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Wang C, Li J, Li J, Li Y, Li C, Ren L. What can be done to protect toddlers from air pollution: Current evidence. J Pediatr Nurs 2024; 76:e50-e59. [PMID: 38278746 DOI: 10.1016/j.pedn.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
PROBLEM Toddlers are more prone to exposure to widely distributed air pollution and to health damage from it. However, systematic summaries of evidence on protective behaviors against air pollution for toddlers are lacking. OBJECTIVE To identify currently available evidence on protective behaviors against air pollution for toddlers. METHODS The literature retrieval was performed in selected databases, limited from 2002 to 2022. Studies meeting the following criteria were included and praised: 1) clinical practice guideline, systematic review, expert consensus, recommended practice, randomized control test (RCT) or cohort study published in Chinese or English; 2) studies reporting effects of protective behaviors against air pollution on toddlers' health outcomes or providing recommendation on these behaviors. The evidence in the included studies was extracted, synthesized and graded for evidence summary. RESULTS Studies (N = 19) were used for evidence summary development and 35 pieces of best evidence were synthesized, which were divided into three categories, including "avoiding or reducing air pollution generation", "removing existing air pollution", and "avoiding or reducing exposure to existing air pollution". CONCLUSIONS More evidence is needed to identify protective measures against outdoor air pollution and tobacco smoke. Research in the future should focus on the safety, effectiveness and feasibility of universal measures implemented in toddlers, and try to develop protective measures specific to toddlers which highlight their special nature. IMPLICATIONS The results of this study can help pediatric nurses provide individualized advice and assistance for toddlers and their families, and conduct research on the effectiveness of toddler-targeting protective behaviors more efficiently.
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Affiliation(s)
- Chongkun Wang
- School of Nursing, Peking University, Beijing, China
| | - Junying Li
- School of Nursing, Peking University, Beijing, China
| | - Jiahe Li
- School of Nursing, Peking University, Beijing, China
| | - Yuxuan Li
- School of Nursing, Peking University, Beijing, China
| | - Chunying Li
- Associate Research Librarian, Peking University Medical Library, Peking University, Beijing, China
| | - Lihua Ren
- Associate Researcher, School of Nursing, Peking University, Beijing, China.
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Mason TG, Chan KP, Schooling CM, Sun S, Yang A, Yang Y, Barratt B, Tian L. Air quality changes after Hong Kong shipping emission policy: An accountability study. CHEMOSPHERE 2019; 226:616-624. [PMID: 30954896 DOI: 10.1016/j.chemosphere.2019.03.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND On July 1st, 2015, Hong Kong became the first city in Asia to implement a policy regulating sulfur dioxide (SO2) in shipping emissions. We conducted an accountability study assessing the improvement in ambient air quality and estimating the effect on health outcomes of the policy. METHOD We used interrupted time series (ITS) with segmented regression to identify any change in ambient concentrations of SO2 in contrast to other ambient pollutants (particulate matter <10 μm in diameter (PM10), nitrogen dioxide (NO2) and ozone (O3)) at 10 monitoring stations in Hong Kong from 2010 to 2017. We validated these findings using cumulative sum control (CUSUM) charts. We used a validated risk assessment model to estimate effects of changes in air quality on death for natural causes, cardiovascular and respiratory diseases. RESULTS Mean monthly concentrations of SO2 fell abruptly at the monitoring station closest to the main shipping port (Kwai Chung (KC)) by -10.0 μgm3 p-value = 0.0004, but not elsewhere. No such changes were evident for the other pollutants (PM10, NO2, O3). CUSUM charts confirmed a change in July 2015. Estimated deaths avoided per year as a result of the policy were 379, 72, 30 for all natural causes, respiratory and cardiovascular diseases respectively. CONCLUSION Implementation of the shipping emission policy in Hong Kong successfully reduced ambient SO2, with the potential to reduce mortality. However, to gain full benefits, restrictions on shipping emissions need to be implemented throughout the region.
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Affiliation(s)
- Tonya G Mason
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - King Pan Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Aimin Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yang Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin Barratt
- MRC-PHE Centre for Environment and Health & NIHR GSTFT/KCL Biomedical Research Centre, Analytical and Environmental Sciences Division, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Linwei Tian
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Burns J, Boogaard H, Polus S, Pfadenhauer LM, Rohwer AC, van Erp AM, Turley R, Rehfuess E. Interventions to reduce ambient particulate matter air pollution and their effect on health. Cochrane Database Syst Rev 2019; 5:CD010919. [PMID: 31106396 PMCID: PMC6526394 DOI: 10.1002/14651858.cd010919.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ambient air pollution is associated with a large burden of disease in both high-income countries (HICs) and low- and middle-income countries (LMICs). To date, no systematic review has assessed the effectiveness of interventions aiming to reduce ambient air pollution. OBJECTIVES To assess the effectiveness of interventions to reduce ambient particulate matter air pollution in reducing pollutant concentrations and improving associated health outcomes. SEARCH METHODS We searched a range of electronic databases with diverse focuses, including health and biomedical research (CENTRAL, Cochrane Public Health Group Specialised Register, MEDLINE, Embase, PsycINFO), multidisciplinary research (Scopus, Science Citation Index), social sciences (Social Science Citation Index), urban planning and environment (Greenfile), and LMICs (Global Health Library regional indexes, WHOLIS). Additionally, we searched grey literature databases, multiple online trial registries, references of included studies and the contents of relevant journals in an attempt to identify unpublished and ongoing studies, and studies not identified by our search strategy. The final search date for all databases was 31 August 2016. SELECTION CRITERIA Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs, including controlled interrupted time-series studies (cITS-EPOC), interrupted time-series studies adhering to EPOC standards (ITS-EPOC), interrupted time-series studies not adhering to EPOC standards (ITS), controlled before-after studies adhering to EPOC standards (CBA-EPOC), and controlled before-after studies not adhering to EPOC standards (CBA); these were classified as main studies. Additionally, we included uncontrolled before-after studies (UBA) as supporting studies. We included studies that evaluated interventions to reduce ambient air pollution from industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and several air pollutant concentrations. We did not restrict studies based on the population, setting or comparison. DATA COLLECTION AND ANALYSIS After a calibration exercise among the author team, two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We conducted data extraction, risk of bias assessment and evidence synthesis only for main studies; we mapped supporting studies with regard to the types of intervention and setting. To assess risk of bias, we used the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the Centre for Public Health Excellence at the UK National Institute for Health and Care Excellence (NICE). For each intervention category, i.e. those targeting industrial, residential, vehicular and multiple sources, we synthesized evidence narratively, as well as graphically using harvest plots. MAIN RESULTS We included 42 main studies assessing 38 unique interventions. These were heterogeneous with respect to setting; interventions were implemented in countries across the world, but most (79%) were implemented in HICs, with the remaining scattered across LMICs. Most interventions (76%) were implemented in urban or community settings.We identified a heterogeneous mix of interventions, including those aiming to address industrial (n = 5), residential (n = 7), vehicular (n = 22), and multiple sources (n = 4). Some specific interventions, such as low emission zones and stove exchanges, were assessed by several studies, whereas others, such as a wood burning ban, were only assessed by a single study.Most studies assessing health and air quality outcomes used routine monitoring data. Studies assessing health outcomes mostly investigated effects in the general population, while few studies assessed specific subgroups such as infants, children and the elderly. No identified studies assessed unintended or adverse effects.The judgements regarding the risk of bias of studies were mixed. Regarding health outcomes, we appraised eight studies (47%) as having no substantial risk of bias concerns, five studies (29%) as having some risk of bias concerns, and four studies (24%) as having serious risk of bias concerns. Regarding air quality outcomes, we judged 11 studies (31%) as having no substantial risk of bias concerns, 16 studies (46%) as having some risk of bias concerns, and eight studies (23%) as having serious risk of bias concerns.The evidence base, comprising non-randomized studies only, was of low or very low certainty for all intervention categories and primary outcomes. The narrative and graphical synthesis showed that evidence for effectiveness was mixed across the four intervention categories. For interventions targeting industrial, residential and multiple sources, a similar pattern emerged for both health and air quality outcomes, with essentially all studies observing either no clear association in either direction or a significant association favouring the intervention. The evidence base for interventions targeting vehicular sources was more heterogeneous, as a small number of studies did observe a significant association favouring the control. Overall, however, the evidence suggests that the assessed interventions do not worsen air quality or health. AUTHORS' CONCLUSIONS Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Most included studies observed either no significant association in either direction or an association favouring the intervention, with little evidence that the assessed interventions might be harmful. The evidence base highlights the challenges related to establishing a causal relationship between specific air pollution interventions and outcomes. In light of these challenges, the results on effectiveness should be interpreted with caution; it is important to emphasize that lack of evidence of an association is not equivalent to evidence of no association.We identified limited evidence for several world regions, notably Africa, the Middle East, Eastern Europe, Central Asia and Southeast Asia; decision-makers should prioritize the development and implementation of interventions in these settings. In the future, as new policies are introduced, decision-makers should consider a built-in evaluation component, which could facilitate more systematic and comprehensive evaluations. These could assess effectiveness, but also aspects of feasibility, fidelity and acceptability.The production of higher quality and more uniform evidence would be helpful in informing decisions. Researchers should strive to sufficiently account for confounding, assess the impact of methodological decisions through the conduct and communication of sensitivity analyses, and improve the reporting of methods, and other aspects of the study, most importantly the description of the intervention and the context in which it is implemented.
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Affiliation(s)
- Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | | | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | - Anke C Rohwer
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa7505
| | | | - Ruth Turley
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)1 Museum PlaceCardiffUKCF10 3BD
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
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Li H, Zhou L, Wang C, Chen R, Ma X, Xu B, Xiong L, Ding Z, Chen X, Zhou Y, Xu Y, Kan H. Associations Between Air Quality Changes and Biomarkers of Systemic Inflammation During the 2014 Nanjing Youth Olympics: A Quasi-Experimental Study. Am J Epidemiol 2017; 185:1290-1296. [PMID: 28459948 DOI: 10.1093/aje/kww209] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/27/2016] [Indexed: 12/12/2022] Open
Abstract
There is increasing interest in quasi-experimental research to evaluate whether actions taken to improve air quality will benefit public health. We conducted a quasi-experimental study to evaluate inflammatory response to changes in air quality during the 2014 Nanjing Youth Olympics in China. We repeatedly measured 8 biomarkers of systemic inflammation in 31 healthy adults and obtained hourly air pollutant concentrations from a nearby fixed-site monitoring station. We used linear mixed-effect models to examine the associations between air quality changes and blood biomarkers. Air pollutant concentrations decreased apparently during the Youth Olympics. Concomitantly, we observed significant decreases in levels of soluble cluster of differentiation 40 (CD40) ligand and interleukin 1β (geometric means ratios were 0.45 and 0.24, respectively) from the pre-Olympic period to the intra-Olympic period. Afterwards, levels of C-reactive protein and vascular cell adhesion molecule 1 increased significantly (geometric means ratios were 2.22 and 1.29, respectively) in the post-Olympic period. Fine particulate matter and ozone were significantly associated with soluble CD40 ligand, P-selectin, interleukin 1β, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1. Other pollutants showed positive but nonsignificant associations. Our study indicated that reduced air pollution, especially fine particulate matter and ozone, during the 2014 Nanjing Youth Olympics was associated with alleviated systemic inflammation in healthy adults.
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Affiliation(s)
- Huichu Li
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China
| | - Lian Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- School of Applied Meteorology, Nanjing University of Information Science and Technology, Nanjing, China
| | - Cuicui Wang
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai, China
| | - Xiaoying Ma
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bin Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lilin Xiong
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Zhen Ding
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaodong Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yun Zhou
- Jiangning District Center for Disease Control and Prevention, Nanjing, China
| | - Yan Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Haidong Kan
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai, China
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Lin H, Liu T, Xiao J, Zeng W, Guo L, Li X, Xu Y, Zhang Y, Chang JJ, Vaughn MG, Qian ZM, Ma W. Hourly peak PM 2.5 concentration associated with increased cardiovascular mortality in Guangzhou, China. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:333-338. [PMID: 27805624 DOI: 10.1038/jes.2016.63] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
Hourly peak concentration may capture health effects of ambient fine particulate matter pollution (PM2.5) better than daily averages. We examined the associations of hourly peak concentration of PM2.5 with cardiovascular mortality in Guangzhou, China. We obtained daily data on cardiovascular mortality and hourly PM2.5 concentrations in Guangzhou from 19 January 2013 through 30 June 2015. Generalized additive models were applied to evaluate the associations with adjustment for potential confounding factors. Significant associations were found between hourly peak concentrations of PM2.5 and cardiovascular mortality, particularly from ischemic heart diseases (IHD) and cerebrovascular diseases (CBD). Every 10 μg/m3 increment of hourly peak PM2.5 at lag 03 day was associated with a 1.15% (95% CI: 0.67%, 1.63%); 1.02% (95% CI: 0.30%, 1.74%) and 1.09% (95% CI: 0.27%, 1.91%) increase in mortalities from total cardiovascular diseases, IHD and CBD, respectively. The effects remained after adjustment for daily mean PM2.5 and gaseous air pollutants, though there was a high correlation between PM2.5 peak and PM2.5 mean (correlation coefficient=0.95). No significant association was observed for acute myocardial infarction (AMI). In addition to daily mean concentration of PM2.5, hourly peak concentration of PM2.5 might be one important risk factor of cardiovascular mortality and should be considered as an important air pollution indicator when assessing the possible cardiovascular effects of PM2.5.
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Affiliation(s)
- Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanjun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yonghui Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jen Jen Chang
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Zhengmin Min Qian
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Rich DQ. Accountability studies of air pollution and health effects: lessons learned and recommendations for future natural experiment opportunities. ENVIRONMENT INTERNATIONAL 2017; 100:62-78. [PMID: 28089581 PMCID: PMC5291758 DOI: 10.1016/j.envint.2016.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 05/26/2023]
Abstract
To address limitations of observational epidemiology studies of air pollution and health effects, including residual confounding by temporal and spatial factors, several studies have taken advantage of 'natural experiments', where an environmental policy or air quality intervention has resulted in reductions in ambient air pollution concentrations. Researchers have examined whether the population impacted by these air quality improvements, also experienced improvements in various health indices (e.g. reduced morbidity/mortality). In this paper, I review key accountability studies done previously and new studies done over the past several years in Beijing, Atlanta, London, Ireland, and other locations, describing study design and analysis strengths and limitations of each. As new 'natural experiment' opportunities arise, several lessons learned from these studies should be applied when planning a new accountability study. Comparison of health outcomes during the intervention to both before and after the intervention in the population of interest, as well as use of a control population to assess whether any temporal changes in the population of interest were also seen in populations not impacted by air quality improvements, should aid in minimizing residual confounding by these long term time trends. Use of either detailed health records for a population, or prospectively collected data on relevant mechanistic biomarkers coupled with such morbidity/mortality data may provide a more thorough assessment of if the intervention beneficially impacted the health of the community, and if so by what mechanism(s). Further, prospective measurement of a large suite of air pollutants may allow a more thorough understanding of what pollutant source(s) is/are responsible for any health benefit observed. The importance of using multiple statistical analysis methods in each paper and the difference in how the timing of the air pollution/outcome association may impact which of these design features is most important is also discussed. Based on these and other lessons learned, researchers may provide a more epidemiologically rigorous evaluation of cause-specific health impacts of an air quality intervention or action.
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Affiliation(s)
- David Q Rich
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY, United States.
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Henneman LRF, Liu C, Mulholland JA, Russell AG. Evaluating the effectiveness of air quality regulations: A review of accountability studies and frameworks. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2017; 67:144-172. [PMID: 27715473 DOI: 10.1080/10962247.2016.1242518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 05/22/2023]
Abstract
UNLABELLED Assessments of past environmental policies-termed accountability studies-contribute important information to the decision-making process used to review the efficacy of past policies, and subsequently aid in the development of effective new policies. These studies have used a variety of methods that have achieved varying levels of success at linking improvements in air quality and/or health to regulations. The Health Effects Institute defines the air pollution accountability framework as a chain of events that includes the regulation of interest, air quality, exposure/dose, and health outcomes, and suggests that accountability research should address impacts for each of these linkages. Early accountability studies investigated short-term, local regulatory actions (for example, coal use banned city-wide on a specific date or traffic pattern changes made for Olympic Games). Recent studies assessed regulations implemented over longer time and larger spatial scales. Studies on broader scales require accountability research methods that account for effects of confounding factors that increase over time and space. Improved estimates of appropriate baseline levels (sometimes termed "counterfactual"-the expected state in a scenario without an intervention) that account for confounders and uncertainties at each link in the accountability chain will help estimate causality with greater certainty. In the direct accountability framework, researchers link outcomes with regulations using statistical methods that bypass the link-by-link approach of classical accountability. Direct accountability results and methods complement the classical approach. New studies should take advantage of advanced planning for accountability studies, new data sources (such as satellite measurements), and new statistical methods. Evaluation of new methods and data sources is necessary to improve investigations of long-term regulations, and associated uncertainty should be accounted for at each link to provide a confidence estimate of air quality regulation effectiveness. The final step in any accountability is the comparison of results with the proposed benefits of an air quality policy. IMPLICATIONS The field of air pollution accountability continues to grow in importance to a number of stakeholders. Two frameworks, the classical accountability chain and direct accountability, have been used to estimate impacts of regulatory actions, and both require careful attention to confounders and uncertainties. Researchers should continue to develop and evaluate both methods as they investigate current and future air pollution regulations.
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Affiliation(s)
- Lucas R F Henneman
- a School of Civil and Environmental Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Cong Liu
- b School of Energy and Environment , Southeast University , Nanjing , China
| | - James A Mulholland
- a School of Civil and Environmental Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Armistead G Russell
- a School of Civil and Environmental Engineering , Georgia Institute of Technology , Atlanta , GA , USA
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Li S, Williams G, Guo Y. Health benefits from improved outdoor air quality and intervention in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 214:17-25. [PMID: 27061471 DOI: 10.1016/j.envpol.2016.03.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats.
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Affiliation(s)
- Shanshan Li
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Gail Williams
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yuming Guo
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Yorifuji T, Suzuki E, Kashima S. Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study. Environ Health 2014; 13:67. [PMID: 25115710 PMCID: PMC4237832 DOI: 10.1186/1476-069x-13-67] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/08/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND Epidemiological studies have shown adverse effects of short-term exposure to air pollution on respiratory disease outcomes; however, few studies examined this association on an hourly time scale. We evaluated the associations between hourly changes in air pollution and the risk of respiratory disease in the elderly, using the time of the emergency call as the disease onset for each case. METHODS We used a time-stratified case-crossover design. Study participants were 6,925 residents of the city of Okayama, Japan, aged 65 or above who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of respiratory disease. We calculated city-representative hourly average concentrations of air pollutants from several monitoring stations. By using conditional logistic regression models, we estimated odds ratios per interquartile-range increase in each pollutant by exposure period prior to emergency call, adjusting for hourly ambient temperature, hourly relative humidity, and weekly numbers of reported influenza cases aged ≥60. RESULTS Suspended particulate matter (SPM) exposure 24 to <72 hours prior to the onset and ozone exposure 48 to <96 hours prior to the onset were associated with the increased risk of respiratory disease. For example, following one interquartile-range increase, odds ratios were 1.05 (95% confidence interval: 1.01, 1.09) for SPM exposure 24 to <48 hours prior to the onset and 1.13 (95% confidence interval: 1.04, 1.23) for ozone exposure 72 to <96 hours prior to the onset. Sulfur dioxide (SO2) exposure 0 to <24 hours prior to onset was associated with the increased risk of pneumonia and influenza: odds ratio was 1.07 per one interquartile-range increase (95% confidence interval: 1.00, 1.14). Elevated risk for pneumonia and influenza of SO2 was observed at shorter lags (i.e., 8-18 hours) than the elevated risks for respiratory disease of SPM or ozone. Overall, the effect estimates for chronic obstructive pulmonary disease and allied conditions were equivocal. CONCLUSIONS This study provides further evidence that hourly changes in air pollution exposure increase the risks of respiratory disease, and that SO2 may be related with more immediate onset of the disease than other pollutants.
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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10
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Gao Y, Chan EYY, Li L, Lau PWC, Wong TW. Chronic effects of ambient air pollution on respiratory morbidities among Chinese children: a cross-sectional study in Hong Kong. BMC Public Health 2014; 14:105. [PMID: 24484614 PMCID: PMC3914361 DOI: 10.1186/1471-2458-14-105] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The chronic health effects from exposure to ambient air pollution are still unclear. This study primarily aims to examine the relationship between long-term exposure to ambient air pollution and respiratory morbidities in Chinese children. METHODS A cross-sectional study was conducted among 2,203 school children aged 8-10 in three districts with different air pollution levels in Hong Kong. Annual means for ambient PM10, SO2, NO2 and O3 in each district were used to estimate participants' individual exposure. Two questionnaires were used to collect children's respiratory morbidities and other potential risk factors. Multivariable logistic regression was fitted to estimate the risks of air pollution for respiratory morbidities. RESULTS Compared to those in the low-pollution district (LPD), girls in the high-pollution district (HPD) were at significantly higher risk for cough at night (ORadj. = 1.81, 95% CI: 1.71-2.78) and phlegm without colds (ORadj. = 3.84, 95% CI: 1.74-8.47). In addition, marginal significance was reached for elevated risks for asthma, wheezing symptoms, and phlegm without colds among boys in HPD (adjusted ORs: 1.71-2.82), as well as chronic cough among girls in HPD (ORadj. = 2.03, 95% CI: 0.88-4.70). CONCLUSIONS Results have confirmed certain adverse effects on children's respiratory health from long-term exposure to ambient air pollution. PM10 may be the most relevant pollutant with adverse effects on wheezing and phlegm in boys. Both PM10 and NO2 may be contributing to cough and phlegm in girls.
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Affiliation(s)
- Yang Gao
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Emily YY Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Liping Li
- Injury Prevention Research Center, Medical College of Shantou University, Shantou, China
| | - Patrick WC Lau
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Tze Wai Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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11
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Henschel S, Atkinson R, Zeka A, Le Tertre A, Analitis A, Katsouyanni K, Chanel O, Pascal M, Forsberg B, Medina S, Goodman PG. Air pollution interventions and their impact on public health. Int J Public Health 2012; 57:757-68. [DOI: 10.1007/s00038-012-0369-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 04/23/2012] [Accepted: 04/23/2012] [Indexed: 11/27/2022] Open
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12
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Thach TQ, Wong CM, Chan KP, Chau YK, Chung YN, Ou CQ, Yang L, Hedley AJ. Daily visibility and mortality: assessment of health benefits from improved visibility in Hong Kong. ENVIRONMENTAL RESEARCH 2010; 110:617-23. [PMID: 20627276 PMCID: PMC7094411 DOI: 10.1016/j.envres.2010.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 05/03/2023]
Abstract
Visibility in Hong Kong has deteriorated significantly over 40 years with visibility below 8km in the absence of fog, mist, or precipitation, increasing from 6.6 days in 1968 to 54.1 days in 2007. We assessed the short-term mortality effects of daily loss of visibility. During 1996-2006, we obtained mortality data for non-accidental and cardiorespiratory causes, visibility recorded as visual range in kilometers, temperature, and relative humidity from an urban observatory, and concentrations of four criteria pollutants. A generalized additive Poisson regression model with penalized cubic regression splines was fitted to control for time variant covariates. For non-accidental mortality, an interquartile range (IQR) of 6.5km decrease in visibility at lag0-1 days was associated with an excess risk (ER%) [95% CI] of 1.13 [0.49, 1.76] for all ages and 1.37 [0.65, 2.09] for ages 65 years and over; for cardiovascular mortality of 1.31 [0.13, 2.49] for all ages, and 1.72 [0.44, 3.00] for ages 65 years and over; and for respiratory mortality of 1.92 [0.49, 3.35] for all ages and 1.76 [0.28, 3.25] for ages 65 years and over. The estimated ER% for daily mortality derived from both visibility and air pollutant data were comparable in terms of magnitude, lag pattern, and exposure-response relationships especially when using particulate matter with aerodynamic diameter < or = 10 microm to predict the mortality associated with visibility. Visibility provides a useful proxy for the assessment of environmental health risks from ambient air pollutants and a valid approach for the assessment of the public health impacts of air pollution and the benefits of air quality improvement measures in developing countries where pollutant monitoring data are scarce.
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Key Words
- visibility
- mortality
- air pollution
- time series
- hong kong
- ages ≥65 years, ages 65 years and over
- ci, confidence interval
- df, degrees of freedom
- er%, excess risk in percent in daily mortality for a decrease in visibility
- km, kilometer
- icd-10, tenth revision of the international classification of diseases
- icd-9, ninth revision of the international classification of diseases
- iqr, interquartile range
- no2, nitrogen dioxide
- o3, ozone
- pm10, particulate matter with aerodynamic diameter less than or equal to (≤) 10 micrometers
- pm2.5, particulate matter with aerodynamic diameter less than or equal to (≤) 2.5 micrometers
- so2, sulfur dioxide
- teom, tapered element oscillating microbalance
- μg m−3, microgram per cubic meter
- μm, micrometer
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Affiliation(s)
- Thuan-Quoc Thach
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
| | - Chit-Ming Wong
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
- Corresponding author. Fax: +852 2855 9528.
| | - King-Pan Chan
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
| | - Yuen-Kwan Chau
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
| | - Yat-Nork Chung
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
| | - Chun-Quan Ou
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Lin Yang
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
| | - Anthony J. Hedley
- School of Public Health, The University of Hong Kong, 5th Floor, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China
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CHAN-YEUNG M, LAI CK, CHAN KS, CHEUNG AH, YAO TJ, HO AS, KO FW, YAM LY, WONG PC, TSANG KW, LAM WK, HO JC, CHU CM, YU WC, CHAN HS, IP MS, HUI DS, TAM CY. The burden of lung disease in Hong Kong: A report from the Hong Kong Thoracic Society. Respirology 2008; 13 Suppl 4:S133-65. [DOI: 10.1111/j.1440-1843.2008.01394.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Maio S, Baldacci S, Carrozzi L, Polverino E, Angino A, Pistelli F, Di Pede F, Simoni M, Sherrill D, Viegi G. Urban residence is associated with bronchial hyperresponsiveness in Italian general population samples. Chest 2008; 135:434-441. [PMID: 18719062 DOI: 10.1378/chest.08-0252] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The role of different risk factors for bronchial hyperresponsiveness (BHR), such as gender, atopy, IgE, and environmental factors (smoking, occupational exposure, infections), has been described. Indoor and outdoor pollution play an important role too, but few studies have analyzed the association with BHR. The aim of this study was to assess the effect of urban residence on BHR. METHODS We studied two general population samples enrolled in two cross-sectional epidemiological studies performed in Northern Italy (Po Delta, rural area) and Central Italy (Pisa, urban area). We analyzed 2,760 subjects (age range, 8 to 74 years). We performed analysis of variance and logistic regression analysis using ln slope of the dose-response curve of the methacholine challenge test as dependent variable, and sex, age, smoking habits, respiratory symptoms, skin-prick test results, IgE value, residence, and airway caliber as independent variables. RESULTS The mean value of ln slope of the dose-response curve adjusted for initial airways caliber (by baseline FEV(1) percentage of predicted value) was significantly higher in female subjects, in smokers, in subjects with respiratory symptoms, in younger and older ages, in subjects with high values of IgE, and in subjects with positive skin-prick test results. After controlling for the independent effects of all these variables, living in urban area was an independent risk factor for having BHR (odds ratio, 1.41; 95% confidence interval, 1.13 to 1.76). CONCLUSION Living in urban area is a risk factor for increased bronchial responsiveness.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Laura Carrozzi
- Cardiopulmonary Department, University and Hospital, Pisa, Italy
| | - Eva Polverino
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Francesco Di Pede
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marzia Simoni
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Duane Sherrill
- College of Public Health, University of Tucson, Tucson, AZ
| | - Giovanni Viegi
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy.
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15
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Zhao Z, Sebastian A, Larsson L, Wang Z, Zhang Z, Norbäck D. Asthmatic symptoms among pupils in relation to microbial dust exposure in schools in Taiyuan, China. Pediatr Allergy Immunol 2008; 19:455-65. [PMID: 18221461 DOI: 10.1111/j.1399-3038.2007.00664.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Microbial exposure has been indicated as significant in the development of asthma and allergy among children. The aim of the study was to test whether microbial exposure and allergens in the school environment are associated with asthmatic symptoms in pupils. Data on asthmatic symptoms and respiratory infections were collected through a questionnaire survey among 1993 pupils aged 11-15 yr in 10 randomly selected schools in Taiyuan, China. Settled dust in classrooms was analysed using tandem gas chromatography-mass spectrometry for 3-hydroxy fatty acids, marker of lipopolysaccharide (LPS) from endotoxin, muramic acid (MuA), marker of bacteria and ergosterol (Erg) for fungi, quantifying both culturable and non-culturable microbes. A total of 29.8% reported daytime attacks of breathlessness, 8.4% wheeze and 1.2% had doctor's diagnosed asthma. Generally, MuA was negatively associated with wheeze and daytime attacks of breathlessness, the latter of which was negatively associated with Erg to a weaker extent. Total concentration of LPS was positively associated with daytime attacks of breathlessness, but shorter lengths of LPS, C10, C12 and C14 LPS were negatively associated with either wheezing or daytime attacks of breathlessness. For MuA and C10 and C12 of LPS, the associations were independent of airborne allergens and classroom crowdedness, and even independent of the other two microbial markers for MuA. Microbial exposure indicated by certain chemical markers (e.g. MuA) could be protective for asthmatic symptoms, but for LPS (endotoxin), the picture is more complex, varying by different lengths of fatty acids of LPS.
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Affiliation(s)
- Zhuohui Zhao
- Department of Occupational and Environmental Medicine, University Hospital and Uppsala University, Uppsala, Sweden.
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16
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Craig L, Brook JR, Chiotti Q, Croes B, Gower S, Hedley A, Krewski D, Krupnick A, Krzyzanowski M, Moran MD, Pennell W, Samet JM, Schneider J, Shortreed J, Williams M. Air pollution and public health: a guidance document for risk managers. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2008; 71:588-698. [PMID: 18569631 DOI: 10.1080/15287390801997732] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This guidance document is a reference for air quality policymakers and managers providing state-of-the-art, evidence-based information on key determinants of air quality management decisions. The document reflects the findings of five annual meetings of the NERAM (Network for Environmental Risk Assessment and Management) International Colloquium Series on Air Quality Management (2001-2006), as well as the results of supporting international research. The topics covered in the guidance document reflect critical science and policy aspects of air quality risk management including i) health effects, ii) air quality emissions, measurement and modeling, iii) air quality management interventions, and iv) clean air policy challenges and opportunities.
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Affiliation(s)
- Lorraine Craig
- Network for Environmental Risk Assessment and Management, University of Waterloo, Waterloo, Ontario, Canada.
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17
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Hedley AJ, McGhee SM, Barron B, Chau P, Chau J, Thach TQ, Wong TW, Loh C, Wong CM. Air pollution: costs and paths to a solution in Hong Kong--understanding the connections among visibility, air pollution, and health costs in pursuit of accountability, environmental justice, and health protection. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2008; 71:544-554. [PMID: 18569625 DOI: 10.1080/15287390801997476] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Air quality has deteriorated in Hong Kong over more than 15 yr. As part of a program of public accountability, photographs on Poor and Better visibility days were used as representations of the relationships among visibility, air pollution, adverse health effects, and community costs for health care and lost productivity. Coefficients from time-series models and gazetted costs were used to estimate the health and economic impacts of different levels of pollution. In this population of 6.9 million, air quality improvement from the annual average to the lowest pollutant levels of Better visibility days, comparable to the World Health Organization air quality guidelines, would avoid 1335 deaths, 60,587 hospital bed days, and 6.7 million doctor visits for respiratory complaints each year. Direct costs and productivity losses avoided would be over US$240 million a year. The dissemination of these findings led to increased demands for pollution controls from the public and legislators, but denials of the need for urgent action arose from the government. The outcome demonstrates the need for more effective translation of the scientific evidence base into risk communication and public policy.
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Affiliation(s)
- Anthony J Hedley
- Department of Community Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR, China
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18
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Lee SL, Wong WHS, Lau YL. Association between air pollution and asthma admission among children in Hong Kong. Clin Exp Allergy 2007; 36:1138-46. [PMID: 16961713 PMCID: PMC1618810 DOI: 10.1111/j.1365-2222.2006.02555.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective To examine the association of air pollutants with hospital admission for childhood asthma in Hong Kong. Methods Data on hospital admissions for asthma, influenza and total hospital admissions in children aged ≤18 years at all Hospital Authority hospitals during 1997–2002 were obtained. Data on daily mean concentrations of particles with aerodynamic diameter <10 μm (i. e. PM10) and <2.5 μm (i. e. PM2.5), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) and data on meteorological variables were associated with asthma hospital admissions using Poisson's regression with generalized additive models for correction of yearly trend, temperature, humidity, day-of-week effect, holiday, influenza admissions and total hospital admission. The possibility of a lag effect of each pollutant and the interaction of different pollutants were also examined. Results The association between asthma admission with change of NO2, PM10, PM2.5 and O3 levels remained significant after adjustment for multi-pollutants effect and confounding variables, with increase in asthma admission rate of 5.64% (3.21–8.14) at lag 3 for NO2, 3.67% (1.52–5.86) at lag 4 for PM10, 3.24% (0.93–5.60) at lag 4 for PM2.5 and 2.63% (0.64–4.67) at lag 2 for O3. Effect of SO2 was lost after adjustment. Conclusion Ambient levels of PM10, PM2.5, NO2 and O3 are associated with childhood asthma hospital admission in Hong Kong.
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Affiliation(s)
- S L Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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19
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Zhao ZH, Elfman L, Wang ZH, Zhang Z, Norbäck D. A comparative study of asthma, pollen, cat and dog allergy among pupils and allergen levels in schools in Taiyuan city, China, and Uppsala, Sweden. INDOOR AIR 2006; 16:404-13. [PMID: 17100662 DOI: 10.1111/j.1600-0668.2006.00433.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We compared the school environment, asthma and allergy in 10 schools in Taiyuan, China, with eight schools in Uppsala, Sweden. In total 2193 pupils (mean age 13 years) participated. Chinese pupils had more respiratory symptoms, particularly daytime breathlessness after exercise (29.8% vs. 7.1%; P < 0.001), while cat allergy (1.2% vs. 6.6%; P < 0.001) and dog allergy (1.3% vs. 4.0%; P < 0.01) was less common. Cumulative incidence of asthma (1.8% vs. 9.5%; P < 0.001) and doctor's diagnosed asthma (1.2% vs. 9.0%; P < 0.001) were less common in China, indicating an under-diagnosis of asthma. Chinese classrooms were colder (mean 14.7 vs. 21.4 degrees C), more humid (mean 42% vs. 31% RH) and had higher CO2-levels (mean 2211 vs. 761 ppm). Levels of cat (Fel d1), dog (Can f1) allergens were low in settled dust from China (< 200 ng/g dust), but high in airborne dust on Petri-dishes (GM 16.8 ng/m2/day for Fel d1 and 17.7 for Can f1). The Swedish settled dust contained cat, dog and horse allergens in high levels (median 1300 ng/g, 1650 ng/g, 1250 U/g dust, respectively). In conclusion, there were large differences in the school environment, and in respiratory symptom and allergy. Allergen measurements in settled dust only may largely underestimate the classroom exposure. Practical Implications There is a need to improve the school environment, both in China and Sweden. The Swedish schools contained high levels of cat, dog and horse allergens and more amounts of open shelves and textiles that can accumulate dust and allergens. The air measurements indicated that Chinese schools may contain significant amounts of cat and dog allergen, and analysis of settled dust only may not reflect the true allergen exposure. Since the Chinese schools had no mechanical ventilation, they could not fulfill the ventilation standard in winter, and hence there is a need for improving the ventilation. The great discrepancy between respiratory symptoms and reports on asthma, and the high prevalence of attacks of breathlessness without wheeze, may have implication for future questionnaire studies on asthma in China.
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Affiliation(s)
- Z H Zhao
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden.
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Mi YH, Norbäck D, Tao J, Mi YL, Ferm M. Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms. INDOOR AIR 2006; 16:454-64. [PMID: 17100666 DOI: 10.1111/j.1600-0668.2006.00439.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We investigated 10 naturally ventilated schools in Shanghai, in winter. Pupils (13-14 years) in 30 classes received a questionnaire, 1414 participated (99%). Classroom temperatures were 13-21 degrees C (mean 17 degrees C), relative air humidity was 36-82% (mean 56%). The air exchange rate was 2.9-29.4 ac/h (mean 9.1), because of window opening. Mean CO2 exceeded 1000 ppm in 45% of the classrooms. NO2 levels were 33-85 microg/m3 indoors, and 45-80 microg/m3 outdoors. Ozone were 1-9 microg/m3 indoors and 17-28 microg/m3 outdoors. In total, 8.9% had doctors' diagnosed asthma, 3.1% wheeze, 23.0% daytime breathlessness, 2.4% current asthma, and 2.3% asthma medication. Multiple logistic regression was applied. Observed indoor molds was associated with asthma attacks [odds ratio (OR) = 2.40: P < 0.05]. Indoor temperature was associated with daytime breathlessness (OR = 1.26 for 1 C; P < 0.001), and indoor CO2 with current asthma (OR = 1.18 for 100 ppm; P < 0.01) and asthma medication (OR = 1.15 for 100 ppm; P < 0.05). Indoor NO2 was associated with current asthma (OR = 1.51 for 10 microg/m3; P < 0.01) and asthma medication (OR = 1.45 for 10 microg/m3; P < 0.01). Outdoor NO2 was associated with current asthma (OR = 1.44 for 10 microg/m3; P < 0.05). Indoor and outdoor ozone was negatively associated with daytime breathlessness. In conclusion, asthma symptoms among pupils in Shanghai can be influenced by lack of ventilation and outdoor air pollution from traffic. Practical Implications Most urban schools in Asia are naturally ventilated buildings, often situated in areas with heavy ambient air pollution from industry or traffic. The classes are large, and window opening is the only way to remove indoor pollutants, but this results in increased exposure to outdoor air pollution. There is a clear need to improve the indoor environment in these schools. Building dampness and indoor mold growth should be avoided, and the concept of mechanical ventilation should be introduced. City planning aiming to situate new schools away from roads with heavy traffic should be considered.
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Affiliation(s)
- Y-H Mi
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
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Lippmann M, Ito K, Hwang JS, Maciejczyk P, Chen LC. Cardiovascular effects of nickel in ambient air. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1662-9. [PMID: 17107850 PMCID: PMC1665439 DOI: 10.1289/ehp.9150] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 07/20/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND Fine particulate matter (FPM) in ambient air causes premature mortality due to cardiac disease in susceptible populations. OBJECTIVE Our objective in this study was to determine the most influential FPM components. METHODS A mouse model of atherosclerosis (ApoE-/-) was exposed to either filtered air or concentrated FPM (CAPs) in Tuxedo, New York (85 microg/m3 average, 6 hr/day, 5 days/week, for 6 months), and the FPM elemental composition was determined for each day. We also examined associations between PM components and mortality for two population studies: National Mortality and Morbidity Air Pollution Study (NMMAPS) and Hong Kong. RESULTS For the CAPs-exposed mice, the average of nickel was 43 ng/m3, but on 14 days, there were Ni peaks at approximately 175 ng/m3 and unusually low FPM and vanadium. For those days, back-trajectory analyses identified a remote Ni point source. Electrocardiographic measurements on CAPs-exposed and sham-exposed mice showed Ni to be significantly associated with acute changes in heart rate and its variability. In NMMAPS, daily mortality rates in the 60 cities with recent speciation data were significantly associated with average Ni and V, but not with other measured species. Also, the Hong Kong sulfur intervention produced sharp drops in sulfur dioxide, Ni, and V, but not other components, corresponding to the intervention-related reduction in cardiovascular and pulmonary mortality. CONCLUSIONS Known biological mechanisms cannot account for the significant associations between Ni with the acute cardiac function changes in the mice or with cardiovascular mortality in people at low ambient air concentrations; therefore, further research is needed.
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Affiliation(s)
- Morton Lippmann
- New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York 10987, USA.
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Bayer-Oglesby L, Grize L, Gassner M, Takken-Sahli K, Sennhauser FH, Neu U, Schindler C, Braun-Fahrländer C. Decline of ambient air pollution levels and improved respiratory health in Swiss children. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1632-7. [PMID: 16263523 PMCID: PMC1310930 DOI: 10.1289/ehp.8159] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The causality of observed associations between air pollution and respiratory health in children is still subject to debate. If reduced air pollution exposure resulted in improved respiratory health of children, this would argue in favor of a causal relation. We investigated whether a rather moderate decline of air pollution levels in the 1990s in Switzerland was associated with a reduction in respiratory symptoms and diseases in school children. In nine Swiss communities, 9,591 children participated in cross-sectional health assessments between 1992 and 2001. Their parents completed identical questionnaires on health status and covariates. We assigned to each child an estimate of regional particles with an aerodynamic diameter < 10 microg/m3 (PM10) and determined change in PM10 since the first survey. Adjusted for socioeconomic, health-related, and indoor factors, declining PM10 was associated in logistic regression models with declining prevalence of chronic cough [odds ratio (OR) per 10-microg/m3 decline = 0.65, 95% confidence interval (CI), 0.54-0.79], bronchitis (OR = 0.66; 95% CI, 0.55-0.80), common cold (OR = 0.78; 95% CI, 0.68-0.89), nocturnal dry cough (OR = 0.70; 95% CI, 0.60-0.83), and conjunctivitis symptoms (OR = 0.81; 95% CI, 0.70-0.95). Changes in prevalence of sneezing during pollen season, asthma, and hay fever were not associated with the PM10 reduction. Our findings show that the reduction of air pollution exposures contributes to improved respiratory health in children. No threshold of adverse effects of PM10 was apparent because we observed the beneficial effects for relatively small changes of rather moderate air pollution levels. Current air pollution levels in Switzerland still exceed limit values of the Swiss Clean Air Act; thus, children's health can be improved further.
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Affiliation(s)
- Lucy Bayer-Oglesby
- Institute of Social and Preventive Medicine of the University of Basel, Basel, Switzerland.
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Saraçlar Y, Kuyucu S, Tuncer A, Sekerel B, Saçkesen C, Kocabaş C. Prevalence of asthmatic phenotypes and bronchial hyperresponsiveness in Turkish schoolchildren: an International Study of Asthma and Allergies in Childhood (ISAAC) phase 2 study. Ann Allergy Asthma Immunol 2004; 91:477-84. [PMID: 14692432 DOI: 10.1016/s1081-1206(10)61517-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Numerous epidemiologic studies have revealed that bronchial asthma affects populations without regard to frontiers. However, standardized methodological approaches are necessary to compare these populations. OBJECTIVE To investigate objective markers of childhood asthma on an epidemiologic basis and to include Turkish children in international comparisons. METHODS Parental questionnaires were collected and skin prick tests performed on fourth grade primary schoolchildren, aged 8 to 11 years, residing in Ankara, Turkey. Pulmonary function tests and bronchial challenge with hypertonic saline (HS) were conducted in children selected from this cohort with a stratified random sampling according to the presence of current wheezing. RESULTS A total of 3,041 questionnaires were included in the evaluation. Skin prick tests were performed on 2,774 children (97.1%). A total of 347 children from this cohort underwent pulmonary function and bronchial challenge tests. In 18 (5.1%) of the 347 children, bronchial challenge tests could not be successfully completed. The prevalence values were 11.5% for current wheezing, 6.9% for physician-diagnosed asthma, and 7.7% for physician-diagnosed recurrent bronchitis. Population-based weighted prevalence of bronchial hyperresponsiveness (BHR) was 21.8%. Frequency of responses to HS was 38.6% among physician-diagnosed asthma cases and 30.5% among patients with current wheezing. Skin test positivity was present in 38.7% of the children with a diagnosis of asthma or asthmatic bronchitis, 35.0% of current asthmatic patients, and 19.2% of patients with current wheezing. CONCLUSIONS Objective markers, in addition to the questionnaire-based prevalence figures, need to be used in epidemiologic surveys for asthma, especially in countries with inadequate health care facilities or problems with interpretation of the wheeze concept.
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Affiliation(s)
- Yildiz Saraçlar
- Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey.
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Hedley AJ, Wong CM, Thach TQ, Ma S, Lam TH, Anderson HR. Cardiorespiratory and all-cause mortality after restrictions on sulphur content of fuel in Hong Kong: an intervention study. Lancet 2002; 360:1646-52. [PMID: 12457788 DOI: 10.1016/s0140-6736(02)11612-6] [Citation(s) in RCA: 220] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In July, 1990, a restriction was introduced over one weekend that required all power plants and road vehicles in Hong Kong to use fuel oil with a sulphur content of not more than 0.5% by weight. This intervention led to an immediate fall in ambient sulphur dioxide (SO2). We assessed the effect of this intervention on mortality over the next 5 years. METHODS Changes in trends in deaths were estimated by a Poisson regression model of deaths each month between 1985 and 1995. Changes in seasonal deaths immediately after the intervention were measured by the increase in deaths from warm to cool season. We also estimated the annual proportional change in number of deaths before and after the intervention. We used age-specific death rates to estimate person-years of life gained. FINDINGS In the first 12 months after introduction of the restriction, a substantial reduction in seasonal deaths was noted, followed by a peak in the cool-season death rate between 13 and 24 months, returning to the expected pattern during years 3-5. Compared with predictions, the intervention led to a significant decline in the average annual trend in deaths from all causes (2.1%; p=0.001), respiratory (3.9%; p=0.0014) and cardiovascular (2.0%; p=0.0214) diseases, but not from other causes. The average gain in life expectancy per year of exposure to the lower pollutant concentration was 20 days (females) to 41 days (males). INTERPRETATION Pollution resulting from sulphur-rich fuels has an effect on death rates, especially respiratory and cardiovascular deaths. The outcome of the Hong Kong intervention provides direct evidence that control of this pollution has immediate and long-term health benefits.
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Charton C, Droulers I, Girault E, Laurent C, Housset B, Delacourt C. [Detection of exercise-induced bronchospasm in sixth-grade students: impact of health education]. Arch Pediatr 2002; 9:245-54. [PMID: 11938535 DOI: 10.1016/s0929-693x(01)00760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Underdiagnosis of asthma is frequent in children and may be improved by the development of school-based health programs. MATERIAL AND METHODS We developed an educational program in 11-year-old schoolchildren who participated in a screening test for exercise-induced asthma (EIA). All children were given an asthma questionnaire before and after two educational sessions. RESULTS Mean score for asthma knowledge quiz increased from 63 to 85% (p < 0.001). Thirty-six children (3.7%) were initially considered as asthmatic and showed better responses than non-asthmatic children. Peak expiratory flow (PEF) was measured before and after an outside running exercise. A fall in PEF of at least 15% was considered an abnormal result. Seventy-height children (8%) had a decrease in PEF, including 65 children initially not recognized as asthmatic. For these latter, a medical evaluation was recommended to parents. Only 28 of these children gave informations on follow-up: 19 had lung function tests, two received a treatment without preliminary function test, and seven had neither lung function test nor treatment. Among the children who realized lung function tests, five had criteria for airway obstruction at baseline, and ten had significant bronchial hyperreactivity. CONCLUSIONS However, a new screening test revealed that only a small minority of children initially not recognized as asthmatic but having decreased their PEF, were consequently considered as asthmatic by their practitioner, even in case of positive lung function test.
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Affiliation(s)
- C Charton
- Service de promotion de la santé en faveur des élèves, inspection académique du Val-de-Marne, 68, avenue du Général-de-Gaulle, 94010 Créteil, France
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Lau JT, Yu A, Cheung JC, Leung SS. Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong. J Adolesc Health 2000; 27:443-52. [PMID: 11090747 DOI: 10.1016/s1054-139x(99)00075-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes. METHODS A cross-sectional questionnaire survey of 3355 participating secondary school students (response rate = 98%). RESULTS Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care. CONCLUSIONS This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students' attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.
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Affiliation(s)
- J T Lau
- Centre for Clinical Trials and Epidemiological Research, the Chinese University of Hong Kong, Hong Kong
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