Jacqueline MacDonald Gibson

Indoor air pollutants and health in the United Arab Emirates

Background: Comprehensive global data on the health effects of indoor air pollutants are lacking. There are few large population-based multi–air pollutant health assessments. Further, little is known about indoor air health risks in the Middle East, especially in countries undergoing rapid economic development. Objectives: To provide multifactorial indoor air exposure and health data, we conducted a population-based study of indoor air pollution and health in the United Arab Emirates (UAE). Methods: We conducted a cross-sectional study in a population-based sample of 628 households in the UAE. Indoor air pollutants [sulfur dioxide (SO2), nitrogen dioxide (NO2), hydrogen sulfide (H2S), formaldehyde (HCHO), carbon monoxide (CO), and particulate matter] were measured using passive samplers over a 7-day period. Health information was collected from 1,590 household members via in-person interviews. Results: Participants in households with quantified SO2, NO2, and H2S (i.e., with measured concentrations above the limit of quantification) were twice as likely to report doctor-diagnosed asthma. Participants in homes with quantified SO2 were more likely to report wheezing symptoms {ever wheezing, prevalence odds ratio [POR] 1.79 [95% confidence interval (CI) 1.05, 3.05]; speech-limiting wheeze, POR 3.53 (95% CI: 1.06, 11.74)}. NO2 and H2S were similarly associated with wheezing symptoms. Quantified HCHO was associated with neurologic symptoms (difficulty concentrating POR 1.47; 95% CI: 1.02, 2.13). Burning incense daily was associated with increased headaches (POR 1.87; 95% CI: 1.09, 3.21), difficulty concentrating (POR 3.08; 95% CI: 1.70, 5.58), and forgetfulness (POR 2.68: 95% CI: 1.47, 4.89). Conclusions: This study provides new information regarding potential health risks from pollutants commonly found in indoor environments in the UAE and other countries. Multipollutant exposure and health assessments in cohort studies are needed to better characterize health effects of indoor air pollutants.

Burden of disease attributed to anthropogenic air pollution in the United Arab Emirates: estimates based on observed air quality data.

This study quantifies the national burden of disease attributed to particulate matter (PM) and ozone (O(3)) in ambient air in the United Arab Emirates (UAE), a rapidly growing nation in which economic development and climatic conditions pose important challenges for air quality management. Estimates of population exposure to these air pollutants are based on observed air quality data from fixed-site monitoring stations. We divide the UAE into small grid cells and use spatial-statistical methods to estimate the ambient pollutant concentrations in each cell based on the observed data. Premature deaths attributed to PM and O(3) are computed for each grid cell and then aggregated across grid cells and over a year to estimate the total number of excess deaths attributable to ambient air pollution. Our best estimate is that approximately 545 (95% CI: 132-1224) excess deaths in the UAE in the year 2007 are attributable to PM in ambient air. These excess deaths represent approximately 7% (95% CI: 2-17%) of the total deaths that year. We attribute approximately 62 premature deaths (95% CI: 17-127) to ground-level O(3) for the year 2007. Uncertainty in the natural background level of PM, due to the frequent dust storms occurring in the region, has significant impacts on the attributed mortality estimates. Despite the uncertainties associated with the integrated assessment framework, we conclude that anthropogenic ambient air pollution, in particular PM, causes a considerable public health impact in the UAE in terms of premature deaths. We discuss important uncertainties and scientific hypotheses to be investigated in future work that might help reduce the uncertainties in the burden of disease estimates.

Prioritizing Environmental Health Risks in the UAE

This article presents the results of a comparative environmental risk-ranking exercise that was conducted in the United Arab Emirates (UAE) to inform a strategic planning process led by the Environment Agency-Abu Dhabi (EAD). It represents the first national-level application of a deliberative method for comparative risk ranking first published in this journal. The deliberative method involves a five-stage process that includes quantitative risk assessment by experts and deliberations by groups of stakeholders. The project reported in this article considered 14 categories of environmental risks to health identified through discussions with EAD staff: ambient and indoor air pollution; drinking water contamination; coastal water pollution; soil and groundwater contamination; contamination of fruits, vegetables, and seafood; ambient noise; stratospheric ozone depletion; electromagnetic fields from power lines; health impacts from climate change; and exposure to hazardous substances in industrial, construction, and agricultural work environments. Results from workshops involving 73 stakeholders who met in five separate groups to rank these risks individually and collaboratively indicated strong consensus that outdoor and indoor air pollution are the highest priorities in the UAE. Each of the five groups rated these as being among the highest risks. All groups rated soil and groundwater contamination as being among the lowest risks. In surveys administered after the ranking exercises, participants indicated that the results of the process represented their concerns and approved of using the ranking results to inform policy decisions. The results ultimately shaped a strategic plan that is now being implemented.

Probabilistic approach to estimating indoor air concentrations of chlorinated volatile organic compounds from contaminated groundwater: a case study in San Antonio, Texas.

This paper describes a probabilistic model, based on the Johnson-Ettinger algorithm, developed to characterize the current and historic exposure to tricholorethylene (TCE) and tetrachlorethylene (PCE) in indoor air from plumes of groundwater contamination emanating from the former Kelly Air Force Base in San Antonio, Texas. We estimate indoor air concentration, house by house, in 30 101 homes and compare the estimated concentrations with measured values in a small subset of homes. We also compare two versions of the Johnson-Ettinger model: one used by the Environmental Protection Agency (EPA) and another based on an alternative parametrization. The modeled mean predicted PCE concentration historically exceeded PCE screening levels (0.41 ug/m(3)) in 5.5% of houses, and the 95th percentile of the predicted concentration exceeded screening levels in 85.3% of houses. For TCE, the mean concentration exceeded the screening level (0.25 ug/m(3)) in 49% of homes, and the 95th percentile of the predicted concentration exceeded the screening level in 99% of homes. The EPA model predicts slightly lower indoor concentrations than the alternative parametrization. Comparison with measured samples suggests both models, with the inputs selected, underestimate indoor concentrations and that the 95th percentiles of the predicted concentrations are closer to measured concentrations than predicted mean values.

Environmental risks to public health in the United Arab Emirates: a quantitative assessment and strategic plan.

Background: Environmental risks to health in the United Arab Emirates (UAE) have shifted rapidly from infectious to noninfectious diseases as the nation has developed at an unprecedented rate. In response to public concerns over newly emerging environmental risks, the Environment Agency–Abu Dhabi commissioned a multidisciplinary environmental health strategic planning project. Objectives: In order to develop the environmental health strategic plan, we sought to quantify the illnesses and premature deaths in the UAE attributable to 14 environmental pollutant categories, prioritize these 14 risk factors, and identify interventions. Methods: We estimated the disease burden imposed by each risk factor using an attributable fraction approach, and we prioritized the risks using an empirically tested stakeholder engagement process. We then engaged government personnel, scientists, and other stakeholders to identify interventions. Results: The UAE’s environmental disease burden is low by global standards. Ambient air pollution is the leading contributor to premature mortality [~ 650 annual deaths; 95% confidence interval (CI): 140, 1,400]. Risk factors leading to > 10,000 annual health care facility visits included occupational exposures, indoor air pollution, drinking water contamination, seafood contamination, and ambient air pollution. Among the 14 risks considered, on average, outdoor air pollution was ranked by the stakeholders as the highest priority (mean rank, 1.4; interquartile range, 1–2) and indoor air pollution as the second-highest priority (mean rank 3.3; interquartile range, 2–4). The resulting strategic plan identified 216 potential interventions for reducing environmental risks to health. Conclusions: The strategic planning exercise described here provides a framework for systematically deciding how to invest public funds to maximize expected returns in environmental health, where returns are measured in terms of reductions in a population’s environmental burden of disease.

Health impact assessment of traffic-related air pollution at the urban project scale: Influence of variability and uncertainty

This paper develops and then demonstrates a new approach for quantifying health impacts of traffic-related particulate matter air pollution at the urban project scale that includes variability and uncertainty in the analysis. We focus on primary particulate matter having a diameter less than 2.5 μm (PM2.5). The new approach accounts for variability in vehicle emissions due to temperature, road grade, and traffic behavior variability; seasonal variability in concentration-response coefficients; demographic variability at a fine spatial scale; uncertainty in air quality model accuracy; and uncertainty in concentration-response coefficients. We demonstrate the approach for a case study roadway corridor with a population of 16,000, where a new extension of the University of North Carolina (UNC) at Chapel Hill campus is slated for construction. The results indicate that at this case study site, health impact estimates increased by factors of 4-9, depending on the health impact considered, compared to using a conventional health impact assessment approach that overlooks these variability and uncertainty sources. In addition, we demonstrate how the method can be used to assess health disparities. For example, in the case study corridor, our method demonstrates the existence of statistically significant racial disparities in exposure to traffic-related PM2.5 under present-day traffic conditions: the correlation between percent black and annual attributable deaths in each census block is 0.37 (t(114)=4.2, p<0.0001). Overall, our results show that the proposed new campus will cause only a small incremental increase in health risks (annual risk 6×10(-10); lifetime risk 4×10(-8)), compared to if the campus is not built. Nonetheless, the approach we illustrate could be useful for improving the quality of information to support decision-making for other urban development projects.

Health and Air Quality Benefits of Policies to Reduce Coal-Fired Power Plant Emissions: A Case Study in North Carolina

We analyzed sulfur dioxide (SO2) emissions and fine particulate sulfate (PM2.5 sulfate) concentrations in the southeastern United States during 2002-2012, in order to evaluate the health impacts in North Carolina (NC) of the NC Clean Smokestacks Act of 2002. This state law required progressive reductions (beyond those mandated by federal rules) in pollutant emissions from NCs coal-fired power plants. Although coal-fired power plants remain NCs leading SO2 source, a trend analysis shows significant declines in SO2 emissions (-20.3%/year) and PM2.5 sulfate concentrations (-8.7%/year) since passage of the act. Emissions reductions were significantly greater in NC than in neighboring states, and emissions and PM2.5 sulfate concentration reductions were highest in NCs piedmont region, where 9 of the states 14 major coal-fired power plants are located. Our risk model estimates that these air quality improvements decreased the risk of premature death attributable to PM2.5 sulfate in NC by about 63%, resulting in an estimated 1700 (95% CI: 1500, 1800) deaths prevented in 2012. These findings lend support to recent studies predicting that implementing the proposed federal Cross-State Air Pollution Rule (recently upheld by the U.S. Supreme Court) could substantially decrease U.S. premature deaths attributable to coal-fired power plant emissions.

Spatiotemporal variability of tetrachloroethylene in residential indoor air due to vapor intrusion: a longitudinal, community-based study

The migration of volatile contaminants from groundwater and soil into indoor air is a potential health threat at thousands of contaminated sites across the country. This phenomenon, known as vapor intrusion, is characterized by spatial and temporal heterogeneity. This study examined short-term fluctuations in concentrations of tetrachloroethylene (PCE) in the indoor air of residential homes due to vapor intrusion in a community in San Antonio, Texas, that sits atop an extensive, shallow plume of contaminated groundwater. Using a community-based design, we removed potential indoor sources of PCE and then collected twelve 3-day passive indoor air samples in each of the 20 homes. Results demonstrated a one-order-of-magnitude variability in concentration across both space and time among the study homes, although all measured concentrations were below risk-based screening levels. We found that within any given home, indoor concentrations increase with the magnitude of the barometric pressure drop (P=0.048) and humidity (P<0.001), while concentrations decrease as wind speed increases (P<0.001) and also during winter (P=0.001). In a second analysis to examine sources of spatial variability, we found that indoor air PCE concentrations between homes increase with groundwater concentration (P=0.030) and a slab-on-grade (as compared with a crawl space) foundation (P=0.028), whereas concentrations decrease in homes without air conditioners (P=0.015). This study offers insights into the drivers of temporal and spatial variability in vapor intrusion that can inform decisions regarding monitoring and exposure assessment at affected sites.

Deaths and Medical Visits Attributable to Environmental Pollution in the United Arab Emirates

Background This study estimates the potential health gains achievable in the United Arab Emirates (UAE) with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country’s disease burden. Methods and Findings We assessed the burden of disease attributable to six environmental exposure routes outdoor air, indoor air, drinking water, coastal water, occupational environments, and climate change. For every exposure route, we integrated UAE environmental monitoring and public health data in a spatially resolved Monte Carlo simulation model to estimate the annual disease burden attributable to selected pollutants. The assessment included the entire UAE population (4.5 million for the year of analysis). The study found that outdoor air pollution was the leading contributor to mortality, with 651 attributable deaths (95% confidence interval [CI] 143–1,440), or 7.3% of all deaths. Indoor air pollution and occupational exposures were the second and third leading contributors to mortality, with 153 (95% CI 85–216) and 46 attributable deaths (95% CI 26–72), respectively. The leading contributor to health-care facility visits was drinking water pollution, to which 46,600 (95% CI 15,300–61,400) health-care facility visits were attributed (about 15% of the visits for all the diseases considered in this study). Major study limitations included (1) a lack of information needed to translate health-care facility visits to quality-adjusted-life-year estimates and (2) insufficient spatial coverage of environmental data. Conclusions Based on international comparisons, the UAE’s environmental disease burden is low for all factors except outdoor air pollution. From a public health perspective, reducing pollutant emissions to outdoor air should be a high priority for the UAE’s environmental agencies.

The Effects of Urban Form on Ambient Air Pollution and Public Health Risk: A Case Study in Raleigh, North Carolina

Since motor vehicles are a major air pollution source, urban designs that decrease private automobile use could improve air quality and decrease air pollution health risks. Yet, the relationships among urban form, air quality, and health are complex and not fully understood. To explore these relationships, we model the effects of three alternative development scenarios on annual average fine particulate matter (PM2.5 ) concentrations in ambient air and associated health risks from PM2.5 exposure in North Carolinas Raleigh-Durham-Chapel Hill area. We integrate transportation demand, land-use regression, and health risk assessment models to predict air quality and health impacts for three development scenarios: current conditions, compact development, and sprawling development. Compact development slightly decreases (-0.2%) point estimates of regional annual average PM2.5 concentrations, while sprawling development slightly increases (+1%) concentrations. However, point estimates of health impacts are in opposite directions: compact development increases (+39%) and sprawling development decreases (-33%) PM2.5-attributable mortality. Furthermore, compactness increases local variation in PM2.5 concentrations and increases the severity of local air pollution hotspots. Hence, this research suggests that while compact development may improve air quality from a regional perspective, it may also increase the concentration of PM2.5 in local hotspots and increase population exposure to PM2.5 . Health effects may be magnified if compact neighborhoods and PM2.5 hotspots are spatially co-located. We conclude that compactness alone is an insufficient means of reducing the public health impacts of transportation emissions in automobile-dependent regions. Rather, additional measures are needed to decrease automobile dependence and the health risks of transportation emissions.