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Biomedical subjects

Doug Brugge

Publications and source records attributed to Doug Brugge.

At least 19 recordsLinked to original sources
PubMed2006

Air pollution in Boston bars before and after a smoking ban.

BACKGROUND: We quantified the air quality benefits of a smoke-free workplace law in Boston Massachusetts, U.S.A., by measuring air pollution from secondhand smoke (SHS) in 7 pubs before and after the law, comparing actual ventilation practices to engineering society (ASHRAE) recommendations, and assessing SHS levels using health and comfort indices. METHODS: We performed real-time measurements of respirable particle (RSP) air pollution and particulate polycyclic aromatic hydrocarbons (PPAH), in 7 pubs and outdoors in a model-based design yielding air exchange rates for RSP removal. We also assessed ventilation rates from carbon dioxide concentrations. We compared RSP air pollution to the federal Air Quality Index (AQI) and the National Ambient Air Quality Standard (NAAQS) to assess health risks, and assessed odor and irritation levels using published SHS-RSP thresholds. RESULTS: Pre-smoking-ban RSP levels in 6 pubs (one pub with a non-SHS air quality problem was excluded) averaged 179 microg/m3, 23 times higher than post-ban levels, which averaged 7.7 microg/m3, exceeding the NAAQS for fine particle pollution (PM2.5) by nearly 4-fold. Pre-smoking ban levels of fine particle air pollution in all 7 of the pubs were in the Unhealthy to Hazardous range of the AQI. In the same 6 pubs, pre-ban indoor carcinogenic PPAH averaged 61.7 ng/m3, nearly 10 times higher than post-ban levels of 6.32 ng/m3. Post-ban particulate air pollution levels were in the Good AQI range, except for 1 venue with a defective gas-fired deep-fat fryer, while post-ban carcinogen levels in all 7 pubs were lower than outdoors. CONCLUSION: During smoking, although pub ventilation rates per occupant were within ASHRAE design parameters for the control of carbon dioxide levels for the number of occupants present, they failed to control SHS carcinogens or RSP. Nonsmokers' SHS odor and irritation sensory thresholds were massively exceeded. Post-ban air pollution measurements showed 90% to 95% reductions in PPAH and RSP respectively, differing little from outdoor concentrations. Ventilation failed to control SHS, leading to increased risk of the diseases of air pollution for nonsmoking workers and patrons. Boston's smoking ban eliminated this risk.

Air Movements↗
PubMed2006

A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing.

Pest infestation is a major problem in urban, low-income housing and may contribute to elevated asthma prevalence and exacerbation rates in such communities. However, there is poor understanding of the effectiveness of integrated pest management (IPM) efforts in controlling pediatric asthma, or of the interactions among various interventions and risk factors in these settings. As part of the Boston-based Healthy Public Housing Initiative, we conducted a longitudinal, single-cohort community-based participatory research intervention study. Fifty asthmatic children aged 4-17 from three public housing developments in Boston, Massachusetts, USA successfully completed interventions and detailed environmental, medical, social, and health outcome data collection. Interventions primarily consisted of IPM and related cleaning and educational efforts, but also included limited case management and support from trained community health advocates. In pre-post analyses, we found significant reductions in a 2-week recall respiratory symptom score (from 2.6 to 1.5 on an 8-point scale, p = 0.0002) and in the frequency of wheeze/cough, slowing down or stopping play, and waking at night. Longitudinal analyses of asthma-related quality of life similarly document significant improvements, with a suggestion of some improvements prior to environmental interventions with an increased rate of improvement subsequent to pest management activities. Analyses of potential explanatory factors demonstrated significant between-development differences in symptom improvements and suggested some potential contributions of allergen reductions, increased peak flow meter usage, and improved social support, but not medication changes. In spite of limitations with pre-post comparisons, our results are consistent with aggressive pest management and other allergen reduction efforts having a positive impact on clinical health outcomes associated with asthma. Our findings reinforce the multifactorial nature of urban asthma and suggest a need for further study of the relative contributions of and possible synergies between environmental and social factors in asthma intervention programs.

Adolescent↗
PubMed2006

Challenges of conducting community-based participatory research in Boston's neighborhoods to reduce disparities in asthma.

Boston is one of the preeminent health care and research centers in the world, but for much of its urban core, these resources are largely out of reach. Community Based Participatory Research (CBPR) provides a model with the potential to bridge the gaps between its research prominence and the health of its residents. We report here two case studies of major research projects that were partnerships between universities in Boston and community based organizations and city agencies. The Healthy Public Housing Initiative (HPHI) and the Asthma Center on Community Environment and Social Stress (ACCESS) are projects that provide numerous lessons about the potential and challenges of conducting CBPR. Ensuring that the projects were true partnerships emerged as key issues in both, especially with respect to funding mechanisms and distribution of resources, although the nature of the challenges differed substantially in the two projects. We note that both academic and community partners may harbor stereotypes about the other and that generalizations about broad populations, academics or community members, may not apply well to everyone. Aligning objectives and expectations emerged as another key lesson. In HPHI, tension between service delivery and research was both a source of conflict and a source of creative development that led to divergent but interesting outcomes. In ACCESS, the tensions revolved more around community capacity building while attempting to build and maintain a large cohort for epidemiological investigations. We conclude that open and frank discussion and a transparent process upfront about project direction, finances, expectations, and other dimensions are necessary but not sufficient to address the inherent challenges in CBPR, and that even so, there are likely to be differences in perspective in such partnerships that require honest negotiation throughout the process of the project.

Asthma↗
PubMed2006

Protecting the Navajo People through tribal regulation of research.

This essay explores the process and issues related to community collaborative research that involves Native Americans generally, and specifically examines the Navajo Nation's efforts to regulate research within its jurisdiction. Researchers need to account for both the experience of Native Americans and their own preconceptions about Native Americans when conducting research about Native Americans. The Navajo Nation institutionalized an approach to protecting members of the nation when it took over Institutional Review Board (IRB) responsibilities from the US Indian Health Service (IHS) in 1996. While written regulations for the Navajo Nation IRB are not dissimilar, and in some ways are less detailed than those of the IHS IRB, in practice the Navajo Nation allows less flexibility. Primary examples of this include not allowing expedited review and requiring prepublication review of all manuscripts. Because of its broad mandate, the Navajo Nation IRB may also require review of some projects that would not normally be subject to IRB approval, including investigative journalism and secondary research about Navajo People that does not involve direct data collection from human subjects.

Codes of Ethics↗
PubMed2005

Teratogenicity of depleted uranium aerosols: a review from an epidemiological perspective.

BACKGROUND: Depleted uranium is being used increasingly often as a component of munitions in military conflicts. Military personnel, civilians and the DU munitions producers are being exposed to the DU aerosols that are generated. METHODS: We reviewed toxicological data on both natural and depleted uranium. We included peer reviewed studies and gray literature on birth malformations due to natural and depleted uranium. Our approach was to assess the "weight of evidence" with respect to teratogenicity of depleted uranium. RESULTS: Animal studies firmly support the possibility that DU is a teratogen. While the detailed pathways by which environmental DU can be internalized and reach reproductive cells are not yet fully elucidated, again, the evidence supports plausibility. To date, human epidemiological data include case examples, disease registry records, a case-control study and prospective longitudinal studies. DISCUSSION: The two most significant challenges to establishing a causal pathway between (human) parental DU exposure and the birth of offspring with defects are: i) distinguishing the role of DU from that of exposure to other potential teratogens; ii) documentation on the individual level of extent of parental DU exposure. Studies that use biomarkers, none yet reported, can help address the latter challenge. Thoughtful triangulation of the results of multiple studies (epidemiological and other) of DU teratogenicity contributes to disentangling the roles of various potentially teratogenic parental exposures. This paper is just such an endeavor. CONCLUSION: In aggregate the human epidemiological evidence is consistent with increased risk of birth defects in offspring of persons exposed to DU.

Abnormalities, Radiation-Induced↗
PubMed2005

Screening for asthma in Cantonese-speaking immigrant children.

BACKGROUND: Asthma prevalence among Chinese immigrant children is poorly understood and attempts to screen these children have produced varied outcomes. We sought to learn how to improve screening for asthma in Chinese immigrant children. METHODS: Children (n = 152) were administered the Brief Pediatric Asthma Screen in either Cantonese or English, they then viewed and reacted to a video showing people wheezing and subsequently took a pulmonary function test. RESULTS: The diagnosed asthma prevalence for our study population was 27.0%, with another 5.3% having possible undiagnosed asthma. Very few children had spirometry findings below normal. In multivariate analysis, being native born (p = 0.002) and having a family history of asthma (p = 0.003) were statistically associated with diagnosis of asthma. After viewing the video, 35.6% of respondents indicated that the images differed from their conception of wheezing. Of four translations of the word "wheeze" no single word was chosen by a majority. CONCLUSION: Our findings suggest that asthma diagnoses are higher for Chinese children who were born in the US suggesting that desegregation of data might reveal at risk subpopulations. Care needs to be taken when diagnosing asthma for Cantonese speakers because of the centrality of the word wheeze and the challenges of translation.

Adolescent↗
PubMed2005

Susceptibility of elderly Asian immigrants to persuasion with respect to participation in research.

Familism, respect for authority, and a sense of shame/pride are cultural characteristics that might influence research participation of Asian Americans. We compared 79 elderly Asian immigrants, most of whom immigrated from China or Hong Kong, with 58 elders who were not Asian and mostly not immigrants. Responding to hypothetical situations presented on a self-administered questionnaire, the Asian group professed to be more likely to be influenced by a request from a son/daughter, landlord, physician, or advertisement (p<0.001) and by a monetary incentive (p=0.05). Multivariate adjustment for potential confounders attenuated the strength of these relations, but except in the case of the monetary offer, differences remained statistically significant. Within the Asian group, multivariate logistic regression modeling indicated that years lived in the US was associated with more likelihood of refusing requests to participate in research. We conclude that acculturation or assimilation into American society may build resistance to pressure to participate in research. Our findings also suggest that elderly Asian immigrants may need additional protections to achieve truly informed consent.

Aged↗
PubMed2004

Assessment of sources of second-hand smoke exposure in a putatively unexposed population.

The authors sought to determine levels of urinary cotinine and its association with collateral exposure to second-hand smoke in public health workers. Urinary cotinine was measured twice at 1-wk intervals in 28 public health workers or their spouses. Information on sources of second-hand smoke exposure and a dietary history were obtained from each participant. Geometric mean and median cotinine levels were 2.74 and 2.33 ng/mL, respectively. Only 6 instances of second-hand smoke exposure were reported from a combined 204 days of potential exposure, and these did not correspond to higher cotinine values. There was no association between consumption of foods containing nicotine and log-transformed urine cotinine levels (p = .80). The authors' analysis indicates dietary sources of nicotine are not important, even for persons with very low urinary cotinine levels. Further study is needed to determine sources of variation in urinary cotinine among largely unexposed populations.

Adult↗
PubMed2003

A case study of community-based participatory research ethics: the Healthy Public Housing Initiative.

We conducted and analyzed qualitative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage in community-based collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community.

Beneficence↗
PubMed2003

Environmental management of asthma at top-ranked U.S. managed care organizations.

We evaluated the status of nationally top-ranked managed care organizations' (MCOs) asthma disease management programs to identify "best practices" in the environmental treatment and control of asthma. Application materials were developed and mailed to the top 34 managed care organizations, as determined by the ranked results from the October 1998 edition of US News and World Report. Based on the results of a staff and panel review, five applicants were selected for site visitation. The results of the site visits determined two finalists and three runners-up. We recommend that MCOs integrate population and community-based strategies and seek an emphasis on prevention. We encourage collaborations with other organizations and agencies. We endorse home visitation to assess environmental factors and also support use of telephonic case management. We think that smoking cessation programs should be coordinated with asthma management. We consider it important to use alternative forms of communication such as the Internet. And we find that it is important to be mindful of language, culture, and literacy.

Asthma↗
PubMed2003

The radiation exposure compensation act: what is fair?

In 1990 the U.S. Congress passed a law providing compensation to former uranium miners who became ill while the U.S. Government was the sole purchaser of uranium. Ten years later, in 2000, the law was amended to correct widely perceived problems. We reviewed the content of the Radiation Exposure Compensation Act (RECA) laws and regulations, cataloged complaints about the 1990 law, compared the law to the scientific knowledge base in 1990 and in the present, reviewed the 2000 amendments to RECA, and drew lessons about how such compensation programs might be better structured. We concur with popular sentiment that the 1990 law had numerous flaws, the central one being that it failed to compensate many miners who by most other standards would have been deemed deserving. This problem arose through setting exposure criteria very high (at six to 15 times elevated risk), with a disproportionate burden placed on miners who had smoked. The additional burden on smokers was exacerbated by a very stringent definition of smokers (one pack-year in a lifetime). Federal compensation laws should prioritize payment to deserving claimants rather than excluding un-deserving claimants. Thus, a doubling of risk should be an upper limit for setting an eligibility threshold and a lower "significant contributory effect" standard could be considered more appropriate. Uncertainties in exposure and in dose response should be considered and resolved with a bias toward compensation. Beyond setting appropriate criteria, an active effort is needed to inform potentially eligible people and to assist them in qualifying; the eligibility criteria and the requirements for documentation should be appropriate for Native Americans and other cultural groups. Built-in evaluation mechanisms are needed for all compensation programs to assess whether they are meeting their stated objectives.

Journal Article↗
PubMed2003

"Where does the damp come from?" Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase has been most marked in children 0-14 years of age, and there is evidence that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environment risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, NO2, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that lay the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research to our work are also discussed.

Adolescent↗
PubMed2002

Traffic injury data, policy, and public health: lessons from Boston Chinatown.

We note that long-standing land use and transportation policy are critical factors in creating traffic conditions and will have to play a role in reducing injuries. We present the historical progression of events that created current traffic conditions in Boston Chinatown and an analysis of traffic-related injuries at the community level for the years 1996-1998. Injuries were found to be as likely on weekends as on weekdays and frequently occurred late at night. Nighttime occupant injuries were found to be more likely on Friday, Saturday, and Sunday nights (relative risk = 2.26; confidence interval = 1.35-3.78, P =.0014). Injuries varied significantly by location for occupant (P = <.001) and for pedestrian injuries (P =.039). There were no peaks of injuries at traditionally defined commuter hours, which have been the standard time for assessing "worst case" traffic impacts by developers and government agencies. There was, however, a strong association between injuries and vehicle volume at 9 intersections with simple configurations for AM and PM commuter hours (R(2) = 0.589, P =.010), resulting in a calculated increase of 3-5 injuries per year for each increase of 1,000 vehicles. There was no such association at 10 intersections with complex configurations (R(2) = 0.104, P =.397). The 24-hour weekend patterns of vehicle volumes showed that traffic abated only between 3 and 7 AM, and the patterns appeared qualitatively to mirror the 24-hour pattern of injuries, suggesting that they were also indicative of injury risk. We suggest that there is a need for both long-term changes in policy and more immediate interventions. We also conclude that researchers should be cautious about assuming that traffic patterns conform to naive expectations such as rush hour peaks.

Accidents, Traffic↗
PubMed2002

The history of uranium mining and the Navajo people.

From World War II until 1971, the government was the sole purchaser of uranium ore in the United States. Uranium mining occurred mostly in the southwestern United States and drew many Native Americans and others into work in the mines and mills. Despite a long and well-developed understanding, based on the European experience earlier in the century, that uranium mining led to high rates of lung cancer, few protections were provided for US miners before 1962 and their adoption after that time was slow and incomplete. The resulting high rates of illness among miners led in 1990 to passage of the Radiation Exposure Compensation Act.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

Development of targeted message concepts for recent Asian immigrants about secondhand smoke.

Residents of Boston's Chinatown and the Vietnamese community in Boston's Dorchester section are recent immigrants from China and Vietnam, countries whose smoking prevalence rates for men are among the highest in the world and whose rates for women are very low. We conducted exploratory focus groups in these communities to examine issues related to secondhand smoke and to generate message concepts for health education materials that would convince recent Asian immigrants to respond to the public health threat that secondhand smoke poses. The message concepts, which were tailored specifically for Chinese and Vietnamese immigrants, used themes that were consistent with the cultural values of each group as expressed in the focus groups, yet also reflected the fact that, in many ways, these immigrants are seeking to adapt to American norms. We suggest that it is possible to construct culturally appropriate health education materials for recent immigrant populations rather than rely on simple translations of English-language materials. An intervention study using these message concepts is needed.

Asian↗
PubMedDate not supplied

Asthma prevalence among inner-city Asian American schoolchildren.

OBJECTIVE: Though asthma has been studied in many inner-city populations in the United States, there have been no studies specifically on Asian American immigrants. The authors conducted a cross-sectional survey of the prevalence of asthma among schoolchildren at the Josiah Quincy Elementary School, located in Boston Chinatown. Roughly 62% of the students in the school are Asian American. METHODS: The authors utilized the Brief Asthma Pediatric Screen (BAPS), a five-question instrument that was validated through the Chicago public schools. The survey was administered to kindergarten through fifth grade students. RESULTS: Of the 606 respondents (69.9% of the students), 16% had previously diagnosed asthma and 3% had possible undiagnosed asthma. Asthma was more prevalent in boys than in girls (relative risk [RR] 1.75; 95% confidence interval [CI] 1.20, 2.56). In addition, the respondents who lived in Chinatown were less likely to have been diagnosed with asthma (RR 0.59; 95% CI 0.39, 0.90), as were those with Asian surnames (RR 0.65; 95% CI 0.44, 0.97). CONCLUSION: Although this study was preliminary, our results suggest that asthma rates are substantial among inner-city Asian immigrant children, but possibly lower than for other inner-city children.

Asian↗
PubMedDate not supplied

Exposure pathways and health effects associated with chemical and radiological toxicity of natural uranium: a review.

Natural uranium exposure derives from the mining, milling, and processing of uranium ore, as well as from ingestion of groundwater that is naturally contaminated with uranium. Ingestion and inhalation are the primary routes of entry into the body. Absorption of uranium from the lungs or digestive track is typically low but can vary depending on compound specific solubility. From the blood, two-thirds of the uranium is excreted in urine over the first 24 hours and up to 80% to 90% of uranium deposited in the bone leaves the body within 1.5 years. The primary health outcomes of concern documented with respect to uranium are renal, developmental, reproductive, diminished bone growth, and DNA damage. The reported health effects derive from experimental animal studies and human epidemiology. The Lowest Observed Adverse Effect Level (LOAEL) derived from animal studies is 50 microg/m3 for inhalation and 60 ug/kg body weight/day for ingestion. The current respiratory standard of the Occupational Safety and Health Administration (OSHA), 50 microg/m3, affords no margin of safety. Considering the safety factors for species and individual variation, the ingestion LOAEL corresponds to the daily consumption set by the World Health Organization Drinking Water Standard at 2 microg/L. Based on economic considerations, the United States Environmental Protection Agency maximum contaminant level is 30 microg/L. Further research is needed, with particular attention on the impact of uranium on indigenous populations, on routes of exposure in communities near uranium sites, on the combined exposures present at many uranium sites, on human developmental defects, and on health effects at or below established exposure standards.

Adsorption↗