Corrigendum to "City scale climate change policies: Do they matter for wellbeing?" [Prev. Med. Rep. 6 (2017) 265-270]

[This corrects the article DOI: 10.1016/j.pmedr.2017.03.019.].

Advancements in Life Cycle Human Exposure and Toxicity Characterization

BACKGROUND

The Life Cycle Initiative, hosted at the United Nations Environment Programme, selected human toxicity impacts from exposure to chemical substances as an impact category that requires global guidance to overcome current assessment challenges. The initiative leadership established the Human Toxicity Task Force to develop guidance on assessing human exposure and toxicity impacts. Based on input gathered at three workshops addressing the main current scientific challenges and questions, the task force built a roadmap for advancing human toxicity characterization, primarily for use in life cycle impact assessment (LCIA).

OBJECTIVES

The present paper aims at reporting on the outcomes of the task force workshops along with interpretation of how these outcomes will impact the practice and reliability of toxicity characterization. The task force thereby focuses on two major issues that emerged from the workshops, namely considering near-field exposures and improving dose–response modeling.

DISCUSSION

The task force recommended approaches to improve the assessment of human exposure, including capturing missing exposure settings and human receptor pathways by coupling additional fate and exposure processes in consumer and occupational environments (near field) with existing processes in outdoor environments (far field). To quantify overall aggregate exposure, the task force suggested that environments be coupled using a consistent set of quantified chemical mass fractions transferred among environmental compartments. With respect to dose–response, the task force was concerned about the way LCIA currently characterizes human toxicity effects, and discussed several potential solutions. A specific concern is the use of a (linear) dose–response extrapolation to zero. Another concern addresses the challenge of identifying a metric for human toxicity impacts that is aligned with the spatiotemporal resolution of present LCIA methodology, yet is adequate to indicate health impact potential.

CONCLUSIONS

Further research efforts are required based on our proposed set of recommendations for improving the characterization of human exposure and toxicity impacts in LCIA and other comparative assessment frameworks. https://doi.org/10.1289/EHP3871.

Characterizing Aggregated Exposure to Primary Particulate Matter: Recommended Intake Fractions for Indoor and Outdoor Sources

Exposure to fine particulate matter (PM_2.5) from indoor and outdoor sources is a leading environmental contributor to global disease burden. In response, we established under the auspices of the UNEP/SETAC Life Cycle Initiative a coupled indoor-outdoor emission-to-exposure framework to provide a set of consistent primary PM_2.5 aggregated exposure factors. We followed a matrix-based mass balance approach for quantifying exposure from indoor and ground-level urban and rural outdoor sources using an effective indoor-outdoor population intake fraction and a system of archetypes to represent different levels of spatial detail. Emission-to-exposure archetypes range from global indoor and outdoor averages, via archetypal urban and indoor settings, to 3646 real-world cities in 16 parametrized subcontinental regions. Population intake fractions from urban and rural outdoor sources are lowest in Northern regions and Oceania and highest in Southeast Asia with population-weighted means across 3646 cities and 16 subcontinental regions of, respectively, 39 ppm (95% confidence interval: 4.3-160 ppm) and 2 ppm (95% confidence interval: 0.2-6.3 ppm). Intake fractions from residential and occupational indoor sources range from 470 ppm to 62 000 ppm, mainly as a function of air exchange rate and occupancy. Indoor exposure typically contributes 80-90% to overall exposure from outdoor sources. Our framework facilitates improvements in air pollution reduction strategies and life cycle impact assessments.

Spatial and temporal trends in the mortality burden of air pollution in China: 2004-2012

While recent assessments have quantified the burden of air pollution at the national scale in China, air quality managers would benefit from assessments that disaggregate health impacts over regions and over time. We took advantage of a new 10×10km satellite-based PM_2.5 dataset to analyze spatial and temporal trends of air pollution health impacts in China, from 2004 to 2012. Results showed that national PM_2.5 related deaths from stroke, ischemic heart disease and lung cancer increased from approximately 800,000 cases in 2004 to over 1.2 million cases in 2012. The health burden exhibited strong spatial variations, with high attributable deaths concentrated in regions including the Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Pearl River Delta, Sichuan Basin, Shandong, Wuhan Metropolitan Region, Changsha-Zhuzhou-Xiangtan, Henan, and Anhui, which have heavy air pollution, high population density, or both. Increasing trends were found in most provinces, but with varied growth rates. While there was some evidence for improving air quality in recent years, this was offset somewhat by the countervailing influences of in-migration together with population growth. We recommend that priority areas for future national air pollution control policies be adjusted to better reflect the spatial hotspots of health burdens. Satellite-based exposure and health impact assessments can be a useful tool for tracking progress on both air quality and population health burden reductions.

Indoor inhalation intake fractions of fine particulate matter: review of influencing factors

Exposure to fine particulate matter (PM_2.5 ) is a major contributor to the global human disease burden. The indoor environment is of particular importance when considering the health effects associated with PM_2.5 exposures because people spend the majority of their time indoors and PM_2.5 exposures per unit mass emitted indoors are two to three orders of magnitude larger than exposures to outdoor emissions. Variability in indoor PM_2.5 intake fraction (iF_in,total ), which is defined as the integrated cumulative intake of PM_2.5 per unit of emission, is driven by a combination of building-specific, human-specific, and pollutant-specific factors. Due to a limited availability of data characterizing these factors, however, indoor emissions and intake of PM_2.5 are not commonly considered when evaluating the environmental performance of product life cycles. With the aim of addressing this barrier, a literature review was conducted and data characterizing factors influencing iF_in,total were compiled. In addition to providing data for the calculation of iF_in,total in various indoor environments and for a range of geographic regions, this paper discusses remaining limitations to the incorporation of PM_2.5 -derived health impacts into life cycle assessments and makes recommendations regarding future research.

Public health impacts of city policies to reduce climate change: findings from the URGENCHE EU-China project

BACKGROUND

Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments.

METHODS

Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response functions. Additionally there were literature reviews, three longitudinal observational studies and two cross sectional surveys.

RESULTS

There are four key findings. Firstly introduction of electric cars may confer some small health benefits but it would be unwise for a city to invest in electric vehicles unless their power generation fuel mix generates fewer emissions than petrol and diesel. Second, adopting policies to reduce private car use may have benefits for carbon dioxide reduction and positive health impacts through reduced noise and increased physical activity. Third, the benefits of carbon dioxide reduction from increasing housing efficiency are likely to be minor and co-benefits for health and wellbeing are dependent on good air exchange. Fourthly, although heating dwellings by in-home biomass burning may reduce carbon dioxide emissions, consequences for health and wellbeing were negative with the technology in use in the cities studied.

CONCLUSIONS

The climate-change reduction policies reduced CO2 emissions (the most common greenhouse gas) from cities but impact on global emissions of CO2 would be more limited due to some displacement of emissions. The health and wellbeing impacts varied and were often limited reflecting existing relatively high quality of life and environmental standards in most of the participating cities; the greatest potential for future health benefit occurs in less developed or developing countries.

Building-related health impacts in European and Chinese cities: a scalable assessment method

BACKGROUND

Public health is often affected by societal decisions that are not primarily about health. Climate change mitigation requires intensive actions to minimise greenhouse gas emissions in the future. Many of these actions take place in cities due to their traffic, buildings, and energy consumption. Active climate mitigation policies will also, aside of their long term global impacts, have short term local impacts, both positive and negative, on public health. Our main objective was to develop a generic open impact model to estimate health impacts of emissions due to heat and power consumption of buildings. In addition, the model should be usable for policy comparisons by non-health experts on city level with city-specific data, it should give guidance on the particular climate mitigation questions but at the same time increase understanding on the related health impacts and the model should follow the building stock in time, make comparisons between scenarios, propagate uncertainties, and scale to different levels of detail. We tested The functionalities of the model in two case cities, namely Kuopio and Basel. We estimated the health and climate impacts of two actual policies planned or implemented in the cities. The assessed policies were replacement of peat with wood chips in co-generation of district heat and power, and improved energy efficiency of buildings achieved by renovations.

RESULTS

Health impacts were not large in the two cities, but also clear differences in implementation and predictability between the two tested policies were seen. Renovation policies can improve the energy efficiency of buildings and reduce greenhouse gas emissions significantly, but this requires systematic policy sustained for decades. In contrast, fuel changes in large district heating facilities may have rapid and large impacts on emissions. However, the life cycle impacts of different fuels is somewhat an open question.

CONCLUSIONS

In conclusion, we were able to develop a practical model for city-level assessments promoting evidence-based policy in general and health aspects in particular. Although all data and code is freely available, implementation of the current model version in a new city requires some modelling skills.

Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of mixtures in residential indoor air

The maximum cumulative ratio (MCR) method allows the categorisation of mixtures according to whether the mixture is of concern for toxicity and if so whether this is driven by one substance or multiple substances. The aim of the present study was to explore, by application of the MCR approach, whether health risks due to indoor air pollution are dominated by one substance or are due to concurrent exposure to various substances. Analysis was undertaken on monitoring data of four European indoor studies (giving five datasets), involving 1800 records of indoor air or personal exposure. Application of the MCR methodology requires knowledge of the concentrations of chemicals in a mixture together with health-based reference values for those chemicals. For this evaluation, single substance health-based reference values (RVs) were selected through a structured review process. The MCR analysis found high variability in the proportion of samples of concern for mixture toxicity. The fraction of samples in these groups of concern varied from 2% (Flemish schools) to 77% (EXPOLIS, Basel, indoor), the variation being due not only to the variation in indoor air contaminant levels across the studies but also to other factors such as differences in number and type of substances monitored, analytical performance, and choice of RVs. However, in 4 out of the 5 datasets, a considerable proportion of cases were found where a chemical-by-chemical approach failed to identify the need for the investigation of combined risk assessment. Although the MCR methodology applied in the current study provides no consideration of commonality of endpoints, it provides a tool for discrimination between those mixtures requiring further combined risk assessment and those for which a single-substance assessment is sufficient.

Environmental burden of disease in Europe: assessing nine risk factors in six countries

BACKGROUND

Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report.

OBJECTIVES

The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands).

METHODS

Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting.

RESULTS

About 3-7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000-10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600-1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust.

CONCLUSIONS

With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability.

Population exposure to fine particles and estimated excess mortality in Finland from an East European wildfire episode

Long-range transported particulate matter (PM) air pollution episodes associated with wildfires in the Eastern Europe are relatively common in Southern and Southeastern Finland. In severe cases such as in August-September 2002, the reduced visibility and smell of the smoke, and symptoms such as irritation of eyes and airways experienced by the population raise the issue into the headlines. Because PM air pollution, in general, has been identified as a major health risk, and the exposures are of repeating nature, the issue warrants a risk assessment to estimate the magnitude of the problem. The current work uses the available air quality data in Finland to estimate population exposures caused by one of the worst episodes experienced in this decade. This episode originated from wildfires in Russia, Belarus, Ukraine, and the Baltic countries. The populations of 11 Southern Finnish provinces were exposed between 26 August and 8 September 2002, for 2 weeks to an additional population-weighted average PM(2.5) level of 15.7 microg/m(3). Assuming similar effect on mortality for these particles as observed in epidemiological time series studies on urban particles (0.5%-2% increase in mortality per 10 microg/m(3), central estimate 1%), this exposure level would be associated with 9-34 cases (17 cases central estimate) of additional mortality. Epidemiological evidence specific to particles from biomass combustion is scarce, affecting also the reliability of the current risk assessment. Do the wildfire aerosols exhibit the same level of toxicity as the urban particles? To shed light on this question, it is interesting to look at the exposure data in relationship to the observed daily mortality in Finland, even though the limited duration of the episode allows only for a weak statistical power. The percentage increases observed (0.8%-2.1% per 10 microg/m(3) of fine PM) are in line with the more general estimates for urban PM and those used in the current risk assessment.

Driver and passenger exposure to aerosol particles in buses and trams in Helsinki, Finland

This study investigates commuter and driver exposure to aerosol particles in buses and trams in Helsinki, Finland. Particle number and PM(2.5) concentrations were determined in the cabin and the driver's compartment. In addition, the <2.5 microm black carbon concentration was measured in the driver's compartment and PM(2.5) was collected for elemental analysis in the cabin. The measurements were repeated on two generations of buses and trams including two measurement days in each vehicle type. Fine particle number and mass concentrations in the driver's compartments were only slightly increased compared to Helsinki background air. Daily average ratios of number and mass to the background varied in range 0.8-4.3 and 1.0-2.9, respectively, both being the highest in the older bus type. However, the drivers were exposed to elevated levels of black carbon, which some studies have addressed to be strongly correlated with adverse health effects. The daily average ratio of black carbon to the background varied between 2.4 and 11.4. Additionally, the black carbon concentration had spatial variation. The drivers were exposed to higher peak concentrations of black carbon in downtown area. Particle concentrations were smaller in the driver's compartment than in the cabin. The newer technology in the newer model of the tram and bus seemed to decrease driver exposure to aerosol particles.

The INDEX project: executive summary of a European Union project on indoor air pollutants

The prevalence of allergies, asthma and other respiratory diseases in large populations has increased in recent decades. Among other factors, this phenomenon has been connected to adverse health effects of air pollution. Although some causal links between occupational exposures and their health effects are shown, still little is known about the health risks of lifelong exposure to indoor air pollutants. To assess the health risks of indoor air pollutants at prevailing concentration levels in Europe, the Joint Research Centre of the European Commission carried out a project called "Critical Appraisal of the Setting and Implementation of Indoor Exposure Limits in the EU" (INDEX). The aims of the project were: (1) to assess health risks of indoor-originated chemical pollutants that might be regulated in the EU and (2) to provide suggestions and recommendations on potential exposure limits or other risk management measures. The results of the INDEX project should contribute to the development of an EU strategy for the management of indoor air quality. The highest priority was given in this study to: formaldehyde, nitrogen dioxide, carbon monoxide, benzene and naphthalene. Exposure limits, recommendations and management options were also given to minimize the health risks for these compounds.

Issues in consumer exposure modeling: towards harmonization on a global scale

Understanding where and how chemicals are used throughout their life cycle is becoming increasingly important. In 2003, within the context of REACH and GPSD legislation, the European Commission started developing a European and global infrastructure of exposure methods and tools. The infrastructure aims (1) to link modeling tools and exposure-related data and scenarios in a single framework so that harmonized exposure assessment procedures can be developed for consumer products in the EU and (2) to make this framework flexible enough to allow global application. A number of issues are raised by a global infrastructure of consumer exposure modeling that answers to multi-legislative mandates. These include transparency, consistency, usability, and defensibility of the models, including the relevant degree of complexity for priority setting versus assessment. As part of the initiative to set up a harmonized global infrastructure on consumer exposure assessment, these issues were presented, discussed, and further developed in a series of European Commission-sponsored workshops organized in October 2004 and June 2005 as part of the "Harmonization of Consumer Exposure Models on a Global Scale" project. The project focused on development, harmonization, and validation of consumer exposure modeling approaches. The workshops included experts from the EU, USA, Japan, and Canada. The conclusions and recommendations made on the basis of this work are described. To help achieve harmonization of approaches, the European Commission's Joint Research Centre is proposing a framework (1) to compare information on elements of chemical risk assessment to understand exposure regulations in different countries, (2) to save time and expense by sharing information and models, and (3) to promote credible science through better communication among organizations and by peer review of assessments and assessment procedures.

Risk management measures for chemicals in consumer products: documentation, assessment, and communication across the supply chain

This paper analyzes the way risk management measures (RMMs) for consumer products have been used to date in authority and industry risk assessments. A working concept for consumer product RMMs is developed, aimed at controlling, limiting or avoiding exposures, and helping to insure the safe use (or handling) of a substance as part of a consumer product. Particular focus is placed on new requirements introduced by REACH (registration, evaluation, and authorization of chemicals). A RMMs categorization approach is also developed, dividing consumer product RMMs into those that are product integrated and those that are communicated to consumers. For each of these categories, RMMs for normal use, accidental use or misuse need to be distinguished. The level of detail for documenting, assessing and communicating RMMs across supply chains can vary, depending on the type of the assessment (tiered approach). Information on RMMs was collected from published sources to demonstrate that a taxonomical approach using standard descriptors for RMMs libraries is needed for effective information exchange across supply chains.

Source apportionment of population representative samples of PM(2.5) in three European cities using structural equation modelling

Apportionment of urban particulate matter (PM) to sources is central for air quality management and efficient reduction of the substantial public health risks associated with fine particles (PM(2.5)). Traffic is an important source combustion particles, but also a significant source of resuspended particles that chemically resemble Earth's crust and that are not affected by development of cleaner motor technologies. A substantial fraction of urban ambient PM originates from long-range transport outside the immediate urban environment including secondary particles formed from gaseous emissions of mainly sulphur, nitrogen oxides and ammonia. Most source apportionment studies are based on small number of fixed monitoring sites and capture well population exposures to regional and long-range transported particles. However, concentrations from local sources are very unevenly distributed and the results from such studies are therefore poorly representative of the actual exposures. The current study uses PM(2.5) data observed at population based random sampled residential locations in Athens, Basle and Helsinki with 17 elemental constituents, selected VOCs (xylenes, trimethylbenzenes, nonane and benzene) and light absorbance (black smoke). The major sources identified across the three cities included crustal, salt, long-range transported inorganic and traffic sources. Traffic was associated separately with source categories with crustal (especially Athens and Helsinki) and long-range transported chemical composition (all cities). Remarkably high fractions of the variability of elemental (R(2)>0.6 except for Ca in Basle 0.38) and chemical concentrations (R(2)>0.5 except benzene in Basle 0.22 and nonane in Athens 0.39) are explained by the source factors of an SEM model. The RAINS model that is currently used as the main tool in developing European air quality management policies seems to capture the local urban fraction (the city delta term) quite well, but underestimates crustal particle levels in the three cities of the current study. Utilizing structural equation modelling parallel with traditional principal component analysis (PCA) provides an objective method to determine the number of factors to be retained in a model and allows for formal hypotheses testing.

Risk characterization and proposal of exposure thresholds to indoor chemical agents: the Index European project

The European INDEX project was finalised to identify priorities and to assess the needs for an European Community strategy and action plan in the area of indoor air pollution. A list of 5 chemicals, with potential of high indoor concentrations, uncontested health impacts, and effective risk management, were selected to be regulated with priority: Formaldehyde, Carbon Monoxide, Nitrogen Dioxide, Benzene and Naphtalene. For each compound, guideline values and management options were suggested.

Current state of the science: health effects and indoor environmental quality

Our understanding of the relationship between human health and the indoor environment continues to evolve. Previous research on health and indoor environments has tended to concentrate on discrete pollutant sources and exposures and on specific disease processes. Recently, efforts have been made to characterize more fully the complex interactions between the health of occupants and the interior spaces they inhabit. In this article we review recent advances in source characterization, exposure assessment, health effects associated with indoor exposures, and intervention research related to indoor environments. Advances in source characterization include a better understanding of how chemicals are transported and processed within spaces and the role that other factors such as lighting and building design may play in determining health. Efforts are under way to improve our ability to measure exposures, but this remains a challenge, particularly for biological agents. Researchers are also examining the effects of multiple exposures as well as the effects of exposures on vulnerable populations such as children and the elderly. In addition, a number of investigators are also studying the effects of modifying building design, materials, and operations on occupant health. Identification of research priorities should include input from building designers, operators, and the public health community.

Personal carbon monoxide exposure levels: contribution of local sources to exposures and microenvironment concentrations in Milan

In the framework of the EXPOLIS study in Milan, Italy, 48-h carbon monoxide (CO) exposures of 50 office workers were monitored over a 1-year period. In this work, the exposures were assessed for different averaging times and were compared with simultaneous ambient fixed-site concentrations. The effect of gas cooking and smoking and different methods of commuting on the microenvironment and exposure levels of CO were investigated. During the sampling the subjects completed a time-microenvironment-activity diary differentiating 11 microenvironments and three exposure influencing activities: gas cooking, smoking and commuting. After sampling, all exposure and time allocation data were stored in a relational database that is used in data analyses. Ambient 48-h and maximum 8-h distributions were similar compared to the respective personal exposures. The maximum 1-h personal exposures were much higher than the maximum 8-h exposures. The maximum 1-h exposures were as well higher than the corresponding ambient distribution. These findings indicate that high short-term exposures were not reflected in ambient monitoring data nor by long-term exposures. When gas cooking or smoking was present, the indoor levels at "home-" and in "other indoor" microenvironments were higher than without their presence. Compared with ambient data, the latter source was the most affective to increase the indoor levels. Exposure during commuting was higher than in all other microenvironments; the highest daily exposure contribution was found during "car/taxi" driving. Most of the CO exposure is acquired in indoor microenvironments. For the indoor microenvironments, ambient CO was the weakest predictor for "home indoor" concentrations, where the subjects spent most of their time, and the strongest for "other indoor" concentrations, where the smallest fraction of the time was spent. Of the main indoor sources, gas cooking, on average, significantly raised the indoor exposure concentrations for 45 min and tobacco smoking for 30 min. The highest exposure levels were experienced in street commuting. Personal exposures were well predicted, but 1-h maximum personal exposures were poorly predicted, by respective ambient air quality data. By the use of time-activity diaries, ETS exposure at the workplaces were probably misclassified due to differences in awareness to tobacco smoke between smokers and nonsmokers.

Simulation of working population exposures to carbon monoxide using EXPOLIS-Milan microenvironment concentration and time-activity data

Current air pollution levels have been shown to affect human health. Probabilistic modeling can be used to assess exposure distributions in selected target populations. Modeling can and should be used to compare exposures in alternative future scenarios to guide society development. Such models, however, must first be validated using existing data for a past situation. This study applied probabilistic modeling to carbon monoxide (CO) exposures using EXPOLIS-Milan data. In the current work, the model performance was evaluated by comparing modeled exposure distributions to observed ones. Model performance was studied in detail in two dimensions; (i) for different averaging times (1, 8 and 24 h) and (ii) using different detail in defining the microenvironments in the model (two, five and 11 microenvironments). (iii) The number of exposure events leading to exceeding the 8-h guideline was estimated. Population time activity was modeled using a fractions-of-time approach assuming that some time is spent in each microenvironment used in the model. This approach is best suited for averaging times from 24 h upwards. In this study, we tested how this approach affects results when used for shorter averaging times, 1 and 8 h. Models for each averaging time were run with two, five and 11 microenvironments. The two-microenvironment models underestimated the means and standard deviations (SDs) slightly for all averaging times. The five- and 11-microenvironment models matched the means quite well but underestimated SDs in several cases. For 1- and 24-h averaging times the simulated SDs are slightly smaller than the corresponding observed values. The 8-h model matched the observed exposure levels best. The results show that for CO (i) the modeling approach can be applied for averaging times from 8 to 24 h and as a screening model even to an averaging time of 1 h; (ii) the number of microenvironments affects only weakly the results and in the studied cases only exposure levels below the 80th percentile; (iii) this kind of model can be used to estimate the number of high-exposure events related to adverse health effects. By extrapolation beyond the observed data, it was shown that Milanese office workers may experience adverse health effects caused by CO.

Description and demonstration of the EXPOLIS simulation model: two examples of modeling population exposure to particulate matter

As a part of the EXPOLIS study, a stochastic exposure-modeling framework was developed. The framework is useful to compare exposure distributions of different (sub-) populations or different scenarios, and to gain insight into population exposure distributions and exposure determinants. It was implemented in an MS-Excel workbook using @Risk add-on software. Basic concept of the framework is that time-weighted average exposure is a sum of partial exposures in the visited microenvironments. Partial exposure is determined by the concentration and the time spent in the microenvironment. In the absence of data, indoor concentrations are derived as a function of ambient concentrations, effective penetration rates and contribution of indoor sources. Framework input parameters are described by probability distributions. A lognormal distribution is assumed for the microenvironment concentrations and for the contribution of indoor sources, and a beta distribution for the time spent in a microenvironment and for the penetration factor. Mean and standard deviation values parameterize the distributions. In this paper, Latin Hypercube sampling is used for the input distributions. The outcome of the framework is an estimate of the population exposure distribution for the selected air pollutant. The framework is best suited for averaging times from 24 h upwards. Sensitivity analyses can be performed to determine the most influential factors of exposure. The application of the framework is illustrated in two examples. The EXPOLIS PM(2.5) example uses microenvironment measurement and time-activity data from the EXPOLIS study to model PM(2.5) population exposure distributions in four European cities. The results are compared to the observed personal exposure distributions from the same study. The Dutch PM(10) example uses input data from several (Dutch) databases and from literature, and shows a more complex application of the framework for comparison of scenarios and subpopulations.

EXPOLIS simulation model: PM2.5 application and comparison with measurements in Helsinki

PM(2.5) exposure distributions of adult Helsinki citizens were simulated using a probabilistic simulation framework. Simulation results were compared to corresponding personal exposure distributions measured in the EXPOLIS study in Helsinki. The simpler models 1 and 2 (with two and three microenvironments, respectively) predict the general outline of the exposure distributions reasonably well. Compared to the observed exposure distribution, the mean is underestimated by less than 3 microg m(-3) (20%) and the standard deviation by 23-35%. In the improved simulation models (3 and 4), the environmental tobacco smoke (ETS)-exposed subjects are excluded, the time-activity models of working and nonworking subpopulations are modeled separately, and the correlations of input concentration and time fraction variables have been accounted for. The output of these models was very close to the observed distributions; the differences in the means were less than 0.1 microg m(-3) and the differences in standard deviation less than 1%. We conclude that when the required input data are available or can be reliably estimated, the target population PM(2.5) exposure distributions can be predicted accurately enough for most practical purposes using this kind of a microenvironment model.

Chapter one: exposure measurements

Determining human exposure to suspended particulate concentrations requires measurements that quantify different particle properties in microenvironments where people live, work, and play. Particle mass, size, and chemical composition are important exposure variables, and these are typically measured with time-integrated samples on filters that are later submitted to laboratory analyses. This requires substantial sample handling, quality assurance, and data reduction. Newer technologies are being developed that allow in-situ, time-resolved measurements for mass, carbon, sulfate, nitrate, particle size, and other variables. These are large measurement systems that are more suitable for fixed monitoring sites than for personal applications. Human exposure studies need to be designed to accomplish specific objectives rather than to serve too many purposes. Resources need to be divided among study design, field sampling, laboratory analysis, quality assurance, data management, and data analysis phases. Many exposure projects allocated too little to the non-measurement activities.

Fine PM measurements: personal and indoor air monitoring

This review compiles personal and indoor microenvironment particulate matter (PM) monitoring needs from recently set research objectives, most importantly the NRC published "Research Priorities for Airborne Particulate Matter (1998)". Techniques and equipment used to monitor PM personal exposures and microenvironment concentrations and the constituents of the sampled PM during the last 20 years are then reviewed. Development objectives are set and discussed for personal and microenvironment PM samplers and monitors, for filter materials, and analytical laboratory techniques for equipment calibration, filter weighing and laboratory climate control. The progress is leading towards smaller sample flows, lighter, silent, independent (battery powered) monitors with data logging capacity to store microenvironment or activity relevant sensor data, advanced flow controls and continuous recording of the concentration. The best filters are non-hygroscopic, chemically pure and inert, and physically robust against mechanical wear. Semiautomatic and primary standard equivalent positive displacement flow meters are replacing the less accurate methods in flow calibration, and also personal sampling flow rates should become mass flow controlled (with or without volumetric compensation for pressure and temperature changes). In the weighing laboratory the alternatives are climatic control (set temperature and relative humidity), and mechanically simpler thermostatic heating, air conditioning and dehumidification systems combined with numerical control of temperature, humidity and pressure effects on flow calibration and filter weighing.

Photometrically measured continuous personal PM(2.5) exposure: levels and correlation to a gravimetric method

There is evidence that hourly variations in exposure to airborne particulate matter (PM) may be associated with adverse health effects. Still there are only few published data on short-term levels of personal exposure to PM in community settings. The objectives of the study were to assess hourly and shorter-term variations in personal PM(2.5) exposure in Helsinki, Finland, and to compare results from portable photometers to simultaneously measured gravimetric concentrations. The effect of relative humidity on the photometric results was also evaluated. Personal PM(2.5) exposures of elderly persons were assessed for 24 h every second week, resulting in 308 successful measurements from 47 different subjects. Large changes in concentrations in minutes after cooking or changing microenvironment were seen. The median of daily 1-h maxima was over twice the median of 24-h averages. There was a strong significant association between the two means, which was not linear. Median (95th percentile) of the photometric 24-h concentrations was 12.1 (37.7) and of the 24-h gravimetric concentrations 9.2 (21.3) microg/m3. The correlation between the photometric and the gravimetric method was quite good (R2=0.86). Participants spent 94.1% of their time indoors or in a vehicle, where relative humidity is usually low and thus not likely to cause significant effects on photometric results. Even outdoors, the relative humidity had only modest effect on concentrations. Photometers are a promising method to explore the health effects of short-term variation in personal PM(2.5) exposure.

Comparison of black smoke and PM2.5 levels in indoor and outdoor environments of four European cities

Recent studies on separated particle-size fractions highlight the health significance of particulate matter smaller than 2.5 microm (PM2.5), but gravimetric methods do not identify specific particle sources. Diesel exhaust particles (DEP) contain elemental carbon (EC), the dominant light-absorbing substance in the atmosphere. Black smoke (BS) is a measure for light absorption of PM and, thus, an alternative way to estimating EC concentrations, which may serve as a proxy for diesel exhaust emissions. We analyzed PM2.5 and BS data collected within the EXPOLIS study (Air Pollution Exposure Distribution within Adult Urban Populations in Europe) in Athens, Basel, Helsinki, and Prague. 186 indoor/outdoor filter pairs were sampled and analyzed. PM2.5 and BS levels were lowest in Helsinki, moderate in Basel, and remarkably higher in Athens and Prague. In each city, Spearman correlation coefficients of indoor versus outdoor were higher for BS (range rspearman: 0.57-0.86) than for PM2.5 (0.05-0.69). In a BS linear regression model (all data), outdoor levels explained clearly more of indoor variation (86%) than in the corresponding PM2.5 model (59%). In conclusion, ambient BS seizes a health-relevant fraction of fine particles to which people are exposed indoors and outdoors and exposure to which can be assessed by monitoring outdoor concentrations. BS measured on PM2.5 filters can be recommended as a valid and cheap additional indicator in studies on combustion-related air pollution and health.

Exposures to nitrogen dioxide in EXPOLIS-Helsinki: microenvironment, behavioral and sociodemographic factors

Personal exposures to nitrogen dioxide (NO(2)) were monitored for 176 randomly selected inhabitants (25-55 years old) of Helsinki Metropolitan area as a part of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) study between October 1996 and December 1997. NO(2) measurements were 48-h averages collected by Palmes passive sampler tubes. Differences in personal exposures to NO(2) were analyzed between sub-populations stratified by microenvironment, behavioral, socioeconomic and demographic factors. Factors significantly associated with differences in exposures to NO(2) were home and work location, housing characteristics, traffic volume near home, season and keeping windows open at home. Exposure to environmental tobacco smoke (ETS) and use of gas stove were also associated with increased personal exposures, although only few participants had a gas stove in Helsinki, and other gas appliances are non-existent. Single adults had higher average exposures to NO(2) than married or cohabiting participants, suggesting differences in living conditions between these two groups. Increased education was associated with decreased exposures to NO(2) and employed men were more exposed than unemployed men. Increased exposures to NO(2) were not associated with age or occupational status in Helsinki. Thus, behavioral and sociodemographic factors may have significant impact on personal exposures to NO(2) and should be considered in addition to environmental determinants in any monitoring program.

Evaluation of VOC measurments in the EXPOLIS study. Air Pollution Exposure Distributions within Adult Urban Urban Populations in Europe

Personal exposures and microenvironment concentrations of 30 target VOCs were measured for 401 participants living in five European cities as a part of the EXPOLIS (Air Pollution Exposure Distributions within Adult Urban Populations in Europe) study. Measurements in Basel used an active charcoal (Carbotech) adsorbent as opposed to the Tenax TA used in the other study centres. In addition, within each centre, personal and microenvironment VOC sampling required different sampling pumps and, because of different sampling durations, different sampling flow rates. Thus, careful testing of the sampling and analysis procedures was required to ensure accuracy and comparability of collected data. Monitor comparison tests using Tenax TA showed a mean VOC concentration ratio of 0.95 between the personal and microenvironment monitors. The LODs for the target VOCs using Tenax TA ranged from 0.7 to 5.2 microg m(-3). The LODs for the 14 target compounds quantifiable using Carbotech ranged from 0.9 to 3.2 microg m(-3). Tenax TA field blanks showed no remarkable contamination with the target VOCs, except benzaldehyde, a known artefact with this adsorbent. Thus, the diffusion barrier system used prevented contamination of Tenax TA samples by passive diffusion during non-sampling periods. Duplicate and parallel evaluations of the Tenax TA and Carbotech showed an average difference of < 17% in VOC concentrations within the sampling methods, but a systematic difference between the methods (Tenax TA: Carbotech concentration ratio = 1.18-2.36). These field evaluations and quality assurance tests showed that interpretation and comparison of the results in any VOC monitoring exercise should be done on a compound by compound basis. It is also apparent that carefully planned and realised QA and QC (QA/QC) procedures are needed in multi-centre studies, where a common sampling method and laboratory analysis technique are not used, to strengthen and simplify the interpretation of observed VOC levels between participating centres.

Personal exposure levels and microenvironmental concentrations of formaldehyde and acetaldehyde in the Helsinki metropolitan area, Finland

Personal 48-hr exposures to formaldehyde and acetaldehyde of 15 randomly selected participants were measured during the summer/autumn of 1997 using Sep-Pak DNPH-Silica cartridges as a part of the EXPOLIS study in Helsinki, Finland. In addition to personal exposures, simultaneous measurements of microenvironmental concentrations were conducted at each participant's residence (indoor and outdoor) and workplace. Mean personal exposure levels were 21.4 ppb for formaldehyde and 7.9 ppb for acetaldehyde. Personal exposures were systematically lower than indoor residential concentrations for both compounds, and ambient air concentrations were lower than both indoor residential concentrations and personal exposure levels. Mean workplace concentrations of both compounds were lower than mean indoor residential concentrations. Correlation between personal exposures and indoor residential concentrations was statistically significant for both compounds. This indicated that indoor residential concentrations of formaldehyde and acetaldehyde are a better estimate of personal exposures than are concentrations in ambient air. In addition, a time-weighted exposure model did not improve the estimation of personal exposures above that obtained using indoor residential concentrations as a surrogate for personal exposures. Correlation between formaldehyde and acetaldehyde was statistically significant in outdoor microenvironments, suggesting that both compounds have similar sources and sinks in ambient urban air.

Nitrogen dioxide exposure assessment and cough among preschool children

The association between exposure to ambient air nitrogen dioxide and cough was evaluated in a panel study among 162 children aged 3-6 y. The weekly average nitrogen dioxide exposure was assessed with Palmes-tube measurements in three ways: (1) personally, (2) outside day-care centers, and (3) inside day-care centers. Ambient air nitrogen dioxide concentrations were obtained from the local network that monitored air quality. The parents recorded cough episodes daily in a diary. The risk of cough increased significantly (relative risk = 3.63; 95% confidence interval = 1.41, 9.30) in the highest personal nitrogen dioxide exposure category in winter, and a nonsignificant positive trend was noted for the other assessment groups. In spring, risk increased nonsignificantly in all exposure-assessment groups, except for the fixed-site monitoring assessment. It is important that investigators select an exposure-assessment method sufficiently accurate to reflect the effective pollutant dose in subjects.

Sociodemographic descriptors of personal exposure to fine particles (PM2.5) in EXPOLIS Helsinki

Demographic and socioeconomic differences between population sub-groups were analyzed, as a component of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) Helsinki study, to explain variation in personal exposures to fine particles (PM2.5). Two-hundred one individuals were randomly selected among 25--55-year-old inhabitants of Helsinki Metropolitan area. Personal exposure samples and residential indoor, residential outdoor and workplace indoor microenvironment measurements of PM2.5 were collected between October 1996 and December 1997. Variation in PM2.5 personal exposures, between sociodemographic sub-groups, was best described by differences in occupational status, education and age. Lower occupational status, less educated and young participants had greater exposures than upper occupational status, more educated and older participants. Different workplace concentrations explained most of the socioeconomic differences, and personal day and night exposures and concentrations in home (but not workplace or outdoor concentrations) caused the PM2.5 exposure differences between age groups. Men had higher exposures and much larger exposure differences between the sociodemographic groups than women. No gender, socioeconomic or age differences were observed in home outdoor concentrations between groups. Exposure to tobacco smoke did not seem to create new differences between the sociodemographic groups; instead, it amplified the existing differences.

Validity of ambient levels of fine particles as surrogate for personal exposure to outdoor air pollution--results of the European EXPOLIS-EAS Study (Swiss Center Basel)

To evaluate the validity of fixed-site fine particle levels as exposure surrogates in air pollution epidemiology, we considered four indicator groups: (1) PM2.5 total mass concentrations, (2) sulfur and potassium for regional air pollution, (3) lead and bromine for traffic-related particles, and (4) calcium for crustal particles. Using data from the European EXPOLIS (Air Pollution Exposure Distribution within Adult Urban Populations in Europe) study, we assessed the associations between 48-hr personal exposures and home outdoor levels of the indicators. Furthermore, within-city variability of fine particle levels was evaluated. Personal exposures to PM2.5 mass were not correlated to corresponding home outdoor levels (n = 44, rSpearman (Sp) = 0.07). In the group reporting neither relevant indoor sources nor relevant activities, personal exposures and home outdoor levels of sulfur were highly correlated (n = 40, rSp = 0.85). In contrast, the associations were weaker for traffic (Pb: n = 44, rSp = 0.53; Br: n = 44, rSp = 0.21) and crustal (Ca: n = 44, rSp = 0.12) indicators. This contrast is consistent with spatially homogeneous regional pollution and higher spatial variability of traffic and crustal indicators observed in Basel, Switzerland. We conclude that for regional air pollution, fixed-site fine particle levels are valid exposure surrogates. For source-specific exposures, however, fixed-site data are probably not the optimal measure. Still, in air pollution epidemiology, ambient PM2.5 levels may be more appropriate exposure estimates than total personal PM2.5 exposure, since the latter reflects a mixture of indoor and outdoor sources.

The methadone-maintained pregnancy

Methadone treatment during pregnancy offers overwhelming advantages compared with the less acceptable option of medical detoxification or the unacceptably dangerous option of leaving heroin-addicted women dependent on street drugs. General agreement exists that pregnancy offers a unique opportunity to bring women into medical, obstetric, and drug treatment. Methadone maintenance in the setting of comprehensive service provision during pregnancy reduces maternal morbidity and mortality and promotes fetal stability and growth. With an accumulated experience of over 25 years, methadone maintenance has been shown to be an invaluable and often an essential ingredient in bettering the health of women during pregnancy, in improving the outcomes of those pregnancies, and in offering opiate-addicted women a chance to improve both their lives and the lives of their families.

Seasonal exposure to NO2 and respiratory symptoms in preschool children

One hundred seventy-two preschool children, aged three to six years, who attended municipal day-care centers in central and suburban areas of Helsinki, were followed up for seven weeks during the winter season and for eight weeks during the spring season in 1991. For each child, the weekly average NO2 exposure was estimated using passive samplers attached to the outer garments of the children during their everyday activities. Respiratory symptoms were recorded in daily diaries by the parents. The median of personally measured seasonal NO2 exposures was 21 micrograms/m3 (range 11-45.8 micrograms/m3). The seasonal median NO2 exposure was significantly larger (p < 0.001) in the central area (27.4 micrograms/m3) than in the suburban area (18.2 micrograms/m3), reflecting a difference in exposure caused by automobile traffic. There also were significantly (p < 0.001) more days with stuffed nose (26% vs. 20%) and cough (18% vs. 15%) in the central area than in the suburban area. At the individual level, there was a nonsignificant positive correlation between personal NO2 exposure and cough during the spring season. Thus the areal difference in these symptoms was partly, but not completely, due to the difference in exposure to NO2.

Stimulation of prostacyclin synthesis by physical exercise in type I diabetes

We examined the effect of short- and long-term exercise on prostacyclin (prostaglandin I2 [PGI2]) and thromboxane A2 (TXA2) synthesis in type I (insulin-dependent) diabetic patients and healthy control subjects. PGI2 synthesis was assessed by determining the urinary excretion of 6-keto-PGF1 alpha and 2,3-dinor-6-keto-PGF1 alpha and TX synthesis by measuring TXB2 in serum and urine. In the resting state, prostanoid excretion and concentrations were similar in diabetic and control subjects. During 40 min of ergometric cycling exercise, the urinary excretion of 6-keto-PGF1 alpha (a hydration product of vasodilatory PGI2) increased 5.8-fold more in the 12 control subjects than in the 15 diabetic patients (P less than .02). Serum TXB2 concentration rose similarly in diabetic patients and control subjects (P less than .05). During a 75-km competitive cross-country ski race (7 h, 30 min), urinary excretion of 6-keto-PGF1 alpha rose 1.9-fold in 7 diabetic (P less than .05) and 3.3-fold in 10 control (P less than .001) subjects, whereas urinary dinor excretion, reflecting vascular PGI2 synthesis more closely, increased only in the control subjects (P less than .01). Urinary TXB2 excretion remained unchanged in both groups during long-term exercise. These data suggest that diabetic patients have normal PGI2 and TXA2 synthesis in the resting state but diminished PGI2 response to both acute and prolonged exercise.