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A cohort case–control study was conducted in XiangYa Hospital, Changsha, China, which involved 305 patients and 399 healthy women, from June 2010 to December 2018, to evaluate the association between Chinese women's short- and long-term exposure to industrial air pollutant, SO2 and gynaecological cancer (GC). We obtained personal and family information from the XiangYa Hospital electronic computer medical records. Using data obtained from the air quality monitoring stations in Changsha, we estimated each woman's exposure to the industrial air pollutant, sulphur dioxide (SO2), for different time windows, including the past 1, 5, 10 and 15 years before diagnosis of the disease. A multiple logistic regression model was used to assess the association between GC and SO2 exposure. GC was significantly associated with long-term SO2 exposure, with adjusted odds ratio (95% confidence interval) = 1.56 (1.10–2.21) and 1.81 (1.07–3.06) for a per interquartile range increase in the past 10 and 15 years, respectively. Sensitivity analysis showed that different groups reacted in different ways to long-term SO2 exposure. We concluded that long-term exposure to high concentration of industrial pollutant, SO2 is associated with the development of GC. This finding has implications for the prevention and reduction of GC. [ABSTRACT FROM AUTHOR]

Increasing studies linked outdoor air pollution (OAP), indoor environmental factors (IEFs), and antibiotics use (AU) with the first wave of allergies (i.e., asthma, allergic rhinitis, and eczema), yet the role of their exposures on children's second wave of allergy (i.e., food allergy) are unknown. To investigate the association between exposure to OAP and IEFs and childhood doctor-diagnosed food allergy (DFA) during the pre-pregnancy, prenatal, early postnatal, and current periods, and to further explore the effect of OAP and IEFs on DFA in children co-exposed to antibiotics. A retrospective cohort study involving 8689 preschoolers was carried out in Changsha, China. Data on the health outcomes, antibiotic use, and home environment of each child were collected through a questionnaire. Temperature and air pollutants data were obtained from 8 and 10 monitoring stations in Changsha, respectively. Exposure levels to temperature and air pollutants at individual home addresses were calculated by the inverse distance weighted (IDW) method. Multiple logistic regression models were employed to assess the associations of childhood DFA with exposure to OAP, IEF, and AU. Childhood ever doctor-diagnosed food allergy (DFA) was linked to postnatal PM 10 exposure with OR (95% CI) of 1.18 (1.03–1.36), especially for CO and O 3 exposure during the first year with ORs (95% CI) = 1.08 (1.00–1.16) and 1.07 (1.00–1.14), as well as SO 2 exposure during the previous year with OR (95% CI) of 1.13 (1.02–1.25). The role of postnatal air pollution is more important for the risk of egg, milk and other food allergies. Renovation-related IAP (new furniture) and dampness-related indoor allergens exposures throughout all time windows significantly increased the risk of childhood DFA, with ORs ranging from 1.23 (1.03–1.46) to 1.54 (1.29–1.83). Furthermore, smoke-related IAP (environmental tobacco smoke [ETS], parental and grandparental smoking) exposure during pregnancy, first year, and previous year was related to DFA. Additionally, exposure to pet-related indoor allergens (cats) during first year and total plant-related allergens (particularly nonflowering plants) during previous year were associated with DFA. Moreover, exposure to plant-related allergy during first and previous year was specifically associated with milk allergy, while keeping cats during first year increased the risk of fruits/vegetables allergy. Life-time and early-life AU was associated with the increased risk of childhood DFA with ORs (95% CI) = 1.57 (1.32–1.87) and 1.46 (1.27–1.67), including different types food allergies except fruit/vegetable allergy. Postnatal OAP, life-time and early-life IEFs and AU exposure played a vital role in the development of DFA, supporting the "fetal origin of childhood FA" hypothesis. [Display omitted] • Postnatal exposure to outdoor CO, O 3 , SO 2 , and PM 10 was related with children's food allergy (FA). • Renovation- and smoke-related indoor air pollution (IAP) elevated the risk of childhood FA. • Dampness- and plant- related indoor allergens exposure increased risk of childhood FA. • Life-time and early-life antibiotic use increased the risk of childhood FA. • Children without using antibiotic had higher FA risk of outdoor and indoor environment exposure. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is the leading cause of death and hospitalization among young children worldwide, but its risk factors remain unclear.Objective: To evaluate the effect of maternal exposure to diurnal temperature variation (DTV) during preconceptional and prenatal periods on childhood pneumonia.Methods: A retrospective cohort study by case-control design was conducted for pneumonia (N = 699) and normal (N = 811) children under age of 14 who were enrolled in XiangYa Hospital, Changsha, China from May 2017 to April 2019. Demographic data including gender, age, birth season, gestational age, parity, mode of delivery, and parental atopy were collected from the electronic medical records in the hospital system. We obtained the data of daily DTV in Changsha during 2003-2019 from China Meteorological Administration. Maternal exposure to DTV during preconceptional and prenatal periods was respectively calculated by the average of daily DTV during one year and three months before conception and entire pregnancy as well as the three trimesters. The association between maternal exposure to outdoor DTV and childhood pneumonia was analyzed by multiple logic regression model.Results: We found that childhood pneumonia was significantly associated with exposure to an increase in DTV during one year before conception and entire pregnancy, with ORs (95 % CI) = 2.53 (1.56-4.10) and 1.85 (1.24-2.76). We further identified a significant risk of pneumonia of DTV exposure during the first and second trimester of pregnancy. Sensitivity analysis showed that boys were more susceptible to the effect of prenatal exposure to outdoor DTV during pregnancy particularly in the first two trimesters compared to girls.Conclusions: Preconceptional and prenatal exposure to DTV plays an important role in development of childhood pneumonia, especially during the first and second trimesters of pregnancy. [ABSTRACT FROM AUTHOR]

Despite mounting evidence linking outdoor air pollution with otitis media (OM), the role of air pollutant(s) exposure during which critical window(s) on childhood OM remains unknown. We sought to identify the key air pollutant(s) and critical window(s) associated with the onset and recurrent attacks of OM in kindergarten children. A combined cross-sectional and retrospective cohort study involving 8689 preschoolers aged 3–6 years was performed in Changsha, China. From 2013–2020, data on air pollutants were collected from ambient air quality monitoring stations in Changsha, and the exposure concentration to each child at their home address was calculated using the inverse distance weighted (IDW) method. The relationship between air pollution and OM in kindergarten children was studied using multiple logistic regression models. Childhood lifetime OM was associated with PM 2.5 , SO 2 and NO 2 , with ORs (95% CI) of 1.43 (1.19–1.71), 1.18 (1.01–1.37) and 1.18 (1.00–1.39) by per IQR increase in utero exposure and with PM 2.5 , PM 2.5–10 and PM 10 , with ORs = 1.15 (1.00–1.32), 1.25 (1.13–1.40) and 1.49 (1.28–1.74) for entire post-natal exposure, respectively. The 2nd trimester in utero and the post-natal period, especially the 1st year, were key exposure time windows to PM 2.5 and PM 10 associated with lifetime OM and the onset of OM. Similarly, the 4th gestational month was a critical window for all pollutants except CO exposure in relation to lifetime OM and OM onset, but not recurrent OM attacks. PM 2.5 exposure during the nine gestational months and PM 10 exposure during the first three years had cumulative effects on OM development. Our subgroup analysis revealed that certain children were more susceptible to the OM risk posed by air pollution. Early-life exposure to air pollution, particularly PM 2.5 during the middle of gestation and PM 10 during the early post-natal period, was associated with childhood OM. [Display omitted] • Children's otitis media (OM) is mainly affected by pre-natal PM 2.5 and post-natal PM 10 exposures. • The 2nd trimester and the first year are critical windows for PM 2.5 and PM 10 exposures, respectively. • The 4th gestational month is critical for pollution exposure in relation to lifetime OM and OM onset. • Cumulated pre-natal PM 2.5 and post-natal PM 2.5–10 and PM 10 exposures play key roles in OM risk. • Our study supports and expands upon the "fetal origin of OM" hypothesis. [ABSTRACT FROM AUTHOR]

Despite mounting evidence linking allergic rhinitis (AR) to air pollution, it remains unclear which major air pollutant(s) and critical window(s) of exposure play important roles in children's AR. To examine the effects of intrauterine and early postnatal exposure to outdoor air pollution on children with doctor-diagnosed allergic rhinitis (DDAR). A retrospective cohort study involving 8689 kindergarten children was conducted in Changsha, China, from 2019 to 2020. A questionnaire survey was conducted to collect information on the health status of children and their family members, as well as their living habits and home environment. Personal exposure to daily outdoor air pollutants (PM 2.5 , PM 2.5-10 , PM 10 , SO 2 , NO 2 , and CO) was estimated during 40 gestational weeks, three trimesters, the entire pregnancy, and the first year after birth. Multiple logistic regression models were used to assess the associations between air pollution and children's DDAR. Children's DDAR was associated with intrauterine CO exposure, with adjusted ORs (95% CI) of 1.18 (1.03–1.34) for each IQR increase in CO exposure. The second and third trimesters were critical windows for PM 2.5 and CO exposure in relation to DDAR. Furthermore, early postnatal exposure to PM 2.5-10 and PM 10 in first year of life was associated with DDAR development, with adjusted ORs (95% CI) of 1.11 (1.01–1.22) and 1.27 (1.09, 1.47). The entire pregnancy and the first year of life were critical windows for CO and PM 10 exposure. Some children were predisposed to DDAR risk due to exposure to traffic-related air pollution (TRAP). Our findings support the hypothesis of "fetal origin of allergic rhinitis" by demonstrating that intrauterine and early postnatal exposure to air pollution plays an important role in children's DDAR. [Display omitted] • Allergic rhinitis (AR) was affected by traffic-related air pollution (TRAP). • Prenatal exposure to CO and PM 2.5 enhanced the risk of childhood AR. • Early postnatal exposure to PM 10 and NO 2 was associated with childhood AR. • Some sub-groups were more susceptible to AR risk of air pollution exposure. • Our study supports and develops the hypothesis of "fetal origin of allergic rhinitis". [ABSTRACT FROM AUTHOR]

Despite mounting evidence linked pneumonia with air pollution, it is unclear what main pollutant(s) exposure in which critical window(s) play a key role in pneumonia. To examine effects of intrauterine and post-natal exposure to air pollution on children's doctor-diagnosed pneumonia (DDP). A combination of cross-sectional and retrospective cohort study was conducted at Changsha, China during 2019–2020. Personal exposure to outdoor air pollutants at each child's home address was estimated using inverse distance weighted (IDW) method based on data from 10 air quality monitoring stations. Associations between personal air pollution exposure and DDP were evaluated. Children's DDP was associated with intrauterine and post-natal exposure to PM 2.5 , PM 2.5–10 , and PM 10 , adjusted ORs (95% CI) of 1.17 (1.04–1.30), 1.09 (1.01–1.17), and 1.07 (1.00–1.14) for IQR increase in intrauterine exposure and 1.12 (1.02–1.22), 1.13 (1.06–1.21), and 1.28 (1.16–1.41) for post-natal exposure. Intrauterine PM 2.5 exposure and post-natal PM 10 exposure were associated with a higher risk of pneumonia. We identified the 2nd trimester, 3rd trimester, and first year as critical windows respectively for PM 2.5 , PM 2.5–10 , and PM 10 exposure. Daytime exposure to traffic-related air pollution especially during early life increased DDP. Intrauterine and post-natal exposure to particulate matters played a dominant role in children's DDP. [Display omitted] • Childhood pneumonia was dominantly affected by particulate matters (PMs) exposure. • Intrauterine exposure to PM 2.5 especially in 2nd trimester enhanced pneumonia risk. • Postnatal exposure PM 10 particularly in first year elevated pneumonia risk. • Daytime was identified as key time for traffic pollution in relation to pneumonia. • Our study supports and develops the hypothesis of 'fetal origin of infection. [ABSTRACT FROM AUTHOR]

Despite numerous studies demonstrating a link between asthma and meteorological parameters, the role of maternal exposure in pregnancy on childhood asthma remains unknown. To investigate the association of meteorological factors during pregnancy with childhood asthma and identify key exposure windows. In central China's Changsha city, we carried out a retrospective cohort study involving 8,689 preschoolers. We used questionnaires to collect information about childhood health, personal factors, socioeconomic status (SES), and indoor environment. We considered meteorological parameters including temperature (mean, maximum, minimum), diurnal temperature variation (DTV), relative humidity, wind speed (mean, extreme), rainfall, pressure, and sunshine during early life. We investigated the links between childhood asthma and meteorological factors using logistic regression models. Doctor-diagnosed asthma (D-DA) in preschoolers was associated with exposure to increased temperatures (mean, maximum, and minimum) by per IQR increment in the first month with ORs (95% CI) of 2.03 (1.21–3.40), 1.86 (1.15–3.00) and 2.08 (1.23–3.50) as well as in the first trimester with ORs of 2.40 (1.36–4.24), 2.20 (1.26–3.83) and 2.54 (1.43–4.53), respectively. D-DA was inversely related to wind speed in the first month and first two trimesters. Compared to an increased risk of D-DA when exposed to pressure in the third trimester, exposure to DTV during pregnancy, particularly in the third trimester, significantly decreased the risk. Some preschoolers with certain personal factors and high SES were more vulnerable to pre-natal meteorological exposure. Prenatal exposure to meteorological factors, especially high temperatures and low wind speeds in early pregnancy, contributes to childhood asthma. [Display omitted] • The impact of meteorological factors in pregnancy on childhood asthma is unclear. • Asthma was linked to higher temperatures and lower wind speed in pregnancy. • Early pregnancy was identified as a critical window for climatic susceptibility. • Personal and socioeconomic factors modified asthma risk of climate exposure. • Our study supports "Fetal origins of asthma" hypothesis by meteorological factors. [ABSTRACT FROM AUTHOR]

Food allergy increased in the recent years causing heavy disease burden worldwide, yet the unique factors for the second-wave allergy epidemic since a rise of allergic diseases are unclear. To examine the impact of introduction timing of complementary foods on childhood food allergy and whether ambient air pollution modify this association. A retrospective cohort study of 2,598 preschoolers was conducted at 36 kindergartens at Changsha of China during 2011–2012. A standard questionnaire was developed to survey each preschooler's introduction timing of complementary foods, food allergy, and home environments. Each subject's exposure to ambient air pollutants including PM 10 , SO 2 , and NO 2 was estimated for pregnancy and postnatal period. Association between food allergy and introduction timing of complementary foods as well as its modification by ambient pollution were evaluated by multiple logistic regression model. Childhood total food allergy (14.6%) was significantly positively associated with early introduction to fruit or vegetable before 3 months with OR = 1.97 (1.25–3.11), especially for egg and milk allergies. Food allergy was also significantly associated with NO 2 exposure in pregnancy especially during the 1st trimester with ORs (95% CI) = 1.24 (1.00–1.54) and 1.27 (1.03–1.58) and postnatal period with OR of 1.30 (1.01–1.66) respectively for per IQR increase in their exposure. We observed that living near traffic-main road and other areas significantly increased food allergy risk of early introduction of fruit and vegetable. We further detected that early introduction of milk powder or porridge significantly decreased the risk of food allergy at the condition of light outdoor air pollution exposure during postnatal period. Sensitivity analysis showed that children living at urban area, male sex, younger age, and having breast-feeding were more susceptible to the effect of early introduction of fruit and vegetable on food allergy. Our study indicates that the role of introduction timing of complementary foods on food allergy could be adjusted by air pollution exposure level, which may partly explain the second-wave allergy epidemic and provide a potential preventive strategy. [Display omitted] • Childhood food allergy was associated with early introduction of fruit and vegetable before 3 months. • Food allergy was related to NO 2 exposure in pregnancy especially 1st trimester and postnatal stage. • Living near traffic area increased food allergy risk of early introduction of fruits and vegetables. • Low air pollution increased protective effect of early introduction of food allergens on food allergy. • Air pollution modified effect of solid food addition at different time on food allergy development. [ABSTRACT FROM AUTHOR]

Cervical, endometrial, and ovarian cancers are three major gynecological cancers (GCs) leading to heavy disease burden and high mortality among women worldwide, which are associated with environmental exposure. However, the role of air pollution and temperature on GCs remains unclear. To assess the combined effects of short-term, medium-term, and long-term exposure to ambient air pollution and temperature indicators on GCs in women. A case-control study was conducted in XiangYa Hospital from 2010 to 2018 at Changsha, China. A standard questionnaire was designed to collect the health status and personal factors of 305 cases with GCs including cervical, endometrial, and ovarian cancers and 399 healthy women as control group. Personal exposure to ambient air pollution (PM 10 , SO 2 , and NO 2), temperature, and diurnal temperature variation (DTV) during past one year, past five years, and past ten years was calculated by inverse distance weighted (IDW) method based on each subject's home address. Multiple logistic regression model was used to analyse the relationship of GCs with outdoor air pollution and temperature indicators. Exposure to NO 2 during past five years and past ten years was significantly associated with GCs, with adjusted ORs (95% CI) of 1.40 (1.02–1.91) and 1.41 (1.03–1.93). Furthermore, an increase in temperature during past ten years was related with GCs, with OR (95% CI) = 1.95 (1.16–3.25). We strikingly found that high temperature increased the effect of long-term exposure to PM 10 and NO 2 during past ten years on GCs, while low DTV elevated GCs risk of air pollution exposure. Sensitivity analysis suggests that some specific subjects were more susceptible to the effect of air pollution and temperature indicators on GCs. Relatively long-term exposure to traffic-related air pollution (NO 2) and increased temperature played important roles in the development of women's GCs. There may be interactions between air pollution and temperature indicators on GCs. [Display omitted] • Exposure to NO 2 longer than 5 and 10 years was associated with gynecological cancers (GCs). • Long-term exposure to an increase in temperature elevated GC risk. • High temperature significantly increased effect of long-term exposure to NO 2 on GCs. • Low diurnal temperature variation elevated GT risk of PM 10 and/or NO 2 exposure. • There are interactions of traffic-related air pollution and temperature indicators on risk of GCs. [ABSTRACT FROM AUTHOR]

Otitis media (OM) is a common pediatric infectious disease worldwide. Increasing evidence have associated indoor environment with OM, yet the role of home environmental factor(s) exposure during which critical window(s) on childhood OM are unclear. To examine the association between indoor environmental factors exposure and childhood OM, to identify main indoor factor(s) and key window(s). A retrospective cohort study involving 8689 preschoolers aged 3–6 was performed in Changsha, China. The data about each child's health outcome and home environments was obtained through a standard questionnaire. Exposure timing windows included 1 year before pregnancy, pregnancy, first year of life, and past year. Multiple logistic regression models were used to analyze the association between indoor environmental factors and childhood OM. We found that exposure to mold/damp stains and mold/damp clothes or bedding during preconceptional, prenatal, and postnatal periods was consistently associated with childhood OM, with ORs ranged from 1.25 (1.02–1.54) to 1.38 (1.13–1.68). Past year was identified as a critical time window for mold/damp stains exposure in relation to OM risk. We further found that exposures to new furniture during pregnancy and environmental tobacco smoke (ETS) and grandparental smoking during first year were significantly associated with an increase in childhood OM, with ORs (95% CI) = 1.28 (1.00–1.64), 1.20 (1.01–1.42), and 1.21 (1.00–1.48). Moreover, current exposure to total plants especially for non-flowering plants significantly increased OM risk, with ORs (95% CI) = 1.23 (1.05–1.44) and 1.25 (1.06–1.46). The association between early life exposure to indoor environmental factors and OM was stronger among children living near traffic roads. Outdoor air pollution and temperature could modify the effect of indoor environmental exposure on childhood OM. Our sensitivity analysis indicated that some subgroups were more susceptible to OM risk of indoor exposure. Our findings suggest that exposure to home environmental factors played an important role in childhood OM, and the association can be interacted by outdoor air pollution and temperature. [Display omitted] • Both pre- and post-birth exposure to home environmental factors increase risk of childhood OM. • Dampness related indoor allergen plays a key role in the development of otitis media. • Renovation exposure in pregnancy was associated with an increase in childhood otitis media. • Current period was identified as the critical time window for OM risk of home environment. • Our study supports a hypothesis of "Fetal origin of childhood OM" by indoor exposure. [ABSTRACT FROM AUTHOR]

The rapid increase of food allergy (FA) has become the "second wave" of allergy epidemic and is now a major global public health concern. Mounting evidence indicates that early life exposure to air pollution is associated with the "first wave" of allergy epidemic (including asthma, allergic rhinitis and eczema) in children, but little is known about its association with FA. We hypothesize FA has triple exposure pathways, gut-skin-airway, and investigate the effects of airway exposure to outdoor and indoor air pollution on childhood FA. A cohort study of 2598 preschool children aged 3–6 years old was conducted in Changsha, China. The prevalence of FA was surveyed using a standard questionnaire by International Study of Asthma and Allergies in Childhood (ISAAC). Exposure to indoor air pollution was assessed by four indicators: new furniture, redecoration, mold or dampness, and window condensation. Exposure to outdoor air pollution was evaluated by the concentrations of PM10, SO2 and NO2, which were obtained from the monitored stations. Both prenatal and postnatal exposure windows were considered. The association between exposure to outdoor/indoor air pollution and childhood FA was estimated by multiple logistic regression models using odds ratio (OR) and a 95% confidence interval (CI). A total of 14.9% children reported FA. The prevalence was significantly associated with exposure to indoor air pollution, OR (95% CI) = 1.93 (1.35–2.75) for prenatal exposure to mold/dampness and 1.49 (1.07–2.10) and 1.41 (1.04–1.89) respectively for postnatal exposure to new furniture and window condensation. The prevalence of FA was also associated with prenatal and postnatal exposure to outdoor air pollution, particularly the traffic-related air pollutant NO2, with adjusted ORs (95% Cls) respectively 1.24 (1.00–1.54) and 1.38 (1.03–1.85) per interquartile range (IQR) increase. Sensitivity analysis showed that the association between outdoor/indoor air pollution and childhood FA was significant only in young children aged 3–4 years. Early-life exposure to high levels of outdoor and indoor air pollution in China due to the rapid economic growth and fast urbanization in the past decades may contribute to the rapid increase of food allergy (FA) in children. Our study indicates that, in addition to gut and skin, airway may be a new route of food sensitization. Air pollution leads to the first and second waves of allergy epidemics, suggesting a concept of 'one allergy' disease. [Display omitted] • The association between air pollution and food allergy (FA) in children is unclear. • Airway is a new pathway contributing to FA, in addition to gut and skin. • Prenatal exposure to both outdoor and indoor air pollution increased FA risk. • High levels of outdoor and indoor air pollution may cause the rapid increase of FA in China. • Air pollution leads to the first and second waves of allergy epidemics. [ABSTRACT FROM AUTHOR]

The prevalence of childhood allergies has increased during past decades leading to serious hospitalization and heavy burden worldwide, yet the key factors responsible for the onset of early symptoms and development of diagnosed diseases are unclear. To explore the role of early life exposure to ambient air pollution and indoor environmental factors on early allergic symptoms and doctor diagnosed allergic diseases. A retrospective cohort study of 2598 preschool children was conducted at 36 kindergartens in Changsha, China from September of 2011 to February of 2012. A questionnaire was developed to survey each child's early onset of allergic symptoms (wheeze and rhinitis-like symptoms) and doctor diagnosis of allergic diseases (asthma and rhinitis) as well as home environments. Each mother's and child's exposures to ambient air pollutants (PM 10 , SO 2 , and NO 2) and temperature were estimated for in utero and postnatal periods. The associations of early symptoms and diagnosed diseases with outdoor air pollution and indoor environmental variables were examined by logistic regression models. Childhood early allergic symptoms (33.9%) including wheeze (14.7%) and rhinitis-like symptoms (25.4%) before 2 years old were not associated with outdoor air pollution exposure but was significantly associated with maternal exposure of window condensation at home in pregnancy with ORs (95% CI) of 1.33 (1.11–1.59), 1.30 (1.01–1.67) and 1.27 (1.04–1.55) respectively, and was associated with new furniture during first year after birth with OR (95% CI) of 1.43 (1.02–2.02) for early wheeze. Childhood diagnosed allergic diseases (28.4%) containing asthma (6.7%) and allergic rhinitis (AR) (7.2%) were significantly associated with both outdoor air pollutants (mainly for SO 2 and NO 2) during first 3 years and indoor new furniture, redecoration, and window condensation. We found that sex, age, parental atopy, maternal productive age, environmental tobacco smoke (ETS), antibiotics use, economic stress, early and late introduction of complementary foods, and outdoor air pollution modified the effects of home environmental exposure in early life on early allergic symptoms and diagnosed allergic diseases. Our study indicates that early life exposure to indoor environmental factors plays a key role in early onset of allergic symptoms in children, and further exposure to ambient air pollution and indoor environmental factors contribute to the later development of asthma and allergic rhinitis. [Display omitted] • Early life home environment exposure plays a key role in allergic symptoms onset. • PM 10 and SO 2 exposure in first 3 years elevate risk of persistent allergic symptom. • Later outdoor and indoor environment exposures elevate risk of asthma and rhinitis. • Antibiotics use in early life increases risk of childhood early allergic symptoms. • Indoor and outdoor exposures play different roles in allergy onset and development. [ABSTRACT FROM AUTHOR]

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear. To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s). A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019–2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO 2 , CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI). Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12–1.44), 1.26 (1.09–1.46), 1.34 (1.14–1.57), and 1.28 (1.05–1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01–1.36) and 1.19 (1.02–1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05–1.30) and 1.14 (1.03–1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure. Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia". [Display omitted] • Pre- and post-birth exposure to indoor pollution and allergen were related with childhood pneumonia. • 1 year before pregnancy was identified as a critical window for pneumonia risk of indoor exposure. • Renovation and mold/dampness exposure posed higher risk of pneumonia in pre-birth periods. • Mold or damp stains and clothing or bedding have a cumulative effect on childhood pneumonia. • Traffic pollution and high temperature increased pneumonia risk of indoor environmental factors. [ABSTRACT FROM AUTHOR]

Mounting studies have associated asthma with environmental and climatic factors, but their interaction during pregnancy on childhood asthma are unclear. This study aims to investigate the interaction of in utero air pollution and environmental temperature exposure on childhood asthma, to identify key timing windows for exposure. A retrospective cohort study with 2,598 pre-schoolers was conducted during 2011–2012 in Changsha, China. Maternal exposure to three critical ambient air pollutants (PM 10 , SO 2 and NO 2 , as proxies of industrial and vehicular air pollution) and temperature (T), was assessed for the 40 gestational weeks, three trimesters of gestation, and entire pregnancy by an inverse distance weighted (IDW) method. Logistic regression analysis was used to examine the association of childhood asthma with air pollution and temperature exposure. Our results showed that pre-schooler's asthma was significantly associated with SO 2 and NO 2 exposure in utero, ORs = 1.46 (95% CI: 1.12–1.89) and 1.67 (95% CI: 1.24–2.26) by inter quartile range (IQR) increase of their exposure respectively. Significant risk was observed for exposure of SO 2 and NO 2 particularly during the 1st and 2nd trimesters and their specific gestational weeks. Pre-schooler's asthma was related with high temperature exposure during 1st trimester, OR = 2.33 (95% CI: 1.11–4.90) by IQR increase of T exposure. Low T and high T respectively increased the asthma risk of NO 2 exposure in the 1st and 3rd trimester. Boys were more susceptible to the temperature-pollution interaction on asthma development. Our study indicates that low and high temperature respectively during early and late pregnancy significantly increased the impact of air pollution exposure in utero on pre-schooler's asthma. [Display omitted] • Childhood asthma was mainly associated with prenatal exposure to SO 2 and NO 2 in pregnancy. • Asthma was related with high temperature (T) and more summer days in the 1st trimester. • Low T in 1st trimester and high T in 3rd trimester increased asthma risk of NO 2 exposure. • Boys were more susceptible to the temperature-pollution interaction on asthma risk. • Our study supports the hypothesis of "fetal origin of allergy" via temperature-pollution interaction. [ABSTRACT FROM AUTHOR]

There is growing evidence that allergic rhinitis (AR) is associated with indoor environmental factors, but their role in childhood AR during early life remains unclear. To investigate the association of preconceptional, prenatal, early postnatal, and current exposure to home environmental factors with childhood AR, and to further explore whether this association can be interacted by outdoor air pollution and temperature. A retrospective cohort study of 8689 preschool children was conducted during 2019–2020 in Changsha, China. A standard questionnaire was used to collect data on each family's health outcomes and home environments. We considered home environmental exposures during one year before conception, pregnancy, first year of life, and past year. Associations of indoor air pollution and allergens with AR were assessed by multiple logistic regression models. Pre-birth exposure to indoor air pollution emitted by new furniture or redecoration and dampness related allergen derived from mold/damp stains and mold/damp clothes or bedding during 1 year before conception and pregnancy was significantly associated with increased AR, with adjusted ORs (95% CI) ranging from 1.35 (1.05–1.75) to 1.87 (1.55–2.27). Childhood AR was also significantly related with post-birth exposure to dampness related indoor allergen including mold/damp stains and mold/damp clothes or bedding in first year and past year and pollen allergen including total and nonflowing plants in past year, with a range of ORs (95% CI) from 1.20 (1.01–1.42) to 1.79 (1.42–2.27). We identified that pre-birth, particularly in utero exposure to both indoor air pollution from renovation and dampness related allergens, played a key role in AR development compared to post-birth exposures, and accumulative effect was observed with the highest risk of AR. High exposure to traffic-related air pollution (TRAP) including outdoor PM 2.5 , NO 2 , CO, and O 3 , as well as living near traffic road not only significantly increased adverse effect of home environmental factors but also decreased protective effect of household dogs on childhood AR. Early life exposure to low temperature in pregnancy and high temperature in first year significantly increased AR risk of home environmental exposure. Sensitivity analysis indicated that some sub-groups were more susceptible to AR risk of home environmental exposure. Our study suggests that pre-birth exposure to home environmental factors played an important role in AR development and this effect can be interacted by TRAP and temperature, which supports a hypothesis of "(pre)fetal origin of childhood AR". [Display omitted] • Pre-birth home air pollution and allergen were related with allergic rhinitis (AR). • Post-birth home mold/dampness and plant allergens exposure increased AR risk. • Pre-birth is a critical window for AR risk of home environmental exposure. • Traffic-related air pollution increased AR risk of indoor environmental exposure. • Low and high temperature interacted with indoor environment on AR in early life. [ABSTRACT FROM AUTHOR]

Prevalence of allergic rhinitis has rapidly increased among Chinese children, but the reasons are unclear. Recent findings have suggested that exposure to outdoor air pollutants may increase the risk of allergic rhinitis, but the results were inconsistent. This study further investigated the effect of outdoor air pollutants on allergic rhinitis among preschool children. A standardized questionnaire on health, home and environmental factors was conducted for 4988 children aged 1–8 in the city of Changsha, and the concentrations of PM 10 (particle diameter ⩽10 μm), sulfur dioxide (SO 2) and nitrogen dioxide (NO 2) during 2006–2011 were acquired from the official web of Changsha Environmental Protection Agency. Results showed that the prevalence of children’s doctor diagnosed rhinitis was 8.4% (95% confidence interval [CI] 7.0%–10.0%). It was found that the prevalence of rhinitis was not associated with site-specific background concentrations of air pollutants, but significantly positively correlated with age-related accumulative personal exposure of PM 10, SO 2 and NO 2. We conclude that age-related accumulative personal exposure to ambient air pollution may play an important role in the development of rhinitis. [ABSTRACT FROM AUTHOR]

Small for gestational age (SGA) is a major public health problem that affects 32.4 million infants worldwide and its prevalence is increasing rapidly in new-borns. However, the key risk factors and their exposure time window on the development of SGA are unclear. We aim to investigate the association between exposure to outdoor air pollution and indoor environmental factors during which critical timing window and SGA, and to evaluate which specific personal factors modify this association. A retrospective cohort study of 3509 infants was conducted in Changsha, China during 2011–2012. A questionnaire survey was performed to obtain the formation on infant's birth outcomes and prenatal exposure of indoor environmental factors containing parental (maternal and/or paternal) smoking, new furniture, house redecoration, mold or dampness, window condensation, and keeping dogs in gestational age. Intrauterine exposure to industrial air pollutant (SO 2), traffic-related air pollutant (NO 2) and inhalable particulate matter (PM 10) was estimated during three trimesters and entire pregnancy. Associations between outdoor air pollutants and indoor environmental factors and SGA, term SGA (TSGA) and preterm SGA (PSGA) were assessed by multiple logistic regression model in terms of odds ratio (OR) and 95% confidence interval (CI). Prevalence of SGA (5.2%) and TSGA (4.9%) were significantly associated with intrauterine exposure to outdoor SO 2 during the entire gestational age with adjusted ORs (95% CI) of 1.08 (1.01–1.15) and 1.08 (1.00–1.15) for per 10 μg/m3 increase in SO 2 exposure after adjusting for the covariates, indoor environmental factors, and outdoor air temperature, and PSGA prevalence (0.3%) was significantly related with PM 10 exposure during whole pregnancy with odds = 2.21 (1.08–4.51). However, no association was observed for traffic-related air pollutant NO 2 exposure. Specifically, the association was more significant for SO 2 exposure during the 1st and/or 2nd trimester. We further found that TSGA and PSGA were associated with indoor exposure to parental smoking and new furniture, respectively, ORs (95% CI) = 1.46 (1.00–2.11) and 10.95 (1.46–81.95). We observed that the odds of SGA and TSGA attributed to SO 2 exposure in the first two trimesters was only significant among families with parental smoking and new furniture in gestation. Sensitivity analysis showed that infants with female sex and born in cold months were more susceptible to the effect of outdoor SO 2 exposure during the first two trimesters and entire gestational age on SGA and TSGA. On the other hand, infants born in the cold season and by a younger mother were more sensitive to the effect of indoor parental smoking in utero on SGA and TSGA. Maternal exposure to industry-related air pollution and indoor environmental risk factors during pregnancy, particularly during the first two trimesters, significantly increased SGA risk, and some specific personal factors could modify these associations. [Display omitted] • Industrial air pollution was associated with small for gestational age (SGA). • We identified the first two trimesters as critical windows for SGA development. • Parental smoking and new furniture in utero increased risk of term and preterm SGA. • Parental smoking amplifies the effect of outdoor industrial air pollution on SGA. • Personal factors could interact with air pollution in critical windows on SGA risk. [ABSTRACT FROM AUTHOR]

Increasing evidence has linked childhood pneumonia with early exposure to ambient air pollution. However, the impact of exposure to air pollutants before birth is unclear. To further clarify whether exposure to a particular pollutant during preconceptional and prenatal periods, may pose a higher risk of developing childhood pneumonia. This case-control cohort study consisted of 1510 children aged 0–14 years in Changsha, China between 2017 and 2019. Data of children's history of pneumonia and blood biomarkers were obtained from the XiangYa Hospital records. Each child's exposure to air pollutants, including nitrogen dioxide (NO 2), sulfur dioxide (SO 2), and particulate matter with an aerodynamic diameter ≤ 10 µm (PM 10), was calculated using data from ten air pollution monitoring stations. A multivariate logistic regression model was used to quantify the relationship between childhood pneumonia and exposure to ambient air pollution during the preconceptional and prenatal periods. Childhood pneumonia was significantly associated with preconceptional and prenatal exposure to the industrial-related air pollutant, SO 2 , for 1 year before conception, for 3 months before conception and for the entire pregnancy, with ORs(95% CI)= 4.01(3.17–5.07), 4.06(3.29–5.00) and 6.51(4.82–8.79). Also, children who were sick with pneumonia had higher white blood cell and neutrophil counts, and children with low eosinophil count or hemoglobin are likely to get pneumonia. Sensitivity analysis showed that boys, and children in high temperature area were susceptible to the effect of both preconceptional and prenatal exposure to industrial SO 2. Preconceptional and prenatal exposure to industrial-related air pollution plays a significant role in the incidence and progression of childhood pneumonia, supporting the hypothesis of "(pre-)fetal origin of childhood pneumonia". ga1 • Preconceptional and prenatal exposure to industrial SO 2 promote childhood pneumonia. • Boys and high-temperature environment area are more susceptible to SO 2 exposure. • A "(pre-)fetal origin of childhood pneumonia" due to industrial SO 2 was supported. [ABSTRACT FROM AUTHOR]

Low birth weight (LBW) remains a major public health problem worldwide, yet its crucial environmental risk factors are still unclear. To examine the association between LBW (term and preterm LBW) and prenatal exposure to ambient air pollution and home environmental factors as well as their combination, in order to identify critical time window for exposure and key outdoor and indoor factors in LBW development. A cohort study of 3509 preschool children was performed in Changsha, China during the period 2011–2012. A questionnaire was conducted to survey each child's birth outcome and each mother's exposure to home environmental factors including parental smoking, new furniture, redecoration, mold/damp stains, window pane condensation, and household pets during pregnancy. Maternal exposure to inhalable particulate matter (PM 10), industrial air pollutant (SO 2), and traffic air pollutant (NO 2) was estimated during different time windows of gestation, including conception month, three trimesters, birth month, and whole gestation. Associations of term and preterm LBW with ambient air pollutants and home environmental factors were assessed by multiple logistic regression models in terms of odds ratio (OR) with 95% confidence interval (CI). Term LBW (TLBW) was significantly associated with exposure to ambient PM 10 during pregnancy, with OR (95% CI) = 1.47 (1.00–2.14) for per IQR increase after adjustment for the covariates and home environmental factors. Specifically, we identified the significant association in early phase of pregnancy including conception month (1.90, 1.09–3.30) and the first trimester (1.72, 1.10–2.69). We further found that TLBW was significantly related with parental smoking at home, OR (95% CI) = 2.17 (1.09–4.33). However, no association was observed for preterm LBW (PLBW). The TLBW risk of ambient air pollution and home environmental factors was independent each other and hence the combined exposure to ambient PM 10 and indoor parental smoking caused the highest risk. Sensitivity analysis suggested that foetus with younger mothers were significantly more susceptible to risk of indoor parental smoking, while those with smaller house and cockroaches were more sensitive to risk of outdoor PM 10 exposure. Prenatal exposure to combined outdoor and indoor air pollution, particularly in critical window(s) during early pregnancy, significantly increases the risk of term LBW. • Air pollution was associated with term low birth weight (LBW) but not with preterm LBW. • We found term LBW was associated with prenatal exposure to ambient inhalable particle (PM 10). • Term LBW was also related with parental smoking at home during pregnancy. • Exposure to combined outdoor and indoor air pollution posed the highest risk of term LBW. • Early pregnancy was identified as the most critical time window for exposure susceptibility. [ABSTRACT FROM AUTHOR]

Although mounting evidence have linked traffic-related air pollution (TRAP) with increased risk of preterm birth (PTB), whether it can interact with indoor environmental factors remains unknown, and its window(s) susceptibility at the stage of gestation is unclear. To explore PTB risk for prenatal exposure to traffic-related air pollution and home environmental factors during pregnancy, so as to identify critical window(s) in the combined effect of traffic air pollution and main home environmental factor(s) on PTB development. A retrospective cohort study of 3,509 preschool children was performed in Changsha, China during 2011–2012. The PTB prevalence was reported by the parents based on a questionnaire. We estimated each mother's exposure to traffic-related air pollutant NO 2 in different windows of gestation, including conception month, three trimesters, birth month, and whole gestation. Maternal exposure to home environmental factors was considered by renovation (new furniture/redecoration) in pregnancy, and mold/damp stains and window condensation during perinatal period. Associations of PTB with both ambient NO 2 and home environmental factors, and their interactions on PTB were evaluated by logistic regression models using odds ratio (OR) with 95% confidence interval (CI). Traffic air pollutant NO 2 exposure in utero was significantly associated with PTB, with adjusted odds ratio (OR) (95% CI) of 1.41 (1.00–1.98) for an IQR increase in NO 2 exposure during whole pregnancy, particularly in the conception month and 1st trimester. We further found a positive relationship between perinatal exposure to mold/damp stains in the homes and PTB, OR (95% CI) = 1.73 (1.04–2.90). Especially, we detected a significant interaction between outdoor NO 2 and indoor mold/damp stains on PTB risk. Male and female foetus were respectively more susceptible to perinatal mold/dampness at home and outdoor NO 2 exposure in early gestation. Our finding indicates that both outdoor traffic air pollutant and indoor mold/dampness play key roles in PTB development, and their interaction effect in early pregnancy significantly increases PTB risk. Image 1 • PTB was significantly associated with traffic air pollutant NO 2 exposure during pregnancy. • The effect of NO 2 exposure in the conception month and 1st trimester was more important. • Indoor mold/damp stains in pregnancy was also related with an increased risk of PTB. • There is a significant interaction between outdoor NO 2 and indoor mold/damp stains on PTB. • Sensitive populations were more susceptible to the PTB risk of outdoor and indoor air pollution. [ABSTRACT FROM AUTHOR]

Mounting evidence have linked ambient air pollution and temperature with childhood pneumonia, but it is unclear whether there is an interaction between air pollution and temperature on childhood pneumonia. We aim to assess the combined effect of ambient air pollution and temperature exposure during preconception and pregnancy on pneumonia by a case-control study of 1510 children aged 0–14 years in Changsha, China. We obtained the data of childhood pneumonia from XiangYa Hospital electrical records. We estimated personal exposure to outdoor air pollution (PM 10 , SO 2 and NO 2) by inverse distance weighted (IDW) method and temperature indicators. Multiple logistic regression models were used to evaluate associations of childhood pneumonia with air pollution, temperature (T), and diurnal temperature variation (DTV). We found that exposure to industry-related air pollution (PM 10 and SO 2) during preconception and pregnancy were associated with childhood pneumonia, with ORs (95% CI) of 1.72 (1.48–1.98) and 2.96 (2.50–3.51) during 1 year before pregnancy and 1.83 (1.59–2.11) and 3.43 (2.83–4.17) in pregnancy. Childhood pneumonia was negatively associated with T exposure during 1 year before pregnancy and pregnancy, with ORs (95% CI) of 0.57 (0.41–0.80) and 0.85 (0.74–0.98). DTV exposure during pregnancy especially during the 1st and 2nd trimesters significantly increased pneumonia risk, with ORS (95% CI) of 1.77 (1.19–2.64), 1.47 (1.18–1.83), and 1.37 (1.07–1.76) respectively. We further observed interactions of PM 10 and SO 2 exposure with low T and high DTV during conception and pregnancy in relation to childhood pneumonia. This study suggests that there were interactions air pollution with temperature and DTV on pneumonia development. [Display omitted] • Early life exposure to industry air pollution elevated risk of childhood pneumonia. • Exposure to an increase in temperature (T) decreased risk of childhood pneumonia. • DTV exposure in utero and first two trimesters was related with pneumonia risk. • Low T interacted with high PM10 and SO2 in preconception and utero on pneumonia. • There was an interaction of high DTV with high PM10 and SO2 exposure on pneumonia. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world since December 8, 2019. However, the key factors affecting the duration of recovery from COVID-19 remain unclear. To investigate the associations of long recovery duration of COVID-19 patients with ambient air pollution, temperature, and diurnal temperature range (DTR) exposure. A total of 427 confirmed cases in Changsha during the first wave of the epidemic in January 2020 were selected. We used inverse distance weighting (IDW) method to estimate personal exposure to seven ambient air pollutants (PM 2.5 , PM 2.5-10 , PM 10 , SO 2 , NO 2 , CO, and O 3) at each subject's home address. Meteorological conditions included temperature and DTR. Multiple logistic regression model was used to investigate the relationship of air pollution exposure during short-term (past week and past month) and long-term (past three months) with recovery duration among COVID-19 patients. We found that long recovery duration among COVID-19 patients was positively associated with short-term exposure to CO during past week with OR (95% CI) = 1.42 (1.01–2.00) and PM 2.5 , NO 2 , and CO during past month with ORs (95% CI) = 2.00 (1.30–3.07) and 1.95 (1.30–2.93), and was negatively related with short-term exposure to O 3 during past week and past month with ORs (95% CI) = 0.68 (0.46–0.99) and 0.41 (0.27–0.62), respectively. No association was observed for long-term exposure to air pollution during past three months. Furthermore, increased temperature during past three months elevated risk of long recovery duration in VOCID-19 patients, while DTR exposure during past week and past month decreased the risk. Male and younger patients were more susceptible to the effect of air pollution on long recovery duration, while female and older patients were more affected by exposure to temperature and DTR. Our findings suggest that both TRAP exposure and temperature indicators play important roles in prolonged recovery among COVID-19 patients, especially for the sensitive populations, which provide potential strategies for effective reduction and early prevention of long recovery duration of COVID-19. [Display omitted] • Short-term exposure to CO and NO 2 was associated with prolonged recovery of COVID-19. • Long-term and short-term exposure to PM 2.5 was related with risk of prolonged COVID-19 recovery. • High temperature and low diurnal temperature range increased duration of COVID-19 recovery. • Traffic-related air pollution (TRAP) and temperature played key roles in COVID-19 recovery. • We suggest the COVID-19 patients avoiding from TRAP and heat exposure. [ABSTRACT FROM AUTHOR]