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Environ Health Perspect; DOI:10.1289/ehp.1307541

Evaluating Potential Response-Modifying Factors for Associations between Ozone and Health Outcomes: A Weight-of-Evidence Approach

Lisa C. Vinikoor-Imler,1 Elizabeth O. Owens,1 Jennifer L. Nichols,2 Mary Ross,1 James S. Brown,1 and Jason D. Sacks
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1National Center for Environmental Assessment (NCEA), U.S. Environmental Protection Agency (EPA), Research Triangle Park, North Carolina, USA; 2Oak Ridge Institute for Science and Education, at National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
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Citation: Vinikoor-Imler LC, Owens EO, Nichols JL, Ross M, Brown JS, Sacks JD. Evaluating Potential Response-Modifying Factors forAssociations between Ozone and Health Outcomes:A Weight-of-Evidence Approach. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307541.

Received: 23 August 2013
Accepted: 11 June 2014
Advance Publication: 13 June 2014

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Abstract

Background: Epidemiologic and experimental studies have demonstrated a variety of health effects in response to ozone (O3) exposure. Studies have demonstrated that some populations may be at increased or decreased risk of O3-related health effects.

Objectives: To identify potential response-modifying factors to determine if specific groups of the population or lifestages are at increased or decreased risk of O3-related health effects using a weight-of-evidence approach.

Methods: Epidemiologic, experimental, and exposure science studies of potential factors that may modify the relationship between O3 and health effects were identified in U.S. EPA’s 2013 Integrated Science Assessment for Ozone and Related Photochemical Oxidants. Scientific evidence from studies that examined factors that may influence risk were integrated across disciplines to evaluate consistency, coherence, and biological plausibility of effects. The factors identified were then classified using a weight-of-evidence approach to conclude whether a specific factor modifies the response of a population or lifestage resulting in increased or decreased risk of O3-related health effects.

Discussion: We found “adequate” evidence that populations with certain genotypes, preexisting asthma, and reduced intake of certain nutrients, along with different lifestages and outdoor workers, are at increased risk of O3-related health effects. Additionally, we identified other factors (i.e., sex, SES, and obesity) for which there was “suggestive” evidence that they may increase the risk of O3-related health effects.

Conclusions: Using a weight-of-evidence approach we identified a diverse group of factors that should be considered when characterizing the overall risk of health effects associated with exposures to ambient O3.


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