While previous studies have shown a clear connection of air pollutants with some heart and lung diseases, the new research published Aug. 13 in JAMA demonstrates an association between long-term exposure to all major air pollutants — especially ozone — with an increase in emphysema seen on lung scans. Emphysema is a condition in which destruction of lung tissue leads to wheezing, coughing and shortness of breath, and increases the risk of death.

“We were surprised to see how strong air pollution’s impact was on the progression of emphysema on lung scans, in the same league as the effects of cigarette smoking, which is by far the best-known cause of emphysema,” said the study’s senior co-author, Dr. Joel Kaufman, UW professor of environmental and occupational health sciences and epidemiology in the School of Public Health.

In fact, the researchers found, if the ambient ozone level was 3 parts per billion higher where you live compared to another location over 10 years, that was associated with an increase in emphysema roughly the equivalent of smoking a pack of cigarettes a day for 29 years. And the study determined that ozone levels in some major U.S. cities are increasing by that amount, due in part to climate change. The annual averages of ozone levels in study areas were between about 10 and 25 ppb.

“Rates of chronic lung disease in this country are going up and increasingly it is recognized that this disease occurs in nonsmokers,” said Kaufman, also a professor of internal medicine and a physician at UW School of Medicine. “We really need to understand what’s causing chronic lung disease, and it appears that air pollution exposures that are common and hard to avoid might be a major contributor.”

The results are based on an extensive, 18-year study involving more than 7,000 people and a detailed examination of the air pollution they encountered between 2000 and 2018 in six metropolitan regions across the U.S.: Chicago, Winston-Salem, N.C., Baltimore, Los Angeles, St. Paul, Minnesota, and New York. The participants were drawn from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung studies.

“To our knowledge, this is the first longitudinal study to assess the association between long-term exposure to air pollutants and progression of percent emphysema in a large, community-based, multi-ethnic cohort,” said first author Meng Wang, an assistant professor of epidemiology and environmental health at the University at Buffalo who conducted the research as a postdoctoral researcher at the UW.

The authors developed novel and accurate exposure assessment methods for air pollution levels at the homes of study participants, collecting detailed measurement of exposures over years in these metropolitan regions, and measurements at the homes of many of the participants. This work in the MESA Air study was led at the University of Washington. While most of the airborne pollutants are in decline because of successful efforts to reduce them, ozone has been increasing, the study found. Ground-level ozone is mostly produced when ultraviolet light reacts with pollutants from fossil fuels.

“This is a big study with state-of-the-art analysis of more than 15,000 CT scans repeated on thousands of people over as long as 18 years. These findings matter since ground-level ozone levels are rising, and the amount of emphysema on CT scans predicts hospitalization from and deaths due to chronic lung disease,” said Dr. R. Graham Barr, professor of medicine and epidemiology at Columbia University who led the MESA Lung study and is a senior author of the paper.

“As temperatures rise with climate change,” Barr explained, “ground-level ozone will continue to increase unless steps are taken to reduce this pollutant. But it’s not clear what level of the air pollutants, if any, is safe for human health.”

Emphysema was measured from CT scans that identify holes in the small air sacs of the participants’ lungs, and lung function tests, which measure the speed and amount of air breathed in and out.

“This study adds to growing evidence of a link between air pollution and emphysema. A better understanding of the impact of pollutants on the lung could lead to more effective ways of preventing and treating this devastating disease,” said James Kiley, director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

“It’s important that we continue to explore factors that impact emphysema,” Kiley added, “particularly in a large, well-characterized multi-ethnic group of adults such as those represented by MESA.”

Previous research has already shown that children born severely prematurely, more than ten weeks early, are more likely to suffer educational problems. But the new findings highlight the disadvantage children born moderate-to-late premature may face, who were thought to be at a lower risk.

New research, from the University of Leeds and Born in Bradford, looked at the complex interplay between the educational disadvantage of being born moderately premature, and when during the year a child was born, to understand whether extra support might be necessary for some children.

This was in response to conversations with schools participating in the Bradford Opportunity Area programme, a Department for Education initiative aimed at improving outcomes for children and young people in areas that face significantly higher barriers to social mobility compared to their peers in other parts of the country. They indicated this was a specific area they would value further research into, to help inform their decision making.

Co-author Dr Liam Hill, from the University of Leeds’ School of Psychology, said: “Some children born prematurely not only have to contend with having spent less time developing in the womb but also have to start school a year earlier than they would have, had they been born on their due date. This amounts to having less time also developing outside of the womb at the point they start school.

“This can pose additional challenges right from the start of their education, and we found this can have an immediate impact on their performance, after just one year of school.”

The researchers looked at more than 10,000 school children from the Born in Bradford birth cohort study and found that the odds of a child not achieving a ‘Good Level of Development’ at the end of reception, if they were born prematurely, were approximately twice as high as those for children born at full term.

The children found to be most at risk were those born prematurely in the summer months (June to August), who consequently started school a year earlier than expected. These children were three times less likely to reach a good level of development compared to other children born prematurely during the summer, whose early arrival didn’t change the year they started school in.

The researchers also analysed data that suggested that holding premature children back from starting school by a year may not compensate for being born prematurely, although they did not test that directly.

Co-author Dr Katherine Pettinger, a neonatal doctor from Born in Bradford and the Bradford Teaching Hospitals NHS Foundation Trust, said: “Whilst it seems like an obvious solution, delayed entry for premature children is not likely to compensate for being born early, as we found that within a given school year, the risks to development faced by children born premature did not vary depending on when within that school year they were born.

“To try to better support this at risk group we instead suggest that schools should be informed which of their pupils were born prematurely so they can be given extra support, particularly early on in their schooling.”

According to national guidelines, once discharged from hospital severely premature children are given follow up medical support, and it is recommended that their schools are informed of their circumstances. But for moderately premature children, born between three to eight weeks early, there is no routine follow up support offered, so schools are unlikely to be informed.

To try to tackle the problem the researchers suggest:

• Tailored advice is provided to families of premature children
• Learning resources are provided for teachers to support children born prematurely in the classroom
• Routine sharing of data between health and education services

As well as highlighting the risk for premature children who start school earlier than expected, the findings also show evidence for differences in development of children born prematurely at an earlier age than any previous studies. The researchers therefore argue that from an early age there is a complex interplay between health and education, which should help encourage education providers to move away from arbitrary decision making, towards a more targeted, personalised approach.

Mark Douglas, Head of Children’s Services at Bradford City Council, added: “As a City of Research, Bradford City Council is committed to supporting the translation of research into policy and practice.

“This research is a great example of how we have used the latest evidence from Born in Bradford to improve the life chances for the children of Bradford, by introducing a smarter system to share information between our health and education services.”

The study by Forest Service scientists Randall Morin, Chris Oswalt and Andrew Liebhold with lead author Songlin Fei of Purdue University used data from 92,978 field plots sampled by the Forest Service’s Forest Inventory and Analysis (FIA) program in is the first attempt to comprehensively quantify the cumulative losses of trees following invasion by all species of non-native insects and diseases at a national scale.

In North America, forests account for an estimated 76 percent of carbon sequestration, or removal from the atmosphere and storage globally. “The key impact of the tree-killing alien insects and diseases is that they are greatly increasing the rate at which trees die on average,” Liebhold said. “This transfers carbon stored in live trees to dead material and much of this carbon will likely return to the atmosphere.”

Scientists emphasized that the study does not suggest that insect-killed trees become instant sources of carbon emissions. “Carbon transfers from living trees and plants to dead organic matter, and the release of carbon occurs gradually with decomposition of organic matter,” Fei said. “However, the total amount of carbon in these dead materials are substantial, which is comparable to carbon emissions from 4.4 million cars or nearly one-fifth of all wildfires in the United States annually.”

More than 430 non-native insects and diseases have found their way to U.S. forests. Most of these species have little known effects on forests, however 83 have caused noticeable damage. In their study, Fei and Forest Service scientists examined the impacts of these 83 known damaging non-native forest insect and disease species and estimated the rate at which live tree biomass has been killed by the 15 species that have had the greatest impacts on forests. Insects such as the emerald ash borer, gypsy moth, and hemlock woolly adelgid and diseases including Dutch elm disease, beech bark disease and laurel wilt disease are among the 15 most damaging non-native species.

As these insects and diseases continue to spread and tree mortality increases, the toll on forested landscapes and associated carbon storage will continue; the study suggests that 41 percent of the total live forest biomass remaining in the conterminous United States is threatened.

For more than 80 years, FIA has been collecting data that informs forest management. Historically the large dataset has been used by states and private groups to monitor forest area, health, and conditions. Recent collaborations have demonstrated novel, interdisciplinary applications. “This study demonstrates the power of the FIA data to quantify the impact that non-native forest pests are having in the United States,” Morin said.

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Materials provided by USDA Forest Service – Northern Research Station. Note: Content may be edited for style and length.