Air Pollution and Public Health

in California

Wendy Ring MD, MPH

Agenda

California's air quality problemHealth effectsVulnerable populationsCalifornia research studiesLocal air quality issuesFuture trendsActions

Selma, CA

Real time Air Advisory Network App

State of the Air 2016

(American Lung Association, 2016)

654321

CALIFORNIA'S MAJOR AIR POLLUTANTS

TOXICBlack CarbonDiesel ParticulatesDioxinsAromatic Hydrocarbons

CRITERIAParticulatesOzoneNitrogen Oxides

MAJOR SOURCES

Motor vehiclesWood stovesWildfiresDustPower plantsOil Wells and refineriesAsia

HEALTH EFFECTS

Well established

Premature death

CVD

Asthma/COPD exacerbations

Impaired lung development

Cancer

Prematurity

Low Birth Weight

Significant morbidity and mortality

Statewide 7,000 CA CVD deaths/year (CARB, 2015)

10,000 hospital/ER visits and $60 million/year (Romley, 2010)

LA County1 in 10 deaths (EPA, 2015)

27,000 cases of childhood asthma (CARB)

11% of ER visits and 20% of hospitalizations for ped asthma (Brandt, 2014)

SUSPECTED HEALTH EFFECTS (evidence accumulating)

Neurotoxicity– Cognitive

• Alzheimers• Child Development

– Behavioral• ADD• Autism

Endocrine Disruption– Diabetes– Obesity

EPIDEMIOLOGY

Study DesignCohortCross Sectional Community

Measured Exposurepersonal air monitoringcommunity air monitoring

Markers for exposure:PAH adductsproximity to known source

USC Children's Health Study

STUDY FINDINGS

Exposure to air pollution increases:New onset asthma

Bronchitis symptoms

School absences from respiratory infections

Proportion of non asthmatics with subnormal lung development

Percent of cohort with reduced FEV1 decreasing over time

(Guaderman, 2015)

Children's Health and Air Pollution Study

StanfordUCSF FresnoUC Berkeley

Epigenetic effect of pollutants

Effect of PAH exposure on major mediator of T cell regulation

(Nadeau, 2010)

Fresno vs Palo Alto

(Nadeau, 2010)

(McConnell, 2014)

Near road pollution exposure and BMI at age 18

(Jarrett, 2010)

Columbia Center for Children's Environmental Health

Highest quintile of prenatal PAH exposure doubled risk of obesity at age 7

(Rundle, 2012)

Biomonitoring California PAH

(CDPH, OEHHA, 2016)

USC Child Obesity Research CenterStudy of Latino Adolescents at Risk of Type 2

Diabetes (SOLAR) study

Cohort of overweight and obese Latino teens

At age 18, interval exposure to PM2.5 and NOx linked to:

Increased BMI

Decreased insulin sensitivity

Decreased beta cell function

(Goran, 2017)

DIFFERENTIAL VULNERABILITY

DemographicFetusesChildrenElderlyWomenLow incomePeople of color

Health Status

Cardiovascular diseaseChronic lung diseaseDiabetes

(Ferrar, 2016)

Proximity

Topography

MARINE INVERSION

Wind DirectionEast Bay Children's Respiratory Health Study

(Kim, 2008)

Environmental JusticeCal Enviro Screen

(OEHA, 2015)

Local Air Quality Issues

Wildfire pm2.5

Wildfire contribution to ozone

Biomass from wood waste

TONS EMITTED PER YEAR

Local Biomass PGE natural gas

CO 2808 8NOx 472 15PM 2.5 95 1

EPA permitted emission rates (in lb/ MMBtu)

Local Biomass Coal (past decade) NOx 0.15 - 0.26 .088

CO 0.50 - 4.0 .144

PM 0.02 - 0.04 .017

(EPA and NCUAQMD)

TransPacific pollutant transport

TransPacific pollutant transport

(Hadley, 2007)

Ozone

(Zhang, 2008)

Serpentine soil and asbestos

(USGS, 2015)

Future Trends

But recent uptick due to climate change(Gauderman, 2015)

Air quality has improved dramatically

Temperature related increases in OZONE

(Fann, 2014)

Cal Adapt projected increase in burned area

Frequency of large fires has nearly doubled

Fire season is 2 months longer

Cal-adapt.org

Recommendations

Appreciate.

Anticipate.

Advocate.

HOW TO GET INVOLVED

Health Professionals for Clean AirDoctors for Climate Health jenny.bard@lung.org Climate 911 www.climate911.org

PSR www.psr.org