Air pollution and population health: a global challenge

“Air pollution and population health” is one of the most important environmental and public health issues. Economic development, urbanization, energy consumption, transportation/motorization, and rapid population growth are major driving forces of air pollution in large cities, especially in megacities. Air pollution levels in developed countries have been decreasing dramatically in recent decades. However, in developing countries and in countries in transition, air pollution levels are still at relatively high levels, though the levels have been gradually decreasing or have remained stable during rapid economic development. In recent years, several hundred epidemiological studies have emerged showing adverse health effects associated with short-term and long-term exposure to air pollutants. Time-series studies conducted in Asian cities also showed similar health effects on mortality associated with exposure to particulate matter (PM), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and ozone (O₃) to those explored in Europe and North America. The World Health Organization (WHO) published the “WHO Air Quality Guidelines (AQGs), Global Update” in 2006. These updated AQGs provide much stricter guidelines for PM, NO₂, SO₂ and O₃. Considering that current air pollution levels are much higher than the WHO-recommended AQGs, interim targets for these four air pollutants are also recommended for member states, especially for developing countries in setting their country-specific air quality standards. In conclusion, ambient air pollution is a health hazard. It is more important in Asian developing countries within the context of pollution level and population density. Improving air quality has substantial, measurable and important public health benefits.     

Public perception and behavior change in relationship to hot weather and air pollution

Background

Changes in climate systems are increasing heat wave frequency and air stagnation, both conditions associated with exacerbating poor air quality and of considerable public health concern.

Objectives

Heat and air pollution advisory systems are in place in many cities for early detection and response to reduce health consequences, or severity of adverse conditions. Whereas the ability to forecast heat waves and/or air pollution episodes has become increasingly sophisticated and accurate, little is known about the effectiveness of advisories in altering public behavior.

Methods

Air quality and meteorological conditions were measured during advisory and control days in Portland, OR and Houston, TX in 2005 and 2006 and 1962 subjects were interviewed by telephone about their perception and response to these conditions.

Results

Elevated ambient temperatures were accurately recognized regardless of air conditioning use; in Portland, respondents resorted to active cooling behavior (AC, fan, etc.), while in Houston no such change was observed. More heat-related symptoms were reported in Portland compared to Houston, probably due to low air conditioning use in the northwest. One-third of study participants were aware of air quality advisories but only ∼10-15% claimed to have changed activities during such an episode. Not the advisory, however, drove their behavior change, but rather the perception of poor air quality, which was not related to PM_2.5 or ozone measurements.

Conclusions

Messages are not reaching the public during potentially hazardous weather and air quality conditions. Climatic forecasts are increasingly predictive but public agencies fail to mount an appropriate outreach response.     

Observations of massive air-pollution transport and associated air quality in the Yellow Sea region

Presently, China is the world’s second largest energy consumer, and it generates extensive atmospheric emissions in the Yellow Sea region in East Asia. In the westerly region, the downwind effect creates large-scale transport of air pollution and significantly impacts on air quality semi-periodically in Korea, Japan, and the western Pacific Ocean. Observations with satellite and ground measurements of regional air quality show the movements and impact of anthropogenic and natural origins of air pollution in the Yellow Sea region. Fifteen air-pollution cases were recorded from January to September 2007. These are the basis for our findings on regional-scale transport of air pollution and variations of air quality in Korea and SW Japan. Impacts on air quality and health are included.     

Update of WHO air quality guidelines

Based on a systematic review of literature on adverse health effects of air pollution, the World Health Organization has updated its Air Quality Guidelines in 2005. The current update is intended to be relevant and applicable worldwide and takes into consideration large regional inequalities in exposures to air pollution. It recommends guideline levels for particulate matter, ozone, nitrogen dioxide and sulfur dioxide, as well as the set of interim targets for these pollutants’ concentrations, encouraging gradual improvement of air quality and reduction of health impacts of the pollution.

Social Support and Sense of Program Belonging Discriminate Between Youth-Staff Relationship Types in Juvenile Correction Settings

This study explored the association between personal and social characteristics of incarcerated juvenile offenders and youth-staff relationship types. Employing the three relationship categories identified in a typology by Marsh and Evans (2009), multinomial logistic regression indicated that youth reporting higher levels of social support and sense of program belonging were least likely to belong to the relationship category associated with expressed dissatisfaction about problem solving and more negative forecasts. Results highlight the importance of socio-environmental factors in developing and administering productive youth correction programs.     

济南铁路局部分旅客空调列车空气质量检测结果分析

[目的]了解旅客列车空气质量状况,为制定相关措施提供依据。[方法]2007年1月至2010年5月对济南铁路局96列192节空调旅客列车车厢空气进行检测分析。[结果]合计检测96列车192节车厢,各指标合格率,二氧化碳(CO2)、可吸入颗粒物(IP)、细菌总数、甲醛开车前为88.54%、88.54%、90.63%、95.83%,开车后为78.13%、76.56%、75.00%、90.63%(P<0.05);风速、一氧化碳(CO)开车前为95.83%、89.58%,开车后为91.67%、78.13%(P>0.05)。风速、CO、CO2、甲醛冬季为93.14%、88.24%、80.39%、92.16%,夏季为90.00%、78.89%、75.56%、88.89%(P<0.05)。各指标检测值,风速、CO2、COI、P、细菌总数、甲醛均为开车后高于开车前(P<0.05);CO、CO2、甲醛、细菌总数冬季高于夏季(P<0.05);硬座车厢与卧铺车厢,一等座与二等座差异均无统计学意义(P>0.05)。[结论]济南铁路局旅客列车总体状况较好,夏季、开车后污染物浓度较高。     

Measuring public health accountability of air quality management

Accountability of air quality management is often measured by tracking ambient pollution concentrations over time. These changes in ambient air quality are rarely linked to changes in public health, a major driver for such programs. We propose a method to assess the accountability of air quality management programs with respect to improvements in public health by estimating national temporal trends in health risk attributable to air pollution. The air health indicator (AHI) is a function of two temporal functions, annual air pollutant concentrations and annual estimates of health risk obtained by time series statistical methods, to indicate the trend in annual percent attributable risk (the product of concentration and risk times 100). Random effects models are used to obtain a distribution of risk over space. The model is illustrated by examining the association between daily nonaccidental deaths in 24 of Canada’s largest cities and daily concentrations of ozone and nitrogen dioxide over the 17-year period 1984–2000. Our analysis demonstrates that examining trends in exposure alone, which has typically been the approach to air quality indicators, provides an incomplete picture of trends in the impact of air pollution. The AHI appears to provide a more informative measure of the population burden of illness associated with air pollution over time.     

Decreased fertility in mice exposed to environmental air pollution in the city of Sao Paulo

It has largely been shown that air pollution can affect human health. Effects on human fertility have been shown mainly in males by a decrease in semen quality. Few studies have focused on the environmental effects on female fertility. The aim of the present study was to analyze the effects of air pollution in the city of Sao Paulo on mouse female fertility. Four groups of female Balb/c mice were placed in two chambers 10 days (newborn) or 10 weeks (adults) after birth. Mice were maintained in the chambers 24 h a day, 7 days a week, for 4 months. The first chamber received air that had passed through an air filter (clean chamber) and the second received ambient air (polluted chamber). We measured PM₁₀ and NO₂ inside both chambers. Mice belonging to the adult groups were bred to male mice after living for 3 months inside the chambers. The newborn groups mated after reaching reproductive age (12 weeks). After 19 days of pregnancy the numbers of live-born pups, reabsorptions, fetal deaths, corpora lutea, and implantation failures were determined. PM₁₀ and NO₂ concentrations in the clean chamber were 50% and 77.5% lower than in the polluted chamber, respectively. Differences in fertility parameters between groups were observed only in animals exposed to air pollution at an early age (10 days after birth). We observed a higher number of live-born pups per animal in the clean chamber than per animal from the polluted chamber (median=6.0 and 4.0, respectively; P=0.037). There was a higher incidence of implantation failures in the polluted group than in the clean group (median=3.5 and 2.0, respectively; P=0.048). There were no significant differences in the other reproductive parameters between groups. These results support the concept that female reproductive health represents a target of air pollutants.     

The risk of dying on days of higher air pollution among the socially disadvantaged elderly

Rationale

The estimated mortality rate associated with ambient air pollution based on general population studies may not be applicable to certain subgroups.

Objective

The objective of the present study was to determine the influence of age, education, employment status and income on the risk of mortality associated with ambient air pollution.

Methods

Daily time-series analyses tested the association between daily air pollution and daily mortality in seven Chilean urban centers during the period January 1997–December 2007. Results were adjusted for long-term trends, day-of-the week and humidex.

Results

Interquartile increases in particulate matter (PM₁₀ and PM_2.5), sulphur dioxide, nitrogen dioxide, carbon monoxide, and elemental and organic carbon were associated with a 4–7% increase in mortality among those who did not complete primary school (p<0.05) vs. 0.5–1.5% among university graduates (p>0.05). Among those at least 85 years of age respective estimates were 2–7%. However, among the elderly who did not complete primary school, respective estimates were 11–19% (p<0.05). The degree of effect modification was less for income and employment status than education, and sex did not modify the results.

Conclusion

The socially disadvantaged, especially if elderly appear to be especially susceptible to dying on days of higher air pollution. Concentrations deemed acceptable for the general population would not appear to protect this susceptible subgroup.     

Forty-five minutes of physical activity at school each day? Curricular promotion of physical activity in grades one to four

Aim  

According to the US Department of Health and Human Services (2008) and the World Health Organization (2008), regular physical activity is essential to the healthy development of children and contributes to the reduction of chronic diseases throughout their life span. However, coordinated comprehensive national and international programs to promote physical activity and sports participation are lacking. According to the German Sports Federation (2006), physical education (PE) classes at German schools are increasingly being canceled or taught outside the school. "fit for pisa" is a German intervention developed in response to the demand for scientific evaluation of interventions like daily physical education. Its goal is to provide quality management-secured, structured and standardized PE instruction by qualified instructors.     

Outdoor Air Quality Awareness,Perceptions, and Behaviors Among U.S. Children Aged 12–17 Years, 2015–2018

PurposeThis study aimed to assess U.S. adolescents' perceptions and knowledge about air quality and their behaviors aimed to reduce air pollution exposure and whether they vary by demographic characteristics.MethodsWe analyzed data from the Porter Novelli Public Services YouthStyles survey, a nationally representative survey of U.S. adolescents aged 12–17 years. In survey years 2015–2018, a total of 3,547 adolescents self-reported awareness, perceptions, and behaviors related to air pollution. We calculated weighted percentages of respondents reporting each aspect of air quality awareness, perception, and behaviors overall and by categories of age, gender, parental education, metropolitan status, region, and survey year.ResultsOverall, an estimated 81% of U.S. adolescents thought outdoor air pollution could impact health, 52% thought there were things they could do to limit their or their family's exposure, 19% were aware of air quality alerts, 46% of those who thought or were informed air quality was bad did something differently, and 19% always or usually avoided busy roads to reduce air pollution exposure; differences were reported by some demographic variables.ConclusionsAmong U.S. adolescents, awareness that air pollution could impact health was relatively high. However, gaps were found in the awareness of the potential impacts and other aspects of awareness and perceptions related to air pollution and the engagement in behaviors to reduce exposure, some of which varied by demographic characteristics. These results can be used to inform interventions that increase awareness and behaviors to reduce air pollution exposures among U.S. adolescents.     

Daily visibility and mortality: Assessment of health benefits from improved visibility in Hong Kong

Visibility in Hong Kong has deteriorated significantly over 40 years with visibility below 8 km in the absence of fog, mist, or precipitation, increasing from 6.6 days in 1968 to 54.1 days in 2007. We assessed the short-term mortality effects of daily loss of visibility. During 1996-2006, we obtained mortality data for non-accidental and cardiorespiratory causes, visibility recorded as visual range in kilometers, temperature, and relative humidity from an urban observatory, and concentrations of four criteria pollutants. A generalized additive Poisson regression model with penalized cubic regression splines was fitted to control for time variant covariates. For non-accidental mortality, an interquartile range (IQR) of 6.5 km decrease in visibility at lag 0-1 days was associated with an excess risk (ER%) [95% CI] of 1.13 [0.49, 1.76] for all ages and 1.37 [0.65, 2.09] for ages 65 years and over; for cardiovascular mortality of 1.31 [0.13, 2.49] for all ages, and 1.72 [0.44, 3.00] for ages 65 years and over; and for respiratory mortality of 1.92 [0.49, 3.35] for all ages and 1.76 [0.28, 3.25] for ages 65 years and over. The estimated ER% for daily mortality derived from both visibility and air pollutant data were comparable in terms of magnitude, lag pattern, and exposure-response relationships especially when using particulate matter with aerodynamic diameter ≤10 μm to predict the mortality associated with visibility. Visibility provides a useful proxy for the assessment of environmental health risks from ambient air pollutants and a valid approach for the assessment of the public health impacts of air pollution and the benefits of air quality improvement measures in developing countries where pollutant monitoring data are scarce.     

Exposure to air pollution and pulmonary function in university students

Objectives: Exposure to air pollution has been reported to be associated with increase in pulmonary disease. The aims of the present study were to examine the use of personal nitrogen dioxide (NO₂) samplers as a means of measuring exposure to air pollution and to investigate the relationship between personal exposure to air pollution and pulmonary function. Methods: We measured individual exposures to NO₂ using passive personal NO₂ samplers for 298 healthy university students. Questionnaire interview was conducted for traffic-related factors, and spirometry was performed when the samplers were returned after 1 day. Results: Personal NO₂ concentrations varied, depending on the distance between residence and a main road (P=0.029). Students who used transportation for more than 1 h were exposed to higher levels of NO₂ than those using transportation for less than 1 h (P=0.032). In terms of transportation, riding in a bus or subway caused significantly higher exposure than not using them (P=0.046). NO₂ exposure was not significantly associated with forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV₁) but was associated with the ratio of FEV₁/FVC and mid-expiratory flow between 25% and 75% of the forced vital capacity (FEF_25–75) (P<0.05). Conclusions: This study indicates that concentrations of personal exposure to NO₂ are significantly influenced by traffic-related air pollution and are associated with decreased pulmonary function.     

Health benefits of a reduction of PM10 and NO2 exposure after implementing a clean air plan in the Agglomeration Lausanne-Morges

Exposure to urban air pollution has been associated with adverse effects on cardio-vascular and respiratory health, both short and long term. Consequently, governments have applied policies to reduce air pollution. Quantitative health impact assessments of hypothetic changes in air pollution have been conducted at national and global level, but assessments of observed air pollution changes associated with specific clean air policies at a local or regional scale remain scarce. This study estimates health impacts attributable to a decrease in PM₁₀ and NO₂ exposure in the Agglomeration of Lausanne-Morges (ALM), Switzerland, between 2005 and 2015, corresponding to the implementation period of a supra-municipal plan of measures to reduce air pollution in different sectors such as transport, energy, and industry (called Plan OPair 05). The health impact assessment compares health effects attributed to air pollution exposure levels in 2015 (reference case) with those in 2005 (counterfactual scenario), using 2015 as baseline for all other input data.In the ALM, the modeled PM₁₀ exposure reduction of 3.3 μg/m³ from 2005 to 2015 prevents 26 premature deaths (equivalent to around 290 years of life lost), 215 hospitalization days due to cardio-vascular and respiratory diseases as well as approximately 47,000 restricted activity days annually. Monetized health impacts of the reduction of PM₁₀ exposure are valued at approximately CHF 36 million annually. Immaterial costs, mainly related to the economic valuation of years of life lost, dominate the monetized health impacts (90% of total value), while savings at the workplace (net loss in production and reoccupation costs) amount to about CHF 1.9 million, and savings in health care costs to about CHF 0.5 million. The assessment is sensitive to the value assigned to immaterial costs and to uncertainties in the relative risk estimates, whereas variations in the baseline year (i.e. using 2005 data instead of 2015 data) affect results to a much lower degree. The alternative calculation based on NO₂ exposure, which dropped by 5.6 μg/m³, suggests the prevention of 51 premature deaths (equivalent to around 550 years of life lost) overall impacts valued at CHF 49 million. All in all, the reduction in mortality due to the air quality improvements accounts for (depending on the considered pollutant) about 1% to 2% of total all-cause annual mortality in the ALM population or 4–8 times larger than the annual traffic fatalities in the ALM.     

Socioeconomic disparities in air pollution-associated mortality

This study aimed to determine whether individuals with lower socioeconomic status (SES) were more susceptible to the acute effects of ambient air pollution than those with higher SES. We included 24,357 Hong Kong Chinese aged 30 or above who died of natural causes in 1998. Information on individual socioeconomic characteristics was obtained by interviewing proxy informants with a standardized questionnaire in all four death registries. Individual SES was indicated by three measures: type of housing, occupational group and education attainment. Poisson regression was performed to assess the short-term effects of ambient air pollution measured by PM₁₀, NO₂, SO₂ and O₃ on mortality for each SES group. The differences in the effects between SES groups were estimated by the interaction between air pollution and SES. We found that PM₁₀ and NO₂ were associated with greater risk of mortality on people living in public rental housing than in private housing. The effects of all four pollutants were significantly greater in blue-collar workers than the never-employed and white-collar groups (p<0.05). However, we found no compelling evidence of effect modification by education attainment. Our results provide new evidence on the role of individual's SES as effect modifiers of the short-term effects of air pollution on mortality. The reduction of risks associated with air pollution for socially disadvantaged populations should be a high priority in public health and environmental policies.     

The impact of air pollution on physical disability in a middle-aged and older Chinese population using regression discontinuity design

Emerging evidence has shown the association between ambient air pollution exposure and comorbid chronic diseases, which can subsequently impair physical function. However, less is known about the causal and contextual effect of air pollution on physical disability. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study employs a geographical regression discontinuity design based on the Huai River Policy to estimate the impact of ambient air pollution on physical disability in activities of daily living (ADL) in China. We find that a 10 μg/m³ increase in particulate matter [particulate matter smaller than 10 μm (PM₁₀)] leads to a 5.4% increase in the incidence of physical disability among middle-aged and older adults. This result is robust to using alternative measurement of key variables, different bandwidths and polynomial functions, and adjustment for a set of sociodemographic covariates. Stroke might be one of the potential pathological pathways linking air pollution and physical disability, with a 10 μg/m³ increase in PM₁₀ leading to a 4.7% increase in the incidence of stroke. In heterogeneity analyses, we find that older adults, males, urban residents, and people with lower socioeconomic status are more vulnerable to air pollution. These results contribute to the limited evidence on the causal and contextual effect of air pollution on physical health, and further provide policy implications for air quality control and health protection for vulnerable populations.     

Migrant population is more vulnerable to the effect of air pollution on preterm birth: Results from a birth cohort study in seven Chinese cities

BackgroundStudies have reported that exposure to air pollution during pregnancy was associated with preterm birth (PTB). However, it remains unknown whether this association differs between local residents and migrants.ObjectiveThis study aimed to differentiate the associations between maternal air pollution exposure and PTB between local residents and migrants.MethodsWe established a retrospective birth cohort in seven Chinese cities in Pearl River Delta (PRD) region during 2015–2017. The mothers were included in the cohort at their first time of hospital visit for pregnancy, and the endpoint events were identified using the birth registry. The air pollution exposure was estimated based on the daily air pollution concentrations in the nearby air monitoring stations during different pregnancy periods. Cox proportional hazards models were utilized to estimate the associations between each air pollutant and PTB for different pregnancy periods.ResultsOur cohort included a total of 628,439 mother-and-live-birth pairs. Among them, 308,201 women were local residents, and 320,238 were migrants. We observed stronger effects of air pollutants among the migrants than the local residents. For the exposure during the entire pregnancy, the hazard ratio (HR) among the migrants and local residents were 1.56 (95% CI: 1.50, 1.63) and 0.98 (95% CI: 0.93, 1.02) for each 10 μg/m³ increase in PM_2.5, 1.32 (95% CI: 1.27, 1.39) and 1.18 (95% CI: 1.12, 1.23) for each 10 ppb increase in O₃, and 1.48 (95% CI: 1.40, 1.57) and 0.99 (95% CI: 0.93, 1.05) for each 10 μg/m³ increase in SO₂, respectively. Similarly higher effects were observed among the migrants for the exposures in different trimesters of pregnancy. However, the effects of NO₂ were comparable between the two groups.ConclusionOur study suggests that maternal PM_2.5, O₃ and SO₂ exposures might be important risk factors of preterm birth, particularly among the migrants. More specific protective and education measures should be considered for the migrant pregnant women.     

空调系统与室内空气品质

该文从新风量不足与新风口位置不合理、空调系统设备及用材、空调通风管道污染、气流组织、空气负离子、空调水系统等方面分析了不良的空调系统对室内空气品质的影响,并提出了保证室内空气品质的相关技术措施,建议采取有力措施确保新风质量,加强对风管及空调设备的定期清洗与维护,改进室内的气流组织,利用新技术和新设备确保室内空气品质,建立健全相关的规章制度与行业标准.     

Environmental factors and productivity on Dutch hospitals: a semi-parametric approach

This paper describes the efficiency of Dutch hospitals using the method of Data Envelopment Analysis (DEA). In particular the analysis focuses on explaining cost inefficiency measures due to each hospital’s operating environment. In previous works, the resulting DEA score is regressed on environmental factors via a Tobit approach. Previously, these approaches have been used (Simar and Wilson, J Prod Anal 7(1):63–80, 2000) but later these authors (Simar and Wilson 2007) demonstrated that bias is incurred since the efficiency score is a point estimate without a probability distribution around it that is required by the Tobit methodology. In this paper we use the Simar and Wilson bootstrapping techniques in order to obtain more efficient estimates of the environmental effects. It is shown that differences in estimated effects exist between the non-bootstrapped and bootstrapped models.     

Status and determinants of individual actions to reduce health impacts of air pollution in US adults

Although regulation of emissions is the primary strategy to reduce air pollution–related morbidity, individual-level interventions are also helpful in mitigating health impacts. We used data from 2007–2008 National Health and Nutrition Examination Survey to study the prevalence of individual-level action among the US adult population if informed of air pollution, and to see if this differed by demographic and health factors. Only 13.5% (95% confidence interval [CI]: 11.6–15.4%) of participants aware of air quality reported changing their individual behaviors. Males (adjusted odds ratio [AOR]: 0.66, 95% CI: 0.56–0.77) and those without cardiovascular disease (AOR: 0.58, 95% CI: 0.47–0.71) were least likely to take action. Results show that individual action was infrequent among the population. Health promotion of individual intervention is necessary, and this effort may need to target specific subgroups of the population. Further studies on effective individual interventions are needed.