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      From Good Intentions to Proven Interventions: Effectiveness of Actions to Reduce the Health Impacts of Air Pollution

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          Abstract

          BackgroundAssociations between air pollution and a multitude of health effects are now well established. Given ubiquitous exposure to some level of air pollution, the attributable health burden can be high, particularly for susceptible populations.ObjectivesAn international multidisciplinary workshop was convened to discuss evidence of the effectiveness of actions to reduce health impacts of air pollution at both the community and individual level. The overall aim was to summarize current knowledge regarding air pollution exposure and health impacts leading to public health recommendations.DiscussionDuring the workshop, experts reviewed the biological mechanisms of action of air pollution in the initiation and progression of disease, as well as the state of the science regarding community and individual-level interventions. The workshop highlighted strategies to reduce individual baseline risk of conditions associated with increased susceptibility to the effects of air pollution and the need to better understand the role of exposure duration in disease progression, reversal, and adaptation.ConclusionWe have identified two promising and largely unexplored strategies to address and mitigate air pollution–related health impacts: reducing individual baseline risk of cardiovascular disease and incorporating air pollution–related health impacts into land-use decisions.

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          Most cited references 88

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          Health benefits of physical activity: the evidence.

          The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.
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            Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association.

            In 2004, the first American Heart Association scientific statement on "Air Pollution and Cardiovascular Disease" concluded that exposure to particulate matter (PM) air pollution contributes to cardiovascular morbidity and mortality. In the interim, numerous studies have expanded our understanding of this association and further elucidated the physiological and molecular mechanisms involved. The main objective of this updated American Heart Association scientific statement is to provide a comprehensive review of the new evidence linking PM exposure with cardiovascular disease, with a specific focus on highlighting the clinical implications for researchers and healthcare providers. The writing group also sought to provide expert consensus opinions on many aspects of the current state of science and updated suggestions for areas of future research. On the basis of the findings of this review, several new conclusions were reached, including the following: Exposure to PM <2.5 microm in diameter (PM(2.5)) over a few hours to weeks can trigger cardiovascular disease-related mortality and nonfatal events; longer-term exposure (eg, a few years) increases the risk for cardiovascular mortality to an even greater extent than exposures over a few days and reduces life expectancy within more highly exposed segments of the population by several months to a few years; reductions in PM levels are associated with decreases in cardiovascular mortality within a time frame as short as a few years; and many credible pathological mechanisms have been elucidated that lend biological plausibility to these findings. It is the opinion of the writing group that the overall evidence is consistent with a causal relationship between PM(2.5) exposure and cardiovascular morbidity and mortality. This body of evidence has grown and been strengthened substantially since the first American Heart Association scientific statement was published. Finally, PM(2.5) exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality.
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              An association between air pollution and mortality in six U.S. cities.

              Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks. In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities. Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most polluted of the cities as compared with the least polluted was 1.26 (95 percent confidence interval, 1.08 to 1.47). Air pollution was positively associated with death from lung cancer and cardiopulmonary disease but not with death from other causes considered together. Mortality was most strongly associated with air pollution with fine particulates, including sulfates. Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.
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                Author and article information

                Affiliations
                [1 ] School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, Canada
                [2 ] British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
                [3 ] Swiss Tropical and Public Health Institute, Basel, Switzerland
                [4 ] University of Basel, Basel, Switzerland
                [5 ] International Agency for Research on Cancer, Lyon, France
                [6 ] Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
                [7 ] Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [8 ] Providence Heart and Lung Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
                [9 ] Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
                [10 ] School of Environmental Health and
                [11 ] Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [12 ] Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
                [13 ] Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
                [14 ] Center for Environmental Health Sciences, University of Montana, Missoula, Montana, USA
                [15 ] Département de Santé Environnementale et Santé au Travail, Université de Montréal, Montréal, Quebec, Canada
                [16 ] Institut National de Santé Publique du Québec, Montréal, Quebec, Canada
                [17 ] Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
                [18 ] London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
                Author notes
                Address correspondence to M. Brauer, School of Environmental Health, The University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver, BC Canada, V6T 1Z3. Telephone: (604) 822-9585. Fax: (604) 822-9588. E-mail: brauer@ 123456interchange.ubc.ca

                The authors declare they have no actual or potential competing financial interests.

                Journal
                Environ Health Perspect
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                January 2011
                20 August 2010
                : 119
                : 1
                : 29-36
                3018496
                20729178
                10.1289/ehp.1002246
                ehp-119-29
                This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.
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