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2008 MDPH MASSCHIP ASTHMA REPORT FOR SALEMMassCHIP Asthma Report [Instant Topics Home] Page 1 of 7 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MassCHIP Massachusetts Community Health Information Profile Asthma Report for Salem • Prevalence of Asthma, Massachusetts • Prevalence of Risk Factors for Asthma by Gender, Massachusetts • Prevalence of Risk Factors amone_people with and without Asthma, Massachusetts • Asthma Mortality_ • Asthma Related Inpatient Hospitalizations . Asthma Related Emergency Visits • Asthma Related Hospital Observation Stays . Report Specific Notes More detail for specific datasets is available by using custom reports General Notes: Notes on Population data Population data are used as the denominators for all rates in MassCHIP except for Infant Deaths and Early Intervention clients which use the Births file as the denominator. The population data used for a given rate depends on the year of the numerator: MISER Estimates for 1991-1998 MDPH Estimates for 1999 MDPH Post-Censal Estimates for 2000-2005 Population data may also be present in this report as Counts and Percentages. These data are MDPH Post-Censal Estimates. Socio -demographic data other than geography, age, sex and or Race/Hispanic ethnicity are from the selected sample data for 2000 from the U.S. Census Bureau Summary File 3 (SF3). Post-censal yearly population estimates for the state and counties are from the National Center for Health Statistics, Modified Age, Race, and Sex (MARS) file. City/town population estimates were derived by apportioning MARS county estimates to cities and town estimates from the Census Bureau Population Estimates Program, with some adjustments for non-white population undercounts. The MDPH post-censal estimates file is called the Massachusetts Modified Age, Race/Ethnicity, Census Estimates 2000-2005 (MMARS00-05). Limitations of Small Numbers http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 MassCHIP Asthma Report Page 2 of 7 Cells in some tables in MassCHIP reports, and particularly those specific to individual cities and towns, contain small numbers. In general, rates and proportions based upon less than five observations are suppressed (specific protocols differ by data sets and are noted on the relevant reports). Whether or not the small numbers are suppressed, rates and trends based upon small numbers should be interpreted cautiously. Note on NA MassCHIP marks cells with the tag "NA" if one or more of the following is true: • The data are suppressed for confidentiality reasons. See report -specific notes for Suppression Rules specific to the data sets used in this Standard Report. • The particular combination of data element, selector value and statistical calculation is not available. • The population on which a particular cell is based is too small to calculate reliable results. Differences with Previously Published Data Numbers and rates in MassCHIP reports may differ slightly from those contained in previous reports or other publications. These differences may be due to file updates; slight variations in coding schemes used in categorizing the data; differences in the formulas used in calculating rates; and the re -calculating of rates using updates of population estimates from the Massachusetts Institute for Social and Economic Research (MISER). Note on Time Period Counts for most data sets are cumulative for the given Calendar or Fiscal year. Children in Foster Care (DSS), WIC, Child Care Services (OCCS) and Department of Transitional Assistance (DTA) data sets give point in time 'snapshot' counts. These are counts taken at a specified point during the year. See last page for additional informational report -specific notes. Prevalence of Asthma, Massa chusetts(a) Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 hfp://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&Ivl=2 7/7/2008 State 3 -Year Percent Total 9.8 Sex Male 7.4 Female 11.9 Race/Hispanic Ethnicity White Non -Hispanic 9.9 hfp://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&Ivl=2 7/7/2008 MassCHIP Asthma Report Page 3 of 7 Black Non -Hispanic 10.2 Hispanic 10.6 Asian/Pacific Islander Non -Hispanic 4.5 Age 13.2 18 to 24 12.3 25 to 44 9.9 45 to 64 9.8 65 plus 7.9 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors for Asthma by Gender, Massachusetts(a) Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors among people with and without Asthma, Massachusetts(a) Copyright ©2005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 State 3 -Year Percent Male Female Smoke Regularly 15.3 13.2 Former Smoker 30.9 28.8 Overweight or Obese 64.4 44.2 Low Physical Activity 46.3 48.2 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors among people with and without Asthma, Massachusetts(a) Copyright ©2005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Asthma Mortality: Salem http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 State 3 -Year Percent Persons with Asthma Persons without Asthma Smoke Regularly 18.6 13.7 Former Smoker 30.1 29.8 Unable to Work 9.6 3.5 Overweight or Obese 59.3 53.6 Low Physical Activity 48.8 48.1 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Asthma Mortality: Salem http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 MassCHIP Asthma Report Page 4 of 7 Copyright ©2005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2004-2006 Mortality (Vital Records) ICD -10 based Asthma Related Inpatient Hospitalizations (d) Salem Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 Area 3 Year Count Area Age Adjusted Rate N. State Age Adjusted Rate (b) Total 3 2.2 1.0 Gender Male 0 0.0 0.6 Female 3 4.0 1.3 Race White Non -Hispanic 3 2.5 0.8 Black Non -Hispanic 0 0.0 2.5 Hispanic 0 0.0 2.7 Asian/Pacific Islander Non -Hispanic 0 0.0 1.2 Area Count Area Age Specific Rate W. State Age Specific Rate (c) Age 0 to 19 yrs 0 0.0 0.1 20 and Older 3 3.1 1.5 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2004-2006 Mortality (Vital Records) ICD -10 based Asthma Related Inpatient Hospitalizations (d) Salem Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 Area 3 Year Count Area Age Adjusted Rate N State Age Adjusted Rate (b) Total 1,146 885.6 782.7 Gender Male 326 571.8 564.4 Female 820 1151.0 978.9 Race White Non -Hispanic 987 896.8 676.3 Black Non -Hispanic 47 1808.4 1564.1 Hispanic 1 77 476.1 1524.4 Asian/Pacific Islander Non -Hispanic NA NA 234.7 Area Age State Age http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 MassCHIP Asthma Report Page 5 of 7 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Asthma Related EmergencyrRoom=Visits� Salem Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 Area Count Specific Rate (c) Specific Rate (c). Age 492 0 to 4 yrs 62 849.2 645.5 5 to 9 yrs 30 436.2 320.9 10 to 19 yrs 49 340.9 329.1 20 to 29 yrs 103 500.5 561.4 30 to 39 yrs 134 707.5 683.5 40 to 49 yrs 217 1134.9 818.1 50 to 59 yrs 200 1280.8 952.3 60 to 69 yrs 124 1345.3 1299.9 70 or older 227 1711.2 1782.1 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Asthma Related EmergencyrRoom=Visits� Salem Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid-324&Geo=1681&lvl=2 7/7/2008 Area Count Area Age Adjusted Rate (b) State Age Adjusted Rate (b) Total 492 %'1205.8 10.38;3✓✓ Gender Male 186 972.3 899.8 Female 306 1407.8 1165.5 Race White Non -Hispanic 356 1105.8 841.4 Black Non -Hispanic 28 1856.3 2275.7 Hispanic 89 1349.1 2080.4 Asian/Pacific Islander Non -Hispanic 0 0.0 227.3 Area Count Area Age Specific Rate State Age Specific Rate Age 0 to 4 yrs 54 2188.5 1764.5 5 to 9 yrs 42 1862.4 1217.9 10 to 19 yrs 63 1313.3 1056.1 20 to 29 yrs 1 96 1385.2 1419.7 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid-324&Geo=1681&lvl=2 7/7/2008 MassCHIP Asthma Report Page 6 of 7 30 to 39 yrs 59 979.5 1151.1 40 to 49 yrs 70 1104.1 976.0 50 to 59 yrs 69 1296.7 722.2 60 to 69 yrs 25 801.1 554.5 70 or older 14 318.8 448.8 • See Notes on Population Data • 2005 Hospital Emergency Visits Asthma Related Hospital Observation Stays (d) Salem Copyright 02005-2008 Massachusetts Department of Public Health - All Rights Reserved, Printed: 5/8/2008, 14:30:20 See Notes on Population Data • 2005 Hospital Outpatient Observation Stays Asthma Report Notes http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 Area Count Area Age Adjusted Rate (b) State Age Adjusted Rate (b) Total 37 53.5 109.5 Gender Male 13 40.2 93.7 Female 24 65.4 122.8 Race White Non -Hispanic 30 49.6 87.5 Black Non -Hispanic NA NA 244.4 Hispanic NA NA 223.0 Asian/Pacific Islander Non -Hispanic 0 0.0 35.8 Area Count Area Age Specific Rate (c) State Age Specific Rate OC 0 to 4 yrs NA 0.0 286.7 5 to 9 yrs NA 0.0 139.3 10 to 19 yrs NA 0.0 79.7 20 to 29 yrs NA NA 80.9 30 to 39 yrs NA 73.9 84.1 40 to 49 yrs NA 120.3 99.6 50 to 59 yrs NA 102.5 118.5 60 to 69 yrs NA NA 106.4 70 or older NA NA 89.2 See Notes on Population Data • 2005 Hospital Outpatient Observation Stays Asthma Report Notes http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=2 7/7/2008 MassCHIP Asthma Report Page 7 of 7 a. Behavioral Risk Factor Surveillance System (BRFSS), maintained by the Massachusetts Department of Public Health, Bureau of Health Statistics, Research and Evaluation. The BRFSS is a series of annual random -digit -dial telephone surveys of adults (aged 18+) using standardized questionnaires developed by the federal Centers for Disease Control and Prevention, as well as state -added questions. BRFSS data are weighted in order to approximate the prevalence of particular behaviors and conditions among Massachusetts adults. Data are initially provided as weighted population estimates of the number of adults who report a particular behavior or condition. Percents are based on these weighted estimates. Questions vary as to which years they were included in the survey. b. Age-adjusted rate: A procedure for adjusting rates, designed to minimize the effects of differences in age distributions when comparing rates for different populations. Age-adjusted rates are usually expressed per 100,000 persons. For standardization within MassCHIP the standard population used is the 2000 US population. c. Age-specific rate: A rate for a specific age group. The numerator and denominator refer to the same age group. Age- specific rates are expressed per 100,000 persons in the specific age group. d. Asthma as principal diagnosis or any associated diagnosis (ICD 9: 493) Suppression Rules: . Counts and related calculations of 1 - 6 [Hospitalizations] are suppressed . BRFSS: Data are suppressed when the number of respondents to a given question with the given demographic stratifiers is less than 125 For Information or Assistance, contact MassCHIP Massachusetts Department of Public Health 250 Washington Street Boston, MA 02108 Voice: In MA: (888) MAS -CHIP Outside MA: (617) 624-5629 E -Mail: MassCHIP Support@state.ma.us [MassCHIP Privacy Policyl [Instant Topics Home] http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&Ivl=2 7/7/2008 MassCHIP CardioVascular Report [instant 19 Rom Page 1 of 10 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MassCHIP Massachusetts Community Health Information Profile Cardiovascular Health Report for Salem . Mortality To---- t ---a--1 and_by Gender . H_.osprtalizations Total and by_Gender . Mortality _byRace . Hospitalizations -by -Race . Mortality_and HosPitah?atio_u_s by_Gend_er and_,Race • . Mortality_and Hospitalizations b_X Gendei and Age . Behavioral_ Risk Factor -Surveillance More detail for specific datasets is available by using custom reports General Notes: Notes on Population data Population data are used as the denominators for all rates in MassCHIP except for Infant Deaths and Early Intervention clients which use the Births file as the denominator. The population data used for a given rate depends on the year of the numerator: MISER Estimates for 1991-1998 MDPH Estimates for 1999 MDPH Post-Censal Estimates for 2000-2005 Population data may also be present in this report as Counts and Percentages. These data are MDPH Post-Censal Estimates. Socio -demographic data other than geography, age, sex and or Race/Hispanic ethnicity are from the selected sample data for 2000 from the U.S. Census Bureau Summary File 3 (SF3). Post-censal yearly population estimates for the state and counties are from the National Center for Health Statistics, Modified Age, Race, and Sex (MARS) file. City/town population estimates were derived by apportioning MARS county estimates to cities and town estimates from the Census Bureau Population Estimates Program, with some adjustments for non-white population undercounts. The MDPH post-censal estimates file is called the Massachusetts Modified Age, Race/Ethnicity, Census Estimates 2000-2005 (MMARS00-05). Limitations of Small Numbers t.....//..,.,,.,...1,7ror.,f....,.,I k..lvl=2 9/7/2007 MassCHIP CardioVascular Report Page 2 of 10 Cells in some tables in MassCHIP reports, and particularly those specific to individual cities and towns, contain small numbers. In general, rates and proportions based upon less than five observations are suppressed (specific protocols differ by data sets and are noted on the relevant reports). Whether or not the small numbers are suppressed, rates and trends based upon small numbers should be interpreted cautiously. Note on NA MassCHIP marks cells with the tag "NA" if one or more of the following is true: The data are suppressed for confidentiality reasons. See report -specific notes for Suppression Rules specific to the data sets used in this Standard Report. The particular combination of data element, selector value and statistical calculation is not available. The population on which a particular cell is based is too small to calculate reliable results. Differences with Previously Published Data Numbers and rates in MassCHIP reports may differ slightly from those contained in previous reports or other publications. These differences may be due to file updates; slight variations in coding schemes used in categorizing the data; differences in the formulas used in calculating rates; and the re -calculating of rates using updates of population estimates from the Massachusetts Institute for Social and Economic Research (MISER). Note on Time Period Counts for most data sets are cumulative for the given Calendar or Fiscal year. Children in Foster Care (DSS), WIC, Child Care Services (OCCS) and Department of Transitional Assistance (DTA) data sets give point in time 'snapshot' counts. These are counts taken at a specified point during the year. See last page for additional informational report -specific notes. Cardiovascular Mortality Total and by Gender: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 i. «... n..,..,.�..h7.. �t.,r., — 6R klVl=2 9/7/2007 Area State Area Area State Area 3 yr 3 yr 3 yr 3 yr 3 yr Pre -Mature Pre -Mature 3 yr Age- Age- Pre -Mature Count adjusted adjusted (h) Age- Age - Rate (a) Rate (a) Count adjusted adjusted Rate (h) Rate (n) All Circulatory System 338 223.9 241.2 91 76.7 78.7 Diseases Male 151 275.7 291.6 57 105.7 109.6 i. «... n..,..,.�..h7.. �t.,r., — 6R klVl=2 9/7/2007 MassCHIP CardioVascular Report Page 3 of 10 Female 187 188.3 202.3 34 52.8 51.7 Coronary Heart Disease 172 114.3 120.1 51 42.9 43.9 Male 90 163.9 159.3 36 66.7 65.7 Female 82 81.7 91.0 15 NA 24.8 Cerebrovascular Disease 56 37.0 41.4 14 NA 10.3 Male 18 33.8 42.0 4 NA 12.0 Female 38 39.4 40.2 10 NA 8.8 Acute Myocardial Infarction 44 29.7 44.3 16 NA 17.6 Male 25 44.7 58.6 12 NA 26.0 Female 1 19 19.2 33.6 4 NA 10.3 • See Notes on Population Data . 2003-2005 Mortality (Vital Records) ICD -10 based Cardiovascular Hospitalizations Total and by Gender: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Cardiovascular Mortality by Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 i ...... ia-_----1':-...t_+,......IT .. r o k1,..,..,,'91?"t;A-Z nr R.(;Pn=16181 kIVI=i 9/7/7007 Area Syr Count Area 3 y Age-adjusted Rate (a) State 3 y Age-adjusted Rate (a) All Circulatory System Diseases 2,173 1552.8 1686.1 Male 1,151 2035.7 2095.9 Female 1,022 1193.2 1357.6 Coronary Heart Disease 600 441.0 537.0 Male 389 679.8 750.9 Female 211 257.8 360.9 Cerebrovascular Disease 351 248.1 241.9 Male 152 272.3 276.7 Female 199 233.0 215.1 Acute Myocardial Infarction 299 217.0 235.5 Male 184 325.4 316.0 Female 115 135.2 169.7 • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Cardiovascular Mortality by Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 i ...... ia-_----1':-...t_+,......IT .. r o k1,..,..,,'91?"t;A-Z nr R.(;Pn=16181 kIVI=i 9/7/7007 MassCHIP CardioVascular Report Page 4 of 10 • See Notes pn_Population_Data • 2003-2005 Mortality (Vital Records) ICD -10 based Cardiovascular Hospitalizations by Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 L...-.n.__.._,.,.t_:_,............ .... r'R1,C1V1=2 9/7/2007 Area 3 yr Count Area 3 yr Age- adjusted Rate (a) State 3 yr Age- adjusted Rate (a) Area 3 yr Pre -Mature N Count Area 3 yr Pre -Mature Age- adjusted Rate (b)_ State 3 yr Pre -Mature Age - adjusted Rate (b) All Circulatory System Diseases White, non -Hispanic 328 227.3 242.8 84 78.4 77.6 Black, non -Hispanic 2 165.4 291.6 1 NA 133.9 Hispanic 4 58.9 149.9 3 NA 72.2 Asian/PI, non -Hispanic 4 317.6 111.1 3 NA 33.5 American Indian, non- Hispanic 0 0.0 146.3 0 0.0 88.1 Coronary Heart Disease White, non -Hispanic 167 122.0 47 44.1 44.4 Black, non -Hispanic 2 133.0 1 NA 63.3 Hispanic 1 g203.2 67.4 1 NA 32.3 Asian/PI, non -Hispanic 2 45.3 2 NA 13.6 American Indian, non- Hispanic 0 0.0 85.9 0 0.0 NA Cerebrovascular Disease White, non -Hispanic 54 37.0 41.0 13 NA 9.5 Black, non -Hispanic 0 0.0 52.4 0 NA 19.5 Hispanic 2 32.6 34.4 1 NA 16.1 Asian/PI, non -Hispanic 0 0.0 31.9 0 NA 11.0 American Indian, non- Hispanic 0 0.0 20.7 0 0.0 NA Acute Myocardial Infarction White, non -Hispanic 43 30.6 45.2 15 NA 18.0 Black, non -Hispanic 0 0.0 44.2 0 NA 21.5 Hispanic 1 7.0 26.9 1 NA 13.1 Asian/PI, non -Hispanic 0 0.0 15.5 0 NA 5.4 American Indian, non- Hispanic 0 0.0 37.9 0 0.0 NA • See Notes pn_Population_Data • 2003-2005 Mortality (Vital Records) ICD -10 based Cardiovascular Hospitalizations by Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:58 L...-.n.__.._,.,.t_:_,............ .... r'R1,C1V1=2 9/7/2007 MassCHIP CardioVascular Report Page 5 of 10 • See Notes on Poputation_nata • 2003-2005 Hospital Discharges (UHDDS) Cardiovascular Mortality and Hospitalizations by Gender and Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:59 Area Area 3 yr Count Area 3 yr Age-adjusted Rate (a) State 3 yr Age-adjusted Rate U All Circulatory System Diseases State White, non -Hispanic 1,976 1521.1 1600.6 Black, non -Hispanic 45 2665.2 2098.1 Hispanic 99 1654.2 1793.5 Asian/PI, non -Hispanic 12 1686.4 675.1 American Indian, non -Hispanic 0 0.0 386.2 Coronary Heart Disease White, non -Hispanic 546 437.2 510.9 Black, non -Hispanic 11 589.5 400.4 Hispanic 20 297.0 534.5 Asian/PI, non -Hispanic NA NA 186.7 American Indian, non -Hispanic 0 0.0 126.0 Cerebrovascular Disease White, non -Hispanic 323 244.9 230.3 Black, non -Hispanic 10 604.2 323.3 Hispanic 13 284.3 257.8 Asian/PI, non -Hispanic NA NA 139.4 American Indian, non -Hispanic 0 0.0 60.8 Acute Myocardial Infarction White, non -Hispanic 278 218.6 224.7 Black, non -Hispanic NA NA 172.1 Hispanic 10 169.1 224.7 Asian/PI, non -Hispanic NA NA 91.0 American Indian, non -Hispanic 0 0.0 62.5 • See Notes on Poputation_nata • 2003-2005 Hospital Discharges (UHDDS) Cardiovascular Mortality and Hospitalizations by Gender and Race: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:59 Area Area State AreaArea State 3 3 yr 3 yr 3 3 yr 3 yr Age- adjusted Age- adjusted u Count Age- adjusted Age- adjusted Rate (a). Rate (a) Rate (a) Rate (a) I,++ -//-. t.:, f�f,.....acn7Rnti(1="2o nPn=i ARI kIvl=2 9/7/2007 MassCHIP CardioVascular Report Page 6 of 10 All Circulatory System Diseases White, non -Hispanic Male 148 285.6 294.7 1,051 2019.7 2008.3 Female 180 186.9 202.7 925 1149.1 1273.7 Black, non -Hispanic Male 0 0.0 347.3 27 3227.9 2271.1 Female 2 233.2 249.9 18 1997.4 1947.6 Hispanic Male 2 56.9 178.9 44 1673.3 2039.2 Female 2 50.6 127.0 55 1619.1 1601.8 Asian/PI, non -Hispanic Male 1 79.2 128.5 7 1103.8 742.3 Female 3 412.6 96.0 NA NA 608.8 American Indian, non - Hispanic Male 0 0.0 150.4 0 0.0 406.6 Female 0 0.0 140.7 0 0.0 398.3 Coronary Heart Disease White, non -Hispanic Male 89 171.5 162.5 363 693.2 718.5 Female 78 80.2 91.9 183 238.6 339.4 Black, non -Hispanic Male 0 0.0 171.6 NA NA 479.6 Female 2 233.2 105.0 7 692.2 336.8 Hispanic Male 1 14.9 88.4 8 270.7 664.1 Female 0 0.0 51.6 12 314.0 432.4 Asian/PI, non -Hispanic Male 0 0.0 55.0 NA NA 248.6 Female 2 261.6 37.0 0 0.0 130.7 American Indian, non - Hispanic Male 0 0.0 102.1 0 0.0 148.2 Female 0 0.0 70.2 0 0.0 117.9 Cerebrovascular Disease White, non -Hispanic Male 17 33.4 41.5 138 264.9 265.7 Female 37 39.8 39.8 185 233.1 203.0 Black, non -Hispanic Male 0 0.0 50.5 NA NA 337.1 Female 0 0.0 52.6 NA NA 312.1 Hispanic 1_44._. I I.__........t,:.. ............. -'A Or R,C1n=1 AR1 Rdvl=2 9/7/2007 MassCHIP CardioVascular Report Page 7 of 10 Male 1 42.0 38.3 NA NA 289.0 Female 1 20.2 31.4 7 250.6 234.5 Asian/PI, non -Hispanic 3 yr Male 0 0.0 34.2 NA NA 148.5 Female 0 0.0 29.7 0 0.0 129.1 American Indian, non - Hispanic All Circulatory System Diseases Male 0 0.0 21.9 0 0.0 72.3 Female j 0 0.0 18.8 0 0.0 51.4 Acute Myocardial Infarction White, non -Hispanic Male 24 45.7 60.2 173 333.4 303.1 Female 19 20.2 34.0 105 131.7 160.8 Black, non -Hispanic Male 0 0.0 51.9 NA NA 199.7 Female 0 0.0 38.4 NA NA 147.9 Hispanic Male 1 14.9 35.5 NA NA 280.4 Female 0 0.0 20.5 NA NA 179.6 Asian/PI, non -Hispanic Male 0 0.0 18.9 NA NA 114.3 Female 0 0.0 12.7 0 0.0 69.5 American Indian, non - Hispanic Male 0 0.0 43.1 0 0.0 78.1 Female 0 0.0 30.2 0 0.0 1 59.9 • See Notes on Population Data • 2003-2005 Hospital Discharges (UIIDDS) • 2003-2005 Mortality (Vital Records) ICD -10 based Cardiovascular Mortality and Hospitalizations by Gender and Age: Salem Copyright © 2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:33:59 _..._.ia__......,.1.:...-f-+-.....k'lvl=7 9/7/7007 Mortality Hospitalizations Area Area State Area Area State 3 yr 3 yr 3 yr 3 yr 3 yr 3 yr Count Age-specific Age-specific Count Age-specific Age-specific Rate (c) Rate (.c) Rate (c) Rate (c) All Circulatory System Diseases Ages 20-54 22 32.7 32.6 367 545.5 522.9 Male 16 50.1 48.1 250 783.3 689.3 _..._.ia__......,.1.:...-f-+-.....k'lvl=7 9/7/7007 MassCHIP CardioVascular Report Page 8 of 10 Female 6 17.0 17.5 117 330.9 361.6 Ages 55-74 69 342.5 354.6 787 3906.8 4314.4 Male 41 450.8 477.7 451 4958.3 5504.7 Female 28 253.4 246.6 336 3041.1 3269.7 Ages 75+ 247 2649.3 2971.3 1,004 10768.7 12256.2 Male 94 2850.3 3092.2 439 13311.6 14118.5 Female 153 2539.2 2901.6 565 1 9377.0 11181.6 Coronary Heart Disease Ages 20-54 15 22.3 17.3 129 191.8 189.6 Male 9 28.2 28.3 100 313.3 292.2 Female 6 17.0 6.7 29 82.0 90.1 Ages 55-74 36 178.7 203.0 271 1345.3 1610.8 Male 27 296.8 292.0 180 1978.9 2295.5 Female 9 81.5 124.8 91 823.6 1010.0 Ages 75+ 121 1297.8 1394.2 200 2145.2 3155.5 Male 54 1637.4 1600.9 109 3305.2 4016.2 Female 67 1112.0 1274.9 91 1510.3 2659.1 Cerebrovascular Disease Ages 20-54 0 0.0 3.8 46 68.4 58.4 Male 0 0.0 4.1 23 72.1 62.4 Female 0 0.0 3.5 23 65.1 54.6 Ages 55-74 14 69.5 46.7 123 610.6 595.2 Male 4 44.0 54.4 60 659.6 701.1 Female 10 90.5 39.9 63 1 570.2 502.3 Ages 75+ 42 450.5 565.7 179 1919.9 1964.8 Male 14 424.5 503.6 68 2061.9 2141.5 Female 28 464.7 601.5 111 1842.2 1862.9 Acute Myocardial Infarction Ages 20-54 4 6.0 6.2 64 95.1 80.2 Male 3 9.4 10.1 49 153.5 126.8 Female 1 2.8 2.4 15 42.4 35.0 Ages 55-74 12 59.6 83.8 112 556.0 610.3 Male 9 99.0 118.8 72 1 791.6 831.2 Female 3 27.2 53.1 40 362.0 416.6 Ages 75+ 28 300.3 486.9 123 1319.3 1687.8 Male 13 394.2 562.8 63 1910.3 2002.1 Female 15 249.0 443.2 60 995.8 1506.5 • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) • 2003-2005 Mortality (Vital Records) ICD -10 based ------ ,9Rnt;d=IOCR,C'Pn=1 I,R1 R.Ivl=7 9/70007 MassCHIP CardioVascular Report Behavioral Risk Factor Data (d) : Massachusetts MassCHIP v3.0 019.0 Printed: 4/5/2007, 18:33:59 Copyright ©2007 Massachusetts Department of Public Health - All Rights Reserved Page 9 of 10 The Percents are based on Behavioral Risk Factor Surveillance System (13KP'J ) responses forme three most recent ycats available for the given question Cardiovascular Health Report Notes a. Age-adjusted rate: A procedure for adjusting rates, designed to minimize the effects of differences in age distributions when comparing rates for different populations. Age-adjusted rates are usually expressed per 100,000 persons. For standardization within MassCHIP the standard population used is the 2000 US population. b. Pre -Mature Counts and Rates are for persons who died pre -maturely under the age of 75. The Premature Age-adjusted rate uses the same calculation mentioned above based on the standard population distribution for persons < 75 in the 2000 US population. c. Age-specific rate: A population based rate for a specific age group. The numerator and denominator refer to the same age group. Age-specific rates are expressed per 100,000 persons in the specific age group. d. Behavioral Risk Factor Surveillance System (BRFSS), maintained by the Massachusetts Department of Public Health, Bureau of Health Statistics, Research and Evaluation. The BRFSS is a series of annual random -digit -dial telephone surveys of adults (aged 18+) using standardized questionnaires developed by the federal Centers for Disease Control and Prevention, as well as state -added questions. BRFSS data are weighted in order to approximate the prevalence of particular behaviors and conditions among Massachusetts adults. Data are initially provided as weighted population estimates of the number of adults who report a particular behavior or condition. Percents are based on these weighted estimates. Questions vary as to which years they were included in the survey. Suppression Rules: 1...._.iI------ 1.:...............CRI klvl=7 9/7/2007 State Percent Current Smoker (regularly) 14.2 Current Smoker (occassional) 4.6 Former Smoker 29.8 Never Smoked 51.4 Smoking Intensity: Smoke 1-10 Cigarettes/Day (of all smokers) 43.3 Smoking Intensity: Smoke 11-20 Cigarettes/Day (of all smokers) 38.5 Smoking Intensity: Smoke 21 or more Cigarettes/Day (of all smokers) 11.3 Ever have Diabetes 6.1 Have Diabetes and Take Insulin 29.9 Ever Diagnosed with High Blood Pressure 23.6 Ever Diagnosed with High Blood Cholesterol 32.0 The Percents are based on Behavioral Risk Factor Surveillance System (13KP'J ) responses forme three most recent ycats available for the given question Cardiovascular Health Report Notes a. Age-adjusted rate: A procedure for adjusting rates, designed to minimize the effects of differences in age distributions when comparing rates for different populations. Age-adjusted rates are usually expressed per 100,000 persons. For standardization within MassCHIP the standard population used is the 2000 US population. b. Pre -Mature Counts and Rates are for persons who died pre -maturely under the age of 75. The Premature Age-adjusted rate uses the same calculation mentioned above based on the standard population distribution for persons < 75 in the 2000 US population. c. Age-specific rate: A population based rate for a specific age group. The numerator and denominator refer to the same age group. Age-specific rates are expressed per 100,000 persons in the specific age group. d. Behavioral Risk Factor Surveillance System (BRFSS), maintained by the Massachusetts Department of Public Health, Bureau of Health Statistics, Research and Evaluation. The BRFSS is a series of annual random -digit -dial telephone surveys of adults (aged 18+) using standardized questionnaires developed by the federal Centers for Disease Control and Prevention, as well as state -added questions. BRFSS data are weighted in order to approximate the prevalence of particular behaviors and conditions among Massachusetts adults. Data are initially provided as weighted population estimates of the number of adults who report a particular behavior or condition. Percents are based on these weighted estimates. Questions vary as to which years they were included in the survey. Suppression Rules: 1...._.iI------ 1.:...............CRI klvl=7 9/7/2007 MassCHIP CardioVascular Report . Counts and related calculations of 1 - 6 [Hospital Discharges] are suppressed For Information or Assistance, contact MassCHIP Massachusetts Department of Public Health 250 Washington St. Boston, MA 02108 Voice: In MA: (888) MAS -CHIP Outside MA: (617) 624-5629 E-mail: masschip suppQO@state.ma us. [MassCHIP Privacy Policy] [Instant. Topics Home] Page 10 of 10 t,tt..•//maccrhin ctatP mn nc/TnetnntTnn;Pe/thrPP asn?Rntitt=106&Ge0=1691 &1 vl=2 9/7/2007 M�assCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 1 of 7 [lnstant_Topics Home] MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MassCHIP Massachusetts Community Health Information Profile Healthy People 2010 - Chronic Disease Objectives Report (a) for Salem . Chronic...Disease .Objective.s . Rep ort_Spccific Notes.. More detail for specific datasets is available by using custom reports General Notes: Notes on Population data Population data are used as the denominators for all rates in MassCHIP except for Infant Deaths and Early Intervention clients which use the Births file as the denominator. The population data used for a given rate depends on the year of the numerator: MISER Estimates for 1991-1998 MDPH Estimates for 1999 MDPH Post-Censal Estimates for 2000-2005 Population data may also be present in this report as Counts and Percentages. These data are MDPH Post-Censal Estimates. Socio -demographic data other than geography, age, sex and or Race/Hispanic ethnicity are from the selected sample data for 2000 from the U.S. Census Bureau Summary File 3 (SF3). Post-censal yearly population estimates for the state and counties are from the National Center for Health Statistics, Modified Age, Race, and Sex (MARS) file. City/town population estimates were derived by apportioning MARS county estimates to cities and town estimates from the Census Bureau Population Estimates Program, with some adjustments for non-white population undercounts. The MDPH post-censal estimates file is called the Massachusetts Modified Age, Race/Ethnicity, Census Estimates 2000-2005 (MMARS00-05). Limitations of Small Numbers Cells in some tables in MassCHIP reports, and particularly those specific to individual cities and towns, contain small numbers. In general, rates and proportions based upon less than five observations are suppressed (specific protocols differ by data sets and are noted on the relevant reports). Whether or not the small numbers are suppressed, rates and trends based upon small numbers should be interpreted cautiously. http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 MassCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 2 of 7 Note on NA MassCHIP marks cells with the tag "NA" if one or more of the following is true: . The data are suppressed for confidentiality reasons. Seereport-specific_notes for Suppression Rules specific to the data sets used in this Standard Report. . The particular combination of data element, selector value and statistical calculation is not available. . The population on which a particular cell is based is too small to calculate reliable results. Differences with Previously Published Data Numbers and rates in MassCHIP reports may differ slightly from those contained in previous reports or other publications. These differences may be due to file updates; slight variations in coding schemes used in categorizing the data; differences in the formulas used in calculating rates; and the re -calculating of rates using updates of population estimates from the Massachusetts Institute for Social and Economic Research (MISER). Note on Time Period Counts for most data sets are cumulative for the given Calendar or Fiscal year. Children in Foster Care (DSS), WIC, Child Care Services (OCCS) and Department of Transitional Assistance (DTA) data sets give point in time 'snapshot' counts. These are counts taken at a specified point during the year. See last page for additional informational report-specficnotes. Chronic Disease Objectives: Salem Copyright ©2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 17:49:20 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 Area Area State Age- Age - Count adjusted adjusted Rate (b.) Rate (b) 3-01: 80 170.7 184.2 Reduce the overall cancer death rate to no more more than 159.9 per 100,000 population. (Cancer: All types - Deaths (ICD 10 based)) 3-02: 22 49.4 52.4 Slow the rise in lung cancer deaths to achieve a rate of no more than 44.9 per 100,000 population. (Cancer: Lung - Deaths (ICD 10 based)) 2 7.6 23.0 3-03: http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 MassCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 3 of 7 Reduce Breast Cancer deaths to no more than 22.3 per 100,000 females. (Cancer: Female Breast - Deaths (ICD 10 based)) 3-04: 1 3.6 1.6 Reduce deaths from cancer of the uterine cervix to no more than 2.0 per 100,000 women. (Cancer: Cervical (Cervix Uteri) = Deaths) 3-05: 11 22.6 17.4 Reduce colo -rectal cancer deaths to no more than 13.9 per 100,000 population. (Cancer: Colo -Rectal - Deaths (ICD 10 based)) 3-06 1 2.3 2.1 Reduce oropharyngeal cancer death rate to no more than: 13.9 per 100,000 population. (Cancer: Oral Cavity - Deaths (ICD 10 based)) 3-07: 2 10.8 21.8 Reduce prostate cancer death rate to no more than: 28.8 per 100,000 males. (Cancer: Prostate - Deaths (ICD 10 based)) State Percent 3-11 a: 94.8 Increase the proportion of women aged 18 years and older who have ever received a Pap test to 97% (c). (Cervical: Ever Had Pap Test - BRFS Survey) 3-11b: 85.7 Increase the proportion of women aged 18 years and older who have received a Pap test within the preceding 3 years to 90%(c). (Cervical: Had Pap Test in Last 3 Years - BRFS Survey) 3-13: 84.1 Increase the proportion of women aged 40 and older who have received a mammogram within the preceding 2 years to 70%. (Mammogram: Had in Last 1 Year - BRFS Survey (BY AGE)) 5-03: 6.4 Reduce the ovarall rate of diabetes that is clinically diagnosed to no more than 25 per 1,000 people (=2.5%),(d). (Diabetes: Ever Been Told Have - BRFS Survey) Area Area State Age- Age- http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 M�ssCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 4 of 7 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 adjusted adjusted Count Rate (b) Rate (b) 5-05: 7 14.8 17.3 Reduce diabetes death rate to no more than 45 per 100,000 people (Endocrine: Diabetes Mellitus - Deaths (ICD 10 based)) 12-01: 35 73.1 111.1 Reduce coronary heart disease deaths to no more than 166 per 100,000 population. (Circulatory Coronary Heart Disease - Deaths (ICD 10 based)) 12-07: 14 26.5 37.7 Reduce stroke deaths to no more than 48 per 100,000 population. (Circulatory: Cerebrovascular Disease - Deaths (ICD 10 based)) State Percent 12-15: 79.3 Increase to at least 80 percent the proportion of adults who have had their blood cholesterol checked within the preceding 5 years. (Cholesterol: Checked in Last 5 Years - BRFS Survey) State Percent 19-02: 20.7 Reduce the proportion of adults who are obese to no more than 15%(_0 (Obese: Based on Body Mass Index - BRFS Survey) Area Area State Age- Age - Count specific specific Rate (g) Rate (g). 24-01a: 0 0.0 0.0 Reduce asthma deaths among children under age 5 years to no more than 0.1 deaths per 100,000 population(W . (Respiratory: Asthma - Deaths (ICD 10 based)) 24-01b: 0 0.0 0.0 Reduce asthma deaths among children aged 5 to 14 years to no more than 0.1 deaths per 100,000 population(h) . (Respiratory: Asthma - Deaths (ICD 10 based)) 0 0.0 0.6 24-01c: Reduce asthma deaths among adolescents and adults aged 15 to 34 years to no more than 0.2 deaths per 100,000 population(h) . http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 MassCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 5 of 7 (Respiratory: Asthma - Deaths (ICD 10 based)) 24 -Old: 2 12.1 1.1 Reduce asthma deaths among adults aged 35 to 64 years to no more than 0.9 deaths per 100,000 population(h) . (Respiratory: Asthma - Deaths (ICD 10 based)) 24-01e: 0 0.0 5.4 Reduce asthma deaths among adults aged 65 years and older to no more than 6.0 deaths per 100,000 population(h) . (Respiratory: Asthma - Deaths (ICD 10 based)) 24-02a: 7 283.7 317.7 Reduce hospitalizations for asthma among children under age 5 years to no more than 250 hospitalizations per 100,000 population(i). (Respiratory: Asthma - Hospitalization) 24-02b: 39 116.5 108.3 Reduce hospitalizations for asthma among children and adults aged 5 to 64 years to no more than 77 hospitalizations per 100,000 population W. (Respiratory: Asthma - Hospitalization) 24-02c: 8 140.6 261.9 Reduce hospitalizations for asthma among adults aged 65 years and older to no more than 110 hospitalizations per 100,000 population(i).. (Respiratory: Asthma - Hospitalization) 24-10: 18 112.5 105.3 Slow the rise in deaths from chronic obstructive pulmonary diseases (COPD) among adults aged 45 and older to achieve a rate of no more than 60 per 100,000 people(j_). (Respiratory: Chronic Lower Respiratory Diseases (CLRD), All - Deaths (ICD 10 based)) Area Area State Age- Age - Count adjusted adjusted Rate (b) Rate (b) 26-02: 6 12.6 7.2 Reduce cirrhosis deaths to no more than 3 deaths per 100,000 population. (Digestive: Chronic Liver Disease - Deaths (ICD 10 based)) State Percent 13.5 27-01a: http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 M3ssCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 6 of 7 Reduce cigarette smoking among adults aged 18 years and older to 12%.(d) (Smoking Incidence: Current Smoker (Smokes Regularly)- BRFS Survey) 27-05: 56.4 Increase smoking cessation attempts by adult smokers aged 18 years and older to 75%. (Smoking Quit: Quit for 1+ Days in Last Year - BRFS Survey) • See Notes qn Population_Data • 2004 Behavioral Risk Factor Surveillance System (BRFSS) • 2005 Behavioral Risk Factor Surveillance System (BRFSS) • 2005 Hospital Discharges (LJHDDS) • 2005 Mortality (Vital Records) ICD -10 based Healthy People Chronic Disease Report Notes a. In some cases, the MassCHIP measure is closely related to, but not an exact or complete match, with the Healthy People 2010 measure. These are further noted below. b. Age-adjusted rate: A procedure for adjusting rates, designed to minimize the effects of differences in age distributions when comparing rates for different populations. Age-adjusted rates are usually expressed per 100,000 persons. For standardization within MassCHIP the standard population used is the 2000 US population. c. MassCHIP can approximately measure both sections of this Objective. MassCHIP Contains data elements from the BRFSS Data Set among women who have not had a hysterectomy, whereas the Objective refers to all women (a minor discrepancy in most cases). d. The BRFSS Data Set data element (persons who have ever been told he/she had diabetes) only captures data on adults, although the Objective measures prevalence in the entire population. [In addition, survey responses may differ from other methods of determining the prevalence of diabetes in a population.] The BRFSS data are reported as a percent, while the objective refers to the number of cases per 1,000. To convert the BRFSS data to the same scale, multiply the percent by 10. MassCHIP has a data element (Endocrine: Diabetes Mellitus) from the Hospital Discharge related to but not an exact match to Objective 5-02 which may be of interest to some MassCHIP users. This data element only captures certain cases. e. The MassCHIP definition of "diabetes -related" causes of death includes only those deaths with ICD -10 code E10 -E14 as the underlying cause of death. This may differ from other definitions of the Healthy People 2010 objective and may understate the death rates in Massachusetts. A related data element in MassCHIP is drawn from the Hospital Discharge Data Set and can identify hospital discharges due both to diabetes and to 'complications of diabetes". f MassCHIP also has the data element 'Endocrine: Obesity - Hospitalizations" related to this Objective (from the Hospital Discharge Data Set) which may be of interest to some MassCHIP http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 M,assCHIP Healthy People 2010 - Chronic Disease Objectives Report Page 7 of 7 users. g. Age-specific rate: A rate for a specific age group. The numerator and denominator refer to the same age group. Age- specific rates are expressed per 100,000 persons in the specific age group. Denominators use 1990, 2000 Census counts and inter-censal population estimates. h. Objectives 24 -01(a -e) have been reworded, but maintains the same meaning. The objectives seeks a rate of deaths per 1.0 million. The modified definition converts the rate to deaths per 100,000. MassCHIP can only approximately measure Objective 24 -02(a -c). Hospital Discharges data set does not include emergency room visits, where many cases of asthma are seen. Objectives 24-02 (a -c) have been reworded, but maintains the same meaning. The objectives seeks a rate of hospitilizations per 10,000. The modified definition converts the rate to deaths per 100,000. j. The ICD 10 based Mortality dataset labels COPD as Chronic Lower Respiratory Disease (CLRD) Suppression Rules: Counts and related calculations of 1 - 6 [Hospital Discharges] are suppressed Calculations of infant mortality rat&(IMR) when denominator is less than 500 are suppressed For Information or Assistance, contact MassCHIP Massachusetts Department of Public Health 250 Washington Street Boston, MA 02108 Voice: In MA: (888) MAS -CHIP Outside MA: (617) 624-5629 E-mail: massch.ip support@state.n a u -s [MassCHIP Privacy Policy] [Instant Topics Horne] http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=287&Geo=1681&lvl=2 8/29/2007 MassCHIP Asthma Report [InstantTopics Home] Page 1 of 7 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MassCHIP Massachusetts Community Health Information Profile Asthma Report for Salem . Prevalence of Asthma, Massachusetts . Prevalence of Risk Factors.._for Asthma by Gender, Massachusetts . Prevalence of Risk Factors among people with and without Asthma, Massachusetts . Asthma._Mortality . Asthma Related Inpatient_.. Hospitalizations . Asthma Rel ate d_ Emergency_ Visits . Asthma Related Hospital Ob...seivation„Stay s . Report Specific Notes More detail for specific datasets is available by using custom reports General Notes: Notes on Population data Population data are used as the denominators for all rates in MassCHIP except for Infant Deaths and Early Intervention clients which use the Births file as the denominator. The population data used for a given rate depends on the year of the numerator: MISER Estimates for 1991-1998 MDPH Estimates for 1999 MDPH Post-Censal Estimates for 2000-2005 Population data may also be present in this report as Counts and Percentages. These data are MDPH Post-Censal Estimates. Socio -demographic data other than geography, age, sex and or Race/Hispanic ethnicity are from the selected sample data for 2000 from the U.S. Census Bureau Summary File 3 (SF3). Post-censal yearly population estimates for the state and counties are from the National Center for Health Statistics, Modified Age, Race, and Sex (MARS) file. City/town population estimates were derived by apportioning MARS county estimates to cities and town estimates from the Census Bureau Population Estimates Program, with some adjustments for non-white population undercounts. The MDPH post-censal estimates file is called the Massachusetts Modified Age, Race/Ethnicity, Census Estimates 2000-2005 (MMARS00-05). Limitations of Small Numbers http://massehip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 2 of 7 11 It Cells in some tables in MassCHIP reports, and particularly those specific to individual cities and towns, contain small numbers. In general, rates and proportions based upon less than five observations are suppressed (specific protocols differ by data sets and are noted on the relevant reports). Whether or not the small numbers are suppressed, rates and trends based upon small numbers should be interpreted cautiously. Note on NA MassCHIP marks cells with the tag "NA" if one or more of the following is true: . The data are suppressed for confidentiality reasons. See report -specific notes for Suppression Rules specific to the data sets used in this Standard Report. . The particular combination of data element, selector value and statistical calculation is not available. . The population on which a particular cell is based is too small to calculate reliable results. Differences with Previously Published Data Numbers and rates in MassCHIP reports may differ slightly from those contained in previous reports or other publications. These differences may be due to file updates; slight variations in coding schemes used in categorizing the data; differences in the formulas used in calculating rates; and the re -calculating of rates using updates of population estimates from the Massachusetts Institute for Social and Economic Research (MISER). Note on Time Period Counts for most data sets are cumulative for the given Calendar or Fiscal year. Children in Foster Care (DSS), WIC, Child Care Services (OCCS) and Department of Transitional Assistance (DTA) data sets give point in time 'snapshot' counts. These are counts taken at a specified point during the year. See last page for additional informational report -specific- notes. Prevalence of Asthma, Massachusetts Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 State 3 -Year Percent Total 9.8 Sex Male 7.4 Female 11.9 Race/Hispanic Ethnicity White Non -Hispanic 9.9 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 3 of 7 Black Non -Hispanic 10.2 Hispanic 10.6 Asian/Pacific Islander Non -Hispanic 4.5 Age 13.2 18 to 24 12.3 25 to 44 9.9 45 to 64 9.8 65 plus 7.9 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors for Asthma by Gender, Massachusetts.(a) Copyright 02005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors among people with and without Asthma, Massachusetts(a) Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 State 3 -Year Percent Male Female Smoke Regularly 15.3 13.2 Former Smoker 30.9 28.8 Overweight or Obese 64.4 44.2 Low Physical Activity 46.3 48.2 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Prevalence of Risk Factors among people with and without Asthma, Massachusetts(a) Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Asthma Mortality: Salem http://massehip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 State 3 -Year Percent Persons with Asthma Persons without Asthma . Smoke Regularly 18.6 13.7 Former Smoker 30.1 29.8 Unable to Work 9.6 3.5 Overweight or Obese 59.3 1 53.6 Low Physical Activity 48.8 1 48.1 The Percents are based on Behavioral Risk Factor Surveillance System (BRFSS) responses for the three most recent years available for the given question Asthma Mortality: Salem http://massehip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 4 of 7 Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Mortality (Vital Records) ICD -10 based Asthma Related Inpatient Hospitalizations (d) Salem Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 Area 3 Year Count Area Age Adjusted Rate (b) State Age Adjusted Rate (b) Total 2 1.5 1.1 Gender Male 0 0.0 0.8 Female 2 2.8 1.3 Race White Non -Hispanic 2 1.7 1.0 Black Non -Hispanic 0 0.0 2.7 Hispanic 0 0.0 2.5 Asian/Pacific Islander Non -Hispanic 0 0.0 1.3 Area Count Area Age Specific Rate State Age Specific Rate Age 0 to 19 yrs 0 0.0 0.2 20 and Older 2 2.1 1.6 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Mortality (Vital Records) ICD -10 based Asthma Related Inpatient Hospitalizations (d) Salem Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 Area 3 Year Count Area Age Adjusted Rate N State Age Adjusted Rate M Total 1,146 885.6 782.7 Gender Male 326 571.8 564.4 Female 820 1151.0 978.9 Race White Non -Hispanic 987 896.8 676.3 Black Non -Hispanic 47 1808.4 1564.1 Hispanic 77 476.1 1524.4 Asian/Pacific Islander Non -Hispanic NA NA 234.7 Area Age State Age http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 5 of 7 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Asthma Related Emergency Room Visits (d) Salem Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 Area Count Specific Rate (c)- Specific Rate () Age 492 0 to 4 yrs 62 849.2 645.5 5 to 9 yrs 30 436.2 320.9 10 to 19 yrs 49 340.9 329.1 20 to 29 yrs 103 500.5 561.4 30 to 39 yrs 134 707.5 683.5 40 to 49 yrs 217 1134.9 818.1 50 to 59 yrs 200 1280.8 952.3 60 to 69 yrs 124 1345.3 1299.9 70 or older 227 1711.2 1782.1 The Counts and Rates are 3 Year aggregates • See Notes on Population Data • 2003-2005 Hospital Discharges (UHDDS) Asthma Related Emergency Room Visits (d) Salem Copyright ©2005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 Area Count Area Age Adjusted Rate (b). State Age Adjusted Rate N Total 492 1205.8 1038.3 Gender Male 186 972.3 899.8 Female 306 1407.8 1165.5 Race White Non -Hispanic 356 1105.8 841.4 Black Non -Hispanic 28 1856.3 2275.7 Hispanic 89 1349.1 2080.4 Asian/Pacific Islander Non -Hispanic 0 0.0 227.3 Area Count Area Age Specific Rate State Age Specific Rate Age 0 to 4 yrs 54 2188.5 1764.5 5 to 9 yrs 42 1862.4 1217.9 10 to 19 yrs 63 1313.3 1056.1 20 to 29 yrs 96 1385.2 1419.7 http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 6 of 7 30 to 39 yrs 59 979.5 1151.1 40 to 49 yrs 70 1104.1 976.0 50 to 59 yrs 69 1296.7 722.2 60 to 69 yrs 25 801.1 554.5 70 or older 14 318.8 448.8 • See Notes on Population Data • 2005 Hospital Emergency Visits Asthma Related Hospital Observation Stays (d) Salem Copyright (02005-2007 Massachusetts Department of Public Health - All Rights Reserved, Printed: 4/5/2007, 18:42:26 See Notes_on Population__ Data • 2002 Hospital Outpatient Observation Stays Asthma Report Notes http://massehip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 Area Count Area Age Adjusted Rate 0) State Age Adjusted Rate Total 37 94.8 109.5 Gender Male 13 77.7 93.7 Female 24 109.5 122.8 Race White Non -Hispanic 30 91.2 87.5 Black Non -Hispanic NA NA 244.4 Hispanic NA NA 223.0 Asian/Pacific Islander Non -Hispanic 0 0.0 35.8 Area Count Area Age Specific Rate (e) State Age Specific Rate ic.) Age 0 to 4 yrs NA NA 286.7 5 to 9 yrs NA NA 139.3 10 to 19 yrs NA NA 79.7 20 to 29 yrs NA NA 80.9 30 to 39 yrs NA NA 84.1 40 to 49 yrs NA NA 99.6 50 to 59 yrs NA NA 118.5 60 to 69 yrs NA NA 106.4 70 or older NA NA 89.2 See Notes_on Population__ Data • 2002 Hospital Outpatient Observation Stays Asthma Report Notes http://massehip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 MassCHIP Asthma Report Page 7 of 7 a. Behavioral Risk Factor Surveillance System (BRFSS), maintained by the Massachusetts Department of Public Health, Bureau of Health Statistics, Research and Evaluation. The BRFSS is a series of annual random -digit -dial telephone surveys of adults (aged 18+) using standardized questionnaires developed by the federal Centers for Disease Control and Prevention, as well as state -added questions. BRFSS data are weighted in order to approximate the prevalence of particular behaviors and conditions among Massachusetts adults. Data are initially provided as weighted population estimates of the number of adults who report a particular behavior or condition. Percents are based on these weighted estimates. Questions vary as to which years they were included in the survey. b. Age-adjusted rate: A procedure for adjusting rates, designed to minimize the effects of differences in age distributions when comparing rates for different populations. Age-adjusted rates are usually expressed per 100,000 persons. For standardization within MassCHIP the standard population used is the 2000 US population. c. Age-specific rate: A rate for a specific age group. The numerator and denominator refer to the same age group. Age- specific rates are expressed per 100,000 persons in the specific age group. d. Asthma as principal diagnosis or any associated diagnosis (ICD 9: 493) Suppression Rules: Counts and related calculations of l - 6 [Hospitalizations] are suppressed BRFSS: Data are suppressed when the number of respondents to a given question with the given demographic stratifiers is less than 125 For Information or Assistance, contact MassCHIP Massachusetts Department of Public Health 250 Washington Street Boston, MA 02108 Voice: In MA: (888) MAS -CHIP Outside MA: (617) 624-5629 E -Mail: MassCHIP_Support@state.ma.us [MassCHIP Privacy Policy] [Instant_ Topics H..ome.] http://masschip.state.ma.us/InstantTopics/three.asp?Rptid=324&Geo=1681&lvl=4 8/29/2007 The Massachusetts Anti -Idling Law Massachusetts General Law (MGL), Chapter 90, Section 16A, 310 Code of Massachusetts Regulation (CMR), Section 7.11 and MGL, Chapter 111, Sections 142A —142M MGL, Chapter 90, 16A and 310 CMR, 7.11: "No person shall cause, suffer, allow, or permit the unnecessary operation of the engine of a motor vehicle while said vehicle is stopped for a foreseeable period of time in excess of five minutes. 310 CMR 7.11 shall not apply to: • Vehicles being serviced, provided that operation of the engine is essential to the proper repair thereof, or • Vehicles engaged in the delivery or acceptance of goods, wares, or merchandise for which engine assisted power is necessary and substitute alternate means cannot be made available or, • Vehicles engaged in an operation for which the engine power is necessary for an associated power need other than movement and substitute alternate power means cannot be made available provided that such operation does not cause or contribute to a condition of air pollution." Note: the regulation applies to all motor vehicles. Penalties • Penalties can range from $100(MGL Chapter 90, Section 16A) to as much as $25,000 (MGL Chapter 111, Section 142A); • Drivers and/or companies can be held responsible for paying the fine; • Local police have the authority to enforce the law, as do health officials or other officials who hold enforcement authority. C:\Documents and Settings\jscott\Local Settings\Temporary Internet Files\OLK2\anti-idling law with penalties.doc M a s s a c h u s e t t s D e p a r t m e n t of ENVIRONMENTAL P R O T E C T I O N f a c t s h e e t Engine Idling: Impacts on Your Health and the Environment Exhaust from motor vehicles is a key component of ground -level ozone or smog, a contributor to global warming and can cause serious health effects. In addition, very fine particles emitted from diesel and gas engines are lung irritants and can trigger asthma attacks and more serious health conditions. All of these contaminants are produced when motor vehicles idle. The anti -idling law and DEP and DEP anti -idling regulation are designed to decrease these harmful gases by reducing unnecessary idling. In Massachusetts, state law (M.G.L. Chapter 90, Section 16A) and DEP regulation (310 CMR 7.11) limit vehicle idling to no more than five minutes in most cases. A vehicle may idle longer only if absolutely necessary. The law includes exceptions for vehicles being serviced, vehicles making deliveries that need to keep their engines running (to power refrigerators, for example), and vehicles that need to run their engines to operate accessories (such as power lifts). What kind of emissions do vehicles produce? Diesel trucks and buses produce fine particulates as well as nitrogen oxides, sulfur dioxide, carbon oxides and over 40 kinds of toxic emissions. Gasoline powered vehicles produce significantly less fine particulates than diesel -powered vehicles but still produce nitrogen oxides, carbon oxides and other toxic contaminants, such as benzene. Catalytic converters reduce vehicle emissions, but the number of vehicles on the road is increasing. Collectively, the impact of these emissions is significant. How does vehicle exhaust contribute to smog? Ground -level ozone, or smog, is formed by the reaction of volatile organic compounds and nitrogen oxides in the presence of sunlight and warm temperatures. Volatile organic compounds and nitrogen oxides are produced when fuel is burned in vehicle engines. The reaction of these compounds with sunlight and heat is why smog is more of a problem in the summer months. Nitrogen oxides and ozone occur naturally; however, fossil fuel use has greatly increased the amounts found in our breathing zone. Low concentrations of ground -level ozone can irritate the eyes, nose and throat. As smog increases, it can trigger more serious health problems, including asthma, bronchitis, increased susceptibility to respiratory infections, and decreased lung function. In addition, particulates from vehicle exhaust contribute to haze observed year round. How do fine particles pose a health problem? Blue clouds and black soot are the most noticeable forms of exhaust from buses, trucks and other heavy-duty vehicles, but it is the diesel pollution we can't see or smell that poses the greatest risks to our health. Exhaust from buses and other diesel -powered vehicles contains particulate matter, including fine particles that can penetrate deep into the lungs and even enter the blood stream, posing serious health problems for children, the elderly, and people with respiratory ailments. Fine particles can cause lung damage, aggravate respiratory conditions such as asthma and bronchitis, increase heart disease, lead to cancer, and can contribute to premature death. Fact sheet Feb 23, 2005 • t of 2 How does vehicle exhaust contribute to global warming? Carbon dioxide, the largest contributor to global warming, is produced when fuel is burned to power vehicles and other machinery. It is produced even when the vehicle is idling. An increase in concentration of carbon dioxide and other global warming gases in the atmosphere has been linked to rising global average temperatures. This increase in temperature may be responsible for numerous problems caused by weather extremes, such as heat waves, droughts, floods and spread of disease. Stabilizing atmospheric carbon dioxide concentrations is essential to avoid these potential environmental impacts. A simple way to reduce carbon dioxide production is to stop idling vehicles unnecessarily. What can you do to help? Each one of us can take the following steps to reduce unnecessary idling: • Reduce warm-up idling time to 30 seconds. The best way to warm up your car is to drive it. • Turn your engine off after 10 seconds of waiting, except in traffic. Massachusetts Department of . Minimize the use of remote car starters. Environmental Protection . Encourage your friends and family to reduce idling. One Winter Street • Start an anti -idling program in your city or town. Boston, MA 02108-4746 Your municipal government can make a significant contribution to reducing idling and Commonwealth of should be encouraged to do so. The effort will not only help clear the air, but will save your city or town money on reduced fuel costs. Some steps for a municipal idling Massachusetts reduction program include: Mitt Romneey,y, Governor norr • Adopt anti -idling policies for municipal vehicles, to set an example. Executive Office of Educate municipal employees on how to comply with the Massachusetts anti - Environmental Affairs idling law. Ellen Roy Herzfelder, Secretary • Train health officials and local police to enforce the law. • Publicize the program by posting anti -idling signs in key locations where drivers often wait and promote the program through the media. Department of Make sure school bus drivers are trained in the law. Environmental Protection Robert W. Golledge, Jr., DEP's website has sample idling reduction policies, a program implementation plan, Commissioner sign designs, and other useful items to help start your program. Please visit: DEP WEB LINK TO BE DETERMINED Produced by the Bureau of Waste Prevention Other sources of information and assistance December 2004. EPA website links include general information about emissions from mobile sources Printed on recycled paper. and emissions from diesel engines: This information is available in http://www.epa.goy/oms/ and http://www.epa.goy/ne/eco/diesel/ alternate format by calling our ADA Coordinator at The Asthma Regional Council promotes awareness and action on contributors to (617) 574-6872. asthma. One area of interest of theirs is school bus idling reduction htti)://www.asthmaregionalcouncil.or_q/about/BusToolkit.htm Fact Sheet Feb 23, 2005 • Page 2 of 2 International Finance Corporation Environmental, Health and Safety Guidelines for Waste Management Facilities These guidelines are for the design, construction and operation of facilities for the management of hazardous and non -hazardous wastes, including landfills, incinerators, solvent recovery systems, and other waste management systems. The guidelines incorporate the general provisions of the World Bank policies for cultural properties, indigenous peoples, involuntary resettlement, biodiversity, water resources management and wildlands. Environmental issues that are identified by the project sponsor or other interested parties, but not addressed by World Bank policies or guidelines, must be brought to the immediate attention of IFC for consideration and guidance. Project Siting The principal elements of World Bank policy regarding siting, land acquisition and development of waste management facilities and associated project features are summarized below. Sites should be chosen through a systematic, documented process that includes consideration of alternatives and their environmental impacts. The sponsors must provide information regarding project siting, addressing the following guidelines: a) The site and access routes must be selected taking environmental factors into consideration in a maturer which will minimize, to the extent possible, impacts to natural resources, land use patterns, sensitive ecosystems and cultural resources. b) A surface and subsurface investigation of geology, soils, groundwater and surface water resources should be conducted to determine leachate migration potential and the need for additional design requirements. c) Special consideration should be given to site proximity to developed areas and potential impacts resulting from air emissions, odor, contamination of water resources (i.e., groundwater and/or surface water), vector attraction, noise and truck traffic. d) The project site should include enough land area to provide a buffer zone to minimize aesthetic impacts. e) Land acquisition must be carried out in accordance with World Bank resettlement policy which requires quantification of impacts on land- based livelihood, and fair compensation to landowners and people relying on the land for their residence and/or livelihood. f) Selection of the site should be made after consultation with government agencies, affected communities and concerned nongovernmental organizations. Project sponsors must provide IFC with a complete record of the process by which the site was selected, including the analysis of alternative sites, and the consultation with government agencies, affected communities and nongovernmental organizations. Erosion and Sediment Project sponsors should develop an erosion and sediment control plan to minimize erosion in construction areas and along access roads, reduce the risk of sediment discharge to nearby streams, and provide for long-term maintenance and operation practices that will control erosion and The information is intended for use by staff of the International Finance Corporation and its consultants in carrying out the policies set out in the Operational Policy on Environmental Assessment (OP 4.01) and related documents. 4 International Finance Corporation Waste Management Facilities July 1. 1998 sedimentation. The control plan should include, but should not be limited to, the following measures. a) The area cleared of vegetation to accommodate construction of should be minimized and slopes should be stabilized to prevent erosion. b) Cleared areas should be promptly revegetated with native grasses, shrubs and trees. c) Overland drainage should be controlled to prevent channeling and sediment transport by diverting flows from areas where soils are exposed, and/or by providing filter barriers or settling basins to remove sediment before the runoff is discharged to surface waters. d) Revegetated areas and areas subject to erosion should be monitored and maintained during project operation. Waste Collection, Handling and Transport Project sponsors must conduct a survey to assess the waste management requirements of its service area and develop a compatible program for the collection, handling and transportation of wastes. The program should include the following measures to mitigate potential adverse impacts to the environment, as well as public and employee health and safety. a) Ensure scheduled collection services and public awareness of such services. b) Provide waste generators with appropriate refuse containers to segregate hazardous and non -hazardous wastes. c) Provide enclosed refuse collection vehicles or cloth tarps to cover open vehicles. d) Minimize waste handling and maximize waste containment during all operations. e) Control odors and the loss of wastes during transportation and at loading and unloading areas. f) Include materials recovery facilities in the project to receive, separate, process and market or reclaim materials where possible. g) Ensure proper maintenance of collection vehicles to ensure safe collection and transport of wastes. General Environmental Requirements a) Project facilities must be designed to minimize impacts to air and water resources, and may include, where appropriate: venting and gas collection systems; adequate depth between the bottom of waste piles/landfills and the top of the aquifer; adequate horizontal distance between waste treatment facilities and the nearest surface water; stormwater runoff control systems; and leachate collection and treatment systems. b) Prior to construction, project sponsors must devise a program to: survey, identify and assess cultural resource sites within the project area; train construction personnel in the identification of cultural resources; and mitigate adverse impacts resulting from project development. c) The potential impacts to vegetation and wildlife habitat as a result of the project should be assessed and a plan established to mitigate the impacts. d) Landfill design must include gas control systems to protect deep-rooted vegetation in the project area and minimize the potential for explosions or toxic conditions from the accumulation of landfill gas in buildings. Project Operations a) Facilities should have separate receiving and handling areas for hazardous and non -hazardous wastes. b) Wastes should be analyzed prior to disposal for compatibility with treatment and disposal methods. c) Air quality control measures must be implemented to minimize fugitive dust from materials loading/ unloading, and odors from land disposal sites and composting systems. The information is intended for use by staff of the International Finance Corporation and its consultants in carrying out the policies set out in the Operational Policy on Environmental Assessment (OP 4.01) and related documents. d) Adequate and environmentally sound and contained storage areas must be available for materials that cannot be treated or disposed of immediately upon arrival to the facility. e) All containment cells should be covered with soil or other suitable cover material at the end of each working day to minimize odors and infringement by animals. f) Waste should be composted whenever possible. g) A monitoring program should be implemented to detect any groundwater contamination or gas migration as a result of project operations. h) Treated leachate and other liquid effluents from the waste management facility and associated project facilities must meet the requirements for liquid effluents in the General Environmental Guidelines. i) Maintenance practices should include routine checks for failure of spill containment facilities, air quality controls and emergency devices. Incinerator Stack Emissions Concentrations of contaminants emitted from the stacks of incinerators, or other significant sources of air emissions, including boilers, furnaces, and electrical generating equipment should not exceed the following limits: Pararueter/Pollutatit Maxiuturtt Value Particulate Matter 100 mg/Nm3 Nitrogen Oxides, as NO2 Coal fired 750 mg/Nm3 Oil fired 460 mg/Nm3 Gas fired 320 mg/Nm3 Sulfur Dioxide 2,000 mg/Nm3 Dioxin 1 ng/Nm3 Furan 1 ng/Nm3 Hazards Protection a) Waste management facilities should be located, to the extent possible, to minimize potential risks from earthquakes, tidal waves, floods and fires from surrounding areas. International Finance Corporation Waste Management Facilities July 1, 1998 b) Buildings and other support structures must be designed to criteria appropriate to the local seismic risk, wind and snow loading, and any other dynamically imposed loads associated with climatic and geological factors inherent at the location, certification of the design criteria used must be provided by the structural engineers or architect. Employee Health and Safety Project sponsors must develop an Employee Health and Safety Program that includes the following: a) Employees working in hazardous waste facilities must undergo a medical examination when they are hired and, at a minimum, every two years thereafter. b) Emergency escape routes should be provided for all employees in the event of fire, toxic gas emissions, explosions, radiation and other hazards exposure. c) Firewalls and other fireproof structures should be incorporated into the facility design. d) No smoking, eating or drinking rules should be strictly enforced in all work areas. e) Unauthorized personnel should be prevented from entering hazardous or restricted areas. f) An operations and public emergency response program should be implemented for spills, fires and major accidents, including emergency equipment and trained personnel, and critical components of the program tested on a regular basis. Training a) Personnel involved in the construction and operation of the project must be trained on the hazards, safety procedures and emergency response plan associated with their tasks in accordance with the General Health and Safety Guidelines and the General Environmental Guidelines. b) Training should incorporate information from the Material Safety Data Sheets (MSDSs) for potentially harmful materials. The information is intended for use by staff of the International Finance Corporation and its consultants in carrying out the policies set out in the Operational Policy on Environmental Assessment (OP 4.01) and related documents. International Finance Corporation Waste Management Facilities July 1, 1998 Record Keeping And Reporting c) Personnel should be trained in environmental, health and safety matters a) The sponsor must maintain records of including accident prevention, safe lifting significant environmental matters, including practices, the use of MSDSs, safe waste handling monitoring data, spills, occupational accidents practices, and proper control and maintenance of and illnesses, and fires and other emergencies. equipment and facilities. d) Project sponsors must provide training for monitoring and mitigating the effects of the project on environmental and sociocultural resources. b) Records of public complaints and accidents involving the general public must be maintained. c) The above information must be reviewed and evaluated to improve the effectiveness of the environmental, health and safety program, and an annual summary provided to IFC. The information is intended for use by staff of the International Finance Corporation and its consultants in carrying out the policies set out in the Operational Policy on Environmental Assessment (OP 4.01) and related documents. Public Health and Diesel I American Lung Association of California LUNG ASSOCIATIOW of California your email addre — Narking to prevent lung disease andpromote lung health Inipmuing Life One Bmath at aTime in the spotlight May is Clean Air Month! -- May 2004 Public Health and Diesel Page 1 of 5 Despite remarkable progress in cleaning up the air over the last 30 years, 95 percent of Californians still live in areas that fail to meet health -based standards for a variety of air pollutants. Diesel exhaust is a major source of air pollution, which contributes to lung and other types of cancer, respiratory tract infections and lung diseases such as asthma, emphysema and chronic bronchitis. Lung disease is a leading cause of death in America, killing nearly 350,000 people each year, and those numbers are growing. No Smog Check for Buses and Trucks While California has been working to reduce car emissions through the use of smog -controlling devices like catalytic converters and maintenance and inspection programs like the Smog Check Program, diesel buses and trucks have gone relatively uncontrolled. Despite their small numbers compared to the total number of vehicles in California, diesel engines account for 40 percent of the nitrogen oxide and about 60 percent of the total particulate matter from mobile sources. Diesel Exhaust and Health Since 1990, diesel exhaust has been listed as a known carcinogen under California's Proposition 65, and in 1998, the California Air Resources Board (CARB) formally listed diesel particulate as a toxic air contaminant. The extensive scientific literature demonstrates that exposure to diesel exhaust increases the risk of developing lung cancer and other non -cancer health problems. In listing diesel as a toxic air contaminant, CARB determined that I� the increased cancer risk from diesel particulates could cause premature deaths in more than 14,000 Californians exposed to — -! diesel pollution over a lifetime. Diesel exhaust contains hundreds of constituent chemicals, including many that are human toxicants, carcinogens, or present reproductive hazards. Forty chemicals in diesel exhaust are on California's list of toxic air contaminants, and California residents face high diesel -related health risks based on the heavy concentration of diesel truck traffic in urbanized areas and recent reports demonstrating that diesel cancer risks far outweigh cancer risks from other toxic air contaminants. http://www.ealifomialung.org/spotlight/diesel health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 2 of 5 Diesel exhaust is a major source of particle pollution in California. Ninety-four percent of diesel emissions are estimated to be fine particles, less than 2.5 microns in diameter, which can bypass respiratory defense mechanisms and lodge deep in the lungs. Numerous studies have found that fine particles impair lung function, aggravate respiratory illnesses such as asthma, bronchitis and emphysema, and are associated with premature deaths. Dozens of studies link airborne fine particle concentrations to increased hospital admissions for respiratory diseases, chronic obstructive lung disease, pneumonia and heart disease. Diesel is also a major contributor to ozone pollution in California. Ozone air pollution, generated by nitrogen oxide and hydrocarbons from fuel combustion, is a powerful respiratory irritant that may lead to shortness of breath, chest pain, wheezing, coughing, and exacerbation of respiratory illnesses such as asthma. Long-term and repeated exposures may lead to large reductions in lung function and inflammation of the lung lining. Recent studies on the relationship between asthmatic responses and proximity to major roadways add to concerns about diesel's contribution to asthma. Studies have shown that the proximity of a child's school or home to major roads may be linked to asthma, and the severity of children's asthmatic symptoms increases with proximity to truck traffic. Studies are ongoing in this area of research. Recent reports by CARB and the South Coast Air Quality Management District have concluded that diesel exhaust is the most significant source of air toxics in California and accounts for more than 70 percent of the cancer risk statewide from toxic air contaminants. While the particulate component of diesel was specifically listed as a toxic air contaminant by CARB, both the particulate and hydrocarbon components of diesel have been associated with diesel toxic risks. Vulnerable Populations Most at Risk It is impossible for most people to avoid exposure to diesel exhaust. Trucks and buses are everywhere. To make matters worse, the most vulnerable among us are being exposed to the most diesel exhaust. Children are among those most vulnerable to the health risks of diesel exhaust exposure, yet they ride on some of the oldest and most polluting diesel buses on the road today, sometimes for hours at a time. Constant, significant exposure to diesel exhaust, coupled with a child's heightened vulnerability to pollution, is widely recognized as a potential cause of severe health problems in children. It is well known, for example, that children raised in heavily polluted areas face the prospect of reduced lung capacity and prematurely aged lungs. In addition, childhood asthma is on the rise and is, among chronic conditions, the leading cause of absenteeism from school. Another vulnerable population is low-income communities where http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 3 of 5 large numbers of people of color and the elderly live. These communities are often located near freeways, shipping yards, and other areas with heavy diesel truck traffic. Diesel emissions are also released throughout the process of fuel production, refining, distribution and dispensing. Diesel refining, distribution and storage facilities are predominantly located in these communities, which are already burdened by major air pollution and toxic risks. Continued use of diesel fuel increases toxic air pollution and raises the risk of lung cancer and other lung diseases in these communities. There are ways to reduce the risk, such as limiting exercise and activity to areas far from freeways or industrial complexes. But for most Californians, avoiding diesel exhaust is nearly impossible. Reducing Diesel Health Dangers There is a way to reduce public exposure to diesel exhaust and transition to cleaner fuels. Alternative power sources such as natural gas and fuel cells can eventually replace diesel fuel. Upgrades and engine replacements are available tools to reduce on - road diesel emissions. Buses and trucks can run on natural gas today, and fuel cells are being developed that could be capable of powering them in the future. To significantly reduce the amount of pollutants and cancer-causing toxic air contaminants, California must promote cleaner alternatives where possible and substantially reduce diesel emissions through the use of retrofit devices and lower -emitting diesel fuel. The American Lung Association of California has been advocating for restrictions on diesel emissions and promotion of alternative fuels. Local American Lung Associations around the state have been working with their local transit agencies and school districts to encourage them to switch over to buses powered by natural gas. Until we make a concerted effort to rid our state of dirty diesel fuel and transition to lower -emission fuels and cleaner alternative fuels, diesel exhaust will remain a serious public health threat Clean Air Month 2004 Links Clean Air is Everyone's Business: Cleaner Options are Here Now 34 California Counties Flunk American Lung Association's Annual Clean Air Test for Smog and First -Ever Tests for Particle Pollution -- American Lung Association of California Fights Roll -Back of Federal Clean Air Act That Would Increase Pollution; 30.3 Million California Residents Threatened by Dangerous Particle Pollution Levels (News Release -- April 29, 2004) n I nral Air (:harkar http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 4 of 5 0 Go 0 State of the Air Report 2004 report with California data)_ (1.IMB PDF - requires free Adobe@ Acrobat@ Reader) What Can You Do to Protect Yourself and Your Family_ from Ozone and Particle Pollution? What Individuals, Businesses and Government Agencies Can Do to Reduce Air Pollution Tips for Fighting Air Pollution in Your Community Cleaner Vehicles Clean Fleets Program & Zero -Emission Vehicles Information Cleaner Fuels Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust California Air District Resource Directory 2004 California Air Monitoring Sites 2004 The Children's Health Study Print Ads: There's Even More You Should Know About Diesel View or Download Ads Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Diesel Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Public Health and Diesel Fact Sheet Renewable Energy - There's Even More You Should Know About Renewable Energy http://www.califomialung.org/spotlight/diesel health.html 8/14/2007 R� ' Reduce Air Pollution and Get Your Reduced Rental Rate or Purchase Price for an Electric, Natural Gas or Hybrid Car Now! &'NVltiONM4NTAt R E N T V&N/CLG A L California Air District Resource Directory 2004 California Air Monitoring Sites 2004 The Children's Health Study Print Ads: There's Even More You Should Know About Diesel View or Download Ads Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Diesel Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Public Health and Diesel Fact Sheet Renewable Energy - There's Even More You Should Know About Renewable Energy http://www.califomialung.org/spotlight/diesel health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 5 of 5 Smart Growth Reduces Air Pollution and Promotes Health Fact Sheet Clean Air Month 2004 Proclamation Sample Proclamation for California Cities & Counties Milestones in Air Pollution History American Lung Association Timeline Cleaner Fuels -- There's Even More You Should Know About Cleaner Vehicles Environmental Justice Fact Sheet Links to Fact Sheets About Kids and Air ualit Call 1 -800 -LUNG -USA to connect automatically to your local American Lung Association office. Home I Local Offices I Donate I Volunteer I Take Action I News/Reporter Center I Contact Us I Search I Espanol ©1999-2002 American Lung Association of California 424 Pendleton Way, Oakland, CA 94621 tel: (510) 638 -LUNG, fax: (510) 638-8984, e-mail: info californial mg.00r . Privacy. http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 1 of 5 Working to prevent lung disease and promote lung health Improving Life, One Breath at a Tinge in the spotlight May is Clean Air Month! -- May 2004 your email addrf �m Public Health and Diesel 84 Despite remarkable progress in cleaning up the air over the last 30 years, 95 percent of Californians still live in areas that fail to meet health -based standards for a variety of air pollutants. Diesel exhaust is a major source of air pollution, which contributes to lung and other types of cancer, respiratory tract infections and lung diseases such as asthma, emphysema and chronic bronchitis. Lung disease is a leading cause of death in America, killing nearly 350,000 people each year, and those numbers are growing. No Smog Check for Buses and Trucks While California has been working to reduce car emissions through the use of smog -controlling devices like catalytic converters and maintenance and inspection programs like the Smog Check Program, diesel buses and trucks have gone relatively uncontrolled. Despite their small numbers compared to the total number of vehicles in California, diesel engines account for 40 percent of the nitrogen oxide and about 60 percent of the total particulate matter from mobile sources. Diesel Exhaust and Health Since 1990, diesel exhaust has been listed as a known carcinogen under California's Proposition 65, and in 1998, the California Air Resources Board (CARB) formally listed diesel particulate as a toxic air contaminant. The extensive scientific literature demonstrates that exposure to diesel exhaust increases the risk of developing lung cancer and other non -cancer health problems. In listing diesel as a toxic air contaminant, CARB determined that EMM the increased cancer risk from diesel particulates could cause -- premature deaths in more than 14,000 Californians exposed to ---- diesel pollution over a lifetime. Diesel exhaust contains hundreds of constituent chemicals, including many that are human toxicants, carcinogens, or present reproductive hazards. Forty chemicals in diesel exhaust are on California's list of toxic air contaminants, and California residents face high diesel -related health risks based on the heavy concentration of diesel truck traffic in urbanized areas and recent reports demonstrating that diesel cancer risks far outweigh cancer risks from other toxic air contaminants. http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 2 of 5 Diesel exhaust is a major source of particle pollution in California. Ninety-four percent of diesel emissions are estimated to be fine particles, less than 2.5 microns in diameter, which can bypass respiratory defense mechanisms and lodge deep in the lungs. Numerous studies have found that fine particles impair lung function, aggravate respiratory illnesses such as asthma, bronchitis and emphysema, and are associated with premature deaths. Dozens of studies link airborne fine particle concentrations to increased hospital admissions for respiratory diseases, chronic obstructive lung disease, pneumonia and heart disease. Diesel is also a major contributor to ozone pollution in California. Ozone air pollution, generated by nitrogen oxide and hydrocarbons from fuel combustion, is a powerful respiratory irritant that may lead to shortness of breath, chest pain, wheezing, coughing, and exacerbation of respiratory illnesses such as asthma. Long-term and repeated exposures may lead to large reductions in lung function and inflammation of the lung lining. Recent studies on the relationship between asthmatic responses and proximity to major roadways add to concerns about diesel's contribution to asthma. Studies have shown that the proximity of a child's school or home to major roads may be linked to asthma, and the severity of children's asthmatic symptoms increases with proximity to truck traffic. Studies are ongoing in this area of research. Recent reports by CARB and the South Coast Air Quality Management District have concluded that diesel exhaust is the most significant source of air toxics in California and accounts for more than 70 percent of the cancer risk statewide from toxic air contaminants. While the particulate component of diesel was specifically listed as a toxic air contaminant by CARE, both the particulate and hydrocarbon components of diesel have been associated with diesel toxic risks. Vulnerable Populations Most at Risk It is impossible for most people to avoid exposure to diesel exhaust. Trucks and buses are everywhere. To make matters worse, the most vulnerable among us are being exposed to the most diesel exhaust. Children are among those most vulnerable to the health risks of diesel exhaust exposure, yet they ride on some of the oldest and most polluting diesel buses on the road today, sometimes for hours at a time. Constant, significant exposure to diesel exhaust, coupled with a child's heightened vulnerability to pollution, is widely recognized as a potential cause of severe health problems in children. It is well known, for example, that children raised in heavily polluted areas face the prospect of reduced lung capacity and prematurely aged lungs. In addition, childhood asthma is on the rise and is, among chronic conditions, the leading cause of absenteeism from school. Another vulnerable population is low-income communities where http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 3 of 5 large numbers of people of color and the elderly live. These communities are often located near freeways, shipping yards, and other areas with heavy diesel truck traffic. Diesel emissions are also released throughout the process of fuel production, refining, distribution and dispensing. Diesel refining, distribution and storage facilities are predominantly located in these communities, which are already burdened by major air pollution and toxic risks. Continued use of diesel fuel increases toxic air pollution and raises the risk of lung cancer and other lung diseases in these communities. There are ways to reduce the risk, such as limiting exercise and activity to areas far from freeways or industrial complexes. But for most Californians, avoiding diesel exhaust is nearly impossible. Reducing Diesel Health Dangers There is a way to reduce public exposure to diesel exhaust and transition to cleaner fuels. Alternative power sources such as natural gas and fuel cells can eventually replace diesel fuel. Upgrades and engine replacements are available tools to reduce on - road diesel emissions. Buses and trucks can run on natural gas today, and fuel cells are being developed that could be capable of powering them in the future. To significantly reduce the amount of pollutants and cancer-causing toxic air contaminants, California must promote cleaner alternatives where possible and substantially reduce diesel emissions through the use of retrofit devices and lower -emitting diesel fuel. The American Lung Association of California has been advocating for restrictions on diesel emissions and promotion of alternative fuels. Local American Lung Associations around the state have been working with their local transit agencies and school districts to encourage them to switch over to buses powered by natural gas. Until we make a concerted effort to rid our state of dirty diesel fuel and transition to lower -emission fuels and cleaner alternative fuels, diesel exhaust will remain a serious public health threat Clean Air Month 2004 Links Clean Air is Everyone's Business: Cleaner Options are Here Now 34 California Counties Flunk American Lung Association's Annual Clean Air Test for Smog and First -Ever Tests for Particle Pollution -- American Lung Association of California Fights Roll -Back of Federal Clean Air Act That Would Increase Pollution; 30.3 Million California Residents Threatened by Dangerous Particle Pollution Levels (News Release -- April 29, 2004) M. I oral Air r:harkar http://www.califomialung.org/spotlighUdiesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 4 of 5 State of the Air Report 2004 report (with California data)_ (1.1MB PDF - requires free Adobe@ Acrobatp Reader) What Can You Do to Protect Yourself and Your Family_ from Ozone and Particle Pollution? What Individuals, Businesses and Government Agencies Can Do to Reduce Air Pollution Tips for Fighting Air Pollution in Your Community Cleaner Vehicles Clean Fleets Program & Zero -Emission Vehicles Information Cleaner Fuels Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust California Air District Resource Directory 2004 California Air Monitoring Sites 2004 The Children's Health Study Print Ads: There's Even More You Should Know About Diesel View or Download Ads Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Diesel Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Public Health and Diesel Fact Sheet Renewable Energy_ - There's Even More You Should Know About Renewable Energy http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Reduce Air Pollution and Get Your Reduced Rental Rate or Purchase Price for an_Electri�Natural Gas or Hybrid tar Now $NV)RONMGNTAL A E IV T V$N)CLB A L California Air District Resource Directory 2004 California Air Monitoring Sites 2004 The Children's Health Study Print Ads: There's Even More You Should Know About Diesel View or Download Ads Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Diesel Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Public Health and Diesel Fact Sheet Renewable Energy_ - There's Even More You Should Know About Renewable Energy http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Public Health and Diesel I American Lung Association of California Page 5 of 5 Smart Growth Reduces Air Pollution and Promotes Health Fact Sheet Clean Air Month 2004 Proclamation Sample Proclamation for California Cities & Counties Milestones in Air Pollution History_ American Lung Association Timeline Cleaner Fuels -- There's Even More You Should Know About Cleaner Vehicles Environmental Justice Fact Sheet Links to Fact Sheets About Kids and Air ualit Call 1 -800 -LUNG -USA to connect automatically to your local American Lung Association office. Home i Local Offices i Donate i Volunteer i Take Action i News Reporter Center i Contact Us I Search I EspOol @1999-2002 American Lung Association of California 424 Pendleton Way, Oakland, CA 94621 tel: (510) 638 -LUNG, fax: (510) 638-8984, e-mail: info@calfornialung.org. Privacy Policy. http://www.califomialung.org/spotlight/diesel_health.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 1 of 12 ASSOCiATIOM of Califamia your email addrf. SEARCH FIND 'Working to prevent lung disease and promote lune bealib Improving Life, One Breath at a Time in the spotlight May is Clean Air Month! -- May 2003 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust (May 2002) Scientific Findings 1. Increased Childhood Asthma Hospital Visits Linked to Proximity of Traffic 2. Lung Development of Young Monkeys Drastically Changed when Exposed to Ozone Pollution 3. Diesel Exhaust Particles Linked to Asthma 4. Long -Term Exposure to Particulate Pollution Linked to Lung Canter 5. Children's Health Study Finds Slower Lung Function Growth Rate, Asthma Onset in Children Exposed to Pollution 6. U.S. Cancer Risk Estimates Determined for Diesel Exhaust Particles 7. High Diesel Exhaust Levels Found in School Buses 8. Newsletter Highlights Emerging Scientific Findings on Air Pollution Link to Asthma Other Respiratory Illnesses 9. Bibliography 1. Increased Childhood Asthma Hospital Visits Linked to Proximity of Traffic Lin, Shao, Et Al. "Childhood Asthma Hospitalization and Residential Exposure to State Route Traffic." New York: 2000. Available online- http_//www. idea library. com/lin to 2/ Overview: This study looked at whether pediatric hospitalization for asthma was related to living near a road with heavy traffic. This study consisted of 934 white children between the ages of 0-14 living in Erie County, New York, with the exception of the city of Buffalo. The children studied lived in the suburban areas near heavily traveled roads. In this study, http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 2 of 12 objective measures of outcome and exposure data was used. These measures include asthma hospitalizations from a statewide program and traffic counts on state routes measured by the New York State Department of Transportation. Each home in Erie County used in this study was given an approximate distance, measured by researchers that told them how far they were from the main traffic routes, which was correlated with the levels of diesel emissions they were exposed to. Many studies have consistently demonstrated a positive association between childhood asthma and residential exposure to heavy traffic. What is unique about this study is that it actually measured the distance from traffic routes to homes and determined the distance believed to expose certain homes to unhealthy diesel pollution. This study does have some limitations, such as: seasonality could not be controlled for, indoor air exposure levels among different households could not be controlled for, and the information on the duration of traffic exposures was not available. Despite the stated limitations, this study still provides support for the hypothesis that exposure to automobile and truck pollutants within 200 meters from homes does contribute to childhood asthma hospitalization, though more studies such as this one are needed in the future. Key Findings: The study concluded that white children living in areas with heavy traffic density or heavy trucks/trailers passing by within 200 meters of their homes had an increased risk of asthma hospitalizations after age and poverty level were controlled for. The impact of distance to major state routes, alone, was not found to be a significant factor. However, when adding in consideration of heavy traffic volume and heavy truck volume, the impact on asthma hospitalization was significant. Bibliograf y I Table of Contents 2. Lung Development of Young Monkeys Drastically Changed when Exposed to Ozone Pollution Fell, Andy. "Primate research shows link between ozone pollution, asthma." California: 2000. Available online- http: /www.dateline.ucdavis.edu/-101300/DL_asthma.htmi. Overview: A study conducted at UC Davis' California Regional Primate Research Center is shedding new light on the relationship between air pollution, common allergies, and asthma. This new research shows for the first time that occasional exposure to the air pollutant ozone can change how the lungs of young rhesus monkeys develop, and lead to a disease similar to childhood asthma in humans, which is problematic for so many children today. The research center now contains the first http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 3 of 12 real monkey model of human asthma. Never before has research been able to prove that assumed levels of ozone can change lung development. This is the first study to integrate studies of the immune response with anatomy. There were clear differences found in the immune systems of those monkeys with normal lungs and those exposed to the allergen. This study presents data suggesting that the changes caused by ozone pollution are long lasting, and maybe even permanent. Little has been proved scientifically about the long-term affects of air pollution, however short-term affects are well researched. Research on monkeys may open up the possibility of seeing the affects of pollution over a period of time, and therefore help people to understand that air pollution can cause long-lasting and expensive health problems. Key Findings: When young monkeys were exposed to ozone soon after birth, they showed significant changes in their lung development. For example, researchers found that the lungs of exposed monkeys had fewer branches as well as other structural and cellular changes similar to those seen in humans with asthma. The airways of exposed monkeys closed down more quickly when stimulated, a condition called hyper- responsiveness. These changes became more obvious when the monkeys exposed to ozone were also sensitized to house -dust -mite allergen. When these young monkeys were later exposed to the allergen in the air, they developed rapid, shallow breathing, and a drop in oxygen in their blood, which are all symptoms of childhood asthma. This disease became worse when they were later exposed to ozone. Bibliography I Table of Contents 3. Diesel Exhaust Particles Linked to Asthma Pandya, Robert; Et Al. "Diesel exhaust and asthma: Hypothesis and molecular mechanisms of action." California: 2002. Available online- http://ehpnetl. niehs. nih.gov/docs/2�p1-1J Y03-112pandva/absract. html. Overview: This report from the NRDC and the UCSF School of Medicine shows the strongest evidence to date on the causal link between diesel and asthma. Many components of air pollution have been linked to asthma. In addition to many well -studied pollutants such as nitrogen oxide, sulfur dioxide, and ozone; diesel exhaust particles (DEPs) may also play a role in respiratory and allergy health problems. Diesel -fueled engines emit particles composed of vapors, gases, and very fine particulates. This research was focused on determining the role of DEPs in causing respiratory problems. One of the key studies done to http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 4 of 12 support this research was the monitoring of three locomotive railroad workers. All three had no prior respiratory health issues. All three workers regularly traveled behind the lead diesel -powered locomotive engine and eventually developed acute or sub -acute onset of respiratory symptoms. Railroad workers exposed to DEPs demonstrated symptoms consistent with asthma, including hyperreactive airways, airflow limitation, and bronchial symptoms. This evidence may help promote the hypothesis that children living by major trucking routes are more likely to have respiratory dysfunction. Key Findings: The study found that DEPs can act as airway irritants by causing inflammation, mucus secretion, serum leakage, and muscle contraction of the airways. In this study, researchers found that DEPs may promote expression of an immunologic response that has been associated with asthma and allergic disease. DEPs have a greater health risk in the presence of environmental allergens than they do by themselves. The study's authors indicate they have shown how diesel exhaust can work to both trigger asthma attacks in individuals with no pre-existing asthmatic history, as well as to cause chronic problems by making an individual susceptible to developing an asthmatic response. The authors also found that possibly because of this dual effect, individuals exposed to diesel exhaust and a common allergen, such as pollen, will have a greater response to the allergen. Biblioyraohv_ I Table of Contents 4. Long -Term Exposure to Particulate Pollution Linked to Lung Cancer Burnett, T. Richard; Et Al. "Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution." Journal of the American Medical Association; 2002. Available online- htto://iama.ama-assn.org/issues/v287n9/abs/ioc11435.html. Overview: The objective of this study was to assess the relationship between long-term exposure to fine particulate air pollution and all -cause lung cancer and cardiopulmonary mortality. According to this study of 500,000 people in 116 American cities, long-term exposure to air that is polluted with tiny particles of soot raises the risk of dying of lung cancer or other diseases associated with it. In the past associations have been made between every day air pollution and cardiopulmonary disease, however there have been no conclusive studies on long-term effects. This study was conducted over a period of sixteen years. Risk factor data information, socioeconomic, and personal information was http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 5 of 12 collected through questionnaires from individuals recruited for the study in 1982. Sixteen years later the 500, 000 adults were linked to pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data. This study finds that long-term exposure to combustion -related fine particulate air pollution is an environmental risk factor for cardiopulmonary disease and lung cancer mortality. According to researchers involved with this study, many city residents face a long-term risk of fatal lung cancer, similar to being subjected to second-hand smoke constantly These findings help to explain many lung cancer deaths and give a sense of importance for the need of more studies such as this one. Key Findings: This study is important because it represents the first time there has been research stating that there is a link between long-term exposure to particulate matter and lung cancer. The study showed that fine particulate matter and sulfur oxide were associated with ail -cause lung cancer, and cardiopulmonary mortality. The study found that when there were slight increases in the particulate matter pollution level, there was a correlating increase for all three of the health risks listed above. However, measures of coarse particulate fraction and total suspended particles were not linked to associated mortality on a consistent basis. Bibliography_ I Table of Contents 5. Children's Health Study Finds Slower Lung Function Growth Rate, Asthma Onset in Children Exposed to Pollution "Children's Health Study part of the Long -Term Exposure Health Effects Research Program." California: 2001. Available online- http-./IWww.arb.ca,gLv/-researchLchs/-chs.htm. Overview: The Children's Health Study (CHS) is a ten-year study of children funded by the California Air Resources Board (CARB) and being conducted by the University of Southern California to determine the impacts of long-term air pollution exposures on children's health. Dr. John Peters at USC directs the study that was begun in 1982. The CHS is a three-part program designed to determine whether children that grow up in Southern California, and have long term exposure to air pollution, show evidence of measurable effects on lung function or other adverse health effects. About 5500 children living in http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 6 of 12 twelve communities in Southern California have been enrolled in the study; two-thirds of the children were enrolled as fourth graders. Data on children's health, air pollution exposures and other factors affecting their response to air pollution is being gathered annually until the children graduate from high school. Six communities in the study have higher than average ozone levels and six have lower than average ozone levels. While all parts of the study are not yet completed, researchers have already come to many important conclusions concerning the impacts of pollution on growth and development of the lungs and development of respiratory illnesses based on evidence from the first years of the study. Key Findings: The study found a clear correlation between lower lung function in children and more intense air pollution. The effect is more pronounced in girls who reported spending the most time outdoors. Breathing capacity is lower for girls living in the most populated communities with high ozone levels. Boys also appear to have lower breathing capacity if they live in communities with high ozone levels, provided they spend a good deal of their time outdoors. Wheezing is more evident in boys that are exposed to higher levels of NO2 and acid vapor. Days with elevated ozone levels resulted in significantly higher school absences due to respiratory illness. This study showed that children growing up in smoggier air tend to be slower in their lung function growth as compared to those children that are exposed to lower pollution levels daily. High levels of NO2, P1110, and P112.5, and acid vapor appear to be associated with slower lung growth. Children in the most polluted cities were found to have their lung development slowed down by about 10% compared to their peers in less polluted communities. Children with decreased lung function are more susceptible to respiratory disease and may experience more respiratory problems as an adult. The latest finding of the study is that children living in high ozone communities who actively participate in several sports are more likely to develop asthma than children in these communities not participating in sports. Bibliography I Table of Contents 6. U.S. Cancer Risk Estimates Determined for Diesel Exhaust Particles "Cancer Risk from Diesel Particulate: National Metropolitan Area Estimates for the United States." Prepared by State and Territorial Air Pollution Program Administrators and the Association of Local Air Pollution Control Officials. March 2000. Overview: http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 7 of 12 In 1998, California declared particulate emissions from diesel -fueled engines a toxic air contaminant, based on data that supported links between diesel exposure and lung cancer. Many other studies have been done since then in order to collect more evidence to support this link between diesel pollution and cancer. Important research was released in the fall of 1999 by the South Coast Air Quality District (SCAQMD), which included an analysis of the cancer risk in the region from exposure to diesel particulate. The SCAQMD measured diesel particulate levels by using elemental carbon as a surrogate and applied a cancer potency factor determined by the state of California. Based on this research SCAQMD concluded two things: that mobile sources were responsible for approximately 90 percent of the cancer risk in the area, and that 70 percent of the total cancer risk was due to diesel particulate exposure. The State and Territorial Air Pollution Program Administrators (STAPPA) and the Association of Local Air Pollution Control Officials (ALAPCO) sought to extend this research even further across the country and to other cities, using the same methods as prior studies. They developed diesel cancer risk numbers for the United States and for metropolitan areas in the U.S. Key Findings: This study concluded that soot emitted from diesel powered engines is responsible for an estimated 125, 000 cancers in the United States. Their study found that of those estimated 125, 000 cancer cases, 119, 570 were from Metropolitan Areas and only 5, 540 were from Non - Metropolitan Areas. The Metropolitan city with the largest number of cancers was Los Angeles with 16, 250 cases. This study also reinforced earlier research by demonstrating that individuals living in Metropolitan Areas are more likely to be exposed to diesel emissions, therefore they are more likely to have cancer in their lifetime. Bibliography I Table of Contents 7. High Diesel Exhaust Levels Found in School Buses Solomon, Gina and Campbell, Todd. "No breathing in the Aisles." California: 2001. Available on line- http://www.nrdc.org/air/transportation/schoolbus/sbusinx.aso. Overview: The Natural Resources Defense Council (NRDC) designed and performed this study to measure the level of diesel exhaust to which children are being exposed to as they ride on buses to and from school daily, and to determine whether years of this type of exposure produces a health risk to young children. There have been many http://www.californialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 8 of 12 studies that measure the diesel exhaust levels outside buses, however in this study the researchers wanted to measure the exhaust levels present inside buses. This study produced some alarming results regarding children's exposure to diesel exhaust fumes. It is important yet troubling to report that most of the school buses that were tested did not emit a significant amount of visible black smoke. This means that even a smokeless school bus could be carrying unsafe levels of diesel pollution inside the bus, while not being caused by emissions from the tailpipe. These exposures translate to a very dangerous risk of cancer to children: from 23 to 46 times the cancer risk level compared to what is considered acceptable under federal law. Incorporated in this study is a summary of information available on the health effects of diesel exhaust. For example, diesel exhaust is a major source of fine particulates which lodge deep in the lungs and can cause lung cancer and exacerbate asthma. Smog -forming oxides of nitrogen that are emitted from diesel engines have also recently been linked to decreased lung function growth in children. In this study, the authors posed a couple solutions for reducing children's exposure to diesel exhaust. Solution include: utilizing cleaner alternative technologies, such as buses that run on natural gas and propane; and retrofitting existing diesel powered buses to reduce pollution emissions by using particulate traps and other technological advances. Key Findings: This study is important because it measured the level of diesel exhaust present inside the school buses, not just the levels outside of the buses. The study found that a child riding inside of a diesel school bus may be exposed to as much as four times the level of toxic diesel exhaust as someone standing or driving next to the bus. The study also found that diesel exhaust levels are higher in the back of the bus as compared to the front, and are highest when the windows on the bus are closed. The author's estimate that for every one million children riding the school bus 1 to 2 hours each day during their school year, 23 to 46 children may develop cancer from the excess diesel exhaust they inhale. This translates to 23-46 times the cancer risk considered "significant" by the EPA and under federal law. BibliograpV I Table of Contents 8. Newsletter Highlights Emerging Scientific Findings on Air Pollution Link to Asthma, Other Respiratory Illnesses Moore, Curtis & Bates, David M.D. (Eds.). "Air Pollution Causes Asthma: A Review of Recent Studies." Available online- www.healthandcleanair.orgL. Overview: The "Health and Clean Air Newsletter" was first released in the fall of hftp://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 9 of 12 2001 as a resource designed to make current research findings on health effects of air pollution available to a wide range of readers, from scientists to laypersons and news media. The California Air Resources Board is currently funding this newsletter, edited by Curtis Moore & David Bates, M.D. The hopes of the editors working to make this newsletter a successful resource, are to publish three newsletters by the end of 2002. The second newsletter will be focused on particulate air pollution, and is due out by June 11t, 2002. The newsletter can be located online at www.healthandcleanair.org/. Key Findings: The Fall, 2001 newsletter contains a review of recent studies from around the world including the Children's Environmental Health Study funded by the California Air Resources Board, that has shown an association between outdoor air pollution and the development of asthma in children and adults alike. After carefully examining their findings the editors agree that these studies demonstrate that air pollution is almost certainly a cause of asthma. Blblioaraphy I Table of Contents This summary of scientific findings was prepared by the American Lung Association of California (ALAC) Government Relations Office with many thanks for the assistance of Kristen Andersen, ALAC Government Relations Intern, Spring 2002. For further information, please contact Bonnie Holmes -Gen, Assistant Vice President for Government Relations, ALAC at bhgen@alac.org. Bibliography 1. Lin, Shao, Et Al. "Childhood Asthma Hospitalization and Residential Exposure to State Route Traffic." New York: New York State Department of Health, 2000. [On line] Available http://www.idealibrary.com/links/toc/enrs 88/2 2. Fell, Andy. "Primate research shows link between ozone pollution, asthma." Dateline UC Davis. October 13, 2000. [On line] Available http://www-dateline.ucdavis.edu/101300/DL asthma.htmi. 3. Pandya, Robert; Et Al. "Diesel exhaust and asthma: Hypothesis and molecular mechanisms of action." Environmental Health Perspectives 110 (suppl 1): 103-112 (2002). [On line] Available http�Lpnet1.niehs.nih.gov docs/22/suppl_1/103- I12pandya/abstract. html 2002. University of California at San Francisco. 4. Burnett, T. Richard; Et Al. "Lung Cancer, Cardiopulmonary Morality, and Long-term Exposure to Fine Particulate Air Pollution". Journal of the American Medical Association Vol. 287 No. 9. March 6, 2002. [On line] Available http:lliama.ama-assn.org/Lssue-s/v287ng/abs:j*ocll435.htmi. 5. "Children's Health Study part of the Long -Term Exposure Health Effects Research Program." [On line] Available http.lLwww.arb.ca.goy/research/chs/�chs.htm. January 23, 2001. 6. "Cancer Risk from Diesel Particulate: National and Metropolitan Area Estimates for the United States." Prepared by the State and Territorial Air Pollution Program Administrators and the Association of Local Air Pollution http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 10 of 12 Control Officials. March 15, 2000. 7. Solomon, Gina and Campbell, Todd. "No breathing in the Aisles." University of California Berkeley. January 2001. [On line] Available http://www.nrdc.org/air/transportation schoolbus/sbusinx.aso 8. Moore, Curtis & Bates, David M.D. (Eds.). "Air Pollution Causes Asthma: A Review of Recent Studies." Health and Clean Air Newsletter. Fall 2001. [On line] Available www.healthandcleanair.ora/. Clean Air Month 2003 Links Clean Air is Everyone's Business: Cleaner Options are Here Now 28 California Counties Receive F Grades for Ozone Air Pollution According to State of the Air Report -- American Lung Association Raises Awareness About Cleaner Transportation Options during Clean Air Month in May (News Release -- May 1, 2003) Are you one of the 137 million Americans who breathe unhealthy air? FIND OUT. Enter Your Zip: r '[Gifl State of the Air Report 2003 report (with California data). (1.1MB PDF - requires free Adobe(p) Acrobat@ Reader) American Lung Association Raises Awareness About Cleaner Transportation Options During Clean Air Month in May -- "Clean Air is Everyone's Business: Cleaner Options are Here Now" (News Release -- April, 2003) Print Ads: There's Even More You Should Know About Diesel View or Download Ads Clean Air is Everyone's Business Tips for Fighting Air Pollution in Your Community Cleaner Vehicles Clean Fleets Program & Zero -Emission Vehicles Information Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 11 of 12 Reduce Air Pollution and Get Your Reduced Rental Rate or Purchase ' A-=-- Price for an Electric, Natural Gas o14r Hybrid Car Now! ENVIPONM5STAL V8N/CL4 A E N T A 4 California Air District Resource Directory_ Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Public Health and Diesel Fact Sheet Renewable Energy - There's Even More You Should Know About Renewable Energy There's Even More You Should Know About Smart Growth, Urban S rp awl. Air Quality and Health Fact Sheet Clean Air Month 2003 Proclamation Sample Proclamation for California Cities & Counties Milestones in Air Pollution History American Lung Association Timeline Cleaner Fuels -- There's Even More You Should Know About Cleaner Vehicles Environmental Justice Fact Sheet Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Air Quality Fact Sheets Call 1 -800 -LUNG -USA to connect automatically to your local American Lung Association office. Home I Local Offices I Donate I Volunteer I Take Action I News/Reporter Center I Contact Us I Search I Espanol ©1999-2002 American Lung Association of California 424 Pendleton Way, Oakland, CA 94621 tel: (510) 638 -LUNG, fax: (510) 638-8984, e-mail: info@californialuno.00 . Privacy. http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 12 of 12 http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust of your email addre SEARCH FIND Page 1 of 12 Emu Working to prevent lung disease and prornote lung health Improving Life, Otte Breath at a'Pime in the spotlight May is Clean Air Month! -- May 2003 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust (May 2002) Scientific Findings 1. Increased Childhood Asthma Hospital Visits Linked to Proximityof Traffic 2. Luna Development of Young Monkeys Drastically -Changed when Exposed to Ozone Pollution 3. Diesel Exhaust Particles Linked to Asthma 4. Long -Term Ex oossure to Particulate Pollution Linked to Luna Cancer 5. Children's Health Study Finds Slower Luna Function Growth Rate, Asthma Onset in Children Exposed to Pollution 6. U.S. Cancer Risk Estimates Determined for Diesel Exhaust Particles 7. High Diesel Exhaust Levels Found in School Buses 8. Newsletter Highlights Emerging Scientific Findings on Air Pollution Link to Asthma, Other RespiratoryIllnesses 9. Bibliography 1. Increased Childhood Asthma Hospital Visits Linked to Proximity of Traffic Lin, Shao, Et Al. "Childhood Asthma Hospitalization and Residential Exposure to State Route Traffic." New York: 2000. Available online- http://www.idealibrarv.com/links/toc/-enrs/881210. Overview: This study looked at whether pediatric hospitalization for asthma was related to living near a road with heavy traffic. This study consisted of 934 white children between the ages of 0-14 living in Erie County, New York, with the exception of the city of Buffalo. The children studied lived in the suburban areas near heavily traveled roads. In this study, hfp://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 2 of 12 objective measures of outcome and exposure data was used. These measures include asthma hospitalizations from a statewide program and traffic counts on state routes measured by the New York State Department of Transportation. Each home in Erie County used in this study was given an approximate distance, measured by researchers that told them how far they were from the main traffic routes, which was correlated with the levels of diesel emissions they were exposed to. Many studies have consistently demonstrated a positive association between childhood asthma and residential exposure to heavy traffic. What is unique about this study is that it actually measured the distance from traffic routes to homes and determined the distance believed to expose certain homes to unhealthy diesel pollution. This study does have some limitations, such as: seasonality could not be controlled for, indoor air exposure levels among different households could not be controlled for, and the information on the duration of traffic exposures was not available. Despite the stated limitations, this study still provides support for the hypothesis that exposure to automobile and truck pollutants within 200 meters from homes does contribute to childhood asthma hospitalization, though more studies such as this one are needed in the future. Key Findings: The study concluded that white children living in areas with heavy traffic density or heavy trucks/trailers passing by within 200 meters of their homes had an increased risk of asthma hospitalizations after age and poverty level were controlled for. The impact of distance to major state routes, alone, was not found to be a significant factor. However, when adding in consideration of heavy traffic volume and heavy truck volume, the impact on asthma hospitalization was significant. Bibliography I Table of Contents 2. Lung Development of Young Monkeys Drastically Changed when Exposed to Ozone Pollution Fell, Andy. "Primate research shows link between ozone pollution, asthma." California: 2000. Available online- http://www.dateline.ucdavis.edu/101300/Dl asthma.html. Overview: A study conducted at UC Davis' California Regional Primate Research Center is shedding new light on the relationship between air pollution, common allergies, and asthma. This new research shows for the first time that occasional exposure to the air pollutant ozone can change how the lungs of young rhesus monkeys develop, and lead to a disease similar to childhood asthma in humans, which is problematic for so many children today. The research center now contains the first http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 3 of 12 real monkey model of human asthma. Never before has research been able to prove that assumed levels of ozone can change lung development. This is the first study to integrate studies of the immune response with anatomy. There were clear differences found in the immune systems of those monkeys with normal lungs and those exposed to the allergen. This study presents data suggesting that the changes caused by ozone pollution are long lasting, and maybe even permanent. Little has been proved scientifically about the long-term affects of air pollution, however short-term affects are well researched. Research on monkeys may open up the possibility of seeing the affects of pollution over a period of time, and therefore help people to understand that air pollution can cause long-lasting and expensive health problems. Key Findings: When young monkeys were exposed to ozone soon after birth, they showed significant changes in their lung development. For example, researchers found that the lungs of exposed monkeys had fewer branches as well as other structural and cellular changes similar to those seen in humans with asthma. The airways of exposed monkeys closed down more quickly when stimulated, a condition called hyper- responsiveness. These changes became more obvious when the monkeys exposed to ozone were also sensitized to house -dust -mite allergen. When these young monkeys were later exposed to the allergen in the air, they developed rapid, shallow breathing, and a drop in oxygen in their blood, which are all symptoms of childhood asthma. This disease became worse when they were later exposed to ozone. Bibliography I Table of Contents 3. Diesel Exhaust Particles Linked to Asthma Pandya, Robert; Et Al. "Diesel exhaust and asthma: Hypothesis and molecular mechanisms of action." California: 2002. Available online- http:: ehi)netl.niehs.nih.gov/doc-s/2002,Lsupl)1-1/103-1121)andy labsract.htmi. Overview: This report from the NRDC and the UCSF School of Medicine shows the strongest evidence to date on the causal link between diesel and asthma. Many components of air pollution have been linked to asthma. In addition to many well -studied pollutants such as nitrogen oxide, sulfur dioxide, and ozone; diesel exhaust particles (DEPs) may also play a role in respiratory and allergy health problems. Diesel -fueled engines emit particles composed of vapors, gases, and very fine particulates. This research was focused on determining the role of DEPs in causing respiratory problems. One of the key studies done to http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 4 of 12 support this research was the monitoring of three locomotive railroad workers. All three had no prior respiratory health issues. All three workers regularly traveled behind the lead diesel -powered locomotive engine and eventually developed acute or sub -acute onset of respiratory symptoms. Railroad workers exposed to DEPs demonstrated symptoms consistent with asthma, including hyperreactive airways, airflow limitation, and bronchial symptoms. This evidence may help promote the hypothesis that children living by major trucking routes are more likely to have respiratory dysfunction. Key Findings: The study found that DEPs can act as airway irritants by causing inflammation, mucus secretion, serum leakage, and muscle contraction of the airways. In this study, researchers found that DEPs may promote expression of an immunologic response that has been associated with asthma and allergic disease. DEPs have a greater health risk in the presence of environmental allergens than they do by themselves. The study's authors indicate they have shown how diesel exhaust can work to both trigger asthma attacks in individuals with no pre-existing asthmatic history, as well as to cause chronic problems by making an individual susceptible to developing an asthmatic response. The authors also found that possibly because of this dual effect, individuals exposed to diesel exhaust and a common allergen, such as pollen, will have a greater response to the allergen. Bibliography I Table of Contents 4. Long -Term Exposure to Particulate Pollution Linked to Lung Cancer Burnett, T. Richard; Et Al. "Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution." )ournal of the American Medical Association; 2002. Available online- htto://iama.ama-assn.orq/issues/v287n9/abs 'oc11435.html. Overview: The objective of this study was to assess the relationship between long-term exposure to fine particulate air pollution and all -cause lung cancer and cardiopulmonary mortality. According to this study of 500,000 people in 116 American cities, long-term exposure to air that is polluted with tiny particles of soot raises the risk of dying of lung cancer or other diseases associated with it. In the past associations have been made between every day air pollution and cardiopulmonary disease, however there have been no conclusive studies on long-term effects. This study was conducted over a period of sixteen years. Risk factor data information, socioeconomic, and personal information was http://www.califomialung.org/spotlight/cleanair03 research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 5 of 12 collected through questionnaires from individuals recruited for the study in 1982. Sixteen years later the 500, 000 adults were linked to pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data. This study finds that long-term exposure to combustion -related fine particulate air pollution is an environmental risk factor for cardiopulmonary disease and lung cancer mortality. According to researchers involved with this study, many city residents face a long-term risk of fatal lung cancer, similar to being subjected to second-hand smoke constantly These findings help to explain many lung cancer deaths and give a sense of importance for the need of more studies such as this one. Key Findings: This study is important because it represents the first time there has been research stating that there is a link between long-term exposure to particulate matter and lung cancer. The study showed that fine particulate matter and sulfur oxide were associated with all -cause lung cancer, and cardiopulmonary mortality. The study found that when there were slight increases in the particulate matter pollution level, there was a correlating increase for all three of the health risks listed above. However, measures of coarse particulate fraction and total suspended particles were not linked to associated mortality on a consistent basis. Bibliography I Table of Contents 5. Children's Health Study Finds Slower Lung Function Growth Rate, Asthma Onset in Children Exposed to Pollution "Children's Health Study part of the Long -Term Exposure Health Effects Research Program." California: 2001. Available online- httpp/Imww.arb.ca.aov/research/chs/chs.htm. Overview: The Children's Health Study (CHS) is a ten-year study of children funded by the California Air Resources Board (CARB) and being conducted by the University of Southern California to determine the impacts of long-term air pollution exposures on children's health. Dr. John Peters at USC directs the study that was begun in 1982. The CHS is a three-part program designed to determine whether children that grow up in Southern California, and have long term exposure to air pollution, show evidence of measurable effects on lung function or other adverse health effects. About 5500 children living in hftp://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 6 of 12 twelve communities in Southern California have been enrolled in the study; two-thirds of the children were enrolled as fourth graders. Data on children's health, air pollution exposures and other factors affecting their response to air pollution is being gathered annually until the children graduate from high school. Six communities in the study have higher than average ozone levels and six have lower than average ozone levels. While all parts of the study are not yet completed, researchers have already come to many important conclusions concerning the impacts of pollution on growth and development of the lungs and development of respiratory illnesses based on evidence from the first years of the study. Key Findings: The study found a clear correlation between lower lung function in children and more intense air pollution. The effect is more pronounced in girls who reported spending the most time outdoors. Breathing capacity is lower for girls living in the most populated communities with high ozone levels. Boys also appear to have lower breathing capacity if they live in communities with high ozone levels, provided they spend a good deal of their time outdoors. Wheezing is more evident in boys that are exposed to higher levels of NO2 and acid vapor. Days with elevated ozone levels resulted in significantly higher school absences due to respiratory illness. This study showed that children growing up in smoggier air tend to be slower in their lung function growth as compared to those children that are exposed to lower pollution levels daily. High levels of NO2, PM10, and PM2.5, and acid vapor appear to be associated with slower lung growth. Children in the most polluted cities were found to have their lung development slowed down by about 10% compared to their peers in less polluted communities. Children with decreased lung function are more susceptible to respiratory disease and may experience more respiratory problems as an adult. The latest finding of the study is that children living in high ozone communities who actively participate in several sports are more likely to develop asthma than children in these communities not participating in sports. Biblioarapy I Table of Contents 6. U.S. Cancer Risk Estimates Determined for Diesel Exhaust Particles "Cancer Risk from Diesel Particulate: National Metropolitan Area Estimates for the United States." Prepared by State and Territorial Air Pollution Program Administrators and the Association of Local Air Pollution Control Officials. March 2000. Overview: hftp://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 7 of 12 In 1998, California declared particulate emissions from diesel -fueled engines a toxic air contaminant, based on data that supported links between diesel exposure and lung cancer. Many other studies have been done since then in order to collect more evidence to support this link between diesel pollution and cancer. Important research was released in the fall of 1999 by the South Coast Air Quality District (SCAQMD), which included an analysis of the cancer risk in the region from exposure to diesel particulate. The SCAQMD measured diesel particulate levels by using elemental carbon as a surrogate and applied a cancer potency factor determined by the state of California. Based on this research SCAQMD concluded two things: that mobile sources were responsible for approximately 90 percent of the cancer risk in the area, and that 70 percent of the total cancer risk was due to diesel particulate exposure. The State and Territorial Air Pollution Program Administrators (STAPPA) and the Association of Local Air Pollution Control Officials (ALAPCO) sought to extend this research even further across the country and to other cities, using the same methods as prior studies. They developed diesel cancer risk numbers for the United States and for metropolitan areas in the U.S. Key Findings: This study concluded that soot emitted from diesel powered engines is responsible for an estimated 125, 000 cancers in the United States. Their study found that of those estimated 125, 000 cancer cases, 119, 570 were from Metropolitan Areas and only 5, 540 were from Non - Metropolitan Areas. The Metropolitan city with the largest number of cancers was Los Angeles with 16, 250 cases. This study also reinforced earlier research by demonstrating that individuals living in Metropolitan Areas are more likely to be exposed to diesel emissions, therefore they are more likely to have cancer in their lifetime. Bibliography I Table of Contents 7. High Diesel Exhaust Levels Found in School Buses Solomon, Gina and Campbell, Todd. "No breathing in the Aisles." California: 2001. Available on line- http://www.nrdc.org/air transportation/schoolbus/sbusinx.aso. Overview: The Natural Resources Defense Council (NRDC) designed and performed this study to measure the level of diesel exhaust to which children are being exposed to as they ride on buses to and from school daily, and to determine whether years of this type of exposure produces a health risk to young children. There have been many http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 8 of 12 studies that measure the diesel exhaust levels outside buses, however in this study the researchers wanted to measure the exhaust levels present inside buses. This study produced some alarming results regarding children's exposure to diesel exhaust fumes. It is important yet troubling to report that most of the school buses that were tested did not emit a significant amount of visible black smoke. This means that even a smokeless school bus could be carrying unsafe levels of diesel pollution inside the bus, while not being caused by emissions from the tailpipe. These exposures translate to a very dangerous risk of cancer to children: from 23 to 46 times the cancer risk level compared to what is considered acceptable under federal law. Incorporated in this study is a summary of information available on the health effects of diesel exhaust. For example, diesel exhaust is a major source of fine particulates which lodge deep in the lungs and can cause lung cancer and exacerbate asthma. Smog -forming oxides of nitrogen that are emitted from diesel engines have also recently been linked to decreased lung function growth in children. In this study, the authors posed a couple solutions for reducing children's exposure to diesel exhaust. Solution include: utilizing cleaner alternative technologies, such as buses that run on natural gas and propane; and retrofitting existing diesel powered buses to reduce pollution emissions by using particulate traps and other technological advances. Key Findings: This study is important because it measured the level of diesel exhaust present inside the school buses, not just the levels outside of the buses. The study found that a child riding inside of a diesel school bus may be exposed to as much as four times the level of toxic diesel exhaust as someone standing or driving next to the bus. The study also found that diesel exhaust levels are higher in the back of the bus as compared to the front, and are highest when the windows on the bus are closed. The author's estimate that for every one million children riding the school bus 1 to 2 hours each day during their school year, 23 to 46 children may develop cancer from the excess diesel exhaust they inhale. This translates to 23-46 times the cancer risk considered "significant' by the EPA and under federal law. BibMraPhy I Table of Contents 8. Newsletter Highlights Emerging Scientific Findings on Air Pollution Link to Asthma, Other Respiratory Illnesses Moore, Curtis & Bates, David M.D. (Eds.). "Air Pollution Causes Asthma: A Review of Recent Studies." Available online- www.healthandcleanair.oro/. Overview: The "Health and Clean Air Newsletter" was first released in the fall of http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 9 of 12 2001 as a resource designed to make current research findings on health effects of air pollution available to a wide range of readers, from scientists to laypersons and news media. The California Air Resources Board is currently funding this newsletter, edited by Curtis Moore & David Bates, M.D. The hopes of the editors working to make this newsletter a successful resource, are to publish three newsletters by the end of 2002. The second newsletter will be focused on particulate air pollution, and is due out by June 1st, 2002. The newsletter can be located online at www.healthandcleanair.org/. Key Findings: The Fall, 2001 newsletter contains a review of recent studies from around the world including the Children's Environmental Health Study funded by the California Air Resources Board, that has shown an association between outdoor air pollution and the development of asthma in children and adults alike. After carefully examining their findings the editors agree that these studies demonstrate that air pollution is almost certainly a cause of asthma. Bibliography I Table of Contents This summary of scientific findings was prepared by the American Lung Association of California (ALAC) Government Relations Office with many thanks for the assistance of Kristen Andersen, ALAC Government Relations Intern, Spring 2002. For further information, please contact Bonnie Holmes -Gen, Assistant Vice President for Government Relations, ALAC at bhgen@alac.org. Bibliography 1. Lin, Shao, Et Al. "Childhood Asthma Hospitalization and Residential Exposure to State Route Traffic." New York: New York State Department of Health, 2000. [On line] Available http-.//www• idealibrary com/links/toc/en rs/88/2/0. 2. Fell, Andy. "Primate research shows link between ozone pollution, asthma." Dateline UC Davis. October 13, 2000. [On line] Available t�J: /www-dateline.ucdavis.edu/101300 DL asthma.html. 3. Pandya, Robert; Et Al. "Diesel exhaust and asthma: Hypothesis and molecular mechanisms of action." Environmental Health Perspectives 110 (suppl 1): 103-112 (2002). [On line] Available http:Rehpnetl.niehs.min gov docs 2002/suopl_1/103- 112pandya/abstract.html 2002. University of California at San Francisco. 4. Burnett, T. Richard; Et Al. "Lung Cancer, Cardiopulmonary Morality, and Long-term Exposure to Fine Particulate Air Pollution". Journal of the American Medical Association Vol. 287 No. 9. March 6, 2002. [On line] Available httpJ/jama.ama-assn.org issues v287n9/ab /joc11435.html. 5. "Children's Health Study part of the Long -Term Exposure Health Effects Research Program." [On line] Available http.,//www.arb.ca.gov/research/chs chs.htm. January 23, 2001. 6. "Cancer Risk from Diesel Particulate: National and Metropolitan Area Estimates for the United States." Prepared by the State and Territorial Air Pollution Program Administrators and the Association of Local Air Pollution http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 10 of 12 Control Officials. March 15, 2000. 7. Solomon, Gina and Campbell, Todd. "No breathing in the Aisles." University of California Berkeley. January 2001. [On line] Available ham_//www. nrdc.org/airltransl)ortation/schoolbus/sbusinx.asp 8. Moore, Curtis & Bates, David M.D. (Eds.). "Air Pollution Causes Asthma: A Review of Recent Studies." Health and Clean Air Newsletter. Fall 2001. [On line] Available www.healthandcleanair.org/. Clean Air Month 2003 Links Clean Air is Everyone's Business: Cleaner Options are Here Now 28 California Counties Receive F Grades for Ozone Air Pollution According to State of the Air Report -- American Lung Association Raises Awareness About Cleaner Transportation Options during Clean Air Month in May (News Release -- May 1, 2003) Are you one of the 137 million Americans who breathe unhealthy air? FIND OUT. Enter Your Zip: F-- do State of the Air Report 2003 report (with California data)_ (1.1118 PDF - requires free AdobeAcrobatCU Reader) American Lung Association Raises Awareness About Cleaner Transportation Options During Clean Air Month in May -- "Clean Air is Everyone's Business: Cleaner Options are Here Now" (News Release -- April, 2003) Print Ads: There's Even More You Should Know About Diesel View or Download Ads Clean Air is Everyone's Business Tips for Fighting Air Pollution in Your Community Cleaner Vehicles Clean Fleets Program & Zero -Emission Vehicles Information Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 11 of 12 'B Reduce Air Pollution and Get Your Reduced Rental Rate or Purchase Price for an Electric. Natural Gas or Hybrid Car Now! QNVIAQNMRNrA4 V4HjQL 6 a E 1Y r A L California Air District Resource Directory Frequently Asked Questions About Diesel Technologies and Fuels Particulate Matter Air Pollution - There's Even More You Should Know About Particulate Matter Public Health and Diesel Fact Sheet Renewable Energy - There's Even More You Should Know About Renewable Energy There's Even More You Should Know About Smart Growth, Urban Sprawl, Air Quality and Health Fact Sheet Clean Air Month 2003 Proclamation Sample Proclamation for California Cities & Counties Milestones in Air Pollution History_ American Lung Association Timeline Cleaner Fuels -- There's Even More You Should Know About Cleaner Vehicles Environmental Justice Fact Sheet Position Statement: Reducing Public Exposure To Diesel Emissions From Heavy Duty Vehicles Air Quality Fact Sheets Call 1 -800 -LUNG -USA to connect automatically to your local American Lung Association office. Home I Local Offices I Donate I Volunteer I Take Action I News/Reporter Center I Contact Us I Search I Espanol @1999-2002 American Lung Association of California 424 Pendleton Way, Oakland, CA 94621 tel: (510) 638 -LUNG, fax: (510) 638-8984, e-mail: info@californialun.o P-masy o is . http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 Recent Scientific Findings on Health Effects of Air Pollution and Diesel Exhaust Page 12 of 12 http://www.califomialung.org/spotlight/cleanair03_research.html 8/14/2007 To view this report online, see real time videos of CATF's diesel monitoring, and read the accompanying white paper go to: www.catf.us/goto/noescape CLEAN AIR TASK FORCE 18 Tremont Street, Boston, MA 02108 Tel: 617-624-0234 /Fax: 617-624-0230 Credits Written by: Conrad G. Schneider, Advocacy Director and L. Bruce Hill, Ph.D., Senior Scientist Principal Investigator. L. Bruce Hill, Ph.D., Senior Scientist Research Assistant: James Gooch Edited by: Maria Padian Designed by: Jill Bock Design Printed by: Spectrum Printing and Graphics, Inc. © 2007 Clean Air Task Force Acknowledgements The Beldon Fund,George Gund Foundation, Heinz Endowments,Joh n Merck Fund, Kendeda Fund, Mari sla Foundation, Newyork Community Trust, Oa k Foundation, Prospect Hill Foundation, and Turner Foundation have provided support that made this report possible. Tom Balon and Todd Da nos of M.J. Bradley Associates provided technical support. John D. Spengler and Jonathan I. Levy, Harvard School of Public Health and George Allen of the Northeast States for Coordinated Air Use Management provided invaluable advice regarding monitoring tech- niques. Staff from Texas Public Citizen,Ohio Environmen- tal Council, and volunteers Andrew Hill and Windy Kelly provided field support in Austin,Texas, Columbus, Ohio, Boston, Massachusetts,and New Hampshire, respectively. We thank Kenneth and Wilma Johnsen fortheir assistance in Columbus. We thank staff from the American Lung Association ofNewYorkState for their assistance inNew ® n York City. to February 2007 FSC Mixed Sources rasa s,oun iaa.,.rvm.�.em m,..aa.,anm,aah..a ■ This report has been printed on recycled (50016 recydedQ546 post re,W.e.e°erenx, consumer waste), Processed Chlorine Free (PCF) with soy ink Foreword Exposure to diesel exhaust is part of our everyday lives. We encounter diesel -powered vehicles, and the air pollution they create, each day. This occurs in our neighborhoods where diesel -powered vehicles make deliveries or pickup trash, or when wed rive behind them during our daily rounds to the store or travel on a highway. Most often, Americans are exposed to diesel pollution on their way to and from work or school, whether commuting via a car, riding on diesel buses and trains, or on foot or bike near a busy thoroughfare. In thousands of medical studies, scientists have documented serious adverse health impacts from the air pollutants resulting from diesel exhaust. Our own studies at New York University have linked diesel pollution exposures to higher incidences of asthma in New York City communities. One of the most dangerous of these diesel emissions is carbonaceous particulate matter, or fine particle soot. Diesel particles are very tiny in comparison to many other atmospheric particles.Theyare so small, in fact, that they can even penetrate from the lungs into the bloodstream, carrying with them other toxic substances. Some health researchers have estimated that such fine particles are respon- sible for shortening the lives of at least 70,000 Americans each year, and studies have also associated this pollution with a host of other serious adverse health impacts, such as asthma attacks. Scientists now even have evidence that these very tiny particles may disrupt normal heart rhythms and cause inflammation leading to cardiovascular problems, such as heart attacks and stroke. Given the potentially severe health dangers posed by diesel exhaust, it is important to ask: When are we most exposed to these deadly particles? Findings in published, peer-reviewed health re- search estimate that, although we spend only about six percent of our day commuting to and from work, over half of our exposure to these particles may occur during that travel time. The Clean AirTask Force (CATF), using the same type of monitoring instruments and scientific methodologies presently used by health researchers at major universities, has investigated the levels of diesel particles during commutes in several cities.These investigators measured pollutant levels during commutes by car, transit bus, commuter train,ferry, and while walking.They found that regardless of how you get to work, there is no escape from exposure to diesel exhaust, and that pollution levels measured inside cars, buses, and trains during commutes were many times greater than levels in the outdoor air in these cities at that same time.The combined weight of scientific evidence from this new CATF diesel exposure study along with the existing medical studies supports the conclusion that exposure to diesel exhaust during commutes poses a serious public health risk that needs to be addressed. Solving the problem will require political will. But as the CATF investigation also helps illustrate, the good news is that cleaner fuels and emissions control technologies that can reduce the emis- sions of this pollution by up to 90 percent are here today.We need to make retrofitting the diesel engines on the road today with these highly effective emissions controls a public health priority, so that we can all breathe easier. ff t �� (George D.Thurston,Sc.D. New York University5chool ofMedicine Executive Summary Every day, Americans are needlessly sickened from exposure to air pollution in the form of fine particles. Overall, health researchers estimate that fine particles, such as those found in diesel exhaust, shorten the lives of 70,000 Americans each year. Many more suffer the effects of particle -related respiratory and cardiovascu- lar disease. When during our day are we exposed to these particles? According to the California Air Resources Board, although we spend only about six percent of our day commuting to and from work, it is during that time when we receive over half of our exposure to utlrafine particles. For the most part, the particles we breathe come from the diesel engines we encounter while driving or taking diesel -powered mass transit. According to the Transportation Research Board, one hundred and fifty million people—roughly half the population—travel to and from work in the U.S. daily. Most commuters drive, but many others take diesel -powered trains or city buses and ferries. Today's average commute lasts 25 minutes each way, and current trends indicate that our commutes, and therefore our exposures, are lengthening. Legions of published, peer-reviewed studies have documented the increased exposure and resultant health risk from particles in and around nearby road- ways. Using comparable instruments and research techniques as those employed by health researchers Although we may spend only 6%ofour daycommuting, that is when we get up to 60%ofourdaily exposure to harmful ultrafine particles Commute 6% at major universities, Clean Air Task Force (CATF) investigated the exposure to diesel particles during typical commutes in four cities: Austin,Texas, Boston, Massachusetts, New York City, and Columbus, Ohio. In addition, CATF tested the air quality benefits due to emission control retrofits of transit buses in Boston and transit buses and garbage trucks in New York City. CATF's investigation demonstrated that whether you commute by car, bus, ferry, train, or on foot, you may be exposed to high levels of diesel particles. Specifically, CATF documented diesel particle levels four to eight times higher inside commuter cars, buses, and trains than in the ambient outdoor air in those cities. In some cases, the ultrafine particle levels during the commutes were so high as to be comparable to driving with a smoker! Several cities like Seattle, Boston and New York have purchased new cleaner transit buses and retrofitted many of their older buses and garbage trucks with effective emission controls.These emission controls are widely available today because U.S. EPA rules require them for new diesel engines starting this year. The only commutes where the researchers found little or no diesel exposure were commutes on electric -powered subways and commuter trains, on buses that have been retrofitted with diesel particu- late filters or run on alternative fuels like compressed natural gas, and in cars traveling along routes with little or no truck traffic. Percen t of Day Commuting PercentofDailyExposure to Harmful Particles (SOURCE: CARS) Itrs the Diesels In Austin, Texas, CATF compared the particle levels in a car during a commute on Interstate 35 between Roundrock and Austin to the levels experienced in the same car traveling on the MOPAC (an expressway that follows the Missouri -Pacific railroad line). MOPAC provided a "no truck" alternative for comparison be- cause MOPAC prohibits truck traffic CATF also com- pared the levels on I-35 to levels monitored in downtown Austin. Ultrafine particle levels on 1-35 were consistently higher than on the MOPAC and black carbon levels were six times greater than at the downtown site. CATF also documented similarly high levels of diesel pollution during car commutes in Boston, Massachusetts and Columbus,Ohio. See Findings on pages 10-11. gam..«.. ...-�.. a. - .e ... In -cabin particle exposures are much higherforcommuters along routes with diesel trucks. The MOPAC highway (right) a no-truckalternative to 1-35 (left) in Austin, Texashad lowerdiesel pollution levels. A Solution Within Our Reach The good news is that affordable technology exists today that can reduce diesel particle emis- sions by up to 90 percent. CATF tested pollution levels in a commuter car following directly be- hind a conventional diesel truck and recorded high levels of diesel particles inside the car. However, after being retrofitted with a diesel particulate filter QPF), the next day the same truck emits such low amounts of diesel particles that the levels in the car following directly behind are barely detectable. Fine particle levels behind a conventional box truck(lef ),and behind the same truckafterbeing retrofitted with a diesel particle filter (right). To view videos,go to www.catfus/goto/noescap 3 M Transit Buses CATF's researchers investigated in -cabin levels of diesel pollution on city buses in Boston. We found the levels inside the conventional buses on average were about four times greater than the outdoor air. We then compared those levels to the levels monitored during commutes on similar buses in Boston that had been retrofitted with diesel particle flters.The moni- toring demonstrated the filters substantially reduced the pollution in the buses. CATFresearchers measured high ultrafine particle levels on a conventional transitbus in Boston (left), while levels on a bus retrofitted with a particle filter were barelydetectable (right). Conventional and retrofit MBTAbuses in Boston show the benefits ofdiesel particle filters to people in cars following behind. To view videos,go to www.catfus/goto/noescape/ How to Reduce Exposure to Diesel Exhaust While Commuting The best solution is to clean up the existing diesels with diesel particle filters so that we can all breathe easier. Until then, commuters can help protect themselves by taking clean transit such as electrified subways and light rail. If you must drive to workchoose commuter routes that are less heavily traveled by trucks. When in traffic, close your windows and set your ventilation system to recirculate the cabin air. M Commuter Trains CATF researchers observed that when a diesel locomotive pulls its passenger cars, the plume of diesel exhaust from the engine blows down onto the cars following the locomotive and invades the coaches. Pollution levels in these pulled coaches increased during the course of the commutes. When a train is pushed, however, the diesel exhaust plume trails behind the locomotive and does not invade the coaches. The difference measured between the levels in a pulled versus a pushed train demonstrates the amount of in -coach pollution attributable to the diesel locomotive's engine. Mea- sured ultrafne particle levels in the coaches of a pulled train were four times higher than the pushed train and as much as 17 times greater than the outdoor air. Regardless of whether the coaches were pulled or pushed, pollutant levels in the coaches skyrocketed when the trains arrived at an under - ground station. CATF documented diesel exhaust penetrating into the cabins of commuter trains through the open doors at the platform when the diesel locomotives entered underground rail stations in Boston. When pulled bya locomotive (left), pollution from the engine invades the coaches behind. When the train is pushed, the pollution plume trails behind leaving in -coach levels low (right). The plume of dieselexhaustfrom the engine invades the coaches. Policy Recommendations The good news is that affordable technology is available today that can virtually eliminate commuter exposure to diesel particles on the road. The Diesel Particulate Filter (DPF) can reduce tailpipe emissions of these particles by up to 90 percent. EPA rules for new engines now mandate emissions consistent with this technology and the cleaner fuel it requires. These filters also work on the vast majority of existing diesel vehicles. CATF's study documented that particle concentrations did not increase above outdoor levels in cars following trucks and buses retroftted with DPFs. In the interior of transit buses retrofitted with a DPF, passenger exposure from the bus exhaust was virtually eliminated. The following policies will be necessary for all Americans to enjoy a cleaner commute: m State and local governments should clean up public fleets and fleets doing public work. States and local governments should take steps to clean up existing transit bus, school bus, garbage truck, and other public fleets. States should follow the lead of California, which is implementing a comprehensive diesel cleanup program, and New York, which recently required all state-owned or contracted fleets to use best available emission controls. e States should create diesel cleanup funds. States should follow the lead of California (Carl Moyer) and Texas (Texas Emission Reduction Plan orTERP) in creating publicly -funded programs to provide the money necessary to retrofit existing dirty diesel fleets. n Congress should fully fund federal diesel cleanup programs and states should use the money for diesel retrofits. The 2005 Transporta- tion Bill (SAFETEA-LU) included $8.6 billion for Congestion Mitigation and Air Quality (CMAQ) projects. Congress gave priority to funding diesel retrofits because of their cost-effectiveness. It is up to local metropolitan planning organizations and state departments of transportation to award CMAQ monies for diesel retrofits. To date, only a few such projects have been funded at the state and metropolitan government level. In addition, 0 in 2005, Congress passed the Diesel Emission Reduction Act (DEKA) authorizing up to 200 million dollars a year over fve years to pay for the cost of diesel retrofts. To date, however, Congress has failed to appropriate the money. To clear the air and create a healthier ride for hundreds of millions of commuters stuck in traffic with dirty diesels, Congress should fully fund DERA and state and local governments should prioritize awarding money to diesel retroft projects. U.S. EPA should adopt an engine rebuild rule requiring long-haul trucks to upgrade their emission controls whenever their engines are rebuilt. Long-haul truck engines are typically driven for up to a million miles before they are replaced. Most of these engines are rebuilt several times during their useful lives. They emit the lion's share of diesel pollution that affects commuters on highways. Because these interstate trucks cross state borders, cleaning them up will likely require a federal solution. EPA should use it's authority under the Clean Air Act to require that their owners install best available controls whenever these engines are rebuilt. n U.S. EPA should finalize its new engine rules for ferries and locomotives. U.S. EPA in the next year plans to issue a emission standards for new marine vessels and loco- motives. Overtime this will mean significant im- provement in emissions from these sources. In i the near term, it should help demonstrate the viability and lower the cost of emission control solutions for existing ferries and loco- motives. Why We Care: Health Consequences of Breathing Diesel Exhaust While the link between lung cancer and a lifetime of breathing diesel fumes has been known for years, recent research links the particulate components of diesel exhaust to cardiovascular and respiratory harms over much shorter time frames, such as a single day. The following is a summary of selected findings: Years of Breathing Diesel Particles May Lead to... o Lung Cancer. Diesel exhaust is a probable carcinogen based on occupational health studies of truckers and railroad workers.' Diesel particulate matter is recognized as such by U.S. EPA, the State of California and the International Agency for Research on Cancer(IARC)234 Gaseous and particulate compounds found in diesel exhaust, such as polycyclic aromatic hydrocarbons and formaldehyde, are also carcinogens. e Cardiovascular death. Two of the largest long term air pollution studies ever conducted (one tracking one million people in 150 cities over 16 years) found a strong association between exposure to fine particles—a major component of diesel exhaust—with an elevated risk of premature cardiac death.' A four-year study of 65,000 women in 36 cities found that those living in cities with higher levels of particle pollution are at greater risk of death from cardiovascular causes. The risk variec within cities suggesting the importance of localized pollution sources.b' e Stroke. Diesel exhaust particles may increase the risk of stroke' a Asthma, respiratory infections and allergic symptoms. Multiple studies link diesel particles to asthma and allergic sensitization910 An East Bronx, New York, study suggests children exposed to higher levels of truck exhaust have higher incidences of asthma" In a California study, asthma and bronchitis were found to be seven percent higher among children attending school in high -traffic areas,compared with a neighbor- hood with quieter streets.12 o Reduced lung function growth. In a cohort of 3677 children tracked for 8 years,those living within 500 meters of a California freeway had deficits in lung volume growth, 1314 o Slowed fetal growth as a result of maternal exposure during pregnancy.15 e Infant mortality.16 a DNA damage.18 A Day of Breathing Diesel Particles May Lead to.... a Asthma symptoms and asthma attacks in children.' 1,1121 a Increased susceptibility to allergy.'z.23 ■ Premature death, based on a 90 -city study associating daily particle exposures with prema- ture death.24 e Increased circulatory and cardiovascular risk for diabetics based on 24 hour exposures to particles.2' o Nervous system impairment based on a study of railroad workers exposed to diesel exhaust, which concluded:"crews may be unable to operate trains safely."" a Increased allergies, with increased sensitization caused by diesel exhaust exposures." a Infant mortality." A Few Hours of Breathing Diesel Particles May Lead to... e Irritation of nose and eyes, respiratory/lung function changes, cough, headache, fatigue and nausea. e Pulmonary inflammation found after one hour of exposure to diesel exhaust" e Increased risk of pulmonary inflammation to asthmatics after two hours of exposure" e Adverse cardiovascular effects. Changes in heart rate variability, heartbeat and blood indices were recorded in North Carolina Highway troopers exposed to elevated in -vehicle particulate matter during midnight to 9 AM shifts." a Doubled risk of death due to stroke. Risk increased by a factor greater than two within two hours of exposure to high levels of fine particles in a Japanese study." Suppressed defense mechanisms and in- creased susceptibility to lung bacterial infec- tion for a week after exposure. Rats exposed to diesel exhaust for four hours per day for five days experienced prolonged growth of bacteria in the lung during exposure" Findings Exposure to Fine Particles has Deadly Consequences Particulate matter is a potent pollutant. In fact, medical researchers believe that fine particulate matter pollution in the air is responsible for at least 70,000 deaths a year 11,11 Two analyses by Abt Associates for the Clean Air Task Force, following EPA Science Advisory Board -approved methodologies, have estimated that approximately 45,000 American lives are lost prematurely each year from exposure to particulate matter pollution from two sources of particles -21,000 from diesel engines and 24,000 from power plants.36 This is roughly equivalent to the 44,000 motor vehicle deaths per year in the U.S. each year." For the average risk from diesel pollution in your community go to the CATF website at: www.catfus/ projects/diesel/dieselhealth/. Our study suggests that your exposure may be considerably higher if you commute. Our Daily Commute: Over Half of Our Exposure to Diesel Particles Studies throughout the world show that people who live or work around diesel engines are at highest risk.38 But what about the rest of us? Exposure studies, including this study, suggest that commuters on busy roadways, on diesel transit buses, and on commuter trains receive above-average exposures to fine Commute Outdoom 6% 4%, �i—T OEFHHome work 55% 35% particles. Studies by California Air Resources Board (CARB) researchers estimate that during the relatively small part of the day when we are in our vehicles, we experience over halfof our exposures to ultrafine particles and black carbon.'"c", Home 75% Commute 55% PercentofDaily Exposure to Harmful Particles 8% (SOURCE: CARB) CATF researchers wanted to determine whether the California studies are applicable to other areas of the country. We chose Columbus, Ohio, whose particulate air pollution is commonly thought to come largely from coal-fired power plants. CATF completed I approximately two dozen runs and ten commuter "profiles" investigating particle exposures at home, in traffic, and at work, to estimate the relative proportion of ultra - fine particles experienced during different times of a commuter's day. The researchers found that, as in California, Columbus commut- ers experience the majority of their exposures to particles during their trips to and from work. Cars Columbus, Ohio Commute 4% or � 8g% Home 58 A Austin Boston Columbus 25,0130 1 t3 Average PercentofDay Commuting 7Commute 55% Percent of Daily Exposure to Harmful Particles t❑ 20,000 q Peak E M Outdoors a c 15,000 n 'w x W x 10,000- 5,000- 0 0,000 5 0000 r7a Austin Boston Columbus Austin Boston Columbus Austin Boston Columbus Car commute exposures for the four primary diesel pollutants were sim ilarly high across the three cities where we conducted car tests. 6ars representforall runs the average and peak pollution levels inside the carcompared to outdoorlevels. (Pollutantexposure data was normalized bysubtracting daily ambient background concentrations.) 60 Case Study: Austin, Texas zs,M In Austin,Texas, CATF investigated simultan- eous commuter exposures during commutes 2019a0 on Interstate 35 and on the MOPAC express- � cmomuang m 1.35 way between Austin and Roundrock,Texas, the `0 15'0°O home of Dell Computer. I-35 is a truck route iu °DO, while MOPAC prohibits heavy trucks, thereby providing a no-truck"control"for our study. All 2 a,doa ovwntarn!wean air diesel pollutants were significantly higher on 1-35 than on MOPAC, even when the two routes 9'1Q s:ao 9:2 D 9:40 MID 11MID nmta tato were comparably congested, and were many times nrne higher than levels measured in downtown Austin. r 199 1 " r 61zII 11 0 a 1749 4749 iCantWalTlar In -cabin fine particle exposures are much higherforcommuters along routes with diesel trucks. The MOPAC highway (right) a no-truckalternative to I-35 (left) in Austin, Texas, had lowerdiesel pollution levels. Case Study: Boston, Massachusetts CAN investigated car commutes from the southern suburbs to downtown Boston and back along one of the busiest commuter routes in the northeast: the Southeast Expressway (1-93). Inbound morning commutes typically included heavy truck traffic, leading to elevated levels of all the measured pollut- ants. Some outbound evening commutes involved little or no truck traffic, providing a reasonable no - truck "control" for comparison purposes. CATE found pollutant levels during the car commutes in the presence of trucks were four times greater than dur- ing the commutes without trucks. Above left. -inbound traffic with trucks results in high diesel ultraline particle exposures.Above right. traffic without trucks means commuting without particle pollution.To view videos, go to www.catfus/goto/noescape/ IN Case study: Columbus, Ohio CATF investigated car commutes in Columbus, Ohio, and recorded levels typically three times higher than at a monitoring site located in a downtown area. The level of pollution measured in the commuter car corresponded directly to the presence or absence of trucks in the roadway around the monitoring vehicle. CATF found that particle exposures were minimally higher than levels in the outdoor air when there were no trucks on the road. Truck -filled roads were found to result in much higher particle exposures. In Columbus, Ohio, CATFfound that particle exposures were lower when there were no trucks on the road (right). Truck -filled roads resulted in higherexposures (left). To view videos, go to www.catfus/gota/noescape/ Diesel Particle Filter: The 90 Percent Solution Starting this year, because of new EPA regulations, new diesel trucks will be sold with a diesel particulate filter (DPF) that achieves a 90 percent -plus reduction in diesel particles. Cleaner, ultra-low sulfur diesel fuel is now available nationwide to help these cleaner engines stay that way. However, the EPA rules do not regulate the emissions from the 13 million diesel engines in use today. Nevertheless, most of these vehicles can take a diesel particle filter and achieve a comparable 90 percent level of reduction. These filters work. Our researchers detected minimal diesel pollu- tants following a truck retrofitted with a DPF DPFs can be installed on most trucks built since 1994. Y Ma. s6 T"16 cs:s Solutions that work. CAM installation ofa diesel particle filteron a box truckdramaticallyreduced fine particles (PM,.,) near the tailpipe from 5,000 pg/m' to 25µg/m3. Asa result fine particles from the truckbarely registered in the carfollowing behind. To view videos,go to www.catf us/goto/noescaae/ The combination of Diesel Particulate Filters (DPFs) and Ultra-LowSulfur Diesel (ULSD) can achieve a 90% reduction in diesel particles. Because CATF's investigation demonstrated that the level of pollution exposure in the cabin of a com- muter car is a function of the presence of diesel truck traffic,we wanted to test the difference in cabin exposure for commuters following a conventional truck vs.the same truck retroftted with a diesel particle filter. Our monitoring car followed behind the conven- Transit Buses CATF investigated particle levels inside transit buses in Boston and following buses in Boston and New York City. In CATF's earlier school bus studies, we found that diesel exhaust from the bus tailpipe infiltrated the bus cabins, thus elevating on -board pollution levels. See www.catf.us/publications/view/82. CATF's results in the present study suggest that this same effect occurs in transit buses. However, inside buses that had Above: Honeycomb particle trap from DPFon box truck Leff Installation ofa DPFsimply requires replacementofmuffler and tailpipe. tional truck and measured the elevated levels of diesel particles in the car's cabin. We then had a diesel particle filter installed on the same truck:. When following the newly retrofitted truck, the investigators found minimal Increases in diesel fine particles in the cabin of the chase vehicle. The particle filter virtually eliminated the exposure to diesel particles from the truck for the commuter car following behind. been retrofitted with DPFs, particle levels were sub- stantially lower. Case Study: Boston, Massachusetts In Boston, CATF researchers boarded conventional buses as well as those retrofitted with particulate filters and measured in -cabin diesel particle Ievels.The Metropolitan Boston Transit Authority has replaced or Lek: Pollution from a conventional bus infiltrates the cabin exposing passengers to elevated levels. Right.Diesel ultrarine particle pollution from the bus is undetectable in the cabin ofa bus with a DPF. 12 retrofitted the vast majority of its bus fleet. Levels on the remaining conventional buses were on average four times higher than outdoors, whereas the Case Study: New York City In the past few years, New York City has retrofitted or replaced with lower -emitting diesel-electric hybrid buses the vast majority of its fleet. To test the benefits of these improvements relative to the conventional buses still on the street, CATF investigators followed particle levels on the new and retrofitted buses were substantially lower and sometimes even below outdoor levels, resulting in a cleaner, healthier ride. buses in a commuter car outfitted with monitoring equipment. The investigators found high diesel exhaust levels behind conventional buses while levels behind buses with DPFs were barely detectable. Left. Exhaust from a conventional NewYork City transit bus infiltrates a car following behind. Right: Ultrafine particle levels behind a bus equipped with a dieselparticulate filterare virtually eliminated. To view videos go to www.catfus/ooto/noescape/ Commuter Trains CATF investigators monitored pollutant levels inside passenger trains in Boston and New York City. Results suggest surprisingly high exposures to diesel exhaust in the passenger compartment, especially with the locomotive pulling the train. While trains with emis- sions control equipment were unavailable to test against conventional diesel trains, we nevertheless were able to conduct a "controlled" experiment, Many commuter trains are so-called 'push-pull" trains. That is,the locomotive pulls the train in one direction to the end of its com- muter run, e.g., inbound, and then pushes the train back to the other end of the line, e.g., outbound. CATF researchers observ- ed that when a diesel locomotive pulls its passenger cars,the plume of diesel exhaust from the engine blows down onto the cars following the locomotive and invades the coaches. Pollution levels in the coach typically increased during the course of the commutes in a pulled train. However, on a train pushed by the diesel locomotive such that the exhaust plume was left behind, particle levels remained low. Even in trains being pushed by a locomotive, investigators found pollution levels spiked in the passenger cars when the doors opened at an underground station platform with inadequate ventilation in Boston. 13 t Case Study: Boston, Massachusetts In Boston, CATF investigators rode commuter trains inbound and outbound to study the relative pollution levels on board a "push"versus a "pull"train. Levels in the coaches of the trains being pulled by a diesel locomotive were many times higher than those when the train was being pushed. In -coach levels ofultratme diesel particles in this test were 10-100 times higherin coaches being pulled bya locomotive (left) than in coaches being pushed (right). Case Study: New York City As in B elevate City-ar( by a to in train In N mot diffi leve beh 'pu, 500;000 400,000 ee u 300.000 200;000 c r 100,000 7 � 0 i0 0 10 20 30 00 so fi0 Mill Utes ® Pedestrians —Boeton—CplunIXla Commuting via Ferry A relatively few commuters travel to work on a passen- ger ferry, but if they think they are getting fresh air, they may be wrong. Time Extreme PM,,,exposures on Boston harbor ferry. Exhaustsmoke eddies behind the boat and enters through the rear door. 15 Motor Vehicle and Rail Tunnels It may come as no surprise that air quality in vehicular and rail, tunnels is exceptionally poor. A variety of tunnel studies have been undertaken in California. One study documented black carbon levels up to 50 times as high as in the already polluted outdoor air, especially in the presence of Extreme change in particlelevels entering and leaving Boston's Big Dig (O'Neill) Tunnel Summary of Results Peak and average levels below indicate how many times greater CATF researchers found the pollution numerous trucks in the tunnel. Where one tunnel bore allows trucks and another does not, heavy- duty trucks were responsible for 93 percent of the black carbon emissions in the truck -influenced bore 41 CATF's investigation confirms extreme exposures in tunnels. Extreme particle levels in Boston's Back Bay train station levels were in commuter vehicles compared to the levels in the outdoor air. POLLUTANT Tru—ns Peak Avera a Oruns Peak Avera a &runs Peak Avera a Bruns Peaveracie LCAR Austin 1-35 15 8 1.4 _ 15 35 4 4 - 22 3 15 33 7 Boston 1-93 15 14 1.7 15 38 4 6 50 9 14 35 6 Columbus 1-71 31 5 1.0 34 19 4 17 14 4 25 12 5 All -city Mean 9 1.4 30 4 32 5 27 6 BUS_.._e.. Boston _.._..._. _....�-..-� Conventional 5 _..�-__ 11 ___.. 2.4 -. __.�_.._��..�_�..�.._.�.._..�...�....�� 5 11 4 1 12 Na n/a n/a 22 DPF 9 14 3.4 5 3 1 6 30 7 4 7 3 TRAIN Boston Push 6 U7 3.6 6 44 4 I 4 22 fi 4 54 4 Pull 6 45 3.2 6 60 17 5 69 15 4 45 17 New York Push 2 28 1.0 2 19 5 2 11 2 n/a n/a n/a Pull 3 29 1.7 3 49 15 3 12 3 n/a Na n/a 2 FERRY Boston 2 14 2.6 3 21 3 2 117 __ 17 _ __ 1 50 6 [PEDESTRIAN_ Boston 6 12 1.5 5 19 2 1 43 8 1 15 2 Columbus 3 16 1.4 3 29 3 1 34 2 n/a n/a n/a CATF's commuterstudy results suggest thatbreathing particles while commuting resulted in exposures that are many timesgreaterthan breathing air pollution in the outdoorair—no matter the mode ofcommute. 16 How the Studies Were Done Representative cities were selected for investigating commuter exposure to diesel exhaust (Austin,TX; Boston, MA, Columbus, CH and New York City) using methodologies developed at major universities. Four key constituents of diesel exhaust were tracked with continuous monitors: fne particles (PM,,),ultrafine particles (PM<0.1), black carbon, and particulate polycyclic aromatic hydrocarbons (PAHs). Because CATF's monitoring suggests ultrafine particles may be the best marker of fresh diesel ex- haust across all modes of transit, those results are highlighted in this report. Graphics were selected to illustrate key findings. Pollutant ex - results from "windows open" runs are reported here. a Transit Buses: Researchers boarded buses in Boston and Columbus using monitors housed in backpacks and roll -around bags. posure data was normalized by j subtracting daily ambient back- „6= ground concentrations. For in-depth results and methodological details see companion white paper at , www.catf.us/goto/noescape/. _M e Car Commutes: In Boston, Austin and Columbus typical commute routes were run in a 2006 minivan equipped with four monitors for a total of 107 runs over 79 hours. CATF investigated the effects of window position, air conditioning, and recirculation of cabin air. The Adashboard-mounteddigital video camera inside the chase carallowed researchers to film the driver's -eye -view behind the diesel vehicles while monitoring instruments recorded pollution levels inside the car. To view videos, go to www catf us/cioto/noescave/ Above CATFresearchersetting up particle monitoring equipment to monitorboth cabin and outdoorairsimultaneously with twosetsofequipment. Left: Monitoring equipmentin a roll - around suitcase was used forrecording pollution levels in buses, trains and ferries. e Commuter Rail: Researchers boarded trains in Boston and New York City with monitors housed in backpacks and roll -around bags for inbound (locomotive push) and outbound (locomotive pull) runs. a Ferries: Researchers boarded Boston commuter ferries with monitors housed in a backpack. o Walking Commutes: With monitors in backpacks, researchers walked from residential to commercial areas in Boston and Columbus. a Chase Studies: CATF monitored comparative particle levels behind conventional and DPF retro- fit buses in New York City and Boston and behind garbage trucks in New York City. As a controlled experiment,CATF retrofitted a Class -5 box truck with a DPF, testing air behind the truck before and after. 17 Previous Commuter Exposure Studies Previously published, peer-reviewed studies firmly establish that we can be exposed to high levels of diesel pollution when we are commuting. Numerous exposure studies confirm that diesel pollutants are concentrated in areas of high traffic. Methods have been developed to quantify commuter pollutant ex- posures in a variety of cities around the world. CATF researchers employed similar instruments and protocols to those used in these previous studies: a A 2003 California study points to commuting as the principal route of human diesel exposure accounting for up to one half of total exposure 41 The ultrafine particle concentrations in California vehicles were seven times higher than the national average. Exposure levels on Los Angeles freeways were similar to the findings of the CATF study.44 a In a Los Angeles study, elevated exposures were recorded within 100 meters of a freeway (about the length of one large -city block) beyond which they fell rapidly.a5 e A London study investigated ultrafne particle exposures while commuting on foot, by bicycle, in a car, in buses, and by taxi in London m As in the CATF study, the researchers documented elevated exposures in every mode of transit. Exposures in taxicabs were the highest. Personal exposures on sidewalks were multiple times higher than fixed urban background monitoring sites .41 ■ A 2004 study by researchers at the Northeast States for Coordinated Air Use Management of Boston diesel commuter rail exposures document- ed high levels of black carbon particles in passen- ger coaches and at train station S.41 ■ In Amsterdam, black carbon levels increased near highways by a factor of three times over more distant area S41 s Elevated black carbon exposures on Harlem, New York, sidewalks are associated with increased truck and bus counts 50 Exposures increased near a bus depot 51 Researchers concluded that adolescents in Harlem are exposed to elevated levels of diesel exhaust. e A personal exposure study in Mexico City found elevated fine particle exposures in a variety of microenvironments, including people riding in cars and using public transportation 52 London Taxi Study You might think riding in a taxi would expose you to less air pollution than you would get walking down a city sidewalk, but that does not seem to be the case. Researchers at Imperial College, London, walked, biked, drove,and rode buses or taxis up and down streets in central London. Surprisingly, riding in a taxi resulted in the worst exposure—nearly twice as much as walking. The suggested explanation: taxis tend to get stuck in traffic surrounded by other pollution -belching vehicles. CATF used a similar methodology to the published, peer- reviewed techniques used in the London study to conduct its commuter study. Health Effects of Diesel Exhaust Diesel exhaust is unhealthy to breathe. The scientifc community has been aware of the adverse health effects of breathing diesel pollution for decades. Diesel exhaust is a toxic combination of carbon, sulfur and nitrogen particulate matter compounds and related gases created from combustion of diesel fuel and burnt lubricating oil commonly containing minute metallic particles from the engine. Research, based on occupational studies conducted in the U.S. and Canada, has linked diesel exhaust exposure to cancer. 13 Recent investigations of health damages resulting from exposure to pollutants found in diesel exhaust include long-term, short term and laboratory studies. But commuters are not the only people exposed to diesel exhaust—we all breathe it every day whenever we are near diesel vehicles whether we drive on a country road or a city street. We are surrounded by 13 million diesel engines—workhorses that power tractor -trailer trucks, transit and school buses, trains, ferries, and construction and agricultural equipment. Particulate matter may be the most carcinogenic and harmful component in diesel exhaust.The Inter- national Agency for Research on Cancer (IARC) states that there is sufficient animal experimental evidence to establish the carcino- genicity of diesel engine exhaust particles, but inadequate evidence for the carcinogenicity of gas - phase diesel engine exhaust 54 Nevertheless, coronary artery constriction has been docu- mented in animal studies resulting from exposure to these gas -phase diesel compounds" Diesel particles are not only toxic, they also make up the tiniest fraction of com- bustion particles. In general, diesels emit two sizes of particles—fine particles, less than two and one-half microns (a millionth of meter) in diameter, and ulrraBne particles, less than a tenth of a micron. Under U.S. law, the Environmental Protection Agency has set daily and annual health standards for fine particles (35 µg/m3 and 15 µg/m3 respectively). Health standards have not yet been established for ultrafine particles, but recent health research suggests that their ex- tremely small size may allow them to pass easily into the bloodstream where they can cause oxidative stress and inflammation leading to cardiovascular disease symptoms.56 These particles are, at their core, commonly made up of black carbon. This core often is coated in toxic substances such as particulate polycyclic aromatic hydrocarbons (PAHs), a probable carcinogen, and metals from engine wear. The U.S. Environmental Protection Agency's most recent National Air Toxics Assessment estimated that the average concentration of diesel particles in the air in the U.S. is about 1.2 µg/m3, much lower than CATF found in commuter vehicles=' Using the cancer Proximity to Traffic is Associated with Adverse Health Risk Traffic studies have consistently and overwhelmingly defined an adverse relationship between proximity to highly trafficked areas and a variety of illnesses. Epidemiological studies generally suggest that living within approximately 50-100 meters of a busy road potency factor developed by the California Air Resources Board (CARB), this translates to about 363 lung cancers per million,well above EPA's acceptable level of one cancer per million. Moreover,the cancer risk from diesel exhaust in the U.S. exceeds the combined total of all the other 132 air toxics tracked by EPA.58 However, in many areas, diesel particles may be even more concentrated in 'hot spots'such as areas of congested traffic, heavy machinery use, or construction. may result in mild to acute respiratory symptoms. A New York City study underway links asthma to truck traffic 59 An assessment of the health impacts of traffic - related air pollution estimated approximately 40,000 premature deaths annually in Austria, France and 19 Switzerland, a whopping six percent of total mortality.60 Importantly, studies find that the volume of truck traffic is most strongly related to health risks rather than car volume fi1 61,63 These studies comport with our findings that particle levels on freeways are directly associated with volume of truck traffic. Medical studies have linked proximity to traffic to: e Heart attacks (myocardial infarction).' 65,66 A study of 700 heart attack survivors shows that they were most likely to have been in heavy traffic the hour before they suffered the heart attack than any other hour of the day. ■ Increased risk of mortality.61 ■ Reduced lung function growth. In a cohort of 3677 children tracked for 8 years, those living within 500 meters of a California freeway had deficits in lung volume growth .� a Heart rate variability changes. A study of North Carolina highway patrolmen found particle concentrations were linked to heart rate variability changes and irregular heartbeats."" o Chronic respiratory symptoms in children and adults such as cough, persistent wheeze and bronchitis." 12, 73, 74, 75, 76 e Asthma in children, with larger effects in girls, and children's hospital admissions for asthma. 77 79,79.80 e School absences a' e Aging effect ("mortality rate advancement"), similar in magnitude to chronic respiratory and pulmonary diseases and diabetes." State Trooper Exposure Study In a 2004 study, University of North Carolina research- ers tracked particle exposures and cardiac response in young (ages 23-30), healthy and physically fit highway patrolmen on their daily shift. Using the same or similar monitoring devices as used by CATF research- ers, particulate matter concentrations—well within the same ranges as CATF observed in the present study—were linked to significant changes in heart rate variability, irregular heartbeats, and increases in blood inflammatory markers within hours of exposure. Recommendations: Today's Technology Can Mean Cleaner Commutes Now Tackling this serious public health problem now—for the health of this generation of Americans—depends on aggressive efforts to retrofit existing engines rather than waiting decades for cleaner new engines to replace the older dirty ones. While EPA's new engine rules will mean huge air quality improvements over time, a child born today will be 23 years old by the time those rules are fully effective. The emissions control technology required for new engines starting this year is available, affordable, and proven to reduce PLO pollution significantly from most of the vehicles on the road today. In order to improve our health, and that of our children, millions of older engines still in use must be retrofitted using the same technology as required for today's new engines. Retrofitting buses and trucks to reduce diesel particles by up to 90 percent can be as simple as replacing the muffler with a diesel particulate filter (DPF). In fact, the vast majority of highway diesel engines built since 1994 can be retrofit with a DPF. With the availability now nationwide of ultra-low sulfur diesel (ULSD) fuel, there is no obstacle remain- ing to cleaning up today's diesel Fleet. a State and local governments should clean up public fleets and fleets doing public work. The State of New York recently required that every state-owned diesel vehicle and every vehicle used by firms that contract with the State use best available control technology on these vehicles. Cities such as Seattle, Washington, D.C., New York, and Boston have taken a lead, retrofitting much of their transit bus fleets with diesel particulate filters. Several cities, New York Boston and Seattle operate large fleets ofnewor retrofitted diesel particulate filter -equipped transit buses. The New York 0tygarbage truckon the left leaves a diesel exhaust plume behind, in comparison to the truck on the right thathas been retrofitted with a diesel particulate filter which leaves no measurable plume in its wake. The investment New York has made in DPFs means healthierairqualityin and along- side the roadwayand in adjacentneighborhoods. To view videos, go to www.catf us/goto/noescap including Chattanooga, Tennessee, have been replacing their older buses with new diesel-electric hybrid or compressed natural gas buses. New York City has also retrofitted most of its fleet of sanitation trucks. Other cities are experimenting with other emissions controls strategies, such as the use of biodiesel fuel in Columbus, Ohio. a States should create diesel cleanup funds. The current cost of retrofitting a highway diesel engine with a diesel particulate filter averages between $5000-7000 per vehicle. It is likely that EPA's new engine rules will result in better economies of scale for the manufacture of diesel particulate filters and thus reduce their cost. States must step up to the plate to provide diesel retrofit funding. States can follow the lead of California (Carl Moyer $140 million per year) and Texas (Texas Emission Reduction Plan or TERP $120 million per year) in creating publicly funded programs to provide the money necessary to retrofit existing dirty diesel fleets. a Congress should fully fund federal diesel cleanup programs and states should use the money for diesel retrofits. In 2005, as part of the Energy Bill, Congress passed the Diesel Emission Reduction Act (DERA) authorizing up to $200 million a year for five years to pay for the cost of diesel retrofits. To date, however, Congress has failed to appropriate the money. To clear the air and create a healthier ride for hundreds of millions of commuters stuck in traffic with dirty diesels, Congress should fully fund DERA and state and local govern- ments should prioritize awarding federal money to diesel retrofit projects. 21 In addition, the 2005 Transportation Bill (SAFEfFA- LU) included $8.6 billion for congestion mitigation and air quality (CMAQ) projects. Congress gave priority to funding diesel retrofits because of their cost-effective- ness. The Federal Highway Administration should recognize this priority in its CMAQ guidance and urge states to target CMAQ funds to diesel retrofits. Ultimately though, it is up to local metropolitan planning organizations and state departments of transportation to award CMAQ monies for diesel retrofits. To date, only a few such projects have been funded. u U.S. EPA should adopt an engine rebuild rule requiring long-haul trucks to upgrade their emission controls whenever their engines are rebuilt. Particularly key to healthier commutes will be regula- tions to clean up interstate long-haul trucks that travel city -to -city and state -to -state. A vast majority of retroft funding to date has been focused on public fleets such as garbage collection, transit buses and even school buses in part because the source of the funding has been public. Long-haul trucks, however, consume the vast majority of the on -road diesel fuel sold every year and as a result represent most of the diesel pollution annually. They are typically corpo- rately or privately owned. U.S. EPA has the authority under the Clean Air Act to require that trucks upgrade their pollution controls whenever they rebuild their engines. EPA should exercise this authority and require that existing engines meet today's emission standards. 22 e U.S. EPA should finalize its new engine rules for ferries and locomotives. Retrofitting non -road vehicles is also an important part of the solution. Technologies to clean up loco- motives and ferries are still largely under development with the most recent progress being the successful proof of concept for implementing oxidation catalyst technology on two-stroke diesel engines. For locomo- tive and ferry engines, the best practice first includes rebuilding with new internal components or repower- ing with the newer Tier 2 engines, followed by retro- fitting with diesel emission control technology such as an oxidation catalyst. FPA should issue the new Tier 3 and Tier 4 standards in late 2007 and these new technology -forcing standards are expected to drive the implementation of diesel particulate filter (DPF) technology for these applications. This is substantially similar to the technology pathway on -road and off- road diesel engines have followed, but the timelines for rail and marine have lagged behind these other sectors. These emission control technologies also need ultra-low sulfur diesel (ULSD) fuel to perform at their best. For ferries and locomotives this fuel will not be required until 2012. Until then, the results of the CATF study suggest the need to improve coach ventilation systems on trains, have locomotives push passenger trains to the maximum extent feasible, and ban the use of diesel in underground stations and tunnels. Overall, the best solution to the problem of commuter exposure to diesel exhaust is to clean up the existing diesel fleet with diesel particle flters so that we can all breathe easier. Until then, commuters can help protect themselves by taking clean transit, such as electrified subways and light rail. If you must drive to work,choose commuter routes that are less heavily traveled by trucks. To reduce your exposure when in traffic, our study suggests that you should close your windows and set your ventilation system to recirculate the cabin air. Installing a catalyzed diesel particulate filter (DPF) is nearlyas simple as replacing the muffle[ DPFs are extremely effective and remove over 90 percent ofdiesel exhaustparticles.These filters can typically be installed on 7994 and newer vehicles that have electronic engine systems. Endnotes 1 Upsett,M., Cam pleman, S.,(1999). Occupationa l exposure to diesel exhaust and lung cancer: a meta-analysis. American Journal of Public Health v. 89, no 7, p. 1009 1017, 2 EPA, Health Assessment Document for Diesel Exhaust: Office of Research and Development, EPA/600/8-90 057F May 2002.P.9-14; 3 California Air Resources Board (1998): Resolution 98-35— Identification of diesel exhaust as a toxic air contam- inant. Go to: htto://www.arb.ca.gov/regact/diesltac diesltachtm 4 International Agency on Cancer, Monograph 46. See at: hSto�//monographs.iarc.fr/ENG/Monographs/ vol46volume46.odf. 5 See, e.g., Pope, C.A., Thun, M.J., Namboordiri, M.M. and Dockery, D.W., et al.; Particulate Air Pollution as a Predictor of Mortality in a Prospective Study of U.S. Adults. 151 American Journal of Respiratory and Critical Care Medicine (1995). Available online at httoWajrccm. atsiournals.org/search.shtm I. Krewski, D., Burnett, R.T., Goldberg, M.S., Hoover, K., Siemiatycki, J., Jerrett, M., Abrahamowia, A. and White, W.H., Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Matter and Mortality; Special Report to the Health Effects Institute, Cambridge, MA (July 2000). 6 Miller, K.,SiscovikD.,Sheppard, L., Shepherd, K., Sullivan, J., Anderson,G.and Kaufmanj(2007). Long-term exposure to air pollution and incidence of cardiovascular events in women. New England Journal of Medicine, v. 356, No.5,p.447-458, February 1, 2007. 7 Dockery, D., and Stone, P. (2007) Cardiovascular risks from fine particulate air pollution. Editorial, New England Journal of Medicine,v.356, no 5, p.511-513, February 1, 2007. 8 Nemmar,A.,Hoet,P.,Dinsdale,D.,Vermylen,J.,Hoylaerts,M., and Nemery, B., Diesel Exhaust Particles in Lung Acutely Enhance Experimental Peripheral Thrombosis, Circulation. Vol. 107, (2003), pp.1202-1208. 9 Brown, J., and Frew, A. (2002). 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Association between air pollution and lung function growth in Southern California children. American Journal of Res- piratory and Critical Care Medicine,vol. 162,no.4,pp. 18. 14 Ga uderma n, J., Vora, H., McConnell, R., Berhane, K., Gil I i land, F., Thomas, D., Lurmann, F., Avol, E., Kunzli, N., Jerrett, M., and Peters,J. (2007). Effect of exposure to traffic on lung development from 10-18 years of age: a cohort study. The Lancet, Early Online Publication, 26 January 2007. 15 Dejmek, J, Selevan, S., Benes, I., Solansku, L, and Sram, R. (1999). Fetal growth and maternal exposure to particulate matter during pregnancy; Environmental Health Perspectives, v.107, no.6. 16 Woodruff, T., Grillo, J. and Schoendorf, K. 1997. The re- lationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environmental Health Perspectives, vol. 105, 608-612. 17 Kaiser, R., Romieu, I.,Medina, S., Schwartz, J., Krzyzanowski, M., and Kunzli, N. (2004). Air pollution attributable postneonatal Infant mortality in U.S.metropolitan areas: a risk assessment study. Environmental Health, A Global Access Science Source v.3, no.4. 18 Upadhyay, D., Panduri V., Chid A, Kamp DW. (2003) Particulate matter induces alveolar epithelial cell DNA damage and apoptosis: role of free radicals and the mitochondria. Am J Resoir Cell Mol Blol.2003 Aug; 29(2):180-7. Epub 2003 Feb 21. 19 Norris, G,YoungPong, S.,Koenig, J., Larson,T., Sheppard, L., and Stoutj (1999).An association between fine particles and asthma emergency department visits for children in Seattle. Environmental Health Perspectives, v. 107, no. 6. 20 Gielen, M., van der Zeee, S., Winjen, J., van Steen, C., and Brunkreef,8.(1997). Acute effects of summerair pollution on respiratory health of asthmatic children. American Journal of Respiratory and Critical Care Medicine,v.155, p. 2105-2108. 21 Yu, 0., Sheppard, L., Lumley, T., Koenig, J., and Shapiro, G. (2000). Effects of ambient air pollution on symptoms of asthma in Seattle -area children enrolled in the CAMP study. Environmental Health Perspectives, v.108, no. 12, p.1209-1214. 22 Finkelman, F, Yang, M., Orekhova, T., Clyne, E., Bernstein, Whitekus, M, Diaz -Sanchez, D.,and Morris, S. (2004) Diesel Exhaust Particles Suppress In Vivo IFN -y Production by Inhibiting Cytokine Effects on NK and NKTCells.Journal of Immunology. V.172, no. 6, p. 3803-3813. 23 Brown, J. and Frew, A. (2002) Diesel exhaust particles and respiratory allergy. Eur Respir Mon, 2002, 21,180-192. 24 See e.g,Samet,J.M.,Dominici,F.,Zeger,S.L.,Schwartz,J.and Dockery, D.W.; National Morbidity, Mortality and Air Pollution Study, Part II: Morbidity, Mortality and Air Pollution in the United States; Health Effects Institute Research Report No. 94, Cambridge MA (June 2000). Dockery, D.W., Pope, C.A., Xu, S. and Spengler, J.D., et al; An Association Between Air Pollution and Mortality in Six U.S. Cities; 329 New England 1. Medicine 1753-59 (1993). Available online at httol/neim.org/content/1993/0329 0024/1753.asp. 25 O'Neill, M., Veves,A., Zanobetti,A., Samar, J., Gold, D., Econ- omides, P., Horton, E., and Schwartz,J.(2005). Diabetes Enhances Vulnerability to Particulate Air Pollution - Associated Impairment in Vascular Reactivity and Endothelial Function. Circulation, Jun 2005; 111: 2913 -2920. 26 Kilburn, K.H. (2000). Effects of diesel exhaust on neurobehavioral and pulmonary functions. Archives of Environmental Health, v. 55, no. 1, p.11-17. 27 Sydborn, A., Blomberg, A.,Parnia,S.,Stenfors,N.,Sandstrom, T.,and Dahlen,S-E.(2001) Health effects ofdiesel exhaust 23 emissions. Eur. Respir.J.; 17:733-746. 28 Loomis, D, Castillejos, M., Gold, D., McDonnell, W. Borja- Aburto,V. 1999. Air pollution and infant mortality in Mexico City. Epidemiology, vol. 10, p.118-123. 29 Salvi,S.,Blomberg,A,RudeII, B., Kelly, ESandstrom,T, Holgate, S. and Frew, A. (1999). Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. American Jour. Resp. Crit. Care Medicine, v.159, 702-709. 30 Stenfors,N.,Nordenhdll,C., Salvi,S., Mudway,l., Soderberg, M., Blomberg,A., Helleday,R., Levin,J., Holgate,S., KeIIy, F, Frew, A., and Sandstrom, T. (2004). Different airway inflammatory responses in asthmatic and healthy humans exposed to diesel. Eur. Respir. J., Jan 2004; 23:82-86. 31 Riediker,M.,Cascia,W.,Griggs,T.,Herbst, M.mBromberg ,P., Neas, L., Williams, R., and Devlin, R. (2004). Particulate matterexposure in cars is associated with cardiovascular effects in healthy young men. American Journal of Respiratory and Critical Care Medicine,v. 1 69,p.934-940. 32 Yamazaki, S, Nitta, H.,Ono, M., Green, J., Fukuhara, S.(2006) Intracerebral hemmorrage associated with hourly concentration ofambient particulate mattercase-cross- over analysis. 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