- Email: [email protected]
A Longitudinal Study on the Impact of Ambient Temperature on Monthly Cerebrovascular Mortality in Greater Lisbon
514
Abstracts / Annals of Epidemiology 27 (2017) 504e540
Objective: To test whether effects of multiple (up to 5) disasters on mental health responses were cumulative (additive effects), or whether an earlier disaster produced sensitization (higher) or habituation (lower) responses to a later one. Method: The GROWH study interviewed 1366 southern Louisiana women regarding their exposure to Hurricanes Katrina, Rita, Gustav, and Ike and the Gulf oil spill (measured several ways), and administered validated measures of symptoms of depression and PTSD. Multiple linear and logistic regression with disaster exposures entered singly, combined, and as an interaction were used to model mental health. Results: Both exposure to the oil spill and hurricane disaster exposure were associated with likely depression and PTSD, consistent with a cumulative model, but we did not find statistical interactions that would suggest sensitization or habituation. When results were examined with continuous symptom measures of depression and PTSD, they were similar, with the exception that exposure to the oil spill and experiencing illness or injury due to the hurricane disaster showed a significant interaction (p<0.05) in a manner consistent with a sensitization effect when predicting PTSD symptoms. The results of this study point mainly to a cumulative risk for the mental health effects of multiple disasters, although some indication of sensitization occurred among those with particularly severe experiences. There was no evidence for habituation. Conclusions: These findings may guide efforts to assist those in regions experiencing multiple disasters that occur in close sequence.
P36. The Gulf oil spill, miscarriage, and infertility: The GROWH Study Emily Harville, Arti Shankar, Leah Zilversmit, Pierre Buekens. Tulane University, New Orleans, LA, USA Purpose: To examine whether reported exposure to the oil spill was related to reproductive failure (reported miscarriage or infertility). Methods: 1524 women aged 18-45 recruited through prenatal and WIC clinics, and community events were interviewed about their experience of the oil spill and reproductive history. 1434 women had information on outcomes of at least one pregnancy, and 633 on a pregnancy both before and after the spill. Generalized estimating equations were used to examine the relationship between contact with oil and economic and social consequences of the spill with postponement of pregnancy, miscarriage, and infertility (time to pregnancy >12 months or reported fertility issues), with adjustment for age, race, BMI, smoking, and socioeconomic status. Results were compared for pregnancies occurring prior to and after the oil spill. Results: 77 (5.1%) women reported postponing pregnancy due to the oil spill, which was more common in those with high contact with oil or overall high exposure (aOR 2.92, 95% CI 1.31-6.51). An increased risk of miscarriage was found with any exposure to the oil spill (aOR, 1.54, 95% CI 1.17-2.02). Fertility issues were more common in the overall most highly exposed women (aOR 1.88, 1.19-2.95), when the data were limited to those with pregnancies before and after. However, no particular aspect of oil spill exposure was strongly associated with the outcomes, and effects were almost as strong for pregnancies prior to the oil spill. Conclusions: This study does not indicate strong effects of chemical exposure to the oil spill on reproductive failure in humans.
P37. Obesity, Air Pollution and Lung Function: Findings from the Survey of the Health of Wisconsin (SHOW) Kristen Chossek Malecki, Amy Schultz, Maria Nikodemova, Tamara LeCaire. Population Health Sciences, University of Wisconsin, Madison, WI, USA Purpose: Obesity may increase human sensitivity to environmental toxicants through multiple mechanisms including inflammation. Obesity has been shown to increase susceptibility of asthma symptoms and severity with exposures to outdoor and indoor pollution in children but few studies have explored obesity as a risk factor for reduced lung function associated with chronic ambient air pollution exposure among adults. Data from the 20082013 Survey of the Health of Wisconsin study were utilized to determine if previously found associations between air pollution and reduced lung
function were modified by obesity status among non-asthmatic adults age 21-74 (n¼2011). Results: Multiple linear regression analysis using survey procedures to account for complex design and spatial clustering were used to estimate the association between chronic 3-year average fine particulate matter (PM2.5) exposure and lung function measured by FEV1 (forced exploratory volume in 1 second (L/sec). Air pollution exposure was estimated using the USEPA’s Bayesian space-time downscaler model for PM2.5, and body mass index was calculated using measured height and weight. Methods: Overall, average FEV1 was 2.98 L (SD .89) and 3-year average PM2.5 was 10.5 mg/m3. In fully adjusted models, a five-unit increase in PM2.5 was associated with a -0.18 L/s (CI -0.32, -0.04) reduction in FEV1 among nonasthmatics. In stratified analyses, larger effects were seen in obese with BMI over 30 (B¼ -0.23, CI -0.29, -0.17) than non-obese (B¼ -0.15, CI -0.16, -0.14). No significant interactions between air pollution and BMI were observed in the total sample, however, among obese, air pollution and BMI interaction terms were significant (p<.001). Conclusions: Results suggest obese individuals may be more prone to adverse effects of ambient air pollution on lung function even with relatively low chronic exposures. Additional research is needed to track longitudinal changes overtime and understand the biologic underpinnings of observed sensitivity among obese.
P38. Association of Perfluoroalkyl substances with Hyperuricemia and Gout Franco Scinicariello, Lina Balluz. Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, 30341 USA Introduction: Previous population cross-sectional studies have reported a positive association of perfluoroalkyl and polyfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), with hyperuricemia and chronic kidney diseases (CKD) defined as estimate glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2. Aim of the study: To investigate whether there is an association between exposure to PFAS, and serum uric acid and gout in the adult population (20 -85 years) of the National Health and Nutrition Examination Survey (NHANES) 2009-2012 (n¼3248). PFAS includes PFOA, PFOS perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Methods: Multivariate logistic regression were performed to analyze the association of PFAS with hyperuricemia and self-reported gout. Serum PFOA, PFNA, PFOS and PFHxA were analyzed as quartiles. Multivariate linear regression were performed to analyze the association of PFAS with uric acid and eGFR. Analyses were also restricted to individuals with normal eGFR. Results: The weighted prevalence of hyperuricemia was 17.7 % (95% CI: 15.8% e 19.73%), and of self-reported gout was 3.2 % (95% CI: 2.5% e 4.1%). After adjustment for demographic, socioeconomic and other potential confounders, all four PFAS investigated were associate with increased serum uric acid and decreased eGRF. There were statistically significant associations between the highest quartile of PFOA, PFNA and PFHxS, but not PFOS, and hyperuricemia. These association were confirmed for PFOA and PFNA, but not PFHxS when the analyses were restricted to participants with normal eGFR.The adjusted odd ratio for gout among participants in the 4th PFOA quartile was 2.80 (95% CI: 1.16, 6.74) compared the 1st PFOA quartile. The positive association was also found when the analyses excludes individuals with CKD. Conclusions: In this large population cross-sectional analysis, we found an association between PFOA with self-reported gout. We also confirmed previous reports of an association of PFAS with hyperuricemia and decreased eGFR. Longitudinal studies examining the relationship of PFAS renal function are needed.
P39. A Longitudinal Study on the Impact of Ambient Temperature on Monthly Cerebrovascular Mortality in Greater Lisbon Mónica Rodrigues, Maria do Rosário de Oliveira Martins. Institute of Hygiene and Tropical Medicine (IHMT) NOVA University of Lisbon
Abstracts / Annals of Epidemiology 27 (2017) 504e540
Purpose: Cerebrovascular disease remains a leading cause of death in Portugal, and monitoring its occurrence is valuable to health care providers. The primary goal of this study was to analyze the relationship between incidence of cerebrovascular death by age and sex and weather, measured by temperature, over a period of 14 years. Methods: Monthly cerebrovascular deaths (ICD - 10: I60eI69) were provided by the National Institute of Statistics by sex and age (0e64 and 65 years), from 1998 to 2012 for Greater Lisbon, Portugal. Meteorological data were ex- tracted from European Climate Assessment & Dataset project. Monthly average ambient temperature was used as an indicator of weather conditions. Several negative binomial generalized additive models were estimated using different co- variate combinations and the final model was selected using Akaike Information Criterion and Restricted Maximum Likelihood. We used a 5% significance level and R software package. Results: Over the 14 years, the probability of dying from cerebrovascular disease in Greater Lisbon decreased by 5.9% and the temperature increased by 0,2◦C. In the multivariate model, we found that, adjusting for other factors cere- brovascular deaths are 82% higher for males; however if we consider only those with 65 years or more, this figure is inverted (34% lower for men). Furthermore, the probability of dying from cerebrovascular disease was significantly higher for older people and positively associated with monthly temperature. Conclusions: Although the probability of dying from cerebrovascular dis- ease has declined over time, it is higher for men, older people and associated with higher temperature. In Greater Lisbon, monitoring this disease should be a priority for health care planning, namely if we consider the actual context of climate change in this region and in Portugal as a whole.
P40. Mental Health Effects Associated with the 2010 Deepwater Horizon Oil-Spill Richard K. Kwok,a Sarah R. Lowe,b Lawrence S. Engel,c John A. McGrath,d W. Braxton Jackson II ,d Matthew D. Curry,d Julianne Payne,e Sandro Galea,f Dale P. Sandlerg. a Epidemiology Branch, NIEHS, NIH, Department of Health and Human Services, Research Triangle Park, NC, USA, b Montclair State University, Montclair, NJ, USA, c University of North Carolina, Chapel Hill, NC, USA, d Social & Scientific Systems, Inc., Durham, NC, USA, e RTI International, Durham, NC, USA, f Boston University, Boston, MA, USA, g National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, USA Purpose: The Deepwater Horizon disaster spilled over 4.9 million barrels of oil into the Gulf of Mexico, severely affecting the entire region. Individuals involved in the clean-up response may have been disproportionately affected, with consequences for their health. Methods: We evaluated the impact of oil spill response and clean-up (OSRC) exposures on the mental health of workers using data from the GuLF STUDY. A total of 8,968 workers and 2,225 non-workers completed a home exam that included standardized scales of mental health indicators. Results: OSRC work was associated with increased prevalence of depression, PRDep¼1.22 (1.08, 1.37) and PTSD, PRPTSD ¼1.35 (1.07, 1.71). Among workers, those who reported smelling oil, dispersants or cleaning chemicals had an elevated prevalence of depression, PRDep¼1.58 (1.38, 1.81) and PTSD, PRPTSD¼2.29 (1.71, 3.07). Other factors associated with depression and PTSD included stopping work because of the heat (PRDep¼1.36 [1.22, 1.52] and PRPTSD ¼1.41 [1.14, 1.74]) and working as a commercial fisherman prior to the spill (PRDep¼1.36 [1.19, 1.56]; PRPTSD ¼1.86 [1.46, 2.38]). Increasing exposure to total hydrocarbons (TH) appeared associated with depression and PTSD, but after taking into account work experiences, only the association between the highest TH level (3ppm) and PTSD remained, PRPTSD¼1.75 (1.11, 2.76). Conclusions: One to three years after the Deepwater Horizon oil spill, workers with higher levels of exposure to oil spill chemicals or potentially stressful work experiences had increased prevalence of depression and PTSD. Professionals who treat these workers should be aware of the potential mental health consequences of clean-up activities.
P41. Influence of Ambient Air Pollution on Daily Television Use among Residents in Shanghai, China: A Time Series Analysis Ruopeng An,a Sheng Zhangb. a University of Illinois at Urbana-Champaign, Champaign, IL, USA, b Shanghai University of Sport, Yangpu Qu, Shanghai Shi, China
515
Purpose: Although the adverse effects of ambient air pollution on health outcomes have been extensively documented, much less is known regarding its impact on people’s health behavior. This study examined the impact of daily ambient air pollution on television use among residents in Shanghai, China. Methods: Device-measured daily average duration of television use from January 2014 to December 2016 was obtained from a random sample of 300 households, and were matched to ambient air pollution and weather data. Autoregressive moving-average model was performed to estimate the association between air quality index (AQI) and television use. Results: A negative non-linear relationship was identified between air pollution level and television use. Compared to the days when air quality was good (0AQI50), days with fair air quality (50150) were associated with a reduction in daily average television use by 2.9 (p¼0.002), 4.6 (p<0.001), and 1.9 (p¼0.369) minutes, respectively. Television use was found to decrease with daytime temperature while increase on weekend days, holidays, and rainy days. Conclusions: Modest but not more severe air pollution was found to be associated with reduced television use. People might mitigate the detrimental impact of air pollution by engaging in other indoor activities and/or sleeping. Future individual-level longitudinal studies adopting a comprehensive set of validated measures on sedentary behavior, physical activity, health indicators, and both objectively-monitored and self-perceived ambient air quality are warranted to advance research regarding the influence of air pollution on residents’ health behavior.
Health Services P42. Does Maintaining a Patientphysician Relationship Result in Improved Outcomes of Diabetic Retinopathy in South Carolina?: A 2013-2015 BRFSS Analysis Andrew Broadway, Chelsea Lynes, Betsy Barton, Jacqlyn Atkins, Rhonda Hill, Harley T. Davis. South Carolina Department of Health and Environmental Control Introduction: A patient-physician relationship, particularly one with active collaboration and communication, is associated with improved patient health outcomes. Nationally about 34.6% of people with diabetes are believed to suffer from some form of diabetic retinopathy. Is having a personal doctor associated with prevalence of retinopathy among people with diabetes in South Carolina (SC)? Methods: Data from the SC Behavioral Risk Factor Surveillance System (BRFSS) were obtained from 2013-2015 and restricted to those with selfreported diabetes (n¼5,445). The exposure measured was assessed by the response to the question, “Do you have one person you think of as your personal doctor or health care provider.” The outcome of diabetic retinopathy was determined by the response to the question, “Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?.” Survey logistic regression models were run in SAS 9.4 to obtain unadjusted (OR) and adjusted (aOR) odds ratios and associated 95% confidence intervals (CIs) to assess the association of interest. The adjusted model accounted for potential confounders: race/ethnicity; number of years living with diabetes; ability to afford physicians care; and regularity of eye examinations. Results: People with diabetes who reported not having a regular doctor had two times higher odds (OR: 1.98; 95%CI: 1.34-2.94) of having reported loss of vision or diabetic retinopathy than those who had a regular doctor. After adjusting for covariates, the association attenuated but did not lose significance (aOR: 1.69; 95%CI: 1.11-2.57). Discussion: It has been previously indicated in literature that a physicianpatient relationship may have a beneficial effect on patient outcomes. Our findings were consistent with these assumptions, though we were limited by our data in our ability to assess quality of care and temporality. Adults with diabetes, especially young adults, may see improved health outcomes from attaining a personal physician.
P43. Together We Can Get There: Participatory Assessment of the Needs of Young M/TSM in Quezon City, Philippines Genesis May J. Samonte,a Jessica Raphaela G. Mirano,a John Edgar S. Tiu,a Natasha Denise S. Montevirgen,a Lyka Eunice F. Trinidad,a
Abstracts / Annals of Epidemiology 27 (2017) 504e540
Objective: To test whether effects of multiple (up to 5) disasters on mental health responses were cumulative (additive effects), or whether an earlier disaster produced sensitization (higher) or habituation (lower) responses to a later one. Method: The GROWH study interviewed 1366 southern Louisiana women regarding their exposure to Hurricanes Katrina, Rita, Gustav, and Ike and the Gulf oil spill (measured several ways), and administered validated measures of symptoms of depression and PTSD. Multiple linear and logistic regression with disaster exposures entered singly, combined, and as an interaction were used to model mental health. Results: Both exposure to the oil spill and hurricane disaster exposure were associated with likely depression and PTSD, consistent with a cumulative model, but we did not find statistical interactions that would suggest sensitization or habituation. When results were examined with continuous symptom measures of depression and PTSD, they were similar, with the exception that exposure to the oil spill and experiencing illness or injury due to the hurricane disaster showed a significant interaction (p<0.05) in a manner consistent with a sensitization effect when predicting PTSD symptoms. The results of this study point mainly to a cumulative risk for the mental health effects of multiple disasters, although some indication of sensitization occurred among those with particularly severe experiences. There was no evidence for habituation. Conclusions: These findings may guide efforts to assist those in regions experiencing multiple disasters that occur in close sequence.
P36. The Gulf oil spill, miscarriage, and infertility: The GROWH Study Emily Harville, Arti Shankar, Leah Zilversmit, Pierre Buekens. Tulane University, New Orleans, LA, USA Purpose: To examine whether reported exposure to the oil spill was related to reproductive failure (reported miscarriage or infertility). Methods: 1524 women aged 18-45 recruited through prenatal and WIC clinics, and community events were interviewed about their experience of the oil spill and reproductive history. 1434 women had information on outcomes of at least one pregnancy, and 633 on a pregnancy both before and after the spill. Generalized estimating equations were used to examine the relationship between contact with oil and economic and social consequences of the spill with postponement of pregnancy, miscarriage, and infertility (time to pregnancy >12 months or reported fertility issues), with adjustment for age, race, BMI, smoking, and socioeconomic status. Results were compared for pregnancies occurring prior to and after the oil spill. Results: 77 (5.1%) women reported postponing pregnancy due to the oil spill, which was more common in those with high contact with oil or overall high exposure (aOR 2.92, 95% CI 1.31-6.51). An increased risk of miscarriage was found with any exposure to the oil spill (aOR, 1.54, 95% CI 1.17-2.02). Fertility issues were more common in the overall most highly exposed women (aOR 1.88, 1.19-2.95), when the data were limited to those with pregnancies before and after. However, no particular aspect of oil spill exposure was strongly associated with the outcomes, and effects were almost as strong for pregnancies prior to the oil spill. Conclusions: This study does not indicate strong effects of chemical exposure to the oil spill on reproductive failure in humans.
P37. Obesity, Air Pollution and Lung Function: Findings from the Survey of the Health of Wisconsin (SHOW) Kristen Chossek Malecki, Amy Schultz, Maria Nikodemova, Tamara LeCaire. Population Health Sciences, University of Wisconsin, Madison, WI, USA Purpose: Obesity may increase human sensitivity to environmental toxicants through multiple mechanisms including inflammation. Obesity has been shown to increase susceptibility of asthma symptoms and severity with exposures to outdoor and indoor pollution in children but few studies have explored obesity as a risk factor for reduced lung function associated with chronic ambient air pollution exposure among adults. Data from the 20082013 Survey of the Health of Wisconsin study were utilized to determine if previously found associations between air pollution and reduced lung
function were modified by obesity status among non-asthmatic adults age 21-74 (n¼2011). Results: Multiple linear regression analysis using survey procedures to account for complex design and spatial clustering were used to estimate the association between chronic 3-year average fine particulate matter (PM2.5) exposure and lung function measured by FEV1 (forced exploratory volume in 1 second (L/sec). Air pollution exposure was estimated using the USEPA’s Bayesian space-time downscaler model for PM2.5, and body mass index was calculated using measured height and weight. Methods: Overall, average FEV1 was 2.98 L (SD .89) and 3-year average PM2.5 was 10.5 mg/m3. In fully adjusted models, a five-unit increase in PM2.5 was associated with a -0.18 L/s (CI -0.32, -0.04) reduction in FEV1 among nonasthmatics. In stratified analyses, larger effects were seen in obese with BMI over 30 (B¼ -0.23, CI -0.29, -0.17) than non-obese (B¼ -0.15, CI -0.16, -0.14). No significant interactions between air pollution and BMI were observed in the total sample, however, among obese, air pollution and BMI interaction terms were significant (p<.001). Conclusions: Results suggest obese individuals may be more prone to adverse effects of ambient air pollution on lung function even with relatively low chronic exposures. Additional research is needed to track longitudinal changes overtime and understand the biologic underpinnings of observed sensitivity among obese.
P38. Association of Perfluoroalkyl substances with Hyperuricemia and Gout Franco Scinicariello, Lina Balluz. Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, 30341 USA Introduction: Previous population cross-sectional studies have reported a positive association of perfluoroalkyl and polyfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), with hyperuricemia and chronic kidney diseases (CKD) defined as estimate glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2. Aim of the study: To investigate whether there is an association between exposure to PFAS, and serum uric acid and gout in the adult population (20 -85 years) of the National Health and Nutrition Examination Survey (NHANES) 2009-2012 (n¼3248). PFAS includes PFOA, PFOS perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Methods: Multivariate logistic regression were performed to analyze the association of PFAS with hyperuricemia and self-reported gout. Serum PFOA, PFNA, PFOS and PFHxA were analyzed as quartiles. Multivariate linear regression were performed to analyze the association of PFAS with uric acid and eGFR. Analyses were also restricted to individuals with normal eGFR. Results: The weighted prevalence of hyperuricemia was 17.7 % (95% CI: 15.8% e 19.73%), and of self-reported gout was 3.2 % (95% CI: 2.5% e 4.1%). After adjustment for demographic, socioeconomic and other potential confounders, all four PFAS investigated were associate with increased serum uric acid and decreased eGRF. There were statistically significant associations between the highest quartile of PFOA, PFNA and PFHxS, but not PFOS, and hyperuricemia. These association were confirmed for PFOA and PFNA, but not PFHxS when the analyses were restricted to participants with normal eGFR.The adjusted odd ratio for gout among participants in the 4th PFOA quartile was 2.80 (95% CI: 1.16, 6.74) compared the 1st PFOA quartile. The positive association was also found when the analyses excludes individuals with CKD. Conclusions: In this large population cross-sectional analysis, we found an association between PFOA with self-reported gout. We also confirmed previous reports of an association of PFAS with hyperuricemia and decreased eGFR. Longitudinal studies examining the relationship of PFAS renal function are needed.
P39. A Longitudinal Study on the Impact of Ambient Temperature on Monthly Cerebrovascular Mortality in Greater Lisbon Mónica Rodrigues, Maria do Rosário de Oliveira Martins. Institute of Hygiene and Tropical Medicine (IHMT) NOVA University of Lisbon
Abstracts / Annals of Epidemiology 27 (2017) 504e540
Purpose: Cerebrovascular disease remains a leading cause of death in Portugal, and monitoring its occurrence is valuable to health care providers. The primary goal of this study was to analyze the relationship between incidence of cerebrovascular death by age and sex and weather, measured by temperature, over a period of 14 years. Methods: Monthly cerebrovascular deaths (ICD - 10: I60eI69) were provided by the National Institute of Statistics by sex and age (0e64 and 65 years), from 1998 to 2012 for Greater Lisbon, Portugal. Meteorological data were ex- tracted from European Climate Assessment & Dataset project. Monthly average ambient temperature was used as an indicator of weather conditions. Several negative binomial generalized additive models were estimated using different co- variate combinations and the final model was selected using Akaike Information Criterion and Restricted Maximum Likelihood. We used a 5% significance level and R software package. Results: Over the 14 years, the probability of dying from cerebrovascular disease in Greater Lisbon decreased by 5.9% and the temperature increased by 0,2◦C. In the multivariate model, we found that, adjusting for other factors cere- brovascular deaths are 82% higher for males; however if we consider only those with 65 years or more, this figure is inverted (34% lower for men). Furthermore, the probability of dying from cerebrovascular disease was significantly higher for older people and positively associated with monthly temperature. Conclusions: Although the probability of dying from cerebrovascular dis- ease has declined over time, it is higher for men, older people and associated with higher temperature. In Greater Lisbon, monitoring this disease should be a priority for health care planning, namely if we consider the actual context of climate change in this region and in Portugal as a whole.
P40. Mental Health Effects Associated with the 2010 Deepwater Horizon Oil-Spill Richard K. Kwok,a Sarah R. Lowe,b Lawrence S. Engel,c John A. McGrath,d W. Braxton Jackson II ,d Matthew D. Curry,d Julianne Payne,e Sandro Galea,f Dale P. Sandlerg. a Epidemiology Branch, NIEHS, NIH, Department of Health and Human Services, Research Triangle Park, NC, USA, b Montclair State University, Montclair, NJ, USA, c University of North Carolina, Chapel Hill, NC, USA, d Social & Scientific Systems, Inc., Durham, NC, USA, e RTI International, Durham, NC, USA, f Boston University, Boston, MA, USA, g National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, USA Purpose: The Deepwater Horizon disaster spilled over 4.9 million barrels of oil into the Gulf of Mexico, severely affecting the entire region. Individuals involved in the clean-up response may have been disproportionately affected, with consequences for their health. Methods: We evaluated the impact of oil spill response and clean-up (OSRC) exposures on the mental health of workers using data from the GuLF STUDY. A total of 8,968 workers and 2,225 non-workers completed a home exam that included standardized scales of mental health indicators. Results: OSRC work was associated with increased prevalence of depression, PRDep¼1.22 (1.08, 1.37) and PTSD, PRPTSD ¼1.35 (1.07, 1.71). Among workers, those who reported smelling oil, dispersants or cleaning chemicals had an elevated prevalence of depression, PRDep¼1.58 (1.38, 1.81) and PTSD, PRPTSD¼2.29 (1.71, 3.07). Other factors associated with depression and PTSD included stopping work because of the heat (PRDep¼1.36 [1.22, 1.52] and PRPTSD ¼1.41 [1.14, 1.74]) and working as a commercial fisherman prior to the spill (PRDep¼1.36 [1.19, 1.56]; PRPTSD ¼1.86 [1.46, 2.38]). Increasing exposure to total hydrocarbons (TH) appeared associated with depression and PTSD, but after taking into account work experiences, only the association between the highest TH level (3ppm) and PTSD remained, PRPTSD¼1.75 (1.11, 2.76). Conclusions: One to three years after the Deepwater Horizon oil spill, workers with higher levels of exposure to oil spill chemicals or potentially stressful work experiences had increased prevalence of depression and PTSD. Professionals who treat these workers should be aware of the potential mental health consequences of clean-up activities.
P41. Influence of Ambient Air Pollution on Daily Television Use among Residents in Shanghai, China: A Time Series Analysis Ruopeng An,a Sheng Zhangb. a University of Illinois at Urbana-Champaign, Champaign, IL, USA, b Shanghai University of Sport, Yangpu Qu, Shanghai Shi, China
515
Purpose: Although the adverse effects of ambient air pollution on health outcomes have been extensively documented, much less is known regarding its impact on people’s health behavior. This study examined the impact of daily ambient air pollution on television use among residents in Shanghai, China. Methods: Device-measured daily average duration of television use from January 2014 to December 2016 was obtained from a random sample of 300 households, and were matched to ambient air pollution and weather data. Autoregressive moving-average model was performed to estimate the association between air quality index (AQI) and television use. Results: A negative non-linear relationship was identified between air pollution level and television use. Compared to the days when air quality was good (0AQI50), days with fair air quality (50
Health Services P42. Does Maintaining a Patientphysician Relationship Result in Improved Outcomes of Diabetic Retinopathy in South Carolina?: A 2013-2015 BRFSS Analysis Andrew Broadway, Chelsea Lynes, Betsy Barton, Jacqlyn Atkins, Rhonda Hill, Harley T. Davis. South Carolina Department of Health and Environmental Control Introduction: A patient-physician relationship, particularly one with active collaboration and communication, is associated with improved patient health outcomes. Nationally about 34.6% of people with diabetes are believed to suffer from some form of diabetic retinopathy. Is having a personal doctor associated with prevalence of retinopathy among people with diabetes in South Carolina (SC)? Methods: Data from the SC Behavioral Risk Factor Surveillance System (BRFSS) were obtained from 2013-2015 and restricted to those with selfreported diabetes (n¼5,445). The exposure measured was assessed by the response to the question, “Do you have one person you think of as your personal doctor or health care provider.” The outcome of diabetic retinopathy was determined by the response to the question, “Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?.” Survey logistic regression models were run in SAS 9.4 to obtain unadjusted (OR) and adjusted (aOR) odds ratios and associated 95% confidence intervals (CIs) to assess the association of interest. The adjusted model accounted for potential confounders: race/ethnicity; number of years living with diabetes; ability to afford physicians care; and regularity of eye examinations. Results: People with diabetes who reported not having a regular doctor had two times higher odds (OR: 1.98; 95%CI: 1.34-2.94) of having reported loss of vision or diabetic retinopathy than those who had a regular doctor. After adjusting for covariates, the association attenuated but did not lose significance (aOR: 1.69; 95%CI: 1.11-2.57). Discussion: It has been previously indicated in literature that a physicianpatient relationship may have a beneficial effect on patient outcomes. Our findings were consistent with these assumptions, though we were limited by our data in our ability to assess quality of care and temporality. Adults with diabetes, especially young adults, may see improved health outcomes from attaining a personal physician.
P43. Together We Can Get There: Participatory Assessment of the Needs of Young M/TSM in Quezon City, Philippines Genesis May J. Samonte,a Jessica Raphaela G. Mirano,a John Edgar S. Tiu,a Natasha Denise S. Montevirgen,a Lyka Eunice F. Trinidad,a