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Epidemiology and Air Pollution (1985) / Chapter Skim
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1 INTRODUCTION
Pages 21-36

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From page 21...
... Despite the absence of positive findings, Farr and his associates were inclined to believe that smoke in the ambient air was injurious to health. Current concerns about the role of epidemiology in the study of air pollution resemble theirs to a striking degree.
From page 22...
... Studies of the air pollution "disasters" in the Meuse Valley during December 1930, Donora in November 1948, and London in December 1952 established that sudden peaks of exposure to coal combustion products and industrial pollution, superimposed on persistently high relative levels of exposure, could cause excess deaths among persons in the community who suffered from chronic cardiorespiratory diseases.7 These epidemiologic demonstrations that air pollution can, at its worst, increase mortality due to respiratory diseases led to major clean air legislation in the United States and abroad. In the 1960s, new problems for study began to emerge as the concerns of researchers expanded from the gross effects of short-term peaks toward effects associated with long-term, low-dose exposures.
From page 23...
... In Farr's day, air pollution effects might have been masked by epidemics of infectious disease; today, the effects might be masked by the predominance of cigarette smoking as a cause of respiratory disease. The impact of ambient air pollutants on the total respiratory disease burden in the United States must be small relative to the
From page 24...
... Even if the proportion of COPD cases attributable to air pollution were low, the absolute amount of attributable disease would be high, in proportion to other public health problems. Chapter 2 presents some of the evidence that current air pollution can cause substantial health effects.
From page 25...
... This report discusses how this application further complicates the demands on epidemiology. In summary, the technical demands on epidemiologic studies of air pollution are greater than ever before.
From page 26...
... It affords a direct means of obtaining scientific information on the impact of actual air pollution on free-living human populations. Epidemiology can be distinguished from other forms of air pollution research by the special role it plays in the formulation and evaluation of preventive strategies.
From page 27...
... Utilizing at least 80 years of observation on the effects of London's killer fogs, health authorities chose to emphasize control of visible smoke from coal combustion before the specific agents responsible for illness could be identified.1 The choice was propitious, inasmuch as analyses have since shown that fine particles appear to have played a greater role in causing episodic excesses in mortality than SO2.9 This direct use of epidemiology to develop preventive measures, without reliance on knowledge of specific causal paths, must be kept in mind in evaluating the potential contribution of epidemiologic studies of air pollution. DIFFICULTIES IN EPIDEMIOLOGIC STUDIES OF AIR POLLUTION Nearly all epidemiologic studies on air pollution are observational, rather than experimental.
From page 28...
... An analogy with a diagnostic tool, such as the microscope, applies here, if we think of limits to the resolving power of lenses. To discern the broad but relatively faint image of the air pollution health effect among surrounding images, epidemiologic studies must either reduce error in the estimation of variables used in the analysis (improve the optical quality of the lenses)
From page 29...
... Several excellent and recent reviews are available, and the inclusion here of yet another would divert attention from issues more pertinent to the charge.3 12, 13 and 14 18 The report is also not intended as a primer on epidemiologic principles, although it discusses some specific principles related to the problems of studying air pollution. The reader should consult current textbooks on epidemiologic methods for more detailed discussion.4, 5 and 6 Because decisions about the future control of air pollutants must be based on more sensitive end points than have generally been used in the past, we emphasize indexes of morbidity, rather than mortality.
From page 30...
... Most future epidemiologic studies on air pollution should adopt a perspective that accounts for pollutant exposure in both environments. The report deals primarily with four of the EPA criteria air pollutants: SO2, particles, nitrogen oxides, and O3.
From page 31...
... In Chapter 5, the Committee applies various designs and strategies to current research questions related to air pollution. Such questions include those on chronic and acute respiratory effects and on effects of specific air pollutants.
From page 32...
... Menzel. Health Effects of Air Pollution.
From page 33...
... Vena, J.E. Air pollution as a risk factor in lung cancer.
From page 35...
... 35 Chapter 2 Assessment of Health Effects


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