Ambient air pollution in China poses a multifaceted health threat to outdoor physical activity

Impact of ambient air pollution on physical activity and sedentary behavior in children

BACKGROUND

Exposure to air pollution has become a serious environmental issue affecting children's health and health-related behavior in China. Previous studies have focused on the associations between air pollution and physical activity among adults; however, few have examined the relationship between air pollution and health-related behavior among children, which are particularly susceptible population subgroups. The present study aims to examine the impact of air pollution on daily physical activity (PA) and sedentary behavior (SB) among children in China.

METHODS

PA and SB data were collected by actiGraph accelerometers for eight consecutive days. PA and SB data from 206 children were matched to daily air pollution obtained from the Ministry of Environmental Protection of the People's Republic of China, including the average daily air quality index (AQI), PM_2.5 (µg/m³), and PM₁₀ (µg/m³). Associations were estimated using linear individual fixed-effect regressions.

RESULTS

A 10-unit increase in daily AQI was associated with a reduction in daily PA by 5.94 (95% confidence interval [CI] = -8.79, -3.08) minutes of moderate to vigorous physical activity (MVPA) and 229.82 (95% CI = -345.35, -114.28) walking steps and an increase in daily SB by 15.77 (95% CI = 9.01, 22.53) minutes. A 10 µg/m³ increase in air pollution concentration in daily PM_2.5 was associated with a reduction in daily PA by 7.51 (95% CI = -11.04, -3.97) minutes of MVPA, 295.69 (95% CI = -438.46, -152.92) walking steps and an increase in daily SB by 21.12 (95% CI = 12.77, 29.47) minutes. A 10 µg/m³ increase in air pollution concentration in daily PM₁₀ was associated with a reduction in daily PA by 13.18 (95% confidence interval [CI] = -15.98, -10.37) minutes of MVPA, 518.34 (95% CI = -631.77, -404.91) walking steps and an increase in daily SB by 19.87 (95% CI = 13.10, 26.64) minutes.

CONCLUSION

Air pollution may discourage physical activity and increase sedentary behavior among children. Policy interventions are needed to reduce air pollution and develop strategies to decrease risks to children's health.

Urban Air Pollution and Greenness in Relation to Public Health

Background

Air pollution is the result of economic growth and urbanization. Air pollution has been progressively recognized as a serious problem for cities, through widespread effects on health and well-being. There is less concern from stakeholders about greenness and air pollution mitigating factors in an urban area. This research targeted to indicate the spatial dissemination of greenery, air quality levels (PM_2.5, PM₁₀, CO₂, and AQI), and exposure to air quality-related health risks for the people in the urban area.

Method

The data were collected by measuring air quality at transportation stations and manufacturing industries with Air visual pro, then observing and mapping greenness in the city within the administrative boundary by GIS (street greenery, forest, availability of greenness in the manufacturing industry), and lastly questionnaire and interview were employed for air quality-related health issues. Then, the air quality data were analyzed by using USAQI standards and health messages. Both quantitative and qualitative research approach had employed to explore air pollution levels, availability of greenness, and air quality-related health issues. Moreover, Health questionnaires and greenness were correlated with air quality levels by a simple linear regression model.

Result

The result indicated that there was unhealthy air quality in the transportation and manufacturing industries. The measured air quality showed in a range of 50.13-96.84 μg/m³ of PM_2.5, 645-1764 ppm of CO_2, and 137-179 Air quality index (AQI). The highest mean of PM_2.5 and air quality concentrations at Addis Ababa transportation stations and manufacturing sites ranged between 63.46 and 104.45 μg/m³ and 179-326, respectively. It was observed with less street greenery and greenness available in residential, commercial areas, and manufacturing industries. The pollution level was beyond the limit of WHO standards. The result has shown a health risk to the public in the city, particularly for drivers, street vendors, and manufacturing industry employees. Among 480 respondents, 57.92% experienced health risks due to air pollution by medical evidence.

Conclusion

High health risks due to industries and old motor vehicles in the city need to be reduced by introducing policies and strategies for low-carbon, minimizing traveling distance, encouraging high occupancy vehicles, and promoting a green legacy in the street network and green building.

Association between Air Pollution and Physical Activity and Sedentary Behavior among Adults Aged 60 Years or Older in China: A Cross-Sectional Study

BACKGROUND

Exposure to air pollution is associated with an increased risk of all-cause mortality in older adults. Promoting physical activity (PA) and avoiding sedentary behavior (SB) serve as key strategies to maintain and improve human health. However, ambient air pollution can adversely affect PA and SB, increasing the risks of health problems. This study aimed to visualize national spatial patterns of average AQI concentration, PA, and SB distributions and to examine the associations between air pollution and PA and SB in a national sample of Chinese older adults aged 60 years or older.

METHODS

We analyzed the data of the China Longitudinal Aging Social Survey 2020 (CLASS 2020), which sampled 11,399 older men and women from 30 cities in China. Moderate, vigorous, and light PA and SB were measured using the Chinese version of the International Physical Activity Questionnaire-Short Form (IPAQ-C). The environmental measures included the average hourly air quality index (AQI), PM_2.5, PM₁₀, and NO₂ (µg/m³). The data were analyzed using multivariable linear regression.

RESULTS

Increases in the standard deviations (±SD) of AQI, PM_2.5, PM₁₀, and NO₂ concentrations were associated with decreases in MVPA per week of -2.34 (95%CI = -3.36, -1.32), -2.58 (95%CI = -3.61, -1.55), -1.96 (95%CI = -3.05, -0.08), and -1.19 (95%CI = -2.06, -0.31) and decreases in LPA per week of -6.06 (95%CI = -7.15, -4.97), -4.86 (95%CI = -5.88, -3.85), -4.78 (95%CI = -5.89, -3.68), and -4.59 (95%CI = -5.57, -3.61) h/week, respectively. Increases in one SD of AQI, PM_2.5, PM₁₀, and NO₂ were associated with increases in SB per week of 1.32 (95%CI = 0.77, 1.88), 0.62 (95%CI = 0.09, 1.14), 1.03 (95%CI = 0.48, 1.59), and 0.98 (95%CI = 0.46, 1.49) h/week, respectively.

CONCLUSIONS

The spatial distributions of the average AQI concentration, MVPA, LPA, and SB are useful and allow environmental and health policymakers to identify the areas with the highest priority air pollution environmental equality concerns. AQI was positively associated with MVPA and LPA, and it was negatively associated with SB among older adults. AQI, PM_2.5, PM₁₀, and NO₂ were hardly associated with women's average time spent engaged in MVPA. Region-specific and multi-level health policy options are needed to reduce ambient air pollution by taking different types of pollutants into account in order to avoid changes in PA and SB in this population, especially in locations with high air pollution concentrations.

Imaging particulate matter exposed pine trees by vehicle exhaust experiment and hyperspectral analysis

This study analyzed spectral variations of the particulate matter (PM hereafter)-exposed pine trees using a spectrometer and a hyperspectral imager to derive the most effective spectral indices to detect the pine needle exposure to PM emission. We found that the spectral variation in the near-infrared (NIR hereafter) bands systemically coincided with the variations in PM concentration, showing larger variations for the diesel group whereas larger dust particles showed spectral variations in both visible and NIR bands. It is because the PM adsorption on needles is the main source of NIR band variation, and the combination of visible and NIR spectra can detect PM absorption. Fourteen bands were selected to classify PM-exposed pine trees with an accuracy of 82% and a kappa coefficient of 0.61. Given that this index employed both visible and NIR bands, it would be able to detect PM adsorption. The findings can be transferred to real-world applications for monitoring air pollution in an urban area.

Posture economy: the importance of metabolic state on metabolic phenotype assessment and the energy cost of sitting and standing. A whole body calorimetry trial

BACKGROUND

Metabolic state (fed vs fasted) can result in marked differences in exercise metabolism, fat, and carbohydrate oxidation. In addition, a large inter-individual range in metabolic response to sitting and standing when fasted has been observed. Here, we examined the effect of metabolic state on the energy cost of posture allocation.

METHODS

Thirty male participants were recruited and followed a 1 h sit-stand protocol in a fasted and fed state inside a whole body calorimeter to measure energy expenditure (EE) and respiratory quotient (RQ). Body composition and resting metabolic rate were measured before the start. Fasted EE response was used to phenotype participants as energy savers (≤5% ΔEE from sitting to standing) or energy spenders (>5% ΔEE).

RESULTS

In a fasted state, ΔEE from sitting to standing in energy spenders was 10.2 ± 2.7% compared to 2.6 ± 1.9% in energy savers (p < 0.001). Postprandial, there was no difference in ΔEE between energy spenders and energy savers (10.8 ± 5.1% vs 9.4 ± 5.7%). In a fasted state, significant correlations were observed between body fat (%) and ΔEE (%) (R² = 0.55, p < 0.001), body fat (%) and ΔRQ (R² = 0.28, p < 0.001) and ΔEE (%) and ΔRQ (R² = 0.43, p < 0.001); these correlations were not present after the meal.

CONCLUSIONS

The current study showed for the first time, that the observed difference between energy spenders and energy savers in a fasted state, disappeared after the consumption of a meal. Therefore, metabolic state may be important to consider when assessing metabolic phenotypes. Differences in body composition were observed between the energy spender and energy saver phenotype. The current findings may have implications on health and weight management recommendations on posture to increase non-exercise activity thermogenesis. This trial was retrospectively registered on 19 December 2017 as NCT03378115 on Clinicaltrials.gov .

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014-2019

BACKGROUND

Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM).

METHODS

We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference.

RESULTS

Per 10 ug/m³ increase of particles with an aerodynamic diameter < 2.5 μm (PM_2.5), particles with an aerodynamic diameter < 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbonic oxide (CO) and ozone (O₃) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM_2.5 and PM₁₀) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m³ increase in PM_2.5 and PM₁₀, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM_2.5 and PM₁₀, respectively. Given WHO 2021 air quality guideline as the reference, PM_2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM.

CONCLUSION

PM_2.5 and PM₁₀ are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.

Engagement in outdoor physical activity under ambient fine particulate matter pollution: A risk-benefit analysis

BACKGROUND

Outdoor physical activity (PA) brings important health benefits, but exposure to polluted air increases health risks. This study aimed to quantify the tradeoff of PA under fine particulate matter (PM2.5) air pollution by estimating the optimal PA duration under various pollution levels.

METHODS

A risk-benefit analysis was performed to estimate the optimal outdoor moderate-intensity PA (MPA) duration under varying PM2.5 concentrations.

RESULTS

An inverse nonlinear relationship was identified between optimal MPA duration and background PM2.5 concentration levels. When background PM2.5 concentration increased to 186 µg/m3, the optimal outdoor MPA duration decreased to 2.5 h/week, the minimum level recommended by current PA guidelines. When background PM2.5 concentration further increased to 235 µg/m3, the optimal outdoor MPA duration decreased to 1 h/week. The relationship between optimal MPA duration and background PM2.5 concentration levels was stronger when exercising at a location closer to a source of air pollution. Compared to the general adult population, adults aged 60 years and older had substantially steeper curves-the optimal outdoor MPA duration decreased to 2.5 h/week when background PM2.5 concentration reached 45 µg/m3.

CONCLUSION

The health benefit of outdoor MPA by far outweighs the health risk of PM2.5 pollution for the global average urban background concentration (22 μg/m3). This modeling study examined a single type of air pollutant and suffered from measurement errors and estimation uncertainties. Future research should examine other air pollutants and indoor PA, incorporate short- and mid-term health effects of MPA and air pollution into the risk-benefit analysis, and provide estimates specific for high-risk subgroups.

The Process and Platform for Predicting PM2.5 Inhalation and Retention during Exercise

In recent years, people have been increasingly concerned about air quality and pollution since a number of studies have proved that air pollution, especially PM2.5 (particulate matter), can affect human health drastically. Though the research on air quality prediction has become a mainstream research field, most of the studies focused only on the prediction of urban air quality and pollution. These studies did not predict the actual impact of these pollutants on people. According to the researchers’ best knowledge, the amount of polluted air inhaled by people and the amount of polluted air that remains inside their body are two important factors that affect their health. In order to predict the quantity of PM2.5 inhaled by people and what they have retained in their body, a process and a platform have been proposed in the current research work. In this research, the experimental process is as follows: (1) First, a personalized PM2.5 sensor is designed and developed to sense the quantity of PM2.5 around people. (2) Then, the Bruce protocol is applied to collect the information and calculate the relationship between heart rate and air intake under different activities. (3) The amount of PM2.5 retained in the body is calculated in this step using the International Commission on Radiological Protection (ICRP) air particle retention formula. (4) Then, a cloud platform is designed to collect people’s heart rate under different activities and PM2.5 values at respective times. (5) Finally, an APP is developed to show the daily intake of PM2.5. The result reveals that the developed app can show a person’s daily PM2.5 intake and retention in a specific population.

Analyzing the relationship between air pollution and various types of crime

Air pollution has a severe impact on human physical and mental health. When the air quality is poor enough to cause respiratory irritation, people tend to stay home and avoid any outdoor activities. In addition, air pollution may cause mental health problems (depression and anxiety) which were associated with high crime risk. Therefore, in this study, it is hypothesized that increasing air pollution level is associated with higher indoor crime rates, but negatively associated with outdoor crime rates because it restricts people's daily outdoor activities. Three types of crimes were used for this analysis: robbery (outdoor crime), domestic violence (indoor crime), and fraud (cybercrime). The results revealed that the geographically and temporally weighted regression (GTWR) model performed best with lower AIC values. In general, in the higher population areas with more severe air pollution, local authorities should allocate more resources, extra police officers, or more training programs to help them prevent domestic violence, rather than focusing on robbery.

Removing of the Sulfur Compounds by Impregnated Polypropylene Fibers with Silver Nanoparticles-Cellulose Derivatives for Air Odor Correction

The unpleasant odor that appears in the industrial and adjacent waste processing areas is a permanent concern for the protection of the environment and, especially, for the quality of life. Among the many variants for removing substance traces, which give an unpleasant smell to the air, membrane-based methods or techniques are viable options. Their advantages consist of installation simplicity and scaling possibility, selectivity; moreover, the flows of odorous substances are direct, automation is complete by accessible operating parameters (pH, temperature, ionic strength), and the operation costs are low. The paper presents the process of obtaining membranes from cellulosic derivatives containing silver nanoparticles, using accessible raw materials (namely motion picture films from abandoned archives). The technique used for membrane preparation was the immersion precipitation for phase inversion of cellulosic polymer solutions in methylene chloride: methanol, 2:1 volume. The membranes obtained were morphologically and structurally characterized by scanning electron microscopy (SEM) and high resolution SEM (HR SEM), energy dispersive X-ray analysis (EDAX), Fourier transform infrared spectrometry (FTIR), thermal analysis (TG, ATD). Then, the membrane performance process (extraction efficiency and species flux) was determined using hydrogen sulfide (H2S) and ethanethiol (C2H5SH) as target substances.

Objectively measured association between air pollution and physical activity, sedentary behavior in college students in Beijing

The purpose of this study is to examine the association between hourly air pollution on hourly physical activity (PA) and sedentary behavior (SB) among college students in Beijing, China. The secondary aim was to examine such associations varied at specific time. A total of 340 participants were recruited from the Tsinghua University, in Beijing, China. Accelerometers provided PA measures, including moderate-to-vigorous physical activity (MVPA), walking steps, energy expenditure and sedentary time for 7 consecutive days. Corresponding air pollution data by the Beijing Municipal Ecological Environment Bureau in the closed site (Wan Liu site) in Tsinghua University were collected including average hourly air quality index (AQI) and PM_2.5 (μg/m³). Associations were estimated using linear individual fixed-effect regressions. We also conducted an air pollution risk perception survey among 2307 freshmen (76.6% males) who were enrolled in Tsinghua in 2016, and the survey was done in May 22-26, 2017. A one level increase in hourly air quality index (AQI) was associated with a reduction in 1-h PA by 0.083 (95% confidence interval [CI] = -0.137, -0.029) minutes of MVPA, 8.8 (95% CI = -15.0, -2.6) walking steps, 0.65 (95% CI = -1.03, -0.27) kcals of energy expenditure. A 10 μg/m³ increase in air pollution concentration in hourly PM_2.5 was associated with a reduction in 1-h PA by 0.021 (95% confidence interval [CI] = -0.033, -0.010) minutes of MVPA, 2.2 (95% CI = -3.5, -0.9) walking steps, 0.170 (95% CI = -0.250, -0.089) kcals of energy expenditure an increase in 1-h sedentary behavior 0.045 (0.005, 0.0845). At specific time, stronger negative associations of AQI and PM_2.5 air pollution with PA at 8 a.m., 4 p.m., 5 p.m. and 7 p.m. Similarly, stronger positive associations of 1 h AQI and PM_2.5 air pollution with SB at 8 a.m., 9 a.m., 11 a.m., and 7 p.m. A total of 94.9% participants (n = 2235) responded "yes" to air pollution change activities in the survey, which may partially explain PA change. Air pollution may discourage physical activity and increases sedentary behavior among freshman students living in Beijing, China. This is preliminary study. The impact of air pollution on physical activity and sedentary behavior at a specific time may be different.

How Social Media Exposure to Health Information Influences Chinese People's Health Protective Behavior during Air Pollution: A Theory of Planned Behavior Perspective

Haze has become one of the most life-threatening problems in China and affects over one billion Chinese people's health. Chinese people have become more dependent on receiving health information from social media, especially Weibo and WeChat, which shapes their health perceptions and behaviors. To investigate how Chinese people's exposure to health information on social media influenced their health protective behaviors in response to haze, particularly wearing a PM2.5 anti-haze mask, we conducted a longitudinal web-based survey of mainland Chinese. The results from the structural equation modeling showed that (a) attitude and descriptive norm positively mediated the relationships between using Weibo for health information and behavioral intention while descriptive norm negatively mediated the relationship between using WeChat for health information and intention, and that (b) attitude, descriptive norm, and injunctive norm significantly predicted behavioral intention and wearing mask, but perceived behavior control did not. Theoretical and practical implications are discussed.

Air pollution, physical activity and health: A mapping review of the evidence

BACKGROUND

Exposure to air pollution and physical inactivity are both significant risk factors for non-communicable diseases (NCDs). These risk factors are also linked so that the change in exposure in one will impact risks and benefits of the other. These links are well captured in the active transport (walking, cycling) health impact models, in which the increases in active transport leading to increased inhaled dose of air pollution. However, these links are more complex and go beyond the active transport research field. Hence, in this study, we aimed to summarize the empirical evidence on the links between air pollution and physical activity, and their combined effect on individual and population health.

OBJECTIVES AND METHODS

We conducted a non-systematic mapping review of empirical and modelling evidence of the possible links between exposure to air pollution and physical activity published until Autumn 2019. We reviewed empirical evidence for the (i) impact of exposure to air pollution on physical activity behaviour, (ii) exposure to air pollution while engaged in physical activity and (iii) the short-term and (iv) long-term health effects of air pollution exposure on people engaged in physical activity. In addition, we reviewed (v) public health modelling studies that have quantified the combined effect of air pollution and physical activity. These broad research areas were identified through expert discussions, including two public events performed in health-related conferences.

RESULTS AND DISCUSSION

The current literature suggests that air pollution may decrease physical activity levels during high air pollution episodes or may prevent people from engaging in physical activity overall in highly polluted environments. Several studies have estimated fine particulate matter (PM2.5) exposure in active transport environment in Europe and North-America, but the concentration in other regions, places for physical activity and for other air pollutants are poorly understood. Observational epidemiological studies provide some evidence for a possible interaction between air pollution and physical activity for acute health outcomes, while results for long-term effects are mixed with several studies suggesting small diminishing health gains from physical activity due to exposure to air pollution for long-term outcomes. Public health modelling studies have estimated that in most situations benefits of physical activity outweigh the risks of air pollution, at least in the active transport environment. However, overall evidence on all examined links is weak for low- and middle-income countries, for sensitive subpopulations (children, elderly, pregnant women, people with pre-existing conditions), and for indoor air pollution.

CONCLUSIONS

Physical activity and air pollution are linked through multiple mechanisms, and these relations could have important implications for public health, especially in locations with high air pollution concentrations. Overall, this review calls for international collaboration between air pollution and physical activity research fields to strengthen the evidence base on the links between both and on how policy options could potentially reduce risks and maximise health benefits.

Respiratory Effects of Exposure to Traffic-Related Air Pollutants During Exercise

Traffic-related air pollution (TRAP) is increasing worldwide. Habitual physical activity is known to prevent cardiorespiratory diseases and mortality, but whether exposure to TRAP during exercise affects respiratory health is still uncertain. Exercise causes inflammatory changes in the airways, and its interaction with the effects of TRAP or ozone might be detrimental, for both athletes exercising outdoor and urban active commuters. In this Mini-Review, we summarize the literature on the effects of exposure to TRAP and/or ozone during exercise on lung function, respiratory symptoms, performance, and biomarkers. Ozone negatively affected pulmonary function after exercise, especially after combined exposure to ozone and diesel exhaust (DE). Spirometric changes after exercise during exposure to particulate matter and ultrafine particles suggest a decrease in lung function, especially in patients with chronic obstructive pulmonary disease. Ozone frequently caused respiratory symptoms during exercise. Women showed decreased exercise performance and higher symptom prevalence than men during TRAP exposure. However, performance was analyzed in few studies. To date, research has not identified reliable biomarkers of TRAP-related lung damage useful for monitoring athletes' health, except in scarce studies on airway cells obtained by induced sputum or bronchoalveolar lavage. In conclusion, despite partly counteracted by the positive effects of habitual exercise, the negative effects of TRAP exposure to pollutants during exercise are hard to assess: outdoor exercise is a complex model, for multiple and variable exposures to air pollutants and pollutant concentrations. Further studies are needed to identify pollutant and/or time thresholds for performing safe outdoor exercise in cities.

Pollution, Health, and the Moderating Role of Physical Activity Opportunities

Air and water pollution have detrimental effects on health, while physical activity opportunities have a positive relationship. The purpose of this study was to explore whether physical activity opportunities moderate the relationships among air and water pollution, and measures of health. Aggregate data were collected at the county level in the United States (n = 3104). Variables included the mean daily density of fine particle matter (air pollution), reported cases of health-related drinking water violations (water pollution), subjective ratings of poor or fair health (overall health), the number of physically and mentally unhealthy (physical and mental health, respectively), and the percentage of people living in close proximity to a park or recreation facility (access to physical activity). Air and water pollution have a significant positive effect on all measures of residents’ poor health, while physical activity opportunities only have a negative effect on overall health and physical health. Access to physical activity only moderates the relationship between air pollution and all health outcomes. Since physical activity behavior can be more rapidly changed than some causes of pollution, providing the resident population with better access to physical activity can represent an effective tool in environmental health policy.

Reaction of the Organisms of Young Football Players to City Smog in the Sports Training

The essence of a sports training includes not only developing the skills necessary in a chosen sport but also particular care about athlete’s health. This issue should be taken into account especially in case of children and youth engaged in sporting activities. In the paper there are issues connected to the control of physical effort abilities in the sports training of young football players and the assessment of the reaction of the body to physical exercise in city smog conditions (the environment of the city of Kraków) and clean air conditions (the environment of the town of Głuchołazy). This paper shows that, when assessing physical effort, one can consider not nly the results of physical tests but also the reaction of the body to a given physical load. One should remember that physical load depends not only on the methods used and the range of intensity, but also on the environmental conditions, like the quality of the air. Determining the reaction of the body to physical load (performance tests), taking into account the conditions in which the training takes place, prevents overloading and sets directions for rational sports training. The analysis of the results of the study leads to three main conclusions: (1) The planning of sports training has to consider not only the methods and means of the training but also environmental factors (air pollution); (2) Physical effort in smog conditions should be done with the use of antismog face masks; (3) The arrangement of sports training (particularly for youth) should strictly take into account the environment in which the training takes place.

Cumulative exposure to air pollution and subsequent mortality among older adults in China

BACKGROUND

Research on the health effects of exposure to air pollution is growing. However, relatively little attention has been paid to the effects of long-term and cumulative exposure to air pollutants. Individual-level studies on the health consequences of air pollution in China are especially scarce. The purpose of this study is to examine the effect of cumulative exposure to sulfur dioxide (SO2), an air pollutant of particular concern in China, on all-cause mortality in older Chinese adults.

METHODS

Using a nationally representative sample of older adults in China (N = 11 199), we tracked mortality over an 11-year period (2000-11). Air pollution data were linked to respondents using provincial identifiers. To examine the effect of cumulative SO2 exposure on mortality, we employed multilevel multinomial logistic regression models that account for within subject clustering of observations over time and clustering at the province level.

RESULTS

We found that every 10-μg/m3 increase in cumulative exposure to SO2 increased the odds of death by nearly 1% (OR = 1.008; 95% CI: 1.002-1.014), controlling for province- and individual-level social and economic characteristics.

CONCLUSIONS

Our analysis shows that air pollution is a risk factor for morality in older Chinese adults. Findings suggest that stronger SO2 regulations may enhance longevity.

A deep learning and image-based model for air quality estimation

The serious threat of air pollution to human health makes air quality a focus of public attention, and effective, timely air quality monitoring is critical to pollution control and human health. This paper proposes a deep learning and image-based model for air quality estimation. The model extracts feature information from scene images captured by camera equipment and then classifies them to estimate air quality levels. A self-supervision module (SCA) is added to the model and the global context information of the feature map is used to reconstruct the features by using the interdependence between the channel maps to enhance the interdependent channel maps and improve the ability of feature representation. In addition, a high-quality outdoor air quality data set (NWNU-AQI) was compiled to facilitate the training and evaluation of the model's performance. This paper compares and analyzes AQC-Net, Support Vector Machine (SVM), and Deep Residual Network (ResNet) on NWNU-AQI. The experimental results show that AQC-Net yields more accurate results for air quality classification than other methods.

Associations between perceived environmental pollution and health-related quality of life in a Chinese adult population

BACKGROUND

Health-related quality of life (HRQoL) measures are being used in increasingly diverse populations. However, there have no known studies to date to examine the associations between perceived environmental pollution and HRQoL in a Chinese population. This study aimed to report the associations between air, water, noise pollution and HRQoL among Chinese adult population.

METHODS

A cross-sectional survey data was used from East Asian Social Survey 2010 with a sample of 3866 Chinese populations regarding environmental pollution. HRQoL was computed by SF-12 and reflected by physical and mental component summary score (PCS & MCS). Ordinary least regression analyses were used to examine associations between perceived environmental pollution and PCS and MCS scores. Models in SPSS PROCESS were selected to demonstrate the moderating and mediating effects.

RESULTS

Only considering one pollutant, perceived air pollution and perceived water pollution had significant associations with PCS and MCS scores. Perceived noise pollution had significant associations with PCS scores. Perceived air×noise, air×water, noise×water, and air×noise×water pollution had significant associations with PCS and MCS scores. Conditional (moderated) mediation showed that there were no moderating effects and mediating effects of perceived one pollutant on another pollutant.

CONCLUSIONS

Co-occurring perceived environmental pollution were mainly associated with progressive increase in PCS and MCS scores among the Chinese adult population. These results suggested that some effective policies should be carried out to improve environmental quality in Chinese adult population.

Depression in the house: The effects of household air pollution from solid fuel use among the middle-aged and older population in China

BACKGROUND

Although the adverse health effects of ambient air pollution are well documented, evidence on the depression effects of household air pollution (HAP) are scarce.

OBJECTIVES

We investigated the effects of HAP exposure from the use of solid fuel on depression using a nationally representative dataset of middle-aged and older population in China.

METHODS

By employing the propensity score matching method, we first matched the type of household fuel based on background information, including demographic characteristics, lifestyles, health status, and household economic levels. Based on the matched data, we conducted OLS and logistic regressions with cluster standard error at community level to examine the effects of household solid fuel use on depression and adjusted for potential confounders. Heterogeneous effects for vulnerable population were also considered.

RESULTS

We found a significantly higher Center for Epidemiologic Studies Depression Scale (CES-D) score and depression risk among current household solid fuel users. After matching and adjusting for potential confounders, current solid fuel users had a higher CES-D score of 0.59 (95% confidence interval [CI]: 0.31, 0.89) than clean fuel users. The OR of depression risk were 1.26 (95% CI: 1.14, 1.41). Solid fuel users had the highest CES-D scores (β = 0.99, 95% CI: 0.62, 1.36) and depression risk (OR = 1.49, 95% CI: 1.30, 1.73) for over five years. These associations were generally higher in females, participants aged 65 years and older, with a BMI ≥ 25, with low education, with low household economic levels, and those suffer from chronic diseases, including diabetes, chronic lung diseases, and cardiovascular diseases.

CONCLUSIONS

Exposure to HAP from solid fuel combustion was linked with strong depression outcomes. Findings suggested a need to strengthen public health efforts, such as controlling the social, health, and economic costs of depression by taking the physical environment, including HAP exposure, into account.

Effect of aerobic exercise and different levels of fine particulate matter (PM2.5) on pulmonary response in Wistar rats

BACKGROUND

Exposure of particulate matter of <2.5 μm (PM_2.5) has been associated with adverse respiratory and the risk of inflammation. While regular physical activity (PA) reduces the risk of many adverse health effects. This study aimed to examine the protection of exercise on adverse pulmonary health induced by PM_2.5 exposures in rats.

METHODS

80 Wistar rats were randomly divided into 8 groups: Sedentary (S), Exercise (E), Sedentary+ Low concentration PM_2.5 exposures (S + LPM), Exercise+Low concentration PM2.5 exposures (E + LPM), Sedentary+Medium concentration PM_2.5 exposures (S + MPM), Exercise+ Medium concentration PM_2.5 exposures (E + MPM), Sedentary+High concentration PM_2.5 exposures (S + HPM), and Exercise+ High concentration PM_2.5 exposures (E + HPM). The rats in all E-related groups went through 8-week aerobic interval treadmill training (5 days/week, 1 h/day). The PM-related groups of rats were exposed to different concentration PM_2.5 exposure in Beijing. After one bout of PM exposure, the pulmonary function, structure of lung tissues and several pulmonary biomarkers were observed.

RESULTS

1) Compared with S group, following changes occurred in various S + PM_2.5 exposure groups: lung tissues were seriously damaged, local bleeding, pus exudation, and inflammatory cell infiltration, as well as the decline of the SOD, CAT and GSH while the incline of Penh, Ti, Te, MDA, TNF-α and IL-1β were observed. 2) Compared with the corresponding different concentration of S + PM_2.5 exposure groups, Penh, Ti, Te, MDA, TNF-α and IL-1β were decreased and CAT and GSH were increased in related E + PM groups respectively.

CONCLUSION

In summary, the results suggest that acute PM_2.5 with different concentrations can cause different degrees of adverse effects on lung, especially in medium and high concentrations. The aerobic interval training improved the pulmonary function and impeded the lesion progression, which is due to effective in impeding the oxidative stress and inflammation.

Air pollution risks human mental health: an implication of two-stages least squares estimation of interaction effects

The study investigates the relationship between air pollution and the status of human mental health using the data of the China Migrant Dynamic Survey (CMDS), 2014. Various econometric methods were used. Particularly, the ordinary least square (OLS) was used to estimate the parametric impact of mental health. Moreover, a robustness test was used to estimate negative impact of air pollution on mental health. Results found that air pollution significantly increased psychological disorder. The concentration of PM2.5 in the air leads to higher prominence of the four negative emotions such as nervous, depression, powerless, and restless or fidgety. After introducing the instrumental variable to solve the endogenous problem, the impact of air pollution on the level of the mental illnesses was still significant and negative. Results are also evident that air pollution has heterogeneity to the negative status of residents' mental health. Specifically, it has a significant and negative impact on women, rural and urban population, and middle- and low-income groups. The study results suggest that the government must have to revise the environmental regulation policy reduce the negative impact on human health.

Deciphering the stroke-built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention

Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyle-associated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings. Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model. The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. To offset the adverse effects of increasingly dense urban environments, more efforts should also be made to provide better access to the identified salubrious resources. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.

Impact of ambient air pollution on physical activity and sedentary behavior in China: A systematic review

This study systematically reviewed scientific evidence linking ambient air pollution to physical activity and sedentary behavior in China. A keyword and reference search was conducted in PubMed, Web of Science, and the Cochrane Library. Predetermined selection criteria included-study designs: interventions or experiments, retrospective or prospective cohort studies, cross-sectional studies, and case-control studies; subjects: people of all ages; exposures: specific air pollutants and/or overall air quality; outcomes: physical activity and/or sedentary behavior; and country/area: mainland China. Ten studies met the selection criteria and were included in the review. Six adopted a cross-sectional design and the remaining four adopted a prospective cohort design. Four studies assessed a specific air pollutant namely particulate matter with diameter <2.5 μg/m3 (PM2.5), whereas the remaining six focused on overall air quality, defined using air quality indexes. Decline in overall air quality and increase in PM2.5 concentration were found to be associated with reduced daily/weekly duration of outdoor leisure-time and/or transportation-related physical activity such as walking but increased duration of daytime/nighttime sleeping among Chinese residents. In contrast, evidence linking overall air quality and PM2.5 concentration to sedentary behavior remains mixed and inconclusive. In conclusion, preliminary evidence indicates that ambient air pollution impacts Chinese residents' daily physical activity-related behaviors. Future studies adopting objective measures of physical activity and a longitudinal or experimental study design are warranted to examine the impact of air pollution on sensitive sub-populations such as children, older adults and people with pre-existing conditions, and in locations outside China.

Spatiotemporal Characteristics of Air Quality across Weifang from 2014-2018

Air pollution has become a severe threat and challenge in China. Focusing on air quality in a heavily polluted city (Weifang Cty), this study aims to investigate spatial and temporal distribution characteristics of air pollution and identify the influence of weather factors on primary pollutants in Weifang over a long period from 2014-2018. The results indicate the annual Air quality Index (AQI) in Weifang has decreased since 2014 but is still far from the standard for excellent air quality. The primary pollutants are O3 (Ozone), PM10 (Particles with aerodynamic diameter ≤10 µm), and PM2.5 (Particles with aerodynamic diameter ≤10 µm); the annual concentrations of PM10 and PM2.5 show a significant reduction but that of O3 is basically unchanged. Seasonally, PM10 and PM2.5 show a U-shaped pattern, while O3 exhibits inverted U-shaped variations, and different pollutants also present different characteristics daily. Spatially, O3 exhibits a high level in the central region and a low level in the rural areas, while PM10 and PM2.5 are high in the northwest and low in the southeast. Additionally, the concentration of pollutants is greatly affected by meteorological factors, with PM2.5 being negatively correlated with temperature and wind speed, while O3 is positively correlated with the temperature. This research investigated the spatiotemporal characteristics of the air pollution and provided important policy advice based on the findings, which can be used to mitigate air pollution.

Cross-sectional associations between long-term exposure to particulate matter and depression in China: The mediating effects of sunlight, physical activity, and neighborly reciprocity

BACKGROUND

Although numerous studies have speculated about the direct and indirect linkage between long-term air pollution (i.e., PM_2.5) concentrations and mental health in developed countries, evidence for developing countries is limited. Our aim was to examine the mediation effects of sunlight, physical activity, and neighborly reciprocity on the association between air pollution and depression.

METHODS

In a sample of 20,861 individuals in China in 2016, depression was measured using the Center for Epidemiological Studies Depression screener (CES-D) and linked to annual city-wide PM_2.5 data. We used multilevel regression models to assess the associations between depressive symptoms and PM_2.5 and tested the mediation of sunlight, physical activity, and neighborly reciprocity in this association. Propensity score matching was used to evaluate whether selection bias may affect the association between CES-D scores and PM_2.5.

RESULTS

PM_2.5 concentration was positively associated with depression symptoms. All mediators were significantly and negatively associated with PM_2.5. Our mediation analyses indicated that physical activity, neighborly reciprocity, and exposure to sunlight are important mechanisms through which PM_2.5 affects depressive symptoms.

LIMITATIONS

The limitations of the present study were the cross-sectional nature of the data and modifiable areal unit problem.

CONCLUSIONS

Our findings suggest not only that PM_2.5 is directly associated with depression, but also that this association seems to be partially mediated by physical activity, neighborly reciprocity, and sunlight.

Blood pressure and pulmonary health effects of ozone and black carbon exposure in young adult runners

Physical activity has been shown to promote health and well-being, however, exercising in environments with high level of air pollution might increase the risk of cardio-respiratory impairments. In this crossover study, we constructed linear mixed models to investigate the impact of short-term exposure to black carbon (BC) and ozone on blood pressure and pulmonary functions among 30 healthy adult runners after 30-minute run on a clean and polluted route on separate days in August 2015 in Hong Kong. Runners were on average 20.6 years old, with mean body mass index of 20.3 kg/m². Air pollution concentrations were higher in the polluted route than in the clean route, with the highest difference in BC (5.4 μg/m³ versus 1.3 μg/m³). In single-pollutant models, no significant association was found between air pollution and changes in blood pressures, forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow and fractional exhaled nitric oxide, after adjusting for gender, type of route, temperature and relative humidity. When further adjusting for both BC and ozone simultaneously, increment in BC became statistically significantly associated with increase in systolic blood pressure (relative risk = 3.18; 95% CI: 0.24, 6.13) after running exercise. Stratified analysis further shows that the significant adverse association between systolic blood pressure and BC was only observed in the polluted route (e.g., relative risk = 4.51, 95% CI: 0.75, 8.27 in two-pollutant). Our finding of BC is consistent with existing literature, while further studies with greater sample size and longer exposure time are needed to investigate the effects of ozone to cardio-respiratory functions in runners. Given that exercise has clear health benefits, one should consider ways to minimize the air pollution exposure.

Public awareness and support for environmental protection-A focus on air pollution in peninsular Malaysia

As in many nations, air pollution linked to rapid industrialization is a public health and environmental concern in Malaysia, especially in cities. Understanding awareness of air pollution and support for environmental protection from the general public is essential for informing governmental approaches to dealing with this problem. This study presents a cross-sectional survey conducted in the Klang Valley and Iskandar conurbations to examine urban Malaysians’ perception, awareness and opinions of air pollution. The survey was conducted in two languages, English and Malay, and administered through the online survey research software, Qualtrics. The survey consisted of three sections, where we collected sociodemographic information, information on the public perception of air quality and the causes of air pollution, information on public awareness of air pollution and its related impacts, and information on attitudes towards environmental protection. Of 214 respondents, over 60% were positive towards the air quality at both study sites despite the presence of harmful levels of air pollution. The air in the Klang Valley was perceived to be slightly more polluted and causing greater health issues. Overall, the majority of respondents were aware that motor vehicles represent the primary pollution source, yet private transport was still the preferred choice of transportation mode. A generally positive approach towards environmental protection emerged from the data. However, participants showed stronger agreement with protection actions that do not involve individual effort. Nonetheless, we found that certain segments of the sample (people owning more than three vehicles per household and those with relatives who suffered from respiratory diseases) were significantly more willing to personally pay for environmental protection compared to others. Implications point to the need for actions for spreading awareness of air pollution to the overall population, especially with regards to its health risks, as well as strategies for increasing the perception of behavioural control, especially with regards to motor vehicles’ usage.

Association between ambient air pollution and hospital admission for epilepsy in Eastern China

BACKGROUND

We aimed to study the short-term association between air pollutants and hospitalization for epilepsy in 47 hospitals from 10 cities in eastern China.

METHOD

We identified hospital epilepsy admissions in 2014 and 2015. A conditional Poisson regression model was used to examine the association between air pollutants and hospital admission, with temperature and relative humidity adjusted using the natural spline (ns) function. Pollutants included sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and particulate matter (PM). The association was stratified by sex, age, and geographic region in single-pollutant and two-pollutant models.

RESULTS

An interquartile (IQR) increase of NO₂ and CO on the concurrent day is correlated with an increased admission of 2.0% (0.5%, 3.6%) and 1.1% (0.1%, 2.1%), respectively. The association is stronger in children (≤18 years) and in northern China, but did not vary with sex. A positive association was also observed on the previous day for CO [1.5%, 95% confidence interval (CI): 0.3%, 2.6%], NO₂ (2.5%, 95% CI: 0.6%, 4.3%), and PM_2.5 (1.32%, 95% CI: 0.16%, 2.48%). Moving average concentration of 7 days for all pollutants was associated with decreased admission (CO: -1.29%, NO₂: -0.4.69%, SO₂:-2.12%, PM_2.5:-0.98%, PM₁₀:-1.70%).

CONCLUSION

Exposures to NO₂ and CO on concurrent days, and PM_2.5 on the previous day, are associated with increased epilepsy hospitalization, whereas cumulative exposure appeared protective.

Impact of Air Pollution on Sedentary Behavior: A Cohort Study of Freshmen at a University in Beijing, China

Human populations worldwide have experienced substantial environmental issues in part due to air pollution, notably in China. Gaps in the scientific literature remain regarding the relationship between air pollution and sedentary behavior among young adults in China. The purpose of this study is to examine the effect of air pollution on sedentary behavior among college students living in Beijing, China. We conducted follow-up health surveys on 12,174 freshman students enrolled at Tsinghua University from 2013 to 2017. Sedentary behavior was measured using the short version of the International Physical Activity Questionnaire (IPAQ). Corresponding air pollution data measured by the Ministry of Environmental Protection of the People's Republic of China were collected to include the average hourly air quality index (AQI), PM_2.5, PM₁₀, and NO₂ (µg/m³). The data were analyzed using linear individual fixed-effect regressions. An increase in air pollution concentration of one standard deviation in AQI, PM_2.5, PM₁₀, and NO₂ was associated with an increase in weekly total hours of sedentary behavior by 7.35 (95% confidence interval (CI) = 5.89, 8.80), 6.24 (95% CI = 5.00, 7.49), 6.80 (95% CI = 5.46, 8.15), and 7.06 (95% CI = 5.65, 8.47), respectively. In the presence of air pollution, women students tended to increase their sedentary behavior more than men. Air pollution increases sedentary behavior among freshman students living in Beijing, China. Replication of this study is warranted among various populations within China.

Stochastic Modelling of Air Pollution Impacts on Respiratory Infection Risk

The impact of air pollution on people's health and daily activities in China has recently aroused much attention. By using stochastic differential equations, variation in a 6 year long time series of air quality index (AQI) data, gathered from air quality monitoring sites in Xi'an from 15 November 2010 to 14 November 2016 was studied. Every year the extent of air pollution shifts from being serious to not so serious due to alterations in heat production systems. The distribution of such changes can be predicted by a Bayesian approach and the Gibbs sampler algorithm. The intervals between changes in a sequence indicate when the air pollution becomes increasingly serious. Also, the inflow rate of pollutants during the main pollution periods each year has an increasing trend. This study used a stochastic SEIS model associated with the AQI to explore the impact of air pollution on respiratory infections. Good fits to both the AQI data and the numbers of influenza-like illness cases were obtained by stochastic numerical simulation of the model. Based on the model's dynamics, the AQI time series and the daily number of respiratory infection cases under various government intervention measures and human protection strategies were forecasted. The AQI data in the last 15 months verified that government interventions on vehicles are effective in controlling air pollution, thus providing numerical support for policy formulation to address the haze crisis.

The Relationship between Air Pollution and Depression in China: Is Neighbourhood Social Capital Protective?

There is increasing evidence from the developed world that air pollution is significantly related to residents’ depressive symptoms; however, the existence of such a relationship in developing countries such as China is still unclear. Furthermore, although neighbourhood social capital is beneficial for health, whether it is a protective factor in the relationship between health and environment pollution remains unclear. Consequently, we examined the effects of cities’ PM_2.5 concentrations on residents’ depressive symptoms and the moderating effects of neighbourhood social capital, using data from the 2016 wave of China Labourforce Dynamics Survey and the real-time remote inquiry website of Airborne Fine Particulate Matter and Air Quality Index. Results showed that PM_2.5 concentrations and neighbourhood social capital may increase and decrease respondents’ depressive symptoms, respectively. Notably, neighbourhood social capital decreased the negative effect of PM_2.5 concentrations on respondents’ depressive symptoms. These analyses contributed to the understanding of the effect of air pollution on mental health in China and confirmed that neighbourhood social capital were protective factors in the relationship between health and environment hazards.

Implementation of Brain Breaks® in the Classroom and Effects on Attitudes toward Physical Activity in a Macedonian School Setting

The purpose of this study was to explore the effects of Brain Break^® activities on interest and motivation for physical activity among schoolchildren and the contribution of such activities on learning for health and holistic development. The study sample was comprised of 283 participants, primary school students from 3rd to 5th grades from two public schools in the Republic of Macedonia. Six experimental and six control groups were included in the study. Interventions in classroom settings—based Brain Break^® video exercises were introduced in the experimental group during a period of three months. Students’ attitudes toward physical activity were tested using a self-report survey instrument entitled “Attitudes toward Physical Activity Scale (APAS)” before and after intervention. Applied factor analyses were completed and the results of these analysis support APAS validity and the successful use of this application in the measurement of the learning experience, self-awareness, self-efficacy, and self-confidence in developing physical fitness. Learning was enhanced by using video exercises. Information presented in this paper is meaningful for the promotion of better exercise habits and the holistic approach to better health by using personal motivation and motivation provided by others. The results from repeated ANCOVA suggest positive effects of the applied Brain Break^® video exercises as an interventional program. The study confirms the effect of application of Brain Break^® video exercises on children’s attitudes for physical activity, motivation for PA, internalization of movement habits as personal good.

Health status, mental health and air quality: evidence from pensioners in Europe

Environmental quality is an important determinant of individuals' well-being and one of the main concerns of the governments is the improvement on air quality and the protection of public health. This is especially the case of sensitive demographic groups, such as the old aged people. However, the question this study attempts to answer is how do individuals value the effects on the environment. The study explores the effects of old and early public pension schemes, as well as the impact of air pollution on health status of retired citizens. The empirical analysis relies on detailed micro-level data derived from the Survey of Health, Ageing and Retirement in Europe (SHARE). As proxies for health, we use the general health status and the Eurod mental health indicator. We examine two air pollutants: the sulphur dioxide (SO₂) and ground-level ozone (O₃). Next, we calculate the marginal willingness-to-pay (MWTP) which shows how much the people are willing to pay for improvement in air quality. We apply various quantitative techniques and approaches, including the fixed effects ordinary least squares (OLS) and the fixed effects instrumental variables (IV) approach. The last approach is applied to reduce the endogeneity problem coming from possible reverse causality between the air pollution, pensions and the health outcomes. For robustness check, we apply also a structural equation modelling (SEM) which is proper when the outcomes are latent variables. Based on our favoured IV estimates and the health status, we find that the MWTP values for one unit decrease in SO₂ and O₃ are respectively €221 and €88 per year. The respective MWTP values using the Eurod measure are €155 and €68. Overall, improvement of health status implies reduction in health expenditures, and in previous literature, ageing has been traditionally considered the most important determinant. However, this study shows that health lifestyle and socio-economic status, such as education and marital status, are more important, and furthermore, air pollution cannot be ignored in the agenda of policy makers.

Exposure to air pollution and self-reported effects on Chinese students: A case study of 13 megacities

Air pollution causes severe physical and psychological health complications. Considering China's continuously-deteriorating air quality, this study aimed to assess the self-reported effects of air pollution on the behavior and physical health of the students of 13 densely populated cities, and their awareness, practices, and perception of air pollution and its associated public health risks. A detailed, closed-ended questionnaire was administered to 2100 students from 54 universities and schools across China. The questionnaire, which had 24 questions, was categorized into four sections. The first two sections were focused on air pollution-associated behavior and psychology, and physical effects; while the final two sections focused on the subjects' awareness and perceptions, and practices and concerns about air pollution. The respondents reported that long-term exposure to air pollution had significantly affected their psychology and behavior, as well as their physical health. The respondents were aware of the different adverse impacts of air pollution (respiratory infections, allergies, and cardiovascular problems), and hence had adopted different preventive measures, such as the use of respiratory masks and glasses or goggles, regularly drinking water, and consuming rich foods. It was concluded that air pollution and haze had negative physical and psychological effects on the respondents, which led to severe changes in behavior. Proper management, future planning, and implementing strict environmental laws are suggested before this problem worsens and becomes life-threatening.

Relationship Between Air Quality and Outdoor Exercise Behavior in China: a Novel Mobile-Based Study

PURPOSE

Based on data collected from an exercise app, the study aims to provide empirical evidence on the relationship between air quality and patterns of outdoor exercise in China.

METHODS

Objective outdoor exercise data spanning 160 days were collected from 153 users of an exercise app, Tulipsport in China. Each exercise mode (running, biking, and walking, respectively) was organized into five air quality categories based on Air Quality Index (AQI): excellent, good, mild pollution, moderate pollution, and serious pollution. Key parameters of each app user were calculated and analyzed: the total number of exercise bouts, the average duration, and the average distance of each exercise mode in each air quality category.

RESULTS

Multivariate analyses of variance indicate that the users were less likely to participate in outdoor running, biking, and walking (F = 24.16, p < .01, Wilk's Λ = 0.64) as levels of air pollution increased. However, there is no difference in terms of average distance and duration of exercise across different air pollution categories.

CONCLUSIONS

People's participation in outdoor exercise is impeded by air pollution severity, but they stick to their exercise routines once exercise is initiated. Although people should protect themselves from health damages caused by exercising under pollution, the decreases in physical activity associated with air pollution may also pose an indirect risk to public health. The interactive relationship between air quality, exercise, and health warrants more empirical and interdisciplinary explorations.

Association of polycyclic aromatic hydrocarbons exposure with atherosclerotic cardiovascular disease risk: A role of mean platelet volume or club cell secretory protein

BACKGROUND

Inflammation may play an important role in the association between exposure to polycyclic aromatic hydrocarbons (PAHs) and atherosclerotic cardiovascular disease (ASCVD) risk. However, the underlying mechanisms remain unclear.

OBJECTIVES

To investigate the association of PAHs exposure with ASCVD risk and effects of mean platelet volume (MPV) or Club cell secretory protein (CC16) on the association.

METHODS

A total of 2022 subjects (689 men and 1333 women) were drawn from the baseline Wuhan residents of the Wuhan-Zhuhai Cohort study. Data on demography and the physical examination were obtained from each participant. Urinary monohydroxy PAH metabolites (OH-PAHs) levels were measured by a gas chromatography-mass spectrometry. We estimated the association between each OH-PAHs and the 10-year ASCVD risk or coronary heart disease (CHD) risk using logistic regression models, and further analyze the mediating effect of MPV or plasma CC16 on the association by using structural equation modeling.

RESULTS

The results of multiple logistic regression models showed that some OH-PAHs were positively associated with ASCVD risk but not CHD risk, including 2-hydroxyfluoren (β = 1.761; 95% CI: 1.194-2.597), 9-hydroxyfluoren (β = 1.470; 95% CI: 1.139-1.898), 1-hydroxyphenanthrene (β = 1.480; 95% CI: 1.008-2.175) and ΣOH-PAHs levels (β = 1.699; 95% CI: 1.151-2.507). The analysis of structural equation modeling shows that increased MPV and increased plasma CC16 levels contributed 13.6% and 15.1%, respectively, to the association between PAHs exposure and the 10-year ASCVD risk (p < 0.05).

CONCLUSIONS

Exposure to PAHs may increase the risk of atherosclerosis, which was partially mediated by MPV or CC16.

Physical Activity, a Critical Exposure Factor of Environmental Pollution in Children and Adolescents Health Risk Assessment

It is an extremely urgent problem that physical fitness promotion must face not only the increasing air pollution but also the decline of physical activity level of children and adolescents worldwide at present, which is the major reason that forms an inactive lifestyle and does harm to adolescents’ health. Thus, it is necessary to focus on the exposure factor in environmental health risk assessment (EHRA) which conducts supervision of environmental pollution and survey of adolescents’ activity patterns according to the harmful characteristics of air pollutant and relationship between dose and response. Some countries, such as USA, Canada and Australia, regard both respiratory rate and physical activity pattern as main exposure factors for adolescents in both air pollution health risk assessment and exercise risk assessment to forecast a safe exposing condition of pollutant for adolescents while they are doing exercise outdoors. In addition, it suggests that the testing indexes and testing methods of these two exposure factors, such as investigating the time of daily physical activity, strength, and characteristic of frequency, help to set up the quantitative relationship between environmental pollution index and the time, strength, frequency of daily activities, and formulate children’s and adolescents’ activity instructions under different levels of environmental pollutions. As smog becomes increasingly serious at present, it is meaningful to take physical activity as a critical composition of exposure factor and establish physical activity guideline, so as to reduce the risk of air pollution, and promote physical health of children and adolescents effectively.

The association between ambient fine particulate air pollution and physical activity: a cohort study of university students living in Beijing

Background

Air pollution has become a substantial environmental issue affecting human health and health-related behavior in China. Physical activity is widely accepted as a method to promote health and well-being and is potentially influenced by air pollution. Previous population-based studies have focused on the impact of air pollution on physical activity in the U.S. using a cross-sectional survey method; however, few have examined the impact on middle income countries such as China using follow-up data. The purpose of this study is to examine the impact of ambient fine particulate matter (PM_2.5) air pollution on physical activity among freshmen students living in Beijing by use of follow-up data.

Methods

We conducted 4 follow-up health surveys on 3445 freshmen students from Tsinghua University from 2012 to 2013 and 2480 freshmen completed all 4 surveys. Linear individual fixed-effect regressions were performed based on repeated-measure physical activity-related health behaviors and ambient PM_2.5 concentrations among the follow-up participants.

Results

An increase in ambient PM_2.5 concentration by one standard deviation (44.72 μg/m³) was associated with a reduction in 22.32 weekly minutes of vigorous physical activity (95% confidence interval [CI] = 24.88–19.77), a reduction in 10.63 weekly minutes of moderate physical activity (95% CI = 14.61–6.64), a reduction in 32.45 weekly minutes of moderate to vigorous physical activity (MVPA) (95% CI = 37.63–27.28), and a reduction in 226.14 weekly physical activity MET-minute scores (95% CI = 256.06–196.21). The impact of ambient PM_2.5 concentration on weekly total minutes of moderate physical activity tended to be greater among males than among females.

Conclusions

Ambient PM_2.5 air pollution significantly discouraged physical activity among Chinese freshmen students living in Beijing. Future studies are warranted to replicate study findings in other Chinese cities and universities, and policy interventions are urgently needed to reduce air pollution levels in China.

Impact of ambient air pollution on physical activity among adults: a systematic review and meta-analysis

AIMS

This study systematically reviewed literature regarding the impact of ambient air pollution on physical activity among children and adults.

METHODS

Keyword and reference search was conducted in PubMed and Web of Science to systematically identify articles meeting all of the following criteria - study designs: interventions or experiments, retrospective or prospective cohort studies, cross-sectional studies, and case-control studies; subjects: adults; exposures: specific air pollutants and overall air quality; outcomes: physical activity and sedentary behaviour; article types: peer-reviewed publications; and language: articles written in English. Meta-analysis was performed to estimate the pooled effect size of ambient PM_2.5 air pollution on physical inactivity.

RESULTS

Seven studies met the inclusion criteria. Among them, six were conducted in the United States, and one was conducted in the United Kingdom. Six adopted a cross-sectional study design, and one used a prospective cohort design. Six had a sample size larger than 10,000. Specific air pollutants assessed included PM_2.5, PM₁₀, O₃, and NO_x, whereas two studies focused on overall air quality. All studies found air pollution level to be negatively associated with physical activity and positively associated with leisure-time physical inactivity. Study participants, and particularly those with respiratory disease, self-reported a reduction in outdoor activities to mitigate the detrimental impact of air pollution. Meta-analysis revealed a one unit (μg/m³) increase in ambient PM_2.5 concentration to be associated with an increase in the odds of physical inactivity by 1.1% (odds ratio = 1.011; 95% confidence interval = 1.001, 1.021; p-value < .001) among US adults.

CONCLUSIONS

Existing literature in general suggested that air pollution discouraged physical activity. Current literature predominantly adopted a cross-sectional design and focused on the United States. Future studies are warranted to implement a longitudinal study design and evaluate the impact of air pollution on physical activity in heavily polluted developing countries.

Body weight status and health-care expenditure among university retirees in Beijing, China

OBJECTIVE

This study examined the impact of overweight and obesity on health-care expenditure among university retirees in Beijing, China.

METHODS

Annual health surveys of retirees were conducted at Tsinghua University during 2011-2016. Individual random-effect regressions were performed to estimate incremental health-care expenditures attributable to overweight/obesity, adjusting for various individual characteristics.

RESULTS

Compared to their normal-weight counterparts, obesity was associated with an increase in annual out-of-pocket expenditure on outpatient care by 27%, inpatient care 19% and medication 15%, and an increase in annual total out-of-pocket health-care expenditure by 33%. Overweight was associated with an increase in annual out-of-pocket expenditure on inpatient care by 13%, and an increase in annual total out-of-pocket health-care expenditure by 13%. The impact of obesity on health-care expenditure was statistically significant among men but not women.

CONCLUSION

Overweight, and obesity in particular, was associated with substantial increases in out-of-pocket health-care expenditures among Chinese older adults.

No seasonal variation in physical activity of Han Chinese living in Beijing

Background

Physical activity (PA) is widely acknowledged to be beneficial to health and wellbeing, and is potentially influenced by a variety of environmental factors such as ambient temperature, weather conditions and air pollution levels. Since these factors vary seasonally, physical activity participation may also respond seasonally. Current population studies to profile physical activity often sample individuals only once, and this may result in biased estimates if there is strong seasonal variation.

Methods

We conducted a study of 40 Han Chinese adults living in Beijing using GT3X accelerometers. We measured PA levels every two months across a complete year, while simultaneously monitoring ambient temperatures and air pollution levels. Average hourly vector magnitude (VM) and percentage time spent at each PA intensity (sedentary to light, moderate, vigorous and very vigorous) were measured. General Linear models (GLMs) were used to explore the effects of time of day, temperature and PM 2.5 levels on PA. One way ANOVA was used to test whether there were seasonal differences in body weight and body fatness.

Results

The main factors influencing activity levels were the time of day and individual characteristics including age and body fatness, but there was no significant difference between the months. In addition, there was no significant impact of either ambient temperature or air pollution levels (PM2.5). There were also no significant differences over the year in the time spent at sedentary-light, moderate and very vigorous PA levels, but for vigorous PA level which occupied less than 0.5% daily physical activity, both month and individual were significant factors.

Conclusions

The relatively constant pattern of urban daily life, independent of time of year, may override the potential impacts of environmental factors that would be anticipated to impact PA levels. These subjects did not specifically avoid activity coincident with elevated air pollution levels (PM2.5). Single week long measurements of physical activity could provide a representative measurement of the physical active levels in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0503-1) contains supplementary material, which is available to authorized users.

Developmental origins of type 2 diabetes: a perspective from China

There has been a marked increase in the prevalence of diabetes in Asia, including China, over the last few decades. While the increased prevalence of diabetes has often been attributed to the nutritional transition associated with recent economic development, emerging data suggest that early-life exposures also play a major role in shaping developmental trajectories, and contributes to alter an individual's susceptibility to diabetes and other non-communicable diseases (NCDs). Early-life exposures such as in utero exposure to undernutrition has been consistently linked with later risk of diabetes and obesity. Furthermore, in utero exposure to maternal hyperglycemia, maternal obesity and excess gestational weight gain are all linked with increased childhood obesity and later risk of diabetes. Emerging data have also highlighted the potential link between early-feeding practices, the role of one-carbon metabolism in metabolic programming and endocrine disrupting chemicals (EDCs) with later risk of diabetes. These different developmental exposures may all be highly relevant to the current epidemic of diabetes in China. For example, the prevalence of gestational diabetes has increased markedly over the last two decades, and may contribute to the diabetes epidemic by driving macrosomia, childhood obesity and later risk of diabetes. In order to address the current burden of diabetes, a lifecourse perspective, incorporating multisectoral efforts from public health policy down to the individuals, will be needed. Several major initiatives have been launched in China as part of its national plans for NCD prevention and treatment, and the experience from these efforts would be invaluable.

Living near the port area is associated with physical inactivity and sedentary behavior

CONTEXT AND OBJECTIVE:

The impact of the port of Santos, Brazil, on the population's health is unknown. We aimed to evaluate the association between living near the port area and physical inactivity and sedentary behavior.

DESIGN AND SETTING:

Cross-sectional study developed at a university laboratory and a diagnostic clinic.

METHODS:

553 healthy adults were selected and their level of physical activity in daily life was assessed using accelerometers. Multiple linear and logistic regressions were performed using physical inactivity and sedentary behavior as the outcomes and living near the port area as the main risk factor, with adjustments for the main confounders.

RESULTS:

Among all the participants, 15% were resident near the port area. They took 699 steps/day and presented, weekly, 2.4% more sedentary physical activity, 2.0% less time in standing position and 0.9% more time lying down than residents of other regions. Additionally, living near the port area increased the risk of physical inactivity by 2.50 times and the risk of higher amounts of sedentary behavior (≥ 10 hours/day) by 1.32 times.

CONCLUSION:

Living near the port of Santos is associated with physical inactivity and higher sedentary behavior among adults, regardless of confounders. The reasons for this association should be investigated in longitudinal studies.

Air Pollution and Mortality in China

Ambient air pollution has been an important environmental issue in most areas of China. This chapter summarized the mortality effects of short-term and long-term exposures to various air pollutants among Chinese population. The literature review identified sufficient information to support significant short-term mortality effects of various air pollutants from time series analyses and case-crossover studies, such as PM₁₀, PM_2.5, SO₂, NO₂, and O₃. On the other hand, though the literature review suggested a positive effect of long-term exposure to air pollution on mortality and lung cancer risk, the evidence has been limited among Chinese population, indicating that more studies, especially cohort studies, are warranted.

Physical activity among older Chinese adults living in urban and rural areas: A review

With an increase in rural-to-urban migration, a rapidly aging population, and the rising risk of developing noncommunicable diseases in China, it is important to understand the epidemiology of physical activity (PA) and health in the context of disease prevention and population health. Despite its public health importance, there is a significant lack of knowledge about PA in older Chinese adults that may hamper primary prevention efforts of health promotion in an increasingly aging population. To fill this gap, this article presents a narrative review of PA in the older Chinese adult population with a special focus on residential settings (i.e., urban and rural). Using existing studies, the review examines overall PA patterns and their correlates and discusses public health implications and future research. Although there are some preliminary indications of urban and rural differences in PA in the aging population in China, continued research efforts are needed to facilitate primary prevention efforts aimed at reducing noncommunicable diseases and promoting an active lifestyle among the largest population of older people in the world.

Physical activity and health in the presence of China's economic growth: Meeting the public health challenges of the aging population

Three decades of rapid economic development in China have not only benefited millions of Chinese by improving their living standards but have also dramatically increased the number of people who are part of the country's aging population. However, economic growth has not been accompanied by sufficient attention given to important public health issues, including an increase in the incidence of chronic diseases and a decline in physical activity (PA) that comes with an aging population. The rapid growth in China's older population will soon exert an impact on the nation's economy, population health status, and health behaviors, and will increase stress on its healthcare system. This review article provides a broad perspective on the impact of rapid economic development, industrialization, and urbanization on health-related behaviors, with a specific focus on PA among older adults. Specifically, the article offers an overview of the demographic context, significant public health challenges, evidence on PA and exercise interventions, and knowledge gaps and future directions for research.