Background Physical inactivity, ambient air pollution and obesity are modifiable risk factors for non-communicable diseases, with the first accounting for 10% of premature deaths worldwide. Although community level interventions may target each simultaneously, research on the relationship between these risk factors is lacking. Objectives After comparing spatial interpolation methods to determine the best predictor for particulate matter (PM2.5; PM10) and ozone (O3) exposures throughout the U.S., we evaluated the cross-sectional association of ambient air pollution with leisure-time physical inactivity among adults. Methods In this cross-sectional study, we assessed leisure-time physical inactivity using individual self-reported survey data from the Centers for Disease Control and Prevention's 2011 Behavioral Risk Factor Surveillance System. These data were combined with county-level U.S. Environmental Protection Agency air pollution exposure estimates using two interpolation methods (Inverse Distance Weighting and Empirical Bayesian Kriging). Finally, we evaluated whether those exposed to higher levels of air pollution were less active by performing logistic regression, adjusting for demographic and behavioral risk factors, and after stratifying by body weight category. Results With Empirical Bayesian Kriging air pollution values, we estimated a statistically significant 16–35% relative increase in the odds of leisure-time physical inactivity per exposure class increase of PM2.5 in the fully adjusted model across the normal weight respondents (p-value<0.0001). Evidence suggested a relationship between the increasing dose of PM2.5 exposure and the increasing odds of physical inactivity. Conclusions In a nationally representative, cross-sectional sample, increased community level air pollution is associated with reduced leisure-time physical activity particularly among the normal weight. Although our design precludes a causal inference, these results provide additional evidence that air pollution should be investigated as an environmental determinant of inactivity.
References
[1]
Pratt M, Sarmiento OL, Montes F, Ogilvie D, Marcus BH, et al. (2012) The implications of megatrends in information and communication technology and transportation for changes in global physical activity. Lancet 380: 282–293. doi: 10.1016/s0140-6736(12)60736-3
[2]
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, et al. (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380: 219–229. doi: 10.1016/s0140-6736(12)61031-9
[3]
Awatef M, Olfa G, Rim C, Asma K, Kacem M, et al. (2011) Physical activity reduces breast cancer risk: a case-control study in Tunisia. Cancer Epidemiol 35: 540–544. doi: 10.1016/j.canep.2011.02.011
[4]
Haggar FA, Boushey RP (2009) Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 22: 191–197. doi: 10.1055/s-0029-1242458
[5]
Arsenault BJ, Rana JS, Lemieux I, Despres JP, Kastelein JJ, et al. (2010) Physical inactivity, abdominal obesity and risk of coronary heart disease in apparently healthy men and women. Int J Obes (Lond) 34: 340–347. doi: 10.1038/ijo.2009.229
[6]
Pietilainen KH, Kaprio J, Borg P, Plasqui G, Yki-Jarvinen H, et al. (2008) Physical inactivity and obesity: a vicious circle. Obesity (Silver Spring) 16: 409–414. doi: 10.1038/oby.2007.72
[7]
Lee IM, Djousse L, Sesso HD, Wang L, Buring JE (2010) Physical activity and weight gain prevention. JAMA 303: 1173–1179. doi: 10.1001/jama.2010.312
[8]
Herring MP, Puetz TW, O′Connor PJ, Dishman RK (2012) Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 172: 101–111. doi: 10.1001/archinternmed.2011.696
[9]
Motl RW, Birnbaum AS, Kubik MY, Dishman RK (2004) Naturally occurring changes in physical activity are inversely related to depressive symptoms during early adolescence. Psychosom Med 66: 336–342. doi: 10.1097/01.psy.0000126205.35683.0a
[10]
Ogden C, Carroll M, Kit BK, Flegal KM (2012) Prevalence of obesity in the United States, 2009-2010 - NCHS Data Brief. Centers for Disease Control and Prevention. Available: http://www.cdc.gov/nchs/data/databriefs/？db82.pdf. Accessed 2013 February 1.
[11]
Fryar CD, Carroll MD, Ogden C (2012) Prevalence of overweight, obesity, and extreme obesity among adults: United States, Trends 1960–1962 through 2009–2010 - NCHS Health E-Stat. Centers for Disease Control and Prevention. Available: http://www.cdc.gov/nchs/data/hestat/obes？ity_adult_09_10/obesity_adult_09_10.htm. Accessed 2013 January 15.
[12]
Singh GK, Kogan MD, van Dyck PC (2010) Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adolesc Med 164: 598–607. doi: 10.1001/archpediatrics.2010.84
[13]
CDC (2011) Obesity rates among low-income preschool children. Centers for Disease Control and Prevention. Available: http://www.cdc.gov/obesity/childhood/dat？a.html. Accessed 2012 March 12.
[14]
Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, et al. (2013) Myths, presumptions, and facts about obesity. N Engl J Med 368: 446–454. doi: 10.1056/nejmsa1208051
[15]
Voss JD, Masuoka P, Webber BJ, Scher AI, Atkinson RL (2013) Association of elevation, urbanization and ambient temperature with obesity prevalence in the United States. Int J Obes (Lond) doi:10.1038/ijo.2013.5 [Online 30 January 2013].
[16]
Brunekreef B, Holgate ST (2002) Air pollution and health. Lancet 360: 1233–1242. doi: 10.1016/s0140-6736(02)11274-8
[17]
Gent JF, Triche EW, Holford TR, Belanger K, Bracken MB, et al. (2003) Association of low-level ozone and fine particles with respiratory symptoms in children with asthma. JAMA 290: 1859–1867. doi: 10.1001/jama.290.14.1859
[18]
Laden F, Neas LM, Dockery DW, Schwartz J (2000) Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environ Health Perspect 108: 941–947. doi: 10.1289/ehp.00108941
[19]
Pope CA 3rd, Burnett RT, Thurston GD, Thun MJ, Calle EE, et al. (2004) Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation 109: 71–77. doi: 10.1161/01.cir.0000108927.80044.7f
[20]
Cakmak S, Dales R, Leech J, Liu L (2011) The influence of air pollution on cardiovascular and pulmonary function and exercise capacity: Canadian Health Measures Survey (CHMS). Environ Res 111: 1309–1312. doi: 10.1016/j.envres.2011.09.016
[21]
Marr LC, Ely MR (2010) Effect of air pollution on marathon running performance. Med Sci Sports Exerc 42: 585–591. doi: 10.1249/mss.0b013e3181b84a85
[22]
Cutrufello PT, Rundell KW, Smoliga JM, Stylianides GA (2011) Inhaled whole exhaust and its effect on exercise performance and vascular function. Inhal Toxicol 23: 658–667. doi: 10.3109/08958378.2011.604106
[23]
Rundell KW, Caviston R (2008) Ultrafine and fine particulate matter inhalation decreases exercise performance in healthy subjects. J Strength Cond Res 22: 2–5. doi: 10.1519/jsc.0b013e31815ef98b
[24]
Mokdad AH, Stroup DF, Giles WH (2003) Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) 52: 1–12.
[25]
Nelson DE, Holtzman D, Waller M, Leutzinger CL, Condon K (1998) Objectives and design of the Behavioral Risk Factor Surveillance System. American Statistical Association 1998 Proceedings of the Section on Survey Methods. Alexandria, VAAmerican Statistical Association. pp. 214–218.
[26]
VDH (2012) BRFSS Methodology. Virginia Department of Health. Available: http://www.vahealth.org/brfss/methodolog？y.htm. Accessed 2012 December 1.
[27]
CDC (2012) Methodologic changes in the Behavioral Risk Factor Surveillance System in 2011 and potential effects on prevalence estimates. Morbidity and Mortality Weekly Report MMWRCenters for Disease Control and Prevention. pp. 410–413.
[28]
Battaglia MP, Frankel MR, Link MW (2008) Improving standard poststratification techniques for random-digit-dialing telephone surveys. Survey Research Methods 2: 11–19.
[29]
EPA (2011) AQS Data Dictionary. U.S. Environmental Protection Agency. Available: http://www.epa.gov/ttn/airs/airsaqs/manu？als/AQS Data Dictionary.pdf. Accessed 2012 December 20.
[30]
Marshall JD, Nethery E, Brauer M (2008) Within-urban variability in ambient air pollution: Comparison of estimation methods. Atmospheric Environment 42: 1359–1369. doi: 10.1016/j.atmosenv.2007.08.012
[31]
Son JY, Bell ML, Lee JT (2010) Individual exposure to air pollution and lung function in Korea: spatial analysis using multiple exposure approaches. Environ Res 110: 739–749. doi: 10.1016/j.envres.2010.08.003
[32]
Hystad P, Demers PA, Johnson KC, Brook J, van Donkelaar A, et al. (2012) Spatiotemporal air pollution exposure assessment for a Canadian population-based lung cancer case-control study. Environ Health 11 22. doi: 10.1186/1476-069x-11-22
[33]
Krivoruchko K (2012) Empirical Bayesian Kriging: Implemented in ArcGIS Geostatistical Analyst. ESRI. Available: http://www.esri.com/news/arcuser/1012/fi？les/ebk.pdf. Accessed 2012 December 15.
[34]
Pilz J, Sp？ck G (2008) Why do we need and how should we implement Bayesian kriging methods. Stoch Environ Res Risk Assess 22: 621–632. doi: 10.1007/s00477-007-0165-7
[35]
EPA (2004) Developing spatially interpolated surfaces and estimating uncertainty. U.S. Environmental Protection Agency. Available: http://www.epa.gov/airtrends/specialstud？ies/dsisurfaces.pdf. Accessed 2012 February 21.
[36]
Wen XJ, Balluz LS, Shire JD, Mokdad AH, Kohl HW (2009) Association of self-reported leisure-time physical inactivity with particulate matter 2.5 air pollution. J Environ Health 72: 40–44; quiz 45.
[37]
Hankey S, Marshall JD, Brauer M (2012) Health impacts of the built environment: within-urban variability in physical inactivity, air pollution, and ischemic heart disease mortality. Environ Health Perspect 120: 247–253. doi: 10.1289/ehp.1103806
[38]
Alexeeff SE, Litonjua AA, Suh H, Sparrow D, Vokonas PS, et al. (2007) Ozone exposure and lung function: effect modified by obesity and airways hyperresponsiveness in the VA normative aging study. Chest 132: 1890–1897. doi: 10.1378/chest.07-1126
[39]
Delfino RJ, Tjoa T, Gillen DL, Staimer N, Polidori A, et al. (2010) Traffic-related air pollution and blood pressure in elderly subjects with coronary artery disease. Epidemiology 21: 396–404. doi: 10.1097/ede.0b013e3181d5e19b
[40]
Peters A, Liu E, Verrier RL, Schwartz J, Gold DR, et al. (2000) Air pollution and incidence of cardiac arrhythmia. Epidemiology 11: 11–17. doi: 10.1097/00001648-200001000-00005
[41]
Pope CA 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, et al. (2002) Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287: 1132–1141. doi: 10.1001/jama.287.9.1132
[42]
Brook RD, Rajagopalan S, Pope CA 3rd, Brook JR, Bhatnagar A, et al. (2010) Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation 121: 2331–2378. doi: 10.1161/cir.0b013e3181dbece1
[43]
EPA (2008) Appendix G: Health-based cost-effectiveness of reductions in ambient PM 2.5 associated with illustrative PM NAAQS attainment strategies. U.S. Environmental Protection Agency. Available: http://www.epa.gov/ttnecas1/regdata/RIAs？/Appendix G-Health Based Cost Effectiveness Analysis.pdf. Accessed 2012 March 7.
