Evidence shows that fetuses and infants are more affected than adults by a variety of environmental toxicants because of differential exposure, physiologic immaturity, and a longer lifetime over which disease initiated in early life can develop. In this article we review data on the effects of in utero exposure to common environmental contaminants, including polycyclic aromatic hydrocarbons (PAH), particulate matter and environmental tobacco smoke (ETS). We then summarize results from our molecular epidemiologic study to assess risks from in utero exposures to ambient air pollution and ETS. This research study, conducted in Poland, used biomarkers to measure the internal and bioeffective dose of toxicants and individual susceptibility factors. The study included 160 mothers and 160 newborns. Ambient air pollution was significantly associated (p < 0.05) with the amount of PAH bound to DNA (PAH-DNA adducts) in both maternal and infant cord white blood cells (WBC). Newborns with elevated PAH-DNA adducts (greater than the median) had significantly decreased birth weight (p = 0.05), birth length (p = 0.02), and head circumference (p = 0.0005) compared to the newborns with lower adducts (n = 135). Maternal and infant cotinine levels were increased by active and passive cigarette smoke exposure of the mother (p < 0.01). An inverse correlation was seen between newborn plasma cotinine (nanograms per milliliter) and birth weight (p = 0.0001) and length (p = 0.003). Adducts were elevated in placental tissue and WBC of newborns who were heterozygous or homozygous for the cytochrome P4501A1 MspI restriction fragment length polymorphism (RFLP) compared to newborns without the RFLP. Levels of PAH-DNA and cotinine were higher in newborns than mothers. These results document that there is significant transplacental transfer of PAH and ETS constituents from mother to fetus; that PAH-DNA adduct levels in maternal and newborn WBC were increased with environmental exposure to PAH from ambient pollution; and that the fetus is more sensitive to genetic damage than the mother. The study also provided the first molecular evidence that transplacental PAH exposure to the fetus is compromising fetal development. If confirmed, these findings could have significant public health implications since a number of studies have found that reduction of head circumference at birth correlates with lower intelligence quotient as well as poorer cognitive functioning and school performance in childhood. Key words: air pollution, cigarette smoking, CYP1A1 MspI RFLP, GSTM1, newborns, PAH-DNA adducts, Poland. -Environ Health Perspect 107(suppl 3): 451-460 (1999). http://ehpnet 1. niehs. nih.gov/docs/1 999/suppl-3/451-460perera/abstract html The context of the work reviewed here is the growing awareness of the vulnerability of the developing fetus and child to certain environmental contaminants, including those commonly found in urban areas around the world. Following a summary of the toxicity and occurrence of polycyclic aromatic hydrocarbons (PAH), partic...

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents' homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI > or = 20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13-3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64-3.59), allergy (OR = 1.89, 95% CI: 1.34-2.66), and Environmental Tobacco Smoke (OR = 1.54; 95% CI: 1.05-2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43-1.00) when compared with children from households where coal or gas was used for home heating.

The aim of this study was to assess the respiratory effects of outdoor air pollution after correcting for allergy and indoor air quality. The respiratory health survey targeted 1,129 schoolchildren, 9 yrs of age, attending schools in Krakow located in city areas differing in outdoor air pollution levels. Chronic phlegm as a unique symptom was related neither to allergy nor to indoor variables, but was associated with the outdoor air pollution level (odds ratio (OR): 4.2; 95% confidence interval (CI): 1.1-16.9). The same relationship has been confirmed for the self-reported local sources of industrial air pollution in the area of residence (OR: 4.2; 95% CI: 1.5-11.7). Hay fever appeared to be related to outdoor air pollution level (OR: 1.43; 95% CI: 1.1-2.0) and self-reported heavy traffic (OR: 1.3; 95% CI: 1.0-1.7). In the total sample, wheezing was connected exclusively to allergy and parental atopy, while attacks of dyspnoea with wheezing and asthma diagnosed by physician only were associated with allergy. Since the effect of outdoor pollutants on chronic cough and wheezing (odds ratio: 1.85; 95% confidence interval: 1.03-3.33) was only shown to be significant in the subsample of children without allergy and parental atopy, it may be postulated that either allergy is predisposing to respiratory reactions, or outdoor air pollution is coinvolved in an allergization process of the preadolescent children. Consequently, allergy should be considered as an important confound in epidemiological studies on the respiratory effects of air pollution.

The goal of this epidemiologic investigation was to analyze the associations between prenatal and postnatal exposure to airborne polycyclic aromatic hydrocarbons (PAH) and severity of wheeze and recurrent wheeze. The 257 children included in this analysis had a complete set of prenatal and postnatal PAH measurements and attended regular health checkups over a four-year follow-up period since birth. Transplacental PAH exposure was measured by personal air monitoring of the mothers during the second trimester of pregnancy; postnatal exposure was estimated using the same instruments indoors at the children’s’ residences at age 3. Chemical analysis tests were performed to determine airborne concentrations of nine PAH compounds. The results show that both prenatal and postnatal exposure were associated positively with the severity of wheezing days and recurrent wheezing reported in the follow-up. While the IRR (incidence rate ratio) for severity of wheeze and prenatal PAH exposure was 1.53 (95%CI: 1.43 – 1.64) that for postnatal PAH exposure was 1.13 (95%CI: 1.08 – 1.19). However, recurrent wheezing was more strongly associated with airborne PAH levels measured at age 3 (OR= 2.31, 95%CI: 1.26 – 4.22) than transplacental PAH exposure (OR = 1.40, 95% CI: 0.85 – 2.09), but the difference was statistically insignificant. In conclusion, it appears that prenatal PAH exposure may precipitate and intensify early onset of wheezing symptoms in childhood, resulting from the postnatal exposure and suggest that success in reducing the incidence of respiratory diseases in children would depend on reducing both fetal and childhood exposure to air pollution.

. Sickness absence caused by chest diseases in relation to smoking and chronic bronchitis symptoms. The relationship between sickness absence caused by chest diseases, smoking habit, and symptoms of chronic bronchitis among the workers of a fertilizer factory in Krak6w is examined. The analysis of absence was based on the spells and days of absence registered during a period of six years. The results show that the group of workers with symptoms of chronic bronchitis had many more spells and days of absence caused by chest diseases than persons free from these symptoms. The activity and chronicity of bronchitis symptoms strongly influenced the level of absence, but the role of smoking was not so evident. From the results obtained it appears that analysis of absence can be a valid screening test in the detection of chronic chest diseases, the frequency of which can easily be estimated from absence data.Absence caused by illnesses and accidents is not only a health and social problem but an economic one universally. Among the main reasons for sickness absence, chest diseases are the most serious and most frequent. Although much attention is given to the problem this complex phenomenon should be studied thoroughly so that practical guidelines can be given to physicians in charge of the health of workers.The aim of the paper was to verify the hypothesis that illness caused by chest diseases is particularly frequent in workers with chronic chest diseases that are non-specific. As there is evidence that the smoking habit is the strongest factor in the aetiology of these diseases it would be useful to know whether the risk of sickness absence caused by chest diseases is much higher in smokers than in non-smoking workers. Material and methodsSickness absence was analysed for an epidemiological prospective study on chronic non-specific chest diseases in thepopulation of the inhabitants of Krak6w(Brzezifiski et al., 1972). The study which began in 1968 also included workers of the fertilizer factory situated in the city. Out of 248 male workers examined in 1968 only 197 persons were re-examined in 1973, that is, 79 4 % of the population covered in the first field study.In the first cross-sectional study performed in 1968 we used the technique of standardized interviews on those with chronic chest symptoms. These interviews were held in the factory with specially trained interviewers. The questionnaire used was the Polish version of the Medical Research Council's questionnaire on chest symptoms (Brzeziiiski et al., 1972; Ciba Foundation Symposium, 1959; Medical Research Council, 1965). A diagnosis of chronic bronchitis was made ifchronic cough and chronic phlegm were present for a minimum ofthree consecutive months a year and for at least two successive years. Interviews on chronic chest symptoms of the same person taken twice during a five-year period gave the possibility of measuring the activity and chronicity of chronic bronchitis symptoms.Thoroughout the period of six years ) data on sickness absence for the 197 wor...