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PubMed1994

The role of soda lime during administration of inhaled nitric oxide.

We have studied the ability of three commercially available preparations of soda lime to act as nitrogen dioxide scavengers during administration of inhaled nitric oxide. Soda lime, with a green to brown colour change (indicator = potassium permanganate), markedly reduced concentrations of nitrogen dioxide, but also markedly reduced inhaled concentrations of nitric oxide. The other varieties of soda lime, with colour changes from pink to white (indicator = kenazol yellow) or white to violet (indicator = ethyl violet), produced little effect on concentrations of nitrogen dioxide. None of the above soda limes can be recommended for use as a nitrogen dioxide scavenger during administration of inhaled nitric oxide.

Calcium Compounds↗

PubMed1998

Respiratory symptoms of primary school children living in a petrochemical polluted area in Taiwan.

In 1994-1995 a cross-sectional epidemiological study investigating the respiratory health of school children in two Taiwan areas was conducted; one area was located in a region with petrochemical manufacturing complexes (Linyuan), and the other was situated in a reference area with no local industrial emissions (Taihsi). All primary school children residing in the two areas were involved in the study. Four hundred seventy children were studied in the area with high exposure to industrial emissions, and 611 children lived in the reference area. Respiratory health was assessed by evaluation of the children's respiratory symptoms and illnesses, using a parent-completed questionnaire. Particulates, sulfur dioxide (SO2), nitrogen dioxide (NO2), and acid aerosols levels were significantly higher in the exposed area than in the reference area. The school children in the petrochemical area had significantly more upper respiratory symptoms and asthma compared with the children living in the control area. Although the association with known petrochemical air pollution is suggestive, this cross-sectional study cannot confirm a causal relation and further studies are needed.

Air Pollutants↗

PubMed1997

Air pollution and doctors' house calls: results from the ERPURS system for monitoring the effects of air pollution on public health in Greater Paris, France, 1991-1995. Evaluation des Risques de la Pollution Urbaine pour la Santé.

This study examines short-term relationships between doctors' house calls and urban air pollution in Greater Paris for the period 1991-1995. Poisson regressions using nonparametric smoothing functions controlled for time trend, seasonal patterns, pollen counts, influenza epidemics, and weather. The relationship between asthma visits and air pollution was stronger for children. A relative risk (RRP95/P5) of 1.32 [95% confidence interval (CI) = 1.17-1.47)] was observed for an increase from the 5th to the 95th percentile (7-51 micrograms/m3) in daily concentrations of black smoke (BS). The risks for 24-hr sulfur dioxide and nitrogen dioxide levels were in the same range. Cardiovascular conditions, considered globally, showed weaker associations than angina pectoris/myocardial infarction, for which RRP95/P5 was 1.63 (95% CI = 1.10-2.41) in relation to ozone ambient levels. Eye conditions were exclusively related to ozone (RRP95/P5 = 1.17, 95% CI 1.02-1.33). Asthma visits and ozone showed an interaction with minimum temperature: an effect was observed only at 10 degrees C or higher. In two-pollutant models including BS with, successively, SO2, NO2, and O3, only BS and O3 effects remained stable. Along with mortality and hospital admissions, house call activity data, available on a regular basis, may be a sensitive indicator for monitoring health effects related to air pollution.

Air Pollutants↗

PubMed1999

Air pollution and respiratory drug sales in the City of Le Havre, France, 1993-1996.

The aim of this study is to evaluate ambulatory respiratory drug sales data as health indicators for the short-term effects of ambient air pollution in the city of Le Havre. Daily respiratory drug sales data were crossed with daily ambient air concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and black smoke (BS) using an autoregressive Poisson regression model adjusting for time trends, seasonal variations, influenza epidemics, and weather. Relative risks (RR) were expressed for an increase of two standard deviations above the mean of each pollutant. Respiratory drug sales were associated with most pollutants studied with lags varying from 1 to 9 days. For daily mean concentrations of BS, RR = 1.037 (95% confidence interval (CI) 1.009-1.066) for lag 1 and RR = 1.052 (95% CI 1.023-1.081) for lag 8. For daily mean concentrations of N02, RR = 1.033 (95% CI 1.001-1.066) for lag 1 and RR = 1.046 (95% CI 1.014-1.079) for lag 8. RR observed with a daily 1 h maximum of SO2 were RR= 1.027 (95% CI 1.004-1.051) for lag 3 and RR= 1.032 (95% CI 1.009-1.056) for lag 9. Our study concludes that ambulatory respiratory drug sales data could be useful for epidemiological surveillance of air pollutant health effects.

Air Pollution↗

PubMed1986

[Air pollution and lung diseases in adults].

Short-time exposure to air pollutants and in particular to sulfur dioxide, nitrogen oxides and photochemical oxidants may cause respiratory symptoms similar to acute bronchial asthma. In healthy adults however the concentrations required to evoke significant bronchial obstruction lie still above the level of atmospheric air pollution usually observed in our country. In contrast patients with preexisting pulmonary diseases or with impaired bronchopulmonary defense mechanisms may show harmful reactions even at concentrations which actually occur in urban and rural atmospheres. In addition there is evidence of on increased prevalence of chronic obstructive pulmonary diseases in countries with high chemical pollution indicating that long-term exposure of ambient air pollution may cause chronic illness as well. Since air pollution is accepted to produce adverse health effects, emergent efforts are required to improve air quality in order to avoid further injuries in man.

Adult↗

PubMed2006

Modelling atmospheric pollution during the games of the XXVIII Olympiad: effects on elite competitors.

UNLABELLED: The present study investigated the specific atmospheric conditions expected in Athens during the summer of 2004 in relation to the performance of elite athletes. DESIGN: Atmospheric pollution and weather data for the period April 16th to September 30th covering the entire greater Athens area and collected from 1984 to 2003 were used for descriptive statistics and model fitting. The analysis was focused on carbon monoxide (CO), ozone (O3), sulfur dioxide (SO2), nitrogen oxide (NO), nitrogen dioxide (NO2), and particulate matter with a diameter of < 10 microm (PM10). Factor and cluster analysis were used to describe atmospheric pollution in the northern, central, and southern sector of Athens. Generalized estimated equations (GEE) analysis was used to predict mean August 2004 pollutant concentration. Increased concentrations of O3 and PM10 (mean 2003 values: 134.3 +/- 9.3, 44 +/- 1.9 microg/m3, respectively) may generate adverse health and performance effects. The highest O3 values were recorded in the northern Athenian sector during the period June 12th to July 23rd, peaking around mid-day (12:00-18:00) (p < 0.05). The highest PM10 concentrations were recorded in the central Athenian sector during the period August 20th to September 9th, peaking at late afternoon (14:00-22:00) (p < 0.05). Similar concentrations were observed during all days of the week (p > 0.05). GEE approximated mean August 2004 pollutant concentrations similar to: CO: 2.8 (mg/m3), O3: 136, SO2: 24, NO: 134, and NO2: 106 (microg/m3). Concentrations of O3 and PM10 during the XXVIII Olympiad may generate adverse health and performance effects on the cardiovascular function of the elite competitors. (The present manuscript was submitted shortly before the start of the Games and became published after their completion. In this light, the actual pollution rates in Athens during August 2004 are presented in the Note Added in Proof as credence to the statistics used).

Air Pollutants↗

PubMed2005

Systematic development of an artificial neural network model for real-time prediction of ground-level ozone in Edmonton, Alberta, Canada.

Ground-level ozone is a secondary pollutant that has recently gained notoriety for its detrimental effects on human and vegetation health. In this paper, a systematic approach is applied to develop artificial neural network (ANN) models for ground-level ozone (O3) prediction in Edmonton, Alberta, Canada, using ambient monitoring data for input. The intent of these models is to provide regulatory agencies with a tool for addressing data gaps in ambient monitoring information and predicting O3 events. The models are used to determine the meteorological conditions and precursors that most affect O3 concentrations. O3 time-series effects and the efficacy of the systematic approach are also assessed. The developed models showed good predictive success, with coefficient of multiple determination values ranging from 0.75 to 0.94 for forecasts up to 2 hr in advance. The inputs most important for O3 prediction were temperature and concentrations of nitric oxide, total hydrocarbons, sulfur dioxide, and nitrogen dioxide.

Air Pollutants↗

PubMed1997

Air pollution and mortality in Philadelphia, 1974-1988.

Analyses involving data from many locations throughout the world have now been conducted to assess the association between air pollution and mortality. To date, six independent analyses of mortality data for Philadelphia, Pennsylvania, have been reported. In this new analysis of Philadelphia data for 1974-1988, Poisson regression models were developed to estimate the increased risk of daily mortality associated with air pollution while controlling for longer-term time trends and season and for weather. Model development was based on prior understanding of the effects of these factors on mortality and on consideration of model fit. The authors found moderate correlations of daily concentrations of total suspended particles (TSP), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO), and only slight correlations of ozone (O3) with other pollutants. When included individually in the model, the means of current and previous days' levels of TSP, SO2, and O3 had statistically significant effects on total mortality; pollutant increases of an interquartile range (34.5 micrograms/m3, 12.9 ppb, and 20.2 ppb, respectively) were associated with increases in mortality of around 1% for TSP and SO2, and of around 2% for O3. The effects of TSP and SO2 were diminished when both pollutants were simultaneously included in the model, whether pairwise or in the full multi-pollutant model. These analyses confirm the association between TSP and mortality found in previous studies in Philadelphia and show that the association is robust to consideration of other pollutants in the model.

Aged↗

PubMed1981

Seasonal relationship of sudden infant death syndrome and environmental pollutants.

Evidence that chronic hypoxia precedes death from sudden infant death syndrome (SIDS) is mounting. Prolonged exposure to moderate levels of pollutants could be a contributing factor to hypoxia. Levels of carbon monoxide (CO), sulphur dioxide (SO2), nitrogen dioxide (NO2) and hydrocarbons (HC) are highest in the winter when incidence of SIDS is increased. SIDS cases in Los Angeles County were correlated with daily mean levels of these pollutants, temperature, barometric pressure and monthly lead levels with the aid of time series analyses. Peaks in CO, SO2, NO2, HC and lead preceded the seasonal increase in SIDS by seven weeks. Theoretical considerations, such as the hypoxia-inducing effects of CO, support the hypothesis that this temporal relation has functional significance. Three additional findings provided evidence for this hypothesis: 1) SIDS infants born during months of low pollution lived longer than those born during months of high pollution. 2) SIDS infants born in a district with low pollution lived longer than those born in a district with high pollution. 3) The bimonthly rate of SIDS was directly proportional to the level of CO pollution to which the infants had been exposed between conception and two months of age. The role of pollution levels as a predisposing factor in risk for SIDS cannot be summarily dismissed.

Air Pollutants↗

PubMed1999

The 21st century environment and air quality influences on asthma.

"Criteria" air pollutants are federally regulated pollutants that occur widely outdoors and have diverse sources, most often related to combustion. They include ozone (O3), particulate matter, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and lead. All except lead may interfere with oxygen delivery, and so may be of special concern to asthmatics. In controlled experiments, SO2 causes acute asthma symptoms and bronchoconstriction, preventable by beta-agonist medications. Ozone causes acute irritant symptoms, restrictive lung dysfunction, increased bronchial reactivity, and lower-airway inflammation in healthy people and asthmatics. Exposures to O3, and possibly to other pollutants, appear to exacerbate bronchoconstrictive or inflammatory responses to inhaled aeroallergens (bioaerosols); this may represent an important health risk to asthmatics. Exposure levels known to evoke acute responses to O3 or SO2 are uncommon in community air pollution; however, some asthmatics might be susceptible to lesser, more common exposures. Evidence concerning NO2 is equivocal, but it may have O3-like effects in some asthmatics. Epidemiology has often associated particulate pollution with asthma exacerbations and other cardiorespiratory illnesses, even in cities with relatively mild air pollution. Current laboratory research cannot fully explain this association. Advances in emission controls should further reduce ambient pollution levels, but probably will not reduce asthma morbidity. Better asthma management, with improved anti-inflammatory medications, more careful monitoring by patients and health care providers, and reasonable efforts to reduce pollutant and aeroallergen exposures, offers the best hope to reduce asthma morbidity in the new century.

Air Pollutants↗

PubMed1996

New insights into risk factors of asthma.

The prevalences of bronchial asthma in the Asia-Pacific region range from 0 to 24% and appear to be increasing in some countries. The increased prevalence of asthma may be related to the urbanization of these countries or areas. Risk factors relating to the development of asthma are multiple and complex. These include: Predisposing or genetic factors: (atopy and bronchial hyperresponsiveness; BHR) that increase an individuals susceptibility. Longitudinal studies in children have shown that BHR precedes asthma in some individuals. A gene governing BHR is located near a major locus that regulates serum IgE levels on chromosome 5 q. An additional gene that determines the specificity of the immune response located in the human leukocyte antigen complex (HLA) may govern the specificity of the immune response to common aeroallengens in some individuals. Causal Factors: inhaled allergens are the most important causal factors of asthma, which include indoor allergens (domestic mites, animal, cockroach and fungus allergens), domestic mites being the most common potential allergen, and outdoor allergens (pollens from trees, grasses and weeds). Owing to the geographic location and different sensitivity to allergen between races, allergens vary from area to area. Certain drugs, food and food additives are also the cause of asthma attack. Contributing factors: smoking is an important trigger and a serious problem in most Asian-Pacific countries. Air pollution in particular sulfur dioxide (SO2), nitrogen dioxide (NO2) and respirating particles are common contributing factors. Very low concentration of SO2 (0.5 ppm) can cause bronhospasm in asthmatics. A combination of low concentration of SO2 and NO2 often encountered in heavy traffic further enhances the airway responsiveness to inhaled allergen. In addition, respiratory virus infection is closely associated to the development of asthma in childhood.

Air Pollution↗

PubMed1996

Asthma and ambient air pollution in Helsinki.

OBJECTIVE: To study whether ambient air levels of sulphur dioxide (SO2), nitrogen dioxide (NO2), total suspended particulates (TSP), and ozone (O3) affect the number of hospital admissions for asthma. DESIGN: The associations between the daily number of admissions and air pollutants were analysed with Poisson regression, taking into account potential confounding factors by using the standardised protocol of the APHEA project. SETTING: Helsinki, Finland, 1987-89. PATIENTS AND MEASUREMENTS: Patients admitted to hospitals through emergency rooms because of asthma (n = 2421). The daily mean concentration was 13-25 micrograms/m3 for SO2, 33-41 micrograms/m3 for NO2, 19-41 micrograms/m3 for O3, and 58-109 micrograms/m3 for TSP during the different seasons. Values are means for various stations. The daily mean temperature during the three year period was +5.4 degrees C (range -37-27 degrees C). MAIN RESULTS: Positive associations with admissions were observed for O3 levels in all children under 14 years, and for SO2 levels in 15-64 year olds and among those older than 64. Significant associations were also seen between admissions for digestive tract diseases (the control) and O3 levels. This suggests that the modelling, which proved to be problematic, was unsatisfactory, or it may be a statistical coincidence. A rise in temperature was associated with a low number of admissions for asthma among 0-14 year olds and among 15-64 year olds, whereas humidity did not have a significant effect on the number of admissions. CONCLUSIONS: It is possible than even low level pollution may increase hospital admissions for asthma. However, definitive conclusions will be justified only after meta-analysis comprising several studies. The methodology was seen to have a strong effect on the results and standardised methods, possibly differing from those for the study concerning mortality, are needed to investigate the association between morbidity and ambient air pollutants.

Adolescent↗

PubMed1993

Effect of ambient winter air pollution on respiratory health of children with chronic respiratory symptoms.

The acute respiratory effects of ambient air pollution were studied in a panel of 73 children with chronic respiratory symptoms in the winter of 1990 to 1991. The participating children were selected from all children aged 6 to 12 yr in Wageningen and Bennekom, two small, nonindustrial towns in the east of the Netherlands. Peak flow was measured twice daily with MiniWright meters. A diary was used to register the occurrence of acute respiratory symptoms and medication use by the children. Exposure to air pollution was characterized by the ambient concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), black smoke (BS), and particulate matter less than 10 microns (PM10). Associations between air pollution concentrations and health outcomes were analyzed using time series analysis. During the study period an air pollution episode occurred, with moderately elevated concentrations of PM10 and SO2. There were 6 days with 24-h average PM10 concentrations in excess of the WHO suggested lowest observed effect level of 110 micrograms/m3. After adjustment for ambient temperature, there were small but statistically significant negative associations of PM10, BS, and SO2 with both morning and evening PEF. There was a consistent positive association between PM10, BS, and SO2 with the prevalence of wheeze and bronchodilator use. Overall, the observed associations suggest a mild to moderate response to these moderately elevated levels of air pollution in a group of potentially sensitive children.

Air Pollution↗

PubMed2002

The effect of air pollution on inner-city children with asthma.

The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA, using data from the National Cooperative Inner-City Asthma Study. Daily air pollution concentrations were extracted from the Aerometric Information Retrieval System database from the Environment Protection Agency in the USA. Mixed linear models and generalized estimating equation models were used to evaluate the effects of several air pollutants (ozone, sulphur dioxide (SO2), nitrogen dioxide (NO2) and particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) on peak expiratory flow rate (PEFR) and symptoms in 846 children with a history of asthma (ages 4-9 yrs). None of the pollutants were associated with evening PEFR or symptom reports. Only ozone was associated with declines in morning % PEFR (0.59% decline (95% confidence interval (CI) 0.13-1.05%) per interquartile range (IQR) increase in 5-day average ozone). In single pollutant models, each pollutant was associated with an increased incidence of morning symptoms: (odds ratio (OR)=1.16 (95% CI 1.02-1.30) per IQR increase in 4-day average ozone, OR=1.32 (95% CI 1.03-1.70) per IQR increase in 2-day average SO2, OR=1.48 (95% CI 1.02-2.16) per IQR increase in 6-day average NO2 and OR=1.26 (95% CI 1.0-1.59) per IQR increase in 2-day average PM10. This longitudinal analysis supports previous time-series findings that at levels below current USA air-quality standards, summer-air pollution is significantly related to symptoms and decreased pulmonary function among children with asthma.

Air Pollutants↗

PubMed2003

Air pollution and mortality in The Netherlands: are the elderly more at risk?

The association between daily mortality and short-term variations in the ambient levels of ozone (O3), black smoke (BS), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and particulate matter was studied in The Netherlands. Daily total and cause-specific mortality counts (cardiovascular, chronic obstructive pulmonary disease (COPD) and pneumonia), air quality, temperature, relative humidity and influenza data were obtained from 1986-1994. The relationship between daily mortality and air pollution was modelled using Poisson regression analysis. All pollution mortality associations were adjusted for potential confounding due to long-term trends, seasonal trends, influenza epidemics, ambient temperature, ambient relative humidity, day of the week and holidays, using generalised additive models. Statistically significant associations were mostly found in the elderly, that is the age categories of 65-74 and > or = 75 yrs for the pollutants PM10 (particles with a 50%, cut-off aerodynamic diameter of 10 microm), BS, SO2, NO2 and CO. This may partly be due to a better precision of relative risk (RR) estimates for the larger numbers of deaths in these age groups. Significant associations for those < 65 yrs were found for O3 (total and COPD mortality), PM10 (pneumonia), NO2 (pneumonia) and CO (pneumonia). RR estimates for deaths between 45-65 yrs tended to be smaller than those in > 65 yrs, with the exception of ozone; for cardiovascular mortality the RR for PM10, O3 and CO were similar in these age groups. In conclusion, larger relative risks for air pollution were mostly found in the elderly except for ozone and for death-cause pneumonia which showed larger relative risk in younger age groups.

Aged↗

PubMed2005

Susceptibility to air pollution in elderly males and females.

It is important to know which individuals in the general population have increased susceptibility to air pollution. The aim of this study was to identify susceptible subgroups by studying airways hyperresponsiveness (AHR), high total immunoglobulin (Ig)E and sex. Diary data on lower and upper respiratory symptoms (LRS and URS, respectively), cough, and morning and evening peak expiratory flow (PEF) were collected in 327 elderly patients (50-70 yrs) for a period of 3 months. Acute effects of particulate matter with a diameter <10 microm, black smoke, sulphur dioxide and nitrogen dioxide on symptoms and PEF were estimated using logistic regression. In total, 48 (14.7%) subjects had AHR+/IgE+, 112 (34.3%) had AHR-/IgE+, 42 (12.8%) had AHR+/IgE- and 125 (38.2%) had AHR-/IgE-. In the AHR+/IgE+ group, each 10 microg x m(-3) increase in air pollution was associated with a significant increase in prevalence of URS (odds ratio ranging 1.03-1.19), cough (1.03-1.08) and fall in morning PEF (1.04-1.26). In the AHR+/IgE+ group, males responded predominantly with symptoms and females with a fall in morning PEF. In conclusion, elderly individuals with both airway hyperresponsiveness and high total immunoglobulin E are especially susceptible to air pollution. Identifying susceptible subgroups might enlarge insight into the actual mechanisms by which air pollution evokes specific modes of response.

Age Factors↗

PubMed2000

A time-series analysis of acidic particulate matter and daily mortality and morbidity in the Buffalo, New York, region.

A component of particulate matter (PM) air pollution that may provide one biologically plausible pathway for the observed PM air pollution-health effect associations is aerosol acidity (H(+)). An increasing number of observational studies have demonstrated associations between H(+) and increased adverse health effects in the United States and abroad. Although studies have shown significant H(+) associations with increased morbidity in the United States, similar associations have yet to be shown with daily mortality. We considered a 2.5-year record of daily H(+) and sulfate measurements (May 1988-October 1990) collected in the Buffalo, New York, region in a time-series analysis of respiratory, circulatory, and total daily mortality and hospital admissions. Other copollutants considered included particulate matter [less than/equal to] 10 microm in aerodynamic diameter, coefficient of haze, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. Various modeling techniques were applied to control for confounding of effect estimates due to seasonality, weather, and day-of-week effects. We found multiple significant pollutant-health effect associations--most strongly between SO(4)(2-) and respiratory hospital admissions (as indicated by its t-statistic). Additionally, H(+) and SO(4)(2-) demonstrated the most coherent associations with both respiratory hospital admissions [H(+): relative risk (RR) = 1. 31; 95% confidence interval (CI), 1.14-1.51; and SO(4)(2-): RR = 1. 18, CI, 1.09-1.28] and respiratory mortality (H(+): RR = 1.55, CI, 1. 09-2.20; and SO(4)(2-): RR = 1.24, CI, 1.01-1.52). Thus, acidic sulfate aerosols represent a component of PM air pollution that may contribute to the previously noted adverse effects of PM mass on human health, and the associations demonstrated in this study support the need for further investigations into the potential health effects of acidic aerosols.

Acids↗

PubMed2003

Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada.

The association between ambient air pollution and adverse health effects, such as emergency room visits, hospitalizations, and mortality from respiratory and cardiovascular diseases, has been studied extensively in many countries, including Canada. Recently, studies conducted in China, the Czech Republic, and the United States have related ambient air pollution to adverse pregnancy outcomes. In this study, we examined association between preterm birth, low birth weight, and intrauterine growth retardation (IUGR) among singleton live births and ambient concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone in Vancouver, Canada, for 1985-1998. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for such effects. Low birth weight was associated with exposure to SO2 during the first month of pregnancy (OR = 1.11, 95% CI, 1.01-1.22, for a 5.0 ppb increase). Preterm birth was associated with exposure to SO2 (OR = 1.09, 95% CI, 1.01-1.19, for a 5.0 ppb increase) and to CO (OR = 1.08, 95% CI, 1.01-1.15, for a 1.0 ppm increase) during the last month of pregnancy. IUGR was associated with exposure to SO2 (OR = 1.07, 95% CI, 1.01-1.13, for a 5.0 ppb increase), to NO2 (OR = 1.05, 95% CI, 1.01-1.10, for a 10.0 ppb increase), and to CO (OR = 1.06, 95% CI, 1.01-1.10, for a 1.0 ppm increase) during the first month of pregnancy. In conclusion, relatively low concentrations of gaseous air pollutants are associated with adverse effects on birth outcomes in populations experiencing diverse air pollution profiles.

Adult↗