A New Air Quality Perception Scale for Global Assessment of Air Pollution Health Effects

Despite improvements in air quality in developed countries, air pollution remains a major public health issue. To fully assess the health impact, we must consider that air pollution exposure has both physical and psychological effects; this latter dimension, less documented, is more difficult to measure and subjective indicators constitute an appropriate alternative. In this context, this work presents the methodological development of a new scale to measure the perception of air quality, useful as an exposure or risk appraisal metric in public health contexts. On the basis of the responses from 2,522 subjects in eight French cities, psychometric methods are used to construct the scale from 22 items that assess risk perception (anxiety about health and quality of life) and the extent to which air pollution is a nuisance (sensorial perception and symptoms). The scale is robust, reproducible, and discriminates between subpopulations more susceptible to poor air pollution perception. The individual risk factors of poor air pollution perception are coherent with those findings in the risk perception literature. Perception of air pollution by the general public is a key issue in the development of comprehensive risk assessment studies as well as in air pollution risk management and policy. This study offers a useful new tool to measure such efforts and to help set priorities for air quality improvements in combination with air quality measurements.     

Target Levels—Tools for Prevention

Although occupational exposure limits are sought to establish health-based standards, they do not always give a sufficient basis for planning an indoor air climate that is good and comfortable for the occupants in industrial work rooms. This paper considers methodologies by which the desired level, i.e., target level, of air quality in industrial settings can be defined, taking into account feasibility issues. Risk assessment based on health criteria is compared with risk-assessment based on "Best Available Technology" (BAT). Because health-based risk estimates at low concentration regions are rather inaccurate, the technology-based approach is emphasized. The technological approach is based on information on the prevailing concentrations in industrial work environments and the benchmark air quality attained with the best achievable technology. The prevailing contaminant concentrations are obtained from a contaminant exposure databank, and the benchmark air quality by field measurements in industrial work rooms equipped with advanced ventilation and production technology. As an example, the target level assessment has been applied to formaldehyde, total inorganic dust and hexavalent chromium, which are common contaminants in work room air.     

The Perceived Health Risks of Indoor Radon Gas and Overhead Powerlines: A Comparative Multilevel Approach

Radon and overhead powerlines are two radiation risk cases that have raised varying levels of concern among the general public and experts. Despite both involving radiation—a typically feared and unseen health hazard—individuals' perceptions of the two risk cases may invoke rather different factors. We examined individual and geographic-contextual factors influencing public perceptions of the health risks of indoor radon gas and overhead powerlines in a comparative research design, utilizing a postal questionnaire with 1,528 members of the general public (response rate 28%) and multilevel modeling techniques. This study found that beliefs about the two risk cases mainly differed according to the level of "exposure"—defined here in terms of spatial proximity. We argue that there are two alternative explanations for this pattern of findings: that risk perception itself varies directly with proximity, or that risk is more salient to concerned people in the exposed areas. We also found that while people living in high radon areas are more concerned about the risks of indoor radon gas, they find these risks more acceptable and have more trust in authorities. These results might reflect the positive effects of successive radon campaigns in high radon areas, which may have raised awareness and concern, and at the same time may have helped to increase trust by showing that the government takes the health risks of indoor radon gas seriously, suggesting that genuine risk communication initiatives may have positive impacts on trust in risk management institutions.     

Review of Radon and Lung Cancer Risk

Radon, a long-established cause of lung cancer in uranium and other underground miners, has recently emerged as a potentially important cause of lung cancer in the general population. The evidence for widespread exposure of the population to radon and the well-documented excess of lung cancer among underground miners exposed to radon decay products have raised concern that exposure to radon progeny might also be a cause of lung cancer in the general population. To date, epidemiological data on the lung cancer risk associated with environmental exposure to radon have been limited. Consequently, the lung cancer hazard posed by radon exposure in indoor air has been addressed primarily through risk estimation procedures. The quantitative risks of lung cancer have been estimated using exposure-response relations derived from the epidemiological investigations of uranium and other underground miners. We review five of the more informative studies of miners and recent risk projection models for excess lung cancer associated with radon. The principal models differ substantially in their underlying assumptions and consequently in the resulting risk projections. The resulting diversity illustrates the substantial uncertainty that remains concerning the most appropriate model of the temporal pattern of radon-related lung cancer. Animal experiments, further follow-up of the miner cohorts, and well-designed epidemiological studies of indoor exposure should reduce this uncertainty.     

Comparative Risk and Policy Analysis in Environmental Health

There is increasing interest in the integration of quantitative risk analysis with benefit-cost and cost-effectiveness methods to evaluate environmental health policy making and perform comparative analyses. However, the combined use of these methods has revealed deficiencies in the available methods, and the lack of useful analytical frameworks currently constrains the utility of comparative risk and policy analyses. A principal issue in integrating risk and economic analysis is the lack of common performance metrics, particularly when conducting comparative analyses of regulations with disparate health endpoints (e.g., cancer and noncancer effects or risk-benefit analysis) and quantitative estimation of cumulative risk, whether from exposure to single agents with multiple health impacts or from exposure to mixtures. We propose a general quantitative framework and examine assumptions required for performing analyses of health risks and policies. We review existing and proposed risk and health-impact metrics for evaluating policies designed to protect public health from environmental exposures, and identify their strengths and weaknesses with respect to their use in a general comparative risk and policy analysis framework. Case studies are presented to demonstrate applications of this framework with risk-benefit and air pollution risk analyses. Through this analysis, we hope to generate discussions regarding the data requirements, analytical approaches, and assumptions required for general models to be used in comparative risk and policy analysis.     

A Probabilistic Transmission Dynamic Model to Assess Indoor Airborne Infection Risks

The purpose of this article is to quantify the public health risk associated with inhalation of indoor airborne infection based on a probabilistic transmission dynamic modeling approach. We used the Wells-Riley mathematical model to estimate (1) the CO2 exposure concentrations in indoor environments where cases of inhalation airborne infection occurred based on reported epidemiological data and epidemic curves for influenza and severe acute respiratory syndrome (SARS), (2) the basic reproductive number, R0 (i.e., expected number of secondary cases on the introduction of a single infected individual in a completely susceptible population) and its variability in a shared indoor airspace, and (3) the risk for infection in various scenarios of exposure in a susceptible population for a range of R0. We also employ a standard susceptible-infectious-recovered (SIR) structure to relate Wells-Riley model derived R0 to a transmission parameter to implicate the relationships between indoor carbon dioxide concentration and contact rate. We estimate that a single case of SARS will infect 2.6 secondary cases on average in a population from nosocomial transmission, whereas less than 1 secondary infection was generated per case among school children. We also obtained an estimate of the basic reproductive number for influenza in a commercial airliner: the median value is 10.4. We suggest that improving the building air cleaning rate to lower the critical rebreathed fraction of indoor air can decrease transmission rate. Here, we show that virulence of the organism factors, infectious quantum generation rates (quanta/s by an infected person), and host factors determine the risk for inhalation of indoor airborne infection.     

Health Risk,Inequality Indexes,and Environmental Justice

Inequality indexes have long been used to analyze distributions of income. Studies have recently begun to use these tools to evaluate the equity of distributions of environmental harm. In response, issues have been raised regarding the appropriateness of using income-based measures in the context of undesirable outcomes. We begin from first principles, identifying a theoretical preference structure under which income-based tools can be appropriate for ranking distributions of “bads.” While some critiques of existing applications are valid, they are not a justification for rejecting the approach altogether. Instead, we show how standard income-based measures can be adjusted to accommodate bad outcomes. Rather than inequality indexes, we argue that equally distributed equivalents (EDEs) are well-suited for this purpose since they account for levels and dispersion of outcome distributions. The Kolm–Pollak EDE is particularly useful, having the advantage of consistently evaluating both bads and their complementary goods (e.g., mortality risk and survival probability). As an illustration, we show how these tools can inform an environmental justice analysis of a proposed Environmental Protection Agency (EPA) rule addressing indoor air pollution.     

Examining Localized Patterns of Air Quality Perception in Texas: A Spatial and Statistical Analysis

Environmental and human health issues associated with outdoor air pollution, such as ozone, sulfur dioxide, and other pollutants in metropolitan regions, are an area of growing concern for both policy officials and the general public. Increasing attention from the news media, new health data, and public debate over the effectiveness of clean air regulations have raised the importance of air quality in the public consciousness. While public perceptions of air quality have been studied thoroughly dating back to the 1960s, little empirical research has been conducted to explain the spatial aspects of these perceptions, particularly at the local level. Although recent studies suggest characteristics of local setting are important in shaping perceptions of air quality, the roles of proximity, neighborhood characteristics, and location have not been clarified. This study seeks to improve understanding of the major factors shaping public perceptions of air quality by examining the spatial pattern of local risk perception, the role of socioeconomic characteristics in forming these perceptions, and the relationship between perceived and scientifically measured air pollution. First, we map the spatial pattern of local air quality perceptions using Geographic Information Systems (GIS) across the Dallas and Houston metropolitan areas. Next, we explain these perceptions through local contextual factors using both bivariate correlations and multivariate regression analysis. Results indicate that perceptions of air quality in the study areas are not significantly correlated with air quality based on readings of air monitoring stations. Instead, perceptions appear to be influenced by setting (urban vs. rural), state identification, access to information, and socioeconomic characteristics such as age, race, and political identification. We discuss the implications of the findings and provide direction on how further research can provide a deeper understanding of the local contextual factors influencing public perceptions.     

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.     

The Role of Cancer Risk in the Regulation of Industrial Pollution

The extent of carcinogen regulation under existing U.S. environmental statutes is assessed by developing measures of the scope and stringency of regulation. While concern about cancer risk has played an important political role in obtaining support for pollution control programs, it has not provided the predominant rationale for most regulatory actions taken to date. Less than 20% of all standards established to limit concentrations of chemicals in various media address carcinogens. Restrictions on chemical use are more frequently based on concerns about noncancer human health or ecological effects. Of the chemicals in commercial use which have been identified as potential human carcinogens on the basis of rodent bioassays, only a small proportion are regulated. There is an inverse relationship between the scope of regulatory coverage and the stringency of regulatory requirements: the largest percentages of identified carcinogens are affected by the least stringent requirements, such as information disclosure. Standards based on de minimis cancer risk levels have been established for only 10% of identified carcinogens and are restricted to one medium: water. Complete bans on use have affected very few chemicals. The general role that carcinogenicity now plays in the regulatory process is not dramatically different from that of other adverse human health effects: if a substance is identified as a hazard, it may eventually be subject to economically achievable and technically feasible restrictions.     

雾霾感知风险与公众应对行为的实证分析

通过在雾霾严重时期收集的大规模问卷调查数据,建立了雾霾感知风险等因素与应对行为之间关系的结构方程模型.分析显示,对环境信息越敏感、雾霾感知风险越大、对雾霾知识了解越多、雾霾感知可控性越大的公众会采取更多的防护与应对措施,他们对相关防护产品的购买意愿也越强.特别是,感知风险在环境信息与应对行为以及环境满意度之间起着重要的中介变量作用,即当雾霾污染引起人们的感知风险时,会促使他们采取更多的应对行为,并且对环境满意度评价产生负面影响.另外,雾霾感知可控性在雾霾知识熟悉度与应对行为以及环境满意度之间起着部分中介变量的作用.     

Consideration of Background Exposures in the Management of Hazardous Waste Sites: A New Approach to Risk Assessment

The current approach to health risk assessment of toxic waste sites in the U.S. may lead to considerable expenditure of resources without any meaningful reduction in population exposure. Risk assessment methods used generally ignore background exposures and consider only incremental risk estimates for maximally exposed individuals. Such risk estimates do not address true public health risks to which background exposures also contribute. The purpose of this paper is to recommend a new approach to risk assessment and risk management concerning toxic waste sites. Under this new approach, which we have called public health risk assessment, chemical substances would be classified into a level of concern based on the potential health risks associated with typical national and regional background exposures. Site assessment would then be based on the level of concern for the particular pollutants involved and the potential contribution of site contaminants to typical background human exposures. While various problems can be foreseen with this approach, the key advantage is that resources would be allocated to reduce the most important sources of human exposure, and site remediation decisions could be simplified by focussing on exposure assessment rather than questionable risk extrapolations.     

The Indoor Radiological Problem in Perspective

Measures to tighten homes to conserve energy, as are being encouraged and subsidized by federal and state governments, may reduce air infiltration by 20% or more. Standard prudent risk-assessment methodologies predict that, due to increased levels of indoor radon caused by this reduction in ventilation, the added lifetime lung cancer risk to members of the public is of order 200/million people exposed. In situations where the radon source term is unusually high, or extreme reductions in ventilation are made, the added risk can be more than an order of magnitude greater. While these imputed risks are far outside the range that is normally tolerated, no systematic efforts are in progress to mitigate or limit the risk in any way. Furthermore, efforts to determine better the variations in radon source term and the health effects of indoor radon are being deemphasized. The technical background is presented in some detail, and implications with regard to management of risks to the public are discussed.     

Risk Perception of Heavy Metal Soil Contamination by High-Exposed and Low-Exposed Inhabitants: The Role of Knowledge and Emotional Concerns

Soil contaminated with heavy metals is a salient example of environmental risk. Consumption of vegetables cultivated in contaminated soil or direct ingestion of soil by small children can damage health. In contrast to other kinds of pollution or risks such as air pollution or exposure to ozone, the individual risk concerning soil contamination is highly dependent on the way one is exposed to the local source of risk. Thus, we wanted to know if risk perception varies according to the level of exposure. A quasi-experimental, questionnaire-based study was conducted in a community in northwest Switzerland, where the soil is widely contaminated. The level of contamination varies with the distance from the source of the contamination, a metal processing plant. We investigated the perception of risk of heavy-metal-contaminated soil by inhabitants with high-exposure levels (N= 27) and those with low-exposure levels (N= 30). Both groups judged the risk for oneself similarly whereas the low-exposure group, when compared to the high-exposure group, judged perceived risk for other affected people living in their community to be higher. Besides this exposure effect, risk perception was mainly determined by emotional concerns. Participants with higher scores in self-estimated knowledge tended to provide low-risk judgments, were less interested in further information, showed low emotional concern, and thus displayed high risk acceptance. In contrast, actual knowledge showed no correlation with any of theses variables. Judgments on the need for decontamination are determined by risk perception, less application of dissonance-reducing heuristics and commitment to sustainability. The desire for additional information is not affected by missing knowledge but is affected by emotional concerns.     

Health Risks of Energy Systems

Health risks from fossil, renewable and nuclear reference energy systems are estimated following a detailed impact pathway approach. Using a set of appropriate air quality models and exposure-effect functions derived from the recent epidemiological literature, a methodological framework for risk assessment has been established and consistently applied across the different energy systems, including the analysis of consequences from a major nuclear accident. A wide range of health impacts resulting from increased air pollution and ionizing radiation is quantified, and the transferability of results derived from specific power plants to a more general context is discussed.     

Gender and Race in Beliefs about Outdoor Air Pollution

Universal need for, or reactions to, risk communications should not be assumed; potential differences across demographic groups in environmental risk beliefs, attitudes, and behaviors could affect risk levels or opportunities for risk reduction. This article reports relevant findings from a survey experiment involving 1,100 potential jurors in Philadelphia concerning public responses to outdoor air pollution and air quality information. Flynn et al. (1994) and Finucane et al. (2000) found significant differences in risk ratings for multiple hazards, and in generic risk beliefs, between white men (or a subset) and all others (white women, nonwhite men, and nonwhite women). This study examined whether white men had significantly different responses to air pollution and air pollution information. An opportunity sample of volunteers from those awaiting potential jury duty in city courts (matching census estimates for white versus nonwhite proportions, but more female than the city's adult population and more likely to have children) filled out questionnaires distributed quasi-randomly. On most measures there were no statistically significant differences among white men (N = 192), white women (N = 269), nonwhite men (N = 165), and nonwhite women (N = 272). Nonwhites overall (particularly women) reported more concern about and sensitivity to air pollution than whites, and were more concerned by (even overly sensitive to) air pollution information provided as part of the experiment. Nonwhites also were more likely (within-gender comparisons) to report being active outdoors for at least four hours a day, a measure of potential exposure to air pollution, and to report intentions to reduce such outdoor activity after reading air pollution information. Differences between men and women were less frequent than between whites and nonwhites; the most distinctive group was nonwhite women, followed by white men. Flynn et al. (1994) and Finucane et al. (2000) found a far larger proportion of significant differences, with white men as most distinctive, probably due to use of different measures, study design, and population samples. However, all three studies broadly confirm the existence of gender and race interactions in risk beliefs and attitudes (particularly for white men and nonwhite women) that deserve more attention from researchers.     

Peak Exposures in Epidemiologic Studies and Cancer Risks: Considerations for Regulatory Risk Assessment

We review approaches for characterizing “peak” exposures in epidemiologic studies and methods for incorporating peak exposure metrics in dose–response assessments that contribute to risk assessment. The focus was on potential etiologic relations between environmental chemical exposures and cancer risks. We searched the epidemiologic literature on environmental chemicals classified as carcinogens in which cancer risks were described in relation to “peak” exposures. These articles were evaluated to identify some of the challenges associated with defining and describing cancer risks in relation to peak exposures. We found that definitions of peak exposure varied considerably across studies. Of nine chemical agents included in our review of peak exposure, six had epidemiologic data used by the U.S. Environmental Protection Agency (US EPA) in dose–response assessments to derive inhalation unit risk values. These were benzene, formaldehyde, styrene, trichloroethylene, acrylonitrile, and ethylene oxide. All derived unit risks relied on cumulative exposure for dose–response estimation and none, to our knowledge, considered peak exposure metrics. This is not surprising, given the historical linear no‐threshold default model (generally based on cumulative exposure) used in regulatory risk assessments. With newly proposed US EPA rule language, fuller consideration of alternative exposure and dose–response metrics will be supported. “Peak” exposure has not been consistently defined and rarely has been evaluated in epidemiologic studies of cancer risks. We recommend developing uniform definitions of “peak” exposure to facilitate fuller evaluation of dose response for environmental chemicals and cancer risks, especially where mechanistic understanding indicates that the dose response is unlikely linear and that short‐term high‐intensity exposures increase risk.     

Exposure Assessment: Methods of Analysis for Environmental Carcinogens1

Human populations are exposed to environmental carcinogens in both indoor and outdoor atmospheres. Recent studies indicate that pollutant concentrations are generally higher in indoor atmospheres than in outdoor. Environmental pollutants that occur in indoor air from a variety of sources include radon, asbestos, organic and inorganic compounds, and certain particles (e.g., tobacco smoke). Some of the gases or vapors are adsorbed on suspended particulate matter, whereas others exist entirely in the gas phase or are distributed between the latter and a particle-bound state. Because of differences in chemical and physical properties, each class of carcinogens generally requires different sampling and analytical methods. In addition, a single indoor environment may contain a wide variety of air pollutants from different sources. Unfortunately, no single best approach currently exists for the quantitative determination of such complex mixtures and, for practical reasons, only the more toxic or the more abundant pollutants are usually measured. This paper summarizes the currently available monitoring methods for selected environmental pollutants found in indoor atmospheres. In addition, some possible sources for those pollutants are identified.     

Radon Risk Information and Voluntary Protection: Evidence from a Natural Experiment

This study examines the perceived risks and mitigating behavior of Maine households who received new information on their exposures to significant health risks from indoor radon. The observed responses of these households illustrate conceptual issues related to designing an effective risk information program. Despite the involvement of generally well-motivated homeowners and well-intentioned researchers and government officials, we conclude that the risk information approach used in Maine failed to induce appropriate, cost-effective voluntary protection. The results indicate that, after receiving radon test results, information on associated health risks, and suggestions on how to reduce exposures: perceived risks tended to understate objective risks by orders of magnitude, and there was no statistically significant relationship between mitigating behavior and objective risks. These results suggest that the formation of risk perceptions and subsequent behavioral adjustments involve complex interactions among information, contextual, socioeconomic, and psychological variables. Therefore, government programs that seek to reduce health and safety risks with information programs, instead of using more conventional enforced standards, must be crafted very carefully to accommodate this complex process.     

Intake fraction for multimedia pollutants: a tool for life cycle analysis and comparative risk assessment.

We employ the intake fraction (iF) as an effective tool for expressing the source-to-intake relationship for pollutant emissions in life cycle analysis (LCA) or comparative risk assessment. Intake fraction is the fraction of chemical mass emitted into the environment that eventually passes into a member of the population through inhalation, ingestion, or dermal exposure. To date, this concept has been primarily applied to pollutants whose primary route of exposure is inhalation. Here we extend the use of iF to multimedia pollutants with multiple exposure pathways. We use a level III multimedia model to calculate iF for TCDD and compare the result to one calculated from measured levels of dioxin toxic equivalents in the environment. We calculate iF for emissions to air and surface water for 308 chemicals. We correlate the primary exposure route with the magnitudes of the octanol-water partition coefficient, Kow, and of the air-water partitioning coefficient (dimensionless Henry constant), Kaw. This results in value ranges of Kow and Kaw where the chemical exposure route can be classified with limited input data requirements as primarily inhalation, primarily ingestion, or multipathway. For the inhalation and ingestion dominant pollutants, we also define empirical relationships based on chemical properties for quantifying the intake fraction. The empirical relationships facilitate rapid evaluation of many chemicals in terms of the intake. By defining a theoretical upper limit for iF in a multimedia environment we find that iF calculations provide insight into the multimedia model algorithms and help identify unusual patterns of exposure and questionable exposure model results.