Protecting Children's Health: Asthma and Climate Change

ABSTRACT

Children are particularly vulnerable to the impacts of climate change. Their lungs are developing, making children with asthma especially susceptible to temperature extremes, variations in precipitation, poor air quality, and changes in pollen and flora. Structural and social determinants of health, such as racism and poverty, that disproportionately affect children of color are linked to higher rates of asthma and negative effects of climate change. These factors lead to increased absences from school and social activities, loss of work for caregivers, and increased health care costs, thus negatively affecting children, their families, and the greater community. Nurses must support caregivers and children to link climate change to asthma care, be involved in health education; climate change mitigation and adaptation strategies and policies; and develop the evidence to address climate change and asthma strategies. We address the impacts of climate change on children with asthma and nursing adaptation responses.

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

Children are particularly vulnerable to the detrimental health impacts of poor air quality. In the UK, recent initiatives at local council level have focussed on mitigating children's air pollution exposure at school. However, an overview of the available evidence on concentration and exposure in school environments - and a summary of key knowledge gaps - has so far been lacking. To address this, we conducted a review bringing together recent academic and grey literature, relating to air quality in outdoor school environments - including playgrounds, drop-off zones, and the school commute - across high-income countries. We aimed to critically assess, synthesise, and categorise the available literature, to produce recommendations on future research and mitigating actions. Our searches initially identified 883 articles of interest, which were filtered down in screening and appraisal to a final total of 100 for inclusion. Many of the included studies focussed on nitrogen dioxide (NO₂), and particulate matter (PM) in both the coarse and fine fractions, around schools across a range of countries. Some studies also observed ozone (O₃) and volatile organic compounds (VOCs) outside schools. Our review identified evidence that children can encounter pollution peaks on the school journey, at school gates, and in school playgrounds; that nearby traffic is a key determinant of concentrations outside schools; and that factors relating to planning and urban design - such as the type of playground paving, and amount of surrounding green space - can influence school site concentrations. The review also outlines evidence gaps that can be targeted in future research. These include the need for more personal monitoring studies that distinguish between the exposure that takes place indoors and outdoors at school, and a need for a greater number of studies that conduct before-after evaluation of local interventions designed to mitigate children's exposure, such as green barriers and road closures. Finally, our review also proposes some tangible recommendations for policymakers and local leaders. The creation of clean air zones around schools; greening of school grounds; careful selection of new school sites; promotion of active travel to and from school; avoidance of major roads on the school commute; and scheduling of outdoor learning and play away from peak traffic hours, are all advocated by the evidence collated in this review.

A primary school driven initiative to influence commuting style for dropping-off and picking-up of pupils

The use of cars for drop-off and pick-up of pupils from schools is a potential cause of pollution hotspots at school premises. Employing a joint execution of smart sensing technology and citizen science approach, a primary school took an initiative to co-design a study with local community and researchers to generate data and provide information to understand the impact on pollution levels and identify possible mitigation measures. This study was aimed to assess the hotspots of vehicle-generated particulate matter ≤2.5 μm (PM_2.5) and ≤10 μm (PM₁₀) at defined drop-off/pick-up points and its ingress into a nearby naturally ventilated primary school classroom. Five different locations were selected inside school premises for measurements during two peak hours: morning (MP; 0730-0930 h; local time), evening (EP; 1400-1600 h), and off-peak (OP; 1100-1300 h) hours for comparison. These represent PM measurements at the main road, pick-up point at the adjoining road, drop-off point, a classroom, and the school playground. Additional measurements of carbon dioxide (CO₂) were taken simultaneously inside and outside (drop-off point) the classroom to understand its build-up and ingress of outdoor PM. The results demonstrated nearly a three-fold increase in the concentrations of fine particles (PM_2.5) during drop-off hours compared to off-peak hours indicated the dominant contribution of car queuing in the school premises. Coarse particles (PM_2.5-10) were prevalent in the school playground, while the contribution of fine particles as a result of traffic congestion became more pronounced during drop-off hours. In the naturally ventilated classroom, the changes in indoor PM_2.5 concentrations during both peak hours (0.58 < R² < 0.67) were followed by the outdoor concentration at the drop-off point. This initiative resulted in valuable information that might be used to influence school commuting style and raise other important issues such as the generally fairly high PM_2.5 concentrations in the playground and future classroom ventilation plans.

The Pivotal Role of the Social Sciences in Environmental Health Sciences Research

Environmental health sciences research seeks to elucidate environmental factors that put human health at risk. A primary aim is to develop strategies to prevent or reduce exposures and disease occurrence. Given this primary focus on prevention, environmental health sciences research focuses on the populations most at risk such as communities of color and/or low socioeconomic status. The National Institute of Environmental Health Sciences research programs incorporate the principles of Community-Based Participatory Research to study health disparities. These programs promote community engagement, culturally appropriate communications with a variety of stakeholders, and consideration of the social determinants of health that interact with environmental factors to increase risk. Multidisciplinary research teams that include social and behavioral scientists are essential to conduct this type of research. This article outlines the history of social and behavioral research funding at National Institute of Environmental Health Sciences and offers examples of National Institute of Environmental Health Sciences-funded projects that exemplify the value of social science to the environmental health sciences.

Factors influencing the outdoor concentration of carbonaceous aerosols at urban schools in Brisbane, Australia: Implications for children's exposure

This comprehensive study aimed to determine the sources and driving factors of organic carbon (OC) and elemental carbon (EC) concentrations in ambient PM2.5 in urban schools. Sampling was conducted outdoors at 25 schools in the Brisbane Metropolitan Area, Australia. Concentrations of primary and secondary OC were quantified using the EC tracer method, with secondary OC accounting for an average of 60%. Principal component analysis distinguished the contributing sources above the background and identified groups of schools with differing levels of primary and secondary carbonaceous aerosols. Overall, the results showed that vehicle emissions, local weather conditions and secondary organic aerosols (SOA) were the key factors influencing concentrations of carbonaceous component of PM2.5 at these schools. These results provide insights into children's exposure to vehicle emissions and SOA at such urban schools.

School children's personal exposure to ultrafine particles in the urban environment

There has been considerable scientific interest in personal exposure to ultrafine particles (UFP). In this study, the inhaled particle surface area doses and dose relative intensities in the tracheobronchial and alveolar regions of lungs were calculated using measured 24-h UFP time series of school children personal exposures. Bayesian hierarchical modeling was used to determine mean doses and dose intensities for the various microenvironments. Analysis of measured personal exposures for 137 participating children from 25 schools in the Brisbane Metropolitan Area showed similar trends for all participating children. Bayesian regression modeling was performed to calculate the daily proportion of children's total doses in different microenvironments. The proportion of total daily alveolar doses for home, school, commuting, and other were 55.3%, 35.3%, 4.5%, and 5.0%, respectively, with the home microenvironment contributing a majority of children's total daily dose. Children's mean indoor dose was never higher than the outdoor's at any of the schools, indicating there were no persistent indoor particle sources in the classrooms during the measurements. Outdoor activities, eating/cooking at home, and commuting were the three activities with the highest dose intensities. Children's exposure during school hours was more strongly influenced by urban background particles than traffic near the school.

The impact of an anti-idling campaign on outdoor air quality at four urban schools

Idling school buses may increase concentrations of air pollutants including fine particulate matter (PM2.5) and elemental carbon (EC) near schools. Efforts to reduce vehicle idling near schools have rarely included air sampling to objectively assess changes in concentrations of air pollutants. The objective was to determine the impact of an anti-idling campaign on outdoor air quality at four schools with varying exposure to bus and automobile traffic. Outdoor air sampling for PM2.5, EC and particle number concentration (PNC) was conducted at four schools for five days before and after an anti-idling campaign. Sampling began before the morning arrival of buses and concluded after their afternoon departure. Sampling was simultaneously conducted at four corresponding community sites. Differences in PM2.5, EC, and PNC measured at school and community sites for each sampling day were calculated before and after the campaign. Before the campaign, the average outdoor concentration of PM2.5 during the school day at three of the four schools exceeded community background levels and the difference was greatest (4.11 μg m(-3), p < 0.01) at the school with the most buses (n = 39). The largest difference in EC between school and community sites was also observed at the school with the greatest number of buses (0.40 μg m(-3), p < 0.01). Following the anti-idling campaign, the average difference in PM2.5 at the school with the most buses decreased from 4.11 μg m(-3) to 0.99 μg m(-3) (p < 0.05). Similarly, at this school, the difference in the EC level decreased from 0.40 μg m(-3) to 0.15 μg m(-3) and PNC decreased from 11,560 to 1690 particles per cm(3) (p < 0.05). The outdoor concentrations of pollutants at schools with fewer buses (n = 5-11) were not significantly reduced. The concentration of air pollutants near schools may significantly exceed community background levels, particularly in the presence of idling school buses. Anti-idling campaigns are effective in reducing PM2.5, EC and PNC at schools with significant amounts of buses and passenger cars.

Aerosol mass spectrometric analysis of the chemical composition of non-refractory PM(1) samples from school environments in Brisbane, Australia

Long-term exposure to vehicle emissions has been associated with detrimental health effects. Children are amongst the most susceptible group and schools represent an environment where they can experience significant exposure to vehicle emissions. However, there are limited studies on children's exposure to vehicle emissions in schools. The aim of this study was to quantify the concentration of organic aerosol (OA) and in particular, vehicle emissions that children are exposed to during school hours. Therefore an Aerodyne compact time-of-flight aerosol mass spectrometer (TOF-AMS) was deployed at five urban schools in Brisbane, Australia. TOF-AMS enabled the chemical composition of the non-refractory (NR-PM1) to be analysed with a high temporal resolution to assess the concentration of vehicle emissions and other OA components during school hours. The organic fraction at each school comprised the majority of NR-PM1. Primary emissions were found to dominate the OA at only one school which had an O:C ratio of 0.17, due to fuel powered gardening equipment used near the TOF-AMS. A significant source of the OA at two of the schools was aged vehicle emissions from nearby highways. More oxidised OA was observed at the remaining two schools, which also recorded strong biomass burning influences. In general, the diurnal cycle of the total OA concentration varied between schools and was found to be at a minimum during school hours. The major organic component that school children were exposed to during school hours was secondary OA at all schools. Peak exposure of school children to vehicle emissions occurred during school drop-off and pick-up times. Unless a school is located near major roads, children are exposed predominately to regional secondary OA as opposed to local emissions during school hours in urban environments.

Nitric oxide and superoxide mediate diesel particle effects in cytokine-treated mice and murine lung epithelial cells--implications for susceptibility to traffic-related air pollution

Background

Epidemiologic studies associate childhood exposure to traffic-related air pollution with increased respiratory infections and asthmatic and allergic symptoms. The strongest associations between traffic exposure and negative health impacts are observed in individuals with respiratory inflammation. We hypothesized that interactions between nitric oxide (NO), increased during lung inflammatory responses, and reactive oxygen species (ROS), increased as a consequence of traffic exposure ─ played a key role in the increased susceptibility of these at-risk populations to traffic emissions.

Methods

Diesel exhaust particles (DEP) were used as surrogates for traffic particles. Murine lung epithelial (LA-4) cells and BALB/c mice were treated with a cytokine mixture (cytomix: TNFα, IL-1β, and IFNγ) to induce a generic inflammatory state. Cells were exposed to saline or DEP (25 μg/cm²) and examined for differential effects on redox balance and cytotoxicity. Likewise, mice undergoing nose-only inhalation exposure to air or DEP (2 mg/m³ × 4 h/d × 2 d) were assessed for differential effects on lung inflammation, injury, antioxidant levels, and phagocyte ROS production.

Results

Cytomix treatment significantly increased LA-4 cell NO production though iNOS activation. Cytomix +  DEP-exposed cells incurred the greatest intracellular ROS production, with commensurate cytotoxicity, as these cells were unable to maintain redox balance. By contrast, saline + DEP-exposed cells were able to mount effective antioxidant responses. DEP effects were mediated by: (1) increased ROS including superoxide anion (O₂˙^-), related to increased xanthine dehydrogenase expression and reduced cytosolic superoxide dismutase activity; and (2) increased peroxynitrite generation related to interaction of O₂˙^- with cytokine-induced NO. Effects were partially reduced by superoxide dismutase (SOD) supplementation or by blocking iNOS induction. In mice, cytomix +  DEP-exposure resulted in greater ROS production in lung phagocytes. Phagocyte and epithelial effects were, by and large, prevented by treatment with FeTMPyP, which accelerates peroxynitrite catalysis.

Conclusions

During inflammation, due to interactions of NO and O₂˙^-, DEP-exposure was associated with nitrosative stress in surface epithelial cells and resident lung phagocytes. As these cell types work in concert to provide protection against inhaled pathogens and allergens, dysfunction would predispose to development of respiratory infection and allergy. Results provide a mechanism by which individuals with pre-existing respiratory inflammation are at increased risk for exposure to traffic-dominated urban air pollution.

A multi-site analysis of the association between black carbon concentrations and vehicular idling, traffic, background pollution, and meteorology during school dismissals

A study was performed to assess the relationship between black carbon (BC), passing traffic, and vehicular idling outside New York City (NYC) schools during student dismissal. Monitoring was performed at three school sites in East Harlem, the Bronx, and Brooklyn for 1month per year over a two-year period from November 2006-October 2008. Monitoring at each site was conducted before and after the Asthma Free School Zone (AFSZ) asthma reduction education program was administered. Real-time equipment with a one-minute averaging interval was used to obtain the BC data, while volume counts of idling and passing school busses, trucks, and automobiles were collected each minute by study staff. These data were matched to ambient PM(2.5) and meteorology data obtained from the New York State Department of Environmental Conservation. A generalized additive model (GAM) model was run to examine the relationship between BC concentration and each variable while accounting for site-to-site differences. F-tests were employed to assess the significance of each of the predictor variables. The model results suggested that variability in ambient PM(2.5) concentration contributed 24% of the variability in transformed BC concentration, while variability in the number of idling busses and trucks on the street during dismissal contributed 20% of the variability in transformed BC concentration. The results of this study suggest that a combination of urban scale and local traffic control approaches in combination with cessation of school bus idling will produce improved local BC concentration outside schools.

Aerosol particles generated by diesel-powered school buses at urban schools as a source of children's exposure

Various heath effects in children have been associated with exposure to traffic-related particulate matter (PM), including emissions from school buses. In this study, the indoor and outdoor aerosol at four urban elementary schools serviced by diesel-powered school buses was characterized with respect to the particle number concentrations and size distributions as well as the PM2.5 mass concentrations and elemental compositions. It was determined that the presence of school buses significantly affected the outdoor particle size distribution, specifically in the ultrafine fraction. The time-weighted average of the total number concentration measured outside the schools was significantly associated with the bus and the car counts. The concentration increase was consistently observed during the morning drop-off hours and in most of the days during the afternoon pick-up period (although at a lower degree). Outdoor PM2.5 mass concentrations measured at schools ranged from 3.8 to 27.6 µg m-3. The school with the highest number of operating buses exhibited the highest average PM2.5 mass concentration. The outdoor mass concentrations of elemental carbon (EC) and organic carbon (OC) were also highest at the school with the greatest number of buses. Most (47/55) correlations between traffic-related elements identified in the outdoor PM2.5 were significant with elements identified in the indoor PM2.5. Significant associations were observed between indoor and outdoor aerosols for EC, EC/OC, and the total particle number concentration. Day-to-day and school-to-school variations in Indoor/Outdoor (I/O) ratios were related to the observed differences in opening windows and doors, which enhanced the particle penetration, as well as indoor activities at schools. Overall, the results on I/O ratio obtained in this study reflect the sizes of particles emitted by diesel-powered school bus engines (primarily, an ultrafine fraction capable of penetrating indoors).