Integrated Pulmonary Function and Air Quality Research in Northern New England

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Integrated Pulmonary Function and Air Quality
Research in Northern New England Cameron Wake,
Adam Wilson, and many others University of New
Hampshire Mid-Atlantic Air Management Association
Meeting, Baltimore, MD 20 Jan 2003
Trends in Asthma 1980-2000 Linking Asthma to
Air Pollution Asthma just the tip of the
iceberg Integrated Human Health and Air Quality
Research (INHALE) -multidisciplinary, community
based prospective time-series study of
pulmonary function and air quality in three
northern New England cities.
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Indicators of Climate Change in New England
SeaWiFS 9/12/01 Eastern North America and
Hurricane Erin
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Noontime photograph of Denora, Pennsylvania on 29
Oct 1948 during a deadly smog event. From the
Pittsburgh Post-Gazette.
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Factors which cause asthma and/or responsible
for recent rise in asthma prevalence Hereditary
Atopic Disorder Exposure to
contaminants Cigarette smoke Obeisty Heigene P
ollution? ??? Factors which provoke
asthma Cigarette Smoke Biological - Pollen,
Mold Emotional Stress Indoor Air Quality (dust
mites, etc.) Weather / Outdoor Air Quality
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Linking Asthma to Air Pollution
Majority of research links air pollution with
exacerbation, not prevalence
(California study by McConnell et al notable
exception) Recent focus has shifted to
time-series studies of weather driven day-to-day
variations in relatively low levels of air
pollution over long periods of time as
determinants of mortality, hospital admissions
and other public health indicators.
Advantages include large contrast in
exposure over time, populations serve as their
own control, use of routinely collected
data Comments based on recent reviews
by Harvard Six City/ACS Reanalysis Air
Pollution and Heath, Holgate et al (eds), 1999,
Academic Press Brunekreef and Holgate, Lancet v.
360, p.1233-1242, 2002 And human health response
during Interventions -Atlanta summer Olympics
(Friedman et al, 2001) -Closure of Steel Mill in
Utah (Pope, 1989)

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Reanalysis of the Harvard Six Cities Study and
the American Cancer Society (ACS) Study of
Particulate Air Pollution and Mortality Health
Effects Institute, July 2002
Study Overview Harvard
ACS sulfate particles No. cities
6 151 50 No.
subjects 8,111 552,138 295,223 No.
deaths 1,430 38,963 20,765 Mean age
49.7 58.5 58.6 Air
Quality study based EPA
EPA monitors Total followup yrs 14-16
about 7 ?PM2.5(µg/m3) 18.6 (11-29.6)
24.5(9-33.5) ?SO4 8.0(4.8-12.8) 19.9(3.6-23.5)
Original Works Dockery et al., An association
between air pollution and mortality in six US
cities, NE Journal of Medicine 329, 1753-1759,
1993. Pope et al., Air pollution as a predictor
of mortality in a prospective study of U.S.
adults. Am J Respir Crit Care Med 151, 669-674,
1995.
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Relative Risk of Mortality Associated with an
18.6 µg/m3 Increase in Fine Particles in the
Reanalysis of the Six Cities Study
Risk Models Base air pollution only Original
air pollution, sex, age, smokers, pack-years
smoking, BMI, education Full Original plus
several other covariates (passive smoking,
marital status, alcohol, etc.)
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Relative Risk of Mortality Associated with an
24.5 µg/m3 Increase in Fine Particles in the
Reanalysis of the ACS Study
Risk Models Base air pollution only Original
air pollution, sex, age, smokers, pack-years
smoking, BMI, education Full Original plus
several other covariates (passive smoking,
marital status, alcohol, etc.)
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Relative Risk of Mortality Associated with an
19.9 µg/m3 Increase in Sulfate in the Reanalysis
of the ACS Study
Risk Models Base air pollution only Original
air pollution, sex, age, smokers, pack-years
smoking, BMI, education Full Original plus
several other covariates (passive smoking,
marital status, alcohol, etc.)
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Reported relative risks of mortality associated
with a 100 ppb increase In 1-h maximum ozone
(with 95 CI). From Thurston and Ito, 1999
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Reported relative risks of respiratory hospital
admission with a 100 ppb increase in daily 1-h
maximum ozone (with 95 CI). From Thurston and
Ito, 1999
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Ozone / Hospital Admissions(Burnett, et al 2001)
1.0 0.5 0.0 -0.5
Respiratory Hospital Admissions
Anomalies (adjusted)
-20 0 20
40 O3 (ppbv) difference from mean value (5-day
average filtered Max 1-hour ppb)
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Impact of Changes in Transportation Behaviors
During 1996 Summer Olympic Games in Atlanta on
Air Quality and Childhood Asthma Friedman et al.,
2001, J. American Medical Assoc., vol. 285, p.
897-905 Strategies to minimize road traffic
congestion during the Olympics -integrated 24
hour-a-day public transportation
system -addition of 1000 buses for park-and-ride
services -alternative work hours and
telecommuting -altered downtown delivery
schedules -public warning of potential traffic
and air quality problems
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Change During 1996 Olympic Period Compared to
Baseline Period change Olympics
Baseline (July 19-Aug 4) (Jun
21-Jul 18 Aug 5 - Sep 1) traffic
counts -23 ---- ----- Public
transportation217 ---- ---- Ozone (1 hr
ppb) -30 59 81 CO (8 hr ppm) -19
1.26 1.54 PM10 (24 hr µg/m3) -16
30.8 36.7 Acute Asthma Events (visits per
day ages 1-16 ) Georgia Medicaid -42
4.23 2.47 HMO -44 1.36
0.67 NOTE little to no change in acute
nonasthma events CONCLUSIONS extended reduction
in ozone and PM10 at levels below EPA National
Ambient Air Quality Standards (NAAQS ozone 120
ppb CO 9 ppm PM10 150 µg/m3)can reduce asthma
morbidity in children decreasing auto emission
through citywide changes in transportation and
commuting practices can prevent a substantial
number of asthma exacerbations requiring medical
attention.
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Respiratory Disease Associated with Air Pollution
and Steel Mill Closures, Utah Valley Pope 1989,
Am. Journal of Public Health p. 623
Study assessed hospital admissions in Utah Valley
from April 1985 - February 1988 Local Geneva
Steel Plant closed from August 1986 - September
1987 due to labor dispute Steel plant was primary
source of PM10 in Utah County Only 5.5 of adults
were smokers Results indicate a significant
reduction in PM10 and hospital admissions for
children ages 0-17 during winter.
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Tip of the Iceberg
Present day adverse health effects that could be
avoided every year by meeting the US EPA's (80
ppb 8-hour) daily maximum ozone standard in New
York, NY. Figure sections not drawn to scale.
From Thurston, 1997.
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Integrated Human Health and Air Quality Research
(INHALE)
Goal To improve public health by 1) engaging a
wide range of stakeholders in the development and
implementation of a strategic plan to better
define the link between pulmonary health and air
pollution and 2) using the results of the
investigation to create informed public policy
and guide the product development of the
NOAA-funded AIRMAP air quality forecasting
research effort. Key Features (or why is this
study different?) -multidisciplinary (physical
scientists, epidemiologist, health economist, UNH
Masters of Public Health Program, Office of
Sustainability, nurses, public health officials).
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-involve key stakeholders and community leaders
from the beginning to assist with development of
strategic research plan, implementation,
analysis, and dissemination of results (Manchester
Health Dept., Manchester School Nurses, American
Lung Association, Jordan Institute, Asthma
Regional Coordinating Council Council, American
Lung Association, NESCAUM, NH DES, NH Health and
Human Services, EPA) -spatial and temporal
resolution 3 cities (Manchester, Portland and
Burlington) hourly (or better) air quality data
(AIRMAP, state agencies) outdoor and indoor air
quality (O3, PM2.5, hydrocarbons, etc) collect
hierarchy of pulmonary function data
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INHALE will focus on three northern New England
cities Manchester, Portland, and Burlington
Manchester Portland
Burlington Population 107,006 64,249
38,889 Race White 92
91 92 Black
2 3 2
Asian 2 3
3 Home ownership 46
43 42 High School
graduate 75 83
82 Median Household income 31,911
26,576 25,523 Per capita income
15,111 14,914 13,918 2001 Air Quality
Summary (EPA) O3 exceedance days 1
8 1 O3 max 8 hr
average(ppb) 98 105
82 PM10 annual mean(µg/m3) 16 29
15 SO2 max 1 hr (ppb) 156
38 n/a SO2 annual mean
(ppb) 3 3
n/a
Burlington
Portland
Manchester
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Ozone peak 1 hour concentrations - from EPA
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INHALE Timeline Spring/Summer 2003 develop
strategic plan summit meeting in June
retrospective study for Portland complete Summer
2003 test pulmonary function methodology and
interventions at childrens summer camps in NH
train Manchester school nurses on data entry Fall
2003 begin collecting multi-level pulmonary
function data in Manchester Fall 2004 Identify
key stakeholders/schools in Portland and
Burlington
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Retrospective Study of Weather, Air Quality and
visits to the Hospital and Emergency Room for
Respiratory Problems in Portland, Maine

• Time-series analysis of day-to-day variation in
• Counts of hospital admittances and emergency room
  visits
• Air Quality Ozone (summers 1987-2000), SO2
  (1987-2000), and PM2.5 (2000) measured at
  centrally located monitors
• Weather Synoptic classification and measured
  parameters (temp, relative humidity, etc)
• While adjusting for time (weekday, season,
  long-term trend)
• Generalized additive models allow quantification
  of non-linear relationships
• Analysis should be completed by May 2003

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Portland, Maine Air Quality and Hospital
Admittances
PM2.5 ug/m3
SO2 ppbv
O3 ppbv
Respiratory Hospital Admittances
1987 1990
1995 2000
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Portland, Maine Air Quality and Emergency Room
Visits
PM2.5 ug/m3
SO2 ppbv
O3 ppbv
Respiratory Emergency Room Visits
1998 1999
2000
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Ongoing/Future Human Health/Air Pollution Research
Community Action to Remediate Respiratory
Distress (CARRD) partners with the low-income,
ethnic/racial, and refugee communities of
Manchester, NH (NIH proposal) Influence of
allergenic pollen on asthma exacerbation Paul
Epstein et al., Harvard Center for Health and the
Global Env. Diesel school buses NESCAUM/David
Brown state environment agencies potential for
intervention study International Center for Air
Quality and Health -led by Maine Chapter, ALA
and New Brunswick CLA Chapter Indoor/Outdoor Air
Quality -NESCAUM/Melinda Treadwell Interdicsiplna
ry Analysis of Childhood Asthma Using
GIS -Elissa Levine (NASA Goddard)/Samantha
Langley USM
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Hidden Health Benefits of Greenhouse Gas
Mitigation Luis Cifuentes, Victor
H. Borja-Aburto, Nelson Gouveia, George Thurston,
Devra Lee Davis actions that reduce GHG
emissions also yield powerful immediate benefits
to public health by reducing adverse effects
of local air pollution air pollution currently
sickening or killing millions throughout
world reducing emissions from older coal-fired
power plants in U.S. could provide substantial
benefits to public health avoidance of 18,700
deaths, 3 million lost work days, 16 million
restricted activity days (Clean Air Task
Force, Boston, MA 2000) reduction in adverse
health effects over 20 years (2001-2020) in 4
cities (Mexico City, New York, Santiago, and
Sao Paulo - combined population 65 million)
through adoption of GHG mitigation
technologies that would reduce ozone and PM by
10. This would avoid 64,000 premature
deaths 65,000 chronic bronchitis cases 37
million person days of restricted activity GHG
mitigation can provide considerable local public
health benefits air pollution reduction-related
health benefits could be strong motivator for GHG
mitigation actions
www.sciencemag.org SCIENCE VOL 293 17
AUGUST 2001
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