Man-made environmental air pollution and children's health

Ambient air pollution and morbidity were studied by the visits of children under 7 years to a doctor. A total of 950 children living in the areas that are notable for the level and pattern of ambient air pollution were examined. The greater pollution of development lands is, the higher general morbidity and childhood morbidity of respiratory nervous, sensory, skin, and subcutaneous fat diseases are. Ambient air chlorinated and aromatic hydrocarbons may cause a high incidence of biliary and hepatic diseases and chlorinated hydrocarbons in children. Equations have been derived to predict childhood morbidity due to the level and pattern of air pollution.     

A research programme in lifestyle and health: methodological and theoretical considerations

Traditionally, research in health behaviour has been dominated by research ideologies and methods which developed in the health sciences and the social sciences. To a great extent these subjects have followed "classical" research designs propounded by the natural sciences. The result has been a marked dependency on survey research, quasi-experimental designs, case-control studies and other "static" designs. This research has been characterised by brief periods of intensive "data-collection", followed by long periods of analysis and report writing. These research endeavours often constitute an extensive, elaborate, and usually accurate picture of health attitudes, opinions and behaviours at the point of data collection. But they are simply "snapshots" of a group, culture, nation, etc. at one moment in time. This research is not "dynamic" and it is not surprising that despite the considerable amount of health behaviour research which exists, we still know relatively little about the process and dynamics of health behaviour change. Fortunately there is increasing concern, both theoretical and methodological, with the problem of behavioural change over time. On balance, the theoretical arguments are not well developed, however the methodological techniques for exploring continuous data are becoming available. This paper presents one model for an emerging research programme in lifestyle and health which attempts to address some of the theoretical and methodological issues discussed.     

Mapping health on the internet: a new tool for environmental justice and public health research

This paper examines the prospects for integrating Internet platform GIS or 'web-GIS' into environmental justice and related public health research. Specifically, we document the development of a web-GIS created for investigating relationships between health, air quality and socioeconomic factors in Hamilton, Canada. After development of the web-GIS site, we assembled a focus group of public health professionals to test functionality and render opinions about the potential of the site and geographic information in their program implementation. Results show overwhelming support for the further integration of GIS into public health practice. The results also underscore the potential of web-GIS to alleviate concerns of cost and data availability that often limit the use of GIS in community debates centred on environmental justice issues.     

GIS modeling of air toxics releases from TRI-reporting and non-TRI-reporting facilities: impacts for environmental justice

The Toxics Release Inventory (TRI) requires facilities with 10 or more full-time employees that process > 25,000 pounds in aggregate or use > 10,000 pounds of any one TRI chemical to report releases annually. However, little is known about releases from non-TRI-reporting facilities, nor has attention been given to the very localized equity impacts associated with air toxics releases. Using geographic information systems and industrial source complex dispersion modeling, we developed methods for characterizing air releases from TRI-reporting as well as non-TRI-reporting facilities at four levels of geographic resolution. We characterized the spatial distribution and concentration of air releases from one representative industry in Durham County, North Carolina (USA). Inclusive modeling of all facilities rather than modeling of TRI sites alone significantly alters the magnitude and spatial distribution of modeled air concentrations. Modeling exposure receptors at more refined levels of geographic resolution reveals localized, neighborhood-level exposure hot spots that are not apparent at coarser geographic scales. Multivariate analysis indicates that inclusive facility modeling at fine levels of geographic resolution reveals exposure disparities by income and race. These new methods significantly enhance the ability to model air toxics, perform equity analysis, and clarify conflicts in the literature regarding environmental justice findings. This work has substantial implications for how to structure TRI reporting requirements, as well as methods and types of analysis that will successfully elucidate the spatial distribution of exposure potentials across geographic, income, and racial lines.     

Making the environmental justice grade: the relative burden of air pollution exposure in the United States

This paper assesses whether the Clean Air Act and its Amendments have been equally successful in ensuring the right to healthful air quality in both advantaged and disadvantaged communities in the United States. Using a method to rank air quality established by the American Lung Association in its 2009 State of the Air report along with EPA air quality data, we assess the environmental justice dimensions of air pollution exposure and access to air quality information in the United States. We focus on the race, age, and poverty demographics of communities with differing levels of ozone and particulate matter exposure, as well as communities with and without air quality information. Focusing on PM2.5 and ozone, we find that within areas covered by the monitoring networks, non-Hispanic blacks are consistently overrepresented in communities with the poorest air quality. The results for older and younger age as well as poverty vary by the pollution metric under consideration. Rural areas are typically outside the bounds of air quality monitoring networks leaving large segments of the population without information about their ambient air quality. These results suggest that substantial areas of the United States lack monitoring data, and among areas where monitoring data are available, low income and minority communities tend to experience higher ambient pollution levels.     

Personal exposures to traffic-related air pollution and acute respiratory health among Bronx schoolchildren with asthma

Background

Previous studies have reported relationships between adverse respiratory health outcomes and residential proximity to traffic pollution, but have not shown this at a personal exposure level.

Objective

We compared, among inner-city children with asthma, the associations of adverse asthma outcome incidences with increased personal exposure to particulate matter mass ≤ 2.5 μm in aerodynamic diameter (PM_2.5) air pollution versus the diesel-related carbonaceous fraction of PM_2.5.

Methods

Daily 24-hr personal samples of PM_2.5, including the elemental carbon (EC) fraction, were collected for 40 fifth-grade children with asthma at four South Bronx schools (10 children per school) during approximately 1 month each. Spirometry and symptom scores were recorded several times daily during weekdays.

Results

We found elevated same-day relative risks of wheeze [1.45; 95% confidence interval (CI), 1.03–2.04)], shortness of breath (1.41; 95% CI, 1.01–1.99), and total symptoms (1.30; 95% CI, 1.04–1.62) with an increase in personal EC, but not with personal PM_2.5 mass. We found increased risk of cough, wheeze, and total symptoms with increased 1-day lag and 2-day average personal and school-site EC. We found no significant associations with school-site PM_2.5 mass or sulfur. The EC effect estimate was robust to addition of gaseous pollutants.

Conclusion

Adverse health associations were strongest with personal measures of EC exposure, suggesting that the diesel “soot” fraction of PM_2.5 is most responsible for pollution-related asthma exacerbations among children living near roadways. Studies that rely on exposure to PM mass may underestimate PM health impacts.     

Scales of environmental justice: combining GIS and spatial analysis for air toxics in West Oakland, California

This paper examines the spatial point pattern of industrial toxic substances and the associated environmental justice implications in the San Francisco Bay Area, California, USA. Using a spatial analysis method called Ripley's K we assess environmental justice across multiple spatial scales, and we verify and quantify the West Oakland neighborhood as an environmental justice site as designated by the US Environmental Protection Agency. Further, we integrate the ISCST3 air dispersion model with Geographic Information Systems (GIS) to identify the number of people potentially affected by a particular facility, and engage the problem of non-point sources of diesel emissions with an analysis of the street network.     

Loose-coupling an air dispersion model and a geographic information system (GIS) for studying air pollution and asthma in the Bronx,New York City

This study developed new procedures to loosely integrate an air dispersion model, AERMOD, and a geographic information system (GIS) package, ArcGIS, to simulate air dispersion from stationary sources in the Bronx, New York City, for five pollutants: PM₁₀, PM_2.5, NO_x, CO, and SO₂. Plume buffers created from the model results were used as proxies of human exposure to the pollution from the sources and they modified the commonly used fixed-distance proximity buffers by considering the realities of air dispersion. The application of the plume buffers confirmed that the higher asthma hospitalization rates were associated with the higher potential exposure to local air pollution. The air dispersion modeling exhibited advantages over proximity analysis and geostatistical methods for environmental health research. The loose integration provides a relatively simple and feasible method for health scientists to take advantage of both air dispersion modeling and GIS by avoiding the need for intensive programming and substantial GIS expertise.     

Some considerations for the communication of results of air pollution health effects tracking

Communicating effectively and efficiently on air quality and its health impacts is an important but difficult and complex task. It requires careful consideration of the audience one wants to reach, the messages one is trying to present, the venue through which the message will be delivered. The audience, context, technique, and content factors may affect how well it is heard and how appropriately it is interpreted. In this short paper, I describe many of these concerns and provide some suggestions for how best to address them. However, since every audience differs in goals, characteristics, and nature, what is most important is implementing an effective communications program. This program should include frequent two-way communication, repeated and on-going evaluation of how well the audience understands the messages, and consideration of how to improve the delivery.     

Evaluative designs in public health: methodological considerations

Evaluation of public health interventions poses numerous methodological challenges. Randomization of individuals is not always feasible and interventions are usually composed of multiple factors. To face these challenges, certain elements, such as the selection of the most appropriate design and the use of a statistical analysis that includes potential confounders, are essential. The objective of this article was to describe the most frequently used designs in the evaluation of public health interventions (policies, programs or campaigns). The characteristics, strengths and weaknesses of each of these evaluative designs are described. Additionally, a brief explanation of the most commonly used statistical analysis in each of these designs is provided.     

Contribution of case-crossover design to the analysis of short-term health effects of air pollution: reanalysis of air pollution and health data

BACKGROUND: During the last decades, numerous studies have shown significant links between short-term exposure to air pollution and health. Time series design have been widely used in order to study these associations. In recent years, the case-crossover design has been applied to the analysis of acute effects of environmental exposures, especially air pollution. The aims of this paper are to describe the case-crossover design and to compare this approach with time series design to assess the association between air pollution and health. METHODS: In the case-crossover approach, a case-control study is conducted whereby each person who had a health event (case period) is matched with himself/herself on a nearby time period where he/she did not have the event (control period). Review of the literature shows that the referent selection strategies can be associated to a bias in the estimation of the health effect of air pollution. In comparison with time series design, the case-crossover design is easier to conduct, and individual factors can be taken into account. Nevertheless, it is not possible to take into account the overdispersion in the health indicator with this approach. RESULTS AND CONCLUSION: In conclusion, we suggest to use time series analysis with population data and case-crossover design with individual data.     

Exposure data for the study of acute health effects of air pollution

The use of aerometric network data has been criticized before on the grounds that it might give an unreliable picture of population exposure. However, the extensive data obtained from networks is still being used for studies of health effects of air pollution. This study uses a rigorous approach in analyzing these data to test their suitability for studies of acute health effects of air pollution. New York City, with one of the most extensive aerometric networks, consisting of 40 air pollution monitoring stations, is taken as an example. Three years of hourly SO2 readings and bi-hourly readings of smokeshade have been analyzed. The use of one aerometric station to represent the daily exposure of the population of New York City as has been done in previous studies is shown to be invalid. The use of individual monitoring stations of the New York City aerometric network to represent the day-to-day exposure to SO2 and smokeshade of the populations surrounding these monitoring stations is examined, with results showing that further work will be necessary before such an approach is justified.     

Linking environmental effects to health impacts: a computer modelling approach for air pollution

STUDY OBJECTIVE AND SETTING: To develop a computer model, using a geographical information system (GIS), to quantify potential health effects of air pollution from a new energy from waste facility on the surrounding urban population. DESIGN: Health impacts were included where evidence of causality is sufficiently convincing. The evidence for no threshold means that annual average increases in concentration can be used to model changes in outcome. The study combined the "contours" of additional pollutant concentrations for the new source generated by a dispersion model with a population database within a GIS, which is set up to calculate the product of the concentration increase with numbers of people exposed within each enumeration district exposure response coefficients, and the background rates of mortality and hospital admissions for several causes. MAIN RESULTS: The magnitude of health effects might result from the increased PM10 exposure is small-about 0.03 deaths each year in a population of 3 500 000, with 0.04 extra hospital admissions for respiratory disease. Long term exposure might bring forward 1.8-7.8 deaths in 30 years. CONCLUSIONS: This computer model is a feasible approach to estimating impacts on human health from environmental effects but sensitivity analyses are recommended.Relevance to clinical or professional practice: The availability of GIS and dispersion models on personal computers enables quantification of health effects resulting from the additional air pollution new industrial development might cause. This approach could also be used in environmental impact assessment. Care must be taken in presenting results to emphasise methodological limitations and uncertainties in the numbers.     

Indoor air pollution in developing countries: a major environmental and public health challenge

Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.     

Use of health information in air pollution health research: past successes and emerging needs

In September 2006, the US Environmental Protection Agency and the US Centers for Disease Control (CDC) co-organized a symposium on "Air Pollution Exposure and Health." The main objective of this symposium was to identify opportunities for improving the use of exposure and health information in future studies of air pollution health effects. This paper deals with the health information needs of such studies. We begin with a selected review of different types of health data and how they were used in previous epidemiologic studies of health effects of ambient particulate matter (PM). We then examine the current and emerging information needs of the environmental health community, dealing with PM and other air pollutants of health concern. We conclude that the past use of routinely collected health data proved to be essential for activities to protect public health, including the identification and evaluation of health hazards by air pollution research, setting standards for criteria pollutants, surveillance of health outcomes to identify incidence trends, and the more recent CDC environmental public health tracking program. Unfortunately, access to vital statistics records that have informed such pivotal research has recently been curtailed sharply, threatening the continuation of the type of research necessary to support future standard setting and research on emerging exposure and health problems (e.g. asthma, multiple sclerosis, diabetes, and others), as well as our ability to evaluate the efficacy of regulatory and other prevention activities. A comprehensive devoted effort, perhaps new legislation, will be needed to address the standardization, centralization, and sharing of data sets, as well as to harmonize the interpretation of confidentiality and privacy protections across jurisdictions. These actions, combined with assuring researchers and public health practitioners appropriate access to data for evaluation of environmental risks, will be essential for the achievement of our environmental health protection goals.