1. Out of the Fog: Public Health Impacts of PM 2.5 in Cache Valley Out of the Fog: Public Health Impacts of PM 2.5 in Cache Valley Roger A. Coulombe, Jr Utah State University Logan, UT USA Roger A. Coulombe, Jr Utah State University Logan, UT USA

2. Pope III (2000) Environ. Health Perspectives 108 Pope III and Dockery (2006) J. Air Waste Manag. 56:709 Diseases associated with PM 2.5 Cardiovascular, cardiopulmonary diseases Early mortality: –Stroke, cardiovascular disease, cancer  Hospital admissions for cardiovascular and respiratory disease Exacerbation of COPD Alzheimer’s disease Autism

3. Brook et al (2010) Circulation 121:2331 No safe threshold Short-term exposures not risk-free 10 year exposures associated with ~ 16% mortality increase

4. Brook et al (2010) Circulation 121:2331 Short-term (~24 hr) PM 2.5 exposures Each 1  g/m 3 PM 2.5 increase - 0.4-1.0% increase in cardiovascular mortality

5. Brook et al (2010) Circulation 121:2331 Long-term ( > 24 hr) PM 2.5 exposures Each 10  g/m 3 - increases relative risk (RR) 1.06 – 1.76

6. PM 2.5 : Dose-Response No “safe” exposures [Low]: cardiovascular/cardiopulmonary/ischemic heart diseases [High]: Lung Cancer No “safe” exposures [Low]: cardiovascular/cardiopulmonary/ischemic heart diseases [High]: Lung Cancer

7. PM 2.5 : Steep Dose-Response Small reductions in PM 2.5  significant public health improvement!

8. Toxicology of Cache Valley PM 2.5 :

9. Experimental design PM 2.5 Sampling station PTFE filter with PM 2.5 Cytotoxicity Human bronchial epithelial (BEAS-2B) cells 24 hr Total RNA Total RNA protein Proteins - westerns Aqueous PM 2.5 extract Endotoxin CRP, IL-1, 6, 12 NF-kB, TNF sonicate mRNA - qRT-PCR Gene expression - Microarray

10. Consistently increased disease pathways * Across all three treatments

12. CVPM Causes Increase in Disease Predictors Modestly cytotoxic C-Reactive Protein (CRP) Inflammatory proteins Oncogenes (cancer genes) Ammonium nitrate inert Similar to PM 2.5 from other locales

13. Translational Studies

15. Clinical Study Design

16. A -preinversionB - inversion C – postinversion (recovery) Significant PM 2.5 associated decreases in FVC and FEV1 during unhealthy air vs. pre and post-inversion days

17. CVPM Causes Increase in Same Disease Predictors C-Reactive Protein (CRP) Inflammatory proteins Oncogenes (cancer genes)

18. 3-6% reduction pulmonary function 9% increase lung inflammation 10-40% increase systemic inflammation 10 µg/m 3 increase in PM 2.5 :

19. Relative Health Risk of CVPM 2.5 :

20. Relative Risks: PM 2.5 vs Passive Smoke Relative Risks: PM 2.5 vs Passive Smoke 18 m 3 /day respiration Low-moderate (< 19) passive = 0.36 mg PM 2.5 Moderate – High (> 20) passive = > 0.90 mg PM 2.5 18 m 3 /day respiration Low-moderate (< 19) passive = 0.36 mg PM 2.5 Moderate – High (> 20) passive = > 0.90 mg PM 2.5

21. Relative Risks PM 2.5 vs Passive Smoke Relative Risks PM 2.5 vs Passive Smoke @35 μg/m 3 = 0.63 mg PM 2.5 @75 μg/m 3 = 1.35 mg PM 2.5 @100 μg/m 3 = 1.8 mg PM 2.5 @35 μg/m 3 = 0.63 mg PM 2.5 @75 μg/m 3 = 1.35 mg PM 2.5 @100 μg/m 3 = 1.8 mg PM 2.5

22. 3 deaths @ $8.4 million* $25,200,000 5 hospitalizations @ $22,716 $113,580 109 ER/outpatient visits @ $303$33,027 344 asthma attacks @ $25 $8,600 200 follow-up visits @ $82$16,400 300 extra prescriptions @$101$30,300 400 sick days @ $202$80,800 TOTAL $25,482,707 3 deaths @ $8.4 million* $25,200,000 5 hospitalizations @ $22,716 $113,580 109 ER/outpatient visits @ $303$33,027 344 asthma attacks @ $25 $8,600 200 follow-up visits @ $82$16,400 300 extra prescriptions @$101$30,300 400 sick days @ $202$80,800 TOTAL $25,482,707 Adapted from Ed Redd M.D., Randy Martin 2015 From winter 2004: 2003 as base; *Current EPA life value Public Health Cost of CVPM – Winter 2004

23. PM 2.5 : Steep Dose-Response Small reductions in PM 2.5  significant public health improvement!

24. When do we act?

25. Proof in Science Elusive

26. “Weight of Evidence” “Beyond a reasonable doubt” – Criminal Law “Preponderance of evidence” – Civil Law

27. “Weight of Evidence” accounts for different kinds of scientific evidence to assess validity of causal hypothesis Now used by regulatory agencies in risk assessment

28. The Choice is Ours…. PM 2.5 = 6.1 µg/m 3 PM 2.5 = 85.3 µg/m 3

29. Thank You