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Oudin A, Raza W, Flanagan E, Segersson D, Jalava P, Kanninen KM, Rönkkö T, Giugno R, Sandström T, Muala A, Topinka J, Sommar J. Exposure to source-specific air pollution in residential areas and its association with dementia incidence: a cohort study in Northern Sweden. Sci Rep 2024; 14:15521. [PMID: 38969679 PMCID: PMC11226641 DOI: 10.1038/s41598-024-66166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
The aim of this study was to investigate the relationship between source-specific ambient particulate air pollution concentrations and the incidence of dementia. The study encompassed 70,057 participants from the Västerbotten intervention program cohort in Northern Sweden with a median age of 40 years at baseline. High-resolution dispersion models were employed to estimate source-specific particulate matter (PM) concentrations, such as PM10 and PM2.5 from traffic, exhaust, and biomass (mainly wood) burning, at the residential addresses of each participant. Cox regression models, adjusted for potential confounding factors, were used for the assessment. Over 884,847 person-years of follow-up, 409 incident dementia cases, identified through national registers, were observed. The study population's average exposure to annual mean total PM10 and PM2.5 lag 1-5 years was 9.50 µg/m3 and 5.61 µg/m3, respectively. Increased risks were identified for PM10-Traffic (35% [95% CI 0-82%]) and PM2.5-Exhaust (33% [95% CI - 2 to 79%]) in the second exposure tertile for lag 1-5 years, although no such risks were observed in the third tertile. Interestingly, a negative association was observed between PM2.5-Wood burning and the risk of dementia. In summary, this register-based study did not conclusively establish a strong association between air pollution exposure and the incidence of dementia. While some evidence indicated elevated risks for PM10-Traffic and PM2.5-Exhaust, and conversely, a negative association for PM2.5-Wood burning, no clear exposure-response relationships were evident.
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Affiliation(s)
- Anna Oudin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden.
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Wasif Raza
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katja M Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Topi Rönkkö
- Aerosol Physics Laboratory, Physics Unit, Tampere University, Tampere, Finland
| | - Rosalba Giugno
- Computer Science Department, University of Verona, Verona, Italy
| | - Thomas Sandström
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Ala Muala
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Jan Topinka
- Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine of the CAS, Prague, Czech Republic
| | - Johan Sommar
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
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Casey JA, Daouda M, Babadi RS, Do V, Flores NM, Berzansky I, González DJ, Van Horne YO, James-Todd T. Methods in Public Health Environmental Justice Research: a Scoping Review from 2018 to 2021. Curr Environ Health Rep 2023; 10:312-336. [PMID: 37581863 PMCID: PMC10504232 DOI: 10.1007/s40572-023-00406-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW The volume of public health environmental justice (EJ) research produced by academic institutions increased through 2022. However, the methods used for evaluating EJ in exposure science and epidemiologic studies have not been catalogued. Here, we completed a scoping review of EJ studies published in 19 environmental science and epidemiologic journals from 2018 to 2021 to summarize research types, frameworks, and methods. RECENT FINDINGS We identified 402 articles that included populations with health disparities as a part of EJ research question and met other inclusion criteria. Most studies (60%) evaluated EJ questions related to socioeconomic status (SES) or race/ethnicity. EJ studies took place in 69 countries, led by the US (n = 246 [61%]). Only 50% of studies explicitly described a theoretical EJ framework in the background, methods, or discussion and just 10% explicitly stated a framework in all three sections. Among exposure studies, the most common area-level exposure was air pollution (40%), whereas chemicals predominated personal exposure studies (35%). Overall, the most common method used for exposure-only EJ analyses was main effect regression modeling (50%); for epidemiologic studies the most common method was effect modification (58%), where an analysis evaluated a health disparity variable as an effect modifier. Based on the results of this scoping review, current methods in public health EJ studies could be bolstered by integrating expertise from other fields (e.g., sociology), conducting community-based participatory research and intervention studies, and using more rigorous, theory-based, and solution-oriented statistical research methods.
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Affiliation(s)
- Joan A. Casey
- University of Washington School of Public Health, Seattle, WA USA
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Misbath Daouda
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Ryan S. Babadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Vivian Do
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Nina M. Flores
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Isa Berzansky
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - David J.X. González
- Department of Environmental Science, Policy & Management and School of Public Health, University of California, Berkeley, Berkeley, CA 94720 USA
| | | | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
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Flanagan E, Malmqvist E, Rittner R, Gustafsson P, Källén K, Oudin A. Exposure to local, source-specific ambient air pollution during pregnancy and autism in children: a cohort study from southern Sweden. Sci Rep 2023; 13:3848. [PMID: 36890287 PMCID: PMC9995328 DOI: 10.1038/s41598-023-30877-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
Evidence of air pollution exposure, namely, ambient particulate matter (PM), during pregnancy and an increased risk of autism in children is growing; however, the unique PM sources that contribute to this association are currently unknown. The aim of the present study was to investigate local, source-specific ambient PM exposure during pregnancy and its associations with childhood autism, specifically, and autism spectrum disorders (ASD) as a group. A cohort of 40,245 singleton births from 2000 to 2009 in Scania, Sweden, was combined with data on locally emitted PM with an aerodynamic diameter < 2.5 µm (PM2.5). A flat, two-dimensional dispersion model was used to assess local PM2.5 concentrations (all-source PM2.5, small-scale residential heating- mainly wood burning, tailpipe exhaust, and vehicle wear-and-tear) at the mother's residential address during pregnancy. Associations were analyzed using binary logistic regression. Exposure to local PM2.5 during pregnancy from each of the investigated sources was associated with childhood autism in the fully adjusted models. For ASD, similar, but less pronounced, associations were found. The results add to existing evidence that exposure to air pollution during pregnancy may be associated with an increased risk of childhood autism. Further, these findings suggest that locally produced emissions from both residential wood burning and road traffic-related sources (tailpipe exhaust and vehicle wear-and-tear) contribute to this association.
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Affiliation(s)
- Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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Flanagan E, Malmqvist E, Gustafsson S, Oudin A. Estimated public health benefits of a low-emission zone in Malmö, Sweden. ENVIRONMENTAL RESEARCH 2022; 214:114124. [PMID: 35998694 DOI: 10.1016/j.envres.2022.114124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/27/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Air pollution is one of the leading causes of morbidity and mortality worldwide. Low-emission zones (LEZ) have been increasingly implemented in cities throughout Europe as a measure to reduce the adverse health effects and premature deaths associated with traffic-related air pollution. In the present study, a health impact analysis was conducted to estimate the effect of a hypothetical LEZ on mortality and morbidity in Malmö, Sweden. Baseline health statistics were gathered from health registers and applied to each resident according to individual-level data on age and/or sex. Concentration-response parameters were derived from current epidemiological literature, specifically meta-analyses. A Gaussian dispersion model (AERMOD) combined with a detailed emission database was used to calculate NO2 emissions from traffic, which could be applied on an individual-level using data on each person's residential coordinates. The adjusted exposure scenario replaced all vehicles on municipal roads having Euro 5 or lower emission standards with Euro 6 equivalents. This LEZ would, on average, decrease NO2 concentrations by 13.4%, preventing an estimated 9-26 deaths in Malmö each year. Additionally, 12 respiratory disease hospitalizations, 8 childhood asthma cases, and 9 cases of hypertensive disorders of pregnancy were estimated to be avoided annually. These results suggest that LEZs can effectively improve air quality, reduce greenhouse gas emissions, and safeguard public health.
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Affiliation(s)
- Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden.
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden.
| | - Susanna Gustafsson
- Environmental Department of the City of Malmö, 21154, Malmö, Skåne, Sweden.
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden; Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Västerbotten, Sweden.
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Raaschou-Nielsen O, Taj T, Poulsen AH, Hvidtfeldt UA, Ketzel M, Christensen JH, Brandt J, Frohn LM, Geels C, Valencia VH, Sørensen M. Air pollution at the residence of Danish adults, by socio-demographic characteristics, morbidity, and address level characteristics. ENVIRONMENTAL RESEARCH 2022; 208:112714. [PMID: 35031338 DOI: 10.1016/j.envres.2022.112714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exposure to outdoor air pollution is associated with adverse health effects. Previous studies have indicated higher levels of air pollution in socially deprived areas. AIM To investigate associations between air pollution and socio-demographic variables, comorbidity, stress, and green space at the residence in Denmark. METHODS We included 2,237,346 persons living in Denmark, aged 35 years or older in 2017. We used the high resolution, multi-scale DEHM/UBM/AirGIS air pollution modelling system to calculate mean concentrations of air pollution with PM2.5, elemental carbon, ultrafine particles and NO2 at residences held the preceding five years. We used nationwide registries to retrieve information about socio-demographic indicators at the individual and neighborhood levels. We used general linear regression models to analyze associations between socio-demographic indicators and air pollution at the residence. RESULTS Individuals with high SES (income, higher white-collar worker and high educational level) and of non-Danish origin were exposed to higher levels of air pollution than individuals of low SES and of Danish origin, respectively. We found comparable levels of air pollution according to sex, stress events and morbidity. For neighborhood level SES indicators, we found high air pollution levels in neighborhoods with low SES measured as proportion of social housing, sole providers, low income and unemployment. In contrast, we found higher air pollution levels in neighborhoods with higher educational level and a low proportion of manual labor. People living in an apartment and/or with little green space had higher air pollution levels. CONCLUSION In Denmark, high levels of residential air pollution were associated with higher individual SES and non-Danish origin. For neighborhood-level indicators of SES, no consistent pattern was observed. These results highlight the need for analyzing many different socio-demographic indicators to understand the complex associations between SES and exposure to air pollution.
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Affiliation(s)
- Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.
| | - Tahir Taj
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Aslak H Poulsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Ulla A Hvidtfeldt
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, University of Surrey, Guildford, UK
| | - Jesper H Christensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; IClimate - Interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Victor H Valencia
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark
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Orru H, Olstrup H, Hagenbjörk A, Nordin S, Orru K. Exposures, Symptoms and Risk Perception among Office Workers in Relation to Nanoparticles in the Work Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105789. [PMID: 35627326 PMCID: PMC9141247 DOI: 10.3390/ijerph19105789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 12/10/2022]
Abstract
Submicroscopic nanoparticles (NPs) in air have received much attention due to their possible effects on health and wellbeing. Adverse health impacts of air pollution may not only be associated with level of exposure, but also mediated by the perception of the pollution and by beliefs of the exposure being hazardous. The aim of this study was to test a model that describes interrelations between NP pollution, perceived air quality, health risk perception, stress, and sick building syndrome. In the NanoOffice study, the level of NPs was measured and a survey on health risk perception was conducted among 260 employees in twelve office buildings in northern Sweden. Path analyses were performed to test the validity of the model. The data refute the model proposing that the NP exposure level significantly influences stress, chronic diseases, or SBS symptoms. Instead, the perceived exposure influences the perceived risk of NP, and the effect of perceived exposure on SBS and chronic disease is mediated by stress. There was little concern about nanoparticles, despite relatively high levels in some facilities. Perceived pollution and health risk perception may explain a large part of the environmentally induced symptoms and diseases, particularly in relatively low levels of pollution. The research results raise important questions on the physiologically or psychologically mediated health effects of air pollution.
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Affiliation(s)
- Hans Orru
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, 901 87 Umeå, Sweden;
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Correspondence: (H.O.); (H.O.); Tel.: +372-737-4203 (H.O.); +46-70-614-33-66 (H.O.)
| | - Henrik Olstrup
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, 901 87 Umeå, Sweden;
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Correspondence: (H.O.); (H.O.); Tel.: +372-737-4203 (H.O.); +46-70-614-33-66 (H.O.)
| | - Annika Hagenbjörk
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Steven Nordin
- Department of Psychology, Faculty of Social Sciences, Umeå University, 901 87 Umeå, Sweden;
| | - Kati Orru
- Institute of Social Studies, University of Tartu, Lossi 36, 51003 Tartu, Estonia;
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Hande V, Teo K, Srikanth P, Wong JSM, Sethu S, Martinez-Lopez W, Hande MP. Investigations on the new mechanism of action for acetaldehyde-induced clastogenic effects in human lung fibroblasts. Mutat Res 2020; 861-862:503303. [PMID: 33551104 DOI: 10.1016/j.mrgentox.2020.503303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/31/2022]
Abstract
Acetaldehyde (AA) has been classified as a probable human carcinogen by the International Agency for Research on Cancer (IARC, WHO) and by the US Environmental Protection Agency due to its ability to cause tumours following inhalation or alcohol consumption in animals. Humans are constantly exposed to AA through inhalation from the environment through cigarette smoke, vehicle fumes and industrial emissions as well as by persistent alcohol ingestion. Individuals with deficiencies in the enzymes that are involved in the metabolism of AA are more susceptible to its toxicity and constitute a vulnerable human population. Studies have shown that AA induces DNA damage and cytogenetic abnormalities. A study was undertaken to elucidate the clastogenic effects induced by AA and any preceding DNA damage that occurs in normal human lung fibroblasts as this will further validate the detrimental effects of inhalation exposure to AA. AA exposure induced DNA damage, involving DNA double strand breaks, which could possibly occur at the telomeric regions as well, resulting in a clastogenic effect and subsequent genomic instability, which contributed to the cell cycle arrest. The clastogenic effect induced by AA in human lung fibroblasts was evidenced by micronuclei induction and chromosomal aberrations, including those at the telomeric regions. Co-localisation between the DNA double strand breaks and telomeric regions was observed, suggesting possible induction of DNA double strand breaks due to AA exposure at the telomeric regions as a new mechanism beyond the clastogenic effect of AA. From the cell cycle profile following AA exposure, a G2/M phase arrest and a decrease in cell viability were also detected. Therefore, these effects due to AA exposure via inhalation may have implications in the development of carcinogenesis in humans.
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Affiliation(s)
- Varsha Hande
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keith Teo
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; University of Auckland, New Zealand
| | - Prarthana Srikanth
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jane See Mei Wong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swaminathan Sethu
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Wilner Martinez-Lopez
- Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay; Associate Unit on Genomic Stability, Faculty of Medicine, University of the Republic (UdelaR), Montevideo, Uruguay; Vellore Institute of Technology, Vellore, India
| | - Manoor Prakash Hande
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Vellore Institute of Technology, Vellore, India; Mangalore University, India; Tembusu College, National University of Singapore, Singapore.
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Through Internet and Friends: Translation of Air Pollution Research in Malmö Municipality, Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124214. [PMID: 32545656 PMCID: PMC7345806 DOI: 10.3390/ijerph17124214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022]
Abstract
Air pollution is estimated to cause more than 7000 deaths annually in Sweden alone. To reduce the impact of air pollution and to plan and build sustainable cities, it is vital that research is translated into efficient decisions and practice. However, how do civil servants in a municipality access research results? How do they normally find relevant information, and what obstacles are there to accessing and applying research results? As part of the collaborative and transdisciplinary research project Air Pollution Research in Local Environmental Planning (ARIEL), these questions were explored through interviews and seminars with civil servants within the Malmö Municipality Environmental Office. We found that the civil servants generally have proficiency in processing research results, but often do not use such results as part of their everyday decision making and practices. Instead, the data and measurements used are mostly produced case-by-case within the municipal sector itself. Information about best practices is also collected via a number of knowledge access practices, involving the Internet or social networks within other municipalities. Lack of time, paywalls, and the insufficient applicability of research hinder the dissemination of up-to-date results. This slows down the process whereby research, funded by tax-money, can be put to best practice in the effort to create healthy and sustainable cities.
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