1. TEMPLATE DESIGN © 2007
www.PosterPresentations.com
Air Quality & Asthma: Impacts in Georgia
Janelle Eradiri, B.S.1
Advisor: Francesca Lopez, MSPH, AE-C 2
Howard University1
Georgia Department of Public Health2
1. To compare the risks of asthma morbidity for children who reside in non-
attainment counties versus those who reside in attainment counties in
Georgia in 2012.
2. Identify major contributors within the non-attainment counties.
3. Design a toolkit—public health awareness intervention targeted in non-
attainment areas.
Children with asthma living in non-attainment counties experience higher risks
of asthma morbidity than children living in attainment counties in Georgia.
Among the one hundred fifty-nine counties in Georgia, fifteen percent (twenty-
four counties) were designated as non-attainment (NAA) for the study period
2004-2012 (Chart 1). The two criteria pollutants that affect Georgia are
Ground-level Ozone and Particulate Matter (PM-2.5).
The relative difference (RD) in rates between attainment (1,018.1) and non-
attainment (1,263.6) areas for asthma ER visits was 245.5. Accordingly, it is
concluded that there was a significantly higher ER visit rate in children (0-17)
residing in NAA as compared to those residing in AA , as seen in Figure 1.
Studying hospitalization discharge rates, the RD between the attainment
(140.0) and non-attainment (111.5) areas for asthma hospitalizations was 28.9
which concludes that hospitalization rates for asthma among children (0-17)
were statistically lower in NAA’s than in AA’s, as seen in Figure 2.
There were no significant differences in the childhood asthma prevalence
between NAA and AA counties.
The EPA air monitoring sites are scarce in southern rural counties as opposed
to being very densely-populated in northern metropolitan counties. This is
supported according to the environmental public health tracking maps. The
maps depict both monitored and modeled, or estimated air monitoring sites,
meaning the data is an estimate. Additionally, it also reveals a cluster of
Southwestern counties with a significant PM-2.5 distribution. This creates
inaccuracy in regards to the designation of non-attainment and attainment
counties, which ultimately limits public health workers ability to intervene in
areas that are truly in need.
Asthma is a chronic disease of the lungs and airways that makes it difficult
to breathe. Airways become inflamed or swollen, and a production of excess
mucus and tightening of the muscles surrounding the airway. Symptoms are
recurrent episodes of coughing, shortness of breath, and chest tightness
and can be triggered by environmental pollutants, mold, allergens, &
exercise.2
Georgia’s 2012 childhood asthma prevalence was 12%, which is
higher than the national average. In Georgia, children ages 0-9 make up 14%
of the population, but account for 36% of asthma ER visits which in 2011,
equated to 27.8 million dollars.2
The National Ambient Air Quality Standard sets limits on the concentration of
the six ambient criteria pollutants in the U.S. Ambient air monitoring
networks are used to monitor the air quality based on individual criteria
pollutants. Criteria pollutants are monitored on one hour, four hour, eight
hour, 24 hour, monthly and yearly intervals in both urban metropolitan
statistical areas (MSA) as well as rural non-MSA’s.
The two criteria pollutants found within Georgia are ground level ozone-1997
& 2008 standard, and particulate matter (PM-2.5)-1997 standard. Ground level
ozone is a colorless gas found in the air that we breathe that forms after
pollution emissions react chemically in the presence of sunlight. It is a
powerful lung irritant that ultimately aggravates asthmatic symptoms and
exacerbations. It is more susceptible to the youth and elderly, particularly
during warmer months. PM-2.5 are particles less than 2.5 micrometers in
diameter and are found in the air, such as dust, soot, smoke, and liquid
droplets that form in the atmosphere
OPTIONAL
LOGO HERE
Abstract
Introduction
Purpose
Hypothesis
Methodology
Results Limitations
Conclusions/ Discussion
Acknowledgements & References
Acknowledgements
Francesca Lopez, MSPH, AE-C, Program Manager, Asthma Control Program Georgia Department of Public
Health
Francis Annor, MPH, Asthma Epidemiologist, Georgia Department of Public Health
Solomon Pollard, PhD-EPA, Senior Toxicologist, Air, Pesticides & Toxics Management Division
References
1.
Moorman JE, Akinbami LJ, Bailey CM, et al. National Surveillance of Asthma:
United States, 2001–2010. National Center for Health Statistics. Vital Health
Stat 3(35). 2012
2. Annor, F., Bayakly, A., Vajani, M., Drenzek, C., Lopez, F., O'Connor, J., et al. (n.d.). 2014 Georgia Asthma
Surveillance Report. . Retrieved , from dph.georgia.gov/asthma-surveillance
3. Friedman, M. S., Powell, K. E., Hutwager, L., Graham, L., & Teague, G. American Medical
Association . Impact of Changes in Transportation and Commuting Behaviors During the 1996 Summer
Olympic Games in ATL on Air Quality & Childhood Asthma, 285.
4. Laumbach, R. American Academy of Family Physicians . Outdoor Air pollutants & Patient Health , 81.
5. The New York Department of Health. Statistical Significance.
2014;http://www.health.ny.gov/statistics/chac/chai/docs/statistical_significance.pdf. Accessed 7/21/2014,
2012.
6. Monitor + Model Air Data. (2012, April 17). . Retrieved July 22, 2014, from
http://ephtracking.cdc.gov/showAirMonModData.action
Contact Information
National statistics show that Asthma exacerbations (asthma attacks) are the primary
cause of Emergency Room (ER) visits and Hospitalizations among children ages 0-
171
. Environmental factors such as pollutants are asthma triggers and are major
contributors to asthma exacerbations. As a means to measure and control the level of
environmental pollutants across the nation, the passage of the Clean Air Act (CAA) of
1970 created the National Ambient Air Quality Standard (NAAQS). The Environmental
Protection Agency (EPA) is the administrative agency for the NAAQS, which
designates Six (6) Criteria Pollutants: Carbon monoxide, Ground-level Ozone, Lead,
Nitrogen oxide, Particulate matter and Sulfur dioxide. States are required to
participate in annual reporting on a county level for each of the Criteria Pollutants.
Counties that meet the EPA’s standards are classified as Attainment areas (AA).
Counties that do not meet the EPA’s standards are designated Non-attainment areas
(NAA). For this study, it is hypothesized that children living in NAA within Georgia will
experience higher asthma morbidity measured by ER visits and hospitalization
discharge rates as compared to children that live in Attainment Areas.
Results: Findings revealed that there was a decreased risk of hospitalizations for
children with asthma residing in NAAs versus AA counties and an increased risk of
ER visits in children with asthma residing in NAA versus AA counties.
Conclusion: While the relationship between environmental pollutants and ER visits is
strong, there is less of a relationship between hospitalizations and environmental
pollutants in Georgia for children with asthma. It was found that there is a disparity in
the distribution of air monitoring networks between northern metropolitan Georgia
and southern rural Georgia. While this can serve to introduce some bias in the
analysis, it is recommended that further analysis is conducted using a combination of
modeled and actual air quality measure to account for the lack of air quality
monitoring sites in the southern region of the state. It is recommended that public
health awareness campaigns be implemented in NAAs to increase the understanding
of the impacts air quality has on asthma and to promote prevention strategies.
Janelle Eradiri
Janellee1992@gmail.com
516-808-1412
July 2014
Figures 1 and 2 display the five major interstate highways surrounding the majority of
the non-attainment counties within the Atlanta metropolitan area. Major roadways
translate to high traffic volume with substantial amounts of automobile exhaust
emission, which is a main contributor to air pollution.
From a public health standpoint, in order to accurately designate non-attainment
areas, and evaluate its impact on asthma, an evenly distributed amount of air
monitoring networks in both northern metropolitan areas as well as southern rural
areas need to be implemented. Until such time that there are more evenly distributed
sampling sites in the southern region of the state, the Environmental Public Health
Tracking website should be the primary method utilized for examining an accurate
depiction of air pollutant distribution and non-attainment area designation. This will in
turn assist public health workers in creating intervention plans targeted to parents,
schools, childcare centers, and primary caregivers of NAA counties that could be
used to promote awareness of risk factors of asthma exacerbations.
Figure 3 represents a 2008 PM-2.5 concentration measured by person-days. The shaded
counties are modeled sites due to a lack of representation from actual monitoring
sites. The map suggests that if there were more monitoring sites, it would be
predicted that there would be a cluster of non-attainment counties in the
southwestern rural region of Georgia.
The main contributors to the air pollution in Georgia are automobile exhaust,
pollen, dry cleaners, industrial facilities, airplanes and trains. There are direct
linkages between asthma and PM-2.5 Long -term exposure often leads to
aggravated lungs and reduced lung function. 3, 4
Chart 1: Trend of
NAA counties
Figure 1
Figure 2
Figure 3