Multiple studies have already shown the impact of health behaviour and the environment, including air pollutants, on cardiovascular and respiratory health. Whether these environmental indicators affect mental health is nonetheless still under debate. Furthermore, as people do not stay at the same place the whole day, it is difficult to assess their actual exposure. Using internal biomarkers of exposure (measurable biological indicator of exposure condition) and early health effect will enable Sciensano to gain more insight in these subjects.
Human health is determined by health behavior such as smoking and by exposures like residential green space and air pollution. While residential green space has been associated with multiple positive health outcomes such as a lower adiposity level, higher birthweight and higher self-rated health, exposure to air pollution and smoking have been associated with respiratory and cardiovascular disorders
Air pollution modelling is most often used to assess air pollution exposure and smoking behavior is typically self-reported in surveys. Although these models and surveys are validated, risks might be considerably underestimated because of exposure misclassification. Ambient concentrations of air pollutants at potentially harmful levels are ubiquitous in urban areas and subject to high spatial and temporal variability. At the same time, every individual has unique activity patterns. Similarly, quantifying smoking behaviour is challenging because this is typically self-reported in surveys and research showed that self-reported smoking is often underestimated. Epidemiological studies based on surveys, spatial temporal interpolation models or personal monitoring are extremely valuable. Nevertheless, their scientific contribution can be enhanced and integrated thanks to biomarkers. The latter have been introduced under the assumption that they could improve scientific research on health effects of air pollution and other exposures by:
- improving the personal exposure assessment because of the close biological link with the individual;
- increasing the understanding of action mechanisms, e.g. by measuring intermediate biomarkers;
- allowing the investigation of individual susceptibility.
HuBiHIS aims to investigate in a human biomonitoring study (participants ≥ 18 years) whether the outdoor environment (air pollution and surrounding greenness) and health behaviour (smoking) contributes to cardiovascular, respiratory and mental health in Belgium by integrating biomarkers of exposure and early health effects.
The overall objective of the HuBiHIS project is to complement the Health Interview Survey (HIS 2018) and the Belgian Health Examination Survey (BELHES) with biological samples to assess individual measures of environmental exposures, health behaviour and early health effects.
Specific objectives of the study
- To assess residential air pollution and green space in association with respiratory, cardiovascular and mental health in an adult/elderly population;
- To assess smoking in association with respiratory, cardiovascular and mental health based on the smoking questionnaire data and the cotinine concentrations;
- To perform a mediation analysis in which we evaluate if the biomarkers of biological aging are a mediator of the association between residential green space and respiratory, cardiovascular and mental health in an adult/elderly population;
- To perform a mediation analysis in which we evaluate if the biomarkers of biological aging are a mediator of the association between air pollution, represented by urinary BC, and respiratory, cardiovascular and mental health in an adult/elderly population;
- To perform a mediation analysis in which we evaluate if the biomarkers of biological aging are a mediator of the association between smoking, represented by cotinine, and respiratory, cardiovascular and mental health status in an adult/elderly population;
- To assess the association between air pollution, black carbon and polycyclic aromatic hydrocarbons.
Added value at the scientific level
The use of biomarkers will improve personal exposure assessment, as they strengthen the link with the individual. Furthermore, they improve the understanding of the underlying mechanisms ruling the environmental exposure and health effects.
Added value for public health
Biological samples and individual measures of environmental exposure will offer an added value in several domains of public health, as they offer an objective assessment base for monitoring. The HuBiHIS project will include for the first time a feasibility study to assess the health effects of air pollution exposure in Belgium using biomarkers of exposure and effect.