PHE-CRCE-010: Estimating Local Mortality Burdens associated with Particulate Air Pollution

The increase in mortality risk associated with long-term exposure to particulate air pollution is one of the most important, and best-characterised, effects of air pollution on health. This report presents estimates of the size of this effect on mortality in local authority areas in the UK, building upon the attributable fractions reported as an indicator in the public health outcomes framework for England. It discusses the concepts and assumptions underlying these calculations and gives information on how such estimates can be made. The estimates are expected to be useful to health and wellbeing boards when assessing local public health priorities, as well as to others working in the field of air quality and public health. The estimates of mortality burden are based on modelled annual average concentrations of fine particulate matter (PM2.5) in each local authority area originating from human activities. Local data on the adult population and adult mortality rates is also used. Central estimates of the fraction of mortality attributable to long-term exposure to current levels of anthropogenic (human-made) particulate air pollution range from around 2.5% in some local authorities in rural areas of Scotland and Northern Ireland and between 3 and 5% in Wales, to over 8% in some London boroughs. Because of uncertainty in the increase in mortality risk associated with ambient PM2.5, the actual burdens associated with these modelled concentrations could range from approximately one-sixth to about double these figures. Thus, current levels of particulate air pollution have a considerable impact on public health. Measures to reduce levels of particulate air pollution, or to reduce exposure of the population to such pollution, are regarded as an important public health initiative.

Impact of a smoking ban in public places: a rapid assessment in the Seychelles.

Background We assessed the impact of a smoking ban in hospitality venues in the Seychelles 9 months after legislation was implemented. Methods Survey officers observed compliance with the smoking ban in 38 most popular hospitality venues and administered a structured questionnaire to two customers, two workers and one manager in each venue. Results Virtually no customers or workers were seen smoking in the indoor premises. Patrons, workers and managers largely supported the ban. The personnel of the hospitality venues reported that most smokers had no difficulty refraining from smoking. However, a third of workers did not systematically request customers to stop smoking and half of them did not report adequate training. Workers reported improved health. No substantial change in the number of customers was noted. Conclusion A ban on public smoking was generally well implemented in hospitality venues but some less than optimal findings suggest the need for adequate training of workers and strengthened enforcement measures. The simple and inexpensive methodology used in this rapid survey may be a useful approach to evaluate the implementation and impact of clean air policy in low and middle-income countries.

Warm Front, Better Health: Health Impact Evaluation of the Warm Front Scheme

About 4 million households in the UK cannot adequately heat their homes in winter due to low income and poor quality housing, the two main causes of fuel poverty. The primary impact of fuel poverty is cold homes in winter which can lead to various health problems and even death among the vulnerable young and the elderly population. The government launched the Warm Front scheme in 2000 to tackle fuel poverty among the vulnerable households in England by providing energy efficiency measures in the forms insulation and modern heating system(??). By 2004, about 770,000 households had benefited from the Warm Front scheme and a total of 2 million households are still expected to benefit by 2010. Since 2001, the Bartlett has been investigating with London School of Hygiene & Tropical Medicine and Sheffield Hallam University, the health and the environmental impact of the Warm Front scheme. This investigative study is the most detailed to date on fuel poor dwellings based on detailed surveys of household and dwelling data, fuel consumption record and monitored temperature and relative humidity from 3,100 dwellings before and after the energy efficiency measures. The Warm Front investigation was expected to continue until the end of 2007. The findings from the investigation indicated that the Warm Front scheme was likely to have benefits in terms of improved thermal comfort and well-being as a result of mean temperature rise of 1.6C in the living room and 2.8C in the bedroom. Warm Front also lead to a decrease in indoor relative humidity mainly from the increased temperature since there appeared to be little impact on vapour pressure from changes in air tightness. Pressure test results indicated that the effects of air tightness measures such as draught stripping and cavity wall insulation were offset by the installation of a central heating system, particularly when the pipe work feeding radiators was installed below timber floors.

Mise en oeuvre des politiques de la mobilité urbaine : analyse comparée de processus de régulation des usages des voies publiques et de l'air dans quatre villes suisses

Résumé Ce travail s'intéresse à la mise en oeuvre des politiques publiques visant à résoudre les problèmes engendrés par le développement de la mobilité urbaine. Nous adoptons sur cette dernière un point de vue nouveau, à savoir que l'enjeu de la régulation du trafic est d'abord celui de la maîtrise des usages nombreux et conflictuels sur deux ressources collectives, l'air et les voies publiques. Pour comprendre comment ces usages sont régulés, nous mobilisons les deux apports théoriques de l'économie institutionnelle (Bromley 1991, Devlin et Grafton 1990, Ostrom 1990, 2000) et de l'analyse des politiques publiques (Knoepfel et al. 2001) au sein du cadre d'analyse des régimes institutionnels de ressources collectives. La première problématise la difficulté de définir des règles communes d'usage pour éviter la surexploitation des ressources alors que la seconde met en jeu notamment le problème de la coordination des politiques publiques d'exploitation et de protection de l'environnement. Sur ce socle, nous choisissons de retenir une approche « institutionnaliste centrée sur les acteurs » (Scharpf 1997), aussi thématisée par les approches néo-institutionnalistes (Hall/Taylor 1996, March/Olsen 1989) visant à expliquer le changement politique par deux types de variables explicatives, à savoir les changements dans la régulation publique (variable institutionnelle) et les changements de la configuration des acteurs en présence, à partir desquels nous bâtissons nos hypothèses de recherche. En l'espèce, l'étude mobilise la variable explicative des régimes institutionnels de l'air et du sol mobilisés par les acteurs de la mobilité pour comprendre l'évolution de la répartition des usages sur les routes urbaines. Ce processus passe par le recours à des ressources de politiques publiques comme le droit, l'argent, l'information, le consensus, le soutien politique, l'infrastructure ou le temps que les acteurs peuvent activer en fonction des règles institutionnelles en présence. On peut classer ces dernières d'abord selon leur niveau de généralité (niveaux opérationnel, des choix collectifs et constitutionnel - Ostrom 1990). L'étude établit que la régulation des usages connaît une importante gradation que rend compte le concept de résistance normative. En fonction de cette dernière, les acteurs essaient de s'imposer au moyen de deux dimensions des règles, que ce travail met en exergue, à savoir selon qu'elles régulent tantôt le mode de décision tantôt le mode d'appropriation. Ces règles décisionnelles et possessionnelles déterminent les possibilités d'accès, ainsi que la procédure d'intervention et la place qui sont réservées aux acteurs, aussi bien pour les ressources collectives physiques que de politique publique. L'étude permet ainsi à la fois d'apporter des éléments nouveaux à la théorie des changements de régimes institutionnels de ressources collectives, d'éclairer un peu plus les processus de mise en couvre de l'action publique et de contribuer au débat sur les principales propositions permettant de maîtriser les impacts négatifs du développement de la mobilité.

Major influencing factors of indoor radon concentrations in Switzerland.

PURPOSE: In Switzerland, nationwide large-scale radon surveys have been conducted since the early 1980s to establish the distribution of indoor radon concentrations (IRC). The aim of this work was to study the factors influencing IRC in Switzerland using univariate analyses that take into account biases caused by spatial irregularities of sampling. METHODS: About 212,000 IRC measurements carried out in more than 136,000 dwellings were available for this study. A probability map to assess risk of exceeding an IRC of 300 Bq/m(3) was produced using basic geostatistical techniques. Univariate analyses of IRC for different variables, namely the type of radon detector, various building characteristics such as foundation type, year of construction and building type, as well as the altitude, the average outdoor temperature during measurement and the lithology, were performed comparing 95% confidence intervals among classes of each variable. Furthermore, a map showing the spatial aggregation of the number of measurements was generated for each class of variable in order to assess biases due to spatially irregular sampling. RESULTS: IRC measurements carried out with electret detectors were 35% higher than measurements performed with track detectors. Regarding building characteristics, the IRC of apartments are significantly lower than individual houses. Furthermore, buildings with concrete foundations have the lowest IRC. A significant decrease in IRC was found in buildings constructed after 1900 and again after 1970. Moreover, IRC decreases at higher outdoor temperatures. There is also a tendency to have higher IRC with altitude. Regarding lithology, carbonate rock in the Jura Mountains produces significantly higher IRC, almost by a factor of 2, than carbonate rock in the Alps. Sedimentary rock and sediment produce the lowest IRC while carbonate rock from the Jura Mountains and igneous rock produce the highest IRC. Potential biases due to spatially unbalanced sampling of measurements were identified for several influencing factors. CONCLUSIONS: Significant associations were found between IRC and all variables under study. However, we showed that the spatial distribution of samples strongly affected the relevance of those associations. Therefore, future methods to estimate local radon hazards should take the multidimensionality of the process of IRC into account.

Air pollution exposure during pregnancy and reduced birth size: a prospective birth cohort study in Valencia, Spain

Background Maternal exposure to air pollution has been related to fetal growth in a number of recent scientific studies. The objective of this study was to assess the association between exposure to air pollution during pregnancy and anthropometric measures at birth in a cohort in Valencia, Spain. Methods Seven hundred and eighty-five pregnant women and their singleton newborns participated in the study. Exposure to ambient nitrogen dioxide (NO2) was estimated by means of land use regression. NO2 spatial estimations were adjusted to correspond to relevant pregnancy periods (whole pregnancy and trimesters) for each woman. Outcome variables were birth weight, length, and head circumference (HC), along with being small for gestational age (SGA). The association between exposure to residential outdoor NO2 and outcomes was assessed controlling for potential confounders and examining the shape of the relationship using generalized additive models (GAM). Results For continuous anthropometric measures, GAM indicated a change in slope at NO2 concentrations of around 40 μg/m3. NO2 exposure >40 μg/m3 during the first trimester was associated with a change in birth length of -0.27 cm (95% CI: -0.51 to -0.03) and with a change in birth weight of -40.3 grams (-96.3 to 15.6); the same exposure throughout the whole pregnancy was associated with a change in birth HC of -0.17 cm (-0.34 to -0.003). The shape of the relation was seen to be roughly linear for the risk of being SGA. A 10 μg/m3 increase in NO2 during the second trimester was associated with being SGA-weight, odds ratio (OR): 1.37 (1.01-1.85). For SGA-length the estimate for the same comparison was OR: 1.42 (0.89-2.25). Conclusions Prenatal exposure to traffic-related air pollution may reduce fetal growth. Findings from this study provide further evidence of the need for developing strategies to reduce air pollution in order to prevent risks to fetal health and development.

Biofilm formation at the solid-liquid and air-liquid interfaces by Acinetobacter species

The members of the genus Acinetobacter are Gram-negative cocobacilli that are frequently found in the environment but also in the hospital setting where they have been associated with outbreaks of nosocomial infections. Among them, Acinetobacter baumannii has emerged as the most common pathogenic species involved in hospital-acquired infections. One reason for this emergence may be its persistence in the hospital wards, in particular in the intensive care unit; this persistence could be partially explained by the capacity of these microorganisms to form biofilm. Therefore, our main objective was to study the prevalence of the two main types of biofilm formed by the most relevant Acinetobacter species, comparing biofilm formation between the different species. Findings: Biofilm formation at the air-liquid and solid-liquid interfaces was investigated in different Acinetobacter spp. and it appeared to be generally more important at 25°C than at 37°C. The biofilm formation at the solid-liquid interface by the members of the ACB-complex was at least 3 times higher than the other species (80-91% versus 5-24%). In addition, only the isolates belonging to this complex were able to form biofilm at the air-liquid interface; between 9% and 36% of the tested isolates formed this type of pellicle. Finally, within the ACB-complex, the biofilm formed at the air-liquid interface was almost 4 times higher for A. baumannii and Acinetobacter G13TU than for Acinetobacter G3 (36%, 27% & 9% respectively). Conclusions: Overall, this study has shown the capacity of the Acinetobacter spp to form two different types of biofilm: solid-liquid and air-liquid interfaces. This ability was generally higher at 25°C which might contribute to their persistence in the inanimate hospital environment. Our work has also demonstrated for the first time the ability of the members of the ACB-complex to form biofilm at the air-liquid interface, a feature that was not observed in other Acinetobacter species.

Formulation and Implementation of Air Quality Control Pogrammes : Patterns of Interest Consideration

This article investigates some central aspects of the relationships between programme structure and implementation of sulphur dioxide air quality control policies. Previous implementation research, primarily adopting American approaches, has neglected the connections between the processes of programme formulation and implementation. 'Programme', as the key variable in implementation studies, has been defined too narrowly. On the basis of theoretical and conceptual reflections and provisional empirical results from studies in France, Italy, England, and the Federal Republic of Germany, the authors demonstrate that an integral process analysis using a more extended programme concept is necessary if patterns of interest recognition in policies are to be discovered. Otherwise, the still important question of critical social science cannot be answered, namely, what is the impact of special interests upon implementation processes.

Residential Exposure to Outdoor Air Pollution during Pregnancy and Anthropometric Measures at Birth in a Multicenter Cohort in Spain

BACKGROUND. A growing body of research suggests that prenatal exposure to air pollution may be harmful to fetal development. We assessed the association between exposure to air pollution during pregnancy and anthropometric measures at birth in four areas within the Spanish Children's Health and Environment (INMA) mother and child cohort study. METHODS. Exposure to ambient nitrogen dioxide (NO2) and benzene was estimated for the residence of each woman (n = 2,337) for each trimester and for the entire pregnancy. Outcomes included birth weight, length, and head circumference. The association between residential outdoor air pollution exposure and birth outcomes was assessed with linear regression models controlled for potential confounders. We also performed sensitivity analyses for the subset of women who spent more time at home during pregnancy. Finally, we performed a combined analysis with meta-analysis techniques. RESULTS. In the combined analysis, an increase of 10 µg/m3 in NO2 exposure during pregnancy was associated with a decrease in birth length of -0.9 mm [95% confidence interval (CI), -1.8 to -0.1 mm]. For the subset of women who spent ≥ 15 hr/day at home, the association was stronger (-0.16 mm; 95% CI, -0.27 to -0.04). For this same subset of women, a reduction of 22 g in birth weight was associated with each 10-µg/m3 increase in NO2 exposure in the second trimester (95% CI, -45.3 to 1.9). We observed no significant relationship between benzene levels and birth outcomes. CONCLUSIONS. NO2 exposure was associated with reductions in both length and weight at birth. This association was clearer for the subset of women who spent more time at home.