Effects on respiratory health of a reduction in air pollution from vehicle exhaust emissions

Investigating the impact of London's ultra low emission zone on children's health: children's health in London and Luton (CHILL) protocol for a prospective parallel cohort study

BACKGROUND

Air pollution harms health across the life course. Children are at particular risk of adverse effects during development, which may impact on health in later life. Interventions that improve air quality are urgently needed both to improve public health now, and prevent longer-term increased vulnerability to chronic disease. Low Emission Zones are a public health policy intervention aimed at reducing traffic-derived contributions to urban air pollution, but evidence that they deliver health benefits is lacking. We describe a natural experiment study (CHILL: Children's Health in London and Luton) to evaluate the impacts of the introduction of London's Ultra Low Emission Zone (ULEZ) on children's health.

METHODS

CHILL is a prospective two-arm parallel longitudinal cohort study recruiting children at age 6-9 years from primary schools in Central London (the focus of the first phase of the ULEZ) and Luton (a comparator site), with the primary outcome being the impact of changes in annual air pollutant exposures (nitrogen oxides [NOx], nitrogen dioxide [NO2], particulate matter with a diameter of less than 2.5micrograms [PM2.5], and less than 10 micrograms [PM10]) across the two sites on lung function growth, measured as post-bronchodilator forced expiratory volume in one second (FEV1) over five years. Secondary outcomes include physical activity, cognitive development, mental health, quality of life, health inequalities, and a range of respiratory and health economic data.

DISCUSSION

CHILL's prospective parallel cohort design will enable robust conclusions to be drawn on the effectiveness of the ULEZ at improving air quality and delivering improvements in children's respiratory health. With increasing proportions of the world's population now living in large urban areas exceeding World Health Organisation air pollution limit guidelines, our study findings will have important implications for the design and implementation of Low Emission and Clean Air Zones in the UK, and worldwide.

CLINICALTRIALS

GOV: NCT04695093 (05/01/2021).

Health Equity Impact Assessment Related to Air Pollution Reduction

Despite considerable improvements in terms of prevention, management, and regulation, air pollution remains a leading environmental health issue worldwide [...].

Urban Air Quality Assessment by Fusing Spatial and Temporal Data from Multiple Study Sources Using Refined Estimation Methods

In urban environmental management and public health evaluation efforts, there is an urgent need for fine-grained urban air quality monitoring. However, the high price and sparse distribution of air quality monitoring equipment make it difficult to develop effective and comprehensive fine-scale monitoring at the city scale. This has also led to air quality estimation methods based on incomplete monitoring data, which lack the ability to detect urban air quality differences within a neighborhood. To address this problem, this study proposes a refined urban air quality estimation method that fuses multisource spatio-temporal data. Based on the fact that urban air quality is easily affected by social activities, this method integrates meteorological data with urban social activity data to form a comprehensive environmental data set. It uses the spatio-temporal feature extraction model to extract the multi-source spatio-temporal features of the comprehensive environmental data set. Finally, the improved cascade forest algorithm is used to fit the relationship between the multisource spatio-temporal features and the air quality index (AQI) to construct an air quality estimation model, and the model is used to estimate the hourly PM2.5 index in Beijing on a 1 km × 1 km grid. The results show that the estimation model has excellent performance, and its goodness-of-fit (R2) and root mean square error (RMSE) reach 0.961 and 17.47, respectively. This method effectively achieves the assessment of urban air quality differences within a neighborhood and provides a new strategy for preventing information fragmentation and improving the effectiveness of information representation in the data fusion process.

Urban air pollution control policies and strategies: a systematic review

A wide range of policies, strategies, and interventions have been implemented to improve air quality all over the world. This systematic review comprehensively appraises the policies and strategies on air pollutants controls enacted in different countries, worldwide. Three databases, Web of Science, PubMed and Scopus, were used for the search. After screening, a total of 114 eligible manuscripts were selected from 2219 documents for further analysis. Selected articles were divided into two categories: (1) articles focusing on introducing the policies and strategies enacted for controlling air pollution in different countries, and (2) articles which focused on different policies and strategies to control one or more specific pollutants. In the former one, urban air pollution control strategies and policies were divided into four categories, namely, general strategies and policies, transportation, energy, and industry. In case of latter category, policies and strategies focused on controlling six pollutants (PM, SO₂, NO₂, VOC_S, O₃ and photochemical smog). The results indicated that, the most common policies and strategies enacted in most countries are pertinent to the transportation sector. Changing energy sources, in particular elimination or limited use of solid fuels, was reported as an effective action by governments to reduce air pollution. Overall, most policies enacted by governments can be divided into three general categories: (a) incentive policies such as implementing a free public transportation program to use fewer private cars, (b) supportive policies such as paying subsidies to change household fuels, and (c) punitive policies such as collecting tolls for cars to enter the congestion charging areas. Depending on the circumstances, these policies are implemented alone or jointly. In addition to the acceptance of international agreements to reduce air pollution by governments, greater use of renewable energy, clean fuels, and low-pollution or no-pollution vehicles such as electric vehicles play an important role in reducing air pollution.

Cross-Regional Highway Built through a City Centre as an Example of the Sustainable Development of Urban Transport

Sustainable development requires ensuring the mobility of residents and must not cause deterioration of the quality of the environment in the selected area. The purpose of this study is to verify if the construction of a cross-regional highway through the city centre affected air quality in the neighbourhood of a newly built road. Air quality was assessed based on measurements of concentrations of nitrogen dioxide, which is considered to be typical for automotive sources air pollution. The spectrophotometric method with passive sampling was used in the 24 h NO2 measurements. The calculated mean NO2 concentrations in the periods before and after road construction were within the ranges of 23.2–31.9 μg/m3 and 22.3–28.9 μg/m3, respectively. The relative NO2 concentrations determined in the study for 10 out of 11 sampling points were lower than the unity, including 5 points markedly lower (0.82–0.89). The obtained results indicate that the construction of the new artery by the city centre, using appropriate technical solutions and traffic organization (tunnel, noise barriers, roundabouts, speed limit) likely contributed to an overall reduction in NO2 concentrations. The presented solution may serve as an example for other cities struggling with problems of low air quality associated with inefficient transportation systems.

Interventions to reduce ambient air pollution and their effects on health: An abridged Cochrane systematic review

BACKGROUND

A broad range of interventions have been implemented to improve ambient air quality, and many of these have been evaluated. Yet to date no systematic review has been conducted to identify and synthesize these studies. In this systematic review, we assess the effectiveness of interventions in reducing ambient particulate matter air pollution and improving adverse health outcomes.

METHODS

We searched a range of electronic databases across multiple disciplines, as well as grey literature databases, trial registries, reference lists of included studies and the contents of relevant journals, through August 2016. Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs often used for evaluating air quality interventions. We included studies that evaluated interventions targeting industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and the concentrations of particulate matter (PM - including PM₁₀, PM_2.5, coarse particulate matter and combustion-related PM), as well as several criteria pollutants, including ozone, carbon monoxide, nitrogen oxides, nitrogen dioxide, nitric oxide and sulphur dioxide. We did not restrict studies based on the population, setting or comparison. Two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We assessed risk of bias using the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the UK National Institute for Health and Care Excellence. We synthesized evidence narratively, as well as graphically using harvest plots. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

RESULTS

We included 42 studies assessing 38 unique interventions. These comprised a heterogeneous mix of interventions, including those aiming to address industrial sources (n = 5; e.g. the closure of a factory), residential sources (n = 7; e.g. coal ban), vehicular sources (n = 22; e.g. low emission zones), and multiple sources (n = 4; e.g. tailored measures that target both local traffic and industrial polluters). Evidence for effectiveness was mixed. Most included studies observed either no significant association or an association favoring the intervention, with little evidence that the assessed interventions might be harmful.

CONCLUSIONS

Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Some evidence suggests that interventions are associated with improvements in air quality and human health, with very little evidence suggesting interventions were harmful. The evidence base highlights the challenges related to establishing the effectiveness of specific air pollution interventions on outcomes. It also points to the need for improved study design and analysis methods, as well as more uniform evaluations. The prospective planning of evaluations and an evaluation component built into the design and implementation of interventions may also be particularly beneficial.

Air pollution control and the occurrence of acute respiratory illness in school children of Quito, Ecuador

Because of air quality management and control, traffic-related air pollution has declined in Quito, Ecuador. We evaluated the effect of a city-wide 5-year air pollution control program on the occurrence of acute respiratory illness (ARI). We compared two studies conducted at the same location in Quito: in 2000, 2 years before the policy to control vehicle emission was introduced, and in 2007. Each study involved ~ 730 children aged 6-12 years, observed for 15 weeks. We examined associations between carboxyhemoglobin (COHb) serum concentration-an exposure proxy for carbon monoxide (CO)-ambient CO, and ARI in both cohorts. In 2007, we found a 48% reduction in the ARI incidence (RR 0.52; 95% CI 0.45-0.62, p < 0.0001), and 92% decrease in the percentage of children with COHb > 2.5% as compared to the 2000 study. We found no association between COHb concentrations above the safe level of 2.5% and the ARI incidence (p = 0.736). The decline in air pollution due to vehicle emissions control was associated with a lower incidence of respiratory illness in school children.

Interventions to reduce ambient particulate matter air pollution and their effect on health

BACKGROUND

Ambient air pollution is associated with a large burden of disease in both high-income countries (HICs) and low- and middle-income countries (LMICs). To date, no systematic review has assessed the effectiveness of interventions aiming to reduce ambient air pollution.

OBJECTIVES

To assess the effectiveness of interventions to reduce ambient particulate matter air pollution in reducing pollutant concentrations and improving associated health outcomes.

SEARCH METHODS

We searched a range of electronic databases with diverse focuses, including health and biomedical research (CENTRAL, Cochrane Public Health Group Specialised Register, MEDLINE, Embase, PsycINFO), multidisciplinary research (Scopus, Science Citation Index), social sciences (Social Science Citation Index), urban planning and environment (Greenfile), and LMICs (Global Health Library regional indexes, WHOLIS). Additionally, we searched grey literature databases, multiple online trial registries, references of included studies and the contents of relevant journals in an attempt to identify unpublished and ongoing studies, and studies not identified by our search strategy. The final search date for all databases was 31 August 2016.

SELECTION CRITERIA

Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs, including controlled interrupted time-series studies (cITS-EPOC), interrupted time-series studies adhering to EPOC standards (ITS-EPOC), interrupted time-series studies not adhering to EPOC standards (ITS), controlled before-after studies adhering to EPOC standards (CBA-EPOC), and controlled before-after studies not adhering to EPOC standards (CBA); these were classified as main studies. Additionally, we included uncontrolled before-after studies (UBA) as supporting studies. We included studies that evaluated interventions to reduce ambient air pollution from industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and several air pollutant concentrations. We did not restrict studies based on the population, setting or comparison.

DATA COLLECTION AND ANALYSIS

After a calibration exercise among the author team, two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We conducted data extraction, risk of bias assessment and evidence synthesis only for main studies; we mapped supporting studies with regard to the types of intervention and setting. To assess risk of bias, we used the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the Centre for Public Health Excellence at the UK National Institute for Health and Care Excellence (NICE). For each intervention category, i.e. those targeting industrial, residential, vehicular and multiple sources, we synthesized evidence narratively, as well as graphically using harvest plots.

MAIN RESULTS

We included 42 main studies assessing 38 unique interventions. These were heterogeneous with respect to setting; interventions were implemented in countries across the world, but most (79%) were implemented in HICs, with the remaining scattered across LMICs. Most interventions (76%) were implemented in urban or community settings.We identified a heterogeneous mix of interventions, including those aiming to address industrial (n = 5), residential (n = 7), vehicular (n = 22), and multiple sources (n = 4). Some specific interventions, such as low emission zones and stove exchanges, were assessed by several studies, whereas others, such as a wood burning ban, were only assessed by a single study.Most studies assessing health and air quality outcomes used routine monitoring data. Studies assessing health outcomes mostly investigated effects in the general population, while few studies assessed specific subgroups such as infants, children and the elderly. No identified studies assessed unintended or adverse effects.The judgements regarding the risk of bias of studies were mixed. Regarding health outcomes, we appraised eight studies (47%) as having no substantial risk of bias concerns, five studies (29%) as having some risk of bias concerns, and four studies (24%) as having serious risk of bias concerns. Regarding air quality outcomes, we judged 11 studies (31%) as having no substantial risk of bias concerns, 16 studies (46%) as having some risk of bias concerns, and eight studies (23%) as having serious risk of bias concerns.The evidence base, comprising non-randomized studies only, was of low or very low certainty for all intervention categories and primary outcomes. The narrative and graphical synthesis showed that evidence for effectiveness was mixed across the four intervention categories. For interventions targeting industrial, residential and multiple sources, a similar pattern emerged for both health and air quality outcomes, with essentially all studies observing either no clear association in either direction or a significant association favouring the intervention. The evidence base for interventions targeting vehicular sources was more heterogeneous, as a small number of studies did observe a significant association favouring the control. Overall, however, the evidence suggests that the assessed interventions do not worsen air quality or health.

AUTHORS' CONCLUSIONS

Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Most included studies observed either no significant association in either direction or an association favouring the intervention, with little evidence that the assessed interventions might be harmful. The evidence base highlights the challenges related to establishing a causal relationship between specific air pollution interventions and outcomes. In light of these challenges, the results on effectiveness should be interpreted with caution; it is important to emphasize that lack of evidence of an association is not equivalent to evidence of no association.We identified limited evidence for several world regions, notably Africa, the Middle East, Eastern Europe, Central Asia and Southeast Asia; decision-makers should prioritize the development and implementation of interventions in these settings. In the future, as new policies are introduced, decision-makers should consider a built-in evaluation component, which could facilitate more systematic and comprehensive evaluations. These could assess effectiveness, but also aspects of feasibility, fidelity and acceptability.The production of higher quality and more uniform evidence would be helpful in informing decisions. Researchers should strive to sufficiently account for confounding, assess the impact of methodological decisions through the conduct and communication of sensitivity analyses, and improve the reporting of methods, and other aspects of the study, most importantly the description of the intervention and the context in which it is implemented.

Impact of London's low emission zone on air quality and children's respiratory health: a sequential annual cross-sectional study

BACKGROUND

Low emission zones (LEZ) are an increasingly common, but unevaluated, intervention aimed at improving urban air quality and public health. We investigated the impact of London's LEZ on air quality and children's respiratory health.

METHODS

We did a sequential annual cross-sectional study of 2164 children aged 8-9 years attending primary schools between 2009-10 and 2013-14 in central London, UK, following the introduction of London's LEZ in February, 2008. We examined the association between modelled pollutant exposures of nitrogen oxides (including nitrogen dioxide [NO₂]) and particulate matter with a diameter of less than 2·5 μm (PM_2·5) and less than 10 μm (PM₁₀) and lung function: postbronchodilator forced expiratory volume in 1 s (FEV₁, primary outcome), forced vital capacity (FVC), and respiratory or allergic symptoms. We assigned annual exposures by each child's home and school address, as well as spatially resolved estimates for the 3 h (0600-0900 h), 24 h, and 7 days before each child's assessment, to isolate long-term from short-term effects.

FINDINGS

The percentage of children living at addresses exceeding the EU limit value for annual NO₂ (40 μg/m³) fell from 99% (444/450) in 2009 to 34% (150/441) in 2013. Over this period, we identified a reduction in NO₂ at both roadside (median -1·35 μg/m³ per year; 95% CI -2·09 to -0·61; p=0·0004) and background locations (-0·97; -1·56 to -0·38; p=0·0013), but not for PM₁₀. The effect on PM_2·5 was equivocal. We found no association between postbronchodilator FEV₁ and annual residential pollutant attributions. By contrast, FVC was inversely correlated with annual NO₂ (-0·0023 L/μg per m³; -0·0044 to -0·0002; p=0·033) and PM₁₀ (-0·0090 L/μg per m³; -0·0175 to -0·0005; p=0·038).

INTERPRETATION

Within London's LEZ, a smaller lung volume in children was associated with higher annual air pollutant exposures. We found no evidence of a reduction in the proportion of children with small lungs over this period, despite small improvements in air quality in highly polluted urban areas during the implementation of London's LEZ. Interventions that deliver larger reductions in emissions might yield improvements in children's health.

FUNDING

National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, NHS Hackney, Lee Him donation, and Felicity Wilde Charitable Trust.

Near-Road Air Pollutant Measurements: Accounting for Inter-Site Variability Using Emission Factors

A daily integrated emission factor (EF) method was applied to data from three near-road monitoring sites to identify variables that impact traffic related pollutant concentrations in the near-road environment. The sites were operated for 20 months in 2015-2017, with each site differing in terms of design, local meteorology, and fleet compositions. Measurement distance from the roadway and local meteorology were found to affect pollutant concentrations irrespective of background subtraction. However, using emission factors mostly accounted for the effects of dilution and dispersion, allowing intersite differences in emissions to be resolved. A multiple linear regression model that included predictor variables such as fraction of larger vehicles (>7.6 m in length; i.e., heavy-duty vehicles), vehicle speed, and ambient temperature accounted for intersite variability of the fleet average NO, NO _x, and particle number EFs (R²:0.50-0.75), with lower model performance for CO and black carbon (BC) EFs (R²:0.28-0.46). NO _x and BC EFs were affected more than CO and particle number EFs by the fraction of larger vehicles, which also resulted in measurable weekday/weekend differences. Pollutant EFs also varied with ambient temperature and because there were little seasonal changes in fleet composition, this was attributed to changes in fuel composition and/or post-tailpipe transformation of pollutants.

Air Quality Strategies on Public Health and Health Equity in Europe-A Systematic Review

Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO₂) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO₂ were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.

London Hybrid Exposure Model: Improving Human Exposure Estimates to NO2 and PM2.5 in an Urban Setting

Here we describe the development of the London Hybrid Exposure Model (LHEM), which calculates exposure of the Greater London population to outdoor air pollution sources, in-buildings, in-vehicles, and outdoors, using survey data of when and where people spend their time. For comparison and to estimate exposure misclassification we compared Londoners LHEM exposure with exposure at the residential address, a commonly used exposure metric in epidemiological research. In 2011, the mean annual LHEM exposure to outdoor sources was estimated to be 37% lower for PM_2.5 and 63% lower for NO₂ than at the residential address. These decreased estimates reflect the effects of reduced exposure indoors, the amount of time spent indoors (∼95%), and the mode and duration of travel in London. We find that an individual's exposure to PM_2.5 and NO₂ outside their residential address is highly correlated (Pearson's R of 0.9). In contrast, LHEM exposure estimates for PM_2.5 and NO₂ suggest that the degree of correlation is influenced by their exposure in different transport modes. Further development of the LHEM has the potential to increase the understanding of exposure error and bias in time-series and cohort studies and thus better distinguish the independent effects of NO₂ and PM_2.5.

Decline of ambient air pollution levels due to measures to control automobile emissions and effects on the prevalence of respiratory and allergic disorders among children in Japan

BACKGROUND

In Japan, air pollution due to nitrogen oxides (NOx) and particulate matter (PM) has been gradually reduced since control measures based on the Automobile NOx/PM law were enforced beginning in 2001. The effects of decrease in air pollutants due to the control measures during the past decade on the prevalence of respiratory and allergic disorders such as asthma in children were evaluated.

METHODS

Using data of 618,973 children collected in 28 regions of Japan from 1997 to 2009, we evaluated whether reductions in the concentrations of nitrogen dioxide (NO2) and suspended particulate matter (SPM) contribute to the decrease in the prevalence of asthma, wheezing, bronchitis, allergic rhinitis, and atopic dermatitis by multiple linear regression analysis, including adjustments for related factors.

RESULTS

The annual rates of decrease in air pollution in the PM-law-enforced areas were 2.0 and 2.5 times higher for NO2 and SPM, respectively, compared with those in the non-enforced areas. The prevalence of asthma decreased significantly at -0.073% per year in the areas in which measures based on the Automobile NOx/PM law were taken but not in area where such measures were not applied. Multiple linear regression analysis showed a reduction in the ambient air pollution was significantly associated with a reduction in the prevalence of asthma, with a rate of 0.118% [95% confidence interval (CI): 0.012-0.225] per 1 ppb for NO2, and 0.050% [95% CI: 0.020-0.080] per 1 μg/m(3) for SPM. An increase in the ambient air pollution was associated with an increase in the prevalence of atopic dermatitis of 0.390% [95% CI: 0.107-0.673] per 1 ppb for NO2, 0.141% [95% CI: 0.058-0.224] per 1 μg/m(3) for SPM. The changes in the prevalence of wheezing and allergic rhinitis were not significantly correlated with changes in air pollutant concentrations.

CONCLUSIONS

The enforcement of measures to control automobile emissions based on the Automobile NOx/PM law was shown to have reduced air pollution and contributed to decreases in the prevalence of respiratory and allergic disorders in 3-year-old children.

Respiratory health in home and leisure pursuits

Many home-based and leisure activities can generate hazardous respirable exposures. Routine domestic activities and a variety of hobbies, avocations, and leisure pursuits have been associated with a spectrum of respiratory tract disorders. Indoor environments present a special risk for high-intensity exposures and adverse health effects. There are important knowledge gaps regarding the prevalence of specific health hazards within and across communities, exposure-response effects, population and individual susceptibilities, best management strategies, the adverse health effects of mixed exposures, and long-term clinical outcomes following exposures. The home environment presents special health risks that should be part of the health assessment.

Evaluating socioeconomic and racial differences in traffic-related metrics in the United States using a GIS approach

Previous studies have reported that lower-income and minority populations are more likely to live near major roads. This study quantifies associations between socioeconomic status, racial/ethnic variables, and traffic-related exposure metrics for the United States. Using geographic information systems (GIS), traffic-related exposure metrics were represented by road and traffic densities at the census tract level. Spearman's correlation coefficients estimated relationships between socio-demographic variables and traffic-related exposure metrics, and ANOVA was performed to test for significant differences in socio-demographic variables for census tracts with low and high traffic-related metrics. For all census tracts in the United States, %Whites, %Blacks, and %Hispanics (percent of tract population) had correlation coefficients greater than 0.38 and 0.16 with road density and traffic density, respectively. Regions and states had correlation coefficients as high as 0.78. Compared with tracts with low road and traffic densities (<25th percentile), tracts with high densities (>75th percentile) had values of %Blacks and %Hispanics that were more than twice as high, 20% greater poverty levels, and one-third fewer White residents. Census tracts that had mid-level values for road and traffic densities had the most affluent characteristics. Results suggest that racial/ethnic and socioeconomic disparities exist on national level with respect to lower-income and minority populations living near high traffic and road density areas.

Respiratory health before and after the opening of a road traffic tunnel: a planned evaluation

Objective

The construction of a new road tunnel in Sydney, Australia, and concomitant reduction in traffic on a major road presented the opportunity to study the effects of this traffic intervention on respiratory health.

Methods

We made measurements in a cohort of residents in the year before the tunnel opened (2006) and in each of two years afterwards (2007–2008). Cohort members resided in one of four exposure zones, including a control zone. Each year, a respiratory questionnaire was administered (n = 2,978) and a panel sub-cohort (n = 380) performed spirometry once and recorded peak expiratory flow and symptoms twice daily for nine weeks.

Results

There was no consistent evidence of improvement in respiratory health in residents living along the bypassed main road, despite a reduction in traffic from 90,000 to 45,000 vpd. Residents living near tunnel feeder roads reported more upper respiratory symptoms in the survey but not in the panel sub-cohort. Residents living around the tunnel ventilation stack reported more upper and lower respiratory symptoms and had lower spirometric volumes after the tunnel opened. Air pollutant levels measured near the stack did not increase over the study period.

Conclusion

The finding of adverse health effects among residents living around the stack is unexpected and difficult to explain, but might be due to unmeasured pollutants or risk factors or an unrecognized pollutant source nearby. The lack of improvement in respiratory health among people living along the bypassed main road probably reflects a minimal change in exposure due to distance of residence from the road.

Redistribution of traffic related air pollution associated with a new road tunnel

The aim of this study was to assess the effect of a new road tunnel on the concentration and distribution of traffic-related air pollution (TRAP), specifically nitrogen dioxide (NO(2)) and particulate matter (PM), and to determine its relationship to change in traffic flow. We used continuously recorded data from four monitoring stations at nonroadside locations within the study area and three regional monitors outside the area. The four monitors in the study area were in background locations where smaller pollutant changes were expected compared with changes near the bypassed main road. We also deployed passive samplers to assess finer spatial variability in NO(2) including application of a land use regression model (LUR). The study was conducted from 2006 to 2008. Analysis of the continuously recorded data showed that the tunnel intervention did not lead to consistent reductions in NO(2) or PM over the wider study area. However, there were significant decreases in NO(2), NO(x), and PM(10) in the eastern section of the study area. Analysis of passive sampler data indicated that the greatest reductions in NO(2) concentrations occurred within 100 m of the bypassed main road. The LUR model also demonstrated that changes in NO(2) were most marked adjacent to the bypassed main road. These findings support the use of methods that highlight fine spatial variability in TRAP and demonstrate the utility of traffic interventions in reducing air pollution exposures for populations living close to main roads.

Decreased PM10 exposure attenuates age-related lung function decline: genetic variants in p53, p21, and CCND1 modify this effect

BACKGROUND

Decreasing exposure to airborne particulates was previously associated with reduced age-related decline in lung function. However, whether the benefit from improved air quality depends on genetic background is not known. Recent evidence points to the involvement of the genes p53 and p21 and of the cell cycle control gene cyclin D1 (CCND1) in the response of bronchial cells to air pollution.

OBJECTIVE

We determined in 4,326 participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) whether four single-nucleotide polymorphisms in three genes [CCND1 (rs9344 [P242P], rs667515), p53 (rs1042522 [R72P]), and p21 (rs1801270 [S31R])] modified the previously observed attenuation of the decline in the forced expiratory flow between 25% and 75% of the forced vital capacity (FEF(25-75)) associated with improved air quality.

METHODS

Subjects of the prospective population-based SAPALDIA cohort were assessed in 1991 and 2002 by spirometry, questionnaires, and biological sample collection for genotyping. We assigned spatially resolved concentrations of particulate matter with aerodynamic diameter < or = 10 microm (PM(10)) to each participant's residential history 12 months before the baseline and follow-up assessments.

RESULTS

The effect of diminishing PM(10) exposure on FEF(25-75) decline appeared to be modified by p53 R72P, CCND1 P242P, and CCND1 rs667515. For example, a 10-microg/m(3) decline in average PM(10) exposure over an 11-year period attenuated the average annual decline in FEF(25-75) by 21.33 mL/year (95% confidence interval, 10.57-32.08) among participants homozygous for the CCND1 (P242P) GG genotype, by 13.72 mL/year (5.38-22.06) among GA genotypes, and by 6.00 mL/year (-4.54 to 16.54) among AA genotypes.

CONCLUSIONS

Our results suggest that cell cycle control genes may modify the degree to which improved air quality may benefit respiratory function in adults.

Altered pulmonary function in children with asthma associated with highway traffic near residence

Cross-sectional analyses were conducted to evaluate the effects of exposure to highway traffic on pulmonary function in Fresno, California. Traffic and spirometry data were available for 214 children (enrollment ages six to 11 years). Multiple linear regression was used to evaluate the relations between pulmonary function and traffic parameters. Heavy-duty vehicle count was used as a surrogate measure for diesel-related exposures. Pulmonary function was non-significantly associated with longer distance-to-road and non-significantly associated with higher traffic intensity. Evaluation of effect modification by FEF(25-75)/FVC (a measure of intrinsic airway size) showed that all pulmonary function measures of flow were significantly inversely related to a traffic metric that incorporates traffic intensity and roadway proximity. The results indicate that residence proximity to highway traffic is associated with lower pulmonary function among children with asthma, and smaller airway size is an important modifier of the effect of traffic exposure on pulmonary function and a marker of increased susceptibility.

On exposure and response relationships for health effects associated with exposure to vehicular traffic

This work examines various metrics and models that have been used to estimate long-term health effects of exposure to vehicular traffic. Such health impacts may include effects of air pollution due to emissions of combustion products and from vehicle or roadway wear, of noise, stress, or from socioeconomic effects associated with preferred residential locations. Both categorical and continuous exposure metrics are considered, typically for distances between residences and roadways, or for traffic density or intensity. It appears that continuous measures of exposure tend to yield lower risk estimates that are also more precise than categorical measures based on arbitrary criteria. The selection of appropriate exposure increments to characterize relative risks is also important in comparing pollutants and other agents. Confounding and surrogate variables are also important issues, since studies of traffic proximity or density cannot identify the specific agents related to traffic exposures that might be responsible for the various health endpoints that have been implicated. Studies based on ambient air quality measurements are necessarily restricted to species for which data are available, some of which may be serving as markers for the actual agents of harm. Studies based on modeled air quality are limited by the accuracy of mobile source emission inventories, which may not include poorly maintained (high emitting) vehicles. Additional exposure modeling errors may result from precision limitations of geocoding methods. Studies of the health effects of traffic are progressing from establishing the existence of relationships to describing them in more detail, but effective remedies or control strategies have generally not yet been proposed in the context of these epidemiological studies. Resolution of these dose-response uncertainties is important for the development of effective public health strategies for the future.

Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice

Background

Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice.

Methods

Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers.

Results

Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA.

Conclusion

Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.

Dose–response studies involving controlled deposition of less than 100 particles generated and levitated in an ac trap onto lung cells, in vitro, and quantitation of ICAM-1 differential expression

A developing area of interest regarding the relationship between the adverse health effects associated with particles suspended in the troposphere is an understanding of how particle chemical composition influences different biological outcomes. Described is the development and application of an apparatus and methodology wherein a known number of particles of tropospherically relevant chemical composition can be designed and levitated in an alternating current (ac) trap followed by their controlled deposition directly from the ac trap onto air-liquid interface cultured lung cells. A downstream biological response, differential upregulation of intercellular adhesion molecule (ICAM)-1, was measurable using fluorescence microscopy in the air-liquid interface human lung cell cultures even though the dose per culture was 0-100 lipopolysaccharide (LPS)-containing elemental carbon particles (52 pg LPS per 6.3 microm diameter particle). Fluorescence emission intensity data measured from a 1 mm2 area centered over the site of particle deposition were fitted using a least squares linear regression line. Because the total mass of each different compound comprising each of the particles delivered to the culture was known, the data generated with this methodology can be expressed as a pro-inflammation potential (in this case ICAM-1 expression) per particle number and composition. Also described is how this methodology affords opportunities to quantitatively study pro-inflammatory intercellular signaling leading to ICAM-1 expression at sites distal to the site of particle deposition.

Air particulate pollution due to bushfires and respiratory hospital admissions in Brisbane, Australia

To examine the impact of bushfire smoke on hospital admission rates for respiratory disease, a time series study was conducted in Brisbane, Australia. Data on particles of 10 microns or less in aerodynamic diameter (PM10) per cubic metre, bushfire events, meteorological conditions, and daily respiratory hospital admissions were obtained for the period of 1 July 1997 to 31 December 2000. A generalized linear model with the negative binomial distribution was used to estimate the effects of bushfire smoke on respiratory hospital admissions. The results of this study show that daily respiratory hospital admission rates consistently increased with increasing levels of PM10 for both bushfire and non-bushfire periods. This relationship appeared stronger during bushfire periods than non-bushfire periods, especially for the current day. The findings suggest that bushfire smoke was statistically significantly associated with an increased risk of respiratory hospital admissions in Brisbane (p < 0.05). The health impact assessment needs to be considered in the control and management of bushfires.

The air quality impacts of road closures associated with the 2004 Democratic National Convention in Boston

BACKGROUND

The Democratic National Convention (DNC) in Boston, Massachusetts in 2004 provided an opportunity to evaluate the impacts of a localized and short-term but potentially significant change in traffic patterns on air quality, and to determine the optimal monitoring approach to address events of this nature. It was anticipated that the road closures associated with the DNC would both influence the overall air pollution level and the distribution of concentrations across the city, through shifts in traffic patterns.

METHODS

To capture these effects, we placed passive nitrogen dioxide badges at 40 sites around metropolitan Boston before, during, and after the DNC, with the goal of capturing the array of hypothesized impacts. In addition, we continuously measured elemental carbon at three sites, and gathered continuous air pollution data from US EPA fixed-site monitors and traffic count data from the Massachusetts Highway Department.

RESULTS

There were significant reductions in traffic volume on the highway with closures north of Boston, with relatively little change along other highways, indicating a more isolated traffic reduction rather than an across-the-board decrease. For our nitrogen dioxide samples, while there was a relatively small change in mean concentrations, there was significant heterogeneity across sites, which corresponded with our a priori classifications of road segments. The median ratio of nitrogen dioxide concentrations during the DNC relative to non-DNC sampling periods was 0.58 at sites with hypothesized traffic reductions, versus 0.88 for sites with no changes hypothesized and 1.15 for sites with hypothesized traffic increases. Continuous monitors measured slightly lower concentrations of elemental carbon and nitrogen dioxide during road closure periods at monitors proximate to closed highway segments, but not for PM2.5 or further from major highways.

CONCLUSION

We conclude that there was a small but measurable influence of DNC-related road closures on air quality patterns in the Boston area, and that a low-cost monitoring study combining passive badges for spatial heterogeneity and continuous monitors for temporal heterogeneity can provide useful insight for community air quality assessments.

Airborne chemicals cause respiratory symptoms in individuals with contact allergy

Exposure to fragrance chemicals causes various eye and airway symptoms. Individuals with perfume contact allergy report these symptoms more frequently than individuals with nickel allergy or no contact allergies. However, the associations between contact allergy and respiratory symptoms elicited by airborne chemicals other than perfumes are unclear. The study aimed to investigate the association between eye and airway symptoms elicited by airborne chemicals (other than perfumes) and contact allergy in a population-based sample. A questionnaire on respiratory symptoms was posted, in 2002, to 1189 individuals who participated in 1997/1998 in a Danish population-based study of allergic diseases. Questions about eye and airway symptoms elicited by different airborne chemicals and airborne proteins were included in the questionnaire. Data from the questionnaire were compared with data on patch testing and prick testing. Having at least 1 positive patch test (adjusted odds ratio 1.7, 95% CI 1.2-2.5) was associated with the symptoms, and the odds ratio increased with the number of positive patch tests (P-value for test for trend <0.05). Bronchial hyperreactivity, female sex and psychological vulnerability were independently associated with symptoms, but no association was found between prick test reactivity to proteins and the symptoms elicited by airborne chemicals.