Air Qual Atmos Health (2010) 3:149158 DOI 10.

1007/s11869-010-0063-x

Assessment of intra-urban variability in indoor air quality and its impact on childrens health
B. K. Padhi & Pratap Kumar Padhy & Lokanath Sahu & V. K. Jain & Rupak Ghosh

Received: 30 June 2008 / Accepted: 5 January 2010 / Published online: 9 March 2010 # Springer Science+Business Media B.V. 2010

Abstract The results from a number of studies suggest that children living close to busy roads may have impaired respiratory health. The study reported here was designed specifically to test the hypothesis that exhaust from traffic has an impact on indoor air quality and childrens respiratory health. Children living at three different locations in a suburban area in India were enrolled in the study, and the concentrations of indoor air quality parameters were measured at selected households during the period March 2006February 2007 using portable air quality monitors. Respiratory symptoms were identified by means of a questionnaire completed by parents and from the results of a pulmonary function test (PFT) carried out using an electronic Spiro Meter. The logistic regression model revealed associations between respiratory symptoms and traffic-related indoor air pollutants among our study population. The prevalence of respiratory disorders was greater among children living in close proximity to traffic sources than among those living more distant from these sources, even after the adjustment of confounding factors. We also found intra-urban variability of indoor air quality

and associated differences in respiratory symptoms. Our findings support the hypothesis that traffic has an impact on indoor air quality and that it is associated with childrens health. The findings from this study have important policy and program implications, including the need for public information campaigns designed to inform people about the risks of exposure to traffic exhausts. Keywords Children . Indoor air pollution . Intra-urban . Lung function . Respiratory symptoms . Traffic

Introduction The World Health Organization (WHO) reports that 25% of all preventable diseases are due to a poor physical environment (World Health Organization 2002). It has also been reported that over 40% of the global burden of diseases attributed to environmental factors falls on children, who account for about 10% of the worlds population (Murray and Lopez 1996; Tamburlini et al. 2002). Air pollution is the single largest environmentrelated cause of ill health among children in most countries. Motor vehicle emissions are a major source of air pollution throughout the world (Mage et al. 1996; Mayer 1999; Samet 2007) and there is widespread public concern over their effect on asthma, particularly among children (Venn et al. 2001; Janssen et al. 2003). Air pollution from motor vehicles is one of the most serious and rapidly growing problems in urban centers of India (UNEP/WHO 1992; CRRI 1999). The problem of air pollution has assumed serious proportions in some of the major metropolitan cities of India, with vehicular emissions having been identified as one of the major contributors to the deteriorating air quality (CPCB 2001).

B. K. Padhi : V. K. Jain School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India P. K. Padhy (*) : L. Sahu Centre for Environmental Studies, Visva-Bharati University, Santiniketan, West Bengal, India e-mail: padhypk@gmail.com R. Ghosh Suri Sadar Hospital, West Bengal, India

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Numerous epidemiological studies have documented adverse effects of air pollution on health (Wjst et al. 1993; Oberdorster et al. 1995; Kramer et al. 2000; Aneja et al. 2001; Vedal et al. 2003). In sub-urban areas, motor vehicle emissions are likely to vary substantially within a small area, and researchers have begun to document differences in traffic-related pollutants on a neighborhood scale (Hoek et al. 2002; Lebret et al. 2002; Wilsona et al. 2005; Samet 2007). A number of recent epidemiological studies have found associations between residential proximity to busy roads and a variety of adverse respiratory health outcomes in children, including respiratory symptoms, asthma exacerbations, and decrements in lung function (Ghose et al. 2005; Kaushik et al. 2006). Therefore, it is important to evaluate the extent to which proximity to traffic may affect the indoor air quality. The indoor environment is especially relevant in such studies because pollutants, such as, ambient particulate matter (PM), carbon monoxide (CO), nitrogen oxide (NO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) may penetrate from the outside. The study of air pollution exposures at the intra-urban scale therefore presents a challenge in a new era of exposure assessment in epidemiological research and one that has been recently identified as a preferential area for future work (Brunekreef and Holgate 2002; Sajani et al. 2004; Jerrett et al. 2005; Padhi and Padhy 2008). The study reported here examined the impact of traffic on indoor air quality and childrens health at the intraurban spatial scale within a suburban area in India.

Indoor Air Quality (IAQ) measurements The IAQ investigation at the households enrolled in the study was conducted from June 2006 to July 2007. In each sample area, the indoor air quality was studied in detail in 20 representative households selected from among the larger group on which health data were collected. These households were selected on the basis of fuel use, indoor smoking, and other potential sources of indoor air pollution. The selection criteria were the use of LPG (liquefied petroleum gas) as a cooking fuel and no indoor smoking. Each investigated household was monitored on at least two to three, and 24-h average value was taken as the final result. The air quality parameters measured in this study were of CO, CO2, NO, NO2, SO2, O3, and suspended SPM as well as relative humidity (RH) and temperature. Instruments were positioned at the center of the living room, 0.5 m above the ground, at least 0.5 m away from the walls, and 1 m away from potential sources of air pollutants. All gaseous pollutants as well as temperature and RH were measured by a portable multigas air quality monitor (YES Plus, Canada), whereas the, SPM was monitored by a Handy Sampler (model KDM HS-7; KDM. Pvt. Ltd., New Delhi, India) using pre-weighed Whatman-GF/A glass fiber filter paper (USEPA 1971). Study subjects In each sampling site, we selected approximately 100 households (site-I:108, site-II: 105, site-III: 110) that used LPG for cooking for enrollment in this study. The households were virtually indistinguishable from each other in terms of socio-economic status, economy, diet, home construction, and access to health care. They were expressly matched on these key characteristics in order to minimize the potential for confounding factors and to provide some control of all major known and suspected risk factors for indoor air quality and respiratory diseases. There were 435 children in these households (site-I 145, site-II 138, site-III 152) aged between 6 and 10 years who were included in this study. Study of respiratory symptoms of children A questionnaire developed on the pattern of IUATLD (International Union Against Tuberculosis and Lung Disease) (Burney et al. 1989) and ISAAC (International Study of Asthma and Allergies in Childhood) (Asher et al. 1995), with a few modifications, was used for evaluating respiratory health. The questionnaire contained questions on personal characteristics (name, sex, age, height, weight, parents smoking habit, family income, mother s education, etc.), respiratory symptoms [history of cough with or without any expectoration, amount of expectoration/day,

Materials and methods Study area Bolpur is situated between latitude 24N and longitude 87E in the north-western part of West Bengal, a highly populated state in the eastern part of India. It is one of the growing urban cities in India. Uncontrolled and mixed vehicular density on insufficient and badly cared road space, inadequate parking facilities, low turnover of old vehicles with too frequent breakdowns, and undisciplined drivers together with a bad traffic management strategy have profound effects on the air quality of this area. In addition to these factors, the widespread use of solid biomass fuels in food and tea stalls has worsened the situation and poses a threat to human health. The study area was divided into three sampling sites, namely, site-I (within 0.5 km of the main road), site-II (within 1.0 km of the main road), and site-III (within 5.0 km of the main road). The condition of the terrain in all three sites was comparable. Site selection was based on vehicle density, road condition, proximity to other stationary sources, and human habitat.

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winter exacerbations, history of hemoptysis and amount, history of any post-nasal drip, history of any wheezing, history of chest tightness, doctor-diagnosed asthma, and any systematic complaints (fever, headache, etc.)]. Lung function measurement Our study was designed specifically to investigate trafficrelated indoor air pollution on the lung function of children. Of the 435 children from the selected households, lung function measurements were performed on only 240 children (site-I 78, site-II 82, site-III 80); the remaining children had already had been diagnosed with a systematic respiratory illnesses. The lung function parameters, such as peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), slow vital capacity (SVC), were measured on an electronic Spiro Meter (model DT Spiro; Maestros Medline Systems, Mumbai, India) interfaced to a personal computer. All pulmonary function tests (PFT) were carried out at a fixed time of the day (09001300 hours) to minimize the diurnal variation. The spirometer was calibrated daily and operated within the ambient temperature range. The lung function test of our study was based on the operation manual of the instrument with special reference to the official statement of the American Thoracic Society of Standardization of Spirometry (American Thoracic Society 1987). Each subject was instructed to stand upright in a stable position, to place the mouthpiece in the mouth while keeping the nose closed, and then to make a maximal inspiratory effort and to blow out with a maximal effort. The test was repeated five times after adequate rest, and the data were transferred from the spirometer to the computer for analysis. Anthropometric measurements Height, weight, and the circumference of the waist (WC) and hip were recorded using a standard technique (Lohman et al. 1988) by the recorder. Height and weight were measured to the nearest 0.1 cm and 0.5 kg, respectively. Waist and hip circumferences were measured with an inelastic tape to the nearest 0.2 cm. Body mass index (BMI) and waisthip ratio (WHR) were computed using the following formula:  BMI Weightkg Heigth2 m2 WHR Waist circumferencecm=Hip circumferencecm

The General Linear Model (GLM) was applied to study the relationship of intra-urban variation of indoor air quality. To investigate the relationship between PFT and air pollutants, we used multiple regression analysis. Finally, to explore the relationship between respiratory symptoms and the exposure to pollutants, we used multiple logistic regression analysis, in which the potential confounding factors were controlled. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were computed. The adjusted ORs were calculated for an interquartile range (IQR) of measured pollutant concentrations (i.e., the OR for a given health outcome given a pollutant concentration at the 75th percentile of the distribution relative to that at the 25th percentile). All statistical analyses were performed using the SPSS statistical package ver. 10.0 (SPSS, Chicago, IL).

Results The basic socio-demographic characteristics of the study households are given in Table 1. Houses were similar in terms of type and structure. On average, each house had three rooms and housed eight people. The majority of the houses were naturally ventilated. The summary statistics of indoor air quality along with micro-meteorological conditions are described in Table 2. The indoor concentrations of all the pollutants were greater in houses located at 0.5 km of the main road. The highest mean levels of indoor air quality parameters were measured in houses located at 0.5 km of the main road: 240.0, 2525.0, 42.5, 55.0, 48.7, 22.0 ppb for the gaseous components (CO, CO2, NO, NO2, SO2, and O3, respectively) and 185.0 g/m3 for SPM. In comparison, the lowest mean levels were recorded in houses located 5.0 km away from the main road and averaged 138.9, 2127.0, 22.3, 25.6, 20.0, and 10.5 ppb for the gaseous components (CO, CO2, NO, NO2, SO2, O3, respectively) and 87.5 g/m3 for SPM. These differences in the levels of the measured pollutants are highly significant (p <0.001) (Table 2). We found a decrease in the concentrations of all indoor air quality parameters with increasing distance from the main road, indicating that increases in the distance from automobile sources is correlated to a decrease in the concentrations of air quality parameters. The GLM with Scheffes posthoc test was applied and revealed that there is a statistically significant difference in the indoor concentrations of air quality parameters at the different study locations (Table 2). Table 3 shows the anthropometric characteristics of the study subjects, and Table 4 shows the results of the PFT on the study subjects. A comparison of PFT values among the three study groups using one-way analysis of variance (ANOVA) with Turkeys posthoc test revealed statistically significant differences between the lung function results of the

Statistical analysis Analysis of the descriptive statistics, such as mean, standard deviation (SD) of anthropometry, air pollutants, and respiratory functions of the subjects, was performed.

152 Table 1 Comparison of socio-demographic characteristics of the households in the study areas Variable 0.5km from main road (%), n =108

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1.0km from main road (%), n =105

5.0km from main road (%), n =110

Materials used for house construction Mud, grasses, and bamboos Stones and bricks Mechanical ventilation Yes No Separate kitchen Yes No Number of people in the house <5 >5 No. of smokers in the house None One Two or more Childs mother s education Uneducated Primary school Secondary school Monthly average family income in US$ <100 >100

11.1 88.9 9.2 90.8 86.1 13.9 16.7 83.3 37.0 48.1 14.9 4.6 27.8 67.6 23.1 76.9

13.3 85.7 12.4 87.6 85.7 14.3 21.0 79.0 57.1 28.6 14.3 8.5 42.8 48.7 19.1 80.9

18.2 81.8 4.6 95.4 77.3 22.7 27.3 72.7 47.3 36.4 16.3 13.7 45.4 40.9 25.5 74.5

Table 2 Comparison of indoor air quality (IAQ) among the study sites during study period Air quality parameters 0.5km from main road (site-I) Meana CO (ppb) CO2 (ppb) NO (ppb) NO2 (ppb) SO2 (ppb) O3 (ppb) SPM (g/m3) Temperature (C) Relative humidity (%) 240.5 2525.0 42.5 55.0 48.7 22.0 185.0 25.0 63.3 2575% 180.0372.0 1200.04130.0 18.365.8 22.580.2 24.073.5 10.838.5 140.0236.0 12.232.0 58.070.0 1.0km from main road (site-II) Meana 185.8 2134.0 31.8 30.5 28.5 18.5 115.0 24.2 65.8 2575% 125.0235.0 1050.03275.0 12.745.9 15.352.0 12.037.5 10.025.3 105.8138.5 10.530.2 58.368.5 5.0km from main road (site-III) Meana 138.9 2127.0 22.3 25.6 20.0 10.5 87.5 23.5 63.0 2575% 83.5175.1 1015.03125.0 10.033.5 12.237.5 10.832.0 8.520.2 72.8102.0 10.530.0 58.567.0 0.0003 0.0001 0.0001 0.0002 0.001 0.001 0.0001 0.05 0.05 P valueb

SPM Suspended particulate matter, CO carbon monoxide, CO2 carbon dioxide, NO nitrogen oxide, NO2 nitrogen dioxide, SO2 sulphur dioxide, O3 ozone
a b

24-h average

General Linear Model (GLM) with Scheffes posthoc test revealed that: site-I had significantly greater means compared to site-II and -III; site-II had significantly greater mean compared to site-III; site III had significantly smaller mean compared to all sites

Air Qual Atmos Health (2010) 3:149158 Table 3 Basic anthropometric characteristics of the study subjects Variables 0.5km from main road (n =145) 8.01.0 61.53 97.93 13.50.91 0.920.23 44.87 3.44 1.0km from main road (n =138) 7.51.5 64.63 96.37 13.60.87 0.850.15 50.0 5.07 5.0km from main road (n =152) 8.01.0 56.25 92.10 13.30.90 0.890.17 38.75 1.97

153

P value

Age, years (mean SD) Sex (male, %) Race/ethnicity (Asian Indian, %) BMI kg/m2 (mean SD) WHR (mean SD) Nutritional status (good, %) Disease history, including anemia (yes, %) BMI Body mass index, WHR waist-to-hip ratio

0.135 0.113 0.153 0.231 0.173 0.08 0.12

groups. Children living in the households at 0.5 km of the main road were found to have lower a lung function than those who lived in the households located 5.0 km away from the main road (PEF=3.2, 3.9, and 4.3, FVC=2.0, 3.5, and 3.8, FEV1 =1.5, 2.1, and 2.8, FEF2575% =1.8, 2.5, and 2.9, and SVC,=2.5, 3.2, and 3.6 l/s for site-I, -II, and III, respectively). Correlations among indoor air quality variables are reported in Table 5. With the exception of temperature and RH, all of the air quality variables were found to be positively correlated, with stronger correlations for CO, NO, NO2, and SO2. The correlations between potential confounders and pulmonary function results are presented in Table 6. Age, BMI, WHR, environmental tobacco smoke, and living habitat were important factors affecting the lung function of our study subjects. Multiple regressions were used to test the association between indoor air pollutant concentrations and lung function variability among the study subjects. The results of the adjusted pulmonary function tests regressed on indoor air pollution data are presented in Table 7. These regressions of adjusted pulmonary function values for children residing at 0.5 km of the main road showed that NO2 and SPM were most strongly associated with lower values of PEF, FVC, FEV1, FEF2575%, and SVC. We found statistically significant relationships between air pollutant levels and pulmonary function tests in the three

groups. SPM exposure was associated with statistically significant decreases in all five measures of pulmonary function, and theses associations were stronger than those of the other pollutants measured. The effects of traffic-related indoor air pollution on the prevalence of asthma, wheeze, and shortness of breath are summarized in Table 8. Unlike many other studies, we observed a significant association between the prevalence of respiratory symptoms in the study populations and indoor air pollution exposures. The results of the logistic regression analysis are shown in Table 8. Not all the data on respiratory symptoms collected during the survey are presented in this tableonly the significant respiratory symptoms associated with the exposure to air pollutants. The results revealed that the observed differences in air pollutant level had a significant impact on respiratory health even after these were adjusted for confounding factors. The children living at 0.5 km of the main road had a higher risk of developing respiratory symptoms or diseases than those living in 5.0 km away from the main road.

Discussion We have studied the relationship between traffic-related indoor air pollution and the development of asthmatic

Table 4 Comparison of pulmonary function test results in children stratified by the distance of the houses from the main road Variables (l/s) 0.5km from main road (n =78) 3.21.0 2.00.7 1.50.8 1.80.5 2.50.8 1.0km from main road (n =82) 3.90.5 3.50.35 2.10.3 2.50.23 3.20.35 5.0km from main road (n =80) 4.30.62 3.80.78 2.80.25 2.90.31 3.60.42 P value

PEF FVC FEV1 FEF2575% SVC

0.001 0.002 0.005 0.001 0.004

PEF Peak expiratory flow, FVC forced vital capacity FEV1 forced expiratory volume in 1 s, FEF forced expiratory flow, SVC slow vital capacity All values are given as the mean SD

154 Table 5 Correlations among pollutants and weather variables Variables CO CO2 NO NO2 SO2 O3 SPM Temp RH CO 1.0 0.79 0.63 0.61 0.56 0.34 0.41 0.12 0.31 CO2 NO NO2 SO2 O3 SPM

Air Qual Atmos Health (2010) 3:149158

Temperature

Relative humidity

1.0 0.25 0.21 0.13 0.11 0.09 0.18 0.28

1.0 0.78 0.45 0.63 0.36 0.24 0.35

1.0 0.52 0.58 0.43 0.21 0.20

1.0 0.32 0.49 0.15 0.15

1.0 0.13 0.35 0.11

1.0 0.29 0.38

1.0 0.46 1.0

symptoms and respiratory infections among children living in a suburban setting in India. To the best of our knowledge, this is the first epidemiological study in India to evaluate relationships between traffic-related indoor air pollution and respiratory symptoms. We found that the children in our study who lived near a busy road had a significantly increased chance of having bronchitis symptoms and doctor-diagnosed asthma than those living further away from a main road. These monitoring results indicate a significant difference between the indoor air quality of the roadside-situated households and those situated further away from roads. Vehicles in major metropolitan cities are estimated to account for 70% of the CO, 50% of the hydrocarbons, 3040% of the NOx, 30% of the SPM, and 10% of the SO2 of the total pollution, with two thirds of this contributed by two wheelers alone. These high levels of pollutants are the main causal factors of respiratory and other air pollution-related ailments, including lung cancer and asthma (CPCB 2001). The localized vehicular pollution contributes to about 1.1% of all deaths annually worldwide and has recently been estimated to be responsible for up to 6% of all deaths annually in Europe (Knzli et al. 2000). Several studies indicate that traffic on roads is a major source of air pollutants in urban areas, but relatively few studies have evaluated the specific effects of traffic-related air pollution on individuals living close to traffic-intensive roads.
Table 6 Partial correlations of lung function measurements with potential confounders

A qualitative comparison of our results can be made with those from several previous studies. Chattopadhyay et al. (2007) studied the levels of PM10 and volatile organic compounds in motor vehicle exhaust and the lung function of 505 residents of Kolkata (India) and found that changes in lung function were associated with higher traffic loads and an increased deterioration of respiratory function. In this study, 3.76% of the subjects had restrictive impairment, 3.17% had obstructive impairment, and 1.98% had both. Ghose et al. (2005) studied the status of urban air pollution and its impact on human health in the city of Kolkata and found that SPM, NOx, and CO levels were associated with respiratory disorders and had a negative effect on human health. Sharma et al. (2004) studied the effects of particulate air pollution on the respiratory health of subjects who lived in three different areas of Kanpur, India and found that an increase of 100 g/m3 in PM10 was associated with a reduction of approximately 3.2 l/min in mean PEF rate for an individual. Nitta et al. (1993) conducted a cross-sectional study in Tokyo, Japan and found that exposure to automobile exhaust may be associated with an increased risk of certain respiratory symptoms, including chronic cough, chronic phlegm, chronic wheezing, and chest cold with phlegm. Sekine et al. (2004) studied the long-term effects of exposure to automobile exhaust on the pulmonary function of female

Variable Age Sex BMI WHR Nutritional status Environmental tobacco smoke Living habitat Parents respiratory diseases

PEF 0.13** 0.08* 0.19** 0.15** 0.03 0.25*** 0.09* 0.10**

FVC 0.08* 0.05 0.11** 0.09* 0.02 0.18*** 0.1** 0.08*

FEV1 0.05* 0.12* 0.10** 0.13** 0.08* 0.31*** 0.11** 0.09*

FEF2575% 0.04* 0.07* 0.08* 0.10** 0.01 0.11** 0.08* 0.09*

SVC 0.03 0.04 0.09* 0.07* 0.03 0.23*** 0.09* 0.06*

Significant at: *P <0.05; **P <0.01; ***P <0.001

Air Qual Atmos Health (2010) 3:149158 Table 7 Regression of the pulmonary function test results on indoor air pollutants stratified by distance from the main roada PFT pollutantb 0.5km from main road (n =78) B (SE) 1.0km from main road (n =82) B (SE)

155

5.0km from main road (n =80) B (SE)

PEF CO NO NO2 SO2 O3 SPM FVC CO NO NO2 SO2 O3 SPM FEV1 CO NO NO2 SO2 O3 SPM FEF2575% CO NO NO2 SO2 O3 SPM SVC CO NO NO2 SO2 O3 SPM

38.31 42.25 55.71 48.37 20.52 58.30 36.21 41.00 53.11 37.17 15.32

(53.0)* (28.0)** (20.5)*** (30.5)** (35.6)* (17.5)*** (73.8) * (20.0)** (15.3)*** (28.5)** (30.1)*

22.11 20.00 18.53 25.28 5.00 42.50 27.13 31.56 43.15 35.78 11.28

(65.0)* (38.5)** (13.0)*** (20.5)** (29.8)* (11.15)*** (48.0)* (25.0)** (22.5)*** (32.1)** (39.3)*

8.25 6.42 3.65 5.83 10.31 8.79 9.24 7.32 5.18 7.42 18.21

(62.0) (25.0) (30.5) (32.5) (40.6) (15.5)* (61.0) (35.3) (20.5) (30.5) (42.3)

73.18 (27.0)*** 35.00 44.15 58.22 50.29 15.12 63.20 32.51 51.25 55.00 40.37 10.00 50.00 (60.0)* (32.0)*** (21.0)*** (28.1)** (43.0)* (11.2)*** (78.5)* (28.0)** (20.5)*** (32.0)** (52.5)* (13.2)***

37.30 (14.5)*** 27.31 39.25 51.71 50.00 20.52 40.30 28.31 42.25 55.71 30.26 20.52 38.28 (53.0)* (28.0)** (20.5)*** (30.5)** (35.6)* (18.5)*** (53.0)* (28.0)** (19.2)*** (30.5)** (35.6)* (23.0)***

12.25 (32.8)* 10.00 6.31 2.00 6.25 20.5 5.20 8.23 2.25 3.20 5.18 15.38 7.13 (53.1) (25.0) (15.3) (22.5) (51.3) (29.0)* (53.7) (28.6) (20.7) (22.5) (40.5) (22.5)*

30.25 (53.0)* 45.15 (38.0)** 51.71 42.30 11.22 52.24 (18.1)*** (28.1)** (65.2)* (18.0)***

25.30 (70.8)* 38.00 (22.0)** 55.71 29.37 10.13 35.00 (17.0)*** (47.5)** (25.31)* (19.21)***

9.15 (41.2) 2.32 (25.5) 2.78 7.70 12.52 8.25 (18.1) (39.5) (36.8) (15.0)*

For definition of abbreviations, see Tables 2 and 4

a

Single pollutant models adjusted for confounding factors (sex, age, BMI, WHR, nutritional status, parental smoking, socio-economic status, and distance from the main road)

b Regression coefficients are scaled to the inter-quartile range (IQR) for each pollutant. Five models fit each pulmonary function test, one for each pollutant. IQR values of average pollutant concentration: CO=85.0, NO=15.3, NO2 =20.6, SO2 =18.5, O3 =5.8, SPM=65.3 Significant at *p < 0.05; **p <0.01; ***p <0.001

adults in Tokyo, Japan and found that subjects living in areas with high concentrations of air pollution showed higher prevalence rates of respiratory symptoms and a larger decrease in FEV1 than those living in areas with low concentrations of air pollution. Shima et al. (2003) found that the prevalence of asthma in girls living in Chiba

prefecture, Japan was higher among those living <50 m away from major roads and increased significantly with increases in the concentration of air pollution. Another study in Japan by Shima and Adachi (2000) studied the effect of outdoor and indoor NO2 on respiratory symptoms in schoolchildren and showed a significant association

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Table 8 Adjusteda odds ratios (95% confidence intervals) for the association between average indoor air pollution concentrations and respiratory symptoms Risk factors Usually cough for 3 month/year Usually cold for 3 month/year Usually phlegm for 3 month/year Usually expectoration for 3 months/year Usually wheeze for 3 months/year Doctor-diagnosed asthma Doctor-diagnosed bronchitis
a

0.5km from main road (n =145) 3.13 3.51 2.15 2.00 3.10 4.15 3.20 (2.003.75)** (3.184.00)** (2.003.63)** (1.953.50)* (3.004.15)** (3.984.95)*** (3.154.30)**

1.0km from main road (n =138) 2.23 2.31 2.75 1.80 2.80 2.97 2.70 (2.163.45)** (2.203.50)** (2.583.68)** (1.453.20)* (2.723.95)** (2.893.65)*** (2.523.63)**

5.0km from main road (n =152) 1.15 1.07 1.03 1.05 1.01 1.00 1.02 (1.001.98) (0.951.90) (0.931.93) (0.901.65) (0.881.92) (0.851.50) (0.891.45)

Adjusted for sex, age, BMI, WHR, nutritional status, parental smoking, mothers education, number of persons in the household, household characteristics, distance from the main road', and socio-economic status using logistic models Significant at *p <0.05, **p <0.01, ***p <0.001

between outdoor NO2 concentrations and wheezing. In this study, girls were more susceptible to indoor NO2 than boys. In a Japanese study, Shima and Adachi (1996) studied the serum immunoglobulin (Ig) E and hyaluronate levels in children living along major roads and found that serum hyaluronate concentrations were higher in those who lived <50 m away from a major road than in those who lived farther away. Those children with high serum IgE concentrations appeared to be particularly susceptible to the effects of motor vehicle exhaust. Yamazaki et al. (2005) suggested that traffic exposure led to lower vitality and poorer mental health among the respondents in their study living near roadways in Japan. Hwang et al. (2005) suggested that long-term exposure to traffic-related pollutants, such as NOx, CO, and O3, increases the risk of childhood asthma in Taiwan. Yang et al. (2003) found the prevalence of preterm delivery was significantly higher among mothers living within 500 m of a freeway than among mothers living 500 1500 m away from the freeway in Taiwan. Lee et al. (2003) found that doctor-diagnosed allergic rhinitis was associated with higher non-summer temperatures and traffic-related air pollutants in Tiwan. Song (2001) suggested that with increases of 100 g/m3 in total suspended particulate (TSP) and 50 ppb in SO2, the relative risk (RR) of asthma attacks was 1.27 and 1.56, respectively, among children living in Seoul, South Korea. Janssen et al. (2003) showed that children attending schools close to motorways with high truck traffic counts in the Netherlands experienced more respiratory symptoms than those attending schools near motorways with low truck traffic counts. Venn et al. (2001) reported that among children living within 150 m of a main road, the risk of wheeze increased with increasing proximity by an OR of 1.08 (95% CI 1.001.16) per 30-m increment in primary schoolchildren and by an OR of 1.16 (1.021.32) in secondary schoolchildren. In our study, we found that

children living within 0.5 km of a main road were significantly associated with a decline in PFT and increased respiratory symptoms compared to those children who lived 5.0 km from the main road. Studies addressing the assessment of the intra-urban variability of indoor air pollutants in suburban environments are scarce in developing countries, and only a few studies have investigated the intra-urban variability of outdoor air pollution (Hewit 1991; Lebret et al. 2002; Wilsona et al. 2005). In addition, direct comparisons are limited because the measurements of ambient air pollutants, sources of air pollutants, and the investigated areas are different. Results from the few studies that have been carried out in India and the relatively more studies carried out abroad suggest that there is a strong relationship between air pollution and automobile activities, but the majority of these studies used pollutant concentrations measured at central monitoring sites to estimate exposures and did not, in general, consider local spatial variability in pollutant levels. Our study, in contrast, provides the opportunity to define more accurately the types and concentrations of air pollutants in the indoor air. As such, it differs from all earlier studies that have investigated the urban air pollution. The major limitation of our study is that the respiratory suspended particulate matter (PM10, PM2.5) was not estimated. Despite this limitation, based on our results, we conclude that living near busy roads leads to adverse respiratory health effects. The results of this study are consistent with the findings of studies in other cities where elevated levels of exposure to motor vehicle-related pollutants on roadside microenvironments were observed (Venn et al. 2001; Janssen et al. 2003). All of the above findings lead to the simple fact that transportation has a great impact on indoor air quality. In our study, the roadside-dwelling children were exposed to elevated levels of air pollutants and were at great health risks. Low-quality fossil fuel combustion and transportation

Air Qual Atmos Health (2010) 3:149158

157 hyperresponsiveness, and respiratory symptoms in Dutch schoolchildren. Environ Health Perspect 111:15121518 Jerrett M, Arain A, Kanaroglou P, Beckerman B, Potoglou D, Sahsuvaroglu T, Morrison J, Giovis C (2005) A review and evaluation of intraurban air pollution exposure models. J Expo Anal Environ Epidemiol 15:185204 Kaushik CP, Ravindra K, Yadav K, Mehta S, Haritash AK (2006) Assessment of ambient air quality in urban centres of Haryana (India) in relation to different anthropogenic activities and health risks. Environ Monit Assess 98:114 Kramer U, Koch T, Ranft U, Ring J, Behrendt H (2000) Traffic-related air pollution is associated with atopy in children living in urban areas. Epidemiology 11:6470 Kunzli N, Kaiser R, Medina S, Studnicka M, Chanel O, Filliger P, Herry M, Horak F Jr, Puybonnieux-Texier V, Quenel P, Schneider J, Seethader J, Vergnaud JC, Sommer H (2000) Public-health impact of outdoor and traffic-related air pollution: a European assessment. Lancet 356:795801 Lebret E, Briggs D, van Reeuwijk H, Fisher P, Smallbone K, Harsemma H, Kriz B, Gorynski P, Elliot P (2002) Small area variations in ambient NO2 concentrations in four European areas. Atmos Environ 34:177185 Lee YL, Shaw CK, Su HJ, Lai JS, Ko YC, Huang SL, Sung FC, Guo YL (2003) Climate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in Taiwan. Eur Respir J 21:964970 Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization references manual. Human Kinetics Books, Chicago Mage D, Ozolins G, Peterson P, Webster A, Orthofer R, Vandeweered V, Gwynne M (1996) Urban air pollution in megacities of the world. Atmos Environ 30:681686 Mayer H (1999) Air pollution in cities. Atmos Environ 33:30294037 Murray CJL, Lopez AD (1996) Global Health Statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions. In: Murray CJL, Lopez AD (eds) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projectsd to 2020. Harvard University Press, Cambridge Nitta H, Sato T, Nakai S, Maeda K, Aoki S, Ono M (1993) Respiratory health associated with exposure to automobile exhaust. I. Results of cross-section studies in 1979, 1982, and 1983. Arch Environ Health 48:5358 Oberdorster G, Gelein RM, Ferin J, Weiss B (1995) Association of particulate air pollution and acute mortality: involvement of ultrafine particles. Inhal Toxicol 7:111124 Padhi BK, Padhy PK (2008) Estimation of intra-urban variability in outdoor air quality parameters for population exposure assessment. Inhal Toxicol 20:17 Sajani SZ, Scotto F, Lauriola P, Galassi F, Montanari A (2004) Urban air pollution monitoring and correlation properties between fixedsites stations. J Air Waste Manag Assoc 54:12361241 Samet JM (2007) Traffic, air pollution, and health. Inhal Toxicol 19:10211027 Sekine K, Shima M, Nitta Y, Adachi M (2004) Long term effects of exposure to automobile exhaust on the pulmonary function of female adults in Tokyo, Japan. Occup Environ Med 61:350357 Sharma M, Kumar VN, Katiyar SK, Sharma R, Shukla BP, Sengupta B (2004) Effects of particulate air pollution on the respiratory health of subjects who live in three areas in Kanpur, India. Arch Environ Health 59:348358 Shima M, Adachi M (1996) Serum immunoglobulin E and hyaluronate levels in children living along major roads. Arch Environ Health 51:425430 Shima M, Adachi M (2000) Effect of outdoor and indoor nitrogen dioxide on respiratory symptoms in schoolchildren. Int J Epidemiol 29:862870

exert an important influence on this increase in pollutant concentrations. Future studies that can better characterize exposures to traffic pollutants and their sources will provide important information towards gaining a better understanding of the public health impacts of motor vehicle emissions and to developing an integrated assessment that will be helpful to the air quality concerns in epidemiological studies.
Acknowledgments The authors acknowledge the cooperation of the households and the local communities of the Bolpur-Santiniketan area during the study. The financial support provided by the UGC, India to one of the authors (B. K. Padhi) is gratefully acknowledged. The authors are also grateful to the two anonymous reviewers for their valuable comments and suggestions which helped in improvement of the quality of the manuscript.

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