Environmental Epidemiology

This study focuses upon the health effects of air pollution as pollution is a global problem and has been causing havoc to the health of people worldwide. The research question has been represented in the PICO format. The researcher had used secondary research design for the collection of data where he had mainly focused upon case study analysis. Additionally, a number of keywords were used of making the search such as ‘air pollution’, ‘health effects’. The plausible biological mechanism in the research question has been discussed. The gaps in the evidence and pathway for future research have been mentioned.

Running head: ENVIRONMENTAL EPIDEMIOLOGY
Environmental Epidemiology
Name of the student
University name
Author’s note

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ENVIRONMENTAL EPIDEMIOLOGY
Table of Contents
1. Research question using PICO format...............................................................................2
2. Systematic review of literature based on research question...............................................2
A. Search strategy......................................................................................................................2
B. summary of the results...........................................................................................................3
C. plausible biological mechanism in the research question......................................................6
D. gaps in the evidence and pathway for future research..........................................................6
References..............................................................................................................................8

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ENVIRONMENTAL EPIDEMIOLOGY
1. Research question using PICO format
The current study focuses upon the health effects of air pollution as pollution is a
global problem and has been causing havoc to the health of people worldwide. For the current
assignment, we have been mainly taken the aspect of air pollution has been taken into
consideration.The air pollution has been seen to result in a number of respiratory disorders
within people. Most of the times, the affect of pollutants are deleterious resulting in serious
sickness such as lung cancer. Additionally, the air pollution has been damaging public and
private properties alike. The high amount of sulphur dioxide which are released in the form of
green house gases get dissolved in the atmospheric water droplets and are precipitated in the
form of acid rain (11). For example, the white marble of the Taj Mahal have been corroded
owing to the acid rain.
The further effects of air pollutions can be evaluated with the help of drafting an
effective research question. The research question has been represented in the PICO format.
Here, PICO refers to – Problem, Intervention, Comparison and Outcome.
In children and old age group (P) how can air pollution control strategies (I) against
exposure to large amount of air pollution compared to small amount of air pollution(C)
positively impact the health in the population group (O)?
2. Systematic review of literature based on research question
A. Search strategy
The researcher had used secondary research design for the collection of data where he
had mainly focused upon case study analysis. Some of this case study analysis has adopted
randomised control trial whereas the rest were case study analysis. For the randomised
control trials, the patients who had been suffering from some of the other respiratory issues

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ENVIRONMENTAL EPIDEMIOLOGY
owing to exposure to high amount of air pollution had been taken into consideration. The
study methods have been further divided into control and experimental setups. The effect of
the control and intervention methods on the focus groups gad been further evaluated through
the research papers. The goal of the randomised control trials has been to reduce or control
the ill effects of air pollution on individual well being.
A number of inclusion and exclusion principle have been applied while doing the
research such as only secondary databases have been utilised for the collection of the journal
articles. Some of the secondary databases which had been used by the researcher over here
are CINAHL, PUBMED, NCBI etc.
During making the search only articles printed in English had been taken into
consideration. Additionally, the articles which had been published prior to the last 10 years
have not been taken into consideration. Additionally, a number of keywords were used of
making the search such as ‘air pollution’, ‘health effects’. The articles which had been
generate apart from the above search criteria had not been taken into consideration.
There were a number of strengths and limitation of the search criteria. Since
secondary databases were used only authentic peer reviewed article were taken into
consideration. Additionally, considering only the recent articles and journals the past biases
could be removed. However, there were a number of limitations of the search criteria as the
researcher narrowed down his search criteria to the past 10 years. Thus, some of the articles
published before that date was not taken into consideration, which could make the base of the
research much more strong.
B. summary of the results
Auth
or
year Researc
h setting
Study
design
Study
populati
Exposur
e
Outcome Bias Results

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ENVIRONMENTAL EPIDEMIOLOGY
on
Olm
o et
al.
April
2011
Pubmed
database
journal
articles
based
upon the
effect of
air
pollution
upon the
health of
people
will be
analysed
Secondar
y
research
design
has been
followed
over here
80 such
case
study
analysis
had been
taken
into
considera
tion
which
clearly
showed
the effect
of
atmosphe
ric
pollution
on
human
health
The
researche
rs
narrowed
down to
16 such
articles
which
mentione
d public
policies
aimed at
changing
emission
standards
There is a
need to
incorpoarte
epidemiolo
gical
evidence
into
decisions
related to
environme
ntal
regulations.
Of the
113
Brazilian
and non-
Brazilian
articles
that were
analysed
only 4 did
not find
any
associatio
n between
pollution
and
health
which
could be
attributed
to
publicatio
n biases.
It was
found that
in even in
low
concentrat
ions the
atmospher
ic
pollutant
can affect
human
health (9).
Feret
ti et
al.
A 1000
children
(200
children
per
town )
within
the age
group of
6-8 years
were
recruiter
from
first
grade
school
Comet
assay
and
micronuc
lei test in
oral
mucosa
cells of
6-8 years
old
children
will be
investiga
ted to
measure
the
amount
of DNA
damage
caused
1000
children
enrolled
in
different
areas in
two
different
seasons
Sources
of
exposure
to air
pollutants
and
lifestyle
variables
will be
accessed
with the
help of a
structure
d
questionn
aire
Tentative
model for
calculating
global
absolute
risk of
having
early
biological
effects
caused by
air
pollution
will be
proposed.
Some of
the early
childhood
disorders
may have
been
geneticall
y
inherited
It was
found that
genetic
modificati
on caused
in early
childhood
due to
exposure
to heavy
pollutants
can impair
the
normal
immunity
levels
present
within the
children
(10).
Xu et
al.
2013 Populati
on based
study to
investiga
te the
effect of
air
populatio
n
exposure
on
A
randomis
ed
control
trial had
been
conducte
d over
here
White
respirator
y cancer
patients
in the
two areas
such as
Honolulu
and Los
Angeles
The
participa
nt from
two
different
geograph
ical
locations
were
selected
as the
Survival
time was
calculated
as the
interval
from the
time of
diagnosis
to the time
of death
Basic
demograp
hics and
stages of
cancer
were
included
as
confound
ers in the
model
More than
90 % of
cases
were
bronchus
or lung
cancers
which
could be
attributed
to high

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ENVIRONMENTAL EPIDEMIOLOGY
affecting
g the
survival
time of
the
respirato
ry cancer
cases
climate
of both
the areas
had
significan
t amount
of
differenc
e in air
particulat
e matter
concentra
tion
exposure
to
pollutants
Lyon
s et
al.
23rd
may,
2016
Longitud
inal
anonymi
sed data
were
used for
thematic
analysis
Quasi-
experime
ntal
study
design
had been
adopted
over here
describin
g
accuracy
of alerts
compare
d to
pollution
trigger
factors
Participa
nts who
reportedl
y had
asthma ,
COPD
and
residents
in
industrial
areas of
south
Wales
were
taken
into
considera
tion
2 year
interventi
on period
alerts
were
issued on
208-248
occasions
The
interventio
n was
associated
with four
fold
increase for
admissions
due to
respiratory
conditions
Non-
randomis
ed
interventi
on is
associate
d with
bias.
Before
and after
approach
used for
comparin
g change
in health
service
utilisation
The
sensitivity
of the
system
was
83.9%
especially
on
occasions
were
correct
alarms
were sent
(7).
Ren
&
Tong
29th
Janua
ry
2008
The
study
was
conducte
d in 14
centres
using a
common
protocol
Case
cross
over
study
design
adopted
for
measurin
g the
long and
short
effects
of air
pollutant
s upon
the
health of
people
Each
study
centre
urban
and rural
class of
symptom
atic
children
Exposure
to low
level air
pollution
and
health
outcomes
The
exposure to
heavy air
pollutants
have been
seen to
produce
significant
birth
outcomes
such as low
birth
weight ,
premature
delivery
Bias may
occur in
defining
the type
of model
It was
seen that
air
pollution
arising
from
common
emission
sources
was
responsibl
e for
producing
cardiovas
cular
distress in
the elderly
(12).
An et
al.
2017 Metanaly
sis of
evidence
based
journals
Cross
sectional
study
design
was
Out of
the broad
literature
search
seven
Increase
in
ambient
concentra
tion to be
The effect
of air
pollution
on physical
activity
Publicatio
n bias of
the
research
journals
Air
pollution
discourag
e physical
activity

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ENVIRONMENTAL EPIDEMIOLOGY
conducte
d
adopted met the
inclusion
criteria
associate
d with
psychical
inactivity
was limited
to
particulate
matter
(8).
(Source: author)
C. plausible biological mechanism in the research question
There has been growing concerns regarding the health effects of air pollution. One
such serious concern has been with respect to the abundance of particulate matter in the air.
As mentioned by Watts et al., the particulate matters are mainly in the form of free carbon
dust or soot particles (1). These have been seen to enhance the respiratory troubles along with
causing breathing difficulties. Evidence has linked exposure to particulate matter (PM) with
cardiopulmonary disease (2). A systematic response to PM induced pulmonary infection
could lead to cytokine release which can later cardiac function. Studies have suggested that
threshold level of PM above 2.5 can trigger a range of diseases w within an individual. As
suggested by Percival, Schroeder, Miller, Leape , improving air quality is not the most
effective method either (3). For instance, there is a need for stronger control methods, which
could help in controlling the concentration of PM in the air. The free carbon or dust has been
seen to produce carcinogenic effects in an individual which could further lead to the
development of lung cancer (4).
D. gaps in the evidence and pathway for future research
Inspite of sufficient research done on the topic and effective measures taken the rate
of air pollution and the concentration of particulate matters is still high in certain places of the
world. This could be attributed to the fast and the rapid rate of globalization. With the advent
of globalization more and more people have been using public transit for travelling (5).
Additionally, fast industrialization has also been affected with increasing rates of air pollution
(6). However, none of the control measures pertaining to reducing the events of gloablization

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ENVIRONMENTAL EPIDEMIOLOGY
had been covered effectively so far as the theories suggested by one school of thought has
been rejected by the other.

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ENVIRONMENTAL EPIDEMIOLOGY
References
[1] Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, Chaytor S, Colbourn T,
Collins M, Cooper A, Cox PM. Health and climate change: policy responses to
protect public health. The Lancet. 2015 Nov 7;386(10006):1861-914.
[2] Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A,
Frumkin H, Gong P, Head P, Horton R. Safeguarding human health in the
Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on
planetary health. The Lancet. 2015 Nov 14;386(10007):1973-2028.
[3] Percival RV, Schroeder CH, Miller AS, Leape JP. Environmental regulation: Law,
science, and policy. Wolters Kluwer Law & Business; 2017 Dec 28.
[4] Münzel T, Sørensen M, Gori T, Schmidt FP, Rao X, Brook J, Chen LC, Brook RD,
Rajagopalan S. Environmental stressors and cardio-metabolic disease: part I–
epidemiologic evidence supporting a role for noise and air pollution and effects of
mitigation strategies. European heart journal. 2017 Feb 21;38(8):550-6.
[5] Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved
understanding of risk. Environmental geochemistry and health. 2015 Aug
1;37(4):631-49.
[6] Van De Loo KF, Van Gelder MM, Roukema J, Roeleveld N, Merkus PJ, Verhaak CM.
Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-
analysis. European Respiratory Journal. 2016 Jan 1;47(1):133-46.

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[7] Lyons RA, Rodgers SE, Thomas S, Bailey R, Brunt H, Thayer D, Bidmead J, Evans BA,
Harold P, Hooper M, Snooks H. Effects of an air pollution personal alert system on
health service usage in a high-risk general population: a quasi-experimental study
using linked data. J Epidemiol Community Health. 2016 May 23:jech-2016.
[8] An R, Zhang S, Ji M, Guan C. Impact of ambient air pollution on physical activity among
adults: a systematic review and meta-analysis. Perspectives in public health. 2018
Mar;138(2):111-21.
[9] Olmo NR, Saldiva PH, Braga AL, Lin CA, Santos UD, Pereira LA. A review of low-level
air pollution and adverse effects on human health: implications for epidemiological
studies and public policy. Clinics. 2011;66(4):681-90.
[10] Feretti D, Ceretti E, De Donno A, Moretti M, Carducci A, Bonetta S, Marrese MR,
Bonetti A, Covolo L, Bagordo F, Villarini M. Monitoring air pollution effects on
children for supporting public health policy: the protocol of the prospective cohort
MAPEC study. BMJ open. 2014 Sep 1;4(9):e006096.
[11] Lamothe M, Rondeau É, Malboeuf-Hurtubise C, Duval M, Sultan S. Outcomes of
MBSR or MBSR-based interventions in health care providers: A systematic review
with a focus on empathy and emotional competencies. Complementary therapies in
medicine. 2016 Feb 1;24:19-28.
[12] Ren C, Tong S. Health effects of ambient air pollution–recent research development and
contemporary methodological challenges. Environmental Health. 2008 Dec;7(1):56.

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