html. † Underlying medical condition status was classified as "known" if any of these 10 conditions, specified on the standard case report form, were reported as present or absent: diabetes mellitus; cardiovascular disease (includes hypertension); severe obesity (body mass index ≥40 kg/m 2 ); chronic renal disease; chronic liver disease; chronic lung disease; immunosuppressive condition; autoimmune condition; neurologic condition (including neurodevelopmental, intellectual, physical, visual, or health impairment); and psychologic/psychiatric condition.

Background-Increased serum C-reactive protein (CRP) is an independent risk factor for cardiovascular disease. Previous studies have suggested that genetic variation within the CRP gene is associated with serum CRP. Methods and Results-We genotyped CRP genetic variants in 7159 individuals from the Third National Health and Nutrition Examination Survey (NHANES III). NHANES III is American population-based sample linked to hundreds of phenotypes, including CRP; however, the CRP assay used in this survey is not a high-sensitivity CRP assay, and 65% of participants (nϭ4679) had CRP measurements at or below the level of detection. Despite these limitations, we identified specific CRP single-nucleotide polymorphisms (SNPs) and haplotypes associated with serum CRP levels in the general population. Two variants were associated with increased levels of serum CRP: SNP rs3093058 (in linkage disequilibrium with a CRP promoter SNP rs3093062) in the non-Hispanic black sample and the triallelic promoter SNP rs3091244 in the non-Hispanic black and Mexican American samples. Two other SNPs were associated with decreased levels of serum CRP in either the non-Hispanic black (rs1205 and rs2808630) or Mexican American (rs1205) samples. Three haplotypes inferred from 7 SNPs (ATTGCGA, TTAGCGA, and AAAGAGA) were associated (PՅ0.01) with increased levels of serum CRP in the non-Hispanic black sample; 2 haplotypes (ATTGCGA and AAAGCGA) were associated (PϽ0.05) with increased levels in the Mexican American sample; and 1 haplotype (AAAGCGA) was associated (PϽ0.03) with increased levels in the non-Hispanic white sample. Post hoc analysis suggests that the AA genotype of the triallelic SNP rs3091244, after adjustment for covariates, was associated with prevalent coronary heart disease in the non-Hispanic white population sample. Conclusions-Genetic variation within CRP is associated with serum CRP levels in the general population and may be associated with prevalent coronary heart disease. (Circulation. 2006;114:2458-2465.)

Problem: Asthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthmarelated complications.

Background Asthma is a leading cause of chronic disease-related school absenteeism. Little data exist on how information on absenteeism might be used to identify children for interventions to improve asthma control. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia. Methods The Behavioral Risk Factor Surveillance System Child Asthma Call-back Survey is a random-digit dialing survey designed to assess the health and experiences of children aged 0–17 years with asthma. During 2014–2015, multivariate analyses were conducted using 2006–2010 data to compare children with and without asthma-related absenteeism with respect to clinical, environmental, and financial measures. These analyses controlled for sociodemographic and clinical characteristics. Results Compared to children without asthma-related absenteeism, children who missed any school because of asthma were more likely to have not well controlled or very poorly controlled asthma (prevalence ratio: 1.50; 95% CI: 1.34–1.69) and visit an emergency department or urgent care center for asthma (prevalence ratio: 3.27; 95% CI: 2.44–4.38). Mold in the home and cost as a barrier to asthma-related health care were also significantly associated with asthma-related absenteeism. Conclusions Missing any school because of asthma was associated with suboptimal asthma control, urgent or emergent asthma-related health care utilization, mold in the home, and financial barriers to asthma-related health care. Further understanding of asthma-related absenteeism could establish how to most effectively use absenteeism information as a health status indicator.

This is the first successful application of the BRFSS-ACBS during 2006-2008 to estimate asthma incidence rates from participating states and DC. As with known patterns in asthma prevalence, we found that asthma incidence was higher in children than adults, higher in younger children than older children and adolescents, and higher in adult females than adult males. However, we were unable to identify statistically significant differences in asthma incidence among most race/ethnic groups. As additional data on asthma incidence become available from the ACBS, these rates, coupled with ACBS data on symptoms, asthma self-management practices, and healthcare utilization, may help asthma control programs identify risk factors for disease development and target asthma prevention and control measures to populations most affected.

Background:Relationships between air quality and health are well-described, but little information is available about the joint associations between particulate air pollution, ambient temperature, and respiratory morbidity.Objectives:We evaluated associations between concentrations of particulate matter ≤ 2.5 μm in diameter (PM2.5) and exacerbation of existing asthma and modification of the associations by ambient air temperature.Methods:Data from 50,356 adult respondents to the Asthma Call-back Survey from 2006–2010 were linked by interview date and county of residence to estimates of daily averages of PM2.5 and maximum air temperature. Associations between 14-day average PM2.5 and the presence of any asthma symptoms during the 14 days leading up to and including the interview date were evaluated using binomial regression. We explored variation by air temperature using similar models, stratified into quintiles of the 14-day average maximum temperature.Results:Among adults with active asthma, 57.1% reported asthma symptoms within the past 14 days, and 14-day average PM2.5 ≥ 7.07 μg/m3 was associated with an estimated 4–5% higher asthma symptom prevalence. In the range of 4.00–7.06 μg/m3 of PM2.5, each 1-μg/m3 increase was associated with a 3.4% [95% confidence interval (CI): 1.1, 5.7] increase in symptom prevalence; across categories of temperature from 1.1 to 80.5°F, each 1-μg/m3 increase was associated with increased symptom prevalence (1.1–44.4°F: 7.9%; 44.5–58.6°F: 6.9%; 58.7–70.1°F: 2.9%; 70.2–80.5°F: 7.3%).Conclusions:These results suggest that each unit increase in PM2.5 may be associated with an increase in the prevalence of asthma symptoms, even at levels as low as 4.00–7.06 μg/m3.Citation:Mirabelli MC, Vaidyanathan A, Flanders WD, Qin X, Garbe P. 2016. Outdoor PM2.5, ambient air temperature, and asthma symptoms in the past 14 days among adults with active asthma. Environ Health Perspect 124:1882–1890; http://dx.doi.org/10.1289/EHP92

Introduction Monitoring the level of asthma control is important in determining the effectiveness of current treatment which may decrease the frequency and intensity of symptoms and functional limitations. Uncontrolled asthma has been associated with decreased quality of life and increased health care use. The objectives of this study were to assess the level of asthma control and identify related risk factors among persons with current asthma. Methods Using the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey, asthma control was classified as well-controlled or uncontrolled (not-well-controlled or very-poorly-controlled) using three impairment measures: daytime symptoms, night-time symptoms, and taking short-acting β2-agonists for symptom control. Multivariate logistic regression identified predictors of asthma control. Results Fifty percent of adults and 38.4% of children with current asthma had uncontrolled asthma. About 63% of children and 53% of adults with uncontrolled asthma were on long-term asthma control medications. Among children, uncontrolled asthma was significantly associated with being younger than 5 years, having annual household income <$15 000, and reporting cost as barriers to medical care. Among adults, it was significantly associated with being 45 years or older, having annual household income of <$25 000, being “other” race, having less than a 4-year college degree, being a current or former smoker, reporting cost as barriers, being obese, and having chronic obstructive pulmonary disease or depression. Conclusion Identifying and targeting modifiable predictors of uncontrolled asthma (low educational attainment, low income, cigarette smoking, and co-morbid conditions including obesity and depression) could improve asthma control.

Strains of Xylella fastidiosa, isolated from sweet orange trees (Citrus sinensis) and coffee trees (Coffea arabica) with symptoms of citrus variegated chlorosis and Requeima do Café, respectively, were indistinguishable based on repetitive extragenic palindromic polymerase chain reaction (PCR) and enterobacterial repetitive intergenic consensus PCR assays. These strains were also indistinguishable with a previously described PCR assay that distinguished the citrus strains from all other strains of Xylella fastidiosa. Because we were not able to document any genomic diversity in our collection of Xylella fastidiosa strains isolated from diseased citrus, the observed gradient of increasing disease severity from southern to northern regions of São Paulo State is unlikely due to the presence of significantly different strains of the pathogen in the different regions. When comparisons were made to reference strains of Xylella fastidiosa isolated from other hosts using these methods, four groups were consistently identified consistent with the hosts and regions from which the strains originated: citrus and coffee, grapevine and almond, mulberry, and elm, plum, and oak. Independent results from random amplified polymorphic DNA (RAPD) PCR assays were also consistent with these results; however, two of the primers tested in RAPD-PCR were able to distinguish the coffee and citrus strains. Sequence comparisons of a PCR product amplified from all strains of Xylella fastidiosa confirmed the presence of a CfoI polymorphism that can be used to distinguish the citrus strains from all others. The ability to distinguish Xylella fastidiosa strains from citrus and coffee with a PCR-based assay will be useful in epidemiological and etiological studies of this pathogen.