Air quality around schools: Part I - A comprehensive literature review across high-income countries

The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews

PURPOSE OF REVIEW

This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.

RECENT FINDINGS

There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.

The impact of indoor air pollution on children's health and well-being: the experts' consensus

BACKGROUND

Pollution of the indoor environment represents a concern for human health, mainly in case of prolonged exposure such as in the case of women, children, the elderly, and the chronically ill, who spend most of their time in closed environments.

MAIN BODY

The aim of the study is to organize a group of experts in order to evaluate the evidence and discuss the main risk factors concerning indoor air and the impact on human health as well as challenging factors regarding preventive strategies to reduce pollution. The experts highlighted the main risk factors concerning indoor air, including poor ventilation, climatic conditions, chemical substances, and socio-economic status. They discussed the impact on human health in terms of mortality and morbidity, as well as challenging factors regarding preventive strategies to reduce pollution.

CONCLUSION

The experts identified strategies that can be reinforced to reduce indoor pollution and prevent negative consequences on human health at national and local levels.

The effects of urban green space and road proximity to indoor traffic-related PM2.5, NO2, and BC exposure in inner-city schools

BACKGROUND

Since there are known adverse health impacts of traffic-related air pollution, while at the same time there are potential health benefits from greenness, it is important to examine more closely the impacts of these factors on indoor air quality in urban schools.

OBJECTIVE

This study investigates the association of road proximity and urban greenness to indoor traffic-related fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in inner-city schools.

METHODS

PM2.5, NO2, and BC were measured indoors at 74 schools and outdoors at a central urban over a 10-year period. Seasonal urban greenness was estimated using the Normalized Difference Vegetation Index (NDVI) with 270 and 1230 m buffers. The associations between indoor traffic-related air pollution and road proximity and greenness were investigated with mixed-effects models.

RESULTS

The analysis showed linear decays of indoor traffic-related PM2.5, NO2, and BC by 60%, 35%, and 22%, respectively for schools located at a greater distance from major roads. The results further showed that surrounding school greenness at 270 m buffer was significantly associated (p < 0.05) with lower indoor traffic-related PM2.5: -0.068 (95% CI: -0.124, -0.013), NO2: -0.139 (95% CI: -0.185, -0.092), and BC: -0.060 (95% CI: -0.115, -0.005). These associations were stronger for surrounding greenness at a greater distance from the schools (buffer 1230 m) PM2.5: -0.101 (95% CI: -0.156, -0.046) NO2: -0.122 (95% CI: -0.169, -0.075) BC: -0.080 (95% CI: -0.136, -0.026). These inverse associations were stronger after fully adjusting for regional pollution and meteorological conditions.

IMPACT STATEMENT

More than 90% of children under the age of 15 worldwide are exposed to elevated air pollution levels exceeding the WHO's guidelines. The study investigates the impact that urban infrastructure and greenness, in particular green areas and road proximity, have on indoor exposures to traffic-related PM2.5, NO2, and BC in inner-city schools. By examining a 10-year period the study provides insights for air quality management, into how road proximity and greenness at different buffers from the school locations can affect indoor exposure.

Home as a new physical workplace: a causal model for understanding the inextricable link between home environment, work productivity, and well-being

The home has become a new physical workplace, and can therefore influence the work, health, and life of workers. This cross-sectional study aimed to evaluate the chronology of the effects of work hazards at home on factors such as workers' health, productivity, and well-being (WB). Information on novice working-from-home (WFH) workers was derived from the "Occupational health of WFH" project. The selected variables in the hypothesis model comprised problems such as perceived indoor environmental quality (IEQ), working conditions (WC), sick house syndrome (SHS), occupational stress (OS), work productivity (WP), and WB. The relationship between these variables was analyzed using a structural equation model. The group analysis results showed the following significant indirect path effects from work environment through WP: IEQ-> SHS->OS->WP. A non-significant direct effect was observed between IEQ and WP. While WC problems could also have a significant direct effect on WP, or be mediated by OS, WP is a significant consequence and a direct effect of WB. In conclusion, the WFH model's causal impact between home environment, WP, and WB is a physiopsychological pathway. Therefore, creating a healthy home environment and WC, along with OS management, comprise important issues for improving productivity and WB for this new work style.

Fine particulate matter exposure and pediatric mental health outcomes: An integrative review

INTRODUCTION

Climate change is expected to worsen air pollution globally, which contributes to a multitude of negative health outcomes in humans.

AIM

The purpose of this integrative review is to examine the relationship between exposure to fine particulate matter (PM2.5 ) and mental health outcomes in children and adolescents.

METHODS

This review utilized Whittemore and Knafl's methodology for conducting an integrative review. After a thorough search of the literature, 17 articles were selected for this review and evaluated utilizing the Johns Hopkins Evidence Based Practice Appraisal Tool.

RESULTS

Of the 17 articles, all were quantitative observational study designs. The studies were then synthesized into four outcome themes. These themes included emergent and general psychiatric outcomes, neurodevelopmental disorders, stress and anxiety, and depression.

DISCUSSION

The strongest evidence supports a possible correlation between PM2.5 exposure and adolescent mental health outcomes, although there were some studies that contradicted these associations. While research on this topic is in its early stages, more needs to be conducted to determine causality with any of the associations presented to improve generalizability of the findings.

IMPLICATIONS FOR PRACTICE

Nurses must be aware of and part of the solution to address climate change and resulting air pollution, as it is a potentially significant threat to children's mental health in the 21st century.

Air quality and individual-level academic performance in Brazil: A nationwide study of more than 15 million students between 2000 and 2020

Studies have shown that living and studying in places with poor air quality is associated with cognitive deficits. However, there is still a limitation in the literature in terms of study design and geographic location. Also, only a few studies have looked at the effects of more than one air pollutant. To address this research gap, in this study we estimated the association between air pollution (considering three criteria air pollutants - PM_2.5, NO₂, and O₃) and academic performance (a proxy of cognitive performance) at the student level in Brazil between 2000 and 2020. We assessed academic performance data from a nationwide high school exam. The data included 15,443,772 students who took this national test between 2000 and 2020 in Brazil. Air pollution data was derived from satellite remote sensing observations. We fit mixed-effects regression models with a state-specific random intercept and adjusted for school characteristics, spatio-temporal factors, and socioeconomic status. We performed sub-group analyses by stratifying the analysis by type of school management (private or public), location of the school (urban or rural), sex, and periods. Our findings suggest air pollution exposure was associated with drops in the students' marks varying from 0.13% to 5.39%. To our knowledge, this is the first study that estimates the association between air pollution and individual-level academic performance in Brazil. This study is of substantial environmental and educational importance by supporting policymakers to improve the air quality surrounding schools.

Lichen biomonitoring of seasonal outdoor air quality at schools in an industrial city in Thailand

Poor air quality in school environments causes adverse health effects in children and decreases their academic performance. The main objective of this study was to use lichens as a biomonitoring tool for assessing outdoor air quality at schools in the industrial area of Laem Chabang municipality in Thailand. Thalli of the lichen Parmotrema tinctorum were transplanted from an unpolluted area to nine schools in the industrial area and to a control site. The lichens were exposed for four periods in the dry, hot, early rainy, and late rainy seasons, for 90 days each. The concentrations of 14 elements, including As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sb, Ti, V, and Zn, were determined using inductively coupled plasma‒mass spectrometry (ICP‒MS), and 8 physiological parameters were measured. The concentrations of all 14 investigated elements were clearly higher at the schools than at the control site. The contamination factors (CFs) suggested that 9 out of the 14 elements, including As, Cd, Co, Cr, Cu, Mo, Pb, Sb, and Ti, heavily contaminated the school environments, especially Pb, the concentration of which was 3 to 11 times higher than at the control site. The most polluted time was the hot season as evidenced by the investigated elements, and the least polluted time was the late rainy season. The pollution load indices (PLIs) demonstrated that schools in the inner and middle zones clearly had higher pollution loads than the schools in the outer zone during the rainy seasons, while the hot and dry seasons showed similar pollution levels in all zones. The vitality indices (VIs) showed that the lower lichen vitalities at most schools were observed during the dry season and at the schools in the inner and middle zones. Accordingly, the air performance indices (APIs) revealed that poorer air quality at most schools was found during the dry season and at the schools in the inner and middle zones. This study clearly showed that the transplanted lichen P. tinctorum was an effective bioindicator of air quality in school environments. The results illustrated that all studied schools were contaminated by air pollutants; therefore, improving air quality at the schools is crucial and should be an urgent issue for maintaining good health and may benefit children's academic achievements and careers in the long run.

A parent-school initiative to assess and predict air quality around a heavily trafficked school

Many primary schools in the UK are situated in close proximity to heavily-trafficked roads, yet long-term air pollution monitoring around such schools to establish factors affecting the variability of exposure is limited. We co-designed a study to monitor particulate matter in different size fractions (PM₁, PM_2.5, PM₁₀), gaseous pollutants (NO₂, O₃ and CO) and meteorological parameters (ambient temperature, relative humidity) over a period of one year. The period included phases of national COVID-19 lockdown and its subsequent easing and removal. Statistical analysis was used to assess the diurnal patterns, pollution hotspots and underlying factors driving changes. A pollution episode was observed early in January 2021, owing to new year celebration fireworks, when the daily average PM_2.5 was around three-times the World Health Organisation limit. PM_2.5 and NO₂ exceeded the threshold limits on 15 and 10 days, respectively, as the lockdown eased and the school reopened, despite the predominant wind direction often being away from the school towards the roads. The peak concentration levels for all pollutants occurred during morning drop-off hours; however, some weekends showed higher or comparable concentrations to those during weekdays. The strong disproportional Pearson correlation between CO and temperature demonstrated the possible contribution of local sources through biomass burning. The impact of lifting restrictions after removing the weather impact showed that the average pollution levels were low in the beginning and increased by up to 22.7 % and 4.2 % for PM_2.5 and NO₂, respectively, with complete easing of lockdown. The Prophet algorithm was implemented to develop a prediction model using an NO₂ dataset that performed moderately (R², 0.48) for a new monthly dataset. This study was able to build a local air pollution database at a school gate, which enabled an understanding of the air pollution variability across the year and allowed evidence-based mitigation strategies to be devised.

Interventions for improving indoor and outdoor air quality in and around schools

Students spend nearly one third of their typical day in the school environment, where they may be exposed to harmful air pollutants. A consolidated knowledge base of interventions to reduce this exposure is required for making informed decisions on their implementation and wider uptake. We attempt to fill this knowledge gap by synthesising the existing scientific literature on different school-based air pollution exposure interventions, their efficiency, suitability, and limitations. We assessed technological (air purifiers, HVAC - Heating Ventilation and Air Conditioning etc.), behavioural, physical barriers, structural, school-commute and policy and regulatory interventions. Studies suggest that the removal efficiency of air purifiers for PM_2.5, PM₁₀, PM₁ and BC can be up to 57 %, 34 %, 70 % and 58 %, respectively, depending on the air purification technology compared with control levels in classroom. The HVAC system combined with high efficiency filters has BC, PM₁₀ and PM_2.5 removal efficiency up to 97 %, 34 % and 30 %, respectively. Citizen science campaigns are effective in reducing the indoor air pollutants' exposure up to 94 %. The concentration of PM₁₀, NO₂, O₃, BC and PNC can be reduced by up to 60 %, 59 %, 16 %, 63 % and 77 %, respectively as compared to control conditions, by installing green infrastructure (GI) as a physical barrier. School commute interventions can reduce NO₂ concentration by up to 23 %. The in-cabin concentration reduction of up to 77 % for PM_2.5, 43 % for PNC, 89 % for BC, 74 % for PM₁₀ and 75 % for NO₂, along with 94 % reduction in tailpipe emission of total particles, can be achieved using clean fuels and retrofits. No stand-alone method is found as the absolute solution for controlling pollutants exposure, their combined application can be effective in most of the scenarios. More research is needed on assessing combined interventions, and their operational synchronisation for getting the optimum results.

School-Based Interventions to Support Healthy Indoor and Outdoor Environments for Children: A Systematic Review

Environmental exposures are associated with children's health. Schools are often urban exposure 'hotspots' for pollution, noise, lack of green space and un-walkable built environments. The aim of this systematic review was to explore the impact of school-based interventions on the modification of indoor and outdoor stressors related to the built and natural environment on children's exposure and health. A systematic review of seven databases was performed. We included quantitative studies on children aged 5-12, which reported intervention delivered within school settings aimed at addressing key environmental exposures including air pollution, green spaces, traffic noise or active travel; and reported physical and mental health, physical activity or active travel behavior. The quality of studies was assessed and interventions were described using a standardized framework. A narrative synthesis approach was used to describe the findings. Thirty-nine papers were included on three main intervention types: improve indoor air quality by the increase of ventilation rates in classrooms; increase children's green time or greening schools, and multicomponent interventions to increase active travel to school by changes in pedestrian facilities. No eligible intervention to reduce traffic noise at school was found. Increasing ventilation rates improved short-term indoor air quality in classrooms, but the effect on cognitive performance was inconsistent. Greening schools and increasing children's green time have consistent positive effects on cognition and physical activity, but not in behavior. Multi-component interventions can increase walking and cycling after three years. Overall, the studies were rated as having poor quality owing to weak study designs. We found modest evidence that school-based built and natural environment interventions can improve children's exposure and health.

Establishment of background pollution levels and spatial analysis of moss data on a regional scale

The determination of background pollution levels is fundamental for the interpretation of the results obtained from environmental biomonitoring. In this paper we propose a new probabilistic method, based on a Gaussian mixture model, for determining the distribution of regional background levels of different pollutants. The distribution of the reference level is used to categorize the observations as "background" or "above-background" and spatial statistical techniques are then applied to determine the probability of the background level being exceeded. To exemplify its use, we applied the method to concentrations of five potentially toxic elements (Cd, Cu, Hg, Pb and Zn) measured in the moss Pseudoscleropodium purum. The proposed method was applied to data resulting from sampling at ca. 150 sampling stations in a regular grid (15 × 15 km) in Galicia (NW Spain). Sampling was carried out in June in 2000 and 2002, and in March and September in 2004, 2006, 2008 and 2014. The proposed method yielded consistent results for all of the different sampling surveys, and the pollution levels were found to be closely related to the sources of pollution identified in the study region. In short, although not an optimal solution, the proposed method seems to be suitable and realistic for the qualitative assessment of regional pollution.

Equity in temporary street closures: The case of London's Covid-19 'School Streets' schemes

School Streets are a street space reallocation scheme that has proliferated since the beginning of the Covid-19 pandemic in the UK, reducing motor traffic on streets outside many schools. Utilising a minimum-standards approach to equity, this paper examines the distribution of School Streets closures across social and environmental indicators of equity, and spatially across London's administrative geography. Using a multi-level regression analysis, we show that although School Streets have been equally distributed across several socio-demographic indicators, they are less likely to benefit schools in car-dominated areas of poor air quality, and their spatial distribution is highly unequal. This study presents an example of using environmental and spatial variables alongside more typical sociodemographic indicators in measuring the equity of school travel provision. For policymakers, the findings signal the need to implement complementary policies that can benefit schools with worse air quality, and to accelerate School Street implementation in slower districts.

Green areas and students' academic performance in the Federal District, Brazil: An assessment of three greenness metrics

Most of the epidemiological investigations looking at the health benefits of green spaces have measured the level of green areas by using only one approach, mainly the Normalized Difference Index - NDVI (a satellite-derived indicator). We hypothesized a difference in the association between health and green space depending on the metric used to measure green exposure. This study considers students' academic performance as a proxy of cognitive abilities (a health indicator). We estimated the relationship between green areas and students' academic performance in the Federal District (FD), Brazil, with three different greenness metrics: NDVI, distance to green spaces (m) - obtained from land use data, and quantity of green spaces (m²) - also from land use data. We assessed student-level academic performance data provided by the Department of the Education in the FD. The data includes students from the public schools in the FD for 256 schools (all the public schools in the FD) and 344,175 students (all the students enrolled in the public schools in the FD in 2017-2020).). For the first metric represented by the distance to green spaces, we estimated the straight-line distance between each school and the nearest green area. For NDVI and quantity of green spaces, we estimated the area of all green spaces within buffers of 500 m, 750 m, and 1 km around the schools. We applied a cross-sectional study design using mixed-effects regression models to analyze the association exposure to green areas around schools and student-level academic performance. Our results confirmed our hypothesis showing that the impact of green areas on students' performance varied significantly depending on the type of green metric. After adjustments for the covariates, we estimated that NDVI is positively associated with school-level academic performance, with an estimated coefficient of 0.91 (95%CI: 0.83; 0.99) for NDVI values at a school's centroid. Distance to green areas was negatively associated with academic performance [-2.09 × 10^-5 (95CI: 3.91 × 10^-5; -2.84 × 10^-6]. The quantity of green areas was estimated with mixed results (direction of the association), depending on the buffer size. Results from this paper suggest that epidemiological investigations must consider the different effects of greenness measures when looking at the association between green space and academic performance. More studies on residual confounding from this association with a different study design are needed to promote public health by making schools healthier.

Air Quality Outside Schools in Newcastle upon Tyne, UK: An Investigation into NO2 and PM Concentrations and PM Respiratory Deposition

Air pollution is the principal environmental threat to public health in the UK. Ever-increasing evidence links ambient air pollutants, preventable diseases, and health inequalities. Children are particularly vulnerable to harmful effects due to their short height, developing lungs, and higher rate of respiration. Using data from air quality monitors around schools, we investigated 2018–2019 ambient NO2, PM10, PM2.5, and PM1 concentrations at 12 schools in Newcastle upon Tyne, UK. We compared findings with EU/UK air quality regulations and guidelines, identified patterns, and calculated PM respiratory deposition doses (RDDs). The range of annual average (AA) concentrations across the schools for the two-year period was 23.7–39.2 µg/m3 for NO2, 7.4–22.2 µg/m3 for PM10, 3.5–11.6 µg/m3 for PM2.5, and 1.7–9.0 µg/m3 for PM1. The highest PM RDD children were exposed to at school was 30 µg/h. One school’s AA NO2, two schools’ hourly PM2.5 averages, and one school’s 24-h PM10 averages exceeded EU/UK regulations. All schools exceeded WHO2005 24-h PM10 and PM2.5 guidelines in 2018, less in 2019. All 12 schools would have exceeded WHO2021 NO2 AA guidelines (10 µg/m3), 2 the WHO2021 PM10 AA (15 µg/m3), and 10 the WHO2021 PM2.5 AA (5 µg/m3). Evidence-based policy is required to improve school ambient air quality and reduce children’s exposure.

Exposure of Malaysian Children to Air Pollutants over the School Day

Children are sensitive to air pollution and spend long hours in and around their schools, so the school day has an important impact on their overall exposure. This study of Kuala Lumpur, Selangor and its surroundings assesses exposure to PM2.5 and NO2, from travel, play and study over a typical school day. Most Malaysian children in urban areas are driven to school, so they probably experience peak NO2 concentrations in the drop-off and pick-up zones. Cyclists are likely to receive the greatest school travel exposure during their commute, but typically, the largest cumulative exposure occurs in classrooms through the long school day. Indoor concentrations tend to be high, as classrooms are well ventilated with ambient air. Exposure to PM2.5 is relatively evenly spread across Selangor, but NO2 exposure tends to be higher in areas with a high population density and heavy traffic. Despite this, ambient PM2.5 may be more critical and exceed guidelines as it is a particular problem during periods of widespread biomass burning. A thoughtful adjustment to school approach roads, design of playgrounds and building layout and maintenance may help minimise exposure.

School neighbourhood and compliance with WHO-recommended annual NO2 guideline: A case study of Greater London

Despite several national and local policies towards cleaner air in England, many schools in London breach the WHO-recommended concentrations of air pollutants such as NO₂ and PM_2.5. This is while, previous studies highlight significant adverse health effects of air pollutants on children's health. In this paper we adopted a Bayesian spatial hierarchical model to investigate factors that affect the odds of schools exceeding the WHO-recommended concentration of NO₂ (i.e., 40 μg/m³ annual mean) in Greater London (UK). We considered a host of variables including schools' characteristics as well as their neighbourhoods' attributes from household, socioeconomic, transport-related, land use, built and natural environment characteristics perspectives. The results indicated that transport-related factors including the number of traffic lights and bus stops in the immediate vicinity of schools, and borough-level bus fuel consumption are determinant factors that increase the likelihood of non-compliance with the WHO guideline. In contrast, distance from roads, river transport, and underground stations, vehicle speed (an indicator of traffic congestion), the proportion of borough-level green space, and the area of green space at schools reduce the likelihood of exceeding the WHO recommended concentration of NO₂. We repeated our analysis under a hypothetical scenario in which the recommended concentration of NO₂ is 35 μg/m³ - instead of 40 μg/m³. Our results underscore the importance of adopting clean fuel technologies on buses, installing green barriers, and reducing motorised traffic around schools in reducing exposure to NO₂ concentrations in proximity to schools. Also, our findings highlight the presence of environmental inequalities in the Greater London area. This study would be useful for local authority decision making with the aim of improving air quality for school-aged children in urban settings.

Proximity of schools to roads and students' academic performance: A cross-sectional study in the Federal District, Brazil

Investigations of the educational implications of children's exposure to air pollutants at school are crucial to enhance our understanding of the hazards for children. Most of the existing literature is based on studies performed in North America and Europe. Further investigation is required in low- and middle-income countries, where there are important challenges related to public health, transportation, environment, and education sector. In response, in this present study, we studied the association between proximity of schools to roads and the academic achievement of the students in the Federal District, Brazil. We accessed academic achievement data at the student level. The data consist of 256 schools (all the public schools in the FD) and a total of 344,175 students (all the students enrolled in the public schools in the FD in 2017-2020). We analyzed the association between the length of all roads within buffers around schools and student-level academic performance using mixed-effects regression models. After adjustments for several covariates, the results of the primary analysis indicate that the presence of roads surrounding schools is negatively associated with student-level academic performance in the FD. This association varies significantly depending on the buffer size surrounding schools. We found that the highest effects occur in the first buffer, with 250 m. While in the first buffer we estimated that an increase of 1 km of length of roads around schools was associated with a statistically significant decrease of 0.011 (95%CI: 0.008; 0.013) points in students' grades (students' academic performance varies from 0 to 10), in the buffer of 1 km we found a decrease of 0.002 (95%CI: 0.002; 0.002) points in the student-level academic performance. Findings from our investigation provide support for the creation of effective health, educational and urban planning policies for local intervention in the FD. This is essential to improve the environmental quality surrounding schools to protect children from exposure to environmental hazards.