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Adverse Health Impacts of Outdoor Air Pollution, Including from Wildland Fires, in the United States: "Health of the Air," 2018-2020

Cromar, Kevin; Gladson, Laura; Gohlke, Julia; Li, Yunyao; Tong, Daniel; Ewart, Gary
PMID: 37906164
ISSN: 2325-6621
CID: 5625822

Respiratory Health Impacts of Outdoor Air Pollution and the Efficacy of Local Risk Communication in Quito, Ecuador

Zhou, Jiang; Gladson, Laura; Díaz Suárez, Valeria; Cromar, Kevin
Relatively few studies on the adverse health impacts of outdoor air pollution have been conducted in Latin American cities, whose pollutant mixtures and baseline health risks are distinct from North America, Europe, and Asia. This study evaluates respiratory morbidity risk associated with ambient air pollution in Quito, Ecuador, and specifically evaluates if the local air quality index accurately reflects population-level health risks. Poisson generalized linear models using air pollution, meteorological, and hospital admission data from 2014 to 2015 were run to quantify the associations of air pollutants and index values with respiratory outcomes in single- and multi-pollutant models. Significant associations were observed for increased respiratory hospital admissions and ambient concentrations of fine particulate matter (PM2.5), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2), although some of these associations were attenuated in two-pollutant models. Significant associations were also observed for index values, but these values were driven almost entirely by daily O3 concentrations. Modifications to index formulation to more fully incorporate the health risks of multiple pollutants, particularly for NO2, have the potential to greatly improve risk communication in Quito. This work also increases the equity of the existing global epidemiological literature by adding new air pollution health risk values from a highly understudied region of the world.
PMID: 37510559
ISSN: 1660-4601
CID: 5594322

Science-Based Policy Recommendations for PM2.5 in the United States

Cromar, Kevin R; Lee, Alison G; Harkema, Jack R; Annesi-Maesano, Isabella
PMID: 35856816
ISSN: 1535-4970
CID: 5279112

Comprehensive Evidence Implies a Higher Social Cost of CO2

Rennert, Kevin; Errickson, Frank; Prest, Brian C; Rennels, Lisa; Newell, Richard G; Pizer, William; Kingdon, Cora; Wingenroth, Jordan; Cooke, Roger; Parthum, Bryan; Smith, David; Cromar, Kevin; Diaz, Delavane; Moore, Frances C; Müller, Ulrich K; Plevin, Richard J; Raftery, Adrian E; Ševčíková, Hana; Sheets, Hannah; Stock, James H; Tan, Tammy; Watson, Mark; Wong, Tony E; Anthoff, David
The social cost of carbon dioxide (SC-CO2) measures the monetized value of the damages to society caused by an incremental metric tonne of CO2 emissions and is a key metric informing climate policy. Used by governments and other decision-makers in benefit-cost analysis for over a decade, SC-CO2 estimates draw on climate science, economics, demography, and other disciplines. However, a 2017 report by the US National Academies of Sciences, Engineering, and Medicine1 (NASEM) highlighted that current SC-CO2 estimates no longer reflect the latest research. The report provided a series of recommendations for improving the scientific basis, transparency, and uncertainty characterization of SC-CO2 estimates. Here we show that improved probabilistic socioeconomic projections, climate models, damage functions, and discounting methods that collectively reflect theoretically consistent valuation of risk, substantially increase estimates of the SC-CO2. Our preferred mean SC-CO2 estimate is $185 per tonne of CO2 ($44-413/t-CO2: 5-95% range, 2020 US dollars) at a near-term risk-free discount rate of 2 percent, a value 3.6-times higher than the US government's current value of $51/t-CO2. Our estimates incorporate updated scientific understanding throughout all components of SC-CO2 estimation in the new open-source GIVE model, in a manner fully responsive to the near-term NASEM recommendations. Our higher SC-CO2 values, compared to estimates currently used in policy evaluation, substantially increase the estimated benefits of greenhouse gas mitigation and thereby increase the expected net benefits of more stringent climate policies.
PMID: 36049503
ISSN: 1476-4687
CID: 5337822

Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis

Cromar, Kevin R; Anenberg, Susan C; Balmes, John R; Fawcett, Allen A; Ghazipura, Marya; Gohlke, Julia M; Hashizume, Masahiro; Howard, Peter; Lavigne, Eric; Levy, Karen; Madrigano, Jaime; Martinich, Jeremy A; Mordecai, Erin A; Rice, Mary B; Saha, Shubhayu; Scovronick, Noah C; Sekercioglu, Fatih; Svendsen, Erik R; Zaitchik, Benjamin F; Ewart, Gary
RATIONALE/BACKGROUND:Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. OBJECTIVES/OBJECTIVE:In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. METHODS:Regionally-resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. RESULTS:Effect estimates, and associated uncertainties, varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1-1.1% per 1 degree C) was estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel, and include: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socio-economic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. CONCLUSIONS:This work provides an example for how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates.
PMID: 35073249
ISSN: 2325-6621
CID: 5140742

Personal Interventions to Reduce Exposure to Outdoor Air Pollution

Laumbach, Robert J; Cromar, Kevin R
Unhealthy levels of air pollution are breathed by billions of people worldwide, and air pollution is the leading environmental cause of death and disability globally. Efforts to reduce air pollution at its many sources have had limited success, and in many areas of the world, poor air quality continues to worsen. Personal interventions to reduce exposure to air pollution include avoiding sources, staying indoors, filtering indoor air, using face masks, and limiting physical activity when and where air pollution levels are elevated. The effectiveness of these interventions varies widely with circumstances and conditions of use. Compared with upstream reduction or control of emissions, personal interventions place burdens and risk of adverse unintended consequences on individuals. We review evidence regarding the balance of benefits and potential harms of personal interventions for reducing exposure to outdoor air pollution, which merit careful consideration before making public health recommendations with regard to who should use personal interventions and where, when, and how they should be used. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see for revised estimates.
PMID: 34936825
ISSN: 1545-2093
CID: 5108922

Excess Morbidity and Mortality Associated with Air Pollution above American Thoracic Society Recommended Standards, 2017-2019

Cromar, Kevin R; Gladson, Laura A; Hicks, E Anne; Marsh, Brenda; Ewart, Gary
PMID: 34847333
ISSN: 2325-6621
CID: 5065572

Evaluating the Utility of High-Resolution Spatiotemporal Air Pollution Data in Estimating Local PM2.5 Exposures in California from 2015"“2018

Gladson, Laura; Garcia, Nicolas; Bi, Jianzhao; Liu, Yang; Lee, Hyung Joo; Cromar, Kevin
Air quality management is increasingly focused not only on across-the-board reductions in ambient pollution concentrations but also on identifying and remediating elevated exposures that often occur in traditionally disadvantaged communities. Remote sensing of ambient air pollution using data derived from satellites has the potential to better inform management decisions that address environmental disparities by providing increased spatial coverage, at high-spatial resolutions, compared to air pollution exposure estimates based on ground-based monitors alone. Daily PM2.5 estimates for 2015"“2018 were estimated at a 1 km2 resolution, derived from NASA"™s Moderate Resolution Imaging Spectroradiometer (MODIS) satellite instrument and the Multi-Angle Implementation of Atmospheric Correction (MAIAC) algorithm in order to assess the utility of highly refined spatiotemporal air pollution data in 92 California cities and in the 13 communities included in the California Community Air Protection Program. The identification of pollution hot-spots within a city is typically not possible relying solely on the regulatory monitoring networks; however, day-to-day temporal variability was shown to be generally well represented by nearby ground-based monitoring data even in communities with strong spatial gradients in pollutant concentrations. An assessment of within-ZIP Code variability in pollution estimates indicates that high-resolution pollution estimates (i.e., 1 km2) are not always needed to identify spatial differences in exposure but become increasingly important for larger geographic areas (approximately 50 km2). Taken together, these findings can help inform strategies for use of remote sensing data for air quality management including the screening of locations with air pollution exposures that are not well represented by existing ground-based air pollution monitors.
ISSN: 2073-4433
CID: 5146252

Communicating respiratory health risk among children using a global air quality index

Gladson, Laura A; Cromar, Kevin R; Ghazipura, Marya; Knowland, K Emma; Keller, Christoph A; Duncan, Bryan
Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km2 spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.
PMID: 34920275
ISSN: 1873-6750
CID: 5084692

Personal Interventions for Reducing Exposure and Risk for Outdoor Air Pollution: An Official American Thoracic Society Workshop Report

Laumbach, Robert J; Cromar, Kevin R; Adamkiewicz, Gary; Carlsten, Christopher; Charpin, Denis; Chan, Wanyu R; de Nazelle, Audrey; Forastiere, Francesco; Goldstein, Jeffrey; Gumy, Sophie; Hallman, William K; Jerrett, Michael; Kipen, Howard M; Pirozzi, Cheryl S; Polivka, Barbara J; Radbel, Jared; Shaffer, Ronald E; Sin, Don D; Viegi, Giovanni
Poor air quality affects the health and wellbeing of large populations around the globe. Although source controls are the most effective approaches for improving air quality and reducing health risks, individuals can also take actions to reduce their personal exposure by staying indoors, reducing physical activity, altering modes of transportation, filtering indoor air, and using respirators and other types of face masks. A synthesis of available evidence on the efficacy, effectiveness, and potential adverse effects or unintended consequences of personal interventions for air pollution is needed by clinicians to assist patients and the public in making informed decisions about use of these interventions. To address this need, the American Thoracic Society convened a workshop in May of 2018 to bring together a multidisciplinary group of international experts to review the current state of knowledge about personal interventions for air pollution and important considerations when helping patients and the general public to make decisions about how best to protect themselves. From these discussions, recommendations were made regarding when, where, how, and for whom to consider personal interventions. In addition to the efficacy and safety of the various interventions, the committee considered evidence regarding the identification of patients at greatest risk, the reliability of air quality indices, the communication challenges, and the ethical and equity considerations that arise when discussing personal interventions to reduce exposure and risk from outdoor air pollution.
PMID: 34468284
ISSN: 2325-6621
CID: 4998432