

Keywords: Air pollution, particulate matter, community outreachFP-160[Outcomes » Cardiovascular diseases]

Associations of racial residential segregation
and air pollution exposure with cardiovasculardisease and cardiovascular disease-related
mortality
Anna L. Harrington1, Carolyn A. Fahey1, Hiwot Y. Zewdie1, Claire L. Leiser1, Elizabeth W. Spalt2, Joel
D. Kaufman3, Anjum Hajat1
1Department of Epidemiology, University of Washington, Seattle, United States
2Department of Environmental and Occupational Heath Sciences, University of Washington, Seattle,

United States
3Department of Environmental and Occupational Health Sciences, University of Washington, Seattle,

United States; Department of Epidemiology, University of Washington, Seattle, United States;
Department of Medicine, University of Washington, Seattle, United States

BACKGROUND AND AIM:Both air pollution exposure and racial residential segregation (RRS) increase
cardiovascular disease (CVD) risk, with communities of color experiencing a disproportionate burdenof air pollution exposure. However, scant research exists on the potential interaction between RRS and
air pollution in shaping CVD risk.
METHOD:We analyzed data of Black and White participants of the Multi-Ethnic Study of Atherosclerosis(MESA), a prospective cohort study, from 2000-2017 (N=4,464). We predicted annual average
exposure to ambient PM2.5 and NO2 at participant residence from 2000-2016 using national spatiotemporal models and used interpolated Decennial Census data to create annual single-race spatial
isolation metrics of Census-tract-level RRS. We fit multilevel Cox proportional hazards models(adjusting for sex, age, income, employment, education, marital status, smoking, MESA site, andregion) to estimate hazard ratios for stroke (136 events), myocardial infarction (MI, 179 events), andCVD-related mortality (115 events) associated with time-varying a.) RRS alone, b.) RRS and PM2.5
jointly, and c.) RRS and NO2 jointly. Joint exposures were assessed using interaction terms.
RESULTS:For Black participants, 1 standard deviation increase in Black isolation was linked to 6%
higher risk of CVD-related mortality while, for White participants, 1 standard deviation increase in
White isolation was linked to 39% lower risk of CVD-related mortality (95% CI: 0.88-1.28; 95% CI:
0.45-0.83, respectively). We observed similar findings for stroke (Black isolation aHR: 1.24, 95% CI:
1.05-1.46; White isolation aHR: 0.89, 95% CI: 0.68-1.10). All RRS-MI results were null. Among White
participants, for each 1-unit increase in PM2.5 exposure, White isolation was less strongly associatedwith CVD-related mortality (p-value<0.05). All other interaction results were null.
CONCLUSIONS:Findings suggest that greater RRS is associated with greater CVD risk among Black
populations yet lower CVD risk among White populations. However, PM2.5 exposure may attenuate
the association among White populations. Additional research is needed.

Keywords: Built environment, Air pollution, Environmental epidemiology, Environmental disparities

FP-161[Neurologic and mental health outcomes » Mental health outcomes]

Impact of Pesticide Exposure on Affective Wellbeing: A Study on Agricultural Workers in Chile's
Maule Region
Boris Lucero1, Maria Teresa Muñoz Quezada2
1CINPSI Neurocog Faculty of Health Sciences, Universidad Catolica del Maule, Talca, Chile
2Escuela de Salud Publica, Facultad de Medicina, Universidad de Chile, Santiago, Chile

BACKGROUND AND AIM:Pesticide use is widespread in global agriculture to manage pests, withorganophosphate pesticides (OP) dominating in Chile's Maule region. Concerns about the mental wellbeing of agricultural laborers exposed to these chemicals have prompted investigations into theirpotential impact on affective states and neurobehavioral patterns. This study aimed to evaluate theassociation between pesticide exposure and affectivity and depressive symptoms in workers from theMaule region.
METHOD:A quantitative, cross-sectional approach was adopted, involving an exposed group (E) and a
non-exposed group (NE) to pesticides. Agricultural laborers were randomly sampled from anagricultural development database, while non-exposed individuals were selected from transportation,cleaning, and construction company databases. The study included 80 participants, with matchingbased on age, sex, and educational level. Survey instruments used were the Pesticide Exposure
Questionnaire, a sociodemographic and health-related questionnaire, the Positive and Negative Affects
Questionnaire (PANAS), and the Depression Scale of the Center for Epidemiological Studies (CES-D).
Data collection occurred during the pesticide application period from August to December 2022. Data
analysis involved exploratory analysis, U Mann Whitney tests, chi-square analysis, and multiple linear
regression.
RESULTS:The study found that the exposed group exhibited a significantly lower positive affect scoreand fewer anxiety symptoms compared to the non-exposed group. However, no statistically significant
differences in depression symptoms were observed. The multiple linear regression model
demonstrated that the highest positive affect score was associated with non-exposure to pesticides
and higher cigarette consumption, with adjustment for educational level.
CONCLUSIONS:The study concludes that there are no substantial depression disparities, highlighting
the complex relationship between pesticide exposure and mental health. Continued investigation isessential to develop interventions that safeguard the mental well-being of agricultural workers
exposed to pesticides, providing valuable insights to address their specific challenges and uphold theirmental health protection.

Keywords: Pesticides, occupational exposure, mental healthFP-162[Chemical exposures » Pesticides]

Associations of Pesticide Exposure with
Depression and Anxiety in Ecuadorian
Adolescents, and Effect Modification by Social
Determinants of HealthBriana Nc Chronister1, Eduardo Gonzalez1, Andrea Contreras1, Dolores Lopez Paredes2, Harvey
Checkoway1, Jose Suarez Torres2, Sheila Gahagan3, David R Jacobs Jr.4, Danilo Martinez2, Jose
Suarez Lopez1
1Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San

Diego, La Jolla, CA, 92093, USA
2Fundación Cimas del Ecuador, Quito, Ecuador
3Department of Pediatrics, University of California, San Diego, La Jolla, CA, 92093, USA
4School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA

BACKGROUND AND AIM:Pesticide exposure has been associated with elevated depression and anxiety
in occupational populations but limited studies exist in adolescents. Socioeconomic status (SES) has
attenuated adverse effects of certain environmental exposures; assessment in agricultural settings isneeded. We tested pesticide-mental health associations in adolescents and explored effectmodification by SES.
METHOD:We assessed 531 Ecuadorian 11-to-17-year-olds (50.3% female) for depression (CDI-2) andanxiety (MASC-2) symptoms. Specific urinary metabolites of organophosphates, pyrethroids,
herbicides, neonicotinoids and DEET were measured; a summary score for each class was created. We
used logistic regression to calculate odds ratios (OR) of elevated depression (T-score≥60) or anxiety(T-score≥65) symptoms in relation to exposures, and linear regression measured percent increase (β)
of anxiety and depression scores per 50% increase of chemical concentrations. Interaction by parental
education, income and housing quality was assessed. Models adjusted for demographic andanthropometric measures.
RESULTS:Increased odds of elevated depression symptoms were observed with pyrethroid summaryscore (OR per unit increase [95% CI]=1.50 [1.15, 1.95]), 3-phenoxybenzoic acid (3-PBA [pyrethroid])(OR=1.21 [1.01, 1.44]), trans-3-(2,2-Dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (transDCCA [pyrethroid]) (OR=1.23 [1.01, 1.50]), and 3,5,6-Trichloro-2-pyridinol (TCPy[organophosphate]) (OR=1.10 [1.03, 1.16]). Some significant interactions (p<0.05) with parental
education and income were observed. Participants in the lower median of parental education had apositive association between 2,4-Dichlorophenoxyacetic acid (2,4-D [herbicide]) and depression score(β=0.31% [0.04%, 0.58%]), but no association was observed among those in the upper median.
Stratifying by monthly income, there was no association between para-Nitrophenol (PAR [pyrethroid])
and anxiety in the lower median, but there was a negative association in the upper median (β=-0.65%[-1.16%, -0.14%]).
CONCLUSIONS:Pyrethroid and organophosphate metabolite concentrations were associated withelevated depression and anxiety scores. Education and monthly income were modest effect modifiers:
Lower education strengthened the association between 2,4-D and depression, while higher monthly
income was protective for the PAR-anxiety association.

Keywords: Pesticides, Mental Health Outcomes, Environmental Epidemiology

FP-163[Air pollution » General]

Ambient Air Pollution and Dementia Risks in
Taiwan - A Spatial Risk Analysis
Chen Yang Hsiao1, Hui Min Hsieh2
1Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
2Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Director of Center for

Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Director of Division of
Biostatistics and Bioinformatic, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

BACKGROUND AND AIM:The proportion of Taiwan's rapidly aging population has increased from 7% in
1993 to 16.2%. It is projected to surpass 20% in 2026, which has escalated the prevalence andincidence of dementia. Meanwhile, urbanization and energy consumption have accelerated, leading toa worsening problem of air pollution. Air pollutants infiltrate the brain via the bloodstream anddamage neurons and neural networks, affecting cognitive and memory functions. Therefore, this study
conducts a spatial risk analysis examining the relationship between ambient air pollution and dementia
risks.
METHOD:We conducted a retrospective cross-sectional study using nationwide National Health
Insurance administrative claims in Taiwan and the Taiwan Air Quality Monitoring Database from 2009
to 2018. The primary outcome of interest was comparing the standardized prevalence rate (SPR) of
dementia and air pollution trends in urban and rural areas for those older than 65. We calculated thetotal prevalence per 100 persons for each patient. The SPR was calculated by weighting the
proportions of people in the corresponding age groups of the WHO standard population in 2000.
RESULTS:We found that the SPR trend of dementia in people older than 65 years is higher in urban
areas than in rural areas. The trend of ambient air pollution is higher in urban areas than in rural
areas. Air pollution increases dementia risk. The risk of developing dementia in urban areas is higher
than in rural areas after controlling ambient air pollution.
CONCLUSIONS:Our findings show that from 2009 to 2018, dementia SPR and ambient air pollution in
the elderly population are higher in urban areas than rural areas. Reducing air pollution can prevent
dementia, and policies may need to vary between urban and rural areas to impact public healthpositively.

Keywords: Air pollution, PM2.5, Dementia, Taiwan National Health Insurance Research DatabaseFP-164[Cancer and cancer-precursors » Incidence]

Polygenic risk score is associated with the riskof oral cancer among the male Taiwanese
population
Chih Ching Yeh1, Ming Zhen Yu2, Shiang Fu Huang3, Ming Jang Su4
1School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan
2School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
3Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan

City, Taiwan
4Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City,

TaiwanBACKGROUND AND AIM:Many studies have focus on the risk of oral cancer with environmental factors
or a few genetic polymorphisms. However, few studies have recruited more significant singlenucleotide polymorphisms (SNPs) to test the risk of oral cancer. Therefore, we selected 15 SNPs fromprevious genome-wide association study to establish a polygenic risk score (PRS) and to investigate
the risk of oral cancer.
METHOD:We conducted a case-control study which included 500 male oral cancer patients from theHead and Neck Surgery Department at Chang Gung Memorial Hospital and 2,321 male healthy
controls from Taiwan Biobank. Genotypes were determined by the technology platform developed by
Affymetrix using the Axiom Genome-Wide Array Plate. Multivariate logistic regressions were used toanalysis individual SNP and PRS associated with the risk of oral cancer by estimating odds ratio (OR)and 95% confidence intervals (CI). The SNPs significantly associated with oral cancer risk wereselected to calculate the PRS.
RESULTS:Among the 15 SNPs, CLPTM1L (rs10462706) CC genotype (OR=1.39, 95% CI=1.031.86), HLA-DQA1 (rs34518860) GG genotype (OR=1.60, 95% CI=1.07-2.39),
and ZSWIM4 (rs3745455) GG+GT genotype (OR=1.96, 95% CI=1.29-2.97) significantly increased therisk of oral cancer (all P values < 0.05). For PRS, subjects with 0.8527~1.0584 points (OR=1.64, 95%
CI=1.08-2.49) and over 1.0584 points (OR=2.45, 95% CI=1.64-3.66) had significantly increased riskof oral cancer, compared to subjects with below 0.8527 point.
CONCLUSIONS:Our results suggest that individuals with higher PRS are predisposed to oral cancer.
These high-risk groups are suitable for oral mucosal examinations for early diagnosis and treatment oforal cancer.

Keywords: Molecular epidemiology, MaleFP-165[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

Legacy and Alternative Per- and Polyfluoroalkyl
Substances in Paired Serum-Urine Data from the
2009-2012 Taiwan Birth Panel Study
Ching Yu Sun1, Mei Huei Chen2, Ching Chun Lin3, Pau Chung Chen4
1Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University College of Medicine and Hospital, Taipei, Taiwan
2Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;

Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
4Department of Environmental and Occupational Medicine, National Taiwan University College ofMedicine and Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences,
National Taiwan University College of Public Health, Taipei, Taiwan; National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Scientists have discovered possible relationships between levels of per- andpolyfluoroalkyl substances (PFAS) in blood and harmful health effects in people. Because of the healthconcern of PFAS, manufacturers have replaced select chemistries (“legacy” PFAS) with PFAS withshorter biological half-lives (e.g., perfluorobutanoate [PFBA]). While most of the studies mentioned
above use serum concentration of PFAS for assessment of PFAS exposure, information on urinary
concentrations of PFAS is limited. It may be important topic since current studies show that shortchain PFAS mainly eliminate through kidney. We hope to evaluate the relationship between urine andserum concentration of PFOS and the possibility to us urine as a biomonitoring matrix for assessmentof PFAS exposure.
METHOD:We use the urinary and serum concentrations of 17 legacy and alternative short-chain PFAS
in 595 children in Taiwan Birth Panel Study (TBPS) II. Concentration below LOD was replaced by
LOD/2 and urine concentration was adjust by urine creatinine. We use Pearson correlation test toevaluated the relationship between log serum and log urine PFAS concentration when the detection
rate is above 70%.
RESULTS:In 2018, 595 urine-serum sample were collected.17 kinds of PFAS were elevated.
Concentrations of PFBS in serum and urine were median correlated (r = 0.45) with p-value<0.05.
Concentrations of PFOA in serum and urine were median correlated (r = 0.41) in male with pvalue<0.05. Other PFAS did not show low positive or negative correlation between urine and serum
concentration.
CONCLUSIONS:There is no strong linear correlation between PFAS urine and serum concentration. It
may because there is other pathway to eliminate PFAS in human body. Serum may still be a more
appropriate way to measure the exposure of PFAS. But urine concentration of PFAS is still importantsince it will give us more information to elimination half-life and the metabolic pathway.

Keywords: PFAS, Exposure assessment, Children's environmental healthFP-166[Other » Other (to be specified with keywords in the keywords section)]

Environmental health and safety climate andone’s emotional status in non-healthcare
workplace during pandemic: A cross-sectional
study in Hong Kong
Choi Miu (cherry) Wan, Feng Wang, Kit Han Mo, Chor Sze Ng, Dong Dong, Kin Fai Ho, Yeung Shan
Wong, Lap Ah Tse
JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR

BACKGROUND AND AIM:Occupational settings have involved potential risks to get infected during
pandemic, even some could pose higher risks in transmissions between workers. While a number of
employees could work from home, others cannot have the chance because of their occupational
characteristics, for example, construction workers. Even though occupational settings cannot bechanged easily, organisations could initiate effective implements to mitigate the infection rates interms of environmental safety and health climates. Meanwhile, the enduring high infection rates of
COVID-19 lead to restricted outdoor events and worries about one's own infection risks. This might
impair their psychological health in the long run. Since working accounts for a large portion in one’s
lives, one may wonder whether a secure safety climate could alleviate mental burden during
pandemic. This study, therefore, aims for examining the association between one’s safety and healthclimate in workplace and psychological status during COVID-19.
METHOD:This is a cross-sectional study where workers were enrolled in various work settings. An
online questionnaire was used to collect their current work industry, Safety climate index (SCI),
vaccination of SARS-CoV-2, infection, and DASS-21 etc. Occupational SCI was measured from theshared perception of workers regarding the significance of environmental health and safety within an
organization. Spearman rank correlation was used to compare correlations between different
variables.
RESULTS:A total of 327 participants finished the survey. There were more female (58.5%) than male
(41.5%). Around 90% of them completed their high school education. There is a weak negative
association between SCI and mental concerns (r = -0.115). Additionally, SCI was negatively
associated with stress concerns (r = -0.110). However, it isn’t associated with depression and anxiety.
CONCLUSIONS:This study showed that environmental health and safety climate in occupationalsettings is negatively associated with stress. But there is no correlation with depression and anxiety.

Keywords: occupational settings, safety climate, emotional (or psychological) status, COVID-19

FP-167[Air pollution » Particulate matter]

The impacts of reduction in ambient fineparticulate (PM2.5) air pollution on life
expectancy in Taiwan
Shang Shyue Tsai1, Chun Yuh Yang2
1Department of Healthcare Adiministration, I-Shou University, Kaohsiuing, Taiwan
2Department of Public Health, Kaohsiung Medical University, Kaohsiuing, Taiwan

BACKGROUND AND AIM:Fine particulate matter, particles less than 2.5 um in diameter (PM2.5), is an
important environmental human health factor to consider. The long- and short-term influence of
PM2.5 on health has been extensively studied in relation to many health outcomes, although few
investigations examined the consequences of chronic ambient PM2.5 on life expectancy, whichconstitutes an important gauge of public human health status. Therefore, the aim of this study was toinvestigate the effects of reducing ambient PM2.5 levels in Taiwan on life expectancy there from 2000
to 2020.
METHOD:Officially reported island-wide annually average concentrations of ambient PM2.5, countylevel life expectancies, and demographic and socioeconomic and proxy variable were collected for theprevalence of smoking from various national public agencies and organizations, since variables thesemight potentially confound life expectancy results. The relationship between changes in ambient
PM2.5 levels and life expectancy were determined using linear regression.
RESULTS:Data demonstrated that counties with greater reductions in ambient PM2.5 concentrations
were associated with higher life expectancies. Adjusting for alterations in demographic andsocioeconomic variables and proxy parameter, the prevalence of smoking data from a multiple
regression model, it was found that a 0.3-year rise in life expectancy was noted for each 10 ug/m3
decrease in PM2.5 in those counties.
CONCLUSIONS:Our findings show that reducing ambient PM2.5 levels play an important role forprolongation of life expectancy in Taiwan.

Keywords: PM2.5, air pollution, life expectancy

FP-168[Outcomes » Obesity and metabolic disorders]

Exposure to Persistent Organic Pollutants andDiabetes Mellitus of Residents Living Near a
Nonferrous Metal Smelter Area
Dahee Han1, Yong Min Cho1, Ju Shin Oh1, Kyung Hwa Choi2, Moon Ju Oh3, Young Seoub Hong4
1Institute of Environmental Health, Seokyeong University, Seoul, South Korea
2Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
3Business Development and Quality Assurance Unit, Theragen Bio co., Seoungnam, South Korea
4Department of Preventive Medicine, School of Medicine, Dong-A University, Busan, South Korea

BACKGROUND AND AIM:Nonferrous metal smelters are known to emit unintentionally persistentorganic pollutants (POPs). This study investigated POPs exposure levels and experience of diagnosis ofseveral chronic diseases such as diabetes mellitus, hypertension, myocardial infarction, andhyperlipidemia of residents in a region where a nonferrous metal smelter has been operating for along time.
METHOD:A total of 121 serum samples were collected from residents living near a nonferrous metalsmelter in Korea, and 25 congeners of POPs were analyzed using high-resolution gas-chromatography
mass spectrometry. We used lipid-adjusted POPs concentrations. Also, the residents were selfreported whether they have been diagnosed or taking medications with diabetes mellitus and others.
Lastly, logistic regression was done to investigate the associations between POPs exposure anddiabetes mellitus.
RESULTS:Among the congeners, geometric mean and arithmetic mean of beta-Hexachlorocyclohexane(beta-HCH) were 10.196, 16.877 ng/g lipid. Those were higher than the geometric mean of reference
value of US population [National Health and Nutrition Examination Survey, 7.89 ng/g lipid (N=1,370))
and arithmetic mean of a previous study in Korean adults [8.8 ng/g lipid (N=185)], respectively. The
odds ratio of beta-HCH for diabetes mellitus was 1.022 (95% confidence interval: 1.000-1.045).
Besides, polychlorinated biphenyls (PCB) 74, PCB 118, and PCB 167 showed significant increases ofodds ratio (OR 1.795 for PCB 74; OR 1.247 for PCB 118; OR 3.358 for PCB 167) as well, although
their means were not higher than reference values.
CONCLUSIONS:This study suggests that POPs exposures may increase the risk of diabetes mellitus inresidents living near nonferrous metal smelters.
FUNDING: The Korea Environment Industry and Technology Institute through the Core Technology
Development Project for Environmental Disease Prevention and Management, funded by the Korea
Ministry of Environment (grant number 2021003320003).

Keywords: Exposure assessment, Obesity and metabolic disorders

FP-169[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Association Between Iron Concentrarion in
PM10 and Alzheimer's disease in Lima, Peru: An
Ecological Study
Diego Fano Sizgorich1, Carol Ordoñez Aquino3, Odón Sánchez Coyllo2, Gustavo F. Gonzales1
1Laboratorio de Endocrinología y Reproducción, Facultad de Ciencias e Ingeniería, Universidad

Peruana Cayetano Heredia, Lima, Peru
2Grupo de Investigación en Contaminación Atmosférica, Facultad de Ingenieria y Gestión, Universidad

Nacional Tecnológica de Lima Sur, Lima, Peru
3Dirección General de Salud Ambiental e Inocuidad Alimentaria -DIGESA, Lima, Peru

BACKGROUND AND AIM:Alzheimer’s Disease (AD) is characterized by impairment of memory, thinking
skills, and inability to perform simple tasks. Air pollution has been found to be associated with AD.
Higher iron deposits in the brain have been found in AD patients. PM10 is composed of different
chemical compounds, including iron-related ones. It is possible that iron exposure through inhalationof PM10 might contribute to the development or symptoms. Thus, the aim of the study is to evaluate
the association between iron concentration in PM10 and proportion of AD in Lima, Peru.
METHOD:Ecological study. Monthly average of iron concentration in PM10 of six different districts of
Lima was obtained from DIGESA, while monthly cases of AD in these districts were obtained from the
Peruvian Ministry of Health. Only data from 2017 – 2019 and 2022 were available. Proportion of cases
x 100,000 inhabitants was calculated using the general population, or the population aged 60 years or
higher. Iron concentration was log-transformed. Generalized Linear Model (GLM) of gaussian andnegative binomial family were constructed. Since in Lima downtown is located the country main
Neurology Institute, we did a sensitivity analysis without this district data.
RESULTS:Mean iron concentration was 1.16 ± 0.66 µg/m3, with Comas and San Juan de Miraflores
showing the highest levels. Lima downtown had the highest proportion of AD with 11.90 based in thegeneral population and 68.90 based in the 60-over population. In the complete model, no significant
association was found in the gaussian and negative binomial GLM. In the sensitivity analysis it was
found that iron concentration increased the proportion in the 60-over (β=7.41 95%CI 1.80 – 13.03,
p=0.010), with an IRR of 1.69 (95%CI 1.03 – 2.79, p=0.038).
CONCLUSIONS:Iron concentration was associated with a higher proportion of AD cases in Lima but
might be influenced by a potential sub-diagnosis.

Keywords: Particulate matter, Particle components, Neurodegenerative outcomesFP-170[Chemical exposures » Phenols]

Urinary triclosan and prevalence of metabolic
syndrome among adults in Southern China
Feng Wang1, Shaoyou Lu2, Suyang Wu1, Yi Chen3, Wenbo Li4, Zhhimin Li5, Liuzhuo Zhang5, Wenting
Feng5, Victoria H Arrandale6, Greg J Evans6, Lap Ah Tse1
1JC School of Public Health and Primary Care, the Chinese University of Hong Kong, New Territories,

Hong Kong
2School of Public Health (Shenzhen), Sun Yat-Sen University, Guangzhou, China
3State Key Laboratory of Pollution Control and Resource Reuse, Nanjing University, Nanjing, China
4Institute of Environmental Pollution and Health, Shanghai University, Shanghai, China
5Institute of Occupational Medicine, Shenzhen Prevention and Treatment Center for Occupational

Diseases, Shenzhen, China
6Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

BACKGROUND AND AIM:Triclosan (TCS) is widely applied in personal care products (PCPs) as anantimicrobial preservative. Due to its toxicity and potential risk to human health, TCS has attracted
mounting concerns in recent years. However, the health effect TCS on metabolic disease remains
limited in China.
METHOD:This is a cross-sectional with 1,159 adults recruited in 2013 from Southern China. Modified
Adult Treatment Panel III criteria were used to identify the cases of MetS. Urinary triclosan
concentration was assessed using high-performance liquid chromatography-tandem mass
spectrometry, and it was categorized into three subgroups by tertiles (low, middle, and high) to obtain
the adjusted odds ratios (OR) and 95% CI using logistic regression model.
RESULTS:TCS was detected from 99.6% of urine samples, indicating ubique exposure in the study
population. Urinary concentrations of TCS ranged from below the limit of detection (LOD) to 270 μg/L,with a median value of 3.66 μg/L. The prevalence of metabolic syndrome was 2.1%, 5.2%, and 2.6%
for low, middle, and high groups of urinary triclosan, respectively. The adjusted OR increased by theincrease of urinary concentration (OR 1.32, 95%CI 0.50-3.51 for middle group; and OR 2.14, 95%CI
0.96-4.75), although there was no statistic significance.
CONCLUSIONS:Urinary triclosan might associate with the occurrence of metabolic syndrome which
need further investigation.

Keywords: Phenols, Obesity and metabolic disorders

FP-171[Air pollution » General]

Estimating years of life lost from suicidemortality due to air pollution in Seoul, South
Korea
Gyeong Chan Kim, Sun Woo Kang, Subin Jeong, Hyewon Lee
Department of Health Administration and Management, Soonchunhyang University, Asan, South Korea

BACKGROUND AND AIM:According to the World Health Organization (WHO), suicide is a leading causeof death among people aged 15–29 years worldwide. Recently, limited studies have found a significant
role of air pollution in suicide. It is necessary to estimate the burden of air pollution-inducedpremature mortality from suicide using an analytical measure of disease burden, such as the years oflife lost (YLLs). The YLLs from suicide attributable to air pollution has not been examined to date.
METHOD:This study examined the YLLs from suicide mortality due to air pollution in Seoul, South
Korea, during 2002-2021. We applied a generalized additive model (GAM) assuming a Gaussian
distribution to estimate the effects of particles <10μm (PM10), particles <2.5 μm (PM2.5), sulfur
dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) on the YLLs fromsuicide. We also considered a maximum lag of 7 days to study single and cumulative effects of air
pollution on the YLLs.
RESULTS:During the study period, 43,642 completed suicide cases occurred, and the average daily
YLLs from suicide was 194 years. Among six pollutants, NO2 had an immediate effect on significant
increase of YLLs from suicide (6.6 years [95% CI, 2.5-10.6 years, lag 0]) and O3 had cumulative
effect on significant increase of YLLs from suicide (8.9 years [95% CI, 1.5-16.4 years, lag 0-4). Two
pollutants analyses showed similar finding with single pollutants analyses.
CONCLUSIONS:Our study showed significant associations of exposure to O3 and NO2 with the YLLs
from suicide. These findings suggest that O3 and NO2 could be an important environmental risk
affecting premature mortality from suicide. Our findings contribute to the basis for suicide prevention
strategies associated with air pollution. (No.2022R1C1010045)

Keywords: Air pollution, Ozone, Oxides of nitrogenFP-172[One health » COVID-19]

Prevalence and risk factors of post-acutesequelae of COVID-19 (PASC) among adults inSouth Korea
Ha Eun Son, Seungho Lee, Young Seoub Hong, Hyunjin Son
Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea

BACKGROUND AND AIM:Many people continue to experience symptoms even after the acute phase of
COVID-19, and the World Health Organization defines cases where symptoms persist beyond threemonths after the onset of COVID-19 as Post COVID-19 condition. The previous studies conducted inSouth Korea so far have been limited by the lack of representativeness of the sample. We aimed to
identify the prevalence and risk factors of post-acute sequelae of COVID-19 (PASC), the pre-stage of
Post COVID-19 condition, using a representative sample.
METHOD:This study was conducted an online survey at 4 weeks after the diagnosis of COVID-19,
using systematic sampling of 1,648 out of 4,779 total confirmed cases of COVID-19 aged 19-64
reported in a public health center over a period of 5 weeks. Of the 1,398 participants who agreed toparticipate, 1,047 completed the survey. The survey consisted of questions on persistence of COVID19 symptoms, vaccination status, underlying conditions, and other related factors. PASC was definedby the National Institutes of Health as the persistence of one or more symptoms for 4-12 weeks after
diagnosis of COVID-19.
RESULTS:The prevalence at 4 weeks among males was 40.9% (178/435), while among females it was
62.3% (381/612). By age group, the prevalence was 46.2% (103/223) for aged 19-29, 60.1%(131/218) for aged 30-39, 58.3% (148/254) for aged 40-49, and 50.3% (177/352) for aged 50-64.
The prevalence by vaccination status was 49.1% (28/57) for unvaccinated individuals, 46.2% (6/13)
and 56.0% (139/248) for those who received one and two doses, 53.3% (342/642) for those who
received three doses, and 50.6% (44/87) for those who received four or more doses.
CONCLUSIONS:We identified the prevalence of PASC at 4 weeks after COVID-19 diagnosis, and plan
to conduct a follow-up survey at 12 and 24 weeks in the future.

Keywords: Epidemiology, Community-engaged researchFP-173[Reproductive outcomes » Female reproductive outcomes]

Urine concentration of endocrine disrupting
chemicals and premature puberty: findings fromthe 4th Korean National Environmental Health
SurveyHan Ho Kim1, Young Yoo2, Seung Ah Choe3
1Department of Pediatrics, Anam Hospital
2Department of Pediatrics, Korea University
3Department of Preventive Medicine, Korea University

BACKGROUND AND AIM:Several studies explored the association between exposure to EDCs andtiming of puberty which are mostly about menarche. Using a data of population-based sample ofyoung girls, we analyzed the association of urine level of EDCs with premature thelarche (breast
budding before age of 9) and early menarche (menarche before age of 11).
METHOD:We utilized data from the 4th Korean National Environmental Health Survey (KoNEHS)
conducted from 2018 to 2020. To identify girls at risk of premature thelarche and early menarche, andestimate recent EDC exposures, our analysis restricted to those aged 10-11 years. To estimate
exposure to EDCs, we utilized the urinary concentrations of 23 EDCs including phthalate metabolites(mono(n-butyl) phthalate [MnBP], mono (2-ethyl-5-hydroxyhexyl), phthalate [MEHHP], and mono (2ethyl-5-oxohexyl) phthalate [MEOHP]), and environmental phenols (bisphenol A [BPA] and triclosan[TCS]). Urinary EDC levels were log-transformed and compared between normal and premature/early
puberty groups. Least square means of EDCs were calculated from multivariable regression models
including covariates.
RESULTS:Of 134 girls aged 10-11 years, premature thelarche occurred in 10.5% and early menarche
was observed in 14.2%. When log-transformed urinary concentration of 23 EDCs were comparedaccording to premature thelarche, there was no significant difference between normal and prematurethelarche groups. For early menarche, levels of TCS (mean log[TCA] = -1.29, 95% confidence interval[CI]: -0.94, -0.6 for normal vs -1.81, 95% CI: -1.46, -1.1 for early menarche) and BPA (-0.01, 95%
CI: 0.43, 0.87 vs -1.08, 95% CI: -0.44, 0.20) of normal group were higher than those of girls withearly menarche which did not reach statistical significance. Comparing least square means of 23 EDCs
yielded similar results.
CONCLUSIONS:We observed no difference in the exposure to common EDCs between girls withpremature or early puberty and their counterparts. Our finding would need to be confirmed with otherstudies with different settings.

Keywords: Menarche, Thelarche, Endocrine Disruptors, Girls

FP-174[Exposures » Food/nutrition]

Application of National Food Consumption
Database: Risk Assessment of Cadmium incurstaceans food between 2005 to 2016
She Yu Chiu1, Hsing Yi Chang2
1Center for Biomedical Resources, National Health Research Institutes,Miaoli,Taiwan
2Institute of Population Health Sciences, National Health Research Institutes,Miaoli,Taiwan

BACKGROUND AND AIM:Risk Assessment of Cadmium in crustaceans food is an important issue.
According to the data from The International Agency for Research on Cancer (IARC), cadmium
compounds are carcinogenic to humans (Group 1). Our study aims to focus on the systemic risk
assessment and exposure assessment of cadmium related to curstaceans consumption in Taiwan
METHOD:Intakes of the Nutrition and Health Survey in Taiwan (NAHSIT) from 2005-2012 and 20132016 were included and data were combined according to the food description and classification
system of the National Food Consumption Database (NFCD). The participants of our study were
included all age of national representative survey. Hazard Quotient (HQ) was calculated for risk and If
HQ was lower than 1, it means within acceptable range from dietary exposure. We also calculated thesystemic risk by life-time average daily dose (LADD).
RESULTS:Intakes in consumer only participant showed that 19-65 years old male had the highest
intakes (Mean ± SD grams: 49.21 ± 61.22 grams) and with max consumption of curstaceans (488.59
grams, 43.14) in 2005-2012. In 2013-2016, 19-65 years old male also had the highest intakes (Mean± SD grams: 621.63 ± 36.14 grams), but 16-18 years old male with max consumption of curstaceans(43.14 grams). The HQ of all age groups were in the acceptable range. The LADD of >65 year old
male who had max dose of curstaceans (2005-2012:0.000614 mg/kg-day; 2013-2016:0.001578
mg/kg-day) was in the acceptable range.
CONCLUSIONS:Food description and classification system of NFCD could provide useful intakes toanalyze the systemic risk assessment of cadmium in curstaceans. The HQ was within the acceptable
exposure range in 2005-2013.

Keywords: Consumption database, Food risk assessment, CadmiumFP-175[Exposures » Food/nutrition]

Application of National Food Consumption
Database: Risk Assessment of Cadmium incrustacean food in 2005-2016
She Yu Chiu1, Hsing Yi Chang2
1Center for Biomedical Resources, National Health Research Institutes,Miaoli,Taiwan
2Institute of Population Health Sciences, National Health Research Institutes,Miaoli,Taiwan

BACKGROUND AND AIM:Risk assessment of cadmium in crustacean food is an important issue.
According to the data from the International Agency for Research on Cancer (IARC), cadmium
compounds are carcinogenic to humans (Group 1). Our study aims to focus on the systemic risk
assessment and exposure assessment of cadmium related to crustacean food consumption in Taiwan.
METHOD:Intakes of the Nutrition and Health Survey in Taiwan (NAHSIT) in 2005-2012 and 2013-2016
were included, and data were combined according to the food description and classification system of
the National Food Consumption Database (NFCD). The participants of our study were included in allages of the national representative survey. Hazard quotient (HQ) was calculated for risk and if HQ wasless than 1, it means within acceptable range of dietary exposure. We also calculated the systemic risk
by lifetime average daily dose (LADD).
RESULTS:Intake in consumers only participants showed that 19-65 years old men had the highest
intake (mean ± SD: 49.21 ± 61.22 grams) and with maximum consumption of curstacean food(488.59 grams) in 2005-2012. In 2013-2016, 19-65 years old males also had the highest intake(mean ± SD: 621.63 ± 36.14 grams), but 16-18 years old males with max consumption of curstacean
food (43.14 grams). The HQ of all age groups were in the acceptable range. The LADD of >65 years
old male who had max dose of curstacean food (2005-2012:0.000614 mg/kg-day; 20132016:0.001578 mg/kg-day) was in the acceptable range.
CONCLUSIONS:The food description and classification system of the NFCD could provide useful intakes
to analyze the systemic risk assessment of cadmium in crustacean food. The HQ was within theacceptable exposure range in 2005-2016.

Keywords: Consumption database, Food risk assessment, CadmiumFP-176[Cancer and cancer-precursors » Incidence]

Differentiating Benign Pulmonary Lesions from
Suspected Lung Cancer in Never Smokers:
Based on a Comprehensive Questionnaire
Hsu-Li Huang1, Xu-Heng Chiang2, Ching-Chun Lin1, Jin-Shing Chen3, Pau-Chung Chen4
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
2Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; Department ofSurgery, National Taiwan University Hospital and National Taiwan University College of Medicine,
Taipei, Taiwan
3Department of Surgery, National Taiwan University Hospital and National Taiwan University Collegeof Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer
Center, Taipei, Taiwan
4Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National
Taiwan University Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences,
National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:With the widely use of lung cancer screening, there is a growing concern thatbenign lung lesions are frequently misidentified as lung cancer. Distinguishing between benign andmalignant lung lesions with precision is still a crucial challenge. This study aimed to characterizepulmonary lesions that were initially suspected to be lung cancer, but were later confirmed as benign
following surgical resection.
METHOD:Between November 2021 and October 2022, a total of 391 never-smoker patients presenting
with focal pulmonary lesions, and who had been suspected by surgeons with lung cancer, were
included in this study. Prior to undergoing the operation, patients were required to complete acomprehensive questionnaire. The diagnoses of the patients were subsequently confirmed by expert
pathologists after resection. Multivariable logistic regression models were employed to differentiatepatients with benign lung diseases from lung cancer patients.
RESULTS:Out of the 391 cases reviewed, 309 were confirmed with malignant pathology, while 82
were benign. After adjusted by age and gender, the odds ratios (OR) for five risk factors in favored ofmisidentifying benign lesions as lung cancer were statistically significant, including comorbidity of
diabetes mellitus (OR 2.92, p = 0.018), higher household income (OR 2.06, p = 0.022), living in anewer house (OR 1.98, p = 0.021), living in a house never painted (OR 2.33, p = 0.011) and selfreported unusual odor near home (OR 2.12, p = 0.008).
CONCLUSIONS:Diabetes mellitus, household income and home environment were factors influencing
on the diagnosis of lung cancer. A questionnaire before operation could help distinguishing patientswith high risk on misidentification.

Keywords: Environmental epidemiology, ModelingFP-177[Climate » Natural disasters]

Impact of Extreme Heat Event and WildfireRelated PM2.5 Exposure on the Risk of
Hospitalization and Mortality among
Hemodialysis Patients
Hyeonjin Song1, Nicole E Sieck2, Jochen Raimann3, Peter Kotanko4, Frank W Maddux5, Hao He6, Evan
Andrew Ellicott7, Amir Sapkota1
1Department of Epidemiology and Biostatistics, University of Maryland College Park, United States ofAmerica2Maryland Institute for Applied Environmental Health, University of Maryland College Park, UnitedStates of America
3Research Division, Renal Research Institute, New York, United States of America
4Research Division, Renal Research Institute, New York, United States of America; Icahn School of

Medicine at Mount Sinai, New York, United States of America
5Fresenius Medical Care North America, Waltham, MA, USA
6Department of Atmospheric and Oceanic Sciences, University of Maryland, College Park, UnitedStates of America
7Department of Geographical Sciences, University of Maryland, College Park, United States of America

BACKGROUND AND AIM:Ongoing climate change is leading to increases in frequency and severity of
wildfires and extreme heat events. Such exposures may disproportionately impact hemodialysis
patients, increasing their risk of hospitalization and mortality. We investigated the effect of wildfirerelated PM2.5 on hospitalization and mortality risk among hemodialysis patients and examined how
this association is modified by extreme heat events.
METHOD:We estimated wildfire-related PM2.5 for each of the Fresenius Kidney Care clinics in
California, Oregon, and Washington during 2005-2009 period using satellite-derived smoke polygons
and ground-based EPA monitors. Likewise, we identified extreme heat events for each clinic location
during the same time period using 95th percentile maximum temperature thresholds determined using
the Global Historical Climatology Network database. Currently we are in the process of linking
individual dialysis patient records with the wildfire-related PM2.5 and extreme heat event metric. We
will conduct a time-stratified case-crossover analysis with a conditional Poisson model to investigate
the effect of exposure to wildfire-related PM2.5 on hospitalization and mortality risk. We will
additionally assess how this association was modified by extreme heat events.
RESULTS:This study included a total of 131 hemodialysis clinics. The daily PM2.5 concentration during
the study period ranged from 0 to 485.8 μg/m³ with the average of 10.8 μg/m³ (SD=8.9 μg/m³). The
average PM2.5 concentration during wildfire events (16.8 μg/m³) was higher than those days without
wildfire smoke (10.6 μg/m³). We will present results depicting association between wildfire related
PM2.5 exposure and risk of hospitalization and mortality. We will further show how this risk is further
exacerbated by extreme heat events.
CONCLUSIONS:Our findings highlight the need for enhanced readiness for wildfires and extreme heatevents targeting vulnerable populations, such as hemodialysis patients, within the context of ongoingclimate change.

Keywords: Temperature extremes and variability, Natural disasters, Mortality

FP-178[Neurologic and mental health outcomes » Mental health outcomes]

Prenatal maternal mobile phone use anddepressive and anxiety symptoms in 10-year-old
childrenHyunjoo Joo, Jonghyuk Choi, Hyungryul Lim, Mina Ha
Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Korea

BACKGROUND AND AIM:In recent years, with the rapid technological development of wirelesscommunication, it has been important to study possible negative health effects of mobile phone
exposure. One of the concerns is a possible relation between prenatal mobile phone exposures andvarious mental health problems in their children.
METHOD:A prospective cohort data from Mother and Children’s Environmental Health Study was used,which had examined various environmental exposure and health outcomes with repeatedmeasurements in mothers and their children. The depression and anxiety of 10-years-old children
were assessed by using the Children's Depression Inventory(CDI), State Anxiety Inventory ofChildren(SAIC) and Trait Anxiety Inventory of Children(TAIC). Pregnant women before 20 weeks ofpregnancy were enrolled and the number of participants was 1,751 mother-child pairs. After excluding
participants who were not responded to mobile phone questionnaire or not assessed the depression
and anxiety, 215 pairs were included in the present study. Multiple generalized linear model wasapplied to examine the association between prenatal maternal mobile phone usage and children’s
depression and anxiety symptoms, adjusted for children’s own mobile phone use, residential area,maternal age at childbirth, household income, and secondhand smoke exposure.
RESULTS:The mean and standard deviation of CDI, SAIC and TAIC score were 7.45 ± 5.76, 27.80 ±6.95 and 28.74 ± 7.07, respectively. CDI and TAIC score in girls were significantly 5.72-point(p=0.002) and 6.69- point (p=0.003) higher in group of 30 minutes or more prenatal calling a day
than those of less than 30 minutes, respectively. No significant results showed in boys.
CONCLUSIONS:This study showed that prenatal maternal mobile phone use for longer time affect the
10-years old girls’ symptoms of depression and traits of anxiety.

Keywords: mobile phone use, depressive symptoms, anxiety symptoms

FP-179[Air pollution » Long-term exposure]

Particulate matters and the risk of depression:
analysis of the Korean Longitudinal Study ofAging (KLoSA) 2016-2020 in South Korea
Hyunkyung Park1, Cinoo Kang2, Aims Create Team3, Ho Kim2
1Department of Public Health Sciences, Graduate School of Public health, Seoul National University,

Seoul, Republic of Korea; National Evidence-based Health Care Collaborating Agency, Seoul, Republicof Korea
2Department of Public Health Sciences, Graduate School of Public health, Seoul National University,

Seoul, Republic of Korea
3AiMS-CREATE TeamBACKGROUND AND AIM:There is a growing concern that particulate matter (PM) such as PM2.5 andPM10 has contributed to exacerbating psychological disorders, in particular, depression. However, little
is known about the roles of these air pollutants on depression in elderly. Therefore, this study aimed
to examine the association between two types of particulate matter and depression in the elderly
population in South Korea.
METHOD:We used panel survey data, the Korean Longitudinal Study of Aging (KLoSA), administeredby the Labor Institute during the study period of 2016, 2018, and 2020 covering 217 districts in South
Korea (n=7,674). Annual district-specific PM2.5 and PM10 concentrations were calculated for the
study period from the monthly prediction concentrations produced by a machine-learning-based
ensemble model (cross-validated R²: 0.87), then linked to the individuals matching with year andtheir residential district. Depression was defined by the CES-D 10 questionnaire (10 items with a 4point Likert scale), with a cut-off score of 22 points. We constructed a generalized estimating equation(GEE) model to identify the associations between each of the long-term PM2.5 and PM10 exposuresand depression after adjusting for individual and regional factors as confounders. Estimates for theodds ratio (OR) per 10 μg/m³ increment of concentration level and 95% confidence interval (95% CI)
were calculated.
RESULTS:We found that long-term 10 μg/m³ increments in PM2.5 (OR 2.83, 95% CI 2.18-3.67) andPM10 (OR 2.36, 95% CI 1.99-2.79) were associated with depression in the elderly. Associations wereconsistent after adjusting for other air pollutants (NO2, O3, and CO) in two-pollutant models. In
addition, the impacts substantially differed by regions grouped by the tertile of the population density.
CONCLUSIONS:Long-term exposure to PM2.5 and PM10 was associated with a higher risk ofdeveloping depression in elderly people. The impact was modified by the population density level ofthe region where they reside.

Keywords: Air pollution, Particulate matter, Long-term exposure, Mental health outcomesFP-180[Chemical exposures » Pesticides]

Mapping the key characteristics of carcinogens
for glyphosate and its formulations: A
systematic review
Iemaan Rana, Patton K. Nguyen, Gabrielle Rigutto, Allen Louie, Jane Lee, Martyn T. Smith, Luoping
Zhang
Department of Environmental Health Sciences, School of Public Health, University of California,
Berkeley

BACKGROUND AND AIM:Glyphosate was classified as a probable human carcinogen by theInternational Agency for Research on Cancer partially due to strong mechanistic evidence in 2015.
Since then, numerous studies of glyphosate and its formulations (GBF) have emerged. These studies
can be evaluated for cancer hazard identification with the ten key characteristics (KC) of carcinogens
approach. We aimed to assess all in vivo, ex vivo, and in vitro mechanistic studies of human andexperimental animals (mammals) comparing exposure to glyphosate/GBF with low/no exposure
counterparts for evidence of the ten KCs.
METHOD:Two blinded reviewers screened studies available in PubMed before August 2021 for inclusion
criteria (protocol: INPLASY202180045). Data extraction was conducted in duplicate for each KC
outcome reported along with key aspects of internal/external validity, results, and reference
information. These data formed a matrix analyzed in R to conduct strength of evidence and quality
assessments.
RESULTS:Of 2537 articles screened, 175 met inclusion criteria, from which >50,000 KC-related data
points were extracted. Data analysis revealed strong evidence for KC2, KC4, KC5, KC6, KC8, limited
evidence for KC1 and KC3, and inadequate evidence for KC7, KC9, and KC10. For KC2, we foundstudies conducted in humans and human cells provided stronger evidence than animal models; GBF
elicited a stronger effect in both human and animal systems compared to glyphosate alone; and thehighest quality studies in humans and human cells consistently revealed strong evidence of
genotoxicity. KC8 analyses revealed glyphosate’s ability to modulate hormone levels and estrogen
receptor activity is sensitive to exposure concentration and formulation, and provided clear evidence
that glyphosate interacts with receptors, alters receptor activation, and modulates the levels andeffects of endogenous ligands (including hormones).
CONCLUSIONS:Our findings strengthen the mechanistic evidence that glyphosate is a probable humancarcinogen and provide biological plausibility for reported human cancer associations, such as nonHodgkin lymphoma.

Keywords: big data, occupational exposures, causal inference, pesticides, risk assessment

FP-181[Neurologic and mental health outcomes » Mental health outcomes]

Long-term exposure of bis(2-ethylhexyl)
phthalate causes neurobehavioral disorders by
disrupting glutamate-glutamine homeostasis in
the mPFC
Jae Soon Kang1, Ji Hyeong Baek1, Mi Yeong Song1, Hyeong Chan Park1, Naveed Ur Rehman2, Hye Jin
Chung2, Dong Kun Lee3, Dae Young Yoo1, Hyun Joon Kim1
1Department of Anatomy and Convergence Medical Sciences, Institute of Health Sciences, Tyrosine

Peptide Multiuse Research Group, Anti-aging Bio Cell Factory Regional Leading Research Center,
Gyeongsang National University Medical School, Jinju, Republic of Korea
2College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National

University, Jinju, Republic of Korea
3Department of Physiology, Institute of Health Sciences, Tyrosine Peptide Multiuse Research Group,

Gyeongsang National University Medical School, Jinju, Republic of Korea

BACKGROUND AND AIM:Bis(2-ethylhexyl) phthalate (DEHP) is the most used phthalate and its
extensive use allows daily exposure to humans via various routes. Although a positive relationshipbetween DEHP exposure and neurobehavioral disorders is suspected, there are insufficient data on theharmfulness of neurobehavioral disorders caused by DEHP exposure, particularly at daily exposurelevels. We try to identify the relationship between DEHP and neurobehavioral disorders, and explain
the underlying mechanism.
METHOD:We assessed the consequences of DEHP ingestion including daily exposure concentration inmale mice for 30 (short-term) and 100 (long-term) days and examined its effects on neuronal
functions associated with neurobehavioral disorders, such as depression and cognitive decline.
RESULTS:We found the noticeable depressive behaviors and decline of learning and memory functionin the DEHP-ingestion groups, and that biomarkers related to chronic stress such as corticosterone
and ROS/RNS were elevated in plasma and brain tissues. DEHP ingestion induced collapse ofglutamate (Glu) and glutamine (Gln) homeostasis as a result of disruption of the Glu-Gln cycle in the
medial prefrontal cortex and hippocampus. The electrophysiological approach demonstrated that DEHP
ingestion lowered the glutamatergic neurotransmission activity involved in emotional and cognitive
functions in the brain.
CONCLUSIONS:Our research revealed that the long-term exposure of environment-relevant DEHP,
even levels of exposure lower than the tolerable daily intake (TDI), have the strong potential to cause
neurobehavioral disorders. Further, since the developing and commercializing a safe substance toreplace DEHP is a time-consuming process, it is necessary to prepare stricter regulations and todevelop and implement a method to prevent neurobehavioral disorders caused by daily exposure to
DEHP to protect the human mental health from this hazardous material.
This research was supported by the National Research Foundation (NRF-2020R1I1A1A0107229813,
2021R1A5A802949012, 2022R1A2C100529611 and 2023R1A2C1005658) and the Commercializations
Promotion Agency for R&D Outcomes (1711173796) funded by the Korea government.

Keywords: bis(2-ethylhexyl) phthalate, neurobehavioral disorders, medial prefrontal cortex,

glutamate-glutamine homeostasis, neuro-hazardous substance

FP-182[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Differential impact of subjective perceptions ofworkplace interactional demands on cognitive
function according to occupations: A
longitudinal study
Seong Uk Baek1, Jin Ha Yoon2, Jaelim Cho2
1Department of Occupational & Environmental Medicine, Severance Hospital, Seoul, Korea
2Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

BACKGROUND AND AIM:Interpersonal interactions are known to be positively associated withcognitive function. However, subjective demands of interpersonal interactions may lead to negative
mental health (emotional labor) in workers with limited autonomy. We examined whether the level ofsubjective perceptions of workplace interactional demands (WID) was associated with cognitive
function and how this association varied according to occupations.
METHOD:A nationally representative sample of 4,693 middle-aged and older workers underwent
longitudinal measurement of the Mini Mental Status Examination (MMSE), with 2-year intervals(yielding 15,657 observations). A change in cognitive function was calculated as MMSE score at eachmeasurement minus MMSE score at the previous measurement. Nine categories of the KoreanStandard Classification of Occupation were used. Subjective perception of WID was defined as theextent to which workers were required to have skills to deal with co-workers and clients, and its level
was classified as low and high WID. We used generalized estimating equations, adjusting for
demographics and socioeconomic status.
RESULTS:The proportion of high WID was 51.5%. In the overall sample, high WID was significantly
associated with an increased cognitive function (β=0.22, 95% CI: 0.13 to 0.30). In occupationstratified analyses, this protective effect of high WID remained significant in professionals (β=0.82[95% CI: 0.48 to 1.17]), agricultural, forestry, and fishery workers (0.38 [0.10 to 0.65]), craft andrelated trades workers (0.28 [0.06 to 0.50]), plant and machine operators and assemblers (0.27 [0.03
to 0.51]), and elementary workers (0.18 [0.00 to 0.51]). By contrast, high WID was not significantly
associated with a change in cognitive function in clerks, service workers, and sales workers.
CONCLUSIONS:Our study suggests differential impacts of subjective percerceptions of WID on
cognitive function between occupations among middle-aged and older individuals. Subjective
perceptions of WID may protect against cognitive decline in professionals, but not in service and sales
workers.

Keywords: Occupational exposures, Occupational epidemiology, cognitive function, repeatedmeasures analysis

FP-183[Climate » Other (to be specified with keywords in the keywords section)]

Temperature modifies the association between
air pollution and respiratory disease
hospitalisation an industrial area of South Africa
Nandi Mwase1, Bukola Olutola2, Janine Wichmann1
1School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa2Independent Institute of Education, South Africa

BACKGROUND AND AIM:Despite epidemiological studies reporting distinct effects of air pollution andtemperature on human health, these two exposures are frequently considered as separate risk factors.
There have been limited investigations into the modifying effects of temperature on the health impactsof air pollution in Africa, and no studies have explored the effects of black carbon on respiratory
disease (RD) hospitalisations. The aim of this study was to assess whether the association between RD
hospitalisations and air pollution in the Vaal Triangle Air Pollution Priority Area was modified byapparent temperature (Tapp) between January 2013 and February 2020.
METHOD:RD admission data (ICD10 J00-J99) were obtained from two hospitals located in
Vanderbijlpark and Vereeniging. Ambient PM10, PM2.5, BC, NO2, SO2 and O3, temperature andrelative humidity data were obtained from six monitoring stations. A case-crossover epidemiologicalstudy design was applied. Lag0-1 was investigated, i.e. the average air pollutant level on the day andthe day before hospitalisation. Regression models were adjusted for public holidays and Tapp. Effectmodification was investigated by stratifying days into low, moderate and high Tapp days.
Susceptibility by age and sex was investigated.
RESULTS:Out of a total of 43386 hospital admissions, 50.9% were females and 51.4% were children
aged 0-14 years. Air pollutants exceeded the World Health Organization's (WHO) daily air quality
guidelines on more than 50% of the days. Moderate Tapp, in general, exacerbated the adverse effectsof PM2.5, PM10, SO2, and BC, while high Tapp amplified the effects of NO2 and O3. The elderly andfemales were more susceptible to the effects of air pollution, particularly on days with moderate Tapp.
CONCLUSIONS:The findings suggest that the risk of hospitalisation for RD due to exposure to ambient
air pollution varies on days with low, moderate and high Tapp in Vanderbijlpark and Vereeniging.

Keywords: Effect modification, air pollution, temperature, respiratory disease, industrial area, South
AfricaFP-184[Air pollution » Long-term exposure]

Association of outdoor air pollution and breast
cancer: A systematic review of longitudinal
study
Jeeraporn Tippila, Naw Lah Say Wah, Kraiwuth Kallawicha
College of Public Health Sciences, Chulalongkorn University,Bangkok, Thailand

BACKGROUND AND AIM:Breast cancer is the most prevalent malignancy among women. Certain air
pollutants have carcinogenic and estrogenic properties that promote breast cancer development. In
this systemic review, we explore the association between air pollution and breast cancer using
epidemiological evidence
METHOD:Articles published between 2013-2022 from Scopus and PubMed databases weresystematically reviewed. We included articles that primarily emphasized on cohort and nested casecontrol in cohort studies, and outdoor air pollution and breast cancer. In the end, 26 papers wereretained for analysis; Most of articles from America and Europe. Studies were reviewed in accordancewith the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines.
RESULTS:Most of the study focused on old adults and over. Total of 11 out-door pollutants have been
analyzed in this study, 6 pollutants were associated with breast cancer risk, All of black carbon andBenzo[a]pyrene(BaP) studies were associated with breast cancer risk with OR=1.03, 95%CI = 1.00 1.07, 1.15; 95%CI= 1.04 - 1.27, respectively, 52.63% of PM2.5 studies were associated with breast
cancer (HR=1.03 - 1.86; 95%CI = 1.01 - 3.10), while 50% of NO2, NOx found an association with
HR= 1.03 – 1.44; 95%CI=1.00 - 1.99 and 1.35; 95%CI = 1.02 - 1.79, respectively. In contrast,
66.67% of PM10 studies found no association while 100% of NO, SO2, ultra-fine particle, O3 andCadmium studies were found no association with breast cancer risk.
CONCLUSIONS:This study indicated that various outdoor air pollutant was associated with breast
cancer risk. Causal nature of the association needs to be further investigated. Future research should
investigate the mechanisms that could relate the carcinogenic effects of environmental pollutants toan epigenetic pathway that contributes to the advancement of breast cancer.

Keywords: Outdoor Air pollution, Breast cancer, Incident

FP-185[Air pollution » Particulate matter]

Effects of abdominal fat on the association
between ambient air pollution and thyroid
function in Korean
Jeoung A Kwon1, Byungmi Kim2, Hyun Jin Kim2, Seyoung Kim1, Jin Ho Park3
1National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
2National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea;

National Cancer Center Graduate School of Cancer Science and Policy, Goyang, 10408, Republic of
Korea
3National Cancer Center Graduate School of Cancer Science and Policy, Goyang, 10408, Republic of

Korea
4Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea

BACKGROUND AND AIM:We investigated the association between exposure to air pollution and thyroid
function, and whether this association are modified by abdominal fat distribution such as waist
circumference, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) in Korean adults
METHOD:We included 4704 adults in the final analysis and used each person’s annual average
exposure to 4 air pollutants, namely, particulate matter with an aerodynamic diameter less than orequal to 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide, and carbon monoxide (CO). We
measured serum thyrotropin (TSH) and free thyroxine (FT4) concentrations as indicators of thyroid
function according to abdominal fat distribution.
RESULTS:The annual average exposure of air pollution was significantly associated with an elevated
TSH and reduced FT4 concentration after adjusting for possible confounding factors. In stratified
analysis by abdominal fat traits, we found that exposure to air pollutants was significantly associatedwith an increased TSH or decreased FT4 level and showed stronger effects of PM10 exposure in TSH
and CO exposure in FT4 (all P <.05). In addition, air pollution including PM10, NO2 and CO wassignificantly associated with both TSH and FT4 levels in the high-VSR group (all P <.05)., but not in
those of normal group.
CONCLUSIONS:This study provides the first evidence that association between air pollution exposureand thyroid function is different by abdominal fat distribution.

Keywords: air pollution, thyroid function, abdominal fat distribution, general adults

FP-186[Outcomes » Infectious diseases]

Early and late onset of acute otitis media (AOM)
according to long term PM2.5 exposure:national longitudinal cohort
Ji Hyen Lee1, Hyemin Jang2, Whanhee Lee3, Jongmin Oh4, Eunji Kim5, Jung Won Lee1, Hae Soon
Kim1, Eunhee Ha6
1Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic of Korea;

Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
2Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of

Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul,
Republic of Korea
3School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic ofKorea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
4Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
5Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
6Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health(IESEH), College of Medicine, Ewha Womans University, Seoul, Republic of Korea

BACKGROUND AND AIM:Experimental studies have reported that air pollution could make the middle
ear more susceptible to infections, but the associations between particulate matter 2.5 (PM2.5) andacute otitis media (AOM) were inconsistent. We examined the association of long-term exposure toPM2.5 with the risk of AOM.
METHOD:We used the National Health Insurance Service-National Sample Cohort spanning from 2002
to 2019, which consists of one million beneficiaries representative of the entire population in South
Korea. The onset of AOM was defined as the first hospital visit record with a primary diagnostic code
based on the International Classification of Disease, 10th edition codes. For PM2.5 exposures, we used
a machine learning-based ensemble prediction model with a spatial resolution of 1 km2 and allocatedthe district-specific annual average concentration of PM2.5 across all 229 districts in South Korea. We
estimated the association between PM2.5 and the onset of AOM using a time-varying Cox proportional
hazard model adjusted for age, sex, socioeconomic status, region, and community level indicators.
RESULTS:Our study included 379,585 beneficiaries aged 0-18 years at enrollment and followed until
the first onset of AOM. We identified 196,762 cases of AOM and found a positive association between
exposure to PM2.5 and the development of AOM, with a hazard ratio of 1.064 (95% CI 1.053 to
1.076) for every 5μg/m³ increase in annual PM2.5. In the subgroup analysis, the highest HR was
observed in beneficiaries in the 0-5 year age (1.078; 1.065 to 1.092), low-income (1.079; 1.042 to
1.118), and rural area (1.119; 1.093 to 1.144).
CONCLUSIONS:In this nationwide, population-based cohort study, long-term childhood exposure toPM2.5 was associated with an increased incidence of AOM. These results indicate plausible

mechanisms of air pollution and AOM, and our findings could provide important fundamental data forpreventing AOM in children.

Keywords: Particulate matter, Air pollution, Infectious diseases, Long-term exposureFP-187[Outcomes » Childrens environmental health]

One Year Progress summary of Children’s
Environmental Health Clinic in Korea (CHECK)Ji Hyen Lee1, Hanna Kim2, Jung Won Lee1, Hae Soon Kim1, Yi⁻ Jun Kim3, Jungsil Lee3, Kyoung⁻ Ryul
Lee4, Saeyun Baik4, Eunhee Ha5
1Environmental health Clinic in Korea (CHECK), College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul,
Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
2Environmental health Clinic in Korea (CHECK), College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea; Department of Environmental Medicine, College ofMedicine, Ewha Womans University, Seoul, Republic of Korea
3Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
4Department of Laboratory Medicine, Seoul Clinical Laboratories, Gyeonggi-do, Republic of Korea
5Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science andEngineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

BACKGROUND AND AIM:Since the 1990s, Pediatric Environmental Health Specialty Units (PEHSUs) in
the United States have provided rigorous research, clinical care, and public health interventions.
However, this systematic network is scarce globally, particularly throughout Asia. In 2022, weestablished the children’s environmental health clinic in South Korea. This is the first-year progress
report.
METHOD:We structured the questionnaires divided into five pediatric periods, namely infant, toddler,
preschool age, school age, and adolescents, and established an examination system for our outpatient clinic. Following institutional review board (IRB) approval, we examined pediatric patients forallergic, renal, and immunologic diseases, and precocious puberty by checking their laboratory tests(including heavy metals, volatile organic compounds, and endocrine-disrupting chemicals) from bloodand urine samples through integrated system of Seoul Clinical Laboratories. At the same time, we
performed a physical examination of the patients and provided specialized counseling and education
for patients and their parents to reduce the exposure to high levels of environmental pollutants inblood and urine, and followed up their environmental pollutant levels every 6 months.
RESULTS:Since August 2022, thirty-two patents, with ratio of female to male 1:1, visited our CEH
clinic. Through the structured pediatric environment questionnaire, living and educational
environment, food intake, past medical history, and children’s sleep status were identified.
Particularly, pediatric patients with allergic skin diseases showed high bisphenol A, paraben, andphthalate levels in urine. In addition, elevated levels of these chemicals were seen in theenvironments with frequent food delivery and use of plastic containers. We will follow up the children’s
health and their environmental pollutant levels every 6 months.
CONCLUSIONS:CHECK is the first pediatric environmental health clinic in Korea. We will provide amodel of pediatric environmental health care as a standardized and specialized clinic with laboratories.

Keywords: Children's environmental health, Endocrine disrupting chemicals, OutcomesFP-188[Respiratory and allergic outcomes » Asthma]

Indoor carbon monoxide and sulfur dioxide wereassociated with schoolchildren's asthma andlung function in an industrial city
Jia Lin Zhang, Yu Chuan Yen, Pei Shih Chen
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City,
TaiwanBACKGROUND AND AIM:The prevalence of childhood asthma has increased annually. Indoor air
pollutants were one of the most important risk factors because children spend most of their time athome. To our knowledge, no study discussed the difference in indoor pollutants between thehouseholds of children with and without asthma in an industrial city, and evaluate the effects of indoor
CO, CO2, SO2, and O3 in households on schoolchildren’s lung function.
METHOD:Between April 2010 and October 2010, a case-control study of 30 healthy children and 30
asthmatic children was conducted. The indoor air pollutants samples in children’s households were
measured by real-time monitoring equipment for 24 hours, and children’s lung function values werealso assessed in the beginning of and at the end of environmental sampling dates.
RESULTS:We observed the concentrations of indoor CO2, SO2, PM10, and PM2.5 in households ofasthmatic children were significantly higher than those of non-asthmatic children. In both the stepwise
regression models and in the multiple regression models, the acute effects of indoor CO, and SO2 onchanges in children’s lung function values were observed with statistical significance, and indoor CO2
had a significant positive association with children’s lung function in this study.
CONCLUSIONS:This is the first study to investigate the difference in indoor pollutants especially forSO2 between the households of children with and without asthma in an industrial city, and evaluate
the effects of indoor CO, CO2, SO2, and O3 exposure on schoolchildren’s lung function. In our finding,the indoor CO and SO2 affect the children’s lung function, indicating that indoor air in households andschoolchildren’s lung function should be more concerned.

Keywords: Household, Sulfur dioxide, Carbon monoxide, Lung function, Industrial cityFP-189[Exposures » Occupational exposures]

The effect of financial performance indicators infinancial statements on the incidence ofoccupational injuries and diseases in South
Korea
Jinyoung Moon
Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, SouthKorea

BACKGROUND AND AIM:By examining the effect of the numbers in specific accounts of financial
statements on the incidence of occupational injuries and diseases, the author and readers could
understand how a specific operating characteristic affects the occupational safety and health of thecompany.
METHOD:For the Workplace Panel Survey (WPS) datasets, a multilevel Poisson regression or multilevellinear regression was applied.
RESULTS:For the number of workers who acquired occupational injuries and diseases during the fiscal
year, the average number of workers at the workplace, interest income, interest expense, and valueadded per person showed an increased relative risk with statistical significance. On the contrary, lease
expense, depreciation and amortization, and industrial property right both at the start and end of the
fiscal year showed a decreased relative risk with statistical significance. For whether or not there is
any worker who acquired occupational injuries and diseases during the fiscal year, taxes and duties
and welfare and benefits expense showed an increased risk with statistical significance. On thecontrary, severance pay, depreciation and amortization, and the average number of workers at theworkplace showed a decreased relative risk with statistical significance.
CONCLUSIONS:All statistically significant results were interpreted based on the general operating
characteristics of each workplace. In general, as the financial status of the workplace was worse, theincidence of occupational injuries and diseases increased. On the contrary, as the number of workers,
operating profit, and the magnitude of physical assets (subject to depreciation and amortization)
increased, the incidence of occupational injuries and diseases decreased. The results about
vehicles/transport devices might be associated to a special consignment subcontract in South Korea
between cargo truck owners and shipping companies.

Keywords: Financial Performance, Occupational Injuries and Diseases, South Korea, Workplace Panel
Survey, Operating Characteristics

FP-190[Birth and pregnancy outcomes » Birth outcomes]

A propensity score analysis on the effect ofmobile phone use during pregnancy on birthoutcomes in Ko-CHENS
Jonghyuk Choi, Hyungryul Lim, Hyunjoo Joo, Mina Ha
Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic ofKorea

BACKGROUND AND AIM:In modern society, exposure to electromagnetic waves is an unavoidable
ubiquitous exposure. It is not yet clear whether the use of mobile phones during pregnancy has acausal adverse effect on birth outcomes.
METHOD:In the Korea Children's Environment and Health Study cohort, information was gathered via
a questionnaire on mobile phone usage among 5,213 women who was recruited before 20 weeks ofpregnancy and gave birth between 2015 and 2020. Participants with missing information of cell phone
use or birth outcome and with multiple births were excluded, and finally 4628 women-child pair wereanalyzed in the present study. Birth outcomes evaluated were birth weight and height, Ponderal index,
gestation age, preterm birth, and low birth weight. Propensity scores(PS) were generated for groups
with high and low mobile phone usage during pregnancy classified at the 75percentile of average daily
call time distribution. Variables for PS calculation were selected using general characteristics and
LASSO regression. Ultimately, the effects of prenatal mobile phone use on birth outcomes were
examined through PS matching(PSM) and Inverse Probability of Treatment Weighting(IPTW) analysis.
RESULTS:The balances of the general characteristics of the groups with low and high call time weresimilarly distributed, ensuring comparability. The high call time group compared to low group showed
7.22 and 5.70 g more birth weight, 0.10 and 0.11 cm more birth height, 0.02 and 0.01 less ponderal
index, in PSM and IPTW analysis, respectively, although all were not statistically significant. The risks
was HR=1.02(0.95-1.10) and 1.05(0.99-1.12) for reduction of gestation age, OR=1.06(0.75-1.51)
and 0.97(0.70-1.36) for preterm birth, and OR=0.97(0.71-1.34) and 0.96(0.64-1.45) for low birthweight, respectively, in PSM and IPTW analysis.
CONCLUSIONS:We did not observe evidence that prenatal mobile phone use causally affects birthoutcomes. Additional studies using more advanced RF exposure assessment such as applying specificabsorption rate are needed.

Keywords: RM-EMF, mobile phone calls, birth outcome, propensity score, IPTW

FP-191[Birth and pregnancy outcomes » Birth outcomes]

Critical Windows of Greenness Exposure during
Preconception and Gestational Periods and their
Association with Birthweight Outcomes
Zhenchun Yang1, Jiawen Liao2, Yi Zhang3, Chenyu Qiu2, Kiros Berhane2, Zhipeng Bai4, Bin Han5, Jia
Xu5, Yong Hui Jiang5, Frank Gilliland6, Weili Yan2, Zhanghua Chen3, Guoying Huang2, Junfeng (jim)Zhang71Duke Global Health Institute, Duke University, Durham, NC, United States of America
2Department of Population and Public Health Sciences, Keck School of Medicine of University ofSouthern California, Los Angeles, CA, United States of America
3Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, China
4Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY,

United States of America
5State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy ofEnvironmental Sciences, Beijing, China
6Department of Genetics, Neuroscience, and Pediatrics, Yale University School of Medicine, New

Haven, CT, United States of America
7Duke Global Health Institute & Division of Environmental Science and Policy, Nicholas School of theEnvironment, Duke University, Durham, NC, United States of America

BACKGROUND AND AIM:Few studies have been conducted to examine the association between
greenness exposure and adverse birth outcomes. This study aims to identify critical exposure time
windows during pregnancy for the association between greenness exposure and birth weightoutcomes.
METHOD:A preconception cohort of 13,890 pregnant women and newborns in Shanghai, China from2016-2019 were included in the study. We assessed greenness exposure using Normalized Difference
Vegetation Index (NDVI) during the preconception and gestational periods, and evaluated theassociation with term birthweight, birthweight z-score, small-for-gestational age (SGA), and large-forgestational age (LGA) using linear and logistic regressions. We also controlled for meteorologicalvariables of ambient temperature and relative humidity, and air pollution levels of PM2.5 and NO2 ofthe same period for sensitivity analysis. Furthermore, we explored the effects of urbanicity and park
accessibility through stratified analysis.
RESULTS:We found that higher greenness exposure, as quantified via NDVI, during the second
trimester and the whole pregnancy was associated with higher birthweight and birthweight Z-score.
Specifically, a 0.1 unit increase in second trimester averaged NDVI value was associated with anincrease in birthweight of 10.2 g (95% CI: 1.8 g to 18.5 g) and in birthweight Z-score of 0.024 (0.003
to 0.045). Averaged NDVI during the entire pregnancy was associated with 10.1 g (95% CI: 1.0 g to19.2 g) increase in birthweight and 0.025 (0.001 to 0.048) increase in birthweight Z-score. Moreover,
the associations of greenness exposure were larger among participants living in urban areas comparedto the suburban areas and in areas without park accessibility within 500 m compared to with park
accessibility within 500 m, particularly during the second trimester.
CONCLUSIONS:Our findings suggest that increased greenness exposure, particularly during thesecond trimester, may be beneficial to increase in birth weight towards normal levels in an intra-urban
environment.

Keywords: Greenness, NDVI, Air Pollutant; Small for Gestational Age; Large for Gestational age;
Preconception; Pregnancy; BirthweightFP-192[Exposures » Other (to be specified with keywords in the keywords section)]

Toxicity of Boron Carbide (B4C) Nanomaterials
on Caenorhabditis elegans Models
Kai Jie Yang1, How Ran Chao1, Adriana Taw2
1Kai-Jie Yang,How-Ran Chao
2Adriana Taw

BACKGROUND AND AIM:Boron carbide (B4C) is a widely known ceramic material composed of boron
and carbon. It is known for its toughness, high melting point, low density, and good mechanicalproperty. Due to its diverse properties, it is widely used in industrial applications such as cutting tools
grinding wheels, ballistic armor, and neutron absorbers in nuclear power. Despite the various
advantages of B4C, constant exposure to boron carbide nanoparticles (B4C NPs) may induce adverse
effects on the human body via inhalation, skin contact, or consumption.
METHOD:In this study, B4C NPs were investigated using Caenorhabditis elegans (C. elegans) as invivo model to determine the different toxicological endpoints including reproductive (brood size),
growth measurement (body length), locomotion (head thrashing and body bending), lifespan, andoxidative stress (gene expression of sod-1, sod-3, ctl-2, and cyp35a2) and metal detoxification (geneexpression of mtl-2). The
RESULTS:The L1 nematodes were exposed to B4C NPs concentrations of 320, 160, 80, 40 mg/L until
the nematodes attained the L4 stage. The reproductive and locomotion assay revealed a significant
decrease in brood size and body bending in 80 to 320 mg/L B4C NPs concentration which indicates
B4C NPs can induce reproductive toxicity and reduce motor function. The exposed nematodes exposed
at high concentration of B4C NP showed decrease in survival rate compared to the control group. With
regards to the growth measurement assay, there were no significant changes in the body length of the
exposed nematodes.
CONCLUSIONS:The genes responsible for regulating the oxidative stress and metal detoxification were
found to be downregulated resulting to affected biological system of nematodes. These findings
indicate that B4C NPs can cause adverse effects on C. elegans and further observation of otherphysiological changes in nematodes can done in future studies.

Keywords: Exposure assessment, Long-term exposureFP-193[Exposures » Water quality]

Characteristics, Pollution and Health Risk
Assessment of Metals and Metalloid in Drinking
Water of Yangtze River and Taihu Lake
Keqin Wu, Wenwei Liu, Xinliang Ding, Yuanhua Meng
Wuxi Center for Disease Control and Prevention

BACKGROUND AND AIM:Metal pollution in drinking water pose multiple risks, thus have drawn the
public attention worldwide. Yangtze River delta is the most economically vigorous region in China.
However, metal pollution condition of the main water source remains systematic study. Therefore, thisstudy characterized the 21 elements distribution, and then the pollution index and health risk
assessment were conducted to evaluate the potential risk of metal exposure through oral and dermal
ingestion to local resident.
METHOD:120 drinking water samples were collected in four main cities of Yangtze River Delta from
Dec, 2015 to Dec, 2016, and inductively coupled plasma-mass spectrometry was employed to analyze
21 common elements. then Heavy metal pollution index method and health risk assessment process
combined Monte Carlo simulation uncertainty analysis were applied to assess the pollution level,
health risk and main risk factors.
RESULTS:The most abundant element was Sr, and significant spatial distribution difference was found.
B and Mo presented strong positive correlation both in Yangtze River(R2=0.847) and Taihu
Lake(R2=0.807). the median Heavy Metal Pollution Index values were 8.93 and 4.40 of Yangtze River
and Taihu Lake respectively. For non-carcinogenic, the medians hazard index of Yangtze River for
adult, children, Taihu Lake for adult and children were 3.14E-01, 1.09E-01, 2.61E-01 and 9.04E-02
respectively. Exposure duration(r=0.7931) and ingestion rate(r=0.4897) played dominated role inhealth risk prediction. The total carcinogenic risks were 1.44E-05 and 1.75E-05 of Taihu Lake andYangtze River, which means the non-carcinogenic and carcinogenic risks were all within the acceptable
range. However, As and Ni were the leading factors and its pollution could not be neglected for humanhealth.
CONCLUSIONS:In summary, our findings provide detailed data of water metal distribution
characteristics and health risks caused by metal ingestion through drinking water in Yangtze River
Delta, Baseline information and risk factors were provided for drinking-water safety and governance.

Keywords: metal pollution, drinking water, health risk assessment, Monte Carlo analysis

FP-194[Air pollution » Particulate matter]

Association between exposure to PM2.5 andblood pressure among participants of the
globally conducted May Measurement Month2018-2019
Kritika Anand1, Siddhartha Mandal1, Thomas Beaney2, Dorairaj Prabhakaran1, Neil Poulter2
1Centre for Chronic Disease Control, New Delhi, India
2Imperial Clinical Trials Unit, Imperial College London, UK

BACKGROUND AND AIM:Evidence on link between short and long-term air pollution exposure withraised blood pressure (BP) and hypertension is concentrated in high income settings. Low-middle
income countries face most of the burden of both air pollution and increasing incidence and mortality
from increased BP, yet there is a paucity of studies conducted in such areas. We aim to extend thespatial coverage of the evidence by including a variety of countries with different income and air
pollution levels. We investigated the cross-sectional associations between exposure to short (1-month,
3-month average) and long-term (6-month, 1-year average) ambient PM2.5 and BP in 125,198
participants from 29 countries during May Measurement Month (MMM) BP screening campaigns in2018 and 2019.
METHOD:We used satellite derived data on monthly average PM2.5 and assigned exposure (averaged
for 1-month, 3-months, 6-months, and 1-year) to participants for the month in which the BP
measurement was recorded based on the coordinates of the MMM screening site. Generalized additivemodels with penalized splines were used while accounting for potential confounders and country-levelclustering effects.
RESULTS:Short and long-term exposure to ambient PM2.5 was associated with increases in SBP and
DBP at an individual level but not at the country level globally. We found the relationship to be nonlinear with significantly higher effects beyond 70ug/m3. Stratified analysis showed that individuals
with high BMI, hypertensives specifically those not on antihypertensive medication and participants
with comorbidities were more susceptible to the effect of air pollution on BP.
CONCLUSIONS:More high-quality data are required linking individual air pollution exposure (using
robust and granular data) with cardiovascular risk factors such as BP and major adverse
cardiovascular events. Meanwhile, health policies which promote the reduction of air pollution areneeded, particularly for those at highest risk.

Keywords: Air pollution, Particulate matter, Long-term exposure, Cardiovascular diseases

FP-195[Chemical exposures » Phthalates]

Urinary Phthalates Esters in Nationwide
Representative Samples of Taiwan in 2019
Kuan Yi Chen1, Pau Chung Chen1, Ching Chun Lin1, Mei Huei Chen2, Chi Chang Ho1
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan.
2National Taiwan University College of Medicine, Taipei, Taiwan.

BACKGROUND AND AIM:Since 2011, there was an incident involving phthalate-tainted food that di-(2ethylhexyl) phthalate (DEHP) and di-isononyl phthalate (DiNP) were illegally added to foodstuffs andmedications. DEHP and DiNP, as widespread plasticizers, are considered endocrine disrupting
chemicals (EDCs) with main toxicological effects on reproductive and metabolic systems. Nationwide
human biomonitoring (HBM) surveys have been conducted in many countries long time ago. Like theUnited States beginning in the early 1960s, which call the National Health and Nutrition Examination
Survey (NHANES); and German Environmental Survey (GerES) started in 1985; other like Korean
National Environmental Health Survey (KoNEHS), which began in 2005; and the other is Canada, they
conducted Canadian Health Measures Survey (CHMS) beginning in 2007. However, there is nonationwide human biomonitoring survey had been conducted in Taiwan recent years.
METHOD:We aimed to establish the urinary levels and reference values (RVs) of phthalate metabolites
and identify exposure characteristics among Taiwan’s population. We enrolled 1748 participants 7
years of age and older from the Nutrition and Health Survey in Taiwan (NAHSIT) conducted in 2019 byusing probability proportional to size (PPS) and primary sampling unit (PSU) sampling covering 20
cities or counties of Taiwan. Each township was classified into one of two groups according to its
population density and urbanization level. We collected participant’s urine, blood, and environmental
and lifestyle questionnaires.
RESULTS:Levels of 12 different phthalate metabolites in participants’ urine samples were determined
by Ultra Performance Liquid Chromatography-tandem mass spectrometry (UPLC-MS/MS) for analysis.
The results of phthalate esters distribution in Taiwan were compared with other national
representative samples that provide national estimates on various health-related topics.
CONCLUSIONS:We used our RVs of urinary phthalate metabolites compared with HBM guidance values(HBM-GVs) announced from Human biomonitoring initiative (HBM4EU). In order to make sure general
population in Taiwan keep in a safe living environment.

Keywords: Biomarkers of exposure, Endocrine disrupting chemicals

FP-196[Methods » Environmental epidemiology]

National representative prevalence survey on
idiopathic environmental intolerance attributed
to electromagnetic fields in Taiwan
Kun Hua Li1, How Ran Guo2
1Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng
Kung University Hospital, Tainan, Taiwan

BACKGROUND AND AIM:The prevalence rate of idiopathic environmental intolerance attributed toelectromagnetic fields (IEI-EMF), also known as electromagnetic hypersensitivity, was 13.3% in 2007
in Taiwan, which is most likely the highest that has been reported globally. The prevalence of IEI-EMF
seems to decline during the last decade, and it decreased dramatically to 4.6% in 2012 in Taiwan. We
conducted a survey that aimed to assess the prevalence rate of IEI-EMF in 2019 in Taiwan andcompare the results to those of previous surveys.
METHOD:We adopted a cross-sectional study design. For comparison, we applied the same method as
used by the previous surveys in Taiwan. Specifically, we conducted a nationwide random digital dialing(RDD) telephone survey and utilized two-stage stratified sampling according to the administrative
division. Households were randomly selected in each administrative division in proportion to the
population size. In addition, a post-stratification method was applied to transform the raw data intoweighted data based on the distribution of the national population in 2018 in Taiwan.
RESULTS:A total of 1,355 participants were included, yielding a response rate of 13.0%--lower thanthe 23.6% in the 2012 survey but higher than the 11.6% in the 2007 survey. The contact rate oflandline phone users has decreased gradually over time, from 52.3% in 2007 to 46.9% in 2012, andthen to 31.7% in 2019, which might have been influenced by changes in the use of landline phones in
Taiwan—more and more people use cell phone for personal communications and so the proportion ofbusiness numbers becomes larger. The weighted prevalence rate of IEI-EMF was 4.6%, which was thesame as in the 2012 survey.
CONCLUSIONS:The prevalence rate of self-reported IEI-EMF did not change remarkably during theperiod from 2012 to 2019 in Taiwan.

Keywords: Epidemiology, Long-term exposureFP-197[Air pollution » General]

Exposure to air pollutants and prevalence ofmyopia: a nationwide cross-sectional study in
Korean males
Kyeongmin Kwak1, Sangchul Yoon2, Sun Young Kim3
1Department of Occupational and Environmental Medicine, Korea University College of Medicine,

Seoul, Republic of Korea
2Department of Humanities and Social Medicine, Yonsei University College of Medicine, Seoul, Republicof Korea
3Department of Cancer AI and Digital Health, National Cancer Center Graduate School of Cancer

Science and Policy, Goyang, Republic of Korea

BACKGROUND AND AIM:While the cause of myopia is primarily explained by genetic factors, recently,
the possibility of corneal inflammation due to air pollution has been raised as a potential risk factor formyopia. Some epidemiological studies showed a significant relationship between air pollutants andmyopia, but there were limitations in representativeness. We aim to identify the association between
prevalence of myopia and air pollutants targeting the whole male population in Korea.
METHOD:We linked the military physical examination data from 2010 to 2019 and air pollution
information from the Korea Environment Corporation were l based on the address of the subjects. We
analyzed the correlation between air pollutant concentration and the prevalence of myopia using a
multivariate logistic regression model. Education, urbanization, regional prevalence of atopic
dermatitis, and regional income were used as covariates for adjustments.
RESULTS:When analyzed in connection with the air pollution concentration for one year immediately
before the physical examination, PM10 did not show a significant association with the prevalence ofmyopia in the multiple logistic regression model corrected for covariates (odds ratio [OR] 0.986, 95%
confidence interval [CI] 0.985-0.987) and NO2 showed a significant association (OR 1.022, 95% CI
1.022-1.023). Similarly, when analyzed in connection with the average air pollution concentration forthe previous three years, PM10 did not show a significant association with the prevalence of myopia inthe covariate-corrected model (OR 0.981, 95% CI 0.980-0.982), but NO2 showed a significant
association (OR 1.021, 95% CI 1.021-1.022).
CONCLUSIONS:This study is representative by using the whole male population in Korea, and it also
has the strength of using the objective myopia prevalence data obtained from the visual acuity test
conducted at the age of 19, when myopia does not progress any further. Our findings imply theevidence to support that air pollutants is associated with the prevalence of myopia.

Keywords: myopia, air pollutant, particulate matter, inflammation

FP-198[Air pollution » Particulate matter]

12-Year Trend of PM2.5 Air Pollution andSuicide Deaths in Kaohsiung City and Taiwan
Lee Zong Rong1, Hsieh Hui Min2
1Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan2Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Director of Center for

Big Data Research, Kaohsiung Medical University; Director of Division of Biostatistics andBioinformatic, Kaohsiung Medical University Hospital

BACKGROUND AND AIM:Air pollution is the most important environmental factor which is harmful tohuman health. Existing studies have investigated the association between air pollution and suicide
rates. However, very few studies compared the suicide rate in heavy industrial cities with greater air
pollution, and in Taiwan generally. This study aimed to compare the trend of the concentration of
airborne particulate matters (PM2.5) and the suicide death rate in Kaohsiung city and Taiwan.
METHOD:This study used the national death registry and the Taiwan Air Quality Monitoring Databasefrom 2008 to 2019. Three-periods (2008-2011, 2012-2015, 2016-2019) age-standardized mortality
rate for suicide death by gender (male and female) were calculated based on the WHO 2000
population distribution. Ordinal least squares regression was used to analyze the association between
the trends of PM2.5 exposure and the suicide death rate.
RESULTS:Our study found that both the age-standardized suicide rate and level of PM2.5 had showeda decreasing trend in Taiwan and Kaohsiung city. The overall suicide death rate and level of PM2.5
were greater in Kaohsiung city than in Taiwan. The changes of PM2.5 from 2008 to 2019 were about
50.97% in Kaohsiung and 48.60% in Taiwan, while the percentage decrease in the suicide rate inKaohsiung (12.48%) is higher than that in Taiwan (10.86%).
CONCLUSIONS:Our finding suggests that air pollution is associated with an increased risk of suicide.
Given that air pollution can have negative effects on mental health and may increase the risk ofdepression and anxiety, which in turn leads to suicidal behavior. As a result, our study considers that
it is necessary for further research to focus on the influence of environmental exposure on susceptible
populations.

Keywords: Air pollution, Particulate matter, Age-standardized mortality rate, Suicide

FP-199[Birth and pregnancy outcomes » Pregnancy outcomes]

Umbilical cord serum elementomics of 52 traceelements and early childhood neurodevelopment
Li Su1, Liangmin Wei2, Hui Huang2, Xin Chen2, Xiang Wang2, Ruyang Zhang2, Weiwei Duan2,
Mahmudur Rahman3, Md Golam Mostofa3, Quazi Qamruzzaman3, Hongbing Shen4, Zhibin Hu4,
Yongyue Wei2, Feng Chen2, David C Christiani1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115,

USA
2Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166,

China
3Dhaka Community Hospital Trust, Dhaka, Bangladesh
4Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166,

China

BACKGROUND AND AIM:Prenatal exposures to neurotoxic metals and trace elements are associatedwith early childhood neurodevelopmental outcomes. However, consequences of simultaneous
exposure to mixtures of elements remain unclear. We aim to examine individual and joint effects ofprenatal trace element exposure on early childhood neurodevelopment.
METHOD:Using a well-established Bangladesh prospective birth cohort (2008-2011), we measured
concentrations of 52 trace elements in umbilical cord serum of 569 mother-infant pairs using
inductively coupled plasma mass spectrometry. Neurodevelopment was evaluated at 20-40 months ofage using Bayley Scales of Infant and Toddler Development, Third Edition. Stability elastic net (ENET)
was used to screen elements individually associated with the outcome; candidate exposures werecombined by weighted linear combination to form a risk score representing their mixture effect onearly childhood neurodevelopment.
RESULTS:Stability ENET identified 15 trace elements associated with cognitive composite score and 14
associated with motor composite score, which were linearly combined to form the element risk score(ERS). Children with higher ERScognitive had lower probability of cognitive developmental delay(ORhighest vs lowest: 0.21; 95 %CI: 0.10, 0.40; P < 0.001; Ptrend < 0.001). Children with ERSmotorin the top quintile had a significantly lower risk of motor developmental delay (OR: 0.16; 95 %CI:
0.09, 0.31; P < 0.001; Ptrend < 0.001) versus the lowest quintile. In Bayesian kernel machine
regression analyses, lithium [conditional posterior inclusion probability (cPIP) = 0.68], aluminum (cPIP= 0.83) and iron (cPIP = 1.00) contributed most to the lower cognitive composite score; zinc (cPIP =1.00), silver (cPIP = 0.81), and antimony (cPIP = 0.65) mainly contributed to the change of motor
composite score.
CONCLUSIONS:Co-exposure to lithium/aluminum/iron or zinc/silver/antimony appears to impact
children's neurodevelopment. ERS score reflecting maternal exposure could indicate children's risk ofneurodevelopmental delay, warranting further studies to explore the underlying mechanism.

Keywords: Bangladesh, Early childhood neurodevelopment, Elementomics, Umbilical cord serumFP-200[Outcomes » Childrens environmental health]

Climate change-related exposures and risk ofpediatric hospitalization in New York State,
2005-2019
Lisa Frueh1, Rachit Sharma1, Ellen J. Kinnee2, Allan C. Just3, Perry E. Sheffield3, Jane E. Clougherty11Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health,Philadelphia, PA, USA
2University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
3Department of Environmental Medicine and Public Health, and Pediatrics, Icahn School of Medicine atMount Sinai, New York, NY, USA

BACKGROUND AND AIM:The Understanding Pediatric Susceptibility Across Temperature andEnvironment in New York (UPStATE NY) Study will characterize relationships between climate changerelated exposures and pediatric health in NY State and identify community assets and stressors
shaping these relationships. Here, we link all NY pediatric hospitalizations with residential minimum
temperature (Tmin) and fine particulate matter (PM2.5).
METHOD:We use conditional logistic regression in a time-stratified case-crossover design to estimate
associations on admission day and 6 lag days using 2005-2019 inpatient data from the NY Statewide
Planning and Research Cooperative System (SPARCS) and daily fine-scale exposure estimates.
RESULTS:Among children under 17, excluding newborns (N = 1,906,971), a 10 μg/m3 increase inPM2.5 conferred an increased risk of hospitalization year-round, [1.22% excess case-day risk (95%
CI: 0.87, 1.57)] adjusted for case-day Tmin. Associations were stronger among younger children (04y), males, in urban areas, and in warmer months. Case-day PM2.5 was most strongly associated withrisk of hospitalization for injury [3.53% (95% CI: 2.32, 4.75)], non-infectious respiratory disease[3.24% (95% CI: 2.18, 4.31)], and respiratory infections [2.21% (95% CI: 1.22, 3.20)].
A 10°F increase in case-day Tmin conferred an increased cool-season risk of hospitalization [2.46%(95% CI: 2.18, 2.73)] and decreased warm-season risk [-2.02% (95% CI: -2.45, -1.59)] adjusted forcase-day PM2.5. Warm-season protective effects were strongest in urban areas. Associations werestrongest (positive in the cool season, negative in the warm season) for respiratory and psychiatricoutcomes. Injury and infections/parasitic diseases were positively associated with Tmin in bothseasons with stronger warm-season associations [injury: 3.58% (95% CI: 2.12, 5.06), infections:
4.05% (95% CI; 2.00, 6.14)].
CONCLUSIONS:These results suggest that younger children and children in urban areas are
particularly vulnerable to temperature and PM2.5. Future analyses will include ozone exposure,emergency department visit outcomes, and community-identified assets and stressors as potential
effect modifiers.

Keywords: Air pollution, Particulate matter, Temperature, Climate, Environmental epidemiology

FP-201[Built environment » Green space]

The Association and Causal Effect of Park Visits
on Social-Emotional Development in the ALSPAC
cohort.
Mark Ferguson
The European Centre for Environment & Human Health, University of Exeter, Penryn, UK

BACKGROUND AND AIM:Literature has shown that greenspace is associated with child socialemotional development (SED). This study used repeat measures of maternal-reported park visits fromthe Avon Longitudinal Study of Parents and Children (ALSPAC), to assess the association between park
visits and SED.
METHOD:Park visit variables were produced for 5 development periods from birth to 11 years old.
Firstly, an analysis investigated the social patterning of park visits and covariates, by maternal
educational attainment.
The association between parental-reported Strength and Difficulties total difficulties score (TDS) at 5time points and park visits metrics (Less than Once a week vs Once a week or more) was assessed
through a time-sequenced analysis (regressions with park visits preceding TDS), and a randomintercept model. Individual and area level covariates were identified through directed acyclic graph apriori.
RESULTS:Park visits were socially patterned over time. In early developmental periods, moreeducated families visited parks more frequently. In the latter three developmental periods families oflower educational attainment visited more frequently.
Time sequenced linear and random-intercept models produced consistent results. Adjusted models
showed park visits, more than once a week, was consistently associated with reduced TDS. Adjusted
coefficients were attenuated (while still providing evidence of an effect) in early development periods,
in later developmental periods adjustment strengthened the associations.
CONCLUSIONS:The ALSPAC cohort was highly socially patterned. Lower maternal education linearly
predicted increased adverse exposures, in all the studies covariates. Therefore, the inverted social
patterning of park visits over time, coupled with the consistent associations between increased park
visits and decreased TDS, means that it is implausible that the models were subject to conclusionaltering residual confounding. Sensitivity analyses assessed the impact of selection bias as being
limited. Therefore, I posit that park visits more than once a week constitutes a causal effect on
improved SED development.

Keywords: Greenspace, Self-report, Social-Emotional, Longitundal, Causal-InferenceFP-202[Air pollution » Particulate matter]

Assessing the effects of fine particulate matteron cognitive function in healthy elderly womenusing amyloid positron emission tomography
Meifang Cheng1, Chi Hsien Chen2, Pei Ju Chuang3, Shih Chun Pan4, Yi Chuan Chen5, Wei Shan Chin6,
Yue Liang Leon Guo Guo7
1Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University

College of Medicine, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene,
National Taiwan University, Taipei, Taiwan
2Department of Occupational Medicine, National Taiwan University Hospital and National Taiwan

University College of Medicine, Taipei, Taiwan
3Department of Nuclear Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
4National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli

County, Taiwan
5Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
6School of Nursing, National Taiwan University Hospital and National Taiwan University College ofMedicine, Taipei, Taiwan
7Department of Occupational Medicine, National Taiwan University Hospital and National Taiwan

University College of Medicine, Taipei, Taiwan; National Institute of Environmental Health Sciences,
National Health Research Institutes, Miaoli County, Taiwan; Institute of Occupational Medicine andIndustrial Hygiene, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Exposure to fine particulate matter (PM) has been linked to Alzheimer’s
disease (AD) in epidemiology studies. Amyloid positron emission tomography (amyloid-PET) using
18F-florbetaben, is used clinically to quantify brain β-amyloid deposition, a pathological hallmark of
AD. The aim of the present study is to evaluate whether fine PM concentrations are associated withbrain amyloid load in elderly women.
METHOD:Women aged ≥70 years are randomly selected from a previous established healthy cohort in
Northern Taiwan. Subjects with known neurological diseases, brain injury or cancer requiring therapy
were excluded. Amyloid-PET images were analyzed using an automated quantification software. The
PET parameter, standardized uptake value ratio (SUVR), was computed for six predefined corticalbrain regions (anterior cingulate, frontal, occipital, parietal, posterior cingulate, and temporal cortices)by normalizing the regional count with cerebellar cortex (reference region). SUVRs were correlatedwith PM2.5, O3, and NO2 concentrations, Mini-Cog, and Apolipoprotein E4 (APOE4) genotype using
Spearman’s correlation.
RESULTS:Among 44 women (mean age, 74.3±2.8 years) included in the study, 20.5% (9/44) had
only elementary school education. Twelve (27.3%) subjects scored <3 in Mini-Cog test, and 14(31.8%) carried one APOE ε4 allele. The median concentration (interquartile range) of PM2.5, O3, andNO2 from 2014 to 2018 were 23.5 (2.99), 23.0 (3.17), and 25.5 (2.25) μg/m3, respectively. Positive
correlation, albeit mild, was noted between the degree of PM2.5 exposure and SUVR of anterior
cingulate cortex (r=0.322, 95% CI=0.04 to 0.59; P=0.043), independently of age and APOE4
genotype. No association was found between other brain areas and pollutant concentrations or MiniCog score.
CONCLUSIONS:Chronic ambient PM2.5 exposure can lead to increased β-amyloid neuritic plaquedeposition in the anterior cingulate cortex of elderly women. The region is in close proximity to theolfactory bulb and plays a unique role in cognition and emotion.

Keywords: Neurodegenerative outcomes, ExposuresFP-203[Chemical exposures » Phthalates]

Phthalate exposure was associated with the riskof depressive symptoms in the US adult
population
Ming Chieh Li, Chien Ju Wang, Hui Wen Yang
Department of Health Promotion and Health Education, College of Education, National Taiwan Normal
University, Taipei, Taiwan

BACKGROUND AND AIM:Our study aimed to examine the association between phthalate exposure andthe risk of depressive symptoms in the US adult population.
METHOD:We used data from the National Health and Nutrition Examination Survey (NHANES) from2005 to 2018 to analyze the association between urinary phthalates and depressive symptoms. We
included 11 urinary phthalate metabolites in our analysis and used the 9-item Patient Health
Questionnaire (PHQ-9) to assess the presence of depression among study participants. Participants
were divided into quartiles for each urinary phthalate metabolite, and we evaluated the association
using a generalized linear mixed model with a logit link and binary distribution.
RESULTS:A total of 7340 participants were included in the final analysis. After controlling for potential
confounders, we found a positive association between the molar sum of di(2-ethylhexyl) phthalate(DEHP) metabolites and depressive symptoms, with an odds ratio of 1.30 (95% CI = 1.02-1.66) forthe highest compared to the lowest quartile. In addition, we found positive associations of mono(2ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) withdepressive symptoms, with odds ratios of 1.43 (95% CI = 1.12-1.81, p for trend = 0.02) and 1.44
(95% CI = 1.13-1.84, p for trend = 0.02), respectively, for the highest compared to the lowest
quartile.
CONCLUSIONS:In conclusion, this study is the first to identify a positive association between DEHP
metabolites and the risk of depressive symptoms in the general adult population in the United States.

Keywords: Phthalates, Mental health outcomes, Environmental epidemiology

FP-204[Chemical exposures » Heavy metals]

Analysis of Urinary Metal Levels in Taiwan's
2019 Human Biomonitoring and Epidemiology
Study
Ming Siang Chen1, Ching Chun Lin1, Pau Chung Chen2
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan2Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan; National Taiwan University Hospital, Taipei, Taiwan

BACKGROUND AND AIM:Human beings are often exposed to metals and metalloid elements in ourdaily life. Human biomonitoring can be used to determine internal aggregate exposures to chemicals
from all different sources and through all exposure routes. The aim of this study was to establish theconcentration distributions of heavy metals in urine among the general population in Taiwan.
Compared with the National Health and Nutrition Examination Survey (NHANES), find out the heavy
metals with higher concentration in Taiwan human biomonitoring.
METHOD:The research population was collected nationwide in 2019, recruiting a total of 1748 subjects
aged 7 and over, collecting urine samples and conducting questionnaire interviews. The study design
was a cross-sectional study with a stratified multistage cluster sampling design. The concentrations of
20 environmental heavy metals were analyzed by inductively coupled plasma mass spectrometry (ICPMS).
RESULTS:The metal concentration distribution in urine presents the geometric mean concentration of
20 heavy metals and the 25%, 50%, 75% and 95% concentration value. It was found that theconcentration of zinc was higher in men (358.3 µg/g creatinine) than in women (357.0 µg/g
creatinine), and the concentrations of other heavy metals were higher in women. The concentration
distribution of heavy metals in each age group (07-12 years old, 13-18 years old, 19-39 years old, 4064 years old, and over 65 years old) showed a U-shaped trend, and the concentration of each age
group was significantly different.
CONCLUSIONS:This study established the concentration distributions of heavy metals in urine among
the general population in Taiwan. Seven heavy metals, including arsenic, barium, cadmium,
chromium, manganese, nickel, and lead, were found to be present in the urine of the general
population in Taiwan at higher concentrations than NHANES. The contribution and impact on heavy
metal concentrations will be further discussed from environmental factors and main sources of dietary
exposure.

Keywords: exposure assessment, environmental epidemiology

FP-205[Other » Other (to be specified with keywords in the keywords section)]

Reasons for wanting to be a dental surgeon as acareerNabhira Aftabi Binte Islam1
1Department of dental public health, Marks medical college dental unit, Bangladesh
2Ph.D. Felloe at Bangabandhu sheikh mujib medical university, Bangladesh

BACKGROUND AND AIM:In Bangladesh, more than 80% of the population has one or more oral anddental diseases.
METHOD:Its A descriptive type of cross-sectional survey and respondents were selected purposively.
Semi-structured questionnaires were developed and delivered to the respondent. A total of 78
respondents were selected purposively from the old and new batches of 1st year BDS students. The
survey was conducted on the period from 3rd February to 1st July 2022 at Marks Medical College
Dental Unit, Mirpur-14, Dhaka with verbal consent from the principal of the institution.
RESULTS:The respondents sex distribution, females were 80.77%. 51% of respondents were from
Dhaka, Bangladesh and 27% came from the periphery. Fathers 25.6% and mothers 11.5% have postgraduation degrees. Graduation done by mother 24.4% and fathers 55.1% of the respondent's.
76.9% of respondents’ fathers were service holders, 16.7% were businessmen and 15.4% mothers of
the respondents had done a job, and 83.3% were homemakers. 75.6% did not get a chance at Gov.
University and others got a chance at Government University among them, 36.8% did not get
admission due to distance from Dhaka. 26.3% of replied subjects were not so good, and 31.6%
mentioned, their family not supported them to study there. 18% of respondents responded that
becoming a doctor was their aim in life, whether it may be MBBS or BDS. 53.8% of respondents haveadmitted to the BDS course to fulfill their parent’s dream and 20.5% of participants reveled that BDS
course is Less costly.
CONCLUSIONS:Every person has an aim in life. But sometimes they have been forced to do anotherthing that they are not want to be. So parents should understand their children’s desires.

Keywords: Dental surgeon, career, choice.

FP-206[Omics technologies » Other (to be specified with keywords in the keywords section)]

Relationship of fungal spore richness, evenness,
and abundance in school air with surrounding
forestNicholas T Minahan1, Chi Hsien Chen2, Yu Chen Chuang2, Kun Hsien Tsai3, Yue Leon Guo4
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan2Department of Environmental and Occupational Medicine, National Taiwan University and NTU

Hospital, Taipei, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan; Department of Public Health, National Taiwan University, Taipei, Taiwan
4Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University and NTU
Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences, National HealthResearch Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Fungal spores are important aeroallergens linked to childhood asthma andother respiratory diseases. Next-generation sequencing-based methods have enabled the detailed
study of airborne fungal spore diversity, including taxonomic richness (i.e., the number of unique taxa
present) and evenness (i.e., the distribution of relative abundance among taxa). In a previous study,
we found that the amount of forest cover surrounding schools influences fungal spore richness inclassroom air in a season-dependent manner. This study aimed to examine the relationship of fungal
spore richness, evenness, and abundance in school air with surrounding forest.
METHOD:Air was passively sampled for 24 h in up to 5 classrooms in 44 schools throughout Taiwan
from December 2021 to April 2022, and DNA was promptly extracted in a sterile environment. A
universal fungal DNA barcode (ITS2) was PCR-amplified from classroom DNA, and libraries wereconstructed with purified amplicons at equimolar amounts for each school and sequenced using
Illumina MiSeq v3. Fungal spore equivalents were estimated using SYBR qPCR based on ITS2 copy
number. Data were analyzed using R packages DADA2 (taxonomy assigned using UNITE), phyloseq,
microbiome, and iNEXT.
RESULTS:School air had 4.4E+03 to 3.6E+05 mean fungal spore equivalents/m2/h. Camargo’s
evenness ranged from 0.04 to 0.28, and 93 to 280 genera were observed with sufficient sample
coverage. Evenness and richness had a moderate positive association (Spearman’s r = 0.5). The
percentage of surrounding forest cover in a 10-km buffer was a significant positive predictor of bothrichness and evenness, although schools with high abundance had similarly low evenness regardlessof the amount of surrounding forest.
CONCLUSIONS:Fungal spore richness and evenness are positively related in school air and similarly
influenced by surrounding forest, but only evenness is influenced by abundance. Hence, evenness may
be a useful indicator of airborne fungal spore exposure independent of richness.

Keywords: Microbes/Microbiome, Exposure assessment, Air pollution, Green spaceFP-207[Outcomes » Childrens environmental health]

Prenatal Mitochondrial DNA Copy Number
Predicts Childhood Verbal Memory
Pei Wen Tung1, Tessa R Bloomquist1, Andrea A Baccarelli1, Julie B Herbstman1, Virginia Rauh1, Amy
Margolis2, Allison Kupsco1
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, NY, USA
2Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New

York, NY, USA

BACKGROUND AND AIM:Mitochondrial dysfunction, indicated by reductions in mitochondria DNA copy
number (mtDNAcn) has been linked to cognitive decline associated with neurodegenerative illness.
However, few studies have examined the role of mtDNAcn in healthy cognitive development. We
investigate associations between mtDNAcn measured in cord and child blood samples and children’s
memory and learning. We hypothesized that increased cord and childhood mtDNAcn would be
associated with higher cognitive performance.
METHOD:Participants were drawn from a prospective longitudinal birth cohort following African
American and Latinx children in New York City (N=342). Duplexed qRT-PCR quantified mtDNAcn
relative to nuclear DNA collected at birth from umbilical cord blood and from children age 5-7. The
Children’s Memory Scale (CMS), administered to children ages of 9-14, measured immediate visualand verbal memory as well as attention/concentration. Multivariable linear regression models
evaluated associations between mtDNAcn at birth or childhood and memory performance (Verbal
Immediate Index; Visual Immediate Index; Attention/Concentration Index scores). We also examinedassociations between change in mtDNAcn (cord blood to childhood) with CMS Index scores. Models
were adjusted for sex, ethnicity, maternal age, maternal BMI, education status, maternal hardship,
and age at CMS assessment.
RESULTS:Analyses showed a significant positive association between cord blood mtDNAcn and Verbal
Immediate Memory Index (β=10.77, 95% CI [2.31, 19.22], p=0.01) but not Visual or
Attention/Concentration Indexes. There were no significant associations between childhood mtDNAcn
or mtDNAcn change and CMS Index scores. No effect modification by sex was observed andadjustment of models for cell type composition did not alter our findings.
CONCLUSIONS:Our results provided novel data suggesting that prenatal mtDNAcn may be a potential
biomarker of children’s verbal memory. Our findings also suggest that mtDNAcn may be a marker ofhealthy child development, in contrast to previously documented reductions in mtDNAcn as a marker
of cognitive decline in the elderly.

Keywords: Molecular epidemiology, Neurodevelopmental outcomesFP-208[One health » Disease spatial surveillance]

The Power of Metatranscriptomics: A New
Frontier in TB Surveillance in Low and Middle
Income countries
Poovendhree Reddy1, Hlengiwe Nombuso Mtetwa2, Isaac Dennis Amoah3, Sheena Kumari1, Faizal
Bux1
1Institute of Water And Wastewater Technology, Durban University of Technology, Durban, South

Africa2Department of Community Health Studies, Faculty of Health Sciences, Durban University ofTechnology, Durban, South Africa
3Department of Environmental Science, University of Arizona, Tucson, Arizona

BACKGROUND AND AIM:Tuberculosis (TB) is a significant public health issue globally, especially in
low- and middle-income countries (LMICs), including Africa. Multidrug-resistant tuberculosis (MDR-TB)
is a major concern, and accurate surveillance data on TB/MDR-TB is essential for tracking changes inresistance, setting national and global priorities, assessing the impacts of interventions, identifying
new kinds of resistance, and investigating outbreaks of resistant pathogens. The aim of this study was
to use a metatranscriptomic approach to profile the diversity of Mycobacterium tuberculosis complex(MTBC) species and related functional genes in domestic sewage samples from six African countries todetermine the prevalence of MTBC species, antibiotic-resistant genes associated with TB drug
resistance, and associated virulence genes, and to assess the feasibility of metatranscriptomics as anadditional surveillance option for community TB/MDR-TB.
METHOD:We collected wastewater samples from Ghana, Nigeria, Kenya, Uganda, Cameroon andSouth Africa from untreated and treated wastewater (post-chlorination). Total RNA was extracted fromwastewater samples and multiplexed paired-end libraries were prepared using the KAPA mRNA
HyperPrep Kits (Roche) following the manufacturer's instructions and sequencing by the NovaSeq
6000 system (Illumina).
RESULTS:The study found that MTBC species were more abundant in untreated than treated samples,with Mycobacterium tuberculosis and related variants being the most common compared to other
MTBC species. M. tuberculosis and related variants (BT2, PanR (0203,0704,0909,1007,1101), TRS29,
Kurono, CCDC5180) were most abundant compared to other MTBC species (M. africanum, M. bovis[BCG Korea & Tokyo variant], M. caprae, M. microti found. Antibiotic-resistant genes associated with
TB drug resistance and associated virulence genes were detected (alr, pncA, gyrA, InhA, rpoB genes).
Functional annotation showed high gene expression associated with virulence in M. tuberculosis
complex spp, particularly M. tuberculosis.
CONCLUSIONS:The findings suggest that metatranscriptomics applied to domestic sewage could be anaffordable surveillance option for community TB/MDR-TB where early case detection will mitigate
disease spread.

Keywords: Wastewater-based epidemiology, Tuberculosis surveillance, metatranscriptomics

FP-209[One health » Public health]Comparison of Bactericidal Efficacy among
Cleaning Agents for Residence
Pornpun Watcharavitoon, Chonticha Seangchana, Thatsaphon Phukingngam, Duangsuda Pongjangrit,
Sroisuda Rotkamnoed, Jaruwan Khannak
Institute of Publics Health School of Occupational Health and Safety, Suranaree University ofTechnology, Nakhon Ratchasima, Thailand.

BACKGROUND AND AIM:During COVID-19 situation. Room cleaning is necessary in order to control
and prevent a hotbed of germs from this pandemic. The floor of the residence is the part that needs to
be cleaned which must be cleaned regularly otherwise it will accumulate dust and germs. This study
was to compare different cleaning products in terms of Bactericidal Efficiency for the Residence.
METHOD:The experiment was set up to investigate the efficacy of cleaning agents. Five different
cleaning products (laundry detergent liquid plus Sodium hypochlorite 6%, disinfectant products plus
alkyl dimethyl benzoyl ammonium chloride 2.4%, disinfectant products plus Chloroxylenol 4.8%, Floor
Cleaner product plus disinfectant Sodium laureth sulfate 0.7%, and distilled water have been used for
Negative Control. Bactericidal activities were evaluated against seven bacteria species, Staphylococcus
spp., Lactobacillus, P. Aeruginosa, B. Licheniformis, B. Cereus, B. fragilis and Bacillus spp., by Disc
Diffusion Method. The tests were conducted before and after the cleaning with tested agents in themorning and in the evening. All plates were collected by Microflow following NIOSH Method 0800.
RESULTS:The results revealed that the efficacy of bactericidal properties was significantly different
among each type of cleaning products both before and after cleaning. (p<0.05). When analyzing the
average number of microorganisms, it was found that disinfectant products plus Chloroxylenol 4.8%,
disinfectant products plus alkyl dimethyl benzoyl ammonium chloride 2.4%, laundry detergent liquidplus Sodium hypochlorite 6%, Floor Cleaner product plus disinfectant Sodium laureth sulfate 0.7%,
and distilled water were the destruction of total bacteria., respectively.
CONCLUSIONS:The disinfectant products plus chloroxylenol 4.8% is the highly efficient bactericide forcleaning and safety for humans. It should be advised to use in the home.

Keywords: Microbes, ExposuresFP-210[Outcomes » Childrens environmental health]

Association of cord blood levels of lead, arsenic,
and intelligent quotient among 14 years oldadolescents: Chitwan Birth Cohort Study
Rajendra P Parajuli1, Shristi Bhandari1, Masahiro Umezaki2
1Central Department of Zoology, Central Campus, Institute of Science & Technology (IOST),

Tribhuvan University, Kritipur-1, Kathmandu, Nepal
2Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo,

Bunkyo-Ku, Tokyo, 113-0033, JapanBACKGROUND AND AIM:On a birth cohort living in Chitwan Valley, lowland Nepal, we have previously
reported inverse associations between in utero levels of lead (Pb), arsenic (As) and neurodevelopment
at birth measured by Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III).
Follow-up of the same cohort at 6, 24-and 36-month-old infants was conducted using the Bayley Scaleof Infant Development, Second Edition (BSID II). Postnatal raising environment was evaluated usingHome Observation for Measurement of Environment (HOME) scale. Unlike the NBAS conducted fornewborns, none of BSID II cluster scores in 6, 24 and 36-months-old infants were associated withcord blood levels of Pb, As, and Zn. Only the total HOME score was positively associated with mental
development scale (MDI) score and Psychomotor Development Index (PDI) evaluated using BSID II.
METHOD:Now, same birth cohort (n=74) is followed after 14 years. The associations between in utero
levels of Pb and As and intelligence quotient (IQ) evaluated by Wechsler Abbreviated Scale ofIntelligence, Second Edition (WASI II) was evaluated by multiple regression analysis.
RESULTS:Association between in utero levels of Pb and As were consistently negatively associatedwith full-scale IQ (β = - -0.160 and -0.052), full-scale IQ-2 subtests (FSIQ-2) (β =-0.166 and 0.073), verbal comprehension index (VCI) (β =-0.114 and - 0.173), and perceptual reasoning index(PRI) (β =-0.165 and 0.090), respectively. Yet, none of the associations reach statistical significance.
Association was strong and consistent between mothers’ education and all four measures of WASI II(i.e., FSIQ, FSIQ-2, VCI and PRI). In addition to maternal education, annual income, reported/self
rated growth environment, self rated health and body mass index (BMI) indicated consistent direction(positive) in association with WASI II measures and reported GPA by participants.
CONCLUSIONS:These findings highlight the importance of in utero exposure and growth environment
in developing countries like Nepal.

Keywords: Chitwan Birth Cohort Study of Nepal, In Utero Exposure of arsenic and lead, intelligencequotient (IQ), Wechsler Abbreviated Scale of IntelligenceFP-211[Exposome » General]

Advancing Exposome Research for ADRD to
Enable Precision Environmental HealthApproaches to Treatment and Prevention
Richard K Kwok
Population Studies and Genomics Branch, Division of Neuroscience, Extramural Research Program,
National Institute on Aging, National Institutes of Health

BACKGROUND AND AIM:The complexity and heterogeneity of Alzheimer’s Disease and Related
Dementias (ADRD) are a consequence of a dynamic interaction between genes and the environment
over the lifespan and a growing body of epidemiologic, genomic and mechanistic research pointing toa significant contribution of various environmental factors (i.e. the exposome) on ADRD risk andresilience.
METHOD:The National Institute on Aging (NIA) has embarked on a series of initiatives towards a
Precision Environmental Health approach to ADRD risk reduction and disease prevention and toadvance our understanding of ADRD etiology through the next-generation of Environmental Healthresearch occurring at the intersection of G (epigenome/genome) perturbations x E (environmental
exposures) x D (data-omics i.e. exposome, epigenome, genome, proteome, metabolome).
Additionally, NIA supports the development of novel artificial intelligence / machine learning (AI/ML)
approaches to identify patterns and relationships across large, complex, and disparate datasets todraw meaningful insights into the etiology of complex diseases such as ADRD.
RESULTS:This poster will highlight infrastructure enhancements for exposome research on ADRD
including new research opportunities for understanding the mechanisms by which environmental
toxicants influence the molecular trajectories of brain aging and ADRD and contribute to healthdisparities.
CONCLUSIONS:Opportunities for unique collaborations between the environmental and ADRD
communities will be presented in addition to research perspectives between the communities andchallenges in advancing exposome research to enable a precision environmental health approach to
ADRD treatment and prevention. Studying populations in low and middle income countries (LMIC) will
be prioritized.

Keywords: Exposome, ADRD, Precision environmental health, Infrastructure, LMICFP-212[Neurologic and mental health outcomes » Mental health outcomes]

The association between alcohol intake andpolymorphisms of alcohol metabolism genes
and the risk of cognitive impairment
Rong Xuan Liu1, Chih Ching Yeh2
1Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University,

TaipeiCity, Taiwan
2School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, TaipeiCity, Taiwan

BACKGROUND AND AIM:As of 2019 in Taiwan, 18.45% of people over 65 years old have cognitive
impairment. The National Health Administration’s National Health Interview Survey also pointed outthat about 8.43 million people over 18 years old have the habit of drinking. Studies have suggested
that cognitive impairment may be affected by alcohol and the genes involved in alcohol metabolism,
but there is a lack of relevant research in Taiwan. We aimed to observe the association between
alcohol intake and polymorphisms of alcohol metabolism genes and the risk of cognitive impairment.
METHOD:We collected 22,779 short-term intelligent test (Mini-Mental State Examination, MMSE) datafrom the Taiwan Biobank for the elderly population aged 60 to 70. The total score of MMSE ranges
from 0 to 30, and the cognitive impairment is determined to be less than 24. The personal drinking
habit was obtained from the health behavior questionnaire, and the genetic polymorphismsof ALDH2 rs671, ADH1B rs1229984, and ADH1C rs1693482 were also obtained from the database.
The logistic regression models were used to estimate the association between genotype and drinking
and the risk of cognitive impairment, and all the statistics analysis were performed using SAS version
9.4 software.
RESULTS:Although no significant association between alcohol consumption and ADH1B rs1229984
and ADH1C rs1693482 genotypes and cognitive impairment risk, ALDH2 rs671 genotype wassignificantly associated with cognitive impairment risk (P=0.0063). After covariates adjustment, both
the dominant model (OR=1.164, 95% CI=1.052-1.288) and recessive model (OR=1.204, 95%
CI=1.009-1.436) of ALDH2 rs671 polymorphism were significantly associated with cognitive
impairment risk. However, alcohol consumption did not significantly interact with the threepolymorphisms of alcohol metabolism genes to affect cognitive impairment risk.
CONCLUSIONS:Our results suggest that alcohol consumption is not a risk factor of cognitive
impairment, and ALDH2 rs671 polymorphism may serve as a biomarker for risk prediction of cognitive
impairment.

Keywords: Neurodegenerative outcomes, Molecular epidemiology, Food and nutrition, Public healthFP-213[Neurologic and mental health outcomes » Mental health outcomes]

The Impact of Sleep Duration on Health-Related
Quality of Life in Korean Workers: Explainable AI(XAI) Investigation
Saemi Jung, Seung Ho Lee
Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital,
Yangsan, Gyeongsangnam, Republic of Korea

BACKGROUND AND AIM:Health-related Quality of Life (HRQoL) is a measure of the physical,
emotional, and social aspects of an individual's life directly influenced by their health condition. Whilevarious instruments have been developed to measure HRQoL, HINT-8 (Health-related Quality of Life
Instrument with 8 Items) was recently developed as a more suitable instrument for Korean
characteristics. This study employed machine learning techniques to identify key features that affect
HINT-8 scores among Korean workers and to explore the association between sleep duration and
HINT-8 scores. So we aimed to findout the factors that influence HRQoL in this population.
METHOD:Data was obtained from the eighth Korea National Health and Nutrition Examination Survey,
conducted by the Korea Ministry of Health and Welfare and the Korea Centers for Disease Control andPrevention, with 2489 Korean workers. Permutation feature and accuracy was calculated by using Cat
Boost model. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of were calculated after
adjusting for socioeconomic status, by using logistic regression model.
RESULTS:Using permutation feature with Cat Boost model, our study identified education (0.034 ±0.013), shiftwork (0.012 ± 0.008), sleep duration (0.010 ± 0.013), and occupation (0.006 ± 0.015)
as the key features with high weights. We found that short sleep duration (aOR 1.27, 95% CI 1.05 1.54) was significantly associated with lower HRQoL, when compared to a reference sleep duration of
7-8 hours. The accuracy of the train set was 0.831, and the accuracy of the test set was 0.749 among
the study population.
CONCLUSIONS:Our study contributes to the body of knowledge on HRQoL among Korean workers,
highlighting the crucial role of sleep duration, education, shiftwork, and occupation in determining
HRQoL. The findings may inform the development of targeted interventions to improve HRQoL among
this population and promote overall well-being.

Keywords: Health related quality of life (HRQoL), Sleep duration, Occupatinal health, Explainableartificial intelligenceFP-214[Climate » Temperature]

Temperature effects on cerebrovasculardisease: a nationwide study using ambulancecall data in Japan
Saori Kashima
Center for the Planetary Health and Innovation Science, IDEC Institute; Environmental Health
Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University,
Higahi-Hiroshima, JapanBACKGROUND AND AIM:Cerebrovascular diseases are the leading cause of morbidity and mortality.
Meteorological factors have been shown to be a key aspect in causing this deadly disease. However, it
is not clear whether the impacts of those factors are different in background meteoritical conditions.
This study aims to evaluate the temperature effects on cerebrovascular disease in Japan and show theregional characteristics of those associations.
METHOD:Ambulance call data of cerebrovascular disease (ICD:10: I60-I69) between 2015 and 2019
in Japan except for Tokyo was obtained from Fire and Disaster Management Agency. We used a timestratified case-crossover design and calculate the prefecture-specific Odds ratios (ORs) by using
conditional logistic models. We then calculated pooled ORs in each geographical region and the entire
Japan.
RESULTS:Decreasing the temperature (1°C) was significantly associated with an elevated risk of
cerebrovascular disease. This association was observed shortly after decreasing the temperature(pooled adjusted OR of Japan in Lag0: 1.018 (95% CI: 1.017⁻1.019)). Similar trends were observed
for three days. In the regional-based pooled analysis, slightly higher impacts were observed in theSouth-West area [e.g. 1.021 (1.018⁻1.025) in the Chugoku region) than North-East area [e.g. 1.016(1.014⁻1.019). These associations were also observed in the summer season. Meanwhile, during
extremely hot days (above 90% tile), with increased temperature (1°C) was also associated win anelevated risk of cerebrovascular disease. These associations were observed 5-6 days after the event[1.014 (1.002⁻1.027) lag5]. These associations were particularly observed in the Kanto area, but
geographical differences were still not clear.
CONCLUSIONS:Increasing risks of cerebrovascular disease were observed shortly after thetemperature decrease and 5 might be different in background meteorological conditions.
This study is supported by Pfizer health research foundation 2019 and JSPS KAKENHI Grant Number
JP21K10496.

Keywords: Environmental epidemiology, Big data, Cerebrovascular diseases

FP-215[Chemical exposures » PFAS]

Strengthening regulation of PFAS in Food
Packaging: Perspectives from the Philippines
Sary Valenzuela, Michelle Alexandra S. Edillon, Martin Sebastian S. Tan, Ysobel Beatriz C. Luna,
Geminn Louis C. Apostol
Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City,
Philippines

BACKGROUND AND AIM:We sought to determine the presence and extent of the regulations in place
for per- and polyfluoroalkyl substances (PFAS) in food packaging standards, trade on food packaging,waste management, locally and internationally, and provide recommendations to strengthen andbridge the gaps within the local policy landscape.
METHOD:We conducted a scoping review of Republic Acts and policy documents from relevant
Philippine government agencies, including the Food and Drug Administration (FDA) and Department ofEnvironment and Natural Resources (DENR). We reviewed international guidelines and international
best practices on PFAS regulation from news articles and original research articles from PubMed, theCochrane Library, and Scopus.
RESULTS:Existing standards and regulations for PFAS are limited both in the local and international
context. Food packaging is primarily regulated by the FDA, and specific policy issuances that tackle
food manufacturing and packaging safety requirements do not explicitly mention PFAS. There is also
an absence of regulation and supporting guidelines on the monitoring and surveillance of PFAS in
waste management chains and the environment at large. In the international scene, best practices
and guidelines are publicly available. While there has been a call to action, these remain especiallyweak among Asian countries despite being a major source of food packaging manufacturing products.
CONCLUSIONS:Including PFAS as an issue of concern in national agendas for health and research canhelp develop and strengthen policies and guidelines for its usage, monitoring, and disposal. Support
for local research projects and initiatives focused on PFAS monitoring, measurement, and investigating
impacts to health and environment would help find alternatives and ways to mitigate existing or
potential effects. Through time, the Philippines can also transition from using alternative products to acomplete ban of PFAS substances altogether, to avoid further harm to health and the environment.

Keywords: Food/nutrition, Public health, Policy researchFP-216[Chemical exposures » Mixtures]

Associations between phthalate metabolites andphenol concentrations measured in urine withfood consumption among Swedish adolescents
Sebastian Pineda1, Anders Glynn1, Christian Lindh2, Sanna Lignell3
1Department of Biomedical Science and Veterinary Public Health, Swedish University of Agricultural

Sciences, Uppsala, Sweden
2Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund

University, Lund, Sweden
3Department of Risk and Beneﬁt Assessment, Swedish National Food Agency, Uppsala, Sweden

BACKGROUND AND AIM:Many studies use single spot samples of urine when investigating relations
between phthalate and phenolic substance exposure and health outcomes. To identify possible
confounding factors in such studies, we analysed associations between substance concentrations inurine and demographic/lifestyle determinants, and the food consumption of the Swedish adolescentsduring the entire day prior to urine sampling.
METHOD:The study population came from the Riksmaten Adolescent 2016-17 national dietary survey,
ages 11-21 (N=983). Up to 29 substances, including phthalate metabolites, DiNCH-metabolites,
phosphorus flame retardants (PFRs), bisphenols, metabolites of polycyclic aromatic hydrocarbons(PAH), two insecticide metabolites, triclosan, the preservative 3-tert-Butyl-4-hydroxyanisole (BHA)
and benzophenone-3 were analysed in spot urine samples using LC-MS/MS. Two sets of log-linear
regression models were used to identify associations of density-adjusted concentrations with basedeterminants and food consumption.
RESULTS:Age, gender, adolescent/maternal birth country and rural/urban living were the most
predominant significant determinants. Consumption of milk/sour milk/yoghurt, processed meat,cheese, fish and vegetables during the day prior to sampling were predominantly associatednegatively with many of the analysed urine substances. One food covariate, ice-cream consumption,
was positively associated with concentrations of the metabolites of different phthalates particularly,
diethyl phthalate (DEP), dibutyl phthalate (DBP), di-2-propylheptyl phthalate (DPHP), di-2-ethylhexyl
phthalate (DEHP), the PFR tri-2-butoxyethyl phosphate (TBEP), and the preservative BHA. Sampling
month was significantly associated with metabolites of several phthalates, PAHs and TBEP, withincreased adjusted mean concentrations in most cases for November and December. The weekday ofsampling was significantly associated with 18 of the measured substances with varying trends.
CONCLUSIONS:We identified several demographic/lifestyle factors and food consumption variables
that may be confounding factors in studies of relations between rapidly excreted toxic substances inurine and health effects when only using a spot urine sample in exposure assessment.

Keywords: phenol, phthalates, adolescents, sampling-time, food-consumption

FP-217[Birth and pregnancy outcomes » Birth outcomes]

Effect modification by gestational weight gain in
the association between maternal exposure to
heavy metals and birthweight
Seung Ah Choe1, Young Yoo1, Ko Chens Study Group2
1Korea University College of Medicine
2Multiple institutions

BACKGROUND AND AIM:The association between blood level of heavy metals in pregnant women andfetal growth can be mediated by gestational weight gain (GWG). We assessed serially mediation by
GWG and blood heavy metal in late pregnancy in the path linking early blood heavy metal levels andfetal growth using a prospective cohort of pregnant mothers.
METHOD:We analyzed 4,712 term singleton live births from the participants of the Korean CHildren's
ENvironmental health Study (Ko-CHENS), a prospective cohort study conducted in 12 regional centersof South Korea from 2015 to 2018. Maternal blood lead (Pb), mercury (Hg), and cadmium (Cd) levels
were measured in early and late pregnancy and neonatal birthweight and height were recorded. We
fitted a path analysis model that includes the direct effect of early metal level on neonatal
anthropometric measures and the indirect effect of early metal level on neonatal anthropometricmeasures involving GWG and late metal level.
RESULTS:In single exposure models, late lead (adjusted coefficient = -15.470, P = 0.036) and latecadmium (-24.150, P = 0.004) were associated with lower birthweight. Serial mediation model
showed different mediation features across metals and anthropometric measures. For early lead andbirthweight z-score, the total negative effect of early lead (-14.787, P = 0.036) was mediated by thelate lead level (-7.417, P = 0.049). For the model of early mercury level and birthweight, the indirect
effect involving GWG was positive while the direction of total effect was toward negative (-8.519, P =0.301).
CONCLUSIONS:This study provides an insight in understanding the causal pathway from intrauterine
exposure to heavy metals to fetal growth mediated by GWG and blood metal levels in the latepregnancy.

Keywords: metal, pregnancy, birthweightFP-218[One health » Public health]

Retention of medical doctors in rural area in
Bangladesh: challenges and way out
Shahana Sultana, Md. Maruf Haque Khan, Marium Salwa, Kamrun Nahar, Md. Atiqul Haque
Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka,Bangladesh

BACKGROUND AND AIM:Bangladesh faces significant challenges in providing adequate healthcare
services to rural communities due to physician shortages, unequal workforce distribution, and highattrition rates. Despite government recruitment efforts, poor retention of medical doctors in rural
areas remains a major obstacle to efficient healthcare delivery. This study intends to find andinvestigate challenges and barriers to rural physician retention in Bangladesh.
METHOD:A concurrent mixed-method approach will be employed in randomly selected Medical College
Hospitals, District Hospitals, Upazila Health Complexes, and Union Health Sub-Centers, from all eightadministrative divisions of Bangladesh. Quantitative data will be collected from the medical doctors
working in rural and urban government health facilities, whereas qualitative data will be fromphysicians, government officials, professional and local leaders, and journalists. A document review
will be done to understand the physician retention rate and factors influencing the retention. In thequantitative part, a self-administered questionnaire includes the well-being index, job satisfaction
scale, and work environment scale to measure the doctor’s mental well-being, job satisfaction, andworking environment, respectively. Qualitative data will be collected through in-depth (20 physicians)
and key informant interviews (30 other professionals). The Institutional Review Board, Bangabandhu
Sheikh Mujib Medical University, Dhaka, approved the protocol.
RESULTS:Multiple logistic regression and structural equation modeling will be used to identify
predictors and understand their interrelationships. We will do manifest content analysis to identify
codes, categories, and themes to capture medical doctors' challenges in rural areas. We will utilize
triangulation to ensure the validity of findings obtained from various data sources.
CONCLUSIONS:The study will help policymakers develop and implement targeted healthcare service
policies to improve healthcare quality and access nationwide.

Keywords: Physician retention, Healthcare workers, Health care delivery, Rural area, Bangladesh

FP-219[Air pollution » General]

Association between PM2.5, PM10, SO2, and O3
Exposure and Prehypertension: A Systematic
Review and Meta-Analysis
Shiue Shiuan Tu, Tzu Hsuen Yuan
Department of Health and Welfare, University of Taipei, College of City Management, Taiwan

BACKGROUND AND AIM:Prehypertension is a medical condition characterized by elevated bloodpressure levels, which may lead to hypertension and an increased risk of cardiovascular disease.
Despite numerous studies exploring the connection between air pollution and hypertension, there wasa lack of studies to comprehensively investigate the association between air pollution andprehypertension. Therefore, we conducted a meta-analysis to assess the relationship between air
pollution and prehypertension in the general public.
METHOD:We searched PubMed and Embase for relevant studies published until March 26, 2023. A
total of 4 studies reporting OR with 95% CI for the association between air pollution and the risk ofprehypertension were included, with a total of 44660 individuals involved. Meta-analysis was
performed using STATA.
RESULTS:The analysis revealed significant positive correlations between prehypertension andexposure to O₃ and SO₂, with the odds ratios of 1.17 (95% CI: 1.07-1.27, p = 0.50) and 1.15 (95%
CI: 1.03-1.29, p = 0.26), respectively, per IQR of exposure. As to particulate matter pollutants, it
showed that the risk of prehypertension was not statistically associated with the PM10 and PM2.5
exposure, with the odds ratios of 1.10 (95% CI: 0.94-1.29, p = 0.11) and 1.01 (95% CI: 0.95-1.08, p= 0.30), respectively, per IQR of exposure.
CONCLUSIONS:We conducted this pilot study to find the association between exposure to O₃ and SO₂
pollutants and the risk of prehypertension. Further course of prehypertension to hypertension by air
pollution should be concerned. In addition, more evidence was needed to clarify the association
between particulate matter exposure and prehypertension.

Keywords: Air pollution, Particulate matter, Ozone, Cardiovascular diseases

FP-220[Exposures » Water quality]

Realities of living and perceptions on water
quality of an urban slum at Yamuna bank inDelhi: An exploratory study
Sonal Singh1, Sonal Singh2
1Centre for Environmental Health, Public Health Foundation of India, Delhi, India
2Centre for Chronic Disease and Control, Delhi, India

BACKGROUND AND AIM:Urban slums at the bank of Yamuna River in Delhi possess more exposure towaterborne disease along with the issues like safe drinking water, sanitation facilities, and healthcare
services due to a surge in its population.
The aim of the study was to explore the realities about accessibility and usage patterns of available
water sources with concomitant water testing for various contaminants.
METHOD:An exploratory qualitative study was conducted to explore sources of water supply,
perceptions about the water quality and related health issues among 17 participants living in thevicinity of Yamuna River along with the chemical and microbial analysis of water samples collectedfrom river and hand pumps to understand their contamination profile. Convenience sampling was done
to select the participants who were above the age of 18 years living in study area for more than 6months. River water samples were collected from the centre of river stream and ground water wascollected from the hand pumps from different location of the slum to cover the whole area. Aninterviewer-administered topic guide was used. For water testing of ammonia and E.coli Jal –Tara kit
was used. Pesticides contamination was tested in laboratory.
RESULTS:Thematic analysis was done and data was categorized into themes and subthemes.
Participants had different perceptions on the quality of available water sources based on odor, taste
and transparency of water which determined their usage pattern. Participants also reported various
dermatological and gastro-intestinal symptoms. Chemical and microbial testing showed that water
sample collected from hand pump located in nearest proximity of river was the most polluted.
CONCLUSIONS:Due to the lack of availability and accessibility to clean water people were unable toadhere to hygienic habits. Waterborne symptoms including diarrhea, vomiting, etc. are mostly
prevalent among the population living in the proximity of polluted water sources.

Keywords: Water quality, Pesticides, Public Health, Infectious DiseaseFP-221[Air pollution » General]

The Correlation Between School Neighborhood
Environment And PM2.5 In Taichung City
Tzu Han Hung1, Chi Jung Chung1, Chi Da Wu2
1Department of Public Health, College of Public Health, China Medical University, Taichung City,

Taiwan.
2Department of Geomatics, National Cheng Kung University, Tainan City, Taiwan.

BACKGROUND AND AIM:Air pollution is one of the biggest health and environmental issues worldwide,and children are more vulnerable to its impacts than adults. Particulate matter (PM) is a common
indicator of air pollution, and many studies have found that exposure to PM may have negative effects
on children's health. However, previous research has focused mainly on assessing PM2.5
concentrations through aerodynamic sampling or satellite remote sensing to discuss health-related
issues, with less attention given to the impact of environmental factors on PM2.5. Therefore, thisstudy aims to use unsupervised machine learning to cluster the school environments in Taichung City
and analyze their correlation with PM2.5.
METHOD:PM2.5 concentration data for Taichung City schools were obtained from the EDIMAX AIRBOX
open data provided by the Networked Research Laboratory and were organized into annual average
concentrations. The normalized Difference Vegetation Index (NDVI) was used to estimate green
spaces on school campuses. Other environmental data (such as the number of factories and bus
stops) were obtained from the government's open data platform and standardized. The K-means
algorithm was used to cluster 231 elementary schools in Taichung City, and 10-fold cross-validation
was applied. Descriptive analysis was performed on the different clusters, and generalized linear
models were used to compare the relationships between different environmental factors and PM2.5.
RESULTS:The optimal number of clusters is expected to be determined using the Elbow Method. The
study found that different school environment characteristics (such as the number of factories, bus
stops, etc.) are correlated with PM2.5.
CONCLUSIONS:Different clusters reflect different environmental characteristics of schools, andunderstanding these characteristics can help improve PM2.5 concentrations and create a better
learning environment for students.

Keywords: Particulate matter, Environmental epidemiology, Children's environmental healthFP-222[Air pollution » General]

The impact on air pollution by epidemic
prevention policy of COVID-19 in Taipei of
TaiwanChia Yi Lu1, Ruei Hao Shie2, Chia Yu Chang1, Tzu Hsuen Yuan1
1Department of Health and Welfare, University of Taipei, Taiwan
2Green Energy and Environment Research Laboratories, Industrial Technology Research Institute of

Taiwan, Taiwan

BACKGROUND AND AIM:This study aims to investigate the changes in concentrations of NO2, PM2.5
and PM10 as well as possible influencing factors during the level 3 alert period and outbreak period of
the COVID-19 pandemic in Taipei and New Taipei city.
METHOD:Using the monthly average of hourly data from 18 central air quality monitoring stations of
the Environmental Protection Administration from 2015 to 2019 for Theil-Sen trend estimation. The
data from the same period in 2019 was applied to estimate the predicted concentrations of pollutants
during level 3 alert period (May 19,2021 - July 25,2021) and outbreak period (May 19,2022 - July
25,2022). The predicted concentrations of pollutants were further compared with the actual
concentrations to calculate the percentage difference. In addition, Google Mobility Trends was used toestimate the changes in the stream of people during study period.
RESULTS:NO2 decreased significantly during the level 3 alert, especially at traffic stations. NO2
significantly decreased 27.3% (95%CI -25.3%, -29.9%). There were no significant changes of NO2
during the outbreak. The concentration changes of PM2.5 was not statistically significant during thelevel 3 alert. During the outbreak, PM2.5 increased 11.9% (95%CI -0.4%, 23.4%). PM10 significantly
decreased 8.4% (95%CI -1.5%, -14.3%) during the level 3 alert, while there was no statisticallysignificant change during the outbreak. Google Mobility Trends indicated that the stream of people
only increased in residential area.
CONCLUSIONS:During the level 3 alert, the concentrations of NO2 and PM10 significantly decreased.
The impact of changes in stream of human may related to the changes of air pollution during
pandemic. In the future, it could clarify the patterns of traffic and stream of people changes during
COVID-19 pandemic period to further adjust relevant traffic policies to effectively improve air pollution
in the post-epidemic era.

Keywords: COVID-19, Particulate matter, Oxides of nitrogenFP-223[Air pollution » General]

Biomass Smoke Exposure and Anthropometric
Growth among Children in Rural Guatemala
Participating in the RESPIRE and CRECER
Prospective Cohort Studies
Wenxin Lu1, Alisa Jenny2, Carolina Romero3, Andrea Kuster4, Eduardo Canuz3, Ajay Pillarisetti1, Kirk
Smith1, John Balmes5, Lisa Thompson6
1School of Public Health, University of California, Berkeley, USA
2Institute for Global Health Sciences, University of California, San Francisco, USA
3Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
4School of Nursing, University of California, San Francisco, 94158 San Francisco, USA
5School of Public Health, University of California, Berkeley, USA; Department of Medicine, Universityof California, San Francisco, San Francisco, USA
6Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA

BACKGROUND AND AIM:Cooking-related biomass smoke is a major source of household air pollution
and an important health hazard in rural regions of low-income countries. Prior studies have associatedearly-life air pollution exposure with childhood stunting, but less is known for other growth indicatorssuch as underweight and wasting.
METHOD:557 households in rural Guatemala were assigned to three groups that received chimney
stoves at different ages (< 3, ~18, and ~57 months) of the study children. Multiple personal CO
exposure measurements were combined to estimate children’s cumulative CO exposures as a proxyfor biomass smoke exposure. Children’s height and weight were measured around 5 years old. Heightfor-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were
calculated based on the World Health Organization’s child growth standards. Two or three standard
deviations below a median international reference population were classified as moderate or severe forstunting, underweight and wasting, respectively.
RESULTS:541 children had valid anthropometric measurements, among whom 488 (90.2%) werestunted, 192 (35.5%) were underweight, and none were wasted. No significant difference was foundacross study groups. A 1 ppm-year higher cumulative CO exposure was associated with 0.02 lower
HAZ (95% CI: -0.004, 0.04), 0.005 lower WAZ (95% CI: -0.01, 0.02), moderate stunting (OR = 1.01,
95% CI: 0.92 – 1.13), severe stunting (OR = 1.003, 95% CI: 0.95 – 1.06), moderate underweight(OR = 1.03, 95% CI: 0.98, 1.09) and severe underweight (OR = 1.05, 95% CI: 0.92, 1.16).
CONCLUSIONS:Although not statistically significant, we found suggestive evidence that early-life
exposure to biomass smoke might be associated with higher risks of underweight among children inrural Guatemala. Biomass chimney stoves might not be effective enough to reduce HAP exposures tolevels that benefit childhood body growth. Larger, future studies with clean fuel stoves should beconsidered.

Keywords: Air pollution, Environmental epidemiology, Children's environmental health, Long-term
exposureFP-224[Methods » Methodological study design]

Challenges and a Way Forward in Constructing
Geospatial Data Pipeline to Assess Health
Effects of Environmental-Risk Factors in SouthKorea
Won Kyung Kim, Goeun Jung, Dongook Son, Sun Young Kim
Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, National
Cancer Center, Goyang, South Korea

BACKGROUND AND AIM:There have been dramatic increase of data availability and incredible
technological advance for data storage and processing to enhance public health research. These
improvements led to emerging interests in data pipeline that comprises the series of steps includingtransferring raw data from disparate sources, modifying data, storing to a unified database, andconstructing analytical platforms. As constructing data pipelines of accumulating genomic data allows
understanding genetic risk factors and biological mechanisms, the pipelines of geospatial data can
improve our understanding of environmental risk factors and mechanisms in human health. This
research intends to investigate challenges to construct the geospatial data pipeline for epidemiologicalresearch as a case study in South Korea.
METHOD:This research examined challenges in constructing the pipeline of South Korean geospatial
data including various sociodemographic features and physical/built environments. Our investigation
specifically focused on 1) data quality and accuracy, 2) processing and management, and 3) privacy
and security.
RESULTS:For quality and accuracy, there are spatial data errors resulting from sampling, digitizing
and projection, data inconsistency such as different spatio-temporal scales across multiple data
sources, and data deficiency derived by technical limitations. In processing and management, we finddifferent types of data including geographic information system files, satellite images, and nongeocoded tables and continuous updates with changes in formats and contents, that makes it difficult
to create a unified database. Lastly, publicly-available geospatial data are often available as
aggregated data with a coarse spatial scale to avoid privacy concerns which result in the limitations in
identifying environmental risk factors.
CONCLUSIONS:Our investigation suggests that we should prioritize not only standardized proceduresof data acquisition and processing but also application of efficient workflows in order to construct a
geospatial data pipeline.

Keywords: data pipeline, geospatial, heath effects, environmental-risk factors, big data

FP-225[Other » Other (to be specified with keywords in the keywords section)]

Exploring the relationship between low carbon
behavior drives, behavior intention and actual
carbon emissions, from a game design thinking
perspective
Xinyu Shen1, Yi Lu2, Xinzhe Cheng3, Huijun Hu1
1Design Innovation Center, China Academy Of Arts, Hangzhou, China
2Hangzhou Landscaping Incorporated, Hangzhou, China
3Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

TaiwanBACKGROUND AND AIM:The ecosystem of university campuses, as one of the most important green
space in the city, is strongly influenced by the behaviors of the students live there. Theoretically,
Understanding students' carbon emissions and promoting low-carbon behavior is an available way toachieve a sustainable campus ecosystem. However, the relationship between low-carbon behavior
intention and actual carbon emissions has not been verified. Therefore this study aims to assess users'
carbon footprint and collect their low-carbon behavior intention, then discuss the feasibility of reducing
actual carbon emission by increasing low-carbon behavior intention. Meanwhile, the study also
explores the relationship between users' behavioral motivations and their low-carbon behavioral
intentions from the perspective of game design thinking, hoping to build sustainable campuses fromthe perspective of enhancing students' low-carbon behavior motivations.
METHOD:This study is divided into two parts. The first part collects the daily carbon emission
behaviors and low-carbon behavior intention of university students by online questionnaire, andobtains their carbon footprint data through conversion. In the second part, based on low carbon
behavior theories, an Octalysis Framework is established to collect students' agreement on the eightcore drives of low-carbon behaviors and their low-carbon behavior intention through online
questionnaire.
RESULTS:Preliminary findings show that users' actual carbon emission have a significant negative
correlation with low-carbon behavior intention, while the stepwise linear regression result (Rsquared=0.672) shows that meaning，accomplishment and scarcity have a significant positive impact
on users' low carbon behavior intention.
CONCLUSIONS:This work contributes to confirming the correlation between low-carbon behavior
intention and actual carbon emissions, and proposes an effective model to predict low-carbon behavior
intention through behavior motivation. This study is also an effective attempt of game design thinking
in understanding pro-environment behavior motivations and provides new ideas for achieving asustainable campus ecosystem.

Keywords: Ecosystem healthFP-226[Air pollution » Other (to be specified with keywords in the keywords section)]

Anemia Prevalence and Ambient Air Lead Levels
in Taiwan: A Before and After Comparison of the
Leaded Gasoline Ban
Ya An Liu1, Chi Chang Ho2, Mei Huei Chen3, Ching Chun Lin2, Pau Chung Chen4
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan.
2Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan.
3Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;

Department of Pediatrics, National Taiwan University Hospital and National Taiwan University Collegeof Medicine, Taipei, Taiwan.
4Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Public Health, College of Public Health, National
Taiwan University, Taipei, Taiwan; National Institute of Environmental Health Sciences, National
Health Research Institutes, Miaoli, Taiwan; Department of Environmental and Occupational Medicine,National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei,
Taiwan.

BACKGROUND AND AIM:Lead exposure can adversely affect many physiologic functions of human,and it was associated with anemia risk. Due to the adverse health effects of lead exposure, thegovernments worldwide put forward the regulation to decrease lead emissions. Therefore, the leaded
gasoline was banned in Taiwan in 2000. The introduction of lead-free gasoline resulted in a decreasein air lead levels and a decrease in average blood lead levels consequently. My study aimed toinvestigate the differences of prevalence of anemia and ambient air lead level before and after the banof leaded gasoline in Taiwan.
METHOD:The study population would be adults aged from 19 to 64. Data of hematological indicators,
such as hemoglobin level, was obtained from Nutrition and Health Survey in Taiwan during 1993-1996
and 2004-2008. Anemia was defined using a strict cut-off of <13.0 g/dl in men and <12.0 g/dl inwomen. And the ambient air lead levels of years were extracted from Environmental Protection
Administration in Taiwan.
RESULTS:The ambient air lead levels in Taiwan have been decreasing from 1998 to 2021.
Furthermore, among adults aged from 19 to 64 that included in this study, prevalence of anemia(12.4%) in 2005-2008 was lower than the prevalence (13.5%) in 1993-1996.
CONCLUSIONS:The prevalence of anemia was decreased among adults aged from 19 to 64 included inthis study after the ban of leaded gasoline. The potential confounding variables are considered and thefurther analysis will be conducted. The results of this study can provide evidence of the improvementof anemia risk after the ban of leaded gasoline and help the authorities to evaluate the impact of theenvironmental regulations.

Keywords: Air pollution, Heavy metals, Policy and practiceFP-227[Chemical exposures » Endocrine disrupting chemicals]

Using Silicone Wristband to Estimate theConcentrations of UV Filters in Indoor
Environment
Ya Lun Yu, Shih Wei Tsai
Department of Public Health, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Nowadays, UV filters are widely used in the world. They are added topersonal care products, sunscreens, cosmetics, and so on to protect human skin. Therefore, mostpeople worldwide are exposed to UV filters via dust, air, and water, including males, females, babies,
and all ages. As we know, UV filters exposures have many adverse effects, such as skin irritation,
endocrine disruptors, phototoxicity, and decreased vitamin D synthesis. The exposure routes of UV
filters include inhalation, skin absorption, and ingestion. Hence, a tool that can obtain theconcentrations of UV filters in multi-environmental media will greatly benefit exposure assessment.
Recently, using silicone wristbands has been an excellent way to sample because there are lots ofadvantages like cheap, non-invasive sampling, long-term exposure assessment, ease to wear, andpresent personal exposure. Thus, the aim of this study aim is to use the silicone wristband to take air
samples and convert them into gas-phase concentrations, followed by establishing the correlations
between air and dust concentrations of UV filters indoors.
METHOD:After sampling, the silicone wristband was divided into pieces, followed by solvent desorption
and analysis with Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS).
RESULTS:The findings showed that various UV filters, including benzophenone-3 (BP-3),
benzophenone-8 (BP-8), homosalate (HMS), octyl methoxycinnamate (OMC) and butyl
methoxydibenzoylmethane (BMDM), were determined at different indoor environments. The estimatedgas-phase concentration from the silicone wristband was used to find the relationship between air anddust samples. Temperature, wind speed, and photodegradation might affect the correlations between
air and dust concentrations.
CONCLUSIONS:The relationship between the concentrations of UV filters in the air and dust wasestablished. Chances are that by using only the silicone wristbands to take air samples, the exposuresof UV filters in the indoor air and indoor dust can be assessed simultaneously in the future.

Keywords: Chemical exposures, Endocrine disrupting chemicals, Exposure assessment

FP-228[Respiratory and allergic outcomes » Allergies]

Effect of residential environment on children's
allergic diseases in the Greater Taipei area
Ya Wen Yang, Hsing Jasmine Chao, Yi Hua Chen, Ling Chu Chien, Ming Lun Zou
School of Public Health, College of Public Health, Taipei Medical University, Taipei Taiwan

BACKGROUND AND AIM:In recent years, the prevalence of allergic diseases in children has been
increasing, affecting their quality of life. To prevent the development and exacerbation of allergic
diseases in children, this study aims to evaluate the household environmental characteristics andallergen levels and their impacts on allergic diseases in children in the Greater Taipei area.
METHOD:The participants were recruited from an ongoing birth cohort study, Longitudinal Examination
Across Prenatal and Postpartum Health in Taiwan. Structured questionnaires were used to collectinformation on the participants' demographic factors, health conditions, and household environmental
status. Environmental sampling was performed to assess indoor allergens and important pollutants atparticipants’ homes. Multiple regressions were used to examine the correlation between allergic
diseases and household environmental factors.
RESULTS:A total of 108 households were recruited in this study. The mean concentrations of air
pollutants were below Taiwan's Indoor Air Quality Standards. The levels of total volatile organic
compounds, formaldehyde, ozone, and carbon dioxide in some households exceeded the standards
due to recent renovation, the presence of pollutant sources, and insufficient ventilation. The prevalent
fungal spores in the air and children’s bed dust were ascospores, Aspergillus/Penicillium,
Cladosporium, and basidiospores. Aspergillus/Penicillium had the highest concentration in the livingroom and children's bed dust. According to the regression analysis, fungal spores and dust miteallergen (Der p 1) in children’s beds, airborne fungal spores, and PM10 adversely impacted children’s
allergic diseases.
CONCLUSIONS:The results of this study indicate that household pollutants can affect children's health.
Regular cleaning and proper ventilation may reduce pollutant exposure and the health risk of children.

Keywords: Built environment, Children's environmental health, Environmental epidemiology,
Exposure assessment, Microbes

FP-229[Air pollution » Traffic-related]

Efficacy of Portable Air Purification on Public
Buses: A Pilot Study
Yanming Liu1, Yuxi Zhang1, Shanshan Li1, Rongbin Xu1, Pei Yu1, Christian Ramos2, Amir
Ebrahimifakhar2, Yuming Guo1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
2Delos Living LLC, New York, United States

BACKGROUND AND AIM:High concentrations of fine particulate matters (PM2.5) has been frequently
reported in public transit systems and can cause adverse health effect. Portable air purifier is an
inexpensive solution and has the potential to clean in-cabin PM2.5.
METHOD:This study aims to find the PM2.5 removal efficacy of portable air purifiers in a public transit
bus. In various scenarios, after artificially preloading in-cabin PM2.5 concentration to 400 μg/m3, thePM2.5 concentration was measured every 10 seconds with and without the intervention of air
purifiers, respectively.
RESULTS:The results showed that in a test bus with a volume of approximately 65 m3, after an
artificial preload of high concentration PM2.5, three portable air purifiers reduced the average
concentration of PM2.5 by 42-74% to levels below 15 μg/m3, the acceptable short-term exposure
concentration recommended by WHO. When high concentration PM2.5 came into the bus fromoutdoors, purifiers maintained a relatively low level of in-cabin PM2.5. Therefore, air purifiers weresignificantly more effective in reducing in-cabin PM2.5 than traditional air filtration and ventilation
methods (air conditioning system filtration and door opening) in public transit buses.
CONCLUSIONS:The deployed air purifiers reduced the concentration of particulate matter inside thebus, which may reduce the health risk of PM2.5 exposure and the spreading of airborne infections inpublic transit; thus, implying the potential to enhance passengers’ and drivers’ health.

Keywords: Particulate matter, Exposure assessment

FP-230[Outcomes » Other (to be specified with keywords in the keywords section)]

Aristolochic Acid and the Risk of Liver cirrhosis
in Patients with Hepatitis B Virus Infection
Yao Hsu Yang1, Chi Jen Chen2, Ko Jung Chen3, Pau Chung Chen4
1Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan;Health

Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of
Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
2Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public

Health, Taipei, Taiwan
3Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
4Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei,Taiwan; Department of Public Health, National Taiwan University College of Public
Health, Taipei, Taiwan; Department ofEnvironmental and Occupational Medicine, National Taiwan
University Hospital and National Taiwan University College ofMedicine, Taipei, Taiwan; National
Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,Taiwan

BACKGROUND AND AIM:BACKGROUND: Some studies indicated that aristolochic acid (AA) can causes
liver injury, playing an important role in liver cirrhosis. However, epidemiology research regardingwhether AA increases the risk of cirrhosis are limited. The purpose of this study was to investigate
whether the exposure of AA was associated with increased risk of cirrhosis among Hepatitis B virus(HBV)-infected patients.
METHOD:This population-based cohort study identified a total of 800,701 HBV infected patients using
the National Health Insurance Research Database in Taiwan. Landmark analysis design was conductedin this study. The use of Chinese herbal products containing AA, including Guan Mu Tong, Guang
Fangchi (Aristolochia fangchi), Ma Dou Ling (Fructus Aristolochiae), Qing Mu Xiang (Radix
Aristolochiae), Tian Xian Teng (Caulis Aristolochiae), and Xi Xin (Asarum heterotropoides), wasidentified during the exposure window between1997 and 1999. The Cox proportional hazards
regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the
association between the use of Chinese herbal products containing AA and the occurrence of cirrhosis.
RESULTS:There were 51,304 cirrhosis in the HBV-infected cohorts during the follow-up period; andthere were higher risks of cirrhosis in patients with HBV infection who took Chinese herbal products
containing AA (adjusted HR, 1.09; 95% CI, 1.07 to 1.12). Consistent result was found in two
additional landmark analyses with 5-year and 7-year exposure window, which showed AA exposure
might increase cirrhosis risk.
CONCLUSIONS:Our study found the exposure of AA associated with increase cirrhosis risk in patientswith HBV infection.

Keywords: Aristolochic acids, hepatitis B virus,liver cirrhosis, National Health Insurance Research
Database, NHIRD

FP-231[One health » Public health]

Disability Prediction in Ageing Population Basedon Disease Status: Machine Learning
Approaches
Yi Chun Lin1, Yu Ning Chien2, Wan Chun Yang3, C. Y. Yvonne Lai3, Kwang Hwa Chang4, Shih Wei
Huang5, Tsan Hon Liou5, Hung Yi Chiou3
1School of Public Health, Taipei Medical University, Taipei, Taiwan
2Department of Health and Welfare, University of Taipei, Taipei, Taiwan
3Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
4Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University,

Taipei, Taiwan
5Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University,

New Taipei City, Taiwan

BACKGROUND AND AIM:Elderly disability represents an inescapable public health challenge for all
aging nations, and the profound burden it imposes on healthcare resources is a critical concern. To
efficiently allocate long-term care resources and prevent disability, it is crucial to employ accurate
disability prediction models to evaluate the elderly population's disability status. Previous research had
demonstrated a strong association between chronic diseases and disability. Accordingly, this study
utilizes healthcare claims data to identify diseases associated with disability and construct a diseasebased disability prediction model. The model provides information on high-risk disability groups anddiseases with significant impacts on disability, facilitating the formulation of resource allocation andprevention strategies.
METHOD:This study adopts the Long-Term Care Database to define the elderly disability population
and utilizes the National Health Insurance Research Database to construct disability-related diseasevariables. Five explainable machine learning models are employed to build the disability prediction
model. The disability model assesses the probability of disability for each elderly person throughdisease status and identifies the disabled population in the elderly population. Additionally, we employ
the Shapley Additive Explanation method to analyze the extent to which diseases impact disability andidentify illnesses that significantly influence disability.
RESULTS:The study revealed that among all the algorithms tested, the XGBoost algorithm exhibitedthe strongest predictive power. Its AUC was 0.867 and balance accuracy was 0.795. Based on thefeature importance ranking generated by the predictive model, it was found that chronic conditions,
including renal failure, dementia, cerebral vascular obstruction and stenosis, and hypertension, weresignificantly associated with disability.
CONCLUSIONS:Our disease-based disability prediction model offers a real-time digital prediction
mechanism to identify high-risk groups of disability among the elderly, serving as a valuable decisionmaking tool for disability prevention and allocation of medical care resources.

Keywords: Big data, Risk assessment, Policy and practiceFP-232[Respiratory and allergic outcomes » Asthma]

Inter-alpha-trypsin inhibitor heavy chain 4
mitigated allergic response in OVA-induced
asthma mouse
Yi Hsuan Liu, Hsiao Chi Chuang
School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

BACKGROUND AND AIM:Asthma is a chronic inflammatory disease of the airway. Approximately 510% of asthma patients remain uncontrolled with current treatments. Previous research has shown
elevated blood levels of Inter-Alpha-Trypsin Inhibitor Heavy Chain 4 (ITIH4) during acuteinflammation, but its significance in respiratory diseases remains unknown.The aim of this study is toinvestigate the therapeutical potential of ITIH4 in the physiological and pathological changes of thelungs in asthma.
METHOD:An asthma animal model was established by intraperitoneally administering 50μg/kg OVA tosix-week-old Balb/C mice once a week for 4 weeks. The control group received the same volume ofphosphate-buffered saline (PBS) under the same conditions as the OVA group. After 4 weeks, the OVA
group was intranasally administered 0 (PBS), 1.25, or 2.5 μg/mL of recommended ITIH4 protein for 7
days. Subsequently, the mice were challenged with intranasal administration of 100μg/kg OVA for 3
days. We collected bronchoalveolar lavage fluid and lung samples to analyze airway inflammation andthickness. Additionally, we measured body weight, exercise oxygenation, lung function, white blood
cell, and serum IgE levels.
RESULTS:In the OVA-induced asthma mouse model, ITIH4 treatment significantly reduced bodyweight loss and airway resistance. ITIH4 administration led to a significant decrease in serum IgElevels, indicating a reduction in the allergic response. The analysis of white blood cells showed adecrease in eosinophils, lymphocytes, and monocytes, further supporting the anti-inflammatory
properties of ITIH4. Additionally, H&E staining indicated that ITIH4 effectively suppressed OVAinduced allergic airway inflammation and thickness, leading to a mitigation of asthma-related
pathological changes.
CONCLUSIONS:ITIH4 mitigated body weight loss, exercise oxygen desaturation, central airway
resistance, white blood cell count, and serum IgE levels. ITIH4 played an anti-inflammatory role in the
OVA-induced asthma mouse model, indicating its potential as a drug for the treatment of asthma.

Keywords: inter-alpha-trypsin inhibitor heavy chain 4, airway inflammation

FP-233[Exposures » Other (to be specified with keywords in the keywords section)]

Investigation of the toxic effects of the nanomaterial Titanium dioxide on Cryptobacterium
elegans
You Jia Huang1, Yu Shien Su1, How Ran Chao1, Sherwin M. Juan2
1You-Jia Huang,Yu-shien Su,How-Ran Chao
2Sherwin M. JuanBACKGROUND AND AIM:This study investigated the toxicity of Titanium dioxide using Caenorhabditis
elegans as the model organism. The lethality, lifespan, growth, reproduction, locomotion, andoxidative stress induced by varying concentration of TiO2 on C. elegans were investigated. In thisstudy, commercially available (Degussa P25) and synthetically prepared TiO2 solutions were prepared.
METHOD:The nematodes were acutely exposed (from L3 to young adult stage) to 4 concentrationlevels of each TiO2 solutions (10 mg/L, 1 mg/L, 0.1 mg/L, and 0.01 mg/L).
RESULTS:The results showed that there is no significant effect to the survival rate, growth, and life
span of the nematodes for all concentrations of both solutions compared to the control group.
However, there is an observed decrease in the brood size of the nematodes as the concentration of
TiO2 increased. The same is observed in the locomotion of the nematodes, where the head thrashingand body bending decreased as the concentration increased. Oxidative stress expression of sod-1,
sod-3, ctl-1, ctl-2, cyp35A2, mlt-1, and mlt-2 was also observed. For commercially available TiO2,
there is an overexpression of all genes at 1 mg/L exposure and for synthetic TiO2, there is asignificant overexpression of all genes at 10 mg/L exposure.
CONCLUSIONS:In conclusion, acute exposure of C. elegans to high concentrations of TiO2 reduced thebrood size produced and have affected the locomotion of the nematodes.

Keywords: Titanium dioxide, Caenorhabditis elegans, Reproductive toxicity, Neurobehavioral toxicity

FP-234[Air pollution » Short-term exposure]

The association of hourly exposure to PM2.5
and O3 with emergency department visits ofasthmaYu Cheng Chen1, Mu Jean Chen1, Shih Chang Hung2, Hung Chang Hung2
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2Nantou Hospital of the Ministry of Health and Welfare, Nantou, Taiwan

BACKGROUND AND AIM:The short-term exposure to air pollutants, such as particles with anaerodynamic diameter ≤ 2.5 μm (PM2.5) and ozone (O3), has been linked to an increased risk ofasthma exacerbations. Although most studies have explored the relationship between 24-hour air
pollution exposure and the daily risk of asthma exacerbations, there is limited evidence regarding theassociation between hourly exposure and health risk.
METHOD:This study collected hourly data of PM2.5 and O3 as well as meteorological information fromthe air quality monitoring station of Nantou, central Taiwan, between 2011 and 2021. The study
included data on emergency department visits (EDVs) related to asthma (ICD-9-CM: 493 and ICD-10CM: J45) for all age groups during the same period from Nantou Hospital of the Ministry of Health andWelfare.
The excess risks (ERs) of asthma EDVs were estimated using multivariable quasi-Poisson generalized
additive models (GAMs), with adjustments made for days of the week, season, and smoothing splines
such as the year, temperature, and relative humidity at the same hours.
RESULTS:The study revealed that positive associations exist between the hourly concentration of
PM2.5 and O3 pollutants and asthma EDVs, even with only one-hour exposure. The highest risks wereobserved with a 10-ug/m3 increase in 6-hour exposure to PM2.5 at lag 21 and a 10 ppb increase in 1hour exposure to O3 at lag 8, associated with an increase in hourly asthma EDVs by 5.41% (95% CI:
2.53-8.29) and 2.91% (95% CI: 2.36-3.46), respectively.
CONCLUSIONS:The findings indicate that hourly exposure to PM2.5 and O3 is significantly associatedwith an increased risk of asthma EDVs. The study highlights the need for setting hourly air quality
standards and interventions for PM2.5 and O3 to mitigate the negative health impact of air pollution.

Keywords: fine particle, ozone, asthma, hourly exposure and outcome, emergency department visits

FP-235[Air pollution » Particulate matter]

The Effect of Concurrent Exposure to PM2.5 andHigh Glucose on the Toxicity Induced in A549
Lung Cancer Cells
Yu Ting Chang1, How Ran Chao1, Jian He Lu2
1Department of Environmental Science and Engineering, National Pingtung University of Science andTechnology, Neipu, Pingtung 91201, Taiwan
2General Research Service Center of National Pingtung University Science and Technology, Neipu,

Pingtung 91201, Taiwan

BACKGROUND AND AIM:Fine particulate matter (diameter <2.5μm) or PM2.5 can adsorb a variety of
toxic and harmful substances which can be deposited in the lower respiratory tract and alveoli throughthe respiratory system to enter into the whole body through blood circulation. Previous study indicatedthat PM2.5 exposure increased the incidence of diabetes.This study aimed to investigate the healthrisk of PM2.5, with/without high glucose exposure on lung cancer cells A549.
METHOD:In this experiment, PM2.5 and high glucose were first exposed to A549 cells, and then coexposed to selected toxic concentrations to measure cell growth, cell apoptosis and wound healing in
A549 cells. The study involved exposing A549 lung cancer cells to varying concentrations of PM2.5(control, 10, 20, 50, 100 µg/mL) and glucose (control, 20, 40, 80, 120 mM). After analyzing theresults, a concentration of 80 mM glucose and 50 µg/mL PM2.5 were selected for co-exposure toassess whether the combined exposure to PM2.5 and high glucose levels would result in higher
toxicity.
RESULTS:The results showed that 10-100 µg/mL PM2.5, or 20-120 mM glucose exposure significant
decreased A549 cell lines growth and wound healing, but increased mortality compared with thecontrol group. According to the findings, both PM2.5 and glucose exposure caused a significant
reduction in the growth of A549 cell lines and increased mortality when compared to the control
group. Additionally, the combined exposure of PM2.5 and glucose intensified the negative effects on
A549 cells.
CONCLUSIONS:This highlights the importance of considering the impact of high glucose levels in
combination with PM2.5 exposure. This study may provide a potential therapeutic or preventive
approach for people with diabetes or residents located in areas with high PM2.5, exposure.

Keywords: PM2.5, High glucose, A549 cells

FP-236[Birth and pregnancy outcomes » Birth outcomes]

Identifying Critical Windows of Air Pollution
Exposure during Preconception and Gestational
Period on Birthweight
Jiawen Liao1, Yi Zhang2, Zhenchun Yang3, Chenyu Qiu1, Wu Chen1, Junfeng (jim) Zhang4, Kiros
Berhane5, Bin Han6, Jia Xu6, Yong Hui Jiang7, Frank Gilliland1, Weili Yan2, Guoying
Huang2, Zhanghua Chen1
1Department of Population and Public Health Sciences, Keck School of Medicine of University ofSouthern California, Los Angeles, CA, United States of America
2Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, China
3Duke Global Health Institute, Durham, NC, United States of America
4Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University,

Durham, NC, United States of America
5Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY,

United States of America
6State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy ofEnvironmental Sciences, Beijing, China
7Department of Genetics, Neuroscience, and Pediatrics, Yale University School of Medicine, New

Haven, CT, United States of America

BACKGROUND AND AIM:Few studies have assessed air pollution exposure association with birthweight
during both preconception and gestational periods. In this study, we aim to identify critical periods of
air pollution exposure during preconception and gestational period on birthweight outcomes.
METHOD:Leveraging a preconception cohort consisting of 14,220 pregnant women and newborns inShanghai, China during 2016 – 2018, we assessed effects of NO₂ and PM₂.₅ exposure, derived fromhigh-resolution spatial-temporal models, during preconception and gestational periods on outcomes
including term birthweight, birthweight Z-score, small-for-gestational age (SGA) and large-forgestational age (LGA). Linear and logistic regression approaches were used to estimate 3-monthpreconception and trimester-averaged air pollution exposure associations; and distributed lag models(DLM) were used to identify critical exposure time windows at the weekly period from preconception todelivery. Two-pollutant models and effect modifications of children’s sex were explored.
RESULTS:One standard deviation (SD) (11.5 µg/m³, equivalent to 6.1 ppb) increase in NO₂ exposuresduring the second and third trimesters were associated with 13% (95% confidence interval: 2 % –26%) and 14% (95% CI: 1% – 29%) increase in SGA, respectively; and one SD (9.6 µg/m3) increasein PM2.5 exposure during the third trimester was associated with 15% (95% CI: 1% – 31%) increasein SGA. DLM found that gestational weeks 22 – 32 a critical exposure time window, when NO₂
exposure had strongest associations with SGA. The effects of air pollution exposure tended to bestronger in female newborns than in male newborns (p-value < 0.05).
CONCLUSIONS:We found that air pollution exposure during mid-to-late pregnancy was associated withadverse birthweight outcomes.

Keywords: Air Pollutant; Birth outcomes; Environmental epidemiology; Multi-pollutant; Pregnancy
outcomes

FP-237[Air pollution » Long-term exposure]

Saving collection efforts of mobile monitoring
campaigns by transfer learning methods
Zhendong Yuan1, Jules Kerckhoffs1, Gerard Hoek1, Roel Vermeulen2
1Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; Julius Centre for

Health Sciences and Primary Care, University Medical Centre, University of Utrecht, The Netherlands

BACKGROUND AND AIM:Generating hyperlocal air pollution maps for the whole Europe requires
efficiently conducting numerous mobile monitoring campaigns in different cities. Previous mobile
studies have shown that stepwise linear regression (SLR) can achieve stable and satisfactory accuracy
in mapping long-term concentrations with only a few collection days. This work investigates whether
transfer-learning based land-use regression (LUR) models can further reduce collection durations
without compromising accuracy.
METHOD:Our Amsterdam Google AirView campaign collected mobile measurements for 10 months(165 individual collection days, weekdays only). SLR and two transfer learning methods - CPH2AMSand Global2Local were developed using the Amsterdam mobile measurements and validated byindependent long-term routine monitors (Palmes, n=82). Transfer-learning LUR models adapt external
knowledge from another similar task in order to save the demanded amount of training data.
CPH2AMS does this by transferring mobile measurements from another city (e.g., Copenhagen), while
Global2Local leverages long-term measurements from a larger geographic region (e.g., Airbase
measurements from several neighboring countries – Netherlands, Belgium, Luxemburg and Germany).
We plotted the performance (R2 and MAE) of all three methods trained with the Amsterdam mobile
measurements sliced into sequentially increasing continuous collection days (from 1 to 160) andresampled 20 times (randomly selecting a starting date and averaging the mobile measurements ofthe following days).
RESULTS:The performance curve of CPH2AMS increased faster than SLR when sequentially addingcollection days. In case of a small number of collection days (e.g., 1 to 20), the MAE of CPH2AMS wason average only 62% of SLR’MAE (5.04 ug/m lower). With only 10 collection days, CPH2AMS alreadyachieved 70% accuracy of the SLR fitted with mobile data collected for 160 days.
CONCLUSIONS:Transferring mobile knowledge from another mobile-monitored city or long-termknowledge from larger geographic regions can shorten collection durations, which stimulates the
progress of conducting mobile campaigns covering the entire Europe.

Keywords: Exposure assessment-air pollution, Oxides of nitrogen, Long-term exposureFP-238[Outcomes » Mortality]

Association of Metal Exposure and Mortality in
American Indian Populations: A Prospective
Cohort Study
Zheng Li1, Michael Lewin2, Patricia Ruiz3, Anne E Nigra4, Jeffery M Jarrett5, Angela Ragin Wilson6,
Ana Navas Acien4
1Office of Capacity Development and Applied Prevention Science, Agency for Toxic Substances andDisease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
2Office of Community Health Hazard Assessment, Agency for Toxic Substances and Disease Registry,

Centers for Disease Control and Prevention, Atlanta, Georgia, USA
3Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Centers for

Disease Control and Prevention, Atlanta, Georgia, USA
4Department of Environmental Health Sciences, School of Public Health, Columbia University, NewYork City, New York, USA
5Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease

Control and Prevention, Atlanta, Georgia, USA
6Office of Associate Director, Agency for Toxic Substances and Disease Registry, Centers for Disease

Control and Prevention, Atlanta, Georgia, USA

BACKGROUND AND AIM:Metal exposure has been associated with premature mortality in the U.S.
population; however, little is known among American Indian (AI) communities. This analysis assessed
the association between exposure to five elements (four toxic metals and one essential element) andthree mortality outcomes in the Strong Heart Study (SHS) cohort.
METHOD:The study population comprised 2,004 participants from 12 AI communities in four U.S.
states. Archived blood samples collected during 1988-1989 (SHS Phase-3) were analyzed for lead,manganese, mercury, cadmium, and selenium. Mortality surveillance on these participants wascollected during subsequent Phases 4-6 (2001-2021). The target outcomes for this analysis were allcause, cardiovascular disease (CVD)-related, and cancer-related mortality. For each blood metal andmortality outcome, a set of six progressive Cox proportional hazard regression models were developedby adding covariate classes to the model sequentially. Covariates were identified based on resultsfrom univariate and exploratory multivariable regression analyses, including participant demographics,
characteristics, comorbidities, tobacco smoking, other metal exposure, and state.
RESULTS:Blood cadmium, lead and manganese were positively associated with all-cause mortality inall models. Hazard ratios (HR) and 95% confidence intervals in the final adjusted models were 1.10
(0.98-1.23), 1.17 (1.11-1.23), and 1.14 (1.06-1.23), respectively, for an interquartile change in blood
metal concentration. Blood selenium (0.88 [0.82-0.94]) and mercury (0.88 [0.76-1.00]) wereinversely associated with all-cause mortality. For cause-specific mortalities, blood cadmium (1.33[1.06-1.66]) and lead (1.18 [1.09-1.29]) were associated with cancer-related mortality, and lead was
associated with CVD-related mortality (1.18 [1.06-1.31]).
CONCLUSIONS:Toxic metal exposures were positively associated with all-cause mortality in AI
communities. Lead also increased the risks of cancer- and CVD-related mortalities. Selenium, amicronutrient, was negatively associated with all-cause mortality, suggesting a protective effect.
These findings highlight the harmful effects of toxic metal exposures and low micronutrient level on
mortality.

Keywords: Exposure, Heavy metals, Mortality, Environmental justiceFP-239[Neurologic and mental health outcomes » Mental health outcomes]

Neuropsychiatric disorders in Farmers
associated with pesticide exposure – Resultsfrom the study in Kelantan State, Malaysia
Zulkhairul Naim Bin Sidek Ahmad1, Zulkhairul Naim Bin Sidek Ahmad2
1Department of Medical Education, Faculty of Medicine and Health Sciences, Universiti Malaysia

Sabah, Kota Kinabalu, Malaysia
2Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia

Sabah, Kota Kinabalu, Malaysia

BACKGROUND AND AIM:Chronic exposure to pesticides have been linked to various symptoms ofneuropsychiatric disorders. However, little information available on this issue in Malaysia. Hence, thisstudy sough to investigate the associations between neuropsychiatric disorders and pesticide exposure
among farmers in Kelantan State, Malaysia.
METHOD:A cross-sectional study was carried out in the areas around Kelantan, between September
2018 and February 2019. A questionnaire was used to collect information neuropsychiatric disorders
and pesticide exposure. Multiple logistic regression was performed to analyse the predictors forneuropsychiatric disorders.
RESULTS:150 farmers growing either rice (n=83) or vegetables/fruits (n=67) participated in thisstudy. One screen positive case of dementia was identified. However, no screen-positive cases ofParkinsonism/neurology and depression were identified. 18.0%, 16% and 9.3% of farmers reported
being bothered at all by any of the Parkinsonism/neurology, dementia and depression symptoms,
respectively. The farmers who had incident while using pesticide had 4-folds increase (OR=4.48;
95%CI:1.46, 10.94) of having bothered at all of Parkinsonism/neurology symptoms. There was atrend towards significance for having an incident while using pesticide with an OR of 3.06 (95%CI:
0.92, 10.18) and dementia symptoms. There was no significant association between depression
symptoms and pesticide exposure.
CONCLUSIONS:This study found that the farmers who reported being bothered at all for
Parkinsonism/neurology and depression but not dementia symptoms were more likely to have had an
incident while handling pesticides. Given the potential effect resulting from pesticide exposure, further
toxicologic and epidemiologic research is required to confirm these findings and assess the impact on
public health.

Keywords: Pesticide, exposure assessment, neuropsychiatric disorder, chronic exposureFP-241[Air pollution » Particulate matter]

Emission characteristics of condensable andfiltration PM2.5 from coal-power and steel
plantsChien Cheng Jung1, Charles C. K. Chou2, Yi Tang Huang2, Kai Hsien Chi3, Chung Te Lee4, Bing Hil
Xie5, Shuenn Chin Chang5, Chih-wei Chang5
1Department of Public Health, China Medical University, Taichung city, Taiwan
2Research Center for Environmental Changes, Academia Sinica, Taipei city, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei city, Taiwan
4Graduate Institute of Environmental Engineering, National Central University, Taoyuan city, Taiwan
5Environmental Protection Administration, Taipei city, Taiwan

BACKGROUND AND AIM:Receptor models are often used to investigate the source of outdoor PM2.5
according to chemical profiles from emission sources for reducing PM2.5 exposure. Stationary sources
are important contributors to PM2.5, most studies analyzed chemical profiles in filterable particulatematter (FPM) samples to assess sources of PM2.5. However, an increasing number of studies foundthat condensable particulate matter (CPM) concentrations from stationary sources are much higher
than that of FPM. A few studies analyzed chemical profiles in CPM for source identification.
METHOD:In this study, we used Taiwan’s reference methods to collect FPM and CPM samples fromstacks of two major emission sources (coal-power and steel plants) in Taiwan, for chemical profile
analyses and comparison.
RESULTS:Our data showed that CPM concentrations were much higher than that of FPM in coal-power
plant and steel plant by 42 and 12 times, respectively. There were higher ion concentrations in CPM inthese two sources, which accounted for 92-96%, the predominant ions were sulfate and ammonia.
The results reflected that secondary aerosol formation is not the only the source of PM2.5. The metal
concentrations in FPM and CPM, which accounted for 33-37% and 1-4%, respectively. The major
metals were Al, Fe, Mg, and Ca in FPM from coal-power plant, Al, Fe, Na, K, Ca, and Zn in CPM. The
corresponding results for steel plant were Fe, Na, Mg, K, Ca, and Pb in FPM, Al, Na, Ca, and Zn in
CPM. The organic acids, phthalates, and polycyclic aromatic hydrocarbons (PAHs)) concentrations
were significantly higher in CPM, the major species were oxalic acid, phthalic acid, Di(2ethylhexyl)phthalate, fluoranthene, and pyrene, which means that we only analyze chemical profiles in
FPM will influence the accuracy of source identification.
CONCLUSIONS:In summary, this study suggests that chemical profile analyses in CPM is necessary to
improve the identification accuracy.

Keywords: PM2.5, source identification, FPM, CPM

FP-242[One health » Virology]

Surveillance of zoonotic infectious diseases inwildlife, the advance of Taiwanese rabies
surveillance based on WOAH twinning projectfor rabies
Ai Ping Hsu1, Yu Chia Chang1, Ching Hsun Cheng2, Chung Ching Lin2, Chun Hsien Tseng1, Yu Hua
Shih1, Shu Chia Hu1, Emmanuelle Robardet3, Florence Cliquet3, Chien Yuan Huang1, Chwei Jang
Chiou2, Wen Jane Tu4
1Animal Health Research Institute, Council of Agriculture, New Taipei City, Taiwan
2Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Taipei, Taiwan
3WOAH/WHO/EU Laboratory for Rabies and Wildlife, French Agency for Food, Environmental andOccupational Health & Safety, Anses, Nancy, France
4Council of Agriculture, Taipei, Taiwan

BACKGROUND AND AIM:In order to upgrade Taiwanese rabies management with all-round
improvements, with the special focus on zoonotic infectious diseases in wildlife, the WOAH twinning
project for rabies between Anses-Nancy (Nancy WOAH/WHO/EU Laboratory for Rabies and Wildlife,
France) and AHRI (Animal Health Research Institute, Taiwan) was signed in 2018. The implementationof this project fully demonstrated both the One Health and solidarity of Taiwan veterinary service
system.
METHOD:This project was designed to reach ultimate goals of improving laboratory quality system forrabies diagnosis at AHRI, enhancing the Taiwanese rabies veterinary service system through education
activities, and providing proficiency testing service for rabies diagnosis in Asian region.
RESULTS:After the implementation of this project, the diversity of wildlife specimens for input to
Taiwanese rabies surveillance system was increased, and in addition, rabies in yellow-throated marten
and new bat lyssaviruses were discovered as well. Moreover, to provide the sound rabies laboratory
diagnosis as the staunch backing of Taiwan rabies surveillance system, AHRI established the quality
management for rabies laboratory work based on ISO 17025, and successfully launched proficiency
testing activity for rabies diagnosis in Asia with a total of 11 participating laboratories from 7
countries.
CONCLUSIONS:Through the implementation of this project, AHRI deeply experienced expertise
construction, unity of Taiwan, the cooperation of regional network, and the improvement of Taiwan
rabies surveillance system.

Keywords: Surveillance of zoonotic infectious diseases, wildlife diseases, rabies, WOAH twinning
project

FP-243[One health » Vectors and vector-borne diseases]

Association between environmental factors anddengue incidence in the Lao People’s
Democratic Republic: a nationwide time-series
study
Masumi Sugeno1, Erin C Kawazu2, Hyun Kim3, Virasack Banouvong4, Nazife Pehlivan5, Daniel
Gilfillan6, Ho Kim5, Yoonhee Kim1
1Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo,

Tokyo, Japan
2Institute for Global Environmental Strategies, Hayama, Japan
3School of Public Health, University of Minnesota Twin Cities, Minneapolis, US
4Lao PDR Centre for Malariology, Parasitology and Entomology, Vientiane Capital, Lao People's

Democratic Republic
5Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
6Fenner School of Environment and Society, The Australian National University, Canberra, Australian

Capital Territory, Australia

BACKGROUND AND AIM:Dengue fever is a global public health concern. Previous studies have shownthat meteorological factors influence dengue transmission; however, evidence for weather-dengue
linkages is lacking in the Lao People’s Democratic Republic (Lao PDR). We aimed to assess theassociation between meteorological factors (i.e., temperature and rainfall) and dengue incidence andexamine whether this association differed by altitude in Lao PDR.
METHOD:We used weekly dengue incidence and meteorological data across 18 subnational
jurisdictions (17 provinces and the capital city of Vientiane) in Lao PDR from 2015 to 2019. A twostage distributed lag nonlinear model with a quasi-Poisson distribution was used to account for
nonlinear and delayed associations between dengue incidence and meteorological variables, adjusting
for long-term time trends and autocorrelation. Moreover, we conducted a meta-regression analysis byincorporating the area of low and high altitudes for health care facilities.
RESULTS:There were 55,561 dengue cases reported in the Lao PDR from 2015 to 2019. In general,
the risk of dengue increased with increasing weekly mean temperature. The cumulative relative risk
(RR) for the 90th percentile of temperature over 22 weeks was estimated at 4.21 (95% CI = 2.008.84), relative to the 25th percentile. We observed a bell shape relationship between rainfall anddengue risk. The cumulative RR for the weekly total rainfall over 12 weeks peaked at 82 mm (RR =1.76, 95% CI = 0.91-3.40) relative to no rain. We observed a protective effect of heavy rain
exceeding 200 mm. We found no effect modification of altitude on the associations.
CONCLUSIONS:We found a lagged nonlinear relationship between meteorological factors and dengue
incidence in Lao PDR. The association found in this study may help to develop climate-informed early
warning systems and provide insights into improving vector control in the country.

Keywords: climate, temperature, risk assessment, infectious diseases

FP-244[Birth and pregnancy outcomes » Pregnancy outcomes]

Prenatal exposure to per- and polyfluoroalkyl
substances and adverse pregnancy outcomes
Ram Chandra Siwakoti1, Amber Cathey1, Wei Hao1, David E Cantonwine2, Thomas F Mcelrath2,
Bhramar Mukherjee1, John D Meeker1
1University of Michigan, School of Public Health, Ann Arbor, Michigan 48105
2Brigham and Women's Hospital, Boston, Massachusetts, 02115

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) are a group of ubiquitoussynthetic chemicals widely used in consumer and industrial products. Some studies have linked
prenatal PFAS exposures to adverse pregnancy-related outcomes (APROs) such as preterm birth (PTB)
and low birthweight (LBW), but the evidence remains limited and inconsistent. This study aimed to
examine associations between PFAS and APROs: overall PTB, placental PTB (pPTB), spontaneous PTB(sPTB), BW Z-score (BWZ), small for gestational age (SGA), and large for gestational age (LGA).
METHOD:Concentrations of eight PFAS congeners were measured in early pregnancy plasma samples(median GA = 9.9 week) collected from 478 pregnant women (122 PTB cases; 356 controls) enrolled
in the LIFECODES study, a longitudinal birth cohort based in Brigham and Women's Hospital in Boston,
MA. Logistic regression was used to assess individual PFAS-outcome associations, while Bayesian
Kernel Machine Regression (BKMR) was used to evaluate the joint effects of all PFAS congeners.
RESULTS:In adjusted models, an interquartile range (IQR) increase in concentrations ofperfluorononanoic acid (PFNA) (OR = 1.63, 95% CI: 1.07-2.5) and perfluorodecanoic acid (PFDA) (OR= 1.6, 95% CI: 1.01-2.55) were associated with increased odds of pPTB, with stronger associations
observed in males. Associations between PFAS and overall PTB, sPTB, BW, and SGA were mostly null.
However, positive associations were observed between some PFAS (PFDA and perfluorooctanoic acid)and LGA in females only; and Perfluoroundecanoic acid and LGA in males only. The BKMR analysis
confirmed the findings from the logistic regression models and selected PFNA as the most important
PFAS congener responsible for observed associations with pPTB.
CONCLUSIONS:Prenatal exposure to PFAS was associated with higher odds of some APROs, with fetal
sex modifying the associations. Future studies should strongly consider examining PTB subtypes andsex-specific effects of PFAS in relation to pregnancy outcomes.

Keywords: perfluoroalkyl substances, placental, preterm birth, birthweightFP-245[Chemical exposures » Mixtures]

Association among endocrine-disrupting
chemicals, metabolic syndrome, and nonalcoholic fatty liver disease in adolescents andadultsBohyun Park1, Chung Ho Kim2, Byungmi Kim3, Hyun Jin Oh4, Bomi Park2
1National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
2Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of

Korea
3National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea; National

Cancer Center Graduate School of Cancer Science and Policy, Republic of Korea
4Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and

Detection, National Cancer Center, Goyang, Republic of Korea.

BACKGROUND AND AIM:Metabolic syndrome (MetS) and Non-Alcoholic Fatty liver Disease (NAFLD)
are common and increasing in prevalence worldwide. MetS is more common in patients with NAFLD
than in those without, and NAFLD has shown to be a risk factors for cardiovascular disease and MetS.
This study explored the association and mediation effects among endocrine-disrupting chemicals(EDC) mixtures, NAFLD, and MetS in both adolescents and adults.
METHOD:A total of 2,942 adults and 803 adolescents participated in the Korean National
Environmental Health Survey 2018 to 2020 were included in this study. Urinary concentrations ofeight phthalate metabolites, three phenols, one antibacterial, four parabens, four polycyclic aromatichydrocarbons, and one pyrethroid pesticides metabolite and blood concentrations of five perfluorinatedcompounds were quantified. We used hepatic steatosis index (HSI) to define NAFLD and those with
HSI>36 were thought to have NAFLD. Continuous metabolic syndrome score (cMetS) was calculated
to evaluate MetS in adolescents. We assessed the mixed effects of EDCs on the risk of MetS or NAFLD
using weighted quantile sum (WQS) regression. In addition, we conducted causal mediation analysis(CMA) to explore the mediation effects of NAFLD to the association between EDC mixture and the riskof MetS. All estimates were adjusted for age, sex, education level, physical activity, drinking, smoking,and involuntary smoking.
RESULTS:High WQS scores had increased risk of NAFLD and MetS in both adolescents (OR=1.37(1.01-1.85), β=0.51 (0.05-0.97)) and adults (OR=1.30 (1.11-1.52), OR=1.28 (1.09-1.51)). NAFLD
significantly mediated 40% (p=0.003) and 32% (p< 0.001) association between WQS score and MetS
in adolescents and adults respectively.
CONCLUSIONS:The findings of this study suggest that exposure to EDC mixtures is associated withthe existence of MetS and NAFLD in both adolescents and adults. In addition, EDC mixtures may
increase the risk of MetS through NAFLD.

Keywords: endocrine-disrupting chemicals, Non-Alcoholic Fatty liver Disease, metabolic syndrome,
weighted quantile sum regression, causal mediation analysis

FP-246[Climate » Temperature]

Intersectional inequalities in temperaturerelated mortality risk in South Korea
Sera Kim1, Jong Tae Lee2
1Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate

School of Korea University, Seoul, South Korea
2Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate

School of Korea University, Seoul, South Korea; School of Health Policy and Management, College of
Health Sciences, Korea University, Seoul, South Korea

BACKGROUND AND AIM:Previous studies have found spatial heterogeneity in temperature-related
mortality across regions. However, despite the intersectional experience of multiple disadvantages atregional-level, most studies have focused on a single factor contributing to spatial variations inmortality risks. This study explored spatial variations in heat- and cold-related mortality in South
Korea and examined interactions among multiple regional-level susceptibility characteristics based on
the intersectionality framework.
METHOD:We used daily meteorological and non-accidental mortality data at the district level in sevenmetropolitan cities in South Korea, 2011-2020. In the first stage, we used a quasi-Poisson regression
model with a distributed lag non-linear model for each district over 21 days of lag. We then fitted amultivariate meta-regression model and calculated the number of deaths attributable to heat and coldfrom the best linear unbiased prediction of the temperature-mortality association for each district. In
the second stage, using district-specific deaths attributable to heat and cold per 10,000 population as
outcomes, we used a multilevel model that nested 74 districts within 8 intersectional strata combining
categories of the level of socioeconomic deprivation, the proportion of persons with disabilities (PwD),
and the prevalence of obesity to explore interactions of three dimensions of susceptibility.
RESULTS:The deaths attributable to cold per 10,000 population ranged from 14.0 for districts with low
deprivation, low proportion of PwD, and low prevalence of obesity to 28.8 for districts with highdeprivation, high proportion of PwD, and high prevalence of obesity. We found evidence for elevatedhealth burdens associated with heat and cold in multiply disadvantaged districts. Although most of the
between-strata variation was explained by additive main effects, results showed meaningfulinteraction effects for the intersectional strata (adjusted VPC=4.5%).
CONCLUSIONS:The intersectionality framework can provide a detailed mapping of regional-level
inequalities in temperature-related health burdens and more accurately guide public health policies.

Keywords: Health inequalities, environmental epidemiology

FP-247[Air pollution » General]

Performance of a low-cost sensor (LCS) network
for long-term indoor and outdoor PM2.5
measurements at rural communities in Beijing,
China
Xiaoying Li1, Jill Baumgartner2, Christopher Barrington Leigh3, Collin Brehmer4, Sam Sam Harper2,
Brian Brian Robinson5, Guofeng Shen6, Talia Sternbach2, Shu Tao6, Xiang Zhang5, Yuanxun Zhang7,
Ellison Carter4
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal,

Quebec, Canada; Department of Civil and Environmental Engineering, Colorado State University, Fort
Collins, CO, USA
2Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social

Policy, McGill University, Montreal, Quebec, Canada.
3Institute for Health and Social Policy and Bieler School of Environment, McGill University, Montreal,

Quebec, Canada
4Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
5Department of Geography, McGill University, Montreal, Quebec, Canada
6Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, College of

Urban and Environmental Sciences, Peking University, Beijing, China
7College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China;

CAS Center for Excellence in Regional Atmospheric Environment, Chinese Academy of Sciences,
Xiamen, China

BACKGROUND AND AIM:Low-cost sensors have been widely developed and applied globally tomeasure high temporal and spatial resolution air pollution data for exposure, epidemiology, andenvironmental justice studies. However, obtaining accurate and precise measures from low-cost
sensors is a challenge, especially in developing countries and low-income areas, where high-caliber
environmental stations are not available to provide reference data for sensor calibration.
METHOD:We set up a low-cost sensor network to measure indoor and outdoor PM2.5 for four
consecutive winters in 50 villages in rural Beijing, China. In each village, two sensors were deployed indifferent locations to measure outdoor PM2.5, and six were randomly deployed in six homes for indoor
measurements. Before and after each field campaign, all low-cost sensors were co-located with
Federal Equivalent Method (FEM) instruments for 7-10 days to evaluate the performance of sensors.
We co-located filter-based PM2.5 samplers with both indoor and outdoor sensors in the field for later
calibration.
RESULTS:Sensor performance was consistently good over the four years of deployment. The
Intraclass Correlation Coefficients (ICCs) of our low-cost sensors relative to FEM PM2.5 were larger
than 0.75 with tight confidence, indicating our low-cost sensors performed well in catching hourly
variation in ambient PM2.5. Including meteorological information in the linear regression between
filter-based PM2.5 and time-weighted average sensor-based PM2.5 concentration did not improve theexplanation of data. Calibration factors for indoor and outdoor PM2.5 were different, and varied from
1.11 to 1.14, and from 0.98 to 0.94, respectively, due to the different meteorology and emission
sources of indoor and outdoor environments.

CONCLUSIONS:It is essential to conduct careful calibration in the field, and our low-cost sensors
performed well over multiple years. Due to the different meteorology and emission sources of indoor
and outdoor environments, indoor and outdoor sensors should be calibrated separately.

Keywords: Low-cost sensor, indoor PM2.5, calibration, rural community, long-termFP-248[Neurologic and mental health outcomes » Mental health outcomes]

Long-term effects of indirect and direct
exposure to oil spills on post-traumatic stressdisorder: the Hebei Spirit Oil Spill Cohort
Lita Kim1, Yun Hee Choi1, Da An Hu2, Kyoung Whan Moon3, Min Sung Kang4, Yong Jin Lee5
1Department of Health and Safety Convergence Science, Korea University, Republic of Korea; Instituteof Health Sciences, Korea University, Republic of Korea
2Institute of Health Sciences, Korea University, Republic of Korea
3Department of Health and Safety Convergence Science, Korea University, Republic of Korea; Instituteof Health Sciences, Korea University, Republic of Korea; Department of Health and Environmental
Science, Korea University, Republic of Korea
4Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, Republic of Korea
5Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, Republic of Korea;

Environmental Health Center, Soonchunhyang University Cheonan Hospital, Republic of Korea

BACKGROUND AND AIM:Environmental disasters such as oil spills have been shown to increase theprevalence of post-traumatic stress disorder (PTSD) more in exposed communities than the natural
disasters. These effects may not immediately manifest and could take months or even years toappear. Additionally, subsequent negative experiences may continue to increase long-term mental
health risks. However, most of the previous studies were conducted only in the acute phase and useda single indirect exposure indicator. This study aimed to evaluate the long-term effects of PTSD,
considering both indirect and direct exposure to oil spill accidents.
METHOD:Using the 2009–2016 Hebei Spirit Oil Spill Cohort survey data for adults, we confirmed theeffect on PTSD by dividing the oil spill accident into indirect (n=7,771) and direct (n=660) exposure
indicators. Hazard ratio (HR) and a 95% confidence interval (CI) were estimated using the Cox
proportional hazards regression model, adjusted for gender, age, marital status, income level,
drinking, smoking, physical activity, BMI, education level, and comorbidities.
RESULTS:As the distance from the accident site increased, the adjusted HR (95% CI) for PTSD was
0.975 (0.96, 0.991), and as the clean-up work duration increased, the adjusted HR (95% CI) was
1.005 (1.003, 1.007). In addition, as the urinary level of 1-hydroxypyrene, a direct exposure
indicator, increased, the adjusted HR (95% CI) was 1.585 (1.051, 2.389).
CONCLUSIONS:In conclusion, exposure to oil spills increases the risk of PTSD in the long term.
Although the exact mechanisms of these effects have yet to be precisely elucidated, we suggest that
long-term effects on oil spills may be attributable to direct oil spill exposure. A comprehensive
understanding of the long-term effects of exposure to future environmental disasters on mental healthis needed, and disaster response and management strategies should be designed to support
community mental health.

Keywords: Environmental disasters, Mental health, Oil spill exposure, Post-traumatic stress disorder.

FP-249[Methods » Environmental epidemiology]

The effectiveness of infection control strategies
in a workplace during COVID-19 pandemic
Tzu Hsuen Yuan1, Yi Ching Hsieh2, Chen Hsiang Hsu1, Chang Chuan Chan2
1Department of Health Welfare,University of Taipei,Taipei,Taiwan
2Institute of Enviromental and Occupational Health Sciences,National Taiwan University,Taipei,Taiwan

BACKGROUND AND AIM:This study investigated the effectiveness of screening tests performed in aworkplace infection control intervention. By evaluating whether frequent screening tests can be a
successful occupational hygiene measure that maintains maximum productivity and infection control
for occupational settings during the COVID-19 pandemic.
METHOD:This study has used data obtained from a factory in Vietnam from October 25 to December
22, 2021. Vaccination records, diagnosis and recovered data of workers has been used into extended
Susceptible-Infected-Quarantined-Recovered (SIQR) models. By concerning different prevalence, R0value and different screening frequency were simulated. The cost-effective analysis conducted toevaluate the costs and effectiveness of screening test strategies in the factory by Average CostEffectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER).
RESULTS:The transmission rates were calculated in different screening frequencies and simulated by
SIQR model. The results of the screening frequencies of five and seven times a week would not cause
any infection in the factory. The frequency of every three days resulted in 0.1% of workers being
infected, and the frequency of once-a-week results in 1% of the workers being infected. When
compared to higher prevalence rate, the lower prevalence rate with high screening frequency could
have more effective infection control in this factory. ACER results showed that the lowest cost is oncea-week screening test. ICER results showed the frequency of five times a week maintained the 100%
production capacity and was less expensive when compared to the seven times a week screening test.
CONCLUSIONS:To implement a high-frequency screening test strategy in a factory with low COVID-19
prevalence initially could effectively control COVID-19 infections, and it might maintain the production
capacity with cost saving.

Keywords: COVID-19,occupational hygiene,screening test,compartmental models,agent-basedmodels.

FP-250[Air pollution » Short-term exposure]

A study on the association between heat waves
and acute kidney injury (AKI) due to climatechangeYoungrin Kwag1, Jieun Min2, Eun Hee Ha3, Whanhee Lee5, Min Ho Kim4, Duk Hee Kang1
1Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, SouthKorea
2Department of Environmental Medicine, School of Medicine, Graduate Program in System Health

Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
3Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans

University
4Ewha Medical Data Organization, Seoul, South Korea
5School of Biomedical Converegence Engineering, Pusan National University

BACKGROUND AND AIM:Although a link has been reported between heatwaves caused by climatechange and kidney health, researches on heat waves and kidney disease are scarce. Thus, we aim toinvestigate the association between heat wave and hospital visits for acute kidney injury (AKI).
METHOD:Daily time-series data on 17,730 outpatients who visited hospitals with AKI were obtained
from the data of the Korea National Health Insurance Corporation during 2002–2019. Heatwave wasdefined as the occurrence of daily mean temperature above the 75th (moderate heatwave) and 99th
(extreme heatwave) percentile of the temperature distribution for two or more consecutive days. We
estimated the heatwave-related risks of hospital visits for AKI using a time-series regression with a
distributed lag linear model. The association was also examined by age, sex, path to hospital visit (viaemergency room or not), and disease history.
RESULTS:Extreme heatwave was associated with increased risk of hospital visits for AKI with RR of
1.87 (95% CI: 1.68, 2.08) and the risk was more prominent in male than female. Moreover, theassociation between hospital visits for AKI and heatwave was more evident in the case of hospital
visits through emergency room than them not through emergency room (Wald p-value < 0.05).
CONCLUSIONS:Among kidney diseases, AKI disease requires attention because the risk may increasedepending on high temperature, temperature exposure duration.

Keywords: Heat, Heatwave, Acute kidney injury (AKI)FP-251[Methods » Causal inference]

Evaluation of confounding for occupationalradiation exposure and cancer incidence amongradiologic technologists
Won Jin Lee1, Ye Jin Bang1, Young Min Kim2
1Korea University College of Medicine
2Kyungpook National University

BACKGROUND AND AIM:Confounding is essential in observational epidemiology, particularly in lowdose radiation studies. We examined the impact of potential confounders on cancer risk fromoccupational radiation exposure and the magnitude and direction of these potential confounding
estimates among radiologic technologists.
METHOD:The study included 4,308 radiologic technologists who participated in the questionnaire
survey study that investigated non-radiation factors and 19,408 radiation technologists from theregistration-based cohort study enrolled in the National Dose Registry that obtained non-radiation
factors by multiple imputations. We quantified the confounding effects of cancer risks on radiation
exposure based on a linear dose-response model. To determine whether a given risk factor caused
confounding on the estimate of the baseline model, we compared the estimated measure of theassociation before and after adjusting for non-radiation factors.
RESULTS:In the questionnaire survey-based cohort, the ERR per 100 mSv of the baseline model forthe association between radiation dose and cancer risk was 0.58 (95% CI: -0.91, 2.07, 10-years
lagged) after adjusting for sex, attained age, birth year, and years of employment duration. Directly
adjusted for confounding by smoking (ERR/100mSv=0.58), alcohol intake (0.57), BMI (0.64), exercise(0.55), sleep (0.62), shift work (0.53), personal medical examination (0.52), and past medical history(0.70). In the registration-based cohort, the baseline ERR per 100mSv estimate was 0.12 (95% CI: 0.34, 0.57). After indirectly adjusting for the imputed non-radiation factors by smoking(ERR/100mSv=0.13), alcohol intake (0.12), BMI (0.11), exercise (0.12), sleep (0.13), and shift work
(0.13), there was no significant difference compared to the estimation of the baseline model.
CONCLUSIONS:We found little evidence of factors with statistically significant confounding effects on
risk per unit dose of cancer between directly and indirectly confounder-adjusted effects. However,cautious interpretation is needed due to the possibility that unmeasured confounders or insufficiently
measured confounding factors cannot be excluded.

Keywords: ionizing radiation, causation, occupation, cohort

FP-252[Air pollution » Particulate matter]

Assessing the Impact of Household Energy
Transition on Winter Indoor Air Quality in Rural
Beijing, China: Field Evidence and Implications
Xiaoying Li1, Xiang Zhang2, Jill Baumgartner3, Christopher Barrington Leigh4, Collin Brehmer5, Sam
Harper3, Brian Robinson2, Guofeng Guofeng Shen6, Talia Sternbach3, Shu Tao6, Yuanxun Zhang7,
Ellison Carter5
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal,

Quebec, Canada; Department of Civil and Environmental Engineering, Colorado State University, Fort
Collins, CO, USA
2Department of Geography, McGill University, Montreal, Quebec, Canada
3Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social

Policy, McGill University, Montreal, Quebec, Canada
4Institute for Health and Social Policy and Bieler School of Environment, McGill University, Montreal,

Quebec, Canada
5Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
6Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, College of

Urban and Environmental Sciences, Peking University, Beijing, China
7College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China;

CAS Center for Excellence in Regional Atmospheric Environment, Chinese Academy of Sciences,
Xiamen, China

BACKGROUND AND AIM:Air pollution has been identified as one of the major threats to environmental
safety and human health. To alleviate the contributions of residential coal combustion to ambient air
pollution, China has pursued household energy transitions to replace coal stoves with clean energy forspace heating. Studies that assess the impacts of household energy transition programs are scarce,
especially those that are based on large-scale field measurements.
METHOD:We recruited 50 villages from four districts in Beijing, and randomly selected 6 households ineach village to monitor indoor PM2.5 in winter, using both sensor-based measurements (over several
months) and filter-based measurements (24-h). Community-level outdoor PM2.5 was measured
concurrently. In the first year (Year-1), 10 of 50 villages were involved in the energy transition
program and, therefore, did not use coal. Ten more were involved in the second year (Year-2). We
used a two-way fixed effects difference-in-difference (DID) analysis to assess the impact of the energy
program on indoor air quality.
RESULTS:Geometric mean [95% Confidence Interval] indoor PM2.5 levels in the recruited homes
decreased in Year-2 (to 47 [42, 53] µg/m3) compared to Year-1 (73 [66, 80] µg/m3). We observed
the largest reduction in indoor PM2.5 [mean (SD): 55 (48) µg/m3] in the ten villages which weretreated in Year-2. By our analysis, the energy transition program contributed 37.5 (SD: 13.0) μg/m3
to the reduction of indoor PM2.5 in homes in treated villages.
CONCLUSIONS:The household energy transition program in Beijing, China contributed partially to the
reduction in indoor PM2.5 levels. One of the key goals for the future is to promote learning andongoing progress in such projects, in order to extend their benefits to other regions in China, and evenglobally, to achieve further improvements in air pollution.

Keywords: Indoor air quality, household energy transition, coal stove, clean energy, Difference-indifference (DID)FP-253[Air pollution » General]Air pollution and cognitive impairment among
the Chinese elderly population: A Nationwide
cohort study
Qingyang Zhu1, Yuebin Lyu2, Keyong Huang3, Jinhui Zhou2, Wenhao Wang1, Kyle Steenland1,
Howard H Chang4, Stefanie Ebelt1, Xiaoming Shi2, Yang Liu1
1Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA, USA
2China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental

Health, Chinese Center for Disease Control and Prevention, Beijing, China
3Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital,

National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China.
4Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University,

Atlanta, GA, USA

BACKGROUND AND AIM:Cognitive decline and dementia have long been recognized as growing publichealth threats, especially in an aging society. Studies have found that air pollution is a potential risk
factor for dementia, but the association between air pollution and cognitive impairment has not been
fully understood. This study aimed to evaluate the association between three major air pollutants (i.e.,
PM2.5, O3, and NO2) and cognitive impairment among the Chinese elderly population.
METHOD:Study participants were selected from the Chinese Longitudinal Health Longevity Survey(CLHLS) after 2005. We define cognitive impairment as a Chinese Mini-Mental-State Exam (CMMSE)
score lower than 24. Yearly mean exposure to PM2.5, NO2, and warm-season (April-September)average MDA8 O3 were evaluated by assigning three high-performance satellite remote sensing
models to the participants’ residential addresses. The association between air pollution and cognitive
impairment was evaluated with a logistic regression model adjusted for time since enrollment,sociodemographic characteristics as well as chronic conditions like high blood pressure, heart disease,and diabetes.
RESULTS:A total of 3,887 participants were enrolled in this study, and 931 (24%) developed cognitive
impairment during follow-up visits. In single-pollutant models, we found that per IQR increase inwarm-season O3 (OR per 20.98 µg/m3 = 1.011 [1.000, 1.022], p = 0.033), yearly average PM2.5(OR per 18.34 µg/m3 = 1.009 [1.001,1.016], p = 0.034), and NO2 (OR per 18.20 µg/m3 = 1.019[1.007, 1.031], p = 0.001) were positively associated with cognitive impairment. Only NO2 remained
positively associated with cognitive impairment (OR per 10 µg/m3 = 1.018 [1.002, 1.033], p = 0.033)
in a multi-pollutant model with PM2.5 and O3.
CONCLUSIONS:Our results suggested that cognitive impairment could be positively linked to PM2.5,
O3, and NO2. O3 is possibly more hazardous in the warm season (April-September).

Keywords: Air pollution, cognitive impairment, CLHLS, concentration-response relationshipFP-254[Built environment » General]

Source and infiltration of carcinogenic metals inindoor air in an urban area
Chien Cheng Jung, Yang Hsueh Chen, Kuan Yuan Chen
Department of Public Health, China Medical University, Taichung city, Taiwan

BACKGROUND AND AIM:Arsenic (As) and cadmium (Cd) are classified as carcinogenic compounds tohuman. People spend over 80% of their time indoors. However, a few studies investigated the sourcesof As and Cd in indoor PM2.5. The objective of this study was to investigate the source of As and Cd inindoor PM2.5 in households through lead (Pb) isotope ratios, and to calculate the infiltration factors(Finf).
METHOD:Indoor and outdoor PM2.5 simultaneously were collected for As, Cd, and Pb isotope ratios
analyses from residential buildings in 2021 to 2022 in an urban area. Pb isotope ratios were used toassess the possible source of As and Cd based on the ratios from pollution sources. This study also
calculated the Finf values of As and Cd and further estimated the contribution of indoor- and outdoorgenerated As and Cd to indoor air.
RESULTS:The average concentrations of As and Cd in indoor air were 0.87 ± 0.69 ng/m3 and 0.19 ±0.15 ng/m3, respectively; the corresponding values for outdoor air were 1.44 ± 0.80 ng/m3 and 0.33
± 0.19 ng/m3, respectively. The 208Pb/207Pb ratio indicated that traffic-related emission was animportant source of indoor and outdoor As and Cd. However, significant correlations between indoor
208Pb/207Pb values and As and Cd concentrations in indoor air were found only in households withventilation rate >1.5 h-1. The Finf values of As and Cd were 0.60 ± 0.37 and 0.58 ± 0.39,
respectively. The contribution of outdoor-generated As and Cd to indoor air pollution wasapproximately 85%.
CONCLUSIONS:These findings suggest that 208Pb/207Pb is a useful indicator for the identification of
the source of indoor and outdoor As and Cd; however, ventilation conditions influence the applicabilityof this approach on source identification in indoor air. The traffic-related emission outdoors was
identified as a major source of As and Cd.

Keywords: indoor air, PM2.5, metal, isotope, infiltration factor

FP-255[Chemical exposures » Heavy metals]

Assessment of DNA Adducts Related to
Oxidative Stress in Residents of Heavy MetalContaminated Areas
Bo Ri Kim1, Sang-Yong Eom2, Young-Seoub Hong3, Yong-Dae Kim2, Heon Kim2
1Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju,

Republic of Korea
2Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju,

Republic of Korea; Chungbuk Environmental Health Center, Chungbuk University Hospital, Cheongju,
Republic of Korea
3Department of Preventive Medicine, College of Medicine, Dong-A University, Pusan, Republic of Korea

BACKGROUND AND AIM:Heavy metals are known to cause oxidative stress in the body, leading to theformation of DNA adducts. This study aimed to develop an analysis method for DNA adducts related tooxidative stress and assess the level of DNA adducts in residents of heavy metal-contaminated areas.
METHOD:Quantification of eight DNA adducts related to oxidative stress was performed using Liquid
Chromatography-Tandem Mass Spectrometry (LC-MS/MS) in Multiple Reaction Monitoring mode. The
analytical method was verified for linearity, precision, recovery rate, and matrix effect using a
synthetic urine standard calibration curve. Ten non-smoker residents of heavy metal-contaminatedareas who had lived there for more than 30 years were included here. Urine was collected from thesubjects for DNA adducts analysis.
RESULTS:The study demonstrated excellent linearity (R² >0.99), precision (RSD <5 %), andrecoveries (94.6 – 125.9 %) for the eight oxidative stress-related DNA adducts, with the matrix effectbeing less than 15 %. 7-Methyl-guanine and 8-Hydroxy-2-deoxyguanosine were detected in 100 % of
the urine samples collected from residents of heavy metal-contaminated areas. The average values forthese markers were 0.33 µg/mL and 2.01 ng/mL, respectively. The detection rate for the remaining
six DNA adducts was less than 50 %.
CONCLUSIONS:This study established an LC-MS/MS method for the quantification of eight DNA
adducts related to oxidative stress in urine. The detection of 7-Methyl-guanine and 8-Hydroxy-2deoxyguanosine in all samples suggests that heavy metal exposure can cause oxidative stress and
DNA damage. This preliminary study underscores the potential use of DNA adducts as biomarkers infuture environmental epidemiological studies.

Keywords: DNA adducts, heavy metal, oxidative stress, biomarker

FP-256[Built environment » Green space]

Exposure to residential greenness and allergic
rhinitis in children
Jieun Lee1, Dong Wook Lee2, Yun Chul Hong3
1Department of Human Systems Medicine, College of Medicine, Seoul National University, Seoul

03080, South Korea
2Department of Occupational and Environmnetal Health, Inha University Hospital, Incheon, 22332,

South Korea.
3Department of Human Systems Medicine, College of Medicine, Seoul National University, Seoul

03080, South Korea; Institute of Environmental Medicine, Seoul National University Medical ResearchCenter, Seoul, 03080, South Korea

BACKGROUND AND AIM:Allergic rhinitis (AR) is a disease that frequently occurs in childhood, such as
atopy and asthma, and the prevalence rate is increasing worldwide. Various studies are being
conducted to find the cause, and explanations of air pollution, climate change, and environmental
pollution are dominant. Young children have relatively many outdoor activities and are inevitably
exposed to green areas, so further research on this seems necessary. Currently, research on therelationship between green space and AR are not inconsistent. This study attempts to examine therelationship by adding air pollution as a mediating factor.
METHOD:We used a data that the Environment and Development of Children (EDC) cohort study in
525 children at age 8. AR data was collected using the ISSAC questionnaire, and 243 respondents who
answered "YES" were classified as case group, and 283 respondents who answered "NO" wereclassified as control group. The satellite-derived land cover map from Environmental Geographic
Information Service in South Korea was used to estimate the residential exposure to greenness. We
controlled the covariates and used a logistic regression model to estimate the association between
green exposure and AR. Mediation analysis was conducted by SPSS PROCESS macro.
RESULTS:We found that exposure to built greenness in 50m buffer was associated with AR in a crude
model [OR (95% CI) = 1.014(1.00-1.03)]. In fully adjusted models, exposure to total greenness in
50m buffer [OR (95% CI) = 1.015(1.00-1.03)] and built greenness in 50m buffer [OR (95% CI) =1.020(1.00-1.04)] was also associated with AR.
CONCLUSIONS:The results of the study showed that higher exposure to green area had an adverse
effect on AR. Although health benefits of greenness were shown in many studies, we also need toconsider an harmful effect on AR, possibly through the influence of weed and tree pollen.

Keywords: Residential greenness, Allergic rhinitis, Children, Air pollution

MODERATED POSTERS

MP-001[Climate » Temperature]

Development of spatiotemporal high-resolution
temperature data for São Paulo, Brazil; avaluable resource for epidemiologists
Aina Roca Barcelo1, Monica Pirani1, Rochelle Schneider2, Frédéric B. Piel3, Adelaide C. Nardocci4,
Paolo Vineis1, Daniela Fecht5
1MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of

Public Health, Imperial College London, Norfolk Place, W2 1PG, London, United Kingdom
2Φ-lab, European Space Agency, Frascati, 00044, Italy; Forecast Department, European Centre for

Medium-Range Weather Forecast, Reading, RG2 9AX, United Kingdom
3MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of

Public Health, Imperial College London, Norfolk Place, W2 1PG, London, United Kingdom; National
Institute for Health Research Health Protection Research Unit in Environmental Exposures and Health,
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London,
Norfolk Place, W2 1PG, London, United Kingdom
4Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo,

Brazil5MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of

Public Health, Imperial College London, Norfolk Place, W2 1PG, London, United Kingdom; National
Institute for Health Research Health Protection Research Unit on Chemical and Radiation Threats andHazards, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College
London, Norfolk Place, W2 1PG, London, United Kingdom

BACKGROUND AND AIM:Most studies investigating temperature-related health effects in cities rely on
temperature recordings from few meteorological stations or models at coarse spatial resolution.
Overlooking the spatial variability of temperature in cities may lead to biased epidemiological findings.
Here, we propose a machine learning algorithm to predict daily mean temperature at 500m-squared inSão Paulo between 2015 and 2019, and we compare it to traditional multilinear regression
approaches.
METHOD:We built a random forest (RF) model combining daily mean temperature from 44 stations
with satellite data and satellite-based products. A gap-filling approach was performed to recover the
missing values from satellite products before including them into the RF model. The most relevant
features were identified through a forward feature selection and the hyper-parameters were tuned
using a grid search technique. The model was validated using a 10-fold spatial cross-validation (CV)and an external hold-out dataset with 5 stations. Finally, we compared our RF algorithm against alinear model using the same features. The root mean squared error (RMSE) and R-squared were used
to compare their performance capability.
RESULTS:Based on feature selection, the final model included: land surface temperature, solar zenith
angle, black sky albedo, normalized difference vegetation index, day length, wind, and skin surface
temperature. Of all features, land surface temperature was the best predictor. The RF, with an Rsquared and RMSE of 0.88 and 1.26°C, respectively, outperformed the linear model (R-squared: 0.78
and RMSE: 1.72°C). Validation of the RF results with the hold-out dataset showed a performance of0.75 and 1.22°C for R-squared and RMSE, respectively. Overall,the RF model outperformed linear
model, probably as it better captures microclimates and complex associations.
CONCLUSIONS:Our model provides epidemiologists with data of high spatiotemporal resolution toinvestigate patterns in daily mean temperature exposure and associated health outcomes in São Pauloat an unmatched resolution.

Keywords: Modeling, exposure assesment, temperature variability, spatial statistics, big dataMP-002[Chemical exposures » Endocrine disrupting chemicals]

Determination of Bisphenols and Phthalate
Metabolites in Human Urine with Ultraperformance Liquid Chromatography/Tandem
Mass Spectrometry
Min Yuan Lai1, Tsung Ta Wu2, Mei Huei Chen2, Pau Chung Chen3, Chia Yang Chen4
1Institute of Food Safety and Health, College of Public Health, National Taiwan University, Taipei City,

Taiwan2Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei City, Taiwan
4Institute of Environmental and Occupational Health Sciences and Institute of Food Safety and Health,College of Public Health, National Taiwan University, Taipei City, Taiwan

BACKGROUND AND AIM:Bisphenols and phthalates can leach from products; humans can get exposedto them directly or indirectly, which may result in reproductive and developmental adverse healtheffects. This study evaluated human exposure by measuring bisphenols and phthalate metabolites inurine.
METHOD:150 urine samples were obtained from the 2019 National Nutrition and Health Survey in
Taiwan, aged 14 to 91. Six bisphenols and twelve phthalate metabolites were measured. Urine
samples were mixed with β-glucuronidase/arylsulfatase enzymes for 40-min hydrolysis at 37°C; after
adding acetonitrile, the samples were filtered through a Sirocco 96-well plate, and 20 µL of dimethyl
sulfoxide was added. The samples were concentrated to about 20 µL and were reconstituted withmethanol for the analysis with ultra-performance liquid chromatography coupled with tandem mass
spectrometry with isotope-dilution techniques. Analytes were separated on an Atlantis Premier BEH
C18 AX (50 × 2.1 mm, 1.7 µm) column with 10-min gradient elution.
RESULTS:The linear range of the calibration curves were between 0.5-500 ng/mL with a coefficient ofdetermination greater than 0.99. The matrix effect factors ranged from 42% to 94%, and theextraction efficiency ranged from 80% to 129%. The intra-day and inter-day quantitative biases andrelative standard deviations were mainly less than 20%. The positive rates of bisphenol A, bisphenol
S, and the metabolites of DEHP, DnBP, DiBP, DPHP, and DEHTP were higher than 90%. Levels inelderly people (> 65 years old) were significantly higher than those in adults below 65 years old.
CONCLUSIONS:The analytical method possesses good quantitative precision and accuracy indetermining six bisphenols and 12 phthalate metabolites in urine, facilitating future biomonitoring forhuman exposure assessment.

Keywords: Endocrine disrupting chemicals, Phthalates, Phenols, Exposure assessment-biomarkers of
exposure, Environmental epidemiology

MP-003[Methods » Environmental epidemiology]

Exposure measurement error correction in air
pollution epidemiology: Scale matters
Barbara K Butland1, Dimitris Evangelopoulos2, Evangelia Samoli3, Joel Schwartz4, Klea Katsouyanni5
1Population Health Research Institute, St George’s, University of London, London, UK
2Environmental Research Group, MRC Center for Environment and Health, Faculty of Medicine,

Imperial College London, UK & NIHR HPRU in Environmental Exposures and Health, Imperial College
London, UK
3Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University ofAthens, Medical School, Greece
4Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
5Environmental Research Group, MRC Center for Environment and Health, Faculty of Medicine,

Imperial College London, UK & Department of Hygiene, Epidemiology and Medical Statistics, National
and Kapodistrian University of Athens, Medical School, Greece

BACKGROUND AND AIM:In air pollution epidemiology it is common to use modelled or measured
ambient concentrations as a surrogate for people’s “true” exposure, either total personal or personalfrom outdoor sources. A problem in this approach is that even though these are measured in the sameunits, personal exposures tend to be much lower because individuals spend most of their time indoors.
These discrepancies inflate the resulting measurement error bias in epidemiological analyses. We usedsimulations to quantify these biases using two correction methods and a range of plausible scenarios.
METHOD:We simulated true and surrogate long-term ambient NO₂ concentrations for 10,000 subjects
using the latent variable mixed error model and assuming varying correlations and variance ratios
between the exposures. To introduce the different scales of measurements, true personal exposures toNO₂ from outdoor sources were calculated as 50% of the corresponding true ambient concentrations
and an all-cause mortality outcome was generated. Cox proportional hazards models produced naïve
estimates for surrogate exposures without scaling and corrected ones scaled by the mean ratio of true
personal versus ambient concentrations or reported per interquartile range (IQR) increase in thecorresponding exposures.
RESULTS:Mean percent bias in the unscaled health effect estimates was large and negative, ranging
from -48.8% to -93.6%. When no measurement error was assumed in the surrogate exposure, bothcorrection methods reduced mean percent bias from 50% to less than 3%. For scenarios withmeasurement error, bias was consistently smaller in magnitude when using IQR correction fordifferent scales rather than mean ratio correction.
CONCLUSIONS:Investigators should be aware of the additional bias in health effect estimates resulting
from using a surrogate exposure which is measured at a different scale compared to the true exposure(but with the same units) and apply a method to correct for this.

Keywords: Environmental epidemiology, long-term exposure, exposure measurement error,
measurement error correction, simulations

MP-004[Methods » Big data]

Construction of a geospatial data pipeline for
epidemiology: a case study of land use and road
network in South Korea
Goeun Jung, Won Kyung Kim, Dongook Son, Sun-Young Kim
Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, National
Cancer Center Korea

BACKGROUND AND AIM:Given the extended data availability of geospatial data along with improved
computational capability, the application to epidemiological research has gained considerable
attention. However, researchers may encounter challenges when handling geospatial data. Efforts toovercome these challenges require significant investments of time and resources as geospatial data
are continuously updated and need repetitive processing. The construction of a data pipeline that
automates data acquisition, processing, and calculation can minimize such efforts. Given our ultimate
goal of constructing a geospatial data pipeline including sociodemographic, physical, and built
environment characteristics for assessing the associations with mortality and morbidity in South
Korea, this study aimed to illustrate key issues of geospatial data processing.
METHOD:We investigated spatial-temporal consistency and coordinate systems of nationwide land use
and road network data in South Korea. We obtained land use data from the Ministry of Environmentfor 2000-2019 including different types of land use such as residential and commercial areas. Road
networks for 2005-2020 available through the Korea Transport Database consist of eight types ofroads from national highways to local roads.
RESULTS:The land use map over South Korea consists of about 750 sections each of which includes 7,
22, and 41 types of land use categories at the low, middle, and high levels, respectively. We founddifferent parts of the sections were updated in different years, and some sections have never obtained
high-level categories. The coordinate system of land use data also varies over time: ‘Korean
1985/Modified Central Belt’ or ‘Korea 2000/Central Belt’. Likewise, road network data had different
coordinate systems depending on the year.
CONCLUSIONS:Our findings suggest geospatial data processing should achieve data consistency overtime and space as well as coordinate systems to construct a geospatial data pipeline and our practicalguidance will help assess the association of environmental risk factors with human health research.

Keywords: Geospatial data pipeline, Geospatial data processing, ModelingMP-005[Methods » Big data]

Attitudes and perceptions of public healthpostgraduate students towards the use of
artificial intelligence in public healthNandi Mwase1, Sean Patrick1, Liz Wolvaart1, Mari Van Wyk2, Washington ` Junger3, Janine
Wichmann1
1School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa2Comprehensive Online Education Services, University of Pretoria, South Africa
3State University of Rio de Janeiro, Rio de Janeiro, Brazil

BACKGROUND AND AIM:Artificial Intelligence (AI) subfields such as machine learning, deep learning,
robotics and virtual agents (chatbots) are increasingly applied in medicine and public health. AI
education for students in these field is therefore essential, as addressed in the National Digital HealthStrategy for South Africa (2019-2024). This study aimed to assess the perceptions and attitudes
regarding AI among Postgraduate Diploma in Public Health students at the School of Health Systems
and Public Health, University of Pretoria, South Africa.
METHOD:Students were enrolled in a 7-week Introduction to Research Methodology course during 2
May to 17 June 2022. The online questionnaire was administered anonymously in English using
Qualtrics. Ethics approval was obtained for the study (Ref 171/2022). The data from Qualtrics wasexported to a Microsoft Excel spreadsheet before being imported to STATA 15 for statistical analysis.
RESULTS:618 students (507 females, 108 males, 5 chose not to indicate their gender) completed thequestionnaire (81.5% response rate). Generally, students thought AI would be capable of performing
various tasks that did not provide direct care to individuals. Most (69%) agreed that introduction of AI
could reduce job availability in public health fields. Students agreed that AI in public health could raise
ethical (84%), social (77%) and health equity (77%) challenges. Relatively few students (52%)
thought they were being adequately trained to work alongside AI tools and the majority (76%) felt
training of AI competencies should begin at an undergraduate level.
CONCLUSIONS:The results highlight diverse perceptions and attitudes regarding AI among thestudents. This study is a baseline for more extensive in-depth studies to be done within an African
context. Follow-up studies could better inform the inclusion of AI into medical and public healthtertiary education. The subject of AI is still quite a novel concept that needs to be explored.

Keywords: Attitudes, perceptions, postgraduate students, artificial intelligence, South Africa

MP-006[Air pollution » Short-term exposure]

Burden of disease from short-term exposure tofine particulate matter in South Korea
Jongmin Oh1, Youn Hee Lim2, Changwoo Han3, Dong Wook Lee4, Jisun Myung5, Hyun Joo Bae6
1Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea; Department of Human System Medicine, College ofMedicine, Seoul National University
2Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
3Department of Preventive Medicine, Chungnam National University College of Medicine
4Department of Occupational and Environmental Medicine, College of Medicine, Inha University,

Incheon5Institute of Environmental Medicine, Medical Research Center, Seoul National University
6Korea Environment Institute, Sejong, Republic of Korea

BACKGROUND AND AIM:Previous studies have estimated excess mortality from long-term exposure tofine particulate matter (PM2.5), but studies on short-term exposures are still scarce. Moreover, moststudies have estimated the burden of disease based on the linear relationship between air pollutant
and mortality. Therefore, we aimed to investigate the cause-specific mortality burden due to shortterm PM2.5 exposure by considering potential non-linear relationship in South Korea.
METHOD:We obtained daily cause-specific mortality data in 2010-2019 from the Korea National
Statistical Office and ambient PM2.5 concentration levels from modeling and monitoring stations
covering 17 provinces of South Korea. We used a generalized additive mixed model to estimate therelative risk of mortality for 1 μg/m3 increase in PM2.5 exposure. Assuming a non-linear relationship,
we estimated the number of deaths attributable to short-term exposure to ambient PM2.5. To
estimate the health impact of PM2.5, we calculated excess mortality due to short-term exposure toambient PM2.5 compared to two counterfactual PM2.5 levels: WHO air quality guideline level (15μg/m3) and minimum concentration (2 μg/m3).
RESULTS:Of 2,749,704 deaths, 2,453,686 (89.2%), 591,267 (21.5%), and 141,066 (5.1%) were nonaccidental, cardiovascular, and respiratory deaths, respectively. Daily mean PM2.5 levels ranged
between 14.7 µg/m3 (Jeju) and 28.4 µg/m3 (Chungbuk). A supralinear relationship between exposure
to PM2.5 at lag 0 and all-cause mortality was observed. A total of 9,591, 7,593, 1,642, and 1,412 allcause, non-accidental, cardiovascular, and respiratory deaths were attributable to short-term
exposure to PM2.5 above the WHO guideline. The doubled burden of deaths was estimated when the
population was exposed to daily PM2.5 levels above 2 µg/m3.
CONCLUSIONS:The study suggests a supralinear relationship between short-term exposure to PM2.5
and mortality in South Korea. These results indicate the need for immediate action plans to preventthe population’s health from daily exposure to PM2.5.

Keywords: Burden of disease, Fine particulate matter, Health impact assessment, Premature
mortality, Short-term exposureMP-007[Birth and pregnancy outcomes » Other (to be specified with keywords in the keywords section)]

Advancing chemical risk assessment throughprioritization and systematic mapping of highthroughput mechanistic in vitro data
Juleen Lam, Vivian Lopez, Zella Torrence, Destiny Castenada
Department of Public Health, California State University, East Bay, Hayward, USA

BACKGROUND AND AIM:Synthetic chemical use has outgrown our ability to regulate. Our project’s
object was to develop a prioritization framework to identify environmental chemicals of greatest
concern for human reproductive and developmental effects, and utilize systematic approaches to
identify current high throughput in vitro data and identify data gaps and evaluate its predictivity ofhuman health outcomes.
METHOD:We established a protocol outlining a process to prioritize environmental chemicals ofconcern for reproductive or developmental health outcomes. The considerations included identifying
environmental chemicals: 1) measured at detectable levels in pregnant women; 2) produced at highproduction volumes; 3) targeted for assessment by environmental regulatory agencies; and 4) thatcan be assessed using high-throughput screening approaches. A subset of chemicals identified throughthe prioritization process was then evaluated using systematic evidence mapping and predictivemodels to validate high throughput in vitro data with in vivo toxic potencies using a semi-automatedbenchmark concentration modeling approach.
RESULTS:Our prioritization framework yielded a list of 40 environmental chemicals of concern. Fivechemicals were selected for further evaluation (two PBC congeners, BPA, and two PBDE congeners).
Systematic evidence maps for each chemical illustrated study design characteristics and results fromhigh throughput in vitro studies. Validation of data with the U.S. Environmental Protection Agency’s
ToxRef database (supplemented with published scientific studies) of mammalian in vivo endpoints
found that the in vitro studies predicted rodent toxicity with balanced accuracy nearing 70%. The
assay was most predictive of rodent ovarian defects and overall reproductive performance with arelative risk value close to 10.
CONCLUSIONS:Leveraging scientific findings in a comprehensive and systematic manner is critical todevelop public policies. This study proposes a prioritization process to identify environmental
chemicals of greatest concern, and illustrates that high throughput in vitro screening data may be aneffective approach to support rapid development of health-protective policies.

Keywords: Chemical exposures, Children's environmental health, Risk assessment

MP-008[Methods » Causal inference]

Estimating Heterogeneous Causal Effects under
Bipartite Network Interference: An Application
to Air Pollution Regulatory Policy
Kevin L. Chen, Falco J. Bargagli Stoffi, Raphael C. Kim, Rachel C. Nethery
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Given the disproportionately high air pollution exposures experienced bymarginalized population groups, robust evaluations of the heterogeneous health impacts of air quality
regulations are key to justifying and designing maximally protective future interventions. Suchevaluations are complicated by two key issues: 1) much of air pollution regulatory policy is aimed atintervening on large emissions generators while resulting health impacts are measured in the
populations exposed to emissions from these sources; 2) due to air pollution transport, interventions
on one emissions generator can impact geographically distant communities. In causal inference, sucha scenario has been described as that of bipartite network interference (BNI). In this work, we develop
novel methodology to estimate heterogeneous causal effects under BNI and apply these methods tostudy the impacts of power plant emissions interventions on ischemic heart disease (IHD)
hospitalizations, particularly for vulnerable subpopulations.
METHOD:Within the BNI context, we propose and implement causal estimators for subgroup-specificdirect and spillover treatment effects via G-computation and augmented inverse propensity weighting
methods. Using the proposed methods, we estimate the causal impact of power plant scrubber
installations on IHD hospitalizations in 2005 among Medicare fee-for-service beneficiaries in 29,034
U.S. ZIP codes.
RESULTS:In the overall study sample, we found that scrubber installation at the power plant that mostinfluences a ZIP code is associated with a decrease in the ZIP code's IHD hospitalization rates, thoughthese decreases were not statistically significant at the α=0.05 level. However, for high-poverty andlargely non-white ZIP codes, treating their most influential power plants when less-influential plants
were untreated was found to result in statistically significant decreases in hospitalization rates.
CONCLUSIONS:We present the first study of heterogeneous treatment effects within the BNI setting,which provides evidence that marginalized populations may benefit most from power plant emissions
reduction interventions.

Keywords: air pollution, cardiovascular diseases, environmental disparities, environmental justice,policyMP-009[Air pollution » Particulate matter]

Spatial distribution of PM₂.₅ in Bangkok and its
vicinity during 2011 – 2020
Kraiwuth Kallawicha1, Chuphan Chompuchan2
1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
2Faculty of Engineering at Kamphaeng Saen, Kasetsart University, Nakhonpathom, Thailand

BACKGROUND AND AIM:Bangkok is the capital city of Thailand and is seriously affected by PM₂.₅
which contributes from various sources spatially. High concentration exposure results in various
adverse health outcomes of the residents. This study aims to reveal the spatial distribution of PM₂.₅ in
Bangkok and its vicinity from the first monitoring in 2011 – 2020.
METHOD:The monitoring station data for Bangkok metropolis and vicinity provinces during the periodof 2011 – 2020 were obtained from the Pollution Control Department. The land utilization information
was obtained from the Land Development Department. The concentration of PM₂.₅ was reported asµg/m³, Geographic information system was used to illustrate the spatial distribution of PM₂.₅.
RESULTS:Currently, there are 23 stations covered in the study areas. PM₂.₅ in Bangkok and vicinity
areas show a seasonal trend and are strongly influenced by land utilization. The concentration of
PM₂.₅ peaked in the winter season (Nov - Feb). Although the average annual concentration was lower
than Thailand standard (50 µg/m³), the maximum concentration of PM₂.₅ was reached to 173 µg/m³
which was considered as the health hazard. Spatial distribution map indicated that the highconcentration during winter originated from the northwestern area of Bangkok, which is the sugar
cane planting area. The harvesting by open field burning can cause high pollutant levels. The southernand eastern parts of Bangkok show much lower concentrations. These areas are the rice paddies,
residential, and industrial areas that are close to the coastal area. The rice harvesting method causes
a lower concentration of PM₂.₅. Moreover, the coastal wind can also dilute the atmosphericconcentration of PM₂.₅ in the area.
CONCLUSIONS:Proper land utilization management would help to reduce the concentration of PM₂.₅,
which consequently benefits the resident’s health and well-being.

Keywords: Air pollution, Particulate matter, Exposure assessment

MP-010[Air pollution » Ozone]

Comparison of the use of a chemistry transportmodel with a recurrent neural network method
for modeling ambient ozone concentrations
Leghrib Radouane, Adnane Anas, Ajdour Amine, Chaoufi Jamal
LETSMP, Department of Physics, Faculty of Science, University Ibn Zohr, Agadir, Morocco

BACKGROUND AND AIM:Air pollution has become a major priority and a global issue at a worldwide
scale. Ozone is considered as one of the most toxic and dangerous air pollutants with widely known
harmful effects on the environment and the human health. Predicting ozone concentrations has a lotof benefits, and one of them is to provide legislators an idea about the near future situation to takethe necessary measures.
METHOD:In this work, we acquired meteorological and air pollution data from February to March 2021
from the Moroccan General Directorate of Meteorology. Then, we compared the performance and thecapacity of two different models in term of modeling and predicting ambient ozone concentrations
over the city of Casablanca. The first model is a special case of recurrent neural networks, called
Nonlinear Autoregressive Network with eXogenous inputs (NARX). The second model is CHIMERE: it isa chemistry-transport model that allows analysis of pollution episodes as well as forecasts of ozone,
aerosols, and other pollutants.
RESULTS:The results show that the NARX models are more suitable for short term prediction of ozone
concentrations, while the CHIMERE transport model can perfectly predict the long-term trend of theseconcentrations.
CONCLUSIONS:We highlight the potentiel and the deficiencies of each technique for air quality
forecasting. A combination between both techniques could has a potentiel application in this domain.

Keywords: Machine learning, Chemistry transport model, CHIMERE, NARX, Ozone forecastingMP-011[Exposure assessment methods » Exposure assessment-air pollution]

A hybrid spatiotemporal model for estimating
daily NO₂ concentrations across Israel
Mike Zhongyu He1, Maayan Yitshak Sade1, Itai Kloog2
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, United States
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, United States; Department of Geography and Environmental Development, Ben-Gurion
University of the Negev, Beer Sheva, Israel

BACKGROUND AND AIM:Nitrogen dioxide (NO₂) is an important traffic-related pollutant associatedwith both short- and long-term health effects. Exposure to NO₂ has been associated with numerous
health outcomes, including asthma, decreased lung function, lung cancer, and premature mortality.
There has been growing interest and efforts in recent years to construct fine-scale air pollution
prediction models, including for NO₂, but such efforts have been mainly focused in the United Statesand Europe.
METHOD:We modeled average daily ground-level NO₂ concentrations in Israel using a multistage
framework from 2004 to 2022. Spatial and temporal predictor variables included data from the Ozone
Monitoring Instrument (OMI), Copernicus Atmosphere Monitoring Service (CAMS), land use data, andmeteorological variables. We employed linear mixed effects (LMM) and random forest (RF) models to
downscale satellite measurements and incorporate local sources, then utilized a generalized additivemodel (GAM) to geographically weight predictions from the two base learners (LMM and RF).
Performance from all models were evaluated based on 10-fold cross-validation.
RESULTS:On average, the LMM, RF, and GAM models explained 68, 74, and 84% of variations inmeasured NO₂ concentrations. We observed higher levels of NO₂ in urban centers (including Tel Aviv,
Jerusalem, and Haifa), heavy traffic corridors, and along valleys in mountainous areas. Lower levels of
NO₂ were observed in more rural areas, with levels dropping to nearly zero in areas of high altitude.
CONCLUSIONS:This is one of the first studies, to the best of our knowledge, which show the potentialof using earth observation data to develop robust models with fine-scale spatial (1-km²) and temporal(daily) variation of NO₂ across Israel from 2004 to 2022. The predicted NO₂ concentrations will bemade available to facilitate health research in Israel.

Keywords: air pollution, nitrogen dioxide, ensemble modeling, Israel

MP-012[Air pollution » Particulate matter]

Environmental Disparities in Outdoor PM 2.5
Across Different Residential Densities in Ibadan,
Nigeria
Oluwafunmilade A Deji Abiodun1, Olalekan J Taiwo2, Susan Duncan3, Anindita Dutta1, Tope
Ibigbami4, Samuel Adekunle4, Olufadekemi Ajani4, Oladosu Ojengbede5, Christopher O Olopade6
1Department of Medicine, Section of Pulmonary / Critical Care, The University of Chicago, IL, U.S.A
2Department of Geography, Faculty of the Social Sciences, University of Ibadan, Nigeria
3Department of Medicine, Center for Global Health
4Research, Healthy Life For All Foundation, University College Hospital, Ibadan, Nigeria
5Centre for Population and Reproductive Health, University of Ibadan, Ibadan, Nigeria
6Department of Medicine, Section of Pulmonary / Critical Care,The University of Chicago, IL, U.S.A;

Center for Global Health, The University of Chicago, IL, U.S.A

BACKGROUND AND AIM:Globally, air pollution constitutes a major risk to human health. Research has
focused on the impact of PM₂.₅ pollution on health in cities, with scant attention to its variations
across different residential densities in cities. Socioeconomic, demographic, and cooking behaviour
often vary across different residential densities in cities. We analysed variations in outdoor PM₂.₅
concentrations across different residential densities and its association with household cooking fueland power generator usage.
METHOD:Previous studies guided identification of High Density Residential Areas (HDRA), Medium
Density Residential Areas (MDRA), and Low Density Residential Areas (LDRA) in Ibadan, Nigeria.
Fifteen households were selected in each residential density. An air quality monitoring device wasplaced outside eacoh household, far from known polluting sources. Air quality data was continuously
sampled for 24-hours and averaged for each household. Socioeconomic, cooking fuel, and power
generator usage information were obtained through a questionnaire. Variations in outdoor PM₂.₅ wasanalyzed using Chi-Square and Analysis of Variance at P<0.05.
RESULTS:Households varied significantly in outdoor PM₂.₅ concentrations (𝑥²=14.329, df=4,
ρ<0.006), with ratings from fair (22%) to poor (76%) to very poor (2%). Concentrations varied
significantly by residential density (F(2,42) =6.585, ρ<.005). The average outdoor PM₂.₅
concentrations in HDRA, MDRA, and LDRA were 38.67±15.83µg/m³ 30.78±4.54µg/m³, and25.53±5.26µg/m³ respectively. There was no significant difference in the type of cooking fuel used
across HDRA, MDRA and LDRA (𝑥²=8.780, df=6, ρ=0.186), but mean outdoor PM₂.₅ concentrations
differed significantly across households using different fuels (F(³ ⁴¹)=5.325, ρ<.005). Number ofhouseholds that used power generators differed significantly by residential density (𝑥²=22.878, df=2,
ρ<0.005), with owning a generator showing higher mean PM₂.₅ concentrations (F(¹ ⁴³)=8.271, ρ=0.006).
CONCLUSIONS:Outdoor PM₂.₅ concentrations in Ibadan, overall, is poor, with the most elevated PM₂.₅
in HDRA. Household’s choice of cooking fuel has an impact on outdoor PM₂.₅ concentrations, as does
use of power generators.

Keywords: Particulate Matter, Enviromental Disparities, Respiratory Outcomes, Policy, Exposure
Assesment- Air Pollution

MP-013[Exposure assessment methods » Spatial statistics]

The combination effects of feature selection andmachine learning on SO2 spatiotemporalestimation: a case study in Kaohsiung, Taiwan
Pei Yi Wong1, Yu Ting Zheng2, Huey Jen Su1, Shih Chun Candice Lung3, Chih Da Wu4
1Department of Environmental and Occupational Health, National Cheng Kung University, Tainan,

Taiwan2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
3Research Center for Environmental Changes, Academia Sinica, Taipei, Taiwan & Department ofAtmospheric Sciences, National Taiwan University, Taipei, Taiwan & Institute of Environmental Health,National Taiwan University, Taipei, Taiwan
4Department of Geomatics, National Cheng Kung University, Tainan, Taiwan & National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Feature selection is noted as an efficient approach in data preprocessing,
especially for high-dimensional data. Machine learning models are widely used to predict the
spatiotemporal variation of air pollution concentration. This study aimed to assess whether the
combination of statistical and machine learning based feature selection methods with machine learningmodels can maximize the efficiency in air pollution modelling. Feature selection methods (including
SelectKBest, stepwise feature selection, elastic net, and random forest) and XGBoost machine learningmodel were applied to test the combinations in estimating SO2 concentration variations.
METHOD:Daily SO2 of period 1994 to 2018 in Kaohsiung was collected from Taiwan Environmental
Protection Agency. Variable such as land-use/land cover information, roads, landmarks,
meteorological factors, socioeconomic indicators, and satellite images were collected as potential
predictors. Important variables were identified by SelectKBest, stepwise feature selection, elastic net,and random forest feature selection methods, respectively. The four groups of identified features werethen fitted in XGBoost model to create different combinations to estimate SO2 variation.
RESULTS:The combination of features selected from random forest with XGBoost performed best with
R2 of 0.83, followed by the combination of stepwise feature selection (R2=0.81), SelectKBest(R2=0.80), and elastic net (R2=0.77) with XGBoost. The results from external data validation showeda similar model prediction accuracy with training model, which indicated no overfitting issue and good
extrapolation ability. Features with temporal variation including Kriged SO2, NO2, PM2.5, PM10, andwind speed were identified by random forest. In addition, local and major roads, distance to thermal
power plant and density of industrial reflected SO2 spatial variation.
CONCLUSIONS:The combination of random forest with XGBoost model outperformed the othercombination using statistical based feature selection methods. The applied feature selection andmodelling procedure in this study could help estimate spatiotemporal variation of SO2 concentration.

Keywords: air pollution, big data, modelling, exposure assessment, spatial statistics

MP-014[Air pollution » Particulate matter]

A new single particle mass spectrometer
detects health-relevant Polycyclic Aromatic
Hydrocarbons, soot and metals from individual
aerosol particles
Ralf Zimmermann1, Johannes Passig1, Julian Schade1, Robert Irsig2, Andreas Walte2, Sven Ehlert2
1Chair of Analytical Chemistry and JMSC, HMGU and Universität Rostock, Rostock, Germany
2Photonion GmbH, Schwerin, Germany

BACKGROUND AND AIM:The chemical composition of aerosol particles is highly relevant for the PMtoxicity. In particular, the content of toxic compounds/fractions such as soot, polycyclic aromatichydrocarbons (PAH) or redox-active metals (e.g., Fe, Cu) is of concern. An analysis of filter samples
gives only integral values for pollutant concentrations but no information on the toxicant-mixing state(i.e., the distribution of toxicants in the particle ensemble). The mixing state, however, is a crucial
parameter to assess health effects: the toxicants could be highly concentrated within a specific, small
sub-population (externally mixed) and the few particles with very high toxicant-concentration induce
stronger cellular and systemic effects (e.g., by DA

MP-signaling). Consequently, on-line analysis techniques enabling the mixing-state-analysis of healthrelevant PM-chemicals are required for innovative health-related aerosol studies.
METHOD:An on-line Single Particle Mass Spectrometry (SPMS) with a novel laser ionization process ispresented. The aerosol particles are directly on-line sampled from air and size-characterized by laser
velocimetry. The organic coating of particles is desorbed by IR-laser pulses and subsequently therelevant toxicants are ionized particle-by-particle, using a novel UV-laser ionization-scheme. The ionsare detected by MS (Schade et al. Anal. Chem. 2019). The novel SPMS particle characterization
system offers the characterization of the most relevant aerosol particle-borne toxicants (soot, metals,
PAH) on a sized-resolved, single particle basis.
RESULTS:Thus, in addition to classifying sources and quantifying main aerosol compound the systems
gives insight into the mixing state of the revenant air toxicants (PAH/metals/soot) and othercompounds (nitrate, sulfate etc.). First results for PAH, e.g., show that, depending on the conditions,
PAH may either concentrate on a very small fraction of the particles (Passig et al. ACP 2022) or berather uniformly distributed over all dust particles.
CONCLUSIONS:The system enables a new approach in source apportionment and toxicant
internal/external mixture
analysis and suggest new epidemiological and health studies.

Keywords: Air pollution, Heavy metals, Particle components, Risk assessment, Chemical exposuresMP-015[Methods » Big data]

Machine Learning-Based Analysis on Factors
influencing Blood Heavy Metal Concentration in
Korean Children Health and Environmental Study(Ko-CHENS)
Seowoo Jung1, Surabhi Shah2, Jongmin Oh3, Yoorim Bang4, Jungsil Lee2, Ji Hyen Lee5, Eunkyung
Lee1, Eunhee Ha6, Ko Chens Study Group7
1Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
2Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea
3Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
4Institute for Development and Human Security, Ewha Womans University, Seoul, Republic of Korea
5Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic of Korea;

Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
6Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science andEngineering, Ewha Womans University, Ewha Medical Research Institute, College of Medicine, Seoul,
Republic of Korea
7Core center; Supportive center

BACKGROUND AND AIM:Heavy metal concentration in pregnant women affects neurocognitive andbehavioral development of their infants and children. The majority of existing research focusing on
pregnant women’s heavy metal concentration has considered individual environmental factor.
Therefore, in this study, we aim to comprehensively consider lifestyle, food, and environmental factors
to determine the most influential factor affecting heavy metal concentration in pregnant women.
METHOD:The Ko-CHENS(Korean Children Health and ENvironmental Study) is a nationwide
prospective birth cohort study in South Korea enrolling pregnant women from 2015 to 2020. A total of
5,458 eligible pregnant women were included in this study, and 897 variables were included inquestionnaire comprising: maternal general information, indoor and living environment, dietary habits,
health behavior, exposure to chemicals. Lead, cadmium and mercury concentration on blood were
measured in early, late pregnancy and in cord blood at birth. The randomforest model was used forpredicting and extracting important factors affecting concentration of heavy metals in pregnant
women.
RESULTS:We finally used 447 variables for 4,033 pregnant women in the model. The Mean Squared
Errors (MSE) of models for lead were 0.27, 0.25, and 0.35 in early and late pregnancy, and cord
blood, respectively. The most important variable influencing lead concentration was BMI. The MSEs ofmodels for mercury were 0.18, 0.18, and 0.19. The most important variable influencing mercury
concentration was the frequency of eating raw fish. The MSEs of models for cadmium were 0.13, 0.08,
and 0.07. The most important variable influencing cadmium concentration was age for early and latepregnancy, while it was the frequency of dried laver intake for cord blood.

CONCLUSIONS:Our study showed that pregnant women could reduce their exposure to heavy metals
by eliminating and modifying specific factors in their environment and thereby decrease their negative
effects on the children’s development.

Keywords: Children's environmental health, Environmental epidemiology, Heavy metals

MP-016[Methods » Causal inference]

Sufficient conditions for causal reasoning in
mixtures epidemiology
Thomas F Webster1, Marc G Weisskopf2
1Department of Environmental Health, Boston University School of Public Health, Boston, USA
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA

BACKGROUND AND AIM:Investigations of the health effects of mixtures have surged in the last
decade with the increased availability of biomarkers for multiple exposures and the development of
new statistical methods. We have previously identified a number of situations where such methods
yield biased, non-causal inferences. Here we identify some conditions where the results can beinterpreted causally.
METHOD:We previously used directed acyclic graphs (DAGs) to identify several problematic situations.
Suppose for simplicity that there are two exposures of interest that are correlated because of someunmeasured common cause, e.g., a common source. Coexposure amplification bias occurs when oneof the two exposures is subject to uncontrolled confounding. Table 2 errors—improperly interpretingbeta coefficients as total causal effects—are other problems that can occur when one exposure canaffect another, e.g., by modifying pharmacokinetics. Biomarkers of exposure are more prone to theseissues. We derive other directed acyclic graphs where these problems do not occur.
RESULTS:Use of external measures of exposure (rather than biomarkers) avoid Table 2 errors due tomodification of pharmacokinetics of one biomarker by another. As correlations between large numbersof exposure biomarkers typically show a block diagonal structure, backdoor paths between suchgroups will be weaker if they occur, reducing co-exposure amplification bias (care is still needed withingroups). For exposure biomarkers that are correlated because of a common source, it may often beeasier to identify and control backdoor pathways between the source and the outcome; if there are noother confounding pathways and the biomarkers do not affect each other, then many recent statisticalmethods for mixtures may be adequate.
CONCLUSIONS:Despite pitfalls there are situations where mixtures epidemiology can yield unbiased
causal estimates.
This work was supported by NIEHS grant R01ES028800.

Keywords: causal inference, mixtures, chemical exposuresMP-017[Omics technologies » Metabolomics]

Identifying Novel Alzheimer’s disease
Biomarkers Using Hair Metabolomics andMachine Learning
Ya Yun Cheng1, Yuan Chih Chen2, Wei Chen3, Chih Wei Chang2, Chi Hua Yu3, Pao Chi Liao2
1School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
3Department of Engineering Science, NCKU, No.1 University Rd., East Dist., Tainan, Taiwan; Programon Smart and Sustainable Manufacturing Academy of Innovative Semiconductor and Sustainable
Manufacturing, National Cheng Kung University, No.1 University Rd., East Dist., Tainan, Taiwan

BACKGROUND AND AIM:The prevalence of Alzheimer's disease (AD) among elderly individuals isincreasing globally, posing a significant threat to public health. Detecting and preventing AD at an
early stage is crucial for improving patient outcomes. However, current diagnostic methods areinvasive, expensive, and often unreliable, highlighting the need for reliable and non-invasive
biomarkers for early detection and disease progression prediction. Machine learning has emerged as a
powerful tool for identifying AD biomarkers from hair metabolomics.
METHOD:To investigate the predictive and novel metabolomics features associated with AD in elderly
patients, we conducted a case-control study that included 48 age and sex-matched individuals fromtertiary medical centers in Tainan city. We analyzed the data using both epidemiological and machinelearning approaches, and applied random forest and deep learning models to identify essential
features for differentiating between AD and control groups.
RESULTS:Based on our criteria, we selected 772 meaningful features from 12,358 positive ions, whichwere then filtered and subjected to machine learning-based AD biomarker investigation procedures.
We trained the Random Forest classification model and selected 271-294 peak features in each modelwith an importance score greater than 0%. Our final model, which used 12 selective features fromhair metabolomics, achieved 100% accuracy in training and testing for predicting AD. Additionally, thecross-validation of the model was 0.833, indicating good generalizability beyond the specific training
dataset. The accuracy between training (1.0) and validation (0.8) from the deep learning model was
also considered reliable. Although our study was conducted using a small sample size, we were able toidentify significant and novel biomarkers for AD classification from the hair metabolomics dataset.
CONCLUSIONS:However, these findings need further validation using larger sample sizes and different
populations. Overall, our results highlight the potential of machine learning and metabolomics todevelop non-invasive diagnostic tools for AD detection and treatment.

Keywords: Alzheimer’s disease (AD), metabolomics, machine learningMP-018[Air pollution » Traffic-related]

Integrating traffic pollution dispersion into
spatiotemporal high-resolution NO2 prediction
Yunhan Wu1, Jianzhao Bi2, Adam A. Szpiro1, Joel D. Kaufman2
1Department of Biostatistics, University of Washington, Seattle, WA, USA
2Department of Environmental and Occupational Health Sciences, University of Washington, Seattle,

WA, USABACKGROUND AND AIM:Accurately predicting ambient NO2 concentrations has great public healthimportance, as traffic-related air pollution is of major concern in urban areas. Previous studies showedthat line-source dispersion models such as Research LINE source (RLINE) added predictive power toland-use regression for NO2. In this study, we formulated a framework in which point-based traffic
data are linked with RLINE and further incorporated into an advanced spatiotemporal smoothingmodel for NO2.
METHOD:Our experiment was conducted in the greater Los Angeles area (4,555 km2) over a five-year
period, with regulatory, low-cost, and road-side gradient snapshot observations for NO2 (N ofmonitors = 283). We implemented spatial regression models with nearest-neighbor Gaussian
processes (spNNGP) to obtain road-type specific annual average daily traffic (AADT) prediction on roadsegments; the model is trained based on over 1 million observations nationwide. Along withmeteorological data from AERMET, the AADT estimates on all A1 roads served as the input for the
RLINE model. We proposed two strategies to integrate RLINE estimates into our NO2 model:
incorporating RLINE estimates as a space-only covariate and as a spatiotemporal covariate.
RESULTS:The results showed that integrating the RLINE estimates as a space-only covariate
contributed to an increased in overall cross-validation R2 from 0.83 to 0.84, and a decreased root
mean squared error (RMSE) from 3.58 to 3.48 ppb. The improvement was more profound in snapshot
sites close to highways, with R2 increased from 0.56 to 0.66 and RMSE decreased from 3.52 to 3.11.
CONCLUSIONS:This improvement indicates that the RLINE estimates added strong predictive valueeven after considering a comprehensive list of geographic covariates and the improvement is highly
related to distance to roads. Our data and methodology are available nationwide in the U.S.; ourmodeling framework can be easily generalized to predicting traffic-related NO2 in other urban areas.

Keywords: Long-term exposure, Oxides of nitrogen, Spatial statistics, ModelingMP-019[Chemical exposures » Heavy metals]

Diagnosis Of WasteWater Contamination By
Metal Trace Elements In The Areas Of Yopougon(Abidjan South) And Marcory, Koumassi (Abidjan
North)
Amon Lydie Nina1, Diaby Aboubakar Sidik2, Yao Kouame Eric3, Kouakou Lébé Prisca Marie Sandrine4,
Konan Koffi Léon4, Andji Yapi Yao Jonas4, Coulibaly Kalpy Julien1, Dosso Mireille5
1department environment and health, institut pasteur, abidjan, cote d'ivoire
2department pollution prevention and response preparedness, centre ivorian anti pollution, abidjan,

cote d'ivoire
3department hydrobiology, university felix houphouet boigny of cocody, abidjan, cote d'ivoire
4department of chemistry, university felix houphouet boigny of cocody, abidjan, cote d'ivoire
5department of bacteriology and virology, institut pasteur, abidjan, cote d'ivoire

BACKGROUND AND AIM:The contamination of the aquatic environment by trace metals (TMEs) is oneof the major problems facing society today. In Côte d'Ivoire, certain communes in the city of Abidjan,
which are made up of residential and industrial areas, discharge wastewater of a worrying nature intorainwater channels, which end up directly in the Ebrié lagoon. In fact, these wastewater discharges
linked to human activities have a strong colouration and foul odours that make the daily life of theresidents of certain communes in the city of Abidjan unpleasant.To highlight the origin of the chemical
pollution carried by these waters, we evaluated the TMEs of the wastewater samples taken upstream
and downstream of the canals.
METHOD:A multiparameter was used to measure pH, temperature and ICP-OES was used for the
analyses and PCA and Excel were used for data processing.
RESULTS:The waters are neutral at the Abidjan North sites with an average pH of 7.28 and saline
waters with an average pH of 8.95 at the Abidjan South sites. The average temperature of the wateris 23.7°C and 22.31°C respectively. From Abidjan North to Abidjan South, the lowest values wereobserved at the sites north of Abidjan. The metal concentrations exceeded the standard recommended
by the USA standard except for Cd. The typological structure shows 85.74% of the total information
for TMEs. The F1 design represents 63.90% of the variance and describes the overloading of water bycopper (0.95), zinc (0.90), iron (0.84) and aluminium (0.84). Design F2 accounts for 21.84% anddescribes the enrichment of water with lead (0.84).
CONCLUSIONS:It is therefore more than necessary to raise the awareness of industries on thetreatment of their waste and to set up treatment systems for this wastewater before its natural outlet,
including the water bodies of the city of Abidjan.

Keywords: TME, wastewater, contamination, typology, channels

MP-020[One health » Public health]

Perceptions and governance of One Health inAfrican countries: A workshop report
Aziza Menouni1, Samir El Jaafari2
1Cluster of Competence Environment and Health, Moulay Ismail University, Meknes 50000, Morocco;

Health and Environment Unit, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium
2Cluster of Competence Environment and Health, Moulay Ismail University, Meknes 50000, Morocco

BACKGROUND AND AIM:There is strong evidence connecting epidemics with the disruption of thehuman-animal-environment interaction. Despite the fact that several cases of emerging and endemic
zoonotic diseases in different parts of Africa have been documented, there is limited evidence
regarding which specific interventions are effective in preventing and managing the associated risks
using a One Health approach. The aim of the African One Health Initiative study is to better
understand perceptions and ongoing research related to interventions in Africa through theimplementation of suitable projects and policies.
METHOD:A bibliometric review of the scientific literature on one health studies with a focus on Africancountries was conducted, followed by a qualitative survey among stakeholders involved in fields
related to One Health research or management in the Africa, including veterinary experts, publichealth professionals, environmentalists and policy makers, to learn about determinants of theirperceptions, as well as barriers to and promoters of successful interventions and governance. The
project was concluded with an international workshop in March 2023, where a broad range of topics
relevant to One Health were discussed.
RESULTS:94% of the respondants were aware of the importance of the One Health approach andstrongly endorse it within their respective countries. The top reported barriers to One Healthdevelopment in Africa included paucity of data, weak linkages and institutional communication
between the different departments and the lack of funding. Key areas of improvement identified were
the impact evaluation of current initiatives, awareness raising compaigns among citizens targeted at
behavioral changes, capacity building of relevant professionals and stakeholders, as well as theimplementation of adequate policies with an intersectoral approach and enforcement of national andcontinental regulations, allowing for better coordination on the African level.
CONCLUSIONS:All One Health sectors in Africa require strong governance and leadership, as well asinterministerial, intersectoral, and interdisciplinary cooperation.

Keywords: One health, governance, Africa

MP-021[Climate » Other (to be specified with keywords in the keywords section)]

ASSOCIATIONS OF HISTORICAL REDLINING AND
FLOOD RISK PROPERTIES IN PHILADELPHIA, PA,
and EFFECT MODIFICATION BY NEIGHBORHOODGENTRIFICATION
Janelle R Edwards1, Anneclaire J De Roos1, Irene Headen2, Michelle Kondo1, Chén Kenyon4, Loni
Tabb3, Leah H Schinasi1
1Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel

University, Philadelphia, PA, United States
2Department of Community Health and Prevention, Dornsife School of Public Health, Drexel

University, Philadelphia, PA, United States
3Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University,

Philadelphia, PA, United States
4Children's Hospital of Philadelphia, Philadelphia, PA, United States

BACKGROUND AND AIM:Upstream drivers, such as the historical deprivation of funding for built water
infrastructure in certain neighborhoods, may place context for current spatial inequities in flood
vulnerability. Historical redlining, introduced by the Homeowners Loan Corporation (HOLC) in 1938,
graded neighborhoods from A-“best” to D-“hazardous” which indicated the risk for mortgage approval
based on the neighborhood’s racial composition. Previous research indicates that historically“hazardous” neighborhoods may be associated with increased climate vulnerability indicators such as
land surface temperatures and lower tree canopy cover yet few studies have explored associations
with flood risk or how the extent to which these relationships vary across categories of neighborhood
gentrification.
METHOD:To calculate census tract level percentages of properties at risk for flood, we utilized 2022
First Street’s risk assessment data which ranked the number of properties within each census tractthat were flood prone from 0-10. We used 1938 HOLC grade maps and areal weighting to identify
historically redlined neighborhoods. We identified census tracts that were ineligible to gentrify, were
eligible but did not gentrify, and did gentrify between years 1990-2000, by calculating changes inneighborhood sociodemographics using decennial Census data. We calculated associations between
categorical redlining grades and the continuous measure of tract-level flood risk percentages, overalland stratified by gentrification categories.
RESULTS:Across all 384 residential Philadelphia census tracts, the mean risk score percentage was
15.2±18.5. Census tracts subjected to historical redlining had higher mean percentages of flood risk
(HOLC Dhazardous= 18.1±21.5 versus HOLC A+Bbest/ still desirable = 11.3±8.6). Lastly, HOLC
Dhazardous census tracts that underwent gentrification were less likely to have properties that were
flood risk (mean=12.9 ±14.5) compared to those that did not (mean= 15.9±18.8).
CONCLUSIONS:Our preliminary results suggest that flood risk is related to a past indicator ofstructural racism (redlining) and that these relationships may be attenuated by contemporary
gentrification processes.

Keywords: climate, built environment, public healthMP-022[Climate » Natural disasters]

Social disparities in flood exposure andassociations with the built environment in
47,187 urban neighborhoods in eight Latin
American countries
Josiah L. Kephart1, Usama Bilal2, Andrêa Ferreira3, Nelson Gouveia4, Daniel A. Rodríguez5, Ignacio
Sarmiento Barbieri6, J. Jaime Miranda7, Ana V. Diez Roux2
1Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel

University, Philadelphia, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel
University, Philadelphia, USA
2Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University,

Philadelphia, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University,
Philadelphia, USA
3The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of

Public Health, Drexel University, Philadelphia, USA
4Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil
5Department of City and Regional Planning, University of California, Berkeley, USA; Institute forTransportation Studies, University of California, Berkeley, USA
6Department of Economics, Universidad de Los Andes, Bogotá, Colombia
7Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru;

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,
London, UK; The George Institute for Global Health, UNSW, Sydney, Australia

BACKGROUND AND AIM:Climate change is expected to greatly increase population exposure toflooding and related health impacts, particularly in urban areas of the Global South. We aimed to
examine within-city social disparities in exposure to flooding within 326 Latin American cities andassociated features of the neighborhood environment.
METHOD:We used a high spatial resolution dataset of historical flood events from 2000-2018 todescribe flood exposure at the neighborhood level for all cities with 100,000+ residents in eight Latin
American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, and Panama).
We estimated the percent of the population living in neighborhoods with one or more observed floods,
comparing across neighborhood educational attainment quintiles. We also contrasted within-city
disparities across study cities (i.e. Slope Index of Inequality). We modeled univariable city- andneighborhood-level factors of the urban environment associated with flood exposure.
RESULTS:We examined 47,187 neighborhoods in 326 cities from eight countries with a total of 236
million residents, and over 150 distinct flood events from 2000-2018. Over 22% of residents inneighborhoods in the lowest education quintile lived in neighborhoods with flooding, while only 4.3%

of residents in the highest neighborhood education quintile lived in flooded neighborhoods.
Neighborhood flooding was associated with lower neighborhood-level educational attainment and withneighborhoods that were less dense (population or intersection), further from the city center, greener,and had steeper slopes (all p-values < 0.05). There was no association between city-level educational
attainment and flood risk.
CONCLUSIONS:There are large social disparities in neighborhood flooding within Latin American cities.
Residents of areas with lower education attainment face substantially higher risks of flooding.
Neighborhoods that were less dense, more peripheral, greener, and had steeper slopes had higher
odds of flooding. Policymakers must prioritize flood adaptation and recovery efforts in neighborhoods
with lower socioeconomic position.

Keywords: built environment, environmental disparities, environmental justice, socio-economic
factorsMP-023[Methods » Environmental epidemiology]

Prospective study on health status of patientswith idiopathic environmental intolerance
attributed to electromagnetic fields after a
provocation test
Kun Hua Li1, How Ran Guo2
1Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng
Kung University Hospital, Tainan, Taiwan

BACKGROUND AND AIM:The self-reported symptoms of patients with idiopathic environmental
intolerance attributed to electromagnetic fields (IEI-EMF) are generally non-specific. Previous shortterm follow-up studies showed that IEI-EMF sufferers still had IEI-EMF after a provocation test, but
the severity of symptoms substantially decreased. Around 30% of them were willing to consider the
possibility that their symptoms might have been caused by something else. However, there are few, ifany, long-term follow-up of IEI-EMF sufferers. We conducted a study aiming to investigate long-termchanges in symptoms and concerns about IEI-EMF after a provocation test and to assess thereversibility of IEI-EMF.
METHOD:We conducted a prospective follow-up of the participants in the previous provocation tests
from 2010 to 2015 in 2019 in Taiwan. The same questionnaire was applied to interview theparticipants by phone, and the results were compared.
RESULTS:Of the 147 participants of the provocation tests, 48 changes their contact phone number,and 29 did not answer the phone after five trials. All the remaining 70 completed the telephoneinterview, and 35 of them had IEI-EMF, of whom 62.9% reported they had recovered. Of therecovered sufferers, 86.4% described idiopathic recovery. Of the participants with IEI-EMF, 60.0%
were willing to consider the possibility that their symptoms might have been caused by somethingother than electromagnetic fields (EMFs). In comparison with the condition while participating in the
provocation test, the self-reported symptoms generally decreased, but the levels of the disturbanceand worry related to EMFs were similar.
CONCLUSIONS:In the long-term follow-up of four years or more, 62.9% of the IEI-EMF sufferers had
recovered after the provocation test, and 60.0% were willing to consider the possibility that their
symptoms might have been caused by something other than EMFs; both were higher than thosereported by previous short-term studies.

Keywords: Epidemiology, Long-term exposureMP-024[Built environment » General]

Urban Public Space Initiatives and Health inAfrica: A Mixed-Methods Systematic Review
Meelan Thondoo1, Louise Foley1, Taibat Lawanson2, Felix Assah3, Ghazel Mukhtar4, Tolullah Oni1
1Global Diet and Activity Research Group and Network, MRC Epidemiology Unit, University ofCambridge, United Kingdom
2Centre for Housing and Sustainable Development, University of Lagos, Nigeria
3Health of Populations in Transition Research Group, University of Yaounde 1, Cameroon
4Faculty of Medicine, Imperial College London, London, England

BACKGROUND AND AIM:Africa has one of the fastest rates of urban growth in the world. With
unplanned urbanisation, African cities run the risk of getting locked in cycles of informality and poverty
where residents face high socio-economic inequalities, lack sufficient resources, and struggle to accessbasic services. As resources to address health and social impacts of unplanned and inequitableurbanisation are limited, it is crucial to examine and deploy high-impact, city-scale interventions thatcan rapidly produce health and wellbeing gains.
METHOD:We synthesized evidence on public space initiatives to prevent non-communicable disease(NCD) in African cities. Between May and June 2020, we searched PubMed, Scopus, Web of Scienceand Global Health for studies published between 1990 and 2020. We used predetermined medical
subject headings (MeSH) terms and consulted grey literature. We followed PRISMA guidelines,
complied with the PRISMA checklist and registered with PROSPERO.
RESULTS:We analyzed 48 studies, 15 of which were mixed methods, 23 qualitative and 10
quantitative. Sports accounted for 50% of initiatives. 30 of the 48 papers originated from South
Africa. Communities viewed initiatives’ wellbeing impacts through social, economic, and ecologicallenses, with health being but one dimension. The sustainability of initiatives was often limited byfunding, historical marginalization, and competing land uses.
CONCLUSIONS:Given ongoing urban infrastructure expansion on the continent, public space initiatives
are a high-impact avenue to equitably improve the health of the public. Existing evidence on suchinterventions shows that use of public spaces for sporting activities and gardening are dominant, andthat public space initiatives are valued for their social, economic, ecological and health benefits. Thereis a need for more comprehensive documentation and implementation of interventions that address
public health through initiatives in public spaces across the continent.

Keywords: Africa, public spaces, public health, cities, non-communicable diseases

MP-025[Methods » Environmental justice]Electrification equity planning: a framework
Michael T Schmeltz, Nicholas Lam, Chandrakala Ganesh
Department of Public Health, California State University, Hayward, CA, USA

BACKGROUND AND AIM:Transitioning away from fossil fuel use towards electricity from renewableenergy (electrification) is important to achieve California’s goal to be carbon free by 2045. In
response, many cities and implementers across the state have established aggressive goals totransition gas appliances to electric alternatives, increase solar installation, and electricity storage,
with an eye towards equitable transitions.
The framework developed includes analytical tools and programming guidelines for policy
development, analysis, and advocacy that will enable implementers to screen proposed communities
for electrification potential, enhance outreach into disadvantaged communities, and develop initial
estimates of required economic incentives and potential impacts (e.g. health co-benefits and GHG
emission reduction).
METHOD:The framework combined existing datasets to enable multiple criteria to be considered whenscreening potential project sites, including rooftop solar resource potential (Google EIE), air quality
data (Google EIE, Purple Air sensor network), demographic and health data (e.g. CalEnviroScreen,
census data, EPA EJScreen); and relevant energy, building, appliance efficiency, and infrastructure
data available from partner cities and/or publicly available sources. Additionally, cost-savings
calculations, GHG emissions reduction calculations, and assumed health benefits were identified
RESULTS:Spatial analyses identified neighborhoods in California that would benefit most fromelectrification. Wealthy neighborhoods versus low income neighborhoods were 5x more likely to takeadvantage of the current incentive structures for electrification. Though, disadvantaged neighborhoods
show greater cost-saving and assumed health co-benefits if targeted more for electrification.
CONCLUSIONS:Those who contribute the least to climate change, in terms of GHG emissions, continue
to suffer the most from environmental pollution and climate impacts. Structuring adaptive measures,
like electrification, to target environmental justice communities (low income, hazard prone,
racial/ethnic diverse) with incentives and programs to build resilience and sustainable infrastructure
can greatly improve social, health and economic wellbeing of these communities.

Keywords: Environmental Justice, Climate, Public Health, Policy ResearchMP-026[Climate » Temperature]

Short-term associations of diarrhoeal diseases
with temperature and precipitation: a multicountry study in Asia and Africa
Nasif Hossain1, Lina Madaniyazi1, Chris Fook Sheng Ng3, Dilruba Nasrin5, Xerxes Tesoro Seposo6,
Paul L.c. Chua2, Abu Syed Golam Faruque7, Masahiro Hashizume4
1Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1-

12-4 Sakamoto, Nagasaki, 852-8523.
2Department of Global Health Policy, School of International Health, Graduate School of Medicine, The

University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
3Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1-

12-4 Sakamoto, Nagasaki, 852-8523. and Department of Global Health Policy, School of International
Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
4Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1-

12-4 Sakamoto, Nagasaki, 852-8523. and Department of Global Health Policy, School of International
Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. and Institute of Tropical Medicine (Nekken), Nagasaki University, 1-12-4 Sakamoto,Nagasaki, 852-8523, Japan.
5Center for Vaccine Development and Global Health, University of Maryland School of Medicine,

Baltimore, Maryland, USA. and 4. Department of Medicine, University of Maryland School of Medicine,
Baltimore, Maryland, USA.
6Department of Hygiene, Faculty of Medicine and Graduate School of Medicine, Hokkaido University,

Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
7Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,

Bangladesh(icddr,b), Mohakhali, Dhaka, Bangladesh.

BACKGROUND AND AIM:Diarrheal diseases continue to be a major disease burden in developing
countries. Although studies described the seasonality of diarrheal diseases, the association of weather
variables with diarrheal diseases has not been well characterized in resource-limited settings where
the burden remains high. This study examines the short-term associations between weather andhospital visits due to diarrhoea in children in seven low-income and middle-income countries.
METHOD:The primary health outcome was hospital visits due to diarrhoea among children under five
years of age. The data were collected from seven sites in each country via the Global EntericMulticenter Study project from December 2007 to March 2011. Daily weather data in the same period
were downloaded from the ERA5-Land. For each of the seven sites, we fitted a time series regression
model to examine the relationship of daily diarrhoeal cases with daily ambient temperature andprecipitation for the last 21 days using a generalized linear model with distributed lag nonlinear
functions.
RESULTS:The analysis included 66,056 cases of diarrhoea. Daily mean temperatures ranged from 15.2
°C in Bangladesh to 37.4 °C in The Gambia over the study period. Sites had a highly skewed
distribution of precipitations. The associations of diarrhoeal hospital visits with temperature andprecipitation varied by country. The relative risk (RR) of diarrhoeal visits for temperature exposure(95th percentile vs. 1st percentile) ranged from 0.19 to 8.80, with Mozambique, Kenya, andBangladesh showing positive associations, while Mali and Pakistan having negative associations. The

RR for precipitation (95th percentile vs. 1st percentile) ranged from 0.82 to 1.66, with Mali and India
showing positive associations, while the only negative association was observed in Pakistan.
CONCLUSIONS:Our findings suggest the essential roles of ambient temperatures and precipitations,especially high temperatures and high precipitation, in increasing diarrhoeal infection both in south
Asia and sub-Saharan African countries.

Keywords: temperature, infectious diseases, children's environmental health.

MP-027[Outcomes » Childrens environmental health]

Prenatal residential greenness exposure on
behavior and cognitive development in children
Yuhsuan Chuang1, Ya Hui Hu1, Chih Da Wu2, Pei Chen Lee3, Shu Li Wang4
1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
3Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan;

Centre for Research in Epidemiology and Population Health (CESP), U1018, INSERM, Villejuif, France
4National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli

County, Taiwan

BACKGROUND AND AIM:We investigated the association between residential greenness exposure
during pregnancy and children’s intelligence and behavior, while accounting for the potential
confounding and mediating effects of air pollutants.
METHOD:We analyzed a birth cohort study on 231 mother-child pairs enrolled in central Taiwan
between 2000 and 2001, and with the maximum of six-times followed up until 2019. Greenness wasestimated based on the normalized difference vegetation index (NDVI), and air pollutant wasestimated using hybrid kriging-land use regression based marching learning model. Children’s
intelligence was assessed with the Wechsler Intelligence Scale for Children (WISC), and behavior wasdetermined based on the Achenbach Child Behavior Checklist (CBCL). For analysis, multiple linear
regressions were used to investigate the association of greenness with children’s IQ and CBCL scoresat each follow-up. We also account for repeated measurements using mixed model. Lastly, we
estimated the mediating effects of air pollutants through causal mediation analyses.
RESULTS:Greenness exposure was associated with a higher IQ score at 2-3 years of age (Estimate =3.65, p-value = 0.02). When we further adjusted for PM2.5 and NO2 air pollutants, the association
became stronger (Estimate = 5.96, p-value = 0.001) and, interestingly, the greenness-IQ association
was only seen in boys. Greenness was associated with a lower CBCL score at 14-15 years of age(Estimate = -1.68, p-value = 0.09), especially for withdraw, anxiety, and internalizing problems, andthese associations were only seen in girls. Mixed model revealed that greenness was associated with ahigher overall IQ score in boys, and a lower overall CBCL score in children whose mother did not havea college degree. We do not find evidence to show that the associations were mediated by air
pollutants.
CONCLUSIONS:Maternal exposure to greenness has beneficial long-term effects on children’s
intelligence and behavior.

Keywords: Green space, Children's environmental health, Mental health outcomes, Multi-pollutant,
Air pollution

MP-028[Chemical exposures » Heavy metals]

Trace metal concentrations, geoaccumulationindex and risk assessment from soil ofelectronic waste (e-waste) exposed and nonexposed area, Bangladesh
Sarker Masud Parvez1, Shaikh Sharif Hasan3, Mohammad Moniruzzaman4, Farjana Jahan3, Mahbubur
Rahman3, Nirupam Aich5, Zahir Islam2, Rubhana Raqib3, Luke D Knibbs6, Peter D Sly2
1Child Health Research Centre, The University of Queensland, Australia and Environmental

Intervention Unit, icddr,b, Dhaka, Bangladesh
2Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
3Environmental Intervention Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
4Bangladesh Council of Scientific & Industrial Research, Dhaka, Bangladesh
5Civil and Environmental Engineering, University at Nebraska, NE, USA
6School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW,

Australia

BACKGROUND AND AIM:Electronic waste (e-waste) recycling is primarily carried out in the informal
sector, where it releases significant quantities of hazardous pollutants into the environment. We
evaluated distribution, contamination, and human health risks of trace metals in soil from e-waste
exposed and non-exposed sites in Bangladesh.
METHOD:20 exposed and 11 non-exposed soil samples were collected and analysed for lead (Pb),cadmium (Cd), mercury (Hg), arsenic (As), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni),zinc (Zn), beryllium (Be), cobalt (Co), selenium (Se), and vanadium (V) using ICP-MS.
RESULTS:Pb, Cd, Hg, Cu and Zn were the most abundant elements in exposed soil (587, 25.57, 2912,
894 ppm) and were present in significantly greater concentrations than in non-exposed control sites(15.94, 0.07, 23.71, 121; all p: ≤0.001). The mean concentrations of Pb, Cd, Hg, Cu and Zn werehigher than their corresponding values of the WHO, USEPA limits, Dutch soil guidelines. The meangeoaccumulation index values of Cd, Hg, Cu indicated “extremely contaminated” and “heavily to
extremely contaminated” for Pb. E-waste combustion sites were associated with substantially higher
levels of soil contamination than dismantling, storage, or disposal sites. Non-carcinogenic risks fromingestion were significant with children being more susceptible than adults. Noncarcinogenic risks fromdermal and inhalation exposure were negligible. Median Pb, maximum Hg and Cu showed hazard
index >1, implying a greater than acceptable risk in children. In contrast, no contributor was found tothe cancer risk; these values are less than the permissible limit (1*10⁻⁴).
CONCLUSIONS:This study suggests significant accumulation of trace metals in e-waste exposed sites
and exposure via soil poses environmental and human health risks, especially for children. Therefore,
there is an urgent need for decision-makers to initiate control measures and deploy cost-effective
techniques to limit the trace metal pollution of the environment.

Keywords: E-waste, trace metals, soil, geo-accumulation index, health risk assessment

MP-029[Built environment » General]

The urban burden of disease estimation forpolicy-making: a project for European cities
Sasha Khomenko1, Ali Abbas2, Juliana Angelova3, Elisa Berardi4, Alonso Bussalleu5, Xuan Chen4,
Carolyn Daher1, Kees De Hoogh5, Benjamin Flückiger5, Ulrike Gehring4, Gerard Hoek4, Haneen
Khreis2, Vlatka Matkovic3, Natalie Mueller1, Anne Stauffer3, Cathryn Tonne1, James Woodcock2, Mark
Nieuwenhuijsen1
1Institute for Global Health (ISGlobal), Barcelona, Spain
2MRC Epidemiology unit, University of Cambridge School of Clinical Medicine, Cambridge, United

Kingdom
3Health and Environment Alliance (HEAL), Brussels, Belgium
4Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
5Swiss Tropical and Public Health Institute, Allschwil, Switzerland

BACKGROUND AND AIM:In Europe, over 70% of the population lives in urban areas. Cities promote
innovation and wealth creation; however, they are also a main source of pollution, disease andmortality, to some extent linked with suboptimal urban and transport planning practices. The aim of
the project is to improve the estimation of health impacts and socioeconomic costs of environmental
stressors related to urban and transport planning, advance modelling approaches and strengthen
evidence-based policy-making.
METHOD:We will (1) develop an overall urban burden of disease impact assessment framework; (2)identify health and wellbeing indicators; (3) obtain exposure-response relationships for environmental
stressors and health outcomes of interest; (4) develop tools and guidelines for cost-benefit analyses;(5) obtain health and environmental stressors data for cities for 2015, 2018, 2021 and 2024 and (6)calculate health and socioeconomic impacts and monitor trends. The analyses will focus on air
pollution, noise, temperature/heat and lack of green spaces for nearly 1000 European cities. Specificurban and transport planning scenarios will be developed for selected cities and include additional
aspects such as mobility, physical activity and inequities. To achieve greater science-policy impacts,
we will conduct consultation with and provide knowledge translation to cities and stakeholders.
RESULTS:The project started in January 2023 with initial workshop planning. Objective 1 will be
addressed at the kick-off meeting (May 2023) and at the first stakeholder workshop (summer 2023),
while objectives 2 and 3 will be addressed at the second stakeholder workshop (autumn 2023). Data
collection on health and environmental stressors for the 1000 cities has started and will continue
throughout 2023. Additionally, development of case studies has started for Utrecht, the Netherlands,
and Sofia, Bulgaria.
CONCLUSIONS:By improving health impact and socioeconomic costs estimations and engaging withstakeholders we expect to generate impact and promote healthier urban and transport planning
practices in European cities.

Keywords: Health impact assessment, air pollution, noise, green spaces, European cities

MP-030[Chemical exposures » Heavy metals]

A Field Application of an Innovative Digital
Sensor for Arsenic without Reagents andCalibration
Chihchung Liu1, Shenliang Xu2, Haowei Wang2, Jenlin Chang3
1Department of Environmental Technology, Sinotech Environmental Technology, Ltd., Kaohsiung City,

Taiwan2Department of Research and Development, Accusensing Technology Co., Ltd., New Taipei City,

Taiwan3Department of Chemistry, National Chung Hsing University, Taichung City, Taiwan

BACKGROUND AND AIM:This research proposes a digital microfluidic sensor similar to blood glucose
meter, adopting anodic stripping voltammetry(ASV) to rapid test arsenic(III) in water in 180 sec.
without reagent and calibration. Inorganic arsenic is listed as Group 1: "Carcinogenic to humans" by
IARC. In countries such as Taiwan, Bangladesh, India, China, etc. whose groundwater taken as
irrigation or drinking may contains high concentrations of arsenic due to geological conditions, which
put local residents in serious risks of various types of cancer. It is crucial to detect arsenic with atimely, convenient and reliable method.
METHOD:86 groundwater well samples were collected in this study from 4 counties along thesouthwest Taiwan. All 86 samples were tested for arsenic(III) right in field by digital microfluidic
sensor and 45 of them were selected to lab for total arsenic analysis by ICP-OES. The arsenic
microfluidic sensor used in this study has a detection range of 0.03-0.50 mg/L, which is pre-coatedwith reagents and also been calibrated in factory. Users can easily operate it like blood glucose strip infield without adding reagents and calibration. The field data from microfluidic sensor and the lab. datafrom ICP-OES of the same 45 samples will be compared by simple linear regression to evaluate theapplicability of this microfluidic sensor.
RESULTS:The comparison result shows the correlation coefficient r reaches 0.978 and R2=0.9572,
which indicates 〔As3+〕and 〔total As〕 has a strongly linear positive relationship and also
represents the data from microfluidic sensor in field is able to predict the concentration of total As.
CONCLUSIONS:As an innovative rapid digital testing method for arsenic, an user-friendly design ofreagents-free and calibration-free with non-toxic substances contained, this technology can provide
rapid and reliable data for local governments whose water source threaten by arsenic to make a watersupply policy.

Keywords: Heavy metals, Water quality, Epidemiology, Waterborne diseases

MP-031[Chemical exposures » General]

Implementation of Flipped Education to Improve
Home Prevention Chemical Hazard Literacy for
the Elderly within the Community
Chia Lin Ko1, Shiu Yun Fu2, Fuh Yuan Shih3, Brian Mcavan2
1Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Nursing,West Garden Hospital, Taipei City, Taiwan.
2Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
3Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan

BACKGROUND AND AIM:Cleaning and disinfection are one of the most important steps in theprevention of the coronavirus virus. The elderly are a vulnerable population during the Covid-19
pandemic. Therefore, it is vital to help the community elders in learning of the usage and storage ofany chemical disinfectants to prevent chemical hazards within the home setting.
METHOD:This study used purposive sampling, a quasi-experimental research design within
randomized allocation and intervention methods. There were 118 participants who were 65 years orolder individuals involved from Luzhou, District, New Taipei City. The experimental group (n=59)
received the modified flipped education program as the intervention method, and the control group(n=59) maintained a non-experimental regular lifestyle. Both groups filled out the pre-test and 4week post-test questionnaires. The assessments included: Basic Demographic Data, Health Literacy
Questionnaires (HLQ), Chemical Hazard Literacy Scale (CHLS), and Covid-19 Prevention Knowledge
Scale (CPKS).
RESULTS:The modified flipped education results revealed that there was improvements which were
found in the elderly’s knowledge of CPKS (p=0.05) and CHLS (p=0.07) in the intervention group. The
average score of HLQ in the experimental group was 38.12±3.94 which was higher than the control
group (36.85±5.67). The elderly had better knowledge of CPKS, which had relatively improved theCHLS scores (β =0.19, p =0.04). Thus, the dilution of home-based concentrated disinfectant products
increased a higher learning challenge for the elderly within the community.
CONCLUSIONS:A modified flipped education intervention effectively improved the community elder’sknowledge of health literacy, chemical hazard literacy, and Covid-19 prevention. It is essential tocontinue to provide systematic learning activities with the use of interesting but interactive technology
using webpage models or internet applications.

Keywords: Chemical Exposures, COVID-19, Solvents

MP-032[Exposures » Microplastics]

Occurrence and accumulation of microplastics
contamination in freshwater fishes from naturaland farmed sources in Taiwan
Tomohiko Yanagawa1, Wei Hsiang Chang2, Wei Hsuan Hsu1, Ching Chang Lee3
1Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung

University, Tainan 704, Taiwan
2Research Centre of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung

University, Tainan 704, Taiwan
3Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan 704, Taiwan

BACKGROUND AND AIM:The presence of microplastics (MPs) in the marine environment with adiameter less than 5 mm has sparked widespread public concern. Although rivers are potentially the
major transport pathway of MPs pollution to the ocean, accumulation of MPs in freshwater and farmed
fishes is comparatively understudied. This study was carried out to investigate MPs bioaccumulation in
freshwater in 30 major Taiwan’s
rivers and farmed fishes in Southern Taiwan.
METHOD:90 freshwater fishes and 9 farmed fishes of the main species Oreochromis mossambicus
were collected in 30 principal rivers and 4 fish farms. The fish sample's intestine, gills, head, andmuscle were digested by KOH before MPs were isolated using a 5 mm stainless steel sieve. Image J
was used to measure the diameters of the MPs and Raman spectroscopy was used to analyze the MPs'
types. Mann–Whitney U test was used to compare the differences in the amount of MPs between the
freshwater and farmed fishes as well as the different areas in Taiwan. The correlations between theamounts of MPs and the fish characteristics were examined.
RESULTS:The average MPs concentration in 99 fishes was less than 0.01 MPs/g, and the intestine had
the highest MPs level of the four tissues. The most identified polymer of MPs was polyethylene (PE),and followed by polyethylene terephthalate (PET), polystyrene (PS), and polypropylene (PP). The
amount of MPs was positively correlated with the weight of the intestines in the farm fish. There wasno significant
difference in MP amounts between freshwater and farmed fish.
CONCLUSIONS:The freshwater and farmed fishes were highly contaminated with PE plastic. Further
studies are needed to assess the dietary risk of MPs through ingesting these fishes for the Taiwanese
populations.

Keywords: Microplastics, ExposuresMP-033[Built environment » Green space]

Association between Residential Greenness andChildren’s Behavioral Development
Wen Yi Lee1, Ching Chun Lin2, Pau Chung Chen1
1National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taiwan

BACKGROUND AND AIM:With the rapid development of modern society, greenness on earth haslargely decreased. People in urban area are hard to access greenness in their daily lives. However,many studies show a positive association between greenness and health. Among the population,
children are the most sensitive to the environment and the main subjects to protect in sustainable
development. Therefore, we aimed to compare prenatal exposure and postnatal exposure toresidential greenness and children's behavioral development.
METHOD:Participants were from Taiwan Birth Panel Study (TBPS I). A total of 172 infants born in
2004~2005 and their parents were recruited in this study. They were asked to do Children Behavior
Checklist (CBCL) at the age of 2 and 5. Greenness levels were gathered from the image of Landsat 5
within a 250, 500, and 1000 meters radius, counted as Normalized Difference Vegetation Index(NDVI). Multiple linear regression was used to investigate the association.
RESULTS:The participants showed a low level of exposure to greenness because most lived in
Northern Taiwan urban areas. Our study showed a slight negative association between prenatal
exposure and initializing problems, emotionally reactive, somatic complaints, and sleeping problems.
This could only be observed within 250 and 500 meters radius.
CONCLUSIONS:We found a slight negative association might exist between prenatal residential
greenness exposure and the early development of children’s behavioral or emotional problems.
Further research could be conducted to demonstrate the impact and promote a green environment forchildren in urban cities.

Keywords: Residential greenness, Children health, Behavioral development, Neurodevelopment,
Prenatal exposureMP-034[One health » Public health]Study of Home Visiting for Elderly Live Alone
Clients and their Specific Health and Safety
Requirements
Shiu Yun Fu, Hui Lin Hsu, Yi Ching Lin, Yi Yun Chi, Brian Mcavan
Department of Nursing, College of Medicine Fu Jen Catholic University, New Taipei City, Taiwan

BACKGROUND AND AIM:According to a study by the Ministry of Health and Welfare in Taiwan, onethird of the elderly over 65 years old and one-half of the elderly over 80 years old and in a home living
situation have experienced a fall within the previous year. After the fall, they may have suffered somephysical disablement and poorer quality of life.
METHOD:Using the community-engaged research and nurse visit to investigate the elderly’s fall risk
assessment, medication literacy abilities, physiological and mental health outcomes, interaction needs
and environmental health and safety situations within their home. There were 30 elderly people living
alone at home from New Taipei City who were involved in this study.
RESULTS:The results of the study showed that in addition to the problems of aging and normal
physiological deterioration and inappropriate medication usage, other external factors included
wearing unsuitable shoes and clothing, dim lighting, no anti-slip mats, wet and slippery floors,
unassisted bathrooms, floor placement, too much debris, and a generally unsafe home environment.
Elderly people living alone need external support to improve their living needs, but most elderly do not
use relevant long-term care services because they do not understand social welfare resources,
resulting in more serious daily life problems and practices. Most elderly people living alone suffer fromchronic diseases, they often cannot receive timely care when sickness and accidents occur, whichmakes it difficult to recover from their health status, and even worsens.
CONCLUSIONS:We recommend the promotion and the installation of the government initiated “HomeEmergency Rescue System” in the homes of the elderly who live alone. Health professionals will makeregular visits and daily follow-up, and can intervene in a timely manner to provide relevant assistance,
so as to reduce the occurrence of accidents and promote a safer home environment for the elderly
living alone.

Keywords: Community-engaged Research, Mental Health OutcomesMP-035[Built environment » Green space]

Influence of the green view index and evergreen
trees on ambient fine particulate matter in
Tainan City
Ying Jhen Huang1, Ping Hsien Lee2, Yu Ting Lee2, Ta Chien Chan1
1Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei,

Taiwan; Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City, Taiwan
2Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City, Taiwan

BACKGROUND AND AIM:Introducing greenery into urban areas can mitigate air pollution, butconventional green indices, such as the normalized difference vegetation index (NDVI), fail to include
the contributions of green plants and roadside trees at the community level due to insufficient spatial
resolution. To bridge this gap, this study elucidated the difference between the greening index at the
bird’s eye view and the pedestrian perspective in terms of air pollution by comparing NDVI fromsatellites and green view index (GVI) from street view, and evaluated their impacts on PM2.5.
METHOD:We sampled observation points at 30-m intervals following the road network in the Tainan
metropolitan area. NDVI was calculated using satellite data from Landsat 8 with a geographic
resolution of 30 m and MODIS with a spatial resolution of 250 m. We computed GVI by analyzing
760,080 Google Street View images using a deep learning algorithm to extract greenness at horizontal
and vertical angles, spanning a panorama at 0-degree and 45-degree elevation angles. We applied a
multiple linear regression model to assess the relationship between the green index and PM2.5
concentrations from 320 airboxes, and adjusted for 15 land-use related variables with varying buffer
sizes.
RESULTS:In our multiple regression model, GVI and PM2.5 displayed a significant negative association(β= -0.063, p=0.029). No significant association was observed between PM2.5 and NDVI at different
buffer sizes. Among different types of trees, evergreen trees were found to exert a stronger dustcapturing effect on PM2.5 than deciduous trees (β= -2.83, p=0.002).
CONCLUSIONS:The association between increases in GVI and reductions in PM2.5 is significant andsuperior to NDVI. Planting evergreen trees will reduce PM2.5 to a greater extent than planting
deciduous trees. These findings can provide a reference for future urban planning and air quality
improvement.

Keywords: Built environment, Green space, Particulate matter, Big dataMP-036[Built environment » Other (to be specified with keywords in the keywords section)]

Developing Study Protocol to Determine the
Association Between Built Environment Factors
and Physical Activity
Zarirah Adzni Mokhtar, Siti Aisah Mokhtar, Mohd Rafee Baharudin
Department of Community Health, University Putra Malaysia, Serdang, Malaysia

BACKGROUND AND AIM:Physical activity (PA) can prevent and manage NCDs such as heart disease,stroke, diabetes, and some cancers, but over a quarter of the world’s adults are insufficiently active.
Previous studies have found that higher built environment (BE) scores were linked to higher PA levels
in residents of various countries. This cross-sectional study will use objective measures of BE and PA
in Putrajaya. This study aims to examine the relationship between the BE and PA in Putrajaya, theadministrative capital of Malaysia with high prevalence of noncommunicable diseases (NCDs).
METHOD:This protocol follows the Strengthening the Reporting of Observational Studies in
Epidemiology (STROBE) checklist to ensure all recommended elements are addressed. This crosssectional study will investigate how personal and built environment (BE) factors affect physical activity(PA) among adults in Putrajaya. A questionnaire with personal factors and the long-version
International Physical Activity Questionnaire (IPAQ-LF) will measure PA levels. The ArcGIS software
will map respondent distribution based on their house coordinates (longitude and latitude) and the BE
factors of residency and intersection density, land use mix and park access. IBM SPSS software will
analyse the data to predict the factors associated with PA in Putrajaya. Ethical approval from
University Putra Malaysia Ethics Committee will be obtained.
RESULTS:A comprehensive protocol with introduction, methods and analysis and discussion wasdeveloped based on the STROBE checklist. This study expects to find that residents in areas with highresidential and intersection density, high land use mix and closer park access will have higher physicalactivity levels.
CONCLUSIONS:These findings will inform targeted interventions for the community and future town
planning.

Keywords: Built environment, Physical activity, Methodological study design, Epidemiology

MP-037[Outcomes » Obesity and metabolic disorders]

Negative Associations of Cord Blood
Mitochondrial DNA Copy Number with Childhood
Adiposity Trajectories in Children
Aalekhya Reddam1, Tessa R Bloomquist1, Heng Hu1, Sharon E Oberfield2, Dympna Gallagher3, Jeff
Goldsmith4, Andrew G Rundle5, Andrea A Baccarelli1, Julie B Herbstman1, Allison Kupsco1
1Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University,

New York, NY
2Department of Pediatrics, New York-Presbyterian Hospital, Columbia University Medical Center, New

York, NY
3Nutrition Obesity Research Center, Columbia University Medical Center, New York, NY
4Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
5Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

BACKGROUND AND AIM:Mitochondrial DNA copy number (mtDNAcn) is a biomarker representing the
average number of mitochondrial genomes in a cell. Significant changes in mtDNAcn may indicate
mitochondrial dysfunction and can be used as a measure for mitochondrial toxicity or cellular stress.
While alterations in mtDNAcn have been implicated in dysregulated pathways associated with diabetes
and obesity, research has mainly focused on adults and not on children.
METHOD:The study sample included a cohort of Dominican and African American children from
Northern Manhattan and South Bronx, NY recruited from 1998 to 2006. mtDNAcn was measured incord blood and split into low (<33rd percentile), middle (33rd-67th percentile), or high (>67th
percentile) categories. Children were followed up with measurements for height, weight, andbioimpedance at ages 5, 7, 9, and 11 years. Mixed-effects models with random intercepts forparticipants were used to assess associations between mtDNAcn in cord blood and child BMI and BMIz scores. Interactions between mtDNAcn categories and child age or child age squared were used toassess associations between age and adiposity trajectories at different levels of mtDNAcn.
RESULTS:Adjusting for relevant covariates (maternal age, ethnicity, BMI, completion of high school,
previous birth, environmental tobacco smoke exposure, receipt of public assistance, sex, age, age
squared, and DNA input concentration), BMI was on average 1.2 kg/m2 higher (β = 1.2, 95% CI:
0.24, 2.15) and BMIz was on average 0.34 standard deviations higher (β = 0.34, 95% CI: 0.07, 0.62)
in individuals with low mtDNAcn compared to individuals in the middle mtDNAcn group. BMI
trajectories also differed by mtDNAcn level – children beginning life with lower cord blood mtDNAcn
tended to follow a trajectory of higher BMI and BMI z-score.
CONCLUSIONS:Results suggest that lower cord blood mtDNAcn is associated with higher childhood
adiposity in this cohort of Dominican and African American children.

Keywords: mtDNAcn, Childhood Adiposity, biomarker, trajectoryMP-038[Air pollution » Particulate matter]

Associations of home and school-level ambient
air pollution exposures with blood pressure inschoolchildren in Accra, Ghana
Abosede Sarah Alli1, Kate Kyeremateng2, James Nimo2, Nancy Derry2, Prince Anku2, Solomon Baah2,
Gifty Borquaye2, Lilly Adzrakor2, Youssef Oulhoute3, Allison Hughes2, Raphael E Arku1
1Department of Environmental Health Sciences, School of Public Health and Health Sciences,

University of Massachusetts, Amherst, USA
2Department of Physics, University of Ghana, Accra, Ghana
3Department of Epidemiology, School of Public Health and Health Sciences, University of

Massachusetts, Amherst, USA

BACKGROUND AND AIM:Air pollution exposure has been linked to elevated blood pressure (BP) in
adults, but research is limited among children, particularly in sub-Saharan Africa (SSA). We
investigated the effect of long-term exposure to ambient fine particulate matter (PM₂.₅) and black
carbon (BC) on BP in schoolchildren in Accra, Ghana, one of the fastest growing cities in SSA.
METHOD:We performed a cross-sectional analysis among 502 (57% girls) schoolchildren aged 8-12
years across 50 (39% private) schools. Home- and school-level PM₂.₅ and BC exposures were
estimated using recently developed spatiotemporal empirical models for Accra. Additionally, weeklong
PM₂.₅ samples collected in school yards were compared with model-predicted exposures. Mixedeffects linear and logistic regression models were used to investigate the associations.
RESULTS:The mean systolic and diastolic BP among the children were 107.5 (9.6) and 69.4 (7.1)
mmHg, respectively. BP was higher in overweight/obese children (33%) and in public schools. 34% of
the children had elevated BP, with a higher proportion in those living in poorer homes. Children’s
PM₂.₅ exposure at both home and school were 5-8 times the World Health Organization annual
guideline of 5 μg/m³, and BC levels were above the maximum value in the “good practice statement
for BC” (5.1 μg/m³). The measured PM₂.₅ was moderately correlated with corresponding modelpredicted values (r=0.58). In adjusted models, children living in more polluted areas (≥75th
percentile) had 2.16 mmHg (95% CI: -4.13, -0.18) and 1.66 mmHg (95% CI: -3.11, -0.22) lower
systolic and diastolic BP, respectively, compared to those in less polluted areas, but the odds of having
elevated BP were similar in the two exposure groups.
CONCLUSIONS:Our interim analyses showed no evidence of pro-hypertensive effect of long-term
exposure to PM₂.₅ and BC pollution among schoolchildren in Accra. Childhood obesity and poverty
may be the main determinant of BP in Accra children.

Keywords: Black Carbon, Children's environmental health, Childhood hypertension, Environmental
Epidemiology, Ghana

MP-039[Exposures » Environmental disparities]

Prevalence of hookah smoking and associatedfactors among male high school students in Iraq
Ahmed Khalaf Al Delaimy1, Waleed At Al Ani2
1Department of family and community medicine, Al-Anbar University, Ramadi, Iraq
2Department of family and community medicine, Al-Mustansiriya University, Baghdad, Iraq

BACKGROUND AND AIM:The use of the hookah-smoking device is increasing in the Eastern
Mediterranean region. The purpose of this study was to determine the prevalence of hookah use
among male high school students in the region and to study different associated factors in order toprovide local tobacco control officials with an understanding of this public health problem.
METHOD:A convenient non-probability sampling study was conducted among students in three highschools in Al-Karkh district, Baghdad. The study included 847 male students aged 15–18years old.
Using a simple random technique to select the high schools from a list of schools. Bivariate, andmultivariate logistic regression analyses of data were carried out for identifying the risk factors
associated with hookah smoking among these high school adolescent males.
RESULTS:The overall prevalence of hookah smoking in the last 30days among male high school
students was 46.1%. More than two-thirds (70.6%) of the students thought that hookah smoking wasmore socially acceptable than cigarette smoking. Factors such as having first heard about it fromfriends, and the presence of a hookah café near their residence were significantly associated (p>0.05) with hookah smoking among the students. Similarly, being surrounded by friends who usedhookah was also found to be significantly associated with hookah smoking, with an odds ratio of 0.18,
95% CI (0.087–0.394). Hookah smokers were less likely than non-hookah smokers to report its use
as forbidden in Islam and more likely to say it is allowed in Islam.
CONCLUSIONS:We found an alarmingly high use of hookah smoking among male high school students
in this study. Family members and peers had an important role in the prevention of hookah smoking
among these students. There is a need for students to be educated about the toxicity of hookah
tobacco smoking and its direct effect on their health.

Keywords: Prevalence, Hookah use, High school students, Risk factors, Iraq

MP-040[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Interaction between long-term air pollution
exposure and neighbourhood unemployment on
cognitive functions in Central-European aging
population
Andrea Dalecká1, Daniel Szabó1, Albert Kšiňan1, Hynek Pikhart2, Naděžda Čapková3, Martin Bobák2
1RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
2Institute of Epidemiology & Health Care, University College London, London, United Kingdom;

RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
3National Institute of Health, Prague, Czech Republic

BACKGROUND AND AIM:Current evidence suggests that long-term air pollution (AP) exposure as wellas living in disadvantaged neighbourhoods may be associated with impaired cognitive functions.
However, little is known about the potential interactive effect of these factors. This study examined
the joint effects of AP exposure and neighbourhood unemployment rate (NUR) on cognitive function inan urban aging population.
METHOD:Cross-sectional sample of the Czech arm of the HAPIEE cohort included 4,343 participants
aged 45-69 years at baseline (2002-2005). Europe-wide land-use regression model was used toestimate 3-year (2000-2003) average concentrations of PM10 and PM2.5. NUR was measured for eachbasic administrative unit (N=128). Both AP and NUR were linked to participants’ residential addresses.
Cognitive assessment included memory, verbal fluency and concentration, from which we computed afactor score reflecting a general cognitive function. Hierarchical linear modelling was conducted to
examine the effects of AP exposure (first level) and NUR (second level) on cognition. Cross-levelinteraction was estimated to test for possible effect modification. All models estimated standardised β
coefficients adjusted for age, sex, education, marital status, individual deprivation, smoking, physicalactivity, chronic disease, and depression.
RESULTS:Impaired cognitive function was observed in participants living in areas with higher
concentrations of PM10 (β=-0.202, p<0.001), PM2.5 (β=-0.226, p<0.001) and NUR (β=-0.087,
p<0.001) compared to those living in less polluted and less disadvantageous areas. There was asignificant cross-level interaction between AP and NUR (β=0.162, p<0.001) whereby the effect of AP
on cognition was attenuated in neighbourhoods with higher NUR.
CONCLUSIONS:Our results suggest that living in both air polluted areas and socially disadvantaged
areas has negative effect on cognitive performance. Complex interactions between environmental andsocial exposures should be further investigated.
Funding: European Union’s Horizon 2020 research and innovation programme: No 857487 and The
NPO „Systemic Risk Institute“ (Programme EXCELES, No. LX22NPO5101).

Keywords: Particulate matter, Cognitive functions, Socio-economic deprivation, Aging, Multi-level
analysisMP-041[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Muscular and nervous system emergency
department visits during a hydrogen sulfide
emergency in Southern Los Angeles County, CA,
USA
Arbor J. Quist, Jill E. Johnston
Department of Population and Public Health Sciences, University of Southern California, Los Angeles,
California, USA

BACKGROUND AND AIM:In October 2021, thousands of residents in Carson, California begancomplaining of noxious odor and headaches. Hydrogen sulfide (H2S), a toxic odorous gas, wasmeasured at concentrations up to 7000 parts per billion (ppb) and remained above California’s acute
air quality standard of 30 ppb for 4 weeks. Residents complained of various symptoms, from dizzinessand nausea to muscle weakness, and want to understand the event’s impact on health. Because
existing research on the health effect of low-level H2S exposure has yielded conflicting results, weaimed to assess the acute neurological and muscular effects of this H2S emergency. Few studies haveexamined how H2S emergencies affect diverse communities like Carson.
METHOD:We calculated daily rates of emergency department (ED) visits for diseases of the nervous
system and muscular system in Carson area ZIP codes (<8 km from Carson) and in Los Angeles
County ZIP codes >20 km from Carson (control). Using controlled interrupted time series, we
compared ED visit rates during the 4 weeks of the H2S incident in Carson to the predicted rates had
this event not occurred, based on 2018-2021 ED trends, and controlling for ED visit rate changes incontrol areas of Los Angeles County.
RESULTS:We observed a 13% increase (rate ratio (RR): 1.13, 95% CI: 1.04, 1.22) in ED visit rate fordiseases of the nervous system and a 9% increase (RR=1.09, 95% CI: 1.03, 1.15) for diseases of themuscular system in Carson during the 4 weeks of the event. Specifically, these increases weregreatest for visits for chronic pain (RR=1.19, 95% CI: 1.05, 1.24) and osteoarthritis (RR=1.24, 95%
CI: 1.06, 1.41).
CONCLUSIONS:Malodors, like H2S, are an understudied environmental justice issue. H2S releases canharm the nervous and muscular system, even at low and medium exposure levels.

Keywords: Chemical exposures, environmental justiceMP-042[Respiratory and allergic outcomes » Asthma]

Mixture effects of particle components on
asthma in children and adults in the UnitedStates between 2000 and 2016
Bryan N Vu1, Heresh Amini2, Xinye Qiu1, Yijing Feng3, Yaguang Wei1, Joel Schwartz1
1Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
2Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Air pollutants including PM2.5 and ozone has been shown to adversely affectasthma exacerbation in people of all ages. However, few studies have investigated the long-term
exposure of particle components in conjunction with nitrogen dioxide and ozone to assess their
mixture effects. We aim to utilize weighted quantile sum regression to assess the cumulative effects ofmajor particle components including organic carbon (OC), elemental carbon (EC), nitrate, sulfate, andammonium, along with nitrogen dioxide and ozone, on counts of inpatient asthma hospitalizations forchildren ages 0 to 18 and adults ages 19 to 64 years.
METHOD:Inpatient records for asthma hospitalizations were collected from the State Inpatient
Databases which included hospitals from 12 U.S. states ranging in years from 2000 through 2016. Wealso included temperature from Daymet and variables from the U.S. census to control for socioeconomic status. All variables were aggregated to the annual level.
RESULTS:We observed an increase of 6.4% (95%CI: 6.3%,6.6%) and 6.6% (95%CI: 6.4%,6.7%) in
the number of asthma inpatient hospitalizations each year for each decile increase of the pollutant
mixture in children ages zero to 18 and adults ages 19 to 64, respectively. Sulfate, nitrate, andammonium contributed the most weight to the pollutant mixture.
CONCLUSIONS:Our results indicate that long-term exposure to pollutant mixtures result in increased
asthma hospitalizations in both children and adults, and daily measurements of particle components
data is needed to assess short-term exposure.

Keywords: Asthma, PM Components, NO2, Ozone, WQS

MP-043[Chemical exposures » Mixtures]

Neurobehavioral effects of gestational exposure
to mixtures of non-persistent endocrine
disruptors in preschoolers of the ECHO Program
Dorothy Nakiwala1, John L Adgate2, Greta Wilkening3, Emily S Barrett4, Akhgar Ghassabian5, Douglas
M Ruden6, Susan L Schantz7, Anne Anne Dunlop8, Patricia A Brennan9, Deborah H Glueck1, Dana
Dabelea1, Anne Starling10, Program Collaborators For The Environmental Influences On Child Health
Outcomes Program11
1Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado, Anschutz

Medical Campus, Aurora, CO, USA
2Department of Environmental and Occupational Health, Colorado School of Public Health, Universityof Colorado Anschutz Medical Campus
3Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical

Campus4Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental andOccupational Health Sciences Institute, Rutgers, the State University of New Jersey, Piscataway, New
Jersey5Departments of Pediatrics and Population Health, New York University Grossman School of Medicine,

New York, NY, USA
6Institute of Environmental Health Sciences, C. S. Mott Center for Human Health and Development,

Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States.
7University of Illinois at Urbana-Champaign, Beckman Institute for Advanced Science and Technology,

405 N Mathews, Urbana, IL 61801, USA
8Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, UnitedStates.
9Psychology Department, Emory University, Atlanta, GA, United States
10Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado, Anschutz

Medical Campus, Aurora, CO, USA; Department of Epidemiology, University of North Carolina-Chapel
Hill, Chapel Hill, NC, USA
11The Environmental influences on Child Health Outcome (ECHO) Program

BACKGROUND AND AIM:Exposures to phthalates and synthetic phenols are common among pregnant
women in the US. Previous studies on the neurotoxicity of these compounds primarily assessedindividual compound effects on behavior, ignoring potential combined effects. We assessed
associations between prenatal exposure to a mixture of phthalates and phenols with behavioral scoresamong preschool age children from three pediatric cohorts participating in the Environmental
influences on Child Health Outcome (ECHO) Program.
METHOD:The study sample included 1426 mother-child pairs from three cohorts in the ECHO programwith available biomonitoring data on 10 phenols and 11 phthalate metabolites during pregnancy, alongwith caregiver reported Child Behavioral Checklist Ages 1½ to 5 (CBCL) data. Using covariate-adjusted
weighted quantile sum (WQS), we estimated the associations between the phenol/phthalate mixture
and the CBCL total problem scores and two broadband scores of internalizing and externalizing
problems. Missing covariate data were imputed using multiple imputation.

RESULTS:While the association between the phenol and phthalates mixture with the externalizing
scores was positive in both sexes (beta = 0.02, 95% CI: -0.2; 0.26), it only reached statisticalsignificance in males. A quantile increase in the WQS index was associated with a 0.04 (95% CI: 0.07;
0.0,) points increase in the externalizing score in males. The major contributors to this mixture effectwere methylparaben (with a weight of 33%), Mono-hydroxyisobutyl phthalate (MHiBP, 11%) andBenzophenone-3 (10%). No statistically significant associations were observed with the Total orInternalizing composite scores in either sex or the combined group.
CONCLUSIONS:Our findings suggest that gestational exposure to synthetic phenol and phthalate
metabolite mixtures may contribute to alterations in childhood externalizing behavior especiallyamong males, especially acting out behaviors. These results contribute to the growing body ofevidence on the potential cumulative effects of these compounds and highlight the need for policies
that address mixture exposures.

Keywords: Mixtures, Endocrine disrupting chemicals, Phenols, Phthalates,

MP-044[Birth and pregnancy outcomes » Birth outcomes]

In-utero exposure to ambient PM2.5 and the riskof low birth weight in India
Ekta Chaudhary1, Sagnik Dey1, Franciosalgeo Franciosalgeo2, Santu Ghosh2
1Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi, India
2St. John’s Medical College, Bengaluru, India

BACKGROUND AND AIM:Low birthweight (LBW) attributable to fine particulate matter (PM2.5)
exposure has become a global threat affecting the health of children, particularly in low- and middleincome countries (LMICs). Growing concerns have been raised regarding the association between inutero PM2.5 exposure and LBW, however little is known about which specific exposure window
contributes to LBW. Here, we examined the association between PM2.5 exposure during different
gestational phases on LBW in India.
METHOD:The birth weight records and socio-demographic details were collected from the National
Family Health Survey version 5 (2019-2021). For the In-utero PM2.5 exposure, we used a satellitederived national database at 1-km2 resolution (Dey et al.,2020). We used a generalized linear
regression model adjusted with risk factors such as wealth index, religion, residence type(urban/rural), type of cooking fuel, mother’s hemoglobin level, education, and BMI. Further, weestimated the interaction of the season of conception and type of cooking fuel (clean versus unclean)on the association.
RESULTS:The estimated mean values of PM2.5 exposure during the entire pregnancy and threetrimesters were 61.47, 63.98, 58.33, and 59.07 μg/m3, respectively. The LBW prevalence wasincreased with a 10 μg/m3 increment in PM2.5 for the first trimester (OR = 1.022, 95% CI: 1.01,
1.04), the second trimester (OR = 1.017;1.0, 1.03), the third trimester (OR = 1.019; 1.01, 1.03), andthe entire pregnancy (OR = 1.04; 1.02, 1.06). Further, the interaction analysis showed a higher OR of
LBW prevalence under unclean fuel conditions than the clean fuel throughout the in-utero exposure.
Mothers who conceived during the winter season showed a higher risk of LBW in their new-born.
CONCLUSIONS:Our findings suggest that in-utero exposure to PM2.5 could be associated with the riskof LBW in the context of high pollution levels of PM2.5, and the trimester 1 and 3 were identified as
potentially relevant exposure windows.

Keywords: Birth and pregnancy outcomes, LBW, PM2.5, in-utero exposure, air pollution

MP-045[Air pollution » Long-term exposure]

Association between long-term PM2.5 exposureand risk of Kawasaki disease in children:
nationwide longitudinal cohort study
Hanna Kim1, Hyemin Jang2, Jongmin Oh3, Jung Won Lee4, Hae Soon Kim4, Whanhee Lee5, Ji Hyen
Lee4, Eun Hee Ha6
1Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; CHildren's Environmental health Clinic in Korea (CHECK), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
2Graduate School of Public Health, Seoul National University. Seoul, Republic of Korea; Institute of

Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul,
Republic of Korea
3Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea
4Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic of Korea;

CHildren's Environmental health Clinic in Korea (CHECK), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
5School of Biomedical Converegence Engineering, Pusan National University, Yangsan, Republic ofKorea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans
University, Seoul, Republic of Korea
6Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science andEngineering, Ewha Womans University, Ewha Medical Research Institute, College of Medicine, Seoul,
Republic of Korea

BACKGROUND AND AIM:Based on the previous studies that have suggested air pollution as a potential
risk factor for Kawasaki Disease, we examined the association of long-term exposure to childhood fineparticulate matter (PM2.5) with the risk of Kawasaki disease (KD).
METHOD:We used the National Health Insurance Service-National Sample Cohort (NHIS-NSC)
spanning from 2002 to 2019, consisting of one million beneficiaries representative of the entire
population living in South Korea. Beneficiaries were systemically enrolled in the cohort from the timethey were born and followed up until age 5. The onset of KD was defined as the first hospital visit
record with a primary diagnostic code based on the International Classification of Disease (ICD-10:30.3). We also defined the onset of KD with intravenous immunoglobulin (IVIG) prescription. As PM2.5
exposures, we used a machine learning-based ensemble prediction model with a spatial resolution of 1
km2 and allocated the district-specific annual average concentration of PM2.5 across all 229 districtsin South Korea. We estimated the association between PM2.5 and the onset of KD with a time-varying
Cox proportional hazard model with an adjustment for age, sex, socioeconomic status, region, andcommunity level indicators.
RESULTS:Our study included 134,634 individuals aged five or younger (1,685 KD onsets and 685 KD
onsets with IVIG prescription). The annual exposure to PM2.5 was associated with an increased risk of
KD onset (HR 1.130; 95% CI 1.002 to 1.273 per 5 ㎍/m³ increase) as well as with KD onset with IVIG
(HR 1.422; 95% CI 0.963 to 2.100 per 5 ㎍/m³ increase).
CONCLUSIONS:In this nationwide, population-based cohort study, long-term childhood exposure toPM2.5 was associated with an increased incidence of KD in children. These results indicate theplausible mechanisms of air pollution and KD, and further studies are needed to confirm our findings.

Keywords: Particulate matter, Long-term exposure, Children's environmental healthMP-046[Air pollution » Particulate matter]

Prenatal air pollution exposure andmitochondrial DNA copy number at birth, asystematic review and meta-analysis
Holly Nguyen, Sydney Powell, Theresa M. Bastain, Shohreh F. Farzan, Carrie V. Breton, Zhongzheng
Niu
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA

BACKGROUND AND AIM:Mitochondria play a crucial role in cellular bioenergetics and signaling cellfate. Mitochondrial DNA copy number (mtDNAcn), a widely used measure of mitochondrial function,
may be impacted by air pollution exposure, particularly during sensitive life stages, such as in fetal
development.
METHOD:We systematically searched two databases (PubMed and Embase) for English- language
articles published through January 20th, 2023, that examined the association of prenatal air pollution
exposure with birth mtDNAcn. We excluded full-text articles lacking complete information on air
pollution exposure or mtDNAcn. We extracted data on the study population, air pollutant type,
exposure duration and level, mtDNAcn measurement quality, and effect estimation. We evaluatedstudy quality using a tailored Newcastle-Ottawa Scale and used random-effect models to combine
effect estimates.
RESULTS:We ultimately included nine articles (out of 177 identified) with 2,955 participants from allcontinents. These studies were designed as cross-sectional, prospective, or experimental, with moststudies having a medium-quality score. Birth mtDNAcn was measured from cord blood, the placenta,
or both, all with real-time polymerase chain reaction but using different primers. PM2.5, with levels
ranging from 6.2 to 167.0 mg/m³, was the most assessed air pollutant. Therefore, we conducted ameta-analysis of five studies (with significant heterogeneity, I² =80.78, P<0.05) and found a -1.50%(95% CI: -2.78, -0.22) reduction in birth mtDNAcn by each 1 mg/m³ increase in prenatal PM 2.5
exposure throughout pregnancy. Other sporadically examined air pollutants included PM10, nitrogendioxide, ozone, sulfur dioxide, carbon monoxide, and polycyclic aromatic hydrocarbons, withinconsistent associations with mtDNAcn. Meta- analyses on these air pollutants were not conducted
due to the small number of studies (N<3).
CONCLUSIONS:In this systematic review, we found prenatal air pollution exposure to PM 2.5 was
associated with lower birth mtDNAcn. Studies on the birth mtDNAcn effect of other air pollutants arestill limited.

Keywords: air pollution, mtDNAcn, systematic review, meta-analysis, prenatal

MP-047[Chemical exposures » Fluoride]Long-term effects of prenatal fluoride and lead
exposure on educational delay in Mexico
Jose Luis Figueroa1, Sergio Bautista Arredondo1, Alvarez Sandra1, Peterson E. Karen2, Bashash
Morteza3, Till Christine4, Martinez Mier E. Angeles5, Téllez Rojo Martha María6, Hu Howard7
1Division of Health Economics and Health Systems Innovation, National Institute of Public Health,Cuernavaca, Mexico
2Department of Nutritional Sciences, School of Public Health, University of Michingan, Ann Arbor,

United States
3Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
4Department of Psychology, Faculty of Health, York University, Toronto, Canada
5School of Dentistry, Indiana University, Indianapolis, United States
6Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
7Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, United States

BACKGROUND AND AIM:Detrimental effects of prenatal fluoride exposure on children's cognitive
development have been recently described. However, no studies have investigated associations
between prenatal fluoride exposure and long-term effects on educational attainment. We aim toinvestigate the long-term impact of prenatal fluoride and lead exposure on a key predictor of socialand economic well-being: school delay.
METHOD:We analyzed longitudinal data from 283 mother-child pairs in the Early Life Exposures in
Mexico to Environmental Toxicants (ELEMENT) cohort. We measured maternal urinary fluoride
concentrations adjusted for creatinine and averaged across trimesters, and educational attainment on
their children between ages 10 and 18. We operationalized school delay by comparing the highest
grade completed with the grade children should have completed by the time they were surveyed.
RESULTS:Mean (SD) maternal urinary fluoride and blood lead concentrations were 0.91(0.44) mg/L
and 5.28(3.3) µg/dL, respectively; 9.6% of children demonstrated school delay (6.3% one year, 2.1%
two years, and 1% three years). Using Poisson multivariate regression, we found that a one standard
deviation increase in urinary fluoride concentration was associated with an increased risk of school
delay of 1.56 (95% CI: 1.06, 2.27) controlling for sex, maternal and child age, maternal education,socioeconomic status, and maternal lead in blood. In the same model, maternal blood lead level also
predicted a higher risk of school delay, with a one standard deviation increase in blood lead associatedwith an increase in the risk of school delay of 1.35 (95% CI: 0.95, 1.89).
CONCLUSIONS:Both prenatal fluoride and lead exposure have independent detrimental effects on thelevel of educational attainment in children and adolescents. Findings suggest that prenatal fluoride
exposure may increase the risk of school delay. This is the first study to document fluoride exposureon school outcomes.
Funding: U.S. NIH R01ES021446, NIH R01-ES007821, NIEHS/EPA P01ES022844, NIEHS P42ES05947, NIEHS Center Grant P30ES017885

Keywords: fluoride, lead, prenatal exposure, epidemiology, education.

MP-048[Exposures » Multi-pollutant/Multi-media]

Association between nicotine urinary andexposure factors among children exposed tosecondhand smoking in an urban household,
Bangkok, Thailand
Jadsada Kunno1, Mark Gregory Robson Robson2
1Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital,

Navamindradhiraj University, Bangkok, Thailand.
2School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey,

USA.

BACKGROUND AND AIM:Tobacco use is the most important preventable cause of premature morbidity
and mortality in young children. The purpose of this study was to investigate on children secondhand
smoking among children in urban households and urinary nicotine metabolite concentrations areassociated with exposure factors.
METHOD:Children aged 2-4 years provided a urine sample (n = 85). Parent completed thequestionnaires. We focus on children secondhand smoking living at household all time in urban
community. Urine sample were analyzed for nicotine metabolite concentration by using enzyme-linked
immunosorbent assay kit (ELISA). In a univariable and multivariable analysis, we analyzed
associations between exposure factors and the proportion of urinary nicotine metabolites.
RESULTS:All young children had detectable nicotine metabolite concentrations (range: 0.01-6.88
ng/mL). The multiple logistic regression test presented an association between exposure factors andnicotine metabolite concentration. Time period of smoker (≥ 10 years smoking) presented a significant
association with young children's nicotine metabolite concentration (p-value = 0.024, OR = 4.495,
95% CI 1.218–16.596).
CONCLUSIONS:Suggestions to reduce the risk of long-term tobacco exposure to children living inurban households include increased education, awareness, and management.

Keywords: nicotine urinary, children, secondhand-smoking, urban household

MP-049[Chemical exposures » Pesticides]

Urinary Organophosphate and Neonicotinoid
Metabolites in relation to Sex and Adrenal
Hormones among Adolescents living in Ecuador
Briana Nc Chronister1, Denise Justo1, Dolores Lopez Paredes2, Eduardo Gonzalez1, Jose Suarez
Torres2, Sheila Gahagan3, Danilo Martinez2, David R Jacobs Jr.4, Harvey Checkoway1, Jose R. Suarez
Lopez1
1The Herbert Wertheim School of Public Health and Human Longevity Science, University of California,

San Diego, La Jolla, CA, 92093, USA
2Fundación Cimas del Ecuador, Quito, Ecuador
3Department of Pediatrics, University of California, San Diego, La Jolla, CA, 92093, USA
4School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA

BACKGROUND AND AIM:Organophosphate (OP) and neonicotinoid (NNI) insecticides have caused
adrenal and gonadal hormone disruption in animal and in vitro studies; limited epidemiologic evidence
in humans exists. We assessed relationships between insecticide metabolites with adrenal and gonadal
hormones in adolescents living in agricultural communities in Ecuador.
METHOD:We examined 522 adolescents (11-17y, 49% male) in 2016. We measured urinary
concentrations of three OPs (3,5,6-trichloro-2-pyridinol [TCPy], malathion dicarboxylic acid [MDA],
and para-nitrophenol [PNP]), two NNIs (acetamiprid-N-desmethyl [AND] and 5-hydroxy imidacloprid[OHIM]), and salivary 17β-estradiol (boys only), dehydroepiandrosterone (DHEA), testosterone, andcortisol. We imputed concentrations below the detection limit using multiple imputation. Linear
regression models assessed associations between ln-metabolite and ln-hormone concentrations (β=%hormone difference per 50% increase of pesticide concentration), and were stratified by gender.
Curvilinearity was assessed by testing squared terms in the linear models. Bayesian kernel machine
regression assessed interactions. All models adjusted for age, race, saliva time minus awakening time,BMI-for-age z-score and tanner score.
RESULTS:The organophosphate MDA had positive associations with testosterone (βboys=5.88%[1.21%, 10.78%], βgirls=4.10% [-0.02%, 8.39%]), and borderline positive associations, in boys only,with cortisol (βboys=6.06 [-0.23%, 12.75%], The organophosphate PNP had negatively-trending
curvilinear associations, among boys only, with testosterone (β²boys=-0.17 (-0.33, -0.003), p=0.04)
and DHEA (β²boys=-0.49 (-0.80, -0.19), p=0.001). The neonicotinoid summary score (βboys=5.60%[0.14%, 11.36%]) and the neonicotinoid AND (βboys=3.90% [1.28%, 6.58%]) were positively
associated with 17β-estradiol. In girls, bivariate response associations identified interactions between
the three organophosphate metabolites (MDA, PNP, and 3,5,6-Trichloro-2-pyridinol) on DHEA andtestosterone concentrations. In boys, we observed an interaction between MDA and PNP for the DHEA
association.
CONCLUSIONS:We observed evidence of endocrine disruption with organophosphate andneonicotinoid exposures in adolescents. Urinary organophosphate metabolites were associatednegatively with DHEA and positively with testosterone concentrations, with stronger associations inboys than girls. Urinary neonicotinoids were positively associated with 17β-estradiol. Replication is
warranted.

Keywords: endocrine disrupting chemicals, pesticides, environmental epidemiology, Children'senvironmental health, MIxtures analysis

MP-050[Exposures » Other (to be specified with keywords in the keywords section)]

Preliminary Analysis of Chemical and NonChemical Stressors Collected from Mother-Child
Pairs in the National Children’s Study
Nicolle S Tulve1, Jacob Donovan2, Kent Thomas1
1Center for Public Health and Environmental Assessment, Office of Research and Development, U.S.

Environmental Protection Agency, Research Triangle Park, NC, USA
2Oak Ridge Associated Universities, National Student Services Contractor, Assigned to Center for

Public and Environmental Assessment, Office of Research and Development, U.S. Environmental
Protection Agency, Research Triangle Park, NC, USA

BACKGROUND AND AIM:Children are exposed to diverse chemical and non-chemical stressors found intheir everyday community environment. These stressors, individually and in combination, are thought
to contribute to their health and well-being during each developmental stage throughout theirlifecourse. Our research approach considers how these complex interrelationships interact to affecthealth and well-being. The National Children’s Study Vanguard Study database contains a wide arrayof environmental, survey, and outcome data collected from approximately 6,000 mothers who
participated in the pilot studies from 2009-2014. This database provides a robust dataset to explore
analytical approaches for combining and assessing both quantitative and qualitative information as it
relates to explaining health outcomes for children in secondary data analyses.
METHOD:We used the nationally standardized PRAPARE (Protocol for Responding to and Assessing
Patients' Assets, Risks, and Experiences) tool to organize our demographic and non-chemical stressors
into social determinant of health clusters with associated scores. We examined relationships between
PRAPARE scores with the chemical exposure information derived from maternal biomarker andresidential measurements. All information was then examined to assess associations with selectedchildren’s health outcomes.
RESULTS:Because health outcomes are often associated with many stressors and demographic
variables, we used supporting information from the literature to focus our preliminary analysis on birthweight. Birth weight has been associated with exposure to many chemical stressors including PAHs,
phthalates, pesticides, metals, and other consumer product chemicals all of which were included in the
NCS dataset.
CONCLUSIONS:This presentation will highlight our preliminary analysis to better understandcumulative exposures and risks.

Keywords: chemical, non-chemical, children, cumulative

MP-051[Exposome » General]

An exposome-wide approach oforganophosphate flame retardants in the
Taiwanese population: Parent-child pairsinteraction and potential health risk
Pei Yu Wu1, Wei Hsiang Chang2
1Department of Food Safety/Hygiene and Risk Management, Medical College, National Cheng Kung

University, Tainan 701401, Taiwan
2Department of Food Safety/Hygiene and Risk Management, Medical College, National Cheng Kung

University, Tainan 701401, Taiwan；Research Center of Environmental Trace Toxic Substances,
National Cheng Kung University, Tainan 701401, Taiwan

BACKGROUND AND AIM:Organophosphate flame retardants (OPFRs) are substitutes forpolybrominated diphenyl ethers and are widely used as flame retardants and plasticizers in thecommercial products. Human exposure to OPFRs has been raised the great concern due toassociations with adverse health effects, especially in susceptible populations. In this study, total bodyburden and interaction of four exposure pathways of OPFRs were investigated for Parent-child pairs.
METHOD:11 OPFRs of residential environmental matrices (air, dust and skin wipe), selected foodsamples and the corresponding urinary metabolites were measured for 89 healthy children and theirpaired parents. The Average daily dose of adults and children through indoor and outdoor inhalation
exposure, house dust ingestion and dermal exposure were estimated respectively. The total daily
intake of OPFRs was back estimated using urinary OPFRs metabolites. The correlations between the
OPFRs in four major pathways as well as the external and internal dose were explored.
RESULTS:The average daily exposure dose of Σ11OPFRs for adults and children via inhalation ofindoor air (5.08×10-4 to 9.17×10-2 µg/kg bw/day), inhalation of outdoor air (2.12×10-4 to 1.78×102 µg/kg bw/day), ingestion of dust (1.11×10-5 to 8.45×10-3 µg/kg bw/day), dermal sorption(7.50×10-4 to 1.05 µg/kg bw/day) and ingestion of foods (2.09×10-2 to 4.79×10-1 µg/kg bw/day)were estimated respectively, which suggested that dermal sorption is an important source of human
exposure to OPFRs. Tributoxyethyl phosphate and Tri(1-chloro-2-propyl) phosphate showed the mostabundant in all exposure pathways. The positive correlations of external (air inhalation and dermal
sorption) and internal intake were found in TDCIPP and TBP.
CONCLUSIONS:Dermal absorption is the main exposure pathway of OPFRs but inhalation ofindoor/outdoor air and ingestion of house dust cannot be ignored. Exposure to OPFRs in different age
and sex groups in Taiwan posed no potential health risk through all exposure pathways.

Keywords: Exposures, Chemical exposures, Risk assessment

MP-052[Policy » Policy research]

Pathways for India to reduce air pollution healthburden and meet sustainable development goal
3.4 target
Sagnik Dey1, Debajit Sarkar1, Fahad Imam1, Alok Kumar1, Akash Mukherjee2, Pallav Purohit3, Gregor
Kiesewetter3, Zbiginiew Klimont3
1Centre of Atmospheric Sciences, Indian Institute of Technology Delhi, India
2School of Public Policy, Indian Institute of Technology Delhi, India
3International Institute for Applied Systems Analysis, Vienna, Austria

BACKGROUND AND AIM:Whether India's recent efforts to reduce PM2.5 exposure would reduce healthburden and what India should do to meet the sustainable development goal (SDG) 3.4 target of
reducing non-communicable disease burden by one-third in 2030 (relative to 2015) are not known.
Here we estimate the health benefits of reducing PM2.5 exposure following three pathways and set
exposure reduction targets for India to meet SDG3.4 goal.
METHOD:We simulate PM2.5 exposure using the GAINS model in 2015 (baseline) and in 2030 for the
scenarios - business-as-usual (BAU), advanced control technology (ACT), and sustainable
development scenario (SDS). We project age-distributed population data based on the census andproject the disease-specific baseline mortality based on the past trends. Finally, we estimate themortality burden attributable to ambient PM2.5 for the baseline and near future apportioned to
sectoral emissions.
RESULTS:We find that if India meets the national ambient air quality standard or the next WHOinterim targets, IT) in 2030, 13 states from north-east and Peninsular India would achieve the SDG
target. In a few states, the health burden would increase because the projected rise in baseline
mortality and population would over-compensate the benefit of exposure reduction. We show that
exposure reduction targets are unrealistic for many states even if the SDS scenario (the best among
the three) is followed. In this scenario, regional contributions and the contributions from residential
and commercial sectors and secondary precursors would drastically reduce. The burden would
increase in the BAU scenario and marginally decrease in the ACT scenario.
CONCLUSIONS:India would substantially gain by meeting the clean air targets but would remain far
away from meeting the SDG3.4 target in 2030. Policies aiming to reduce exposure alone would not be
sufficient; baseline mortality needs to be reduced by strengthening the healthcare system toaccelerate progress towards the SDG3.4 goal.

Keywords: SDG3.4, air pollution, health burden, India, pathways

MP-053[Air pollution » Particulate matter]

The toxic effects with cotreatment of PM2.5 andhigh glucose in A549 Lung Cancer Cells
Yu Ting Chang1, How Ran Chao1, Jian He Lu2
1Department of Environmental Science and Engineering, National Pingtung University of Science andTechnology, Neipu, Pingtung 91201, Taiwan
2General Research Service Center of National Pingtung University Science and Technology, Neipu,

Pingtung 91201, Taiwan

BACKGROUND AND AIM:This study aimed to investigate the health risk of PM2.5, with/without highglucose exposure on lung cancer cells A549.
METHOD:In this experiment, PM2.5 and high glucose were firstly exposed to A549 cells, and then coexposed to selected toxic concentrations to measure cell growth, cell apoptosis and wound healing in
A549 cells. The study involved exposing A549 lung cancer cells to varying concentrations of PM2.5(control, 10, 20, 50, 100 µg/mL) and glucose (control, 20, 40, 80, 120 mM). After analyzing theresults, a concentration of 80 mM glucose and 50 µg/mL PM2.5 were selected for co-exposure toassess whether the combined exposure to PM2.5 and high glucose levels would result in higher
toxicity.
RESULTS:The results showed that 10-100 µg/mL PM2.5, or 20-120 mM glucose exposure significant
decreased A549 cell lines growth and wound healing, but increased mortality compared with thecontrol group. In addition, 50 µg/mL PM2.5, and 80 mM glucose co-treatment had similar resultscompared with only 50 ug/mL PM2.5, or only 80 mM glucose exposure, or control group.
CONCLUSIONS:This study may provide a potential therapeutic or preventive approach for people withdiabetes or residents located in areas with high PM2.5, exposure. According to the findings, both
PM2.5 and glucose exposure caused a significant reduction in the growth of A549 cell lines andincreased mortality when compared to the control group. Additionally, the combined exposure of
PM2.5 and glucose intensified the negative effects on A549 cells. This highlights the importance ofconsidering the impact of high glucose levels in combination with PM2.5 exposure.

Keywords: PM2.5, High glucose, A549 cells, would healing, health risks

MP-054[Birth and pregnancy outcomes » Birth outcomes]

Population attributable fraction of low birthweight risk factors in Japan
Yukiko Nishihama1, Shoji F Nakayama1, Takahiro Tabuchi2
1Japan Environment and Children’s Study Programme Office, National Institute for Environmental

Studies, Tsukuba, Ibaraki, Japan
2Cancer Control Center, Osaka International Cancer Institute, Chuo-ku, Osaka, JapanBACKGROUND AND AIM:Low birth weight (LBW) is well-known to associate with significant healthproblems on later life; however, there are few studies on population attributable fraction (PAF) of LBW
risk factors. Objective of this study is to evaluate associations between risk factors for LBW reported inprevious studies of the Japan Environment and Children’s Study (JECS) data, and to assess themagnitude of risk using the PAF.
METHOD:91,559 mother–child dyads data were extracted from the JECS data. Risk factors reported toassociate with LBW in the previous JECS studies were used to calculate odds ratios for LBW using alogistic regression model. The PAF was calculated based on the calculated odds ratios.
RESULTS:Parity, history of adenomyosis, hypertension disorder of pregnancy, maternal age at birth,
prepregnancy body mass index, gestational weight gain (GWG), maternal smoking and lead (Pb)
exposure were all significantly related to LBW. The sum of the PAF of all factors was 79.4%. The
largest PAF among the factors was the GWG (16.5%); whereas, the PAF of the environmental portion,i.e., the sum of Pb exposure (14.6%) and maternal smoking (12.1%), was greater than the PAF of the
GWG.
CONCLUSIONS:Our findings indicate that the number of LBW possibly can be decreased by about 27%
if Pb exposure is reduced to the lowest quantile and maternal smoking is removed. Further studies are
inquired to clarify unknown risk factors for LBW.

Keywords: Birth outcomes, Children's environmental health, Environmental epidemiology, Heavy
metals, Risk assessment

MP-055[Omics technologies » Epigenomics]

Contribution of blood DNA methylation to theassociation between smoking and lung cancer
Arce Domingo Relloso1, Roby Joehanes2, Zulema Rodriguez Hernandez1, Lies Lahousse3, Karin
Haack4, Daniele Fallin5, Miguel Herreros6, Jason G Umans7, Lyle G Best8, Tianxiao Huan9, Chunyu
Liu10, Jiantao Ma11, Chen Yao12, Allan Jerolon13, Jose D Bermudez Edo14, Shelley A Cole4, Dorothy A
Rhoades15, Daniel Levy2, Ana Navas Acien16, Maria Tellez Plaza1
1Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for

Epidemiology, Carlos III Health Institute, Madrid, Spain.
2Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health,Bethesda, MD
3Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
4Population Health Program, Texas Biomedical Research Institute (San Antonio, TX)
5Emory University Rollins School of Public Health
6Bioinformatics Unit, Institute for Biomedical Research INCLIVA, Valencia, Spain
7MedStar Health Research Institute, Washington DC, USA
8Missouri Breaks Industries and Research Inc., Eagle Butte, SD, USA
9University of Massachusetts Medical School, Worcester, MA, USA
10Boston University School of Public Health, Boston, MA, USA
11Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
12Bristol Myers Squibb, Cambridge, MA, USA
13Université Paris Cité, CNRS, MAP5, F-75006 Paris, France
14Department of Statistics and Operations Research, University of Valencia, Spain.
15Stephenson Cancer Center, and University of Oklahoma Health Sciences Department of Medicine,

Oklahoma City, OK, US
16Department of Environmental Health Sciences, Columbia University Mailman School of Public Health(New York, NY)BACKGROUND AND AIM:Altered DNA methylation (DNAm) might be a biological intermediary in thepathway from smoking to cancer. In this study, we investigated the contribution of differential blood
DNAm to explain the association between smoking and lung cancer incidence.
METHOD:Blood DNAm was measured in 2321 Strong Heart Study (SHS) participants. Incident lungcancer was assessed as time to event diagnoses. We conducted mediation analysis, including
validation using DNAm and paired gene expression data from the Framingham Heart Study (FHS). We
also conducted a bioinformatics analysis to assess the biological plausibility of the findings.
RESULTS:In the SHS, current versus never smoking and pack-years single-mediator models showed,
respectively, 29 and 21 differentially methylated positions (DMPs) for lung cancer (14 of 20 available,
and five of 14 available, replicated, respectively, in FHS) with statistically significant mediated effects.
In the FHS, replicated DMPs showed gene expression downregulation largely in trans, and wererelated to biological pathways in cancer identified in the bioinformatics analysis. The multimediatormodel identified that DMPs annotated to the genes AHRR and IER3 jointly explained a substantial
proportion of lung cancer.
CONCLUSIONS:The association of smoking with lung cancer was partly explained by differences inbaseline blood DNAm at few relevant sites. These findings contribute to the identification of potentiallynovel mechanisms of lung cancer, and provide evidence in favor of DNAm as a potential biologicalintermediary in the association between smoking and lung cancer. Experimental studies are needed toconfirm the biological role of identified eQTMs and to evaluate potential implications for the prevention
and control of lung cancer.

Keywords: Smoking, DNA methylation, cancer incidence, causal inferenceMP-056[Exposures » Multi-pollutant/Multi-media]

Exposome Epidemiology for Suspect
Environmental Chemical Exposures during
Pregnancy Linked to Subsequent Breast Cancer
Diagnosis
Dean Jones1, Jaclyn Weinberg1, Sami Teeny1, Piera Cirillo2, Nickilou Krigbaum2, Grant Singer1, Vilinh
Ly1, Young Mi Go1, Barbara Cohn2
1Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA 30322, USA
2The Center for Research on Women and Children’s Health, Child Health and Development Studies,

Public Health Institute, Berkeley, CA 94709 USA

BACKGROUND AND AIM:Breast cancer is now the most common cancer globally, and new approaches
to identify suspect carcinogens are critical because research over the last 50 years has not translated
to a strategy for individual breast cancer prevention. We developed an exposome epidemiology
approach to use omics scale biomonitoring of pregnancy cohort biospecimens from women who
subsequently developed breast cancer and women who did not to identify suspect chemical
associations with subsequent breast cancer outcome.
METHOD:Second (T2) and third (T3) trimester archival serum samples from 182 women who
subsequently developed breast cancer and 384 who did not develop were selected from the Child
Health and Development Studies (CHDS) data from the California Cancer Registry. Environmental
chemicals were annotated with the Toxin and Toxin-Target Database (T3DB) and used with datadependent network analysis using xMWAS and pathway enrichment analyses using mummichog.
RESULTS:Analyses showed consistent linkage in both T2 and T3 to inflammation pathways, including
linoleate, arachidonic acid and prostaglandins, and identified new suspect environmental chemicals
associated with breast cancer, i.e., an N-substituted piperidine insecticide and a common commercial
product, 2,4-dinitrophenol (DNP), linked to variations in amino acid and nucleotide pathways in T2 andbenzo[a]carbazole and a benzoate derivative linked to glycan and amino sugar metabolism in T3.
CONCLUSIONS:The results identify new suspect environmental chemical risk factors for breast cancer
and provide an exposome epidemiology framework for discovery of suspect environmental chemicals
and potential mechanistic associations with breast cancer.

Keywords: Breast cancer, carcinogen, metabolic disruption, pregnancy, environmental chemical

MP-057[Chemical exposures » Endocrine disrupting chemicals]

Are hygiene, cosmetics and hair products
associated with breast cancer? The MCC-Spain
study
Gemma Castaño Vinyals1, Ainhoa De La Torre2, Virginia Lope3, Alba Marcos Delgado4, Pilar Amiano5,
Eva Ardanaz6, Marina Pollán3, Manolis Kogevinas1
1ISGlobal, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain;

Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP),
Madrid, Spain
2ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología

y Salud Pública (CIBERESP), Madrid, Spain
3National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER Epidemiología

y Salud Pública (CIBERESP), Madrid, Spain
4Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad deLeón, Spain; The Research Group in Gene-Environment and Health Interactions, Institute of
Biomedicine (IBIOMED), Universidad de León, Spain
5Public Health Division of Gipuzkoa, BioDonostia Research institute, Donostia San Sebastian, Spain;

CIBER Epidemiología y Salud Pública, Madrid, Spain
6Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research,

Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

BACKGROUND AND AIM:Breast cancer is the most common tumor in women worldwide and is
hormone-sensitive. Cosmetics are widely used and include a wide variety of ingredients, some of themknown to be mutagenic or have endocrine disruption properties. We investigated the association
between different types of cosmetics and hygiene products in relation to breast cancer risk.
METHOD:We included 1738 histologically confirmed breast cancer cases and 1910 female controls
from the MCC-Spain study, a multicase control study conducted in Spain 2008-2013. Participants wereasked in a face-to-face interview, about their use of cosmetics and hygiene products (perfumes, hairshampoo and conditioner, hair molding products, lotion for face, lotion for body, hand/foot cream,
deodorant, nail polish) during the past 10 years, and also about socio-demographic, reproductive
factors, nutrition and other relevant variables. We used logistic regression to calculate Odds Ratio(OR) and 95% Confidence Intervals (CI), using exposure variables in tertiles, and adjusting forpossible confounders.
RESULTS:Participant used several cosmetics and hygiene products, ranging from 48% (nail polish) to
99.5% (hair shampoo/conditioner). Heavy users (3rd tertile, times/week) of hair shampoo andconditioner had an increased risk of breast cancer (OR=1.42; 95%CI 1.14-1.77), compared to nonusers and low users as the reference (p-trend<0.05). We did not observe associations of breast
cancer risk with any other products. A cumulative score based on number of cosmetics/products used
was also not associated with cancer risk, observing an OR of 0.95 (95&CI 0.78-16.16 for the highest
tertile).
CONCLUSIONS:We did not observe an overall association of use of cosmetic and hygiene productswith breast cancer but observed an association between the use of hair products such as shampoo or
conditioner and breast cancer risk. This specific association should be further investigated, since notmuch literature is available.

Keywords: Cancer and cancer precursors, Chemical exposures, Endocrine disrupting chemicals

MP-058[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Pre-disease biomarkers of poly chlorinatedbiphenyls (PCB) and amyotrophic lateralsclerosis (ALS) risk
Ian W Tang1, Paul Knekt2, Panu Rantakokko3, Markku Heliövaara2, Harri Rissanen2, Päivi Ruokojärvi3,
Rajarshi Mukherjee4, Marc G Weisskopf5
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
3Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
4Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Polychlorinated biphenyls (PCB) are toxic, persistent chemicals that wereused in pesticides and industrial material. Occupations using PCBs have been associated withamyotrophic lateral sclerosis (ALS), one study found some PCB congeners in blood associated with
ALS, but samples were collected post-ALS onset. We evaluated the association of pre-disease PCB
exposure and ALS risk in a nested case-control study.
METHOD:Using the Finnish Mobile Clinic, its Follow-Up Study, and Mini-Finland Health Survey cohorts,
we identified 97 ALS cases and matched 194 alive controls based on cohort, age, sex, municipality,
and serum freeze-thaw cycles. Serum was collected from participants from 1968-1979 and measured
for 13 PCB congeners. We assessed the relationship between PCB concentration (individual congeners
and groups) and ALS with conditional logistic regression adjusting for smoking, occupation, BMI, andcholesterol level.
RESULTS:ALS cases had a mean time-to-diagnosis of 25 years, and had a higher proportion of “bluecollar” workers and smokers compared to controls. Overall, we observed no consistent results whenevaluating PCBs as individual congeners. However, the sum of all PCBs showed an inverse doseresponse association with ALS with an OR in the 4th quartile of 0.39 (95% CI: 0.15-1.03; p-value fortrend: 0.03). The sum of non-dioxin-like PCBs (excluding congeners 118 and 156) showed a similar
trend, while the trend was less pronounced for the sum of dioxin-like PCBs (118 and 156: 4th quartile
OR: 0.89; 95% CI: 0.37-2.11; p-value for trend:0.09).
CONCLUSIONS:We observed an inverse-relationship between pre-disease PCB exposure and ALS
incidence. A similar association was found in Finland for PCBs and Parkinson’s disease possibly
suggesting some common mechanisms or PCB- associated neuroprotective factors (e.g. fish oils) inboth neurodegenerative conditions. The possibility of informative censoring (i.e. PCBs associated withdeath before age of ALS) and lack of repeated measures should be considered. Supported by
T32ES007069, R01TS000315 and P30ES000002.

Keywords: Chemical exposures, biomarkers of exposureMP-059[Cancer and cancer-precursors » Incidence]

Association of residential exposure to dioxin
emissions with lymphoid malignancies in aprospective US based cohort of women
Jie Chen1, Jaime E. Hart1, Trang Vopham2, Elise G. Elliott3, Francine Laden4, Brenda M. Birmann5
1Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, MA
2Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle,

WA
3Health Effects Institute, Boston, MA
4Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of
Public Health, Boston, MA
5Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, MA

BACKGROUND AND AIM:The etiology of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) is
still unclear. Increased NHL risk has been found among individuals living in the vicinity of incineratorswith high dioxin emission levels. However, limited evidence is available from prospective cohorts andfor individual NHL subtypes. We aimed to assess the associations between exposure to dioxin
emissions and incident NHL and MM in the US-based prospective Nurses’ Health Study II (NHSII,
1989-2013).
METHOD:We estimated residential exposure to dioxin emissions using a nationwide database ofdioxin-emitting facilities. The emission index was estimated as the inverse-distance-weighted sum ofemissions from all facilities within 3, 5, or 10 km of a residence, expressed in units of gram [g] toxic
equivalency quotient [TEQ]/year/km2; higher emission values indicate higher toxicity. We defined
three emission index categories: (1) no exposure (reference), (2) >0−median, and (3) ˃mediangTEQ/year/km2. We then applied time-varying Cox proportional hazards models, adjusting forpotential confounders including age, race, lifestyle factors, and individual- and area-levelsocioeconomic status to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk ofincident NHL or MM.
RESULTS:We observed 378 NHL and 48 MM cases during 2,371,385 person-years of follow-up. The
study included mostly white, married, and/or non-smoking females who were on average aged 46
years over follow-up. Within all buffers, higher levels of dioxin emissions were associated withincreased NHL and MM risk. For example, participants exposed to ˃0.03 gTEQ/year/km2 within a
10km buffer had a HR (95% CI, vs. unexposed participants) of 1.30 (1.00, 1.68) for NHL and of 1.53
(0.72, 3.27) for MM.
CONCLUSIONS:We found positive associations between residential exposure to dioxin emissions andrisk of NHL (in aggregate) and MM in a prospective nationwide cohort of women. Forthcoming
analyses by common NHL subtype will further elucidate these associations.

Keywords: Dioxin, non-Hodgkin lymphoma, multiple myeloma, industrial emissions

MP-060[Air pollution » Long-term exposure]

Air Pollution Exposure During Pregnancy andPlacental Inflammation
Emily Craig1, Yan Lin1, Tom O'connor2, Sally Thurston2, David Q Rich2, Yihui Ge1, Philip K Hopke1,
Kristin Scheible2, Catherine Yount2, Junfeng (jim) Zhang1
1Nicholas School for the Environment, Duke University, Durham, NC, USA
2University of Rochester Medical Center, Rochester, NY, USA

BACKGROUND AND AIM:Regulation of pro and anti-inflammation at various stages of development isimperative to placental growth, function, and an overall healthy pregnancy. Air pollution exposure atcritical times during development in the form of PM2.5, NO2, and pyrene may dysregulate immune
function and lead to systemic inflammation. This study examines the relationship between air pollution
exposure at various time points throughout development and placenta inflammation.
METHOD:Using estimates of residential ambient PM2.5 and NO2 concentrations, placental
inflammation markers (IL-6, TNF-α) measured in placental tissue (N=277 births), and 1-hydroxypyrene [1-OHP] measured in the urine of pregnant women living in Rochester NY, in 3 trimesters.
Multivariable, generalized additive and linear regression models were then used to examine theassociation between placental TNF-α, IL-6, PM2.5, and NO2 concentrations in the previous 2, 4, 8, 12,
and 36 weeks and urinary 1-OHP in the 1st, 2nd, and 3rd trimesters, adjusting for maternal age, bodymass index before pregnancy, and smoking status.
RESULTS:Each 1.6 µg/m3 increase in PM2.5 concentration in trimester 1 was associated with a 23%
decrease in IL6 (95% CI: 6.8 %, 52.6%). Conversely, a 20% increase in urinary 1-OHP concentrationin the first trimester was associated with a 7.13% increase in placental TNF-α concentrations (95% CI:
3.33%-10.95%), but not IL-6 0.46%, (95% CI: -1.96%-2.96). However, no associations wereobserved between other weekly averages of PM2.5 and NO2 concentrations and placental
inflammation markers (TNF-α, and IL6) in other trimesters. Sensitivity analysis for medication andillness during pregnancy showed no change in the main effect.
CONCLUSIONS:Results from our study show a potential relationship between air pollution exposureand changes in placental inflammation markers (IL6 and TNF-α) during the first trimester ofpregnancy.

Keywords: Pregnancy outcomes, Traffic-related

MP-061[Birth and pregnancy outcomes » Pregnancy outcomes]

Non-persistent Chemicals in Urine and Glycemia
during Pregnancy: The Healthy Start Study
Mia Q. Peng1, Dana Dabelea2, Wei Perng3, Deborah H. Glueck1, Anne Starling4
1Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center, Colorado School of Public Health &Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
2Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center & Department of Epidemiology,

Colorado School of Public Health & Department of Pediatrics, University of Colorado School of
Medicine, Aurora, CO, United States
3Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center & Department of Epidemiology,

Colorado School of Public Health, Aurora, CO, United States
4Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center & Department of Epidemiology,

Colorado School of Public Health, Aurora, CO, United States & Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, UnitedStatesBACKGROUND AND AIM:Some non-persistent chemicals may alter glucose metabolism, but
epidemiologic findings are inconsistent in pregnant women. We evaluated associations between 26
chemicals frequently found in consumer products and glucose-insulin traits among pregnant women.
METHOD:Thirteen phthalate metabolites, six phenols, two parabens, and five organophosphate flame
retardant metabolites were measured in mid-pregnancy urine (median gestational age 27 weeks) in
301 women participating in the Healthy Start Study, a mother-offspring cohort. Glucose, insulin, andHomeostatic Model Assessment-Insulin Resistance (HOMA-IR) were assessed concurrently using
fasting blood. Results from 1-hour 50g glucose challenge tests (GCT) were abstracted from medical
records. Linear regression models estimated associations between each chemical and each trait,adjusted for confounders including pre-pregnancy body mass index. Quantile-based g-computation
was used to examine associations with the chemical mixture.
RESULTS:In single-pollutant models, most phthalate metabolites and bisphenol A were positively
associated with fasting glucose, insulin, and HOMA-IR; bisphenol S was positively associated with GCT
glucose. Each doubling of di(2-ethylhexyl) phthalate (DEHP) metabolites was associated with 0.63 –1.57 mg/dL higher fasting glucose (mono(2-ethylhexyl) phthalate (MEHP): 0.63, 95% CI: 0.13, 1.12;
mono(2-ethyl-5-carboxypentyl) phthalate (MECPP): 1.57, 95% CI: 0.84, 2.29) and 4.2-10.7% higher
HOMA-IR (MEHP: 4.2%, 95% CI: 0.63%, 7.8%; mono(2-ethyl-5-oxohexyl) phthalate (MEOHP):
10.7%, 95% CI: 5.5%, 16.1%). In multi-pollutant models, each quartile increment in all chemicals
was associated with higher fasting glucose (1.82 mg/dL, 95% CI: -0.75, 4.39), insulin (14.8%, 95%
CI: -1.7%, 34.1%), and HOMA-IR (17.7%, 95% CI: -0.81%, 39.7%). MECPP and MEOHP explained
the highest proportions of the mixture’s positive associations.
CONCLUSIONS:DEHP exposure was positively associated with fasting glucose, insulin, and estimatedinsulin resistance among heathy pregnant women. If causality is confirmed, limiting DEHP exposure
may reduce the risk of dysglycemia in pregnancy. This study was funded by the National Institutes of
Health (grants R01ES022934, R01ES032213, R01DK076648, and UH3OD023248).

Keywords: Endocrine disrupting chemicals, Mixtures, Phthalates, Obesity and metabolic disorders

MP-062[Birth and pregnancy outcomes » Birth outcomes]

Associations between residential greenness andbirth outcomes: results from the KoreanChildren’s Environmental health Study
Myung Sook Park1, Dirga Kumar Lamichhane2, Yun Chul Hong1, Hwan Cheol Kim2
1Institute of Environmental Medicine, Seoul National University of Medical Research Center, Seoul,

Korea
2Department of Occupational and Environmental Medicine, Inha University School of Medicine,

Incheon, Korea

BACKGROUND AND AIM:The amount of greenness around mother’s residences has been reported to
be positively associated with birth outcomes; however, findings are inconclusive. Hence, weinvestigated the association between residential greenness and birth outcomes in a birth cohort studyin Korea.
METHOD:We used data from the Korean Children’s Environmental health Study on singleton live birth(n = 4,714) from 2015 to 2019. Residential greenness, represented by the normalized difference
vegetation index (NDVI), was obtained from satellite measurements. Multiple logistic regression
models were used to evaluate the associations of NDVI exposure with preterm birth and low birthweight. Further, linear regression models were used to determine the associations of NDVI exposure
with birth weight (BW), birth length (BL), birth weight to length ratio (BWtL), body mass index (BMI),
and ponderal index (PI), controlling for individual and neighborhood factors.
RESULTS:There was no significant relationship between residential greenness and preterm births andlow birth weight. An interquartile range (IQR) increment in the fraction of green space within 2000mof residence was statistically significantly associated with 0.138 increase birth length (95% ConfidenceInterval [0.072, 0.205]. On the other hand, there was a significant decrease in the ponderal index [β= -0.192, 95%CI:(-0.291, -0.092)], and BMI [β = -0.070, 95%CI:(-0.109, -0.032)] in the 2000m
buffer. In multi-pollutant models, increase in residential greenness was associated with increase birthlength [β = 0.093, 95%CI:(0.020, 0.165)] in 2000m. Whereas, there was a significant decrease in the
ponderal index [β = -0.132, 95%CI:(-0.245, -0.019)], BMI [β = -0.049, 95%CI:(-0.092, -0.007)] in
2000m buffer. Results were generally robust with different buffer sizes and controlling for fineparticles (PM2.5) and Nitrogen.
CONCLUSIONS:Our finding suggests beneficial impact of residential greenness on birth length.
Exposure to greenness was also associated with lower anthropometric ratio, indicating lower risks of
adiposity in newborn baby.

Keywords: Residential greenness, NDVI, birth outcome, cohort study, Ko-CHENS

MP-063[Reproductive outcomes » Female reproductive outcomes]

PRegnancy and UrbaN Environment (PRUNE)
cohort profile and built environment in infertile
couples
Seung Ah Choe1, Han Ho Kim2, Jee Hyun Kim3
1Department of Preventive Medicine, Korea University
2Department of Pediatrics, Anam Hospital
3Department of Obstetrics and Gynecology, CHA University

BACKGROUND AND AIM:Addressing the association between perceived physical environment andhuman fertility is necessary to understand the impact of built environment on reproductive health anddeveloping effective interventions to improve human fertility. We assessed the association between
perceived built environment and pregnancy in infertility patients.
METHOD:We constructed a prospective cohort study (PRegnancy and UrbaN Environment, PRUNE)
recruiting 726 infertility patients (470 women and 256 men) who visited one of the two universityaffiliated infertility centers for infertility treatment between October 2019 and July 2022. Using amobile survey, we collected the information of demographic, clinical characteristics, residential
address, perceived proximity to neighborhood green and blue space, and environmental noise.
Adjusted risk ratios (aRR) were calculated for achievement of pregnancy within three months ofsurvey participation.
RESULTS:Median age of women and men was 39 and 40 years, respectively. Majority of patients
reported they have green (88.7%) and blue space (66.0%) within a 10-min walking distance. A fourthof patients (23.3%) had an annoying environmental noise. Adjusted risk ratio for pregnancy within 3months was higher when they have green space within a 10-min walking distance (2.97, 95%
confidence interval [CI]: 1.13, 7.82). The association between blue space within a 10-min walking
distance (1.05, 95% CI: 0.72, 1.51) and pregnancy was close to null. Higher neighborhood noise wasassociated with lower probability of pregnancy (0.68, 95% CI: 0.46, 1.01) which did not reachstatistical significance. The risk estimates of pregnancy within 1 year were close to null for green andblue spaces within a 10-min walking distance, and presence of annoying neighborhood noise.
CONCLUSIONS:We observed some positive association between having green space within a 10-min
walking distance and achieving pregnancy. This finding would provide evidence of potential impact ofbuilt environment on human fecundity.

Keywords: Built environment, Infertility, Cohort

MP-064[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Exposure to Ultrafine Particles and Cognitive
Decline Among Older People in the United States
Wenqi Gan1, Kevin J. Manning2, Ekaterina G. Cleary3, Richard H. Fortinsky4, Doug Brugge1
1Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington,USA.
2Department of Psychiatry, University of Connecticut School of Medicine, Farmington, USA.
3Exponent Engineering and Scientific Consulting, Natick, USA.
4Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington,

USA; UConn Center on Aging, University of Connecticut School of Medicine, Farmington, USA;
Department of Medicine, University of Connecticut School of Medicine, Farmington, USA

BACKGROUND AND AIM:Some studies suggest that ambient particulate air pollution is associated withcognitive decline. However, the findings are mixed, and there is no relevant research examining theinfluences of ultrafine particles (UFP), which may have more toxicity than larger particles. We
therefore conducted this study to investigate whether residential UFP exposure is associated withcognitive decline using data from the Alzheimer’s Disease Research Centers in the United States.
METHOD:This is a longitudinal study of participants who were aged 65 years and older and had normal
cognitive status at baseline. Residential UFP exposure, expressed as particle number concentrations(PNC), was assessed in 2016-2017 using a nationwide land use regression model, and was assigned toeach participant using their 3-digit residential ZIP codes. Cognitive functions including memory,
attention, language, executive function, and global function were assessed annually using 15
neuropsychological tests from March 2015 to February 2022. Linear mixed-effects models were used
to examine the associations after adjustment for covariates including baseline age, sex, APOE e4
status, race, education, smoking status, history of diabetes, and quartiles of neighborhood medianhousehold income.
RESULTS:This study included 5646 participants (mean age 76 years, 65% female). On average, eachparticipant had 4 annual visits. When PNC was treated as a continuous variable, there were no
statistically or clinically significant changes in annual decline of each cognitive function in relation to
an interquartile range elevation in PNC (4026 particles/cm3). Similarly, when PNC was treated as acategorical variable including five exposure groups, there were no statistically significant differences inannual decline of each cognitive function across the five exposure groups.
CONCLUSIONS:This study found no meaningful associations between residential UFP exposure andcognitive decline in global and domain-specific functions. There is a need for further research thatassigns UFP exposure at a finer geographic scale.

Keywords: air pollution, particulate matter, long-term exposure, neurodegenerative outcomes,
environmental epidemiology

MP-065[Built environment » Light pollution]

Outdoor light at night and mortality in the UK
Biobank: a prospective cohort study
Liang Xue1, Wang Zixin1, Honglin Cai1, Zeng Yi Qian1, Jinjian Chen1, Xianglin Wei1, Guanghui Dong2,
Huang Yu3, Xiang Qian Lao3, Xiang Qian Lao4
1Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong

Kong, China
2School of Public Health, Sun Yat-sen University, Guangzhou, China
3Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
4School of Public Health, Zhengzhou University, Zhengzhou, China

BACKGROUND AND AIM:More than 83% of the world’s population lives under light-polluted skies while
information about health effects of outdoor light at night (LAN) is limited. We examined theassociation of LAN with natural cause (NC) and CVD mortality using the UK Biobank (UKB).
METHOD:We included 273,335 participants recruited between 2006 and 2010. Level of LAN was
estimated at each participant’s address using time-varying satellite data for a composite of persistentnight-time illumination at ~1km2 scale. Information on causes of death until 12 November, 2021 was
obtained through record linkage. Cox proportional hazards regression was used for data analysis.
RESULTS:In the follow-up with an average of 12.4 years, 14,864 NC and 3,100 CVD deaths wereidentified. Compared with the participants exposed to the first quartile of LAN, participants exposed tothe highest quartile showed an 8% higher risk of NC mortality (hazard ratio (HR): 1.08, 95%
confidence interval (CI): 1.03-1.14) after adjusting for age, sex, social-economic status, lifestylefactors and body mass index. However, the association disappeared after further adjustment forPM2.5 and evening noise, with HRs (95% CIs) of 1.02 (0.97-1.07), 1.01 (0.97-1.07) and 1.03 (0.981.09), respectively, for the participants exposed to the second, third and fourth quartiles of LAN. No
significant associations were observed between LAN and CVD mortality, either.
CONCLUSIONS:We did not observe significant associations of LAN with NC and CVD mortality in thislarge nationwide cohort. The health effects of LAN remain unclear. Further studies are warranted toaddress this public health concern.

Keywords: Outdoor light at night, mortality, cardiovascular diseaseMP-066[Exposures » Multi-pollutant/Multi-media]

Environmental Exposure to Risk Factors and Its
Effects on Heart Rate Variability in Vulnerable
and Susceptible Individuals
Yeonjae Park1, Yong Whi Jeong1, Sung Hwa Kim1, Jihye Lim1, Sumi Lee1, Dae Ryong Kang2
1Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
2Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic ofKorea

BACKGROUND AND AIM:Heart rate variability (HRV) refers to the variation in time between successive
heartbeats and is an important indicator of autonomic nervous system function. It has been shownthat exposure to environmental hazardous substances, such as environmental risk factors, can havenegative effects on HRV. Vulnerable and susceptible individuals, such as elderly individuals and thosewith pre-existing cardiovascular disease, may be particularly susceptible to these effects. However,there is still a need for further research to better understand the relationship between environmental
exposures and HRV in these individuals.
METHOD:The study involved 40 participants, including those with existing cardiovascular and airway
diseases, who wore an ECG monitor and personal air quality monitoring devices to collect data on
ambient environmental risk factors. The data collected included PM1.0, PM2.5, PM10, CO2, airtemperature, humidity, and TVOC. A Dual-Stage Attention-Based Recurrent Neural Network (DARNN)
was trained using the collected data to predict changes in HRV for 5 minutes when exposed toenvironmental hazardous substances for 10 minutes.
RESULTS:Our deep learning study found a strong correlation between environmental risk factors
exposure and reduced HRV in vulnerable individuals. These results emphasize the need to mitigate
such exposure to prevent adverse health effects. The HRV prediction model performed best with a 100
ms criterion (81% accuracy), with humidity, PM2.5, PM1.0, and PM10 being the most importantvariables. Among these, humidity and PM2.5 had the greatest impact on model performance.
CONCLUSIONS:Environmental risk factors can negatively affect HRV, especially in vulnerable andsusceptible individuals such as the elderly and those with pre-existing cardiovascular disease. We use
the DARNN model to predict changes in HRV due to environmental exposure, indicating its potential toidentify high-risk individuals. However, it is important to consider changes in HRV due to individual
risk factors as well, in addition to environmental factors.

Keywords: Heart Rate Variability, Vulnerable and Susceptible Individuals, Environmental Exposure,
Recurrent Neural Network

MP-067[Neurologic and mental health outcomes » Mental health outcomes]

Association between Long-term Noise Exposureand Bipolar Disorder: a Community-based
Cohort Study in Taiwan
Hsin Lan Huang1, Yi Hui Wu1, Chih Ting Dong1, Chih Da Wu2, Hwai I Yang3, Wen Chi Pan1
1Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
3Genomics Research Center, Academia Sinica, Taipei, Taiwan

BACKGROUND AND AIM:The statistics provided by the World Health Organization showed that about
45 million people worldwide are affected by bipolar disorder. Additionally, noise pollution is an urgent
environmental issue in Taiwan, and only limited studies explored the relationship between noise
exposure and bipolar disorder. Therefore, we aimed to explore the association between long-term
exposure to noise and incidence of bipolar disorder using a cohort study in Taiwan.
METHOD:We recruited 12,626 participants who resided in Main Taiwan Island from REVEAL-HBV, acommunity-based cohort study established in 1991. Participants’ long-term noise exposure wasestimated from noise information provided by the Taiwan EPA (2003-2017) followed by spatial
interpolation using land-use regression models. The diagnosis of bipolar disorder was based onparticipants’ medical claim data retrieved from National Health Insurance Health Database (NHIRD) in
the follow-up period (2008-2017). Cox proportional hazards models were utilized to evaluate therelationship between noise exposure and bipolar disorder.
RESULTS:A total of 247 incidence of bipolar disorder was identified during follow-up with a meanfollow-up time of 9.19 years. Higher noise exposure levels were found among bipolar disorderparticipants (mean noise level = 65.28 dBA) compared with those without diseases (mean noise level= 64.28 dBA). Noise exposure was significantly associated with an increased incidence of bipolar
disorder (adjusted hazard ratio [HR] =1.03 per 1 dBA increment on noise; 95% confidence intervals =1.01 -1.05); p-value < 0.01). Further stratified analysis on participants’ residential townships showeda consistent result with the major findings (HR ranged from 0.97 to 1.05), although the statisticalsignificance was marginal.
CONCLUSIONS:Long-term noise exposure was positively associated with bipolar disorder. Reduction
on environmental noise exposure will alleviate the health burden related to bipolar disorder. This study
was funded by the Taiwan National Science and Technology Council and Academia Sinica.

Keywords: Noise, Mental health outcomes, Long-term exposure, IncidenceMP-068[Air pollution » Particulate matter]

Effect of PM2.5 and Noise Exposure on the Risk
of Blood Glucose Impairment in Pregnant
Women
Yu Ting Lin, Chin Chi Kuo
Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Fine particulate matter (PM2.5) and noise exposure have been linked toadverse health effects in various populations. However, their impact on glucose metabolism during
pregnancy remains unclear. Therefore, this study aims to investigate the association between PM2.5
and noise exposure and oral glucose tolerance tests (OGTT) in pregnant women.
METHOD:Data from China Medical University Hospital for the period of 2003-2019 were utilized in thisstudy. Individual PM2.5 exposure was calculated using satellite-based spatiotemporal models based on
subjects’ residences. Ordinary Kriging models were used to determine annual average noise exposure
with a resolution of 1-km. Univariable and multivariable linear regression models were employed.
Additionally, restricted cubic splines were used to investigate the dose-response relationships.
RESULTS:In the multivariable linear regression models, a significant positive association was foundbetween PM2.5 exposure and OGTT-1h and OGTT-2h. The adjusted effect estimate of OGTT-1h and
OGTT-2h for a 10 ug/m3 increase in PM2.5 was 4.11 mg/dl and 3.02 mg/dl for first trimester
exposure, and 4.25 mg/dl and 3.93 mg/dl for the second trimester exposure, respectively. In addition,for each dBA increase in noise level, the effect estimate of OGTT-1h and OGTT-2h was found toincrease by 2.73 mg/dl and 2.53 mg/dl glucose level, respectively (p-value < 0.05).
CONCLUSIONS:Our study indicates that environmental factors, such as PM2.5 and noise exposure
associated with blood glucose impairment in pregnant women. Further research is required to fully
understand the mechanisms involved in these associations.

Keywords: Environmental epidemiology, Noise, Female

MP-069[Chemical exposures » General]

Maternal Factors Associated with Plasma
Concentrations of Persistent Organic Pollutants
Among Women from Pregnancy to Postpartum
PeriodChenyu Qiu1, Ni Kang1, Nosa Osazuwa1, Caleb Schimke1, Wu Chen1, Dean Jones2, Frank Gilliland1,
Thomas Buchanan3, Anny H. Xiang4, Zhanghua Chen1
1Department of Population and Public Health Sciences, Keck School of Medicine of the University ofSouthern California, Los Angeles, California, USA
2Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
3Department of Medicine, Keck School of Medicine of the University of Southern California, Los

Angeles, California, USA
4Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California,

USA

BACKGROUND AND AIM:This study aims to assess maternal factors (age, breastfeeding and weight)that may influence plasma concentrations of persistent organic pollutants (POPs) in women frompregnancy to postpartum period.
METHOD:97 Hispanic women (mean ± SD = 30.47 ± 5.67 years) with gestational diabetes mellitus(GDM) were enrolled in this study. Plasma concentrations of 41 POPs including 21 polychlorinatedbiphenyls (PCBs), 7 organochlorine pesticides (OCPs), 5 polybrominated diphenyl ethers (PBDEs),
2,2’,4,4’,5,5’-hexabromobiphenyl (BB-153), 7 perfluoroalkyl substances (PFASs) were measured fromarchived samples collected at 3rd trimester of pregnancy and 15-60 months postpartum. Multivariate
linear regression model was used to assess associations of 1) maternal age and pre-pregnancy weightwith the POPs concentrations at 3rd trimester; 2) maternal age, weight, and breastfeeding status with
POPs concentrations at 15-60 months postpartum; and 3) maternal age, breastfeeding and weightloss after delivery with the longitudinal changes of POPs concentrations from pregnancy to postpartum
period.
RESULTS:From pregnancy to postpartum period, plasma concentrations of PBDEs and PFASs weresignificantly increased, PCBs and OCPs significantly decreased among the 97 women. Higher age wasassociated with higher levels of PCBs (except PCB-28), OCPs (T-NONA and p,p’-DDE) and BB-153 at
3rd trimester (all p-values<0.05). Breastfeeding was associated with lower levels of 19 POPs (e.g.,
PCB-178, PBDE-28, OXYCHLOR and PFHxS) at postpartum visit (all p-values<0.05). Additionally,
higher age, breastfeeding and less weight loss after delivery were significantly associated with thehigher annual decrease of PCBs and OCPs concentrations from pregnancy to postpartum period (all pvalues<0.05).
CONCLUSIONS:Women of older age had higher plasma concentrations of PCBs. The concentrations oflipophilic POPs declined more in women who breastfed their newborns, while declined less in women
having more weight loss after delivery.

Keywords: Persistent Organic Pollutants, Maternal Age, Weight, BreastfeedingMP-070[Chemical exposures » PFAS]

Longitudinal effects of PFAS exposure on insulin
sensitivity and β-cell function among womenwith gestational diabetes mellitus history
Ni Kang1, Chenyu Qiu1, Dean Jones2, Frank Gilliland1, Thomas Buchanan3, Anny H. Xiang4, Zhanghua
Chen1
1Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

CA, USA.
2Department of Medicine, Emory University School of Medicine, Atlanta, GA.
3Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA

90033, USA.
4Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

BACKGROUND AND AIM:Per-and polyfluoroalkyl substances (PFAS) have been found to be associatedwith gestational diabetes mellitus (GDM) development. However, no studies have explored longitudinal
effect of PFAS on metabolic decline. We investigated PFAS levels from pregnancy to postpartum onchanges in diabetes-related traits over follow-up among women with GDM during pregnancy.
METHOD:Data included 98 Hispanic women with GDM (mean age 32.3±5.6 years at pregnancy)
recruited during 3rd trimester of pregnancy and followed every 12-15 months up to 12 years after
pregnancy. Oral and Intravenous glucose tolerance tests were conducted at each visit. Diabetesrelated traits include fasting and 2-hr glucose and insulin, incremental 2-hr glucose area under the
curve (AUC); insulin sensitivity (SI), acute insulin response (AIRg) and disposition index (DI)measuring β-cell function. Absolute plasma concentrations of PFAS levels (PFNA, PFOA, PFOS, PFHxSand MeFOSAA) were measured at the 3rd trimester of pregnancy and 15-60 months postpartum visits.
Linear mixed effects models were used to investigate the association between PFAS exposure andlongitudinal trajectories of diabetes-related traits, adjusting for age, weight, breastfeeding status, dietand physical activities as time-dependent variables.
RESULTS:Increased 1SD (2.42 ng/ml) of PFOA from pregnancy to postpartum was associated withannual decrease in DI (β=-0.01, p=0.03), SI (β =-0.02, p=0.01), AIRg (β =-0.02, p=0.006) andincrease fasting insulin (β =0.02, p=0.008). Increased 1SD (0.5 ng/ml) PFNA was associated withannual decrease in DI (β=-0.01, p=0.03), SI (β=-0.02, p=0.01), AIRg (β =-0.01, p=0.02) andincrease in fasting insulin (β =0.02, p=0.03). Increased 1SD (0.3 ng/ml) of MeFOSAA was associatedwith annual increase in 2hr incremental glucose AUC (β =0.12, p=0.01).
CONCLUSIONS:Higher PFAS exposure was associated with faster decline in insulin sensitivity, acuteinsulin secretion, β-cell function, and increase in glucose over time among Hispanic women with GDM,
suggesting longitudinal effects of PFAS on metabolic decline for high risk groups.

Keywords: PFAS, gestational diabetes, long-term effect, insulin sensitivity.

MP-071[Respiratory and allergic outcomes » Allergies]

Prenatal polyunsaturated fatty acids andchildhood atopic dermatitis
Kinga Polanska1, Monika Bobrowska Korzeniowska2, Elzbieta Trafalska3, Alexandra Jerzynska4
1Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational

Medicine, Lodz, Poland
2Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Lodz,

Poland3Department of Nutrition and Epidemiology, Medical University of Lodz, Lodz, Poland
4School of Medicine, University College Cork, Cork, Ireland

BACKGROUND AND AIM:Atopic dermatitis is a common chronic inflammatory skin disease for which
several environmental factors such as dietary practices have been identified. The aim of thisprospective study was to evaluate the association between maternal dietary intake of polyunsaturated
fatty acids (PUFA) and atopic dermatitis in their children up to 7 years of age.
METHOD:The study population consists of 557 mother-child pairs from the Polish Mother and Child
Cohort (REPRO_PL). Based on the Food Frequency Questionnaire completed between the 20th–24thweeks of pregnancy, n-3 and n-6 PUFAs as well as n-6:n-3 fatty acid ratio were estimated using foodcomposition tables. Children’s health examinations at the age of 1, 2, and 7 years were performed byan allergist. Generalized Estimating Equations were performed in order to assess the prevalence of
atopic dermatitis at three time points. Independent variables in the equation were n-3, n-6 PUFAs andn-6:n-3 PUFAs ratio. The model was controlled for selected confounders.
RESULTS:The prevalence of atopic dermatitis was 37%, 26% and 21% at age of 1, 2 and 7 years,
respectively. Higher n-6:n-3 fatty acid ratio was correlated with higher prevalence of atopic dermatitis
at age of 7 years (p<0.07). Neither prenatal n-3 nor n-6 PUFAs alone were significantly associatedwith child atopic dermatitis.
CONCLUSIONS:The ratio between maternal dietary n-6 and n-3 PUFA intake possibly influences therisk of developing atopic dermatitis in children. These results may contribute to the existing knowledge
on the impact of maternal diet during pregnancy for children's optimal health, however further studies
are needed before drawing conclusions and creating clinical practice guidelines.

Keywords: Allergies, Food/nutrition,

MP-072[Birth and pregnancy outcomes » Pregnancy outcomes]

Maternal demographic, socioeconomic andenvironmental characteristics and adverse
pregnancy outcomes, A structural equation
model
Valentin Simoncic1, Séverine Deguen2, Christophe Enaux1, Wahida Kihal Talantikite1
1LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100

Strasbourg, France
2Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population

Health Research Center, University of Bordeaux, 33076 Boedeaux, France

BACKGROUND AND AIM:There is a growing number of international studies that confirms that the first
1000 days of life period is a crucial window of development that may be affected by several
environmental stressors as maternal and fetal living conditions. Therefore, beyond the individual andcontextual socio-economic level, the living environment “neighborhood” has emerged as an important
determinant to investigate health disparities, particularly for pregnant women and adverse pregnancy
outcomes. Most of the studies use these variables independently even though they all have potential
interrelationships.
METHOD:Through a structural equation model (SEM), we examined the association between
residential amenities, environmental nuisance, Mother’s socio-economic characteristics and pregnancy
outcome (birthweight and gestational age at birth) in Mobifem cohort, constituted with pregnant
women living in the eurometropolis of Strasbourg in France. We use amenity, environmental nuisanceand socioeconomic deprivation as latent variables. Amenity were estimated from the number of
equipments in a buffer zone of 500m and 250m around the home address (diversity of shops,
playgrounds, sports facilities, green spaces). Environmental nuisance were estimated from daily mean
concentrations of PM10, PM2.5 and NO2; level of noise pollution in the neighbourhood. Demographic
and socioeconomic characteristics were estimated from the socio-economic statue, her employment
situation, of the mother, her age, her weight, the french deprivation index (fdep), and a local
deprivation index (adapted for the city of Strasbourg through a principal component analysis).
RESULTS:A direct association between socioeconomic deprivation and adverse birth outcome estimate
and inverse associations between adverse birth outcome and green space were observed. theassociations between adverse birth outcomes and socioeconomic deprivation were direct.
CONCLUSIONS:The main results suggest that unfavorable environmental amenities and increased
nuisance exposure during the pregnancy might contribute to adverse birth outcomes, especially LBW
and prematurity, especially for unfavorable socio-economic environments.

Keywords: birth outcomes, social determinants, amenity, Environmental exposure, structuraléquation model

MP-073[Chemical exposures » Endocrine disrupting chemicals]

Socio-economic determinants of exposure to
endocrine disrupting chemicals in pregnant
women: Taiwan Maternal Infant Cohort Study
Alexander Waits1, Chia Huang Chang2, Yu Fang Huang3, Ming Song Tsai4, Jia Woei Hou5, Pei Wei
Wang6, Chih Yao Chen7, Chia Jung Hsieh8, Ming Tsang Wu9, Shu Li Wang10, Mei Lien Chen3
1Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei,

Taiwan2School of Public Health, Taipei Medical University, Taipei, Taiwan
3Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan
4Department of OBS & GYN, Cathay General Hospital, Taipei, Taiwan
5Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
6Department of Pediatrics, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
7Division of Obstetrics and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Taipei

Veterans General Hospital, Taipei, Taiwan
8Department of Public Health, Tzu Chi University, Hualien, Taiwan
9Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan10Division of Environmental Health & Occupational Medicine, National Health Research Institutes,

Miaoli, Taiwan

BACKGROUND AND AIM:Exposure to endocrine disrupting chemicals (EDCs) is rigorously studied inassociations with various health outcomes, however less attention is paid to its socio-economic
determinants. This study investigates how EDCs levels in pregnant women may differ on residence,individual- and area-level income, and other socio-economic factors.
METHOD:Maternal urine collected in third semester was analyzed for phthalates, nonylphenol,
bisphenol A (BPA), parabens and benzophenones. Individual socio-economic variables were linked toaverage annual household income of neighborhood/village (area-level income) via participants’ postal
codes. EDCs metabolites concentration were treated as continuous dependent variables adjusted formolar weight and creatinine. Associations between socio-economic factors and EDCs levels were
estimated for the four main Taiwan regions (South, East, Central and North) using linear regressions
models with interaction between individual-level factors and area-level income as quadratic term.
RESULTS:The most distinct individual household income gradient was observed for BPA:
median(range) of 11.10(0.44, 61.50) nmol/g creatinine in the lowest income and 1.44(0.46, 30.90)
nmol/g creatinine in the highest income groups in the South region. However, reverse gradient wasobserved in the East: BPA median(range) of 3.43(0.17, 17.40) nmol/g creatinine in the lowest income
and 7.43(0.34, 50.60) nmol/g creatinine in the highest income groups. After adjustment for age,education, religion and ethnicity non-significant interactions between individual- and area-level income
were detected in areas with higher average household income for phthalates, nonylphenol, BPA in theSouth and East, and for parabens in the East.
CONCLUSIONS:Reduced differences in EDCs exposure across the regions could be due to the highpopulation density and unimpeded flow of consumer products in Taiwan, which may explain the nonsignificant findings. South and East regions indicated potential income inequalities in EDCs exposure.

More specific socio-economic indicators and environmental settings related to EDCs exposure should
be considered in the future investigations of the associations with child health outcomes.

Keywords: Endocrine disrupting chemicals, phthalates, socio-economic factors

MP-074[Chemical exposures » PFAS]

Prenatal PFHxS Concentrations are Negatively
Associated with Infant Birthweight and Weightat Two Years of Age
Alicia K. Peterson, Yeyi Zhu, Lisa A. Croen, Juanran Feng, Jennifer Ames, Stacey Alexeeff, Susanna D.
Mitro, Assiamira Ferrara
Women’s and Children’s Health Section, Division of Research, Kaiser Permanente Northern California,
Oakland, CA, US

BACKGROUND AND AIM:An inverse association between prenatal exposure to per-and-polyfluoroalkyl
substances (PFAS) and lower birthweight has been suggested, but less is known on which PFAS are
most associated and their influences on child weight after infancy. This study assessed the association
between prenatal PFAS concentrations and birthweight and weight at two years of age in a racially andethnically diverse birth cohort.
METHOD:Six PFAS (PFOS, PFOA, PFUnDA, PFHxS, PFDA, PFNA) were measured in maternal serum
collected during pregnancy (12±3 weeks gestation) from 796 individuals in Kaiser Permanente
Northern California participating in the NIH Environmental influences on Child Health Outcomes(ECHO) program. We used linear regression models to assess associations between individual PFAS
concentrations (natural log transformed) and infant birthweight (grams and sex-specific birthweightfor-gestational-age z-scores) and child weight at two years (kilograms, n=630). Models were adjusted
for maternal age, pre-pregnancy body mass index (BMI), race/ethnicity, neighborhood socioeconomic
status, and parity. Infant sex and gestational age at birth were included for birthweight and two-year
old weight models.
RESULTS:Participants were 30±5 years old at pregnancy and racially/ethnically diverse: 19% Asian,
4% Black, 40% Hispanic, 32% White and 5% Multiracial/other. Their infants were born on average
39±2 weeks and weighing 3361±543 grams. Median PFAS concentrations (>60% detection) ranged
between 0.2-2.5 ng/mL with PFOS having the highest median. Although an inverse relationship with
infant birthweight was suggested for all PFAS analytes, only PFHxS reached statistical significance (β=-72.1 grams 95% CI [-112.7, -31.5], p=0.001; β= -0.02 standard deviation 95% CI [-0.3, -0.1],
p=0.0001). Only PFHxS was associated with weight at two years of age (β= -0.2 kilograms, 95% CI [0.4, -0.1], p=0.01).
CONCLUSIONS:Prenatal PFHxS concentrations were associated with lower birthweight and child weightat two years of age. Analyses are underway to investigate the influence of prenatal PFAS exposure on
long-term childhood BMI trajectories within this population.

Keywords: Birth outcomes, Environmental Epidemiology, Obesity, Endocrine disrupting chemicals

MP-075[Air pollution » Particulate matter]

Association between exposure to heavy metals
in atmospheric particulate matter and sleep
quality
Byung Kwon Kim1, Jaelim Cho2, Changsoo Kim2, Changsoo Kim3
1Department of Public Health, Yonsei University College of Medicine
2Department of Preventive Medicine, Yonsei University College of Medicine
3Institute of Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea

BACKGROUND AND AIM:Recent studies have demonstrated that long-term exposure to particulatematter is associated with poor sleep quality. However, there are no studies linking the constituents ofparticulate matter and sleep quality. This study aimed to investigate the association between
exposures to heavy metals in particulate matter and sleep quality.
METHOD:This cross-sectional study was performed using data from the Korean Community Health
Survey performed between August and October 2018 in adults aged 19 to 80 years. Sleep quality wasevaluated using Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined as PSQI ≥5.
The one-year average concentrations of heavy metals (lead, manganese, cadmium, and aluminum) in
particulate matter with diameter ≤10 μm between November 2017 and October 2018 was obtained
from Air Korea and linked to the survey data based on each individual’s district (gu)-level residential
address.
RESULTS:Multivariable logistic regression models were used to investigate the associations between
airborne concentrations of heavy metals and poor sleep quality. A total of 32,051 participants werestudied. Increases in log-transformed lead (odds ratio, 1.14; 95% confidence interval, 1.08−1.20),
manganese (1.31; 1.25−1.37), cadmium (1.03; 1.00−1.05), and aluminum concentrations (1.17;
1.10−1.25) were associated with poor sleep quality.
CONCLUSIONS:We show, for the first time, exposures to airborne lead, manganese, cadmium, andaluminum were associated with poor sleep quality.

Keywords: Particulate matter, heavy metals, sleep quality

MP-076[Birth and pregnancy outcomes » Birth outcomes]

Interactions between maternal arsenic exposureand folate pathway genes on the risk of spina
bifida: A case‒control study in Bangladesh
Chih Fu Wei1, Sudipta Kumer Mukherjee2, Sheikh Muhammad Ekramullah2, D.m. Arman2, Joynul
Islam3, Hafiza Sultana Suchanda4, Gwen Tindula5, Marc G. Weisskopf1, Liming Liang6, David C.
Christiani1, Benjamin C. Warf7, Maitreyi Mazumdar5
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington

Avenue, Boston, MA, US
2Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital, Sher-e-

Bangla Nagar, Agargoan, Dhaka 1207, Bangladesh
3Department of Clinical Neurosurgery, National Institute of Neurosciences & Hospital, Sher-e-Bangla

Nagar, Agargoan, Dhaka 1207, Bangladesh
4Pediatric Neurosurgery Research Committee, National Institute of Neurosciences and Hospital,

Bangladesh
5Department of Neurology, Boston Children’s Hospital, BCH3443, 300 Longwood Avenue, Boston, MA,US
6Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue,

Boston, MA, US
7Department of Neurosurgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, US

BACKGROUND AND AIM:The pathogenesis of spina bifida involves complex gene‒environment
interactions, and folate pathway genes are the main targets of interest. High prenatal arsenic
exposure increases the risk of spina bifida in experimental animals, possibly by its disruption of folate
metabolism. However, few population health studies have examined the effect modification of arsenicinduced spina bifida by genetic polymorphisms involved in folate metabolism.
METHOD:We assessed genotypes of 108 infants with spina bifida (myelomeningocele or meningocele),
113 controls, and their mothers (126 cases and 136 controls) in a case‒control study between
December 2016 to August 2019 in Dhaka, Bangladesh using Illumina Global Screening Array (v1.0).
We measured toenail arsenic concentrations using inductively coupled plasma mass spectrometry. We
tested the interactions between 30 candidate single nucleotide polymorphisms (SNPs) mapped tofolate pathway genes and maternal toenail arsenic concentrations, and the interactions between all
SNPs located 50 kb upstream and downstream of the candidate genes and maternal arsenic with setbased methods.
RESULTS:Infants with rs11191454 (G allele, AS3MT) and rs7085104 (G allele, AS3MT) had higher
odds of spina bifida among mothers with higher than median toenail arsenic concentrations (aOR:
2.93, 95% CI: 1.29-6.63 for rs11191454; aOR 2.53, 95% CI: 1.30-4.91 for rs7085104), but notamong mothers with lower arsenic concentrations. Meanwhile, mothers carrying rs2228611 T allele(DNMT1) had higher odds of spina bifida under higher toenail arsenic concentrations (aOR 2.01, 95%
CI: 1.06-3.82), but the association reversed under lower arsenic concentrations. The AS3MT SNPs
interact with higher maternal toenail arsenic concentrations in iSKAT (p-for-interaction=0.023).
CONCLUSIONS:We found that polymorphisms of folate pathway-related genes, specifically maternal
DNMT1 and infant AS3MT polymorphisms, interacted with higher arsenic exposure to increase the riskof spina bifida.

Keywords: Birth outcomes, children's environmental health, environmental epidemiology, heavy
metalsMP-077[Outcomes » Obesity and metabolic disorders]

Associations of phthalate exposure withincidence of metabolic syndrome and its
component parameters– A prospective study
Yuan Rong Chou1, Pei Tzu Shan1, Chin Li Lu2
1Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung

Hsing University, Taichung, Taiwan
2Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung

Hsing University, Taichung, Taiwan; Department of Food Science and Biotechnology, College ofAgriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan; Department of
Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan

BACKGROUND AND AIM:The association between phthalate exposure and metabolic syndrome (MetS)
have been reported but rarely been examined in prospective study. This longitudinal study
investigated the association between phthalates exposure and the risk of MetS.
METHOD:This cohort study used data collected by Taiwan Biobank in Taiwan general population in
2008–2021. The participants aged 30–70 years without MetS were included. After a mean 4.25 years
of follow-up, changes of five components of MetS (i.e., blood glucose[Δglucose] and glycatedhemoglobin [ΔHbA1c], systolic and diastolic blood pressure [ΔSBP and ΔDBP], waist circumference[ΔWC], serum triglyceride [ΔTG], and high-density cholesterol [ΔHDL]) and the incidence of MetS
were determined. Levels of 10 urinary phthalate metabolites were detected using liquid
chromatography/tandem mass spectrometry and corrected by urine creatinine levels into μg/g
creatinine before data analyses. Multivariable logistic regression models and general linear models
were used to analyze data.
RESULTS:Of 790 participants averagely aged 48.9 years, 49% were males. After adjustment forcofounders, none of the phthalate metabolites was significantly associated with MetS incidence,
Δglucose, or ΔWC. However, several phthalate metabolites were positively associated with ΔHbA1c: 5hydroxy-hexyl phthalate(MEHHP), mono-2-ethyl-5-carboxy-pentyl phthalate (MECPP), mono-2carboxy-methyl-hexyl phthalate (MCMHP), mono-iso-butyl phthalate (MiBP), and sum of MiBP andmono-n-butyl phthalate(MnBP) (ΣDBP) (β[95% confidence interval (CI)]: 0.04[0.01, 0.07], 0.04[0.00,
0.07], 0.02[0.00, 0.04], 0.04[0.01, 0.07], 0.04[0.01, 0.07], respectively). Mono-2-ethylhexyl
phthalate (MEHP), MECPP, molar sum of di-2-ethylhexyl phthalate metabolites (ΣDEHP), and molar
sum of ΣDEHP and mono-benzyl phthalate (MBzP) (Σlongchain) (β[95% CI]: -0.65[-1.22, -0.07], 0.88[-1.72, -0.05], -1.04[-1.90, -0.17], -0.97[-1.85, -0.09], respectively) were negatively associatedwith ΔHDL. Besides, MEHP and MCMHP was positively correlated with ΔSBP and ΔDBP, respectively;
MiBP was negatively correlated with ΔTG.
CONCLUSIONS:In this four-year follow-up study, increased phthalate exposure was not significantly
associated with MetS incidence, but DEHP exposure might increase the increment of HbA1c anddecrement of HDL.

Keywords: phthalates, Obesity and metabolic disorders, Environmental epidemiology, Incidence,
Epidemiology

MP-078[Chemical exposures » PFAS]Childhood Exposure to Perfluoroalkyl
Substances in relation to Child Adiposity
Ching Yu Sun1, Mei Huei Chen2, Ching Chun Lin3, Pau Chung Chen4
1Department of Environmental and Occupational Medicine, National Taiwan University College ofMedicine and Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences,
National Taiwan University College of Public Health, Taipei, Taiwan
2Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;

Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
3Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
4Department of Environmental and Occupational Medicine, National Taiwan University College ofMedicine and Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences,
National Taiwan University College of Public Health, Taipei, Taiwan; National Institute ofEnvironmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) have been used in industrial andconsumer products since the 1950s. While epidemiological studies have found associations between
some harmful health effects and PFAS exposure, including increased serum lipids and decreased infantbirth weight, the evidence linking PFAS to obesity remains unclear. Furthermore, most studies havefocused on long-chain PFAS, which have been prohibited, rather than emerging PFAS used by recent
manufacturers. In this cross-sectional study, we aim to evaluate the associations between childhood
PFAS exposures and health effects related to obesity.
METHOD:17 different PFAS were measured in 595 children aged 6 to 9 in 2018. Various biomarkers
were also measured, including lipid profiles, fasting insulin, fasting glucose, adiponectin, leptin, andinsulin growth factor-1. We also recorded their BMI, body fat percentage, and waist-height ratio. Oneway ANOVA was used to analyze the difference in serum biomarkers linked to metabolic dysfunction
among different PFAS concentration quantiles. Spline regression was used to analyze the association
between PFAS and findings in physical examination.
RESULTS:Among the participants, 99 children were classified as underweight, and 103 as overweightor obese. 13 of the 17 PFAS were detected in over 70% of the participants. ANOVA analysis revealed
an association between increased long-chain PFAS levels and increased serum lipids, consistent withprevious research. We also found a difference in adiponectin and homeostatic model assessment
insulin resistance (HOMA-IR) in both long- and short-chain PFAS exposure, indicating an increased risk
for future metabolic diseases. However, no clear trend was observed between any specific PFAS andobesity.
CONCLUSIONS:Our study shows potential associations between specific PFAS exposure andbiomarkers linked to metabolic dysfunction in children. However, given the complex mixture of PFAS
that humans are exposed to, further investigation is crucial to determine the contribution of the entire
mixture and the different PFAS.

Keywords: PFAS, Obesity and metabolic disorders

MP-079[Chemical exposures » PFAS]

Maternal serum per- and polyfluoroalkyl
substances during pregnancy and breastfeeding
duration
Chloe Friedman1, Dana Dabelea2, John L Adgate3, Deborah H Glueck4, Anne P Starling5
1Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
2Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA, Department of Pediatrics, Schoolof Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
3Department of Environmental and Occupational Health, Colorado School of Public Health, Universityof Colorado Anschutz Medical Campus, Aurora, CO, USA
4Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA,Department of Pediatrics, School of Medicine, University ofColorado Anschutz Medical Campus, Aurora, CO, USA
5Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz

Medical Campus, Aurora, CO, USA, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA, Department of Epidemiology,
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting
chemicals that may affect breastfeeding duration. We examined associations between maternal PFAS
concentrations during pregnancy and breastfeeding cessation. We also investigated potential effectmodification of this relationship by parity status.
METHOD:Among 555 women who initiated breastfeeding in the Healthy Start study (2009-2014), wequantified maternal serum concentrations of 5 PFAS during mid- to late-pregnancy (mean 27 weeks ofgestation). Participants self-reported their breastfeeding practices through 18-24 months postnatally.
Among all participants and stratified by parity, we estimated associations between maternal PFAS
concentrations and breastfeeding discontinuation by 3 and 6 months, using Poisson regression, andbreastfeeding duration, using Cox regression.
RESULTS:Median PFAS concentrations were similar to those in the general U.S. population.
Associations between PFAS and breastfeeding duration differed by parity status. After adjusting forcovariates, among primiparous women, associations between PFAS and breastfeeding cessation by 3
and 6 months were generally null, with some inverse associations. Among multiparous women, there
were positive associations between perfluorohexane sulfonate, perfluorooctane sulfonate,perfluorooctanoate (PFOA), and perfluorononanoate and breastfeeding cessation by 3 and 6 months.
For example, per ln-ng/mL increase in PFOA, the risk ratio for breastfeeding discontinuation by 6months was 1.45 (95% CI, 1.18, 1.78). Hazard ratios reflected similar patterns between PFAS andbreastfeeding duration.
CONCLUSIONS:Among primiparous women, we did not find evidence for associations between PFAS
concentrations and breastfeeding duration. In contrast, among multiparous women, PFAS serum
concentrations were generally inversely associated with breastfeeding duration, though estimates may
be biased due to confounding by unmeasured previous breastfeeding.

Keywords: Female, Endocrine disrupting chemicals, OutcomesMP-080[Climate » General]

Rainfall patterns, water-related diseases,
malnutrition and mortality in Low- and MiddleIncome Countries (LMICs): a systematic review
Indira Ellora Bose1, Genevieve Hadida2, Rosemary Green2, Kris Murray3, Cherie Part1, Sari Kovats1
1Department of Public Health, Environments and Society, London School of Hygiene and Tropical

Medicine, London, U.K
2Department of Population Health, London School of Hygiene and Tropical Medicine, London, U.K
3The Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine,

Fajara, The Gambia

BACKGROUND AND AIM:The objective of this study was to understand and evaluate the strength ofevidence on the association between rainfall (including low rainfall and heavy rainfall events) andhealth outcomes in Low- and Middle- Income Countries (LMICs).
METHOD:A systematic review was carried out, searching 7 databases for epidemiological studies thatquantified an association between rainfall and health outcomes in LMICs. Final screening wasundertaken by 2 independent reviewers. All studies were evaluated to assess quality. The strength ofevidence for each health outcome was disaggregated by 3 exposures: “Rainfall as a continuous
measure”; “Heavy Rainfall” and “Low Rainfall”.
RESULTS:23,679 results were screened. 177 papers met the inclusion criteria. Health outcomes
included diarrheal diseases (n= 119); malnutrition (n=35); mortality (n=21); helminth infections(n=6), and eye infections (n=4).
Studies were heterogenous in design, rainfall exposure and lags, making it difficult to draw
conclusions. The evidence on diarrheal diseases was the strongest. A fairly strong positive association
was found between heavy rainfall and all-cause diarrhea. Studies on undernutrition tended toinvestigate the relationship between anthropometric measurements and exposures over long
timeframes (e.g., prior growing season), finding mainly mixed results for increasing rainfall, and aweak positive relationship with low rainfall. Studies often lacked a clear hypothesis. Although multiple
pathways for rainfall effects are possible, these were not well reflected in the study designs.
CONCLUSIONS:Despite the high number of studies on the health effects of rainfall in LMICs, thelimitations in the data (often from cross-sectional surveys) and study designs, limit the strength ofevidence for many health outcomes. Specifically, studies frequently used inappropriate exposures orlags to reflect the causal pathways. Greater efforts in future studies should be directed to incorporate
causal pathways into models, better defining low rainfall periods, and conceptualising the interaction
between rainfall and inter-related health outcomes.

Keywords: Environmental epidemiology, Methodological study design, Waterbourne diseases,
Food/nutrition, Mortality

MP-081[Chemical exposures » Phenols]

Urinary concentration of phenols and parabens,
and biomarkers of oxidative stress in pregnant
women
Ju Hee Kim, Nalae Moon, Su Ji Heo
College of Nursing Science, Kyung Hee University, Seoul, South Korea

BACKGROUND AND AIM:The aim of this study is to investigate the associations between urinary
concentration of phenols and parabens, and biomarkers of oxidative stress in pregnant women in
Korea
METHOD:We analyzed urinary samples of 242 pregnant women from “No Environmental Hazards forMother-Child pairs” cohort study which was conducted from 2022 to 2023 in Korea. All urinary
samples were analyzed to determine the concentrations of five phenols (BPA, BPF, BPS, TCS, and BP3) and four parabens (MP, EP, PP, and BP) using LC-MS/MS. The oxidative stress biomarkers weremalondialdehyde (MDA) and 8-Oxo-2-deoxyguanosine (8-OHdG). A multiple linear regression model
was used after adjusting for maternal age, maternal pre-pregnancy body mass index, and gestational
week.
RESULTS:The detection rates of phenols (BPA, BPF, BPS, TCS, and BP-3) were 78.5, 42.1, 98.8, 71.5,
and 71.5%, respectively, and the geometric mean levels ranged from 0.133 to 0.416 µg/g creatinine.
The detection rates of parabens (MP, EP, PP, and BP) were 100, 99.6, 31.0, and 100%, respectively,
and the geometric mean levels ranged from 0.332 to 32.046 µg/g creatinine. In the univariate model,
MP was not a significant predictor of MDA level (B = 0.08, p = 0.054), but it showed significant results
in a multivariate model (B = 0.053, p = 0.048). BP was a significant factor for 8-OHdG in both theunivariate (B = -0.406, p < 0.001) and multivariate models (B = -0.397, p < 0.001).
CONCLUSIONS:Exposure to parabens is significantly associated with increased oxidative stress.
Therefore, efforts are needed to reduce the exposure to plastic materials including parabens in
pregnant women..

Keywords: PHENOL, PARABEN, OXIDATIVE STRESS, PREGNANT WOMENMP-082[Chemical exposures » Endocrine disrupting chemicals]

Urinary concentration of polycyclic aromatichydrocarbons and volatile organic compounds
are associated with biomarkers of oxidative
stress in pregnan
Ju Hee Kim, Nalae Moon, Su Ji Heo
College of Nursing Science, Kyung Hee University, Seoul, South Korea

BACKGROUND AND AIM:According to previous epidemiological studies, exposure to polycyclicaromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) is associated with increasedoxidative stress biomarkers that mediate diverse adverse health effects across body organ systems.
This study aimed to confirm the association between urinary PAHs and VOCs concentrations andoxidative stress.
METHOD:We recruited 242 pregnant women from 2022 to 2023 and collected spot urine samples in
the first trimester. Four PAHs (1-OHP, 2-NAP, 1-PHE, and 2-FLU) and two VOCs (t, t-MA and BMA)
were analyzed in the urine samples using LC-MS/MS. The oxidative stress biomarkers weremalondialdehyde (MDA) and 8-oxo-2-deoxyguanosine (8-OHdG). Univariate and multivariate linear
regression analyses were conducted after adjusting for maternal age, maternal pre-pregnancy bodymass, and gestational weeks
RESULTS:The detection rate of PAHs (1-OHP, 2-NAP, 1-PHE, and 2-FLU) ranged from 77.3 to 100%,and the geometric mean ranged from 0.049 to 2.388 µg/g creatinine. The detection rates of VOCs (t,t-MA and BMA) were 99.6 and 99.6%, and the geometric mean levels were 44.298 and 2.816 µg/g
creatinine, respectively. The t, t-MA was a significant variable of MDA, which reflects the increased
radical oxygen activities during inflammation (B = -0.162, p < 0.001).
CONCLUSIONS:Exposure to VOCs is significantly associated with higher levels of oxidative stress.
Pregnant women should pay attention to the use of consumer products that emit PAHs and VOCs indaily life.

Keywords: polycyclic aromatic hydrocarbons, volatile organic compounds, oxidative stress,
malondialdehyde

MP-083[One health » COVID-19]

The Impact of COVID-19-related Visiting
Restrictions on Effectiveness of Discharge
Planning: A retrospective Hospital-based Cohort
Study
Mao-Ting Lee1, Yi-Te Hsu2, Ie-Fn Jan3, Chin-Li Lu4, Pi-I Li1
1Department of Family Medicine, Chi Mei Medical Center, Tainan City, Taiwan (R.O.C)
2Community Health Development Team, Chi Mei Medical Center, Tainan City, Taiwan (R.O.C)
3Nursing Department, Chi Mei Medical Center, Tainan City, Taiwan (R.O.C)
4Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung

Hsing University, Taichung, Taiwan (R.O.C)

BACKGROUND AND AIM:Discharge planning is an individualized discharge preparation by aninterdisciplinary team, with collaboration of the patient and family. However, visiting restrictions were
implemented worldwide during COVID19 pandemic, and little is known about the impact on theeffectiveness of discharge planning. Thus, we aim to explore the outcomes of discharge planningduring the pandemic, by measure of 14-day unplanned hospital readmission after discharge.
METHOD:This retrospective study is a single-center cohort of adult patients admitted to ordinary
medical wards between April 1st and July 31 in 2019 and 2022. The strictest visiting restrictions wereadopted in this interval in 2022. Those with medical/care needs were recruited for discharge planning.
We analyzed the association between discharge planning and risk of 14-day unplanned hospital
readmission by binary logistic regression. Additional sensitive analyses were performed among
patients with cancers, aged over 65 and without COVID-19 at admission. We also compared the timefrom discharge to hopsital readmission by the Wilcoxon rank-sum test.
RESULTS:In total, 4419 patients in 2019 and 6894 patients in 2022 were included. Patients in 2022
were older, with higher propotion of nursing home residents and cancers. When adjusted for all
potential confounders, the adjusted odds ratio(aOR) for discharge planning and risk of 14-day
unplanned hospital readmission increased from 2.31(1.61-3.30) in 2019 to 7.28(4.60-11.54) in 2022.
Sensitivity analysis among patients with cancers, aged over 65 and without COVID-19 at admission
showed similar results. There was no statistically significant difference in time from discharge toreadmission (7.11(4.09-10.24) in 2019 and 6.94(4.24-10.55) in 2022, p=0.744), whether patientswere recruited in discharge planning or not.
CONCLUSIONS:Vsiting restrictions had negative impact on discharge planning, according to its
association with higher risk of 14-day unplanned hospital readmission in 2022. Therefore, it'ssuggested that health care authorites make the necessary plans to revise discharge planning during
the pandemic.

Keywords: Outcomes, Policy and practiceMP-084[Birth and pregnancy outcomes » Birth outcomes]

Associations of prenatal exposure to flame
retardants and birth outcomes in the Puerto Rico
Testsite for Contamination Threats (PROTECT)
cohortSkarlet G Velasquez1, Wesley Z Billings1, Jessica H Knight1, Stephen L Rathbun1, John D Meeker2,
José F Cordero1
1Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens,USA
2Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann

Arbor, USA

BACKGROUND AND AIM:Preterm birth disproportionately impacts pregnancies in Puerto Rico and theexposure to organophosphate flame retardants (OPFRs) is widespread. Therefore, the aim of thisstudy was to examine the associations of OPFRs with birth weight z-scores and gestational age.
METHOD:In a subset of 146 pregnant women from the PROTECT cohort study, based in Northern
Puerto Rico, we measured four OPFR metabolites in urine measured twice during pregnancy. TheseOPFRs are bis (2-chloroethyl) phosphate (BCEtP), bis (1-chloro-2-propyl) phosphate (BCPP), bis (1, 3dichloro-2-propyl) phosphate (BDCPP), and diphenyl phosphate (DPhP). Gestational age and birthweight were extracted from medical records. We used multivariable linear regression to estimate
covariate adjusted associations between urinary OPFR metabolite concentrations and birth outcomes.
RESULTS:In unadjusted models, we observed a subtle increase in gestational age and a nonstatistically significant decrease in birth weight z-scores associated with all OPFRs. After covariate
adjustment, these associations remained the same. For a 10% increase in DPhP, gestational age
increased by 0.22 weeks (β: 0.22, 95% CI: -0.12, 0.55). For a 10% increase in both BDCPP (β: 0.12,
95%CI: -0.21, 0.45) and BCPP (β: 0.12, 95% CI: -0.27, 0.47), gestational age increased by 0.12
weeks. For a 10% increase in BCPP (β:-0.02, 95% CI: -0.25, 0.21) and BDCPP (β: -0.02, 95%CI: 0.23, 0.18) there was a -0.02 decrease in birthweight z-scores.
CONCLUSIONS:In this cohort, urinary OPFRs were not associated with gestational age and birthweight, yet additional research is needed to elucidate its full impact on birth outcomes. OPFRs are
emerging chemicals, and little is known about their effect on birth outcomes. A better understandingof environmental risk factors for adverse birth outcomes will help in the development of targetedintervention and prevention strategies.
Acknowledgements-Support for this research was provided by grant P42ES017198 from the National
Institute of Environmental Health Sciences, National Institutes of Health

Keywords: endocrine disrupting chemicals, environmental epidemiology

MP-085[Methods » Modeling]

Scenarios of healthier urban transport regimes –An agent-based modeling case study of
Amsterdam
Tabea Simone Sonnenschein1, Ardine De Wit2, Roel Vermeulen1, Simon Scheider1
1Utrecht University
2Vrije Universiteit Amsterdam

BACKGROUND AND AIM:With ever more people living in cities worldwide, it becomes increasingly
important to understand the positive and negative impacts of the urban habitat on livability, healthbehaviors and health outcomes. However, implementing interventions that tackle the exposome incomplex urban systems can be costly and have long-term, sometimes unforeseen and indirect,
impacts. Hence, it is crucial to not only assess the health impact of interventions, but also its costeffectiveness and the social distributional impacts of possible urban exposome interventions before
implementing them.
METHOD:Spatial agent-based modeling can capture complex behavior-environment interactions,
exposure dynamics, and social outcomes in a spatial context. We present our work on agent-basedmodeling of transport interventions in the context of the city of Amsterdam. The goal of our model is
to capture the health impacts of multiple hypothetical transport intervention scenarios, such as carfree zones, replacement of parking places with active transport infrastructure, and separation of active
and motorized transport routes. Our agent-based modeling approach entails the integration of abehavioral model of people’s mobility choices and dynamic physical models of environmental stressors(e.g. air pollution).
RESULTS:Together these sub-models result in an exposure interaction that approximates personal
behavioral and environmental exposure for different population groups within an urban environment,
e.g. based on demographics, the neighbourhoods they live in or on their social economic
circumstances. Consequently, the accumulated health impacts for different interventions andpopulation groups are assessed using exposure-response functions.
CONCLUSIONS:We present our model architecture, the strength and limitations of the method, andour findings on effects of transport interventions.

Keywords: Agent-based Modeling, Exposome, Urban Transport Planning, Health Impact Assessment,
Scenario Analysis

MP-086[Exposures » Occupational exposures]Line List Analysis of Occupational Exposure to
COVID-19 in Newfoundland and Labrador,
CanadaThaneswary Rajanderan1, Rod Russell1, Chand S Mangat2, Douglas Howse3, Cheryl Foo4, Atanu
Sarkar1
1Faculty of Medicine, Memorial University of Newfoundland and Labrador
2National Microbiological Laboratory, Winnipeg, Manitoba
3Department of Health and Community Services, Government of Newfoundland and Labrador
4Eastern Health, Government of Newfoundland and Labrador

BACKGROUND AND AIM:COVID-19 has disproportionately impacted various occupational groups,
especially those that worked on the frontline, performed essential work and had to travel. This cancreate a stressful and unsafe working environment due to the increased risk of COVID-19 infections.
So, this study aimed to analyze a COVID-19 line list and explore the distribution and incidence of
COVID-19 among various occupational groups in Newfoundland and Labrador, Canada.
METHOD:A Newfoundland and Labrador COVID-19 line list was constructed to contain all 2,143 cases
from March 14, 2020 (first case) to December 15, 2021. The variables included demographical,
laboratory, clinical, and immunization-related information. SPSS V.26® was used to screen the data,
generate descriptive statistics, and perform statistical testing.
RESULTS:Out of the 2,143 COVID-19 cases, the occupational groups identified in the line list wereindustrial [mining, warehouse, and construction] (245), healthcare (144), office [administrative andremote work] (31), school/daycare (21), retail (27), and food service (8) workers. The COVID-19
incidence rates of industrial and healthcare workers in the province were 892 and 627 cases per
100,000 persons, respectively. The other occupational groups had COVID-19 incidence rates of 100 to
250 cases per 100,000 persons each. Both healthcare and industrial workers had higher COVID-19
incidence rates than the general Newfoundland and Labrador population (429 cases per 100,000
persons). The relative risks for COVID-19 among both groups compared to the rest of the population
were 1.57 (healthcare) and 2.32 (industry).
CONCLUSIONS:Based on the relative risk, healthcare and industrial workers had a greater risk of
COVID-19 infection than the rest of Newfoundland and Labrador during the early phase of thepandemic. These findings will help inform workplace and general policies to manage infectious disease
outbreaks and create safer working environments. Future investigations can also be made into thesource of infection at these workplaces.

Keywords: COVID-19, Epidemiology, Infectious diseases

MP-087[Built environment » Walkability]

Association between neighborhood walkability
and chronic kidney disease: A longitudinalcohort study in Taiwan
Wei Yi Chen1, Yi Qian Zheng2, Tsung Yu3, Gavin Rudge4, G.neil Thomas4, Xiang Qian Lao51Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
2JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR,

China
3Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
4Department of Public Health, Epidemiology &Biostatistics, University of Birmingham, Birmingham, UK
5Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China & School of

Public Health, Zhengzhou University, Zhengzhou, China

BACKGROUND AND AIM:Physical activity is essential for overall well-being. Walkable neighborhood
can promote physical activity levels across a broad population. However, the association between
walkability and health, particularly chronic kidney disease (CKD), is relatively poorly documented. We
explored the association between neighborhood walkability and CKD in a Taiwanese population.
METHOD:A total of 27,665 participants without CKD who enrolled in a standard medical examination
program in Taiwan between 1996 and 2017 were included in our study. Walkability was measured
using three domains: point of interest (POI), transit stations, and impedance. POI and transit stations
measured densities of goods providers and public transportation within a 640m walking distance fromthe participant's address. Impedance measured increasing walking impedance. CKD diagnosis was
based on the estimated glomerular filtration rate computed from serum creatinine measured in the
medical screening program. We used a time-varying Cox regression model to investigate the effects ofneighborhood walkability on the incidence of CKD.
RESULTS:The study identified 1,332 CKD cases with a total follow-up of 162,423.75 person-years.
Residents living in the fourth quartile of POI had a 31.1% lower risk of developing CKD compared tothose living in the first quartile of POI [hazard ratio (HR): 0.679; 95% confidence interval (CI): 0.548,
0.842]. In addition, compared with the participants exposed to the first quartile of impedance,
participants exposed to the fourth, third, and second quartiles of impedance had a hazard ratio of
1.06(0.92,1.21), 1.26(1.10,1.45) and 1.24(1.07,1.44) for CKD development, respectively. Residents
living in the fourth quartile of transit station had a 40.1% higher risk of developing CKD compared tothose living in the first quartile of transit station [HR: 1.40; 95% CI: 1.11,1.77].
CONCLUSIONS:Higher POI and lower impedance were associated with a lower incidence of CKD.
Further studies are warranted for the association of transit station with CKD.

Keywords: Walkability, Chronic kidney disease, Cohort, Taiwan

MP-088[Built environment » Walkability]

Exposure to neighbourhood walkability andmortality: A longitudinal cohort study
Yi Qian Zeng1, Weiyi Chen2, Tsung Yu3, Marc Ka Chun Chong1, Gavin Rudge4, G. Neil Thomas4, Xiang
Qian Lao5
1Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong

Kong SAR, China.
2Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China.
3Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan.
4Department of Public Health, Epidemiology &Biostatistics, University of Birmingham, Birmingham,UK.
5Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China; School of

Public Health, Zhengzhou University, Zhengzhou, China

BACKGROUND AND AIM:Good walkability has been proposed as a broad strategy for promoting
physical activity. However, little is known about the association between walkability and health,especially in the context of Asian regions with high population densities. Our study aims to investigate
the association between neighborhood walkability and mortality in Taiwanese adults.
METHOD:We selected 362,740 participants (≥18 years old) from Taiwan who joined a standard
medical examination program between 2001 and 2016, and followed them until 31 July 2021. Threewalkability measures were estimated within a walking distance of 640m of participant’s addresses:
point of interest (POI), transit stations, and impedance. Mortality data was obtained from the National
Death Registry maintained by the Ministry of Health and Welfare in Taiwan. A time-varying Cox
regression model was used to investigate the association of neighborhood walkability with death fromnatural-cause and specific causes.
RESULTS:This study identified 14,351 deaths over 5,327,780.58 person-years of follow-up. Comparedwith living in areas with the first tertile of POI and transit station, living in areas with higher numbersof POI and transit stations were associated with a lower risk of natural-cause mortality, with hazard
ratios(HRs) (95% confidence intervals(CIs)) of 0.95 (0.91, 0.99) and 0.89 (0.86, 0.93) for second andthird tertiles of POI, and 0.95 (0.91, 0.99) and 0.92 (0.89, 0.96) for second and third tertiles of transit
station, respectively. In addition, compared with living in areas with the first tertile of impedance,
living with the third tertile of impedance was associated a higher risk of natural-cause mortality, withHRs(95%CI) of 1.07 (1.02, 1.11). We also found protective effects of POI and transit station on deathfrom cardiovascular diseases and cancer.
CONCLUSIONS:Better neighborhood walkability was associated with a lower risk of mortality. Ourfindings reinforced the importance of neighborhood walkability in urban planning and health guideline
development.

Keywords: Adults, Walkability, Mortality, Cohort, Taiwan

MP-089[Exposures » Socio-economic factors (non-chemical stressors)]

Associations Between Maternal Negative Life
Events Measured During the COVID-19
Pandemic and Child Sleep Health
Yueh Hsiu Mathilda Chiu1, Camille Almada2, Francheska M Merced Nieves1, Nicole Mathews3, RosalindJ Wright1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA & The Kravis Children’s Hospital, Department of Pediatrics, Icahn School of
Medicine at Mount Sinai, New York, NY, USA
2Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA &Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New
York, NY, USA
3The Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai,

New York, NY, USA

BACKGROUND AND AIM:Healthy sleep supports growth and development throughout the lifespan.
Maternal stress has been linked to child sleep health. Both stress and sleep alterations have increased
during the COVID-19 pandemic. We examined associations between maternal stress measured during
the pandemic and child sleep health, and identified susceptible groups.
METHOD:Analyses included 307 maternal-child pairs enrolled in a multi-ethnic longitudinal cohort,with maternal stress and child sleep health ascertained between March 1, 2020 and March 1, 2021.
Mothers completed the Crisis in the Family Systems-Revised (CRISYS-R), where stress was indexed bya negative life events (NLE) score across 11 stress domains (e.g., financial strain, legal, housing,home/community safety, etc.). Mothers reported child’s sleep disturbance (SlpDist) and sle

EP-related impairment (SlpImp) using validated PROMIS short forms. We used multivariable-adjusted
regressions to evaluate associations between NLE score and child sleep outcomes, adjusting formaternal age, education, race/ethnicity, child age, sex, and duration since March 1, 2020. Effectmodification by race/ethnicity was examined.
RESULTS:Mothers were primarily ethnic minorities (48% Black, 34% Hispanic, 18% White). Blackchildren were more likely to have SlpImp t-scores above the United States norm (t-score=50),
compared to other racial/ethnic groups (p=0.03). Maternal NLE score was significantly associated with
SlpDist t-score (β=0.71, p=0.02) and SlpImp t-score (β=0.76, p=0.02), after adjusting for covariates.
Home safety (β=4.03, p=0.05) and other home issues (β=4.52, p<0.001) domains were associatedwith SlpDist. Home safety (β=6.47, p<0.01), legal (β=4.82, p=0.01), and authority (β=5.10, p=0.04)
domains were associated with SlpImp. Stratified analyses showed that the relationship with NLEs wasmost significant among Hispanic (p=0.03 for SlpImp) and Black participants (p=0.05 for SlpDist,
p=0.06 for SlpImp).
CONCLUSIONS:Maternal stress was associated with child sleep quality during the COVID-19 pandemic,
particularly in Black and/or Hispanic groups. Interventions targeted at alleviating maternal stress inthese groups may improve child sleep health.

Keywords: Non-chemical stressors, Children's environmental health, Mental health, Other outcomes(Sleep health), Environmental epidemiology

MP-090[Planetary health » Agricultural productivity]

Effect of combined agricultural and sustainablediet policies on air pollution, dietary patterns
and health in the UK
James Milner1, Silvia Pastorino1, Rosemary Green2, Paul Wilkinson1, Massimo Vieno3, Edward
Carnell3, Stefan Reis3, Ai Milojevic1
1Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
2Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine,

London, UK
3UK Centre for Ecology & Hydrology, Edinburgh, UK

BACKGROUND AND AIM:There are opportunities to align agricultural policies that reduce air pollution
emissions with dietary sustainable policies, while reducing greenhouse gas (GHG) emissions. We
assessed the potential effects of combined agricultural and dietary policies on air pollution exposure,dietary patterns and health in the UK.
METHOD:We modelled a range of current and future policy options to reduce air pollution (PM2.5,
NOx) from agriculture in the UK using the atmospheric chemistry transport model EMEP4UK in 2020,
2030 and 2050. We assessed the potential effects of aligned dietary policies (meat/dairy taxes,
fruit/vegetable subsidies, substituting meat/dairy with plant-based analogues) by applying UK-specificprice elasticities and market share data to diet survey data. The effects of changes in PM2.5 exposureand changes in dietary consumption (including red meat, fruits and vegetables) on mortality andmorbidity were quantified using a life table model augmented by calculations of disease prevalence fora range of health outcomes using published exposure-response functions.
RESULTS:Overall in England, population-weighted PM2.5 exposure was decreased by 2.4% compared
to business-as-usual scenario in 2030 with high ambition mitigation uptake to achieve Net Zero for
GHG emissions. Reduction rate slightly improved (3.1%) with additional policy, replacement of farmed
animal products with lab/plant alternatives. Implementing fiscal measures and innovations in
production of meat alternatives would accelerate existing positive trends in UK diets, with forecasted
decreases in meat (30%) and dairy (32%) and increases in fruits and vegetables (14%). GHG
emissions were reduced under all scenarios. The combined agricultural and dietary scenarios resulted
in large reductions in mortality, improvements in life expectancy and reductions in the prevalence ofcancers, circulatory and respiratory conditions.
CONCLUSIONS:There is considerable potential for agricultural policies to improve health in the UK.
The health and environmental benefits of such action could be enhanced using complementary policies
aimed at improving the sustainability of diets.

Keywords: Air pollution, Particulate matter, Food/nutrition, Modeling, Health co-benefits

MP-091[Outcomes » Obesity and metabolic disorders]

The association between environmental noise
and adiposity in a Central-European population
sample: the Kardiovize study
Anna Bartoskova Polcrova1, Andrea Dalecka1, Daniel Szabo1, Juan Pablo Gonzalez Rivas2, Martin
Bobak3, Hynek Pikhart3
1RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
2International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech

Republic and Department of Global Health and Population. Harvard TH Chan School of Public Health.
Harvard University, Boston, Massachusetts, USA.
3RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic and Departmentof Epidemiology and Public Health, University College London, United Kingdom

BACKGROUND AND AIM:The effect of environmental noise exposure on cardiovascular diseases havebeen established before, but less is known about the impact of noise on adiposity, one of the main
drivers of cardiometabolic diseases. This study aimed to investigate the association between
environmental noise exposure and diverse adiposity biomarkers in Central-European urban population.
METHOD:Cross-sectional population-based sample from Czechia included 2033 participants aged 2564 years (examined in 2013-2014, 54.70% women). The environmental noise exposures wereobtained from the geographical prediction modelling for the 2nd report of Strategic noise mapping in
the Czech Republic (2012), conducted in accordance with the Environmental Noise Directive (END)
requirements and methodology. Global combined (road, railway, and airport) Lden (day-eveningnight) noise levels were calculated for each residential building at its centroid, and mean, median andstandard deviation values were obtained for each street. Four adiposity biomarkers (BMI, body fat
percentage, waist circumference, and visceral fat area) were assessed. Linear regression analyses withan adjustment for sex, age, education, income, lifestyle factors, stress, and depression were applied.
RESULTS:The average noise exposure was 53.79 dB, ranging from 42.50 dB to 66.97 dB. The
difference between the highest vs. lowest quartile of noise exposure was for BMI 0.96 kg/m2 (95%CI:
0.35-1.56), body fat 1.48% (95%CI: 0.51-2.44), waist circumference 2.30 cm (95%CI: 0.79-3.80)
and visceral fat 7.52 cm2 (95%CI: 2.92-12.12).
CONCLUSIONS:CONCLUSION: The results suggest positive associations between environmental noise
exposure and several adiposity measures. Future studies are needed to confirm the association and toinvestigate the underlying physiological and psychosociological mechanisms.
Funding: European Union’s Horizon 2020 research and innovation programme: No 857487 and The
National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, No.
LX22NPO5104).

Keywords: noise, obesity and metabolic disorders

MP-092[Air pollution » Wildfires]

Short-term exposure to PM2.5 from vegetation
fire events and mortality in Upper Northern
Thailand
Athicha Uttajug1, Kayo Ueda1, Xerxes Teroso Seposo1, Arthit Phosri2, Vera Ling Hui Phung3,
Muhammad Abdul Basit Ahmad Tajudin1
1Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
2Department of Environmental Health Sciences, Faculty of Public Health, Mahidol University, Bangkok,

Thailand
3Center for Climate Change Adaptation, National Institute for Environmental Studies (NIES), Tsukuba,

Japan

BACKGROUND AND AIM:Recently, several epidemiological studies documented that short-term
exposure to air pollution from vegetation fire events poses detrimental health effects across Southeast
Asia. However, few studies have been conducted to examine the association between PM₂.₅ originatedfrom vegetation fire events and health effects in this area due to scarcity of PM₂.₅ information. The
objective of this study was to investigate the association between vegetation fire PM₂.₅ and mortality
in Upper Northern Thailand (UNT).
METHOD:We obtained mortality records during 2017-2021 from the Strategy and Planning Division
Office, Ministry of Public Health Thailand which covers UNT population for 657 sub-districts. Each
record included age, sex, mortality date, and cause of mortality. Vegetation fire PM₂.₅ was collectedfrom System for Integrated modeLling of Atmospheric coMposition (SILAM) model, which wasestimated based on Fire Radiative Power (FRP) data of Moderate Resolution Imaging
Spectroradiometer (MODIS) satellite at a 0.1 × 0.1 resolution. The daily PM₂.₅ was averaged withineach sub-district. Data were restricted to burning periods (January to April) for this study. We
performed a time-stratified case-crossover analysis using a generalized linear model to investigate theassociation between vegetation fire PM₂.₅ and mortality. Stratification analysis was also conducted forthe specific cause of mortality.
RESULTS:There were 59,800 deaths in Upper Northern Thailand during the study period. Overall, weobserved a statistically significant increase in all-cause mortality for each 10 μg/m³ increment invegetation fire PM₂.₅ on the same day (RR:1.005 (95% CI: 1.000, 1.011)). With stratification
analysis, vegetation fire PM₂.₅ was also associated with respiratory mortality (RR: 1.029 (95%CIs:
1.008, 1.050)), but not cardiovascular (RR: 1.018 (95%CIs: 0.998, 1.039)) or stroke mortality (RR:
1.013 (95%CIs: 0.983, 1.044)).
CONCLUSIONS:This study indicates that short-term exposure to PM₂.₅ from vegetation fire events has
immediate effects on mortality in UNT.

Keywords: Vegetation fire events, PM2.5, Mortality, Upper Northern Thailand

MP-093[Methods » Causal inference]

Causal associations between gut microbiomeand Hypertension
Chan Il Jeon, Ji Young Lee, Keum Ji Jung, Heejin Kimm, Do Yeon Lim, Sun Ha Jee
Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of
Public Health, Yonsei University, Seoul, Korea

BACKGROUND AND AIM:The association of intestinal microbiome and hypertension has been observedin several studies, but not proven by a causal relationship. We conducted a two-sample Mendelianrandomization (MR) analysis to investigate the causal relationship between gut microbiome andhypertension.
METHOD:A two-sample Mendelian randomization study was conducted using inverse varianceweighting(IVW), weighted median, weighted mode, and MR-Egger regression. We selected single
nucleotide polymorphisms (SNPs) related to gut microbiome and hypertension from a large GenomeWide Association Studies (GWAS) study. Dataset based on the UK Biobank served as outcome with alarge sample of hypertension. Dataset of intestinal microbiomes of European descent from genomewide association studies (GWASs) was used as an exposure.
RESULTS:The IVW method found strong evidence to suggest a causal relationship between theintestinal microbiota and hypertension risk (beta=−0.002, standard error [SE]=0.0004, p=0.003).
The regression test of MR-Egger showed that the directional pleiotropy was unlikely to be a bias
(intercept=0.002, SE=0.007, p=0.697). and the MR-Egger study showed relation between theintestinal microbiota and the hypertension risk (beta=−0.002, SE=0.001, p=0.03). The weighted
median analysis also have indications of a causal relationship between the intestinal microbiota andthe hypertension risk (beta=−0.002, SE=0.001, p=0.01.) The MR results calculated using IVW, theweighted median and the weighted mode methods were consistent.
CONCLUSIONS:Our results indicated that MR analysis support a causal relationship between intestinal
microbiome and hypertension risk.

Keywords: microbiome, Epidemiology, Causal inference, Cardiovascular diseases

MP-094[Exposures » Occupational exposures]Role of Gut Microbiota between Metal Fumes
and Intestinal Permeability
Yun Ting Hsiao, Ching Huang Lai
School of Public Health, National Defense Medical Center, Taipei, Taiwan

BACKGROUND AND AIM:Welding workers expose metal particles which may enter the body throughinhalation or ingestion. Gut microbiota is recognized as having many different effects on humanhealth. Heavy metals may harm the microbiotas directly and cause the gut-leaky syndrome. This
study explores the relationship among exposure to metal fume particles, gut microbiota, and intestinal
permeability.
METHOD:This is a cross-sectional study with a total of 76 workers. We divided two groups by Fe andMn in fecal supernatant according to the mail composition of the welding rod, which consisted of 24
high-internal-dose subjects and 52 low-internal-dose controls in a shipyard in northern Taiwan in
2022. The concentration of heavy metals, gut microbiota, and intestinal permeability biomarkers wasassessed via feces samples. ICP-MS detected metals. Gut microbiota was analyzed by full-length 16S
rDNA sequencing. ELISA kits detected biomarkers for intestinal permeability. All statistics wereconducted in SPSS version 22.0.
RESULTS:All concentrations of fecal metals except Se are significantly higher in the high-internal-dosegroup. In the phylum level of gut microbiota, we found that Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Cd,
Hg, and Pb caused a significant decrease in Actinobacteria. At the genus level, Al, V, Cr, Fe, Co, Ni,
Cu, Zn, Cd, and Pb caused a significant decrease in Oscillibacter. At the species level, Al, V, Cr, Fe, Co,
Ni, Cu, Zn, Cd, and Pb caused a significant decrease in Oscillibacter_valericigenes. Fecal zonulin issignificantly higher in the high-internal-dose group, but fecal calprotectin is lower in this group. Somemicrobiota species were associated between metals and the two biomarkers of intestinal permeability.
CONCLUSIONS:The results demonstrated that heavy metals in welding fume decrease the diversity ofgut microbiota and influence the richness of specific microbiota. Also, the gut microbiota modulates
metals and intestinal permeability.

Keywords: heavy metals, microbiome, occupational exposuresMP-095[One health » Public health]

Immortal time bias in the association between
fecal occult blood test and metabolic syndrome:
A cohort study
Do Yeon Lim1, Sang Yop Shin2, Heejin Kimm1, Sun Ha Jee1
1Department of Epidemiology and Health Promotion, Yonsei University, Seoul, Korea; Institute for

National Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
2Korea Medical Institute, Seoul, Korea

BACKGROUND AND AIM:This study aims to investigate the relationship between the fecal occult blood
test in Korean adults and the metabolic syndrome to identify if fecal occult blood test can provide
more clinical information.
METHOD:This study is a cohort study of the population of adults aged 20 years or older who visitedthe Korea Medical Institute from 2011 to 2019 and received a health checkup. Subjects responded tothe question of whether or not to undergo a screening test on a questionnaire. In the data of
3,195,823 visits among 1,542,807 adults aged 20 years or older, Cox proportional hazard model
analysis on the association between metabolic syndrome and whether or not to undergo a fecal occult
blood test was used. Time-fixed Cox, time-dependent Cox, and landmark analysis were conducted to
exclude the immortal time bias.
RESULTS:As a result of identifying the relevance of fecal occult blood test-related syndrome in adultsubjects aged 20 years or older, time-fixed Cox analysis showed the risk of related syndrome
decreased by 6% in subjects compared to those who did not undergo fecal occult blood test. As aresult of time-dependent Cox analysis, compared to the untested group, the comparative risk ofmetabolic syndrome remained significant at 0.94 (95% CI 0.94-0.95) after adjusting for age and sex.
CONCLUSIONS:In conclusion, in a study on fecal occult blood test and metabolic syndrome in Korean
adults, the risk of metabolic syndrome was lower in subjects who did undergo fecal occult blood test
than in those who did not.

Keywords: Fecal occult blood test, metabolic syndrome, immortal time bias

MP-096[Outcomes » Obesity and metabolic disorders]

A Study on the Association between Body Mass
Index and Diabetes Incidence according to theGamma-Glutamyl Transferase Level in Korea
Ji Woo Baek1, Yeonsu Yang1, Keum Ji Jung1, So Young Kim2, Sunmi Lee2, Sun Ha Jee1
1Department of Public Health, Graduate school, Yonsei University, Seoul, South Korea
2Health Insurance Research Institute, National Health Insurance Service, South Korea

BACKGROUND AND AIM:Gamma-glutamyltransferase (GGT) has been widely used as a marker forexcessive alcohol intake and various hepatobiliary diseases such as alcoholic hepatitis, and fatty liver.
This study sought to analyze how the between body mass index (BMI) and diabetes mellitus (DM)incidence changes according to GGT levels in the Korean people.
METHOD:This study was conducted on participants of the Korean Cancer Prevention Study-II. As ageneral population cohort developed by the Seoul Metabolic Syndrome Research Project in 2005,
121,053 participants were included in the final analysis among the total 160,407 participants whose
blood samples had been obtained. Those with prediabetes at the time of registration and those withmissing values on blood tests or questionnaires were excluded. Out of 121,053 participants, 18,116(14.9%) with diabetes.
RESULTS:A total of 121,053 participants were studied, consisting of 77,312 men and 43,741 women.
BMI was classified into 4 groups of lower than 21.3 kg/m², 21.3–23.5 kg/m², 23.5–25.6 kg/m², andhigher than 25.6 kg/m², GGT was also classified into 4 groups of lower than 16.0 mg/dL, 16.0–24.0
mg/dL, 24.0–41.0 mg/dL, and higher than 41.0 mg/dL, and the incidence rate of DM was compared
between the gender groups. In all groups, the incidence rate of DM increased with GGT. In particular,
the highest incidence rate of DM was observed in BMI (Q4) and GGT (Q4) (men: 13.19%, women:
15.78%)
CONCLUSIONS:In Korean adult men and women, the incidence between BMI and the risk of DM
tended to increase in the group with higher GGT levels.

Keywords: Epidemiology, Exposures, Outcomes, Obesity and metabolic disorders

MP-097[Respiratory and allergic outcomes » Asthma]

Estimated Travel Time and Distance to Trial Site:
Modifiers of St

EP-Up Treatment Efficacy in Black Adults with
Poorly Controlled Asthma
Lizbeth Gomez1, Ellen Kinnee2, Fernando Holguin3, Jane E. Clougherty11Drexel University Dornsife School of Public Health
2University of Pittsburgh Graduate School of Public Health
3University of Colorado Denver School of Medicine

BACKGROUND AND AIM:Access to trial sites in RCTs remains a critical issue known to exacerbate
health disparities, especially in the case of asthma. While asthma disproportionately affects Black
individuals, they are often underrepresented in clinical trials due to barriers to participation such asaccess to trial site. As a result, treatments and interventions may not be adequately tested or tailoredto the needs of these communities, further widening the gap in health outcomes. Here, we evaluate
whether access to care in the Best African American Response to Asthma Drugs (BARD) trial modifies
the treatment efficacy of adding a long-acting beta-agonist (LABA) to inhaled glucocorticoids among
Black adults.
METHOD:We re-assessed data from 195 adults randomized to a sequence of adding LABA to baseline
ICS (1xICS+LABA), double-ICS with LABA (2xICS+LABA), quintuple-ICS (5xICS), and double-ICS(2xICS). Treatment preference was determined via the number of treatment-period-specific asthma
exacerbations. Using Origin-Destination Cost Matrix network analysis, we calculated estimates oftravel distance and time from each individual's geocoded residence to their trial site. We evaluatedtreatment effect modification by travel distance and time using mixed effects models.
RESULTS:Overall, we found that participants' access to trial sites varied substantially; for instance,
among the Boston sample, estimated travel time and distance ranged from 3.09-65.47 minutes and1.04-68.28 km, respectively. In mixed effect model analysis, we found that both time and distanceconferred more exacerbations [1.02 events (95% CI: 0.98 - 1.07), 1.14 events (95% CI: 1.10 –1.27), respectively], though neither significantly altered treatment preference in these data.
CONCLUSIONS:Our analysis revealed that estimated travel distance was associated with the numberof asthma exacerbations during each treatment periods among adults. However, neither estimatedtravel distance nor estimated travel time significantly altered treatment preference or effectiveness inthis data. Considering trial site accessibility can enhance the design and generalizability of RCTs
findings.

Keywords: Asthma, Healthcare Access, Randomized Clinical Trials, LABA,ICS

MP-098[Chemical exposures » Heavy metals]

Spatial distribution of blood lead concentrationin preschoolers from Arica, Chile
María Pía Muñoz1, Marta Saavedra2, Gina Saavedra2, Ximena Cannobbio2, Verónica Iglesias3
1Programa de Doctorado en Salud Pública, Escuela de Salud Pública, Facultad de Medicina,

Universidad de Chile, Santiago, Chile
2Departamento de Salud Pública, Secretaría Regional Ministerial de Salud Arica y Parinacota, Arica,

Chile
3Programa de Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile,

Santiago, Chile

BACKGROUND AND AIM:The city of Arica, northern Chile, has a history of heavy metal contaminationof anthropogenic origin. Our study aimed to describe lead screening results in children attending
educational establishments.
METHOD:We analyzed secondary data from 1,313 preschoolers with blood lead concentration
measured using the rapid LeadCare technique who attended educational establishments between 2018and 2019. We used information about soil lead concentration (n=394) from a study of the soil
chemical quality in 2008 available on the web. We characterized the blood lead concentrationaccording to sociodemographic variables. Using RStudio software, we geocoded and assigned the soil
lead value to preschool children based on their residence. We used the density Kernel function to
calculate the spatial pattern of the intensity of blood lead concentrations ≥ 3.5 μg/dl.
RESULTS:15.7% of the preschoolers had lead levels above the limit of detection (LOD). The
prevalence of blood lead concentration ≥ 3.5 μg/dl was 14.9%, and ≥ 5 μg/dl was 4.7%. The
proportion of children with blood lead ≥ 5 μg/dl was higher in those residing in neighborhood units
with lead soil concentrations ≥ 400 mg/kg compared to those residing in sectors with concentrations <400 mg/kg (Prevalence ratio= 2.1; 95% confidence intervals 1.04, 4.32). The spatial analysis showed
a geographic pattern of high concentration of preschoolers with a blood lead level ≥ 3.5 μg/dl.
CONCLUSIONS:The findings reveal a crude association between blood lead levels ≥ 5 μg/dl and soil
lead levels. Since there is no safe level of exposure, it is necessary to mitigate potential sources of
exposure in order to protect children's health.

Keywords: Children's environmental health, Hazardous waste, Spatial statistics

MP-099[Other » Other (to be specified with keywords in the keywords section)]

Association of Water, Sanitation and Hygiene
Facilities and Children’s Stools Disposal
Methods in Myanmar
Naw Lah Say Wah, Kraiwuth Kallawicha
College of Public Health Sciences Chulalongkorn University Thailand

BACKGROUND AND AIM:Unsafe children’s stool disposal has been a significant public health problem
globally. The purpose of this study is to identify the association between water, sanitation and hygiene
facilities (WASH) and unsafe children’s stool disposal methods in Myanmar.
METHOD:This is the secondary analysis of the 2015-2016 Myanmar Demographic and Health
Survey(MDHS), the first and latest survey conducted in Myanmar. The mothers were questioned about
how they disposed of the last passed faeces of the youngest child. The only way to dispose of a child's
faeces safely is to assist the child to use the toilet on his or her own, for very young children, rinsing
the faeces into a toilet or burying as all other methods are regarded as unsafe.WASH facilities includedin this study are sources of drinking water, type of toilet facilities and toilets being shared or unsharedwith others.
RESULTS:The dataset contains of 4,699 children younger than 5 years of age residing with mothers.
Ultimately, nearly half of the children's faeces were disposed of unsafely. Approximately 80% ofhouseholds have access to improved sources of drinking water. Half of the households have improved
sanitation facilities while more than 60% have shared toilet facilities with others and furthermore,
11% of the households have no sanitation facilities at all. In the Chi-Square test, sources of drinking
water, toilet facilities and shared toilet facilities were significantly associated with methods of disposalof children’s stools with p<0.05. But, even in households with improved WASH facilities, unsafe
disposal methods are still observed.
CONCLUSIONS:This study indicated that WASH facilities are one of the main determinants of unsafe
children’s stool disposal. But improved sanitation facilities alone are not sufficient for safe disposal.
Other determinants should be taken under consideration to implement safe disposal of children’s
stools.

Keywords: WASH facilities, Drinking Water, Toilets, Unsafe Disposal Methods, Children’s stools

MP-100[Air pollution » Other (to be specified with keywords in the keywords section)]

Bioaerosols’ Size Fractions and associatedRespiratory morbidities in Elementary School in
Ibadan, Nigeria
Oyewale Mayowa Morakinyo, Godson Rowland Ana
Department of Environmental Health Sciences, University of Ibadan, Ibadan, Nigeria

BACKGROUND AND AIM:Exposure to bioaerosols have been linked to increased respiratory morbiditiesin schools children. In Nigeria, there is dearth of information on the size distribution of bioaerosols andtheir deposition site within the airways. This study determined the bioaerosols’ size distribution andprevalence of associated respiratory morbidities among elementary school pupils
METHOD:A six-stage cascade impactor was used to sample indoor air in occupied classrooms in ninerandomly selected schools. Regions between the human primary bronchus and alveolar duct were
sampled for fungal respirable fractions (FRF) and bacterial respirable fractions (BRF). The BRF and FRF
were estimated and dichotomised into high (> median) and low (≤ median) categories. Bacterial 16s
RNA and fungal ITS genes of extracted genomic DNA of 100 isolates were amplified by PCR,
sequenced, and analysed. A standardised questionnaire was adapted to elicit information from 554
randomly selected pupils on respiratory morbidities. Data were analysed using Mann-Whitney U andmultivariate logistic regression model at α0.05.
RESULTS:Respirable fractions made up 67.5% of the total bacterial and 77.8% of the total fungal
aerosols. Dominant bacteria and fungi fractions were recorded at the aerodynamic size fractions of
2.1-3.3 µm and 0.65-1.1 µm, respectively. Allergy causing fungal species identified by 95% similarity
included Aspergillus funmigatus, Candida neurogosa and Penicillum antarcticumza while bacterial
species included Staphylococcus aureus, Escherichia coli, Klebsiella, Bacillus and Cladosporium.
Exposure to high BRF and FRF was significantly associated with current rhinitis (aOR = 1.78, 95%CI:
1.11–2.85 and aOR = 1.83, 95%CI: 1.14–2.93) and current wheeze (aOR = 2.77, 95%CI: 1.73–4.43
and aOR = 1.88, 95%CI: 1.18–3.00), respectively.
CONCLUSIONS:Exposure to high levels of BRF and FRF was associated with respiratory healthoutcomes. Measure aimed at dipping the levels of indoor bioaerosols’ fractions and the prevalence of
associated respiratory morbidities should be instituted.

Keywords: Indoor air quality, Elementary schools, Microbial aerosols, Aerosol size distribution

MP-101[Chemical exposures » Solvents]

A study of methanol poisoning outbreak frompickled liquor in three communities, Chonburi,
Thailand
Patcharaporn Dejburum, Pitikhun Setapura, Chalo Sansilapin, Thanawadee Chantian
Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi,
Thailand.

BACKGROUND AND AIM:On 20 Oct 2019, the Department of Disease Control was notified that there
were 14 patients having chest tightness, nausea, hematemesis after ingesting new formula pickled
liquor mixed with a toad went to Chonburi Hospital, and one of them died. Then, the Joint
Investigation Team conducted the investigation on 21–22 Sep 2019 to verify the diagnosis, identify
severity factors, and provide recommendations.
METHOD:We reviewed medical records and conducted a descriptive study. Implicated liquor was sent
to determine toxic substances levels. An analytic study was performed to identify factors associatedwith severity among the patients. The liquor distribution point and the production process were also
investigated.
RESULTS:Of 25 liquor drinkers living in 3 communities in Chonburi, 22 cases (88.0%) were identified;
5 of them died. Fifty percent of them were hospitalized; 31.8% required hemodialysis. The medianage was 42 years old (IQR=16.3). The median latent period was 17 hours. The most common
symptom was confusion (40.9%), followed by nausea/vomiting (36.4%) and abnormal vision(18.2%). Most of the cases had high anion gap. Methanol levels in two liquor samples were extremely
high (36.2 g/dl). High amount of liquor drinking was significantly associated with cases' severity(Adjusted coefficient 4.5x10-4, 95%CI 2.7x10-5-8.8x10-4). The seller illegally mixed the pickled
liquor and distributed the liquor door-by-door. The components of the pickled liquor cannot be
identified.
CONCLUSIONS:A confirmed cluster of methanol poisoning caused by methanol contaminated picked
liquor ingestion. No toad was involved. The case fatality rate was in the average of other previous
outbreaks. Permanent visual impairments were detected. The amount of pickled liquor drinking was
statistically significant among severe and non-severe cases. Health education on methanol poisoning
and strengthen enforcement on selling illegal liquor are recommended.

Keywords: Epidemiology, Toxicology, Foodborne diseases

MP-102[Chemical exposures » General]

Exposure Assessments of Photoinitiators: theDietary Intakes from the Migrations in PaperBased Food Packaging
Szu Yu Lin, Shih Wei Tsai
Department of Food Safety and Health, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Photoinitiators can pose threats to the human body, and the migration andexposure level of potentially harmful chemicals from paper-based food packaging, such as
benzophenone (BP), isopropyl thioxanthone (ITX), and 4-methylbenzophenone (4-MBP), is still
uncertain. Meanwhile, the decomposition products of PIs may also exist as the non-intentionally added
substances (NIAS) in food packages. Hence, it is an important issue for food safety to estimate daily
exposure to PIs. However, though paper bags are constantly used, there is limited research on PIs in
paper bags or their migration to food. In addition, there are no regulations for PIs in either coated, or
uncoated paper bags and wrappers. Thus, this study aims to assess the exposure of specific PIs in
paper bags and determine their specific migration level to food.
METHOD:The PIs, such as benzophenone (BP), isopropyl thioxanthone (ITX), 4-methylbenzophenone(4-MBP), and 4-phenylbenzophenone (PBZ), were dissolved in acetonitrile as the stock solution. The
PIs were prepared in the range of 0.1 to 20.0 μg/mL for calibration curves.
FastPrEP-based extraction coupled with GC-MS was used for sample analysis. The inlet temperature was set
at 300℃, and the injection value was 1μL. The column temperature was initially set at 70℃, andgradually increased by 10℃/min to 300℃, and then hold for 7 min. Selective ion monitoring (SIM)mode used for particular PIs identification.
RESULTS:The study has shown that BP has the highest frequency and strongest abundance among thePIs. The general existence of PIs in paper bags indicates that it is necessary for the governmental
agency to carefully establish regulations and the Tolerable Daily Intake (TDI) for PIs to protect people
from adverse health effects.
CONCLUSIONS:Migration test of PIs and decomposition products identification were also conducted inthis study. We intend to establish analytical method and regulation foundation for PIs in Taiwan.

Keywords: Photoinitiators, Migration, Exposure assessment

MP-103[Exposures » Food/nutrition]

Dietary Habits and β-Adrenergic Agonists in
Urine of Representative Population in Taiwan
Tzu Hsuan Peng, Pau Chung Chen, Ching Chun Lin, Mei Huei Chen, Chi Chang Ho
Institute of Environmental and Occupational Health Sciences, National Taiwan University College of
Public Health, Taiwan, Taipei

BACKGROUND AND AIM:Except ractopamine in the United States, β-adrenergic agonists are illegal
feed additives in most countries. Hence, there are fewer relative research about not only distribution
but dietary exposure. This study aimed to establish the distributions of 8 kinds of β-adrenergic
agonists among a representative of population in Taiwan and to find out the association between thediet habits (types of food especially meat) and the detection rates of 8 kinds of β-adrenergic agonists.
METHOD:The representative samples used in this study came from Human Biomonitoring in 2019. The
cases were enrolled from population which residents are over 7 years old and registering in the mainisland of Taiwan and Penghu area, and the sampling methods referred NAHSIT enrollment. The chosen
specimen was urine. After urine was pretreated, LC/MS/MS would be used to detect 8 kinds ofcommon β-adrenergic agonists as analytes. Then the detected results would be combined with thevariables about poultry-related products ingestion in nutrition and diet questionnaire for analysis byusing Fisher’s exact test and Logistics regression.
RESULTS:The detection rate of clenbuterol was much higher than the other 7 kinds of β-adrenergic
agonists. The results showed that 4 feet poultry ingestion positively related to clenbuterol detection
rate, and meat product would increase the risk of tulobuterol detection. Similarly, offal ingestion had
positive association with detection of tulobuterol and fenoterol. In the other hands, vegetableingestion and terbutaline detection were negatively correlated.
CONCLUSIONS:The detection rates of β-adrenergic agonists were positively associated with some
types of foods such as 4 feet poultry, meat products and offal. However, the nutrition and diet habits
questionnaire we used wasn’t designed for specific sources of β-adrenergic agonists. Hence, forclenbuterol with a particularly high detection rate, it might need to trace the exposure sources in the
future.

Keywords: β-adrenergic agonist, human biomonitoring (HBM), diet habits

MP-104[Exposure assessment methods » Mixtures analysis]

Emerging foodborne contaminants in infant
formula: Integrating mixtures risk assessment
based on probabilistic and sensitive approach
Wei Jeng Chao1, Wei Hsiang Chang2, Ching Chang Lee3, Chung Feng Hung4, Yu Ting Wang4
1Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung

University, Tainan, Taiwan; Research Center of Environmental Trace Toxic Substances, National Cheng
Kung University, Tainan, Taiwan
3Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan,

Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng
Kung University, Tainan, Taiwan
4Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan,

TaiwanBACKGROUND AND AIM:The environment and baby food are contaminated with multiple endocrine
disrupting chemicals (EDCs), which are also intentionally added to baby care products. These complex
mixtures of EDCs may pose a cumulative risk to newborn health. Our goal was to characterize andprioritize infant concurrent exposures to mixtures of EDCs in infant formula and identify the potential
for health risk.
METHOD:11 groups of endocrine disrupting chemicals (EDCs) were analyzed in 58 infant formula
samples purchased from major supermarkets. Two scenarios of the consumption data were assumed
based on the Taiwan National Food Consumption database and labeling recommendations. Hazard
Index (HI) and combined total margin of exposures based approaches were applied to identify healthrisk for the concurrent exposures to EDCs mixtures. The method of grouped weighted quantile sum
regression allows for mixtures of EDCs to be considered in the model such that different magnitudes
and directions of associations are possible for each group of EDCs using a probabilistic approach.
RESULTS:Five target effects, including liver and kidney function, neurodevelopment, thyroid function,
development and reproduction were assayed for EDCs mixtures. The magnitude of the risk for earlychildhood referred to the adverse effect of thyroid gland, and the following was reproduction,neurodevelopment and liver. The prioritizing risk of thyroid function in infant feeding was attributed topolybrominated diphenyl ethers (PBDEs) and thiocyanate; of reproduction were phthalate andorganophosphate flame retardants (OPFRs); and of neurodevelopment were OPFRs, PBDE andHexabromocyclododecane.
CONCLUSIONS:Our approach provides for characterizing and prioritizing the cumulative risks of reallife EDCs mixtures during infant feeding. This study may be helpful to develop regulatory standards
and a framework for EDCs mixtures having additive health effects.

Keywords: Endocrine disrupting chemicals, mixtures, cumulative risk, Children's environmental
healthMP-105[Built environment » General]

Socioeconomic status as a moderator in theassociation between diet and the foodenvironment: findings from the CIVISANOproject
Yasemin Inac1, Suzannah D'hooghe1, Delfien Van Dyck5, Nico Van De Weghe4, Sarah Dury3, Stefanie
Vandevijvere1, Benedicte Deforche2, Eva De Clerq1, Karin De Ridder1
1Sciensano, Department of Epidemiology and Public Health, Belgium
2Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary

Care, Belgium
3Vrije Universiteit Brussel, Faculty of Psychology and Educational Sciences, Adult Educational

Sciences, Belgium
4Ghent University, Faculty of Sciences, Department of Geography, Belgium
5Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports

Sciences, Belgium

BACKGROUND AND AIM:Globally the prevalence of obesity has increased dramatically over the last
decades. A social gradient has been observed whereby social economic status (SES) and other factors
influence the development of obesity. There is a link with the food environment, which plays animportant role in shaping people’s diet. This role is hypnotized to differ according to SES and be more
influential among those with a lower SES. Therefore this study aimed to determine whether
associations between the food environment and diet were moderated by SES.
METHOD:Survey data on demographics, diet, physical activity and the food environment was obtained
from 564 respondents aged 25 to 65 years from Flanders, Belgium. Spatial data on the foodenvironment was collected through a retailer database. Using ArcGIS the density of healthy food andunhealthy food outlets in 500m and 1000m buffers and their proximity to respondents' homes wascalculated. The Modified Retail Index (mRFEI) was also calculated. Regression models with interaction
terms were adjusted for age and sex.
RESULTS:SES moderated the association between fruit- and vegetable (FV) intake, the mRFEI in the
1000m buffer (p=-0.02;CI -3.88,-0.17) and the perceived availability of FV (p=0.04;CI 0.01,0.52).
Moderation was also present in the association between snacks, the proximity of healthy food outlets(p=-0.0001;CI -0.0002,-0.00001) and the density of healthy food outlets in the 1000m buffer(p=0.42;CI 0.19,0.64). The association between the density of unhealthy outlets in the 1000m buffer(p=-0.04;CI 0.08,0.003) and sugar-sweetened beverages was also moderated by SES. For fast-foodconsumption, no moderation was observed.
CONCLUSIONS:Our findings suggest that people in distinct socioeconomic positions react differently totheir food environment. Although moderation was not present for all outcomes and indicators. Morein-depth research, especially qualitative research, is needed to examine the complex relationshipbetween SES and the food environment.

Keywords: Food/nutrition,Socio-economic factors, Obesity and metabolic disorders

MP-106[Other » Other (to be specified with keywords in the keywords section)]

Exploring the Role of SGLT2 Inhibitors in
Preventing and Managing Diabetic
Complications
Yu Jyun Lin1, Hung Yi Chiou2, Chien An Sun3, Yu Ning Chien4
1Master Program of Big Data Analysis in Biomedicine, College of Medicine Fu Jen Catholic University,

Taiwan2Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
3Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taiwan.(Co-

Corresponding author)
4Department of Health and Welfare, University of Taipei, Taiwan.(Corresponding author)

BACKGROUND AND AIM:Based on statistics from the International Diabetes Federation (IDF), theglobal population of individuals with diabetes is expected to exceed 600 million by 2045. As a chronic
disease, diabetes leads to the development of multiple complications. As a result, the effectiveness ofcurrent glycemic medications in controlling blood glucose levels and reducing the risk of complications
among diabetic patients has become a significant concern among healthcare professionals andpatients alike.
METHOD:This study utilizes data from the National Health Insurance Research Database (2011-2020)
to compare the incidence rates of complications among patients with type 2 diabetes treated with
SGLT2 inhibitors, GLP1 agonists, and DPP4 inhibitors. And we also compare which antidiabetic drugs of
SGLT2, GLP1, and DPP4 are more effective in reducing the incidence of multiple complications.
RESULTS:The finding shows that both GLP1 and SGLT2 exhibit significantly better protective effects
than DPP-4 in stroke, heart failure, and diabetic chronic kidney disease. The incidence rate ratios forstroke were 0.33(GLP1 vs DPP4) and 0.44(SGLT2 vs DPP4), for heart failure were 0.54(GLP1 vs DPP4)
and 0.44(SGLT2 vs DPP4), and for diabetic chronic kidney disease were 0.73(GLP1 vs DPP4) and0.78(SGLT2 vs DPP4), respectively. The statistical significance of controlling for multiple comorbidities
has not yet been achieved.
CONCLUSIONS:Although there was no significant difference in the control of multiple comorbidities,
SGLT2 and GLP1 have shown promising results in controlling single complication in diabetes patients.
For indication patients, this provides an alternative treatment option.

Keywords: Type 2 diabetes,SGLT2,complication

MP-107[Respiratory and allergic outcomes » Respiratory outcomes]

Seasonal impact and Risk factors of Concurrent
Spontaneous Pneumomediastinum andPneumorrhachis in Adolescents
Yu Wei Liu1, Yu Tang Chang2, Chieh Ni Kao3, Po Chih Chang3, Shah Hwa Chou3
1Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung Medical University & Ph.D. Program in Environmental and Occupational Medicine, College ofMedicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
2Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung Medical University, Kaohsiung, Taiwan
3Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung Medical University, Kaohsiung, Taiwan

BACKGROUND AND AIM:Although uncommon, available evidence suggests pneumorrhachis (PR)complicated by spontaneous pneumomediastinum (SPM) in adulthood is usually benign and selflimiting. This study aimed to review our experience and identify the seasonal impact and risk factorsof PR in adolescent patients with SPM.
METHOD:Between September 2007 and September 2017, SPM in patients aged ≤18 years was
retrospectively reviewed. The clinical features and outcomes between SPM patients with and without
PR were analyzed.
RESULTS:In total, thirty consecutive occurrences of SPM in 29 patients were finally identified andclassified into SPM (n=24) and SPM plus PR (n=6) groups. No significant differences in received
interventional exams, prophylactic antibiotic administration or restriction of oral intake between thetwo groups were found. Both groups were treated with hospitalization predominantly, whereas the
SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08).
PR was observed more frequently in patients with abnormal serum C -reactive protein (CRP) level (>5mg/L), identified predisposing factors, and those with more severe grade of SPM (p =0.005, 0.001
and <0.001 respectively). A tendency of increased prevalence in the summer season (4 cases;
66.7%) and 2 (33.3%) with recent respiratory infection history and 2 (33.3%) with asthmatic patientswas shown in the SPM plus PR group (p = 0.06).
CONCLUSIONS:Although patients with pneumorrhachis retained a higher CRP level, more identified
predisposing factors, and prolonged inpatient care, conservative management without an extensive
work-up would be an appropriate and favorable strategy in adolescents of SPM concurrent with PR. In
addition, PSP tends to cluster seasonally. Further large scale prospective studies are needed to clarify
the onset of SPM with or without PR as well as other weather conditions being involved.

Keywords: Climate, Respiratory outcomes, IncidenceMP-108[Built environment » Other (to be specified with keywords in the keywords section)]

Heat and cold impacts on mortality by Local
Climate Zone in London and South East, England
Ai Milojevic1, Oscar Brousse2, Charles Simpson2, Paul Wilkinson1, James Grellier3, Mike Davies2, Clare
Heaviside2
1Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
2Bartlett School Environment, Energy & Resources, Faculty of the Built Environment, University

College London, London, UK
3European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK

BACKGROUND AND AIM:The Local Climate Zone (LCZ) classification provides coherent and consistentdescriptions on form and function of urban morphology relevant to climate weather worldwide. We
assessed heat and cold impacts on mortality by LCZ in London and South East regions and explored
the attribution of the cause-specific mortality related to heat and cold to proxy of UHI intensities.
METHOD:Daily time series of cause-specific mortality by sex, age group, Index of Multiple Deprivation
deciles and temperature (UKCP18 HadUK Gridded Climate Observations, 1x1km) were assembled by
LCZ in London, 2007-2016. Time-series analysis was conducted using unconstrained distributed lag
model (0-1d lag and 0-13d lag for heat and cold) with adjustment for day-of-week, season and secure
trend (natural cubic splines with 7 df per year), PM10, Ozon (lag 0-1d) and flu. Autocorrelation andoverdispersion were adjusted. Quantification of heat/cold risk assumed log linear threshold model
above/below the cut-off point (95th/5th centile).
RESULTS:437,505 deaths in ten LCZs in London were analysed. Most of the deaths occurred in Open
low-rise (LCZ 6, 74.9%) and Open mid-rise (LCZ 5, 16.9%). Cold and Heat thresholds ranged 3.13.85 °C and 18.64-19.88 °C in Dense trees (LCZ A) to in Compact mid-rise (LCZ 2). Relative risk (RR)of cardiovascular disease deaths for heat is lower in open mid-/low-rise (LCZ 5-6) than large low-riseor sparsely built area (LCZ 8-9). Opposite for RR of respiratory deaths. Analysing only for those aged
75+ years showed little difference from the main finding.
CONCLUSIONS:Our initial results from time-series analysis suggested LCZ-specific temperatureresponse functions especially for deaths from CVD and respiratory diseases. This case study
demonstrated fair potential that LCZs can be utilised in public health researches as a common
measure of UHI intensity in worldwide setting. Further developments using case crossover study
design and building characteristics is needed.

Keywords: Urban heat island, heat, cold, Local Climate Zones,

MP-109[Policy » Research translation to affect policy and practice]

Impact of COVID-19 on neighbouringcommunities of large-scale mining industry andrecommendations for its management
Antonia Fortt Zunzunegui, Yoshy Luengo Oyarzun
GreenRiver, Santiago, Chile

BACKGROUND AND AIM:In December 2019, China officially notified the World Health Organization(WHO) about a conglomerate of pneumonia cases, a virus later labeled SARS-CoV-2 or the COVID-19
disease. In Chile, this illness produced its first casualty in March 2020, unleashing a series of statemeasures. Until March 2023, COVID-19 has killed 64.301 people according to the official figures of the
Ministry of Health in Chile.Currently, a number of preventive measures have been establishedthroughout all national industries, particularly in the mining sector. Given that Chile is the biggest
producer of copper in the planet, with Antofagasta and Atacama concentrating most mining
companies, it is interesting to analyze the coverage of all these measures on the mining industry,
paying particular attention to the particular characteristics of health, economy, and communities.
METHOD:Through a descriptive analysis, a multi-criteria analysis of risks with territorial coverage, thisstudy discusses the gaps between the observed and the recommended, raising this situation as amultivariable problem with potential coverage through different angles.
RESULTS:This study discusses, likewise, the current situation of mining community management, thesocioeconomic contexts in Antofagasta and Atacama, and the management of COVID-19 in mining
sectors in Chile and the rest of the world. Results show that a territorial approach is useful for decision
making in mining, in order to take measures according to local needs and adding data in the pandemic
strategy.
CONCLUSIONS:The authors recommend for the industry to incorporate geographical analysis duringcommunity issues such as the COVID-19 pandemic

Keywords: environment, communities, mining, COVID-19

MP-110[Climate » Temperature extremes and variability]

El Niño-Southern Oscillation, thermal
conditions, and some specific health outcomesin Taiwan
Emanuel Svensson1, Yu Chun Wang2, Gerry Andhikaputra2, Ayushi Sharma2, Amir Sapkota3, Chuansi
Gao1
1Department of Design Science, Lund University, Lund, Sweden
2Department of Environmental Engineering, Chung Yuan Christian University, Zhongli, Taiwan
3Department of Epidemiology and Biostatistics, University of Maryland, Marryland, USA

BACKGROUND AND AIM:As a result of climate change, extreme weather events have become more
frequent. El Niño-Southern Oscillation (ENSO) in the tropical eastern Pacific Ocean affects temperatureand precipitation in Asia Pacific Region. The objectives of this study were to investigate therelationship between Oceanic Niño Index (ONI) and high temperatures in 15 regions in Taiwan, andthe relationship between Universal Thermal Climate Index (UTCI, based on human heat balance
model) and health outcomes.
METHOD:ONI data for the Niño 3.4 region was obtained from NOAA/National Weather Service. The
UTCI data was acquired through an open-source dataset computed using the ERA5 reanalysis productof the European Centre for Medium-Range Weather Forecasts (ECMWF) from 2008-2019. The daily
health specific mortality records were obtained from Taiwan. International classification of disease
ICD10 codes were used for classification of diseases including, I50.0: congestive heart failure, I50.1:
left ventricular failure and I50.9: heart failure, unspecified. Linear regression models for ONI andtemperature were applied. A Poisson regression model was used to describe the incidence of thehealth outcomes in relation to UTCI.
RESULTS:The results show a positive relation between 95th percentile average daily temperature and
ONI during June, July, and August in the southern and mid-western regions of Taiwan (the correlation
coefficients for Changhua, Chiayi, Nantou, and Pingtung are 0.096[0.0093 0.18], 0.21[0.091 0.32],
0.45[0.19 0.71] and 0.090[0.024 0.16] respectively. Furthermore, there is a weak positive relation
between average monthly temperature and ONI during winter and spring. The results of the healthdata analysis indicate an increased relative risk of mortality of these diseases during cold conditions in
Taiwan.
CONCLUSIONS:It is possible to predict extreme heat with ONI during summer in Taiwan. In most of
the regions, cold conditions indicate an increased risk of cardiovascular health outcomes.
Acknowledgement: Forte funded the study (2019-01552) through Belmont AWARD-APR project.

Keywords: climate, temperature extremes, mortality, risk assessment

MP-111[Climate » Temperature]

Effect Of Meteorological Factors On Children's
Asthma In Taichung City
Han Wei Chen, Liang You Wu, Chi Jung Chung
Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.

BACKGROUND AND AIM:Asthma is a common chronic respiratory disease in children, and it is a highly
heterogeneous disease. In addition to being positively correlated with air pollution and environmental
allergens, recent studies have found that meteorological factors are more closely related to asthma
exacerbations (AE) in children than air pollution. Nowadays, the problems of climate change andglobal warming are becoming more and more serious. In Taichung, Taiwan, the temperature trend in
the past 30 years has increased by about 0.32°C per 10 years, second only to 0.41°C in Taipei, thesecond highest in Taiwan. At the same time, few studies have focused on the lagged effect between
meteorological factors and asthma, especially in Taiwan. Therefore, this study explored the impact of
meteorological factors on children's asthma in Taichung City, Taiwan.
METHOD:This study collected asthma clinic data from the Taiwan Health and Welfare Data Science
Center and meteorological data from the Central Weather Bureau from 2009 to 2018. First, descriptive
statistical analysis of the year and seasons was carried out. Secondly, the correlation between
environmental factors was analyzed using Spearman correlation analysis. Finally, using the Poisson
generalized linear regression model combined with a distributed lag nonlinear model, the lagged andnonlinear effects of the year-round and different seasonal meteorological factors on children's AE wereanalyzed after adjusting the confounders.
RESULTS:We expected an increased relative risk (RR) of AE at high and low temperatures. The lagged
effect is longer at low temperatures and shorter at high temperatures. The RR of AE is also increased
in low humidity and high diurnal temperature range.
CONCLUSIONS:Meteorological factors are one of the causes of AE in children. Children should beprotected from exposure to adverse weather conditions to reduce the risk of AE.

Keywords: Temperature variability, Asthma, Children's environmental health, Environmental
epidemiology

MP-112[Other » Other (to be specified with keywords in the keywords section)]

Effect of snow on the emergency medical
service response times of out-of-hospital
cardiac arrest in Japan, 2009-2019 (JCS-ReSS)
Hirokuni Wataki1, Xerxes Tesoro Seposo2, Athicha Uttajug2, Asuna Arai2, Muhammad Abdul Basit
Ahmad Tajudin2, Toshihisa Anzai3, Isao Yokota4, Kayo Ueda2, Takanori Ikeda5, Yoshio Tahara5,
Naohiro Yonemoto5
1School of Medicine, Hokkaido University, Sapporo, Japan
2Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
3Department of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University, Sapporo,Japan
4Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
5The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, JapanBACKGROUND AND AIM:Out-of-hospital cardiac arrests (OHCAs) have been a major public healthconcern and emergency medical service (EMS) response time is a risk factor for prognosis of OHCA.
Extreme weather such as snow can increase EMS response time. However, there has been no studies
about the association between EMS response time and snow. This study aims to examine theassociation between snow and EMS response time for the OHCA patients in Japan.
METHOD:Prefecture-level, winter-specific (December, January, February), daily EMS response timefrom 2009-2019 were obtained from the Utstein registry; a prospective nationwide population-based
registry of all OHCA patients in Japan. EMS response time and snow depth were considered as thedependent and independent variables, respectively. EMS response time was dichotomized into
“prolonged” (EMS response time > 6.5 minutes) and “not-prolonged”, based on previous studies.
Subsequently, a multivariate logistic regression model was implemented in examining the prefecturespecific EMS response time and snow association. Covariates of average ambient temperature, year,
days of the week, holidays and the daily number of OHCA were adjusted in the model. Prefecturespecific analysis were pooled using a random effect meta-analysis in obtaining the pooled estimates.
We further examined the association by subgroups which are composed of heavy-snow prefecturesand less-snow prefectures.
RESULTS:We observed statistically significant positive association between EMS response time andsnow depth (Pooled Odds Ratio (OR) of prolonged EMS response time: 1.019; %CI, 1.014-1.024 per 1
cm snow depth). In subgroup analysis, the effect estimates in less-snow prefectures (OR: 1.027;
95%CI, 1.021-1.034) is significantly higher than in heavy-snow prefectures (OR: 1.007; 95%CI,
1.005-1.010).
CONCLUSIONS:Snow depth was associated with prolonged EMS response time. The results suggest
regional heterogeneity in the effect of snow depth.

Keywords: Cardiovascular diseases, Environmental epidemiology

MP-113[Climate » Temperature]

Long- and medium-term ambient air
temperature and sudden cardiac death in aprospective US cohort
William Borchert1, Jaime Hart1, Rachel Nethery2, Christine Albert3, Francine Laden4
1Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital andHarvard Medical School, Boston, MA, USA
2Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
3Cedars Sinai Medical Center, Los Angeles, CA, USA
4Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital andHarvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of
Public Health, Boston, MA, USA

BACKGROUND AND AIM:Temperature has a well-established association with all-cause andcardiovascular mortality. Sudden cardiac death (SCD) and temperature have been studied in the
short-term context, focusing on the hours and days leading up to the event, but there has been little
investigation of medium- and long-term temperature trends and SCD. Therefore, the objective of thisstudy was to investigate if there is an association between ambient air temperature and SCD in thelong- and medium-term.
METHOD:Participants from the Nurses’ Health Study, a prospective cohort of married woman nurses in
the US, began enrollment in 1976. Confirmed cases of SCD were identified using medical records andnext-of-kin reports. Interpolated temperature data from the Oregon State University PRISM groupwere appended to geocoded participant addresses. We explored the linearity of temperature and SCD
using cubic splines prior to our regression analyses. Time-varying Cox proportional hazards models
adjusted for individual and neighborhood socioeconomic variables, individual risk factors, andcardiovascular comorbidities were used to examine the association between 1- and 12-month moving
average temperature and SCD.
RESULTS:During the study period from 1986-2013, there were 382 cases of confirmed SCD. There
was no evidence of nonlinearity in our exposures. With the minimum temperature in the interval
serving as the referent temperature, an interquartile range increase in the 1-month moving averagetemperature was associated with a 43% decrease in the odds of SCD (HR=0.57, 95% CI 0.56, 0.58)
and for the 12-month moving average temperature a 25% decrease in the odds of SCD (HR=0.75,
95% CI 0.73, 0.78).
CONCLUSIONS:Both the 1-month and 12-month moving average temperatures were associated with
SCD. This effect is more prominent at lower temperatures. Changing climates that drive temperatureswings may increase exposure to cold temperatures, thereby increasing the risk of SCD.

Keywords: Cardiovascular diseases, Other-Sudden Cardiac Death, Environmental epidemiology,
Long-term exposureMP-114[Climate » Temperature]

Assessing the impact of high temperatures on
kidney disease in Australia: Past and futureburdenJingwen Liu, Blesson M Varghese, Alana L Hansen
School of Public Health, The University of Adelaide, Adelaide, Australia

BACKGROUND AND AIM:The burden of high temperature-attributable kidney disease (BoKD) is
increasingly important due to the dual impacts of global warming and the rising prevalence of kidneydisease. This study aims to quantify the high temperature-related BoKD in all Australian states andterritories, and project changes in the attributable BoKD under climate change scenarios.
METHOD:We estimated the annual average of fatal and non-fatal BoKD for each of the 2,310
statistical level 2 areas in Australia from 2003 to 2018. A multivariate meta-regression model wasused to estimate the exposure-response association, based on meta-predictors and relative risks frompublished international literature. We then predicted future high temperature-attributed BoKD
between 2026-2065, using gridded temperature projections data from eight downscaled climate
models. The future projections were evaluated under two greenhouse gas emissions scenarios (RCP4.5
and RCP 8.5), accounting for population ageing under different projection series, and adjusting forhuman adaptation.
RESULTS:Between 2003 and 2018, high temperatures were responsible for 3.1% (SD: 0.4%) of thetotal observed BoKD in Australia, equating to an annual loss of 1,654 years of healthy life or 7.4
disability-adjusted life years (DALYs) per million. The projected future temperatures are expected tocontribute to a consistent rise in BoKD across all jurisdictions. The projected increase in hightemperature-attributable BoKD by 2060 is 213.8% under the higher-emission RCP8.5 scenario, evenafter adjusting for human adaptation. The Northern Territory, which has a relatively warmer climate
and a high level of BoKD amongst vulnerable populations, had the highest rate of high temperatureattributable BoKD in both the baseline and future decades.
CONCLUSIONS:This study highlights the urgent need for public health interventions that address theadverse health effects of a warming climate on kidney disease.

Keywords: Climate, Temperature extremes, Environmental epidemiology

MP-115[Climate » Temperature]

Summer temperature and hospitalization due tourinary tract infection in the elderly: anationwide sample cohort study in South Korea
Jiwoo Park1, Dukhee Kang2, Eunhee Ha3, Whanhee Lee1
1School of Biomedical Convergence Engineering, Pusan National University
2Department of Internal Medicine, School of Medicine, Ewha Womans University
3Department of Environmental Medicine, School of Medicine, Ewha Womans University

BACKGROUND AND AIM:Recent previous studies have investigated the association between ambient
temperatures and major kidney diseases, such as chronic kidney disease and end-stage kidneydisease; however, despite its clinical importance and plausible mechanisms, the impact of temperatureon urinary tract infection (UTI) in the elderly has rarely been studied.
METHOD:We constructed a longitudinal cohort to examine the relationship between hospitalization due
to UTI and exposure to summer temperatures (June to August), based on the Korean National Health
Insurance System - National Sample Cohort, which includes around one million beneficiaries that are
representative of the population living in South Korea from 2002 to 2019. A conditional logistic model
was performed to estimate the risk of summer temperatures on hospitalizations for UTI via theemergency room in the elderly (beneficiaries aged 65 or older). The hospital admissions for UTI were
defined using the primary diagnostic codes (ICD-10: N10, N30, and N390).
RESULTS:A total of 12,067 hospital admissions for UTIs were observed during the study period. In the
total population, there was an association between the summer population and hospital admissions for
UTIs with a hazard ratio (HR) of 1.03 (95% CI: 1.00, 1.06). The association was more prominent in
the low-income groups (HR: 1.06) and females (1.03) than in the high- or mid-income groups (1.001.03) and the males (1.02). In addition, the association was more evident in the recent periods(2011-2019 with HR: 1.05), compared to the earlier period (0.95).
CONCLUSIONS:We revealed a relationship between ambient temperature and hospital admissions for
UTI in South Korea based on the population-representative national sample cohort. Our results
provide scientific evidence for establishing evidence-based guidelines and heat action plans forpatients with UTIs.

Keywords: temperature, urinary tract infection, cohort studyMP-116[Methods » Methodological study design]

Health effects of the disabled due to climatechange and air pollution: a study protocol
Kyung Hwa Choi, Hyun A Jang, Hyungryul Lim, Jonghyuk Choi, Ho Jang Kwon
Department of Preventive Medicine, Dankook University College of Medicine

BACKGROUND AND AIM:Climate change and air pollution might have a greater adverse effect on
people with disabilities (PWD), who are medically and health-vulnerable groups, than non-disabled(ND). This study aims to evaluate the risk of mortality and morbidity according to climate change andair pollution among PWD by disability type and severity compared to ND.
METHOD:We made the study cohort from a 5% random sample of the whole South Korean population(approximately 120,000 PWD out of a total of about 2.5 million people) from the Korea National
Health Insurance System Database from 2002 to 2019. City-level of long-term exposure metrics using
monthly averaged PM2.5, PM10, NO2, SO2, and O3 concentration from 2006 to 2019 were individually
linked with the cohort participants. Applying Cox proportional hazard model, we will estimate theeffect size of air pollution on both PWD and ND. Additionally, we plan to estimate the relative risk ofmortality on PWD compared to ND due to daily maximum temperature as heat waves and daily
minimum temperature as cold waves using time-series analysis as an ecological study. For outcomes,mortality, hospitalization, and emergency room visits for cardiovascular disease including ischemic
heart disease or respiratory disease will be assessed. The hazard ratios of air pollution exposure andthe relative risks of extreme weather events for the various disease-specific mortalities andmorbidities will be presented.
RESULTS:All analyses will be performed by classifying PWD into 15 disability types and severity levels
based on Korean law.
CONCLUSIONS:The estimated health effects of the PWD will provide an opportunity to realize
environmental justice in the field of environmental health.

Keywords: Environmental justice, Methodological study design, Environmental epidemiology, Big dataMP-117[Climate » Temperature]

A nationwide comparative analysis oftemperature effect on mortality and morbidity inJapan
Lei Yuan1, Lina Madaniyazi2, Ana M. Vicedo Cabrera3, Yasushi Honda4, Chris Fook Sheng Ng1, KayoUeda5, Kazutaka Oka6, Aurelio Tobias7, Masahiro Hashizume8
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan
2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
3Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Oeschger

Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
4School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Center for

Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
5Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
6Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba,

Ibaraki, Japan
7School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute ofEnvironmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research(CSIC), Barcelona, Spain
8Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, JapanBACKGROUND AND AIM:The impact of temperature on morbidity remains largely unknown. Moreover,extensive evidence indicates contrasting patterns between temperature-mortality and temperaturemorbidity associations. A nationwide comparison of the impact of temperature on mortality andmorbidity in more specific subgroups is necessary to strengthen understanding and help explore
underlying mechanisms by identifying susceptible populations. This study aims to quantify andcompare the impact of temperature on mortality and morbidity in 47 prefectures in Japan.
METHOD:We applied a two-stage time-series design with distributed lag nonlinear models and mixedeffect multivariate meta-analysis to assess the association of temperature with mortality andmorbidity by causes (all-cause, circulatory, and respiratory) at prefecture and country levels between
2015-2019. Subgroup analysis was conducted by sex, age, and regions.
RESULTS:The patterns and magnitudes of temperature impacts on morbidity and mortality differed.
For all-cause outcomes, cold exhibited larger effects on mortality, and heat showed larger effects on
morbidity. At specific temperature percentiles, cold (1st percentile) was associated with a higher
relative risk (RR) of mortality [1.45; (95% confidence interval [CI]: 1.39-1.52] than morbidity (1.26;
95% CI: 1.20, 1.34), as compared to the minimum mortality/morbidity temperature. Heat (99thpercentile) was associated with a higher risk of morbidity (1.39; 95% CI: 1.36, 1.42) than mortality(1.04; 95% CI: 1.02, 1.06). For cause-specific diseases, mortality due to circulatory diseases wasmore susceptible to heat and cold than morbidity. However, for respiratory diseases, both cold andheat showed higher risks for morbidity than mortality. Subgroup analyses suggested varied
associations depending on specific outcomes.
CONCLUSIONS:Distinct patterns were observed for the association of temperature with mortality andmorbidity, underlying different mechanisms of temperature on different endpoints, and the differencesin population susceptibility are possible explanations. Future mitigation policies and preventivemeasures against non-optimal temperatures should be specific to disease outcomes and targeted atsusceptible populations.

Keywords: Environmental epidemiology, Cardiovascular diseases, Respiratory outcomes, Mortality

MP-118[Neurologic and mental health outcomes » Mental health outcomes]

Which comes first: asthma or anxiety?
Diana C Garcia Sanchez1, Darsy Darssan1, Sheleigh P Lawler1, Christopher M Warren3, Adel De Klerk
Braasch4, Nicholas J Osborne2
1School of Public Health, The University of Queensland, Herston, QLD, Australia.
2School of Public Health, The University of Queensland, Herston, QLD, Australia; School of Population

Health, University of New South Wales, Sydney, NSW, Australia; European Centre for Environmentand Human Health, University of Exeter, Truro TR1 3HD, UK.
3Preventive Medicine, North Western University, Evanston, Illinois, USA.
4Ipswich Hospital, Brisbane, QLD, Australia; West Moreton Hospital and Health Service, Brisbane,

QLD, Australia; Queensland Health, QLD, Australia

BACKGROUND AND AIM:Asthma is a frequent chronic respiratory condition worldwide. This condition
has been linked to psychological disorders in both ways, as effect or cause, but evidence iscontradictory. The present study leverages a large, national longitudinal cohort study to evaluate if
children who develop asthma in early in childhood are more likely to subsequently develop asthma, or
if in contrast, children with asthma develop anxiety in the following decade
METHOD:The study included 9369 children from two different cohorts (baby (B) and child (K)) at two
age points each (4-5 and 14-15 years old) from the Longitudinal Study of Australian Children (LSAC).
Parental report of physician-diagnosed asthma plus medication use and/or wheezing symptoms
defined asthma cases. The Strengths and Difficulties Questionnaire (SDQ) was used for anxiety
assessment.
RESULTS:We found a unidirectional association between asthma in children aged 4–5 years and future
anxiety development in weighted generalized linear adjusted models (B cohort OR(CI 95%)= 1.54
(1.14–2.08); K cohort OR(CI 95%)= 1.87 (1.40–2.49). Children with asthma (no anxiety at 4 years)
had a higher prevalence of anxiety in adolescence compared with non-asthmatics (B cohort: 26.8% vs
17.6%. K cohort: 27.7% vs 14.3%). A higher proportion of adolescents with wheezing and no
medication developed anxiety than those taking asthma medication (B cohort: 38.9% vs 27.7%. K
cohort: 32.1% vs 23.1%). Anxiety in childhood was not associated with the development of asthma
from 6 years old to adolescence.
CONCLUSIONS:Australian children with asthma have a greater risk of developing anxiety between 6
and 15 years of age. Mental health screening as part of the regular monitoring of asthmatic children
may help to identify those cases with a high risk to develop anxiety. Psychological support may bebeneficial to prevent increased risk of anxiety and/or promote optimal management of this condition.

Keywords: Asthma; Anxiety; Children; Adolescents; Longitudinal.

MP-119[Climate » Temperature extremes and variability]

Extreme heat exposure and risk of
hospitalization and mortality in hemodialysis
patients in the conterminous United States
Nicole E. Sieck1, Hyeonjin Song2, Hao He3, Frank W. Maddux4, Jochen G. Raimann5, Peter Kotanko6,
Amir Sapkota2
1Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
2Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
3Department of Atmospheric and Oceanic Sciences, University of Maryland, College Park, MD, USA
4Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
5Research Division, Renal Research Institute, New York, NY, USA
6Research Division, Renal Research Institute, New York, NY, USA; Icahn School of Medicine at Mount

Sinai, New York, NY, USA

BACKGROUND AND AIM:Climate change may disproportionately impact individuals living with chronic
conditions. In this study, we examined the association between exposure to extreme heat events andrisk of hospitalization and mortality among end-stage kidney disease (ESKD) patients undergoinghemodialysis treatment. We additionally examined effect modification by climate region, sex, age, andrace/ethnicity.
METHOD:We obtained patient data from 20% random sample of Fresenius Medical Care hemodialysis
clinics in the conterminous United States (US). Extreme heat was determined using the 95th
percentile threshold as a cutoff using a 30-year baseline during the warmer months, May-September.
We used clinic zip code to link the extreme heat event metric with the individual hemodialysis
patients. Climate region was assigned using US climate region categories developed by the National
Oceanic and Atmospheric Administration. We used a case-crossover analysis to estimate the risk of
hospitalization and mortality among hemodialysis patients following exposure to extreme heat events.
RESULTS:A total of 621 clinics were included in our analyses. We will provide a national perspective on
association between exposure to extreme heat events and increased risk of hospital admission andmortality among ESKD patients. We will further show how this association varies by climate region,sex, age, and race/ethnicity.
CONCLUSIONS:This work expands our understanding of the role of extreme heat exposure on hospital
admissions and mortality in patients with ESKD. By uncovering potential disparities within the ESKD
population, our results will inform future interventions, including early heat warning systems, and help
ESKD communities adapt to the growing threats of climate change.

Keywords: Temperature extremes and variability, Mortality, Hospitalization

MP-120[Climate » Temperature]

Daily deviation from historical temperature andmortality in seven cities in South Korea
Sanghyuk Bae1, Youn Hee Lim2
1Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,

Korea
2Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark

BACKGROUND AND AIM:While mean temperature was widely used to investigate health effects ofclimate change, few studies examined temperature differences from historical temperature. We aimed
to examine the association between daily deviation from historical temperature due to climate change
and daily mortality.
METHOD:Daily mean temperature and number of non-accidental death from 7 metropolitan cities(Seoul, Busan, Daegu, Incheon, Daejeon, Gwangju, and Ulsan) in Korea between Jan. 1, 2006 andDec. 31, 2019 were used. Daily deviation from historical temperature (ΔT) was calculated bysubtracting the mean temperature of the same day in 1960-1990 from the daily mean temperature on
the day. Distributed lag non-linear model examining the cumulative association of ΔT with mortality
for lag up to 7 days was constructed, adjusting for daily mean temperature, humidity, and time trend.
In addition, we examined the association between the absolute value of ΔT (a ΔT) and mortality.
RESULTS:The mean ΔT ranged from 1.0±2.7°C (Busan) to 1.3±2.9°C (Daegu). The associations
between daily ΔT and mortality were generally U-shaped, except in Gwangju and Incheon. The relativerisk (RR) of mortality in Seoul for increased temperature was less than 1 up to ΔT of 4°C, and the RR
at 6.5°C was 1.034 (95% Confidence Intervals: 1.003, 1.081) compared to 0°C. The RR for decreased
temperature was less than 1 down to -9.5°C of ΔT and was not statistically significant. The aΔT
generally showed J-shaped associations, with a threshold of aΔT around 3°C.
CONCLUSIONS:The present study shows that daily deviation from historical temperature is associatedwith mortality independent of the effect of daily temperature. The findings provide evidence of thehealth effect of temperature variability due to climate change.

Keywords: mortality, temperature deviation

MP-121[Climate » Temperature]

Effect of temperature on dengue in 291
Southeast Asian locations: a regionally
representative analysis
Sophearen Ith1, Xerxes Seposo2, Southeast Asia Research on Climate change and dengue (SEARCD)
Collaborative Network Collaborative Network2, Masahiro Hashizume1
1Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
2Department of Hygiene, Hokkaido University, Hokkaido, JapanBACKGROUND AND AIM:Dengue fever is a major public health concern in Southeast Asia, where thedisease is endemic and poses a significant burden on healthcare systems. Temperature is a criticalfactor in dengue transmission as changes in temperature can affect the behavior, and the rate of virus
replication within the mosquito. This study aims to investigate the association between temperatureand dengue fever in Southeast Asian countries.
METHOD:We obtained monthly dengue cases from 291 locations across eight (8) Southeast Asian
countries including Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, the Philippines,
Singapore, Thailand, and Vietnam with varying observation periods ranging from 1998-2021. We
implemented a generalized additive mixed model coupled with a distributed lag non-linear model inestimating the association between temperature and dengue.
RESULTS:The overall cumulative association between temperature and dengue infection was noted to
depict an inverted U-shaped curve. Compared with the median temperature (25.7°C), temperature
above 25.7°C showed a significant increase in dengue risk with the highest risk at temperature 28°C
(RR = 1.567; 95% CI: 1.471, 1.669). In addition, the 1st percentile (15.3°C) and 99.9th percentile(31.8°C) temperatures showed significant reductions in reported dengue cases with RR = 0.003 (95%
CI: 0.002, 0.005) and RR = 0.663 (95% CI: 0.500, 0.879), respectively.
CONCLUSIONS:Southeast Asia wide-, temperature-dengue association was noted to have an inverse
U-shaped curve, with the risks peaking at temperature 28°C and approaching the null from both ends.

Keywords: infectious diseases, temperature, temperature extremes, environmental epidemiology

MP-122[Climate » Temperature]

Uncovering Urban Heat: Measuring hightemperature exposure and its determinants inhomes and neighborhoods in Accra, Ghana
Vishwanath Doreswamy Gowda1, Ricky Nathvani1, Emmalin Buajitti3, Divine Djanie4, Majid Ezzati1,
Daniela Fecht2, Allison Hughes4, Samuel Agyei Mensah5, Raphael Arku6, Jill Baumgartner3
1Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London,

London, United Kingdom
2Medical Research Council Centre for Environment and Health, School of Public Health, Imperial

College London, London, United Kingdom
3Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill

University, Montreal, Canada
4Department of Physics, University of Ghana, Accra, Ghana
5Department of Geography and Resource Development, University of Ghana, Accra, Ghana
6Department of Environmental Health Sciences, School of Public Health and Health Sciences,

University of Massachusetts, Amherst, USA

BACKGROUND AND AIM:Urban densification and climate change in sub-Saharan Africa (SSA) may
expose urban residents to higher average and episodic extreme temperatures. Empirical assessmentsof neighborhood and indoor temperature at fine spatial and temporal scales in SSA cities are virtually
non-existent. We investigated urban heat islands and their effects on indoor temperature in Accra,
Ghana, to investigate built environment determinants of heat exposure in homes and neighborhoods.
METHOD:We measured temperature at 147 representative outdoor (neighborhood) sites and in 120
homes near 48 of the residential sites. Measurements were conducted at 70 min intervals between
August 2022 to August 2023, capturing all seasons and times of day with iButton thermochron
loggers. Humidity was measured at a subsample of 10 sites. Data on each dwelling’s characteristics,
such as rooftop material, and factors such as the presence of air conditioning, were also collected toinvestigate their impact on indoor temperature.
RESULTS:In preliminary analyses, mean (standard deviation) indoor temperature was 29.7±1.9°C, on
average 1.9±2.9°C warmer than nearby outdoor temperatures, 28.5±3.4°C, with a median (IQR)
correlation between them of r = 0.61 (0.42-0.73) across dwellings. Temperatures inside dwellings inhigh-density, low-income neighborhoods (30.7±1.8°C) and commercial areas (30.1±1.7°C) werehigher than in peri-urban and rural homes (28.4±1.9°C) despite similar outdoor temperatures (27.728.3°C) across land-use categories. Compound homes experienced higher average temperatures(30.8±1.5°C) than other dwelling types (29.1±1.8°C) even after accounting for rooftop materials.
CONCLUSIONS:Our preliminary findings show that despite correlation between indoor and outdoor
temperatures exposure, the former varies more than the latter in corresponding neighborhoods.
Dwelling type, e.g. compound homes vs apartments, may influence this discrepancy with implications
for urban planning, building design, and policy intervention in Accra.

Keywords: Climate, Built environment, Temperature variability, Environmental disparities

MP-123[Birth and pregnancy outcomes » Birth outcomes]

Relation of PM2.5 and high temperature
exposures with birth outcomes among women in
Harris County, Texas, 2018–2020
Wei Jen Chen1, Amal Rammah2, Elaine Symanski3, Allan C. Just4, Kristina W. Whitworth3
1Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College ofMedicine, Houston, TX, USA
2Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
3Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College ofMedicine, Houston, TX, USA; Center for Precision Environmental Health, Baylor College of Medicine,
Houston, TX, USA
4Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA

BACKGROUND AND AIM:While the literature points toward associations of fine particulate matter(PM2.5) and extreme heat exposures with preterm birth (PTB) or term low birth weight (TLBW), moststudies in the U.S. were conducted on East and West coasts and relied on exposure data that lacked
spatiotemporal specificity.
METHOD:We conducted a retrospective cohort study using birth records of 120,020 singleton live
births in Harris County, Texas (11/2018–12/2020). Census tract-level daily PM2.5 concentrations andmean air temperature were estimated using the “XGBoost-IDW Synthesis” model. Women wereassigned exposure estimates based on their census tract of residence at delivery and daily exposures
were averaged across their entire gestational period. We dichotomized PM2.5 and temperature at the90th percentile to explore the impact of relatively high exposures. We applied modified Poisson
regression using generalized estimating equations (to account for correlation among women living inthe same census tract) and adjusted for sociodemographic characteristics to estimate risk ratios (RR)
and 95% confidence intervals (CI) for associations of prenatal PM2.5 or temperature exposures withPTB (gestation <37 weeks) and TLBW (gestation ≥37 weeks and birthweight <2,500-g). Stratified
analyses explored the differential impact of exposures on PTB and TLBW by race/ethnicity.
RESULTS:Overall, women with the highest prenatal PM2.5 exposures had an elevated risk of PTB(RR=1.32, 95%CI=1.25,1.40) but not TLBW (RR=1.08, 95%CI=0.95,1.22). Women with the highest
prenatal mean temperatures had increased risk of PTB (RR=3.06, 95%CI=2.94,3.19) and TLBW
(RR=1.75, 95%CI=1.57,1.95). We observed little evidence of racial/ethnic differences in most
associations.
CONCLUSIONS:This study adds to the evidence that prenatal PM2.5 and high temperature exposures
are associated with PTB and TLBW in this diverse urban population. Our results do not provide strong
evidence that these exposures contribute to racial/ethnic disparities. Future analyses will explore
interactions between PM2.5 and temperature, as well as between environmental exposures and nonchemical stressors.

Keywords: Air pollution, Particulate matter, Temperature, Birth outcomes, Environmental disparities.

MP-124[Air pollution » Short-term exposure]

Association between short-term exposure to thesummer temperature and hospital admission
due to acute kidney injury: a national healthinsuranc
Whanhee Lee1, Min Ho Kim2, Youngrin Kwag3, Jieun Min4, Duk Hee Kang3, Eun Hee Ha5
1School of Biomedical Converegence Engineering, Pusan National University
2Ewha Medical Data Organization, Seoul, South Korea
3Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, South

Korea
4Department of Environmental Medicine, School of Medicine, Graduate Program in System Health

Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
5Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans

University

BACKGROUND AND AIM:Several recent studies have examined the association between heat andacute kidney injury (AKI); however, the generalizability of these results was limited because of the
non-representative nature of the study populations.
METHOD:This study constructed a longitudinal cohort study based on the National Health Insurance
Service – National Sample Cohort in South Korea. This sample cohort was representative of the
population living in South Korea and included around one million beneficiaries from 2002 to 2019. We
performed a conditional logistic regression to estimate the association between ambient temperatureand the hospital admission due to AKI through an emergency room in the summer (June to
September).
RESULTS:Our cohort contained 2,914 hospital admissions for AKI as the primary discharge diagnosis
code. We revealed a positive association between the summer temperatures and an increased risk of
hospital admissions for AKI, and the association differed by sex, income levels, and urbanibity.
CONCLUSIONS:The results of this study provide beneficial implications for public health policies andair pollution guidelines to mitigate healthcare burden attributable to AKI.

Keywords: short-term exposure, hospital admission, a national health insurance cohort study, acutekidney injury

MP-125[Respiratory and allergic outcomes » Asthma]

The seasonal attack patterns in asthmaticchildren are influenced by the climate regions in
TaiwanYi Sheng Yang1, Chi Hsien Chen2, Bing Yu Chen3, Yue Leon Guo4
1Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University
College of Public Health, Taipei, Taiwan
2Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

Taiwan; Department of Environmental and Occupational Medicine, College of Medicine, National
Taiwan University, Taipei, Taiwan
3Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan

University, Taipei, Taiwan
4Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei,

Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University
College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine,College of Medicine, National Taiwan University, Taipei, Taiwan; National Institute of Environmental
Health Sciences, National Health Research Institutes, Miaoli, Taiwan

BACKGROUND AND AIM:Asthma is the most common chronic disease in children globally, and its
acute attack is affected by seasonal change. There are few studies group asthmatic children according
to their seasonal attack pattern. This study aims to identify the seasonal attack patterns of asthmaticchildren in Taiwan, and their association to the climate regions.
METHOD:During 2016-2017, the Taiwanese children’s allergic condition, hereditary and residential
environmental factors were surveyed from one elementary and one middle schools in each of the 22
cities/counties across the island. Exposure data of air pollutants, ambient temperature, and relative
humidity were collected from nearby air monitoring stations. The monthly attack scores of those withcurrent asthma were analyzed using principal component analyses and classified into different attack
subtypes. Generalized Estimating Equation was used to examine the climatic effects on each asthma
attack subtypes, in tropical region and subtropical region respectively.
RESULTS:A total of 11,585 school children were surveyed, and 6.6% of them reported asthma attackin the past 1 year. Four seasonal attack patterns were identified, namely, spring, summer/fall, winterand perennial. The prevalence of current childhood asthma was lower in tropical Taiwan, particularly in
winter and spring attack subtypes. The warm and humid climate were associated with lower odds ofwinter and spring attack only in tropical Taiwan, but not subtropical Taiwan.
CONCLUSIONS:Current asthmatic children exhibit different seasonal attack patterns, which are
influenced by their residential climatic region. In different climate regions, development of appropriate
preventive strategies can be facilitated by considering the individual subtypes of childhood asthma.

Keywords: Children's environmental health, Asthma, Climate, Temperature

MP-126[Chemical exposures » Heavy metals]

Metal exposure from e-cigarette use:characterization and comparison of biomarkers
among sole e-cigarette users, smokers, dual
users, and non-users
Angela Aherrera1, Anna Tillery1, Joyce Linn1, Rui Chen1, Mina Tehrani1, Jana Mihalic1, Ana Navas
Acien2, Ana Rule1
1Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of

Public Health2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health

BACKGROUND AND AIM:Metals have been detected in electronic cigarette (e-cigarette) aerosol
inhaled by the user. Few studies have assessed metal biomarkers and compared concentrations
between users of different types of e-cigarette devices (MODs, PODs), and to smokers, dual users,
and non-users. The objective was to assess metal concentrations in blood, urine, saliva, and exhaled
breath condensate (EBC) across user groups.
METHOD:We recruited 95 participants from April 2019 to March 2020 (41 e-cigarette users (24 POD,
17 MOD users)), 15 dual users, 9 smokers, 30 non-users). Sociodemographic characteristics, ecigarette use and device characteristics were collected by survey. Bio-specimen samples wereanalyzed for heavy metals using ICP-MS. ANOVA and linear regression models on log-transformed
metal concentrations to calculate geometric mean ratios (GMR) were performed.
RESULTS:E-cigarette users were found to have significantly higher Ni and Cr metal concentrations inurine compared to non-users, dual users, and cigarette smokers. According to e-cigarette device
types, POD users had higher urine Ni and Cr GMRs compared to non-users (GMR Cr: 1.56 (95%CI
1.41, 1.73), GMR Ni: 1.37 (95%CI 1.12, 1.68)); higher Fe in urine (p = 0.03) and in blood (GMR:
1.11 (95%CI 1.04, 1.19) was also observed. MOD users were found to have the higher Ni (p <0.001)
and Cr (GMR: 1.34 (95% CI 1.11, 1.63)) metal concentrations in blood. E-cigarette users, dual users,and cigarette smokers were all found to have significantly higher As concentrations in saliva and EBC
compared to non-users, with cigarette smokers having the highest concentrations.
CONCLUSIONS:E-cigarette use represents a relevant contribution to metal exposure as exclusive ecigarette users had higher metal biomarkers levels compared to non-users, and to cigarette smokers
and dual users. Differences in device type also determine exposure to certain metals. With ecigarettes rapidly evolving, surveillance of metal exposure and establishing standards are warranted toprevent involuntary metal exposure.

Keywords: heavy metals, electronic cigarettes, tobacco control, environmental epidemiology,
biomarkers of exposureMP-127[Chemical exposures » PFAS]

Bottled Water Consumption and Per- andPolyfluorinated Alkyl Substances (PFAS):
Findings from the MetaAIR Study and NHANES
2003-2018
Elizabeth Costello1, Jesse A Goodrich1, Douglas I Walker2, Hailey E Hampson1, Brittney O Baumert1,
Emily Beglarian1, Sarah Rock1, Frank D Gilliland1, Tanya L Alderete3, Zhangua Chen1, Rob
Mcconnell1, Max Aung1, David V Conti1, Lida Chatzi1
1Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, CA, United States
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States

BACKGROUND AND AIM:Contamination of drinking water with per- and polyfluoroalkyl substances(PFAS) is a growing concern, especially in areas experiencing drought or water insecurity. Populations
with concerns about water quality often choose bottled water over tap water, though there are fewer
regulations in place for monitoring PFAS contamination in bottled water. This study aims to examine
the relationship between bottled water consumption and PFAS levels in young adults in Southern
California and to compare results to a nationally representative US population sample.
METHOD:Plasma PFAS (PFOA, PFOS, PFNA, PFHxS, PFDA, PFPeS, and PFHpS) were measured in young
adults (n=124, 57% Hispanic) recruited into the MetaAIR study for one visit between 2014-2018.
Participants in eight two-year National Health and Nutrition Examination Survey (NHANES) cycles
between 2003-2018 who were 12 years old, not pregnant, and had available serum PFAS (PFOA,PFOS, PFNA, and PFHxS) data (n=15,276) were included. In both studies, water consumption wasassessed using 24-hour dietary recalls. Bottled water consumption was evaluated as a percentage of
total water consumed. All analysis were performed using linear regression and adjusted for age, sex,
race/ethnicity, education, and NHANES analyses were adjusted for study design.
RESULTS:Each 10 percentage-point increase in bottled water consumption was associated with a 2.1%
(95%CI: 0.37-3.9%) increase in PFOA, and a 5.4% (95%CI: 0.32-11.0%) increase in PFPeS in
MetaAIR. Bottled water consumption was also positively associated with PFOA, PFOS, PFNA, andPFHpS in MetaAIR, though these associations were not statistically significant (p>0.05). In NHANES,
positive but non-statistically significant associations were observed between bottled water
consumption and PFOA and PFNA in seven of the eight included cycles (2003-2016), and between
bottled water and PFOS in six cycles (2003-2010, 2013-2016).
CONCLUSIONS:Bottled water may be a source of PFAS exposure. Strengthening quality standards for
all water sources is critical to preventing PFAS contamination of drinking water.

Keywords: PFAS, water quality, environmental epidemiology

MP-128[Chemical exposures » PFAS]

A Statistical Association for Toxicity ofIndividual Perfluorinated n-Alkyl Acid
Components in Co-Exposures to Multiple PFAS
Eugene Demchuk
Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Atlanta, GA,USA

BACKGROUND AND AIM:Exposures to per- and polyfluoroalkyl substances (PFAS) often transpire as
co-exposures to multiple PFAS entities, some without toxicological information. The present work
describes a statistical association that may help to fill the gap. The association was establishedbetween the number of fluorine atoms in perfluoro-n-alkyl acids and PFAS toxicity.
METHOD:Using data from national and international agencies which identify key studies, critical healtheffects, and points of departure (PODs), a categorical regression model was developed (p-value <10^-4) that links individual PFAS chemicals to observed toxicity. Various effects were considered.
They included critical health effects associated with PFAS exposures: hepatic, endocrine,
developmental, and immunological.
RESULTS:The regression model suggested an exponential dependence on the number of fluorine
atoms adjusted for study duration. The sizes of other effects, including types of critical health effects
and types of PODs, were small and did not statistically significantly influence the dependence.
Immunological critical health effects were confounded by other effects, like study duration and test
species, making it impossible to delineate their contribution at the present level of knowledge.
CONCLUSIONS:The available information suggests that toxicity of the tested perfluoro-n-alkyl acids
depends exponentially on the degree of fluorination adjusted for chemical’s subclass and study
duration. This information may be used to delineate the magnitude of health effects attributable toindividual PFAS components in epidemiologic studies of co-exposures to multiple PFAS. Further
laboratory studies are desirable to confirm or refute the observed dependence. Disclaimer: thefindings and conclusions in this presentation have not been formally disseminated by the Centers for
Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry and should not
be construed to represent any agency determination or policy.

Keywords: PFAS, polyfluoroalkyl, co-exposures, mixtures

MP-129[Chemical exposures » PFAS]

Association of serum per- and polyfluoroalkyl
substances with age-related maculardegeneration among U.S. adults: NHANES
2005–2008
Habyeong Kang1, Sung Kyun Park2, Dong Hyun Kim3, Yoon Hyeong Choi4
11Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
2Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
3Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
4School of Health and Environmental Science, Korea University, Seoul, Korea

BACKGROUND AND AIM:Age-related macular degeneration (AMD) is a leading cause of blindness inolder adults. Despite possible links of environmental factors, such as exposure to air pollution andmetals, to AMD risk, the role of per- and polyfluoroalkyl substances (PFAS), ubiquitous persistentneurotoxic chemicals, in etiology of AMD remains unclear. We examined the cross-sectional
association between serum PFAS and AMD in US adults using data from National Health and Nutrition
Examination Survey (NHANES) 2005-2008.
METHOD:A total of 1722 participants aged 40 years or older with complete data on PFAS, AMD, andcovariates were included. PFAS, including perfluorooctanoic acid (PFOA), perfluorononanoic acid
(PFNA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonic acid (PFOS), were
measured in serum. AMD was diagnosed based on retinal image examination. The associations of
PFAS (tertile groups: low, medium, high) with AMD were evaluated using survey-weighted logistic
regression models adjusted for sex, race/ethnicity, age, age2, education, smoking pack-year, BMI,
and seafood consumption. Mixture effects were also evaluated with overall PFAS burden calculated byitem response theory (IRT) scoring. Effect modification by age, sex, race/ethnicity, and seafood
consumption was evaluated.
RESULTS:Serum PFOS concentration was positively associated with AMD, with an odds ratio (OR)(95% CI) of 1.99 (1.05, 3.79) for the high versus low group. The associations of PFAS mixture with
AMD were not monotonous: positive associations with ORs (95% CIs) of 2.18 (1.18, 4.04) and 1.88
(0.96, 3.68) for the medium and high groups, respectively. Effect modification was found for the
association between PFAS mixture and AMD, with stronger associations among participants aged <60years, males, Non-Hispanic White, and those with high seafood consumption.
CONCLUSIONS:Our findings suggest that exposure to PFAS, particularly PFOS, may be a risk factor for
AMD. Future research is needed to explore the mechanisms underlying the association between PFAS
exposure and ocular health.

Keywords: Chemical exposures, Environmental epidemiology, Multi-pollutant, Outcomes, PFAS

MP-130[Chemical exposures » Endocrine disrupting chemicals]

Association between urinary parabens andinsulin resistance in the general population of
TaiwanHsi Chen1, Leung Shih Hao1, Chang Jung Wei1, Huang Po Chin2, Chang Wang Ting2, Chen Hsin
Chang3
1Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan3Department of Chemistry, Tunghai University, Taichung, Taiwan

BACKGROUND AND AIM:Parabens are preservatives used in the cosmetics and are widely used inpeople's daily lives. However, few epidemiological studies have been investigated on the correlation
between obesity and insulin resistance. Therefore, we aimed to explore the association between
parabens exposure and insulin resistance, adipokines and obesity.
METHOD:Our study used the 2013 data of the cross-sectional representative general population
generation from Taiwan Environmental Survey for Toxicants, with a total of 341 subjects, toinvestigate the exposure of parabens and the association between parabens and insulin resistance,
obesity and adipokines.
RESULTS:Our study showed the participants aged 40–65 are the most. 24.1% and 26.3% of theparticipants were overweight and obese. 75.5% of adults didn’t smoke and most of them were nondrinkers. Then, linear regression Stratified by Gender, we found that urinary propylparaben
concentration in male was positively correlated with adiponectin (β=1.78, p=0.044). However, theurinary ethylparaben (EtP) concentration in females was negatively associated with adiponectin and
Adiponectin-Leptin ratio (β=-1.65, p=0.016; β=-0.43, p=0.044) and positively associated withtriglyceride‐glucose index (TyG index) and triglyceride‐body mass index (TyG-BMI) (β=0.20, p=0.012；β=11.7, p=0.001). Furthermore, we found that parabens concentration in males were negatively
associated with HOMA-β and TyG-BMI (methylparaben = OR: 0.16, 95%CI: 0.03, 0.82; butylparaben= OR: 0.10, 95%CI: 0.02, 0.61) by using logistic regression. As for females, EtP concentration was
positively correlated with TyG index (OR: 3.86, 95%CI: 1.01, 14.7).
CONCLUSIONS:In our study, we found parabens can affect the sensitivity of insulin and adipokines inbody. However, the differences in mechanisms between different genders still need to be explored.
Besides, our study design was cross-sectional, we couldn’t clearly make sure the causal relationship.
Therefore, we need conduct a long-term study to further explore the association between parabens
exposure and insulin resistance and obesity.

Keywords: Endocrine disrupting chemicals, Exposure assessment, Obesity and metabolic disordersMP-131[Chemical exposures » Endocrine disrupting chemicals]

Health Risk Assessment for Ingestion Exposure
to Endocrine Disruptors in Lip Products
Hsin Yi Wu, Shih Wei Tsai
Department of Public Health, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Endocrine disruptors are substances that can interfere with the normal
functioning of the endocrine system, which regulates hormones in the body. Some studies havesuggested that endocrine disruptors may be linked to health problems like hormone-related cancers,
reproductive problems, and developmental disorders. Many endocrine disruptors are synthetic
chemicals commonly used in consumer products, including cosmetics such as lip products. Studies
have found that lip products, including lipsticks, lip glosses, and lip balms, can contain varying
endocrine disruptors such as parabens, phthalates, triclosan, etc. However, the information regarding
the distribution of EDcs in lip products in Taiwan was limited. Hence, there is a need to fully
understand the extent of the risk posed by endocrine disruptors in lip products in Taiwan and todevelop strategies for reducing or eliminating these chemicals from lip products in the market.
METHOD:Sample collection was conducted from the Taiwan beauty market, followed by sample
pretreatment, and eventually analyzed using Gas Chromatography-Tandem Mass Spectrometry (GCMS/MS).
RESULTS:The results show that various kinds of EDCs were found in different types of lip products in
Taiwan. The findings of this study were compared with existing regulations and subsequently
conducted health risk assessment with the associated exposures.
CONCLUSIONS:Endocrine disruptors can cause various hormonal and reproductive diseases, making
monitoring their levels in lip products crucial. A more comprehensive health risk assessment isprovided for consumers and government reference by testing popular lip products on the market.

Keywords: Endocrine disruptors, Lip products, GC-MS/MS, SPME, Health risk assessment

MP-132[Chemical exposures » PFAS]

Serum levels of perfluoroalkyl substances(PFAS) and exposure determinants inadolescents: A population-based study in Korea
Hyoseon Kim1, Jeoung A Kwon2, Yoonjoo Choi1, Seyoung Kim1, Taiyue Jin1, Eunjeong Choi1, Bohyun
Park1, Bomi Park3, Byungmi Kim4
1National Cancer Control Institute, National Cancer Center, Goyang, Korea.
2National Cancer Control Institute, National Cancer Center, Goyang, Korea; Institute of HealthServices Research, Yonsei University, Seoul, Korea.
3Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
4National Cancer Control Institute, National Cancer Center, Goyang, Korea; Department of Cancer

Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center,
Goyang, Korea

BACKGROUND AND AIM:Research is limited on how PFAS-associated household products use differs
by parental socioeconomic status (SES), particularly during the sensitive period of adolescents.
Therefore, the aim of this study was to examine whether the combination of parental SES and use ofHousehold Products was associated with the serum PFAS levels among adolescents.
METHOD:Methods Data were obtained from a cross-sectional study of 781 adolescents who
participated in the Korean National Environmental Health Survey during 2018–2020 and for whom
serum PFAS exposure and Household products data were available. We measured the most abundant
five PFAS including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS),
perfluorohexane sufonic acid (PFHxS), perfluorodecanoic acid (PFDeA), and perfluorononanoic acid
(PFNA) among adolescents. Multiple linear regression analysis was used to evaluate the association
between PFAS exposure and household products (frying pans, coating containers, coating pot) as wellas parental SES (alone and in combination).
RESULTS:Mother’s education level was inversely associated with serum PFOS concentration inadolescents, but no association was detected in serum PFOA concentration. Mothers with higher
education level and lower use frequency of coating containers had significantly lower serum PFOS
concentrations among adolescents than those without lower education level and lower use frequency
of coating containers (adjusted β= -2.19, 95% CI= -4.23- -0.15).
CONCLUSIONS:This study suggests that the combination of mother’s education level and use ofhousehold Products in mothers may play an important role in PFOS exposure among adolescents, andit should be considered that providing education to parents for reduce PFAS exposure.

Keywords: SES(socio-economic status), education, PFAS, Adolescent, Household productMP-133[Chemical exposures » PFAS]

Prenatal exposure to perfluoroalkyl substancesand lung function in mid-childhood: Resultsfrom Project Viva
Jennifer A Oliver1, Diane R Gold2, Birgit Claus Henn1, Yorghos Tripodis3, Thomas F Webster1, Abby F
Fleisch4, Jessica G Young5, Sheryl L Rifas Shiman5, Emily Oken5, Patricia A Janulewicz1
1Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, USA
3Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA and Boston

University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA,
USA
4Center for Interdisciplinary and Population Health Research, Maine Health Institute for Research,

Portland, ME, USA and Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA
5Department of Population Medicine, Harvard Medical School, Boston, MA, USA and Harvard Pilgrim

Health Care Institute, Boston, MA, USA

BACKGROUND AND AIM:The fetal lung rapidly grows and develops prenatally, making this apotentially vulnerable window for exposure to exogenous chemicals. Animal studies suggest that
exposure to PFAS prenatally may adversely affect lung maturation, but there are limited
epidemiological studies.
METHOD:In Project Viva, an on-going cohort study of mother-child pairs recruited in Massachusetts(1999-2002), we examined the association between prenatal PFAS exposure and childhood prebronchodilator (i.e., baseline) lung function (N=546), and also post-bronchodilator lung function in a
sub-cohort (N=375) to evaluate fixed lung obstruction. We used multivariable linear regression toassess the associations of 6 PFAS (i.e., PFOA, PFOS, PFNA, PFHxS, MeFOSAA, and EtFOSAA) measured
in maternal plasma during early pregnancy [mean (SD) 9.9 (2.3) weeks gestation] with forced
expiratory volume (FEV1), forced vital capacity (FVC), FEV1/FVC, forced mid-expiratory flow (FEF2575), and BDR in mid-childhood [mean (SD) 8 (0.9) years], with base models adjusted for child age,sex, and height.
RESULTS:Baseline FEV1, FVC, and FEV1/FVC [mean (SD) 1.47L (0.30), 1.79L (0.34), 83% (7),respectively] increased following inhaler use [mean (SD) 1.53L (0.31), 1.80L (0.33), 85% (7),respectively]. Each IQR increase in PFHxS was associated with lower FEV1/FVC (β -0.51%, 95%CI 0.93, -0.10) after inhaler use. Higher concentrations of all PFAS (except PFNA) were associated withlower BDR, although confidence intervals included the null [e.g., BDR -0.60% (95%CI -1.22, 0.01) per
IQR PFHxS]. Contrary to our a priori hypothesis, each IQR increment in PFOA was associated withhigher FVC before (β 26.1mL, 95%CI 5.3, 46.9) and after (β 23.8mL, 95%CI 1.6, 46.0) inhaler use.
CONCLUSIONS:We found that children with higher prenatal PFHxS had decreased childhood lungfunction, particularly after inhaler use. We otherwise found no consistent evidence for an adverse
effect of prenatal PFAS on childhood lung function. Future studies will benefit from exploring theimpact of exposure to the mixture of PFAS.

Keywords: respiratory outcomes, children’s environmental health, environmental epidemiology

MP-134[Chemical exposures » Heavy metals]

Associations of a Toenail Metal Mixture with
Adult Attention and Memory in the Gulf
Longterm Follow-up (GuLF) Study
Joyce Jy Lin1, Jordan R Kuiper1, Kaitlyn G Lawrence2, Diane S Rohlman3, W. Braxton Jackson4, Dale P
Sandler2, Aisha S Dickerson5, Jessie P Buckley1, Lawrence S Engel6, Ana M Rule1
1Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore,

MD, USA
2Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of

Health, Research Triangle Park, NC, USA
3Department of Occupational and Environmental Health, University of Iowa College of Public Health,Iowa City, IA, USA
4Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
6Department of Epidemiology, University of North Carolina Gillings School of Global Public Health,Chapel Hill, NC, USA

BACKGROUND AND AIM:Many metals share common mechanisms of neurotoxicity and joint exposures
to multiple metals in a mixture can compound their individual neurotoxic effects. This study examines
potential synergistic effects of metal exposures as well as an overall mixture of arsenic (As),chromium (Cr), manganese (Mn), and lead (Pb) on attention and memory in men from the Gulf Longterm Follow-up (GuLF) Study.
METHOD:We measured toenail concentrations of 13 metals/metalloids using inductively coupledplasma mass spectrometry in 413 non-smoking men from the GuLF Study. Previous work in thiscohort identified inverse associations between toenail As, Cr, Mn, and Pb concentration andperformance on tests of sustained attention (Continuous Performance Test [CPT]) and working
memory (Digit Span Test [DST]). We used Bayesian kernel machine regression to evaluate
interactions among specific metals, and the overall metal mixture, with attention and memory
adjusting for covariates (education, age, smoking, marital status, and alcohol consumption).
RESULTS:While estimates were imprecise, we observed inverse relations between increasing quartilesof the overall 4-metal mixture and performance on the CPT (sustained attention) and DST (working
memory). Increasing all metals in the mixture from the 50th to the 75th percentile resulted in a - 0.07(-0.19, 0.05) decrease in reverse DST score and a - 0.05 (-0.11, 0.01) decrease in CPT D’ score.
Sustained attention deficits were driven by toenail As and Cr concentration. Working memory deficits
were driven by toenail Mn. No evidence of non-linearity or metal interactions was observed.
CONCLUSIONS:Our findings suggest that higher exposure to arsenic and chromium is associated withlower sustained attention and manganese with decreased working memory. We did not observe strong
evidence of synergistic interaction for either outcome across the metals examined. Further research iswarranted given the cross-sectional design and sub-clinical nature of the neurobehavioral test
outcomes.

Keywords: Heavy metals, Mixtures, Neurologic outcomes

MP-135[Chemical exposures » Heavy metals]

Longitudinal Glycemic Trajectories in Relation to
Toxic and Essential Metals among Mexican
Americans
Margaret Weiss1, Jiehuan Sun1, Brian P Jackson3, Luyu Wang2, Eric L Brown4, Craig L Hanis4, Maria
Argos1, Robert M Sargis2
1Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
2Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, IL,USA
3Department of Earth Science, Dartmouth College, Hanover, NH, USA
4Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas

Health Science Center, Houston, TX, USA

BACKGROUND AND AIM:Both toxic metal exposures and disruptions in essential metal homeostasis
are associated with various adverse health effects, including type 2 diabetes mellitus (T2D). Mexican
Americans are at greater risk of metal exposures and have higher rates of T2D compared to otherracial/ethnic groups, yet they remain underrepresented in environmental health research. We sought
to evaluate time trend associations between continuous glycemic traits and baseline urinary toxic andessential metals as well as their mixtures among 616 Mexican American adults living in Southern
Texas.
METHOD:Utilizing data from a longitudinal cohort, 616 Mexican American adults, aged 35 to 69 years,
were followed for 3 years with 6 repeated examinations (baseline, 3, 6, 12, 24, and 36 months).
Urinary toxic and essential metals were assessed by inductively-coupled plasma mass spectrometry atbaseline. Stratified by baseline diabetes status, linear mixed-effects models were used to estimate permonth changes in hemoglobin A1c, fasting plasma glucose, and post-load glucose in relation tourinary metal levels. Principal component analysis (PCA) was utilized to assess the effects of the metal
mixtures.
RESULTS:Among individuals who were normoglycemic at baseline, higher arsenic was associated witha higher per month increase in fasting plasma glucose and post-load glucose after adjustment.
Additionally, higher copper, molybdenum, nickel, selenium, and tin were associated with a higher per
month increase in post-load glucose. Mixture analyses by PCA yielded appreciably similar results tothe individual metal analysis.
CONCLUSIONS:In this under-represented, high-risk sample, exposure to toxic metals, alterations inessential metal homeostasis, and metal mixtures were associated with glycemic deterioration overtime. As type 2 diabetes rates continue to climb, it is vital to discern any modifiable risk factors forprimary prevention, especially among underserved populations.

Keywords: Heavy Metals, Mixtures, Endocrine disrupting chemicals, Type 2 Diabetes,

MP-136[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Association between prenatal cadmium
exposure and child development: The Japan
Environment and Children’s study
Masumoto Toshio1, Hiroki Amano1, Shinji Otani2, Michihiro Kamijima3, Shin Yamazaki4, Yayoi
Kobayashi4, Youichi Kurosawa1
1Division of Health Administration and Promotion, Department of Social Medicine, Faculty of Medicine,

Tottori University, Tottori, Japan
2International Platform for Dryland Research and Education, Tottori University, Tottori, Japan
3Department of Occupational and Environmental Health, Nagoya City University Graduate School of

Medical Sciences, Aichi, Japan
4Health and Environmental Risk Division, National Institute for Environmental Studies, Ibaraki, JapanBACKGROUND AND AIM:Cadmium is a heavy metal that can be found in soil, air, food, and water.
Cadmium has toxic effects on the kidneys, bones, and respiratory system. In animal study andepidemiological study, prenatal exposure to cadmium has been found to affect the mental
development of children, but inconsistent results have been found in different studies. We attempted
to clarify this inconsistency by analyzing the relationship between the cadmium concentration inmaternal blood during pregnancy and child development in participants of a nationwide birth cohort
study, the Japan Environment and Children’s Study.
METHOD:Prenatal cadmium concentrations in blood from mothers in the second or third trimester
were determined by inductively coupled plasma mass spectrometry. Child development was evaluatedusing “Ages and Stages” questionnaires. The effects of cadmium were investigated by performing
logistic regression analyses, multinomial logistic regression analyses and generalized linear mixed
model using the child development parameters as dependent variables and the cadmium
concentrations in maternal blood as the independent variable.
RESULTS:Significant associations were found between child development and the cadmium
concentration 6 months, 1 year, and 1.5 years after birth. However, the effect had disappeared at 2
years after birth or later. The number of developmental delays was positively associated with thecadmium concentration after adjusting individual difference.
CONCLUSIONS:The results indicate that prenatal exposure affects child development but the effectdecreases with age.

Keywords: Cadmium, JECS, child development, ASQ-3

MP-137[Chemical exposures » Phthalates]

Association between phthalates exposure andoxidative stress biomarkers in women withrecurrent pregnancy loss: results from TREPLESPo Chin Huang1, Yu Jung Lin1, Wan Ting Chang1, Pao Lin Kuo2
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2Department of Obstetrics Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan

BACKGROUND AND AIM:Some studies revealed that phthalate exposure increased oxidative stressbiomarkers (OSB) in pregnant women. However, little is known about whether a similar phenonium
occurred in women with recurrent pregnancy loss (RPL). The purpose of this study was to determine
the relationship between urinary phthalate exposure and OSB in RPL groups.
METHOD:We used our established study, the Taiwan Recurrent Pregnancy Loss and Environmental
Study (TREPLES), a hospital-based case-control study conducted from 2013 to 2022. The LC-MS/MS
method was used to measure the urinary levels of 11 phthalate metabolites and theoxidative/nitrosative stress biomarkers (such as, 8-OHdG, 8-NO2Gua). Besides, we estimated thedaily intake (DI) of phthalates based on the back-calculation method.
RESULTS:The patients with RPL had a significantly higher median of 8-NO2Gua and HNE-MA (5.72,
29.82) than the control groups (3.77, 21.54, respectively). After adjustment of age and time topregnancy, the sums of DEHP (ΣDEHPm), and DBP metabolites (ΣDBPm), were significantly positively
associated with urinary MDA (r=0.30 and 0.40) and ΣOSB (r=0.31 and 0.40) in the control group, but
not in the RPL group. We found significant positive associations among ΣDEHPm, the DI of DEHP andΣ 8-NO2Gua and HNE-MA (r=0.16 and 0.21, P<0.01) in the RPL group, respectively. Besides, theΣDBPm and the DI of DnBP were significantly positively associated with the Σ8-NO2Gua and HNE-MA(r=0.26 and 0.29, P<0.01), respectively.
CONCLUSIONS:Our findings supported the hypothesis that phthalate exposure increase certain
oxidative/nitrosative stress biomarkers in women with RPL.

Keywords: Phthalates, recurrent pregnancy loss, oxidative stress biomarkers

MP-138[Exposures » Occupational exposures]Role of advanced glycation end products in theassociation between metal fume particulatematter exposure and oxidative stress
Ruei Jing Gao, Ching Huang Lai
School of Public Health, National Defense Medical Center, Taipei, Taiwan

BACKGROUND AND AIM:Few studies have explored the association between metal fumes particles andglycation end products and whether they will affect AGEs through the mechanism of oxidative stress.
This study explores the relationship between exposure to metal fume particles and the circulatingplasma AGEs through the mechanism of oxidative damage.
METHOD:We applied a longitudinal design and recruited 49 welders and 20 administrative staff from ashipyard in northern Taiwan from 2014 to 2015. Air sampling in the personal breathing zone was
performed during the Monday shift before blood and urine sample collection on Tuesday morning.
Heavy metals (chromium (Cr), manganese (Mn), iron (Fe), nickel (Ni), copper (Cu), zinc (Zn), andcadmium (Cd) was measured from personal air and urine samples using Inductively Coupled Plasma
Mass Spectrometry (ICP-MS). In addition, blood samples from each participant were collected after
fasting overnight for AGEs analyses. All statistics were conducted in SPSS version 26.0 (IBM
Corporation).
RESULTS:The concentration of PM2.5, as well as Cr, Mn, Fe, Ni, Cu, Zn, and Cd in the PM2.5, werehigher in welders than those of administrative staff. After adjustment for all confounders, nosignificant differences in urinary 8-OHdG and 8-iso-PGF2α between welders and administrative
workers. The concentration of AGEs was higher in welders than in administrative staff. After
adjustment for all confounds through a generalized estimating equations (GEE) analysis, noassociations of numerous urinary metals with oxidative stress were found. Adjusted for age, work
type, and smoking habit, urinary Ni (β =0.169, 95% CI: 0.006 to 0.332, p<0.05) was positively
associated with AGEs.
CONCLUSIONS:The component of welding fume particles, such as metals, have different potency ofoxidative stress and are associated with AGEs. However, the mediation effect between metal exposure
biomarkers and AGEs is worth be clarified in future studies.

Keywords: Air pollution, Particulate matter, Heavy metals

MP-139[Outcomes » Obesity and metabolic disorders]

Association between serum manganese andbone mineral density: a nationwide crosssectional study in South Korea
Seung Woo Ryoo, Baek Yong Choi, Juho Choi, Seok Yoon Son, Kyoung Bok Min
Department of Preventive Medicine, Seoul National University, College of Medicine, Seoul, Republic ofKorea

BACKGROUND AND AIM:Manganese (Mn) is one of the trace elements essential to the human body.
However, excessive exposure causes detrimental health effects in several ways, and one possible
toxicity is impaired bone homeostasis. Few studies have examined the relationship between Mn
exposure and bone metabolism, yet no definite conclusions have been drawn, especially among Asianethnicity. This study aimed to investigate the association between Mn level and bone mineral density(BMD) in the South Korean population.
METHOD:National population-based cross-sectional study of South Korean adults using KNHANES IV(2008-2009), a survey assessing the health and nutritional status of South Koreans, was constructed.
Two thousand four hundred sixty adults aged ≥20 years were selected as the study sample after
excluding ineligible participants. We included BMD of the total hip, femur neck, and lumbar spine(L1~L4) as outcome variables. Multiple linear regression models with stratification analysis according
to gender and menopausal status were used to investigate the association between serum Mn and
BMD.
RESULTS:The mean serum Mn concentration of the study sample was 1.34 µg/dL. A fully adjusted
linear regression model demonstrated a positive association between serum Mn and femur neck BMD(β [SE] = 0.0136 [0.006]; p = 0.027). In contrast, subgroup analysis showed menopausal women had
decreased femur neck BMD (β [SE] = -0.0282 [0.012]; p = 0.023) and lumbar spine BMD (β [SE] = 0.0370 [0.017]; p = 0.026) as Mn level increased after covariates adjustment. No significant
association was found in men or premenopausal women.
CONCLUSIONS:We observed a significant association between serum Mn and BMD. Our results
suggest that, unlike the overall population, high Mn exposure may negatively affect bone metabolism
in menopausal women.

Keywords: Environmental epidemiology; Heavy metals, Female

MP-140[Chemical exposures » Endocrine disrupting chemicals]

Association between paraben exposure andrenal function index among the general
Taiwanese
Yen Hsuan Huang1, Jung Wei Chang1, Po Chin Huang2, Hsin Chang Chen3, Wan Ting Chang2
1Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan3Department of Chemistry, Tunghai University, Taichung, Taiwan

BACKGROUND AND AIM:Exposure to consumer chemicals has been associated with chronic kidneydisease (CKD) among humans, but their associations with estimated glomerular filtration rate (eGFR)
are inconsistent. We aimed to assess the relationship between paraben exposure and renal function
including the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin,
albumin, protein, and creatinine from a population-based study.
METHOD:We enrolled 361 participants (≥18 y, N = 269; <18 y, N = 92) who provided questionnaire
information as well as blood and urine samples from a nationally representative study. Urinary
parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben(BuP) are measured by liquid chromatography/ tandem mass spectrometry. From the renal function
index, we measured the serum level of BUN, and the urinary levels of microalbumin, albumin, protein,and creatinine. We used multiple logistic regressions to evaluate the relationship between paraben
exposure and renal function in our participants.
RESULTS:Median levels of urinary MeP, EtP, PrP and BuP in adults were 397, 38.7, 117 and 6.77
ng/mL, respectively, which were significantly higher than those in children/adolescents (all P<0.001).
Multivariate regression models adjusted for the same confounding factors confirmed the positive
association of BUN and the negative association of eGFR with urinary EtP (β: 0.059; 95% confidence
interval [CI] =0.001 to 0.116; β: -0.049; 95% CI = -0.094 to -0.005).
The multiple logistic regression showed that the adjusted odds ratio of the higher EtP and PrP level in
adults for lower eGFR were 1.81 and 1.82 times than the lower group, respectively.
All regression showed that there were null association between paraben exposure and renal function
index in children/adolescents participants.
CONCLUSIONS:Our findings suggested that daily exposure to EtP were significantly positively
associated with an increased risk of higher BUN and lower eGFR in Taiwanese ≥18 y.

Keywords: Chemical exposures, Endocrine disrupting chemicals, Biomarkers of exposure, Exposure
assessment

MP-141[Omics technologies » Metabolomics]

Application of metabolomics to toxicity
assessment of perfluorooctane sulfonic acid
Yen Jou Chao1, Tzu Hsin Yen1, Yan Chi Huang3, Hao Jan Liang1, Su Yin Chiang2, Ching Yu Lin1
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
2School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China
Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Poly- and perfluoroalkyl substances (PFAS) are a group of artificial chemicals
with thousands of individual compounds based on their diverse structures that pose severe publichealth concerns. However, regulation of PFAS is challenging due to the need for more toxic data.
Therefore, a sensitive and rapid assessment method, such as metabolomics, is needed to provide
information for PFAS management. In this study, we aimed to use metabolomic approaches to
examine the dose-response relationship of perfluorooctane sulfonate (PFOS) and correlate with cell
toxicity.
METHOD:HepG2 cell line was applied to the in-vitro model and treated with a series of doses of PFOS
for 48 hours. After PFOS exposure, cell viability quantification was first conducted by MTS assay, andthe 1/10 inhibition concentration (IC)10, IC10, and IC20 values were determined as the low-, median, and high-dose treatment groups. Then, the control and treatment groups were collected andextracted for nuclear magnetic resonance-based metabolomics analysis, followed by multivariate
analysis.
RESULTS:The results of the triplicate in-vitro experiments showed that 1%, 10%, and 20% ICs of
PFOS were 12.5, 50, and 150 μM. Numerous cellular metabolites were detected in the NMR spectra
Treatment of PFOS altered the metabolic profiles of HepG2 cells. Critical metabolite responses wereidentified.
CONCLUSIONS:The experiments of cell viability determined the exposure dose of PFOS for
metabolomics analysis. Identifying the representative metabolic responses of PFOS is essential. Thisapproach can also be applied to risk assessment for other chemicals.

Keywords: Toxicology, Metabolomics, PFAS

MP-142[Chemical exposures » PFAS]

Decreased perfluoroalkyl substances found inpatients undergoing hemodialysis treatment
Yi Ting Lin1, Yun Shiuan Chuang2, Samira Salihovic3, Ming Tsang Wu4
1Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of

Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for
Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
2Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
3School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
4Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Collegeof Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, College of
Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical
Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

BACKGROUND AND AIM:Perfluoroalkyl substances (PFAS) have been reported to be harmful tomultiple organs in the human body. We aimed to compare the serum PFAS concentrations of patients
undergoing regular hemodialysis (HD) and controls. Additionally, we also investigated the correlation
between PFAS and biochemical data, as well as concurrent comorbidities.
METHOD:We recruited 301 participants who had been on maintenance dialysis for more than 90 days
and 55 control participants. Eight different PFAS, namely perfluorooctanoic acid (PFOA), total andlinear perfluorooctanesulfonic acid (PFOS), perfluoroheptanoic acid (PFHpA), perfluorohexanesulfonicacid (PFHxS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic
acid (PFUnDA), were measured using ultra-performance liquid chromatography-tandem mass
spectrometry (UPLC-MS/MS). Spearman correlation and multivariable linear regression with 5% false
discovery rate were used to evaluate the relationships between PFAS and clinical biochemistry in HD
patients and controls.
RESULTS:Results
Circulating concentrations of seven PFAS, including total and linear PFOS (T-PFOS and L-PFOS) PFDA,
PFNA, PFHxS, PFOA, and PFUnDA, were significantly lower in the HD group compared to the control
group. For the interplay between biochemical data and PFAS, all of the studied PFAS were positively
correlated with liver function, glucose, blood urea nitrogen, ferritin, and vitamin D in the controls,
while in HD patients, the PFAS were all positively correlated with albumin, uric acid, iron, and vitamin
D. As for comorbidities, we discovered that individuals with coronary artery disease had lower levels of
PFNA and PFHpA, while those with hypertension had higher levels of linearPFOS.
CONCLUSIONS:Conclusion
The levels of T-PFOS, L-PFOS, PFDA, PFNA, PFHxS, PFOA and PFUnDA, but not PFHpA, weresignificantly lower in the patients under HD treatment. HD played an important role in removing PFAS
in patients with ESRD. Moreover, PFAS were positively associated with vitamin D, AST, and ALT inboth HD patients and control populations.

Keywords: PFAS, ExposuresMP-143[Neurologic and mental health outcomes » Mental health outcomes]

Correlation of heavy metal levels andemotional/behavioral problems among
adolescents in North Taiwan: a preliminary
reportYu Hsin Huang1, Hui Chun Huang2, Shen Ing Liu1, Tien Hui Luo3, Chao Shoun Lee1, Fang Yu Hsiao2,
Shih Min Hung2, Shu Li Wang4
1Department of Psychiatry, MacKay Memorial Hospital
2Department of Medical Research, MacKay Memorial Hospital
3MacKay Junior College of Medicine, Nursing and Management
4National Institute of Environmental Health Sciences, National Heath Research Institutes

BACKGROUND AND AIM:Previous studies showed some correlation between heavy metal anddepression. However, the data among adolescents is limited. Thus we plan this study to survey the
relationship. We also control related confounding factors of depression and emotional problems.
METHOD:We invited youths aged 15 to 19 years in the community to participate in the study. They
filled in the questionnaires about socio-demographic data, emotional and behavioral problems (YouthSelf Report Form, YSR), experiences of being bullied, childhood trauma experiences, family
relationships, alcohol use, smoking, number of physical illnesses, and family psychiatric history. We
also collected their urine to examine the heavy metal level, including vanadium, chromium,manganese, iron, cobalt, nickel, copper, zinc, gallium, arsenic, and selenium. We performed the linear
regression analysis to see if the heavy metal level is correlated with emotional or behavioral problems.
The confounding factors mentioned above were also put into the analysis.
RESULTS:Among these 137 students, 95.6% were female. We found that the risk factors for severeinternalizing problems are childhood trauma experiences (B=0.400, p<0.001), psychiatric family
history (B=5.485, p=0.015), and a higher level of urine vanadium (B=820.215, p=0.041). The risk
factors for severe externalizing problems are childhood trauma experiences (B=0.215, p<0.001),
being victims of a passive bully (B=0.827, p=0.042), and a higher level of urine vanadium(B=545.669, p=0.030) or tin (B=646.304, p=0.010). The risk factors for total problems of YSR are
childhood trauma experiences (B=0.849, p<0.001), family psychiatric history (B=10.012, p=0.048),
and a higher level of urine vanadium (B=1915.487, p=0.042) or tin (B=2112.087, p=0.023).
CONCLUSIONS:Our results are consistent with previous research that a higher tin level correlates withdepressed mood in adults. There is very limited data reporting the relationship between vanadium andemotion and behavior. Adolescents should consider avoiding exposure to these 2 metals. Longitudinalstudies are warranted to survey the causal inference.

Keywords: Children's environmental health, Community health, Environmental epidemiology, Heavy
metalsMP-144[Exposures » Occupational exposures]Musculoskeletal symptoms and disorders, andrelated knowledge, attitude and practices amongfemale textile workers in Karachi, Pakistan
Ali Hussaini
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

BACKGROUND AND AIM:The aim of this study was to determine the prevalence of Musculoskeletal
symptoms and disorders (MSD) and to assess Knowledge, Attitude and Practices regarding
Musculoskeletal symptoms and disorders among female textile workers
METHOD:To assess prevalence of MSD, we used the adopted version of Nordic Musculoskeletal
Questionnaire (NMQ). For assessing individual and work-related factors, a structured questionnaire
was used. Data was captured on EpiData and analyzed using SPSS 19. Percentages, frequencies,
Standard deviation, and means were calculated. KAP variables, responses were coded as “positive” or“negative”. Those scoring “positive” were considered as having good knowledge, attitude, andpractices.
RESULTS:311 female workers participated in this study. 253 (81.4%) workers reported
musculoskeletal symptoms. The Lower back was the most frequently affected region (71.7%),
followed by shoulders (70.7%) and neck (43.4%). Self-reported average difficulty of pain wasmoderate, and most individuals (29.6–53.1%) reported duration of pain to be between 3-5 days.
69.5% of workers were very dissatisfied with their working space. Frequency of musculoskeletal
complaints were popular among 26-35 years old. MSD prevalence had significant associations withinsurance coverage (p = 0.014), working postures (p = 0.012), marital status, (p = 0.025) and lower
educational attainment (p = 0.029). Those with MSD complaints were more likely to have betterknowledge and safer practices score.
CONCLUSIONS:There is a high prevalence of musculoskeletal symptoms and disorders among female
textile workers in economically developing countries. Preventive measures and worksite interventions
are needed to reduce work-related musculoskeletal disorders in this population. Health insurance,
treatment and reimbursement schemes should be launched.

Keywords: Textile workers, Musculoskeletal symptoms and disorders, Women Health, LMIC, Health
Insurance

MP-145[Climate » Temperature]

Quantifying the Burden of Heat-Attributable
Occupational Injuries in Australia: A DALY-based
analysis
Blesson Mathew Varghese, Alana Hansen, Jingwen Liu, Peng Bi
School of Public Health, The University of Adelaide

BACKGROUND AND AIM:Many studies have shown that high temperatures increase the risk ofoccupational injuries. However, these studies typically use relative risk or odds ratios to summarize
the impact of high temperatures, and none has reported the burden of disease summary measures forheat-attributable occupational injuries. This study sought to address this gap by quantifying theburden of occupational injuries attributable to high ambient temperatures in Australia at the national,
state and territory, and climate zone level.
METHOD:The population attributable fraction of heat-attributable occupational injuries for the period
2014-2019 was calculated using relative risk functions sourced from a systematic review and metaanalysis. The burden of occupational injuries and the proportion attributable to heat (i.e., above themean annual temperature) in each Köppen-Geiger climate zone and Australian jurisdictions were
estimated using Disability-adjusted life years (DALY), factoring in fatal and non-fatal health loss.
RESULTS:Between 1 July 2014 and 30 June 2019 in Australia, a total of 42,884 years of healthy life
were lost due to occupational injuries, with an average rate of 0.8 DALY per 1,000 workers per year.
Heat-attributable DALYs accounted for an estimated 2.3% of the total DALY of occupational injuries,
with the fatal burden representing 92%, and the non-fatal burden representing 8% of the estimated968 heat-attributable DALYs. Tropical climate zones had the highest proportion of heat attributable
occupational injury DALYs, and the states of Northern Territory and Queensland had higher heatattributable occupational injury DALY rates per 1,000 workers.
CONCLUSIONS:This study highlights that over 2% of the burden of occupational injuries in Australia
can be attributed to high ambient temperatures. Without adaptive measures and industry-based
policies to reduce heat exposure and protect worker health and safety, the heat-attributable burden ofoccupational injuries is likely to increase as heat exposure increases due to climate change.

Keywords: Heat; DALY; Injury; Occupational

MP-146[Exposures » Occupational exposures]

A police officer-specific model for predicting
the 10-year risk of major adverse cardiovascular
eventsHyunji Park1, Mun Joo Bae2, Changsoo Kim3, Changsoo Kim4, Jaelim Cho3, Jaelim Cho4
1Department of Public Health, Yonsei University College of Medicine
2Department of Occupational and Environmental Health, Yonsei University Graduate School of Public

Health3Department of Preventive Medicine, Yonsei University College of Medicine
4Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea

BACKGROUND AND AIM:Police officers are at high risk for cardiovascular diseases. This study aimed
to develop a 10-year major adverse cardiovascular events (MACE) risk prediction model in police
officers.
METHOD:We obtained medical claims data (2006−2020) from National Health Insurance Service in
the Republic of Korea. We constructed a retrospective fixed cohort of police officers (identified in 2009
and 2010) who underwent national health check-up between 2008 and 2010. The cohort was followed
for 10 years from health check-up (closest to identification year). The endpoint was defined as first
hospitalization for MACE (acute myocardial infarction, ischemic stroke, and hemorrhagic stroke) during
the follow-up. Health check-up data were randomly assigned into two sets for model development(70%) and validation (30%). A Cox regression analysis was performed to estimate the risk of MACE
given a set of various cardiovascular-related predictors.
RESULTS:A total of 1,351 (2.1%) police officers developed MACE based on the development set(n=64,557). The 10-year MACE risk prediction model included sex (hazard ratio, 1.682; 95%
confidence intervals, 1.228−2.305; male vs. female), underweight (1.577; 0.739−3.365; vs. normal),current smoker (1.435; 1.255−1.641; vs. non−smoker), history of hypertension (1.424;
1.239−1.637; vs. no history of hypertension), history of diabetes mellitus (1.301; 1.098−1.542; vs.
no history of diabetes mellitus), obese (1.259; 1.082−1.465; vs. normal), overweight (1.168;
0.990−1.378; vs. normal), age (1.062; 1.054−1.069), former smoker (1.029; 0.889−1.192; vs.
non−smoker), diastolic blood pressure (1.015; 1.006−1.023), systolic blood pressure (1.005;
0.999−1.011), fasting blood glucose (1.003; 1.002−1.005), total cholesterol level (1.002;
1.001−1.003), low−risk alcohol drinking (0.877; 0.773−0.994; vs. non−drinker), moderate−riskalcohol drinking (0.635; 0.472−0.854; vs. non−drinker), and high−risk alcohol drinking (0.524;
0.372−0.739; vs. non−drinker). The model performance (Harrell’s C-index) was estimated at 0.75
based on the validation set.
CONCLUSIONS:We developed a police officer-specific MACE prediction model using nationwide medical
claims data in the Republic of Korea.

Keywords: Cardiovascular diseases, Occupational epidemiology

MP-147[Cancer and cancer-precursors » Incidence]

Occupation and the incidence of female breast
cancer in Taiwan: A longitudinal and nationwide
cohort study
Jia Yi Lin1, Chau Ren Jung1, Ching I Hung2, Bing Fang Hwang3, Ta Yuan Chang3
1Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
2Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei, Taiwan
3Department of Occupational Safety and Health, College of Public Health, China Medical University,

Taichung, Taiwan

BACKGROUND AND AIM:Female breast cancer has been the first cause of cancer incidence in Taiwan
over decades, but the incidence of female breast cancer at different stages among workers is limited.
This study aimed to investigate the associations between the incidence of breast cancer at different
stage with various occupations and industries among female workers in Taiwan.
METHOD:We incorporated databases from Ministry of Labor and Ministry of Health and Welfare toestablish an occupational cohort of 4,742,717 female workers and a non-occupational cohort of
2,124,616 women during 2010-2018. The cox regression models were used to evaluate thedifferences in the incidence of female breast cancer over occupations and industries.
RESULTS:Female workers had a significantly higher risk of breast cancer at full-stage (Hazard ratio[HR]=1.16, 95% confidence interval [CI]: 1.14-1.19), stage 0 (1.43, 1.36-1.50), stage 1 (1.28, 1.231.32), stage 2 (1.16, 1.12-1.20), stage 3 (1.05, 1.00-1.10), but a significantly lower risk at stage 4(HR=0.85, 95% CI: 0.79-0.92) compared with the non-occupational women. Female workers in thefinancial and insurance activities (HR=1.07, 95% CI: 1.00-1.13) and real estate activities (HR=1.10,
95% CI: 1.01-1.20) had significantly higher risks of full-stage breast cancer than those employed in
the educational industry. Similar patterns were observed at stage 0 (HR=1.75, 95% CI: 1.52-2.02),
stage 1 (HR=1.40, 95% CI: 1.30-1.50), and stage 2 (HR=1.25, 95% CI: 1.17-1.35) in the financial,
and at stage 0 (HR=2.15, 95% CI: 1.82-2.54), stage 1 (HR=1.35, 95% CI: 1.18-1.56), and stage 2(HR=1.28, 95% CI: 1.12-1.47) in the real estate activities.
CONCLUSIONS:We found that the significantly higher risk of breast cancer was identified amongfemale workers and those employed in the specific industries.

Keywords: Breast cancer, incidence, industry, occupation, perspective cohort

MP-148[Climate » Temperature]

The impact of urban heat island on heatattributable excess deaths in the past and future
warming climate
Jinyu He1, Lina Madaniyazi1, Ai Milojevic2, Yasushi Honda3, Masahiro Hashizume4
1Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University,

Nagasaki, Japan
2London School of Hygiene and Tropical Medicine, London, United Kingdom.
3Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University,

Nagasaki, Japan, AND Center for Climate Change Adaptation, National Institute for Environmental
Studies, Ibaraki, Japan
4Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University,

Nagasaki, Japan, AND Department of Global Health Policy, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan, AND Institute of Tropical Medicine, Nagasaki University, Nagasaki,Japan

BACKGROUND AND AIM:To assess and project the impact of urban heat island (UHI) on heat-related
mortality in the Tokyo Metropolitan Area (TMA), Japan.
METHOD:We collected daily time series data on mean ambient temperature and all-cause mortality
from 2010 to 2019 for 242 municipalities in TMA. We quantified the UHI intensity using municipalityspecific UHI anomaly (UHIa) and classified them into decile zones. We examined the heat-related
mortality for each UHIa zone and then assessed its association with the UHIa. We estimated the heatattributable excess deaths due to the UHI effect by comparing the observed UHI-related mortality withthat under a counterfactual scenario in the past. Next, we projected the heat-attributable excess
deaths under two climate change scenarios (RCP 2.6 and 8.5) for each UHIa zone, by allowing for two
different assumptions on UHI and adaptation in the future. The difference under each climate change
scenario was interpreted as the future impact of UHI on heat-related excess death.
RESULTS:The mean UHIa ranged from -2.80°C to 1.29°C. A 1°C increase in mean UHIa wasassociated with an increase of 0.018 (95% CI: 0.002, 0.034) in heat-related log-relative risk after thefull adjustment of all the other confounders. The heat-related excess death attributable to UHI was
0.42% (95% empirical CI [eCI]: 0.26,0.56) in TMA during 2010-2019. Under RCP 8.5, heat-related
attributable fraction in TMA is projected to increase from 0.76% (95% eCI: 0.44,1.24) in the 2010s to
2.04% (95% eCI: 1.19,3.05) in the 2090s, and the corresponding attributable fraction due to UHI
would increase from 0.52% (95% eCI: 0.33,0.77) to 1.02% (95% eCI: 0.67,1.40).
CONCLUSIONS:Our findings suggest UHI contributes to heat-related mortality in TMA, and its impact
is projected to increase under a warming climate.
*This work was supported by the Japan Science and Technology Agency (JST) as part of SICORP.
Grant Number JPMJSC20E4.

Keywords: environmental epidemiology, temperature, mortality

MP-149[Exposures » Occupational exposures]

Temperature related occupational accidents in
Spain: socioeconomic drivers of adaptation
during the last 3 decades
Constanza Vielma, Hicham Achebak, Marcos Quijal Zamorano, Raúl Méndez, Guillaume
Chevance, Joan Ballester
Barcelona Institute for Global Health (ISGlobal). Barcelona, Spain.

BACKGROUND AND AIM:To analyze the association between ambient temperatures and work
accidents in 48 provinces of Spain during the period 1988-2020, along with the variations throughtime in the relative risk of work-accidents under heat and cold temperatures, and to explore thedrivers of adaptation and/or maladaptation.
METHOD:We obtained daily timeseries of work-related accidents with at least one day of leave fromthe Spanish Labor Administration. We used distributed lag non-linear models to estimate theassociation between daily mean temperatures (E-OBS) and work accidents, and we pooled the results
through a meta-regression to compute the country-level estimates of relative risk (RR) at extreme
temperatures. We performed separate analyses for heat (months from May to September) and cold
(December to March) to study the role of a range of variables as meta-predictors of the temporalchanges in risk between the years 1989-1993, 1999-2003, 2009-2013 and 2015-2019 (subperiods 1,
2, 3 and 4, respectively).
RESULTS:We found that the overall RR at temperature percentiles 1 and 99 was 1.05 and 1.08 in
1988-2020, respectively, with the minimum accident temperature at 12 ºC. The found non-monotonic
trends in the RR, with values of 1.19, 1.11, 1.12, 1.15 in subperiods 1, 2, 3 and 4 at percentile 99th,
and of 1.0, 1.09, 1.17 and 1.06 at percentile 1st. We found significant associations of RRs withsocioeconomic and demographic non-monotonic temporal changes (specifically unemployment andworkforce age).
CONCLUSIONS:This study is one of the first to emphasize the changes in time of the relation oftemperature and work-accidents during an extended period (33 years) in a country specificallyvulnerable to climate change. Potential factors for the (mal)adaptation of workers to temperatures are
discussed, highlighting the potential decision-making actions that can be taken in order to enhance
our early adaptation response to climate change.

Keywords: Occupational epidemiology, Temperature, Temperature extremes and variability, Socioeconomic factors, Climate

MP-150[Outcomes » Other (to be specified with keywords in the keywords section)]

Risk factors for threats and humiliation at theworkplace of envrionmental scientists
Jutta Lindert1, Felix Sisenop1, Keren Agay Shay2, Andrea Baccarelli3, Ruth Etzel4
1University of Applied Sciences Emden/Leer, Constantiaplatz 4, 2243 Emden, Germany
23Health and Environment Research (HER) Lab, Azrieli Faculty of Medicine, Bar Ilan University, 8Henrietta Szold St, Safed, Israel
3Department of Environmental Health and Social Justie, Columnbia University, New York, USA
44Milken Institute School of Public Health, George Washington University, Washington, DC, USA

BACKGROUND AND AIM:Threats and humiliation are common at the workplace. Factors (personal-,
intra-institutional, extra-institutional factors) which influence threats and humiliation at the workplace
are largely unknown. We aim to provide data on those factors which contribute to threats andhumiliation at the workplace based on an ecological model (personal-, intra-institutional, extrainstitutional factors).
METHOD:Online survey of International Society of Environment (ISEE) embers and persons affiliatedwith ISEE (January – March 2022) To identify factors contributing to threats and humiliation weestimated logistic regression models. We analyzed at the personal level gender, age, migration
position, and research area.
RESULTS:The response rate for the whole sample was 32.9% (n= 627 / 1, 907). For this study weincluded those who responded to the threats and humiliation items (n=500; 64.2 female; 35.8 males).
Gender and age were not related to threats and humiliation; however, migration increased the risk ofbeing humiliated, and being Full Professor decreased the risk. At the institutional level, social support
reduced the risk of for threats and for humiliation (Support be colleagues: OR= -0.818,95CI: -1.354. 0282), Hum: OR= -1.229, 95 CI: -1.001. -0468)). Considering politics more than research in theinstitution was related to threats but not to humiliation. Extra-institutional factors related to decreased
threats were being able to publish research regardless of the level of controversy. In a multilevel
model adjusting for adjusted for gender, age, migration, region, job position, job sector, and researcharea, freedom of expression regardless of political interest is related to less threats and lesshumiliation (OR: -1.066, 95% CI: -1.781, -0461).
CONCLUSIONS:Scientific integrity and freedom publish research regardless of the level of controversy
reduce the risk of threats and humiliation at the workplace.

Keywords: Threats, humiliation, risk factors, environmental scientists

MP-151[Exposures » Multi-pollutant/Multi-media]

Coexposure to organophosphate flame
retardants and phthalates in patients withchronic kidney disease and the potential
nephrotoxicity
Kai Fan Tsai1, Chia Te Kung2, Chien Te Lee1, Wen Chin Lee1
1Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung, Taiwan
2Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung

University College of Medicine, Kaohsiung, Taiwan

BACKGROUND AND AIM:Organophosphate flame retardants (OPFRs) and phthalates are widely usedadditives in various consumer products and have potential nephrotoxicity. However, the hazardous
effects of coexposure to OPFRs and phthalates have not yet been evaluated in patients with chronic
kidney disease (CKD).
METHOD:Adult CKD patients in Taiwan were recruited from the Kaohsiung Chang Gung Memorial
Hospital to measure the urinary concentrations of ten OPFR compounds and eight phthalate
metabolites. The total urinary concentrations of OPFRs and phthalates were calculated, and theurinary kidney injury molecule-1 (KIM-1) concentration was measured as the biomarker of renal
tubular injury in the study population. The urinary concentrations of OPFRs and phthalates wereassessed in univariate and multivariate analyses to identify factors independently associated withurinary KIM-1 concentration.
RESULTS:Among the 163 CKD patients enrolled in this study (stage 3: n = 79 (49.47%); stage 4: n =48 (29.45%); stage 5: n = 36 (22.08%)), the overall urinary detection rates of OPFRs and phthalates
were 97.88% and 100.00%, respectively. The median total OPFR and phthalate concentrations were
2.04 μg/g creatinine (Cr) (interquartile range (IQR), 0.84–4.27) and 52.96 μg/g Cr (IQR, 31.12–
102.29), respectively. Both urinary OPFR and phthalate concentrations were independent predictors ofurinary KIM-1 concentration in the enrolled patients after adjusting for baseline covariates, with a
0.171 log ng/g Cr increase in KIM-1 (95% confidence interval (CI), 0.046–0.296, p = 0.008) by perlog μg/g Cr total OPFRs and a 0.364 log ng/g Cr elevation in KIM-1 (95% CI, 0.170–0.557, p <0.001)
by per log μg/g Cr total phthalates.
CONCLUSIONS:Coexposure to OPFRs and phthalates is prevalent and associated with renal tubular
injury in CKD patients, which highlights the nephrotoxic potentials of these pollutants in thisvulnerable population.

Keywords: chemical exposures, phthalates, multi-pollutant

MP-152[Exposures » Other (to be specified with keywords in the keywords section)]

Boron Carbide nanoparticles caused the toxic
effects on Caenorhabditis elegans Models
Kai Jie Yang1, How Ran Chao1, Adriana Taw2, Lemmeul L Tayo2
1Kai-Jie Yang, How-Ran Chao
2Adriana Taw,Lemmeul L. TayoBACKGROUND AND AIM:Boron carbide (B4C) is a widely known ceramic material composed of boron
and carbon. It is known for its toughness, high melting point, low density, and good mechanicalproperty. Due to its diverse properties, it is widely used in industrial applications such as cutting tools
grinding wheels, ballistic armor, and neutron absorbers in nuclear power. Despite the various
advantages of B4C, constant exposure to boron carbide nanoparticles (B4C NPs) may induce adverse
effects on the human body via inhalation, skin contact, or oral ingestion.
METHOD:In this study, B4C NPs were investigated using Caenorhabditis elegans (C. elegans) as invivo model to determine the different toxicological endpoints including reproductive (brood size),
growth measurement (body length), locomotion (head thrashing and body bending), lifespan, andoxidative stress (gene expression of sod-1, sod-3, ctl-2, and cyp35a2) and metal detoxification (geneexpression of mtl-2). The L1 nematodes were prolongedly exposed to B4C NPs concentrations of 320,
160, 80, 40 mg/L until the nematodes attained the L4 stage.
RESULTS:The reproductive and locomotion assay revealed a significant decrease in brood size andbody bending in 80 to 320 mg/L B4C NPs concentrations which indicate B4C NPs can induce
reproductive toxicity and disrupt neurological function. The nematodes exposed at high concentrationof B4C NP showed decrease in survival rate compared to the control group. With regards to the growthmeasurement assay, there were no significant changes in the body length of the exposed nematodes.
CONCLUSIONS:The genes responsible for regulating the oxidative stress and metal detoxification were
found to be downregulated resulting to affected biological system of nematodes. These findings
indicate that B4C NPs can cause adverse effects on C. elegans and further observation of otherphysiological changes in nematodes can done in future studies.

Keywords: Boron carbide (B4C), nanomaterials, Caenorhabditis elegans, reproduction, neurological
toxicity

MP-153[Exposures » Occupational exposures]

Coal Production Trends and Black Lung Disease
Incidence Rate in Indonesia during 2013-2021
Kurnia Ardiansyah Akbar1, Kurnia Ardiansyah Akbar2, Kraiwuth Kallawicha1
1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
2Public Health Faculty, Jember University, Jember, Indonesia

BACKGROUND AND AIM:The use of coal in the world continues to increase, resulting in countries
supplying coal products continuing to increase their production. Indonesia as the world's largest coalsupplier also seeks to increase coal production every year. The aim of this study is to reveal theoccupational health perspective of increasing coal production and its impact on black lung disease inIndonesia.
METHOD:This research is a retrospective longitudinal study conducted on 3 coal mines in Indonesia.
The research focused on the annual medical check-up program data from 2013 – 2021. Data is takenfrom Indonesia's national coal production data and black lung disease data. Rate ratios were examinedfor differences in rates between men and women workers, and annual percent change was calculated
to quantify changes in incidence rates over time.
RESULTS:Trends analysis shows that coal production in Indonesia has continued to increase at least
24.49% in the last decade from 490 million tons in 2013 and gradually increased to 610 million tons in
2021. According to the annual chest X-Ray of coal mine workers in Indonesia, the incidence of blacklung disease in coal miners was found 112 cases (13.88%) during these period which larger thanworldwide incidence rate (9%). Male workers have a greater ratio of black lung disease in coal mining
companies. The age of workers over 40 years have an incidence rate twice (69.64%; 78 cases) that ofworkers under 40 years.
CONCLUSIONS:Increasing coal production in Indonesia results in increasing new cases of black lungdisease among coal mine workers in Indonesia. Proper occupational health intervention and early
detection of disease would benefit to workers to avoid serious health consequences due to coal
exposure.

Keywords: long-term exposure, respiratory outcomes, occupational epidemiology, occupational
exposures

MP-154[Climate » Temperature extremes and variability]

Changes in susceptibility to heat during thesummer: the role of air conditioning
Lisa Yamasaki1, Chris Fook Sheng Ng2, Aurelio Tabios3, Yasushi Honda4, Yoonhee Kim5, Yuya
Takane6, Kazuki Yamaguchi7, Masahiro Hashizume2
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan & Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
2Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan
3Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research,

Barcelona, Spain & School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki,
Japan
4National Institute for Environmental Studies, Ibaraki, Japan
5Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo,

Tokyo, Japan
6Environmental Management Research Institute, National Institute of Advanced Industrial Science andTechnology, Tsukuba, Ibaraki, Japan
7TEPCO Research Institute, Tokyo Electric Power Company Holdings, Inc, Yokohama, JapanBACKGROUND AND AIM:Heat can increase the risk of morbidity and mortality in early summer, evenwith relatively milder air temperature. However, the factors underlying the variability of heat risk
throughout the summer are not well understood. This study aims to investigate the role of air
conditioning in the association between summer temperature and heat-related illness ambulancetransport (HIAT) using electricity consumption data.
METHOD:We collected daily HIAT, maximum temperature, relative humidity, and electricity
consumption (EC) data for Chiba prefecture in Japan from June to August 2016-2019. Quasi-Poisson
regression with distributed lag non-linear model was used to estimate the association between
temperature and HIAT in each month. An interaction term between temperature and EC was added toestimate the risk of HIAT, centered at the average level of EC in each month.
RESULTS:There were 9,921 cases of HIAT during the summer months in the four-year period. The
average monthly EC were 3457, 3907, and 4070 Watt/floor m2 in June, July, and August,respectively. The estimated exposure-response curve showed an exponential increase in risk during
the three months. The same pattern was observed in each month from June to August but at adifferent momentum, with August showing the steepest risk increase. The inclusion of EC attenuatedthe increase in risk of HIAT during the summer, particularly in July and August, but not in June.
CONCLUSIONS:The findings suggest that air conditioning reduced the risk of heat on HIAT in thesummer. However, the reduction was not noticeable in June, indicating insufficient adaption in earlysummer. The results based on electricity usage data have implications for public health policies,
particularly on the timing of preventive measures.

Keywords: Environmental epidemiology, Temperature extremesMP-155[Built environment » Other (to be specified with keywords in the keywords section)]

Experience of implementing MultiTex RCTintervention package at textile mills in Karachi,
Pakistan: A qualitative study
Muhammad Muneeb Ullah Siddiqui1, Asaad Ahmed Nafees1, Muhammad Zia Muneer2
1The Aga Khan University, Karachi
2Interactive Research and Development, Karachi

BACKGROUND AND AIM:The MultiTex RCT aims to determine the effectiveness of a multifacetedintervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory
symptoms among cotton textile workers, and improving their lung function. A total of 38 textile mills
were included in the MultiTex RCT. This qualitative study is nested within the larger MultiTex RCT
study.
Through this, we have explored the experiences and views of textile mill workers, managers, andstakeholders, involved with the MultiTex RCT using qualitative research methods. It was initiated tohave an understanding of the experiences and barriers faced during the implementation of theintervention package.
METHOD:10 managers were selected for in-depth interviews (IDIs), 5 stakeholders for Key Informant
Interviews(KIIs) and 8 focus group discussions (FGDs) were conducted among workers using a semistructured questionnaire. Interviews were recorded and then transcribed verbatim. Thematic analysis
was used to generate themes and subthemes.
RESULTS:Participants identified audit and compliance requirements as key factors that facilitatedcompliance with PPE guidelines.
stakeholders identified government and worker unions as key for the proper implementation of thesafety package and to ensuring compliance of workers with it. Participants also believed that thisintervention package had numerous health and safety benefits however there was still a lack ofcompliance by the workforce which was attributed to a combination of factors, including educationlevel and cultural attitudes toward PPE. Covid-19 emerged as a strong facilitating factor that led toincrease in compliance as factories and the government had strict implementation of PPEs during the
spread of this infection.
CONCLUSIONS:The implementation of safety measures in the workplace can be challenging, andseveral factors can hinder their effectiveness. This highlights the need for proper education andtraining on the importance of wearing facemasks to prevent the spread of chronic respiratory
diseases.

Keywords: Occupational health, Chronic respiratory disease, textile mills, RCT nested qualitative
study, Qualitative study

MP-156[Neurologic and mental health outcomes » Mental health outcomes]

Digitalization of Medical Records: Streamlining
Healthcare Operations: Enhancing Efficiency andReducing Burnout
Nur Adibah Shaharul1, Mohd ‘ammar Ihsan Ahmad Zamzuri2, Ahmad Azuhairi Ariffin1, Ahmad Zaid
Fattah Azman1, Noor Khalili Mohd Ali3
1Department of Community Health, Faculty of Medicine and Health Sciences, University Putra

Malaysia, Serdang 43400, Malaysia
2Negeri Sembilan State Health Department, Ministry of Health Malaysia, Seremban 70300, Malaysia
3Seremban District Health Office, Ministry of Health Malaysia, Seremban 70590, Malaysia

BACKGROUND AND AIM:The electronic medical record (EMR) systems remain a significant priority forthe improvement of healthcare services. However, their implementation may have resulted in aburden on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout
symptoms among HCWs who use EMRs at their workplace, as well as burnout-associated factors.
METHOD:This is an analytical cross-sectional study was conducted at six public health clinics equippedwith an electronic medical record system. The respondents were from a heterogeneity of job
descriptions. Consent was obtained before enrolment into the study. A questionnaire was distributed
through an online platform. Ethical approval was secured.
RESULTS:A total of 161 respondents were included in the final analysis, accounting for a 90.0%
response rate. The prevalence of burnout symptoms
was 10.7% (n = 17). Three significant predictors were obtained in the final model: experiencing
ineffective screen layouts and navigation systems, experiencing physical or verbal abuse by patients,and having a poor relationship with colleagues.
CONCLUSIONS:The prevalence of burnout symptoms among healthcare workers working withelectronic medical record systems was low. Despite several
limitations and barriers to implementation, a paradigm shift is needed to equip all health sectors withelectronic medical record systems to improve healthcare service delivery. Continuous technicalsupport and financial resources are important to ensure a smooth transition and integration.

Keywords: electronic medical record, healthcare system delivery, burnout, mental health, healthcare
information system.

MP-157[Exposures » Occupational exposures]

Korean Radiation Workers Study: Baseline
Characteristics of an Expanded Cohort
Songwon Seo, Dalnim Lee, Eunbi Noh, Eun Shil Cha, Hyoju Jeong, Haesu Jeong, Soyeon Jung, Won Il
Jang, Sunhoo Park
National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences,
Seoul, Korea

BACKGROUND AND AIM:The Korean Radiation Workers Study (KRWS) is a large cohort study ofradiation workers to assess health effects of occupational radiation exposure. The initial cohort
included 20608 workers in active at the time of enrollment from 2016 to 2017, and the cohort wasrecently expanded to include retired workers. The aim of this study is to present the baselinecharacteristics of cancer incidence and mortality of the cohort along with the comparison with thegeneral population.
METHOD:The study population of the expanded cohort are 196379 workers registered in the National
Dose Registry (1984-2021). In order to identify cancer and death of individual workers, we linked thecohort with the National Cancer Registry (1988-2018) and the National Vital Statistics Registry (19922020). For external comparisons of cancer incidence and mortality in the cohort with those in the
Korean general population, age and sex standardized incidence ratios (SIRs) and mortality ratios(SMRs) were calculated.
RESULTS:A total of 6113 cancer cases were identified from 1988 to 2018, and thyroid cancer was themost prevalent (20.7%), followed by stomach cancer (18.4%) and liver cancer (8.9%). For mortality,
a total of 4709 workers (2.4%) deceased from 1992 to 2020, and cancer (33.1%) was the mostprevalent cause of death, followed by external causes (29.6%) and circulatory diseases (14.8%). The
SIR for all cancer combined was significantly decreased (SIR = 0.89, 95% CI 0.87–0.92); however,that for thyroid cancer was significantly increased (SIR = 1.24, 1.17–1.32). Overall, SMRs for mostcauses of death were decreased with statistical significance for all causes of death combined(SMR=0.62, 0.60–0.64). Those low SMRs remained after stratification by sex, birth year, and working
periods.
CONCLUSIONS:The baseline findings did not deviate from those of other studies, indicating a healthy
worker effects, and a continued follow-up is needed with dose-response analyses.

Keywords: Ionizing radiation, Public healthMP-158[Policy » Research translation to affect policy and practice]Transitioning to safer LPG cylinder exchange forhousehold cooking in Ghana: lessons frommixed methods pilot study of user experiences
Theresa Afia Serwaa Tawiah1, Kwaku Poku Asante1, Reginald Quansah2, Samuel Afari Asiedu1, Joseph
Wilson3, Emily Nix4, Elisa Puzzolo4, Daniel Popo4, Matthew Shupler4, Serena Saligari4, Michael
Abbot4, Rachel Anderson De Cuevas4
1Kintampo Health Research Center, Research and Development Division, Kintampo, Ghana
2Department of Behavioural, Environmental and Occupational Health, School of Public Health,

University of Ghana, Accra, Ghana
3National Petroleum Authority, Accra Ghana
4Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom

BACKGROUND AND AIM:Ghana is transitioning from a customer-controlled cylinder model (CCCM) ofliquefied petroleum gas (LPG) distribution to a branded cylinder recirculation model (BCRM) to
increase population-level LPG access for cooking to 50% of Ghanaians by 2030. As the BCRM aims to
improve consumer safety, distribution and accessibility, we explored users’ perceived advantages andlimitations of obtaining LPG under the BCRM during a pilot phase implemented by the Ghanaian
Government in Obuasi, Ghana
METHOD:We adopted a mixed methods approach comprising a survey (n=50) and in-depth qualitativeinterviews (n=7) conducted among LPG customers selected from retail points in Obuasi to explore
fuel/stove use and opinions/experience of the BCRM. We applied a framework analytic method andthematic analysis to describe and identify emerging patterns and themes in the qualitative data.
RESULTS:The survey participants were mostly young people (mean age 28.3+/-8.9) and the majorityof them were females (74%). LPG was the primary cooking fuel for all of them. Only half (n=26;52%) of participants had successfully exchanged their old cylinders for the branded cylinders underthe BCRM; the old model of LPG procurement (i.e partial filling of customer-owned cylinders at fillingstations) continued in parallel. The interviews revealed that study participants did not perceive thenovelty and intended advantages of the BCRM. Branded cylinder holders could only access their LPG
refills at designated refilling stations, with fewer access options than those offered by the CCCM at thetime of the pilot. Interviews revealed insufficient branded cylinders in circulation coupled with cylinder
cross-filling and poor monitoring of cylinder quality.
CONCLUSIONS:The BCRM pilot in Obuasi did not achieve its intended benefits, pointing out the needfor a much larger number of fully audited/high-quality branded cylinders to avoid the coexistence ofthe two distribution models and an increased number of retail points to maximize customer access.

Keywords: Transition, Liquefied Petroleum Gas, clean cooking, cylinders recirculation, Ghana

MP-159[Climate » Temperature]“Cumulative preventable number” for heathealth alert system
Yasushi Honda, Kazutaka Oka, Yasuaki Hijioka
Center for Climate Change Adaptation, National Institute for Environmental Studies

BACKGROUND AND AIM:Last year, we proposed the new index, preventable number, for heat-healthalert system to set the alert criterion of daily maximum wet-bulb globe temperature (=WBGTmax). In
brief, the idea is as follows: If a counterfactual "perfect action" is implemented at a certain WBGTmax
criterion, all the emergency ambulance car visits (=EVs) estimated to occur on the day with the
WBGTmax equal to or higher than the criterion should be prevented. This number can be regarded as“preventable number” (= PN).
METHOD:Data we used were the daily maximum WBGT estimated with weather factors and daily
number of EVs, both obtained from the governmental agencies of Japan. The study period was 2015
to 2019, during warmer season (May to September). Using these data, we first modelled the relation
between WBGTmax and EVs, assuming quasi-Poisson distribution with log link in generalized linear
model. From the highest integer WBGTmax to the lowest, we can accumulate the PN using the model
mentioned above. This can be regarded as cumulative preventable number (= CPN). In this study, weobserved the difference in the pattern of the month-specific CPN for 47 prefectures in Japan.
RESULTS:In most of the prefectures, the CPN was highest in July, followed by August. Although therisk at a certain WBGTmax, say 30 degC, is higher for May or June, the CPN was much lower for thesemonths, as well as September, when the acclimatization made the risk lower and the number of hotdays became much smaller than July or August. However, some prefectures, including Tokyo, thehighest CPN was August. Another finding was that May, June and September needs lower criterion
WBGTmax than July and August to substantially prevent the EV occurrence.
CONCLUSIONS:The variation of the CPN pattern clearly shows that the heat-health alert criterion
should be area- and month-dependent.

Keywords: Web Bulb Globe Temperature, Ambulance car visits, Heatstroke, Heat-health alert,
preventable number

MP-160[Exposures » Other (to be specified with keywords in the keywords section)]

Nanomaterial Titanium dioxide caused the
toxicity on Caenorhabditis elegans
You Jia Huang1, Yu Shien Su1, How Ran Chao1, Sherwin M. Jualo2, Lemuel L. Tayo2
1You-Jia Huang,Yu-Shien Su,How-Ran Chao
2Sherwin M. Jualo,Lemuel L. TayoBACKGROUND AND AIM:This study investigated the toxicity of nano Titanium dioxide (nTiO2) using
Caenorhabditis elegans as the model organism. The lethality, lifespan, growth, reproduction,
locomotion, and oxidative stress induced by varying concentrations of nTiO2 on C. elegans were
investigated. In this study, commercially available (Degussa P25) and synthetically prepared nTiO2
solutions were prepared.
METHOD:The nematodes were acutely exposed (from L3 to young adult stage) to 4 concentrations ofeach nTiO2 solutions (10, 1.0, 0.1, and 0.01 mg/L).
RESULTS:The results showed that there are no significant effects to the survival rate, growth, and life
span of the nematodes for all concentrations of both solutions compared to the control group.
However, there is an observed decrease in the brood sizes (reproductive effects) of the nematodes as
the concentrations of nTiO2 increased. The same is observed in the locomotion of the nematodes,
where the head thrashing and body bending decreased as the concentration increased. Oxidative
stress expression of sod-1, sod-3, ctl-1, ctl-2, cyp35A2, mlt-1, and mlt-2 was also observed.For
commercially available nTiO2, there is an overexpression of all genes at 1 mg/L exposure and forsynthetic nTiO2, there is a significant overexpression of all genes at 10 mg/L exposure.
CONCLUSIONS:In conclusion, acute exposure of C. elegans to high concentrations of nTiO2 reduced
the brood size produced and have affected the locomotion of the nematodes.

Keywords: nano Titanium dioxide, Caenorhabditis elegans, Reproductive toxicity, Neurobehavioral
toxicity, Oxidative stressMP-161[Exposures » Other (to be specified with keywords in the keywords section)]

PM2.5 emission from air fryers to cause theharmful effects on Caenorhabditis elegans
modelsZhan Yu Huang1, How Ran Chao1, Yi Ming Kuo2
1Department of Environmental Science and Engineering, National Pingtung University of Science andTechnology, Neipu, Pingtung 91201, Taiwan
2Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical

Technology, Tainan 71703, Taiwan

BACKGROUND AND AIM:The purpose of this study was to examine the emission characteristics ofindoor air pollution generated by air fryers and their potential effects on human health, specifically the
impact of PM₂.₅.
METHOD:To achieve this, we utilized Caenorhabditis elegans (C. elegans) as an animal model due tothe nematodes’ genetic similarity to humans. We established an in-vivo model and conducted toxic
tests to evaluate lethality, reproductive toxicity, locomotor behavior, body length, and lifespan.
RESULTS:A statistical analysis revealed that the concentration of PM2.5 did not prove to be fatal for C.
elegans. However, there was a locomotor behaviour effect that was noticed at a dosage of 7.5 x 10-3
μg/L and was significantly different from the control group. At higher concentrations of 7.5 x 10-2
μg/L and 7.5 x 10-1 μg/L, the negative impact on the body length, locomotor behavior, andreproductive toxicity of C. elegans was noticeable. In particular, the locomotor system of C. elegans
was affected, causing a significant reduction in locomotor behavior, body length, and reproductive
capacity when compared to the control group.
CONCLUSIONS:The air fryer generated PM2.5 at toxic concentrations can impede the development of
C. elegans and studying the organism's other physiological characteristics can provide valuable
insights for diverse research applications.

Keywords: Air fryer, Indoor air pollutants, PM2.5, C. elegans, neurological toxicity

MP-162[Climate » Temperature extremes and variability]

Older Queenslanders’ behaviours during hot
weather: factors impacting their heat response
actions
Zhiwei Xu1, Mehak Oberai4, Aaron Bach1, Sebastian Binniweis2, Ella Jackman4, Connor Forbes2,
Steven Baker3, Dung Phung5, Shannon Rutherford1
1School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute,

Griffith University, Gold Coast, Australia
2School of Information and Communication Technology, Griffith University, Gold Coast, Australia
3School of Human Services and Social Work, Griffith University, Gold Coast, Australia
4School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
5School of Public Health, The University of Queensland, Brisbane, Australia

BACKGROUND AND AIM:Understanding the determinants of individual heat response behaviours isimportant for promoting these behaviours, especially among at-risk populations. Therefore, this study
was conducted to understand the status and determinants of heat response behaviours in the older
population of Queensland, Australia
METHOD:Online- and paper-based surveys were administered from 15 September 2022 to 29
November 2022 to recruit and survey a representative sample of older Queenslanders (n = 547). The
survey questionnaire included five sections: (1) sociodemographic factors (age, gender, educationlevel, and financial status); (2) pre-existing heat-sensitive diseases; (3) heat-health risk knowledge(multiple questions); (4) heat-health risk perception; and (5) heat response behaviours. Chi-square
tests were conducted to identify each factor associated with heat response behaviours, followed byordinal modelling analyses of significant factors (identified from the Chi-square tests) to identify the
key factors associated with heat response behaviours.
RESULTS:The top heat response behaviours which older Queenslanders use most frequently are:adjusting their clothing (55.7%), increasing fluid intake (52.2%), using fans (38.3%), and using air
conditioning (21.3%). Chi-square tests reveal that heat-health risk knowledge and heat-health risk
perception are associated with all these heat response behaviours. Age, education level, self-reported
financial status, or self-reported pre-existing heat-sensitive diseases, were not significantly associatedwith any of these response behaviours. The ordinal regression results suggest that older
Queenslanders with higher heat-health risk perception were more likely to adjust their clothing (oddsratio [OR]: 3.00, 95% confidence interval [CI]: 1.13-7.99), increase fluid intake (OR: 4.51, 95% CI:
1.78-11.45), and use fans (OR: 4.52, 95% CI: 1.79 - 11.45).
CONCLUSIONS:This study shows that raising awareness around heat-health risk perception in older
Queenslanders irrespective of the sociodemographic factors could be useful for increasing their heat
response behaviours.

Keywords: climate, temperature extremes, environmental epidemiology

ORAL ABSTRACTS

OP-001[Exposome » External exposome]

The potential of biodiversity interventions tomodulate immune response - experiences fromthe first generation of randomized trials
Aki Sinkkonen1, Marja Roslund2
1Horticulture Technologies, Natural Resources Institute Finland, Turku, Finland
2Horticulture Technologies, Natural Resources Institute Finland, Helsinki, Finland

BACKGROUND AND AIM:Urban populations are suffering from increasing levels of immune-mediateddiseases. The costs of these diseases are hundreds of billions of dollars in developed countries.The
biodiversity hypothesis states that one of the core reasons for the epidemic is unsufficient daily
contact with rich and diverse environment microbiota that flourishes in organic soil and vegetation. To
test the hypothesis, my research group - jointly with collaborators - has performed intervention trials
for several years in urban environment.
METHOD:Microbial diversity was added to urban outdoor and indoor environment. The target groups
covered daycare children and adult volunteers. Yard rewilding was done using horticultural soil anddiverse vegetation. Green walls were tested indoors. Four randomized trials were performed. The trials
lasted from two weeks to two years. One of the trials was double-blinded. Volunteers were exposed tobiodiversity on five days per week. Shifts in environmental and commensal microbiota as well as
several cytokines and regulatory T cells were measured using standard methodology.
RESULTS:In yard rewilding experiments, commensal microbiota was enriched and immune modulation
was enhanced in all trials. In the green wall experiment, the results were similar. In general, the levelof interleucin-10 in the intervention arms increased compared to the control arm. Skin microbiota wasassociated with immune modulation, e.g. the level of regulatory T cells, more often than stool
microbiota.
CONCLUSIONS:Based on these biodiversity interventions, adding microbial diversity to everyday
urban living environment causes shifts in commensal microbiota and immune modulation. In previous
studies, similar shifts have been connected to low risk of several immune-mediated diseases. Similar
but large-scale trials should be run for longer periods to find out whether disease incidence is lessamong those exposed to rich natural microbiota on a daily basis.

Keywords: External exposome, health co-benefits, other (biodiversity intervention), other (immune
modulation), other (environmental microbiota)

OP-002[One health » Public health]The WEF HEALTH NEXUS: Assessment ofStrategies & Co-Benefits in the Eastern
Mediterranean Region
Ihssane El Marouani1, Kenza Khomsi2, Rabi Mohtar3, Mohamed Khalis1
1Mohammed VI Center for Research & Innovation at the University Mohammed VI of Health Sciences,

Casablanca, Morocco.
2Direction Générale de la Météorologie (DGM) – Morocco.
3University of Texas AM

BACKGROUND AND AIM:The water-energy-food (WEF) and Health (H) sectors are typically dealt withfrom different perspectives and through different interventions, which makes assessing theirinteractions complex. However, a conceptual system analysis that incorporates data from all these
sectors can enable policy and decision-makers to gain a comprehensive understanding of the WEF-H
Nexus, seek large benefits, and aggregate the sectors' key political objectives. The goal of this study
is to change the projection on Health in the WEF analysis from a healthcare and burden perspective toa resource and enabler perspective, which can help us connect the Energy, Water, and Food indicatorswith the Health and well-being indicators.
METHOD:The study uses the WEF-H Nexus Software, a scenario-based platform designed to help
identify sustainable resource management strategies informed by the WEF-H Nexus. The scenariobased tool quantifies the interconnections between the WEF and Health resources and captures theimpacts of challenges and other stresses.
RESULTS:The review of databases for this study found that the explicit interaction between Health andthe WEF Nexus is not well-studied. Although Health is often addressed within the WEF Nexus, it is stillviewed mainly as a burden rather than as an asset for well-being. Therefore, this study proposes a
conceptual system modeling approach to address this research gap, particularly in the Eastern
Mediterranean Region.
CONCLUSIONS:The WEF Nexus concept is relatively recent, but it shows great potential as a businessmodel that incorporates resource efficiency. However, there is a need for more research to integrate
Health as a resource for sustainability. By changing the projection on Health in the WEF analysis froma burden to a resource and enabler, we can promote a holistic approach to sustainability thatconsiders the interconnections between the WEF and Health sectors.

Keywords: WEF, Nexus, Modeling, Health co-benefits.

OP-003[Planetary health » Biodiversity]

Biodiversity interventions for well-being of
humans and planet
Marja I. Roslund1, Aki Sinkkonen2
1Natural Resources Institute Finland, Helsinki, Finland
2Natural Resources Institute Finland, Turku, Finland

BACKGROUND AND AIM:Biodiversity is essential for well functioning urban ecosystems and humanwell-being. Biodiversity loss limits exposure to rich microbial communities, which is associated withcommensal microbiota and poor immunological resilience. In addition, urban pollutants, such aspolycyclic aromatic hydrocarbons (PAHs), may alter microbial communities and interfere with immune
regulation. Our aim was to estimate the connections between biodiversity, PAH pollution,
environmental and commensal microbiota and immune regulation.
METHOD:In the first experiments, we estimated PAH induced bacterial shifts in several urban
landscaping materials, and whether environmental exposure to PAHs affects commensal bacterial
communities on the skin and in the gut among urban and rural populations. Results from the pollution
studies were combined with publicly available land cover data. Thereafter, we set up a placebocontrolled human intervention trial in which novel landscaping material with high microbial diversity
was used to examine its effects on commensal microbiota and immune regulation in daycare children.
RESULTS:In the PAH experiment, the magnitude of shifts in bacterial communities, including shifts in
Gammaproteobacteria, depended on landscaping material. High playground soil PAH contamination
was associated with Proteobacterial communities on the children's skin, whereas high coverage offorests was associated with decreased PAH levels in ambient air. In the placebo-controlled biodiversity
intervention trial among daycare children, skin Gammaproteobacterial community shifted only among
the intervention children, which was associated with enhanced immunoregulation.
CONCLUSIONS:The PAH pollution studies indicate that PAHs may induce shifts in environmental andcommensal bacterial communities that are associated with human health, and that it is possible todesign landscaping materials that are more resilient to bacterial shifts induced by pollution. Urban
biodiversity might be an important determining factor in the context of pollution-induced disturbances
within commensal microbiota. Our placebo-controlled biodiversity intervention indicates thatplayground microbial diversity can be modulated in order to enhance children's immunologicalresilience.

Keywords: Biodiversity, Microbiome, Children's environmental healthOP-004[Built environment » General]

Environmental changes and general healthcondition
Nabhira Aftabi Binte Islam1
1Department of dental public health, Marks medical college dental unit, Bangladesh
2Ph.D. Fellow at Bangabandhu sheikh mujib medical university, Bangladesh

BACKGROUND AND AIM:The environment directly affects health status and plays a major role inquality of life, years of healthy life lived, and health disparities. Humans impact the physicalenvironment in many ways, like overpopulation, pollution, burning fossil fuels, and deforestation.
To assess environmental changes and the general health condition.
METHOD:It were a cross-sectional study. To assess environmental changes and general healthcondition of dental second-year students and data were collected by checklist.
RESULTS:Distribution of the respondents according to sex, 64.5% were female and 35.5% male.
Majority of the student (51.6%) come from outside of Dhaka. 45.2%of respondents were lived in
Dhaka by born. 80.6% respondents lived with their family. It was alarming that 83.9%of respondents
never did physical exercise and only 16.1 % did sometimes physical exercise. 61.3%of respondent
admired that they have hair loss, 16.1 % has no problems in skin but others have problems. 51.6%
has dust, 12.9% has food allergy. 6.5 % has frequents exposure of diarrheal diseases. Often 67.7%
has been suffered from headaches. Reason of seasonal changes 29% respondents suffered by itching.
77.4% and 83.9%of respondents were affected by anxiety and depression. 77.4% respondent has
knowledge about weather change in our country as well as the whole world.
CONCLUSIONS:General health condition may change multiple causes. The environment is one of thestrong factors. The relationship between environmental temperature and health has been known for avery long time.

Keywords: Health, environmental change, knowledge, weather, relationship.

OP-005[Climate » Health co-benefits]

Clean Energy for Healthy Environments andLives: Rural and Remote Community Leadershipin Clean Energy Solutions for Australia and India
Sotiris Vardoulakis1, Shiva Nagendra2, Linda Payi Ford3, Veronica Matthews4, Supriya Mathew5,
Catherine Joyce3, Krishna Vasudevan2, Kerstin Zander3, Amelia Joshy1, Shoumick Mitra2, Gopika
Indu2, Soma Shekar2, Prerna Sharma6, Bipasha Mukherjee6, Prarthana Borah7, Pratika Chawla2, Kris
Vine4
1Australian National University, Canberra, Australia
2Indian Institute of Technology Madras, Chennai, India
3Charles Darwin University, Darwin, Australia
4University Centre for Rural Health, University of Sydney, Lismore, Australia
5Menzies School of Health Research, Alice Springs, Australia
6Clean Air Asia, Delhi, India
7Carbon Disclosure Project, Delhi, India

BACKGROUND AND AIM:The Clean Energy for Healthy Environments and Lives (CE4HEAL) project
aimed to engage with Central Australian and South Indian communities in rural and remote areas to
identify barriers and enablers to adopting solar energy for improved health outcomes. The project
aimed to collect, synthesise and communicate examples of good practice in solar energy projects inrural and remote communities with high levels of poverty and climate change vulnerability.
METHOD:We involved Indigenous and non-Indigenous collaborators and communities from Central
Australia and South India. Qualitative methods were used for data collection and thematic analysis,
including a scoping review, stakeholder interviews and focus group discussions. Local schools and art
centres were involved in artwork development aiming to enhance awareness of the health benefits ofclean energy and design solar energy advocacy materials.
RESULTS:The lack of clean, reliable and affordable energy is a key contributor to poor healthoutcomes and social injustice in rural and remote communities. Indigenous communities in particularhave often been excluded from electrification programmes and impacted by large scale renewableenergy developments on traditional lands. Low home ownership, inadequate housing construction andmaintenance, and inter-linked institutional, financial, technical, cultural and linguistic barriers posechallenges to clean energy transition in rural and remote communities. Without close and ongoing
consultation with community stakeholders, clean energy projects may fail to gain acceptance, making
their sustainable implementation difficult.
CONCLUSIONS:Successful implementation of solar energy projects in rural and remote Central
Australia and South India requires community led participatory processes, integrating clean energy
and housing adaptation approaches, suitable finance models, and appropriate microgrid technology.
Indigenous environmental knowledge and culture are critical to enhancing awareness andunderstanding the challenges to implementing clean energy solutions. This can help to decreaseenergy vulnerability, achieve better environmental, health and socio-economic outcomes for rural andremote communities.

Keywords: Climate, built environment, health equity, environmental justice, health co-benefits

OP-006[Cancer and cancer-precursors » Incidence]

Thyroid nodules, Fine Needle Aspiration
Cytology, and Thyroid cancer in Fukushima
Yutaka Hamaoka
Keio University

BACKGROUND AND AIM:After the Fukushima–Daiichi nuclear power plant disaster, thyroid ultrasoundexamination (TUE) was performed on subjects who were aged ≤18 years. In the first round of TUE(October 2011 to March 2014), 115 malignancies were detected. In the second and later rounds ofTUE, while much less malignancy was expected, additional 71, 31, and 38 malignancies weredetected. Most studies focused on thyroid cancers and thus failed to understand the protocol of TUE;
cancer detection depends on whether fine needle aspiration cytology (FNAC) is applied to participants
with nodules larger than 5mm. With regarding this protocol, this study analyzes the relationships
between thyroid dose and thyroid nodule, FNAC, and thyroid cancer detected in Fukushima.
METHOD:The relationship between thyroid dose and the number of participants with a thyroid nodule,with whom fine needle aspiration test (FNA) was conducted, and with malignancy were analyzed using
publicly available municipality-level data without regional grouping (N=59). A Poisson regression
model with log(Thyroid dose for ten years old) and age on TUE was introduced as regressors.
RESULTS:UNSCEAR(2022) re-estimated thyroid dose incorporating the latest information on theingestion of contaminated food, the flow of radiation plumes, and other factors. The estimates werereduced by 1/8 lower than the previous estimates (UNSCEAR 2013). Although magnitudes werereduced, previous and re-estimated thyroid doses have a positive and significant correlation of 0.44.
The coefficient of log (Thyroid dose for ten years old) was positive and significant for small nodules(β= 0.112, p=0.008 ), FNA (β= 0.514, p=0.000 ), and malignancy (β= 0.36, p=0.077 )CONCLUSIONS:Although this was an ecological study, health follow-up for children in Fukushima isurgent. Since the third screening, municipality-level data has been undisclosed because of privacy
concerns. Data disclosure is necessary to understand the effect of the Fukushima disaster.

Keywords: Thyroid cancer, radiation epidemiology, Fukushima nuclear disasterOP-007[Exposure assessment methods » Exposure assessment-air pollution]

Land use regression model developments for air
pollutants and particle-bound heavy metals inTaichung City, Taiwan
Chia Pin Chio1, Shtaher Wang2, Yao Hsien Tseng3, Yu Kang Chang1, Szu I Yu1, Yi Jiun Chou4, Jui
Huen Lee5, Chang Chuan Chan6
1Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung City, Taiwan
2Department of Occupational Medicine, Tungs’ Taichung MetroHarbor Hospital, Taichung City, Taiwan
3Division of Endocrinology and Metabolism, Department of Internal Medicine, Tungs’ Taichung

MetroHarbor Hospital; Department of Post-Baccalaureate Medicine, National Chung Hsing University,
Taichung City, Taiwan
4Department of Nursing, Tungs’ Taichung MetroHarbor Hospital, Taichung City, Taiwan
5Green Energy and Environment Research Laboratories, Industrial Technology Research Institute,

Hsinchu City, Taiwan; Institute of Environmental and Occupational Health Science, National Taiwan
University, Taipei City, Taiwan
6Institute of Environmental and Occupational Health Science, National Taiwan University, Taipei City,

TaiwanBACKGROUND AND AIM:In order to understand the intra-city variations of air pollutants and particlebound heavy metals in Taichung City located at the central Taiwan. At the same time, the land use
regression (LUR) model developments for above mentioned pollutants would be supported the further
exposure assessments link with the epidemiological studies.
METHOD:Thirty-three micro-environmental sites included 26 schools (in each district) and 3 buildings(total 7 sites) scattered on Taichung City were chosen. For obtaining the spatial variations, one
continuous site (Situn EPA Air Quality Monitoring Network Station) was selected as time-adjusted
reference. Harvard impactor and Ogawa passive samplers were used to measure the concentrations of
PM2.5 and SO2/NOx, respectively. Particle- bound heavy metals were analyzed by Inductively Coupled
Plasma – Mass Spectrum (Model 7500c, Agilent). We also measured the absorption coefficients ofsampled filters to be considered as soot or elemental carbon measurement. Land use, demographic,
and road network numerical data were selected to develop the LUR models. The major buffer radiusesof each selected variable were set 25, 50, 100, 300, 500, 1000 and 5000 meters, respectively. All the
LUR models were diagnosed following the standard protocols from the European Study of Cohorts for
Air Pollution Effects (ESCAPE) project.
RESULTS:Modeled R2 (Coefficient of Determination) for PM2.5 and PM2.5 absorbance were 0.61 and
0.72, respectively. For SO2 and NOx, the modeled R2 were 0.51 and 0.68, respectively. The modeled
R2 ranged from 0.36 and 0.65 for five particle-bound heavy metals (As, Cd, Cr, Ni, and V). The
background/site-specific variables, point-, line-, and area-land use variables had taken into accounted
in the developed LUR models.
CONCLUSIONS:PM2.5, PM2.5 absorbance, SO2, NOx, and particle-bound heavy metals based LUR
models could be developed with well performances. Finally, these model-based exposure assessments
could be effectively used for environmental epidemiological study.

Keywords: Air pollution, Particulate matter, Heavy metals, Exposure assessment

OP-009[Air pollution » Particle components]

Atmospheric fine particulate matter (PM2.5) in
Bloemfontein, South Africa
Deidré Van Der Westhuizen1, Chantelle Howlett Downing2, Peter Molnár3, Johan Boman4, Janine
Wichmann2, Karel Von Eschwege1
1Department of Chemistry, University of the Free State, Bloemfontein, South Africa
2School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa3Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska

Academy, University of Gothenburg, Sweden
4Department of Chemistry and Molecular Biology, Atmospheric Science Division, University ofGothenburg, Sweden

BACKGROUND AND AIM:Indoor and outdoor pollution is a global issue that has adverse effects on
both the environment and human health. While research-based studies have been conducted to assess
air pollution in larger South African cities such as Cape Town and Pretoria, there has been minimal
research conducted in the Free State province. The aim of the current study was to report on PM2.5
levels and its chemical components in Bloemfontein, the capital of the Free State Province.
METHOD:The 24-hour PM2.5 samples were manually collected on PFTE filters every third day during
26 June 2020 to 18 August 2021. Smoke stain reflectometry and X-ray fluorescence were used for thechemical analyses.
RESULTS:The average concentration of PM2.5 during the study period was 11 μg/m3, which exceeded
the World Health Organization's (WHO) annual guideline limit of 5 μg/m3, but not the annual South
African National Ambient Air Quality Standard of 20 μg/m3. The daily WHO guideline of 15 μg/m3 wasexceeded on 28 of the 180 days sampled, but not the daily South African standard of 40 μg/m3. The
average soot concentration was 1.2 μg/m3. On average, winter had the highest PM2.5 and sootconcentrations, followed by autumn, summer and spring. The five most abundant trace elements
detected in the PM2.5 filter samples were S (540 ng/m3), Si (440 ng/m3), K (160 ng/m3), Fe (130ng/m3) and Ca (100 ng/m3).
CONCLUSIONS:PM2.5 and its trace element concentrations pose a risk to human health inBloemfontein.

Keywords: PM2.5, soot, trace elements, South Africa, health risk

OP-010[Exposure assessment methods » Exposure assessment-air pollution]

Biases in estimated ambient PM2.5 exposureand associated health burden in India due tosatellite aerosol optical depth sampling gaps
Sagnik Dey, Varun Katoch, Alok Kumar, Fahad Imam, Debajit Sarkar
Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, India

BACKGROUND AND AIM:Satellite-derived ambient PM2.5 became the main source for exposure
assessment and attributable health burden estimation in countries that do not have adequate groundmonitors. PM2.5 is derived from satellite aerosol optical depth (AOD), which has sampling gaps due toclouds and other challenges. The bias in exposure and health burden estimates due to the AOD
sampling gaps is not known. Here we estimate this bias for India and discuss the implications for air
quality management and epidemiology studies.
METHOD:We develop a machine learning algorithm to fill the sampling gap in MODIS AOD data
available at 1 km spatial scale. We further build a machine learning model to convert AOD to surface
PM2.5 using predictor variables. We then estimate the mortality burden attributable to PM25 exposurefor the years 2017 to 2022 for India. The difference in exposure and burden with and without filling
the AOD sampling gaps provide the biases.
RESULTS:Our 5-fold cross validation of satellite-PM2.5 (derived from gap-filled AOD) with the grounddata from the Central Pollution Control Board shows a very high level of accuracy. We show that
population-weighted exposure in India during the period was 18.1% lower than that estimated using
unfilled AOD, more so in the states having high rainfall during the monsoon. We find that the rising
trend in PM2.5 exposure has either stabilised or PM2.5 exposure has declined in recent years in India.
This cannot be explained by the changes in meteorology. Without accounting for the sampling gap,
mortality burden in India would have been over-estimated by 0.1 million (95% confidence interval:
0.07-0.13), with a higher bias in the middle socio-demographic indicator states.
CONCLUSIONS:Our results suggest that exposure modelling using satellite data should adjust the
sampling gaps on a daily scale before any further applications in air quality and epidemiology studies.

Keywords: Ambient PM2.5 exposure, health burden, AOD sampling gap, bias, India

OP-011[Exposure assessment methods » Exposure assessment-air pollution]

Global estimates of daily ambient fineparticulate matter concentrations and unequal
spatiotemporal distribution of population
exposure
Wenhua Yu1, Tingting Ye1, Yiwen Zhang1, Rongbin Xu1, Yadong Lei2, Zhuying Chen3, Zhengyu Yang1,
Yuxi Zhang1, Jiangning Song4, Xu Yue5, Shanshan Li1, Yuming Guo1
1Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash

University
2State Key Laboratory of Severe Weather & Key Laboratory of Atmospheric Chemistry of CMA,

Chinese Academy of Meteorological Sciences, Beijing, 100081, China
3Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University,

Melbourne, VIC 3800, Australia
4Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash

University, Melbourne, VIC 3800, Australia
5Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Jiangsu

Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School ofEnvironmental Science and Engineering, Nanjing University of Information Science & Technology,
Nanjing, 210044, China

BACKGROUND AND AIM:Short-term exposure to ambient particles with a diameter of 2·5 µm or less(PM2·5) is a leading contributor to the global burden of diseases and mortality. However, few studies
provide the global spatiotemporal variations of daily PM2·5 concentrations over two decades.
METHOD:We implemented a deep ensemble machine learning (DEML) model based on ground-based
measurements from 5,446 monitoring stations in 65 countries worldwide, combined with GEOS-Chem
chemical transport model (CTM) simulations, satellite-based data, and meteorological and land cover
information to estimate global daily ambient PM2·5 concentration at 0·1°×0·1° spatial resolution in
2000-2019. We investigated the population-weighted (PWD) PM2·5 and annual population-weighted
exposed days (PED) above daily WHO Air Quality Guidelines levels (15 µg/m3) to measure thespatiotemporal unequal exposure from 2000 to 2019.
RESULTS:Our global DEML model achieved state-of-the-art performance with a cross-validation
coefficient of determination (R2) of 0·91 and root mean square error (RMSE) of 7·86 µg/m3. Globally,
there was a slight upward trend in the annual average PWD PM2·5 in 2000-2019, from 31·6 µg/m3 ±10·5 µg/m3 in 2000 to 32·3 µg/m3 ± 10·1 µg/m3 in 2019. Despite a dramatic decline in Europe andNorth America, some regions in Asia, Oceania and Northern Africa have witnessed substantial
increases in PWD PM2·5 over two decades. Only 0·18% of the global land area and 0·001% of the
global population were exposed to PM2·5 below the WHO AQG annual guideline value in 2019, withmore than 70% of days experiencing the daily PM2·5 concentrations above AQGs. Distinct seasonalpatterns were found in many regions of the world.
CONCLUSIONS:Our global high-resolution estimates of daily PM2·5 provide the first global view of theunequal spatiotemporal distribution in PM2·5 exposure over decades, which is of significance forassessing short- and long-term health impacts of PM2·5, especially for areas where monitoring station
data are not available.

Keywords: Exposure assessment, Particulate matter, Big dataOP-012[Methods » Methodological study design]

A global One Health tool to prioritize climatesensitive zoonotic diseases
Adam C. Castonguay1, Sukanta Chowdhury2, Ireen Sultana Shanta2, Bente Schrijver3, Remco
Schrijver3, Shiyong Wang4, Ricardo Soares Magalhaes5
1Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland,

Brisbane, Australia
2International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
3VetEffecT Veterinary & Public Health, Bilthoven, the Netherlands
4World Bank, Washington, DC, USA
5Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland,

Brisbane, Australia; Children’s Health and Environment Program, Children’s Health Research Centre,
The University of Queensland, Brisbane, Australia

BACKGROUND AND AIM:Zoonotic diseases pose a significant threat to humanity and animals and thisthreat is further aggravated by amplifying drivers of transmission including climate change. Given thecomplex interplay between zoonoses and climate change, and the limited resources available to tackle
this combined threat, a structured decision-making process is critical to effectively identify priority
climate-sensitive zoonotic pathogens (CSZs) to target prevention and surveillance efforts. In thisstudy, we developed a novel structured and scalable process that enables the prioritization of CSZs toinform decisions across human and animal health.
METHOD:As a first step we performed a literature review to unravel the epidemiological links between
climate hazards stemming from climate change, the mechanisms by which these impact on zoonotic
disease transmission and the resulting impacts on animal and human health. Based on this, wedeveloped a 4-step framework which included: a) development of 3-dimentional set of criteria
considering climate hazard, mechanisms of transmission and health impact, b) utilization of fuzzy
analytical hierarchy process (AHP) methodology to compare relative importance of each strata within
criteria, c) define a comprehensive list of questions to rank CSZs and d) ranking of CSZs using fuzzy
AHP during rounds of expert elicitation.
RESULTS:This prioritization process provides a ranked list of zoonotic diseases that are consideredsensitive to climate hazards. With the fuzzy AHP methodology, this approach also enables theassessment of uncertainty in disease prioritization.
CONCLUSIONS:The CSZ prioritization tool developed in this research is a scalable evidence-based andtransparent approach that enables human, animal, and environmental experts to engage andcommunicate the impacts of climate hazards on zoonotic disease transmission. The resulting ranked
list of CSZs corresponds to priority diseases for which One Health investment priorities need to betargeted to enhance surveillance and prevention efforts. This work was funded by the World Bank
Group.

Keywords: Climate change, zoonoses, disease prioritization, One Health, stuctured decision-making

OP-014[Neurologic and mental health outcomes » Mental health outcomes]

A longitudinal analysis of residential
greenspace and anxiety symptoms among acohort Australian women living in cities
Tafzila A Mouly1, Gita D Mishra2, Perry Hystad3, Mark J Nieuwenhuijsen4, Luke D Knibbs1
1School Of Public Health / Public Health Unit, The University Of Sydney / Sydney Local Health District,

Sydney 2006, Australia
2School of Public Health, The University of Queensland, Brisbane, Australia
3College of Public Health and Human Sciences, Corvallis Oregon, United States of America
4Institute for Global Health (ISGlobal), Barcelona, Spain

BACKGROUND AND AIM:Relatively few longitudinal studies have reported on the mental healthbenefits of residential
greenspace. We assessed longitudinal associations between two greenspace exposures and anxiety
symptoms in Australian women living in cities.
METHOD:Our study comprised 3,938 women, born between 1973-78. Anxiety symptoms in theprevious month were assessed at follow-up (every three years in 2003-2018), using the Goldberg
Anxiety and Depression Scale. Seasonal average normalized difference vegetation index (NDVI) was
estimated from 30 m Landsat satellite images in a 500 m buffer (NDVI500m) around participants’address per survey. Annual percentage cover of non-photosynthesising vegetation (fNPV500m, e.g.
dead leaf litter, dry grass) was estimated. A generalised estimating equation tested for associations
between greenspace and anxiety symptoms (as odds ratios [ORs]), adjusting for individual-levelcovariates. Sensitivity analyses addressed women experiencing substantial (>1 SD) between-survey
changes due to moving, and adjusting for NO2 and PM2.5.
RESULTS:A 0.12 (1 SD) unit increase in NDVI500m was significantly associated with lower odds ofanxiety symptoms (OR: 0.96, 95% CI: 0.93-0.99) in the adjusted model. A 5.2% (1 SD) increase inannual fNPV500m was not significantly associated with anxiety symptoms in the adjusted model (OR:1.03, 95% CI: 0.99-1.07). NDVI500m was modestly attenuated when air pollutants were adjusted for,though fNPV500m only became significant when PM2.5 was adjusted for. Between-survey contrasts
had no clear effect for NDVI500m, while a marked increase in fNPV500m between surveys wasconsistently associated with anxiety, compared with those experiencing similar exposure (OR: 1.15,
95% CI: 1.02-1.31).
CONCLUSIONS:NDVI500m was generally associated with lower odds of anxiety symptoms, while
fNPV500m was generally associated with higher odds of anxiety. The adverse effects of fNPV may
reflect a sub-optimal restorative capacity and/or lower aesthetic value and ability to hold attention
compared with greener spaces, among other potential explanations.

Keywords: greenspace, cohort study, mental health, anxiety, womenOP-015[Cancer and cancer-precursors » Incidence]

Geospatial co-distribution of human and canine
urothelial cell carcinoma and associatedenvironmental risk factors in Queensland,
Australia
Kei Owada1, Chiara Palmieri1, Wenbiao Hu2, Ting Gan2, Luke D Knibbs3, Ricardo J Soares Magalhães4
1School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
2School of Public Health & Social Work, Faculty of Health, Queensland University of Technology,

Brisbane, Queensland, Australia
3Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia; School of

Public Health, The University of Sydney, Camperdown, New South Wales, Australia
4School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia;

Children’s Health and Environment Program, The University of Queensland, South Brisbane,
Queensland, Australia

BACKGROUND AND AIM:Available evidence indicates that tumours in dogs and humans show a wide
variety of biological and clinical similarities. Recent evidence suggests that environmental pollutants
may contribute to increased risk of cancers of the urinary tract such as urothelial cell carcinoma (UCC)in humans and dogs. We hypothesised if such a relationship exists then urinary cancer incidence inhumans could be spatially and temporally collocated with that of canine companion animals.
METHOD:We used human UCC patient records for 4937 individuals and 170 dogs in Queensland,
Australia from 2008 to 2018, retrieved from Cancer Data Queensland and from the VetCompass
Australia and the University of Queensland’s pathology laboratory databases, respectively. Bothhuman and canine data were aggregated to the postcode-level, using postcode of residence forhumans and postcode of veterinary clinic for dogs. Climate and environmental exposures including
precipitation, land surface temperature, model predictions of outdoor annual fine particulate matter≤2.5μm (PM2.5) and nitrogen dioxide (NO₂) concentrations, and distances to cropland and industrial
areas were linked to the postcodes. Cluster analysis of canine UCC incidence was performed using
Anselin Local Moran's I and a statistical model of human UCC incidence was developed, taking into
account environmental and climate factors, including PM2.5, NO2, precipitation, land surface
temperature, and land use.
RESULTS:Our results suggest that human UCC incidence is higher in postcodes surrounding clusters ofhigh canine UCC incidence. The significance of this result is partly explained by environmental
pollution factors. The findings of this study highlight significant spatial variation in both human andcanine UCC incidence are associated with common environmental and climatic factors in Queensland.
CONCLUSIONS:These results suggest the potential for canine UCC incidence to be used as sentinel
data in high-risk postcodes for human UCC.

Keywords: Air pollution, Epidemiology, Long-term exposure, Spatial statistics, TemperatureOP-016[One health » Bacteriology]

Multidrug-Resistant and Extended-Spectrum βLactamase Escherichia coli in Dairy Farms: One
Health Perspective
Yuvaneswary Veloo1, Syahidiah Syed Abu Thahir2, Sakshaleni Rajendiran2, Zunita Zakaria3, Salina
Rahman2, Rozaihan Mansor4, Rafiza Shaharudin2
1Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia; Institute of

Bioscience, Universiti Putra Malaysia
2Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
3Institute of Bioscience, Universiti Putra Malaysia; Faculty Veterinary Medicine, Universiti Putra

Malaysia
4Faculty Veterinary Medicine, Universiti Putra Malaysia

BACKGROUND AND AIM:As Escherichia coli is a key species linked to antimicrobial resistance (AMR)
and often used as an indicator for AMR surveillance across humans, animals, and environments, weaimed to investigate the dispersion of multidrug-resistant (MDR) and extended-spectrum β-lactamase(ESBL) E. coli in various domains within dairy farms.
METHOD:Soil, effluent, cow dung, milk, and human samples were collected from eight dairy farms in
Selangor, Malaysia. A total of 145 pure strains were isolated and stored. Identification and antibiotic
susceptibility testing were conducted using VITEX® 2 system. VITEK® 2 AST card N314 was used totest 16 types of antimicrobials representing 8 antimicrobial categories, including the presence of ESBL.
RESULTS:The highest resistance of E. coli strains was recorded by penicillin (18.6%), followed bytrimethoprim/sulfamethoxazole (9.0%). A total of 10 strains (6.9%) were MDR E. coli with amaximum of four antimicrobial categories. MDR-producing ESBL was observed among cow dung(n=3), milk (n=2), and soil (n=2). Both strains from milk exhibited CTX-M β-lactamases.
CONCLUSIONS:The presence of MDR and ESBL E. coli in dairy farms implies antimicrobial usage. It isworrying as there might be a possible route transfer of MDR bacteria and AMR genes from food andenvironment to animals and humans. Therefore, quantification of antibiotic residues and resistancegenes could further add value to identify the high-risk source of contaminants.

Keywords: microbes, infectious disease, exposuresOP-017[One health » Tropical health]

One Health approach to fight Rabies inCasablanca Region-Morocco
Zakia Abadane1, Mustapha Amirich2
1Zakia Abadane, Public Health Department, Regional Health Directorate, Casablanca, Morocco.
2Mustapha Amirich

BACKGROUND AND AIM:Rabies is a neglected zoonosis, especially in Africa and Asia. In Morocco,
cases occur mainly in rural areas in Casablanca Region. Preventing rabies is considered a high priority
national program for both human and animal health sectors. Since 2018, Morocco is moving towards a
one-health approach to counter this endemic disease.
Our Objective is to share our promising experience of dealing with rabies in Casablanca Region since
the implementation of the Intersectoral One Health convention in 2022.
METHOD:A retrospective study examined human rabies data routinely collected by Regional Public
Health Department (RPHD) from 2000 to 2023.
We also described the multidisciplinary One Health National Rabies control strategy initiated regionallysince January 2022.
RESULTS:During the period from January 01, 2000, to March 01, 2023, 91 human rabies cases havebeen reported (0,05 per 100000 population). Age distribution of cases ranged from 1 year to 30
years, with a median age of 11 years, 66% of cases occurred in rural areas, all 16 Casablanca
provinces have reported cases.
Since January 2022, to improve access and quality health care for the exposed population, Casablanca
Region ensured the implementation of 59 Post Exposure Prophylaxis PEP centers. RPHD organizedtraining sessions for PEP centers (120 medical and paramedical staff).6629 exposed patients received
PEP (incidence rate 92,5 per 100000 population), 36,1% of exposed patients are aged under 15 years,
68,8% are male. 60,7% of cases are from rural areas, 79,7% of cases are caused by dog bites. 45%
of exposed patients visiting PEP centers reported Exposure Category II.
CONCLUSIONS:The first steps of one health response implementation in Casablanca Region havehelped to raise public awareness to prevent exposures, to seek proper treatment and reduce
unnecessary PEP.

Keywords: Outcomes, Infectious diseases, Mortality, Policy and practice.

OP-018[Air pollution » Particulate matter]

Estimating the Health Benefits of Achieving the
Air Quality Guidelines for PM2.5 in Korea
Hyun Joo Bae, Sun Yeong Gan
Korea Environment Institute, Sejong, Republic of Korea

BACKGROUND AND AIM:One component of air pollution, in particular, fine particulate matter (PM2.5)
has been known to enter deep into the lungs of humans, causing negative health effects andpremature death of cardiovascular and respiratory-related disease. In 2021, the World HealthOrganization published the new Air Quality Guidelines (AQG) and strengthen the annual standard offine particulate matter (PM2.5) from 10 to 5 ㎍/㎥.
This study estimates the health benefits in Korea if it achieved new Air Quality Guidelines of PM2.5.
METHOD:The Environmental Benefits Mapping and Analysis Program (BenMAP) of Environmental
Protection Agency and AirQ+ of World Health Organization were used to estimate the health benefitsof improved air quality, and the two results were compared. Additionally, Statistics Korea’s population
and baseline mortality data were used, and the Krewski function were used to calculate theconcentration-response function of PM2.5 and its health benefits.
RESULTS:The study was conducted with 2020 as the reference year, when the annual concentration of
PM2.5 in Korea was 18.6 ㎍/㎥ and the regional concentration ranged between 11.9 and 29.5 ㎍/㎥. To
achieve the AQG of PM2.5, the annual concentration of PM2.5 would have to be improved to
6.36~19.07 ㎍/㎥.
The results of the BenMAP and AirQ+ showed that if Korea had achieved an AQG of PM2.5, premature
mortality would have decreased by 20,111(95% CI: 13,794~26,300) and 21,175(95% CI:
14,005~27,698), respectively. The difference between the two results was not significant, and thecontribution of PM2.5 to the total mortality was 7.96%.
CONCLUSIONS:In conclusion, this study showed that it is crucial to devise appropriate mitigation
strategies for PM2.5 to improve air quality owing to its critical role in improving health benefits.

Keywords: PM2.5, BenMAP, AirQ+, Health benefitsOP-019[Air pollution » Particulate matter]

Effects of long-term exposure to air pollution on
all-cause and cause-specific mortality in South
Korea
Jeongmin Moon1, Ejin Kim1, Aims Create Team2, Whanhee Lee3, Ho Kim1
1Department of Public Health Sciences, Graduate School of Public health, Seoul National University, 1

Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
2AiMS-CREATE Team
3School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do,
50612, South Korea

BACKGROUND AND AIM:It has been widely reported that long-term exposure to particulate matter(PM) is associated with mortality. Due to limitations in PM2.5 exposure data and health data, researchon PM2.5 risk assessment with a national cohort was limited. Using machine learning-based PM2.5
prediction model that covers the entire continental areas of South Korea from 2002 to 2019, thisstudy aims to investigate the associations between PM2.5 and all-cause and cause-specific mortality inSouth Korea.
METHOD:Participants above 50 years in enrollment were included from the National Health Insurance
Service-National Sample Cohort (NHIS-NSC) between 2002 and 2019. The NHIS-NSC data include all
medical claims of approximately 1 million individuals, accounting for 2% of the national population byrandom sampling. To secure representation of the Korean population, stratified sampling was
conducted based on gender, age, income level and region. PM2.5 exposures using a 1-km^2 grid
network across South Korea was assessed with ensemble-based prediction model. Monitoring data for
PM2.5 were obtained in our study area from 2000 to 2020. Cox regression model with time-varying
covariates was used to estimate the associations of PM2.5 with mortality. Furthermore, generalized
propensity score weighting and sub-population analyses were performed for those between 50 and 65
years and those aged 65 and older.
RESULTS:With the weighted pseudo-population, a 1μg/m3 increase in PM2.5 was associated with allcause mortality hazard ratio (HR) 1.002 [95% confidence interval (CI): 0.998-1.007]. Specifically, thecirculatory (HR 1.012; 95% CI 1.003-1.021) and digestive mortality (HR 1.026; 95% CI 1.005, 1.048)
were significantly associated with PM2.5. Moreover, circulatory mortality in individuals below 65 (HR1.017; 95% CI 1.000-1.033) and digestive mortality in elder population (HR 1.043, 95% CI 1.0161.070] were significantly associated with air pollutant.
CONCLUSIONS:Long-term exposure to one-year average PM2.5 was associated with elevated risks of
all-cause mortality and deaths from circulatory and digestive diseases.

Keywords: Air pollution, Particulate matter, Long-term exposure, Environmental epidemiology,
Mortality

OP-020[Air pollution » Short-term exposure]

Short-term exposure to air pollution and acutekidney injury-related mortality: a global timeseries study in 136 cities in 6 countries
Jieun Min1, Duk Hee Kang2, Cinoo Kang3, Juyeon Yang4, Jung Won Lee5, Ho Kim3, The Mcc
Collaborative Research Network6, Eunhee Ha7, Whanhee Lee8
1Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
2Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of

Medicine, Ewha Medical Research Center, Seoul, Republic of Korea
3Department of Public Health Sciences, Graduate School of Public Health, Seoul National University,

Seoul, Republic of Korea
4Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
5Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
6The MCC Collaborative Research Network
7Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health(IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department ofMedical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute,
Seoul, Republic of Korea
8School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, Yangsan, Republic of Korea

BACKGROUND AND AIM:Recent studies have shown the association between air pollution and chronic
kidney disease. However, less is known about effects of exposure to air pollution on acute kidney
injury (AKI) and resultant disease burden. Therefore, this study aimed to estimate the short-term
association between three air pollutants (PM2.5, O3, and NO2) and AKI-related death using a multicity multi-country database.
METHOD:We obtained data on daily time-series of AKI-related death count and concentration of air
pollutants for 136 cities across the six countries during the period 1987–2018 from the Multi-City
Multi-Country (MCC) Collaborative Research Network. We conducted a novel case time-series design
with quasi-Poisson distribution to estimate the association between each air pollutant and AKI-related
death and calculated the excess deaths due to noncompliance with the new WHO air quality
guidelines. Air pollutant was included in a model using a distributed lag model (DLM) with 35 lag days.
RESULTS:Total of 41,379 AKI-related deaths were included in this study. AKI-related deaths werepositively associated with air pollutants, with RRs of 1.06 (95% CI: 0.99, 1.12) for PM2.5, 1.03 (95%
CI: 0.99, 1.08) for warm season (April to September) O3, and 1.03 (95% CI: 0.98, 1.08) for NO2, per5, 10, and 10 µg/m3 increase in each air pollutant. In lag-distributed associations, the risks of AKI
death tended to decrease during the early lag periods and started to increase after 15 lag days forPM2.5 and warm season O3. Proportions of excess AKI deaths attributable to air pollutant levels above
the new WHO guidelines were 2.6%, 5.1%, and 4.7% for PM2.5, warm season O3, and NO2,
respectively.
CONCLUSIONS:Our findings provide evidence that short-term exposure to air pollution is associatedwith an increased risk of AKI-related death and implications on disease burden of AKI attributable toair pollution.

Keywords: Mortality, Particulate matter, Ozone, Oxides of nitrogenOP-021[Air pollution » Particulate matter]

Reducing PM 2.5 seasonal concentration in
urban areas could reduce the number of hospital
admissions in Cote d'Ivoire
kouame kouadio1, sylvain konan s'douffou gnamien2, constant konan1, veronique yoboue2
1kouadio kouame
2gnamien n'douffou konan sylvain

BACKGROUND AND AIM:Rapid urban expansion has severely increased ambient levels of air pollution,
including both particulate matter consisting of a diverse set of suspended solid and liquid particles ofvarying size and chemical composition, as well as gases dioxide.
Epidemiological studies have contributed much to the understanding of both the short and long term
effects by documenting adverse effects of air pollution on various organ systems, such as the
respiratory, cardiovascular, metabolic and central nervous systems
Health impacts due to pollution are being studied worldwide in response to high levels of PM 2.5
pollution and a growing understanding of the damages air pollutants have on respiratory,
cardiovascular, and neurological systems.
The objective of this study was therefore to assess the impact of air pollution on health in Abidjan andKorhogo, with special attention to cardiorespiratory and skin diseases, by measuring both exposure toPM 2.5 and health objectively.
METHOD:The study was conducted from December 2018 to September 2019. PM2.5 concentrations
were measured in Abidjan as well as in Korhogo. In addition, the medical admission outcomes wererecorded and the health impact analysis were done via health risks.
Also, we use a multinomial regression to assess the health problem that can be induced by exposure
to the PM2.5 pollutant and the number of deaths to avoid
RESULTS:The results showed that the average daily concentrations of PM 2.5 levels were 77 µg/m3
and 155 µg/m3 for Korhogo and Abidjan respectively. 682 patients in Korhogo and 1396 patients in
Abidjan were recorded during both dry and rainy season.
Using health impact assessment, in Abidjan 704 respiratory admissions and 227 could have been
avoided where 338 where observed and 26 avoided in Korhogo if PM 2.5 was under 12 µg/m3
annually
CONCLUSIONS:Reduicing PM 2.5 as required by WHO could avoid hospital admission in Abidjan

Keywords: PM 2.5, respiratory,admission avoided

OP-022[Air pollution » Short-term exposure]

Association between ambient air pollution andmortality in Brazil: a nationwide time-series
study
Weeberb J Requia1, Ana Maria Vicedo Cabrera2, Heresh Amini3, Joel D Schwartz4
1School of Public Policy and Government, Getulio Vargas Foundation, Brasília, Distrito Federal, Brazil
2Oeschger Center for Climate Change Research, University of Bern Bern, Switzerland
3Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
4Department of Environmental Health, Harvard TH Chan School of Public Health Boston,

Massachusetts, United States

BACKGROUND AND AIM:This is the first study to explore the association between ambient air pollution(PM2.5, O3, and NO2) and cardiorespiratory mortality across different population groups by sex andage in Brazil using a nationwide death record from 2003 to 2017.
METHOD:We used a time-series analysis with a distributed lag model to assess this association. Our
study population includes 2,872,084 death records in Brazil.
RESULTS:Our results suggest association between air pollution and mortality in Brazil. The
associations vary significantly by region, type of air pollutant, and population group. We found thatthe older population (> 65 years) was most affected, with men having a higher proportion of deaths.
The national meta-analysis for the whole population showed that for every 10µg/m3 increase in PM2.5
concentration, there was a 2.93% (95%CI: 1.42; 4.43) increase in the risk of death from respiratory
diseases. For every 10ppb increase in O3, there is a 2.21% (95%CI: 0.59; 3.83) increase in the riskof all-cause mortality for the age group of 46-65 years old, and a 3.53% (95%CI: 0.34; 6.72)
increase in the risk of circulatory mortality for women of all ages. For every 10ppb increase in NO2,
the risk of respiratory mortality increases by 17.56% (95%CI: 4.44; 30.64) and the risk of all-cause
mortality by 5.63% (95%CI: 1.83; 9.44).
CONCLUSIONS:These results provide epidemiological evidence that air pollution poses a higher risk ofcardiorespiratory mortality in Brazil. This study's findings are critical for policymakers as there is a lackof nationwide studies on air pollution in Brazil.

Keywords: Air pollution, Cardiovascular diseases, Respiratory outcomes, Mortality

OP-023[Climate » Temperature]

Climate Change Adaptation: Exploring the Riskof Acute Myocardial Infarction in Hot ClimateNaïve Population Immigrating to Hot Climate
Country
Adi Shiloh1, Victor Novack1, Isabella Karakis2, Lena Novack1
1Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Negev

Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel
2Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Negev

Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel;
Environmental Epidemiology Division, Israel Ministry of Health, Jerusalem, Israel

BACKGROUND AND AIM:During the last three decades Israel, a hot climate country, absorbed a waveof immigration from global North (mainly USSR) comprising 10% of the country population. This study
aimed to investigate the adaptation to the increased temperature exposure and the risk of acute
myocardial infarction (MI), focusing on this hot climate naïve population.
METHOD:We identified all MI cases that were hospitalized between 2000 and 2018 at a 1300-beds
tertiary hospital serving a population of 800,000. Temperature exposure was determined using datafrom monitoring stations. We analyzed events occurring during the summer, when increased
temperature is expected to have an adverse effect on health. Study population was divided into
groups: immigrants, and Israel-born populations of Jewish and Bedouin-Arab ethnicities. The analysis
was conducted in a case-crossover design. Exposure was measured as interquartile range increase inambient temperature. Risk estimates were retrieved using conditional logistic regression.
RESULTS:A total of 1,285 MI events were included in the analysis. Increased risk of MI was positively
associated with exposure to elevated temperatures on the day of the event in all populations:immigrants (OR 1.03 [95% CI 0.9-1.16]), Jewish Israeli-born (OR 1.11 [95% CI 1.03-1.19]), andBedouin-Arab Israeli-born (OR 1.08 [95% CI 0.90-1.30]). Recent (≤ 5 years) immigration was
associated with higher effect compared to an earlier one: OR 1.13 [95% CI 0.55-2.30] and 1.03 [95%CI 0.91-1.16], respectively.
CONCLUSIONS:Exposure to higher temperatures during the summer is associated with an increased
risk of MI. Furthermore, our results provide support for the adaptation theory by showing an increased
sensitivity to elevated temperatures in hot climate naïve population.

Keywords: environmental epidemiology, short-term exposure, cardiovascular diseases, outcomesOP-024[Climate » Temperature]

Non-optimum temperatures and productivityadjusted life years lost in Brazil: a nationwide
time-series study
Bo Wen1, Zanfina Ademi2, Yao Wu1, Rongbin Xu1, Pei Yu1, Tingting Ye1, Micheline De Sousa Zanotti
Stagliorio Coêlho3, Paulo Hilario Nascimento Saldiva3, Yuming Guo1, Shanshan Li1
1Climate, Air Quality Research (CARE) Unit, School of Public Health and Preventive Medicine, Monash

University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
2Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash

University, 381 Royal Parade, Parkville, VIC, 3052, Australia
3Laboratory of Urban Health, Faculty of Medicine, University of São Paulo/INSPER, São Paulo, Brazil

BACKGROUND AND AIM:Non-optimal temperatures are associated with premature deaths globally.
However, the evidence is limited in low- and middle-income countries, and the productivity losses due
to non-optimal temperatures have not been quantified. In this study, we aimed to estimate the workrelated impacts and economic losses attributable to non-optimal temperatures in Brazil.
METHOD:We collected daily mortality data from 510 immediate regions in Brazil during 2000 and2019. A two-stage time-series analysis was applied to evaluate the association between non-optimum
temperatures and the Productivity-Adjusted Life-Years (PALYs) lost. The temperature-PALYs
association was fitted for each location in the first stage and then we applied meta-analyses to obtainthe national estimations. The attributable fraction (AF) of PALY lost due to ambient temperatures andthe corresponding economic costs were calculated for different subgroups of the working-age
population.
RESULTS:A total of 3,629,661 of PALYs lost were attributed to non-optimal temperatures during
2000–2019 in Brazil, corresponding to 2.90% (95% CI: 1.82%, 3.95%) of the total PALYs lost. Nonoptimal temperatures have led to US$104.86 (95% CI: 65.95, 142.70) billion of economic costs
related to PALYs lost and the economic burden was more substantial in males and the population aged
15–44 years. Higher risks of extreme cold temperatures were observed in the South region in Brazil
while extreme hot temperatures were observed in the Central West and Northeast regions.
CONCLUSIONS:Non-optimal temperatures are associated with considerable labour losses as well as
economic costs in Brazil. Tailored policies and adaptation strategies should be proposed to mitigate
the impacts of non-optimal temperatures on the labour supply in a changing climate.

Keywords: temperature, mortality, climate, short-term exposureOP-025[Climate » Temperature]

Comparing the effect of different temperature
indicators on mortality and hospital admissions
in the Asian subtropical city of Hong Kong
Janice Y Ho1, Yitong Guo1, Marc K C Chong1, John C K Ho2, Hiu Fai Law2, Edward Y Y Ng3, Kevin K L
Lau4
1The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong,

Hong Kong SAR, China
2Hong Kong Observatory, Hong Kong SAR, China
3Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR, China; School ofArchitecture, The Chinese University of Hong Kong, Hong Kong SAR, China
4Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR, China; Department

of Civil, Environmental and Natural Resources Engineering, Luleå University of Technology, Luleå,SwedenBACKGROUND AND AIM:Different temperature indicators may demonstrate different patterns ofassociation with adverse health outcomes. It is important to identify suitable indicators for evidencebuilding and potential use in heat-health warning systems. The purpose of this study was to compare
the associations of maximum, mean, and minimum temperatures on mortality and hospital admissions
in the Asian subtropical city of Hong Kong.
METHOD:Meteorological, mortality, and hospital admissions data was obtained for Hong Kong, 20102019 hot seasons. Maximum, mean, and minimum temperatures were examined for their associations
with mortality and hospital admissions using a combination of Generalized Additive Models (GAM) andDistributed Lag Non-linear Models (DLNM).
RESULTS:While maximum temperatures were not found significantly associated, mean and minimum
temperatures were significantly associated with non-cancer mortality and hospital admission outcomesin Hong Kong. Particularly, minimum temperatures were more sensitive to the acute effects of hospital
admissions. The associations were statistically significant mainly among older adults aged 65 andabove, with only a slight variation when using higher age cut-offs.
CONCLUSIONS:Our study identified that mean and minimum temperatures were strong indicators in
the highly dense subtropical city of Hong Kong. The study findings also suggest the potential
protective effect of currently implemented hot weather warnings on maximum temperatures. This
study was novel to comprehensively examine the effect of different temperature indicators on bothmortality and hospital admissions in an Asian city, and simultaneously assess multiple age cut-offs andoutcomes. With increased temperature variability due to climate change, the study findings can beused to support continued development of heat-health warning systems and other climate adaptation
efforts.

Keywords: Temperature extremes and variability, Mortality, Epidemiology, Public health, ModelingOP-026[Climate » Temperature]

Association between heatstroke incidence andwet bulb globe temperature in Japan according
to regionality and location of occurrence
Kazutaka Oka, Yasushi Honda, Vera Ling Hui Phung, Yasuaki Hijioka
Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, JapanBACKGROUND AND AIM:Heatstroke has become a serious issue in Japan. It is important tounderstand regionality in the location of heatstroke occurrence in order to plan effective adaptation
measures. This study analyzed the association between heatstroke incidence and daily maximum wet
bulb globe temperature (WBGT) for the 47 prefectures in Japan according to location of occurrence.
METHOD:The data on the number of heatstroke patients transported by ambulance was provided by
the Fire and Disaster Management Agency, and the daily maximum WBGT data was provided by the
Ministry of the Environment. The locations of occurrence considered were residences, workplaces 1(such as factories), workplaces 2 (such as farms), educational institutions, public areas 1 (indoors),
public areas 2 (outdoors), and roads. The study period was from May to September, 2015 to 2019. A
distributed lag non-linear model was adopted to analyze the association between the number ofpatients and daily maximum WBGT, controlling for the day of the week, holidays, long-term trend, andconsidering lags. Next, the relative risk (RR30) at a daily maximum WBGT of 30 ℃ relative to WBGT
threshold (at which patients began to increase) were evaluated. Finally, the correlation between theregional climate (average daily maximum WBGT during study period) and RR30 were analyzed.
RESULTS:Except for workplaces 1, the correlation (regression line) between the regional climate and
RR30 showed a negative trend (the higher the regional climate, the lower the RR30). The slope of theregression line and R^2 value varied from location to location. It is considered that the larger theregional difference (the larger the slope of the regression line), the greater the difference in theamount of adaption measures required to reduce the number of patients.
CONCLUSIONS:Regional differences were observed in the location of heatstroke incidence. The
implementation of adaptation measures that considers these differences is required.

Keywords: Climate, Temperature, Risk assessment, Environmental epidemiology

OP-027[Climate » Natural disasters]

A mixed-methods systematic review: extreme
events and gender-based violence
Kim R. Van Daalen1, Sarah Savić Kallesøe2, Fiona Davey3, Sara Dada4, Laura Jung5, Lucy Singh6,
Rita Issa10, Christina Alma Emilian2, Isla Kuhn7, Ines Keygnaert8, Maria Nilsson9
1British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary

Care, University of Cambridge, Cambridge, United Kingdom
2Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge,

Cambridge, United Kingdom
3Health Equity Network, University of Cambridge, Cambridge, United Kingdom
4UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems, School of

Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
5Medical Faculty, Leipzig University, Leipzig, Germany
6London School of Hygiene & Tropical Medicine, London, United Kingdom
7Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
8International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent

University, Ghent, Belgium
9Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
10Institute for Global Health, University College London, London, UK

BACKGROUND AND AIM:Due to antroprogenic climate change, the intensity and frequency of extreme
weather and climate events are expected to increase. Left unabated this results in profound negative
human and ecosystem impacts. This systematic review explores extreme events and one of the more
overshadowed consequences: gender-based violence (GBV) experienced by women, girls, and sexualand gender minorities.
METHOD:Ten databases were searched from inception up to February, 2022 without language
restriction. Grey literature was searched using the websites of key organisations working on GBV and
Google. Quantitative studies were described narratively, whereas qualitative studies underwent
thematic analysis.
RESULTS:26,381 records were identified. After de-duplication,16,257 records were screened by title
and abstract and 192 in full-text. 41 studies were included exploring several types of extreme events(storms, floods, droughts, heatwaves, and wildfires) and GBV (sexual violence and harassment,
physical violence, witch killing, early or forced marriage, and emotional violence). Only one study
included sexual and gender minorities. Most studies showed an increase in one or several GBV forms
during or after extreme events, often related to economic instability, food insecurity, mental stress,
disrupted infrastructure, increased exposure to men, tradition, and exacerbated gender inequality.
Importantly, the experience of GBV during and after extreme events seems to be a shared experiencein most contexts studied, suggesting that amplification of GBV is not constrained geographically.
CONCLUSIONS:Overall, whilst considering the limitations of available data, the results suggest that
extreme events may be associated with GBV. These findings could have important implications forsexual-transformative and gender-transformative interventions, policies, and implementation. Given
the anticipated acceleration of weather and climate shocks, further high-quality quantitative andqualitative research with ethnographically diverse, longitudinal cohorts comparing changes in GBVlevels before, during, and after an event is imperative.

Keywords: climate change, extreme events, gender-based violence, systematic review

OP-028[Climate » Temperature extremes and variability]

Heat stress and associated mortality risk invaried climate zones of India
Pallavi Joshi Lahari1, Rohit Kumar Choudhary1, Santu Ghosh2, Dilip Ganguly1, Kalpana Balakrishnan3,
Nidhi Singh4, Rk Mall5, Sagnik Dey6
1Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, India
2Department of Biostatistics, St. John’s Medical College, Bengaluru, India
3SRU-ICMR Centre for Advanced Research on Air Quality, Climate and Health Department ofEnvironmental Health Engineering, Faculty of Public Health Sri Ramachandra Institute for Higher
Education and Research, Chennai, India
4IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
5DST-Mahamana Centre of Excellence in Climate Change Research, Institute of Environment andSustainable Development, Banaras Hindu University, Varanasi, India; Institute of Environment andSustainable Development, Banaras Hindu University, Varanasi, India
6Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, India; Centre of Excellence for

Research on Clean Air, Indian Institute of Technology Delhi, India

BACKGROUND AND AIM:Heat stress is associated with mortality, morbidity, and economic losses.
India is at high risk, given the tropical climate, expanding population and limited adaptive capacity.
Yet, studies on the health impacts of heat stress across varied climate zones of India are missing. In
this study, we examine heat stress related health impacts in India using long range meteorological
data from ERA5 (1979-2020) and developing climate-zone specific percentile-based human comfort
class thresholds.
METHOD:We examine the association of heat stress, captured as India specific Heat Index (IHI), withdaily all-cause mortality in three cities: Delhi (semi-arid), Varanasi (humid subtropical), and Chennai(tropical wet and dry), using a semi-parametric quasi-Poisson regression model, adjusted for nonlinear
confounders, time and PM2.5.
RESULTS:We find that heat stress is highest during heatwave days. The non heat wave days are notcompletely free from heat stress related health impact. The all-cause mortality risk on sweltering days
(high heat stress days) as compared to comfortable days is 8.1% (95% confidence interval, CI: 6.010.3), 5.9% (4.6-7.2), and 8.0% (1.7-14.2) 34 during ‘sweltering’ days in Varanasi, Delhi, andChennai, respectively. Females are at higher risk of mortality due to heat stress than males in
Chennai, while the gender difference is not found in the other two cities. The impact is more severe in
Varanasi (ranging from a 3.2-7.5% increase in mortality risk per unit rise in heat stress) than in Delhi(2.6-4.2% higher risk) and Chennai (0.9-5.7% higher risk).
CONCLUSIONS:The study highlights heat stress induced health risks in India vary by climate zones.
Our findings underline the need for regional thermal stress alerts and early warning systems.

Keywords: Heatwave, Heat stress, Mortality, India Heat Index, Human Comfort

OP-029[Climate » Temperature extremes and variability]

The impact of high ambient temperature on childhealth outcomes: a systematic review andmetaanalysis
Clare Faurie, Blesson Varghese, Peng Bi
School of Public Health, University of Adelaide, Adelaide, Australia

BACKGROUND AND AIM:Increased ambient temperatures and extreme heat events are wellestablished risk factors for increased human mortality and morbidity rates. Most studies to date havefocused on adult age groups. However, the paediatric population has an established vulnerability toillness or mortality in increased temperatures. This is likely due to a combination of physiological andsocial vulnerabilities characteristic of children. This presentation will summarise the literature andpresent the findings of a systematic review and meta-analysis on increased heat and childhood healthglobally
METHOD:A literature search was carried out of three scientific databases: Pubmed, Embase, and Web
of Science. Articles were identified which used an increased heat metric (either incremental
temperature increase or heatwave) as an exposure, and included a paediatric population. This
included studies limited to children, or studies reporting data from all ages with effects reported byage groups, one of which included children. The data was pooled and summarised in statistical metaanalysis, and presented as relative risk (RR) scores.
RESULTS:There is evidence that increased heat increases all-cause mortality in the paediatricpopulation. Increased heat is a risk factor for morbidity throughout the childhood years, fromincreased rates of preterm birth, to increased adolescent mental health presentations. There isevidence that heat increases the risk of respiratory, nutritional, heat illness, renal disease, mental
health, and infectious diseases in children. The majority of studies which quantified the relationshipbetween increased heat and illness did not separate children from adults in statistical analyses.
CONCLUSIONS:There is a substantial body of evidence demonstrating that children have higher rates
of morbidity and mortality as a result of higher than usual; temperatures. It will be argued thatfurther research is required into the effects of global warming on child health, and that researchers
should consider subgroup analyses of children in wider population studies.

Keywords: Children's environmental health, Temperature extremes and variability

OP-030[Built environment » Other (to be specified with keywords in the keywords section)]

School building energy efficiency and health:Modelling childhood asthma and hospital
admissions in England and Wales
Filiz Karakas1, Duncan Grassie2, Yair Schwartz2, Jie Dong2, Zaid Chalabi2, Dejan Mumovic2, Anna
Mavrogianni2, James Milner1
1Department of Public Health, Environments and Society, London School of Hygiene & Tropical

Medicine, London, United Kingdom
2Bartlett School Env, Energy & Resources, University College London, London, United Kingdom

BACKGROUND AND AIM:Recent evidence has emphasized the importance of the school indoor
environment for childhood asthma. We assessed how different strategies for improving the energy
efficiency of school buildings in England and Wales may affect asthma incidence and healthcare
utilization costs in the future.
METHOD:Changes in internal nitrogen dioxide (NO2) were modelled inside school buildings covering
13 climate regions in England and Wales under four energy efficiency interventions consisting of
combinations of retrofit and operational indoor environmental quality strategies. We developed ahealth impact assessment model to quantify the resulting burden of childhood asthma incidence ineach region using regional asthma incidence and county based-population data with exposureresponse functions from a recent high quality systematic review/meta-analysis. We compared theeffects of each energy efficiency on asthma incidence and associated hospitalisation costs.
RESULTS:The Thames Valley region (including London) had the highest NO2 levels and childhood
asthma incidence, particularly in older school buildings, whereas the newest schools in Wales had thelowest concentrations and health burdens. Asthma incidence decreases with age, with primary school
children nearly twice as likely to develop asthma as secondary school children. Two interventions
including only operational improvement or a combination of both operational and retrofit strategies
resulted in reductions in childhood asthma incidence (547 and 676 per annum average of 13 regions,
respectively) and hospital utilization costs (£52,050 and £64,310 per annum average of 13 regions,
respectively).
CONCLUSIONS:Our results demonstrate that increasing the energy efficiency of school buildings can
reduce NO2 exposure, childhood asthma incidence and healthcare costs providing it is accompanied bymeasures to improve indoor environmental quality. The findings from this study make several
contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air
pollutants and their effects on children’s health.

Keywords: Air pollution, asthma, built environment, children's environmental health, modellingOP-031[Air pollution » Other (to be specified with keywords in the keywords section)]

Attributable risk of household solid fuel use andsecond-hand smoke associated with under-5
mortality in 46 low- and lower-middle-income
countries
Kaung Suu Lwin1, Shuhei Nomura2, Khin Thet Swe3, Stuart Gilmour4, Md Ashraful Alam1, Masahiro
Hashizume1
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan
2Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
3Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
4Graduate School of Public Health, St. Luke’s International University, Tokyo, JapanBACKGROUND AND AIM:Household solid fuel use (including indoor and outdoor) and second-handsmoke (SHS) are considered to be major contributors of under-5 mortality (U5M) in low- and lowermiddle-income countries (LMICs). This study provides a comprehensive assessment of their odds
ratios and attributable mortality in LMICs.
METHOD:We used the Demographic Health Surveys data for under-5 children in 46 LMICs (n =778,532) from 2010 to 2020. Mixed effect multilevel logistic regressions were conducted to estimate
the pooled adjusted odds ratio (aOR) for U5M due to solid fuel use, SHS and their combinationcompared to no exposure to them in 46 LMICs. The attributable mortality of solid fuel use, SHS, andtheir combination were assessed for each LMIC.
RESULTS:The pooled aOR of solid fuel use and SHS for U5M was estimated to be 1.27 (95%
Confidence Interval (CI): 1.19–1.36) and 1.13 (95%CI: 1.06–1.25),respectively, whereas those of
their combination was 1.40 (95%CI: 1.31–1.50). U5M attributable to indoor and outdoor solid fuel use
was the highest in Myanmar(18.0%) and the Gambia (16.5%), respectively, while those attributable
to SHS was the highest in Indonesia (9.8%). U5M attributable to the combination of solid fuel use and
SHS was the highest in Timor-Leste (22.7%).
CONCLUSIONS:The combined effect of exposure to solid fuel and SHS had a higher risk of U5M than
the individual risk. The use of clean fuel and tobacco control measures should be integrated with otherchild health promotion policies.

Keywords: household air pollution, solid fuel use, second-hand smoke, under-5 mortality, low- andlower-middle-income countries

OP-032[Birth and pregnancy outcomes » Birth outcomes]

The effect of geography, ambient air pollution
and seasonality on placental-related adverse
outcomes in regions of Mozambique, India, andPakistan
Liberty Makacha1, Prestige Tatenda Makanga3, Benjamin Barratt2, Jeffrey N Bone4, George Gs
Downward5, Rachel Craik1, Hiten D Misty1, Marianne Vidler4, Laura A Magee1, Ghillia Giulia1, Reason
Mlambo3, Esperança Sevene6, Khatia Munguambe6, Charfudin Sacoor6, Mrutynjaya B Bellad7,
Ashalata A Mallapur7, Shivaprasad S Goudar7, Rahat N Qureshi7, Zulfiqar A Bhutta8, Peter Von
Dadelszen1
1Department of Women and Children’s Health, School of Life Course and Population Sciences, Facultyof Life Sciences & Medicine, King’s College London, London, UK
2Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,

London. UK
3Place Alert Labs, Department of Surveying and Geomatics, Faculty of Science and Technology,

Midlands State University, Zimbabwe
4Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British

Columbia, Canada.
5Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology (EEPI),

Utrecht University, Utrecht, Netherlands; Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht, Netherlands
6Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique; Faculty of Medicine,

Eduardo Mondlane University, Maputo, Mozambique
7Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research,

Belgaum, Karnataka, India; S Nijalingappa Medical College and HSK Hospital and Research Centre,
Bagalkot, Karnataka, India
8Centre of Excellence, Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan;

Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada

BACKGROUND AND AIM:Ambient air pollution, precipitation, and temperature influence maternal
health outcomes. However, there is limited knowledge regarding the specificity of effect of these
exposures on placental-related outcomes. The study sought to understand the role of seasonalvariation in the effects of ambient air pollution, precipitation, and temperature on birth outcome
responses in the Community Level Interventions for Preeclampsia (CLIP) trials (Mozambique, India,
and Pakistan).
METHOD:This analysis used cross-linked CLIP health outcome data retrofitted to either openly sourced
or modelled average monthly exposure estimates. We employed spatio-temporal statistical analysis on
14,931, 25,786 and 28,685 de-identified pregnant women (2013 – 2018), with mappable residencesin Mozambique, India, and Pakistan respectively. Additional sensitivity analyses were performed
accounting for pre-pregnancy exposure effects.
RESULTS:Geographically consistent weak, but significant, seasonal environmental exposure effects onplacenta-related adverse maternal health were observed. Exposure-response relationships differedmostly in peak exposure effect timings. Cycles of exposure effects on health endpoints did not
perfectly follow defined meteorological seasons. Seasonal responses pre-pregnancy exhibited higher
effect responses compared with corresponding exposures during pregnancy.
CONCLUSIONS:Non-conformity of seasonality responses to defined meteorological patterns
emphasizes underestimated geographical influences on in-built physiologies. We challenge seasonality
definitions presented to date, as a static and time-bound response to wet and dry conditions.
Seasonality ought to be viewed through dynamic and spatially inclined lenses. Weak seasonal
responses reported potentially reflect data quality and/or spatial resolutions in openly sourced allpurpose repositories. Improving locational exposure characterization through personal monitoring willfurther the understanding of why locational differences exist in exposome geographies.

Keywords: seasonality of outcomes, spatial effect, environment, placenta-related maternity
outcomes.

OP-033[Birth and pregnancy outcomes » Pregnancy outcomes]

Reference Intervals for Clinical Biochemical
Tests and Hormones in Cord Blood from
Taiwanese Newborn - TMICS Cohort
Hui Ming Chen1, Chia Jung Hsieh2, Shu Li Wang3, Mei Lien Chen4, Ming Tsang Wu5
1Department of Family Medicine and Occupational Medicine, Kaohsiung Chang Gung Memorial

Hospital, Kaohsiung, Taiwan
2Department of Public Health, Tzu Chi University, Hualien, Taiwan
3National Environmental Health Research Center, National Institute of Environmental Health Sciences,

National Health Research Institutes, Miaoli, Taiwan
4Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan
5PhD Program in Environmental and Occupational Medicine and Research Center for Precision

Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Department of Family
Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

BACKGROUND AND AIM:Very few studies have established the reference intervals in cord blood. This
study aimed to create biochemical analyte reference levels for cord blood from newborns of Taiwan
Maternal and Infant Cohort Study participants (TMICS).
METHOD:2,136 pregnant women receiving regular routine prenatal health assessments in their third
trimester (weeks 29-40) were recruited from nine hospitals in Taiwan between October 2012 and May
2015. After exclusion, we were left with 580 cord blood samples to include in this study.
RESULTS:Cord blood thyroid-stimulating hormone was higher in males than females (p<0.05). Males
also had significantly higher sex hormone levels (estradiol, follicle-stimulating hormone, and sex
hormone-binding globulin), while females had higher levels of luteinizing hormone. Male newborns had
higher cord blood immunoglobulin E (IgE), while females had higher insulin-like growth factor-1 (IGF1) levels. We found a slight positive link between maternal blood and cord blood in thyroid hormonesand sex hormones.
CONCLUSIONS:This study found gender differences in cord blood thyroid hormone, sex hormone, IGF1, and IgE levels and a link between maternal blood levels of thyroid and sex hormones and those in
the cord blood of their infants. The establishment of reference values can be used as important pointsof reference for studies investigating the relationships between the concentrations of the analytes andhuman development in the clinic.

Keywords: Reference intervals, cord blood, hormones, sex differences, Taiwan Maternal and Infant
Cohort Study

OP-034[Chemical exposures » Heavy metals]

Postnatal Metal Exposure and Decreased Kidney
Function in Children – a 17 Years Followed Birth
Cohort Study
Tsung-Lin Tsai1, Chin-Chi Kuo2, Chien-Wen Sun1, Huei-Ju Liu1, Shu-Li Wang1
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2Big Data Center, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:The global burden of chronic kidney disease increased in past decades, andthe environmental factors may contribute significantly to the pathogenesis of chronic kidney disease.
The nephrotoxicity from exposure to metals had been reported in occupational population or generaladults, but the evidence for the long term and cumulative effects on young population remains lack.
Our purpose is to investigate the association between metal exposure and kidney function fromchildhood to adolescence.
METHOD:We studied 159 children from a mother-infant paired birth cohort by 6 follow-up interviewsand examinations at ages of approximately 2, 5, 8, 11, 14, and 17 years. The structural
questionnaires, blood and urinary specimens were collected from participants during follow-up periods.
We quantified the concentration of urinary chromium, nickel, arsenic, cadmium, thallium, and lead byinductively coupled plasma dynamic reaction cell mass spectrophotometry. The glomerular filtration
rate in children was estimated through the CKD-EPI40 equation with age-adjusted creatinine values,
and we also used age- and sex-dependent Schwartz Equations to validate our observation.
RESULTS:After adjustment for sex, household income, blood pressure and environmental tobaccosmoke at childhood in the model, increased urinary chromium significantly associated with declined
kidney function in children (β = -1.59, p < 0.01). Similarly, urinary arsenic, cadmium, thallium andlead had negative association with kidney function (β from -1.71 to -3.02). By using Schwartz
Equations for estimated kidney function, we observed similar results in exposure to chromium,arsenic, cadmium, thallium and lead (β from -0.94 to -2.91).
CONCLUSIONS:From this birth cohort study, we observed childhood and adolescence exposure tometals may associate with declined kidney function, and this scenario may have sex difference. Future
work is needed to consider the co-exposure of potentially nephrotoxicity chemicals.

Keywords: Children's environmental health, Environmental epidemiology, Heavy metals, Long-term
exposureOP-035[Respiratory and allergic outcomes » Asthma]

Interdiary Temperature Variation and Children
Asthma Cases in Lima, Peru, 2010-2016
Diego Fano Sizgorich1, José Chauca2, William Checkley3, Stella Hartinger4
1Laboratory of Endocrinology and Reproduction, Facultad de Ciencias y Filosofía, Universidad Peruana

Cayetano Heredia, Lima, Peru; Centro Latinoamericano de Excelencia en Cambio Climático y Salud,
Universidad Peruana Cayetano Heredia, Lima, Peru
2Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia,

Lima, Peru
3Department of International Health, Bloomberg School of Public Health, Johns Hopkins University,

Baltimore, Maryland, USA
4Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru;

Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano
Heredia, Lima, Peru

BACKGROUND AND AIM:Asthma is the most prevalent respiratory disease in children under 5-yearsold. Although its etiology is not known, ambient temperature has been associated with the appearanceof cases, specially low temperatures. Nonetheless, short term variations, such as inter-day
temperature variation may trigger asthma episodes due to alterations in the airway tissue. For thisreason, the aim of the study was to evaluate the association between inter-day temperature variation
or nocturnal temperature range in children daily asthma cases in Lima from 2010-2016.
METHOD:Ecological panel time series study in which daily asthma cases for children <5-years-old forthe different districts of Lima were obtained from Peru’s CDC. Daily mean (Tprom), maximum (Tmax)
and minimum (Tmin) temperature, and relative humidity were downloaded from NASA POWER
platform (grid resolution 0.5° x 0.625°). Inter-day variation or Nocturnal Temperature Range (NTR)
was calculated as the difference between present-day Tmin and previous-day Tmax (Tminn-Tmaxn-1).
Seasonal ARIMA models were evaluated for the ambient variables. General Linear Mixed Models ofnegative binomial family were employed to evaluate the association between asthma daily cases andNTR at lag 0-7 days. Additionally, Tprom was evaluated as an interaction factor to assess if the effectof NTR is modified.
RESULTS:Nocturnal Temperature Range increased the risk of daily asthma cases in 3% for every
increase of 1°C (aRR 1.03, 95%CI 1.02 – 1.04, p<0.001) at lag 0. This association was also found forlags 1 – 7, being higher for lags 2 and 6 with an aRR=1.05 (95% CI 1.04 – 1.06 and 1.05 – 1.06,
respectively). Mean daily temperature was not found to be an effect modifier in the association.
CONCLUSIONS:A higher drop of temperature during the night increases the number of asthma casesin children under 5-years-old. The mechanism of this, such as inflammation of respiratory tissue
should be further explored.

Keywords: Asthma, Temperature variability, Children's environmental healthOP-036[Climate » Temperature]

Asthma hospitalisations and heat exposure in
England: A case-crossover study during 20022019
Garyfallos Konstantinoudis1, Cosetta Milnelli2, Holly Ching Yu Lam3, Elaine Fuertes2, Joan Ballester4,
Bethan Davies5, Ana Maria Vicedo Cabrera6, Antonio Gasparrini7, Marta Blangiardo1
1MRC Centre for Environment and Health, Imperial College London, UK
2National Heart and Lung Institute, Imperial College London, London, United Kingdom
3UK Health Security Agency, UK
4Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona,Spain
5UK Small Area Health Statistics Unit, Imperial College London, London, UK
6Institute of Social and Preventive Medicine, University of Bern, Switzerland
7Department of Public Health Environments and Society, London School of Hygiene Tropical Medicine,

London, UK

BACKGROUND AND AIM:Previous studies have reported evidence of an association between heat
exposure and asthma hospitalisation. The focus has been on sex- and age-related vulnerabilities,
nevertheless little is known about how this effect has changed over time and how it varies in space. In
this nationwide study in England, we aim to estimate the effect of temperature on asthma hospital
admissions and investigate vulnerabilities by age, sex, time, and space.
METHOD:Individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial(postcodes) resolution during 2002-2019 in England was available from NHS Digital. The main
exposure was defined as mean temperature over the 0-3 days lag and was retrieved at 1km x 1km
resolution from the UK Met Office. We fitted Bayesian hierarchal Poisson models within a case-crossover study design and accounted for possible confounders including rainfall, relative humidity, windspeed and national holidays.
RESULTS:We report an increase of 1.13 (95% Credible Interval: 0.92% to 1.34%) and 1.11% (0.88%
to 1.34%) in the asthma hospitalisation risk for every 1oC increase in the ambient summer
temperature in the unadjusted and fully adjusted models respectively. The effect was highest formales aged 16-64 (2.10%, 1.59% to 2.61%). We found evidence of a decreasing linear trend of theeffect over time. Populations in Yorkshire and the Humber and East and West Midlands were the mostvulnerable.
CONCLUSIONS:This study provides evidence of an association between warm temperature andhospital admission for asthma. The effect has decreased over time with potential explanations
including temporal differences in patterns of heat exposure, adaptive mechanisms, asthma
management, lifestyle, comorbidities, and occupation.

Keywords: temperature, asthma, hospital admissions, extreme heatOP-037[Climate » Temperature]

Health risks of temperature variability on
hospital admissions in Cape Town, 2011-2016
Malebo Makunyane1, Hannes Rautenbach3, Neville Sweijd4, Joel Botai2, Janine Wichmann1
1School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa2South African Weather Service, Pretoria, South Africa
3Faculty of Natural Sciences, Akademia, Pretoria, South Africa
4Applied Centre for Climate and Earth Systems Science, Council for Scientific and Industrial Research,

Cape Town, South Africa

BACKGROUND AND AIM:In developed countries, epidemiological studies provided evidence of
associations between temperature variability (TV) and health outcomes. However, such studies arelacking in developing countries. This study aimed to investigate the association between TV andhospital admissions for cardiovascular diseases (CVD) and respiratory diseases (RD) in Cape Town,
South Africa.
METHOD:Daily counts of CVD and RD hospitalisation data (1 January 2011 to 31 October 2016) wereobtained from seven hospitals. Hourly temperature, relative humidity and air pollution data weresourced from the South African Weather Service. A time-series epidemiological study design wasapplied along with quasi-Poisson regression models, which adjusted for seasonal trends, daily mean
temperature, relative humidity and air pollution. TV is calculated as a composite of intraday and interday variability using the minimum and maximum temperatures. Lag0-1 to lag0-7 of TV were
investigated as well as vulnerability by age (all ages combined, 0-14 years, 15-64 years, and ≥65
years) and sex.
RESULTS:For the entire study group, the highest increase in CVD hospitalisations (2.84% 95% CI:
1.44% to 4.27%) was observed at 0-5 exposure days and at 0-1 days for RD hospitalisations (2.79%
95% CI: 1.44% to 4.17%). The elderly and the 15-64 year old group were more at risk for RD and
CVD hospitalisation, respectively. Men were more at risk for RD and CVD disease hospitalisation thanfemales.
CONCLUSIONS:The results indicate that more attention should be paid to the effects of TV and change
on human health in Cape Town. Furthermore, different weather and climate metrics, such as TV,
should be considered in understanding the climate component of the epidemiology of these (and otherdiseases), especially in the light of climate change, where a wider range and extreme climate eventsare expected to occur in future.

Keywords: Health risks, temperature variability, hospital admissions, South Africa

OP-038[Omics technologies » Epigenomics]

Ambient Temperature and Heat Index Exposuresin Relation to Epigenetic Aging among
Participants in Taiwan Biobank
Kuan Chih Chiu1, Yen Tsung Huang2, Chen Yu Liu1
1Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
2Institute of Statistical Science, Academia Sinica, Taipei, Taiwan & Department of Mathematics,

College of Science, National Taiwan University, Taipei, Taiwan & Institute of Epidemiology andPreventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Due to climate change, many people, including people in Taiwan, have been
exposed to increasing ambient temperature and decreasing temperature variations. Increasing
ambient temperature has been reported to link with biological aging in a prenatal study. However,
little is known about how biological age in the general adult population was affected by high ambient
temperature. DNA methylation age was developed to evaluate biological aging. We aimed toinvestigate the effects of ambient temperature, heat index (HI), and diurnal temperature range (DTR)
in relation to DNA methylation age acceleration in Taiwan Biobank, a general adult population in
Taiwan.
METHOD:This study included 2,084 participants recruited in Taiwan from 2008 to 2016. Meteorological
data were obtained from Taiwan’s Central Weather Bureau. Ordinary kriging was used to estimate
individual exposures. Moving averages were calculated from 1 to 365 days before enrollments. The
Horvath, Hannum, Weidner, ELOVL2, FHL2, and phenotypic DNA methylation age were computed fromblood genome-wide DNA methylation profiles measured by Infinium MethylationEPIC BeadChip. Age
acceleration was the difference between DNA methylation age and chronological age. We used
multivariable linear regression model to study age acceleration in relation to ambient temperature, HI,
and DTR exposures in multiple exposure windows.
RESULTS:Exposure to high ambient temperature and high HI in the 90- and 180-day exposure
windows were associated with a 21 to 38 days increase in age acceleration, whereas low DTR was
associated with a 92 to 230 days increase in age acceleration. Increasing days of extreme
temperature were also associated with increased age accelerations.
CONCLUSIONS:Climate change could accelerate biological aging. Accompanying the effects of globalwise population aging trends and urban warming, the threats of climate change to human health may
exacerbate in the future.
Taiwan's Ministry of Education and Ministry of Science and Technology supported this work.

Keywords: Environmental epidemiology, Climate, TemperatureOP-039[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Air pollution, temperature, and social stressors
in pediatric seizures and epilepsy: A Structural
Equation Modeling approach
Rachit Sharma1, David Gefen2, Perry E Sheffield3, Jane E Clougherty11Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel

University, Philadelphia, PA, USA
2Department of Decision Sciences and MIS, LeBow College of Business, Drexel University,

Philadelphia, PA, USA
3Department of Environmental Medicine and Public Health, and Pediatrics, Icahn School of Medicine atMount Sinai, New York, NY, USA

BACKGROUND AND AIM:Air pollution, temperature, and social stressors are linked to multiple
neurological disorders, but research on seizures and epilepsy is scarce. Using covariance-based
structural equation modeling (CBSEM), we examined the effects of multiple pollutants, temperature,and social stressors on seizures and epilepsy among children (0-4 years) in New York City.
METHOD:Data on seizure and epilepsy cases (n = 28,385), presented at NYC emergency departments(EDs) from 2005 to 2011 were obtained from New York Statewide Planning and Research Cooperative
System. Age-standardized annual ED visit rates were assigned to each census tract. Tract-level annual
average concentrations of PM2.5, NO2, SO2, O3, and minimum temperature (Tmin) were assigned
using NYC Community Air Survey spatial data and U.S. EPA and NOAA temporal data. Point-level NYPD
crime data were aggregated to create tract-level annual average rates. Tract-level American
Community Survey (ACS) 2007-11 estimates of percent poverty, percent not graduated from highschool, percent unemployed, median household income, and percent population Hispanic and nonHispanic Black were assigned. ‘Chronic stress’ reflected by crime and ACS indicators was modeled as alatent construct in exploratory and confirmatory factor analyses. Pollutants, temperature, and ‘chronic
stress’ were then fitted in a CBSEM as potential predictors of ED visit rates under maximum likelihood
estimation.
RESULTS:While PM2.5 was positively associated with ED visit rates [path coefficient = 0.128 (95% CI:
0.069, 0.186)], NO2 was negatively associated [-0.342 (-0.402, -0.283)], and SO2, O3, and Tmin
effects were statistically insignificant. Positive association was also observed with ‘chronic stress’[0.464 (0.423, 0.505)], with violent crime and felony assault rates explaining most variability [factor
loadings = 0.852 and 0.844, respectively]. Also, PM2.5 was positively associated with ‘chronic stress’,
and percent population Hispanic.
CONCLUSIONS:Chronic stress, particularly from neighborhood crime, and PM2.5 exposures may be
associated with pediatric seizure and epilepsy risk.

Keywords: Air pollution, Temperature, Non-chemical stressors, Children's environmental health,Environmental epidemiology

OP-040[Climate » Temperature]

Short-term association between ambient
temperature and renal disease mortality inJapan from 1979 to 2019: a time-stratified
case-crossover analysis
Zin Wai Htay1, Chris Fook Sheng Ng1, Yoonhee Kim2, Youn Hee Lim3, Masao Iwagami4, Masahiro
Hashizume1
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo
2Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo
3Section of Environmental Epidemiology, Department of Public Health, University of Copenhagen
4Department of Health Services Research, University of Tsukuba

BACKGROUND AND AIM:Renal diseases are sensitive to extreme ambient temperatures. However,existing findings on the association between renal disease-related mortality and temperature were
mostly limited to the summer season. Changes of this association over time are also not wellunderstood. This study aims to examine the association between daily temperatures and renal diseasemortality in 47 prefectures of Japan from 1979 to 2019.
METHOD:We collected daily average temperature and mortality due to renal diseases (ICD-10: N00N39), acute renal injury (N17) and chronic renal diseases (N18). A two-stage analysis based on atime-stratified case-crossover study design was performed. First, we applied a distributed lag
nonlinear model with quasi-Poisson regression to examine the associations between daily mortality
and temperature in each prefecture. Meta-analytical approach was used to combine the estimatedassociations across prefectures. Heat and cold effects were defined as the risk of mortality at 97.5th
and 2.5th percentiles of mean temperature compared to the risk at the minimum mortality
temperature percentile. We conducted additional analyses stratified by subperiods(1979-1988 and2009-2018), sex and age groups(0-64,65-84,and ≥85 years).
RESULTS:We analyzed a total of 997,590 renal deaths over 41 years period in Japan. Low
temperatures were associated with mortality due to renal diseases with a relative risk(RR) of 1.34
(95% CI 1.29-1.40). A similar association was observed for chronic renal disease [RR=1.33(95% CI
1.24-1.43)], and acute renal injury [RR=1.51(95% CI 1.33-1.71)]. Subperiod analysis showed thatrisks for high temperatures declined over time for mortality due to all renal and chronic renal disease.
Similar cold risk was observed for all subgroups except for the 0-64 age groups.
CONCLUSIONS:Low temperatures may increase the risk of mortality attributable to renal diseases andchronic kidney disease, and the underlying mechanism requires further investigation. The attenuationof risk associated with high temperatures may imply population gradual adaption to heat.

Keywords: Mortality, Outcomes, Temperature, Temperature extremesOP-043[Climate » Temperature]

The association between prenatal and postnatal
ambient temperature and rapid infant weight
gain: a population-based cohort study
Neora Alterman1, Iaroslav Youssim1, Daniel Nevo2, Bar Weinstein2, Ronit Calderon Margalit1, Itai
Kloog3, Michael Hauzer4, Raanan Raz1
1Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem –Hadassah, Jerusalem, Israel
2Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
3Department of Geography and Environmental Development, Ben- Gurion University of the Negev,

Beer-Sheva, Israel
4Bonen Clinic, Haifa & Western Galilee District, Clalit Health Services Community Division, Haifa, Israel

BACKGROUND AND AIM:Rapid weight gain during infancy is a risk factor for childhood overweight.
Studies have associated prenatal ambient temperature exposure with birthweight and we havepreviously described an association between ambient temperature during the first year of life andrapid infant weight gain. We aimed to assess the association between prenatal and postnatal ambient
temperature and rapid weight gain in infants.
METHOD:Using data from the Israeli network of maternal and child health clinics, we conducted apopulation-based cohort study that includes 986,088 infants born at term with birthweight ≥2.5 kg in
2011-2019. We assessed residential weekly mean ambient temperature during pregnancy and the first
four postnatal weeks using a high-resolution hybrid spatio-temporal model. Weight gain velocity
during infancy was modelled using the SuperImposition by Translation and Rotation (SITAR) method,a mixed-effects nonlinear model specialized for modelling growth curves. Rapid weight gain was
defined as the highest tertile of weight gain velocity. We used distributed lag nonlinear models withmodified Poisson regression to measure relative risks and 95% confidence intervals. Adjustments weremade for socioeconomic status, population group, subdistrict, month and year of birth, and thealternate exposure period – prenatal or postnatal.
RESULTS:We found a positive association between ambient temperature exposure during pregnancy
or postnatally and rapid weight gain in infants. Compared with the lowest mean weekly ambient
temperature quintile (0.03-15.32°C), exposure to the highest quintile (26.68-37.90°C) throughout theentire pregnancy was associated with a cumulative adjusted relative risk of 1.38 (95% CI 1.30-1.47)
for rapid weight gain. The same exposure during the first four postnatal weeks was associated with acumulative adjusted relative risk of 1.17 (95% CI 1.13-1.21) for the highest quintile compared withthe lowest.
CONCLUSIONS:Prenatal or early postnatal exposure to higher ambient temperature are eachindependently associated with rapid weight gain in Israeli infants.

Keywords: ambient temperature, infant growth, obesity, overweightOP-044[Air pollution » Particle components]

Prenatal exposure to PM2.5 constituents andweight growth trajectory from in utero to 3
years: a birth cohort study
Shuang Zhou1, Tiantian Li2, Na Han3, Jinlang Lyu1, Shiyu Yan1, Zhihan Yue1, Jianlin Hu4, Ting Liu4,
Haijun Wang1
1Department of Maternal and Child Health, School of Public Health, Peking University, National HealthCommission Key Laboratory of Reproductive Health, Beijing, 100191, China
2China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental

Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
3Tongzhou Maternal and Child Health Care Hospital of Beijing, 101101, China
4Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative

Innovation Center of Atmospheric Environment and Equipment Technology, Nanjing University ofInformation Science & Technology, Nanjing 210044, China

BACKGROUND AND AIM:This study aimed to examine the associations of prenatal exposure to PM2.5
constituents and weight growth trajectory from in utero to three years.
METHOD:The study was embedded in a birth cohort in China, including 16372 mother-child pairs.
Prenatal PM2.5 and its constituents' [organic carbon(OC), elementary carbon(EC), ammonium(NH4+),
nitrate(NO3-), and sulfate(SO42-)] concentrations were estimated based on maternal residential
addresses. Head circumference, abdominal circumference, and femur length were measured byultrasound examinations at 20-24, 29-32, and 37-41 gestational weeks, and estimated fetal weight(EFW) was calculated according to these indicators. Newborn’s birthweight and children’s weight at theage of 6 months, 1, 2, and 3 years were measured. Latent class growth modeling was used to identify
weight Z-score growth trajectory from in utero to 3 years. Multinomial logistic regression was used to
examine the associations of prenatal exposure to PM2.5 constituents with weight Z-score growthtrajectories.
RESULTS:Three weight Z-score growth trajectories were identified: normal growth trajectory (26.6%
and 17.7% in boys and girls, respectively), faster growth trajectory (63.0% and 66.7%), andaccelerated growth trajectory (10.4% and 15.6%). Compared with normal growth trajectory, aninterquartile range (IQR) increase in prenatal exposure to PM2.5, OC, EC, NH4+, and SO42- wasassociated with 1.135 (95%CI:1.050-1.228), 1.239 (95%CI:1.080-1.421), 1.199 (95%CI:1.0861.324), 1.105 (95%CI:1.035-1.179), and 1.319 (95%CI:1.138-1.529) times higher risk of faster
growth trajectory, respectively. Prenatal exposure to PM2.5, OC, EC, NH4+, NO3-, and SO42- wasalso associated with higher risk of accelerated growth trajectory. The results were robust in sensitivity
analysis with inverse probability weighting and excluding preterm birth.
CONCLUSIONS:The study suggested that prenatal exposure to PM2.5 and its constituents was
associated with higher risk of faster and accelerated growth trajectory from in utero to 3 years. Publichealth policy on regulation of harmful PM2.5 constituents should be developed to protect lifelong
health,Keywords: Particle components,Birth outcomes,Public health,Environmental epidemiology

OP-045[Air pollution » Wildfires]

Association of stillbirths and preterm birth withwildfire-specific PM2.5 in Sydney, Australia
between 2006 and 2020
Tanya Singh1, Donna Lisa Green1, Edward Jegasothy2, Joseph Van Buskirk3
1Climate Change Research Centre, University of New South Wales, Sydney, Australia
2Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown,

Australia & University Centre for Rural Health, Faculty of Medicine and Health, University of Sydney,
Lismore, Australia & The Centre for Air Pollution, Energy and Health Research (CAR), Glebe, Australia
3Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown,

Australia & Sydney Local Health District, NSW Health, Camperdown, Australia

BACKGROUND AND AIM:Exposure to fine particulate matter of less than 2.5 μm (PM2.5) has been
associated with a higher rate of stillbirth and preterm birth. PM2.5 from wildfires may have different
toxicological effects than non-wildfire PM2.5, and the specific effects of wildfire smoke on birthoutcomes are not well understood. We conducted a study in Greater Metropolitan Sydney, Australia(2006-2020) to assess the association between wildfire-specific PM2.5 rates of stillbirth andspontaneous preterm birth. Both overall exposure and trimester-specific exposure periods were
evaluated to identify potential sensitive periods.
METHOD:Daily PM2.5 concentrations were estimated using inverse-distance weighting from monitoring
station readings. Wildfire days were identified using visual identification via satellite imagery of
extreme days (PM2.5 at or above the 95th percentile). Seasonal trend loess decomposition was used
to identify ‘excess’ expected PM2.5 concentrations deemed to be wildfire-specific PM2.5. Cox
proportional hazards models were used to estimate the effects of wildfire-specific PM2.5 exposure on
stillbirths and preterm births, controlling for potential confounders.
RESULTS:A total of 993,846 births were analysed. Median exposure to wildfire PM2.5 throughout
pregnancy was 0.13 μg/m (interquartile range: 0.04 - 0.31 μg/m3). A one unit μg/m3 increase inwildfire-specific PM2.5 was associated with 2.1% (HR: 1.021, 95% CI: 0.979–1.064) increased risk ofstillbirth and 0.2% (HR: 1.002, 95% CI: 0.983–1.022) higher risk of preterm birth. Higher exposure
during the first and third trimesters was associated with a higher stillbirth hazard (HR: 1.042, 95% CI:
1.006 –1.080 and HR: 1.047, 95% CI: 1.02–1.075, respectively). For preterm births no trimesterspecific effect was identified.
CONCLUSIONS:Wildfire-specific PM2.5 exposure during the first and third trimesters was associatedwith an increased risk of stillbirth. Our findings emphasize the importance of studying potential
sensitive periods of exposure. Considering the increasing frequency and intensity of wildfires globally,
greater attention should be paid to pregnant women as a vulnerable subpopulation.

Keywords: birth outcomes, particulate matter, survival

OP-046[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Prenatal Exposure to Toxic Air Contaminants andthe Risk for Cerebral Palsy
Haoran Zhuo1, Beate Ritz2, Zeyan Liew1
1Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA.
2Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles(UCLA), Los Angeles, USA.

BACKGROUND AND AIM:Cerebral palsy (CP) is the most common neuromotor disorder in childhoodand the causes for most CP cases are unknown. Environmental neurotoxicants, including toxic air
contaminants (TACs), can affect fetal neurodevelopment. We conducted a statewide study in California
to investigate whether prenatal exposure to TACs is associated with CP in childhood.
METHOD:We performed a case-cohort study of 799 CP cases and 147,820 controls selected among
singleton births with geocoded maternal residential addresses located within a 5-mile radius around a
TACs monitoring station in California. CP diagnostic records were ascertained from the Department ofDevelopmental Services. We focus on 30 TACs (19 volatile organic compounds (VOCs) and 11 metals)
selected a priori using the EPA ToxCast. We estimated the Risk Ratio (RR and 95% CI) for CP
according to pregnancy- and trimester-averaged exposures to each TAC, adjusting for maternal socioeconomic measures. We used 36-48 months after delivery as a “negative control exposure” period toevaluate uncontrolled confounding. We utilized the quantile-based g-computation to estimate themixture effects of multiple VOCs or metals.
RESULTS:Per interquartile-range increase of the ambient exposure level of four VOCs (acetaldehyde,
acetone, styrene, trichloroethylene) and four metals (antimony, iron, lead, manganese) during
pregnancy were associated with 8-19% higher risk for CP. The estimated joint effects from prenatal
exposure to the four VOCs as a mixture and CP was RR=1.21, 95% CI: 1.11-1.37, and the four metals
RR=1.31, 95% CI: 1.17-1.47. Stronger associations were observed for exposure in the first andsecond trimesters. No associations were found for VOCs and metals exposures in the negative control
period suggesting limited evidence for uncontrolled confounding bias.
CONCLUSIONS:Prenatal exposures to VOCs and metals from ambient air pollutants were associatedwith CP risk in California. Toxic air pollutants may be a novel environmental risk factor for CP that
requires further scrutiny.

Keywords: Air pollution, Neurodevelopmental outcomes, Causal inference, Chemical exposures,
Mixtures analysis

OP-047[Air pollution » Particulate matter]

Forecasting Particulate Matter (PM10) Using
Machine Learning Algorithms in Agadir
Anass Houdou1, Kenza Khomsi2, Radouane Leghrib3, Imad El Badisy4, Sammila Andrade Abdala1,
Azeddine Ibrahimi5, Mohamed Khalis6
1Department of Epidemiology and Health Data Sciences, Mohammed VI Center for Research &Innovation Rabat, Morocco; International School of Public Health, Mohammed VI University of
Sciences and Health, Casablanca, Morocco
2Directorate General of Meteorology, Mohammed VI University of Sciences and Health, Casablanca,

Morocco3Laboratory MatSim, Faculty of Sciences, University Ibn Zohr, Agadir, Morocco
4Department of Epidemiology and Health Data Sciences, Mohammed VI Center for Research &Innovation Rabat, Morocco; Inserm UMR912 Sciences Economiques & Sociales de la Santé &Traitement de l’Information Médicale (SESSTIM), Marseille, France
5Mohammed VI Center for Research & Innovation, Rabat, Morocco
6Department of Epidemiology and Health Data Sciences, Mohammed VI Center for Research &Innovation Rabat, Morocco; International School of Public Health, Mohammed VI University of
Sciences and Health, Casablanca, Morocco; Higher Institute of Nursing Professions and Technical
Health, Rabat, Morocco

BACKGROUND AND AIM:This study aims to develop a machine learning model to forecast PM10
concentrations in the city of Agadir, Morocco.
METHOD:Long short-term memory (LSTM) neural networks, decision tree, and random forest models
were used to forecast PM10 pollution levels for the next time step. LSTM was based on data from 5
previous time steps and decision tree/random forest were based on data from 1 previous time step.
Meteorological conditions such as temperature, wind components, and other atmosphericcompositions, including PM2.5, were selected as predictors based on the decision tree and random
forest models. The models were trained on data from 2015 to 2019 and tested on data from 2020.
RESULTS:The LSTM model outperformed traditional models with a mean absolute error (MAE) of
0.0003 μg/m3, while random forest and decision tree achieved MAEs of 0.0023 μg/m3 and 0.0032
μg/m3, respectively, on PM10 concentrations in Agadir, with an average of 0.021845 μg/m3.
CONCLUSIONS:Using past data is important for accurate PM10 forecasting with LSTM models, which
can help policymakers take actions to reduce air pollution and protect public health in cities like Agadir
and other urban areas.

Keywords: big data, modelingOP-048[Air pollution » Traffic-related]

Identifying moving vehicles in global cities forenvironmental applications using highresolution satellite imagery and deep learning
Annalisa Sheehan, Andrew Beddows, David Green, Sean Beevers
Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,
London, United Kingdom

BACKGROUND AND AIM:The global impact of vehicle emissions on air quality, health and climate areconsiderable, yet traffic data are at best fragmented and at worst non-existent. Therefore, there is anurgent need for a common approach to developing large urban traffic datasets. We aimed to quantify
vehicle flow and speed on each road in Barcelona, Spain, using high-resolution satellite imagery andDeep Learning (DL).
METHOD:We trained a DL object detection algorithm (You Only Look Once version 3) to identify
vehicles, road by road, in Barcelona (2017-2019), based on high-resolution WorldView-2/-3 satellite
imagery (50 cm). Additionally, we developed a novel geospatial method to estimate vehicle speed
from satellite images by exploiting the fraction of a second gap between each image capture from the
8 multi-spectral sensors on board the WorldView-2/-3 satellites.
RESULTS:Our best performing vehicle detection model had a precision (percentage of model
detections that are correct) of 71% and a recall (percentage of vehicles in the image scene identified
by the model) of 72%. The model detected 601,450 vehicles in 10 satellite images across Barcelona,with estimated average speeds of 7km/h on residential roads and 77km/h on motorways. The
validation between satellite-vehicle speed estimates and Google Directions API showed good
agreement (NMB: 0.1, NMGE: 0.2). The validation between satellite-vehicle flow and traffic counters
showed that the satellite method is predicting correct vehicle flow across Barcelona, however there isa lot of variability road by road (NMB: 0.03, NMGE: 0.49).
CONCLUSIONS:High-resolution satellite imagery can be used in object detection to identify vehicles on
all roads in cities and vehicle speed can be calculated from satellite multi-spectral sensors. Thisdataset can be linked to emissions and air pollution models to provide an important dataset for
epidemiologists, especially in LMICs where traffic counts and local air pollution measurement islimited.

Keywords: air pollution, exposure assessment-air pollution, big dataOP-049[Exposure assessment methods » Spatial statistics]

Machine learning and GIS-based spatial analysis
of cardiovascular disease in South Korea
Eunjin Kang, Dongjin Cho, Siwoo Lee, Jungho Im
Department of Urban & Environmental Engineering, Ulsan National Institute of Science andTechnology, Ulsan, South Korea

BACKGROUND AND AIM:Cardiovascular diseases (CVD) are the leading cause of mortality worldwide,
according to the World Health Organization. Thus, it is essential to manage CVD using various factors
including air pollution, extreme meteorological conditions, and socioeconomic vulnerability, but it isvery difficult as the factors are intricately related to CVD. To solve such a problem, machine learning(ML) can be effective as it can address the nonlinear relationship between multiple data. Recent CVD
analysis studies have been conducted using ML techniques at an individual level. However, few studies
have been conducted at a neighborhood level, helping identify regional risk factors for CVD. Therefore,
this study aimed to examine the relationship between CVD mortality and neighborhood-level factors,
including air pollution, weather conditions, and sociodemographic factors, based on ML algorithms inSouth Korea.
METHOD:Spatial analysis was performed using municipal-level data averaged from 2010 to 2019.
Regression-based model (i.e., ElasticNet) and tree-based models (i.e., random forest (RF) and light
gradient boosting model (LGBM)) were applied to examine the relationship. A recent explainable AI
technique, Shapley Additive exPlanations (SHAP), was adopted to analyze the contributions andinteractions of factors in the LGBM.
RESULTS:Nested five-fold cross-validation results showed that tree-based models outperformed the
ElasticNet, with a correlation coefficient of 0.85 and an index of agreement of 0.9. The spatial
distribution of the LGBM-derived CVD mortality estimated extreme values well, indicating that LGBM
was able to simulate hotspots much better than RF. In SHAP analysis, socio-demographic factors
mainly contributed to estimating the high CVD mortality, indicating that CVD mortality is significantly
affected by social vulnerability compared to air pollutants. In addition, the larger the daily
temperature difference and the larger the SO2 concentrations, the higher the estimated mortality.
CONCLUSIONS:This ML-based spatial analysis can potentially assist public health decision-makers inestablishing CVD-related initiatives considering latent regional risk factors.

Keywords: Big data, Cardiovascular diseases, Spatial statistics, Socio-economic factors, Air pollution

OP-050[Air pollution » Other (to be specified with keywords in the keywords section)]

Ozone forecasting based on new powerful hybrid
models: CHIMERE-NARX & CHIMERE-NARX-DWT
Leghrib Radouane1, Khomsi Kenza2, Khomsi Kenza3
1Laboratory MatSim, Faculty of Sciences, University Ibnou Zohr, Agadir, Morocco
2General Directorate of Meteorology, Casablanca, Morocco
3Mohamed 6 University for Health Sciences, Casablanca, Morocco

BACKGROUND AND AIM:Taking into account the limitations from which suffers the dynamic air quality
modelling, two hybrid models based on CHIMERE-NARX and CHIMERE-NARX-DWT were built.
METHOD:two hybrid models based on CHIMERE-NARX and CHIMERE-NARX-DWT were built andvalidated by observation from collected from the Mediouna station in Casablanca, Morocco, fromFebruary 1st to March 27th 2021.
RESULTS:As result, ﬁrst hybrid successfully increased the correlation coeﬃcient from 88 to 93% andreduced RMSE from 23.99 μg/m3 to −3.54 μg/m3. The second hybrid successfully balanced theweight of NARX at night against the day, increasing the correlation coeﬃcient to 98% and decreasing
RMSE to −0.02 μg/m3.
CONCLUSIONS:This study presents a new generation of post-processing based on deterministic model
processes.

Keywords: CHIMERE model, machine learning, hybrid models, Ozone prediction, North Africa

OP-051[Air pollution » Particulate matter]

Machine Learning versus Land Use Regression:
Fine-scale spatial predictions of on-road air
pollution levels in Bengaluru, India
Srishti Srishti1, Adithi R Upadhya2, Vinod Solomon2, Pratyush Agrawal1, Padmavati Kulkarni1, Mahesh
Kalashetty1, Meenakshi Kushwaha2, Pratima Singh1, Sreekanth Vakacherla1
1Center for Study of Science Technology and Policy, Bengaluru, India
2ILK Labs, Bengaluru, India

BACKGROUND AND AIM:Land Use Regression (LUR) is a well-established methodology that uses land
use parameters to predict fine spatial scale long-term average pollution levels. With the recent
advancements in AI, machine learning models are being applied to make air pollution predictions. The
aim of this study is to develop a classical linear model LUR (LM-LUR) and compare its performanceagainst RF-based model’s performance in predicting on-road air pollution levels, using the same
predictors for both models.
METHOD:The on-road air pollution data was collected using a mobile monitoring approach in
Bengaluru, India. The pollutants include the mass concentration of PM2.5, black carbon (BC) andultrafine particles (UFPs). We collected the on-road pollution data covering a distance of ~400
kilometers, between November 2021 and June 2022. The route consists of a variety of road classes
with 12 repeat measurements. After applying the corresponding correction factors, a grid-wise (50meter length) aggregation was made, and the central tendencies were estimated. Around 8000
gridded on-road concentrations were available for the model training.
For LM-LUR modeling, the European Study of Cohorts for Air Pollution Effects (ESCAPE) methodology
was followed. For RF-LUR, hyperparameter tuning was performed using a grid-search approach. The
model performances were evaluated based on the hold-out validation method and quantified using the
Root Mean Square Error (RMSE) and Normalized RMSE (NRMSE) of the test data set.
RESULTS:RF-LUR model showed better performance for all the pollutants compared to LM-LUR model.
An improvement of ~25 to 40% was observed in the RF-LUR test data NRMSE values. The
performance of RF-LUR was further quantified based on various configurations of hold-out validation
exercises.
CONCLUSIONS:The study shows that RF-LUR outperforms LM-LUR in predicting on-road air pollution
levels using the same predictors for both models. The findings highlight the potential of using machinelearning models for air pollution predictions.

Keywords: Traffic-related, Particle components, ModelingOP-052[Air pollution » Particulate matter]

Estimation of daily PM2.5 in Korea during 20152020 with a high spatial resolution random
forest model
Seoyeong Ahn1, Ayoung Kim2, Cinoo Kang2, Aims Create Team3, Whanhee Lee1
1School of Biomedical Convergence Engineering, Pusan National University, Busan, South Korea
2Graduate School of Public Health, Seoul National University, Seoul, South Korea
3Aims Create TeamBACKGROUND AND AIM:Estimating daily series of PM2.5 concentrations with high spatial resolution isimportant to assess the health effects associated with exposure to PM2.5. Despite its importance,
there are no studies developing machine learning models to estimate daily PM2.5 with a high spatial
resolution.
METHOD:This study used a machine learning model based on random forest algorithm to estimate
daily PM2.5 at a resolution of 1 km × 1 km across the contiguous Korea. The model included multiple
predictors inclusive of satellite data, meteorological variables, land-use variables, and others.
RESULTS:Total number of monitoring stations for PM2.5 were 471 during the period 2015-2020. In
the total areas, the random forest model showed a R2 of 0.857, RMSE of 5.544, and MAE of 3.886 fortrain/valid/test split dataset over the whole study period.
CONCLUSIONS:This study provides the high-resolution daily PM2.5 prediction estimates with excellent
performance. Our models can be used to evaluate the more precise health impacts of PM2.5.

Keywords: PM2.5, High spatial resolution, Machine learning model, Republic of Korea

OP-053[Exposure assessment methods » Exposure assessment-air pollution]

Comparisons of land-use regression withmachine learning and microenvironmental
exposure models for short-term exposure
estimates of PM2.5
Yu Cheng Chen1, Wei Ting Hsu1, Chih Da Wu2
1National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan

BACKGROUND AND AIM:Air pollution is a major public health concern worldwide, with PM2.5 being
one of the most harmful pollutants. The land use regression with machine learning (LUR_ML) andmicroenvironmental exposure (ME) models have been used to estimate PM2.5 exposure, but theirperformance in population-based studies is not well-understood. We conducted a study in Taiwan tocompare the predictive performance of LUR_ML and ME models.
METHOD:We collected PM2.5 personal sampling and microenvironmental measurements for 53 elderly
volunteers across four regions (including urban, sururban, rural, and industrial sites) of Taiwan overfour seasons (2016-2018). We used LUR_ML and ME models to estimate daily PM2.5 exposure
concentrations and compared their predictive performance. We also conducted personal monitoring,household (indoor and outdoor), and ambient measurements for PM2.5. We validated the model
predictions with daily personal concentrations of PM2.5 exposure.
RESULTS:Our results showed that the LUR_ML (R2 = 0.72) and ME (R2 = 0.94) models were highly
correlated with ambient PM2.5 concentrations from the air quality monitoring station (AQMS), whileboth models were moderately correlated (R2 = ~0.50) with personal exposure to PM2.5. The LUR_ML
model may underestimate personal PM2.5 exposure in daily concentrations. We observed regionalvariations in the models' predictive performance.
CONCLUSIONS:Our study supports the use of LUR_ML and ME models in specific regions for PM2.5 inepidemiological studies of air pollution.

Keywords: fine particle, prediction model, machine learning, microenvironment, validation

OP-054[Air pollution » Particulate matter]

Early life exposure to particulate matter andadult-onset hypertension: investigation of
association and effect modification in a US
nationwide cohort
Jie Chen1, Jaime E. Hart1, Naomi D. L. Fisher2, Peter James3, Francine Laden4
1Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, MA, USA
2Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA,USA
3Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute,
Boston, MA, USA
4Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of
Public Health, Boston, MA, USA

BACKGROUND AND AIM:Long-term exposure to particulate matter (PM) air pollution has been
associated with increased risk of cardiovascular disease and hypertension in adults. Early-life exposure
during critical windows of development may be essential for future disease onset, especially invulnerable subpopulations, but few studies have been able to examine this. We investigated theassociation of childhood PM exposure with adult-onset hypertension, and potential effect modification
by demographic characteristics.
METHOD:Study participants were from the Growing Up Today Study (GUTS), two prospective US
nationwide cohorts. The cohorts were established in 1996 and 2004 by enrolling children who werethen between the ages of 9 and 14 (GUTSI) or 10 and 17 (GUTSII). Follow-up questionnaires havebeen sent to participants approximately annually. Incident hypertension was identified by self-reporton questionnaires. We assessed cumulative average exposure to PM2.5, PM10, and PM2.5-10 atparticipants’ residential address throughout childhood (9-18y). We followed the participants from age
18 until the onset of hypertension, loss to follow-up, or the end of follow-up (year 2021), whichevercame first. We applied Cox proportional hazards models adjusted for potential confounders at theindividual and area-level. We considered potential effect modification by sex, obesity, region, andfamily history of hypertension.
RESULTS:Among 18,059 participants, 1,553 hypertension cases were reported during an averagefollow-up of 12.8 years. Average exposure throughout childhood was 11.9±2.9 µg/m3 for PM2.5,
20.5±5.4 µg/m3 for PM10, and 7.8±4.1 µg/m3 for PM2.5-10. Our results showed no association
between childhood PM exposure and adult-onset hypertension (e.g., Hazard Ratio: 1.00, 95%
confidence interval 0.92-1.09 per 5 µg/m3 increase in PM2.5). Suggestive positive associations wereobserved among females, non-obese participants, residents in Midwest and South, and with family
history of hypertension, but, p-values for interactions were all above 0.1.
CONCLUSIONS:Our results did not support an association between early-life PM exposure and adultonset hypertension.

Keywords: Air pollution, Particulate matter, Cardiovascular diseases, hypertension

OP-055[Built environment » Noise]

Association of aircraft noise around four major
UK airports with subclinical atherosclerosis andhypertension
Katie Eminson1, Glory O Atilola2, Xiangpu Gong3, Calvin Jephcote1, Kathryn Adams1, Gabriella
Captur4, Marta Blangiardo2, John Gulliver3, Anna L Hansell3
1Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United

Kingdom
2UK Small Area Health Statistics Unit, Department Epidemiology and Biostatistics, School of Public

Health, Imperial College London, W2 1PG, United Kingdom & MRC Centre for Environment and Health,
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London,
London, United Kingdom
3Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United

Kingdom & The National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU)
in Environmental Exposure and Health at the University of Leicester, Leicester, United Kingdom
4MRC Unit for Lifelong Health & Ageing, Population Science & Experimental Medicine, Faculty of Pop

Health Sciences, University College London, London, United Kingdom & UCL Institute of Cardiovascular
Science, University College London, London, United Kingdom & The Royal Free Hospital, Centre forInherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, United
Kingdom

BACKGROUND AND AIM:While there is a large body of research on annoyance and sleep disturbancefrom aircraft noise, there is very limited epidemiological evidence on aircraft noise and cardiovasculardisease despite good biological plausibility. The aim of this study was to investigate associations ofaircraft noise around four major UK airports (Birmingham, London Heathrow, London Gatwick, andManchester) with cardiovascular disease risk factors.
METHOD:The UK Biobank cohort recruited 502,651 individuals aged 40-69 years across the UK during
2006-2010, with ~105,000 participants living near the four airports. Modelled annual average aircraft
noise in 2006 and 2011 were provided by the Civil Aviation Authority for Lnight (night-time) and Lden
(24-hour period with penalty weighting for evening and night noise) metrics. Outcomes were systolicand diastolic blood pressure (S/DBP) readings in clinic, hypertension (doctor-diagnosed, clinic
measurement or on medication) and carotid intima-media thickness (cIMT), a biomarker of subclinicalatherosclerosis. We used multivariable linear, logistic, and mixed regression models, adjusting forclinical, demographic, socioeconomic, lifestyle, and environmental covariates including nitrogendioxide (NO2).
RESULTS:Initial results show that associations with measured clinic blood pressure were close to null,but odds of having hypertension were 1.15 times greater (95%CI 1.08, 1.22) for those living in thehighest aircraft noise exposure category (Lden>63dB), compared with the lowest (Lden≤51dB). There
was a 4.87% (95%CI 2.37, 7.14) increase in mean cIMT, with a larger association in males, for thosein the highest noise exposure category compared to the lowest. Similar results were seen for exposure
to aircraft Lnight >45 db.
CONCLUSIONS:Daytime and nocturnal exposure to aircraft noise from 4 major UK airports was
associated with hypertension and a greater extent of carotid atherosclerotic vascular disease,independent of NO2 air pollution. These findings contribute to evidence suggesting that aircraft noise
exposure might be a contributing risk factor for cardiovascular disease.

Keywords: Built environment, Noise, Cardiovascular diseases, Environmental epidemiology

OP-056[Air pollution » Other (to be specified with keywords in the keywords section)]

Individual protective measures for air pollution
and cardiopulmonary health: A systematic
review and meta-analysis
Surabhi Suresh Shah1, Eunji Kim2, Kyoung Nam Kim3, Eunhee Ha4
1Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul,

Republic of Korea.
2Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul,

Republic of Korea. Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
3Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic ofKorea.
4Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul,

Republic of Korea. Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea. Institute of Ewha-SCL for Environmental Health(IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea. Department ofMedical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute,
Seoul, Republic of Korea

BACKGROUND AND AIM:Individual protective measures (IPMs) on air pollution are protective against
cardiac and pulmonary health, but information on their effectiveness is relatively scarce. In thissystematic review and meta-analysis, we investigated the effects of air purifiers, air-purifying
respirators, and cook stove changes on cardiopulmonary health outcomes.
METHOD:We searched PubMed, Scopus, and Web of Science from 1st January 1990 - 31st December
2022, 90 articles and 39760 participants were included. Two authors independently searched andselected the studies, extracted information, and assessed each study’s quality and risk of bias. We
performed meta-analyses when three or more studies were available for each IPMs, with comparable
intervention and health outcome.
RESULTS:Systematic review showed that IPMs were beneficial in children and elderly with asthma
along with healthy individuals. Meta-analysis results showed a reduction in cardiopulmonary
inflammation using air purifiers than in control groups (with sham/no filter) with a decrease ininterleukin 6 by -0.247 μg/mL (95% confidence intervals [CI] = -0.413, -0.082). A sub-group analysis
for air purifier as an IPMs in developing counties reduced fractional exhaled nitric oxide by -0.208 ppb(95% confidence intervals [CI] = -0.394, -0.022). However, evidence describing the effects of air
purifying respirator and cook stove changes on cardiopulmonary outcomes remained insufficient.
CONCLUSIONS:Air purifiers can aid as an effective IPMs against air pollution. The useful effect of air
purifiers is likely to have a greater effect in developing countries than in developed countries.

Keywords: Air pollution interventions, air purifier, air-purifying respirator, cookstove change,
cardiopulmonary healthOP-057[Outcomes » Cardiovascular diseases]

Impact of exposure to ambient PM₂.₅ on theprevalence of hypertension among Women of
Reproductive Age in India
Taruna Singh1, Sagnik Dey2, Ambuj Roy3, Santu Ghosh4, Ekta Chaudhary2
1School of Interdisciplinary Research, Indian Institute of Technology Delhi, India
2Center for Atmospheric Sciences, Indian Institute of Technology Delhi, India
3Department of Cardiology, All India Institute of Medical Sciences Delhi, India
4Department of Biostatistics, St. John Medical College Bangalore, India

BACKGROUND AND AIM:Air pollution is one of the leading risk factors for cardiovascular disease indeveloped and developing countries. Exposure to PM₂.₅ increases blood pressure (BP), elevating therisk of hypertension. There is limited epidemiological evidence for the same in low and middle-income
countries. This study is conducted to examine whether exposure to PM₂.₅ is associated withhypertension among women of reproductive age (WRA, 15–49 years).
METHOD:The analysis involves health data from the National Family Health Survey-5 (NFHS-5) andsatellite-driven PM₂.₅ exposure at 1-km×1-km spatial resolution. Hypertension was defined as systolicBP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. A logistic regression model was used to estimate theeffects of PM₂.₅ on hypertension in WRA, adjusted for confounders such as socioeconomic (SES)
indicators, age, smoking, place of residence, education level, and cooking fuel. Further moderating
effects of socioeconomic indicators, such as smoking, BMI, education, etc., were explored bymultiplicative interaction with PM₂.₅.
RESULTS:The adjusted odds ratio (OR) of hypertension was estimated at 1.052 (95% CI: 1.047–
1.057) for a 10 μg/m³ increase in ambient PM₂.₅ exposure. Significant moderating effects wereobserved among smokers, with an OR of 1.11 (95% CI: 1.106–1.165) against an OR of 1.050 (95%
CI: 1.045–1.055) for non-smokers. The poorest socioeconomic class was the most susceptible group
among all SES classes, with an OR of 1.076 (95% CI: 1.064–1.089). Similar moderating effects wereobserved for BMI and education level.
CONCLUSIONS:The study found a statistically positive association between ambient PM₂.₅ exposureand hypertension among WRA. The effort will be further extended to study the differential effects of
PM₂.₅ constituents on hypertension.

Keywords: Ambient PM2.5, Air pollution, Hypertension, Women

OP-058[Air pollution » Mixtures]

Individual and joint associations of long-term
exposure to air pollutants and cardiopulmonary
mortality: A 22-year cohort study in Northern
China
Wenzhong Huang1, Yang Zhou2, Xi Chen3, Xiaowen Zeng4, Luke D Knibbs5, Bin Jalaludin6, Shyamali
C Dharmage7, Lidia Morawska8, Yuming Guo1, Xueli Yang3, Liwen Zhang3, Anqi Shan3, Jie Chen9,
Tong Wang10, Joachim Heinrich11, Meng Gao12, Lizi Lin4, Xiang Xiao13, Peien Zhou14, Yunjiang Yu2,
Naijun Tang15, Guanghui Dong4
1Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash

University, Melbourne, Australia
2State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment,

South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou
510655, China
3Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical

University, Tianjin 300070, China & Tianjin Key Laboratory of Environment, Nutrition and Public
Health, Tianjin Medical University, Tianjin 300070, China & Center for International Collaborative
Research on Environment, Nutrition and Public Health, Tianjin 300070, China
4Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health

Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun
Yat-sen University, Guangzhou 510080, China
5School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW 2006,

Australia
6Centre for Air Quality and Health Research and Evaluation, Glebe, NSW, 2037, Australia & Ingham

Institute for Applied Medial Research, Liverpool, NSW 2170, Australia & School of Public Health andCommunity Medicine, The University of New South Wales, Kensington, NSW 2052, Australia
7Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of

Melbourne, Melbourne, VIC 3052, Australia
8International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane,

Queensland 4001, Australia
9Department of Occupational and Environmental Health, School of Public Health, China Medical

University, Shenyang 110122, China
10School of Public Health, Shanxi Medical University, Taiyuan 030001, China
11Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU

Munich, Munich 80336, Germany
12Department of Geography, Hong Kong Baptist University, Hong Kong SAR, China
13Department of Geography, Hong Kong Baptist University, Hong Kong SAR, China & Department ofEnvironmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, Harvard
T.H. Chan School of Public Health, Boston, MA 02115, USA
14Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 1TN, UK
15Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical

University, Tianjin 300070, China

BACKGROUND AND AIM:Evidence on the associations between long-term exposure to multiple air
pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher
pollutant level. We aimed to characterize the individual and joint associations of long-term exposure to
air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contribute to
the mortality risk.
METHOD:We followed 37,442 participants in four cities in northern China from 1998-2019. Annual
PM2.5, PM10, SO2 and NO2 were estimated using daily average values from satellite-derived machinelearning models and monitoring stations. Time-varying Cox proportional hazards model was used toevaluate the individual association between air pollutants and mortality from non-accidental causes,
cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer,
accounting for demographic and socioeconomic factors. Effect modifications by age, gender, income
and education level were also examined. Quantile-based g-Computation was applied to evaluate theco-effects and the relative weight of contributions.
RESULTS:During 785,807 person-years of follow-up, 5,812 (15.5%) died from non-accidental causes,
among which 2,932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552(1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5 µg/m3), PM2.5(70.2), SO2 (113.0) and NO2 (39.2) were consistently associated with all mortality outcomes. A
monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold wasobserved for the exposure-response relationship of mortality with individual or joint exposure to air
pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant
mixture, followed by SO2 or PM10.
CONCLUSIONS:There was a strong and positive association of long-term individual and joint exposure
to air pollutants with cardiopulmonary mortality in high-exposure settings, with PM2.5 potentiallybeing the main contributor. The shapes of associations were consistent with a linear or supra-linear
exposure-response, with no lower threshold observed.

Keywords: Multi-pollutant, Long-term exposure, Mortality, Mixtures analysis

OP-059[Air pollution » Ozone]Long-term exposure to ambient ozone and Creactive protein level: a longitudinal cohort
study
Xianglin Wei1, Alexis KH Lau2, Changqing Lin2, Kin Fai Ho1, Bo Huang3, Xiang Qian Lao4
1Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong

Kong SAR, China
2Division of Environment and Sustainability, The Hong Kong University of Science and Technology,

Hong Kong SAR, China
3Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong

Kong SAR, China
4Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China

BACKGROUND AND AIM:C-reactive protein (CRP) is a biomarker for systematic inflammation and therisk of cardiovascular diseases. Few studies investigated the long-term effect of ozone (O₃) exposure
on CRP levels. This study aims to examine the association of chronic exposure to O₃ with CRP in a
general population.
METHOD:Participants were adults from the Taiwan MJ cohort and attended regular medical
examinations. The concentrations of O₃, particulate matter of diameters ≤ 2.5 μm (PM₂.₅), andnitrogen dioxide (NO₂) were estimated from each participant’s address using satellite-based spatialtemporal regression models. The two-year average exposure of the year of medical check-ups and thepreceding year was calculated to represent the long-term exposure. High-sensitivity CRP
concentrations were measured using overnight fasting blood samples of participants. We excluded
observations with CRP higher than 10 mg/L to rule out acute infection. Linear mixed effects models
with individual-specific random terms were applied in the analysis. We performed both single-pollutant
and multiple-pollutant analyses.
RESULTS:We included 45,705 adults from the cohort between 2006 and 2016. Their median level of
CRP was 0.89 (interquartile range: 0.45–1.81) mg/L. In the single-pollutant model, every 10 μg/m³
increment of O₃ was associated with a CRP increase of 4.09% [95% confidence interval (CI): 2.88–
5.31%]. After separately adjusting PM₂.₅ or NO₂, CRP ascended by 3.59% (95%CI: 2.39–4.81%) or
6.27% (95%CI: 4.62–7.94%) per 10 μg/m³ of O₃. In the three-pollutant model, O₃ rising 10 μg/m³
elevated CRP level by 4.75% (95%CI: 3.10–6.42%), second only to PM₂.₅ [6.28% (95%CI: 5.07–
7.51%)] and outweighing NO₂ [0.73% (95%CI: 0.03–1.44%)].
CONCLUSIONS:Long-term exposure to O₃ was positively associated with CRP level and hence
systematic inflammation. This association was consistently prominent using multiple-pollutant models.
Further studies are warranted to demonstrate the association of chronic exposure to O₃ withcardiovascular health.

Keywords: Long-term exposure, Multi-pollutant

OP-060[Built environment » Green space]Is fine particulate matter air pollution or
greenness associated with cause-specificmortality in US men diagnosed with prostatecancer?
Charlotte Roscoe1, Hari S. Iyer2, Timothy R. Rebbeck3, Francine Laden4
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, US;

Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, US
2Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New

Brunswick, NJ, US
3Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, US
4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, US

BACKGROUND AND AIM:Cardiovascular disease (CVD) and prostate cancer (CaP) mortality are leading
causes of death among men with CaP. Higher exposure to fine particulate matter (PM2.5, particles ≤2.5 µm in aerodynamic diameter) air pollution has been associated with increased CVD mortality in US
cancer survivors. Additionally, higher residential vegetation cover (greenness) has been associatedwith lower CVD mortality. We assessed associations of PM2.5 and greenness with mortality in aregistry-based cohort of men diagnosed with CaP.
METHOD:Using data from men with CaP diagnosed from 2000 to 2015 in the California, Louisiana,
Massachusetts, New Jersey, Ohio, Pennsylvania, and Seattle-Puget-Sound cancer registries, weestimated hazard ratios and 95% confidence intervals (CI) for CVD and CaP mortality using Cox
models. We linked exposures to masked residential addresses at diagnosis: 1) annual averaged PM2.5
from spatiotemporal models (1km resolution) and 2) annual average greenness (30m resolution
Normalized Difference Vegetation Index (NDVI) averaged within a 270m circular distance buffer). In
multi-exposure (PM2.5 + greenness) models, we used age as the underlying timescale, adjusting for
diagnosis period, stage, marital status, a principal components-based neighborhood socioeconomic
status index, population density, and an inverse probability weight for competing cause of death.
RESULTS:By the end of follow-up (December 31st, 2018), 239,124 of the 795,798 men diagnosed
with CaP had died (82,588 CVD deaths; 74,321 CaP deaths). PM2.5 (scaled per 5g/m3) was
positively associated with CVD (HR 1.04; 95% CI 1.03, 1.05) but not CaP mortality, whereas
greenness (scaled per 0.1 increase in NDVI) was negatively associated with both CVD (HR 0.98; 95%
CI 0.98, 0.99) and CaP mortality (HR 0.94; 95% CI 0.93, 0.95).
CONCLUSIONS:In a large registry-based CaP cohort, we showed that long-term exposure to PM2.5
and residential greenness may influence CVD and CaP mortality. Environmental risk factors may
contribute to survival differences among men with CaP.

Keywords: Cancer and cancer precursors, Survival, Air pollution, Particulate matter, Green spaceOP-061[Built environment » Green space]

Does green space make people move or moveaway? A relocation analysis of green space andphysical activity
Joe Van Buskirk1, Luke Knibbs1, Geoffrey Morgan2, Ding Ding2
1School of Public Health, University of Sydney, Sydney, Australia; Public Health Research Analytics

and Methods for Evidence, Sydney Local Health District, Sydney, Australia
2School of Public Health, University of Sydney, Sydney, Australia

BACKGROUND AND AIM:There is growing evidence to suggest accessible green space improves healthoutcomes via facilitating physical activity. However, most evidence to date comes from cross-sectional
studies and are subject to self-selection bias (e.g., people moving to greener neighbourhoods foropportunities of physical activity). Relocation studies provide a unique opportunity to address several
biases in existing literature.
METHOD:Participants from the Australian ‘45 and Up’ cohort of >250,000 persons aged 45 and older
were assessed on self-reported physical activity (outcome) and two metrics of residential green space(exposure) at two consecutive time points (mean follow-up time 6.3 years), interacted with relocation
between time points. Green space exposure was assessed using the proportion of available parklandfrom Australian Bureau of Statistics census and annual mean Normalised Difference Vegetation Index(NDVI). Both exposures were assessed within a 1600m Euclidean buffer. Covariates included
socioeconomic status, age, follow-up time and sex. Linear regression models were weighted using
inverse probability censoring weights to adjust for informative censoring due to attrition.
RESULTS:Fifteen percent of participants relocated between baseline and follow-up, with relocation
associated with around 30 mins/week higher physical activity at the univariate level. Available
parkland was negatively associated with physical activity (β = -5.4mins/week, 95% CI -11.0 to 0.2
mins/week)-at follow-up in participants that did not relocate. However, in those who relocated togreener areas, the association was positive, with 5.7 mins/week higher (95% CI: 0.2-11.3 mins/week)
physical activity at follow-up for a one percent change in green space proportion. A similar effect wasobserved for NDVI, though this was smaller and highly variable.
CONCLUSIONS:Those who relocated to greener areas increased their physical activity, while those
whose residential area became greener did not. Self-selection bias may thus partially explain theobserved positive effect of green space on physical activity in our analysis.

Keywords: Environmental epidemiology, green space, physical activity, relocation

OP-062[Neurologic and mental health outcomes » Mental health outcomes]

Nature's remedy: uncovering pathways linking
greenspace to behavioural problems in PolishchildrenNitika Singh1, Nitika Singh2, Dorota Buczyłowska1, Clemens Baumbach1, Jakub Bratkowski3, Yarema
Mysak1, Maja Wierzba Łukaszyk1, Katarzyna Sitnik Warchulska3, Krzysztof Skotak3, Małgorzata
Lipowska4, Małgorzata Lipowska5, Bernadetta Izydorczyk1, Marcin Szwed1, Angel M. Dzhambov6,
Angel M. Dzhambov7, Iana Markevych1, Iana Markevych8
1Institute of Psychology, Jagiellonian University, Krakow, Poland
2Doctoral school of social sciences, Jagiellonian University, Kraków, Poland
3Institute of Environmental Protection-National Research Institute, Warsaw, Poland
4Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian

University, Krakow, Poland
5Institute of Psychology, University of Gdansk, Gdansk, Poland
6Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
7Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz,

Austria
8Research group “Health and quality of life in a green and sustainable environment”, SRIPD, Medical

University of Plovdiv, Plovdiv, Bulgaria

BACKGROUND AND AIM:A number of cross-sectional studies have found a beneficial relationshipbetween greenspace and children's behavior. Nevertheless, nearly no research investigated themechanistic linkages behind the association. Our study ought to examine how the availability of green
spaces in Poland is related to behavioural problems among school-aged children, and to determine thesignificance of nature perception, neighborhood social cohesion, and physical activity in thisrelationship.
METHOD:Data was obtained from the case-control NeuroSmog study, in which children with andwithout Attention Deficit Hyperactivity Disorder (ADHD) were enrolled. Analytic sample consisted of
679 children aged 10 to 13 years. Parents reported internalizing, externalizing, and total behaviouralproblems via the Child Behaviour Check List (CBCL), as well as information about the mediators anddomestic garden. Tree and grass cover were extracted in 500m Euclidean buffers around lifelong
residences. Structural equation modeling (SEM) was used to examine the psychosocial pathways andtheir interplay linking the three greenspace metrics to behavioural problems.
RESULTS:We found that greenspace was only indirectly related to less behavioral problems. SEM
results revealed that tree cover was related to both physical activity and greenspace perception, andphysical activity was subsequently linked to both internalizing and total behavioral problems.
Moreover, greenspace perception was associated with neighbourhood cohesion which was then linked
to both externalizing and total behavioral problems. When stratified by ADHD status, the pattern incontrols was very similar to that of the entire sample except that the associations of tree coverthrough greenspace perception to externalizing problems and tree cover to greenspace perception toneighborhood cohesion to internalizing problems became significant. Only the association between
tree cover and physical activity persisted among ADHD cases.
CONCLUSIONS:Greenspace was associated with less behavioural problems in Polish schoolchildrenthrough greenspace perception, neighbourhood cohesion, and physical activity. No direct link was
observed.

Keywords: Green space, Behavioural problems, Child Behavior Checklist, Children, Mental HealthOP-063[Built environment » Green space]

Place-based directionality of associations
between greenness and coronary heart disease
Ray Yeager, Daniel W. Riggs, Aruni Bhatnagar
Division of Environmental Medicine, University of Louisville, Louisville, United States of America

BACKGROUND AND AIM:Environmental vegetation, or greenness, imparts many distinct benefits tonearby residents and is inversely associated with rates of cardiovascular disease, the primary cause ofdeath worldwide. Yet, little is known about how this association varies among unique intersections ofplaces and populations and there is insufficient evidence to subsequently inform place-based
greenness implementation approaches.
METHOD:To evaluate the importance of place in associations between greenness and coronary heartdisease (CHD), we classified all 69,076 census tracts of the contiguous United States with complete
data into 108 unique intersectional categories of population density, urbanicity, plant hardiness zones,
and socioeconomic vulnerability. We utilized linear regression models to assess associations between
Normalized Difference Vegetation Index (NDVI) indicator of greenness and CHD prevalence withineach place classification while adjusting for age, obesity, smoking, and socioeconomic vulnerability.
RESULTS:Nationwide, we observed higher NDVI associated with lower CHD, but large variations whencomparing associations within place categories. We observed stronger significant inverse associations
among categories with high socioeconomic vulnerability, outside of cities, and low-density populations,with mean coefficient estimates of -1.68, -0.44, and -0.02, respectively. Contrastingly, we observed
positive associations among categories with low socioeconomic vulnerability, within cities, and highpopulation density, with mean coefficient estimates of 1.12, 0.38, and 0.30, respectively. There wassubstantial variation of association directionality within cities and dense areas, consistent associations
among SES groups, and more consistence within hardiness zones than between.
CONCLUSIONS:These results demonstrate the importance of place- and people-based contexts whenevaluating links between greenness and health. Importantly, more evidence is needed to understandplace-specific associations of both positive and negative influences of greenness to maximize benefits
and minimize detriments of future interventions. Place-based understanding of optimal greenness forhealth co-benefits could leverage billions of dollars spent annually on greenness interventions
worldwide to better improve public health impacts.

Keywords: Greenness, CVD, CHD, Geography, Implementation

OP-064[Built environment » Green space]

The association between neighborhoodgreenness and hospitalization for
cardiorespiratory diseases in Brazil
Weeberb J Requia1, Reizane Maria Damasceno1, Mariana Andreotti Dias1, Vitória Rodrigues Ferreira
Barbosa2, Francisco Jablinski Castelhano3
1School of Public Policy and Government, Getulio Vargas Foundation, Brasília, Distrito Federal, Brazil
2Geoscience Institute, University of Brasilia Brasília, Distrito Federal, Brazil
3Geography Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

BACKGROUND AND AIM:The beneficial effects of greenness on human health have been widely
documented. However, to date, there are no nationwide studies in Brazil, a country with challenges
related to land use planning, deforestation, and a growing burden of diseases due to environmental
health risk factors. This study aimed to investigate the association between greenness andhospitalization for cardiorespiratory diseases in Brazil.
METHOD:We accessed hospital admissions data from 967,771 zip codes (total of 26,724,624
admissions) covering Brazil for the period between 2008 and 2018. We used the Normalized
Difference Vegetation Index (NDVI) to assess the greenness in each zip code. Five different exposure
metrics were used, including the average NDVI within the zip code boundaries and the average NDVI
within buffers of 500; 1,000; 1,500; and 2,000m surrounding each zip code. We applied a quasiPoisson regression model to verify the association between greenness and hospitalizations forcirculatory and respiratory diseases, adjusted for air pollution, weather variables, and SES. The
analyses were stratified by sex, age group, health outcome, and Brazilian regions.
RESULTS:The national meta-analysis for the whole population showed a reduced risk of
hospitalizations for circulatory diseases in areas with more green spaces. An IQR increase in average
NDVI within the zip code boundaries was associated with 17% (95% CI: 8%, 27%) decrease in
cardiovascular admissions. In contrast, we did not find robust associations for respiratory admissions.
CONCLUSIONS:Our study highlights the potential health benefits of green spaces in reducing
hospitalizations for circulatory diseases in Brazil, emphasizing the importance of policies andinterventions that prioritize the preservation and creation of green areas in urban settings.

Keywords: Green space, Cardiovascular diseases, Respiratory outcomesOP-065[One health » Public health]Brownfield land and health: a systematic reviewof the literature
Weiyi Wang1, Sarah Dack2, Ian Mudway3, Holly Walder3, Bethan Davies1, Robie Kamanyire2, Daniela
Fecht1
1UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, School of Public

Health, Imperial College London, London, UK; National Institute for Health and Care Research HealthProtection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health,
Imperial College London, London, UK
2UK Health Security Agency, London, UK; National Institute for Health and Care Research HealthProtection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health,
Imperial College London, London, UK
3MRC Centre for Environment and Health, Environmental Research Group, School of Public Health,

Imperial College London, London, UK; National Institute for Health and Care Research HealthProtection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health,
Imperial College London, London, UK

BACKGROUND AND AIM:Brownfield land is vacant or derelict land that was previously used forindustrial or commercial purposes. Brownfield land is increasingly being targeted for housingdevelopment, however, depending on the previous use and remediation activity, it might pose
potential risks to the health of residents on or in the vicinity of redeveloped sites. This systematic
review of the literature synthesises the empirical evidence on the associations between brownfieldland and health.
METHOD:We systematically searched EMBASE, MEDLINE, Global Health, Web of Science, Scopus andGreenFile using a study protocol registered on PROSPERO (CRD42022286826). The search strategy
combined the keywords “brownfield” and its interchangeable terms such as “previously developedland”, and any health outcomes such as “respiratory diseases” and “mortality”. Publications identified
from the search were screened for eligibility by two authors, and data were extracted from theselected articles. Study quality was assessed based on the Newcastle-Ottawa Scale.
RESULTS:Of the 1,987 records retrieved, 6 studies met the inclusion criteria; 5 cross-sectional studies(including 3 small-area analyses) and 1 longitudinal study. There was considerable heterogeneity inthe exposure metrics and health outcomes assessed. All studies found significant positive associations
between brownfield land proximity or density with at least one health relevant outcome, including selfreported general health, mortality, birth defects, serum metal levels and accelerated immune aging.
CONCLUSIONS:Brownfield land may negatively affect the health of nearby residents. The
epidemiological evidence on health effects associated with brownfield land in local communities,
however, remains inconclusive and limited. Further studies are required to build the evidence base to
inform future housing policies and urban planning.

Keywords: Built environment - Other (Brownfields), Chemical exposures, Outcomes, Environmental
disparities

OP-066[Omics technologies » Metabolomics]

The associations of preconception urinary
phthalate metabolite concentrations with theserum metabolome and outcomes of infertility
treatment
Jillian Nelson1, Robert B Hood1, Lidia Minguez Alarcon2, Russ Hauser2, Dean Jones3, Donghai
Liang4, Audrey J Gaskins1
1Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
3Division of Pulmonary, Allergy, & Critical Care Medicine, Emory University School of Medicine,Atlanta, USA
4Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health,Atlanta, USA

BACKGROUND AND AIM:Phthalate exposure has been linked with diminished fertility in women. Thus,
the objective of our study was to utilize untargeted high-resolution metabolomics to identify serum
metabolites and pathways associated with maternal preconception urinary phthalate metabolite
concentrations and investigate whether any of these metabolic features or pathways may mediate theassociation between urinary phthalate metabolites and live birth.
METHOD:Our analysis included 184 women in the Environment and Reproductive Health (EARTH)
study that underwent in vitro fertilization at a fertility clinic in New England (2005-2016). On the same
day during ovarian stimulation, women provided a serum sample, which was analyzed formetabolomics using liquid chromatography coupled with high-resolution mass spectrometry, and aurine sample, which was analyzed for 11 phthalate metabolites. We used multivariable linear
regression models to identified metabolic features associated with urinary phthalate metabolite
concentrations and live birth, followed by enriched pathway analysis. We then used a meet in the
middle approach to identify overlapping pathways and featuresRESULTS:A total of 10,803 and 12,968 metabolic features were detected in the serum in the C18
negative and HILIC positive columns, respectively. Pathway enrichment analysis revealed 50 uniquepathways in the C18 negative and HILIC positive columns that were significantly associated with atleast one of the 11 urinary phthalate metabolites or molar sum of di-2-ethylhexyl phthalate
metabolites. The classes of pathways that were most often associated with urinary phthalate
metabolites were lipid metabolism, amino acid metabolism, and oxidative stress. Three pathwayscarnitine shuttle, biopterin metabolism, and bile acid biosynthesis- were also identified as being
associated with at least one phthalate metabolite and live birth.
CONCLUSIONS:Our study provides insight into the serum metabolites and biological pathways,
including lipid and amino acid metabolism and oxidative stress, which may underlie the observed
associations between phthalate exposures and lower fertility in women.

Keywords: Phthalates, Endocrine disrupting chemicals, Internal exposome, Female reproductive
outcomes, Birth outcomesOP-067[Chemical exposures » Endocrine disrupting chemicals]

Polycyclic aromatic hydrocarbons and volatileorganic compounds negatively affect thyroid
function in pregnant women
Ju Hee Kim, Nalae Moon, Su Ji Heo
College of Nursing Science, Kyung Hee University, Seoul, South Korea

BACKGROUND AND AIM:The thyroid-stimulating hormone (TSH) level plays an important role in fetal
development and pregnancy outcomes. Polycyclic aromatic hydrocarbons (PAHs) and volatile organic
compounds (VOCs) are known environmental hazards that cause adverse effect on the reproductive
health. This study aimed to confirm the association between the urinary concentrations of PAHs,
VOCs, and TSH levels in pregnant women.
METHOD:We analyzed 242 urinary samples of pregnant women from “No Environmental Hazards forMother-Child pairs” cohort study which was conducted from 2022 to 2023 in Korea. We analyzed four
PAHs (1-OHP, 2-NAP, 1-PHE, and 2-FLU) and two VOCs (t, t-MA and BMA) using LC-MS/MS. The TSHlevels in pregnant women were measured using blood sampling in the first trimester. The level of TSH
was categorized as normal (0.1–2.5 mIU/L) and abnormal (over 2.5 mIU/L).
RESULTS:The detection rate of PAHs (1-OHP, 2-NAP, 1-PHE, and 2-FLU) ranged from 77.3 to 100%,and the geometric mean ranged from 0.049 to 2.388 µg/g creatinine. The detection rates of VOCs (t,t-MA and BMA) were 99.6 and 99.6%, and the geometric mean levels were 44.298 and 2.816 µg/g
creatinine, respectively. In the univariate logistic regression model, t, t-MA was significantly
associated with abnormal TSH levels (B = 0.462, p = 0.031). After adjusting for confounding factors,
t, t-MA also showed an association with abnormal TSH levels in the multivariate model (B = 0.440, p= 0.042).
CONCLUSIONS:Exposure to VOCs is significantly associated with negative TSH levels. Further studies
are needed to evaluate this causal relationship.

Keywords: polycyclic aromatic hydrocarbons, volatile organic compounds, thyroid stimulating
hormoneOP-068[Chemical exposures » Endocrine disrupting chemicals]

Prenatal exposure to phthalates and fetal growthin the SEPAGES cohort relying on repeated urine
collection
Marion Ouidir1, Paulina Jedynak2, Matthieu Rolland1, Sarah Lyon Caen1, Cathrine Thomsen3, Amrit K
Sakhi3, Azemira Sabaredzovic3, Sam Bayat4, Rémy Slama1, Claire Philippat1
1University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology

Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
2University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology

Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France& ISGlobal, Barcelona, Spain
3Norwegian Institute of Public Health, Oslo, Norway
4Department of Pulmonology and Physiology, Grenoble University Hospital, La Tronche, France &Synchrotron Radiation for Biomedicine Laboratory (STROBE), Inserm UA07, Grenoble Alpes University,
Grenoble, France

BACKGROUND AND AIM:Most previous studies looking at the associations between prenatal exposure
to short half-life chemicals and fetal growth relied on biological measurement at a single time point,
which inadequately represents exposure over the course of pregnancy. Most studies focus onbirthweight without assessing different growth parameters and velocities over time, preventing themto highlight potential period of fetal vulnerability. We examined the associations between pregnancy
urinary phthalate metabolites and fetal growth outcomes, both measured twice during pregnancy.
METHOD:Among 484 pregnant women, we assessed 13 phthalate and two DINCH (1,2-Cyclohexane
dicarboxylic acid, diisononyl ester) metabolite concentrations from two within-subject weekly pools(median 18 and 34 gestational weeks, respectively). Biparietal diameter, head and abdominal
circumferences, and femur length were measured during two routine pregnancy follow-up
ultrasonographies (median 22 and 32 gestational weeks, respectively). Associations between eachphthalate and outcome parameters were investigated using adjusted linear regression models. To
account for exposure measurement error and correct the dose–response function, we performed
regression calibration as sensitivity analysis.
RESULTS:Detection rates were above 99% for all phthalate MiBP (mono-iso-butyl phthalate) and
MnBP (mono-n-butyl phthalate) were positively associated with most fetal growth parameters
measured at the second trimester. Specifically, MiBP was positively associated with increased
biparietal diameter, head and abdominal circumference, while MnBP was associated with increased
head and abdominal circumference at second trimester, with stronger associations observed among
males than females. Pregnancy MnBP exposure was also positively associated with biparietal diameterand femur length at third trimester. Regression calibration analysis gave similar results overall.
CONCLUSIONS:In this prospective pregnancy cohort, prenatal exposure to MiBP and MnBP was
associated with increased fetal growth parameters, with stronger associations among males. Further
investigation on the effects of phthalates on child health would be relevant for improving current
knowledge on their long-term effects.

Keywords: Endocrine disrupting chemicals, Phthalates, Pregnancy outcomesOP-069[Methods » Methodological study design]

Inferring effects of time-varying prenatal
exposures on pregnancy loss from live-birthidentified conceptions: A simulation study
Michael Leung1, Sebastian T Rowland2, Brent A Coull3, Ander Wilson4, Marc G Weisskopf1, Marianthi
Anna Kioumourtzoglou2
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York City, USA
3Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
4Department of Statistics, Colorado State University, Fort Collins, USA

BACKGROUND AND AIM:Identifying the determinants of pregnancy loss is a critical public healthconcern. However, it is difficult to enumerate the outcome, and so past studies have been limited to
medically-identified losses or small, highly selected cohorts. Instead, we show through a simulation
study of the effect of nitrogen dioxide (NO2) on pregnancy loss that researchers can use records oflive births and gestational ages to identify live-birth-identified conceptions (LBICs)—the difference
between the total number of conceptions and those lost for a given time window—to infer effects
about pregnancy loss.
METHOD:We simulated ten years of conceptions, pregnancies, losses, and births under several
confounding patterns (no confounding, seasonal conceptions, temperature-influenced loss, long-term
conception trends, and the previous three combined), and two NO2 effect forms (no effect andmoderate effect). We used a time-series design and fit quasi-Poisson distributed lag models adjusted
for season, year, and temperature. We considered two approaches to estimate the week-specific and
40-week cumulative effects of NO2 on pregnancy loss: 1) direct interpretation of estimated regression
coefficients from the quasi-Poisson model and 2) g-computation to estimate the corresponding
additive effects.
RESULTS:Across all scenarios, our models, on average, correctly identified the critical window withappropriate coverage (range: 90% to 100%) and low percent bias (range: -0.51% to 1.5%). For
example, under a moderate NO2 effect and combined confounding structure, the average bias andcoverage for the additive cumulative association was 1.1% (standard deviation: 6.28%) and 96%,
respectively.
CONCLUSIONS:We demonstrated through simulations that our method relying on LBICs (typicallyavailable in administrative datasets) offers a viable approach to infer effects on pregnancy loss underrealistic confounding scenarios.
FUNDING: National Institute of Environmental Health Sciences R01 ES029943 and US Environmental
Protection Agency RD-835872.

Keywords: air pollution, traffic-related, pregnancy outcomes, causal inferenceOP-070[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Prenatal polycyclic aromatic hydrocarbon
exposure and neurodevelopment among childrenin Puerto Rico
Savannah M. Sturla1, Amber L. Cathey1, Emily Zimmerman2, Zaira Y. Rosario Pabón4, Gredia Huerta
Montañez3, Carmen M. Vélez Vega4, Akram N. Alshawabkeh3, José F. Cordero5, John D. Meeker1,
Deborah J. Watkins1
1Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
2Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
3Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
4Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, PR,USA
5Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA

BACKGROUND AND AIM:Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental
contaminants produced through the combustion of fuels, tobacco, smoked meat, wildfires, andhazardous waste. PAH exposure has been associated with adverse health impacts; however, few
studies have examined exposure in relation to neurodevelopment. Our study aims to investigate theimpacts of prenatal PAH exposure on the odds of early neurodevelopmental delay.
METHOD:We measured 7 hydroxylated PAH metabolites in spot urine samples up to three times
during pregnancy in the PROTECT cohort using tandem mass spectrometry: 1-hydroxynaphthalene(OH-NAP), 2-OH-NAP, 2-hydroxyfluorene (OH-FLU), 1-hydroxyphenanthrene (OH-PHE), the sum of 2and 3- OH-PHE, 4-OH-PHE, and 1-hydroxypyrene (OH-PYR). Neurodevelopmental delay was identified
using score cutoffs from the Ages and Stages Questionnaire, 3rd edition (ASQ-3, Spanish), acrosscommunication, gross motor, fine motor, problem-solving, and personal-social domains at 12, 24, 36,
and 48 months. We utilized logistic regression (n=97) and linear mixed models (n=297) to assess
associations between geometric mean PAH concentrations across pregnancy and above versus below
ASQ-3 domain cutoffs, adjusting for age, sex, maternal education, and environmental tobacco smoke.
RESULTS:Our results unexpectedly show mostly decreased odds of neurodevelopmental delays withhigher exposure for several domains in both models (p<0.05). However, male children showed higher
odds of delayed development across communication, fine motor, gross motor, and personal-social
domains. Particularly, 2-OH-FLU, 1-OH-PYR, and 1-, 2,3-, and 4-OH-PHE exposure were associatedwith delays in gross and fine motor function (interaction p-value<0.2). For example, 1-OH-PHE wasassociated with 1.05 times odds of delay in fine motor function (95%CI: 0.97, 1.14) in males versus
0.93 (95%CI: 0.85, 1.01) times odds of delay in females.
CONCLUSIONS:Our preliminary results suggest that PAH exposure may impact neurodevelopment inmale children. These findings prompt further investigation into mechanisms of PAHs on motor function
and how hormonal or neurotransmitter differences by sex may play a role in susceptibility.

Keywords: Children’s environmental health, chemical exposures, environmental epidemiology,
biomarkers of exposureOP-071[Chemical exposures » Phthalates]

Gestational exposure to phthalates, phthalate
replacements and their mixture in relation toeicosanoid biomarkers during pregnancy
Seonyoung Park1, Amber Cathey1, Wei Hao2, Lixia Zeng3, Subramaniam Pennathur4, Zaira Rosario
Pabon5, Carmen M. Velez Vega5, Jose F. Cordero6, Akram Alshwabekah7, Deborah J. Watkins1, John
D. Meeker1
1Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann

Arbor MI, USA
2Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
3Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
4Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA & Department of

Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
5Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR,USA
6Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
7College of Engineering, Northeastern University, Boston, Massachusetts, USA

BACKGROUND AND AIM:Humans are exposed to complex mixtures of phthalates. Gestational
exposure to phthalates has been linked to preeclampsia and preterm birth through potential pathways
such as endocrine disruption, oxidative stress, and inflammation. Eicosanoids are bioactive signaling
lipids that are related to a variety of homeostatic and inflammatory processes.
METHOD:We investigated associations between urinary phthalates and their mixtures with plasma
eicosanoid levels during pregnancy using the PROTECT cohort in Puerto Rico (N=655). After adjustingfor covariates, we estimated pair-wise associations between the geometric mean of individual
phthalate metabolite concentrations across pregnancy and eicosanoid biomarkers using multivariablelinear regression. We used bootstrapping of adaptive elastic net regression (adENET) to evaluate
phthalate mixtures associated with eicosanoids and subsequently create environmental risk scores(ERS) to represent weighted sums of phthalate exposure for each individual.
RESULTS:After adjusting for false-discovery, in single-pollutant analysis, 14 of 20 phthalate
metabolites or parent compound indices showed significant and primarily negative associations withmultiple eicosanoids. In our mixture analysis, associations with several metabolites of low molecularweight phthalates – DEP, DBP, and DIBP – became prominent. Additionally, MEHHTP and MECPTP,
metabolites of a new phthalate replacement, DEHTP, were selected as important predictors fordetermining the concentrations of multiple eicosanoids from different pathway groups. A unit increasein ERS was positively associated with several eicosanoids from the cytochrome p450 pathway group,
such as (±)11,12-DHET (β=0.994, 95%CI: 0.309,1.679), 17(S)-HETE (β=0.37, 95%CI: 0.092,0.648),
9(10)-EpOME (β =0.107, 95%CI: 0.034,0.181), and 9s-HODE (β =0.332, 95%CI: 0.08,0.584). ERS
was also associated with lipoxygenase pathway group, such as 12-OxoETE (β =0.123, 95%CI:
0.028,0.217) and 15-OxoETE (β =0.122, 95%CI: 0.015,0.229).

CONCLUSIONS:Gestational exposure to phthalates and phthalate mixtures were associated witheicosanoid levels during pregnancy. Results from the mixture analyses underscore the complexity ofphysiological impacts of phthalate exposure and call for further in-depth studies to examine these
relationships.

Keywords: phthalates, pregnancy outcomes, mixture analysis, modelingOP-072[Climate » Temperature]

Increasing temperature levels are associatedwith less severe depression: results from the
DeprAir project
Elisa Borroni1, Luca Fedrizzi2, Massimiliano Buoli3, Valentina Bollati1, Guido Nosari4, Angela Cecilia
Pesatori1, Michele Carugno1
1EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, via sanBarnaba 7 8, 20122, Milan, Italy;
2Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via sanBarnaba 11 8, 20122, Milan, Italy
3Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35,

20122, 13 Milan, Italy
4Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore

15 Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

BACKGROUND AND AIM:Evidence between ambient temperature effects and mental health is very
limited. The aim of the study is to investigate the relationship between ambient apparent temperature(AP) and the severity of major depressive disorder (MDD) in 396 patients enrolled from the DeprAir
project
METHOD:Participants have been recruited among patients accessing the Psychiatry Unit of the
Policlinico Hospital (Milan, Italy) for mild, moderate or severe depression between September 2020and December 2022. After collecting informed consent, we administered a questionnaire on personal,
lifestyle and clinical characteristics, assessed MDD severity through psychiatric rating scales (MADRS,HAM-D, CGI, SDS, GAF) and collected blood samples. AP concentrations were estimated fromtemperature, humidity and wind speed measured by the network of monitoring stations of the regional
environmental protection agency. Based on his/her residential address, each subject was assigned themean levels of AP in the two weeks preceding recruitment.
Multivariate linear regression models were performed adjusting for age, sex, education, occupation,month, year and source of recruitment, and NO2 in the two weeks preceding recruitment. Results are
expressed as β (95%CI) with the unit of measure of the given severity scale.
RESULTS:In 396 patients affected by MDD (median age: 52 years, females: 65%), we observed
negative associations between AP and MADRS (-0.57; (-1.03; -0.12), p=0.013), HAMD (-0.55; (-1.02;-0.08), p=0.021) scales as well as the scores of the Disability (-0.14; (-0.26; -0.02), p=0.026),
Relationship (-0.11; (-0.22; -0.00), p=0.043), and Family (-0.13; (-0.24; -0.02), p=0.021) domainsof DISS scale. In all these scales, lower values indicate minor severity. Similarly, we observed higher
values of GAF scale, indicating minor severity, for increasing levels of AP (0.55; (0.02; 1.08),
p=0.042)
CONCLUSIONS:These results suggest that higher temperatures levels contrast MDD severity.
Completion of data collection for all participants will allow us to strengthen our conclusions.

Keywords: Temperature, climate, depression, severity

OP-073[Air pollution » Mixtures]

Exposure to mixture of pollutants impacts theseverity of major depressive disorder: resultsfrom the DeprAir project
Elisa Borroni1, Luca Fedrizzi2, Massimiliano Buoli3, Valentina Bollati1, Guido Nosari4, Angela Cecilia
Pesatori1, Michele Carugno1
1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
2Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via sanBarnaba 11 8, 20122, Milan, Italy
3Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35,

20122, 13 Milan, Italy
4Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore

15 Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

BACKGROUND AND AIM:Recent studies showed that air pollution might play a role in the etiology ofmental disorders. However, exposure to air pollution occurs with a multitude of pollutants. We
evaluated the relationship between exposure mixture to air pollution and the severity of major
depressive disorder (MDD) in 396 patients enrolled from the DeprAir project, using two different
approaches.
METHOD:Participants have been recruited among patients accessing the Psychiatry Unit of the
Policlinico Hospital (Milan, Italy) for MDD between September 2020 and December 2022. After
collecting informed consent, we administered a questionnaire on personal, lifestyle and clinicalcharacteristics, assessed MDD severity through psychiatric rating scales (MADRS, HAM-D, CGI, SDS,
GAF). Air pollution concentrations were estimated as daily means in 1x1 km cells using a chemicaltransport model developed by regional environmental protection agency. Based on personal residential
addresses, each subject was assigned to mean levels of PM10, NO2, and O3 of the two weeks
preceding recruitment. Bayesian kernel regression (BKR) and weighted quantile sum (WQS) models
were performed to verify the association between MDD severity and exposure to combined mixture ofthree pollutants. Models were adjusted for age, sex, education, occupation, month, year and source ofrecruitment.
RESULTS:Overall, we observed a significant positive association between mixture exposure and the
HAM-D scale using both BKR (quantile 75 vs 10: 12.80, 95% CI: (1.84; 23.77)) and WQS (1.85, 95%
CI: (0.33; 3.37)). When looking at single pollutants no effects were seen for PM10, while positive
associations were observed for NO2 and O3. Effects of mixture exposure were greater in the warm
seasons, especially in summer. No associations were observed in winter.
CONCLUSIONS:Our results suggest that exposure to pollutants mixture potentially affect MDD
severity. Gaseous pollutants seem to play a more relevant role. Completion of data collection for allparticipants will strengthen our conclusions.

Keywords: Air pollution, depression, severity, exposure mixtureOP-074[Built environment » Green space]

Effects of Forest Healing Program on Physical
Health, Mental Health, and Health Behavior
Hae Ryoung Chun1, Inhyung Cho1, Yoon Young Choi1, Geonwoo Kim2, Su Jin Park2, Sung Il Cho1
1Department of Public Health Sciences, Graduate School of Public Health, Seoul National University,

Seoul 08826, Korea
2Future Forest Strategy Department, Forest Human Service Division, National Institute of Forest

Science, Seoul 02455, Korea

BACKGROUND AND AIM:Although interest in the health promotion effect of forest therapy isincreasing, there is a lack of research to investigate changes in health indicators and exercise behavior
for the mid-to long-term impacts of Forest Therapy effects. This study examines changes in physicalhealth, mental health, and exercise behavior until one, two, and four weeks after the end of the
program to establish a healthcare foundation for forest healing programs and provide a foundation fordeveloping a standardized evaluation system.
METHOD:This study conducted blood pressure and heart rate variability pre- and post-evaluation on
99 adults participating in the forest healing program and conducted follow-up experiments on fivemental health indicators(State-Trait Anxiety Inventory of anxiety, Beck Depression Inventory toevaluate anxiety and depression, Profile of Mood States-Brief, Euro-Quality of Life-5 Dimension toevaluate quality of life, and Positive Effect and Negative Effect Schedule to measure positive andnegative mood). In addition, a follow-up experiment was conducted on questions that could evaluate
exercise time according to exercise intensity and questions that could assess changes in exercise typeusing Global Physical Activity Questionaire (GPAQ).
RESULTS:Anxiety, Depression, Mood, Quality of Life, Heart rate, and Blood pressure control showedsignificant differences before and after the program. In addition, the effect of controlling depression
and increasing medium-intensity exercise time continued until one week, two weeks, and four weeks
after the end of the program.
CONCLUSIONS:The results of this study can confirm the tracking effect of various health indicatorsand clearly distinguish between indicators suitable for short-term observation and indicators requiringlong-term observation. In addition, it is the first paper to discover that the experience of forest healing
programs can affect exercise behavior, suggesting that continuous health behavior tracking
investigation is needed.

Keywords: Shinrin-yoku, forest healing, physiological effect, psychological effect, health behavior

OP-075[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Lithium in Drinking Water and Autism Spectrum
DisorderZeyan Liew1, Qi Meng2, Qi Yan2, Jörg Schullehner4, Birgitte Hansen3, Søren Munch Kristiansen5,
Denitza D. Voutchkova3, Jørn Olsen6, Annette Kjær Ersbøll7, Matthias Ketzel8, Ole Raaschou Nielsen9,
Beate Ritz2
1Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA.
2Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles(UCLA), Los Angeles, USA.
3Geological Survey of Denmark and Greenland (GEUS), Aarhus, Denmark.
4Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark.
5Department of Geoscience, Aarhus University, Aarhus, Denmark.
6Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
7National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
8Department of Environmental Science, Aarhus University, Roskilde, Denmark.
9Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark

BACKGROUND AND AIM:Lithium is a natural-occurring and trace element that has mood-stabilizing
effects. Maternal therapeutic use of lithium was associated with adverse birth outcomes. In animalmodels, lithium modulates Wnt/β-catenin signaling that is important for neurodevelopment. We
evaluated whether autism spectrum disorder (ASD) in offspring is associated with maternal exposure
to drinking water lithium during pregnancy.
METHOD:We conducted a nationwide case-control study in Denmark including 8842 children
diagnosed with ASD born 2000–2013 and 43,864 controls matched by birth year and sex from thebirth registry. Geocoded maternal residential addresses during pregnancy were linked to lithium levels(range 0.6 to 30.7 μg/L) in drinking water estimated using kriging interpolation based on 151
waterworks measurements of lithium across all regions in Denmark. ASD diagnoses were ascertained
from the Danish Psychiatric Central Register. We estimated odds ratios (OR) and 95% confidence
interval (CI) for ASD according to prenatal lithium exposure as a continuous (per inter-quartile-range(IQR)) or a categorical (quartile) variable, adjusting for socio-demographic factors and ambient air
pollutants levels. We also conducted stratified analyses by birth years, child’s sex, and urbanicity.
RESULTS:Every IQR increase in prenatal drinking water lithium was associated with 23% higher odds
for ASD (OR=1.23, 95% CI 1.17, 1.29). Elevated odds for ASD were estimated starting from thesecond quartile (7.36-12.67 μg/L) of prenatal lithium, and the OR for the highest quartile (>16.78μg/L) compared with the reference group (<7.39 g/L) was 1.46 (95% CI 1.35, 1.59). The estimatedassociations were unchanged when adjusting for air pollution exposures, and no differences wereapparent in stratified analyses.
CONCLUSIONS:Maternal prenatal exposure to lithium from naturally occurring drinking water sourcesin Denmark was associated with an increased ASD risk in the offspring. This study suggests thepotential fetal neurotoxicity of lithium from drinking water that needs to be further investigated.

Keywords: Neurodevelopmental outcomes, Spatial statistics, Water quality

OP-076[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Associations between phosphate flame
retardants and steroid/reproductive hormones at
pubertal age: the Hokkaido Study
Atsuko Ikeda1, Yu Ait Bamai2, Takeshi Yamaguchi3, Celine Gys4, Maarten Roggeman4, Fatima Den
Ouden4, Yoshinori Ikenaka5, Zeng Yi6, Ketema Mesfin Rahel1, Megasari Marsela7, Chihiro Miyashita8,
Adrian Covaci4, Reiko Kishi8
1Hokkaido University Faculty of Health Sciences, Hokkaido University Center for Environmental and

Health Sciences
2University of Anterp Toxicological Center, Hokkaido University Center for Environmmental and Health

Sciences
3Hokkaido University Center for Environmmental and Health Sciences, Hokkaido University Faculty of

Medicine
4University of Anterp Toxicological Center
5Hokkaido University Faculty of Veterinary Medicine
6Hokkaido University Graduate School of Health Sciences
7Hokkaido University Faculty of Health Sciences
8Hokkaido University Center for Environmental and Health Sciences

BACKGROUND AND AIM:Phosphate flame retardants and plasticizers (PFR) are a class of chemicals
causing concern about endocrine disrupting properties. Associations between PFR levels and infertility
outcomes have been reported, but their association with reproductive and steroid hormone levels at
pubertal age is not well known. The aim of this study is to assess PFR levels in urine and investigate
their association with these hormones at pubertal age.
METHOD:The Hokkaido Study is an ongoing birth cohort. At age 9-12, children living in Sapporo area
were asked to visit a pediatrician for face-to-face health check-up, and blood and urine samples werecollected. Thirteen PFR metabolites in urine and 14 steroid hormones in plasma were measured by
LC/MSMS. Luteinizing hormone (LH), follicle stimulating hormone (FSH), Inhibin B and Insulin likefactor E (INSL3) were measured by ELISA. Specific gravity corrected PFR metabolites were molar
summed based on their parent compounds. Both PFRs and hormones were log-natural transformed
and adjusted for age and BMI after stratification by sex.
RESULTS:In this study, 231 boys and 198 girls were included. Median levels of metabolites ofΣTCIPP,
ΣTPHP, ΣEHDPHP, ΣTBOEP, and TDCIPP were 1.20 nM, 1.10 nM, 0.89 nM, 0.63 nM, and, 0.39 nM,
respectively. Among boys, all PFRs except ΣEHDPHP were positively associated with estradiol, whereas
ΣTPHP was inversely associated with estradiol (E2). TDCIPP, ΣTPHP, and ΣTBOEP were positively
associated with E2/testosterone ratio (E2/T). ΣTBOEP, ΣEHDPHP, ΣTCIPP were inversely associatedwith INSL3. Among girls, ΣTPHP was also associated with E2 and E2/T. ΣEHDPHP and ΣTPHP showed
positive association with Inhibin B.
CONCLUSIONS:The results suggest that exposure to PFRs is associated with altered steroid andreproductive hormone levels at pubertal age children. The results should be interpreted with caution,
as the study has a cross-sectional design.

Keywords: phosphate flame retardants and plasticizers, Children's environmental health, Endocrine
disrupting chemicals, Environmental epidemiology,

OP-077[Chemical exposures » Pesticides]

Exposure of children to glyphosate in Morocco:
Urinary levels and predictors of exposure
Imane Mme Berni1, Aziza Mme Menouni2, Lode Pr Godderis3, Radu Corneliu Dr Duca4, Samir Pr El
Jaafari1
1Higher Institutes of Nursing Professions and Health Technologies - Laayoune
2Cluster of Competency “Health and Environment”, Moulay Ismail University, Meknes, Morocco
3Environment and Health Unit, Department of Public Health and Primary Care, Katholieke Universiteit

Leuven, Leuven, Belgium
4Unit Environmental Hygiene and Human Biological Monitoring, Department of Health Protection,

National Health Laboratory (LNS), Dudelange, Luxembourg

BACKGROUND AND AIM:Glyphosate is one of the most frequently used organophosphorus plant
protection products worldwide, and has recently been classified as probably carcinogenic to humans by
the International Agency for Research and Cancer (IARC)
METHOD:We aimed to evaluate the urinary levels of glyphosate and its metaboliteaminomethylphosphonic acid (AMPA) in Moroccan children, to identify the main predictors and to
perform a risk assessment. Data was collected during a cross sectional study of 48 children from anintensive agricultural area. Urinary glyphosate and AMPA were extracted using solid phase extraction(SPE) and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).
RESULTS:Urinary glyphosate and AMPA were extracted using solid phase extraction (SPE) andanalyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Overall, glyphosate and
AMPA were detected in 73% and 75% of urine samples, respectively. The mean concentrations were0.97 μg L− 1 (2.06 μg/gcreatinine) for glyphosate and 0.79 μg L− 1 (1.52 μg/gcreatinine) for AMPA.
Children younger than 5 years had a higher AMPA and glyphosate urine concentration than children
aged 6–12. Children living near the pesticide spraying fields (<50 m) had 14.91 μg L− 1 and 2.35 μg
L− 1 more glyphosate and AMPA, respectively, than children living in urban counties. The HQs were
calculated considering 0.5 mg/kg BW/day as an acceptable daily intake (ADI), which EFSA has
established as a healthbased reference value for both analytes.
CONCLUSIONS:This study provides further evidence on factors associated with glyphosate exposure,especially in developing countries

Keywords: Pesticide exposure, Glyphosate, Aminomethylphosphonic acid, Socio-demographic factors,
ChildrenOP-078[Air pollution » Traffic-related]

Influence of PAHs and Genetic Polymorphisms
on Urinary PAHs Metabolite and DNA Damage
among Malaysian Children in Urban Traffic Area
Nur Hazirah Hisamuddin1, Juliana Jalaludin1, Suhaili Abu Bakar2, Mohd Talib Latif3
1Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences,

Universiti Putra Malaysia, Serdang Malaysia
2Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra

Malaysia, UPM Serdang, Malaysia
3Department of Earth Sciences and Environment, Faculty of Science and Technology, Universiti

Kebangsaan Malaysia, Bangi, Selangor

BACKGROUND AND AIM:Polycyclic Aromatic Hydrocarbon (PAHs) is one of a major group of genotoxic
carcinogens found in urban atmospheric pollution. This study investigated the association between
particulate PAHs with urinary 1-hydroxypyrene (1-OHP) and DNA damage among Malaysian children inurban traffic area. In addition, this study assessed the influence of genetic polymorphisms of PAHs
metabolizing enzymes (CYP1A1, GSTT1, GSTM1) on urinary 1-OHP and DNA damage in children.
METHOD:This cross-sectional comparative study was conducted at eight schools in high traffic (HT)area and low traffic (LT) area in Klang Valley. The indoor and outdoor samples of particulate matter
PM2.5-bound PAHs were collected using a MiniVol and quantified using Gas Chromatography-Mass
Spectrometry (GC-MS). DNA damage was assessed in buccal cells using Comet Assay, while urinary 1hydroxypyrene (1-OHP) was quantified using High-Performance Liquid Chromatography. PAHsmetabolizing enzymes were studied for polymorphisms using PCR-RFLP and multiplex PCR.
RESULTS:Total PAHs concentrations in the schools in HT area were higher than LT area ranging from
4.4 to 5.76 ng/m3 and 1.36 to 3.79 ng/m3, respectively. The urinary 1-OHP concentration was
significantly higher among children in HT as compared to LT (0.07 vs 0.04 µmol/mol-creatinine). The
DNA damage was significantly higher among children in HT as compared to LT. There was no
modifying effect of CYP1A1, GSTM1 and GSTT1 genotypes on urinary 1-OHP and DNA damage. The
multiple linear regression analysis showed that PAHs exposure was the significant predictor associatedwith urinary 1-OHP and DNA damage in Malaysian children, after controlling the possible confounders.
CONCLUSIONS:This study provided evidence that children attending schools near heavy traffic area
are more likely to be exposed to environmental PAHs and had a significantly higher risk of cancer thanchildren attending schools in low traffic areas. Effective mitigation measures need to be taken to
reduce PAHs pollution in school environments.

Keywords: Traffic-related, Exposure assessment, Children's environmental healthOP-079[Exposure assessment methods » Risk assessment]

Cumulative risk assessment of exposure to a
mixture of pesticides among Czech adults andchildren from the CELSPAC-SPECIMEn cohort
Tomáš Janoš1, Libor Šulc1, Daniel Figueiredo2, Ilse Ottenbros3, Petr Šenk1, Ondřej Mikeš1, Anke
Huss2, Pavel Čupr1
1Recetox, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
3Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; Center for

Sustainability, Environment and Health, National Institute for Public Health and the Environment(RIVM), Bilthoven, Netherlands

BACKGROUND AND AIM:Current-use pesticides (CUP) are extensively applied in both agricultural andurban settings. Exposure occurs mainly via the dietary pathway; however, other pathways such as
inhalation or skin contact are also important. Because of multiple exposures to pesticides as well asother environmental contaminants, single-substance health risk assessment could underestimate any
real health impact and, therefore, cumulative risk assessment is needed.
METHOD:In this study, urinary levels of 12 CUP metabolites were investigated among 110 parent-childpairs during two seasons of 2020. We estimated daily intakes of parent pesticides using a toxicokinetic
model according to three possible scenarios considering the amount of the metabolite excreted inurine. To assess the possible risk of combined exposure to a mixture of pesticides with respect toeffects on the nervous system, the EFSA cumulative risk assessment approach was deployed.
RESULTS:Metabolites of pyrethroids, chlorpyrifos, and tebuconazole were detected in more than 60%of the samples. CUP urinary metabolite levels were significantly higher in children in comparison toadults, except for tebuconazole. If any seasonal difference occurred, winter samples were those withsignificantly higher concentrations. The risk of pesticide mixtures based on the total margin of
exposure (MOET) calculations was assessed within two cumulative assessment groups: chronic
functional effects on the motor division (CAG NAM) and the brain and/or erythrocyte
acetylcholinesterase inhibition (CAG NAN). Generally higher risk was observed for CAG NAN, however,using a realistic scenario, none of the median MOETs was below 100 and thus did not indicate any
risk.
CONCLUSIONS:Nevertheless, the risk observed using the worst-case scenario suggests the need forcontinuous evaluation of exposure to such compounds and for extension of the range of commonly
analysed substances, especially in children. Additionally, further research is needed to distinguishbetween excretion factors in children and adults in order to responsibly evaluate associated healthrisks.

Keywords: Chemical exposures, Pesticides, Mixtures, Exposure assessment, Risk assessment

OP-080[Respiratory and allergic outcomes » Allergies]

Organophosphate Flame Retardants Mixture
associated with Increased Urinary Oxidative
Stress Biomarkers among School Children: The
Hokkaido Study
Yi Zeng1, Yu Ait Bamai2, Houman Goudarzi3, Rahel Mesfin Ketema4, Maarten Roggeman5, Fatima Den
Ouden5, Celine Gys5, Chihiro Miyashita6, Sachiko Ito6, Satoshi Konno3, Adrian Covaci5, Reiko Kishi6,
Atsuko Ikeda4
1Graduate School of Health Sciences, Hokkaido University
2Hokkaido University Center for Environmental and Health Sciences & Toxicological Center, Universityof Antwerp
3Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University
4Hokkaido University Center for Environmental and Health Sciences & Faculty of Health Sciences,

Hokkaido University
5University of Antwerp Toxicological Centre
6Hokkaido University Center for Environmental and Health Sciences

BACKGROUND AND AIM:Exposure to organophosphate flame retardants (PFRs) has been reported to
be associated with increased risks of asthma and allergies. Oxidative stress contributes to thedevelopment of asthma, allergic diseases and inflammation. This study examined the association ofindividual and mixture exposure to PFRs with urinary oxidative stress biomarkers among school
children.
METHOD:The study is a part of the Hokkaido Study on Environment and Children's Health. School
children aged 9-12 years living in Sapporo and its suburbs were included. The concentration of 13
PFRs metabolites and 3 oxidative stress biomarkers including 4-hydroxynonenal (HNE), hexanoyllysine (HEL), and 8-hydroxy-2’-deoxyguanosine (8-OHdG), were measured in spot urine samples(n=412). Multiple regression analysis, Quantile-based g-computation (qg-computation) and Bayesiankernel machine regression (BKMR) were used to analyze the associations.
RESULTS:The median for HNE, HEL and 8-OHdG were 21.6 (µg/mL), 106.4 (nmol/L), 9.52 (ng/mL),
respectively. For the individual PFRs, a natural log unit increase in ΣTPHP was associated withincreased levels of all oxidative stress biomarkers, ΣTBOEP was positively associated with 8-OHdG
levels. PFRs mixtures were positively associated with HEL (β, 95% CI: 0.08, 0.01–0.15) and 8-OHdG(0.05, 0.01–0.10). For the individual contributions of each chemical among the PFRs mixture, thehighest weight (%) in the positive direction were TDCIPP (35.8%), ΣTPHP (33.%) and ΣTBOEP(23.2%) for HEL, ΣTBOEP (53.7%) and ΣTPHP (46.3%) for 8-OHdG.
CONCLUSIONS:PFRs were positively associated with HEL, HNE and 8-OHdG among 9-12 year-old
children. The main contributors to the association were TPHP, TBOEP and TDCIPP metabolites. A study
reported that higher levels of 3 PFRs metabolites levels were associated with increased HEL, HNE
among 7-year-old children. This study found consistent results after examining both individual andmixture exposure to PFRs. PFRs could be associated with allergic diseases through increased oxidative
biomarkers.

Keywords: Organophosphate Flame Retardants, Mixtures analysis, Biomarkers of exposure,Children's environmental health, Environmental epidemiology

OP-081[Built environment » Noise]

Metabolic profiles of traffic noise exposures: a
discovery analysis in the NFBC1966 cohort in
the LongITools project
Yiyan He1, Jules Kerckhoffs2, Anna Pulakka3, Marko Kantomaa1, Gerard Hoek2, Sylvain Sebert1
1Research Unit of Population Health, University of Oulu, Oulu, Finland
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
3Research Unit of Population Health, University of Oulu, Oulu, Finland & Population Health Unit,

Finnish Institute for Health and Welfare, Helsinki, Finland

BACKGROUND AND AIM:Environmental noise pollution is a risk factor for multiple health outcomes,
but its molecular imprints in the body remain uncertain. We aim to investigate associations of road,rail and air traffic noise exposures with the metabolic profile in young adults with targeted NMR
metabolomics.
METHOD:We used data from Northern Finland Birth Cohort 1966 (N = 5491, mean age 31 years,
51.7% women) to examine the associations of modelled residential road, rail and air traffic noiselevels (separately) with fasting 228 NMR metabolic traits encompassing lipids, lipoproteins, fatty acids,
amino acids, phospholipids, glycolysis and miscellaneous other metabolites. We linked modelled traffic
noise levels to the residences of the participants in year 1997 when the clinical examinations took
place. We used linear regression adjusted for sex, education, income, body mass index, smoking,alcohol consumption, air pollutant and built environment and corrected for multiple testing to examine
the associations.
RESULTS:The number of participants exposed to the road, rail and air traffic noise > 50 dB were1646, 392 and 39, respectively. Exposure to road, rail and air traffic noise was associated with 26, 7
and 47 metabolic traits, respectively (P≤0.002). All three modelled noise levels were negatively
associated with phenylalanine. Rail and road traffic noise was negatively associated with low-density
lipoprotein (LDL) triglycerides. However, positive associations were observed between road traffic
noise and VLDL triglycerides, intermediate-density lipoprotein and high-density lipoprotein cholesterolcompositions.
CONCLUSIONS:These findings suggest multiple associations between traffic noise exposure andmetabolites. We will conduct a multi-cohort analysis in the LongITools to further examine theassociations.

Keywords: road, rail and air traffic noise exposure, NMR metabolomics

OP-082[Air pollution » Short-term exposure]

Influence of air pollution and climate variability
on dengue in Singapore – A time-series analysis
Diyar Mailepessov, Janet Ong, Joel Aik
Environmental Health Institute, National Environemtn Agency of Singapore

BACKGROUND AND AIM:The associations between air quality and respiratory and cardiovascular
health outcomes have been well examined. Less conclusive are studies assessing the relationshipbetween air quality and dengue, a mosquito-borne illness which continues to pose a risk to more thanhalf the world’s population. We examined this relationship in Singapore, a tropical city-state located in
the South-East Asian region where the burden of dengue is among the highest across the globe.
METHOD:Assuming a negative binomial distribution, we analyzed the short-term associations between
all laboratory-confirmed dengue reports and variations in PM2.5, PM10, CO, O3, NO2 and SO2 in
Singapore from 2009 to 2019 using the Distributed Lag Non-linear Model (DLNM) framework. We
accounted for the effects of long-term trend, seasonality, day-of-the week effects, the immediate andlagged effects of ambient temperature and air quality, and changes in human population size.
RESULTS:PM2.5 (RR90th percentile: 1.28, 95% CI: 1.11,1.49), PM10 (RR90th percentile: 1.30, 95%
CI: 1.12, 1.51), and CO (RR90th percentile: 1.30, 95% CI: 1.06, 1.61), were positively associatedwith dengue up to a period of 48 days with observed maximum threshold effects, while O3 and NO2
were negatively associated with dengue. There was a positive, non-linear association between ambient
temperature and dengue. We observed strong evidence of ambient temperature modifying theassociation between particulate matter and dengue risk. Our results remained resilient in sensitivity
analysis.
CONCLUSIONS:In conclusion, particulate matter and carbon monoxide concentrations exhibited apositive association with dengue reports. Variations in the concentrations of these air pollutant species
may inform short-term dengue control resource augmentation plans.

Keywords: Dengue, PM2.5, PM10, Air quality, TemperatureOP-083[Climate » Temperature]

Ambient Temperature and Preeclampsia: A
Historical Cohort Study
Iaroslav Youssim1, Offer Erez2, Lena Novack3, Daniel Nevo4, Itai Kloog5, Raanan Raz1
1Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem,

Jerusalem, Israel
2Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheba, Israel &Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
3Soroka University Medical Center, Israel, Ben-Gurion University of the Negev, Beer Sheba, Israel
4Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
5The Department of Geography and Environmental Development, Ben-Gurion University of the Negev,

Beer Sheba, Israel

BACKGROUND AND AIM:Previous studies found inconsistent associations between ambient
temperature during pregnancy and risk of preeclampsia. If such associations are causal, they may
have an impact on the future burden of preeclampsia in the context of climate change. The aim of thisstudy was to estimate the association between the exposure to ambient temperature during
pregnancy and incidence of early- and late-onset preeclampsia, and to identify critical exposure
periods.
METHOD:This is a historical cohort of 130,340 pregnancies (5,142 preeclampsia cases) from southern
Israel, merged with temperature assessments from a hybrid satellite-based exposure model. We used
distributed-lag and cause-specific hazard models to study time to preeclampsia, and identify critical
exposure periods.
RESULTS:We found a positive association between temperature and preeclampsia during the entire
gestation period, which was stronger in the 3rd trimester. The associations existed with both earlyand late-onset preeclampsia; however, the associations with early-onset disease were somewhat
stronger, limited to the first weeks of pregnancy and third trimester, and with larger confidence
intervals.
CONCLUSIONS:Exposure to high temperatures at the beginning and, particularly, the end of gestation,is associated with increased risk of preeclampsia in southern Israel.

Keywords: pregnancy outcomes, environmental epidemiology

OP-084[Climate » Health co-benefits]

The role of built environment on the healtheffects of ambient temperature: Systematic
review of the literature
Magda Cepeda, Gabriela Negrete Tobar, María Camila León Sanabria
Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá DC,
Colombia

BACKGROUND AND AIM:Emerging evidence suggests that built environment atributes can modify
climate change-related health effects, thus leading to a geographical distribution of these effects andto potential leveraging factors for climate adaptation and mitigation efforts.
METHOD:In this systematic review, we searched four online databases (Pubmed, EMBASE, BVS,
Google Scholar) from inception to March 8, 2023, without language or temporal restrictions forobservational studies (cohort, cross-sectional, case-control, and before and after) or ecological studies(before and after, time series, etcetera) that assessed the effect modification of climate-changerelated health effects according to build environment atributes or air pollution, irrespective of theoutcomes being assessed. We excluded studies that addressed indirect outcomes, such as the effecton vectors for vector-borne diseases. Study selection was conducted in duplicate. Currently, the study
is on extraction phase. From each study, we will extract descriptive information and association
measurements (absolute or relative) along with sample size. For each effect modification, we will
extract crude and adjusted or interaction measurements. A qualitative summary will be conducted, as
considerable heterogeneity is expected. The literature will be described in relation to studies
characteristics, critical appraisal, and according to built environment attributes.
RESULTS:We identified 7,533 results, of which 325 were selected for full-text apparisal and 169 were
included; 98 were published after 2020. The most frequent outcome is all-cause mortality. The urban
attributes most frequently assessed were air pollution and green spaces. Most studies are conductedin Europe and China.
CONCLUSIONS:There has been an steep increase in the literature that addresses the effectmodification of climate-related health effects due to built environment and air pollution. A better
understanding of the role of these attributes helps to identify vulnerable population and sources ofenvironmental inequality, and to identify attributes that can be levareged for climate adaptation andmitigation efforts to achieve maximizing health co-benefits.

Keywords: Built environment, Climate, Health co-benefits, Air pollution, Mortality, TemperatureOP-085[Methods » Environmental epidemiology]

Bayesian-spatial distributed lag non-linear
models: A temperature-mortality case study inBarcelona
Marcos Quijal Zamorano1, Miguel A. Martinez Beneito2, Joan Ballester3, Marc Marí Dell’olmo4
1ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
2Departament d’Estadística i Investigaciò Operativa, Dr. Moliner 50, 46100, Burjassot, Valencia, Spain
3ISGlobal, Barcelona, Spain
4Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023 Barcelona, Spain; Institutd’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain;
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte
de Lemos, 3-5, 28029 Madrid, Spain

BACKGROUND AND AIM:In the context of climate change, the interest in the health effects ofenvironmental exposures has remarkably increased. The development of the distributed lag non-linear
models (DLNM) has become rapidly the referent framework when studying temperature-mortality
short-term associations. DLNMs facilitates the modelling of the non-linear and lagged effect oftemperatures on mortality. However, the small-area analysis of temperature-mortality is still scarce.
METHOD:In that sense, here we present four models. The first two models generalize standard DLNMs
to a Bayesian framework, using a case-crossover design (model 1) and the common DLNM time-seriesconfiguration, where time trend and seasonality are modelled by using splines (model 2). We propose
models 3 and 4 specifically for dealing with unstable estimates from small numbers in small-area
analyses. These two models are extensions of model 1 and model 2 respectively, where we use Leroux
models to spatially-smooth in one-stage approaches the coefficients of the exposure-response
relationships for each small area. We apply all proposed models to a case-study for assessing thetemperature-mortality relationships in the 73 neighborhoods of Barcelona during summer months.
39.569 deaths were considered in the period 2007-2016, 19 of them corresponding to theneighborhood with the lowest number of deaths.
RESULTS:Curves defining the relative risks of mortality were unstable and unreliable in the
independent models, with regions with extremely high and low risks distributed all over the city.
Spatial models benefit from adjacent regions to smooth the association and reveal hidden spatial
patterns of risk. In addition, the flexibility of these Bayesian models allowed us to explore the resultsof these epidemiological models in new intuitive ways.
CONCLUSIONS:This novel multidimensional approach brings the opportunity to estimate ecologicaltemperature-mortality models in a smaller spatial scale to better understand the socioeconomic andbuilt environment factors driving the effect of temperature on human health.

Keywords: Spatial statistics, Environmental epidemiology, Modeling, Mortality, TemperatureOP-086[Climate » Temperature]

The Impact of Temperature and Relative
Humidity on Ventricular Arrhythmias in Patientswith Implanted Cardiac Devices in North
Carolina, 2010-2021
Stephanie E Cleland1, Lindsey Rosman2, K. Lloyd Hill3, Anthony J Mazzella2, Cavin Ward-Caviness3,
Ana G Rappold3
1Center for Public Health and Environmental Assessment, US EPA, Chapel Hill, North Carolina, USA;

Department of Environmental Sciences & Engineering, UNC-Chapel Hill, Chapel Hill, North Carolina,
USA
2Division of Cardiology, UNC School of Medicine, Chapel Hill, North Carolina, USA
3Center for Public Health and Environmental Assessment, US EPA, Chapel Hill, North Carolina, USA

BACKGROUND AND AIM:Medical professionals are considering ways to use remote monitoring to
identify at-risk populations, reduce outcome disparities, and provide timely interventions to vulnerable
patients. We examined the effect of climate change-relevant warm season weather conditions on therisk of potentially life-threatening arrhythmias [ventricular tachycardia (VT)/ventricular fibrillation(VF)] in patients with implanted cardiac devices.
METHOD:We used remote monitoring data on daily VT/VF occurrence in the one year following cardiac
device implantation in 526 patients enrolled in the University of North Carolina Cardiovascular Device
Surveillance Registry between 2010-2021. Local average temperature and relative humidity (RH)
exposure during mid-April to mid-October was estimated using weather station data. Associations
between meteorology and VT/VF occurrence, overall and by demographic and neighborhood
characteristics, were estimated using a case time series design with distributed lag non-linear models.
Models were adjusted for temporal trends and physical activity.
RESULTS:VT/VF events occurred on 1,404 of the 96,144 person-days. Temperature was not
associated with VT/VF, nor did it confound the association with RH. In contrast, high RH increased
VT/VF risk in the 1-2 days following exposure. When RH increased from the median (73.8%) to the95th percentile (90.0%), the odds of VT/VF occurring the next day increased by 11.7% (95% CI:
3.4%, 20.7%). Patients in neighborhoods with low urbanicity and high area deprivation, as well as
male, older (>65yr), and white patients, had an elevated risk of VT/VF when exposed to high RH.
CONCLUSIONS:Exposure to humid conditions during the warm season increased risk of VT/VF inpatients with implanted cardiac devices, with key differences by individual- and area-level
characteristics. Additional research in larger populations is needed to determine generalizability ofthese findings. Remote monitoring data may provide opportunities to increase resilience and reduce
inequalities in patient outcomes. This work was supported by an ORISE fellowship and does notnecessarily reflect EPA policy.

Keywords: Cardiovascular diseases, Short-term exposure, Environmental epidemiology, Built
environment, Temperature extremesOP-087[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Ambient Temperature and Nervous System
Diseases-related Mortality in Japan from 2010
to 2019: A Time-Stratified Case-Crossover
Analysis
Szu Yu Lin1, Chris Fook Sheng Ng2, Yoonhee Kim3, Zin Wai Htay1, Alton Quan Cao1, Rui Pan3,
Masahiro Hashizume2
1Department of global health policy, Graduate school of medicine, The University of Tokyo, Tokyo,

Japan
2Department of global health policy, Graduate school of medicine, The University of Tokyo, Tokyo,

Japan & School of tropical medicine and global health, Nagasaki University, Nagasaki, Japan
3Department of global environmental health, Graduate school of medicine, The University of Tokyo,

Tokyo, JapanBACKGROUND AND AIM:Despite the substantial disease burden caused by nervous system diseases,
few studies have examined the association between ambient temperature and nervous systemdiseases, especially during cold seasons. Evidence for specific disease subgroups such as Alzheimer's
and Parkinson's is also lacking. This study examined the association between short-term changes inambient temperature and nervous system diseases-related mortality in ten Japanese prefectures from
1 January 2010 to 31 December 2019.
METHOD:A two-stage analysis based on a time-stratified case-crossover study design was conducted.
A conditional quasi-Poisson regression model with a distributed lag non-linear model for temperature
was applied followed by a multivariate random-effects meta-analysis to obtain average associations.
Mortality due to all and cause-specific nervous system diseases (major neurodegenerative diseases,
Alzheimer's, and Parkinson's) were analyzed, with consideration for sex and age (0–84 and 85+ years
old) subgroups.
RESULTS:We analyzed 162,315 death cases due to nervous system diseases. Cold was associatedwith all categories of nervous system diseases-related mortality, but not heat. The estimated relative
risks for cold, obtained by comparing the 2.5th percentile of daily mean temperature distribution to
the minimum mortality temperature (MMT), were 1.43 (95 % CI: 1.28–1.60), 1.37 (95 % CI: 1.17–
1.59), 1.53 (95 % CI: 1.07–2.01), and 1.54 (95 % CI: 1.13–2.10) for all nervous system diseases,
major neurodegenerative diseases, Alzheimer's, and Parkinson's, respectively. These associations
were also observed in the sex and age subgroups in general but without evidence of effectmodification. Heat (the 97.5th percentile of daily mean temperature distribution vs. MMT) was
associated with Parkinson’s disease-related mortality among those aged 85 years and over.
CONCLUSIONS:Cold was associated with an increased risk of nervous system disease-related
mortality. The effect of heat was not observed, except for mortality among the elderly aged 85 years
and older with Parkinson's disease.

Keywords: Temperature, Mortality, Other(elderly), Other(Japan),Other(delayed effects)

OP-089[Birth and pregnancy outcomes » Pregnancy outcomes]

Association between urinary parabens andmaternal thyroid hormones by different
trimesters in pregnant Taiwanese women (TBCS)Hsi Chen1, Jung Wei Chang1, Hsin Chang Chen2, Wan Ting Chang3, Po Chin Huang3
1Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan.
2Department of Chemistry, Tunghai University, Taichung, Taiwan.
3National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

TaiwanBACKGROUND AND AIM:Parabens are widely used as preservatives in various personal care products,
pharmaceuticals, and foodstuffs. Previous studies had already linked parabens exposure to thyroid
dysfunction in pregnant women, however the data of Taiwan pregnant women were few. So, we aimed
to investigate the background level of urinary paraben in pregnant women in southern Taiwan andestimate the correlation between parabens concentration and thyroid hormone in different trimester.
METHOD:A total of 97 pregnant women were recruited at a medical center between 2013 and 2014.
Urine and cord blood samples were collected in three trimesters. Analyzed four types of parabens
including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) by
using LC-MS-MS. The cord and maternal serum levels of T4, free T4, T3, TSH, and thyroxine-binding
globulin (TBG) were measured using an electrochemiluminescence immunoassay.
RESULTS:The urinary MeP and PrP were the main compounds in all parabens from 97 pregnant
women in different trimesters. The median and 95% CI of urinary MeP in the third trimester was 513
ng/mL [95%CI: 413-679], followed by PrP in the second trimester [130 ng/mL; 109-156]. The MeP
was 5.5 times higher than US pregnant women from NHANES (789.0 vs 143.58 μg/g creatinine). Even
the lowest paraben was detected in BuP, which is still more than 100 times higher than other Asian
countries. After adjusting the confounder, urinary Ln-EtP (ln-transformed) was negative associate with
Ln-TBG (β=0.119, P=0.037) in third trimester, also Ln-BuP had a positive association between Ln-T3
and Ln-T4 (β=0.109, P=0.096; β=0.065, P=0.099). Moreover, we observed a positive association
between Ln-MeP and Ln-TBG (β=0.147, P=0.054) at second trimester, which means 1% increase in
Ln-MeP was associated with 14.7% increase in Ln-TBG.
CONCLUSIONS:For this study cohort, we observe high concentration of parabens exposure, alsopregnant women exposure to parabens in different trimester may alter thyroid hormone indicatorhomoeostasis.

Keywords: Endocrine disrupting chemicals, Pregnancy outcomes, Exposure assessment-biomarkers of
exposureOP-090[Reproductive outcomes » Male reproductive outcomes]

Mixtures of phenol and phthalate exposure
biomarkers in relation to semen parameters
among men from a fertility clinic
Lidia Minguez Alarcon1, Maximilien Génard Walton2, Glen L Mcgee3, Paige Williams4, Ramace B
Dadd5, Jennifer E Ford6, Jorge Chavarro7, Irene Souter8, Russ Hauser9
1Univ Rennes, Inserm, EHESP, Irset, Rennes, France.
2Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
3Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston,USA.
4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA.
5Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
6Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston,MA
7National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, USA.
8Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health,Boston, USA.
9Channing Lab, Harvard Medical School and Brigham and Women’s Hospital, Boston, USA.

BACKGROUND AND AIM:Epidemiologic studies on the associations of urinary phenols and phthalate
metabolites, as a mixture, with semen quality are rare. We examined whether mixtures of urinary
concentrations of bisphenol A, methylparaben, propylparaben and several phthalate metabolites wererelated to semen parameters among men from a fertility center (2004-2017).
METHOD:This study included 420 men who contributed 875 paired urine and semen samples(median=2, range=1-8 sample per person). Semen parameters (volume, concentration, total count,total motility, normal morphology) were measured following WHO guidelines. We estimated the joint
effects of the chemical biomarker mixture on the semen parameters applying quantile g-computation
with robust standard errors to account for within-man exposure-outcome correlations and weights toaccount for the informative difference in the number of repeated measures per participant. We
adjusted models for age, BMI, race, education, physical activity, history of varicocele, year of sample
collection, abstinence time and specific gravity.
RESULTS:The 420 men had a median (IQR) age of 36.5 (32.8; 39.4) years and body mass index(BMI) of 26.9 (24.5; 29.6) kg/m². Median (IQR) sperm concentration, total count and motility were
59.2 (27.9; 103.1) mil, 136.1 (66.8; 254.4) mil/mL, and 47 (28; 64) %, respectively. A quartile
increase in urinary concentrations of the chemical exposure biomarker mixture was not associatedwith ejaculated volume (Beta = -0.067, 95% CI = -0.237, 0.102), sperm concentration (Beta =0.040, 95% CI = -0.013, 0.093), total sperm count (Beta = 0.004, 95% CI = -0.058, 0.065), motility(Beta = 1.14, 95% CI = -2.31, 4.58) or percent with normal morphology (>4%) (Beta = -0.012, 95%

CI = -0.060, 0.037).
CONCLUSIONS:Overall, we observed no associations between the urinary chemical exposure
biomarker mixture and semen parameters. Further studies are needed to corroborate these findings
among other men and to evaluate mixtures of phenol and phthalate replacements.

Keywords: Phenols, Phthalates, Semen, Mixtures, quantile-g computation.

OP-091[Omics technologies » Metabolomics]

Association of the phthalate level and perturbed
lipid profiles in a Taiwanese child cohort
Sheng Han Lee1, Wei Chen Tseng2, Wan Yu Lin3, Yue Leon Guo4, Pau Chung Chen4, Ching Yu Lin5
1School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan3Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan

University, Taipei, Taiwan; Master of Public Health Degree Program, College of Public Health, National
Taiwan University, Taipei, Taiwan
4Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taipei,
Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes,
Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University
Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
5Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,

Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taipei,
TaiwanBACKGROUND AND AIM:Phthalates are one of the important environmental hormones. However, theadverse health effects and mechanism in response to phthalate in children were not fully elucidated.
The aim of this study was to examine associations between urinary phthalate level and the serum
lipidome in a Taiwanese children population.
METHOD:In this study, 256 children (average 9-year-old) from two individual Taiwanese cohorts wereenrolled. A high-performance liquid chromatography/mass spectrometry (LC/MS) was used to monitor
the 12 phthalate metabolites in child urine. Meanwhile, the serum lipid profiles, which focused on
phosphatidylcholine (PCs) and sphingomyelin (SMs), of children were assessed by a LC/MS-based
lipidomic approach. The partial least squares analysis and multiple linear regression analysis wereused to suggest the critical phthalate exposure and to examine the relationship of phthalate exposureand lipid responses in children.
RESULTS:Our results showed that mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl5-oxohexyl) phthalate, and monoethyl phthalate were most common phthalates existed in Taiwanesechild urine (over 90% detection rate). The results of partial least squares analysis revealed that the
MEHHP level were associated with the distinct lipid profiles among the total of 12 phthalates. The
results of multiple linear regression showed that increased diacyl-PCs and lyso-PCs, as well as
decreased ether-linked PCs (including O-alkyl-acyl-PCs and O-alkenyl-acyl-PCs) and SMs werecorrelated with a higher MEHHP exposure.
CONCLUSIONS:These lipid changes may be associated with very low-density lipoproteins secretion,
pro-inflammatory effects, anti-oxidative capacity, and neurotoxicity. Our results suggested that Di(2ethylhexyl) phthalate, the parent compound of MEHHP, exposure may cause systemic lipid
perturbation in children, which may be involved in several important physiological function. In
addition, the lipidomic approach is a powerful tool to monitor health effects in response toenvironmental levels of toxicants in human population.

Keywords: Endocrine disrupting chemicals, Phthalates, Children's environmental health, other(lipidomics)

OP-092[Chemical exposures » Phenols]

Urinary concentrations of phenols/parabens andchanges in body size and composition: The
Study of Women’s Health Across the Nation(SWAN)
Seulbi Lee1, Carrie Karvonen Gutierrez1, William H. Herman2, Bhramar Mukherjee3, Sung Kyun Park1
1Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan,

United States
2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, UnitedStates3Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan,

United States

BACKGROUND AND AIM:Phenols and parabens widely used in personal care products are consideredobesogens but evidence of the link between these chemicals and adiposity markers is scant. We
examined the associations of urinary concentrations of phenols and parabens with longitudinalchanges in body size and composition in midlife women.
METHOD:This study included 1,393 women aged 45-56 years in 1999-2000 from the Study of
Women’s Health Across the Nation Multi-Pollutant Study (SWAN-MPS). Body weight, waist
circumference, and proportion fat mass were measured at near-annual visits from 1999 to 2006.
Urinary concentrations of bisphenols, triclosan, 2,4-dichlorophenol, 2,5-dichlorophenol,
benzophenone-3, and parabens were measured at SWAN-MPS baseline (1999-2000) and three years
later (2002-2003), the mid-point of follow-up. Generalized additive mixed effects models with splinesof time were fitted to capture non-linear trajectories of body size and composition. We computed thepredicted means of adiposity measures at baseline, 3 years and 5 years and computed the difference
in means by tertiles of phenols and parabens.
RESULTS:The predicted means of waist circumference at 5 years of follow-up were higher in thehighest tertile vs. the lowest tertile for 2,4-dichlorophenol (difference=0.55cm, 95% CI: 0.07 to1.03); triclosan (difference=0.50cm, 95% CI: 0.02 to 0.98); and benzophenone-3(difference=0.43cm, 95% CI: -0.05 to 0.91), although there were no differences in means at baseline.
We also observed a significant difference in mean of body weight between the highest vs. lowest
tertiles of 2,4-dichlorophenol (difference=0.69kg, 95% CI: 0.27 to 1.11) at 5 years of follow-up. We
found a borderline significant difference in mean of proportional fat mass for 2,4-dichlorophenol(difference=0.18, 95% CI: -0.05 to 0.41) at 3 years of follow-up, but the difference was attenuatedand not significant at 5 years of follow-up.
CONCLUSIONS:Our findings suggest potential obesogenic effects of 2,4-diclorophenol, 2,5diclorophenol, triclosan, and benzophenone-3 among mid-life women.

Keywords: Phenols, body composition, body weight, midlife women, longitudinal studyOP-093[Chemical exposures » Endocrine disrupting chemicals]

Exposure assessment of the relationshipbetween urinary paraben and early renal injury ina middle-aged adult population in Taiwan
Yen Hsuan Huang1, Jung Wei Chang1, Po Chin Huang2, Shih Hao Leung1, Wan Ting Chang2
1Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

TaiwanBACKGROUND AND AIM:Parabens are a class of preservatives used in the cosmetics industry and arewidely used in personal care products (PCPs), pharmaceuticals and food. Epidemiological studies
concerning the relations of exposure to parabens with renal function were limited. Our aims are toinvestigate the potential sources of paraben exposure, estimate the daily intake (DI) of four parabens
based on their urinary levels and evaluate association between urinary paraben and renal function in a
middle-aged adult population in Taiwan.
METHOD:We recruited 591 subjects aged from ≥40 to <65 years old (yrs) who have participated in
Taiwan Environmental Survey for Toxicants study from 2013-2016. Urinary parabens including
methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) have been
analyzed by liquid chromatography/ tandem mass spectrometry. The cross-sectional analysis of theassociation between urinary paraben and biomarkers of renal function have also been established.
RESULTS:The median of urinary paraben levels were 442, 42.9, 107 and 5.92 μg/L in MeP, EtP, PrP
and BuP, respectively, which were also 10 times higher than other countries. Subjects aged from ≥55
to <65 yrs had higher urinary MeP, EtP levels and DI than those aged from ≥40 to <55 yrs. The
median of DI was higher in lotion, perfume and nail polish users than those seldom used. However,there were no significant difference between two aged groups, DI and PCPs usage, or the cumulative
usage of PCPs by gender. The median of creatinine, microalbumin, urinary protein and uric acid weresignificantly higher in men than in women, the albumin to creatinine ratio was significantly higher inwomen than in men.
CONCLUSIONS:The urinary paraben concentration of middle-aged adults in Taiwan was significantly
higher than those in US, Canada, and Korea. There was no significant difference among paraben
levels, age and gender. PCPs usage was a source of paraben exposure.

Keywords: Chemical exposures, Endocrine disrupting chemicals, Exposure assessment, Biomarkers of
exposureOP-094[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Exposure to greenspace and ADHD in thecontext of physical activity, neighborhood safety
and neighborhood cohesion: Analysis in Polishchildren
Dorota Buczyłowska1, Nitika Singh2, Clemens Baumbach1, Jakub Bratkowski3, Yarema Mysak1, Maja
Wierzba Łukaszyk1, Katarzyna Sitnik Warchulska4, Krzysztof Skotak3, Małgorzata Lipowska5,
Bernadetta Izydorczyk1, Marcin Szwed1, Iana Markevych6, Angel M. Dzhambov7
1Institute of Psychology, Jagiellonian University, Krakow, Poland
2Institute of Psychology, Jagiellonian University, Krakow, Poland; Doctoral school of social sciences,

Jagiellonian University, Krakow, Poland
3Institute of Environmental Protection-National Research, Warsaw, Poland
4Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian

University, Krakow, Poland
5Institute of Psychology, University of Gdansk, Gdansk, Poland; Faculty of Management and Social

Communication, Institute of Applied Psychology, Jagiellonian University, Krakow, Poland
6Institute of Psychology, Jagiellonian University, Krakow, Poland; Research group “Health and qualityof life in a green and sustainable environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
7Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria;

Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz,
Austria; Research group “Health and quality of life in a green and sustainable environment”, SRIPD,
Medical University of Plovdiv, Plovdiv, Bulgaria

BACKGROUND AND AIM:Previous research has shown a protective association between greenspace
exposure and attention deficit hyperactivity disorder (ADHD) in children. However, none of theprevious studies examined potential pathways relevant for this association. Our study aimed to
examine whether there is an association between tree/grass cover and availability of garden and
ADHD diagnosis, and whether greenspace perception, physical activity, neighborhood safety andneighborhood social cohesion play a role in this association.
METHOD:Data was obtained from the case-control NeuroSmog study, in which children with andwithout ADHD were enrolled. Analytic sample consisted of 696 children aged 10 to 13 years.
ADHD diagnosis was established or ruled out according to the International Classification of Diseases
11th Revision (ICD-11) criteria. Parents reported information about the mediators and the availabilityof domestic garden via questionnaires. Tree and grass cover were extracted in 500m Euclidean buffers
around lifelong residences. Structural equation modeling was used to examine the pathways and theirinterplay linking the three greenspace measures to ADHD.
RESULTS:We found that greenspace was indirectly related to ADHD diagnosis: tree cover was
positively related to both perceived greenspace and physical activity, and physical activity was
subsequently negatively related to ADHD diagnosis. Moreover, garden was positively related toperceived greenspace, which in turn was related to neighborhood social cohesion. Neighborhood safety
was positively related to both perceived greenspace and neighborhood social cohesion.
CONCLUSIONS:Greenspace was only indirectly related to ADHD diagnosis in Polish schoolchildrenthrough physical activity. Increased physical activity may have a protective role in the context ofADHD for this age group.

Keywords: Green space, ADHD, physical activity, neighborhood cohesion, neighborhood safetyOP-095[Built environment » Green space]

Association between green space exposure andliver enzymes in adult workers: A longitudinalcohort study
Kanawat Paoin1, Chanathip Pharino1, Prin Vathesatogkit2, Arthit Phosri3, Suhaimee Buya4, Krittika
Saranburut5, Kayo Ueda6, Xerxes Tesoro Seposo6, Thammasin Ingviya7, Taya Kitiyakara2, Nisakron
Thongmung8, Piyamitr Sritara2
1Department of Environmental Engineering, Faculty of Engineering, Chulalongkorn University,

Bangkok, Thailand
2Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University,

Bangkok, Thailand
3Department of Environmental Health Sciences, Faculty of Public Health, Mahidol University, Bangkok,

Thailand4School of Information, Computer and Communication Technology, Sirindhorn International Instituteof Technology, Thammasat University, Pathum Thani, Thailand
5Cardiovascular and Metabolic Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University,

Bangkok, Thailand
6Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
7Medical Data Center for Research and Innovation, Faculty of Medicine, Prince of Songkla University,

Songkhla, Thailand
8Research center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

BACKGROUND AND AIM:A previous study found a negative association between cord blood levels of
liver enzymes and green space exposure during pregnancy. However, studies on such an association
with adult liver enzyme levels are currently nonexistent. We investigated associations between longterm green space exposure and serum liver enzymes [aspartate aminotransferase (AST) and alanine
aminotransferase (ALT)] in adult workers of the Electricity Generating Authority of Thailand (EGAT) in
the Bangkok Metropolitan Region (BMR), Thailand.
METHOD:We conducted secondary analyses using data from 2,022 individuals (aged 25 to 55 as of2009) in the EGAT3 cohort study from 2009 to 2019. Serum liver enzymes were measured in 2009,2014, and 2019. The Normalized Difference Vegetation Index (NDVI), obtained from satellite data,
was used to measure the level of greenness. The Kriging method was used to determine the average
concentration of each air pollutant (PM10, O3, NO2, SO2, and CO). In this study, average NDVI and
air pollutant concentrations were used at the sub-district level in BMR from 2008 to 2019. Eachparticipant was exposed for an average of one year prior to their follow-up date. We used linear mixed
effects models to assess the associations of NDVI with AST and ALT. We also tested the robustness of
the results by adding air pollutants to the models.
RESULTS:Interquartile range increase in NDVI was associated with lower AST [-2.18% (95%CI: -3.74,-0.60)] after relevant confounders were controlled. The association between NDVI and AST was
influenced by air pollutants, especially SO2. In contrast, we observed no association between NDVI
and ALT.
CONCLUSIONS:There was an inverse association between NDVI and AST but not ALT in the EGAT
cohort of adult workers. Air pollution has a significant impact on the association between NDVI and
AST. Further studies in other settings and populations are required to confirm our findings.

Keywords: Long-term exposure, green space, air pollution, liver enzymes

OP-096[Built environment » Green space]

Associations between greenness and rhinitis in
the Constances cohort
Marine Savouré1, Rose Altucher2, Emeline Lequy3, Jean Bousquet4, Marcel Goldberg3, Bénédicte
Leynaert5, Céline Ribet3, Marie Zins3, Rachel Nadif5, Bénédicte Jacquemin2
1Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d’Epidémiologie Respiratoire

Intégrative, CESP, Villejuif, France; French Environment and Energy Management Agency 20, avenue
du Grésillé, Angers, France
2Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, Rennes, France
3Université Paris-Saclay, Université de Paris, UVSQ, Inserm, Cohortes Epidémiologiques en population,

UMS 11, Villejuif, France
4Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Comprehensive

Allergy Center, Department of Dermatology and Allergy, Berlin Institute of Health, Berlin, Germany;
Centre Hospitalier Universitaire, Montpellier, France; MASK-air, Montpellier, France
5Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d’Epidémiologie Respiratoire

Intégrative, CESP, Villejuif, France

BACKGROUND AND AIM:Rhinitis is one of the most common diseases, for which environmental factors
probably play a role. Among them, greenness could be a potential protective or deleterious factor, andthese relationships may differ according to the degree of urbanicity. Furthermore, the associations
could be different between allergic rhinitis (AR) and non-allergic rhinitis (NAR) phenotypes, but nostudy has investigated the effect of greenness exposure on NAR. Our aim was to investigate theassociations between greenness exposure and rhinitis among adults from the population-based cohort
Constances.
METHOD:Questionnaire responses at inclusion (2012-2019) were used to define current rhinitis (CR),allergic (AR) and non-allergic rhinitis (NAR). Greenness exposure was estimated using Normalized
Difference Vegetation Index (NDVI) within 300 meter around each participant’s residential address.
Cross-sectional analyses were all stratified by urban unit defined by the French National Institute of
Statistics and Economic Studies (Insee), as greenness decreases with increasing urbanicity. Logistic
models adjusted for age, sex, smoking status, education level and French deprivation index wereused. Main analyses were performed as complete cases. Sensitivity analyses were conducted using
marginal model, multiple imputations, and with other NDVI buffers.
RESULTS:Among the 168,787 participants included in the analyses, 35.4% had CR, 24.6% AR, and10.8% NAR. An increase of 0.10 NDVI was significantly associated with a decreased risk of CR incenter cities (OR: 0.95 (95%CI: 0.94-0.97)), isolated cities (0.91 (0.88-0.94)), and suburban areas(0.94 (0.92-0.95)) and for both AR and NAR. No significant association was found in rural areas for CR
and for either AR or NAR. These results remained consistent in sensitivity analyses.
CONCLUSIONS:Exposure to greenness was associated with a decreased risk of rhinitis in urban areas
and thus could be a potential lever for public-health policies to reduce rhinitis prevalence.

Keywords: Environmental epidemiology, Green space, Respiratory outcomes, Allergies, Built
environmentOP-097[Neurologic and mental health outcomes » Mental health outcomes]

Effects of urban green land use types onparental depression and anxiety during
pregnancy
Ming Lun Zou1, Chi Da Wu2, Hsing Chao1, Wen Yi Lin3, Hsueh Wen Hsu1, Yi Hua Chen1
1School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
3Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical

University and National Health Research Institutes, Taipei, Taiwan

BACKGROUND AND AIM:While residential green spaces have been shown to have beneficial effects on
mental health, few studies have examined their impact on parental mental health during pregnancy,
particularly in urban areas. This study aims to examine the association between urban green land use
types (UGLUTs) and parental depression and anxiety during each trimester, using data from an
ongoing cohort study: the Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan.
METHOD:We analyzed participants who were recruited between January 2011 and March 2020 during
their prenatal visits and lived in the Greater Taipei Area. Parental depression and anxiety status were
evaluated at each trimester using the Edinburgh Postpartum Depression Scale and the State-Trait
Anxiety Inventory-State scale, respectively. UGLUTs, which includes school, park, and forest area,
were estimated within a designated radius surrounding participants' residences. Multiple regressions
were used for examination.
RESULTS:A total of 1,116 couples were included in the analysis. During each trimester, mothers
reported higher levels of depression and anxiety than fathers. In final models, we observed school
areas (per 1 km² increased, β=-3.38 (95% C.I.= (-5.16, -1.6)) were beneficial for maternal
depression during the first trimester, while park areas (per 1 km² increased, β=-16.01 (95% C.I.= (23.92, -8.10) at the first trimester, and β=-16.45 (95% C.I.= (-24.16, -8.74) at the second trimester)
were beneficial for maternal anxiety. Although, forest areas were beneficial for paternal depression
and anxiety, no significant was observed.
CONCLUSIONS:Our results provide valuable insights into the relationship between green space andparental mental health during pregnancy in an urban setting, highlighting the important role of urban
green spaces in promoting maternal mental health.This work was supported by National Science andTechnology Council, Taiwan (MOST111-2314-B038-043-MY3, MOST108-2314-B-038-083-MY,
MOST105-2314-B-038-031-MY3, NSC102-2314- B-038-038-MY3, NSC99-2628-B-038-015-MY3).

Keywords: Green space, mental health, parents

OP-098[Built environment » Green space]

Associations between neighbourhood green
space and multiple birth outcomes across two
metropolitan areas in Australia
Tingting Ye, Yiwen Zhang, Gongbo Chen, Zhengyu Yang, Yuming Guo, Michael J Abramson, Shanshan
Li
Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC 3004, Australian

BACKGROUND AND AIM:Beneficial effects of green space on birth outcomes have been reported.
However, insights on key windows of exposure and underlying mechanisms are needed.
METHOD:Births in Sydney (2016–2019) were retrieved from NSW Midwives Data Collection. Births in
Brisbane (2000–2014) were retrieved from Queensland Health Perinatal Data Collection. Satellite
image-derived normalized difference vegetation index (NDVI) and night time light (NTL) index wereused. For each city, linear regression models were used to assess associations between green spaceand birth weight, and logistic models to estimate the risks of preterm birth (PTB), low birth weight(LBW), and small for gestational age (SGA) per interquartile range (IQR) increase in NDVI. We
examined the trimester-specific associations, and heterogeneities by exposure to night time light.
RESULTS:The study included 193264 singleton births in Sydney and 155606 singleton births in
Brisbane. An IQR increase in green space during whole pregnancy was associated with 25.6 g (95%CI
21.4 to 29.8) increase in birth weight in Sydney, and 12.1 g (9.48 to 14.6) in Brisbane. The odds
ratios were 0.96 (95%CI 0.94 to 0.99) for LBW, 0.98 (0.95 to 1.01) for PTB, and 0.96 (0.93 to 0.98)
for SGA per IQR increase in NDVI during whole pregnancy for participants in Sydney. Similarly,
reduced odds of adverse birth outcomes were observed in Brisbane. Trimester specific models
demonstrated a consistent pattern of associations in the same direction across all outcomes. We foundthat effects of green space exposure on birth outcomes attenuated after adjusting for NTL, but
stronger effects among babies of mothers from areas with more NTL.
CONCLUSIONS:These findings suggest a beneficial association between neighbourhood green spaceand healthier pregnancies in urban areas. We provide novel evidence of interactions between green
space and NTL.

Keywords: green space, birth weight, preterm birth, small for gestational age, night time lightOP-099[Exposure assessment methods » Risk assessment]

Health risk assessment of PM2.5 and PM2.5bound trace elements in Pretoria, South Africa
Chantelle Howlett Downing1, Peter Molnár2, Johan Boman3, Joyce Shirinde1, Janine Wichmann1
1School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa2Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska

Academy, University of Gothenburg, Sweden
3Department of Chemistry and Molecular Biology, Atmospheric Science Division, University ofGothenburg, Sweden

BACKGROUND AND AIM:In Africa, there is a shortage of studies that assess the risks of air pollution
on human health. A study was therefore conducted in Pretoria, South Africa, employing the health risk
framework of the US EPA.
METHOD:PM2.5 samples were collected on PTFE filters over 24 hours and every third day at an urban
background site during 16 April 2017 to 28 February 2020 (n=350). X-ray fluorescence was used toanalyse the elemental composition. The study was carried out for total PM2.5 and the eight traceelements (Br, Cl, K, Ni, S, Si, Ti and U) for which the United States Environmental Protection Agency(US EPA) lists reference concentrations. The World Health Organization (WHO) air quality guideline of
5 µg/m3 and the yearly South African National Ambient Air Quality Standard of 20 µg/m3 were used
as reference dosages for total PM2.5. Inhalation was assumed to be the predominant route of
exposure.
RESULTS:The average PM2.5 concentration during the 34-month study period was 23.2 µg/m3. The
24-hour WHO guideline of 15 µg/m3 was exceeded on 217 of the 350 sampling days and the 24-hour
South African standard of 40 µg/m3 was exceeded on 53 days. The average PM2.5 levels weresignificantly higher during autumn and winter compared to spring and summer. The HQ values for
total PM2.5 were 1.17, 3.47, and 3.78 for adults, children, and infants, respectively. Trace elements K,
Cl, S and Si had non-carcinogenic risks above 1 for adults throughout the year, with Si being thehighest during autumn (1.9) and S during spring (5.5). HQ values for K and Cl were highest during
winter. Ni posed a cancer risk throughout the year, whilst As posed a cancer risk during winter.
CONCLUSIONS:Ambient PM2.5 and its trace element components pose a risk to human health inPretoria.

Keywords: Health risk assessment, PM2.5, trace elements, South Africa

OP-100[Air pollution » Particulate matter]

Personal, household, and community PM2.5
exposure by cooking and heating fuel use andother key characteristics in the CKB-Air study
Ka Hung Chan1, Xi Xia2, Cong Liu3, Haidong Kan3, Aiden Doherty4, Hung Lam Steve Yim5, Neil
Wright6, Christiana Kartsonaki7, Xiaoming Yang6, Rebecca Stevens6, Xiaoyu Chang8, Canqing Yu9,
Jun Lv9, Liming Li9, Kin Fai Ho10, Kin Bong Hubert Lam6, Zhengming Chen7
1Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health,

University of Oxford, UK; Oxford British Heart Foundation Centre of Research Excellence, University of
Oxford, UK
2School of Public Health, Shaanxi University of Chinese Medicine, China; The Jockey Club School of

Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
3School of Public Health, Fudan University, China
4Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, UK; Big Data

Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK; National
Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHSFoundation Trust, John Radcliffe Hospital, UK
5Asian School of the Environment, Nanyang Technological University, Singapore; Lee Kong Chian

School of Medicine, Nanyang Technological University, Singapore; Earth Observatory of Singapore,
Nanyang Technological University, Singapore
6Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health,

University of Oxford, UK
7Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health,

University of Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population
Health, University of Oxford, UK
8NCDs Prevention and Control Department, Sichuan CDC, China
9Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health

Science Center, China; Peking University Center for Public Health and Epidemic Preparedness andResponse, China
10The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong,

Hong Kong SAR

BACKGROUND AND AIM:We aimed to assess the integrated and time-resolved personal, household,and community PM₂.₅ exposure patterns associated with different cooking and heating fuels and otherkey characteristics in rural and urban China.
METHOD:The CKB-Air study involved parallel measurements of personal, household, and community
PM₂.₅ in summer (MAY-SEP 2017) and winter (NOV 2017-JAN 2018) in ~380 participants from one
urban and two rural communities in China, with ~61,000-81,000 person-hours of data across different
locations after data cleaning. Age- and sex-adjusted geometric means of PM₂.₅ were calculated, by
key participant characteristics overall and by season. Spearman correlation coefficients between PM₂.₅
levels across different locations were computed.
RESULTS:Solid fuel users had ~90% higher personal and kitchen 24-hour average PM₂.₅ exposure
than clean fuel users or those who did not cook or heat. They also had a more substantial increase(~75%) in personal and household PM₂.₅ in winter (versus summer) compared to other participants(~20%), whereas community levels were 2-3 times higher in winter regardless of fuel use. Overall,solid fuel users had markedly higher weighted annual average PM₂.₅ exposure (personal: 77.8 [71.185.2] µg/m³, ~90% higher; kitchen: 103.7 [91.5-117.6] µg/m³, ~130% higher; living room (62.0[57.1-67.4] µg/m³, ~65% higher) than clean fuel users. There was a remarkable diurnal variability in
PM₂.₅ exposure among the participants, with 5-minute moving average 700-1,200µg/m³ in typicalmeal times. Personal PM₂.₅ was moderately correlated with living room (Spearman r: 0.64-0.66) andkitchen (0.52-0.59) levels, but only weakly correlated with community levels, especially in summer(r_summer_range: 0.15-0.34) and among solid fuel users (r_summer_range: 0.11-0.31).
CONCLUSIONS:Solid fuel use for cooking and heating was associated with estimated annual personaland household PM₂.₅ exposure levels at 15-20 times the WHO Air Quality Guideline. Household PM₂.₅
was a better proxy of personal exposure than community PM₂.₅ in this setting.

Keywords: Particulate matter, Exposure assessment, Air pollution

OP-101[Methods » Causal inference]

Ambient carbon monoxide and sepsis risk:
Triangulation of evidence in Hong Kong
Pei Zhang1, Fang Guo1, Erica C. Conway1, Kun Zhang2, Linwei Tian1
1School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, HKSAR,

China
2Department of Philosophy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA

BACKGROUND AND AIM:While exposure to certain kinds of air pollutants has been associated withincreased sepsis risk, carbon monoxide (CO), a well-known environmental toxicant at high level(>3000 ppm), has attracted substantial interest from scientists due to its therapeutic potential on
sepsis (‘blood poisoning’) at low concentrations (50~500ppm). Yet it remains unknown whether ourambient exposure to CO (0.5~5ppm), which is ubiquitous and inevitable, can affect human health.
This study aims to infer the causal relationship between ambient CO and sepsis risk.
METHOD:Daily data of sepsis emergency hospital admissions, air pollution, and weather in Hong Kong
were collected for the period of 1998-2008. A thoughtful selection of three distinct methods -traditional generalized additive model (GAM), dynamic system approach empirical dynamic modelling(EDM), and constraint-based causal discovery method Peter-Clark-momentary-conditionalindependence plus (PCMCI+) -- were applied for the data analysis and causal inference.
RESULTS:A negative effect of ambient CO on sepsis emergency hospital admission was consistently
identified in all three methods used. In GAM, this protective effect of CO is found at lag1 and lag2days. In EDM, this beneficial effect emerges at lag0, lag1, and lag2 days, with a peak at lag1 day; andCO effect size varies with CO concentrations. In PCMCI+, similar effect is also detected, at lag2 day.
CONCLUSIONS:This study selected 3 distinct methods, GAM, EDM, and PCMCI+, to analyze the sametime series dataset for the triangulation of evidence on the relationship between ambient CO andemergency admissions of sepsis. Causal analysis supports the hypothesis that CO bears a negative
causal influence on sepsis risk. Ambient CO exposure as low as 0.5-5ppm may exhibit a protective
effect on sepsis. The findings of this study can not only help complement the spectrum of CO healtheffects but contribute to environmental health policy making.

Keywords: Air pollution, Short-term exposure, Environmental epidemiology

OP-102[Policy » Research translation to affect policy and practice]

Air Pollution Indexes, a Latin América focusedscoping review and recommendations
Samuel David Osorio1, Laura Rodriguez2, Jose Texcalac1, Aurelio Tobias3, Horacio Riojas1
1Mexico National Institute of Public Health
2Santander Industrial University
3Institute of Environmental Assessment and Water Research

BACKGROUND AND AIM:Air quality indices are risk communication tools that allow decision makers
and the general population to know the effects of air pollution on their health and make decisions that
reduce exposure; its use is promoted by the World Health Organization as a strategy for countries toimprove air quality and adhere to its air quality guidelines. The aim was systematically mapping whichindexes are used in cities and countries in Latin America, which new indexes were proposed, theirbuilding and validation methods, and gaps in knowledge.
METHOD:We reviewed articles published between 2013 and 2023 in Pubmed and Latin American
databases (Scielo, Redalyc and Dialnet), and gray literature documents from government sources;
Prisma's indications for scope review were followed, and documents were processed in the Endnote 20
software.
RESULTS:314 documents were obtained after duplicates removal, which were filtered by title andabstract, leaving 56 for full text reading. All countries use independent pollutant type indices, following
the US EPA index; none of the indices is based on human health effects, and none of them have hadvalidation processes for their operation and communication to the public. No documents were foundthat evidence the use of indices in several countries. Of the existing indices, the most stringent follow
intermediate objectives 2 and 3 of the WHO guidelines, but not the guideline value. Few indices arelinked to alert or contingency systems for air quality.
CONCLUSIONS:Air quality indices are a useful tool in risk management and communication, but few
countries in the region implement them. It is recommended to promote its use so that the population
knows the effects on their health and promote air quality management.

Keywords: air pollution indices and human health, knowledge translation, risk communication

OP-103[Air pollution » Particle components]

Vertical characteristics and predictive model
development of bioaerosols in Taipei Metropolis
Tsung Han Johann Cheng, Ming Lun Zou, Hsing Jasmine Chao
School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

BACKGROUND AND AIM:Bioaerosols may cause various health effects. However, few studies wereconducted to develop land use regression models for bioaerosols. Furthermore, the influence of height
has not been discussed in such models. Thus, this study aims to identify vertical characteristics anddevelop predictive models of bioaerosols in Taipei Metropolis.
METHOD:The sampling was performed at two buildings in Taipei Metropolis from August 2016 toNovember 2020. Samples were collected from the first-, sixth-, and eleventh-floor balconies of one
building, and the seventh and thirteenth-floor balconies of the other. Each air sample was collected for
24 hours using polycarbonate filters with a pore size of 0.4 μm and a 3-piece 37mm plastic cassetteholder. The samples were extracted and analyzed for fungal spores and endotoxin. Mixed models will
be used to develop land use regression models, and an exponential correlation covariance structure
will be used for controlling the autocorrelation of repeated measurements.
RESULTS:The highest fungal spore concentrations were observed in spring and on the ground level.
The fungal spore levels ranged from 146 to 1821 spores/m³. The most prevalent fungal taxa wereascospores, 𝘈𝘴𝘱𝘦𝘳𝘨𝘪𝘭𝘭𝘶𝘴/𝘗𝘦𝘯𝘪𝘤𝘪𝘭𝘭𝘪𝘶𝘮, basidiospores, and 𝐶𝑙𝑎𝑑𝑜𝑠𝑝𝑜𝑟𝑖𝑢𝑚. The concentrations of endotoxin
ranged from 0.06 to >20.89 EU/m³, and the highest concentration was found in summer and on the
ground level. Based on our preliminary analysis, wind speed and precipitation are the main predictorsof fungal spore concentrations. Similarly, wind speed is negatively correlated with the concentration ofendotoxin.
CONCLUSIONS:The results of this study will provide the vertical and seasonal characteristics of fungal
spores and endotoxin in a metropolis. Besides, land use regression models will be developed toevaluate potential bioaerosol exposure of health impacts on the public.

Keywords: exposure assessment, microbes, modelingOP-104[Air pollution » Traffic-related]

Hourly LUR modelling of hyperlocal long-term
average NO2 using mobile monitoring data
Zhendong Yuan1, Jules Kerckhoffs1, Youchen Shen1, Gerard Hoek1, Roel Vermeulen2
1Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands, Julius Centre for

Health Sciences and Primary Care, University Medical Centre, University of Utrecht, The Netherlands

BACKGROUND AND AIM:The association between time-activity based exposure and health outcomes isdebated due to the lack of spatiotemporal maps of hyperlocal long-term air pollution. The random
roaming collection strategy of the mobile monitoring campaign results in air pollution being measured
in large spatial coverage. However, most locations can rarely be measured uniformly for every hour.
This work evaluated the merit of adding a temporal dimension to the land-use regression (LUR) model
for interpolating hourly hyperlocal NO2 maps using spatiotemporally unstructured mobile
measurements.
METHOD:We monitored 1-second NO2 in Amsterdam for 10 months (5.7 Million GPS points) and thenaggregated these points into 50m road segments in one-hour intervals. We exanimated two
spatiotemporal LUR models, namely ST-Kriging and GTWR (Geographical and Temporal Weighted
Regression), and two spatial LUR models implemented separately in each hour, namely RF_LUR(random-forest based LUR) and SLR (Linear Stepwise Regression). Comprehensive spatial, temporaland spatiotemporal validations were performed against independent hourly long-term routine
monitoring measurements (RIVM, n=9).
RESULTS:Different levels and spatiotemporal patterns were observed for different seasons and roadtypes. NO2 at major roads during warm seasons was on average 2.5 times higher than residential
locations during cold seasons. GTWR achieved the best performance and its timeseries of predictions
was the smoothest across hours. While the other models were affected more erratically by thefluctuation of opportunistic mobile measurements caused by the random sampling. The spatiotemporal
distribution of NO2 strongly followed the intra-urban commuting pattern.
CONCLUSIONS:The spatiotemporal LUR model can capture spatiotemporal autocorrelations hidden inopportunistic mobile measurements. The interpolated hourly hyperlocal NO2 maps stimulate theparadigm shifts towards dynamic exposures in epidemiology analysis.

Keywords: Oxides of nitrogen, Spatial statistics

OP-105[Climate » Temperature]

Examining the spatial variation of heatwaverelated morbidity and mortality in Adelaide,
Australia
Blesson Mathew Varghese1, Matt Beaty2, Monika Nitschke3, Peng Bi1, John Nairn4
1School of Public Health, The University of Adelaide
2Australian Bureau of Statistics
3South Australian Department for Health and Wellbeing
4Australian Bureau of Meteorology

BACKGROUND AND AIM:Heatwaves are a growing concern to population health, causing increased
morbidity and mortality. As the climate continues to warm, it is critical to understand the impact ofheatwaves at a fine spatial scale to inform effective policy, planning, and interventions for the mostaffected communities. This study aimed to examine heatwave impacts on morbidity and mortality in
Adelaide at a small geographical level using five indicators: General Practitioner (GP) visits,
ambulance-callouts, Emergency Departments (ED) presentations, hospitalisations, and deaths.
METHOD:We collected data on GP visits (2011-2016), ambulance-callouts (2005-2014), ED
presentations (2005-2014), hospitalisations (2005-2014), deaths (2007-2017), and vulnerability
factors (socio-demographic, health, and environmental). Using a space-time-stratified case-crossoverdesign we quantified the impact of heatwaves (defined using Excess Heat Factor) on health outcomes
during the warm-season (October-March) at the Statistical Area Level 2 (SA2) geography(representing suburbs). Effect modification by neighborhood characteristics was examined, and citylevel estimates were pooled using random-effects meta-analyses. Results are reported as percent
increase in risk according to heatwave-severity compared with non-heatwaves and mapped tospatially represent risks.
RESULTS:A dose-response relationship was evident between health outcomes and heatwaves in
Adelaide across the heatwave-severity, with significant increases observed in GP visits, ambulancecallouts, ED presentations, hospitalisations, and mortality. Of concern, ambulance callouts showed thehighest increase at 21% (95%CI: 18-25%) during severe/extreme heatwaves compared to nonheatwaves. Spatial variations in the impact of heatwaves were observed, with high-risk areas
identified in the western and southern suburbs. These areas were associated with a higher proportionof people living in rented housing, living alone, living in flats, having diabetes, and low vegetation
cover.
CONCLUSIONS:The impacts of heatwaves go beyond mortality, and hospitalisations to include
frontline health services such as GPs, ambulance-callouts, and EDs. The significant increase inspatially variable health outcomes in Adelaide warrants geographically targeted public healthstrategies to reduce heatwave-associated health outcomes.

Keywords: Heatwave, Morbidity, Vulnerability, Mortality, Neighbourhood

OP-106[Climate » Temperature extremes and variability]

Current and projected heatwave-attributable
occupational injuries, illnesses, and associatedeconomic burden in Australia: a national timeseries
Matthew Anthony Borg1, Jianjun Xiang2, Olga Anikeeva1, Peng Bi1
1School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia
2School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia; School of Public Health,Fujian Medical University, Fuzhou, Fujian Province, 350122, China

BACKGROUND AND AIM:The costs of climate change are substantial. These include costs fromoccupational illnesses and injuries (OIIs), which have been associated with increases during
heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs andtheir costs in Australia.
METHOD:Climate and workers’ compensation claims data were extracted from seven Australian capitalcities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat
Factor. OIIs and associated costs were estimated separately per city with time-series distributed lag
non-linear models. City estimates were pooled with multivariate meta-analysis to derive national
estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065).
RESULTS:Of all OIIs, 0.13% (95%eCI: 0.11-0.16%) were heatwave-attributable, equivalent to 120(95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%),
equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050,
under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.100.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under
RCP4.5 and RCP8.5 were 0.13% (95%eCI: -0.27-0.46%) and 0.04% (95%eCI: -0.66-0.60),
respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04%(95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: -0.270.46) for all heatwaves and 0.04% (95%eCI: -0.01-0.09%) for extreme heatwaves. Attributablefractions were approximately similar to baseline when assuming theoretical climate adaptation.
CONCLUSIONS:Heatwaves represent notable and preventable portions of preventable OIIs andeconomic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in
2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributablemorbidity and costs.

Keywords: Temperature, Occupational exposures, Environmental epidemiology, Occupational
epidemiology, ModelingOP-107[Cancer and cancer-precursors » Incidence]

Associations of occupational heat exposure andstomach cancer in a population-based casecontrol study
Michelle C Turner1, Alice Hinchliffe2, Miquel Vallbona Vistós3, Juan Alguacil4, Sanni Uuksulainen5,
Nuria Aragonés6, Adonina Tardón7, Jesus Vioque8, Manoli Garcia De La Hera8, Mary H Ward9, Charles
S Rabkin9, M Constanza Camargo9, Claudio Pelucchi10, Carlo La Vecchia10, Paolo Boffetta11, Manolis
Kogevinas12
1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER
Epidemiología y Salud Pública – CIBERESP), Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
2Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain
3Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
4Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad deHuelva, Campus Universitario de El Carmen, Huelva, Spain
5Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
6Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud

Pública – CIBERESP), Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain; Public Health Division,
Department of Health of Madrid, Spain
7Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud

Pública – CIBERESP), Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain; Institute of HealthResearch of the Principality of Asturias (ISPA)/University of Oviedo, 03301, Oviedo, Spain
8Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud

Pública – CIBERESP), Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain; Instituto de Investigación
Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain
9Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
10Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
11Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; Department of Medical

and Surgical Sciences, University of Bologna, Bologna, Italy
12Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER
Epidemiología y Salud Pública – CIBERESP), Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain;
IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003 Barcelona,Spain

BACKGROUND AND AIM:Global warming is increasingly affecting human populations. Occupational
heat stress occurs frequently, however little is known regarding potential long-term adverse healtheffects of chronic occupational heat exposure. In other recent work, we examined associations oflifetime occupational heat exposure and colorectal cancer in a large Spanish multi-case-control study(MCC-Spain). We observed no clear evidence for associations with ever occupational heat exposure
overall, though there were some positive associations observed among women in the highest
categories of lifetime cumulative exposure and duration. Here we extend work to examine potential

associations with stomach cancer.
METHOD:Data from a total of 459 incident stomach cancer cases and a common set of 3,440 matched
controls recruited from 10 regions from 2008-2013 in MCC-Spain were examined. The Spanish job
exposure matrix, MatEmEsp, was used to assign heat exposure estimates to participant lifetime
occupational history. Three exposure indices were constructed: ever vs. never, duration (years), andcumulative exposure. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjustingfor 5-year age group, sex, education, body mass index, cigarette smoking status, and family history ofstomach cancer.
RESULTS:Overall, 53.9% included cases and 37.7% of controls were ever occupationally exposed toheat. There was a positive association of ever occupational heat exposure and stomach cancer overall(odds ratio (OR) 1.45; 95% CI 1.10, 1.90). ORs were also elevated in the medium (OR 1.52; 95% CI
1.06, 2.17) and highest tertiles of lifetime cumulative exposure (OR 1.62; 95% CI 1.12, 2.34) (ptrend < 0.05), as well as of duration of exposure (ORs 1.88; 1.24, 2.86 and 1.41; 0.98, 2.03
respectively) (p trend = 0.02).
CONCLUSIONS:Preliminary findings provide some evidence for a positive association of occupational
heat exposure and stomach cancer risk in MCC-Spain; findings are being extended in a pooled analysisof data from three case-control studies.

Keywords: stomach cancer, occupation, heatOP-108[Climate » Other (to be specified with keywords in the keywords section)]

Heat Exposure and Acute Kidney Injury in a
Sonoran Agricultural Population
Rietta S Wagoner1, Nicolas I Lopez Galvez2, Robert A Canales3, Leslie V Farland4, Frank A Von
Hippel1, Melissa A Furlong1
1Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public

Health, University of Arizona,Tucson, United States
2Division of Environmental Health, San Diego State University, San Diego, United States
3Department of Environmental and Occupational Health, George Washington University, Washington,

United States
4Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health,

University of Arizona, Tucson, United States

BACKGROUND AND AIM:Agricultural workers in the US-Mexico border region are exposed to heat andhigh intensity working conditions on a daily basis, increasing the risk for heat stress and other heatrelated health conditions. As an individual’s body temperature increases and body mass is lost via
sweat, acute kidney injury (AKI) can occur. The aim of this study is to assess the relationship between
heat on AKI in agricultural workers
METHOD:A cohort of adult males working in agriculture (n=72) and the non-agricultural sector (n=21)
in Sonora, Mexico was recruited in Spring 2019 and followed through summer. A questionnaire
including demographics, work history, historical heat exposure, medical history, and occupational
exposures was administered at enrollment. Wet-bulb-globe temperature and anthropometricmeasurements were recorded. Physiological strain index (PSI) was calculated for each participant toestimate heat exposure. Urine was collected and analyzed for AKI biomarker neutrophil gelatinaseassociated lipocalin (NGAL) and creatinine. All measurements were collected twice, once in spring andonce in summer. We compared NGAL levels in agricultural workers to office workers during both thespring and summer seasons, and evaluated changes in NGAL over time using t-tests.
RESULTS:Agricultural workers reported higher levels of speaking an Indigenous language as theirprimary language in a predominantly Spanish-speaking area, lower education rates and pay, andhigher rates of migration for work compared to non-agricultural workers. NGAL levels in agricultural
workers were significantly higher in the summer than in the spring (p<0.001), suggesting that NGAL
varies by season and that heat exposure may affect kidney functioning. However, NGAL levels were
not different between agricultural and office workers, during either spring or summer (p>0.05).
CONCLUSIONS:As the number of hot days and heat waves is expected to increase globally, it isexpected that vulnerable populations, including agricultural workers, will experience increased heatrelated morbidity and mortality.

Keywords: Occupational Exposures, Environmental Disparities, TemperatureOP-109[Exposures » Occupational exposures]

Heat-related illness among workers in British
Columbia: Extreme hot weather in 2021
compared to 2001-2020
Xiaocong Guo1, Kate R. Weinberger2, Lillian Tamburic1, Cheryl E. Peters3, Christopher B. McLeod1
1School of Population and Public Health, The University of British Columbia, Vancouver, British

Columbia, Canada
2ICF, Reston, Virginia, United States
3School of Population and Public Health, The University of British Columbia, Vancouver, British

Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada;
BC Cancer, Vancouver, British Columbia, Canada

BACKGROUND AND AIM:The summer of 2021 in British Columbia (BC), Canada, was characterized byunprecedented high temperatures, yielding substantial increase in attributable deaths. This study
aimed to characterize the ambient temperature, and demographics, industry sectors, and occupationsof workers with heat-related illness (HRI) from 2021 summer compared to historical averages.
METHOD:We identified work-related HRI from accepted workers’ compensation claims among workers
aged 15 and greater in BC, 2001-2021. Incidence rates were calculated by age, sex, industry sector,
and occupation, using working population estimates from Statistics Canada’s Labour Force Survey.
HRI claims that occurred during the 2021 summer were compared to those during summers from2001-2020.
RESULTS:521 eligible claims were identified between June and August from 2001-2021, of which 107(20.5%) occurred in 2021. The incidence rates for 2021 and typical summers were 3.97 (95%
confidence interval, 3.26-4.80) and 0.93 (0.85-1.03) claims per 100,000 workers, respectively. Thisdifference represents a 327% increase. The 99th, 95th, and 90th percentiles of summertime daily
maximum temperatures by Local Health Areas accounted for 20.6%, 49.5%, and 64.5% of claims,
respectively, in 2021. Whereas in typical summers, they accounted for 8.5%, 32.4%, and 46.4% ofclaims, respectively. Incidence rates in 2021 were amplified, but consistent with typical summers, inthat they were higher among younger workers, male workers, those working in public administrationindustry sector, and those with occupations related to primary industry; trades, transport, andequipment operators; and processing, manufacturing, and utilities. Strikingly, rates in 2021 wereexacerbated in industry sectors of transportation and warehousing; and agriculture, forestry, fishing,and hunting, as well as intermediate-level occupations in primary industry and health occupations.
CONCLUSIONS:The unprecedented hot weather in 2021 placed some workers at higher risk of HRI.
The study findings may inform development and improvement of prevention strategies targeting atrisk workers. This research was funded by WorkSafeBC.

Keywords: climate, temperature, temperature extremesOP-110[Climate » Temperature]

Impact of indoor/ambient temperature on
urinary biomarkers for oxidative stress among
the elderly: a panel study in Hong Kong
Yi-tong Guo, Kin-fai Ho
Jokey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong
Kong, China

BACKGROUND AND AIM:The subclinical pathophysiological responses to temperature and theircontribution to development of health abnormalities are not well understood. Hence, this study aimed
to measure indoor temperature, which more accurately reflects individual exposure than ambient
temperature, and examined its short-term impact on urinary biomarkers for oxidative stress. We also
compared the potential health effects of indoor temperature to those of ambient temperature.
METHOD:We conducted a panel study of 45 healthy elderly individuals aged 60 and above in Hong
Kong during 2021-22. Each participant was followed for 6 consecutive days in the summer and wintercampaign, respectively. Temperature/Relative Humidity (RH) data loggers were placed in theparticipant’s residence and monitored indoor climate throughout the sampling periods. Urine samples
were collected on each sampling day at a 24-h interval and tested for the levels of two establishedbiomarkers for oxidative stress, i.e., 8-hydroxy-deoxy-guanosine (8-OHdG) and malondialdehyde(MDA). Ambient weather data were extracted from Hong Kong Observatory and matched toparticipants’ residence. We applied generalized mixed-effect models to estimate the associations ofindoor/outdoor temperature with the levels of biomarkers, controlling for potential covariates andwithin-participant correlation.
RESULTS:Of the 45 participants, 25 were females and the median age (interquartile range) was 83(80 - 85) years old. We found that increased mean 0-24h indoor temperatures were associated withdecreased levels of 8-OHdG and increased levels of MDA in urine samples, after controlling forcovariates. Similar associations were found for ambient temperature but with different magnitudes of
estimated effects.
CONCLUSIONS:This study provides insight into the role of indoor temperature exposure in potential
pathophysiological mechanisms of oxidative stress responses and highlights the need to monitor
personal-level exposure to environmental stressors when assessing its health impact. The findings will
inform future climate research and temperature regulation intervention.

Keywords: Biomarkers of exposure, Climate, Environmental epidemiology, Short-term exposure,
TemperatureOP-111[Outcomes » Other (to be specified with keywords in the keywords section)]

Associations between daily PM2.5 exposure andhospitalizations for COVID-19
Cavin Keith Ward Caviness1, Alyssa Platt2, Elliot Fisher2, Anne Weaver1, Mercedes Bravo2
1US Environmental Protection Agency
2Duke University

BACKGROUND AND AIM:The COVID-19 pandemic has resulted in over 103 million COVID-19 cases in
the United States (US). However, studies of associations between environmental exposures and
COVID-19 hospitalizations are limited. We examined associations between fine particulate matter(PM2.5) and COVID-19 hospitalizations within the National COVID Cohort Collaborative (N3C) – a
national electronic health record (EHR) resource.
METHOD:This study utilized 83,353 individuals with a hospital-confirmed SARS-CoV-2 infection
between January 1, 2020 and December 31, 2020. Information on SARS-CoV-2 infection, COVID-19
hospitalizations, disease history, and demographics were collected from EHRs. PM2.5 exposures were
estimated using ground-based regulatory monitoring data. Daily PM2.5 observations were averaged
over the 21 days prior to each COVID-19 hospitalization and were linked with each individual based onresidential zip code. Core Based Statistical Area (CBSA; a geographical unit for urban areas)-specificanalyses were performed followed by regional meta-analyses. Associations were modeled using atime-stratified case-crossover approach, control periods matched on month, year, and day of week,that adjusted for temperature, precipitation, dew point, day of week, CBSA-specific days since
pandemic start, and county-level COVID-19 cases. Associations are reported as the odds ratio (OR)and 95% confidence interval (CI).
RESULTS:There was substantial variation in associations by CBSA and Census region. Associations
were observed in the South region (OR = 1.04; 95% CI = 1.01, 1.08) with the other regions having
generally null associations. In the South, associations were larger for those with those cardiovasculardisease (OR = 1.07; 95% CI = 1.04, 1.11), metabolic disease (OR = 1.06; 95% CI = 1.02, 1.10), andage < 65 (OR = 1.07; 95% CI = 1.02, 1.11).
CONCLUSIONS:In this study, PM2.5 exposure was associated with COVID-19 hospitalization in thesouthern US. This could have important implications for understanding how the SARS-CoV-2 pandemic
unfolded. This abstract does not necessarily represent EPA policy.

Keywords: COVID19, Air pollution, hospitalizations, electronic health records

OP-112[Air pollution » General]

The impact of sulfur dioxide in industrial areasof Taiwan during the COVID-19 epidemic period
Chih Yu Chang, Jia Yi Lu, Zhi Yun Li, Tzu Hsuen Yuan
Department of Health and Welfare, University of Taipei, College of City Management, Taiwan

BACKGROUND AND AIM:To prevent the spread of COVID-19, it caused the tremendous effect oninternational industry chain. In Taiwan, there was no policy to restrict industrial activities due to
COVID-19. Therefore, our study compared the changes in sulfur dioxide (SO₂) concentrations inindustrial areas of Taiwan during the COVID-19 epidemic period.
METHOD:We collected hourly SO₂ data from five industrial area air quality monitoring stations of
Taiwan EPA from 2015 to 2022. Using one-way ANOVA analysis, we compared the differences of theaverage daily SO₂ concentrations among the level 3 alert period (5/19~7/25) and the preceding andfollowing periods in 2021. And we compared the average daily SO₂ concentrations among the level 3
alert period in 2021 and corresponding periods in 2020 and 2022. In addition, the average monthly
data from 2015 to 2019 were used for Theil-Sen trend estimation to predict the SO₂ concentrations
during 5/19 to 7/25 in 2020~2022 to calculate the difference between the actual and predicted SO₂
concentrations.
RESULTS:The average daily concentration of SO₂ during the level 3 alert period was 1.75±0.81 ppb,
which was significantly lower than the preceding period of 2.05±0.89 ppb, and it recovered to
2.00±0.81 ppb after the alert period. Furthermore, the average daily SO₂ concentrations for the same
period (5/19~7/25) from 2020 to 2022 were 2.03±0.58 ppb, 1.75±0.81 ppb, and 1.52±0.50 ppb,
respectively, with a significant decrease in concentrations. According to Theil-Sen trend estimation,
the predicted SO₂ concentrations were decreasing year by year. But the actual values for 2020, 2021,
and 2022 increased by 16%, 22.8%, and 37% compared to the predicted values.
CONCLUSIONS:The SO₂ concentrations in Taiwan decreased with stricter precaution for COVID-19
prevention. However, the actual concentrations were higher than predicted ones, and the differenceswere increasing with the worsening of the COVID-19 epidemic.

Keywords: COVID-19, Air pollution, Occupational exposures, Environmental epidemiology

OP-113[Exposure assessment methods » Risk assessment]

COVID-19 infection risk assessment in akindergarten utilizing continuous air quality
monitoring data
Chung Yen Chen1, Chia Pin Chio2, Jia Kun Chen3, Ta Chen Su4, Chang Chuan Chan3
1National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Institute of Environmental

and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei,
Taiwan; Department of Occupational and Environmental Medicine, National Taiwan University Hospital,
Taipei, Taiwan
2Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan
3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan
4Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan; Department of Occupational and Environmental Medicine, National
Taiwan University Hospital, Taipei, Taiwan

BACKGROUND AND AIM:Researchers and transnational public health organizations have recognizedaerosol transmission as an essential route of COVID-19 transmission. Therefore, improving ventilation
systems is now adopted as a core preventive measure. As young children aged 2-6 in kindergartens
generally lack vaccine protection and multiple infection clusters have been identified during the
pandemic, we aimed to evaluate the effectiveness of ventilation systems and the risk of aerosol
transmission in kindergartens in Taiwan.
METHOD:From August to November 2021, we conducted on-site visits and continuously monitoredindoor air quality indicators, such as PM2.5, carbon dioxide (CO₂), relative humidity, and temperature,
in a kindergarten located in northern Taiwan. We utilized the Wells-Riley model to estimate the basic
reproduction number (R0) of each classroom and staff office, with input parameters including thenumber of occupants, duration of their stay, and indoor/outdoor carbon dioxide concentration.
Contagious settings were defined as those where the R0 estimates exceeded 1. We conducted ascenario and sensitivity analysis to assess the effect of simulated improvement measures.
RESULTS:During school hours, the average concentration of CO₂ in each classroom and staff office
exceeded 900 ppm. The R0 estimates gradually increased from Monday to Friday and throughout
school hours, corresponding to the hourly and daily distribution of the CO2 concentration, which could
not dissipate completely during off-duty time. The R0 estimates during school hours ranged from 3.01
to 3.12 in classrooms with a maximum of 30 occupants. To lower the R0 estimates, a substantial
reduction in the number of occupants, the duration of their stay, and/or indoor CO₂ concentration isneeded.
CONCLUSIONS:The risk of outbreaks of cluster infections in kindergartens should not be
underestimated. Feasible strategies to mitigate this risk include improving ventilation systems throughengineering controls and limiting the number of indoor occupants and their residence time throughadministrative controls.

Keywords: COVID-19, Modeling, Occupational exposures, Policy and practice, Science communication

OP-114[Outcomes » Infectious diseases]

School-level COVID-19 preventive measures andinfection rates in England’s primary andsecondary schools in the Autumn 2021: an
ecological analysis
Liang Yu Lin1, Sarah Cook1, Jody Phelan1, Dylan Stocker2, Byron Davies2, Alison Judd2, Alex Lewin1,
Patrick Nguipdop Djomo1, Punam Mangtani1, Covid 19 Schools Infection Survey 2 Study Group (sis2)31Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine,

London2Office for National Statistics
3Members of the COVID-19 Schools Infection Survey 2 Study Group are Elliot McClenaghan; Gillian

McKay; Jody Phelan; Liang-Yu Lin; Alex Lewin (all from LSHTM), and Alison Judd; Byron Davies;
Anisah Saib; James McCrae; Joe Kelly; Ian Diamond; Emma Rourke; Fiona Dawe; Pete Jones (all fromONS).

BACKGROUND AND AIM:We aimed to describe the school-based COVID-19 preventive measures
implemented in English schools in the Autumn 2021, when the SARS-CoV-2 Omicron variant was
emerging, and explore their ecological associations to incident SARS-CoV-2 infections in pupils.
METHOD:We used data from England’s COVID-19 Schools Infection Survey (SIS), a nationally
representative sample of publicly-funded primary and secondary schools. Between November andDecember 2021, headteachers completed questionnaires about the implementation of preventive
measures, which we grouped into four hazard-control domains: elimination (e.g. stay-at-home whensick), engineering (e.g. improving ventilation), administrative (e.g. pupil bubbles) controls, andpersonal protective equipment (PPE; e.g. facemasks). We investigated their association with schoollevel COVID-19 infection rates in pupils (from laboratory reports) during the Autumn 2021 term using
negative binomial regression models adjusting for school-level characteristics.
RESULTS:Overall 107 headteachers completed the questionnaires (76 primary and 31 secondary
schools). Most schools were in urban areas (78.5%), and about 40% of eligible pupils had received atleast one COVID-19 vaccine dose. The levels of implementing preventive measures varied among
schools, with most schools implementing engineering controls (84%) and elimination controls(57.5%), while fewer schools used administrative controls (43.3%). More secondary schools (58.7%)
implemented PPE than primary schools (26.81%). After adjusting for covariates, we found noassociations at the school-level between control measures and COVID-19 incidence in pupils in the
Autumn 2021 term.
CONCLUSIONS:We describe a useful framework to investigate SARS-CoV-2 infection control measuresin schools, in a period of intense community transmission. The variability in implementation between
schools likely reflects the local epidemiological situation, risk perception, health-seeking behaviour,and implementation challenges. Rapidly changing epidemiological circumstances and adaptive changes

to preventative measures may have contributed to a blurring of ecological associations. Further
studies using a similar hierarchy of controls framework are needed.

Keywords: COVID-19, Infectious diseases, Public health, Occupational exposuresOP-115[Air pollution » Traffic-related]

Air pollution mortality benefits of sustained
COVID-19 mobility restrictions in Australian
cities
Timothy Chaston1, Luke Knibbs2, Geoffrey Morgan3, Bin Jalaludin4, Richard Broome5, Martine
Dennekamp6, Fay Johnston7, Sotiris Vardoulakis8
1Environment Protection Authority Victoria, Melbourne, Australia, The University of Sydney, University

Centre for Rural Health, Lismore, Australia
2Public Health Unit, Sydney Local Health District, Sydney, Australia, The University of Sydney, Schoolof Public Health, Sydney, Australia
3The University of Sydney, University Centre for Rural Health, Sydney, Australia
4The University of New South Wales, Sydney, Australia
5Public Health Unit, Sydney Local Health District, Sydney, Australia
6Environment Protection Authority Victoria, Melbourne, Australia
7Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
8National Centre for Epidemiology and Public Health, Australian National University, Canberra,

Australia

BACKGROUND AND AIM:In many cities around the world, emissions from road traffic, power
generation and industry were substantially reduced during COVID-19 lockdown periods.
We analyse the reductions in traffic-related air pollution (in Australian capital cities?) during theAustralian lockdown period (March–April 2020) and then model the potential life expectancy benefits
that could be realised if similar reductions were sustained through structural policy interventions.
METHOD:Satellite-based observations were used to estimate ground-level nitrogen dioxide (NO2)concentrations in all Australian capital cities during: (a) a typical year with no prolonged air pollution
events; (b) a hypothetical sustained reduction in NO2 of equivalent to the COVID-19 lockdowns.
We use the WHO recommended NO2 exposure-response coefficient for mortality (1.023, 95% CI:
1.008–1.037, per 10 μg/m3 annual average) to assess gains in life expectancy and population wideyears of life from reduced exposure to traffic-related air pollution. Sensitivity analyses evaluated theinfluence of alternative theoretical minimum exposure levels and an alternative NO2 exposureresponse coefficient derived from an Australian study.
RESULTS:Although COVID-19 related reductions in NO2 varied widely between Australian cities, 3314
years of life would be gained annually if those NO2 concentrations were maintained.
CONCLUSIONS:As unprecedented policy scenarios, the COVID-19 lockdowns of Australian cities give
us insight into the potential reductions in exposure to traffic-related air pollution from policies that
limit the motor vehicle use. This paper provides an indication of the effect such a change in exposure
would have on mortality if the change was sustained over decades. Future work should focus on theeffectiveness of long-term measures in providing these sustained reductions in road traffic pollution incities, for example by reducing motor vehicle use, improving engine and fuel standards, wider use ofelectric vehicles and reduced need for commuting.

Keywords: Long-term exposure, COVID-19

OP-116[Exposures » Microbes/Microbiome]

Risk assessment of airborne transmission ofnovel coronavirus (COVID-19) in long-distancetransport
Ping Ju Hsieh1, Jia Kun Chen2, Ta Chen Su3
1Department of Environment and Occupational Medicine, National Taiwan University Hospital Yunlin

Branch, Yunlin, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, Taipei, Taiwan
3Department of Environmental and Occupational Medicine, National Taiwan University Hospital andNational Taiwan University College of Medicine, Taipei, Taiwan

BACKGROUND AND AIM:Airborne transmission is a major route of transmission of the novel
coronavirus, including confined space like in public transportation of long-distance transport. This
study evaluates the current air-conditioning ventilation of long-distance transport and estimates therisk of airborne transmission of disease.
METHOD:During 2020 to 2021, we recruited 32 long-distance bus drivers to evaluate effects ofventilation status on indoor air quality and risk of airborne transmission of novel coronavirus among
drivers in a public transportation company. The continuous data of long-distance bus driving wererecorded, including vehicle ventilation status, indoor carbon dioxide concentration (CO2) and numberof passengers. The Well-Riley model was used to assess differences in basic reproduction number (R0)between groups by ventilation status.
RESULTS:A total of 108 transportations were included in the study analysis, including Taipei toNantou, Chiayi, or Yuanlin. Of these, 52 were in the poor ventilation group. Multiple linear regression
analysis found that turning on the ventilation device significantly reduced CO2 concentrations by 252.2
ppm with 95% CI [111.3 to 393.2]. The CO2 concentrations increased significantly by 35.1 ppm (95%
CI [23.5 to 46.8] for each additional passenger. The basic reproduction number (R0) was 1.45 [0.68
to 2.15] in the poorly ventilated group and was significantly higher than that in the ventilation group(R0= 0.95 [0.44 to 1.43]).
CONCLUSIONS:Open a ventilation system can effectively reduce the CO2 concentration in longdistance passenger buses. The Well-Riley model assessment found that there is still a risk of outward
transmission of novel coronavirus in poorly ventilated buses.

Keywords: COVID-19, Infectious diseases, Occupational exposures, Risk assessment

OP-118[Chemical exposures » Heavy metals]

Urinary metals and incident Heart Failure in
Indigenous communities in the US: Evidence
from the Strong Heart Study
Irene Martinez Morata1, Arce Domingo Relloso1, Gernot Pichler2, Jose Manuel Garcia Pinilla3, Jason
Umans4, Ana Barac5, Walter Goessler6, Maria Tellez Plaza7, Daichi Shimbo8, Richard B. Devereux5,
Ana Navas Acien1
1Department of Environmental Health Sciences, Mailman School of Public Health Columbia University,

New York, NY, USA.
2Department of Cardiology and Karl Landsteiner Institute for Cardiovascular and Critical Care

Research, Vienna, Austria
3Department of cardiology. Hospital Universitario Virgen de la Victoria. IBIMA. University of Malaga,

Spain
4MedStar Health Research Institute, Hyattsville, MD; Georgetown-Howard Universities Center for

Clinical and Translational Science, Washington, DC, USA
5Department of Cardiology, Weill Cornell Medicine, New York, NY, USA
6Department of Analytical Chemistry for Health and Environment, University of Graz, Austria.
7Department of Chronic Diseases Epidemiology, National Center of Epidemiology, Carlos III HealthInstitute, Madrid, Spain
8Department of Cardiology. Columbia University Irving Medical Center, New York, NY, USA

BACKGROUND AND AIM:Exposure to metals, which is highly prevalent among Indigenous communities
in the US, has been identified as an independent risk factor for cardiovascular disease. Heart Failure(HF) is a leading cause of death, yet the role of metal exposure on HF and HF subtypes remains
understudied. We evaluate the prospective association between urinary metal levels and incident HF in
the Strong Heart Study, the largest cohort of American Indian adults.
METHOD:Urinary inorganic arsenic(iAs), cadmium(Cd), molybdenum(Mo), selenium(Se), tungsten(W)and zinc(Zn) were measured at baseline (1989-1991)(n=2,076, mean age 56.3 years, 58% women).
HF events were ascertained through 2019 by a physician-panel following a standardized protocol.
Participants with ejection fraction (EF) available were classified as EF≥50%(preserved), andEF<50%(reduced). Progressively adjusted Cox proportional hazards models were used to identify therisk of incident HF and subtypes by an interquartile range (IQR) change in urine metals.
RESULTS:444 participants developed incident HF (92EF≥50%, 118EF<50%, 234unclassified). Baseline
levels of all metals were higher among participants who developed HF. In models adjusted bysociodemographic and clinical covariates, the hazard ratio (95%CI) for incident HF per IQR change inmetal levels were 0.95(0.7, 1.29) for iAs, 1.08(0.84, 1.39) for Cd,1.33(1.03, 1.72) for Mo, 1.11(0.84,
1.39) for Se, 1.69(1.25, 2.29) for Zn, and 1.04(0.83, 1.3) for W. The associations varied by HF
subtype, with no significant associations between metal levels and EF≥50% while for EF<50%, the HR(95%CI) per IQR metal level was 1.55(0.86, 2.78) for iAs, 1.26(0.78, 2.03) for Cd, 2.44(1.50, 3.99)
for Mo, 1.67(0.96, 2.92) for Se, 2.14(1.18, 3.89) for Zn, and 1.61(1.06, 2.47) for W).
CONCLUSIONS:We identified an association between baseline urine levels of several essential andnon-essential metals and incident HF risk in the Strong Heart Study, with strongest associations for
EF<50%. These findings can help identify novel modifiable risk factors of HF and inform prevention.

Keywords: metals, biomarkers of exposure, cardiovascular disease, heart failure, American IndiansOP-119[Chemical exposures » Heavy metals]

Serum mercury is not associated with incident
diabetes in a cohort of older Americans:findings from the REGARDS study
Yijia Zhang, Meghan Angley, Liping Lu, Ka Kahe
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY,
USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA

BACKGROUND AND AIM:Laboratory studies suggest that mercury exposure may induce oxidative
stress and cause pancreatic islet β-cell dysfunction. Although it is biologically plausible, data areinconsistent linking mercury exposure to the incidence of type 2 diabetes.
METHOD:A sub-cohort (N=2,666) was randomly selected from the Reasons for Geographic and Racial
Differences in Stroke (REGARDS) study. The study population consisted of 1,227 participants (meanage=63) without baseline diabetes and had returned for the second measure of diabetes status.
Serum mercury was assessed at baseline and was categorized into quartiles. Multivariable-adjusted
odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated using logistic
regression. In the sensitivity analysis, multiple imputation was used for missing data in the REGARDS
random sub-cohort.
RESULTS:After controlling for potential confounders including demographic, behavioral, and medical
factors, no statistically significant association was observed between serum mercury concentration andthe incidence of type 2 diabetes. The adjusted odds ratio (OR) and 95% confidence interval (CI)across quartiles 1 to 4 were 1.00, 0.91 (0.47 – 1.76), 1.24 (0.65 – 2.37, and 0.84 (0.41 – 1.70), p fortrend =0.40. In the sensitivity analysis with multiple imputation, the observed non-significant
association persisted.
CONCLUSIONS:This study does not support an association between mercury exposure and theincidence of type 2 diabetes in a cohort of general Americans.

Keywords: Public Health, Environmental Epidemiology, Food/nutrition

OP-120[Exposures » Multi-pollutant/Multi-media]

Patterns of exposure to toxic and essential
elements in whole blood in the Baltimore
Memory Study
Katherine A Moon, Brian S Schwartz
Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public
HealthBACKGROUND AND AIM:We aimed to identify patterns of toxic and essential element exposures.
METHOD:The Baltimore Memory Study is a cohort study of cognitive and cardiovascular outcomes thatenrolled 1,140 adults 50-70 years in 2001-2002. In 2022, we measured 22 elements, including lead(Pb), cadmium (Cd), mercury (Hg), arsenic (As), strontium (Sr), vanadium (V), copper (Cu), iron (Fe),manganese (Mn), molybdenum (Mo), selenium (Se), and zinc (Zn) in whole blood from stored samples
in 710 (62%) participants using inductively coupled plasma-mass spectrometry. Participants with
sufficient sample volume were not different from persons without. We used k-means cluster analysis(CA) and principal component analysis (PCA) to characterize exposure patterns. We evaluatedassociations between each element and neighborhood and individual-level variables using linear
regression.
RESULTS:The k-means algorithm identified two clusters. One cluster (56% participants) had higher
levels of toxic (Pb, Cd, Sr, and V) and higher essential (Zn, Mo, Sr, V) elements. There were few
differences in sociodemographics between clusters. Five principal components explained 65% of thetotal variance: Sr-V-Mo-Zn (18%), Cu-Fe (16%), As-Hg (12%), Cd-Pb (11%), and Mn (8%). Women
had higher levels Pb, As, Cd, Cu, and Fe but lower Se and Zn. Pb, As, Cd, Sr, and Cu were higher inBlack participants, while Fe, Mn, and Se were lower. Greater education and wealth were associatedwith higher Hg, Fe, and Mn, and lower Cd, Sr, and Cu. Worse neighborhood psychosocial hazards wereassociated with higher Pb, Cd, Sr, and Cu, and lower Hg, Fe, Mn, and Se. Smokers had higher Pb, Cd,and Fe but lower Se. Higher intake of vegetables and fruits was associated with higher Cd, Hg, andSe, and lower Pb.
CONCLUSIONS:Patterns of exposure to toxic and essential elements in the Baltimore Memory Studysuggest common behavioral and neighborhood sources.

Keywords: metals, mixtureOP-121[Exposures » Other (to be specified with keywords in the keywords section)]

Pooled-cohorts Genome-Wide association studyof metals: Introduction to the Metal-GWAS
Initiative
Zulema Rodriguez Hernandez1, Shelley Cole2, Arce Domingo Relloso3, Pablo Fernandez Navarro4,
Maria Grau Perez5, Ka Kahe6, Martin Laclaustra7, Juan Carlos Martin Escudero8, Belén Moreno
Franco7, Victor Moreno9, Ana Navas Acien3, Beatriz Perez Gomez4, Josep Redon5, Jerome I.
Rotter10, Maria Tellez Plaza4
1Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III HealthInstitutes, Madrid, Spain and Department of Biotechnology, Universitat Politecnica de Valencia,
Valencia, Spain
2Population Health, Texas Biomedical Research Institute, San Antonio, US
3Department of Environmental Health Sciences, Columbia University, New York, US
4Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III HealthInstitutes, Madrid, Spain
5Cardiometabolic and Renal Risk Unit, Biomedical Research Institute INCLIVA, Valencia, Spain
6Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University,

New York, USA
7Facultad de Medicina, Universidad de Zaragoza; IIS Aragón; CIBERCV, Spain
8Department of General Internal Medicine, University of Valladolid, Spain
9Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de

Llobregat, Spain
10Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California,

USA

BACKGROUND AND AIM:Previous genome-wide association studies (GWAS) of metal biomarkers havebeen modest in sample size. We propose to use a multi-cohort approach to evaluate how levels of
metal biomarkers are influenced by genetic variation, which can point to biological mechanisms formetal toxicokinetic and gene-environment effects of metal exposures.
METHOD:Six cohorts have currently joined the metal-GWAS: Hortega, AWHS and MCC (Spain), and
MESA, REGARDS and SHS (US). In a pilot analysis, we used data from AWHS (N=1,867) and Hortega(N=1,401) participants with available metal concentrations and TOPMED-imputed SNPs. After quality
control and SNPs selection -1541 candidate genes related to metals transport or toxicity identified
using NCBI-Gene database-, we retained 228,915 SNPs that were commonly available in both cohorts.
Subsequently, we first conducted a GWAS with urinary levels of antimony, arsenic (sum of inorganicand methylated species adjusted for arsenobetaine), cadmium, chromium, copper and zinc, separately
in both studies. Second, for each metal, we meta-analysed coefficients and standard errors.
RESULTS:At a suggestive statistical significance level of 0.001, there was evidence of an association
between a number of SNPs with urine metal biomarkers (94 for arsenic, 68 for cadmium, 102 forchromium, 170 for copper, 84 for antimony and 26 for zinc). The SNP with the lowest p-values wasannotated to PTCH1 (F-statistic [F] =17.2) for antimony, CNGA3 (F=37.2) for arsenic, SLC38A4(F=13.9) for cadmium, ANO1 (F=19.4) for chromium, BAK1 (F=2.3) for copper and SLC30A2(F=14.3) for zinc.
CONCLUSIONS:Proteins encoded by the identified top genes have been reported to have a role onmetal-related health endpoints. The Metal-GWAS Initiative will create the necessary structure for large
collaborative efforts to assess, in the most possible robust and reproducible way, potential metalrelated health effects and associated gene-environment interactions. Other epidemiologic studies withavailable metal and genomic data are welcome to join (Contact: Maria Tellez-Plaza; m.tellez@isciii.es).

Keywords: metals, metalloids, single-nucleotide polymorphisms (SNPs), genome-wide association
studies (GWAS), genetics consortiumOP-122[Outcomes » Cardiovascular diseases]

Lead and cadmium exposure and biomarkers of
subclinical cardiovascular disease in the
National Health and Nutrition Examination
Survey 1999-2004
Molly E Schwalb1, Amelia S Wallace2, Elizabeth Selvin2, Ana Navas Acien3, John William Mc Evoy4,
Mary R Rooney2, Robert Christenson5, Miranda R Jones1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, UnitedStates2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, UnitedStates; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg
School of Public Health, Baltimore, United States
3Department of Environmental Health Sciences, Columbia University, New York, United States
4Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National

University of Ireland, Galway, Ireland
5Department of Pathology, University of Maryland School of Medicine, Baltimore, USA

BACKGROUND AND AIM:Exposure to contaminant metals like lead and cadmium increase the risk ofcardiovascular disease (CVD), but less is known on the effects of metal exposure on subclinical CVD.
We evaluated associations of lead and cadmium exposure with biomarkers of myocardial stress andcardiac damage: N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP), and high sensitivity cardiac
troponins I (hs-cTnI) and T (hs-cTnT).
METHOD:Blood lead and cadmium and serum cardiac biomarkers were measured in 10,172 adults
aged ≥20 years without a history of CVD who participated in the 1999-2004 National Health andNutrition Examination Survey (NHANES). We used logistic regression to estimate odds ratios (OR,
95% CI) for elevated cardiac biomarkers (defined as >90th percentile) per interquartile range increasein blood lead and cadmium concentrations. We additionally modeled metal concentrations as quartiles
of exposure. All models were adjusted for demographics, tobacco use, body mass index, hypertension,
diabetes, and kidney function.
RESULTS:The median concentrations of blood lead and cadmium were 1.70 μg/dL and 0.40 μg/L,
respectively. We observed positive associations between metals and elevated NT-proBNP (lead: OR
1.08 [95% CI: 0.98-1.18]; cadmium: OR 1.03 [95% CI: 0.91-1.16]), hs-cTnT (lead: OR 1.08 [95%
CI: 0.99-1.19]; cadmium: OR 1.05 [95% CI: 0.96-1.16]), and hs-cTnI (lead: OR 1.05 [95% CI: 0.981.14]; cadmium: OR 1.03 [95% CI: 0.94-1.12]) per interquartile range increase in metal
concentrations. We observed similar results when the metals were modeled as quartiles, withstatistically significant associations comparing the fourth to first quartile of exposure between lead andhs-cTnT (OR 1.62 [95% CI: 1.05-2.50]) and cadmium and NT-proBNP (OR 1.70 [95% CI: 1.062.73]).
CONCLUSIONS:In US adults, lead and cadmium measured in whole blood were positively associatedwith biomarkers of myocardial stress and cardiac damage. This provides evidence of lead andcadmium exposure as risk factors for CVD.

Keywords: chemical exposures, heavy metals, cardiovascular diseases

OP-123[Air pollution » General]

Longitudinal disparities in air pollution exposureby racial residential segregation in the UnitedStates: a meta-analysis of harmonized multicohort
Carolyn A. Fahey1, Hiwot Y. Zewdie1, Elizabeth W. Spalt2, Jaime E. Hart3, James Stewart4, Eric A.
Whitsel4, Mary L. Biggs5, Leslie Mcclure6, Joel D. Kaufman2, Anjum Hajat1
1Department of Epidemiology, University of Washington, Seattle, United States
2Department of Environmental and Occupational Health Sciences, University of Washington, Seattle,

United States
3Department of Environmental Health, Harvard University, Boston, United States
4Department of Epidemiology, University of North Carolina, Chapel Hill, United States
5Department of Biostatistics, University of Washington, Seattle, United States
6Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, United States

BACKGROUND AND AIM:Ambient air pollution has declined in the United States since the passage of
the Clean Air Act, however disparities by race and ethnicity persist. Racial residential segregation may
contribute to differential reductions in air pollution.
METHOD:We harmonized data from eight longitudinal cohort studies: Nurses’ Health Study I and II,
Health Professionals Follow-up Study, Women’s Health Initiative Clinical Trial and Observational Study,
Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, and Reasons for Geographic andRacial Differences in Stroke. Annual residential address-level mean NO2 and PM2.5 were estimatedfrom national spatio-temporal models. Neighborhood segregation was measured using a spatial
adaptation of the multi-race divergence index created from US Census tract-level data. We evaluateddifferences in the rate of change in NO2 from 1991 and PM2.5 from 1999 through 2016 by divergencez-score and race using adjusted log-linear generalized estimating equations. Cohort-specific results
were combined using fixed effects meta-analysis.
RESULTS:Our total sample included 425,593 adults (85% female; 8.9 million person-years). Adjusted
mean NO2 exposure decreased over time by 57% for Black (from 21.6 to 9.3 ppb) and 55% for White
participants (14.4 to 6.5 ppb); PM2.5 declined by 48% (15.3 to 7.9 µg/m3) and 45% (13.2 to 7.2µg/m3) respectively. Among Black participants, exposures were consistently higher in more
segregated neighborhoods, where the rate of decline lagged: each standard deviation increase indivergence was associated with slower average 5-year declines by 0.30% for NO2 (95% CI: 0.21,
0.39) and 0.34% for PM2.5 (95% CI: 0.29, 0.39). In contrast, among White participants increasing
segregation was associated with faster rates of decline in NO2 [-2.35% (-2.42, -2.27)] and PM2.5 [0.96% (-1.01, -0.91)].

CONCLUSIONS:Improvements in air quality have not been equitably distributed. Black populations
continue to experience higher levels of air pollution, particularly in more segregated neighborhoods.
These disparities may fuel enduring inequities in health outcomes.

Keywords: Air pollution, environmental disparities, environmental justice, socio-economic factors

OP-124[Climate » Health co-benefits]A ‘synthetic population’ model for evaluating theimpacts of city-level climate change mitigation
policies on health and health inequalities
James Milner1, Filiz Karakas1, Gregor Kiesewetter2, Sam Younkin3, Henry Fremont3, Jonathan Patz3,
Mike Davies4, Paul Wilkinson1
1Department of Public Health, Environments and Society, London School of Hygiene & Tropical

Medicine, London, UK
2Pollution Management Research Group, International Institute for Applied Systems Analysis,

Laxenburg, Austria
3Global Health Institute, University of Wisconsin-Madison, Madison, WI, USA
4UCL Institute for Environmental Design and Engineering, University College London, London, UK

BACKGROUND AND AIM:Modelling the health effects of climate change mitigation policies can provide
evidence to guide decision-making, but the effects of policies are likely to vary across populationgroups and conventional methods do not generally account for these differential effects. To improvecurrent methods, we developed a novel modelling framework for assessing the effects of climate
policies on health and health inequalities.
METHOD:The model generates a large (>1M) georeferenced ‘synthetic population’ of individuals withcharacteristics (age, gender, socioeconomic status) and health risks (mortality and disease rates)
representative of the population. Environmental exposures (ambient and indoor air pollution, housingrelated risks) and health-relevant behaviours (dietary consumption, transport behaviours) are
assigned to each individual, accounting for variations in each with respect to population characteristics
using evidence on their joint distributions. The effects of policy actions on health are modelled byapplying published exposure-response functions at individual-level.
RESULTS:The model is illustrated for a policy example in London. Linking to outputs from existingmodels of air pollution (Greenhouse Gas and Air Pollution Interactions and Synergies, GAINS) andtransport-related physical activity (Health-Oriented Transportation Model, HOT), we modelled theimpact of switching from motorised to active travel (walking, cycling) under scenarios with different
levels of switching in different population groups. The results show that the health benefits of thepolicy would result largely from increased physical activity rather than reduced air pollution exposure.
Increasing active travel in some groups would have considerably greater benefit to overall population

health. In particular, the largest impact could be achieved by increasing active travel for groups whoare currently least active.
CONCLUSIONS:The synthetic population model extends related methods to quantify the impacts ofclimate change mitigation policies on health inequalities. Other advantages of the model include
targeting of actions at subgroups and accounting for double counting when multiple actions are
considered in parallel.

Keywords: Health co-benefits, Health inequalities, Policy research, Built environmentOP-125[Exposure assessment methods » Exposure assessment-air pollution]

Sociodemographic Disparities in Mercury
Exposure from U.S. Coal-Fired Powerplants
Mona Dai1, Benjamin M Geyman1, Xindi C Hu2, Colin P Thackray1, Elsie M Sunderland1, Elsie M
Sunderland3
1Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge,

MA, USA
2Mathematica, Inc., Oakland, CA, USA
3Department of Environmental Health, Harvard T.H. Chan School of Health, Boston, MA, USA

BACKGROUND AND AIM:Hazardous Air Pollutants (HAP) emitted by U.S. coal and oil-fired powerplants
have been controlled by the Mercury and Air Toxics Standards (MATS) since 2012, yet
sociodemographic disparities in potential mercury (Hg) exposure from powerplants have not been
evaluated. Here we: (1) test whether potentially vulnerable groups disproportionately reside near
powerplants, (2) examine whether these subpopulations benefited equally from changes inatmospheric Hg deposition, and (3) construct an end-member scenario for the highest powerplant Hg
exposure following the MATS rule.
METHOD:We collated geospatial data on Hg emissions from U.S. powerplants before (ca. 2010) andafter (ca. 2020) implementation of the MATS rule. We combined modeled atmospheric Hg deposition
with U.S. Census data to examine the proportions of residential populations living close topowerplants, focusing on communities susceptible to high Hg exposures due to frequent fishconsumption, low-income, <high-school education, and limited English proficiency.
RESULTS:Prior to MATS (ca. 2010), we found that proportions of residents within 5-km of powerplants(n = 512) who were high fish consumers, low-income, <high-school educated, or limited Englishspeaking households were significantly greater relative to the general population. Within 5-km of 2020
facilities, proportions of low-income individuals were greater near active plants relative to retired ones.
Atmospheric Hg deposition from plants decreased by 90% across the contiguous U.S. between 20102020. However, a screening-level risk analysis for the largest emitting 2020 powerplants suggests
facility attributable exposure of anglers who consume self-caught fish could still exceed the U.S. EPA
reference dose for methylmercury.
CONCLUSIONS:Potentially vulnerable subgroups were disproportionately located around powerplants
in 2010, suggesting a lack of distributional justice in plant siting. The socioeconomic status ofresidential areas <15km from powerplants may play a role in determining plant retirement. Ongoing
Hg emissions from the largest remaining powerplants still present plausible exposure risks for somevulnerable groups.

Keywords: environmental justice, environmental disparities, air pollution, exposures, other (mercury)OP-126[Exposures » Environmental disparities]

The environmental conditions of mass
incarceration: National estimates ofenvironmental exposures impacting US
incarcerated populations
Raenita Spriggs1, Maggie Li1, Vivian Do1, Ishika Kaushal1, Marianthi Anna Kioumourtzoglou1, Joan A.
Casey2, Robbie M. Parks1, Seth J. Prins3, Anne E. Nigra1
1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA
2Department of Environmental and Occupational Health Sciences, Washington University School of

Public Health, Seattle, WA, USA
3Departments of Epidemiology and Sociomedical Sciences, Columbia University Mailman School of

Public Health, New York, NY, USA

BACKGROUND AND AIM:In the US, ~2 million people are incarcerated in correctional facilities, yetnationwide estimates of environmental exposures impacting these populations are not yet available.
Our objective was to estimate the total incarcerated US population (regionally and nationally)
impacted by several major environmental exposures, both individually and in combination.
METHOD:We analyzed 5,141 correctional facilities registered with the US Department of Homeland
Security (2022) that met our inclusion criteria; these facilities incarcerated 2,343,173 people. We
spatially linked facilities to the following dichotomized exposures: average public water arsenic anduranium concentrations > US Environmental Protection Agency regulatory standards (2000-2011);
annual mean PM2.5 and NO2 concentrations > World Health Organization guidelines (2005-2018);
any county-level wildfire event (2018-2020); and any county-level power outage of 8+ hours (20182020). We then summed the total incarcerated population with assigned exposures exceeding thesethresholds. We repeated our analysis stratified by US Geological Survey Climate Adaptation Regions.
RESULTS:Nationwide, 98.8% of the incarcerated population under study (N= 2,314,159) was assigned
to at least one exposure exceeding our thresholds. The most prevalent exposures nationwide were
elevated PM2.5, power outages, and wildfires, with 92%, 41%, and 21% of the incarcerated
population exposed, respectively. Both the average 2018 PM2.5 annual mean concentration for thenation (5.22 μg/m3) and correctional facilities (7.21 μg/m3) exceeded the WHO threshold (5 μg/m3).
An estimated 113,288 (4.8%) incarcerated people were exposed to elevated PM2.5, power outages,
and wildfires between 2018-2020; these facilities were most often located in the Southeast (34.6%),
Southwest (32.6%), and South Central (19.7%) regions.
CONCLUSIONS:We identified elevated annual mean PM2.5 levels as a key environmental exposure ofconcern for US incarcerated populations. Environmental exposures of concern for incarcerated
populations differed regionally. Ongoing work includes incorporating available data for extreme heat,
oil and gas wells, and ozone concentrations to expand our studies of compound environmental threats.

Keywords: environmental justice, environmental disparities, multi-pollutant, air pollution, wildfiresOP-128[Exposures » Other (to be specified with keywords in the keywords section)]

Geospatial modelling and socioeconomic
inequalities of transportation, human, andnature-based sounds in Accra, Ghana
Sierra N Clark1, Majid Ezzati3, James Bennett1, Raphael Arku4, Abosede S Alli4, Ricky Nathvani1,
James Nimo6, Josephine Bedford Moses6, Solomon Baah6, Allison Hughes6, Alicia Cavanaugh7, Brian
Robinson7, Samuel Agyei Mensah8, George Owusu9, Michael Brauer5, Mireille B Toledano2
1Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London,

London, UK
2Department of Epidemiology and Biostatistics & the Mohn Centre for Children’s Health and Wellbeing,

School of Public Health, Imperial College London, London, UK
3Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK;

Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London,
UK; Regional Institute for Population Studies, University of Ghana, Accra, Ghana
4Department of Environmental Health Sciences, School of Public Health and Health Sciences,

University of Massachusetts, Amherst, USA
5School of Population and Public Health, The University of British Columbia, Vancouver, Canada
6Department of Physics, University of Ghana, Accra, Ghana
7Department of Geography, McGill University, Montreal, Canada
8Department of Geography and Resource Development, University of Ghana, Accra, Ghana
9Institute of Statistical, Social & Economic Research, University of Ghana, Accra, Ghana

BACKGROUND AND AIM:Urban environments are filled with mixtures of mechanical, human, andnature-based sounds, which can be detrimental, neutral, or even beneficial to physical andpsychological health. The majority of epidemiological studies have focused on the harmful effects oftransportation noise exposure, and there is a major gap in city-scale information on the distribution ofother types of sounds which may impact health and wellbeing.
METHOD:Within a large-scale multi-pollutant measurement campaign in Accra, Ghana, we collected anovel dataset of audio recordings at 146 locations over 1yr. The recordings were processed with a pretrained neural network to classify different types of sounds and then modelled with Random Forest
land use regression (LUR) to make predictions across the city with both day and night-time models.
We also investigated possible socioeconomic (SES) inequalities by linking the sound predictions tosmall area data on household consumption, higher educational attainment, and unemployment.
RESULTS:LUR model performance, assessed with 10fold cross-validation, was good for road-transport
and animal sounds (R2 range 0.37 – 0.70), moderate for human speech and music (R2 range 0.210.42), and poor for nature sounds (R2 range: 0 – 0.10). The prevalence of road-traffic sounds washighest in the urban core and along major motorways (median: 63%-42%), human speech and musicin low-income high-density residential neighbourhoods (median: 9%-23%), and animal sounds inperi-urban areas (median: 64-71%). There was a weak inverse association between road-traffic
sounds and SES (Pearson correlation (r): -0.16 to -0.20). Conversely, animal sounds (like birds) areoften described in soundscape surveys as ‘calming’ and ‘pleasant’ and were more prevalent inwealthier neighbourhoods (r: 0.37).
CONCLUSIONS:We have illustrated a high-resolution approach to characterising the abundance of avariety of sound types at city scale, which can be incorporated into epidemiological investigations of
the direct and interactive effects of harmful and/or potentially beneficial sound exposures.

Keywords: Noise, Exposure assessment, Environmental disparities, Spatial statistics

OP-129[Climate » Other (to be specified with keywords in the keywords section)]

Future health burden under a projectedprescribed fire management scenario in
California
Ana Rappold1, Sumi Hoshiko2, Joseph Ryan Buckman3, Kirstin R Yeomans2, Thomas Hayashi4,
Samantha J Kramer5, Shihming Huang5, Nancy Hf French6
1Center for Public Health and Environmental Assessment, United States Environmental Protection

Agency, Durham, North Carolina, USA.
2Environmental Health Investigations Branch, California Department of Public Health, Richmond,

California, USA
3California Epidemiologic Investigation Service Fellowship Program (Cal-EIS), Department of Public

Health, Sacramento, California
4Sequoia Foundation, La Jolla, California, USA
5Sonoma Technology, Inc., Petaluma, California, USA
6Michigan Tech Research Institute, Michigan Tech University, Ann Arbor, Michigan, USA

BACKGROUND AND AIM:To mitigate the growing wildfire risk in California, forest management
agencies plan to increase the use of prescribed fire. We characterized the anticipated change in healthimpacts from exposure to smoke under a future fire-management scenario relative to the historicalperiod (2008-2016).
METHOD:Daily concentrations of fine particulate matter (PM2.5) emitted by future prescribed fires
were estimated using HYSPLIT dispersion models that simulated the burning of 500,000-acresclassified as high priority. Daily smoke-PM2.5 concentrations from historical wildfires and prescribedfires were estimated based on satellite-derived data and historical fire records. Using previously
estimated excess daily cardiopulmonary burden rates attributed to all-source PM2.5 in the historicalperiod, we differentiated the burden by days impacted by smoke for each fire type and estimatedsmoke-PM2.5 concentration and applied concentration-specific burden rates to the future scenarios.
RESULTS:The annual number of person-days of exposure to prescribed fire smoke was 15x more thanpast prescribed fires, although exposures were associated with lower concentrations. We estimated a
reduction in high PM2.5 concentrations from prescribed fire relative to the past. The increased numberof days with low-concentration exposure across populated, high-priority areas was associated with anincreased health burden in the future. The largest increase in burden was observed in northern-central
and southern coastal regions.
CONCLUSIONS:This approach for characterizing the potential impacts of prescribed fire is a metricthat integrates spatiotemporal differences in exposure, baseline morbidity, and population size andmay be a useful tool to inform effective future implementation for public health protection and safety
from wildfires.

Keywords: prescribed fire, wildfire, health burden, climate changeOP-130[Outcomes » Mortality]

Associations of Body Constitution and All-cause
Mortality in Patients with Type 2 Diabetes
Cheng Hung Lee1, Chia I Tsai1, Tsai Chung Li2
1Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;

Department of Post‐Baccalaureate Medicine, College of Medicine, National Chung Hsing University
2Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan;

Department of Healthcare Administration, College of Medical and Health Science, Asia University,
Taichung, Taiwan

BACKGROUND AND AIM:The present study aimed to examine the associations of baseline body
constitutions with subsequent risks of all-cause mortality among Chinese persons with type 2
diabetes.
METHOD:Persons with type 2 diabetes enrolled in managed care in 2010 were participants (n=887)
and they were followed up to 2015. Death status was determined via linkage of Taiwan National Death
Datasets. BC status of Yin deficiency, Yang deficiency, and phlegm stasis was evaluated using a wellvalidated body constitution (BC) questionnaire at baseline. Hazard ratios (HR) of mortality for BC
status were estimated using multivariate Cox proportional hazards model.
RESULTS:During the 6,807.2 person-years of follow-up from 887 participants with a mean follow up of
7.7 years, 190 persons died with an incidence density of 0.0279 person-years. Yin deficiency was
independently associated with all-cause mortality (HR, 95% CI: 1.39, 1.02–1.90), while theassociation of phlegm stasis with all-cause mortality was borderline significant when diabetes-related
factors were considered (1.47, 0.99–2.19). Yang deficiency was not a significant predictor.
Stratification analysis indicated the absence of significant associations of all BC types with mortality inpersons with good glucose control, whereas in persons with poor glucose control, body constitutions ofYang deficiency, Ying deficiency, or phlegm stasis were associated with 75%–88% increase inmortality.
CONCLUSIONS:This study shows TCM BCs of Yin deficiency is associated with all-cause mortality andglucose control modifies the associations of Yin and Yang deficiency with all-cause mortality. Thesefindings may provide information for translation into TCM care for persons with type 2 diabetes.

Keywords: Traditional Chinese medicine, body constitution, all-cause mortality, type 2 diabetes
mellitus

OP-131[Other » Other (to be specified with keywords in the keywords section)]

A Nationwide Population-Based Cohort Study Of
The Association Between Visual Loss And Risk
Of Suicide And Mental Illness In Taiwan
Chieh Sung1, Chi Hsiang Chung2, Fu Huang Lin2, Wu Chien Chien3, Chien An Sun4, Chang Huei Tsao5,
Daphne Yih Ng6
1Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
2School of Public Health, National Defense Medical Center, Taipei, Taiwan
3Department of Public Health, National Defense Medical Center, Taipei, Taiwan & College of Medicine,

Fu-Jen Catholic University, Taipei, Taiwan
4Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
5Department of Microbiology & Immunology, Tri-Service General Hospital, Taipei, Taiwan
6Department of Family Medicine, Tri-Service General Hospital, Taipei, Taiwan

BACKGROUND AND AIM:The psychosocial and health consequences of ocular conditions that cause
visual impairment (VI) are extensive and include impaired daily activities, social isolation, cognitive
impairment, impaired functional status and functional decline, increased reliance on others, increased
risk of motor vehicle accidents, falls and fractures, poor self-rated health, and depression. We aimed
to determine whether VI increases the risk and progression of mental illness, suicide, and mortality
over time.
METHOD:In this large, nationwide, population-based, nested, cohort study, we used data from 2000 to2015 in the Taiwan National Health Insurance Research Database (NHIRD), which includes all
diagnoses of patients with VI. Baseline features, comorbidities, and prognostic variables were
evaluated in a 1:4-matched analysis and comparison cohorts using Cox proportional hazards
regression to study the association between VI and poor prognosis (mental illness, suicide, andmortality). The study outcome was the cumulative incidence of poor prognosis among the visually
impaired and controls.
RESULTS:Among the 1,949,101 patients enlisted in the NHIRD, 271 had been diagnosed with VI. Risk
factors for poor prognosis, and the crude hazard ratio was 3.004 (95% confidence interval 2.135–
4.121, p<0.001). Participants with VI had an increased risk of poor prognosis, according to thesensitivity analysis with a poor prognosis within the first year and first five years. VI was associatedwith suicide and mental health risks.
CONCLUSIONS:VI increases the likelihood of a poor prognosis. Early detection through comprehensive
examinations based on increased awareness in the clinical context may help maintain visual function
and avoid additional complications.

Keywords: National Health Insurance Research Database, suicide, vision loss, mental illness

OP-132[Chemical exposures » PFAS]

Perceptions and experiences of PFAS
biomonitoring in Australian communities
affected by environmental contamination
Kayla S Smurthwaite1, Nina Lazarevic1, Sandra Nilsson2, Susan Trevenar1, Cathy Banwell1, Rosemary
Korda1, Martyn D Kirk1
1National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian

National University, Canberra, Australia
2Queensland Alliance for Environmental Health Sciences, University of Queensland, Woolloongabba,

Australia

BACKGROUND AND AIM:Understanding human exposure to persistent environmental pollutants is
critical to informing public health responses and addressing community concerns in contaminatedareas. We aimed to investigate community perceptions and experiences of human biomonitoring for
PFAS in Australian towns impacted by environmental contamination.
METHOD:From 2016 to 2019, the Australian Government conducted the Voluntary Blood Testing
Program for PFAS for current and former residents and workers of three Australian towns. From 2019
to 2020, we surveyed 812 people who provided a blood sample for the Program and used an inductive
approach to thematically analyse responses on the usefulness of the blood testing for PFAS andrelated access to health services. We examined the association of the perceived usefulness of theblood testing with blood serum PFAS concentrations and psychological distress measures.
RESULTS:We observed distinct thematic differences in community experiences and perceptions of the
PFAS blood testing. Participants who reported that the blood testing was helpful communicated thatthe results confirmed their exposure. However, participants assumed that the test results could be
used to make inferences to their health or that levels within reference values can be considered ‘safe’.
In contrast, participants who indicated that the test was not helpful, or who were unsure, reflected on
the uncertainty in the relationships between exposure and potential health effects. These participants
had unanswered questions about their results after their post-test consultation.
CONCLUSIONS:Communities affected by local environmental contamination consistently request
access to individual blood testing and results to understand their exposure. However, risk
communication strategies related to the reporting of these results may not adequately consider the
potential psychosocial implications. Globally, there is a need to evaluate and standardise approaches
to reporting individual blood serum PFAS results, including the selection and reporting of reference
values, in research and clinical settings.

Keywords: Biomarkers of exposure, Chemical exposures, Environmental epidemiology, PFAS, Policy
and practiceOP-133[Methods » Environmental epidemiology]

Cost-Constrained Optimal Treatment Regimes
under Bipartite Network Interference
Raphael Kim, Falco Bargagli Stoffi, Kevin Chen, Rachel Nethery
Department of Biostatistics, Harvard T.H. Chan School of Public Health (Boston, MA)

BACKGROUND AND AIM:Numerous studies have linked fine particulate matter (PM 2.5) to adverse
health effects such as cardiovascular disease and stroke. Coal-fired power plants are a notable source
for PM 2.5 generation in the US via sulfur dioxide emissions. As a result, policy makers haveconsiderable interest in understanding the health effects of installing flue gas desulfurizationequipment (i.e., “scrubbers”) on coal-fired power plants. Due to significant monetary installation andupkeep costs, it is important to understand the effects of installing scrubbers at any given location
before investing. This problem can be formalized as determining the cost-constrained optimaltreatment regime (CC-OTR) under bipartite network interference (BNI), in which the intervention units(power plants) are different from the units that outcomes are observed on and treatment units canaffect multiple outcome units. In this work, we introduce a Q-Learning approach for determining CCOTR under BNI, derive the asymptotic properties of our proposed estimators, and demonstrate themethod’s efficacy through extensive simulation studies.
METHOD:We design a Monte Carlo simulation to test the proposed method on semi-simulated data
inspired by Medicare fee-for-service beneficiary data. The method’s mean ± standard error of meanfor decision accuracy and L2 total effect (TE) errors are calculated under different BNI network
densities and effect sizes.
RESULTS:The decision error across all simulations is 0 ± 0. Across all effect sizes, the TE error is
0.00059 ± 0.00063. Across densities, when certain power plants have stronger interference effects,
the TE error is 0.00059 ± 0.00063. When all power plants have uniform interference effects, the TE
error is 0.0011 ± 0.00087.
CONCLUSIONS:To our knowledge, we present the first method for CC-OTR under BNI. This method
can be applied broadly to determine optimal policy interventions subject to BNI.

Keywords: Bipartite Network Interference, Optimal Treatment Regime, Q-LearningOP-134[Cancer and cancer-precursors » Survival]

Counterfactual Event-Based Mediation Analysis
of Socioeconomic Status for Cancer Patient
Survival
Kartika Nur Anisa1, Shi Woei Lin2, Chiang Sheng Lee2
1Department of Industrial Engineering, Airlangga University, Surabaya, Indonesia
2Department of Industrial Management, National Taiwan University of Science and Technology, Taipei,

TaiwanBACKGROUND AND AIM:Although many studies have examined the association between
socioeconomic status (SES) and the prognosis of cancer, few studies have investigated the variables
mediating this association, which can serve as possible targets for policy intervention. This study
examined the effect of SES on cancer patient survival directly and indirectly by considering the cancer
stage and medical treatment (ie, surgery) to identify multiple pathways from SES to health outcomesand simplify their mechanistic implications for certain cancers (lung, liver, colorectal, and stomach
cancers).
METHOD:Mediation (survival) analysis based on a counterfactual framework of the Surveillance,
Epidemiology, and End Results data from the National Cancer Institute of the United States was
performed using the Cox proportional hazard model.
RESULTS:Mediation analysis based on a counterfactual framework revealed that the effect of SES on
cancer survival can be further decomposed into direct and indirect effects through pathways mediatedby the stage at diagnosis and surgery. In particular, the inconsistent mediation (or suppression)
effects found for colorectal and stomach cancers are critical for evaluating the counterproductive
effects of the cancer stage and treatment on survival.
CONCLUSIONS:SES can exert a direct or indirect effect on cancer patient survival, and the mediation
analysis indicated that the discrepancy in the cancer stage and surgery is significantly caused by SES.
Opportunities to reduce cancer inequality should be emphasized in policies or mechanisms with varied
resources, recovery medication, health-care facilities, and access to medical facilities.

Keywords: Methods, causal inferenceOP-135[Birth and pregnancy outcomes » Other (to be specified with keywords in the keywords section)]

The Association Between Birth Weight andChildhood Cancer Risk in Taiwan
Ya-Chi Chang, Pau Chung Chen
Institute of Environmental and Occupational Health Sciences, National Taiwan University College of
Public Health, Taipei, Taiwan

BACKGROUND AND AIM:Previous studies have attempted to establish a link between birth weight andchildhood cancer, but research among Asian populations is limited. In the present study, we aimed toinvestigate the relationship between birth weight and childhood cancer in Taiwan using nationwide
population data.
METHOD:We utilized data from two large national databases – the Taiwan Birth Registration database
and the Taiwan Cancer Registration database – to conduct our analysis. Our study comprised
7,857,354 infants born between 1978-2000; we excluded 451,434 premature and post-term births. Of
these, 7,281 children were diagnosed with childhood cancer from 1979-2001. We divided newborns
into five weight groups and used Cox proportional hazards model to investigate the association
between birth weight and cancer risk, while controlling for variables such as gender, maternal age,and socioeconomic status.
RESULTS:After a follow-up period of 20 years and one hundred million person-years, we observed thatbirth weight between 3500-3999 gm was associated with a slight increase in hazard ratios (HRs) for
certain childhood cancers, such as soft tissue sarcoma ([HR] =1.30, 95% CI=1.03-1.65) and germ celltumors ([HR]=1.52, 95% CI=1.24-1.86). Additionally, birth weight over 4000 gm increased the risk ofsoft tissue sarcoma ([HR] =1.55, 95% CI=1.06-2.26) and bone tumor ([HR] =2.40, 95% CI=1.463.96), but decreased for leukemia ([HR] =0.82, 95% CI=0.68-0.99) and renal tumors ([HR] =0.53,
95% CI=0.29-0.99). Furthermore, large gestational age (LGA) was also associated with an increased
risk of cancer ([HR] =1.30-1.56, 95% CI=1.03-2.57).
CONCLUSIONS:Our study suggests that higher birth weight and large gestational age may increase
the risk of childhood cancer. Our findings add to the current knowledge on the association between
birth weight and childhood cancer and highlight the importance of early life factors in the developmentof pediatric malignancies. Further research is needed to better understand the underlying mechanisms
and to develop preventive strategies.

Keywords: birth weight, childhood cancer

OP-136[Birth and pregnancy outcomes » Pregnancy outcomes]

Increased HbA1c During Pregnancy is
Associated with In-utero Exposure to PM2.5 at
Levels below Current Air Quality Guidelines
Yan Lin1, Ruoxue Chen1, Yihui Ge1, Philip K Hopke2, Sally W Thurston2, Thurston G O'connor2, DavidQ Rich2, Junfeng Zhang1
1Duke University
2Rochester University

BACKGROUND AND AIM:Previous epidemiological studies found increased risk of gestational diabetes
associated with fine particle matter (PM2.5) exposure. However, there is a paucity of mechanistic
evidence for such an association. We examined to what extent in utero exposure to PM2.5 perturbs
the longitudinal trajectory of a maternal hyperglycemia biomarker (HbA1c) during pregnancy.
METHOD:We measured HbA1c in 601 blood samples collected from 237 pregnant women in Rochester,NY (≤3 samples per woman). We matched participants’ residential addresses to 1 km2 grids for which
we estimated ambient PM2.5 concentrations for the 1-12 weeks prior to blood collection. We
estimated the longitudinal trajectory of HbA1c during pregnancy using a generalized additive modelwith a smooth function of the gestational week of HbA1c measurement and a random subject effect.
To this model we added the ambient PM2.5 concentrations to estimate the difference in HbA1c
associated with PM2.5. Finally, we added an interaction term to determine whether the HbA1c-PM2.5
association differed across trimesters.
RESULTS:The median (IQR) 12-week PM2.5 concentration was 6.81 (5.99 – 7.45) μg/m3. The median(IQR) Hba1c level was 5.18 (4.86 – 5.54) % with a U-shaped trajectory during pregnancy. Comparedwith the first trimester, HbA1c decreased by 0.14% (95%CI: 0.06% to 0.19%) in the second trimesterand increased by 0.31% (95%CI: 0.22% to 0.40%) in the third trimester. Each IQR (1.46 μg/m3)
increase in 12-week PM2.5 concentration was associated with a 0.06% (95%CI: 0.00% to 0.12%)
increase in Hba1c. Greater increases in HbA1c per IQR PM2.5 increase were observed in the first(0.08%, 95%CI: -0.01 to 0.16%) and third (0.07%, 95%CI: -0.01 to 0.14%) trimesters, than thesecond trimester (0.03%, 95%CI: -0.03 to 0.10%).
CONCLUSIONS:Exposure to PM2.5, especially in the 1st and 3rd trimesters and even at levels below
12 μg/m3, may impair glucose metabolism in pregnant women.

Keywords: Particulate matter, Pregnancy outcomes, Obesity and metabolic disordersOP-137[Air pollution » Long-term exposure]

Prenatal Exposure to Air Pollutants in Two
Generations and Birth Outcomes in the Third
Generation
Michelle Pearl1, Kimberly Berger2, Kara Rudolph3, Joan Casey4, Andrew Rosenberg1, Nicholas
Williams3, Alan Hubbard5, Marty Kharrazi2
1Environmental Health Investigations Branch, California Department of Public Health, Richmond,United States of America
2Sequoia Foundation, Berkeley, United States of America
3Mailman School of Public Health, Columbia University, New York, United States of America
4School of Public Health, University of Washington, Seattle, United States of America
5School of Public Health, University of California Berkeley, Berkeley, United States of America

BACKGROUND AND AIM:Recognizing the transgenerational effects of numerous toxicants, weestimated the impact of prenatal air pollution exposure among mothers and grandmothers on third
generation birth outcomes.
METHOD:Annual estimates of particulate matter (PM2.5) and nitrogen dioxide (NO2) at the census
tract level were linked to California births corresponding to women born from 1982 onward(Generation 1 [G1]) and their offspring born from 1997-2011 (Generation 2 [G2]; N=666,837),
representing prenatal exposure in two generations. Third generation birth outcomes, derived from G2birth and prenatal records, include preterm birth (prior to 37 weeks gestation; PTB) and term lowbirthweight (<2500 g and gestation 37+ weeks; TLB). Doubly robust, data-adaptive estimation of
longitudinal modified treatment policies (LMTP) was used to estimate total effect risk differences (RDs)if each person’s levels of PM2.5 and NO2 were both reduced by 10%, at each generation, adjusting for
generation-specific temperature, race-ethnicity, age, parity, neighborhood poverty, rural/urban
residence, and, for G2 only, public insurance and education.
RESULTS:At observed air pollutant levels, risk of PTB was 8.8% and risk of TLB was 2.2%. Jointly
lowering G1 prenatal PM2.5 and NO2 by 10% resulted in a small reduction in third generation PTB risk
compared to no change in exposure (RD=-0.04 [95% CI -0.08, -0.001), but did not result in reduction
in TLB risk (RD=0.01 [-0.01, 0.03]). Reducing both PM2.5 and NO2 in G2 resulted in larger risk
reductions for PTB (RD=-0.20 [-0.23, -0.17]) and TLB (RD=-0.02 [-0.04, -0.01]) compared to the G1
reductions.
CONCLUSIONS:Using a novel method of effect estimation for joint continuous exposures, we foundreductions in PTB and TLB with 10% reduction in second generation PM2.5 and NO2, and smaller
reductions in PTB with first generation exposure to air pollutants. Future research should explore
mediation and effect modification of prenatal air pollution exposures across generations.

Keywords: Particulate matter, Oxides of nitrogen, Birth outcomes, Environmental epidemiology

OP-138[Air pollution » Particulate matter]

Fine particulate matter and preterm birth: acausal survival approach
Michael Leung1, Anna M Modest2, Michele R Hacker3, Hari Iyer4, Jaime E Hart5, Yaguang Wei1, Joel
Schwartz6, Brent A Coull7, Francine Laden8, Marc G Weisskopf6, Stefania Papatheodorou9
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA;

Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA
3Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA;

Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston,
USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
4Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New

Brunswick, USA
5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, USA
6Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
7Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
8Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing
Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, USA
9Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA

BACKGROUND AND AIM:With the escalating threat of climate change, there is increasing interest inunderstanding the impact of environmental exposures on preterm birth (<37 weeks). The standard
approach treats prematurity as a binary outcome and thus complicates analyses of exposures that
depend on gestational age (e.g., cumulative exposure) as the exposure data does not always alignwith the at-risk window. We overcome this limitation by treating preterm delivery as a time-to-event
outcome and use a survival framework to assess its association with particulate matter ≤ 2.5 µm(PM2.5).
METHOD:We used data on 9,446 births from 2011-2016 in a Massachusetts-based cohort. PM2.5 wastaken from a 1-km grid model and assigned to address. We considered two exposure windows which
depend on gestational week t: 1) the cumulative exposure to week t, and 2) 4-weeks prior to week t.
We applied g-computation to estimate the effect—i.e., risk ratios (RRs) and differences (RDs)—of ahypothetical intervention reducing PM2.5 exposure to the new World Health Organization air quality
guidelines of 5 µg/m3. Models were adjusted for socio-demographics, time trends, temperature, andnitrogen dioxide.
RESULTS:There were 805 (8.5%) preterm births in this cohort. Average PM2.5 was 7.4 µg/m3 for the
cumulative exposure (95% had >5 µg/m3) and 8.74 µg/m3 for the 4-week window (97% had >5µg/m3). We found that setting the exposure ceiling to 5 µg/m3 lowered the risk of preterm birth—the
RR was 0.82 (95% CI: 0.67, 1.03) and the RD was -0.01 (95% CI: -0.03, 0.0003), which translates toabout 137 (95% CI: -27, 258) fewer preterm births in this cohort. PM2.5 in the 4-week window was
not associated with preterm birth.

CONCLUSIONS:Using a causal survival approach, we found that higher cumulative PM2.5 exposure
was associated with increased risk of preterm birth.
FUNDING: NIEHS P30 ES000002 and USEPA RD-835872

Keywords: birth outcomes, methods, causal inferenceOP-139[Air pollution » Particulate matter]

Associations between ambient PM2.5 andmarkers of platelet activity in pregnant womenin Puerto Rico
Trenton Honda1, Trenton Henry1, Laura Corlin2, Kipruto Kirwa2, Akram Alshawabkeh3, José F.
Cordero4, Carmen M. Velez Vega5, Zaira Y. Rosario Pabon6, John Meeker7, Helen Suh8
1School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, USA
2Department of Public Health, Tufts University, Medford, USA
3Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
4Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
5University of Puerto Rico Medical Campus, San Juan, Puerto Rico, USA
6Northeastern University, Boston, USA
7School of Public Health, University of Michigan, Ann Arbor, USA
8Department of Civil and Environmental Engineering, Tufts University, Medford, MA

BACKGROUND AND AIM:Pregnancy is associated with increased platelet activity, which is associatedwith hypercoagulability and the pathogenesis of preeclampsia. This platelet activity is partiallymediated through elevated platelet thromboxane A2 (TXA2) formation in the pregnant state, which
increases the production of superoxide and other reactive oxygen species (ROS). Whether and to what
extent exposure to ambient PM2.5 in pregnant women, which also has been associated with disordersof platelet aggregation and ROS production, may impact thromboxane levels remains unclear.
METHOD:We investigate associations between 30-day moving average PM2.5 and maternal
thromboxane (TXB2, a proxy measure for serum TXA2) levels in a cohort of 1,117 pregnant women
between the ages of 18 and 41 enrolled in the Puerto Rico Testsite for Exploring Contamination
Threats (PROTECT) study. We calculated PM2.5 estimates using EPA Air Quality System data from 13
island monitors, ascribing individual exposure estimates using inverse distance weighting. TXB2
samples were taken during the third trimester visit, and ordinary least squares regression was used
for statistical analysis. All models were adjusted for fetal gestational age, parity, history of adverse
pregnancy outcomes, maternal demographics (i.e., age, race) socioeconomic status, exercise, BMI,
and seasonality.
RESULTS:Mean 30-day PM2.5 exposure was 8.7 ug/m3, and mean TXB2 level was 6.6 nmol/L. A 10
ug/m3 increase in the 30-day moving average PM2.5 increased TXB2 level by 55.5% (95% CI: 6.2,
127.7, p = 0.0233). Examination of quintiles of exposure demonstrated a non-linear dose-response
relationship (p-trend <0.001).
CONCLUSIONS:Particulate matter air pollution may impact platelet activity, and thus
hypercoagulability and risk for adverse pregnancy outcomes, by increasing TXA2 production inpregnant women.

Keywords: PM2.5, pregnant women, thromboxane, platelet activity

OP-140[Air pollution » Particulate matter]

Associations between ambient PM2.5 andplacental Corticotropin Releasing Hormone(CRH) in pregnant women in Puerto Rico
Trenton Honda1, Trenton D. Henry1, Laura Corlin2, Kipruto Kirwa2, Akram Alshawabkeh3, José F.
Cordero4, Carmen M. Velez Vega5, Zaira Y Rosario Pabon6, John Meeker7, Helen Suh8
1School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, USA
2Department of Public Health, Tufts University, Medford, USA
3Department of Civil and Environmental Engineering, Northeastern University, Boston, USA
4Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
5University of Puerto Rico Medical Campus, San Juan, Puerto Rico, USA
6Northeastern University, Boston, USA
7School of Public Health, University of Michigan, Ann Arbor, USA
8Department of Civil and Environmental Engineering, Tufts University, Medford, MA

BACKGROUND AND AIM:Corticotropin releasing hormone (CRH) is an important placental productduring pregnancy which is thought to have neuroprotective and metabolic regulatory effects in thefetus and mother. Previous studies suggest that perturbations in CRH can adversely affect pregnancy
outcomes, however no prior study has examined the impact of particulate matter (PM) on CRH despitea growing body of literature linking PM to placental health.
METHOD:We used generalized estimating equations to investigate associations between PM2.5 andmaternal CRH in a cohort of 1,117 pregnant women (aged 18-41) enrolled in the Puerto Rico Testsite
for Exploring Contamination Threats (PROTECT) study. Exposure estimates were derived from EPA Air
Quality System (AQS) data, and individual 30-day moving average exposure estimates were assigned
using inverse distance weighting from 13 island monitors spanning 2010-2020. Blood CRH levels wereanalyzed over two visits for each participant. All models were adjusted for fetal gestational age at thetime of the blood draw, number of prior pregnancies, history of adverse pregnancy outcomes,maternal demographics (i.e., age, race) socioeconomic status (i.e., education, employment status,
income, marital status), maternal exercise habits, pre-pregnancy BMI, and seasonality.
RESULTS:Mean PM2.5 exposure was 8.7ug/m3 and mean CRH levels were 54.0ng/mL and 54.1ng/mL
for visits 1 and 3, respectively. A 10ug/m3 increase in the 30-day moving average PM2.5 exposure
was associated with a decrease in CRH of 77.2% (95% CI:-72.4,-81.1). A statistically significant andmonotonic dose response relationship was also observed in quintile analyses, with the highest quintile
of exposure associated with an 89.8% lower CRH (95% CI:-84.1,-93.5, p-trend <0.001).
CONCLUSIONS:In the first examination of the association between ambient PM2.5 exposure andplacental CRH levels, we identify significant and large magnitude associations. This may indicate that
perturbations in placental endocrine physiology is an important and understudied pathway by which
PM may adversely impact fetal and maternal health.

Keywords: Pregnancy, Corticotropin releasing hormone, particulate matter, PM2.5,

OP-141[Birth and pregnancy outcomes » Birth outcomes]

Maternal Metabolomics Linking Prenatal
Exposure to Fine Particulate Matter and Birth
WeightWu Chen1, Chenyu Qiu1, Jiayuan Hao1, Jiawen Liao1, Fred Lurmann2, Nathan Pavlovic2, Rima Habre1,
Dean P Jones3, Theresa M Bastain1, Carrie V Breton1, Zhanghua Chen1
1Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, CA, USA
2Sonoma Technology Inc, Petaluma, CA, USA
3Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, School of

Medicine, Emory University, Atlanta, GA, USA

BACKGROUND AND AIM:Prenatal exposure to fine particulate matter (PM₂.₅), especially during second
trimester, has been associated with lower birth weight in Maternal and Developmental Risks from
Environmental and Social Stressors (MADRES) study. This study aims to investigate potential maternal
metabolic pathways in third trimester mediating the association between second-trimester PM₂.₅
exposure and lower birth weight.
METHOD:Based on the ongoing MADRES study in Los Angeles, 421 maternal serum samples collected
at third trimester were analyzed for untargeted metabolomics using LC-MS. Daily estimates of PM₂.₅
concentrations were assigned to each participant’s residential address using inverse-distance-squared
weighted spatial interpolation and calculated as second-trimester averages. Birth weight andcovariates were retrieved from electronic medical records or questionnaires. Metabolome-wide
association studies were conducted using linear regression to identify metabolomic features associatedwith second-trimester PM₂.₅ exposure and birth weight Z-score, respectively. Metabolic pathways
common to prenatal PM₂.₅ exposure and birth weight were identified using Mummichog pathway
analysis.
RESULTS:Numbers of metabolomic features associated with second-trimester PM₂.₅ exposure andbirth weight Z-score were 692 and 356 for HILIC positive mode, and 779 and 495 for C-18 negativemode, respectively (p<0.05). 35 positive-mode and 40 negative-mode metabolomic features were
found to be associated with both PM₂.₅ exposure and birth weight. The most significant pathways
associated with second-trimester PM₂.₅ exposure were ascorbate (vitamin C) and aldarate metabolism(p=0.01) and C21-steroid hormone biosynthesis and metabolism (p<0.01). Dysregulated metabolism
of glycerophospholipid (p=0.01) and vitamin D3 (cholecalciferol) (p<0.01) was associated with birthweight Z-score. Ascorbate (vitamin C) and aldarate metabolism was a common metabolic pathway
associated with both PM₂.₅ exposure and birth weight Z-score.
CONCLUSIONS:Metabolomics analysis suggested a potential mediating role of maternal oxidative
stress during pregnancy in the association between prenatal PM₂.₅ exposure and lower birth weight.

Keywords: Air pollution, Birth outcomes, Metabolomics, Particulate matter

OP-142[Air pollution » General]

The NASA TEMPO Mission: Hourly Observationsof Major Air Pollutants from Space forAdvancing Air Quality and Health Applications
Aaron Naeger1, Michael Newchurch2, Xiong Liu3, Kelly Chance3, Allan Just4
1University of Alabama in Huntsville, Huntsville, AL; NASA Marshall Space Flight Center, Huntsville, AL
2University of Alabama in Huntsville, Huntsville, AL
3Harvard–Smithsonian Center for Astrophysics, Cambridge, MA
4Icahn School of Medicine at Mount Sinai, New York City, New YorkBACKGROUND AND AIM:NASA is launching the Tropospheric Emissions: Monitoring of POllution(TEMPO) instrument, an ultraviolet and visible grating spectrometer, into Geostationary Earth Orbit(GEO) in April 2023. TEMPO will observe trace gases and aerosols, including nitrogen dioxide (NO2),
sulfur dioxide (SO2), formaldehyde (HCHO), ozone (O3), and aerosol optical depth (AOD), at highspatial resolution (e.g., ~2 km x 4.75 km) every daylight hour over a Field of Regard (FoR) covering
greater North America. TEMPO is part of a GEO air quality constellation, together with theGeostationary Environment Monitoring Spectrometer (GEMS; launched February 2020) covering Asiaand the Sentinel-4 instrument (planned for launch in 2024) covering Europe.
METHOD:TEMPO will observe major air pollutants with high accuracy and detail at hourly and subhourly frequency throughout the daytime, which will enable new and improved health studies at suburban scales. TEMPO will provide the first-ever O3 profile product from space for diagnosing O3
concentrations in the 0-2 km layer where people live and breathe.
RESULTS:During the pre-launch era of the TEMPO mission, a large diversity of end users andstakeholders have participated in workshops, data tutorials, and focus sessions hosted by the TEMPO
Early Adopters Program, supported by the NASA Applied Sciences Program (ASP), which aims tomaximize the societal benefit of the mission data after launch. These user engagement activities have
led to a better understanding of the unprecedented health applications that could be achieved throughapplication of the high-resolution air quality products from TEMPO.
CONCLUSIONS:The TEMPO mission will provide multi-pollutant data at high spatiotemporal resolution
for enabling more robust and accurate public health studies, including assessment model results for
acute and chronic exposures to different pollutants. Altogether, the GEO air quality constellation willlead to improved health studies across highly populated areas across the globe.

Keywords: air quality, health, satellites, ozone, NO2

OP-143[Air pollution » General]

Electromechanical Control of Metal Oxide Thin
Films deposition in Successive Ionic Layer
Adsorption and Reaction for gas sensors
devlopement
Ydir Brahim, Ajdour Amine, Soumane Mouad, Leghrib Radouane, Bousseta Mohamed, Lahlou Houda
Laboratory of Materials, Signals, Systems and Physical modeling, Faculty of Science-University Ibnou
Zohr- Agadir (Morocco)

BACKGROUND AND AIM:The control of air quality and exposure to hazardous chemical agents requires
the development of efficient gas sensors. Gas sensors based on thin film technology have gained a
special interest as this technology allows developing robust and low cost efficient detection systems.
METHOD:We describe the device developed to control the deposition parameters to manage, theadsorption and reaction process of metal oxide thin films for different applications such as gas
sensors. The growth of nanostuctures thin films using SILAR technique is affected by two types offactors: chemical parameters (pH, concentration of precursor solutions, immersion time), andmechanical parameters (number of cycles, immersion angle and speed).
Mechanical parameters are the most difficult parameters to control because they can affect theproperties of the film (thickness, uniformity, adhesion to the substrate). The control of thesemechanical parameters is not at all possible by the manual process. Therefore, the developed
electromechanical system allows controlling all these parameters during deposition.
The design of our electromechanical system is based on 1.8-degree-of-freedom motorized moving
platform equipped with multiple substrate supports, a control board to regulate horizontal and verticalvelocity, and an enhanced graphical interface to control and monitor key parameters.
RESULTS:The system's performance is evaluated by depositing crystalline zinc oxide film. X-ray
diffraction, ultraviolet/visible spectroscopy, and Scanning electron microscopy showed a goodcorrelation between the evolution of number of deposition cycles, precursor solution concentration,
pH, crystallite/grain size, crystallinity, and film thickness. In addition, the control of the instrument
results in thin films with good adhesion and homogeneity. The developed thin films were tested
towards detection of ethanol vapour, a hazardous chemical with high flammability risk.
CONCLUSIONS:The automated SILAR system developed in this work has shown good capability for
producing gas sensing films with good homogeneity and fair sensing capability towards the detectionof hazardous vapours.

Keywords: Hazardous chemical, gas sensors, metal oxides, Thin film, Automated SILAR techniqueOP-144[Exposure assessment methods » Exposure assessment-air pollution]

Design and characterization of micro-tubes
based on SnO2 for toxic gas detection
applications: Experimental and theoretical study
Soumane Mouad1, Bouaaliouat Omar1, Ydir Brahim1, Atmani El Houssaine2, Leghrib Radouane1,
Fazouan Nejma2, Lahlou Houda1
1Laboratory of Materials, Signal, Systems and Physical Modeling, Physics Department, University of

Ibn Zohr, Agadir, Morocco
2Laboratory of Nanostructures and Advanced Materials, Mechanics and Thermofluids, Physics

Department, Faculty of Sciences and Technologies, Hassan II University of Casablanca, Mohammedia,
Morocco.

BACKGROUND AND AIM:SnO2 is among the most suitable materials for detection of toxics gases,
because of its excellent morphological and electrical properties. SnO2 is also a chemo-resistive
material and its gas sensing it mainly controlled by the change in resistance of the sensor as gas
molecules react on its surface.
METHOD:In this work, SnO2 micro-tubes have been fabricated by a simple forcespining method. The
prepared material are analyzed using XRD and SEM techniques. The sensory properties of thesynthesized material were also studied under exposure to different toxic organic volatile compounds(ethanol, benzene and acetone). Calculations based on the Density Functional Theory (DFT) according
to the Ultra-Soft Pseudo-Potentials (USPP) method implemented in the Quantum ESPRESSO code werecarried out in order to reveal the mechanism of SnO2 detection.
RESULTS:The synthesized SnO2 micro-tubes show a good morphological (fig. a, b and c) andstructural properties (fig.d). The characterization results of our sensor under ethanol, acetone andbenzene at 180°C suggested a high sensitivity to ethanol (fig.e). In addition, DFT results showed that
SnO2 has a higher adsorption effect towards ethanol than other target gases (fig. f) in good
agreement with experimental results.
CONCLUSIONS:By analyzing the rate of change in the electrical conductivity in the presence of gas
molecules, we observe that the conductivity of SnO2 (110) surface changes significantly when
exposed to ethanol vapour (fig. g), which is in accordance with experimental results.

Keywords: SnO2 micro-tubes, organic volatile compounds, DFT, Adsorption, sensitivity.

OP-145[Air pollution » Particulate matter]

Application of a Mobile Apparatus for Ultrafine
Particle Exposure in Urban Communities
Wei Chung Su1, Jinho Lee1, Inkyu Han2
1Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas

Health Science Center at Houston
2Department of Epidemiology and Biostatistics, Temple University

BACKGROUND AND AIM:Ultrafine Particles (UFPs) in the urban community have been, and continue tobe, an essential public health concern. Thus, it is significant to investigate urban UFP exposure. This
research carried out a series of field measurements to study urban UFP exposure in Great Houston
Area (GHA) through UFP respiratory deposition experiments.
METHOD:The newly developed Mobile Aerosol Lung Deposition Apparatus (MALDA) was employed toestimate size-dependent UFP respiratory deposition. MALDA consists of a human airway system andan aerosol measurement system. MALDA has the feature of carrying out aerosol respiratory deposition
experiments in real-life settings outside the laboratory. The human airway system contains 3D-printed
realistic human airway replicas covering head airways, TB airways, and the alveolar region. The
aerosol measurement system includes two particle sizers to simultaneously measure UFP particle size
distributions at the inlet and outlet of a human airway region to estimate UFP deposition fractions. In
this research, MALDA was deployed in representative locations around the GHA throughout one year
to measure UFP respiratory depositions. Data acquired was applied to calculate UFP respiratory
deposited mass and then estimate the associated UFP average daily dose for the population in urban
communities.
RESULTS:Results obtained showed that the UFP hourly deposited mass in the human airways ranged
from 2.36 µg/hr (rush hour), 1.76 µg/hr (noon), to 2.09 µg/hr (afternoon) in the industrial area. In
contrast, the UFP hourly deposited mass around the medical center was from 1.38 µg/hr (rush hour),
0.94 µg/hr (noon), to 1.14 µg/hr (afternoon). Based on these results, the highest UFP average daily
dose estimated was 0.13 µg/kg-day.
CONCLUSIONS:UFP respiratory deposited mass and average daily dose can be reasonably estimatedusing the MALDA approach. When chemical analysis data on UFP composition are available, healthrisks caused by UFP-contained harmful substances through prolonged UFP exposure could be further assessed.

Keywords: Ultrafine particle, Exposure, Respiratory deposition, Average daily doseOP-147[Air pollution » Particulate matter]

Association of air pollution, temperature andrelative humidity with emphysema severity in
COPD
Amja Manullang1, Jer Hwa Chang2, Yuan Chien Lin3, Hsiao Chi Chuang4
1International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei,

Taiwan2School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan;

Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan
3Department of Civil Engineering, National Central University, Taoyuan City, Taiwan;
4School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan;

National Heart and Lung Institute, Imperial College London, London, UK

BACKGROUND AND AIM:Air pollution has been associated with chronic obstructive pulmonary disease(COPD); nonetheless, the associations of air pollution with emphysema severity are limited. Our study
aim was to examine the association of air pollution, temperature, relative humidity with emphysema
severity in COPD.
METHOD:A cross-sectional study was conducted on 111 COPD patients obtained from a hospital in
Taiwan. A spatial-temporal model was used to estimate the personal exposure to air pollution,
temperature, and relative humidity. Ordinal regression models were performed to investigate theassociations of air pollution, temperature, and relative humidity with emphysema severity. Twopollutant models were conducted to investigate the associations of air pollution with severity ofemphysema. The models were adjusted for age, sex, body mass index (BMI), and smoking packyears.
RESULTS:We found that exposure to particulate matter with an aerodynamic diameter of <10 µm(PM10) and ozone (O3) was associated with emphysema severity. We observed that a 1 µg/m3
increase in PM10 was associated with an increased risk of emphysema severity (OR = 1.070 and 95%
CI = 1.008–1.136). A 1 µg/m3 increase in PM10 and O3 was associated with increased risk ofemphysema severity (OR = 1.092 and 95% CI = 1.021-1.167).
CONCLUSIONS:Exposure to PM10 was associated with increasing emphysema severity in COPD.
Improving air quality can reduce the impact of air pollution on respiratory health, particularly for
individuals with COPD.

Keywords: Emphysema, PM10, relative humidity, temperature.

OP-148[Air pollution » Particulate matter]

Resilience to air pollution and coronary heartdisease: a UK Biobank study
Chialing Kuo, Doug Brugge
Department of Public Health Sciences, University of Connecticut Health, USA

BACKGROUND AND AIM:Air pollution (AP) is associated with increased risk of coronary heart disease(CHD). However, not everyone exposed to AP develops CHD. We hypothesized that the resilience to
AP varies with individuals, which modifies the risk of CHD. The aim was to identify contributing factors
to resilience to AP and CHD.
METHOD:Data were from 436,346 CHD-free participants at recruitment/baseline (2006-2010), withthe mean age 56.3 years (SD=8.1) and a mean follow-up of 12.6 years (SD=0.8). The residential
annual average estimates for PM2.5 in 2010 was used to identify participants highly exposed to AP(high PM2.5: ≥11.3 mg/m3, 90th percentile of PM2.5). Baseline sociodemographics and lifestylefactors plus disease-associated biomarkers and CHD comorbidities, one at a time, were tested forinteractions with high PM2.5 on incident CHD using logistic regression models. Significant interactions
at the Bonferron-corrected level were characterized by odds ratios (ORs) associated with the factors in
the high and non-high PM2.5 groups
RESULTS:The interaction between sex and high PM2.5 was statistically significant (p=0.003). The ORcomparing males to females was 2.23 (95% CI 2.17-2.29) in the high PM2.5 group (n=44,026; CHD
incidence 75 per 1000) versus 1.94 (95% CI 1.80-2.08) in the non-high PM2.5 group (n=392,320;
CHD incidence 70 per 1000). Other contributing factors to resilience to AP and CHD included
biomarkers associated with type 2 diabetes (glucose and HbA1c: OR=1.54 per SD [high] versus
OR=1.45 per SD [non-high], p=0.001), inflammation biomarkers (lymphocyte count and CRP:
OR=1.42 per SD [high] versus OR=1.34 per SD [non-high], p=0.001), and the liver biomarker
alkaline phosphatase (OR=1.28 per SD [high] versus OR=1.21 per SD [non-high], p=0.003).
CONCLUSIONS:Individuals who are male and have higher levels of biomarkers with indications for
type 2 diabetes, inflammation, or decreasing liver function are at higher risk for CHD and the risk isfurther elevated by high exposure of AP.

Keywords: PM2.5, interaction, biomarkers

OP-149[Air pollution » Long-term exposure]Long-term exposure to air pollution andcoronary atherosclerosis, calcification, and noncalcified plaques – results from the Swedish
SCAPIS study
Karl Kilbo Edlund1, Eva M Andersson2, Christian Asker3, Lars Barregard2, Göran Bergström4, Kristina
Eneroth5, Tomas Jernberg6, Stefan Ljunggren7, Peter Molnár2, Johan Nilsson Sommar8, Anna Oudin9,
Åsa Persson10, Andrei Pyko10, Mårten Spanne11, Martin Tondel12, Mikael Ögren2, Göran Pershagen13,
Petter Ljungman10, Leo Stockfelt2
1Occupational and Environmental Medicine, School of Public Health and Community Medicine, Instituteof Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
2Occupational and Environmental Medicine, School of Public Health and Community Medicine, Instituteof Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational
and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
3Swedish Meteorological & Hydrological Institute, Norrköping, Sweden
4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy,

University of Gothenburg, Sweden; Department of Clinical Physiology Sahlgrenska University Hospital,
Göteborg, Sweden
5SLB-analys, Environment and Health Administration, Stockholm, Sweden
6Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm,

Sweden7Occupational and Environmental Medicine Center, Department of Clinical and Experimental Medicine,

Linköping University, Linköping, Sweden
8Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå,Sweden9Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of

Medicine, Lund University, Sweden
10Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
11Environmental Department of the City of Malmö, Sweden
12Occupational and Environmental Medicine, Department of Medical Sciences, Medical Faculty,

Uppsala University, Sweden; Occupational and Environmental Medicine, Uppsala University Hospital,
Uppsala, Sweden
13Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Centre for

Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden

BACKGROUND AND AIM:Despite firm evidence for an association between long-term air pollution
exposure and cardiovascular events also at low exposure levels, previous epidemiological studies on
the association with atherosclerosis have been inconsistent. The aim of this study was to investigate
associations between long-term low-level air pollutant exposure and coronary atherosclerosis.
METHOD:We performed a cross-sectional analysis in the large Swedish CardioPulmonary bioImaging
Study (SCAPIS, n = 30 154). Men and women 50–64 years old were recruited from the generalpopulation of six Swedish cities 2013–2018. Outcomes were coronary atherosclerosis (segment
involvement score, SIS), coronary artery calcium score (CACS), and non-calcified coronary plaque(NCP) prevalence. Hourly total and source-specific residential PM2.5, PM10, and NOx were modelled indispersion models with high spatial resolution and averaged over 10 years before recruitment.
Prevalence odds ratios (POR) were estimated with ordinal logistic regression models adjusted for site
and known risk factors, based on a directed acyclical graph.
RESULTS:Median PM2.5 exposure was 6.2 µg/m3; 44% of participants had detectable coronary
atherosclerosis. PM2.5 was not associated with SIS or CACS, but with a higher NCP prevalence (POR
1.65, 95% CI 1.18, 2.31, per interquartile range [2.05 µg/m3] higher PM2.5) with a dose-response
pattern (p = 0.034 for linear trend). Other pollutants and source-specific exposures did notdemonstrate consistent positive associations with any of the outcomes.
CONCLUSIONS:In this large, middle-aged general population sample at low exposure levels, PM2.5
exposure was not associated with estimates of general coronary atherosclerosis or calcification, yetappeared to be associated with non-calcified plaques, which may reflect an association with the earlyphase of atherosclerosis or more vulnerable forms of atherosclerosis.
The main funder of SCAPIS is the Swedish Heart and Lung Foundation. Funding for this study wasprovided by the Swedish Research Council for Health, Working Life and Welfare (FORTE).

Keywords: cardiovascular diseases, particulate matter, environmental epidemiology

OP-150[Outcomes » Cardiovascular diseases]

The association of particulate mattercomponents with heart rate variability
Kashish Jain1, Gazala Habib1, Sandeep Singh2
1Indian Institute of Technology Delhi
2All India Institute of Medical Science

BACKGROUND AND AIM:The effect of particles having aerodynamic diameter less than 2.5 microns(PM2.5) on cardiovascular health has been well established in the literature, however, the total PM2.5
mass constitutes a complex mixture of organic and inorganic species. The differential impact of these
species on health is still poorly understood but is imperative to policy formulations especially in highly
polluted regions like India.
METHOD:In this research study, we assessed the impact of PM2.5 components on the heart ratevariability (HRV) indices in a panel of health subjects situated near the entrance gate of college
campus in a traffic micro-environment. 35 male security guards were monitored during their duty
period (exposure period) during which they wore an ECG holter device to record both time andfrequency domain parameters of HRV at 5-min interval. The Aerosol Chemical Speciation Monitor(ACSM) was used with a cyclone of 1-micron diameter cut-size to determine the concentrations of thePM1 components (chloride, ammonium, nitrate, organics and sulfate) and the concentrations wereextrapolated for PM2.5 mass assuming homogeneity in the contributing sources. We used mixed-effectmodels to quantify the effect of per inter-quartile (IQR) change in pollutants on the HRV parameters(SDNN- standard deviation of normal-to-normal; pNN50- percent normal-to-normal intervals > 50ms;
rMSSD- root mean square of successive differences between normal heart beats; HF- high frequency;
LF- low frequency and LF/HF ratio).
RESULTS:We observed a significant decline of more than 10% in the pNN50 per IQR increase in all
PM2.5 components. Similar associations were also seen for other HRV parameters.
CONCLUSIONS:The results of the study are indicative of the fact that exposure to PM2.5 components
adversely affects the cardiac autonomic functioning of the body and suggests the need to study the
associations with other PM components.

Keywords: Traffic-related, Particulate matter, Short-term exposure, Cardiovascular diseases,
Envrionmental Epidemiology

OP-151[Air pollution » General]

Prenatal Air Pollution Exposure and Blood
Pressure during Childhood and Adolescence:findings from Project Viva
Pi I Debby Lin1, Sheryl L. Rifas Shiman1, Andres Cardenas2, Mingyu Zhang1, Diane Gold3, Heike
Luttmann Gibson4, Emily Oken1, Izzuddin M. Aris1, Alison P. Sanders5
1Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine,

Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
2Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
3Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston, MA, USA;

Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
4Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston, MA, USA
5Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh,

Pittsburgh, PA, USA

BACKGROUND AND AIM:To examine the associations of prenatal air pollution exposures with bloodpressure (BP) from childhood to adolescence.
METHOD:Using residential addresses and a satellite-based spatiotemporal model, we estimatedprenatal exposure to PM2.5, black carbon (BC), ozone, and nitrogen dioxide (NO₂) for participants of
the Boston-area pre-birth cohort, Project Viva. We modeled associations of trimester-specific air
pollution exposures with age-, sex- and height-standardized BP z-scores at early-childhood (mean age
3.2y), mid-childhood (7.7y), early-adolescence (12.9y), and late-adolescence (17.5y) using linear
regression models. We adjusted for maternal age, pre-pregnancy BMI, race and ethnicity, education,smoking status, and household income.
RESULTS:We included 1446 children (49% female) in the analysis. Participants’ mothers were mostly
White, non-smokers, were college-educated, and had annual household income >USD$70,000/year.
The mean (interquartile range) prenatal exposure was 11.30 (10.28, 12.19) µg/m3 for PM2.5 and0.72 (0.57, 0.84) µg/m³ for BC. After covariate adjustment, 3rd trimester PM2.5 and BC werepositively associated with BP at early-childhood [e.g. 0.04 (95% CI: 0.02-0.07) higher systolic BP zscore per µg/m³ increment in PM2.5; 0.38 (0.14-0.62) and 0.39 (0.20-0.57) higher systolic anddiastolic BP z-scores, respectively, per µg/m³ increment in BC]. Prenatal BC was also associated withhigher BP in mid-childhood and late-adolescence. NO₂ was associated with higher systolic BP in earlychildhood and late-adolescence, higher diastolic BP in early-childhood, but lower systolic BP in midchildhood. The associations between ozone and BP were also inconclusive; 2nd trimester ozone wasassociated with higher systolic BP in early-childhood while 3rd trimester ozone was associated withlower diastolic BP in early-childhood.
CONCLUSIONS:Third-trimester PM2.5 and BC exposures were associated with higher BP in earlychildhood. Next, we will model BP trajectories across the four time points and evaluate mixture effectsof co-exposure to multiple air pollutants during critical windows in early life.

Keywords: air pollution, children's environmental health, environmental epidemiology, cardiovasculardiseases, blood pressureOP-153[Air pollution » Long-term exposure]

Relationships between Short-term Exposure to
Ambient PM2.5 and Incident Cases of
Cardiovascular Disease
Yang Zhao1, Haotian Chen2, Chunlei Han2
1The George Institute for Global Health, University of New South Wales, Sydney, Australia
2School of Public Health and Management, Binzhou Medical University, Yantai, China

BACKGROUND AND AIM:There are limited studies investigating the association between short-term
exposure to PM2.5 and incident cardiovascular disease (CVD) cases in China. This study aims to
examine the short-term effects of PM2.5 on the incidence of cardiovascular diseases.
METHOD:Daily air pollutant concentrations including PM2.5 derived from continuous daily monitored
data obtained from 12 monitoring sites in Yantai Environmental Monitoring Center from 2014 to 2019.
Daily counts of incident CVD cases (International Classification of Diseases, 10th revision- ICD10)
were collected from the Disease Control and Prevention Center Disease Registry System of Yantai.
Combination of Poisson-distribution generalized linear model and distributed lag non-linear model
were used to examine the association between short-term exposure to PM2.5 and incident cases of
CVD.
RESULTS:The results revealed that per 10 µg/m3 increment of PM2.5 increased the incident CVD
cases by 0.147% (Relative Risk: 1.00147, 95% Confidence Interval: 1.00008-1.00286) at a lag of 2days. The stratified analyses showed higher effects of CVD risk due to PM2.5 exposure in females,
older residents (aged 60-75 years) and acute myocardial infarction group (p-value for difference <0.05).
CONCLUSIONS:This study indicates that short-term exposure to PM2.5 may increase the risk of CVD
and highlights the necessity for a higher air quality standard in Yantai and eastern China.

Keywords: Air pollution, Cardiovascular disease, Incident cases, PM2.5, Generalized linear modelOP-154[Exposures » Occupational exposures]

Investigation of semen quality among Thai maletobacco farmers over harvest season
Anu Surach1, Mark Gregory Robson2, Wattasit Siriwong3
1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
2School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, USA
3Center for Risk Analysis and Health Surveillance, Chulalongkorn University, Bangkok, Thailand

BACKGROUND AND AIM:Semen quality is affected by a variety of factors that include tobacco use.
Tobacco exposure are avoidable factors which may affect male fertility that reduces semen quality.
Thailand is one of the most famous tobacco-growing zones. The farmers have been exposed to thenicotine in tobacco leaves and might be at risks to its health effects. This study aimed to evaluate thesemen quality different between the season periods among male tobacco farmers.
METHOD:A cross-sectional study was performed to describe the semen quality over harvesting season
period among 62 participants who were between 20-40 years of age in Sukhothai Province, Thailand.
Sperm motility, sperm morphology and sperm count were evaluated for semen quality. Semen
samples were collected two times during processing of cultivation tobacco growing. Paired t-test wasused for data analysis.
RESULTS:In the 62 participants, the mean of sperm motility, sperm morphology and sperm count in
the male tobacco farmers at the picking top of tobacco plants and dry curing of tobacco plants weresignificantly lower than those in the picking first of tobacco plants (p < 0.05).
CONCLUSIONS:The result of this study suggested that the effects of nicotine reducing semen quality.
Tobacco exposure over harvesting season period leads to reduce potential semen quality. Therefore,
education and prevention programs should be directly towards specific risk group. In addition, maletobacco farmers should be advised about the potential adverse effects of their work on sperm quality.

Keywords: Occupational exposures, tobacco exposure, semen quality

OP-155[Air pollution » Long-term exposure]

Prevalence of Chronic Respiratory Symptoms
among Workers Exposed to Cement Dust inGauteng Province, South Africa
Asanda Mkulisi1, Shalin Bidassey Manilal2, Phoka Caiphus Rathebe2, Elizabeth Kachingwe3
1Department of Environmental Health, University of Johannesburg, Doornfontein Campus,

Johannesburg, South Africa; Epidemiology and Surveillance Department, National Institute for
Occupational Health, Division of the National Health Laboratory Services, Johannesburg, South Africa
2Department of Environmental Health, University of Johannesburg, Doornfontein Campus,

Johannesburg, South Africa
3National Institute for Communicable Diseases, Division of National Health Laboratory Services,

Johannesburg, South Africa

BACKGROUND AND AIM:Cement workers are exposed to various kinds of occupational hazards, dust
being the most hazardous. Despite certain exposure limits on the emission of air pollutants in place,several people die each year due to complications from respiratory disease. This study aimed toassess the prevalence of chronic respiratory symptoms among workers exposed to cement dust. We
conducted the study to identify the prevalence of respiratory symptoms among cement workers,
evaluate workers’ practices regarding the use of respiratory protection gear and to determine factors
associated with respiratory symptoms.
METHOD:A quantitative, descriptive cross-sectional design was employed among 81 workers from two
cement production companies. A self-administered questionnaire, anthropometric measurements anda spirometry test were used as data collection tools. Data were analyzed using Wilcoxon rank sum,binary logistic regression, Pearson’s chi-squared and Fischer’s exact tests.
RESULTS:Respiratory symptoms such as wheezing, recurring blocked nose, sneezing/stuffy nose,
fatigue/tiredness, rapid breathing, soreness/watery eyes and breathlessness were significantly
prevalent among participants from both facilities. Being a driver or an administrator and an operator
was significantly associated with blocked nose, wheezing, phlegm and breathlessness, with a p-valueof 0.018, 0.006, 0.037 and 0.018 respectively. Workers who smoked were more likely to experience
any respiratory symptoms (95 percent CI=1.69-23.73, p=0.006).
CONCLUSIONS:Engineering and housekeeping control measures such as the use of a High-Efficiency
Particulate Air (HEPA) vacuums to clean up dust and proper use of Personal Protective Equipment(PPE) where workers are exposed to dust particles should be implemented. This control will help in
reducing silica exposure during production.

Keywords: chemical exposures, exposures, occupational exposures, respiratory outcomesOP-156[Other » Other (to be specified with keywords in the keywords section)]

Improving environmental, occupational healthand safety for small and micro-small enterprises
in a mechanical craft village, outside of Hanoi,
VietnamHien Thi Thu Ngo1, Ngoc Bach Nguyen1, An Hoang Duong1, Tuyen Thi Kim Le2, Quyen Thi Nguyen3,
Nhung Thi Hong Ngo4
1Department of Public Health, Faculty of Health Sciences, Thang Long University, Hanoi, Vietnam,

1000002Thang Long Institute of Mathematics and Applied Sciences, Thang Long University, Hanoi, Vietnam,

1000003Medical Center, Thanh Oai district, Hanoi, Vietnam, 100000
4Department of Labor - Salary, Faculty of Human Resource Management, University of Labor andSocial Affairs, Hanoi, Vietnam, 100000

BACKGROUND AND AIM:The small and micro-small sized enterprises (SMEs) have a vital role increating jobs, increasing local income, and reducing poverty in rural areas in Vietnam, they also posechallenges to the environment, the local economies, and to public health. This study was carried out to1) enhance understanding and skills in applying ergonomic solutions to improve environmental,
occupational health and safety (EOHS) in mechanical SMEs; and 2) applying Work Improvement in
Small Enterprises (WISE) method to improve EOHS conditions at the studied SMEs.
METHOD:Ergonomic intervention design was applied in this study. Training and communication were
provided for employers and workers in a total of 40 mechanical SMEs, and general population living in
the craft village. WISE developed by the International Labour Organization was used for improvementof EOHS conditions at 9 mechanical SMEs.
RESULTS:A significant difference in the knowledge on the applicability of ergonomic interventions
before and after training was found (37.5% vs 79.5%, p < 0.01). All enterprises have evaluated the
WISE method as very suitable (69.2%) and suitable (30.8%) with their production conditions and89.7% of enterprises wish to apply this method to improve EOSH conditions. Some intervention
activities were carried out at 9 mechanical SMEs include: providing earplugs and earmuffs for workers;
supplementing essential medicine cabinets for first aid; increasing the number of bulbs and adjusting
the lighting direction to improve the lighting intensity in the workshop; equipping fire prevention andfighting means; improving the seat size to be more suitable for each working position; reducing heavyloads by using self-designed trolleys in the workshop, and increasing industrial aesthetics by adding
green plants to the workshop.
CONCLUSIONS:These results emphasized the need to have a further intervention program to promote
SMEs applying WISE method to improve their EOHS towards enhancement of productivity and workers
health at the workplace

Keywords: Ergonomic intervention, WISE, EOHS conditions, SMEs, mechanical craft village

OP-157[Neurologic and mental health outcomes » Mental health outcomes]

Occupational exposure to pesticides andsymptoms of depression in agricultural workers.
A systematic review
María Teresa Muñoz Quezada1, Javier Cancino2, Karly Soto2, Joaquín Tapia2, Boris Lucero1, CaterinaContreras1
1Center for Research in Neuropsychology and Cognitive Neurosciences (CINPSI Neurocog), Faculty of

Health Sciences, Universidad Católica del Maule, Talca, Chile
2School of Psychology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile; Center

for Research in Neuropsychology and Cognitive Neurosciences (CINPSI Neurocog), Faculty of Health
Sciences, Universidad Católica del Maule, Talca, Chile

BACKGROUND AND AIM:BACKGROUND: Pesticides cause damage to the environment and humanhealth. In the area of occupational health, there is concern about the effects on the mental health ofagricultural workers.
OBJECTIVES: The objective of this review was to systematize the scientific evidence of the last ten
years on the effects of occupational exposure to pesticides on the development of depression
symptoms in agricultural workers.
METHOD:A search was conducted in PubMed and Scopus databases including articles in Spanish,
English, and Portuguese from 2011 to September 2022 that evaluated the relationship of occupational
exposure to pesticides with mental health, specifically symptoms of depression in agricultural workers.
For the search, recommendations required by the PRISMA statement and the PICO strategy(Patient/participant, intervention, comparison, and outcomes) were followed.
RESULTS:Of 24 articles selected, 75% found an association between exposure to pesticides and thedevelopment of depressive symptoms. The most frequently reported pesticides wereorganophosphates (17 studies), herbicides (12 studies), and pyrethroids (11 studies). The quality ofthe studies oscillates between intermediate (46%) and high intermediate (46%). The study designs
correspond mainly to cross-sectional (75%). Just one 20% of the studies measured with biologicalbiomarkers and only one investigation measured with specific pesticide biomarkers. Depression
symptomatology was measured in 10 studies with validated scales or inventories. Only one study
measured levels of neurotransmitters and physiological markers associated with depression.
CONCLUSIONS:The review is conclusive about the association between exposure to pesticides and thedevelopment of depressive symptoms. More longitudinal research with biomarkers of urine exposure isrequired, controlling for sociocultural variables. However, due to the increased use of these pesticides
and the health risk that depression implies, it would be advisable to apply stricter measures in thesurveillance of agricultural companies that apply pesticides and monitoring the mental health of
exposed agricultural workers frequently

Keywords: pesticides, mental health, occupational health, depression, farmers

OP-158[Cancer and cancer-precursors » Incidence]

Exposure to hydrocarbons and risk of bladdercancer in petroleum workers
Nita Kaupang Shala1, Jo Steinson Stenehjem1, Ronnie Babigumira1, Fei Chih Liu2, Leon Alexander
Mclaren Berge1, Debra Silverman3, Melissa Friesen3, Nathaniel Rothman3, Qing Lan3, H Dean
Hosgood4, Sven Ove Samuelsen5, Magne Bråtveit6, Jorunn Kirkeleit6, Bettina Kulle Andreassen2,
Marit Bragelien Veierød7, Tom Kristian Grimsrud2
1Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Biostatistics,

Faculty of Medicine, University of Oslo, Oslo, Norway
2Department of Research, Cancer Registry of Norway, Oslo, Norway
3Division of Cancer Epidemiology and Genetics, Occupational and Environmental Epidemiology Branch,

National Cancer Institute, Bethesda, Maryland, USA
4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, The Bronx,

New York, USA
5Department of Mathematics, University of Oslo, Oslo, Norway
6Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
7Department of Biostatistics, Faculty of Medicine, University of Oslo, Oslo, Norway

BACKGROUND AND AIM:Increased risk of urinary bladder cancer has been observed in the petroleum
industry, and studies based on validated exposure data have been asked for to explain theobservations.
METHOD:Data were organised for case-cohort analyses of 189 identified bladder cancer cases
diagnosed 1999–2017 and 2,065 randomly drawn non-cases from the Norwegian Offshore Petroleum
Workers cohort. Cancers were recorded by the national Cancer Registry of Norway, and information on
work histories, and on demographic and lifestyle factors was collected by questionnaires at baseline in
1998. Linkage was performed by unique personal identity numbers. Exposure data at offshore
petroleum platforms on the Norwegian continental shelf were evaluated and organized in job-exposure
matrices by experts in offshore industrial hygiene. Weighted Cox regressions were used to derivehazard ratios (and 95% confidence intervals (CI)), adjusted for age (as the time scale), tobaccosmoking, education, and year of first employment, using lagged or unlagged exposures. Missing data
were added with multiple imputation for 20 data sets.
RESULTS:Exposure to benzene was associated with increased risk of bladder cancer modelled as
duration of exposure or cumulative exposure, compared with workers considered unexposed. The risks
at the highest levels were, for duration (≥18.8 years), HR=1.91, 95% CI: 1.15–3.16; P-trend=0.041;
and for cumulative exposure, HR=1.60, 95% CI: 0.97–2.63; P-trend=0.065. Associations persistedwith 20-year exposure lag (disregarding most recent exposures). No association was found for crude
oil (skin or inhalation exposure), mineral oil (for lubrication, hydraulics, or drilling), or for exposure todiesel exhaust.
CONCLUSIONS:The results suggested that exposure to benzene, or to compounds following thebenzene fraction of the petroleum, is associated with increased risk of bladder cancer.

Acknowledgements: Funding was received from Research Council of Norway [grant number 280537]

Keywords: Cancer and cancer precursors, Occupational epidemiology, Occupational exposures

OP-159[Chemical exposures » Pesticides]

Glyphosate use and mosaic loss of chromosome
Y among male farmers in the Agricultural HealthStudy
Vicky C. Chang1, Weiyin Zhou2, Sonja I. Berndt1, Gabriella Andreotti1, Meredith Yeager2, Christine G.
Parks3, Dale P. Sandler3, Nathaniel Rothman1, Laura E. Beane Freeman1, Mitchell J. Machiela4,
Jonathan N. Hofmann1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
2Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National

Cancer Institute, National Institutes of Health, Bethesda, MD, USA
3Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of

Health, Durham, NC, USA
4Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National

Cancer Institute, National Institutes of Health, Bethesda, MD, USA

BACKGROUND AND AIM:Glyphosate, the most commonly used herbicide worldwide, has been
implicated in the development of certain hematologic cancers. While mechanistic studies in humancells and animals support the genotoxic effects of glyphosate, evidence in human populations is
scarce. We evaluated the association between lifetime occupational glyphosate use and mosaic loss ofchromosome Y (mLOY) as a marker of genotoxicity among male farmers.
METHOD:We analyzed blood-derived DNA from 1,606 farmers ≥50 years of age in the Biomarkers of
Exposure and Effect in Agriculture study, a subcohort of the Agricultural Health Study. mLOY wasdetected using genotyping array intensity data in the pseudoautosomal region of the sex
chromosomes. Cumulative lifetime glyphosate use was assessed using self-reported pesticide
exposure histories. Using multivariable logistic regression, we estimated odds ratios (ORs) and 95%
confidence intervals (CIs) for the associations between glyphosate use and any detectable mLOY
(overall mLOY) or mLOY affecting ≥10% of cells (expanded mLOY).
RESULTS:Overall, mLOY was detected in 21.4% of farmers, and 9.8% of all farmers had expanded
mLOY. Increasing total lifetime days of glyphosate use was associated with expanded mLOY (highest
vs. lowest quartile, OR = 1.75, 95% CI: 1.00-3.07, p-trend = 0.03) but not with overall mLOY; theassociations with expanded mLOY were most apparent among older (age ≥70 years) individuals (2.30,
1.13-4.67, p-trend = 0.01), never smokers (2.32, 1.04-5.21, p-trend = 0.04), and non-obese

individuals (2.04, 0.99-4.19, p-trend = 0.03). Similar patterns of associations were observed forintensity-weighted lifetime days of glyphosate use.
CONCLUSIONS:High lifetime glyphosate use could be associated with mLOY affecting a larger fractionof cells, suggesting glyphosate could confer genotoxic or selective effects relevant for clonal
expansion. As the first study to investigate this association, our findings contribute novel evidence
regarding the carcinogenic potential of glyphosate and require replication in future studies.

Keywords: Cancer and cancer precursors, Male, Molecular epidemiology, Long-term exposure,
Occupational epidemiology

OP-160[Chemical exposures » PFAS]

Personal care product use and perfluoroalkyl
substances in pregnant and postpartum womenand adolescents in the United States andCanadaAmber M Hall1, Jillian Ashley Martin2, Chun Lei Liang2, George Papandonatos3, Tye E Arbuckle2,
Michael M Borghese2, Jessie P Buckley4, Kim M Cecil5, Aimin Chen6, Mandy Fisher2, Bruce P
Lanphear7, Jana Palaniyandi8, Dorothea Fk Rawn9, Kimberly Yolton10, Joseph Braun1
1Department of Epidemiology, Brown University, Providence, Rhode Island, United States.
2Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
3Department of Biostatistics, Brown University, Providence, Rhode Island, United States.
4Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public

Health, Baltimore, Maryland, United States.
5Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Ohio,

United States; Department of Radiology, Cincinnati Children’s Hospital Medical Center, University ofCincinnati, Ohio, United States.
6Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Universityof Pennsylvania, Philadelphia, Pennsylvania, United States.
7Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
8Department of Biology and Institute of Biochemistry, Carleton College, Ottawa, Ontario, Canada.
9Food Research Division, Bureau of Chemical Safety, Health Products and Food Branch, Health

Canada, Ottawa, Ontario, Canada.
10Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati,

Ohio, United States.

BACKGROUND AND AIM:Perfluoroalkyl substances (PFAS) are ubiquitous chemicals routinely detectedin personal care products (PCPs), associated with numerous adverse health outcomes. Few studies
have quantified the contribution of PCPs on PFAS concentrations. This study evaluates PCP use and
PFAS in maternal-plasma, human-milk, and adolescent-serum.
METHOD:We used 2 pregnancy cohorts; MIREC (2008-2011) and HOME (2003-2006) enrolled people
from 10 Canadian cities and Cincinnati, Ohio, respectively. Participants reported frequency of PCP use
in MIREC and past 24-hour in HOME. In MIREC, we quantified perfluorooctanoic acid (PFOA),
perfluorooctane sulfonic acid (PFOS), and perfluorohexanoic acid (PFHxS) in maternal-plasma(N=1,940) and PFOA, PFOS, PFHxS, and perfluorononanoic acid (PFNA) in human-milk (N=664). In
HOME, we measured PFOS, PFOA, PFHxS, and PFNA in the serum of 11–14-year-old adolescents(N=193). Using linear regression, we estimated percent differences in PFAS concentrations with PCPuse, adjusting for covariates.
RESULTS:In MIREC, higher use of several PCPs was associated with higher maternal-plasma andhuman-milk PFOA and PFOS concentrations. For example, people using hair spray or gel daily had
11.7% (95%CI: 4.9%-18.8%) higher maternal-plasma PFOA concentrations than people not using
hair spray or gel. In human-milk, higher use of several PCPs was also related to higher PFNA andPFHxS concentrations, with people who wore makeup daily having human-milk PFHxS levels 32.6%

(95%CI: 6.4%-65.2%) higher those who never wore makeup. In HOME, use of several PCPs was
associated with lower PFOA, PFOS, and PFHxS in adolescents.
CONCLUSIONS:Our results suggest some PCPs contribute to higher maternal-plasma and human-milk
PFAS concentrations. PCP use was not associated with higher PFAS levels in adolescents. Futurestudies could examine if associations between PCP use and PFAS depend on country, child age, timing
and frequency of PCP use, or product formulation.
Funding: R01-ES028277, R01-ES031621, R01-ES033252, R01-ES032836.

Keywords: PFAS, Pregnancy outcomes, Endocrine disrupting chemicals, Children’s environment andhealth, Chemical exposuresOP-161[Birth and pregnancy outcomes » Birth outcomes]

Maternal arsenic exposure, folic acid use during
early pregnancy and spina bifida risk: A case‒control study in Bangladesh
Chih Fu Wei1, Sudipta Kumer Mukherjee2, Sheikh Muhammad Ekramullah2, D.m. Arman2, Joynul
Islam3, Hafiza Sultana Suchanda4, Gwen Tindula5, Marc G. Weisskopf1, Liming Liang6, David C.
Christiani1, Benjamin C. Warf7, Maitreyi Mazumdar5
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington

Avenue, Boston, MA, US
2Department of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital, Sher-e-

Bangla Nagar, Agargoan, Dhaka 1207, Bangladesh
3Department of Clinical Neurosurgery, National Institute of Neurosciences & Hospital, Sher-e-Bangla

Nagar, Agargoan, Dhaka 1207, Bangladesh
4Pediatric Neurosurgery Research Committee, National Institute of Neurosciences and Hospital,

Bangladesh
5Department of Neurology, Boston Children’s Hospital, BCH3443, 300 Longwood Avenue, Boston, MA,US
6Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue,

Boston, MA, US
7Department of Neurosurgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, US

BACKGROUND AND AIM:Spina bifida is a common neural tube defect that can have lifelong healthconsequences. Few human studies have tested the association between arsenic exposure and spina
bifida, and whether arsenic exposure could modify the protective effects of folic acid supplementation
on spina bifida risk. This study aims to examine the associations between 1) prenatal arsenic exposureand spina bifida and 2) folic acid use during early pregnancy and spina bifida under different maternalarsenic exposure levels.
METHOD:The study recruited families and children with spina bifida visiting the National Institute of
Neurosciences & Hospital (NINS&H) and Dhaka Shishu Hospital (DSH), two major referral centers forpediatric neurologic diseases in Bangladesh, between December 2016 and August 2022. Infants who
visited the study sites for other diseases during the corresponding period were included in the control
group. Spina bifida was evaluated by neurosurgeons at the study sites through clinical evaluations.
The study team obtained maternal folic acid use information with questionnaires and tested arsenic
concentrations from toenails and primary water sources.
RESULTS:There were 282 children with spina bifida and 163 controls in the study. Water and toenailarsenic concentrations were not associated with spina bifida in the study population. We observed aprotective association between maternal folic acid use during early pregnancy and spina bifida among
mothers with concentrations lower than or equal to the median toenail arsenic concentration (adjusted
odds ratio [aOR]: 0.49, 95% confidence interval [CI]: 0.24-0.99, p=0.046) but not among those withconcentrations higher than the median (aOR: 0.98, 95% CI: 0.47-2.03, p=0.949).
CONCLUSIONS:Maternal folic acid use during early pregnancy was associated with lower odds of spina
bifida among mothers with toenail arsenic concentrations lower and equal to the median, but notamong mothers with higher than the median arsenic concentrations in Bangladesh. Funded: National
Institutes of Environmental Health Sciences.

Keywords: Birth outcomes, children's environmental health, environmental epidemiology, heavy
metals.

OP-162[Chemical exposures » PFAS]

Gestational blood levels of PFAS mixtures andassociations with global DNA methylation inpregnant women and their infants
Gro D. Villanger1, Kjell Vegard F. Weyde1, Ann Karin Olsen1, Nur Duale1, Jorke H. Kamstra2, Thea S.
Skogheim1, Adriano Winterton1, Ida H. Caspersen1, Stephanie M. Engel3, Cathrine Thomsen1, Line S.
Haug1, Guido Biele1, Heidi Aase1
1Norwegian Institute of Public Health, Oslo, Norway
2Institute for Risk Assessment Sciences, Department of Population Health Sciences, Faculty of

Veterinary Medicine, Utrecht University, The Netherlands
3Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA

BACKGROUND AND AIM:Pregnant women and their foetuses are exposed to multiple perfluoroalkyl
substances (PFAS) that may alter epigenetic regulation, such as DNA methylation, which may
negatively affect health and development in childhood and later in life. The aim of the study was toinvestigate the associations between gestational levels of PFAS, and their mixtures, with global DNA
methylation levels in pregnant women and their newborn children.
METHOD:Seven PFAS and markers of global DNA methylation status [5-methylcytocine (5mC) and 5hydroxymethylcytosine (5hmC)] were measured in blood of 634 pregnant women (gestation week~18) from the Norwegian Mother, Father, and Child Cohort Study (MoBa). Blood levels of 5mC and5hmC were also measured in their newborn children (cord blood). Multivariable adjusted elastic net
regression was used to identify the most important PFAS-global methylation relationships as well as
two-way interactions (PFAS and covariates). Potential non-linear associations were also assessed. The
joint effects of PFAS mixtures on DNA methylation markers were investigated using a quantile gcomputation approach.
RESULTS:In both pregnant women and their infants, PFHxS was the most important PFAS in relation
to 5mC. For mothers, this relationship varied with levels of seafood intake and PFDA concentrations,whereas for newborns, it varied with maternal education level, maternal seafood intake and smoking
during pregnancy. In pregnant mothers, PFHxS and PFOS (both non-linear) were identified as themost important PFAS in relation to 5hmC. No joint effect was observed of the PFAS mixtures on DNA
methylation markers.
CONCLUSIONS:The results show that some specific PFAS may alter the DNA methylation status in
pregnant women and/or their child. As DNA methylation dysregulation might be a key mechanism indisease development and thus of high importance for public health, future studies should be aimed at
replicating these findings, as well as investigating the potential health consequences of suchdysregulation.

Keywords: PFAS; DNA methylation; Neonates; Pregnant women; The Norwegian Mother, Father andChild Cohort study (MoBa)

OP-163[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Exposure to organophosphate ester flame
retardants and plasticizers (OPEs) during
pregnancy and autism-related outcomes
Jennifer L Ames1, Juanran Feng1, Lyndsay A Avalos1, Emily Barrett2, Theresa M Bastain3, Deborah H
Bennett4, Jessie P Buckley5, Courtney Carignan6, Patricia Cintora7, Assiamira Ferrara1, Akhgar
Ghassabian8, Ghassan B Hamra5, Monique M Hedderson1, Julie B Herbstman9, Ixel Hernandez3,
Margaret R Karagas10, Catherine Karr11, Jordan R Kuiper5, Donghai Liang12, Kristen Lyall13, Cindy T
McEvoy14, John Meeker15, Rachel Morello-Frosch16, Thomas G O'Connor17, Jiwon Oh4
1Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
2Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental andOccupational Health Sciences Institute; Piscataway, NJ, USA
3Department of Population and Public Health Sciences, University of Southern California, Los Angeles,

CA, USA
4Department of Public Health Sciences, University of California, Davis, Davis CA, USA
5John Hopkins University, Bloomberg School of Public Health, Baltimore, MD USA6) Michigan State

University, East Lansing, MI, USA
6Michigan State University, East Lansing, MI, USA
7University of Illinois Urbana-Champaign, Urbana, IL, USA
8New York University Grossman School of Medicine, New York, NY USA
9Columbia University Mailman School of Public Health, New York, NY, USA
10Geisel School of Medicine at Dartmouth, Hanover, NH USA
11University of Washington, Department of Pediatrics and Department of Environmental andOccupational Health Sciences
12Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA USA
13A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
14Department of Pediatrics, Oregon Health & Science University
15University of Michigan, School of Public Health, Ann Arbor, MI, USA
16School of Public Health, University of California, Berkeley, CA USA
17Department of Psychiatry, University of Rochester, Rochester, NY USABACKGROUND AND AIM:Growing evidence suggests that organophosphate esters (OPEs), chemicals
widely used as plasticizers and replacements for PBDE flame retardants, may be developmental
neurotoxicants. We investigated whether urinary concentrations of OPEs during pregnancy wereassociated with child autism-related outcomes in a large and diverse US sample.
METHOD:We included 3,246 mother-child pairs born between 2006-2020 from 15 cohorts in the NIH
Environmental influences on Child Health Outcomes (ECHO) Program. Nine OPE analytes were
measured in spot urine samples collected during mid- to late- pregnancy. We assessed child autismrelated traits via a) parent report on the Social Responsiveness Scale (SRS) and b) clinical autism
diagnosis from parent report and medical records. We examined relations of OPEs with SRS T-scoresand autism diagnosis in multivariable linear and logistic regression models, respectively, using
generalized estimating equations to account for clustering by cohort. OPEs were modeled continuously(log2-transformed), categorically (high [> median], low [≤ median], non-detect), or as detect/nondetect depending on the proportion of values above the limit of detection.
RESULTS:The mean SRS T-score was 47.7 (SD=8.5) and 94 children had an autism diagnosis. Bis(1chloro-2-propyl) phosphate (BCPP), bis(butoxyethyl) phosphate (BBOEP), and bis(2-methylphenyl)
phosphate (BMPP) were each associated with modest increases in autistic traits (BCPP adj-β for low
vs. non-detect: 1.08, 95% CI: 0.16, 2.01; BBOEP adj-β for high vs. non-detect: 1.08, 95% CI: 0.69,
1.47; and BMPP adj-β for detect vs. non-detect: 0.94, 95% CI: 0.31, 1.57). These analytes were also
associated with greater odds of autism diagnosis (BCPP adj-OR: 1.25, 95% CI:1.03, 1.51; BBOEP adjOR 1.33 [1.03, 1.73]), though the estimate for BMPP was imprecise (adj-OR: 1.30, 95% CI: 0.92,1.81). Other OPE analytes were not associated with autism-related outcomes.
CONCLUSIONS:Pregnancy exposures to OPEs, specifically BCPP, BBOEP, and BMPP, may be associatedwith slightly greater likelihood of traits and diagnosis of autism in childhood.

Keywords: Environmental epidemiology, Endocrine disrupting chemicals, Children's environmental
healthOP-164[Chemical exposures » Endocrine disrupting chemicals]

Pregnancy and early infancy exposure to
endocrine disruptors and post-natal growth in acohort relying on repeated urine collection
Marion Ouidir1, Aminata H Cissé2, Jérémie Botton3, Sarah Lyon Caen1, Cathrine Thomsen4, Amrit K
Sakhi4, Azemira Sabaredzovic4, Sam Bayat5, Rémy Slama1, Barbara Heude2, Claire Philippat1
1University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology

Applied to Development and Respiratory Health, Institute for Advanced Biosciences, 38000 Grenoble,
France2Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in

Epidemiology and StatisticS (CRESS), F-75004 Paris, France
3Université Paris-Saclay, Faculté de Pharmacie, Orsay, 91400, France
4Norwegian Institute of Public Health, Oslo, Norway
5Department of Pulmonology and Physiology, Grenoble University Hospital, La Tronche, France &Synchrotron Radiation for Biomedicine Laboratory (STROBE), Inserm UA07, Grenoble Alpes University,
Grenoble, France

BACKGROUND AND AIM:Endocrine disrupting chemicals (EDCs) may play a role in adiposity growthduring infancy. Literature in this scope suffers from limitations in exposure assessment: only one or
few urine samples used or exposure only assessed during pregnancy and not in early infancy, anothercritical period. We investigated associations between early-life exposure to short half-life EDCs andpost-natal growth, relying on repeated within-subject urine collections over pregnancy and early
infancy.
METHOD:In SEPAGES cohort, we studied exposure to 4 phenols, 4 parabens, 7 phthalates and 1 nonphthalate plasticizer from weekly pooled urine sample collected from 364 mother during pregnancy(median 18 and 34 gestational weeks) and from their infant (at 2 and 12 months of age). Infant
weight, height, body mass index (BMI) and head circumference were estimated at 3 and 36 months ofage by modeling of repeated measures obtained from study visits and children’s health record booklet.
We assessed associations between these parameters and either individual chemicals using adjusted
linear regression or their mixture using a Bayesian Kernel Machine Regression model.
RESULTS:The uni-pollutant analyses revealed few associations. Bisphenol-S at second trimester ofpregnancy was positively associated with all infant growth parameters at 3 and 36 months. Mono-nbutyl phthalate (MnBP) at 12 months was positively associated with BMI, weight and headcircumference at 36 months. Mixture analysis revealed positive associations between exposure at 12
months and BMI and weight at 36 months, with MnBP showing the highest effect size within the
mixture.
CONCLUSIONS:This study suggests that exposure to a mixture of EDCs in early infancy may be
associated with increased weight and BMI in early childhood, a risk factor of obesity in later-life.
Furthermore, this study highlighted a potential impact of prenatal bisphenol-S exposure, a newcompound that had never been studied in this context.

Keywords: Phthalates, Phenols, Children's environmental health, Obesity and metabolic disorders,
Mixtures analysis

OP-165[Exposures » Environmental disparities]

Assessment of environmental sources ofarsenic, lead, and cadmium exposure among
pregnant women in rural, BangladeshMusa Baker1, Allison R Sherris4, Ferdous Anowar1, Hafsa Hossain Atia1, Jesmin Sultana1, Mohammad
Sabbir Ahmed1, Nairita Ahsan Faruqui1, Christlee Doris Elmera2, Seth Hoffman2, Ahmed Moutwakil2,
Jenna E Forsyth2, Muntasir Alam1, Shahana Parveen1, Mahbubur Rahman1, Ashley Styczynski3, Dr.
Shams El Arifeen1, Stephen P. Luby3, Dr. Emily Gurley5, Mohammad Zahid Hossain1
1Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,

Bangladesh(icddr,b), Dhaka-1212, Bangladesh
2Woods Institute for the Environment, Stanford University, Stanford, California, U.S.A.
3Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
4Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford,

California, USA
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

BACKGROUND AND AIM:Exposure to heavy metals during pregnancy has been associated with anincreased risk of adverse birth outcomes, including stillbirth. Our study aims to investigate the sourcesof exposure to select metals (arsenic, lead, and cadmium) during pregnancy among women residing
Faridpur and adjacent districts, namely Madaripur, Rajbari, Jhenaida, Magura, Gopalganj, Kushtia andDhaka, Bangladesh.
METHOD:We have enrolled women who experience stillbirths (N=31) and live births (N=33) at
Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur in Bangladesh, with 64 participants
enrolled to date. Samples of drinking and cooking water, rice, courtyard and agricultural soil, andturmeric were collected from homes where participants resided for at least two trimesters ofpregnancy. Concentrations of lead, cadmium, and arsenic in turmeric and soil were measured using ahandheld X-ray fluorescence analyzer.
RESULTS:Turmeric lead concentrations exceeded the Bangladesh standard (2.5 μg/g.) inapproximately 10% of turmeric samples, with a maximum concentration of 46 μg/g. Arsenic was notdetected in these samples. Out of 64 participant households, 27 had agricultural land and provided
agrarian soil samples. None of the courtyard or agricultural soil samples had lead concentrations
exceeding the threshold of 400 μg/g set by the US EPA. Only one courtyard was found to have soil
arsenic concentrations exceeding the threshold level for arsenic (20 μg/g); however, over 40% of
agricultural soil samples had arsenic concentrations above 20 μg/g, with an average concentration of
16.8 μg/g (±12.1 μg/g). Cadmium was not detected in the courtyard or agricultural soil samples.
CONCLUSIONS:Pregnant women residing in Faridpur and adjacent districts of Bangladesh may face a
potential risk of exposure to high concentrations of lead in turmeric as well as arsenic in agriculturalsoil or output. Our continued research will evaluate associations between heavy metal exposure andstillbirth in this community.

Keywords: stillbirth, heavy metals, environmental exposureOP-166[Outcomes » Cardiovascular diseases]

A Multi-Country Effort to UnderstandTemperature Associations with Stroke-Specific
Mortality
Barrak Alahmad1, Haitham Khraishah2, Antonella Zanobetti1, Dominic Roye3, Aaron S Bernstein4,
Stefania I Papatheodorou1, Niilo R Ryti5, Eric Lavigne6, Ben Armstrong7, Joel Schwartz1, Mcc The
Multi Country Multi City Collaborative Research Network9, Antonio Gasparrini8, Petros Koutrakis1
1Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, USA
2Cardiology Division, University of Maryland Medical Center, Baltimore, USA
3Department of Geography, University of Santiago de Compostela, Spain
4Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, USA; Centerfor Climate, Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston,USA
5Biocenter Oulu, University of Oulu, Finland
6School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
7Department of Public Health Environments and Society, London School of Hygiene and Tropical

Medicine, UK
8Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, UK; Centre on

Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, UK
9The Multi-Country Multi-City Collaborative Research Network

BACKGROUND AND AIM:Globally, extreme temperatures contribute to millions of deaths each year,
including stroke-related deaths. However, existing environmental evidence has overlooked the distinct
causes and mechanisms of different stroke outcomes. Stroke-specific studies have been limited tosingle-city or single-country analyses, that are limited by publication bias and generalizability.
Within the Multi-country Multi-City (MCC) Network, we built a new mortality database for ischemic andhemorrhagic stroke to conduct a multi-national, multi-decade analysis on the relationship between
extreme temperatures and the two most common causes of stroke.
METHOD:We used a two-stage protocol to analyze stroke-specific deaths. In the first stage, we fitted
conditional quasipoisson regression for daily mortality counts with distributed lag non-linear models
for the temperature exposure in each city. In the second stage, the cumulative risk from each city waspooled using mixed effects meta-analysis, accounting for potential higher-level effect modification andclustering of cities with similar features. We compared temperature-stroke associations acrosscountry-level gross domestic product (GDP) per capita. We computed excess deaths in each city thatare attributable to the hottest and coldest 2.5% of days.
RESULTS:We collected a total of 3,443,969 ischemic stroke and 2,454,267 hemorrhagic stroke deaths
from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme coldand hot days contributed 9.1 (95% eCI:8.6,9.4) and 2.2 (95%eCI:1.9,2.4) excess deaths,
respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2
(95% eCI:10.9,11.4) and 0.7 (95% eCI:0.5,0.8) excess deaths, respectively. The study found thatcountries with low GDP per capita were at higher risk of heat-related hemorrhagic stroke mortality
than countries with high GDP per capita (p=0.02).
CONCLUSIONS:As climate change is driving more extreme temperatures and weather events, urgent

attention to meaningful clinical outcomes can help identify and minimize the risk of death from stroke,especially in low-income countries.

Keywords: ischemic stroke, hemorrhagic stroke, pathophysiology, extreme temperature, climatechangeOP-167[Climate » Temperature]

Geographical variation in the impact of extreme
heat events on respiratory hospitalizations
among older adults in 120 U.S. metropolitan
areas
Cassandra R Olenick1, Mallory Turner2, William Steinhardt2, Stephanie Cleland2, Lloyd Hill2, Lucas
Neas2, Meghan E. Rebuli1, Ilona Jaspers1, Ana G. Rappold2
1University of North Carolina at Chapel Hill
2United States Environmental Protection Agency

BACKGROUND AND AIM:Extreme heat exposure is a well-known cause of mortality, particularly
among older adults. However, evidence of the effect of extreme heat on morbidity is inconsistent. We
applied a uniform modeling approach across 120 of the largest US metropolitan areas to assess heatrelated hospitalizations for respiratory disease among older adults.
METHOD:We obtained ZIP code-level daily counts of respiratory disease hospitalizations using
Medicare billing claims from short-stay, inpatient hospitalizations. We estimated ambient heat
exposure using spatially interpolated, population weighted weather station data. To estimate heathealth impacts during the warm season (June-Sept), we explored lag days 0-6, and used conditional
Poisson with a distributed lag non-linear model, matched on ZIP code of residence, month, and day of
hospitalization. We fit separate models for three heat exposure metrics; all models were adjusted for
temporal trends and meteorology.
RESULTS:From 2000 to 2017, we identified 9,141,138 respiratory disease hospitalizations during thewarm season. Associations between respiratory hospitalizations and extreme heat days - defined as
the 95th percentile of the city-specific warm season temperature - exhibited substantial geographic
variation. When comparing the 95th percentile to the 50th percentile of temperature, cumulative odds
ratios ranged from 1.09 (95% CI: 1.03, 1.15) in Palm Bay, Florida to 0.95 (95% CI: 0.89, 1.00) in
Boise City, Idaho. Geographical variation was not explained by U.S. region/division or Köppen
classification of climate zones. Associations were generally larger on lag days 0-2 compared to laterlag periods.
CONCLUSIONS:Considerable geographical variation in the magnitude and direction of odds ratios
suggest that drivers of heat-health impacts are occurring at the local level. Future work should
investigate area-level factors that modify risk. This work was supported by a cooperative agreement
between the U.S. EPA and University of North Carolina-Chapel Hill. The abstract does not necessarilyreflect the views and policies of the U.S. EPA.

Keywords: Built environment, Temperature extremes, Respiratory outcomes, Environmental
epidemiology

OP-168[Climate » Temperature extremes and variability]

Excess mortality of heat waves: comparison of
the periods, the worst heat waves in the historyof South Korea
Jonghyuk Choi1, Hyungryul Lim1, Sanghyuk Bae2, Kyung-Hwa Choi1, Xue Han1, Mina Ha1, Ho-Jang
Kwon1
1Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic of

Korea
2Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,

Republic of Korea

BACKGROUND AND AIM:Climate change has been causing extreme weather, including frequentsummer heat waves. We examined how the effects of high air temperatures on mortality in South
Korea have changed in the past and recently.
METHOD:Temperature data from the Korea Meteorological Administration and mortality data from
Statistics Korea were used. Time series analysis was performed for each of the five years (1991–1995
and 2015–2019), including 1994 and 2018, the worst heat wave years since the meteorologicalhistory of South Korea. The maximum daily temperatures observed at all stations in 1994 and 2018
were 39.4°C and 40.1°C, respectively. We used distributed lag nonlinear models to estimate
cumulative relative risks (CRRs) to determine the association between daily maximum temperature insummer (June to September) and mortality. CRRs were estimated for each province, and CRRs for all
provinces were pooled using random-effects meta-analysis.
RESULTS:The CRR of the daily maximum summer temperature on mortality for the entire 10-year
period (1991–1995 and 2015–2019) was 1.04 (1.02, 1.06), 1.07 (1.04, 1.09), and 1.14 (1.08, 1.21)
at the 90th, 95th, and 99th percentile, respectively, based on the temperature of 30°C. The slope of
the CRR for mortality increases along with increasing temperature and has been steeper in the pastthan in the recent and steeper in older than in younger people. Excess mortality has recently declined
compared with that in the past.
CONCLUSIONS:The impact of high summer temperatures on mortality has changed over the past 25
years, suggesting improved population resilience.

Keywords: high air temperature, heat waves, mortality, distributed lag nonlinear modelOP-169[Other » Other (to be specified with keywords in the keywords section)]

Tracking climate change and health in Europe
Kim R. Van Daalen1, Marina Romanello2, Joacim Rocklöv3, Jan C. Semenza3, Cathryn Tonne4, Anil
Markandya5, Niheer Dasandi6, Slava Jankin7, Vladimir Kendrovski8, Oliver Schmoll8, Josep M. Anto4,
Maria Nilsson9, Rachel Lowe10
1Barcelona Supercomputing Center (BSC), Barcelona, Spain
2Institute for Global Health, University College London, UK
3Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
4Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
5BC3 Basque Centre for Climate Change, Bilbao, Spain
6School of Government, University of Birmingham, Birmingham, UK
7Data Science Lab, Hertie School, Berlin, Germany
8European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany
9Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
10Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain

BACKGROUND AND AIM:Climate change impacts health through complex multidimensional pathways.
However, whilst evidence and awareness of the health implications of climate change are increasing,
there is a need for accessible information allowing effective communication of complex climate-healthtrends. Responding to this need in Europe, the Lancet Countdown in Europe (LCDE) developed
indicators that monitor and quantify the health-climate change nexus since the 1950s.
METHOD:33 indicators act as summary measures representing the heterogenous climate-healthrelationships across (1) impact, exposure, and vulnerability; (2) adaption, planning and resilience; (3)mitigation actions and health co-benefits; (4) economics and finance; and (5) politics and governance.
RESULTS:Health risks (1) for almost all indicators have been increasing; clinically relevant pollen
seasons are starting 10-20 days earlier each year (1981-2020), the climatic suitability for climatesensitive infectious diseases have been rapidly increasing (1951-2020), and heat exposure isestimated to have increased by 57% between the first and second half of the 21st century. Someencouraging trends for adaptation (2) could be observed. Yet, despite progress in the reduction of the
carbon intensity of energy systems and phasing out coal for electricity generation, mitigation efforts
remain inadequate to meet reduction targets (3); European energy systems should decarbonise fivetimes the current pace to reach net-zero CO2 emissions by 2050. Likewise, 94% of the European
population is still estimated to live at PM2·5 concentrations higher than the WHO guidelines.
Furthermore, several substantial economic losses due to climate-related health impacts are reported(4), including losses to due extreme events or reduced labour supply. Lastly, whilst strengthening
climate action requires key actors to engage with the health dimensions of climate change, political,
corporate, scientific, and individual engagement remains low (5).
CONCLUSIONS:The LCDE highlights the accelerating trends in health-related hazards, exposures,
vulnerabilities and risk from climate change, and the insufficient adaptation and mitigation actions in
Europe.

Keywords: climate change, health, indicators

OP-170[Climate » Temperature]

The influence of socio-economic factors on theassociation between temperature and dengue
incidence in the Philippines, 2010-2019
Sary Valenzuela1, Xerxes T. Seposo2, Geminn Louis C. Apostol1
1Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City,

Philippines
2Department of Hygiene, Hokkaido University, Sapporo, JapanBACKGROUND AND AIM:This study sought to determine the association between dengue andtemperature in multiple provinces in the Philippines and explore the extent of which socioeconomic
factors influence this relationship.
METHOD:Nationwide dengue cases per province from 2010 to 2019 and data on temperature wereobtained from the Philippines’ Department of Health – Epidemiological Bureau and ERA5-landrespectively. After examining the dengue-temperature association using a negative binomial
regression coupled with a distributed lag non-linear model, we further implemented a meta-regression
analysis in examining apparent heterogeneity in the province-specific associations.
RESULTS:Nationwide temperature-dengue risk function was noted to depict an inverted U-shaped
pattern. Dengue risk increased linearly alongside increasing mean temperature from 23-25 degrees
Celsius and peaking at 27 degrees Celsius before declining. However, province-specific analyses
revealed significant heterogeneity (I2 =86.1%; p-value < 0.001). Population density, people living inurban areas, poverty incidence, average household size, and health expenditure significantly andsubstantially explained 85.30-86.30% of total heterogeneity.
CONCLUSIONS:The high levels of heterogeneity in the province-specific associations, in part, can be
explained by the province-specific meta-predictors. From a programmatic standpoint, the highvariability in dengue risk across provinces necessitates that risk management efforts must be tailorfitted to each local context. Addressing the social determinants of health, boosting health systemspending, and intensifying dengue prevention programs in such areas would help reduce dengue
transmission nationwide. Understanding the likelihood of a dengue outbreak in the months given
temperature trends would empower policy makers to deploy the most effective and agile interventions
in resource-limited settings.

Keywords: Socio-economic factors, Vectors and vector-borne diseases, Modeling, Health inequalities

OP-171[Exposures » Other (to be specified with keywords in the keywords section)]

Association of prenatal solar activity withfertility and pregnancy loss in Eastern
Massachusetts
Veronica A Wang1, Michael Leung2, Man Liu1, Anna M Modest3, Michele R Hacker4, Carolina LZ
Vieira1, Marc Weisskopf2, Joel Schwartz1, Brent A Coull5, Stefania Papatheodorou6
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
3Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical

School, Boston, MA, USA
4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, USA
5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Previous studies have linked solar activity to biological mechanisms that may
be important to conceiving and sustaining a pregnancy, including folate and melatonin levels andinflammatory markers. We examined the association of prenatal solar activity with fertility (ability toconceive) and pregnancy loss.
METHOD:Our study included singleton births conceived in 2002-2016 at an academic medical center in
Eastern Massachusetts. We considered several solar activity metrics, including sunspot number, Kp
index, and ultraviolet radiation, from the NASA Goddard Space Flight Center and the European Centre
for Medium-Range Weather Forecasts. We used a novel time series variation to infer associations withfertility and pregnancy loss based on the number of live birth-identified conceptions (LBICs) —thedifference between the total number of conceptions and those that result in loss for each week—and
fitted distributed lag models adjusted for time trends using a pair of harmonics. Effect heterogeneity
by sex was also examined.
RESULTS:Higher solar activity was associated with fewer LBICs, which, given our analytic method, canbe interpreted as more pregnancy losses for pregnancy exposures but as more pregnancy losses
and/or lower fertility for pre-conception exposures. Out of approximately 95 conceptions per week,
14.5% (95% CI: 7.1%, 21.6%) would be lost for an interquartile range increase in sunspot number(78.8 sunspots) in the first 24 weeks of pregnancy. While Kp index and ultraviolet radiation during
pregnancy were not associated with pregnancy loss, exposure prior to conception, particularly in the
1-2 months prior, was associated with fertility/pregnancy loss. These associations did not vary by sex.
CONCLUSIONS:Our findings suggest that solar activity may be harmful to conceiving and sustaining apregnancy. Solar activity is a complex phenomenon, and more studies are needed to clarify theunderlying pathways and to develop interventions.
FUNDING: National Institutes of Health P30 ES000002 and U.S. Environmental Protection Agency RD835872.

Keywords: solar activity, pregnancy outcomes, environmental epidemiology

OP-172[Air pollution » Particulate matter]

Asian dust and daily mortality in East Asian
cities: analysis using the European Union
Reference Method for decomposing PM₁₀
Chris Fook Sheng Ng1, Aurelio Tobias2, Jorge Pey3, Sara Basart4, Massimo Stafoggia5, Satbyul Estella
Kim6, Xerxes Seposo7, Lina Madaniyazi8, Ho Kim9, Haidong Kan10, Shih Chun Pan11, Yue Liang Leon
Guo12, Xavier Querol2, Masahiro Hashizume1
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan
2Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research,

Barcelona, Spain
3Instituto Pirenaico de Ecología, Spanish Council for Scientific Research, Zaragoza, Spain
4World Meteorological Organization, Geneva, Switzerland
5Department of Epidemiology, Lazio Region Health Service, Rome, Italy
6Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
7Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
8School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
9Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
10School of Public Health, Fudan University, Shanghai, China
11National Institute of Environmental Health Sciences, National Health Research Institute, Miaoli,

Taiwan
12Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine andNTU Hospital, Taipei, Taiwan

BACKGROUND AND AIM:The association between desert dust and daily mortality has been
investigated previously in East Asia, but with a different analytical approach and methods forquantifying dust exposure, rendering it difficult to compare results with other regions. We conducted astudy to examine the association using the European Union (EU) Reference Method (Directive
2008/50/EC) to identify desert dust events and quantify exposure as a continuous measurement ofparticulate matter with diameters of 10 micrometers or less (PM₁₀).
METHOD:We collected data on daily mortality (total respiratory and cardiovascular), PM₁₀, andaverage temperature from four cities – Beijing, Seoul, Fukuoka, and Taipei – with a period of 4-6
years between 2011-2017. Desert dust days were identified using aerosol maps (NAAPS-NRL), backtrajectories of air masses (HYSPLIT) and reanalysis product (MERRA-2). We estimated the backgroundlevel of PM₁₀ and quantified PM₁₀ concentrations by desert and non-desert sources. City-specific
Poisson regression models with distributed lags were used to estimate the associations between
mortality and source-specific PM₁₀ (by 3 sources: desert and non-desert PM₁₀ on days with or without
dust events).
RESULTS:Cities located closer to the desert areas had more dust events, ranging from 45% of thedays in Beijing to 10% in Taipei. The exposure response curves tend to be more curvilinear for cities
located closer to desert areas. We observed associations between mortality and PM₁₀ originating fromdesert dust notably in Beijing. The largest relative risks estimated for total, respiratory andcardiovascular mortality were 1.05 (95% confidence interval: 1.01, 1.10), 1.20 (1.06, 1.36), and 1.08

(1.02, 1.14), respectively, in comparison to the risk at the 1st percentile (3 microgram/m). Local PM₁₀
were also associated daily mortality but the association varied by cities.
CONCLUSIONS:PM₁₀ from desert dusts is an independent risk factor for mortality in populations living
near arid areas affected by desert dust.

Keywords: desert dust, particulate matter, air pollution, short-term exposure, mortality

OP-173[Air pollution » Particle components]

Mortality burden due to PM composition andfuture projections from SLCP reduction
scenarios: A regional comparison
Muhammad Abdul Basit Ahmad Tajudin, Athicha Uttajug, Xerxes Tesoro Seposo, Kayo Ueda
Department of Hygiene, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, JapanBACKGROUND AND AIM:Reducing emission of short-lived climate pollutants (SLCPs) is expected toprevent premature deaths from PM2.5 as well as to mitigate global warning. Although previous studies
estimated the premature mortality using total PM2.5 mass concentration, PM2.5 toxicity may vary by
its composition. Accounting for PM composition may be useful to consider the optimum mitigation pathof SLCPs reduction. This study aims to estimate the PM composition-related mortality based on thevarious SLCPs reductions by region.
METHOD:Initially, we systematically reviewed the literature and pooled the mortality risk function foreach PM composition (Black Carbon, Organic Carbon, Nitrate and Sulphate). Using the PM composition
data obtained from atmospheric simulation, we projected the PM composition-related mortality with its
population attributable fraction (PAF) from 2010 until 2050 for several scenarios which includes the“reference” scenario representing business as usual, as well as the combination of mitigation
measures to reduce SLCPs emission (“end-of-pipe” scenario) and to limit global warming to < 2℃.
RESULTS:Globally, the projected estimates in 2050 based on the “reference” and “end-of-pipe only”
scenario showed an increased in premature mortality due to PM composition while the combination of“2℃ target & end-of-pipe” scenario showed a reduction in the PM composition related mortality.
Region wise, Eastern Asia, Southern Asia and Sub-Saharan Africa showed the biggest difference inmortality burden when comparing the “reference” scenario and the “2℃ target & end-of-pipe”
scenario.
CONCLUSIONS:A combination of “2℃ target & end-of-pipe” for the mitigation scenario could
potentially reduce PM composition related mortality in the world. The regions that could benefit mostfrom these mortality burden reductions are Eastern Asia, Southern Asia, and Sub-Saharan Africa. This
study was supported by Environment Research and Technology Development Fund S-20
(JPMEERF21S12020) of the Environmental Restoration and Conservation Agency Provided by the
Ministry of Environment of Japan.

Keywords: climate, long-term exposure, mortality

OP-174[Air pollution » Particulate matter]

Associations between fine particulate air
pollution and cause specific mortality in 337
cities in Latin America from 2009 to 201
Nelson Gouveia1, Jordan Rodriguez Hernandez2, Ana Ortigoza2, Josiah Kephart2, Brisa Sanchez2, Ana
V Diex Roux2, Goro Yamada2
1University of Sao Paulo Medical School
2Urban Health Collaborative - Drexel University

BACKGROUND AND AIM:Air pollution has become a major problem in Latin America with its rapid andunplanned urbanization. Yet no studies have examined the association of mortality and air pollutantsin the region across a wide range of cities. We aimed to evaluate whether ambient levels of PM2.5
from satellite measurements are associated with cardiovascular and respiratory mortality among
adults in 337 cities from 9 Latin-American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, El
Salvador, Guatemala, Mexico, and Panama).
METHOD:We compiled mortality, PM2.5 and temperature data for all cities for the period 2009-2015.
For each city, we evaluated the association between monthly changes in PM2.5 and cause-specificmortality for each sex using Poisson models, adjusted for seasonality, long-term trend, andtemperature. To accommodate possible different associations between changes in mortality and PM2.5
by age, we included interaction terms between changes in PM2.5 and age (20-39, 40-59, and 60+
years) in the models. Then, we combined the city-specific estimates using a random effects metaregression to obtain mortality relative risks (RR) for each sex and age group.
RESULTS:We analyzed 3,026,861 and 1,222,623 cardiovascular and respiratory deaths, respectively
from a total population that represents 41% of the population of Latin America. We observed that
increases in monthly PM2.5 were associated with increases in CVD and respiratory mortality in both
sexes. After stratification by age, for CVD associations increased with age but were statisticallysignificant only for males aged 60+ years (RR = 1.02, 95%CI 1.01,1.03). For respiratory mortality
associations were larger in the middle aged (40-60) but mostly not significant, especially after
adjustment for temperature.
CONCLUSIONS:Ambient air pollution is associated with CVD mortality in elderly population in Latin
America, a region with different socioeconomic, environmental and health contexts than higher income
cities from where most of the evidence so far comes from.

Keywords: air pollution; particulate matter; mortality; cardiovascular diseases; respiratory
outcomes;

OP-175[Air pollution » Particulate matter]

Propagation of annual PM2.5 concentration
uncertainty into the association with mortality in
the United States
Robbie M Parks1, Sebastian T Rowland2, Francesca Dominici3, John Paisley4, Brent Coull3, Marianthi
Anna Kioumourtzoglou1
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, New York, USA
2Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, New York, USA; PSE Healthy Energy, Oakland, California, USA
3Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston,

Massachusetts, USA
4Department of Electrical Engineering, Columbia University, New York, New York, USA

BACKGROUND AND AIM:Even at historically low air pollution concentrations in the US, pollutants are
consistently associated with adverse health. To improve exposure assessment, spatio-temporal
predictions are used, which possess inherent uncertainty. This uncertainty, however, is not commonly
accounted for in health effects models. Uncertainty propagation is critical for comprehensively
assessing air pollution impacts on health. We characterized the association between estimated annual
PM2.5 concentrations and Medicare death rates in Washington State (WA) while fully propagatingPM2.5 uncertainty.
METHOD:We leveraged WA-wide annual all-cause death records for people ≥65 years (N=222,503) atthe ZIP Code level from Medicare claims (2010–2015). We used the Bayesian Non-parametric
Ensemble (BNE) to generate spatio-temporal PM2.5 concentrations and uncertainties, then used 500
random samples of annual ZIP Code-level PM2.5 concentrations from the BNE posterior distribution
estimates. For each of the 500 WA-wide sample estimates, we fit a health model with a Bayesian
formulation of the conditional Poisson model, adjusting for potential confounders. We then collected2000 samples from each posterior health estimate (for 1,000,000 total samples) into a single pool forthe final overall association incorporating uncertainty.
RESULTS:In a preliminary analysis assuming a linear exposure-response relationship, we estimated an
overall increase in death rates of 0.68% [95%CrI: 0.08%, 1.44%; 98.8% posterior probability ofpositive association] per 1µg/m3 increase in PM2.5 concentrations. 474 of 500 (95%) estimates had a>95% posterior probability of a positive association.
CONCLUSIONS:During 2010–2015, when propagating the full spatio-temporal uncertainty in PM2.5
predicted concentrations in WA state, estimates of the positive association between PM2.5
concentrations and death rates were still positive indicating a consistently harmful association even at
PM2.5 levels well below the newly proposed national standards.

Keywords: air pollution, PM2.5, mortality, health effects, uncertainty

OP-176[Air pollution » Particulate matter]

Spatial and sector-specific emissions
contribution to ambient air pollution andmortality in European cities
Sasha Khomenko1, Enrico Pisoni2, Philippe Thunis2, Bertrand Bessagnet2, Marta Cirach1, Tamara
Iungman1, Evelise Pereira Barboza1, Haneen Khreis3, Natalie Mueller1, Cathryn Tonne1, Kees De
Hoogh4, Gerard Hoek5, Sourangsu Chowdhury6, Jos Lelieveld7, Mark Nieuwenhuijsen1
1Institute for Global Health (ISGlobal), Barcelona, Spain
2European Commission, Joint Research Centre (JRC), Ispra, Italy
3MRC Epidemiology unit, University of Cambridge School of Clinical Medicine, Cambridge, United

Kingdom
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland
5Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
6CICERO Centre for International Climate Research, 0318 Oslo, Norway
7Max Planck Institute for Chemistry, Mainz, Germany

BACKGROUND AND AIM:Ambient air pollution is a major cause of ill-health in European cities. We
aimed to estimate spatial and sector-specific emissions contribution to ambient air pollution andmortality in European cities to promote targeted source-specific actions to tackle air pollution andprotect population health.
METHOD:We estimated source contributions to annual PM2.5 and NO2 concentrations employing theScreening for High Emission Reduction Potentials for Air quality (SHERPA) model. We evaluatedcontributions from transport, industry, energy, residential, agriculture, shipping and aviation sectors
and natural sources for 857 cities in Europe. For each city and sector, three spatial levels wereconsidered: contributions from the same city, rest of country and transboundary. Mortality impacts
were estimated for adult populations (≥ 20 years old) following standard comparative risk assessment
methods to calculate the annual mortality preventable upon spatial and sector-specific reductions inPM2.5 and NO2.
RESULTS:We observed strong variability in spatial and sectoral contributions among European cities.
For PM2.5, the main contributors to mortality were the residential (mean contribution of 22.1%) andagricultural (17.5%) sectors, followed by industry (13.5%), transport (13.2%), energy (9.7%) andshipping (5.3%). For NO2, the main contributor to mortality was transport (47.1%), with additional
contributions from industry (14.6%), energy (14.4%), residential (10.0%) and shipping (9.4%). On
average, the city contribution to its own air pollution mortality was 13.3% for PM2.5 and 33.6% for
NO2 and increased among cities of largest area (22.0% for PM2.5 and 51.6% for NO2) and among
European capitals (29.9% for PM2.5 and 62.7% for NO2).
CONCLUSIONS:We estimated city-level and source-specific air pollution health impacts and provide
novel insights into actions that might be most effective to target air pollution and protect population
health in European cities. Our results show strong variability, pointing out the need for local policies
and coordinated actions that consider city-level specificities in source contributions.

Keywords: Health impact assessment, particulate matter, nitrogen dioxide, source contributions,
European cities

OP-177[Neurologic and mental health outcomes » Mental health outcomes]

Influence of demographics and having chronic
disease on worker mental health in foodprocessing and agricultural industries insouthern Thailand
Elizabeth K Hom Thepaksorn1, Phayong Thepaksorn1, Wiphawan Kaewlai1, Manopporn Pedmetha1,
Suthat Siammai1, Sukhumaporn Sriwisit1, Prakrit Prapa Inthara2, Jammaree Sornboot3
1Trang Research Center for Occupational Health, Sirindhorn College of Public Health, Trang, Faculty of

Public Health and Allied Health Sciences, Praboromarajchanok Institute (Trang, Thailand)
2Sirindhorn College of Public Health, Phitsanulok, Faculty of Public Health and Allied Health Sciences,Praboromarajchanok Institute (Phitsanulok, Thailand)
3Sirindhorn College of Public Health, Yala, Faculty of Public Health and Allied Health Sciences,Praboromarajchanok Institute (Yala, Thailand)

BACKGROUND AND AIM:Mental health disorders and chronic diseases often co-occur together,influencing the course and severity of the other. We investigated the influence of demographics andhaving a chronic disease on the mental health status of 434 workers at 5 different food processing andagricultural industry workplaces in southern Thailand. Findings will be used to design future workplace
wellness programs using the total worker health framework.
METHOD:From January through February 2023, participants completed a survey about theirdemographic characteristics and health history, as well as the 66-item Thai Mental Health Indicators(TMHI-66) questionnaire. We used Chi-square analysis to examine the association of demographics
with both chronic disease and mental health status. Controlling for sex, age, and body mass index, we
employed multiple logistic regression to investigate the impact of having a chronic illness on the riskof poor mental health.
RESULTS:About 16% of participants reported having a chronic disease; while 9% of participants hadpoor mental health. Roughly 40% of our participants were either overweight or obese. We foundassociations between being male, over 45 years old, and overweight or obese with having chronic
disease. Surprisingly, participants with higher monthly salary were more likely to have chronic
disease. There were no associations between demographic characteristics with risk of having poor
mental health. Nor did we observe any connections between having a chronic disease and increased
risk of poor mental health in our study.
CONCLUSIONS:Our study results suggest that efforts to prevent chronic disease in workplaces should
focus especially on males, the elderly, and those at risk for developing obesity. Future research should
explore the potential link between rising incomes on changes in nutrition and physical activity. Moreinvestigation is needed to better identify what underlying factors are contributing to poor mental
health in workers.

Keywords: community-engaged research, mental health outcomes, occupational epidemiology

OP-179[Air pollution » Particulate matter]

Absolute risk of PM2.5-attributable mortality
differs by racial identity, income, and age
Scott W Delaney1, Kevin P Josey2, Xiao Wu3, Rachel C Nethery2, Priyanka Desouza4, Francesca
Dominici2, Danielle Braun2
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
3Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
4Department of Urban and Regional Planning, University of Colorado Denver, Denver, USA

BACKGROUND AND AIM:Long-term PM2.5 exposure likely causes premature mortality. In prior work,
we reported that populations marginalized by both structural racism and poverty may be more
susceptible to PM2.5 pollution than socially advantaged groups. Whether age further modifies these
relationships remains understudied. Here, we extend our prior work to estimate PM2.5-mortality
exposure-response curves reporting absolute mortality rates for subpopulations defined by multiple
dimensions of identity (race, income, age).
METHOD:We analyzed Medicare data from 73 million persons age 65y and older from 2000-2016 in
the United States to estimate associations between annual PM2.5 and mortality in subpopulations
defined simultaneously by racial identity (Black / White), income level (Medicaid eligible / ineligible),and age (65-74, 75-84, 85-94, 95+). We tailored a causal inference method for continuous exposures
to estimate exposure-response curves adjusted for 16 confounders. The method uses an outcome
model and an inverse probability of exposure weight derived from the generalized propensity score,
yielding a doubly robust estimator.
RESULTS:Each 1 μg/m³ increase in annual PM2.5 was associated with 7.08 (95% CI: 5.43, 8.73)
additional deaths / 10,000 person-years for Black persons versus 3.96 (95% CI: 3.73-4.18) additional
deaths / 10,000 person-years for white persons. However, this difference varied considerably whenfurther stratifying by income and age. Among higher-income (Medicaid-ineligible) persons, themortality risk was higher for Black vs. white persons aged 65-74 and 75-84 but lower for persons
aged 85-94. For low-income (Medicaid-eligible) persons of all ages, mortality risk was higher for white
vs. Black persons.
CONCLUSIONS:Overall, the Black vs. white PM2.5-attributable mortality rate was higher, but in somestrata (low-income, older), mortality rates were lower, underscoring the importance of studying how
multiple dimensions of identity alter susceptibility. Selective survival may explain some variation in
relative mortality rates.

Keywords: air pollution, mortality, causal inference, environmental justiceOP-180[Built environment » Noise]Interplay of Traffic Flow, Noise, and Air
Pollutants on Mental Illness in the REVEAL-HBV
Cohort Study
Chih Ting Tung1, Chih Da Wu2, Yi Fang Chuang3, Hwai I Yang4, Wen Chi Pan1
1Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
3Institue of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
4Genomics Research Center, Academia Sinica, Taipei, Taiwan

BACKGROUND AND AIM:Exposure to traffic-related pollution (e.g. noise, air pollutants) is known toincrease risk of mental illness, but little is known about which compartment contributes more diseaserisks. Therefore, we aimed to explore the relationship between long-term traffic exposure and mental
illness using in Taiwanese cohort.
METHOD:We recruited 7,908 eligible subjects who were participated in REVEAL-HBV, a cohort study
established in 1991-1992. The annual traffic flow data (e.g. passenger cars unit [PCU]) (2005 -2007)
was retrieved from the Taiwan Ministry of Transportation and Communications. We obtained annual
noise and air pollution (e.g. NO₂) information (2003-2017) from the Taiwan EPA. Participants’residential exposure to noise and air pollutants were based on land-use regression models. The
diagnosis of mental illness (i.e. insomnia, anxiety, and depression) was based on participants’ medical
claim data linking with the Taiwan National Health Insurance Research Database. Cox regression
hazards models were utilized to assess the association between traffic flow exposure and mental
illness. Causal mediation models were applied to quantify mediation effects of NO₂ and noise on
traffic-mental illness association.
RESULTS:A total of 1,537 participants were diagnosed with incident mental illness during follow-up
period (2008-2017) with a mean follow-up of 7.1 years. Mental illness was positively associated with
exposure to PCU (adjusted hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.08 - 1.33; pvalue < 0.001) and NO₂ [HR = 1.29; 95% CI = 1.17 - 1.44; p-value < 0.001] in a dichotomous
exposure fashion (above median vs. below median). In causal mediate analyses, NO₂ contributed asignificant mediation effect (i.e. natural indirect effect) on PCU-mental illness association (HR = 1.16;
95% CI = 1.09 - 1.25).
CONCLUSIONS:Long-term exposure to traffic flow increased the risk of mental illness, and this finding
was partly mediated through traffic-related air pollutant (i.e. NO₂).

Keywords: Mental health outcomes, Environmental epidemiology, Traffic-related, Long-term
exposureOP-181[Exposome » External exposome]

Systematic evaluation of the environmental
effect on depressive symptoms: exposome-wide
association study and twin modeling
Zhiyang Wang1, Stephanie Zellers1, Alyce Whipp2, Marja Heinonen Guzejev2, Jordi Júlvez3, Irene Van
Kamp4, Jaakko Kaprio2
1Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki,

Helsinki, Finland
2Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki,

Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
3Clinical and Epidemiological Neuroscience (NeuroÈpia), Institut d'Investigació Sanitària Pere Virgili(IISPV), Reus, Spain; ISGlobal-Instituto de Salud Global de Barcelona Campus MAR, Parc de Recerca
Biomèdica de Barcelona (PRBB), Barcelona, Spain
4Centre for Sustainability, Environment and Health, National Institute for Public Health and theEnvironment (RIVM, Netherlands), Bilthoven, the Netherlands

BACKGROUND AND AIM:The prevalence of depressive symptoms leads to a severe public healthburden. The exposome represents the totality of environmental exposures, but systematic evaluationin relation to depressive symptoms is seldom undertaken. We sought to identify the association ofmultiple domains of the exposome with depressive symptoms in late adolescence and early adulthood.
Then we estimated to what degree the association is due to environmental vs. genetic effects basedon a twin analysis.
METHOD:The participants were selected from the FinnTwin12 cohort (3025 in young adulthood and4127 at age 17). Exposures were from multiple sources and grouped into 12 domains. At first, theexposome-wide association study (ExWAS) was used to identify the significant exposures associatedwith General Behavior Inventory (GBI) scores in young adulthood and at age 17. Based on thesesignificant exposures, exposome scores were generated by confirmatory factor analysis. Then,bivariate Cholesky twin models, estimating additive genetic and environmental variance components,
were fitted to the exposome score and depressive symptoms.
RESULTS:In ExWASes, 29 and 46 exposures were significantly associated with depressive symptoms
in young adulthood and late adolescence, respectively, belonging to the domains of family andparents, friend and romantic relationships, school and teachers, and stressful life events. The physical,
built, and social environments did not show significant associations with GBI at either age point. Twinmodels indicated that both genetic and unique environmental factors contributed to the covariance
between the exposome and depressive symptoms. Additionally, we identified substantial sex
differences in those two factors.
CONCLUSIONS:In summary, family- and parents-related environments substantially affect depressive
symptoms in late adolescence and young adulthood. With the two-stage method, our findings
underscore the systematic approach of the exposome and recommend the consideration of genetic
effects when studying the role of environmental exposures.

Keywords: Built environment, Environmental epidemiology, Exposome, Mental health outcomes,
Socio-economic factors

OP-182[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Longitudinal associations between prenatal
paraben exposure with children's intelligencequotient development– TMICS-pilot Study
Yu Bei Tsai1, Chin Li Lu2, Pen Hua Su3, Hui Jui Wen4, Chien Wen Sun4, Kery Kuo1, Shu Li Wang4
1Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung

Hsing University, Taichung, Taiwan
2Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung

Hsing University, Taichung, Taiwan; Department of Food Science and Biotechnology, College ofAgriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan; Department of
Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
3Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
4National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

TaiwanBACKGROUND AND AIM:Parabens (PB) is an antimicrobial agent and has been widely used aspreservatives. Maternal PB exposures may alter offspring’s neurodevelopment in animal studies.
Therefore, this study aimed to investigate the longitudinal effect of prenatal PB exposure on children's
intelligence quotient (IQ).
METHOD:In the Taiwan Maternal and Infant Cohort Study-pilot, we recruited pregnant women in their
third trimester in 2001. The mother-infant pairs were followed as the children aged 2-3, 5-6, 8-9, 1112, 14-15, and 17-18 years. The concentration of methyl-paraben (MP), ethyl-paraben (EP), propylparaben (PP), and butyl-paraben (BP) in maternal urine were determined by on-line coupling withsolid-phase extraction (SPE) with liquid chromatography-electrospray ionization tandem mass
spectrometry (LC-ESI-MS/MS). The ΣPB was molar sum of the four PBs levels. Multiple linear
regression model with generalized estimating equation were applied to investigate the associations
across different ages.
RESULTS:In this study, the mothers were averagely aged 29.11 years. MP levels was the highest
among the four PB. Data analyses included 62–110 valid mother-child pairs at different follow-ups.
After adjustment for confounders, we found maternal urinary MP, PP and ΣPB concentrations weresignificantly positively associated with 2-3-year-old children's Mental Development Index (β=2.56,
β=1.35, β=2.35). We also observed positive associations of maternal urinary MP, PP or ΣPB
concentrations with 5-9-year-old girls’ Verbal IQ (VIQ) (β=3.10, β=0.55, β=3.20) and Performance IQ(PIQ) (β=2.43, β=1.39, β=2.22), as well as with 11-18-year-old boys’ Verbal Comprehension Index(VCI) (β=2.09, β=1.46, β=2.29) and Working Memory Index (WMI) (β=1.24, β=0.55, β=1.37) andgirls’ WMI (β=0.54, β=0.47, β=0.65).

CONCLUSIONS:In this longitudinal study, we observed positive associations between prenatal PB
exposure and children's IQ in different life stages. However, residual confounding including parental
IQ, parenting style, and child’s growing environment may not be fully adjusted. Further studies withlarge sample size and comprehensive information of children’s genetic and socioeconomic status wereneeded.

Keywords: Endocrine disrupting chemicals, Epidemiology, Neurodevelopmental outcomes

OP-183[Air pollution » Particulate matter]

Association between fine particle matter(PM2.5) and hypothyroidism during prenatal andpostnatal periods: A birth cohort study in Taiwan
Chung Chin Lee1, Wei Chen1, Bo Ting Chen1, Chau Ren Jung2, Bing Fang Hwang1
1Department of Occupational Safety and Health, College of Public Health, China Medical University,

Taichung, Taiwan.
2Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.

BACKGROUND AND AIM:Thyroid function is a critical part of the immune system for the human body.
The evidence of PM2.5 on the risk of childhood hypothyroidism is still limited. We investigated theassociation between exposure to PM2.5 during pregnancy and infancy period and hypothyroidism, andidentified sensitive key periods.
METHOD:We conducted a birth cohort study of 2,374,257 children born in Taiwan during 2004-2017from the Taiwan Maternity and Childhood Database and follow- up until 2018. The exposure
assessment of PM2.5 was satellite-based with 1 km resolution using the XGboost model corresponding
to their residential address. We performed a Cox proportional hazard model to estimate the effect of
PM2.5 on the risk of hypothyroidism and used a distributed lag nonlinear model (DLNM) to evaluate
the relationship between PM2.5 and hypothyroidism during pregnancy and infancy period. The results
were expressed as hazard ratio (HR) and 95% confidence interval (CI).
RESULTS:Our results showed 3.32 people per 10,000 person-years developed hypothyroidism during
the study period. In the Cox proportional hazard model, the HR of hypothyroidism increased by 1.67%(95% CI: 1.01-1.03) with a 10 μg/m3 PM2.5 during the infancy period. The sensitive key period was
during 7-34 weeks after birth.
CONCLUSIONS:Our finding suggests that exposure to PM2.5 during infancy period may increase therisk of hypothyroidism.

Keywords: Children's environmental health, Pregnancy outcomesOP-184[Chemical exposures » PFAS]

Exposure to Perfluoroalkyl Substances andLongitudinal Changes in Bone Mineral Density in
Adolescents and Young Adults: A Multi-Cohort
Study
Emily Beglarian1, Elizabeth Costello1, Doug Walker2, Hongxu Wang1, Tanya L. Alderete4, Zhanghua
Chen1, Damaskini Valvi2, Brittney O. Baumert1, Sarah Rock1, Bruna Rubbo1, Max Aung1, Frank D.
Gilliland1, Michael I. Goran5, Dean P. Jones3, Rob McConnell1, Sandrah Eckel1, David V. Conti1, Jesse
A. Goodrich1, Lida Chatzi1
1Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, CA, United States
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine,

Emory University, Atlanta, GA, United States
4Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
5Department of Pediatrics, Children’s Hospital Los Angeles, The Saban Research Institute, UnitedStatesBACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) may impair bone accrual. No
previous studies have examined prospective associations of PFAS with changes in bone mineraldensity (BMD) in Hispanic young persons, a population at high risk of osteoporosis and bone fracturein adulthood. We aimed to examine associations of PFAS exposure with longitudinal changes in BMD in
an adolescent Hispanic cohort and examine generalizability of findings in a mixed-ethnicity young
adult cohort.
METHOD:We included overweight/obese adolescents from the Study of Latino Adolescents at Risk ofType 2 Diabetes (SOLAR; n=304; mean follow-up=1.39 years) and a subset of young adults from theSouthern California Children’s Health Study (CHS; n=137; mean follow-up=4.07 years) in thisanalysis. Plasma PFAS levels were measured at baseline and dual x-ray absorptiometry scans were
performed at baseline and follow-up to measure BMD. We estimated associations between five PFAS
and BMD outcomes using linear mixed effects models adjusted for covariates.
RESULTS:In Hispanic youth from SOLAR, plasma perfluorooctanesulfonic acid (PFOS) levels atbaseline were associated with the development of BMD during adolescence. Specifically, at the end offollow-up, participants with high PFOS concentrations (90th percentile) had 0.043 g/cm² lower trunk
BMD than those with low concentrations (10th percentile; p=0.0415). In young adults from CHS, high
PFOS was associated with lower BMD, suggesting that effects observed in adolescence persist into
adulthood. Participants with high PFOS demonstrated 0.051 g/cm² lower baseline total BMD thanthose with low PFOS (p=0.0426) and similar differences were observed at follow-up. We did not find

associations of other PFAS with BMD.
CONCLUSIONS:PFOS exposure was associated with lower BMD in Hispanic participants in adolescence,
an important period for bone accrual. These effects persisted in mixed-ethnicity young adults. Low
BMD in these time periods may increase risk of osteoporosis and fractures later in life.

Keywords: Children's environmental health, Environmental epidemiology

OP-185[Omics technologies » Epigenomics]

Multi-tissue DNA methylation analysis to
identify an appropriate surrogate tissue for aunique tissue specific to spina bifida
Gwen Tindula1, Sudipta Kumer Mukherjee2, Sheikh Muhammad Ekramullah2, DM Arman2, Joynul
Islam3, David C Christiani4, Benjamin C Warf5, Maitreyi Mazumdar6
1Department of Neurology, Boston Children’s Hospital, Boston, US; Department of Neurology, Harvard

Medical School, Boston, US
2Department of Paediatric Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka,Bangladesh
3Department of Clinical Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka,Bangladesh
4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, US
5Department of Neurosurgery, Boston Children’s Hospital, Boston, US
6Department of Neurology, Boston Children’s Hospital, Boston, US; Department of Neurology, Harvard

Medical School, Boston, US; Department of Environmental Health, Harvard T.H. Chan School of Public
Health, Boston, US

BACKGROUND AND AIM:Neural tube defects, including spina bifida, are severe birth defects that occur
when the neural plate fails to close in early gestation, potentially causing lifelong health consequencesin surviving children. Animal models suggests a role of epigenetic mechanisms, including DNA
methylation, in neural tube closure; however, studies characterizing DNA methylation profiles in
nervous system tissue from humans with spina bifida are limited. In this study, we assessed DNA
methylation profiles in dural tissue collected at the time of surgical closure of the neural tube defect ininfants diagnosed with spina bifida in a case-control study in Bangladesh and examined whether whole
blood or buccal swab are appropriate surrogate tissues, as they are more practical to collect in largescale epidemiological studies and less invasive.
METHOD:Infant DNA methylation was measured in dural tissue, buccal swab, and whole blood
samples collected from 27 infants with spina bifida using the Illumina Infinium MethylationEPIC
BeadChip array. We used M-values in paired analyses to discover differentially methylated probes
between the tissue types.
RESULTS:After accounting for multiple hypothesis testing, 34% of CpG sites assessed were notsignificantly differentially methylated between dural tissue and whole blood samples, compared to the
27% of sites not differentially methylated between dural tissue and buccal swab samples.
CONCLUSIONS:These preliminary results using DNA methylation profiles from a unique nervous
system tissue, specifically dural tissue samples collected from infants with spina bifida, suggest whole
blood samples may be a more appropriate surrogate tissue than buccal swab samples. The study
warrants replication in larger groups to validate findings and may assist researchers restricted to moreaccessible biospecimens (i.e. blood) to further characterize epigenetic contributors to neural tube
defect etiology.
Funding: NIEHS R01 ES026317, R21 ES030784, P30 ES000002; NIMH T32 MH112510; NICHD P50
HD105351 and R13 HD100191.

Keywords: pregnancy outcomes, neurodevelopmental outcomesOP-186[Chemical exposures » Pesticides]

Gestational glyphosate exposure and earlychildhood neurodevelopment in a Puerto Ricobirth cohort
Haley M. Jenkins1, Emily Zimmerman2, Amber Cathey1, Gredia Huerta Montañez3, Zaira Rosario
Pabón3, Carmen M. Vélez Vega4, José F. Cordero5, Akram Alshwabekah6, John D. Meeker1, Deborah
J. Watkins1
1Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann

Arbor, MI 48109, USA
2Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115,

USA
3Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115, USA
4Department of Social Sciences, UPR Medical Sciences Campus, University of Puerto Rico Graduate

School of Public Health, San Juan, PR 00936, USA
5Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA
6Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA

BACKGROUND AND AIM:N-(phosphonomethyl) glycine, or glyphosate, is a non-selective systemic
herbicide that is widely used in agricultural, industrial, and residential settings. Early life exposure toglyphosate has been inconsistently linked to neurotoxic effects in animals, and studies of theneurodevelopmental effects of gestational glyphosate exposure among humans are scarce. Our study
aimed to investigate the relationship between prenatal maternal urinary glyphosate metabolites andearly childhood neurodevelopment.
METHOD:Mother-child pairs from the PROTECT-ECHO birth cohort in Puerto Rico with information forboth maternal urinary glyphosate metabolites and early childhood measures of neurodevelopment
were included for analysis (n=147). Spot urine samples were collected up to three times throughout
pregnancy and analyzed for glyphosate and (aminomethyl)phosphonic acid (AMPA), a glyphosate
degradation product, using gas chromatography tandem mass spectrometry. Child neurodevelopment
was assessed at 6, 12, and 24 months using normalized scores from the Battelle Developmental
Inventory, 2nd edition (BDI-2) in Spanish. The BDI-2 provides scores for adaptive, personal-social,communication, motor, and cognitive domains. We used multivariable linear regression to examine
associations between the geometric mean of maternal urinary glyphosate metabolite across pregnancy
and BDI-2 domain scores at each follow-up, adjusting for child's age, birthweight, and sex.
RESULTS:At 24 months, all five BDI-2 domains were associated with maternal urinary AMPA: adaptive(β=-5.43, 95%CI:-9.51,-1.35), personal-social (β=-7.86, 95%CI:-6.23,-0.49), communication (β=8.57, 95%CI:-15.40,-1.73), motor (β=-3.36, 95%CI:-6.23,-0.49), and cognitive (β=-6.04, 95%CI:9.52,-2.55). Motor domain scores at 24 months were associated with maternal urinary glyphosate(β=-3.13, 95%CI:-6.16,-0.11). At 12 months, communication domain scores were associated withAMPA (β=-10.68, 95%CI:-17.99,-3.38). We found no significant associations with BDI-2 scores at 6
monthsCONCLUSIONS:Our preliminary results suggest that gestational exposure to glyphosate is associatedwith adverse neurodevelopment across all domains, with more pronounced delays at older ages.
Further investigation into the impact of gestational glyphosate exposure on neurodevelopment iswarranted.

Keywords: pesticides, neurodevelopmental outcomes, children’s environmental health, chemical
exposures, environmental epidemiology

OP-188[Omics technologies » Epigenomics]

Epigenome-wide association study of urinary
total nicotine equivalents in multiethnic current
smokers from three prospective cohorts
Brian Z Huang1, Alexandra M Binder2, Brandon Quon2, Yesha M Patel1, Annette Lum Jones2, Maarit
Tiirikainen2, Sharon E Murphy3, Lenora Loo2, Alika K Maunakea2, Christopher A Haiman1, Lynne R
Wilkens2, Woon Poh Koh4, Qiuyin Cai5, Melinda C Aldrich5, Kimberly D Siegmund1, Stephen S Hecht3,
Jian Min Yuan6, William J Blot5, Daniel O Stram1, Loic Le Marchand2, Sungshim L Park2
1Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles,

CA, USA
2Population Sciences of the Pacific Program-Epidemiology, University of Hawaii Cancer Center,

Honolulu, HI, USA
3Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
4Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National

University of Singapore, Singapore
5Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center,

Vanderbilt University Medical Center, Nashville, TN, USA
6Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center & Department of

Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA

BACKGROUND AND AIM:Prior epidemiologic studies have observed that the influence of smoking onlung cancer risk varies by race/ethnicity. This disparity may be partially explained by interethnic
differences in the mechanism in which smoking impacts blood DNA methylation. While many studies
have investigated the associations between smoking status and DNA methylation, the effect of internalsmoking dose on the epigenome has been less investigated, especially across racial/ethnic
populations.
METHOD:We conducted a two-stage epigenome-wide association study (EWAS) of internal smoking
dose, as measured by urinary total nicotine equivalents (TNE), in six racial/ethnic groups across threecohort studies. The discovery phase was performed in 1,994 smokers from five racial/ethnic groups(White, African American, Latino, Japanese American and Native Hawaiian) in the Multiethnic Cohort
Study (MEC). We then externally replicated the findings in 171 Chinese smokers from the Singapore
Chinese Health Study (SCHS) and 197 White and African American smokers from the SouthernCommunity Cohort Study (SCCS).
RESULTS:In the discovery EWAS, TNE was associated with differential methylation in 408 CpG sites
across >200 genes (p=9x10⁻⁸). The top ten statistically significant probes were annotated
to AHRR, F2RL3, RARA, GPR15, PRSS23 and 2q37.1, all of which had decreasing methylation withincreasing TNE (average decrease ranging from 0.53%-4.44% per log-unit increase in TNE). We also
identified 45 novel CpG sites, the most significant of which werein 17q21.32, SLC28A1, CXXC5, MIR383;SGCZ and SPTBN1. Thirty-four of the 408 discovery CpG sites
were replicated in the SCHS and SCCS (Bonferroni-corrected p=1.23x10⁻⁴). Moreover, significant
heterogeneity by race/ethnicity was detected for CpG sites in MYO1G and CYTH1.
CONCLUSIONS:Our study illustrates the transethnic and ethnic-specific effects of TNE on DNA
methylation across multiple racial/ethnic groups. Additional investigations in diverse populations are
warranted to further clarify how epigenetics may contribute to the known racial/ethnic disparities insmoking-related lung cancer risk.

Keywords: Epigenomics, Epidemiology, Biomarkers of exposure, Omics technologies, Chemical
exposuresOP-189[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

Evaluation on the sex-related association
between cigarette smoke exposure andinflammatory markers - C-reactive protein andwhite blood cell countDong Hee Koh1, Sangjun Choi2, Ju Hyun Park3, Sang Gil Lee4, Hwan Cheol Kim5, Inah Kim6, Dong Uk
Park7
1Department of Occupational and Environmental Medicine, International St. Mary’s Hospital, Catholic

Kwandong University
2Graduate School of Public Health and Healthcare Management, The Catholic University of Korea,

Seoul
3Department of Statistics, Dongguk University
4Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency,
5Department of Occupational and Environmental Medicine, Inha University
6Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University,
7Department of Environmental Health, Korea National Open University

BACKGROUND AND AIM:Smokers are exposed to hazardous particles and gases which induce
inflammation. Accordingly, cigarette smoke exposure increases peripheral white blood cell (WBC)count. However, the association between cigarette smoking and C-reactive protein (CRP) which is oneof the important inflammatory markers has been reported as inconsistent. Here, the associations were
evaluated using both smoking questionnaires and urine cotinine as exposure markers.
METHOD:The Korea National Health and Nutrition Examination Survey data were used for analyzing
the associations. Data on age, sex, body mass index, smoking questionnaires, high-sensitivity CRP,
WBC count, urine cotinine, blood pressure, cholesterol, glucose, alanine aminotransferase, and uricacid were obtained. The associations between cigarette smoke exposure, assessed by questionnaires
and urine cotinine, and health effect, assessed by CRP and WBC, were examined using multiple
regression analyses, controlling for relevant factors.
RESULTS:The exposure-response relationship represented a significant increase in CRP level in malesmokers compared to male non-smokers, whereas no significant increase was found in female
smokers. A significant dose-response relationship between urine cotinine and CRP was observed inmale smokers, whereas no significant dose-response relationship was observed in female smokers.
WBC count showed significant exposure-response and dose-response relationship consistently in both
sexes.
CONCLUSIONS:WBC count was a consistent effect marker of cigarette smoke exposure, whereas CRP
level showed an inconsistent association according to sex. CRP level was elevated in current malesmokers, and a dose-response relationship was observed when assessed by urine cotinine. However,this association was not observed in women. The sex-related response to cigarette smoke exposure
warrants further exploration in the future study.

Keywords: Cigarette smoke, C-reactive protein, White blood cell, cotinine, Tobacco

OP-190[Exposures » Water quality]

Assessing nitrate contamination in drinking
water on indigenous Māori Reserves in the Ngāi
Tahu takiwā, South Island New ZealandHana Royal1, Tim Chamber1, Simon Hales1, Annabel Ahuriri Driscoll2
1Department of Public Health, University of Otago, Wellington, New Zealand
2School of Health Sciences, University of Canterbury, Christchurch, New Zealand

BACKGROUND AND AIM:Increasing epidemiological evidence suggests an association between
elevated nitrate levels in drinking water and a number of poor health outcomes. Rural and private
drinking water sources are particularly vulnerable to nitrate contamination due to neighbouring
agricultural activity. Private water supplies, including many on indigenous land, are not routinely
monitored for nitrate contamination. We aimed to systematically test drinking water supplies on Māori
land in the Ngāi Tahu (an indigenous New Zealand tribe) takiwā (area) to identify areas of nitratecontamination.
METHOD:We implemented 18 marae (meeting house)-based testing sessions within the 18 subregions of the Ngāi Tahu Takiwā. Samples were obtained from all drinking water sources in thecommunity including at the marae and within the community. Nitrate levels were determined onsite
using a TriOS OPUS UV optical nitrate sensor.
RESULTS:A total of 18 marae-based testing sessions were carried out. At least two marae had nitratelevels that breached drinking water standards (11.3mg/L nitrate-nitrogen), while other areas had
elevated levels (5.65mg/L nitrate-nitrogen). Areas of elevated nitrate in drinking water were adjacent
to intense agricultrural actvity.
CONCLUSIONS:Māori living on reserves are exposed to unsafe drinking water that breach the drinking
water standards. Nitrate contamination on Māori land primarily comes from agricultural activity whichis permitted by government policy and regulation. The potential disproportionate level ofcontamination on Māori land compared to non-Māori land may breach the Treaty of Waitangi, New
Zealand’s founding document. At the least, it may represent an another environmental injustice toindigenous communities. Future research should collate more monitoring data on Māori land to ensure
the best policy and infrastructure is implemented to prevent and mitigate contamination of waterways.
All sources of funding: University of Otago, Health Research Council of New Zealand and Ngāi Tahu
freshwater entity.

Keywords: Community-engaged research, Environmental disparities, Exposures, Water quality

OP-191[Outcomes » Obesity and metabolic disorders]Insulin resistance and thyroid cancer in Korea:
using the Korean National Health and Nutrition
Examination Survey (KNHANES) 2016-2021
Yeong Mi Park, Yoonjoo Choi, Byungmi Kim, Jungsoo Im
National Cancer Control Institute, National Cancer Center Korea, Goyang, South Korea

BACKGROUND AND AIM:The association between insulin resistance and thyroid carcinoma is
controversial. The purpose of this study is to examine the potential effects of insulin resistance on therisk of thyroid cancer among Korean adults.
METHOD:This cross-sectional study included a total of 1,782 adults (204 cases and 1,764 controls
without chronic diseases) aged 19 to 59 years from the Korea National Health and Nutrition
Examination Survey 2016-2021. Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and
Quantitative Insulin Sensitivity Check Index (QUICKI) were used as insulin resistance indices. The
multivariable conditional logistic regression analysis was applied to calculate odds ratios (ORs) and
95% confidence intervals (CIs).
RESULTS:HOMA-IR was positively associated with the risk of thyroid cancer in all models: compared totertile 1 of HOMA-IR, ORs were 1.69 (95% CIs = 0.93-3.05) and 4.57 (2.56-8.16) for tertiles 2 and 3,
respectively (p for trend <0.001) in multivariable model. Similarly, QUICKI was inversely associatedwith the risk of thyroid cancer in all models: compared to tertile 1 of HOMA-IR, ORs were 0.37 (95%
CIs = 0.22-0.61) and 0.22 (0.12-0.39) for tertiles 2 and 3, respectively (p for trend <0.001) in
multivariable models.
CONCLUSIONS:We found a significant association between higher levels of insulin resistance and ahigher prevalence of thyroid cancer among Korean adults. In conclusion, our study suggests theimportance of developing strategies for insulin management to prevent thyroid cancer in Korea,
particularly through dietary intervention, which is known to be related to our findings.

Keywords: thyroid cancer, insulin resistance, HOMA-IR, QUIKI, metabolic healthOP-192[Other » Other (to be specified with keywords in the keywords section)]

Association of Alcohol Drinking andPolymorphisms of Alcohol Metabolism Genes
with Cataract Risk
Yi Chien Lai1, Chih Ching Yeh2
1School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
2School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan

BACKGROUND AND AIM:Cataract, the major cause of blindness worldwide, is caused by a partial or
total opacification of the crystalline lens. In Taiwan, about 5.7% of the population has cataracts,
mainly over the age of 65, and the prevalence of alcohol consumption among adults is about 43%.
Cataract may be affected by alcohol and the genes involved in alcohol metabolism. However, there isa lack of relevant research of the association between alcohol metabolism genes and cataract risk.
Therefore, we explore the association between alcohol drinking, alcohol metabolism genes(including ADH1B and ALDH2 ) and their interaction with the risk of cataract.
METHOD:We obtained 62,436 individuals over 45 years old from Taiwan Biobank and their genetic
polymorphism data of ADH1B rs1229984 and ALDH2 rs671 from Axiom Genome-Wide Array Plate. The
logistic regression model was used to determine the alcohol drinking and genotypes associated risk ofcataract. The synergistic interaction between the two factors was assessed using the synergy factor.
All statistical analyses were performed using SAS version 9.4 software.
RESULTS:We found out alcohol drinking (OR=0.84, 95% CI=0.77-0.92, P<0.0001), compared to nondrinkers, and the ALDH2 rs671 GA genotype (OR=0.95, 95% CI=0.90-0.99, P=0.0262) and GA+AA
genotype (OR=0.95, 95％ CI=0.91-1.00, P=0.0324), compared to the GG genotype, were significantly
associated with lower risk of cataract. However, these associations were attenuated after adjusted forcovariates. Also, the ADH1B rs1229984 was not significantly associated with cataract risk.
Unfortunately, the interaction between alcohol consumption and alcohol metabolism genes was notdiscovered in this study.
CONCLUSIONS:Though we found that cataract risk was marginally associated with ALDH2 rs671
genotype and not effected by the alcohol-gene interaction, we cannot exclude the possibility ofresidual confounding. Further studies with more alcohol metabolism genes and in other population are
required to clarify the alcohol associated risk of cataract.

Keywords: Cataract, Alcohol drinking, Alcohol metabolism, Genetic polymorphism, Interaction

OP-193[Methods » Toxicology]

Transgenerational effects of maternal exposure
to ambient PM2.5 on sperm functions and DNA
methylation in mouse offspring
Ping Chi Hsu1, Chia-Wei Lee1, Kuan Ling Chen1, Chung Shin Yuan2, Ching Shu Lai3, Xiang Yi Tsai1
1Department of Safety, Health and Environmental Engineering, National Kaohsiung University of

Science and Technology, Kaohsiung, 81157, Taiwan
2Institute of Environmental Engineering, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
3Department of Seafood Science, National Kaohsiung University of Science and Technology,

Kaohsiung, 81157, Taiwan

BACKGROUND AND AIM:Fine atmospheric particles, which are particulate matter (PM) with a diameter≤ 2.5 μm in total suspended atmospheric particles, can enter the terminal alveoli and even blood
circulation along with human respiratory movement; insoluble PM2.5 particles can attach to various
toxic entities and could threaten human health, and result in a variety of human dysfunctions anddiseases. Knowledge about the effects of prenatal insoluble PM2.5 particle particles on male
reproduction and whether transgenerational effects occur in subsequent generations are scant.
METHOD:Therefore, in this study, we tested the hypothesis that prenatal exposure to insoluble PM2.5
particles disrupted sperm function in the F1, F2, and F3 generations of male mice. Pregnant Balb/c
mice were treated by intratracheal instillation in gestation day 7, 11, and 15 with 10 mg insoluble
PM2.5 particles/kg/day. On postnatal day 105 for all generations, epididymal sperm counts, motility,
morphology, mitochondrial membrane potential (MMP), reactive oxygen species (ROS) generation,
sperm chromatin DNA structure integrity, testicular DNA content in spermatogenesis, serum
testosterone, and testicular DNA methyltransferases (Dnmts) levels were assessed.
RESULTS:In the F1 generation, prenatal exposure to insoluble PM2.5 particles decreased anogenital
distance (AGD) and normal sperm morphology, disrupted body weight, testis, and caput epididymal
weight, and significant differences in ROS generation, MMP, and Dnmt1. In the F2 generation,
insoluble PM2.5 particles decreased AGD, sperm motility, and normal sperm morphology, withsignificant differences in ROS generation and MMP. In the F3 generation, disrupted body weight, testis
weight, and normal sperm morphology showed significant differences in ROS generation.
CONCLUSIONS:Prenatal exposure to insoluble PM2.5 particles might induce the transgenerational
effects on male reproductive toxicity in F3.

Keywords: Water soluble PM2.5, Insoluble PM2.5 particles, Intratracheally instillation, Male
reproductive toxicity, Transgenerational effects

OP-194[Birth and pregnancy outcomes » Birth outcomes]

A quality assessment framework for evaluating
study quality and risk of bias of studies of air
pollution and preterm birth
Shawn Lee1, Rachel B Smith2, Karen Exley3, Heather Walton1
1Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,

London, UK; NIHR HPRU in Environmental Exposures and Health, UK
2NIHR HPRU in Environmental Exposures and Health, UK; Mohn Centre for Children’s Health andWellbeing, Imperial College London, London, UK
3UK Health Security Agency, UK

BACKGROUND AND AIM:Recent guidance by GRADE recommended the development of tailored quality
assessment framework for reviews of observational studies. There is currently no tailored quality
assessment framework available for epidemiological studies of air pollution and preterm birth (PTB),
thus there is a clear need to develop one to critique the increasing volume of evidence.
METHOD:Our previous work identified 23 SR/MAs in this area, from which information regarding
quality assessment tools used and confounders considered was extracted and compared. In particular,
studies that conducted stepwise adjustment of confounders to observe their effect on the observed
association have been examined. Experts in air pollution exposure and preterm birth were also
consulted, and direct acyclic graphs were produced. The WHO Air Quality Guideline Risk of Bias
Evaluation (AQG RoB) tool was used as the basis for a framework for studies of air pollution exposure.
The framework was then modified to include specific considerations for birth outcome studies.
RESULTS:Several changes to the WHO AQG RoB tool have been proposed. In the ‘confounding’domain, a key confounder to be added is parity. Alcohol consumption, time-activity pattern andseason of conception are confounders highlighted in past literature. In the domain of ‘outcome
measurement’, an additional question is recommended to evaluate if the authors have considered howinteracting or effect modifying variables may impact the observed association, namely methods ofdelivery, conception, the type of PTB, or the method of gestational dating. Studies that satisfied thesechanges would be classified to have a low risk of bias in the subdomains.
CONCLUSIONS:The modified WHO AQG RoB tool is not finalised and further changes will be suggested
subject to further discussions with experts and examination of the literature. It will be piloted in a
subgroup of studies in an upcoming SR/MA on air pollution exposure during pregnancy and PTB.

Keywords: Epidemiology, Methodological study design, Pregnancy outcomes, Reproductive
Outcomes, FemaleOP-195[Air pollution » Particulate matter]

The Effects of Air Pollution on Children’s
Educational Attainment at Schools in England
Sophia Garkov1, Lorraine Dearden2, Ben Armstrong1, Ai Milojevic1
1Department of Public Health, Environments and Society, London School of Hygiene & Tropical

Medicine, London, UK
2Institute of Education, University College London, London, UK

BACKGROUND AND AIM:Evidence suggests air pollution exposure may impact children’s health,including cognitive development. This study examines the effects of PM₂.₅ and NO₂ on children’s
performance on standardised tests throughout school, while considering the methodological challenges
posed by relationships among environmental and socioeconomic characteristics.
METHOD:The exposure of children born between 2000-2002 attending schools in England to annual
average PM₂.₅ and NO₂ was determined in a 1km radius around their home and school postcodes fromtheir first year of life to age 17 years old using government modelled background pollution data.
Related environmental covariates – greenspace exposure from Copernicus’ Normalised Difference
Vegetation Index and National Strategic Noise Mapping of road and rail noise – were also assessed atchildren’s home and school postcodes. Children’s total achievement on standardised English andmathematics tests at ages 6, 8, 12 and 17 years old were obtained from the National Pupil Database.
Pupil-level factors – relative age, gender, language, ethnicity and socio-economic status – were also
included. Linear mixed-effects models of life-time average PM₂.₅ and NO₂, separately, on performanceon standardised tests at school at ages 6, 8, 12 and 17 years old, respectively, were conducted whileaccounting for potential confounders and geographic clustering by local authority district and school.
RESULTS:In fully adjusted models, cross-sectional analyses indicate no observable associations
between either air pollutant and total attainment at age 6 or 12 years old; PM₂.₅ exposure wasassociated with lower total attainment at ages 8 and 17 years old, while NO₂ showed evidence ofborderline associations with lower total attainment at ages 8 and 17 years old. Longitudinal andsensitivity analyses are planned to investigate these relationships further.
CONCLUSIONS:This study utilises comprehensive environmental data and powerful, country-wide
administrative data to demonstrate some negative impacts of air pollution exposure on children’s
cognitive development.

Keywords: Air pollution, Children's environmental health, Environmental epidemiology, Green space,NoiseOP-196[Outcomes » Childrens environmental health]Susceptible windows of exposure to fineparticulate matter and behavioral symptoms
related to attention-deficit hyperactivity
disorderWei Jen Chen1, Alison M. Rector2, Mònica Guxens3, Carmen Iñiguez4, Michael D. Swartz5, Elaine
Symanski6, Jesús Ibarluzea7, Antonia Valentin8, Aitana Lertxundi9, Suneet P. Chauhan10, Kristina W.
Whitworth6
1Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College ofMedicine, Houston, TX, USA
2Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College ofMedicine, Houston, TX, USA; Department of Biostatistics and Data Science, The University of Texas
Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
3Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III,

Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; ISGlobal, Barcelona, Spain;
Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre(Erasmus MC), Rotterdam, The Netherlands
4Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III,

Madrid, Spain; Department of Statistics and Operational Research, Universitat de València, València,
Spain; Epidemiology and Environmental Health Joint Research Unit, The Foundation for the Promotionof Health and Biomedical Research of Valencia Region (FISABIO), Universitat Jaume I-Universitat deValència, València, Spain
5Department of Biostatistics and Data Science, The University of Texas Health Science Center at

Houston (UTHealth) School of Public Health, Houston, TX, USA
6Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College ofMedicine, Houston, TX, USA; Center for Precision Environmental Health, Baylor College of Medicine,
Houston, TX, USA
7Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III,

Madrid, Spain; Group of Environmental Epidemiology and Child Development, Biodonostia HealthResearch Institute, San Sebastian, Spain; Ministry of Health of the Basque Government, SubDirectorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain; Faculty ofPsychology, Universidad del País Vasco (UPV/EHU), San Sebastian, Spain
8ISGlobal, Barcelona, Spain
9Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III,

Madrid, Spain; Group of Environmental Epidemiology and Child Development, Biodonostia HealthResearch Institute, San Sebastian, Spain; Department of Preventive Medicine and Public Health,
University of the Basque Country (UPV/EHU), Leioa, Spain
10Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The

University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

BACKGROUND AND AIM:Few studies have explored temporally refined susceptible windows of
exposure to fine particulate matter (PM2.5) and child behavior. We utilized distributed lag non-linearmodels (DLNMs) to identify susceptible windows of pre- and postnatal PM2.5 exposures on attentiondeficit hyperactivity disorder (ADHD) symptoms in school-aged children.
METHOD:We included 1,475 mothers recruited in early pregnancy (2003–2008) from the Spanish
INMA (INfancia y Medio Ambiente) Project; mother-child pairs were followed through early childhood.
ADHD-related symptoms and behaviors were assessed around ages 4-5 and 6-8, using the ADHD
Diagnostic and Statistical Manual of Mental Disorders (ADHD-DSM-IV) and Conner’s Parent Rating
Scales (CPRS), respectively. PM2.5 exposures in 4-week windows from conception to age 6 were
estimated using a two-stage random forest model with temporal back-extrapolation. We applied
DLNMs within the Bayesian hierarchical model framework to identify susceptible windows of exposure
to pre- and postnatal PM2.5 (per 5-μg/m³) on (a) age- and sex-standardized T-scores for CPRS
subscales (ADHD index, cognitive problems/inattention, hyperactivity, and oppositional), using theidentity link and (b) number of inattention or hyperactivity/impulsivity symptoms from ADHD-DSM-IV,
using the log link. Models were adjusted for covariates identified from a directed acyclic graph.
Cumulative effects were calculated by aggregating estimates across individual susceptible windows
identified in adjacent periods.
RESULTS:No associations of prenatal PM2.5 with ADHD symptoms or behaviors were observed.
Postnatal PM2.5 exposure during 1.4-2.7 years and 1.0-2.6 years of age was associated withincreased risk of hyperactivity/impulsivity symptoms on the ADHD-DSM-IV [Cumulative risk ratio(RRcum) = 2.72, 95% credible interval (CrI) = 1.98, 3.74] and higher T-scores on the CPRS
hyperactivity subscale (βcum = 3.70, 95% CrI = 2.36, 5.03), respectively. Associations were notobserved between postnatal PM2.5 exposures and other ADHD-related symptoms or behaviors.
CONCLUSIONS:Our study suggests early toddlerhood as a susceptible period of exposure to PM2.5 onhyperactivity symptoms in school children.

Keywords: Air pollution, Particulate matter, Neurodevelopmental outcomes, Children's environmental
health.

OP-197[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Impact of exposure to PM2.5 in household air
pollution on child neurocognitive development
at seven years of age
Yetunde Celia Adeniyi1, Susan Darden Duncan2, Folasayo Ifedayo Ayoola3, Tope Babatunde
Ibigbame3, Samuel Tolulope Adekunle3, Timilehin Helen Ojo3, Olufemi Adesina Adewole3, Omolola
Oluwaseyi Omojola3, Oluseyi Olurunleke Fatile3, Olanike Ayomide Azeez3, Anindita Dutta4,
Oluwafunmilade Deji Abiodun4, Ryan Tanguay Chartier5, Ajibola Olufadekemi Ajani3, Ganiyu
Olatunbosun Arinola6, Adegoke Gbadegeshin Falade7, Oladosu Akanbi Ojengbede8, Michael Joseph
Boivin9, Michael E Msall10, Mihai Giurcanu11, Dezheng Huo11, Christopher Olusola Oloapade12
1Department of Psychiatry, College of Medicine, University of Ibadan; Department of Child andAdolescent Psychiatry, University College Hospital, Ibadan, Nigeria
2Department of Medicine; Center for Global Health, University of Chicago, Chicago, USA
3Department of Research, Healthy Life for All Foundation, University College Hospital, Ibadan, Nigeria
4Department of Medicine, Section of Pulmonary / Critical Care, University of Chicago, Chicago, USA
5Environment and Protection Group, Research Triangle International (RTI), Research Triangle Park,USA
6Department of Immunology, University of Ibadan, Ibadan, Nigeria
7Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
8Centre for Population and Reproductive Health, University of Ibadan, Ibadan, Nigeria
9Department of Psychiatry; Department of Neurology & Ophthalmology, Michigan State University,

East Lansing, USA
10Department of Pediatrics, Section of Developmental and Behavioral Pediatrics, University of

Chicago, Chicago, USA
11Department of Public Health Sciences, University of Chicago, Chicago, USA
12Department of Medicine, Section of Pulmonary / Critical Care; Center for Global Health, University of

Chicago, Chicago, USA

BACKGROUND AND AIM:93% of the world’s children under age 15 breathe polluted air that harms
their health and development. Fine-grained particulate matter (PM2.5) in household air pollution is aparticular threat. A significant source of PM2.5 is use of polluting cookstoves in the home. Mothers andchildren suffer the highest exposures, with risks to children beginning in-utero, potentially impairing
their later neurocognitive development. We examine the association between PM2.5 exposures andneurocognitive development in children at age seven.
METHOD:This study follows up on a randomized controlled trial that compared effects, on Nigerianpregnant women, of cooking with polluting fuels versus ethanol. We have followed the children born tothese women and measured their personal and indoor PM2.5 exposures at age seven. We assessed
their neurocognitive development using the Kaufman Assessment Battery for Children, 2nd Edition(KABC-II) and the Vineland Adaptive Behavior Scales (VABS). Multiple linear regression was used to
examine the association between PM2.5 exposures and neurocognitive ability, adjusting for child’sage, family assets, and mother’s education.
RESULTS:Our sample of 198 children (mean age 7.2 years, SD 0.2) included 132 children from

households using clean cookstoves (liquefied petroleum gas, ethanol) and 66 children from households
using polluting cookstoves (firewood, charcoal). Indoor peak PM2.5 levels were higher in householdswith polluting stoves (geometric mean, 276 μg/m3) than those with clean stoves (192 μg/m3).
Children’s PM2.5 exposure levels were inversely associated with their KABC-II and VABS scores. A 2fold increase in child’s peak personal PM2.5 exposure was associated with a 3.9-unit reduction in
KABC-II score (p<0.001); a 2-fold increase in peak indoor PM2.5 exposure with a 2.0-unit reduction in
VABS score (p=0.03). Clean stove use was associated with higher KABC-II scores (coef. 4.1, p=0.04).
CONCLUSIONS:Household use of polluting cookstoves contributes to children’s PM2.5 exposure levels,
potentially impairing their neurocognitive development.

Keywords: Air pollution, exposures, particulate matterOP-198[Chemical exposures » PFAS]

Associations of socioeconomic factors and perand polyfluoroalkyl substance exposure profilesin The Norwegian Mother, Father, and Child
Cohort Study
Adriano Winterton1, Gro Dehli Villanger1, Guido Biele1, Stephanie Engel4, Anne Lise Brantsæter2, LineSmåstuen Haug2, Terje Andreas Eikemo3, Heidi Aase1
1Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
2Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
3Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Facultyof Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim,
Norway4Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina,

Chapell Hill, NC, USA

BACKGROUND AND AIM:Socioeconomic status (SES) is an important determinant of exposure to anumber of environmental toxicants, including among pregnant women and their developing foetuses.
As a combined measure of a person’s social and economic position, socioeconomic status is in addition
to income, education, and occupation, also related to many lifestyle factors which in turn are linked tohealth outcomes in children. The purpose of this study is to investigate whether socioeconomic statusis associated with levels of per- and polyfluoroalkyl substances (PFAS) in the mother's blood during
pregnancy.
METHOD:The present study utilizes data from 3271 pregnant women in The Norwegian Mother andChild Cohort Study (MoBa) with available blood measurements of seven PFAS. Latent Profile Analysis(LPA) was used to identify latent subpopulations characterised by common PFAS exposure profiles. We
examined the associations between these profiles and education, household income, and fish intake
using linear regression models.
RESULTS:The LPA detected four profiles of PFAS exposures. The relative probabilities of belonging to
the first two profiles (characterised by lower overall exposure, one with slightly higher
perfluorooctanesulfonate) showed negative association with higher income, education and dietary fish
intake (p.adj < 0.0001).
CONCLUSIONS:These preliminary results indicate that different PFAS exposure profiles are differently
associated with socioeconomic status. The negative association between income, education, fish intake
and with lower PFAS exposure profiles is consistent with previous findings. Future development of thisstudy will integrate data from Statistics Norway to get a more precise picture of SES of the parents
and grandparents, will use latent class analysis to identify subgroups with similar socioeconomic
status, and then evaluate their link to profiles of prenatal PFAS and other toxicant exposures using
latent transition analysis, as well as analysing associations with child neurodevelopmental disorders.

Keywords: PFAS, Mixtures analysis, Socio-economic factors

OP-199[Chemical exposures » PFAS]

Per/poly fluoroalkyl substances induce lipid
accumulation via the serotonergic signaling
pathway in Caenorhabditis elegans
Jia Yu Jiang1, Chia Cheng Wei2
1Institute of Food Safety and Health, National Taiwan University, Taipei, Taiwan
2Institute of Food Safety and Health, National Taiwan University, Taipei, Taiwan; Department of Public

Health, National Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:Per/polyfluoroalkyl substance (PFASs) are persistent chemicals that
contaminate the environment worldwide. Previous studies have found PFASs could disrupt lipid
homeostasis in vivo; however, the possible underlying mechanism is still unclear.
METHOD:In this study, Caenorhabditis elegans (C. elegans) was used as a model organism toinvestigate the toxic effects of perfluorononanoic acid (PFNA), perfluorooctanesulfonamide (PFOSA),
and perfluorooctane sulfonate (PFOS) on lipid accumulation and evaluate the mechanism involved.
RESULTS:The results showed that exposure to 1 µM PFNA, PFOSA, and PFOS did not affect thedevelopment but significantly increase the lipid accumulation in C. elegans by both bodipy 493/503
and nile red staining methods. Among them, PFNA showed a higher level of lipid accumulation than
PFOS, followed by PFOSA. In addition, PFNA, PFOSA, and PFOS did not increase the food intake basedon the results of decreased pharyngeal pumping rate. Since serotonin plays a crucial role inmaintaining the energy balance and regulating lipid metabolism, we further evaluated the serotonin
pathway-related gene expression. The results showed that exposure to 1 µM PFNA, PFOSA, and PFOS
significantly downregulated the expression of tph-1, mod-1, and nhr-76 genes. Additionally, PFNA andPFOSA significantly downregulated the expression of adipose triglyceride lipase, atgl-1. These suggest
PFNA, PFOSA, and PFOS may reduce serotonin production and then affect beta-oxidation. Meanwhile,
exposure to 1 µM PFNA, PFOSA, and PFOS upregulated the expression of dgat-2, which is involved intriacylglycerol synthesis.
CONCLUSIONS:This study demonstrates that PFNA, PFOSA, and PFOS promote fat accumulation,
which is mediated by the serotonin-involved pathway and lipogenesis, to induce the obesogenic effect.

Keywords: Chemical exposures, PFAS, Toxicology, Obesity and metabolic disordersOP-200[Chemical exposures » PFAS]

Prenatal and early postnatal exposure toperfluoroalkyl substances and intelligencequotient score in 7-year-old children
Iben Have Beck1, Niels Bilenberg2, Sören Möller3, Flemming Nielsen4, Philippe Grandjean5, Frederik
Damsgaard Højsager4, Thorhallur Ingi Halldorsson6, Christel Nielsen7, Tina Kold Jensen8
1Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark,Odense, Denmark & Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense,
Denmark
2Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region ofSouthern Denmark, Odense, Denmark
3Open Patient data Explorative Network (OPEN), Odense University Hospital and Department ofClinical Research, University of Southern Denmark Odense, Denmark
4Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark,Odense, Denmark
5Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark,Odense, Denmark & Department of Environmental Health, Harvard T.H. Chan School of Public Health,Boston, Massachusetts, United States
6Center for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut,

Copenhagen, Denmark & Faculty of Food Science and Nutrition, School of Health Sciences, Universityof Iceland, Reykjavik, Iceland
7Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark,Odense, Denmark & Division of Occupational and Environmental Medicine, Department of Laboratory
Medicine, Lund University, Lund, Sweden
8Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark,Odense, Denmark & Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense,
Denmark & Open Patient data Explorative Network (OPEN), Odense University Hospital andDepartment of Clinical Research, University of Southern Denmark Odense, Denmark

BACKGROUND AND AIM:Perfluoroalkyl substances (PFAS) are persistent chemicals capable of crossing
the placenta and passing into breastmilk. Evidence suggests that PFAS exposure may affect brain
development. We investigated whether prenatal or early postnatal PFAS exposure was associated withintelligence quotient (IQ) scores in 7-year-old schoolchildren.
METHOD:We studied 967 mother-child pairs enrolled in the Odense Child Cohort, Denmark from 2010
to 2012. We assessed perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA),
perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid
(PFDA) concentrations in maternal serum collected in the 1st trimester of pregnancy and in childserum at age 18 months. At 7 years of age children completed an abbreviated version of Wechsler
Intelligence Scale for Children version-V (WISC-V) from which Full Scale Intelligence Quotient (FSIQ)
and Verbal Comprehension Index (VCI) were estimated. We applied multiple linear regressions andelaborated the complex associations by use of structural equation modeling (SEM).
RESULTS:A doubling in maternal PFOS and PFNA concentrations was associated with a 1.5 (95%
Confidence Interval (CI) 0.3;2.6) and 1.4 (0.2;2.6) point lower FSIQ, respectively, while no significant
associations were observed for PFOA, PFHxS or PFDA. Strong correlations were observed between
duration of breastfeeding and PFAS concentrations at 18 months. Despite application of SEM, it wasnot possible to isolate potential adverse associations between early-life PFAS exposure and FSIQ fromthe beneficial association between duration of breastfeeding and FSIQ.
CONCLUSIONS:As PFAS exposure is ubiquitous, even a small reduction in cognitive development is of
public health importance, as many children exposed to a small risk may have greater societal impact
compared to a few children exposed to a large risk. This work was funded by the Novo Nordic
Foundation; the Danish Council for Independent Research, medical sciences; HBM4EU, EU Horizon
2020; the Odense University Hospital PhD Fund.

Keywords: neurodevelopmental outcomes, children's environmental health, environmental
epidemiology

OP-201[Chemical exposures » PFAS]

Perfluoroalkyl Substances and Metabolic
Dysregulations over the Life-course: A
Longitudinal Metabolome Investigation using
Causal Inference Framework
Vishal Midya1, Meizhen Yao1, M. Ryan Smith2, Dean P. Jones2, Douglas I. Walker3, Sandra India
Aldana1, Flemming Nielsen4, Pal Weihe5, Philippe Grandjean4, Marie Abèle C. Bind6, Damaskini Valvi1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
2Department of Medicine, Emory University, Atlanta, GA, United States
3Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA, United States
4Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine,

University of Southern Denmark, Odense, Denmark
5Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn,

Faroe Islands
6Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States

BACKGROUND AND AIM:Studying the human metabolome could unravel metabolic dysregulations
caused by per-and poly-fluoroalkyl substances (PFAS). However, limitations of observational designs
and lack of longitudinal metabolomics measures make it challenging to infer causal associations. Using
causal inference methods, we estimated associations between PFAS and metabolomics across the life
course.
METHOD:We studied 125 Faroese individuals followed from birth (1986–1987) to mid-childhood (age7), adolescence (age 14), and adulthood (ages 22 and 28). PFAS were measured in cord whole bloodat birth and serum at later ages. In addition, serum untargeted metabolomics was measured at ages
7–28 by liquid chromatography with high-resolution mass spectrometry. We used the Rubin causal
model to reconstruct hypothetical randomized experiments that investigate the causal question ‘Does
increasing PFAS exposure alter the human metabolome?’ and evaluated the long-term effects of PFAS
at each exposure window on the metabolome using linear regression models with a randomizationbased multiple comparison error correction. Metabolites altered by PFAS exposure were enriched into
pathways using Reactome.
RESULTS:Prenatal PFOS was associated with increased pantothenic acid over the life course anddecreased DL-glutamate from adolescence to adulthood. We found effects by other PFAS for postnatal
exposures only when exposures were higher. Mid-childhood PFOA and PFHxS were associated withincreased dimethyl-arginine and N-acetylneuraminic acid in adolescence and adulthood. Adolescence,
PFHxS, and PFNA were associated with decreased iminodiacetic and 8,11,14–eicosatrienoic acid,respectively, in adulthood. Smaller effect sizes were found for adulthood PFAS compared todevelopmental exposures. All reported significant associations had adjusted p-value<0.2. Metabolites
altered by developmental PFAS exposures are involved in the cellular response to chemical stress,
transport of small molecules, SLC-mediated transmembrane transport, ABC transporters in lipid
homeostasis, and free fatty acid receptors, among other pathways.
CONCLUSIONS:Using hypothetical PFAS interventions, we found that developmental PFAS exposures
may have long-term and persistent effects on the human metabolome through adulthood.

Keywords: Metabolomics, Causal inference,OP-202[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

PFAS Exposure in a Community with a Former
Paper Mill: Source Apportionment and Relative
Exposure via Drinking Water and Diet
Ying Guo1, Rachel Bauer2, Ankita Bhattacharya1, Heather M Stapleton3, Sarah Choyke4, Christopher P
Higgins4, John Adgate5, Courtney C Cairgnan6
1Department of Food Science and Human Nutrition, Michigan State University, Lansing, USA；Instituteof Integrative Toxicology, Michigan State University, Lansing, USA
2Department of Pharmacology and Toxicology, Michigan State University, Lansing, USA；Institute ofIntegrative Toxicology, Michigan State University, Lansing, USA
3Environmental Sciences and Policy, Nicholas School of the Environment, Duke University, Durham,

USA
4Department of Civil and Environmental Engineering, Colorado School of Mines, Golden, USA
5Colorado School of Public Health, Aurora, USA
6Department of Food Science and Human Nutrition, Michigan State University, Lansing, USA；

Department of Pharmacology and Toxicology, Michigan State University, Lansing, USA；Institute ofIntegrative Toxicology, Michigan State University, Lansing, USA

BACKGROUND AND AIM:Drinking water is an important exposure pathway when PFAS concentrations
are elevated whereas for the general population diet is believed to contribute the most exposure. Local
and homegrown foods may also be an important exposure pathway for some communities. Therefore,
we conducted a detailed biomonitoring study for a Midwestern community with historic (pre-2018)
PFAS drinking water contamination (1600 ppt). We enrolled 129 participants from 92 homes,
administered dietary surveys, collected samples of serum and drinking water, and collected data on
historic drinking water concentrations. We investigated 48 PFASs in water from private wells andfound elevated concentrations of nine more not previously identified. Serum concentrations were
elevated compared to the general population for PFOS, PFOA, PFHxS, PFHpS and NMeFOSAA.
METHOD:We utilized source apportionment methods(Principle Component Analysis-Multiple Linear
Regression and Postive Matrix Factorization) to identify predominant PFAS mixtures in the serum
samples. We also determined relative contributions of serum PFASs from the drinking water anddietary exposure pathways.
RESULTS:For source apportionment methods that adopting receptor models, we identified 3 to 4
major contamination sources. And all of them were able to identify historical drinking water as a majorcontamination source.
CONCLUSIONS:The findings indicate that these three methods can successfully identify sources inhigh-exposure populations. Future research on PFAS exposure should concentrate on analyzing serum
for an expanded PFAS panel, identifying cohorts with other distinct point source exposures, andcombining biological and environmental data to better understand source apportionment results in thecontext of PFAS toxicokinetic behavior.

Keywords: PFAS, Source apportionment, human exposure, Drinking water and Diet, receptor models

OP-203[Air pollution » Short-term exposure]

Differences in association of PM2.5 and PM10
with respiratory hospitalization in Korea from2006 to 2019
Dajeong Ham1, Hyun Joo Bae2, Ho Jang Kwon3, Sanghyuk Bae4
1Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,

Republic of Korea
2Division for Environmental Risk, Korea Environment Institute, Republic of Korea
3Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan,

Chungcheongnam-do, Republic of Korea
4Environmental Health Center, College of Medicine, The Catholic University of Korea, Seoul, Republicof Korea

BACKGROUND AND AIM:The health effects of air pollution do not act equally on the entire population.
Even if exposed to the same level of air pollution, the magnitude of the association of air pollution on
health may appear differently depending on time, spatial factors, and populations with specificcharacteristics. This study examined the association of PM2.5 and PM10 with hospitalization due torespiratory diseases according to the variation of spatiotemporal and socioeconomic levels.
METHOD:Time series study was conducted using data from 2006-2019 for daily average of PM2.5 andPM10 (grid 9 km), daily average temperature, daily average humidity, and the number of respiratory
hospitalizations (ICD code: J00-J46; upper and lower respiratory infections, influenza, chronic
obstructive pulmonary disease, and allergic asthma) in South Korea. Spatial variation was subdivided
into 16 cities and provinces, and temporal variation was subdivided into 5-year moving intervals. A
Poisson distribution was assumed, and the relative risk was calculated through a generalized additivemodel.
RESULTS:Increase of 10 μg/m3 concentrations of PM2.5 and PM10 was significantly associated with all
respiratory hospitalization. The magnitude of association of hospitalization and PM2.5 was greaterthan the that of PM10. In a meta-analysis according to the income level, 10 μg/m3 increase inconcentrations of PM2.5 and PM10 were associated with different amount of excess hospitalizationaccording to income level. The range of excess hospitalization according to income level was 1.23%(95% CI: 0.80; 1.66) to 1.37% (95% CI: 0.77; 1.98) for PM2.5 and 0.67% (95% CI: 0.47; 0.87) to
0.84%(95% CI: 0.62; 1.06) for PM10. In addition, spatial and temporal heterogeneity was observed.
CONCLUSIONS:Groups with low or high socioeconomic status were evaluated to be more affected by
the increase in PM2.5 and PM10. Further research is needed to elucidate the causes of temporal andspatial heterogeneity.

Keywords: Air Pollutant, Particulate Matter, Hospitalizations, Respiratory diseaseOP-204[Air pollution » Wildfires]

Association between wildfire, respiratory andcardiovascular disease admission: Mediating
effect of air pollutants in Korea
Eunjin Oh, Sanghyuk Bae
Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Republic of Korea

BACKGROUND AND AIM:Although the impact of wildfires on health is diverse, few studies
quantitatively estimate this impact. This study aimed to evaluate the effects of wildfires on respiratory
and cardiovascular disease hospitalizations and to estimate the direct and indirect effects through air
pollution on these admissions.
METHOD:We used data from the Korea National Health Insurance Service, AirKorea, and the Korea
Meteorological Administration. We compared the relative risk of admission in Kangwon province before
and after wildfire with those of other regions using a difference-in-differences approach. We conducted
mediation analysis to estimate the mediating effects of air pollutants.
RESULTS:We observed increased risks of respiratory and cardiovascular diseases admission during 1
week after the wildfire, and the relative risk was 1.01 [95% Confidence Intervals (CI):0.97, 1.04] and1.07 (95% CI: 0.95, 1.21) for respiratory and cardiovascular diseases, respectively. Mediation effects
were observed for all air pollutants in respiratory [RR (95% CI): Indirect effect 7.78(3.92, 13.56);
Direct effect 0.00(0.00, 4.91)] and cardiovascular [RR (95% CI): Indirect effect 1.67(0.01, 3.41);
Direct effect 2.01(0.41, 6.18)].
CONCLUSIONS:The study provides evidence on the health effects of wildfire and mediation effect of
air pollution.

Keywords: Wildfire, Respiratory disease, Cardiovascular disease, Difference-in difference, Mediation

OP-205[Respiratory and allergic outcomes » Respiratory outcomes]

Long-term exposure to air pollution and risk ofacute lower respiratory infections: The Danish
Nurse Cohort
Jiawei Zhang1, Youn Hee Lim1, Rina So1, Laust H. Mortensen2, George Maria Napolitano1, Thomas
Cole Hunter1, Stéphane Tuffier1, Marie Bergmann1, Matija Maric1, Seyed Mahmood Taghavi Shahri1,
Jørgen Brandt3, Matthias Ketzel4, Steffen Loft1, Zorana Jovanovic Andersen1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Denmark Statistic, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health,

University of Copenhagen, Copenhagen, Denmark
3Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate,Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
4Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for

Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom

BACKGROUND AND AIM:Air pollution is major risk factor for chronic cardiorespiratory diseases, while
the evidence on respiratory infections remains sparse. We examined the association between longterm exposure to air pollution and incidence and episodes of acute lower respiratory infections(ALRIs).
METHOD:We followed 23,912 female nurses in Danish Nurse Cohort (aged > 44) from baseline (1993or 1999) to 2018. Using primary diagnosis, we defined ALRIs incidence as the first-ever hospital
contact and ALRIs episodes as all hospital contacts after baseline. The residential annual mean
concentrations of particulate matter with diameters ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2) andblack carbon (BC), since 1979 were modelled by the Danish DEHM/UBM/AirGIS modeling system.
Marginal Cox models with time-varying exposures were used to assess the association between 3-year
mean air pollution and ALRIs incidence and episodes. Concentration-response functions (CRF) wereassessed using natural cubic splines with 3 degrees of freedom, and effect modifications wereassessed by adding interaction terms and likelihood ratio test.
RESULTS:During mean 21.3 years’ follow-up, 4,746 ALRIs were observed, of which 2,553 wereincident (first-ever) events. We observed strong associations of all three pollutants with ALRIs
incidence, with hazard ratios and 95% confidence intervals of 1.19 (1.08-1.31) per 2.5 µg/m3 forPM2.5, 1.17 (1.11-1.24) per 8.0 µg/m3 for NO2, and 1.09 (1.05-1.12) per 0.3 µg/m3 for BC. We
detected even stronger associations with ALRIs episodes. We found supra-linear CRFs for all
pollutants, indicating a stronger association at lower concentrations. We identified people with baseline
chronic respiratory diseases, or low physical activities were more susceptible to the adverse effect of
air pollution.
CONCLUSIONS:Long-term exposure to air pollution, even at low levels, was associated with risk ofboth new and subsequent ALRIs.

Keywords: Respiratory outcomes,Infectious diseases, Air pollution, Long-term exposure, IncidenceOP-206[Respiratory and allergic outcomes » Allergies]

Constituents of fine particle air pollution andoxidative stress, quality of life of patient withallergic rhinitis: A panel study
Xin Li1, Haisheng Wu2, Weiwei Xing3, Pingping Jia4, Kun Yuan5, Fang Guo2, Jinjun Ran6, Xiaoling
Wang7, Yanxin Ren8, Lina Dong9, Shengzhi Sun5, Donggang Xu3, Jinhui Li10
1Department of Otorhinolaryngology–Head and Neck Surgery, Shanxi Provincial People’s Hospital,

Taiyuan, China
2School of Public health, The University of Hong Kong, Pok Fu lam, Hong Kong
3Beijing Institute of Basic Medical Sciences, Beijing, China
4JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong

Kong
5Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University,

Beijing, China
6School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
7Clinical Laboratory, Shanxi Academy of Traditional Chinese Medicine, Taiyuan, China
8Department of Head and Neck Surgery, Third Affiliated Hospital of Kunming Medical University,

Kunming, China
9Core Laboratory, Shanxi Provincial People’s Hospital, Taiyuan, China
10Department of Urology, Stanford University Medical Center, Stanford, California, USA

BACKGROUND AND AIM:Allergic rhinitis (AR) is significant global public health issue that affects
individuals worldwide, with environmental exposure exacerbating the condition. However, the effectsof particulate matter (PM) on AR patients remain inconsistent, with limited studies exploring therelationship between PM2.5 constituents and AR, especially in developing countries with severe
pollution.
METHOD:We conducted a panel study to investigate the association between 17 PM2.5 constituentsand 49 AR patients, diagnosed >1 year in Taiyuan, China. From June 2017 to January 2018, a face-toface interview and nasal lavage were conducted to assess their health status, life quality, andoxidative parameters for four times in both heating and non-heating seasons. The timemicroenvironment-activity pattern was applied in this study to assess individual PM2.5 exposure, andthe constituent-specific concentration of the nearest fixed sampling point was used to proxy individual
exposure. Spearman's rank correlation coefficients were used to assess PM2.5 constituent
correlations, while mixed-effects regression models were used to investigate short-term exposure
effects.
RESULTS:The results showed that PM2.5 mass and constituents, including BaP, PAHs, SO2- 4, NH+ 4,
V, Cr, Cu, As, Se, Cd, and Pb, were significantly associated with increased oxidative stress, as
indicated by an increase in Malondialdehyde (MDA) index. Additionally, PM2.5 constituents, including
V, Mn, Fe, Zn, As, and Se, were associated with decreased antioxidant activity, as indicated by adecrease in Superoxide Dismutase (SOD) index. PM2.5 and constituents were also associated withmore severe subjective symptoms and a lower quality of life, as indicated by increased Visual

Analogue Scale (VAS) and rhinitis Related Quality of Life Scale (RQLQ) scores.
CONCLUSIONS:Our findings suggest that persistent PM2.5 exposure, along with specific constituents,
could exacerbate AR patients' inflammatory symptoms and adversely affect their quality of life inheavy-industrial city of Taiyuan, China. These findings may have potential biological and policy
implications.

Keywords: Particulate matter, Chemical components, Air pollution, Allergic rhinitis,

OP-207[Omics technologies » Other (to be specified with keywords in the keywords section)]

Antagonistic interactions between aging genetic
variants and air pollution exposure on chronic
respiratory conditions in elderly womenSara Kress1, Michael Lau2, Michael J. Abramson3, Holger Schwender4, Tamara Schikowski1
1IUF– Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
2Mathematical Institute, Heinrich Heine University, Düsseldorf, Germany; IUF– Leibniz ResearchInstitute for Environmental Medicine, Düsseldorf, Germany
3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
4Mathematical Institute, Heinrich Heine University, Düsseldorf, Germany

BACKGROUND AND AIM:Aging is described as the accumulation of modifiable risk factors for chronic
diseases. Evidence supports that aging and related diseases are regulated by both the individual
genetic make-up and environmental factors such as air pollution. We aimed to investigate theirinterplay on chronic respiratory conditions in elderly women using an aging genetic risk score (GRS).
METHOD:We used data from 834 women (67–80 years) enrolled in the German cohort study on theinfluence of air pollution on lung function, inflammation and aging (SALIA) between baseline (years
1984–94) and first follow-up (2007–10). Chronic respiratory conditions were defined as any of thefollowing conditions at a mean age of 74 years (SD=3) including asthma, chronic bronchitis, cough,cough with sputum, or chronic obstructive pulmonary disease (n=248). Out of 77 aging candidate
single nucleotide polymorphisms, we constructed and evaluated a GRS utilizing bagging and random
forests as the statistical learning procedures. Main and interaction effects between GRS and chronic
NO2, NOx, PM2.5, PM10, PMcoarse, and PM2.5 absorbance exposure over observation time were
investigated on chronic respiratory conditions by adjusted logistic regression models.
RESULTS:Higher exposures to air pollutants increased the odds of chronic respiratory conditions by
34% (NOx: IQR=32.1 µg/m³, p-value=0.007) to 43% (NO2: IQR=11.6 µg/m³, p value=0.001).
Additionally, antagonistic gene-environment interaction effects were identified (GRSxNO2: p-valueinteraction=0.030, GRSxPM2.5: p-value interaction=0.016, GRSxPM10: p-value interaction=0.023,
GRSxPM2.5 absorbance: p-value interaction=0.014, GRSxPMcoarse: p-value interaction=0.042). In
individuals exposed to air pollution exceeding the EU thresholds, the GRS suppressed the effect onchronic respiratory conditions.
CONCLUSIONS:In elderly German women, chronic respiratory conditions as an indicator of aging wereassociated with air pollution exposure, while the individual aging genetic make-up reduced this effect.

Keywords: air pollution, big data, environmental epidemiology, respiratory outcomesOP-208[Exposures » Microbes/Microbiome]

Occurrence of Cryptosporidium species in
Wastewater Treatment Plants in Gaza Strip:
Environmental health problem
Adnan Ibrahim Alhindi1, Kamal E El Kahlout2, Afnan Z Abdelmoneim2
1Medical Laboratory Sciences Department, Faculty of Health Sciences, Islamic University of Gaza, P.O.

Box 108, Gaza, Palestine
2Biology and Biotechnology Department, Faculty of Science, Islamic University of Gaza, P.O. Box 108,

Gaza, Palestine

BACKGROUND AND AIM:Sewage is a common problem in developing and developed countries, where
there are many pathogens in wastewater, but they are relatively few. Cryptosporidium spp. Whichmay contaminate the environment. This study aimed to detect Cryptosporidium spp. in the twowastewater treatment plants (WWTPs) (North Gaza and Sheikh Ejleen WWTPs).
METHOD:Over the course of 5 months 85 wastewater samples were collected from the North Gaza andfrom Sheikh Ejleen WWTPs. The collection process was carried out through the use of a plastic
container designated for collection with a capacity of 1 liter. All samples were screened using wet
mount, flotation method, acid-fast stain (AFS) and polymerase chain reaction (PCR).
RESULTS:The results showed that Cryptosporidium spp. oocyst detected only in 4/85(8%) of sewage
samples using the PCR, and these samples had previously were tested positive using the Acid-faststain. Those samples were from the Sheikh Ejleen WWTP, while the NGWWTP did not record any
positive sample for Cryptosporidium spp. The prevalence of the parasite varied over the course of theexamination months. It was in September and October 2.3%, while in December and July it was only
1.7%.
CONCLUSIONS:Our findings shed light on the presence of pathogenic parasites in wastewater
treatment plants, especially Cryptosporidium spp., which can reach the environment especially Gaza
shore where there is a partial treatment for sewage in Gaza, in addition the potential infection forhumans.

Keywords: Gaza Strip, wastewater, Cryptosporidium, environment, nested PCR.

OP-209[Climate » General]

Climate variability and occurrence of vector
borne diseases: evidence from National Capital
Region of Delhi, India
Harshal Ramesh Salve1, Sagnik Dey2, Santu Ghosh4, Tanu Jasuja1, Nitish Dogra3, Anand Krishnan1
1All India Institute of Medical Sciences, New Delhi
2Indian Institute of Technology, Delhi
3Teri, New Delhi
4St Johns Medical College,Bengaluru

BACKGROUND AND AIM:The driver of climate variability in the form of unseasonable rain and risingtemperatures in this scenario amplifies the risk of vector borne diseases (VBDs) such as malaria,
dengue and Chikungunya. We aimed to develop the climate based prediction model for VBDs in
National Capital Region - Delhi India
METHOD:A secondary data for eight years (2010–2017) of confirmed VBDs cases in all 10 districts ofDelhi - NCR was obtained from local municipalities. District wise monthly data were segregated withrespect to the reported residential address of the cases. Climate data, such as atmospherictemperature (AT), relative humidity (RH),rainfall were extracted from satellite, using modern ERA
Retrospective analysis for research and Applications. The data were produced on a 0.5 * 0.66 degree
grid with 72 layers at hourly scale and averaged for Delhi on a daily basis at district level. Information
on Normalized Difference Vegetation Index (NDVI), socio-demographic characteristics were also
obtained. The exposure-response was estimated at district level by multivariate generalized linear
additive mixed effects model with Quasi-Poisson family.
RESULTS:Gradual increase in monthly average temperature and seasonal variation in occurrence of
VBD were observed. RR of VBDs was estimated as 1.17 (95% CI: 1.12-1.23) for AT. There were 18%(95% CI: 12-23%) increase in Dengue cases and 7% (95% CI: 2-12%) increase in Malaria cases forunit increase in monthly average AT. Monthly VBD cases at district level increase monotonically withtemperature, RH and NDVI. On interaction analysis AT was correlated with VBD cases if monthly rain
fall is between 1-3cm. No impact of temperature on VBD was observed when relative humidity wasabove 40%
CONCLUSIONS:Temperature and associated climate variability drives the outbreaks of VBDs in Delhi NCR region. Climate based prediction model could play important role in management of VBDs in
India.

Keywords: Climate variability, Vector borne diseases, India

OP-210[One health » Virology]

Airborne Avian Influenza Virus in Ambient Air in
the Winter Habitats of Migratory Birds
Jia Lin Zhang, Zi Yu Chen, Si Ling Lin, Pei Shih Chen
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City,
TaiwanBACKGROUND AND AIM:Airborne avian influenza virus (AIV) has been evaluated in live poultrymarkets and case farms. However, no study has discussed airborne AIV in ambient air in the winterhabitat of migratory birds. Therefore, this study aimed to evaluate airborne AIV, specifically H5, H7,
and H9, in a critical winter habitat of migratory birds and assess the factors influencing airborne AIVtransmission in ambient air.
METHOD:A total of 357 ambient air samples were collected in the Aogu Wetland, Taiwan, Republic ofChina, between October 2017 and December 2019, and analyzed using quantitative real-timepolymerase chain reaction. The effects of environmental factors including air pollutants,
meteorological factors, and the species of the observed migratory birds on the concentration of
airborne AIV were also analyzed.
RESULTS:This is the first study to investigate the relationship between airborne AIV in ambient air andthe influence factors in winter habitat of migratory birds, demonstrating the benefits of environmental
sampling for infectious disease epidemiology. The positive rate of airborne H7 (12%) was higher thanthat of H5 (8%) and H9 (10%). The daily mean temperature and daily maximum temperature had asignificant negative correlation with influenza A, H7, and H9. Cold air masses and bird migration weresignificantly associated with airborne H9 and H7, respectively. In addition, we observed a significant
correlation between AIV and the number of pintails, common teals, Indian spot-billed duck, northern
shovelers, Eurasian wigeon, tufted duck, pied avocets, black-faced spoonbill, and great cormorants.
CONCLUSIONS:We illustrated the potential for alternative surveillance approaches (monitoring bird
species) as an indicator of influenza-related risks and identified cold air masses and the presence ofspecific bird species as a potential driving factor for the presence of airborne AIV.

Keywords: H5, H7, H9, airborne avian influenza virus, cold air mass

OP-213[One health » Tropical health]

Factors Influencing Mosquito Bed Net
Ownership and Utilization in Eastern Uganda
Jezelle Lynch1, Chi Wen2, Chinasa Ekweremuba1, Jessie Stone3, Charles Kalumuna3, Nils
Hennig1, Yueh Hsiu Mathilda Chiu1
1Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Mount Sinai Health System, New York, NY, USA
3Soft Power Health Uganda, Kyabirwa, Uganda

BACKGROUND AND AIM:Malaria remains a major global health problem. Although distribution ofmosquito bed nets is a widely used approach for malaria prevention, data on how bet net use may be
influenced by its source and other factors are still limited. We examined the factors associated with
bed net ownership and the pattern of usage in an eastern region of Uganda.
METHOD:Home visits and participant interviews were conducted to collect data from 2540 households
among 10 villages in Buwagi Parish, Uganda in 2019. Household- and individual-level data werecollected, such as bed net ownership (at least one net versus none), acquirement source(governmental campaigns versus others), and sociodemographics. Net-level information including bed
net quantity, conditions, materials used, as well as pattern of usage (e.g., whether nets were hungproperly, alternative uses, etc.) were also collected. Multivariable-adjusted regression models were
performed to identify the key determinants of bed net usage profiles.
RESULTS:Only 1438 (57%) households processed at least one bed net; households owning net(s)were more likely to have at least one child ≤5 years of age, compared to households without a net(56.5% vs. 40.8%, p<0.01). Among households owning net(s), the odds of a bed net being correctly
used (i.e., to sleep under) after adjusting for potential confounders were significantly lower for larger
household size (OR=0.91, 95% CI: 0.83, 0.99, p<.001) and households owning more nets made ofpolyethylene (OR=0.58, 95% CI: 0.35, 0.94, p<.001), resulting in an alternative use of the net.
Interestingly, a bed net obtained from the government for free was associated with lower odds ofbeing correctly hung, compared to a net obtained or purchased from other sources (OR=0.24, 95%
CI: 0.08, 0.80, p=0.02).
CONCLUSIONS:Identifying the factors influencing the patterns of bed net use may help provide
information to more effectively plan for malaria control programmes.

Keywords: Malaria, prevention, insecticidal nets, sociodemographics, health behaviors

OP-214[Air pollution » Particulate matter]Examining the oxidative potential of residential
outdoor PM2.5 through multiple assays andtheir potential chemical drivers
Sonali Babulal Borse1, Shreya Dubey1, Nupoor Patil1, Kavya Sugur2, Saurabh Lonkar1, RajdeepSingh1, Priya Samdarshi1, Rajesh Thimulappa2, Harish Chandra Phuleria3
1Environmental Science and Engineering Department, Indian Institute of Technology, Mumbai, India
2Department of Biochemistry, JSS academy of Higher Education and Research, Mysuru India
3Environmental Science and Engineering Department, Indian Institute of Technology, Mumbai, India,

Koita Centre for Digital Health, Indian Institute of Technology Bombay, Mumbai, India

BACKGROUND AND AIM:Several studies have shown that inhalation of PM2.5 constituents induces
oxidative stress, which increases the risk of cardio-respiratory disorders, irrespective of age. This
study examines the oxidative potential of fine particulate matter using multiple acellular assays atresidential outdoor locations in urban India. Comparison against a novel cellular assay and its
association with PM chemical constituents is also examined.
METHOD:As a part of the APEAL (Longitudinal Effect of Air Pollution Exposure on Adolescents’ Lungs)
study, a multi-centric cohort study, a pilot study was conducted in the summer of 2022 across
Mumbai, Bangalore, Mysore, and Delhi, where daily outdoor PM2.5 was collected using low volume
samplers outside 7-9 homes for a week. Water-extracted PM samples were subjected to two standard
acellular assays, OPAA, OPDTT, and a very sensitive assay based on lipid-peroxidation, OPLPO. OP
association was examined with various PM chemical constituents.
RESULTS:Delhi shows the maximum OP activity (mean ± SD:1.30 ± 0.37 nmol min-1m-3), which is3%, 57%, and 63% higher than Mumbai, Bengaluru, and Mysuru, respectively. For OPAA and OPLPO,
Mumbai shows the highest toxicity (0.3±0.2 and 23.86±14.78 nmol mi-1m-3). Both OPDTT and OPAA
show association with different transition metals. For OPDTT, Cu and Se show a strong affinity in Delhi(p<0.05), while Co is positively correlated in Bengaluru. On the pother hand, As and Cd are strongly
associated with OPAA and OPLPO, respectively in Mumbai (p<0.05)..In Mysuru nitrate is positively
associated with OPDTT and OPLPO.
CONCLUSIONS:This study provides OP levels outside residential environments in different cities using
multiple assays. Delhi and Mumbai exhibit the highest but similar toxicity, while having significant
difference in PM2.5 levels. Thus, PM mass concentration, alone, may not be an appropriate metric forsafeguarding the public health. Additional analyses including carbonaceous characterization isunderway.

Keywords: chemical exposures, heavy metals, particle components, children's environmental health,long-term exposureOP-215[Exposure assessment methods » Risk assessment]

Inhalation health risk assessment of ambient
PM2.5 and associated trace elements in CapeTown, South Africa
Anna Alfeus1, Anna Alfeus2, Peter Molnár3, Johan Boman4, Joyce Shirinde1, Janine Wichmann1
1School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South

Africa2Veterinary Medicine, University of Namibia, Oshakati, Namibia
3Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska

Academy, University of Gothenburg, Sweden
4Department of Chemistry and Molecular Biology, Atmospheric Science Division, University ofGothenburg, Sweden

BACKGROUND AND AIM:There is a lack of human health risk assessment studies on air pollution in
Africa. A study was therefore conducted in Cape Town, South Africa, using the US EPA health risk
framework.
METHOD:The study investigated the human health risks associated with inhaling ambient PM2.5 andsome of its trace elements (Cl, Si, and Ti) over a period of 12 months (April 2017 to April 2018).
PM2.5 samples were collected over 24 hours and every third day at an urban background site in Cape
Town (n=121). X-ray fluorescence was used to determine the trace element concentrations. The otherfive trace elements (Ca, Fe, K, S, and Zn) do not have reference concentrations and were notinvestigated in the health risk assessment study. The safe average daily dose was determined using
the yearly WHO guideline and South African ambient air quality standard for PM2.5, as well as the US
EPA regional screening levels for trace elements.
RESULTS:The average yearly PM2.5 concentration was 13 mg/m3, which exceeded the yearly WHO
guideline of 5 mg/m3, but was below the yearly South African standard of 20 mg/m3. Thirty-eightsamples exceeded the daily WHO guideline (15 mg/m3), but not the daily South African standard (40mg/m3). Si had the highest median concentration (380 ng/m3), followed by Cl (290 ng/m3) and Ti(33 ng/m3). The average yearly PM2.5 concentration posed a low risk to adults (Hazard Quotient of0.66) but a higher risk to infants (HQ of 2.13) and children (HQ of 1.96). Additionally, Cl posed healthrisks to all age groups (HQ > 1).
CONCLUSIONS:PM2.5 and its trace element components have adverse health effects on all population
age groups. Since the toxicity of PM2.5 depends on its composition, the study recommends a source
apportionment study to quantify source contributions and inform appropriate abatement strategies.

Keywords: Human health risk assessment; inhalation exposure; PM2.5; trace elements

OP-216[Air pollution » Short-term exposure]

Association between Asian Dust and adverse
health effects in Japan
Kazunari Onishi1, Masanori Nojima2, Teruya Maki3, Yasunori Kurosaki4
1Division of Environmental Health, Graduate School of Public Health, St.Luke’s International

University, 3-6-2 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
2Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo,

4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
3Department of Life Science, Faculty of Science and Engineering, Kindai University3-4-1 Kowakae,

Higashiosaka, Osaka 577-8502, Japan
4Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, JapanBACKGROUND AND AIM:This study aimed to assess the adverse health effects of Asian Dust (AD)among healthy individuals in Japan. AD storms occur seasonally, mostly in spring, affecting Japan andneighboring countries such as Mongolia, China, Taiwan, and Korea. Climate and westerly windconditions determine which countries get affected. AD includes other components of air pollution.
While health issues related to AD have been reported, the possibility of adverse effects remains
unclear. This study addresses the above gap.
METHOD:We administered self-report questionnaires online to healthy volunteers residing in Yonago,
Japan between 2013 and 2015. We followed 96 volunteers aged 19–65 years at baseline. We usedvisibility-judged data from Japan Meteorological Agency (JMA) and Light Detection and Ranging(LIDAR) data to assess AD exposure. Associations between AD and subjective symptoms wereassessed using a linear mixed model, with climate, other air pollutants, pollen, disease history, andpreventive behavior as possible covariates.
RESULTS:We classified the data into: AD (February to May) and non-AD (June to January) seasons. By
comparing the JMA’s judgment with corresponding LIDAR data, a dust coefficient of above 0.036/km
was defined as an AD day. In the AD season, the score difference for nasal symptom on AD days
compared to non-AD days was 0.05 (95% CI: 0.01–0.08, p < 0.05), indicating a significant
association between nasal symptom and AD exposure. In the non-AD season, there was no significant
relationship between nasal symptom and AD exposure.
CONCLUSIONS:We conducted a long-term survey to investigate the short-term effects of AD on nasal
symptoms in healthy participants by adjusted possible confounding factors. Even healthy participants
demonstrated elevated symptom scores during AD events in AD seasons. Future studies shouldattempt to provide more detailed component effects.

Keywords: Allergies, Heavy metals, ExposuresOP-217[Exposure assessment methods » Exposure assessment-air pollution]

Emissions of Airborne Pollutants from OpenDumpsites and Perceived Health Effects among
Residents in Ile-Ife, Osun State, Nigeria
Olufemi Oludare Aluko, Abdulkabir A Adebayo, Olusola Fajobi, Oyindamola A Adeniran, Tolu E
Akinwumi, Peter A Aladeyelu, Iyinoluwa A Animasaun
Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife,
Nigeria

BACKGROUND AND AIM:Globally, wastes generated are poorly managed and encumbered by theincreasing population, inadequate waste management infrastructure, personnel and logistics,
especially in least developing countries like Nigeria. municipal waste is disposed by open dumping
without environmentally friendly alternatives, compromising environmental quality. The study
measured the diversity and air pollutants from open dumpsites and perceived health effects on
populations.
METHOD:The study utilised a comparative cross-sectional design and measured atmosphericemissions from open dumpsites and health symptoms from exposed residents. The target population
were high-exposed (≤ 250m) and low-exposed (251-500m) around open dumpsites residents. With
non-response, the sample size for the household survey was a total of 183 respondents per group. A
purposive sampling technique was used to select open dumpsites close to residential settlements, andsimple random sampling identified streets and households that satisfied the inclusion criteria. The datacollection instruments were Aeroqual 200 series, Wolf pack area monitor, Aerocet 831 series, andhousehold questionnaire. The questionnaire was pretested and validated before use. Field data wereanalysed with IBM-SPSS version 20. The association among variables was determined by chi-squarestatistics at p-value <0.05.
RESULTS:53.5% of respondents were below 40 years. 42.9% respondents had at least a secondary
level education, and 74.9% were traders, artisans, and masons. Measurement of gaseous pollutants
revealed an increased level of SO2, H2S, NO, NO2, and PM10 as against their ambient thresholds.
More than three-fifths of respondents (63.5%) had a poor perception of the health hazard of open
dumping, though respondents from high- and low-exposure groups had experienced respiratory andgastrointestinal symptoms.
CONCLUSIONS:Dumpsites emit gaseous pollutants that may adversely affect the health of theresident population. Hence, population awareness of the health risks of open dumpsites and a systemapproach to waste management should be applied. Adequate monitoring of air quality and gaseous
pollutants levels should be instituted.

Keywords: Air pollution, Exposure assessment-air pollution, Environmental epidemiology, Public
HealthOP-218[Air pollution » Particulate matter]

Air Quality and Health Risk Assessment ofParticulate Matter (PM2.5 and PM10) in Awotan
and Aba-Eku Dump Sites, Ibadan, Nigeria
Temitope Ayodeji Laniyan, Oyewale Mayowa Morakinyo, Kolawole Charles Akindulureni
University of Ibadan, Ibadan

BACKGROUND AND AIM:Report on air quality across dump sites in most Nigeria cities showed greater
values for airborne particles than their acceptable limits. The study therefore assessed air quality andhealth risk of particulate matter (PM2.5 and PM10) in Awotan and Aba-eku dump sites, Ibadan,
Nigeria.
METHOD:Ambient air at the dumpsites was sampled for particulate matter (PM2.5 and PM10) using
particle counter twice per day (morning and afternoon). A total of 1080 samples were collected atboth dump sites. Non-cancer risk of exposure to PM2.5 and PM10 was estimated using hazard quotient
while cancer risk for exposure to PM2.5 through exposure routes was estimated using excess lifetime
cancer risk (ELCR).
RESULTS:Average mean value of PM2.5 and PM10 in Awotan was 46.02±17.02 μg/m3 and58.19±21.15 μg/m3 in the morning and 60.94±29.27 μg/m3 and 75.45±34.46 μg/m3 in theafternoon while PM2.5 and PM10 in Aba-eku was 81.62±68.46 μg/m3 and 127.69±100.82 μg/m3 inthe morning and 86.11±56.32 μg/m3 and 128.20±95.53 μg/m3 in the afternoon. Air quality index at
both dump sites ranges from no pollution (HRA≤50) to very hazardous pollution (HRA˃250). Average
excess lifetime cancer risk values of exposure to PM2.5 for adult and children were found to exceed
1×10−6. Non-cancer risk of exposure to PM2.5 and PM10 via routes of exposure at both dump sites inchildren and adults presents low values below maximum acceptable levels of 1 except for children via
ingestion route.
CONCLUSIONS:Exposure to PM2.5 and PM10 from both dump sites can result to health risks amongresidents living close. However, children are more likely to be affected compared to adults. Therefore,
it is necessary to close and relocate both dump sites to prevent health risk of children living near
dump sites.

Keywords: Particulate Matter, ExposureOP-219[Air pollution » General]

Determinants of measurement error in surrogate
exposures assigned as proxies of personal
exposure to ambient air pollution: the MELONS
study
Dylan Wood1, Dimitris Evangelopoulos1, Ben Barratt1, Hanbin Zhang1, Heather Walton1, Klea
Katsouyanni2
1MRC Centre for Environment and Health, Environmental Research Group, Imperial College London,

UK; NIHR HPRU in Environmental Exposures and Health, Imperial College London, UK
2MRC Centre for Environment and Health, Environmental Research Group, Imperial College London,

UK; NIHR HPRU in Environmental Exposures and Health, Imperial College London, UK; Department ofHygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian Universityof Athens, Greece

BACKGROUND AND AIM:Assignment of surrogate estimates of personal exposure to ambient air
pollution to individuals in epidemiological studies introduces error and these estimates may not always
be suitable proxies of “true” exposure. Investigation into quantification of the magnitude, type(classical/Berkson) and determinants of error in assigned surrogate estimates is limited. The aim of
the present study was to investigate measurement error and identify its determinants.
METHOD:In the MELONS study, personal exposure estimates of nitrogen dioxide (NO2) and particulatematter ≤2.5 micrometres in diameter (PM2.5) of ambient origin were available through a personalmonitoring campaign (defined here as “true” exposure) of 76 older individuals. Surrogate measures ofambient exposure to the same pollutants, derived from spatio-temporal models and a fixed-sitemonitoring network, were also assigned per individual in addition to individual-level characteristics
collected throughout the campaign. Linear regression models were constructed to estimate theinfluence of each covariate on the magnitude of error in each surrogate exposure estimate (thedifference between the surrogate and “true” exposure).
RESULTS:The difference in “true” exposure and ambient residential estimates from a fixed-sitemonitor were most influenced by smoking and socioeconomic status; the error magnitude increased incurrent smokers (NO2: 20.7µg/m3 [4.10, 37.20] increase in disparity with “true” in comparison toformer smokers) and for those living in areas of higher deprivation score (PM2.5: 0.10 [0.03, 0.17]).
For modelled surrogate exposure, the largest determinants of error were residential building type(NO2: -15.30 [-25.60, -4.96] decrease in disparity for those living in detached or semi-detachedhousing in comparison to those living in a flat/apartment) and smoking status (NO2: -13.90 [-27.50, 0.21] decrease for non-smokers).
CONCLUSIONS:The magnitude of error observed in surrogate measures of ambient air pollution
assigned as proxies of personal exposure is likely influenced by individual-level characteristics that
may need to be adjusted for in epidemiological studies.

Keywords: Air pollution, Exposure assessment-air pollution, Environmental epidemiology

OP-220[Air pollution » Wildfires]

Characterization of Wildfire Particulate
Emissions using Computer Controlled ScanningElectron Microscopy Techniques
Gary Casuccio, Traci Lersch, Roger West, Long Li
Environmental Department, RJ Lee Group, Pittsburgh, PA, USA

BACKGROUND AND AIM:Conditions related to global warming have resulted in more frequent andintense wildfires in the western United States and other parts of the world. Smoke produced during
wildfires is comprised of a mixture of gas-phased and particle pollution, and there is a growing body ofscientific evidence that links wildfire smoke exposure to various health effects. Thus, there is a need togain a better understanding of particulate emissions generated during wildfire events.
METHOD:Studies incorporating the collection of samples during wildfire events using passive andactive samplers and subsequent analysis of the samples using computer controlled scanning electron
microscopy (CCSEM) have been performed to characterize particulate emissions on an individual
particle basis. Data obtained from the CCSEM analysis was used to speciate the particulate matter into
particle classes based on size, shape, elemental composition, and review of digital images collectedduring the CCSEM analysis.
RESULTS:Results indicate that wildfire emissions can be identified by the presence of spherical carbon
particles (‘tar balls’), and show that tar balls and soot concentrations were significantly higher during
wildfires events. As an example, particles classified as tar balls accounted for 23.4 ug/m3 during awildfire event compared to 1.1 ug/m3 during a non-wildfire event.
CONCLUSIONS:The ability to speciate particulate matter on an individual particle basis using CCSEM
techniques provides greater specificity of wildfire emissions as compared to bulk analytical methods
and demonstrates the benefit of using CCSEM to complement other analytical methods related to thecharacterization wildfire emissions.

Keywords: particulate matter, particle components, long-term exposure, short-term exposureOP-221[Chemical exposures » General]

Spatiotemporal Characteristics and Changes in
Hazard-Based Result Scores Using Pollutant
Release and Transfer Register Data
Hyun Joo Bae, Yura Lim, Yang Won Suh
Korea Environment Institute, Sejong, Republic of Korea

BACKGROUND AND AIM:The constant consumption of chemical products owing to expanding
industrialization has led to an increase in public interest in chemical substances. As the production anddisposal processes for these chemical products cause environmental problems, regional information on
the hazard level of chemical substances is required considering their effects on humans and in order toensure environmental safety.
This study aimed to identify hazard contribution and spatiotemporal characteristics by region andchemical by calculating a hazard-based result score using pollutant release and transfer register(PRTR) data.
METHOD:This study calculated the chemical discharge and hazard-based result score from the RiskScreening Environmental Indicators (RSEI) model, analyzed their spatiotemporal patterns, andidentified hot-spot areas where chemical discharges and high hazard-based scores were concentrated.
The amountof chemical discharge and hazard-based risk scores for 250 cities and counties across South Korea
were calculated using PRTR data from 2011 to 2020.
RESULTS:The chemical discharge and hazard-based result scores showed varying spatial patterns. The
chemical discharge and hazard-based result score hot-spots were identified. Additionally, identificationof the hazard-based result scores revealed differences in the type of chemicals contributing to thedischarge. Chromium accounted for >90% of the discharged chemicals in the hazard-based result
score hot-spots.
CONCLUSIONS:The RSEI hazard-based result score is a quantitative indicator that considers thedegree of impact on human health as a toxicity-weighted value. It can be used for the management ofindustries discharging chemical substances as well as local environmental health management.

Keywords: Risk-Screening Environmental Indicators, pollutant release and transfer register, hazard
scoreOP-222[Exposure assessment methods » Exposure assessment-air pollution]

Comparison of Performance in Removing
Submicrometer Particles between Kitchen
Hoods by Using a Systematic Measurement Test
I Hsuan Tsai, Wan Chen Lee
Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,
TaiwanBACKGROUND AND AIM:Cooking emissions are an influential factor in indoor air quality, as they
contribute up to 30% of human daily particle exposure and could have health effects. The use of
kitchen hoods is an effective intervention strategy in maintaining indoor air quality. However, there is
no standardized method to assess the performance of kitchen hoods in Taiwan. Previous studies used
tracer gas to determine kitchen hood capture efficiency instead of particles, which makes it difficult to
extrapolate the results. Additionally, differences in cooking style, kitchen hood types, andenvironmental conditions make it challenging to directly apply Western study findings to Taiwan.
Therefore, the objective of this study is to apply a systematic and quantitative method to compare theperformance of kitchen hoods under the kitchen-simulated condition.
METHOD:We conducted laboratory tests to evaluate the performance of 26 kitchen hoods. To simulate
cooking scenarios, we generated artificial aerosols using an electric heating chamber. Particles within
the range of 14.6 to 685.4 nm in size were measured using Scanning Mobility Particle Sizer™
spectrometers (SMPS™). The capture efficiency (CE) was used as the index of kitchen hood
performance. Additionally, air exchange rate (ACH) and particle deposition rate measurements wereconducted, which helped to characterize the performance of kitchen hoods under controlled conditions.
RESULTS:We successfully built a controllable simulated kitchen zone with ACH from 1.6 to 2.4. Fixedflow rate (6 and 16 m3/min) among 26 kinds of kitchen hoods provided comparable particle sizeresolved CE results. The 3 times repeated results showed that the CE of kitchen hood varies withparticle sizes, the design of hood geometry, and flow rate.
CONCLUSIONS:Overall, this study can be a baseline to provide a guideline to customers on how to
select an effective kitchen hood in order to improve residential indoor air quality and reduce
population exposure to cooking emissions.

Keywords: Particulate matter, Methodological study design, Air pollution

OP-223[Air pollution » Other (to be specified with keywords in the keywords section)]

A Review and Quality Assessment of Systematic
Reviews and Meta-Analyses of Traffic-Related
Air Pollution Epidemiological Studies
Juleen Lam1, Nicholas Chartres2, Swati Rayasam2, Max Aung2, Chanese Forte2, Courtney Cooper2,
Hannah Vesterinen2, Tracey Woodruff2
1Department of Public Health, California State University, East Bay, Hayward, USA
2Department of OB/GYN and Reproductive Sciences, University of California, San Francisco, San

Francisco, USA; Program on Reproductive Health and the Environment, San Francisco, USA

BACKGROUND AND AIM:Decision-making to prevent harmful exposures relies on high-quality scientificevidence. Our objective was to overview the state of systematic reviews on traffic-related air pollution(TRAP) and human health effects and evaluate whether systematic reviews are being conductedfollowing best practices.
METHOD:We conducted a systematic search of the scientific literature until December 2022 in
PubMed, Embase, and Web of Science. Two independent screeners identified studies that: 1) selfidentified as a systematic review; 2) investigated traffic related air pollution exposures; 3) reported onhuman health outcomes. Data were extracted to categorize included references by study design andcharacteristics. The Policy From Science’s Literature Review Appraisal Toolkit (LRAT) was used toassess the credibility of each systematic review and provide an ultimate decision regarding the level ofconfidence in the overall conclusions of each review.
RESULTS:Our search retrieved over 2,000 studies and our screening identified 92 studies that met our
inclusion criteria. These studies were published between 2010-2022; the majority were self-reported
as being a systematic review (n=82), of which 43 also included a meta-analysis for quantitativesynthesis of data. Studies were heterogeneous in terms of population, exposure (14 unique chemicalcomponents), health outcome (11 different categories), and review methodology (5 named tools orlack of a structured assessment tool). The LRAT tool revealed that the quality of included studies was
generally poor. Almost all reviews performed unsatisfactorily on at least 5 of the 9 domains, inparticular the use of protocol (n=85), directness (n=64), methodological quality (n=40), andsynthesis of evidence (n=61).
CONCLUSIONS:Systematic reviews can contribute to understanding and improving scientificknowledge – however, all systematic reviews are not equal and does not automatically result in highquality reviews.

Keywords: Systematic review, quality assessment, air pollution, epidemiology

OP-224[Methods » Causal inference]

Implementation of the Negative Control
Exposure Method in Environmental
Epidemiology: A Simulation Study
Raanan Raz1, Tzach Ben Menachem1, Daniel Nevo2
1School of Public Health, The Hebrew University of Jerusalem
2Department of Statistics and Operations Research, Tel Aviv University

BACKGROUND AND AIM:Residual confounding is the primary barrier to causal inference inenvironmental epidemiology. Several methods have been developed to detect whether an observed
association is biased by residual confounding. One of these methods uses negative control exposures(NCE): alternative exposures that, under certain assumptions, indicate residual confounding. While theNCE method has seen a growth in use in recent years, it is unclear how the method is affected by the
relations among the different study variables and how to correctly select and implement an NCE thatwill have an optimal ability to detect residual confounding. This is a simulation study examining theseissues.
METHOD:We constructed three possible causal scenarios in epidemiological settings, represented indirected acyclic graphs, with varying degrees of residual confounding, linear causal effects, and effectstrengths among the main variables. We then applied the NCE method under varying conditions andtested its ability to detect residual confounding.
RESULTS:The ability of an NCE to detect residual confounding increases the stronger its association
with the unobserved confounder is relative to the association of the unobserved confounder with theexposure. This ability is further improved when the association of the unobserved confounder with theoutcome is also strong. In addition, a variable that is a common cause of the NCE and the exposure,but is not a confounder, can affect the performance of the NCE method due to a collider bias and due
to its effect on statistical power, requiring researchers to consider this possibility during the planningstage of the study.
CONCLUSIONS:The performance of the NCE method highly depends on the causal relations among thevariables and their relative strengths. Further research is needed to reveal the conditions in which
NCEs can be safely used and the most appropriate statistical tests, and to expand the simulations to
non-linear relations.

Keywords: Environmental epidemiology, ModelingOP-225[Policy » Research translation to affect policy and practice]

Co-production and evaluation of air pollution
interventions with school-age citizen scientists
Tiffany C Yang1, Mònica Ubalde Lopez2, Teumzghi Mebrahtu1, Cathy Knamiller1, Berta Franch
Martínez2, Ishfaq Vaja1, Mark Nieuwenhuijsen2, Rosemary R C McEachan1
1Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford,

United Kingdom
2Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

BACKGROUND AND AIM:School children are exposed to high levels of pollution during the school
journey but are typically not involved in the development of interventions to reduce their exposure.
We assessed patterns of pollution exposure on the school journey with pupil citizen scientists anddescribe the co-production of interventions to reduce exposure, their implementation, and evaluation.
METHOD:Two schools in urban areas were recruited at each study site (Bradford, United Kingdom;
Barcelona, Spain). Pupils (n=40) aged 9-11 years carried mobile sensors collecting particulate matter(PM), nitrogen dioxide (NO₂) and GPS data. Co-production workshops with pupils, teachers, parents,and local stakeholders were carried out to develop acceptable and feasible interventions to reduce
pollution. Interventions were implemented in June-July 2022 with pollution monitoring occurring one
week before and one week after implementation. Change in exposure levels (PM2.5, PM10, NO₂) were
examined using Generalized Linear Models separately for the morning and afternoon travel periods.
Focus groups and interviews with parents, children and teachers gathered views on intervention
acceptability and sustainability.
RESULTS:Personal monitoring found large variation in exposure between children with peaks during
school journeys. Co-production workshops identified alternate routes to school, walking buses,
informational campaigns, and additional monitoring as feasible interventions. No changes wereobserved in monitored pollutants from pre- to post-intervention in the morning (PM2.5 (μg/m3) –Bradford: 1.7 (95% CI: -1.0, 4.4); Barcelona: -1.6 (-5.6, 2.4)) or afternoon travel periods (Bradford:
0.8 (-4.1, 5.7); Barcelona: -2.1 (-4.9, 0.7)). Focus groups and interviews revealed a preference forstructural changes to reduce pollution rather than individual behaviors.
CONCLUSIONS:School communities are motivated to find ways to reduce exposures, but meaningful
reductions may require structural, in addition to individual behavior, changes.

Keywords: community outreach, air pollution, built environment, exposure assessment, children’s
environmental healthOP-226[Policy » Other (to be specified with keywords in the keywords section)]

Assessing the effect of the Akoben programmeon the environmental performance of mining
industries in Ghana: A case study Approach
Abigail Serwaa Akoto Bawua1, Richmond Owusu2
1Department of Biological, Environmental and Occupational Health Sciences, School of Public Health,

University of Ghana, Legon, Accra, Ghana.
2Department Health Policy and Planning and Management, School of Public Health, University of

Ghana, Legon, Accra, Ghana.

BACKGROUND AND AIM:The adverse impact of mining activities means human health could be at risk.
In effect, Ghana Environmental Protection Agency (EPA) make serious attempts to improve theenvironmental performance of mining and manufacturing companies to mitigate environmental
pollution, hence this study aim to evaluate the impact of Ghana's EPA Akoben programme, a rating
and disclosure tool which seeks to promote better environmental performance in the mining andmanufacturing industries by promoting transparency and accountability in Ghana.
METHOD:Using a case study approach, this study analysed the Akoben audit report card for a mining
company in Ghana over a four-years year period (2009-2012) based on seven- criteria – legal
requirements, hazardous on-site waste management, toxic emissions management, environmental
monitoring and reporting, best practice environmental management, complaint management, andcorporate social responsibility. Key stakeholders mainly the Ghana Chamber of Mines, EPA, and somemining companies’ perceptions on the programme's appropriateness were solicited
RESULTS:findings of the study revealed that the overall environmental performance for the four-year
period between 2009 and 2012 (2009 – 56.6%; 2010 – 65.6%; 2011 – 59.1%; 2012 – 61.4%) underreview was poor, with none criteria meeting the required minimum standards, except for legal
requirements and corporate social responsibilities. With the company's toxic and Non-toxic waste
emissions being significant concerns. Toxic parameters, such as Arsenic, and Cyanide, were exceeded.
The weaknesses of the programme were identified by stakeholders as inadequate publicity, lack oflegal support, insufficient incentives for outstanding performance and the stringent nature of the
programme.
CONCLUSIONS:Notwithstanding, the stakeholders acknowledge the fact that the Akoben programme
has improved the environmental performance of the mining companies because it puts theiroperations in check, although more can yet be achieved with regards to environmental sustainability
with this programme if adequate measures including legal backing are put in place to ensure its
continuity

Keywords: Environmental performance rating, Policy effectiveness, MiningOP-228[Policy » Research translation to affect policy and practice]

Management of waterborne diseases: anepidemiological approach for health policy
analysis
Malik Shahzad Azeem1, Malik Faisal Azeem2, Tahir Hayat3
1Department of Management Sciences, University of Gujrat, Pakistan
2Department of Management Sciences, COMSATS Institute of Information Technology, Faculty Block

2, Park Road, Islamabad, Pakistan
3Department of Environmental Sciences, COMSATS University Islamabad, Abbottabad Campus

Pakistan

BACKGROUND AND AIM:Pakistan faces a high burden of waterborne diseases, particularly diarrhea,
due to poor water quality and inadequate sanitation facilities. According to the World HealthOrganization (WHO), an estimated 16,500 children under the age of five die each year in Pakistan due
to diarrhea alone. Other waterborne diseases, such as malaria, gastroenteritis typhoid fever andhepatitis A, also remain prevalent in many parts of the country.
METHOD:We analyzed national health management policy from 2015 to 2020 in the context offinancial resource allocation, prevention of child exposure to unsafe drinking water, child mortality,
increasing access to healthcare, and promoting better hygiene practices. Primary and secondary data
were consulted to assess effectiveness of health policies.
RESULTS:Health sector's share of 0.42% in 2015 increased to 0.47% in 2020 of total federal budget
of Pakistan which is lowest in Southeast Asia. Child mortality rates have improved during this period(76 to 66 deaths per 1,000 live births) but are still high than many other countries. Survey of school
children from Abbottabad district reveals high Diarrheal incidence owing to drinking unpurified water(odds ratio= 2.3, 95% CI=1.28-3.89), using public tap water (odds ratio=3.16, 95% CI=1.82-5.48).
Large family size with poor income group attributed to overall high prevalence of waterborne diseases.
Local government in rural areas was unable to provide adequate sanitation facilities due to financial
constraints hence exposure to environmental fecal contamination remained unprecedented.
CONCLUSIONS:Policy implementation to raise public awareness is non-existent that promotes poor
hygiene practices, which, in turn, contribute to the spread of diseases. Progress in health systemmanagement has been slow between 2015 and 2018 due to a variety of factors, including limited
resources, political instability, and social and cultural barriers. However, in 2019 and 2020 there werestill considerable differences in waterborne diseases from rural to urban context.

Keywords: Children's environmental health, Epidemiology, Waterborne diseases, Water quality

OP-229[Air pollution » Other (to be specified with keywords in the keywords section)]

What are the air pollution co-benefits of Net
Zero in the UK?
Sean Beevers, Nosha Assareh, Gregor Stewart, Andrew Beddows, Tuan Vu, David Dajnak
Environmental Research Group - MRC Centre for Environment and Health, Imperial College London,UK

BACKGROUND AND AIM:The UK has committed to legally binding Net Zero (NZ) targets, setting up an
independent advisor, the Climate Change Committee (CCC), to assess current progress towards NZ
and to recommend future pathways to meet NZ by 2050.
The aim of this research was to combine UK Government 2030/40 emissions forecasts with the UK’s
CCC Balanced Net Zero and Widespread Innovation Pathways in 2030/40 and 50, and to understandthe air pollution co-benefits of domestic and vehicle emissions changes on exposure outdoors andindoors.
METHOD:We used European, UK National and Imperial’s vehicle emissions model forecasts between
2019 and 2030/40 and 50. The emissions were combined with the WRF met. and CMAQ-urban coupledmodel, providing outdoor hourly UK NOx, NO2, PM10, PM2.5 and O3 at 2km spatially, down to every
20m close to major roads as well as Imperial’s indoor air pollution model providing NO2 exposure
indoors.
RESULTS:PM2.5 concentrations in 2030 were below the WHO interim target of 10 ug m-3 for the vast
majority of the UK with significant reductions occurring in NO2. The widespread adoption of electricvehicles, whilst beneficial for tailpipe emissions increased non-exhaust emissions for tyre wear, roadsurface wear and resuspension, limiting future benefits for PM from these vehicles. Widespreadchanges to domestic heating and the removal of gas cookers in 2040 led to important reductions inPM2.5 and NO2 exposure indoors and outdoors.
CONCLUSIONS:We have shown the combined benefits of UK air quality policies and Net Zeropathways for PM2.5 and NO2 control. We identified important but uncertain emissions sources, suchas non-exhaust electric vehicle emissions, NOx from gas cooking and domestic wood burning.

Keywords: Particulate matter, Oxides of Nitrogen, Policy, Traffic-related, Built environmentOP-231[Built environment » Other (to be specified with keywords in the keywords section)]

Effect of home energy efficiency retrofit onindoor temperature and self-reported health:evaluation of Dublin’s ‘Warmth & Wellbeing’schemeJames Milner, Emma Hutchinson, Ben Armstrong, Paul Wilkinson
Department of Public Health, Environments and Society, London School of Hygiene & Tropical
Medicine, London, UK

BACKGROUND AND AIM:The Irish Government’s ‘Warmth & Wellbeing’ scheme, introduced in 2016,
installed energy efficiency measures in the homes of people with chronic respiratory conditions livingin parts of Dublin. We aimed to evaluate the impact of the scheme on health, wellbeing, social
participation and other outcomes.
METHOD:955 participants were enrolled in the research study. Pre- and post-intervention data on
general health, thermal comfort and aspects of psycho-social health were collected by Ireland's HealthService Executive (HSE) through a questionnaire and three survey instruments: EQ-5D, SGRQ and SF36. Data on monthly drug prescriptions were acquired through the Primary Care Reimbursement
Service (PCRS). A building survey was performed and, for a subset of homes, hourly internal
temperatures were monitored. We treated each measure separately and analysed before-after
differences using standard parametric methods.
RESULTS:545 participants (66.2% female, mean age 68.9 years) had pre-intervention data and at
least one post-intervention follow-up. The mean increase in standardised indoor winter temperature
was 1.29 °C. Participants reported improved thermal comfort, satisfaction with their ability to control
home temperature, ability to pay fuel bills and comfort inviting visitors to their home. Self-reported
health service contacts over the previous six months decreased for GP visits (before-after change: 1.10, 95%CI -0.75 to -1.44), respiratory emergency department visits (-0.13, -0.06 to -0.21) andrespiratory hospital admissions (-0.12, -0.06 to -0.18). There were improvements in physical, mental
and psycho-social health across most EQ-5D, SGRQ and SF-36 dimensions. For example, EQ-5D
summary score decreased by 5.36 (-2.68 to -8.04) and SGRQ total score by 11.70 (-10.31 to -13.08).
Monthly PCRS drug prescriptions also reduced.
CONCLUSIONS:Installation of home energy efficiency measures resulted in improvements in a rangeof measures of physical and mental health. Although the pathways to health cannot be elucidated, thebenefits appear to be substantial, at least in the short-term.

Keywords: Built Environment, Housing, Temperature, Health co-benefits, Respiratory outcomesOP-232[Exposures » Socio-economic factors (non-chemical stressors)]

Examining the utility of the Singapore Housing
Index in a Singaporean cross-sectional,
population-based elderly cohort
Jun Jie Lian1, Ecosse Luc Edouard Lamoureux2, Preeti Gupta2, Aurora Wing Dan Chan2, Ting Hway
Wong6, Daniel Yan Zheng Lim4, Marcus Eng Hock Ong3, Andrew Fu Wah Ho5
1Duke-NUS Medical School, Singapore, Singapore
2Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
3Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
4Health Services Research Unit, Medical Board, Singapore General Hospital, Singapore, Singapore
5Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
6Department of General Surgery, Singapore General Hospital, Singapore, Singapore

BACKGROUND AND AIM:To determine the utility of the Singapore Housing Index (SHI) as a proxy ofsocioeconomic status (SES) in a multi-ethnic population of elderly Singaporeans. The SHI wasdeveloped as an areal-level SES indicator, with advantages of overcoming limitations in collecting andhandling individual-level SES data.
METHOD:A SHI dataset, containing the SHI value for every residential postcode in Singapore, wasassembled using an open‐data query procedure previously developed. We included individuals fromThe PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans (PIONEER), a populationbased study of Singaporean Chinese, Malays, and Indians adults aged 60 years or older in Singapore.
Participants were deeply phenotyped on sociodemographic characteristics including: age, gender,
income, education, and housing. A merged dataset containing the SHI value for each participant was
analysed with spearman correlation against traditional markers of SES (income, education,
occupation, type of housing) as a monotonic relationship was assumed.
RESULTS:In 2,522 participants (mean age±SD 73.5±8.5; 55% female), the mode of SES variables
including income<S$1,000, completed secondary education, retiree and living in a 4-room public
housing was 40%, 37%, 60% and 30%, respectively. Mean SHI assigned to all participants was
4.10±1.23. Spearman’s rho [95% confidence interval] between variables showed SHI demonstrated
stronger monotonic relationship with income 0.40[0.35,0.44] than Education–Income 0.31[0.25,0.35]
or Occupation–Income 0.31[0.26,0.35], while matching the strength of Housing–
Income 0.42[0.38,0.47]. Similarly, associations were found in SHI–Education 0.35[0.31,0.39]
and Housing–Education 0.38[0.34,0.41]. All coefficients were statistically significant (p<0.05).
CONCLUSIONS:The SHI can serve as a straight-forward and reliable proxy for SES in Singapore simply
by obtaining a participant’s residential postcode. Understanding this association allows us to use the
SHI to account for SES in health studies and guide policy beyond medical and public health programs.
Future studies to explore the use of the SHI in a younger adult population will certainly be valuable.
Funding:Singapore National Medical Research Council((NMRC-CSA-SI#JRNMRR140601)

Keywords: socio-economic factors, epidemiology, policy, policy and practiceOP-233[Built environment » Other (to be specified with keywords in the keywords section)]

Identification of key predictors of severe
annoyance caused by railway induced vibrations
using machine learning: an external exposome
study
Jurriaan Hoekstra, Elise Van Kempen, Sendrick Simon, Arnaud Kok, Nick Mabjaia, Harm Van Wijnen,
Irene Van Kamp
National Institute for Public Health and the Environment, (RIVM, The Netherlands)

BACKGROUND AND AIM:Rail transport is considered to be a sustainable mode of transport. However,people living near a railway line are also exposed to noise and vibrations. While there is limited
knowledge about the effects of train noise, the health effects of exposure to train vibrations are largely
unknown. In addition, few studies have investigated what external factors influence these healtheffects. We performed an untargeted analysis using machine learning (ML) techniques to identify key
determinants of severe annoyance caused by train vibrations within an external exposome dataset
METHOD:In 2021, we administered a questionnaire among people aged 16 years and older living
within 300 meters of a railway track in The Netherlands. The questionnaire included questions aboutannoyance caused by railway induced vibrations and possible co-determinants of annoyance. The
survey was enriched with various assessments of railway vibration levels (using the Dutch railway
vibration calculation model)), noise levels and other environmental exposures such as NO2 and urban
green. The final dataset contained information on 5,611 persons and 70 different variables. Leastabsolute shrinkage and selection operator (LASSO) regression and random forest (RF) were used to
identify key predictors of annoyance. Individual contributions of vibration and noise were examinedusing accumulated local effect (ALE) plots.
RESULTS:In both LASSO and RF, annoyance by railway noise, concerns regarding structural damage
caused by railway vibrations and attitude towards rail transport were the strongest predictors ofannoyance. Factors related to vibration exposure were less predictive compared to these personal
predictors. The ALE plots show a non-linear relationship between vibration exposure and annoyance,and suggest interaction between distance, vibrations and noise levels.
CONCLUSIONS:This study shows that both personal factors and, to a lesser extent, environmental
stressors contribute to railway vibration annoyance. Furthermore, the novel application of LASSO and
RF techniques demonstrates the potential of ML in environmental studies.

Keywords: External exposome, Noise, Traffic-relatedOP-234[Built environment » Noise]

East vs. West, The Decibel Duel. A Comparative
Systematic Review of Noise Pollution Research
Sakshi Saraswat1, Wen Chi Pan2
1International Ph.D. Program in Environmental Science and Technology, University System of Taiwan;

Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung
University, Taipei, Taiwan
2Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan

BACKGROUND AND AIM:Environmental noise is a growing concern in urban areas across the globe,
impacting the health of millions of people. This systematic literature review aims to compare
researches conducted on environmental noise exposure in the East and West.
METHOD:The review followed PRISMA guidelines for selection of all research articles published in theyear 2022. Separate searches were conducted for the East and West using keywords for each region.
The search was conducted using Google Scholar, Web of Science, and PubMed databases. The articles
obtained from PubMed search were further evaluated for quality.
RESULTS:The systematic search resulted in 1200 and 1960 studies on Google Scholar, 18,908 and
14,114 studies on Web of Science, and 126 and 174 studies on PubMed for East and West respectively
with majority of studies from China, Japan, and South Korea in the East, and the United States andvarious European countries in the West. Studies conducted in the West generally had higher quality
with larger sample sizes, intricate methodologies, and meticulous findings as compared to the East.
Moreover, studies in the East primarily focused on community noise, while those in the West focusedon individual-specific noise.
CONCLUSIONS:These differences in the number and quality of studies between the East and West canbe attributed to differences in research funding, institutional support, and cultural attitudes towards
noise. The high number of studies from China may be due to the country's rapidly growing
urbanization, resulting in increased noise pollution. However, the lower quality of studies from theEast is concerning due to the region's large population and the significant public health concern ofenvironmental noise exposure. There is an urgent need for more high-quality research on noise
exposure in Asia to understand its effects and help policymakers take action to mitigate its negative
impact and improve public health outcomes.

Keywords: Environmental disparities, Public health, Environmental epidemiology

OP-235[Climate » Temperature]

Household analysis of health-related indoor
temperature exposure: comparison between
thermal comfort and health conditions in English
dwellings
Shih-Che Hsu1, Ian Hamilton1, Alison Moody2, Shaun Scholes2, Feifei Bu2, Cesar Messias De Oliveira2,
Tadj Oreszczyn1, Jenny Mindell2, Andrew Steptoe2
1UCL Energy Institute, University College London, London, United Kingdom
2UCL Institute of Epidemiology and Health Care, University College London, London, United Kingdom

BACKGROUND AND AIM:Excess deaths during winter and heatwaves have been observed in Englandand Wales. There were 13,400 additional deaths in winter 2021, and 3,271 extra deaths in summer
2022. Household temperature significantly impacts vulnerable individuals who spend extended periods
indoors. Previous research has identified housing factors that affect thermal comfort. This study aims
to investigate the differences in housing factors that impact thermal comfort and health conditions due
to exposure to high/low indoor temperature.
METHOD:This study focused on potentially vulnerable populations, particularly older adults. Twosources were analysed: (1) 2011 Energy Follow Up Survey (EFUS) collecting information on energyuse, indoor temperature and self-rated thermal comfort for 823 English households; (2) English
Longitudinal Study of Ageing (ELSA) providing information on health, social, wellbeing and economic
circumstances, and indoor temperature for 11,578 households of the English population aged 50 andolder. Linear regression and chi-square automatic interaction detection were used to explore therelationships between outdoor/indoor temperature, housing factors, and occupant thermal
comfort/health.
RESULTS:Energy performance determinants (e.g., building envelope, efficiency improvements, Energy
Performance Certificate) and household characteristics (e.g., age, income, tenure) affected indoor
temperatures. Under a similar location- and time-matched outdoor temperature, there was no
significant difference between the mean household indoor temperatures in EFUS (automaticallymeasured by temperature loggers) and in ELSA (manually measured by a trained nurse using aconsistent protocol and equipment). A link between high/low indoor temperature (above 24.6°C/under18°C) and self-rated thermal discomfort was found. However, thermal comfort was not significantly
associated with indicators of physical health, including self-rated general health and physiciandiagnosed conditions.
CONCLUSIONS:This research highlights energy efficiency improvements and fuel payment eligibility
may affect indoor temperature and occupant health. It is crucial to consider energy use practices andhousehold characteristics in housing energy policies to reduce energy use and improve the health ofolder occupants.

Keywords: English dwellings, Indoor temperature, Thermal comfort, Physical health, Older adults

OP-236[Exposures » Other (to be specified with keywords in the keywords section)]

Europe-wide road traffic noise modelling using aharmonized methodological framework(CNOSSOS-EU)
Youchen Shen1, Kees De Hoogh2, Oliver Schmitz3, John Gulliver4, Derek Karssenberg3, Roel
Vermeulen1, Gerard Hoek1
1Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Swiss Tropicaland Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
3Department of Physical Geography, Faculty of Geosciences, Utrecht University, Utrecht, theNetherlands
4Centre for Environmental Health and Sustainability, School of Geography, Geology and theEnvironment, University of Leicester, Leicester, UK

BACKGROUND AND AIM:Road traffic is the most pervasive source of noise in urban environments.
Strategic noise mapping in Europe only covers populations in large urban areas. The limited coverageof harmonised noise exposure data prevents us from studying the health effect of road traffic noise inlarger populations across Europe. Therefore, this study aims to develop models capturing variations inroad traffic noise exposures across Europe to facilitate pan-European multi-cohort studies. To estimate
noise, we used a simplified version of CNOSSOS-EU (Common NOise aSSessment MethOdS)
framework. The major challenge was to obtain all the input data required in the model at a European
scale.
METHOD:Firstly, we estimated Europe-wide annual average daily traffic (AADT) counts at the
OpenStreetMap (OSM) road network. We trained random forest models with traffic count observations
collected in six central and western European countries. The models were built separately for four roadtypes (highway, primary, secondary/tertiary and residential). Predictor variables included road-related
variables, LULC and population within different circular buffer (ranging 100m to 200km). A 5-foldcross-validation showed relative RMSE of 0.43, 0.5, 0.57, 0.87 and 0.92 (AADTs) for respectively
highway, primary, secondary, tertiary, and residential roads. Secondly, we approximated traffic speedwith the speed limit from OSM and legal speed limits for missing data. With these input data andbuilding geometries with an assigned default building height of 10m, road traffic noise was estimatedat noisiest building façades (i.e., points nearest to nearby roads) using CNOSSOS-EU.
RESULTS:Plausible noise levels were obtained in test runs (range 52.17 dB to 72.54 dB at 500 points
in Bristol, UK). We will compare our Europe-wide noise estimates with national noise model estimatesin the Netherlands, Switzerland, and Barcelona.
CONCLUSIONS:In conclusion, we developed the Europe-wide input data required for noise modelling.
Modelled noise will be used to study Europe-wide health effects of noise.

Keywords: Modeling, Traffic-relatedOP-238[Exposures » Environmental disparities]

Increasing exposures to compound wildfire
smoke and extreme heat hazards in California,
2011-2020
Caitlin Greer Jones1, Sara Ludwick2, Mohammad Al Hamdan3, Jason Vargo4, Erwan Monier2, Kathryn
C Conlon1
1Department of Public Health Sciences, University of California, Davis, Davis, USA
2Department of Land, Air, and Water Resources, University of California, Davis, Davis, USA
3National Center for Computational Hydroscience and Engineering, University of Mississippi,

University, USA
4Community Development, Federal Reserve Bank of San Francisco, San Francisco, USA

BACKGROUND AND AIM:Wildfire smoke and extreme heat hazards are inherently linked, yet thefrequency and distribution of exposure to compound events, i.e., co-occurring wildfire smoke andextreme heat, is not well understood. Shared climatic drivers are worsening these hazards and thethreat they pose to public health and safety; thus, there is a critical need to investigate exposure
risks. We examine compound hazard exposures to wildfire smoke and extreme heat from 2011-2020
in California to characterize populations at greater risk.
METHOD:We calculate population-weighted estimates of compound exposures within ZIP Code
Tabulation Areas (ZCTA) using (a) fine-resolution population estimates (1-km resolution), (b) daily
wildfire smoke-influenced fine particulate matter (wf-PM2.5; 3-km resolution) and, (c) maximum
temperature (4-km resolution), which were resampled to 1-km resolution to create populationweights, then aggregated to the ZCTA-level. We apply dichotomous exposure definitions for wf-PM2.5(presence/absence) and temperature (ZCTA and month-specific 95th percentile threshold) to countannual exposure days to wildfire smoke only, heat only, and compound wildfire smoke and heat (CHdays). CH days were classified if both exposures occurred within a 3-day exposure lag window, i.e.,each may occur up to three days prior to the measured day. The distribution of CH days was thenexamined statewide and by ZCTA community characteristics: income, education, race/ethnicity,urbanicity, housing.
RESULTS:Results are presented in maps to illustrate the distribution of compound hazard exposurechanges across 10 years. ZCTAs experienced differing degrees of exposure in each year, highlighting
both Northern and Southern regions. Nonetheless, recent years (2017 and 2020) showed increasing
exposures with the highest annual CH days. Additionally, we show community-level risk factors relate
to differential exposure to compound hazards.
CONCLUSIONS:This research presents a robust method to assess exposure risk to compound hazards,
as well as characterizing the worsening, yet unequal, threat of wildfire smoke and extreme heat
events.

Keywords: Wildfires, Temperature extremes, Exposure assessment methods, Environmental
disparities, Public HealthOP-239[Birth and pregnancy outcomes » Pregnancy outcomes]

Extreme Heat and Fertility Outcomes in Nigeria
Nina Brooks1, Cascade Tuholske2, Kathryn Mcmahon3, Kwaw Andam4
1Department of Public Policy, University of Connecticut, Hartford, Connecticut, USA
2Department of Earth Sciences, Montana State University, Bozeman, Montana, USA
3Department of Geography, University of California, Santa Barbara, Santa Barbara California, USA
4International Food Policy Research Institute, Nigeria Strategy Support Program, Abuja, Nigeria

BACKGROUND AND AIM:Nigeria has experienced an exponential growth in extreme humid-heat
exposure. Nigeria also has one of the highest fertility rates in the world. While nascent research has
explored the heat-fertility nexus, this relationship has yet to be studied with longitudinal, highresolution data across a country as geographically diverse as Nigeria. To fill this gap, we examine theheat-fertility nexus in Nigeria from 1983 – 2016 using a new, high-resolution daily climate record andsix waves of the Demographic and Health Survey (DHS).
METHOD:We spatially integrate six DHS waves with a new, high-resolution (5-km) dataset of daily
humid-heat extremes, defined as the number of days per year wet bulb globe temperatures exceed
30°C from 1983 – 2016. We map the effect of extreme humid-heat exposure on three individual-levelfertility outcomes – conception, termination, live birth. Next, we use a fixed-effect probit model tocompare extreme humid-heat effects across the three fertility outcomes.
RESULTS:On average, households experienced a 3-fold increase in annual extreme humid-heat
exposure from 1983 to 2016. Extreme humid-heat is correlated with average parity and exhibits aheterogenous geographic pattern across Nigeria’s strong climate gradient. While descriptive results
suggest that fertility outcomes vary by demographic characteristics, model results indicate that
extreme humid-heat exposure has a negligible effect on conceptions and births. In contrast, extreme
humid-heat exposure is significantly associated with a 0.01 percentage point increase in theprobability of experiencing a pregnancy termination. This effect implies a 16.1% increase interminations across the entire 30-year period.
CONCLUSIONS:Extreme humid-heat exposure has increased across Nigeria, but the effects may not
be impacting conceptions and births. However, it may be influencing terminations, suggesting that as
we continue to warm the climate, increased extreme humid-heat exposure may impact key aspects offertility patterns in Nigeria.

Keywords: extreme heat, climate change, fertility, maternal and child health, Africa

OP-240[Outcomes » Other (to be specified with keywords in the keywords section)]

Exploring the Link Between Temperature andSick Leave in Norway
Lin Ma1, Meizhu Chen2, Shilpa Rao3
1Center for International Climate Research (CICERO), Oslo, Norway
2Faculty of Medicine, University of Oslo, Oslo, Norway
3Norwegian Institute of Public Health (FHI), Oslo, Norway

BACKGROUND AND AIM:In this study, we aim to gauge the impact of temperature fluctuations on
productivity loss in Norway by examining the relationship between past temperature and sick leave.
METHOD:We conduct our analysis using a panel dataset in the year of 2018 for individual-locationspecific daily temperatures and sick leave records from a national registry in Norway based on the
Cohort of Norway (CONOR). A logistic regression model is utilized to estimate the relationship for
winter and summer periods.
RESULTS:Our findings suggest that temperature fluctuations had significant impacts on health andproductivity, and these effects varied depending on the season and personal characteristics. We findthat immediate temperature during the summer season did not have a statistically significant effect onsick leave, while a 14-day lagged temperature was found to have a small but significant positive
impact on sick leave likelihood. This finding reveals that heat temperature fluctuations have a delayed
impact on health and productivity. In contrast, short-term temperatures had significant and negative
effects on the probability of sick leave during the winter. Moreover, our analysis indicates that higher
education levels were associated with a lower probability of sick leave, possibly reflecting better
access to healthcare and healthier lifestyle choices among those with higher education levels.
Additionally, females had a higher probability of taking sick leave than males in both seasons of theyear, indicating gender differences in the perceptions or needs of sick leave. In this paper, we also
conducted sensitivity analyses to examine the robustness of the estimates.
CONCLUSIONS:Due to climate change, extreme temperatures are observed on a more frequent basis.
This paper provides insight into the potential productivity loss and economic impacts of moretemperature variability.

Keywords: temperature variability, temperature extremes, femaleOP-241[Climate » Temperature extremes and variability]

Attribution of extreme heat and heat-related
mortality events to climate change in Europe: anintegrated age- and sex-specific continental
analysis
Thessa M. Beck1, Lukas Gudmundsson3, Sonia I. Seneviratne3, Dominik Schumacher3, Hicham
Achebak4, Raul Méndez2, Joan Ballester2
1Barcelona Institute for Global Health, Barcelona, Spain; Universidad Pompeu Fabra, Barcelona, Spain
2Barcelona Institute for Global Health, Barcelona, Spain
3Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
4INSERM, Paris, France; Barcelona Institute for Global Health, Barcelona, Spain

BACKGROUND AND AIM:Extreme Event Attribution (EEA) aims to answer the question of whether andto what extent the intensity and likelihood of an observed extreme weather event have changed due
to climate change. In this study, we apply the EEA framework to estimate how the the probability ofdifferent extreme temperature and heat-related mortality events has changed from a pre-industrial
climate to present-day climate conditions (+1.2ºC warmer globally).
METHOD:In the first step, we apply a distributed lag non-linear model to estimate the association
between temperature and mortality counts. We use ERA5-Land temperature data and a mortality
database including 92.612.620 death counts from 823 contiguous regions spanning 35 European
countries and over 534 million people. We then separately fit a conditional extreme value distribution
to the annual maxima of temperatures and heat-related mortality counts. By shifting the location of
the distributions proportional to the global mean surface temperature, we calculate how the likelihoodof events with different return periods has changed under climate change.
RESULTS:We see a strong climate change signal in both the increased probabilities of extreme
temperature and heat-related mortality events. We find that the probability ratios differ between
temperature and heat-related mortality, highlighting the non-linear relation between heat andmortality, but also showing how health risks largely depend on socio-demographic factors. Amongthem, we analyse gender differences by stratifying by age and sex, and find a higher risk not only withage but also for women. The probability ratios differ largely among societies with the strongest climatechange contributions to heat-realated mortality detected in the Mediterranean.
CONCLUSIONS:This study demonstrates the use of epidemiological models in EEA studies, and opens
the door for further work, including rapid attribution studies, studies of other health impacts andextreme weather events, and the extension of the EEA framework to analyse sociodemographic
inequalities in adaptation.

Keywords: Climate, Environmental epidemiology, Mortality, Socio-Economic Factors, Temperature
Extremes

OP-242[Built environment » Green space]

Effect modification of greenness on PM2.5associated mortality in a multidrug-resistanttuberculosis cohort
Erjia Ge1, Jianhui Gao1, Xiaolin Wei1, Ying Peng2, Juan Lei3, Ming Luo4
1Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
2Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
3Institute of Ningxia Tuberculosis Control, The Fourth People's Hospital of Ningxia, Ningxia, China.
4School of Geography and Planning, Sun Yet-Sen University, Guangzhou, Guangdong

BACKGROUND AND AIM:Evidence for the association between fine particulate matter (PM2.5) andmortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollutionrelated mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely
unknown.
METHOD:2,305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis
until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index(NDVI) in the 500 m buffer of patient’s residence, annual average PM2.5 and estimated oxidant
capacity Ox were assigned to patients regarding their geocoded home addresses. Cox proportional
hazards regression models were used to estimate HRs per 10 μg/m3 exposure to PM2.5 and all-cause
mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates.
RESULTS:HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM2.5
associated with mortality for the full cohort and individuals with the greatest tertile of NDVI.
Exposures to PM2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432
to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from
Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM2.5-related mortality,
while greater greenness flattened the risk with HRs reduced in 0.188–0.194 on average.
CONCLUSIONS:Individuals with MDR-TB could benefit from greenness by having attenuatedassociations between PM2.5 and mortality. Improving greener space and air quality may contribute tolower the risk of mortality from TB/MDR-TB and other diseases.

Keywords: Air pollution, Green space, Environmental epidemiology, Long-term exposure, Mortality

OP-243[Built environment » Green space]

Health Impact Assessment of Greenness
Promotion on All-cause Mortality in 37 Chinese
CitiesTong Han1, Linyan Li2
1School of Data Science, City University of Hong Kong, Hong Kong SAR, China
2School of Data Science, City University of Hong Kong, Hong Kong SAR, China; Department of

Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong SAR, China

BACKGROUND AND AIM:Urban green space has the potential to improve population health in cities.
This health impact assessment study aimed to estimate the number of preventable deaths in 37 major
Chinese cities by implementing a targeted urban planning policy.
METHOD:The health impact of green spaces was assessed using two matrices as policy inputs: theNormalized Difference Vegetation Index (NDVI) and the percentage of Green Area (%GA). The
relationship between %GA (tree, shrub, and grass) and NDVI was assessed in the urban built-up areas(250m x 250m grids) of each city using generalized models. The health effect (preventable deaths) of
NDVI increase was calculated based on a meta-analysis, as well as the city’s population size andmortality rate. Further, The Chinese government's policy target of %GA at 42% was translated into atargeted NDVI for each city, and preventable deaths were calculated correspondingly under this policy.
RESULTS:In the 37 major Chinese cities, an increase of 0.1 in NDVI could have prevented 68,330
deaths (approximately 878 fewer deaths per 100,000 residents). Trees and grass are the main groupsof green space in built-up areas, and the proportion of vegetation species varies significantly
depending on the geographical location. 26 out of the 37 cities were able to establish a goodcorrelation between %GA and NDVI (adjusted R-squared > 0.2). A targeted 42% %GA could prevent
20,322 deaths (approximately 378 fewer deaths per 100,000 residents) in these cities.
CONCLUSIONS:This study provides a quantitative assessment of the benefits of green space, bridging
the gap between public health studies and urban planning matrices. The findings provide evidencebased support for policy makers to promote healthy and sustainable urban development.

Keywords: Policy, Mortality

OP-244[Neurologic and mental health outcomes » Mental health outcomes]

Urban greenness space and parental positive
and negative affect during pregnancy
Ming Lun Zou1, Chi Da Wu2, Hsing Jastmine Chao1, Wen Yi Lin3, Hsueh Wen Hsu1, Yi Hua Chen1
1School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
3Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical

University and National Health Research Institutes, Taipei, Taiwan.

BACKGROUND AND AIM:Maternal mental illnesses during pregnancy have been found to influencechild health. Although studies evidences suggested greenness space may beneficial to mental
illnesses, little is known about whether it is to enhance subject well-being to maintain mental health,especially for pregnant couples in urban area. The study aims to examine the association between
urban greenness and parental positive and negative affect at each trimester.
METHOD:Participants were selected from an ongoing cohort study: Longitudinal Examination acrossPrenatal and Postpartum Health in Taiwan. We analyzed the data between June 2017 and March
2020.Six items of self-report questions, three of positive (higher the score, the worse positive affect)
and three of negative affect (higher the score, the higher the negative affect), during each trimester
were assessed using the guidelines of the Joint Research Centre of the European Commission and theOECD. Urban greenness space was assessed using Normalized Difference Vegetation Index (NDVI)
within a designated radius (250, 500, 750, 1000, 1500, and 2000m) surrounding participants'
residences. Multiple regressions were used for examination the associations.
RESULTS:There were 330 pairs were enrolled in analysis. No matter positive and negative affect,
average of parental level of each trimester was similar. In the univariate model, NDVI shows beneficial
for parental positive and negative subject at midterm. After adjustment for other covariates, higher
NDVI within a 2000m buffer (β=-1.65 95% C.I.= (-2.49, -0.80) were beneficial for maternal positive
affect at the second trimester, while no other significant association were observed in other trimester.
Besides, no significant association was observed in paternal positive or negative affect in the final
model.
CONCLUSIONS:We found evidence that having more green space near the residence supported
maternal positive affect, highlighting the important role of urban green spaces in promoting maternal
mental health. This work was supported by National Science and Technology Council, Taiwan

Keywords: Green space, mental health, parents, subject well-beingOP-245[Climate » Other (to be specified with keywords in the keywords section)]

Pollen exposure and the risk of respiratory
emergency department visits among adults 65
and older in Michigan, Ohio, and Pennsylvania,
Peter S Larson1, Allison S Steiner2, Alan P Baptist3, Marie S O'neill4, Carina J Gronlund1
1Social Envrionment and Health, Institute of Social Research, University of Michigan, Ann Arbor, MI,USA
2Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI, USA
3Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, MI, USA
4Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA

BACKGROUND AND AIM:Climate change is increasing the length of intensity of seasonal patterns ofvarious species of aeroallergenic pollens. These pollens have been shown to exacerbate respiratory
disease symptoms of allergic rhinitis and asthma. However, the extent and nature of how short termlag exposures to pollens impact respiratory health events is not well understood. This research uses a
database of respiratory related emergency department visits in Medicare recipients age 65+ (N= 5.1
million visits) in 30 counties each in Michigan, Ohio and Pennsylvania and a prognostic, model basedraster of four classes of pollens to test and estimate associations of pollen exposure with symptomatic
respiratory disease.
METHOD:We regressed daily ED visit count by ZIP code on cumulative seasonal pollen concentration
counts for each evergreen, deciduous broadleaf, grass and ragweed pollen class including confounders
for precipitation and temperature. Models were Poisson regression models with daily population-at-risk
offsets within a distributed-lag-non-linear models with a 7-lag-day exposure history.
RESULTS:We found that one week cumulative exposure to >90th percentile of deciduous broadleaf
pollens was positively associated with increases in ED visits (RR 1.09 95\% CI(1.02, 1.16)). However,
we found no association for cumulative exposure to evergreen (RR 1.00 95\% CI(.95, 1.05)), grasspollens (RR 1.01 95\% CI(.95, 1.05)) and ragweed pollens (RR 1.03 95\% CI(.98, 1.08))
CONCLUSIONS:Cumulative exposure to deciduous broadleaf pollens, which appear in late Winter/early
Spring may increase risk for serious respiratory symptoms in elderly adults.

Keywords: climate, Respiratory outcomes, Air pollution, Environmental epidemiology, AllergiesOP-246[Neurologic and mental health outcomes » Mental health outcomes]

Impacts of greenspace on the relationshipbetween particulate matter exposure and mental
health related mortality in Detroit, Michigan,
U.S.A
Vivian H. Fong1, Peter S. Larson2
1College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
2Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

BACKGROUND AND AIM:Anthropogenic climate change impacts humans through increased exposure
to air pollutants, including particulate matter (PM2.5). Increased exposure to PM2.5 has been
associated with increased risk for depression and other mental health outcomes. However, greenspacesuch as public parks and tree cover could mitigate the most serious impacts of air pollution on mental
health. This research will explore how neighborhood greenspace can mitigate impacts of PM2.5
exposure and mental health related mortality using zip code level data from the post industrial Detroit,
MI, USA.
METHOD:To measure greenspace, we use a dataset of latitude and longitude locations of trees
collected from major cities in the United States. We count the number of trees within each zip codetabulation area (ZCTA) within the city limits of Detroit. From death records from the State of Michigan,
we count up all mental health related deaths within each ZCTA between 2006 and 2016. Finally, we
calculate mean PM2.5 exposure from a prognostic, model based raster of PM2.5 concentrations. We
regress PM2.5 exposure and the number of trees on mortality counts using Poisson regression models,
including the population of each ZCTA as an offset.
RESULTS:We found that tree cover varies by ZCTA, with tree count being positively associated withwhite race and ZCTA level median income. When controlling for median income, while we found apositive association of tree count with mental health related mortality, we also found that there were
small but statistically significant protective effects of tree counts against PM2.5 on mental healthrelated mortality.
CONCLUSIONS:Positive associations between greenspace and mental health related mortality could
reflect underlying racial disparities in the recording of mental health in vital records, but might also
reflect known disparities in the etiology of mental health between white and Black groups.

Keywords: Environmental justice, Air pollution, Particulate matter, Mental health outcomes, GreenspaceOP-247[Built environment » Green space]

Spatial distribution of greenness in Bangkok,
Thailand during 2018-2020: Ecological study
Wilaipak NilsalaiCollege of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

BACKGROUND AND AIM:Greenness has become an essential element for urban residents because ofits various contributions to citizens’ health and quality of life. Previous studies have conducted
greenness assessments; however, most were studied in developed countries. This study applied an
ecological analysis aimed to reveal the spatial distribution of greenness in Bangkok, Thailand, during
2018–2020, using the district as a unit of analysis.
METHOD:Greenness data during 2018–2020 was provided by NASA, and it was measured by a Terra
Moderate Resolution Imaging Spectroradiometer (Terra-MODIS) sensor with 250m x 250m spatial
resolution. The Normalized Difference Vegetation Index is a satellite-image-based vegetation index
that was used to estimate greenness in each district. MODIS NDVI images were collected withacquisition dates closer to the middle of the month. The ArcGIS program was used to extract NDVI
values and generate a greenness map. Finally, monthly greenness values were calculated to estimate
the annual average values of greenness in each district.
RESULTS:There are 50 districts in Bangkok, Thailand, and the results showed the greenness values in
2018, 2019, and 2020: the minimum was 0.14-0.22, 0.15-0.23, and 0.15-0.24; the maximum was
0.43-0.53, 0.45-0.56, and 0.45-0.55 respectively. From 2018 to 2020, the greenness values in
Bangkok’s East and West were higher; most are large districts that border other provinces, indicatingthat it is more rural than the urban area. Moreover, the greenness values were lower in the Central
areas of Bangkok from 2018-2020, which are the urban, economic, and densely populated areas of
Bangkok.
CONCLUSIONS:Greenness exposure may contribute to reducing health issues. It is recommended thatpolicymakers and communities increase environmental greenness to moderate the health burden.

Keywords: Green space, Exposure assessment, Spatial statistics, Built environmentOP-248[Air pollution » Particulate matter]

Association between long-term exposure toPM2.5 and mortality varied by serious
underlying disease in South Korea: national
health insurance cohort
Hyemin Jang1, Jinah Park1, Jeongmin Moon1, Aims Create Team3, Ho Kim1, Whanhee Lee2
1Graduate School of Public Health, Seoul National University
2School of Biomedical Convergence Engineering, Pusan National University
3AiMS-CREATE TeamBACKGROUND AND AIM:The association between exposure to PM₂.₅ and mortality is well established,however, fewer studies have investigated the risk of PM₂.₅ considering underlying disease in large
national cohorts due to the limitation of data. Therefore, this study aims to examine the association
between PM₂.₅ and mortality by serious underlying diseases in beneficiaries of the national healthinsurance cohort in South Korea, in order to better understand the specific health risks associated with
exposure to PM₂.₅.
METHOD:We constructed a longitudinal cohort for 2002 to 2019, including beneficiaries aged 48 to 80
years enrolled in 2002. The cohort was based on the National Insurance Service – National Sample
Cohort, which can be representative of the population in South Korea. Using the Charlson Comorbidity
Index criteria, we defined beneficiaries who were diagnosed with seven serious underlying diseases in2002 and 2003. We performed Cox proportional hazard models with time-varying exposures andconfounders.
RESULTS:We identified 52,318 cases of death among 212,912 individuals aged 50 years or older. For
each 5μg/m³ increase in annual PM₂.₅ concentrations, the hazard ratio (HR) for patients without
serious underlying disease was 1.023 [95% CI 1.017-1.029] and it was the lowest among other
underlying diseases. The highest HR was observed in beneficiaries with liver disease (1.046 [1.031 to
1.062]), renal disease (1.043 [0.996 to 1.092]), and peripheral vascular disease (1.040 [1.016 to
1.065]).
CONCLUSIONS:We estimated the mortality risk of long-term exposure to PM₂.₅ for each underlying
disease. Our results provide scientific evidence for the establishment of target-specific PM₂.₅
guidelines based on the medical histories of individuals.

Keywords: Particulate matter, Long-term exposure, Mortality

OP-249[Methods » Causal inference]

Interpretability – using causal modelingframeworks to investigate the association
between long-term exposure to nitrogen dioxide
and COVID-19 disease
Jiawei Zhang1, Thomas Scheike2, George Maria Napolitano1, Zorana Jovanovic Andersen1, Youn Hee
Lim1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Section of Biostatistic, Department of Public Health, University of Copenhagen, Copenhagen,Denmark

BACKGROUND AND AIM:The current evidence linking long-term exposure to air pollution andcoronavirus (COVID-19) disease is still sparse and inconsistent. Moreover, to enhance communication
with clinicians and policymakers, findings need to be more interpretable and related to potential policy
intervention. We aimed to examine the association between long-term exposure to nitrogen dioxide(NO₂) and COVID-19 hospitalization and mortality risk, and estimate the preventable cases underpolicy intervention.
METHOD:We followed residents aged 30 years or older in Denmark from March 1, 2020 until March 1,
2021. Annual mean concentration of NO2 in 2019 were estimated at each residence address by theDanish DEHM/UBM model. Risks were modelled through binomial regression with inverse probability
censoring weighting, to account for censoring. Then, risk differences were estimated undercounterfactual scenarios for low/high NO₂ exposure, dichotomized by 10 μg/m³ of World HealthOrganization Air Quality guideline (G-computation). In a further analysis, we estimated the excess risk
under the hypothetical scenario where the guideline would be met comparing with the current
exposure. The covariates and confounders, including sex, age, individual and area-level socioeconomic
status were considered in the model.
RESULTS:During the first year of COVID-19 pandemic in Denmark, 10,187 were hospitalized and2,442 died from COVID-19 out of 3,721,813 participants. During this period, we estimated an excess
risk [95% confidence interval] of 769 [640-898] COVID-19 hospitalization and 224 [160-288]
mortality per 1 million persons associated high NO₂ exposure. Furthermore, using counterfactual
analysis with linear NO₂ exposure, we further estimated that reaching the WHO guideline for NO₂
could avoid 1025 [848-1202] COVID-19 hospitalizations and 289 [205-373] deaths.
CONCLUSIONS:Long-term exposure to NO₂ contributes to a significant increase in the risk of COVID19 hospitalization and mortality in Denmark, and our results highlight a potential health benefit of air
pollution reduction in reduced COVID-19 hospitalization and mortality.

Keywords: Air pollution, COVID-19, Causal inference, Policy, Risk assessment

OP-250[Methods » Methodological study design]

Association between Long-Term Exposure to Air
Pollution and COVID-19 Mortality: Investigationof potential collider bias
Jiawei Zhang, Zorana Jovanovic Andersen, George Maria Napolitano, Youn Hee Lim
Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark

BACKGROUND AND AIM:Studies examining the link between exposure to air pollution and COVID-19
mortality, only including COVID-19 infected or hospitalized patients, can be subject to collider bias.
However, this potential bias has not been investigated in the recent literature on air pollution and
COVID-19. We aimed to investigate the association between long-term exposure to air pollution and
COVID-19 mortality among the general population, COVID-19 infected and hospitalized patients.
METHOD:We followed Danish residents aged ≥ 30 years old from March 1st 2020 until COVID-19
death or April 26th 2021, whichever came first. We assigned annual mean concentration levels to allparticipants based on their residential addresses in 2019: particulate matter with diameter ≤ 2.5 µm(PM2.5) and nitrogen dioxide (NO2) estimated by the Danish DEHM/UBM model. The associations
between exposure to air pollution and COVID-19 mortality were assessed in three baseline groups:
general population (n=3,721,813), and COVID-19 infected (n=138,742) and hospitalized (n=11,270)
patients. We used Cox regression models after adjusting for potential covariates.
RESULTS:Mean levels of air pollution were higher in COVID-19 infected or hospitalized patients (11.411.5/7.5 µg/m³ for NO2/PM2.5) compared to the general population (10.7/7.4 µg/m³ for NO2/PM2.5).
We detected greater associations of exposure to air pollution with COVID-19 mortality in the general
population compared to the COVID-19 infected and hospitalized patients. Hazard ratios (95%
confidence intervals) for the risk of COVID-19 mortality were 1.23 (1.04-1.44), 1.08 (0.93-1.26), and1.04 (0.87-1.24) per 0.55 µg/m3 increase in PM2.5 based on the general population and COVID-19
infected and hospitalized patients, respectively. A similar declining pattern of the associations was also
observed with exposure to NO2.
CONCLUSIONS:Our findings suggest that associations between long-term exposure to air pollution and
COVID-19 mortality is likely prone to be underestimated in patient-based cohorts due to potential
collider bias.

Keywords: Environmental epidemiology, Methodological study design, COVID-19, Air pollution

OP-251[Air pollution » Wildfires]

Health economic loss of mortality attributable towildfire-related PM2.5: a nationwide time series
study in Brazil
Yao Wu1, Shanshan Li1, Rongbin Xu1, Gongbo Chen1, Xu Yue2, Pei Yu1, Tingting Ye1, Bo Wen1,
Micheline De Sousa Zanotti Stagliorio Coêlho3, Paulo Hilario Nascimento Saldiva3
1Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash

University, Melbourne, VIC, Australia
2Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative

Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental
Science and Engineering, Nanjing University of Information Science and Technology, Nanjing, China
3Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

BACKGROUND AND AIM:Wildfire imposes a high mortality burden on Brazil. However, there is alimited assessment of the health economic losses attributable to wildfire-related fine particulate matter(PM2.5).
METHOD:We collected daily time-series data on all-cause, cardiovascular, and respiratory mortality
from 510 immediate regions in Brazil during 2000–2016. The chemical transport model GEOS-Chem
driven with Global Fire Emissions Database (GFED), in combination with ground monitored data andmachine learning was used to estimate wildfire-related PM2.5 data at a resolution of 0.25° × 0.25°. A
time-series design was applied in each immediate region to assess the association between economic
losses due to mortality and wildfire-related PM2.5 and the estimates were pooled at the national level
using a random-effect meta-analysis. We used a meta-regression model to explore the modification
effect of GDP and its sectors (agriculture, industry, and service) on economic losses.
RESULTS:During 2000–2016, a total of US$81.08 billion economic losses (US$5.07 billion per year)
due to mortality were attributable to wildfire-related PM2.5 in Brazil, accounting for 0.68% of
economic losses and equivalent to approximately 0.14% of Brazil’s GDP. The attributable fraction (AF)of economic losses due to wildfire-related PM2.5 was positively associated with the proportion of GDP
from agriculture, while negatively associated with the proportion of GDP from service.
CONCLUSIONS:Substantial economic losses due to mortality were associated with wildfires, which
could be influenced by the agriculture and services share of GDP per capita. Our estimates of theeconomic losses of mortality could be used to determine optimal levels of investment and resources tomitigate the adverse health impacts of wildfires.

Keywords: Mortality, Short-term exposure, Respiratory outcomes, Cardiovascular diseases.

OP-252[Air pollution » Particulate matter]

Improving Health by Mitigating the Air
Pollution? Mortality and Trends caused by
PM2.5 in the heavy-industrial areas in southern
TaiwanYu Hsiang Tsao1, Yu Hsiang Tsao2, Hui Min Hsieh1, Hui Min Hsieh2, Hui Min Hsieh3
1Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan2Department of Medical Research, Division of Biostatistics and Bioinformatic, Kaohsiung Medical

University Hospita, Kaohsiung, Taiwan
3Director of Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan

BACKGROUND AND AIM:Heavy industry produces many air pollutants during production, such as
airborne particulate matter (PM10 and PM2.5). Although the exposure concentration of air pollution
has decreased in recent years, it still exceeds the World Health Organization (WHO) standard.
Especially in Linyuan, where heavy industries gather in southern Taiwan, the concentration of PM2.5
exposures is more than 4 times the 2021 WHO standard. This study attempts to analyze the effect of
PM2.5 on mortality rates, and further compare areas with different levels of PM2.5 between heavy
industrial areas and general areas.
METHOD:A retrospective study design used Taiwan National Health Insurance Research Database andthe Taiwan Air Quality Monitoring Database from 2008 to 2019. The major outcome of interest was tocompare age-adjusted mortality by area. Through literature review, five air pollution-related causes ofdeath (all causes of death, malignant tumors, pneumonia, chronic lower respiratory diseases (CLRD),
and lung cancer) were selected. In addition to estimating the trends of PM2.5 exposure and specificdisease mortality, repeated measures were used to determine the time and regional impact of PM2.5
exposure and mortality.
RESULTS:Taiwan's PM2.5 exposure concentration has shown a downward trend since 2008. The
mortality of all causes of death, malignant tumors, pneumonia, and CLRD in males, and the mortalityof all causes of death, pneumonia, and CLRD in females decreased over time. Compared with Taiwan
in general, the heavy industrial area (Linyuan) presents a higher risk of death for both genders.
CONCLUSIONS:Our findings show that air pollution has indeed improved in Taiwan since 2008 andassociated risk of death decreased. The standardized death rate is higher in areas with higher air
pollution, especially in heavy industrial areas (Linyuan). Policy may need to continue improving air
quality to positive benefit in public health.

Keywords: PM2.5, age-adjusted mortality, Taiwan National Health Insurance Research Database(NHIRD), Air pollution

OP-253[Chemical exposures » Heavy metals]

Indoor particulate matter heavy metals and theirpotential health risks in low socio-economic
communities
Busisiwe Shezi1, Nkosana Jafta2, Rajen N Naidoo2
1Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South

Africa; Environment and Health Research Unit, South African Medical Research Council, Durban, South
Africa; Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa
2Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South

AfricaBACKGROUND AND AIM:There is growing evidence that, pollutants such as particulate matter andheavy metals are associated with significant health impacts. The aim of this study was to identify thepredictors and common sources of indoor PM2.5 heavy metals and evaluate the health risk to thechildren living in Durban.
METHOD:Thirty households belonging to mothers participating in the mother and child in theenvironment birth cohort study were selected for this study. Airmetrics MiniVol samplers loaded with
Teflon membrane filters were used for sampling airborne indoor PM2.5. A wavelength-dispersive x-ray
fluorescence technique was used to assess the amount of heavy metals in the filters. Contaminationlevels were evaluated using contamination factor (CF), enrichment factor (EF), and pollution load
index (PLI). Multivariate linear regression models were used to identify the predictors of indoor PM2.5
heavy metals. The common sources of PM2.5 heavy metals were identified using Pearson correlationand principal component analysis. The measured concentrations of metals were used to estimate thehealth risk for children.
RESULTS:According to CF, EF and PLI contamination exist in the assessed homes. Proximity toindustry, wall type, age of the house, presence of windows, and proximity to pollution generating
activities were associated with an increase in the levels of some indoor PM2.5 heavy metals. Cross
ventilation was associated with a reduction in indoor PM2.5 As and Cu levels. The use of Pearson
correlation and principal component analysis point to the potential roles of household characteristics,
traffic emissions, industries, and natural sources. The health index was >1, and the cancer risk valuesin PM2.5 As and Pb exceeded the maximum acceptable level of carcinogenic risk for humans.
CONCLUSIONS:This study highlights the potential contribution of heavy metals to indoor PM2.5
toxicity. To protect vulnerable groups from exposure to heavy metals, it is necessary to prevent
exposure to high-risk metals.

Keywords: Air pollution, Children's environmental healthOP-254[Chemical exposures » Heavy metals]

Assessment and mitigation of cadmium
exposure based on human bioavailability
Di ZhaoCollege of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing, Jiangsu

BACKGROUND AND AIM:Cadmium (Cd) is a ubiquitous environmental pollutant, posing a threat tohuman health. Health risks assessment of dietary Cd exposure is depended not only on total Cd
concentration, but also on Cd relative bioavailability.
METHOD:Rice samples collected from contaminated areas were analyzed for Cd concentration and Cd
relative bioavailability using an in vivo mouse bioassay. Measured urinary Cd for 119 nonsmokers withrice as the staple food was compared to predicted values from rice-Cd intake with and without
considering Cd relative bioavailability. Furthermore, the effects of mineral nutrients (Zn, Fe, and Ca)
on Cd relative bioavailability in rice based on an in vivo mouse bioassay model were evaluated.
RESULTS:In rice, Cd relative bioavailability varied from 16.9% to 57.4%. Predicted human urinary Cd(geometric mean: 4.14 μg/g creatinine) based on a toxicokinetic model using total Cd concentration inrice was 3.5-fold greater than the measured urinary Cd. While when rice Cd relative bioavailability wasincorporated, predicted urinary Cd agreed well with the measured urinary Cd (1.07 vs 1.20 μg/g
creatinine), highlighting the importance of bioavailability in accurately estimating human Cd exposureand related health risks. Evidence based on mouse bioassay showed that increased dietary levels of Fe
and Ca effectively reduced Cd exposure by decreasing Cd-RBA in rice, thereby reducing Cd
accumulation in humans via rice intake.
CONCLUSIONS:This research will provide valuable information on accurately assessing the health risk
in humans and developing effective dietary strategies to reduce Cd exposure and its associated healthrisks.

Keywords: Metals, risk assessment, food/nutrition, biomarkers of exposureOP-255[Chemical exposures » Mixtures]

Urinary metal mixtures and their association
with renal function: A cross-sectional study in
MexicoElodia Rojas Lima1, Mara Medeiros2, Manolo Ortega Romero2, Juan Carlos Rubio Gutiérrez1, Mariela
Esparza García2, Juana Narvaez Morales1, Juan Alfredo Tamayo Y Orozco4, Miguel Angel Mejía4, Pablo
Méndez Hernández3, Olivier Barbier1
1Departamento de Toxicología, Centro de Investigación y Estudios Avanzados del Instituto Politécnico

Nacional, Ciudad de México, México
2Hospital Infantil de México Federico Gómez, Ciudad de México, México
3Secretaría de Salud de Tlaxcala, Tlaxcala de Xicohténcatl, México
4Accesalud S.A. de C.V., Ciudad de México, México

BACKGROUND AND AIM:Epidemiological and experimental studies have established that individual
metal exposure, such as arsenic, lead, mercury, and cadmium, can cause kidney damage, resulting inalterations at molecular, structural, and function levels. However, these exposures occur jointly in realcontexts, and their effect on renal function has been incipiently studied. Tlaxcala is a Mexican entitythat presents a high incidence of chronic kidney disease in the young population without traditionalrisk factors. Therefore, studying the possible environmental causes of kidney disease development ispertinent. This work aims to associate urinary metal mixtures with renal function markers inadolescents from Tlaxcala.
METHOD:A cross-sectional study was carried out, including 914 healthy adolescents. The urinary
concentrations of aluminum (Al), vanadium(V), manganese (Mn), copper (Cu), zinc (Zn), arsenic (As),selenium (Se), strontium (Sr), molybdenum (Mo) tin (Sn), lead (Pb), lithium (Li), nickel (Ni), iodine(I), and barium (Ba), were determined by inductively coupled plasma mass spectrometry (ICP-MS)and corrected for urinary density. Renal function markers were glomerular filtration rate (eGFR
mL/min/1.73m2) and albumin/creatinine ratio (ACR) with the following cut-off points: <30 and ≥30
mg/g -creatinine. The mixtures' effect on renal function markers was evaluated using Weighted
Quantile Sum regression (WQS) adjusted by confounders.
RESULTS:The average age of the study population was 13±1.6 years, and 55% were women. The
median eGFR was 103.7mL/min/1.73m2(p25-p75:92.04-121.52), and 18% of subjects presented
proteinuria. Two urinary metal mixtures with opposite associations with log-eGFR were found: [V, I,
Sn, Al, Pb, and Sr; β:0.037, p-value<0.001] and [Mn, Cu, Se, Ni; β:-0.026, p-value=0.036].
CONCLUSIONS:Our study provides evidence that the metal mixture's effects on renal function inapparently healthy adolescents were associated with increased and decreased glomerular filtration
rates. Mixture analysis approximates exposure to multiple contaminants, their possible metabolic
interactions, and possible mechanisms of kidney damage.

Keywords: Mixtures, biomarkers of exposure, Multi-pollutant, Heavy metals.

OP-256[Other » Other (to be specified with keywords in the keywords section)]

Exposure to uranium and its decay products is
associated with plasma metabolome of people
living near former uranium processing site
Vrinda Kalia1, Susan M. Pinney2, Promita Bose1, Saurabh Dubey3, Hanisha Udhani3, Renu
Nandakumar3, Changchun Xie2, Jeanette M. Buckholz2, Gary W. Miller1, Andrea A. Baccarelli1, Hui
Chen Wu1, Diddier Prada4
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York City, USA
2Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH,USA
3Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, Columbia

University Irving Medical Center, Columbia University, New York City, USA
4Department of Basic Science, Instituto Nacional de Cancerología – Mexico, Mexico City, Mexico

BACKGROUND AND AIM:There is an urgent need for bioassays that provide biodosimetric assessmentof low-dose radiation exposure and their associated health effects. In this study, we determinedcirculating metabolic features associated with low-dose radiation exposure, emitted from uranium andits decay product, radon, in people living in the vicinity of a former uranium processing site.
METHOD:The Fernald Community Cohort (FCC) was created to study the effects of uranium and radon
exposure among people who lived in the vicinity of a uranium processing site at Fernald (nearCincinnati), Ohio. The Fernald Dosimetry Reconstruction Project (FDRP) estimated exposure touranium, released from the plant during production, and radon, from two large silos, using dosimetry
algorithms. Untargeted plasma metabolomic profiles were generated using liquid chromatography
coupled to a Thermo Orbitrap HFX mass spectrometer at the Columbia Exposomics Core. We studied
the relationship between estimated uranium and radon exposure and circulating metabolites among
40 male participants of the FCC. We used unsupervised dimensionality reduction to find linear
combinations of metabolites associated with radiation exposure, adjusted for age.
RESULTS:The mean (standard deviation) age of participants was 59.8 (2.5) years. We generated
principal components (PCs) using metabolomic data and tested their association with uranium andradon exposure. PC7 was significantly associated with exposure and explained 3% of variance in themetabolomic data. The metabolic features with the highest absolute loadings on PC7 enriched
glycerophospholipid, glycine, serine, and threonine, and alpha-linolenic acid metabolic pathways aswell as pantothenate and CoA, and aminoacyl-tRNA biosynthesis pathways.
CONCLUSIONS:To our knowledge, this is the first population study exploring the metabolic response
to low-dose radiation exposure. Our results show a metabolic response to radiation consistent witheffects reported in toxicological studies using rodent models and cell lines, which may contribute toadverse human health effects.

Keywords: radiation, uranium, radon, metabolome, population studies.

OP-257[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Risks of exposure to benzotriazoles: fromgenotoxicity to human liver stem cells to
exposure levels in Czech male population
Nina Pálešová, Katarína Řiháčková, Lucie Bláhová, Anežka Sharma, Pavel ČuprRECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic

BACKGROUND AND AIM:Benzotriazoles (BTRs), mostly used as corrosion inhibitors, have beenclassified as high-production-volume chemicals of emerging concern due to wide distribution in theenvironment (including human tissues) and significant toxicological data gaps. This study aims toevaluate genotoxic effects of BTRs on human liver stem cells and assess the exposure levels in Czech
male population.
METHOD:HL1-hT1 cells were used for Comet assay to assess genotoxicity of 5 frequently usedbenzotriazoles – 1H-benzotriazole (BTR), 1-methyl-1H-benzotriazole (1M-BTR), 4-methyl-1Hbenzotriazole (4M-BTR), 5-methyl-1H-benzotriazole (5M-BTR) and 4-hydroxybenzotriazole (4OH-BTR).
No-observed-adverse-effect-level (NOAEL) was derived from the results. Furthermore, a liquid
chromatography-electrospray ionization tandem mass spectrometry (LC-ESI(+)MS/MS) method for
determination of BTRs in human urine have been developed. 165 male urine samples were analysed
and the levels in blood were determined by toxicokinetic modelling based on renal clearance.
RESULTS:Significant increase in DNA damage induced by 1H-BTR, 4M-BTR, and 4OH-BTR was
detected at the concentration 17 ng.mL-1 and higher, with derived NOAEL of 1.7 ng.mL-1. Detection
frequency (DF) was highest for 1M-BTR (76.9%) and 1H-BTR (66.7%) with medians 1.79 and 0.24
ng.mL-1, respectively. Other compounds had DF lower than 17%. The sum of 5 BTRs in human urine
ranged from <LOD to 47.6 ng.mL-1. The estimated 1H-BTR blood concentrations ranged from <LOD
up to 0.84 ng.mL-1.
CONCLUSIONS:In this study, benzotriazoles were tested for genotoxic effects on human cells, to thebest of our knowledge, for the first time. The results point to potential genotoxic effects at
environmentally relevant concentrations and provide the ground for future human health risk
assessment. More toxicokinetic and human biomonitoring studies focusing on benzotriazoles are
warranted.
This project received funding from the EU´s Horizon 2020 N°857340 and the research council of
Norway (N°ES577371) and was supported by RECETOX RI (No°LM2018121), CETOCOEN EXCELLENCE(No°CZ.02.1.01/0.0/0.0/17_043/0009632) and CETOCOEN Plus
(No°CZ.02.1.01/0.0/0.0/15_003/0000469).

Keywords: Toxicology, Exposure assessment, Outcomes, Risk assessment,

OP-258[Exposure assessment methods » Exposure assessment-biomarkers of exposure]

Saliva and Urine Sampling to Quantify Trace
Metal Exposure for Epidemiologic Studies
Shelbie D. Stahr1, Edgar T. Ellis2, Lora J. Rogers3, Huyen Vi Do2, Tamier L. Wells4, Ping-Ching Hsu1,
L. Joseph Su5
1Environmental Health Sciences, College of Public Health, University of Arkansas for Medical Sciences,

Little Rock, US
2Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, US
3Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for

Medical Sciences, Little Rock, US
4Health Behavior & Health Education, College of Public Health, University of Arkansas for Medical

Sciences, Little Rock, US
5School of Public Health, UT Southwestern Medical Center, Dallas, US

BACKGROUND AND AIM:Urine is a common biospecimen used for trace metal analysis in
epidemiological studies, but the results of measurement vary depending on the timing of sample
collection and adjustment methods used. Saliva is a natural filtrate of blood that consist of leukocytes
and endothelial cells, contains small molecules, trace metals, proteins, and DNA, making it ideal for
epidemiological studies on individual's exposome. This study aims to examine results from spot urine
collection versus 24-hour urine collection, to determine the efficacy of saliva versus urine sampling for
trace metal analysis.
METHOD:Two pilot experiments were conducted: Experiment 1 (n=10) tested the efficacy of spot
versus 24-hour urine collection, while Experiment 2 (n=100) tested the efficacy of spot urine versus
saliva sampling to quantify arsenic and cadmium. Both studies quantified heavy metals using theinductively coupled plasma mass spectrometry (iCAP RQ ICP-MS, Thermofisher).
RESULTS:Experiment 1 found significant positive correlations between spot and 24-hour urine
collections for arsenic [Specific Gravity (SG) adjusted; r=0.998] and cadmium (SG adjusted; r=0.97).
A non-significant decreasing trend were observed among spot samples throughout the day,particularly after the first spot urine samples. Experiment 2 found significant differences among urine
adjustment methods depending on population demographics. While saliva concentrations aresubstantially lower than urine concentrations, Pearson correlations observed a significant positivecoefficient among arsenic [Creatinine/Specific Gravity (CR/SG) adjusted; r=0.66], but not cadmium.
Weighted kappa correlations observed significant agreement between arsenic tertiles (CR/SG
adjusted; κ=0.415).
CONCLUSIONS:Although the trace metal measurements varied throughout the day, the results of spot
samples are comparable to 24-hour urine samples when measuring arsenic and cadmium
concentrations. Further, in comparison to urine, saliva sampling is a reasonable method to determine
the variation of arsenic for epidemiological studies. Similar correlations did not exist in cadmium
between urine and saliva samples.

Keywords: Epidemiology, Heavy metals, Environmental epidemiology, Biomarkers of exposure,
ExposuresOP-259[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Association of prenatal and childhood exposure
to benzophenones and neurobehavioral
development in children
Boopathi Subramani1, Yuan Xuan Lin1, Chia Hung Chang2, Yu Fang Huang1, Ming Song Tsai3, Jia Woei
Hou4, Pei Wei Wang5, Chih Yao Chen6, Chia Jung Hsieh7, Ming Tsang Wu8, Shu Li Wang9, Mei Lien
Chen1
1Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung

University, Taipei, Taiwan
2School of Public Health, Taipei Medical University, Taipei, Taiwan & Ph.D. Program in Global Healthand Health Security, Taipei Medical University, Taipei, Taiwan
3Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
4Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
5Department of Pediatrics, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
6Division of Obstetrics and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Taipei

Veterans General Hospital, Taipei, Taiwan
7Department of Public Health, Tzu Chi University, Hualien, Taiwan
8Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan9Division of Environmental Health & Occupational Medicine, National Health Research Institutes,

Miaoli, Taiwan

BACKGROUND AND AIM:Benzophenones (BPs) are used as UV filters and photoinitiators to be added
to various products, such as cosmetics, printing inks, etc. The daily usage of such products increases
exposure to BPs, including pregnant women and children. This study aims to determine the exposureof various BPs in the urine of pregnant women and their children and to investigate the correlation
between prenatal and childhood BPs exposure and neurobehavioral development in children.
METHOD:This study collected urine samples from 796 pregnant women and 364 children aged 2 to 6
from four regions of Taiwan (TMICs), and levels of various BPs were detected and quantified using
UHPLC-MS/MS. The neurobehavioral development was evaluated using the Wechsler Preschool andPrimary Scale of Intelligence (WPPSI–IV), and information on socio-demographics was collected
through a questionnaire.
RESULTS:Prenatal geometric mean (GM) concentrations of BP, BP-1, BP-3, BP-8, and 4-OHBP in the
796 Taiwanese pregnant women, corrected for creatinine, were 4.96 μg/g Cr, 0.05 μg/g Cr, 0.03μg/g
Cr, <LOD μg/g Cr, and 0.002 μg/g Cr, respectively. The GM concentrations of BP, BP-1, BP-3, BP-8,
and 4-OHBP in the 364 children, corrected for creatinine, were 4.03 μg/g Cr, 0.05 μg/g Cr, 0.008 μg/g
Cr, <LOD μg/g Cr, and 0.001 μg/g Cr, respectively. BP-2 and BP-4 were not detected. Prenatal BP and
BP-3 exposures were negatively correlated with almost all WPPSI-IV scale index scores, and prenatal
BP exposures approached a significant negative correlation with children's FRI (Fluid Reasoning Index)
scores, whereas exposure to BP in children approached a significant negative correlation with PSI(Processing Speed Index) scores.

CONCLUSIONS:The BPs exposure patterns of pregnant women and children in Taiwan differ greatly
from those of other countries. Further studies will be required to identify the sources of BPs exposureand the effects of prenatal and children's BPs exposure on neurobehavioral development.

Keywords: endocrine disrupting chemicals, exposure assessment, neurodevelopmental outcome

OP-260[Chemical exposures » Heavy metals]

The Association of Children’s Blood Lead Levels
and Prevalence of Stunting in Tin Mining Area inIndonesia
Budi Haryanto, Zarmawi Rismarini
Department of Environmental, Faculty of Public Health, Universitas Indonesia

BACKGROUND AND AIM:Metal mining and smelting activities are regarded as major sources of heavy
metals such as lead, mercury, arsenic and cadmium in the environment and humans living at
surrounding area. Among others, lead can enter and accumulate in the human body and very
influential in children's growth and development. This study aims to assess the association between
children’s blood lead levels and stunting in a mining area in Indonesia
METHOD:A cross-sectional design was implemented by involving 193 children living surrounding Tin
Mining in Bangka Island, Indonesia. Venous blood was drawn, and blood lead level was measured by
Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Stunting status was measured byanthropometry standing height and converted to sex- and age-specific Z-scores based on World
Health Organization (WHO) growth reference. Children’s dietary was assessed using 24-hour dietary
recall method. Statistics of chi-square test and multiple-logistic regression were performed for the
analyses
RESULTS:The geometric mean of Blood Lead Levels (BLLs) was 5.5 microgram/dl (± 2.6 µg/dl; 95%
CI: 5.1 - 5.9). The interquartile range of BLLs and height for age Z-score (HAZ) were 3.0
microgram/dl and -1.5, respectively. The data revealed that 23.3% children were stunted (HAZ < -2).
The multiple logistic regression models suggest that elevated BLLs was an independent predictor of
the stunting. The odds stunted if blood lead concentration elevated was about ten times higher[adjusted odd ration (AOR) = 9.75 (95% Confidence interval (CI): 3.1 – 30.7); p<0.001] incomparison to the odds of normal BLLs. The BLLs of children at age 2 - 9 years were found associatedwith stunting after controlling of mother’s education, residence, and the intake of energy, protein,zinc, vitamin A, calcium, and phosphorus
CONCLUSIONS:The study suggested that living at surrounding Tin Mining was dangerous for children
health and their development

Keywords: Children, Blood Lead Levels, Stunting, Tin MiningOP-261[Climate » Temperature extremes and variability]

Understanding Pediatric Susceptibility AcrossTemperature and Environment in New York(UPStATE NY)
Jane E Clougherty1, Ellen J Kinnee2, Rachit Sharma1, Lisa Frueh1, Leah H Schinasi1, Allan Just3, PerryE Sheffield3
1Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
2University Center for Social and Urban Research (UCSUR), University of Pittsburgh, Pittsburgh, PA,USA
3Icahn School of Medicine at Mount Sinai, New York, NY, USA

BACKGROUND AND AIM:This project will identify community stressors and assets that shape
relationships between climate-related exposures [heat, ozone (O3), fine particulate matter (PM2.5)]
and child health, across the urban-rural gradient. Communities with high social stressors (e.g.,poverty) also have health-promoting assets (e.g., greenspace), which may be utilized or enhance toimprove child health and resilience.
METHOD:We are working with statewide partners - the Pediatric Environmental Health Specialty Units(PEHSU), Children’s Environmental Health Centers (NYSCHECK) network, and community andgovernment partners – to identify stressors and assets which may buffer child health impacts, underclimate scenarios. Candidate assets are identified following the Resilience Activation Framework(aspects of human, economic, social, political, environmental capital), and the NYS DEC Climate
Justice Working Group.
We use complete data on emergency department visits and hospitalizations for 2005-19 from theStatewide Planning and Research Cooperative System (SPARCS) (~7 million cases), for children aged
0-17. We have generated fine-scale estimates for heat, O3, and PM2.5, and are examining exposurehealth relationships using case-crossover and other methods (e.g., structural equations models).
Finally, we will apply climate projections to estimate future impacts, and integrate findings into local
and state climate adaptation and pediatric clinical initiatives.
RESULTS:Preliminary results suggest that a 10-deg F increase in Tmin conferred increased risk of
hospitalization on case day (1.14% excess risk, 95% CI: 0.91, 1.37),) after adjustment for case-day
PM2.5, with stronger associations among children aged 0-4 or 14-17, in urban areas, and in EJ areas.
We also observe positive associations for PM2.5 and epilepsy/ seizure risk, among children aged 2-4
years, in NYC, with possible weaker relationships in high-crime neighborhoods.
CONCLUSIONS:We will identify stressors and assets which exacerbate or buffer climate impacts on
health across a diverse state, and provide guidance to partners on targeted investments in EJ
communities which may alleviate climate impacts on health.

Keywords: particulate matter, ozone, temperature, socio-economic factors (non-chemical stressors),
children's environmental healthOP-262[Birth and pregnancy outcomes » Birth outcomes]

Environmental risk factors associated with birthdefects in a war-zone in Iraq
Jeffrie Quarsie1, Jenny Deng1, Samira Alaani2, Dick Heederik1
1Institute of Risk Assessment Sciences, University of Utrecht, Utrecht, the Netherlands
2Fallujah Children's Hospital, Fallujah, Iraq

BACKGROUND AND AIM:Ever since the war started in 2003, Iraqi doctors have reported an increase in
the birth of children with congenital anomalies. According to them, the rise in incidence could be
attributed to war-related exposure e.g. from mercury, depleted uranium, lead and arsenic. As the war
impeded research, the current post-conflict situation has given space for research. The aim of thepresent study is to assess to what extent exposure to environmental pollution might be associatedwith the incidence of congenital anomalies in Iraq.
METHOD:: A case-control study was conducted in Fallujah, a heavily bombarded city, comparing 50
parents of children with birth defects and 50 parents of children without birth defects. We used aquestionnaire to comprehensively document environmental exposure and history of residence of eachcouple. Further, we complemented the interviews with biomonitoring through hair analysis of parents
on heavy metals using ICP-MS. In addition, we took soil samples of the city of Fallujah using grid
sampling and compared this to a control city in northern Iraq which has been less bombarded. We
used R to statistically assess the differences in case and control groups regarding exposure and heavy
metal concentrations, correcting for confounders like age and socio-economic status.
RESULTS:Our results point towards a relation between congenital anomalies and the occupation offathers. Fathers of children with birth defects are more often construction workers, working on houses
often damaged or levelled by war. In addition, analyses also show that mothers of children withcongenital anomalies more often experienced bombing compared to mother of healthy children.
CONCLUSIONS:Having a child with a congenital anomaly in Iraq seems associated with indicators ofpaternal and maternal environmental exposure.

Keywords: Heavy metals, Exposome, Neurodevelopmental outcomes, Children's environmental
health, Environmental justiceOP-263[Birth and pregnancy outcomes » Birth outcomes]

Associations Between Gestational
Environmental Phenols and Preterm Birth in a
Diverse Population; a Prospective Study of
Racial Disparities
Michael S Bloom1, Meghana Varde1, Roy R Gerona2, Victor Y Fujimoto2, Roger B Newman3
1Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
2Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San

Francisco, San Francisco, California, USA
3Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South

Carolina, USA

BACKGROUND AND AIM:Studies report associations between gestational exposure to environmental
phenols (EPs) and preterm birth (PTB), which may vary by maternal race. We conducted a prospective
investigation to investigate racial disparities
METHOD:We enrolled n=299 mothers with a pregnancy, n=27 with PTB; n=139 self-identified asBlack and n=160 self-identified as non-Black. We determined urinary levels of methyl- (MP), ethyl-,
propyl-, and butyl parabens, benzophenones 1 (BZP-1) and 3 (BZP-3), pentachlorophenol (PCP),
triclosan, and bisphenols A and S (BPS), in urine specimens collected between 18-22 gestational
weeks, using liquid chromatography-tandem mass spectrometry. We used logistic regression toestimate associations between individual EPs and PTB, log transformed and scaled to the interquartile
range, adjusting for specific gravity, maternal age, race, BMI, education, and infant sex. We estimatedthe association between PTB and co-exposure to the mixture of 10 urinary EPs using Bayesian kernel
machine regression (BKMR).
RESULTS:Greater BZP-1 (OR: 0.65; 95%CI: 0.39, 1.09) and BPS (OR: 0.09; 95%CI: 0.03, 0.25) wereassociated with lesser odds of PTB, whereas PCP measured above the detection limit was associatedwith greater odds of PTB (OR: 12.41; 95%CI: 4.31, 36.46). Maternal race interacted with MP(P=0.092) and PCP (P=0.055), such that there were stronger inverse and positive association for MP
and PTB, respectively, among the Black than the non-Black racial grouping. Using BKMR the
association was non-linear; the greatest PTB risk was for the 60th %ile relative to the 50th %ile of the
EP mixture distribution, adjusted for covariates. BZP-3, BPS, and PCP were the most important
mixture components.
CONCLUSIONS:Gestational urinary BZP-1, BPS, and PCP associated with PTB and associations
diverged by race for MP and PCP. There was a non-linear association for PTB with the mixture of 10
gestational urinary EPs. Our results suggest that select EPs are associated with PTB and may be
modified by maternal race.

Keywords: Phenols, Environmental disparities, Mixtures

OP-264[Policy » Research translation to affect policy and practice]

Prioritizing interventions to reduce children’s
exposure to urban exposures: a Delphi study
Tiffany C Yang1, Olivia Sharp1, Mònica Ubalde-Lopez2, Amanda Fernandes2, Rodney Ortiz2, Julianna
Angelova3, Génon Jensen3, Rosemary R C McEachan1
1Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford,

United Kingdom
2Barcelona Institute for Global Health-ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
3Health and Environment Alliance (HEAL), Brussels, Belgium

BACKGROUND AND AIM:Urban exposures such as air pollution have been shown to negatively impact
health with young people especially vulnerable. Interventions to reduce harmful exposures in theurban environment are likely to improve health but there is little evidence of the types of interventions
which may be most effective and whether they would be acceptable and feasible to implement incommunities.
METHOD:A Delphi consensus study was carried out among a wide range of stakeholders to prioritizeinterventions. A list of candidate interventions were identified from stakeholder and community
consultations and published systematic reviews focusing on interventions aimed at reducing urban
exposures and improving health outcomes in children under 18 years old. A Steering Group comprisedof research, community, and key stakeholders mapped and provided contacts to relevant health andcommunity research groups and local and national governments and agencies. Three survey rounds
were planned to reach consensus on effectiveness, acceptability, feasibility and impact. Responses will
be analyzed descriptively and will explore whether ratings differ by stakeholder groups. Findings will
be refined into a key list of recommendations in workshop consultations with key stakeholder groups.
RESULTS:Twenty-three interventions were identified and included individual behaviors such as walking
buses to local structural changes such improvement to green and active infrastructure, as well aslarger policy initiatives such as implementation of low emission zones. Results from the survey andworkshop consultations will be presented.
CONCLUSIONS:Findings will provide insight into whether different stakeholder groups consider
different interventions more effective and implementable.

Keywords: air pollution, built environment, community-engaged research, children’s environmental
health, health co-benefitsOP-265[Climate » Temperature]

Heat and risks of emergency department visits
in the Medicaid population in South Korea: alongitudinal health insurance-based cohort
study
Ayoung Kim1, Jinah Park1, Cinoo Kang1, Ho Kim1, Whanhee Lee2
1Department of Public Health Science, School of Public Health, Seoul National University, Seoul,

Republic of Korea
2School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University

BACKGROUND AND AIM:The association between hot temperatures and health is a well-establishedarea of environmental research; however, little is known about how the association differs in the
Medicaid population − low-income individuals who might be disproportionately affected byenvironmental health hazards. This study aimed to evaluate the association between heat and visits to
Emergency Department (ED) for beneficiaries eligible to Medicaid with a longitudinal nationwide cohort
in South Korea.
METHOD:We collected data from the National Sample Cohort of the National Health Insurance Service
from 2002 to 2019 in South Korea. From the data, we constructed a longitudinal cohort for the
Medicaid beneficiaries. A conditional logistic regression was performed to estimate the relationshipbetween summer temperatures and all-cause ED visits with a time stratified case crossover design.
RESULTS:In our cohort, a total of 78,973 ED visits were recorded among Medicaid beneficiaries per
1,000,000 people for any cause. Heat was associated with an excess risk of ED visits (Odds Ratio(OR): 1.09, 95% Confidence Interval (CI): 1.00-1.18) for the 95th percentile of summer
temperatures, compared to the minimum ED visits temperature. Also, the association was higher inthe Medicaid people aged below 35 (OR: 1.26, 95% CI: 1.04-1.52) than the Medicaid people aged
over 65 (OR: 1.17, 95% CI: 1.04-1.31).
CONCLUSIONS:Our results identified the association between heat and ED visits in the Medicaid
population in South Korea. The association with heat in the Medicare population was more pronounced
than that of the general population estimated by previous studies, and the results provide theappropriateness of differentiated heat action plans for vulnerable populations.

Keywords: Temperature extremes, Socio-economic factors, Climate

OP-266[Climate » Temperature extremes and variability]

Anomalous temperatures increase occupational
injuries, illnesses and associated costs inAustralia
Matthew Anthony Borg1, Jianjun Xiang2, Olga Anikeeva1, Peng Bi1
1School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia
2School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia; School of Public Health,Fujian Medical University, Fuzhou, Fujian Province, 350122, China

BACKGROUND AND AIM:Anomalous ambient temperatures elevate the risk of occupational injuries
and illnesses (OIIs). However, the associated economic burden is underexplored internationally yet
likely substantial. Understanding the temperature-attributable variations in OIIs and costs canmitigate occupational burden. This study aimed to establish a national Australian profile of heat- andcold-attributable OIIs and their associated costs.
METHOD:Workers’ compensation claims from seven Australian capital cities were extracted from July
2005 to June 2018. OIIs and associated costs attributable to daily maximum wet bulb globe
temperature (WBGT) were estimated, including stratification of both workers and WBGT byindoor/outdoor status. Individual models were pooled to produce national and city-level estimates.
Results were projected to 2030 (2016-2045) and 2050 (2036-2065).
RESULTS:The heat-attributable and cold-preventable fractions of OIIs were 1.66% (95% eCI: 1.381.94) and 0.66% (95% eCI: 0.45-0.89%), respectively. These represented 38,540 heat-attributable
OIIs and 15,409 cold-preventable OIIs. 1.53% (95% eCI: 0.77-2.27%) and 1.33% (95% eCI: 0.661.97%) of costs were heat- and cold-attributable, respectively, with increased costs per OII duringcold despite less OIIs. The associated financial burdens were AU$651 and AU$574 million,
respectively, collectively representing AU$94 million annually. In 2050 under Representative
Concentration Pathway [RCP]8.5, heat-attributable and cold-preventable fractions of OIIs were 0.21%(95% eCI: 0.12-0.54) and 2.10% (95% eCI: 1.50-2.66%), respectively, and heat- and coldattributable fractions for costs were 0.76% (95% eCI: 0.08-1.43) and 0.05% (95% eCI: -1.84 to1.83).
CONCLUSIONS:Environmental heat and cold temperatures in workers poses a substantial morbidity
and cost burden in Australia. The relationship between anomalous temperatures and costs does notnecessarily follow that of OII occurrence, which is likely more influenced by heat compared to cold
relative to their associated costs. Although heat adaptation is likely more important for preventing
OIIs than cold adaptation, addressing both is important to reduce OII-associated costs.

Keywords: Environmental epidemiology, Modeling, Occupational exposures, Occupational
epidemiology, TemperatureOP-267[Climate » Temperature]

The impact of multiple marginalization on theassociation between acute exposure to hotsummer temperature and reduced childhood
cognitive performance
Scott William Delaney1, Daniel Mork2, Marc Weisskopf1, Henning Tiemeier3, Danielle Braun2,
Antonella Zanobetti1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston,USA

BACKGROUND AND AIM:Climate change is increasing the number of extremely hot days. Previously,
we reported that acute exposure to high temperatures may decrease childhood cognitive performance.
However, children who are socially marginalized may be more susceptible to heat than their sociallyadvantaged peers. Here, we extend our prior work to explore how intersecting forms of
marginalization may alter susceptibility to heat for child cognitive performance.
METHOD:We linked daily maximum heat indexes from PRISM meteorologic data to cognitive
performance data from 4,387 children (age 9-10y) who completed NIH Toolbox neurocognitive
assessments (age-normed total cognition score; mean=100.5; sd=17.9) from June-August, 20162018, in the Adolescent Brain Cognitive Development Study. We modeled 7-day lagged heat indexcognition relationships using a statistical learning method combining distributed lag models andBayesian additive regression trees to identify characteristics that induce heterogeneity from a highdimensional set of potential modifying factors. We considered 4 possible effect modifiers: climate type(5 types) and 3 proxies of marginalization (race / ethnicity, 5 groups; parental education, 5 levels;family income, 4 levels).
RESULTS:439 of 500 possible combinations for climate type, race / ethnicity, family income, andparental education were represented in our data. Effects were largest among non-Hispanic Blackchildren of low family income and low parental education living in a cold climate: each 1C over 30C
was associated with a -0.62 (95% credible interval (CI): -1.45, -0.26) unit decrease in total cognition
score. Overall, race / ethnicity and parental education appeared as the most salient effect modifiers.
For example, among Hispanic children of low-income households in a hot-dry climate, effects of each
1C over 30C were larger among children of lower educated parents (-0.36, 95% CI: -1.15, -0.08)
than of higher educated parents (-0.07, 95% CI: -0.95, 0.20).
CONCLUSIONS:Multiple forms of social marginalization may combine in unique ways to alter heatsusceptibility among children.

Keywords: climate, temperature, neurodevelopmental outcomes, environmental justiceOP-268[One health » Public health]

Epidemiological characteristics of heat-related
illness: nationwide data between 2000 and 2018
in Taiwan
Wan Yin Kuo1, Chien Cheng Huang2, Chi An Chen3, Chung Han Ho4, Chien Chin Hsu5, Hung Jung Lin6,
Shih Bin Su7, How Ran Guo8
1Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department ofOccupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Environmental andOccupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department ofEmergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
3Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
4Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Information

Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
5Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
6Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department ofEmergency Medicine, Taipei Medical University, Taipei, Taiwan
7Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of

Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology,
Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
8Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng
Kung University Hospital, Tainan, Taiwan

BACKGROUND AND AIM:Heat-related illness (HRI) is expected to occur more frequently and become aprominent issue in the context of global warming and climate change. Previous epidemiological studies
of HRI were generally limited to selected populations or specific settings. The objective of this study
was to characterize the epidemiological characteristics of HRI in a general population at the national
level to fill the data gaps.
METHOD:Using the National Health Insurance Research Database, we identified all HRI patients in
Taiwan between 2000 and 2018. We described the epidemiological characteristics of HRI patients andevaluated the differences between the two sexes. In addition, we evaluated the mortality rates ofdifferent types of HRI.
RESULTS:We identified 101,614 HRI patients, and male patients constituted the majority (56.2 %).
The mean age was 48.2 years, and most of the patients were between 20 and 44 years old (44.8%).
In comparison with female patients, male patients were younger (46.4 vs. 50.5 years, p < 0.001) andmore likely to receive treatment in hospitals (51.6% vs. 25.3%, p < 0.001). Among HRI, heat stroke
was the most common diagnosis and had the highest mortality rate. The 7-day, 1-month, and 3month mortality rates in heat stroke patients were 0.5%, 0.7% and 1.0%, respectively.
CONCLUSIONS:In Taiwan, patients with HRI are more likely to males and between 20 and 44 years
old. Male patients were younger and more likely to receive treatment in hospitals. Heat stroke was themost common HRI and had the highest mortality rate, which calls for establishment of the prevention
and treatment strategies.

Keywords: epidemiology, incidenceOP-270[Climate » Temperature extremes and variability]

Heatwaves and renal disease-related mortality
during summer seasons in Japan
Zin Wai Htay1, Chris Fook Sheng Ng1, Yoonhee Kim2, Masahiro Hashizume1
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo
2Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo

BACKGROUND AND AIM:High ambient temperature can trigger renal failure and increase the risk of
hospitalization for acute kidney injury based on existing research. However, the impacts of heatwaves
remain poorly understood, including Japan. This study examines the association between heatwaves
and mortality due to renal diseases in 47 prefectures of Japan during warm seasons (June to
September).
METHOD:We collected daily count of mortality for all renal (ICD10: N00-N39), acute renal injury (N17)and chronic renal disease(N18) during 1979-2019. We created six heatwave indicators using a
combination of different prefecture-specific temperature thresholds (the 95th, 97.5th and 99th
percentile) of mean temperature and duration (2 or 4 consecutive days). We performed a two-stage
analysis using a time-stratified case-crossover study design and combined the first-stage prefecturespecific estimates using a meta-analytical approach. Distributed lag nonlinear model was used toinvestigate the lagged effects of heatwaves. We adjusted for ambient temperature (two-day moving
average) to explore an alternative explanation of heatwaves as an added effect.
RESULTS:A total of 300,506 renal deaths were analyzed. Heatwaves were associated with increased
risks of mortality for all renal diseases including acute renal injury and chronic renal diseases, withrelative risks (RR) that varied by heatwaves definitions and ranged from 1.03 (95% confidence
interval [CI] 1.01-1.06) to 1.11 (95% CI 1.00-1.25). When a 10-lag period was considered, theseassociations disappeared, except for acute renal injury mortality, which remained associated with
heatwaves (97.5th percentile and 4 days) after the adjustment of temperature.
CONCLUSIONS:Heatwaves are associated with increased risks of renal disease mortality in Japan
including both chronic and acute conditions. Public health interventions should target populations withrenal problems to raise their awareness for preventive measures.

Keywords: Temperature extremes, Mortality, Outcome, Environment epidemiology

OP-271[Air pollution » Short-term exposure]

Acute Effects of Psychosocial Stress and Diesel
Exhaust on Cardiovascular Health: Evidence
from a Controlled Exposure Facility
Anjum Hajat1, Karen Jansen2, James Stewart2, Joel D Kaufman3
1Department of Epidemiology, University of Washington, Seattle USA
2Department of Environmental and Occupational Health Sciences, University of Washington, SeattleUSA
3Department of Environmental and Occupational Health Sciences, University of Washington, Seattle

USA; Department of Epidemiology, University of Washington, Seattle USA; Department of General
Internal Medicine, University of Washington, Seattle USA

BACKGROUND AND AIM:Traffic-related air pollution exposure, including diesel exhaust (DE), andpsychosocial stress are known to independently increase the risk of cardiovascular disease, likely
through changes in the sympathetic nervous system and oxidative stress. We conducted a randomized
blinded case cross-over trial in a controlled exposure facility where participants were exposed to DE
and psychosocial stress simultaneously to measure acute health effects.
METHOD:Eighteen healthy participants 20-49 years old received four separate two-hour exposures
randomized to order: two with filtered air (FA), and two with 200 μg/m3 diesel exhaust (DE). On twoof the exposure days, the participants were challenged with the Trier Social Stress Test (TSST) that
asked participants to give a short speech in front of trained evaluators and do an arithmetic test
quickly and correctly without aids. Exposures were separated by 3-4 weeks. Outcomes of interest
included systolic and diastolic blood pressure and complete blood count. Blood pressure was measured
before exposure, during exposure (15 minutes, 40 minutes, 60 minutes, 1 hour 50 minutes) and 2.5,
5, 6 and 24 hours after exposure began. Blood samples were collected before exposure, and 2.5, 6,
and 24 hours after exposure began. T-tests compared within and between exposure conditions.
RESULTS:Average PM2.5 concentrations were 208 µg/m3. Participants were able to detect filtration
status about 57% of the time. Preliminary results suggest a higher systolic blood pressure when
exposed to DE with the TSST as opposed to DE alone 1 hr 50 min after exposure. Results forneutrophils and white blood cells were null.
CONCLUSIONS:Our study contributes to the larger body of evidence on acute effects of DE byincorporating psychosocial stress, which has implications for vulnerable populations.

Keywords: Socio-economic factors (non-chemical stressors), Cardiovascular diseases, Toxicology

OP-272[Air pollution » Short-term exposure]

Impact of air pollution on the incidence of outof-hospital cardiac arrest: a nationwide casecrossover study in South Korea
Cinoo Kang1, Whanhee Lee2, Juyeon Yang1, Chaerin Park1, Ho Kim1
1Department of Public Health Sciences, Graduate School of Public health, Seoul National University,

Seoul, Republic of Korea
2School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, Yangsan, Republic of Korea

BACKGROUND AND AIM:The negative effects of air pollution on health have been established inepidemiological studies. However, there is still a lack of evidence on the association between air
pollution and the incidence of out-of-hospital cardiac arrest (OHCA). Therefore, we aimed to evaluate
the impact of air pollutants, including CO, NO2, O3, PM10, PM2.5, and SO2, on OHCA occurrence
nationwide in South Korea.
METHOD:We used individual-level OHCA data in a study period of 2008–2018 provided by the Korea
Disease Control and Prevention Agency. Air pollution data were collected on an hourly basis from the
Korea Environment Corporation, then we calculated average concentrations for five air pollutants, anda daily average 8-hour maximum concentration for O3 across 229 districts. Daily averages oftemperature and relative humidity are also obtained. District-specific daily air pollution concentrations
and meteorological information were linked to each patient (n=220,227) corresponding to theresidential district and the date of the OHCA event, as well as a few days before (1 to 3 days) the
OHCA occurrence to consider lagged impact. We used a time-stratified case-crossover design toanalyze the impact of air pollution on OHCA occurrences. We estimated the odds ratio (OR) per IQR
increase of each pollutant level and 95% confidence interval (95% CI) using a conditional logistic
regression model.
RESULTS:We found that exposure to CO (OR 1.006, 95% CI 1.000-1.012), O3 (OR 1.016, 95% CI
1.006-1.025), and SO2 (OR 1.006, 95% CI 1.001-1.011) on the same day was related to an increase
in OHCA risk and the risks lasted up to three lagged days, with no substantial risk observed on theother air pollutants.
CONCLUSIONS:Exposure to higher concentrations of CO, O3, and SO2 has been associated with anelevated risk of OHCA incidence, along with the lagged impacts observed at least up to 3 days earlier.

Keywords: Air pollution, Short-term exposure, Cardiovascular diseaseOP-273[Air pollution » Particulate matter]

Long-term Exposure to PM2.5 Species andCardiovascular Hospital Admissions Among
Medicare Beneficiaries 2000-2016
Mahdieh Danesh Yazdi1, Heresh Amini2, Yaguang Wei3, Matthew Benjamin Sabath4, Liuhua Shi5,
Francesca Dominici4, Joel D Schwartz6
1Program in Public Health, Stony Brook University, Stony Brook, NY, United States
2Icahn School of Medicine at Mount Sinai, New York, NY, United States
3Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, UnitedStates4Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, United States
5Gangarosa Department of Environmental Health, Rollins School of Public Health at Emory University,

Atlanta, GA, United States
6Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, UnitedStates; Department of Epidemiology, Harvard TH Chan School of Public Heath, Boston, MA, UnitedStatesBACKGROUND AND AIM:The goal of this study was to examine the effects of exposure to PM2.5
species on the risk of first hospitalization with cardiovascular diseases (CVDs).
METHOD:We examined the relationship between long-term exposure to fifteen PM2.5 species;
namely: elemental carbon, organic carbon, ammonium, sulfate, nitrate, bromine, calcium, copper,
iron, potassium, lead, nickel, silicon, vanadium, and zinc, and rates of first hospital admissions withCVDs in the fee-for-service Medicare population from 2000 to 2016. Our outcomes of interest included
all cardiovascular outcomes, as well as specific outcomes such as: myocardial infarction,
cerebrovascular infarction, atrial fibrillation and flutter, and congestive heart failure. We used
estimates from high-resolution spatiotemporal models aggregated to zip code to assign annual
exposure levels. We included demographic and socioeconomic characteristics, seasonal temperatureand time trends as covariates in all our models. We used a weighted quantile sum approach to assess
this relationship.
RESULTS:RESULTS: Our initial results show that each decile increase in the levels of the PM2.5
mixture increased the rate of hospitalization for all CVDs by 4.3% (95% CI: 4.2%-4.3%). Of the
fifteen species included, those with the highest weights in the exposure mixture were sulfate, nickel,
zinc, vanadium, and elemental carbon, respectively. Similarly, for MI, the rate of first hospitalization
increased by 3.8% (95% CI: 3.7%-3.9%) for each decile increase in the levels of the PM2.5 mixture.
The highest weights contributing to MI toxicity were sulfate, nickel, vanadium, lead, and nitrate,
respectively.
CONCLUSIONS:The results thus far suggest that exposure to PM2.5 species as a mixture increases therate of first hospitalization with CVDs. The species with the highest contribution to toxicity found in
this study suggest that sources of air pollution such as combustion of coal, oil, and other fossil fuels
may be detrimental to cardiovascular health.

Keywords: air pollution, PM2.5 species, cardiovascular disease, mixtures analysis

OP-274[Air pollution » Long-term exposure]Long-term exposure to air pollution andincidence of major cardiovascular diseases: a
Danish nationwide administrative cohort study
Matija Maric1, Rina So2, Youn Hee Lim1, Jiawei Zhang1, Laust H Mortensen3, Kees De Hoogh4, Steffen
Loft1, George Maria Napolitano1, Thomas Cole Hunter1, Stéphane Tuffier1, Marie Bergmann1, Nebojsa
Tasic5, Natasa Dragic6, Peter Ljungman7, Bert Brunekreef8, Gerard Hoek8, Zorana Jovanovic
Andersen1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Department of Epidemiology and Public Health, University College London, London, United Kingdom
3Denmark Statistic, Copenhagen, Denmark
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland
5Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
6Institute of Public Health of Vojvodina, Novi Sad, Serbia
7Karolinska University, Stockholm, Sweden
8Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands

BACKGROUND AND AIM:The association between long-term exposure to air pollution and ischemic
heart disease
and stroke is well established, yet evidence for other major cardiovascular diseases (CVD) remains
limited. In a large nationwide cohort, we examined the associations of long-term exposure to lowlevels of air pollution with incidence of myocardial infarction (MI), stroke, atrial fibrillation (AF), andheart failure (HF).
METHOD:We followed ca. 3,330,000 subjects aged ≥30 years and residing in Denmarkon 1st of January, 2000, until first-ever hospital contact (inpatient, emergency or outpatient) for
MI(ICD-10: I21), ischemic stroke(I63), AF(I48), or HF(I50, I13, I42), death or 31 st December, 2018,
whichever came first. Annual residential mean levels of particulate matter with diameter <2.5 µm(PM2.5), nitrogen dioxide (NO2), and black carbon (BC) at baseline were estimated by hybrid landuse regression models developed for ELAPSE (Effects of Low-Level Air Pollution: A Study inEurope) project. We used Cox proportional hazard models to estimate the associations between air
pollution and the four CVDs, separately, adjusting for gender, age, and individual and area-levelsocioeconomic status.
RESULTS:Of total subjects without MI (n=3,015,916), stroke (3,026,984), AF (3,046,321), and HF(3,058,897) in 2000, during mean follow-up of 18 years 134,536, 198,583, 196,556, and 124,956
subjects developed MI, stroke, AF, and HF, respectively. The hazard ratios (HR) (95% confidence
intervals) per 5 µg/m 3 increase in PM 2.5 were 0.98(0.96-1.00) for MI, 1.06(1.05-1.08) for stroke,
1.03(1.02-1.05) for AF, and 1.13 (1.11-1.15) for HF. The HRs per 10 µg/m 3 increase in NO 2 were1.00(0.99-1.01) for MI, 1.06(1.05-1.06) for stroke, 1.02(1.01-1.02) for AF, and 1.11(1.10-1.12) forHF. Results for BC were almost identical to those for NO2.
CONCLUSIONS:In this nationwide study, we found that long-term exposure to low levels of air
pollution,even at low levels, may lead to development of ischemic stroke, AF and HF.

Keywords: Air pollution, long-term exposure, cohort, cardiovascular diseases

OP-275[Air pollution » Particulate matter]

Evaluating Source-Specific PM2.5
Cardiovascular Health Effects from a Natural
Experiment Intervention
Wuyue Yu, George D. Thurston
NYU School of Medicine, New York, US

BACKGROUND AND AIM:Despite their differing sources and compositions, particulate matter (PM)particles are implicitly assumed to have equivalent toxicity in PM2.5 regulatory activities. As a result,the health benefits from interventions regulating potentially higher toxicity particles, such as fromcoal-based power and industrial sources, may well be underestimated in present health benefit
analyses. By inducing a dramatic source-specific air pollution reduction, the shutdown of theShenango, Inc. coke plant in Pennsylvania, US, in January 2016 provided an ideal intervention bywhich to evaluate the source-specific health impacts from a coal-related PM2.5 emission source.
METHOD:Air pollution data were obtained from Allegheny County Health Department Air Monitoring
Network. Daily cardiovascular emergency department (ED) visit data were from the Pennsylvania
Department Health. Quasi-Poisson time-series analyses were applied to the same population 3 years
before vs. 3 years after the coke plant closure to assess the associations between daily PM variations
and daily cardiovascular ED visits. An interrupted time-series analysis was also applied to assess thechange in PM effects after the plant closure.
RESULTS:We confirmed a statistically significant association between PM2.5 mass exposures andincreased risk of cardiovascular ED visits before the closure of the coke plant, but after the closure theassociation became non-significant. The interrupted time series analysis yielded a significant decreasein the central estimate of the PM2.5 mass cardiovascular ED effect after closure, associated withroughly a 20% step decrease in PM2.5 mass. This effect was larger than expected vs. CVD ED risk
estimates per µg/m3 of PM2.5 in general, such as provided in the EPA BenMAP.
CONCLUSIONS:Our study provides evidence that regulating source-specific PM can contributesignificant improvements in local cardiovascular health, and that coal-related PM2.5 particles have alarger than average CVD health effect vs. general ambient PM2.5.

Keywords: Cardiovascular diseases, Environmental epidemiology, Public healthOP-276[Air pollution » Long-term exposure]

In vitro DNA methylome and transcriptome
analysis in human alveolar epithelial cells after
long-term exposure of diesel exhaust particles
Alexandra Lukyanchuk1, Naomi Muraki2, Tsuyoshi Ito2, Tomoko Kawai3, Kenichiro Hata4, Kazuyoshi
Hosomichi5, Takayuki Kannon6, Takehiro Sato1, Atsushi Tajima1
1Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical

Sciences, Kanazawa University, Kanazawa, Japan
2Health Effects Research Group, Environment Research Division, Japan Automobile Research Institute,

Tsukuba, Japan
3Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development,

Tokyo, Japan
4Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development,

Tokyo, Japan & Department of Human Molecular Genetics, Gunma University Graduate School of
Medicine, Maebashi, Japan
5Laboratory of Computational Genomics, School of Life Science, Tokyo University of Pharmacy and Life

Sciences, Hachioji, Japan
6Department of Biomedical Data Science, Fujita Health University School of Medicine, Toyoake, JapanBACKGROUND AND AIM:Due to the extensive usage of diesel engines in various industries, diesel
exhaust particles (DEP) have become one of the factors that have a lifelong impact on the health ofcitizens. Long-term exposure of DEP can induce airway hyperresponsiveness, lung fibrosis, andinflammation. However, the molecular mechanisms underlying the adverse effects of DEP are poorly
understood. It is well known that changes in methylation levels can alter gene expression and affectcellular status, tissue metabolism, and health. Here, we performed in vitro experiments to investigate
the effect of DEP on DNA methylome after long-term exposure. The results obtained were thencompared to changes in transcriptome levels.
METHOD:Human lung epithelial A549 cells were treated in triplicate with medium containing 0, 3, 10,
and 30 μg/ml of DEP for 4 weeks. DNA and RNA were extracted from the cells after 4-week exposureof DEP. Infinium Methylation EPIC arrays (Illumina) and SurePrint G3 Huma GE microarrays (Agilent)
were used to analyze DNA methylation levels and gene expression levels, respectively.
RESULTS:A549 cells exposed to DEP for 4 weeks showed a dose-dependent change in methylationlevels, with statistically significant changes in cells exposed to 30 μg/ml of DEP. Integrated analysis of
DNA methylome and transcriptome data identified 85 differently methylated CpG sites and 6
differently methylated regions in or near 50 genes with significantly altered expression levels. These
genes were significantly enriched for extracellular matrix and epithelial-mesenchymal transition
pathways.
CONCLUSIONS:This study is the first to characterize coordinated changes in DNA methylation andgene expression in A549 cells and will provide insight into the mechanism of action of DEP following
the long-term exposure.

Keywords: traffic-related, epigenomics, exposure assessment

OP-277[Air pollution » Traffic-related]

Traffic-related air pollution and Parkinson’s
disease in central California
Beate Ritz1, Dayoon Kwon1, Jeff M Bronstein2, Jun Wu3, Kimberly C Paul2
1Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, USA
2Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, USA
3Department of Environmental and Occupational Health, UCI Susan and Henry Samueli College of

Health Sciences, Irvine, USA

BACKGROUND AND AIM:Air pollution exposure may increase the risk of Parkinson’s Disease (PD). We
assessed associations between long-term traffic-related air pollution exposures and PD in central
California.
METHOD:We generated air pollution exposures for 688 PD patients and 851 population controls
enrolled in the Parkinson’s, Environment and Genes (PEG) studies 1 and 2. First, we estimated annual
average carbon monoxide (CO) concentrations between 1981-2016 using the California Line Source
Dispersion Model, version 4 (CALINE4) to model local traffic sources and, additionally, fine particulatematter (PM2.5) concentrations between 2000-2016 based on a high-resolution geoscience-derived
model. Exposures were assessed as 10-year averaged CO and 5-year averaged PM2.5 prior to a PD
diagnosis and a reference date in controls. We used logistic regression models to estimate odds ratios(OR) and 95% confidence intervals (95%CI), adjusting for age, sex, race, education, and study wave.
RESULTS:For CO, each interquartile range (IQR) increase in 10-year average exposure prior to
diagnosis was found to be associated with an OR of 1.06 (95% CI: 1.01-1.11) for residential and of
1.08 (0.99-1.18) for occupational address-based exposures. A per IQR increase in 5-year average
PM2.5 prior to PD also increased the OR for PD at occupational address (OR=1.26; 95% CI 0.961.67). Associations were similar for 5- and 15-year exposure averages and were robust to adjustment
for smoking or pesticide exposures.
CONCLUSIONS:We found consistent evidence for positive associations between PD and long-term
exposure to local traffic-related air pollution in central California measured by CO and PM2.5 at home
and workplace addresses.

Keywords: Air pollution, Environmental epidemiology, Long-term exposure, Neurodegenerative
outcomes, Traffic-relatedOP-278[Cancer and cancer-precursors » Incidence]

Global DNA methylation levels of LINE-1 inpatients with leukoplakia and oral cancer
Chiao Chen Wang1, Ming Zhen Yu1, Shiang Fu Huang2, Ming Jang Su3, Chih Ching Yeh4
1School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
2Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan

City, Taiwan
3Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City,

Taiwan4School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan

BACKGROUND AND AIM:In 2016, oral cancer was ranked fifth among all cancers in Taiwan. Oral
potentially malignant disorders, such as leukoplakia, have a high risk of malignant transformation. The
well-known risk factors of oral cancer included tobacco smoking, alcohol consumption, and betel quidchewing; however, the roles of epigenetic factors (e.g. DNA methylation) in the risk of oral cancer stillneed to be further explored. This study aimed to compare the LINE-1 methylation levels, a global DNA
methylation biomarker, between patients with leukoplakia and oral cancer.
METHOD:A total of 200 subjects (including 100 oral cancer patients and 100 leukoplakia patients)
were included in this study. LINE-1 methylation levels were measured by using pyrosequencing
methods and represented as percentage. The mean percentage of LINE-1 between patients withleukoplakia and oral cancer was compared by Student’s t-test. LINE-1 methylation level was also
divided into high and low groups based on the median in leukoplakia patients. The odds ratio (OR) and
95% confidence interval (CI) of high versus low levels of LINE-1 methylation between leukoplakia andoral cancer was analyzed by logistic regression.
RESULTS:The levels of LINE-1 methylation in leukoplakia patients (0.83%±0.01%) was significantly
higher than in oral cancer patients (0.80%±0.02%) (P<0.001). Comparing the binary LINE-1
methylation level in leukoplakia patients, oral cancer patients have 2-times risk of low level of LINE-1
methylation (OR=2.00, 95% CI=1.14-3.52, P=0.016). After adjusting for age, alcohol consumption,
tobacco smoking, and betel quid chewing in a multivariate logistic regression, the OR increased to
2.14 (95% CI=1.16-3.94, P=0.015).
CONCLUSIONS:The finding suggests that LINE-1 hypomethylation may play a role in the malignant
transformation of oral cancer. Further studies including a healthy group and with a large sample size
are needed to validate this observation.

Keywords: Oral cancer, Oral potentially malignant disorders, Epigenomics

OP-279[Methods » Environmental epidemiology]

Thermal and optical carbon fractions for sourcespecific epidemiological studies
Judith C Chow1, John G Watson1, Xiaoliang Wang1, Steven D Kohl1, David Q Rich2, Philip K Hopke2
1Desert Research Institute, Reno, Nevada, USA
2University of Rochester School of Medicine and Dentistry, Rochester, New York, USA

BACKGROUND AND AIM:A recent epidemiological study in New York state (doi:
10.1016/j.envint.2019.02.018) successfully linked increased gasoline engine exhaust PM2.5 source
contributions to excess rates of cardiac arrhythmia hospitalizations and increased diesel engine
exhaust with increased rates of congestive heart failure hospitalizations.
METHOD:This source-specific attribution was made possible by applying the positive matrix
factorization (PMF) receptor model to long-term measurements from the U.S. Chemical Speciation
Network (CSN) acquired within the region. Specific use was made of the thermal carbon fractions
obtained from the IMPROVE_A protocol (doi: 10.3155/1047-3289.57.9.1014) that produces four welldefined organic carbon (OC) fractions in an inert helium (He) environment (OC1, OC2, OC3, and OC4
evolving at 140, 280, 480, and 580°C, respectively), and three elemental carbon (EC) fractions in an
O2/He carrier gas (EC1, EC2, and EC3 at 580, 740, and 840°C, respectively). The higher temperature
fractions are more prominent in diesel exhaust.
RESULTS:After 18 October 1, 2018, there was an undocumented change in instrumentation andprocedures to implement the IMPROVE_A protocol for CSN samples resulting in inconsistencies in thelong-term trends for the carbon fractions. The protocol changes resulted in large shifts in the OC4, OP,
and EC2 fractions, thereby precluding further use of the data set in extended health studies. Whensample remnants were re-analyzed using the original method, it was found that OC4 concentrations
increased and EC2 concentrations decreased by large amounts, thereby biasing the source
apportionment and decreasing the utility of CSN data for epidemiological studies. From 2016 to 2018,
CSN carbon analysis also included multiwavelength measurements of filter transmittance andreflectance, thereby permitting more specific attribution of biomass burning contributions as indicatedby a brown carbon (BrC) fraction derived from these optical absorption measurements.
CONCLUSIONS:As the IMPROVE_A carbon fractions are widely used for PM2.5 characterization, it isimportant to verify their consistency over multiyear periods.

Keywords: Epidemiology, Particle components, Long-term exposure, Traffic-related,OP-280[Exposures » Environmental disparities]

Genome-wide DNA methylation landscapeassociated with high arsenic exposure
Ping Ching Hsu1, Michael Bauer1, Shelbie D Stahr1, Edgar T Ellis1, Lora J Rogers1, Gail Runnels1, L.
Joseph Su2
1University of Arkansas for Medical Sciences, Little Rock, AR, US
2UT Southwestern Medical Center, Dallas, TX, USBACKGROUND AND AIM:Alterations in DNA methylation result in changes in gene expression and leadto the development of a spectrum of human diseases. Numerous environmental stressors have beenshown to affect DNA methylation. Furthermore, interplay between DNA methylation and theenvironment is recognized as an important step in the response to environmental stimuli and theonset of disease. However, little is known about the epigenetic modifications in relation to arsenic
exposure.
METHOD:133 salivary DNA samples randomly selected from participants of the Arkansas Rural
Community Health (ARCH) study cohort, where more than 26,000 women from all 75 counties in
Arkansas contributed saliva samples and answered a short baseline questionnaire. Arsenic levels were
quantified using the inductively coupled plasma mass spectrometry (iCAP RQ ICP-MS). DNA samples
were processed for bisulfide conversion and genome-wide DNA methylation profiles were conductedusing the Illumina Infinium MethylationEPIC 850K array. R package CpGassoc was used to identify
probes that are significantly associated with arsenic levels.
RESULTS:Our analysis found that arsenic levels were strongly associated with methylation status.
Using the relative beta values, we identified the top 100 probes associated with high (top 15%)
salivary arsenic concentrations when compared with low (bottom 85%) concentrations among 133
ARCH participants, with 5 genes hypermethylated and 15 genes hypomethylated including the proapoptotic gene TP53AIP1. When the participants were stratified by breast cancer diagnosis, arseniclevels were significantly higher among breast cancer patents than healthy participants were.
CONCLUSIONS:Heavy metals are endocrine disruptors with the ability to induce epigenetic aberration.
Here we demonstrated the strong correlation of epigenetic alterations from arsenic exposure. Further
study is needed to understand mechanisms underlying those changes to address the environmental
heavy metal exposure and high cancer incidence in rural communities.

Keywords: Arsenic, DNA methylation, breast cancer, ruralOP-281[Methods » Environmental epidemiology]

Assessing the Risk of Bias for EpidemiologicalStudies Evaluating the Association Between
Long-Term Exposures to PM2.5 & All-Cause
Mortality
Saumitra Rege, Neil Barone, Marusia Popovech, R Jeffrey Lewis
ExxonMobil Biomedical Sciences Inc.

BACKGROUND AND AIM:Risk of bias (RoB) tools are used in systematic reviews of environmental
epidemiology to increase the quality of evidence (Eick et al., 2020). This pilot study aimed todetermine the comparability and consistency of specific RoB tools.
METHOD:We focused on the World Health Organization (WHO) commissioned systematic review oflong-term exposure to PM2.5 and all-cause mortality (Chen et al., 2020). We selected the first 15
references based on the last name of the first author from the alphabetically arranged reference list ofincluded studies. We applied the WHO RoB tool to the selected studies, documenting the rationale forour ratings. We further selected 5 high and 5 low WHO-rated studies, based on the confounding andexposure assessment domains to apply the WHO RoB tool for evaluating the reproducibility of ratings.
Finally, we applied the Newcastle Ottawa Scale (NOS) and The Office of Health Assessment andTranslation (OHAT) RoB tools to the initially selected 15 studies.
RESULTS:The study demonstrated rating variability due to tool differences and assessor
interpretation. For example, for the initial selection of fifteen studies, our study ratings forconfounding and exposure assessment domains based on the WHO tool contrasted with the WHOanalysis but were largely consistent for other domains. Our ROB ratings were largely in agreementwith WHO for studies that were rated as high risk of bias for exposure assessment and confounding.
However, studies rated by WHO as low risk of bias frequently differed from our assessment for the
exposure assessment domain. Lastly, RoB assessments using NOS and OHAT were in agreement with
our RoB ratings but inconsistent with the WHO ratings.
CONCLUSIONS:While a direct comparison of the RoB tools was challenging, the results suggest thatdifferences in the interpretation of evaluation criteria across tools contribute to variability in ratings
which may have significant policy implications.

Keywords: Long-term exposure, Particulate matterOP-282[Omics technologies » Metabolomics]

Proposing a Potential Mechanistic Link Between
Early Life Air Pollution Exposure and Childhood
Obesity Risk in Latinos
Elizabeth A Holzhausen1, Bridget Chalifour1, Natalie Shen2, Vilinh Tran2, Zhenjiang Li2, Jeremy A
Sarnat2, Fredrick Lurmann3, Howard H Chang2, Dean P Jones2, Michael I Goran4, Donghai Liang2,
Tanya L Alderete1
1University of Colorado Boulder, Boulder, Colorado, USA
2Emory University, Atlanta, Georgia, USA
3Sonoma Technology Inc., Petaluma, California, USA
4Children's Hospital Los Angeles, Los Angeles, California, USA

BACKGROUND AND AIM:Exposure to ambient air pollution (AAP) is associated with childhood obesity
risk, independent of diet or inactivity. The biological mechanisms driving this relationship are not wellunderstood, but AAP exposure has been linked with the gut microbiome. The fecal metabolome may
represent a functional readout of gut bacteria, with potential systemic metabolic effects. This study
sought to assess the longitudinal relationship between prior month AAP and the fecal metabolome
during the first 2 years of life.
METHOD:Participants included 127 Latino mother-infant dyads from the Southern California Mother’s
Milk Study. AAP indicators, PM10, PM2.5, NO2, were modeled using residential addresses and infant
fecal metabolome was profiled via untargeted liquid chromatography with high-resolution mass
spectrometry at 1-,6-,12-,18-, and 24-months. Linear mixed effects models estimated the relationshipbetween AAP and logged intensity of fecal metabolites, both for known metabolites identified withlevel-1 evidence (N=247) and unknown features (N=18,164), adjusting for infant sex, socioeconomic
status, study visit season, breastfeeding, and mean AAP from birth-2-years. The Benjamini-Hochberg(BH) procedure was used to adjust for multiple testing using PBH < 0.2. Metapone was used forpathway enrichment analysis.
RESULTS:There were 581 metabolic features associated with PM10, 3 associated with PM2.5, and 122
associated with NO2. 28 known metabolites were associated with PM10 and 18 with NO2. Unidentified
metabolic signatures were found to be enriched in pathways including fatty and amino acidmetabolism. Known metabolites linked with AAP (e.g., histamine, tryptophan, hypoxanthine, carnitine)
were enriched in pathways including amino acid and fatty acid, which have previously been linked withbody weight and satiety.
CONCLUSIONS:These findings provide preliminary evidence that AAP may impact the infant fecal
metabolome, contributing to the known associations between AAP and childhood obesity. Future workin this cohort will include integrated analyses of the gut microbiome and fecal metabolome andassociation with childhood obesity risk.

Keywords: Air pollution - Particulate matter, Outcomes - Obesity and metabolic disorders, Omics
technology - Metabolomics

OP-283[Air pollution » General]Air pollution and childhood cancer:
Methodological challenges in exposure
assessment for epidemiological research
Emilio Gianicolo1, Hiltrud Merzenich1, Andrea Pozzer2
1Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of

the Johannes Gutenberg University Mainz
2Max Planck Institute for Chemistry, Mainz, Germany

BACKGROUND AND AIM:Exposure to outdoor air pollution has been associated with different types ofchildhood cancer but evidence remains inconclusive. The aim of this contribution is to explore anddiscuss methodological issues related to exposure assessment.
METHOD:We conducted a selective literature review to identify methodological main issues inobservational studies on outdoor air pollution and childhood cancer: Exposure metrics, periods of
exposure, the complex and multiple nature of exposure.
RESULTS:Different methods of exposure metrics have been employed to assess the effect of airpollutants on childhood cancer. Self-reports to assess exposure has potential for recall bias. Ecologicalapproaches, like the comparison of urban high-polluted areas with rural areas and traffic-related
measures only indirectly address the potential for air-pollutants exposure. Monitored concentrations of
air-pollutants might induce misclassification, particularly if monitoring stations represents large
geographical units. Concerns have arisen for the potential of misclassification of exposure when using
mathematical models to estimate exposure. However, misclassification is not expected to produce
false positive results but rather influence the association towards the null.
The effects of exposure in different life-stages might be different. Meta-analyses showed generally
stronger associations for exposures that happened during the postnatal period compared to theprenatal period. However, other studies showed a role of the period during pregnancy. In order toaddress this issue complete residential history of persons under study is warranted.
Studies are often based on models, which use exposure to single pollutants and control for otherpollutants. However, since populations are simultaneously exposed to a complex mixture of multiplepollutants, a multiple-pollutant approach is warranted.
CONCLUSIONS:So far, the investigation on air pollution and childhood cancer has brought to results,
which still need to be confirmed. Furthermore, several methodological issues have arisen in this field,
which require high quality data on exposure.

Keywords: Air pollution, Children’s environmental health, Exposure assessment

OP-284[Air pollution » Particulate matter]

Inhibitory control mediates the association
between perinatal exposure to air pollution andchildhood obesity: The PROGRESS cohort study
Jamil M. Lane1, Hsiao Hsien Leon Hsu1, Erika Osorio Valencia2, Allan C. Just1, Linda Valeri3, Brent
Coull4, Martha M. Téllez Rojo5, Robert O. Wright1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
2National Institute of Perinatology, Mexico City, Mexico
3Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
4Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
5Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos,

MexicoBACKGROUND AND AIM:Perinatal exposure to air pollution has been linked to impaired inhibitory
control and obesity in children. Evidence also indicates that lower inhibitory control is associated withunhealthy eating behaviors contributing to obesity. We propose that inhibitory control mediates theeffect of air pollution on childhood obesity as part of a temporal neuro-program.
METHOD:We assessed children in the longitudinal PROGRESS birth cohort in Mexico City (N = 389)
with complete data on the Conner’s Kiddie Continuous Performance Test (KCPT) at age 4 to assess
inhibitory control; prenatal and postnatal daily PM2.5 and Body mass index (BMI) z-scores andpercent body fat (PBF) at mean age 9.7. We use a k-means clustering analysis on KCPT outcomes as
our index of poorer inhibitory control, categorizing t-scores of inhibitory control phenotypes as normal,
inattentive, and impulsive. We applied a covariate-adjusted multinomial causal mediation analysis toassess the relationship between prenatal and postnatal air pollution (PM2.5) with BMI and PBF and the
mediation effect of inhibitory control, estimating the natural total, direct, and indirect (i.e., mediated)
effects.
RESULTS:After adjusting for socioeconomic status, child age, and sex, our analysis showed asignificant natural indirect effect between postnatal exposure to PM2.5 levels and increased BMI-z
score (β=0.1, 95%CI: 0.002-0.23) and PBF (β=3.5, 95%CI: 1.5-5.5). No evidence of mediation by
inhibitory control was found for prenatal PM2.5 predicting BMI and PBF.
CONCLUSIONS:Postnatal PM2.5 predicts obesity-related outcomes indirectly through a pathway
mediated by poor inhibitory control. Our findings show that prior research on air pollution as apredictor of neurodevelopment and obesity may be connected as a common neurobehavioral pathway.

Keywords: Air Pollution, Inhibitory Control, Childhood Obesity, Mediation Analysis, Childhood HealthOP-286[Air pollution » Traffic-related]

Prenatal residential air quality and childhood
neurobehavioral diseases - A nationwide birthcohort follow-up approach
Shu Li Julie Wang1, Li Kwang Chen2, Tsung Lin Tsai1, Chong Shiow Wang1, Chih Da Wu3, Yu Hsin
Huang4
1National Environmental Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli

County, Taiwan
2Institute of Population Sciences, National Health Research Institutes, Zhunan Town, Miaoli County,

Taiwan3Department of Geomatics, National Cheng Kung University, Tainan, Taiwan.
4Department of Psychiatry, MacKay Memorial Hospital, Taiwan.

BACKGROUND AND AIM:Air pollution was associated with decreased brain functions. However,representative large prospective follow-up studies with prenatal air quality data are scarce. The aim isto To investigate the incidence of children's prevalent complex diseases and their association with prepregnancy and perinatal exposure to air pollution in a population-based birth cohort across Taiwan
METHOD:We utilized the Taiwan Maternal and Child Health Database (TMCHD), linking to the birth
registry, and the National Health Insurance Research Database (NHIRD) to establish a birth cohortfrom the whole island. There were 478,735 singletons born in 2007~2011 and follow-up till 8 years ofage to study the neurobehavioral disorder of attention deficit hyperactivity disorder (ADHD) andautism spectrum disorder (ASD) without major pregnancy complications nor congenital diseases. We
integrated the data from 73 stationary air monitors and considered air quality for each child from 8
weeks before conception till birth. We restricted the pediatric psychiatrist's underlying diagnosis forthe conditions by the International Classification of Disease 9th and 10th versions for ≥ 3 times or
hospitalization ≥ once within a year.
RESULTS:The children experienced increased neurobehavioral diseases from the 2nd compared to the
1st Quartile of nitric dioxide (NO2) level (>13 ppb) before birth. Further, the Hazard Ratio (HR) were1.10 (confidence interval 0.98~1.24), 1.16 (1.01~1.32), and 1.27 (1.10~1.47) for Q2~Q4 for ADHD
in girls, adjusted for sex, maternal smoking status, insurance premium, and parental history of ADHD,
PM2.5 and urbanization in the Cox's model. The results are similar for ASD to ADHD. There were no
significant associations for epilepsy as expected because of its different pathogenesis fromneurobehavioral abnormalities.
CONCLUSIONS:The result corresponded to the new WHO guideline of optimized 20 ppb or even lower
for NO2 as a surrogate exposure index. Early-life traffic-related air pollution control might be essential
for preventing children's ADHD and ASD.

Keywords: Birth cohort, Attention deficit and hyperactivity disorder, Autism spectrum disorder,
National health insurance data, Nitrate dioxide

OP-287[Chemical exposures » Pesticides]

Setting a baseline for human biomonitoring andepigenetic studies of pesticides in Morocco: The
PaPOE study
Aziza Menouni1, Radu Corneliu Duca2, Imane Berni3, Kaoutar Chbihi1, Said Abousaid3, Hala
Chetouani3, Lode Godderis4, Samir El Jaafari3
1Cluster of Competence Environment and Health, Moulay Ismail University, Meknes 50000, Morocco;

Health and Environment Unit, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium
2Unit of Environmental Hygiene and Biological Monitoring, Department of Health Protection,

Laboratoire National de Santé (LNS), L-3555 Dudelange, Luxembourg
3Cluster of Competence Environment and Health, Moulay Ismail University, Meknes 50000, Morocco
4Health and Environment Unit, Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium / IDEWE,

External Service for Prevention and Protection at Work, 3001 Heverlee, Belgium

BACKGROUND AND AIM:In Morocco, due to the lack of education and the presence of a counterfeit
and illegal market, pesticides constitute a major problem to be addressed by occupational andenvironmental health. In fact, growing evidence suggests a link between pesticides exposure andepigenetic changes, including variations in DNA methylation. In this context, the purpose of the PaPOE
study is to examine comprehensively whether multi-residue exposure to commonly used pesticides,
could induce epigenetic alterations.
METHOD:The PaPOE study is divided into two major phases: a cross-sectional study assessing theoccupational exposure among farmworkers and pesticide appliers in Meknes (Morocco), and a birthcohort where pregnant healthy women attending maternity care hospitals in Meknes.
Survey questionnaires have been conducted between 2018 and 2022 to assess pesticide exposures
and work practices of the farmers. AChE and BuChE were analyzed in blood. The biomonitoring
approach using LC-MS and GC-MS targeted the profiling of 28 pesticides and their metabolites inurine. Oxidative stress biomarkers include GSH and 8-OHdG. Global DNA methylation is performed
using LC-MS in blood.
RESULTS:Overall, knowledge was significantly associated with education level and previous training on
pesticides use, while health risks were significantly associated with the use of PPE. Pesticides weredetected in 77% of samples, with mainly organophosphates and organochlorines. Glutathione and 8OHdG were significantly associated with pesticides exposure. Global DNA methylation status is alteredin the pesticides-exposed population compared to the non or less-exposed group.
CONCLUSIONS:Our study paves the way for a biomonitoring system in Morocco to assess
environmental and occupational exposures and to provide insight into the long‐term course andpotential health consequences of the pesticides exposure.

Keywords: Occupational exposure, Epigenome, Morocco.

OP-288[Chemical exposures » Pesticides]

Exploring the association between nonoccupational pesticides exposures andmetabolomics biomarkers
Saranya Palaniswamy1, Khaled Abass2, Jaana Rysä3, Joan O. Grimalt4, Jon Øyvind Odland5, Arja
Rautio6, Marjo Riitta Järvelin7
1Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.
2Environmental Health Sciences, College of Health Sciences, University of Sharjah, Sharjah, United

Arab Emirates.
3School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
4Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific

Research (CSIC), Barcelona, Spain.
5NTNU The Norwegian University of Science and Technology, Trondheim, Norway.
6Thule Institute, University of Arctic, University of Oulu, Oulu, Finland.
7Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London,

London, United Kingdom.

BACKGROUND AND AIM:The relationship between pesticide exposures and metabolomics biomarkers
is not well understood. We examined the changes in the serum metabolome (early biomarkers) andthe metabolic pathways associated with various pesticide exposure scenarios (OPE: overall exposure,
PEM: exposure in months, PEY: exposure in years, and PEU: reported specific pesticides use).
METHOD:We utilized questionnaire data on pesticide exposures and blood samples for nuclear
magnetic resonance (NMR)-based metabolomics analyses from the Northern Finland Birth Cohort 1966
31-year cross-sectional examination. For exposures and metabolites associations, participants size
varied between 2361 and 5035. To investigate associations between metabolomics biomarkers andexposure to pesticide scenarios compared to those who reported no exposures multivariable
regression analyses stratified for sex and adjustment with covariates (season of pesticide use,socioeconomic position (SEP), alcohol consumption, BMI, and latitude of residence) were performed.
Multiple testing by Benjamini–Hochberg false discovery rate (FDR) correction.
RESULTS:Pesticide exposures differed by sex, season of pesticide use, alcohol, SEP, latitude ofresidence. Our results showed that all pesticide exposure scenarios were negatively associated withdecreased HDL concentrations across all lipoprotein subclasses in women. OPE, PEY, and PEU wereassociated with decreased branched-chain amino acid concentrations in men and decreased albumin
concentrations in women. OPE, PEY and PEU were also associated with changes in glycolysis
metabolites and ketone bodies in both sexes. Specific pesticides exposure was negatively associatedwith sphingolipids and inflammatory biomarkers in men. In women, OPE, PEM, and PEU wereassociated with decreased apolipoprotein A1 and increased apolipoprotein B/apolipoprotein A1 ratio.
CONCLUSIONS:Our findings suggest that identification of early biomarkers of disease risk related topesticide exposures can inform strategies to reduce exposure and investigate causal pathways.
Women may be more susceptible to non-occupational pesticide exposures when compared to men,and future sex-specific studies are warranted.

Keywords: pesticides, metabolomics, biomarkers of exposure, chemical exposures, cardiovasculardiseases

OP-289[Chemical exposures » Pesticides]

Evaluating the effectiveness of aerial pesticide
application in reducing the risk of pesticiderelated diseases
Wei Te Wu1, Jyun Ming Chen1, Shian Da Lin2, Shih Tzong Chen2, Yu Tang Hung2
1National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan,

Taiwan2Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Executive Yuan

BACKGROUND AND AIM:The purpose of this study was to evaluate the risk of pesticide-relateddiseases among pesticide-spraying personnel compared to farmers and to assess the effectiveness ofthe new method of aerial pesticide application in reducing this risk.
METHOD:This study included all 2,725 pesticide-spraying personnel who passed the national
certification examination from 2010 to 2021. To compare their risk of pesticide-related diseases with
farmers, we matched them with four times the number of farmer controls of the same age, gender,and enrollment area (n=10,858). The study population was linked to the National Health Insurance
Research Database from 2010 to 2020 to track inpatient/ outpatient cases. The target diseases of thisstudy were pesticide-related diseases, including pesticide poisoning (ICD-10 CM: T60), acute liver
failure (K72), acute renal failure (N17), asthma (J45, J46), chronic bronchitis (J410, J411, J418, J42),
Parkinson's disease (G20, G21)). Logistic regression was used to assess odds ratios and 95%
confidence intervals for outcomes.
RESULTS:This study found only a slight increase in the prevalence of pesticide poisoning among
pesticide-spraying personnel compared to the farmer controls (25.69 per 100,000 vs. 23.95 per
100,000), but there was no statistical difference between the two groups. To further analyze theeffectiveness of different application methods, we compared the risk of disease between aerial
pesticide applicators (n=1,001) and ground pesticide applicators (including indoor facility fumigation,
outdoor soil fumigation, and seed disinfection) (n=1,724) among pesticide-spraying personnel. Aftercorrecting for age, gender, and place of residence, we found that the aerial applicators had a lower
risk of asthma (OR=0.30; 95%CI=0.15-0.57) and chronic bronchitis (OR=0.20; 95%CI=0.06-0.66)
compared to the ground pesticide applicators.
CONCLUSIONS:This study suggests the aerial pesticide spraying can reduce the risk of asthma andchronic bronchitis in applicators compared to ground application. Field surveys are recommended toverify these potential health risk indicators.

Keywords: Pesticides, Respiratory and allergic outcomes, Aerial pesticide application

OP-290[Chemical exposures » Pesticides]

Efficacy of electrolyzed water in degrading andhydrolyzing pesticides
Yen Con Hung1, Qingguo Huang2
1Department of Food Science and Technology, University of Georgia, Griffin, GA, USA
2Department of Crop and Soil Sciences, University of Georgia, Griffin, GA, USA

BACKGROUND AND AIM:This study aimed to investigate the efficacy of electrolyzed oxidizing (EO)
water and electrolyzed reducing (ER) water in degrading and hydrolyzing diazinon, cyprodinil, andphosmet in aqueous solution. The effect of pH, available chlorine content (ACC), and treatment time ofboth EO and ER waters were tested. The study also investigated the appropriate methods for pesticide
inoculation and washing procedure for grapes.
METHOD:Pesticide extraction was carried out using Quechers method and the remained pesticides
were determined by an ultra-performance liquid chromatography with tandem mass detector.
RESULTS:EO water at pH 2.80 was significantly (P < 0.05) more effective than at pH 5.00 and 6.00 indegrading diazinon, cyprodinil, and phosmet. Higher ACC and longer treatment time also enhanced
the reduction of the tested pesticides. ER water, however, was only shown to be effective inhydrolyzing phosmet (99.7% reduction), slightly effective in reducing diazinon (7.4% reduction), andineffective on cyprodinil (0.0% reduction).
CONCLUSIONS:The oxidizing power of free chlorine in EO water may be the main reason for its
effectiveness in degrading pesticides. The difference in the tested pesticides chemical structure may
play an important role in determining the sensitivity of each pesticide against EO and ER water
treatment. Soaking grapes in 12 mg/L mixed pesticide solution for 10 min was found to be the mostconsistent method for pesticide inoculation. A 500 ml of EO water combined with 100 rpm shaking was
found to be the best condition to wash 200 g grapes.

Keywords: electrolyzed water, diazinon, cyprodinil, phosmet, chlorineOP-291[Air pollution » General]

Associations of air pollution with risks ofdecline of kidney function: An analysis of
mediation by diabetes mellitus
Jia Ling Wu, Chung Yi Li
Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan

BACKGROUND AND AIM:Studies on the effect of air pollution on the decline of kidney function are still
limited. Furthermore, whether diabetes mellitus plays a mediating role in the associations between air
pollution and the decline of kidney function remains unclear. We aimed to create an assessment model
investigating the associations between air pollution and the decline of kidney function and toinvestigate whether diabetes mellitus acts as a mediator between air pollution and kidney function
progression.
METHOD:We recruited 83,349 adults as participants who received health check-up at MJ clinic from2010 to 2017. Participants with an eGFR decline≧30% from baseline were defined as having
progression of kidney function decline. Allowing a latent period of 3 years, land use regression (LUR)models were used to estimate participant‘s exposures to air pollutions including PM2.5, PM10, CO, O3,
NO2, and SO2. Mediation analyses for progression of kidney function decline risk were performed
using logistic regression models. Generalized additive models (GAM) were used to estimate theassociations between exposures and the kidney function progression.
RESULTS:In all, 641 (0.8%) participants were found to experience kidney function decline progression
during a median follow-up of 2.5 years. The direct effect of PM2.5, PM10, and SO2 was associatedwith an increased risk of kidney function decline progression, independent of diabetes mellitus. A
mediation analysis clarified that diabetes mellitus only explained 2%~5% of the associations of air
pollution exposures with the decline of kidney function. GAM also showed exposure-response
relationships of PM2.5 and PM10 with kidney function decline progression.
CONCLUSIONS:This study demonstrated a significant associations of renal function decline progression
and PM2.5, PM10, and SO2 exposures, but not CO, O3, and NO2, in the past 3 years. On the other
hand, diabetes mellitus contributed little to mediate the relationships between air pollutants and renal
function decline progression.

Keywords: air pollution, reduced renal function, estimated Glomerular Filtration Rate (eGFR), causal
mediation analysis, cohort studyOP-292[Air pollution » Long-term exposure]Ambient air pollution exposure and incidence of
cataract surgery: the prospective 3City-Alienor
study
Laure Gayraud1, Marion Mortamais2, Cédric Schweitzer3, Kees De Hoogh4, Audrey Cougnard
Grégoire1, Jean François Korobelnik3, Marie Noelle Delyfer3, Marie Bénédicte Rougier3, Karen
Leffondré1, Catherine Helmer1, Danielle Vienneau5, Claudine Berr2, Cécile Delcourt1
1Univ. Bordeaux, Inserm, BPH, U1219, F-33000 Bordeaux, France
2Univ. Montpellier, Inserm, Institute for Neurosciences of Montpellier INM, UMR 1298, 34091-

Montpellier, France
3Centre Hospitalier Universitaire de Bordeaux, Service d'Ophtalmologie, Bordeaux, France
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland
5University of Basel, Basel, Switzerland

BACKGROUND AND AIM:Cataract is the leading cause of blindness worldwide. It is a multifactorialdisease, involving oxidative stress mechanisms. The aim of our study was to investigate therelationship between air pollution exposure and incidence of cataract surgery.
METHOD:The 3C-Alienor study is a population-based cohort of residents of Bordeaux, France, aged 65
years or more, recruited in 1999-2000 and followed every 2-3 years until 2017. Cataract surgery was
self-reported and checked at slit-lamp. Air pollution exposures (particulate matter <= 2.5 microns(PM2.5), black carbon (BC), nitrogen dioxide (NO2)) during the 10 years preceding the inclusion were
estimated at the participants’ geocoded residential address using Land-Use Regressions models.
Associations of air pollution exposure with incidence of cataract were estimated using Cox proportional
hazard models adjusted for age as the time-scale, sex, deprivation index, corticosteroid use, asthma,diabetes, hypertension, body mass index, ultraviolet exposure, smoking status.
RESULTS:The study included 829 subjects without prior cataract surgery; the mean age at inclusion
was 72.6 years (Standard deviation (SD): 4.2) and 61% were women. The median (Interquartilerange (IQR)) [Minimum-maximum] follow-up duration was 7.7 years (5.8) [0.01-17.3] during which
507 participants underwent cataract surgery. The 10-year median (IQR) of average of NO2
concentrations was 34.1 µg/m3 (7.5) with range from 25.6 to 73.3 µg/m3. Participants exposed to aconcentration ≥40 µg/m3, which corresponds to the current regulatory limit value in Europe, had a
50% increased risk of incident cataract surgery during follow-up compared to those exposed to <40µg/m3 (HR=1.50, CI (1.19, 1.90), p<0.001). No statistically significant association was foundbetween PM2.5 or BC and the risk of cataract surgery.
CONCLUSIONS:Exposure to a NO2 concentration ≥40 µg/m3 was associated with a 50% increased
risk of cataract. Although this regulatory limit value has been ratified since 2008 in Europe, it is still
not achieved in several cities.

Keywords: Environmental epidemiology, Incidence, Oxides of nitrogen, Particulate matterOP-293[Air pollution » Short-term exposure]

Short-term exposure to ultrafine particles andchildren’s hospital admissions in Copenhagen,Denmark
Marie Bergmann1, Zorana Jovanovic Andersen1, Andreas Massling2, Claus Nordstrøm2, Heresh
Amini3, Steffen Loft1, Rina So1, Jiawei Zhang1, Thomas Cole Hunter1, Youn Hee Lim1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Department of Environmental Science, iClimate, Aarhus University, Denmark
3Icahn School of Medicine at Mount Sinai, New York, United States

BACKGROUND AND AIM:Ultrafine particles (UFP; particulate matter <100 nm in diameter) may be
more harmful to human health than larger particles, but epidemiological evidence on their healtheffects is still limited. Short-term exposure to UFP may trigger morbidity from respiratory diseases,
potentially even more so among children. In this study, we examined the association between shortterm exposure to UFP and children’s hospital admissions, and possible modification of this association
by socio-economic status, age and sex in Copenhagen, Denmark.
METHOD:Daily levels of UFP (particle number concentration in a size range 11-700 nm) andmeteorological factors were monitored at an urban background station in central Copenhagen during
2002-2018. Daily counts of hospital contacts (outpatient and inpatient) from respiratory diseases
among children (<14 years) in Copenhagen were obtained from Danish health registers. Hospital
admissions associated with interquartile range (IQR) increases in UFP exposure for up to six days
preceding the admission were examined in a case-crossover study design. Odds ratios (OR) with 95%
confidence intervals (CI) were estimated after adjusting for temperature and relative humidity.
Additionally, we analyzed the associations for different sex, age and disposable family income groups.
RESULTS:We observed 126,156 hospital admissions between 2002 and 2018. Hospital admissions due
to respiratory diseases were significantly associated with IQR increases in two-day moving averages of
UFP (OR: 1.04 [95% CI: 1.00, 1.07]). Among the specific causes, the strongest associations were
found for asthma hospital admissions and five-day moving averages of UFP (1.18 [1.06, 1.31]).
Associations were highest among boys, younger children, and those in the lowest income group.
CONCLUSIONS:We find that short-term exposure to UFP can trigger respiratory diseases in children,with strongest associations with asthma. We also find that boys, youngest children, and children fromfamilies in lowest income groups are most susceptible.

Keywords: Respiratory outcomes, Asthma, Children's environmental healthOP-294[Air pollution » Long-term exposure]Long-term exposure to air pollution anddementia incidence among elderly individuals ofa Danish nationwide administrative cohort
Rina So1, Youn Hee Lim2, Jiawei Zhang2, Laust H. Mortensen3, Kees De Hoogh4, Steffen Loft2, George
Maria Napolitano2, Thomas Cole Hunter2, Stéphane Tuffier2, Marie Bergmann2, Matija Maric2, Paola
Zaninotto5, Bert Brunekreef6, Gerard Hoek6, Zorana J. Andersen2
1Department of Epidemiology and Public Health, University College London, London, UK; Section ofEnvironmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
2Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
3Denmark Statistic, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health,

University of Copenhagen, Copenhagen, Denmark
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel,

Switzerland
5Department of Epidemiology and Public Health, University College London, London, UK
6Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands

BACKGROUND AND AIM:Evidence on the association between air pollution and dementia is growing,
but it remains mixed for pollutants other than fine particulate matter (PM₂.₅). Furthermore, only a few
studies examined vulnerability by socioeconomic status (SES). Here we aimed to evaluate associations
between long-term exposure to air pollutants and dementia incidence and to investigate whether SES
modifies this association.
METHOD:We followed all inhabitants in Denmark aged ≥60 years on 1-Jan-2000 (N=934,767) until
31-Dec-2018. Incident dementia was defined as the first dementia hospital contact or a prescription ofanti-dementia drugs during the follow-up, whichever came first. Annual mean PM₂.₅, nitrogen dioxide(NO₂), and black carbon (BC) levels at baseline addresses were estimated by hybrid land-use
regression models. We used Cox proportional hazard models to estimate associations, adjusting for
demographic and socioeconomic factors, smoking status, and obesity. We considered householdincome, education level, and employment status as potential effect modifiers.
RESULTS:During the mean follow-up of 11.6 years, 81,728 subjects developed dementia. We detectedassociations with all 3 pollutants, with hazard ratios (HR) (95% confidence intervals) of 1.41 (1.35,
1.48) per 5 µg/m³ for PM₂.₅, 1.23 (1.21, 1.27) per 10 µg/m³ for NO₂, and 1.22 (1.19, 1.24) per
0.5×10⁻⁵/m for BC. Additionally, we found that individuals with lower household incomes and thoseunemployed at baseline had a higher risk of developing dementia than those with higher incomes or
employment. For instance, HRs per 5 µg/m³ for PM₂.₅ were 1.56 (1.50, 1.62) for the lowest income
quintile and 1.21 (1.13, 1.29) for the highest, and the corresponding HRs were 1.45 (1.41, 1.48) for
the unemployed and 1.22 (1.14, 1.31) for the employed.
CONCLUSIONS:This nationwide study provides strong evidence of a link between long-term exposure
to air pollution and an increased risk of dementia in older people, with those in lower SES groups
being the most vulnerable.

Keywords: neurodegenerative outcomes, Incidence, Environmental epidemiology, socio-economic

factors

OP-296[Exposure assessment methods » Risk assessment]

Estimation of Health Risks Caused by Metals
Contained in E-cigarette Aerosol throughPassive Vaping
Wei Chung Su, Jinho Lee
Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas
Health Science Center at Houston

BACKGROUND AND AIM:It is expected that secondary exposure to e-cigarette aerosol (passive
vaping) will soon become an issue of public health. Passive vaping inhales e-cigarette aerosol
containing similar harmful substances as active vaping. However, parallel studies on passive vaping
are minimal. Therefore, there is a need for passive vaping-related health risk studies to assess theimpact of vaping on public health.
METHOD:This research conducted a series of experiments in a test room using a puffing machine andthe Mobile Aerosol Lung Deposition Apparatus (MALDA) to study e-cigarette aerosol respiratory
deposition caused by passive vaping. The experimental data acquired were then applied to estimate
the deposited mass and health risks caused by toxic metals contained in e-cigarette aerosol. Five
popular e-cigarette products were used in this study to generate e-cigarette aerosol for respiratory
deposition experiments. Besides, size-segregated e-cigarette aerosol samples were collected, and themetal compositions in the e-cigarette aerosol were carefully analyzed by the ICP/MS technique.
RESULTS:No potential non-cancer health risk was found under the passive vaping exposure scenarios
studied. However, cancer risks caused by chromium (Cr VI) contained in e-cigarette aerosol revealed
an unacceptable risk ranging from 1.3x10-6 to 4.3x10-6, slightly higher than the generally acceptable
lifetime excess cancer risk (10-6).
CONCLUSIONS:Based on the data acquired, it is the e-cigarette aerosol concentration inhaled by thepassive vaper that determines the respiratory deposited mass and the daily dose of metals containedin e-cigarette aerosol and then causes related health risks. Therefore, by using a suitable ventilation
rate to dilute the e-cigarette aerosol in the room and by applying enough distance between the active
and passive vapers, the e-cigarette aerosol concentration inhaled by the passive vaper could bedrastically decreased. In this way, health risks caused by toxic metals contained in the e-cigaretteaerosol could be reduced.

Keywords: E-cigarette aerosol, Passive vaping, Respiratory deposition, Health risk

OP-297[Policy » Research translation to affect policy and practice]

The Associations of Exposure to Ambient PM2.5
with Hypertension, Diabetes and Multimorbidity
among Floating Population in China
Yang Zhao1, Hongyu Li2, Chunlei Han2
1The George Institute for Global Health, University of New South Wales, Sydney, Australia
2School of Public Health and Management, Binzhou Medical University, Yantai, China

BACKGROUND AND AIM:Studies on the relationships between air pollution exposure and chronic
disease multimorbidity were inconclusive and showed scarce evidence of floating people from China.
In this context, we examined the associations of exposure to ambient PM2.5 with diabetes,
hypertension, and multimorbidity among the floating population.
METHOD:The study used the China Migrants Dynamic Survey data in 2017, including information onsocio-demographic characteristics, PM2.5, temperature, humidity and other related meteorological
data. The multivariable logistic regression models were performed to examine the association between
PM2.5 and chronic diseases in the floating population after adjusting for covariates. Stratified analyses
were also performed to identify whether the association varied across subgroups.
RESULTS:Overall, every 10 µg/m3 increment in annual average PM2.5 was associated with increased
odds of hypertension (OR=1.053, 95%CI: 1.018-1.087) and multimorbidity (OR=1.099, 95%CI:
1.006-1.201) in the floating population in China. The results suggested that there was no significant
association between ambient PM2.5 and diabetes. The stratified analysis showed that there was a highhealth risk of PM2.5 in males, older adults, low education status and people living in the westernregion of China.
CONCLUSIONS:This study suggests that PM2.5 exposure was associated with an increased risk ofhypertension and multimorbidity in the floating population, particularly among older people andresidents in western China. Air pollution reduction strategies should be considered by policymakers for
improving the migrants’ health status.

Keywords: Air pollution, Hypertension, Diabetes, Multimorbidity, Floating population

OP-298[Air pollution » Wildfires]

Understanding Age-Specific Mortality Impacts
Associated with Wildland Fires: An Assessment
for the Continental United States, 2005-2018
Ambarish Vaidyanathan1, Pierre Masselot2, Forrest Lacey3, Antonio Gasparrini2
1Centers for Disease Control and Prevention (CDC)
2London School of Hygiene & Tropical Medicine (LSHTM)
3National Center for Atmospheric Research (NCAR)BACKGROUND AND AIM:Climate change and other related factors have contributed to an increase incatastrophic wildfires. As wildfire disasters continue to increase in the United States, the use ofplanned burning (e.g., prescribed burning) to reduce wildfire risk has also increased. Wildland firesmoke, which is a combination of both wildfires and planned burning activities, poses a significant
threat to air quality and public health.
METHOD:We analyzed a county-level, daily time series of all-cause mortality and environmental
variables in the continental United States, for years 2005 – 2018. A conditional quasi-Poisson
regression with strata by county, year, month, and day of the week was used to estimate the relativerisk (RR) and 95% confidence interval (CI) of mortality associated with smoke-related fine particulatematter (smoke-PM) and ozone (smoke-O3) concentrations. The modelling framework controlled fornon-fire related air pollutants and other relevant risk factors, and estimated overall cumulative RRs[CI] for age groups over a 1-day lag period.
RESULTS:Deaths associated with smoke exposure can be observed across all regions in thecontinental United States. A 10 μg/m3 and a 10 ppb increase in smoke-PM and smoke-O3,
respectively, were significantly associated with mortality for age groups, between 0-65 (RR [95%CI]smoke-PM:1.009 [1.006, 1.012]; RR[95% CI]smoke-O3: 1.004 [1.002, 1.007]) and >= 65 (RR[95% CI]smoke-PM: 1.010 [1.008, 1.012]; RR [95% CI]smoke-O3: 1.002 [1.000, 1.004]). Across age
groups, a total of 3,179 (95% CI: 2,645 – 3,686) and 1,012 (95% CI: 531 – 1,548) deaths were
attributable to smoke-PM and smoke-O3 exposures each year, respectively; most of these smokeattributable deaths were observed among adults aged 65 and over.
CONCLUSIONS:From a public health perspective, quantifying smoke-related mortality impacts bysensitive subgroups, such as older adults, could shed light on interventions that are populationspecific and help reduce air quality and health impacts associated with wildland fires.

Keywords: Wildland fires, Mortality, Air Pollution, Climate ChangeOP-299[Air pollution » Wildfires]

Personal Exposure Monitoring During Wildfire
Smoke Events
Lilian (Ziqi) Liu
University of Washington

BACKGROUND AND AIM:Wildfire events have become more prevalent in the Pacific Northwest in
recent years and regional PM2.5 concentrations may not reflect personal exposures.
METHOD:Twenty-six wearable particle sensors were deployed among a convenience sample ofvolunteers during a 2022 wildfire impacted period Seattle for personal, indoor, and outdoor PM2.5
measurements. We corrected wearable sensor measurements with nephelometer colocation and EPA
correction factors. We compared our findings to hourly Puget Sound Clean Air Agency (PSCAA)
regional PM2.5 concentrations and used linear regression to assess relationships between calibrated
personal, indoor, outdoor, and hourly regional concentrations.
RESULTS:Findings indicated higher outdoor than indoor or personal PM2.5 concentrations as well as asignificant correlation between personal and indoor exposure levels. Results showed around two-foldhigher regional PM2.5 concentration compared to the personal and indoor concentrations. While there
were differences in outdoor sensor concentrations by site, overall, these differences were relatively
similar to the regional PSCAA PM2.5 concentrations.
CONCLUSIONS:Findings from the wearable particle sensors suggested that regional concentrations do
not fully capture the variations in personal individual exposures, which tended to be lower thanregional outdoor concentrations, and were more correlated with indoor concentrations. Findings
support public health guidance to shelter indoors during wildfire smoke events.

Keywords: Air pollution, Exposure, Exposure assessment, Particulate matter, WildfiresOP-300[Climate » Natural disasters]

Prenatal exposure to wildfire smoke andpregnancy loss in Colorado, USA
Michael Leung1, Seongwon Im2, Sebastian T Rowland3, Stefania Papatheodorou4, Brent A Coull5,
Marianthi Anna Kioumourtzoglou3, Marc G Weisskopf6, Ander Wilson2
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
2Department of Statistics, Colorado State University, Fort Collins, USA
3Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York City, USA
4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
6Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA

BACKGROUND AND AIM:Wildfires—which are expected to be larger and more intense due to climatechange—pose a threat to human health. Although past studies have shown that exposure to wildfire
smoke (WFS) may be associated with adverse birth outcomes, its association with pregnancy loss has
been understudied. We examined the association between prenatal WFS exposure and pregnancy loss
in Colorado, USA.
METHOD:We retrieved all birth records from the 17 “front range” counties of Colorado, containing
84% of the Colorado population, from 2007-2018 (n=614,321). We considered WFS exposure fromtwo products: 1) overall PM2.5 from the Community Multiscale Air Quality Modeling Systemdownscaling files and 2) wildfire-specific PM2.5 from a novel machine learning model. For both, we
calculated daily average county-level exposure by taking a population-weighted average of censustract level estimates. We fitted distributed lag quasi-Poisson models for each WFS exposure
separately, adjusting for temperature and time trends, to estimate their associations with live-birthidentified conceptions (LBICs), from which we can infer about WFS-pregnancy loss associations.
RESULTS:Average weekly number of LBICs was 1095 (standard deviation [SD]: 63). Average weekly
overall and wildfire-specific PM2.5 was 6.4 µg/m3 (SD: 6.4) and 0.3 µg/m3 (SD: 1.1), respectively.
Both WFS exposures were associated with fewer LBICs (i.e., more pregnancy loss). The cumulativerisk ratio (RR) for a 1-µg/m3 higher overall PM2.5 sustained throughout pregnancy was 0.981 (95%
CI: 0.973, 0.989). Although the cumulative association for wildfire-specific PM2.5 was null, gestational
weeks 6-13 appeared to be a critical exposure window. The cumulative RR for a 1-µg/m3 higher
wildfire-specific PM2.5 sustained throughout weeks 6-13 was 0.994 (95% CI: 0.990, 0.999).
CONCLUSIONS:Our findings suggest that higher WFS exposure was associated with more pregnancy
loss and adds to the growing literature on the harmful effects of wildfires.
FUNDING: National Institute of Environmental Health Sciences R01 ES029943.

Keywords: air pollution, wildfires, particulate matter, pregnancy outcomesOP-301[Air pollution » Long-term exposure]

Exposure to wildfire related PM2.5 and site
specific cancer mortality in Brazil from 2010 to
2016: A retrospective study
Pei Yu1, Rongbin Xu1, Shanshan Li1, Xu Yue2, Gongbo Chen1, Tingting Ye1, Micheline S.z.s. Coêlho3,
Paulo H. N. Saldiva3, Malcolm R. Sim1, Michael J. Abramson1, Yuming Guo1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
2Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative

Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental
Science and Engineering, Nanjing University of Information Science & Technology (NUIST), Nanjing,
China
3Laboratory of Urban Health Insper/Faculty of Medicine of the University of São Paulo, São Paulo,

BrazilBACKGROUND AND AIM:Long-term exposure to fine particles less than 2.5 micrometres in diameter(PM2.5) has been linked to cancer mortality. However, the effect of wildfire related PM2.5 exposure on
cancer mortality risk was unknown. This study evaluates the association between wildfire related
PM2.5 and site specific cancer mortality in Brazil, from 2010 to 2016.³³
METHOD:Nation-wide cancer death records were collected during 2010-2016 from Brazilian Mortality
Information System. Death records were linked with municipal level wildfire and non-wildfire related
PM2.5 concentrations, at a 2.0° latitude by 2.5° longitude resolution. We applied a variant difference
in difference approach with quasi-Poisson regression, adjusting for seasonal temperature and grossdomestic product (GDP) per capital. Relative risks (RRs) and 95% confidence intervals (CIs) for the
exposure on specific cancer sites were estimated. Attributable fractions and cancer deaths were also
calculated.
RESULTS:In total 1,332,526 adult cancer deaths (age≥20), from 5,565 Brazilian municipalities,
covering 136 million adults were included. The annual wildfire related PM2.5 concentration was 2.38μg/m3 and the non-wildfire related PM2.5 was 8.20 μg/m3. The RR for mortality from all cancers was
1.02 (95% CI: 1.01-1.03), per 1 μg/m3 increase of wildfire related PM2.5 concentration, which was
higher than non-wildfire related PM2.5 (1.01, [1.00-1.01]). Wildfire related PM2.5 was associated withmortality from cancers of the nasopharynx (1.10, [1.04-1.16]), oesophagus (1.05, [1.01-1.08]),
stomach (1.03, [1.01-1.06] ), colon-rectum (1.08, [1.05-1.11]), larynx (1.06, [1.02-1.11]), skin(1.06, [1.00-1.12]), breast (1.04, [1.01-1.06]), prostate (1.03, [1.01-1.06] ) and testis (1.10, [1.031.17]). For all-cancers combined, the attributable deaths were 37 per 100,000 population and ranged
from 18/100,000 in Northeast of Brazil, to 71/100,000 in Central West.
CONCLUSIONS:Exposure to wildfire related PM2.5 can increase the risks of cancer mortality at manysites and the effect for wildfire related PM2.5 was higher than non-wildfire sources.

Keywords: Mortality, Cancer and cancer precursors, WildfiresOP-302[Climate » Natural disasters]

The Association between Wildfire andEmergency Department (ED) Visits for Anxiety
Disorders in the Western United States
Qingyang Zhu1, Danlu Zhang2, Wenhao Wang1, Rohan Richard D'souza2, Haisu Zhang1, Noah
Scovronick1, Stefanie Ebelt1, Howard H Chang2, Yang Liu1
1Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA, USA
2Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University,

Atlanta, GA, USA

BACKGROUND AND AIM:Wildfire is a growing threat to the global economy and public health.
However, little is known about whether wildfire smoke PM2.5 is associated with mental healthoutcomes, especially anxiety disorders. Therefore, we aimed to examine the association between
wildfire smoke PM2.5 and emergency department (ED) visits for anxiety disorders in the Western
United States (WUS).
METHOD:We used a case-crossover design for the present study. Records of ED visits were obtained
from five different WUS states, including Arizona, California, Nevada, Oregon, and Utah. Anxiety
disorders were defined as ICD-10 codes F40-F48. Exposure to wildfire smoke PM2.5 and backgroundPM2.5 was evaluated with an ensemble learning method. We used a conditional logistic regression toevaluate the association between wildfire smoke PM2.5 and ED visits for anxiety disorders.
RESULTS:A total of 1,898,023 cases from 2007-2018 were included in this study. We found that per
10 μg/m3 increase in wildfire smoke PM2.5 was associated with an 0.6% (OR = 1.006 [1.001,1.012],
p = 0.029) increase in the risk of ED visits for anxiety disorders. Age- and sex-stratified analysis
showed that females (OR per 10 μg/m3 = 1.012 [1.002,1.021], p = 0.020) and the elderly population(OR per 10 μg/m3 = 1.035 [1.017, 1.054], p < 0.001) were more vulnerable to wildfire smoke PM2.5
regarding anxiety disorders. Additionally, an extreme smoke event (defined as smoke PM2.5
contributed to >= 75% of the total PM2.5 in the past 48 hours) was also associated with an increasein the risk of ED visits for anxiety disorders (OR = 1.063 [1.015, 1.113], p = 0.009).
CONCLUSIONS:We found that exposure to wildfire smoke PM2.5 and smoke events were both
associated with an increased risk of ED visits for anxiety disorders. Females as well as the elderly
population were more susceptible to wildfire smoke PM2.5 regarding anxiety disorders.

Keywords: wildfires, Mental health outcomes, Environmental epidemiology

OP-303[Air pollution » Wildfires]Wildfire exposure and academic performance inBrazil: a causal inference approach for
spatiotemporal data
Sean McGrath1, Rajarshi Mukherjee1, Weeberb J. Réquia2, Wan-Chen Lee3
1Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
2School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Brazil
3Institute of Environmental and Occupational Health Sciences, College of Public Health, National

Taiwan University, Taipei, Taiwan

BACKGROUND AND AIM:To estimate the effect of wildfire exposure on academic performance of highschool students in Brazil between 2009 and 2015.
METHOD:We obtained data on academic performance from the High School National Exam, which was
divided into the following subjects: natural sciences, social sciences, mathematics, Portuguese
language, and essay writing. Wildfire data were provided by the National Institute of Spatial Researchof Brazil, which were then aggregated to estimate the spatial density of wildfires in each municipalityof Brazil. Low and high levels of wildfire exposure were defined based on the first and third sample
quartiles of the municipalities-specific wildfire densities, respectively. We estimated the average causal
effect (ACE) comparing low and high levels of wildfire exposure on academic performance using
spatially varying regression models which adjust for potential confounders. We also performed
subgroup analyses to investigate how these effects change over time.
RESULTS:Data from 8,183 high schools across 1,571 municipalities in Brazil were included in our
analyses. We estimated that the average performance in most academic subjects decreased as thedensity of wildfires increased (e.g., a decrease of 9.43 points in the natural sciences (p-value =0.02)), although the average performance in essay writing increased. In the subgroup analyses, wefound that the ACE estimates became more negative over time. For instance, in the subgroup analysis
comparing data before and including 2012 to data after 2012, the ACE estimates decreased in allacademic subjects, ranging from 13.70 points (p-value = 0.04) in the natural sciences to 36.83 points(p-value = 0.02) in essay writing. Similar trends were observed in the subgroup analyses with othercutoff years.
CONCLUSIONS:Our results suggest that exposure to wildfires may worsen performance in mostacademic subjects and that such effects are becoming increasingly pronounced.

Keywords: children’s environmental health, causal inference, spatial statistics

OP-304[Air pollution » Particulate matter]

Wildfires are becoming a major contributor to
population exposure to PM2.5 pollution in theContinental United States
Yang Liu1, Danlu Zhang1, Wenhao Wang1, Yuzhi Xi1, Jianzhao Bi2, Yun Hang1, Qingyang Zhu1, Kirk R
Baker3, James T Kelly3, Howard Chang1
1Rollins School of Public Health, Emory University, Atlanta, USA
2School of Public Health, University of Washington, Seattle, WA, USA
3U.S. Environmental Protection Agency, Research Triangle Park, NC, USA

BACKGROUND AND AIM:As the frequency and intensity of wildfires increase in a warming climate, firesmoke has emerged as a critical contributor to ambient air pollution and its associated health risks.
METHOD:To better understand the impact of wildfire smoke on air quality, we developed a modelingsystem to estimate daily PM2.5 concentrations attributed to both fire smoke and non-smoke sources
across the Continental US.
RESULTS:We found that wildfire smoke has the most significant on air quality in the West Coast,
followed by the Southeastern US. Between 2007 and 2018, fire smoke affected daily PM2.5
concentrations at 40% of all regulatory air monitors in EPA's Air Quality System (AQS) for more than
one month each year. People residing outside the vicinity of an EPA AQS monitor were subject to 36%
more smoke impact days compared to those residing nearby. This underscores the importance ofsatellite- and model-based air quality assessment tools with wider spatial coverage to ensure a morecomprehensive understanding of PM2.5 levels nationwide. Lowering the national ambient air quality
standard (NAAQS) for annual mean PM2.5 concentrations to between 9 and 10ug/m3 would result inapproximately 29% to 40% of the AQS monitors falling in nonattainment areas without taking into
account the effect of fire smoke. When fire smoke impact is considered, this percentage would rise to
35% to 49%, demonstrating the significant negative impact of wildfires on air quality.
CONCLUSIONS:Our study highlights the growing threat of wildfires to air quality and public health in
the Continental United States.

Keywords: Wildfires, Exposure assessment, Modeling, Climate

OP-305[Respiratory and allergic outcomes » Asthma]

Ambient variation of fine particulate matterassociated with asthma treatment
Firdian Makrufardi1, Ting-Yu Lin2, Yuan-Chien Lin3, Hsiao-Chi Chuang4
1International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei,

Taiwan; Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas
Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
2Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;

Department of Thoracic Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
3Department of Civil Engineering, National Central University, Taoyuan City, Taiwan
4School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan;

National Heart and Lung Institute, Imperial College London, London, UK

BACKGROUND AND AIM:This study was to examine associations of daily averages and daily variationsin ambient relative humidity (RH), temperature, and fine particulate matter (PM₂.₅) on asthma
treatment.
METHOD:A cross-sectional study was conducted on 288 asthma patients recruited from hospitals in
Taipei between July 2018 and December 2020. The radial basis function method was used to spatiallyestimate meteorological and PM₂.₅ data of each case location. Logistic regression was used to
examine the odds ratio (OR) of outcome variables (daily mean or difference in PM₂.₅, RH, andtemperature for 1, 7, and 30 days) with asthma treatment defined by GINA guideline. Two-factor
logistic regression models were conducted to further examine the OR of PM₂.₅ with the daily mean ordifference in humidity or temperature with the asthma treatment.
RESULTS:We observed associations of mean PM₂.₅ and RH with respective increases of 0.047 and0.053 step 4 use in 1-day difference and 1-month difference. PM₂.₅ and RH were associated with therespective increases of 0.052 and 0.047 medium ICS+LABA use in 1-day difference and 1-monthdifference. An increase in daily PM₂.₅ difference of 1 μg/m³ increased 0.115 step 4 treatment use. A
daily RH increase of 1% increased the step 2 treatment use by 0.180, whereas a daily increase in thetemperature of 1°C increased the step 3 treatment use by 0.408. In addition, a daily decrease in thetemperature of 1°C decreased the step 4 treatment use and medium ICS+LABA treatment use by
0.336 and 0.353, respectively. The two-factor model confirmed the most robust associations ofambient PM₂.₅ with the asthma treatment.
CONCLUSIONS:Short-term ambient variations in PM₂.₅, RH, and temperature were associated withchanges in the treatment of asthma patients. Minimizing exposure to high levels of ambient PM₂.₅,
RH, and temperature could have a positive impact on asthma management.

Keywords: air pollution, asthma, climate, particulate matter, temperatureOP-306[Air pollution » Particulate matter]

Association between respiratory tract depositedinhaled dose of PM0.25-10 mass-count andairway inflammation based on individual
exposure assessment
Kyungjun Jeong1, Yongjin Lee3, Youngwook Lim2, Dongchun Shin2, Changsoo Kim2
1Department of Public Health, Graduate School, Yonsei University & Institute of Environmental

Research, Department of Preventive Medicine, Yonsei University
2Department of Preventive Medicine, Yonsei University & Institute of Environmental Research,

Department of Preventive Medicine, Yonsei University
3Institute of Environmental Research, Department of Preventive Medicine, Yonsei University

BACKGROUND AND AIM:Short-term exposure of particulate matter mass and count could be related to
airway inflammation for children.
This research is to find different risk level of airway inflammation by size-segregated PM from 0.25 um
to 10.0 um.
METHOD:Based on individual exposure assessment, PM mass and count were monitored for 5
consecutive days against 51 children.
Baseline information including exposure factors related airway inflammation was surveyed.
Real-time portable monitoring device able to detect both mass and count over size from 0.25 um to
10 um was utilized.
The PM sizes were classified into six categories: PM0.25-10.0, PM0.25-4.0, PM0.25-2.5, PM0.25-1.0,
PM0.25-0.5, PM0.25-0.25.
FeNO was measured two times day (early morning and late evening) under the standardized
procedures by the American Thoracic Society.
All participants were adjusted accelerometer device in order to consider physical activity level.
Deposition fraction of particle in each respiratory region (ET: Extrathoracic, TB: Tracheobronchial, AV:
Alveolor) was calculated by using dosimetry model (MPPD v3.04 by ARA. US).
Dose was calculated with concentration of PM mass and count by size, inhalation rate fromaccelerometer, and deposition fraction from dosimetry model.
We applied distributed non-linear lag model and linear mixed-model to evaluate the FeNO and PM
mass-count association.
RESULTS:Different relative risk level and dose-response relations was observed in different PM masscount sizes.
Risk was higher when PM size was smaller.
Different dose-response between PM mass and count in same respiratory regions was detected.
Also different dose-response over PM sizes in same respiratory regions was detected.
Risk patterns were different in different respiratory region for same PM size
CONCLUSIONS:Our study showed clear risk pattern of FeNO by PM mass and count over sizes and by
respiratory tract.
Small size of PM is more vulnerable than Big size of PM.
Particle count shows more risk than PM mass.

Keywords: PM mass-count, FeNO, Dose, Risk

OP-307[Air pollution » Long-term exposure]Long-term exposure to air pollution and the riskof obstructive lung disease in a Danish
nationwide administrative cohort
Rina So1, Youn Hee Lim2, Jiawei Zhang2, Laust H. Mortensen3, Kees De Hoogh4, Steffen Loft2, George
Maria Napolitano2, Thomas Cole Hunter2, Stéphane Tuffier2, Marie Bergmann2, Matija Maric2, Bert
Brunekreef5, Gerard Hoek5, Zorana J. Andersen2
1Department of Epidemiology and Public Health, University College London, London, United Kingdom;

Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
3Denmark Statistic, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health,

University of Copenhagen, Copenhagen, Denmark
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel,

Switzerland
5Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands

BACKGROUND AND AIM:Air pollution has been associated with obstructinve lung disease in adults,
including asthma and chronic obstructive pulmonary diseases (COPD). However, the evidence is still
mixed, and the definition of the incidence of these outcomes varies across studies. Therfore, we aimed
to explore associations of long-term exposure to air pollution with asthma and COPD incidence inadults and a joint outcome defined by medication use for obstructive airway disease.
METHOD:All residents in Denmark aged ≥ 30 years (3,074,599) were followed for their first hospital
contact for asthma or COPD and the prescribed medication for obstructive respiratory diseases from 1Jan-2000 until 31-Dec-2018. Annual residential mean levels of fine particulate matter (PM₂.₅),
nitrogen dioxide (NO₂), and black carbon (BC) at baseline addresses were estimated by hybrid landuse regression models. We used Cox proportional hazard models, adjusting for potential confounders,
to assess the associations.
RESULTS:During mean follow-up of 16 years, we identified 52,648 and 146,269 individuals withincident asthma and COPD from hospitalization records, respectively, and 419,203 individuals from theprescribed medication for obstructive airway disease. We observed that a 5 µg/m³, 10 µg/m³, and
0.5×10⁻⁵/m increase in PM₂.₅, NO₂, and BC, respectively, were associated with higher risks of asthma
incidence [hazard ratio: 1.30 (95% confidence interval: 1.23, 1.38); 1.17 (1.14, 1.19); 1.18 (1.15,
1.21)], COPD incidence [1.11 (1.07, 1.16); 1.06 (1.05, 1.08); 1.08 (1.06, 1.09)], and medication use[1.04, (1.01, 1.06); 1.05 (1.04, 1.06); 1.03 (1.02, 1.05)].
CONCLUSIONS:Long-term exposure to air pollution were strongly associated with asthma and COPD
incidence defined by hospital contact and weakly with the joint outcome defined by medication use in
the Dnaish nationwide analysis.

Keywords: Asthma, incidence, Respiratory outcome

OP-308[Air pollution » Long-term exposure]Long-term exposure to air pollution and risk of
hospital admissions for obstructive lung disease
among older English people
Rina So, Giorgio Di Gessa, Thomas Byrne, Paola Zaninotto
Department of Epidemiology and Public health, University College London, London, United Kingdom

BACKGROUND AND AIM:Air pollution is the established risk factor for adverse respiratory healthoutcomes, yet its effect on hospital admission for obstructive lung disease, especially for the elderly,remains unclear. We aimed to examine the associations of incident obstructive lung disease with longterm exposure to fine particulate matter (PM₂.₅) and nitrogen dioxide (NO₂).
METHOD:We followed 6,343 respondents (aged > 50 years) from the English Longitudinal Study ofAgeing (ELSA), from the time of study interview in wave 5 (2010-2011) to 31-1-2018 for hospital
admission for obstructive lung disease. Incident obstructive lung disease was defined as the first
hospital contact for chronic obstructive pulmonary disease or asthma between baseline and 2018.
Annual mean levels of residential exposure to PM₂.₅ and NO₂ were assessed by the Data Integration
Model for Air Quality at 0.1°×0.1° spatial resolution during the follow-up. We examined theassociations with time-varying Cox proportional hazards models adjusting for potential confounders.
We also examined effect modifications by socioeconomic status (SES) and urbanicity.
RESULTS:During the mean follow-up of 6.3 years, 340 incident obstructive lung disease cases weredetected. We observed the suggestive association between incident obstructive lung disease andPM2.5 with a hazard ratio (HR) (95% confidence interval) of 1.18 (0.85-1.64), per 5 µg/m³, not withNO₂ (HR: 0.99, 0.87-1.12). We did not observe effect medication by SES, while increased associations
were detected in rural area for both pollutants [HR (95% CI) for rural vs urban area: 1.24 (0.63-2.43)
vs 1.15 (0.80-1.66) per 5 µg/m³ for PM₂.₅, respectively; 1.27 (0.90-1.80) vs 0.91 (0.78-1.07) per 10µg/m³ for NO₂, respectively].
CONCLUSIONS:This study suggests that long-term exposure to PM₂.₅, or NO₂ in rural area, may leadto incident chronic lung disease in the elderly, and that the risk may be higher in rural area. Futurestudies for elucidating what drive this difference is needed.

Keywords: Respiratory outcomes, Environmental epidemiology

OP-309[Air pollution » Long-term exposure]

Investigating links between long-term air
pollution exposure and SARS-CoV-2 infection,
hospitalisation and mortality:a meta-analysis ofcohort studies
Shawn Lee1, Abigail B Schneider2, Heather Walton1, Klea Katsouyanni3, Dimitris Evangelopoulos2
1Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,

London, UK; NIHR HPRU in Environmental Exposures and Health, UK
2Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,

London, UK
3Environmental Research Group, MRC Centre for Environment and Health, Imperial College London,

London, UK; Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian
University of Athens, Medical School, Greece

BACKGROUND AND AIM:Exposure to air pollution has harmful effects on respiratory health. However,it was unclear after the COVID-19 pandemic, whether air pollution increases the chance of catching
COVID-19 or worsens health outcomes such as mortality after being infected. A plethora of studies
has been published, but they vary widely in quality and content. We conducted a systematic review
and meta-analysis to synthesize the current evidence available concerning exposure to PM₂.₅, PM10,
NO₂, and O₃ and risk of SARS-CoV-2 infection, hospitalisation, and mortality, focusing on cohort
studies with individual-level information.
METHOD:We systematically searched EMBASE, Medline, Scopus and Web of Science. Studies retrieved
were screened with inclusion and exclusion criteria set a priori. Relevant data was extracted, andstudy quality was assessed using the WHO Air Quality Guidelines Risk of Bias Evaluation tool. Effectestimates were scaled to per 1µg/m³ increment and converted to odds ratios (OR). Pooled ORs were
calculated using random-effect meta-analysis for the respective pollutant-outcome pairs.
RESULTS:12 studies were included in the meta-analysis. A 1µg/m³ increase in PM₂.₅ exposure wasassociated with a higher risk of SARS-CoV-2 infection (OR = 1.06, 95% Confidence Interval: 1.01 –1.11) and hospitalisation (1.08, (0.99 - 1.17)). A 1µg/m³ increase in NO₂ exposure was associatedwith a higher risk of SARS-CoV-2 mortality (1.01, (1.00 – 1.01)). O₃ exposure was not significantly
associated with the SARS-CoV-2 outcomes investigated. An insufficient number of studies wereavailable to meta-analyse the relationship between NO₂ exposure and risk of SARS-CoV-2 mortality,
and O₃ exposure and risk of SARS-CoV-2 hospitalisation among SARS-CoV-2 positive individuals.
CONCLUSIONS:Higher previous exposures to PM₂.₅ and, to a lesser extent, NO₂, were associated withhigher risk of SARS-CoV-2 infection and hospitalisation. Long-term exposure to these pollutants may
increase the vulnerability of populations to SARS-CoV-2 infection and severity. More studies areneeded to confirm the associations found.

Keywords: COVID-19, OutcomesOP-310[Respiratory and allergic outcomes » Respiratory outcomes]

Effects of climate-mediated PM2.5 on lungfunction decline in chronic obstructive
pulmonary disease
Tran Minh Huan1, Lin Yuan Chien2, Tsai Fen Jen3, Chuang Hsiao Chi4
1Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical

University, Taipei, Taiwan; Faculty of Public Health, Da Nang University of Medical Technology andPharmacy, Vietnam
2Department of Civil Engineering, National Central University, Taoyuan City, Taiwan
3Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical

University, Taipei, Taiwan
4School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan;

National Heart & Lung Institute, Imperial College London, UK

BACKGROUND AND AIM:This study aims to examine the mediating effects of short-term exposure tofine particulate matter (PM2.5) on the associations of climate with lung function among chronic
obstructive pulmonary disease (COPD) patients.
METHOD:A cross-sectional study was conducted among 930 COPD patients in three hospitals in
Taiwan. Exacerbation history, modified Medical Research Council dyspnea scale, and COPD
Assessment Test score were measured to categorize different groups of COPD patients (A, B, E) basedon the Global Initiative for COPD guideline. Lung function was linked to the daily mean or difference
for 1, 7, and 30 days of individual-level exposure to relative humidity (RH), temperature, and PM2.5.
A mediation analysis was conducted to examine the mediating effects of PM2.5 on the associations ofdaily mean or difference for RH and temperature with lung function.
RESULTS:We observed that a 1oC decrease in mean temperature for 1 day was associated with a
0.21% decrease in FEV1/FVC and 0.29% in FEV1 among group A COPD patients. A decrease in the 1day RH difference of 1% was associated with a 0.91% decrease in FEV1, and a 0.92% decrease in FVC
among group B COPD patients, while an increase in the 7-day RH difference of 1% was associatedwith a 0.95% increase in FVC among group B COPD patients. A 1 µg/m3 increase in mean PM2.5 for 1day, 7 days, and 30 days were associated with 0.61%, 0.55%, and 0.56% decreases in FEV1 andwere associated with 0.69%, 0.67%, and 0.69% in FVC among group B COPD patients, respectively.
The association of RH difference with FEV1 among group B COPD patients was partially mediated by
PM2.5.
CONCLUSIONS:Climate-mediated PM2.5 increases the risk of lung function declines among COPD
patients. The study highlights the importance of climate variability associated with air pollution in thehealth outcomes of COPD patients.

Keywords: Climate, Environmental epidemiology, Particulate matter, Respiratory outcomes, Shortterm exposureOP-311[Outcomes » Mortality]

Mortality trends of chronic obstructive
pulmonary disease in South Korea, 1995–2021
using joinpoint regression analysis
Baek Yong Choi, Juho Choi, Seung Woo Ryoo, Seok Yoon Son, Kyoung Bok Min
Department of Preventive Medicine, Seoul National University, College of Medicine, 103 Daehangno,
Jongno-gu, Seoul 110-799, Republic of Korea

BACKGROUND AND AIM:Chronic obstructive pulmonary disease (COPD) is the third leading cause ofdeath in worldwide. Regional differences in COPD mortality trends exist, but studies on Asian countries
are insufficient. We aimed to analyze COPD mortality trends by sex and age from 1995 to 2021 inSouth Korea.
METHOD:This study obtained COPD deaths between 1995 and 2021 from the Korean Statistics
Information Service (KOSIS), using the International Classification of Diseases 10 (ICD-10) codes J40(bronchitis), J41-42 (chronic bronchitis), J43 (emphysema), J44 (other COPD), and J47(bronchiectasis). Using the world standard population, we estimated COPD age-standardized mortality
rates (ASR), and executed a joinpoint regression analysis.
RESULTS:ASR per 100,000 population decreased from 8.12 to 3.84 between 1995 and 2021. It
showed some fluctuation for the study period. ASR was high increased from 7.50 to 15.68 between
1998 and 2002, after that it steadily reduced from 15.68 to 3.84. Further stratifying sex, ASR per
100,000 has decreased from 13.43 to 7.24, from 5.23 to 1.72 in male and female for the study
period, respectively. It was found that the gender gap in COPD mortality was narrowing.
CONCLUSIONS:We found an upward trend from 1998 to 2002 and downward trend from 2002 to 2021
of COPD mortality in South Korea. A gap of mortality by sex has been narrowed and it was supposed
to be smoking rate change. We found similar pattern of the trends that concentration of particulatematter ≤10 μm increased 1998-2002 and decreased 2002-2012 in Seoul. COPD mortality trends could
be considered as making policy related to smoking cessation and particulate matter reduction.

Keywords: COPD, Mortality, Particulate matterOP-312[Respiratory and allergic outcomes » Asthma]

Hepatitis C Virus Antibody Positivity Strongly
Associated with Prevalent Asthma
Li Han Lan1, Fu Hsiung Su2, Chih Ching Yeh3
1School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
2Department of Family Medicine, Cardinal Tien Hospital, Fu Jen Catholic University, New Taipei City,

Taiwan3School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan

BACKGROUND AND AIM:Although asthma prevalence in Taiwan is only around 3.54%, it is one of the
primary sources of health concern. In addition, hepatitis has long been regarded as one of the mostprominent diseases in Taiwan, with 17.3% of the population being carriers of hepatitis B virus (HBV)
infection, and an estimated 4.4% prevalence of hepatitis C virus (HCV) infection. However, studies
that investigate potential association between asthma and hepatitis are lacking. We aimed toinvestigate the relationship between hepatitis and asthma among the Taiwanese adult population.
METHOD:This study analyzed the data of 122,071 subjects aged between 30 to 70 years old in Taiwan
Biobank, with information of asthma status, socioeconomics and lifestyle factors obtained via
questionnaire and hepatitis antigen and antibody measurements obtained from physical examination
results. Demographic analyses of both diseases were first carried out, then calculations of odds ratio(OR) and 95% confidence intervals (CI) were made to evaluate association between asthma andhepatitis. A logistic regression model was used with adjustment for potential confounders. All
statistical analyses were performed via the SAS 9.4 software.
RESULTS:The results showed that the two diseases had differing demographic distributions. It wasalso found that while HBV infection had a significant association with asthma (OR=1.237, 95%
CI=1.082-1.393, P=0.0015), HCV positivity had a stronger significant association with asthma(OR=1.379, 95% CI=1.145-1.66, P=0.0007). Increased risk of asthma was particularly morestrengthened in subjects infected with HCV alone, with OR=1.519 (95% CI=1.078-2.140, P=0.0168),
compared to non-hepatitis subjects.
CONCLUSIONS:The study’s findings offer more insight into the relationship between hepatitis andasthma and suggests that asthma and HCV may be closely linked. This prompts a strong
recommendation for future studies to explore the underlying mechanisms that bring about such a
relationship.

Keywords: Asthma, Hepatitis

OP-313[Respiratory and allergic outcomes » Asthma]

The relationship between reproductive
hormones and asthma-related outcomes in boys
residing in the rural Western Cape
Mandy S Phuti1, Mohamed Aqiel Dalvie1, Toyib Olaniyan2, Mohamed F Jeebhay1
1School of Public Health, University of Cape Town, Cape Town, South Africa
2Division of Health analysis, Statistics Canada, Ottawa, Canada

BACKGROUND AND AIM:Asthma is more prevalent and severe among boys but this pattern reverses
after puberty. It has been suggested that reproductive hormones may play a role in explaining thesesex differences after puberty, but the evidence is still limited especially for children living in low- andmiddle-income countries. This study investigated the association between reproductive hormones andasthma-related outcomes among boys residing in a rural setting.
METHOD:A cross-sectional study of 314 boys (9-16 years), residing in the rural Western Cape
province of South Africa was conducted. General questionnaires were administered to the boys andtheir caregivers including an abbreviated International Study of Asthma and Allergies in Childhood(ISAAC) questionnaire. Testosterone (TST and FT), luteinizing hormone (LH), serum folliclestimulating hormone (FSH), oestradiol and serum hormone-binding globulin (SHBG), were assessedusing electrochemiluminescence immunoassays. Multivariate logistic regression models were used toassess the relationship between asthma and measured endocrines levels.
RESULTS:The mean age of the boys was 11.2 (Standard deviation -1.7 years). Current wheeze (CW),
asthma symptom score ≥ 2 (ASS) and parental reported asthma (PA) prevalence were 6.1%, 6.7%
and 8.0%, respectively. In the adjusted multivariate logistic regression models, total serum
testosterone (TST) levels were negatively associated with CW (OR=0.66, 95% CI: 0.45-0.98), ASS(OR=0.64, 95% CI: 0.43-0.95) and PA (OR=0.86, 95% CI: 0.59-1.25). Free testosterone (FT) levels
were similarly negatively associated with all three asthma-related outcomes. Similar associations werealso found for LH and FSH, but there were no clear associations for estradiol and SHBG with asthmarelated outcomes. The concentration-response curves confirmed that higher levels of testosterone(TST and FT) were associated with reduced risk of asthma-related outcomes.
CONCLUSIONS:This study provides evidence that increasing testosterone levels are associated with
reduced asthma risk among rural boys in South Africa.

Keywords: Male, reproductive outcomes, children's environmental health,OP-314[Air pollution » Ozone]Long-term exposure to ambient ozone and lungfunction decline over 20 years in adults: The
ECRHS study
Tianyu Zhao1, Iana Markevych2, Elaine Fuertes3, Kees De Hoogh4, Simone Accordini5, Anne Boudier6,
Lidia Casas7, Bertil Forsberg8, Judith Garcia Aymerich9, Marco Gnesi10, Mathias Holm11, Christer
Janson12, Deborah Jarvis3, Ane Johannessen13, Benedicte Leynaert14, José Antonio Maldonado
Perez15, Andrei Malinovschi12, Lars Modig8, James Potts16, Nicole Probst Hensch4, Valerie Siroux17,
Isabel Urrutia Landa18, Danielle Vienneau4, Simona Villani10, Bénédicte Jacquemin19
1Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU

Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for
Lung Research (DZL), Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health, Neuherberg, Germany
2Institute of Psychology, Jagiellonian University, Krakow, Poland; Research group “Health and qualityof life in a green and sustainable environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
3National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre forEnvironment & Health, London, UK
4Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel,

Switzerland
5Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, Universityof Verona, Verona, Italy
6Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institutefor Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000
Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France
7Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Facultyof Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment
and Sustainable Development (IMDO), University of Antwerp, Belgium
8Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University,Umeå, Sweden
9ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología

y Salud Pública (CIBERESP), Barcelona, Spain
10Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental andForensic Medicine, University of Pavia, Pavia, Italy
11Occupational and Environmental Medicine, School of Public Health and Community Medicine,

Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
12Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University,

Uppsala, Sweden
13Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
14Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population

Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France
15Sección de Neumología, Hospital Juan Ramón Jiménez, Huelva, Spain
16National Heart and Lung Institute, Imperial College London, London, United Kingdom
17Pediatric Department, CHU Grenoble Alpes, Grenoble, France

18Department of Pneumology, Galdakao Hospital, Galdakao, Spain
19Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail),

UMR_S 1085, F-35000 Rennes, France

BACKGROUND AND AIM:Short-term exposure to ambient ozone consistently shows adverse effects onlung function in children and adults. However, little is known whether long-term exposure also has
detrimental effects on lung function.
We explored the association between long-term exposure to ozone and lung function decline over 20
years in 3014 adults from 17 centers in 8 countries participating in the population-based cohort of theEuropean Community Respiratory Health Survey (ECRHS).
METHOD:Pre-bronchodilation forced expiratory volume in 1 second (FEV1) and forced vital capacity(FVC) were measured by spirometry when participants were 25–44, 30–55, and 40–64 years old.
Annual mean values of daily maximum running 8-hour average ozone concentrations were assigned tothe individual residential addresses at each lung function measurement. Co-pollutants (PM2.5 andNO2) and greenness (Normalized Difference Vegetation Index, NDVI) were also considered for
adjustment. Associations between rate of lung function decline and ozone concentrations wereanalyzed by adjusted linear mixed effects regression models.
RESULTS:Mean ambient ozone concentrations were around 65 µg/m³. An increase by an interquartile
range of 7 µg/m³ ozone concentration was associated with a faster decline in FEV1 by -2.08 mL/year(95% confidence interval: -2.79, -1.36) and in FVC by -2.86 mL/year (-3.73, -1.99) mL/year.
Associations were robust across different models, including adjustments for co-exposure to PM2.5,
NO2, and NDVI. They were more pronounced in residents of northern Europe and those with higher
education or older. No consistent associations were detected with the FEV1/FVC ratio.
CONCLUSIONS:Long-term exposure to elevated ambient ozone concentrations was associated with afaster decline of spirometric lung function over 20 years in middle-aged European adults.
Nevertheless, further studies in other regions with other populations and exposure levels are needed
to substantiate the associations identified in this study.

Keywords: Long-term exposure; Green space; Respiratory outcomes; Environmental epidemiology

OP-315[Air pollution » Wildfires]

Association between smoke haze andrespiratory clinic visits in Central Kalimantan
Vera Ling Hui Phung1, Kayo Ueda2, Nina Yulianti3, Masafumi Ohashi4, Masahiro Kawasaki5,
Abdurahman Al Hakim S.p.s.6, Fatmaria Fatmaria6, Kahanjak Donna6, Syamsul Arifin6, Daisuke
Naito7
1Center for Climate Change Adaptation, National Institute for Environmental Studies (NIES), Tsukuba,Japan
2Department of Hygiene, Graduate School of Medicine, Hokkaido University, Japan
3Department of Agronomy, Faculty of Agriculture, Universitas Palangka Raya, Palangka Raya,

Indonesia
4Department of Information Science and Biomedical Engineering, Graduate School of Science andEngineering, Kagoshima University, Kagoshima, Japan
5Research Institute for Humanity and Nature, Kyoto, Japan
6Faculty of Medicine, Universitas Palangka Raya, Palangka Raya, Indonesia
7Graduate School of Agriculture, Kyoto University, Kyoto, Japan; Center for International Forestry

Research (CIFOR), Indonesia

BACKGROUND AND AIM:Smoke haze due to vegetation fires is one of the major air pollution issues inSoutheast Asia. Exposures of the residing populations to the smoke haze may pose health impacts,
but such evidence from the Southeast Asia remains scarce. In this study, we examined the association
between smoke haze and respiratory clinic visits in Central Kalimantan. Specifically, we investigatedwhether duration and intensity modify the association.
METHOD:The study period spanned from July 7th, 2015 to December 31st, 2019, with different date
range for each clinic depending on data availability. We applied a time-stratified case-crossoverdesign, adjusting with smoothing spline on three-days moving average of temperature and indicatorvariable of holidays. PM10 was estimated using a combination of ground-measured, Himawari-8
satellite, albedo, and visibility data. Fire hotspot counts derived from fire radiative power (FRP)
information was used to define haze, duration of continuous haze days, and intensity of haze days, in
combination with PM10 concentration. Haze day was defined if PM10 ≥100μg/m³ and FRP >0.
Duration indicators were defined as at least one- and three- continuous haze days over the past sevendays. Intensity of low and high were distinguished by: “low” (PM10 ≥100μg/m³ and 0<firehotspot≤10 (50th-percentile of fire hotspot in whole region), and “high” (PM10 ≥100μg/m³ and fire
hotspot ≥10.
RESULTS:Overall, we found weak evidence for smoke haze effects on respiratory clinic visits in Central
Kalimantan, although a few significant higher risks were observed at specific lags in some clinics.
CONCLUSIONS:This study further discussed the possibility of associations near the null, and the roleof duration and intensity in estimating health risks of smoke haze.

Keywords: wildfires, respiratory, Southeast Asia

OP-316[Reproductive outcomes » Female reproductive outcomes]

Ambient air pollution in relation to ovarian
reserve and oocyte quality in young, healthyoocyte donors
Audrey J Gaskins1, Jaqueline C Lee2, Zsolt P Nagy3, Daniel B Shapiro3, Howard H Chang1, Armistead
G Russell4, Heather S Hipp2
1Emory University Rollins School of Public Heath, Atlanta, GA
2Emory University School of Medicine, Atlanta, GA
3Reproductive Biology Associates, Sandy Springs, GA
4Georgia Institute of Technology, Atlanta, GA

BACKGROUND AND AIM:Our objective was to evaluate the effects of air pollution on ovarian reserveand outcomes of ovarian stimulation among young, healthy females.
METHOD:We included 184 oocyte donors who underwent 244 ovarian stimulation cycles at a fertility
clinic in Atlanta, Georgia, USA (2006-2011). Daily ambient exposure to nitric oxide (NOx), carbon
monoxide (CO), and particulate matter <2.5 (PM2.5) was estimated using a fused regional+linesource model for near-surface releases at a 250 m resolution based on residential address. Antral
follicle count (AFC) was assessed with transvaginal ultrasonography and mature oocyte count wasassessed following oocyte retrieval. Poisson regression models with robust standard errors were used
to estimate the associations of each air pollutant with AFC and oocyte count adjusted for age, race,
BMI, smoking, education, year, and season.
RESULTS:The median (interquartile range, IQR) age among oocyte donors was 26.0 (4.0) years and
25% were racial/ethnic minorities. The median (IQR) exposure to NOx, CO, and PM2.5 in the 3months prior to stimulation was 40.6 (29.2) ppb, 699.2 (364.4) ppb, and 12.2 (3.0) µg/m3,
respectively. Air pollution in the 3 months prior to ovarian stimulation was not associated with AFC.
Higher exposure to PM2.5 (but not NOx or CO) during ovarian stimulation (8-13 days) was associatedwith significantly fewer mature oocytes retrieved (% change: -10.5, 95% CI -19.5, -0.5 per IQR
increase). When modelled using cubic splines, there was a strong, negative association between PM2.5
and AFC up to 14 µg/m (the 75th percentile), with no additional decrements with higher PM2.5
exposures (p-value for non-linearity <0.001).
CONCLUSIONS:In our cohort of young, healthy women, higher exposure to PM2.5 was associated withpoorer response to ovarian stimulation. Future work will investigate whether there are additional
impacts of PM2.5 on embryo and clinical outcomes following the use of these vitrified donor oocytes byrecipient couples.

Keywords: air pollution, fertility, ovary, fecundity

OP-317[Birth and pregnancy outcomes » Pregnancy outcomes]

Diminished association of acute exposure toambient pollutants and preterm prematurerupture of membranes risk with the usage of
facemasks
Cheng Li1, Jing Jing Xu1, Chuan Luo1, Kai Zhen Su2, Yan Ting Wu1
1Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University,

Shanghai, China
2International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong

University, Shanghai, China

BACKGROUND AND AIM:Maternal exposure to ambient air pollutants has been shown to be associatedwith a variety of adverse perinatal outcomes, including preterm premature rupture of membranes(PPROM). Face masks are regarded as a common personal-level intervention to reduce ambient air
pollutant exposure. The usage of face masks has become prevalent since the outbreak of COVID-19.
This study was designed to explore the association of the usage of face masks with acute exposure toambient pollutants and PPROM risk.
METHOD:Pregnant women receiving antenatal care at hospitals were enrolled. Women who delivered
between January 2020 and December 2021 were included in the group with face mask usage, while
those who delivered outside that period were included in the group without face mask usage. The
effects of ambient pollutants on PPROM risk were estimated using generalized additive models(GAMs). Exposure-response relationship curves were also evaluated using GAMs after adjustment for
confounding factors. Potential lagged effects were examined using distributed lag nonlinear models.
RESULTS:During the period from October 2013 to December 2019 without face mask usage, anincreased risk of PPROM was associated with increased concentrations of PM2.5, PM10, SO2, CO andNO2 on lag day 2, while no association was found during the period from January 2020 to December
2021 with face mask usage after the outbreak of COVID-19. After adjustment for confounding factors,
the exposure-response curves did not indicate positive associations between PPROM risk and PM2.5,
PM10, SO2, and CO exposure during the period with face mask usage; however, positive associations
were indicated during the period without face mask usage.
CONCLUSIONS:Acute exposure to six critical air pollutants was associated with an increased risk of
PPROM. The usage of face masks may reduce the impact of air pollution exposure on PPROM risk.

Keywords: acute exposure, ambient pollutants, preterm premature rupture of membranes, facemasks

OP-318[Air pollution » Particulate matter]

Antioxidant Consumption as an Effect Modifierin the Association Between Air Pollution
Exposure and Preterm Birth
Miatta A. Buxton1, Caroline Smerdon1, Marisol Castillo Castrejón2, Marie S. O’neill3, Felipe Vadillo
Ortega4
1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
2Department of Pathology, Stephenson Cancer Center, Harold Hamm Diabetes Center, University ofOklahoma Health Sciences Center, Oklahoma City, OK, USA
3Departments of Environmental Health Sciences and Epidemiology, School of Public Health, Universityof Michigan, Ann Arbor, MI, USA
4Unidad de Vinculación Cientíﬁca de la Facultad de Medicina, Universidad Nacional Autónoma deMéxico en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico; Department ofEnvironmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA

BACKGROUND AND AIM:Exposure to particulate matter likely contributes to risk of preterm delivery
among pregnant women due to increased oxidative stress and systemic inflammation. Consumption ofantioxidants during pregnancy may help to reduce these effects, and ultimately reduce the risk ofpreterm delivery. We calculated dietary antioxidant intake during pregnancy to evaluate individual andjoint associations of prenatal antioxidant intake and exposure to fine particulate air pollution (PM2.5)
with preterm delivery.
METHOD:Data were from the Pregnancy Research on Inflammation, Nutrition, and City Environment:
Systematic Analyses (PRINCESA) cohort in Mexico City; participants were enrolled and followed from2009-2015. Antioxidant intake was assessed through a food frequency questionnaire based on foodservings per week and PM2.5 exposure was estimated using geostatistically kriged data from the
Mexico City Atmospheric Monitoring System. Adjusted Cox proportional hazards models were used toevaluate the associations between trimester-specific and entire pregnancy PM2.5 exposure andpreterm birth and to assess effect modification by antioxidant intake.
RESULTS:Mean antioxidant consumption did not differ by preterm birth status among 817
participants. After adjusting for mother’s age, prepregnancy body mass index, education, parity,
marital status, secondhand smoke, and infection, PM2.5 exposure was not associated with preterm
birth (for any point during pregnancy). The hazard ratios and 95% confidence intervals (CI) for first,
second, third trimester and overall exposure to PM2.5 were 0.98 (0.92, 1.04), 1.05 (0.98, 1.12) and
0.95 (0.90, 1.00), and 0.97 (0.84, 1.12), respectively. Considering interaction between PM2.5 anddietary antioxidant index did not affect this null association.
CONCLUSIONS:Although no association between PM2.5 exposure and preterm birth was observed inthis sample, other research suggests that pollutants may impact the risk of adverse birth outcomes inpregnant women. Future studies should explore the effects of additional pollutants on the risk ofpreterm delivery as well as their interaction with dietary antioxidant intake.

Keywords: Particulate matter, Birth outcomes, Food/nutrition

OP-319[Exposures » Water quality]

Nitrate contamination in drinking water and therisk of preterm birth: Overview of a national
retrospective cohort study
Tim James Chambers
Department of Public Health, University of Otago, Wellington, New Zealand

BACKGROUND AND AIM:OBJECTIVES: To provide an overview of a large national retrospective birthcohort assessing the relationship between nitrate contamination in drinking water and preterm birth.
To provide an opportunity for collaboration using a powerful individual-level database of routinely
collected government information called the Integrated Data Infrastructure (IDI) in New Zealand.
METHOD:METHODS: We have established a national birth cohort of all babies born 2009-2021 (13years) (~700,000 births) identified in the IDI. The IDI is a database of routinely collected information(health, tax, crime, census, housing, social services) linked at the individual-level using probabilistic
matching that can be used for public good research in New Zealand.
RESULTS:RESULTS: We have an established retrospective cohort of births between 2009-2021 which
provide opportunities to investigate the impact of environmental exposures. Our project is currently
collating drinking water data from the 67 territorial authorities responsible for drinking water service
provision in New Zealand. Future research is anticipated to look at the relationship between nitrate
and other birth outcomes including congenital abnormalities, and bowel cancer.
CONCLUSIONS:CONCLUSION: The IDI is a powerful national scale database with the capacity toanswer research questions related to environmental epidemiology. Nitrate exposure is one aspect ofwater quality that will be first investigated, but future studies could investigate a broader range ofwater quality contaminants. This research is funded by the Health Research Council of New Zealand(HRC#22-059).

Keywords: water quality, birth outcomes, public health, methodological study design, environmental
epidemiology.

OP-320[Air pollution » General]

Associations of early pregnancy air pollution
with adverse birth outcomes and infant
neurocognitive development
Yingxin Chen1, Tao Kuang2, Ting Zhang3, Yutong Samuel Cai1, Alex Harper4, Ting Li Han5, Yinyin
Xia6, John Gulliver1, Anna L Hansell1, Hua Zhang3, Philip N Baker7
1Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK;The

National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental
Exposure and Health at the University of Leicester, Leicester, UK
2Department of public health and management, Zunyi Medical and Pharmaceutical College, ZunYi,

563000, Guizhou, China
3Stomatological Hospital of Chongqing Medical University, Chongqing, 401147, China
4College of Life Sciences, University of Leicester, Leicester, UK
5Department of Obstetrics and Gynaecology, the First Affiliated Hospital of Chongqing Medical

University, Chongqing, 400016, China
6School of Public Health, Chongqing Medical University, Chongqing, 400016, China
7College of Life Sciences, University of Leicester, Leicester, UK;Department of Obstetrics andGynaecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

BACKGROUND AND AIM:This study aimed to investigate the associations of traffic-related air pollution
exposures in early pregnancy with birth outcomes and infant neurocognitive development in the
Complex Lipids in Mothers and Babies (CLIMB) cohort in Chongqing, China.
METHOD:1,273 pregnant women enrolled in 2015-2016 and 1,174 births were included in thisanalysis. Air pollution concentrations at their home addresses, including particulate matter (PM) withdiameter ≤2.5μm (PM2.) and nitrogen dioxide (NO2), during pre-conception and each trimester period(TI, T2, T3) were estimated using land-use regression models. Mental and psychomotor development
functions were assessed using the Mental Development Index (MDI) and the Psychomotor
Development Index (PDI) of the Bayley Scales of Infant Development (BSID) at 12 months of age.
The associations of exposure to air pollution in each time window, with birth and neurodevelopment
outcomes were estimated by linear and logistic regression models, adjusted for maternal age, infantsex, maternal body mass index (BMI), parity, monthly household income level, and season of births.
RESULTS:Median PM2.5 exposure levels were 57.31 μg/m3 (IQR: 5.76) and median NO2 exposurelevels were 50.46 μg/m3 (IQR: 5.51) during the whole pregnancy period. An association between
small for gestational age (SGA ) and per IQR increases in NO2 was found during the whole pregnancy(OR: 1.34, 95% CI: 1.01, 1.77) and in T1 (OR: 1.58, 95% CI: 1.07, 2.34) in fully-adjusted model.
PM2.5 exposure in the 90 days prior to conception was associated with lower PDI score (β: -6.06,
95% CI: -8.77, -3.34). NO2 was associated with lower PDI in all pregnancy periods, except T2. These
effects were stronger in the two-pollutant models.
CONCLUSIONS:Air pollution pre- and during pregnancy were associated with increased risk of SGA
and infants' neurocognitive development. Pre-conception PM2.5 exposure was associated with adverse
neurodevelopment outcomes at 12 months of age only.

Keywords: Particulate matter, Oxides of nitrogen, Neurodevelopmental outcomes, Children'senvironmental health,OP-321[Exposures » Occupational exposures]

Relationship of Long Working Hours and Early
Chronic Kidney Disease: A Retrospective Cohort
Study in Taiwan
Wan Chin Chen1, Hsiao Yu Yang2
1Department of Family Medicine, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City,

Taiwan2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of

Public Health, No. 17 Xuzhou Road, Zhongzheng Dist., Taipei, Taiwan

BACKGROUND AND AIM:The relationship between long working hours and early chronic kidney disease(CKD) is still unclear. We aimed to evaluate the association between long working hours andestimated glomerular filtration rate (eGFR) among healthcare workers.
METHOD:We conducted a retrospective cohort study among healthcare workers in a tertiary medical
center in Taiwan from 2002 to 2021. All hospital employees aged 20-65, except for physicians, wholack of records of working hours, were eligible. We excluded participants with eGFR <60 ml/min/1.73
m2 at enrollment to focus on early CKD. The total working hours in each year were collected. We
compared the baseline characteristic among tertiles of total working hours in the enrolling year. We
assessed the relationship between total working hours and eGFR using the generalized linear mixed
model (GLMM), adjusting for demographic and laboratory profiles.
RESULTS:The study included 10117 participants with the mean age of 26.7 years (standard deviation
7.1), 88.9% were females. The median follow-up was 4 years (interquartile range 2 to 9 years). For
every 10-hour increase in weekly working hours, the eGFR decreased by -1.59 (-2.13, -1.06).
Increases in age, diastolic blood pressure, glucose, uric acid, and male sex were all associated withlower eGFR. Comparing with the effect of age, the effect of 10-hour increase in weekly working hours
are nearly twice of that of every 2-year increase in age.
CONCLUSIONS:Long working hours were associated with lower eGFR. Regulation of working hours
could be one way to halt the progression to early chronic kidney disease.

Keywords: long working hours, chronic kidney disease, lower glomerular filtration rateOP-322[Exposures » Occupational exposures]

The effect of hypoxia on salivary α-amylase inflight cadets
Ke Ting Pan1, Hung Wei Huang1, Wun Wei Huang2, Chao Chien Cheng2, Chung Yu Lai1
1Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei City, Taiwan
2Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung City, Taiwan

BACKGROUND AND AIM:Pilots frequently encounter low-oxygen environments due to the demands oftheir profession. In-flight, hypoxia is recognized as a stressor that impairs human performance andjeopardizes flight safety. Research has indicated that salivary α-amylase levels are positively
correlated with blood norepinephrine, which increases under conditions of stress. Accordingly, theobjective of this study was to investigate the fluctuation of salivary α-amylase levels before and after
exposure to hypoxia.
METHOD:This study was conducted in October 2022 at the Aviation Physiology Research Laboratory in
Taiwan, recruiting flight cadets from the Air Force Academy attending hypoxia awareness training. The
hypobaric chamber Contract 540 (Guardite Inc., Chicago, IL) was used during the training, and saliva
samples were taken before and after the training to measure α-amylase levels with a Nipro CM-21
salivary α-amylase monitor. The time of useful consciousness (TUC) at 25,000 feet was also recorded
during the training, and all data was analyzed using SPSS 24.0 software.
RESULTS:Twenty-two participants (20 males, 2 females) aged 22-24 years old were studied. The
mean time of TUC at 25,000 feet was 3.6 ± 0.9 minutes. Results indicated that the α-amylase value
significantly increased after training (before: 14.8 ± 8.6 kIU/L; after: 21.2 ± 14.6 kIU/L, p value =0.036). However, no correlation between α-amylase and TUC was observed during the training.
CONCLUSIONS:Our findings suggest that hypoxia exposure can elevate α-amylase levels in flight
cadets. This could be a potential factor for understanding physiological responses to in-flight hypoxia.
Nevertheless, the small sample size and the inability to exclude demographic factors and lifestyle
habits limit the generalizability of the results. Further research with larger sample sizes and moredetailed information is needed to clarify the relationship between α-amylase and TUC and the effect ofaltitude.

Keywords: hypoxia, α-amylase, pilot, flightOP-323[Exposures » Occupational exposures]

Kidney Function Affected by Heat Stress andPesticide Exposure in Migrant Farmworkers
Nicolas I Lopez Galvez1, Rietta Wagoner2, Robert Canales2, Paloma Beamer2
1San Diego State University, School of Public Health
2Mel and Enid Zuckerman College of Public Health University of Arizona

BACKGROUND AND AIM:The risk factors of Chronic Kidney Disease of Undetermined Etiology (CKDu)
are not fully understood; however, several factors, such as pesticides and heat exposure, have been
proposed to explain the pattern of this disease. Llittle is known about the impact of short-term
exposure to heat/pesticides in intense work-environmental conditions on kidney functioning.
METHOD:We recruited 72 male migrant farmworkers in a large-scale grape farm. To determine kidney
functioning during the pre-harvest and late-harvest season, urine and serum were collected andanalyzed for several biomarkers. The estimated glomerular filtration rate (eGFR) was calculated fromserum creatinine. The association between heat stress was measured using the Physiological Strain
Index (PSI), which was calculated from participants’ ear temperature and heart rate at rest and during
their working activities. Several urinary pesticide biomarkers, including those for organophosphates
and pyrethroids, were analyzed to evaluate a possible association between pesticides and kidney
function. Linear mixed model regressions were built with eGFR as the dependent variable, while PSI
and pesticide biomarkers were the main predictors after adjusting for demographic-occupational
factors.
RESULTS:We found that for a 1% increment in their PSI, a significant decrease of eGFR of 19.14
mL/min/1.73 m2 (95% CI: −26.92, −11.36) was observed. Regarding the exposure to pyrethroid
pesticides, we determine a significant decline of eGFR 3.10 mL/min/1.73 m2 (95% CI: −5.13, -0.98)
and 4.17 mL/min/1.73 m2 (95% CI: −7.5, -0.81) for every 1% increment of the urinary 3phenoxybenzoic acid and 4-fluoro-3-phenoxybenzoic acid, respectively. Also, for every 1% increase in
the urinary organophosphate marker of chlorpyrifos, a significant eGFR decline of 2.97 mL/min/1.73
m2 (95% CI: −5.54, −0.40) was observed.
CONCLUSIONS:Our results indicated that heat stress in combination with pesticides can affect kidney
function. This study provided a better understanding of the association between environmental risk
factors and kidney functioning in migrant farm workers.

Keywords: Kidney function, pesticide exposure, heat stress, farmworkers

OP-324[Outcomes » Other (to be specified with keywords in the keywords section)]

Combined effects of occupational physicalactivity and ambient heat on kidney function infemale harvest workers in Southern Spain
Sarah Koch1, Gabriel Pombo2, Loes Werkman3, Joren Buekers1, Juan Gómez Salgado4, Lourdes
Arjona5, Francisco Brocal6, Ben Chaplin7, Ana Espinosa1, Amin Oomatia7, Ali Al Rashed7, Manolis
Kogevinas5, Neil Pearce8, Oriana Ramirez Rubio9, Carlos Ruíz Frutos4, Judith Garcia Aymerich1,
Cristina O' Callaghan Gordo10
1ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología

y Salud Pública (CIBERESP), Madrid, Spain
2ISGlobal, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
3ISGlobal, Barcelona, Spain; Leiden University of Applied Sciences, Leiden, Netherlands
4Preventive Medicine and Public Health Unit. Sociology, Social Work and Public Health Department,

University of Huelva, Huelva, Spain; Safety and Health Postgraduate Programme, University Espíritu
Santo, Guayaquil, Ecuador
5ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología

y Salud Pública (CIBERESP), Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute),
Barcelona, Spain
6Universidad de Alicante, Alicante, Spain
7Centre for Nephrology, University College London Medical School, London, United Kingdom
8Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United

Kingdom
9ISGlobal, Barcelona, Spain; Department of Epidemiology, Boston University School of Public

Health,Boston, USA
10ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER

Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Universitat Oberta de Catalunya (UOC),
Barcelona, Spain

BACKGROUND AND AIM:Heat stress (HS) due to physical activity in high temperatures has beenshown to reduce kidney function in sport settings. We studied the association between occupational
physical activity and ambient temperatures with kidney function throughout one work shift in female
harvest workers.
METHOD:Physical activity was measured in vector magnitude units (VMU) and heart rate (HR) in
women picking berries in greenhouses. We calculated the mean (VMU_mean; HR_mean), standard
deviation (VMU_sd; HR_sd), and 3-minute-maximum (VMU_max; HR_max) for those variables. HS ingreenhouses was estimated using wet bulb globe temperature (WGBT). Pre-post-shift differences inserum creatinine (scr_dif), urinary neutrophil gelatinase associated lipocalin (NGAL_dif) and Cystatin C(Cystatin C_dif) were measured. Acute Kidney Injury (AKI) was defined as a post-shift increase inserum creatinine ≥0.3 mg/dl or ≥1.5 times the pre-shift levels. We used linear and logistic regressions
adjusted for age, body mass index, and HS.
RESULTS:At an average WBGT of 25.2 (±3.6)°C, 67 of 90 women experienced HS, 61 were
dehydrated, and 6 women’s serum creatinine changes were consistent with the definition of AKI.
Women with and without AKI had a scr_dif of 0.33 (±0.10) vs. 0.04 (±0.13)mg/dl, a NGAL_dif of27.85 (±18.39) vs 12.02 (±24.91)ug/l, and a Cystatin C_dif of 0.00 (±0.02) vs.0.03 (±0.07)mg/l.

Results pointed towards a positive association between VMU_sd and AKI (OR: 1.57 (95% CI: 0.82;
3.21, p-value = 0.2)), NGAL (β: 2.2 (95% CI: -2.5; 6.9, p-value = 0.4) per 100 VMU_sd increases),and Cystatin C (β: 0.90 (95% CI: -0.80, 2,7; p-value = 0.3 per 100 VMU_sd increases).
CONCLUSIONS:Whether positive associations between VMU_sd and all kidney markers are indicativeof kidney injury remains unclear. The lack of increase in Cystatin C suggests that increased creatininelevels post-shift are not explained by a reduction in renal filtration. However, the increase detected in
NGAL levels warrants further research.

Keywords: Temperature; Occupational exposures; agricultural productivity; occupational
epidemiology, renal healthOP-326[Policy » Research translation to affect policy and practice]

Occupational and Sociodemographic Factors
Influencing Pregnant Women’s Awareness andKnowledge of the New York City Pregnant
Workers Fairness Act
Justine Marcinek1, Venu Gopal Bangla3, Michael Belingheri4, Lynn C Onyebeke2, Demetrios M
Papazaharias2, Omara Afzal5, Marti Soffer6, Roberto G Lucchini7, Yueh Hsiu Mathilda Chiu2
1Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
3Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
4School of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy
5Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount

Sinai, New York, NY, USA
6Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital,

Boston, MA, USA
7Department of Environmental Health Science, Robert Stempel College of Public Health and Social

Work, Florida International University, Miami, FL, USA

BACKGROUND AND AIM:Although the New York City (NYC) Pregnant Workers Fairness Act (PWFA) was
enacted in 2014 to provide greater flexibility for pregnant workers’ accommodations, no studies todate have evaluated effectiveness of PWFA from employees’ perspectives. We examined occupationaland sociodemographic factors associated with pregnant workers’ PWFA awareness and knowledge in afemale working population with lower socioeconomic status in NYC.
METHOD:Analyses included 481 pregnant workers attending prenatal visits at Mount Sinai Hospital
Obstetrics and Gynecology clinics between January–September 2017. Detailed occupational andsociodemographic data were collected via in-person interviews. Information on PWFA awareness,knowledge, and benefits received was also ascertained. Multivariable-adjusted logistic regressions
were used to identify the factors associated with PWFA awareness and benefits received. Zero-inflated
Poisson regressions assessed the relationships with knowledge of benefits. Covariates considered
include age, race/ethnicity, education, marital status, and manager status.
RESULTS:Participants were primarily black and/or Hispanic (84%) with low household income(<$30,000, 64%); 86% reported never heard of PWFA, 8% were informed of PWFA by employers, and
6% learned about PWFA from other sources. Higher education level (>12 years) was associated withincreased PWFA awareness (OR=1.80, 95% CI=1.03–3.17). Those unsure about or with no maternity
leave policy at workplace had lower PWFA awareness than others (p=0.05). Regardless of PFWA
awareness, unpaid maternity leave policy was associated with higher risk of having no knowledge of
eligible pregnancy-related benefits (β=5.56, p<0.01 vs. paid policy). Women working ≥5 years attheir job were more likely to receive time off after childbirth than those working <5 years (OR=5.82,
95% CI=2.88–11.77).
CONCLUSIONS:Education level, workplace maternity leave policy, and job tenure were associated withPWFA awareness and/or benefits received. As more women continue to work during pregnancy,interventions targeted at promoting PWFA awareness and knowledge may be particularly important forprotecting pregnant women and their children’s well-being.

Keywords: Socio-economic factors, Policy, Occupational exposures, Non-chemical stressors, FemaleOP-327[Air pollution » Particulate matter]

A four year exposure assessment of ambient
PM2.5 Concentration in Kampala, Uganda:
Experiences from The Eastern Africa GEOHealthHub
Etajak Samuel Ebuut1
1Etajak Samuel Makerere University School of Public Health
2Atuyambe Lynn Makerere University School of Public Health3William Bazeyo Makerere University School of Public Heallth

BACKGROUND AND AIM:Air pollution (AP) remains a major a major environmental risk to the publichealth. Worldwide, 3.7 million deaths occur every year as a result of exposure to ambient air pollution.
In Africa, AP is the 2nd largest death threat, causes more deaths than tobacco, alcohol, roadaccidents, and drug abuse. Sources of AP: traffic, especially in urban areas where traffic is a threat toPH (Samet 2001); biomass fuel burning; Industrial process. We prospectively monitored the PM2.5
levels in Kampala city and examined the daily and seasonal trends of PM2.5
METHOD:A time series design, we prospectively monitored daily ambient AP (PM2.5) concentrationlevels in micrograms per cubic meter (μg/m3). The study site was Kampala Capital City, Uganda. The
PM2.5 sampling site is located at the Makerere University School of Public Health premise, Mulago
National Referral Hospital. The study used data for the period 1st January 2018 to 31st December
2021
RESULTS:the annual PM2.5 Concentration for 4 years (2018-2021) was 39.3 μg/m3, 34.9 μg/m3,
37.4 μg/m3 & 42.0 μg/m3 respectively. December, January, and February stand out with the highest
concentration above 80μg/m3. The 4 years of monitoring AP in Kampala shows that PM2.5
concentrations were above the WHO annual interim target 1 of 35 μg/m3
CONCLUSIONS:the findings show that air pollution in Kampala is way above the WHO Air Quality
Guideline values, thus this situation poses an increased risk for adverse health effects including deaths
attributed to air pollution

Keywords: Air Pollution, PM2.5

OP-328[Policy » Research translation to affect policy and practice]

The impact of secondhand smoke on air quality
in partially enclosed hospitality venues: A
systematic review
Michael Tong, Nigel Goodman, Sotiris Vardoulakis
The Australian National University

BACKGROUND AND AIM:Smoking is a leading cause of premature mortality and morbidity globally.
The pollutants generated from smoke are not only harmful to smokers, but also to those exposed tosecondhand smoke. Although smoke-free policies have been widely implemented in indoor public
spaces, outdoor smoking control policies have developed much more slowly. As a result of increasingly
restrictive indoor smoke-free policies in many countries, there is a tendency for tobacco smoking tomove outdoors into partially enclosed settings in hospitality venues. The aim of this systematic review
was to evaluate the impact of secondhand smoke on air quality in partially enclosed public spaces
such as pubs, bars and restaurants.
METHOD:A systematic search of the literature was conducted following PRISMA guidelines and using
two electronic databases (PubMed and Scopus) in addition to manual searches.
RESULTS:The literature search identified a total of 625 articles, of which 13 studies met the inclusion
criteria and were included in this review. All reviewed studies indicated that air quality within partiallyenclosed public spaces where smoking is permitted is unlikely to meet current World HealthOrganization (WHO) ambient air quality guidelines for PM2.5. Secondhand smoke can also drift into
adjacent smoke-free outdoor areas or infiltrate into indoor environments thus affecting air quality inspaces where smoking is not permitted.
CONCLUSIONS:Customers and staff in partially enclosed public spaces with active smoking, and inadjacent outdoor and indoor non-smoking areas, are potentially exposed to secondhand smoke atlevels exceeding WHO guidelines. Although scarce in the literature, studies of e-cigarette emissions in
outdoor locations indicate that PM2.5 levels can also exceed WHO ambient air quality guidelines.
Stronger smoking control policies that include e-cigarettes are recommended for partially enclosed
outdoor public spaces to protect the health of customers and staff from harmful secondhand smoke
exposure.

Keywords: Secondhand smoke; Tobacco, Air pollution; PM2.5; Hospitality venue

OP-329[Chemical exposures » Heavy metals]

Arsenic in Groundwater Sources from Selected
Communities Surrounding Taal Volcano,Philippines: An Exploratory Study
Sary Valenzuela1, Xerxes T. Seposo2, Geminn Louis C. Apostol1
1Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City,

Philippines
2Department of Hygiene, Hokkaido University, Sapporo, JapanBACKGROUND AND AIM:After the eruption of Taal Volcano in the Philippines in 2020, followed bycontinuous volcanic activity throughout 2020, we sought to investigate the extent of As contaminationof groundwater sources in volcanic regions to provide the first comparative documentation in a
volcano-sedimentary region in the Philippines.
METHOD:Matched, repeated As measurements were performed in 26 individual wells from 11
municipalities and 1 city in Batangas province from July 2020 to November 2021. Physico-chemical
analyses using the electrothermal atomic absorption spectrometric method were conducted andanalyzed using a Wilcoxon signed-rank test and bivariable regression qualitative methods.
RESULTS:Analysis of the wells revealed that 23 out of 26 (88.46%) had As levels above the WHO limitof >10 ppb while 20 out of 26 wells (76.92%) had persistently high As levels a year later in both 2020
(p-value < 0.001) and 2021 (p-value = 0.013). There was also no evidence of an association foundbetween As levels and distance (p-value 2020, 2021 = 0.537, 0.128) or elevation in relation to thesource (p-value 2020, 2021 = 0.500, 0.584).
CONCLUSIONS:Lack of difference in proximal and distal As levels coupled with persistently andsignificantly elevated As groundwater levels in areas suggest As contamination through volcanichydrothermal systems. Ground movements, as a result of volcanic activity, is known to cause greaterinteractions between groundwater and As-rich rocks, causing an increase in As concentrate. The
geochemical and geomicrobiologic processes working in concert may have led to the long-distancetransportation of As. We recommend geomapping of the hydrothermal system that interacts with theprovincial groundwater aquifer and the inclusion of further sampling sites to more accurately
determine the extent of the affected population’s exposure to As.

Keywords: Water quality, Public health, ExposuresOP-330[Exposome » General]

Multi-omic signatures of traffic related air
pollution (TRAPs) in London
Sibo Lucas Cheng1, Michael Hedges1, Pekka Keski Rahkonen2, Barbara Bodinier1, Kian Fan Chung1,
Paolo Vineis1, Sonia Dagnino3, Marc Chadeau Hyam1
1School of Public Health, Imperial College London, United Kingdom
2International Agency for Research on Cancer, Lyon, France
3Université Cote d'Azur- Polytech Nice Sophia, Nice, France

BACKGROUND AND AIM:Traffic-related air pollutants (TRAPs) are a major source of urban air pollution
and are associated with adverse health outcomes. However, the downstream molecular signatures ofacute exposure to TRAPs remain underexplored. This work aimed to identify metabolic, transcriptomic
and multi-omic biomarkers of five TRAPs measured in a crossover experimental study.
METHOD:In the Oxford Street study, 60 participants visited Oxford Street and Hyde Park. Their
exposures to NO₂, PM25, PM10, black carbon and number of particles, were measured. Serumsamples were taken 2 hours before, 2 and 24 hours after visits for metabolomics and transcriptomics
profiling. Multivariate normal (MVNs) regressions were used to identify -omic features associated with
TRAP exposures. Pathway analysis was performed using Mummichog to identify enriched metabolic
pathways. Conditional independence networks were performed at each time point using features
significantly associated with TRAPs to characterise correlations between -omic signals that cannot be
explained by other features.
RESULTS:In regression models, 78 metabolic features and 38 mRNAs were significantly associatedwith short-term TRAP exposures. NO₂ had the most associations amongst the 5 TRAPs. Several
significant metabolic features had identical retention times, suggesting they were likely fragmentsfrom the same compounds. Pathway analysis identified 9 significantly enriched metabolic pathways,
including leukotriene, tryptophan, and linoleate metabolisms. Novel conditional independent
correlations emerged in multi-omic network models amongst significant metabolic and transcriptomic
features 2 and 24 hours after exposure, which were absent prior to exposure.
CONCLUSIONS:NO₂ is the predominant TRAP in molecular signatures. Novel metabolic pathways
associated with TRAP exposure are identified. Conditional independence networks provided snapshotsof multi-omic responses to TRAP exposure at each time point, showing increased interplay amongst
biomarkers in response to TRAP-related perturbations which could be functionally important.
The funding sources of this work include MRC centre for environment & health, NIHR health protection
research unit, EXPOsOMICs, and EXPANSE project.

Keywords: Air pollution - Traffic-related, Omics technology - exposome, Exposure assessment biomarkers of exposureOP-331[Air pollution » Particulate matter]

Integrating micro-air quality sensors andsatellite-based measurements to establish ahigh spatial-temporal resolution PM2.5 model in
TaiwanWen Hsuan Chuang1, Wei Ting Chen2, Hui Fen Chiang3, Hui Fen Chiang4, Bing Fang Hwang5, Chau
Ren Jung1
1Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
2Department of Atmospheric Sciences, National Taiwan University, Taipei, Taiwan
3Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
4Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan
5Department of Occupational Safety and Health, College of Public Health, China Medical University,

Taichung, Taiwan

BACKGROUND AND AIM:Fine particulate matter (PM2.5) estimation models are frequently limited byinsufficient temporal coverage of in-situ measurements from routine air quality monitoring stations.
The micro air quality sensor can provide high temporal-spatial resolution data owing to its highcoverage and rapid data updated frequency. Hence, our study aimed to improve the spatial-temporal
resolution of the existing model in Taiwan by integrating the micro sensors data with satellite-based
aerosol optical depth (AOD).
METHOD:This study collected micro-air quality sensor data, multi-Angle Implementation of
Atmospheric Correction (MAIAC) AOD, meteorological variables, and land use data in 2020. A twostage random forest model has been applied to build the model. The first-stage model was used tocalibrate the micro sensors data. The second-stage model was leveraged to build a daily 250-m
resolution PM2.5 prediction model. The model performance was evaluated by using the ten-fold crossvalidation (CV) and the temporal validation that used data in 2019.
RESULTS:The results have shown that the CV Coefficient of determination (R2) of the first-stage
model was 0.97. After integrating the data from 11,612 sensors, the second-stage model showed an
excellent performance with training R2 (root mean square error [RMSE]) and CV R2 (RMSE) of 1 (0.42μg/m3) and 0.99 (0.75 μg/m3), respectively. The t

OP-ten most important predictors were temperature, zonal winds, precipitation, meridional winds,
AOD, surface pressure, boundary layer height, downward UV radiation, surface solar radiation, andrelative humidity. The temporal validation by 2019 data showed that R2 (RMSE) was 0.49 (7.76μg/m3).
CONCLUSIONS:Our model can improve spatial resolution and provide accurate PM2.5 estimates byintegrating micro sensors data, while the temporal validation still represented the model was
overfitting. It is expected that the future study need to train the model with more data and reduce themodel complexity to improve performance.

Keywords: EPA air quality micro station, particulate matter, aerosol optical depth, machine learningOP-332[Exposure assessment methods » Exposure assessment-air pollution]

Air Pollution Monitor Network Design for Fair
Exposure Estimation
Zoe Haskell Craig1, Rumi Chunara2
1Department of Biostatistics, School of Global Public Health, New York University, New York, USA
2Department of Biostatistics, School of Global Public Health, New York University, New York, USA;

Tandon School of Engineering, New York University, New York, USA

BACKGROUND AND AIM:Land-use regression (LUR) is widely used for predicting air pollution exposurefor epidemiological studies. LUR uses a few monitored locations and land-use characteristics such as
traffic to predict pollution concentrations throughout an area. Several monitor network design (MND)
algorithms have been proposed to select the monitor locations. As an algorithmic process, LUR may beprone to unfairness due to biases in the location of the air pollution monitors. We assessed
associations between monitor sites, neighborhood socioeconomic status (SES), and prediction
accuracy under different MNDs.
METHOD:Ground-truth pollution measurements for particulate matter, black carbon, NO, and NO2
were obtained from mobile monitoring deployments in Pittsburgh, Pennsylvania and San Francisco,California. We studied four different MNDs via 30 monitor placement simulations per MND, per city.
For each simulation, we built a stepwise linear regression model and predicted pollution concentrations
throughout the study area. Monitor coverage was quantified by the number of monitors located within
a 2, 3, 5, and 10 km radius from each census tract, adjusting for geographic and data-availability
constraints. The association between average mean squared error and census tract SES was assessed
via Spearman’s correlation coefficient.
RESULTS:Three MNDs showed, on average, a non-zero correlation (p < 0.005) between census tract
SES and monitor placement: higher SES tracts received more coverage in San Francisco and viceversa in Pittsburgh. More monitors within 2 and 3 km of the census tract was associated with lower
prediction root mean squared error. Tracts with higher SES had higher prediction error in Pittsburgh
for all MNDs but lower prediction error in the Bay Area for some MNDs. Prediction errors were large
and comparable to pollution levels relevant to health risks.
CONCLUSIONS:Placing monitors by optimizing only for air pollution variance may lead to biased
measurement quality by neighborhood SES.

Keywords: Methodological study design, Environmental disparities, Environmental justiceOP-333[Omics technologies » Epigenomics]

Arsenic Exposure and Accelerated Aging: The
Association with Cardiovascular Disease andAll-Cause Mortality in the Strong Heart Study
Enoch X Jiang1, Arce Domingo1, Ahlam Abuawad1, Karin Haack2, Maria Tellez Plaza3, Daniele Fallin4,
Jason G Umans5, Lyle G Best6, Ying Zhang7, Allison Kupsco1, Daniel W Belsky8, Shelley A Cole2, Ana
Navas Acien1
1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health,

New York, NY, USA
2Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
3Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for

Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
4Emory University Rollins School of Public Health
5MedStar Health Research Institute, Washington, District of Columbia, USA
6Missouri Breaks Industries Research, Eagle Butte, South Dakota, USA
7Center for American Indian Health Research, Department of Biostatistics and Epidemiology, The

University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
8Department of Epidemiology and Butler Columbia Aging Center, Columbia University, New York,

United States

BACKGROUND AND AIM:Inorganic arsenic (As) may increase the risk of cardiovascular disease (CVD)
and all-cause mortality through accelerated aging, which can be measured by epigenetic-based
measures. We evaluated three DNA methylation-based aging measures (PhenoAge, GrimAge,
DunedinPACE) as potential mediators of the previously reported association of As exposure with CVD
incidence, CVD mortality, and all-cause mortality in the Strong Heart Study (SHS), an epidemiologicalcohort of American Indians.
METHOD:Blood DNA methylation and urinary As levels were measured in 2,323 SHS participants(41.5% men, mean age 55 years). PhenoAge and GrimAge values were calculated using a residualbased method. We tested the association of As with epigenetic aging measures using linear
regression, and conducted a mediation analysis of As-related CVD incidence, CVD mortality, and allcause mortality by epigenetic aging measures using additive hazards models.
RESULTS:SHS participants with higher vs. lower urinary-As levels had similar PhenoAge age, older
GrimAge age, and faster DunedinPACE. Comparing the 75th vs. 25th percentiles of GrimAge andDunedinPACE, participants with older GrimAge and faster DunedinPACE were at increased risk forincident CVD [GrimAge HR=1.29 95%CI (1.16, 1.43); DunedinPACE HR=1.27 (1.16, 1.39)], CVD
mortality [GrimAge 1.75 (1.46, 2.11); DunedinPACE HR=1.50 (1.28, 1.77)], and all-cause mortality[GrimAge HR=1.78 (1.61, 1.97); DunedinPACE HR=1.46 (1.34, 1.60)]. In mediation analyses,
GrimAge and DunedinPACE mediated 10.3-20.7% of associations between As and the three healthoutcomes.
CONCLUSIONS:Arsenic exposure was associated with older GrimAge and faster DunedinPACE
measures of biological age. Furthermore, accelerated biological aging measured from DNA methylationaccounted for a relevant fraction of As-associated risk for CVD, CVD mortality, and all-cause mortality
in the SHS, supporting the role of As in accelerated aging. Research of the biological underpinnings
can contribute to a better understanding of the role of aging in arsenic-related disease.

Keywords: Epigenetic aging, arsenic, DNA methylation, cardiovascular diseaseOP-334[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Systematic review of lead (Pb) effects on social
cognition and autism
Haesoo Kim1, Timothy Anderson2, Ellen Kirrane2, Zahra Gohari1, Stephanie Deflorio-Barker2, Evan
Coffman2
1Oak Ridge Institute for Science and Education Research Participation Program, U.S. Environmental

Protection Agency, Center for Public Health and Environmental Assessment, Health and Environmental
Effects Assessment Division, Research Triangle Park, North Carolina, USA
2U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment,

Health and Environmental Effects Assessment Division, Research Triangle Park, North Carolina, USA

BACKGROUND AND AIM:Social cognition effects of lead (Pb) exposures are an emerging area of
research, and to our knowledge, systematic review methods have not yet been applied to this body ofevidence. We will conduct a systematic review of the epidemiologic studies of children and youths(<21 years old) and experimental animal studies (all ages) to evaluate the relationships between Pb
exposure and outcomes including autism, adaptive skills, social-emotional development, social
communication, and social behavior.
METHOD:This review is informed by COSTER and PRISMA guidelines. Titles and abstracts focusing on
studies that evaluate Pb concentrations in blood, tooth, or bone will be identified from keyword andcitation network searches of all publication years. These will be double screened using a machinelearning tool to predict relevant references, and then undergo full-text double screening using PECO
criteria.
RESULTS:Preliminary work identified 16 epidemiologic studies in children and 1 rodent study publishedbetween 2011 and 2022. Positive associations between tooth and blood Pb levels (BLLs) and autism
status/severity and social development were observed in three studies, of which two reported low
mean BLLs (<5 μg/dL). Twelve studies reported null associations with autism and social cognition, of
which four noted nonsignificant decreases in social scores. Four studies reported interactions withbiological or psychosocial factors potentially explaining heterogeneity in the results.
CONCLUSIONS:Preliminary evidence did not find strong evidence of an association between Pb
exposure and social cognition. However, a pattern of social cognition deficits at BLLs <5 μg/dL wassupported by several studies. The application of formal systematic review methods will strengthenfindings and conclusions regarding the effect of Pb exposure on social cognition in children and youths.
The views expressed in this abstract are those of the author(s) and do not necessarily represent theviews or policies of the U.S. Environmental Protection Agency.

Keywords: Children’s environmental health, Heavy metals, Risk assessment

OP-335[Exposures » Food/nutrition]

Influence of folate+B12 supplementation onarsenic methylation: A double-blinded, placebocontrolled trial in Bangladeshi children
Irene Martinez Morata1, Haotian Wu1, Faruque Parvez1, Mahbubul Eunus2, Jeff Goldsmith3, Vesna
Ilievski1, Vesna Slavkovich1, Olgica Balac1, Chiugo Izuchukwu1, Ronald A. Glabonjat1, Alexander Van
Geen4, Tariqul Islam2, Anwar Sadat Arif2, Ana Navas Acien1, Joseph H. Graziano1, Mary V. Gamble1
1Department of Environmental Health Sciences. Columbia University Mailman School of Public Health,

New York, USA.
2Columbia University Arsenic Project in Bangladesh, Dhaka, Bangladesh.
3Department of Biostatistics. Columbia University Mailman School of Public Health, New York, USA.
4Lamont Earth Observatory, Columbia University, New York, USA.

BACKGROUND AND AIM:Inorganic arsenic (iAs) is metabolized to less toxic mono- (MMA) anddimethyl- (DMA) species via one-carbon metabolism (OCM). OCM is driven by folate and B12 andprevious randomized control trials (RCTs) showed that that folic acid (FA) supplementation increases
arsenic methylation in adults. This RCT investigated the effects of FA+B12 supplementation on arsenic
methylation in children, a key developmental stage where OCM supports growth.
METHOD:A total of 240 participants (8-11 years, 50% female) dependent on wells with iAs
concentrations >50μg/L, switched to low iAs wells and were randomized to receive 400μg FA+5μg B12or placebo daily for 12-weeks. Urine and blood samples were collected at baseline, week1 (only urine)
and week12. GEE models were used to assess treatment effects on arsenic species in blood and urine.
RESULTS:At baseline, the mean total blood and urinary arsenic were 6.2±3μg/L and 93.8±89μg/L;
and the mean plasma folate, B12, and homocysteine levels were 25.1±15nM/L, 346±171pM/L, and
7.6±2.1μmol/L respectively. Overall, total blood and urine arsenic decreased by 11.7% and 17.6% at
the end of follow up, likely due to well switching. Compliance with the nutritional intervention was
excellent. Compared to placebo, the supplementation group experienced a significant increase in theconcentration of blood DMA by 14.0%(95%CI 5.0, 25.0) at 12 weeks. Similarly, there was asignificant increase in the urinary %DMA by 2.4%(95%CI: 0.6, 4.2) and a significant decrease in%MMA by 0.9%(95%CI: -1.6, -0.3) in the supplementation group after one week compared toplacebo group. These changes in urinary metabolites remained until the end of follow up compared tobaseline, though they were not statistically significant.
CONCLUSIONS:This RCT confirms that FA+B12 supplementation increases iAs methylation in children
as reflected by decreased MMA and increased DMA in blood and urine. Nutritional interventions may
improve arsenic methylation and elimination in children, potentially reducing toxicity.

Keywords: Arsenic, nutrition, folate, children healthOP-336[Outcomes » Cardiovascular diseases]

Urine Cadmium Levels and Coronary Artery
Calcification: A Longitudinal Study in the MultiEthnic Study of Atherosclerosis (MESA)
Katlyn E Mcgraw1, Kathrin Schilling1, Ronald A Glabonjat1, Marisa Sobel1, Arce Domingo Relloso1,
Miranda R Jones2, Wendy Post2, Joel Kaufman3, Maria Tellez Plaza4, Linda Valeri1, Richard Kronmal3,
Elizabeth R Brown3, Steven Shea1, Ana Navas Acien1, Tiffany R Sanchez1
1Columbia University
2Johns Hopkins University
3University of Washington
4Institute of Health Carlos III, Spain

BACKGROUND AND AIM:Growing evidence indicates that cadmium is a risk factor for cardiovasculardisease (CVD). Urinary cadmium is a biomarker of long-term exposure. We hypothesized that higher
urine cadmium levels are associated with higher levels of coronary artery calcium, a subclinical marker
of atherosclerotic CVD.
METHOD:We used data from 6,226 participants in MESA with urine cadmium levels at baseline (20002002) and 1-4 repeated measures of spatially weighted coronary calcium score (SWCS) over a 10year period. SWCS is a unitless measure highly correlated to the Agatston score but with numericalvalues assigned to Agatston score=0. We used linear mixed effect models to assess the association of
baseline urine cadmium with baseline SWCS, annual change in SWCS, and SWCS at ten years offollow-up. Urine cadmium levels were reported in µg/g creatinine and log transformed. SWCS was logtransformed. Models were adjusted for baseline sociodemographic factors and estimated glomerular
filtration rate, lifestyle factors, and clinical factors.
RESULTS:At baseline, the median (25th, 75th) SWCS and cadmium were 6.31 (0.75, 58.5) and 0.53
(0.35, 0.79) µg/g creatinine. Participants who were older, male, of White race, with less education,
currently smoking, diagnosed with diabetes, and with higher cadmium levels had higher SWCS. In
fully adjusted models, the geometric mean ratio (GMR) (95%Cl) of SWCS per interquartile rangechange in urine cadmium was 1.32 (1.16, 1.50) at baseline and 1.35 (1.05, 1.74) at ten years offollow-up; the annual change was 1.002 (0.989, 1.015). The GMRs of baseline SWCS were 1.16 (0.97,
1.39), 1.45 (1.17, 1.80), and 1.53 (1.06, 2.20) among 3,139 never, 2,289 former, and 798 current
smokers, respectively.
CONCLUSIONS:Long-term exposure to cadmium, as measured in urine, was associated with
subclinical CVD at baseline and at follow-up. These findings support the hypothesis that cadmium is a
pro-atherogenic factor.

Keywords: metals, cardiovascular disease, subclinical disease, longitudinal studyOP-337[Chemical exposures » Heavy metals]

Environmental arsenic exposure, hypertension,and diabetes mellitus: a systematic review anddose-response meta-analysis
Kim R. Van Daalen1, Nusrat Khan2, Clare Oliver Williams3, Adam S. Butterworth1
1British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary

Care, University of Cambridge, Cambridge, United Kingdom
2Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge,

United Kingdom
3Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester,

United Kingdom

BACKGROUND AND AIM:Literature on environmental arsenic exposure in relation to hypertension(HTN) or diabetes mellitus (DM) is not entirely consistent. Therefore, this systematic review and doseresponse meta-analysis explores the association between environmental arsenic exposure and risk on
HTN and DM across exposure levels.
METHOD:Five electronic databases were searched for HTN and four for DM. Two-stage random-effects
dose-response meta-analyses of arsenic concentrations stratified by media (water, urine, blood,plasma, nail) were performed for HTN, DM and gestational DM (GDM), assuming both log-linear
associations and restricted cubic splines. Meta-analyses were also performed for arsenic metabolism
markers (iAs%, MMA%, DMA%) and HTN.
RESULTS:From the 6,024 retrieved publications, 71 were included (26 HTN, 49 DM, 4 both) in thesystematic review, and 41 in meta-analyses (16 HTN, 22 DMT2, 6 GDM). The 71 studies reported
predominantly significant or non-significant positive associations for one or more arsenic categories orin continuous models. Few reported non-significant negative associations, and none reported
significant negative associations. Dose-response meta-analyses identified consistent positive log-linear
associations between water and urinary arsenic exposure and risk of HTN, DM and GDM, with someevidence of a departure from linearity for cumulative water arsenic and HTN, and toenail arsenic and
DM. Analyses on low levels of water arsenic utilising 1 µg/l as the reference category showed positive
log-linear associations below 10 µg/l for all outcomes. Results were consistent across sensitivity
analyses. No significant pooled associations for urinary iAs%, MMA% and DMA% with HTN wereobserved.
CONCLUSIONS:Evidence was most conclusive at moderate-high arsenic levels, whilst highlighting thata potential downward revision of the WHO guidelines (10 µg/l) may be considered for healthprotection. Yet, given the inconsistencies around the impact of individual arsenic species and arsenic
metabolism on HTN and DM, elucidation of the interplay between arsenic species, arsenic metabolismand HTN and DM warrants further research.

Keywords: Arsenic, diabetes mellitus, hypertension, meta-analysis

OP-338[Chemical exposures » Endocrine disrupting chemicals]

Exposure to airborne polychlorinated biphenyls
and risk of uterine leiomyomata, endometriosis,
and PCOS: a register-based Danish cohort study
Sandra S Tøttenborg1, Laura Deen1, Lauren A Wise4, Amelia K Wesselink4, Henriette Svarre Nielsen5,
Kajsa Ugelvig Petersen1, Marie Frederiksen3, Harald W Meyer1, Karin S Hougaard3, Jens Peter E
Bonde2
1Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital,

Copenhagen University Hospital, Denmark
2Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Denmark
3National Research Centre for the Working Environment, Denmark
4Department of Epidemiology, School of Public Health, Boston University, United States
5Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Denmark

BACKGROUND AND AIM:Polychlorinated biphenyls (PCBs) are some of the most widespread persistentorganic pollutants in the environment due to their extensive use in electrical equipment and building
materials from the late 1920s to the 1970s and their continuous release from waste and building
materials from that period. The industrially produced PCBs are known to possess endocrine properties
and to increase cellular levels of reactive oxygen species. They may therefore play a role in thedevelopment of hormone-related gynecological conditions including uterine leiomyomata (UL),
endometriosis, and polycystic ovarian syndrome (PCOS). Several studies have shown adverse
associations between higher-chlorinated PCB congeners and these gynecological conditions, but so far,our knowledge about risk related to lower-chlorinated PCBs which dominate indoor air and constitutethe primary exposure for individuals who work or live in PCB-contaminated buildings is scarce. We
examined the extent to which female residents of PCB contaminated homes had a higher incidence ofhormone-related gynecologic disorders, including UL, endometriosis, and PCOS.
METHOD:We studied females from the Health Effects of PCBs in Indoor Air (HESPAIR) cohort
comprising residents of two partially PCB contaminated residential dwellings in the Greater
Copenhagen area during 1970-2018. We used the Danish National Patient Register to identify theclinical diagnoses of UL, endometriosis, and PCOS. By combining register-based relocation history withmeasurement-based contamination status, we quantified annual, cumulative PCB exposure. We thenfit multivariable Cox regression models with time-varying exposure to estimate associations between
PCB exposure and incident UL, endometriosis, and PCOS. To ensure incident cases, we excluded
individuals with preexisting UL, endometriosis, PCOS, menopause, hysterectomy, oophorectomy,
fibroid operation, and those above 50 years of age. All models were adjusted for ethnicity, parity,socioeconomic status, and calendar time in decades.
RESULTS:Results will be ready for the conference
CONCLUSIONS:Conclusion will be ready for the conference

Keywords: PCB,Gynecological,EDC,register,environmentOP-339[Air pollution » Particulate matter]

The Association Between Particulate Air
Pollution and the Risk of Sudden Death inPatients on Maintenance Hemodialysis: A CaseControl Study
Chien Fong Huang1, Yu Ting Lin1, Hsiu Yin Chiang1, Hung Lin Chen1, Chieh Hua Lin1, David Ray
Chang2, I Wen Ting2, Hung Chieh Yeh2, Bing Fang Hwang3, Chin Chi Kuo4
1Big Data Center, China Medical University Hospital and College of Medicine, China Medical University,

Taichung, Taiwan.
2Division of Nephrology, Department of Internal Medicine, China Medical University Hospital andCollege of Medicine, China Medical University, Taichung, Taiwan
3Department of Occupational Safety and Health, College of Public Health, China Medical University,

Taichung
4Division of Nephrology, Department of Internal Medicine, China Medical University Hospital andCollege of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical
University Hospital and College of Medicine, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Previous evidence has linked high concentrations of PM₂.₅ to an increased
risk of sudden death (SD). However, it is still unknown whether exposure to PM₂.₅ predisposespatients on maintenance hemodialysis (MHD) to an increased risk of SD.
METHOD:The Clinical Research Data Repository of China Medical University Hospital (CMUH-CRDR)
and iHi Platform identified 178 cases of SD among adult patients on MHD between 2003 and2020.Each patient with SD was individually matched based on age, sex, and dialysis duration with four
controls selected from the HD population of CMUH-CRDR. The occurrence of SD was verified using themonthly HD care quality committee report of CMUH and a data algorithm that included MHD patients
whose mortality date and last HD session were within 72 hours, but had no admission records. We
utilized satellite-based spatiotemporal models with 1-km resolution to individually estimate the 1-yearand 3-day average PM₂.₅ concentration prior to the index date of the SD event. Multiple logistic
regression modeling was employed to estimate odds ratios (OR) and corresponding 95% confidence
intervals (CI) between PM₂.₅ exposure and the occurrence of SD.
RESULTS:The median age and dialysis duration was 70.1 years (IQR, 60.2, 78.6) and 2.9 years (1.1,
5.6), respectively, in this study population. Patients who experienced a sudden death event were more
likely to have comorbidities such as cardiovascular disease, diabetes, and atrial fibrillation comparedto the control group. Adjusted odds ratio for each 10 μg/m³ increase in 1-year and 3-day average
PM₂.₅ exposure was 1.32 (95% CI, 0.87, 2.00) and 1.019 (95% CI, 0.81, 1.28), respectively.
CONCLUSIONS:Our result found a positive association between both long-term and short-term PM₂.₅
exposure and SD among MHD patients, although this association was not statistically significant.
Larger-scale studies are needed to confirm whether reducing PM₂.₅ exposure can effectively modify
the risk of SD.

Keywords: Environmental epidemiology, long-term exposure, short-term exposure

OP-340[Air pollution » Particulate matter]

Retrospective exposure assessment for alongitudinal study of ultrafine particles (UFP)and mortality
Doug Brugge1, Kevin Lane2, Abby Raymond3, Matthew Simon3
1University of Connecticut
2Boston University
3Volpe National Transportation Systems Center

BACKGROUND AND AIM:Ambient ultrafine particles (UFP; <0.1 micrometers aerodynamic diameter),primarily from vehicle combustion in urban areas in the US, have no ambient air quality standards. In
large part, this is because there is no evidence from large, prospective studies of mortality.
METHOD:We utilized a published high-resolution (hourly, 20-m-by-20-m), predictive model of particle
number concentration (PNC, a surrogate for UFP) for the cities of Boston and Chelsea, Massachusetts,in the northeastern US. The U.S. EPA’s latest meteorological preprocessors were used to generatemodel input data for temperature, wind speed and direction, atmospheric stability, and othernecessary variables. The PNC model was then adjusted for residential and occupational time-activity
using surveyed data, retrospectively for people enrolled in the Boston Puerto Rican Health Study(BPRHS). Mortality in this cohort has been high (295 deaths out of 1500 participants).
RESULTS:The PNC model estimated exposure for all participants in the BPHRS cohort within the twostudy areas for every hour from 2004 to 2021. Median modeled ambient hourly PNC decreased overtime in both Boston and Chelsea (13,000 and 16,000 particles/cm3 in 2004 versus 4600 and 4700
particles/cm3 in 2021, respectively). Previous studies in the BPRHS of cardiovascular measures and
CAFEH study found associations with increased PNC and time-activity adjusted PNC. Adjustment of
exposure for time activity and tests of association with mortality are in progress and will be reported
at the conference.
CONCLUSIONS:This analysis, although of a small prospective cohort, has the potential to provide early
evidence for or against association of traffic UFP with mortality due to the high mortality rate,
contributing to filling a critical need in the air pollution policy arena.

Keywords: traffic-related air pollution, ultrafine particles, mortality, time-activity

OP-341[Air pollution » Particulate matter]

Impact of air pollution on mortality during the
COVID-19 pandemic in South Korea and Japan
Hyewon Yun1, Lina Madaniyazi2, Chris Fook Cheng Ng3, Masahiro Hashizume3, Whanhee Lee1
1School of Biomedical Convergence Engineering, Pusan National University
2School of Tropical Medicine and Global Health, Nagasaki University
3Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo

BACKGROUND AND AIM:Multiple studies have reported the impacts of the coronavirus-2019 pandemic
on the association between air pollution and mortality. Nevertheless, the generalizability of thesestudies is limited because of the limited study areas and the nonrepresentative nature of the study
populations.
METHOD:We collected nationwide daily time-series data from South Korea (16 regions) and Japan (47prefectures) from 2016 to 2020. We performed an interrupted time-series analysis to estimate
temporal changes in the association between PM2.5 and mortality (total, cardiovascular diseases, andrespiratory diseases) before (Jan 01, 2016 to Feb 17, 2020) and during the pandemic (Feb 18, 2020
to Dec 31, 2020).
RESULTS:The average annual concentration of PM2.5 decreased during the pandemic in bothcountries. For all-cause deaths, the changes in relative risk were not prominent during the pandemic.
Whereas, for several cardiovascular diseases (ischemic heart and cerebrovascular diseases) andrespiratory diseases, we found an increase in the risks of PM2.5 on mortality during the pandemic in
South Korea and Japan, although there were some differences in both countries.
CONCLUSIONS:We found that the risks of short-term exposure to PM2.5 on mortality for
cardiovascular and respiratory diseases increased in the first pandemic year in South Korea and Japan,
compared to the pre-pandemic years.

Keywords: COVID-19, PM2.5, Mortality

OP-342[Air pollution » Particulate matter]

Long-term exposure to PM2.5 and all-cause
mortality in India using a Difference in
Difference approach
Suganthi Jaganathan1, Massimo Stafoggia2, Ajit Rajiva3, Siddhartha Mandal4, Shweta Dixit3, Jeroen
De Bont5, Dorairaj Prabhakaran6, Poornima Prabhakaran4, Joel Schwartz7, Petter Ljungman8
1Centre for Environmental Health, Public Health Foundation of India, New Delhi, India; Centre for

Chronic Disease Control, New Delhi, India; Institute of Environmental Medicine, Karolinska Institutet,
Stockholm, Sweden
2Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of

Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
3Centre for Environmental Health, Public Health Foundation of India, New Delhi, India
4Centre for Environmental Health, Public Health Foundation of India, New Delhi, India; Centre for

Chronic Disease Control, New Delhi, India
5Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
6Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi,India
7Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
8Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Department of

Cardiology, Danderyd Hospital, Sweden

BACKGROUND AND AIM:Global Burden of Disease estimated 1.7 million deaths were attributed to air
pollution in India in 2019. In contrast, a retrospective cohort study ‘Million Death Study’ reported noexcess deaths from all non-accidental causes due to ambient air pollution. These studies used
exposure-response functions derived from countries with low air pollution exposure levels. To
strengthen the evidence on health effects of air pollution, we studied the association between annual
exposure to particulate matter measuring <2.5 µg/m3 (PM2.5) and all-cause mortality in India using amodified difference-in-difference approach.
METHOD:We used district level annual all-cause mortality and annual population weighted districtlevel PM2.5 exposure from a high-resolution spatiotemporal model for 2009- 2020. Difference-indifference, a causal modeling approach that controls for unmeasured confounders by design was
employed to analyze effect of PM2.5 and mortality. We performed sensitivity analyses using statewide death registration levels to account for measurement error. We estimated exposure-response
function from our main model.
RESULTS:In 655 Indian districts, the population weighted PM2.5 median was 38.9µg/m3 (19.7 (5thpercentile) and 71.8 (95th percentile)) over a decade. Over the study period, death registration levels
ranged from 68.7 to 83.7% with less than 10 states having 100% registration through out. For every
10 µg/m3 increase in PM2.5, we estimated that mortality rate increased by 5.9% (95% CI 3.8,8.1)
which were robust to sensitivity analyses. The exposure-response function was slightly non-linear,with steeper slope up to ~ 95 µg/m3 and levelling afterward.
CONCLUSIONS:Using a causal modelling approach allowed us to harness the full extent of registereddeaths in one of the world’s most populated and polluted country, we provide new evidence ofincreased risk of all-cause mortality from long-term exposure to PM2.5 in India. We expect theseresults to have important implications for current environmental health policy in India.

Keywords: Air pollution, particulate matter, long-term exposure, mortality, causal inferenceOP-343[Air pollution » Short-term exposure]PM2.5, locally generated pollution and daily
mortality in India: Causal analyses modelling
and attributable deaths in 10 cities
Jeroen De Bont1, Bhargav Krishna2, Massimo Stafoggia3, Tirthankar Banerjee4, Hem Dholakia5, Amit
Garg6, Vijendra Ingole7, Suganthi Jaganathan8, Itai Kloog9, Kevin Lane10, R.k. Mall11, Siddartha
Mandal12, Amruta Nori Sarma10, Dorairaj Prabhakaran13, Ajit Rajiva13, Abhiyant Suresh Tiwari14,
Yaguang Wei15, Gregory Wellenius10, Joel Schwartz15, Poornima Prabhakaran13, Petter Ljungman16
1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
2Centre for Policy Research, New Delhi, India
3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of

Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
4Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
5Smart Prosperity Institute, University of Ottawa, Ottawa, Canada
6Public Systems Group, Ahmedabad, India; National Investment & Infrastructure Fund (NIIF) Chair inEnvironment, Social & Corporate Governance (ESG), Ahmedabad, India; Indian Institute ofManagement Ahmedabad, India
7Office for National Statistics, Wales, Newport, UK; Environmental, Climate, and Urban Health

Division, Vital Strategies, New York, USA;
8Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Chronic

Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India
9Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Environmental Medicine andPublic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
10Department of Environmental Health, Boston University School of Public Health, Boston, MA
11DST-Mahamana Center of Excellence in Climate Change Research, Institute of Environment andSustainable Development, Banaras Hindu University, Varanasi, India
12Centre for Chronic Disease Control, New Delhi, India
13Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi,

India
14NRDC India Private Limited, New Delhi, India
15Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
16Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of

Cardiology, Danderyd Hospital, Sweden

BACKGROUND AND AIM:The evidence of acute effects of air pollution on mortality in India is limited.
This is the first multi-city study in India that examines the association between particulate matter<2.5µm (PM₂.₅) and daily mortality using causal methods highlighting the importance of locallygenerated air pollution.
METHOD:We applied a time-series analysis for ten cities in India between 2008-2019. We estimatedcity-wide daily PM₂.₅ levels using a nationwide spatiotemporal model. We evaluated city-specificeffects of PM₂.₅ through a generalised additive Poisson model, and then meta-analysed theassociations. We applied an instrumental variable causal approach to evaluate the causal effect oflocally generated air pollution on mortality. We obtained a pooled concentration-response curvethrough a multivariate meta-regression of the city-specific concentration-response functions (CRF),
and calculated the fraction of deaths attributable to PM₂.₅ levels exceeding the World HealthOrganization (WHO) 24-hour PM₂.₅ guidelines (15μg/m³). We further limited the analyses to days withconcentrations lower than the current Indian PM₂.₅ standard (<60μg/m³).
RESULTS:We observed that a 10 μg/m³ increase in two-day moving average of PM₂.₅ was associatedwith 1.4% (95%CI: 0.7-2.2) higher daily mortality, with a stronger effect of locally generated air
pollution on mortality, as our instrument (per 10 μg/m³) was associated with a 3.6% (95%CI: 2.15.0) increase in mortality. Our pooled CRF indicated no evidence of a threshold below which air
pollutant concentrations are not harmful on mortality. In fact, higher risk of death was observed whenrestricting our analyses to the Indian PM₂.₅standard. We observed that 7.2% (95%CI, 4.0-9.9) of alldeaths were attributed to PM₂.₅ levels exceeding the WHO guidelines.
CONCLUSIONS:Short-term PM₂.₅ exposure was associated with increased mortality in India, even atconcentrations below the current Indian PM₂.₅ standard. These associations were stronger whenemploying causal modelling methods accounting for locally generated air pollutants, further supportinga plausible causal link.

Keywords: Air pollution, Particulate matter, Mortality, Causal inference, Short-termOP-344[Air pollution » Wildfires]

A pilot study to determine the impact ofprescribed burns on indoor air quality andassociated health impacts for residents
Dwan Vilcins1, Wen Ray Lee1, Stephania Cormier2, Slawo Lomnicki3, Peter David Sly1
1Child Health Research Centre, The University of Queensland, Brisbane, Australia.
2Department of Biological Sciences, Louisiana State University, Baton Rouge, USA
3Department of Environmental Sciences, Louisiana State University, Baton Rouge, USA

BACKGROUND AND AIM:Bushfire smoke poses a significant threat to human health, especially
respiratory, cardiovascular, and mental health. The primary management tool to reduce the risk of
bushfire in urban areas is hazard reduction burns (HRB). This study aimed to answer the following
questions: Does household air quality worsen during HRB?; Is exposure to particulates from HRB
associated with changes in respiratory health?; and what household characteristics influence thepenetration of air pollutants?
METHOD:We conducted a pilot pre-post exposure study. Children-adult pairs (n=18) within 1 km of
the burn site were recruited from 6 households. Homes were visited prior to the HRB, immediately
following and 5 days post-HRB. Indoor and ambient PM2.5 was measured simultaneously using
AirVisual Pros. A survey assessed characteristics of the home and health status of participants. Lung
function was measured via oscillometry using a TremoFlo device.
RESULTS:Mean outdoor PM2.5 increased by 160% on the day of the burn, from 5.22 µg/m3 in the
pre-burn period, to 13.6 µg/m3. Indoor PM2.5 was lowest in the pre-burn period (8.8 µg/m3), rising
to 25 µg/m3 in the 24 hour burn period. Each timepoint showed higher indoor PM2.5 compared withoutdoor air (P = <0.01). Small changes in lung function, per unit increase in PM2.5, were seen in R [0.094 (95% CI -0.118, 0.016) cm H2O.s.L-1, p=0.073] and in X [0.267, (-0.267, -0.016), p-0.084].
These changes are small and not statistically significant but are in the direction that would be seen
with a deterioration in lung function.
CONCLUSIONS:Our preliminary work suggests that particles become trapped within the home, andinadequate ventilation prevents them clearing as ambient air quality improves. If confirmed, thesedata clearly have implications for public health messaging. Our model of HRB provides a useful modelof bushfire smoke exposure.

Keywords: Respiratory outcomes, Children's environmental healthOP-345[Air pollution » Particle components]

Environmentally persistent free radicals inhousehold dust: longitudinal and seasonal
trendsDwan Vilcins1, Wen Ray Lee1, Stephania Cormier2, Slawo Lomnicki3, Peter David Sly1
1Child Health Research Centre, The University of Queensland, Brisbane, Australia.
2Department of Biological Sciences, Louisiana State University and Pennington, Baton Rouge, USA.
3Department of Environmental Sciences, Louisiana State University, Baton Rouge, USA

BACKGROUND AND AIM:Epidemiological links between air pollution and adverse health outcomes arestrong, but the mechanism(s) remain obscure. A newly recognized combustion by-product,environmentally persistent free radicals (EPFRs), may be the missing link. EPFRs persist for extended
periods of time in the environment, however very little is known about the presence of EPFRs insidehomes where prolonged exposure is likely to occur. The objective of this study is to explore thepresence of EPFRs in household dust and ascertain if EPFR concentration is stable across time andseason.
METHOD:The ORChID/ELLF cohort is a longitudinal birth cohort (n=158) with dust samples collectedfrom the family vacuum cleaner at multiple time points. EPFR characteristics were assessed withelectron paramagnetic resonance. Our team developed an algorithm to estimate oxygen-weighted
concentration and impact score for risk of adverse health outcomes. Kruskal-Wallis rank sum test andFisher’s exact tests were used to assess seasonal differences. A simple mixed-effects linear regression,
with random intercepts on participant ID, was employed for longitudinal analysis of EPFR
concentration in households that did not move.
RESULTS:83 participants returned 238 dust samples. EPFRs were measured in virtually all samples.
Most households were exposed to medium (39%) or high (21%) impact EPFRs. Concentration was
stable across visits, except for lower concentration in summer (p=0.05), Oxygen-weighted EPFRs were
not stable. There was a seasonal trend with concentration (p=<0.01), oxygen weighted concentration(p=<0.01) and biological impact (p=0.05) all significantly lower in summer months.
CONCLUSIONS:Our results indicate that the concentration of EPFRs in household dust are stable
across time in households that did not move, but the oxygen-centred radicals are more sensitive tochanges. These findings suggest that exposure to EPFRs occurs in the home and may be a significant
place for exposure to highly biologically reactive EPFRs.

Keywords: Particulate matter, Environmental epidemiology

OP-346[Air pollution » General]

Determinants of indoor air pollution healthliteracy among adults in Taiwan
Jia-Ling Wu, Chung-Yi Li
Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan

BACKGROUND AND AIM:This study aimed to investigate the level of and covariates associated with
Indoor Air Pollution Health Literacy (IAPHL) among adult residents of Taiwan.
METHOD:A cross-sectional web-based online survey of 647 adults aged 20 years and above in Taiwan
was conducted from May 2021 to October 2021 using the reliable and valid IAPHL instrument. The
IAPHL scored 1 to 4 to indicate the lowest and highest level of IAPHL, respectively. We performed
weighted multiple linear regression models to identify covariates significantly associated with overall
and 4 matric-specific IAPHL scores.
RESULTS:The weighted sample size was 616 subjects aged between 20 and 88 years old (mean of
45.8 years, SD 18.1). Generally, adult residents of Taiwan showed only a moderate level of overall
IAPHL (2.46±0.62) with the highest and lowest metric-specific score for “understanding” (2.58±0.72)
and “appraising” (2.36±0.64). The key factors associated with adults’ IAPHL included sex, age,working related to indoor air pollution, smoking status, exposed to second hand smoke, budgeting for
improve indoor air quality, and number of beneficial goods used.
CONCLUSIONS:People in Taiwan had only moderate levels of IAPHL. Adults with certain characteristics
should be the objects of further educational interventions aiming to improve IAPHL.

Keywords: indoor air pollution, environmental health literacy, health competency, cross-sectional
studies, community healthOP-347[Air pollution » Other (to be specified with keywords in the keywords section)]

Validation of Computational Fluid Dynamics
Models in Predict Domestic Kitchen Hood
PerformancePei Yu Fan1, Ying Chieh Chan2, Wan Chen Lee1
1Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei City,

Taiwan2Department of Civil Engineering, National Taiwan University, Taipei City, Taiwan

BACKGROUND AND AIM:Cooking emissions, such as PAHs, VOCs, COx, NOx, and particulate matter,are considered pollutants that may harm human health and affect indoor air quality. Using adequate
kitchen hoods is the key to reducing these hazards. However, no prediction models for hood
performance are available for human exposure assessment. Therefore, our objective is to build a
database of validated Computer Fluid Dynamics (CFD) to predict the performance of kitchen hoods
commonly used in Taiwanese homes.
METHOD:We established a Computer-Aided Design (CAD) model based on the experimental setup in
the simulation kitchen of our lab where we tested kitchen hoods with five different geometric design.
We tested the hoods under the fixed flow rates of 6 and 16 m3/min for their temperature and CO2
concentration distribution. We then compared the simulated values and experimental results forvalidation tests using data from four measurement points. Finally, we calculated the CE values using
the simulation results.
RESULTS:CE values determined from measured CO2 concentrations were higher at the high flow rate
(CE=0.50-1.18) than at the low flow rate (CE=0.32-0.42). And there was good agreement between
the simulated and measured performance. The validated results showed that both the configurationand the flow rate of the hoods could affect the spatial flow field and further influence hood
performance.
CONCLUSIONS:In sum, we have successfully established a validated modeling approach which could
be applied to predicting the performance of different kitchen hoods in the future.

Keywords: Kitchen Hoods, Capture Efficiency, Carbon Dioxide, Indoor Air Quality, Computational
Fluid Dynamics

OP-349[Exposures » Other (to be specified with keywords in the keywords section)]

The Use of Kitchen Exhaust Hoods with Different
Capture Efficiency in an Open Kitchen in Taiwan
Yu Kang Liu, Wan Chen Lee
Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei,
TaiwanBACKGROUND AND AIM:Using a kitchen hood could reduce the risk of adverse respiratory healtheffects caused by cooking emissions. However, different from the traditional kitchen space design in
Taiwan, the open kitchen has gradually become a consideration in modern architectural design. Its
more open space may cause the kitchen hood performance to be less than expected. Therefore, thisstudy aims to explore the performance of kitchen hoods with different capture efficiency in alaboratory open kitchen.
METHOD:This study was conducted in a simulated kitchen space. Nebulized sodium chloride solution
and carbon dioxide were used as surrogates for cooking emissions, measured with Scanning Mobility
Particle Sizer (SMPS) and TSI-7545. The study used two tested kitchen hoods alternately. The
experimental stage was divided into three phases: the background phase, the cooking phase, and thepost-cooking phase. A total of 8 combinations (4 hood flow rates and whether to continue to use the
kitchen hood after the release of pollutants stops) were tested in the study, and each combination wastested per cycle. Finally, these tests were done in triplicates. For data analysis, the measurement
results were used to calculate the capture efficiency (CE) and effectiveness (E) of two kitchen hoods.
RESULTS:The kitchen hood with better capture efficiency still has a higher effectiveness than the otherone. However, whichever kitchen hood was used, the pollutant concentration during the cooking phase
could be reduced more if the hood flow rate was higher. In the post-cooking phase, regardless ofwhether the kitchen hood was continuously used, as long as it was used during the cooking phase, thetime for the concentration of pollutants to return to the background value could be halved.
CONCLUSIONS:Despite changes in kitchen space design, kitchen hoods could still provide acceptablecapture efficiency in the open kitchen.

Keywords: Cooking Emissions, Kitchen Hood, Capture Efficiency, Open Kitchen, Indoor Air Quality(IAQ)OP-350[Air pollution » Short-term exposure]

Air pollution and health burden of urban firedisaster: A case study from tire factory fire in
Korea
Changwoo Han
Chungnam National University College of Medicine

BACKGROUND AND AIM:Urban fire disasters are not commonly studied in terms of smoke exposure
and its health impacts. A tire manufacturing factory in Daejeon city, Korea experienced a prolonged
fire lasting for 58 hours, starting at 10 PM on March 12, 2023. The aim of this research was toestimate the excess air pollution exposure experienced by residents living close to the factory.
METHOD:Hourly air pollution levels (PM10, PM2.5, NO2, O3, SO2 and CO) were gathered from the 11
monitoring stations of Daejeon. The Munpyeong-dong station, located within 500 m from the factory,
was used to estimate the air pollution exposure of residents living in 2 administrative districts(Seokbong-dong and Deogam-dong) located within 1.2 km from the factory. The average difference
between the hourly air pollution levels of the Munpyeong-dong station and synthetic control usinglevels of 10 monitoring stations was estimated.
RESULTS:Based on the population registration data, 29,487 persons (2,431 age 0-10; 4,361 age 65-)
may be exposed to the excess air pollution from the factory fire. Although there was no increase inmonitored air pollutant during the first 24 hours, peaking of PM10, PM2.5, SO2, and CO levels wasobserved during the 2-4 days after the initial fire event. In the week following the initial fire, theresidents may expose to additional 2581.2 (95% confidence interval (CI): 817.6, 3600.7) μg/m3 ofPM10, 985.8 (95%CI: 119.2, 1377.1) μg/m3 of PM2.5, 626.7 (95%CI: 94.1, 1007.7) ppb of NO2,
482.5 (95%CI: 435.6, 632.8) ppb of SO2, and 14.7 (95%CI: 11.2, 19) ppm of CO.
CONCLUSIONS:Residents living close to the tire factory were exposed to excessive amounts of air
pollution. Potential measures, such as temporary evacuation and closure of schools, can be consideredafter urban fire disasters. Future studies using national health insurance data will address excessive
healthcare use in residents.

Keywords: Exposures, Particulate matterOP-351[Air pollution » Long-term exposure]

Air Pollutants and Long-term Kidney Function
Changes in Chronic Kidney Disease: Resultsfrom Southern Taiwan
Cheng Yin Chung1, Tzu Ning Wu3, Yu Tong Wang3, Ming Yen Lin2
1Department of Internal medicine, Pingtung Hospital, Ministry of Health and Welfare, Taiwan.
2Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital,

Kaohsiung Medical University, Taiwan.
3Department of Nursing, Ministry of Health and Welfare, Pingtung Hospital, Ministry of Health andWelfare, Taiwan.

BACKGROUND AND AIM:Taiwan has a t

OP-rank end-stage kidney disease incidence in the world. There is limited information about the air
pollutants’ roles on kidney health in patients with chronic kidney disease (CKD). The study aimed toinvestigate associations of air pollutants with long-term kidney function changes in CKD.
METHOD:This prospective study enrolled 447 CKD patients from the Pingtung Hospital, Ministry of
Health and Welfare 2011–2015. The personal exposure of air pollutants (CO, NO, NO2, NOx, O3,
PM2.5, PM10, and SO2) concentrations and ambient temperature were estimated by inverse distanceweighting approach. The estimated glomerular filtration rate from 2011–2021 was calculated by the
CKD-EPI equation. A mixed model with random intercept and the slope was applied to explore theseassociations. Both standard classifications and restricted cubic spline by five-knot for air pollutant
concentrations were investigated To detect non-linear air pollutant relationships.
RESULTS:The average age of the study population was 77.1±12.6 years, and the median eGFR
decreased by 1.9 ml/min/1.73m2 per year. We identified NO concentration large and equal to 2.36
ppb significantly associated with long-term kidney function changes (ranges of the regression
coefficient from -8.51 to -12.87) after controlling potential confounding effects. The mixed models
with a restricted cubic spline showed the significant effects of increased CO, NOx, and PM2.5
concentrations between knots on the eGFR slope: slow, aggregate, slow, and aggregate.
CONCLUSIONS:We observed that renal function deterioration was significantly attributed to CO, NO,
NOx, and PM2.5 concentrations in patients with CKD. Further research is needed to understand themechanisms of air pollutants, medical care, human protective behaviors, and their effects on longterm kidney function progression.

Keywords: air pollution, long-term exposure, outcomes.

OP-352[Exposure assessment methods » Risk assessment]

Hazard and risk assessment for indoor air
pollutants: alicyclic compound, 1-butanol, longchain aldehydes, chlorinated organic
compounds, and acrolein
Kenichi Azuma1, Hideto Jinno2, Toshiko Tanaka Kagawa3, Shinobu Sakai4
1Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Kashiwara, Japan
2Meijo University Faculty of Pharmacy, Nagoya, Japan
3Yokohama University of Pharmacy, Yokohama, Japan
4Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki, JapanBACKGROUND AND AIM:In the past decades, indoor air pollution has become a major public healthconcern. Japan has established indoor air quality guidelines for 13 chemicals. However, the types andconcentrations of indoor pollutants have not been consistent over time due to alterations in lifestyleand development of novel household products and building materials. Therefore, a comprehensive
approach for the overall reduction of health risks caused by indoor air pollutants are required.
METHOD:To determine the high-risk indoor air pollutants that should be reduced, we conducted apreliminary risk assessment using data from nationwide exposure assessments and existing hazard
data. In this assessment, identifications of the critical effects and the reference concentrations (RfCs)
obtained from reviewing the hazard or toxicological data are crucial. In this study, those data for 9
pollutants, including methylcyclohexane (MCH), propylcyclohexane (PCH), 1-butanol, hexanal,
decanal, trichlorethylene (TCE), tetrachloroethylene (PCE), 1,2-dichloroethane (DCE), acrolein arereported.
RESULTS:Acute RfCs were not derived for MCH, PCH, 1-butanol, and decanal. Chronic RfC for PCH
were not determined. The derived chronic RfCs were as follows: for MCH, 2921 μg/m3 from renal
effects in rats; for 1-butanol, 138 μg/m3 from neurobehavioral effects in rats; for hexanal anddecanal, 130 μg/m3 from nasal effects in dogs; for TCE, 1.2 μg/m3 from thymic effects in mice; for
PCE, 119 μg/m3 from effects of color vision in humans; for DCE, 83 μg/m3 from liver effects in rats;and for acrolein, 2.3 μg/m3 from respiratory effects in mice. Carcinogenic RfCs associated with excess
lifetime risk of 1/100 000 were determined for TCE, 2.4 μg/m3; for PCE, 1.6 μg/m3, and for DCE, 1.6
μg/m3.
CONCLUSIONS:The RfCs for acute and chronic effects for 9 chemicals were evaluated from thereviewed information. RfCs for acute effects in 5 chemicals, chronic effects in 8 chemicals, andcarcinogenic effects in 3 chemicals were identified.

Keywords: Chemical exposures, Hazard assessment, Health risk assessment, Indoor environment,
Volatile organic compounds

OP-353[Air pollution » Particulate matter]

Assessing the particulate matter exposure
reduction and short-term health benefits of
Improved Cook Stoves (ICS) in Rural Nepal
Binaya K C, Rodan Bista, Narayan Gauragain, Prajwal Gautam, Dipak Timalsina, Bim Prasad Shrestha
Department of Mechanical Engineering, Kathmandu University, Dhulikhel, Nepal

BACKGROUND AND AIM:More than 68% population in rural communities of Nepal still combustbiomass fuel in inefficient cook stove that leads to the exposure of high concentration of particulatematter (PM). Exposure to PM can cause chronic and acute health risks, resulting in premature deaths.
Improved cook stoves (ICS) have been proposed as a potential solution to reduce HAP exposure, butthere are limited studies on their short-term health benefits. This study aims to estimate the effect ofenhanced stove design on particulate matter exposure and short-term health impacts in rural Nepal.
METHOD:Baseline data on personal exposure to PM and changes in physiological functions werecollected in rural households using traditional cook stoves. 30 households were then installed with
Alternative Energy Promotion Centre (AEPC) approved two pot mud improved cook stoves. Data on
personal exposure to PM and personal blood pressure, oxygen saturation, pulse and CO concentrationin exhaled breath were collected immediately after installation and statistical analysis was used tocompare data before and after the intervention
RESULTS:The initial data showed a significant reduction in PM exposure after the installation of ICS.
The overall mean PM2.5 exposure concentration in households decreased by 35% after theintervention. The exhaled breath CO concentration also decreased from 7.5ppm to 4.5ppm after the
installation of ICS. The oxygen saturation level was increased by 1% after the intervention. However,there was no significant difference in pulse rate and blood pressure before and after the intervention.
CONCLUSIONS:ICS was effective in reducing personal exposure to PM in the study households of rural
Nepal. However, the findings show no significant benefit of exposure reductions on short term healthimpact. The long term health benefits of reduced exposure from improved cook stove use is hence
necessary to elucidate the actual impact of the intervention on health outcomes.

Keywords: Household air pollution, Improved cook stove, Short term health impact, particulatematter, Rural nepal

OP-354[Air pollution » Particulate matter]

Association between exposure to fineparticulate matter and risk of osteoporosis
Pei Xuan Qiu1, Wei Cheng Lo2, Chih Ching Yeh3
1School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwa
2Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei

City, Taiwan
3School of Public Health, Master Program in Applied Epidemiology, College of Public Health, Taipei

Medical University, Taipei City, Taiwan

BACKGROUND AND AIM:The prevalence rate of osteoporosis among people over 65 years old in
Taiwan is 14.1%, that is, about 1 out of every 7 people has osteoporosis. Air pollution levels in Taiwan
remain high, mainly from the burning of fossil fuels. Recent studies have shown that developing
osteoporosis is significantly related to inflammation caused by exposure to fine particulate matter(PM2.5) from air pollutants. However, there is currently no research in Taiwan. We aimed toinvestigate the association between PM2.5 levels and the risk of osteoporosis and to clarify risk factors
for osteoporosis.
METHOD:Using the data of bone mineral density collected by Taiwan Biobank since 2012, combinedwith data from Taiwan Air Quality Monitoring Station, to explore the association of PM2.5 level andother risk factors with the risk of osteoporosis. In this cross-sectional study, we included 5,346
osteoporosis subjects and 55,114 non-osteoporosis subjects. The stepwise selection was used toestablish a multivariate logistic regression model and PM2.5 exposure was evaluated by one-year,
three-year, and five-year mean levels. The statistical analysis was conducted by using SAS version 9.4
software and a P-value of less than 0.05 indicated a significant difference.
RESULTS:The results shown that age of 60-70 years old [odds ratio (OR)=5.241], family history ofosteoporosis (OR=1.702), smoking (OR=1.589), body mass index less than 18.5 (OR=2.396) andarthritis (OR=1.352) were significant risk factors of osteoporosis, while women (OR=0.675), college
education (OR=0.600), regular exercise (OR=0.843), and diabetes (OR=0.851) were protective
factors. However, exposure to PM2.5 was not significantly associated with osteoporosis risk.
CONCLUSIONS:Although we could not find a clear relationship between PM2.5 exposure andosteoporosis risk, we found important factors associated with osteoporosis risk, which provides
evidence for osteoporosis prevention in Taiwan.

Keywords: Osteoporosis, Fine particulate matter (PM2.5),Osteoporosis Risk Factors

OP-356[Neurologic and mental health outcomes » Mental health outcomes]

Spatio-temporal trends of carbon monoxide
poisoning suicide attempts and associated risk
factors in England between 2002 and 2016
Aina Roca Barceló1, Helen Crabbe2, Rebecca Close2, Helena Fahie3, Giovanni S Leonardi2, Frédéric B
Piel4
1Small Area Health Statistics Unit, Medical Research Council (MRC) Centre for Environment and

Health, School of Public Health, Imperial College London, London, United Kingdom
2Environmental Epidemiology Group, UK Health Security Agency, Radiation, Chemical andEnvironmental Hazards Directorate, Chilton, Oxon, United Kingdom; National Institute of HealthResearch (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures & Health,
Imperial College London, London, United Kingdom
3Specialty Registrar in Public Health, Oxford School of Public Health, Health Education England, United

Kingdom
4Small Area Health Statistics Unit, Medical Research Council (MRC) Centre for Environment and

Health, School of Public Health, Imperial College London, London, United Kingdom; National Instituteof Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures &Health, Imperial College London, London, United Kingdom; National Institute of Health Research(NIHR) Health Protection Research Unit (HPRU) in Chemical & Radiation Threats & Hazards, Imperial
College London, London, United Kingdom

BACKGROUND AND AIM:Suicide and mental health disorders are a recognized public concern. Most
suicide prevention relies on evidence from mortality data, missing a large pool of population at risk.
Herein, describe the spatiotemporal patterns of intentional carbon monoxide (CO) poisoning
hospitalization rates in England between 2002 and 2016, and identify population groups at risk.
METHOD:We collected data on hospital admissions for intentional CO poisoning in England between
2002 and 2016 and on individual (age at admission, gender and residential postcode) and area-level
characteristics (ethnic composition, urbanicity, and socioeconomic deprivation). For each group, weestimated age-standardised rates (ASR) overall and annually and formally tested differences using
chi-square test. Temporal trends were assessed through joinpoint regression analysis.
RESULTS:Overall, there were 178 hospitalizations for intentional CO poisoning annually. Over 2.6% of
patients were hospitalized two or more times, suggesting persistent suicidal thoughts. 81 % ofadmissions occurred in males. We found higher ASR in rural areas, among men and particularly those
aged 35–44 years and living in areas with predominantly white population. The ASR in London(0.08/100,000) was almost six times lower than in the South-West (0.47/100,000). During the study
period, the annual percentage rate change was negative particularly among males (−7.0% [95%CI:−8.6%; −5.4%] males vs. -4.1% [95%CI, −6.2%; −1.9%)] females).
CONCLUSIONS:Based on this work, we recommend: i) the implementation of suicide prevention
schemes particularly targeted at men, aged 35–44 years old; ii) the systematic collection of data on
methods of suicide, including CO poisoning; and iii) routine monitoring at more granular level at therelevant administrative unit to guide effective targeted policies.
Work published https://doi.org/10.1016/j.jad.2023.02.036 under Creative Commons Attribution 4.0
International License. Funded by National Institute for Health and Care Research Health Protection
Research Unit in Chemical and Radiation Threats and Hazards (#NIHR200992) and in Environmental
Exposures and Health (#NIHR200880).

Keywords: Epidemiology, socio-economic factors, short-term exposure, policy

OP-357[Neurologic and mental health outcomes » Mental health outcomes]

The effect of social and physical environment on
mental health among elderly population;comparison between pre- and during COVID-19
pandemic
Kyung Shin Lee1, Ji Eun Lee2, Jeehye Lee3, Hye Sook Min1
1Public Health Research Institute, National Medical Center, 245 Eulgi-Ro, Jung-Gu, Seoul, 04564,

South Korea
2Department of Human Systems Medicine, College of Medicine, Seoul National University, Seoul

03080, South Korea
3National Emergency Medical Center, National Medical Center, Seoul 04564, South Korea

BACKGROUND AND AIM:The social and physical environment can have a significant factor on mental
health. The COVID-19 pandemic has caused widespread changes in mental health, particularly among
the elderly population. The study is to investigate the change in the effect size of the relationshipbetween the social and physical environment and mental health including depressive symptoms orperceived stress among the elderly population during the pandemic compared to the pre-pandemic
period. Additionally, we stratified by urbanity to identify regional differences is these associations.
METHOD:We used data from the 2019 and 2021 Korean Community Health Survey were used as arepresentative nationwide sample dataset. We surveyed the mental health variables including thepresence of perceived stress, or depressive symptom using the Patient Health Questionnaire-9. Twosocial environmental variables and five satisfactions with the physical environment were assessed
based on the questionnaire in participants. Multivariate logistic regression analysis was performed to
explore the association between environmental variables and mental health.
RESULTS:We included data from 73,544 participants in 2019 and 71,287 participants in 2021. In themultiple logistic regression, insufficient social environment variables, including “trust of neighbors”,
and “exchanging help with neighbors”, were significantly associated with depressive symptoms during
the COVID-19 pandemic (odd ratio(OR)=2.07, 95% confidence interval(CI): 1.87, 2.28) and(OR=1.82, 95% CI: 1.65, 2.02), respectively. The OR was higher during the COVID-19 pandemic thanin the pre-COVID19 period. Furthermore, there was a higher OR of depressive symptoms in rural
areas than in urban areas.
CONCLUSIONS:The social and physical environment during the COVID-19 pandemic has a great
psychological impact on Korean elderly population. Appropriate strategies that consider individual andcommunity factors related to the social and physical environment are necessary to improve mental
health among the elderly population.

Keywords: Social environment, Physical environment, Depression, Perceived stress, ElderlyOP-358[Neurologic and mental health outcomes » Mental health outcomes]

The association between work and residential
location and depressive symptoms during the
COVID-19 pandemic in Hong Kong
Lap Ah Tse1, Beixi Li2, Priscilla My Priscilla3, Joey Wy Chan4, Yun Kwok Wing4
1JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,

China & The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
2JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,

China
3JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,

China & Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University,
Aarhus, Denmark
4Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The

Chinese University of Hong Kong, Hong Kong SAR, China

BACKGROUND AND AIM:The increasing poor mental health in the global population has raised
concerns regarding the well-being and livability of humans. Although recent studies showed asignificant association between depression and transportation, the distance between workplace andresidence has rarely been analyzed. The aim of the study was to examine the association between
depressive symptoms and work and residential location.
METHOD:A cross-sectional study was conducted in Hong Kong from 2022.03 to 2023.01. Social
demographic information, work and residential location, and the living environment were collectedfrom full-time workers older than 18 years old. Depression was assessed by the Hospital Anxiety andDepression Scale, with a cutoff point of 8 or higher on the subscale indicating depressive symptoms. A
logistic regression model adjusting for relevant covariates was used to assess the association between
depressive symptoms and work and resident location. Analyses were conducted by SAS 9.4. Ethics
approval: CREC 2021.228.
RESULTS:A total of 1,432 responses were received during the study period, with 1,173 (81.9%)
females and 259 (18.1%) males. The average age of the workers was 34.3 ± 8.3 years old. There
were 397 (46.1%) participants who scored 8 points or higher on the depression subscale, with anaverage score of 7.0 ± 3.8 points. The multivariate logistic regression model showed that working andliving in different districts was not associated with depressive symptoms (OR=1.14, 95%CI: 0.83,
1.56) while living on different floors was significantly related to depressive symptoms (4-6 floors vs
11-20 floors: OR=1.85, 95%CI: 1.02, 3.34; 41+ floor vs 11-20 floor: OR=3.68, 95%CI: 1.38, 9.80).
Interestingly, female workers were less susceptible to depression than male workers (OR=0.66,
95%CI: 0.44, 0.98).
CONCLUSIONS:Our findings provided preliminary evidence that the residential environment is linked
to mental well-being among urban residents. During the COVID-19 pandemic, urban male workers
were more depressed than females.

Keywords: Mental health outcomes, Public health, COVID-19

OP-359[Built environment » Green space]

Advancing GReencare in Europe: a multi-scalar
approach to improve Mental health Equity (theGreenME project)
Helen V.s. Cole1, Silvio Caputo2, Kathrin Specht3, Renata Giedych4, Runrid Fox Kaemper5, Penny
Cook6, Eva Rademacher3, Beata Gawryszewska4, Michele Dostuni7, Juan V. Luciano1, Agnieszka
Olszewska Guizzo8, Marcus Hedblom9, Gary Mitchell10, Konrad Neuberger11, Petra Ellora Cau12,
Giovanna Bubbico13, Hilary Johnston14, Eva Creus15, Albert Feliu Soler1, Michael Hardman16, RaphaelSieber17, Michelle Howarth16, Gauthier Bas18, Nevin Cohen19, Margarita Triguero Mas20
1Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
2Kent School of Architecture and Planning, University of Kent, Canterbury, United Kingdom
3ILS Research Institute for Regional and Urban Development (ILS), Dortmund, Germany
4Warsaw University of Life of Life Sciences, Faculty of Horticulture, Biotechnology and LandscapeArchitecture, Department of Landscape Architecture, Warsaw, Poland
5ILS Research gGmbH (ILS R), Dortmund, Germany
6School of Health and Society, University of Salford, Salford, United Kingdom
7Department of Agricultural and Food Sciences, University of Bologna Alma Mater Studiorum, Bologna,

Italy
8NeuroLandscape, Warszawa, Poland
9Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Uppsala,Sweden10Social Farms & Gardens, Bristol, United Kingdom
11Gesellschaft für Gartenbau und Therapie (GGuT) e.V., Hueckeswagen, Germany
12Shinrin-Yoku, B agarmossen, Stockholm, Sweden
13Social Cooperative EtaBeta, Bologna, Italy
14Mind in Bexley and East Kent, London, United Kingdom
15Spanish Association for social and therapeutic horticulture and gardening, San Mateo de Gállego,

Spain
16Urban Geography, The University of Salford, Salford, United Kingdom
17Stadt Herne, FB Gesundheitsmanagement, Herne, Germany
18Old Continent, Brussels, Belgium
19Graduate School of Public Health and Health Policy, City University of New York, New York, USA
20Universitat Oberta de Catalunya, Barcelona, Spain; Mariana Arcaya’s research group, Department of

Urban Studies and Planning at Massachusetts Institute of Technology (DUSP-MIT), Cambridge, UnitedStates; Barcelona Laboratory for Urban Environmental Justice and Sustainability, Institute forEnvironmental Science and Technology at Universitat Autònoma de Barcelona (ICTA-UAB), Cerdanyola
del Vallès, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, SpainBACKGROUND AND AIM:There is burgeoning evidence that green care (viewed on a continuum that
includes nature-in-everyday-life, nature-based health promotion, and nature-based therapy) can beused to promote mental health and wellbeing particularly for underprivileged populations. However,there is a lack of large-scale studies and of research on health inequities beyond inequitable accessand distributive justice dimensions. Moreover, the causal mechanisms linking nature-based therapies
to health (equity) are not well understood and nature-based therapies are rarely investigated as anintegrated part of healthcare systems, exploring if such programs are accessible to all, how they arefinanced, and how patients find their way to them. GreenME identifies ways in which effective green
care can be scaled-up to improve adult mental health and wellbeing equity while contributing tomultiple socio-ecological co-benefits.
METHOD:GreenME’s approach is: (i) to diagnose the current status of green care in participating
countries, (ii) to increase scientific evidence on mental health and wellbeing equity in urban, semiurban, rural, semi-rural and coastal settings, and (iii) to empower green care actors by co-creating a
set of tools in Sweden, United Kingdom, Spain, Italy, Germany, Poland and the United States.
RESULTS:GreenME will: (a) produce a catalogue of identified successful nature-based therapy models
and fruitful integrations of these therapies in green care frameworks broadly; (b) design a naturebased therapy general evaluation protocol including cost-effective analyses and health evaluation; (c)identify mental health and wellbeing impacts of nine interventions and their causal mechanisms andcost-effectiveness; (d) identify the impact on mental health equity of nature-in-everyday-life andnature-based health promotion in project study countries; and (e) enhance the European green care
network and establish a training course for nature-based therapy providers.
CONCLUSIONS:GreenME will increase the use of nature-based therapy and its integration within amulti-scalar green care framework to ultimately promote just and sustainable healthy communities.

Keywords: Green space, Blue space, Mental health outcomes, Health inequalities, Environmental
justiceOP-360[Neurologic and mental health outcomes » Mental health outcomes]

The association of ambient temperature withdepression in elderly women: a cross-sectional
study from Germany
Nidhi Singh1, Claudia Wigmann1, Ashtyn Tracy Areal2, Tamara Schikowski1
1IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
2IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany & Department of

Epidemiology, Medical Research School, Heinrich-Heine-University, Düsseldorf, Germany

BACKGROUND AND AIM:Depression has been recognized as a common, but serious, mental illness
that is influenced by a range of environmental factors. Ambient temperature is an importantenvironmental factor however, there is limited evidence for an association with a depressive state.
This study explored the short-term association between temperature and depression in elderly
women.
METHOD:We investigated 834 elderly women from the 2007–2010 follow-up of the German SALIA
cohort. Self-reported frequency of depressive symptoms and cognitive performance was evaluatedusing the CESD-R Scale and the CERAD-Plus test. Modelled climate and air pollution data wereassigned to the residential addresses. Semi parametric quasi-Poisson generalized additive regression
model adjusted for potential confounding factors were used. Effect modification by season, individual
characteristics, and cognition level was investigated. Single and cumulative lag effect up to 10 days
was estimated. Because of inverse association relative risk (RR)<1 is considered an adverse risk.
RESULTS:We observed that every 5°C reduction in the current day's average temperature wasassociated with a 16.7 % increase in depression (RR = 0.83, 95% confidence interval (CI): 0.77–0.90,
P<0.001). Subgroup analyses showed that women with low socioeconomic conditions (RR = 0.75,
95% CI: 0.64–0. 88, P< 0.001), living in rural areas (RR = 0.80, 95% CI: 0.71– 0.91, P < 0.001),
living isolated (RR = 0.76, 95% CI: 0.67–0.86, P < 0.001) and having a low cognitive function (RR =0.81, 95% CI: 0.73–0.90, P < 0.001) were more vulnerable. Seasonal analysis showed that decreasein temperature during the winter months were more strongly and adversely associated with higher
depression than summer months. Sensitivity analysis brings forth that the effect estimates varied byexposure days but remained significant up to lag 0–10 days.
CONCLUSIONS:Low temperature was inversely associated with depression in elderly women. The
association is modified by season, individual specific characteristics, and cognitive performance.

Keywords: Depressive symptoms, Cognition, Aging, Ambient Temperature, Cohort

OP-361[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Associations between air pollution, road traffic
noise and incidence of dementia in the Danish
Nurse Cohort
Stéphane Tuffier1, Jiawei Zhang1, Marie Bergmann1, George Maria Napolitano1, Thomas Cole Hunter1,
Seyed Mahmood Taghavi Shahri1, Matija Maric1, Rina So1, Jørgen Brandt2, Matthias Ketzel3, Steffen
Loft1, Youn Hee Lim1, Zorana Jovanovic Andersen1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate,Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
3Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Air

Research (GCARE), University of Surrey, Guildford, United Kingdom

BACKGROUND AND AIM:Several studies suggest associations between road traffic noise and incidence
of dementia. However, findings are inconsistent when air pollution, a recognized risk factor for
dementia, is considered. We investigated associations between air pollution, road traffic noise andincident dementia.
METHOD:We followed 26,461 women from the Danish Nurses Cohort from baseline (1993 or 1999) totheir first hospital contact or first prescription of dementia medication whichever came first until 2021
using Danish registers. Annual air pollution (PM2.5 and NO2) and road traffic noise estimates (Lden)
were modelled at nurses’ residential address using DEHM/UBM/AirGIS and Nord2000 models,
respectively. We applied time varying Cox models to estimate associations between 10- year runningmean air pollution, noise and incident dementia. Models were adjusted for baselines year, individual
lifestyle, socio-economic factors and municipality characteristics.
RESULTS:A total of 1557 incident cases of dementia were during the follow up. Median exposures
were 12.18 µg/m³ with interquartile range (IQR) of 5.79 µg/m³ for PM2.5, 16.51 µg/m³ (IQR
8.25µg/m³) for NO2 and 53.2 dB (IQR 9.3 dB) for Lden. We detected moderate associations between
dementia incidence and PM2.5, with hazard ratio of 1.35 per IQR and 95% confidence interval (1.201.51), or NO2 (1.19; 1.09-1.29) and a weak positive association with Lden (1.04; 0.97-1.13).
Associations with NO2 and Lden diminished when adjusting for PM2.5 with hazard ratios of 0.98 (0.861.12) and 0.95 (0.88-1.00) respectively.
CONCLUSIONS:Our results shows a weak association between road traffic noise or traffic related
pollutants and incident dementia, which may be partially explained by the effects of PM2.5.

Keywords: Air pollution, Noise, Traffic-related, Long-term exposure, Neurodegenerative outcomesOP-362[Exposures » Multi-pollutant/Multi-media]

Gender specific differences in house dust anddietary exposures to lead in preschool children
Chi Sian Kao1, Ying Lin Wang1, Chuen Bin Jiang3, Ying Chih Chuang1, Yi Hua Chen1, Hsing Cheng
Hsi2, Ling Chu Chien1
1School of Public Health, Taipei Medical University, Taipei, Taiwan
2Graduate Institute of Environmental Engineering, National Taiwan University, Taipei, Taiwan
3Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital,

Taipei, Taiwan

BACKGROUND AND AIM:Children exposure to lead (Pb) are through microenvironmental environmentand dietary food. Our objective was to investigate (1) sex-specific differences in internal Pb exposure
based on biomarkers measurements among preschool children in northern Taiwan; (2) external Pb
exposure from ingestion and dermal contact route through household dust and dietary food; (3) sexspecific differences in the relationship between internal Pb exposure and external Pb exposure; (4)specific contribution of exposure source for Pb exposure.
METHOD:Internal Pb exposure dose based on hair and fingernails measurement collected from 359
children under 6 years of age living in northern Taiwan between August 2019 to July 2021. The
potential non-carcinogenic risk through ingestion and dermal contact from household dust and dietary
food were assessed by using the potential risk indicators hazard quotient (HQ) and hazard index (HI).
We also assess sex-specific differences in the relationship between internal Pb exposure dose and HQ.
Pb concentrations in biomarkers, dietary foods and household dust were analyzed using inductively
coupled plasma-mass spectrometry (ICP-MS) and a flame atomic adsorption spectrometry (FAAS).
RESULTS:The geometric mean ± geometric standard deviation Pb concentrations in children’s hair andfingernails were 1.28±2.63 and 0.81±2.04 μg/g, respectively. We demonstrated sex-specificdifferences in hair and fingernail Pb concentrations among preschool children. Hair Pb concentrations
in boys were lower than those in girls, whereas fingernail Pb concentrations in boys were higher thanthose in girls. HQ for ingestion of household dust was significantly correlated with hair Pb
concentrations among boys. The source-oriented contribution results showed that ingestion ofhousehold dust was the main contributor to non-carcinogenic risk for younger children’s exposure to
Pb.
CONCLUSIONS:Keeping cleaner residential environment could potentially reduce Pb exposures fromingestion of indoor dust and thus mitigate health risks to preschool children from Pb exposures.

Keywords: Lead, Children, Dust, Dietary food, Risk assessment

OP-363[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

The association among organophosphatepesticide exposure, genetic polymorphisms andmethylation of paraoxonases I in children withADHD
Chia Huang Chang1, Boopathi Subramani2, Ching Jung Yu2, Jung Chieh Du3, Hsien Chih Chiou4, Jia
Woei Hou5, Winnie Yang6, Chian Feng Chen7, Ying Sheue Chen8, Betau Hwang4, Mei Lien Chen2
1School of Public Health, Taipei Medical University, Taipei, Taiwan.
2Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan.
3Department of Pediatrics, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
4Department of Child and Adolescent Psychiatry, Taipei City Hospital, Songde Branch, Taipei, Taiwan.
5Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
6Department of Pediatrics, Taipei City Hospital, Yangming Branch, Taipei, Taiwan.
7VYM Genome Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
8Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

BACKGROUND AND AIM:The present study determines whether changes in paraoxonases I (PON1)
DNA methylation levels due to organophosphate pesticide (OP) exposure and genetic polymorphism
could increase attention-deficit/hyperactivity disorder (ADHD) risk in children.
METHOD:A total of 181 children participated in this case-control study, including 85 children with
ADHD and 96 children as control. Urinary concentrations of OP metabolites, dialkyl phosphate (DAP),
including dimethyl alkylphosphate (DM) and diethyl alkylphosphate (DE) were analyzed by using gas
chromatography-mass spectrometry (GC-MS). The changes in DNA methylation levels in the proximal
promoter region of PON1 were examined by pyrosequencing.
RESULTS:Children with ADHD had lower methylation levels (22 out of 25 CpG sites; 43.14±11.44 %vs. 50.19±13.74 %, p-value<0.05) than the control children. A negative association between OP
metabolites and mean methylation levels (β=-0.06, p-value<0.05). The methylation levels exhibited
significant difference among 46 PON single nucleotide polymorphisms (SNPs).
CONCLUSIONS:It is warrant to investigate the changes in PON1 methylation and neurobehavioral
development in children.

Keywords: Attention deficit hyperactivity disorder, Organophosphate pesticides, Paraoxonases,
Methylation

OP-364[One health » Co-infections and co-morbidities]

Determining Subpopulations of Children with
Multiple Health Outcomes using Unsupervised
Clustering and Examining Associations with
Prenatal Phthalates
Drew B Day1, Sheela Sathyanarayana2, Kaja Z Lewinn3, Catherine J Karr4, Kecia N Carroll5, Paul E
Moore6, Adam A Szpiro7
1Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle,

WA, USA
2Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle,

WA, USA & Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
3Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco,

CA, United States
4Department of Environmental and Occupational Health Sciences & Department of Epidemiology,

School of Public Health, University of Washington, Seattle, WA, USA & Department of Pediatrics,
School of Medicine, University of Washington, Seattle, WA, USA
5Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
6Division of Allergy, Immunology, and Pulmonology & Department of Pediatrics, Vanderbilt University

Medical Center, Nashville, TN, USA
7Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA

BACKGROUND AND AIM:An outcome-wide epidemiologic approach may indicate common etiologic
mechanisms and lead to better identification of efficient public health interventions. Our objective wasto identify clusters of chronic respiratory, obesity-related, and neurodevelopmental outcomes inchildren and to examine associations between cluster membership and phthalate exposures.
METHOD:In three prospective pregnancy cohort studies (ECHO PATHWAYS), we clustered 15 healthoutcomes for 1092 children. Outcomes included age 8-9 BMI z-score, full-scale IQ, anxiety score,irritability score, depression score, five behavioral problem subscale scores (social, thought, attention,
externalizing, and internalizing problem scores), and parent-reported ever asthma, wheeze, allergies,
speech problems, and learning disabilities. To form generalizable clusters across study sites, eachvariable was regressed on study site (n=7), and scaled residuals were clustered using k-meansclustering. Logistic WQS regressions with permutation test p-values associated odds of cluster
membership with a mixture of 14 late pregnancy maternal urinary phthalate metabolites in full-sample
and sex-stratified models.
RESULTS:Three clusters emerged, including a healthy cluster 1 (n=669) with low scores andprevalences of all outcomes; cluster 2 (n=244) with high asthma, wheeze, and allergy frequencies;and cluster 3 (n=179) with relatively high scores for all outcomes. When restricting to boys in the sexstratified analysis, there was a significant positive association (odds ratio = 1.38; p=0.01) between aphthalate mixture with higher weights for MCIOP, MEOHP, MEHHP, MCINP, and MEP and odds ofmembership in cluster 2 versus the healthy cluster 1.
CONCLUSIONS:These results identified subpopulations of children with co-occurring health outcomes,
including relatively high levels of BMI, respiratory, and neurodevelopmental outcomes that may reflecta shared etiologic pathway, and our findings indicate a positive association between primarily higher
molecular weight phthalates and the probability of membership in a cluster with high asthma, wheeze,and allergies. This analysis demonstrates a viable strategy for outcome-wide epidemiology in multistudy pediatric cohorts.

Keywords: Co-infections and co-morbidities, Asthma, Mental health outcomes, Obesity and metabolic
disorders, PhthalatesOP-365[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Exposure to polychlorinated biphenyls (PCBs)
and cognitive development of pre-school aged
childrenLucia Fábelová1, Soňa Wimmerová1, Eva Šovčíková1, Kamil Čonka2, Beata Drobná2, Tomáš Trnovec1,
Irva Hertz Picciotto3, Ľubica Palkovičová Murínová1
1Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University,

Bratislava, Slovakia
2Department of Toxic Organic Pollutants, Faculty of Medicine, Slovak Medical University, Bratislava,

Slovakia
3Department of Public Health Sciences, University of California, Davis, California, United States

BACKGROUND AND AIM:The aim of this study was to assess the effect of prenatal and postnatal
exposure to polychlorinated biphenyls (PCBs) on the cognitive development of children at 6 years.
METHOD:PCB congeners were analysed in samples of cord blood and blood of 6 years old children
from PCB cohort (Eastern Slovakia) using high-resolution gas chromatography. The Wechsler
Preschool & Primary Scale of Intelligence (3rd Edition) psychological test was used to assess the
cognitive development of children (n=177). Associations between the sum of dioxin-like (DL) and nondioxin-like (NDL) PCB congeners and verbal (VIQ), performance (PIQ), and full-scale IQ (FSIQ) wereanalysed using multiple linear regression. The final models were adjusted for maternal education,
ethnicity, and HOME scores and model for prenatal exposure was also adjusted for maternal age andparity.
RESULTS:Prenatal exposure to DL PCBs was associated with lower VIQ (β = -1.32 CI95% [-2.51; 0.12]), PIQ (β = -1.91 CI95% [-3.40; -0.42]), and FSIQ (β = -1.50 CI95% [-2.58; -0.42]). Postnatal
DL PCB exposure was associated with lower VIQ (β = -1.58 CI95% [-2.82; -0.33]) and FSIQ (β = 1.38 CI95% [-2.48; -0.28]) but not with PIQ. Regarding NDL PCBs, postnatal exposure was associatedwith lower FSIQ (β = -1.01 CI95% [-1.92; -0.11]) and VIQ (β = -1.27 CI95% [-2.25; -0.30]),
however, no significant association was observed for prenatal exposure to NDL PCBs. Analysis of
WPPSI-III verbal subtests showed the associations between postnatal NDL and DL PCB exposure andlower scores in the Vocabulary and in the Word Reasoning subtests.
CONCLUSIONS:We found the negative effect of PCB exposure on child's cognitive development
particularly visible in the verbal area. Our results suggested that both, prenatal and postnatal
exposure to PCBs, may influence the cognitive development of young children, even when the PCB
exposure is decreasing over time.

Keywords: Children's environmental health, Endocrine disrupting chemicals, Chemical exposures,
Outcomes

OP-366[Exposures » Other (to be specified with keywords in the keywords section)]

Exposures, investigations, and outcomes forchildren with elevated blood lead reported to
Health Protection Teams in England, 2014-2022
Mona Dave1, Helen Crabbe2, Neelam Iqbal2, Araceli Busby3, Helen Bagnall4, Louise Coole1
1UK Field Epidemiology Training Programme
2Environmental Epidemiology Group - Radiation, Chemicals and Environmental Hazards (RCE)

Directorate, UK Health Security Agency
3North East and North Central London Health Protection Team and Chair of LEPHIS Working Group, UK

Health Security Agency
4Field Service Midlands, UK Health Security Agency

BACKGROUND AND AIM:Lead is a non-threshold contaminant with children being most vulnerable toits effects. In England, children (≤16 years) with elevated blood lead are notified via UK Health
Security Agency’s (UKHSA’s) Lead Exposure in Children Surveillance System (LEICSS) to regional
Health Protection Teams (HPTs) for management. To date, a detailed review of these cases has notbeen conducted.
AIM: Describe demographics, settings and potential sources of lead exposure, public healthinvestigations, and clinical outcomes for children with elevated blood lead reported to HPTs for
management in England between 2014 and 2022.
METHOD:Data was collected using a lookback and live questionnaire with case managers. Data was
extracted from Select Survey, deduplicated, and cleaned and analysed in R studio.
RESULTS:The completion rate for the lookback questionnaire was 74%. Overall, 340 children werereported to HPTs and had a completed questionnaire. Most were aged 1-4 years (53%), male (69%)
and lived in the most deprived areas (31%). Ethnicity information was largely missing (61%) but
White British was most cited (16%). Paint (43%) and soil (29%) were the most common exposuresources. Pica was recorded in 76% of cases. Where recorded (n=241), the primary exposure setting
was domestic (92%) and exposure source was confirmed for 16%. A site visit was conducted for 50%
of cases, mostly (87%) by local authority public health staff. Advice was the most common control
measure (59%), however, 63% received paediatric/outpatient care. Where recorded (n=99), cases
reportedly lived in older (43%), rented (63%) homes (37% renting privately).
CONCLUSIONS:Lead exposure was mostly linked to the domestic environment with those living in theprivate rented sector being most vulnerable. This sector should be a target for engagement andpreventative intervention. Capturing ethnicity data consistently can aid identification of groups
disproportionately affected by lead exposure due to the link between ethnicity, deprivation, andhousing.

Keywords: lead (Pb) exposures, childhood, inequalities, public health management

OP-367[Chemical exposures » Other (to be specified with keywords in the keywords section)]Children’s exposure to DEHTP, DINCH and DEHA:
Results from the Hokkaido Cohort Study
Rahel Mesfin Ketema1, Monika Kasper Sonnenberg2, Yu Ait Bamai3, Chihiro Miyashita4, Holger Martin
Koch2, Claudia Pälmke2, Reiko Kishi4, Atsuko Ikeda Araki1
1Faculty of Health Sciences, Hokkaido University, Sapporo, Japan; Center for Environmental and

Health Sciences, Hokkaido University, Sapporo, Japan
2Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Instituteof the Ruhr-University Bochum (IPA), Bürkle-de-la-Ca

MP-Platz 1, 44789 Bochum, Germany
3Toxicological Center, University of Antwerp, Antwerp, Belgium
4Center for Environmental and Health Sciences, Hokkaido University, Sapporo, JapanBACKGROUND AND AIM:Due to legacy phthalates such as di-2-ethylhexyl phthalate regulation, theproduction and use of phthalate substitutes such as di-2-ethylhexyl terephthalate (DEHTP) and 1,2cyclohexane dicarboxylic acid diisononyl ester (DINCH) have increased. However, data on human
exposure is scarce, particularly in susceptible children. Thus, we investigated alternative plasticizers
such as DEHTP, DINCH, and di(2-ethylhexyl) adipate (DEHA) exposure trends in school-aged children.
METHOD:Japanese children aged 7 years old from an ongoing perspective Hokkaido birth cohort
participants were included in this study. In total 180 urine samples collected from 2012 to 2017 (30samples/year) were used to quantify 10 metabolites of DEHPT, DINCH, and DEHA using isotope
dilution LC-MS/MS. Exposure trends were examined using a linear regression model and estimateddaily intake (EDI) was calculated.
RESULTS:DEHTP and DINCH metabolites were detected in more than 90% of the children. The highest
concentration was observed in DEHTP metabolite mono(2-ethyl-5-carboxypentyl) terephthalate with a
median of 1.36 µg/L. Among DINCH metabolites cyclohexane-1,2-dicarboxylic acid mono(hydroxyisononyl) ester showed high median of 0.2 µg/L. While DEHA metabolite, mono-5-carboxy-2ethylpentyl adipate was detected in only 2 children. Compared to children in the US, German, andThailand, Japanese children seem to have lower exposure to DEHTP and DINCH metabolites. In thisstudy period, a 5-fold median increase was observed in 5cx-MEPTP with 2.72 µg/L in 2017 compared
to 0.54 µg/L in 2012 and all DINCH metabolites showed a 2-fold increase. The maximum EDI in µg/kg
bw/d was 3.47, 3.58 for DEHTP and DINCH respectively were 300 times below tolerable daily intake
by EFSA, and the maximum metabolites level also were lower than German Human Biomonitoringreference values.
CONCLUSIONS:Japanese children are increasingly exposed to phthalates substitutes DEHTP and
DINCH, which may indicate market changes due to legacy phthalates regulation in Japan. The
increasing exposure warrants future biomonitoring studies in a larger and more diverse population.

Keywords: Phthalates alternatives, DINCH, DEHTP, Chemical exposures, children

OP-368[Exposures » Occupational exposures]

Patterns of occupational exposure todisinfectants and cleaning products among
healthcare workers: the CONSTANCES cohort
Bakari Ibrahim1, Nicole Le Moual1, Guillaume Sit1, Marcel Goldberg2, Bénédicte Leynaert1, Céline
Ribet2, Nicolas Roche3, Raphaëlle Varraso1, Marie Zins2, Rachel Nadif1, Laurent Orsi1, Orianne
Dumas1
1Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire

Intégrative, CESP, Villejuif, France
2Université Paris-Saclay, Université de Paris, UVSQ, Inserm, Cohortes Epidémiologiques en population,

UMS 11, 94807, Villejuif, France
3Respiratory Medicine, Pneumologie, APHP Centre, Cochin Hospital, Université Paris Cité, Institut

Cochin (UMR 1016), Paris, France

BACKGROUND AND AIM:Epidemiological studies have identified cleaning and disinfecting activities asimportant risk factors for respiratory health among healthcare workers. Questions remain about
specific causal agents associated with higher exposure level within occupations. Clustering methods
are useful to better characterize exposures and account for their multidimensional aspects. We aimed
to identify occupational exposure patterns to disinfectants and cleaning products (DCPs) using
unsupervised clustering methods among healthcare workers.
METHOD:CONSTANCES (https://www.constances.fr/index_EN.php) is a French population-based
cohort of >220,000 adults (18-69 years) at inclusion (2012-2020). Among them, 5544 healthcare or
medical laboratory workers completed in 2022 a self-questionnaire on their occupation, workplace,cleaning and disinfection activities, including surfaces and materials cleaned, products used (e.g.,
glutaraldehyde, quaternary ammonium compounds, hydrogen peroxide), their frequency, form, andduration of use. All these categories of variables were used in multiple correspondence analysis,
followed by hierarchical agglomerative clustering and k-means algorithms, to identify occupational
exposure patterns.
RESULTS:The participants were on average 53 years old, 86% were women, 44% nurses, and 84%
used at least one DCPs weekly. Four clusters were identified: cluster 1 (C1, n=2448, 44%) mainly
characterized by unexposed nurses (42%) and physicians (29%), C2 (n=349, 6%) mainly
characterized by medical laboratory staff (81%) moderately exposed to the main DCPs
(chlorine/bleach, alcohol), C3 (n=2220, 40%) mainly characterized by nursing assistants (31%) andnurses (52%) highly exposed to a few DCPs (mainly quaternary ammonium compounds), and C4(n=527, 10%) mainly characterized by nurses (51%) highly exposed to multiple DCPs including
glutaraldehyde, hydrogen peroxide, acids, enzymatic cleaners.
CONCLUSIONS:We identified four patterns of DCPs exposures among healthcare workers. Results
suggest that, although nursing jobs are heterogeneous, nurses and nursing assistants are the mosthighly exposed in terms of frequency and quantity of products. Analyses on the associations between
these patterns and asthma outcomes are ongoing.

Keywords: occupational exposure,clustering, healthcare workers, Constances cohort, DCPs

OP-369[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Amyotrophic lateral sclerosis survival andoccupational lead exposure in the Danish
National Patient Registry
Ian W Tang1, Johnni Hansen2, Aisha S Dickerson3, Marc G Weisskopf4
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Danish Cancer Society Research Center, Copenhagen, Denmark
3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Risk factors associated with amyotrophic lateral sclerosis (ALS) survival are
not well understood. Lead is a known neurotoxicant, but only few studies have examined its effect on
ALS survival. We investigated the relationship between occupational lead (Pb) exposure and ALS
survival using the Danish registry system.
METHOD:We identified 750 ALS cases diagnosed between 1982-2009 with full employment history,
and at least two ALS diagnoses, one of them being in an inpatient setting. Cases were followed until
March 1, 2017, or until censored. We examined Pb exposure as ever/never exposed, based on a
Danish job-exposure matrix, and divided cumulative exposure into tertiles. We evaluated survival
using Cox proportional hazard models with Pb exposure (no lag, 5-year lag, and 10-year lag),stratified analyses by sex, and adjusted for age, socioeconomic status, marital status, and diagnosis
year.
RESULTS:Median survival and age at diagnosis of ALS cases was 23.9 months and 55 years,
respectively, and did not differ by sex. Survival was significantly worse for women ever exposed to Pb(no lag hazard ratio (HR): 1.39; 95% CI: 1.04-1.86) compared to non-exposed women, and this was
similar with either a 5 or 10 year lag period. HRs were also elevated in tertiles of cumulative exposure,with the ten-year lagged exposure showing an increasing dose-response relation. The HR in tertiles 1,
2, and 3 of exposure were 1.19, 1.35, and 1.49, respectively. No associations were seen among men.
CONCLUSIONS:Occupational lead exposure contributed to shorter survival among women withoccupational Pb exposure, while no association was seen among men. Our study adds to three others,
one of which observed higher HRs among women. The lagged analysis results could suggest somehealthy-worker survivor bias among women or that earlier lead exposures before ALS onset are more
relevant for survival. Supported by T32ES007069, P30ES000002, and R01ES019188.

Keywords: Heavy metals, occupational exposures, survival

OP-370[Exposures » Occupational exposures]Night shift work and female breast cancer: atwo-stage dose-response meta-analysis for thecorrect risk definition
Jinyoung Moon
Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, SouthKorea

BACKGROUND AND AIM:The hypothesis of this study is night shift work exposure can increase the riskof female breast cancer. To validate this hypothesis, the author conducted a two-stage dose-response
meta-analysis with improved quality on this topic.
METHOD:The medical librarian searched PubMed, EMBASE, and the Cochrane Library on 30th
December 2022. The 8 inclusion criteria were determined and strictly applied to the selection process.
RESULTS:Finally, 10 cohort studies (12 cohort reports, total cases: 18086, and total person-years:
7987557) and 16 case-control studies (16 case-control reports, total cases: 17805, and total controls:
21184) were included.The pooled RR of female breast cancer for 1, 10, 20, and 30 years of night shift
work exposure was 1.0042 (95% CI 1.0015-1.0069), 1.0428 (95% CI 1.0151-1.0712), 1.0873 (95%
CI 1.0303-1.1475), and 1.1338 (95% CI 1.0459-1.2292), respectively. The pooled OR of female
breast cancer for 1, 10, 20, and 30 years of night shift work exposure was 1.0279 (95% CI 1.01431.0417), 1.3171 (95% CI 1.1530-1.5044), 1.7346 (95% CI 1.3294-2.2633), and 2.2846 (95% CI
1.5328-3.4051), respectively.
CONCLUSIONS:This study (ⅰ) strictly applied 8 transparent inclusion criteria, and (ⅱ) thoroughly
separated RRs from cohort studies and ORs from case-control studies and synthesized each type ofeffect estimates separately. In addition, (ⅲ) exposure dose (years of night shift work) was clearly
defined in evidence synthesis based on the years of night shift work reported in individual studies.
Finally, (ⅳ) the author applied a new two-stage dose-response meta-analysis method reported inrecent literature. Therefore, this study will be the best evidence regarding this topic, and the results
reported in this study will be the most accurate and up-to-date risk definition for breast cancer
according to years of night shift work exposure.

Keywords: Night shift work, Breast cancer, Dose-response meta-analysis, Cohort studies, Casecontrol studies

OP-371[Exposures » Occupational exposures]

Investigation of Mask Protection Efficiency andassociated Respiratory Deposition in
Occupational Aerosol Exposure for Dental
Hygienists
Shafali Patel, Ambereen Khan, Wei Chung Su
Southwest Center for Occupational and Environmental Health, The University of Texas Health Science
Center at Houston, USA

BACKGROUND AND AIM:During the pandemic, there was a great concern among dental hygienists
regarding being infected by the aerosol generated from dental cleaning processes. To protect
themselves, dental hygienists applied various types and different layers of masks. This researchattempted to systematically study the mask protection efficiency of common masks and the associatedmask application combinations used by dental hygienists and the associated aerosol lung deposition.
METHOD:The test masks were surgical and N95 masks with four often-applied combinations (surgical,
N95, 2x surgical, and Surgical + N95). Dental cleaning aerosol was generated by a professional dental
ultrasonic scaler working on a dental typodont. The recently developed Mobile Aerosol Lung Deposition
Apparatus (MALDA) was applied to acquire experimental data. MALDA consists of a set of 3D-printed
human airway replicas and an aerosol particle sizer. With the particle size distributions measured bothin the oral airway and TB airways under conditions w/ and w/o mask-wearing, the mask protection
efficiency and the aerosol respiratory deposition in the upper airways can be systematically estimated.
RESULTS:Experimental data obtained showed that test masks with different combinations could
filtrate 87% to 96% (size-averaged) of the aerosol generated from the dental cleaning process. The
mask protection efficiency increased as the aerosol size increased. The N95 had the lowest mask
protection efficiency shown at the small aerosol size range (70% at 0.5 μm) compared to all the othermask combinations. The respiratory deposition results showed that the aerosol deposition fraction in
the upper airways decreased as the aerosol size increased. Less than 5% of the aerosol larger than 1µm was found deposited in the human head-to-TB airways.
CONCLUSIONS:Data acquired in this study suggests that 2 layers of surgical masks would be sufficient
to provide reasonable protection efficiency against dental cleaning aerosol and significantly reduceaerosol respiratory deposition in the upper airways.

Keywords: Dental cleaning, Aerosol, Mask protection efficiency, Aerosol respiratory deposition

OP-372[Built environment » Noise]

Noise exposure and acute changes to monitored
heart rate among electronic-waste recycling
workers
Xin Zhang, Abas Shkembi, Lauren M. Smith, Richard L. Neitzel
Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann
Arbor, MI, United States

BACKGROUND AND AIM:Globally, about 83% of 53.6 million tons of electronic-waste (e-waste) was
landfilled, incinerated, or informally recycled in 2019. Informal recycling workers manually dismantle
and sort e-waste, often in hazardous conditions without proper protective equipment. Noise, as one of
the hazardous exposures they suffer from, causes hearing loss and increases the risk of adverse
cardiovascular events. This analysis evaluated how acute occupational noise as a stressor changes
individual’s heart rate (HR) during e-waste recycling work.
METHOD:Time-series noise level and HR, both measured at 1-min intervals, were collected in crosssectional studies in Thailand and Chile from 126 adult participants. Equivalent sound level (Leq) andits change from previous minutes (dLeq) were the primary exposures. Outcomes, including HR above
baseline, HR elevation (change in magnitude) and HR increase (change in quantity) were calculatedusing Monte-Carlo simulation. Three mixed-effect time series regression models were fitted
respectively to each outcome, controlling for work tasks, time of the day, stress, and demographics.
All models assigned participant ID as a random intercept to account for within-person correlation andinterpersonal variations. Additionally, the analysis investigated lagged responses up to three minutes.
RESULTS:Noise had an immediate effect on HR at 1min resolution. A 10dB increase in Leq was
associated with a 5.9 beat per minute increase in HR above baseline, a 5% higher risk of HR elevation,and 6% higher odds of increased HR than previous minute. The concurrent effect of dLeq was nonlinear, with more HR changes when dLeq≥12dB, and less to no changes otherwise.
CONCLUSIONS:Doubling the perceived loudness (dLeq=10dB), not sound energy (dLeq=3dB), induced
significant HR changes. This phenomenon supports the theory that perceived noise-induced stressaffects HR through neuroendocrine systems. Reducing acute noise exposure for informal e-waste
recycling workers is critical to lower the risk of stroke, myocardial infarction, and other cardiovasculardiseases.

Keywords: Cardiovascular diseases, Short-term exposure, Occupational exposuresOP-373[Exposures » Occupational exposures]

Impact of occupational heat exposure on blood
lipids among petrochemical workers: An
analysis of 9-year longitudinal data
Yifeng Chen1, Qingyu Li1, Yan Yang1, Zihu Lv2, Wei Zheng2, Jianjun Xiang1
1Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, China
2Minnan Branch of the First Affiliated Hospital of Fujian Medical University, Quanzhou, China

BACKGROUND AND AIM:To analyze the impact of occupational heat exposure on dyslipidemia in
petrochemical workers and identify susceptible groups.
METHOD:A total of 30,847 workers’ occupational health examination data from 2013 to 2021 werecollected from two petrochemical plants, including demographic characteristics, occupational exposure
history, and testing results of blood lipids including total cholesterol (TC), low density lipoproteincholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels.
Generalized estimating equations (GEE) model was used to analyze the impact of heat exposure alone
or coupled with other occupational hazards (e.g., gasoline) on workers' blood lipids, after adjusting forconfounders.
RESULTS:The one-factor exposure model shows that most of the individual occupational hazard weresignificantly negatively associated with dyslipidemia. The two-factor exposure model showed that heatstress coupled with gasoline (Incidence Rate Ratio, IRR=1.267, 95%CI 1.117-1.437), heat withhydrogen sulfide (IRR=1.324, 95%CI 1.166-1.505) significantly increased the risk of high TC.
Stratified analysis revealed that in the model of heat and gasoline double exposure, women(IRR=2.240, 95%CI 1.639-3.062), aged over 35 (IRR=1.317, 95%CI 1.158-1.497), non-smoking(IRR=1.536, 95%CI 1.285-1.836), and non-alcohol drinking (IRR=1.587, 95% CI 1.276-1.973) weremore likely to have heat-related high TC. While in the model of heat and hydrogen sulfide double
exposure, women (IRR=2.347, 95%CI 1.736-3.173), aged over 35 (IRR=1.385, 95%CI 1.215-1.578),
non-smoking (IRR=1.602, 95% CI 1.344-1.911), and non-alcohol drinking (IRR=1.647, 95%CI 1.3232.051) were also more likely to have heat-related high TC. Heat exposure coupled with nitrogenoxides, sulfur dioxide, benzene, methanol, and carbon monoxide double exposure had no significant
impact on dyslipidemia.
CONCLUSIONS:The impact of heat and other petrochemical hazards on blood lipids may be affectedby healthy worker effect. Heat exposure combined with gasoline or hydrogen sulfide can significantly
increase the risk of dyslipidemia. Health interventions should pay more attention to female workers
aged over 35 years without smoking and drinking.

Keywords: Big data, Temperature, Occupational epidemiology, Occupational exposures, Climate

PECHA KUCHA ORAL ABSTRACTSPK-001[Climate » Temperature]

Association between Temperature and Mental
Health Work Loss: Evidence from Santiago, Chile
Alejandro Bañados, Luis Abdón Cifuentes
School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Global Change Center
UC, Santiago, Chile

BACKGROUND AND AIM:The temperature has been shown to have an impact on mental health-related
mortality, hospital admissions, and emergency visits. However, the magnitude of the association withwork loss is still being researched. This study aims to assess the relationship between mental healthrelated medical leaves and daily temperature in the Metropolitan Region of Santiago, Chile.
METHOD:Daily maximum temperature and wet bulb global temperature (WBGT) were obtained from acentrally located weather station. Also, the daily maximum temperature for each of the 52 communesof the region was obtained from a 5x5 km grid estimate (CR2met). Individual medical leaveauthorizations for working-age people were obtained from the National Health Fund (FONASA), which
covers 77% of the population. The analysis was performed for the summer (Dec-Feb) of 2018, 2019and 2020. A Poisson Distributed Lag Non-Linear Model (DLNM) was used at two aggregation levels: 1)
time series analysis for the whole region, and 2) case times series at the commune level. Elevensubgroups of mental health-related diagnosis (subgroups of the ICD10 chapter V) were considered.
Extreme heat was defined at 35°C (regional extreme heat alert) and excess risks were computed withrespect to a baseline of 32°C.
RESULTS:For the time series method, all mental health causes (F00-F99) were significantly associatedwith WBGT (RR= 1.16; 95% CI: 1.06-1.27), but not with plain ambient temperature. For the casetime series design, 3 groups of causes showed a significant association with daily maximum
temperature: all mental health causes with 1.13 (1.07-1.20), organic mental disorders (F00-F09) with
1.42 (1.14-1.75), and mood disorders (F30-F39) with 1.17 (1.07-1.28).
CONCLUSIONS:Mental health work absences were associated with daily temperature. Thermal stressindicators and case time series design improved results and should be used in future studies.
Authorities and private firms should be aware of this kind of effect to implement appropriate
measures.

Keywords: Climate, Temperature, Mental health outcomesPK-002[Respiratory and allergic outcomes » Other (to be specified with keywords in the keywords section)]

The influence of the weather on adolescentairway inflammation
Ashtyn Tracey Areal1, Nidhi Singh2, Qi Zhao3, Dietrich Berdel4, Sibylle Koletzko5, Andrea Von Berg4,
Monika Gappa6, Joachim Heinrich7, Marie Standl8, Michael J Abramson9, Tamara Schikowski2
1IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; Department of

Epidemiology, Medical Research School, Heinrich-Heine-University, Düsseldorf, Germany
2IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
3IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; School of Public

Health, Cheeloo College of Medicine, Shandong University, Jinan, China
4Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
5Department of Pediatrics, Dr. von Hauner Children’s Hospital Munich, University Hospital, LMU

Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of
Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
6Department of Paediatrics, Evangelisches Krankenhaus, Düsseldorf, Germany
7Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU

Munich, Munich, Germany; German Center for Lung Research (DZL), Germany; Allergy and Lung
Health Unit, Melbourne School of Population and Global Health, The University of Melbourne,
Melbourne, Australia
8German Center for Lung Research (DZL), Germany; Institute of Epidemiology, Helmholtz Zentrum

München - German Research Center for Environmental Health, Neuherberg, Germany
9School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia

BACKGROUND AND AIM:Fraction of exhaled Nitric Oxide (FeNO) is a marker of eosinophilic airway
inflammation. We examined the main effects and interactions of low-level short-term air pollutants(AP), temperature and relative humidity (RH) on lung inflammation (FeNO) in adolescents.
METHOD:A total of 2042 participants were included from the 15-year follow-up of the GINIplus and
LISA birth cohorts in Munich and Wesel, Germany. Low-level short-term AP exposure was assessed asdaily average concentrations of ozone (O3), nitrogen dioxide (NO2) and particulate matter <2.5µm(PM2.5) at 0.2 km spatial resolution. Daily meteorological data (maximum [Tmax], minimum [Tmin]
and mean [Tmean] temperatures, and RH) were obtained from the German Weather Service. FeNO
measurements were made with a handheld device following published guidelines. General linear
models were fitted with Ln(FeNO) as the outcome.
RESULTS:Increased FeNO was associated with a decrease in RH and temperature. The interactive
effects between RH and temperature (Tmin p=0.001, Tmax p<0.001, Tmean p=0.001), and air
pollutants (NO2 p=0.029, O3 p=0.019) also showed an increase in FeNO. The association wasconsistently high in the cold season (p<0.050). The effect modification showed females, participants
without respiratory conditions and those living in Munich were more sensitive to interactions of RH
with temperature and pollutants.
CONCLUSIONS:Weather variables are more closely associated with adolescent lung inflammation than
low-level short-term AP.

Keywords: Air pollution, Climate, Temperature, Short-term exposure, Epidemiology

PK-003[Birth and pregnancy outcomes » Birth outcomes]

The association between living near wildfire
before and during pregnancy and congenital
heart disease risk in offspring
Bo Park1, Ruofan Yao2, Rupa Basu3
1Department of Public Health, California State University - Fullerton Fullerton, CA
2Department of Obstetrics and Gynecology, Loma Linda University School of Medicine Loma Linda, CA
3Air and Climate Epidemiology Section, Cal EPA/Office of Environmental Health Hazard Assessment(OEHHA) Oakland, CA

BACKGROUND AND AIM:California wildfires have increased in frequency, duration, and intensity in thepast couple of decades and produced air pollutants that have been associated with complications
during pregnancy. Congenital heart defect (CHD) is the most common birth defect, which affects
approximately 1% of live births. The purpose of this study is to determine the] association between
wildfire exposure before and during pregnancy and the odds of CHD in the offspring.
METHOD:This was a retrospective cohort study using the California Office of Statewide Health Planningand Development Linked Birth File and the California Department of Forestry and Fire Protection data
between 2007 and 2010. Pregnancies complicated by two most common CHDs were identified by theInternational Classification of Diseases Clinical Modification, 9th Revision (arterial septal defect (ASD)
745.5 and ventricular septal defect (VSD) 745.4). Pregnancies were considered exposed to wildfire
smoke if the mother’s primary residence zip code was within 15 miles of the closest edge of a wildfire
and was further broken into first, second, and third trimester, or within four weeks before the last
menstrual period.
RESULTS:Between 2007 and 2010, 1,904,344 births were analyzed in the study. Among these 38,182
were diagnosed with ASD and 19,383 were diagnosed with VSD. Compared to births without wildfire
exposure, those with first, second, and third-trimester exposure were associated with a higher risk of
ASD with adjusted risk ratio (aRR) of 1.12 (95% confidence interval (CI): [1.05 – 1.19]), aRR of 1.14
(95% CI: [1.08 – 1.2]) and aRR 1.08 (95% CI: [1.02 – 1.15]), respectively. Pre-pregnancy wildfire
exposure was not associated with ASD risk. No significant association was found between prenatal
wildfire exposure and VSD risk.
CONCLUSIONS:Wildfire exposure during pregnancy appears to increase the risk of developing arterial
septal defect risk but not ventricular septal defect risk in the offspring.

Keywords: wildfire, congenital heart disease, arterial septal defectPK-004[Climate » Temperature extremes and variability]

Future climate change impacts on child health:An assessment of preterm-births, diarrheal
cases and heat-related mortality for 20 African
citiesFiliz Karakas1, James Milner1, Cherie Part1, Ana Bonell2, Shakoor Hajat1, Sari Kovats1, Robert
Hughes3
1Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London

School of Hygiene & Tropical Medicine, UK
2Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School ofHygiene & Tropical Medicine, UK
3Department of Population Health, Faculty of Epidemiology and Population Health, London School ofHygiene & Tropical Medicine, UK

BACKGROUND AND AIM:Climate risks are known to affect child health. We quantified the impact ofclimate scenarios on annual heat-related child deaths, child diarrheal disease cases, and preterm
births in 20 of the fastest growing cities in Africa.
METHOD:We estimated the impact of the current (2020) and future (2050) high temperatures on
three outcomes for child health under 5s (all-cause mortality, diarrhoeal disease incidence, andpreterm birth) in 20 African cities, using linear threshold models. From 32 CMIP6 climate models, thedata were extracted for each city and three emission scenarios (SSP119, SSP245, SP585). Exposureresponse functions were taken from published meta-analyses. We used daily mean temperature foreach day between 2020 and 2050. The SSP2 (middle-of-the-road) population projection was used for
future populations and the global burden of disease (GBD) national projections (GBD study 2019) inmortality, diarrheal disease and preterm birth accounted for future health improvement.
RESULTS:A significant increase in annual heat-related under-5 mortality over the next 30 years wasobserved in all scenarios (up to 61% under ssp245, and up to 102% under ssp585) in 2050 compared
to 2020, except under SSP119. Heat related deaths were avoided by going from high to low emissions
scenarios. Population growth was the largest contributor to changes in heat related mortality
compared to changes in climate and all-cause mortality rate. While diarrhoea cases decline in all cities(because of projected improvements in treatment and prevention), preterm birth cases increased
between 2-92% under SSP119, 2-200% under 245, and 10-275% under SSP585 by 2050.
CONCLUSIONS:Our results indicate that climate change is likely to have a significant impact on childhealth. Our findings support the need for urgent mitigation and adaptation measures that are focussed
on protecting the health of children.

Keywords: Children's environmental health, climate, mortality, temperature variability, temperature
extremesPK-005[Climate » Temperature extremes and variability]

Heat-Wave and Cold-Spell Vulnerability Analysis
by Physical and Cognitive Functions: A
Prospective Longitudinal Cohort Study in China
Di Xi1, Linxin Liu1, Yi Zeng2, John S Ji1
1Vanke School of Public Health, Tsinghua University, Beijing, China
2Center for Healthy Aging and Development Studies, National School of Development, Peking

University, Beijing, China; Center for the Study of Aging and Human Development, Duke Medical
School, Durham, NC, USA

BACKGROUND AND AIM:There is limited evidence regarding the interaction between individual
behavioural characteristics and temperature-related premature death. We aimed to investigate theshort-term effects of heat-waves and cold-spells on elderly mortality by physical and cognitive
functions.
METHOD:We conducted a longitudinal cohort study utilizing the Chinese Longitudinal Healthy
Longevity Survey (CLHLS, 2008-2018). Our study population consisted of age groups (>65, >80, and>100 years). Heat-wave events were defined as three or more consecutive days with daily minimum
temperature exceeding the 95th percentile (May to September), while cold-spell events were definedas three or more consecutive days with a daily maximum temperature below the 5th percentile(November to March). Demographic and socio-economic data, as well as physical (Activities of Daily
Living, ADL; Instrumental Activities of Daily Living, IADL) and cognitive function (Mini-Mental State
Examination, MMSE), were also collected. We used time-dependent Cox proportional hazard models,
adjusted for possible confounders including age, sex, administrative region, urban or rural residence,co-residence, air pollutants (PM2.5 and ozone), and green and blue space around the residential
locations.
RESULTS:We followed 11,903 participants for 64,372.42 person-year (median baseline age: 86.87,
57.43% female). Both the occurrence of heat-wave day (HR: 1.33, 95% CI: 1.09, 1.60) and cold-spellday (HR: 1.28, 95% CI: 1.10, 1.49) were associated with increased premature mortality compared tonormal days. High age was a risk factor of heat-wave (HR: 1.05, 95%CI:1.04, 1.06) and cold-spell(HR:1.34, 95%CI:1.13, 1.57). Individuals with severe ADL impairments were the most vulnerable tothe short-term effects of heat-waves (HR: 2.13, 95% CI: 1.71, 3.86). Those needing partial help
getting dressed were the most vulnerable subgroup to heat waves (HR:5.41, 95% CI:1.58, 18.56).
CONCLUSIONS:It is crucial to understand the individual behavioural characteristics contributing toincreased or decreased risk for mortality associated with extreme temperature; we found specificdisabilities for public health interventions.

Keywords: vulnerability, heat-wave mortality, cold-spell mortality, physical function, cognitive
function

PK-006[Climate » Temperature]

Gender and seasonal different effects oftemperature in Hand, foot, and mouth disease: A
distributed lag non-linear model
Jongmin Oh1, Whanhee Lee2, Jieun Min3, Eunji Kim3, Joyce Mary Kim3, Youngrin Kwag4, Hae Soon
Kim5, Ji Hyen Lee5, Eunhee Ha6
1Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University; Department of Human System Medicine, College of Medicine, Seoul National
University
2School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, Yangsan, Republic of Korea
3Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
4Department of Environmental Medicine, College of Medicine
5Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans

University; Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Republic of
Korea
6Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha
Womans University; Department of Pediatrics, Ewha Womans University College of Medicine, Seoul,
Republic of Korea

BACKGROUND AND AIM:High temperatures and vulnerabilities in children’s health are known, but few
studies have been conducted. Hand, foot, and mouth disease (HFMD) is an infectious disease thatmainly occurs in children in summer, and the risk may increase due to climate change. This study
aimed to evaluate the association between daily apparent temperature (AT) and HFMD in children.
METHOD:We collected daily counts of hospital admission for HFMD in young children (0-4 years) living
in Seoul, South Korea, from 2015 to 2020. Distributed lag non-linear model (DLNM) with quasiPoisson was conducted to quantify the effects of daily AT on HFMD. We considered for the lag period
to 4, 7, 14, and 21 days. All models adjusted for time trend, day of weeks, and pandemic period(COVID-19). Stratified analysis by gender and season were conducted.
RESULTS:A total of 5,526 counts of hospital admission for HFMD were obtained during the study
period. Children's HFMD hospitalizations showed the highest frequency in July. The mean daily(standard deviation (SD)) number of children HFMD hospitalizations and AT (℃) is 2.5 (4.6), 13.2
(11.9), respectively. We found a non-linear association between daily AT and hospital admission for
HFMD. In the model considering lag periods 4, 7 and 14, the overall effect was peaking at the 38℃(Relative risk [RR]: 2.20, 95% Confidence intervals [CI]: 1.43, 3.37), 34℃ (RR: 2.26, 95% CI: 1.32,
3.86), 33℃ (RR: 2.55, 95% CI:1.16, 5.67) of AT as compared to the 50th percentile of AT,
respectively. As the lag days increased, there was no association between AT and hospitalization for
HFMD. We found significant differences in the stratified analysis by gender and season.
CONCLUSIONS:Our findings suggest that increased apparent temperatures are associated withhospital admission for HFMD in children. The shorter the lag period, the stronger the association
between AT and hospitalization for HFMD.

Keywords: Children, HFMD, time-series, high temperature, Korea

PK-007[Climate » Temperature extremes and variability]

Disparities in healthcare resources associatedwith heatwave-related mortality in 7 major cities
of South Korea
Jungsil Lee‡1, Jieun Min‡2, Whanhee Lee3, Chaerin Park4, Cinoo Kang4, Juyeon Yang5, Dohoon
Kwon4, Eunhee Ha6
1Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea
2Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea
3School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, Yangsan, Republic of Korea; Institute of Ewha-SCL for Environmental
Health (IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea
4Department of Public Health Sciences, Graduate School of Public Health, Seoul National University,

Seoul, Republic of Korea
5Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
6Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul,

Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine,
Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health(IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department ofMedical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute,
Seoul, Republic of Korea

BACKGROUND AND AIM:Health equity begins with creating equal opportunities for people with equal
needs to access necessary healthcare resources. To address the equity issue in climate change, thisstudy examined the relationship between heatwave-mortality risk and regional disparities inhealthcare resource allocation.
METHOD:We collected daily time-series data on mean temperature and all-cause mortality for all 74
districts (shi/gun/gu) in seven metropolitan cities in South Korea from 2011 to 2019, from real-time
re-analysis data of Korea Meteorological Office and from National Statistics Office, respectively.
Heatwave days were defined as the occurrence of daily mean temperature above the 95th, 97.5th, or
99th percentile of the temperature distribution for two or more consecutive days for each district. Dataon district-level healthcare resources were collected from the Korea National Statistics Office during
the study period. For data analysis, we first estimated the district-specific heatwave-mortality risk
using a distributed lag model and subsequently performed a meta-regression to estimate theassociation between healthcare resources and heatwave-mortality risk.
RESULTS:We found that higher number of hospital beds per 100,000 people and emergency room
utilization rate within the standard time were associated with lower risk of heatwave-related mortality.
While stronger association with the number of hospital beds was shown in people aged 0–64 years
compared to the elderly (change in RR of -14.1% (95% CI -24.4%, -2.3%) vs. -1.2 % (95% CI 8.7%, 6.9%) per IQR increase, with definition of heatwave days above the 95th percentile), theassociation with timely emergency room utilization was more evident in the elderly (change in RR of 5.4% (95% CI -17.9%, 8.9%) vs. -9.7% (95% CI -17.7%, -1.0%) per IQR increase, with definition ofheatwave days above the 97.5th percentile).

CONCLUSIONS:This study provides epidemiological evidence to support public health policy that canaddress the importance of healthcare resource allocation to reduce heatwave-related mortality.

Keywords: Environmental disparities, Temperature, Mortality

PK-008[Climate » General]

Large Scale Climate teleconnections andIndicators and Impact on human health and wellbeing
Kenza Khomsi1, Kenza Khomsi2, Oumaima Bouakline3, Imane Sekmoudi4
1General Directorate of Meteorology
2Mohamed VI University for Health Sciences
3Faculty of Science, Ibn Tofail University
4Independent Researcher

BACKGROUND AND AIM:Large-Scale Climate Indicators (LSCI) describe the intricate connections
between the atmosphere, oceans, and continents within specific regions. Prior research has
established a correlation between these indicators and atmospheric and climate variations. Despite thesignificance of climate and health as a research topic, few studies have explored the direct link
between these indicators and human health and well-being. The objective of this study is toinvestigate the LSCI in the Mediterranean region and assess the impact of the most relevant indicators
on human health and well-being. Specifically, this study seeks to enhance our understanding of the
LSCI and their effect on air pollution and skin temperatures in the Mediterranean region.
METHOD:This study gathered data on LSCI, as well as reanalysis data on skin temperature and PM10,
over the Mediterranean region from the past two decades. The trends in the datasets were analyzed
using Theil and Sen's slope, and correlations between the time series were estimated on both anannual and seasonal basis using the Spearman coefficient.
RESULTS:The study identified four key LSCI that affect the Mediterranean region: the North Atlantic
Oscillation (NAO), the Mediterranean Oscillation (MO), the East Atlantic pattern (EA), and the SaharanOscillation (SaO). These indicators were found to be interrelated, and at both annual and seasonalscales, significant correlations were found between the indicators and PM10 and skin temperatures in
the Mediterranean region.
CONCLUSIONS:The study findings suggest that large-scale atmospheric processes partly explain skintemperature, thermal comfort, and the impacts of particulate pollution on human health in the
Mediterranean region. Furthermore, there is potential for exploring the relationships between LSCI andclimate and environmental extremes. Understanding large-scale atmospheric circulation and its
implications in the Mediterranean region would be a significant advancement toward developing a
Climate/Health warning system.

Keywords: Large-Scale circulation, climate, health, PM10, Mediterranean

PK-009[Climate » Temperature]

Ambient Temperature and MaternalHypertensive Disorders in Taiwan
Kuan Hui Chi1, Yin Yi Chang2, Pei Chun Chen1
1Department of Public Health, China Medical University, Taichung, Taiwan; Graduate Institute ofInternational Public Health Program, China Medical University, Taichung, Taiwan
2Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan;

Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Evidence has shown an increased risk of hypertensive disorders (HTDs) inpregnancy associated with extreme temperatures, but whether the association varies over timeremains unclear. We investigated the association between exposures to ambient temperature and
HTDs in pregnancy by time periods in Taiwan.
METHOD:We conducted a retrospective cohort study using birth register data linked to National Health
Insurance claims data. Pregnant women without a diagnosis with hypertension before 20 weeks ofgestation from 2006 to 2017 were included and separated into two groups based on their delivery
year: 2006-2011 and 2012-2017. We calculated mean air temperatures from conception to 20 weeks
of gestation in residing area of each women. Logistic regression models were used to estimate theodds ratio (OR) and 95% confidence interval (95% CI) for the association between of temperature and
HTDs in pregnancy defined as gestational hypertension, pre-eclampsia or eclampsia.
RESULTS:Over the 12-year period, of 676,242 women included, 21,732 (3.2%) had HTDs in
pregnancy. Overall, higher temperature was associated with increased odds of HTDs in pregnancy.
The adjusted OR (95% CI) for women in the <5th, 5th-25th, 50th-75th, 75th-95th, and >95th
percentiles of mean temperature was 1.03 (0.96-1.10), 0.99 (0.95-1.03), 1.05 (1.01-1.09), 1.07
(1.02-1.11), and 1.17 (1.10-1.25), respectively, as compared with those in the 25th-50th percentile
category. Similar results were observed in the 2012-2017 cohort except that an increased risk wasalso observed in women exposed to very low temperature (<5th vs. 25th-50th percentile, adjusted OR[95%CI], 1.15 [1.05-1.26]). However, no significant association between temperature and HTDs in
pregnancy was observed in the 2006-2011 cohort.
CONCLUSIONS:This study suggests that very low and moderately to very high temperatures areassociated with increased risk of HTDs in pregnancy in Taiwan, and the association may differ by time
periods.

Keywords: Temperature, Temperature extremes, Environmental epidemiology

PK-010[Climate » Temperature]

Exploring the Association between Heat Alerts,
Mortality Risk, and Greenspace in Santiago,
Chile: A Case Time Series Design
Alejandro Bañados, Luis Abdón Cifuentes
School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Global Change Center
UC, Pontificia Universidad Católica de Chile, Santiago, Chile

BACKGROUND AND AIM:In 2022 the regional government of Santiago started issuing public alerts
when ambient temperatures exceed certain levels in a central meteorological station. We aim toevaluate the mortality excess risks associated with these alert levels, considering the interaction ofgreenspace.
METHOD:Data for each of the 52 communes of the Chilean Metropolitan Region was used. The daily
maximum temperature was obtained from a 5x5 km grid estimate (CR2met). Normalized Difference
Vegetation Index (NDVI) from Moderate-Resolution Imaging Spectroradiometer (MODIS) was used asa proxy for greenspace. Daily all-cause death certificates were obtained from the Department of
Statistics and Health Information (DEIS) of the Ministry of Health. A case time series design was
performed with a Poisson Distributed Lag Non-Linear Model (DLNM) for the warm season (Oct-Mar)from 2011 to 2021. We defined extreme heat as 35°C (extreme heat alert) and computed excess risks
with respect to a baseline of 32°C (no heat alert).
RESULTS:A significant association was found between extreme heat and mortality (RR = 1.13; 95%
CI: 1.07-1.19). The association was stronger for the communes with the lowest quartile of NDVI (RR= 1.26; 95% CI: 1.12-1.41), compared to those in the highest quartile (RR = 1.07; 95% CI: 0.961.19).
CONCLUSIONS:Heat alerts can be an effective prevention tool for increased mortality risk, but using
the same level for all communes imposes different levels of risk in each of them. Alerts at different
levels for communes grouped based on vulnerability similarities could reduce these inequalities.
Adaptation measures and public health interventions should prioritize communities with lessgreenspace.

Keywords: Climate, Green space, Mortality, TemperaturePK-011[Climate » Temperature extremes and variability]

Association between high ambient temperaturesand road crashes in an Australian city withtemperate climate: A time-series study, 2012¬–
2021
Yannan Li1, Blesson Varghese1, Jingwen Liu1, Peng Bi1, Michael Tong2
1The University of Adelaide
2The Australian National University

BACKGROUND AND AIM:BACKGROUND: High ambient temperatures are associated with increased
morbidity and mortality rates, and some evidence suggests that high temperatures increased the riskof road crashes. However, little is known regarding the burden of road crashes attributable to nonoptimal high temperatures in Australia. Therefore, this study examined the effects of hightemperatures on road crashes using Adelaide in South Australia as a case study.
METHOD:METHODS: Ten-year daily time-series data on road crashes (n=64,597) and weather during
the warm season (October-March) were obtained between 2012 and 2021. A quasi-Poisson distributed
lag non-linear model (DLNM) was used to quantify the cumulative effect of high temperatures over theprevious five days. The associations and attributable burden at moderate and extreme temperature
ranges were computed as relative risks (RR) and attributable fractions.
RESULTS:RESULTS: There was a J-shaped association between high ambient temperatures and therisk of road crashes during the warm season in Adelaide, and pronounced effects were observed withminimum temperatures. The highest risk was observed at lag 1 day and lasting for 5 days. Hightemperatures were responsible for 0.79% (95%CI: 0.15–1.33%) of road crashes, with moderate hightemperatures accounting for most of the burden compared to extreme temperatures (0.55% vs.
0.32%).
CONCLUSIONS:CONCLUSION: In the face of a warming climate, the finding draws the attention ofroad transport, policy, and public health planners to design preventive plans to reduce the risk of roadcrashes attributable to high temperatures.

Keywords: High temperature, Road crash, Accident, Climate change, Australia

PK-012[Climate » Temperature]

Attributing the health impacts of the 2009
Victorian, Australia heatwave to climate change
Nicholas John Osborne1, Samuel Hundessa2, Philipp Algas3, Lansbury Nina2, Stone Daithi4, Selvey
Linda2, Sarah Perkins Kirkpatrick5
1School of Public Health, The University of Queensland, Brisbane; 5. School of Population Health,

University of New South Wales, Sydney, NSW 2052, Australia; 6. European Centre for Environmentand Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall
Hospital, Truro TR1 3HD, Cornwall, UK
2School of Public Health, The University of Queensland, Brisbane
3ARC Centre of Excellence for Climate Extremes, Climate Change Research Centre, UNSW, Sydney
4NIWA, Wellington, Aotearoa New Zealand
5School of Science, UNSW Canberra; 2. ARC Centre of Excellence for Climate Extremes, Climate

Change Research Centre, UNSW, Sydney`

BACKGROUND AND AIM:In an attempt to understand the contribution of anthropogenic climatechange to increasing risk of mortality, we undertook an attribution study of a heat event in 2009. We
wished to calculate how many excess heat-related deaths could be attributed to climate change.
METHOD:We assessed a heat event in Victoria, Australia (popn. 6.6 million) in 2009 where
temperatures were elevated (maximum 20° C higher than the average temperature). Counts of allcause death were obtained from the Australian Bureau of Statistics for 1996-2015. Weather data was
obtained for Melbourne, where 75% of the Victoria population resides, from the Bureau of
Meteorology. We adopted a heatwave definition of a moving average of three days with a maximum
temperature above various intensity thresholds in the 90-99th percentile range.Return periods were
calculated and bootstrapped to enable calculation of confidence intervals.
RESULTS:The heatwave mortality association was assessed with a time series Poisson generalised
additive model (GAM) to assess the effect of heatwave on mortality. Excess deaths for each heatwave
threshold (90-99th percentiles) were calculated using the relative risk obtained from the GAMs. We
used event attribution methods to assess anthropogenic forcing’s contribution to mortality outcomes,
using data from various type of climate models.
CONCLUSIONS:Return periods were calculated and bootstrapped to enable calculation of confidence
intervals.

Keywords: Attriburion, heat, health, time seriesPK-013[Climate » Temperature]

Temporal change and spatial heterogeneity of
the association between ambient temperatureand transport accidents mortality in JapanPan Rui1, Chung Yeonseung2, Sim Kisung2, Hashizume Masahiro3, Hashizume Masahiro4, Honda
Yasushi4, Honda Yasushi5, Honda Yasushi6, Lee Whanhee7, Kim Yoonhee1
1Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo,

Tokyo, Japan
2Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, SouthKorea
3Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo,

Japan
4School of Tropical Medicine and Global Health, Nagasaki University, Japan
5Faculty of Health and Sport Sciences, University of Tsukuba, Japan
6Center for Climate Change Adaptation, National Institute for Environmental Studies, Japan
7chool of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University, Yangsan, South Korea

BACKGROUND AND AIM:Some studies have demonstrated that ambient temperature was associatedwith transport accidents mortality, whereas little is known about the temporal variation and spatial
heterogeneity in the association. To investigate the temporal change and spatial variation of the shortterm association between temperature and transport accidents mortality in Japan from 1972 to 2019.
METHOD:We first used time-stratified case-crossover analyses with a distributed lag nonlinear model
to estimate the risks of transport accidents mortality associated with temperature for each of the 47
prefectures in Japan. Then, we pooled the estimates to obtain the risk at the country level throughmultivariate meta-analysis. In addition, we divided the whole time period into five subperiods to
explore the temporal variation of the associations, and further fitted the mixed effects metaregression to identify some climatic, demographic, and socioeconomic factors that may explain spatial
heterogeneity.
RESULTS:Ambient mean temperature was positively associated with transport accidents mortality inJapan, with a percent change of 1.47% (95% CI: 1.10%, 1.85%) increase in the mortality per 1℃
increases in daily mean temperature. In total, 0.213% (95% CI: 0.170%, 0.255%) of transport
accidents mortality was attributable to high temperatures above the 90th percentile. The risks oftransport accidents mortality associated with temperature have reduced substantially from 1972 to
2000, whereas it slightly increased from 2000 to 2019. The transport accidents mortality risks werelarger in the prefectures with a lower level of development, represented by demographic andsocioeconomic characteristics (i.e., total population, the proportion of older people and females, andthe number of general hospitals).
CONCLUSIONS:Our study may help to understand the association between temperature and transport
accidents in the future and underlying potential mechanisms, which have implications for public healthpolicies for reducing the burden of transport accidents.

Keywords: Temperature, Traffic-related, Mortality

PK-014[Climate » Temperature]

Temperature and violence-related Medicaid
hospital visits in the United States
Robbie M Parks1, Danielle Braun2, Ivan Gu2, Lauren Flynn2, Cascade Tuholske3, Francesca Dominici2,
Jutta Lindert4, Marianthi Anna Kioumourtzoglou1
1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, New York, USA
2Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston,

Massachusetts, USA
3Department of Earth Sciences, Montana State University, Bozeman, Montana, USA
4Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University,

New York, New York, USA; University of Applied Sciences Emden/Leer, Emden, Germany

BACKGROUND AND AIM:Plausible behavioral and physiological pathways exist for how short-term
temperature increases are associated with violent behavior, including reduced inhibitory control andstate anger. A critical equity-focused research gap remains on how temperatures are associated withviolent behavior among the poorest and most vulnerable in society. We aimed to comprehensively
evaluate associations between temperature and violence-related hospital visits across the UnitedStates leveraging Medicaid claims, an insurance program covering low-income and disabledindividuals.
METHOD:We used Medicaid claims on violence-related hospitalizations (N=332,293) and acomprehensive record of dry and humid temperature over 14 years (1999–2012). Using a casecrossover design with distributed lag non-linear terms, we examined how ZIP Code-level dry andhumid temperature was associated with Medicaid daily violence-related hospital visit rates on each day
up to six days after exposure, and how these estimated associations varied by cause (assaults, suicide
attempts), sex, age group, climate region, and ZIP Code-level poverty and education.
RESULTS:We found a linear association between temperature and violence-related hospitalizations
dominated by contributions from lag days 0-1. For assaults, a 5°C increase was associated with anestimated 2.0% [95%CI:1.4–2.6%] and 1.8% [95%CI:1.3–2.4%] cumulative increase for dry andhumid temperature, respectively. For suicide attempts, a 5°C increase was associated with anestimated 5.6% [95%CI:2.6–8.5%] and 2.7% [95%CI:0.1–5.4%] cumulative increase for dry andhumid temperature, respectively. Though not statistically different, point-estimate associations weregreatest in younger age groups, in the Ohio valley (assaults) and the Southwest (suicide attempts),
and in poorest and least educated areas.
CONCLUSIONS:Temperatures were positively associated with higher violence-related hospital visit
rates for assaults and suicide attempts among low-income and disabled Americans. As climate change
drives temperatures higher, more attention should focus on interventions to promote and enhancecontrol to alleviate detrimental mental health-related consequences.

Keywords: Temperature, climate change, violence, mental health, climate justicePK-015[Climate » Temperature]

Association between Ambient Temperature andSuicide attempt, Suicide death in Seoul from2014 to 2019
Seunghyeon Kim, Eunsik Park
Department of Mathematics and Statistics, Chonnam National University, Gwangju, Republic of Korea

BACKGROUND AND AIM:Recent epidemiological studies have shown that short-term exposure to hightemperatures increases the risk of suicide attempts and suicide deaths. Suicide attempts and suicide
deaths have different characteristics. This difference is also more pronounced in age and gender
subgroups. However, few studies have compared the association with temperature between the two.
We analyze the difference in how short-term exposure to temperature relates to suicide attempts andsuicide deaths, and further focus on subgroup characteristics.
METHOD:From 2014 to 2019, the cases of suicide attempts and cases of suicide deaths in Seoul wereclassified. Among the cases of suicide attempts, deaths were excluded. We use time-stratified casecrossover design to control temporal trends and seasonality, and combine conditional quasi-Poisson
regression models with distributed lag non-linear models to investigate the effects of nonlinear, lagged
ambient temperatures on suicide attempts and suicide deaths of primary interests.
RESULTS:During the study period, 35,518 suicide attempts and 13,416 suicide deaths were recorded.
59.4% of suicide attempts were female, and 68.7% of suicide deaths were male. We foundassociations between temperature and suicide attempts and suicide deaths. For suicide attempts, thehighest relative risk (RR) was 1.26 (95% confidence interval (CI): 1.08, 1.46) at 24.4°C compared toa risk of the first percentile mean temperature (-8.5°C) over the lag period of 0–2 days. On the other
hand, the RR of suicide death continued to increase, recording 1.69 (95% CI: 1.32, 2.18) at 30.7°C.
CONCLUSIONS:An increase in daily mean temperature is significantly associated with an increase insuicide attempts and suicide death. The risk of suicide attempts peaked at 24.4 degrees and then therisk leveled off, but the risk of suicide deaths continued to increase. Our study presents detailed
evidence supporting a relationship between suicide attempts, suicide death, and high temperature.

Keywords: Mental health outcomes, Risk assessment, Temperature, Short-term exposure

PK-016[Climate » Other (to be specified with keywords in the keywords section)]

Connecting the Dots: A Framework for
Understanding the Complex Interactions
between Climate and Health
Siti Aisah Binti Mokhtar, Zawiah Binti Mansor
Department of Community Health, Universiti Putra Malaysia

BACKGROUND AND AIM:Climate change is one of the most serious global concerns we face today. It
has a wide range of effects on human health, from rising rates of infectious diseases to more frequentand severe natural disasters. While numerous studies on the health implications of climate change
have been conducted, a comprehensive framework that systematically examines these impacts islacking. The aim of this study is to provide a framework that would allow for a systematic assessmentof the health implications of climate change.
METHOD:MATERIAL-METHODS: The framework was created after conducting a thorough study of thecurrent research on the health effects of climate change. The review aimed to identify the manymechanisms through which climate change affects health, including direct effects like heat stress andextreme weather events, as well as indirect effects like changes in vector-borne diseases and air
pollution. The review also identified the groups most sensitive to these effects, such as the elderly,
children, and low-income areas.
RESULTS:The framework developed in this study has six major components: (1) identification ofclimate change's health impacts, (2) assessment of the populations most vulnerable to these impacts,(3) evaluation of the pathways through which climate change affects health, (4) quantification of thehealth impacts, (5) identification of potential interventions to mitigate these impacts, and (6)evaluation of the effectiveness of these interventions.
CONCLUSIONS:The paradigm created in this study gives a complete way to analyse climate change's
health implications. Policymakers, public health authorities, and other stakeholders can use it toidentify the most significant health concerns connected with climate change and devise effective
actions to address those risks.

Keywords: Climate, outcome, environmental epidemiology

PK-017[Climate » General]

Association Between Meteorological Factors
and Emergency Ambulance Dispatch for the
Epilepsy Patients: A Case-Crossover Study,Japan
Waqas Ali1, Kashima Saori2
1Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering,

Hiroshima University, Higashi-Hiroshima, Hiroshima,Japan
2Center for the Planetary Health and Innovation Science, IDEC Institute, Hiroshima University;

Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering,
Hiroshima University, Higashi-Hiroshima, Hiroshima,JapanBACKGROUND AND AIM:It was estimated that there were 45.9 million patients with all-active epilepsy
globally and epilepsy is still an important cause of disability. Climate factors are considered to be oneof contributing factors to epilepsy seizures. It, however, is still not clear yet. The objective of thestudy was to investigate the impact of various meteorological factors on the number of ambulancedispatches requested by the epilepsy patients to determine the risk factors for the onset of epileptic
seizure.
METHOD:Time-stratified case-crossover design was used to analyze the various meteorologicalparameters against the number of daily emergency ambulance dispatches requested by epilepsy
patients between January 2015 and December 2020 across Japan. Delayed effects of the weather
were assessed considering 0 – 7 days lag. Fire and Disaster Management Agency provided thenationwide data of the emergency ambulance dispatch records during the six years of study period.
Weather data was obtained from the Japan Meteorological Agency (JMA).
RESULTS:Daily ambulance dispatch for epilepsy patients had a significant relationship with daily mean
temperature, sunshine hours, and the atmospheric pressure. Every interquartile range [IQR] decrease
in mean temperature, increase in sunshine hours and atmospheric pressure corresponds to 17%
increase (odds ratio [OR] 1.177, 95% confidence interval [CI] 1.088 – 1.273), 4% increase (OR 1.04,
CI 1.01 – 1.07) and 9.2% increase (OR 1.092, CI 1.04 – 1.14) in number of ambulance dispatches
respectively. While considering the lagged effect of the weather, only temperature and sunshine hours
were significantly associated with the ambulance dispatches.
CONCLUSIONS:The nationwide study suggests the that lower temperature, higher atmosphericpressure, and longer sunshine duration are highly associated with increase in number of ambulancedispatches for epilepsy patients. Developing an early warning system of weather conditions for
epilepsy patients is important, and further studies are needed in considering various meteorologicalconditions.

Keywords: Exposure assessment,Epidemiology,TemperaturePK-018[Birth and pregnancy outcomes » Birth outcomes]

Identifying the critical windows and joint effects
of temperature and PM2.5 exposure on small for
gestational age
Xin Chen1, Sidi Chen2, Zhenghong Zhu1, Jiajun Luo3, Huailin Wang1, Maimaitiminjiang Wulayin1,
Cunrui Huang4, Wei Zhao2, Qiong Wang1
1School of Public Health, Sun Yat-sen University, Guangzhou, China
2National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention,

Beijing, China
3Institute for Population and Precision Health, the University of Chicago, Chicago, USA
4Vanke School of Public Health, Tsinghua University, Beijing, China

BACKGROUND AND AIM:The potential critical windows for extreme ambient temperature, air pollution
exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint
effects on SGA.
METHOD:In a national multi-center prospective cohort, we included 179,761 pairs of mother-infantfrom 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM2.5
concentration were matched to the maternal residential address to estimate personal exposure.
Extreme temperature exposures were categorized by a series of percentile in each meteorological andgeographic division for the entire pregnancy, each trimester and gestational week (GA-week).
Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used toestimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme
temperature and PM2.5 exposures with SGA. Combined effects were evaluated with the relative
excess risk due to interaction (RERI) and proportion attributable to interaction (AP).
RESULTS:We observed that by referring to temperature at the 41st-50th percentile, heat (>90th
percentile) exposure during 13th-29th GA-weeks was associated with SGA; odds ratio (OR) and 95%
confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations
were observed during the 1st-8th GA-weeks. PM2.5 exposure during the 2nd-5th and 19th-27th GAweeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95%CI: 1.0001, 1.0034, for a 10μg/m3 increase). No interactive effects between ambient temperatureand PM2.5 on SGA were observed.
CONCLUSIONS:Our findings suggest the weekly susceptibility windows for heat and PM2.5 exposure
were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective
measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.
Grants: National Key R&D Program of China (2018YFA0606200), National Natural Science Foundationof China (42075178, 42175183), and Guangdong Basic and Applied Basic Research Foundation(2021A1515011947).

Keywords: Environmental epidemiology, Birth outcomes, Temperature extremes, Particulate matter

PK-019[Climate » Temperature]

Effect modification of the association between
high temperature and Out-of-hospital cardiac
arrest (OHCA) risk by PM₂.₅ in Japan
Zhesi Yang1, Chris Fook Sheng Ng1, Kayo Ueda2, Sunao Kojima3, Takanori Ikeda4, Yoshio Tahara4,
Naohiro Yonemoto4, Masahiro Hashizume1
1Department of Global Health Policy, The Univeristy of Tokyo, Tokyo, Japan
2Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
3Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
4The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
5for the Japanese Circulation Society With Resuscitation Science Study (JCS-ReSS) Group

BACKGROUND AND AIM:Out-of-hospital cardiac arrest (OHCA) is a leading cause of cardiovascularmortality worldwide and it can be influenced by the underlying health status and ambient factors.
Though several studies have examined the associations of OHCA with air temperature and PM₂.₅, theeffect of interaction between the two ambient exposures on OHCA has received insufficient attention.
The objective of this study is to investigate the effect modification of the association between
temperature and OHCA risk by different PM₂.₅ levels in Japan. Daily data on OHCAs, mean
temperature and PM₂.₅ were obtained from all 47 prefectures of Japan between 2012 and 2019.
METHOD:The study applied a two-stage design: Firstly, a time-stratified case-crossover design wasapplied to estimate the PM₂.₅-stratified temperature-mortality associations in each prefecture. A
distributed lag non-linear model was specified to estimate the temperature-OHCA risk function
according to the PM₂.₅ levels categorized into high and low using the 75th percentile of the 4-day
moving average (lag 0-3) as a cut-off level. Secondly, a multivariate meta-analysis was used to pool
the prefecture-specific associations. The relative risks (RRs) for heat [99th percentile vs. minimum
morbidity percentile (MMP)] were compared at different PM₂.₅ levels to examine effect modification.
RESULTS:In total, 948894 OHCA cases were included in the final analysis. A U-shaped relationshipwas found between temperature and OHCA morbidity for the pooled overall cumulative association
without significant heterogeneity between the 47 prefectures (I²=19.3%; p=0.03), and MMP was
identified as the 88th percentile. The overall pooled RR for heat was 1.04 (95% CI: 1.02-1.06) at ahigh PM₂.₅ level, which was significantly higher than the RR at a low PM₂.₅ level [1.00 (95% CI:0.991.02)].
CONCLUSIONS:Findings from this study suggested that high PM₂.₅ concentrations could enhance theeffects of heat on OHCA morbidity.

Keywords: Temperature, Particulate matter

PK-020[Other » Other (to be specified with keywords in the keywords section)]

Aircraft noise and cardiovascular morbidity andmortality near Heathrow Airport: a casecrossover study
Nicole Itzkowitz1, Xiangpu Gong2, Glory Atilola1, Kathryn Adams2, Calvin Jephcote2, John
Gulliver2, Anna Hansell2, Marta Blangiardo1
1MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of

Public Health, Imperial College London, London, UK
2Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK

BACKGROUND AND AIM:Aircraft noise causes annoyance and sleep disturbance and there is someevidence of associations between long-term exposures and cardiovascular disease (CVD), but only one
previous study on short-term associations. We aimed to investigate associations between previous day
aircraft noise and cardiovascular events in a population of 6.3 million residing near Heathrow Airport,
using a case-crossover design and exposure data for different times of day and night.
METHOD:Outcome data were all recorded hospitalisations (n=442,442) and deaths (n=49,443) in
2014-2018 due to CVD, obtained from national administrative data. Daily aircraft noise levels for eighttime periods across the 24-hour period were modelled using the Aviation Environmental Design Tool
(AEDT), version 3b. Statistical analyses used conditional logistic regression to estimate ORs, withadjustment for PM2.5 concentration, temperature and holidays. We examined effect modification by
age-sex, ethnicity, deprivation and season as well as noise variability (assessed by stratifying by
high/low coefficient of variation).
RESULTS:We estimated an increase in risk for 10dB increment in noise during the previous evening(Leve OR = 1.004, 95% CI 1.000-1.008), particularly from 22:00-23:00h (OR= 1.007, 95% CI 1.0001.013) and the early morning hours 04:30-06:00h (OR=1.012, 95% CI 1.003-1.022) for all CVD
admissions, but no significant associations with day-time noise. There was effect modification by agesex, ethnicity, deprivation and season, with higher risks in men older than 65 years, those of Blackethnicity, more deprived areas, and in winter. There was some suggestion that high noise variability atnight was associated with higher risks.
CONCLUSIONS:Our findings are consistent with proposed mechanisms for short-term impacts ofaircraft noise at night on CVD from experimental studies, including sleep disturbance, increases inblood pressure and stress hormone levels and impaired endothelial function.

Keywords: Noise, Cardiovascular diseases, Environmental epidemiology, Socio-economic factors(non-chemical stressors)

PK-021[Air pollution » Mixtures]

Impact of combined exposure to multiple air
pollutants on breast cancer risk using bayesian
profil regression
Camille Giampiccolo1, Amina Amadou3, Thomas Coudon3, Delphine Praud3, Lény Grassot3, Elodie
Faure4, Florian Couvidat5, Gianluca Severi6, Francesca Romana Mancini4, Béatrice Fervers3, Pascal
Roy2
1Laboratoire de Biometrie Et Biologie Evolutive, CNRS UMR 5558, Villeurbanne, France & Departmentof Prevention Cancer Environment, Centre Léon Bérard, Lyon, France & Service deBiostatistique-Bioinformatique, Pole Sante Publique, Hospices Civils de Lyon, Lyon, France & Université
Claude Bernard Lyon 1, Lyon, France
2Laboratoire de Biometrie Et Biologie Evolutive, CNRS UMR 5558, Villeurbanne, France & Service deBiostatistique-Bioinformatique, Pole Sante Publique, Hospices Civils de Lyon, Lyon, France & Université
Claude Bernard Lyon 1, Lyon, France
3Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France & Inserm U1296

Radiations: Défense, Santé, Environnement, Lyon, France
4Centre de Recherche en Epidémiologie et Santé des Populations (CESP, Inserm U1018), Facultés de

Médecine, Université Paris-Saclay, UPS UVSQ, Gustave Roussy, Villejuif, France
5National Institute for industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
6Centre de Recherche en Epidémiologie et Santé des Populations (CESP, Inserm U1018), Facultés de

Médecine, Université Paris-Saclay, UPS UVSQ, Gustave Roussy, Villejuif, France & Department of
Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy

BACKGROUND AND AIM:The general population is continuously exposed to multiple and correlated air
pollutants. To date, very few studies has assessed the impact of multiple exposures to air pollutantson breast cancer risk. To address this issue, specific statistical approaches are needed. Our objective
is to estimate the association between the joint exposure to 8 air pollutants (benzo(a)oyrene,
cadmium, dioxins, nitrogen dioxide, ozone, polychlorinated biphenyls, particulate matter and fineparticles) and breast cancer risk.
METHOD:We use a case-control study nested within the French E3N cohort, involving 5222 incident
breast cancer cases and 5222 matched controls. For each woman, an average annual exposure to thepollutants was estimated from 1990 to 2011. Two different statistical approaches were compared. The
first approach consists of grouping individuals according to their exposure to pollutants and thenapplying conditional logistic regression. The second method consists of using the Bayesian Profile
Regression (BPR) model. In both methods, odds ratios(ORs) and their 95% confidence(CI) /credible(CrI) intervals were estimated.
RESULTS:In both approaches, 9 clusters were identified, many similar clusters in terms of exposurelevels were observed, the cluster characterised by low exposures to all pollutants, except ozone wastaken as reference. A consistent increase in breast cancer risk compared to the reference cluster wasobserved for 3 clusters in the first approach, and for 2 clusters in the second approach. The highest
estimated effect is observed for the cluster represented by high exposure to all pollutants except
ozone in both approaches (first approach: OR=2.25, CI=(1.59,3.19); second approach: OR=1.39,
CrI=(1.06,1.83)).
CONCLUSIONS:This is the first study assessing the effect of exposure to a mixture of 8 air pollutants

on breast cancer risk, using two approaches. The results show evidence of a positive joint effect of
exposure to high levels of all pollutants (except ozone) on the risk of breast cancer.

Keywords: Environmental epidemiology, Long-term exposure, Multi-pollutant, Modeling, OutcomesPK-022[Air pollution » Traffic-related]

Association between air pollution and traffic
injuries in Kaohsiung, a motorcycle-dominantcity in Taiwan
Cheng Kai Hsu
Department of City and Regional Planning, UC Berkeley, CA, USA

BACKGROUND AND AIM:Air pollution and road traffic injuries are two major public health concernsthat cause significant mortality and morbidity worldwide. Air pollution can influence traffic safety
through factors such as reduced visibility and impaired driving performance. However, few current
studies have examined the association between air pollution and road traffic injuries, and even fewerstudies have focused on locations where traffic is dominated by motorcycles, which expose users tohigher levels of PM exposure. Therefore, this study aims to explore two research questions concerning
the associations between traffic accidents and air pollution and the susceptibility of motorcycle users
who have direct exposure to the external road environment.
METHOD:This study employed distributed lag non-linear models, incorporating non-linearity anddistributed lag effects to examine bi-dimensional exposure-lag-response associations between traffic
incidents and PM10 concentration. The models were stratified by the mode of transportation involvedin traffic incidents for sub-group analysis. This study calculated the relative risks with 95% confidence
intervals of specific PM10 concentrations at the 50th, 75th, 90th, 95th, and 99th percentiles, withrespect to the reference PM10 concentration corresponding to the minimum number of traffic
incidents, i.e., 8.3 μg/m3.
RESULTS:The results reveal alarming relative risks associated with increased PM10 concentration. The
cumulated relative risks can reach up to 1.34 at 44.5 μg/m3 (50 percentiles), 1.57 at 77.6 μg/m3 (75percentiles), 1.62 at 86.6 μg/m3 (95 percentiles), and 1.82 at 108.5 μg/m3 (99 percentiles). These
indicate the persistent and extended lagged effects of PM10 on traffic safety. Moreover, motorcycle
users exhibit significantly higher relative risks than car users at various levels of PM10 concentration.
CONCLUSIONS:The study highlights the need for policymakers to address the issue of air pollution in
the context of road safety. Policymakers should also consider the risks associated with motorcycle use.

Keywords: Built environment, Particulate matter, IncidencePK-024[Policy » Research translation to affect policy and practice]

Disparity in Ambient PM2.5 Air Pollution
Exposure and Attributable Health Risk among
Indian Sub-population
Debajit Sarkar, Sagnik Dey
Centre for Atmospheric Sciences, IIT Delhi, New Delhi, India

BACKGROUND AND AIM:Long-term exposure to air pollution is one of the major public health burden.
Studies from developed countries are emerging that show evidence of unequal distribution of exposure
among the sub-populations, where minorities and poor are most affected. No such study exists indeveloping countries, especially India, home to one-sixth of the world’s population. Here we examine
the disparity in ambient PM2.5 exposure and associated health risk exposure among Indian subpopulations.
METHOD:Using Atkinson Index (AI), we quantify exposure disparity among population groups (15-54
years) by education, wealth, occupation, ethnicity, and household parameters for multiple spatial units(state, district, urban vs rural areas). We use satellite-derived ambient PM2.5 exposure data at 1 km
spatial scale and health and socio-demographic data from the fourth and fifth rounds of the National
Family Health Survey (NFHS) for the analysis. We further use generalized linear model (GLM)
stratified by age, sex, lifestyle, and various socio-demographic covariates to estimate the populationattributable fraction (PAF) for the sub-groups.
RESULTS:Exposure disparity is found to be higher in rural regions and in the districts belonging tocentral and southern states as compared to the Indo-Gangetic Plain. Significant disparity is foundacross the wealth and education groups, where the impecunious and working classes arecomparatively more exposed. We find higher PAF (5-10%) among less-privileged (minorities, poor,
uneducated, working class) sub-populations. The degree of disparity and PAF reduced among the subgroups between NFHS-4 (2015-2016) to NFHS-5 (2019-2021).
CONCLUSIONS:Results show that exposure disparity was higher in the low and high SDI states, anddeprived sub-populations are at higher exposure risk in India. However, disparity reduced in recent
years, which mirrored the recent improvement in air quality in India. Policies need to be framed toprotect the vulnerable sub-groups and the disparity needs to be accounted for in the burden of disease
study.

Keywords: disparity, PAF, health burden, environmental justice.

PK-025[Respiratory and allergic outcomes » Respiratory outcomes]

Effects of PM2.5 on acute respiratory infection
among under 5y children in India moderated by
micronutrient intake
Franciosalgeo George1, Santu Ghosh2, Tinku Thomas2, Anura V Kurpad3, Harshpal Singh Sachdev4,
Ekta Chaudhary5, Sagnik Dey6
1Division of Epidemiology, Biostatistics, and Population Health, St John’s Research Institute,Bangalore, India
2Department of Biostatistics, St John’s Medical College, Bengaluru, India
3Department of Physiology, St John’s Medical College, Bengaluru, India
4Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science andResearch, New Delhi, India
5Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
6Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Centre of

Excellence for Research on Clean Air, IIT Delhi, New Delhi, India; School of Public Policy, IIT Delhi,
New Delhi, India

BACKGROUND AND AIM:Oxidative stress mediated inflammation is the most explained physiologicalmechanism for air pollution related health effects, particularly related to the lung. If so, a diet inantioxidant rich foods may moderate this effect on health from air pollution. The objective of thisstudy was to investigate the moderating influence of micronutrient intake on the effect of air pollution
on acute respiratory infection (ARI) in under 5y children.
METHOD:A triangulated dataset of the National Family Health Survey-4, (NFHS4) and foodexpenditure (National Sample Survey, NSS68) survey in India, that was statistically matched using
the hot deck method along with satellite driven PM2.5 exposure data was analysed. The effectmoderation of the impact of air pollution on ARI by per capita micronutrient (antioxidant) intake was
explored by logistic regression with interaction.
RESULTS:The association between PM2.5 and ARI was modified by several nutrients, including vitaminC, vitamin B9, vitamin B2, zinc, and selenium. Specifically, for every 10µg/m3 increase in PM2.5
exposure, the odds ratio (OR) of ARI was 1.15 (95% CI 1.14-1.17) when daily vitamin C intake
greater than 65mg, against 1.18 (95% CI: 1.18-1.19) when the daily intake was less than 65mg.
Similarly, for every 10µg/m3 increase in PM2.5 exposure, the OR of ARI was 1.17 (95% CI 1.16-1.18)
with a daily selenium intake greater than 115 µg, compared to 1.19 (95% CI 1.18-1.19) when lessthan 115 µg. Similar results were observed for higher intake of other nutrients, with absolute risk
reduction ranging from 2 to 6 percentage points.
CONCLUSIONS:Our findings suggest that higher intake of antioxidant rich foods such as fruits andnuts may reduce the risk of ARI associated with PM2.5 exposure. Further research is needed toconfirm these findings and determine the optimal intake of these nutrients to provide protection
against effects of PM2.5 on ARI.

Keywords: Acute respiratory infection, Particulate matter, Food/nutrition

PK-026[Neurologic and mental health outcomes » Other (to be specified with keywords in the keywords section)]

Air pollution and epilepsy diagnosis at a first
seizure clinic in The Netherlands: A case-control
study
Geertruida Slinger1, Sien T Verbeek1, Eric G.A.L Van Diessen1, Lotte Noorlag2, Kees P.J Braun1,
Youchen Shen3, Willem M Otte1, George S Downward4
1Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, The

Netherlands
2Department of Neurology and Neurosurgery, University Medical Center Utrecht, The Netherlands.
3Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, The Netherlands
4Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The

Netherlands.

BACKGROUND AND AIM:Increasing evidence suggests that exposure to air pollution is linked tovarious neurological disorders, although little is known about its association with the development anddiagnosis of epilepsy. This study aimed to evaluate the association between exposure to ambient air
pollutants and the likelihood of receiving an epilepsy diagnosis in Dutch children.
METHOD:A population-based case-control study was conducted among children presenting to the first
seizure clinic at the primary children’s hospital in Utrecht, The Netherlands. Children were recruitedfrom 1 January 2008 to 31 May 2021 and were assigned to either cases (i.e., diagnosed with epilepsy,n = 402) or controls (n = 743) based on the findings of (at least) one-year diagnostic follow-up.
Levels of ambient air pollution (nitrogen dioxide [NO2], ozone [O3], particulate matter withaerodynamic diameter <10 μm [PM10] and <2.5 μm [PM2.5]) were assigned for the year ofpresentation at the residences of participants based on EU-wide air pollution metrics. After adjustingfor common confounders, logistic regression models were applied to calculate odds ratios (ORs) with
95% confidence intervals (CIs) to evaluate the association between air pollution and receiving an
epilepsy diagnosis. Subgroup analysis was performed to compare the associations across different
epilepsy aetiologies.
RESULTS:Overall, no association between ambient air pollution and an epilepsy diagnosis wasobserved, including PM2.5 (OR: 0.99, 95% CI: 0.94, 1.04) and NO2 (OR: 1.01, 95% CI: 0.98, 1.03).
Subgroup analysis was suggestive but ultimately underpowered to draw any meaningful conclusions.
CONCLUSIONS:In a case-control study of children presenting to a first seizure clinic, we report noassociation between exposure to ambient air pollutants and a diagnosis of epilepsy. Additional work,
including a longitudinal evaluation of air pollutants, a closer examination of epilepsy aetiologies, and awider, community-based approach will be needed to further explore these findings.

Keywords: Epilepsy, childhood epilepsy, ambient air pollution

PK-027[Omics technologies » Metabolomics]

Metabolomic signatures following long-term
exposure to PM10 and NO2 in the CODA cohort
Jeeyoung Kim1, Eun Ju Lee1, Ha Eun Song2, Hyo Yeong Lee2, Hyun Ju Yoo2, Woo Jin Kim1
1Department of Internal Medicine and Environmental Health Center, Kangwon National University

Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
2Department of Convergence Medicine, Asan Medical Center, Asan Medical Institute of Convergence

Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea

BACKGROUND AND AIM:Long-term exposure to air pollution can increase the risk of respiratory
diseases and adversely affect lung functions. The potential of metabolomics to identify biomarkers
linked to respiratory outcomes and environmental exposure is becoming increasingly apparent.
However, a mechanistic understanding of the affected metabolic pathways is lacking and literature on
long-term exposure to air pollution on the metabolome is limited. Therefore, this study aimed toelucidate the unique plasma metabolite response related to long-term PM10 or NO2 exposure.
METHOD:We estimated the annual average concentrations of PM10 and NO2 at each participant’s
residential address using a spatial prediction model. We performed LC-MS/MS analysis based ontargeted metabolic profiling of plasma sample data from 192 participants enrolled in the COPD in
Dusty Area (CODA) cohort to identify the targeted metabolites (sphingolipids or amino acids)
associated with long-term exposure to PM10 and NO2. A multiple linear regression model after
adjusting and correcting for multiple testing was then used.
RESULTS:The average measured concentrations of PM10 and NO2 were 43.98 μg/m3 and 13.43 ppb,
respectively. Among the evaluated plasma sphingolipids, three specific sphingomyelins (SMs),
SM(d18:0/18:0), SM(d18:0/18:1), and SM(d18:0/24:1) were significantly associated with PM10 [β(95% CI)= 0.0225 (0.003, 0.042); 0.0323 (0.014, 0.051); 0.0264 (0.006, 0.047), respectively].
Meanwhile, Cer(d18:0/24:0) was negatively associated with NO2 exposure [β (95% CI)= – 0.0356 (–0.059, – 0.012)]. However, there was no significant correlation between any of the amino acids andlong-term PM10 or NO2 exposure.
CONCLUSIONS:This study identified significant associations between sphingolipid and amino acidmetabolites and long-term PM10 and NO2 exposure.

Keywords: PM10, NO2, metabolomics, sphingolipid, amino acid

PK-028[Air pollution » Particulate matter]

Long term PM2.5 exposure and memory
functions in northern Sweden
John Andersson1, Anna Sundström2, Maria Nordin1, Bertil Forsberg3, Anna Oudin4
1Department of Psychology, Umeå University, Umeå, Sweden
2Department of Psychology, Umeå University, Umeå, Sweden; Centre for Demographic and Ageing

Research, Umeå University, Sweden
3Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
4Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Division of

Occupational and Environmental Medicine, Lund University, Lund, Sweden

BACKGROUND AND AIM:Growing evidence indicates that air pollution can have a negative impact on
cognitive functions. The aim of this study was to investigate long- term PM2.5 exposure in association
with semantic- and episodic memory functions.
METHOD:Data from 1732 participants (>55 years of age), were obtained from a prospective cohort
study in northern Sweden. Composite z-scores from cognitive testing were used as measures of
episodic- and semantic memory. Estimates of annual mean PM2.5 concentrations at the residential
address at baseline were obtained from a dispersion-model. General linear models were used to
specify repeated measures models. Using the difference between assessments at baseline andsubsequent test-waves, repeated measures models were used to investigate the rate of change ofmemory functions over the 15 year follow up period. The fully adjusted models were adjusted for age,sex, education, APOE-ε4 status, and smoking habits.
RESULTS:A positive association was found between PM2.5 exposure and semantic memory (β = 0.08*
95% CI: 0.02, 0.15), i.e. increased exposure was associated with better semantic memory. In
addition, an interaction between PM2.5 and age (β = 0.01* 95% CI 0.00, 0.01) was found forsemantic memory. When stratifying the sample by age the association persisted only in the younger
group (55-70 years) (β = 0.08* 95% CI: 0.00, 0.16). No associations were found between PM2.5 andany other outcome.
CONCLUSIONS:: It is unlikely that exposure to air pollution would improve semantic memory. Instead,these results could be explained by socioeconomic factors, or survival effects in the study sample.

Keywords: semantic memory, episodic memory, cognitive functions

PK-029[Air pollution » Particulate matter]

Air pollution exposures and brain corticalthinning in adults: A longitudinal neuroimaging
study
Juyeon Ko1, Mun Joo Bae2, Jungwoo Sohn3, Jaelim Cho1, Changsoo Kim1
1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
2Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
3Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Republic ofKorea

BACKGROUND AND AIM:Long-term exposure to air pollutants is associated with higher risk ofneurodegenerative and Alzheimer’s diseases. We conducted a longitudinal study to investigate theassociation between long-term exposure to air pollution and changes in neuroimaging markers.
METHOD:This was based on a prospective cohort of adults residing in four cities in the Republic ofKorea. Long-term concentrations of particulate matter with aerodynamic diameters of ≤10 μm (PM10)
and ≤2.5 μm (PM2.5) and nitrogen dioxide (NO2) at residential addresses were estimated. Wholebrain mean, regional cortical thicknesses, and subcortical volumes were obtained by analyzing brain
3T magnetic resonance images at baseline and 3-year follow-up, respectively. Linear mixed effects
models were constructed to examine the associations between the air pollutants and the brain MRI
markers, adjusting for covariates.
RESULTS:A total of 310 individuals were included. A 10-ug/m3 increase in PM10 was associated with
reduced whole-brain mean [β = −0.035, standard error (SE] = 0.010; P < 0.001), frontal (β =−0.045, SE = 0.012; P < 0.001), parietal (β = −0.043, SE = 0.011; P < 0.001), temporal, (β =−0.030, SE = 0.13; P = 0.021), cingulate (β = −0.031, SE = 0.15; P = 0.041), and insula lobes (β =−0.043, SE = 0.020; P = 0.028). A 10-ppb increase in NO2 was associated with reduced whole-brain
mean (β = −0.015, SE = 0.005; P = 0.002), frontal (β = −0.021, SE = 0.006; P = 0.001), parietal (β= −0.018, SE = 0.006; P = 0.001), and cingulate lobes (β = −0.017, SE = 0.008; P = 0.031).
Subcortical structures associated with the air pollutant included thalamus. There were no significant
associations between PM2.5 and changes in brain cortical thickness and subcortical volume.
CONCLUSIONS:The findings suggest that long-term exposures to PM10 and NO2 may lead to corticalthinning in adults.

Keywords: Particulate matter, Neuroimaging, brain cortical thickness, cognitive function, nitrogendioxidePK-030[Air pollution » Short-term exposure]

Association between Ambient BTEX Mixture and
Neurological Hospitalizations: A Multicity TimeSeries Study in Taiwan
Hong Qiu1, Kai Jen Chuang2, Yen Chun Fan3, Ta Pang Chang3, Hsiao Chi Chuang4, Eliza Lai Yi Wong1,
Chyi Huey Bai2, Kin Fai Ho5
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
2Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University,

Taipei, Taiwan and School of Public Health, College of Public Health, Taipei Medical University, Taipei,
Taiwan.
3School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
4School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan andDivision of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical
University, Taipei, Taiwan
5JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China

and Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong,
HKSAR, China

BACKGROUND AND AIM:The collective term BTEX refers to a hazardous chemical mixture of benzene,
toluene, ethylbenzene, and xylenes, is considered hazardous, and their potential effects onneurological health have not been comprehensively assessed. Our study aims to investigate therelationship between exposure to BTEX and hospital admissions for neurological diseases.
METHOD:A multicity time-series study was conducted in five major Taiwanese cities, where daily
hospital admission records for nervous system diseases from January 1, 2016, to December 31, 2017,
were collected from the National Health Insurance Research Database. The concentrations of ambient
BTEX and criteria pollutants, along with weather factors, were measured at Photochemical Assessment
Monitoring Stations. City-specific effect estimates for BTEX were calculated using a Poisson
generalized additive model (GAM) and weighted quantile sum regression, followed by a randomeffects meta-analysis to pool the estimates.
RESULTS:During the study period, an average of 68 neurological hospitalizations per day wererecorded. The BTEX mixture concentrations had a daily mean of 22.5 µg/m3, with toluene (13.6µg/m3) and xylene (5.8 µg/m3) being the predominant chemicals. Our analysis revealed thatneurological hospitalizations increased by 1.6% (95% CI: 0.6%–2.6%) on average for every
interquartile range (15.8 µg/m3) increase in BTEX at lag 0, as estimated using a GAM model.
Additionally, a quartile increase in the weighted sum of BTEX exposure was associated with a 1.7%
(95% CI: 0.6%–2.8%) increase in daily neurological hospitalizations.
CONCLUSIONS:Our study provides evidence of a strong association between BTEX exposure andneurological hospitalizations in Taiwan, with toluene and xylene identified as the key contributors tothis adverse health effect. These findings underscore the urgent need for more focused public healthinterventions aimed at reducing exposure to these hazardous chemicals in the environment.

Keywords: BTEX mixture, Multicity time-series study, Neurological hospitalizations

PK-031[Air pollution » Particulate matter]

Longitudinal associations between ambient
PM2.5 exposure and lipid levels in two Indian
citiesKritika Anand1, Gagandeep Kaur Walia2, Siddartha Mandal1, Jyothi S Menon2, Ruby Gupta1, Nikhil
Tandon3, K.m.venkat Narayan4, Mohammed K Ali4, Vishwanathan Mohan5, Dorairaj Prabhakaran1,
Joel D Schwartz6
1Centre for Chronic Disease Control, New Delhi, India
2Public Health Foundation of India, Gurugram, India
3All India Institute of Medical Sciences, New Delhi, India
4Emory Global Diabetes Research Center of the Woodruff Health Sciences Center, Atlanta, GA, US
5Madras Diabetes Research Foundation (MDRF), Chennai, India
6Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, US

BACKGROUND AND AIM:Exposure to PM2.5 and elevated lipids are both established risk factors for
cardiometabolic disorders. PM2.5 has been hypothesised to cause elevated lipid levels throughsystemic inflammation, however, seldom studied in low- and middle-income countries such as India
with high levels of PM2.5 and populations with unique lipid profiles. We investigated associations
between longitudinally measured ambient PM2.5 exposure and serum lipid levels [total cholesterol(TC), triglycerides (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C)] in an adult
population based representative cohort in two metropolitan cities of north and south India.
METHOD:We conducted a longitudinal non-linear mixed effects analysis in 11,649 participants
between 2010 and 2017 in Chennai and Delhi. Exposure to PM2.5 was assessed using daily average
PM2.5 predictions at 1kmx1km grids from a hybrid spatiotemporal model. Generalized additive models
were used to examine the association between monthly and annual average exposure to ambient
PM2.5 concentrations and lipid levels after adjusting for residential and neighbourhood level
confounders.
RESULTS:Average annual averages of PM2.5 were 103 [SD: 15.5] and 40 [SD: 5]μg/m3 in Delhi and
Chennai, respectively, with minimal changes over time. HDL-C levels were negatively associated withlong-term ambient PM2.5 exposures in Delhi but not in Chennai. An IQR [90,120 μg/m3] increase inannual exposures of PM2.5 was associated with a decrease of 3mg/dL in HDL-C in Delhi. LDL-C and TC
were positively associated with annual exposure in both cities, for instance increase in 4mg/dL of LDLC and TC with 10μg/m3 increase in PM2.5 above mean in Chennai. Younger and physically active
people had stronger associations in highly polluted settings.
CONCLUSIONS:Exposure to ambient PM2.5 was associated with lipid parameters in both cities,
although specifics differed. Such evidence on association between PM2.5 exposure and cardiovascularrisk factors are crucial for public health interventions and policy advocacy.

Keywords: India, LMIC, particulate matter, ambient air pollution, Lipids

PK-032[Air pollution » Other (to be specified with keywords in the keywords section)]

Economic evaluation of the costs and benefits of
air pollution control: a systematic review
Siyuan Wang1, Rong Song2, Gian Luca Di Tanna3, Zhiwei Xu4, Mingshen Chen5, Stephen Jan1, Lei Si6
1The George Institute for Global Health, Sydney, New South Wales, Australia & UNSW Medicine,

UNSW Sydney, Sydney, New South Wales, Australia
2Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University,

Anhui, China
3Department of Business Economics, University of Applied Sciences and Arts of Southern Switzerland,

Switzerland
4School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland
5School of Health Policy and Management, Nanjing Medical University, Nanjing, China
6School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia &Translational Health Research Institute, Western Sydney University, Penrith, New South Wales,
Australia

BACKGROUND AND AIM:Air pollution poses a significant public health challenge globally. Although
there exists broad mitigation policies, an understanding for the economic consequences is lacking. We
systematically reviewed the economic evidence of costs and benefits of these interventions.
METHOD:We searched PubMed, Scopus, Cochrane Library, Embase and CEA registry databases forstudies that assessed the costs and health benefits of control strategies aimed at reducing air pollution
without limitations on study design, region, or time. Evidence was narratively summarised based onprinciple economic evaluation measurements including net benefits and benefit-cost ratios.
RESULTS:96 studies were included in this review, with most studies from China (n=24) and US(n=21). Almost all studies adopted a risk assessment approach by using dose-response parameters tomodel health outcomes from pollution exposure. The impact of particle matter on all-cause mortality
was the most widely assessed pair of exposure-effects relationship (n=42). Overall, 70 studies
reported that the intervention was good value for money. More studies assessed the value of outdoor
interventions to improve ambient air quality, and 54 out of 67 of which reported positive outcomes. 13
out of 20 studies found similar results for indoor interventions. Commonly employed control
methodologies were regulatory, fiscal or end-of-pipe. Subgroup analysis across intervention types andcontrol methodologies showed that climate change polices assessing health co-benefits generally
reported positive outcomes (n=9). In addition, we found that studies which adopted a broader social
framework of benefits (n=26), including those to the environment, ecology and society reported
positive or partially positive evidence. Despite these results, studies also highlighted some policy flaws
with regards to equity, optimization, and uncertainties.
CONCLUSIONS:Overall, we found broad economic support across various control strategies with morethan 70% of the interventions reporting good value for money. However, future air pollution control
designs also need to address some of its current existing limitations.

Keywords: air pollution, policy

PK-033[Air pollution » Long-term exposure]Long-term exposure to air pollution andincidence of Parkinson’s disease: a Danish
nationwide administrative cohort study
Thomas Cole Hunter1, Rina So2, Sonja Antic3, Youn Hee Lim1, Jiawei Zhang1, Laust H. Mortensen4,
Kees De Hoogh5, Steffen Loft1, George M. Napolitano1, Stéphane Tuffier1, Marie L. Bergmann1, Matija
Maric1, Bert Brunekreef6, Gerard Hoek6, Zorana J. Andersen1
1Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
2Department of Epidemiology and Public Health, University College London, London, United Kingdom;

Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
3Aarhus University Hospital, Aarhus, Denmark
4Denmark Statistic, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health,

University of Copenhagen, Copenhagen, Denmark
5Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel,

Switzerland
6Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands

BACKGROUND AND AIM:Exposure to air pollution has been linked to the incidence of Parkinson’s
disease (PD); however, evidence varies, in part due to diagnostic validity challenges. Here, we
examined the association between long-term exposure to air pollutants and PD incidence in anationwide administrative cohort.
METHOD:We followed 3,035,206 subjects aged ≥30 years and residing in Denmark on 01/01/2000
until 31/12/2018. We defined PD incidence as either the first hospital contact (outpatient or inpatientadmission) for PD or redeemed prescription of anti-PD medication, whichever came first, as recordedin the Danish National Patient Registry or Prescription Registry, respectively. We assessed annual
mean air pollution exposure concentration level at participant residence at baseline using theEuropean-wide ELAPSE-project hybrid land-use regression model (fine particulate matter [PM₂.₅],
nitrogen dioxide [NO₂], ozone [O₃ maximum running 8-hour warm-season average], black carbon[BC]) rendered at 0.1x0.1 km. We used Cox proportional hazard models adjusted for individual age,sex, education, occupation, immigration, and marital status, as well as individual (household) andarea (neighbourhood) level income; further indirectly adjusted for individual body mass index (BMI)
and smoking status.
RESULTS:During a mean follow-up of 15.8 years, 107,238 participants (mean baseline age: 56.9
years) developed PD. Median (interquartile range) levels of PM₂.₅, NO₂, O₃, and BC were 12.34(1.96), 18.71 (10.27), 81.16 (4.28) µg/m³, and 0.92 (0.49) ×10⁻⁵/m, respectively. The hazard ratios(HR) (95% confidence intervals) for association between air pollutants and PD incidence were: 1.05
(1.02, 1.08) per 5 µg/m³ of PM₂.₅; 1.03 (1.01, 1.04) per 10 µg/m³ of NO₂; 1.02 (1.00, 1.04) per 0.5
×10⁻⁵/m of BC, and; 0.99 (0.97, 1.02) per 10 µg/m³ of O₃. These HRs were robust when indirectly
adjusting for BMI and smoking status.
CONCLUSIONS:In our nationwide study, we find that long-term exposure to pollutants PM₂.₅, NO₂,
and BC are associated with valid ascertainment of PD incidence.

Keywords: air pollution, traffic-related, long-term exposure, neurodegenerative outcomes, incidencePK-034[Exposures » Water quality]

Assessing access to and performance ofcommunity water fluoridation in New Zealand:
exposure assessment for a national
retrospective cohort study
Tim James Chambers
Department of Public Health, University of Otago, Wellington, New Zealand

BACKGROUND AND AIM:Background and AIMS: Community water fluoridation (CWF) has proven oral
health benefits. Preliminary analyses of water suppliers in New Zealand show that fluoride targets are
only achieved 54.1% of the time. This project aims to conduct an exposure assessment to assess theaccess to and performance of CWF for different communities in New Zealand. The current exposure
assessment will be used in a retrospective cohort study investigating the association between CWF
and oral health and neurodevelopment outcomes.
METHOD:METHODS: Fluoride levels in municipal drinking water supplies were retrieved for all
fluoridated supplies in New Zealand. Fluoride levels will be linked with the spatial boundaries of each
community water supply. Data on community demographics of each community water supply wereretrieved from census data and will be spatially joined with water supply boundaries.
RESULTS:RESULTS: The exposure assessment will provide insights into the inequities in access to andperformance of CWF. The exposure assessment will be used to assess the impact of CWF on children’s
oral health outcomes and neurodevelopmental outcomes using a powerful individual-level database ofroutinely collected government information called the Integrated Data Infrastructure (IDI) in New
Zealand. A cohort of all babies born 2009-2021 (13 years) (~700,000 births) have been identified in
the IDI.
CONCLUSIONS:CONCLUSIONS: The exposure assessment using actual fluoride levels enables anassessment of the performance of CWF across New Zealand. Actual fluoride levels also enable theassessment of dose-response relationships between fluoride in drinking and key oral health andneurodevelopmental outcomes. The IDI is a powerful, national-level database that can facilitate large
retrospective cohort studies at limited cost. This research is funded by the Ministry of Health’s Oral
health Research Fund.

Keywords: water quality, fluoride, exposure assessment, environmental epidemiology

PK-035[Air pollution » Long-term exposure]Long-term air pollution exposure and tumors of
the central nervous system - a pooled analysis
of six European cohorts
Ulla Arthur Hvidtfeldt1, Jie Chen2, Sophia Rodopoulou3, Maciej Strak4, Kees De Hoogh5, Evangelia
Samoli3, Bert Brunekreef2, Gerard Hoek2, Ole Raaschou Nielsen6
1Danish Cancer Society Research Center, Copenhagen, Denmark.
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
3Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National andKapodistrian University of Athens, Athens, Greece.
4Institute for Risk Assessment Sciences, Utrecht University, Utrecht and National Institute for Public

Health and the Environment, Bilthoven, the Netherlands..
5Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
6Danish Cancer Society Research Center, Copenhagen and Department of Environmental Science,

Aarhus University, Roskilde, Denmark.

BACKGROUND AND AIM:Risk factors for malignant tumors of the central nervous system (CNS) arelargely unknown. We investigated the association between long-term exposure to NO2, PM2.5, BC,ozone (O3), and eight elemental components of PM2.5 and the risk of CNS tumors in the Effects of
Low-level Air Pollution: a Study in Europe (ELAPSE).
METHOD:We pooled six European cohorts (N = 302,493) and assessed the association between
residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), ozone (O3)and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium,and zinc) and malignant intracranial CNS tumors defined according to the International Classificationof Diseases ICD-9/ICD-10 codes 192.1/C70.0, 191.0–191.9/C71.0–C71.9, 192.0/C72.2–C72.5. We
applied Cox proportional hazards models adjusting for potential confounders at the individual andarea-level.
RESULTS:During 5,497,514 person-years of follow-up (average 18.2 years), we observed 623
malignant CNS tumors. The results of the fully adjusted linear analyses showed a hazard ratio (95%
confidence interval) of 1.07 (0.95, 1.21) per 10 μg/m³ NO2, 1.17 (0.96, 1.41) per 5 μg/m³ PM2.5,
1.10 (0.97, 1.25) per 0.5 10−5m−1 BC, and 0.99 (0.84, 1.17) per 10 μg/m³ O3.
CONCLUSIONS:We observed indications of an association between exposure to NO2, PM2.5, and BC
and tumors of the CNS. The PM elements were not consistently associated with CNS tumor incidence.

Keywords: Particulate matter, Particle components, Long-term exposure, Cancer and cancer
precursors

PK-036[Air pollution » Other (to be specified with keywords in the keywords section)]

Free radicals by-products of air pollution inAustralian households
Wen Ray Lee1, Peter David Sly1, Slawo Lomnicki2, Stephania Cormier3, Dwan Vilcins1
1Child Health Research Centre, The University of Queensland, Australia
2Department of Environmental Sciences, Louisiana State University, Baton Rouge, LA, USA
3Department of Biological Sciences, Louisiana State University and Pennington, LA, USA

BACKGROUND AND AIM:The association between air pollution and adverse health outcomes has been
extensively studied, but the causal mechanism is still in discovery. Emerging evidence proposes
environmentally persistent free radicals (EPFRs) as the missing connection between air pollution anddetrimental health impacts. Our study aims to assess the presence of environmentally persistent free
radicals in household dust and discover which household characteristics are predictive of EPFRs.
METHOD:This study recruited 24 participants previously enrolled in the Early Life Lung Function
cohort. Household characteristics were measured through an online survey and confirmed throughresearcher observation. Dust was collected from the vacuum and EPFRs concentration were measured
by electromagnetic resonance spin. Home visits were in winter and summer to assess seasonal
differences. One household was lost to follow-up, resulting in 47 observations in total. Regression
random forest was performed to ascertain which household characteristics predict concentration of
EPFRs.
RESULTS:Household smoking was an important predictor of EPFRs concentration. In addition,
characteristics of the home, such as the age of the house and the type of garage were found to beimportant. These household characteristics may suggest the penetration of outdoor air, potentiallyjustifying the importance of indoor NO2 and PM2.5 concentration in predicting EPFRs concentration.
Frequency of cleaning surfaces around the house, type of cooling method used in child’s bedroom andseason of the home visits also demonstrated to be important predictors of EPFRs concentration inAustralian homes.
CONCLUSIONS:These findings are important in understanding which household factors are linked toharmful air pollutant by-products in Australian homes. With such understanding, changes in householdbehaviours and home ventilation standards can be made to improve air quality in homes, ultimately
protecting the population from adverse respiratory health outcomes.

Keywords: Particulate matter, Other (Environmental Persistent Free Radicals), Environmental
epidemiology

PK-037[Respiratory and allergic outcomes » Respiratory outcomes]

Investigation of personal air pollution andrespiratory diseases: a systematic review
Jianying Liao1, Lirong Liang2, Anna L Hansell1, Yutong Samuel Cai1
1Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
2Department of Clinical Epidemiology & Tobacco Dependence Treatment Research, Beijing Institute of

Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

BACKGROUND AND AIM:Evidence is well established on the effects of ambient air pollution on
respiratory diseases. In contrast, research using personal air monitors (PAMs) to investigate personal
air pollution exposure on respiratory outcomes is slowly emerging. This systematic review was
conducted to summarize latest scientific progress and knowledge gaps in this research area.
METHOD:We followed PRISMA guidelines in conducting and reporting this review. Literature wassearched using PubMed for studies that adopted PAMs to study major respiratory diseases (including
COPD, chronic cough, bronchiectasis, chronic bronchitis, asthma, cystic fibrosis, and idiopathic
pulmonary fibrosis) between January 2017 and March 2023. Screening, data extraction, assessment ofrisk of bias as well as overall quality of evidence were subsequently conducted.
RESULTS:Twenty-four papers were included, 17 from high-income countries, six from China, and one
from India. Eighteen (75%) studies were in longitudinal design; three were cross-sectional, two wererandomized controlled trials and one case-control study. 12 studies each focused on asthma and COPD
respectively. Thirteen studies used portable PAMs, with a mean exposure period of 30 days and amean study sample of 72 individuals, comparing to 67 days and 110 individuals in studies using fixed
PAMs. The most investigated pollutant was PM2.5. Mean PM2.5 exposure ranged from 3.3 to 133.9μg/m3. Majority of studies found that increased personal exposure to PM2.5 was associated withdeterioration of COPD, but its association with asthma was less clear.
CONCLUSIONS:This is the first review summarizing studies of personal air pollution exposure andrespiratory diseases. Current evidence is only drawn from studies in COPD and asthma, with results
for the latter being inconsistent. To inform future research, we highlighted opportunities and practicalchallenges in using PAMs for studying respiratory diseases.
We acknowledge support from National Institute for Health Research (NIHR) Health Protection
Research Unit in Environmental Exposures and Health at UoL.

Keywords: air pollution, personal monitor, respiratory outcomesPK-038[Exposome » Internal exposome]Ambient air pollution and serum cardiometabolic
proteome in young adults with obesity history
Jiawen Liao1, Wu Chen1, Chenyu Qiu1, Jesse Goodrich1, Elizabeth Costello1, Carmen Jiawen Chen1,
Tanya L. Alderete2, Lida Chatzi1, Frank D. Gilliland1, Zhanghua Chen1
1Department of Population and Public Health Sciences, Keck School of Medicine of the University ofSouthern California, Los Angeles, CA, United States of America
2Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States ofAmerica

BACKGROUND AND AIM:Current evidence of air pollution exposure and blood proteomic markers ismostly based on a small number of markers (such as TNF-α, IL6, CRP and fibrinogen) cross-sectionallyand have demonstrated mixed results. In this study, we aim to investigate proteomic biomarkers
involved in cardiometabolic disease onset for their associations with air pollution exposure.
METHOD:In a cohort of young adults with a history of obesity in childhood, serum levels of 384
cardiometabolic-related proteins were measured by Olink Cardiometabolic Explore panel based on
Proximity Extension Assay at baseline (N = 132, age: 19.4 ± 1.3 years) and follow-up (N = 86, age:
24.0 ± 0.8 years). Exposure to air pollutants including PM2.5, PM10, NO2 and O3 were estimated at
1-month and 1-year average before baseline visit, respectively. Marginal linear models using
generalized estimating equation were used to estimate the associations between air pollution exposureand the proteome, controlling for covariates. Over representative analysis (ORA) and Ingenuity
Pathway Analysis (IPA) were conducted to assess enriched pathways, identify diseases andbiofunctions based on associations of proteome and air pollutants, respectively.
RESULTS:We found that air pollution exposures were associated with the cardiometabolic proteome.
For example, 1-month NO₂, 1-month PM₂.₅ and 1-year PM10 air pollution were significantly associatedwith IL-1 receptor like-1 (IL1RL1), plasminogen activator (TLAT) and Amyloid-like protein 1 (APLP1)
after accounting for multiple-testing (false-discovery rate, FDR < 0.05). ORA using Gene Ontology
found enriched pathways of collagen-containing extracellular matrix, exogenous protein binding andinsulin like growth factor binding (FDR < 10E-5). IPA identified significant activation of blood platelets,
angiogenesis, and immune response of cells as significantly enriched diseases and functions
associated with air pollutant exposures (Z-score > 2, FDR < 10E-3).
CONCLUSIONS:Ambient air pollution exposure perturbated the cardiometabolic proteome related tocell signaling, immune responses, and inflammation.

Keywords: Air pollution; Biomarkers of exposure; Proteomics; Obesity and metabolic disordersPK-039[Chemical exposures » Endocrine disrupting chemicals]

Detection of four endocrine disruptors - Methyl
Paraben, 2,4-Dichlorophenoxyacetic acid, monoButyl Phthalate, and Bisphenol-A among Filipino
women
Erlidia F Llamas Clark1, Maria Esterlita V Uy2, Maria Stephanie Fay S Cagayan3, Paulyn Jean R Ubial4,
John Robert Medina5, Lyndon Eliyah L Monte6, Francisco M Heralde Iii7
1Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines, Manila

City, Philippines; Institute of Child Health and Human Development, National Institute of Health,
University of the Philippines Manila City, Philippines
2Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila,

Philippines; Institute of Child Health and Human Development, National Institute of Health, Universityof the Philippines Manila, Manila, Philippines
3Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines,

Manila, Philippines
4College of Public Health, University of the Philippines Manila, Manila, Philippines
5Institute of Health Policy and Development Studies, National Institutes of Health, University of thePhilippines Manila, Manila, Philippines; College of Public Health, University of the Philippines Manila,
Manila, Philippines
6Institute of Biology, University of the Philippines Diliman, Quezon City, Philippines
7Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines

Manila, Manila, Philippines

BACKGROUND AND AIM:Endocrine-disrupting chemicals (EDCs) are environmental pollutants fromhousehold and industrial items that can be a source of exposure via oral and dermal routes. Exposure
to EDCs has been associated with reproductive disorders namely uterine myoma, endometriosis, andpolycystic ovarian syndrome (PCOS). It is also associated with diseases like diabetes, hypertension
complicating pregnancy leading to negative maternal and fetal outcomes. In this report, we present
prevalent exposure to possible EDC-containing items among Filipino women and detection of four
EDCs in their urine samples.
METHOD:Women (18-49 years of age) attending the Philippine General Hospital Department of
Obstetrics-Gynecology clinic were surveyed for their exposure to EDC in their workplaces, households,
and use of personal care products. Using Ultra-Performance Liquid Chromatography-Quadrupole Timeof-Flight (UPLC-QTOF) spectrometry, 169 urine samples from potentially exposed pregnant and nonpregnant women were tested for the presence of four EDCs - Methyl Paraben (MP), 2,4Dichlorophenoxyacetic acid, mono-Butyl Phthalate (MBP), and Bisphenol-A (BPA).
RESULTS:Phthalate (MBP) was detected in 99.36% (155 of 156) urine samples both for exposed andunexposed respondents. Average MP concentrations (ng/mL) were higher among non-pregnant
individuals exposed to shampoos (10.57), lotions (10.56), cosmetics (9.98), nail polish (16.24), andother cleaning solvents (9.4), while MP concentrations were higher for pregnant individuals exposed tovaginal wash (6.78), bleach (31.92) and fragrances (8.46). This is similar to the higher average 2,4dichlorophenoxyacetic acid concentrations among non-pregnant women (4.00) in general compared to
non-pregnant women (3.24). Lastly, minimal BPA concentrations were detected from urine samples of
exposed and unexposed pregnant and non-pregnant participants.

CONCLUSIONS:Non-pregnant women showed more exposure to certain EDC-containing products withhigh detection of MBP and MP while pregnant women had high detection of MP. Exposure anddetection of EDC concentrations between pregnant and non-pregnant individuals vary and needfurther research.

Keywords: Endocrine disrupting chemicals, Phthalates, exposure, womenPK-040[Built environment » Noise]

Aircraft noise and cardiometabolic biomarkers:a cross-sectional and long-term analysis in the
UK Biobank cohort, 2006-2022
Glory O Atilola1, Katie Eminson2, Xiangpu Gong3, Calvin Jephcote2, Kathryn Adams2, Gabriella
Captur4, John Gulliver3, Marta Blangiardo1, Anna L Hansell3
1UK Small Area Health Statistics Unit, Department Epidemiology and Biostatistics, School of Public

Health, Imperial College London, London & MRC Centre for Environment and Health, Department
Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United
Kingdom
2Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United

Kingdom
3Centre for Environmental Health and Sustainability, University of Leicester, Leicester & The National

Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental
Exposure and Health at the University of Leicester, Leicester, United Kingdom
4MRC Unit for Lifelong Health & Ageing, Population Science & Experimental Medicine, Faculty of Pop

Health Sciences, University College London, London & UCL Institute of Cardiovascular Science,
University College London, London & The Royal Free Hospital, Centre for Inherited Heart Muscle
Conditions, Cardiology Department, Pond Street, Hampstead, London, United Kingdom

BACKGROUND AND AIM:Despite increasing evidence of environmental noise impacting cardiometabolic health with good biological plausibility, there are limited population-based studies
investigating biomarkers of cardiometabolic risk. We investigate associations of aircraft noise exposurein 2006 around four major UK airports (Heathrow, Gatwick, Manchester, and Birmingham) withcardiometabolic biomarkers in the UK Biobank cohort during 2006-2022.
METHOD:Of 502,651 individuals (aged 40-69 years) recruited into the UK Biobank cohort, ~105,000
resided near the four airports. Modelled annual average aircraft noise (exposure) was provided by the
Civil Aviation Authority for Lden (average noise over 24 hours penalty weighted for evening and night
noise) and Lnight (night noise). Outcomes were biomarkers of cardiovascular risk: pulse wave arterial
stiffness and reflection index (PWASI, PWRI), pulse rate (PR) and white blood cell count (WBC); andmetabolic risk: body mass index (BMI), triglycerides (TG), glycated haemoglobin (GH) and highdensity lipoprotein (HDL). We specified multivariable linear models for cross-sectional analyses andmixed effect models for long-term analyses, adjusted for sociodemographic, clinical, andenvironmental covariates including ambient nitrogen dioxide (NO2).
RESULTS:Per 5dB increment in Lden, cross-sectional findings found 12.4% (-0.124; 95%CI: -0.175, 0.073) and 64% (-0.643; -1.023, -0.263) reduction in PWASI and PWRI, with PWASI reduction in UKB
having been previously linked to increased risk of cardiovascular events. There was a 20.3% (0.203;
0.032, 0.374) and 9.4% (0.094; 0.065, 0.124) increase in PR and WBC, also a 7% (0.070; 0.008,
0.133), 4.8% (0.048; 0.035, 0.061) and 28.3% (0.283; 0.190, 0.375) increase in BMI, TG, and GH
respectively, with a 1.5% (-0.015; -0.020, -0.010) reduction in HDL. Findings of long-term analyses
were consistent with cross-sectional findings. Similar findings were obtained for Lnight.
CONCLUSIONS:This is the largest population-based study to date, finding associations between
aircraft noise exposure around major UK airports and adverse cardiometabolic biomarker profiles, withmajor public health implications.

Keywords: built environment, noise, cardiovascular diseases, obesity and metabolic disorders,
exposure assessment-biomarkers of exposure

PK-041[Methods » Molecular epidemiology]

Plasma levels of per- and polyfluoroalkyl
substances and circulating extracellular vesicle
and particle microRNAs during pregnancy: A
pilot study
Gyeyoon Yim1, Meghan E Muse1, Megan E Romano1, David A Armstrong2, Thomas J Palys1, Jiang
Gui3, Brock C Christensen1, Margaret R Karagas1, Caitlin G Howe1
1Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon,

NH, USA
2Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; ResearchService, VA Medical Center, White River Junction, VT, USA
3Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College,

Lebanon, NH, USA

BACKGROUND AND AIM:Per- and polyfluoroalkyl substances (PFAS) have been associated withadverse health impacts for both mother and child. Extracellular vesicle and particle microRNAs (EVP
miRNAs) facilitate maternal-fetal communication during pregnancy and have been associated withpregnancy complications and adverse birth outcomes. However, little is known about the impacts of
PFAS on circulating EVP miRNAs during pregnancy.
METHOD:We conducted a pilot study of 50 participants from the New Hampshire Birth Cohort Study.
Seven PFAS and 798 EVP miRNAs were measured in maternal plasma samples collected at
approximately 28 weeks gestation. Statistical analyses focused on 4 PFAS and 142 EVP miRNAs thatwere above limits of detection for ≥ 60% of participants. A principal component analysis was
conducted for the EVP miRNA data. The top 2 principal components (PCs) explained >90% of variancein the data and were retained for downstream analyses. Associations between each PFAS exposureand miRNA PC were evaluated using linear regression, adjusting for parity, educational attainment,
and gestational age at blood collection.
RESULTS:A suggestive inverse association was identified between PFOA and PC2 (P < 0.1). In posthoc analyses, associations between PFOA and the top three miRNAs loading onto PC2 (hsa-miR-451a,
hsa-miR-223-3p, and hsa-miR-150-5p) were assessed. A positive and statistically significant
association was observed between PFOA and hsa-miR-451a (beta=0.50; 95% CI=0.17, 0.83;
Bonferroni P-value = 0.012), which had the largest loading for PC2.
CONCLUSIONS:PFOA was positively associated with hsa-miR-451a levels in circulating EVPs during
pregnancy. Higher circulating levels of this placenta-expressed miRNA has been associated withgestational diabetes, fetal growth restriction, and poor cognitive development in infants. This pilot
study provides support for conducting larger studies that employ environmental mixture modelingapproaches to investigate joint impacts of multiple PFAS on circulating EVP miRNAs during pregnancy
and downstream effects on maternal and child health.

Keywords: Chemical exposures, Endocrine disrupting chemicals, PFAS

PK-042[Chemical exposures » Phthalates]

Phthalates and anogenital distance: phthalates
in maternal urine vs. placental tissue, by tissue
type, by timepoint, and by genital measure
Hai Wei Liang1, Nathaniel Snyder2, Shanna Swan3, Jiebiao Wang4, Janet Catov5, Jennifer Adibi1
1Department of Epidemiology, University of Pittsburgh, Pittsburgh, U.S.A
2Lewis Katz School of Medicine, Temple University, Philadelphia, U.S.A
3Icahn School of Medicine, Mount Sinai, New York, U.S.A
4Department of Biostatistics, University of Pittsburgh, Pittsburgh, U.S.A
5Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, U.S.A

BACKGROUND AND AIM:Phthalates in placental tissue and in maternal urine are not widely correlated,complicating inferences on associations between prenatal phthalate exposure and adverse healthoutcomes. Given that the placenta is more proximal to the fetus, we hypothesized that phthalates inplacenta tissue vs. maternal urine may be more predictive of newborn anogenital distance (AGD)--ananti-androgenic effect previously established in humans and in rodents.
METHOD:Placental tissue samples were collected from 33 male pregnancies enrolled in TIDES at the
University of California, San Francisco. AGD (anus-penis[AP] and anus-scrotum[AS]) were obtained on
all males and transformed to a z-score. 12 phthalates were measured in maternal urine in 3
trimesters, and in two types of term placental tissue - chorion frondosum plus villi(CF) and chorion
smooth with no villi(CS). Generalized linear models were used to generate adjusted R2 values
comparing models with combinations of phthalate metabolites, tissue types, trimester of urine sample,
and type of genital measure. R2 values were sorted to identify models with best fit. Models were
adjusted for confounders (maternal age, BMI, race, marital status, and infant age at AGD exam).
RESULTS:The adjusted R2 is 0.41 for AGD-AP and 0.39 for AGD-AS of models with confounders only.
Models including individual phthalates were predictive of AGD-AP (avg R2 0.54 SD 0.09), and AGD-AS(avg R2 0.45 SD 0.06). AGD-AP was predicted by phthalates measured in both placental tissue (CF)and in maternal urine (2nd trimester) and by MEHP (R2 0.69). AGD-AS was more often predicted byphthalates in urine (1st trimester) and specifically by MCMHP, a metabolite of MEHP (R2 0.60).
CONCLUSIONS:Our results show that (1) placental and urinary phthalate metabolites were both
improved model fit on newborn male genital size; (2) there may be important distinctions in phthalate
associations with AGD-scrotum and AGD-penis by trimester and by method of measuring exposure.

Keywords: phthalates, anogenital distance, placenta

PK-043[Neurologic and mental health outcomes » Neurodegenerative outcomes]

The effect of exposure to Polycyclic aromatichydrocarbons on amnestic mild cognitive
impairment and Alzheimer’s disease: A matchedcase-control study
Heeseon Jang1, Jaelim Cho1, Sang Won Seo2, Changsoo Kim1
1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine,

Seoul, Republic of Korea

BACKGROUND AND AIM:Previous studies have suggested the neurotoxicity of polycyclic aromatichydrocarbons (PAHs). However, the effect of exposure to PAHs on neurodegeneration is still unclear.
Therefore, this study aimed to investigate the association of urinary levels of PAH metabolites withamnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD).
METHOD:Patients with aMCI (n=212) and AD (n=267) were recruited from a university-based hospitalin 2014-2019 in Seoul, Korea. Four cognitively normal controls for each aMCI patient (n=848) and AD(n=1,068) were randomly selected via frequency matching based on sex, age group (<65 or ≥65year-old), and education level (≤9 or >9 years). Urinary levels of 1-hydroxypyrene (1-OHP), 2naphthol (2-NAP), 1-hydroxyphenanthrene (1-OHPhe), and 2-hydroxyfluorene (2-OHFlu) were
measured. A conditional logistic regression model was used, adjusting for potential confounders.
RESULTS:The geometric means (GMs) of the urinary 1-OHP and 2-NAP levels were significantly higher
in aMCI than in it controls (0.08 vs 0.04 µg/L and 0.54 vs 0.20 µg/L, respectively; P<0.05). AD had ahigher GMs of the urinary 1-OHP and 2-NAP levels than in it controls (0.06 vs 0.04 µg/L and 0.46 vs0.20 µg/L, respectively; P<0.05). Each 1-unit increase in log-transformed levels of urinary 1-OHP(odds ratio [OR], 1.15; 95% confidence interval [CI], 1.05−1.26) and 2-NAP (OR, 1.11; 95% CI,
1.05−1.19) was associated with the risk of aMCI. Each 1-unit increase in log-transformed levels ofurinary 1-OHP (OR, 1.16; 95% CI, 1.07−1.26) and 2-NAP (OR, 1.13; 95% CI, 1.07−1.19) was
associated with the risk of AD.
CONCLUSIONS:We revealed that urinary 1-OHP and 2-NAP levels were associated with the risks of
aMCI and AD. These findings suggest that the neurological effect of PAHs exposure, with regard tocognitive function and increased risk of neurodegenerative disorders such as aMCI and AD.

Keywords: Polycyclic aromatic hydrocarbons, amnestic mild cognitive impairment, Alzheimer’s
disease, 1-hydroxypyrene, 2-naphthol

PK-044[Air pollution » Particulate matter]

Is racial residential segregation an importantbut overlooked confounder in air pollution
studies? Evidence from six US-based
prospective cohorts
Hiwot Y Zewdie1, Carolyn A Fahey1, Anna L Harrington1, Claire L Leiser1, Elizabeth W Spalt2, Jamie
Hart3, Mary L Biggs4, Leslie A Mcclure5, Joel D Kaufman2, Anjum Hajat1
1Department of Epidemiology, University of Washington
2Department of Environmental and Occupational Sciences, University of Washington
3Harvard T.H. Chan School of Public Health, Harvard University
4Department of Biostatistics, University of Washington
5Department of Epidemiology and Biostatistics, Drexel University

BACKGROUND AND AIM:Racial residential segregation (RRS) has emerged as a potentially importantfactor in air pollution epidemiology studies, but research examining its association with air pollution,
independent of neighborhood socioeconomic status (NSES), is lacking. A better understanding of therelationship between RRS and air pollution can offer valuable insights into a factor that may need tobe considered when quantifying air pollution-related health burden.
METHOD:We compiled data from six large cohorts, restricting to Black and White participants residing
in urban tracts, to examine associations between RRS, NSES, and individual air pollution exposure.
Cohorts included the Multi-Ethnic Study of Atherosclerosis (n=4,889), Reasons for Geographic andRacial Differences in Stroke (n=24,498), Cardiovascular Health Study (n=3,911), Health Professionals
Follow-up Study (n=33,675), Nurses’ Health Study I (n = 91,319) and Nurses’ Health Study II(n=74,620). We used decennial census data to derive a NSES index and a spatial RRS measure(divergence) for participants' residing census tracts, and national spatiotemporal models to estimate
individual PM2.5 and NO2 exposures at participants' residential addresses. To pool effect sizes acrossadjusted cohort-specific multilevel models we fit random-effects meta-analysis models using a
DerSimonian-Laird estimator. Effect estimates can be interpreted as the percent change in logged air
pollution values for a unit increase in segregation.
RESULTS:A quartile-increase in divergence (more segregation) was associated with 2.73% higher
individual PM2.5 exposure (95%CI: 1.34, 4.12) and 10.26% higher NO2 exposure (95%CI: 6.80,
12.71). This association remained after fitting subsequent models that simultaneously adjust for NSES
(PM2.5= 2.46, 95%CI: 0.80, 4.11; NO2= 9.51, 95%CI: 5.59 13.43), suggesting the association
between the social environment and air pollution is not sufficiently explained by NSES alone.
CONCLUSIONS:Our findings suggest that failing to additionally account for RRS in air pollution-healthassociations may result in biased effect estimates that can undermine current efforts to isolate thehealth impacts of air pollution.

Keywords: Air pollution, Socio-economic factors, Environmental justice, Epidemiology

PK-045[Chemical exposures » Heavy metals]

Timing of Lead Exposure and Age at Death
Justin G Farmer1, Aaron Specht2, Tracy Punshon3, Brian P Jackson4, Felicitas Bidlack5, Rajarshi
Mukherjee6, Dawnie Steadman7, Mary Davis7, Marc G Weisskopf8
1Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA,UnitedStates2Purdue University, West Lafayette, IN, United States
3Department of Biological Sciences, Dartmouth College, Hanover, NH, United States
4Department of Earth Sciences, Dartmouth College, Hanover, NH, United States
5The Forsyth Institute, Cambridge, MA United States; Department of Developmental Biology, Harvard

School of Dental Medicine, Boston, MA, United States
6Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, United States
7Department of Anthropology, University of Tennessee Knoxville, Knoxville, TN, United States
8Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA,UnitedStates; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA,UnitedStatesBACKGROUND AND AIM:To assess the association between lead exposure at different life stages andage at death.
METHOD:Adult tooth and bone post-mortem samples from 208 donors to the University of Tennessee,
Knoxville, Donated Skeletal Collection were analyzed for lead. Bone measurements, reflecting
exposure in the decades preceding death, were assessed by portable X-Ray Fluorescence; lead in
tooth enamel and cementum was measured using Laser Ablation-Inductively Coupled Plasma Mass
Spectrometry. Lead in enamel reflects exposure in early childhood, and lead in cementum throughout
adulthood. We used linear regression models to test lead-age at death associations.
RESULTS:The average age at death of the donors was 72.5 years (sd=10.5; range: 46-97). The
majority of the cohort was female (63.6%) and white (97.3%), and 49.0% had at least some college
education. Pearson correlations between lead measures ranged from 0.24 to 0.57. A one sd(measured in ppm for each) higher lead exposure in enamel (childhood, n=123; mean=86.38,
sd=86.18), cementum (adulthood, n = 110; mean=50.56, sd=31.53), and tibia bone (later life, n =198; mean=24.58, sd= 16.06) were associated with a -0.8 (95% CI: -1.75, 0.16), -1.59 (95% CI: 2.52, -0.66), and -1.52 (95% CI: -2.68, -0.36) year difference in age at death, respectively, after
adjusting for year of birth, sex, social race, and childhood socioeconomic status. Among the 110
donors with all three lead measurements, only adulthood exposure (cementum) remained significantly
associated with age at death (β = -1.79, 95% CI: -2.80, -0.78) after additionally adjusting for
exposure at earlier time points.
CONCLUSIONS:Results suggest that higher lead exposure is associated with an earlier age at death,with adulthood as the life period of most relevance. However, differences between people in boneturnover in later life could have made the bone lead measures less reliable and contributed to a lack ofassociation with that measure.

Keywords: Lead, mortality, life course

PK-046[Reproductive outcomes » Female reproductive outcomes]

Mixtures of phenol and phthalate urinary
biomarkers in relation to the ovarian reserve
among women attending a fertility clinic
Maximilien Génard Walton1, Glen Mcgee2, Paige Williams3, Irene Souter4, Jennifer Ford5, Jorge
Chavarro6, Antonia Calafat7, Russ Hauser8, Lidia Mínguez Alarcón9
1Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-35000 Rennes, France
2Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
3Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston,USA
4Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston,

MA, USA
5Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
6Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA& Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital,
Boston, USA
7National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA,USA
8Departments of Biostatistics and Environmental Health, Harvard T.H. Chan School of Public Health,Boston, USA & Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical
School, Boston, USA
9Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA &Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital,
Boston, USA

BACKGROUND AND AIM:Although prior studies have found associations of the ovarian reserve withurinary concentrations of some individual phenols and phthalate metabolites, little is known about thepotential associations of these chemicals as a mixture with the ovarian reserve.
METHOD:We prospectively investigated whether mixtures of four urinary phenols (bisphenol A,
butylparaben, methylparaben, propylparaben) and eight metabolites of five phthalate diesters
including di(2-ethylhexyl) phthalate were associated with markers of the ovarian reserve among 271
women attending a fertility center who enrolled in the Environment and Reproductive Health study(2004-2017). The analysis was restricted to one outcome per study participant using the closest
outcome after the last exposure assessment. Ovarian reserve markers included lower antral follicle
count (AFC) defined as AFC < 7, circulating serum levels of day 3 follicle stimulating hormone (FSH)
assessed by immunoassays, and diminished ovarian reserve (DOR) defined as either AFC < 7, FSH >10 UI/L or primary infertility diagnosis of DOR. We applied Bayesian Kernel Machine Regression

(BKMR) and quantile g-computation to estimate the joint effects of the chemical exposure biomarker
mixture on the markers of the ovarian reserve while adjusting for confounders.
RESULTS:Among all 271 women, 738 urine samples were collected. In quantile g-computation models,a quartile increase in the exposure biomarkers mixture was not significantly associated with lower AFC(OR = 1.10, 95% CI = 0.52, 2.30), day 3 FSH levels (Beta = 0.30, 95% CI = -0.32, 0.93) or DOR (OR= 1.02, 95% CI = 0.52, 2.05). Similarly, BKMR did not show any evidence of associations between the
mixture and any of the studied outcomes, or interactions between chemicals.
CONCLUSIONS:Despite the lack of associations, further research among other cohorts of women
would provide important information given the scarce literature on mixtures of phenols and phthalates
in relation to the ovarian reserve in women.

Keywords: Mixtures, Female reproductive outcomes, Phenols, Phthalates.

PK-047[Outcomes » Cardiovascular diseases]

Urine Antimony and Risk of Cardiovascular
DiseaseClara Graber Sears1, Erin Jeannine Healy3, Lissa Fortes Soares4, Dana Palermo4, Melissa Eliot2,
Yaqiang Li5, Victoria Fruh6, Tesleem Babalola4, Katherine Ann James7, James Harrington8, Gregory
Wellenius6, Anne Tjonneland9, Ole Raaschou Nielsen10, Jaymie Ross Meliker4
1Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine,

University of Louisville, Louisville, USA; Department of Epidemiology, Brown University, Providence,USA
2Department of Epidemiology, Brown University, Providence, USA
3Stony Brook Medicine, Stony Brook, USA
4Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook

University, Stony Brook, USA
5Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA
6Department of Environmental Health, Boston University School of Public Health, Boston, USA
7Department of Family Medicine, University of Colorado Denver, Denver, USA
8Center for Analytical Science, Research Triangle Institute, Research Triangle Park, USA
9Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health,

University of Copenhagen, Copenhagen, Denmark
10Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental

Science, Aarhus University, Aarhus, Denmark

BACKGROUND AND AIM:To assess the association between urine antimony and incident cardiovascularillness among never smokers in a prospective case-cohort study.
METHOD:The Danish National Patients Registry was used to identify N=809 cases of acute myocardial
infarction (AMI), N=958 of heart failure, and N=534 stroke; among n=19,394 never-smoking adults(ages 50-64 years) enrolled in the Danish Diet, Cancer and Health (DCH) cohort between 1993-1997.
A subcohort of 600 men and 600 women was randomly selected. Antimony concentrations were
measured in spot urine samples collected upon enrollment into the cohort. A case-cohort approachand Cox proportional hazard models was used to estimate adjusted hazard ratios (aHR) for each
incident cardiovascular disease outcome associated with urine antimony, statistically adjusted for
creatinine.
RESULTS:Median urinary antimony concentration was 0.05 µg/L (25-75th percentile= 0.02-0.09) inthe DCH subcohort. Higher urinary antimony concentrations were positively associated with higher
rates of AMI, heart failure, and stroke (aHR= 1.52; 95%CI= 1.12, 2.08, aHR=1.58; 95% CI= 1.15,
2.18, and aHR= 1.29; 95%CI= 0.90,1.85, respectively, comparing participants in the highest (0.092.80 µg/L) with the lowest quartile (<0.02 µg/L) of antimony). Creatinine standardized results were
not materially different. Results did not differ significantly by sex.
CONCLUSIONS:In this population-based Danish cohort, low levels of urine antimony - believed toreflect environmental exposures - were associated with higher rates of incident AMI, heart failure, andperhaps stroke.

Keywords: cardiovascular diseases, exposures, heavy metal

PK-048[Other » Other (to be specified with keywords in the keywords section)]

Disparities in Environmental Health: Findings
From a Community Needs Assessment
Michelle Burbage1, Nicholas Newman2, Mohana Priya Santhan Ramesh Kumar Padma3
1Center for Environmental Genetics, Community Engagement Core, College of Medicine, University ofCincinnati, Cincinnati, United States; Public Health Sciences, Department of Environmental and Public
Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, United States
2Center for Environmental Genetics, Community Engagement Core, College of Medicine, University ofCincinnati, Cincinnati, United States; Pediatric Environmental Health and Lead Clinic, Cincinnati
Children’s Hospital Medical Center, Cincinnati, United States
3Public Health Sciences, Department of Environmental and Public Health Sciences, College of Medicine,

University of Cincinnati, Cincinnati, United States

BACKGROUND AND AIM:The purpose of the study was to identify environmental health concerns
impacting communities in a midwestern city and to identify gaps in community knowledge ofenvironmental health concerns. The extent to which communities understand epigenetics and how it
relates to environmental health problems was investigated.
METHOD:An anonymous online community needs assessment survey was created. A comprehensive
literature review and expert panel aided in survey creation. This panel consisted of one healtheducator, one community needs assessment expert, one environmental epidemiologist, one
environmental health physician, and multiple environmental health community member advocates.
The survey was distributed through various social media platforms and local events. REDCap softwareand SPSS statistical software package were used for data collection and data analysis, respectively.
RESULTS:The results assessed how location, such as zip code, can play a role in environmental healthknowledge and help-seeking behaviors. The study also focused on communities' familiarity about
epigenetics and perceived barriers for resources. These results can provide an understanding of how
to better address environmental exposures and resource barriers to improve the health ofunderserved communities.
CONCLUSIONS:The study is significant for its potential to improve the well-being of underserved
communities. It may help to understand communities' knowledge about possible environmental healthrisks and what resources they perceive as needed to deal with those concerns. Findings can help
identify the health impact of exposures and barriers communities face when obtaining resources toaddress the exposures and health-related issues. It is vital that communities are aware of possible
exposures as well as resources available to address these environmental concerns. Thus, future
research should continue to address gaps in current knowledge to better direct research andcommunity projects.

Keywords: Community outreach, Environmental disparities, Environmental epidemiology, Exposures,
Mental health outcomesPK-049[Cancer and cancer-precursors » Other (to be specified with keywords in the keywords section)]

The association between hepatic viral infections
and cancers: A cross-sectional study in the
Taiwan adult population
Moreen Maliko1, Chih-Ching Yeh2
1School of Public Health, College of Public Health, Taipei Medical University, Taipei City 110301,

Taiwan2School of Public Health, College of Public Health, Taipei Medical University, Taipei City 110301,

Taiwan, and Master Program in Applied Epidemiology, College of Public Health, Taipei Medical
University, Taipei City 110301, Taiwan

BACKGROUND AND AIM:Hepatitis B and C viruses are diseases of global public health concern known
to be associated with liver cancer. A few recent studies reveal associations between hepatic viral
infections and extrahepatic cancers, however, limited by insufficient control of likely confounding
variables. This study was set to explore the associations between hepatitis B and C viruses and cancer
at baseline in the Taiwan biobank database while controlling for a wide range of confounding variables.
METHOD:In a cross-sectional study of adults aged over 30 years, we compared the distribution ofdemographic factors, lifestyle, and comorbidities between viral and non-viral hepatic groups using thechi-square test. Univariate and multivariate logistic regressions were performed to observe theassociations between hepatitis B and C viral infections and cancer by estimating the odds ratio (OR)and 95% confidence interval (CI). The multivariate regression made adjustments forsociodemographic factors, lifestyle, and comorbidities.
RESULTS:In the database, 2,955 participants were identified as having HCV infection, 15,305 as
having HBV infection, and 140,108 as the non-viral group. HBV infection was associated with anincreased likelihood of liver cancer (adjusted OR (aOR) =7.09, 95% CI=3.48-14.44, P<0.001), andovarian cancer (aOR=3.86, 95% CI=1.68-8.88, P=0.002). HCV infection was observed to increase thelikelihood of liver cancer (aOR=4.69, 95% CI=1.34-16.36, P=0.015), ovarian cancer (aOR=5.19, 95%
CI=1.17-22.97, P=0.030), and kidney cancer (aOR=10.27, 95% CI=2.06-52.25 P=0.005).
CONCLUSIONS:Our findings suggest that hepatic viral infections are associated with intra and extrahepatic cancers. However, being cross-sectional in nature, causal inferences cannot be made. A
longitudinal study is recommended to further investigate causality in these associations.

Keywords: Cancer and cancer precursors, Infectious diseases, Risk assessment

PK-050[One health » COVID-19]

Changes in school mitigation strategies anddisease transmission within an independent
school in New York City
Nicholas Defelice, Alison Lee
Environmental Medicine & Public Health Icahn School of Medicine at Mount Sinai

BACKGROUND AND AIM:During the COVID-19 pandemic, governments have implemented a range of
public health measures including school closures to slow the spread of SARS-CoV-2. School closures,in particular, can have immediate and long-lasting impacts on child development and educational
attainment thus it is important to understand the role of the built environment and mitigation
strategies within schools play in respiratory disease transmission.
METHOD:This presentation will report the results of a compartmental model that looks at theassociation between within-school risk of transmission, within-school mitigation strategies, andcommunity-level transmission. During the 2021-2022 school year, infection-control strategies andactive and passive SARS-CoV-2 testing strategies were employed at an independent school in NYC. In
Spring 2022, infection-control strategies were removed. On March 7th, 2022 the independent school
went from mandator masks to masks optional and removed the test-to stay requirement on May 15th,
2022. We present these data alongside the NYC community-level transmission data to understand thestatistical relationship between community spread and within-school infection control.
RESULTS:During the 2021-2022 school year, 56% and 51% of staff (n=231) and students (n=1,145)
were infected, respectively. Following these policy changes, infection rates within the school increased
relative to NYC. Twenty-eight percent occurred after the mask option but with test to stay; 23%
occurred after the mask option without the test to stay. School infections peaked 2 weeks after thetest to stay program was removed, with 7.5% of the school infected.
CONCLUSIONS:We observed 53% of students and staff tested positive for SARS-CoV-2 over theschool year; however, in-school transmission was rare prior to the mask optional and removal of testto-stay policies. Moving forward as the variability within the community spread, it is important tomaintain policies to prevent within-school transmission and keep children healthy and in school.

Keywords: School health, disease transmission, mitigation

PK-051[Chemical exposures » Phenols]

Urinary bisphenol analogues and prevalence of
metabolic syndrome among adults in Southern
China
Shelly Lap Ah Tse1, Feng Wang1, Shaoyou Lu2, Suyang Wu1, Yi Chen3, Wenbo Li4, Zhimin Li5,
Liuzhuo Zhang5, Wenting Feng5, Victoria H Arrandale6, Greg J Evans6
1JC School of Public Health and Primary Care, the Chinese University of Hong Kong, New Territories,

Hong Kong
2School of Public Health (Shenzhen), Sun Yat-Sen University, Guangzhou, China
3State Key Laboratory of Pollution Control and Resource Reuse, Nanjing University, Nanjing, China
4Institute of Environmental Pollution and Health, Shanghai University, Shanghai, China
5Institute of Occupational Medicine, Shenzhen Prevention and Treatment Center for Occupational

Diseases, Shenzhen, China
6Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

BACKGROUND AND AIM:Evidence suggests exposure to bisphenol A (BPA) can influence metabolic
syndrome (MetS) and other health risk in adults. To avoid the adverse health effect, kinds of bisphenol
analogues are used to replace BPA such as bisphenol E, F, and S etc. However, their health effect suchas MetS are unknown.
METHOD:This is a cross-sectional with 1,165 adults recruited in 2013 from Southern China. Modified
Adult Treatment Panel III criteria were used to identify the cases of MetS. Concentrations of urinary
bisphenol analogues were assessed using high-performance liquid chromatography-tandem mass
spectrometry, and they were categorized into three subgroups by below the limit of detection (LOD)
and median of detectable value (low, middle, and high) to obtain the adjusted odds ratios (OR) and
95% CI using logistic regression model.
RESULTS:Eight analogues of bisphenol A were analyzed from urine samples. BPF and BPAF selected to
do further analysis because their detections were above 50%. Their detection rates were 72.6% and52.4%, range were LOD to 85.4 μg/L and LOD to 0.3040, respectively. The prevalence of metabolic
syndrome was 3.3% of all participants. There was no significant association between BPF, BPAF andprevalence of MetS.
CONCLUSIONS:No association was observed between bisphenol analogues and MetS prevalence.

Keywords: Phenols, Obesity and metabolic disordersPK-052[Climate » Temperature]

Countrywide analysis of heat- and cold-related
mortality trends in the Czech Republic: growing
inequalities under recent climate warming
Tomáš Janoš1, Joan Ballester2, Pavel Čupr1, Hicham Achebak3
1Recetox, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
2ISGlobal, Barcelona, Spain
3ISGlobal, Barcelona, Spain; Inserm, France Cohortes, Paris, France

BACKGROUND AND AIM:As some population subgroups are more susceptible to nonoptimal
temperatures, it can be assumed that recent climate warming amplifies these inequalities. However,
little is known about trends in temperature mortality associations among the most vulnerable
subgroups, especially in the areas of central and eastern Europe, which are considered major climatic
hotspot in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related
mortality in the Czech Republic by sex, age, and cause of death and to quantify the temporal evolutionof possible inequalities.
METHOD:We collected daily time series of all-cause (1987-2019) and cause-specific (1994-2019)mortality by sex and age category and daily mean 2-meter temperatures for each region of the Czech
Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specifictemperature-mortality associations, with distributed lag non-linear models (DLNM) and multivariate
random-effects meta-analysis to derive average associations across the country. We then calculated
mortality attributable to nonoptimal temperatures and implemented the indicator of sex-, and agedependent inequalities.
RESULTS:We observed a similar risk of mortality due to cold temperatures for men and women.
Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed aclear pattern of increasing risk due to non-optimum temperatures with increasing age category. The
RR related to cold was considerably attenuated in most of the studied subgroups during the study
period, whereas a significant increase in the RR associated with heat was seen in the overall
population, in women, in the age category 90+ years, and with respect to respiratory causes.
Moreover, underlying sex-, and age-dependent inequalities experienced significant growth.
CONCLUSIONS:Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hottemperatures occurred unequally among population subgroups and resulted in growing inequalities
between the sexes and among age categories.

Keywords: Climate, Temperature, Temperature extremes, Mortality, Short-term exposure

PK-053[Air pollution » Particulate matter]

Ambient pm2.5 and thyroid hormones inpregnant women in Puerto Rico
Trenton Honda1, Trenton Henry1, Laura Corlin2, Kipruto Kirwa2, Akram Alshawabkeh3, José F.
Cordero4, Carmen M. Velez Vega5, Zaira Y. Rosario Pabon6, John Meeker7, Helen Suh8
1School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, USA
2Department of Public Health, Tufts University, Medford, USA
3Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
4Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
5University of Puerto Rico Medical Campus, San Juan, Puerto Rico, USA
6Northeastern University, Boston, USA
7School of Public Health, University of Michigan, Ann Arbor, USA
8Department of Civil and Environmental Engineering, Tufts University, Medford, MA

BACKGROUND AND AIM:Maternal thyroid hormones are important determinants of fetal
neurodevelopment, particularly in early pregnancy stages when the fetal thyroid does not produce
hormones. Air pollution has been linked with neurodevelopmental disorders in infancy and childhood,but it remains unclear whether this may be due to air pollution-related perturbations in the maternal
thyroid hormone axis.
METHOD:We investigated associations between 30-day moving average PM2.5 and maternal thyroid
hormone levels in a cohort of 1,117 pregnant women between the ages of 18 and 41 in Puerto Rico.
Analytes included thyroid stimulating hormone (TSH), triiodothyronine (T3), and free thyroxine (FT4)]
We generated individual PM2.5 estimates using inverse-distance weighting of EPA Air Quality Systemfrom 13 monitors. We used generalized estimating equations to account for repeated measures, andwe performed mediation analyses to examine whether effects of PM on T3 were mediated throughTSH. All models were adjusted for fetal gestational age, parity, history of adverse pregnancy
outcomes, maternal demographics (i.e., age, race) socioeconomic status, exercise, BMI, andseasonality.
RESULTS:Mean PM2.5 exposure was 8.7ug/m3 over the study period. A 10ug/m3 increase in 30-day
moving average PM2.5 was associated with a decrease in log-transformed TSH and T3 of 25.1% (95%
CI: -38.7,-8.4) and 34.2% (95% CI: -41.7,-25.8), respectively. The same exposure was associatedwith a decrease in continuous FT4 of 0.141ng/dL (95% CI: -0.178,-0.104 ). A monotonic dose
response relationship was also observed in quintile analyses for T3 and FT4, with the highest quintile
of exposure associated with hormone decreases of 34.1% (95% CI:-46.5, -18.8, p-trend <0.001) anda decrease in FT4 of 0.178 ng/dL (95% CI: -0.245, -0.111, p-trend < 0.001), respectively.
CONCLUSIONS:We observed significant perturbations in thyroid hormone levels associated with
ambient PM2.5 exposure. This may help explain mechanisms by which ambient air pollution impacts
fetal neurological health and development.

Keywords: Ambient pm2.5, thyroid hormones, pregnant women, Puerto Rico

PK-054[Birth and pregnancy outcomes » Pregnancy outcomes]

Ambient PM2.5 exposure and progesterone
levels in pregnant women in Puerto Rico
Trenton Honda1, Trenton Henry1, Christina A. Porucznik2, Laura Corlin3, Kipruto Kirwa3, Akram
Alshawabkeh4, José F. Cordero5, Carmen M. Velez Vega6, Zaira Y. Rosario Pabon7, John Meeker8,
Helen Suh9
1School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, USA
2Division of Public Health, University of Utah, Salt Lake City, USA
3Department of Public Health, Tufts University, Medford, USA
4Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
5Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
6University of Puerto Rico Medical Campus, San Juan, Puerto Rico, USA
7Northeastern University, Boston, USA
8School of Public Health, University of Michigan, Ann Arbor, USA
9Department of Civil and Environmental Engineering, Tufts University, Medford, MA

BACKGROUND AND AIM:Decreased levels of progesterone and increased levels of corticotropinreleasing hormone (CRH) during pregnancy are associated with risk of miscarriage and adverse fetal
outcomes. Previous studies have found associations between long-term exposure to PM2.5 andreduced progesterone. However, none have examined effects of shorter-term exposures during
pregnancy, or the potential mediating role of CRH.
METHOD:We investigated the associations between PM2.5 exposure and maternal levels ofprogesterone and CRH in a cohort of 1,117 women between 18-41 years old living in Puerto Rico. We
obtained exposure estimates from Environmental Protection Agency Air Quality System data, andassigned individual 30-day moving averages for dates prior to each study visit using inverse distanceweighting. Hormone levels were analyzed in blood collected during the first and third trimester. We
evaluated the association using generalized estimating equation models adjusted for gestational age
at the time of blood draw, parity, history of adverse pregnancy outcomes, maternal demographics(i.e., age, race), socioeconomic status (i.e., education, employment status, income, marital status),
exercise habits, pre-pregnancy body mass index, and seasonality.
RESULTS:Mean 30-day moving average PM2.5 exposure was 8.7ug/m3. For visits one and three,mean progesterone levels were 45.0 and 86.6ng/mL, respectively. A 10ug/m3 higher level of PM2.5
exposure was associated with a 31.9% lower level of progesterone (95% CI: -39.2,-23.6). A
statistically significant and monotonic exposure-response relationship was observed in quintile
analyses (p-trend <0.001). Mediation analysis suggested that 65.5% (p<0.001) of the association
with progesterone is mediated through CRH.
CONCLUSIONS:Higher short-term exposure to PM2.5 may be associated with lower progesterone
levels in pregnancy. The relationship between PM2.5 and progesterone may be mediated by CRH.

Keywords: Ambient PM2.5, progesterone, pregnant women, Puerto Rico

PK-055[Chemical exposures » Phthalates]

The mediating role of phthalate metabolites on
dietary inflammatory index and prostatic
enlargement in Taiwanese adults
Tzu Ling Chu1, Ching Chang Lee2, Wei Hsiang Chang3, Yu Ting Wang4
1Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung

University, Tainan, Taiwan
2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung

University, Tainan, Taiwan；Research Center of Environmental Trace Toxic Substances, National
Cheng Kung University, Tainan, Taiwan
3Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung

University, Tainan, Taiwan；Research Center of Environmental Trace Toxic Substances, National
Cheng Kung University, Tainan, Taiwan
4Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan,

TaiwanBACKGROUND AND AIM:Accumulating evidence suggests that acute and chronic inflammation may
contribute to the development of prostate enlargement. Diet is a critical modifiable target for chronic
disease prevention and the fundamental mechanism has been associated with potential pro- or antiinflammatory properties of the dietary pattern or dietary components. Diet is also a primary source ofphthalate exposure, but prior studies exploring associations of dietary patterns, inflammation andphthalate exposure on prostate enlargement are limited.
METHOD:We evaluated the associations between dietary patterns and urinary phthalate metabolites
among a subset of benign prostatic hyperplasia (BPH) men participating in the Southern Taiwan
Elderly Health (STEH) Cohort Study. 251 BPH patients were recruited from urology clinic in southern
Taiwan during 2015-2017. Dietary inflammatory indexes, including empirical dietary inflammatory
index (EDII) and dietary inflammatory index (DII), were calculated based on self-reported foodfrequency questionnaire (FFQ). 13 phthalate metabolites in urine and 3 oxidative stress markers inserum were analyzed using a high-performance liquid chromatograph coupled with tandem mass
spectrometry.
RESULTS:We fit multivariable linear regression models to estimate the cross-sectional associations
and potential interactions after we adjusted for confounders. Large-sized prostate group showed thehigher score of EDII and higher phthalate metabolites, including MMP, MEP, MiBP, MnBP, and MEHP.
Prostate volume, iNOS, and 8-OHdG were positively associated with EDII (p < 0.05). Urinary MMP,
MEP, MnBP, and DEHP metabolites were positively associated with iNOS or 8-OHdG (p < 0.05).
Urinary DEHP metabolites, MiNP, and MiDP were positively associated with EDII.
CONCLUSIONS:Our results suggested that an inflammatory diet pattern was associated with higher
phthalate exposures, while might play a potential mediating role in men with prostate enlargement.
These findings also suggest that high-fat dietary patterns and bottle tea may be potential sources of
exposure to phthalates in the elderly population.

Keywords: Biomarkers of exposure, Food/nutrition, Male

PK-056[Exposures » Food/nutrition]

Urine high-resolution metabolomics identifies
environmental metal-associated inflammatory
metabolic network community
Young Mi Go, Zachery R. Jarrell, Dean P. Jones
Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA 30322, UnitedStatesBACKGROUND AND AIM:Heavy metal exposures can become toxic because of their non-biodegradable
nature and accumulation in cells and organ tissues. Accumulation of heavy metals, including cadmium(Cd) and cesium (Cs), cause disruption of central metabolic pathways in humans. In this study, weused highly informative, existing human urine samples with an untargeted high-resolution mass
spectrometry (HRMS) approach to discover possible environmental heavy metal- and essential metalassociated metabolites and metabolic pathways.
METHOD:This study used 104 urine samples collected from adults [Age 52.3 ± 5.9 y (mean ±SD),76% female, 2009-2011]. Participants were primarily Emory University or Healthcare employees
enrolled in the Emory-Georgia Tech Center for Health Discovery and Well-Being Cohort. Samples wereanalyzed for high-resolution metabolomics (HRM) by HRMS (C18, negative ESI) followed by advanced
data extraction, annotation and pathway enrichment analysis, and for metals (Mg, Co, Zn, Se, Mo, Cd,
Cs and Ti) by inductively coupled plasma mass spectrometry.
RESULTS:The 16,045 mass spectral features were extracted and used for integrative analysis. Meanurine concentration of metals, Mg, Co, Zn, Se, Mo, Cd, Cs and Ti, were 59.5, 0.24, 5.8, 24.4, 17.8,
0.23, 4.6 and 0.2 ppb, respectively. Quantified metal values were tested for association with metabolic
features using xMWAS for data-driven integration and network analysis (|r| >0.40 and p<0.05).
Network analysis showed three metabolic communities (C1, C2, C3). C1 included the metal Cs and244 metabolites enriched in pentose phosphate pathway. C2 included Cd, Co, Ti and Mg and 310
metabolites enriched in prostaglandin, linoleate and ascorbate pathways. C3 included Zn, Se and Mo
and 235 metabolites enriched in nitrogen and glutathione pathways.
CONCLUSIONS:Urinary heavy metals are strongly associated with metabolites and pathways, which
are closely related to inflammation and oxidative stress.

Keywords: Environmental metal exposure, metabolic disruption, high-resolution metabolomics,
Inflammation pathway

PK-057[Exposures » Food/nutrition]

Dietary intake of organic foods in agrarian
households in India
Aditi Roy1, Alexandra L Bellows2, Poornima Prabhakaran1, Nikhil Srinivasapura Venkateshmurthy1,
Alfred Gathorne Hardy2, Bharath Yandrapu1, John Norrie3, Lilia Bliznashka4, Michael Eddleston5, Peter
Craig6, Ranjit Kumar7, Sailesh Mohan1, Sheril Rajan1, Lindsay M Jaacks2
1Public Health Foundation of India, New Delhi, India
2Global Academy for Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
3Usher Institute, The University of Edinburgh, Edinburgh, UK
4International Food Policy Research Institute, Washington, DC, USA
5Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
6MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
7Agribusiness Management Division, ICAR-National Academy of Agricultural Research Management,

Hyderabad, India

BACKGROUND AND AIM:Consumption of organic foods reduces pesticide exposure, which may bebeneficial for health. In India, a form of organic farming known as natural farming, is increasingly
common. We quantified the proportion and source of naturally farmed food in the daily diet of adults
in agrarian households in south India.
METHOD:We collected data from 2964 participants enrolled at baseline in the BLOOM Study (CoBenefits of Largescale Organic Farming on Human Health), an ongoing evaluation of an agroecology
program in Andhra Pradesh, India. Dietary intake was assessed using an interviewer-administered 24hour recall. For each reported food item, interviewers asked participants about the source (homeproduction/market/ other) and whether the item was naturally farmed.
RESULTS:Mean (SD) participant age was 29 (7) years. Half of the participants were women and 56%
attended secondary school or higher. Majority (65%) of participants reported no consumption ofnaturally farmed foods. Naturally farmed food consumption did not differ by sex. More than half (71%)
of the daily energy intake [Mean (SD): 2406 (847) kcal] came from naturally farmed foods in those
who did consume such foods. Grains and dairy were most likely to be reported as naturally farmed(26% and 22% of grams consumed, respectively). While majority (62%) of homestead foodproduction was naturally farmed, less than 1% of food items sourced from the market were identified
as such. More than half of the home-produced fruits (79%), meat (74%), legumes (68%), vitamin Arich fruits & vegetables (60%), other vegetables (61%), dairy (56%), nuts (54%), and eggs (52%)
were reported as naturally farmed.
CONCLUSIONS:Consumption of naturally farmed foods, which were mostly sourced from homestead
production, was limited. Reported naturally farmed foods may not be organic certified. Strategies toscale the adoption of natural farming in homestead food production and increase consumption are
warranted.

Keywords: Food & nutrition, pesticides, organic food, dietary intake

PK-058[Built environment » Noise]

The relationship between sleep quality, work andresidential location and bedroom environment inHong Kong
Beixi Li1, Choi Miu Wan1, Natalie Hy Tang1, Joey Wy Chan2, Yun Kwok Wing2, Lap Ah Tse3
1JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,

China
2Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, theChinese University of Hong Kong, Hong Kong SAR, China
3JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR,

China & The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China

BACKGROUND AND AIM:A good sleep environment plays a vital role in maintaining good sleep quality.
Increasing numbers of studies have linked sleep quality to environmental factors, including light andnoise. However, other built environment factors like bedroom ventilation, building surroundings, andwork and residential location were rarely assessed for sleep quality. The aim of the study was to
examine the relationship between sleep quality and the built environment factors in Hong Kong.
METHOD:A cross-sectional study was conducted in Hong Kong from 2022.03 to 2023.01. Social
demographic information, work and residential location, bedroom environment, and building
surroundings were collected from full-time workers older than 18 years old. Sleep quality wasassessed by the Pittsburgh Sleep Quality Index (PSQI), while insomnia was assessed by Insomnia
Severity Index. Pearson correlation was used to analyze the relationship between sleep quality andbuilt environment factors. Analyses were conducted by SAS 9.4. Ethics approval: CREC 2021.228.
RESULTS:We received 1,432 responses, including 1,173 (81.9%) females and 259 (18.1%) males.
The average age of the workers was 34.3 ± 8.3 years old. There were 687 (74.0%) workers whoreported poor sleep (PSQI>5), with an average score of 7.7 ± 3.2 points. The Pearson correlation
showed that sleep quality was highly correlated with insomnia (γ=0.67, p <.0001). The built
environment factors like noise at home (γ=0.14, p <.0001) and room ventilation (γ=-0.09, p =0.0125) had a very low correlation with sleep quality, while light at night (γ= -0.11, p = 0.433), andwork and residential location (γ= -0.01, p = 0.849) was not related to sleep quality.
CONCLUSIONS:Our results provided associations between sleep quality and noise at home and room
ventilation. We suggest that direct measurements for the built environment, especially the ventilation
marker like indoor CO2, are necessary to validate the present observations and provide further
explanations for sleep.

Keywords: Built environment, Noise, Light pollution

PK-059[Methods » Modeling]

Regression calibration of 15 particle
components in the United States from 2000 to
2019
Bryan N Vu1, Heresh Amini2, Yijing Feng3, Joel Schwartz1
1Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
2Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

BACKGROUND AND AIM:Estimates for air pollutants including PM₂.₅ and its components derived frommodels utilizing remote sensing and land use variables provide fine spatiotemporal data that are
critical for epidemiological research; however, these estimates may contain bias and measurement
error. We aim to calibrate annual predictions of 15 particle components from 2000 – 2019 in the
United States in four census regions in urban and nonurban areas to reduce measurement error andimprove the estimates for epidemiological studies.
METHOD:Annual predictions of 15 particle components including organic carbon, elemental carbon,
nitrate, and sulfate derived from an ensemble of machine learning models were first divided into urban
and nonurban areas and further stratified into four census regions and calibrated with meteorologicalvariables including temperature, relative humidity and planetary boundary layer height, land use
categorizations, slope and aspect ratio of monitor location, population density, inverse weight of theprobability of having a monitor, and distance to steel plants.
RESULTS:Our regression calibration models achieved an R2 between 0.32 and 0.94 with models forpotassium and nickel performing the worst and models for sulfate and ammonium performance thebest. Of the total 60 models, 55 achieved an R2 greater or equal to 0.5 and 30 achieved an R2 greateror equal to 0.75.
CONCLUSIONS:Our results indicate that certain components are more susceptible to measurement
error and predictions from our models are improved and more generalizable for epidemiologic studies.

Keywords: Calibration, PM Components, ModelingPK-060[Chemical exposures » Phthalates]

Associations of Urinary Phthalate Metabolites
with Household Environments among Mothers
and Their Preschool-Age Children
Hsing Kang Chen1, Shu Li Wang2, Yu Hsun Chang3, Chien Wen Sun2, Ming Tsang Wu4, Mei Lien
Chen5, Chia Jung Hsieh6
1Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of Psychiatry, Yuli

Hospital, Ministry of Health and Welfare, Hualien, Taiwan
2National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli,

Taiwan3Department of Pediatrics, Hualien Tzu Chi General Hospital, Hualien, Taiwan
4Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;

Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan5Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming

Chiao Tung University, Taipei, Taiwan
6Department of Public Health, Tzu Chi University, Hualien, Taiwan

BACKGROUND AND AIM:Phthalates have raised a matter of public health concern due to theirextensive use worldwide and negative health effects. Evaluating potential sources of phthalate
exposure is crucial to design prevention strategies, especially for vulnerable populations. This study
attempted to assess the associations of phthalate exposure with household environments among
mothers and their preschool-age children.
METHOD:This study included 528 mother-child pairs who were followed up at ages 3-6 years in the
Taiwan Mother Infant Cohort Study between 2016 and 2020. Each mother was interviewed by using a
structured questionnaire containing questions on demographic characteristics and factors in lifestyleand household environment, such as the use of plastic food packaging, residential visible mold,insecticide sprays, and electric mosquito repellent. Eleven phthalate metabolites were analyzed inurine samples simultaneously collected from the mother-child pairs.
RESULTS:The phthalate metabolite urinary concentrations were higher among children than among
their mothers, except those of mono-ethyl phthalate (MEP) and mono-2-ethylhexyl phthalate (MEHP).
Multiple linear regression analyses showed that urine samples collected during the summer showed
higher concentrations of phthalate metabolites than those collected in the winter. Family income had
negative associations with the concentrations of MnBP and metabolites of DEHP in children. The use ofplastic food packaging was positively associated with mono-n-butyl phthalate (MnBP) concentrations in
mothers. Residential visible mold or mold stains were significantly associated with higher MnBP and di2-ethylhexyl phthalate (DEHP) metabolite concentrations in children. The use of insecticide sprays was
positively associated with MnBP in children. The use of electric mosquito repellent was significantly
associated with higher MEP concentrations in children.
CONCLUSIONS:Significant associations between household environmental factors and phthalate
exposure were mostly found in children, potentially indicating different exposure pathways between
mothers and their children. Findings from this study provide additional information in designing
prevention strategies to protect child health.

Keywords: Phthalates, Endocrine disrupting chemicals, Household environment, Environmental
epidemiology

PK-061[Birth and pregnancy outcomes » Birth outcomes]

Residential greenness attenuated the adverse
impact of early pregnancy PM2.5 constituent
exposure on congenital heart disease
Die Li, Weize Xu, Qiang Shu
Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine,National Clinical Research Center for Child Health, Hangzhou, China

BACKGROUND AND AIM:The few studies that examined the association between PM2.5 constituentsand congenital heart diseases, and the role of residential greenness played between them. We
examined the mediation and interaction effects of green space on the association between fineparticulate matter (PM2.5) and its constituents during early pregnancy (gestational week 3rd to week8th) and postnatal CHDs.
METHOD:We executed a register system-based case-control study on 7904 singleton live births
between 2019 and 2022 in China. In present study, individual PM2.5 exposure is estimated byordinary kriging interpolation method, and residential green space index is evaluated using normalized
difference vegetation index (NDVI). We applied multiple regression model to estimate the impact of
PM2.5 associated with CHDs, and further conducted causal mediation analysis to estimate themediating effects of green space on PM2.5 related CHDs. Additionally, we speculated the potential
multiplicative interaction between PM2.5 and greenness exposure and its influence on CHD.
RESULTS:Maternal PM2.5 exposure during early pregnancy was related with increased risks for CHDs
while the impact for residential NDVI was the opposite which had OR of 1.046 (95% CI:1.040-1.051),
and OR of 0.966 (95% CI:0.963-0.967), respectively, per inter quantile range increment in
multivariate models. The causal mediation analysis indicated that greenness mediated generally
5.44% of the correlationship between prenatal PM2.5 exposure and CHD. We identified multiplicativeinteractions between maternal exposure to NDVI and PM2.5 for CHD with OR-interaction = 1.043(95%CI: 1.037-1.048).
CONCLUSIONS:This study revealed harmful associations between maternal PM2.5 exposure and CHDs
in gestational week 3 to 8. And such associations were partially reduced when exposed to residential
greenness.

Keywords: Particulate matter,Particle components, Green space,Exposure assessment-air pollution,
Birth outcomesPK-062[One health » Public health]Influence of air pollution and COVID-19 outbreakon sleep and circadian rhythm among Hong
Kong working population
Gengze Liao1, Feng Wang1, Shaoyou Lu2, Victoria H. Arrandale3, Alan Hoi Shou Chan4, Lap Ah Tse1
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR,

China
2School of Public Health, Sun Yat-sen University, Guangzhou, China
3Dalia Lana School of Public Health, University of Toronto, Toronto, Canada
4College of Engineering, City University of Hong Kong, Hong Kong SAR, China

BACKGROUND AND AIM:Air pollution and the waves of COVID-19 outbreak are evident to impair sleep
status and circadian rhythm in the general population. This study assessed such potential associations
among the employed working population in Hong Kong.
METHOD:We recruited 218 workers (i.e., 109 e-waste workers and 109 office workers) at the end of
two COVID-19 community outbreaks (i.e., waves 4th and 5th) in Hong Kong. Participants completed
the standard questionnaires and wore the accelerometer for seven days. The residential addresses
were divided into areas with high or low air pollution levels according to pollutants concentration (i.e.,
PM2.5, PM10, NO2) from monitoring stations. The Pittsburgh Sleep Quality Index and accelerometerdata derived sleep and circadian rhythm parameters. Multivariate linear regressions measured theassociation of the interested independent and outcome variables.
RESULTS:A relatively larger proportion of the participants were middle-aged (mean age: 48 years),male (56.0%), living in high-pollution areas (61.7%), and recruited at the end of wave 5th outbreak(51.8%). Workers living in districts with different levels of air pollution had similar sleep status andcircadian rhythm, except for one of the circadian rhythm parameters, mesor, which is significantly
higher in high-pollution areas. While no significant association was observed between sleep quality
and the waves of the outbreak, workers recruited after wave 5th outbreak (i.e., a severer outbreakcompared to wave 4th) tended to have a less robust circadian rhythm in interdaily stability (β = 0.07), intradaily variability (β = 0.22), relative amplitude (β = -0.07), mesor (β = -38.20), amplitude(β = -73.75).
CONCLUSIONS:The workers’ circadian rhythm was closely associated with the amplitude of COVID-19
waves in the Hong Kong community. Various stakeholders should invest more resources to facilitate
the working population’s better preparedness for the next potential pandemic (Acknowledgements:
GRF/RGC- 14604020 & VCDFIII-136366853).

Keywords: air pollution, COVID-19, environmental epidemiology, outcomes, occupational
epidemiology

PK-063[Climate » Temperature]

Impact of ambient temperature on
disadvantaged population: focusing on persons
with disabilities
Jinah Park1, Whanhee Lee2, Ayoung Kim1, Cinoo Kang1, Yoonhee Kim3, Ho Kim1
1Department of Public Health Sciences, Graduate School of Public health, Seoul National University
2School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering,

Pusan National University
3Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo

BACKGROUND AND AIM:Despite broad findings on the hazardous impacts of ambient temperatures,
little is known about the temperature’s impact on persons with disabilities, who account for 16% of
the global population as of 2021. Moreover, few studies have assessed the impacts of ambient
temperature on emergency department (ED) visits on a national scale even though ED visits show
more sensitive and acute outcomes of extreme temperature effect. Thus, we examined the association
between ambient temperature and any cause ED visits in the persons with disabilities.
METHOD:We collected hospital clinical data based on the Korean National Health Insurance Service –National Sample Cohort database for 18years of data from 2002 to 2019. We used case-crossoverdesign modeling conditional logistic regression with distributed lag non-linear models. For heat effect,
we defined study period from May to September and from November to February for cold effect.
RESULTS:There was 18,173 persons with disabilities (mild grade: 8,964 and severe grade: 9,209)
among a 1 million cohort population. The total number of ED visits was 99,328 for persons withdisabilities. For heat effect, the odds ratio (OR) was 1.06 (95% confidence interval (CI): (0.99, 1.14))
at the 95percentile temperature versus the minimal risk temperature for ED visits. For cold effect, OR
was 1.3 (95% CI: (1.17, 1.44)) at the 5percentile temperature. In mild grade disability group, the OR
for heat was 1.21 and the 1.32 for cold. The OR for heat and cold was 1.09 and 1.28 respectively inthe severe grade disability group.
CONCLUSIONS:Extreme temperatures increased the risk of ED visits for persons with disability andthis risk was higher in mild grade disability group. These results could help understand the potential
impacts of ambient temperature on persons with disabilities and inform policy-makers to better
protect this vulnerable population from adverse health outcomes related to extreme temperatures.

Keywords: Public health, Health inequalities, Temperature extremes

PK-064[Neurologic and mental health outcomes » Mental health outcomes]

Workplace factors and mental health outcomes
Jutta Lindert1, Felix Sisenop1, Keren Agay Shay2, Ruth Etzel3, Andrea Baccarelli4
1University of Applied Sciences Emden/Leer, Constantiaplatz 4, 2243 Emden, Germany
2Health and Environment Research (HER) Lab, Azrieli Faculty of Medicine, Bar Ilan University, 8Henrietta Szold St, Safed, Israel
3Milken Institute School of Public Health, George Washington University, Washington, DC, USA
4Department of Environmental Epidemiology and Social Justice, Columbia University, New York, NY,USA

BACKGROUND AND AIM:Workplace conditions of scientists contribute to depression and anxiety.
METHOD:For this cross-sectional study we analysed de-identified data from environmental scientists
who had responded to an online survey about self-identified threats and humiliation at the workplaceand mental health from January 15th – April 1st. Eligible were environmental scientists who weremembers or former members of the International Society of Environmental Epidemiology (ISEE). We
used generalized linear models to study the cross-sectional association between threats andhumiliation at the workplace and self-reported health, depression, anxiety and stress symptoms.
RESULTS::Of those who were contacted, 1,907 opened the invitation (50·6%), and 627 participated(32·9%). Threats and humiliation were common exposures of environmental health scientists (77.4%
female and 56% male scientists reported at least one threat at the workplace, 77.4% female and68.9% males reported at least one humiliation event at their workplace). Threats were most common
among females, those who were18 – 30 years old, and no professors, humiliation was most common
among females. Exposure to threats (eg. being put on leave) and humiliation (eg. being excluded)
were associated with worse self-perceived health, and more symptoms of depression, anxiety, andstress in a statistically significant dose -response relationship.
CONCLUSIONS:Workpalce exposures to threats and humiliation are signifcaantly related to depression
and anxiety.

Keywords: Workplace, depression,a nxiety, stress symptoms

PK-065[One health » Vectors and vector-borne diseases]

The environmental and social drivers of dengue,
chikungunya and Zika emergence: a systematic
evidence map
Neelam Iqbal1, Giovanni S Leonardi2, Jolyon Medlock3, Louise Kelly Hope4
1Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool; Environmental

Epidemiology Group, RCE, UK Health Security Agency
2Environmental Epidemiology Group, RCE, UK Health Security Agency
3Medical Entomology Group, CCHSC, UK Health Security Agency
4Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool;

BACKGROUND AND AIM:The environment has impacted the transmission of many climate-sensitive
diseases including dengue, chikungunya and Zika with current estimates suggesting 40% of theworld's population are vulnerable to infection. This study aimed to review the range of environmental
and social risk factors of these arboviral diseases in order to build a conceptual framework of key
known drivers, to help inform surveillance and control strategies and to determine gaps in current
knowledge and research.
METHOD:A systematic evidence map approach was used based on the eDPSEEA framework, endorsed
by WHO. The Embase, Pubmed and Web of science databases were searched to identify drivers in thescientific literature using key search terms related to each disease, environmental drivers (rainfall,temperature, humidity, floods, hurricanes etc) and social drivers (water management, socioeconomic
status, travel, behaviours risk perceptions etc). Article abstracts/titles of each article were screened
and included based on an agreed selection criterion. Information on study year, country, journal andrisk factors were summarised.
RESULTS:Initial screening resulted in 9,546 titles with the most articles published in 2017 (n= 2800)
in a variety of infectious disease and epidemiology journals. Preliminary screening indicated mostauthors (n= 6,870) from Brazil, India, and UK. Key risk factors included high temperatures, highprecipitation, extreme dry conditions, lower socioeconomic status, older housing, lack of public watersupplies, ineffective solid waste dumping, and doing outdoor activities in the evening. Full results will
be presented.
CONCLUSIONS:The method used and results from this study will provide a comprehensive overview of
the interacting environmental and social drivers of emerging mosquito-borne arboviruses that pose arisk to the UK, which will help to direct more targeted interventions and strengthen UK’s capacity for
detection and surveillance of these diseases.

Keywords: infectious diseases, climate, environmental disparities, environmental epidemiology,socioeconomic factors

PK-066[Methods » International collaboration]

The comparison of indoor environmental qualityof hospitals in the UK and Taiwan: implications
for the delivery of low-carbon hospitals
Shih-Che Hsu1, Ke-Ting Pan2, Li-Ting Kao3, Harry Kennard4, Gesche Huebner1, Ian Hamilton1
1UCL Energy Institute, University College London, London, United Kingdom
2Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei,

Taiwan3Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
4Center on Global Energy Policy, Columbia University, New York, United States

BACKGROUND AND AIM:Implementing low-carbon/net-zero mitigation strategies in the built
environment has become important to combat climate change. However, these strategies may lead toenvironmental changes (e.g., increased airtightness and unintended low ventilation), which can cause
accumulation of pollutants and damp heat, ultimately affecting the health of people indoors. Hospitals
rely on highly-controlled central ventilation and on-site human adaptations, making them an ideal
setting for examining the impact of mitigation measures. Considering a significant number of staff andpatients would be affected by poor indoor environmental quality (IEQ), establishing monitoring
systems to continuously collect IEQ data along with data on the experience people have becomes
important.
METHOD:This research focuses on monitoring temperature, humidity, PM₂.₅, CO₂ and TVOC, andcomparing the implemented mitigation strategies (e.g., energy efficiency improvement and energy
saving plans) in two university-affiliated teaching hospitals in the UK and Taiwan. Fourteen IEQ
monitoring devices are installed across different hospital departments. Furthermore, medical staff
working in different hospital environments will rate their performance and complete the WarwickEdinburgh Mental Wellbeing Scales.
RESULTS:IEQ data are collected every 5-10 minutes and paired with local outdoor measurements. The
nature of work, department location and human adaptation are found to affect indoor temperatures,
pollutant concentrations and working experience. There are no significant variations in indoor
temperatures among departments within the same hospital. However, PM₂.₅ exhibits the most distinct
distribution patterns among the departments. Particularly in the pharmacy department, PM₂.₅
concentrations are often higher than the ones in other departments, and 2-3 times higher in Taiwan
than in the UK.
CONCLUSIONS:The first-time collaboration between the UK and Taiwan aimed at comparing IEQ,
working performance and wellbeing in hospitals. This research highlights the importance ofrecognising the potential impacts of mitigation strategies and addressing the risk factors of indoor
pollution to minimise long-term exposure and promote wellbeing in the workplace.

Keywords: Indoor environmental quality, Multi-pollutant, Built environment, Hospital, International
collaboration

PK-067[Outcomes » Other (to be specified with keywords in the keywords section)]Long-term exposure to PM2.5 associated withdecline in kidney function in a large urbancohort in two Indian cities
Siddhartha Mandal1, Ram Jagannathan2, Shuchi Anand3, Mohammed K Ali2, K.m. Venkat Narayan2,
Viswanathan Mohan4, Nikhil Tandon5, Poornima Prabhakaran6, Petter Ljungman7, Joel D Schwartz8,
Dorairaj Prabhakaran1
1Centre for Chronic Disease Control, New Delhi, India
2Rollins School of Public Health, Emory University, USA
3Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto,

California, USA
4Madras Diabetes Research Foundation and Dr Mohan’s Diabetes Specialties Centre, Chennai, India
5All India Institute of Medical Sciences, New Delhi, India
6Centre for Environmental Health, Public Health Foundation of India, New Delhi, India
7Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
8Harvard TH Chan School of Public Health, Harvard University, Boston, USA

BACKGROUND AND AIM:Recent studies indicate that exposure to fine particulate matter (PM₂.₅) is
associated with decline in kidney function and chronic kidney diseases. However, evidence linking
time-varying PM₂.₅ with kidney function in the South Asian population exposed to high levels of PM₂.₅
is limited due to few longitudinal studies and lack of robust exposure data.
METHOD:In a representative population-based Indian cohort of 12271 adults in Chennai and Delhi, weinvestigated the longitudinal associations between annual PM₂.₅ and estimated glomerular filtration
rate (eGFR) (using CKD-EPI 2009 equations) at baseline and two follow-ups (average follow-up: 4.4
years, IQR: 3.9,5.2 years). Exposures were assessed at residential geocodes using a high resolution
spatiotemporal model for daily PM₂.₅ at 1kmx1km across India. Within each city, linear mixed effectmodels with inverse probability based weighting for loss-to-followup were implemented, while
adjusting for socioeconomic status, time, diabetes and hypertension status. Effect modification by age,sex and obesity were assessed using stratified models.
RESULTS:Annual average PM₂.₅ exposures at baseline and two follow-ups were 32.9, 37.1 and 29.6μg/m3 (sd: 3.8, 6.6, 3.9 μg/m3) in Chennai and 118, 123 and 129 μg/m3 (sd 15.2, 15.1, 14.3
μg/m3) in Delhi. Median eGFR at baseline were 112 mL/min/1.73 m² (IQR: 101.9,121.0) in Chennai
and 106.4 mL/min/1.73 m² (IQR: 94.4,116.6) in Delhi. A 10 μg/m3 higher annual average PM₂.₅
exposure was associated with 0.82 mL/min/1.73 m² (95% CI: -1.17,-0.47) and 0.78 mL/min/1.73 m²(95% CI: -1.07,-0.49) decrease in eGFR in Chennai and Delhi, respectively. Further, the decline ineGFR was greater in lean individuals in Chennai and obese individuals in Delhi.
CONCLUSIONS:Long-term exposure to PM₂.₅ was associated with decline in eGFR levels in both cities.
Given the high burden of air pollution and chronic diseases in India, there may be high potential longterm benefits of reducing air pollution on renal health in urban India.

Keywords: Particulate matter, Long-term exposure, Kidney disease, Renal function, India

PK-068[Omics technologies » Proteomics]

Proteomics-based discovery of novel
biomarkers for lipid metabolism-relateddiseases in abandoned mine areas
Sora Mun1, Woo Jin Kim2, Sungho Won3, Jeeyoung Kim2, Min Heo4, Hee Gyoo Kang1
1Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University,

Seongnam, South Korea
2Department of Internal Medicine and Environmental Health Center, Kangwon National University

Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
3Interdisciplinary Program for Bioinformatics, College of Natural Science, Seoul National University,

Seoul, South Korea; Institute of Health and Environment, Seoul National University, Seoul, South
Korea; Department of Public Health Sciences, Graduate School of Public Health, Seoul National
University, Seoul, South Korea; RexSoft Corp, Seoul, South Korea
4Interdisciplinary Program for Bioinformatics, College of Natural Science, Seoul National University,

Seoul, South Korea

BACKGROUND AND AIM:This study was to discover new biomarkers associated with diseases related
to abandoned mine areas by performing protein networking mapping of the blood(serum) of residents
in the abandoned mine area.
METHOD:The study was conducted in the Goseong province, an abandoned mine area, and theGimhae province, a control area, in the South Korea. The abandoned mine area was divided into twogroups with different levels of exposure. Serum was collected from the Goseong and Gimhae areas,
and mass spectrometry was performed for protein profiling. The identified proteins were analyzed forthe process of selecting candidate biomarkers through comparative analysis between the exposed andnon-exposed groups through relative quantification. Protein network mapping was performed throughstring software.
RESULTS:As a result of protein profiling, a protein network associated with lipoprotein metabolism was
identified in the abandoned mine area. Besides, lipoprotein metabolism changed step by step
depending on the degree of mine exposure. Final biomarkers related to lipoprotein metabolism are
Alpha-2-macroglobulin, Apolipoprotein A-IV, Apolipoprotein B-100, Apolipoprotein A-I, andApolipoprotein F.
CONCLUSIONS:The study found that the biomarker panel associated with lipoprotein metabolism canserve as a biomarker to track the risk of diseases associated with abandoned mine areas. Lipoprotein
metabolism has a direct connection with cardiovascular disease, which is reported as a major cause ofrenal function disease. By confirming that lipoprotein metabolism proteins form networking in theabandoned mine area, the possibility of using them as leading biomarkers of renal function decline
involved in cholesterol transfer and plasma lipoprotein particle remodeling was validated. Thesefindings suggest that the use of the identified biomarkers can be helpful in predicting the risk of
disease occurrence in the abandoned mine area.

Keywords: Abandoned mine area, Proteomics, Lipid metabolism, Renal function, Cardiovasculardisease

PK-069[Exposures » Occupational exposures]

Application of artificial intelligence algorithms
and low-cost sensors to estimate respirable
dust in the workplace
Ta Yuan Chang, Guan Yu Chen, Jing Jie Chen
Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan

BACKGROUND AND AIM:Internet of Things and low-cost sensor technology are becoming common
tools for environmental exposure monitoring, but few is applied to measure dust in the workplace.
This study aimed to develop a predictive model of respirable dust by artificial intelligence (AI)algorithms and low-cost sensors.³
METHOD:A variety of low-cost sensors were combined into a respirable dust sensor module and placedwith a portable aerosol monitor (GRIMM 11-D) for a two-week monitoring. The data was collected toestablish a predictive model of respirable dust by AI algorithms. The built model was validated byusing an aluminum cyclone with an air pump and polytetrafluoroethene filters to sample the 8-hour
respirable dust during 5 days in an aircraft manufacturing company. The continuous two-weekmonitoring of sensor module was performed to evaluate the stability in the workplace.
RESULTS:The concentration of respirable dust measured by GRIMM 11-D in a general outdoor
environment during two weeks was 28.5±16.1 μg/m³ (range=2.4-85.3 μg/m³). After establishingvarious predictive models based on monitoring data and AI algorithms, the random forest method wasobserved to have the best prediction capacity (R²=0.96, RMSE=3.11, MAE=2.12) compared with other18 methods. In the field validation, the predictive levels of respirable dust (35.9±4.1 μg/m³,
range=32.7-42.9 μg/m³) was close to results collected by the traditional method (38.1±8.9 μg/m³,
range=28.1-52.5 μg/m³), and the correlation between them was high (r=0.86). The overall averagebias was -2.2 μg/m³ with the precision of 5.8 μg/m³ to generate the accuracy of 6.2 μg/m³ (94.2%).
The data completeness was 99.7% during the two-week monitoring periods.
CONCLUSIONS:The developed predictive model of respirable dust based on AI algorithms and low-cost
sensors had the excellent performance in the workplace compared with those measured by the
traditional sampling method. The built sensor module also had good data stability during the sampling
period.

Keywords: Exposure assessment, Modeling, Occupational exposures, Particulate matter.

PK-070[Climate » Temperature]

Temperature and gastroenteritis association in
refugee camps in Bangladesh, 2019-2021
Takuya Takata1, Nasif Hossain2, Xerxes Seposo1, Kayo Ueda1
1Department of hygiene, Graduate school of Medicine, Hokkaido University, Hokkaido, Japan
2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, JapanBACKGROUND AND AIM:This study aims to determine the association between temperature andgastroenteritis of forcibly displaced persons in refugee camps, Bangladesh.
METHOD:Daily time series data, based on case reports, were collected from two clinics organized by
UNHCR in Kutupalong and Nayapara camps in Ukhia and Teknaf Upazila, Cox's Bazar, Bangladesh,from 2019 to 2021. In the absence of a background monitoring station around the refugee camps, we
utilized the internally validated ERA5-land reanalysis temperature data, obtained from the European
Centre for Medium-Range Weather Forecasts, as a proxy for the ambient air temperature exposure.
We modeled the nonlinear lagged associations between daily temperature and gastroenteric cases
using a quasi-Poisson generalized linear model coupled with a distributed lag non-linear model.
Covariates, such as precipitation, long-term time trend, day-of-the-week, holiday, COVID-19 andreporting system indicator terms, sourced out from literature were adjusted in the model.
RESULTS:33,280 cases in Kutupalong and 31,165 cases in Nayapara were registered forgastroenteritis from 2019 to 2021.The two camp clinics have varying cumulative risk curves.
Kutupalong clinic showed an M-shaped risk curve with two distinct peaks at around 21℃ and 29℃,
with a trough, potentially assumed as the minimum risk temperature (MRT), at 26℃. The relative risk
(RR) of 10th percentile (21.1°C) was 2.31 (95% confidence interval [CI]: 1.18, 4.65), while the RR of
90th percentile (28.5°C) was 1.78 (95% CI: 1.24, 2.56), both relative to MRT. In Nayapara, there wasa trend towards increased risk at lower temperature. The RR of 10th percentile (21°C) was 1.32 (95%
CI: 0.78, 2.24), while the RR of 90th percentile (28.3°C) was 0.75 (95% CI: 0.56, 0.99), relative to
MRT.
CONCLUSIONS:Temperatures was found to be associated with gastroenteritis in refugee camps withrisks noted to be higher at low temperature.

Keywords: public health, environmental epidemiology

PK-071[Built environment » Other (to be specified with keywords in the keywords section)]

European city clusters based on morphologicalconfigurations of urban landscapes and relation
with surface urban heat islands
Tamara Iungman, Sasha Khomenko, Evelise Pereira Barboza, Marta Cirach, Karen Gonçalves, Paula
Petrone, Mark Nieuwenhuijsen
Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences,
Universitat Pompeu Fabra, Barcelona, Spain

BACKGROUND AND AIM:The world is becoming highly urbanized. A better understanding of urban
design typologies and their association with environmental exposures can help policy-makers
determine which actions contribute to more sustainable and healthier cities. We aimed to identify
distinct urban configuration types in 932 European cities and evaluate their association with surface
urban heat islands (SUHI).
METHOD:We retrieved data on Local Climate Zones (LCZs) representing 17 urban and natural classes
at 100m resolution for Europe. We divided each city into five rings starting from the urban center,assuming a monocentric urban configuration. For each ring, we determined the most prevalent LCZ.
We conducted a Uniform Manifold Approximation and Projection for Dimension Reduction (UMAP) and
we classified the cities into clusters using the hierarchical density-based clustering algorithm(HDBSCAN). The SUHI was estimated as the difference between rural and urban land surface
temperatures at 250m resolution. Differences in SUHI between clusters were evaluated using one-way
ANOVA and post-hoc Tukey test.
RESULTS:We identified 9 city clusters. Cluster 1 is characterized by compact midrise configurations;cluster 2 has open midrise structures; clusters 3, 4, 5 have open lowrise configurations with low
plants, predominantly in central areas in clusters 4 and 5; clusters 6 and 7 are characterized by large
lowrise structures and clusters 8 and 9 are open lowrise with scattered trees in cluster 8. We found asignificantly lower SUHI in clusters 4, 5, 6 and 7 (mean SUHI range 0.5ºC-1.8ºC) compared toclusters 1, 3, 8 and 9 (mean SUHI range 2.7ºC-3.6ºC).
CONCLUSIONS:Our results suggest that distinct morphological configurations exist among European
cities and that these are associated with differences in environmental exposures. Our findings indicate
a lower SUHI in cities that preserve natural landscapes highlighting the importance of nature-based
solutions, particularly in central areas, to mitigate heat effects.

Keywords: Local Climate Zones, Surface Urban Heat Islands, European cities, Clusters

PK-072[Cancer and cancer-precursors » Survival]

Residential Proximity to Oil and Gas Wells andSurvival in Children with Acute Leukemia
Thanh T. Hoang1, Rutu A. Rathod2, Jeremy M. Schraw1, Erin C. Peckham Gregory1, Michael E.
Scheurer1, Amy E. Hughes2, Philip J. Lupo1
1Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston,

Texas, USA; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston,
Texas, USA; Cancer and Hematology Center, Texas Children’s Hospital, Houston, Texas, USA
2Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas

Texas, USA

BACKGROUND AND AIM:Living near oil and gas developments may increase the risk of developingchildhood leukemia, but their impact on survival is largely unknown. We examined whether living near
oil and gas wells is associated with mortality in children with leukemia.
METHOD:This study included children with a primary diagnosis of leukemia ≤19 years in the Texas
Cancer Registry, 1995-2017. The location of oil and gas wells in Texas was obtained from the Texas
Railroad Commission. Wells were categorized as 1) oil or gas well, 2) service, storage, injection, or
disposal (SSID) well, 3) permitted well, 4) horizontal drainhole, or 5) sidetrack well. Distance between
residential address at diagnosis and wells in Texas was calculated to determine whether children lived
within 1000m from each well type (yes/no). We conducted Cox regression, adjusting for sex, census
tract-level poverty, race/ethnicity, age at diagnosis, and decade patient was diagnosed. Analyses wereconducted for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), separately.
RESULTS:8.2% of leukemia patients lived within 1000m of an oil or gas well. 5,980 and 1,297 children
were diagnosed with ALL and AML, respectively. The 5-year overall survival for ALL was 85% and 59%
for AML. Across the five well types, living within 1000m was not associated with survival in children
with ALL. Mortality was significantly higher in children with AML living within 1000m of an oil or gas
well (aHR: 1.35, 95% CI: 1.02, 1.80). In dose-response analyses, the association was only significant
in those with ≥6 oil or gas wells within 1000m (aHR: 1.81, 95% CI: 1.15, 2.86). Elevated risk ofdeath was also observed with SSID, permitted, and sidetrack wells (aHR range: 1.29-1.66).
CONCLUSIONS:These findings provide preliminary evidence that pollutants from oil and gas wells may
contribute to survival of AML but not ALL.

Keywords: Cancer and cancer precursors, spatial statistics, children's environmental healthPK-073[Birth and pregnancy outcomes » Pregnancy outcomes]

Environmental Tobacco Smoke Exposure andPerinatal Health Outcomes in the United ArabEmirates: Interim Analysis from The Mutaba’ah
StudyZaki Al Ghumgham1, Mohammed Nagdi Zaki1, Nasloon Ali2, Rami H Al Rifai2, Iffat Elbarazi2, Fatma Al
Maskari2, Omar El Shahawy3, Luai Awad Ahmed2, Tom Loney1
1College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United

Arab Emirates.
2Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al Ain, United

Arab Emirates; Zayed Center for Health Sciences, UAE University, Al-Ain, United Arab Emirates.
3Tobacco, Alcohol and Drug Use Section, Department of Population Health, New York University

Grossman School of Medicine, New York, United States.

BACKGROUND AND AIM:Tobacco use is high in the Middle East region; however, there is minimal dataon prenatal exposure or the impact on perinatal outcomes. This study investigated the association
between environmental tobacco smoke (ETS) exposure and perinatal health outcomes in the United
Arab Emirates (UAE).
METHOD:This is an interim analysis of the Mutaba'ah prospective cohort study that is recruiting
17,000 pregnant women in the UAE. We report the available baseline data on ETS exposure(N=8,586) and 4,328 pregnant women who delivered between May 2017 and February 2021. Selfreport questionnaires collected data on socio-demographic factors, prenatal tobacco use, and ETS
exposure. Perinatal outcomes were extracted from hospital medical records. Univariate andmultivariate regression models were used to assess the association between (i) various
sociodemographic factors and tobacco use and ETS exposure; and (ii) tobacco use and ETS exposure
and perinatal health outcomes.
RESULTS:Self-reported tobacco use during pregnancy was low (0.7%), spousal tobacco use was high(37.9%), and a third (34.8%) of expectant mothers were exposed to ETS (28.0% at home).
Employment during pregnancy (adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): 1.191.52), childbirth anxiety (aOR 1.21, 95% CI 1.08-1.36), and increased adults living in the same house(aOR 1.02 95% CI 1.01-1.03) were independently associated with higher odds of being exposed to
ETS. Pregnant women with higher education levels (aOR 0.84, 95% CI 0.75-0.94) and higher gravidity(aOR 0.95, 95% CI 0.92-0.99) were less likely to be exposed to ETS. Women exposed to ETS were
31% more likely to deliver prematurely (aOR 1.31, 95% CI 1.06-1.62).
CONCLUSIONS:The majority of ETS exposure occurs at home; therefore, public health efforts
targeting smoking cessation amongst husbands and promoting smoke-free homes may help reduceprenatal ETS exposure and adverse perinatal outcomes in the UAE.

Keywords: Epidemiology, Female, Long-term exposure, Pregnancy outcomes, Socio-economic
factors.

PK-074[Exposures » Occupational exposures]

Association between leptin and sleep quality of
shipyard workers exposed to metal fumeparticulates
Tzu Ya Hsu, Nain Feng Chu, Ching Huang Lai
School of Public Health, National Defense Medical Center, Taipei

BACKGROUND AND AIM:This study explores the association between leptin and sleep quality among
shipyard workers exposed to metal fume particulates.
METHOD:The study design was a cross-sectional setting. The objects were recruited from a shipyard
in northern Taiwan, including welders and office workers. The personal sampling PM2.5 sample wascollected on Monday during working hours. On Tuesday morning, the body composition was measured
with body composition analyzers. Fasting blood and urine samples were also collected. Inductively
Coupled Plasma Mass Spectrometry (ICP-MS) was used to analyze the metals in air and urine
samples. The Sandwich Enzyme-Linked Immunosorbent Assay measured leptin and serotonin. In
addition, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The statisticalanalyses used IBM SPSS Statistics 22.0.
RESULTS:The concentration of particulate matter (μg/m3) in the exposure group and the control
group were 303.46 (3.15) [GM(GSD)] and 99.38 (3.37) (p<0.001); the serotonin concentration(pg/mL) in the exposure group and the control group were 70.36 (2.83) and 40.23 (3.39) (p=0.09);
the leptin concentration (ng/mL) in the exposure group and the control group were 4.60 (1.27) and4.55 (1.27) (p=0.630), respectively. In linear regression analysis, after adjusting for group, age, andsmoking habits, a negative linear relationship between urinary aluminum (β=-0.220; 95% CI: 0.526,0.000; p=0.050), urinary nickel (β=-0.228; 95% CI:-0.791,-0.012; p=0.044) and serotonin.
After adjusted confounders, a negative relationship between serotonin concentration (β=-0.375; 95%
CI: -0.123,-0.033; p=0.001) and leptin. In addition, there was a positive linear relationship between
the subjective sleep quality index of the Pittsburgh Sleep Quality Index (β=0.345; 95%
CI:0.017,0.083; p=0.003) and leptin concentration.
CONCLUSIONS:We conclude that shipyard welders are exposed to high levels of metal fumeparticulates. Furthermore, some metals are associated with a decrease in serotonin. Conversely, leptin
is associated with decreased serotonin and a worse subjective sleep quality index.

Keywords: Heavy metals, Particulate matter, Obesity and metabolic disordersPK-075[Exposures » Occupational exposures]Role of gut microbiota between exposure to
welding fume and sleep quality
Ya Bei Ynag, Ching Huang Lai
School of Public Health, National Defense Medical Center, Taipei, Taiwan

BACKGROUND AND AIM:Approximately 70% of workers in shipyard are exposed to complex mixturesof welding fume that may affect the composition of gut microbiota in welding workers.In the gut
microbiota fields,sleep can alter the composition of the gut microbiota through the gut-brain
axis,hypothalamic-pituitary-adrenal axis stimulation,immune regulation.This study aimed at thecorrelation between the shipyard workers in metal fume exposure,composition of gut microbiota
species,inflammatory factors and sleep quality.
METHOD:This study conducts a cross-sectional research from a shipyard in northern Taiwan.Since thehighest composition and distribution in welding rods are iron and manganese,the subjects weredivided into high and low iron-manganese group by intrinsic dose.Inductively coupled plasma mass
spectrometry was used to detect the concentration of metals in feces,and the enzyme-linked
immunosorbent assay was used to analyze the concentration of plasma hs-CRP.Sleep quality was usedby Pittsburgh Sleep Quality Index(PSQI).The identification of bacterial species contained in stool
samples was performed by the third-generation sequencing technology,analyzing the 16S ribosomal
genes.Statistical analysis was performed with statistical software SPSS version 22.0.
RESULTS:The fecal metal Al,V,Cr,Mn,Fe,Co,Ni,Cu,Zn,Cd and Pb concentration in the high ironmanganese internal dose group was significantly higher than the low group.The alpha diversity inmicrobiota like Shannon and Simpson were non-significant between the two groups.Regarding thePSQI score, there was a non-significant between the two groups.The fecal Cr,Zn and Hgconcentrations were significantly negatively associated with the abundance of Actinobacteria,
Verrucomicrobia, and Firmicutes.The above fecal metals were also significantly positively associatedwith Proteobacteria and Lachnoclostridium. Besides, hs-CRP was positively associated withLachnoclostridium. Moreover, Phocaeicola and Lachnoclostridium showed a significant negative
association with PSQI.
CONCLUSIONS:Higher fecal metal concentrations increase the relative abundance of Proteobacteria
and some human inflammatory bacteria like Lachnoclostridium. There may have a relationshipbetween worse sleep quality and the abundance of Lachnoclostridium.This study was supported by the
Ministry of Science and Technology (MOST111-2314-B-016 -012-MY2.

Keywords: welding metal fume, microbiota, inflammatory factors, sleep quality

PK-076[Exposures » Other (to be specified with keywords in the keywords section)]

Genetic determinants of serum selenoproteinsand selenometabolites concentrations in the
Aragon Workers Health Study - SelenOmics
project
Zulema Rodriguez Hernandez1, Maria Grau Perez2, Jose L. Gomez Ariza3, Tamara Garcia Barrera3,
Martin Laclaustra4, Belén Moreno Franco4, Fernando Civeira4, José Puzo4, Jose A. Casasnovas4,
Roberto Pastor Barriuso5, Maria Tellez Plaza5
1Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III HealthInstitutes, Madrid, Spain and Department of Biotechnology, Universitat Politècnica de València,
Valencia, Spain
2Cardiometabolic and Renal Risk Unit, Biomedical Research Institute INCLIVA, Valencia, Spain
3Department of Chemistry, University of Huelva, Huelva, Spain
4Facultad de Medicina, Universidad de Zaragoza; IIS Aragón; CIBERCV, Spain
5Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III HealthInstitutes, Madrid, Spain

BACKGROUND AND AIM:Genome-Wide Association Studies (GWAS) pointed out that selenium
biomarkers concentrations may be influenced by genetic variation. However, no study has
comprehensively investigated genetic determinants of selenoprotein and selenometabolites
concentrations. Therefore, we evaluated the association of selenoproteins and selenometabolites
concentrations with single-nucleotide polymorphisms (SNPs) through a candidate gene approach in
the Aragon Workers Health Study (AWHS), a participating cohort in the SelenOmics project.
METHOD:Serum selenoproteins (glutathione peroxidase [GPx], selenoprotein P [SeP], selenoalbumin[SeAlb]) and selenometabolites (Se-metabolites) were measured using HPLC/ICP-MS (N=852).
Participants were genotyped with the Infinium Global Screening array (v3.0, Illumina) and SNPs were
imputed using the TOPMed Imputation Server. For the candidate gene approach, a total of 863 genes
related to selenium, selenoprotein, selenocysteine and glutathione, methionine, cysteine and one
carbon and folate metabolism were selected from the NCBI-Gene database. After quality control and
SNPs identification in the candidate genes regions (±1Kbp from the gene start/end position) 137652
SNPs remained eligible for the GWAS, which was conducted separately for each of the selenoproteins
and total Se-metabolites concentrations (log-transformed). Models were adjusted for age, gender andsmoking status.
RESULTS:Serum GPx, SeP, SeAlb and total Se-metabolites concentrations were, 15.82, 66.07, 14.04
and 0.07 µg/L, respectively. The number of SNPs with a suggestive statistical significance p-value ≤0.001 was 208 for GPx, 161 for SeP, 150 for SeAlb and 132 for total Se-metabolites (no significant
SNPs at the Bonferroni threshold). The genes with the lowest p-value were CSMD1 for GPx and SeAlb,-consistently with previous GWAS; ABCG2 for SeP; and NAT2 for total Se-metabolites.
CONCLUSIONS:Identifying genetic variants of serum selenoproteins and Se-metabolites concentration
can help understanding selenium-related metabolism and health consequences. Additional studies inother populations are needed to validate these findings.

Keywords: selenium, selenoproteins, selenometabolites, single-nucleotide polymorphisms (SNPs),
genome-wide association studies (GWAS)

VO-001[Air pollution » Particle components]

The impacts of fine particulate mattercomponents and trace elements on rates ofdementia hospitalization
Daniel Mork1, Scott W Delaney2, Danielle Braun1, Antonella Zanobetti2
1Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
2Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA

BACKGROUND AND AIM:Research suggests air pollution exposure may accelerate neurodegenerative
disease progression. Higher PM2.5 exposure has been associated with increased risks of
hospitalization among adults with Alzheimer’s Disease and related dementias (ADRD). PM2.5 is a
mixture of particles from a variety of industry- and transportation-related sources, some more
impactful than others. We explored the impact of long-term exposure to specific PM2.5 components
and trace elements on hospitalization with ADRD diagnosis codes among Medicare fee-for-service
beneficiaries.
METHOD:We followed 43,456,616 adults aged 65+ in the United States from 2000-2016. We obtained
high-spatial-resolution annual average PM2.5 components data–including elemental carbon,
ammonium, organic carbon, nitrate, sulfate, bromine, calcium, copper, iron, potassium, nickel, lead,silicon, vanadium, and zinc. We applied nonparametric causal inference methods adjusting for 22
area- and individual-level confounders and estimated hazard ratios (HR) and potential nonlinear
exposure-response relationships in single pollutant models, as well as models additionally adjusting for
total PM2.5.
RESULTS:Nearly all PM components showed harmful effects, with noticeable increases in ADRDinvolved hospitalization risk at lower exposure levels. HRs ranged from 0.924 (95% CI 0.913-0.935)
for silicon to 1.234 (95% CI 1.214-1.254) for sulfate per IQR increase in exposure; only calcium andsilicon had HR<1. Based on nonlinear exposure-response curves, increased sulfate caused the largest
number of additional ADRD-involved hospitalizations; over 2.5 times the number of hospitalizations
occurred at the highest versus lowest sulfate exposure levels. Bromine, potassium, copper, lead, iron,and zinc also showed large increases in ADRD-involved hospitalization rates. Additionally adjusting for
total PM2.5 attenuated impacts, but results of the most harmful components were robust.
CONCLUSIONS:The effects of most PM components exacerbated ADRD as measured via increased
hospitalization rate. Understanding which components are most toxic informs public health efforts totarget damaging sources of air pollution.

Keywords: air pollution, particle components, neurodegenerative outcomes, causal inferenceVO-002[Chemical exposures » General]

Ingested nitrate and nitrite and end-stage renal
disease risk among licensed pesticide
applicators and spouses in the Agricultural
Health Study
Dazhe Chen1, Christine G Parks1, Laura E Beane Freeman2, Jonathan N Hofmann2, Rashmi Sinha3,
Jessica M Madrigal2, Mary H Ward2, Dale P Sandler1
1Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park,

North Carolina, USA
2Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, NIH, Rockville, Maryland, USA
3Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer

Institute, NIH, Rockville, Maryland, USA

BACKGROUND AND AIM:Nitrate and nitrite ingestion has been linked to renal cell carcinoma, possibly
via the endogenous formation of carcinogenic N-nitroso compounds. These exposures might also playa role in end-stage renal disease (ESRD), but there have been no epidemiologic studies on theassociations. We investigated the associations of drinking water nitrate and dietary nitrate and nitrite
intakes with incident ESRD among participants of the Agricultural Health Study and explored effects ofvitamin C and heme iron intake, which may differentially mediate endogenous nitrosation.
METHOD:The primary drinking water source for participants was determined at enrollment. We
computed duration-specific average nitrate concentrations for public water supply users (N=14,769)
from historical measurements data. For private well users (N=44,863), we developed random forestmodel estimates of nitrate concentrations based on well location, depth, nitrogen inputs, and otherpredictors. Dietary nitrate and nitrite were assessed among 30,177 participants who completed theNCI Dietary History Questionnaire at the first follow-up. Incident ESRD between study enrollment(1993-1997) or first follow-up (1999-2003) and December 2018 was ascertained through linkage with
the U.S. Renal Data System. We estimated adjusted hazard ratios (HRs) and 95%CI for associationsof tertiles (T) of exposure with incident ESRD overall and in strata of vitamin C and heme iron.
RESULTS:We identified 469 ESRD cases (206 for dietary analysis). Water nitrate and dietarynitrate/nitrite were not associated with overall ESRD risk. Higher dietary nitrite was associated with
ESRD only among participants with vitamin C <median (T3 vs. T1 HR: 2.26, 95%CI: 1.05, 4.86) andthose with heme iron ≥median (T3 vs. T1 HR: 1.73, 95%CI: 0.89, 3.39).
CONCLUSIONS:ESRD incidence was associated with dietary nitrite intake among participants withlower vitamin C or higher heme iron intake. Research using biomarkers of earlier renal dysfunction
and other nutrient profiles may clarify the potential risks associated with nitrite exposures.

Keywords: Occupational exposures, Water quality, Food/nutritionVO-003[Other » Other (to be specified with keywords in the keywords section)]

The Planetary Child Health and Enterics
Observatory (Plan-EO): an Interdisciplinary
Research Initiative and Web-Based Dashboard
for Mapping Enteric In
Josh Michael Colston1, Margaret Kosek1, Samarth Swarup2, Benjamin Zaitchik3, Lauren Gardner3,
Venkataraman Lakshmi2, Bin Fang2
1The University of Virginia School of Medicine
2The University of Virginia
3Johns Hopkins University

BACKGROUND AND AIM:Diarrhea remains a leading global cause of childhood illness and is caused byvarious species of climate-sensitive pathogens. The emerging Planetary Health movement emphasizes
the interdependence of human health with natural systems, with much of its focus on infectious
diseases and their interactions with environmental and human processes. Meanwhile, the era of big
data has transformed the curation, aggregation and dissemination of health information engendering apublic appetite for open access, web-based repositories of infectious disease data. However, entericinfectious diseases (EID) have largely been overlooked by these developments.
METHOD:The Planetary Child Health and Enterics Observatory (Plan-EO) is a new initiative that builds
on existing partnerships between epidemiologists, climatologists, bioinformaticians, and hydrologists
as well as investigators in numerous low- and middle-income countries (LMICs). Its objective is toprovide the research and stakeholder community with an evidence base for the geographical targetingof EID-specific child health interventions. The initiative will produce, curate, and disseminate spatial
data products relating to the distribution of enteric pathogens and their environmental andsociodemographic determinants, making them available to decisionmakers via an online dashboard.
RESULTS:To date Plan-EO has compiled microdata from 23 studies with ~80,000 diagnostic resultsfrom 35,000 children aged 0 – 59 months at sites in 24 LMICs and georeferenced to over 9,000
unique locations and outreach to additional studies is ongoing. An initial published analysis of Shigellahas yielded detailed prediction maps and insights into the mechanisms underlying transmission. These
approaches will be extended to other pathogens and their findings used to assess their relative
sensitivity to changes in climate compared to other determinants such as sanitation improvements.
CONCLUSIONS:Plan-EO will eventually develop a scenario-based framework to support decisionmaking, resource allocation and identification of priority populations for targeting EID-specificinterventions such as novel vaccines.

Keywords: Planetary health, enteric pathogens, bioinformatics, climate, infectious diseases

VO-004[Chemical exposures » Heavy metals]

Associations of a mixture of whole blood metals
with incident uterine leiomyomata
Ruth J. Geller1, Amelia K. Wesselink1, Birgit Claus Henn2, Kristen Upson3, Marco Vinceti4, Quaker E.
Harmon5, Donna D. Baird5, Ganesa Wegienka6, Lauren A. Wise1
1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
2Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
3Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University,

East Lansing, MI, USA
4Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA;

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia
Medical School, Modena, Italy
5Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
6Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA

BACKGROUND AND AIM:Uterine leiomyomata (UL), smooth muscle tumors of the uterus, are a major
cause of gynecologic morbidity. Metals may influence UL risk through endocrine disruption andmutagenesis. Metals often co-occur and may interact, necessitating a mixture approach for statisticalanalyses. Our objective was to estimate the associations of whole blood metals mixture with risk ofincident UL.
METHOD:We analyzed data from the Study of Environment, Lifestyle and Fibroids, a prospective
cohort study of 1,693 Black individuals with an intact uterus, age 23-35 years, residing in the Detroit,
Michigan area at baseline (2010-2012). Participants provided non-fasting whole blood samples atbaseline, in which we measured concentrations of 17 metals using inductively coupled plasma mass
spectrometry. Participants underwent transvaginal ultrasonography at baseline and 20 months later
for ascertainment of UL (88% cohort retention). We used component-wise Bayesian Kernel Machine
Regression to estimate associations of the metal mixture with probit of incident UL during 20 months,
adjusting for age, body mass index, parity, past-2 year use of depot medroxyprogesterone acetate,
and current smoking at baseline.
RESULTS:Among 1,132 participants without UL at baseline, 117 (10%) developed UL within 20
months. The metal mixture was positively associated with probit of UL (e.g., when all metals were attheir 75th percentiles, compared with their 50th percentiles, β = 0.07, 95% CI: -0.02, 0.16). The
strongest contributor to the association of the mixture with UL was cadmium, followed by barium,
zinc, cobalt, mercury, and nickel. There was no evidence of meaningful interaction between metals.
CONCLUSIONS:In a prospective cohort study, a mixture of metals measured in whole blood was
weakly positively associated with incident ultrasound-detected UL after 20 months. The association
was driven by cadmium, which has been reported to increase fibroid tissue proliferation in laboratory
studies.

Keywords: female, mixtures, reproductive outcomesVO-005[Neurologic and mental health outcomes » Mental health outcomes]

Association of Long-term Exposure to Air
Pollution with Late-Life Depression in Older
Adults in the US
Xinye Qiu1, Liuhua Shi2, Laura D. Kubzansky3, Yaguang Wei1, Edgar Castro1, Haomin Li2, Marc G.
Weisskopf4, Joel D. Schwartz4
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston,

Massachusetts, US
2Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, Georgia, US
3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston,

Massachusetts, US
4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, US& Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston,
Massachusetts, US

BACKGROUND AND AIM:Emerging evidence has suggested harmful associations of air pollutants withneurodegenerative diseases among older adults. However, little is known about late-life mental
outcomes, such as geriatric depression. We aimed to investigate if long-term exposure to air pollution
is associated with increased risk of late-life depression diagnosis among US older adults.
METHOD:We designed a population-based longitudinal cohort study of US Medicare enrollees >64 yrs.
Data were obtained from Centers for Medicare and Medicaid Services Chronic Conditions Warehouse.
We included participants continuously enrolled in the Fee-for-Service program and both Medicare Part
A & B. After 5-year washout period at entry, a total of 8,907,422 unique individuals were covered over
2005-2016, who contributed to 1,526,690 late-onset depression diagnoses. The exposures consistedof residential long-term exposure to fine particulate matter (PM2.5, ug/m3), nitrogen dioxide (NO2,ppb), and ozone (O3, ppb). Late-life depression diagnoses were identified via information from allavailable Medicare claims (i.e., hospital inpatient, skilled nursing facility, hospital outpatient, andphysician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change inrisk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, healthcare access, and urbanicity
level.
RESULTS:A total of 8,907,422 enrollees were included with 56.8% being female and 90.2% being
White. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated withan adjusted percentage increase in depression risk of 0.91% (95%CI, 0.02%-1.81%), 0.61% (95%CI,
0.31%- 0.92%), and 2.13% (95%CI, 1.63%-2.64%), respectively, from tri-pollutant model. Effectheterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual
backgrounds.
CONCLUSIONS:Among US older adults, harmful associations were observed between long-term
exposure to air pollution and increased risk of late-life depression diagnosis. This study suggests air
pollution is a potential risk factor for late-onset depression.

Keywords: Air pollution, Big data, Incidence, Long-term exposure, Mental health outcomesVO-006[Reproductive outcomes » Male reproductive outcomes]

Consistency of findings between experimental
and observational analyses of placental monon-butyl phthalate (MnBP) and anti-androgenic
effects
Jennifer Joan Adibi1, Hai Wei Liang1, David Greenald2, Hannu Koistinen3, Rod T. Mitchell2, Shanna
Swan4, Sheela Sathyanarana5, Jiebiao Wang6, Janet Catov7, Nathaniel W. Snyder8
1Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, USA
2Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
3Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
4Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, NewYork City, USA
5Department of Pediatrics, University of Washington, Seattle, USA
6Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, USA
7Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh,

Pittsburgh, USA
8Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, USA

BACKGROUND AND AIM:Prenatal phthalates, measured in maternal urine, are associated with antiandrogenic effects in the male fetus. Here, phthalates were measured in placental chorion without(CS, chorion smooth) and with villi (CF, chorion frondosum) sampled at birth (N=33). First trimester
placental villi were cultured and dosed with 120 nM mono-n-butyl phthalate (MnBP) and placental
conditioned media (PCM) was placed on male fetal gonads (N=10). Fetal testosterone (experimental)
and AGD (observational) were measured as proxies of one another, and the aim was to assess MnBP
effects, mediated by the placenta.
METHOD:At birth, measures of male AGD-penis (AGD-P) and AGD-scrotum (AGD-S) were obtained.
MnBP was measured by LC-MS in term placental tissues. Placental hormone human chorionicgonadotropin (hCG) was measured in maternal serum (observational) and in PCM (experimental), andhCG mRNA was measured in placental villi. Multivariate regression and causal mediation analyses
were applied to assess and compare direct and indirect effects of MnBP.
RESULTS:Placental (CS) MnBP was negatively associated with AGD-S when first trimester hCG washeld constant (controlled direct effect [CDE]: -0.60 95% CI -1.06, -0.14). The natural indirect effect(NIE, mediated effect of MnBP) was positive (0.19 95% CI -0.03, 0.40). In the experimental model,
MnBP had no effect when PCM hCG protein was analyzed as a mediator (N=10). When placental CGB(mRNA that encodes hCGβ subunit) was treated as the mediator, the effect of MnBP on fetal
testosterone was positive (N=4, CDE 2.63 95% CI 0.32, 4.94), and the mediated effect was negative(NIE -3.57 95% CI -6.31, -0.84).
CONCLUSIONS:Associations of placental MnBP with fetal testosterone and newborn AGD were present

in complementary model systems. MnBP effects were mediated by placental hCG in both models, with
distinctions in mRNA vs. protein mediation in the organoid model. These findings corroborate existingknowledge and add additional insight into placental-fetal endocrine disruption.

Keywords: phthalate, placenta, anti-androgen, epidemiology, organoidVO-007[Neurologic and mental health outcomes » Neurodevelopmental outcomes]

Integrating data across multiple sites in thenortheastern United States to examine
associations between prenatal metal mixturesand child cognition
Maria José Rosa1, Nicolo Foppa Pedretti2, Brandon Goldson3, Nicole Mathews3, Francheska Merced
Nieves3, Michelle Bosquet Enlow4, Richard Gershon5, Emily Ho5, Kathi Huddleston6, Robert O Wright7,
Rosalind J Wright7, Elena Colicino1
1Department of Environmental Medicine and Public Health and Institute for Exposomic Research,

Icahn School of Medicine at Mount Sinai, New York, NY, United States
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
4Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital and Department of

Psychiatry, Harvard Medical School, Boston, MA, United States
5Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University,

Chicago, IL, United States
6College of Public Health, George Mason University, Fairfax, VA, United States
7Department of Environmental Medicine and Public Health, Department of Pediatrics and Institute for

Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND AND AIM:Data integration from sociodemographically and geographically diverse
epidemiologic studies can provide enhanced exposure contrast and statistical power to examine
associations between environmental exposures and health outcomes. We implemented a novel
Hierarchical Bayesian Weighted Quantile Sum (HBWQS) regression to combine data across three sites
in the northeastern United States to examine associations between prenatal exposure to metals andchildhood cognition.
METHOD:Analyses included data from 419 mother-child dyads from the dual-site PRogramming ofIntergenerational Stress Mechanisms (PRISM) cohort, based in New York City (NYC) and Boston, andFirst Thousand Days of Life (FTDL) cohort, based in Northern Virginia. Arsenic (As), Cadmium (Cd),Manganese (Mn), Lead (Pb) and Antimony (Sb) were measured in maternal prenatal urine. Children
aged 3 to 11 years completed the NIH Toolbox Cognition Battery. We examined associations between
metal mixtures and cognition scores using the HBWQS, combining data from multiple cohorts whileaccounting for individual cohort differences. We compared HBWQS regression results to within cohort
analyses and traditionally pooled BWQS results.
RESULTS:The HBWQS regression showed a negative association between the prenatal metal mixture
and the childhood cognition composite score in all cohorts: PRISM-Boston (β: -2.93; 95% CrI: -5.66,
0.44; 90% CrI: -5.17, -0.28), PRISM-NYC (β: -3.40; 95% CrI: -7.07, 0.37; 90% CrI: -6.25, -0.23)
and FTDL (β: -3.63; 95% CrI: -6.96, 0.02; 90% CrI: -6.30, -0.86). The largest contributors to the
mixture effect were As (48%) and Pb (17%). We did not detect these associations in analyses within
individual cohorts or traditionally pooled models.
CONCLUSIONS:As we move into an era of open data sharing, more epidemiologic studies are
combining data among multiple cohorts. We demonstrated the advantages of a novel statisticalapproach that accounts for study heterogeneity and provides enhanced power to detect associations
between a prenatal metal mixture and cognitive outcomes in childhood.

Keywords: Mixtures, heavy metals, Children's environmental health, epidemiology

VO-008[Chemical exposures » General]

Associations between Exposure to Persistent
Organic Pollutants and Subsequent Body
Composition Response to Bariatric Surgery
Nathan Joseph Cohen1, Lida Chatzi2, Matthew Ryan Smith3, Douglas I. Walker4, Meizhen Yao1, Tasha
M. Burley5, Edward Lin6, Lucia Gonzalez Ramirez5, Paula Dene C. Nesbeth5, Jessica A. Alvarez5, Dean
P. Jones5, Rob Mcconnell2, Thomas R. Ziegler5, Damaskini Valvi1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
2Department of Population and Public Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, CA, USA
3Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA

Healthcare System, Decatur, GA, USA
4Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University,

Atlanta, GA, USA
5Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
6Department of Surgery, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA,USA

BACKGROUND AND AIM:Persistent organic pollutants (POPs) may act as obesogens, but whether POP
exposures affect metabolic responses to bariatric surgery is understudied. We assessed theassociations between POP exposures and subsequent changes in body composition measures after
bariatric surgery.
METHOD:We conducted a prospective cohort study of 26 patients who underwent bariatric surgery andwere followed-up at median (IQR) 248 (189, 347) days post-surgery. We measured six lipophilic POPs
concentrations (DDT, DDE, HCB, and PCBs 118, 138 and 153) at baseline in plasma, visceral adipose
tissue (VAT), and subcutaneous adipose tissue (SAT) collected at surgery. Body composition by DEXA
was measured at baseline within 2 months prior to bariatric surgery, and at the follow-up post-surgery
visit. Changes in body mass index (BMI), VAT mass (primary endpoint), total fat mass, total fat massindex, or total fat as a percent of body mass from before to after bariatric surgery were determinedbased on the dates of surgery and the follow-up visit. We estimated the POPs associations withmonthly change in body composition outcomes using mixed effect regression models adjusted for age,
race, smoking status, and surgery type.
RESULTS:Higher baseline plasma concentrations of PCB-118 (concentrations above vs. below
detection limit) were associated with lower changes [β (95%CI)] in BMI [-0.8 kg/m2/month (-1.4, 0.2)], VAT mass [-0.2 kg/month (-0.3, -0.1)], total fat mass [-2.1 kg/month (-3.7, -0.5)], total fat
mass index [-0.6 kg/m2/month (-1.2, -0.2)] and total fat percentage [-0.6%/month (-1.3, 0.0)]. For
other POPs measured in plasma, as well as POPs measured in VAT and SAT, we observed similar
negative associations as for plasma PCB-118 but the associations were weaker.
CONCLUSIONS:Exposure to POPs at baseline may blunt individuals’ body composition responses tobariatric surgery. These pilot data support the concept that certain POPs act as obesogens.

Keywords: Endocrine disrupting chemicals, obesity and metabolic disorders.

VO-009[Chemical exposures » PFAS]

Associations between prenatal exposure Perand polyfluoroalkyl substances and liver fat
content in Singaporean children
Sabiha Nasrin1, Katherine Reeves1, Damaskini Valvi2, Sharon Ng3, Navin Michael3, Suresh
Sadanathan3, Shiao Yng Chan6, Sendhil Velan3, Chia Yang Chen4, Fabian Yap5, Jonathan Huang3,
Youssef Oulhote1
1Department of Epidemiology, School of Public Health & Health Science, University of Massachusetts,

Amherst, MA, USA
2Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, United States
3Singapore Institute for Clinical Sciences (SICS); Agency for Science, Technology and Research(A*STAR); Singapore, Singapore
4Institute of Food Safety and Health; National Taiwan University; Taipei, Taiwan
5Division of Paediatric Medicine; KK Women’s and Children’s Hospital (KKH); Singapore, Singapore
6Singapore Institute for Clinical Sciences (SICS); Agency for Science, Technology and Research(A*STAR); Singapore, Singapore & Department of Obstetric and Gynaecology; Yong Loo Lin School of
Medicine; National University of Singapore, Singapore, Singapore

BACKGROUND AND AIM:The prevalence of non-alcoholic fatty liver disease (NAFLD) in children has
risen significantly in the last two decades, particularly among obese children (30%). Studies suggestthat exposure to per- and polyfluoroalkyl substances (PFAS) may contribute to metabolic changes thatlead to fatty liver. In this study, we aimed to investigate whether prenatal exposure to PFAS is
associated with percent liver fat in healthy children at age 6 and 7, using non-invasive magnetic
resonance spectroscopy (MRS) techniques.
METHOD:We examined 525 mother-newborn pairs from the Growing up in Singapore Towards Healthy
Outcomes birth cohort study. We measured concentrations of eight PFAS compounds in cord blood,and estimated percent liver fat in children at age 6 and 7 using MRS. We estimated covariate-adjusted
associations between PFAS compounds and percent liver fat using multivariable regressions. We also
investigated effect modification by sex.
RESULTS:Mean liver fat content was 0.75 ng/mL. Overall, we did not observe any associations
between PFAS compounds and percent liver fat. For instance, a twofold increase in Perfluorooctanoic
acid was associated with a slight non-significant increase of 0.03% (95% CI: -0.08, 0.14) in child liver
fat content. Similar results were observed for other PFAS. No consistent pattern of effect modification
by sex was observed.
CONCLUSIONS:In this study, we did not observe any associations between prenatal exposure to PFAS
and percent fat in the liver. This is the first study to rely on a direct measure of fat in the liver using
MRS techniques.

Keywords: Children's environmental health, Risk assessment

VIRTUAL ORAL ABSTRACTSVO-010[Chemical exposures » Other (to be specified with keywords in the keywords section)]

Longitudinal Dietary Fluoride Exposures in
Association with Cardiometabolic Outcomes in
School-Aged Children living in Mexico
Sandra India Aldana1, Elena Colicino1, Alejandra Cantoral Preciado2, Andrea A. Baccarelli3, Martha
María Téllez Rojo4, Maricruz Tolentino5, Robert O. Wright1, Damaskini Valvi1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
2Health Department, Iberoamericana University, Mexico City.
3Departments of Environmental Health Sciences and Epidemiology, Columbia University Mailman

School of Public Health, New York, NY, USA.
4Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos,

Mexico.
5Department of Nutrition, National Institute of Perinatology, Mexico City, Mexico.

BACKGROUND AND AIM:Fluoride intake is ubiquitous and constitutes a long-term exposure duringchildhood. Experimental research suggests lipid disturbances induced by fluoride with implications for
cardiometabolic health. However, epidemiological studies are scarce and mostly cross-sectional. We
evaluated associations between repeated dietary fluoride exposure and cardiometabolic outcomes in
Mexican children.
METHOD:Dietary-derived fluoride measurements from food-frequency questionnaires were obtained atages 4, 6 and 8 years for ~500 children from the Programming Research in Obesity, Growth,
Environment and Social Stressors (PROGRESS) cohort. Using covariate-adjusted linear mixed-effects
and linear regression models, we assessed associations of fluoride exposure on cardiometabolic risk
components measured at ages 4-8 years, including lipids (total cholesterol, HDL and LDL in mg/dL,
and log-transformed triglycerides), glucose, log-transformed leptin (in ng/mL), and age- and sexadjusted z-scores of body mass index (z-BMI), waist circumference (WC), and blood pressure (BP).
We also calculated a cardiometabolic risk score using the z-score sum of WC, BP, glucose, andtriglycerides-to-HDL ratio.
RESULTS:A doubling of fluoride intake at age 4 was associated with an annual increase in triglycerides[β=2.02 (95% CI: 0.37, 3.69)], total cholesterol [β=1.46 (95% CI: 0.52, 2.39)], HDL [β=0.39 (95%
CI: 0.02, 0.76)], and LDL [β=0.87 (95% CI: 0.02, 1.71)] and a decrease in leptin [β=-3.58 (95% CI:-6.34, -0.75)] between ages 4-8 years. At age 6, fluoride intake was associated with higher HDL [βper-fluoride-doubling=4.40 (95% CI: 1.70, 7.11)]. Cross-sectional analyses at age 8 indicated thathigher tertiles of fluoride exposure were associated (p-tertile trend<0.05) with increases in z-BMI,
triglycerides, glucose, leptin, and cardiometabolic risk score, with stronger associations observed inboys compared to girls (p-sex interaction<0.05).
CONCLUSIONS:Dietary fluoride exposure in early- and mid-childhood was associated with adverse
cardiometabolic outcomes in school-aged children. Further longitudinal studies are needed tocorroborate these findings and associations at later ages.

Keywords: Fluoride, endocrine disruptor, cardiometabolic outcomes, children

VO-011[Air pollution » Particulate matter]

Ambient fine particulate matter exposure andrisk of incident liver cancer in the NIH-AARP
Diet and Health Study
Xiuqi Ma1, Jared A. Fisher1, Katherine A. McGlynn2, Linda M. Liao2, Vasilis Vasiliou3, Ning Sun4, Joel
D. Kaufman5, Debra T. Silverman1, Rena R. Jones1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics,

National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
2Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer

Institute, National Institutes of Health, Rockville, Maryland, USA
3Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut,

USA
4Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
5Departments of Environmental and Occupational Health Sciences and Medicine, School of Public

Health, University of Washington, Seattle, Washington, USA

BACKGROUND AND AIM:Fine particulate matter (PM₂.₅) exposure has been associated with livercancer incidence and mortality in limited studies. We sought to evaluate this relationship in a large
study with historical exposure assessment and available histology information.
METHOD:We used a spatiotemporal prediction model to estimate annual average historical PM₂.₅
concentrations at residential addresses of 499,729 participants in the NIH-AARP Diet and HealthStudy, a cohort in 6 states (California, Florida, Louisiana, New Jersey, North Carolina, andPennsylvania) and 2 metropolitan areas (Atlanta, Georgia, and Detroit, Michigan) enrolled in 19951996. Historical exposures were estimated for a 5-year period pre-enrollment (1990-1994). We used
Cox regression to estimate hazard ratios (HR) and 95% CIs for risk of incident liver cancer perinterquartile-range increase in PM₂.₅, adjusted for confounders. We also conducted analyses stratified
by sex, age, race/ethnicity, smoking, body mass index (BMI), and state.
RESULTS:A total of 1,625 liver cancers were diagnosed in follow-up through 2017. We observed anon-significantly increased risk of liver cancer associated with PM₂.₅ exposure (HR=1.05 [0.96-1.14]
per 4.43 μg/m³); associations were slightly stronger for hepatocellular carcinoma, the predominant
subtype (84% of cases; HR=1.06 [0.97-1.16]). Participants who were over 70 years old at enrollment
had a significantly increased risk of liver cancer (HR=1.46 [1.01-2.12]) versus other age groups (pinteraction<0.0001) and risk was elevated among Hispanic participants (HR=1.20 [0.89-1.67]; pinteraction<0.0001). State-specific associations ranged from HR=0.61 [0.41-0.89] in North Carolina
to HR=1.28 [0.44-3.73] in Georgia (p-interaction=0.12). We found no interactions with sex, BMI, or
smoking (p-interaction>0.05).
CONCLUSIONS:Our findings from this large U.S. cohort suggest that ambient PM₂.₅ levels at the home
are associated with liver cancer risk. Regional differences in PM₂.₅ chemical constituency and theassociation in the Hispanic population, who have some of the highest liver cancer incidence rates, areimportant areas for future research.

Keywords: long-term exposure, cancer and cancer precursors

VO-012[Chemical exposures » Endocrine disrupting chemicals]

Early-life exposure to persistent organic
pollutants and cardiometabolic health in young
adults from the CHAMACOS cohort
Ana Maria Mora1, Ayca Erkin Cakmak2, Katherine Kogut1, Kim Harley1, Brenda Eskenazi1
1Center for Environmental Research and Community Health (CERCH), School of Public Health, UC

Berkeley, Berkeley, United States
2Department of Pediatric Endocrinology, UC San Francisco, San Francisco, United States

BACKGROUND AND AIM:Early-life exposure to persistent organic pollutants (POPs) may contribute tolater obesity and metabolic disorders. We examined associations of prenatal and childhood exposure
to POPs with obesity and associated metabolic conditions among 530 Mexican-American young adults
from the CHAMACOS cohort.
METHOD:We measured serum concentrations of five organochlorine pesticides [OCPs;
dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene(HCB), β-hexachlorocyclohexane, trans-nonachlor] and four polybrominated diphenyl ether (PBDE)
flame retardants [congeners 47, 99, 100, and 153] in maternal and child samples collected during
pregnancy and at age 9 years. We collected anthropometric measurements and serum markers
associated with metabolic syndrome at age 18 years. We fitted single-pollutant regression models to
examine the exposure-outcome associations of interest.
RESULTS:Overall, we found that higher child OCP concentrations were associated with lower BMI(e.g., βDDE = –3.8; 95% CI: –5.3, –2.3), lower waist circumference (e.g., βDDE = –7.8; 95% CI: –11.5, –4.2), lower HOMA-IR (e.g., βDDE = –2.2; 95% CI: –3.6, –0.7), and decreased odds ofmetabolic syndrome (e.g., OR per 10-fold increase in HCB = 0.1; 95% CI: 0.0,0.9) at age 18. We also
observed that higher prenatal concentrations of DDT, but not other OCPs, were associated with lower
HOMA-IR levels at age 18 (βDDT = –1.0; 95% CI: –1.9, 0.0). Higher child concentrations of BDE-153,
but not other PBDE congeners, were associated with lower waist circumference (β153 = –11.7; 95%
CI: –16.8, –6.5), lower HOMA-IR levels (β153 = –2.1; 95% CI: –4.3, 0.1), and decreased odds ofmetabolic syndrome [OR153 = 0.2; 95% CI: 0.0, 0.7]. We found null associations of prenatal PBDE
concentrations with cardiometabolic health outcomes at age 18.
CONCLUSIONS:We showed an inverse relationship between childhood exposure to several POPs andobesity and metabolic disorders in young adulthood. Our future analyses will examine effectmodification by sex and consider reverse causality.

Keywords: Chemical exposures, Endocrine disrupting chemicals, Obesity and metabolic disorders,Children's environmental healthVO-013[Respiratory and allergic outcomes » Respiratory outcomes]

Association between prenatal exposure topesticides, individually and as a mixture, andchildhood lung function in Mexican children
Cecilia S Alcala1, Hector Lamadrid Figueroa2, Marcela Tamayo Ortiz3, Adriana Mercado Garcia4, SyamS Andra5, Allan C Just1, Martha María Téllez Rojo4, Robert O Wright6, Rosalind J Wright6, Kecia N
Carroll6, Maria José Rosa1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA
2Department of Perinatal Health, Center for Population Health Research, National Institute of Public

Health (INSP), Cuernavaca, Morelos, Mexico
3Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico.
4Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos,

Mexico5Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, One
Gustave L. Levy Place Box 1057, New York, NY, 10029, USA
6Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, One
Gustave L. Levy Place Box 1057, New York, NY, 10029, USA; Kravis Children’s Hospital, Departmentof Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

BACKGROUND AND AIM:Prenatal pesticide exposure may affect lung development and lead to adecrease in lung function in childhood. There is limited epidemiologic data on these associations in
Latin America. We aim to examine associations between prenatal exposures to pesticides, individually
and as a mixture, and lung function in childhood, and explore sex differences.
METHOD:We assessed 197 mother-child dyads enrolled in the Programming Research in Obesity,
Growth, Environment, and Social Stressors birth cohort in Mexico City. We quantified
organophosphate insecticides in 2nd trimester urine. Pre and post bronchodilator (BD) lung function
was tested at ages 8-11 years, and age, height and sex adjusted z-scores were calculated.
Associations were modeled using generalized linear models, Quantile G-Computation (g-comp) andWeighted Quantile Sum (WQS) regression repeated holdout with interaction terms, adjusting formaternal education, age and socioeconomic status at enrollment, and urinary creatinine.
RESULTS:We observed prenatal concentrations of 4-nitrophenol (PNP) were associated with post BD
FEV1 (β: -0.03, 95% CI [-0.05, -0.01]) and post BD FVC z-scores (β: -0.03, 95% CI [-0.05, -0.01]).
In stratified models, 4-nitrophenol was associated with reduced post BD FEV1 and post BD FVC zscores in males (β: -0.03, 95% CI [-0.05, -0.01]; β: -0.03, 95% CI [-0.05, -0.01]) but not in females(β: -0.001, 95% CI [-0.07, 0.07]; β: 0.01, 95% CI [-0.06, 0.09]), respectively. There was asuggestive association between prenatal exposure to pesticide mixtures and reduced post BD FEF zscore (g-comp, OR: -0.22, 95% CI: -0.51, 0.07) and (WQS, OR: -0.09, 95% CI: -0.32, 0.14).
Malathion dicarboxylic acid (MDA) was the main contributor of the mixture.
CONCLUSIONS:Higher prenatal levels of PNP are associated with reduced mid-childhood lung function;
the association was stronger in males compared to females. Future work investigating pesticide
exposure and lung function trajectories will be important for understanding long-term impacts.

Keywords: pesticides, mixtures, respiratory outcomesVO-014[Exposures » Other (to be specified with keywords in the keywords section)]

Persistent organic pollutants in hospitalized
individuals in the municipality of Petropolis,
BrazilLouise Moura Rezende De Carvalho1, Gina Torres Rego Monteiro1, Sabrina Da Silva Santos1, Ana
Cristina Simões Rosa2
1National School of Public Health (Escola Nacional de Saúde Pública - ENSP), Oswaldo Cruz Foundation(FIOCRUZ), Rio de Janeiro, RJ, Brazil
2Center for the Study of Worker’s Health and Human Ecology (Centro de Estudos da Saúde Do

Trabalhador E Ecologia Humana - CESTEH), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ,
BrazilBACKGROUND AND AIM:Persistent organic pollutants (POPs) are highly lipophilic and can accumulate
and biomagnify in food chains. Characterized as a public health problem, exposure to thesecompounds enables the development of diseases like cancer, cardiovascular disease, diabetes, andobesity. The objective of this study was to estimate the plasma levels of organochlorine pesticides and
PCBs in 151 samples (97 women; 54 men) in hospitalized individuals in Petropolis, Brazil.
METHOD:Individuals over 18 years of age and residing for at least 2 years in the mountainous regionof the State of Rio de Janeiro, Brazil, participated in a cross-sectional study. Interviews using a
structured questionnaire and blood samples to estimate plasma levels of persistente organic pollutants
provided data. Gas chromatography coupled with triple quadrupole mass spectrometry provided thelevels of organochlorine pesticides and PCBs.
RESULTS:Compared to data present in the literature, the concentration of POPs was lower, andindividuals from 55 to 64 years of age (3.28 ng mL−1) and women (2.52 ng mL−1) presented ahigher average concentration of organochlorine pesticides; men (0.05 ng mL−1) also presented a highconcentration of PCBs.
CONCLUSIONS:This is the first Brazilian study to estimate the concentration of several POPs in a
hospital-based sample that includes men and women, thus contributing to the characterization of ourpopulation regarding environmental exposures relevant to health.

Keywords: Chemical exposures, Pesticides, Environmental epidemiology.

VO-015[Built environment » Green space]

Quality of urban green spaces and nutritional
status: an epidemiological study in an urban
context using Street View technology
Julia Mariel Wirtz Baker1, Laura Rosana Aballay2, Sandra Castaño3, Maria Camila Orellano3, Nazarena
Rodriguez3, Stefano Staurini2, Sonia Alejandra Pou1
1Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones

Científicas y Técnicas (CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina; Centro deInvestigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias Médicas,
Universidad Nacional de Córdoba, Córdoba, Argentina
2Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias

Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
3Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba,

Argentina

BACKGROUND AND AIM:Urban green spaces (UGS) can be a valuable resource for improving humanhealth. The quality of UGS as determinant of population health have been a topic scarcely explored.
We aim to assess the association between obesity status and the proximity and quality of UGS byusing Google Street View (GSV) images.
METHOD:A population-based study called Córdoba Obesity and Diet Study II (multistage-random
sampling; n=1328 adults from Córdoba, Argentina) was carried out (2019-2022 period), collecting
anthropometric measurements, lifestyles and socio-demographic data. Indicators of proximity (500m
buffer) of dwellings to large UGS (>1ha) were constructed using QGIS 3.28. GSV was used toremotely visualise eight quality dimensions (surroundings, access, facilities, amenities, aesthetics,
safety, potential usage, land cover), adapted from the RECITAL green space quality assessment tool.
Items were scored with a five-point Likert scale for each UGS; mean scores within each buffer were
calculated. The association of obesity status with the presence of UGS within the buffer (total sample:
n=1328), and with overall/partial quality scores of UGS (sub-sample: n=636 subjects living near a
UGS) was assessed by using adjusted logistic regression models.
RESULTS:Obesity status (25.9% of sample) was not associated with the proximity (500m buffer) oflarge UGS. However, a trend towards an inverse association was observed with the mean quality scoreof UGS (OR=0.6; p=0.11) in the sub-sample who had at least one UGS near their home (47.9%). Two
quality dimensions of UGS showed significant inverse associations: aesthetics (OR=0.6; p=0.03), andamenities (OR=0.6; p=0.02), both related to the beauty and attractiveness of spaces, and to featuresthat make them more comfortable and enjoyable.
CONCLUSIONS:In our urban context, proximity to UGS is not associated with obesity, but certain
dimensions of quality may be a protective factor. Digital tools such as GSV are useful resources forfurther exploration of this topic.
Grants FONCYT-PICT-2020-A-03283.

Keywords: obesity and metabolic disorders, green space, environmental epidemiology

VO-016[Built environment » Green space]

Associations of Street-View Greenspace with
Incident Cardiovascular Disease in the US-based
Nationwide Nurses’ Health Study from 2000 to
2016
Marcia Pescador Jimenez1, Pi I Debby Lin2, Esra Suel3, Jochem O Klompmaker4, Wenwen Zhang5,
Perry Hystad6, Steve Hankey7, Eric B Rimm8, Brent Coull9, Jaime E Hart4, Francine Laden4, Peter
James10
1Department of Epidemiology, Boston University, Boston MA, USA
2Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston MA, USA
3Centre for Advanced Spatial Analysis, University College London, UK
4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA
5Edward J. Bloustein School, Rutgers University, New Brunswick, NJ, USA
6College of Public Health and Human Sciences, Oregon State University OR, USA
7Department of Urban Affairs and Planning, Virginia Polytechnic Institute and State University, VA,

USA
8Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA
9Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA, USA
10Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston MA, USA;

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA

BACKGROUND AND AIM:Epidemiologic studies have used satellite-derived measures of greenspace toshow that greenspace is negatively associated with cardiovascular disease (CVD) incidence/mortality.
However, satellite-derived measures do not capture ground-level visible exposures that reflect aparticipant’s lived experience. Google Street View (GSV) images offer the opportunity to measuregreenspace from an on the ground perspective and to examine specific greenspace features that may
be most relevant for health. We aimed to evaluate street-based greenspace-CVD, stroke, andmyocardial infarction incidence associations in a nationwide cohort.
METHOD:We followed 96,531 participants from the US-based Nurses’ Health Study from 2000 to
2016. Based on deep learning algorithms applied to 350 million GSV images, we linked GSV-based
percentage of trees to participants’ biennially assessed residential addresses from 2004 to 2016 in a
100m buffer. We used time-varying Cox proportional hazards models to calculate hazard ratios (HRs)and 95% confidence intervals (95%CI). We specified a model adjusted for individual-level age, race,
marital status, husband’s education, and neighborhood confounders (e.g. median household income).
RESULTS:During follow-up, we observed 5,636 cases of CVD, 2,931 cases of stroke, and 2,705 casesof non-fatal myocardial infarction and fatal coronary heart disease (CHD). For CVD incidence, we
observed a HR of 0.98 (CI 0.92, 1.05) per inter-quartile range (IQR) of percentage of trees. Results
for total CHD and stroke were similar.
CONCLUSIONS:Preliminary results suggest that percentage of trees was not associated with incidence

of CVD, stroke, or CHD. Ongoing studies from our team are examining other specific features ofgreenspace (e.g., percentage of grass, shrubs, and total greenspace) in association withcardiovascular health.

Keywords: Built environment, Green space, Cardiovascular diseases, Public Health, Environmental
Epidemiology

VO-017[Birth and pregnancy outcomes » Birth outcomes]

Associations of Early Pregnancy Per- and PolyFluoroalkyl Substances Exposure with Birth
Outcomes: Effect Modification by Prenatal
Folate Status
Yu Zhang1, Vicente Mustieles2, Qi Sun3, Brent Coull4, Thomas Mcelrath5, Sheryl L. Rifas Shiman6,
Leah Martin1, Yang Sun1, Yi Xin Wang1, Emily Oken6, Andres Cardenas7, Carmen Messerlian1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
2Instituto de Investigación Biosanitaria Ibs GRANADA, Spain. University of Granada, Center for

Biomedical Research (CIBM), Spain. Consortium for Biomedical Research in Epidemiology and Public
Health (CIBERESP), Spain.
3Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
4Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
6Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care

Institute, Boston, MA, USA.
710 Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.

BACKGROUND AND AIM:Folate status was negatively associated with blood PFAS concentrations. This
study aimed to determine if prenatal folate status modifies associations between pregnancy plasma
per- and polyfluoroalkyl substances (PFAS) concentrations and birth outcomes in a large pre-birthcohort in the United States (U.S.).
METHOD:Our study included 1400 mother-singleton pairs from a prospective pre-birth cohort ineastern Massachusetts, U.S. recruited between 1999-2002. Plasma concentrations of folate and six
PFAS compounds, and dietary folate intake (by food frequency questionnaire) were assessed in earlypregnancy (median 9.6 gestational weeks). Birth outcomes included birthweight, birthweight z-scorestandardized by gestational age and sex, and gestational age. We applied generalized additive models(GAM) to explore the changes in PFAS-birth outcome relationships across continuous folate measures(dietary folate intake or plasma folate concentrations). We stratified linear regression models of PFAS
and birth outcomes by quartiles of the two folate measures.
RESULTS:GAM showed that plasma concentrations of select PFAS were associated with lower
birthweight and birthweight z-score, and shorter gestational age only at lower folate levels whileassociations trended to null as folate increased. Stratified analyses showed perfluorooctanoic acid(PFOA) concentrations were associated with lower birthweight and birthweight z-score only among
mothers whose dietary folate (birthweight: -89.13 grams, 95% CI: -166.84, -11.42; birthweight zscore: -0.13, 95% CI: -0.26, -0.003) or plasma folate (birthweight: -87.03 grams, 95% CI: -180.11,
6.05; birthweight z-score: -0.14, 95% CI: -0.3, 0.02) were below the 25th percentiles (660 mcg/day,
14 ng/mL), while no associations were found among mothers in the other folate groups.
CONCLUSIONS:In this large U.S. cohort, early pregnancy PFAS exposure was associated with adverse
birth outcomes only among mothers with lower early pregnancy dietary or plasma folate levels. If
confirmed in other settings, these findings may have important implications for identifying vulnerable
populations and evaluating folate intervention studies.

Keywords: PFAS, birth outcomes, folate, mitigationVO-018[Air pollution » Long-term exposure]Long-term exposure to fine particulate matteron cardiovascular mortality in 11 US States: A
difference-in-difference analysis
Adjani Antonela Peralta1, Mahdieh Danesh Yazdi2, Edgar Castro1, Anna Kosheleva1, Joel Schwartz3
1Department of Environmental Health; Harvard T.H. Chan School of Public Health, Boston, USA
2Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook

University, New York City, USA
3Department of Environmental Health and Epidemiology; Harvard T.H. Chan School of Public Health,Boston, USA

BACKGROUND AND AIM:While some recent air pollution studies have utilized causal modelingmethods to examine cardiovascular outcomes, cause-specific cardiovascular (CVD) mortality studies
are limited. The published studies tend to use propensity score matching or inverse probability
weighting to make the exposure independent of all measured confounders. However, this only controls
for measured confounders or unmeasured confounders that are highly correlated to the measured
confounders.
METHOD:We utilized a variation of a difference-in-difference (DID) approach to assess the effect oflong-term fine particulate matter (PM2.5) exposure on the overall cardiovascular (CVD) mortality rate
between 2000 to 2016 among 11 US States (Florida, Georgia, Indiana, Kansas, Massachusetts,
Missouri, Montana, New Hampshire, New Jersey, Ohio, and Texas). Predicted annual PM2.5 exposuresfrom a validated ensemble exposure model and ambient meteorology from gridMET predictions were
aggregated to all census tracts within the 11 US States. We computed the mortality rate by census
tract and year and included demographic and socioeconomic variables from the decennial Census andthe American Community Survey. Interaction terms were used to assess effect measure modification
by various socioeconomic variables.
RESULTS:For each one μg/m3 increase in annual PM2.5, the absolute rate of annual CVD mortality
increased significantly by 3.29 deaths (95% CI: 2.20-4.37) per one million person-years. The percent
of foreign-born and Hispanic individuals in a census tract modified the association between PM2.5 andCVD mortality by 100.60 deaths (95% CI: 94.40, 106.80) and 26.65 deaths (95% CI: 23.04, 30.26)
per one million person-years, respectively. Median household income decreased the association
between PM2.5 and CVD mortality by 0.83 deaths (95% CI: -0.79, -0.86) per 1 billion person-years.
CONCLUSIONS:Utilizing a casual approach, annual PM2.5 exposure increased the absolute rate of CVD
mortality reported by 11 US States. Specific demographic and socioeconomic variables modified thisassociation.

Keywords: Air pollution, cardiovascular mortality, epidemiology, causal inferenceVO-019[Air pollution » Short-term exposure]

Estimating attributable deaths from short-term
pollution effects using a Total Risk Index
approach
Ariel Spira Cohen, Rebecca Goldberg, Sarah Johnson, Masha Pitiranggon, Kazuhiko Ito
Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental
Hygiene, New York, USA

BACKGROUND AND AIM:Air pollution health effects are traditionally estimated for single pollutants,
but uncertainty exists about impacts from pollutant mixtures. This analysis uses a multi-pollutant risk
estimate – a Total Risk Index (TRI) – to study short-term mortality risk and quantify attributable
deaths in New York City (NYC).
METHOD:Daily citywide average air pollution concentrations were collected from the US Environmental
Protection Agency’s Air Quality System and mortality records from NYC Vital Statistics. Trends in fullyear and seasonal TRI for non-external mortality were examined using time-series models in five-year
rolling segments (2000-2019). Pollutants considered were nitrogen dioxide (NO2), fine particulatematter (PM2.5) and warm season ozone. Due to changes in pollution trends around 2005, attributablecounts (ACs) were extracted from single, co-pollutant, and TRI models covering 2005-2019 for four
mortality outcomes: all-natural-cause, cardiovascular disease (CVD), cancer, and respiratory disease.
RESULTS:Warm-season three-pollutant TRI was generally positive over time, reaching ~3% excess
risk for models in the 2000’s and ~2.5% in the 2010’s, and was most strongly influenced by inclusionof NO2. Annual average TRI-AC was 677 (95%CI: 291,1076) from full-year models, similar to singlepollutant NO2 AC (665; 273, 1052). For all outcomes, warm-season three-pollutant TRI-ACs werehigher than cold-season two-pollutant TRI-ACs, except for CVD mortality which was similar acrossseasons. TRI-ACs for the mortality sub-causes in the warm season were larger than any singlepollutant model ACs. Full-year TRI-ACs declined for non-external and CVD mortality and warm-season
TRI-ACs declined less over the study period. Warm-season respiratory mortality TRI-AC was stable.
CONCLUSIONS:Despite large declines in NYC’s PM2.5 and NO2 concentrations, total pollution risk
remains positive, with NO2 gaining importance for attributable burden. Ozone impacts from regionalsource emissions persist. Novel application of a TRI provides an additional policy tool to quantify
emissions source impacts.

Keywords: air pollution, mortality, time series, mulit-pollutant, attributable deaths

VO-020[Air pollution » Long-term exposure]

Assessing Adverse Health Effects of Long-Term
Exposure to Low Levels of Ambient Air Pollution:
What’s Next?
Hanna Boogaard1, Dan L Crouse1, Eva Tanner1, Ellen Mantus1, Annemoon M Van Erp1, Sverre Vedal2,
Jonathan Samet3
1Health Effects Institute, Boston, MA, United States
2University of Washington, Seattle, WA, United States
3Colorado School of Public Health, Aurora, CO, United States

BACKGROUND AND AIM:Although concentrations of ambient air pollution continue to decline in highincome regions, epidemiological studies document health effects at levels below current standards.
The Health Effects Institute (HEI) recently completed a comprehensive research program toinvestigate the health effects of long-term exposure to low levels of air pollution in the United States(US), Canada, and Europe. We present a summary of the results of the three studies, their strengths
and weaknesses, future research opportunities, and implications of findings for risk assessment andregulation.
METHOD:The three studies considered associations between fine particulate matter (PM2.5), nitrogendioxide, ozone, and other pollutants with many health outcomes, including cause-specific mortality
and cardiovascular and respiratory morbidity, among others. To ensure high quality research andcomparability across studies, HEI worked actively with the study teams, and engaged independent
expert panels for project oversight and review.
RESULTS:All three studies documented positive associations between mortality and PM2.5
concentrations below the US National Ambient Air Quality Standards and current and proposed
European Union (EU) limit values. Furthermore, the studies documented non-threshold linear (US), or
supra-linear (Canada and Europe) exposure-response functions between PM2.5 and mortality.
Substantial heterogeneity was found within and across studies both in the magnitude and shape of theassociation.
Strengths of the studies included the large populations (7-68 million), state-of-the-art exposure
assessment methods, and thorough statistical analyses with novel methods. However, the HEI Review
Panel had concerns about the validity of the exposure estimates in rural areas, zipcode-level
aggregation in the US analysis, and the influence of co-pollutants. Future work is needed to better
understand potential sources of heterogeneity in the findings across studies and regions.
CONCLUSIONS:The research program provided important evidence of associations between long-term
exposures to low levels of air pollution and health effects, suggesting that lowering current standards
could yield further health benefits.

Keywords: air pollution, long-term exposure, mortality, epidemiology, policy

VO-021[Chemical exposures » Phenols]

Exposure to triclosan and adolescent hormone
concentrations in the Health Outcomes andMeasures of the Environment Study
Hannah E Laue1, Bruce P Lanphear2, Antonia M Calafat3, Kim M Cecil4, Aimin Chen5, Yingying Xu6,
Heidi Kalkwarf6, Amy D Willis7, Juliette C Madan8, Margaret R Karagas1, Kimberly Yolton6, Abby F
Fleisch9, Joseph M Braun10
1Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
2Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
3Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease

Control and Prevention, Atlanta, GA, USA
4Departments of Radiology and Pediatrics, Cincinnati Children's Hospital Medical Center, University ofCincinnati College of Medicine, Cincinnati, OH, USA
5Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman

School of Medicine, Philadelphia, PA, USA
6Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati

College of Medicine Cincinnati, OH, USA
7Department of Biostatistics, Hans Rosling Center for Population Health, University of Washington,

Seattle, WA
8Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA;

Departments of Pediatrics and Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
9Center for Interdisciplinary and Population Health Research, Maine Institute for Research, Portland,

ME; Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME
10Department of Epidemiology, Brown University, Providence, RI

BACKGROUND AND AIM:Triclosan, an antimicrobial, has been associated with altered pubertal andandrenarcheal hormone concentrations in cross-sectional studies, but the findings are inconsistent. We
examined associations of gestational and childhood triclosan exposure with hormone concentrations inadolescence.
METHOD:In 157 participants in the Health Outcomes and Measures of the Environment Study, aprospective pregnancy and birth cohort based in Cincinnati, Ohio, we quantified total urinary triclosan
concentrations up to twice during pregnancy and up to 8 times between birth and 12 years. We
averaged measurement-error-corrected and creatinine-adjusted concentrations across the gestationaland childhood periods. At 12 years, we quantified adrenal, pituitary, and gonadal hormones inmorning blood [males (n=73) and females (n=84)—dihydroepiandrostendione sulfate (DHEA-S),
luteinizing hormone (LH), follicle stimulating hormone (FSH); males—testosterone; females—
estradiol]. We calculated percent change in hormone concentration per doubling of urinary triclosan
concentrations in gestation or childhood using generalized linear models adjusting for triclosan
concentrations in the other period and sociodemographic and perinatal factors. For DHEA-S, FSH, and
LH we examined if child’s sex modified associations between urinary triclosan and hormone
concentrations.
RESULTS:For females, each doubling of average childhood triclosan was associated with a 15.9%
decrease in estradiol concentrations (95% CI: -29.1, -0.1). We found suggestive evidence of sexspecific associations between gestational triclosan exposure and FSH concentrations, where a doublingof triclosan was associated with lower observed FSH concentrations among males [-7.3% (-16.6, 3.1)]
and higher observed concentrations among females [5.3% (-4.4, 15.8), p-interaction=0.09]. No
strong evidence of associations between triclosan and other hormones was identified.
CONCLUSIONS:Gestational and childhood triclosan concentrations were related to some pubertal
hormone concentrations in a sex-specific manner. Our findings indicate the need to better elucidate
potential actions of triclosan on the pituitary versus the ovary and more precise windows of exposure
sensitivity.

Keywords: endocrine disrupting chemicals, long-term exposure, children's environmental health;VO-022[Birth and pregnancy outcomes » Birth outcomes]

Prenatal exposure to mixtures of traffic-related
air pollutants and birthweight in a birth cohort
Ian Trees1, Abhisek Saha2, Erin Bell3, Priscilla Clayton1, Pauline Mendola4, Diane L. Putnick1,
Rajeshwari Sundaram2, Edwina Yeung1
1Epidemiology Branch, National Institute of Child Health and Human Development, NIH, Bethesda,

MD, USA
2Biostatistics and Bioinformatics Branch, National Institute of Child Health and Human Development,

NIH, Bethesda, MD, USA
3Department of Environmental Health Sciences, University at Albany, Albany, NY, USA
4Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA

BACKGROUND AND AIM:While previous analyses using linear regression have linked prenatal PM2.5
exposure to decreases in birthweight, studying the effects of air pollutant mixtures on birth outcomesis difficult due to strong correlations between pollutants. This study explored how exposure to a
mixture of traffic-related air pollutants during the 3rd trimester of pregnancy impacts birthweight.
METHOD:We included 4,634 mother-infant pairs from a birth cohort in New York State. Air pollution
data came from the EPA’s Community Multiscale Air Quality model and were matched to the census
tract centroid associated with each maternal home address. Birthweight came from vital records. We
used linear regression to study the association between PM2.5 exposure and birthweight, andBayesian kernel machine regression to study the potential non-linear effects and interactions between
PM2.5 and other traffic-related pollutants (O3, NOx, SO2, and CO), adjusting for maternal sociodemographics, infant characteristics, and seasonality.
RESULTS:Fully-adjusted linear regression models showed that an IQR increase in PM2.5 exposure
during the 3rd trimester led to a 31.9g reduction in birthweight (95% CI: -68.8, 5.1). Individual
exposure-response curves generated by BKMR showed that PM2.5, NOx, and CO exposure negatively
impacted birthweight when other traffic-related pollutants were fixed at their median, with higher
exposures leading to more severe reductions. There was also a significant interaction between PM2.5
and NOx exposure. Specifically, the association between PM2.5 exposure and birthweight wasstrongest when NOx was held constant at its 25th percentile compared to the 50th and 75th
percentiles, respectively. Importantly, the threshold of PM2.5 exposure leading to reductions inbirthweight changed based on NOx concentrations.
CONCLUSIONS:Our results suggest that prenatal exposure to a subset of traffic-related air pollutants
during the 3rd trimester can negatively impact birthweight. The non-linear relationships between air
pollution and birthweight highlight the importance of considering mixtures of pollutants and theirinteractions.

Keywords: Air pollution, birth outcomes, environmental epidemiology, mixtures, particulate matter

VO-023[Air pollution » Wildfires]Comparing wildfire smoke effects on adverse
pregnancy and birth outcomes in the Western US
under changing climate regimes
Ping Jiang1, Yang Li2, Mingkun Tong3, Jing Nie4, Tao Xue3, Meng Wang4
1Department of Obstetrics and Gynecology, Mountain Hospital, Yantai, Shandong Province, China
2Department of Environmental Science, Baylor University, Waco, TX, USA
3Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health

Science Center, Beijing, China
4Department of Epidemiology and Environmental Health, School of Public Health and HealthProfessions, University at Buffalo, Buffalo, NY, USA

BACKGROUND AND AIM:Climate change increases wildfire frequency and levels of air pollution,
causing growing concerns on human health. Little is known about how wildfire smoke exacerbates
reproductive health over long decades. We aim to compare effects of wildfire smoke on adverse
pregnancy and birth outcomes (APBO) between 2001 and 2018 in the western US.
METHOD:Birth record for 647,815 delivers in 2018 and 2,696,128 in 2001-2004 were obtained acrossfive states of the US and were linked with wildfire smoke exposure in the mother’s residential county
during the entire gestational period. Monthly exposure to total fine particulate matters (PM2.5) andtheir components (black/organic carbon) were estimated by high-resolution geo-statistical models andwere further decomposed as fire and non-fire sourced PM2.5 using a chemical transport model.
Double-robust logistic regression model was used to assess the associations between wildfire PM2.5
exposures and APBO, including preterm birth (PTB), low birth weight (LBW), fetal death (FD),gestational hypertension (GTH) and eclampsia, separately between the almost two-decade interval.
RESULTS:Total PM2.5 concentration decreased from 9.2 to 7.3 µg/m3 from 2001 to 2018, whilewildfire PM2.5 exposure increased from 0.5 to 6.3 µg/m3. Compared to the marginal associations
found between 2001-2004, wildfire PM2.5 and its components are consistently and significantly
associated with elevated risk of PTB and LBW, especially over the entire prenatal period [e.g. Odds
Ratio: 1.07 (95%CI: 1.05, 1.09) for PTB and 1.06 (1.04, 1.08) for LWB per 2 µg/m3 in PM2.5]. In
contrast, associations between wildfire exposure and other outcomes were identified in earlier years[1.17 (1.15, 1.19) for GTH and 1.41 (1.30, 1.52) for eclampsia] than a recent year. No associations
were found for FD with exposures in any years.
CONCLUSIONS:This study suggests that increasingly common wildfire exposures exacerbated byclimate change are significantly associated with serious PTB and LBW outcomes across the western
US.

Keywords: Wildfires, Air pollution, Pregnancy outcomes, Reproductive outcomes, Big dataVO-024[Exposures » Ionizing radiation]

A comparative time-series analysis and deeplearning projection of innate radon risk in
Canadian and Swedish residential buildings
Selim M Khan1, Dustin D Pearsona1, Tryggve Rönnqvistc4, Markus E Nielsena,1, Joshua M Taron3,
Aaron A Goodarzia2
1Departments of Biochemistry and Molecular Biology and Oncology, Cumming School of Medicine,

University of Calgary, Calgary, AB, Canada.
2Robson DNA Science Centre, Charbonneau Cancer Institute, Cumming School of Medicine, Universityof Calgary, Calgary, AB, Canada.
3School of Architecture, Planning and Landscape, University of Calgary, Calgary, AB, Canada.
4Radonova Laboratories, AB, Uppsala, Sweden.

BACKGROUND AND AIM:Accumulation of radioactive radon gas in indoor air poses a serious risk tohuman health by increasing the lifetime risk of lung cancer and is classified by IARC as a category one
carcinogen. Radon exposure risks are a function of geologic, geographic, design, and humanbehavioural variables, and can change over time. The objectives of this study were to assess, compare
and predict the risk of exposure to indoor air radon in Canadian and Swedish houses constructed
between 1945 to 2020 to come up with evidence to could support building codes policy that can
reduce the risk.
METHOD:Closed passive etched track detectors made from CR-39 plastic film were used to test radon.
Statistical analysis was conducted in MS Excel 2016, SPSS, Prism 9.0, and R (4.0.2). Predictive timeseries analyses were conducted using traditional Autoregressive Integrated Moving Average (ARIMA),
and the new generation deep learning time series forecasting toolsets in MATLAB2020b using Python
codes.
RESULTS:While Canadian and Swedish properties built between 1970 and 1980 are comparable (96–103 Bq/m3), innate radon risks subsequently diverge, rising in Canada and falling in Sweden such that
21st Century Canadian houses show 467% greater average radon (131 Bq/m3) relative to Swedish
equivalents (28 Bq/m3). These trends are consistent across housing types and regions within eachcountry. The introduction of energy efficiency measures within Canadian and Swedish building codes
coincided with opposing radon level trajectories in each nation. Deep machine learning modelling
predicts that, without intervention, average Canadian residential radon levels will increase to 176
Bq/m3 by 2050.
CONCLUSIONS:The risk from exposure to indoor radon is higher in Canada compared to that in
Sweden and the risk will continue to increase adding burden to lung cancer morbidities andmortalities. This emphases the importance and urgency of future building code intervention to achievesystemic radon reduction in Canada.

Keywords: Radon Health Risk, Time-Series, Deep Machine Learning, Lung Cancer, Canada Sweden.

VO-025[Air pollution » Particulate matter]

Incorporating Exposure Uncertainty in
Estimating Causal Exposure-Response
Relationships Between Long-term Exposure toPM2.5 and Cardiovascular Disease
Yaguang Wei1, Yijing Feng1, Mahdieh Danesh Yazdi2, Alexandra Shtein1, Kanhua Yin3, Brent Coull1,
Francesca Dominici1, Joel Schwartz1
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony

Brook University, Stony Brook, NY, USA
3Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

BACKGROUND AND AIM:The estimate of causal exposure-response relationship between air pollution
and cardiovascular disease remains lacking, and possibility has been raised that exposure uncertainty
may render effect estimate unreliable. We aim to provide robust estimate of causal exposure-response
relationships between long-term PM2.5 exposure and risk of hospitalization with major cardiovasculardiseases (CVD): ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy,
arrhythmia, valvular heart disease, thoracic and abdominal aortic aneurysm, and all these combined.
METHOD:Using national Medicare fee-for-service beneficiaries during 2000–2016, we constructed aseparate cohort for each CVD and linked annual PM2.5 predictions to each person-year. The outcome
was defined as the first hospitalization during follow-up. PM2.5 uncertainty was estimated based on
the difference between monitored and predicted levels. For each person-year, we predicted theprobability of PM2.5 exposure, assuming it was normally distributed, fell within each disjoint unitlength interval from 0 to 20 µg/m3 ([0, 1), [1, 2), … [19, 20]). For each interval, we fitted a beta
regression to estimate inverse probability weights for all person-years with exposures fell within thatinterval, adjusting for measured confounders. We treated exposure effect for lowest interval ([0, 1))
as reference, and estimated relative risks for other intervals comparing to the reference. Stratified
analysis was performed by individual and community-level characteristics.
RESULTS:Except for valvular heart disease, causal exposure-response estimates showed “S”-shaped
curves for all outcomes. Annual PM2.5 posed the highest risk for heart failure, with the risk for thehighest exposure interval 1.74 (95% CI: 1.71, 1.76) times larger than reference. Younger age group,
Medicaid enrollees, and communities with lower population density experienced higher risk for all
outcomes.
CONCLUSIONS:Long-term PM2.5 exposure increased risk of hospitalization for major CVD, except
valvular heart disease. The robust causal exposure-response estimates provide significant implications
for presently being reviewed national standard.

Keywords: Particulate matter, Long-term exposure, Environmental disparities, Cardiovasculardiseases, Causal inferenceVO-026[Climate » Temperature]

Extreme heat exposure and spontaneousabortion: A case-crossover study
Amelia K Wesselink1, Emma L Gause2, Keith Spangler2, Perry Hystad3, Kipruto Kirwa4, Mary D Willis1,
Gregory A Wellenius2, Lauren A Wise1
1Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States ofAmerica
2Department of Environmental Health, Boston University School of Public Health, Boston, MA, UnitedStates of America
3College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United Statesof America
4Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston,

MA, United States of America

BACKGROUND AND AIM:We conducted a case-crossover study nested within a prospective cohort toexamine the association between extreme heat exposure during periconceptional and prenatal periods
and odds of spontaneous abortion (SAB; pregnancy loss before 20 weeks’ gestation).
METHOD:We used data from Pregnancy Study Online, a web-based preconception cohort study inwhich individuals trying to conceive were enrolled during the preconception period and followed
throughout pregnancy. We restricted our analysis to the 616 participants who resided across thecontiguous United States and reported SAB during the study period (2013-2021; May-September). We
examined two potential critical windows of exposure: self-reported SAB date and date of conception.
We used a time-stratified control selection strategy in which we selected all dates in the same monthon the same day of the week as the case date. For all case and control dates, we obtained countylevel population-weighted temperature and wet bulb globe temperature (WBGT) from the ERA5-Land
reanalysis dataset. We defined extreme heat exposure as county-specific temperature or WBGT ≥95th
percentile during any of the three days preceding conception or SAB date. We estimated theassociation between extreme heat and SAB using conditional logistic regression.
RESULTS:Exposure defined as temperature ≥95th percentile during the three days before conception
was associated with increased odds of SAB (odds ratio [OR]=1.23, 95% CI: 0.97, 1.55). Results werein the same direction, but weaker for WBGT ≥95th percentile (OR=1.10, 95% CI: 0.88, 1.39).
Extreme heat in the three days preceding the SAB date was not appreciably associated with odds of
SAB (OR=1.01, 95% CI: 0.77, 1.32).
CONCLUSIONS:Days with extreme heat preceding conception may be associated with greater odds of
SAB. Heat near the SAB event date was not associated with SAB. These results shed light on what
periods are potentially etiologically relevant for heat-related risk of SAB.

Keywords: climate, epidemiology, pregnancy outcomes, reproductive outcomes, temperatureVO-027[Methods » Other (to be specified with keywords in the keywords section)]""Imputation of missing data in long term air
pollution exposure""
Astrid Berena Herrera Lopez1, María Patricia Arbelaez1, Nestor Rojas3, Carlos Arturo Torres4, Victor
Mauricio Herrera2, Horacio Riojas Rodriguez5, Laura Andrea Rodriguez Villamizar2
1Facultad Nacional de Salud Publica, Universidad de Antioquia, Medellín
2Departamento de Salud Publica,Universidad Industrial de Santander, Bucaramanga
3Universidad Nacional de Colombia, Bogota
4Fundacion Neumologica de Colombia, Bogota
5Instituto Nacional de Salud Pública de México, Cuernavaca

BACKGROUND AND AIM:Missing data in air pollutant monitoring is a common problem observed inurban air quality networks that compromises the internal validity of epidemiological studies and air
quality decision making. AIM: To evaluate imputation methods to replace missing data in long-term
exposure.
METHOD:Ecological study, with data the Air Monitoring Network of Bogotá D.C., Colombia for nitrogendioxide during 2018. Several imputation techniques were evaluated: mean, median, random forest,
decision forest, classification trees using regressions, predictive mean matching, linear regression andneural network). Measures of central tendency, dispersion and line graphs were used to compare
methods
RESULTS:Missing data were assumed to follow a completely random pattern (Missing Completely at
Random), since the loss was due to a power outage. The percentage of missing data at the Carvajal
Sevillana (15%), Centro de Alto Rendimiento (19%), Guaymaral (21%) and Puente Aranda (8%)
stations was less than 25%. For the mean and median imputation techniques, similar results wereobtained in the summary measures, differing with the predictive values of the linear regression. On
the other hand, the techniques of classification trees by regression, random forests and decision
forests, underestimate the values of the summary measures with respect to the values without
imputation. While imputation with predictive mean adjustment and neural network, similar values
were observed with the data observed without imputation
CONCLUSIONS:In conclusion, it was observed that the imputation with random forest, predictive
mean adjustment and neural network provides similar data to those observed for 24-hour mean
nitrogen dioxide concentrations.

Keywords: Long-term exposure,Epidemiology, Methodological study designVO-028[Exposures » Environmental disparities]

Socio-spatial profiles of health transition in
Argentina: exploring social inequalities inpreventive practices for breast and cervicalcancerDaiana Sarmiento1, Sofía Aynelén Pereyra2, Graciela Fabiana Scruzzi3, Natalia Tumas4, Sonia
Alejandra Pou5
1Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias

Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
2Instituto de Investigaciones en Ciencias de la Salud (INICSA), Universidad Nacional de Córdoba,

CONICET, Facultad de Ciencias Médicas, Córdoba, Argentina
3Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias

Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Nutrición, Facultad de Ciencias de la
Salud, Universidad Católica de Córdoba, Córdoba, Argentina
4Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Universidad Nacional de

Córdoba, CONICET, Córdoba, Argentina
5Instituto de Investigaciones en Ciencias de la Salud (INICSA), Universidad Nacional de Córdoba,

CONICET, Facultad de Ciencias Médicas, Córdoba, Argentina; Centro de Investigaciones en Nutrición
Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de
Córdoba, Córdoba, Argentina

BACKGROUND AND AIM:Argentina has experienced changes (transitions) in its health system andhealth care, with heterogeneous impacts on women’s health. This work aimed to identify socio-spatial
profiles of health transition (HT) related to preventive practices for breast and cervical cancers within
Argentina.
METHOD:A nationwide ecological study was performed in Argentina. Indicators of socio-sanitaryvulnerability (related to health resources, health services accessibility, and socioeconomic context)
and demographic characteristics (urbanization, population structure) were selected from official data
sources about 24 geographical units (2005-2018 period). Multiple Correspondence Analysis (MCA)
coupled with Hierarchical Cluster Analysis was used to identify socio-spatial clusters representing HT
profiles across Argentina. Mammography screening practice and Pap smear (%) in target women(aged 50-70 and 25-65, respectively) for 2018 were included as supplementary variables andexploratively projected in the graph constructed from MCA. All variables were categorized by tertiles(low/intermediate/high levels).
RESULTS:High socioeconomic stratum and health insurance coverage, low infant mortality, and highrate of physicians appeared close to a high level of mamograms and Pap practices in the dimensional
space produced by the MCA, indicating co-occurrence in the data set. Based on the dimensions
obtained by the MCA (76% of the total explained variance), three socio-spatial profiles of HT wereidentified. The first profile (located in the central and southern region of Argentina) was characterized
by low socio-sanitary vulnerability, high prevalence of preventive practices for breast and cervicalcancer, and aging population. The second one, showed intermediate levels of socio-sanitaryvulnerability and preventive practices, with high density of mammographs (per 10,000 women). The
third HT profile (Northern Region), presented high socio-sanitary vulnerability and low preventive
practices, with low health resources (rate of physicians, mammograph density, and health insurance

coverage).
CONCLUSIONS:Different HT profiles related to preventive practices of breast and cervical cancer
coexist within Argentina, shaping underlying social-spatial inequalities in women's health.

Keywords: cancer and cancer precursors, epidemiology, female, socio-economic factors

VO-029[Climate » Temperature extremes and variability]

Heat-Wave and Cold-Spell Acclimation Analysis
by Physical and Cognitive Functions among an
Advanced Age Cohort in China
Di Xi1, Linxin Liu1, Yi Zeng2, John S Ji1
1Vanke School of Public Health, Tsinghua University, Beijing, China
2Center for Healthy Aging and Development Studies, National School of Development, Peking

University, Beijing, China; Center for the Study of Aging and Human Development, Duke Medical
School, Durham, NC, USA

BACKGROUND AND AIM:Acclimation is a form of adaptation to climate change involving adjusting tofuture climate based on past occurrences. We aim to study acclimation by past exposure to heatwaves and cold spells on premature mortality in China.
METHOD:We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2008-2018).
We counted the number of heat-wave or cold-spell event days in a ten-year period, where heat-wave
events were defined as three or more consecutive days with daily minimum temperature exceeding
the 95th percentile, while cold-spell events were defined as three or more consecutive days with adaily maximum temperature below the 5th percentile. We collected demographic and socio-economic
characteristics, measured physical (IADL) and cognitive disability (MMSE). We used logistic regression
models adjusted for age, sex, administrative region, urban or rural residence, co-residence, air
pollutants (PM2.5, ozone and NO2), green and blue space around the residential locations.
RESULTS:We included 13,744 participants (median baseline age: 86.87, 57.10% female). During thefollow-up period, the average number of heat-wave and cold-spell events were 1.90 and 1.89 perperson-year, respectively. Each day increase in past exposure is associated with lower mortality forboth heat-wave (OR: 0.89, 95%CI: 0.87, 0.91) and cold-spell (OR: 0.83, 95%CI: 0.81, 0.86). The
protective effect of heat-wave frequency (OR:0.93, 95%CI:0.90, 9.60) and cold-spell frequency(OR:0.85, 95%CI:7.99, 9.07) is most significant among people with full IADL function. The protective
effect of cold-spell frequency was higher among those with normal MMSE status (OR: 0.86, 95% CI:
0.83, 0.88) than those with poor MMSE status (OR: 0.991, 95%CI: 0.989, 0.994).
CONCLUSIONS:The study reported protective effects of the frequency of the extreme temperature
events modified by physical and cognitive functions, providing valuable information on targeted caring
strategies. The elderly with physical or cognitive function decline will have worse adaptation to climatechange.

Keywords: acclimation, heat-wave mortality, cold-spell mortality, physical function, cognitive function

VO-030[Cancer and cancer-precursors » Survival]

Survival effects of delays on treatment initiationand conclusion in a cervical cancer hospitalbased cohort of a developing country
Ilce Ferreira Da Silva1, Ileia Ferreira Da Silva2, Valeria Saraceni3, Rosalina Jorge Koifman1
1National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
2Graduate Program of Environmental Public Health, National School of Public Health Sergio Arouca,

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
3Superintendence of Health Surveillance, Municipal Health Secretariat of Rio de Janeiro, Rio deJaneiro, Brazil

BACKGROUND AND AIM:to evaluate the effect of delays in cervical cancer treatment initiation andconclusion in hospital-based survival among Brazilian women
METHOD:A retrospective follow-up study was proceeded in a cohort of women diagnosed with cervicalcancer, treated in 2012-2014, and followed until December 31, 2017, in Rio de Janeiro. Delays intreatment initiation definition were based on the Brazilian law of 60 days for treatment initiation fromdiagnosis. Delays for treatment conclusion definition were based on the literature and sample
distributions: <120/121-200/>200 days. The outcome was the death of all causes from the diagnosis.
Death causes and dates were obtained from a record linkage procedure between the hospital-cancer
registry and the Mortality Information System(SIM). Overall 36 months survival was estimated by
Kaplan-Meier method and Log-Rank test. Crude and adjusted HR, with respective 95%CI, were
estimated by Proportional Cox regression.
RESULTS:From 869 included women, 260(29.9%) died in a median follow-up time of 27 months.
Delays on treatment initiation(> 60 days) was 94.3%, while delay on treatment conclusion(>120
days) was 81.4%. Overall survival was 61.3%, varying from 62.6% among women treated within 60
days to 63.5% for 61-90 days. Among late stage women(IIB-IIIB), those treated within 60 dayspresented poorer survival rate(40.1%) than those treated in 61-90 days(52.5%) and >90days(53.3%). Delays on treatment conclusion reduced survival, ranging from 60.7%(>200 days) to
72.2%(<120 days), (L-R p-value=0.054). Overall multivariate analysis showed that delays on
treatment initiation did not affect death risks in 36 months. Compared to women taking less than 120
days to finish treatment, those taking 121-200 days had a death-risk 89% higher(95%CI:1.10-3.24),
while those taking over 200-days had a death-risk 111% higher(95%CI:1.31-3.39), regardless of age,stage, treatment protocol, and time to treatment initiation.
CONCLUSIONS:Delays in cervical cancer treatment conclusion affected 36-month survival, and deathrisks, rather than delays in treatment initiation, among Brazilians.

Keywords: cervical cancer, delays in treatment, hospital-based cohort, survival, Brazil

VO-031[Other » Other (to be specified with keywords in the keywords section)]

Herbal medication and gout in a population offormer sugarcane workers with elevated risk ofchronic kidney diseaseJennifer Ko1, Tiffany L. Stallings2, Jorge Lau3, Oriana Ramírez Rubio4, David J. Friedman5, Juan Jose
Amador Velázquez6, Daniel R. Brooks6, Katie M. Applebaum2
1The George Washington University, Department of Epidemiology, Washington, DC, US
2The George Washington University, Department of Environmental and Occupational Health,Washington, DC, US
3Nephrologist, Nicaragua
4Boston University School of Public Health, Department of Epidemiology, Boston, MA, US; Barcelona

Institute for Global Health, ISGlobal, Barcelona, Spain
5Beth Israel Deaconess Medical Center, Department of Medicine, Division of Nephrology, Boston,

Massachusetts; Harvard Medical School, Boston, MA, US
6Boston University School of Public Health, Department of Epidemiology, Boston, MA, US

BACKGROUND AND AIM:Sugarcane workers have an elevated prevalence of chronic kidney disease of
non-traditional causes (CKDnt), a disease in which occupational heat exposure and intense physicalexertion are suspected initiators. Sugarcane workers often first exhibit kidney dysfunction.
Hyperuricemia among patients with kidney dysfunction increases risk of gout, an inflammatory
condition which can result in severe pain and swelling. We previously reported that the majority offormer sugarcane workers who had kidney dysfunction were experiencing hyperuricemia. We foundthat the use of natural remedies, including chamomile, was common in this population, though wehave not yet examined whether chamomile, in particular, may influence risk of gout. Our objective
was to determine if consumption of chamomile as an herbal medication was associated with lower
odds of gout, among former sugarcane workers with kidney dysfunction.
METHOD:The study population consisted of 311 former sugarcane workers who were patients at arenal clinic in northwestern Nicaragua. They were male, non-diabetic, attended the clinic for at least
one year. Participants self-reported use of chamomile as a natural remedy in the last year. Gout in thepreceding year was determined from abstracted medical records. Unconditional logistic regression wasused to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs), for 293 subjects withcomplete information on covariables age, hypertension, CKDnt stage, alcohol consumption, andallopurinol prescription.
RESULTS:Gout was experienced by 26% of participants within last year. Overall, 16% percent ofparticipants used chamomile in the last year. The adjusted odds of gout was lower among chamomile
users compared with non-users, though CIs were wide (OR= 0.56, 95% CI (0.20, 1.56)).
CONCLUSIONS:We cannot conclude whether chamomile use reduced odds of gout among former
sugarcane workers with kidney dysfunction. However, greater understanding of what factors affectgout and hyperuricemia in this population would improve quality of life.

Keywords: Food/Nutrition, Cardiovascular diseaseVO-032[Chemical exposures » Heavy metals]

Associations of Exposure to Urinary Metals withKidney Injury Biomarkers among Pre-adolescentChildren: A Cross-Sectional Study
Maria D. Politis1, Meizhen Yao1, Chris Gennings1, Marcela Tamayo Ortiz2, Chitra Amarasiriwardena1,
Ivan Pantic3, Mari Cruz Tolentino4, Guadalupe Estrada Gutierrez5, Jason H. Greenberg6, Martha M.
Tellez Rojo3, Alison P. Sanders7, Maria José Rosa1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai,

New York, New York, United States
2Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico
3Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico;

Department of Developmental Neurobiology, National Institute of Perinatology, Mexico City, Mexico
4Department of Nutrition, National Institute of Perinatology, Mexico City, Mexico
5Research Direction, National Institute of Perinatology, Mexico City, Mexico
6Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven,

Connecticut, United States
7Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh,

Pennsylvania, United States

BACKGROUND AND AIM:Exposure to toxic metal(loid)s, including arsenic (As), cadmium (Cd),mercury (Hg), and lead (Pb) may have nephrotoxic effects in children. We assessed concurrent metal
exposure and their associations with urinary kidney injury biomarkers in pre-adolescent children.
METHOD:Cross-sectional analyses included 551 children participating in the Programming Research in
Obesity, Growth, Environment and Social Stressors birth cohort study in Mexico City. Concentrationsof As, Cd, Pb, and Hg and kidney injury biomarkers were quantified in the child’s urine at the 8-12
years study visit. Associations of urine metal mixtures (As, Cd, Pb, and Hg combined) with individual
kidney injury biomarkers were assessed using weighted quantile sum regression. Covariates included
child’s age, sex, body mass index z-score, urine creatinine, socioeconomic status, and smoking
exposure at time of visit.
RESULTS:Per each quartile increase in the urine metal mixture, osteopontin was 0.36 ng/mL (95% CI:
0.17, 0.55) higher, primarily due to the contributions of Hg (39%) and Cd (31%). Per each quartile
increase in the urine metal mixture, albumin (0.53 ng/mL; 95% CI: 0.35, 0.72), uromodulin (0.29
ng/mL; 95% CI: 0.14, 0.44), retinol-binding protein 4 (0.54 ng/mL; 95% CI: 0.34, 0.74), and beta-2microglobulin (0.45 ng/mL; 95% CI: 0.21, 0.68) were higher, primarily driven by As. Per each quartile
increase in the urine metal mixture, glutathione S-transferase alpha (0.68 ng/mL; 95% CI: 0.36,0.99), alpha-1-microglobulin (0.19 ng/mL; 95% CI: 0.09, 0.29), and kidney injury molecule-1 (0.52ng/mL; 95% CI: 0.39, 0.65) were higher, primarily driven by Cd.
CONCLUSIONS:These findings expand on prior research in which we reported associations between
prenatal exposure to metals and urinary kidney injury biomarkers. Exposure to these metals and their
combinations, may lead to subclinical tubular or glomerular injury in preadolescence.

Keywords: Heavy metals, Children's environmental health, Mixtures, Exposures

VO-033[Air pollution » Other (to be specified with keywords in the keywords section)]

Health impact analysis of source-apportioned
air pollution changes in New York City, 20052015
Masha Pitiranggon, Sarah Johnson, Rebecca Goldberg, Ariel Spira Cohen, Kazuhiko Ito
New York City Department of Health and Mental Hygiene, New York, New York, United States

BACKGROUND AND AIM:To inform pollution policy, we estimated air quality and health impacts
attributable to pollution source changes in New York City (NYC).
METHOD:Air pollution, mortality, and morbidity data were obtained from US EPA’s Air Quality System,
NYC Department of Health and Mental Hygiene Vital Statistics, and New York Statewide Planning andResearch Cooperative System, respectively. “Before” (2005-2007) and “after” (2013-2015) periods
were compared based on policy events and changes in seasonal pollution patterns. PM2.5 source
apportionment was performed using positive matrix factorization. Health impacts of NO2 and sourceapportioned PM2.5 were analyzed using EPA’s BenMAP and NYC-specific concentration-response
functions developed by study co-authors for short-term impacts of air pollution.
RESULTS:Among PM2.5 constituents, the ammonium sulfate factor (associated with coal-fired power
plants) showed the largest reduction in mass (4.2 µg/m3) and annual attributable counts (AC) andfraction (AF)—mortality: (AC: 127 [95%CI: 23,231], AF: 0.26%); asthma emergency department
visits (EDV): (AC: 1516 [1150,1878], AF: 3.3%); asthma hospitalizations: (AC: 312 [213,410], AF:
3.5%); cardiovascular disease (CVD) EDV: (AC: 165 [46,283], AF: 0.37%); CVD hospitalizations:(AC: 251 [105,396], AF: 0.46%). PM2.5 from ammonium nitrate, residual oil, and traffic factors eachfell <0.5 µg/m3. NO2 fell about 11 ppb, yielding greater annual reductions in AC than any PM2.5
source factor—mortality (AC: 208 [83,333]); asthma EDV (AC: 2103 [1659,2541]); asthma
hospitalizations (AC: 392 [271,510]); CVD EDV (AC: 172 [27,315]); CVD hospitalizations: (AC: 410[231,587]).
CONCLUSIONS:Ammonium sulfate reductions comprised the bulk of PM2.5 changes, likely reflecting
lower SO2 emissions from power plants. While PM2.5 from residual oil fell about 54%, traffic andammonium nitrate contributions fell only 20-26%, suggesting greater potential for PM2.5 reductions
from traffic and nitrate precursors. NO2 reductions exhibited the greatest health benefits,
underscoring the importance of NOx mitigation, such as emissions control technologies andelectrification.

Keywords: policy, mortality, respiratory outcomes, cardiovascular diseases

VO-034[Policy » Research translation to affect policy and practice]

How would emission-reductions in Justice40
locations reduce racial-ethnic disparities in air
pollution exposure?
Yuzhou Wang1, Joshua S. Apte2, Jason D. Hill3, Cesunica E. Ivey4, Dana Johnson5, Esther Min6,
Rachel Morello Frosch7, Regan Patterson8, Allen L. Robinson9, Christopher W. Tessum10, Julian D.
Marshall1
1Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
2Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA &School of Public Health, University of California, Berkeley, CA, USA
3Department of Bioproducts and Biosystems Engineering, University of Minnesota, St Paul, MN, USA
4Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
5WE-ACT for Environmental Justice, Washington, DC, USA
6Front & Centered, Seattle, WA, USA
7School of Public Health, University of California, Berkeley, CA, USA & Department of Environmental

Science, Policy and Management, University of California, Berkeley, CA USA
8Department of Civil and Environmental Engineering, University of California, Los Angeles, CA, USA
9Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
10Department of Civil and Environmental Engineering, University of Illinois, Urbana-Champaign, IL,USA

BACKGROUND AND AIM:During the past decades, air quality in the US has improved dramatically,
however, disparities persist. Exposure disparities by race-ethnicity are larger than, and independentof, disparities by income or other socioeconomic measures. The Biden Administration’s Climate andEconomic Justice Screening Tool (CEJST) is the signature element and the ongoing approach of theWhite House Justice40 Initiative (“J40”), which is a general policy to address environmental injustice.
This study aims to explore whether emission-reductions brought about by CEJST/J40 investments will
eliminate disparities in PM2.5 exposure by race-ethnicity and other attributes.
METHOD:We compare a Business As Usual ("BAU") scenario against two scenarios wherein CEJSTidentified locations (“J40 communities”) experience aggressive or very aggressive additional emission
reductions. BAU simply continues historical rates of emissions and emission-changes into the future;in the two CEJST scenarios, we double or quadruple emission reduction in J40 communities, relative to
BAU. We use InMAP to predict how changes in emissions would impact annual-average PM2.5
concentrations and concentration-disparities.
RESULTS:Under the BAU scenario, disparities remain in place. Racial-ethnic disparities remain larger
than disparities for J40 communities and for low-income populations. The CEJST scenarios eliminate
absolute and relative disparities for J40 communities and for low-income populations in 20 years;
however, they do not reduce relative disparities by race-ethnicity.
CONCLUSIONS:Results from our analysis indicate that additional and more targeted actions, beyond

CEJST/J40, will be needed to end racial-ethnic exposure disparities in the next decades. In the bigger
picture, our study argues that Regulatory Impact Analysis (RIA) for air pollution must quantify
whether and how policies/tools will not only affect air quality overall, but also reduce absolute andrelative disparities, and that regulatory approaches are needed that are specifically designed toremove disparities.

Keywords: Air pollution, Particulate matter, Environmental justice, Environmental disparities, Policy

VO-035[Chemical exposures » Phenols]

Effects of triclosan and triclocarban exposure on
bile acid homeostasis in Chinese school-aged
childrenYi Wang1, Yuanping Wang1, Zichen Yang1, Ke Zhao1, Chunhai Shao2, Jiwei Wang1, Hexing Wang1,
Yue Chen3, Qingwu Jiang1
1School of Public Health, Fudan University, Shanghai, China
2Department of Nutrition, Huashan Hospital, Fudan University, Shanghai, China
3School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario,

CanadaBACKGROUND AND AIM:Human exposure to triclosan and triclocarban has been proposed to havepotential effects on bile acid homeostasis by disrupting gut microbiota, but the relevant information
remains limited. Therefore, our study aimed to investigate the associations of triclosan andtriclocarban in urine with bile acid homeostasis in Chinese school-aged children.
METHOD:In 2019 and 2020, we selected 545 Han children aged 7-11 years old from a dynamic cohortof school-aged children established in Shanghai. Urinary concentrations of triclosan, triclocarban andnine typical bile acids, including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid
(DCA), lithocholic acid (LCA), ursodeoxycholic acid (UDCA), glycocholic acid (GCA),
glycochenodeoxycholic acid (GCDCA), glycodeoxycholic acid (GDCA), and glycoursodeoxycholic acid
(GUDCA) were determined by liquid chromatography tandem mass spectrometry. To indicate themicrobial transformation of bile acids by gut microbiota, seven urinary concentration ratios of bile
acids, including DCA/CA, LCA/CDCA, UDCA/CDCA, CA/GCA, DCA/GDCA, CDCA/GCDCA, andUDCA/GUDCA were constructed. Linear models of generalized estimating equations (GEE) were used
to analyze the associations of urinary triclosan and triclocarban with bile acids and their concentration
ratios.
RESULTS:Triclosan and triclocarban were detected in 53.39% and 34.31% of urine samples with the75th percentiles of creatinine-corrected concentrations being 2.94 μg/g and 0.40 μg/g, respectively.
After adjusting for potential confounders, urinary concentration of triclosan was positively associatedwith urinary UDCA concentration and LCA/CDCA, but negatively associated with urinary CA
concentration and CA/GCA. Urinary triclocarban concentration was positively associated with urinary
concentrations of DCA, LCA, UDCA, GCA, and GDCA. Children with detectable triclosan in urine had
lower urinary CA, CDCA, and GCA concentrations and CA/GCA, but higher DCA/CA. Children with
detectable triclocarban in urine had higher urinary GCA concentrations.
CONCLUSIONS:Exposure to triclosan and triclocarban could affect bile acid homeostasis in school-aged
children by inhibiting the microbial transformation of bile acids in gut microbiota.

Keywords: children's environmental health, metabolomics, obesity and metabolic disorders, longterm exposureVO-036[Air pollution » Particle components]

Oxidative potential and health risk assessmentof ambient fine particulate matter around an
opencast coal mining area in India
Kamlika Gupta1, Victor Chang2, Mohan Yellishetty2, Harish C. Phuleria3
1IITB-Monash Research Academy, Indian Institute of Technology, Powai, Mumbai, India;

Environmental Science and Engineering Department, Indian Institute of Technology, Powai, Mumbai,
India; Department of Civil Engineering, Monash University, Melbourne, Australia
2Department of Civil Engineering, Monash University, Melbourne, Australia
3Environmental Science and Engineering Department, Indian Institute of Technology, Powai, Mumbai,

India; Koita Centre for Digital Health, Indian Institute of Technology, Powai, Mumbai, India; InterDisciplinary Program in Climate Studies, Indian Institute of Technology, Powai, Mumbai, India

BACKGROUND AND AIM:Particulate matter (PM2.5) exposures are prominent around opencast coalmining areas due to heavy transportation and mining activities. However, the toxicity of fine PM inmining communities, especially in India, is not well understood. This study aims to examine theoxidative potential (OP) of PM2.5 as an indicator for oxidative stress for better understanding of thehealth risks associated with exposure.
METHOD:PM2.5 was collected from roadsides and residential sites near an active coal mining area in
Eastern Maharashtra, India. Oxidative potential of PM to examine the generation of reactive oxygen
species (ROS) was carried out by dithiothreitol (OPDTT) and ascorbic acid (OPAA) assay. Further,inhalation health risk (USEPA IRIS), and PM2.5 bound water-soluble metals (through ICP-MS) werealso examined.
RESULTS:PM2.5 levels at coal-haul road were 10 times higher than the urban background site
(average ~500 ± 190 µg/m3). The inhalation risk for PM2.5 was observed to be 4 x 10-4, indicating asignificant risk to the population. The OPvolAA and OPvolDTT levels were higher at the roadside (2.3 ±0.6 nmol min-1 m-3 and ~1.9 ± 0.8 nmol min-1 m-3 respectively) compared to residential sites(~0.76 ± 0.01 nmol min-1 m-3 and 0.94 ± 0.2 nmol min-1 m-3 respectively) against the background
0.6 ± 0.2 nmol min-1 m-3 (OPAA) and 0.9 ± 0.12 nmol min-1 m-3 (OPvolDTT). Cr (20 ± 2.3 µg/m3),
Ni (5.6 ± 0.3 µg/m3), Cu (67.2 ± 9.5 µg/m3), and Fe (350 ± 36.7 µg/m3) emerged as prominenttransition metals.
CONCLUSIONS:The present study examines the intrinsic OP of fine PM around opencast coal mines tohighlight the oxidative burden of fine PM and the need for incorporating PM composition andtoxicological basis in regulation of environmental levels of PM. Further statistical analysis to examine
the association of levels of OP and its chemical drivers is underway

Keywords: Exposures, particulate matter, toxicology, heavy metals, risk assessment

VO-037[Air pollution » Traffic-related]

The joint association of air pollution and sleep
posture with mild obstructive sleep apnea inpatients from Taipei Sleep Center
Yan Su He1, Wen Te Liu2, Shang Yang Lin3, Zhi Yuan Li4, Steve Hung Lam Yim5, Hsiao Chi Chuang6,
Kin Fai Ho7
1The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese

University of Hong Kong, Hong Kong, China
2Research Center of Sleep Medicine College of Medicine, Taipei Medical University, Taipei, Taiwan;

School of Respiratory Therapy College of Medicine, Taipei Medical University, Taipei, Taiwan;
Department of Internal Medicine Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
3Research Center of Sleep Medicine College of Medicine, Taipei Medical University, Taipei, Taiwan
4Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong

Kong, China
5The Asian School of the Environment, Nanyang Technological University, Singapore
6School of Respiratory Therapy College of MedicineTaipei Medical University, Taipei, Taiwan;

Department of Internal Medicine Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell
Physiology and Molecular Image Research Center Wan Fang HospitalTaipei Medical University, Taipei,
Taiwan7The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese

University of Hong Kong, Hong Kong, China; Institute of Environment, Energy and Sustainability, The
Chinese University of Hong Kong, Hong Kong, China

BACKGROUND AND AIM:Obstructive sleep apnea (OSA) is negatively affected by a supine sleep
position and air pollution and positively affected by a nonsupine sleep position. However, theirinteraction effects on OSA remain unclear. To evaluate the interaction effects of air pollution(NO2/PM2.5) and sleep position on OSA on additive and multiplicative scales.
METHOD:This study included 3,330 individuals. Personal exposure to air pollution was assessed using
a spatiotemporal model. OSA was diagnosed through polysomnography. The associations of supine
and nonsupine sleep positions and air pollutants with mild OSA and their interaction effects on mild
OSA were explored through generalized logistic regression.
RESULTS:Supine sleep position and high NO2 level independently increased the risk of mild OSA. Theinteractions between supine sleep position and NO2 at lag(0–7 days), lag(0–1 year), and lag(0–2years) were significant (P = 0.042, 0.013, and 0.010 respectively). The relative excess risks due tointeractions on the additive scale for 1-week, 1-year, and 2-year NO2 exposure and supine sleep
position were 0.63 (95% CI: 0.10–1.16), 0.56 (95% CI: 0.13–0.99), and 0.64 (95 % CI: 0.18–1.10);
the corresponding odds ratios for interactions on the multiplicative scale were 1.45 (95% CI: 1.01–
2.07), 1.55 (9% CI: 1.09–2.22), and 1.60 (95% CI: 1.12–2.28). The positive interactions persisted inmen and participants with obesity. No interaction was observed between nonsupine sleep position andNO2 level; nevertheless, significant interactions were noted on both the negative additive andmultiplicative scales for men.
CONCLUSIONS:Prolonged supine sleep duration significantly increased the risk of mild OSA,
particularly in men and participants with obesity. Although the benefits of a nonsupine sleep position
are considerably less than the risks of NO2 exposure, avoiding prolonged sleep in a supine position
may reduce the risk of mild OSA from exposure to high levels of NO2 in men.

Keywords: short-term exposure, long-term exposure, spatial statistics, environmental epidemiology

VO-038[Neurologic and mental health outcomes » Neurodegenerative outcomes]

Interaction between greenspace and risk factors
for dementia and cognitive decline: a cohort
study from UK Biobank
Yanxi Zeng, Weiju Zhou, John S. Ji
Wanke school of public health, Tsinghua University, China

BACKGROUND AND AIM:The Lancet Commission on dementia prevention, intervention, and care had
identified twelve risk factors for dementia and cognitive decline. However, we do not know how
greenspace might modify the relationship between these risk factors and dementia incidence or
cognitive domains.
METHOD:A cohort study was conducted among 435,649 adults aged 37-73 from the UK Biobank
between 2006 to 2010. The outcome measures consisted of ICD-based dementia diagnosis and sevencognitive tests, with each test assessing a specific cognitive domain. Residential greenspace indicatedby percentage of outdoor greenspace at 300m buffers. We used logistic regression models andmultivariate regression models to estimate the effects of 12 identified risk factors, greenspace, andtheir interaction on dementia incidence and cognitive domains, adjusted for a range of key covariates.
RESULTS:Of 502285 participants, 5971(1.20%) were diagnosed with dementia. There is no interaction
between greenspace and any risk factor on dementia incidence. However, for cognitive domains, fullymodels showed interaction effects of greenspace with PMcoarse and PM10 on numeric memory andreaction time scores, respectively.
CONCLUSIONS:Though there is no interaction between greenspace and any risk factor on dementia
incidence, we can find the interaction effects of greenspace with several air pollutants on numeric
memory and reaction time. Strategies are needed to improve air quality and greenspace to decreaserisk of cognitive decline and dementia.

Keywords: greenspace, cognitive function, dementia, risk factor

VO-039[Air pollution » Ozone]

Association of Ambient Air Pollutants andPancreatic Cancer in a Matched Case-Control
Study
Yi Ting Huang1, Yen Tsung Huang1, Chih Da John Wu2, Wen Chi Pan3
1Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
2Department of Geomatics, National Cheng Kung University
3Institute of Environmental and Occupational Health Science, National Yang Ming Chiao Tung

University

BACKGROUND AND AIM:Pancreatic cancer is one of the leading causes of cancer-related death, but
our understanding about the etiology of this devastating disease remains very limited. Air pollution is
the greatest environmental risk causing diseases and premature deaths throughout the world. The aimof study was to explore the relationship between air pollutants and pancreatic cancer in a Taiwan
population-based cohort.
METHOD:A nationwide matched case-control study was conducted using the National Health Insurance
Database in Taiwan. 6,497 cases were selected from those diagnosed with pancreatic cancer during
2015-2017. For each case, we selected two controls by matching their age, sex, occupation, insurance
cover amount, living in the six municipalities or not, diagnosed/examined date, and hospital.
Concentrations of each year from 2005-2014, 5-year and 10-year averages of air pollutants ofparticulate matter (PM) 2.5, PM10, nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide(CO), and ozone (O3) were estimated for residential location. A conditional logistic regression was
implemented to estimate the association between air pollutants and pancreatic cancer.
RESULTS:In univariate analyses, NO2, CO, and O3 were significantly associated with pancreatic cancer
risk; in multivariate analyses, O3 was the only significant pollutant. A dose-response relationship of
O3 with pancreatic cancer was observed. Pancreatic diseases, acute pancreatitis, chronic pancreatitis,and diabetes mellitus (DM) were the significant mediators between O3 exposure and pancreatic cancer
risk.
CONCLUSIONS:O3 might be the key air pollutant to increase the risk of pancreatic cancer. Exposure toO3 would mediate pancreatic diseases, pancreatitis, or DM, raising the risk of pancreatic cancer.

Keywords: air pollution, air pollutant, cause pancreatic cancer, matched case-control study, ozone

VO-040[Birth and pregnancy outcomes » Other (to be specified with keywords in the keywords section)]

Prenatal exposure to air pollution and infant
growth: A trajectory analysis based on a birthcohortJiaying Fu1, Qingmei Lin2, Hualiang Lin1, Zilong Zhang1
1Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
2Foshan Women and Children Hospital, Foshan, China

BACKGROUND AND AIM:Growth during early-life stage is a rapid and dynamic process that isvulnerable to environmental hazards. We examined the associations between prenatal exposure to air
pollution and growth trajectories of infants based on a birth cohort.
METHOD:A birth cohort was constructed using medical records of over 3,800 infants born between
2015 and 2019 in Foshan, China. Physical growth (body length and weight) and neurodevelopment
were measured repeatedly within the first year after birth. Prenatal exposure to air pollutants
including particulate matter with aerodynamic diameter < 2.5 μm (PM2.5), carbon monoxide (CO),sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone(O3) was estimated using satellite-based spatialtemporal models at each participant’s residence. Latent Class Growth Modelling (LCGM) was used to
identify trajectories of physical growth and neurodevelopment. Logistic regression was used toinvestigate the associations between prenatal exposure to air pollution and the risk of physical andneurodevelopmental disruptions among infants, with adjustment for an array of potential confounders.
RESULTS:Based on the LCGM analyses, two growth trajectories were identified for body length[normal (93%) and retardation (7%)], three for body weight [normal (59.6%), retardation (9.4%),
and overgrowth (31%)], and two for neurodevelopment [normal (66.1%) and retardation (33.9%)].
Prenatal exposure to PM2.5, NO2 and SO2 was significantly associated with increased risks ofneurodevelopmental delay. SO2 exposure was also associated with an increased risk of growth
retardation in body length. None of the air pollutants was significantly associated with weight growth.
CONCLUSIONS:Our results suggest that prenatal exposure to air pollution was associated withincreased risks of retardation in both physical growth, particularly body length, and neurodevelopment
in infants.

Keywords: Prenatal exposure, air pollution, infant growth, trajectory analysis

VO-041[Air pollution » Other (to be specified with keywords in the keywords section)]

Residential wood burning in two Swedishcohorts: Public health implications of sourcespecific particulate ambient air pollution
Anna Oudin1, Bertil Forsberg2, Ebba Malmqvist1, Johan Sommar2, Wasif Raza2, Erin Flanagan1
1Department of Laboratory Medicine, Lund University, Lund, Sweden
2Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

BACKGROUND AND AIM:It is well known that wood-smoke is harmful in high doses, for example whencooking without chimneys in low-income countries. There are experimental studies indicating thatwood-smoke even at lower doses, such as those that occur in some residential areas, can be harmful
to our health. But there have previously been few studies on the population level on long-term effects;
despite the fact that wood-smoke in many areas is the largest source of air pollution exposure. A risein wood-burners in the wake of the rising costs for energy are furthermore likely to be creating'pollution hotspots' in affluent areas. Environmental inspectors and policy makers’ call for more
knowledge, as a basis for recommendation, as wood-burning currently is regulated in some areas but
not in others.
In the present study, the aim was to estimate the levels of wood-smoke at the home address in two
population-based cohorts.
METHOD:We used a quite unique data collection on all chimneys, that was available in two counties in
Sweden with high spatial resolution. The cohorts (>100 000 individuals each) have good data on otherrisk factors, and were linked to health records and mortality registries.
RESULTS:We observed an increased risk for low birth weight, autism spectrum disorders and preeclampsia (with adjusted odds ratios of 1.14 (95% confidence interval, CI: 1.04–1.26), 1.12 (95% CI:
0.94–1.34) and 1.35 (95% CI: 1.01-68) per IQR increase in PM2.5 from woodburning in the entire
pregnancy. We observed no dose-response association between PM2.5 from woodburning and incident
diabetes, dementia or lung cancer (but clearer associations with vehicle exhaust, except for
dementia).
CONCLUSIONS:Together, this evidence may imply that health effects of wood-smoke in ambient air
was present for outcomes related to exposure during pregnancy, but not later in life in this setting.

Keywords: Particle components, Long-term exposure, Particulate matter, birth outcomes, planetary
healthVO-042[Air pollution » Long-term exposure]Long-term exposure to air pollution andmortality due to chronic kidney disease – resultsfrom the multicentre ELAPSE-study
Gudrun Weinmayr1, Pauline Kadelbach1, Jie Chen2, Andrea Jaensch1, Giulia Cesaroni3, Daniela
Fecht4, Gerard Hoek2, Kees De Hoogh5, Zorana J Andersen6, Tom Bellander7, Barbara Hoffmann8,
Petter Ljungman9, Ole Raaschou Nielsen10, Evangelia Samoli11, Massimo Stafoggia12, Maciej Strak13,
Kathrin Wolf14, Emanuel Zitt15, Bert Brunekreef2, Gabriele Nagel16
1Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
3Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
4MRC Centre for Environment and Health, School of Public Health, Imperial College London, London,

United Kingdom
5Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
6Section of Environmental Health, Department of Public Health, University of Copenhagen,Copenhagen, Denmark
7Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for

Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
8Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical

Faculty, Heinrich Heine University Düsseldorf, Germany
9Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden; Institute ofEnvironmental Medicine, Karolinska Institutet, Stockholm, Sweden
10Danish Cancer Society Research Center, Copenhagen, Denmark
11Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National andKapodistrian University of Athens, Athens, Greece
12Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Institute ofEnvironmental Medicine, Karolinska Institutet, Stockholm, Sweden
13Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National

Institute for Public Health and the Environment, Bilthoven, the Netherlands
14Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
15Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine

3, LKH Feldkirch, Feldkirch, Austria
16Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for

Preventive and Social Medicine (aks), Bregenz, Austria

BACKGROUND AND AIM:Air pollution has been shown to be associated with cause-specific mortality.
However, mortality due to chronic kidney disease (CKD) is understudied despite the kidney being acentral organ of detoxification. We investigated the association of mortality due to CKD with long-term
exposure to air pollution in the Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE).
METHOD:We included five population-based cohorts from four European countries from the pooled
ELAPSE cohort which were linked to data from local mortality registries. CKD-death was defined as
ICD10 codes N18-N19 or corresponding ICD9 codes. Mean annual exposure at home address wasdetermined with Europe-wide hybrid land use regression models for particulate matter ≤2.5µm(PM2.5), nitrogen dioxide(NO2), black carbon (BC) and ozone (O3) with a spatial resolution of 100m x
100m. Cox regression models were adjusted for age (time-axis), cohort and sex (both as strata),
calendar year of recruitment, smoking status, marital status, employment status and neighbourhoodmean income. Dose-response was investigated with splines, threshold and subset analyses.
RESULTS:Over a mean follow-up time of 20.4 years, 313 of 289,564 persons died from CKD.
Associations were observed for all pollutants, positive for PM2.5 (hazard ratio (HR) with 95%
confidence interval (CI) of 1.31 (1.03-1.66) per 5µg/m3 increase), BC (1.26 (1.03-1.53) per 0.5×10−5/m), NO2 (1.13 (0.93-1.38) per 10µg/m3) and negative for O3 (0.71 (0.54-0.93) per 10µg/m3).
Results were robust when additionally adjusting for smoking intensity and duration, BMI, education orresidential greenness. Exclusion of the large Austrian cohort, that contributed 226 cases, lead to null
associations. Dose-response analysis showed no evidence for a threshold.
CONCLUSIONS:Our results suggest a possible association of air pollution with mortality from CKD.
Results were robust to other model specifications but susceptible to cohort selection. Therefore,
further even larger studies are needed to confirm our results.

Keywords: long-term exposure, particulate matter, oxides of nitrogen,VO-043[Air pollution » Long-term exposure]

Analysis of long-term mortality risks of PM2.5
in the UK Biobank cohort
Jacopo Vanoli1, Antonio Gasparrini1, Lina Madaniyazi2, Chris Fook Sheng Ng3
1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United

Kingdom
2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
3Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo

BACKGROUND AND AIM:The association between long-term exposure to fine particulate matter(PM2.5) and mortality is established. However, several aspects remain unclear regarding the actual
exposure risk window and the form of the temporal dependency. We studied the association of
exposure to PM2.5 on cause-specific mortality in the UK Biobank cohort, characterising the temporaldependencies through a detailed reconstruction of exposure histories and the definition of informativerisk summaries.
METHOD:The analysis included 502,381 participants to the UK Biobank cohort followed-up in the
period 2006-2019. Exposure to PM2.5 was assigned by linking detailed residential histories andlocations with high-resolution spatio-temporal maps. We performed a Cox proportional hazard modelfor time-varying exposure, applying a risk-set sampling scheme to reconstruct annual exposure
averages in 365-day windows prior to the event over eight years (0-7 lags) for 100 controls for eachcase. We analysed risks for different causes of death controlling for several individual-level
confounders.
RESULTS:Long-term exposure to PM2.5 was consistently associated with non-accidental mortality
using different time windows: the hazard ratio (HR) for a 5 μg/m³ increase was 1.06 (95%CI: 1.001.13) at lag0 (previous 365 days), 1.09 (1.01-1.17) at lag0-1, 1.12 (1.03-1.21) at lag0-4, and 1.13
(1.03-1.24) at lag0-7. Preliminary results of an application of distributed lag models suggests a spikein risk at lag 1 (in the window 365-730 days earlier), with an HR of 1.83 (0.96-1.22). We foundpositive but non-significant associations for respiratory and lung cancer mortality, and a null
association for cardiovascular causes.
CONCLUSIONS:Long-term exposures to PM2.5 was associated with an increased risk of natural
mortality at different temporal windows. The magnitude of the association increased when exposures
at longer lags were included, with the highest risks in the window corresponding to 1-2 years earlier.

Keywords: Air Pollution, Particular matter, Long-term exposure, Survival, MortalityVO-044[Omics technologies » Epigenomics]

Associations between prenatal air pollution
exposure and placental DNA methylation: aFrench multi-cohort study
Lucile Broséus1, Ian Hough1, Itai Kloog2, Ariane Guilbert1, Anath Chauvaud1, Emie Seyve1, Daniel
Vaiman3, Barbara Heude4, Cécile Chevrier5, Jörg Tost6, Rémy Slama1, Johanna Lepeule1
1Univ. Grenoble Alpes, INSERM, Team of Environmental Epidemiology applied to Development andRespiratory Health, Institute for Advanced Biosciences (IAB), Grenoble, France
2Department of Geography and Environmental Development, Ben-Gurion University of the Negev,

Be'er Sheva, Israel.
3From Gametes to Birth, Institut Cochin, U1016 INSERM, UMR 8104 CNRS, Paris-Descartes University,

Paris, France
4Univ. Paris, Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, Paris,

France5Université Rennes, INSERM, EHESP, IRSET (Research Institute for Environmental and Occupational

Health), Rennes, France
6Laboratory for Epigenetics and Environment, Centre National de Recherche en Génomique Humaine,

CEA – Institut de Biologie François Jacob, University Paris Saclay, Evry, France

BACKGROUND AND AIM:Exposure to air pollution during pregnancy may alter placental DNA
methylation patterns and induce changes in placental and fetal development and later diseasesusceptibility.
We investigated the association between prenatal NO2, PM10 and PM25 exposure levels and changes
in placental DNA methylation (DNAm) patterns and further explored potential windows of susceptibility
and sex-specific alterations.
METHOD:DNAm levels were measured using the Infinium Methylation EPIC BeadChip in 871 placental
samples from the three mother-child cohorts EDEN, PELAGIE and SEPAGES, recruited across four
different French cities. Daily exposure levels of each pollutant were estimated based on maternal
residential address, using validated spatiotemporally resolved exposure models. We conducted anepigenome-wide association study to identify differentially methylated positions (DMPs) and regions(DMRs).
RESULTS:We found 4 CpG sites significantly associated with at least one air pollutant in the whole
population after correction for multiple tests and more than 300 sex-specific associations. Top DMPs
(p-value<0.001) associated with PM exposure during the third trimester of pregnancy weresignificantly enriched (FDR<0.05) in genes related to the calcium signaling pathway in girls and to thedevelopment of the hypothalamus in boys. The regional analyses identified 31 DMRs associated with
air pollutant exposure in the whole population. Moreover, we detected sex-specific (34 in girls, 35 inboys) and pollutant-specific (5 for NO2, 4 for PM) DMRs. Our results were validated using an
independent data set of 668 EDEN participants whose placenta DNAm levels were measured using theIllumina 450K BeadChip.
CONCLUSIONS:These findings highlight global and sex-specific modifications of placental DNA
methylation patterns associated with prenatal air pollutant levels which could provide clues about themolecular pathways through which air pollution may influence sex-specific response to oxidative stressand brain development.

Keywords: Air pollution, Particulate matter, Pregnancy outcomes, Male, Female

VO-045[Air pollution » Particulate matter]

Critical windows of susceptibility of maternal
exposure to fine particulate matter and the risksof stillbirth and spontaneous preterm birth
Sylvester Dodzi Nyadanu1, Tessema A. Gizachew2, Ben Mullins1, Gavin Pereira3
1Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
2Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia and Schoolof Public Health, University of Adelaide, Adelaide, South Australia, Australia
3Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia, WHO

Collaborating Centre for Environmental Health Impact Assessment. Faculty of Health Science, Curtin
University, Western Australia, Australia, and Centre for Fertility and Health (CeFH), NorwegianInstitute of Public Health, Oslo, Norway

BACKGROUND AND AIM:Few studies have investigated weekly or monthly exposure-lag-response
relationships between ambient fine particulate matter (PM2.5) and spontaneous preterm birth (sPTB)
or stillbirth. This study aimed to identify potential critical windows of susceptibility for theseassociations which are currently unknown.
METHOD:A total of 414,771 singleton birth records which included 0.5% stillbirths and 3.7% sPTB
were spatiotemporally linked to monthly PM2.5 concentrations between 1st January 2000 and 31st
December 2015 in Western Australia. PM2.5 exposure for three months preconception to birth andadjusted hazards of stillbirth and sPTB were estimated by distributed lag linear and non-linear Cox
proportional hazard models.
RESULTS:The mean (standard deviation) PM2.5 exposure was 8.1 (1.0) µg/m3 for the study period.
The identified potential critical windows of susceptibility ranged from the 3rd to the 7th gestational
month. The strongest adjusted hazards per 5 μg/m3 (international annual limit) and 3 μg/m3 (excessof Australian standard over international limit) PM2.5 exposure increase were 1.12 (95% CI 1.05,
1.19) and 1.07 (95% CI 1.03, 1.11), respectively during 3rd gestational month for stillbirth and 1.04
(95% CI 1.02, 1.05) and 1.02 (95% CI 1.01, 1.03), respectively during 5th gestational month for
sPTB. No obvious associations were found for preconception exposures. For stillbirth but not for sPTB,
the interactive effects of PM2.5 exposure and biothermal stress were observed. For both birthoutcomes, the effect estimates were disproportionately elevated for male infants and births tomothers aged 20–34 years, high socioeconomic status, and pregnancy complications.
CONCLUSIONS:Maternal ambient PM2.5 exposure is associated with higher hazards of stillbirth andsPTB, even at levels below the new international yearly average limit of 5 μg/m3. The identified
potential critical windows of exposure susceptibility and sensitive subpopulations could guide future
aetiological studies, public health initiatives, and policy considerations.

Keywords: Long-term exposure, Birth outcomes, Environmental epidemiology, ModelingVO-046[Exposome » External exposome]

The impact of residential relocation on
childhood BMI: an exposome-wide naturalexperiment
Apolline Saucy1, Sarah Warkentin1, Zhebin Yu2, Jeroen De Bont2, Fabián Coloma1, Cyrille Delpierre3,
Ulrike Gehring4, Kees De Hoogh5, Anna Bergström6, Erik Melén7, Marjan Tewis4, Jelle Vlaanderen4,
Roel Vermeulen4, Cathryn Tonne1
1Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
2Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
3Centre for Epidemiology and Research in POPulation Health (CERPOP) UMR1295, Inserm, Université

Toulouse III Paul Sabatier, Toulouse, France
4Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
5Swiss Tropical and Public Health Institute, Allschwil, Switzerland & University of Basel, Basel,

Switzerland
6Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden & Centre ofOccupational and Environmental Medicine, Region Stockholm, Sweden
7Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm,

SwedenBACKGROUND AND AIM:Residential relocation can cause sudden and simultaneous changes in multiple
environmental exposures and provides a unique opportunity to estimate the potential health impacts
of interventions on the external exposome. This study uses residential relocation as a naturalexperiment to assesses the impact of exposome relocation trajectories on BMI during childhood in the
EXPANSE project.
METHOD:We collected 27,019 repeated age-and-sex standardized BMI z-scores (z-BMI) observations
from 2,915 children and adolescents in the PIAMA (Netherlands) and BAMSE (Sweden) studies whochanged address once between 2 and 24 years. Considering various domains of the urban exposome(traffic-related pollution, built surface, green variability, blue space, socioeconomic deprivation), we
used a k-means clustering approach to characterize their living environment before and after moving
as low, medium and high hazard environments for each exposome domain. The impact of changes in
the urban exposome following residential relocation on z-BMI was estimated using fixed-effects
models for panel data. We fitted single and multiple exposome domains models and included nonlinear time-trends in z-BMI.
RESULTS:We found consistent associations between relocating to areas with a worse living
environment and increasing z-BMI in the single domain models. The multiple domains models revealed
that the association for air pollution and built surface was partially confounded by the other exposome
domains. In PIAMA, moving to areas with increased socioeconomic deprivation was significantly
associated with increased z-BMI after relocation in all models.
CONCLUSIONS:This is one of the first studies to use residential relocation as a natural experiment toassess the impact of changes in various aspects of the urban exposome on health. Results suggestthat relocating to new environments with different levels of pollution, built surface and socioeconomic
deprivation can have direct impacts on childhood bodyweight. Results inform planning of urban
environments to promote healthy weight in children.

Keywords: urban exposome, built environment, residential relocation, BMI

VO-047[Chemical exposures » General]

A systematic review of exposure-response
relationships between the exposome andchildren health
Audrey Rocabois1, Blanche Wies2, Amélie Crépet3, Margaux Sanchez4, Karine Angeli5, Martine
Vrijheid2, Mark Nieuwenhuijsen2, Rémy Slama1
1French National Institute of Health and Medical Research (Inserm), University Grenoble Alpes, CNRS,Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble,
France.
2ISGlobal, Barcelona, Spain.
3French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Risk

Assessment Department, Methodology and Studies Unit, Maisons-Alfort, France.
4French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Risk

Assessment Department, Air Risk Assessment Unit, Maisons-Alfort, France.
5French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Risk

Assessment Department, Chemicals Assessment Unit, Maisons-Alfort, France.

BACKGROUND AND AIM:Health impact assessment studies quantifying the impact of the chemical andurban exposomes on children's health are lacking. A synthesis of available exposure-response
relationships is an essential first step to fill the gap. We reviewed exposure-response relationships
available in the literature relating risk factors with health outcomes in children.
METHOD:Out of 621 studied factor-outcome pairs for which level of evidence was assessed, 112
factor-outcome pairs had an overall probability of causation above 60% and were therefore prioritized.
This list included risk factors such as perfluoroalkyl compounds (PFOS, PFAS), metals, phthalates,
phenols, pesticides, polycyclic aromatic hydrocarbon (PAH), tobacco, persistent organic pollutants(POP), air pollution, green spaces, food environment, noise and UV radiation. Our search strategy for
exposure-response relationships consisted in looking for meta-analyses first and if not available for
epidemiological studies.
RESULTS:We could identify exposure-response relationships in the literature for 58 factor-outcome
pairs: half from published meta-analyses, half from single epidemiological studies. Exposure-response
relationships were available for tobacco (death, birth outcomes, orofacial clefts, respiratory health),lead (asthma, neurodevelopment, delayed puberty and iron deficiency anaemia), PCBs
(neurodevelopment, bronchitis and birth outcomes), bisphenol A (cognition and obesity), HCB(respiratory health), BDE-47 (neurodevelopment), BDE-153 (behavior), DDE (hypospadias andcryptorchidism), organophosphate pesticides (cognition), methylmercury (cognition), PFAS (immune
system, birth weight, behavior, miscarriage), arsenic (cognition, birth weight), cadmium (cognition,birth weight), manganese (behavior), air pollution (respiratory health), noise (reading
comprehension), green spaces (birth weight), food environment (malnutrition) and heat (birthoutcomes and stillbirth). For 54 of the 112 substance-outcome pairs, there was a lack of doseresponse relationships from epidemiological studies on children.
CONCLUSIONS:This review can be used to identify research gaps and help perform quantitative healthimpact assessment of the exposome on child health.

Keywords: Exposome, Chemical exposures, Children's environmental health, Environmental

epidemiology

VO-048[Birth and pregnancy outcomes » Pregnancy outcomes]

Effects of ambient temperature on preterm birth,stillbirth, and low Apgar score in Soweto, South
Africa: A case-crossover analysis
Cherie Part1, Carmen Briner2, Shakoor Hajat1, Alane Izu2, Matthew Chersich3, Veronique Filippi4, Britt
Nakstad5, Nathalie Roos6, Jeroen De Bont7, Petter Ljungman8, Massimo Stafoggia9, Shabir Madhi2,
Sari Kovats1
1Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine,

London, UK
2Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand,

Johannesburg, South Africa
3Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
4Centre for Maternal, Adolescent, Reproductive, & Child Health, London School of Hygiene & Tropical

Medicine, London, UK
5Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Paediatrics andAdolescent Health, University of Botswana, Gaborone, Botswana
6Department of Medicine, Karolinska Institutet, Stockholm, Sweden
7Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
8Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of

Cardiology, Danderyd Hospital, Stockholm, Sweden
9Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Italy

BACKGROUND AND AIM:To evaluate acute effects of ambient temperature on risk of preterm birth(PTB), stillbirth, and low Apgar score in a low-income urban setting.
METHOD:Time-stratified case-crossover analysis of 18,226 singleton live PTBs (<37 weeks’ gestation),
4,201 stillbirths, and 748 cases of low Apgar score (≤3 at 5 minutes of age) between April 2016 andMarch 2022 in Soweto, South Africa. Gridded daily mean temperatures (ERA5-Land reanalysis) werelinked with outcomes by date of delivery and location of birthing facility (n=10). Low and hightemperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively,
and compared with the temperature of minimum effect (TME). We explored effect modification byseason of birth, facility type, infant sex, maternal age, parity, and HIV status.
RESULTS:High temperature (22.5°C vs TME) 0-6 days before delivery was associated with a 6.7%
(95% CI 1.8% to 11.9%) increased odds of PTB and 19.1% (2.1% to 38.9%) increased odds ofstillbirth. Point estimates of association between high temperature and stillbirth were greater among
women living with HIV, women who gave birth in primary (vs tertiary) facilities, younger women (<35years), and female foetuses. Maternal factors (age, parity) did not modify the effect of hightemperature on PTB. Low temperature (9°C vs TME) 0-6 days before delivery was associated with anincreased odds of stillbirth among nulliparous, but not multiparous, women (73.7%, 1.6% to 196.9%;-6.1%, -34.5% to 34.6%, respectively) and with an increased odds of PTB among HIV-negative
women (23.8%, 0.73% to 52.0%), but not among women living with HIV (-5.3%, -30.9% to 29.9%).
Exposure to high or low temperatures did not increase risk of low Apgar score.
CONCLUSIONS:High ambient temperatures increase risk of PTB and stillbirth in a low-income setting.
For the first time, we show evidence of temperature effect modification by maternal HIV status.

Keywords: Climate, Temperature extremes, Pregnancy outcomes, Birth outcomes, Environmental
epidemiology

VO-049[Chemical exposures » Mixtures]

In utero exposure to synthetic phenols andphthalates and child respiratory health: amixture analysis based on clustering
Claire Philippat1, Ophélie Coiffier1, Lyon Caen Sarah1, Boudier Anne2, Quentin Joane1, Gioria Yoann1,
Sakhi Amrit4, Sabaredzovic Azemira4, Thomsen Cathrine4, Bayat Sam3, Slama Rémy1, Siroux Valérie1
1University Grenoble Alpes, Inserm U1209, CNRS UMR 5309, Team of Environmental Epidemiology

Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences 38000 Grenoble,
France.
2Pediatric Department, Grenoble University Hospital, 38700 La Tronche, France
3Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France
4Norwegian Institute of Public Health, Oslo, Norway

BACKGROUND AND AIM:Exposure to phthalates and synthetic phenols is ubiquitous and some of them
are suspected to impact child respiratory health. We investigated associations between prenatal
exposure to a mixture of phenols and phthalates and child respiratory health in a cohort withimproved exposure assessment and objective markers of lung function at early age.
METHOD:Prenatal exposure to 7 phenols, 4 parabens, 13 phthalate and 2 non-phthalate plasticizer
metabolites was assessed from two pools of 21 maternal urine samples collected in the 2nd and 3rdtrimesters among 457 mother-child pairs. Lung function was assessed using tidal breathing flowvolume loops and nitrogen multiple breath washout at 2 months and by oscillometry at 3 years.
History of respiratory health diseases was evaluated from repeated questionnaires up to 3 years ofage. A cluster-based analysis was applied to identify prenatal exposure patterns. Adjusted linear
regressions were used to study associations between these clusters and respiratory health.
RESULTS:Four prenatal exposure patterns were identified: 1) low concentrations of all biomarkers (n= 106, reference group), 2) low phenols, parabens, moderate phthalates (n = 162), 3) highphthalates, parabens and phenols except bisphenol S (n = 109), 4) high parabens, moderate phenols,
low phthalates (n = 102). At 2 months, compared to cluster 1infants, cluster 2 infants had lower
functional residual capacity and tidal volume and higher ratio of time to peak tidal expiratory flow to
expiratory time (tPTEF/tE) while cluster 3 had lower lung clearance index and higher tPTEF/tE. No
significant association with history of respiratory health disease in the first 3 years of life was detected
as well as with lung function measurements at 3 years.
CONCLUSIONS:Relying on improved exposure assessments and objective markers of lung function ourstudy suggested that prenatal exposure to mixtures of phthalates might reduce lung volume in earlylife.

Keywords: Phenols, Phthalates, Respiratory outcomes, Children’s environmental health, Mixtures
analysisVO-050[Planetary health » Health inequalities]

Environmental and social inequities incontinental France: an analysis of exposure toheat, air pollution and lack of vegetation
Lucie Adélaïde1, Ian Hough2, Emie Seyve3, Itai Kloog4, Grégory Fifre5, Guy Launoy6, Ludivine
Launay7, Mathilde Pascal8, Johanna Lepeule9
1Santé publique France, 12 rue du Val d’Osne, 94415 Saint-Maurice Cedex, France; Université

Grenoble Alpes, Inserm, CNRS, IAB, Site Santé, Allée des Alpes, 38700 La Tronche, France
2Université Grenoble Alpes, Inserm, CNRS, IAB, Site Santé, Allée des Alpes, 38700 La Tronche,

France; Department of Geography and Environmental Development, Ben-Gurion University of the
Negev, Be'er Sheva, Israel
3Université Grenoble Alpes, Inserm, CNRS, IAB, Site Santé, Allée des Alpes, 38700 La Tronche,

France; Université de Paris Cité, Inserm, INRAE, Centre of Research in Epidemiology and StatisticS(CRESS), 75000 Paris, France
4Department of Geography and Environmental Development, Ben-Gurion University of the Negev,

Be'er Sheva, Israel; Department of Environmental Medicine and Public Health, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
5Météo-France, 73 avenue de Paris, 94165 Saint-Mandé Cedex, France
6U1086 Inserm Anticipe, Avenue Général Harris, 14076 Caen Cedex, France; University Hospital ofCaen, 14076 Caen Cedex, France
7U1086 Inserm Anticipe, Avenue Général Harris, 14076 Caen Cedex, France; Plateforme MapInMed,

US PLATON, Avenue Général Harris, 14076 Caen Cedex, France; Centre François Baclesse, Avenue
Général Harris, 14076 Caen Cedex, France
8Santé publique France, 12 rue du Val d’Osne, 94415 Saint-Maurice Cedex, France
9Université Grenoble Alpes, Inserm, CNRS, IAB, Site Santé, Allée des Alpes, 38700 La Tronche, France

BACKGROUND AND AIM:Cumulative exposure to heat, air pollution, lack of vegetation and social
deprivation increases health vulnerability and limits population’s capacity to adapt to climate change.
Our study sought to characterize fine-scale exposure to heat, air pollution and lack of vegetation incontinental France between 2000 and 2018, describe spatio-temporal trends and environmental
hotspots (i.e. areas that cumulate the strongest overexposures), and study association with social
deprivation.
METHOD:European and French social deprivation indexes (EDI and FDep), vegetation (NDVI,Normalized Difference Vegetation Index) and daily temperatures, PM2.5, PM10, NO2 and O3
concentrations were estimated for 48,185 census districts. Reference values were selected tocharacterize (over-)exposures. Hotspots were defined as areas cumulating over-exposure totemperature, air pollution and lack of vegetation. The associations between i) hotspots and ii)
exposure to heat and social deprivation were studied using logistic regressions.
RESULTS:Over-exposure to heat was higher in 2015-2018 compared to 2000-2014. Exposure to all air
pollutants but O3, decreased during the study period. In 2018, 79 to 100 % of the urban census
districts exceeded the 2021 WHO air quality guidelines depending on the air pollutant. Vegetation
stayed stable between 2000 and 2018. In urban areas, the most deprived census districts were athigher risk of being hotspots (odd ratio (OR): 10.86, 95% CI: 9.87-11.98 using EDI and OR:1.07,
95% CI:1.04-1.11 using FDep).
CONCLUSIONS:Nation-wide fine-scale environmental data reveals inequalities in cumulated exposureto heat, air pollutants and lack of vegetation in France. Such approach can support the integration of
inequities in adaptation strategies to climate change.

Keywords: temperature, particulate matter, green space, socio-economic factors, environmental
disparities

VO-051[Planetary health » Food and nutrition]

Rising food/fuel prices from the Russia-Ukraine
war: Pay-as-you-go LPG consumption & foodsecurity impacts in a Kenyan informal urban
settlement
Matthew Shupler1, James Mwitari2, Mark O'keefe3, Federico Lorenzetti1, Willah Nabukwangwa2,
Arthur Gohole2, Tash Perros1, Emily Nix1, Elisa Puzzolo1, Daniel Pope1, Helen Hoka Osiolo4
1Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
2Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
3PayGo Energy Ltd., Nairobi, Kenya
4University of Nairobi, Nairobi, Kenya

BACKGROUND AND AIM:Higher global energy and food prices from the Russian-Ukrainian war have
led to financial hardships worldwide. We assessed impact of higher prices on clean cooking fuelconsumption and food security in Nairobi, Kenya.
METHOD:From August-October 2022, telephonic surveys were administered to 701 customers of
PayGo Energy, a company offering pay-as-you-go liquefied petroleum gas (PAYG LPG) for clean
cooking in an informal settlement in Nairobi. Food security was assessed using the reduced Coping
Strategies Index (rCSI), a validated tool used by the World Food Programme. Survey data was linked
to customers’ PAYG LPG consumption data to compare cooking patterns before/after the start of theRussian-Ukrainian war.
RESULTS:At the time of the survey, 56% (n=393) of PayGo Energy customers were food insecure.
Nearly all (99%; n=692) customers reported an unusual rise in food prices in their community, and
75% (n=524) reported a noticeable increase in the price of PAYG LPG in 2022. Approximately 30%(n=201) of customers reported reducing their PAYG LPG usage due to rising food prices. Because ofhigher LPG costs, 11% (n=77) of households reported decreasing their PAYG LPG consumption and
5% (n=33) switched their primary cooking fuel. From June-September 2022, when Kenyan food prices
were 13-16% above pre-war levels, households significantly reduced their PAYG LPG consumption by
12% (95%CI:-23%,0%) (from 0.93 to 0.82 kg/capita/month), on average, due to rising food costs.
Households that reported reducing their PAYG LPG consumption due to higher food costs were more
likely (68%) to skip more meals in 2022 than households that did not lower their usage (45%).
CONCLUSIONS:Several households reduced their PAYG LPG consumption in 2022 to cope with higher
food and fuel prices. Keeping these costs stable is important for maintaining food security and accessto clean cooking fuels in informal urban settlements in Kenya.

Keywords: Russia-Ukraine war, food security, energy security, LPG, clean cooking

VO-052[One health » Public health]

Monitoring human-related Encephalitozoon spp.
in farms from Makeni, Sierra Leone
Sergio Llorens Berzosa1, Umar Anjum2, Ethel Ukaegbu3, Fernando Izquierdo1, Antonio Peña
Fernandez2
1Facultad de Farmacia, Universidad San Pablo CEU, Urbanización Montepríncipe, Boadilla del Monte,

Madrid, Spain.
2Leicester School of Allied Health Sciences, De Montfort University, Leicester, LE1 9BH, UK.
3Public Health Department. University of Makeni, Makeni, Sierra Leone.

BACKGROUND AND AIM:Encephalitozoon spp. were previously detected in farm animal faeces sampled
in 2019 from different recreational areas/farms across Bombali and Tonkolili Districts (Sierra Leone).
To perform further monitoring of these species in animals, food and the environment from different
farms (Lion Poultry and family farms) to identify potential risks for the food chain.
METHOD:Ninety-eight samples were collected in Summer 2022: 50 farm animal faeces (chicken, duck,sheep, goat, cow, pig) and 25 water, 20 food and 3 leaf that these farm animals were eating/drinking.
Spores of human-related Encephalitozoon were investigated in concentrated/pre-treated samples byimmunofluorescent-antibody test using a specific monoclonal antibody (Mab) of murine origin IgG2a,patented as a diagnostic tool.
RESULTS:Sixteen samples were positive for spores of the genus Encephalitozoon, specifically 14
animals (8 chicken, 3 goats, 2 ducks, 1 pig) and 2 water. None of the food samples were positive.
Moreover, structures compatible with Encephalitozoon spp. were observed in 5 animal (2 duck, andone chicken, sheep, goat and pig) and 3 water samples. This is the first study reporting the presenceof human-related microsporidia in ducks. Results would be similar to those observed in 2019,suggesting a moderate circulation of Encephalitozoon spp. in the farms. Thus, spores were molecularly
detected using SYBR Green real-time PCR in three goat fresh faecal samples [two E. intestinalis andone E. cuniculi] after processing 75 goat samples in 2019.
CONCLUSIONS:Encephalitozoon spp. could infect humans living in close proximity to these farms
and/or through consumption of contaminated water and/or these farm animals. Although zoonotic
transfer of microsporidia from farm animals to humans are rare, appropriate cleaning andimplementation of hygiene practices and food processing/management would be required to minimise
the risks of infection, especially in immunocompromised individuals due to the opportunistic nature ofthese parasites.

Keywords: Microsporidia, Encephalitozoon, animal and food samples, farms, Sierra Leone.

VO-053[Outcomes » Infectious diseases]

Association between long-term exposure to air
pollution, risk of infection by SARS-CoV-2 virus
and COVID-19 in the French CONSTANCES
cohortChao Xu1, Emeline Lequy2, Antoine Lafontaine1, Kees De Hoogh3, Marcel Goldberg2, Danielle
Vienneau3, Emmanuel Wiernik2, Marie Zins2, Fabrice Carrat4, Emilie Burte5, Bénédicte Jacquemin1
1Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-35000 Rennes, France.
2UVSQ, Inserm UMS 11, Université Paris-Saclay, Université Paris-Cité, Villejuif, France
3Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel,

Switzerland
4Institut Pierre-Louis d’Épidémiologie et de Santé Publique, Sorbonne Université, Inserm,

Département de santé publique, Hôpital Saint- Antoine, APHP, 27 rue Chaligny, 75571 Paris Cedex 12,
France5Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-35000 Rennes, France.CHU Rennes, Rennes, France

BACKGROUND AND AIM:Several studies suggested long-term air pollution exposure was associated toincreased risk of SARS-CoV-2 infection. However, the evidence remains limited for individual-levelstudies and particularly using serology data.
Our objective was to investigate the association between long-term exposure to air pollution and 1)
SARS-CoV-2 infection and 2) COVID-19 disease, among adults from the SAPRIS study based on the
French CONSTANCES population-based cohort.
METHOD:SARS-CoV-2 serology was assessed between May to October 2020 using ELISA test, and
COVID-19 disease was defined by self-reporting medical diagnosis of SARS-COV-2 infection andassociated symptoms. Pre-pandemic (2019) annual exposure to PM with an aerodynamic diameter of≤2.5 (PM2.5), black carbon (BC) and nitrogen dioxide (NO2), was estimated at residential addressusing hybrid land-use regression model. Log-binomial risk ratios (RRs) with inclusion center as arandom effect, adjusting for individual and area-level covariates were used.
RESULTS:Among the 33975 participants, 1695 (4.99%) had a positive serology, and 802 (2.8%)
reported COVID-19 disease. Exposure to PM2.5 and NO2 were associated to a higher probability of
SARS-COV-2 infection (Adjusted RRs per interquartile increase (aRR[95%CI]): 1.28 [1.09: 1.49] forPM2.5, 1.21 [1.07: 1.36] for NO2) and COVID-19 disease (1.40 [1.10: 1.78] for PM2.5, 1.42 [1.19:
1.70] for NO2). Stratified analysis showed higher associations of PM2.5 and NO2 to SARS-COV-2
infection among men, participants over 60 years old, or with pre-existent chronic disease, and to
COVID-19 disease among participants with pre-existent chronic disease. Exposure to BC wasassociated to a higher probability of COVID-19 disease (aRR=1.20 [1.03: 1.39]) but not SARS-COV-2
infection (1.08 [0.94-1.19]), except in stratified analysis in the tertile of the most deprived area.
CONCLUSIONS:Long-term exposure to air pollution was substantially associated to increased risks of
SARS-COV-2 infection and COVID-19 disease. These results could help to better understand or
prevent respiratory infections.

Keywords: air pollution, long-term, infectious disease, COVID-19

VO-054[Built environment » Noise]

Health impact assessment of road traffic noise
exposure – A case study of a pre- and postdensification scenario
Kristoffer Mattisson, Erin Flanagan, Anna Oudin, Ebba Malmqvist
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden

BACKGROUND AND AIM:In many places worldwide there is an ongoing urbanization, often achieved
through densification. An increased number of inhabitants in an area often leads to both increased
traffic and placement of new buildings closer to roads, and thus increased population exposure to roadtraffic noise. The aim of the study was to estimate and compare the health impacts of road traffic
noise exposure for an urban area pre- and post-densification.
METHOD:Noise at the façade of residential buildings within the area of Drottninghög located in the cityof Helsingborg, Southern Sweden, was simulated using the Nordic prediction method for road trafficand exposure assessed for all people living in the area Geographical Information Systems software
SoundPLAN. Health impact assessments based on exposure-response functions from The Worlds
Health Organisation was calculated including road traffic noise annoyance and adverse sleep
disturbance.
RESULTS:A large proportion (70%) of the population was found to be exposed above the health-based
guideline value of Lden 53 dB(A) in pre-densification scenario. In the post-densification scenario this
proportion increased even further to 85% of the population. The proportion of annoyed in the predensification scenario were 5.8% compared to 11.2% in the post-densification and the proportion
adversely sleep disturbed 2.8% respectively 4.3%.
CONCLUSIONS:Densifying the area in accordance with the municipal planned strategy willconsiderably increase the proportion of annoyed and sleep disturbed part of the population living in
the area. Health is an important aspect in creating a sustainable city and urban planning initiatives
needs to be more ambitious.

Keywords: Exposure assessment, Modeling, Risk assessment, Traffic-relatedVO-055[Respiratory and allergic outcomes » Respiratory outcomes]

Municipality assessment of temperature-related
respiratory morbidity risks in Norway
Liliana Vázquez Fernández, Shilpa Rao
Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway

BACKGROUND AND AIM:Local differences in health risks associated with heat and cold temperatures
may result from heterogeneity in the distributions of the drivers of vulnerability. Identifying theserisks factors is crucial to characterize local vulnerability and cope with the trends in changes intemperature improving adaptation to climate change by designing tailored public health interventions.
We aimed to analyse the association between ambient air temperature and respiratory morbidity(hospitalizations) in mainland Norway, and to characterize municipal-level patterns in the risks andimpacts of temperature-related respiratory morbidity.
METHOD:We estimated the association of heat- and cold-related respiratory morbidity by designingcase time series and distributed nonlinear lag models on mean daily temperature and series of
respiratory hospitalizations between 2008 and 2018 for 356 municipalities in Norway. We then derived
pooled associations of heat and cold morbidity for the 11 counties through multivariate metaregression and assessed potential vulnerability factors among predictors of socioeconomic, climate,and other environmental factors at the municipality level.
RESULTS:The analysis included 4 980 626 hospitalizations with a respiratory ICD-10 code, of which
70% corresponded to under 65 years old and under 5% to over 85 years. On average, the relative
risks (RR) due to temperatures increased with younger age and were highly dissimilar geographically.
Under 65 years group reported consistently higher pooled RR at 1st percentile and 99th percentile vs.
the minimum mortality temperature (MMT) than the older groups (RR at 1st percentile 3.83 (95%CI
1.83-7.99), vs. 65-74 2.12 (1.01-4.45), 75-84 1.62 (1.47-1.79), 85+ 1.51 (1.38-1.64) and at 99th
percentile 0-64 1.46 (0.73-2.89), vs. 65-74 1.16 (0.57-2.37), 75-84 1.04 (0.95-1.13) and 85+, 1.00
(0.99-1.01)).
CONCLUSIONS:Our analysis suggests that public health and climate policies should consider both local
and national levels standpoints for designing tailored interventions and effective implementations.

Keywords: Environmental epidemiology, temperature, morbidity, hospitalizations

VO-056[Exposure assessment methods » Other (to be specified with keywords in the keywords section)]

Outdoor artificial light-at-night and cancer risk:
an exposure assessment comparative study
between DMSP, VIIRS and ISS satellite data
Anna Palomar Cros1, Barbara N Harding1, Antonia Valentín1, Ana Espinosa2, Alejandro Sánchez De
Miguel3, Gemma Castaño Vinyals2, Victor Moreno4, Beatriz Pérez Gómez5, Marina Pollán5, Manolis
Kogevinas2
1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; CIBER Epidemiology and Public Health CIBERESP, ISCIII, Madrid, Spain.
2Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF),

Barcelona, Spain; CIBER Epidemiology and Public Health CIBERESP, ISCIII, Madrid, Spain; IMIM
(Hospital del Mar Medical Research Institute), Barcelona, Spain.
3Environment and Sustainability Institute, University of Exeter, Penryn Campus, Penryn, Cornwall,

United Kingdom; Departamento Física de la Tierra y Astrofísica, Universidad Complutense de Madrid,
Madrid, Spain
4CIBER Epidemiology and Public Health CIBERESP, ISCIII, Madrid, Spain;Colorectal Cancer Group,

ONCOBELL Program, Bellvitge Biomedical Research Institute, Barcelona, Spain; Oncology Data
Analytics Program, Catalan Institute of Oncology, Barcelona, Spain; Consortium for Biomedical
Research in Epidemiology and Public Health, Madrid, Madrid, Spain; Department of Clinical Sciences,
Faculty of Medicine, University of Barcelona, Barcelona, Spain.
5CIBER Epidemiology and Public Health CIBERESP, ISCIII, Madrid, Spain; National Centre for

Epidemiology, Carlos III Institute of Health, Madrid, Spain.

BACKGROUND AND AIM:Artificial light-at-night (ALAN) exposure alter circadian rhythms and health.
Most studies use images from the Defense Meteorological Program (DMSP) or the Visible Infrared
Imaging Radiometer Suite (VIIRS) that do not provide information on blue light spectrum. The DMSP
has low spatial resolution (>1km to 5km) and poor sensitivity at low-level exposures. We previously
studied ALAN in relation to colorectal cancer (CRC) using images from the International Space Station(ISS) with high resolution (30m) and color information. We compared individual exposure data fromthe three satellites and their associations with CRC risk.
METHOD:We used data from 410 CRC cases and 970 controls from the MCC-Spain study (2008-2013),
in Barcelona and Madrid. Visual ALAN (radiance) was assessed from DMSP-OLS (2011) and VIIRS(2013) and was compared to visual ALAN (luminance) and an index of blue light spectrum from ISS
images (2012 Madrid; 2013 Barcelona). Estimates were assigned to participants’ residence using GIS.
We compared agreement between estimates (standardized) using Bland Altman plots, and estimated
OR for cancer risk adjusting for relevant confounders.
RESULTS:Both VIIRS and DMSP-OLS-assessed visual light, underestimated ALAN compared to ISS,and there was poor correlation between the three sources of ALAN data. Using ISS data we found an
association between blue light exposure and CRC risk (OR=1.70, 95%CI 1.46–1.99) but no associationfor visual light. We observed an association between DMSP-OLS and CRC risk (OR=1.34, 1.16–1.55).
Finally, we observed a non-linear inverse association between VIIRS and CRC risk.
CONCLUSIONS:Our results suggest that blue light, which is the most relevant to circadian disruption,is most strongly associated with cancer risk. There is a need for validation and standardization of
methods assessing ALAN in epidemiological studies. Older, imprecise methods should be substitutedby images with precise spatial resolution and accurate light estimation, including spectrum data.

Keywords: Artificial light-at-night, satellites, circadian misalignment, cancer

VO-057[Air pollution » Particulate matter]

The impact of the new World HealthOrganization Air Quality Guidelines for
Particulate Matter on the life expectancy inGermany
Myriam Tobollik1, Dietrich Plass2, Dirk Wintermeyer2, Sarah Kienzler2
1Department Environmental Medicine and Health Effects Assessment, German Environment Agency,

Berlin, Germany
2Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin,

Germany

BACKGROUND AND AIM:In 2021 the World Health Organization (WHO) has published their new air
quality guidelines, with much lower guidelines for particulate matter (PM2.5). We aim to estimate thegain in life expectancy if the guideline value for PM2.5 would have been met in Germany in 2017.
METHOD:Using the life table approach we estimated the life expectancy gain if the PM2.5
concentrations in Germany would be reduced to the annual WHO air quality guideline of 5 µg/m3. A
relative risk of 1.08 (95% confidence interval (CI) 1.06-1.09) is applied to the mortality risk of themale and female German population in 2017.
RESULTS:If the average population based PM2.5 exposure in 2017 of 10.7 µg/m3 would be reduced to
5 µg/m3 the life expectancy of males would be prolonged by 154 (95% CI 116-172) days and offemales by 137 (95% CI 103-153) days. For males the life expectancy is prolong from 79.9 years to
80.1 years and for females from 83.9 to 84.3 years if the WHO PM2.5 guideline would be met.
CONCLUSIONS:The compliance of the air quality with the WHO air quality guidelines would have apositive impact on the German life expectancy.

Keywords: Mortality, Public health, Exposure assessment-air pollution, Environmental epidemiology

VO-058[Air pollution » Particulate matter]

Long-term exposure to air pollution and noise,and cardiovascular biomarkers
Sara Allaouat1, Tarja Yli Tuomi2, Pekka Tiittanen2, Jaakko Kukkonen3, Leena Kangas4, Santtu
Mikkonen5, Tiia Ngandu6, Pekka Jousilahti6, Timo Lanki7
1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;

Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
2Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
3Finnish Meteorological Institute, Helsinki, Finland; Centre for Atmospheric and Climate Physics

Research and Centre for Climate Change Research, University of Hertfordshire, Hatfield, UK
4Finnish Meteorological Institute, Helsinki, Finland
5Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
6Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
7Department of Environmental and Biological Sciences and Institute of Public Health and ClinicalNutrition, University of Eastern Finland, Kuopio, Finland; Department of Health Security, Finnish
Institute for Health and Welfare, Kuopio, Finland

BACKGROUND AND AIM:To explore the associations between long-term exposure to PM₂.₅ (i.e.,
particulate matter with an aerodynamic diameter below 2.5 µm) from road-traffic and residential wood
combustion, road-traffic noise, and serum C-reactive protein (CRP), a biomarker for e.g. infection,
inflammation, and cardiovascular risk. To evaluate the association between long-term exposure toroad-traffic nitrogen dioxide (NO₂) and the serum cardiovascular biomarkers troponin I and NT-proBtype natriuretic peptide (NT-proBNP).
METHOD:We obtained the outcome data from the Finnish population based FINRISK study for theperiod 1997-2012. Participants were living in Helsinki, Vantaa, or Turku regions and aged 25–74.
Exposure levels were obtained from detailed emission and atmospheric dispersion computations aswell as the cities involved in the study, and linked to the home addresses of study participants. PM₂.₅
exposure was estimated by using the predicted yearly source-specific PM₂.₅ concentrations in outdoor
air. We performed cross-sectional analyses using linear and additive models and adjusted for potential
confounders.
RESULTS:The mean concentrations for road-traffic PM₂.₅, wood combustion PM₂.₅ and road-traffic
NO₂ in the study samples were 0.64, 0.44 and 7.79 µg/m3, respectively. We found no association
between road-traffic PM₂.₅ (% CRP change for 1 µg/m3 increase in PM₂.₅ levels: 0.6; 95 % CI: -9.6,
12.0; n = 4147), wood combustion PM₂.₅ (-11.8; 95 % CI: -26.2, 5.3; n = 4147) or road-traffic noise
and CRP. We also found no association between road-traffic NO₂ and troponin I (% troponin I change
for 1 µg/m3 increase in NO₂ levels: 0.4; 95 % CI: -0.7, 1.5; n = 1434) or NT-proBNP (-0.4; 95 % CI:-1.5, 0.7; n = 1407).
CONCLUSIONS:Long-term exposure to relatively low levels of air pollution from traffic and residential
wood combustion and to road-traffic noise were not associated with the cardiovascular biomarkers
investigated in this study.

Keywords: Particulate matter, oxides of nitrogen, noise, long-term exposure, cardiovascular diseases

VO-059[Chemical exposures » Pesticides]

Domestic use of pesticides during adulthoodand risk of testicular germ cell tumors: a Frenchnationwide case-control study
Séphora Campoy1, Astrid Coste2, Juliette Marie Dessemon1, Béatrice Fervers3
1Département Prévention Cancer Environnement, Centre Léon Bérard, 28 Rue Laennec, CEDEX 08,

69373 Lyon, France / Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon
Est, F-69008 Lyon, France
2Département Prévention Cancer Environnement, Centre Léon Bérard, 28 Rue Laennec, CEDEX 08,

69373 Lyon, France / INSERM, UMR 1296, Radiations: Defense, Health, Environment, Lyon, France
3Département Prévention Cancer Environnement, Centre Léon Bérard, 28 Rue Laennec, CEDEX 08,

69373 Lyon, France / Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon
Est, F-69008 Lyon, France / INSERM, UMR 1296, Radiations: Defense, Health, Environment, Lyon,
FranceBACKGROUND AND AIM:The most frequent cancers among men between 15 and 39 years old,
testicular germ cell tumors (TGCT), have seen their incidence growing significantly in the past few
decades. Hypotheses have been made that this could be due to environmental causes, one of them
being the exposure to pesticides. Here, we estimated the association between domestic use ofpesticides during adulthood and risk of TGCT.
METHOD:A nationwide case-control study was conducted in 20 university French hospitals, 454 casesof TGCT and 670 controls were recruited. A questionnaire was administered collecting
sociodemographic data, medical history and domestic pesticide use between 18 and 25 years old,
divided in any use of pesticides, insecticides, herbicides and fungicides. Multivariate conditional logistic
regression adjusted for confounders (identified using a directed acyclic graph: participant’s educationand occupation, lived for more than 6 months in rural area during adulthood and use of pesticides
during puberty) was used to estimate odds ratios (OR) for TGCT and by histological subtypes (nonseminomas and seminomas) and their 95% confidence interval (CI).
RESULTS:The prevalence of reported use of any pesticides between 18 and 25 was 85.8% (84.8% forinsecticides, 13.3% for herbicides and 16.7% for fungicides). For domestic exposure to any pesticides
during adulthood statistically significant positive associations with overall TGCT (OR=1.59, CI=1.132.22) and seminomas (OR=2.05, CI=1.20-3.54) were found but not for non-seminomas (OR=1.27,
CI=0.80-2.03). For sub-categories of pesticides, only the use of any insecticides showed a statisticallysignificant positive association with overall TGCT (OR=1.51, CI=1.09-2.08), persistent for seminomas(OR=1.75, CI=1.07-2.86) but not for non-seminomas (OR=1.29, CI=0.81-2.04).
CONCLUSIONS:This study provides some evidence of a positive association between exposure todomestic pesticides during adulthood, particularly insecticides, and TGCT, specifically seminomas
cases.

Keywords: Cancer and cancer-precursors, Testicular germ cell tumors, Risk assessment,
Environmental epidemiology

VO-060[Birth and pregnancy outcomes » Pregnancy outcomes]

Longitudinal associations between prenatal
exposure to phthalates and steroid hormones inmaternal hair samples from the SEPAGES cohort
Vicente Mustieles1, Aurélien Lascouts1, Oscar J. Pozo2, Noemí Haro2, Sarah Lyon Caen1, Sam Bayat3,
Cathrine Thomsen4, Amrit K. Sakhi4, Azemira Sabaredzovic4, Rémy Slama1, Isabelle Ouellet Morin5,
Claire Philippat1
1Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute forAdvanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France.
2Applied Metabolomics Research Group, IMIM, Hospital del Mar, Doctor Aiguader 88, Barcelona, Spain
3Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France. PediatricDepartment, Grenoble Alpes University Hospital, 38700 La Tronche, France.
4Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway.
5Research Center, Institut Universitaire en Santé Mentale de Montréal, Québec, Canada; School of

Criminology, Université de Montréal, Québec, Canada.

BACKGROUND AND AIM:Phthalate metabolites have been linked to hormonal disruption in laboratory
animals and a few mother-child cohorts. Data on phthalate replacements is scarce. Our objective wasto study the longitudinal associations between prenatal exposure to phthalates and maternal steroid
hormones at delivery in a new-generation cohort.
METHOD:Among 382 mother-child dyads from the French SEPAGES cohort (Grenoble, France),
metabolites from 7 phthalate compounds and the replacement di(isononyl)cyclohexane-1,2dicarboxylate (DINCH) were measured in within-subject pools of repeated urine samples collected at
the second and third pregnancy trimesters (≈21 samples/trimester). Metabolites from 5 steroid
hormones were measured in maternal hair samples collected 1-3 days after delivery reflecting on theircumulative levels over the third trimester. Associations between phthalate metabolites (individually or
as a mixture) and hormones were examined using adjusted linear and Bayesian Weighted Quantile
Sum (BWQS) regression models at both the second and third trimesters of pregnancy.
RESULTS:Each doubling in third trimester urinary mono-benzyl phthalate (MBzP) concentrations, ametabolite of butyl-benzyl-phthalate (BBzP), was associated with average increases of 12.9%(95%CI: 2.52, 24.2) for ∑cortisol, 10.5% (95%CI: 0.44, 21.5) for ∑cortisone, 16.5% (95%CI: 5.67,
28.4) for 11-dehydrocorticosterone and 11% (95%CI: 2.27, 20.4) for testosterone, together with asuggestive 10.5% (95%CI: -1.57, 24.1) increase in progesterone hair levels. Each doubling in second
trimester sums of di-isononyl phthalate (∑DiNP) metabolites and ∑DINCH metabolites were inversely
associated with testosterone hair levels (-4.70%; 95%CI: -8.72, -0.50 and -6.73%; 95%CI: -12.9, 0.12, respectively). Other associations appeared isolated, not following a pattern. A non-significant
trend towards a positive phthalate mixture effect was observed with most hormones at the third - but
not second – trimester, with MBzP and mono-isobutyl phthalate (MiBP) showing the highest weights.

CONCLUSIONS:This cohort with improved exposure and hormone assessment showed that somephthalates, especially BBzP, may affect steroid hormone levels during pregnancy.

Keywords: endocrine disruption, phthalate, cortisol, testosterone, pregnancy

VO-061[Methods » Environmental epidemiology]

Associations between perinatal urban
environment and children cardiometabolic
health phenotypes at age 5 years
Wen Lun Yuan1, Aminata Hallimat Cissé2, Muriel Tafflet2, Olfa Khalfallah3, Laëtitia Davidovic3, Marie
Aline Charles4, Johanna Lepeule5, Barbara Heude2
1Université Paris Cité, Inserm, INRAE, CRESS, F-75004 Paris, France; Singapore Institute for Clinical

Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
2Université Paris Cité, Inserm, INRAE, CRESS, F-75004 Paris, France
3Centre National de la Recherche Scientifique, Université Côte d’Azur, Institut de Pharmacologie

Moléculaire et Cellulaire, Valbonne, France
4Université Paris Cité, Inserm, INRAE, CRESS, F-75004 Paris, France; Unité mixte Inserm-Ined-EFS

ELFE, Ined, F-75020, Paris, France
5Université Grenoble Alpes, Inserm, CNRS, IAB, Team of Environmental Epidemiology Applied to

Development and Respiratory Health, 38000, Grenoble, France

BACKGROUND AND AIM:Evidence suggests that urban environment comprising air pollution, built
environment and noise, encompassing pregnancy period, could affect fetus future cardiometabolic
health. Cardiometabolic health parameters were previously mostly explored one at a time, ignoring
their intercorrelation. This study aims to investigate children sex-specific cardiometabolic healthphenotypes at age 5 years in associations with prenatal urban environment.
METHOD:A subsample of the EDEN mother-child cohort study, with available data on biological blood
sampling once the offspring turned 5, was analyzed (n=686). Pregnant women residential exposures
included estimates of air pollution, built environment, natural spaces, traffic, meteorology, unhealthy
food environment and area deprivation index (p=33). Four sex-specific cardiometabolic healthpatterns were previously derived by principal component analysis (“higher adiposity”, “higher insulin
resistance”, “unhealthier lipid profile”, “higher blood pressure” in boys; “higher adiposity”, “higher
insulin resistance and healthier lipid profile”, “higher insulin resistance and unhealthier lipid profile”,“higher blood pressure” in girls). Exposome-wide analysis, i.e. single exposure model, using multiple
linear regression adjusted for parental socioeconomic background (study center, parental educational
attainment, household income) and imputed for missing covariates were carried out. Multiple testingcorrection was performed.
RESULTS:Greater population density (individuals/km²) during pregnancy was associated with boys’higher score for the “unhealthier lipid profile” pattern (β [CI95%]: 0.25 [0.09-0.40]). Living in thehighest deprivation area ("highest quintile") was also associated with girls’ higher score for a “highinsulin resistance and unhealthier lipid profile” pattern (β [CI95%]: 0.70 [0.24-1.16]). No further
associations were observed.
CONCLUSIONS:Children whose mothers lived in a deprived area during pregnancy were more likely tohave an unhealthier lipid profile at 5 years. Our findings call for replications at later ages and in otherpopulation and eventually for further investigation of the proportion of these associations mediated bylifestyle.

Keywords: Environmental epidemiology, Obesity and metabolic disorders, Socio-economic factors,
Children's environmental health