A study protocol to evaluate the relationship between outdoor air pollution and pregnancy outcomes.

BACKGROUND: The present study protocol is designed to assess the relationship between outdoor air pollution and low birth weight and preterm births outcomes performing a semi-ecological analysis. Semi-ecological design studies are widely used to assess effects of air pollution in humans. In this type of analysis, health outcomes and covariates are measured in individuals and exposure assignments are usually based on air quality monitor stations. Therefore, estimating individual exposures are one of the major challenges when investigating these relationships with a semi-ecologic design. METHODS/DESIGN: Semi-ecologic study consisting of a retrospective cohort study with ecologic assignment of exposure is applied. Health outcomes and covariates are collected at Primary Health Care Center. Data from pregnant registry, clinical record and specific questionnaire administered orally to the mothers of children born in period 2007-2010 in Portuguese Alentejo Litoral region, are collected by the research team. Outdoor air pollution data are collected with a lichen diversity biomonitoring program, and individual pregnancy exposures are assessed with spatial geostatistical simulation, which provides the basis for uncertainty analysis of individual exposures. Awareness of outdoor air pollution uncertainty will improve validity of individual exposures assignments for further statistical analysis with multivariate regression models. DISCUSSION: Exposure misclassification is an issue of concern in semi-ecological design. In this study, personal exposures are assigned to each pregnant using geocoded addresses data. A stochastic simulation method is applied to lichen diversity values index measured at biomonitoring survey locations, in order to assess spatial uncertainty of lichen diversity value index at each geocoded address. These methods assume a model for spatial autocorrelation of exposure and provide a distribution of exposures in each study location. We believe that variability of simulated exposure values at geocoded addresses will improve knowledge on variability of exposures, improving therefore validity of individual exposures to input in posterior statistical analysis.

Traffic represents the main source of pollution in small Mediterranean urban areas as seen by lichen functional groups.

The land-use type (residential, green areas, and traffic) within relatively small Mediterranean urban areas determines significant changes on lichen diversity, considering species richness and functional groups related to different ecological factors. Those areas with larger volume of traffic hold lower species diversity, in terms of species richness and lichen diversity value (LDV). Traffic areas also affect the composition of the lichen community, which is evidenced by sensitive species. The abundance of species of lichens tolerant to low levels of eutrophication diminishes in traffic areas; oppositely, those areas show a higher abundance of species of lichens tolerating high levels of eutrophication. On the other hand, residential and green areas have an opposite pattern, mainly with species highly tolerant to eutrophication being less abundant than low or moderate ones. The characteristics of tree bark do not seem to affect excessively on lichen composition; however, tree species shows some effect that should be considered in further studies.

Geostatistical uncertainty of assessing air quality using high-spatial-resolution lichen data: A health study in the urban area of Sines, Portugal.

In most studies correlating health outcomes with air pollution, personal exposure assignments are based on measurements collected at air-quality monitoring stations not coinciding with health data locations. In such cases, interpolators are needed to predict air quality in unsampled locations and to assign personal exposures. Moreover, a measure of the spatial uncertainty of exposures should be incorporated, especially in urban areas where concentrations vary at short distances due to changes in land use and pollution intensity. These studies are limited by the lack of literature comparing exposure uncertainty derived from distinct spatial interpolators. Here, we addressed these issues with two interpolation methods: regression Kriging (RK) and ordinary Kriging (OK). These methods were used to generate air-quality simulations with a geostatistical algorithm. For each method, the geostatistical uncertainty was drawn from generalized linear model (GLM) analysis. We analyzed the association between air quality and birth weight. Personal health data (n=227) and exposure data were collected in Sines (Portugal) during 2007-2010. Because air-quality monitoring stations in the city do not offer high-spatial-resolution measurements (n=1), we used lichen data as an ecological indicator of air quality (n=83). We found no significant difference in the fit of GLMs with any of the geostatistical methods. With RK, however, the models tended to fit better more often and worse less often. Moreover, the geostatistical uncertainty results showed a marginally higher mean and precision with RK. Combined with lichen data and land-use data of high spatial resolution, RK is a more effective geostatistical method for relating health outcomes with air quality in urban areas. This is particularly important in small cities, which generally do not have expensive air-quality monitoring stations with high spatial resolution. Further, alternative ways of linking human activities with their environment are needed to improve human well-being.