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In 2003, nuclear power received renewed interest as a perceived climate-neutral way to meet high energy demands of large industrialized countries, such as China, India, Russia and the USA. It triggered a growing demand for uranium (U) as nuclear fuel. Dubbed the 'nuclear renaissance', the U-price rose over tenfold before the global credit crisis dampend the rush. Many efforts to capitalise on the renewed demand focused on Africa. This paper provides an overview on the type and extent of uranium mining, production and exploration on the African continent and discusses the economic benefits as well as the potential environmental and health risks and the long-term needs for remediation of legacy sites. The actual historical results of uranium mining activities in more than thirty African countries provide data against which to assess the existing risks of uranium development. The already existing uraniferous waste in several African countries threatens scarce water resources and the health of adjacent residents. Responsibility should rest with the governments and the companies to ensure that these threats are not realized. [ABSTRACT FROM AUTHOR]

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker’s needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of hidden asthma in certain immigrant sub-populations in the U.S. Topics discussed include the lower asthma incidence in first generation immigrants compared to immigrants born in the U.S., differences in exposure patterns including environmental conditions and social risk factors, and recommendations for addressing asthma as a social problem. Efforts in primary prevention of asthma are highlighted.

Background: Elevated cardiovascular disease risk has been reported with proximity to highways or busy roadways, but proximity measures can be challenging to interpret given potential confounders and exposure error. Methods: We conducted a cross sectional analysis of plasma levels of C-Reactive Protein (hsCRP), Interleukin-6 (IL-6), Tumor Necrosis Factor alpha receptor II (TNF-RII) and fibrinogen with distance of residence to a highway in and around Boston, Massachusetts. Distance was assigned using ortho-photo corrected parcel matching, as well as less precise approaches such as simple parcel matching and geocoding addresses to street networks. We used a combined random and convenience sample of 260 adults >40 years old. We screened a large number of individual-level variables including some infrequently collected for assessment of highway proximity, and included a subset in our final regression models. We monitored ultrafine particle (UFP) levels in the study areas to help interpret proximity measures. Results: Using the orthophoto corrected geocoding, in a fully adjusted model, hsCRP and IL-6 differed by distance category relative to urban background: 43% (−16%,141%) and 49% (6%,110%) increase for 0-50 m; 7% (-39%,45%) and 41% (6%,86%) for 50-150 m; 54% (−2%,142%) and 18% (−11%,57%) for 150-250 m, and 49% (−4%, 131%) and 42% (6%, 89%) for 250-450 m. There was little evidence for association for TNF-RII or fibrinogen. Ortho-photo corrected geocoding resulted in stronger associations than traditional methods which introduced differential misclassification. Restricted analysis found the effect of proximity on biomarkers was mostly downwind from the highway or upwind where there was considerable local street traffic, consistent with patterns of monitored UFP levels. Conclusion: We found associations between highway proximity and both hsCRP and IL-6, with non-monotonic patterns explained partly by individual-level factors and differences between proximity and UFP concentrations. Our analyses emphasize the importance of controlling for the risk of differential exposure misclassification from geocoding error. [ABSTRACT FROM AUTHOR]

Exposure to high levels of traffic-generated particles may pose risks to human health; however, limited measurement has been conducted at homes near highways. The purpose of this study was to characterize differences between indoor and outdoor particle number concentration (PNC) in homes near to and distant from a highway and to identify factors that may affect infiltration. We monitored indoor and outdoor PNC (6-3000 nm) for 1-3 weeks at 18 homes located <1500 m from Interstate-93 (I-93) in Somerville, MA (USA). Median hourly indoor and outdoor PNC pooled over all homes were 5.2 × 103 and 5.9 × 103 particles/cm3, respectively; the median ratio of indoor-to-outdoor PNC was 0.95 (5th/95th percentile: 0.42/1.75). Homes <100 m from I-93 (n=4) had higher indoor and outdoor PNC compared with homes >1000 m away (n=3). In regression models, a 10% increase in outdoor PNC was associated with an approximately equal (10.8%) increase in indoor PNC. Wind speed and direction, temperature, time of day and weekday were also associated with indoor PNC. Average mean indoor PNC was lower for homes with air conditioners compared with homes without air conditioning. These results may have significance for estimating indoor, personal exposures to traffic-related air pollution. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is known to be associated with proximity to major roadways and highways. Thus, blood samples from 20 near highway and 20 urban background residents were analyzed for presence of cytokines and other biomarkers. Near-highway participants displayed significantly lower socioeconomic status (SES) and significantly higher occupational vehicle exhaust exposure and higher low-density lipoprotein (LDL) levels. Controlling for exposure to vehicle exhaust on the job, interleukin-6 (IL-6) was numerically higher in near highway participants. Using logistic regression analyses, IL-1β was significantly elevated near highway. It is interesting that elevations were found in IL-1β, a key cytokine linked to inflammation from particulate matter (PM). More studies are needed with larger sample sizes to assess the possible role of IL-1β. [ABSTRACT FROM AUTHOR]

Abstract: Ultrafine particles (UFP; aerodynamic diameter < 0.1 μm) are a ubiquitous exposure in the urban environment and are elevated near highways. Most epidemiological studies of UFP health effects use central site monitoring data, which may misclassify exposure. Our aims were to: (1) examine the relationship between distant and proximate monitoring sites and their ability to predict hourly UFP concentration measured at residences in an urban community with a major interstate highway and; (2) determine if meteorology and proximity to traffic improve explanatory power. Short-term (1–3 weeks) residential monitoring of UFP concentration was conducted at 18 homes. Long-term monitoring was conducted at two near-highway monitoring sites and a central site. We created models of outdoor residential UFP concentration based on concentrations at the near-highway site, at the central site, at both sites together and without fixed sites. UFP concentration at residential sites was more highly correlated with those at a near-highway site than a central site. In regression models of each site alone, a 10% increase in UFP concentration at a near-highway site was associated with a 6% (95% CI: 6%, 7%) increase at residences while a 10% increase in UFP concentration at the central site was associated with a 3% (95% CI: 2%, 3%) increase at residences. A model including both sites showed minimal change in the magnitude of the association between the near-highway site and the residences, but the estimated association with UFP concentration at the central site was substantially attenuated. These associations remained after adjustment for other significant predictors of residential UFP concentration, including distance from highway, wind speed, wind direction, highway traffic volume and precipitation. The use of a central site as an estimate of personal exposure for populations near local emissions of traffic-related air pollutants may result in exposure misclassification. [Copyright &y& Elsevier]

The article discusses the development of methods to compare the quality of low-education community-based survey teams to that of teams comprised of college educated graduate students. Topics include an overview of community-based participatory research (CBPR), a comparison of the quality of data collected by both teams, and how the study was implemented.

Three case examples of asthma studies that differ in terms of community and involvement are considered. The Boston Chinatown studies faced limited funding that restricted the level of community involvement, but resulted in some of the first published evidence about asthma in Asian American children. These studies led to an asthma education program grant to a local Asian clinic and elementary school. The public housing study was a well-funded multi-year study of asthma and pest management with city, university and community partners. Residents were trained to collect data and participated throughout the study. Follow up pest management and pesticide buy-back programs headed by the city and community partners have been funded. The Dorchester case had more limited funding, but had the greatest level of involvement of parents of asthmatic children in all phases of the research. This survey led to an interesting novel finding of lower asthma prevalence in foreign born black residents. [ABSTRACT FROM AUTHOR]

Background: Although the number of people living in the United States with limited English proficiency (LEP) is substantial, the impact of language on patients' experience of provider-patient communication has been little explored. Methods: We conducted a series of 12 exploratory focus groups in English, Spanish and Cantonese to elicit discussion about patient-provider communication, particularly with respect to the concerns of the health literacy framework, i.e. ability to accurately understand, interpret and apply information given by providers. Within each language, 2 groups had high education and 2 had low education participants to partially account for literacy levels, which cannot be assessed consistently across three languages. Eighty-five (85) adults enrolled in the focus groups. The resulting video tapes were transcribed, translated and analyzed via content analysis. Results: We identified 5 themes: 1) language discordant communication; 2) language concordant communication; 3) empowerment; 4) providers' attitudes; 5) issues with the health care system. Despite efforts by facilitators to elicit responses related to cognitive understanding, issues of interpersonal process were more salient, and respondents did not readily separate issues of accurate understanding from their overall narratives of experience with health care and illness. Thematic codes often appeared to be associated with education level, language and/or culture. Conclusion: Our most salient finding was that for most of our participants there was no clear demarcation between literacy and numeracy, language interpretation, health communication, interpersonal relations with their provider and the rest of their experience with the health care system. [ABSTRACT FROM AUTHOR]

For Mexican and Chinese immigrants it has been reported that foreign born children have a lower prevalence of asthma than U.S.-born children. Inner-city black populations have a high prevalence of asthma. However, despite growing populations of black immigrants, we are aware of no previous studies that have looked at the effect of nativity on their asthma prevalence. We report data collected from a convenience sample in the Dorchester neighborhood of Boston for black respondents. The survey was conducted by medical students and community residents using a community-based participatory research approach. For adult respondents (n = 290) there was a strong negative association between being born outside the United States and reporting asthma (OR = 0.39; p = 0.033) that was retained in our multivariate model. For children (n = 157, reported by their parents) there was also a strong association with being born outside the United States (p < 0.05 using χ2 tabular analysis); however, there were no foreign-born children with asthma so an OR could not be calculated and this association could not be carried forward into multivariate analyses. For children, but not adults, there were also strong associations between asthma and environmental factors. These findings point to the need for further research into nativity and asthma in black U.S. populations. Future studies should seek to obtain a representative sample, gather more demographic data than we did and seek a larger sample of children. It makes sense to ask about nativity in asthma prevalence studies in order to distinguish these two apparently very different subpopulations. [ABSTRACT FROM AUTHOR]

Near highway residents are exposed to elevated levels of traffic-related air pollution (TRAP), including ultrafine particles, which are associated with adverse health effects. The efficacy of using in-home air filtration units that reduce exposure and potentially yield health benefits has not been tested in a randomized controlled trial. We will conduct a randomized double-blind crossover trial of portable air filtration units for 200 adults 30 years and older who live in near-highway homes in Somerville, MA, USA. We will recruit participants from 172 households. The intervention periods will be one month of true or sham filtration, followed by a one-month wash out period and then a month of the alternate intervention. The primary health outcome will be systolic blood pressure (BP); secondary outcome measures will include diastolic and central BP, C-Reactive Protein (CRP) and D-dimer. Reasons for success or failure of the intervention will be evaluated in a subset of homes using indoor/outdoor monitoring for particulate pollution, personal monitoring, size and composition of particulate pollution, tracking of time spent in the room with the filter, and interviews for qualitative feedback. This trial has begun recruitment and is expected to take 2–3 years to be completed. Recruitment has been particularly challenging because of additional precautions required by the COVID-19 pandemic. This study has the potential to shed light on the value of using portable air filtration in homes close to highways to reduce exposure to TRAP and whether doing so has benefits for cardiovascular health. [ABSTRACT FROM AUTHOR]

This article examines two large, unintended acute releases of uranium at Kerr McGee's Sequoyah Fuels Corporation in Oklahoma and United Nuclear Corporation's Church Rock uranium mill in New Mexico, both of which were incidents comparable in scope to the Three Mile Island incident. The authors urge for an exploration of the limited national interest, the lack of press coverage, and a seeming disregard for the American Indian communities affected by the spills and say more attention needs to be given to the early stages of the nuclear cycle and its impact on health and the environment.

There is growing evidence of a distinct set of freshly-emitted air pollutants downwind from major highways, motorways, and freeways that include elevated levels of ultrafine particulates (UFP), black carbon (BC), oxides of nitrogen (NOx), and carbon monoxide (CO). People living or otherwise spending substantial time within about 200 m of highways are exposed to these pollutants more so than persons living at a greater distance, even compared to living on busy urban streets. Evidence of the health hazards of these pollutants arises from studies that assess proximity to highways, actual exposure to the pollutants, or both. Taken as a whole, the health studies show elevated risk for development of asthma and reduced lung function in children who live near major highways. Studies of particulate matter (PM) that show associations with cardiac and pulmonary mortality also appear to indicate increasing risk as smaller geographic areas are studied, suggesting localized sources that likely include major highways. Although less work has tested the association between lung cancer and highways, the existing studies suggest an association as well. While the evidence is substantial for a link between near-highway exposures and adverse health outcomes, considerable work remains to understand the exact nature and magnitude of the risks. [ABSTRACT FROM AUTHOR]

Background: Asthma prevalence is lower in less developed countries and among some recent immigrant populations in the US, but the reasons for this are not clear. One possibility is that early childhood infections are protective against asthma. Methods: We surveyed Asian immigrant children (n = 204; age 4-18) to assess the relationship between asthma and native or foreign place of birth. We included questions about environmental exposures, demographic variables and family history of asthma to test whether they might explain effects of place of birth on asthma. Results: The native and foreign born groups were similar in most respects. Analysis of association with diagnosed asthma for all ages together resulted in two logistic regression models. Both retained born in the US (ORs were 3.2 and 4.3; p < 0.01) and family history of asthma (ORs were 6.4 and 7.2; p < 0.001). One model retained living near heavy motor traffic (OR = 2.6; p = 0.012). The other retained language (OR = 3.2; p = 0.003). However, for older children (11-18 years of age) being born in the US lost some of its predictive power. Conclusion: Our findings are consistent with early childhood infections that are prevalent outside the US protecting against asthma. [ABSTRACT FROM AUTHOR]

Energy- and water-saving have been promoted as ways of saving money while there has been controversy about the effects (if any) of such measures on resident health. In public housing in the US, energy saving has taken the form of Energy Savings Performance Contracts (ESPC) that pay for renovations out of future savings. In an attempt to test feasibility and pilot research methods we conducted a study of the relationship between gas and water use, exterior heat sensor locations, and basement ventilation with indices developed from resident-reported living conditions and health symptoms in a single housing development. The data sources that we had available to us were not ideal. In particular, we were unable to obtain water use data that coincided in time with our health survey data. Also, we did not have enough surveys in buildings with high water or gas use and had to pool those buildings with other buildings for analysis. Nevertheless, we found several associations between our measures of energy use and resident reports of health symptoms. The associations that we found were generally in the direction that energy and water savings were associated with fewer symptoms and fewer environmental problems. There is a need for studies that obtain better input data but that generally follow the approach we developed. [ABSTRACT FROM AUTHOR]

Abstract: Pest infestation is a major problem in urban, low-income housing and may contribute to elevated asthma prevalence and exacerbation rates in such communities. However, there is poor understanding of the effectiveness of integrated pest management (IPM) efforts in controlling pediatric asthma, or of the interactions among various interventions and risk factors in these settings. As part of the Boston-based Healthy Public Housing Initiative, we conducted a longitudinal, single-cohort community-based participatory research intervention study. Fifty asthmatic children aged 4–17 from three public housing developments in Boston, Massachusetts, USA successfully completed interventions and detailed environmental, medical, social, and health outcome data collection. Interventions primarily consisted of IPM and related cleaning and educational efforts, but also included limited case management and support from trained community health advocates. In pre-post analyses, we found significant reductions in a 2-week recall respiratory symptom score (from 2.6 to 1.5 on an 8-point scale, ) and in the frequency of wheeze/cough, slowing down or stopping play, and waking at night. Longitudinal analyses of asthma-related quality of life similarly document significant improvements, with a suggestion of some improvements prior to environmental interventions with an increased rate of improvement subsequent to pest management activities. Analyses of potential explanatory factors demonstrated significant between-development differences in symptom improvements and suggested some potential contributions of allergen reductions, increased peak flow meter usage, and improved social support, but not medication changes. In spite of limitations with pre-post comparisons, our results are consistent with aggressive pest management and other allergen reduction efforts having a positive impact on clinical health outcomes associated with asthma. Our findings reinforce the multifactorial nature of urban asthma and suggest a need for further study of the relative contributions of and possible synergies between environmental and social factors in asthma intervention programs. [Copyright &y& Elsevier]

This essay explores the process and issues related to community collaborative research that involves Native Americans generally, and specifically examines the Navajo Nation's efforts to regulate research within its jurisdiction. Researchers need to account for both the experience of Native Americans and their own preconceptions about Native Americans when conducting research about Native Americans. The Navajo Nation institutionalized an approach to protecting members of the nation when it took over Institutional Review Board (IRB) responsibilities from the US Indian Health Service (IHS) in 1996. While written regulations for the Navajo Nation IRB are not dissimilar, and in some ways are less detailed than those of the IHS IRB, in practice the Navajo Nation allows less flexibility. Primary examples of this include not allowing expedited review and requiring prepublication review of all manuscripts. Because of its broad mandate, the Navajo Nation IRB may also require review of some projects that would not normally be subject to IRB approval, including investigative journalism and secondary research about Navajo People that does not involve direct data collection from human subjects. [ABSTRACT FROM AUTHOR]

The authors used community-based participatory research to survey 238 residents in public housing. They developed 9 exposure and 2 health symptom indexes through exploratory factor analyses. The univariate analysis showed that most environmental risk factors were associated with the symptom indexes. The authors found a statistically significant intercorrelation between 29 of 36 risk factor pairs. Because of this, most of the univariate associations lost statistical significance in multivariate models. The authors found a normal distribution of risk factors across household; however, risk factors per apartment were associated with symptoms. Environmental risk factors accounted for 2% to 26% of the variation in symptoms. The analysis suggests that correlation between factors could affect surveys in which researchers assess a small number of housing risk factors or assess larger numbers of factors without testing intercorrelation. The analysis is consistent with the possibility that building quality or housekeeping might drive the development of risk factors. [ABSTRACT FROM AUTHOR]

Familism, respect for authority, and a sense of shame/pride are cultural characteristics that might influence research participation of Asian Americans. We compared 79 elderly Asian immigrants, most of whom immigrated from China or Hong Kong, with 58 elders who were not Asian and mostly not immigrants. Responding to hypothetical situations presented on a self-administered questionnaire, the Asian group professed to be more likely to be influenced by a request from a son/daughter, landlord, physician, or advertisement ( p < 0.001) and by a monetary incentive ( p = 0.05). Multivariate adjustment for potential confounders attenuated the strength of these relations, but except in the case of the monetary offer, differences remained statistically significant. Within the Asian group, multivariate logistic regression modeling indicated that years lived in the US was associated with more likelihood of refusing requests to participate in research. We conclude that acculturation or assimilation into American society may build resistance to pressure to participate in research. Our findings also suggest that elderly Asian immigrants may need additional protections to achieve truly informed consent. [ABSTRACT FROM AUTHOR]

Background: Depleted uranium is being used increasingly often as a component of munitions in military conflicts. Military personnel, civilians and the DU munitions producers are being exposed to the DU aerosols that are generated. Methods: We reviewed toxicological data on both natural and depleted uranium. We included peer reviewed studies and gray literature on birth malformations due to natural and depleted uranium. Our approach was to assess the "weight of evidence" with respect to teratogenicity of depleted uranium. Results: Animal studies firmly support the possibility that DU is a teratogen. While the detailed pathways by which environmental DU can be internalized and reach reproductive cells are not yet fully elucidated, again, the evidence supports plausibility. To date, human epidemiological data include case examples, disease registry records, a case-control study and prospective longitudinal studies. Discussion: The two most significant challenges to establishing a causal pathway between (human) parental DU exposure and the birth of offspring with defects are: i) distinguishing the role of DU from that of exposure to other potential teratogens; ii) documentation on the individual level of extent of parental DU exposure. Studies that use biomarkers, none yet reported, can help address the latter challenge. Thoughtful triangulation of the results of multiple studies (epidemiological and other) of DU teratogenicity contributes to disentangling the roles of various potentially teratogenic parental exposures. This paper is just such an endeavor. Conclusion: In aggregate the human epidemiological evidence is consistent with increased risk of birth defects in offspring of persons exposed to DU. [ABSTRACT FROM AUTHOR]

The article presents a study on the urinary cotinine on people with low levels of exposure on environmental tobacco smoke (ETS). The author determines the sources of exposure and dietary factors of individuals that may affect the variation of the measured cotinine levels. It was discovered that sources of urinary cotinine in the body arises from direct exposure to nicotine itself and is not associated with the consumption of foods containing nicotine. However, the variation of urine cotinine levels in the body was not clearly identified.

Asthma in the US is widespread, with incidence rates and morbidity increasing dramatically over the last 2 decades. The cost of asthma-related morbidity and mortality is large. There is substantial and convincing evidence that environmental factors are associated with asthma exacerbation, and more limited evidence that environmental factors play a role in the development of asthma. Educational interventions, which include an avoidance of ‘triggers’ or focus on reducing exposure to cigarette smoke, have been shown to be moderately effective. While various interventions have been shown to reduce environmental exposures, fewer studies have collected sufficient information on their effectiveness in reducing morbidity. Cost-effectiveness analyses on educational interventions suggest that reductions in direct costs are most prominently seen for severe asthma, with the interpretation of study findings impaired by a lack of methodological consistency. One analysis from a study that included physical interventions found that the incremental cost-effectiveness ratio was $US9.20 per symptom-free day (95% CI -$US12.56, $US55.29), with potential cost savings for more severe asthma. We point out that current practice in managed care organizations (MCOs), as well as in other settings, rarely conforms to the current clinical practice guidelines for asthma. Two reviews of the policies and actions of MCOs found that while some were integrating environmental controls into their asthma disease management plans, their commitment to these strategies was limited by lack of a strong evidence base. We recommend the following: (i) continuation of educational programs; (ii) continuation and expansion of case management, including home visits; (iii) full integration of smoking cessation programs into asthma disease management; (iv) development of policies around reimbursement for durable goods; (v) participation in the setting of a policy agenda for population-based approaches to controlling key environmental factors; (vi) development of exploratory programs to address occupational asthma; (vii) integration, analysis and dissemination of environmental data collected by MCOs; and (viii) widespread MCO participation in research on environmental prevention of asthma. [ABSTRACT FROM AUTHOR]

We conducted and analyzed qualititative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage in community-based collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community. [ABSTRACT FROM AUTHOR]

We evaluated the status of nationally top-ranked managed care organizations' (MCOs) asthma disease management programs to identify “best practices” in the environmental treatment and control of asthma. Application materials were developed and mailed to the top 34 managed care organizations, as determined by the ranked results from the 10 1998 edition of US News and World Report. Based on the results of a staff and panel review, five applicants were selected for site visitation. The results of the site visits determined two finalists and three runners-up. We recommend that MCOs integrate population and community-based strategies and seek an emphasis on prevention. We encourage collaborations with other organizations and agencies. We endorse home visitation to assess environmental factors and also support use of telephonic case management. We think that smoking cessation programs should be coordinated with asthma management. We consider it important to use alternative forms of communication such as the Internet. And we find that it is important to be mindful of language, culture, and literacy. [ABSTRACT FROM AUTHOR]

The self-reported prevalence of asthma increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase has been most marked in children 0-14 years of age, and there is evidence that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environment risk factors, especially in homed and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, NO2, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that lay the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research to our work are also discussed. [ABSTRACT FROM AUTHOR]

Presents a study that conducted a cross-sectional survey of the prevalence of asthma among schoolchildren at the Josiah Quincy Elementary School in Boston Chinatown, Massachusetts. Percentage of Asian American students in the school; Methods used; Results of the survey.

From World War I until 1971, the government was the sole purchaser of uranium ore in the United States. Uranium mining occurred mostly in the southwestern United States and drew many Native Americans and others into work in the mines and mills. Despite a long and well-developed understanding, based on the European experience earlier in the century, that uranium mining led to high rates of lung cancer, few protections were provided for US miners before 1962 and their adoption after that time was slow and incomplete. The resulting high rates of illness among miners led in 1990 to passage of the Radiation Exposure Compensation Act. [ABSTRACT FROM AUTHOR]

Boston Chinatown is a community that grapples with a constant pressure from the downtown area to build new and larger buildings. The effort to preserve the residential aspect of Chinatown has used data analysis in recent years by forming partnerships with academics. This has allowed for more sophisticated studies of traffic injuries, scientific surveys of residents about environmental health, the measurement of noise levels and the construction of physical and electronic mapping of data. While not the only factor contributing to the community's efforts to question the role of development, these data have added useful tools that reduce, but do not eliminate, the disparity between what the community brings to discussions about the environmental impact of development and what the developers have at their disposal. [ABSTRACT FROM AUTHOR]

Residents of Boston's Chinatown and the Vietnamese community in Boston's Dorchester section are recent immigrants from China and Vietnam, countries whose smoking prevalence rates for men are among the highest in the world and whose rates for women are very low. We conducted exploratory focus groups in these communities to examine issues related to secondhand smoke and to generate message concepts for health education materials that would convince recent Asian immigrants to respond to the public health threat that secondhand smoke poses. The message concepts, which were tailored specifically for Chinese and Vietnamese immigrants, used themes that were consistent with the cultural values of each group as expressed in the focus groups, yet also reflected the fact that, in many ways, these immigrants are seeking to adapt to American norms. We suggest that it is possible to construct culturally appropriate health education materials for recent immigrant populations rather than rely on simple translations of English-language materials. An intervention study using these message concepts is needed. [ABSTRACT FROM AUTHOR]

Documents the public-health status of public housing and of the residents of Boston, Massachusetts. Rise in asthma incidence, particularly in inner-city neighborhoods; Struggle with environmental issues and social crises; Questions about nexus of health and housing conditions; Public housing as a locus of action and intervention.

Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures, chest x-ray), such panels have included a combination of total and differential cell counts, total immature neutrophil counts, immature to total neutrophil ratio, platelet counts, and levels of acute-phase reactants and cytokines. Furthermore, the science of proteomics and genomics has been applied to the search for biomarkers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the short-term concentration-response data from a randomized crossover trial examining differences in blood pressure (BP) associated with exposure to ultrafine particles (UFP) and black carbon (BC). Topics discussed include association of exposure to traffic-related air pollution (TRAP) and adverse health outcomes, concentration-response functions for particle number concentration (PNC) and BC, and strengths and limitations of the study.

Background: Elevated cardiovascular disease risk has been reported with proximity to highways or busy roadways, but proximity measures can be challenging to interpret given potential confounders and exposure error.Methods: We conducted a cross sectional analysis of plasma levels of C-Reactive Protein (hsCRP), Interleukin-6 (IL-6), Tumor Necrosis Factor alpha receptor II (TNF-RII) and fibrinogen with distance of residence to a highway in and around Boston, Massachusetts. Distance was assigned using ortho-photo corrected parcel matching, as well as less precise approaches such as simple parcel matching and geocoding addresses to street networks. We used a combined random and convenience sample of 260 adults >40 years old. We screened a large number of individual-level variables including some infrequently collected for assessment of highway proximity, and included a subset in our final regression models. We monitored ultrafine particle (UFP) levels in the study areas to help interpret proximity measures.Results: Using the orthophoto corrected geocoding, in a fully adjusted model, hsCRP and IL-6 differed by distance category relative to urban background: 43% (-16%,141%) and 49% (6%,110%) increase for 0-50 m; 7% (-39%,45%) and 41% (6%,86%) for 50-150 m; 54% (-2%,142%) and 18% (-11%,57%) for 150-250 m, and 49% (-4%, 131%) and 42% (6%, 89%) for 250-450 m. There was little evidence for association for TNF-RII or fibrinogen. Ortho-photo corrected geocoding resulted in stronger associations than traditional methods which introduced differential misclassification. Restricted analysis found the effect of proximity on biomarkers was mostly downwind from the highway or upwind where there was considerable local street traffic, consistent with patterns of monitored UFP levels.Conclusion: We found associations between highway proximity and both hsCRP and IL-6, with non-monotonic patterns explained partly by individual-level factors and differences between proximity and UFP concentrations. Our analyses emphasize the importance of controlling for the risk of differential exposure misclassification from geocoding error. [ABSTRACT FROM AUTHOR]

Little is known of the relationship between exposure to the smallest particles of air pollution and socio-demographic characteristics. This paper explores linkages between ultrafine particle (UFP) concentrations and indicators of both race/ethnicity and socioeconomic status in Boston, Massachusetts, USA. We used estimates of UFP based on a highly-resolved land-use regression model of concentrations. In multivariate linear regression models census block groups with high proportions of Asians were associated with higher levels of UFP in comparison to block groups with majority White or other minority groups. Lower UFP concentrations were associated with higher homeownership (indicating higher SES) and with higher female head of household (indicating lower socioeconomic status). One explanation for the results include the proximity of specific groups to traffic corridors that are the main sources of UFP in Boston. Additional studies, especially at higher geographic resolution, are needed in Boston and other major cities to better characterize UFP concentrations by sociodemographic factors. [ABSTRACT FROM AUTHOR]

This study examines the burden of occupational health risks among a convenience sample of three immigrant worker populations (Brazilian, Haitian, and El Salvadoran) in Somerville, Massachusetts. In this community based research initiative (n = 346), logistic regression is used to analyze immigrant occupational health survey data collected from 2006 to 2009. In this study , injuries at work were significantly associated with lower English proficiency (OR = 1.8, 95 % CI 1.1-3.0), workers between the ages of 46 and 65 (OR = 2.7, 95 % CI 1.0-7.0), service workers (OR = 13.8, 95 % CI 1.8-105.2), production workers (OR = 10.8, 95 % CI 1.3-90.1), construction workers (OR: 21.7, 95 % CI 2.8-170.9) and immigrants with no health insurance (OR = 1.8, 95 % CI 1.0-3.1). Injuries were negatively associated with years in the US with more established immigrants in the US >15 years reporting more injuries at work. Older immigrants who have been in the US longer but are less proficient in English, and are still employed in low-wage occupations with no health insurance suffered more injuries than recent immigrants. Further validation of this result is required. [ABSTRACT FROM AUTHOR]

Exposure to elevated levels of vehicular traffic has been associated with adverse cardiovascular and respiratory health effects in a range of populations, including children, the elderly, and individuals with pre-existing heart conditions, diabetes, obesity, and genetic susceptibilities. As these relationships become clearer, public health officials will need to have access to methods to identify areas of concern in terms of elevated traffic levels and susceptible populations. This paper briefly reviews current approaches for characterizing traffic exposure and then presents a detailed method that can be employed by public health officials and other researchers in performing screening assessments to define areas of potential concern within a particular locale and, with appropriate caveats, in epidemiologic studies examining traffic-related health impacts at the intra-urban scale. The method is based on two exposure parameters extensively used in numerous epidemiologic studies of traffic and health—proximity to high traffic roadways and overall traffic density. The method is demonstrated with publically available information on susceptible populations, traffic volumes, and Traffic Analysis Zones, a transportation planning tool long used by Metropolitan Planning Agencies and planners across the USA but presented here as a new application which can be used to spatially assess possible traffic-related impacts on susceptible populations. Recommendations are provided for the appropriate use of this methodology, along with its limitations. [ABSTRACT FROM AUTHOR]

Aim: To establish baseline noninvasive carboxyhemoglobin (COHb) levels in children and determine the influence of exposure to environmental sources of carbon monoxide (CO), especially environmental tobacco smoke, on such levels. Background: Second-hand smoking may be a risk factor for adverse outcomes following anesthesia and surgery in children (1) and may potentially be preventable. Patients and Methods: Parents and their children between the ages of 1–12 were enrolled on the day of elective surgery. The preoperative COHb levels of the children were assessed noninvasively using a CO-Oximeter (Radical-7 Rainbow SET Pulse CO-Oximeter; Masimo, Irvine, CA, USA). The parents were asked to complete an environmental air-quality questionnaire. The COHb levels were tabulated and correlated with responses to the survey in aggregate analysis. Statistical analyses were performed using the nonparametric Mann–Whitney and Kruskal–Wallis tests. P < 0.05 was statistically significant. Results: Two hundred children with their parents were enrolled. Children exposed to parental smoking had higher COHb levels than the children of nonsmoking controls. Higher COHb values were seen in the youngest children, ages 1–2, exposed to parental cigarette smoke. However, these trends did not reach statistical significance, and confidence intervals were wide. Conclusions: This study revealed interesting trends of COHb levels in children presenting for anesthesia and surgery. However, the COHb levels measured in our patients were close to the error margin of the device used in our study. An expected improvement in measurement technology may allow screening children for potential pulmonary perioperative risk factors in the future. [ABSTRACT FROM AUTHOR]

Background: We quantified the air quality benefits of a smoke-free workplace law in Boston Massachusetts, U.S.A., by measuring air pollution from secondhand smoke (SHS) in 7 pubs before and after the law, comparing actual ventilation practices to engineering society (ASHRAE) recommendations, and assessing SHS levels using health and comfort indices. Methods: We performed real-time measurements of respirable particle (RSP) air pollution and particulate polycyclic aromatic hydrocarbons (PPAH), in 7 pubs and outdoors in a model-based design yielding air exchange rates for RSP removal. We also assessed ventilation rates from carbon dioxide concentrations. We compared RSP air pollution to the federal Air Quality Index (AQI) and the National Ambient Air Quality Standard (NAAQS) to assess health risks, and assessed odor and irritation levels using published SHS-RSP thresholds. Results: Pre-smoking-ban RSP levels in 6 pubs (one pub with a non-SHS air quality problem was excluded) averaged 179 μg/m³, 23 times higher than post-ban levels, which averaged 7.7 μg/m³, exceeding the NAAQS for fine particle pollution (PM2.5) by nearly 4-fold. Pre-smoking ban levels of fine particle air pollution in all 7 of the pubs were in the Unhealthy to Hazardous range of the AQI. In the same 6 pubs, pre-ban indoor carcinogenic PPAH averaged 61.7 ng/m³, nearly 10 times higher than post-ban levels of 6.32 ng/m³. Post-ban particulate air pollution levels were in the Good AQI range, except for 1 venue with a defective gas-fired deep-fat fryer, while post-ban carcinogen levels in all 7 pubs were lower than outdoors. Conclusion: During smoking, although pub ventilation rates per occupant were within ASHRAE design parameters for the control of carbon dioxide levels for the number of occupants present, they failed to control SHS carcinogens or RSP. Nonsmokers' SHS odor and irritation sensory thresholds were massively exceeded. Post-ban air pollution measurements showed 90% to 95% reductions in PPAH and RSP respectively, differing little from outdoor concentrations. Ventilation failed to control SHS, leading to increased risk of the diseases of air pollution for nonsmoking workers and patrons. Boston's smoking ban eliminated this risk. [ABSTRACT FROM AUTHOR]

Background: This paper explores strategies to engage community stakeholders in efforts to address the effects of traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately impacted by environmental threats including emissions generated by major roadways.Methods: Qualitative instrumental case study design was employed to examine how community-level factors in two Massachusetts communities, the City of Somerville and Boston's Chinatown neighborhood, influence the translation of research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three data sources: key informant interviews, observations and document reviews. Thematic analysis was used.Results: Findings indicate political history plays a significant role in shaping community action. In Somerville, community organizers worked with city and state officials, and embraced community development strategies to engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including housing and resident displacement resulting in more opposition to local municipal leadership.Conclusions: The ISF was helpful in informing the team's thinking related to systems and structures needed to translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing framework may serve as a useful approach for examining the dynamic relationship between science, community engagement and environmental research translation. Social workers and public health professionals can advance TRAP exposure mitigation by exploring the political and social context of communities and working to bridge research and community action. [ABSTRACT FROM AUTHOR]

This study developed and evaluated a visual approach to promoting environmental health literacy about highway pollution. The Interactive Map of Chinatown Traffic Pollution was the centerpiece of a communication approach designed to make complex scientific information about traffic-related air pollution comprehensible to Chinese immigrants with limited English proficiency. The map enabled visualization of the spatial distribution of ultrafine particles (less than 100 nanometers in diameter), a toxic and invisible form of air pollution, in Boston Chinatown. A university-community partnership enabled design of intergenerational training sessions aimed toward empowering community members to take health-promoting actions that reduce exposure to ultrafine particulate pollution. A mixed methods approach was taken to evaluation. Nine high school youth learned to use the map and then tutored adults recruited from English as a Second Language (ESL) classes and from a community workshop. Seventy-three of these adults completed a pre-post survey measuring change in three domains: pollution knowledge, attitudes toward environmental issues, and self-efficacy in using maps. Adult participants demonstrated statistically significant improvements in all three domains (Wilcoxon signed-rank test, all p < 0.01). Seventeen adults and nine youth participated in interviews. Interview participants reported adjusting daily routines to reduce exposure to pollution. [ABSTRACT FROM AUTHOR]

Air pollution has been linked to adverse cardiovascular outcomes; however, susceptibility may vary by population. Puerto Rican adults living in the US may be a susceptible group due to a high rate of adverse cardiovascular events. We evaluated the effect of changes in ambient particle number concentration (PNC, a measure of ultrafine particles) and effects on biomarkers of cardiovascular risk in the Boston Puerto Rican Health Study (BPRHS), a longitudinal cohort (n = 1499). Ambient PNC was measured at a fixed site between 2004 and 2013 and daily mean concentrations were used to construct PNC metrics, including lags of 0, 1 and 2 days and moving averages (MAs) of 3, 7 and 28 days. We examined the association of each metric with C-reactive protein (CRP) and blood pressure. Each model included subject-specific random intercepts to account for multiple measurements. An interquartile range (IQR) increase in PNC was associated with CRP for all metrics, notably a 3-day increase in PNC was associated with a 7.1% (95% CI: 2.0%, 12.2%) increase in CRP. Significant associations with CRP were seen in women, but not men; with current and former (but not non-) smokers; participants younger (but not older) than 65 y; those without diabetes (but not with), and those with (but not without), hypertension. Our study extends knowledge about the health effects of air pollution to a vulnerable population that has been understudied. [ABSTRACT FROM AUTHOR]

Urbanization is associated with higher prevalence of cardiovascular disease worldwide. Aortic stiffness, as measured by carotid-femoral pulse wave velocity is a validated predictor of cardiovascular disease. Our objective was to determine the association between urbanization and carotid-femoral pulse wave velocity. The analysis included 6166 participants enrolled in an ongoing population-based study (mean age 42 years; 58% female) who live in an 80 × 80 km region of southern India. Multiple measures of urbanization were used and compared: 1) census designations, 2) satellite derived land cover (crops, grass, shrubs or trees as rural; built-up areas as urban), and 3) distance categories based on proximity to an urban center. The association between urbanization and carotid-femoral pulse wave velocity was tested in sex-stratified linear regression models. People residing in urban areas had significantly (p < 0.05) elevated mean carotid-femoral pulse wave velocity compared to non-urban populations after adjustment for other risk factors. There was also an inverse association between distance from the urban center and mean carotid-femoral pulse wave velocity: each 10 km increase in distance was associated with a decrease in mean carotid-femoral pulse wave velocity of 0.07 m/s (95% CI: -0.09, -0.06 m/s). The association was stronger among older participants, among smokers, and among those with other cardiovascular risk factors. Further research is needed to determine which components in the urban environment are associated with higher carotid-femoral pulse wave velocity. [ABSTRACT FROM AUTHOR]

Some studies suggest that ambient particulate air pollution is associated with cognitive decline. However, the findings are mixed, and there is no relevant research examining the influences 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 with cognitive decline using data from the Alzheimer's Disease Research Centers in the United States. 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 to each 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 ε4 status, race, education, smoking status, history of diabetes, quartiles of neighborhood median household income, and interaction terms of follow-up time with each covariate. This study included 5646 participants (mean age 76 years, 65% female). On average, each participant 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 a categorical variable including five exposure groups, there were no linear exposure-response trends in annual decline of each cognitive function across the five exposure groups. This study found no meaningful associations between residential UFP exposure and cognitive decline in global and domain-specific functions. There is a need for further research that assigns UFP exposure at a finer geographic scale. • APOE ε4 carriers had faster annual decline in every cognitive function. • Smoking was associated with faster decline in memory and executive function. • Higher income neighborhoods had greater exposure to ultrafine particles. • No meaningful association was found between ultrafine particles and cognitive decline. [ABSTRACT FROM AUTHOR]

Increasing evidence points to an association of airborne pollutant exposure with respiratory, cardiovascular, and neurological pathology. We examined whether or not ground-level ozone or fine particulate matter ≤ 2.5 μm in diameter (PM2.5) was associated with accelerated cognitive decline. Using repeated measures mixed regression modeling, we analyzed cognitive performance of a geographically diverse sampling of individuals from the National Alzheimer's Coordinating Center between 2004-2008. Ambient air concentrations of ozone and PM2.5 were established using a space-time Hierarchical Bayesian Model that statistically merged air monitor data and modeled air quality estimates. We then compared the ambient regional concentrations of ozone and PM2.5 with the rate of cognitive decline in residents within those regions. Increased levels of ozone correlated with an increased rate of cognitive decline, following adjustment for key individual and community-level risk factors. Furthermore, individuals harboring one or more APOE4 alleles exhibited a faster rate of cognitive decline. The deleterious association of ozone was confined to individuals with normal cognition who eventually became cognitively impaired as opposed to those who entered the study with baseline impairment. In contrast to ozone, we did not observe any correlation between ambient PM2.5 and cognitive decline at regulatory limits set by the Environmental Protection Agency. Our findings suggest that prolonged exposure to ground-level ozone may accelerate cognitive decline during the initial stages of dementia development. [ABSTRACT FROM AUTHOR]

Traffic-related ultrafine particles (UFP; <100 nm diameter) are ubiquitous in urban air. While studies have shown that UFP are toxic, epidemiological evidence of health effects, which is needed to inform risk assessment at the population scale, is limited due to challenges of accurately estimating UFP exposures. Epidemiologic studies often use empirical models to estimate UFP exposures; however, the monitoring strategies upon which the models are based have varied between studies. Our study compares particle number concentrations (PNC; a proxy for UFP) measured by three different monitoring approaches (central-site, short-term residential-site, and mobile on-road monitoring) in two study areas in metropolitan Boston (MA, USA). Our objectives were to quantify ambient PNC differences between the three monitoring platforms, compare the temporal patterns and the spatial heterogeneity of PNC between the monitoring platforms, and identify factors that affect correlations across the platforms. We collected >12,000 h of measurements at the central sites, 1000 h of measurements at each of 20 residential sites in the two study areas, and >120 h of mobile measurements over the course of ∼1 year in each study area. Our results show differences between the monitoring strategies: mean 1 min PNC on-roads were higher (64,000 and 32,000 particles/cm 3 in Boston and Chelsea, respectively) compared to central-site measurements (23,000 and 19,000 particles/cm 3 ) and both were higher than at residences (14,000 and 15,000 particles/cm 3 ). Temporal correlations and spatial heterogeneity also differed between the platforms. Temporal correlations were generally highest between central and residential sites, and lowest between central-site and on-road measurements. We observed the greatest spatial heterogeneity across monitoring platforms during the morning rush hours (06:00-09:00) and the lowest during the overnight hours (18:00-06:00). Longer averaging times (days and hours vs. minutes) increased temporal correlations (Pearson correlations were 0.69 and 0.60 vs. 0.39 in Boston; 0.71 and 0.61 vs. 0.45 in Chelsea) and reduced spatial heterogeneity (coefficients of divergence were 0.24 and 0.29 vs. 0.33 in Boston; 0.20 and 0.27 vs. 0.31 in Chelsea). Our results suggest that combining stationary and mobile monitoring may lead to improved characterization of UFP in urban areas. [ABSTRACT FROM AUTHOR]

The Nuestro Futuro Saludable partnership designed a critical service-learning intervention focused on health equity and action. The 10-week afterschool intervention was implemented in a Boston middle school. Youths who took part in the intervention were knowledgeable about the social determinants of health in their communities, as well as to the barriers to health. Our findings indicate that engaging young people in a meaningful way will be critical if health improvement efforts are to be realized. We found that a critical service-learning framework that incorporates elements of applied inquiry and critical pedagogy was effective as a health intervention and provided opportunities for action. [ABSTRACT FROM PUBLISHER]

Background Long-term exposure to fine particulate matter has been linked to cardiovascular disease and systemic inflammatory responses; however, evidence is limited regarding the effects of long-term exposure to ultrafine particulate matter (UFP, < 100 nm). We used a cross-sectional study design to examine the association of long-term exposure to near-highway UFP with measures of systemic inflammation and coagulation. Methods We analyzed blood samples from 408 individuals aged 40–91 years living in three near-highway and three urban background areas in and near Boston, Massachusetts. We conducted mobile monitoring of particle number concentration (PNC) in each area, and used the data to develop and validate highly resolved spatiotemporal (hourly, 20 m) PNC regression models. These models were linked with participant time-activity data to determine individual time-activity adjusted (TAA) annual average PNC exposures. Multivariable regression modeling and stratification were used to assess the association between TAA-PNC and single peripheral blood measures of high-sensitivity C -reactive protein (hsCRP), interleukin-6 (IL-6), tumor-necrosis factor alpha receptor II (TNFRII) and fibrinogen. Results After adjusting for age, sex, education, body mass index, smoking and race/ethnicity, an interquartile-range (10,000 particles/cm 3 ) increase in TAA-PNC had a positive non-significant association with a 14.0% (95% CI: − 4.6%, 36.2%) positive difference in hsCRP, an 8.9% (95% CI: − 0.4%, 10.9%) positive difference in IL-6, and a 5.1% (95% CI: − 0.4%, 10.9%) positive difference in TNFRII. Stratification by race/ethnicity revealed that TAA-PNC had larger effect estimates for all three inflammatory markers and was significantly associated with hsCRP and TNFRII in white non-Hispanic, but not East Asian participants. Fibrinogen had a negative non-significant association with TAA-PNC. Conclusions Our findings suggest an association between annual average near-highway TAA-PNC and subclinical inflammatory markers of CVD risk. [ABSTRACT FROM AUTHOR]