Erik Lebret

Mapping urban air pollution using GIS: a regression-based approach

As part of the EU-funded SAVIAH project, a regression-based methodology for mapping traffic-related air pollution was developed within a GIS environment. Mapping was carried out for NO2 in Amsterda...

Improving health through policies that promote active travel: A review of evidence to support integrated health impact assessment

BACKGROUND Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences. OBJECTIVES AND METHODS We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions. RESULTS AND DISCUSSION Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time. CONCLUSION Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.

Chronic respiratory symptoms in children and adults living along streets with high traffic density.

OBJECTIVES: To investigate if the population living along streets with high traffic density has a higher prevalence of chronic respiratory symptoms. METHODS: A sample of 673 adults and 106 children (0-15 years), living along busy traffic streets in the city of Haarlem was compared with a control sample of 812 adults and 185 children living along quiet streets. Exposed and control streets were selected on the basis of model calculations of NO2 concentrations. A postal questionnaire containing questions about respiratory symptoms and several potential confounders was used to collect information from the study subjects. RESULTS: After adjustment for potential confounders, children living along busy streets were found to have a higher prevalence of most respiratory symptoms than children living along quiet streets. Adjusted odds ratios were significant for wheeze and for respiratory medication used. Risk ratios were higher for girls than for boys, with significant adjusted odds ratios between 2.9 and 15.8 for girls. In adults, only mild dyspnoea was more often reported by subjects living along streets with high traffic density. CONCLUSIONS: The results suggest that living along busy streets increases the risk of developing chronic respiratory symptoms in children.

Respiratory health effects of airborne particulate matter: the role of particle size, composition, and oxidative potential-the RAPTES project.

Background: Specific characteristics of particulate matter (PM) responsible for associations with respiratory health observed in epidemiological studies are not well established. High correlations among, and differential measurement errors of, individual components contribute to this uncertainty. Objectives: We investigated which characteristics of PM have the most consistent associations with acute changes in respiratory function in healthy volunteers. Methods: We used a semiexperimental design to accurately assess exposure. We increased exposure contrast and reduced correlations among PM characteristics by exposing volunteers at five different locations: an underground train station, two traffic sites, a farm, and an urban background site. Each of the 31 participants was exposed for 5 hr while exercising intermittently, three to seven times at different locations during March–October 2009. We measured PM10, PM2.5, particle number concentrations (PNC), absorbance, elemental/organic carbon, trace metals, secondary inorganic components, endotoxin content, gaseous pollutants, and PM oxidative potential. Lung function [FEV1 (forced expiratory volume in 1 sec), FVC (forced vital capacity), FEF25–75 (forced expiratory flow at 25–75% of vital capacity), and PEF (peak expiratory flow)] and fractional exhaled nitric oxide (FENO) were measured before and at three time points after exposure. Data were analyzed with mixed linear regression. Results: An interquartile increase in PNC (33,000 particles/cm3) was associated with an 11% [95% confidence interval (CI): 5, 17%] and 12% (95% CI: 6, 17%) FENO increase over baseline immediately and at 2 hr postexposure, respectively. A 7% (95% CI: 0.5, 14%) increase persisted until the following morning. These associations were robust and insensitive to adjustment for other pollutants. Similarly consistent associations were seen between FVC and FEV1 with PNC, NO2 (nitrogen dioxide), and NOx (nitrogen oxides). Conclusions: Changes in PNC, NO2, and NOx were associated with evidence of acute airway inflammation (i.e., FENO) and impaired lung function. PM mass concentration and PM10 oxidative potential were not predictive of the observed acute responses.

Aircraft noise around a large international airport and its impact on general health and medication use

Aims: To assess the prevalence of general health status, use of sleep medication, and use of medication for cardiovascular diseases, and to study their relation to aircraft noise exposure. Methods: These health indicators were measured by a cross-sectional survey among 11 812 respondents living within a radius of 25 km around Schiphol airport (Amsterdam). Results: Adjusted odds ratios ranged from 1.02 to 2.34 per 10 dB(A) increase in Lden. The associations were statistically significant for all indicators, except for use of prescribed sleep medication or sedatives and frequent use of this medication. None of the health indicators were associated with aircraft noise exposure during the night, but use of non-prescribed sleep medication or sedatives was associated with aircraft noise exposure during the late evening (OR = 1.72). Vitality related health complaints such as tiredness and headache were associated with aircraft noise, whereas most other physical complaints were not. Odds ratios for the vitality related complaints ranged from 1.16 to 1.47 per 10 dB(A) increase in Lden. A small fraction of the prevalence of poor self rated health (0.13), medication for cardiovascular diseases or increased blood pressure (0.08), and sleep medication or sedatives (0.22) could be attributed to aircraft noise. Although the attributable fraction was highest in the governmentally noise regulated area, aircraft noise had more impact in the non-regulated area, due to the larger population. Conclusions: Results suggest associations between community exposure to aircraft noise and the health indicators poor general health status, use of sleep medication, and use of medication for cardiovascular diseases.

Expert elicitation on ultrafine particles: likelihood of health effects and causal pathways

BackgroundExposure to fine ambient particulate matter (PM) has consistently been associated with increased morbidity and mortality. The relationship between exposure to ultrafine particles (UFP) and health effects is less firmly established. If UFP cause health effects independently from coarser fractions, this could affect health impact assessment of air pollution, which would possibly lead to alternative policy options to be considered to reduce the disease burden of PM. Therefore, we organized an expert elicitation workshop to assess the evidence for a causal relationship between exposure to UFP and health endpoints.MethodsAn expert elicitation on the health effects of ambient ultrafine particle exposure was carried out, focusing on: 1) the likelihood of causal relationships with key health endpoints, and 2) the likelihood of potential causal pathways for cardiac events. Based on a systematic peer-nomination procedure, fourteen European experts (epidemiologists, toxicologists and clinicians) were selected, of whom twelve attended. They were provided with a briefing book containing key literature. After a group discussion, individual expert judgments in the form of ratings of the likelihood of causal relationships and pathways were obtained using a confidence scheme adapted from the one used by the Intergovernmental Panel on Climate Change.ResultsThe likelihood of an independent causal relationship between increased short-term UFP exposure and increased all-cause mortality, hospital admissions for cardiovascular and respiratory diseases, aggravation of asthma symptoms and lung function decrements was rated medium to high by most experts. The likelihood for long-term UFP exposure to be causally related to all cause mortality, cardiovascular and respiratory morbidity and lung cancer was rated slightly lower, mostly medium. The experts rated the likelihood of each of the six identified possible causal pathways separately. Out of these six, the highest likelihood was rated for the pathway involving respiratory inflammation and subsequent thrombotic effects.ConclusionThe overall medium to high likelihood rating of causality of health effects of UFP exposure and the high likelihood rating of at least one of the proposed causal mechanisms explaining associations between UFP and cardiac events, stresses the importance of considering UFP in future health impact assessments of (transport-related) air pollution, and the need for further research on UFP exposure and health effects.

In vitro toxicity of particulate matter (PM) collected at different sites in the Netherlands is associated with PM composition, size fraction and oxidative potential - the RAPTES project

BackgroundAmbient particulate matter (PM) exposure is associated with respiratory and cardiovascular morbidity and mortality. To what extent such effects are different for PM obtained from different sources or locations is still unclear. This study investigated the in vitro toxicity of ambient PM collected at different sites in the Netherlands in relation to PM composition and oxidative potential.MethodPM was sampled at eight sites: three traffic sites, an underground train station, as well as a harbor, farm, steelworks, and urban background location. Coarse (2.5-10 μm), fine (< 2.5 μm) and quasi ultrafine PM (qUF; < 0.18 μm) were sampled at each site. Murine macrophages (RAW 264.7 cells) were exposed to increasing concentrations of PM from these sites (6.25-12.5-25-50-100 μg/ml; corresponding to 3.68-58.8 μg/cm2). Following overnight incubation, MTT-reduction activity (a measure of metabolic activity) and the release of pro-inflammatory markers (Tumor Necrosis Factor-alpha, TNF-α; Interleukin-6, IL-6; Macrophage Inflammatory Protein-2, MIP-2) were measured. The oxidative potential and the endotoxin content of each PM sample were determined in a DTT- and LAL-assay respectively. Multiple linear regression was used to assess the relationship between the cellular responses and PM characteristics: concentration, site, size fraction, oxidative potential and endotoxin content.ResultsMost PM samples induced a concentration-dependent decrease in MTT-reduction activity and an increase in pro-inflammatory markers with the exception of the urban background and stop & go traffic samples. Fine and qUF samples of traffic locations, characterized by a high concentration of elemental and organic carbon, induced the highest pro-inflammatory activity. The pro-inflammatory response to coarse samples was associated with the endotoxin level, which was found to increase dramatically during a three-day sample concentration procedure in the laboratory. The underground samples, characterized by a high content of transition metals, showed the largest decrease in MTT-reduction activity. PM size fraction was not related to MTT-reduction activity, whereas there was a statistically significant difference in pro-inflammatory activity between Fine and qUF PM. Furthermore, there was a statistically significant negative association between PM oxidative potential and MTT-reduction activity.ConclusionThe response of RAW264.7 cells to ambient PM was markedly different using samples collected at various sites in the Netherlands that differed in their local PM emission sources. Our results are in support of other investigations showing that the chemical composition as well as oxidative potential are determinants of PM induced toxicity in vitro.

The use of expert elicitation in environmental health impact assessment: a seven step procedure

BackgroundEnvironmental health impact assessments often have to deal with substantial uncertainties. Typically, the knowledge-base is limited with incomplete, or inconsistent evidence and missing or ambiguous data. Consulting experts can help to identify and address uncertainties.MethodsFormal expert elicitation is a structured approach to systematically consult experts on uncertain issues. It is most often used to quantify ranges for poorly known parameters, but may also be useful to further develop qualitative issues such as definitions, assumptions or conceptual (causal) models. A thorough preparation and systematic design and execution of an expert elicitation process may increase the validity of its outcomes and transparency and trustworthiness of its conclusions. Various expert elicitation protocols and methods exist. However, these are often not universally applicable, and need customization to suite the needs of a specific study. In this paper, we set out to develop a widely applicable method for the use of expert elicitation in environmental health impact assessment.ResultsWe present a practical yet flexible seven step procedure towards organising expert elicitation in the context of environmental health impact assessment, based on existing protocols. We describe how customization for specific applications is always necessary. In particular, three issues affect the choice of methods for a particular application: the types of uncertainties considered, the intended use of the elicited information, and the available resources. We outline how these three considerations guide choices regarding the design and execution of expert elicitation. We present signposts to sources where the issues are discussed in more depth to give the newcomer the insights needed to make the protocol work. The seven step procedure is illustrated using examples from earlier published elicitations in the field of environmental health research.ConclusionsWe conclude that, despite some known criticism on its validity, formal expert elicitation can support environmental health research in various ways. Its main purpose is to provide a temporary summary of the limited available knowledge, which can serve as a provisional basis for policy until further research has been carried out.

SMALL AREA VARIATIONS IN AMBIENT NO2 CONCENTRATIONS IN FOUR EUROPEAN AREAS

Abstract Spatial variations in urban air pollution are of considerable significance both because of the growing evidence for associations between exposure and human health and because of the increasing requirement for action to control and reduce levels of air pollution. This study examines sources and patterns of variation in NO2, as a marker for traffic-related pollution, in four predominantly urban study areas: Amsterdam (Netherlands), Huddersfield (UK), Poznan (Poland) and Prague (Czech Republic). Data on pollution levels were collected using passive samplers, deployed in duplicate for 2 week periods on four occasions over one year. Mixed-effect modelling was used to explore the magnitude of between-survey, between-site and between-sampler and interaction effects, and to provide a measure of mean annual concentration at each sample site. Measured concentrations varied significantly between different surveys, with a tendency to be higher in winter months. Strong correlations were seen, however, between monitored concentrations in successive surveys, suggesting that the geographic pattern of variation in all areas was essentially stable over time. Between-sampler variation was seen to be small (CV generally 5–8%), indicating that the samplers provided consistent measures of NO2 concentrations. There were also strongly significant between-site and site–survey interaction effects. Between-site variation accounted for between 61% (Poznan) and 84% (Prague) of total observed variation; expressed as a coefficient of variation, between-site variation was least in Amsterdam, the smallest and most uniform study area (22%), and greatest in Prague (42%). The modelled mean annual NO2 concentration, derived from the mixed-effect model, gave a good prediction of mean annual concentration measured using passive samplers on a continuous basis, at 8–10 reference sites in each study area (r2>0.85). Based on the modelled results, it appears that WHO and national air quality standards for NO2 will be routinely exceeded at a number of sites in each study area. Given the apparent stability of the pollution surface in each area, these `hotspots’ are also likely to be persistent over time, implying the potential for relatively high risks of chronic exposure in local populations. Overall the results indicate the capability to characterise spatial variation in traffic-related pollution in urban areas using a small number of intensive surveys, with low-cost sampling devices.

Volatile organic compounds in dutch homes

Abstract Weekly average concentrations of 45 volatile organic compounds (VOC) were determined in living rooms of more than 300 homes divided in three age groups. Repeated measurements of the same VOC were carried out in 4 homes every second week for half a year, and in 11 newly built homes before and during occupancy. The results of this exploratory study showed that virtually all VOC had higher indoor than outdoor concentrations; a wide range in indoor VOC levels was observed. Clusters of solvent type compounds were tentatively identified, which suggests the existence of common sources. The repeated measurements showed fairly stable indoor levels for some compounds in some homes, while large variations were observed for other compounds and other homes. During the first few months of occupation, the straight-chain and aromatic hydrocarbon concentrations were generally higher than in older homes. It is concluded that most of the measured VOC have both consumer products and building materials as indoor sources. The highest observed concentrations in the occupied homes were probably the result of incidental occupant activities.