Environmental

Epidemiology on Pollution
HSCI 617
Erich Bonilla
Rochelle Granados
Juan Landeros
Dolores Mancha
Ana Romero
Vocabulary
❖ (LC) Lung Cancer
❖ (PPB) Parts Per Billion
❖ (PM2.5) Particulate Matter with a diameter > 2.5 micrometers
➢ Human hair is approximately 50-70 micrometers
❖ (IARC) International Agency for Research on Cancer
❖ (AHSMOG) Adventist Health Air Pollution Study
❖ (EPA) Environmental Protection Agency
❖ (O3) Ozone
Learning Objectives
❖ To understand that tobacco smoke, outdoor air pollution, particulate matter
(PM), and diesel exhaust (DE) can all be risk factors in LC.
❖ Assess the association between ambient PM2.5 and LC incidence in a
individual that has never smoked.
❖ Study the independent relationship with ambient O3 in two-pollutant models
with PM2.5 .
Article Citation
❖ Title of Article
➢ The Association between Ambient Fine Particulate Air Pollution and Lung
Cancer Incidence: Results from AHSMOG-2 Study
❖ Journal Details
➢ Environmental Health Perspectives
➢ Volume 123 Number 3 March 2017
1. Lung cancer the leading cause of cancer death?
a. True or False
2. Can you get lung cancer if you have never smoked cigarettes?
a. Yes or No
3. Can air pollution lead to lung cancer?
a. Yes or No
Introduction
❖ Objective
➢ The objective of the study was to assess the association between PM2.5
and risk of Lung Cancer (LC) using the Adventist Health and Smog
Study-2 (AHSMOG-2).
➢ A cohort of health conscious nonsmokers where 81% have never
smoked. Never-smoking participants have been underrepresented in
previous studies.
❖ Hypothesis
➢ Increased exposure to outdoor air pollution (PM2.5) can lead to an
increased incidence of cancer amongst non smokers.
Who Are They?
❖ People
➢ The AHSMOG-2 study, with 80,285 participants, which focused on a large group of
health conscious non-smokers derived from the Adventist Health Study-2.
➢ The AHS-2 study had 96,000 participants between the ages of 30 and 112, who all
identified as adventist.
■ 65% female
■ 65% white (non-hispanic)
■ 26.9% african american
■ 1.1% current smokers
❖ Place
➢ The adventist health study-2 compiled data from all 50 U.S. States and 5 provinces in
Canada
❖ Time
➢ AHS-2 study enrollment occurred from 2000-2007
Method (1)
❖ Design:
➢ Cohort Study
❖ Population Sample:
➢ The AHSMOG-2 study, a large,
health conscious cohort of nonsmokers.
➢ The final analytic study population
consisted of 80,285 participants.
❖ A quantitative study.

Figure 1. Study Flowchart for the final analytic

population.
Method (2)
Data Source
❖ A mixture of both primary and secondary data:
➢ Cancer registries
➢ Medical records
➢ U.S. EPA AQS data
Instruments
❖ Computer assisted record linkage of each study participant with state cancer
archives.
❖ Questionnaire which was mailed biennially for self-reported cancers.
Statistical Analysis
❖ Type of Analysis conducted:
➢ Baseline characteristic of cases and non cases were compared using
chi-square test for categorical and student's t-test for continuous
variables.
➢ Cox proportional hazards regression modeling
➢ Single and two pollutant were conducted
Findings
❖ Descriptive findings:
➢ Of the participants, there were 250 identified cases of LC. Most were
women, older, had low educational attainment, higher rates of past
smoking, lower income, more time spent outdoors, and reported less
physical activity.
❖ Most importantly, the data correlated with higher rates of exposure, and
higher concentrations of PM2.5.
Findings cont.

❖ Figure 3. Hazard ratios of incident lung cancer in the study

population stratified by time since quitting smoking among ever
smokers (135 cases) compared to never smokers (115 cases).
Study Strength
❖ The target population is health conscious, and the use of tobacco is very low.
❖ They’re nonsmoking, mostly never smoking population boosts power to
evaluate the association between ambient air pollution and incident Lung
Cancer.
❖ The population living across the United States in both urban and rural
communities.
❖ Had the opportunity to assess the effect modification of time spent
outdoors, length of residence at enrollment address, and moving history
during follow-ups.
Study Limitations
❖ Lack of specific information on environmental tobacco smoke (ETS) in the
data.
❖ There was no information on how many hours the participants spent in their
motor vehicles traveling to and from work that could of potential exposed
them to traffic air pollution.
❖ The data lacked any information regarding the speciation and components of
PM2.5.
❖ The majority of participants were non-hispanic white, and had limited red
meat intake.
Study Implications
❖ This study backs up the IRAC conclusion that air pollution is carcinogenic. It
draws stronger correlations between exposure to PM2.5 and incidence of LC,
which could have implications for ambient air quality standards established by
the EPA.
Discussion
❖ Previous studies have supported the correlation between human health
effects in relation to air pollution.
❖ This research was developed to fill the data gaps in the current research.
➢ Most studies related to lung cancer, never-smoking participants are
underrepresented.
❖ Why were the Netherlands Cohort study have results contradict these
results?
❖ The discussion on the biological mechanism:
➢ Increased DNA damage when bronchial epithelial cells are exposed to
PM2.5 (in vitro).
➢ PM2.5 associated with elevated reactive oxygen
■ Increased cancer risk through oxidative DNA damage
 How Content Relates
to Epidemiology
❖ This is both a social and environmental issue since social practices can lead
to an increased risk for LC. Environmentally, the study is exploring how
environmental exposures impact human health.
❖ The article relates to the class content since this is a global problem and in
efforts to improve outcomes we need to understand the etiology of lung
cancer.
❖ Relatable to the field of public health since it is the leading preventable cause
of death. Education and programs should remain an important aspect to
reduce the incidence of LC. Study findings, like those provided in the study
also provide critical evidence in support for environmental health policies that
focus on air quality.
Conclusion
❖ The study found increased estimates of lung cancer associated with
increments of ambient PM2.5 in participants that have never smoked or that
lived in a area with relatively low concentrations of ambient PM2.5.
❖ Even low concentrations of PM2.5 have health implications for never and past
smokers.
1. What is PM2.5?
2. What are two ways PM2.5 can increase cancer risk?
3. What population was underrepresented in previous LC studies?
4. Name two study limitations?
5. Name one source of secondary data?
 References
Gharibvand, L., Shavlik, D., Ghamsary, M., Beeson, W. L., Soret, S., Knutsen, R.,
& Knutsen, S. F. (2017). The Association between Ambient Fine Particulate Air
Pollution and Lung Cancer Incidence: Results from the AHSMOG-2 Study.
Environmental Health Perspectives,125(3), 378-384. doi:10.1289/ehp124