Indoor air and respiratory health in preadolescent children

The effect of indoor exposure to nitrogen dioxide, ammonia, particulate matter and parental tobacco smoke on respiratory health was studied over a period of six months in all second graders born and living in two area of continental Croatia 8–10 yr of age. The study group was divided into two sections corresponding to area of residence (industrial/rural). Information on respiratory symptoms was collected from a self-administered questionnaire completed by the parents of the children. The mean values of concentrations of indoor air pollution that had been recorded in 24-h samples of air collected at schools were mostly below threshold limit for ambient pollution. In addition, information on parental smoking, the density of habitation and the type of fuel used for heating and/or cooking in the home was obtained by a questionnaire. In the investigated period the prevalence of respiratory illness was 22% in the children exposed to lower indoor air pollution and 25% in those exposed to higher indoor air pollution. Exposure to parental smoking was also associated with more respiratory symptoms (28 : 19%). The results indicate that the measured air pollutants only had a slight effect on the respiratory health of preadolescent children. However, the effect of exposure to parental smoking was more pronounced.     

Association between air quality and quality of life

Air quality—or its converse, air pollution—is a significant risk factor for human health. Recent studies have reported association between air pollution and human health. There are numerous diseases that may be caused by air pollution such as respiratory infection, lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, and asthma. In this study, the relationship between air quality and quality of life was examined by using canonical correlation analysis. Data of this study was collected from 27 countries. WHO statistics were used as the main source of quality of life data set (Y variables set). European Environment Agency statistics and (for outdoor air-PM10) WHO statistics were used as the main source of air quality data set (X variables set). It is found that there are significant positive correlation between air quality and quality of life.     

Respiratory health of road-side vendors in a large industrialized city

GOAL, SCOPE AND BACKGROUND: The literature reports a high prevalence of respiratory symptoms associated with exposure to motor vehicle exhaust emissions and people exposed to vehicle emissions are at risk of reduced lung function and cardiovascular performance. Although the effect of traffic emissions is a known risk to respiratory health, retailers are often situated along major roads in a busy urban environment to maximise customers. Shop assistants in an air-conditioned environment should be less exposed to traffic fumes and their lung function should be better preserved compared to 'unprotected' vendors exposed directly to vehicle emissions. The lung function of these two groups of workers has not previously been compared. The aims of this study are to determine if there is a difference in the concentration of respirable particles of diameter less than 10 micrometers (PM10) inside and outside air-conditioned shops along a busy major road; and to compare the lung function parameters, blood lead levels and respiratory symptoms between road-side vendors directly 'exposed' to traffic fumes and vendors working in 'protected' air-conditioned shops along the same road. METHODS: Roadside vendors (n=33) and adjacent shop assistants (n=31) were recruited for the study in a district known to have high emissions and pollution measures. All subjects were asked to complete a questionnaire providing the frequency of their respiratory symptoms. Spirometry pulmonary function tests were conducted and exhaled carbon monoxide levels (ECO), oxygen saturation and blood lead levels (BLL) were measured. PM10 level was concurrently measured in the subject's working environment. Pulmonary function data and ECO levels collected from a cohort of university staff aged > or = 30 years (n=92) at a university campus were included for comparison. RESULTS: The concentration of particulate matter (PM10) at the roadside (210 +/- 70 microg/m3) was significantly higher than inside the shops (130 +/- 40 microg/m3). There was no difference in lung function parameters or BLL between the groups, however the forced vital capacity of both groups of vendors was significantly lower than a 'control' cohort of academic institution personnel (n=92). DISCUSSION: This study illustrated that while the level of pollution improved with air conditioning, this may not be sufficient to prevent respiratory consequences. Our data suggests that a reduction in occupational exposure is not enough to protect these workers. CONCLUSIONS: Air-conditioned work environment is insufficient to protect the respiratory system against the adverse effects of exposure to vehicle emissions. RECOMMENDATIONS: The overwhelming effect of exposure during travel to and from work and at home cannot be underestimated. More stringent guidelines to control pollution appear necessary to protect the respiratory health of both shop-keepers and road-side vendors and further studies to explore the effect on respiratory health of the exposure to pollutants associated with commuting to and from work are warranted.     

1987 APCA Govermenet Agencies Directory

A method for setting air quality standards for long-term cumulative exposures of a population based on epidemiological studies has been developed. It uses exposure estimates interpolated from monitoring stations to zip code centroids, each month applied to zip code by month residence histories of the population. Two alternative cumulative exposure indices are used—hours in excess of a threshold, and the sum of concentrations above a threshold. The indices are then used with multiple logistic regression models for the health outcome data to form dose response curves for relative risk, adjusting for covariates. These curves are useful for determination of at what exposure amounts and threshold levels, effects which have both statistical and public health significance begin to occur. The method is applied to a ten year follow-up of a sub cohort of 7,343 members of the National Cancer Institute-funded Adventist Health Study. Up to 20 years of residence history was available. Analysis for prevalence of symptoms was conducted for four air pollutants— total oxidants, sulfur dioxide, nitrogen dioxide, and total suspended particulates. For each pollutant, cumulated exposures were calculated above each of five different thresholds. Statistically significant effects were noted for total suspended particulates, total oxidants, sulfur dioxide, past and passive smoking.     

An empirical relationship between PM(2.5) and aerosol optical depth in Delhi Metropolitan

Atmospheric remote sensing offers a unique opportunity to compute indirect estimates of air quality, which are critically important for the management and surveillance of air quality in megacities of developing countries, particularly in India and China, which have experienced elevated concentration of air pollution but lack adequate spatial-temporal coverage of air pollution monitoring. This article examines the relationship between aerosol optical depth (AOD) estimated from satellite data at 5 km spatial resolution and the mass of fine particles ≤2.5 μm in aerodynamic diameter (PM(2.5)) monitored on the ground in Delhi Metropolitan where a series of environmental laws have been instituted in recent years.PM(2.5) monitored at 113 sites were collocated by time and space with the AOD computed using the data from Moderate Resolution Imaging Spectroradiometer (MODIS onboard the Terra satellite). MODIS data were acquired from NASA's Goddard Space Flight Center Earth Sciences Distributed Active Archive Center (DAAC). Our analysis shows a significant positive association between AOD and PM(2.5). After controlling for weather conditions, a 1% change in AOD explains 0.52±0.202% and 0.39±0.15% change in PM(2.5) monitored within ±45 and 150 min intervals of AOD data. This relationship will be used to estimate air quality surface for previous years, which will allow us to examine the time-space dynamics of air pollution in Delhi following recent air quality regulations, and to assess exposure to air pollution before and after the regulations and its impact on health.     

Concorde Emissions at Dulles International Airport: Results of Measurements

Hamilton, Ontario is an industrial city with a population of 300,000 which is situated at the western end of Lake Ontario. Canada’s two largest iron and steel mills are located here; the city historically has had relatively poor air quality, which has improved markedly in the last 25 years. Concern about the health effects of current air quality recently led us to carry out an epidemiological study of the effects of air pollution on the respiratory health of over 3500 school children. Respiratory health was measured by pulmonary function testing of each child, and by an assessment of each child’s respiratory symptoms via a questionnaire administered to the parents. Previous studies had shown that other environmental factors (e.g. parental smoking, parental cough, socioeconomic level, housing, and gas cooking) might also affect respiratory health, and thus “confound” any potential relationships between health and air pollution. The questionnaire also collected information on many of these confounding factors. For the purposes of initial analysis, the city was divided Into five areas in which differences In air quality were expected. In general, factors which have been associated with poor respiratory health were observed to be more prevalent in areas of poorer air quality.     

A Method for Using Air Pollution Measurements and Public Opinion to Establish Ambient Air Quality Standards

Air quality was comprehensively evaluated by means of sampling at 21 locations over metropolitan Birmingham during a period of one year. Thousands of integrated samples of three common atmospheric gaseous pollutants and two common particulate pollutants were collected and analyzed. Following the year of sampling in 1964, a random household survey was completed by conducting personal interviews at more than 7200 households over metropolitan Birmingham. Statistical reduction of household survey results by census tract and by neighborhood area provided domestic fuel and waste burning emission data as well as public (resident) opinion on specific air pollution effects. The relationship between ambient air quality and neighborhood opinion of air pollution effects on health and property are evaluated statistically. Ambient standards are suggested which are based upon those air pollution levels shown to have adverse effects on approximately one-third of the people.     

Deconstruction of annoyance due to air pollution by multiple correspondence analyses

Annoyance caused by air pollution is a matter of public health as it can cause stress and ill-health and affect quality of life, among other burdens. The aim of this study is to apply the multiple correspondence analyses (MCA) technique as a differential tooling to explore relationships between variables that can influence peoples’ behaviour concerning annoyance caused by air pollution. Data were collected through a survey on air pollution, environmental issues and quality of life. Face-to-face survey studies were conducted in two industrialized urban areas (Vitoria in Brazil and Dunkirk in France). These two regions were chosen as their inhabitants often report feeling annoyed by air pollution, and both regions have similar industrial characteristics. The results showed a progressive correspondence between levels of annoyance and other active variables in the “air pollution” factor group: as the levels of annoyance increased, the levels of the other qualitative variables (importance of air quality, perceived exposure to industrial risk, assessment of air quality, perceived air pollution) also increased. Respondents who reported feeling annoyed by air pollution also thought that air quality was very important and were very concerned about exposure to industrial risks. Furthermore, they often assessed air quality as horrible, and they could frequently perceive air pollution by dust, odours and decreased visibility. The results also showed a statistically significant association between occurrence of allergies and high levels of annoyance.

     

Lung cancer mortality and exposure to atmospheric aerosol particles in Guangzhou,China

In recent years, China and other emerging countries have been experiencing severe air pollution problems with high concentrations of atmospheric aerosol particles. Satellite measurements indicate that the aerosol loading of the atmosphere in highly populated regions of China is about 10 times higher than, for example, in Europe and in the Eastern United States. The exposure to extremely high aerosol concentrations might lead to important human health effects, including respiratory and cardiovascular diseases as well as lung cancers. Here, we analyze 52-year historical surface measurements of haze data in the Chinese city of Guangzhou, and show that the dramatic increase in the occurrence of air pollution events between 1954 and 2006 has been followed by a large enhancement in the incidence of lung cancer.     

Monitoring of air pollution in Indian metropolitan cities: modelling and quality indexing

Air quality in cities is the result of a complex interaction between natural and anthropogenic environmental conditions. Delhi, as well as many other cities in India, is facing problems concerning air pollution. The increase in industrialisation and the vehicle fleet, poor control on emissions and little use of catalytic converters, produce a great amount of particulate and toxic gases. Data on air pollutants and meteorological variables were collected in the metropolitan cities Delhi, Kolkata, Mumbai and Chennai for the period July–August, 2001. Data were treated with the bivariate regression model to explore the influence of the meteorological variables on air pollutant concentrations, and were also used to compute an Air Quality Index, using the weighted arithmetic mean method. The proposed index seems to be applicable in the assessment of overall air quality with respect to air pollutants.     

Influence of air pollution on the incidence of respiratory tract neoplasm

To evaluate the possible influence of air pollutants on the incidence of respiratory tract neoplasm we studied 12 S?o Paulo City districts where air pollution is observed. We collected data on pollutants from 1981-1990 and correlated it with the incidence of larynx and lung neoplasms in 1997. Ozone was the pollutant that best correlated with the incidence of neoplasm. The correlation coefficients were 0.7234 (p=0.277) and 0.9929 (p=0.007) for lung and larynx cancer, respectively. There may be a relationship between air pollution and the incidence of respiratory tract neoplasm. This study, however, does not allow us to conclude that there is a causal relationship.     

Statistical modelling of effects on health linked to indoor air pollution, based on kitchen exposure and with reference to a cross-sectional household survey conducted in Nepal

Exposure to suspended particulate matter and carbon monoxide from indoor kitchen air can have significant effects on respiratory health as demonstrated by statistical modelling. Chronic respiratory illnesses and respiratory symptoms are modelled using the techniques of principal component analysis and binary logistic regression. Estimated models are generated from a cross-sectional household survey data conducted in Nepal with 168 respondents who cook for daily meals. The models show that individuals exposed to high levels of indoor air pollution particularly associated with unprocessed solid biomass fuels along with aging, tobacco smoking and living in poorly constructed houses mainly with mud are vulnerable to respiratory disorders.     

Ambient air quality levels in Tehran, Iran, from 1988 to 1993

The objectives of this study were to describe trends in ambient air quality in Tehran between 1988 and 1993, to determine if these levels exceeded the World Health Organization (WHO) guidelines, and to discuss possible health effects related to exposure for these particular pollutants. Data were acquired from Iran's Environmental Protection Agency (IEPA) and the Ministry of Health (MH). These agencies operate five automated ambient air monitoring stations located in areas with heavy traffic. Daily samples of SO₂, NO₂, CO, total suspended particulate matter (TSM), and hydrocarbons (HC) were collected to provide 24 hour averages for each pollutant. Every three months, mean concentrations were reported to IEPA. Composite samples from all five stations were stored in a databank operated by IEPA. The ambient air quality guidelines were obtained from WHO reports. Statistical analysis was carried out using a regression model, which was designed to fit the air pollution data and take into account missing data. The results showed that there was a statistically significant upward trend in air pollution levels for all of the measured pollutants, except NO2, during the years 1988 to 1993. WHO guidelines were routinely and substantially exceeded by all pollutants except TSM. These findings suggest that as the population continues to grow, and increasing numbers of motor vehicles are driven in Tehran, there is concern for the health effects that may result from exposure to these pollutants.     

Perceptions of air pollution during the work-related commute by adults in Queensland,Australia

BackgroundThis study examines perceived health effect risks from air pollution during the work-related commute by socio-demographic and travel mode variables.MethodsPopulation-representative survey data were collected by telephone from 745 adults from Queensland, Australia. Variables assessed included socio-demographics, usual work travel mode, commute perceptions, and perceived health effects associated with air pollution during the work-related commute.ResultsApproximately 45% of the sample perceived air pollution negatively affected health outcomes when commuting to/from work, yet only 13% recognised air pollution as a major barrier to walking or cycling to/from work. No relationships existed between usual travel mode to/from work and perceived health risks associated with air pollution. Those higher educated or living in major cities were more likely to recognise air pollution harmed their health during their work-related commute when compared to respective referent categories (p ≤ 0.05).ConclusionsRecognition of health risks from air pollution during the work-related commute was high, and awareness did not differ by travel mode. For the majority, air pollution was not a primary barrier for walking or cycling to/from work.     

An Epidemiological Appraisal of the Effects of Ambient Air on Health: Particulates and Oxides of Sulfur

This review has attempted to evaluate the present state of our knowledge of the effects on health in man of environmental exposure to oxides of sulfur, sulfates, and particulate matter. There has been a great deal of activity in this field over the last 15 years, and therefore any collation of this material will represent the selected biases of the reviewer. The conclusions reached can be summarized as follows: (1) These pollutants, as they have been measured in epidemiological investigations, can only be considered as indirect indices of general air pollution and in many cases cannot be separated from each other. Therefore, we cannot incriminate a specific source of any one pollutant as the producer of the most harmful substance to reach the ambient air. Conversely, we cannot excuse any specific source of one pollutant because that specific pollutant has not been found to cause disease at a given concentration. The measurements in ambient air are the net results from all sources of pollution in combination with factors influenced by weather and meteorological considerations. (2) Direct effects from acute, high ambient air pollution disasters have been adequately demonstrated. Significant excess mortality has occurred in association with particular air pollution episodes. All of these episodes have occurred during cold weather, and the effects of temperature must also be considered along with elevated levels of smoke and sulfur oxides. (3) Specific working groups exposed to unusually high levels of these pollutants do not demonstrate dramatic effects. This is presumably related to the fact that susceptible people are self-selected out of these environments. (4) Associations between the prevalence of chronic respiratory disease in the general population and specific levels of these air pollutants have been demonstrated. The major thrusts of epidemiological investigations have been to study the effects of chronic exposure to ambient levels of smoke and sulfur dioxide. The studies to date have collected and analyzed point-prevalence data and information obtained from retrospective investigations. Although epidemiological investigations cannot prove a cause-and-effect relationship, the consistency of the results is such that one must conclude that a causal association is likely. In this reviewer’s opinion we have reached the stage at which we no longer need to demonstrate the effect of past exposure to these pollutants. What is needed now is to demonstrate the effects of current and continued exposure. This will require a better understanding of the natural history and pathophysiology of the diseases thought to be associated with chronic exposure to smoke and sulfur dioxide. Because of the nature of chronic respiratory disease, groups of subjects for whom exposure is known, must be followed over extended periods of time. The logical extension of these observations will be the follow-up of large populations for whom exposure has been reduced. Only by studies of this kind may we be able to prove the cause-and-effect relationship which most likely exists.     

Determinants of perceived air pollution annoyance and association between annoyance scores and air pollution (PM2.5, NO2) concentrations in the European EXPOLIS study

Apart from its traditionally considered objective impacts on health, air pollution can also have perceived effects, such as annoyance. The psychological effects of air pollution may often be more important to well-being than the biophysical effects. Health effects of perceived annoyance from air pollution are so far unknown. More knowledge of air pollution annoyance levels, determinants and also associations with different air pollution components is needed. In the European air pollution exposure study, EXPOLIS, the air pollution annoyance as perceived at home, workplace and in traffic were surveyed among other study objectives. Overall 1736 randomly drawn 25–55-yr-old subjects participated in six cities (Athens, Basel, Milan, Oxford, Prague and Helsinki). Levels and predictors of individual perceived annoyances from air pollution were assessed. Instead of the usual air pollution concentrations at fixed monitoring sites, this paper compares the measured microenvironment concentrations and personal exposures of PM_2.5 and NO₂ to the perceived annoyance levels. A considerable proportion of the adults surveyed was annoyed by air pollution. Female gender, self-reported respiratory symptoms, downtown living and self-reported sensitivity to air pollution were directly associated with high air pollution annoyance score while in traffic, but smoking status, age or education level were not significantly associated. Population level annoyance averages correlated with the city average exposure levels of PM_2.5 and NO₂. A high correlation was observed between the personal 48-h PM_2.5 exposure and perceived annoyance at home as well as between the mean annoyance at work and both the average work indoor PM_2.5 and the personal work time PM_2.5 exposure. With the other significant determinants (gender, city code, home location) and home outdoor levels the model explained 14% (PM_2.5) and 19% (NO₂) of the variation in perceived air pollution annoyance in traffic. Compared to Helsinki, in Basel and Prague the adult participants were more annoyed by air pollution while in traffic even after taking the current home outdoor PM_2.5 and NO₂ levels into account.     

Associations and lags between air pollution and acute respiratory visits in an ambulatory care setting: 25-month results from the aerosol research and inhalation epidemiological study

Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0-2 days lagged moving average, as well as the 3-5 days and 6-8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI.     

Long-term associations of morbidity with air pollution: A catalog and synthesis

I searched the National Institutes of Health MEDLINE database through January 2017 for long-term studies of morbidity and air pollution and cataloged them with respect to cardiovascular, respiratory, cancer, diabetes, hospitalization, neurological, and pregnancy-birth endpoints. The catalog is presented as an online appendix. Associations with PM_2.5 (particulate matter with an aerodynamic diameter <2.5 μm), PM₁₀ (PM with an aerodynamic diameter <10 μm), and nitrogen dioxide (NO₂) were evaluated most frequently among the 417 ambient air quality studies identified. Associations with total suspended particles (TSP), carbon, ozone, sulfur, vehicular traffic, radon, and indoor air quality were also reported. I evaluated each study in terms of pollutant significance (yes, no), duration of exposure, and publication date. I found statistically significant pollutant relationships (P < 0.05) in 224 studies; 220 studies indicated adverse effects. Among 795 individual pollutant effect estimates, 396 are statistically significant. Pollutant associations with cardiovascular indicators, lung function, respiratory symptoms, and low birth weight are more likely to be significant than with disease incidence, heart attacks, diabetes, or neurological endpoints. Elemental carbon (EC), traffic, and PM_2.5 are most likely to be significant for cardiovascular outcomes; TSP, EC, and ozone (O₃) for respiratory outcomes; NO₂ for neurological outcomes; and PM₁₀ for birth/pregnancy outcomes. Durations of exposure range from 60 days to 35 yr, but I found no consistent relationships with the likelihood of statistical significance. Respiratory studies began ca. 1975; studies of diabetes, cardiovascular, and neurological effects increased after about 2005. I found 72 studies of occupational air pollution exposures; 40 reported statistically significant adverse health effects, especially for respiratory conditions. I conclude that the aggregate of these studies supports the existence of nonlethal physiological effects of various pollutants, more so for non–life-threatening endpoints and for noncriteria pollutants (TSP, EC, PM_2.5 metals). However, most studies were cross-sectional analyses over limited time spans with no consideration of lag or disease latency. Further longitudinal studies are thus needed to investigate the progress of disease incidence in association with air pollution exposure.

Implications: Relationships of air pollution with excess mortality are better known than with long-term antecedent morbidity. I cataloged 489 studies of cardiovascular, respiratory, cancer, and neurological effects, diabetes, and birth outcomes with respect to 12 air pollutants. About half of the studies reported statistically significant relationships, more frequently with noncriteria than with criteria pollutants. Indoor and cumulative exposures, coarse or ultrafine particles, and organic carbon were seldom considered. Significant relationships were more likely with less-severe endpoints such as blood pressure, lung function, or respiratory symptoms than with incidence of cancer, chronic obstructive pulmonary disease (COPD), heart failure, or diabetes. Most long-term studies are based on spatial relationships; longitudinal studies are needed to link the progression of pollution-related morbidity to mortality, especially for the cardiovascular system.     

An investigation of distributed lag models in the context of air pollution and mortality time series analysis

In particulate air pollution mortality time series studies, the particulate air pollution exposure measure used is typically the current day's or the previous day's air pollution concentration or a multi-day moving average air pollution concentration. Distributed lag models (DLMs) that allow for differential air pollution effects that are spread over multiple days are seen as an improvement over using a single- or multi-day moving average air pollution exposure measure. However, at the current time, the statistical properties of DLMs as a measure of air pollution exposure have not been investigated. In this paper, a simulation study is used to investigate the performance of DLMs as a measure of air pollution exposure in comparison with single- and multi-day moving average air pollution exposure measures under various forms for the true effect of air pollution on mortality. The simulation study shows that DLMs offer a more robust measure of the effect of air pollution on mortality and avoid the potential for a large negative bias compared with single- or multi-day moving average air pollution exposure measures. This is important information. In many U.S. cities, particulate air pollution concentrations are observed only once every six days, meaning it is often only possible to use single-day particulate air pollution exposure measures. The results from this paper will help quantify the magnitude of the negative bias that can result from using single-day exposure measures. The implications of this work for future air pollution mortality time series studies are discussed. The data used in this paper are concurrent daily time series of mortality, weather, and particulate air pollution from Cook County, IL, for the period 1987-1994.     

Ambient Air Pollution and Daily Pediatric Hospitalizations for Asthma (5 pp)

Background, Aim and Scope A series of severe air pollution episodes in Europe and North America prior to 1960 have focused scientific and regulatory attention on the adverse effects of air pollution on human health. As a consequence of significant reductions in ambient air pollution levels in the intervening years, scientists and public health officials have become more concerned with the potential health effects of exposure to routine concentrations of air pollution. Several recent time series studies conducted world-wide have found relatively low levels of air pollutants that are below national standards were associated with adverse effects on mortality and morbidity. This study examined the effects of ambient air pollution indicators on the daily rate of pediatric hospital admissions for asthma in the Oklahoma City Metropolitan area from 2001-2003. Results: Negative binomial regression analysis revealed significant relationships between the total number of hospitalizations per day and the one-hour maximum NO2 level, the proportion of susceptible children < 5 years old, and the ratio of temperature to humidity. Discussion: This study of the total number of children aged ≤ 14 years old experiencing hospitalizations on a daily basis in the Oklahoma City area from 2001-2003 underscores factors other than ambient air pollution, especially when concentrations are low, affect hospitalizations for pediatric asthma. For example, information related to indoor air quality, health care, family history, and exposure to environmental tobacco smoke and other irritants are not obtainable. Yet, those factors are risk drivers for asthma. Similarly, health privacy requirements prevented obtaining data on physiological factors specific to each child such as differentials in airways functional capacity or other impairments influenced asthma exacerbation. This makes calculating relative risk inappropriate. Conclusions: Although ambient air pollution concentrations and meteorological conditions influence pediatric asthma hospitalizations, they are not the major predictors in the Oklahoma City metropolitan area. This is consistent with other research that finds limited effects associated with low levels for concentrations of the criteria pollutants.