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Air Quality and Pulmonary Function: A New England Approach to Integrated Assessment Cameron Wake Institute for the Study of Earth, Oceans and Space Tom Kelly, Jeff Salloway, Robert Woodward and Adam Wilson University of New Hampshire Human Dimensions of Global Environmental Change Montreal, 16-18 October 2003


NOAA OGP Regional Integrated Sciences and Assessment Program Human Health and Air Quality and shortcomings INHALE (Integrated Human Health and Air Quality Research) goals approach stakeholders unique opportunity in 2004 Overview


National Oceanographic and Atmospheric Administration (NOAA) Office of Global Programs - Regional Integrated Sciences and Assessment Focus on climate sensitive issues of concern to decision-makers and policy planners at a regional level California fire, drought, stream flow forecasts, reservoir management, climate change, drought Arizona agriculture and groundwater management, forecast validation, drought response, health Northwest reservoir management, fisheries, drought, climate change mitigation and adaption South East agricultural crop modeling, extension development, hydrology, fire, frost-freeze Western Water water policy, snowpack, drought New England air quality and human health Carolinas* water quality, drought Hawaii* extreme events, climate services


Noontime photograph of Denora, Pennsylvania on 29 Oct 1948 during a deadly smog event. From the Pittsburgh Post-Gazette.


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 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. 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 follow up 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)


Relative Risk of Mortality Associated with a 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.)


Relative Risk of Mortality Associated with an 18.6 µg/m3 Increase in Fine Particles in the Reanalysis of the 6 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.)


Ozone / Hospital Admissions (Burnett, et al 2001) -20 0 20 40 O3 (ppbv) difference from mean value (5-day average filtered Max 1-hour ppb) 1.0 0.5 0.0 -0.5 Respiratory Hospital Admissions Anomalies (adjusted)


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., 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


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 transportation+217% ---- ---- 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.


Present day adverse health effects that could be avoided every year by meeting the US EPA's daily maximum ozone standard (80 ppb 8-hour) in New York, NY. Figure sections not drawn to scale. From Thurston, 1997. “Tip of the Iceberg”


Problem Statement Air Quality Issues -indoor vs outdoor -year round meas. -multi-parameter -discontinuos (e.g. toxics) Health Tracking Issues -access -coarse spatial and temporal resolution -what to track -tip of iceberg


Goal of INHALE project is to improve public health by: 1) engaging a wide range of stakeholders in a collaborative effort to better define the link between broad measures of 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 air quality forecasting effort. 3) Determine the health care costs associated with air pollution events Integrated Human Health and Air Quality Research (INHALE)


•Interdisciplinary •Involve key stakeholders and community leaders development of strategic research plan, implementation, analysis, and dissemination of results •Fine spatial and temporal resolution -hourly air quality data (AIRMAP, state agencies) -collect hierarchy of health effects data **collect continuous pulmonary function data** **focus on children** -city or better spatial resolution INHALE - Key Features


UNH Departments and Institutes AIRMAP (Atmospheric Investigation, Regional Modeling, Analysis and Prediction) Institute for the Study of Earth, Oceans and Space Office of Sustainability Programs Dept of Health Management and Policy Whitemore School of Business and Economics Masters of Public Health New Hampshire Institute of Health Policy Cooperative Extension Stakeholders Lung Association (Maine, NB) International Center for Air Quality and Health New Hampshire Department of Environmental Services New Hampshire Health and Human Services New Hampshire Department of Education Vermont Health and Human Services Manchester Health Department Maine Bureau of Health University of Southern Maine/NASA Environmental Human Health Institute University of Connecticut Health Center Northeast States for Coordinated Air Use Management (NESCAUM) Asthma Regional Council (ARC) of New England EPA Region 1 Center for Disease Control “Environmental Health Tracking Grants INHALE - Key Stakeholders


Low cost pulmonary function monitor Forced Expiratory Volume in 1 sec (FEV1) Peak Flow Download data directly to computer and web page Plus daily respiratory symptoms (cough, wheeze, chest tightness, shortness of breath)


INHALE - Research Activities Pulmonary Health Tracking-Individual Spirometry Measurements PLUS • Summer camp pilot project, Bear Hill Camp, NH • NH Schools • summer 2004 Retrospective Investigations - Air Quality and Hospital Visits • Portland and Manchester complete (1997-2000) • Extended to other cities and states in New England Estimating the Economic Effects of Poor Air Quality in New England •modify Ontario Medical Assoc. Illness Cost of Air Pollution model


Summer 2004 New England/North Atlantic International Climate and Air Quality Field Campaign •detailed 3D, multi-parameter investigation of air quality in NE & NA • multiple measurement platforms to include: aircraft (NOAA P-3, NASA DC-8 & P3, DOE, UMD, MSC, CNRS, ITOP) balloons satellites (Aura, Terra, EnviSat) Ship (NOAA Ronald Brown) Surface Stations -EPA/State monitoring programs (O3-68; SO2-26, PM10-33, PM2.5-44; CO-16; NO2-17) -NOAA Profiler and LIDAR Networks -AIRMAP; Harvard Forest -Buoys (WHOI) • pilot study: 2002 New England Air Quality Study (3 day mtg in May 2003; AGU special session; JGR special issue)


AIRMAP Stations


Atmospheric Measurements at AIRMAP Monitoring Sites


DOE G-1 NOAA P-3 NASA DC-8 UH/UNH Additional Research Platforms Summer 2004 New England/North Atlantic International Climate and Air Quality Field Campaign NOAA R/V Ronald H. Brown NOAA R/V Ronald H. Brown


Summer 2004 represents unique opportunity to better understand the relationship between health effects and air pollution events 1. Collect a hierarchy of health effects data relating primarily to pulmonary health •Daily pulmonary function (FEV1 and respiratory symptoms) -children at summer camps -young adults a summer University sport camps -scientists at research facilities -federal, state and municipal employees -inner city youth (Roxbury, Providence, New Haven, Portland) • Hospital ER visits and drug use in near real time (syndromic data) • ‘standard’ retrospective data as it becomes available to compare to AQ data •Physican visit data via Sentinal Physician Program •Hospital utilization and Physician Visit Data from individual hospitals in near real time (e.g., Wentworth Douglas) Scientific Objectives - Summer 2004 Health Tracking Campaign


•multi-disciplinary approach •stakeholder involvement •link to climate - can we predict poor air quality months in advance? •focused on improving public health -adaption and mitigation •2004 unique opportunity to “piggy back” on major air quality study INHALE - Integrated Assessment - Summary


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 1257

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