2018 Report on Air Pollution and Health Research

UTAH PHYSICIANS FOR A HEALTHY ENVIRONMENT
2018 REPORT ON AIR POLLUTION AND HEALTH RESEARCH

When UPHE was formed in 2007, we committed ourselves first and foremost to delivering a message on air pollution and public health based strictly on the science. As we searched through the research, we were all struck by the parallels between the health consequences of air pollution and those of cigarette smoking. The parallels between those two types of pollution exposure have only grown closer in the last 12 years. What follows is a summary of key medical research from the past year and a reiteration and expansion of concepts that have been strengthened by this research.

The Lungs

The lungs consist of airways that conduct air into the lung, air sacs called alveoli where oxygen enters the blood stream and the waste gas, carbon dioxide is excreted and blood vessels that supply nutrition and carry oxygen and carbon dioxide. The airways are like an upside down tree where the trachea or windpipe is the widest part and as the branches form they keep getting narrower until they reach the alveoli or air sacs. When particles larger than 10 microns (larger than a red blood cell and about 5 to 10 times larger than most bacteria) they usually strike the wall of the airway, especially at a branching point, and are trapped in the thin mucus layer and swept out of the lungs. Pollution particles smaller than 10 microns can make their way down the airway and even settle in the air sacs. They may be blown out in expiration. Particles smaller than 2.5 microns can reach the air sacs and stay there. Thus, the smaller the particle, the greater the chances it can reach the air sac and stay there. Very small particles can even cross the air sac wall and enter the blood that carries it all over the body.

Air pollution consists of many particles of different sizes and in what occurs in the northern valleys of
Utah approximately 70% are 2.5 microns or smaller on an average day. Thus, most of our pollution
can get into the very small airways, the air sacs and even the blood. Some particles may be harmless
and some very harmful such as toxic metals. However, even the so-called harmless particles can
carry harmful chemicals, bacteria and viruses and do their damage through the attached rider. This
can explain many of the harmful effects of air pollution.

The entry into the blood explains the harmful effects on the brain, the fetus and other organs. The
settling of harmful particles in the air sacs explains how these air sacs can be destroyed leading to
emphysema and chronic obstructive pulmonary disease (COPD). (41,56,66,89) The irritation of the
small airway walls causes asthma and chronic bronchitis. The transport of viruses and bacteria in the
lung can lead to pneumonia. The inflammatory reactions to these particles leads to the release of
inflammatory chemical mediators that probably result in the formation and rupture of plaques in the
blood vessels causing strokes and heart attacks. Asthmatic attacks, COPD, bronchitis, pneumonia,
heart attacks and strokes all have been shown to be increased during our inversions and the
accumulation of pollutants in the air.

Cigarette smoking, which we all agree is a danger to our health, is a form of air pollution. When
smoking a cigarette you receive much higher levels of inhaled particles with each puff than you would
get from air pollution with a deep breath. However, a pack a day smoker is probably inhaling that
smoke maybe 400 times a day, or about 40 minutes worth of breathing, while we have to breathe
polluted air 12 times a minute, 24 hours/day. That comes to more than 17,000 breaths a day.
Smokers in our polluted valleys get the worst of both worlds.

The Heart and Blood Vessels

Numerous observational clinical studies have shown that exposure to acutely elevated levels of air
pollution is associated with increased risk of death due to myocardial infarction (“heart attack”) in
patients with preexisting cardiovascular diseases. Recent research from Europe shows that rapid
rises in air pollutants, over a 24 hour period, is associated with increased risk of myocardial infarction,
independently of absolute concentration. (83)

Multiple lines of recently accumulating evidence suggest that not only do acute spikes cause death,
chronic exposure to air pollution can actually contribute to the development of cardiovascular disease
in the first place. Just like cigarette smoking, diabetes mellitus and elevated cholesterol, exposure to
particulate matter (PM 2.5) is now considered a modifiable risk factor for cardiovascular disease.
Researchers in southwestern China found evidence of stiff blood vessels and increased blood
pressure, a well-known risk factor for cardiovascular disease, in middle-aged women exposed to
particulate matter air pollution from wood burning stoves. (80,81)

A national cross-sectional study in Lebanon showed that living conditions characterized by exposure
to indoor and outdoor air pollution are associated with high blood pressure.(82) In Philadelphia,
investigators recently aimed to study racial differences in air pollution exposure to ambient fine
particulate matter. With a median follow-up period of 8.3 years, they concluded that particulate matter
(PM 2.5) exposure was associated with elevated blood glucose, impaired blood vessel function,
increased incidence of adverse cardiovascular events and higher all-cause mortality. In this study,
blacks had higher exposure to PM 2.5 and a 45% higher risk of adverse cardiovascular events and
death from any cause. (76) Although less widely recognized, low-level environmental lead exposure
has recently been associated with increased risk of death from cardiovascular disease in large
population-based studies carried out in the United States. (74)

Finally, there is disturbing evidence accumulating from both clinical studies in people and basic
animal models, showing that exposure to PM 2.5 particulate matter is associated with decreased
cardiac function and increased heart size. In animal models, preconception exposure to PM 2.5, as
well as in utero prenatal and during the post-natal period, can cause cardiac dysfunction in adulthood.
(1)

Air Quality and Fertility, Pregnancy, and Newborn Health

The last year has continued the growth of research reports on the adverse outcomes associated with
poor air quality and women’s and men’s reproductive health. The significant majority of public health
outcomes research confirms that air pollution (particulate and ozone) adversely affects fertility,
pregnancy, and the health of newborns. This research also reveals that there is no “safe” level of air
pollution….adverse effects can be measured even at levels below EPA standards. Of course, these
reports also confirm that more pollution is worse and less pollution is better.

New reports add to earlier research that poor air quality adversely affects sperm quality (84) and this
confirms research done previously here in the Salt Lake Valley (98). Research from around the world
has shown the association of poor air quality with increased risk of spontaneous abortion and this
year a report from the University of Utah found similar risks here in Salt Lake City (5). More reports
from around the world confirm the increased risk of preterm birth and stillbirth with poor air quality (45).
Infants exposed to air pollution prior to birth have poorer cognitive function in school (7). Infants
exposed to poor air pollution have more heart defects (79) and more asthma (86). Although the
increases in all of these adverse effects are small, they are significant on a population level, and very
significant to the affected parents and children.

And there is good news! In California, researchers have looked at the reproductive health
consequences to people living close to oil and coal power plants. They found an increase in fertility in
people living near the recently closed coal and oil power plants, compared to when they were open
(47). They also found a significant decrease in premature births in women who lived nearby after the
power plants were closed (43). This mirrors research from Utah Valley that showed that premature
births dropped after a steel mill was closed (58). Also, data collected by citizen science efforts like
Purple Air allow men and women access to air quality information in their own neighborhood and
inside their own homes so that they can make decisions about driving, outdoor activities, and become
advocates for cleaner air.

Fetal Development, DNA Damage

We have known for several years that air pollution can harm the developing fetus in utero and
contribute to adverse pregnancy outcomes as mentioned above. One likely mechanism by which that
occurs is air pollution’s ability to interfere with DNA and genetic function. The study mentioned above
finding impaired cognition in children who were born in a home near heavily trafficked roads, showed
that the likely mechanism was damage to DNA. That is now a recurring and critical theme in air
pollution research, including a new study showing decreased ability to repair DNA damage with more
air pollution exposure. (30) Changes in the chemical environment of DNA in the placenta increase the
vulnerability of the unborn to chronic disease later in life. (46) Several new studies were published
demonstrating that air pollution changes the functioning of genes, a likely mechanism by which it
provokes chronic diseases of the heart, lungs, and endocrine systems. (67,68,69,70,71)
Telomeres are repeating sequences of DNA on the ends of chromosomes that shorten with cell
division as a person ages. More studies were published showing air pollution causes a specific type
of DNA damage—shorter telomere length, a marker of accelerated aging, and predictor of premature
death. (15,31)

An alarming new study in lab mice starkly shows what air pollution can do to future generations, even
if they are never exposed. In mice, merely “pre-conception” exposure to air pollution, and no
exposure after conception, at a level only slightly above the EPA’s 24 hour standard for PM2.5, was
enough to cause impaired heart function, decreased heart muscle mass, activated an oxidative stress
response and triggered systemic inflammation later on in adulthood. The mechanism was damage to
germ cells in the parents even before conception. The moral to this story is powerful. Even yet
unborn, future generations are harmed by the air pollution breathed today by future parents.1

Diseases of the Brain and Nervous System

Research studies published during the past year have demonstrated how alarmingly harmful air
pollution is to the human brain, including the presence of air pollution particles penetrating brain
tissue itself.

During early development, the brain is especially susceptible to damage from air pollution. A study
showed that air pollution chemically changes the DNA in children (22) while another study further
affirms the danger of diesel exposure showing that there is damage to the olfactory system of the
fetus in-utero. (92) As we have known, early life air pollution exposure affects the microscopic
anatomy of the brain, with a recent study demonstrating decreases in the number of neurons,
alteration of the blood brain barrier and increases in micro hemorrhages, all of which were associated
with impaired brain function in animals. (8) From this past year’s research, there is also new evidence
further connecting air pollution to autism. (72)

Research continues to show that air pollution is associated with a broad range of neurologic diseases.
This year’s research studies break new ground in finding a connection between air pollution and
Amyotrophic Lateral Sclerosis (ALS), i.e. Lou Gehrig’s disease, (97) increased relapses in multiple
sclerosis, (88) and increased risk of stroke and mortality from stroke. (12,13,14)

More air pollution exposure has been found to be associated with smaller volumes of brain grey
matter (78) and exposure to air pollution is associated with lower verbal scores. Less well-educated
men over age 60 are the most vulnerable to this effect. (9) Heavy metal exposure has been shown to
impair cognitive function, specifically, verbal memory, recognition, mental processing speed, and
executive function, which all focused in frontal and pre- frontal lobe areas. (6)

An autopsy study examining brains of 203 younger people age 1 to 40 found abnormal proteins linked
to Alzheimer’s disease in all but one of the specimens! And the amount of these abnormal proteins
was proportional to the amount of air pollution where the subjects lived. The principle author, probably
the world’s expert on this type of research said, “Alzheimer’s disease hallmarks start in childhood in
polluted environments, and we must implement effective preventative measures early. It is useless to
take reactive actions decades later.” (60)

Mental Health

There has long been acceptance that pollution increases the risks of heart disease, stroke dementia,
lung cancer and other lung diseases, and GI issues. In recent years, evidence has emerged that link
air pollution to mental health problems like early brain development, depression, anxiety, psychosis,
and suicide. Adding to the established literature on this topic, 2018 has brought us additional studies,
which confirm earlier concerns as well as introduce new ones.

Pollution may be particularly harmful to a young developing brain, as there appear to be associations
between pollution and autistic spectrum disorder (ASD). (72,99,100,101)

Studies also showed an association between behavioral difficulties of young children and air pollution
their mothers were exposed to while pregnant with them. 8,19 Self-harming in adolescents in China
was associated with pollution. (102) Youth exposed to pollution at age 12 had increased rates of
depression as adults. (103)

Adult brains are also sensitive to pollution’s effects. Behavioral problems, even criminal activity and
unethical behavior, are also observed in adults exposed to pollution. 85 There are higher rates of
depression, substance abuse and psychosis with pollution. (51, 53, 54) Even second-hand smoke
was associated with a roughly 50% increased in risk of major depression in non-smokers. (104)
Suicide rates were shown to be increased with exposure to pollution. (52,105,106)

When considering all-cause mortality, pollution haze was shown to be particularly dangerous for
people with mental illness. The combination of high ozone and haze was associated with a 79%
increase in the risk of death. (107)

Endocrine Diseases

Air pollution increases the risk of insulin resistance, obesity, type II diabetes, metabolic disorders like
fatty liver disease and an adverse blood lipid profile. (10,11,21,62,63,64,65)

Cancer

Just about every type of cancer is provoked by air pollution. Several new studies showed air
pollution’s association with increased risk of cancer—childhood cancers, lung cancer, and cancers of
the upper digestive tract and stomach. (32, 33, 34, 35, 59) Yet another study found a connection
between air pollution and brain cancer, with this one revealing a likely mechanism. (50) Even cancers
thought to be exclusively caused by smoking are associated with air pollution, including
nasopharyngeal cancer. (17)

Infections

Virtually every type of infection has been connected to air pollution. A study was done evaluating a
large patient population of over 100,000 right here on Utah’s Wasatch Front. It showed that serious
lower respiratory infections in every age group were increased with more air pollution, even shortterm
exposure lasting only several days. (61) Other studies showed air pollution triggers upper and
lower respiratory and ear infections in children. (23,55) Two new studies showing increased rates of
appendicitis with more air pollution. (36, 37)

Miscellaneous Diseases (Kidney, Bowel) and Other Studies

The connection between air pollution and kidney disease (16) and inflammatory bowel diseases was
strengthened, with a study showing how the bowel’s bacteria population is disrupted. (48)

We are often asked how bad does the air pollution have to get to make it more dangerous to your
health than the benefits of the exercise itself? We still don’t really know the answer, but this study
suggests that with dirty air, the benefits of the exercise are wiped out after 15 minutes, and that after
75 minutes, the air pollution is doing more damage than the benefits of the exercise. (57)

Another new study suggests that breathing through tightly fitting N-95 masks reduces the amount of
particles inhaled, but doesn’t proportionally decrease the body’s inflammation at the microscopic level,
and therefore the health consequences of pollution may not mitigated much. (58)

Infant mortality increases with air pollution. A study from Africa shows about the same relationship
between infant mortality and air pollution, as adult mortality–a 1% increase for every 1 ug/m3 in
PM2.5, or about 22% of infant deaths in this study. (39)

On a positive note, a new study showed that cardiorespiratory exercise may have a protective effect
on cognition in older women exposed to air pollution. (94)

Conclusions

The last year’s research solidifies these important concepts.

1. There is no safe level of air pollution and the relationship between air pollution and impaired public
health is not linear. Per unit of exposure low levels have even greater impact on health. Any industrial
project, or new source of pollution, must be analyzed in this context, and not judged or permitted in
the context of whether it may result in exceedances of national air quality standards. They must be
judged simply as to whether they add more pollution to a community that is already burdened with
poor air quality.

2. Virtually everyone is affected whether or not they have symptoms.

3. While everyone is affected, they are not affected equally. There are important genetic, gender and
even racial differences in how people respond to the biological stress of air pollution.

4. Pollution averages don’t tell the whole story. Even short term air pollution matters, and has
lingering and potentially long term health consequences, including some pollution particles remaining
inside the body’s organs for months or even permanently.

5. The timing of the exposure, and even the rate of an exposure may be more important than the
quantity of exposure. This is especially true for babies in utero.

6. Not all air pollution, and not even all particulate pollution is created equal. Some sources are
more chemically, mechanically and biologically toxic than others. For example, wood smoke and
diesel exhaust are two of the most toxic types of pollution.

7. Microenvironments matter. Pollution tends to concentrate near its sources, and the health
consequences that we allow as a community can be vastly different comparing the east side of the
valley to the west, and even from one neighborhood to another. No neighborhood or township should
be treated as a sacrifice zone for the economic development of another, or of the state as a whole.
North Salt Lake, Draper, the Point of the Mountain, and the Northwest Quadrant are examples of
communities that are, or will be, disproportionately impacted because of current or planned industrial
operations.

8. As we experienced last year, climate related factors will likely make our air pollution worse. More
regional wild fires and more ozone from hotter temperatures are likely to render current mitigation
strategies inadequate to provide consistently clean air on the Wasatch Front.

We feel it is imperative that the legislature considers all these factors during this and all future
sessions.

Healthy Summary compiled by:
Dr. Brian Moench – President and Founder UPHE
Dr. Park Willis IV – Vice President UPHE
Dr. Richard Kanner – Board Member UPHE
Dr. Kirtly Jones – Board Member UPHE
Dr. John Macfarlane – Board Member UPHE
Dr. Phil Wilson
Dr. Courtney Henley

##

UPHE is a 501(c)(3) tax-exempt, charitable organization. Tax ID# 80-0774496
423 W 800 S, Suite A108, Salt Lake City, UT 84101 Phone: 385.707.3677
www.uphe.org www.facbook.com/utahphysiciansforahealthyenvironment

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