1. Overview of Maine CDC’s Work on Air Quality and Health
Rebecca Lincoln, Sc.D.
Toxicologist
Environmental and Occupational Health Programs
For Andy Smith, S.M., Sc. D.
State Toxicologist and Director

2. Outline Air quality data on the Maine Tracking Network
Research on ozone and emergency department visits for asthma
Research on heat-related health effects

3. Maine Tracking Network Data Portal
Show/explain data portal
BRIEFLY describe EPHT
Mention Martha is on the TAG
Data are out of date but will be brought up to date (and revamped) soon
Mention that AQ content doesn’t get a lot of traffic
Does the group see any ways it could be better tailored to their needs?
Show screenshots of Drupal landing page, air page, portal
Could also show some of Nat’l portal

10. Question for group
These data are fairly out of date – and don’t get much traffic. Are there ways they could be better tailored to meet your needs?

11. Ozone and Asthma in Maine
Study: To determine the effect of ozone (and PM2.5) on ED visits for asthma at the ZIP-code level
Published in 2008, for data
Case-crossover design (uses cases as their own controls)
Exposure:
Maximum daily 8-hour average ozone concentration
Outcome:
Daily count of asthma-related ED visits
Remind them of our past work on ozone/ED (get images/slides from Chris) –
Town-level ED visits for asthma w/ ozone (HB modeled?)
Case-crossover methodology
Major results – show Fig. 2. (and age-specific rates)

12. Effect of ozone on ED visits

13. Effect of ozone by age and sex

14. Question for group
Would it be worthwhile to re-do this analysis with more/updated data?
 could be a nice way of seeing whether ppl are taking precautions we suggest, etc. Do we still see a link btwn ozone and health? If not, is it b/c ppl are listening to our advice? And, levels are lower now than they were at time of original study. Do we still see an effect even at lower levels?

15. Heat and Health in Maine
Extreme heat is a major public health threat
No research on heat/health for the Northeast/New England region, but we might be vulnerable
Recent research (NYC) caused the National Weather Service to lower the advisory threshold from 100F to 95F – for NYC region only
No research on heat/health for the Northeast/New England region
Low population density – rural or semi- rural
Cooler – so less physical/structural adaptation (i.e. AC)
Prior work suggests health effects below current National Weather Service advisory thresholds
Preliminary analyses in ME
Recent work in NYC (Metzger et al )
Northeastern BRACE/EPHT grantees (ME, NH, RI, VT) began collaborating to assess regional heat effects

16. Regional Collaboration
15 sites in ME, NH, RI over ~
Study design: Time-series analysis
Standard method for this type of exposure/outcome – like air pollution
Nonlinear Poisson models for each site
Same-day and cumulative (7-day lag)
Site-specific results combined in meta- analysis to obtain regional estimates

17. Data
Exposure
Daily maximum heat index (calculated from hourly NWS monitor data)
Outcome
Rates of daily all-cause ED visits
Rates of daily heat-related illness ED visits
Rates of daily all-cause mortality

18. Results: ED Visits (7-Day Cumulative)
Cumulative risk, over a 7-day lag, is greater than risk on the same day
Risk increases by 6.6% (95% CI: ) on days with max HI of 95°F (as compared to 75°F)
Smith, Andy E. (DHHS) 1/15/2016
you will need to explain what you mean by cumulative. I assume it is total ED visits over 7-days that can be attributed to HI on day 0, right?

19. Results: Deaths (Same-Day)
Risk increases by 7.4% (95% CI: 3.3, 11.8) on days with max HI of 95°F (as compared to 75°F)

20. Results: Deaths (Same Day, by Location)
Risk of all-cause death on a day with a maximum heat index of 95°F as compared to 75°F, by location

21. Next Steps
Calculate attributable number of ED visits and deaths due to heat
Bring results to National Weather Service; work together to lower threshold for issuing heat advisories and warnings
Other needed research in this area?

22. Questions?
Rebecca Lincoln, Sc.D. Toxicologist
Andy Smith, S.M., Sc.D.
State Toxicologist