Responses to COVID-19 altered environmental exposures and health behaviours associated with non-communicable diseases. We aimed to (1) quantify changes in nitrogen dioxide (NO₂), noise, physical activity, and greenspace visits associated with COVID-19 policies in the spring of 2020 in Barcelona (Spain), Vienna (Austria), and Stockholm (Sweden), and (2) estimated the number of additional and prevented diagnoses of myocardial infarction (MI), stroke, depression, and anxiety based on these changes. We calculated differences in NO₂, noise, physical activity, and greenspace visits between pre-pandemic (baseline) and pandemic (counterfactual) levels. With two counterfactual scenarios, we distinguished between Acute Period (March 15th – April 26th, 2020) and Deconfinement Period (May 2nd – June 30th, 2020) assuming counterfactual scenarios were extended for 12 months. Relative risks for each exposure difference were estimated with exposure-risk functions. In the Acute Period, reductions in NO₂ (range of change from −16.9 μg/m³ to −1.1 μg/m³), noise (from −5 dB(A) to −2 dB(A)), physical activity (from −659 MET*min/wk to −183 MET*min/wk) and greenspace visits (from −20.2 h/m to 1.1 h/m) were largest in Barcelona and smallest in Stockholm. In the Deconfinement Period, NO₂ (from −13.9 μg/m³ to −3.1 μg/m³), noise (from −3 dB(A) to −1 dB(A)), and physical activity levels (from −524 MET*min/wk to −83 MET*min/wk) remained below pre-pandemic levels in all cities. Greatest impacts were caused by physical activity reductions. If physical activity levels in Barcelona remained at Acute Period levels, increases in annual diagnoses for MI (mean: 572 (95% CI: 224, 943)), stroke (585 (6, 1156)), depression (7903 (5202, 10,936)), and anxiety (16,677 (926, 27,002)) would be anticipated. To decrease cardiovascular and mental health impacts, reductions in NO₂ and noise from the first COVID-19 surge should be sustained, but without reducing physical activity. Focusing on cities’ connectivity that promotes active transportation and reduces motor vehicle use assists in achieving this goal.

Cadmium (Cd) exposure is recognized as an important risk factor for psychological health, but suitable physical activity may relieve depression. However, it remains unknown whether physical activity (PA) can reduce the effect of cadmium exposure on depression. Therefore, a cross-sectional data from National Health and Nutrition Examination Survey (NHANES) 2015–2018 was used. The Nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression among the participants. PA was calculated according to the metabolic equivalent (MET), weekly frequency, and duration of each activity. Logistic regression and restricted cubic spline models were used to examine the associations of Cd and depression. A total of 5560 adults aged 20 years and above were finally included in this study. The results indicated a positive correlation between blood Cd and depression. The multivariate-adjusted ORs (95% CI) of the highest quartile were 2.290 (1.754–2.990) for depression, which was still significant after controlling other heavy metals (P < 0.05). Under Cd exposure, the high intensity of physical activity group had the lowest risk of depression (OR = 2.226, 95%CI: 1.447–3.425), while the group with no physical activity had the highest risk (OR = 2.443, 95%CI: 1.382–4.318). Our results indicate that inner Cd exposure may be a risk factor for depression, and physical activity can moderate this relationship to some degree.

Residential greenspace quality may be more important for people's mental health than the quantity of greenspace. Existing literature mainly focuses on greenspace quantity and is limited to exposure metrics based on an over-head perspective (i.e., remote sensing data). Thus, whether greenspace quantity and quality influence mental health through different mechanisms remains unclear. To compare the mechanisms through which greenspace quantity and quality influence mental health, we used both remote sensing and street view data. Questionnaire data from 1003 participants in Guangzhou, China were analysed cross-sectionally. Mental health was assessed through the World Health Organization Well-Being Index (WHO-5). Greenspace quantity was measured by both remote sensing-based Normalized Difference Vegetation Index (NDVI) and Street View Greenness-quantity (SVG-quantity). Greenspace quality was measured by both Street View Greenness-quality (SVG-quality) and questionnaire-based self-reported greenspace quality. Structural equation models were used to assess mechanisms through which neighbourhood greenspace exposure has an influence on mental health. Stress, social cohesion, physical activity and life satisfaction were found to mediate both SVG-quality - WHO-5 scores and self-reported greenspace quality - WHO-5 scores associations. However, only NO₂ (nitrogen dioxide) mediated the association between NDVI and WHO-5 scores, while NO₂, perceived pollution and social cohesion mediated the association between SVG-quantity and WHO-5 scores. The mechanisms through which neighbourhood greenspace exposure influences mental health may vary across different exposure assessment strategies. Greenspace quantity influences mental health through reducing harm from pollution, while greenspace quality influences mental health through restoring and building capacities.

Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying short-term mechanisms remain uncertain.To explore the concomitant and lagged short-term associations between personal exposure to noise and heart rate variability (HRV) in a real life setting in the Île-de-France region.The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate data for 75 participants, aged 34–74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography (ECG) sensor on the chest. HRV parameters and noise levels were calculated for 5-min windows. Short-term relationships between noise level and log-transformed HRV parameters were assessed using mixed effects models with a random intercept for participants and a temporal autocorrelation structure, adjusted for heart rate, physical activity (accelerometry), and short-term trends.An increase by one dB(A) of A-weighted equivalent sound pressure level (Leq) was associated with a 0.97% concomitant increase of the Standard deviation of normal to normal intervals (SDNN) (95% CI: 0.92, 1.02), of 2.08% of the Low frequency band power (LF) (95% CI: 1.97, 2.18), of 1.30% of the High frequency band power (HF) (95% CI: 1.17, 1.43), and of 1.16% of the LF/HF ratio (95% CI: 1.10, 1.23). The analysis of lagged exposures to noise adjusted for the concomitant exposure illustrates the dynamic of recovery of the autonomic nervous system. Non-linear associations were documented with all HRV parameters with the exception of HF. Piecewise regression revealed that the association was almost 6 times stronger below than above 65 Leq dB(A) for the SDNN and LF/HF ratio.Personal noise exposure was found to be related to a concomitant increase of the overall HRV, with evidence of imbalance of the autonomic nervous system towards sympathetic activity, a pathway to increased cardiovascular morbidity and mortality.

Traditional methods of exposure assessment in epidemiological studies often fail to integrate important information on activity patterns, which may lead to bias, loss of statistical power, or both in health effects estimates. Novel sensing technologies integrated with mobile phones offer potential to reduce exposure measurement error. We sought to demonstrate the usability and relevance of the CalFit smartphone technology to track person-level time, geographic location, and physical activity patterns for improved air pollution exposure assessment. We deployed CalFit-equipped smartphones in a free-living population of 36 subjects in Barcelona, Spain. Information obtained on physical activity and geographic location was linked to space-time air pollution mapping. We found that information from CalFit could substantially alter exposure estimates. For instance, on average travel activities accounted for 6% of people's time and 24% of their daily inhaled NO2. Due to the large number of mobile phone users, this technology potentially provides an unobtrusive means of enhancing epidemiologic exposure data at low cost.

Excessive exposure to light at night (LAN) has become a serious public health concern. However, little is known about the impact of indoor LAN exposure on blood pressure, particularly among young adults. We aimed to investigate the effects of bedroom individual-level LAN exposure in real-world environment on blood pressure and hypertension among vulnerable young adults, and to evaluate the possible buffering effect of physical activity. In this cross-sectional study, a total of 400 healthy young adults aged 16–22 years were included. Bedroom LAN exposure was recorded at 1-min intervals for two consecutive nights using a TES-1339 R illuminance meter. Blood pressure was measured three times (8–11 a.m. in the physical examination day) in the seated position using an Omron HEM-7121 digital sphygmomanometer. A wrist-worn triaxial accelerometer (ActiGraph GT3X-BT) was used to assess physical activity for seven consecutive days. Each 1 lx increase of bedroom LAN intensity was associated with 0.55 mmHg-increase in SBP (95% CI: 0.15, 0.95), 0.30 mmHg-increase in DBP (95% CI: 0.06, 0.54), and 0.38 mmHg-increase in MAP (95% CI: 0.12, 0.65). Higher levels of LAN exposure were associated with increased risk of hypertension (LAN ≥ 3lx vs. LAN < 3lx: OR = 3.30, 95%CI = 1.19–9.19; LAN ≥ 5lx vs. LAN < 5lx: OR = 3.87, 95%CI = 1.37–10.98). However, these detrimental effects of bedroom LAN exposure on blood pressure and hypertension were not observed among young adults with high MVPA (≥2 h/day) level. MVPA can alleviate negative effects of bedroom LAN exposure on blood pressure and hypertension. Maintaining bedroom settings darkness at night may be an important strategy for reducing the risk of hypertension. Furthermore, for individuals living with high levels of indoor LAN exposure, regular physical activity may be a good option for preventing cardiovascular disease and hypertension.

Residential green space and neighborhood walkability are important foundations of a healthy and sustainable city. Yet, their associations with atherosclerosis, the disease underlying clinical coronary heart disease (CHD), is unknown, especially in susceptible populations. We aim to explore the associations of exposure to residential green space and neighborhood walkability with coronary atherosclerosis. In this study of 2021 adults with suspected CHD, we evaluated the associations of exposure to green space (using Normalized Difference Vegetation Index [NDVI] and enhanced vegetation index [EVI] surrounding each participant's home) and neighborhood walkability (using walkability index and number of parks near home) with atherosclerosis (using coronary artery calcium score, CAC) using linear regression model adjusted for individual-level characteristics. Mediation analysis was further applied to explore potential mechanisms through the pathways of physical activity, air pollution, and psychological stress. In the primary model, an interquartile increase in annual mean NDVI and EVI within the 1-km area was associated with −15.8% (95%CI: 28.7%, −0.7%), and −18.6% (95%Cl: 31.3%, −3.6%) lower CAC score, respectively. However, an interquartile increase in the walkability index near home was associated with a 7.4% (95% CI: 0.1%, 15.2%) higher CAC score. The combined exposure to a green space area in a 1-km area and the walkability index were inversely associated with atherosclerosis, albeit with a smaller magnitude than a single-exposure model. The findings from a mediation analysis suggested that increased physical exercise and ameliorated particulate matter <2.5 μm (PM₂.₅) may partially contribute to the relationship between green space and atherosclerosis, and for walkability index, partially explained by increased PM₂.₅ exposure. Our study suggested a beneficial association between green space and atherosclerosis, but an adverse association between neighborhood walkability and atherosclerosis. Therefore, urban development that aims to improve neighborhood walkability should jointly account for enhancing green space properties from a public health perspective.

Ultrafine particles (UFP), harmful to human health, are emitted at high levels from motorized traffic. Bicycle commuting is increasingly encouraged to reduce traffic emissions and increase physical activity, but higher breathing rates increase inhaled UFP concentrations while in traffic. We assessed exposure to UFP while cycling along a fixed 8.5 km inner-city route in Copenhagen, on weekdays over six weeks (from September to October 2020), during morning and afternoon rush-hour, as well as morning non-rush-hour, traffic time periods starting from 07:45, 15:45, and 09:45 h, respectively. Continuous measurements were made (each second) of particle number concentration (PNC) and location. PNC levels were summarized and compared across time periods. We used generalized additive models to adjust for meteorological factors, weekdays and trends. A total of 61 laps were completed, during 28 days (∼20 per time period). Overall mean PNC was 18,149 pt/cm³ (range 256–999,560 pt/cm³) with no significant difference between morning rush-hour (18003 pt/cm³), afternoon rush-hour (17560 pt/cm³) and late morning commute (17560 pt/cm³) [p = 0.85]. There was substantial spatial variation of UFP exposure along the route with highest PNC levels measured at traffic intersections (∼38,000-42000 pt/cm³), multiple lane roads (∼38,000-40000 pt/cm³) and construction sites (∼44,000-51000 pt/cm³), while lowest levels were measured at smaller streets, areas with open built environment (∼12,000 pt/cm³), as well as at a bus-only zone (∼15,000 pt/cm³). UFP exposure in inner-city Copenhagen did not differ substantially when bicycling in either rush-hour or non-rush-hour, or morning or afternoon, traffic time periods. UFP exposure varied substantially spatially, with highest concentrations around intersections, multiple lane roads, and construction sites. This suggests that exposure to UFP is not necessarily reduced by avoiding rush-hours, but by avoiding sources of pollution along the bicycling route.

Cadmium (Cd) is a toxic metal found in tobacco, air and food. Recent cross-sectional studies have suggested that Cd negatively impacts physical performance, but the prospective association is uncertain.We used data from 2548 older adults from the Seniors-ENRICA II cohort in Madrid, Spain. Whole blood Cd levels were measured at baseline using inductively coupled plasma-mass spectrometry. At baseline (2017) and follow-up (2019), overall physical function was evaluated using the physical component summary (PCS) of the SF 12-Item Health questionnaire, lower-extremity performance with the Short Physical Performance Battery (SPPB), muscle weakness with a hand dynamometer, and frailty with a Deficit Accumulation index. Mobility limitations and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including tobacco smoke, number of cigarettes smoked per day and time since cessation in former smokers.In cross-sectional analyses, odds ratios (95% confidence interval) per two-fold increase in blood Cd were 1.16 (1.03; 1.31) for low PCS scores, 1.08 (0.97; 1.20) for impaired lower-extremity performance, 1.10 (0.98; 1.23) for low grip strength, 1.11 (1.02; 1.20) for mobility limitations, 1.16 (1.02; 1.31) for frailty, and 1.26 (1.08; 1.47) for IADL disability. In longitudinal analyses, corresponding hazard ratios were 1.25 (1.03; 1.51) for low PCS scores, 1.14 (1.03; 1.27) for impaired lower-extremity performance, 1.02 (0.92; 1.13) for low grip strength, 1.03 (0.91; 1.16) for mobility limitations, and 1.16 (1.00; 1.35) for frailty. All the associations where consistent when current smokers were excluded from the analyses.Our results support the role of Cd as a risk factor for physical function impairments in older adults.

Pyrethroids are an important class of insecticides, and thousands of tons of these compounds are used in the United States every year. This study characterized exposures to pyrethroids and assessed demographic, socioeconomic, and lifestyle factors that modulate pyrethroid exposure using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012, a nationally representative survey of the non-institutionalized population of the United States. Urinary levels of commonly used biomarkers of pyrethroid exposure, including 3-phenoxybenzoic acid (3-PBA), 4-fluoro-3-phenoxybenzoic acid (F-PBA), and cis-dibromovinyl-dimethylcyclopropane carboxylic acid (DBCA), were determined by liquid chromatography-tandem mass spectrometry. The detection rate of 3-PBA, a nonspecific metabolite of several pyrethroids, was 78.1% in adults (N = 5233) and 79.3% in children (N = 2295). The detection rates of all other pyrethroid metabolites were <10%. The median urinary level of 3-PBA in adults was 0.47 μg/L (interquartile range, 0.14–1.22 μg/L). For children, the median urinary level was 0.49 μg/L (interquartile range, 0.17–1.29 μg/L). Age, gender, family income-to-poverty ratio (PIR), levels of physical activity, alcohol intake, and body mass index were associated with 3-PBA levels in adults. In children, age, gender, race/ethnicity, and PIR were associated with 3-PBA levels. 3-PBA levels also differed significantly across NHANES cycles, with higher levels observed in NHANES 2011–2012. Geometric mean 3-PBA levels in U.S. adults were 0.41 μg/L in NHANES 2007–2008, 0.41 μg/L in NHANES 2009–2010, and 0.66 μg/L in NHANES 2011–2012. In U.S. children, geometric mean 3-PBA levels were 0.40 μg/L in NHANES 2007–2008, 0.46 μg/L in NHANES 2009–2010, and 0.70 μg/L in NHANES 2011–2012. These results demonstrate that pyrethroid exposures remain a current environmental health concern and lay the foundation for further preclinical and epidemiological studies assessing human health risks associated with pyrethroids.