School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Subject: search.filters.subject.Asthma

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Now showing 1 - 6 of 6
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    Examining Consumer Product Use And Phthalate Exposure Among Vulnerable Populations
    (2023) Boyle, Meleah; Quirós-Alcalá, Lesliam; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    One in 13 Americans have asthma, and higher rates have been reported among women and Black children.1 In addition, hairdressers who are exposed to chemicals through products used on themselves and their clients frequently report respiratory symptoms and conditions.2–10 Limited studies indicate that chemicals in personal care and consumer products (PCP) may impact respiratory health.11–14 The goal of this dissertation is to describe PCP use and exposures to recognized and suspected respiratory irritants (phthalates) among vulnerable populations who may experience disparate exposures. The aims are to: 1) characterize PCP use among 110 children with asthma, 2) examine associations between PCP use and asthma morbidity among 110 children with asthma, and 3) characterize concentrations and exposure determinants to phthalate metabolites in post-shift urine samples among 23 female hairdressers and 17 female office workers. In aim 1, participants were majority Black (87%), males (56%), and aged 8-11 years (66%). Adolescents (12-17 years) and females reported more frequent use of hair, face, and body products compared to children (8-11 years) and males. Participants used chemical treatments on their hair as young as 4 years and females 11-16 years used feminine wipes, spray, and regular deodorant in the genital area. For aim 2, use of aerosol products, hair products, and nail polish were positively associated with maximal symptom days [number of aerosol products (aOR: 1.36; CI: 1.17, 1.59), hairspray (aOR: 1.63; CI: 1.14, 2.33), perfume (aOR: 1.40; CI: 1.11,1.77); shampoo (aOR: 1.34; CI: 1.05,1.73), hair sheen (aOR: 1.41; CI: 1.00, 2.00), nail polish (aOR: 2.42; CI: 1.72, 3.41)] among children with asthma. For Aim 3, the geometric mean (GM) for monoethyl phthalate (MEP) was 10 times higher among hairdressers (161.4 ng/mL) than office workers (15.3 ng/mL). Hairdressers who provided chemical services had higher GM MEP concentrations than those who did not: texturizing (200.2 vs. 115.4 ng/mL), relaxing (181.6 vs. 92.1 ng/mL), bleaching (182.3 vs. 71.6 ng/mL), hair color (171.9 vs. 83.2 ng/mL), and Brazilian blowout (181.4 vs. 134.6 ng/mL). Hairdressers who provided natural services had lower GM MEP concentrations than those who did not: twists (129.1 vs. 215.8 ng/mL), sister locs/locs (86.0 vs. 241.9 ng/mL), and afros (94.7 vs. 203.9 ng/mL). While larger studies are needed, this dissertation provides new data on PCP use and phthalate exposure among Black children and hairdressers.
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    Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies
    (Springer Nature, 2011-11-11) Kolokotroni, Ourania; Middleton, Nicos; Nicolaou, Nicolas; Pipis, Spyros; Priftis, Kostas N; Milton, Donald K; Yiallouros, Panayiotis K
    The prevalence of childhood asthma and allergies in Cyprus was significantly higher in urban compared to rural areas back in the year 2000, against a background of an overall low prevalence (e.g. current wheeze 6.9%) by comparison to northern European countries. In this study we aimed to assess temporal changes in the prevalence of asthma and allergies in Cyprus after an 8-year interval and to examine whether any differential changes have occurred in urban and rural parts of the island. During the academic years 1999-2000 and 2007-2008, the parents of 7-8 year old children residing in the same set of urban and rural areas completed the ISAAC core questionnaire. In addition to providing prevalence estimates of allergic diseases in 2000 and 2008, changes between the two periods were expressed as odds ratios estimated in multiple logistic regression models adjusting for survey participants' characteristics. The prevalence of current wheeze was higher in 2008 (8.7%, 95% confidence interval 7.5%-9.9%, n = 2216) than the previously recorded figure in 2000 (6.9%, 95% CI 6.2%-7.6%, OR = 1.25, 95% CI: 1.02-1.53, n = 4944). Significant increases were also seen in the prevalence of lifetime asthma (11.3% vs. 17.4%, OR = 1.59, CI: 1.36-1.86), eczema (6.8% vs. 13.5%, OR = 1.91, CI: 1.59-2.29) and allergic rhinoconjuctivitis (2.6% vs. 5.2%, OR = 1.82, CI: 1.39-2.41). The prevalence of current wheeze nearly doubled between 2000 and 2008 in rural areas (5.4% vs. 9.7%, OR 1.81, CI: 1.24-2.64) while no significant change was observed in urban areas (7.5% vs. 8.4%, OR 1.08, CI: 0.84-1.37); p value for effect modification = 0.04. Rises in asthma and rhinitis prevalence, but not eczema were also more pronounced in rural compared to urban areas. The prevalence of allergic diseases in Cyprus is still on the rise; recent increases appear more pronounced among children living in rural areas possibly indicating recent environmental and lifestyle changes in these communities.
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    Effects of endotoxin exposure on childhood asthma risk are modified by a genetic polymorphism in ACAA1
    (Springer Nature, 2011-12-08) Sordillo, Joanne E; Sharma, Sunita; Poon, Audrey; Lasky-Su, Jessica; Belanger, Kathleen; Milton, Donald K; Bracken, Michael B; Triche, Elizabeth W; Leaderer, Brian P; Gold, Diane R; Litonjua, Augusto A
    Polymorphisms in the endotoxin-mediated TLR4 pathway genes have been associated with asthma and atopy. We aimed to examine how genetic polymorphisms in innate immunity pathways interact with endotoxin to influence asthma risk in children. In a previous analysis of 372 children from the Boston Home Allergens and the Connecticut Childhood Asthma studies, 7 SNPs in 6 genes (CARD15, TGFB1, LY96, ACAA1, DEFB1 and IFNG) involved in innate immune pathways were associated with asthma, and 5 SNPs in 3 genes (CD80, STAT4, IRAK2) were associated with eczema. We tested these SNPs for interaction with early life endotoxin exposure (n = 291), in models for asthma and eczema by age 6. We found a significant interaction between endotoxin and a SNP (rs156265) in ACAA1 (p = 0.0013 for interaction). Increased endotoxin exposure (by quartile) showed protective effects for asthma in individuals with at least one copy of the minor allele (OR = 0.39 per quartile increase in endotoxin, 95% CI 0.15 to 1.01). Endotoxin exposure did not reduce the risk of asthma in children homozygous for the major allele. Our findings suggest that protective effects of endotoxin exposure on asthma may vary depending upon the presence or absence of a polymorphism in ACAA1.
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    Prevalence of asthma and allergies in children from the Greek-Cypriot and Turkish-Cypriot communities in Cyprus: a bi-communal cross-sectional study
    (Springer Nature, 2013-06-16) Lamnisos, Demetris; Moustaki, Maria; Kolokotroni, Ourania; Koksoy, Huseyin; Faiz, Muharrem; Arifoglu, Kenan; Milton, Donald K; Middleton, Nicos; Yiallouros, Panayiotis K
    The Greek-Cypriot (G/C) and Turkish-Cypriot (T/C) communities have lived apart since 1974, with the former presumably adopting a more westernized way of life. We estimated the prevalence of asthma and allergies among children in the two communities and investigated differences in socio-demographic and lifestyle risk factors. The ISAAC questionnaire was completed by 10156 children aged 7–8 and 13–14 years. Relative differences in asthma and allergic symptoms between the two communities were expressed as odds ratios (OR), estimated in multivariable logistic regression models before and after adjusting for participants’ risk characteristics. In contrast to our original speculation, consistently lower prevalence rates were observed for respiratory outcomes (but not eczema) among G/C compared to T/C children in both age-groups. For instance, the prevalence of current wheeze among 7–8 year-olds was 8.7% vs 11.4% (OR = 0.74, 95%, CI: 0.61, 0.90) and of current rhinoconjuctivitis 2.6% vs 4.9% (OR = 0.52, 95% CI: 0.37, 0.71). Surprisingly, the proportion reporting family history of allergy was almost double in the G/C community. With the exception of early life nursery attendance, several protective factors were more prevalent amongst T/C, such as bedroom sharing, less urbanized environment and exposure to farm animals. In contrast, exposure to tobacco smoke was more frequent in the T/C community. Controlling for risk factors did not account for the observed lower prevalence of current wheeze (in the younger age-group) and rhinoconjuctivitis (in both age-groups) among G/C children while differences in the prevalence of eczema between the two communities were no longer statistically significant. A mixed picture of potential risk factors was observed in the two communities of Cyprus, not consistently favoring one over the other community since, for example, bedroom sharing and rural living but also exposure to tobacco smoke were more common among T/C children. Investigated risk factors do not fully account for the lower prevalence of asthma and allergies among G/C children, especially against a background of higher family history of allergy in this community.
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    Exposure to extreme heat and precipitation events associated with increased risk of hospitalization for asthma in Maryland, U.S.A.
    (Springer Nature, 2016-04-27) Soneja, Sutyajeet; Jiang, Chengsheng; Fisher, Jared; Upperman, Crystal Romeo; Mitchell, Clifford; Sapkota, Amir
    Several studies have investigated the association between asthma exacerbations and exposures to ambient temperature and precipitation. However, limited data exists regarding how extreme events, projected to grow in frequency, intensity, and duration in the future in response to our changing climate, will impact the risk of hospitalization for asthma. The objective of our study was to quantify the association between frequency of extreme heat and precipitation events and increased risk of hospitalization for asthma in Maryland between 2000 and 2012. We used a time-stratified case-crossover design to examine the association between exposure to extreme heat and precipitation events and risk of hospitalization for asthma (ICD-9 code 493, n = 115,923). Occurrence of extreme heat events in Maryland increased the risk of same day hospitalization for asthma (lag 0) by 3 % (Odds Ratio (OR): 1.03, 95 % Confidence Interval (CI): 1.00, 1.07), with a considerably higher risk observed for extreme heat events that occur during summer months (OR: 1.23, 95 % CI: 1.15, 1.33). Likewise, summertime extreme precipitation events increased the risk of hospitalization for asthma by 11 % in Maryland (OR: 1.11, 95 % CI: 1.06, 1.17). Across age groups, increase in risk for asthma hospitalization from exposure to extreme heat event during the summer months was most pronounced among youth and adults, while those related to extreme precipitation event was highest among ≤4 year olds. Exposure to extreme heat and extreme precipitation events, particularly during summertime, is associated with increased risk of hospitalization for asthma in Maryland. Our results suggest that projected increases in frequency of extreme heat and precipitation event will have significant impact on public health.
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    THE DEVELOPMENT OF A COMMUNITY INFORMED CUMULATIVE STRESSORS AND RESILIENCY INDEX (CSRI) TO EXAMINE ENVIRONMENTAL HEALTH DISPARITIES AND DISEASE RISK IN SOUTH CAROLINA
    (2017) Naney, Kristen Burwell; Wilson, Sacoby M; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Communities with environmental justice (EJ) issues usually have disparities in exposure to chemical and non-chemical stressors and health status compared to other communities without underlying EJ issues. Improving cumulative risk assessment (CRA) screening tools and models can provide the necessary information needed to reduce health disparities and create more resilient communities. To address these gaps in EJ science, this dissertation has three specific aims: 1) Identify perceptions of environmental and resilience factors that may influence health among African-Americans in North Charleston, South Carolina (SC) (Study 1), 2) Develop a Cumulative Stressors and Resiliency Index (CSRI) used to rank risk in SC (Study 2), and 3) Examine associations between CSRI scores and risk of asthma hospitalizations/emergency department (ED) visits in SC (Study 3). Community stakeholders (N=18) participated in key-informant interviews and completed a 26-item paper survey in study one. Interviews were transcribed and coded, while mode, frequencies, and percentages were calculated for each indicator based on its ability to influence health. Statistical tests performed in study two included a Principal Component Analysis (PCA), one-way analysis of variance (ANOVA), and linear regression performed in SAS Enterprise Guide 7.1. Choropleth maps were also developed in ArcMap 10.5. We concluded by calculating descriptive statistics by Environmental Affairs (EA) region, Spearman’s rank-order correlation, one-way ANOVA, and negative binomial regression analyses in study three. Many of the indicators (61%) were rated as extremely high priority items and included environmental hazards, sociodemographic attributes, and factors that may influence resiliency. CSRI scores ranged from 7.4 – 64.0 with a mean score of 29.1. Statistically significant differences in CSRI scores were evident by EA region (p <0.0001) and a one-unit increase in the percentage of non-white populations per census tract projected to increase CSRI scores by roughly 6.1%. The CSRI was not able to predict risk of asthma hospitalizations/ED visits as hypothesized. Overall, we demonstrated that identifying and addressing chemical and non-chemical stressors and resiliency gaps in areas impacted by environmental injustice may lead to overall improvements in community resilience. We anticipate this work will be used as a blueprint to build more resilient and equitable communities in SC.