title: Associations between air pollution and perceived stress: the Veterans Administration Normative Aging Study.
abstract: BACKGROUND
  There is mixed evidence suggesting that air pollution may be associated with increased risk of developing psychiatric disorders. We aimed to investigate the association between air pollution and non-specific perceived stress, often a precursor to development of affective psychiatric disorders.
  
  
  METHODS
  This longitudinal analysis consisted of 987 older men participating in at least one visit for the Veterans Administration Normative Aging Study between 1995 and 2007 (n = 2,244 visits). At each visit, participants were administered the 14-item Perceived Stress Scale (PSS), which quantifies stress experienced in the previous week. Scores ranged from 0-56 with higher scores indicating increased stress. Differences in PSS score per interquartile range increase in moving average (1, 2, and 4-weeks) of air pollution exposures were estimated using linear mixed-effects regression after adjustment for age, race, education, physical activity, anti-depressant medication use, seasonality, meteorology, and day of week. We also evaluated effect modification by season (April-September and March-October for warm and cold season, respectively).
  
  
  RESULTS
  Fine particles (PM2.5), black carbon (BC), nitrogen dioxide, and particle number counts (PNC) at moving averages of 1, 2, and 4-weeks were associated with higher perceived stress ratings. The strongest associations were observed for PNC; for example, a 15,997 counts/cm(3) interquartile range increase in 1-week average PNC was associated with a 3.2 point (95%CI: 2.1-4.3) increase in PSS score. Season modified the associations for specific pollutants; higher PSS scores in association with PM2.5, BC, and sulfate were observed mainly in colder months.
  
  
  CONCLUSIONS
  Air pollution was associated with higher levels of perceived stress in this sample of older men, particularly in colder months for specific pollutants.
authors: Department of Environmental Health, Harvard School of Public Health, Landmark Ctr, West 415, 401 Park Dr, Boston, MA, 02215, USA. amehta@hsph.harvard.edu.
authors: Amar J
authors: AJ
authors: Mehta
authors: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA.
authors: Laura D
authors: LD
authors: Kubzansky
authors: Department of Biostatistics, Harvard School of Public Health, Boston, USA.
authors: Brent A
authors: BA
authors: Coull
authors: Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors: Itai
authors: I
authors: Kloog
authors: Department of Environmental Health, Harvard School of Public Health, Landmark Ctr, West 415, 401 Park Dr, Boston, MA, 02215, USA.
authors: Petros
authors: P
authors: Koutrakis
authors: The VA Normative Aging Study, VA Boston Healthcare System, Boston, USA.|The Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.|Department of Medicine, Boston University School of Medicine, Boston, USA.
authors: David
authors: D
authors: Sparrow
authors: The VA Normative Aging Study, VA Boston Healthcare System, Boston, USA.|Department of Epidemiology, Boston University School of Public Health, Boston, USA.|Department of Psychiatry, Boston University School of Medicine, Boston, USA.
authors: Avron
authors: A
authors: Spiro
authors: The VA Normative Aging Study, VA Boston Healthcare System, Boston, USA.|Department of Medicine, Boston University School of Medicine, Boston, USA.
authors: Pantel
authors: P
authors: Vokonas
authors: Department of Environmental Health, Harvard School of Public Health, Landmark Ctr, West 415, 401 Park Dr, Boston, MA, 02215, USA.
authors: Joel
authors: J
authors: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000009:adverse effects*; D001900:Boston; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis*; D011618:Psychotic Disorders / Q000209:etiology*; D012621:Seasons; D053260:Soot / Q000032:analysis; D013315:Stress, Psychological / Q000139:chemically induced*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D053260:Soot; D009585:Nitrogen Dioxide
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