AIR POLLUTION – MONITORING MODELLING AND HEALTH

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348 Air Pollution – Monitoring, Modelling and Health greater effect in boys may be due to greater time spent outdoors and more physical activity, both of which are factors that would increase exposure to and the respiratory dose of ambient air pollution (Tager et al. 1998). Also, this is plausible as there are differences between male and female airways from early in fetal lung development and throughout life (Becklake and Kauffmann 1999), for example female lungs mature earlier with regard to surfactant production. Throughout life women have smaller lungs than men, but their lung architecture is more advantageous with a greater airway diameter in relation to the volume of the lung parenchyma. Thus, in childhood, airway hyper-responsiveness and asthma are more common among boys than girls. Despite the existed evidence that boys may be more susceptible to air pollution than girls as mentioned above, however, many studies reported the stronger effects among girls. Using the hospital records for 2768 children aged 0 to 18 years from northern Orange County, California, Delfino et al. authors (2009) estimated the association of local traffic-generated air pollution (CO, NO 2 , NOx) with repeated hospital encounters for asthma, and found that associations were stronger for girls but were not significantly from boys. In a dynamic cohort study among Mexican children 8 years of age, Rojas-Martinez et al. (2007) found that negative association of O 3 with lung function growth was stronger on girls than boys in multipollutant models. Also, among Roman children 9–14 years of age, Rosenlund et al. (2009) found associations between chronic residential NO 2 exposure and lung function to be stronger among Roman girls than boys; mean FEV1 and FEF 25–75 decrements were approximately four times greater in girls than boys. The authors indicated complexities in comparing childhood cohorts differing by age, pubertal status, pollution mixtures, study designs, and susceptibilities and noted that the consistency of results across reporting stronger air pollution effects among girls, meriting further investigation. In fact, some authors suggested, when focused on the gender difference of the health responses to air pollution, the types of air pollutants should be fully considered. For example, boys may be more susceptible to some kind of pollutants, whereas, girls may be more susceptible to some other pollutants. Results from the Canada showed that respiratory hospitalizations were significantly associated with PM 2.5–10 among boys and girls, with PM 10 among boys, and with NO 2 among girls (Lin et al. 2005). Also, Rojas-Martinez et al. (2007) associated elevated PM 10 , NO 2 , and O 3 with reduced lung function among boys and girls. Interquartile range increases in NO 2 predicted FEV1 declines in girls, whereas increases in PM 10 predicted FEV 1 declines among boys. Interesting, results from the Northeast Chinese Children Health Study showed, when stratified by allergic predisposition, amongst children without an allergic predisposition, air pollution effects on asthma were stronger in boys compared to girls; Current asthma prevalence was related to PM 10 (ORs=1.36 per 31 μg/m 3 ; 95% CI, 1.08-1.72), SO 2 (ORs=1.38 per 21μg/m 3 ; 95%CI, 1.12-1.69) only among boys. However, among children with allergic predisposition, more positively associations between air pollutants and respiratory symptoms and diseases were detected in girls; An increased prevalence of doctor-diagnosed asthma was significantly associated with SO 2 (ORs=1.48 per 21μg/m 3 ; 95%CI, 1.21-1.80), NO 2 (ORs=1.26 per 10μg/m 3 ; 95%CI, 1.01-1.56), and current asthma with O 3 (ORs=1.55 per 23μg/m 3 ; 95%CI, 1.18-2.04) only among girls (Dong et al. 2011). The difference of health response to air pollution between boys and girls remains unclear and needs to be explored further. Just as Clougherty (2010) elaborated that careful
Air Pollution and Health Effects in Children 349 consideration of gender and sex effects and exploration of nascent methods for quantitative gender analysis may help to elucidate sources of difference. More broadly, exploring the role for gender analysis in environmental epidemiology may provide a model for exploring other social factors that can shape population responses to air pollution. 5. Health effect susceptibility and prevention of air pollution Air pollution has shown significant effects on asthma development and exacerbation. In a recent Indian study, it was suggested that asthma admissions increased by almost 21% due to the ambient levels of pollutants exceeding the national air quality standards (Pande et al. 2002). In Israel, outdoor air pollution revealed significant correlation with ER visits and 61% of the variance could be explained by air pollutants including NOx, SO 2 , and O 3 (Garty et al. 1998). Ambient air pollution was also estimated to attribute 13-15% of the prevalence of childhood asthma in Taiwan, after adjustment for hereditary and indoor factors (Lee et al. 2003). In Central Jakarta and Tangerang, where the average NO 2 concentrations were highest, reduction of NO 2 to a proposed level of 25 ppb could yield savings in mean 15,639- 18,165 Indonesian rupiah (6.80-7.90 US dollars) per capita for treatment of the respiratory symptoms, and reduce average work/school days lost per capita by 3.1-5.5 days (Duki et al. 2003). The overall economic cost (both direct and indirect) of air pollution might be higher than what has been estimated in the study. The worldwide variation in asthma prevalence indicates that environmental factors may be critical. There is now growing evidence to suggest that air pollution is probably responsible, at least in part, for the increasing prevalence of asthma in children. Outdoor ambient air pollutants in communities are relevant to the acute exacerbation and possibly the onset of asthma. From some children’s studies, asthma prevalences were different despite of similar prevalences of atopic sensitization. This supported the hypothesis that outdoor air pollution with unchanged levels of allergen could be a risk factor for the increasing prevalence of asthma observed over the past two decades. However, the ecological association with known outdoor air pollutants and asthmatic morbidities remains suggestive. Outdoor air pollutants at levels below the current standards were shown harmful to susceptible individuals. There might be serious public health consequences if small decreases in lung function were associated causally with chronic exposure to air pollution, especially if the size of the exposed population is large. It is possible that some permissible levels of ambient air pollutants in children are not sufficiently low for human health protection. Better technology and public policy are needed to help prevent the enormous suffering and human loss associated with air pollution. What has yet to be documented is whether reduced outdoor pollution will result in decreased morbidities from children’s health. Studies to investigate this hypothesis are currently under way. 6. Acknowledgement This chapter is partially supported by grant #98-2314-B-002-138-MY3 from the Taiwan National Science Council. The authors report no conflicts of interest.
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AIR POLLUTION - MONITORING, MODELLI
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Contents Preface IX Chapter 1 Urban
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Preface This book provides a compre
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AIR POLLUTION – MONITORING MODELLING AND HEALTH

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