International 9th Conference on Children’s Health

and the Environment Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

ConferenceAbstracts proceedings

All sessions presented at the 9th International Conference on Children’s Health and Environment

27–29 June 2018 Hoam Faculty House (Seoul National University), Seoul, Republic of Korea

Presented by INCHES (International Network on Children’s Health and Safety)

JOURNAL OF HEALTH AND POLLUTION environmental health are discussed in the The 9th INCHES (International international forum. Special attention is drawn to Network on Children’s Health, identify opportunities to maximize health benefits Environment and Safety) Conference for children. INCHES conference introduce a variety of themes to save children at risk and to provide insight in the field of science and policy

Seoul • 27-29 June, 2018 interface. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Theme: Saving the Children at Risk, Shaping Summary of overall organization-wide the Future Sustainability achieved results The International Network on Children’s Health, Overview Environment and Safety (INCHES) (http://www. All humans, including children, are influenced inchesnetwork.net) was founded at a workshop by various harmful environmental exposures. meeting before the 1st International Conference Children are not just small adults. Their organs on Children’s Environmental Health, August and metabolism are still developing and very 1998 in Amsterdam, the Netherlands, where the sensitive to a lot of external stressors. Damaging WHO, European Environmental Agency (EEA), US effects of pollutants are influential even before Environmental Protection Agency (EPA) and other birth. There are multiple environmental hazards organizations endorsed children’s environmental that threaten children’s health such as radiation, health as a global health issue. The WHO and air pollution, pesticides, and heavy metals. INCHES have been active partners for the last Some consumer products such as toys, home 18 years. items, and gardening items, can be harmful, and safe alternatives are needed. Moreover, indoor The Organisation pollution cannot be disregarded since the safety INCHES is a global network with the following of indoor environment is important for human goals: health. Climate change also affects the health of 1) Increase understanding of and accord on how children. environmental factors influence child health; 2) Create a global dissemination of research and These hazards may not be obvious when information on children’s environmental health; exposure is over a short period of time. However, 3) Educate and facilitate information exchange continuous harmful effects on developing on the best practices and policies in children’s organisms may lead to developmental and environmental health; delayed disorders or disturbed functions later 4) Identify information gaps and stimulate new in life. Therefore, it is our mission to protect research; and children as well as to promote their health and 5) Advocate for children’s environmental health environment for the future. in the intergovernmental arena.

Shaping a sustainable future for children is the Some highlights of INCHES activities since its main theme for the 9th International Conference formation in 1998 include: on Children’s Health and the Environment, • There are now about 150 organizational which is organized by INCHES and Korean members, some of which are well Ministry of Environment on June 27-29, 2018 in structured, established and active as Seoul. The latest research findings in children’s

S2 www.journalhealthpollution.org 180908 national NGOs interested in an intensified for the latest research findings in children’s international cooperation. environmental health. Specific attention has been • These organizations represent thousands devoted to identifying opportunities to minimize of individual members (most of them health childhood prenatal and postnatal exposure to professionals). environmental contaminants, to provide insight in the field of science and policy interface and

• Excellent international contacts in the field Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 to develop a greater awareness among health of children, environment and health in the professionals about children’s health. The intergovernmental, governmental and NGO abstracts that are published in the present issue circles. summarize the main research efforts reported at • Some official contacts in the field (relations this meeting. with WHO, EEA, membership in European Health and Environment Alliance Network, The Scientific Program International Society of Doctors for the The scientific program of the 9th INCHES Environment). Conference included more than150 lectures, • Several members in the medical scientific short oral presentations and posters presented community covering most aspects of by scientists from 28 countries covering a environmental health able and ready to give broad spectrum of topics. Abstracts of these foundation to the content of INCHES’ work. presentations appear in this issue of the journal. • Training programs in cooperation with The topics are related to: Environmental hazards several universities in many countries where to children (radiation, air pollution, pesticides, collaborative projects have been conducted. and heavy metals), developmental disorders, health promoting settings and policies, hazards • INCHES initiated several projects funded by and safe alternatives of consumer products (toys, the European Union. home items, and gardening items), information • INCHES organized or co-organized several for health care providers, children’s health and conferences on children’s environmental climate change, indoor air pollution, information health over the last two decades. and technology environment and birth cohort. • INCHES collaborates with similar networks in North America: the Children’s The following is a list of abstracts presented Environmental Health Network, International at the 9th INCHES (International Network of Society for Children’s Health and the Children’s Health, Environment and Safety) Environment and the Canadian Institute of Conference held on June 27-29, 2018 in Seoul, Child Health. Republic of Korea.

Many topics will be addressed in the 9th Abstracts are presented in alphabetical order by International Conference on Children’s corresponding author last name. Environment and Health, which was organized by INCHES on 27-29 June 2018 in Seoul. Neither the conference organizers or the The conference is organized by INCHES and Journal of Health and Pollution can be held Korean Ministry of Environment. The meeting responsible for inaccuracies or errors in any has historically provided an international forum included abstracts.

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Airborne Formaldehyde Exacerbates Atopic Dermatitis in Children Kangmo Ahn1,2

(1) Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (2) Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Kangmo Ahn Contact: Kangmo Ahn, Tel: +82-10-9933-3530, E-mail: [email protected]

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease, frequently occurring in infants and young children. A variety of environmental factors are known to exacerbate AD symptoms. They include infections, inhalant and food allergens, psychological stress, temperature, humidity and air pollutants such as particulate matter, nitrogen dioxide and formaldehyde.

Methods Formaldehyde, one of the main indoor air pollutants, is flammable gas and is originated from many sources such as building materials and consumer products. In a single-blind study by Eberlein-König et al., exposure to formaldehyde on whole body for 4 hours increased transepidermal water loss (TEWL) in adults with AD, while exposure to room air did not. In our previous study, we stimulated the skin of right forearm with airborne formaldehyde in children with AD, and demonstrated an increase in TEWL and skin pH. These results suggest that exposure to airborne formaldehyde impairs the skin barrier function in AD.

Results Recently, we demonstrated in NC/Nga mice with house dust mite-induced AD that epidermal thickness, the severity scores and mast cell degranulation was significantly increased. In addition, the exposure to airborne formaldehyde at 2 ppm caused abnormal processing of profilaggrin to filaggrin, and reduced the expression level of sodium hydrogen exchanger 1 (NHE1), a regulator of pH in the skin. In an experiment with NC/Nga mice, exposure to formaldehyde aggravated AD-like skin inflammation and upregulated mRNA expression of interleukin (IL)-4, IL-13, IL-17A, thymic stromal lymphopoietin (TSLP), interferon (IFN) and cyclooxygenase (COX)-2.

Conclusions There is growing evidence that air pollution may act as an important environmental risk factor in aggravation of AD. Further research is needed to examine the role of air pollutants on AD.

S4 www.journalhealthpollution.org 180908 18-0053

The Effect of Ambient Nitrogen Dioxide on the Acute Symptoms of Atopic Dermatitis in Young Children: Applying the Community Multiscale Air Quality (CMAQ) Model Young-Min Kim1,2, Inbo Oh3, Jihyun Kim1,2, Yoon-Hee Kang4, Kangmo Ahn1,2

(1) Samsung Medical Center, Environmental Health Center for Atopic Diseases, Seoul, Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Sungkyunkwan University, School of Medicine Department of Pediatrics, Samsung Medical Center, Seoul, South Korea, (3) University of Ulsan, College of Medicine Environmental Health Center, Ulsan, South Korea (4) Pusan National University, The Institute of Environmental Studies, Busan, South Korea

Corresponding author: Kangmo Ahn Contact: Kangmo Ahn, Tel: 010-9933-3530, E-mail: [email protected]

Background Few studies have investigated the association between ambient nitrogen dioxide (NO2) and atopic dermatitis (AD) although air pollution has been reported to play an important role in the aggravation of AD. We estimated acute effect of NO2 on AD symptoms in young children.

Methods A total of 128 young children with AD (78 boys and 50 girls <6 years old) in the Seoul Metropolitan Area, Korea, were followed between April and July 2014. The children’s parents recorded their daily AD symptoms, such as itching, sleep disturbance, erythema, dryness, oozing, and edema on a scale of 0 to 4. We estimated the NO2 levels of the participants’ residences using a community multiscale air quality (CMAQ) modeling system with a spatial resolution of 1 km. We used a generalized linear mixed model to evaluate the effects of NO2 on AD symptoms, controlling for confounders.

Results A total of 8,392 person-days of AD symptoms were recorded during the study period. Increased exposure to NO2 by 10 ppb was associated with a 13.2% (95% confidence interval, 2.5-25.0) increased risk of AD symptoms on the same day. This effect was observed in boys, but not in girls. The effect size of the CMAQ-modeled NO2 on AD symptoms was larger than that of NO2 exposure estimates based on an air quality monitoring system. In the CMAQ model, we found that NO2 exposure had significant effects that lasted for up to one day.

Conclusions Our results suggest that ambient NO2 is associated with acute AD symptoms in children. The CMAQ modeling system with high spatial resolution is useful to measure NO2 exposure in epidemiologic studies.

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The Effect of Neighborhood Deprivation on Asthma Exacerbation in African American Youth Jessica W. An1, Luisa N. Borrell2, Celeste Eng3, Adam Davis4, Kelley Meade4, Michael A. LeNoir5, Emirita Brigino-Buenaventura6, S. Katharine Hammond1, Esteban G. Burchard3, Neeta Thakur3 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) University of California, School of Public Health Division of Environmental Health Sciences, Berkeley, CA, USA (2) City University of New York, Graduate School of Public Health and Health Policy Department of Epidemiology and Biostatistics, New York, NY, USA (3) University of California, Department of Medicine Division of Pulmonary and Critical Care Medicine, San Francisco, CA, USA (4) UCSF Benioff Children’s Hospital Oakland Children’s Hospital Oakland Research Institute, Oakland, CA, USA (5) Bay Area Pediatrics, Oakland, CA, USA (6) Kaiser Permanente, Vallejo Medical Center Department of Allergy and Immunology, Vallejo, CA, USA6

Corresponding author: Jessica W. An Contact: Jessica W. An, Tel: 7038632358, E-mail: [email protected]

Background To better account for multiple neighborhood-health influences, we adapted and utilized an index to evaluate the association between neighborhood deprivation and asthma exacerbation among African American youth.

Methods African American youth (8-21 years) with and without asthma were recruited from 2008-2014 in the San Francisco Bay Area as part of the Study of African Americans, Asthma, Genes, and Environments, a pediatric asthma case-control study. Youth with asthma reported none/any asthma exacerbation (defined as oral steroid burst, emergency room visit, or hospitalization due to their asthma) experienced in the 12 months prior to recruitment. Using 19 American Community Survey 2008-2012 variables from a validated index, we conducted principal components analysis and 4 variables were used for our index. The continuous index was categorized into quartiles ranging from 1.0-4.0, with increasing scores indicating worse deprivation. Scores were assigned for all census tracts in the region and linked to participants based on their residential addresses at recruitment. Generalized estimating equations were used to estimate the effects of neighborhood deprivation on asthma exacerbation, adjusting for age, sex, socioeconomic status, and fine particulate matter. We also examined whether these associations vary by atopic status (defined as ≤ or > 100 IU/ml total Immunoglobulin E).

Results Participants reporting any asthma exacerbation in the previous 12-months were more likely to be younger, male, and have lower socioeconomic status. In the adjusted analysis, greater odds of asthma exacerbation were observed for a quartile increase in neighborhood deprivation across all of the neighborhoods. We observed heterogeneity of the association between index quartiles and asthma exacerbation according to atopic status, with atopic asthma increasing the odds of having asthma exacerbation (interaction P=0.01).

S6 www.journalhealthpollution.org 180908 Conclusions The neighborhood deprivation index is associated with asthma exacerbation among African American youth. These results contribute to a growing field of examining neighborhood factors on asthma outcomes in children.

18-0008 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Levels of DDT/HCH in Placenta and Their Association with Birth Size Madhu Anand1, Ajay Taneja1

(1) Dr. B.R. Ambedkar University, Department of Chemistry, Khandari Campus, Uttar Pradesh, India

Corresponding author: Madhu Anand Contact: Madhu Anand, Tel: 9634674957, E-mail: [email protected]

Background Very few epidemiologic studies have investigated the effect of excessively used pesticides i.e., dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) exposure during pregnancy and adverse birth outcomes. The objective of this study is to evaluate the influence of placental concentrations of some organochlorine pesticides on newborn’s anthropometric measurements (height, weight & head circumference).

Methods For this study, we collected 90 placental tissue samples for the measurement of DDT & HCH by gas chromatography equipped with electron capture detector. Regression analysis were performed between birth weight, birth height, head circumference and organochlorine pesticide concentrations.

Results For birth weight, there was a significant decrease of 5.81, 1.94, 4.71, 2.64, 38.50 and 8.43 g for 1ppb increase in placental α-HCH, β-HCH, γ-HCH, total HCH, p,p-DDD and total DDT concentrations respectively.

Conclusions The results of this study support the view for an association between environmental exposure to organochlorine pesticides and the anthropometric development of the fetus leading to a significant reduction in its birth weight, slight and non-significant reduction in birth height and head circumference.

S7 180908 www.journalhealthpollution.org 18-0114

Effects of Joint Exposures to Outdoor Air Pollution, Environmental Noise and Greenness on Children’s Health: A scoping review of Epidemiological Studies Jonathan Andrieux1, Catherine Bouland1

(1) Université Libre de Bruxelles, Environmental Health and Occupational Health, Brussels, Belgium Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Jonathan Andrieux Contact: Jonathan Andrieux, Tel: +32 477 68 86 70, E-mail: [email protected]

Background Outdoor air pollution and environmental noise have been linked to many adverse health effects and are nowadays major public health issues. To promote healthy living in cities, greenness is often presented as a key consideration. Greenness has been associated with beneficial and adverse health effects. To the best of our knowledge, few studies have concomitantly assessed the effects of these exposures on children’s health. This scoping review aims to shed light on epidemiological studies that have investigated effects of joint exposures to outdoor air pollution, environmental noise and greenness on children’s health.

Methods We searched PubMed and Scopus databases from January 2007 to December 2017 for all types of epidemiological studies that have investigated health effects of combined exposures to outdoor air pollution, environmental noise and greenness on children aged 0 to 18 years. No language restriction was applied. Following search terms were used: “greenness” OR “green space” OR “park” OR “trees”, AND “air pollutants” OR “air pollution” OR “particulate matter” OR “nitrogen dioxide” OR “black carbon” AND “Noise” AND “newborn” OR “infant” OR “child*” OR “teenager” OR “adolescent”. When available, Medical Subject Headings were used in PubMed.

Results We identified only five studies, all published in the last four years, that considered impacts of joint exposures to outdoor air pollution, environmental noise and greenness on children’s health. The outcomes studied were: prematurity, low birth weight and small for gestational age (3), overweight (1) and blood pressure (1). We found great heterogeneity in these studies regarding the assessment of environmental exposures. None of these studies assessed the quality of the environmental greenness.

Conclusions The literature available on this topic is scarce and relatively new. Regarding known effects of these exposures, there is scope for further investigations mainly on mediators and effect modifiers of these exposures on children’s health. Quality of greenness should also be investigated.

S8 www.journalhealthpollution.org 180908 18-0044

More Neighborhood Green Space May Protect Child Respiratory Health From Heavy Traffic Volume: A Multilevel Study of 4447 Children in Australia Thomas Astell-Burt1,2,3, Xiaoqi Feng1,2

(1) University of Wollongong, Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Wollongong, Australia (2) University of Sydney, Menzies Centre for Health Policy, Sydney, Australia (3) Peking Union Medical College and the Chinese Academy of Medical Sciences, School of Public Health, Beijing, China

Corresponding author: Thomas Astell-Burt Contact: Thomas Astell-Burt, Tel: 61 4221 5081, E-mail: [email protected]

Background Heavy traffic is a source of air pollution and a safety concern with important public health implications. We investigated whether green space lowers child asthma risk by buffering the effects of heavy traffic and a lack of neighborhood safety.

Methods Multilevel models were used to analyze affirmative asthma cases in nationally representative cross- sectional data from 4447 children aged 6–7 years old in Australia. Case-finding was based upon a triangulation of affirmative responses to three questions on doctor-diagnosed asthma, asthma-related medications and illness with wheezing lasting for at least 1 week within the 12 months prior.

Results Among children considered to be exposed to high traffic volumes and areas with 0 to 20% green space quantity, the odds ratio of affirmative asthma was 1.87 (95% CI 1.37 to 2.55). However, the association between heavy traffic and asthma was significantly lower for participants living ineas ar with over 40% green space coverage (odds ratio for interaction 0.32, 95% CI 0.12 to 0.84). No association between affirmative asthma and green space coverage was observed for participants not exposed to heavy traffic, nor for the area safety variable.

Conclusions Protecting existing and investing in new green space may help to promote child respiratory health through the buffering of traffic-related air pollution.

S9 180908 www.journalhealthpollution.org 18-0137

Does Radiofrequency Exposure Increase Delivery of Lead From Maternal Blood to Fetus? Yong-Han Lee1, Sanghyuk Bae1, Ho-Jang Kwon1, Eunhee Ha2, Hyesook Park3, Yangho Kim4, Yun-Chul Hong5, Ae-Kyoung Lee6, Hyung-Do Choi6, Mina Ha7 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Dankook University, Preventive Medicine, Yongin, South Korea (2) Ewha Womans University, Occupational and Environmental Medicine, Seoul, South Korea (3) Ewha Womans University, Preventive Medicine, Seoul, South Korea (4) Ulsan University, Occupational and Environmental Medicine, Ulsan, South Korea (5) Seoul National University, Preventive Medicine, Seoul, South Korea (6) Electronics and Telecommunications Research Institute Radio Technology Research, Daejeon, Korea (7) Ministry of Environment, Environmental Health Policy Division, Sejong City, South Korea

Corresponding author: Sanghyuk Bae Contact: Sanghyuk Bae, Tel: +82-10-9355-6885, E-mail: [email protected]

Background Some hazardous environmental factors transfer placenta to fetus and affect pregnancy outcomes while the effects of maternal radiofrequency (RF) exposure on the fetus are not well known. We aimed to examine whether maternal RF exposure during pregnancy has an association with maternal-fetal transfer of lead.

Methods We used data of Mothers and Children’s Environmental Health (MOCEH), a multicenter prospective birth cohort study. In 2011-2014, we enrolled 1751 pregnant women in South Korea. Of those, we analyzed 131 women who voluntarily underwent RF exposure measurement and blood samplings in pregnancy. RF exposure was measured via personal exposure meter (EME-Spy100®) for 24 hours within 20 weeks of pregnancy. RF exposure index was calculated as sum of square of arithmetic mean for measured levels over LOD(>0.05V/m) divided by guidance level of each frequency band. Concentrations of lead were measured in maternal blood and umbilical cord blood at the end of pregnancy. We examined the effect of RF in maternal-fetal transfer of lead by using a multiple linear regression model with a dependent variable of level of lead in cord blood (with maternal level of those as a covariate) in association with RF exposure. And we considered various potential confounding factors including maternal genotypes of GSTT1 and GSTM1, which are known to be related with the metabolism of toxic substances.

Results When total RF exposure doubled, the concentration of umbilical cord blood lead (adjusted maternal blood lead) increased by 12.2% in pregnant women who was null type of GSTT1. When RF exposure by mobile phone doubled, the concentration of umbilical cord blood lead increased by 11.7% in them and the conditions. The associations were statistically significant.

S10 www.journalhealthpollution.org 180908 Conclusions Association between RF exposure by phone use during pregnancy and maternal-fetal transfer of lead was significant. In the mothers vulnerable to toxic materials, RF exposure can be more hazardous to their children. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Fine (PM2.5) Particulate Pollution in Apartments of Ulaanbaatar, Mongolia Buyantushig Boldbaatar1, Munkherdene Luvsan1, Enkhjargal Gombojav1

(1) Mongolian National University of Medical Sciences, School of Public Health, Ulan Bator, Mongolia

Corresponding author: Buyantushig Boldbaatar Contact: Buyantushig Boldbaatar, Tel: 976-94008141, E-mail: [email protected]

Background Due to the burden of indoor air pollution, leading mortality causes are the acute lower respiratory diseases for children under five years old and stroke, chronic obstructive disease and lung cancer for adults. According to some studies, the fine particulate pollution caused by coal combustions in Ger districts is well established. However, there is a lack of studies to determine the fine particulate pollution in apartments with central heating system. The aim of the study is to determine the fine particulate concentration level in apartment’s indoor environment and to determine the factors influencing on indoor air particulate pollution.

Methods The study was conducted with a descriptive design. The study was conducted in Sukhbaatar district of Ulaanbaatar, the capital city of Mongolia. Data collected during the 2014 to 2015. PM2.5 sampling was collected for a week with 5-minute intervals with Dylos DC1700 light scattering device. We conducted parallel measurements of PM2.5 concentration in 46 participants with gravimetric method with PTFE filters for a week with a 4L/min flow rate to obtain accurate results.

Results In the study apartments, families had 2 adults and 1 child on average. Mean age of apartments were 19.92 years with 3 windows, home area of 59.38 m2, and volume of 132.75m3, respectively. Indoor PM2.5 concentrations were significantly different (p=0.0001) by daily 24 hours. The lowest concentrations were during the summer. The average PM2.5 concentration was highest in February (77.89 ug/m3) and lowest in July (10.15 ug/m3) in 2014. The fine particulate (PM2.5) concentration was higher in the morning (7-11am) comparing with the evening (9-11pm) at diurnal pattern.

Conclusions Indoor fine particulate pollution is depending on outdoor air pollution. The fine particulate PM2.5 pollution were the higher in winter time, the apartments indoor fine particulate concentrations were varied by hourly, daily, monthly and seasonally.

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Global Pollution and Children’s Health Stephan Bose-O’Reilly1, 2, Richard Fuller3, Samantha Fisher3, Philip Landrigan4

(1) University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, WHO Collaborating Centre for Occupational Health, Unit Global Environmental Health, Munich, Germany (2) University for Health Sciences, Medical Informatics and Technology Institute of Public Health, Medical Decision Making Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall in Tirol, Austria (3) Pure Earth, New York, NY, USA (4) Arnhold Global Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Corresponding author: Stephan Bose-O’Reilly Contact: Stephan Bose-O’Reilly, Tel: +49897201560, E-mail: [email protected]

Background Pollution is responsible for an estimated 9 million deaths each year – one in every six deaths worldwide. This was the main conclusion of the October, 2017 report of The Lancet Commission on Pollution and Health.

Method The main data sources were: (i) Institute for Health Metrics and Evaluation (2015 Global Burden of Disease analysis); (ii) World Health Organization (2012 Burden of Disease analysis), (iii) Pure Earth/GAHP Toxic Sites Inventory (Soil pollution at contaminated sites)

Results Air pollution – ambient air pollution from industry and motor vehicles, and household air pollution from poorly ventilated cook stoves – is responsible for 6.5 million deaths; polluted water for 1.8 million deaths; occupational pollution for 0.8 million deaths; and lead or 0.5 million deaths. Additional, inadequately quantified deaths are caused by toxic chemical pollutants. Pollution is responsible for three times more deaths than AIDS, tuberculosis, and malaria combined and for 15 times more than all wars, terrorism and violence. In the most severely affected countries, pollution accounts for more than one death in four. Pollution causes disease and death in countries at every level of income, but is especially concentrated in low-income and middle-income countries where 92% of pollution-related deaths occur. Pollution is closely linked to poverty, inequality and social injustice. In rapidly developing countries such as India, China, Pakistan and Bangladesh, pollution is worsening as the result of uncontrolled urbanization; rising demands for energy; expansion of mining, smelting, and deforestation; the global spread of toxic chemicals; progressively heavier applications of insecticides and herbicides; and the growing global use of petroleum-powered cars, trucks, and buses.

S12 www.journalhealthpollution.org 180908 Conclusion: Pollution is very costly. Pollution-related diseases cause economic losses estimated to be 4.6 trillion USD annually, more than 6% of global economic output. These losses are so large that they can slow national trajectories of economic development. Pollution is closely linked to global climate change. Fuel combustion—fossil fuel combustion in high- income and middle-income countries, and biomass burning in in low-income countries—accounts for

85% of airborne particulate pollution and is also the major source of greenhouse gases and short-lived Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 climate pollutants.

Children are highly sensitive to pollution. Even extremely low-dose exposures during critical windows of vulnerability in early life can result in disease, death and disability in childhood and across the life span. In 2016, pollution was responsible for 940,000 deaths in children worldwide, two-thirds under the age of 5 years. The great majority occurred in low- and middle-income countries and were due to respiratory and gastrointestinal diseases caused by polluted air and water. In countries at all levels of income, pollution is responsible also for non-communicable diseases in children: low birth weight, asthma, cancer and neurodevelopmental disorders – diminished cognition, ADHD and autism.

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Urinary Concentrations of Acrylamide and Acrolein Metabolites of Children in Taiwan I-Chun Chen1, Chia-Huang Chang1, Ching-Jung Yu1, Jung-Chieh Du2, Hsien-Chih Chiou3, Winnie Yang4, Ying-Sheue Chen5, Betau Hwang3, I-Fang Mao6, Mei-Lien Chen1

(1) National Yang-Ming University, School of Medicine, Institute of Environmental and Occupational Health Sciences, Taipei, Taiwan (2) Taipei City Hospital, Zhongxiao Branch, Pediatrics, Taipei, Taiwan (3) Taipei City Hospital, Songde Branch, Child and Adolescent Psychiatry, Taipei, Taiwan (4) Taipei City Hospital, Yangming Branch, Pediatrics, Taipei, Taiwan (5) Taipei Veterans General Hospital, Psychiatry, Taipei, Taiwan (6) Chung Shan Medical University, Occupational Safety and Health, Taichung, Taiwan

Corresponding author: I-Chun Chen Contact: I-Chun Chen, Tel: +886930677094, E-mail: [email protected]

Background Acrylamide (AA) and acrolein are chemicals that children are usually exposed to through carbohydrate- rich foods, fried or baked at high temperature, or second-hand smoke. In animal studies, AA may have neurotoxicity, reproductive toxicity and genotoxicity. The aim of this study is to evaluate the urinary concentrations of AA and acrolein metabolite of children in Taiwan.

S13 180908 www.journalhealthpollution.org Method We analyzed AA and acrolein metabolite levels of children aged 4-15 years, N-acetyl-S-(2- carbamoylethyl)-cysteine (AAMA) and N-acetyl-S-(3-hydroxypropyl) cysteine (3-HPMA), respectively. Purification of urine samples was conducted by solid phase extraction using ultra-performance liquid chromatography quadruple time-of-flight mass spectrometry (UPLC-QTOF MS). Socio-demographic variables were obtained from structured questionnaires. Multivariable linear regression models and

logistic regression models were used to examine associations between the metabolites concentration, Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 demographic variables and eating habits. All analyses were conducted in SAS 9.4.

Results There were 111 children recruited. AAMA and 3-HPMA concentrations ranged from 0.95 to 656.18 ng/g creatinine and 33.87 to 7796.13 ng/g creatinine, respectively. The geometric means were 46.42 and 763.83 ng/g creatinine.

Both AAMA and 3-HPMA were stratified by median levels. After adjusted the covariate variables, there was a significant negative association between 3-HPMA concentration and age, total calories consumed, and fruit consumption. Taking less total calories would have increased risk of having higher levels of 3-HPMA (OR=0.999; 95%CI: 0.998-1; p=0.039). Association between AAMA concentration and milk consumption and total calories consumed were significantly negative. Drinking more milk would have decreased risk of having higher levels of AAMA (OR=0.725; 95%CI: 0.733-0.969; p=0.0161).

Conclusions To our knowledge, few studies have published on urine concentrations of AAMA and 3-HPMA in children. Our preliminary results showed total calories had association with 3-HPMA levels, and negative association between AAMA levels and milk drinking. It is necessarily to increase our sample size to clarify the contributing factors of internal AAMA and 3-HPMA levels.

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Ten Years Progress in the Taiwan Birth Panel Study Mei-Huei Chen1,2, Ching-Chun Lin3, Meng-Shan Tsai3, Pau-Chung Chen3,4,5

(1) National Health Research Institutes, Institute of Population Health Sciences, Zhunan, Taiwan (2) National Taiwan University, College of Medicine and Hospital, Department of Pediatrics, Taipei, Taiwan (3) National Taiwan University, College of Public Health, Institute of Occupational Medicine and Industrial Hygiene, Taipei, Taiwan (4) National Taiwan University, College of Medicine and Hospital, Department of Environmental and Occupational Medicine, Taipei, Taiwan (5) National Taiwan University, College of Public Health, Department of Public Health, Taipei, Taiwan

Corresponding author: Pau-Chung Chen Contact: Pau-Chung Chen, Tel: 886-2-33668088, E-mail: [email protected]

S14 www.journalhealthpollution.org 180908 Background The Taiwan Birth Panel Study (TBPS) is an ongoing cohort study that has been conducted since 2004. The primary goals are to examine the low-level, prenatal or postnatal exposure and genetic modification effect on the initiation and progress of “environmentally-related childhood diseases”.

Methods

The main health outcomes are focused on fetal and child growth, neurodevelopment, behavior Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 problems and atopic dermatitis as well as lung function. We enrolled 486 mother-infant pairs at birth and subsequently followed children at the ages of 4, 6 months and 1, 2, 3, 5, 7 and 9 years. Various environmental pollutants including cotinine, heavy metals (lead, manganese, and mercury), perfluoroalkyl substances, phthalate and phenolic compounds had been measured. Our recent discovery focused on child health before puberty.

Results We found that the negative impact of prenatal prefluorooctyl sulfonate (PFOS) on fetal growth diminished as children grow up to 8 years of age, and modest effect of gender specific manner. There were trends noted between prenatal PFOS exposure and decreasing lung function at age 9 of children with lower birth weight or allergy. While similar effect on lung function was observed with concurrent exposure to phthalate, such as mono-ethyl phthalate (MEP) at age 9. In addition, we found that concurrent MEP exposure was associated with increment of body mass index (BMI) z-score and pediatric overweight or obesity during pre-puberty stage, particularly in boys.

Conclusions With aforementioned studies we conclude that prenatal environmental pollutants exposure could have long term impact on children before puberty while the impact of concurrent exposure could not be ignored. Further follow-up to explore the change of puberty development is warranted.

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Prevalence of Selected Diseases in Children and Adolescents of Hebei Spirit Oil Spill Area, 2002-2015: Using the National Health Insurance Data Kyung-Hwa Choi1, Myung-Sook Park1, Seung-Hwa Lee1, Mina Ha2, Jong-Il Hur1, Hae-Kwan Cheong3

(1) Taean Environmental Health Center, Taean, South Korea (2) Dankook University, College of Medicine, Department of Preventive Medicine, Yongin, South Korea (3) Sungkyunkwan University, School of Medicine, Department of Social and Preventive Medicine, Seoul, South Korea

Corresponding author: Hae-Kwan Cheong Contact: Hae-Kwan Cheong, Tel: +82-31-299-6290, E-mail: [email protected]

S15 180908 www.journalhealthpollution.org Background Hebei Spirit Oil Spill (HSOS) occurred in western coastal area, Korea, December 7th 2007. This study aims to examine prevalence of selected diseases in children and adolescent of HSOS area according to exposure level using the National Health Insurance (NHI) data.

Methods

We classified the areas into the high and low exposed areas in accordance with closeness to the oil Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 contaminated coast. We used information of diseases in those less than 20 years old the based on data of the NHI (2002-2015), Informative Classification of Diseases (2008-2014), and egistrationr population in Korea. One case of the disease was defined by frequency visits to a clinic, more than once a year per person. We calculated age-standardized prevalence and prevalence ratio (PR, vs. nationwide) and 95% CI by gender.

Results In 2008, the prevalence (/1,000) in the area were 433.9, 248.4, 160.3, 129.5, 125.2, and 123.3 among boys and 416.2, 225.0, 123.1, 133.0, 130.5, 112.3 among girls in bronchitis, rhinitis, asthma, tonsillitis, atopic dermatitis (AD), and sinusitis, respectively. Bronchitis was the most prevalent disease and increased by time while asthma was decreased since 2006 in both genders. Prevalence of AD and rhinitis in 2008-2014 and those of sinusitis in 2013-2014 were higher in the area than those of nationwide, but those of tonsillitis were not. Rhinitis was significantly higher in high exposed area than in low exposed area among boys since 2007 (PR (95% CI) in 2007 = 1.2 (1.1, 1.4)) and among girls since 2009 (PR (95% CI) in 2009 = 1.2 (1.1, 1.3)). AD was significantly higher in high exposed area than in low exposed area in 2007 (PR (95% CI) = 1.3 (1.1, 1.5)), 2010-2013, and 2015 among girls, but not among boys.

Conclusions After HSOS, prevalence of allergic and respiratory disease in Taean children and adolescent were increased, especially for bronchitis, rhinitis, and AD.

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Investigation of Serum from Oncology Patients Under 18 Years of Age by High- Resolution Mass Spectrometry in Full Scan Acquisition Garry Codling1, Veronkia Schacht1, Alin Ionas1, Jiri Palat1, Ana Miralles-Marco1, Jana Klanova1

(1) Masaryk University, RECETOX, Brno, Czech Republic

Corresponding author: Garry Codling Contact: Garry Codling, Tel: +420608161342, E-mail: [email protected]

Background In our daily lives, we are exposed to thousands of potentially toxic compounds, if these chemicals manage to pass into our bloodstream via either diet, inhalation or dermal penetration they can influence

S16 www.journalhealthpollution.org 180908 our physical and mental health. Human biomonitoring is a vital component of understanding exposure but there are some limitations. The mass of material is often limited, the list of target compounds in a given study may be restricted. The latest generation of high-resolution mass spectrometers, (HRMS) offers a new approach. These instruments can provide a targeted assessment of chemicals while also allowing for suspect and non-target screening.

Methods Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 This study developed a non-targeted extraction method developed for low volume human serum (<1 mL) for detection on both gas chromatography (GC) and liquid chromatography (LC) Orbitrap HRMS. Initially, 16 samples of serum obtained from children aged <1 to 18 were tested. Of these 12 were oncology patients, the remainder patients that had other conditions not cancer-related. Samples were collected prior to treatment after preliminary diagnosis. GC-HRMS target analysis for 346 target compounds was performed with further suspect and non-target exploration. In addition to this 168 Oncology samples are being processed for GC and LC HRMS for >700 target compounds.

Results In the initial 16 samples, 174 compounds were quantified above the limit of detection (LOD) by GC- HRMS in electron impact ionization (EI) and negative chemical ionization (NCI) from a target list of compounds while some 10’000 features were determined for suspect and non-target analysis. Compounds detected include PAHs, their metabolites, flame retardants, PCBs and pesticides. Non- target characterization by GC, LC Orbitrap and LC-time-of-flight (TOF) detected some grouping of compounds but assessment of the remaining 168 samples are needed to clarify features driving the variances in samples.

Conclusions Full scan acquisition is a powerful tool that can expand human biomonitoring for organic chemicals providing targeted HRMS results and also allow for screening of suspect and unknown compounds.

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Green Space Quantity and Quality Matter for Child Mental Wellbeing: A Multilevel Longitudinal Study Xiaoqi Feng1,2, Thomas Astell-Burt1,2

(1) University of Wollongong, Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, Wollongong, Australia (2) University of Sydney, Menzies Centre for Health Policy, Sydney, Australia

Corresponding author: Xiaoqi Feng Contact: Xiaoqi Feng, Tel: 61 4221 5713, E-mail: [email protected]

S17 180908 www.journalhealthpollution.org Background There are few studies on the potential benefits of green space quantity and quality for child mental wellbeing. The authors hypothesized that more and better quality residential green space would be favorable for mental wellbeing and that these associations could be subject to effect modification across childhood.

Methods Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Multilevel linear regression adjusted for demographic and socioeconomic confounders was used to track change in mental wellbeing (Strengths and Difficulties Questionnaire Total Difficulties Score and “internalizing” and “externalizing” subscales) across five separate occasions among a cohort of 4,968 Australian children aged 4–5 years beginning in 2004. Mental wellbeing was assessed with respect to objectively measured green space quantity and parent-reported green space quality, with interaction terms fitted with age to assess for potential effect modification. Data ewer analyzed in 2015.

Results Non-linear dose–response associations were observed for favorable mental wellbeing in relation to larger quantities of green space and also green space judged to be higher in quality. Favorable perceptions of green space quality were associated with larger quantities of green space regardless of neighborhood socioeconomic circumstances. Benefits for mental wellbeing appeared to top out at 21%–40% green space coverage and were reasonably consistent across childhood. Inequality in mental wellbeing (especially the internalizing subscale) emerged as children aged in relation to green space quality.

Conclusions Approximately 21%–40% of residential land-use allocated to green space may be an optimal amount for promoting child mental wellbeing, but the quality of this green space increases in importance as children age.

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The UGAAR Randomized Controlled Trial of HEPA Filter Air Cleaner Use and Residential Fine Particulate Matter in Ulaanbaatar, Mongolia Enkhjargal Gombojav7

(1) Mongolian National University of Medical Sciences, School of Public Health, Department of Environmental Health, Ulan Bator, Mongolia (2) Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada (3) City Health Department, Sukhbaatar District Health Center, Ulaanbaatar, Mongolia (4) Public Health Institute, Ministry of Health, Ulan Bator, Mongolia (5) University of Waterloo, Department of Environmental Health, Waterloo, Canada (6) Korea University, Department of Environmental Health, Seoul, South Korea (7) Wadsworth Center, New York State Department of Health, Albany, NY, USA

S18 www.journalhealthpollution.org 180908 Corresponding author: Enkhjargal Gombojav Contact: Enkhjargal Gombojav, Tel: 976-99732960, E-mail: [email protected]

Background The aim of the study were to assess the efficacy of portable HEPA filter air cleaners to reduce indoor residential PM2.5 in homes of non-smoking pregnant women in Ulaanbaatar, Mongolia. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Methods We randomly assigned 540 participants to an intervention (1-2 HEPA air cleaners) or control (no air cleaners) group. For each participant, we conducted home visits at approximately 12 and 30 weeks gestation to make one-week continuous PM2.5 measurements using optical particle counters (Dylos DC1700). In a subset (n=82), one-week gravimetric PM2.5 concentrations were also measured and an equation for converting particle counts to PM2.5 concentrations was derived from co-located measurements. Whole blood samples collected at around 30 weeks gestation were analyzed for lead, mercury, and cadmium. Data on housing characteristics and personal behaviors were obtained via questionnaires. Additionally, 24-hour ambient PM2.5 concentrations were obtained from a centrally- located government monitoring station.

Results One-week optical particle counts were highly correlated with indoor gravimetric PM2.5 concentrations (r=0.86; p<0.001). Ambient 24-hour PM2.5 concentrations were highest in winter [geometric mean (GSD): 87 (2) µg/m3] and lowest in summer [14 (2) µg/m3]. Indoor PM2.5 concentrations followed the same seasonal pattern, with concentrations [(GSD) of 62 (2) µg/m3 and 23 (1) µg/m3 in winter and summer, respectively. Living with a smoker did not contribute substantially to indoor PM2.5 concentrations. On average, PM2.5 concentrations were 26 % lower in intervention homes. Season- specific filter effectiveness, comparing geometric mean PM2.5 concentrations in intervention and control homes ranged from 24-43 % for measurements in early pregnancy, and 5-20 % in later pregnancy. Effectiveness was highest in winter for both visits. The blood cadmium levels [geometric mean (GSD) were lower among intervention [0.20 µg/L (1.69), n= 222] compared to control [0.23 µg/L (1.74), n= 198] participants (p<0.01).

Conclusions HEPA filter air cleaner use was associated with lower indoor PM2.5 and blood cadmium concentrations among pregnant women. Air cleaner effectiveness varied seasonally and decreased over the course of pregnancy.

S19 180908 www.journalhealthpollution.org 18-0124

Associations Between Fetal Exposure to Chemical Pollutants and Development Disorders in the Early Childhood: Case Studies from European Cohorts Joan O Grimalt1, Merce Gari1, Esther Marco1, Barend L van Drooge1 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Environmental Chemistry, Barcelona, Spain

Corresponding author: Joan O Grimalt Contact: Joan O Grimalt, Tel: +34658610695, E-mail: [email protected]

Background There is evidence that ingestion or exposure to chemical pollutants at environmental concentrations have imparing effects for the development of children at the first life ages. We have developed analytical methods for assessment of fetal exposure to these compounds, which have been used to identify associations with adverse development outcomes in the first years of life.

Methods Cord blood serum was used for the analysis of hexachlorobenzene, pentachlorobenzene, polychlorobiphenyls, DDTs and metabolites, mirex, hexachlorocyclohexanes, polybromodiphenyl ethers. Maternal urine was used for the analysis of metals, including cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), selenium (Se), arsenic (As), molybdenum (Mo), cadmium (Cd), antimonium (Sb), cesium (Cs), thallium (Th) and lead (Pb). Mercury was analyzed from children’s hair after birth. Exposure assessment of other pollutants, e.g. polycyclic aromatic hydrocarbons or volatile organic compounds was based on air analyses.

Results Higher incidence of diverse deleterious health effects at 4 years of age have been observed, e.g. hexachlorobenzene and poor social behavior and attention-deficit hyperactivity disorder; 4,4-DDE and asthma, weeze, lower respiratory tract infections and alteration of urinary coproporphyrins; hexachlorobenzene, β-hexachlorocyclohexane and 4,4’-DDE and alteration of thyroid hormones; HCB, 4,4’-DDE and polychlorobiphenyls (PCBs) and overweight; 4,4’-DDT and PCBs and lower neurodevelopment. Breastfeeding was documented to be a protective agent against decreases of cognitive skills in children due to 4,4’-DDT exposure. This protective effect shows that other factors besides pollutant exposure and genetic variability influence the health effects on human populations.

Conclusions Fetal growth is the period of highest development of organs and metabolism, several chemical can have deleterious consequences on infant development. Characterization of the associations between pollutant exposure and development disorders is needed for designing adequate policies for the preservation of children’s health.

S20 www.journalhealthpollution.org 180908 18-0079

Application of Land Use Regression Techniques for Urban Greening: An Analysis of Tianjin, China Ying Guo1,2, Jason G Su2, Ya Dong1, Jennifer Wolch3

(1) Tianjin University, School of Architecture, Tianjin, China Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) University of California, School of Public Health, Berkeley, CA, USA (3) University of California at Berkeley, College of Environmental Design, Berkeley, CA, USA

Corresponding author: Ying Guo Contact: Ying Guo, Tel: 86+13821889626, E-mail: [email protected]

Background This paper aims to identify whether vegetation including trees, shrubs and grasslands have a protective effect on reducing air pollution, such as NO2. Based on the associations between levels of air pollution and land cover information, we evaluated alternative design strategies aimed at reducing air pollution and improving air quality for Tianjin.

Methods Land cover types in a 16 square space (4 km by 4 km), centered by 23 air quality monitoring stations in the city of Tianjin were classified using E-cognition software on aerial photos of 0.1 m spatial resolution. We then recognized the fitness of using land cover types to predict traffic-related air pollution nitrogen dioxide (NO2) through a machine learning land use regression modeling technique (LUR), using the 2015 annual pollutant concentrations of NO2 obtained by the 23 air quality monitoring sites.

Results We found that vegetation significantly decrease air pollution (correlation coefficient r = -0.5, p < 0.01) while highways and major roadways contributed significantly to grown air pollution (r =0.60, p<0.01). The LUR model explained 84% of total variance in measured NO2 concentrations. The effects of land cover types on NO2 concentrations were then estimated using corresponding LUR modeling coefficients and applied to identified land cover retrofitting strategies that could help the city effectively reduce traffic- related air pollution and improve public health.

Conclusions We asserted that one of the most effective strategies to decrease air pollution from traffic-related air pollution is planting vegetation on bare soil. The study shows the results can help urban environmental planners and policy makers adopt effective pollution reduction policies to improve air quality and protect public health in Tianjin and other urban regions in China.

S21 180908 www.journalhealthpollution.org 18-0054

Skin Adhesion Rate of Children’s Modeling Clay for Exposure Assessment Sooyoung Guak1, Kiyoung Lee1,2, Miyoung Lim1, Ji Young Park2

(1) Seoul National University, Graduate School of Public Health, Department of Environmental Health Sciences, Seoul,

South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Seoul National University, Institute of Health and Environment, Seoul, South Korea

Corresponding author: Sooyoung Guak Contact: Sooyoung Guak, Tel: 010-6789-3675, E-mail: [email protected]

Background Children are more vulnerable to chemical exposure. Different usage patterns of children’s goods make risk assessment more challenging. Accurately measuring the use patterns of children’s goods is important to conduct realistic exposure assessments and to manage risk of children’s goods. Adhering children’s modeling clay to their skin, can accurately provide exposure assessment through skin adhesion rate. The purpose of this study was to determinate skin adhesion rate of children’s modeling clay for exposure assessment.

Methods Children’s modeling clays were classified into 10 categories as polyvinyl alcohol (PVA) clay clay, PVA soft clay, starch-based clay, foam clay, rubber clay, oil clay, muddy clay, terra clay, paper clay, and slime. A total of 29 children’s clay goods were selected. Hardness and moisture content (%) of clays were measured. Five young adults aged 20 to 25 handled the modeling clay for 3 minutes. Clays’ gravimetric differences were determined and used to estimate the amount of skin adhesion (g/min). Skin adhesion rate (g/min/cm2) was estimated by measuring the amount of skin adhesion (g/min) and each individual’s palm surface area (cm2).

Results Twenty five of the 29 children’s modeling clay products were adhesive to skins. Four products of foam and rubber clay were not adhered to skin. For the 25 products, the average skin adhesion rate was 5.5x10-4 ± 4.0x10-4 g/min/cm2. The highest skin adhesion rate was 1.1x10-3 ± 2.8x10-4 g/min/cm2 for paper clay. The lowest skin adhesion rate was 4.6x10-5 ± 1.1x10-4 g/min/cm2 for oil clay. The skin adhesion rate was increased with increase of moisture content.

Conclusions This study determined skin adhesion rate of children’s modeling clay. The adhesion rate is useful for exposure and risk assessments and setting safety guidelines to protect children’s health.

S22 www.journalhealthpollution.org 180908 18-0032

Combined Effect of Prenatal Exposure to Multiple Pollutants on Birth Weight Using Two Supervised Machine Learning Methods with Principle Components Analysis Seulbi Lee1, Yun-Chul Hong2, Yangho Kim3, Mina Ha4, Hyesook Park5, Eunhee Ha6 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Ewha Womans University, Department of Medical Science, College of Medicine, Seoul, South Korea (2) Seoul National University, Department of Preventive Medicine, College of Medicine, Seoul, South Korea (3) Ulsan University Hospital, University of Ulsan, College of Medicine, Department of Occupational and Environmental Medicine, Ulsan, South Korea (4) Dankook University, Department of Preventive Medicine, College of Medicine, Yongin, South Korea (5) Ewha Womans University, Department of Preventive Medicine, College of Medicine, Seoul, South Korea (6) Ewha Womans University, Occupational and Environment Medicine, College of Medicine, Seoul, South Korea

Corresponding author: Eunhee Ha Contact: Eunhee Ha, Tel: 82-2-2650-5752, E-mail: [email protected]

Background Prenatal pollutant exposure has been associated with birth weight by single pollutant models. However, individuals are exposed to many air pollutants at the same time that are highly correlated with each other, there is a need to consider the multiple pollutants exposure. The purpose of our study was to investigate the effect of exposure to multiple pollutants on the birth weight.

Methods Our participants were 709 mother-child pairs who recruited from Seoul, Cheonan, and Ulsan through Mothers and Children’s Environmental Health study. The cadmium, lead and mercury were measured in blood samples, and phthalates and bisphenol A (BPA) in urine samples obtained from pregnant women during the third trimesters. Daily exposure to particulate Matter (PM10) and nitrogen dioxide (NO2) were averaged over the duration of gestation. A supervised principal components analysis (SPCA) and a two- step model (PCA after variable selection using classification and egressionr tree (CART)) were applied to estimate the effects of multiple pollutants on birth weight. We first identified pollutants affecting the birth weight and with these pollutants, combined effect of multiple pollutants on birth weight was analyzed. For multivariate analysis, mother’s characteristics (age, education level, socioeconomic status, and body mass index), gestational age and infant sex were adjusted.

Results In both SPCA and two-step model, the four pollutants, mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), mono (2-ethyl-5-buyl) (MEBP), BPA, and lead, were commonly selected. In addition, cadmium was selected in SPCA and mercury was selected in two-step model, respectively. Then two principal components consisting of those five pollutants selected in each model were extracted. Both models showed negative association between birth weight and each of the first component which was loaded by MEOHP, MEBP, and BPA: -40.8 g (95% CI: –75.9, –5.6) and -21.8 g (95% CI: -41.2, -2.4), respectively.

S23 180908 www.journalhealthpollution.org Conclusions Birth weight was associated with exposure to pollutant mixtures including MEOHP, MEBP, and BPA. Our finding suggests that environmental pollutants may contribute to stronger effects when analyzed as mixtures.

18-0116 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Preventive Effect of Green Space on Childhood Neurodevelopment Associated with Air Pollution Exposure Ji-Young Lee1, Lamichhane Kumar Dirga2, Shinhee Ye1, Seulbi Lee1, Hwan-Cheol Kim2, Jong-Han Leem2, Yun-Chul Hong3, Yangho Kim4, Mina Ha5, Eunhee Ha1

(1) Ewha Womans University, School of Medicine, Department of Environmental and Occupational Medicine, Seoul, South Korea (2) Inha University, School of Medicine, Department of Occupational and Environmental Medicine, Incheon, South Korea (3) Seoul National University, Department of Preventive Medicine, College of Medicine Seoul, South Korea (4) Ulsan University Hospital, University of Ulsan College of Medicine Department of Occupational and Environmental Medicine, Ulsan, South Korea (5) Dankook University Department of Preventive Medicine, College of Medicine, Yongin, South Korea

Corresponding author: Eunhee Ha Contact: Eunhee Ha, Tel: 82-2-2650-5752, E-mail: [email protected]

Background The aim of this study was to investigate whether neurodevelopment of early childhood is associated with residential green space and air pollution during pregnancy.

Methods Prospective birth cohort data of 742 mother-child pairs from Mothers and Children’s Environmental Health (MOCEH) study were used. Age and Stage Questionnaire-Korea (K-ASQ) version was used to assess the neurodevelopment of children. Multivariate linear regression analysis was performed to analyze the association between childhood neurodevelopment and green space and air pollution (satellite Aerosol Optical Depth-based estimates of PM2.5, PM10 and NO2) during pregnancy, after adjustment for covariates.

Results Residential green space during pregnancy was inversely associated with K-ASQ at 12 and 24 months of age, after adjustment for covariates such as sex, educational levels of both parents, family income, and maternal body mass index. Air pollution was associated with K-ASQ with adjustment for covariates. The stratified analysis of residential green space revealed stronger associations between childhood neurodevelopment and PM2.5 exposure during the pregnancy in the lower areas of green space.

S24 www.journalhealthpollution.org 180908 Conclusions This study indicated that air pollution exposure during pregnancy is associated with childhood neurodevelopment. Less residential green space may intensify the association between childhood neurodevelopment and air pollution exposure.

18-0042 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Association Between Dietary Patterns and Blood Mercury Concentration: MOCEH Study Eun Mi Jung1, Yun-Chul Hong2, Mina Ha3, Yangho Kim4, Hyesook Park5, Hyesook Kim6, Eunhee Ha1

(1) Ewha Womans University, Department of Occupational and Environmental Medicine, Seoul, South Korea (2) Seoul National University, Department of Preventive Medicine, Seoul, South Korea (3) Dankook University, College of Medicine, Department of Preventive Medicine, Yongin, South Korea (4) Ulsan University, Hospital Department of Occupational and Environmental Medicine, Ulsan, South Korea (5) Ewha Womans University, Department of Preventive Medicine, Seoul, South Korea (6) Ewha Womans University, Department of Nutritional Science and Food Management, Seoul, South Korea

Corresponding author: Eunhee Ha Contact: Eunhee Ha, Tel: 82-2-2650-5752, E-mail: [email protected]

Background It is widely known that fish consumption contributes to elevating blood mercury concentration. Using data from the Mothers and Children’s Environmental Health (MOCEH) study, we evaluated the association between general dietary patterns and blood mercury concentration.

Methods A total of 1225 non-smoking pregnant women were included in this study. Diet was assessed by food frequency questionnaire (FFQ). The principal component analysis was conducted to identify major dietary patterns. After we screened the number of factors by eigenvalues (≥1), we further limited the number of factors with the result of scree plot. Factors were orthogonally rotated for enhanced interpretability. Foods with factor-loading ≥0.4 were retained. The maternal blood samples were obtained at early and late pregnancy. The cord blood sample was obtained as well. Regression analysis was performed to examine the relationship between each dietary pattern and mercury concentration at each pregnancy point and birth.

Results Three major dietary patterns were identified. The first pattern, accounted for 26% of total variance, were rich in sugar, nuts, mushrooms, eggs, seaweeds, fats, and seasonings. The second pattern, accounted for 14% of total variance, were rich in beans, vegetables, and seasonings. The third pattern, accounted for 11% of total variance, were rich in meats, eggs, fishes, and fats. Regression analysis showed the statistically significant association between the third factor and elevated mercury concentration in cord blood (β=0.0178, p=0.017).

S25 180908 www.journalhealthpollution.org Conclusions The results suggest that fish consumption can influence cord blood mercury concentration. Pregnant women need to be careful when they eat fish to avoid exposing their baby to mercury. Further analysis is needed to corroborate the association. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Combined Effect of Prenatal Exposure to Air Pollution and Second-Hand Smoke on Early Neurodevelopment Myeongjee Lee1, Seulbi Lee2, Mina Ha3, Yun-Chul Hong4, Hyesook Park5, Yangho Kim6, Eunhee Ha1,7

(1) Ewha Womans University, Department of Occupational and Environmental Medicine, Seoul, South Korea (2) Ewha Womans University, Department of Medical Science, Seoul, South Korea (3) Dankook University, Department of Preventive Medicine, Yongin, South Korea (4) Seoul National University, Institute of Environmental Medicine, Seoul, South Korea (5) Ewha Womans University, Department of Preventive Medicine, Seoul, South Korea (6) University of Ulsan, College of Medicine, Department of Occupational and Environmental Medicine, Ulsan, South Korea (7) Ewha Womans University, Ewha Medical Research Institute, Seoul, South Korea

Corresponding author: Eunhee Ha Contact: Eunhee Ha, Tel: 82-2-2650-5752, E-mail: [email protected]

Background Neurodevelopment of infants have been associated with exposure to second-hand smoke (SHS) and air pollution (AP). There have been very few previous studies of combined effect of prenatal AP and SHS exposure on early neurodevelopment. We aim to investigate the combined effect of prenatal AP and SHS exposure on neurodevelopment of infants.

Methods We analyzed mothers and their offspring from Korean multicenter birth cohort study: Mothers and Children Environmental Health (MOCEH). We measured maternal urinary cotinine to represent SHS exposure during pregnancy. PM2.5 (particulate matter<2.5μm in diameter) level during the entire pregnancy was modeled using the Community Multiscale Air Quality Modeling. Average exposure levels to PM10 (particulate matter<10μm in diameter) and nitrogen dioxide during the entire pregnancy were estimated using the land use regression model. Infant’s mental developmental index (MDI) and psychomotor developmental index (PDI) were measured using the Bayley Scales of Infant Development at 6, 12, 24, and 36 months of age.

Results We found that each 10 μg/m3 increase in PM2.5 and PM10 was associated with a significant decrease of neurodevelopment at 6 months of age; -1.28 (95% confidence interval (CI): -1.88,-0.69 ) in MDI and -2.06 (95% CI: -5.49, -2.52) in PDI for PM10 and -2.07 (95% CI: -3.30,-0.83 ) in MDI and -4.00 (95% CI:

S26 www.journalhealthpollution.org 180908 -2.78, -1.34) in PDI for PM2.5. Further, the MDI score of 24 months aged girls whose mothers with high urinary cotinine levels was inversely associated with both cotinine level and PM, but no association was detected in boys.

Conclusions These findings suggest that maternal exposure to AP (PM10 and PM2.5) during early pregnancy may

result in delayed neurodevelopment in early childhood along with co-exposure to SHS. The effect of Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 PM2.5 exposure at early pregnancy might be more pronounced comparing to the effect of PM10 on early neurodevelopment.

18-0020

Prediction of COPD Mortality Due to Exposure to Fine Particulate Matter Using Machine Learning Technique: The National Health Insurance Service–National Sample Cohort (NHIS-NSC) Yumin Lee1, Eunhee Ha1, Jin Hwa Lee2, Hawn-Cheol Kim3, Kyoung-Nam Kim4

(1) Ewha Womans University, College of Medicine Occupational and Environmental Medicine, Seoul, South Korea1, Ewha (2) Womans University, College of Medicine, Internal Medicine, Seoul, South Korea2, Inha University, School of Medicine, (3) Occupational and Environmental Medicine, Incheon, South Korea3, Seoul National University, College of Medicine (1) (4) Preventive Medicine, Seoul, South Korea

Corresponding author: Eunhee Ha Contact: Eunhee Ha, Tel: 82-2-2650-5752, E-mail: [email protected]

Background The mortality of patients with chronic obstructive pulmonary disease (COPD) is affected by various factors. The most commonly known risk factors are age, sex, comorbidities, especially asthma (ACOS, asthma and COPD overlap syndrome) and air pollution such as particulate matter (PM). We used the machine Learning, the most recent research methodology, to find out which models predict their mortality, and to evaluate the contribution of each factor.

Methods A retrospective cohort from The National Health Insurance Service–National Sample Cohort (NHIS- NSC) was analyzed for mortality. Subjects with COPD aged 40 years and older who received a national health examination were enrolled and followed up from January 1, 2009 to December 31, 2013. And the subjects were divided into ‘pure COPD’ and‘ACOS. PM10 exposures over a three-month period were estimated based on the date of death or the end of 2013. The exposures were obtained from Kriging interpolation using contemporaneous monitoring data. The exposure estimates were assigned to place of residence for participants. Then several supervised learning methods with good predictability, including random forests models, decision tree models, support vector machines models, artificial neural network models, and logistic regression models were applied to build prediction models.

S27 180908 www.journalhealthpollution.org Results This study included 6,309 participants from the NHIS-NSC. The performance of the decision tree model for all samples with selected features was better than that of the other models, with an accuracy of 97.3%, in mortality prediction. The accuracy of predictive models was 96.6% for random forests models, 96.2% for SVMs, 93.6% for artificial neural network models, and 95.8% for logistic models. Additionally, in the decision tree models, the variables at the top of the root node are the most influential variables.

The effect of PM10 concentration on the mortality risk of COPD patients was the largest. The second Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 most influential variable was the Charlson comorbidity index.

Conclusions The decision tree models were the most predictive of mortality in COPD patients. The 3-month average PM 10 concentration had the greatest impact among the risk factors predicting mortality.

18-0057

Exposure to Humidifier Disinfectants Increases the Risk of Asthma in Children via a Profibrogenic Mechanism Jisun Yoon1, Seung-Hwa Lee2, So-Yeon Lee3, Jae-Rin Ahn2, Han-Na Go2, Eun Mi Kim2, Sungsu Jung3, Hyun-Ju Cho4, Eun Lee5, Soo-Jong Hong3

(1) Mediplex Sejong Hospital, Department of Pediatrics, Incheon, South Korea (2) University of Ulsan, College of Medicine, Asan Institute for Life Sciences, Ulsan, South Korea (3) University of Ulsan, College of Medicine, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, Department of Pediatrics, Ulsan, South Korea (4) International St. Mary’s Hospital, Catholic Kwandong University Department of Pediatrics, Incheon, South Korea (5) Chonnam National University, College of Medicine, Department of Pediatrics, Gwangju, South Korea

Corresponding author: Soo-Jong Hong Contact: Jisun Yoon, Tel: 82-2-3010-3379, E-mail: [email protected]

Background Humidifier disinfectants (HDs) induce acute lung injury (HDLI), but the effect on asthma in children remains unknown. The purpose of this study was to investigate whether exposure to HDs in early childhood affects asthma symptoms later in life and evaluate the potential mechanism in an animal model.

Methods HD-related questionnaires were administered to 1,577 subjects from the Panel Study of Korean Children (PSKC) in 2015. Since the study participants were all born in 2008, and HDs were withdrawn from the Korean market in 2011, HD exposure can be estimated to have occurred within three years of birth. Asthma mouse model with BALB/c mice were intranasally administered polyhexamethyleneguanidine (PHMG) for 5 days with 2 episodes of ovalbumin (OVA) sensitization, and then challenged with a 1% OVA inhalation.

S28 www.journalhealthpollution.org 180908 Results In PSKC study, HD exposure was associated with 2.25-fold greater on asthma treatment during the last 12 months in children with a history of acute bronchiolitis. The risk of asthma treatment during the last 12 months was 5.07-fold higher for children exposed to HDs with acute bronchiolitis than those not exposed to HDs without acute bronchiolitis. The rate of asthma treatment was consistently high in the group of HD exposure who had a history of acute bronchiolitis from 5 to 7 years of age, 5.9%, 9.6%,

and 10.2%. Asthma mouse model indicated that exposure to PHMG significantly enhanced bronchial Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 hyperresponsiveness, airway inflammation, and total IgE. In addition, C-C motif chemokine ligand 11 and SERPINF1/pigment epithelium-derived factor (PEDF) expression in the lung were significantly increased.

Conclusion We propose a novel hypothesis that HD exposure affects asthma in early childhood. These results are the first to link early-life HDs exposure to later development of asthma from a birth cohort study. Our murine model revealed that exposure to HDs could enhance asthma via profibrogenic activity.

18-0012

Association Between Urinary 3-Phenoxybenzoic Acid and Body Mass Index Z-Score of 4-Year-Old Children Kyung-Shin Lee1,2, Young Ah Lee3, Choong ho Shin3, Youn-Hee Lim1,2, Yun-Chul Hong1,2,4

(1) Seoul National University, Medical Research Center Institute of Environmental Medicine, Seoul, South Korea (2) Seoul National University, College of Medicine Environmental Health Center, Seoul, South Korea (3) Seoul National University, College of Medicine Pediatrics, Seoul, South Korea (4) Seoul National University, College of Medicine Preventive Medicine, Seoul, South Korea

Corresponding author: Yun-Chul Hong Contact: Yun-Chul Hong, Tel: 02-740-8394, E-mail: [email protected]

Background Pyrethroids, a class of ubiquitous insecticides, have been considered as endocrine-disrupting chemicals. The use of pesticides has increased over the past few decades in Korea. Few studies examined the relationship between 3-phenoxybenzoic acid (3-PBA) and adiposity in childhood. We aimed to evaluate the association between prenatal and postnatal exposure to 3-PBA concentrations at 4 years of age and adiposity measurements (height, weight, and body mass index Z-scores) in 4-year-old Korean children.

Methods We obtained data from 578 children (309 boys and 269 girls) around 4 years of age who were born from mothers who participated in the Environmental and Development in Children (EDC) cohort study from August 2008 to July 2011. Urinary 3-PBA concentration from mothers at around 20 weeks of gestation and children at 4 years of age was measured as prenatal and postnatal 3-PBA exposure, respectively.

S29 180908 www.journalhealthpollution.org Results Means of height, weight, and body mass index (BMI) z-scores of children at the age 4 years were 0.2, 0.03 and -0.1, respectively. 3-PBA was detected in 98.9-99.8% of prenatal and postnatal urine samples. Postnatal exposure to 3-PBA at 4 years of age were positively associated with weight and BMI z-scores (p-value=0.030, 0.088, respectively). Particularly, the association was significant among girls after adjusting for covariates (p-value=0.015). However, we did not observe significant associations of

prenatal exposure to 3-PBA with children’s height, weight and BMI z-scores. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Conclusions Childhood adiposity was positively associated with urinary 3-PBA concentrations measured at 4 years of age, particularly among girls.

18-0029

Association Between Ambient Air Pollution and Otitis Media in Children Changwoo Han1, Youn-Hee Lim1,2,3, Kweon Jung4, Yun-Chul Hong1,2,3

(1) Seoul National University, Department of Preventive Medicine, Seoul, South Korea (2) Seoul National University, Medical Research Center, Institute of Environmental Medicine, Seoul, South Korea (3) Seoul National University, College of Medicine, Environmental Health Center, Seoul, South Korea (4) Seoul Metropolitan Institute Public Health and Environment, Seoul, South Korea

Corresponding author: Yun-Chul Hong Contact: Changwoo Han, Tel: 821063230538, E-mail: [email protected]

Background Many epidemiological studies are reporting positive association between ambient air pollution exposure and otitis media occurrence in children. In this study, we analyzed nationally representative cohort data to evaluate the association between daily concentration of ambient air pollutants and the otitis media hospital visits among children under age 1 in six metropolitan cities of the Republic of Korea.

Methods We used National Health Insurance Service-National Sample Cohort and analyzed hospital use data of 34,503 babies until they become age 1. We divided study participants into six metropolitan cities and linked daily hospital use data to daily city level air pollution data [nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and particulate matter < 10μg/m3 (PM10)]. Time-series analysis using the Poisson generalized additive model were conducted in each metropolitan city and we meta-analyzed the time-series analysis results using the random effect model.

Results There were total 5,119 otitis media hospital visits. A 10 ppb increase of O3 on lag day 3 was significantly associated with an increased risk of otitis media hospital visits [relative risk (RR), 95% confidence

S30 www.journalhealthpollution.org 180908 interval (CI): l.053, 1.005-1.103]. A 10ug/m3 increase in PM10 on lag day 0 and 2 was significantly associated with an increased risk of otitis media hospital visits [RR, 95% CI: lag 0: l.015, 1.003-1.028; lag 2: 1.017, 1.00-1.027].

18-0152

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Relation Between Urinary Phthalate Metabolites Concentrations and Depressive Symptoms in Pregnant Women Kyung-Shin Lee1,2, Youn-Hee Lim1,2, Yun-Chul Hong1,2,3

(1) Seoul National University, Medical Research Center, Institute of Environmental Medicine, Seoul, South Korea (2) Seoul National University, College of Medicine, Environmental Health Center, Seoul, South Korea (3) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea

Corresponding author Yun-Chul Hong Contact: Yun-Chul Hong, Tel: 02-740-8394, E-mail: [email protected]

Background Our aim is to evaluate the relationship between urinary phthalate metabolites concentration and depressive symptoms in pregnant Korean women.

Methods We recruited 4,468 pregnant women from August 2015 through February 2018, who participated in a multicenter prospective cohort study, the KoCHENS. Urinary phthalate metabolites were measured between the first and second trimester of pregnancy. They are mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-n-butyl phthalate (MnBP), and mono-benzyl phthalate (MBzP). MEHHP, MEOHP, and MECCP are metabolites of diethylhexyl phthalates (DEHP). MnBP and MBzP are metabolites of dibutyl phthalate and butyl benzyl phthalate, respectively. Mono-3-carboxypropyl phthalate (MCPP), mono-carboxyoctyl phthalate (MCOP) and mono-carboxynonyl phthalate (MCNP) were also measured. Depressive symptoms of each participant were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D-20) questionnaires. We categorized the total scores of CES-D-20 by the three groups such as normal, moderate and severe groups. We evaluated the relation between phthalate exposures and depressive symptoms during the pregnancy.

Results The mean of CES-D 20 scale was 9.25 and the standard deviation was 7.58 (ranged 0 to 49). Concentrations of mono-benzyl phthalate (MBzP) metabolites were positively associated with the total score of CES-D-20 (beta: 0.021, P<0.0001), whereas we did not find significant relationship of other phthalate metabolites with the depressive symptoms during the pregnancy. In the least-squares means (LS-means) comparison of phthalate concentration among normal, moderate, and severe depression groups, the severe depression group showed higher concentration of phthalate than the normal depression group.

S31 180908 www.journalhealthpollution.org Conclusions We found a positive relationship between urinary levels of MBzP metabolites and depression symptoms of pregnancy women.

18-0068 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 The Effects of Prenatal Cadmium Exposure and Attention Deficit Hyperactivity Disorder in Preschool Children Woosung Kim1, Youn-Hee Lim2, Bung-Nyun Kim3, Choong Ho Shin4, Young Ah Lee4, Johanna Inhyang Kim3, Yun-Chul Hong1,2,5

(1) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (2) Seoul National University, Institute of Environmental Medicine, Medical Research Center, Seoul, South Korea (3) Seoul National University Hospital, Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul, South Korea (4) Seoul National University Children’s Hospital, Department of Pediatrics, Seoul, South Korea (5) Seoul National University College of Medicine, Environmental Health Center, Seoul, South Korea

Corresponding author: Yun-Chul Hong Contact: Yun-Chul Hong, Tel: +82-2-740-8394, E-mail: [email protected]

Background Prenatal environmental cadmium exposure in children may be associated with attention deficit hyperactivity disorder (ADHD) in children. Our objective is to examine the relationship between the heavy metal cadmium exposure during gestation and child ADHD at 6 years of age.

Methods As part of an on-going cohort named “The Environment and Development of Children”, 479 mother- child pairs from Seoul, Korea were enrolled between 2008 and 2011. Whole blood concentration of cadmium was analyzed. Parents were surveyed regarding ADHD behaviors in their children at ages 4 and 6. Multivariable linear regression models were used to investigate the relationship between prenatal exposure to cadmium with ADHD.

Results Increase in prenatal cadmium concentrations were associated with increased scores for ADHD for girls but not for boys in preschool aged children. Each 2-fold increase in prenatal cadmium level was significantly associated with a 20.7% [95% confidence interval (CI): 8.9%, 33.8%] and 20.0% [95% confidence interval (CI): 9.7%, 31.3%] increase in Attention Deficit Hyperactivity Disorder in girls at 4 years of age and 6 years of age, respectively, as indicated by the linear regression model.

Conclusion Our results identified significant associations between maternal cadmium levels and ADHD in preschool- aged girls.

S32 www.journalhealthpollution.org 180908 18-0160

Environmental Health Survey for Children Around Mining Areas in Mongolia Young-Seoub Hong1,2, Jung-Wook Seo1, Sang-Hun Nam3, Dae-Seon Kim3, Enkhjargal Altangere4

(1) Dong-A University, Heavy Metal Exposure Environmental Health Center Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Dong-A University, College of Medicine, Department of Preventive Medicinev (3) National Institute of Environmental Research (4) Minstry of Health, Ulaanbaatar

Corresponding author: Young-Seoub Hong Contact: Young-Seoub Hong, e-mail: [email protected]

Background Mining activity has accounted for more than 50% of the Mongolia industry. Mining related diseases are increasing annually. Health problems related to the mining sector pose important issues in Mongolia. We conducted a health and exposure assessment of residents living near Umnugobi mining areas in Mongolia using the World Health Organization’s (WHO)recommendation.

Methods Environmental samples were collected in 3 soum (Bayandalai, Tsogttsetsii, Khanbogd). In accordance with the WHO standard method, 27 water and soil samples from different locations were collected from 3 soums of Umnugobi aimag. A total of 118 children, in the 4th and 5th grades, from the 3 soums of Umnugobi aimag participated. We performed a questionnaire survey, measured the level of lead, cadmium, copper, mercury, and arsenic in blood and urinary samples, and measured the level of arsenic and mercury in hair samples from the subjects.

Results The geometric mean concentrations of blood lead levels in the 3 soums children were 7.42ug/dl, 5.13 ug/dl and 4.78 ug/dl, respectively. However, the level of As, Cu, Cd, and Hg in the 3 soums children showed relatively low level compared to the international criteria.

Conclusions Biomonitoring result shows that blood lead level was significant in all soums. It is considered that there is a need for such survey in other Mongolia mining areas.

S33 180908 www.journalhealthpollution.org 18-0078

Effects of Pesticide Exposure During Pregnancy on Birth Outcomes Chia‐Jung Hsieh1, Lih-Ming Yiin1, Yu-Hsun Chang2

(1) Tzu Chi University, Department of Public Health, Hualien, Taiwan

(2) General Tzu Chi Hospital, Department of Pediatrics, Hualien, Taiwan Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Chia Jung Hsieh Contact: Chia Jung Hsieh, Tel: +886-3-8565301 ext.2307, E-mail: [email protected]

Background Along with the wide use of pesticides in the world, there has been public concern raised about the potential health effects of pesticides. Thus, the aim of this study is to conduct a birth cohort study to examine whether exposure to pesticides during pregnancy has effects on birth outcomes.

Methods This study is a longitudinal birth cohort study. We had recruited study subjects in a medical center in east Taiwan between October 2013 and September 2016. A total of 280 pregnancy women and their neonates were recruited in the study. We recruited them before delivery and interviewed the subjects with a structured questionnaire to collect the information of parental occupational pesticide exposure and 6 types of household insecticide use, including sprays or foggers, solid, adhesive type, liquid, mosquito coil, and electric mosquito repellent. Birth outcomes were obtained from medical records, including birth weight, length, and head circumference. Multiple linear regressions were used to explore the relationship between pesticide exposure during pregnancy and birth outcomes.

Results Of the 280 participants, 17 (6.1%) claimed to have occupational exposure to pesticides while 100 (35.7%) reported using pest control method during pregnancy. Maternal occupational exposure to pesticides during pregnancy was related with lower birth weight (β=-173.1; p = 0.04) and head circumference (β=-0.82; p = 0.031). None of any type of pest control method was related with birth outcomes.

Conclusions These results indicate adverse effects of maternal occupational pesticide exposure during pregnancy on their neonates’ birth outcomes.

S34 www.journalhealthpollution.org 180908 18-0093

Epidemiologic Characterization of Sudden Infant Death Syndrome in Relation to Air Pollution in Korea: A Case-Crossover Study Myung-Jae Hwang1, Hae-Kwan Cheong1

(1) Sungkyunkwan University, School of Medicine, Department of Social and Preventive Medicine, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Myung-Jae Hwang Contact: Myung-Jae Hwang, Tel: +82-10-6316-9694, E-mail: [email protected]

Background Sudden infant death syndrome (SIDS) is the unexpected death of an infant without previous morbidity, whose cause of death remains unexplained. Studies suggested that air pollutants may be associated with infantile fatality. We conducted this study to estimate the exposure to air pollutants on infantile death in Korea.

Methods We conducted a case-crossover (1:2 matched) analysis to assess the temporal association of infantile death with air pollution. SIDS cases were recruited from national mortality database from Statistics Korea from 2009 to 2013. We matched each mortality case with 24-hour averages of the air quality indexes and meteorological indexes obtained from the residence based on the date of death by 16 administrative regions. Logistic regression was applied to estimate relative risks (RRs) and 95% confidence intervals (CIs) in single and multi-pollutants model (adjusted PM10).

Results The total number of cases of SIDS over 5 years was 439. We found statistically significant relationships between birth weight, gestational age maternal age and NO2 level in the ambient air in females. The RRs were 2.91 (1.73-4.89) in low-birth weight (≤2500g), 4.62 (2.56-8.35) in preterm infant (gestational age<37 weeks) in single-pollutant model and 4.92 (2.55-9.47) in preterm infant per interquartile range (IQR) in multi-pollutants model.

Conclusions This study suggested that short-term exposure to NO2 increases the risk of female infant mortality.

S35 180908 www.journalhealthpollution.org 18-0156

An Introduction to Korean Children’s Environmental Health Study Namkyoung Hwang1, Mina Ha1, Se Chang Ahn1, Suejin Kim2, Chul Woo Lee2, Eunhee Ha3, Yangho Kim4

(1) Ministry of Environment, Environmental Health Policy Division, Sejong City, South Korea

(2) National Institute of Environmental Research, Environmental Health Research Department, Incheon, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (3) Ewha Womans University, School of Medicine, Department of Occupational and Environmental Medicine, Seoul, South Korea (4) Ulsan University Hospital, University of Ulsan College of Medicine, Department of Occupational and Environmental Medicine, Ulsan, South Korea

Corresponding author: Namkyoung Hwang Contact: Namkyoung Hwang, Tel: +82-32-560-7157, E-mail: [email protected]

Background The Korean Children’s Environmental Health Study (Ko-CHENS) is a large, retrospective cohort for nationwide study in the Republic of Korea lunched in 2015. The purpose of this cohort is to provide the frame to develop the list of environmental hazardous factors at each stage of growth for it will provide the guidelines for environmental hazardous factors and a life course approach to environmental health management system.

Methods Ko-CHENS consists of three parts: Core Cohort, Main Cohort, and Big-CHENS. The total study period is 22 years and as recruitment period is till 2019, the recruitment process is still on going. 5,000 Children in Core Cohort are being followed up at 6 months, every year before admission at elementary school, and every 3 year from 1st year after admission at elementary school. 65,000 Children in Main Cohort are being followed up at the same time as Core Cohort. The total birth population through nationally registered health-related database has been created for Big-CHENS and is being followed-up yearly throughout the study period. Individual biospecimens, questionnaires, and health screening test results are collected for Core Cohort while questionnaires are gathered for Main Cohort and environmental variables such as perinatal outdoor and indoor factors are investigated for all studies. These data will be linked to health outcomes in children and adolescents.

Results As of now, 93% participants of Core Cohort and 58% participants of Main Cohort are recruited. Follow- up rate is 94% for Core Cohort and 99% for Main Cohort and approximately 100% for Big-CHENS as it bases on national database.

Conclusions The openness of government data and their systematic linkage with the cohort data provide a vital lifeline for Ko-CHENS to develop into a new type of large cohort study. This unique framework linking the cohort data to big national data ensures a cost-effective nationwide birth cohort.

S36 www.journalhealthpollution.org 180908 18-0127

Prevalence of Clinically Diagnosed Internet Gaming Disorder and Gaming Behavior Patterns in Adolescents Using Cluster Analysis: Baseline Results from iCURE Hyunsuk Jeong1, Hyeon Woo Yim1 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Catholic University of Korea, Preventive Medicine, Seoul, South Korea

Corresponding author: Hyunsuk Jeong Contact:Hyunsuk Jeong, Tel: 010-4032-2683, E-mail: [email protected]

Background Problematic internet gaming symptoms might be highly heterogeneous and depend on a wide range of psychological and environmental factors. The main objective of this study is to describe the prevalence of clinically diagnosed internet gaming disorder (IGD) and self-reported IGD based on Diagnostic and Statistical Manual, fifth edition (DSM-5) diagnostic criteria in adolescents. eW also investigate differences in gaming behavior patterns and IGD prevalence among the subgroups defined by cluster analysis.

Methods A total of 2,319 third, fourth, and seventh graders enrolled the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study. Self-reported IGD was assessed with a DSM-5 adapted screening tools and confirmed by clinical interviews. Cluster analysis was performed with established risk and protective factors such as anxiety, self-control, immediate satisfaction-seeking tendency, aggression, familial support, parent and peer attachment, communication style with parents, and self-esteem grouped with similar individual and environmental factors. Gaming behavioral patterns and IGD prevalence were evaluated based on cluster analysis.

Results Four different clusters were identified: three clusters of problematic internet users (clusters 1, 2, and 3) and one cluster with no problematic internet users (clusters 4). Cluster 1, which was named “Users with potential internalization & externalization issues,” showed the highest prevalence of IGD and problematic gaming behavior patterns.

Conclusions It is possible to classify some clusters with homogeneous risk patterns ranging from healthy to problematic users. The prevalence of clinically diagnosed IGD and self-reported high risk of IGD was different across different patterns of risk and protective factors.

S37 180908 www.journalhealthpollution.org 18-0040

Status and Improvement Measures for Children’s Product Management in Korea Dawoon Jung1, Sijin Kim1, Hyesoo Shin1

(1) Korea Environment Institute, Department of Living Environment Research, Sejong City, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Dawoon Jung Contact: Dawoon Jung, Tel: 044-415-7404, E-mail: [email protected]

Background Various regulations and policies have been implemented to protect children’s health from hazardous chemicals. However, children are still exposed to environmental contaminants via various routes including children’s products (CP). The objective of this study was to conduct a comprehensive analysis on the present state of CP management in Korea, set priority targets, and suggest management strategies to protect children’s health.

Methods We conducted a literature review, and analyzed current CP management status in Korea. In addition, examined policies, laws, and regulations in Korea and in other countries, including EU and USA. Lastly, we carried out forums and interviews with various stakeholders. Based on our results, we came up with suggestions for improvement measures.

Results First, we identified several issues in CP management. We found blind spots as well as redundancies in pre-market management as well as market surveillance. Also, we identified differences in risk standards among ministries and ambiguity in target CP compared to general use products. Moreover, consumer products frequently used in children’s living spaces were not considered in CP management. Problem response system and risk communication were also identified as areas that needed improvement. In light of our findings, we propose several improvement measures for the protection of children from hazardous chemicals in CP. Protection of vulnerable population, institution of an integrated management system for children’s space and CP, and reduction of exposure should be priorities in children’s environmental health protection strategy. Finally, we introduce means to strengthen pre- and post-market management and risk communication.

Conclusions Protection of children’s health is a critical step towards achieving environmental justice. We anticipate that regulatory recommendations suggested in this study contribute not only to improved management of CP, but also to the protection of children’s environmental health.

S38 www.journalhealthpollution.org 180908

18-0147

Influence of Age at Exposure and Sex on the Relationship Between Phthalate Exposure and Intelligence: A Prospective Birth Cohort Study Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Jung Lee1, Johanna Inhyang Kim2, Yun-Chul Hong3, Choong Ho Shin4, Young Ah Lee4, Youn-Hee Lim3, Bung-Nyun Kim1

(1) Seoul National University, College of Medicine Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul, South Korea (2) Seoul National University, Bundang Hospital, Department of Public Health Medical Services, Seongnam, South Korea (3) Seoul National University, Medical Research Center Institute of Environmental Medicine, Seoul, South Korea (4) Seoul National University, College of Medicine Department of Pediatrics, Seoul, South Korea

Corresponding author: Bung-Nyun Kim Contact: Bung-Nyun Kim, Tel: 82-2-2072-3647, E-mail: [email protected]

Background To identify vulnerable ages at exposure and sex differences in susceptibility to phthalate, we investigated the associations between prenatal and postnatal urinary phthalate metabolite levels and intelligence in a prospective population-based birth cohort study.

Methods The study included 163 children (75 girls) from an on-going cohort named “Environment and Development of Children”. Phthalate metabolites were examined repeatedly in urine samples collected from mothers at pregnancy and children at ages 2, 4 and 6 years. We analyzed urine concentrations of mono-(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-oxohexyl) phthalate as markers of di-(2- ethylhexyl)-phthalate (DEHP) exposure, and Mono-n-butyl phthalate (MBP) as a marker of di-n-butyl- phthalate (DBP) exposure. The children underwent KEDI-WISC at age 6. Multivariable linear regression models were used to investigate the relationship between phthalate metabolites at each age and intelligence at age 6. All multivariable models were controlled for demographic covariates including sex, birth weight, prematurity, paternal education, maternal education and maternal IQ.

Results IQ scores were negatively associated with DEHP exposure at age 2 (β = -16.6, 95% CI:-29.3,-3.9) but not with the prenatal exposure and exposures at age 4 and 6. DEHP exposure at age 2 showed significant association with IQ score in boys (β = -24.9; 95% CI:-42.2,-7.5) but not in girls. pre- and post- natal DBP exposure had no effects on IQ scores.

Conclusions These results suggest that DEHP exposure at age 2 plays a more significant role in children’s intelligence than exposure after age 4 and that boys are more vulnerable to phthalate exposure than girls.

S39 180908 www.journalhealthpollution.org 18-0101

Influence of Environmental Factors and Prenatal Triclosan on Birth Outcomes: The Mother and Kids Environmental Health Study Bohye Shin1, Eun Kyo Park2, Eun Young Park1, Byungmi Kim1

(1) National Cancer Control Institute, National Cancer Center, Goyang, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Ewha Womans University, Medical Research Institute Department of Preventive Medicine, Seoul, South Korea

Corresponding author: Byungmi Kim Contact: Bohye Shin, Tel: 010-7438-2991, E-mail: [email protected]

Background Triclosan (TCS) is an antibacterial agent found in consumer products especially toothpaste, antiseptic soaps and detergents and has a possible role in disrupted hormonal development. There is insufficient research on TCS exposure during the prenatal period or variance according to environmental factors. Therefore, this study examined the relationship between prenatal TCS exposure and birth outcome considering environmental factors.

Methods The MAKE study plans to recruit more than 300 pregnant, Korean women during 2nd and 3rd stage pregnancy between 2017 and 2019. We collected urinary TCS concentrations during the third trimester, as well as information on birth outcome (fetal weight, height, head circumferences and abdominal circumferences), socio-economic status, use of disposable foods, and habits of consumption of consumer products. Multiple regression analysis was performed to assess the effect of TCS exposure on birth outcome.

Results We found that the creatinine-adjusted geometric mean of TCS were 0.8㎍(95% CI: 0.58-3.84) and tended to increase depending on environmental factors (using antimicrobial soap, body cleanser, shampoo and disposable products consumption). There was a significant correlation between urinary concentrations of TCS and birth weight (180.49g, 95% CI : 64.22-296.76) and birth abdominal circumferences (1.21cm, 95% CI : 0.46-1.96) in the case of disposable products use.

Conclusions We found that the association between urinary concentration of TCS and birth outcomes, differed by environmental factors such as the case of consumer products consumption (using antimicrobial soap, intake of disposable products). Further study is required to more fully elaborate this relationship among environmental factors, prenatal TCS exposure and birth outcome.

S40 www.journalhealthpollution.org 180908 18-0096

During Pregnancy and Early Lifetime Exposure to Particulate Matter and Autism Spectrum Disorder in Early Childhood: COCOA Study Hyo-Bin Kim1, Boom Kim2, Sunju Namgoung3, Kangmo Ahn4, Kyung Won Kim5, Youn Ho Shin6, Dong In Suh7, Kyung Sook Lee8, Yee-Jin Shin9, Soo-Jong Hong10 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Inje University, Sanggye Paik Hospital, Pediatrics, Seoul, South Korea (2) University of Ulsan College of Medicine, Asan Institute for Life Science, Ulsan, South Korea (3) University of Ulsan, College of Medicine, Environmental Health Center, Asan Medical Center, Ulsan, South Korea (4) Sungkyunkwan University, School of Medicine Pediatrics, Seoul, South Korea (5) Yonsei University, College of Medicine, Pediatrics, Seoul, South Korea (6) CHA University, School of Medicine, Pediatrics, Pocheon, South Korea (7) Seoul National University, College of Medicine Pediatrics, Seoul, South Korea (8) Hanshin University, Rehabilitation, Osan, South Korea (9) Yonsei University, College of Medicine, Psychiatry, Seoul, South Korea (10) University of Ulsan, College of Medicine Pediatrics, Ulsan, South Korea

Corresponding author: Hyo-Bin Kim Contact: Hyo-Bin Kim, Tel: 010-3433-7685, E-mail: [email protected]

Background Prevalence of autism spectrum disorder (ASD) is increasing recently and association with environmental pollution is suspected. Early life exposure to air pollution may be associated with ASD, but the evidence is not consistent.

Methods This study included 551 mother-child pairs from the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA). Levels of particulate matter with diameters of ≤10 μm (PM10) and ≤2.5 μm (PM2.5) during pregnancy and until 3 years of age were estimated for addresses by land-use regression models based on national monitoring system. ASD was assessed in children at age 4 using the Childhood Autism Spectrum Test (CAST) by validated cut-off.

Results Sex, house income, maternal education level, and maternal smoking during pregnancy were not associated with ASD development. Prenatal PM10 and PM2.5 exposure was associated with ASD (aOR 5.97, 95% CI 3.12-11.39 and aOR 2.75, 95% CI 1.63-4.62, respectively). Exposure to PM10 and PM2.5 during first 3 years after birth was associated with ASD (aOR 3.60, 95% CI 2.17-5.96 and aOR 2.58, 95% CI 1.59-4.18, respectively). Stratifying by prenatal and after birth PM exposure, children exposed to high levels of PM10 and PM2.5 during pregnancy and after birth showed higher risk of ASD development compared to those who were exposed to low levels of PM10 and PM2.5 during pregnancy and after birth (aOR 8.136, 95% CI 3.853-17.179 and aOR 3.366, 95% CI 1.888-6.002, respectively).

S41 180908 www.journalhealthpollution.org Conclusions Exposure to high levels of PM during pregnancy and early childhood was associated with ASD in children.

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Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Early-Life Exposure to Heavy Metals and Development of Allergic Diseases JaHyeong Kim1

(1) Ulsan University Hospital, University of Ulsan, College of Medicine Department of Pediatrics, Ulsan, South Korea

Corresponding author: JaHyeong Kim Contact: JaHyeong Kim, Tel: +82-10-9933-3530, E-mail: [email protected]

Background Occupational or environmental exposure to toxic metals has been associated with adverse effect on human health. In particular, exposure to heavy metals during vulnerable periods from preconception to early childhood could adversely affect immune system. However, the underlying biological mechanisms of metal toxicity remain unclear.

Methods We used revious studies have investigated the relationships of blood heavy metals levels with risk of allergic diseases, IgE levels, Th2-cytokines, and allergic sensitization.

Results Heavy metals are ubiquitous environmental contaminants in air, food, soil and water. Recently several studies have demonstrated that metals may cause immune dysregulations, leading to allergic diseases or autoimmune disorders. Studies have reported in a birth cohort study of Korea that cord blood cadmium level was found to be significantly associated with the development of atopic dermatitis in 6-month-old infants. Additional studies also found that cadmium exposure aggravated the asthmatic status of children. Other studies suggested that lead exposure may alter components of the immune system known to be involved in the development of atopic dermatitis and asthma. Articles have reported that a significant positive relationship between blood lead and immunoglobulin E (IgE) levels in studies on children. Works have shown that intrauterine exposure to lead may enhance sensitization to common inhalant allergens in early childhood. One mechanism to explain the immunotoxic effects of heavy metals on allergic disease are that metal is implicated in changes in levels of DNA. Other studies have demonstrated that exposure to lead or mercury during prenatal and postnatal periods may bias the immune responses toward a Th2 and elevate of IgE or increased Th2 cytokine production. However, more studies are necessary to elucidate the association between heavy metals and risk of allergic diseases.

S42 www.journalhealthpollution.org 180908 Conclusions Further studies are needed to clarify the toxic effects of environmental heavy metals and underlying mechanisms related to epigenetic effects on allergic disease in children.

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Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Health Damage of Humidifier Disinfectant by Big Data Analysis in Korea Jaiyong Kim1

(1) Hanyang University, Institute for Health and Society, Seoul, South Korea

Corresponding author: Jaiyong Kim Contact: Jaiyong Kim, Tel: 01037495973, E-mail: [email protected]

Background The accident of humidifier disinfectants found in 2011 was one of the biggest man-made environmental disaster in South Korea. It was estimated that at least 5 million people were exposed and 5 hundred thousand people experienced health problems. However, the governmental countermeasures focused mainly on the differential diagnosis and compensations for the voluntary registered victims of 6,000 people. So, the epidemiologic studies to uncover the size of health problems were insufficient. We tried to estimate the correlation between humidifier disinfectants consumption with some target diseases (interstitial pulmonary diseases, asthma, etc.) in South Korea using the National Health Insurance Research Database Study.

Methods Data of 50 million people over 15 years (January 2002-September 2017) were reconstructed to extract episodes of care with target diseases diagnosis including residence district and socio-economic status. Relative risk estimates from age-period-cohort and difference in difference analysis were compared with humidifier disinfectant consumptions (1994-2011).

Results In 282,114 interstitial pulmonary diseases patients, correlation coefficients between relative risk estimates of ‘period effect’ and humidifier disinfectant consumption were 0.942 in male and 0.930 in female with 1 year latent period assumption. Correlation coefficients between relative risk estimates of ‘cohort effect’ and humidifier disinfectant consumption were 0.854 in male and 0.797 in female. And, we found a specific rise and fall pattern among 2003-2011 birth cohorts. Although, only about 130 patients under 7 years old seems to be registered for compensation, the number of excess patients were estimated from 728 to 811 with interstitial pulmonary disease diagnosis.

Conclusions We could find high correlation and specific rise and fall patterns of health care episodes with humidifier disinfectant consumption using national total population cohort data. These kinds of big data system can make relatively objective epidemiologic evidences for environmental health problems.

S43 180908 www.journalhealthpollution.org 18-0031

Modifications of Ambient Temperature and Synoptic Meteorology for Respiratory Hospitalization Among Childhood in Seoul, Korea Jayeun Kim1, Ho Kim2

(1) Seoul National University, Institute of Health and Environment, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Seoul National University, Graduate School of Public Health, Seoul, South Korea

Corresponding author: Jayeun Kim Contact: Jayeun Kim, Tel: 82-10-4766-1860, E-mail: [email protected]

Background The Korean Peninsula has relatively distinct seasonal characteristics upon temperature variation. The spatial synoptic classification (SSC) is a daily weather-type classification scheme that has become widely used in climatological and epidemiological investigations. In this study, we aim to investigate the modification effect between temperature and SSC on respiratory-related hospital admission (RA) among children.

Methods Respiratory-related admission information among childhood were collected through the National Inpatient Sample (NIS) database between 2011 and 2015 in Seoul, Korea. We conducted the time-series study using Poisson generalized linear models with an allowance of over-dispersion with stratification by season and each of seven distinctive spatial synoptic (SSC, Dry moderate [DM], Dry polar [DP], Dry tropical [DT], Moist moderate [MM], Moist polar [MP], Moist tropical [MT],Transition [T]). We investigated the modification effects between the SSC and temperature in seasonal stratification adjusting for other meteorological conditions, air pollution, and time trend and considered the delayed effect up to 3 consecutive days. We reported the relative risk with 95% confidence interval (CI) for RA associated with exposure to ambient temperature according to season and the type of SSC.

Results The association between temperature and RA was varied by the season and the type of SSC. Increased association was observed with the ambient temperature and the season-specific effect size was spring [1.27 (95% CI –0.27, 2.83%)], summer [1.14 (95% CI –0.38, 2.68%)], fall [0.72 (95% CI –0.77, 2.24%)], and winter [1.85 (95% CI –0.08, 3.81%)] per 1 °C temperature increase. RA was increased in [MT] with a 1.42% (95% CI 0.15, 2.70%) and the increased association was detected during the dry [1.33% (95% CI 0.07, 2.62%)], moist [1.35 (95% CI 0.10, 2.61%)] and tropical [1.35% (95% CI 0.12, 2.60%)] weather conditions based on the same day of RA event. In addition, season and SSC specifically, temperature effect on RA was greater in [DM] [2.01% (95% CI 0.26, 3.79%)] and dry [1.86% (95% CI 0.18, 3.57%)] during spring period.

S44 www.journalhealthpollution.org 180908 Conclusions According to the temperature variability as a distinction of seasonal characteristics, the temperature effect on RA among the childhood was varied by the type of SSC. The application of SSC can assist to understand the seasonal characteristics for the investigation of ambient temperature and short-term health effects.

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Predictors of Thirdhand Smoke Beliefs on Children Health Among Adults in Korea Jeonghoon Kim1,2, Jin-Ha Yoon3, Jihyun Kim3, Wanhyung Lee3, Yeong-Kwang Kim3, Seunghyun Lee4, KyooSang Kim1

(1) Seoul Medical Center, Department of Environmental Health Research, Seoul, South Korea (2) Seoul National University, Department of Environmental Health Sciences, Graduate School of Public Health, Seoul, South Korea (3) Yonsei University, College of Medicine, Graduate School of Public Health, Seoul, South Korea (4) University of Occupational and Environmental Health, Department of Internal Medicine, School of Medicine, Kitakyushu, Japan

Corresponding author: Jeonghoon Kim Contact: Jeonghoon Kim, Tel: 82-10-8287-1298, E-mail: [email protected]

Background Thirdhand smoke (THS) is residual tobacco smoke pollutants that remain after tobacco smoking. The aim of the study was to investigate predictors of the belief among adults in Korea that THS is harmful to children.

Methods A population-based sample of 3,000 adults aged more than 18 years old in Korea was obtained through a web-based selection panel in 2016. The respondents filled out questionnaires, including THS beliefs, current smoking status, presence of voluntary smoke-free rules at home, and support for the implementation of smoke-free regulations at home. THS beliefs were examined with a statement that staying in a room today where people smoked yesterday can harm the health of children.

Results In total, 92.2 % of adults believed that THS exposure could harm the health of children. In the multivariable logistic analysis, adults who were nonsmokers, believed that SHS exposure were associated with pneumonia of children, lived in home with complete smoke-free rule, and supported the implementation of smoke-free regulation at home were more likely to believe that THS could harm for health of children.

S45 180908 www.journalhealthpollution.org Conclusion The majority of adults in Korea believed THS exposure could harm the health of children. Predictors identified in the study can be useful to enhance the risk of THS beliefs and promote implementation of tobacco control policies.

18-0023 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Associations Between Urinary Cotinine and Symptoms of Attention Deficit/ Hyperactivity Disorder and Autism Spectrum Disorder Kyoung Min Kim1, Myung Ho Lim1, Ho-Jang Kwon1, Seung-Jin Yoo1, Eun-jung Kim1, Ki Chung Paik1

(1) Dankook University, Medical Center Environmental Health Center, Yongin, South Korea

Corresponding author: Kyoung Min Kim Contact: Kyoung Min Kim, Tel: +82-41-550-6390, E-mail: [email protected]

Background The present study investigated associations between urinary cotinine levels as a biomarker of secondhand smoke exposure and symptoms of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

Methods A total of 520 child participants (200 with ADHD, 67 with ASD, and 253 normal control subjects) were assessed using the Korean version of the ADHD rating scale (K-ARS), Autism spectrum screening questionnaire (ASSQ), and Behavioral Assessment System for Children, second edition (BASC-2). The Korean version of the computer-based continuous performance test was used to assess cognitive function. Urinary cotinine was evaluated as a biomarker of secondhand smoke exposure.

Results Urinary cotinine levels were significantly and positively associated with K-ARS score, ASSQ score, the behavioral problem subscales of the BASC-2, and omission and commission errors in the continuous performance test. Urinary cotinine levels were also associated with ADHD and ASD as per odds ratios.

Conclusions Urinary cotinine levels were associated with lower behavioral adaptation and cognitive function and increased odds ratios of ADHD and ASD, indicating a negative effect of secondhand smoke exposure on the symptomatic manifestation of ADHD and ASD.

S46 www.journalhealthpollution.org 180908 18-0145

Cohort Profile: The Environment and Development of Children (EDC) Study: A Prospective Children’s Cohort Kyoung-Nam Kim1,2, Youn-Hee Lim3,4, Choong Ho Shin5, Young Ah Lee5, Bung-Nyun Kim6, Johanna Inhyang Kim7, In Gyun Hwang8, Myung Sil Hwang8, Jin-Hyang Suh8, Yun-Chul Hong2,3,4 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Seoul National University Hospital, Division of Public Health and Preventive Medicine, Seoul, South Korea (2) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (3) Seoul National University, Medical Research Center Institute of Environmental Medicine, Seoul, South Korea (4) Seoul National University, College of Medicine, Environmental Health Center, Seoul, South Korea (5) Seoul National University, College of Medicine, Department of Pediatrics, Seoul, South Korea (6) Seoul National University, College of Medicine, Department of Psychiatry, Seoul, South Korea (7) Seoul National University, Bundang Hospital, Department of Public Health Medical Services, Seongnam, South Korea (8) National Institute of Food and Drug Safety, Evaluation Food Safety Risk Assessment Division, Chungcheongbuk-do, South Korea

Corresponding author: Kyoung-Nam Kim Contact: Kyoung-Nam Kim, Tel: 82-10-9063-4560, E-mail: [email protected]

Background The Environment and Development of Children (EDC) study is a prospective children’s cohort study established to investigate the associations between environmental risk factors and physical and neurobehavioural developments, as well as the mechanisms underlying these associations, particularly with regard to epigenetic processes.

Methods The participants were recruited from the Congenital Anomaly Study, which enrolled pregnant women between 2008 and 2010. A total of 726 children, mostly residing in Seoul and Gyeonggi province, Republic of Korea, who were 2–4 years of age were recruited between 2012 and 2015. We conducted follow-up surveys with 2-year intervals. A total of 80.9% of the children who were enrolled in the study at 2 years of age (n = 425) were followed up at 4 years of age.

Results The EDC data include sociodemographic and lifestyle characteristics and dietary information obtained through structured questionnaires, environmental pollutant levels measured using blood and urine samples, and genome-wide DNA methylation profiles determined using blood collected from children at 6 years of age. The genome-wide DNA methylation profiles were evaluated. Pediatric psychiatrists and clinical psychologists comprehensively evaluated the neurobehavioural development of children using tools such as Social Communication Questionnaire, Autism Diagnostic Observation Schedule, Attention Deficit/Hyperactivity Disorder Rating Scale, Comprehensive Attentional Test Battery, Stroop Colour and Word Test, Wechsler Intelligence Scale for Children, Wisconsin Card Sorting Test, and K- and S-scales.

S47 180908 www.journalhealthpollution.org Conclusions We expect that the EDC cohort study will provide up-to-date information on the different physical and neurobehavioural developmental trajectories associated with various environmental risk factors and underlying mechanisms behind these associations.

18-0089 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

The Potential Impact and Opportunities of ‘Big Data’ for Korean Children’s Environmental Health Study (Ko-CHENS) Jueun Lee1, Eunhee Ha2, Choong-Hee Park1, Woo-Mi Lee1, Soon Won Jung1, Myeongjee Lee2, Seulbi Lee3, Suejin Kim1

(1) National Institute of Environmental Research, Environmental Health Research Department, Incheon, South Korea (2) Ewha Womans University, Occupational and Environment Medicine, College of Medicine, Seoul, South Korea (3) Ewha Womans University, College of Medicine, Medical Sciences, Seoul, South Korea

Corresponding author: Suejin Kim Contact: Suejin Kim, Tel: +82325607112, E-mail: [email protected]

Background Recent advances in the volume and variety of electronic health records, and the rate at which they can be merged and analyzed in the era of big data, provide an opportunity to create very large cohorts to acquire new insights into the environmental health studies. To integrate large-scale clinical, environmental and health information for the purpose of nationwide research, Korean Children’s Environmental Health Study (Ko-CHENS) have defined a new model for the birth cohort study.

Methods Korea’s leading initiatives of open government data, for data curation and data integration, have provided the foundation to cooperate with National Health Insurance Service (NHIS) and build Big- CHENS, a large population-based birth cohort study. As it is possible to cover about 97% of the total birth population in South Korea through mother’s delivery code (ICD code) in NHIS data, Big-CHENS will include around 2 million births during 5 years of recruiting period of Ko-CHENS. Big-CHENS incorporates mothers and their children medical information and also fathers’ medical information as well. Linked with various national environmental monitoring data, e.g., PM10 and PM2.5, Big-CHENS can also offer in-depth knowledge of each participant’s health and their environments.

Results First two years of recruitment period (2015-2016) dataset was created as a preliminary dataset. Compared to national census of Statistics Korea, 92 percent of total births in 2015 and 89 percent of total births in 2016 was covered by mother-child pair dataset; 86 percent of total births in 2015 and 83 percent of total births in 2016 was covered by mother-child-father pair dataset.

S48 www.journalhealthpollution.org 180908 Conclusions With growing needs for large diverse cohort study, we expect Big-CHENS and Ko-CHENS to play a complementary role in identifying the health effects of environmental harmful substances on children.

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Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Maternal Pre-Pregnancy Body Mass Index and Offspring Cord Blood DNA Methylation Woo Jin Kim1, Yuri Han1, Hyun Sub Cheong2, Sung Ok Kwon3

(1) Kangwon National University, Department of Internal Medicine and Environmental Health Center, Chuncheon, South Korea (2) SNP Genetics, Inc. Department of Genetic Epidemiology, Seoul, South Korea (3) Biomedical Research Institute, Department of Biomedical Research, Seoul, South Korea

Corresponding author: Woo Jin Kim Contact: Woo Jin Kim, Tel: 82-33-258-9364, E-mail: [email protected]

Background Maternal pre-pregnancy body mass index (BMI) has been associated with a number of long-term adverse health outcomes in offspring. Epigenetic changes of offspring DNA have been oposedpr as one of mechanisms to explain adverse outcomes. We examined the association of maternal pre-pregnancy BMI in relation to offspring DNA methylation.

Methods We performed an epigenome-wide association study among 190 mother-infant pairs delivered at term in Korean birth cohort study. Cord blood DNA methylation was assessed using Illumina’s Infinium MethylationEPIC BeadChip (805,642 CpGs). Pre-pregnancy overweight/obesity, defined as BMI ≥23.0 kg/m2, was ascertained through standardized questionnaires. To examine the association of maternal pre-pregnancy BMI with DNA methylation at CpG probe, we used robust linear regression. Covariates included maternal age (years), maternal education level, maternal smoking, parity, and estimated cell- type proportions.

Results For 190 mothers, mean maternal age was 30.3 years (range: 23-41). Only 16 women smoked before and during the first trimester. Fifty-three percent of the subjects were college graduates. The mean pre- pregnancy BMI was 22.1 kg/m2 (SD=3.1). Approximately 31% of the pregnant women were identified as overweight and obesity. Several CpGs were differentially methylated in relation to maternal pre- pregnancy BMI after adjustment for cell proportions. The top 3 CpG sites of differentially methylation were annotated to DMTF1, TRMT1, NACC1, and ART4.

S49 180908 www.journalhealthpollution.org Conclusions This study demonstrates that offspring DNA methylation at several loci is associated with pre-pregnancy maternal BMI. These results might suggest a potential role of maternal pregravid obesity-associated epigenetic changes in offspring’s health outcome. Future investigations are needed to explain epigenetic mechanism. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Behavior of Blood Heavy Metal Concentrations in Pregnant Korean Women and Children Yangho Kim1, Kyoung Sook Jeong2

(1) Ulsan University Hospital, University of Ulsan College of Medicine, Department of Occupational and Environmental Medicine, Ulsan, South Korea (2) Hallym University, Sacred Heart Hospital, Department of Occupational and Environmental Medicine, Chuncheon, South Korea

Corresponding author: Yangho Kim Contact: Yangho Kim, Tel: +02-3010-4209, E-mail: [email protected]

Background We assessed the associations of heavy metal concentrations in pregnant women with the concentrations in children during early childhood. Maternal lead and mercury concentrations correlated with the levels in cord blood. This correlation may be due to high trans-placental transmission of these metals.

Methods Lead, total mercury, and cadmium were measured in women during early and late pregnancy, in cord blood, and in children who were 2, 3, and 5 years old in birth cohort. We also assessed iron deficiency in infants.

Results Lead concentration was lowest in cord blood, highest in 24 month-old children, and then decreased with child age. Total mercury concentration was highest in cord blood, and gradually decreased with child age. Cadmium concentration was lowest in cord blood, and increased with child age. We also showed that blood manganese and lead concentrations are elevated among iron-deficient infants. Mechanisms of iron absorption are similar to those of other divalent metals, particularly manganese, lead, and cadmium, and iron deficiency can lead to excess absorption of manganese, lead, and cadmium. Increased blood manganese and lead levels are also likely associated with prolonged breast-feeding, which is also a risk factor for iron deficiency.

S50 www.journalhealthpollution.org 180908 Conclusions High levels of intra-uterine lead or mercury and postnatal exposure related to the prenatal exposure, can simultaneously adversely affect the neurodevelopment of children. We also assess iron deficiency as an important susceptibility factor, especially when carrying out environmental health risk assessments concerning low exposure to neurotoxic metals in children.

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Neurodevelopmental Effect of Di-Buthyl-Phthalate Exposure During Gestation and Lactation in C57BL/6 Mice Yeni Kim1, Ha-Jin Jung1, Sung-Mi Lee1

(1) National Center for Mental Health, Department of Child and Adolescent Psychiatry, Seoul, South Korea

Corresponding author: Yeni Kim Contact: Yeni Kim, Tel: 02-2204-0138, E-mail: [email protected]

Background It has been reported that exposure to phthalates in humans affects the behavior development of children. Previous studies have shown that rats receiving phthalate displayed impaired spatial learning and memory. In this study we examined the effect of di-butyl phthalate (DBP) exposure during gestation and lactation the maternal behavior and on the neurodevelopment in the offspring of C57BL/6 mice.

Methods Pregnant C57BL/6 mice were treated orally with corn oil containing DBP (50 or 100mg/kg/day) from prenatal day (PND) 13 to postnatal day 21. The DBP level were analyzed in 24hour maternal urine from PND 15-16. We measured m-chloro-phenylpiperazine (MCPP) concentration, a metabolite of DBP in maternal urine, and confirmed exposure to DBP.

Results We observed significant increase in immobility time and maternal behavior decrease in treated DBP groups than control group (p<0.01). To elucidate molecular mechanism of opposing effects of DBP, we analyzed expression RNA levels and protein levels of cortex in 50mg/kg/day mothers and control mothers. Our results showed that the decreased expression of depression proteins (p-ERK, p-AKT, p-CREB) and down regulated between control group and DBP 50mg/kg/day group. In behavioral developmental parameters of the offspring of the exposed mother, we observed delayed negative geotaxis at PND7 and decreased olfactory orientation at PND14 in the DBP 50mg/kg/day male pups. To elucidate molecular mechanism of adverse effects of DBP, we analyzed expression RNA levels and protein levels of cortex in 50mg/kg/day male pups. Our results showed that the decreased expression of neurodevelopment proteins (DCX, SNAP25, Syntaxin, CREB) and up regulated relation of dopamine- receptor between control group and DBP 50mg/kg/day group.

S51 180908 www.journalhealthpollution.org Conclusions Cumulatively, the data support the hypothesis that DBP exposure of mother mice during gestation and lactation cause delayed neurodevelopment in male offspring and induced behavior change in the mother.

18-0055 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Temporal Variation of Indoor Air Quality in Daycare Centers Yoonjee Kim1, Sewon Lee1, Hyunkyung Ban1, Sangmin Cha2, Geunbae Kim3, Kiyoung Lee1

(1) Seoul National University, Graduate School of Public Health, Seoul, South Korea (2) Kweather, Environmental Business Division, Seoul, South Korea (3) National Institute of Environmental Research, Environmental Health, Incheon, South Korea

Corresponding author: Yoonjee Kim Contact: Yoonjee Kim, Tel: 8228802818, E-mail: [email protected]

Background Indoor air quality of daycare centers has a significant impact on the health of children. In Korea, indoor air quality management law has been established to manage indoor air quality of public spaces including daycare centers. The law requires measurement of air quality once in a year. Indoor air quality can have temporal fluctuation.

Methods Total 46 daycare centers in the Seoul metropolitan area were recruited. Indoor air quality was measured as specified in the Indoor Air Quality Management law. The official evaluation was conducted in October 2016 and real time monitor was installed at that time. Bootstrap analysis was conducted to compare n-day and 37-day measurements.

Results Daily means of carbon dioxide (CO2) and PM in 46 daycare centers were 1042.74±134.45ppm and 45.07±12.16µg/m3, respectively. Fluctuation of daily mean of PM in 37 days was larger than that of CO2. Noncompliance rate of CO2 with official test method was 2.17% and none of daycare center exceeded PM10 standard of 100µg/m3. Daily noncompliance rates of CO2 were ranged from 0% to 78.57% in continuous monitoring data. Fourteen daycare centers exceeded the CO2 standards in more than 50% of 37 days. There was no daycare center exceeding PM standard. When comparing 37-day average exposure with limited day exposure using the first n days, the difference in mean exposures was significant for short-term exposure and the difference significantly decreased as the exposure time increased. It appears that relative error decreases as the number of day increases. However, significantly large error range was maintained even after ten days sampling.

S52 www.journalhealthpollution.org 180908 Conclusions Indoor air quality in daycare centers had significant temporal fluctuation. When official test method evaluated indoor air of daycare centers once a year, the result might not represent actual indoor air quality for longer period of time.

18-0150 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Environment and Developmental Health of Children in Malawi, Africa Boram Lee1, Hye Jun Park1

(1) Seoul National University, Child Development and Family Studies, Seoul, South Korea

Corresponding author: Boram Lee Contact: Boram Lee, Tel: 02-880-8752, E-mail: [email protected]

Background This study was conducted to examine the relationship between maternal perinatal depression trajectories and infant developmental outcomes in Malawi, Africa. This study started from the awareness of the needs for creating an optimal environment in which young children can grow and develop healthy from the beginning.

Methods Most MCH (mother-child health) project in ODA (Official Development Assistance) have been medically- oriented in order to reduce the maternal and neonatal mortality, and then to improve the quality of nutrition and health status by providing physically safe environment. Along with these medically-oriented approaches, the researchers in this study expanded the scope into psycho-social environment.

Results Psycho-social environments such as maternal depression have a major impact on child development.

Conclusions This result suggests the need for psychosocial interventions, including women empowerment and parenting education, beyond merely providing nutrition and medical services.

S53 180908 www.journalhealthpollution.org 18-0149

Classifying Korean Children’s Behavioral Problems and Their Influencing Factors: A Latent Profile Analysis Jeong Rim Lee1, Gilsook Kim1, YeJin Yi1, Shinyeong Song1, Jinmi Kim1

(1) Korea Institute of Child Care and Education, Integration of ECEC Research, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Jeong Rim Lee Contact: Jeong Rim Lee, Tel: 02-2204-0138, E-mail: [email protected]

Background The purpose of this study is to find patterns in the latent profiles of behavioral problems of children aged 4, 5, and 6, in the child and caregiver variables that affected the composition of the latent profile group, and in the differences in children’s social skills by latent profile groups.

Methods The study relies on a sample of 1,461 children enrolled in the Panel Study on Korean Children. Fostering children’s social abilities has been stressed in recent policy documents in Korea, including the Character Education Promotion Act and the recently introduced Nuri curriculum. Therefore, the current paper investigates factors influencing children’s behavior problems via a longitudinal analysis. A latent profile analysis was performed and resulted in three profile models.

Results Our findings are as follows. First, according to the latent profile of children’s behavior problems, we came up with three group models that best fit the data. Group 1, named the non-problem group, had at all ages below standard scores for behavioral problems. Group 2, named the normal group, had average or slightly above average scores for behavioral problems, though such problems decreased as the child got older. Group 3, named the in-danger group, had average or above standard scores for externalizing behavioral problems while the scores for internalizing behavioral problems were above the subclinical standard point at age 4 and at the clinical standard point at ages 5 and 6. Second, after exploring the influencing factors (at child and parent levels) for children belonging to the in-danger group, the study found that the child was more likely to belong to the in-danger group if female, if the level of activity and sociality was low, if the mother’s parenting stress was high, and if the family income was low. Lastly, the study looked into whether there were any group differences in young children’s social skills. The findings show that regarding capacity for cooperation and self-control, the scores of the non-problem group were higher than those for the in-danger group. Regarding capacity for exhibiting assertiveness and responsibility, the lowest scores among the three groups belonged to the in-danger group.

Conclusions The study found that the child was more likely to belong to the in-danger group if female, if the level of activity and sociality was low, if the mother’s parenting stress was high, and if the family income was low.

S54 www.journalhealthpollution.org 180908 18-0097

Community Greenness and Neurobehavioral Development in Children and Adolescents Mihye Lee1, Mina Ha2

(1) St. Luke’s International University, School of Public Health, Tokyo, Japan Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Dankook University, Department of Preventive Medicine, Yongin, South Korea

Corresponding author: Mihye Lee Contact: Mihye Lee, Tel: +81-3-5550-4399, E-mail: [email protected]

Background Neighborhood greenness appears to be beneficial to human health. However, there is a paucity of studies on the relationship between greenness of children’s residential community and their neurobehavioral development. In this study, we examined the association between neighborhood greenness of children’s residential area and their neurobehavioral development.

Methods We used population-representative sample of schoolers (n=1,776) from 2012 and 2014 in South Korea. Parents or guardians of children completed the Child Behavior Checklist (CBCL) to assesses their children’s neurobehavioral development. The normalized difference vegetation index (NDVI) values at a 30-m resolution were retrieved from the Landsat satellite data operated by the U.S. NASA. The NDVI values then were categorized into tertiles (low, moderate, high greenness). Each child was assigned to the maximum NDVI value within a 2-km radius of their residence. We applied survey regression regressing the CBCL transformed score against the 3 levels of greenness. Covariates controlled include age and sex of children, children’s physical activity, monthly family income, marital status of parents, maternal education, exposure to second-hand smoking, distance to the closest traffic road, and blood lead level.

Results Higher vegetation level in the community was associated with a decrease in the CBCL score (moderate greenness: -0.65, 95% CI, -1.98 to 0.68; high category: -2.06, 95% CI, -3.39 to -0.72). On each scale, the inverse relationship with greenness was strongest in the aggressiveness (moderate greenness: -4.55, 95% CI, -8.09 to -1.01; high category: -7.13, 95% CI, -10.83 to -3.44) and the social problems (moderate greenness: -2.41, 95% CI, -5.94 to 1.12; high category: -7.83, 95% CI, -11.49 to -4.17).

Conclusions Greenness of residential neighborhood was associated with decreased problematic behavior scores in children, especially aggressive behaviors and social problems in children.

S55 180908 www.journalhealthpollution.org 18-0069

Pyrethroid Pesticide is Associated with Attention Deficit/Hyperactivity Disorder Symptom in 4-Year Old Children Woo-Seok Lee1, Youn-Hee Lim2, Bung-Nyun Kim3, Choong Ho Shin4, Young Ah Lee4, Johanna Inhyang Kim3, Yun-Chul Hong1,2,5 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (2) Seoul National University, Medical Research Center, Institute of Environmental Medicine, Seoul, South Korea (3) Seoul National University, College of Medicine, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul, South Korea (4) Seoul National University College of Medicine, Department of Pediatrics, Seoul, South Korea (5) Seoul National University College of Medicine, Environmental Health Center, Seoul, South Korea

Corresponding author: Woo-Seok Lee Contact: Woo-Seok Lee, Tel: +82-2-740-8579, E-mail: [email protected]

Background Using pyrethroid insecticides has increased rapidly over the past decade. Pyrethroid pesticides are known to be able to cause abnormalities in the dopamine system and affect an Attention Deficit/ Hyperactivity Disorder (ADHD) phenotype in animal experiments. However, studies about their potential health effects, especially on children, are limited. In this study, we assessed the association between use of pyrethroid insecticides and ADHD symptom in 4-year old children.

Methods We conducted an analysis of 385 participants in Environment and Development of Children (EDC) Study who were 4 years old from 2014 to 2015. Creatinine adjusted 3-PBA concentration was measured in children’s urine at 4 years of age. We assessed the association between urinary 3-PBA concentration and using pyrethroid insecticides from living environment questionnaire and also assessed the association between urinary 3-PBA concentration and ADHD symtom through generalized estimating equations (GEE).

Results The mean 3-PBA concentration in children’s urine at 4 years of age was 2.267 μg/g creatinine. Natural log transformed 3-PBA concentration was significantly associated with children’s ADHD symtom (β = 0.057, P = 0.003). When stratified by gender, it was significant in boys but not in girls. Higher urinary 3-PBA concentration was significantly associated with using pyrethroid pesticide (β = 0.339, P = 0.009).

Conclusions Our study results indicate that urinary 3-PBA concentration in 4-year old children increases the risk of developing ADHD. As the use of pyrethroid pesticides is increasing, more attention should be paid to their health effects.

S56 www.journalhealthpollution.org 180908 18-0141

The Serum Concentrations of Perfluoroalkyl Compounds Were Inversely Associated with Growth Parameters in 2-Year Old Children Young Ah Lee1, Jin Hee Kim2, Hae Woon Jung3, Youn-Hee Lim4, Sanghyuk Bae5, Younglim Kho6, Yun-Chul Hong4,7, Sei Won Yang1, Choong Ho Shin1 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Seoul National University Children’s Hospital, Department of Pediatrics, Seoul, South Korea (2) Sejong University, Department of Integrative Bioscience and Biotechnology, Seoul, South Korea (3) Kyung Hee University, Kyung Hee Medical Center, Department of Pediatrics, Seoul, South Korea (4) Seoul National University, College of Medicine Environmental Health Center, Seoul, South Korea (5) Dankook University, College of Medicine, Department of Preventive Medicine, Yongin, South Korea (6) Eulji University, Department of Health, Environment and Safety, Seongnam City, South Koreav (7) Seoul National University, College of Medicine Department of Preventive Medicine, Seoul, South Korea

Corresponding author: Young Ah Lee Contact: Young Ah Lee, Tel: 010-9863-5337, E-mail: [email protected]

Background The relationship between the serum concentrations of perfluoroalkyl compounds (PFCs) and growth parameters was investigated in 2-year-old Korean children.

Methods The study included 361 children aged 2 years (192 boys and 169 girls; 22-27 months), born at term appropriate-for-gestational-age. The study was conducted between 2012 and 2013. Growth parameters of height and weight, and serum samples were collected from 2-year-old children.

Results Four PFCs (perfluorohexane sulfonic acid [PFHxS], perfluorooctane sulfonic acid [PFOS], perfluorooctanoic acid [PFOA], and perfluorononanoic acid [PFNA]), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), and perfluoroheptanoic acid (PFHpA) were detected in >99, 93.4, 89.8, and 74.2% of the serum samples, respectively. The duration of breastfeeding was positively associated with the serum concentrations of ln-transformed PFHxS, PFOS, PFHpA, PFOA, PFNA, PFDA, and PFUnDA (all P<0.001). Height at 2 years of age was inversely related to PFHxS, PFOS, PFOA, PFNA, and PFDA concentrations (adjusted β per ln unit [95% confidence interval, CI]: -0.84 [-1.26, -0.42], -0.77 [-1.27, -0.15], -0.91 [-1.36, -0.47], -0.48 [-1.40, -0.51], and -0.44 [-0.77, -0.10] cm, respectively), after adjusting for age, sex, and midparental height. Weight at 2 years of age was inversely associated with PFNA (adjusted β per ln unit [95% CI]: -0.32 [-0.48, -0.15] kg), after adjusting for age, sex, and parental BMI.

Conclusions In conclusion, the serum concentrations of PFCs were inversely associated with growth parameters in 2-year-old children.

S57 180908 www.journalhealthpollution.org 18-0142

Dose-Response Relationships Between Interstitial Pneumonitis and the Exposure of Humidifier Disinfectants in Humidifier Disinfectants Victims and Family Based Control Groups Jong Han Leem1, Dirga Kumar Lamichhane1 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Inha University, Occupational and Environmental Medicine, Incheon, South Korea

Corresponding author: Jong Han Leem Contact: Jong Han Leem, Tel: 010-4734-5770, E-mail: [email protected]

Background In Korea, several household humidifier disinfectants (HDs) was clinically confirmed to cause HD- associated lung injury (HDLI). But following studies, such as big data analysis, showed many other interstitial pneumonitis are also associated with the exposure of humidifier disinfectants. Our study tries to investigate any dose-response relationships between interstitial pneumonitis and the exposure of humidifier disinfectants in humidifier disinfectants victims and family based control groups.

Methods This case-control study included 244 interstitial pneumonitis cases and 244 family controls who lived with the intersitial pneumonitis patients. The interstitial pneumonitis cases were divided into two groups, HDLI (definite or probable cases) and other interstitial pneumonitis (possible or not likely cases), and were matched to family controls based on age and gender. Information on exposure to HDs was obtained from a structured questionnaire and field investigations. Conditional logistic regression was used to estimate odds ratio (ORs) and their corresponding 95% confidence interval (CI), investigating the association of HD-related exposure characteristics with interstitial pneumonitis risk.

Results In analyses separated by HDLI and other interstitial pneumonitis, the HDLI risks associated with airborne HD concentrations and cumulative exposure level were significant in the patient with HDLI group. The odds ratio for other interstitial pneumonitis and average hours used per days (adjusted OR =6.41, 95% CI = 2.06 - 19.95; Q4 versus Q1), cumulative use hours (adjusted OR = 4.98, 95% CI = 1.59 - 15.62; Q4 versus Q1), and cumulative sleeps hours (adjusted OR = 11.38, 95% CI = 2.33 - 55.66; >1 m versus < 0.5 m) was higher among other interstitial pneumonitis.

Conclusions The use of household HDs was associated with other interstitial penomonitis among the patients who were clinically classified as possible or not likely cases. Different exposure patterns and underlying diseases made diverse types of bronchiolar and interstitial lung disease.

S58 www.journalhealthpollution.org 180908 18-0039

Strategy for Obtaining National Exposure Factors of Children’s Goods in Korea: The CREAM Study Miyoung Lim1, Ji Young Park2, Seungryul Park3, Wonho Yang4, Kyunghee Ji5, Myung Hee Moon6, Hunjoo Lee7, Kiyoung Lee1,2

(1) Seoul National University, Graduate School of Public Health, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Seoul National University, Institute of Health and Environment, Seoul, South Korea (3) World Research Inc., San Jose, CA, USA (4) Catholic University of Daegu, Department of Occupational Health, Gyeongsan, South Korea (5) Yong In University, Department of Environmental Health, Yongin, South Korea (6) Ecomom Korea, Seoul, South Korea (7) Chem.I.net Co., Ltd., Seoul, South Korea

Corresponding author: Miyoung Lim Contact: Miyoung Lim, Tel: 82-2-880-2811, E-mail: [email protected]

Background As more consumer products for children enter the market, we are more concerned on the chemical burden in children’s health. Children are more vulnerable to chemical exposure compared to adults because of their physiological characteristics. Children’s behavioral characteristics and different usage patterns of children’s goods make exposure and risk assessment more challenging. Accurately measuring the usage patterns of children’s goods is important to conduct realistic exposure assessments to manage children’s goods based on risk. The purpose of children risk and exposure assessment methodology (CREAM) project was to establish Korea national exposure factors of children’s goods.

Methods In the first year, a total of 40,000 households as survey panels was set and recruited for surveys of children’s goods from 17 metropolitan areas and provinces in Korea. The number of panels were determined by proportionate quota sampling based on the population composition ratio in each area and age distribution. In the second year, the systematic questionnaire was developed to investigate children’s goods usage patterns and information regarding demographics and lifestyle.

Results Surveyed products are classified into 4 categories as toys, household goods, stationery/books and playground equipment. Using the survey panel and questionnaire, the survey will be conducted face- to-face interviews as trained interviewers visit each household. We set 10,000 households as the target study population to ensure that we obtained a substantial number of children of rarely used products. The survey will be conducted two times for summer and winter to identify the seasonal variances of exposure factors.

S59 180908 www.journalhealthpollution.org Conclusions The study will provide a national representative exposure factors of children’s goods for accurate exposure and risk assessment. These exposure factor data will be useful as input data for exposure and risk assessments and setting safety guidelines to protect children’s health.

18-0038

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Estimation of Children’s Dermal Exposure to Preservatives in Modelling Clays and Slimes Miyoung Lim1, Ji Young Park2, Kiyoung Lee1,2

(1) Seoul National University, Graduate School of Public Health, Seoul, South Korea (2) Seoul National University, Institute of Health and Environment, Seoul, South Korea

Corresponding author: Miyoung Lim Contact: Miyoung Lim, Tel: 82-2-880-2811, E-mail: [email protected]

Background Modelling clays and slime have been used for art activities or playing and thus popular to children. They may include preservatives to avoid bacterial growth. Some preservatives can pose harmful effects. The purpose of this study was to investigate the contents of preservatives and to estimate dermal exposures of preservatives in modelling clays and slimes use by children.

Methods Sixty-five modelling clays and fifteen slimes were selected and were analyzed for preservatives. The nationwide survey was performed to get use patterns of modelling clays and slimes by home visit survey of 10,000 children divided into three age groups: 0-2, 3-6, and 7-12 years old. Based on chemical analysis results and exposure factors from nationwide survey, dermal exposure estimates were calculated using deterministic method and were determined by each age group.

Results Five preservatives were detected: triclosan (range: 7-261 μg/kg in clays, 132-153 μg/kg in slimes, detection rate 24/80), methyl paraben (7.1-3220 in clays, not detected in slimes, 6/80), methylisothiazolinone (MIT, 1.6-12 in clays, 1-5.7 in slimes, 22/80), chloromethylisothiazolinone (CMIT, 4-96 in clays, 2.2-43 in slimes, 21/80), octylisothiazolinone (OIT, 10-130 in clays, 85-93 in slimes, 23/80). Proportions of clays and slimes user population were 69.2% and 45.8%, and mean use frequencies were 5.4 and 9.8 per month, respectively. Mean times spent to play with products each use were 23 min (range: 5-200) and 17 min (range: 5-100). Exposure estimates of modelling clays were higher than those of slimes. For modelling clays, exposure estimate was the highest in 3-6 years old age group and for slimes, 7-12 years old group was the highest.

S60 www.journalhealthpollution.org 180908 Conclusions Exposure levels were estimated based on the use pattern information representing children in Korea. Harmful preservatives were found in modelling clays and slimes. Depending on exposure pattern, the use of these products could cause unacceptable risk in the worst cases.

18-0100 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Impact of Bisphenol A Exposure on Adiposity Trajectory in Early Childhood: A Prospective Cohort Study Youn-Hee Lim1, Young Ah Lee2, Choong Ho Shin2, Dongwook Lee3, Bung-Nyun Kim4, Johanna Inhyang Kim4, Yun-Chul Hong1,3

(1) Seoul National University, College of Medicine, Environmental Health Center, Seoul, South Korea (2) Seoul National University, Children’s Hospital, Department of Pediatrics, Seoul, South Korea (3) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (4) Seoul National University Hospital, Division of Children and Adolescent Psychiatry, Seoul, South Korea

Corresponding author: Youn-Hee Lim Contact: Youn-Hee Lim, Tel: 010-2795-1777, E-mail: [email protected]

Background Exposure to bisphenol A (BPA) may impact obesity development, either in the exposed subjects or offspring. The aim of this study is to investigate the association between prenatal and postnatal exposure to BPA and children’s body mass index (BMI) as well as its trajectories, in a cohort study.

Methods We recruited pregnant women in their second trimester, between 2008 and 2011; their creatinine- adjusted urinary BPA levels were measured. In 2012-2016, we measured their children’s BPA levels, at ages 2, 4, and 6 years, and assessed the BMI values, z-scores, and prevalence of overweight (n = 202). Adiposity trajectories were determined in latent class mixed models. We assessed the association between prenatal mid-term exposure to BPA and postnatal exposure, at each age, and anthropometric measurements, at a single time point, at ages 2, 4, and 6 years. The relationship between prenatal exposure to BPA and adiposity trajectory, over multiple ages, was investigated through linear regression.

Results The association of prenatal and postnatal BPA concentrations with the anthropometric measurements, at a single time point, at 2, 4, and 6 years of age, were not statistically significant after controlling for covariates. However, the adiposity trajectories, over ages 2 to 6 years, were related with prenatal BPA concentrations. A 2-fold increase in prenatal BPA level was significantly associated with increasing adiposity trajectories, in early childhood, by 39.6% (95% confidence intervals: 2.2%, 90.7%).

Conclusions Adiposity trajectory, in early childhood, was affected by prenatal BPA exposure levels. The study provides supporting evidence on the transgenerational effects of BPA on children’s growth.

www.journalhealthpollution.org S61 180908 18-0098

Maternal Exposure to Particulate Matter During Early Pregnancy Affects Fetal Cardiac Abnormalities Youn-Hee Lim1, Sanghyuk Bae2, Ji-hoo Yook3, Hyun Joo Bae4, Yun-Chul Hong1,3

(1) Seoul National University, College of Medicine, Environmental Health Center, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Dankook University, Department of Preventive Medicine, Yongin, South Korea (3) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (4) Korea Environment Institute, Department of Environmental Health, Sejong City, South Korea

Corresponding author: Youn-Hee Lim Contact: Youn-Hee Lim, Tel: 010-2795-1777, E-mail: [email protected]

Background Few studies have used ultrasound measurements to assess particulate matter (PM) on fetal abnormalities. We examined the relationship between ambient particulate matter less than 10 um (PM10) and fetal abnormalities found by ultrasound at the 20-week among 2,710 mid-term pregnant women from an obstetrics and gynecology clinic.

Methods We used kriging models to estimate exposure to PM10 from conception to 20 week of pregnancy. We fitted logistic regression models to estimate odds ratios (OR) of having fetal abnormalities including musculoskeletal, nervous, cardiovascular, and urology system after controlling for maternal age, smoking, passive smoking, alcohol drinking, baby sex, multiple births, ultrasound fetal weight, gestational age at the ultrasound measurement, enrollment year, season, and temperature during pregnancy.

Results Exposure to PM10 from conception to 20 week of pregnancy was positively associated with cardiac abnormalities, OR: 1.37 (95% confidence intervals (CI), 1.12 – 1.66) per 1 ug/m3 increase in PM10. However, other fetal abnormalities did not show significant associations with PM10.

Conclusions Our results suggest an effect of exposure to PM from early pregnancy on fetal cardiac abnormalities.

S62 www.journalhealthpollution.org 180908 18-0003

Maternal Exposure to Particulate Air Pollution and Congenital Metabolic Disorders in Korea Youn-Hee Lim1, Changwoo Han1, Hyun Joo Bae1, Yun-Chul Hong1, Youn-Hee Lim1

(1) Seoul National University, College of Medicine, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Youn-Hee Lim Contact: Youn-Hee Lim, Tel: +82-10-2795-1777, E-mail: [email protected]

Background Previous studies suggested evidence for an effect of exposure to ambient air pollutants on risk of certain congenital heart and structural defects. However, few studies have investigated the effects of maternal exposure to particulate air pollution on metabolic defects. We estimated associations between congenital metabolic disorders and maternal exposure to particulate air pollution in Korea.

Methods Among 109,916 infants residing in 251 areas in 7 cities and 9 provinces in Korea, cases with congenital metabolic disorders (n=768) and controls with noninfective enteritis and colitis (n=784) at age 0 were selected from the National Health Insurance Cohort Data during 2007-2013. For each infant, we assigned 12-month mean of particulate matters less than 10 μg/m3 (PM10) prior to birth as a proxy of exposure to pregnant women based on the residential area. For each city and province, we estimated the PM10 effects on congenital metabolic disorders using logistic regression models after controlling for covariates such as sex, income, and year, and pooled the estimates to yield a national average for 2007- 2013.

Results Among the 16 cities and provinces, two provinces (Choong-nam and Cheon-buk) showed significant associations between maternal exposure to PM10 and CMD, odds ratio (OR): 1.10 (95% confidence intervals (95% CI), 1.00, 1.22) and 1.22 (95% CI, 1.01, 1.47), respectively. The national average estimate of PM10 effect was 1.03 (95% CI, 1.00 – 1.06).

Conclusions Our study contributes to the small body of knowledge regarding the associations between in utero exposure to particulate air pollution and congenital metabolic disorders, but confirmation of these associations will be needed in future studies.

S63 180908 www.journalhealthpollution.org 18-0153

Modeling of Indoor PM2.5 Concentration Using Machine Learning and Selected Indoor and Outdoor Environment Youn-Hee Lim1,2, Kyungshin Lee1,2, Yun-Chul Hong1,2,3

(1) Seoul National University, College of Medicine Environmental Health Center, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Seoul National University, College of Medicine, Institute of Environmental Medicine, Seoul, South Korea (3) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea

Corresponding author: Youn-Hee Lim Contact: Youn-Hee Lim, Tel: 010-2795-1777, E-mail: [email protected]

Background Concentration of indoor particulate matter 2.5 micrometers or less in diameter (PM2.5) may come from various sources such as ambient PM2.5 concentrations and use of appliances that produce dust at home. We aimed to model PM2.5 concentrations at home with indoor and outdoor environment using a machine learning approach.

Methods We recruited 4,468 pregnant women from August 2015 through February 2018, who participated in a multicenter prospective cohort study, the KoCHENS. As a pilot study, we included subsample of the KoCHENS participants with measured indoor and outdoor PM2.5 concentrations and completed questionnaires of indoor and outdoor environment. Of 489 participants, we modeled PM2.5 concentrations at home with various variables including mother’s characteristics (age and region), indoor environment (house type, remodeling, temperature and humidity at home, and appliances at home), and outdoor environment (ambient PM2.5 concentrations, environmental hazards, and traffic roads). We categorized indoor PM2.5 concentrations into two levels (low and high) based on various references (10, 20, 30, and 40 ug/m3) and used Random Forest to estimate the accuracy of prediction of PM2.5 concentrations.

Results Out of 31 variables, outdoor environments including ambient PM2.5 concentration and road traffic (road lanes, distance to road, and traffic volumes) were highly associated with indoor PM2.5 concentrations. Indoor environments including temperature and humidity at home, cooking ventilation, air purifier, and humidifier also contributed to indoor particulate matter concentration. Using significant variables, the accuracy of predictions models ranged from 0.64 (<10 ug/m3) to 0.89 (<30 ug/m3) depending on the reference values of PM2.5.

Conclusions This is a pilot study to predict indoor PM2.5 concentrations with indoor and outdoor environment factors. Further studies are needed with more information on indoor environment to enhance the model prediction.

S64 www.journalhealthpollution.org 180908 18-0018

Autism Spectrum Disorder Screening in General Japanese Toddlers Using M-CHAT: An Adjunct Study of the Japan Environment and Children’s Study Machiko Minatoya1,2, Keiko Yamazaki1,2, Sachiko Itoh1,2, Chihiro Miyashita1,2, Atsuko Araki1,2, Sumitaka Kobayashi1,2, Yu Ait Bamai1,2, Naomi Tamura1,2, Yoshiya Ito2,3, Reiko Kishi1,2 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan (2) Hokkaido University, Hokkaido Unit Center for Japan Environment, Sapporo, Japan (3) Japanese Red Cross Hokkaido College of Nursing Faculty of Nursing, Hokkaido, Japan

Corresponding author: Machiko Minatoya Contact: Machiko Minatoya, Tel: +81-11-706-4748, E-mail: [email protected]

Background Early Autism Spectrum Disorder (ASD) screening has the potential to reduce delays between initial parental concerns and diagnosis, and promote early intervention. The aim of this study was to screen ASD using Japanese version of Modified Checklist for Autism in Toddlers (M-CHAT) in the general population and find associated factors with suspected ASD.

Methods M-CHAT consists of 23 items targeting core symptoms of ASD in toddlers between 16 and 30 months. A toddler is screened positive on the M-CHAT if he/she failed any 3 items out of the 23 or if he/she failed 1 critical items out of the 10 that were defined in Japanese version of M-CHAT. Toddlers who screened positive were defined as suspected ASD. Japanese version of M-CHAT was distributed via mail as an adjunct study of the Japan Environment & Children’s Study (JECS) to 3569 mothers in Sapporo and Kitami area, Hokkaido from October 2014 to January 2017.

Result By the end of January 2017, 3065 mothers answered M-CHAT (response rate =85.9%) and we included 2794 valid responses into the statistical analysis. Among 2794 responses, 520 toddlers (18.6%) were categorized into suspected ASD. Comparison of maternal characteristics found that percentage of annual household income ≥ 600 million Japanese Yen was lower, percentages of maternal depression during 3rd trimester of pregnancy and maternal Autism-Spectrum Quotient (AQ) were higher among suspected ASD group compared to non-suspected group. For toddler characteristics, percentages of being a first born was higher in suspected ASD group.

Conclusions In conclusion, this study was the first study to target relatively large sample size (> 3000) in general Japanese toddlers for screening ASD using M-CHAT and examined associated factors of suspected ASD. Further study is needed to investigate other factors associated with ASD such as environmental chemical exposures and other exposures during pregnancy.

S65 180908 www.journalhealthpollution.org 18-0163

Update and the Recent Findings From the Hokkaido Study Machiko Minatoya1, Atsuko Araki1, Chihiro Miyashita1, Sachiko Itoh1, Sumitaka Kobayashi1, Keiko Yamazaki1, Yu Ait Bamai1, Ryu Miura1, Naomi Tamura1, Reiko Kishi1

(1) Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Machiko Minatoya Contact: Machiko Minatoya, Tel: +81-11-706-4748, E-mail: [email protected]

Background The Hokkaido Study on Environment and Children’s Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort (n=514) and the Hokkaido cohort (n=20,926). These two cohorts allow us to examine various outcomes including child growth, neurobehavioral development, allergy, and infectious diseases.

Methods In this presentation, we updated the progress of the Hokkaido Study, summarize the recent results. Among various recent findings from the study, we would like to focus on child neurobehavioral development in association with prenatal exposures to environmental chemicals such as perfluoroalkyl substances, pesticides, phthalates and bisphenol A. We also investigated child behavioral problems in association with pre- and postnatal socioeconomic and lifestyle factors including parental education, smoking and the results will be presented.

Results Overall, we found that exposure to certain environmental chemicals during early life as well as lower maternal education and family income during pregnancy and high pre-pregnancy maternal body mass index were found to be risk factors for child behavioral problems in later life. Parental smoking during pregnancy showed adverse impacts on child hyperactivity/inattention symptom (OR= 1.28, 95% CI 1.03, 1.59 for paternal, OR= 1.97, 95% CI: 1.33, 2.91 for maternal smoking). Additionally, we recently examined adipokines such as adiponectin and leptin, which secreted from adipose tissues and placenta in pregnancy and that were known to be important to modulate a number of metabolic processes. Inverse associations between phthalates and bisphenol A exposures during pregnancy and cord blood levels of leptin were found (β=-0.09, 95% CI: -0.16, -0.03 for ∑DEHP, β=-0.06, 95% CI: -0.11, -0.01 for bisphenol A). Moreover, increased cord blood leptin level was associated with decreased hyperactivity/ inattention risk at preschool age (OR=0.22, 95% CI: 0.06, 0.89).

Conclusions These findings suggested that adipokines may have key roles between environmental chemical exposures and neurobehavioral development of children.

S66 www.journalhealthpollution.org 180908 18-0013

Early Life Secondhand Smoke Exposure Assessed by Hair Nicotine Biomarker May Reduce Children’s Communication, Fine Motor and Problem Solving Skills at 2 Years of Age Hamid Jan Bin Jan Mohamed1, Nur Nadia Binti Mohamed2, See Ling Loy3, Poh Ying Lim4, Abdullah Al Mamun5 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Universiti Sains Malaysia, Nutrition and Dietetics Program, Penang, Malaysia (2) Universiti Sains Malaysia, Department of Community Medicine, Penang, Malaysia (3) KK Women’s and Children’s Hospital, Department of Reproductive Medicine, Kallang, Singapore (4) Universiti Putra Malaysia, Department of Community Health, Selangor, Malaysia (5) University of Queensland, Institute of Social Science Research, Brisbane, Australia

Corresponding author: Hamid Jan Bin Jan Mohamed Contact: Hamid Jan Bin Jan Mohamed, Tel: 60126456477, E-mail: [email protected]

Background Exposure to secondhand smoke (SHS) can affect fetal brain development as well as subsequent neurodevelopment. This study aimed to determine the association between prenatal and postnatal SHS exposure with children’s neurodevelopment at 2 years of age.

Methods Among 107 mother-child pairs from a Malaysia prospective cohort, prenatal and postnatal SHS exposure was determined based on maternal and child hair nicotine concentrations. The third version of the Ages and Stages Questionnaire (ASQ-3) was used to screen for and identify neurodevelopmental delay among children. Multiple linear regressions were used to determine the association between prenatal and postnatal levels of nicotine in maternal and children’s’ hair with children’s neurodevelopment.

Results After adjustment for confounders, prenatal nicotine concentration levels were negatively associated with communication (β=−2.059; p=0.015) and fine motor skills (β=−2.120; p=0.002) while postnatal nicotine concentration levels were inversely associated with fine motors (β=−0.124;p=0.004) and problem solving skills (β=−0.117;p=0.013).

Conclusions This study suggests that early life exposure to SHS may affect children’s neurodevelopment particularly communication, fine motor and problem solving skills.

This work was published in Science of the Total Environment in January 2018 and can be found here: https://doi.org/10.1016/j.scitotenv.2017.08.030

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S67 180908 www.journalhealthpollution.org

Environmental Exposure Assessment in Vulnerable Residential Area in Asia- Pacific Countries Jaean Lee1, Wookhee Choi1, Sanghoon Nam1, Dohyun Kim1, Kongkea Phan2, Enkhjargal Altangerel3, Daeseon Kim1, Chulwoo Lee1, Seungdo Yu1

(1) National Institute of Environmental Research, Environment Health Research Department, Incheon, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) International University, Faculty of Science and Technology, Phnom Penh, Cambodia (3) National Center for Environmental Health, Department for Environmental Health, Ulaanbaatar, Mongolia

Corresponding author: Sanghoon Nam Contact: Sanghoon Nam, Tel: +82-32-560-7122, E-mail: [email protected]

Background Upon the request from WHO after the designation of the WHO Collaborating Centre for Vulnerable Population and Environmental Health (2014), the National Institute of Environmental Research conducted environmental exposure assessment of residents in mining areas in developing countries in the Asia Pacific region.

Methods We selected mines in Mongolia and Cambodia, in which reckless mining development triggered environmental pollution. After signing the agreement on joint research with counterpart organizations in each country, we developed questionnaires and field survey plans in cooperation with local governments. Survey items were individual questionnaires and analysis of heavy metal concentrations (Cu, Pb, Cd, Hg and As) in bio-samples (blood, urine and hair) and environmental samples (water and soil).

Results In Cambodia, we surveyed Batheay City, northern parts of Phnom Phen, in which abandoned mines are located and Phnom Dek, in which artisanal and small scale gold mining (ASGM) is still in operation. According to the results, the As concentrations in soil were higher than those suggested by Agency for Toxic Substances and Disease Registry (ATSDR) in both areas. The Pb concentrations in blood were 3-7 times higher than the HMB value (Germany) and Hg concentrations in hair in children were higher than those in one of the highest lead emitting cities in China.

In Mongolia, we surveyed Tsogttsetsii mine and Oyu Tolgoi mine, national strategic mines near the Gobi desert in southern areas. The heavy metal concentrations in water were below the limit of quantitation. The Pb concentrations in blood were higher than the HMB value (Germany) and Hg concentrations in blood were relatively low in both adults and children. The As concentrations in water showed the difference in the two areas but no significant correlation.

S68 www.journalhealthpollution.org 180908 Conclusions This joint research on environmental exposures and health effects in vulnerable areas is expected to raise awareness of environmental health and enhance mutual research capacity, further contributing to promoting understanding of and resolving on-going environmental health issues which developing countries are facing with. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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TLR4 (rs1927911) Polymorphism Modifies the Association Between Exposure to Nitrogen Dioxide (NO2) During Pregnancy and Symptoms of Allergic Rhinitis in Korean Children Sun Ju Nam Goung1, Lee So-Yeon2, Kang Mi-Jin1, Kim Hyo-Bin4, Yang Song-I5,6, Cho Hyun-ju6, Leem Jong-Han7, Kim Hwan- Cheol8, Kwon Ho-Jang9, Hong Soo-Jong10

(1) University of Ulsan, College of Medicine, Environmental Health Center, Asan Medical Center, Ulsan, South Korea (2) University of Ulsan, College of Medicine Pediatric, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, Ulsan, South Korea (3) Inje University, Sanggye Paik Hospital, Pediatrics, Seoul, South Korea (4) Hallym University, Sacred Heart Hospital, Chuncheon, South Korea (5) Hallym University, College of Medicine, Pediatrics, Chuncheon, South Korea (6) International St. Mary’s Hospital, Catholic Kwandong University, Pediatrics, Incheon, South Korea (7) University, School of Medicine, Social and Preventive Medicine, Incheon, South Korea (8) Inha University, School of Medicine, Occupational and Environmental Medicine, Incheon, South Korea (9) Dankook University, College of Medicine, Preventive Medicine, Yongin, South Korea (10) University of Ulsan, College of Medicine, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, Pediatrics, Ulsan, South Korea

Corresponding author: Sun Ju Nam Goung Contact: Sun Ju Nam Goung, Tel: 010-3318-0536, E-mail: [email protected]

Background Mounting evidence suggests that exposure to traffic-related air pollutant (TRAP) is associated with the development of childhood allergic diseases. Toll-like receptor 4 (TLR4) plays a critical role in innate immunity and responses to pollution particles. However, none of the studies assessed the interaction between TRAP exposure during pregnancy and TLR4 gene on the risk of allergic rhinitis (AR) symptoms in children.

We investigated association between NO2 among TRAP and TLR4 polymorphism on AR in Korean elementary school children.

S69 180908 www.journalhealthpollution.org Method The study population consisted of 1,562 children from the Children’s Health and Environment Research (CHEER) study. Atopic AR was defined as having nasal symptoms within the last 12 months and 1 or more positive allergen responses on skin prick test. Exposure of TRAP were estimated using the calculated concentrations at land-use regression models based on national monitoring system genotyping of the TLR4 polymorphism, rs1927911 was performed using a TaqMan assay. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Results NO2 exposure during pregnancy was associated with an increased risk for atopic AR (aOR 1.62, 95% CI 1.12-2.36). Exposure to high NO2 during the first three years of life and the last two years have increased the risk of atopic AR in school children (aOR 1.54, 95% CI 1.04-2.27; aOR 1.53, 95% CI 1.03- 2.27, respectively). The highest risk of atopic AR was observed in children who were exposed to high concentrations of NO2 continuously from gestation to the first three years of life (aOR 1.90, 95% CI 1.29- 2.80). Children exposed to high concentrations of NO2 during pregnancy and the last two years have a higher risk of atopic AR than children exposed to low NO2 concentrations over the same period (aOR 2.08, 95% CI 1.36-3.19). We have also found polymorphism of TLR4 (rs1927911) interacted with NO2 exposure during pregnancy on childhood atopic AR (P for interaction = 0.04)

Conclusions Traffic-related air pollutant NO2 during pregnancy and childhood is associated with an increased risk of atopic AR. The effect of NO2 exposure during pregnancy on atopic AR can be modified by TLR4 polymorphism in children.

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Exploratory Study to Determine the Cotinine Cut-Off Value to Discriminate Between Second-Hand Smoke (SHS) and Smokers During Pregnancy Jongmin Oh1, Myeongjee Lee1, Seulbi Lee2, Shinhee Ye1, Yu Min Lee1, Eunhee Ha1

(1) Ewha Womans University, College of Medicine, Department of Occupational and Environmental Medicine, Seoul, South Korea (2) Ewha Womans University, College of Medicine, Department of Medical Sciences, Seoul, South Korea

Corresponding author: Jongmin Oh Contact: Jongmin Oh, Tel: 010-5636-5496, E-mail: [email protected]

Background In epidemiologic studies, secondhand smoke (SHS) and smoking status is generally measured by self- reported questionnaire and cotinine-level. However, self-reported smoking questionnaires were reported to be biased and cotinine cut-off value used for the general population may not appropriate for pregnant women. Hence, this study was designed to find the cut-off value of cotinine-levels between SHS oupgr and smoker group in pregnant women using questionnaire and cotinine level.

S70 www.journalhealthpollution.org 180908 Methods Raw data was taken through Mothers and Children’s Environmental Health (MOCEH) study. A total of 1751 pregnant women were enrolled between 2006 and 2010. We obtained information about smoking and SHS through questionnaires and urine cotinine levels. We excluded subjects without ID, biomarker or who did not answer the question ‘Have you ever smoked more than 400 cigarettes?’ By using questionnaires and cotinine values, we made various data sets by various definition of SHS and smoking

group, which we used for analyzing data, comparison and validity. The median differences of cotinine- Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 levels between smoker and SHS group were compared using the non-parametric test. The cut-off points were determined using the Receiver Operating Characteristics (ROC) curve with sensitivity and specificity.

Results Urine cotinine density of the SHS group and the smoker group were skewed to the right(skewness >0), therefore cotinine levels were not normally distributed. The distribution of smoking and SHS groups was somewhat overlapped. Most of median of cotinine-levels in early pregnancy (1.9-3.9) were lower than late stage of pregnancy (8-47). The optimal cut-off value of each of the study design varied between 3.5 and 40.1

Conclusions The cut-off value of cotinine between SHS and smoking in pregnant women is much lower than in general population. Therefore, in order to distinguish the SHS group from the smoking group in the pregnant women, we propose a new cotinine cut-off value different from that used in the general population.

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Seasonal Patterns of Fetal Growth and Air pollution in Ulaanbaatar, Mongolia Hilary Ong1, Samantha Hunter2, Colleen Azen2, Bat-Erdene Erdenedalai3, Otgonbaatar Jugder4, Bayalag Munkhuu5, David Warburton2

(1) Children’s National Medical, Center Division of Emergency Medicine, Washington, D.C., USA (2) Children’s Hospital Los Angeles, Department of Pediatrics, Los Angeles, CA, USA (3) National Center for Maternal and Child Health, Department of Radiology, Ulaanbaatar, Mongolia (4) National Center for Maternal and Child Health, Department of Obstetrics and Gynecology, Ulaanbaatar, Mongolia (5) National Center for Maternal and Child Health, Department of Pediatrics, Ulaanbaatar, Mongolia

Corresponding author: Hilary Ong Contact: Hilary Ong, Tel: (202) 476-4177, E-mail: [email protected]

Background Ulaanbaatar, capital city of Mongolia experiences one of the world’s most extreme seasonal variations in climate and air pollution levels. No study to date has examined the influence of these environmental

S71 180908 www.journalhealthpollution.org factors on fetal growth in Mongolia. This cross-sectional study examines whether there are seasonal variations in prenatal growth patterns on fetal ultrasound evaluations.

Methods We collected 4373 fetal ultrasounds from three antenatal care clinics in Ulaanbaatar city. Season of conception was grouped into Cold and Warm seasons. The impact of season of conception on second

and third trimester ultrasound Z-score measurements, including bi-parietal diameter (BPD), head Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 circumference (HC), abdominal circumference (AC) and femur length (FL), was assessed with two-way ANOVA with interaction at a 0.05 significance level. Cumulative ambient PM2.5 air pollution level over first trimester was calculated based on 5-year averaged monthly PM2.5 air quality data in Ulaanbaatar.

Results Third trimester FL Z-scores in Cold season (1.21 ± 0.84) were significantly larger (p<0.05) than in Warm season (0.97 ± 0.86). BPD Z-scores were smaller in Cold season (second trimester -0.69 ± 0.71; third trimester -1.02 ± 0.69) than in Warm season (second trimester -0.59 ± 0.63; third trimester -1.01 ± 0.85), and differences were statistically significant for both second (p< 0.01) and third trimesters (p<0.05). No differences in HC and AC Z-scores were detected. Mean cumulative PM 2.5 exposure in first trimester was higher for pregnancies conceived in winter (362.4 μg/m3) as compared to summer (137.6 μg/m3) seasons.

Conclusions We observed seasonal differences in fetal growth: bi-parietal diameter and femur length. Our data provide insight into effects on fetal growth across pregnancy when fetuses were conceived during cold, winter months with high air pollution levels. Further investigation is required to examine the gestational window of effect, especially in Ulaanbaatar city, one of the most air polluted cities in the world.

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Bridging Inequities in Childrens’ Health Promotion: Bangalore Model Elizabeth Cherian Paramesh1, Roshan Cherian Paramesh2, Rashmi Cherian Paramesh3

(1) Lakeside Center for Health Promotion, Bangalore, India (2) Lakeside Center for Health Promotion, Dentallium, Bangalore, India (3) Lakeside Center for Health Promotion, Department of Pediatrics Bangalore, India

Corresponding author: Elizabeth Cherian Paramesh Contact: Elizabeth Cherian Paramesh, Tel: +91 9945166887, E-mail: [email protected]

Background We aimed to promote community responsibility for children’s health with focus on healthy environment and to close the gaps in health care, education, and safe environment for children thereby ensuring a future healthy world.

S72 www.journalhealthpollution.org 180908 Children’s’ education rates are low in rural areas. Low socio economic status of rural families makes education unaffordable. Children are initiated into working with parents in construction work, agricultural labor, household work, thereby denying them the right to education. Nutritional deficiencies and resultant diseases are on the rise.

Poor ventilation, lack of electricity and use of agricultural waste for cooking in single room dwelling was

directly related to the high incidence rate of respiratory ailments and allergies. Poor hygienic practices Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 led to increased rate of infections. Poor menstrual hygiene and lack of awareness caused disruption in girl child education due to irregular attendance.

Methods We used field surveys by volunteers, questionnaire surveys for teachers, and regular health and nutritional assessment in six villages for a population of two hundred thousand .

Results E-learning kits in schools have created uniformity in learning. Hygiene education, provision of clean drinking water and midday meals in schools addressed issues of malnutrition and gastro intestinal infections. Solar lamps in schools/ homes has prevented the use of kerosene lamps and resulting respiratory ailments. Setting up of schools and providing necessary facilities has encouraged attendance. Sanitary napkin supplies in schools has encouraged girls to attend school. Self- responsibility for health and environment ensures sustained effectiveness of initiatives.

Conclusion Community specific intervention promotes health effectively. Collective and coordinated efforts of stake holders improved accessibility of health services and education.

Involving children and general population ensure sustainability. Planting saplings and greening the environment and other civic initiatives has improved living conditions of the population. Periodic Health camps and immunization ensures improved health care for children. Community support needs to be tailored to suit the local population. Follow up and continued research on childrens health is imperative.

S73 180908 www.journalhealthpollution.org 18-0076

Impact of Community Education and Social Determinants on Air Pollution in Controlling and Preventing Airway Diseases in Children Haralappa Paramesh1, Rashmi Cherian Paramesh2

(1) Lakeside Center for Health Promotion, Pediatric Pulmonology and Environmental Health, Bangalore, India Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Lakeside Center for Health Promotion, Department of Pediatrics, Bangalore, India

Corresponding author: Haralappa Paramesh Contact: Haralappa Paramesh, Tel: +91 9845022689, E-mail: [email protected]

Background Air pollution is a major risk factor and is responsible for 8 million deaths globally. Airway allergies are the global health epidemic where women and children suffer more. 50% of Indian cities are critically polluted and 13 of the world’s 20 worst cities are in India. It is imperative we need to clean our air pollution as a priority. We aim to find out the impact of our studies and educate society on children health and reduce air pollution

Methods The community was educated with scientific data through the press, social media, radio, TV, talks at schools, social clubs, service clubs and continuing education programs

Results Banning lead in petrol in 1999 is based on our lead poising study. Encouraged car-pooling, decrease use of private vehicles to drop children at school and one-way traffic reduced air pollution by 28%. Education on the dangers of burst fire crackers during festival of lights (Diwali) decreased ER visits for asthma. To combat indoor air pollution, we encouraged commercial cooking fuel, solar heating, use of biomass gas in rural areas and good cross-ventilated in homes. Ill effect of tobacco smoke brought legislation to ban tobacco smoking is public places in 2001. Rapid urbanization and change in demography of our cities resulted in increased airway allergies. We recommend a committee appointed to clean up mega cities. We advocate policy makers to allocate more funds for prevention and research. We suggest creating a training module for doctors for cost containment. Indoor air pollutants can be maintained through increased greenery and keeping indoor plants as a natural air cleaner.

Conclusions The encouraging impact of our efforts should continue in quality education, egulationr of automobiles, discourage use of fossil fuel and making cities sustainable through increase greeneries and reducing population growth

S74 www.journalhealthpollution.org 180908 18-0066

Time Series Analysis of Incidence of Asthma Before and After Discontinued Sales of Humidifier Disinfectant Chorong Park1, Yunsun Kim1, Sangyoung Kim1, Sungho Won2, Soo-Jong Hong3, Hyeon-Jong Yang1,4

(1) Soonchunhyang University Hospital, SCH Biomedical Informatics Research Unit, Seoul, South Korea Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Seoul National University, Institute of Health and Environment, Department of Public Health Science, Interdisciplinary Program of Bioinformatics, Seoul, South Korea (3) University of Ulsan, College of Medicine, Asan Medical Center, Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Ulsan, South Korea (4) Soonchunhyang University Hospital, College of Medicine, Pediatric Allergy and Respiratory Center, Department of Pediatrics, Seoul, South Korea

Corresponding author: Chorong Park Contact: Chorong Park, Tel: 82-10-9076-5727, E-mail: [email protected]

Background The association between humidifier disinfectants (HDs) and children’s interstitial lung disease (ILD) were firstly recognized on 2011, thereafter over 2,000 persons were identified as HDs victims. On November 11, 2011, HDs were permanently banned in South Korea. Asthma has become one of the major diseases appealed by victims. The study aimed to investigate the change of the incidence and prevalence of asthma in the nation-wide level, and to analyze the policy effect of stopping sales of HDs.

Methods We conducted a nationwide, population-based, retrospective birth cohort study using data from Health Insurance Review and Assessment (HIRA). Children under 6 years of age between 2008 to 2015 in Korea, were included and reviewed through the end of 2015. The primary outcome was the time-trends of asthma-prevalence, and comparison of asthma-related health-outcomes before and after the sales ban of HDs. We defined asthma (J45, 46), using KCD-5, 6

Results We analyzed 817,809 children with asthma between 2008 and 2015. After the sales ban of HDs, prevalence of asthma has decreased by 21% (95% CI : -30.1% to -10.6%) compared to before. Asthma hospitalization and ER visits also decreased by 10.8% (95% CI; -12.8% to -8.9%) and 17.1% (95% CI; -21.8% to -12.1%). The hazard ratio of 2012 births with asthma was significantly lower than births during HDs sale period (HR; 0.71, 95% CI; 0.69 to 0.73).

Conclusions We concluded that the incidence of asthma in children have dramatically been reduced by policy implementation. However, it might be impossible to judge the independent policy effect of the ban of HDs because various health-care polices have been implemented at the same time. Further research needs to confirm the causal pathway between HDs and respiratory diseases in children. This research was supported by the Environmental Health Center for Hazardous Chemical Exposure funded by Ministry of Environment Republic of Korea (2017).

S75 180908 www.journalhealthpollution.org 18-0102

A Longitudinal Study of Children’s Lung Function Over 10 Years After the Exposure to Volatile Organic Compounds from the Hebei Spirit Oil Spill

Myung-Sook Park1, Kyung-Hwa Choi1, Seung-Hwa Lee1, Jong-Il Hur1, Mina Ha2, Hae-Kwan Cheong3 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Taean Environmental Health Center, Taean, South Korea (2) Dankook University, College of Medicine, Department of Preventive Medicine, Cheonan, Korea (3) Sungkyunkwan University, School of Medicine, Department of Social and Preventive Medicine, Seoul, South Korea

Corresponding author: Myung-Sook Park Contact: Myung-Sook Park, Tel: +82-41-671-5324, E-mail: [email protected]

Background The Hebei Spirit oil spill (HSOS) spilled 12,547 kl of crude oil in the western coast of the Korean peninsula on December 7th 2007. This study aimed to investigate long-term effects of lung function after exposure to volatile organic compounds (VOCs) exposure from the oil spill through a longitudinal study.

Methods We conducted a long-term follow-up surveillance in every two years from 2009 to 2017. Initial VOCs concentration were estimated with a modeling in the residential areas and schools of the children from December 7th to 31th, 2007. The study subjects were 80 elementary school students (41 boys and 39 girls) who participated all surveys (1st-5th) and have information of lung function test (PFT) and VOCs estimation from the HSOS survey. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC were measured by the PFT. Cumulative VOCs concentration of each home and school were divided into quartiles and classified of two groups: high exposure group (≥ Q3) and low exposure group (< Q3). Least squared mean (LSM) were estimated using linear regression model adjusted for age, gender, second-hand smoking, and parental allergy history.

Results Medians (Q1-Q3) of VOCs concentration were 19407.4 (17023.5 – 41874.6) mg/m3 in residential area and 19192.8 (17942.4 – 44156.0) mg/m3 in school. FVC, FEV1, and FEV1/FVC were significantly lower in the high exposure group compared to the low exposure group until 5 years after the oil spill in both school and residential area; LSM (SE) % of FEV1/FVC were 83.1 (1.5) and 88.1 (0.9) in residential area and 83.6 (1.5) and 87.9 (0.9) in school for the high exposure group and the low exposure group, respectively. However, no significant difference in lung function 7 to 9 years after the oil spill.

Conclusion VOCs exposure was adversely associated with children’s lung function after the HSOS, which lasted until five years after the exposure with subsequent restoration of the lung function.

S76 www.journalhealthpollution.org 180908 18-0061

Organizing for Climate Change Education and Advocacy Jerome A Paulson1

(1) George Washington University, Milken Institute School of Public Health Environmental and Occupational Health,

Washington, D.C., USA Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Corresponding author: Jerome A Paulson Contact: Jerome A Paulson, Tel: + 1-202-302-9012, E-mail: [email protected]

Background Climate change is the most important health problem in the world. In the US, the topic has been controversial; and medical organizations, being generally conservative, did not engage in the topic until relatively recently. The American Academy of Pediatrics (AAP), in 2007, was the first medical professional organization to develop a policy on climate change. The AAP revised that policy in 2015; and in the same year several other medical societies also developed policy statements. Subsequently, the Medical Society Consortium on Climate and Health was created. All of these organizations are involved in the education of their members and the public; and all of the organizations are involved in advocacy. The purpose of this presentation is to describe the development of this effort in the US and to seek international partnerships.

Methods The author will describe the evolution of engagement in climate change activities among medical organizations in the US. Some details will be provided about the development and content of the climate change programs in the American Academy of Pediatrics, where the author has a first hand role, in the American Collage of Physicians, and in other organizations. He will then describe the development of the Medical Society Consortium for Climate and Health, where he has a first hand role, which now includes 20 member groups representing over 500,000 members. There are also 26 other affiliated organizations. The author will describe the educational programs of some of the individual groups as well as the Consortium. The author will then describe the public policy advocacy of the various groups. The development of several state-level Clinicians for Climate Action groups that have evolved to work at the level of the individual states in the US will also be described.

Results There is now a robust system for recruiting physicians, and other health care professionals, to become personally engaged in climate change-related activities. These professionals are educated about the impacts of climate change on their personal lives, on the management of their practices, and on the health of their patients. These professionals are then equipped to educate their peers, their patients, and the general public about the health impacts related to climate change. These professionals are now equipped to educate their political representatives about these issues as well.

Conclusions This system is ready to grow to incorporate organizations and individuals outside of the US.

S77 180908 www.journalhealthpollution.org 18-0113

Correlates of Maternal Diet During Pregnancy Kinga Polanska1, Elzbieta Trafalska2, Pawel Kaluzny1, Ewelina Wesolowska1, Agnieszka Jankowska1, Gemma Calamandrei3, Wojciech Hanke1

(1) Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Lodz, Poland Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (2) Medical University of Lodz, Department of Hygiene and Epidemiology, Lodz, Poland (3) National Institute of Health, Center for Behavioral Sciences and Mental Health, Rome, Italy

Corresponding author: Kinga Polanska Contact: Kinga Polanska, Tel: +48 42 6314 569, E-mail: [email protected]

Background Looking at overall diet quality, through dietary patterns, is believed to represent a valid and meaningful measure of overall nutrient intake and is a promising approach when aiming to study diet related associations. The aim of the study was to evaluate the correlates of maternal diet during pregnancy.

Methods The analysis is based on data from Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy 1318 women filled in Food Frequency Questionnaire (FFQ). In FFQ the women were asked to report how often, on average, they consumed specified amounts of each food. The selected frequency category for each food item was converted to daily intake. Based on factor analysis two dietary patterns were identified. ‘Healthy dietary pattern’ was characterized by high intake of fish, chicken, whole grains, fruit and vegetables while ‘unhealthily dietary pattern’ was related to high intakes of processed food, high-fat dairy, refined grains and sweets.

Results ‘Healthy dietary pattern’ was represented more frequently by older (p=0.05), married women (p=0.03) and these declaring higher level of education (p≤0.001) and socio-economic status (p=0.01). In the group of women that could be classified based on body mass index as overweight or obese (≥25kg/m2) 23% represented ‘unhealthy’ and 37% ‘healthy’ style of eating (p=0.001). Pregnancy weight gain was not significant correlate of maternal diet (p=0.3). Women who were classified as smokers during pregnancy more frequently report ‘unhealthy dietary pattern’ than non-smokers (p=0.02).

Conclusions The study results highlight the need for educational programs and interventions focused on healthy diet quality during pregnancy.

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Impact of Micronutrients During Pregnancy on Children’s Health and Neurodevelopment Kinga Polanska1, Wojciech Hanke1, Jolanta Gromadzinska2, Beata Janasik2, Wojciech Wasowicz2, Joanna Jerzynska3, Iwona Stelmach3, Fiorino Mirabella4, Flavia Chiarotti4, Gemma Calamandrei4 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

(1) Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Lodz, Poland (2) Nofer Institute of Occupational Medicine, Department of Biological and Environmental Monitoring, Lodz, Poland (3) Medical University of Lodz, Department of Pediatrics and Allergy, Lodz, Poland (4) National Institute of Health, Center for Behavioral Sciences and Mental Health, Rome, Italy

Corresponding author: Kinga Polanska Contact: Kinga Polanska, Tel: +48 42 6314 569, E-mail: [email protected]

Background Studies on the impact of micronutrient levels during different pregnancy periods on child health and psychomotor functions are limited. The aim of this study was to evaluate the association between maternal plasma concentrations of copper (Cu), zinc (Zn), selenium (Se), and child health and neuropsychological development.

Methods The study population consisted of 539 mother-child pairs from Polish Mother and Child Cohort (REPRO_ PL). The analysis has been done under HEALS project (603946). The micronutrient levels were measured in each trimester of pregnancy and in the cord blood. Children’s health (atopic dermatitis, food allergy, wheezing) and psychomotor development (Bayley Scales of Infant and Toddler Development) were assessed at the age of 1 and 2 years.

Results The mean plasma Zn, Cu and Se concentrations were 0.9±0.3mg/l, 2.0±0.6mg/l and 48.4±10.5ug/l (in the 1st trimester) and 1.1±0.3mg/l, 0.6±0.3mg/l and 31.1±8.2ug/l (in cord blood), respectively. Higher Zn and Cu concentrations in cord blood were associated with increased likelihood of wheezing in 1-year- old children. This effect was seen only among children exposed to tobacco smoke. In multivariate regression models there were no statistically significant associations between Se levels and the risk of allergy and Cu levels and any of the analyzed domains of child development. A positive association was observed between Se level in the 1st trimester of pregnancy and child language and motor skills at one year of age. Motor score among one-year-old children decreased along with increasing Zn levels in the 1st trimester of pregnancy and in the cord blood. A similar pattern was observed for the association between Zn level in the 1st trimester of pregnancy and language abilities at one year of age.

Conclusions Further epidemiological and preclinical studies are necessary to confirm the associations between micronutrient levels and child health and development as well as to elucidate the underlying mechanisms of their effects.

S79 180908 www.journalhealthpollution.org 18-0111

Concentrations of Phthalate Metabolites in Children from Poland Kinga Polanska1, Mercè Garí2, Wojciech Hanke1, Holger M Koch3, Claudia Claudia Pälmke3, Stephan Bose-O’Reilly2

(1) Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Lodz, Poland

(2) University Hospital Munich, Institute for Occupational, Social and Environmental Medicine, Munich, Germany Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (3) Institute of the Ruhr-Universität Bochum, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany

Corresponding author: Kinga Polanska Contact: Kinga Polanska, Tel: +48 42 6314 569, E-mail: [email protected]

Background Endocrine disrupting chemicals (EDCs) represent a growing public health concern. This is the case of many phthalates, a group of widely used chemicals that affect the hormonal balance in both children and adults. Furthermore, there are critical life stages in which exposures to phthalates may pose an increased risk, such as the developing foetus and the early childhood. The aim of this study was to determine urinary levels of phthalate metabolites in early school children in Poland and compare these results with those observed in other European countries.

Methods The exposure to 11 phthalates was determined by measuring 21 phthalate metabolites in urine of 7-year old children from the Polish Mother and Child Cohort Study (REPRO_PL, n=250, samples collected in 2014-2017), which is the most extensive set of phthalate metabolites ever determined for Poland. Urine sample analyses were performed using on-line high performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) using internal isotope-labelled standards.

Results The highest geometric mean concentrations were found in primary monoester metabolites of di-iso- butyl, di-n-butyl and diethyl phthalate, as follows: 75.7 µg/g for MiBP (111.4 µg/g creatinine); 53.9 µg/g for MnBP (79.6 µg/g creatinine) and 42.7 µg/g for MEP (64.4 µg/g creatinine), respectively.

Conclusions These levels are similar to those found in previous studies performed in Poland, but higher than those from other European populations (Den Hond et al., 2015). The levels of DEHP metabolites in the present study were similar to those observed among children in comparable age from Slovakia but slightly higher than those from Czech Republic and Hungary (Cerná et al., 2015).

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GIS Based Evaluation of Environmental Indicators on Children Health in Turkey Ahmet Ozgur Dogru1, Asli Kahraman2, Dursun Zafer Seker1, Nuket Sivri3

(1) Istanbul Technical University, Department of Geomatics Engineering, Istanbul, Turkey

(2) Istanbul Technical University, Informatics Institute, Istanbul, Turkey Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 (3) Istanbul University, Department of Environmental Engineering, Istanbul, Turkey

Corresponding author: Dursun Zafer Seker Contact: Dursun Zafer Seker, Tel: 00 90 533 3503483, E-mail: [email protected]

Background According to the World Health Organization, basic elements considered as social determinants of the health varies in political, socio-economic, structural and intermediary contexts. Socio-economic and political determinants are directly related with the country-wide; social, economic, public and health policies, structural context including socio-economic dimensions such as income, education, occupation, social class, gender and race/ethnicity. In addition to these determinants, the public, in particularly children health, is also affected by intermediary determinants such as material circumstances including: physical environment, such as housing, consumption potential (i.e. healthy foods, proper clothing etc.) and the physical working and neighborhood environments. Existing experiences show that children who grow up on low socioeconomic conditions or on inappropriate environmental conditions tend to become sick more than the others. Additionally, it is proved that the general structure of urban areas shapes children’s health; physical problems from the built environment are self-evident, mental health problems are relate as well, particularly from inadequate housing and poor urban development plans. Therefore it is important that these plans are made to support children’s health, or they should be rearranged in this context.

Methods The first part of the study aims to outline a general overview of the existing situation in urkeyT by investigating the relationship between socio-economic conditions and children health. For this purpose, province based spatial analysis were performed using the data including social and economic structure of the populations living in the provinces in Turkey and infant and children mortality statistics of the same years. Geographic Information Systems (GIS) was applied as basic technology for the implementation and the Turkish Statistical Institute and Turkish Ministry of Health officially provided the data.

Results As a result of the spatial analysis a correlation between socio-economic conditions and infant mortality were introduced. Based on the produced GIS maps, the provinces with higher mortality rates were populated at the eastern part of the country where socio-economic conditions are lower. The second part of the study focused on the existing development plans in Istanbul, which is the largest city in Europe with the population of 15 million. In this context, development plans of some districts in Istanbul have been examined comparatively by taking into consideration the environmental parameters affecting

S81 180908 www.journalhealthpollution.org children health. At this stage, the distribution of green areas, parks and gardens within the district and the percentage of area and accessibility, the sufficiency and accessibility of educational institutions such as schools and kindergartens have been evaluated utilizing spatial analysis capabilities of GIS.

Conclusions The results of the district based analysis were provided in the study and policies for improving existing

cities in terms of children’s health conditions should be further discussed in order to provide a wider Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 vision to decision makers of the cities.

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Assessment of Airborne Bacterial and Fungal Concentrations in Primary Schools Utilizing GIS Nuket Sivri1, Ahmet Ozgur Dogru2, Arzu Funda Bagcigil3, Kemal Metiner1, Dursun Zafer Seker2

(1) Istanbul University, Department of Environmental Engineering, Istanbul, Turkey (2) Istanbul Technical University, Department of Geomatics Engineering, Istanbul, Turkey (3) Istanbul University, Department of Microbiology, Istanbul, Turkey

Corresponding author: Dursun Zafer Seker Contact: Dursun Zafer Seker, Tel: 00 90 533 3503483, E-mail: [email protected]

Background Indoor air pollution is considered as one of the determinants contributing the burden of disease at a global level. Indoor air pollution is among the worst threats not only to adults but also to children’s health. It causes several diseases varying from impairment of pulmonary function to chronic obstructive lung diseases, including asthma. The presence and concentration of airborne bacteria may be related to the number of school students and activity of the students, to dilution ventilation efficiency, or to the school building itself. The concentration of airborne bacteria, if contributed by the students of the school, may also be used as a surrogate to estimate the probability of the spread of infectious agents.

In this study, a survey of different components of primary schools within İstanbul was undertaken to determine indoor airborne bacterial and fungal concentrations. Determinants of exposure were grouped into environmental (temperature, relative humidity, season), ventilation and comfort parameter (indoor relative humidity (RH), temperature, indoor fungal concentration), and occupancy (number of students, activity levels) variables.

Methods The National Institute of Occupational Safety and Health (NIOSH) Method–0800 “Bioaerosol Sampling (Indoor Air)” was used to evaluate the samples and for bacteriological evaluations, and the Microbial Air Monitoring Sampl’airTM was used to collect samples. For the detection of the concentration of culturable airborne bacteria, total staphylococci Plate Count Agar (PCA), Mannitol Salt Agar (MSA),

S82 www.journalhealthpollution.org 180908 plates were used, respectively. Plates were incubated for 24-48 hours at 37 ̊C. After the incubation, colonies were counted and culturable airborne bacteria (CAB) concentrations CFU/m3 (Colony Forming Units per cubic meter of air) were calculated according to Feller Correction Table. For detection of fungi concentrations, Potato Dextrose Agar (PDA) was used. The point sourced survey results were visualized using Geographic Information System (GIS) Technology. In this context 3D visualization of the indoor air pollution (IAP) were performed by estimating the IAP values of each points in the indoor environment

by using proper interpolation techniques. As the IAP were estimated and visualized in 3D, it provides Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 better understanding of distribution and propagation of indoor microbial pollution. Therefore, the use of Geoinformation technologies in estimation and visualization of IAP will facilitate the measures to be taken to prevent IAP in school for improving the children health conditions.

Results General results showed that concentrations and size distributions of airborne bacteria and fungi varied in various indoor environments due to the appearance of different indoor points and human occupancy. An interesting finding, concentration of airborne bacteria and fungi in classrooms showed higher concentrations than those of common areas. Due to their commitment to technological devices such as mobile phones and tablets, students do not leave the classroom unless they have an urgent need for breaks. This situation is the most important factor in increasing concentrations. Similar seasonal variations of airborne fungal concentrations were observed for all indoor environments. Another important finding was that the highest mean concentration of airborne bacteria and fungi were found in the classrooms, followed by the canteen and dining room, and the lowest concentration in senior staff room. Indoor temperature showed more significant correlation with airborne bacteria and fungi concentrations than RH in all indoor environments. Regression modeling was used to evaluate the association between these factors and measured concentrations of indoor mesophilic bacteria. Analysis of bacterial groups indicated various sources of the bacterial aerosol, with micrococci and staphylococci closely associated with occupancy variables.

Conclusions Indoor air quality should be regularly checked, especially around children, where there is a collective presence and where they spend time, such as schools, nurseries and etc. Additionally, precautions should be taken to reduce potential microbiological pollutant factors in these types of environments.

S83 180908 www.journalhealthpollution.org 18-0105

Peripubertal serum dioxins and subsequent adult semen quality and sperm methylome in the prospective Russian Children’s Study Oleg Sergeyev1,2, Lidia Mínguez-Alarcón3, Alex Shershebnev4, Yulia Medvedeva5, Alexander Suvorov4, Haotian Wu4, Andrey Goltsov6, Evgeny Loukianov7, Tatiana Andreeva7, Fedor Gusev7, Andrey Manakhov7, Luidmila Smigulina2, Maria Logacheva1, Victoria Shtratnikova1, Irina Kuznetsova7, Peter Speranskiy-Podobed7, Jane S. Burns3, Paige L. Williams3, Susan Korrick3, Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Mary M. Lee8, Evgeny Rogaev7, J. Richard Pilsner4, Russ Hauser3

(1) Moscow State University, A.N. Belozersky Research Institute of Physico-Chemical Biology, Moscow, Russia (2) Chapaevsk Medical Association, Chapaevsk, Russia (3) Harvard T.H. Chan School of Public Health, Boston, MA, USA (4) University of Massachusetts, Amherst, MA, USA (5) Institute of Bioengineering Research Center of Biotechnology, Russian Academy of Sciences, Moscow, Russia (6) Ministry of Healthcare of the Russian Federation, Federal State Budget Institution, Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia (7) Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia (8) University of Massachusetts, Medical School, Worcester, MA, USA

Corresponding author: Oleg Sergeyev Contact: Oleg Sergeyev, Tel: +79277465369, E-mail: [email protected]

Background Exposures to endocrine disrupting chemicals during critical windows of testicular development and spermatogenesis may be related to poorer semen parameters and altered sperm DNA methylation. We evaluated the association of peripubertal 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) concentration with semen parameters and sperm epigenetic markers.

Methods The Russian Children’s Study is a prospective cohort of 516 boys who were enrolled at 8-9 years of age and provided blood samples for analysis for TCDD. Subjects who reached sexual maturity and were at least 18 years of age were invited to provide two semen samples approximately one week apart. Among these, 133 young men provided 256 samples, which were analyzed for volume, sperm concentration, and motility. Whole-genome bisulfite sequencing of sperm was conducted to identify differentially methylated regions (DMR) between groups of selected subjects with highest (n=4, 95th -99th percentiles) and lowest (n=4, level below limit of detection) peripubertal serum TCDD concentrations.

Results The median (range) for TCDD was 2.9 (0.4-12.1) pg/g lipid. The highest quartile of peripubertal serum TCDD concentrations was associated with a decrease (95% CI) of 40% (18, 66%), 29% (3, 64%), and 30% (2, 70%) in sperm concentration, total sperm count, and total motile sperm count, respectively, compared with the lowest quartile. The mean (SD) methylation across all CpG sites was significantly lower in the selected highest peripubertal serum TCDD group compared to the selected lowest group

S84 www.journalhealthpollution.org 180908 (49.1 ± 4.9% and 61.9 ± 5.2%, respectively; t-test, p = 0.01). We found 52 differentially methylated regions (DMRs) that distinguished two serum TCDD groups. One of the top scoring networks, “Cellular Assembly and Organization, Cellular Function and Maintenance, Carbohydrate Metabolism”, identified estrogen receptor alpha (ESR1) as its central regulator.

Conclusions

Our study is the first to suggest that peripubertal environmental exposures may be associated with Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 subsequent poorer semen parameters and sperm methylation profiles in young adults.

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Factors Associated with Prenatal Heavy Metals Concentration in Mothers of Ko-CHENS Surabhi Shah1, Eunhee Ha1, Shin Hee Ye1, Yu Min Lee1, Eun Mi Jung1, Eun Kyo Park1

(1) Ewha Womans University, College of Medicine, Department of Occupational and Environmental Medicine, Seoul, South Korea

Corresponding author: Surabhi Shah Contact: Surabhi Shah, Tel: 010-2888-5847, E-mail: [email protected]

Background Prenatal lead, mercury and cadmium exposure is associated with interfering children’s cognitive abilities, physical growth, heme synthesis, gastro-intestinal, cardio-vascular system and kidney function. Prenatal heavy metals exposure, even in small amount can affect the postnatal growth of children. Thus, it is necessary to understand and know the factors that affect prenatal heavy metals: lead, mercury and cadmium concentration. In this study we explored the factors associated and affecting prenatal lead, mercury and cadmium concentration.

Methods The Korea children’s environmental health study (Ko-CHENS) is a prospective birth cohort study in Korea. A total of 3574 eligible participants were included in the analysis. Prenatal heavy metal concentrations were log transformed due to their non-normal distribution at early pregnancy, late pregnancy and from cord blood. Linear model analysis was done to explore the maternal environmental, dietary and lifestyle factors affecting prenatal heavy metals concentration at early pregnancy, late pregnancy and from cord blood.

Results We found that late prenatal lead concentration was marginally (p-value<0.10) associated in pregnant women who reside near roads. Intake of white, blue, shell and big fish more than 3 times/week were significantly associated with increased prenatal mercury concentrations. Early pregnancy cadmium concentration was significantly associated with secondhand smoke exposure.

S85 180908 www.journalhealthpollution.org Conclusion Late pregnancy lead concentration was associated with the residence of pregnant women near roads. Prenatal mercury concentration was positively associated with intake of contaminated white, blue, shell and big fish. Second-hand smoke exposure in pregnant women was observed to be significantly associated with early pregnancy blood cadmium concentration. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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A 5-Year Trend in the Prevalence of Attention-Deficit/Hyperactivity Disorder in Children Jiyoung Shin1, Jueun Lee2, Eui-jung Kim3, Eunhee Ha1

(1) Ewha Womans University, Public Health, College of Medicine, Department of Occupational and Environmental Medicine, Seoul, South Korea (2) National Institute of Environmental Research, Environmental Health Research Department, Incheon, South Korea (3) Ewha Womans University, College of Medicine, Department of Psychiatry, Seoul, South Korea

Corresponding author: Jiyoung Shin Contact: Jiyoung Shin, E-mail: [email protected]

Background Although the symptoms of pervasive development disorders and ADHD in children often overlap, pervasive developmental disorders and attention-deficit/hyperactivity disorder should be diagnosed individually according to the current Diagnostic and Statistical Manual of Mental Disorders-IV. This study was designed to investigate the trends and prevalence of attention-deficit/hyperactivity disorder (ADHD) in children.

Methods The annual number of ADHD patient was obtained by using the cohort database during 2009-2013 provided by National Health Insurance Serve-National Sample Cohort in Korea. Patients over 20 years old were excluded. The number of patients was estimated by the sex of children, age group and income level. Prevalence of diseases for each year was compared.

Results The prevalence of ADHD is 0.69%, 0.66%, 0.72%, 0.74% and 0.70% from 2009 to 2013. Prevalence of ADHD in male is higher than female in children. Prevalence of ADHD in high income group is higher than the prevalence of moderate income group.

Conclusions In this cohort study, ADHD are more prevalent in male children than female. Children aged 5-14 have higher prevalence of ADHD than any other age group of children under 20 years old. National Sample Cohort data in Korea is more useful to estimate the prevalence of disease than patient’s self-reported data.

S86 www.journalhealthpollution.org 180908 18-0016

Assessment of Respirable Suspended Particulate Matter (PM2.5) in Indian Urban Schools Pratima Singh1, Renu Arora1, Radha Goyal2

(1) University of Delhi, Department of Resource Management and Design Application, Institute of Home Economics, New Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Delhi, India (2) Indian Pollution Control Association, New Delhi, India

Corresponding author: Pratima Singh Contact: Pratima Singh, Tel: 9711600550, E-mail: [email protected]

Background According to World Energy Outlook’s special report, nearly 80% of the urban population is breathing air that does not comply with the WHO (World Health Organization) air quality guidelines. Fine particles like PM2.5 can travel deep into lungs and cause harmful effects to human health; especially to sensitive groups like children and elderly. We carried out a study in schools located in Delhi, recognizing the acute problem of air pollution in urban areas and assessed indoor concentrations of PM2.5 and its effect on students’ health. The research focused on studying the effects of class occupancy, classroom ventilation type and different seasons on the indoor PM2.5.

Methods Two air-conditioned (AC) and two naturally ventilated (NV) schools of Delhi were selected for the study. Monitoring of PM2.5 was carried out using the ‘TSI-DustTrak™ II Aerosol Monitor-8530’, in non-winter and winter seasons. The readings were taken at 5 minutes interval on a complete working day. In addition, weather conditions like rain or wind and other relevant classroom observations were also made. The health exposure of students was assessed using a sick building syndrome (SBS) checklist.

Results The concentrations of PM2.5 in NV schools were higher than that in AC schools because of greater infiltration of outdoor pollutants and extensive usage of chalkboards. PM2.5 in winter season was visibly higher than that in the non-winter season in all the selected schools. In both the seasons, the mean values of PM2.5 of all schools exceeded the WHO standard of 25µg/m³ by approximately 1.5 to 2 times in the non-winter season and 6 to 12 times in winter season. The results from the study also highlighted that students’ health was vulnerable inside schools as they experienced the prevalence of a number of SBS symptoms inside their classrooms.

Conclusions Based on the results, it is inferred that different seasons; classroom activities; opening and closing of doors and windows; and ventilation type (AC or NV) played an important role on the concentrations of PM2.5 inside the classrooms. Influence of climatic conditions and outdoor emissions was also evident on elevated PM2.5 levels. The school in urban areas experienced high particulate pollution exposing

S87 180908 www.journalhealthpollution.org students to the unhealthy learning environments. The results thus highlighted that the poor state of school environment and vulnerability of students to their indoor environment, which may negatively affect their health. Based on the results, schools are suggested to adopt some mitigation strategies to limit students’ health exposure to high particulate pollution.

18-0009 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Occupational Risk Perceptions and Behavior Towards Health Risk Exposures, Personal Protective Equipment and Health-Seeking Among Artisanal and Small-Scale Gold Miners in Bornuur Soum, Mongolia Josephine Singo1

(1) University of London, International Programs London School of Hygiene and Tropical Medicine, London, United Kingdom

Corresponding author: Josephine Singo Contact: Josephine Singo, Tel: +256 770 833664, E-mail: [email protected]

Background The aim of this study was to better understand occupational risk perceptions and reported behavior towards occupational health risk exposures, personal protective equipment (PPE) and health-seeking among Artisanal and Small-scale Gold Miners (ASGM) in Bornuur.

Methods Qualitative data was collected in Mongolian language at Bornuur Soum Center through focus group discussion with six female and five male miners and three in-depth interviews with two doctors and one nurse.

Results According to our interviews, dust and injuries were rated higher than mercury in terms of high-risk. Miners acknowledged the occurrences of sicknesses and stigmatization related to ASGM, and correctly identified the causes of occupational diseases in ASGM. Protective clothing was identified as important while the use of protective clothing was regarded as low partly due to perceptions. Delayed health seeking behavior was common especially among the male miners. Most miners preferred the Aimag Hospital to the Local Soum Hospital for confidentiality and better services. Health security insurance registration was rare among the ASGM miners. The perceptions were shaped by the broad socio- economic factors.

Conclusions The ASGM miners were knowledgeable on occupational health risks in ASGM and the associated health impacts. The perceptions and the behavior towards risk exposures, use of PPE and behavior seeking were both positive and negative. Health intervention programs could mainstream children for

S88 www.journalhealthpollution.org 180908 occupational health education on risk exposures, use of PPE and early behavior seeking to empower future ASGM communities thereby addressing the negative perceptions while strengthening the positive perceptions. Child Health programs from organizations such as United Nations Children’s Fund (UNICEF) could also be extended to children in marginalized communities. Policy makers could also include health needs of children in ASGM communities when addressing the broad determinants of health in ASGM.

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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The Prevalence of and Factors Associated with Lead Exposure in Children in Bangkok and Two Industrialized Provinces in Thailand Ratchaneewan Sinitkul1,2,3, Richard J Maude2,3,4, Teerarat Tassanapitikul1, Adisak Plitponkarnpim1

(1) Faculty of Medicine Ramathibodi Hospital, Mahidol University, Pediatrics Department, Bangkok, Thailand (2) Faculty of Tropical Medicine, Mahidol University, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand (3) University of Oxford, Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford, United Kingdom (4) Harvard T.H. Chan School of Public Health of Public Health, Boston, MA, USA

Corresponding author: Ratchaneewan Sinitkul Contact: Ratchaneewan Sinitkul, Tel: +662 201 1244, E-mail: [email protected]

Background Following the ban of leaded gasoline in Thailand, there remain other potential environmental sources of lead exposure in children. There is little information on current blood lead levels in children or potential risk factors for lead exposure in Thailand. We aim to estimate the prevalence of lead exposure in children in Bangkok and nearby industrialized provinces in Thailand and investigate possible risk factors for high blood lead levels in this population.

Methods Demographic data and risk factors were collected from child care-givers via self-administered questionnaires. Capillary blood was collected from children for hemoglobin (cHb) and lead level (cBLL) testing. In those found to have low cHb or high cBLL, complete blood count and venous blood lead level were checked.

Results The prevalence of raised lead levels in 559 participants (149 in Bangkok plus 410 in two nearby industrialized provinces was 21.1% and 4.5% (using cut-offs of cBLL >/= 5 µg/dL and >/= 10 µg/dL, respectively). The prevalence in industrialised provinces was greater than in Bangkok (28.5 vs 7.4% and 6.1 vs 0% for cBLL >/= 5 µg/dL and >/=10 µg/dL, respectively). Factors associated with cBLL >/= 5 µg/ dL were living in industrial provinces (adjusted OR 2.898; 95%CI 1.268 – 6.625, p 0.012) and age less than 36 months (adjusted OR 2.096; 95%CI 1.001 – 4.386, p 0.050).

S89 180908 www.journalhealthpollution.org Conclusions Lead exposure remains a common problem in Thai children, particularly in industrial provinces. Measures including lead inventory, strict control over known sources, early detection of lead exposure and lead release mitigation should be considered.

18-0065 Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

VOCs Exposure and Risk Assessments on Diaper Medium For Infants and Children in Korea Seung Woon Sohn1, Dong Soo Lee1

(1) Seoul National University, Graduate School of Environmental Studies, Environmental Planning Institute, Seoul, South Korea

Corresponding author: Seung Woon Sohn Contact: Seung Woon Sohn, Tel: +8210-2991-5210, E-mail: [email protected]

Background The volatile organic compounds (VOCs) in diapers and sanitary napkins have recently become a controversial issue, but the Ministry of Food and Drug Safety (MFDS) reported that these items do not impose harm on the human body.

However, the entire process of MFDS has not been transparently disclosed and contains no mention of comprehensive risk by VOCs in the diaper. Therefore, this study aims to estimate the risk through a literature survey and Monte Carlo simulation, to determine the comprehensive hazards due to the number of VOCs substances.

Methods Concentration distributions of VOCs were derived from 543 measurement data of 10 VOCs in 205 domestic diapers in the last 3 years. Exposure data were collected from an online survey of infants feeding and diaper usage, and pediatric standard growth chart. To resolve the uncertainty of the risk assessment, Monte Carlo simulation was performed for VOCs concentration, frequency of diaper usage, and infant weight. In this study, the hazard quotient (HQ = systemic exposure dosage (SED)/RfD) and the hazard index (HI = ΣHQ) were calculated to determine the cumulative hazards.

Results HQ was found to be chloroform 0.271, toluene 0.176, ethylbenzene 0.039, xylene 0.031, and styrene 0.014. HI was found to be 0.441, which was not harmful to human body. However, the margin of safety (MOS) of MFDS calculated in the same way as HI was 2.03, which was higher than HI.

S90 www.journalhealthpollution.org 180908 Conclusions Comparing HI calculated from this study, It was found that MOS generally overestimated the risk of VOCs. But MFDS didn’t consider the cumulative risks, so the overall risk was underestimated. When considering people’s health according to the precautionary principle, it would be helpful to assess the overall risk by calculating the cumulative hazards rather than determining the MOS of the individual substance. In the same manner, if the VOCs that have not been investigated are calculated, the existing

risk asessment should be reviewed. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

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Challenges in Assessing the Risk of Environmental Factors on Children’s Health – The Example of Particulate Matter in Ambient Air Myriam Tobollik1, Dietrich Plass1

(1) Federal Environment Agency, Section Exposure Assessment and Health Indicators, Berlin, Germany

Corresponding author: Myriam Tobollik Contact: Myriam Tobollik, Tel: 00493089031224, E-mail: [email protected]

Background Risk assessments are necessary to quantify the impact of risk factors on human health. There is a strong demand for such assessments especially in the area of environmental health, because here statutory regulations are required to improve the environment. Children are a considerably vulnerable population and should be increasingly targeted by risk assessments. In the UKAGEP-project the burden of disease due to 16 risk factors for children aged 3-17 years in Germany is quantified.

Methods Generally, risk assessments consider current exposures and body burdens and derive the according risks for adverse health effects. However, the current exposure might not have an immediate effect and long lag-periods of cumulative exposures may result in health effects after long exposure time. Using the example of particulate matter (PM2.5) we aim to project the development of population-exposure towards PM2.5 and mortality effects of selected diseases (e.g. cardiovascular diseases, lung cancer). Different forecasting methods are tested and probabilistic models are introduced to cover uncertainties of assumptions.

Results Children in countries with high socio-economic development status are a relatively healthy population. Despite immediate effects of environmental hazards, exposure during pregnancy and early childhood can lead to severe health effects in later life. As forecasts tend to be uncertain, therefore the results will cover a business-as-usual scenario but also scenarios including effects of selected prevention and intervention measures on PM2.5 exposures and health.

S91 180908 www.journalhealthpollution.org Conclusions The standard approach of risk assessments applied to children populations might result in an underestimation of the disease burden. Risk assessments tailored towards the characteristics of this vulnerable group can help to identify future streams of disease burden and potential drivers that might improve the environment and health of children throughout their life. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

18-0131

Public Health Policies to Adapt to Climate Change and Changes in Infectious Diseases Patterns Peter van den Hazel1

(1) International Network for Children’s Health, Environment and Safety, Dieren, The Netherlands

Corresponding author Peter van den Hazel Contact: Peter van den Hazel, Tel: +31631997270, E-mail: [email protected]

Background What is most important in the understanding of the relevance to advance public health and public policies to deal with climate change and changes in infectious diseases patterns? A special focus on children is important.

Methods Compilation of data processed by the World Health Organisation, ECDC, project CLIMATE TRAP and other projects.

Results The numbers of infectious diseases cases will change according to climate changes in various geographical areas. There will be increases and decreases of incidences of familiar and unfamiliar diseases. The hazard for new emerging diseases arises from increasing temperature, precipitation change and more extreme weather events. The vulnerability of the population relates to demographics, socio-economic conditions and access public health institutions and its governance. This can be seen as a potential disaster.

Conclusions Professionals have to increase their knowledge about new emerging infectious diseases. Urban areas are vulnerable. Actions are needed to increase knowledge of cascade effects in urban areas that would result in new innovative and effective approaches to improve urban resilience to climate change. Actions are needed to promote raising awareness (risk-informed cities, risk communication with people centered approach, resilient communities). Actions are needed to promote innovative approaches to increase the resilience of urban populations, including adapting critical infrastructure in prevention of infectious diseases. A comprehensive approach between different sectors in public health and beyond is needed.

S92 www.journalhealthpollution.org 180908 For example, raising awareness in the population logically starts with the children. Environmental health programs for schools are available in several countries, but disaster risk resilience programs focusing on infectious diseases and on climate change are less common. Interpretation of data related to the impacts of climate change, infectious diseases and the readiness of societal structures or response by the public health sector needs to be advanced by multidisciplinary research.

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

18-0134

Sustainable Development Goals as Guidelines for Improving Children’s Health Catherine Bouland1, Marija Jevtic1,2,3, Peter van den Hazel4

(1) Université Libre de Bruxelles, Research Centre on Environmental and Occupational Health, Brussels, Belgium (2) University of Novi Sad, Faculty of Medicine Department of Hygiene, Novi Sad, Serbia (3) Insttitute of Public Health of Vojvodina, Department of School Health, Health Promotion Center, Novi Sad, Serbia (4) Public Health Services Gelderland Midden, Environment Related Diseases Section, Arnhem, The Netherlands

Corresponding author: Peter van den Hazel Contact: Peter Van Den Hazel, E-mail: [email protected]

Background In 2015, the UN has established Sustainable Development Goals (SDGs) on the top of agenda 2030, for all people, including vulnerable and marginalized groups, and children. We are questioning if we are on track to achieve, worldwide, the relevant SDGs concerning the target group of children. The aim is the analysis of SDGs as pillars for activities towards children’s health and a safe future.

Methods A descriptive assessment method is used to analyze SDGs and their connection with children’s health.

Results Children ‘s right, their health concerns and their future well-being are addressed in several SDGs: target 1 (no poverty), 2 (zero hunger), 3 (good health and wellbeing), 4 (quality education), 5 (gender equality), 6 (clean water and sanitation), 7 (affordable and clean energy), 8 (decent work and economic growth), 13 (climate action), 16 (peace, justice and strong institution). A total of 44 child-related indicators are integrated across the 17 SDGs. They are directly relevant to children’s health and welfare. These indicators could be correlated to the five major dimensions of children’s rights: the right to survive and thrive, to learn, to be protected from violence, to live in a safe and clean environment, and to have an equal opportunity to succeed. Resulting Priorities should lead to integrate the Developmental Origins of Health and Disease approach and develop specific children’s related standards and thresholds to reinforce SDGs. For example, the 8 indicators connected with environment, include the reliance on clean fuels, the health protection from air pollution and disasters, and the access to safe drinking water, sanitation and hygiene. There are 5 indicators that include measuring the completion of education from pre-primary to secondary, the attainment of adequate learning outcomes, and access to water, sanitation and hygiene in schools worldwide.

S93 180908 www.journalhealthpollution.org Conclusions We need more focused standards, research, action programs, advocacy, and reconsider regularly if the use of those SDGs deliver better future for our children in real terms. The main inter-generational responsibility is that, the major target groups of the SDGs are the children, but their execution is in the hands of the adults of today. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

18-0087

The Center for Research on Early Childhood Exposure and Development (CRECE) Carmen M Velez-Vega1, Zaira Rosario-Pabon2, Jose F Cordero2, Gredia Huerta1, April Gu3, John Meeker4, Helen Suh5, Akram Alshawabkeh3

(1) University of Puerto Rico, Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico (2) University of Georgia, Department of Epidemiology, Athens, GA, USA (3) Northeastern University, Department of Civil and Environmental Engineering, Boston, MA, USA (4) University of Michigan, School of Public Health, Ann Arbor, MI, USA (5) Tufts University, Environmental Science, Medford, MA, USA

Corresponding author: Carmen M Velez-Vega Contact: Carmen M Velez-Vega, Tel: 7873440492, E-mail: [email protected]

Background The Center for Research on Early Childhood Exposure and Development (CRECE) is a Children’s Environmental Health Center that studies how mixtures of environmental exposures and other factors affect the health and development of infants and children living in the heavily-contaminated island of Puerto Rico. CRECE identifies many exposures including air quality, water quality, consumer product use, psychosocial dynamics, and internal factors that can combine to create adverse health effects during infancy and childhood.

Methods CRECE uses a holistic source-to-outcome strategy known as the “exposome” that captures the totality of the environment. As a multi-project Center, CRECE will couple air-pollution epidemiology, high throughput toxicity screening of multi-media pollutant mixtures, and biomarker epidemiology to analyze the impacts of early life exposure on fetal/child health and development, considering environmental, clinical, social, demographic, behavioral, dietary, and other factors.

Results At the moment 300 infants and children’s have been enrolled in the project with a median age of 8.5 months, 59.8% are male, 60.9% were born thru vaginal delivery and 15.6% were born premature. Close to 20% of the participants present developmental delay or signs.

S94 www.journalhealthpollution.org 180908 Conclusions CRECE’s mission is to be a vital and informative children’s environmental health resource for researchers, cohort participants, the broader underserved Puerto Rican community, and beyond.

18-0085

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Community Engagement and Research Translation to PROTECT Environmental Health for Mothers and Infants in Puerto Rico Carmen M Velez-Vega1, Zaira Rosario-Pabon2, Colleen Murphy1, Phil Brown3, Jose Cordero2, John Meeker4, Akram Alshawabkeh5

(1) University of Puerto Rico, Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico (2) University of Georgia, College of Public Health, Athens, GA, USA (3) Northeastern University, Social Science and Environmental Health Research Institute, Boston, MA, USA (4) University of Michigan, School of Public Health, Ann Arbor, MI, USA (5) Northeastern University, College of Engineering, Boston, MA, USA

Corresponding author: Carmen M Velez-Vega Contact: Carmen M Velez-Vega, Tel: 7873440492, E-mail: [email protected]

Background Puerto Rico has the third highest incidence of premature birth at a global level, which is not explained by known risk factors. A study to explore pollution threats in Puerto Rico (PR) Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) is a multicenter program to investigate the threats of exposure to pregnant women and infants in Puerto Rico that began in 2010 and will continue until 2020. The objective is to examine the possible environmental factors and its contribution to premature birth, and other negative birth outcomes.

Methods PROTECT is located in the Northern Karst region in PR seeks to understand pollution phenomena that affect premature birth to develop strategies that mitigate exposure to protect public health. PROTECT’s goals are achieved through integrated analytical, mechanistic, epidemiological and remediation studies, together with a centralized repository of indexed data. The community engagement component facilitates direct communication with the participants and reports individually and in aggregates the results of the research to participants and collaborators. Participants are informed on how to avoid contaminants and are provided with training by health professionals on environmental factors that affect health.

Results The results reveal higher levels of contaminants recognized as endocrine disruptors, when compared to women in E.U. and other countries. Findings indicate an increase in medical care and public health prevention as results from participation. The incidence of premature births in PR has decreased and they are linked to PROTECT’s work.

S95 180908 www.journalhealthpollution.org Conclusions The development of the cohort focuses on the construction of trustworthy ethical relationships that provide valuable resources for the participants; unlike traditional cohorts where people are passive subjects. These lessons should be widely disseminated among researchers in order to provide more democratized and fair ways of participating in research. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

18-0047

Environmental Childhood Asbestos Exposure and Hematologic Malignancies: A Danish Register Study Else Toft Würtz1, Johnni Hansen2, Oluf Dimitri Røe3,4,5, Øyvind Omland1,6

(1) Aalborg University Hospital, Department of Occupational Medicine, Danish Ramazzini Centre, Aalborg, Denmark (2) Danish Cancer Society, Research Center, Copenhagen, Denmark (3) Levanger Hospital, Nord-Trøndelag Health Trust, Cancer Clinic, Levanger, Norway (4) Norwegian University of Science and Technology, Department of Clinical Research and Molecular Medicine, Trondheim, Norway (5) Aalborg University Hospital, Clinical Cancer Research Center, Department of Clinical Medicine, Aalborg, Denmark (6) Aalborg University, Department of Clinical Medicine, Aalborg, Denmark

Corresponding author: Else Toft Würtz Contact: Else Toft Würtz, Tel: +45 50 56 88 56, E-mail: [email protected]

Background Asbestos exposure has no established role in hematologic malignancies, but has been suggested in numerous case reports. We aimed to examine the risk of hematologic malignancies according to childhood environmental asbestos exposure.

Methods Historical school records were used to identify pupils in the seventh forms from four schools nearby the high-volume asbestos-cement production plant in Denmark (operating 1926-1986). The schools were located at a distance of 100-750 meters in the dominant wind direction. The pupils from these schools have been exposed to airborne inhalable asbestos fibers during primary school years and nearby residence. They were born between 1940-1970 and followed-up in national registers until the end of 2015 by a unique personal identifier assigned to all residents. An age and sex matched 1:9 reference population was randomly selected from the Central Population Register. Restricted to alive individuals without cancer before age 12, the cohorts included 12,111 and 108,987, respectively. Standardized incidence ratios (SIR) and hazard ratios (HR) by Cox regression adjusted for sex, occupational benzene and asbestos exposure, were estimated for all-cause mortality, and hematologic malignancy as first cancer, including eight subtypes applied by the Danish Cancer Registry.

S96 www.journalhealthpollution.org 180908 Results Median person-years were 62.4 among pupils and 62.1 among the reference population. The all- cause mortality (n=16,979) was increased among the pupils, SIR 1.09 (95% CI: 1.04-1.14). The overall hematologic malignancy incidence (n=1135) was similar in the two groups. Three subtypes (unspecified cancer in lymphatic and hematopoietic tissue (n=5), unspecified leukemia (n=9), and monocytic leukemia (n=9)) indicated no sex difference in favor of men (confirmed in the other subtypes). The adjusted HR of

monocytic leukemia was 4.44 (95% CI: 1.10-17.92) in the pupils compared to the reference population. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Conclusions The results suggest that monocytic leukaemia is associated to environmental asbestos exposure in childhood. Further studies are needed to challenge this association.

18-0104

The Association of Prenatal Nonylphenol Exposure and Child Health in Taiwan Pregnant Women Nationwide Yu-Chun Xiao1, Shu-Li Wang2, Chia-Jung Hsieh3, Ming-Tsang Wu4, Mei-Lien Chen1

(1) National Yang-Ming University, School of Medicine, Institute of Environmental and Occupational Health Sciences, Taipei, Taiwan (2) National Health Research Institutes, National Institute of Environmental Health Sciences, Zhunan, Taiwan (3) Tzu Chi University, Department of Public Health, Hualien, Taiwan (4) Kaohsiung Medical University, College of Health Science, Department of Public Health, Kaohsiung, Taiwan

Corresponding author: Yu-Chun Xiao Contact: Yu-Chun Xiao, Tel: 0988162290, E-mail: [email protected]

Background Environmental hormones can interfere with the endocrine system and thus affect human health. Although nonylphenol (NP) is not very toxic, its chemical structure is similar as estrogen. NP is identified as a environmental hormone. Nonylphenol is mainly used to produce non-ionic surfactants, often in cleaning agents, cosmetics, personal care products (PCPs), office supplies (such as correction fluid and ink) and so on. Pregnant women exposed to NP can impact the fetus.

The aim of this study is to investigate the concentration of NP in pregnant women and to explore the association between prenatal NP exposure and birth outcomes.

Methods A biological sample was collected during the third trimester of gestation. A questionnaire was used to collect the demographic data for the pregnant women. We used the SPE-HPLC method to determine the urine NP concentration. The recovery of the method was determined by spiking a known amount of analyte in synthetic urine. Data analyses was performed using SAS 9.4. The association between NP levels and birth outcomes was assessed using multivariate linear regression model.

S97 180908 www.journalhealthpollution.org Results In total, 784 samples were analyzed. The mean (SD) of NP in pregnant women was 3.51 (2.29). The mean (SD) of NP levels in the north area, south area, central area, eastern area was 3.46 (2.50), 3.55 (2.72), 3.36 (2.17), and 3.78 (1.82), respectively. NP levels in pregnant women in each area were significantly different (P=0.02). Stratifying the exposure levels into two groups, we found the association between prenatal NP exposure and infant birth weight (P<0.05).

Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Conclusions Our preliminary results confirm the NP concentration of pregnant women in Taiwan. Further study is warranted to explore the health effect of NP exposure among the susceptible populations.

18-0021

Current Trends of Childhood Blood Lead Levels and Exposure Patterns in Kabwe, Zambia John Yabe1, Haruya Toyomaki2, Shouta MM Nakayama2, Yared B Yohannes2, Hokuto Nakata2, Kaampwe Muzandu3, Andrew Kataba2,3, Jack Caravanos4, Yoshinori Ikenaka2, Mayumi Ishizuka2

(1) University of Zambia, Paraclinical Studies, Lusaka, Zambia1, Hokkaido University, Toxicology Laboratory, Sapporo, Japan (2) Univerisity of Zambia, School of Veterinary Medicine, Biomedical Sciences Department, Lusaka, Zambia (3) PureEarth, New York, NY, USA

Corresponding author: John Yabe Contact: John Yabe, Tel: +260973258703, E-mail: [email protected]

Background Childhood lead (Pb) poisoning is a serious public health concern. Children are vulnerable to Pb poisoning as the central nervous system is most sensitive to Pb toxicity during developmental stages. Neurodevelopmental impairment resulting in reduced intelligence and attention deficit hyperactivity disorder, etc. have been reported in exposed children. Since the current upper reference level for blood Pb (BLL) is 5 μg/dL, levels exceeding 10 µg/dL in children are considered elevated. At higher BLLs > 100 µg/dl, clinical symptoms of toxicity including encephalopathy, convulsions, coma and death become visible. In Kabwe, Zambia, lead-zinc mining has caused widespread Pb contamination of the environment, posing a serious human health risk. Because Pb exposure can result in irreversible harm in children, regular monitoring of BLLs is desirable. Therefore, the current study measured BLL in Kabwe communities to characterize the city’s burden of disease and health risks. Moreover, trends of BLLs in children were assessed over a two year period and exposure patterns among children and adults were analyzed.

S98 www.journalhealthpollution.org 180908 Methods Blood samples were collected in heparinized tubes from families (children and parents) at 13 health centers in October 2016 and July-August 2017. BLLs were analyzed using a Lead Care® II analyzer System.

Results

Of the 153 samples that were collected in 2016, BLLs ranged from

Conclusions Results show that there is a serious risk of childhood Pb poisoning in Kabwe. Therefore, urgent remedial measures and chelation therapy of the affected children are recommended.

18-0026

Systematic Review of Heavy Metal Concentrations in Fish and Shellfish in Korea Shinhee Ye1, Jiyoung Shin1, Jueun Lee1, Eun Mi Jung1, Eunhee Ha1

(1) Ewha Womans University, College of Medicine, Department of Occupational and Environmental Medicine, Seoul, South Korea

Corresponding author: Shinhee Ye Contact: Shinhee Ye, Tel: +82-10-9208-8668, E-mail: [email protected]

Background Heavy metals ingested through the consumption of aquatic products can accumulate in the human body over the long-term and cause various health problems. This study aims to present comprehensive data on the amount of heavy metals found in fish and shellfish in Korea using a systematic review of studies that report on that issue.

Methods The study used the following databases: PubMed, Korean Studies Information Service System, and Research Information Sharing Service. The search terms for PubMed included fish OR shellfish OR seafood AND mercury OR cadmium OR lead OR heavy metal AND Korea. The search terms for Korean Studies Information Service System and Research Information Sharing Service included eoryu sueun, eoryu kadeumyum, eoryu nab, eoryu jung-geumsog, paeryu sueun, paeryu kadeumyum, paeryu nab, paeryu jung-geumsog, eopaeryu sueun, eopaeryu kadeumyum, eopaeryu nab, and eopaeryu jung- geumsog.

S99 180908 www.journalhealthpollution.org Results A total of 32 articles were selected for review. The total mercury, lead, and cadmium concentrations in fish and shellfish reported in each of the articles are summarized, as are the species of fish and shellfish with relatively high concentrations of heavy metals. Total mercury concentrations tended to be higher in predatory fish species, such as sharks, billfishes, and tuna, while lead and cadmium concentrations

tended to be higher in shellfish. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021

Conclusions This paper is the first to report a comprehensive summary of the concentrations of heavy metals in fish and shellfish. This data could be used as evidence to protect Koreans from exposure to heavy metals due to the consumption of highly polluted aquatic products.

18-0025

Interactions Between Maternal GSTM1 Polymorphism and Prenatal Polycyclic Aromatic Hydrocarbons Exposure on Atopic Dermatitis at 24 Months Shinhee Ye1, Eun-kyo Park1, Yumin Lee1, Byung-Mi Kim2, Yun-Chul Hong3, Mina Ha4, Yangho Kim5, Hyesook Park1, Eunhee Ha1

(1) Ewha Womans University, School of Medicine, Department of Environmental and Occupational Medicine, Seoul, South Korea (2) National Cancer Control Institute, National Cancer Center, Division of Cancer Prevention, Goyang, South Korea (3) Seoul National University, College of Medicine, Department of Preventive Medicine, Seoul, South Korea (4) Dankook University, College of Medicine, Department of Preventive Medicine, Yongin, South Korea (5) Ulsan University Hospital, University of Ulsan, College of Medicine Department of Occupational and Environmental Medicine, Ulsan, South Korea

Corresponding author: Shinhee Ye Contact: Shinhee Ye, Tel: +82-10-9208-8668, E-mail: [email protected]

Background Postnatal exposure to PAHs is associated with atopic dermatitis. However, the effects of prenatal exposure to PAHs and maternal genetic polymorphisms on children’s atopic dermatitis are controversial.

Methods This study was conducted on 1,751 pregnant women who were enrolled in a Mothers and Children’s Environmental Health (MOCEH) birth cohort study from 2006 to 2010. Urine samples were collected during early and late pregnancy, and the urinary PAHs metabolites 1-OHP and 2-naphtol were analyzed.

S100 www.journalhealthpollution.org 180908 The maternal blood samples were collected and analyzed for GSTM1 polymorphism. Medical history of atopic dermatitis of the children was collected by questionnaires at 6 months, 12 months, and 24 months after birth. The relationship between the concentration of 1-OHP and 2-naphtol in the urine of mothers and the presence or absence of diagnosis of children’s atopic dermatitis at 6, 12, and 24 months was analyzed using multiple logistic regression (SAS 9.4).

Results Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 The 1-OHP and 2-naphtol in late pregnancy urine of GSTM1-negative pregnant women were significantly associated with atopic dermatitis in 24-month-old children. The aOR and 95% CI of 1-OHP and 2-naphtol of GSTM1-negative pregnant women were aOR 1.001 (95% CI: 1.001-1.640) and aOR 1.458 (95% CI: 1.114-1.908), respectively. However, 1-OHP and 2-naphtol of GSTM1-positive pregnant women were not significant. The aOR and 95% CI of 1-OHP and 2-naphtol of GSTM1-positive pregnant women were aOR 0.824 (95% CI: 0.602-1.128) and aOR 0.806 (95% CI: 0.609-1.068), respectively.

Conclusions Exposure to PAHs in late pregnancy affected the development of atopic dermatitis in children when the GSTM1 polymorphism in the mother was negative. The results of this study will be used as a scientific evidence for policy to protect maternal and children health from exposure to automobile-derived air pollution.

18-0099

Main Progress of the 3rd Stage of the Korean National Environmental Health Survey (‘15-’17): Focused on Children and Adolescents Hye-Li Jeon1, Sung Yeon Kim1, Ji-Young Yoo1, Young Min Kwon1, Sun Kyoung Jung1, Young Kyoung Joo1, Chul-Woo Lee1, Seung-Do Yu1

(1) National Institute of Environmental Research, Environmental Health Research Department, Incheon, South Korea

Corresponding author: Ji-Young Yoo Contact: Ji-Young Yoo, Tel: 032-560-7129, E-mail: [email protected]

Background Under the Environmental Health Act (2009), the Korean National Environmental Health Survey (KoNEHS), a nationwide human bio-monitoring study, has been carried out every 3 years to identify exposure level of environmental chemicals in the Korean population. While the 1st and 2nd stage (2009-2014) of KoNEHS were limited to adults, the 3rd stage expanded the scope of the target population to cover children and adolescents as well. In addition, the survey newly included alternatives to legal, but restricted chemicals and chemicals that require continuous investigation in relation to environmental diseases.

S101 180908 www.journalhealthpollution.org Methods The application plan and direction of the 3rd stage were set through a pilot study and overseas bio- monitoring programs conducted for children and adolescents. We only collected urine samples from infants and children and both urine and blood samples from adolescents. Personalized questionnaires, which varied with each age group, were developed considering demographic, socioeconomic characteristics to identify exposure routes of environmental hazards. Downloaded from http://meridian.allenpress.com/jhp/article-pdf/8/19/180908/2337252/2156-9614-8_19_180908.pdf by guest on 23 September 2021 Results The 3rd stage designated daycare centers and schools as its sampling units, recruiting 2,115 subjects including children over 3 years old and adolescents. A total of 26 environmental chemicals were investigated including heavy metals and newly included items such as bisphenol A alternatives, phthalate metabolites. The urinary concentrations of heavy metals, polycyclic aromatic hydrocarbons metabolites increased with age, but those of bisphenol A, paraben and phthalate metabolites were higher in infants.

Conclusions The 3rd stage improved the validity of KoNEHS, developing the standardized questionnaire items for subject and survey system by reviewing the limitations of the 1st and 2nd stage. The results of the survey are expected to be used as basic data for the establishment of environmental health policy based on the analysis of spatio-temporal distribution and influence factors of exposure levels of environmental hazards among the whole population aged 3 years and over including children and adolescents.

S102 www.journalhealthpollution.org 180908