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Additional file 1.

Additional file 8: Figure S1. Partial dependance plots of a selection of top ranked categorical variables within a random forest model to predict self-perceived general health status. Figure S2. Accumulated local effects plots of a selection of top continuous variables within a random forest model to predict self-perceived general health status.

Additional file 1: Table S1. Study population selection. Table S2. Exposure distributions. Table S3. Spearman correlations between exposures (top), and between exposures and neighbourhood socio-economic position (SEP) score (bottom). Table S4. Mean exposure by quintiles of neighbourhood socio-economic position. Table S5. Hazard ratios (95% confidence intervals) for single exposure associations between air pollution and noise exposures and mortality by cause, with increasing level of covariate adjustment in single exposure models. Table S6. Effect modification by sex, hazard ratios (95% confidence intervals) in two exposure models for associations with natural cause mortality (Model 3). Table S7. Non-mover analysis, hazard ratios (95% confidence intervals) in two exposure models for associations with natural cause mortality (Model 3).

BACKGROUND: Green space, air pollution and traffic noise exposure may be associated with mental health in adolescents. We assessed the associations of long-term exposure to residential green space, ambient air pollution and traffic noise with mental wellbeing from age 11 to 20 years. METHODS: We included 3059 participants of the Dutch PIAMA birth cohort who completed the five-item Mental Health Inventory (MHI-5) at ages 11, 14, 17 and/or 20 years. We estimated exposure to green space (the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m, 1000 m and 3000 m), ambient air pollution (particulate matter (PM10 and PM2.5), nitrogen dioxide, PM2.5 absorbance and the oxidative potential of PM2.5) and road traffic and railway noise (Lden) at the adolescents' home addresses at the times of completing the MHI-5. Associations with poor mental wellbeing (MHI-5 score ≤ 60) were assessed by generalized linear mixed models with a logit link, adjusting for covariates. RESULTS: The odds of poor mental wellbeing at age 11 to 20 years decreased with increasing exposure to green space in a 3000 m buffer (adjusted odds ratio (OR) 0.78 [95% CI 0.68-0.88] per IQR increase in the average NDVI; adjusted OR 0.77 [95% CI 0.67-0.88] per IQR increase in the total percentage of green space). These associations persisted after adjustment for air pollution and road traffic noise. Relationships between mental wellbeing and green space in buffers of 300 m and 1000 m were less consistent. Higher air pollution exposure was associated with higher odds of poor mental wellbeing, but these associations were strongly attenuated after adjustment for green space in a buffer of 3000 m, traffic noise and degree of urbanization. Traffic noise was not related to mental wellbeing throughout adolescence. CONCLUSIONS: Residential exposure to green space may be associated with a better mental wellbeing in adolescents.

Supplemental Digital Content is available in the text., Background: Green space, air pollution, and traffic noise exposure may be associated with stress levels in children. A flattened diurnal cortisol slope (the decline in cortisol concentrations from awakening to evening) is an indicator of chronic stress. We examined associations of green space, ambient air pollution, and traffic noise with the diurnal cortisol slope in children 12 years of age. Methods: At age 12 years, 1,027 participants of the Dutch PIAMA birth cohort collected three saliva samples during 1 day. We estimated residential exposure to green space (i.e., the average Normalized Difference Vegetation Index [NDVI] and percentages of green space in circular buffers of 300 m and 3,000 m), air pollution, and traffic noise. Associations of these exposures with the diurnal cortisol slope (in nmol/L per hour) were assessed by multiple linear regression, adjusting for potential confounders. Results: Higher average NDVI and total percentage of green space in a 3,000 m buffer were associated with a larger diurnal decrease in cortisol levels (adjusted difference [95% confidence interval] = −0.11 nmol/L/hr [−0.21, 0.00 nmol/L/hr] per interquartile range increase in the average NDVI; −0.13 nmol/L/hr [−0.26, 0.00 nmol/L/hr] per interquartile range increase in the total percentage of green space). These associations were largely driven by associations with the percentage of agricultural green space and by associations in children living in nonurban areas. We observed no relationships between air pollution or traffic noise and the diurnal cortisol slope. Conclusions: Residential exposure to green space in a buffer of 3,000 m may be associated with lower stress levels in children 12 years of age.

OBJECTIVE To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN Pooled analysis of eight cohorts. SETTING Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES Deaths due to natural causes and cause specific mortality. RESULTS Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 mu g/m(3) in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 mu g/m(3) increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 mu g/m(3) an increase of 5 mu g/m(3) in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.

Background: Long-term exposure to ambient air pollution has been linked to childhood-onset asthma, although evidence is still insufficient. Within the multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we examined the associations of long-term exposures to particulate matter with a diameter

Relatively high concentrations of ultrafine particles (UFPs) have been observed around airports, in which aviation and road traffic emissions are the major sources. This raises concerns about the potential health impacts of airport UFPs, particularly in comparison to those emitted by road traffic. UFPs mainly derived from aviation or road traffic emissions were collected from a location near a major international airport, Amsterdam-Schiphol airport (AMS), depending on the wind direction, along with UFPs from an aircraft turbine engine at low and full thrust. Human bronchial epithelial cells (Calu-3) model in combination with an air-liquid interface (ALI) cloud system was used for the in vitro exposure to UFPs at low doses ranging from 0.09 to 2.07 μg/cm2. Particle size distribution was measured. Cell viability, cytotoxicity and inflammatory potential (interleukin (IL) 6 and 8 secretion) on Calu-3 cells were assessed after exposure for 24 h. The biological measurements on Calu-3 cells confirm that pro-inflammatory responses still can be activated at the high cell viability (> 80%) and low cytotoxicity. By the Benchmark Dose (BMD) analysis, Airport and Non-Airport (road traffic) UFPs as well as UFPs samples from a turbine engine have similar toxic properties. Our results suggest that UFPs from aviation and road traffic in airport surroundings may have similar adverse effects on public health.

Background: Most previous studies that investigated associations of surrounding green, air pollution or traffic noise with mortality focused on single exposures. Objectives: The aim of this study was to evaluate combined associations of long-term residential exposure to surrounding green, air pollution and traffic noise with total non-accidental and cause-specific mortality. Methods: We linked a national health survey (Public Health Monitor, PHM) conducted in 2012 to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n = 339,633) were followed from 1 January 2013 till 31 December 2017. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 m and 1000 m), annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), nitrogen dioxide (NO2)) and traffic noise with non-accidental, circulatory disease, respiratory disease, lung cancer and neurodegenerative disease mortality. Results: We observed 26,886 non-accidental deaths over 1.627.365 person-years of follow-up. Surrounding green, air pollution and traffic noise exposure were not significantly associated with non-accidental or cause-specific mortality. For non-accidental mortality, we found a hazard ratio (HR) of 0.99 (0.98, 1.01) per IQR increase in NDVI 300 m, a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in NO2, a HR of 0.98 (0.97, 1.00) per IQR increase in PM2.5 and a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in road-traffic noise. Analyses restricted to non-movers or excluding subjects aged 85+ years did not change the findings. Conclusion: We found no evidence for associations of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental or cause-specific mortality in a large population based survey in the Netherlands, possibly related to the relatively short follow-up period. Keywords: NDVI, NO2, PM2.5, Traffic noise, Mortality

Introduction In epidemiological studies, exposure to green space is inconsistently associated with being overweight and physical activity, possibly because studies differ widely in their definition of green space exposure, inclusion of important confounders, study population and data analysis. Objectives We evaluated whether the association of green space with being overweight and physical activity depended upon definition of greenspace. Methods We conducted a cross-sectional study using data from a Dutch national health survey of 387,195 adults. Distance to the nearest park entrance and surrounding green space, based on the Normalized Difference Vegetation Index (NDVI) or a detailed Dutch land-use database (TOP10NL), was calculated for each residential address. We used logistic regression analyses to study the association of green space exposure with being overweight and being moderately or vigorously physically active outdoors at least 150 min/week (self-reported). To study the shape of the association, we specified natural splines and quintiles. Results The distance to the nearest park entrance was not associated with being overweight or outdoor physical activity. Associations of surrounding green space with being overweight or outdoor physical activity were highly non-linear. For NDVI surrounding greenness, we observed significantly decreased odds of being overweight [300 m buffer, odds ratio (OR) = 0.88; 95% CI: 0.86, 0.91] and increased odds for outdoor physical activity [300 m buffer, OR = 1.14; 95% CI: 1.10, 1.17] in the highest quintile compared to the lowest quintile. For TOP10NL surrounding green space, associations were mostly non-significant. Associations were generally stronger for subjects living in less urban areas and for the smaller buffers. Conclusion Associations of green space with being overweight and outdoor physical activity differed considerably between different green space definitions. Associations were strongest for NDVI surrounding greenness.

Background Long-term exposure to air pollution has been associated with mortality in urban cohort studies. Few studies have investigated this association in large-scale population registries, including non-urban populations. Objectives The aim of the study was to evaluate the associations between long-term exposure to air pollution and nonaccidental and cause-specific mortality in the Netherlands based on existing national databases. Methods We used existing Dutch national databases on mortality, individual characteristics, residence history, neighborhood characteristics, and national air pollution maps based on land use regression (LUR) techniques for particulates with an aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2). Using these databases, we established a cohort of 7.1 million individuals ≥ 30 years of age. We followed the cohort for 7 years (2004–2011). We applied Cox proportional hazard models adjusting for potential individual and area-specific confounders. Results After adjustment for individual and area-specific confounders, for each 10-μg/m3 increase, PM10 and NO2 were associated with nonaccidental mortality [hazard ratio (HR) = 1.08; 95% CI: 1.07, 1.09 and HR = 1.03; 95% CI: 1.02, 1.03, respectively], respiratory mortality (HR = 1.13; 95% CI: 1.10, 1.17 and HR = 1.02; 95% CI: 1.01, 1.03, respectively), and lung cancer mortality (HR = 1.26; 95% CI: 1.21, 1.30 and HR = 1.10 95% CI: 1.09, 1.11, respectively). Furthermore, PM10 was associated with circulatory disease mortality (HR = 1.06; 95% CI: 1.04, 1.08), but NO2 was not (HR = 1.00; 95% CI: 0.99, 1.01). PM10 associations were robust to adjustment for NO2; NO2 associations remained for nonaccidental mortality and lung cancer mortality after adjustment for PM10. Conclusions Long-term exposure to PM10 and NO2 was associated with nonaccidental and cause-specific mortality in the Dutch population of ≥ 30 years of age. Citation Fischer PH, Marra M, Ameling CB, Hoek G, Beelen R, de Hoogh K, Breugelmans O, Kruize H, Janssen NA, Houthuijs D. 2015. Air pollution and mortality in seven million adults: the Dutch Environmental Longitudinal Study (DUELS). Environ Health Perspect 123:697–704; http://dx.doi.org/10.1289/ehp.1408254

A pilot study was performed to investigate whether the application of a new mechanical ventilation system with a fine F8 (MERV14) filter could improve indoor air quality in a high school near the Amsterdam ring road. PM10, PM2.5 and black carbon (BC) concentrations were measured continuously inside an occupied intervention classroom and outside the school during three sampling periods in the winter of 2013/2014. Initially, three weeks of baseline measurements were performed, with the existing ventilation system and normal ventilation habits. Next, an intervention study was performed. A new ventilation system was installed in the classroom, and measurements were performed during 8 school weeks, in alternating 2-week periods with and without the filter in the ventilation system under otherwise identical ventilation conditions. Indoor/outdoor ratios measured during the weeks with filter were compared with those measured without filter to evaluate the ability of the F8 filter to improve indoor air quality. During teaching hours, the filter reduced BC exposure by, on average, 36%. For PM10 and PM2.5, a reduction of 34% and 30% was found, respectively. This implies that application of a fine filter can reduce the exposure of schoolchildren to traffic exhaust at hot spot locations by about one-third. This article is protected by copyright. All rights reserved.

The capacity of Particulate Matter (PM) to oxidise target molecules, defined as its oxidative potential (OP), has been proposed as a biologically more relevant metric than PM mass. Different assays exist for measuring OP and their methodologies vary in the choice of extraction solvent and filter type. Little is known about the impact of extraction and filter type on reported OP. Four a-cellular assays; electron spin resonance (ESR), dithiothreitol (DTI'), ascorbate acid depletion (AA) and reductive acridinium triggering (CRAT) assay were chosen to evaluate whether these differences affect the OP measurement, the correlation between OP from different assays and the association with PM chemical composition. We analysed 15 urban 48-72 h PM2.5 samples collected on quartz and Teflon filters. The choice of extraction solvent had only a significant effect on OPDTT, while all OP measures for quartz filters were heavily attenuated. OP values derived from quartz were, however, highly correlated with those derived from Teflon. OPDTT correlated highly with OPCRAT, and OPESR correlated highly with OPAA. These correlations were affected by the choice of filter type. Correlations between OP and PM chemical composition were not affected by filter type and extraction solvent. These findings indicate that the measurement of relative OP reactivity is not greatly influenced by filter type and extraction solvent for the investigated assays. This robustness is also promising for exploratory use in monitoring and subsequent epidemiological studies. (C) 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

Background: The oxidative potential (OP) of particulate matter (PM) has been proposed as a more health relevant metric than PM mass. Different assays exist for measuring OP and little is known about how the different assays compare. Aim: To assess the OP of PM collected at different site types and to evaluate differences between locations, size fractions and correlation with PM mass and PM composition for different measurement methods for OP. Methods: PM2.5 and PM10 was sampled at 5 sites: an underground station, a farm, 2 traffic sites and an urban background site. Three a-cellular assays; dithiothreitol (OPDTT), electron spin resonance (OPESR) and ascorbate depletion (OPAA) were used to characterize the OP of PM. Results: The highest OP was observed at the underground, where OP of PM10 was 30 (OPDTT) to >600 (OPESR) times higher compared to the urban background when expressed as OP/m(3) and 2-40 times when expressed as OP/mu g. For the outdoor sites, samples from the farm showed significantly lower OPESR and OPAA, whereas samples from the continuous traffic site showed the highest OP for all assays. Contrasts in OP between sites were generally larger than for PM mass and were lower for OPDTT compared to OPESR and OPAA. Furthermore, OPDTT/mu g was significantly higher in PM2.5 compared to PM10, whereas the reverse was the case for OPESR. OPESR and OPAA were highly correlated with traffic-related PM components (i.e. EC, Fe, Cu, PAHs), whereas OPDTT showed the highest correlation with PM mass and OC. Conclusions: Contrasts in OP between sites, differences in size fractions and correlation with PM composition depended on the specific OP assay used, with OPESR and OPAA showing the most similar results. This suggests that either OPESR or OPAA and OPDTT can complement each other in providing information regarding the oxidative properties of PM, which can subsequently be used to study its health effects. (C) 2013 The Authors. Published by Elsevier B.V. All rights reserved.

Oxidative potential (OP) of ambient particulate matter (PM) has been suggested as a health-relevant exposure metric. In order to use OP for exposure assessment, information is needed about how well central site OP measurements and modeled average OP at the home address reflect temporal and spatial variation of personal OP. We collected 96-hour personal, home outdoor and indoor PM2.5 samples from 15 volunteers living either at traffic, urban or regional background locations in Utrecht, the Netherlands. OP was also measured at one central reference site to account for temporal variations. OP was assessed using electron spin resonance (OP(ESR)) and dithiothreitol (OP(DTT)). Spatial variation of average OP at the home address was modeled using land use regression (LUR) models. For both OP(ESR) and OP(DTT), temporal correlations of central site measurements with home outdoor measurements were high (R>0.75), and moderate to high (R=0.49-0.70) with personal measurements. The LUR model predictions for OP correlated significantly with the home outdoor concentrations for OP(DTT) and OP(ESR) (R=0.65 and 0.62, respectively). LUR model predictions were moderately correlated with personal OP(DTT) measurements (R=0.50). Adjustment for indoor sources, such as vacuum cleaning and absence of fume-hood, improved the temporal and spatial agreement with measured personal exposure for OP(ESR). OP(DTT) was not associated with any indoor sources. Our study results support the use of central site OP for exposure assessment of epidemiological studies focusing on short-term health effects.

Uncertainty about health effects of long-term ozone exposure remains. Land use regression (LUR) models have been used successfully for modeling fine scale spatial variation of primary pollutants but very limited for ozone. Our objective was to assess the feasibility of developing a national LUR model for ozone at a fine spatial scale. Ozone concentrations were measured with passive samplers at 90 locations across the Netherlands (19 regional background, 36 urban background, 35 traffic). All sites were measured simultaneously during four 2-weekly campaigns spread over the seasons. LUR models were developed for the summer average as the primary exposure and annual average using predictor variables obtained with Geographic Information Systems. Summer average ozone concentrations varied between 32 and 61 µg/m(3). Ozone concentrations at traffic sites were on average 9 µg/m(3) lower compared to regional background sites. Ozone correlated highly negatively with nitrogen dioxide and moderately with fine particles. A LUR model including small-scale traffic, large-scale address density, urban green and a region indicator explained 71% of the spatial variation in summer average ozone concentrations. Land use regression modeling is a promising method to assess ozone spatial variation, but the high correlation with NO2 limits application in epidemiology.

Studies have linked air pollution exposure to cardiovascular health effects, but it is not clear which components drive these effects. We examined the associations between air pollution exposure and circulating white blood cell (WBC) counts in humans. To investigate independent contributions of particulate matter (PM) characteristics, we exposed 31 healthy volunteers at five locations with high contrast and reduced correlations amongst pollutant components: two traffic sites, an underground train station, a farm and an urban background site. Each volunteer visited at least three sites and was exposed for 5 h with intermittent exercise. Exposure measurements on-site included PM mass and number concentration, oxidative potential (OP), elemental- and organic carbon, metals, O-3 and NO2. Total and differential WBC counts were performed on blood collected before and 2 and 18 h post-exposure (PE). Changes in total WBC counts (2 and 18 h PE), number of neutrophils (2 h PE) and monocytes (18 h PE) were positively associated with PM characteristics that were high at the underground site. These time-dependent changes reflect an inflammatory response, but the characteristic driving this effect could not be isolated. Negative associations were observed for NO2 with lymphocytes and eosinophils. These associations were robust and did not change after adjustment for a large suite of PM characteristics, suggesting an independent effect of NO2. We conclude that short-term air pollution exposure at real-world locations can induce changes in WBC counts in healthy subjects. Future studies should indicate if air pollution exposure-induced changes in blood cell counts results in adverse cardiovascular effects in susceptible individuals.