1. Georgia 2008 Air Quality & Climate Summit Communicating Risk: How Should We Monitor Air Quality and Respond Appropriately? Gerry Teague

2. We all agree that bad air is bad….. BUT, Are health risks the same for everyone? Is there a minimum “safe” exposure level? Aren’t you safe if you don’t live downtown?

3. Why the Health Message is Lost: Flaws in Current Air Pollution Policy Not consistent among agencies Shaped by political and commercial agendas Emphasis on public vs. personal exposure

4. Communicating Exposure When you can see bad air you hear about it! Vehicular emissions – personal aspects - micro-effects of busy thoroughfares - school buses Effects of age (children) Effects of activity (athletes)

5. The Atlanta Journal-Constitution March 2, 2007 Controlled Fire Leaves Atlanta Area Wheezing….

6. 400 m EC: 9 times higher at road OC: 1.4 times higher at road 4.5 0.5 11 7.8 4.7 4.3 (Soot)(Water-Soluble) Personal Exposure – How near a freeway is safe? Courtesy of Rodney Weber, PhD, Ga Inst. Tech

7. The Dilemma of School Buses: What is Good for the Air Ain’t Good for You Children who ride in school buses are exposed to levels of diesel soot high enough to result in an an additional 23-46 cancer cases per million children exposed. National Resources Defense Council, Coalition for Clean Air, UC Berkeley

8. Zone Concept: Children Inhale More Indoor Irritants 2 ft. Adult 6 ft. Child Breathing Zones Toddlers Disturbed Irritants, Particles, and Allergens Disturbed Irritants, Particles, and Allergens

9. Athletes Hyperventilate Bad Air The lung is more exposed to airborne pollutants: RestExercise Minute ventilation 5 40 - 80 (L/min) Athletes tend to mouth breath, and bypass the nasal filter.

10. Adverse Health Effects of Air Pollution Excellent evidence: - exacerbations of asthma - increased heart attack and stroke Fair to good evidence: - exacerbations of other chronic lung diseases (COPD, cystic fibrosis) - lung cancer - reduced lung growth in children Growing evidence: - environmental genomics - effects of micro-climates - risks in athletes

11. The Challenge: Bad Air is A Soup Ozone (O 3 ) Nitrogen dioxide (NO 2 ) Sulfur dioxide (SO 2 ) Carbon monoxide (CO) Lead (Pb) Particulate matter (PM 2.5 and PM 10 )

12. Old and Young Young children whose lungs are developing, and seniors and people with chronic disorders of the lungs and heart are more sensitive. Sensitive Individuals Individuals with asthma, chronic bronchitis, emphysema, cystic fibrosis, and known cardiac conditions should take extra precautions during air pollution episodes. Healthy People Everyone who works outside or engages in vigorous outdoor exercise for prolonged periods during smog episodes is at increased risk of experiencing adverse health effects caused by smog. Dose = (Pollutant Concentration) X (Breathing Rate) X (Time Engaged in Activity) Another challenge: humans are complicated! Level of Risk: Courtesy of Michael Chang

13. 0 50150 Air Quality Index Risk of symptoms Symptom Risk and the AQI: Does Not Account for Human Variation Does not take into account: - genetic susceptibility - antioxidant status - nutrition

14. Bad Air Myths A person is protected from air pollution if they live in the suburbs or on a farm. A healthy person is not threatened by bad air. Indoor air is safer than outdoor air during a pollution event. A “safe” level of air pollution has been identified.

15. What I Tell My Patient’s Parents Pay attention to the air quality report. If your child takes the school bus, insist on a “retro-fitted” one. On a bad air day avoid outdoors exercise between 4:00 and 6:00 pm. Live and go to school away from busy traffic corridors if you can. Don’t get ripped off by the indoor air purification industry.