Publications

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2019
Nori-Sarma, A, Benmarhnia T, Rajiva A, Azhar GS, Gupta P, Pednekar MS, Bell ML.  2019.  Advancing our understanding of heat wave criteria and associated health impacts to improve heat wave alerts in developing country settings. International Journal of Environmental Research and Public Health. 16   10.3390/ijerph16122089   AbstractWebsite

Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population's adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves' timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11-1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87-1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the "efficiency" (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as "heat wave" versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts.

Benmarhnia, T, Zhao X, Wang J, Macdonald M, Chen H.  2019.  Evaluating the potential public health impacts of the Toronto cold weather program. Environment International. 127:381-386.   10.1016/j.envint.2019.03.042   AbstractWebsite

Background: Extreme cold weather alert programs have been implemented in some areas to address the significant health impacts of exposure to cold. One such program is the Toronto Cold Weather Program (TCWP) that was implemented in the City of Toronto since 1996 to protect the public from extreme weather conditions. In this paper, we aim to evaluate the effectiveness of the TCWP in reducing mortality and morbidity outcomes related to cold temperatures. Methods: We applied a quasi-experimental study design using the Difference-in-Differences method coupled with propensity-score-matching to determine the effect of the TCMP on daily hospitalizations and deaths due to cardiovascular disease (CVD), coronary heart disease (CHD) or cerebrovascular disease, using two complementary analytical approaches. Results: Overall, the analysis did not detect an impact on reduced mortality/morbidity in the City of Toronto from the TCMP. For example, we obtained a Risk Difference (RD) of -0.88 (per 1,000,000 people) (95% CI: -3.27 to 1.51) and a Risk Ratio (RR) of 0.98 (95% CI: 0.91 to 1.05) people for CVD hospitalizations. Conclusions: The TCWP was not found to be effective in reducing cold related mortality and morbidity which demonstrates the importance of improving existing policies related to cold in Canada and other countries.

Bailey, J, Gerasopoulos E, Rojas-Rueda D, Benmarhnia T.  2019.  Potential health and equity co-benefits related to the mitigation policies reducing air pollution from residential wood burning in Athens, Greece. Journal of Environmental Science and Health Part a-Toxic/Hazardous Substances & Environmental Engineering.   10.1080/10934529.2019.1629211   AbstractWebsite

Athens, Greece has been in economic and social crises after the 2008 global recession, resulting in an increase in wood burning as a cheaper method of residential heating in the winter. Reducing wood burning emissions is a source-specific method to address air quality degradation, and indirectly climate change, through instituting policies aimed at human health co-benefits. In this work, we investigate and quantify the potential health co-benefits from policies reducing outdoor particulate matter (PM) pollution from residential wood burning by assessing the pollution conditions during the 2015 calendar year in Athens, Greece, emphasizing vulnerable populations. We conducted a systematic literature search to extract data regarding effective improvements to outdoor PM due to wood burning interventions, and get a range of potential ambient PM reduction estimates regarding realistic benefits from different interventions. We applied a health impact assessment methodology and used existing Athens specific data to calculate the preventable daily average non-accidental deaths associated with reducing PM, additionally considering low and high socioeconomic status (SES) groups. We found that the reduction in outdoor PM concentration showed the potential to benefit lower SES groups as much as 13.5 times more than the high SES group, representing an opportunity for policies to improve not only the health of the total population but also improve environmental equity and health disparities.

Heo, S, Nori-Sarma A, Lee K, Benmarhnia T, Dominici F, Bell ML.  2019.  The use of a quasi-experimental study on the mortality effect of a heat wave warning system in Korea. International Journal of Environmental Research and Public Health. 16   10.3390/ijerph16122245   AbstractWebsite

Many cities and countries have implemented heat wave warning systems to combat the health effects of extreme heat. Little is known about whether these systems actually reduce heat-related morbidity and mortality. We examined the effectiveness of heat wave alerts and health plans in reducing the mortality risk of heat waves in Korea by utilizing the discrepancy between the alerts and the monitored temperature. A difference-in-differences analysis combined with propensity score weighting was used. Mortality, weather monitoring, and heat wave alert announcement data were collected for 7 major cities during 2009-2014. Results showed evidence of risk reduction among people aged 19-64 without education (-0.144 deaths/1,000,000 people, 95% CI: -0.227, -0.061) and children aged 0-19 (-0.555 deaths/1,000,000 people, 95% CI: -0.993, -0.117). Decreased cardiovascular and respiratory mortality was found in several subgroups including single persons, widowed people, blue-collar workers, people with no education or the highest level of education (university or higher). No evidence was found for decreased all-cause mortality in the population (1.687 deaths/1,000,000 people per day; 95% CI: 1.118, 2.255). In conclusion, heat wave alerts may reduce mortality for several causes and subpopulations of age and socio-economic status. Further work needs to examine the pathways through which the alerts impact subpopulations differently.

Wang, Q, Benmarhnia T, Li CC, Knibbs LD, Bao JZ, Ren M, Zhang HH, Wang SH, Zhang YW, Zhao QG, Huang CR.  2019.  Seasonal analyses of the association between prenatal ambient air pollution exposure and birth weight for gestational age in Guangzhou, China. Science of the Total Environment. 649:526-534.   10.1016/j.scitotenv.2018.08.303   AbstractWebsite

Ambient air pollution has been linked to small for gestational age (SGA); however, the relationship with large for gestational age (ILA) is unclear and very few studies have investigated seasonal effects on the association between air pollution and SGA or LGA. Using birth registry data of 506,000 singleton live births from 11 districts in Guangzhou, China between January 2015 and July 2017, we examined associations between ambient air pollutants (PM2.5, PM10, NO2, SO2, and O-3) and SGA/LGA, and further assessed the modification effect of season. Daily concentrations of air pollutants from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district of residence during pregnancy. Two-level binary logistic regression models were used to evaluate associations between air pollution and SGA/LGA. Stratified analyses by season and a Cochran Q test were performed to assess the modification of season. Exposure to PM2.5, NO2, SO2, and O-3 was significantly associated with increased risk of SGA, especially for exposure during the second and trimester. For an interquartile range (IQR) increase in PM2.5(6.5 mu g/m(3)), NO2 (12.7 mu g/m(3)), SO2 (2.8 mu g/m(3)) and O-3 (20.8 mu g/m(3)) during the entire pregnancy, SGA risk increased by 2% (OR - 1.02, 95% CI: 1.00-1.04), 8% (OR = 1.08, 95% CI: 1.04-1.12), 2% (OR - 1.02, 95% CI: 1.01-1.03), and 14% (1.14, 1.11-1.17), respectively. A decreased risk of WA was found for PM2.5, PM10, SO2, and O-3 during the first trimester or entire pregnancy. When examined by season, significant associations between air pollutants and SGA were observed for women who conceived during summer or fall, and the patterns were consistent for all pollutants. Our study suggests that conception during different seasons might modify the association between ambient air pollution and SGA. (C) 2018 Elsevier B.V. All rights reserved.

2017
Benmarhnia, T, Huang J, Basu R, Wu J, Bruckner TA.  2017.  Decomposition analysis of black-white disparities in birth outcomes: The relative contribution of air pollution and social factors in California. Environmental Health Perspectives. 125   10.1289/ehp490   AbstractWebsite

BACKGROUND: Racial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes. OBJECTIVES: To apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution. METHODS: We used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate. Matter, 2.5 micrometers or less (PM2.5) and nitrogen dioxide (NO2)] predictors, we conducted a nonlinear extension of the. Blinder-Oaxaca method to decompose racial/ethnic disparities in PTB. RESULTS: The predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black-white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black-white difference in birth outcomes than air pollution (5.7% for PTB). CONCLUSIONS: Our results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black-white differences in birth outcomes, the individual contribution of PM2.5 is comparable in magnitude to any single individual- or neighborhood-level factor.

Zunzunegui, MV, Belanger E, Benmarhnia T, Gobbo M, Otero A, Beland F, Zunzunegui F, Ribera-Casado JM.  2017.  Financial fraud and health: the case of Spain. Gaceta Sanitaria. 31:313-319.   10.1016/j.gaceta.2016.12.012   AbstractWebsite

Objective: To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life. Methods: Pilot study (n = 188) conducted in 2015-2016 in Madrid and Leon (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Intergroup comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011-2012 National Health Survey. Results: In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages. Conclusion: The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation. (C) 2017 SESPAS. Published by Elsevier Espatia, S.L.U.

2014
Benmarhnia, T, Rey L, Cartier Y, Clary CM, Deguen S, Brousselle A.  2014.  Addressing equity in interventions to reduce air pollution in urban areas: a systematic review. International Journal of Public Health. 59:933-944.   10.1007/s00038-014-0608-0   AbstractWebsite

Integration of equity in evidence-based public health is a great challenge nowadays. In this review we draw attention to the importance of considering equity in air pollution interventions. We also propose further methodological and theoretical challenges when assessing equity in interventions to reduce air pollution and we present opportunities to develop this research area.