Imperial College London

DrRachelSmith

Faculty of MedicineSchool of Public Health

Research Fellow in Population Child Health
 
 
 
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Contact

 

+44 (0)20 7594 3313rachel.smith05

 
 
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Location

 

527Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

33 results found

Traini E, Smith RB, Vermeulen R, Kromhout H, Schüz J, Feychting M, Auvinen A, Poulsen AH, Deltour I, Muller DC, Heller J, Tettamanti G, Elliott P, Huss A, Toledano MBet al., 2024, Headache in the international cohort study of mobile phone use and health (COSMOS) in the Netherlands and the United Kingdom, Environmental Research, Vol: 248, ISSN: 0013-9351

Headache is a common condition with a substantial burden of disease worldwide. Concerns have been raised over the potential impact of long-term mobile phone use on headache due to radiofrequency electromagnetic fields (RF-EMFs). We explored prospectively the association between mobile phone use at baseline (2009-2012) and headache at follow-up (2015-2018) by analysing pooled data consisting of the Dutch and UK cohorts of the Cohort Study of Mobile Phone Use and Health (COSMOS) (N = 78,437). Frequency of headache, migraine, and information on mobile phone use, including use of hands-free devices and frequency of texting, were self-reported. We collected objective operator data to obtain regression calibrated estimates of voice call duration. In the model mutually adjusted for call-time and text messaging, participants in the high category of call-time showed an adjusted odds ratio (OR) of 1.04 (95 % CI: 0.94-1.15), with no clear trend of reporting headache with increasing call-time. However, we found an increased risk of weekly headache (OR = 1.40, 95 % CI: 1.25-1.56) in the high category of text messaging, with a clear increase in reporting headache with increasing texting. Due to the negligible exposure to RF-EMFs from texting, our results suggest that mechanisms other than RF-EMFs are responsible for the increased risk of headache that we found among mobile phone users.

Journal article

Fussell J, Jauniaux E, Smith R, Burton Get al., 2024, Ambient air pollution and adverse birth outcomes: a review of underlying mechanisms, British journal of obstetrics and gynaecology, Vol: 131, Pages: 538-550, ISSN: 0306-5456

Epidemiological data provide varying degrees of evidence for associations between prenatal exposure to ambient air pollutants and adverse birth outcomes (suboptimal measures of fetal growth, preterm birth and stillbirth). To assess further certainty of effects, this review examines the experimental literature base to identify mechanisms by which air pollution (particulate matter, nitrogen dioxide and ozone) could cause adverse effects on the developing fetus. It likely that this environmental insult impacts multiple biological pathways important for sustaining a healthy pregnancy, depending upon the composition of the pollutant mixture and the exposure window owing to changes in physiologic maturity of the placenta, its circulations and the fetus as pregnancy ensues. The current body of evidence indicates that the placenta is a target tissue, impacted by a variety of critical processes including nitrosative/oxidative stress, inflammation, endocrine disruption, epigenetic changes, as well as vascular dysregulation of the maternal-fetal unit. All of the above can disturb placental function and, as a consequence, could contribute to compromised fetal growth as well increasing the risk of stillbirth. Furthermore, given that there is often an increased inflammatory response associated with preterm labour, inflammation is a plausible mechanism mediating the effects of air pollution on premature delivery. In the light of increased urbanisation and an ever-changing climate, both of which increase ambient air pollution and negatively affect vulnerable populations such as pregnant individuals, it is hoped that the collective evidence may contribute to decisions taken to strengthen air quality policies, reductions in exposure to air pollution and subsequent improvements in the health of those not yet born.

Journal article

Feychting M, Schüz J, Toledano MB, Vermeulen R, Auvinen A, Harbo Poulsen A, Deltour I, Smith RB, Heller J, Kromhout H, Huss A, Johansen C, Tettamanti G, Elliott Pet al., 2024, Mobile phone use and brain tumour risk - COSMOS, a prospective cohort study., Environ Int, Vol: 185

BACKGROUND: Each new generation of mobile phone technology has triggered discussions about potential carcinogenicity from exposure to radiofrequency electromagnetic fields (RF-EMF). Available evidence has been insufficient to conclude about long-term and heavy mobile phone use, limited by differential recall and selection bias, or crude exposure assessment. The Cohort Study on Mobile Phones and Health (COSMOS) was specifically designed to overcome these shortcomings. METHODS: We recruited participants in Denmark, Finland, the Netherlands, Sweden, and the UK 2007-2012. The baseline questionnaire assessed lifetime history of mobile phone use. Participants were followed through population-based cancer registers to identify glioma, meningioma, and acoustic neuroma cases during follow-up. Non-differential exposure misclassification was reduced by adjusting estimates of mobile phone call-time through regression calibration methods based on self-reported data and objective operator-recorded information at baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for glioma, meningioma, and acoustic neuroma in relation to lifetime history of mobile phone use were estimated with Cox regression models with attained age as the underlying time-scale, adjusted for country, sex, educational level, and marital status. RESULTS: 264,574 participants accrued 1,836,479 person-years. During a median follow-up of 7.12 years, 149 glioma, 89 meningioma, and 29 incident cases of acoustic neuroma were diagnosed. The adjusted HR per 100 regression-calibrated cumulative hours of mobile phone call-time was 1.00 (95 % CI 0.98-1.02) for glioma, 1.01 (95 % CI 0.96-1.06) for meningioma, and 1.02 (95 % CI 0.99-1.06) for acoustic neuroma. For glioma, the HR for ≥ 1908 regression-calibrated cumulative hours (90th percentile cut-point) was 1.07 (95 % CI 0.62-1.86). Over 15 years of mobile phone use was not associated with an increased tumour risk; for gl

Journal article

Shen C, Smith RB, Heller J, Spiers ADV, Thompson R, Ward H, Roiser JP, Nicholls D, Toledano MBet al., 2024, Depression and anxiety in adolescents during the COVID-19 pandemic in relation to the use of digital technologies: longitudinal cohort study, Journal of Medical Internet Research, Vol: 26, ISSN: 1438-8871

BACKGROUND: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. OBJECTIVE: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. METHODS: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. RESULTS: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3%; anxiety: 125/425, 29.4%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5%; anxiety: 58/425, 13.6%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95% CI 1.5-4.18) and anxiety (OR 2.11, 95% CI 1.23-3.61) at T2. A high level of total mobile

Journal article

Patjamontri S, Spiers A, Smith R, Shen C, Adaway J, Keevil BG, Toledano M, Ahmed SFet al., 2023, Salivary androgens in adolescence and their value as a marker of puberty: results from the SCAMP cohort, Endocrine Connections, Vol: 12, ISSN: 2049-3614

Context: Salivary androgens represent non-invasive biomarkers of puberty that may have utility in clinical and population studies.Objective: To understand normal age-related variation in salivary sex steroids and demonstrate their correlation to pubertal development in young adolescents.Design, Setting, and participants: School-based cohort study of 1,495 adolescents at two time points for collecting saliva samples approximately two years apart.Outcome measures: The saliva samples were analyzed for five androgens (testosterone, androstenedione (A4), 17-hydroxyprogesterone (17-OHP), 11-ketotestosterone (11-KT) and 11β-hydroxyandrostenedione (11-OHA4)) using LC-MS/MS; in addition, salivary dehydroepiandrosterone (DHEA) and oestradiol (OE2) were analyzed by ELISA. Pubertal staging was self-reported using the pubertal development scale (PDS).Results: In 1,236 saliva samples from 903 boys aged between 11-16 years, salivary androgens except DHEA exhibited an increasing trend with an advancing age (ANOVA, p<0.001), with salivary testosterone and A4 concentration showing the strongest correlation (r=0.55, p<0.001 and r=0.48, p<0.001, respectively). In a subgroup analysis of 155 and 63 saliva samples in boys and girls, respectively morning salivary testosterone concentrations showed the highest correlation with composite PDS scores and voice-breaking category from PDS self-report in boys (r=0.75, r=0.67, respectively). In girls, salivary DHEA and OE2 had negligible correlations with age or composite PDS scores.Conclusion: In boys aged 11-16 years, increase in salivary testosterone and A4 is associated with self-reported pubertal progress and represent valid non-invasive biomarkers of puberty in boys.

Journal article

Reedijk M, Portengen L, Auvinen A, Kojo K, Heinävaara S, Feychting M, Tettamanti G, Hillert L, Elliott P, Toledano M, Smith R, Heller J, Schüz J, Deltour I, Harbo Poulsen A, Johansen C, Verheij R, Peeters P, Rookus M, Traini E, Huss A, Kromhout H, Vermeulen Ret al., 2023, Regression calibration of self-reported mobile phone use to optimize quantitative risk estimation in the COSMOS study, American Journal of Epidemiology, ISSN: 0002-9262

Journal article

Thompson R, Smith RB, Bou Karim Y, Shen C, Drummond K, Teng C, Toledano MBet al., 2023, Air pollution and human cognition: a systematic review and meta-analysis, Science of the Total Environment, Vol: 859, ISSN: 0048-9697

Background:This systematic review summarises and evaluates the literature investigating associations between exposure to air pollution and general population cognition, which has important implications for health, social and economic inequalities, and human productivity.Methods:The engines MEDLINE, Embase Classic+Embase, APA PsycInfo, and SCOPUS were searched up to May 2022. Our inclusion criteria focus on the following pollutants: particulate matter, NOx, and ozone. The cognitive abilities of interest are: general/global cognition, executive function, attention, working memory, learning, memory, intelligence and IQ, reasoning, reaction times, and processing speed. The collective evidence was assessed using the NTP-OHAT framework and random-effects meta-analyses.Results:Eighty-six studies were identified, the results of which were generally supportive of associations between exposures and worsened cognition, but the literature was varied and sometimes contradictory. There was moderate certainty support for detrimental associations between PM2.5 and general cognition in adults 40+, and PM2.5, NOx, and PM10 and executive function (especially working memory) in children. There was moderate certainty evidence against associations between ozone and general cognition in adults age 40+, and NOx and reasoning/IQ in children. Some associations were also supported by meta-analysis (N = 14 studies, all in adults aged 40+). A 1 μg/m3 increase in NO2 was associated with reduced performance on general cognitive batteries (β = −0.02, p < 0.05) as was a 1 μg/m3 increase in PM2.5 exposure (β = −0.02, p < 0.05). A 1μgm3 increase in PM2.5 was significantly associated with lower verbal fluency by −0.05 words (p = 0.01) and a decrease in executive function task performance of −0.02 points (p < 0.001).Discussion:Evidence was found in support of some exposure-outcome associations, however more good quality research is required, particula

Journal article

Schmutz C, Burgler A, Ashta N, Soenksen J, Karim YB, Shen C, Smith RB, Jenkins RH, Mireku MO, Mutz J, Maes MJA, Hirst R, Chang I, Fleming C, Mussa A, Kesary D, Addison D, Maslanyj M, Toledano MB, Roosli M, Eeftens Met al., 2022, Personal radiofrequency electromagnetic field exposure of adolescents in the Greater London area in the SCAMP cohort and the association with restrictions on permitted use of mobile communication technologies at school and at home, Environmental Research, Vol: 212, ISSN: 0013-9351

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction).We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz–3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day.Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m2 at home, 94 μW/m2 at school, and 100 μW/m2 overall. In general, restrictions at school or at home made little difference for adolescents’ measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure.Total ex

Journal article

Spiers A, Patjamontri S, Smith RB, Shen C, Toledano MB, Ahmed SFet al., 2022, Urinary gonadotrophins as markers of puberty in girls and boys during late childhood and adolescence: Evidence from the SCAMP Cohort, Publisher: KARGER, Pages: 342-342, ISSN: 1663-2818

Conference paper

Vu TV, Stewart GB, Kitwiroon N, Lim S, Barratt B, Kelly FJ, Thompson R, Smith RB, Toledano MB, Beevers SDet al., 2022, Assessing the contributions of outdoor and indoor sources to air quality in London homes of the SCAMP cohort, Building and Environment, Vol: 222, Pages: 1-8, ISSN: 0360-1323

Given that many people typically spend the majority of their time at home, accurate measurement and modelling of the home environment is critical in estimating their exposure to air pollution. This study investigates the fate and impact on human exposure of outdoor and indoor pollutants in London homes, using a combination of sensor measurements, outdoor air pollution estimated from the CMAQ-urban model and indoor mass balance models. Averaged indoor concentrations of PM2.5, PM10 and NO2 were 14.6, 24.7 and 14.2 μg m−3 while the outdoor concentrations were 14.4, 22.6 and 21.4 μg m−3, respectively. Mean infiltration factors of particles (0.6–0.7) were higher than those of NO2 (0.4). In contrast, higher loss rates were found for NO2 (0.5–0.8 h−1) compared to those for particles (0.1–0.3 h−1). The average concentrations of PM2.5, PM10 and NO2 in kitchen environments were 22.0, 33.7 and 20.8 μg m−3, with highest hourly concentrations (437, 644 and 136 μg m−3, respectively) during cooking times (6–7 pm). Indoor sources increased the indoor concentrations of particles and NO2 by an average of 26–37% in comparison to the indoor background level without indoor sources. Outdoor and indoor air exchange plays an important role in reducing air pollution indoors by 65–86% for particles and 42–65% for NO2.

Journal article

Thompson R, Smith RB, Bou Karim Y, Shen C, Drummond K, Teng C, Toledano MBet al., 2022, Noise pollution and human cognition: An updated systematic review and meta-analysis of recent evidence, Environment International, Vol: 158, Pages: 1-27, ISSN: 0160-4120

BackgroundThis systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition.MethodsWe update a prior review with recent publications (PROSPERO CRD42019151923). The strength of evidence for associations was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. We also conducted random-effects meta-analyses where suitable.Results16 studies were identified and reviewed in tandem with 32 studies previously reviewed by Clark & Paunovic (2018). A meta-analysis from 3 studies found that reading comprehension scores in quiet classrooms were 0.80 (95% confidence interval: 0.40; 1.20) points higher than children in noisier classrooms. Meta-analysis of the impact of 1 dB (dB) increase in environmental noise on reading and language abilities gave a pooled beta coefficient of −0.11(95% confidence interval: −0.32; 0.10). A meta-analysis of Odds Ratios (OR) from 3 studies found higher odds of cognitive impairment in people aged 45 + with higher residential noise exposure (OR 1.40, 95% CI: 1.18;1.61). After qualitative synthesis of remaining studies, there was high quality evidence for an association between environmental noise and cognitive impairment in middle-to-older adults, moderate quality evidence for an association between aircraft noise and reading and language in children, and moderate quality evidence against an association between aircraft noise and executive functioning in children. Generally the literature was supportive for other cognitive outcomes, but with low or very low-quality evidence.DiscussionThe evidence so far suggests that noise exposure is associated with cognition, but more good quality research using standardised methodology is required to corroborate these results and to allow for precise risk estimation by larger meta-analyses. There is also a need for more research with older teenagers and young-to

Journal article

Patjamontri S, Spiers ADV, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed Fet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, European Society for Paediatric Endocrinology

Introduction: Salivary androgens represent a non-invasive marker of puberty that may have utility in population studies as well as in the clinical arena.Objectives: To establish normal reference values of salivary androgens using LC-MS/MS and demonstrate the correlations between salivary androgens and pubertal development in boys.Methods: School-based adolescent cohort study with two time points for collecting saliva samples two years apart. Five androgens (Testosterone;T, androstenedione; A4, 17-hydroxyprogesterone; 17-OHP, 11-ketotestosterone; 11-KT and 11β-hydroxyandrostenedione; 11OHA4 were analyzed in saliva samples using LC-MS/MS. In addition, self-reported assessment of puberty through the Pubertal Development Scale (PDS) was also collected at both time points. Receiver-operating characteristic (ROC) curves were used to determine the areas under the curves (AUCs), of each androgen as a predictor of self-reported voice maturation.Results: A total of 1,166 saliva samples were available from 929 boys aged between 11-16 years at either baseline or follow up or both time points with the median age of 12.3 yrs (range 11.3-13.2) and 14.3 yrs (range 13.4-15.8) at baseline and follow up time point, respectively. Median salivary T increased from 7 pmol/l (10th,90th centile, 5, 41) in participants aged 11-12 yrs to 122 pmol/l (21.6, 267.4) in participants aged 15-16 yrs and median salivary A4 increased from 53 pmol/l (26.2, 92.0) in participants aged 11-12 yrs to 144 pmol/l (50.7, 241.2) in participants aged 15-16 yrs. In a subgroup analysis of 147 saliva samples that were collected within 90 days before or after PDS, salivary T and A4 concentrations showed the highest correspondence with self-reported voice-breaking (One-way ANOVA P < 0.005). ROC curve analysis showed that a salivary testosterone of 82.7 pmol/l and a salivary A4 of 113.4 pmol/l provided a sensitivity of 77% and 74%, respectively and a specificity of 76% and 74%, respectively. Salivary T concent

Poster

Patjamontri S, Spiers A, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed SFet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, 59th Annual Meeting of the European Society for Paediatric Endocrinology - 2021, Publisher: KARGER, Pages: 366-366, ISSN: 1663-2818

Conference paper

Smith RB, Beevers SD, Gulliver J, Dajnak D, Fecht D, Blangiardo M, Douglass M, Hansell AL, Anderson HR, Kelly F, Toledano MBet al., 2020, Impacts of air pollution and noise on risk of preterm birth and stillbirth in London, Environment International, Vol: 134, ISSN: 0160-4120

BackgroundEvidence for associations between ambient air pollution and preterm birth and stillbirth is inconsistent. Road traffic produces both air pollutants and noise, but few studies have examined these co-exposures together and none to date with all-cause or cause-specific stillbirths.ObjectivesTo analyse the relationship between long-term exposure to air pollution and noise at address level during pregnancy and risk of preterm birth and stillbirth.MethodsThe study population comprised 581,774 live and still births in the Greater London area, 2006–2010. Outcomes were preterm birth (<37 completed weeks gestation), all-cause stillbirth and cause-specific stillbirth. Exposures during pregnancy to particulate matter with diameter <2.5 μm (PM2.5) and <10 μm (PM10), ozone (O3), primary traffic air pollutants (nitrogen dioxide, nitrogen oxides, PM2.5 from traffic exhaust and traffic non-exhaust), and road traffic noise were estimated based on maternal address at birth.ResultsAn interquartile range increase in O3 exposure was associated with elevated risk of preterm birth (OR 1.15 95% CI: 1.11, 1.18, for both Trimester 1 and 2), all-cause stillbirth (Trimester 1 OR 1.17 95% CI: 1.07, 1.27; Trimester 2 OR 1.20 95% CI: 1.09, 1.32) and asphyxia-related stillbirth (Trimester 1 OR 1.22 95% CI: 1.01, 1.49). Odds ratios with the other air pollutant exposures examined were null or <1, except for primary traffic non-exhaust related PM2.5, which was associated with 3% increased odds of preterm birth (Trimester 1) and 7% increased odds stillbirth (Trimester 1 and 2) when adjusted for O3. Elevated risk of preterm birth was associated with increasing road traffic noise, but only after adjustment for certain air pollutant exposures.DiscussionOur findings suggest that exposure to higher levels of O3 and primary traffic non-exhaust related PM2.5 during pregnancy may increase risk of preterm birth and stillbirth; and a possible relationship between long-term traff

Journal article

Freni Sterrantino A, Afoakwah P, Smith RB, Ghosh R, Hansell ALet al., 2019, Birth weight centiles and small for gestational age by sex and ethnicity for England and Wales, Archives of Disease in Childhood, Vol: 104, Pages: 1188-1192, ISSN: 1468-2044

Objectives To construct UK Ethnic Birth Weight Centiles (UK-EBWC) for gestational age and cut-offs for small for gestational age (SGA) for England and Wales and to evaluate the SGA misclassification using the UK centiles.Design Analysis of national birth data.Participants All live singleton births in England and Wales in 2006 to 2012, as recorded by the Office for National Statistics (ONS) and birth registrations, linked with National Health Service (NHS) into Numbers for Babies (NN4B).Main Outcome Measures Both sex-specific and ethnicity-sex-specific birth weight centiles for gestational age, and ethnicity-sex-specific SGA cut-offs. Centiles were computed using the Generalized Additive Model for Location, Scale and Shape (GAMLSS). Results Our sex-specific centiles performed well and showed an agreement between the expected and observed number of births below the centiles. The ethnicity-sex-specific centiles for Black and Asian presented lower values compared to the White centiles. Comparisons of sex-specific and ethnicity-sex-specific centiles shows that use of sex-specific centiles increases the SGA diagnosed cases by 50% for Asian, 30% for South Asian (Indian, Pakistani and Bangladeshi) and 20% for Black ethnicity.Conclusions The centiles show important differences between ethnic groups, in particular the 10th centile used to define SGA. To account for these differences and to minimize misclassification of SGA, we recommend the use of customized birth weight centiles.

Journal article

Ghosh RE, Freni-Sterrantino A, Douglas P, Parkes B, Fecht D, de Hoogh K, Fuller G, Gulliver J, Font A, Smith RB, Blangiardo M, Elliott P, Toledano MB, Hansell ALet al., 2019, Fetal growth, stillbirth, infant mortality and other birth outcomes near UK municipal waste incinerators; retrospective population based cohort and case-control study, Environment International, Vol: 122, Pages: 151-158, ISSN: 0160-4120

Background: Some studies have reported associations between municipal waste incinerator (MWI) exposures and adverse birth outcomes but there are few studies of modern MWIs operating to current European Union (EU) Industrial Emissions Directive standards. Methods: Associations between modelled ground-level particulate matter ≤10 μm in diameter (PM10) from MWI emissions (as a proxy for MWI emissions) within 10 km of each MWI, and selected birth and infant mortality outcomes were examined for all 22 MWIs operating in Great Britain 2003–10. We also investigated associations with proximity of residence to a MWI. Outcomes used were term birth weight, small for gestational age (SGA) at term, stillbirth, neonatal, post-neonatal and infant mortality, multiple births, sex ratio and preterm delivery sourced from national registration data from the Office for National Statistics. Analyses were adjusted for relevant confounders including year of birth, sex, season of birth, maternal age, deprivation, ethnicity and area characteristics and random effect terms were included in the models to allow for differences in baseline rates between areas and in incinerator feedstock. Results: Analyses included 1,025,064 births and 18,694 infant deaths. There was no excess risk in relation to any of the outcomes investigated during pregnancy or early life of either mean modelled MWI PM10 or proximity to an MWI. Conclusions: We found no evidence that exposure to PM10 from, or living near to, an MWI operating to current EU standards was associated with harm for any of the outcomes investigated. Results should be generalisable to other MWIs operating to similar standards.

Journal article

Smith RB, Fecht D, Gulliver J, Beevers S, Dajnak D, Blangiardo M, Ghosh R, Hansell A, Kelly F, Anderson HR, Toledano MBet al., 2017, Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study, BMJ, Vol: 359, ISSN: 1756-1833

Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.Design Retrospective population based cohort study.Setting Greater London and surrounding counties up to the M25 motorway (2317 km2), UK, from 2006 to 2010.Participants 540 365 singleton term live births.Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.Results Average air pollutant exposures across pregnancy were 41 μg/m3 nitrogen dioxide (NO2), 73 μg/m3 nitrogen oxides (NOx), 14 μg/m3 particulate matter with aerodynamic diameter <2.5 μm (PM2.5), 23 μg/m3 particulate matter with aerodynamic diameter <10 μm (PM10), and 32 μg/m3 ozone (O3). Average daytime (LAeq,16hr) and night-time (Lnight) road traffic A-weighted noise levels were 58 dB and 53 dB respectively. Interquartile range increases in NO2, NOx, PM2.5, PM10, and source specific PM2.5 from traffic exhaust (PM2.5 traffic exhaust) and traffic non-exhaust (brake or tyre wear and resuspension) (PM2.5 traffic non-exhaust) were associated with 2% to 6% increased odds of term LBW, and 1% to 3% increased odds of term SGA. Air pollutant associations were robust to adjustment for road traffic noise. Trends of decreasing birth weight across increasing road traffic noise categories were observed, but were strongly attenuated when adjusted for primary traffic related air pollutants. Only PM2.5 traffic exhaust and PM2.5 were consistently associated with increased risk of term LBW after adjustment for each of the other air pollutants. It was estimated that 3% of term LBW cases in London are directly attributable to residential exposure to PM2.5>13.8 μg/m3during pregnancy.Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on b

Journal article

Toledano MB, Auvinen A, Tettamanti G, Cao Y, Feychting M, Ahlbom A, Fremling K, Heinävaara S, Kojo K, Knowles G, Smith RB, Schüz J, Johansen C, Poulsen AH, Deltour I, Vermeulen R, Kromhout H, Elliott P, Hillert Let al., 2017, An international prospective cohort study of mobile phone users and health (COSMOS): Factors affecting validity of self-reported mobile phone use., International Journal of Hygiene and Environmental Health, Vol: 221, Pages: 1-8, ISSN: 1438-4639

This study investigates validity of self-reported mobile phone use in a subset of 75 993 adults from the COSMOS cohort study. Agreement between self-reported and operator-derived mobile call frequency and duration for a 3-month period was assessed using Cohen's weighted Kappa (κ). Sensitivity and specificity of both self-reported high (≥10 calls/day or ≥4h/week) and low (≤6 calls/week or <30min/week) mobile phone use were calculated, as compared to operator data. For users of one mobile phone, agreement was fair for call frequency (κ=0.35, 95% CI: 0.35, 0.36) and moderate for call duration (κ=0.50, 95% CI: 0.49, 0.50). Self-reported low call frequency and duration demonstrated high sensitivity (87% and 76% respectively), but for high call frequency and duration sensitivity was lower (38% and 56% respectively), reflecting a tendency for greater underestimation than overestimation. Validity of self-reported mobile phone use was lower in women, younger age groups and those reporting symptoms during/shortly after using a mobile phone. This study highlights the ongoing value of using self-report data to measure mobile phone use. Furthermore, compared to continuous scale estimates used by previous studies, categorical response options used in COSMOS appear to improve validity considerably, most likely by preventing unrealistically high estimates from being reported.

Journal article

Pedersen M, Mendez MA, Schoket B, Godschalk RW, Espinosa A, Landström A, Villanueva CM, Merlo DF, Fthenou E, Gracia-Lavedan E, van Schooten FJ, Hoek G, Brunborg G, Meltzer HM, Alexander J, Nielsen JK, Sunyer J, Wright J, Kovács K, de Hoogh K, Gutzkow KB, Hardie LJ, Chatzi L, Knudsen LE, Anna L, Ketzel M, Haugen M, Botsivali M, Nieuwenhuijsen MJ, Cirach M, Toledano MB, Smith RB, Fleming S, Agramunt S, Kyrtopoulos SA, Lukács V, Kleinjans JC, Segerbäck D, Kogevinas Met al., 2016, Erratum: “Environmental, Dietary, Maternal, and Fetal Predictors of Bulky DNA Adducts in Cord Blood: A European Mother–Child Study (NewGeneris)”, Environmental Health Perspectives, Vol: 124, Pages: A12-A12, ISSN: 1552-9924

Journal article

Toledano MB, Smith RB, Chang I, Douglass M, Elliott Pet al., 2015, Cohort profile: UK COSMOS – a UK cohort for study of environment and health, International Journal of Epidemiology, Vol: 46, Pages: 775-787, ISSN: 1464-3685

Journal article

Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MBet al., 2015, Birth Weight, Ethnicity, and Exposure to Trihalomethanes and Haloacetic Acids in Drinking Water during Pregnancy in the Born in Bradford Cohort., Environmental Health Perspectives, Vol: 124, Pages: 681-689, ISSN: 1552-9924

BACKGROUND: Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately. OBJECTIVES: We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort. METHODS: Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity. RESULTS: Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ≥ 1.82 vs. < 1.05 μg/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption. CONCLUSIONS: To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa. CITATION: Smith RB

Journal article

Toledano MB, Smith RB, Brook JP, Douglass M, Elliott Pet al., 2015, How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century - Lessons from UK COSMOS., PLOS One, ISSN: 1932-6203

Journal article

Smith RB, Bennett JE, Rantakokko P, Martinez D, Nieuwenhuijsen MJ, Toledano MBet al., 2015, The relationship between MX [3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone], routinely monitored trihalomethanes, and other characteristics in drinking water in a long-term survey, Environmental Science & Technology, Vol: 49, Pages: 6485-6493, ISSN: 1520-5851

MX (3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone) is a drinking water disinfection byproduct (DBP). It is a potent mutagen and is of concern to public health. Data on MX levels in drinking water, especially in the UK, are limited. Our aim was to investigate factors associated with variability of MX concentrations at the tap, and to evaluate if routinely measured trihalomethanes (THMs) are an appropriate proxy measure for MX. We conducted quarterly water sampling at consumers’ taps in eight water supply zones in and around Bradford, UK, between 2007 and 2010. We collected 79 samples which were analyzed for MX using GC-HRMS. Other parameters such as pH, temperature, UV-absorbance and free chlorine were measured concurrently, and total THMs were modeled from regulatory monitoring data. To our knowledge this is the longest MX measurement survey undertaken to date. Concentrations of MX varied between 8.9 and 45.5 ng/L with a median of 21.3 ng/L. MX demonstrated clear seasonality with concentrations peaking in late summer/early fall. Multivariate regression showed that MX levels were associated with total trihalomethanes, UV-absorbance and pH. However, the relationship between TTHM and MX may not be sufficiently consistent across time and location for TTHM to be used as a proxy measure for MX in exposure assessment.

Journal article

Pedersen M, Mendez MA, Schoket B, Godschalk RW, Espinosa A, Landstrom A, Villanueva CM, Merlo DF, Fthenou E, Gracia-Lavedan E, van Schooten F-J, Hoek G, Brunborg G, Meltzer HM, Alexander J, Nielsen JK, Sunyer J, Wright J, Kovacs K, de Hoogh K, Gutzkow KB, Hardie LJ, Chatzi L, Knudsen LE, Anna L, Ketzel M, Haugen M, Botsivali M, Nieuwenhuijsen MJ, Cirach M, Toledano MB, Smith RB, Fleming S, Agramunt S, Kyrtopoulos SA, Lukacs V, Kleinjans JC, Segerback D, Kogevinas Met al., 2015, Environmental, dietary, maternal, and fetal predictors of bulky DNA adducts in cord blood: a European mother-child study (NewGeneris), Environmental Health Perspectives, Vol: 123, Pages: 374-380, ISSN: 0091-6765

Background: Bulky DNA adducts reflect genotoxic exposures, have been associated with lower birth weight, and may predict cancer risk.oBjective: We selected factors known or hypothesized to affect inutero adduct formation and repair and examined their associations with adduct levels in neonates.Methods: Pregnant women from Greece, Spain, England, Denmark, and Norway were recruited in 2006–2010. Cord blood bulky DNA adduct levels were measured by the 32P-postlabeling technique (n=511). Diet and maternal characteristics were assessed via questionnaires. Modeled exposures to air pollutants and drinking-water disinfection by-products, mainly trihalomethanes (THMs), were available for a large proportion of the study population.results: Greek and Spanish neonates had higher adduct levels than the northern European neonates [median, 12.1 (n=179) vs. 6.8 (n=332) adducts per 108 nucleotides, p<0.001].Residence in southern European countries, higher maternal body mass index, delivery by cesarean section, male infant sex, low maternal intake of fruits rich in vitaminC, high intake of dairyproducts, and low adherence to healthy diet score were statistically significantly associated with higher adduct levels in adjusted models. Exposure to fine particulate matter and nitrogen dioxide was associated with significantly higher adducts in the Danish subsample only. Overall, the pooled results for THMs in water show no evidence of association with adduct levels; however, there are country-specific differences in results with a suggestion of an association in England.conclusion: These findings suggest that a combination of factors, including unknown country-specific factors, influence the bulky DNA adduct levels in neonates.citation: Pedersen M, Mendez MA, Schoket B, Godschalk RW, Espinosa A, LandströmA, Villanueva

Journal article

Toledano MB, Smith RB, 2014, Future of EMF epidemiology, Epidemiology of Electromagnetic Fields, Pages: 327-342, ISBN: 9781466568167

Radiofrequency-electromagnetic fields (RF-EMFs) and extremely low frequency (ELF)-magnetic fields have been classified as possibly carcinogenic to humans (Group 2B) on the basis of limited evidence (IARC 2002; Baan et al. 2011). Methodological limitations in epidemiological research and the absence of established biological mechanisms for either RF-EMFs or ELF-MFs to support causal relationships make it difficult to reach firm conclusions. For intermediate frequency (IF)-electromagnetic fields, data on health effects are sparse and too limited for risk assessment (SCENIHR 2009). Without established mechanisms to direct efforts to health endpoints of most relevance for investigation, what is driving continuing research in EMF epidemiology? The one certainty in this research field is that there is significant public concern regarding EMF and potential human health effects. In a survey published in 2010, 46% of the public expressed concern about the potential health risks of EMFs, with more than two-thirds of people believing that their health is affected to some extent by high-voltage power lines, mobile phone masts, and mobile phone handsets, and with 35%, 33%, and 26%, respectively, believing that these EMF sources affect their health to a large extent (Eurobarometer 2010). Is it legitimate for this public concern to drive environmental epidemiological research? The National Institute of Environmental Health Sciences defines environmental public health as “the science of conducting and translating research into action to address environmental exposures and health risks of concern to the public” (NIEHS 2012). Research can provide evidence-based on data rather than speculation-with which to both evaluate the public health question and address legitimate public and policy concerns (Elliott and Wartenberg 2004).

Book chapter

Smith RB, Nieuwenhuijsen MJ, Wright J, Raynor P, Cocker J, Jones K, Kostopoulou-Karadanelli M, Toledano MBet al., 2013, Validation of trichloroacetic acid exposure via drinking water during pregnancy using a urinary TCAA biomarker, ENVIRONMENTAL RESEARCH, Vol: 126, Pages: 145-151, ISSN: 0013-9351

Journal article

Smith RB, Nieuwenhuijsen MJ, Bennett JE, Wright J, Raynor P, Toledano MBet al., 2011, Exposure to Disinfection By-products During Pregnancy, Joint Conference of International-Society-of-Exposure-Science/International-Society-for-Environmental-Epidemiology, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: S122-S122, ISSN: 1044-3983

Conference paper

Kogevinas M, Patelarou E, Villanueva CM, Bustamante M, Cordier S, Grazuleviciene R, Smith RB, Stephanou EG, Kargaki S, Gracia E, Costet N, Danileviciute A, Toledano M, Nieuwenhuijsen Met al., 2011, Disinfection Byproducts, Polymorphisms, and Susceptibility to Adverse Pregnancy Outcomes, Joint Conference of International-Society-of-Exposure-Science/International-Society-for-Environmental-Epidemiology, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: S67-S68, ISSN: 1044-3983

Conference paper

Grellier J, Bennett J, Paterlarou E, Smith RB, Toledano MB, Rushton L, Briggs DJ, Nieuwenhuijsen MJet al., 2010, Exposure to disinfection by-products and adverse birth outcomes related to fetal growth and prematurity - a systematic review and meta-analysis., Epidemiology, Vol: 21, Pages: 300-313

Journal article

Smith RB, Toledano MB, Wright J, Raynor P, Nieuwenhuijsen MJet al., 2009, Tap water use amongst pregnant women in a multi-ethnic cohort., Environmental Health, Vol: 21

Journal article

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