EBPH FINAL PAPER

Flood, Spring 2016
The Effects of Air Pollution on Chinese Residents from the Coal Industry
Andrea Flood
University at Albany SUNY

Flood, Spring 2016 2
Executive Summary
China is a country that relies heavily on industry. China’s rapid economic expansion was
due to this increased use of industry and its use of coal burning to fuel it
(Coal Industry Advisory Board, 1999). The burning of coal results in emissions of chemicals into
the air. Some of the chemicals released are sulfur dioxide, nitrogen dioxide, particulate matter 10
and particulate matter 2.5 (Guo et al., 2016). Linfen, China is reported to have the worst air
quality in the country, with an air quality index of 215 (World Air Quality Index, 2016). Air
Pollution in China contributes to 1.6 million deaths per year with the leading cause of death from
cancer due to lung cancer specifically (Wanqing Chen et al., 2015). The evaluation of these
pollutants and their risk for lung cancer was assessed. Yuming Guo et al., found that particulate
2.5 resulted in an increased risk for developing lung cancer because the relative risk for lung
cancer incidence related to 10ug/m^3 increase in PM2.5 were 1.055, which falls within the 95%
confidence interval (Guo et al., 2015). Pope III et al., examined the relationship of long term
exposure to fine particulate pollution and lung cancer and concluded the exposure to fine
particulate and sulfur dioxide related pollution is associated with all-cause, lung cancer, and
cardiopulmonary mortality. Each 10ug/m^3 elevation of fine particulate air pollution was
associated with an 8% increased risk for developing lung cancer (Pope III et al., 2002). A two-
pronged one-year pilot study intervention is being proposed. The first part will be to target the
individual to educate residents of Linfen, China on protective measure they can take to limit their
exposure to air pollution along with dissemination of protective materials. The second part is to
develop a policy to propose to the government to provide strict regulations and surveillance
measures. These will be evaluated through pre and post surveys along with feedback from the
government on the proposal.

Introduction
The air is very important for human health because humans need it to survive. In recent
years, several countries suffer from air pollution such as India, China, Egypt, Japan, Afghanistan
and Pakistan and this can be a result of the emissions of the coal industry, emissions from
nuclear plants, and burning of household fuels (Muller, Rhode, 2015). Among the list of
countries mentioned China is reported to have one of the worst cases of air pollution
(Muller, Rhode, 2015). Linfen, China is one of the largest coal industry cities in China and it is
home to the Linfen Power Station, a two-unit coal burning plant (Worst Polluted, 2007). China’s
rapid economic expansion was due to the increased use of industry, especially led by the burning
of coal. The coal industry is of key importance to China’s industry and accounts for 75% of their
commercial primary energy consumption (Coal Industry Advisory Board, 1999). The World
Bank stated that in the top 20 worst polluted cities in the world China holds 16 of those spots
while also the State Environmental Agency Administration (SEPA) has reported Linfen as
having the worst air quality in China (Worst Polluted, 2007).
The air quality in Linfen is currently rated to be at 215, which is considered to be very
unhealthy by the real-time air quality index (World Air Quality Index, 2016). Some of the major
emissions from the coal industry that result in air pollution are particulate matter 10, particulate
matter 2.5, nitrogen dioxide, and sulfur dioxide (Wanqing Chen et al., 2015). Exposure through
inhalation to these pollutants are risk factors for developing respiratory infections, asthma and
lung cancer (Olzem Kar Kurt et al., 2016). In Wanqing Chen et al., (2015) Chinese men were
evaluated to have a higher incidence rate of developing lung cancer compared with Chinese
women at 70.39 compared to 33.78 (Wanqing Chen et al., 2015). The leading cause of death
from cancer in China in 2010 was lung cancer with the mortality rate of 50.04 compared with all
other cancers in China (Wanqing Chen et al., 2015). Consequentially, air pollution in China

contributes to 1.6 million deaths in China every year (Muller, Rhode, 2015). Hence, the risk of
lung cancer among men above age 40 of Linfen, China is indicated by the high levels of air
pollution PM2.5, PM10, NO2, and SO2 and results from the coal industry. The exposure is the
air pollutants PM2.5, PM10, NO2, and SO2 with the outcome being lung cancer.
Priority Population
Air pollution in China contributes to 1.6 million deaths in China every year
(Muller, Rhode, 2015). Risk of lung cancer among Chinese men above age 40 of Linfen, China
is indicated by the high levels of air pollution particulate matter 2.5, particulate matter 10,
nitrogen dioxide, and sulfur dioxide and results from the coal industry. The air quality in Linfen
is currently rated to be at 215, which is considered to be very unhealthy by the real-time air
quality index. (World Air Quality Index, 2016). Pollutants such as PM10, PM2.5, NO2 and SO2
are some air pollutants that are very abundant in China because of their heavy industry
(Guo et al., 2016). The World Bank stated that in the top 20 worst polluted cities in the world
China holds 16 of those spots while also the State Environmental Agency Administration
(SEPA) has reported Linfen as having the worst air quality in China (Worst Polluted, 2007).
Exposure- Air Pollution: specifically PM2.5, PM10, SO2 and NO2
Rhode and Muller examined hourly air pollution data from over 1,500 areas in China.
The air pollutants PM10, PM2.5, SO2, NO2 and O3 were examined. These pollutants were
mainly results from sources including electric power plants, coal factories, burning of fossil fuels
and automobiles (Rhode, Muller, 2015). To map the sources of the air pollutants they used the
data that is made available from the Chinese government. After examining the data the major
areas where the exposure is worst is in the east but significant levels are also across central and
northern China (Rhode, Muller, 2015). The results showed that 92% of China is experiencing

more than 120 hours of unhealthy air (Rhode, Muller, 2015). This goes beyond the US
Environmental Protection Agencies standard (EPA, 2016). They then calculated the amount of
air exposure to the average Chinese citizen and this was calculated to contribute to 1.6 million
deaths a year in China which converts to 17% of all deaths (Rhode, Muller, 2016). This study
concluded that the highest particulate concentrations are south of Beijing while extensive levels
extent to the interior since PM can remain airborne for weeks and travel thousands of kilometers
(Rhode, Muller, 2015).
Falcon-Rodriguez et al., examined the pollutants SO2, NO2 and particulate matter. China
is a very industry heavy country and this is why their air is so polluted. When it comes to
particulate matter the size and composition associates to the different toxicity levels
(Falcon-Rodriguez et al., 2016). The smaller the PM the more dangerous it is because it can
reach its way into human lungs easier (Falcon-Rodriguez et al., 2016). The particles focused on
are secondary aerosols, which are formed by gases such as sulfates, nitrates and organic
compounds. The pollutants can be released from the burning of fossil fuels, coal and mining
activities (Falcon-Rodriguez et al., 2016). The analysis concluded that these pollutants are strong
mutagenic and carcinogenesis agents, which can be associated with genetic damage associated
with cancer (Falcon-Rodriguez et al., 2016).
Song et al., examined the pollutants released from a coal burning industry plant in
Pingdinshan, China. In the study of the coal burning plant the sulfur in coal is released into the
air mainly as SO2 and partly NO2 through the coal combustion in the plants (Song et al., 2014).
The average PM10 mass concentrations in the city were much higher in the winter v. in the
summer due to the increased use of coal in the winter. The average mass concentrations of PM10
were 190 in the winter and 187 in the summer (Song et al., 2016). Both of these numbers surpass

the 24h Chinese limit of 150. The major sources of PM10 in Pingdinshan City were from sources
of coalmine waste dumps and coal ash from power plants. These pollutants are inhalable once
the coal is burned and present high risk to human health. (Song et al., 2014).
Outcome- Lung Cancer
Zheng et al. assessed the leading types of cancers in China, which can be seen in figure 3
in the appendix below. The study assessed 235 cancer registries in China. The study found that
lung cancer had the highest incidence rate in China and was the leading cause of death from
cancer in China (Zheng et al., 2015). The study also compared men v. women and urban v. rural
areas as shown in figure 4 in the appendix below. Lung cancer incidence rates from the coal
industry are 47.14 in rural areas and 49.44 in urban areas (Zheng et al., 2015). This study shows
that there is no difference between the two types of areas. There is however seen to be a
difference in the incidence rates of lung cancer in men v. females. Men have a rate of 63.90
where as women have an incidence rate much lower of 31.93 (Zheng et al., 2015). The mortality
rates from lung cancer in China follow a similar trend. As the age increases to 40+ the mortality
rate jumps up. The study also controlled for smoking status (Zheng et al., 2015).
Kurt, et. Al reviewed the current literature on how air pollution is associated with
pulmonary morbidity and mortality. The study showed that air pollution poses a greater harm to
children, the elderly and those of lower socio-economic status worldwide (Kurt et al., 2016). The
study showed that air pollution and related PM were a class I human carcinogen based on the
data (Kurt et al., 2016). The study also reviewed data from exposure to coal combustion and
found that exposure to this increased risk for developing asthma and lung cancer. The study
reviewed epidemiological data that indicated a positive correlation between air pollutants and
lung cancer (Kurt et al., 2016). The study also controlled for smoker status to eliminate any

confounding variables. The study concluded that developing countries such as China that still use
coal burning as fuel are at a greater risk of developing various pulmonary health effects
(Kurt et al., 2016).
Wanqing Chen et al., collected epidemiological data from National Central Cancer
Registry. In 2010 there were 605,956 new lung cancer diagnoses in China (Chen et al., 2014).
Lung cancer is a problem in China that seems to be increasing. Of the new cases in 2010,
roughly 57% came from urban areas while 43% came from rural areas (Chen et al., 2014). This
data shows that there is no significant difference between incidences in rural v. urban China.
Lung cancer incidence rates were seen to be heavier in males than female with a rate of 68.16 v.
29.54 (Chen et al., 2014). Information from this literature demonstrates that lung cancer
incidence is still a heavy concern for Chinese citizens especially those who are male.
Particulate matter in air pollution and its risk for lung cancer was examined
(O. Raaschou-Nielsen et al., 2015). Fourteen different cohorts were examined all from European
areas surrounding suburban or rural areas (O. Raaschou-Nielsen et al., 2015). The air pollutants
of interest were PM10, PM2.5, sulfur dioxide and oxides of nitrogen. Baseline air pollution
concentrations were estimated using the Land Use Regression models
(O. Raaschou-Nielsen et al., 2015). The air pollution was monitored from October 2008 until
May 2011. Variables such as age, gender, calendar time and smoker status were controlled for in
this study to reduce confounding. The results concluded that out of the 245,782 participants
1,878 lung-cancer cases were diagnoses during follow-up (O. Raaschou-Nielsen et al., 2015).
Exposure to all elements is associated with a greater risk for developing lung cancer
(O. Raaschou-Nielsen et al., 2015).
Connection between Exposure and Outcome

Pope III et al., assessed the relationship of long-term exposure to fine particulate air
pollution and lung cancer and cardiopulmonary mortality (Pope III et al., 2002). Vital statistics
and all death data were collected from the American Cancer Society from the Cancer Prevention
II study. The study controlled for individual risk factor data such as race, age, sex, smoking
history, diet and occupational exposure (Pope III et al., 2002). The study concluded the exposure
to fine particulate and sulfur dioxide related pollution is associated with all-cause, lung cancer,
and cardiopulmonary mortality. Each 10ug/m^3 elevation of fine particulate air pollution was
associated with an 8% increased risk for lung cancer (Pope III et al., 2002).
Yuming Guo et al., provides information on particulate matter 2.5 and ozone with its
association to lung cancer incidence. The study obtained information on lung cancer incidence
from the National Cancer Registration of China and computed a spatial age-period cohort model
to assess the relative risk of lung cancer incidence with the exposure to PM2.5 and ozone
(Guo et al., 2015). The relative risk for lung cancer incidence related to 10ug/m^3 increase in
PM2.5 were 1.055, which falls within the 95% confidence interval (Guo et al., 2015). The results
of the study give evidence that there is an increased risk for developing lung cancer when
exposed to PM2.5 and ozone.
The world’s largest coal fired power plant; the Taichung power plant in Taiwan’s
emissions were collected to determine the loss of life expectancy and the lifetime risks for PM2.5
health-related mortalities (Kuo et al., 2014). In the study they took into account five different
scenarios of areas around the plant. The mean Loss of Life Expectancy (LLE) for residents of
Taiwan was calculated to be 83.9 days (Kuo et al., 2014). The study also concluded that in
scenarios 3, 4, and 5 indicates that moving the plant to a leeward side of Taiwan can reduce the
LLE significantly (Kuo et al., 2014). The study also found that reducing the fuel source from

coal to natural gas reduces the exposure concentration from the plant to about one-third.
Although the article also recognized that this is not realistic because of the expensive costs of
using natural gas (Kuo et al., 2014).
Discussion
Limitations: Problems with some of the literature was that it did not include some
possible confounding variables. It is concerning that some studies did not mention controlling for
smoker status. The information incidence rates for lung cancer did not specify if occupational
history status was controlled for. This could be a problem because men could be more likely to
be exposed to the pollutants than woman because they are more likely to work in the plants.
Also, some studies that were done in European countries may not be generalizable to the city
Linfen or even China in general because of the difference in demographics and population
density and the fact that China is a developing country.
Past interventions: Since 2012 China has adopted an Ambient Air Quality Standard
(Rhode, Muller, 2015). They have also begun to develop a national air reporting system that
includes over 190 cities (Rhode, Muller, 2015). This is useful because it sets standards of what is
acceptable and not and there is a program set up to analyze air quality and to recognize the
amounts of air pollutants in the atmosphere (Rhode, Muller, 2015). Also, transitioning to the
usage of natural gas in plants reduces the amount of exposure of air pollutants (Kuo et al., 2014).
The clean air act of 1970 in the United States developed by the Environmental Protection
Agency developed policies in the U.S. to limit the usage of coal as an energy source and
developed a monitoring system of air pollutants (Environmental Protection Agency, 2015). The
goal of this act was to achieve National Ambient Air Quality Standards to protect the public’s

health and welfare along with regulating the chemicals that are being admitted into the air
(Environmental Protection Agency, 2015).
Intervention Proposal
The principle investigator and research team will be proposing a two-pronged
intervention. The levels of the ecological model that will be used are at the individual and policy
levels. This intervention will be a pilot study of one year. The first part of the intervention will
target individuals of Linfen, China. Residents will be given educational pamphlets and
prevention resources in order to limit their exposure to the pollutants. The second part of the
intervention will be developing a written document policy to propose at the end of the 1-year
mark to change the air quality in the future. The outcome objective is to increase cleaner air
intake by 10% for Linfen, China residents by implementing policy change through the
development of a full policy proposal by 2030. The impact objective is going to be for
community members of Linfen, China to limit their exposure to polluted air by 15% from
adopting and implementing all protective measures within 6 months after implementation.
The first part of the intervention will be to educate Linfen community members of the
health risks the pollutants in the air have on them and to educate on how to limit exposure to
these. Pamphlets will be handed out with all the education information in them along with
surgical masks, suggested curfews and desk fans. The N95 surgical masks are meant to filter out
the specific air pollutants we are targeting. The suggested curfew will be from 9pm-5am and
windows to be shut at night due to the air quality decreasing at nighttime. The N95 surgical
masks are meant to wear when out in the open air and the fan is meant for at night so the
windows can be kept shut. Everyone who goes to the local markets will have the opportunity to
take a pamphlet along with a surgical mask but the first 500 will only receive a desk fan. In order

to get all of this everyone will have to fill out a pre-survey that has questions about SES,
occupational status, number of hours spent outside, and how often they experience dry eyes,
nasal congestion, tiredness and occasional minor headaches. As noted in the timeline, posters
will be hung up a month in advance to promote the events location and times. There will also be
a post survey a year after asking how often the various preventative measures were used and how
often they experience dry eyes, nasal congestion, tiredness and occasional minor headaches.
Lastly the principle investigator will evaluate the pre and post surveys to see any health and
behavioral/education change. Refer to the timeline in figure 2 to evaluate the time frame of each
activity.
The second part of the intervention is to form a policy to propose to the government to
regulate the emissions from coal burning factories and this will be called “Take off the Black
Hat.” This will be developed by the environmental lawyer hired with the oversight of the
principle investigator. This would include making it mandatory to use natural gas instead of coal
to power the plants with the government providing resources to pay for this due to the fact that it
is very expensive. The policy will set limits to what air pollutant levels should not exceed. The
levels of the hazardous pollutants will be measured on a weekly basis. The major goal of this
proposal will be to reduce the emissions of hazardous pollutants, specifically NO2, SO2, PM2.5
and PM10. At the end of the year the policy proposal will be complete to submit to the Chinese
government. Refer to figure 1 in the appendix below to evaluate all of the resources, activities,
inputs and outputs needed for the intervention to be successful.
The N95 surgical masks have been effective to filter the air and protect people from
inhaling hazardous pollutants such as PM2.5 (Greenpeace, 2012). We will also be suggesting the
use of fans at night and closing windows because the air quality is worse during the night time

hours, usually between 9pm and 5am (World Air Quality Index, 2016). Because of this we are
also suggesting a curfew to stay indoors to avoid the outdoor air quality during these times. We
are asking the participants on the pre and post survey to document their experience of dry eyes,
nasal congestion, tiredness and occasional minor headaches because these are some of the short-
term health effects exposure to these pollutants can cause (Hoffmann, 2016). The policy proposal
is partially being modeled similarly after the Clean Air Act of 1970. This act put restrictions on
the use of burning coal and continually monitored the levels of air pollutants in the air and this
helped towards the increase in quality air in the United States (EPA, 2015). For example since
the Clean Air Act the amount of sulfur dioxide has been down 75% (Face the Facts USA, 2015).
Evaluation Plan
Goal: Improve community member’s knowledge on protective measures against air pollution
along with the formation of air quality policy proposal.
Study Questions Measures
Data Collection Methods
Data Sources Data
Collector(s)
Timeframe
Impact Evaluation
•To what extend was
there a decrease in
exposure to SO2,
NO2, PM2.5 and
PM10?
•To what extend was
there an increased use
of protective
measures?
•To what extend were
the experience of dry
eyes,nasal congestion,
tiredness and
occasional minor
headaches decreased?
•To what extent was
the policy proposal
approved?
Participants
• Number of residents
who completed pre/
post surveys.
•Post-Survey results-
the number and percent
of people who
carry out protective
measures.
•Number of members
whose acute affects
decreased.
•Feedback results on
what needs improving
before government can
take action.
•Pre and Post
surveys
•Feedback from
government on
policy proposal
•Volunteers &
Project Director
• Principle
Investigator &
Environmental
Lawyer
Post
intervention

References:
1. Chen, Wanqing, Rongshou Zheng, Hongmei Zeng, and Siwei Zhang. "Epidemiology of Lung
Cancer in China." Thoracic Cancer 6, no. 2 (2015): 209-15. Accessed February 23, 2016.
PubMed.
2. Cyr, R. S. (2013). Do Pollution Masks Really Work? Retrieved March 22, 2016, from
http://www.myhealthbeijing.com/china-public-health/n95-air-pollution-masks-proof/
3. Environmental Protection Agency. (2015). Summary of the Clean Air Act. Retrieved April 11,
2016, from https://www.epa.gov/laws-regulations/summary-clean-air-act
4. Environmental Protection Agency. (2016, February 23). Cleaner Power Plants. Retrieved
March 22, 2016, from
https://www3.epa.gov/airquality/powerplanttoxics/powerplants.html
5. Falcon-Rodriguez, C. I., Osornio-Vargas, A. R., Sada-Ovalle, I., & Segura-Medina, P. (2016).
Aeroparticles, Composition, and Lung Diseases. Front. Immunol. Frontiers in
Immunology, 7.
6. George Washington University. (2013). Breathing easier: Clean Air Act gets results. Retrieved
April 11, 2016, from http://www.facethefactsusa.org/facts/breathing-easier-clean-air-act-
gets-results
7. Green Peace. (2012). The coal hard truth of air pollution. Retrieved April 11, 2016, from
http://www.greenpeace.org/eastasia/campaigns/air-pollution/problems/coal-hard-truth-
air-pollution/
8. Guo, Y., Zeng, H., Zheng, R., Li, S., Barnett, A. G., Zhang, S., . . . Williams, G. (2016). The
association between lung cancer incidence and ambient air pollution in China: A
spatiotemporal analysis. Environmental Research, 144, 60-65. Retrieved February, 2016.
9. Hoffmann, M. (2016). Pollution in China. Retrieved April 11, 2016, from
http://www.china-family-adventure.com/pollution-in-china.html
10. Kuo, P., Tsuang, B., Chen, C., Hu, S., Chiang, C., Tsai, J., . . . Ku, K. (2014). Risk
assessment of mortality for all-cause, ischemic heart disease, cardiopulmonary disease,
and lung cancer due to the operation of the world's largest coal-fired power plant.
Atmospheric Environment, 96, 117-124. Retrieved February, 2016.
11. Kurt, O. K., Zhang, J., & Pinkerton, K. E. (2016). Pulmonary health effects of air pollution.
Current Opinion in Pulmonary Medicine, 22(2), 138-143. Retrieved February, 2016.
12. Linfen Air Pollution: Real-time PM2.5 Air Quality Index (AQI). (2016, February). Retrieved
February 25, 2016, from http://aqicn.org/city/linfen/

13. "Linfen, China." WorstPolluted Projects Reports. 2007. Accessed February 25, 2016.
http://www.worstpolluted.org/projects_reports/display/22.
14. Pope III, C. A., Burnette, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., &
Thurston, G. D. (2002). Lung Cancer, Cardiopulmonary Mortality, and Long-term
Exposure to Fine Particulate Air Pollution. Jama, 287(9), 1132. Retrieved February,
2016.
15. Priddle, Robert. "Coal in the Energy Supply of China." Coal Industry Advisory Board.
1999. Accessed February 2016. https://www.iea.org/ciab/papers/coalchina99.pdf.
16. Raaschou-Nielsen, O., Beelen, R., Wang, M., Hoek, G., Andersen, Z., Hoffmann, B., . . .
Vineis, P. (2016). Particulate matter air pollution components and risk for lung cancer.
Environment International, 87, 66-73. Retrieved February, 2016.
17. Rohde, R. A., & Muller, R. A. (2015). Air Pollution in China: Mapping of Concentrations
and Sources. PLOS ONE PLoS ONE, 10(8). Retrieved February, 2016.
18. Song, X., Longyi, S., Shushen, Y., Riying, S., Limei, S., & Shihong, C. (2015). Trace
elements pollution and toxicity of airborne PM10 in a coal industrial city. Atmospheric
Pollution Research, 6(3), 469-475.
19. Ventura County Air Pollution Control District. (n.d.). 50 Simple Ways to Reduce Air
Pollution. Retrieved April 9, 2016, from
http://www.vcapcd.org/pubs/Factsheets/50WaysfactSheet.pdf
20. Zheng, R., Zeng, H., Zuo, T., Zhang, S., Qiao, Y., Zhou, Q., & Chen, W. (2015). Lung
cancer incidence and mortality in China, 2011. Thoracic Cancer, 7(1), 94-99. Retrieved
February 2016.

Appendix
Figure 1
Logic Model:
Program: Air Pollution Information Outreach Program & Formation of Policy Regulations on Air
Quality (Two-pronged)
Goal: Improve community member’s knowledge on protective measures against air pollution along with
the formation of air quality policy proposal
Resources Activities Outputs Short/Medium
Outcomes
Long term
Outcomes
• Environmental health
professionals
•Money in donation for
fans, payment of lawyer,
environmental health
professional, and
development of posters
and pamphlets.
•Hospital to kindly donate
500 surgical masks.
•Volunteers to help
disseminate the flyers and
pamphlets with the masks
along with the fans later
on.
•Office supplies to make
pamphlets and posters
(computers, printer, etc.)
•Public policy
professional or lawyer to
develop policy proposal.
•Fan distributer to donate
or sell in bulk discount.
•1 year time
•Develop and
disseminate 500 flyers
and pamphlets along
with surgical masks.
•Recruit volunteers
•Go to hospital to pick
up surgical masks.
•Volunteers post
posters and give out
pamphlets and masks
at market.
•Give away 500 fans
to residents returning
at market after they
have read the
pamphlet.
• Give out pre and
post surveys to
examine behavioral
change.
•Consult with lawyer
and Environmental
Health professional on
forming a policy
proposal.
•# of residents that
use fans instead of
windows.
use AC instead of
windows.
follow suggested
curfew.
• # of residents that
wear surgical masks
when outdoors.
• # of completed parts
of our policy
proposal.
•15% of Linfen
residents will be
knowledgeable about
the benefits of closing
windows at night and
using AC or fans.
•15% of Linfen
residents will be
knowledgeable of the
benefits of staying
inside after 8pm until
5am.
•The environmental
lawyer and principle
investigatorwill
complete full policy
proposalto include all 3
sections and propose to
the Chinese
Government at the end
of the 1-year.
•15% of Linfen
residents will be able to
identify at least two
protective measures
they can use to limit
exposure to air
pollution.
•Community members
of Linfen, China will
limit their exposure to
polluted air by 15%
from adopting and
implementing all
protective measures
within 6 months after
implementation.
• The Coal Industry
and Linfen
community will align
with implemented
policy change to
increase cleaner air
intake by 10% for
Linfen, China by
2030.
Assumptions: Everyone living in the area wants to breath clean air. Everyone wants to see change in the
air quality. Most people go to the market often. Most people want to learn how to improve their health.
External Factors: Low SES,not everyone goes to the market, access to air conditioning, environmental
health values, occupational status, and daily work schedule.

Figure 2
Timeline:
Linfen, China residents: Exposure to air pollution and protective measures along with Public Policy
Tasks – Year One Person
Responsible
June
2015
July
2015
Aug.
2015
Sept.
2015
Oct.
2015
Nov.
2015
Dec.
2015
Jan.
2016
Feb.
2016
Mar.
2016
April
2016
May
2016
Raise money for
program
Project
Director
X X
Recruit andhire a lawyer
or environmental health
professional
Principle
Investigator
X
Meet with hospital to
discuss free masks
Principal
Investigator
X
Meet with fan distributer
to discuss bulk
discountingor donating
fans
Principal
Investigator
X
Creation ofpamphlet and
posters alongwith pre
andpost surveys
Principal
Investigator
X
Recruit volunteers
Principal
Investigator
andProject
Director
X
Pick up masks from
hospital
Project
Director
X
Pick up fans from
distributer
Project
Director
X
Form policyproposal Principal
Investigator
and
Environment
al Lawyer
X X X X X X X
Volunteers post posters
about event date, time,
locationetc.
Project
Director and
volunteers
X
Handout pamphlet, pre-
survey andsurgical
masks
Project
Director and
volunteers
X
When survey handedin
give out fans to returners
Project
director and
volunteers
X
Post-survey Project
director and
volunteers
X
Propose policy to
government
Principal
Investigator
and
environment
al lawyer
X
Feedback on proposal Principal
Investigator
and
Environment
al Lawyer
X
Evaluationof thesurvey
results
Principal
Investigator
X
Dissemination of
findings to stakeholders
Principal
Investigator
X X

Figure 3
Figure 4

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