1. Does Greenspace Mitigate the Impact of Traffic-Related Air Pollution on Asthma and Lung Function? Patrick H. Ryan, PhD Associate Professor of Pediatrics and Environmental Health Division of Biostatistics and Epidemiology Cincinnati Children’s Hospital Medical Center University of Cincinnati, College of Medicine

2. Outline Background –Traffic-Related Air Pollution (TRAP) Respiratory health –Greenspace Potential impact on lung function and asthma Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) –Methods –Results: TRAP  respiratory health –Impact of greenspace on TRAP  respiratory outcomes

3. Traffic-Related Air Pollution (TRAP) Derived from the combustion of gasoline and diesel traffic –Particulate matter, EC, NO x, VOCs, PAHs, metals, mobile air toxics Causally associated with asthma exacerbation –Hospitalization, medication use, symptoms, lung function Role of TRAP on asthma pathogenesis less clear –Likely associated with asthma development

4. Greenspace Open land covered with vegetation –‘Greenness’ –Nearby parks, tree cover, grass, etc Residential proximity to greenspace has been linked to improved health outcomes in children and adults –Mental health –Birth outcomes –Mortality Association between residential proximity to greenspace and respiratory outcomes has been less studied

5. Potential Pathways for Greenspace to Influence Respiratory Disease Greenspace Environmental Benefits Socio-behavioral Benefits ↓ Heat ↓ Noise ↓ Air Pollutants ↓ Crime / Stress ↑ Mental Health ↑ Physical activity ↓ Allergy / Asthma

6. Greenspace and TRAP Associated with ↓ PM2.5 and TRAP concentrations

7. Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) Objective –Determine if children exposed to TRAP, specifically diesel exhaust particles, are at increased risk for developing allergic diseases, asthma, and impaired neurobehavioral development Design –Longitudinal birth cohort study of infants born 2001-2003 in greater Cincinnati, OH, USA Birth record address 1500 m from major road Age1234712 Cohort712674653638617> 400

8. CCAAPS Methods Clinical evaluations (Ages 1, 2, 3, 4, 7, 12) –Questionnaire and physical exam –Skin prick testing (allergic sensitization) –Biomarkers: hair, saliva, blood, urine, teeth –Exhaled NO, spirometry –Neurobehavior outcome assessment (7, 12) Intelligence, reading ability, attention/inhibition, memory, executive function, neuromotor function, behavior, anxiety/depression, MRI (structure, organization, and function) TRAP exposure assessment –PM2.5, Elemental carbon (EC) –Land-use regression (LUR) model applied to all residential locations, schools, daycares

9. TRAP and Development of Asthma Brunst et al. American Journal of Respiratory and Critical Care Medicine. 2015;192(4):421-427.

10. TRAP Exposure and Asthma Onset Brunst et al. American Journal of Respiratory and Critical Care Medicine. 2015;192(4):421-427.

11. Does Greenspace Influence Asthma and Lung Function in the CCAAPS Cohort? Normalized Differential Vegetative Index (NDVI) –Vegetative cover expressed as a normalized continuous variable (-1 to 1) using infrared and visible radiation wavelengths obtained from NOAA satellite remote sensors 30 x 30 m resolution Average NDVI values surrounding (400 m) CCAAPS children’s birth record and current (age 7) residences

13. Greenspace - Asthma and Wheeze (Age 7) Adjusted for maternal education, daycare attendance, secondhand smoke exposure, TRAP, sex, race Unadjusted Adjusted for maternal education, daycare attendance, secondhand smoke exposure, TRAP, sex, race, neighborhood –level SES

14. Greenspace - Lung Function (Age 7) Adjusted for maternal education, daycare attendance, secondhand smoke exposure, TRAP, sex, race Unadjusted Adjusted for maternal education, daycare attendance, secondhand smoke exposure, TRAP, sex, race, neighborhood –level SES

15. Does Greenspace Modify TRAP- Respiratory Health?

16. Summary and Future Directions TRAP exposure during early childhood is associated with asthma at age 7 –TRAP  earlier onset of asthma Exposure to greenspace at age 7 is associated with ↓ wheeze and ↑ lung function Greenspace does not modify the association between TRAP and respiratory outcomes in the CCAAPS cohort Future Directions –Examine time spent outdoors and distances to nearby parks –Characterize greenspace ‘buffers’ for participants residing near major roadways –Examine additional pathways by which greenspace may impact respiratory health Crime / stress Noise Physical activity –Determine the association between greenspace and neurobehavioral outcomes

17. Acknowledgements University of Cincinnati –Grace LeMasters PhD –David Bernstein MD –Jeff Burkle –Sergey Grinshpun PhD –Linda Levin PhD –James Lockey MD, MS –Tiina Reponen PhD –Sang Young Son PhD Funding –NIEHS R01ES011170 –NIEHS R01ES019890 –NIEHS R01ES020387 –NIEHS R21ES017957 –NIEHS R21ES024713 Cincinnati Children’s Hospital Medical Center –G. Khurana Hershey MD PhD –Jocelyn Biagini-Myers PhD –Kim Yolton PhD –Kim Cecil PhD –Rachel Severs –Chris Wolfe US EPA –Rebecca Gernes MPH, MSW –Glenn Rice ScD –J. Michael Wright ScD USDA Forest Service –Geoffrey Donovan PhD –Demetrios Gatziolis PhD –Michelle Kondo PhD Drexel University –Yvonne Michael PhD

18. Greenspace and TRAP ↓ in NO 2 concentrations associated with tree canopy Rao et al. Environmental Pollution. 2014;194:96-104.

20. Study Area: Cincinnati, OH Major north – south cargo route 9.8 million trucks/year on regional highways > 60,000 diesel trucks / day on segments of highways ~150,000 children live < 400 m from a major highway in the region