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Particulate and Lung DiseaseDavid Brown Sc.D.
EHHI
How should the Public Health system work with uncertain but
plausible health hazards?
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Can We Assume That Compliance With Federal Clean Air Standards Protects Against
Short Term Health Impacts?
• Standards are set by expert committees
• There are safety factors built in standards
• Standards must have a bright line for attainment
• Compliance is monitored
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18 Feb 2004 Environment Northeast 7
Public Health Risks Are Significant
Particles are linked to:
Premature death from heart and lung disease
Aggravation of heart and lung diseases
Hospital admissions
Doctor and ER visits Medication use
School and work absences
And possibly to
Lung cancer deaths
Infant mortality
Developmental problems,such as low birth weight in children
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DIESEL PARTICLE
PM 2.5 RANGE
WATER ADSORBED
IRRITANT GAS ABSORBED IN WATER
Irritantgases Deep lung exposure
to irritants
How particles increase exposure of irritants to the deep lungs
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Results from the Harvard Six-cities study: All Cause Mortality Rates most exposed to
least exposed City Fine Particles
• All cause death 1.26 (1.08-1.47)
• Lung Cancer 1.37 (0.81-2.31)
• Cardio pulmonary 1.37 (1.11-1.68)
• Other causes 1.01 (0.79-1.30)
• Range of exposure 11-29.6 ug/m3
• Dockery, NEJM 1993; 329: 1753-1759
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Health actions from exposures of 2 hours or less.
• Peters etal. pm 2.5 & myocardial infarction– 1.48 odds ratio 2 hr after 25ug/m3 increase– 1.69 odds ratio 1 day after 20ug/m3 increase
• Gent etal. Severe asthma & O3, pm 2.5– 35% increase wheeze 1 hr after 50ppb O3 inc.– 47% increase in chest tightness 1 hr after.– 1.24 odds ratio Chest tightness 12-18ug/m3 pm
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Moral stewardship in search of an intellectual framework.
Theories of Deontology and Utilitarianism
1) Value of an act is found within the act.
2) The value of an act is found in the outcome.
Four ideas 1600-1700:
Bacon…..A new science
Newton…Reductionism a new approach
Kant…….The whole is more than the sum of the parts
Bentham….Charity- science serves the needs of men.
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Uncertainty paradox of Good Science in Public Health
• Science- Assume something is not true until proven at a level of statistical certainty.– Preferred action is to collect more data
• Public Health- Assume something may be true based on suggestive but statistically inconclusive evidence– Preferred action is to intervene to prevent
potential health effect.
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Result of application of “Good Science” is loss of time,
lives and treasure• Smoking
• Dioxin
• Asbestos
• Chordane
• Mercury
• Particulate
• Asthma at the end of the 20th century
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Health events that occur to students and teachers in
schools
• Accidents• Colds, flu and headaches• Asthmatic attacks/ treatment• Others
• Could any of these be environmental?
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Health events are rarely linked with environmental exposures
• Most health events have multiple causes• Only a small part of the group responds• The exposures are not known sufficiently• Investigations are complex and data is sparse• The cause of the effect is other than environmental
but there may be an environmental role
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But there are environmentally induced diseases and responses• Some are related to molds and other factors
in buildings
• Some have been found to be related to 6 to 12 pollutants found in outside air
• Two agents, Ozone and PM, are linked to short term asthmatic and cardiac responses
• How do we respond to these agents?
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It is necessary to understand the following
• The Health Effects that are related to air quality
• Pollutant sources
• Movement of air into and within the school
• Ways to reduce the potential for exposures
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“Bad” Air Quality
• Ozone
• Particulate Matter
• Nitrogen Dioxide
• Sulfur Dioxide
• Hazardous Air Pollutants (Toxins)
• Lead
• Carbon Monoxide
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Ozone
Adverse effects following low-concentration exposure:– chest pains, – coughing, – nausea, – throat irritation, and – congestion.
It also can worsen bronchitis, heart disease, emphysema, and asthma, and reduce lung capacity.
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Studies conducted in the northeastern United States and Canada that show that ozone air pollution may be associated with 10-20 percent of all of the summertime respiratory-related hospital admissions.
US Environmental Protection Agency, Criteria Document in support of proposed 8-hour ozone standard
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Particulate Matter
• Premature death; • Respiratory related hospital admissions and emergency
room visits; • Aggravated asthma; • Acute respiratory symptoms; • Chronic bronchitis; • Decreased lung function; and • Work and school absences.
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Particulate Matter
• EPA has revised the primary (health-based) PM standards by adding a new annual PM2.5 standard set at 15
micrograms per cubic meter (µg/m3) and a new 24-hour PM2.5 standard set at 65 µg/m3.
• EPA is retaining the current annual PM10 standard of 50
µg/m3 and adjusting the PM10 24-hour standard of 150
µg/m3 by changing the form of the standard.
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1
EPA’s AQI for PM-2.5
AQI
Index Values
AQI
Descriptor
Concentration
range (24-hour ave.)
Color
0 to 50
Good
0 g/m3 to 15.4 g/m3
Green
51 to 100
Moderate
15.5 g/m3 to 40.4 g/m3
Yellow
101 to 150
Unhealthy
for Sensitive Groups
40.5 g/m3 to 65.4 g/m3
Orange
151 to 200
Unhealthy
65.5 g/m3 to 150.4 g/m3
Red
201 to 300
Very
Unhealthy
150.5 g/m3 to 250.4 g/m3
Purple
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What does this mean?
• Air exposures induce plausible health risks from short term elevation during regulatory attainment of clean air standards.
• Science should be brought to the legal decision making.
• Investigation of the quantitative health risk from localized short term air exposures is needed.
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Question: How to use existing information to assess environmental exposures?
• Attainment model approach• Evoked response model approach• Statistical analyses
– Expected spatial distributions– Expected temporal distributions– S plus approach– Cluster analysis– Edge theory analysis
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Hourly Fine Aerosol
0
10
20
30
40
50
60
ug
/m3
As part of the process to determine whether an area meets the EPA particulate matter standard, this 3-month long series of hourly observations would be collapsed to a single value… 9.2 ug/m3… Totally obscuring any “structure” or other “content” within the data set (Carmine Dibattista, CT DEP).
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Hfd da ave NH da Ave Wby da ave HFD max NH max Wby max5/23 6.00 0.08 1.70 5/23 8.33 0.60 2.775/24 8.09 3.49 4.17 5/24 11.90 7.73 8.205/25 8.52 4.60 5.12 5/25 16.33 7.90 7.935/26 8.87 4.42 4.60 5/26 11.97 5.67 6.235/27 6.96 4.32 4.50 5/27 10.23 8.03 8.775/28 12.60 11.87 13.00 5/28 15.13 15.63 16.935/29 11.85 12.67 10.37 5/29 15.67 16.97 12.975/30 4.10 1.78 3.35 5/30 6.73 2.40 5.135/31 5.68 2.40 5.20 5/31 11.87 4.03 11.306/1 7.40 5.99 5.74 6/1 12.10 9.47 10.306/2 7.51 8.48 8.66 6/2 11.47 9.87 12.576/3 9.08 6.24 7.40 6/3 14.00 14.40 13.806/4 7.79 10.03 10.20 6/4 12.47 20.47 16.976/5 8.98 7.24 9.88 6/5 12.13 14.30 12.206/6 7.10 5.26 7.46 6/6 8.97 9.73 11.606/7 7.39 5.99 7.65 6/7 10.60 9.97 20.176/8 7.92 9.23 7.08 6/8 10.27 21.63 9.576/9 8.32 6.07 5.41 6/9 11.33 13.13 8.43
6/10 9.41 7.95 6.04 6/10 14.13 15.03 10.576/11 19.03 23.03 12.58 6/11 25.33 27.07 17.406/12 13.52 14.94 9.43 6/12 18.03 20.63 15.706/13 26.58 35.21 28.76 6/13 44.43 53.87 43.636/14 30.15 28.81 22.66 6/14 35.87 35.30 30.806/15 23.90 18.33 15.85 6/15 32.33 29.27 20.436/16 13.35 11.26 11.98 6/16 15.43 16.03 15.436/17 7.36 3.27 4.05 6/17 14.70 7.83 11.176/18 12.46 9.10 9.49 6/18 18.27 15.63 13.576/19 19.25 22.88 16.13 6/19 31.93 29.67 29.476/20 27.71 23.72 21.57 6/20 45.33 36.37 38.406/21 11.18 14.67 7.86 6/21 18.63 25.13 16.436/22 10.60 10.39 6.34 6/22 22.53 22.17 12.976/23 8.73 9.45 6.25 6/23 12.00 14.10 10.876/24 6.41 5.80 5.03 6/24 9.80 11.03 7.976/25 9.71 7.33 4.54 6/25 22.30 14.13 8.006/26 13.36 12.54 8.85 6/26 18.27 19.43 13.336/27 22.21 22.36 17.70 6/27 33.90 34.97 31.436/28 33.57 32.86 30.01 6/28 43.43 39.53 39.336/29 8.06 7.71 6.31 6/29 17.70 16.50 12.876/30 3.06 3.06 1.34 6/30 12.10 12.10 7.47
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PM 2.5 New Haven, Hartford and Waterbury (ug/m3)
June daily average
0.0010.0020.0030.00
40.0050.0060.0070.00
5/29 6/3 6/8 6/13 6/18 6/23 6/28 7/3
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Fine particles, or haze, restrict our ability to see long distances
HartfordOct. 8, 20024 p.m. EDT
Unadjusted Hourly conc. of fine particles – 4 g/m3
HartfordOct. 2, 20024 p.m. EDT
Unadjusted Hourly conc. of fine particles – 24 g/m3
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33 Air Toxics in Connecticut
43%
20%
29%
8%
Highw ay
Off Highw ay
Area
Point
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Consider the different sources of toxics in outdoor air separately
• Transport from other regions– Fossil fuel and ozone
• Transport from the within the region– Utilities, fossil fuel and transportation
• Local sources such traffic and area sources– Transportation, off road commercial
• Immediate sources near the buildings– Vehicles diesel, pesticides and construction
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School child exposure, continuous nephelometer15 minute averages
00.020.040.060.080.1
Bus 7:30 to 8:40 and 2:30 to 3:40
mg/
m3
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School child exposure, continuous nephelometer
Central Ct. town, PM 10, 5 min. moving average
00.020.040.06
0.080.1
0.12W
ait
BU
S
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
BU
S
8:30 am to 3:35 pm
mg
/m3
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School Child Exposure Continuous Nephelometer
PM 2.5 Ct. Coastal Town ( 5min moving average) 17 minute bus ride
0
0.02
0.04
0.06
0.08
Wai
t
BU
S
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
Sch
ool
8:15am to 3:20 pm
mg
/m3
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Individual Student Exposure to Particulates (PM 2.5 ug/m3)
Maximum
Mean
25th %
Minimum
75th %
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Comparing ambient pm with School and Buses
0.00
20.00
40.00
60.00
80.00
100.00
120.00
24 hr ave
Max hr
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Feb 2
7 M
ar 8'
Mar 1
5Ma
r 20
Mar 2
9Ap
r 24
Apr 2
6Ma
y 14
May 1
5
ave school
ave Bus
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Compare Bus to School and Ambient monitor for PM.
0
20
40
60
80
100
24 hr ave
Max hr
Ave school
Ave bus
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Difference in amount of exposure between times of day
8/27/99 PM 2.5 exposure ug
0.005.00
10.0015.0020.0025.0030.0035.00
Pm 2.5 exposure for 3 hr periods
0.00
20.0040.00
60.0080.00
100.00
120.00140.00
160.00
8/27/99
24.00
21.00
18.00
15.00
12.00
9.00
6.00
3.00
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Actual inhaled dose varies between day, time of day, activity and location for child
Ug PM/day shown by 3 hr dose indoor and outdoor ( based on ambient levels and normal activity)
0.00100.00200.00300.00400.00500.00600.00700.00800.00900.00
1000.00
8/20
/99
8/22
/99
8/24
/99
8/26
/99
8/28
/99
8/30
/99
9/1/
99
9/3/
99
9/5/
99
9/7/
99
9/9/
99
24.00
21.00
18.00
15.00
12.00
9.00
6.00
3.00
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One half the volume in each hour
One half the volume out each hour
School
0
50
100
150
200
250
inside
outside
Buildings have memories of outside exposuresA 400 ppm diesel particulate emission from a bus that idles for one hour next to the school exposes the students for over 3 hours
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Possible diurnal influence on school air
25% air change in building (ug/m3)out door contribution only
0
10
20
30
40
50
0 2 4 6 8
10 12
2 4 6 8
10
outdoor
indoor
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Possible diurnal influence on school air
50% exchange rate outdoor contribution only
0
10
20
30
40
50
outdoor
indoor
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Analyzing fine PM data by comparing 3-hr exposure distributions to daily and annual averages reveals significant underestimation of potential health risk.
Comparison of PM2.5 24-hr avg and 3-hr max avg for New Haven CT site, 2001
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
1 16 31 46 61 76 91 106
121
136
151
166
181
196
211
226
241
256
271
286
301
316
331
346
361
PM2.5 values ascending by day, 2001
ug
/m3
24 hr avg 3 hr max avg
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Effect of ‘morning’ decrease in local wind-speed and mixing volume during sun rise
Hourly average pm 2.5 Jan/jun 2001
0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
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PM 2.5
0
10
20
30
40
501 4 7 10 13 16 19 22
hour
NH6/27
H6/27
W6/27
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Local air quality events that are seen inside the school
• Buses idling• Morning traffic• Commercial vehicles• Construction• Sun rising and sun setting• Nocturnal Jet• Sun rising and sun setting• Changes in the weather • Pesticide applications
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Information from existing data
• Vt. monitoring data shows 11 compounds drive most of risk.
• Using CEP and NATA, EPA characterized types of risk and sources at county levels.
• Multi-city studies determine level of health risks from PM and ozone nationally.
• Levy shows local and regional risk from two power plants.
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Fine ParticulatesPM2.5 Spatial Distribution in NE
• Current monitoring network analyses average away PM2.5 variability.
• Are spatial and temporal factors (local sources, unique terrain, meteorology) influencing concentrations and creating PM gradients?
• If so, micro-scale exposure assessments must be refined.
• May reveal downward bias of health effects estimates: are missing populations at risk?
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Lessons learned or hints• Short term local exposures are
disproportionate, 5 to 15% of days in NE.
• Sources of variability are:– Location– Season– Time of day– Sources– Meteorology, weather patterns in NE
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Six ways to reduce the potential for exposures
• Identify sources near the building• Restrict emissions during periods of poor
air mixing• Reduce idling of engines during the 3 hours
prior to student occupancy of building• Increase ‘make up’ air during clean periods• Prevent stagnation of air within the school• Adjust student activities
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Conclusions• A more robust reporting statistic is needed
in addition to attainment levels.• The weather variable is discontinuous
existing in 4 forms in the NE.• National analyses do not characterized NE
risk.• Averaging time is critical for understanding
health risk• Health outcome should drive the risk
analysis