Effect of Air Pollution and Hospital Admission: A Systematic Review

The relationship between early life course air pollution exposure and general health in adolescence in the United Kingdom

Air pollution is associated with health in childhood. However, there is limited evidence on sensitive periods during the first 18 years of life. Data were drawn from the Millennium Cohort Study, a large and nationally representative cohort born in 2000/2002. Self-reported general health was assessed at age 17; number of hospital records were derived from linked health data (Hospital Episode Statistics) for consented participants. Residential history was linked to 25 × 25 m grid resolution annual PM2.5, PM10 and NO2 maps between 2000 and 2019; year-specific air pollution exposure in 200-m buffers around postcode centroids were computed. After adjusting for individual and time-variant area-level confounders, children exposed to higher air pollution in early (2-4 y) (n = 9137; PM2.5: OR = 1.06, 95% CI: 1.01-1.11; PM10: OR = 1.05, 95% CI: 1.01-1.09; NO2: OR = 1.01, 95% CI: 1.00-1.02) and middle childhood (5-7) (n = 9171; PM2.5: OR = 1.04, 95% CI: 1.00-1.07; PM10: OR = 1.03, 95% CI: 1.01-1.06) reported worse general health at age 17. Higher PM2.5 and NO2 exposure in adolescence increased the number of hospital episodes in young adulthood. Individuals from non-White and disadvantaged backgrounds were exposed to higher levels of air pollution. Air pollution in early and middle childhood might contribute to worse general health, with ethnic minority and disadvantaged children being more exposed.

Hospital-borne hazardous air pollutants and air cleaning strategies amid the surge of SARS-CoV-2 new variants

Indoor air pollutants and airborne contamination removal have been challenging in healthcare facilities. The airborne transmission control and HVAC system may collapse in hospitals due to the highly infectious respiratory disease-associated patient surge, like COVID-19. Common air filtration systems and HVAC systems enhance the patients' comfort and support indoor hygiene, hitherto insufficient to control highly infectious airborne pathogens and hospital-borne pollutants such as radon, PM2.5, patient droplets, VOC, high CO2, and anesthetic gases. This review summarized important air cleaning interventions to enhance HVAC efficiency and indoor safety. We discussed efficient air cleaning and ventilation strategies including air filtration, air ionization, passive removal materials (PRM), and UVGI to minimize cross-contamination in hospital wards.

Lifetime losses due to cardiovascular and respiratory diseases attributable to air pollution in polluted and unpolluted areas

The article assesses differences in lifetime losses caused by premature deaths from cardiopulmonary disease in populations living in areas with different environmental burdens. The results provide different perspectives on data on total years lost and lifetime losses attributable to air pollution. Such lifetime losses in the industrial area related to cardiovascular causes of death are 7.6 or 5.1 years per male or female deceased, representing an average lifetime loss of 0.01907 years (i.e. 7 days) per 1 male or 0.01273 years (i.e. 4.6 days) per 1 female in the entire population. Losses related to cerebrovascular or respiratory causes of death are about 5.4 or 5.9 years per 1 deceased male or 3.9 or 5 years per 1 deceased female, respectively, which represents a loss of 0.00481 (1.8 days), or 0.00148 years (0.5 days) per 1 male or 0.00466 (1.7 days), or 0.00058 years (0.2 days) per 1 female.

Cluster pattern analysis of environmental stressors and quantifying their impact on all-cause mortality in Belgium

Environmental stress represents an important burden on health and leads to a considerable number of diseases, hospitalisations, and excess mortality. Our study encompasses a representative sample size drawn from the Belgian population in 2016 (n = 11.26 million, with a focus on n = 11.15 million individuals). The analysis is conducted at the geographical level of statistical sectors, comprising a total of n = 19,794 sectors, with a subset of n = 18,681 sectors considered in the investigation. We integrated multiple parameters at the finest spatial level and constructed three categories of environmental stress through clustering: air pollution, noise stress and stress related to specific land-use types. We observed identifiable patterns in the spatial distribution of stressors within each cluster category. We assessed the relationship between age-standardized all-cause mortality rates (ASMR) and environmental stressors. Our research found that especially very high air pollution values in areas where traffic is the dominant local component of air pollution (ASMR + 14,8%, 95% CI: 10,4 - 19,4%) and presence of industrial land (ASMR + 14,7%, 95% CI: 9,4 - 20,2%) in the neighbourhood are associated with an increased ASMR. Cumulative exposure to multiple sources of unfavourable environmental stress (simultaneously high air pollution, high noise, presence of industrial land or proximity of primary/secondary roads and lack of green space) is associated with an increase in ASMR (ASMR + 26,9%, 95% CI: 17,1 - 36,5%).

Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: time series modelling and analysis using visibility graphs

The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO₂, PM₁₀, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas.

A systematic review and meta-analysis on the association between ambient air pollution and pulmonary tuberculosis

There is inconclusive evidence on the association between ambient air pollution and pulmonary tuberculosis (PTB) incidence, tuberculosis-related hospital admission and mortality. This review aimed to assess the extent to which selected air pollutants are associated to PTB incidence, hospital admissions and mortality. This was a systematic review of studies published in English from January 1st, 1946, through May 31st, 2022, that quantitatively assessed the association between PM_2.5, PM₁₀, NO₂, SO₂, CO, O₃ and the incidence of, hospital admission or death from PTB. Medline, Embase, Scopus and The Cochrane Library were searched. Extracted data from eligible studies were analysed using STATA software. Random-effect meta-analysis was used to derive pooled adjusted risk and odds ratios. A total of 24 studies (10 time-series, 5 ecologic, 5 cohort, 2 case–control, 1 case cross-over, 1 cross-sectional) mainly from Asian countries were eligible and involved a total of 437,255 tuberculosis cases. For every 10 μg/m³ increment in air pollutant concentration, there was a significant association between exposure to PM_2.5 (pooled aRR = 1.12, 95% CI: 1.06–1.19, p < 0.001, N = 6); PM₁₀ (pooled aRR = 1.06, 95% CI: 1.01–1.12, p = 0.022, N = 8); SO₂ (pooled aRR = 1.08, 95% CI: 1.04–1.12, p < 0.001, N = 9); and the incidence of PTB. There was no association between exposure to CO (pooled aRR = 1.04, 95% CI: 0.98–1.11, p = 0.211, N = 4); NO₂ (pooled aRR = 1.08, 95% CI: 0.99–1.17, p = 0.057, N = 7); O₃ (pooled aRR = 1.00, 95% CI: 0.99–1.02, p = 0.910, N = 6) and the incidence of PTB. There was no association between the investigated air pollutants and mortality or hospital admissions due to PTB. Overall quality of evidence was graded as low (GRADE approach). Exposure to PM_2.5, PM₁₀ and SO₂ air pollutants was found to be associated with an increased incidence of PTB, while exposure to CO, NO₂ and O₃ was not. There was no observed association between exposure to these air pollutants and hospital admission or mortality due to PTB. The quality of the evidence generated, however, remains low. Addressing the tuberculosis epidemic by 2030 as per the 4th Sustainable Development Goal may require a more rigorous exploration of this association.

Air Pollution in Poland: A 2022 Narrative Review with Focus on Respiratory Diseases

According to the World Bank Group, 36 of the 50 most polluted cities in the European Union are in Poland. Thus, ambient air pollution and its detrimental health effects are a matter of immense importance in Poland. This narrative review aims to analyse current findings on air pollution and health in Poland, with a focus on respiratory diseases, including COVID-19, as well as the Poles’ awareness of air pollution. PubMed, Scopus and Google Scholar databases were searched. In total, results from 71 research papers were summarized qualitatively. In Poland, increased air pollution levels are linked to increased general and respiratory disease mortality rates, higher prevalence of respiratory diseases, including asthma, lung cancer and COVID-19 infections, reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). The proximity of high traffic areas exacerbates respiratory health problems. People living in more polluted regions (south of Poland) and in the winter season have a higher level of air pollution awareness. There is an urgent need to reduce air pollution levels and increase public awareness of this threat. A larger number of multi-city studies are needed in Poland to consistently track the burden of diseases attributable to air pollution.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM₁₀, NO₂, and SO₂ up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM₁₀, NO₂, and SO₂ at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m³ for PM₁₀, 7.3 µg/m³ for NO₂, and 3.6 µg/m³ for SO₂. The overall cumulative risks for RD per IQR increase in PM₁₀ and NO₂ for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM₁₀ and NO₂ concentrations. Associations were strongest among children and warm season for RD.

Thirty-day hospital readmission prediction model based on common data model with weather and air quality data

Although several studies have attempted to develop a model for predicting 30-day re-hospitalization, few attempts have been made for sufficient verification and multi-center expansion for clinical use. In this study, we developed a model that predicts unplanned hospital readmission within 30 days of discharge; the model is based on a common data model and considers weather and air quality factors, and can be easily extended to multiple hospitals. We developed and compared four tree-based machine learning methods: decision tree, random forest, AdaBoost, and gradient boosting machine (GBM). Above all, GBM showed the highest AUC performance of 75.1 in the clinical model, while the clinical and W-score model showed the best performance of 73.9 for musculoskeletal diseases. Further, PM10, rainfall, and maximum temperature were the weather and air quality variables that most impacted the model. In addition, external validation has confirmed that the model based on weather and air quality factors has transportability to adapt to other hospital systems.

Association Between the Ambient Fine Particulate Pollution and the Daily Internal Medicine Outpatient Visits in Zhoushan, China: A Time-Series Study

Background: There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method. Methods: We validated and acquired the daily internal medicine outpatient visits records between January 1, 2014, and December 31, 2019, from the Zhoushan Center for Disease Control and Prevention in Zhejiang, China. Further, we collected the daily average records of the ambient air pollutants from the Zhoushan Environmental Monitoring Centre within the same duration. A generalized additive model with the natural splines was constructed to explore the association between the ambient air pollutants and daily internal medicine outpatient visits. Further, we conducted a lag analysis by using the distributed lag non-linear model to estimate the time-delayed effects of the air pollutants on the daily internal medicine outpatient visits. Results: A total of 2,190,258 daily internal medicine outpatient visits with a mean of 202.4 visits per day were recorded. The non-linear relationships were found among particulate matter2.5 (PM2.5), sulfur dioxide (SO2), and the daily internal medicine outpatient visits. Overall, PM2.5 was positively correlated with the daily internal medicine outpatient visits. Both ozone (O3) and SO2 had significant delayed effects on the daily internal medical outpatient numbers; however, PM2.5 only showed a short-term risk. Conclusion: Short-term exposure to PM2.5 was associated with an increase in the daily internal medicine outpatient visits for circulatory and respiratory diseases/symptoms in Zhoushan, China. SO2 and O3 were shown to induce significant effects after a concentration-dependent time lag.

Association between respiratory hospital admissions and air quality in Portugal: A count time series approach

Although regulatory improvements for air quality in the European Union have been made, air pollution is still a pressing problem and, its impact on health, both mortality and morbidity, is a topic of intense research nowadays. The main goal of this work is to assess the impact of the exposure to air pollutants on the number of daily hospital admissions due to respiratory causes in 58 spatial locations of Portugal mainland, during the period 2005-2017. To this end, INteger Generalised AutoRegressive Conditional Heteroskedastic (INGARCH)-based models are extensively used. This family of models has proven to be very useful in the analysis of serially dependent count data. Such models include information on the past history of the time series, as well as the effect of external covariates. In particular, daily hospitalisation counts, air quality and temperature data are endowed within INGARCH models of optimal orders, where the automatic inclusion of the most significant covariates is carried out through a new block-forward procedure. The INGARCH approach is adequate to model the outcome variable (respiratory hospital admissions) and the covariates, which advocates for the use of count time series approaches in this setting. Results show that the past history of the count process carries very relevant information and that temperature is the most determinant covariate, among the analysed, for daily hospital respiratory admissions. It is important to stress that, despite the small variability explained by air quality, all models include on average, approximately two air pollutants covariates besides temperature. Further analysis shows that the one-step-ahead forecasts distributions are well separated into two clusters: one cluster includes locations exclusively in the Lisbon area (exhibiting higher number of one-step-ahead hospital admissions forecasts), while the other contains the remaining locations. This results highlights that special attention must be given to air quality in Lisbon metropolitan area in order to decrease the number of hospital admissions.

Association with Ambient Air Pollutants and School Absence Due to Sickness in Schoolchildren: A Case-Crossover Study in a Provincial Town of Japan

The effect of ambient air pollutants and Asian dust (AD) on absence from school due to sickness has not been well researched. By conducting a case-crossover study, this study investigated the influence of ambient air pollutants and desert sand dust particles from East Asia on absence from school due to sickness. From November 2016 to July 2018, the daily cases of absence due to sickness were recorded in five elementary schools in Matsue, Japan. During the study period, a total of 16,915 absence cases were recorded, which included 4865 fever cases and 2458 cough cases. The relative risk of overall absence in a 10-μg/m³ increment of PM_2.5 and a 0.1-km^-1 of desert sand dust particles from East Asia were found with 1.28 (95%CI: 1.15-1.42) and 2.15 (1.04-4.45) at lag0, respectively. The significant influence of PM_2.5 persisted at lag5 and that of desert sand dust particles at lag2. NO₂ had statistically significant effects at lag2, lag3, and lag4. However, there was no evidence of a positive association of O_x and SO₂ with absence from school. These results suggested that PM_2.5, NO₂, and AD increased the risk of absence due to sickness in schoolchildren.

Impact of the pandemic of COVID-19 on emergency attendance for stroke and acute myocardial infarction in Beijing, China

To estimate the impact on emergency attendance for stroke and acute myocardial infarction (AMI) during the pandemic of COVID-19 in Beijing, China. Based on 17,123 and 8693 emergency attendance for stroke and AMI, an interrupted time-series (ITS) study was conducted. Since 01/24/2020, the top two levels of regulations on major public health have been implemented in Beijing. This study covered from 03/01/2018 to 06/03/2020, including 19 weeks of lockdown period and 99 weeks before. A segmented Poisson regression model was used to estimate the immediate change and the monthly change in the secular trend of the emergency attendance rates. The emergency attendance rates of stroke and AMI cut in half at the beginning of the lockdown period, with 52.1% (95% CI 45.8% to 57.7%) and 63.1% (95% CI 56.1% to 63.1%) immediate decreases for stroke and AMI, respectively. Then during the lockdown period, 7.0% (95% CI 2.5%, 11.6%) and 16.1% (95% CI 9.5, 23.1) increases per month in the secular trends of emergency attendance rates were shown for stroke and AMI, respectively. Though the accelerated increasing rates, there were estimated 1335 and 747 patients with stroke and AMI without seeking emergency medical aid during the lockdown, respectively. The emergency attendance for stroke and AMI cut in half at the beginning of the pandemic then had gradual restoration thereafter. The results hint the need for more engagement and communications with all stakeholders to reduce the negative impact on CVD emergency medical services during the crisis.

Air Pollution Is Associated with Poor Cognitive Function in Taiwanese Adults

The issue of air pollution is gaining increasing attention worldwide, and mounting evidence has shown an association between air pollution and cognitive decline. The aim of this study was to investigate the relationships between air pollutants and cognitive impairment using the Mini-Mental State Exam (MMSE) and its sub-domains. In this study, we used data from the Taiwan Biobank combined with detailed daily data on air pollution. Cognitive function was assessed using the MMSE and its five subgroups of cognitive functioning. After multivariable linear regression analysis, a high level of particulate matter with an aerodynamic diameter of ≤2.5 μm (PM_2.5), low ozone (O₃), high carbon monoxide (CO), high sulfur dioxide (SO₂), high nitric oxide (NO), high nitrogen dioxide (NO₂), and high nitrogen oxide (NO_x) were significantly associated with low total MMSE scores. Further, high SO₂ and low O₃ were significantly associated with low MMSE G1 scores. Low O₃, high CO, high SO₂, high NO₂, and high NO_x were significantly associated with low MMSE G4 scores, and high PM_2.5, high particulate matter with an aerodynamic diameter of ≤10 μm (PM₁₀), high SO₂, high NO₂, and high NO_x were significantly associated with low MMSE G5 scores. Our results showed that exposure to different air pollutants may lead to general cognitive decline and impairment of specific domains of cognitive functioning, and O₃ may be a protective factor. These findings may be helpful in the development of policies regarding the regulation of air pollution.

The effect of air-pollution and weather exposure on mortality and hospital admission and implications for further research: A systematic scoping review

BACKGROUND

Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research.

METHODS

We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of "environmental factors", "health outcomes", and "Geographical region" revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes.

RESULTS

The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity.

CONCLUSION

Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning.

Impact of a comprehensive tobacco control policy package on acute myocardial infarction and stroke hospital admissions in Beijing, China: interrupted time series study

OBJECTIVE

To evaluate a comprehensive tobacco control policy package on hospital admissions for acute myocardial infarction (AMI) and stroke in a global city.

DESIGN

Interrupted time series study.

SETTING

Beijing, China.

POPULATION

31 707 AMI and 128 116 stroke hospital admissions recorded by the Beijing Medical Claim Data for Employees in 17.7 million residents from January 2013 to June 2017.

INTERVENTION

The policy package including all components of MPOWER has been implemented since June 2015.

MAIN OUTCOME MEASURES

The immediate change of AMI and stroke hospital admissions and the annual change in the secular trend.

RESULTS

There was a secular increase trend for the crude hospital admission rates of AMI and stroke during the observational period. After implementation of the policy, immediate reductions were observed in the hospital admissions for both AMI (-5.4%, 95% CI -10.0% to -0.5%) and stroke (-5.6%, 95% CI -7.8% to -3.3%). In addition, the secular increase trend for stroke was slowed down by -15.3% (95% CI -16.7% to -13.9%) annually. Compared with the hypothetical scenario where the policy had not taken place, an estimated 18 137 (26.7%) stroke hospital admissions had been averted during the 25 months of postpolicy period.

CONCLUSIONS

The results indicated significant health benefits on cardiovascular morbidity after the Beijing tobacco control policy package, which highlighted the importance for a comprehensive tobacco control policy at the national level in China. Similar tobacco control policy which consists of all components of MPOWER is urgently needed in other areas, especially in settings with high tobacco consumption, to achieve greater public health gains.

Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season

Background

A large fraction of population in Almaty and other Kazakhstan cities is employed in the outdoor jobs and likely exposed to high levels of particulate matter (PM) during the cold season. The magnitude of such occupational exposure remains unknown; therefore, the aim was to quantify the levels of exposure to PM₁₀ in the outdoor workplaces in Almaty in order to guide future interventions of primary prevention.

Combinations of Epidemiological and Experimental Studies in Air Pollution Research: A Narrative Review

Scientific literature is evolving to include more systematic reviews that encompass epidemiological and experimental papers so that the whole picture can be examined. The aim of this narrative review is to bridge that gap by combining epidemiological and experimental studies based on the same setting: Examples of Bitterfeld, Utah Valley, Beijing Olympic Games, and Viadana. This review looks at four examples that incorporate multiple epidemiological and experimental papers about air pollution exposure and health effects. The Bitterfeld (spatial) and Utah Valley (temporal) examples showed that particle composition causes the biggest difference in lung injury. In Beijing, a temporal difference of before/after and during the Olympics showed that traffic and industry air pollution-related health effects like lung cancer and cardiovascular disease could be reduced by improvement of air quality. The Viadana example showed a spatial difference in respiratory injury caused by particle composition and interactions with genotoxicity. Combining experimental and epidemiological methods gives a more in-depth look into the whole picture of exposure and health effects. Our review exemplifies the strength of this strategy and encourages further use of it.

Assessment of Spatial Variability across Multiple Pollutants in Auckland, New Zealand

Spatial saturation studies using source-specific chemical tracers are commonly used to examine intra-urban variation in exposures and source impacts, for epidemiology and policy purposes. Most such studies, however, has been performed in North America and Europe, with substantial regional combustion-source contributions. In contrast, Auckland, New Zealand, a large western city, is relatively isolated in the south Pacific, with minimal impact from long-range combustion sources. However, fluctuating wind patterns, complex terrain, and an adjacent major port complicate pollution patterns within the central business district (CBD). We monitored multiple pollutants (fine particulate matter (PM_2.5), black carbon (BC), elemental composition, organic diesel tracers (polycyclic aromatic hydrocarbons (PAHs), hopanes, steranes), and nitrogen dioxide (NO₂)) at 12 sites across the ~5 km² CBD during autumn 2014, to capture spatial variation in traffic, diesel, and proximity to the port. PM_2.5 concentrations varied 2.5-fold and NO₂ concentrations 2.9-fold across the CBD, though constituents varied more dramatically. The highest-concentration constituent was sodium (Na), a distinct non-combustion-related tracer for sea salt (µ = 197.8 ng/m³ (SD = 163.1 ng/m³)). BC, often used as a diesel-emissions tracer, varied more than five-fold across sites. Vanadium (V), higher near the ports, varied more than 40-fold across sites. Concentrations of most combustion-related constituents were higher near heavy traffic, truck, or bus activity, and near the port. Wind speed modified absolute concentrations, and wind direction modified spatial patterns in concentrations (i.e., ports impacts were more notable with winds from the northeast).