Response to Letter Regarding Article, “Childhood Air Pollutant Exposure and Carotid Artery Intima–Media Thickness in Young Adults”

We thank Wang et al for their commentary regarding our recently published article relating childhood O3 exposure to carotid intima–media thickness (CIMT) in adulthood.1 The authors suggest that adjustment for additional clinical information may strengthen our conclusion regarding O3 as a novel predictor of CIMT. Specifically, they suggest we include data on childhood dietary patterns, adolescent blood pressure (BP), and glucose tolerance testing. Although we agree that these data are relevant clinical parameters when assessing cardiovascular disease risk and atherosclerosis, it is unlikely that they will act as confounders of our observed association with O3 if they are not related to exposure. First, the evaluation of elementary and lifetime diet, as suggested by the authors, is a daunting task, and one highly susceptible to recall bias. Most food frequency questionnaires are designed to address recall only …