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Sasha Khomenko, Enrico Pisoni, Philippe Thunis, Bertrand Bessagnet, Marta Cirach, Tamara Iungman, Evelise Pereira Barboza, Haneen Khreis, Natalie Mueller, Cathryn Tonne, Kees de Hoogh, Gerard Hoek, Sourangsu Chowdhury, Jos Lelieveld, Mark Nieuwenhuijsen, Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment. Lancet Public Health 2023; 8: e546-58 (13 p.) [formato PDF, 9,6 MB + Supplementary Material]. Open Access. "Background: Ambient air pollution is a major risk to health and wellbeing in European cities. We aimed to estimate spatial and sector-specific contributions of emissions to ambient air pollution and evaluate the effects of source-specific reductions in pollutants on mortality in European cities to support targeted source-specific actions to address air pollution and promote population health. Methods: We conducted a health impact assessment of data from 2015 for 857 European cities to estimate source contributions to annual PM2.5 and NO2 concentrations using the Screening for High Emission Reduction Potentials for Air quality tool. We evaluated contributions from transport, industry, energy, residential, agriculture, shipping, and aviation, other, natural, and external sources. For each city and sector, three spatial levels were considered: contributions from the same city, the rest of the country, and transboundary. Interpretation: We estimated source-specific air pollution health effects at the city level. Our results show strong variability, emphasising the need for local policies and coordinated actions that consider city-level specificities in source contributions."

Nick Watts, Markus Amann, Nigel Arnell, Sonja Ayeb-Karlsson, Kristine Belesova, Maxwell Boykoff, Peter Byass, Wenjia Cai, Diarmid Campbell-Lendrum, Stuart Capstick, Jonathan Chambers, Carole Dalin, Meaghan Daly, Niheer Dasandi, Michael Davies, Paul Drummond, Robert Dubrow, Kristie L Ebi, Matthew Eckelman, Paul Ekins, Luis E Escobar, Lucia Fernandez Montoya, Lucien Georgeson, Hilary Graham, Paul Haggar, Ian Hamilton, Stella Hartinger, Jeremy Hess, Ilan Kelman, Gregor Kiesewetter, Tord Kjellstrom, Dominic Kniveton, Bruno Lemke, Yang Liu, Melissa Lott, Rachel Lowe, Maquins Odhiambo Sewe, Jaime Martinez-Urtaza, Mark Maslin, Lucy McAllister, Alice McGushin, Slava Jankin Mikhaylov, James Milner, Maziar Moradi-Lakeh, Karyn Morrissey, Kris Murray, Simon Munzert, Maria Nilsson, Tara Neville, Tadj Oreszczyn, Fereidoon Owfi, Olivia Pearman, David Pencheon, Dung Phung, Steve Pye, Ruth Quinn, Mahnaz Rabbaniha, Elizabeth Robinson, Joacim Rocklöv, Jan C Semenza, Jodi Sherman, Joy Shumake-Guillemot, Meisam Tabatabaei, Jonathon Taylor, Joaquin Trinanes, Paul Wilkinson, Anthony Costello, Peng Gong, Hugh Montgomery, The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet 2019; 394: 1836-1878 (43 p.)[formato PDF, 14,3 MB]. "The data published here elucidate the ongoing trends of a warming world with effects that threaten human wellbeing. As the fourth hottest year on record, 2018 saw a record-breaking 220 million additional exposures to extremes of heat, coupled with corresponding increased vulnerability to heat across every continent. As a result of this and broader climatic changes, vectorial capacity for the transmission of dengue fever was the second highest recorded, with 9 of the past 10 most suitable years occurring since 2000. Progress in mitigation and adaptation remains insufficient, with the carbon intensity of the energy system remaining flat; 2-9 million ambient air pollution deaths; and a reversal of the previous downward trend of coal use."

Emily Riley, Patrick Harris, Jennifer Kent, Peter Sainsbury, Anna Lane, Fran Baum, Including Health in Environmental Assessments of Major Transport Infrastructure Projects: A Documentary Analysis, Int J Health Policy Manag 2017, 6(x), 1-11 (10 p.) [formato PDF, 630 kB]. Open Access. Background: Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia. Methods: We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included. Results: We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise. Conclusion: Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant limitation, and there is a need for health issues to be considered when earlier, fundamental decisions about the project are being made."

Urban design, transport, and health. Online/Series. The Lancet 2016 (42 p.) [formato PDF, 6,6 MB]. http://dx.doi.org/10.1016/S0140-6736(16)30068-X [free registration needed]. Part 1: City planning and population health: a global challenge; Part 2: Land use, transport, and population health: estimating the health benefits of compact cities; Part 3: Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities. "Worldwide, the majority of people already live in cities and by 2050, it is estimated that 75% of 10 billion people have cities as an important social determinant of health. Air pollution, physical inactivity, noise, social isolation, unhealthy diets, and exposure to crime play a very important part in the non-communicable disease burden. This 3-part Series explores how integrated multisector city planning, including urban design and transport planning, can be used as an important and currently underused force for health and wellbeing within the framework of the Sustainable Development Goals in both high-income countries and low-income and middle-income countries."

David Rojas-Rueda, Audrey de Nazelle, Zorana J. Andersen, Charlotte Braun-Fahrländer, Jan Bruha, Hana Bruhova-Foltynova, Hélène Desqueyroux, Corinne Praznoczy, Martina S. Ragettli, Marko Tainio, Mark J. Nieuwenhuijsen, Health Impacts of Active Transportation in Europe. PLoS ONE 11(3) 2016 : e0149990 (14 p.) [formato PDF, 1,4 MB]. Open Access. "Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active transportation for commuting populations (age groups 16-64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76-163) annual deaths avoided, Prague 61 (29-104), Barcelona 37 (24-56), Paris 37 (18-64) and Basel 5 (3-9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3-42) deaths avoided annually in Warsaw, 11(3-21) in Prague, 6 (4-9) in Basel, 3 (2-6) in Copenhagen and 3 (2-4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation."

Michael Jerrett, Rob McConnell, Jennifer Wolch, Roger Chang, Claudia Lam, Genevieve Dunton, Frank Gilliland, Fred Lurmann, Talat Islam and Kiros Berhane, Traffic-related air pollution and obesity formation in children: a longitudinal, multilevel analysis. Environmental Health 2014, 13:49 (9 p.) [formato PDF, 1,11 MB]. Open Access. "Background: Biologically plausible mechanisms link traffic-related air pollution to metabolic disorders and potentially to obesity. Here we sought to determine whether traffic density and traffic-related air pollution were positively associated with growth in body mass index (BMI = kg/m2) in children aged 5–11 years. Methods: Participants were drawn from a prospective cohort of children who lived in 13 communities across Southern California (N = 4550). Children were enrolled while attending kindergarten and first grade and followed for 4 years, with height and weight measured annually. Dispersion models were used to estimate exposure to traffic-related air pollution. Multilevel models were used to estimate and test traffic density and traffic pollution related to BMI growth. Data were collected between 2002–2010 and analyzed in 2011–12. Results: Traffic pollution was positively associated with growth in BMI and was robust to adjustment for many confounders. The effect size in the adjusted model indicated about a 13.6% increase in annual BMI growth when comparing the lowest to the highest tenth percentile of air pollution exposure, which resulted in an increase of nearly 0.4 BMI units on attained BMI at age 10. Traffic density also had a positive association with BMI growth, but this effect was less robust in multivariate models. Conclusions: Traffic pollution was positively associated with growth in BMI in children aged 5–11 years. Traffic pollution may be controlled via emission restrictions; changes in land use that promote jobs-housing balance and use of public transit and hence reduce vehicle miles traveled; promotion of zero emissions vehicles; transit and car-sharing programs; or by limiting high pollution traffic, such as diesel trucks, from residential areas or places where children play outdoors, such as schools and parks. These measures may have beneficial effects in terms of reduced obesity formation in children."

Neil Maizlish, James Woodcock, Sean Co, Bart Ostro, Amir Fanai, and David Fairley, Health cobenefits and transportation-related reductions in greenhouse gas emissions in the San Francisco Bay area. American Journal of Public Health, April 2013, Vol 103, No. 4, 703-709 (7 p.) [formato PDF, 554 kB]. "OBJECTIVES: We quantified health benefits of transportation strategies to reduce greenhouse gas emissions (GHGE). METHODS: Statistics on travel patterns and injuries, physical activity, fine particulate matter, and GHGE in the San Francisco Bay Area, California, were input to a model that calculated the health impacts of walking and bicycling short distances usually traveled by car or driving low-emission automobiles. We measured the change in disease burden in disability-adjusted life years (DALYs) based on dose-response relationships and the distributions of physical activity, particulate matter, and traffic injuries. RESULTS: Increasing median daily walking and bicycling from 4 to 22 minutes reduced the burden of cardiovascular disease and diabetes by 14% (32,466 DALYs), increased the traffic injury burden by 39% (5907 DALYS), and decreased GHGE by 14%. Low-carbon driving reduced GHGE by 33.5% and cardiorespiratory disease burden by less than 1%. CONCLUSIONS: Increased physical activity associated with active transport could generate a large net improvement in population health. Measures would be needed to minimize pedestrian and bicyclist injuries. Together, active transport and low-carbon driving could achieve GHGE reductions sufficient for California to meet legislative mandates."

Ting Xia, Ying Zhang, Shona Crabb, and Pushan Shah, Cobenefits of Replacing Car Trips with Alternative Transportation: A Review of Evidence and Methodological Issues. Journal of Environmental and Public Health, Volume 2013 (2013), Article ID 797312, 14 pages [formato PDF, 1,29 MB]. "It has been reported that motor vehicle emissions contribute nearly a quarter of world energy-related greenhouse gases and cause nonnegligible air pollution primarily in urban areas. Reducing car use and increasing ecofriendly alternative transport, such as public and active transport, are efficient approaches to mitigate harmful environmental impacts caused by a large amount of vehicle use. Besides the environmental benefits of promoting alternative transport, it can also induce other health and economic benefits. At present, a number of studies have been conducted to evaluate cobenefits from greenhouse gas mitigation policies. However, relatively few have focused specifically on the transport sector. A comprehensive understanding of the multiple benefits of alternative transport could assist with policy making in the areas of transport, health, and environment. However, there is no straightforward method which could estimate cobenefits effect at one time. In this paper, the links between vehicle emissions and air quality, as well as the health and economic benefits from alternative transport use, are considered, and methodological issues relating to the modelling of these cobenefits are discussed."

V. Adamec, R. Ličbinský, R. Cholava (Transport Research Centre, Brno), Transport and Health Risks of Transport. Transactions on Transport Sciences, 2012, Volume 4, Issue 3, Pages 115–134 (20 p.) [formato PDF, 675 kB]. "The increasing amount of gases and solid pollutants emitted into the atmosphere have a considerable impact on human health and environmental ecosystems. Specifically, long exposure to high concentrations of pollutants may lead to a shortening of life by several years due to cardiovascular and respiratory diseases, and contributes to increased risk of death. Recent studies also indicate cancer occurrences related to some pollutants, namely PM, that are hazardous not only due to their physical parameters, but mainly due to their content of many dangerous organic compounds, such as hydrocarbons, polyaromatic hydrocarbons and their derivates, and inorganic compounds, such as Pb, Pt, Cd, As, Cu, Zn, and others, nitrates, ammonia ions, sulphates, etc."

Jennifer S. Mindell, Deborah Leslie, Malcolm Wardlaw, Exposure-Based, ‘Like-for-Like’ Assessment of Road Safety by Travel Mode Using Routine Health Data. PLoS ONE 7(12): e50606, 2012, 10 p. [formato PDF, 737 kB]. "Background: Official reports on modal risk have not chosen appropriate numerators and denominators to enable like-forlike comparisons. We report age- and sex-specific deaths and injury rates from equivalent incidents in England by travel mode, distance travelled and time spent travelling. Methods: Hospital admissions and deaths in England 2007–2009 were obtained for relevant ICD-10 external codes for pedestrians, cyclists, and car/van drivers, by age-group and sex. Distance travelled by age-group, sex and mode in England (National Travel Survey 2007–2009 data) was converted to time spent travelling using mean trip speeds. Fatality rates were compared with age-specific Netherlands data. Results: All-age fatalities per million hours’ use (f/mhu) varied over the same factor-of-three range for both sexes (0.15– 0.45 f/mhu by mode for men, 0.09–0.31 f/mhu for women). Risks were similar for men aged 21–49 y for all three modes and for female pedestrians and drivers aged 21–69 y. Most at risk were: males 17–20 y (1.3 f/mhu (95% CI 1.2–1.4)) for driving; males 70+ (2.2 f/mhu(1.6–3.0)) for cycling; and females 70+ (0.95 f/mhu (0.86–1.1)) for pedestrians. In general, fatality rates were substantially higher among males than females. Risks per hour for male drivers ,30 y were similar or higher than for male cyclists; for males aged 17–20 y, the risk was higher for drivers (33/Bn km (30–36), 1.3 f/mhu (1.2–1.4)) than cyclists (20/ Bn km (10–37), 0.24 f/mhu (0.12–0.45)) whether using distance or time. Similar age patterns occurred for cyclists and drivers in the Netherlands. Age-sex patterns for injuries resulting in hospital admission were similar for cyclists and pedestrians but lower for drivers. Conclusions: When all relevant ICD-10 codes are used, fatalities by time spent travelling vary within similar ranges for walking, cycling and driving. Risks for drivers were highest in youth and fell with age, while for pedestrians and cyclists, risks increased with age. For the young, especially males, cycling is safer than driving."

Jamie Hosking, Pierpaolo Mudu, Carlos Dora, Health in the green economy: health co-benefits of climate change mitigation – transport sector. World Health Organization, Geneva, 2011, 156 p. [formato PDF, 4,19 MB] "Cycling, walking and rapid transit systems are associated with a wide range of potential health benefits that climate assessment needs to consider more systematically. Health benefits may include: physical activity from walking and cycling, which can help prevent heart disease, some cancers, type 2 diabetes, and some obesity-related risks; lower urban air pollution concentrations; lower rates of traffic injury risks for users of dedicated bicycle and pedestrian networks; and less noise stress. Transport systems that prioritize active transport and rapid transit systems, along with better urban land use, also can help improve access for vulnerable groups, including children, the elderly, people with disabilities, and lower wage earners, enhancing health equity. This new WHO report, part of the Health in the Green Economy series, considers the evidence regarding health co-benefits, and risks, of climate change mitigation strategies for transport, as reviewed by the Intergovernmental Panel on Climate Change (IPCC, 2007)."

Carlos Dora, Jamie Hoskings, Pierpaolo Mudu, Elaine Fletcher, Urban Transport and Health. (Sustainable Transport: A Sourcebook for Policy-makers in Developing Cities, module 5g). Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Eschborn, World Health Organization, Geneva, 2011, 60 p. [formato PDF, 2,47 MB]

James Woodcock, Phil Edwards, Cathryn Tonne, Ben G Armstrong, Olu Ashiru, David Banister, Sean Beevers, Zaid Chalabi, Zohir Chowdhury, Aaron Cohen, Oscar H Franco, Andy Haines, Robin Hickman, Graeme Lindsay, Ishaan Mittal, Dinesh Mohan, Geetam Tiwari, Alistair Woodward, Ian Roberts, Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport, Lancet 2009; 374: 1930–43 [formato PDF, 466 KB] + Supplementary webappendix, 41 p. [formato PDF, 1,06 MB] "We used Comparative Risk Assessment methods to estimate the health effects of alternative urban land transport scenarios for two settings—London, UK, and Delhi, India. For each setting, we compared a business-as-usual 2030 projection (without policies for reduction of greenhouse gases) with alternative scenarios—lower-carbon-emission motor vehicles, increased active travel, and a combination of the two. We developed separate models that linked transport scenarios with physical activity, air pollution, and risk of road traffic injury. In both cities, we noted that reduction in carbon dioxide emissions through an increase in active travel and less use of motor vehicles had larger health benefits per million population (7332 disability-adjusted life-years [DALYs] in London, and 12 516 in Delhi in 1 year) than from the increased use of lower-emission motor vehicles (160 DALYs in London, and 1696 in Delhi). However, combination of active travel and lower-emission motor vehicles would give the largest benefits (7439 DALYs in London, 12 995 in Delhi), notably from a reduction in the number of years of life lost from ischaemic heart disease (10—19% in London, 11—25% in Delhi). Although uncertainties remain, climate change mitigation in transport should benefit public health substantially. Policies to increase the acceptability, appeal, and safety of active urban travel, and discourage travel in private motor vehicles would provide larger health benefits than would policies that focus solely on lower-emission motor vehicles." [per il full text è necessaria la registrazione gratuita sul sito di "The Lancet"].

Transport-related health effects with a particular focus on children. Towards an Integrated Assessment of their Costs and Benefits. State of the Art Knowledge, Methodological Aspects and Policy Directions. Synthesis Report. Austrian Federal Ministry of Agriculture, Forestry, Environment and Water Management, Vienna, 2004, 72 p. [formato PDF, 2,13 MB]. "This study provided evidence for actions to reduce the effects of transport on children's health associated to air pollution, noise, physical activity, as well as the psychosocial impact. Five topic reports cover these issues and the economic valuation. A set of key messages was specifically developed for policy-makers. The study was an initiative of six countries (Austria, France, Malta, Netherlands, Sweden and Switzerland) within the WHO-UNECE pan-European programme on transport, environment and Health."


Natalie Gravett, Luis Mundaca (International Institute for Industrial Environmental Economics, Lund University), Assessing the economic benefits of active transport policy pathways: Opportunities from a local perspective. Transportation Research Interdisciplinary Perspectives 11 (2021) 100456 (17 p.) [formato PDF, 8,8 MB]. Open Access. "Combined with concerns about climate change, air pollution and human health, the COVID-19 pandemic has renewed the use of and policy interest in active transport (AT) modes, namely cycling and walking. However, we note a high degree of uncertainty and lack of assessments addressing the economic benefits of AT policies; particularly when they are used as a mix of policies at the local level. This study aims to address this knowledge gap. We use the city of Oxford as a case study and apply the WHO Health Economic Assessment Tool and different baselines to assess four policy packages promoting a mode shift to AT for the 2030-2050 period. In total, 312 policy scenarios were produced and analysed. Results show that a policy mix that maximises economic benefits entails bike-sharing, cycle parking, training and education, low traffic neighbourhoods, e-bike grants, a workplace parking levy and increased use of a 'cycle-to-work' Scheme. Considering the health impacts from increased physical activity and avoided CO2 emissions, benefits are estimated in the range of: 62-256 prevented premature deaths; 18-50 million tonnes of avoided CO2e emissions; resulting in a total gross benefit of €3.45-11.28 billion. These impacts remain high and robust when key input parameters are tested via a sensitivity analysis. We conclude that investing in AT policy measures represents a multi-faceted low-carbon opportunity that should not be missed by policymakers."

Christian Brand, Evi Dons, Esther Anaya-Boig, Ione Avila-Palencia, Anna Clark, Audrey de Nazelle, Mireia Gascon, Mailin Gaupp-Berghausen, Regine Gerike, Thomas Götschi, Francesco Iacorossi, Sonja Kahlmeier, Michelle Laeremans, Mark J Nieuwenhuijsen, Juan Pablo Orjuela, Francesca Racioppi, Elisabeth Raser, David Rojas-Rueda, Arnout Standaert, Erik Stigell, Simona Sulikova, Sandra Wegener, Luc Int Panis, The climate change mitigation effects of daily active travel in cities. Transportation Research Part D 93 (2021) 102764 (18 p.) [formato PDF, 1,1 MB]. Open Access. "Active travel (walking or cycling for transport) is considered the most sustainable form of personal transport. Yet its net effects on mobility-related CO2 emissions are complex and under-researched. Here we collected travel activity data in seven European cities and derived life cycle CO2 emissions across modes and purposes. Daily mobility-related life cycle CO2 emissions were 3.2 kgCO2 per person, with car travel contributing 70% and cycling 1%. Cyclists had 84% lower life cycle CO2 emissions than non-cyclists. Life cycle CO2 emissions decreased by -14% per additional cycling trip and decreased by -62% for each avoided car trip. An average person who 'shifted travel modes' from car to bike decreased life cycle CO2 emissions by 3.2 kgCO2/day. Promoting active travel should be a cornerstone of strategies to meet net zero carbon targets, particularly in urban areas, while also improving public health and quality of urban life."

Hermes Eduardo Nichele, Relations between cycling and healthcare network and the case of Curitiba. Cad. Metrop., São Paulo, v. 23, n. 52, pp. 993-1016, set/dez 2021 (24 p.) [formato PDF, 2,3 MB]. Open Access. "In the present moment of the COVID-19 pandemic, which demands social distancing, the bicycle confirms itself as an advantageous alternative mode. This article reflects on the association between cycling and health through an index proposed to evaluate such association, the Index of Cycling Mobility in relation to the Healthcare Network (in Portuguese, IMCS). The theoretical framework presents the qualities of cycling and the principles that the planning of bike lanes must involve. As a case study, Curitiba's cycling network and its relation to Primary Care Units are analyzed through the IMCS, in the current and projected situations. The results show that Curitiba neglects cycling mobility and that the local healthcare system is practically inaccessible through the cycling network."

Jessica E. Bourne, Sarah Sauchelli, Rachel Perry, Angie Page, Sam Leary, Clare England and Ashley R. Cooper, Health benefits of electrically-assisted cycling: a systematic review. International Journal of Behavioral Nutrition and Physical Activity (2018) 15:116 (15 p.) [formato PDF, 1,2 MB]. Open Access. "Background: Electrically assisted bicycles (e-bikes) have been highlighted as a method of active travel that could overcome some of the commonly reported barriers to cycle commuting. The objective of this systematic review was to assess the health benefits associated with e-cycling. Method: A systematic literature review of studies examining physical activity, cardiorespiratory, metabolic and psychological outcomes associated with e-cycling. Where possible these outcomes were compared to those from conventional cycling and walking. Seven electronic databases, clinical trial registers, grey literature and reference lists were searched up to November 2017. Hand searching occurred until June 2018. Experimental or observational studies examining the impact of e-cycling on physical activity and/or health outcomes of interest were included. E- bikes used must have pedals and require pedalling for electric assistance to be provided. Results: Seventeen studies (11 acute experiments, 6 longitudinal interventions) were identified involving a total of 300 participants. There was moderate evidence that e-cycling provided physical activity of at least moderate intensity, which was lower than the intensity elicited during conventional cycling, but higher than that during walking. There was also moderate evidence that e-cycling can improve cardiorespiratory fitness in physically inactive individuals. Evidence of the impact of e-cycling on metabolic and psychological health outcomes was inconclusive. Longitudinal evidence was compromised by weak study design and quality. Conclusion: E-cycling can contribute to meeting physical activity recommendations and increasing physical fitness. As such, e-bikes offer a potential alternative to conventional cycling. Future research should examine the long-term health impacts of e-cycling using rigorous research designs."

Richard Larouche, George Mammen, David A. Rowe and Guy Faulkner, Effectiveness of active school transport interventions: a systematic review and update, BMC Public Health (2018) 18:206 (18 p.) [formato PDF, 785 kB]. Open Access. "Background: Active school transport (AST) is a promising strategy to increase children's physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. Methods: Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen's d as a measure of effect size. Results: Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen's d ranged from -0.61 to 0.75, with most studies reporting "trivial-to-small" positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. Conclusions: Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions."

Houshmand E. Masoumi (Technische Universität Berlin), Active transport to school and children's body weight. A systematic review, Tema. Journal of Land Use, Mobility and Environment, 10 (1), 95-110 (16 p.) [formato PDF, 6 MB]. Open Access. "Because of decreasing physical activity of children, they are becoming more obese. Moreover, commuting to school has become more passive during the past decades. The objective was to update the previous systematic reviews by narrowing down the topic to body mass index of children (3-12 years) as a representative of body composition. Applying search terms such as active transport to school, body mass index, childhood obesity, and so on in four online databases: PubMed, ScienceDirect, WorldCat, and Google Scholar. Peer-reviewed English journal papers published between 2005 and 2015 presenting empirical quantitative studies were eligible studies to be reviewed. 310 journal papers were screened, 27 of which were reviewed by studying the full text. The final 13 papers were limited to those that focused only on active commuting to school and body mass index of children and adolescents. Out of 13 final studies, 3 found conclusive associations, three indicate partial associations in subgroups or societal or geographical limitations, and seven show no correlations. The existing literature are still inconsistent, so this study suggests conducting surveys with larger samples on less-studied contexts and applying more complex statistical methods for adjusting some of the variables. It is also argued that this topic can be culturally and contextually specific."

Carlos A Celis-Morales, Donald M Lyall, Paul Welsh, Jana Anderson, Lewis Steell, Yibing Guo, Reno Maldonado, Daniel F Mackay, Jill P Pell, Naveed Sattar, Jason M R Gill (University of Glasgow), Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study, BMJ 2017;357:j1456 (7 p.) [formato PDF, 441 kB]. Open Access. "Commuting by cycling was associated with a lower risk of all cause mortality and adverse CVD and cancer outcomes, and walking commuting was associated with lower risk of CVD incidence and mortality, in a dose dependent manner and independent of a range of confounding factors Mixed mode commuting including a cycle component was associated with a lower risk of all cause mortality and cancer outcomes Policies designed to affect a population level modal shift to more active modes of commuting, particularly by cycle (eg, cycle lanes, city bike hire, subsidised cycle purchase schemes, and increasing provision for cycles on public transport) may present major opportunities for the improvement of public health."

Hannah Verhoeven, Dorien Simons, Jelle Van Cauwenberg, Delfien Van Dyck, Corneel Vandelanotte, Bas de Geus, Ilse De Bourdeaudhuij, Peter Clarys, Benedicte Deforche, Promoting Active Transport in Older Adolescents Before They Obtain Their Driving Licence: A Matched Control Intervention Study. PLoS ONE 11(12): e0168594 (2016) (20 p.) [formato PDF, 1,7 MB]. Open Access. "Background. Active transport has great potential to increase physical activity in older adolescents (17-18 years). Therefore, a theory- and evidence-based intervention was developed aiming to promote active transport among older adolescents. The intervention aimed to influence psychosocial factors of active transport since this is the first step in order to achieve a change in behaviour. The present study aimed to examine the effect of the intervention on the following psychosocial factors: intention to use active transport after obtaining a driving licence, perceived benefits, perceived barriers, subjective norm, self-efficacy, habit and awareness towards active transport. Methods. A matched control three-arm study was conducted and consisted of a pre-test post-test design with intervention and control schools in Flanders (northern part of Belgium). A lesson promoting active transport was implemented as the last lesson in the course 'Driving Licence at School' in intervention schools (intervention group 1). Individuals in intervention group 2 received this active transport lesson and, in addition, they were asked to become a member of a Facebook group on active transport. Individuals in the control group only attended the regular course 'Driving Licence at School'. Participants completed a questionnaire assessing socio-demographics and psychosocial variables at baseline, post (after one week) and follow-up (after eight weeks). To assess intervention effects, multilevel linear mixed models analyses were performed. Results. A sample of 441 older adolescents (56.8% female; 17.4 (0.7) years) was analysed. For awareness regarding the existence of car sharing schemes, a significant increase in awareness from baseline to post measurement was found within intervention group 1 (p = 0.001) and intervention group 2 (p = 0.030) compared to the control group in which no change was found. In addition, a significant increase in awareness from baseline to follow-up measurement was found within intervention group 1 (p = 0.043) compared to a decrease in awareness from baseline to follow-up measurement within the control group. Conclusions. Overall, the intervention was not effective to increase psychosocial correlates of active transport. Future intervention studies should search for alternative strategies to motivate and involve this hard to reach target group."

Sinead Flavin, Siobhan Hamilton (National Transport Authority), Using Physical Activity Challenges to Increase Sustainable Commuting. Proceedings of the ITRN2016, 1st-2nd September 2016, Grangegorman, 8 p. [formato PDF, 154 kB]. "Smarter Travel Workplaces and Smarter Travel Campus are voluntary programmes to promote more sustainable and active travel, as part of a travel plan. Over 120 of the largest employers in the state are engaged in the programme. This includes all of the Irish universities and Institutes of Technology, and a mix of public and private employers comprising hospitals, local authorities, Irish and multi-national enterprises. Partners of the programme sign a Charter at the most senior level within the organisation committing to undertaking baseline/ monitoring travel surveys, implementing actions topromote more sustainable travel, and allocating personnel and financial resources to their plan. The quantum of investment is not stated, as this will depend on the organisation's available resources, and the problem they are looking to solve. While some Partners come to the programme through the planning process, more and more employers are looking at sustainable travel as a way to help them achieve employee wellbeing targets - including stress management, team building, and increasing physical activity. One of the key tools of engagement of the STW/STC programme is the Partner Challenges - which are designed as fun events to engage employees in walking and cycling promotions within their workplaces. The Challenges draw on good practice in the areas of health promotion, community based social marketing and travel planning. This presentation will summarise: the impact of the Pedometer Challenge for workplaces in terms of walking for leisure and on the commute. Year on year the challenge has increased the number of people walking on the commute, and more importantly, the number of drivers switching from car to 'on foot' for the commute; the programme cycling challenges - which again converted other mode users to cycling on the commute, but which has recently evolved from a 'behaviour trial' approach to partaking in the European Cycling Challenge. This event will take place in May 2016 - feedback from the event will be presented".

Noëlla Karusisi, Frédérique Thomas, Julie Méline, Ruben Brondeel, Basile Chaix, Environmental Conditions around Itineraries to Destinations as Correlates of Walking for Transportation among Adults: The RECORD Cohort Study. PLoS ONE 9(5): e88929 (May 2014) (8 p.) [formato PDF, 1,6 MB]. "Introduction: Assessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home - work itinerary, and the home - supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops. Methods: Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops. Results: High individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops. Conclusion: This research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than around the residence. These results provide insight for the development of policies and programs to encourage population level active commuting."

Paul Kelly, Sonja Kahlmeier, Thomas Götschi, Nicola Orsini, Justin Richards, Nia Roberts, Peter Scarborough and Charlie Foster, Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship, International Journal of Behavioral Nutrition and Physical Activity 2014, 11:132 (15 p.) [formato PDF, 192 kB]. Open Access. "Background and objective: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). Data sources: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. Study eligibility criteria and participants: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. Study appraisal and synthesis methods: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. Results: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose–response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose–response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. Conclusions and implications: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities."

Harry Rutter, Nick Cavill, Francesca Racioppi, Hywell Dinsdale, Pekka Oja, Sonja Kahlmeier, Economic Impact of Reduced Mortality Due to Increased Cycling, Am J Prev Med 2013; 44(1) 89–92 (4 p.) [formato PDF, 70 kB]. "Increasing regular physical activity is a key public health goal. One strategy is to change the physical environment to encourage walking and cycling, requiring partnerships with the transport and urban planning sectors. Economic evaluation is an important factor in the decision to fund any new transport scheme, but techniques for assessing the economic value of the health benefits of cycling and walking have tended to be less sophisticated than the approaches used for assessing other benefits. This study aimed to produce a practical tool for estimating the economic impact of reduced mortality due to increased cycling. The tool was intended to be transparent, easy to use, reliable, and based on conservative assumptions and default values, which can be used in the absence of local data. It addressed the question: For a given volume of cycling within a defined population, what is the economic value of the health benefits? The authors used published estimates of relative risk of all-cause mortality among regular cyclists and applied these to levels of cycling defined by the user to produce an estimate of the number of deaths potentially averted because of regular cycling. The tool then calculates the economic value of the deaths averted using the “value of a statistical life.” The outputs of the tool support decision making on cycle infrastructure or policies, or can be used as part of an integrated economic appraisal. The tool's unique contribution is that it takes a public health approach to a transport problem, addresses it in epidemiologic terms, and places the results back into the transport context. Examples of its use include its adoption by the English and Swedish departments of transport as the recommended methodologic approach for estimating the health impact of walking and cycling."

Ellen Flint, Steven Cummins, Amanda Sacker, Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom, BMJ 2014;349:g4887, 19 August 2014 (9 p.) [formato PDF, 590 kB]. Open Access. "Objective: To determine if promotion of active modes of travel is an effective strategy for obesity prevention by assessing whether active commuting (walking or cycling for all or part of the journey to work) is independently associated with objectively assessed biological markers of obesity. Design: Cross sectional study of data from the wave 2 Health Assessment subsample of Understanding Society, the UK Household Longitudinal Study (UKHLS). The exposure of interest, commuting mode, was self reported and categorised as three categories: private transport, public transport, and active transport. Participants: The analytic samples (7534 for body mass index (BMI) analysis, 7424 for percentage body fat analysis) were drawn from the representative subsample of wave 2 respondents of UKHLS who provided health assessment data (n=15 777). Main outcome measures: Body mass index (weight (kg)/height (m)2); percentage body fat (measured by electrical impedance). Results: Results from multivariate linear regression analyses suggest that, compared with using private transport, commuting by public or active transport modes was significantly and independently predictive of lower BMI for both men and women. In fully adjusted models, men who commuted via public or active modes had BMI scores 1.10 (95% CI 0.53 to 1.67) and 0.97 (0.40 to 1.55) points lower, respectively, than those who used private transport. Women who commuted via public or active modes had BMI scores 0.72 (0.06 to 1.37) and 0.87 (0.36 to 0.87) points lower, respectively, than those using private transport. Results for percentage body fat were similar in terms of magnitude, significance, and direction of effects. Conclusions: Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport. These associations were not attenuated by adjustment for a range of hypothesised confounding factors."

James Woodcock, Marko Tainio, James Cheshire, Oliver O’Brien, Anna Goodman, Health effects of the London bicycle sharing system: health impact modelling study, BMJ 2014;348:g425, February 2014 (14 p.) [formato PDF, 1,57 MB]. Open Access. "OBJECTIVE: To model the impacts of the bicycle sharing system in London on the health of its users. DESIGN: Health impact modelling and evaluation, using a stochastic simulation model. SETTING: Central and inner London, England. DATA SOURCES: Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). PARTICIPANTS: 578,607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. MAIN OUTCOME MEASURES: Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. RESULTS: Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change -72 DALYs (95% credible interval -110 to -43) among men using cycle hire per accounting year; -15 (-42 to -6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change -49 DALYs (-88 to -17) among men; -1 DALY (-27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled benefits of cycling were much larger than the harms. Using background injury rates in the youngest age group (15 to 29 years), the medium term benefits and harms were both comparatively small and potentially negative. CONCLUSION: London's bicycle sharing system has positive health impacts overall, but these benefits are clearer for men than for women and for older users than for younger users. The potential benefits of cycling may not currently apply to all groups in all settings."

Lucinda E. Saunders, Judith M. Green, Mark P. Petticrew, Rebecca Steinbach, Helen Roberts, What are the health benefits of active travel? A systematic review of trials and cohort studies, PLoS ONE 8(8): e69912, August 2013 (13 p.) [formato PDF, 192 kB]. "Background. Increasing active travel (primarily walking and cycling) has been widely advocated for reducing obesity levels and achieving other population health benefits. However, the strength of evidence underpinning this strategy is unclear. This study aimed to assess the evidence that active travel has significant health benefits. Methods. The study design was a systematic review of (i) non-randomised and randomised controlled trials, and (ii) prospective observational studies examining either (a) the effects of interventions to promote active travel or (b) the association between active travel and health outcomes. Reports of studies were identified by searching 11 electronic databases, websites, reference lists and papers identified by experts in the field. Prospective observational and intervention studies measuring any health outcome of active travel in the general population were included. Studies of patient groups were excluded. Results. Twenty-four studies from 12 countries were included, of which six were studies conducted with children. Five studies evaluated active travel interventions. Nineteen were prospective cohort studies which did not evaluate the impact of a specific intervention. No studies were identified with obesity as an outcome in adults; one of five prospective cohort studies in children found an association between obesity and active travel. Small positive effects on other health outcomes were found in five intervention studies, but these were all at risk of selection bias. Modest benefits for other health outcomes were identified in five prospective studies. There is suggestive evidence that active travel may have a positive effect on diabetes prevention, which may be an important area for future research. Conclusions. Active travel may have positive effects on health outcomes, but there is little robust evidence to date of the effectiveness of active transport interventions for reducing obesity. Future evaluations of such interventions should include an assessment of their impacts on obesity and other health outcomes."

P. Oja, S. Titze, A. Bauman, B. de Geus, P. Krenn, B. Reger-Nash, T. Kohlberger, Health benefits of cycling: a systematic review, Scand J Med Sci Sports, 2011, 21(4):496-509 (14 p.) [formato PDF, 194 kB]. "The purpose of this study was to update the evidence on the health benefits of cycling. A systematic review of the literature resulted in 16 cycling-specific studies. Cross-sectional and longitudinal studies showed a clear positive relationship between cycling and cardiorespiratory fitness in youths. Prospective observational studies demonstrated a strong inverse relationship between commuter cycling and all-cause mortality, cancer mortality, and cancer morbidity among middle-aged to elderly subjects. Intervention studies among working-age adults indicated consistent improvements in cardiovascular fitness and some improvements in cardiovascular risk factors due to commuting cycling. Six studies showed a consistent positive dose-response gradient between the amount of cycling and the health benefits. Systematic assessment of the quality of the studies showed most of them to be of moderate to high quality. According to standard criteria used primarily for the assessment of clinical studies, the strength of this evidence was strong for fitness benefits, moderate for benefits in cardiovascular risk factors, and inconclusive for all-cause mortality, coronary heart disease morbidity and mortality, cancer risk, and overweight and obesity. While more intervention research is needed to build a solid knowledge base of the health benefits of cycling, the existing evidence reinforces the current efforts to promote cycling as an important contributor for better population health."

David Ogilvie, Fiona Bull, Jane Powell, Ashley R. Cooper, Christian Brand, Nanette Mutrie, John Preston, and Harry Rutter, An Applied Ecological Framework for Evaluating Infrastructure to Promote Walking and Cycling: The iConnect Study, American Journal of Public Health, March 2011, 101, 473–481 [formato PDF, 1,25 MB]. "Improving infrastructure for walking and cycling is increasingly recommended as a means to promote physical activity, prevent obesity, and reduce traffic congestion and carbon emissions. However, limited evidence from intervention studies exists to support this approach. Drawing on classic epidemiological methods, psychological and ecological models of behavior change, and the principles of realistic evaluation, we have developed an applied ecological framework by which current theories about the behavioral effects of environmental change may be tested in heterogeneous and complex intervention settings. Our framework guides study design and analysis by specifying the most important data to be collected and relations to be tested to confirm or refute specific hypotheses and thereby refine the underlying theories."

Miriam Wanner, Thomas Götschi, Sonja Kahlmeier, Eva Martin-Diener, Langsamverkehr, körperliche Aktivität und Übergewicht (Mobilità dolce, attività fisica e sovrappeso). Systematische Literaturübersichten und Sekundäranalyse der Schweizerischen Gesundheitsbefragungen 2002 und 2007. Schlussbericht vom 13. Mai 2011. Universität Zürich, Institut für Sozial- und Präventivmedizin, Zürich, 2011, 75 p. [formato PDF, 1,76 MB] "Im vorliegenden Bericht wurden die Zusammenhänge zwischen Langsamverkehr im Alltag und allgemeiner körperlicher Aktivität respektive Körpergewicht untersucht. Einerseits wurden systematische Literaturübersichten bei Kindern und Erwachsenen durchgeführt, andererseits wurden Daten der Schweizerischen Gesundheitsbefragung zu diesem Thema analysiert."

Active Transportation in Canada: a resource and planning guide. Transport Canada, Ottawa, 2011, 100 p. [formato PDF, 6,60 MB] "This guide is intended primarily for municipal and regional transportation planners in communities with limited active transportation planning and implementation experience, but can also be used by other individuals, including allied professionals (e.g., community planners, engineers, public health officers, etc.). While the guide is intended primarily for town and transportation planners, it recognizes that all types of planners (e.g., recreation, environmental, economic development, etc.) at all levels (e.g., local, regional , provincial, etc.) have a role to play in promoting and supporting active transportation in their communities. Another group that can use this guide is elected representatives, who are a community’s major decision-makers and are critical players in helping support and promote active transportation. Finally, representatives from local advocacy organizations (e.g., environmental groups, healthy living associations, etc.) and community groups with an interest in active transportation (e.g., Chambers of Commerce) can also use this guide to support communitybased active transportation projects initiated outside of City Hall, or as a resource guide to help better support and engage with active transportation projects initiated by the local government." Cette publication est aussi disponible en français sous le titre "Guide de planification et de ressources sur les transports actifs au Canada".

Thomas Götschi, Sonja Kahlmeier, Ökonomische Abschätzung der volkswirtschaftlichen Gesundheitsnutzen des Langsamverkehrs in der Schweiz. Anwendung der „Health Economic Assessment Tools“ (HEAT) for Walking and Cycling der Weltgesundheitsorganisation auf die Schweiz. Universität Zürich, Institut für Sozial- und Präventivmedizin, 14. Mai 2012, 36 p. [formato PDF, 1,57 MB]. "What is already known : Regular physical activity has numerous positive effects for health and wellbeing. In Switzerland, only 41% of the population fulfill the national recommendations on physical activity and health. Active transport (i.e. all non-motorized forms of transport) contributes substantially to total physical activity. Swiss adults who are cycling or walking on a regular basis for commuting, work, shopping or in leisure time are overall more physically active and less overweight and obese than those who don¡¦t walk or cycle. Walking and cycling are more and more recognized as an important pillar of the urban transport system. New findings presented in this report : So far, health aspects have often played a minor role in decision making processes on active transport. Using the "Health Economic Assessment Tools (HEAT)" for cycling and for walking, developed by WHO, the economic benefits of health effects from regular cycling and walking in Switzerland were quantified for the first time. Current economic benefits: Due to more frequent use of active transport, per-capita economic benefits from the positive health effects of active transport are highest in the German-speaking part of Switzerland, at about CHF 2.800 for walking and about CHF 550 for cycling. Benefits were calculated based on reduced mortality due to regular physical activity from walking or cycling, using the willingness-to-pay approach. In the Italian-speaking part of the country, benefits are about 15% lower for walking and about one third of the benefits of cycling found in the German-speaking part; the benefits found in the French-speaking part lie in between. Based on the annual per-capita benefit from walking, relatively small differences were found between the cities of Basel, Bern, Geneva, Lausanne, Winterthur and Zurich (about CHF 3.000). For cycling, a different pattern was found with the presumably more cycling-friendly cities of Basel and Winterthur yielding twice the per-capita benefit (about CHF 800) of the cities of Geneva and Zurich, and an almost eight times higher benefit than Lausanne, where cycling is less attractive for topographical reasons. Scenario analyses: A doubling of time spent cycling in Switzerland would result in an economic benefit of about CHF 2 billion per year. This would be equivalent to raising the national modal split of cycling (5.3%) to the level of the most cycling-friendly cities of Winterthur (10%) or Basel (11%). Increasing cycling on a national level by 10% would result in additional economic health benefits of CHF 1.5 billion per year, compared to the situation in 2005. This is within the same order of magnitude as the approximately CHF 2 billion in external health costs from air pollution or the estimated CHF 1.3 billion in transport-related costs of climate change. If the potential to shift short motorized trips to active transport to reduce CO2 emissions (as calculated elsewhere) would be realized, an additional CHF 2 to 5 billion of economic benefits from health could be achieved in comparison to the reference scenario. Achieving the target of the recently adopted popular initiative to reduce motorized transport in the city of Zurich by ten percentage points within 10 years would lead to estimated annual economic benefits of CHF 40 million from the positive health effects of cycling and walking. What conclusions can be drawn : In Switzerland, active transport is a considerable source of physical activity and thereby already contributes significantly to the health and wellbeing of the population. Synergies with climate change, air pollution and noise protection policies are obvious. Economically quantifying the health benefits of active transport for the first time is contributing to a systematic and quantitative assessment of benefits in this area. This study showed that the expected economic effects from increasing active transport are substantial. International examples show that considerable increases in active transport over time are feasible, if appropriate investments are made and maintained. In view of the substantial health benefits, significant investments into increasing active transport, for example in relation to the agglomeration programs, appear justified."

Sonja Kahlmeier, Nick Cavill, Hywell Dinsdale, Harry Rutter, Thomas Götschi, Charlie Foster, Paul Kelly, Dushy Clarke, Pekka Oja, Richard Fordham, Dave Stone and Francesca Racioppi, Health economic assessment tools (HEAT) for walking and for cycling. Methodology and user guide. Economic assessment of transport infrastructure and policies. World Health Organization, Copenhagen, 2011, 46 p. [formato PDF, 2,33 MB]. "The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This booklet summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. This methodology and user guide will be of key interest to professionals at both national and local levels: transport planners, traffic engineers, and special interest groups working on transport, walking, cycling or the environment, as well as health economists, physical activity experts and health promotion experts."

E.E.M.M. van Kempen, W.Swart, G.C.W. Wendel-Vos, P.E. Steinberger, A.B. Knol, H.L. Stipdonk, M.C.B. Reurings, Exchanging car trips by cycling in the Netherlands : A first estimation of the health benefits. (RIVM Report 630053001/2010). RIVM, Bilthoven, 2010, 74 p. [formato PDF, 414 kB] "As commissioned by the Dutch Ministry of Housing, Spatial Planning and the Environment, we assessed the possible health benefits of the substitution of short-distance car trips with short-distance cycling trips. To this end we used existing methods for Health Impact Assessment and evaluated the availability and quality of data, models and tools that were needed. In our assessment not only the classic environmental pollutants noise and air pollution were taken into account, but also the effects on road safety and physical activity. Application shows that the disease burden related to physical activity reduces at a maximum of 1.3% after one year. As expected, the health benefits due to reduction in road traffic noise levels and traffic-related air pollution are relatively small. Furthermore, it appears that an exchange of short-distance car trips by cycling is only beneficial for young male drivers. Since a lot of information was unavailable and/or unknown and because a lot of choices and assumptions were made, the results have to be seen as a first estimate of what can be expected of interventions that cause an exchange between short-distance car trips with cycling. This study is a follow-up on earlier exemplary assessments of transport interventions."

David R. Bassett, Jr., John Pucher, Ralph Buehler, Dixie L. Thompson, and Scott E. Crouter, Walking, Cycling, and Obesity Rates in Europe, North America, and Australia, Journal of Physical Activity and Health, 2008, 5, 795-814 (20 p.) [formato PDF, 336 KB]. "Purpose: This study was designed to examine the relationship between active transportation (defined as the percentage of trips taken by walking, bicycling, and public transit) and obesity rates (BMI . 30 kg E m.2) in different countries. Methods: National surveys of travel behavior and health indicators in Europe, North America, and Australia were used in this study; the surveys were conducted in 1994 to 2006. In some cases raw data were obtained from national or federal agencies and then analyzed, and in other cases summary data were obtained from published reports. Results: Countries with the highest levels of active transportation generally had the lowest obesity rates. Europeans walked more than United States residents (382 versus 140 km per person per year) and bicycled more (188 versus 40 km per person per year) in 2000. Discussion: Walking and bicycling are far more common in European countries than in the United States, Australia, and Canada. Active transportation is inversely related to obesity in these countries. Although the results do not prove causality, they suggest that active transportation could be one of the factors that explain international differences in obesity rates."

Victor Keihan Rodrigues Matsudo, Timóteo Leandro Araújo, Sandra Marcela Mahecha Matsudo, Andar: passaporte para a saude!, Diagnóstico e Tratamento, 11 (2006) 119-123 [formato PDF, 165 KB]. "Se por um lado as evidências científicas foram progressivamente demonstrando que muitos dos problemas de saúde que hoje nos acometem são em grande parte conseqüência da falta de atividade física, qualquer análise histórica vai indicar que principalmente está faltando andar!" Review di studi scientifici medici sul rapporto tra mobilità (camminare) e riduzione dei rischi di malattie.

Billie Giles-Corti, Robert J. Donovan, Relative Influences of Individual, Social Environmental, and Physical Environmental Correlates of Walking, Am J Public Health 93 (2003) 1583-1589 [formato PDF, 223 KB]. "Objectives. This study sought to examine individual, social environmental, and physical environmental correlates of walking. Methods. A cross-sectional survey was conducted among healthy workers and homemakers residing in metropolitan Perth, Western Australia. Results. Most respondents walked for transport or recreation, but only 17.2% did a sufficient amount of walking to accrue health benefits. After adjustment, the relative influences of individual, social environmental, and physical environmental factors were found to be almost equally important. Conclusions. Although walking is popular, few people do enough walking to benefit their health. Those who walk as well as engage in other physical activities appear more likely to achieve recommended levels of activity. Promoting walking may require a comprehensive strategy."

Roger Mackett (Centre for Transport Studies, UCL), Making children healthier through walking. Presentation for the Pro Walk/Pro Bike conference, held in Victoria BC, Canada, 9 September 2004, 38 slides [formato PDF, 733 kB].

Charles Courtemanche, A Silver Lining? The Connection between Gasoline Prices and Obesity. December 19, 2007, 41 p. [formato PDF, 214 kB]. "A causal relationship between gasoline prices and obesity is possible through mechanisms of increased exercise and decreased eating in restaurants. Using a fixed effects model with a variety of robustness checks, I find empirical support for this theory. My estimates imply that an additional $1 in real gasoline prices would reduce the prevalence of overweight and obesity in the U.S. by 7% and 9% after seven years, and that 8% of the rise in obesity between 1979 and 2004 can be attributed to falling real gasoline prices during this period. I also provide evidence that rising gas prices are associated with both an increase in walking or bicycling and a reduction in the frequency with which people eat at restaurants."

Committee on Physical Activity, Health, Transportation, and Land Use, Transportation Research Board, Institute of Medicine of the National Academies, Does the built environment influence physical activity? : examining the evidence. (TRB Special Report 282). Transportation Research Board, Washington, D.C., 2005, 269 p. [formato PDF, 1,45 MB]. "The report reviews the broad trends affecting the relationships among physical activity, health, transportation, and land use; summarizes what is known about these relationships, including the strength and magnitude of any causal connections; examines implications for policy; and recommends priorities for future research."

Promoting and creating built or natural environments that encourage and support physical activity, (NICE public health guidance 8), National Institute for Health and Clinical Excellence, London, January 2008, 55 p. [formato PDF, 304 KB].

Adrian Davis, Carolina Valsecchi, Malcolm Fergusson, Unfit for Purpose: How Car Use Fuels Climate Change and Obesity. Institute for European Environmental Policy, London, August 2007, 75 p. [formato PDF, 755 KB]. "This study assesses the contribution of this growth in car travel to the decline in human energy expenditure and consequently to the parallel growth in obesity in the UK; and at the same time calculates the contribution to climate change through carbon dioxide emissions as car travel has replaced walking. Through this exploration the study has sought to demonstrate that two of the main challenges facing the UK in health and environment have common origins and some common solutions."

John Pucher, Lewis Dijkstra, Promoting Safe Walking and Cycling to Improve Public Health: Lessons From The Netherlands and Germany, Am J Public Health 93 (2003) 1509-1516 [formato PDF, 165 KB]. "We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany."

World Health Organization, Regional Office for Europe, A physically active life through everyday transport with a special focus on children and older people and examples and approaches from Europe. Roma, World Health Organization, 2002, 48 p. [formato PDF, 405 KB].

Giuseppe Rossi, Roberto Moretti, Monica Pirone, Walter Locatelli, Lotta alla sedentarietà: a scuola con il Piedibus, in: Epidemiologia e Prevenzione, 28 (2004), p. 346-349 [formato PDF, 55 KB].

How Land Use and Transportation Systems Impact Public Health : A Literature Review of the Relationship Between Physical Activity and Built Form (effetti della pianificazione urbana e dei trasporti sulla salute, soprattutto sull’attività fisica, la mobilità pedonale e ciclabile. Ampio documento di sintesi dell’Active Community Environments Initiative (ACES) presso i Centers for Disease Control and Prevention (USA) 147 p. [formato PDF, 845 KB].

How Land Use and Transportation Systems Impact Public Health : An Annotated Bibliography (vedi sopra: bibliografia) 63 p. [formato PDF, 635 KB]


Veronica A Southerland, Michael Brauer, Arash Mohegh, Melanie S Hammer, Aaron van Donkelaar, Randall V Martin, Joshua S Apte, Susan C Anenberg, Global urban temporal trends in fine particulate matter (PM2.5) and attributable health burdens: estimates from global datasets. Lancet Planet Health 2022; 6: e139-46 (8 p.) [formato PDF, 3,3 MB]. Open Access.. "Background: With much of the world's population residing in urban areas, an understanding of air pollution exposures at the city level can inform mitigation approaches. Previous studies of global urban air pollution have not considered trends in air pollutant concentrations nor corresponding attributable mortality burdens. We aimed to estimate trends in fine particulate matter (PM2.5) concentrations and associated mortality for cities globally. Methods: We use high-resolution annual average PM2.5 concentrations, epidemiologically derived concentration response functions, and country-level baseline disease rates to estimate population-weighted PM2.5 concentrations and attributable cause-specific mortality in 13.160 urban centres between the years 2000 and 2019. Findings: Although regional averages of urban PM2.5 concentrations decreased between the years 2000 and 2019, we found considerable heterogeneity in trends of PM2.5 concentrations between urban areas. Approximately 86% (2.5 billion inhabitants) of urban inhabitants lived in urban areas that exceeded WHO's 2005 guideline annual average PM2.5 (10 µg/m3), resulting in an excess of 1.8 million (95% CI 1.34 million-2.3 million) deaths in 2019. Regional averages of PM2.5-attributable deaths increased in all regions except for Europe and the Americas, driven by changes in population numbers, age structures, and disease rates. In some cities, PM2.5-attributable mortality increased despite decreases in PM2.5 concentrations, resulting from shifting age distributions and rates of non-communicable disease. Interpretation: Our study showed that, between the years 2000 and 2019, most of the world's urban population lived in areas with unhealthy levels of PM2.5, leading to substantial contributions to non-communicable disease burdens. Our results highlight that avoiding the large public health burden from urban PM2.5 will require strategies that reduce exposure through emissions mitigation, as well as strategies that reduce vulnerability to PM2.5 by improving overall public health."

Dorota Burchart-Korol, Piotr Folęga (Silesian University of Technology), Impact of Road Transport Means on Climate Change and Human Health in Poland. Promet - Traffic & Transportation, Vol. 31, 2019, No. 2, 195-204 (10 p.) [formato PDF, 380 kB]. Open Access. "Operation of means of transport is one of major sources of environmental impact. The goal of this article was to analyse the greenhouse gas emissions and to assess the impact of operation of means of road transport in Poland on human health using the life cycle assessment technique based on an analysis of emission of dust and gas pollutants. Road transport was assessed by taking the following means of transport into account: passenger cars, other cars with weight of up to 3,500 kg, lorries, buses, motorcycles, mopeds and tractors. The analysis covered various dust and gas pollutants, including the emission of CO2, CO, N2O, CH4, NOx, NMVOC, PM and SO2. Using the IMPACT 2002+ life cycle impact assessment method, transport was assessed in a breakdown into the following impact categories: greenhouse gas emission and damage to human health, including damage caused by organic and inorganic compounds. It has been evidenced that the highest emissions of dust and gas pollutants are caused by passenger cars, which is mainly due to the number of vehicles of this type traversing Polish roads. The main cause of climate changes due to road transport is CO2 emission, while NOx emission is the main factor determining individual categories of damage to human health. The negative environmental impact is primarily related to the operation of combustion engine vehicles. Diesel oil and petrol are currently the main fuels used in Polish transport. In order to reduce their impact on the environment one should intensify the efforts aimed at increasing the share of alternative fuels in transport."

J E Jonson, J Borken-Kleefeld, D Simpson, A Nyíri, M Posch and C Heyes, Impact of excess NOx emissions from diesel cars on air quality, public health and eutrophication in Europe. Environ. Res. Lett. 12 (2017) 094017 (11 p.) [formato PDF, 1,9 MB] Open Access. "Diesel cars have been emitting four to seven times more NOx in on-road driving than in type approval tests. These 'excess emissions' are a consequence of deliberate design of the vehicle's after-treatment system, as investigations during the 'Dieselgate' scandal have revealed. Here we calculate health and environmental impacts of these excess NOx emissions in all European countries for the year 2013. We use national emissions reported officially under the UNECE Convention for Long-range Transport of Atmospheric Pollutants and employ the EMEP MSC-W Chemistry Transport Model and the GAINS Integrated Assessment Model to determine atmospheric concentrations and resulting impacts. We compare with impacts from hypothetical emissions where light duty diesel vehicles are assumed to emit only as much as their respective type approval limit value or as little as petrol cars of the same age. Excess NO2 concentrations can also have direct health impacts, but these overlap with the impacts from particulate matter (PM) and are not included here. We estimate that almost 10000 premature deaths from PM2.5 and ozone in the adult population (age >30 years) can be attributed to the NOx emissions from diesel cars and light commercial vehicles in EU28 plus Norway and Switzerland in 2013. About 50% of these could have been avoided if diesel limits had been achieved also in on-road driving; and had diesel cars emitted as little NOx as petrol cars, 80% of these premature deaths could have been avoided. Ecosystem eutrophication impacts (critical load exceedances) from the same diesel vehicles would also have been reduced at similar rates as for the health effects."

Meltem Kutlar Joss (Schweizerisches Tropen- und Public Health Institut), Gesundheitsrisiken der NO2-Belastung für den Menschen. Kurzexpertise anhand neuerer Übersichtsarbeiten und Studien. Greenpeace e.V., Hamburg, 2017, 28 p. [formato PDF, 786 kB]. Der Bericht wurde im Auftrag von Greenpeace verfasst. "Insgesamt hat die Forschung in den letzten Jahren viele Studien hervorgebracht, welche überzeugend kurz- und langfristige Gesundheitsschäden in Zusammenhang mit der Belastung mit Stickstoffdioxid (NO2) oder Stickstoffmonoxid (NO) aufzeigen. Die US Umweltbehörde bleibt bei der kausalen Zuordnung der beobachteten Zusammenhänge mit NO2 vorsichtig, da andere verkehrsbedingte Schadstoffe dafür (mit-)verantwortlich sein könnten. Andererseits haben experimentelle und halbexperimentelle Studien deutliche Hinweise auf direkte Effekte von NO2 ergeben. Die Messungen von Greenpeace belegen erhöhte NO2-Werte, welche auf die überdurchschnittliche Belastung durch verkehrsbedingte Schadstoffe hinweist. Fär diese Belastungen gelten folgende Aussagen: • Langfristig ist die Sterblichkeit in Gebieten mit hoher NO2-Belastung höher. Dieses mit NO 2 verbundene Risiko ist in manchen Studien unabhängig von der Feinstaub- oder Verkehrsbelastung, in anderen kann es nicht separat nachgewiesen werden. Fär Deutschland rechnet die Europäische Umweltagentur mit über 10.000 vorzeitigen Todesfällen allein durch NO2. • Die Belastung mit Verkehrsemissionen, gemessen mit NO2, ist wahrscheinlich mit einem höheren Risiko für Lungenkrebs verbunden. Welchen Bestandteilen des Aerosols diese Folge zuzuschreiben ist, ist noch nicht erforscht. • NO2 oder Schadstoffe aus dem Verkehr beeinträchtigen das Lungenwachstum bei Kindern. Diese Beziehung wurde mindestens teilweise unabhängig von der Feinstaubmasse beobachtet. In Gegenden mit hoher NO2-Belastung ist auch bei Erwachsenen die Lungenfunktion schlechter. • Kinder entwickeln häufiger Asthma, wenn sie in Verkehrsnähe wohnen: Das Asthmarisiko steigt bei einer um 10 ug/m3 höheren NO2-Belastung um 15 Prozent. • Bei weiteren Krankheiten ist die Datenlage noch offen, am deutlichsten sind die Hinweise auf ein niedrigeres Geburtsgewicht bei hoher NO2- oder Verkehrsbelastung. • Bei kurzfristig erhöhter Belastung ist neben einer erhöhten Sterblichkeit mit mehr Notfallkonsultationen und Krankenhauseintritten zu rechnen, insbesondere für solche die mit der Atemwegsgesundheit zusammenhängen. An Asthma erkrankte Kinder scheinen empfindlicher zu reagieren als Erwachsene mit Asthma, sie kommen bis zu 3 Mal häufiger wegen Atemwegsnotfällen ins Krankenhaus als Erwachsene. Diese Wirkungen werden auch unterhalb der heute in Deutschland gültigen Grenzwerte gefunden. Wie weiter oben dargestellt, können viele der beobachteten Folgen nicht einfach NO2 allein zugeschrieben werden. Andere Verkehrsschadstoffe zeigen dieselbe oder eine ähnliche rüumliche Verteilung wie NO2, werden aber nicht immer oder nicht in den gleichen Studien gemessen. Dieser Vorbehalt kann allerdings auch bei der Beurteilung der Auswirkungen von PM10 oder PM2.5 geltend gemacht werden, da auch hier Mehrschadstoffmodelle - beispielsweise unter Einbezug der Ultrafeinen Partikel - meist fehlen. Es ist daher aus gesundheitlicher Sicht sinnvoll, die NO2-Belastung auf die in den WHO Guidelines genannten Konzentrationen zu limitieren und somit Massnahmen zu verstärken, um die Grenzwerte, welche auch in der deutschen Technischen Anleitung zur Reinhaltung der Luft festgesetzt sind, einzuhalten und damit auch in den übermässig mit NO2 belasteten Wohngebieten eine gute Luftqualität zu erreichen."

Maria Foraster, Nino Künzli, Inmaculada Aguilera, Marcela Rivera, David Agis, Joan Vila, Laura Bouso, Alexandre Deltell, Jaume Marrugat, Rafel Ramos, Jordi Sunyer, Roberto Elosua, and Xavier Basagaña, High blood pressure and long-term exposure to indoor noise and air pollution from road traffic. Environ Health Perspect 122:1193–1200, November 2014 (8 p.) [formato PDF, 232 KB]. "Background: Traffic noise has been associated with prevalence of hypertension, but reports are inconsistent for blood pressure (BP). To ascertain noise effects and to disentangle them from those suspected to be from traffic-related air pollution, it may be essential to estimate people’s noise exposure indoors in bedrooms. Objectives: We analyzed associations between long-term exposure to indoor traffic noise in bedrooms and prevalent hypertension and systolic (SBP) and diastolic (DBP) BP, considering long-term exposure to outdoor nitrogen dioxide (NO2). Methods: We evaluated 1,926 cohort participants at baseline (years 2003–2006; Girona, Spain). Outdoor annual average levels of nighttime traffic noise (Lnight) and NO2 were estimated at postal addresses with a detailed traffic noise model and a land-use regression model, respectively. Individual indoor traffic Lnight levels were derived from outdoor Lnight with application of insulations provided by reported noise-reducing factors. We assessed associations for hypertension and BP with multi-exposure logistic and linear regression models, respectively. Results: Median levels were 27.1 dB(A) (indoor Lnight), 56.7 dB(A) (outdoor Lnight), and 26.8 µg/m3 (NO2). Spearman correlations between outdoor and indoor Lnight with NO2 were 0.75 and 0.23, respectively. Indoor Lnight was associated both with hypertension (OR = 1.06; 95% CI: 0.99, 1.13) and SBP (ß = 0.72; 95% CI: 0.29, 1.15) per 5 dB(A); and NO2 was associated with hypertension (OR = 1.16; 95% CI: 0.99, 1.36), SBP (ß = 1.23; 95% CI: 0.21, 2.25), and DBP (ß = 0.56; 95% CI: –0.03, 1.14) per 10 µg/m3. In the outdoor noise model, Lnight was associated only with hypertension and NO2 with BP only. The indoor noise–SBP association was stronger and statistically significant with a threshold at 30 dB(A). Conclusion: Long-term exposure to indoor traffic noise was associated with prevalent hypertension and SBP, independently of NO2. Associations were less consistent for outdoor traffic Lnight and likely affected by collinearity."

Rob Beelen [et al.], Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 2014 Mar 1;383(9919):785-795 (11 p.) [formato PDF, 351 kB]. Free access, registration needed. "BACKGROUND: Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. METHODS: We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 µm (PM2.5), less than 10 µm (PM10), and between 10 µm and 2.5 µm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. FINDINGS: The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 µg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 µg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 µg/m(3) (1.07, 1.01-1.13). INTERPRETATION: Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value."

Giulia Cesaroni, Francesco Forastiere, Massimo Stafoggia, Zorana J Andersen, Chiara Badaloni, Rob Beelen, Barbara Caracciolo, Ulf de Faire, Raimund Erbel, Kirsten T Eriksen, Laura Fratiglioni, Claudia Galassi, Regina Hampel, Margit Heier, Frauke Hennig, Agneta Hilding, Barbara Hoffmann, Danny Houthuijs, Karl-Heinz Jöckel, Michal Korek, Timo Lanki, Karin Leander, Patrik K E Magnusson, Enrica Migliore, Caes-Göran Ostenson, Kim Overvad, Nancy L Pedersen, Juha Pekkanen J, Johanna Penell, Göran Pershagen, Andrei Pyko, Ole Raaschou-Nielsen, Andrea Ranzi, Fulvio Ricceri, Carlotta Sacerdote, Veikko Salomaa, Wim Swart, Anu W Turunen, Paolo Vineis, Gudrun Weinmayr, Kathrin Wolf, Kees de Hoogh, Gerard Hoek, Bert Brunekreef, Annette Peters, Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ 2014;348:f7412 (16 p.) [formato PDF, 551 kB] Open Access. "Objectives: To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Design: Prospective cohort studies and meta-analysis of the results. Setting: Cohorts in Finland, Sweden, Denmark, Germany, and Italy. Participants: 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline. Main outcome measures: Modelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios. Results: 5157 participants experienced incident events. A 5 μg/m3 increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m3 increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m3 for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m3 increase in PM2.5) and below 40 μg/m3 for PM10 (1.12, 1.00 to 1.27, for 10 μg/m3 increase in PM10). Positive but non-significant associations were found with other pollutants. Conclusions Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values."

Giuseppe Sarno, Sara Maio, Marzia Simoni, Sandra Baldacci, Sonia Cerrai, Giovanni Viegi a nome del Gruppo collaborativo EpiAir2 (a cura di), Inquinamento atmosferico e salute umana, ovvero come orientarsi nella lettura e interpretazione di studi ambientali, tossicologici ed epidemiologici. Seconda edizione. (E&P Quaderni). Epidemiol Prev 2013; 37(4-5) suppl 2: 1-86, luglio-ottobre 2013 (88 p.) [formato PDF, 1,93 MB] "Nel triennio 2010-2013 un gruppo di ricercatori appartenenti a Istituzioni diverse collocate in differenti aree geografiche italiane, partecipando al progetto CCM EpiAir2, ha dato testimonianza del fatto che è possibile consolidare quella tanto desiderata collaborazione e integrazione tra competenze sanitarie e ambientali del nostro Paese necessaria per portare a termine ricerche in questo ambito. Le ricadute sanitarie stimabili per l’esposizione ai livelli di inquinamento atmosferico registrati nella aree urbane continuano a costituire infatti un problema rilevante di sanità pubblica di cui continuare a occuparsi, in Italia e in Europa. L’attenzione rimane alta, nonostante le lievi tendenze di miglioramento nella qualità dell’aria di alcune aree italiane, motivo che aveva indotto il Ministero (tramite il CCM) a finanziare la prosecuzione del progetto di sorveglianza e monitoraggio EpiAir, che ha coinvolto nella seconda edizione un più ampio numero di città (15 in più rispetto alle 10 della precedente edizione), un numero maggiore di Enti e ricercatori, portando alla costituzione di un gruppo collaborativo dedicato all’approfondimento delle relazioni che legano inquinamento dell’aria e salute, che rappresenta oggi un patrimonio culturale e di competenze prezioso per il nostro Paese. In questo contesto, viene integrato e aggiornato quindi con nuove conoscenze disponibili il contenuto del Quaderno di Epidemiologia&Prevenzione su Inquinamento atmosferico e salute umana che gli autori già nel 2009 avevano espressamente rivolto agli operatori di sanità pubblica, ai quali era stato fornito come una utile guida per orientarsi nella lettura e interpretazione di studi ambientali, tossicologici ed epidemiologici sul tema. Oggi questo quaderno mira ad essere materiale di studio e lettura per un pubblico ancora più ampio: oltre agli operatori di sanità pubblica (ASL, ARPA) è rivolto ai decisori istituzionali (Regioni, Province, Comuni), agli Enti di ricerca, sarà segnalato alle scuole, alle associazioni ambientaliste e al grande pubblico che potrà scaricarlo gratuitamente dal sito internet della rivista Epidemiologia&Prevenzione."

Ester Rita Alessandrini, Annunziata Faustini, Monica Chiusolo, Massimo Stafoggia, Martina Gandini, Moreno Demaria, Antonello Antonelli, Pasquale Arena, Annibale Biggeri, Cristina Canova, Giovanna Casale, Achille Cernigliaro, Elsa Garrone, Bianca Gherardi, Emilio Antonio Luca Gianicolo, Simone Giannini, Claudia Iuzzolino, Paolo Lauriola, Mauro Mariottini, Paolo Pasetti, Giorgia Randi, Andrea Ranzi, Michele Santoro, Vittorio Selle, Maria Serinelli, Elisa Stivanello, Riccardo Tominz, Maria Angela Vigotti, Stefano Zauli Sajani, Francesco Forastiere, Ennio Cadum, Gruppo collaborativo EpiAir2, Inquinamento atmosferico e mortalità in venticinque città italiane: risultati del progetto EpiAir2. (Air pollution and mortality in twenty-five Italian cities: results of the EpiAir2 Project). Epidemiol Prev 2013; 37 (4-5): 220-229 (10 p.) [formato PDF, 630 kB] "OBIETTIVO: valutare gli effetti a breve termine dell’inquinamento atmosferico sulla mortalità nelle 25 città italiane partecipanti alla seconda fase del progetto EpiAir (Sorveglianza epidemiologica dell’inquinamento atmosferico: valutazione dei rischi e degli impatti nelle città italiane). DISEGNO: studio di serie temporali con metodologia case-crossover, con aggiustamento per i fattori temporali e meteorologici rilevanti. L’associazione inquinamento atmosferico-mortalità è stata analizzata per ciascuna delle 25 città in studio. Gli inquinanti considerati sono stati il particolato (PM10 e PM2.5), il biossido di azoto (NO2) e l’ozono (O3 estivo). Le stime complessive di effetto sono state ottenute successivamente mediante una metanalisi e sono state espresse per incrementi di 10 ?g/m3 delle concentrazioni di inquinanti. Sono stati implementati modelli mono e bi-pollutant. SETTING E PARTECIPANTI: lo studio ha analizzato 422.723 decessi verificatisi tra i residenti di 35 anni o più nelle 25 città in studio per gli anni 2006-2010. PRINCIPALI MISURE DI OUTCOME: sono stati considerati i conteggi giornalieri di decessi per cause naturali, tra cui le cause cardiache, cerebrovascolari e respiratorie. Le informazioni sulle cause di morte sono state ottenute dai Registri delle cause di morte delle singole città. RISULTATI: il numero medio annuo di decessi per cause naturali varia da 513 a Rovigo e 20.959 a Roma. Circa il 25% delle morti è dovuto a cause cardiache, il 10%a cause cerebrovascolari e il 7%a cause respiratorie. Per incrementi di 10 ?g/m3 di PM10 si osserva un effetto immediato sulla mortalità naturale (0,51%; IC95%0,16-0,86; lag 0-1). Effetti più importanti e prolungati (lag 0-5) si osservano per il PM2.5 (0,78%; IC95%0,12-1,46) e soprattutto per l’NO2 (1,10%; IC95%0,63-1,58). Incrementi della mortalità cardiaca sono associati al PM10(0,93%; IC95% 0,16-1,70) e al PM2.5 (1,25%; IC95%0,17-2,34), mentre per la mortalità respiratoria l’effetto dell’esposizione a NO2 risulta più importante (1,67%; IC95%0,23-3,13; lag 2-5) rispetto a quella a PM10 (1,41%; IC95%-0,23;+3,08). I risultati sono fortemente omogenei tra città per la mortalità cardiaca e cerebrovascolare, ma non per quella respiratoria. Non si riscontrano effetti sulla mortalità cerebrovascolare. L’effetto dell’O3 sulla mortalità è al limite della significatività statistica. CONCLUSIONI: lo studio conferma un chiaro incremento della mortalità associata agli inquinanti atmosferici. Risultano più importanti gli effetti degli inquinanti correlati al traffico autoveicolare, qualiNO2 (per mortalità naturale) e PM2.5 (per mortalità cardiaca e respiratoria), con un ruolo indipendente di NO2 rispetto al particolato in base all’analisi bi-pollutant."

Lidia Morawska, Michael R. Moore, Zoran D. Ristovski, Health Impacts of Ultrafine Particles. Desktop Literature Review and Analysis. Australian Government, Department of the Environment and Heritage, 2004, 311 p. [formato PDF, 1,46 MB]. "As specified by the Australian Department of Environment and Heritage, work to achieve the objectives of this study was summarised as follows: • Undertake a literature search to identify relevant high quality studies that have been conducted, are underway or are proposed on: the health impacts of ultrafine particles; and the relationship between the sulfur content of diesel fuels and the number of ultrafine particles in diesel emissions. • Consult widely with stakeholders as needed within Australia and overseas to identify relevant research and obtain views on information gaps and research priorities for both topics. • Conduct a literature review for both topics, fully referencing all material and using only information from recognised research. • Recommend priorities for future Australian studies designed to address information gaps on both topics. • In relation to the link between the sulfur content of diesel fuels and the number of ultrafine particles in diesel emissions: assess the scale of the problem; and make recommendations for management responses considered necessary, taking into account the existing framework for managing air quality in Australia."

Review of evidence on health aspects of air pollution - REVIHAAP Project. [Final] Technical Report. WHO Regional Office for Europe, Copenhagen, 2013, 309 p. [formato PDF, 2,57 MB]. "This document presents answers to 24 questions relevant to reviewing European policies on air pollution and to addressing health aspects of these policies. The answers were developed by a large group of scientists engaged in the WHO project “Review of evidence on health aspects of air pollution – REVIHAAP”. The experts reviewed and discussed the newly accumulated scientific evidence on the adverse effects on health of air pollution, formulating science-based answers to the 24 questions. Extensive rationales for the answers, including the list of key references, are provided. The review concludes that a considerable amount of new scientific information on the adverse effects on health of particulate matter, ozone and nitrogen dioxide, observed at levels commonly present in Europe, has been published in recent years. This new evidence supports the scientific conclusions of the WHO air quality guidelines, last updated in 2005, and indicates that the effects in some cases occur at air pollution concentrations lower than those serving to establish these guidelines. It also provides scientific arguments for taking decisive actions to improve air quality and reduce the burden of disease associated with air pollution in Europe."

Giulia Cesaroni, Chiara Badaloni, Claudio Gariazzo, Massimo Stafoggia, Roberto Sozzi, Marina Davoli, and Francesco Forastiere, Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome. Environ Health Perspect. 2013 Mar;121(3):324-31 (8 p.) [formato PDF, 3,85 MB]. "BACKGROUND: Few European studies have investigated the effects of long-term exposure to both fine particulate matter (? 2.5 µm; PM2.5) and nitrogen dioxide (NO2) on mortality. OBJECTIVES: We studied the association of exposure to NO2, PM2.5, and traffic indicators on cause-specific mortality to evaluate the form of the concentration-response relationship. METHODS: We analyzed a population-based cohort enrolled at the 2001 Italian census with 9 years of follow-up. We selected all 1,265,058 subjects ? 30 years of age who had been living in Rome for at least 5 years at baseline. Residential exposures included annual NO2 (from a land use regression model) and annual PM2.5 (from a Eulerian dispersion model), as well as distance to roads with > 10,000 vehicles/day and traffic intensity. We used Cox regression models to estimate associations with cause-specific mortality adjusted for individual (sex, age, place of birth, residential history, marital status, education, occupation) and area (socioeconomic status, clustering) characteristics. RESULTS: Long-term exposures to both NO2 and PM2.5 were associated with an increase in nonaccidental mortality [hazard ratio (HR) = 1.03 (95% CI: 1.02, 1.03) per 10-µg/m3 NO2; HR = 1.04 (95% CI: 1.03, 1.05) per 10-µg/m3 PM2.5]. The strongest association was found for ischemic heart diseases (IHD) [HR = 1.10 (95% CI: 1.06, 1.13) per 10-µg/m3 PM2.5], followed by cardiovascular diseases and lung cancer. The only association showing some deviation from linearity was that between NO2 and IHD. In a bi-pollutant model, the estimated effect of NO2 on mortality was independent of PM2.5. CONCLUSIONS: This large study strongly supports an effect of long-term exposure to NO2 and PM2.5 on mortality, especially from cardiovascular causes. The results are relevant for the next European policy decisions regarding air quality."

Eleonora Pieralice, Lucio Triolo, Scelte modali e impatto sanitario del PM10. Rivista di Economia e Politica dei Trasporti (REPT), 2013, 1 (25 p.) [formato PDF, 0,99 MB]. "L’applicazione di metodologie per valutare l’impatto sanitario del PM10, derivante dall’uso dei trasporti, alle indagini dei comportamenti individuali per ottimizzare percorsi e uso dei mezzi, consente di valutare i benefici sulla salute associati a nuovi scenari di emissioni legati alla propensione al cambio modale. Dalle conoscenze teoriche si può simulare l’impatto ambientale derivante dall’uso del mezzo privato, e quindi definire gli ambiti di intervento per l’abbattimento di emissioni inquinanti in atmosfera. Queste emissioni sono costituite da sostanze gassose e da polveri (PM10, PM2.5 e particolato grossolano) le quali oltre ad alterare l’ecosistema globale creano rilevanti effetti nocivi agli ambienti locali e alla salute umana. Lo studio analizza gli inquinanti atmosferici generati dai sistemi di trasporto su strada, contiene una review di alcuni studi internazionali sull’impatto sanitario del PM10, e infine utilizza le funzioni dose-risposta di vari studi epidemiologici e tossicologici per stimare gli impatti sanitari espressi in termini di mortalità e di morbilità determinati dal particolato e da gas inquinanti. L’obiettivo è valutare i benefici per la salute prodotti da nuovi scenari di emissione, associati al cambio delle scelte modali degli utenti del trasporto privato, che determinano una diminuzione delle concentrazioni di PM10. La ricerca, che impiega indici di rischio empirici, si sviluppa su due percorsi: i) l’assessment della mortalità per tutte le cause, per tumore al polmone e per altre patologie croniche quali l’infarto del miocardio, l’aterosclerosi e le malattie ischemiche, è effettuata considerando concentrazioni medie annue di PM10 in termini di aumento degli effetti per incrementi del 10% delle concentrazioni in atmosfera delle polveri PM10; ii) le valutazioni dell’incidenza di morbosità per cause respiratorie in bambini e adulti, sono calcolate in termini di diminuzione del rischio, considerando riduzioni di concentrazioni per intervalli di 10ug/m3. La metodologia proposta mostra scenari potenzialmente importanti per abbattere le emissioni inquinanti e conseguire il risultato di attenuare gli effetti nocivi sulla salute delle popolazioni. L’affermazione di tali scenari migliorativi è regolata principalmente dai cambiamenti dello stile di vita delle persone. A livello europeo i progetti, le esperienze e le soluzioni in tal senso, che hanno riscontrato ampi successi, sono numerose. Le competenze e le politiche per la mobilità sostenibile dispongono di soluzioni per un sistema di trasporti più efficiente ed efficace. Gli studi a sostegno di una mobilità più sostenibile rappresentano lo strumento per creare una visione più cosciente e consapevole della natura al fine di condividere un vivere sociale più responsabile, ma lo strumento può divenire pratica solo se l’esperienza degli uomini è capace di trasformarlo in scelte politiche intelligenti e pragmatiche. La ricerca scientifica prosegue la sperimentazione di nuove linee e la messa a punto di nuove metodologie, ma senza l’applicazione nella realtà sociale delle conoscenze scientifiche e tecnologiche, ne risulterà solo un accanimento diagnostico e progettuale. Inoltre l’assenza di scelte politiche responsabili non consentirà di verificare l’efficienza e l’efficacia delle terapie messe a punto per curare le patologie indagate."

Laura Perez, Christophe Declercq, Carmen Iñiguez, Inmaculada Aguilera, Chiara Badaloni, Ferran Ballester, Catherine Bouland, Olivier Chanel, FB Cirarda, Francesco Forastiere, Bertil Forsberg, Daniela Haluza, Britta Hedlund, Koldo Cambra, Marina Lacasaña, Hanns Moshammer, Peter Otorepec, Miguel Rodríguez-Barranco, Sylvia Medina, Nino Künzli, Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network). European Respiratory Journal Express. Published on March 21, 2013 (30 p.) [formato PDF, 252 kB]. "Recent epidemiological research suggests that near road traffic-related pollution may cause chronic disease, as well as exacerbate related pathologies, implying that the entire "chronic disease progression" should be attributed to air pollution, no matter what the proximate cause was. We estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. We then expanded our approach to include coronary heart diseases in adults.Derivation of attributable cases required combining concentration-response function (CRF) between exposures and the respective health outcome of interest (obtained from published literature), an estimate of the distribution of selected exposures in the target population, and information about the frequency of the assessed morbidities.Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma is assumed, 15% of all episodes of asthma symptoms were attributable to air pollution. Without this assumption, only 2% of asthma symptoms were attributable to air pollution. Similar patterns were found for coronary heart diseases in older adults.Pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbation in European urban areas."

Laura Perez, Fred Lurmann, John Wilson, Manuel Pastor, Sylvia J. Brandt, Nino Künzli, and Rob McConnell, Near-roadway pollution and childhood asthma: implications for developing "win-win" compact urban development and clean vehicle strategies. Environ Health Perspect. 2012 November; 120(11): 1619–1626 (8 p.) [formato PDF, 341 kB]. "BACKGROUND: The emerging consensus that exposure to near-roadway traffic-related pollution causes asthma has implications for compact urban development policies designed to reduce driving and greenhouse gases. OBJECTIVES: We estimated the current burden of childhood asthma-related disease attributable to near-roadway and regional air pollution in Los Angeles County (LAC) and the potential health impact of regional pollution reduction associated with changes in population along major traffic corridors. METHODS: The burden of asthma attributable to the dual effects of near-roadway and regional air pollution was estimated, using nitrogen dioxide and ozone as markers of urban combustion-related and secondary oxidant pollution, respectively. We also estimated the impact of alternative scenarios that assumed a 20% reduction in regional pollution in combination with a 3.6% reduction or 3.6% increase in the proportion of the total population living near major roads, a proxy for near-roadway exposure. RESULTS: We estimated that 27,100 cases of childhood asthma (8% of total) in LAC were at least partly attributable to pollution associated with residential location within 75 m of a major road. As a result, a substantial proportion of asthma-related morbidity is a consequence of near-roadway pollution, even if symptoms are triggered by other factors. Benefits resulting from a 20% regional pollution reduction varied markedly depending on the associated change in near-roadway proximity. CONCLUSIONS: Our findings suggest that there are large and previously unappreciated public health consequences of air pollution in LAC and probably in other metropolitan areas with dense traffic corridors. To maximize health benefits, compact urban development strategies should be coupled with policies to reduce near-roadway pollution exposure."

Christophe Declercq, Mathilde Pascal, Olivier Chanel, Magali Corso, Aymeric Ung, Laurence Pascal, Myriam Blanchard, Sophie Larrieu, Sylvia Medina, Impact sanitaire de la pollution atmosphérique dans neuf villes françaises. Résultats du projet Aphekom. Institut de veille sanitaire, Saint-Maurice, septembre 2012, 36 p. [formato PDF, 468 kB]. "La causalité des relations, tant à court qu’à long terme, entre exposition à la pollution atmosphérique urbaine et santé est désormais largement acceptée. L’existence d’études épidémiologiques quantifiant les relations entre le niveau d’un indicateur d’exposition à la pollution de l’air et le risque de survenue d’un événement de santé rend possible l'évaluation des impacts sanitaires de la pollution atmosphérique à l’échelle d’une agglomération. Cette démarche a été appliquée pour la période 2004-2006 à neuf villes de France métropolitaine dans le cadre du projet européen Aphekom. Les indicateurs d’exposition à la pollution atmosphérique ont été construits à partir des niveaux de polluants mesurés par les stations de fond des réseaux de surveillance de la qualité de l’air. Les indicateurs de santé ont été construits à partir des données du PMSI (hospitalisations) et du CépiDc (décès). Les relations exposition-risque pertinentes ont été sélectionnées sur la base d’une revue de la littérature. Les méthodes classiques de calcul de l’impact sanitaire ont été utilisées pour évaluer, sous différents scénarios de réduction des niveaux de polluants, le nombre de cas évitables (impacts à court et long terme) et le gain d’espérance de vie (impacts à long terme). Une valorisation monétaire de ces bénéfices sanitaires potentiels a été réalisée en utilisant une approche basée sur le consentement à payer pour la mortalité et une approche coût de la maladie pour les hospitalisations. Pour les neuf agglomérations totalisant 12 millions d’habitants, le respect des valeurs guide de l’OMS pour les niveaux d’ozone aurait conduit à différer 69 décès/an et à éviter 62 hospitalisations respiratoires. Pour les niveaux de particules (PM10), ce sont 360 hospitalisations par an pour causes cardiaques et 673 pour causes respiratoires qui auraient pu être évitées. Pour les particules fines, à long terme, le respect des valeurs guides de l’OMS aurait entraîné un gain moyen d’espérance de vie à 30 ans de 3,6 à 7,5 mois selon la ville, représentant au total plus 2 900 décès/an différés en moyenne. Ces impacts à long terme sont ceux dont la valorisation économique est la plus élevée, avec un montant annuel estimé de 4,9 milliards €/an. Ces résultats mettent en évidence la persistance d’un impact substantiel de la pollution de l’air sur la santé dans les villes françaises. Ils sont ainsi susceptibles d’encourager la mise en oeuvre de politiques publiques d’amélioration de la qualité de l’air au niveau local." "The short- and long-term effects of exposure to urban air pollution on health are now well established. These health impacts can be quantified in a metropolitan area by applying concentration-response functions drawn from epidemiological studies to local air quality and health data. This method was applied for the 2004-2006 period to the nine French cities in the Aphekom European project. Data from background air quality monitors were used to estimate population exposure to air pollution. Health indicators were constructed using data from the PMSI (hospitalizations) and CepiDc (mortality) databases. The concentration-response functions were selected from a literature review. Conventional health impact assessment methods were used to quantify the number of avoidable hospitalizations and postponed deaths, as well as the gain in life expectancy, for various scenarios of decrease of particulate matter and ozone levels. The monetary value of these health benefits was assessed using a willingness-to-pay approach for mortality, and a cost-of-illness approach for morbidity. In the nine cities totaling 12 million people, complying with WHO air quality guidelines for ozone (100 µg/m3) would have postponed 69 deaths per year and prevented 66 respiratory hospitalizations per year. Complying with the PM10 guideline (20 µg/m3 for particulate matter with an aerodynamic diameter less than 10 µm) would have prevented 360 hospitalizations for cardiac diseases and 673 hospitalizations for respiratory causes per year. Complying with the PM2.5 guideline (10 µg/m3 for particulate matter with an aerodynamic diameter less than 2.5 µm) would have produced an average gain in life expectancy at age 30 of 3.6 to 7.5 months depending on the city; this gain is equivalent to a yearly burden of over 2,900 postponed deaths per year in the nine cities. The monetary value of these potential health benefits is largely dominated by the long-term effects of PM2.5 on mortality with a total estimated value of . 4.9 billion per year. These findings highlight the continuing, significant impact of air pollution on health in French cities and should encourage the adoption and implementation of public policies aimed at improving air quality."

Mette Sørensen, Barbara Hoffmann, Martin Hvidberg, Matthias Ketzel, Steen Solvang Jensen, Zorana Jovanovic Andersen, Anne Tjønneland, Kim Overvad, Ole Raaschou-Nielsen, Long-term exposure to traffic-related air pollution associated with blood pressure and self-reported hypertension in a Danish cohort. Environ Health Perspect. 2012 March; 120(3): 418–424 (7 p.) [formato PDF, 322 kB]. "BACKGROUND: Short-term exposure to air pollution has been associated with changes in blood pressure (BP) and emergency department visits for hypertension, but little is known about the effects of long-term exposure to traffic-related air pollution on BP and hypertension. OBJECTIVES: We studied whether long-term exposure to air pollution is associated with BP and hypertension. METHODS: In 1993-1997, 57,053 participants 50-64 years of age were enrolled in a population-based cohort study. Systolic and diastolic BP (SBP and DBP, respectively) were measured at enrollment. Self-reported incident hypertension during a mean follow-up of 5.3 years was assessed by questionnaire. We used a validated dispersion model to estimate residential long-term nitrogen oxides (NO(x)), a marker of traffic-related air pollution, for the 1- and 5-year periods prior to enrollment and before a diagnosis of hypertension. We conducted a cross-sectional analysis of associations between air pollution and BP at enrollment with linear regression, adjusting for traffic noise, measured short-term NO(x), temperature, relative humidity, and potential lifestyle confounders (n = 44,436). We analyzed incident hypertension with Cox regression, adjusting for traffic noise and potential confounders. RESULTS: A doubling of NO(x) exposure during 1- and 5-year periods preceding enrollment was associated with 0.53-mmHg decreases [95% confidence interval (CI): -0.88, -0.19 mmHg] and 0.50-mmHg decreases (95% CI: -0.84, -0.16 mmHg) in SBP, respectively. Long-term exposure also was associated with a lower prevalence of baseline self-reported hypertension (per doubling of 5-year mean NO(x): odds ratio = 0.96; 95% CI: 0.91, 1.00), whereas long-term NO(x) exposure was not associated with incident self-reported hypertension during follow-up. CONCLUSIONS: Long-term exposure to traffic-related air pollution was associated with a slightly lower prevalence of BP at baseline, but was not associated with incident hypertension."

Nicole A.H. Janssen, Miriam E. Gerlofs-Nijland, Timo Lanki, Raimo O. Salonen, Flemming Cassee, Gerard Hoek, Paul Fischer, Bert Brunekreef and Michal Krzyzanowski, Health effects of black carbon. (ISBN 978 92 890 0265 3). WHO Regional Office for Europe, Copenhagen, 2012, 96 p. [formato PDF, 2,10 MB]. "Black carbon is a good indicator of combustion-related air pollution, and was only recently recognized as a short-lived climate-forcer, which contributes to warming the Earth's atmosphere. This report presents the results of a systematic review of evidence of the health effects of black carbon in ambient air. Epidemiological studies provide sufficient evidence of the association of cardiopulmonary morbidity and mortality with exposure to black carbon. Toxicological studies suggest that black carbon may operate as a universal carrier of a wide variety of chemicals of varying toxicity to the human body. Although black carbon may not be a major, directly toxic component of fine particulate matter, reducing people’s exposure to particulate matter containing black carbon should reduce its effects on their health, as well as helping to mitigate climate change. This review is of particular interest to environmental health professionals concerned with assessing and reducing the health effects of air pollution, as well as to those who use scientific evidence in support of climate change mitigation policies."

Steve H.L. Yim and Steven R.H. Barrett (MIT), Public Health Impacts of Combustion Emissions in the United Kingdom. Environ. Sci. Technol., 2012, 46 (8), pp 4291–4296 (6 p.) [formato PDF, 2,54 MB]. "Combustion emissions are a major contributor to degradation of air quality and pose a risk to human health. We evaluate and apply a multiscale air quality modeling system to assess the impact of combustion emissions on UK air quality. Epidemiological evidence is used to quantitatively relate PM(2.5) exposure to risk of early death. We find that UK combustion emissions cause ∼13,000 premature deaths in the UK per year, while an additional ∼6000 deaths in the UK are caused by non-UK European Union (EU) combustion emissions. The leading domestic contributor is transport, which causes ∼7500 early deaths per year, while power generation and industrial emissions result in ∼2500 and ∼830 early deaths per year, respectively. We estimate the uncertainty in premature mortality calculations at -80% to +50%, where results have been corrected by a low modeling bias of 28%. The total monetized life loss in the UK is estimated at £6-62bn/year or 0.4-3.5% of gross domestic product. In Greater London, where PM concentrations are highest and are currently in exceedance of EU standards, we estimate that non-UK EU emissions account for 30% of the ∼3200 air quality-related deaths per year. In the context of the European Commission having launched infringement proceedings against the UK Government over exceedances of EU PM air quality standards in London, these results indicate that further policy measures should be coordinated at an EU-level because of the strength of the transboundary component of PM pollution." [no free full text access]

Committee on the Medical Effects of Air Pollutants, The Mortality Effects of Long-Term Exposure to Particulate Air Pollution in the United Kingdom. COMEAP, Chilton, Didcot, Oxfordshire, 2010, 108 p. [formato PDF, 614 kB]. "This report deals with answering what, at first glance, appear to be relatively simple questions regarding the effects of particulate air pollution on mortality in the UK. We have tried to explain not only the approaches we have used to answer the questions, but also the limitations of the interpretations that can be put on the results. We anticipate that it will be useful to policy makers and elected representatives, and hope also that it will make a helpful contribution to public awareness and understanding of the health effects of air pollution. In summary: a) Airborne particles comprise an anthropogenic component and a natural component; b) There is an interest in the effects of air pollution on mortality in terms of the impact that policies for reduction would have, or the current burden in terms of public health; c) These effects can be expressed at the population level in terms of life expectancy, and on loss or gain in life years. The burden can also be expressed in terms of deaths occurring in a specified year across the population; d) As everyone dies eventually no lives are ever saved by reducing environmental exposures – deaths are delayed resulting in increased life expectancy; e) These measures are averages or aggregates across the population; it is not known how the effects are distributed among individuals. We conclude that: a) Removing all anthropogenic (‘human-made’) particulate matter air pollution (measured as PM2.5 1) could save the UK population approximately 36.5 million life years over the next 100 years and would be associated with an increase in UK life expectancy from birth, i.e. on average across new births, of six months. This shows the public health importance of taking measures to reduce air pollution; b) A policy which aimed to reduce the annual average concentration of PM2.5 by 1 ìg/m3 would result in a saving of approximately 4 million life years or an increase in life expectancy of 20 days in people born in 2008; c) The current (2008) burden of anthropogenic particulate matter air pollution is, with some simplifying assumptions, an effect on mortality in 2008 equivalent to nearly 29,000 deaths in the UK at typical ages and an associated loss of total population life of 340,000 life-years. The burden can also be represented as a loss of life expectancy from birth of approximately six months; d) The uncertainties in these estimates need to be recognised: they could vary from about a sixth to double the figures shown."

Nicole A.H. Janssen, Gerard Hoek, Milena Simic-Lawson, Paul Fischer, Leendert van Bree, Harry ten Brink, Menno Keuken, Richard W. Atkinson, H. Ross Anderson, Bert Brunekreef, and Flemming R. Cassee, Black Carbon as an Additional Indicator of the Adverse Health Effects of Airborne Particles Compared with PM10 and PM2.5. Environ. Health Perspect. 119 (2011) 1691–1699 (9 p.) [formato PDF, 405 kB]. "Background: Current air quality standards for particulate matter (PM) use the PM mass concentration [PM with aerodynamic diameters ≤ 10 µm (PM10) or ≤ 2.5 µm (PM2.5)] as a metric. It has been suggested that particles from combustion sources are more relevant to human health than are particles from other sources, but the impact of policies directed at reducing PM from combustion processes is usually relatively small when effects are estimated for a reduction in the total mass concentration. Objectives: We evaluated the value of black carbon particles (BCP) as an additional indicator in air quality management. Methods: We performed a systematic review and meta-analysis of health effects of BCP compared with PM mass based on data from time-series studies and cohort studies that measured both exposures. We compared the potential health benefits of a hypothetical traffic abatement measure, using near-roadway concentration increments of BCP and PM2.5 based on data from prior studies. Results: Estimated health effects of a 1-µg/m3 increase in exposure were greater for BCP than for PM10 or PM2.5, but estimated effects of an interquartile range increase were similar. Two-pollutant models in time-series studies suggested that the effect of BCP was more robust than the effect of PM mass. The estimated increase in life expectancy associated with a hypothetical traffic abatement measure was four to nine times higher when expressed in BCP compared with an equivalent change in PM2.5 mass. Conclusion: BCP is a valuable additional air quality indicator to evaluate the health risks of air quality dominated by primary combustion particles."

Frank Kelly, Ben Armstrong, Richard Atkinson, H. Ross Anderson, Ben Barratt, Sean Beevers, Derek Cook, Dave Green, Dick Derwent, Ian Mudway, and Paul Wilkinson, The London Low Emission Zone Baseline Study. (Research Report n.163). Health Effects Institute, Boston, Massachusetts, November 2011, 116 p. [formato PDF, 3,05 MB] "This report describes a study by Dr. Frank Kelly of King's College London and colleagues evaluating the feasibility of studying potential changes in air quality and health associated with the London Low Emission Zone (LEZ), which went into effect in 2008 and restricts entry of older, more polluting vehicles into Greater London. Based on their earlier study of London's Congestion Charging Scheme, the investigators conducted emissions and exposure modeling to estimate the projected effects of LEZ implementation. They also assessed the feasibility of using medical records from private practices to evaluate the relationships between exposure to traffic and indicators of respiratory and cardiovascular disease."

Martin Andersson, Lars Modig, Linnea Hedman, Bertil Forsberg and Eva Rönmark, Heavy vehicle traffic is related to wheeze among schoolchildren: a population-based study in an area with low traffic flows. Environmental Health 2011, 10:91 (8 p.) [formato PDF, 393 kB]. "Background. An association between traffic air pollution and respiratory symptoms among children has been reported. However, the effects of traffic air pollution on asthma and wheeze have been very sparsely studied in areas with low traffic intensity in cold climate with poor dispersion. We evaluated the impact of vehicle traffic on childhood asthma and wheeze by objective exposure assessment. Methods. As a part of the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a questionnaire was sent to the families of all children attending first or second grade in Luleå (72,000 inhabitants) in Northern Sweden in 2006. The age of the children was 7-8 years and the participation rate was 98% (n = 1357). Skin prick tests were performed in 1224 (89%) children. The home addresses were given geographical coordinates and traffic counts were obtained from the local traffic authorities. A proximity model of average daily traffic and average daily heavy vehicle traffic within 200 meters from each participant's home address was used. The associations between traffic exposure and asthma and wheeze, respectively, were analysed in an adjusted multiple logistic regression model. Results. Exposure to high traffic flows was uncommon in the study area; only 15% of the children lived within 200 meters from a road with a traffic flow of ?8000 vehicles per day. Living closer than 200 meters from a road with ?500 heavy vehicles daily was associated with current wheeze, odds ratio 1.7 (confidence interval 1.0-2.7). A dose-response relation was indicated. An increased risk of asthma was also seen, however not significant, odds ratio 1.5 (confidence interval 0.8-2.9). Stratified analyses revealed that the effect of traffic exposure was restricted to the non-sensitized phenotype of asthma and wheeze. The agreement between self-reported traffic exposure and objective measurements of exposure was moderate. Conclusions. This study showed that already at low levels of exposure, vehicle traffic is related to an increased risk of wheeze among children. Thus, the global burden of traffic air pollution may be underestimated."

Christopher R. Knittel, Douglas L. Miller, and Nicholas J. Sanders, Caution, Drivers! Children Present: Traffic, Pollution, and Infant Health. (CEEPR Working Paper 2011-013). MIT Center for Energy and Environmental Policy Research, Cambridge, MA, July 2011, 45 p. [formato PDF, 480 kB]. "Since the Clean Air Act Amendments of 1990 (CAAA), atmospheric concentration of local pollutants has fallen drastically. A natural question is whether further reductions will yield additional health benefits. We further this research by addressing two related research questions: (1) what is the impact of automobile driving (and especially congestion) on ambient air pollution levels, and (2) what is the impact of modern air pollution levels on infant health? Our setting is California (with a focus on the Central Valley and Southern California) in the years 2002-2007. Using an instrumental variables approach that exploits the relationship between traffic, ambient weather conditions, and various pollutants, our findings suggest that ambient pollution levels, specifically particulate matter, still have large impacts on weekly infant mortality rates. Our results also illustrate the importance of weather controls in measuring pollution’s impact on infant mortality."

Janet Currie, Matthew J. Neidell, Johannes Schmieder, Air Pollution and Infant Health: Lessons from New Jersey. (NBER Working Paper No. 14196). National Bureau of Economic Research, Cambridge, MA, July 2008, 43 p. [formato PDF, 1,37 MB].

Moniek Zuurbier, Gerard Hoek, Marieke Oldenwening, Virissa Lenters, Kees Meliefste, Peter van den Hazel, and Bert Brunekreef, Commuters’ Exposure to Particulate Matter Air Pollution Is Affected by Mode of Transport, Fuel Type, and Route. Environ Health Perspect 2010, 118:783-789 (7 p.) [formato PDF, 1,79 MB]. "Background: Commuters are exposed to high concentrations of air pollutants, but little quantitative information is currently available on differences in exposure between different modes of transport, routes, and fuel types. Objectives: The aim of our study was to assess differences in commuters’ exposure to traffic-related air pollution related to transport mode, route, and fuel type. Methods: We measured particle number counts (PNCs) and concentrations of PM2.5 (particulate matter ? 2.5 µm in aerodynamic diameter), PM10, and soot between June 2007 and June 2008 on 47 weekdays, from 0800 to 1000 hours, in diesel and electric buses, gasoline- and diesel-fueled cars, and along two bicycle routes with different traffic intensities in Arnhem, the Netherlands. In addition, each-day measurements were taken at an urban background location. Results: We found that median PNC exposures were highest in diesel buses (38,500 particles/cm3) and for cyclists along the high-traffic intensity route (46,600 particles/cm3) and lowest in electric buses (29,200 particles/cm3). Median PM10 exposure was highest from diesel buses (47 µg/m3) and lowest along the high- and low-traffic bicycle routes (39 and 37 µg/m3). The median soot exposure was highest in gasoline-fueled cars (9.0 × 10–5/m), diesel cars (7.9 × 10–5/m), and diesel buses (7.4 × 10–5/m) and lowest along the low-traffic bicycle route (4.9 × 10–5/m). Because the minute ventilation (volume of air per minute) of cyclists, which we estimated from measured heart rates, was twice the minute ventilation of car and bus passengers, we calculated that the inhaled air pollution doses were highest for cyclists. With the exception of PM10, we found that inhaled air pollution doses were lowest for electric bus passengers. Conclusions: Commuters’ rush hour exposures were significantly influenced by mode of transport, route, and fuel type." "This study shows that exposure to air pollutants is significantly lower in electric powered buses than in diesel buses. The use of clean buses, such as electric buses, is therefore beneficial not only for outdoor air quality but also for bus passengers. Policy makers are encouraged to increase the use of clean buses, such as electric buses. Cyclists are exposed to air pollutants from surrounding traffic. The higher minute ventilation of cyclists especially increases the inhaled doses of air pollutants. Health implications of exposure to short, high peaks during cycling instead of the lower, longer peaks in cars and buses are not clear but could be important (Peters et al. 2004). Because the positive health effects of cycling (Baumann 2004; de Geus et al. 2009, 2008; Hendriksen et al. 2000) likely outweigh the health risks of increased pollution loads, and because cyclists do not emit any air pollutants and thus contribute to clean air, cycling should not be discouraged. Cyclists should be encouraged to choose for low-traffic routes by making them aware of the potential health benefits and by route planners with options to choose for low-traffic routes. City planners should create bicycle lanes with less (preferably no) contact with motorized traffic. In view of the intimate mixing of bicycles and mopeds in the Netherlands, further improvements can be expected from the replacement of spark engine by electric mopeds."

Air pollution and children's respiratory health. (Report 6353). Swedish Environmental Protection Agency, Stockholm, 2010, 119 p. [formato PDF, 1,59 MB]. "In children, air pollution may cause, contribute to or aggravate respiratory diseases, which are a major cause of their ill-health. Childhood exposure to traffic-related air pollution is therefore of great concern, and has been discussed as a key aetiological factor. This review summarises and evaluates the findings of recent epidemiological studies of how short- and long-term exposure to traffic-related air pollution affects respiratory health and allergic sensitisation in children. In adults, air pollution is also known to contribute to cancer and heart disease. The same may, in principle, be true of children too, but these effects have scarcely been studied; and given the rarity of these diseases in childhood, air pollution is probably a minor contributory factor, at most, in terms of public health. Moreover, there are no reports on possible effects, in the form of adult cancer and heart disease, of childhood exposure to air pollution. Since respiratory tract symptoms are particularly prevalent in young children, elevated risks due to exposure to traffic-related air pollution have major implications for public health. Effects of air pollution may be divided into short-term and long-term effects, depending on the time lag from exposure until they make themselves felt. Exposure to NO2, PM10 and to some extent PM2,5 has been associated with symptoms of the lower respiratory tract in asthmatic children and with their hospital admission for asthma, often on the same or the following day. The overall estimated associations with hospital admissions for asthma were 1.3 % and 2 % rises in such admissions for every 10 ìg/m³ increase in NO2 and PM10 respectively. No threshold levels (i.e. ‘safe’ levels below which there is no risk) can be identified from the existing data. The areas with the best air quality in which a significant association with admissions was found had average levels of 53 ìg/m³ NO2 and 52 ìg/m³ PM10. The symptom studies were more heterogeneous and no overall estimate can be derived. However, the areas with the best air quality where significant effects on asthmatic children’s symptoms were found had average levels of 16 ìg/m³ NO2 and 57 ìg/m³ PM10. Based on a few studies only, asthmatic children thus appear to be at substantially higher risk than non-asthmatic children of having lower respiratory tract symptoms caused by exposure to air pollution. Owing to the variety of methods and definitions in the studies reviewed, no combined analysis of the long-term effects of ambient air pollution on respiratory symptoms or disease was feasible. However, there is evidence that exposure early in life to traffic-related air pollution, including gases (CO, O3, NOx) and particles (PM2.5, PM10), contributes to the onset of respiratory airway diseases, such as asthma and rhinitis, during childhood. This applies especially to children living close to major roads. The lowest long-term levels found to be associated with long-term health effects are 17–20 ìg/m3 of NO2 (in Dresden and Munich, Germany and Stockholm, Sweden). There is strong evidence that exposure to traffic-related air pollution in childhood adversely affects children’s age-dependent improvement in lung function, at least up to adolescence, an effect that probably — although this remains to be studied — persists into adulthood, thus exerting an impact on adult respiratory health as well. The diversity of the studies reviewed makes formal quantitative comparisons of the findings difficult, and rules out any generalisation on how far air pollution affects lung function in children. The cleanest environments where lung function has been shown to be related to air pollution were in Austria and Sweden, where mean levels of NO2/NOx were 18–23 ìg/m3. One study of lung function in children up to late adolescence showed a 3 % rise per ìg/m³ of NO2 or PM10 in the risk of having a clinically serious deficit in lung function after eight years’ exposure. Exposure to NO2 (or NOx) has been shown, in some studies, to be associated with sensitisation to common allergens in children. The pooled estimate gives a 7 % rise in the risk of sensitisation to outdoor allergens for children living in areas with 10 ìg/m³ higher NO2 levels. In addition, the health effects of air pollution may be especially pronounced in individuals who are genetically susceptible, as well as in those exposed to other environmental factors. However, the association between air pollution and sensitisation needs to be studied further before it can serve as the basis for preventive action. Children are judged to be more susceptible than adults to the adverse effects of air pollution. Their developing airway and lung function distinguishes them from adults and, since reduced lung growth may be seen as a permanent impairment, children may indeed be seen as a susceptible group. Whether they are especially susceptible when it comes to other respiratory effects is less clear. In addition, children cannot choose or modify their environment to the same extent as adults. Urban air pollution is caused by a mix of numerous components. Some are correlated, thereby confounding explanations of health effects, if any, in specific studies. Moreover, differences in observed effects may reflect random variation. Error rates in exposure assessments vary from one component and location to another. Accordingly, little emphasis should be laid on the fact that air pollutants derived from the same source seem to be variously related to certain health effects in different studies. Considering the components of air pollution as representing a complex mix is often more meaningful. Selective measures to improve air quality by removing specific components may achieve considerably smaller health gains than the ‘single component’ risks observed in epidemiological studies might lead one to expect."

Anna Lindgren, Emilie Stroh, Peter Montnémery, Ulf Nihlén, Kristina Jakobsson. Anna Axmon, Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden. International Journal of Health Geographics 2009, 8:2 (15 p.) [formato PDF, 4,64 MB]. "Background: There is growing evidence that air pollution from traffic has adverse long-term effects on chronic respiratory disease in children, but there are few studies and more inconclusive results in adults. We examined associations between residential traffic and asthma and COPD in adults in southern Sweden. A postal questionnaire in 2000 (n = 9319, 18–77 years) provided disease status, and self-reported exposure to traffic. A Geographical Information System (GIS) was used to link geocoded residential addresses to a Swedish road database and an emission database for NOx. Results: Living within 100 m of a road with >10 cars/minute (compared with having no heavy road within this distance) was associated with prevalence of asthma diagnosis (OR = 1.40, 95% CI = 1.04–1.89), and COPD diagnosis (OR = 1.64, 95%CI = 1.11–2.4), as well as asthma and chronic bronchitis symptoms. Self-reported traffic exposure was associated with asthma diagnosis and COPD diagnosis, and with asthma symptoms. Annual average NOx was associated with COPD diagnosis and symptoms of asthma and chronic bronchitis. Conclusion: Living close to traffic was associated with prevalence of asthma diagnosis, COPD diagnosis, and symptoms of asthma and bronchitis. This indicates that traffic-related air pollution has both long-term and short-term effects on chronic respiratory disease in adults, even in a region with overall low levels of air pollution."

Eberhard Greiser, Claudia Greiser, Risikofaktor nächtlicher Fluglärm. Abschlussbericht über eine Fall-Kontroll-Studie zu kardiovaskulären und psychischen Erkrankungen im Umfeld des Flughafens Köln-Bonn (Risk factor night-time aircraft noise. Final report on a case-control study in the vicinity of Cologne-Bonn International Airport). (Schriftenreihe Umwelt & Gesundheit Nr. 01/2010). Umweltbundesamt, Dessau, März 2010, 32 p. [formato PDF, 1,38 MB] + Anlagenband (Supplementary Notes) 606 p. [formato PDF, 4,09 MB]. "The aim of the case-control study was to determine the possible impact of aircraft noise, especially at night, on cardiovascular diseases and on psychiatric diseases. The data of more than 1.020 Million persons, insured in compulsory sickness funds with place of residence in the study region (City of Cologne and two counties adjacent to the airport (Rhein-Sieg-Kreis, Rheinisch-Bergischer Kreis) were linked using a geographic information system to environmental noise data, area-specific social welfare rates as well as local nursing home bed density. The study populations comprises more than 55% of the total population of the study region. Multiple logistic regressions were calculated by gender. Results show an linear increase of disease risk for cardiovascular diseases from 40 dB(A) Leq onwards in all investigated time windows (6-22, 22-6, 23-1, 3-5 hours) and from 35,25 dB(A) onwards for 24-hours Leq. This does not apply to acute myocardial infarction. For psychiatric disorders there is one consistent result, only: depressive disorders in females. In most of the analyses there is a considerably larger increase of disease risk for that part of the study population which was not entitled to reimbursement of noise prevention measures for bedroom windows. A discussion of available scientific evidence according to epidemiologic criteria of causation (Hill’s criteria) ascertains that there is sufficient evidence for causation of cardiovascular diseases (except myocardial infarction) by aircraft noise."

W. James Gauderman, Hita Vora, Rob McConnell, Kiros Berhane, Frank Gilliland, Duncan Thomas, Fred Lurmann, Edward Avol, Nino Kunzli, Michael Jerrett, John Peters, Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 2007, 369:571-577 (7 p.) [formato PDF, 121 kB]. Articolo a pagamento su ScienceDirect. "Background: Whether local exposure to major roadways adversely affects lung-function growth during the period of rapid lung development that takes place between 10 and 18 years of age is unknown. This study investigated the association between residential exposure to traffic and 8-year lung-function growth. Methods: In this prospective study, 3677 children (mean age 10 years [SD 0·44]) participated from 12 southern California communities that represent a wide range in regional air quality. Children were followed up for 8 years, with yearly lung-function measurements recorded. For each child, we identified several indicators of residential exposure to traffic from large roads. Regression analysis was used to establish whether 8-year growth in lung function was associated with local traffic exposure, and whether local traffic effects were independent of regional air quality. Findings: Children who lived within 500 m of a freeway (motorway) had substantial deficits in 8-year growth of forced expiratory volume in 1 s (FEV1, –81 mL, p=0·01 [95% CI –143 to –18]) and maximum midexpiratory flow rate (MMEF, –127 mL/s, p=0·03 [–243 to –11), compared with children who lived at least 1500 m from a freeway. Joint models showed that both local exposure to freeways and regional air pollution had detrimental, and independent, effects on lung-function growth. Pronounced deficits in attained lung function at age 18 years were recorded for those living within 500 m of a freeway, with mean percent-predicted 97·0% for FEV1 (p=0·013, relative to >1500 m [95% CI 94·6–99·4]) and 93·4% for MMEF (p=0·006 [95% CI 89·1–97·7]). Interpretation: Local exposure to traffic on a freeway has adverse effects on children’s lung development, which are independent of regional air quality, and which could result in important deficits in attained lung function in later life."

Andrea Baccarelli, Ida Martinelli, Valeria Pegoraro, Steven Melly, Paolo Grillo, Antonella Zanobetti, Lifang Hou, Pier Alberto Bertazzi, Pier Mannuccio Mannucci, Joel Schwartz, Living Near Major Traffic Roads and Risk of Deep Vein Thrombosis. Circulation 2009, 119:3118-3124 (8 p.) [formato PDF, 258 kB]. "Particulate air pollution has been consistently linked to increased risk of arterial cardiovascular disease. Few data on air pollution exposure and risk of venous thrombosis are available. We investigated whether living near major traffic roads increases the risk of deep vein thrombosis (DVT), using distance from roads as a proxy for traffic exposure."

Lennart Bråbäck and Bertil Forsberg, Does traffic exhaust contribute to the development of asthma and allergic sensitization in children: findings from recent cohort studies. Review. Environmental Health 2009, 8:17 (11 p.) [formato PDF, 647 kB]. "The aim of this review was to assess the evidence from recent prospective studies that long-term traffic pollution could contribute to the development of asthma-like symptoms and allergic sensitization in children. We have reviewed cohort studies published since 2002 and found in PubMed in Oct 2008. In all, 13 papers based on data from 9 cohorts have evaluated the relationship between traffic exposure and respiratory health. All surveys reported associations with at least some of the studied respiratory symptoms. The outcome varied, however, according to the age of the child. Nevertheless, the consistency in the results indicates that traffic exhaust contributes to the development of respiratory symptoms in healthy children. Potential effects of traffic exhaust on the development of allergic sensitization were only assessed in the four European birth cohorts. Long-term exposure to outdoor air pollutants had no association with sensitization in ten-year-old schoolchildren in Norway. In contrast, German, Dutch and Swedish preschool children had an increased risk of sensitization related to traffic exhaust despite fairly similar levels of outdoor air pollution as in Norway. Traffic-related effects on sensitization could be restricted to individuals with a specific genetic polymorphism. Assessment of gene-environment interactions on sensitization has so far only been carried out in a subgroup of the Swedish birth cohort. Further genetic association studies are required and may identify individuals vulnerable to adverse effects from traffic-related pollutants. Future studies should also evaluate effects of traffic exhaust on the development and long term outcome of different phenotypes of asthma and wheezing symptoms."

Committee on the Medical Effects of Air Pollutants, Long-Term Exposure to Air Pollution: Effect on Mortality (Final Report). COMEAP, 2009, 196 p. [formato PDF, 1,50 MB]. "The evidence base regarding the effects of long-term exposure to air pollutants has strengthened since our 2001 report. This strengthening comprises both extensions to, and reanalysis of, the results of the studies we looked at in 2001 and publication of a number of European cohort studies and studies of the effects of policy initiatives. The evidence as a whole points strongly to an association between long-term exposure to particulate air pollution and effects on mortality. The evidence also points to PM2.5 as the most satisfactory index of particulate air pollution for quantitative assessments of the effects of policy interventions. The best studied effects and those which we recommend for use in quantification exercises are effects on all-cause mortality, on cardiopulmonary mortality and on lung cancer mortality."

Giorgio Gilli, Tiziana Schilirò, Alessandro Bertello (a cura di), Inquinamento atmosferico e salute. Un documento di approfondimento sui temi della qualità dell’aria e delle implicazioni sulla salute. Provincia di Torino, Università di Torino, Dipartimento di Sanità Pubblica e Microbiologia, 2003, 15 p. [formato PDF, 64 kB]. Ampia scheda sui principali inquinanti atmosferici ed i loro effetti.

Lucy Bayer-Oglesby, Christian Schindler, Marianne E. Hazenkamp-von Arx, Charlotte Braun-Fahrländer, Dirk Keidel, Regula Rapp, Nino Künzli, Otto Braendli, Luc Burdet, L-J. Sally Liu, Philippe Leuenberger, Ursula Ackermann-Liebrich, and the SAPALDIA Team, Living near main streets and respiratory symptoms in adults: the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA). American Journal of Epidemiology, Vol. 164, No. 12 (2006) 1190–1198 [formato PDF, 122 KB]. "The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA), conducted in 1991 (SAPALDIA 1) in eight areas among 9,651 randomly selected adults aged 18-60 years, reported associations among the prevalence of respiratory symptoms, nitrogen dioxide, and particles with an aerodynamic diameter of less than 10 microg/m3. Later, 8,047 subjects reenrolled in 2002 (SAPALDIA 2). The effects of individually assigned traffic exposures on reported respiratory symptoms were estimated, while controlling for socioeconomic and exposure- and health-related factors. The risk of attacks of breathlessness increased for all subjects by 13% (95% confidence interval: 3, 24) per 500-m increment in the length of main street segments within 200 m of the home and decreased in never smokers by 12% (95% confidence interval: 0, 22) per 100-m increment in distance from home to a main street. Living within 20 m of a main street increased the risks of regular phlegm by 15% (95% confidence interval: 0, 31) and wheezing with breathing problems by 34% (95% confidence interval: 0, 79) in never smokers. In 2002, the effects related to road distance were different from those in 1991, which could be due to changes in the traffic pollution mixture. These findings among a general population provide strong confirmation that living near busy streets leads to adverse respiratory health effects."

Joel Schwartz, Air pollution and children's health. Pediatrics, Vol. 113 No. 4 April 2004, pp. 1037-1043 [formato PDF, 256 KB]. "Children’s exposure to air pollution is a special concern because their immune system and lungs are not fully developed when exposure begins, raising the possibility of different responses than seen in adults. In addition, children spend more time outside, where the concentrations of pollution from traffic, powerplants, and other combustion sources are generally higher. Although air pollution has long been thought to exacerbate minor acute illnesses, recent studies have suggested that air pollution, particularly traffic-related pollution, is associated with infant mortality and the development of asthma and atopy. Other studies have associated particulate air pollution with acute bronchitis in children and demonstrated that rates of bronchitis and chronic cough declined in areas where particle concentrations have fallen. More mixed results have been reported for lung function. Overall, evidence for effects of air pollution on children have been growing, and effects are seen at concentrations that are common today. Although many of these associations seem likely to be causal, others require and warrant additional investigation." This article cites 79 articles, 27 of which you can access for free at: Pediatrics.

T. Nicolai, D. Carr, S.K. Weiland, H. Duhme, O. von Ehrenstein, C. Wagner, E. von Mutius, Urban traffic and pollutant exposure related to respiratory outcomes and atopy in a large sample of children. European Respiratory Journal 21 (2003) 956–963 [formato PDF, 274 KB]. "Conflicting results have been reported for the relationship between traffic exposure and inception of atopy. The effect of traffic on the prevalence of asthma and atopy at school age was investigated in a representative population. Random samples of schoolchildren (n=7,509, response rate 83.7%) were studied using the International Study of Asthma and Allergies in Childhood phase-II protocol with skin-prick tests, measurements of specific immunoglobulin E and lung function. Traffic exposure was assessed via traffic counts and by an emission model which predicted soot, benzene and nitrogen dioxide (NO2). Traffic counts were associated with current asthma, wheeze and cough. In children with tobacco-smoke exposure, traffic volume was additionally associated with a positive skin-prick test. Cough was associated with soot, benzene and NO2, current asthma with soot and benzene, and current wheeze with benzene and NO2. No pollutant was associated with allergic sensitisation. High vehicle traffic was associated with asthma, cough and wheeze, and in children additionally exposed to environmental tobacco smoke, with allergic sensitisation. However, effects of socioeconomic factors associated with living close to busy roads cannot be ruled out."

Michael Brauer, Gerard Hoek, Patricia Van Vliet, Kees Meliefste, Paul H. Fischer, Alet Wijga, Laurens P. Koopman, Herman J. Neijens, Jorrit Gerritsen, Marjan Kerkhof, Joachim Heinrich, Tom Bellander, and Bert Brunekreef, Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. American Journal of Respiratory and Critical Care Medicine 166 (2002) 1092–1098 [formato PDF, 96 KB]. "Despite the important contribution of traffic sources to urban air quality, relatively few studies have evaluated the effects of traffic-related air pollution on health, such as its influence on the development of asthma and other childhood respiratory diseases. We examined the relationship between traffic-related air pollution and the development of asthmatic/allergic symptoms and respiratory infections in a birth cohort (n approximately 4,000) study in The Netherlands. A validated model was used to assign outdoor concentrations of traffic-related air pollutants (nitrogen dioxide, particulate matter less than 2.5 micro m in aerodynamic diameter, and "soot") at the home of each subject of the cohort. Questionnaire-derived data on wheezing, dry nighttime cough, ear, nose, and throat infections, skin rash, and physician-diagnosed asthma, bronchitis, influenza, and eczema at 2 years of age were analyzed in relation to air pollutants. Adjusted odds ratios for wheezing, physician-diagnosed asthma, ear/nose/throat infections, and flu/serious colds indicated positive associations with air pollutants, some of which reached borderline statistical significance. No associations were observed for the other health outcomes analyzed. Sensitivity analyses generally supported these results and suggested somewhat stronger associations with traffic, for asthma that was diagnosed before 1 year of age. These findings are subject to confirmation at older ages, when asthma can be more readily diagnosed."

U. Gehring, J. Cyrys, G. Sedlmeir, B. Brunekreef, T. Bellander, P. Fischer, C.P. Bauer, D. Reinhardt, H.E. Wichmann and J. Heinrich, Traffic-related air pollution and respiratory health during the first 2 yrs of life. European Respiratory Journal 19 (2002) 690-698 [formato PDF, 112 KB]. "As part of an international collaborative study on the impact of Traffic-Related Air Pollution on Childhood Asthma (TRAPCA), the health effects associated with long-term exposure to particles with a 50% cut-off aerodynamic diameter of 2.5 microm (PM2.5), PM2.5 absorbance, and nitrogen dioxide (NO2) were analysed. The German part of the TRAPCA study used data from subpopulations of two ongoing birth cohort studies (German Infant Nutrition Intervention Programme (GINI) and Influences of Lifestyle Related Factors on the Human Immune System and Development of Allergies in Children (LISA)) based in the city of Munich. Geographic information systems (GIS)-based exposure modelling was used to estimate traffic-related air pollutants at the birth addresses of 1,756 infants."

Michael S. Friedman, Kenneth E. Powell, Lori Hutwagner, et al., Impact of changes in transportation and commuting behaviors during the 1996 Summer Olympic Games in Atlanta on air quality and childhood asthma. JAMA 2001 Feb 21;285(7) 897-905 [formato PDF, 215 KB]. "Efforts to reduce downtown traffic congestion in Atlanta during the Olympic Games resulted in decreased traffic density, especially during the critical morning period. This was associated with a prolonged reduction in ozone pollution and significantly lower rates of childhood asthma events. These data provide support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic."

Federico Balestreri (ISDE), Impatto sanitario da traffico auto-veicolare. International Society Doctors for the Environment, 11 p. [formato Word, 92 kB].

Lars Jarup, Wolfgang Babisch, Danny Houthuijs, Göran Pershagen, Klea Katsouyanni, Ennio Cadum, Marie-Louise Dudley, Pauline Savigny, Ingeburg Seiffert, Wim Swart, Oscar Breugelmans, Gösta Bluhm, Jenny Selander, Alexandros Haralabidis, Konstantina Dimakopoulou, Panayota Sourtzi, Manolis Velonakis, and Federica Vigna-Taglianti, on behalf of the HYENA study team, Hypertension and Exposure to Noise Near Airports: the HYENA Study. Environmental Health Perspectives 116 (2008) 329-333 [formato PDF, 143 KB].

Alexandros S. Haralabidis , Konstantina Dimakopoulou , Federica Vigna-Taglianti , Matteo Giampaolo , Alessandro Borgini , Marie-Louise Dudley , Göran Pershagen , Gösta Bluhm , Danny Houthuijs , Wolfgang Babisch , Manolis Velonakis , Klea Katsouyanni , Lars Jarup , and for the HYENA Consortium, Acute effects of night-time noise exposure on blood pressure in populations living near airports. European Heart Journal 29 (2008) 658-664 [formato PDF, 264 KB].

Cesare Meloni, Inquinamento atmosferico e salute. (Lettura magistrale tenuta in occasione della inaugurazione del 40° Congresso Nazionale della Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica, Cernobbio, 8 settembre 2002). Igiene e Sanità Pubblica 59 (2003) 117-136 [formato PDF, 611 kB]. "Il problema sanitario dell’inquinamento atmosferico e le sue influenza sulla salute della popolazione sono approfonditi attraverso temi quali l’origine e la tipologia degli inquinanti, l’azione del materiale particellato aerodisperso, l’azione biologica esercitata dagli inquinanti, gli effetti diretti ed indiretti sulla salute umana. La discussione mette in luce come, malgrado l’inquinamento atmosferico abbia subito negli ultimi anni una riduzione, rappresenta ancora un impegnativo problema di sanità pubblica. Il traffico autoveicolare risulta il principale responsabile dell’inquinamento e le polveri fini potenzialmente le più pericolose per la salute. La prevenzione è possibile a condizione che gli organi di governo, in particolare regionali, adottino adeguati provvedimenti normativi e che gli operatori di sanità pubblica progettino e sviluppino organici programmi di prevenzione."

D. Heimann, M. de Franceschi, S. Emeis, P. Lercher, P. Seibert (a cura di), Vivere vicino a una grande via di transito nelle Alpi : inquinamento atmosferico, rumore e salute. [Progetto] ALPNAP. Università degli Studi di Trento, Dipartimento di Ingegneria Civile e Ambientale, Trento, dicembre 2007, 20 p. [formato PDF, 1,94 MB]. "La presente pubblicazione è stata realizzata dal consorzio del progetto ALPNAP, un gruppo di 11 partners provenienti da Austria, Francia, Germania e Italia. Gli obiettivi di ALPNAP erano quelli di raccogliere e descrivere i metodi scientifici e più aggiornati per l’osservazione e la previsione dell’inquinamento atmosferico e acustico lungo i corridoi di transito Alpino e valutarne gli effetti sulla salute e sulla qualità della vita. Tali metodi possono essere utilizzati per stimare le conseguenze indotte da nuove infrastrutture di trasporto (stradale e ferroviario) che si trovino già nella fase di pianificazione o per progettare adeguate misure, sia amministrative che tecniche, per il contenimento dell’inquinamento atmosferico e acustico. La pubblicazione è diretta agli abitanti delle Alpi che sono interessati ai disturbi ambientali. Nel testo si descrivono i processi di emissione dell’inquinamento atmosferico e del rumore, nonché i fattori di trasporto degli inquinanti e di propagazione del rumore in funzione delle condizioni meteorologiche. In particolare si mostrano le peculiarità dell’ambiente Alpino e le differenze con le aree di pianura, sintetizzando infine le possibilità offerte dai moderni strumenti, sviluppati presso le università e i centri di ricerca, per prevedere le concentrazioni di inquinanti o i livelli di rumore e il loro impatto con futuri scenari di traffico."

James J. Corbett, James J. Winebrake, Erin H. Green, Prasad Kasibhatla, Veronika Eyring, and Axel Lauer, Mortality from ship emissions: a global assessment. Environmental Science & Technology 41 (2007) 8512–8518 [formato PDF, 1,91 MB]. "Epidemiological studies consistently link ambient concentrations of particulate matter (PM) to negative health impacts, including asthma, heart attacks, hospital admissions, and premature mortality. A team of leading global scientists led by James Corbett modeled ambient PM concentrations from oceangoing ships using two geospatial emissions inventories and two global aerosol models. This groundbreaking work, which was peer-reviewed and published in the December 15, 2007 issue of the American Chemical Society Journal Environmental Science & Technology, estimated for the first time global and regional mortalities by applying ambient PM increases due to ships to cardiopulmonary and lung cancer concentration-risk functions and population models. The results indicate that shipping-related PM emissions are responsible for approximately 60,000 cardiopulmonary and lung cancer deaths annually, with most deaths occurring near coastlines in Europe, East Asia, and South Asia. Under current regulation and with the expected growth in shipping activity, the study estimates that annual mortalities could increase by 40% by 2012."

N.H.A. Janssen, B.Brunekreef, G. Hoek, M.P. Keuken, Verkeersgerelateerde luchtverontreiniging en gezondheid. Een kennisoverzicht. (health effects of traffic-related air pollution). Utrecht, Institute for Risk Assessment Sciences, 2002, 51 p. [formato PDF, 458 KB].

R.A. Field [et al.], Population Exposure to Air Pollutants in Europe (PEOPLE). Methodological strategy and basic results. European Commission, Joint Research Centre, Ispra, 2005, 74 p. [formato PDF, 2,46 MB]. Rapporto finale del progetto europeo PEOPLE, che ha studiato le emissioni outdoor e indoor e i livelli di esposizione umana al benzene a ad altri inquinanti in sei città europee. "PEOPLE campaigns were completed in six cities, namely; Brussels and Lisbon (22 October 2002), Bucharest and Ljubljana (27 May 2003), Madrid (3 December 2003) and Dublin (28 April 2004). The first stage of the project was accomplished with benzene as the pollutant considered. In Ljubljana, outdoor measurements were extended to include particulate matter and a number of polycyclic aromatic hydrocarbons. In Madrid, measurements were further supplemented with an assessment of the heavy metal content of particulate matter. In Dublin, particulate monitoring also included human exposure and indoor environments."

Francesco Forastiere (Dipartimento di Epidemiologia ASL Roma E), Gli effetti dell'inquinamento atmosferico sulla salute. Roma, 29 novembre 2002, 17 p. [formato PDF, 244 kB]. Ampia scheda, ancora di grande attualità e utilità, sugli effetti sanitari delle polveri sottili e ultrasottili (PM10). Contiene una tabella sull’impatto sanitario dell’inquinamento atmosferico, con l'incremento percentuale nella frequenza dei fenomeni sanitari in una città all’aumentare di 10 microgrammi/m3 nella concentrazione delle polveri sottili (PM10) e una bibliografia degli studi fondamentali.

Marco Martuzzi, Francesco Mitis, Ivano Iavarone, Maria Serinelli, Impatto sanitario di PM10 e ozono in 13 città italiane , Roma, APAT, gennaio 2007, 148 p. [formato PDF, 1,24 MB]. Traduzione italiana della versione originale in inglese, pubblicata dall'OMS nel 2006.

Marco Martuzzi, Francesco Mitis, Ivano Iavarone, Maria Serinelli, Health impact of PM10 and ozone in 13 Italian cities, Copenhagen, WHO, 2006, 147 p. [formato PDF, 1,64 MB]. "An average of 8220 deaths a year in 13 Italian cities are attributable to PM10 concentrations above 20 mg/m3. This corresponds to 9% of the mortality for all causes (excluding accidents) in the population over 30 years of age…". La più recente ricerca dell’OMS/WHO (Organizzazione Mondiale della Sanità) sulle conseguenze sanitarie (in morti e malati) dell’inquinamento atmosferico da particolato (PM10) e da ozono in 13 città italiane (Torino, Milano, Genova, Trieste, Padova, Venezia-Mestre, Verona, Bologna, Firenze, Roma, Napoli, Catania, Palermo).

Michele Faberi, Marco Martuzzi, Franco Pirrami, Assessing the health impact and social costs of mopeds: feasibility study in Rome. World Health Organization, Rome, 2004, xvii, 193 p. [formato PDF, 8,07 MB] (studio molto completo, accurato e dettagliato sull’impatto sociale (incidenti, mortalità, morbilità) e ambientale (emissioni) causati dai motorini nella città di Roma, con una valutazione dei costi esterni (monetarizzati). Contiene diversi riferimenti a dati italiani e generali (fattori di emissione, parco motorini per provincia, ecc.) e costituisce un modello per un possibile studio a livello nazionale (italiano).

Afsse (Agence française de sécurité sanitaire environnementale), Impact sanitaire de la pollution atmosphérique urbaine, Rapport 1, Estimation de l’impact lié à l’exposition chronique aux particules fines sur la mortalité par cancer du poumon et par maladies cardio-respiratoires en 2002 avec projections d’ici 2020, Mai 2004, 95 p. [formato PDF, 1,89 MB].

Afsse (Agence française de sécurité sanitaire environnementale), Impact sanitaire de la pollution atmosphérique urbaine, Rapport 2, Proposition de scénarios pour la poursuite d’actions en faveur de la réduction de la pollution atmosphérique, de l’exposition chronique de la population en milieu urbain et des risques sanitaires, Mai 2004, 151 p. [formato PDF, 1,91 MB].

Daniele Grechi (ARPAT), MISA-2, Metanalisi Italiana degli Studi sugli effetti a breve termine dell’inquinamento Atmosferico 1996-2002, Dati ambientali, 17 slides [formato PDF, 59 kB] relazione al Seminario di presentazione dei risultati di MISA-2 "1205 L'aria di città rende liberi, 2005 L'aria di città fa morire", Firenze, ARPAT, 18 febbraio 2005

Annibale Biggeri (Italian MISA Group), Metanalisi degli studi italiani sugli effetti a breve termine degli inquinanti atmosferici, 32 slides [formato PDF, 110 kB] relazione al Seminario di presentazione dei risultati di MISA-2 "1205 L'aria di città rende liberi, 2005 L'aria di città fa morire”, Firenze, ARPAT, 18 febbraio 2005

Emanuele Stagnaro (et al.), Effetto a breve termine dell’inquinamento sulla salute: Genova 1996-2002 (presentazione dati provenienti dallo studio epidemiologico ) MISA 2 : metanalisi italiana degli studi sugli effetti a breve termine dell’inquinamento atmosferico – MISA 1996-2002 [formato PowerPoint, 1,64 MB]. (Oltre ai dati di Genova, le tabelle riportano anche i dati di tutte le 15 città italiane che hanno partecipato allo studio. Il risultato di MISA 2 suggerisce che l’effetto dell’esposizione all’inquinamento atmosferico nelle 15 città è responsabile di almeno 2000 decessi all’anno. Per quanto riguarda la città di Genova tale effetto risulta di almeno 136 decessi/anno attribuibili a tutto l’inquinamento atmosferico).

Sintesi dello studio MISA 2 Metanalisi italiana degli studi sugli effetti a breve termine dell’inquinamento atmosferico 1996-2002: ampliamento dello studio MISA 1, condotto sui dati del 1990-1999 in 8 città italiane. Il MISA-2 ha ampliato a 15 il numero delle città (Bologna, Catania, Firenze, Genova, Mestre-Venezia, Milano, Napoli, Palermo, Pisa, Ravenna, Roma, Taranto, Torino, Trieste, Verona) e ha analizzato le serie giornaliere degli anni 1996-2002. 3 p. [formato PDF, 34 KB]. (Tra le conclusioni: i limiti fissati dalle direttive europee per il 2010 avrebbero contribuito se applicati a risparmiare circa 900 decessi (1.4%) per il PM10 e 1400 decessi per l’NO2 (1.7%) nell’insieme delle città considerate).

Informazioni sanitarie – Effetti sulla salute [delle PM10] : campagna di informazione e comunicazione “Operazione liberiamo l’aria: meno smog, più salute!” della Regione Emilia-Romagna ; sullo stesso sito anche ulteriori informazioni sulla polveri o materiale particolato (PTS, PM10, PM2,5) e dati e previsioni sulla qualità dell’aria.

Sito dell’ACES/CDC: http://www.cdc.gov/nccdphp/dnpa/aces.htm

Preventive Health Protection by Exploiting the Reduction Potential with respect to Road Traffic Noise and Air Pollution (short version), elaborated within the framework of the Action Program Environment and Health North Rhine-Westphalia, 2004, 16 p. [formato PDF; 2,24 MB]

Christian Ege, Diesel particles – a health hazard. The Danish Ecological Council, 2004, 20p. [formato pdf, 1,87 MB]. (opuscolo molto dettagliato sugli effetti sanitari del particolato diesel, si concentra sul tema dei filtri per gli autoveicoli, con l’esempio della Danimarca).

Transport, Environment and Health WHO Regional Office for Europe, 2000, 86 p. (formato Pdf, 1,25 MB) [tradotto in italiano e pubblicato come n. 126 di "Quaderni di Sanità Pubblica", CIS Editore


C. Castillo, M. Viu-Roig, E.J. Alvarez-Palau (Universitat Oberta de Catalunya), COVID-19 lockdown as an opportunity to rethink urban freight distribution: Lessons from the Barcelona metropolitan area. Transportation Research Interdisciplinary Perspectives 14 (2022) 100605 (9 p.) [formato PDF, 592 kB]. Open Access. "The COVID-19 health crisis has had a strong impact on societies around the world, affecting both the health of populations and countries' economies. While lockdowns imposed to stop the spread of infection reduced urban mobility and had a positive impact on air quality, lowering the emission of polluting particles and greenhouse gases, they had the opposite effect on urban freight distribution (UFD). With the population remaining at home, ecommerce-driven shipments surged, and total freight traffic increased. In order to have a better understanding of this phenomenon, the aim of this study was to identify the impact of COVID-19 lockdowns on the daily operation of the region's main logistics agents. Lessons learned from this cyclical scenario could be used to define more sustainable public policies regarding UFD in the post-COVID era. To meet the above objectives, semi-structured interviews were conducted with public administrations and private operators, before being transcribed and encoded for later analysis. The results of our study show that common problems in UFD, such as traffic congestion or problems finding parking in the loading and unloading (L/U) zones, temporarily disappeared during the lockdown phase. Delivery times were consequently reduced, despite an increase in operations due to ecommerce. In addition, the public administrations took advantage of this situation to adapt the urban space and force a transition towards new delivery systems, such as cargo-bikes, to guarantee sustainable last-mile operations in specific zones."

Andreas Nikiforiadis, Lambros Mitropoulos, Pantelis Kopelias, Socrates Basbas, Nikiforos Stamatiadis, Sofia Kroustali, Exploring mobility pattern changes between before, during and after COVID-19 lockdown periods for young adults. Cities 125 (2022) 103662 (11 p.) [formato PDF, 1,3 MB]. "The paper aims to investigate changes in travel behavior due to COVID-19 focusing in one of the most active social groups in Greece. A questionnaire survey was conducted and 306 young adults (age 18-34 years) living in various Greek cities responded. The survey collected information about travel-related preferences before, during and after the 1st lockdown and during the 2nd lockdown of the COVID-19 pandemic in Greece. City attributes of the respondent's residency location before and after the 1st lockdown were collected. The data are analyzed descriptively and through statistical modelling techniques. During the 1st lockdown an important increase in physical exercise frequency was observed, but this increase was not permanent. The COVID-19 pandemic resulted in essential reductions in the frequency of public transport use and in an increase of walking frequency. The public transport use reduction was mainly attributed to people that had access to a private car and after the 1st lockdown moved to a smaller city. On the other hand, the changes in walking frequency are closely linked to the city's attributes. Useful policy implications are being derived about how the pandemic can assist in promoting sustainable urban mobility goals."

João Filipe Teixeira, Cecília Silva, Frederico Moura e Sá, The role of bike sharing during the coronavirus pandemic: An analysis of the mobility patterns and perceptions of Lisbon's GIRA users. Transportation Research Part A 159 (2022) 17-34 (18 p.) [formato PDF, 4,2 MB]. "COVID-19 has dramatically impacted urban mobility, of which public transport (PT) has been particularly affected. With PT ridership plummeting due to infection fears and many people returning to work, there is a danger of a steep rise in car use that would exacerbate environmental and health problems. Therefore, other modes such as bike sharing should be considered as potential alternatives during the coronavirus pandemic. This study focuses on assessing how coronavirus has impacted bike sharing by implementing a travel behaviour survey to the users of GIRA, the bike sharing system (BSS) of Lisbon. While the coronavirus has led some to decrease the frequency of use or quit the system, other users have increased the usage or joined GIRA during the pandemic. Furthermore, most users who have quit or decreased the usage of GIRA justify their decision not so much on avoiding the risk of infection (although for some it is an important reason) but on having stopped commuting due to COVID-19. The survey has also revealed substantial changes not only on the usage patterns of GIRA users but also on their relationship with other modes of transport. While before the pandemic, most respondents were shifting from PT to GIRA, that percentage has declined, with an increase on the share of users replacing walking, private car, and personal cycling. Moreover, the motivations for using bike sharing related with avoiding PT and maintaining a social distance during the trip have gained more relevance. Concurrently, the perceived safety of using PT has drastically declined, and while the perceived safety of using GIRA has also decreased it was in a much smaller scale. Policy insights can be derived from this research on how bike sharing can contribute to a more sustainable and resilient urban transport system. During infectious public health crises such as COVID-19, BSS can be a viable transport alternative, not only providing the population with an affordable mode of transport where social distancing can be maintained in most of the trip but also mitigating a modal shift from PT to the private car."

Massimo Stafoggia, Giorgio Cattani, Carla Ancona, Andrea Ranzi, La valutazione dell'esposizione della popolazione italiana all'inquinamento atmosferico nel periodo 2016-2019 per lo studio della relazione tra inquinamento atmosferico e COVID-19. Exposure assessment of air pollution in Italy 2016-2019 for future studies on air pollution and COVID-19. Epidemiol Prev 2020; 44 (5-6) Suppl 2:161-168 (8 p.) [formato PDF, 1,9 MB]. (free full text). "L'inquinamento atmosferico è una delle principali cause di morte in tutto il mondo, con effetti avversi legati a esposizioni sia a breve sia a lungo termine. Di recente è stato anche accostato alla pandemia COVID-19. Per analizzare questa possibile associazione a livello italiano, è necessario indagare tutta l'area della penisola, sia le zone urbane sia quelle non urbane. Si rileva quindi la necessità di uno strumento per la valutazione dell'esposizione, omogeneo e applicabile su tutto il territorio nazionale. Esistono già esperienze in Italia di modelli ad alta risoluzione spazio-temporale, per la stima del materiale particolato (PM), con l'uso di predittori spazio-temporali, dati satellitari, dati di monitoraggio della qualità dell'aria. Il presente lavoro completa la disponibilità di queste stime per gli anni più recenti (2016-2019) e viene applicato anche per stimare gli ossidi di azoto e l'ozono. La risoluzione spaziale è di 1x1 km. Il modello si conferma capace di catturare la variabilità del PM (R2=0,78 e 0,74 per PM10 e PM2,5, rispettivamente) e fornisce stime attendibili anche per l'ozono (R2=0,76); per l'NO2 le performance del modello sono inferiori (R2=0,57). Le stime modellistiche sono state utilizzate per calcolare la PWE (population-weighted exposure) come media annua pesata sulla popolazione residente in ogni singola cella, che rappresenta la stima dell'esposizione cronica all'inquinamento atmosferico della popolazione italiana. Queste stime sono pronte per essere utilizzate negli studi sull'associazione tra esposizione cronica all'inquinamento atmosferico e patologia COVID-19, così come per indagini sul ruolo dell'inquinamento dell'aria sulla salute della popolazione italiana. Air pollution is one of the leading causes of death worldwide, with adverse effects related both to short-term and long-term exposure. It has also recently been linked to COVID-19 pandemic. To analyze this possible association in Italy, studies on the entire area of the peninsula are necessary, both urban and non-urban areas. Therefore, there is a need for a homogeneous and applicable exposure assessment tool throughout the country. Experiences of high spatio-temporal resolution models for Italian territory already exist for PM estimation, using space-time predictors, satellite data, air quality monitoring data. This work completes the availability of these estimations for the most recent years (2016-2019) and is also applied to nitrogen oxides and ozone. The spatial resolution is 1x1 km. The model confirms its capability of capturing most of PM variability (R2=0.78 and 0.74 for PM10 e PM2.5, respectively), and provides reliable estimates also for ozone (R2=0.76); for NO2 the model performance is lower (R2=0.57). The model estimations were used to calculate the PWE (population-weighted exposure) as the annual mean, weighted on the resident population in each individual cell, which represents the estimation of the Italian population's chronic exposure to air pollution. These estimates are ready to be used in studies on the association between chronic exposure to air pollution and COVID-19 pathology, as well as for investigations on the role of air pollution on the health of the Italian population."

Aloi, A.; Alonso, B.; Benavente, J.; Cordera, R.; Echániz, E.; González, F.; Ladisa, C.; Lezama-Romanelli, R.; López-Parra, Á.; Mazzei, V.; Perrucci, L.; Prieto-Quintana, D.; Rodríguez, A.; Sañudo, R., Effects of the COVID-19 Lockdown on Urban Mobility: Empirical Evidence from the City of Santander (Spain). Sustainability 2020, 12, 3870 (18 p.) [formato PDF, 9,3 MB]. Open Access. "This article analyses the impact that the confinement measures or quarantine imposed in Spain on 15 March 2020 had on urban mobility in the northern city of Santander. Data have been collected from traffic counters, public transport ITS, and recordings from traffic control cameras and environmental sensors to make comparisons between journey flows and times before and during the confinement. This data has been used to re-estimate Origin-Destination trip matrices to obtain an initial diagnostic of how daily mobility has been reduced and how the modal distribution and journey purposes have changed. The impact on externalities such as NO2 emissions and traffic accidents have also been quantified. The analysis revealed an overall mobility fall of 76%, being less important in the case of the private car. Public transport users dropped by up to 93%, NO2 emissions were reduced by up to 60%, and traffic accidents were reduced by up to 67% in relative terms."

Paolo Pinzuti, Paolo Gandolfi, Valerio Montieri, Matteo Dondé, Gabriele Sangalli, Piano di azione per la mobilità urbana post Covid. Bikenomist, Milano, aprile 2020, 33 p. [formato PDF, 1,7 MB]. Piano Emergenziale della Mobilità Urbana post-Covid: manuale d'uso. "Abbiamo redatto un Piano Emergenziale per la Mobilità Urbana Post-Covid che contiene le istruzioni strategiche e tecniche per evitare il collasso totale della mobilità urbana alla riapertura delle attività. Nella prima parte del documento si valutano i fenomeni in essere con un'analisi di scenario a cui si vuole dare risposta attraverso: una gestione mirata del trasporto pubblico; la creazione di una Rete di Mobilità di Emergenza per stimolare l'utilizzo di mezzi di trasporto veloci, leggeri e non congestionanti; l'allargamento degli spazi per la pedonalità allo scopo di garantire il distanziamento sociale; gestione delle Zone a Traffico Limitato e politiche della sosta. Nella seconda parte del documento si presentano le soluzioni tecniche adottabili in via immediata da parte delle amministrazioni comunali in ottemperanza alla normativa vigente. A conclusione del documento si trova un'indicazione di massima dei costi di realizzazione degli interventi proposti e una carrellata di best practice dall'Italia e dal mondo."

National Academies of Sciences, Engineering, and Medicine, A Guide for Public Transportation Pandemic Planning and Response. NCHRP Report 769. The National Academies Press, Washington, DC, 2014, 66 p. [formato PDF, 3,1 MB]. "TRB's National Cooperative Highway Research Program (NCHRP) Report 769: A Guide for Public Transportation Pandemic Planning and Response is designed to assist transportation organizations as they prepare for pandemics and other infectious diseases such as seasonal flu. Addressing decision-making challenges in pandemic response in the transportation context is a multi-dimensional task, involving not only transportation/transit organizations, but health organizations, emergency management agencies, and communications outlets as well. The guide is designed to outline broad guidance on dealing with pandemic preparedness planning, not detailed procedures. It provides information, tools, tips, and guidance on where to find up-to-date recommendations from federal agencies and other resources, prior to and during a pandemic. In addition to the guide, a methodology report and a PowerPoint presentation describing the entire project are available online."


Afsset, Agence française de sécurité sanitaire de l'environnement et du travail. "Dans le but d’assurer la protection de la santé humaine, l’agence a pour mission de : contribuer à assurer la sécurité sanitaire dans l'ensemble des milieux de vie, incluant le travail ; évaluer les risques sanitaires liés à l’environnement en général et à l'environnement professionnel en particulier ; coordonner l’expertise en santé environnement et en santé au travail; fournir au Gouvernement, par tout moyen, l’expertise et l’appui scientifique et technique nécessaires à l’élaboration et à la mise en oeuvre des dispositions législatives et réglementaires ; informer le public et contribuer au débat public." (L'agenzia conduce studi per valutare l'impatto sanitario dell'inquinamento atmosferico).

the Clean Air Task Force (CATF). Founded in 1996, CATF is a nonprofit organization dedicated to restoring clean air and healthy environments through scientific research, public education, and legal advocacy. Made up of 20 senior scientists, lawyers, MBAs, economists, and public outreach professionals, CATF is headquartered in Boston but located throughout the United States.

Liberiamo l'Aria. Sito dell'Arpa Emilia-Romagna con previsioni meteo, dati sulle polveri sottili (PM10) e informazioni ambientali, sanitarie e sulla mobilità.

THSG - Transport and Health Study Group is an independent scientific society set up to study the links between transport and health and to promote a healthy transport system.

EpiCentro - Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute. Sito aggiornato sull'indagine epidemiologica e sugli impatti dell'inquinamento atmosferico (in particolare del particolato fine) sulla salute. "Lo studio Misa (Metanalisi sugli effetti a breve termine dell’inquinamento atmosferico) è stato presentato da una lettera, inviata da Francesco Forastiere, segretario dell’Aie alle autorità sanitarie e ambientali del nostro Paese. Purtroppo fino ad oggi non sembra che quanto contenuto in quel messaggio sia stato preso seriamente in considerazione."

Associazione Medici per l’Ambiente – ISDE Italia

Committee on the Medical Effects of Air Pollutants (COMEAP). COMEAP is an Advisory Committee of independent experts that provides advice to (UK) Government Departments and Agencies on all matters concerning the potential toxicity and effects upon health of air pollutants.

Deutsche Gesellschaft für Verkehrsmedizin e.V. (DGVM).

Environmental Research Group (ERG), part of the School of Biomedical and Health Sciences at King’s College London (UK). The group combines air pollution science, toxicology and epidemiology to determine the impacts of air pollution on health and the causal factors. We work closely with those responsible for air quality management to support policies and actions to minimise air pollution health effects.

International Society of Doctors for the Environment

the International Traffic Medicine Association (ITMA). Former "International Association for Accident and Traffic Medicine" (IAATM).

Rundum) mobil, Büro für Mobilität, Thun (CH). Azienda specializzata nel tema della mobilità collegata alla salute e all'ambiente.

THE PEP Clearing House (Transport, Health and Environment Pan-European Programme). "The portal for user-friendly access to policy, legal and scientific information, as well as good practices, on Transport, Health and Environment in the pan-European region". Sito di WHO/Europe e United Nations Economic Commission for Europe (UNECE) in inglese, francese e russo.

The Transport and Health Group is a multi-disciplinary group of researchers interested in the links between transport and health. This includes: evaluations of the impact of large scale transport interventions on public health; research on the health outcomes of different transport modes; and research into the wider public health implications of transport systems. Our research addresses public transport, private motorised transport and active modes, such as walking and cycling, in the context of a broad definition of the public health, which includes physical, mental and social well being (London School of Hygiene and Tropical Medicine, UK).

World Health Organization, Regional Office for Europe Transport, environment and health in Europe