Air pollution, avoidance behaviour and children's respiratory health: evidence from England

Defending against environmental threats: Unveiling household adaptation strategies and population heterogeneity

Humanity faces a variety of risks from pollution and environmental degradation. Societal advancement has equipped the public with numerous self-protection measures to mitigate these threats. However, the ways in which individuals deploy and balance self-defence mechanisms within this complex risk landscape and the resulting consequences remain largely unexplored. Drawing on a detailed survey of households' self-defence practices, this study rigorously analyses the heterogeneity and driving factors behind household-level self-defence strategies. Through exploratory latent class modelling, we identified four distinct defence patterns: inaction, water-sensitive, air-sensitive, and multifaceted. These patterns reveal varied defence capabilities among the population. By integrating frameworks from economics and social psychology, significant disparities were found in the driving factors behind these patterns. Practices aimed at combating air pollution are primarily driven by the actual severity of pollution and perceived coping capabilities, whereas measures to enhance water quality are influenced more by perceived threats. This disparity arises from variations in information availability and health awareness. The study also highlights a misalignment between the distribution of defence capabilities and the levels of pollution. Given that income restricts self-defence options, this mismatch indicates that economically disadvantaged groups are disproportionately affected by severe health inequalities.

Does air pollution fuel irrational behaviors in stock investments?

This paper investigates the influence of air pollution on irrational behaviors in stock trading through behavioral experiments in laboratory, simulating air pollution by burning straw and mosquito coils. The results of this study show that air pollution significantly improves disposition effect and repurchase effect in an asymmetric way, which are thought as irrational behaviors in stock investments, making subjects prefer selling winning stocks (part of disposition effect) and repurchasing stocks that have fallen in price since the sale (part of repurchase effect). Furthermore, regret, a negative emotion, is the psychological mechanism by which air pollution influences the irrational behaviors.

A conceptional model integrating geographic information systems (GIS) and social media data for disease exposure assessment

Although previous studies have acknowledged the potential of geographic information systems (GIS) and social media data (SMD) in assessment of exposure to various environmental risks, none has presented a simple, effective and user-friendly tool. This study introduces a conceptual model that integrates individual mobility patterns extracted from social media, with the geographic footprints of infectious diseases and other environmental agents utilizing GIS. The efficacy of the model was independently evaluated for selected case studies involving lead in the ground; particulate matter in the air; and an infectious, viral disease (COVID- 19). A graphical user interface (GUI) was developed as the final output of this study. Overall, the evaluation of the model demonstrated feasibility in successfully extracting individual mobility patterns, identifying potential exposure sites and quantifying the frequency and magnitude of exposure. Importantly, the novelty of the developed model lies not merely in its efficiency in integrating GIS and SMD for exposure assessment, but also in considering the practical requirements of health practitioners. Although the conceptual model, developed together with its associated GUI, presents a promising and practical approach to assessment of the exposure to environmental risks discussed here, its applicability, versatility and efficacy extends beyond the case studies presented in this study.

"I have to stay inside …": Experiences of air pollution for people with asthma

Asthma, characterized by airway inflammation, sensitization and constriction, and leading to symptoms including cough and dyspnoea, affects millions of people globally. Air pollution is a known asthma trigger, yet how it is experienced is understudied and how individuals with asthma interact with air quality information and manage exacerbation risks is unclear. This study aimed to explore how people living with asthma in Scotland, UK, experienced and managed their asthma in relation to air pollution. We explored these issues with 36 participants using semi-structured interviews. We found that self-protection measures were influenced by place and sense of control (with the home being a "safe space"), and that the perception of clean(er) air had a liberating effect on outdoor activities. We discuss how these insights could shape air quality-related health advice in future.

Leave for where? The impact of air quality on migration: Evidence at the city-pair level in China

We comprehensively explore the question of "Leave for where?" by utilizing city-pair level data of China spanning from 2011 to 2017. Our investigation focuses on the impact of disparities in air quality between city pairs on migration. we find that a 1% increase in the difference air quality between inflow and outflow locations raises the number of people migrating from the outflow to the inflow location by approximately 0.07%. This finding is robust after overcoming possible endogeneity problems with average wind speed as an instrumental variable. In addition, we conducted a heterogeneity analysis in terms of intention to migrate and individual characteristics, finding that individuals who migrated for work and family are more sensitive to differences in air quality between city pairs, whereas those who moved for business are not sensitive to differences in air quality. Regarding individual characteristics, differences in air quality between city pairs have a greater impact on the migration decisions of low-educated, female, and younger migrants. Further, a mechanistic analysis by constructing cohort dummy variables reveals that poor air quality is more motivational than the desire for good air quality and the crowding-out effect of air pollution on migration is more pronounced.

Air pollution and motor vehicle collisions in New York city

Road traffic accidents are a pervasive feature of everyday life, killing 36,500 people, injuring 4.5 million and, overall, generating costs to the American society of $340 billion in 2019. Understanding the underlying factors can improve the design of prevention strategies. We use all road traffic collisions in New York City between 2013 and 2021 (N = 1,269,600) and match each individual collision to the nearest weather and air pollution station. Our study uses highly disaggregated data using an hourly frequency of collisions at a fine spatial level incorporating various air pollutants and weather factors. We employ an instrumental variable approach using temperature inversions to provide exogenous variation in air pollution addressing endogeneity and measurement error concerns. We find that higher concentrations of carbon monoxide (CO) and sulfur dioxide (SO2) increase the number of collisions but leave the severity (persons injured or killed) unaffected. Part of this can be explained by the effect of air pollutants on aggressive behavior: CO (p < .05) and SO2 (p < .01) increase the number of collisions caused by aggressive driving. Interestingly, this channel is only present in male drivers. Our results provide additional evidence that air pollution not only adversely affects health, but also has "non-health" related effects which are costly for the society.

A cross-sectional study of inequalities in digital air pollution information access and exposure reducing behavior uptake in the UK

Air pollution is a pervasive global environmental challenge that presents substantial and differential risk across populations. Individual-level pollution exposure is a function of varying factors, including but not limited to geographic location, proximity to point sources, ventilation, and behavioral patterns. Mounting evidence suggests that informational interventions can play a substantial role in mediating exposures for specific population subgroups and reduce downstream adverse health outcomes. The literature has yet to address whether access to air quality information is sociodemographically stratified, and whether such access correlates with increased uptake of exposure reducing behaviors at the population level. This study represents a first step in answering these questions by analysing responses from the "Clean Air Public Insight Tracker" nationally representative survey (n = 1,993) of the UK population, administered by UK charity Global Action Plan. Results from logistic regression and zero-inflated negative binomial models estimate 28% of the population have accessed air pollution information, while the odds of younger individuals (ages 18-36), men, and non-white individuals of accessing digitally available air quality information are greater that those outside these categories. Additionally, the odds of behavior uptake is greater if an individual accesses digital information sources like the internet, mobile apps or social media, has a higher education qualification or cares for someone with a health condition. These findings contribute to the growing literature surrounding which population groups engage with environmental and health-relevant information channels, and what connects engagement with air quality channels and uptake of exposure reducing behaviors. These results reinforce the need for additional research around air pollution informational alerts and exploring causal links between specific exposure reducing behaviours and improved health outcomes. It can also help inform the flow of resources and targeting of informational campaigns towards sociodemographic groups that are less likely to engage with air quality information.

Association of Air Pollution with the Number of Common Respiratory Visits in Children in a Heavily Polluted Central City, China

Children's respiratory health is vulnerable to air pollution. Based on data collected from June 2019 to June 2022 at a children's hospital in Zhengzhou, China, this study utilized Spearman correlation analysis and a generalized additive model (GAM) to examine the relationship between daily visits for common respiratory issues in children and air pollutant concentrations. Results show that the number of upper respiratory tract infection (URTI), pneumonia (PNMN), bronchitis (BCT), and bronchiolitis (BCLT) visits in children showed a positive correlation with PM2.5, PM10, NO2, SO2, and CO while exhibiting a negative correlation with temperature and relative humidity. The highest increases in PNMN visits in children were observed at lag 07 for NO2, SO2, and CO. A rise of 10 μg/m3 in NO2, 1 μg/m3 in SO2, and 0.1 mg/m3 in CO corresponded to an increase of 9.7%, 2.91%, and 5.16% in PNMN visits, respectively. The effects of air pollutants on the number of BCT and BCLT visits were more pronounced in boys compared to girls, whereas no significant differences were observed in the number of URTI and PNMN visits based on sex. Overall, air pollutants significantly affect the prevalence of respiratory diseases in children, and it is crucial to improve air quality to protect the children's respiratory health.

Does It Measure Up? A Comparison of Pollution Exposure Assessment Techniques Applied across Hospitals in England

Weighted averages of air pollution measurements from monitoring stations are commonly assigned as air pollution exposures to specific locations. However, monitoring networks are spatially sparse and fail to adequately capture the spatial variability. This may introduce bias and exposure misclassification. Advanced methods of exposure assessment are rarely practicable in estimating daily concentrations over large geographical areas. We propose an accessible method using temporally adjusted land use regression models (daily LUR). We applied this to produce daily concentration estimates for nitrogen dioxide, ozone, and particulate matter in a healthcare setting across England and compared them against geographically extrapolated measurements (inverse distance weighting) from air pollution monitors. The daily LUR estimates outperformed IDW. The precision gains varied across air pollutants, suggesting that, for nitrogen dioxide and particulate matter, the health effects may be underestimated. The results emphasised the importance of spatial heterogeneity in investigating the societal impacts of air pollution, illustrating improvements achievable at a lower computational cost.

Air pollution and timing of childbirth: a retrospective survey analysis based on birth registration data of Chinese newborns

Objectives

Currently, there is a lack of research on whether people will take action to avoid the harm of air pollution and the heterogeneous behavior of different groups. The goal of this paper is to examine the effects of air pollution on the resulting differential effects on newborns and the timing of pregnancy.

Methods

Based on a survey of newborns in a total of 32 hospitals in 12 cities across China in 2011, and after matching with city-level air pollution data, a multiple regression statistical method is then used to examine how the pollution level in a certain period is related to the number of conceptions in that certain period, after controlling for region and season fixed effects.

Results

We first demonstrate that exposure to air pollution during pregnancy is associated with a significant increase in adverse birth outcomes. Most importantly, the empirical results show that the number of conceptions decreased significantly during periods of severe air pollution.

Conclusion

Evidence suggests that air pollution may be causing some families to delay conception to reduce the possible adverse impact on neonatal outcomes. This helps us to understand the social cost of air pollution more, and then make more accurate environmental policies.

US Embassy air-quality tweets led to global health benefits

The World Health Organization estimates that over 90% of the world’s population is exposed to hazardous levels of local air pollution. Air pollution is markedly worse in low- and middle-income countries, yet air-quality monitoring is typically sparse. In 2008, the US Embassy in Beijing began tweeting hourly air-quality information from a newly installed pollution monitor, dramatically improving the information on air quality available to Beijing residents. Since then, the United States has installed over 50 monitors around the world, tweeting real-time reports on air quality in those locations. Using spatially granular measurements of local air pollution from satellite data that span the globe, we employ variation in whether and when US embassies installed monitors to evaluate the impact of air-quality information on pollution. We estimate that embassy monitors led to reductions in fine particulate concentration levels in host countries of 2 to 4 µg/m 3 . Our central estimate of the annual monetized benefit of the decrease in premature mortality due to this reduction in pollution is $127 million for the median city in 2019. Our findings point to the substantial benefits of improving the availability and salience of air-quality information in low- and middle-income countries.

Environmental decentralization, environmental public service, and public health: evidence from 289 cities in China

Effective supply of environmental public services (EPS) is important to guarantee the mitigation of residential pollution exposure risk. This study analyzes the impact of the supply efficiency of EPS on residential health through the sample of 289 cities in China by fixed-effect model and threshold regression model. The results show that: (1) Improving the efficiency of EPS can significantly increase the efficiency of pollution control, and improve the environmental quality and health level of residents. (2) Improving the efficiency of EPS can have a greater positive effect on residents' health in areas with high-level population aging, poor medical condition, and low population density. (3) Environmental decentralization weakens the positive effect of EPS on residential health. Giving more power of environmental management to local governments may be detrimental to pollution control. Therefore, differentiated strategies of EPS should be developed to realize the equalization of basic public services with healthcare and environmental protection. It is necessary to strengthen central environmental supervision and establish resident offices for environmental supervision.

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data-from the China Family Panel Studies 2010-2020-of 26,902 school-age children and adolescents aged 6-16 years and China's new reference standard ("WS/T586-2018") are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder-Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6-16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban-rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban-rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.

Same environment, stratified impacts? Air pollution, extreme temperatures, and birth weight in South China

This paper investigates whether associations between birth weights and prenatal ambient environmental conditions-pollution and extreme temperatures-differ by 1) maternal education; 2) children's innate health; and 3) interactions between these two. We link birth records from Guangzhou, China, during a period of high pollution, to ambient air pollution (PM₁₀ and a composite measure) and extreme temperature data. We first use mean regressions to test whether, overall, maternal education is an "effect modifier" in the relationships between ambient air pollution, extreme temperature, and birth weight. We then use conditional quantile regressions to test for effect heterogeneity according to the unobserved innate vulnerability of babies after conditioning on other confounders. Results show that 1) the negative association between ambient exposures and birth weight is twice as large at lower conditional quantiles of birth weights as at the median; 2) the protection associated with college-educated mothers with respect to pollution and extreme heat is heterogeneous and potentially substantial: between 0.02 and 0.34 standard deviations of birth weights, depending on the conditional quantiles; 3) this protection is amplified under more extreme ambient conditions and for infants with greater unobserved innate vulnerabilities.

An Evaluation of Risk Ratios on Physical and Mental Health Correlations due to Increases in Ambient Nitrogen Oxide (NOx) Concentrations

Nitrogen oxides (NOx) are gaseous pollutants contributing to pollution in their primary form and are also involved in reactions forming ground-level ozone and fine particulate matter. Thus, NOx is of great interest for targeted pollution reduction because of this cascade effect. Primary emissions originate from fossil fuel combustion making NOx a common outdoor and indoor air pollutant. Numerous studies documenting the observed physical health impacts of NOx were reviewed and, where available, were summarized using risk ratios. More recently, the literature has shifted to focus on the mental health implications of NOx exposure, and a review of the current literature found five main categories of mental health-related conditions with respect to NOx exposure: common mental health disorders, sleep, anxiety, depression, and suicide. All the physical and mental health effects with available risk ratios were organized in order of increasing risk. Mental health concerns emerged as those most influenced by NOx exposure, with physical health impacts, such as asthma, only beginning to surface as the fourth highest risk. Mental health conditions occupied seven of the top ten highest risk health ailments. The results summarized in this narrative review show that there are clear positive correlations between NOx and negative physical and mental health manifestations, thus strengthening the argument in support of the reduction in ambient NOx levels.

Empirical dynamic modeling of the association between ambient PM2.5 and under-five mortality across 2851 counties in Mainland China, 1999-2012

BACKGROUND

Ambient fine particulate matter (PM_2.5) pollution has been associated with mortality from various diseases, however, its association with under-five mortality rate (U5MR) has remained largely unknown.

METHODS

Based on the U5MR data across 2851 counties in Mainland China from 1999 to 2012, we employed approximate Bayesian latent Gaussian models to assess the association between ambient PM_2.5 and U5MR at the county level for the whole nation and sub-regions. GDP growth rate, normalized difference vegetation index (NDVI), temperature, and night-time light were included as covariates using a smoothing function. We further implemented an empirical dynamic model (EDM) to explore the potential causal relationship between PM_2.5 and U5MR.

RESULTS

We observed a declining trend in U5MR in most counties throughout the study period. Spatial heterogeneity in U5MR was observed. Nationwide analysis suggested that each 10 µg/m³ increase in annual concentration of PM_2.5 was associated with an increase of 1.2 (95% CI: 1.0 - 1.3) per 1000 live births in U5MR. Regional analyses showed that the strongest positive association was located in the Northeastern part of China [1.8 (95% CI: 1.4 - 2.1)]. The EDM showed a significant causal association between PM_2.5 and U5MR, with an embedding dimension of 5 and 7, and nonlinear values θ of 4 and 6, respectively.

CONCLUSION

China exhibited a downward trend in U5MR from 1999 to 2012, with spatial heterogeneity observed across the country. Our analysis reveals a positive association between PM_2.5 and U5MR, which may support a causal relationship.

The Hot Topics, Frontiers and Trends about Research on the Relationship between Air Pollution and Public Health—Visual Analysis Based on Knowledge Map

It is of great practical significance to analyze the hot issues, research frontiers, and trends concerning the relationship between air pollution and public health and to adopt reasonable strategies to control air pollution and prevent health hazards for follow-up research in this field. Unlike traditional literature reviews, this paper adopts a visual, flexible, and scientifically systematic approach to the analysis, which makes these analysis results more intuitive and comprehensive. Based on the core collection of the Web of Science and CNKI databases, this paper uses CiteSpace software to draw and comment on the maps of Chinese and English keywords, publishing time, author, country, and research institutions in this field. The results show the following: (1) The number of studies on the relationship between air pollution and health has increased year by year; researchers have formed sub cooperation networks, and the trend of cooperation and exchange has become more and more obvious in recent years; the impact of air pollution on health is a hot topic in the world. (2) Research hot topics mainly focus on the selection of air pollutants, health economic consequences of air pollution and the global burden of disease it causes, health indicators, research samples, which are gradually being refined, the synergistic governance of air pollution, and climate change. (3) The analysis of research frontiers and trends reveals that, first, the study of air pollutants in the English literature has undergone a refinement from nitrogen dioxide to fine particulate matter, and the sources of air pollutants in the Chinese literature have undergone changes in the petrochemical industry, indoor formaldehyde pollution, and haze. Second, atmospheric pollution has a significant negative impact on health, increasing the incidence of respiratory and cardiovascular diseases, and even causing death. Third, sustained exposure to pollution then causes greater damage to health and will be a key direction for future research. Fourth, the literature not only studies the correlation but also emphasizes the causal inference between air pollution and health and measures the economic costs associated with health. Finally, air pollution and climate change need to be governed synergistically. The article points out that the three areas of sustained pollution exposure, indirect consequences of negative health effects of air pollution, and air pollution and climate change may be the future focus of the field.

Air Pollution, Foreign Direct Investment, and Mental Health: Evidence From China

Recently, there has been interest in the relationship between mental health and air pollution; however, the results are inconsistent and the contribution of foreign direct investment (FDI) has received little attention. This article studies the effects of air pollution on mental health and the moderating role of FDI based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2015 and 2018 applying the fixed effects panel regression approach and the threshold model. The results show that mental health is adversely affected by air pollution, especially PM_2.5, PM₁₀, sulfur dioxide (SO₂), carbon monoxide (CO), and nitrogen dioxide (NO₂). Second, FDI has an alleviating influence on the negative relationship. Third, the effects of air pollution and FDI are heterogeneous based on regional characteristics, including location, medical resource and investment in science and technology, and individual characteristics covering education level, age, income, and physical health. Finally, the threshold effects show that FDI has a moderating effect when it is >1,745.59 million renminbi (RMB). There are only 11.19% of cities exceeding the threshold value in China. When the value of air quality index (AQI) exceeds 92.79, air pollution is more harmful to mental health. Government should actively introduce high-quality FDI at the effective level and control air pollution to improve mental health.

Health Benefits of Air Quality Improvement: Empirical Research Based on Medical Insurance Reimbursement Data

Measuring the health benefits of air quality improvement is a new perspective for evaluating government investment in pollution control. Improving air quality can reduce the burden on medical insurance funds and patients themselves; however, patients with higher reimbursement rates are more affected by air quality changes. This study calculated health benefits using medical insurance reimbursement data from a sample city in China. The results show that for every 10 μg/m3 decrease in PM2.5, patients' average medical cost will decrease by CNY 1,699 (USD 263.6), and the loss of ordinary working and living time will decrease by 1.24 days. PM2.5 has a more significant impact on patients with chronic respiratory diseases and inpatients with circulatory diseases. Suppose the city's annual PM2.5 concentration drops to the national standard of 35 μg/m3. In that case, it will bring more than CNY 1.28 billion (USD 198 million) in health benefits, accounting for 18% of the city's annual investment in environmental protection.

Air pollution and life expectancy in Europe: Does investment in renewable energy matter?

This study examines the relationship between health and air pollution using a novel approach that allows differentiation between potential and observed health. It also permits an analysis of those factors that may contribute towards reducing any differences between the latter concepts. To this end, a panel data from 29 European countries for the periods 2005 and 2018 is used. Results indicate that the main pollutants affecting European countries, namely NOx, PM10 and PM2.5 have a negative impact on life expectancy at birth, while investment in renewable energies has a positive effect. Several conclusions can be drawn from these results. Firstly, if the aim is to minimize the detrimental effects of the global production of goods and services on air quality, a greater investment in renewable energies as compared to other more polluting ones, is called for. In turn, this would contribute to an improvement in the general health of citizens and the planet thereby increasing overall potential life expectancy. Secondly, NOx gases seem to be the ones that most affect the population's mean potential life expectancy. Results indicate that with regard to particulate matters, those with a diameter of less than 2.5 μm, are the ones that have the greatest impact on the health of European citizens, more so than larger particles (with a diameter between 10 and 2.5 μm).

Trading quality for quantity? Evidence from patient level data in China

In China, overcrowding at hospitals increases the workload of medical staff, which may negatively impact the quality of medical services. This study empirically examined the impact of hospital admissions on the quality of healthcare services in Chinese hospitals. Specifically, we estimated the impact of the number of hospital admissions per day on a patient's length of stay (LOS) and hospital mortality rate using both ordinary least squares (OLS) and instrumental variable (IV) methods. To deal with potential endogeneity problems and accurately identify the impact of medical staff configuration on medical quality, the daily air quality index was selected as the IV. Furthermore, we examined the differential effects of hospital admissions on the quality of care across different hospital tiers. We used the data from a random sample of 10% of inpatients from a city in China, covering the period from January 2014 to June 2019. Our final regression analysis included a sample of 167 disease types (as per the ICD-10 classification list) and 862,722 patient cases from 517 hospitals. According to our results, the LOS decreased and hospital mortality rate increased with an increasing number of admissions. Using the IV method, for every additional hospital admission, there was a 6.22% (p < 0.01) decrease in LOS and a 1.86% (p < 0.01) increase in hospital mortality. The impact of healthcare staffing levels on the quality of care varied between different hospital tiers. The quality of care in secondary hospitals was most affected by the number of admissions, with the average decrease of 18.60% (p < 0.05) in LOS and the increase of 6.05% (p < 0.01) in hospital mortality for every additional hospital admission in our sample. The findings suggested that the supply of medical services in China should be increased and a hierarchical diagnosis and treatment system should be actively promoted.

Evolution of Romania's Economic Structure and Environment Degradation - An Assessment Through LMDI Decomposition Approach

Purpose

This paper studies the relationships between air pollutants (PM₁₀, PM_2.5, N₂O) and different diseases (tumors, skin and respiratory) and the factors influencing air pollutant emissions in Romania.

Methods

The methods are Toda-Yamamoto procedure of non-causality Granger test, grey relational analysis and logarithmic mean Divisia index method (LMDI).

Results

Air pollutants intensities dropped significantly over 2008–2017 period due to structural changes. The only economic activity that showed an increase both in volume and intensity of air pollutants, despite a downward trend of farming activities output is agriculture. Technology improvements play a significant role in mitigation of PM_2.5 emissions and a moderate role in mitigation of PM₁₀ emissions. For N₂O emissions technology used contributed to an increase of N₂O intensities.

Conclusion

Health policy makers should address the issue of technology improvements and mitigation of agriculture emissions to improve health of individuals and air quality.

When particulate matter strikes cities: Social disparities and health costs of air pollution

We investigate the heterogeneous effects of particle pollution on Italian daily hospitalizations and their costs by exploiting public transportation strikes as plausibly-exogenous shocks in pollution exposure. We find that a one standard deviation increase in PM₁₀ causes additional 0.79 hospitalizations per 100,000 residents, and the effect is stronger for the elderly, low educated individuals and migrants. Furthermore, we find that young individuals, an arguably healthy age group, exhibit economically meaningful responses to air pollution with an effect ranging between 0.45 and 1.04. Our results imply a large role of avoidance behavior driving heterogeneous marginal health effects. Total daily costs of a one standard deviation increase in PM₁₀ represent 0.5% of the total daily health expenditure, and 85% of this additional spending comes from more patients hospitalized, while the remaining 15% can be attributable to more costly, and likely more complex, hospitalizations.

Impact of air pollution on human activities: Evidence from nine million mobile phone users

To measure the effects of air pollution on human activities, this study applies statistical/econometric modeling to hourly data of 9 million mobile phone users from six cities in China’s Zhejiang Province from December 18 to 21, 2013. Under a change in air quality from “Good” (Air Quality Index, or AQI, between 51 and 100) to “Heavily Polluted” (AQI between 201 to 300), the following effects are demonstrated. (i) Consistent with the literature, for every one million people, 1, 482 fewer individuals are observed at parks, 95% confidence interval or CI (−2, 229, −735), which represents a 15% decrease. (ii) The number of individuals at shopping malls has no statistically significant change. (iii) Home is the most important location under worsening air quality, and for every one million people, 63, 088 more individuals are observed at home, 95% CI (47, 815, 78, 361), which represents a 19% increase. (iv) Individuals are on average 633 meters closer to their home, 95% CI (529, 737); as a benchmark, the median distance from home ranges from 300 to 1900 meters across the cities in our sample. These effects are not due to weather or government regulations. We also provided provisional evidence that individuals engage in inter-temporal activity substitutions within a day, which leads to mitigated (but not nullified) effects of air pollution on daily activities.

Effect of air pollution on health care expenditure: Evidence from respiratory diseases

Recent reports show that at least 95% of the world's population is breathing polluted air. However, the impact of air quality on air pollution-related medical expenditure and utilization is sparse. This study estimates the short-term health care cost impacts of air pollution using a meteorological phenomenon-thermal inversion-as an instrumental variable for air quality. Using information on outpatient care for respiratory diseases from universal health insurance claim data in Taiwan during 2006-2012, our estimates suggest that a one-unit reduction in the air quality index (AQI) leads to NT$2.3 billion (nearly US$74 million) of savings in respiratory-related outpatient expenditure per year. Given that the average AQI is equal to 32 during our study period, completely removing air pollution would reduce the national health expenditure by approximately 8% annually. Our results provide the important implication that the cost of controlling air pollutant emissions can be offset by curtailing health care expenditure.

Low emission zones and population health

Air pollution has a detrimental impact on population health, but the effectiveness of policy measures targeting pollution is underexplored. I exploit the natural experiment generated by the staggered implementation of low emission zones in large cities across Germany to assess their impact on health. Using register data on outpatient and inpatient health care, I find that low emission zones reduce the number of patients with cardiovascular disease by 2-3%. This effect is particularly pronounced for those over the age of 65. The findings suggest that low emission zones can be an effective way to reduce air pollution and improve health.

Cost of economic growth: Air pollution and health expenditure

This study examines the causal effect of air pollution on health expenditure using a sample of the China Health and Nutrition Survey in 2015. It concludes that exposure to air pollution is associated with the increase in health expenditure with an elasticity of 10.013. The coefficient is roughly seven times bigger than the cost of traditional respiratory diseases. The large coefficient will be the social cost of medical insurance and various diseases. Results also indicate that sample mobility can underestimate health cost. Meanwhile, we identify heterogeneity among different populations and pollutants. The estimates show that PM_2.5 is the main cause of health expenditure and that males, high-income individuals, highly educated individuals, people with health insurance, and older people are more sensitive to air pollution. Moreover, our evidence suggests that air pollution nonlinearly affects health expenditure. We also find that the mechanism is through diseases occurrence and diseases severity to increase health expenditure.

Real-time information on air pollution and avoidance behavior: evidence from South Korea

This study provides new empirical evidence on the relationship between information about air pollution and avoidance behavior. Many countries provide real-time information to describe the current level of air pollution exposure. However, little research has been done on people's reactions to that real-time information. Using data on attendance at professional baseball games in South Korea, this study investigates whether real-time information on particulate matter affects individuals' decisions to participate in outdoor activities. Regression models that include various fixed effects are used for the analysis, with the results showing that real-time alerts reduce the number of baseball game spectators by 7%, and that the size of the effect is not statistically different from that of air pollution forecasts. The study demonstrates that providing real-time information can be a way to protect the public's health from the threat of air pollution. Moreover, the findings suggest that having easy access to the relevant information and an awareness of the risks involved are necessary for a real-time information policy to succeed.

Impacts of air pollution on health: evidence from longitudinal cohort data of patients with cardiovascular diseases

This study uses longitudinal cohort data to estimate the impacts of air pollution on health outcomes among people first hospitalised with heart diseases. Despite the generally low level of pollution in Australia, we find that acute exposure to pollution increases readmissions to hospitals within 3-12 months after discharge and is more evident among those suffering from heart failure. We further show that chronic exposure to air pollution increases the risk of death within 72 months, hospital admissions and general practitioner (GP) visits. Patients with coronary heart disease or cerebrovascular disease are the most affected groups. Finally, a cost saving of $1.3 billion will be generated to the health sector, if the monthly concentration of PM₁₀ and CO was lowered to 15.49 µg/m³ and 122.99 µg/m³, respectively. The findings from our study emphasize the need for policies that target significant reduction in ambient PM₁₀ and CO to decrease the demand for scarce healthcare resources for cardiac diseases.

Particulate air pollution, birth outcomes, and infant mortality: Evidence from Japan's automobile emission control law of 1992

This study investigates the impacts of the Automobile NO_x Law of 1992 on ambient air pollutants and fetal and infant health outcomes in Japan. Using panel data taken from more than 1500 monitoring stations between 1987 and 1997, we find that NO_x and SO₂ levels reduced by 5% and 11%, respectively in regulated areas following the 1992 regulation. In addition, using a municipal-level panel data set from Japan's Vital Statistics Survey and a difference-in-differences approach, we find that the regulation explains most of the improvements in the fetal death rate after the regulation came into effect. This study provides evidence on the positive impacts of this large-scale automobile regulation policy on fetal health.

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We estimate the effects of Automobile NOx Law on fetal and infant health.

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Monitoring station-level and municipal-level panel datasets are used.

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Regression differences-in-differences models are adopted.

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NOx and SO₂ levels were reduced by 5% and 11% by the regulation.

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The fetal death rate was substantially improved by the regulation.

Queensland Cardiovascular Data Linkage (QCard): A population-based cohort study

Queensland is Australia's hotspot for cardiovascular disease (CVD). Critically, beyond modifiable lifestyle risk factors; socio-demographic differences and environmental factors account for significant variations in healthcare use and outcomes among cardiac patients across the country. To better understand the impacts of these factors on the health of cardiac patients, there is a need for a comprehensive and robust longitudinal cohort study that can unpack the underlying dynamics. This paper describes the protocol for the Queensland Cardiovascular Linkage (QCard) Study. The QCard is a longitudinal linkage cohort study of cardiac patients who were first hospitalised with any cardiac condition in 2010, with follow up hospitalisations until December 2015. The primary aim of the QCard is to identify and characterise the nature and impact of socio-demographic inequality among those presenting for the first time with the most common form of CVD in Australia (heart disease) in Queensland from 2010 with minimum 5-years follow-up of subsequent healthcare utilisation and outcomes. A secondary aim is to undertake an exploration of the impact of environmental and specific health service factors on healthcare use and survival time in the same QCard cohort. Administrative public and private hospital inpatient, outpatient and emergency department data for all of Queensland will be linked with individual primary care data and pharmaceutical data. These data will also be linked to regional socio-demographic data and environmental data, as well as data that describes the features of each hospital in the region. The findings from the study will provide critical information for cardiac patients, clinicians and health policymakers. Such information ranges from identifying most vulnerable cardiac patients who may require targeted needs to providing estimates for cost-effective ways of evaluating healthcare interventions that seek to improve the health of cardiac patients.

Self-care behaviors related to air pollution protection questionnaire: a psychometric analysis

Background

Air pollution is an environmental health issue that has received much attention due to its harmful effects on public health. The aim of this study was to determine the psychometric properties of the self-care behaviors related to air pollution protection. To this mean, questionnaire responses provided by Iranian college students were analyzed and a Health Belief Model (HBM) determined.

Methods

The self-care behavior related to air pollution protection was determined from responses from 301 university students using test item characteristics, face validity, reliability (internal consistency) and construct validity. Moreover, we carried out an exploratory factor analysis (EFA) to determine the factorial structure and explained variance.

Results

Based on Eigenvalues of ≥1.00 and factor loadings of ≥0.40, seven factors were extracted. The calculated Kaiser–Meyer–Olkin value was 0.804. Overall, the seven factors explain 66.39% of the variance in the hypothesized model. Cronbach’s alpha for the measured factors: the perceived susceptibility, severity, barriers, benefits, self-efficacy, cues to action and behavior were 0.85, 0.79, 0.86, 0.66, 0.74, 0.83, and 0.75, respectively.

Conclusion

The analysis of the questionnaire’s reliability and validity properties resulted in good values. The questionnaire is a promising instrument to assess self-care behavior related to air pollution protection from the perspective of college students.

Do cognitive and non-cognitive abilities mediate the relationship between air pollution exposure and mental health?

Considered as a key component of human capital, mental health has drawn substantial scholarly attention for its effect on people’s health status and economic outcome. When facing the challenge of stress, people’s heterogeneity in cognitive ability and non-cognitive ability causes difference in patterns of coping, resulting in different manifestations in mental health. Previous researches have shown that cognitive and non-cognitive abilities have positively direct or indirect effects on mental health, but few studies research their role of coping with air pollution. We used the China Family Panel Survey (CFPS) and matched individual data with county or district level PM_2.5 information from NASA. The study found that air pollution has negative effect on mental health with every increase of 1μg/m³ in PM_2.5 deteriorating mental health by 0.038 standard deviation, which is the total effect of air pollution. However, the direct effect of air pollution on mental health will decrease to 0.028 in absolute value when considering mediating effects. By employing different approaches, we found positive mediating effects via cognitive ability and non-cognitive ability. Individuals with high cognitive and non-cognitive abilities are able to accurately diagnose problems and select the optimal coping strategies, thus restoring positive mental health.

Air pollution, respiratory illness and behavioral adaptation: Evidence from South Korea

Air pollution is closely associated with the development of respiratory illness. Behavioral adaptations of people to air pollution may influence its impact, yet this has not been investigated in the literature. Our hypothesis is that people experience and learn the underlying air quality to decide their adaptation, and they have a stronger incentive to behaviorally adapt to the air quality as it deteriorates. We tested our hypothesis on a sample of approximately 25,700 individuals from South Korea from 2002 to 2013 that contained information on daily doctor's visits due to respiratory disease. We matched individuals to the mean of the past seven-day concentration of the particulate matter of size between 2.5 and 10 micrometers (PM10) in their county of residence. We examined whether people living in counties with greater air pollution suffer less from respiratory disease when the concentration increases. For the analysis, we separated counties into quintiles based on their mean seven-day PM10, and regressed the binary indicator of a daily doctor's visit with a resulting diagnosis of respiratory disease on the seven-day PM10 concentration of the county of residence interacted with the quintile dummies. The key findings are that a 1-standard-deviation increase in the seven-day PM10 concentration in the two lowest quintiles is associated with an increase of 0.054 percentage points in the likelihood of a doctor's visit with a resulting diagnosis of respiratory disease, which is about 40% larger than the effect in higher quintiles, and the size of 1-standard-deviation gradually increases from 0.037 percentage points in the third quintile to 0.040 percentage points in the fifth quintile. The smaller increase in the likelihood of respiratory disease in more polluted locations can be explained by the behavioral adaptation to the environment, but the effectiveness of the adaptation seems limited among the highly polluted locations.

Air pollution and visitation at U.S. national parks

Hundreds of millions of visitors travel to U.S. national parks every year to visit America's iconic landscapes. Concerns about air quality in these areas have led to strict, yet controversial pollution control policies. We document pollution trends in U.S. national parks and estimate the relationship between pollution and park visitation. From 1990 to 2014, average ozone concentrations in national parks were statistically indistinguishable from the 20 largest U.S. metropolitan areas. Further, relative to U.S. cities, national parks have seen only modest reductions in days with ozone concentrations exceeding levels deemed unhealthy by the U.S. Environmental Protection Agency. We find a robust, negative relationship between in-park ozone concentrations and park visitation. Still, 35% of all national park visits occur when ozone levels are elevated.

Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review

BACKGROUND

Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings.

METHOD

In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework.

RESULTS

Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices, being exposed to health messages that reduced both concern about air pollution and perceived susceptibility, as well as perceived lack of self-efficacy/locus of control, reliance on sensory cues and lack of time.

CONCLUSION

We found frequent suboptimal adherence rates to health advice accompanying air quality alerts. Several psychosocial facilitators and barriers of adherence were identified. To maximise their health effects, health advice needs to target these specific psychosocial factors.

Chinese Yellow Dust and Korean infant health

Naturally-occurring Yellow Dust outbreaks, which are produced by winds flowing to Korea from China and Mongolia, create air pollution. Although there is a seasonal pattern of this phenomenon, there exists substantial variation in its timing, strength, and location from year to year. To warn residents about air pollution in general, and about these dust storms in particular, Korean authorities issue different types of public alerts. Using birth certificate data on more than 1.5 million babies born between 2003 and 2011, we investigate the impact of air pollution, and the avoidance behavior triggered by pollution alerts on various birth outcomes. We show that air pollution rises during Yellow Dust outbreaks and that exposure to air pollution during pregnancy has a significant negative impact on birth weight, the gestation weeks of the baby, and the propensity of the baby being born low weight. Public alerts about air quality during pregnancy help mitigate the adverse effect of pollution on fetal health. The results provide evidence for the effectiveness of pollution alert systems in promoting public health. They also underline the importance of taking into account individuals' avoidance behavior when estimating the impact of air quality on birth outcomes. We show that when the preventive effect of public health warnings is not accounted for, the estimated relationship between air pollution and infant health is reduced by more than fifty percent. In summary, air pollution has a deteriorating impact on newborns' health, and public alerts that warn individuals about increased air pollution help alleviate the negative impact.

Effects of fine particles on children's hospital admissions for respiratory health in Seville, Spain

This study analyzes the influence of fine particles PM2.5 on nonprogrammed children's hospital admissions that occurred in the city of Seville between 2007 and 2011, and makes an economic assessment of the cost of the children's hospital admissions for respiratory causes due to particle pollution. The PM2.5 dose-response functions for each type of hospital admission were used to quantify the cost of the hospital admissions. It can be concluded that the PM2.5 concentrations have negative effects on bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM2.5 concentration from the existing levels to 10 µg/m3 would show an annual average reduction of children's hospital admissions due to respiratory diseases of 0.09 cases. This paper shows that the daily average cost for children hospital admissions due to respiratory reasons in the city of Seville, associated with daily average annual levels of PM2.5 above 10 µg/m3, was almost 200€.

IMPLICATIONS

Elevated PM2.5 concentrations in Seville have negative effects on children's bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM2.5 concentration from the existing levels to 10 μg/m3 would suppose an annual mean reduction of children's hospital admissions due to respiratory diseases of 0.09 cases.