Children's exposure to air pollution in a natural gas industrial area and their risk of hospital admission for respiratory diseases

Impacts of short-term exposure to ambient air pollutants on outpatient visits for respiratory diseases in children: a time series study in Yichang, China

BACKGROUND

There is growing evidence that the occurrence and severity of respiratory diseases in children are related to the concentration of air pollutants. Nonetheless, evidence regarding the association between short-term exposure to air pollution and outpatient visits for respiratory diseases in children remains limited. Outpatients cover a wide range of disease severity, including both severe and mild cases, some of which may need to be transferred to inpatient treatment. This study aimed to quantitatively evaluate the impact of short-term ambient air pollution exposure on outpatient visits for respiratory conditions in children.

METHODS

This study employed data of the Second People's Hospital of Yichang from January 1, 2016 to December 31, 2023, to conduct a time series analysis. The DLNM approach was integrated with a generalized additive model to examine the daily outpatient visits of pediatric patients with respiratory illnesses in hospital, alongside air pollution data obtained from monitoring stations. Adjustments were made for long-term trends, meteorological variables, and other influencing factors.

RESULTS

A nonlinear association was identified between PM2.5, PM10, O3, NO2, SO2, CO levels and the daily outpatient visits for respiratory diseases among children. All six pollutants exhibit a hysteresis impact, with varying durations ranging from 4 to 6 days. The risks associated with air pollutants differ across various categories of children's respiratory diseases; notably, O3 and CO do not show statistical significance concerning the risk of chronic respiratory conditions. Furthermore, the results of infectious respiratory diseases were similar with those of respiratory diseases.

CONCLUSIONS

Our results indicated that short-term exposure to air pollutants may contribute to an increased incidence of outpatient visits for respiratory illnesses among children, and controlling air pollution is important to protect children's health.

Correlations between ambient air pollution and the prevalence of hospitalisations and emergency room visits for respiratory diseases in children: a systematic review

OBJECTIVE

It is known that exposure to air pollution is associated with an increased risk for cardiovascular and respiratory diseases. This review aimed to summarise observational studies on the impact of short and long-term exposure to ambient air pollution on prevalence of hospitalisations and/or emergency department visits caused by respiratory diseases in children and adolescents.

SOURCES

Pubmed, Scopus, Embase and Cochrane Library databases were searched for the years 2018 to December 2022, including studies in any language.

SUMMARY OF THE FINDINGS

A total of 15 studies published between 2018 and 15 January 2022 were included in this review. PM2.5 was the most type of particulate matter studied. Short-term exposure to PM2,5, PM10, NO2, SO2 and O3, even at concentrations less than the current health-based guidelines, was significantly correlated with increased risk of outpatient/hospital visits and hospitalisations for respiratory diseases by children.

CONCLUSIONS

Our findings emphasise the importance and urgency of long-term control of air pollution and pollution-related diseases, especially among children and adolescents. There is a need for further research employing more homogeneous methodologies for assessing exposure and outcome measurements, in order to enable systematic reviews with meta-analysis.

Visible Light-Activated Room Temperature NO2 Gas Sensing Based on the In2O3@ZnO Heterostructure with a Hollow Microtube Structure

The persistent challenge of poor recovery characteristics of NO2 sensors operated at room temperature remains significant. However, the development of In2O3-based gas sensing materials provides a promising approach to accelerate response and recovery for sub-ppm of NO2 detection at room temperature. Herein, we propose a simple two-step method to synthesize a one-dimensional (1D) In2O3@ZnO heterostructure material with hollow microtubes, by coupling metal-organic frameworks (MOFs) (MIL-68 (In)) and zinc ions. Meanwhile, the In2O3@ZnO composite-based gas sensor exhibits superior sensitivity performance to NO2 under visible light activation. The response value to 5 ppm of NO2 at room temperature is as high as 1800, which is 35 times higher than that of the pure In2O3-based sensor. Additionally, the gas sensor based on the In2O3@ZnO heterostructure demonstrates a significantly reduced response/recovery time of 30 s/67 s compared to the sensor based on pure In2O3 (74 s/235 s). The outstanding gas sensing properties of the In2O3@ZnO heterostructure-based sensors can be attributed to the enhanced photogenerated charge separation efficiency resulting from the heterostructure effect, and the improved receptor function toward NO2, which can increase the reactive sites and gas adsorption capacity. In summary, this work proposes a low-cost and efficient method to synthesize a 1D heterostructure material with microtube structures, which can serve as a fundamental technique for developing high-performance room-temperature gas sensors.

Short-term associations of PM10 attributed to biomass burning with respiratory and cardiovascular hospital admissions in Peninsular Malaysia

BACKGROUND

Biomass burning (BB) is a major source of air pollution and particulate matter (PM) in Southeast Asia. However, the health effects of PM smaller than 10 µm (PM10) originating from BB may differ from those of other sources. This study aimed to estimate the short-term association of PM10 from BB with respiratory and cardiovascular hospital admissions in Peninsular Malaysia, a region often exposed to BB events.

METHODS

We obtained and analyzed daily data on hospital admissions, PM10 levels and BB days from five districts from 2005 to 2015. We identified BB days by evaluating the BB hotspots and backward wind trajectories. We estimated PM10 attributable to BB from the excess of the moving average of PM10 during days without BB hotspots. We fitted time-series quasi-Poisson regression models for each district and pooled them using meta-analyses. We adjusted for potential confounders and examined the lagged effects up to 3 days, and potential effect modification by age and sex.

RESULTS

We analyzed 210 960 respiratory and 178 952 cardiovascular admissions. Almost 50% of days were identified as BB days, with a mean PM10 level of 53.1 µg/m3 during BB days and 40.1 µg/m3 during normal days. A 10 µg/m3 increment in PM10 from BB was associated with a 0.44% (95% CI: 0.06, 0.82%) increase in respiratory admissions at lag 0-1, with a stronger association in adults aged 15-64 years and females. We did not see any significant associations for cardiovascular admissions.

CONCLUSIONS

Our findings suggest that short-term exposure to PM10 from BB increased the risk of respiratory hospitalizations in Peninsular Malaysia.

Association between short-term exposure to ambient air pollutants and the risk of hospital visits for acute upper respiratory tract infections among adults: a time-series study in Ningbo, China

OBJECTIVES

Acute upper respiratory tract infections (AURTIs) are prevalent in the general population. However, studies on the association of short-term exposure to air pollution with the risk of hospital visits for AURTIs in adults are limited. This study aimed to explore the short-term exposure to air pollutants among Chinese adults living in Ningbo.

METHODS

Quasi-Poisson time serious regressions with distributed lag non-linear models (DLNM) were applied to explore the association between ambient air pollution and AURTIs cases. Patients ≥ 18 years who visit three hospitals, being representative for urban, urban-rural junction and rural were included in this retrospective study.

RESULTS

In total, 104,441 cases with AURTIs were enrolled in hospital during 2015-2019. The main results showed that particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2) and nitrogen dioxide (SO2), were positively associated to hospital visits for AURTIs, except for nitrogen dioxide (O3), which was not statistically significant. The largest single-lag effect for PM2.5 at lag 8 days (RR = 1.02, 95%CI: 1.08-1.40), for NO2 at lag 13 days (RR = 1.03, 95%CI: 1.00-1.06) and for SO2 at lag 5 days (RR = 1.27, 95%CI: 1.08-1.48), respectively. In the stratified analysis, females, and young adults (18-60 years) were more vulnerable to PM2.5 and SO2 and the effect was greater in rural areas and urban-rural junction.

CONCLUSIONS

Exposure to ambient air pollution was significantly associated with hospital visits for AURTIs. This study provides epidemiological evidence for policymakers to control better air quality and establish an enhanced system of air pollution alerts.

Projecting non-communicable diseases attributable to air pollution in the climate change era: a systematic review

OBJECTIVES

Climate change is a major global issue with significant consequences, including effects on air quality and human well-being. This review investigated the projection of non-communicable diseases (NCDs) attributable to air pollution under different climate change scenarios.

DESIGN

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability.

DATA SOURCES

The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies.

DATA EXTRACTION AND SYNTHESIS

Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution.

RESULTS

This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population.

CONCLUSION

The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era.

PROSPERO REGISTRATION NUMBER

CRD42023435288.

Identification of potential source regions and long-range transport routes/channels of marine PM2.5 at remote sites in East Asia

Long-range transport (LRT) of air masses in East Asia and their impacts on marine PM2.5 were explored. Situated in the leeward region of East Asia, Taiwan Island marked by its elevated Central Mountain Range (CMR) separates air masses into two distinct air currents. This study aims to investigate the transport of PM2.5 from the north to the leeward region. Six transport routes (A-F) were identified and further classified them into three main channels (i.e. East, West, and South Channels) based on their transport routes and potential sources. Green Island (Site GR) and Hengchun Peninsula (Site HC) exhibited similarities in their transport routes, with Central China, North China, and Korean Peninsula being the major source regions of PM2.5, particularly during the Asian Northeastern Monsoons (ANMs). Dongsha Island (Site DS) was influenced by both Central China and coastal regions of East China, indicating Asian continental outflow (ACO) as the major source of PM2.5. The positive matrix factorization (PMF) analysis of PM2.5 resolved that soil dust, sea salts, biomass burning, ship emissions, and secondary aerosols were the major sources. Northerly Channels (i.e. East and West Channels) were primarily influenced by ship emissions and secondary aerosols, while South Channel was dominated by oceanic spray and soil dust. The results of W-PSCF and W-CWT analysis indicated that three remote sites experienced significant contributions from Central China in the highest PM2.5 concentration range (75-100%). In contrast, PM2.5 in the 0-25% and 25-50% ranges primarily originated from the open seas, with ship emissions being the prominent source. It suggested that northern regions with heavy industrialization and urbanization have impacts on high PM2.5 concentrations, while open seas are the main sources of low PM2.5 concentrations.

Short-term association between air pollution and daily genitourinary disorder admissions in Lanzhou, China

The aim of this study was to determine the relationship between short-term exposure to ambient air pollution and the number of daily hospital admissions for genitourinary disorders in Lanzhou. Hospital admission data and air pollutants, including PM2.5, PM10, SO2, NO2, O38h and CO, were obtained from the period 2013 to 2020. A generalized additive model (GAM) combined with distribution lag nonlinear model (DLNM) based on quasi-Poisson distribution was used by the controlling for trends, weather, weekdays and holidays. Short-term exposure to PM2.5, NO2 and CO increased the risk of genitourinary disorder admissions with RR of 1.0096 (95% CI 1.0002-1.0190), 1.0255 (95% CI 1.0123-1.0389) and 1.0686 (95% CI 1.0083-1.1326), respectively. PM10, O38h and SO2 have no significant effect on genitourinary disorders. PM2.5 and NO2 are more strongly correlated in female and ≥ 65 years patients. CO is more strongly correlated in male and < 65 years patients. PM2.5, NO2 and CO are risk factors for genitourinary morbidity, and public health interventions should be strengthened to protect vulnerable populations.

Short-term effects of air pollution on hospitalization for acute lower respiratory infections in children: a time-series analysis study from Lanzhou, China

BACKGROUND

Short-term exposure to air pollution is associated with acute lower respiratory infections (ALRI) in children. We investigated the relationship between hospitalization for ALRI in children and air pollutant concentrations from January 1, 2014 to December 31, 2020 in Lanzhou City.

METHODS

We collected data on air pollutant concentrations and children's hospitalization data during the study period. A time series regression analysis was used to assess the short-term effects of air pollutants on ALRI in children, and subgroup analyses and sensitivity analyses were performed.

RESULTS

A total of 51,206 children with ALRI were studied, including 40,126 cases of pneumonia and 11,080 cases of bronchiolitis. The results of the study revealed that PM2.5, PM10, SO2 and NO2 were significantly associated with hospitalization for ALRI in children aged 0-14 years. For each 10 µg/m3 increase in air pollutant concentration in lag0-7, the relative risk of ALRI hospitalization in children due to PM2.5, PM10, SO2 and NO2 increased by 1.089 (95%CI:1.075, 1.103), 1.018 (95%CI:1.014, 1.021), 1.186 (95%CI:1.154. 1.219) and 1.149 (95%CI:1.130, 1.168), respectively.

CONCLUSIONS

PM2.5, PM10, SO2 and NO2 short-term exposures were positively associated with ALRI, pneumonia and bronchiolitis hospitalizations in Lanzhou, China. Local governments should make efforts to improve urban ambient air quality conditions to reduce hospitalization rates for childhood respiratory diseases.

City-level meteorological conditions modify the relationships between exposure to multiple air pollutants and the risk of pediatric hand, foot, and mouth disease in the Sichuan Basin, China

Background

Several studies have examined the effects of city-level meteorological conditions on the associations between meteorological factors and hand, foot, and mouth disease (HFMD) risk. However, evidence that city-level meteorological conditions modify air pollutant-HFMD associations is lacking.

Methods

For each of the 17 cities in the Sichuan Basin, we obtained estimates of the relationship between exposures to multiple air pollutants and childhood HFMD risk by using a unified distributed lag nonlinear model (DLNM). Multivariate meta-regression models were used to identify the effects of city-level meteorological conditions as effect modifiers. Finally, we conducted subgroup analyses of age and sex to explore whether the modification effects varied in different subgroups.

Results

The associations between PM2.5/CO/O3 and HFMD risk showed moderate or substantial heterogeneity among cities (I 2 statistics: 48.5%, 53.1%, and 61.1%). Temperature conditions significantly modified the PM2.5-HFMD association, while relative humidity and rainfall modified the O3-HFMD association. Low temperatures enhanced the protective effect of PM2.5 exposure against HFMD risk [PM2.5 <32.7  μg/m3 or PM2.5 >100  μg/m3, at the 99th percentile: relative risk (RR) = 0.14, 95% CI: 0.03-0.60]. Low relative humidity increased the adverse effect of O3 exposure on HFMD risk (O3 >128.7 μg/m3, at the 99th percentile: RR = 2.58, 95% CI: 1.48-4.50). However, high rainfall decreased the risk of HFMD due to O3 exposure (O3: 14.1-41.4  μg/m3). In addition, the modification effects of temperature and relative humidity differed in the female and 3-5  years-old subgroups.

Conclusion

Our findings revealed moderate or substantial heterogeneity in multiple air pollutant-HFMD relationships. Temperature, relative humidity, and rainfall modified the relationships between PM2.5 or O3 exposure and HFMD risk.

Chemical characteristics and spatiotemporal variation of marine fine particles for clustered channels of air masses transporting toward remote background sites in East Asia

This study investigated the chemical characteristics, spatiotemporal distribution, and source apportionment of marine fine particles (PM_2.5) for clustered transport channels/routes of air masses moving toward three remote sites in East Asia. Six transport routes in three channels were clustered based on backward trajectory simulation (BTS) in the order of: West Channel > East Channel > South Channel. Air masses transported toward Dongsha Island (DS) came mainly from the West Channel, while those transported toward Green Island (GR) and Kenting Peninsula (KT) came mostly from the East Channel. High PM_2.5 commonly occurred from late fall to early spring during the periods of Asian Northeastern Monsoons (ANMs). Marine PM_2.5 was dominated by water-soluble ions (WSIs) which were predominated by secondary inorganic aerosols (SIAs). Although the metallic content of PM_2.5 was predominated by crustal elements (Ca, K, Mg, Fe, and Al), enrichment factor clearly showed that trace metals (Ti, Cr, Mn, Ni, Cu, and Zn) came mainly from anthropogenic sources. Organic carbon (OC) was superior to elemental carbon (EC), while OC/EC and SOC/OC ratios in winter and spring were higher than those in other two seasons. Similar trends were observed for levoglucosan and organic acids. The mass ratio of malonic acid and succinic acid (M/S) was commonly higher than unity, showing the influences of biomass burning (BB) and secondary organic aerosols (SOAs) on marine PM_2.5. We resolved that the main sources of PM_2.5 were sea salts, fugitive dust, boiler combustion, and SIAs. Boiler combustion and fishing boat emissions at DS had higher contribution than those at GR and KT. The highest/lowest contribution ratios of cross-boundary transport (CBT) were 84.9/29.6% in winter and summer, respectively.

Associations between congenital heart disease and air pollutants at different gestational weeks: a time-series analysis

Exposure to air pollution during pregnancy has been linked to birth defects. But the directions of studies on the associations between air pollutants exposure and effect on the incidence of congenital heart disease (CHDs) were inconsistent. To date, few studies were concentrated on the effects of both particulate matter and gaseous air pollutant exposure on CHDs across the full gestational week simultaneously. Our study aimed to investigate the critical exposure windows for each air pollutant throughout 40 gestational weeks. Data on CHDs, air pollution, and meteorological factors from 2013 to 2019 were collected in Lanzhou, China. A distributed lag nonlinear model combined with a quasi-Poisson regression model was applied to evaluate the weekly exposure-lag-response association between air pollutants levels and CHDs, and the subgroup analyses were conducted by gender (baby boy and baby girl). The study included 1607 mother-infant pairs. The results demonstrated that exposure of pregnant women to particulate matter ≤ 5 μm (PM_2.5) at lag 1-4 weeks was significantly associated with the risk of CHDs, and the strongest effects were observed in the lag 1 week (1.150, 95%CI 1.059-1.248). For exposure to particulate matter ≤ 10 μm (PM₁₀) at lag 1-3 weeks, the strongest effects were observed in the lag 1 week (1.075, 95% CI 1.026-1.128). For exposure to sulfur dioxide (SO₂) at lag 1-4 weeks, the strongest effects were observed in the lag 1 week (1.154, 95% CI 1.025-1.299). For exposure to carbon monoxide (CO) at lag 1-3 weeks, the strongest effects were observed in the lag 1 week (1.089, 95% CI 1.002-1.183). For exposure to ozone (O₃) concentration at lag 9-15 weeks, the strongest effects were observed in the lag 15 weeks (1.628, 95% CI 1.001-2.649). The cumulative effects of PM_2.5, PM₁₀, SO₂, and CO along weeks with a maximum of 1.609 (95%CI 1.000-2.589), 1.286 (95%CI 1.007-1.641), 1.648 (95%CI 1.018-2.668), and 1.368 (95%CI 1.003, 1.865), respectively. The effects were obvious in the initial gestational weeks too. Through the gender stratification analysis, the air pollutants with significant effects were PM_2.5 for baby boys and PM_2.5, PM₁₀, SO₂, CO, NO₂, and O₃ for baby girl. For the relationship between CHDs and air pollution in Lanzhou, PM_2.5, PM₁₀, SO₂, CO, and O₃ played an important role in the initial gestational weeks, especially for baby girl.

Preparation of BiOI-Functionalized ZnO Nanorods for Ppb-Level NO2 Detection at Room Temperature

Light activation is an effective method to improve sensor performance at room temperature (RT). This work realized the effective detection of trace-level NO₂ at RT under visible light by combining ZnO with the excellent photocatalyst BiOI. A 1.5 atom % BiOI-ZnO-based sensor under 520 nm light exhibited optimal sensing properties with the maximum responses (13.9 to 1 ppm NO₂), fast response/recovery time (66 s/47 s to 1 ppm), and a low detection limit of 25 ppb (theoretically 0.34 ppb). In the meantime, the sensor also possessed excellent selectivity, repeatability, and stability. The excellent properties were attributed to the high concentration of oxygen vacancies and the prolonged lifetime of photogenerated carriers. In addition, the observed photovoltaic effect of the sensor at RT indicated that the sensor held application prospects in the photovoltaic self-power field.

Association between short-term ambient nitrogen dioxide and type 2 diabetes outpatient visits: A large hospital-based study

Type 2 diabetes (T2DM) as a non-communicable disease imposes heavy disease burdens on society. Limited studies have been conducted to assess the effects of short-term air pollution exposure on T2DM, especially in Asian regions. Our research aimed to determine the association between short-term exposure to ambient nitrogen dioxide (NO₂) and outpatient visits for T2DM in Chongqing, the largest city in western China, based on the data collected from November 28, 2013 to December 31, 2019. A generalized additive model (GAM) was applied, and stratified analyses were performed to investigate the potential modifying effects by age, gender, and season. Meanwhile, the disease burden was revealed from attributable risk. Positive associations between short-term NO₂ and daily T2DM outpatient visits were observed. The strongest association was observed at lag 04, with per 10 μg/m³ increase of NO₂ corresponded to increased T2DM outpatient visits at 1.57% [95% confidence interval (CI): 0.48%, 2.65%]. Stronger associations were presented in middle-aged group (35-64 years old), male group, and cool seasons (October to March). Moreover, there were 1.553% (8664.535 cases) of T2DM outpatient visits attributable to NO₂. Middle-aged adults, males, and patients who visited in cool seasons suffered heavier burdens. Conclusively, short-term exposure to NO₂ was associated with increased outpatient visits for T2DM. Attention should be paid to the impact of NO₂ on the burden of T2DM, especially for those vulnerable groups.

Dissociation characteristics and anthropogenic emissions from the combustion of double gas hydrates

Gas hydrates are an alternative and environmentally friendly energy source increasingly in the focus of scientific attention. The physicochemical processes behind gas hydrate combustion are studied experimentally and numerically with a view to improving the combustion efficiency and reducing gas emissions. It is important to estimate the pollutant emission concentrations in the context of combustion conditions. The research deals with the dissociation and combustion behavior of double gas hydrates in a tubular muffle furnace. Gas hydrates of different composition are considered: methane, methane-ethane, methane-propane and methane-isopropanol. Double gas hydrates are characterized by more stable combustion compared to methane hydrate. It is also shown that the double gas hydrate dissociation rate increases by 15-30% with increasing temperature. Dissociation and combustion processes were also modeled as part of the research, accounting for phase transitions in a gas hydrate layer. According to the simulation results, the total dissociation rate of gas hydrate increases by 3 times with an about 2.5-times increase in the powder layer thickness. Our experiments also focused on the impact of furnace temperature and gas hydrate composition on concentrations of anthropogenic gas emissions. We have found that the presence of heavy hydrocarbons such as ethane, propane and isopropanol in double gas hydrates reduce unburned CH₄ emissions by 60%. Also, an increase in the combustion efficiency of double gas hydrates, accompanied by a decrease in the concentrations of unburned CH₄ and CO, affects the yield of CO₂, which increased by 13-35%. When we increased the temperature in the furnace from 750 °C to 1050 °C, concentrations of nitrogen oxides and carbon dioxide increased by up to five times. Thus, the resulting correlations between the key parameters of these processes and a set of the main inputs illustrate the possibility to predict the optimal conditions for the combustion of gas hydrates.

Impacts of climate change and environmental degradation on children in Malaysia

The impacts of climate change and degradation are increasingly felt in Malaysia. While everyone is vulnerable to these impacts, the health and wellbeing of children are disproportionately affected. We carried out a study composed of two major components. The first component is an environmental epidemiology study comprised of three sub-studies: (i) a global climate model (GCM) simulating specific health-sector climate indices; (ii) a time-series study to estimate the risk of childhood respiratory disease attributable to ambient air pollution; and (iii) a case-crossover study to identify the association between haze and under-five mortality in Malaysia. The GCM found that Malaysia has been experiencing increasing rainfall intensity over the years, leading to increased incidences of other weather-related events. The time-series study revealed that air quality has worsened, while air pollution and haze have been linked to an increased risk of hospitalization for respiratory diseases among children. Although no clear association between haze and under-five mortality was found in the case-crossover study, the lag patterns suggested that health effects could be more acute if haze occurred over a longer duration and at a higher intensity. The second component consists of three community surveys on marginalized children conducted (i) among the island community of Pulau Gaya, Sabah; (ii) among the indigenous Temiar tribe in Pos Kuala Mu, Perak; and (iii) among an urban poor community (B40) in PPR Sg. Bonus, Kuala Lumpur. The community surveys are cross-sectional studies employing a socio-ecological approach using a standardized questionnaire. The community surveys revealed how children adapt to climate change and environmental degradation. An integrated model was established that consolidates our overall research processes and demonstrates the crucial interconnections between environmental challenges exacerbated by climate change. It is recommended that Malaysian schools adopt a climate-smart approach to education to instill awareness of the impending climate change and its cascading impact on children's health from early school age.