The influence of risk awareness and government trust on risk perception and preparedness for natural hazards.

Risk perception is considered the primary motivator for taking preparedness actions. But people with prior experience and a high-risk perception are not necessarily more prepared. This relationship is even more complex when assessing preparedness levels for hazards with different characteristics. These inconsistent findings can be explained by how preparedness has been measured and the influence of other factors, such as trust and risk awareness. Thus, the main goal of this study was to analyze the role of risk awareness and trust in authorities on risk perception and intention to prepare for natural hazards in a coastal city in Chile. A representative sample of the city of Concepción, located in the center-south zone of Chile (n = 585), completed a survey. We measured risk awareness, risk perception, trust in authorities, and intention to prepare for two hazards: earthquakes/tsunamis and floods. Through structural equation models, we tested five hypotheses. We found that the perception of risk maintained a direct and positive influence on the intention to prepare for both hazards. The results showed that awareness and risk perception influence the intention to prepare and should be considered different concepts. Finally, trust did not significantly influence risk perception when faced with known hazards for the population. Implications for understanding the relationship between risk perception and direct experience are discussed.

[The threat of climate change on population health and the urgent need to act]. / La amenaza del cambio climático a la salud de la población y la necesidad urgente de actuar.

Climate change is associated with negative health outcomes, such as cardiovascular and respiratory diseases. This article analyses the threat of climate change on population health and the urgent need to implement measures to avoid this damage. Heat vulnerability, heatwave exposures, and wildfire exposure to forest fires have increased in Chile. In 2018, the annual mean concentration of fine particulate matter (PM2.5) exceeded the safe level proposed by the World Health Organization, increasing the risk of negative health outcomes. Thus, multidisciplinary and intersectoral mitigation and adaptation policies are needed. Among other elements, mental health impacts of climate change, health education provided by health workers to reduce negative health impacts of climate change, greater engagement of academia to generate evidence useful for policy-making processes and a better articulation between central and local governments should be considered. Finally, achieving a healthy population should be the aim of all these policies and efforts.

Structured expert judgment to characterize uncertainty between PM2.5 exposure and mortality in Chile.

To further the understanding and implementation of expert elicitation methods in the evaluation of public policies related to air pollution, the present study's main goal was to explore the potential strengths and weaknesses of structured expert judgment (SEJ) methodology as a way to derive a C-R function for chronic PM(2.5) exposure and premature mortality in Chile. Local experts were classified in two groups according to background and experience: physicians (Group 1) and engineers (Group 2). Experts were required to provide an estimate of the true percent change in nonaccidental mortality resulting from a permanent 1 µg/m(3) reduction in PM2.5 annual average ambient concentration across the entire Chilean territory. Cooke's Classical Model was used to combine the individual experts' assessments. Experts' mortality estimations varied markedly across groups: while experts in Group 1 delivered higher estimations than those reported in major international cohort studies, estimations from Group 2 were, to varying degrees, anchored to previous studies. Accordingly, combined distributions for each group and all experts were significantly different, due to the high sensitivity of the weighted distribution to experts' performance in calibration variables. Results of this study suggest that, while the use of SEJ has great potential for estimating C-R functions for chronic exposure to PM2.5 and premature mortality and its major sources of uncertainty in countries where no studies are available, its successful implementation is conditioned by a number of factors, which are analyzed and discussed.

Multicity study of air pollution and mortality in Latin America (the ESCALA study).

INTRODUCTION: The ESCALA* project (Estudio de Salud y Contaminación del Aire en Latinoamérica) is an HEI-funded study that aims to examine the association between exposure to outdoor air pollution and mortality in nine Latin American cities, using a common analytic framework to obtain comparable and updated information on the effects of air pollution on several causes of death in different age groups. This report summarizes the work conducted between 2006 and 2009, describes the methodologic issues addressed during project development, and presents city-specific results of meta-analyses and meta-regression analyses. METHODS: The ESCALA project involved three teams of investigators responsible for collection and analysis of city-specific air pollution and mortality data from three different countries. The teams designed five different protocols to standardize the methods of data collection and analysis that would be used to evaluate the effects of air pollution on mortality (see Appendices B-F). By following the same protocols, the investigators could directly compare the results among cities. The analysis was conducted in two stages. The first stage included analyses of all-natural-cause and cause-specific mortality related to particulate matter < or = 10 pm in aerodynamic diameter (PM10) and to ozone (O3) in cities of Brazil, Chile, and México. Analyses for PM10 and O3 were also stratified by age group and O3 analyses were stratified by season. Generalized linear models (GLM) in Poisson regression were used to fit the time-series data. Time trends and seasonality were modeled using natural splines with 3, 6, 9, or 12 degrees of freedom (df) per year. Temperature and humidity were also modeled using natural splines, initially with 3 or 6 df, and then with degrees of freedom chosen on the basis of residual diagnostics (i.e., partial autocorrelation function [PACF], periodograms, and a Q-Q plot) (Appendix H, available on the HEI Web site). Indicator variables for day-of-week and holidays were used to account for short-term cyclic fluctuations. To assess the association between exposure to air pollution and risk of death, the PM10 and O3 data were fit using distributed lag models (DLMs). These models are based on findings indicating that the health effects associated with air pollutant concentrations on a given day may accumulate over several subsequent days. Each DLM measured the cumulative effect of a pollutant concentration on a given day (day 0) and that day's contribution to the effect of that pollutant on multiple subsequent (lagged) days. For this study, exposure lags of up to 3, 5, and 10 days were explored. However, only the results of the DLMs using a 3-day lag (DLM 0-3) are presented in this report because we found a decreasing association with mortality in various age-cause groups for increasing lag effects from 3 to 5 days for both PM10 and O3. The potential modifying effect of socioeconomic status (SES) on the association of PM10 or O3 concentration and mortality was also explored in four cities: Mexico City, Rio de Janeiro, São Paulo, and Santiago. The methodology for developing a common SES index is presented in the report. The second stage included meta-analyses and metaregression. During this stage, the associations between mortality and air pollution were compared among cities to evaluate the presence of heterogeneity and to explore city-level variables that might explain this heterogeneity. Meta-analyses were conducted to combine mortality effect estimates across cities and to evaluate the presence of heterogeneity among city results, whereas meta-regression models were used to explore variables that might explain the heterogeneity among cities in mortality risks associated with exposures to PM10 (but not to O3). RESULTS: The results of the mortality analyses are presented as risk percent changes (RPC) with a 95% confidence interval (CI). RPC is the increase in mortality risk associated with an increase of 10 microg/m3 in the 24-hour average concentration of PM10 or in the daily maximum 8-hour moving average concentration of O3. Most of the results for PM10 were positive and statistically significant, showing an increased risk of mortality with increased ambient concentrations. Results for O3 also showed a statistically significant increase in mortality in the cities with available data. With the distributed lag model, DLM 0-3, PM10 ambient concentrations were associated with an increased risk of mortality in all cities except Concepci6n and Temuco. In Mexico City and Santiago the RPC and 95% CIs were 1.02% (0.87 to 1.17) and 0.48% (0.35 to 0.61), respectively. PM10 was also significantly associated with increased mortality from cardiopulmonary, respiratory, cardiovascular, cerebrovascular-stroke, and chronic obstructive lung diseases (COPD) in most cities. The few nonsignificant effects generally were observed in the smallest cities (Concepción, Temuco, and Toluca). The percentage increases in mortality associated with ambient O3 concentrations were smaller than for those associated with PM10. All-natural-cause mortality was significantly related to O3 in Mexico City, Monterrey, São Paulo and Rio de Janeiro. Increased mortality risks for some specific causes were also observed in these cities and in Santiago. In the analyses stratified by season, different patterns in mortality and O3 were observed for cold and warm seasons. Risk estimates for the warm season were larger and significant for several causes of death in São Paulo and Rio de Janeiro. Risk estimates for the cold season were larger and significant for some causes of death in Mexico City, Monterrey, and Toluca. In an analysis stratified by SES, the all-natural-cause mortality risk in Mexico City was larger for people with a medium SES; however we observed that the risk of mortality related to respiratory causes was larger among people with a low SES, while the risk of mortality related to cardiovascular and cerebrovascular-stroke causes was larger among people with medium or high SES. In São Paulo, the all-natural-cause mortality risk was larger in people with a high SES, while in Rio de Janeiro the all-natural-cause mortality risk was larger in people with a low SES. In both Brazilian cities, the risks of mortality were larger for respiratory causes, especially for the low- and high-SES groups. In Santiago, all-natural-cause mortality risk did not vary with level of SES; however, people with a low SES had a higher respiratory mortality risk, particularly for COPD. People with a medium SES had larger risks of mortality from cardiovascular and cerebrovascular-stroke disease. The effect of ambient PM10 concentrations on infant and child mortality from respiratory causes and lower respiratory infection (LRI) was studied only for Mexico City, Santiago, and São Paulo. Significant increased mortality risk from these causes was observed in both Santiago (in infants and older children) and Mexico City (only in infants). For O3, an increased mortality risk was observed in Mexico City (in infants and older children) and in São Paulo (only in infants during the warm season). The results of the meta-analyses confirmed the positive and statistically significant association between PM10 and all-natural-cause mortality (RPC = 0.77% [95% CI: 0.60 to 1.00]) using the random-effects model. For mortality from specific causes, the percentage increase in mortality ranged from 0.72% (0.54 to 0.89) for cardiovascular disease to 2.44% (1.36 to 3.59) for COPD, also using the random-effects model. For O3, significant positive associations were observed using the random-effects model for some causes, but not for all natural causes or for respiratory diseases in people 65 years or older (> or = 65 years), and not for COPD and cerebrovascular-stroke in the all-age and the > or = 65 age groups. The percentage increase in all-natural-cause mortality was 0.16% (-0.02 to 0.33). In the meta-regression analyses, variables that best explained heterogeneity in mortality risks among cities were the mean average of temperature in the warm season, population percentage of infants (< 1 year), population percentage of children at least 1 year old but < 5 years (i.e., 1-4 years), population percentage of people > or = 65 years, geographic density of PM10 monitors, annual average concentrations of PM10, and mortality rates for lung cancer. CONCLUSIONS: The ESCALA project was undertaken to obtain information for assessing the effects of air pollutants on mortality in Latin America, where large populations are exposed to relatively high levels of ambient air pollution. An important goal was to provide evidence that could inform policies for controlling air pollution in Latin America. This project included the development of standardized protocols for data collection and for statistical analyses as well as statistical analytic programs (routines developed in R by the ESCALA team) to insure comparability of results. The analytic approach and statistical programming developed within this project should be of value for researchers carrying out single-city analyses and should facilitate the inclusion of additional Latin American cities within the ESCALA multicity project. Our analyses confirm what has been observed in other parts of the world regarding the effects of ambient PM10 and 03 concentrations on daily mortality. They also suggest that SES plays a role in the susceptibility of a population to air pollution; people with a lower SES appeared to have an increased risk of death from respiratory causes, particularly COPD. Compared with the general population, infants and young children appeared to be more susceptible to both PM10 and O3, although an increased risk of mortality was not observed in these age groups in all cities. (ABSTRACT TRUNCATED)

Environmental health indicators and a case study of air pollution in Latin American cities.

Environmental health indicators (EHIs) are applied in a variety of research and decision-making settings to gauge the health consequences of environmental hazards, to summarize complex information, or to compare policy impacts across locations or time periods. While EHIs can provide a useful means of conveying information, they also can be misused. Additional research is needed to help researchers and policy-makers understand categories of indicators and their appropriate application. In this article, we review current frameworks for environmental health indicators and discuss the advantages and limitations of various forms. A case study EHI system was developed for air pollution and health for urban Latin American centers in order to explore how underlying assumptions affect indicator results. Sixteen cities were ranked according to five indicators that considered: population exposed, children exposed, comparison to health-based guidelines, and overall PM(10) levels. Results indicate that although some overall patterns in rankings were observed, cities' relative rankings were highly dependent on the indicator used. In fact, a city that was ranked best under one indicator was ranked worst with another. The sensitivity of rankings, even when considering a simple case of a single pollutant, highlights the need for clear understanding of EHIs and how they may be affected by underlying assumptions. Careful consideration should be given to the purpose, assumptions, and limitations of EHIs used individually or in combination in order to minimize misinterpretation of their implications and enhance their usefulness.

Human-environmental drivers and impacts of the globally extreme 2017 Chilean fires.

In January 2017, hundreds of fires in Mediterranean Chile burnt more than 5000 km2, an area nearly 14 times the 40-year mean. We contextualize these fires in terms of estimates of global fire intensity using MODIS satellite record, and provide an overview of the climatic factors and recent changes in land use that led to the active fire season and estimate the impact of fire emissions to human health. The primary fire activity in late January coincided with extreme fire weather conditions including all-time (1979-2017) daily records for the Fire Weather Index (FWI) and maximum temperature, producing some of the most energetically intense fire events on Earth in the last 15-years. Fire activity was further enabled by a warm moist growing season in 2016 that interrupted an intense drought that started in 2010. The land cover in this region had been extensively modified, with less than 20% of the original native vegetation remaining, and extensive plantations of highly flammable exotic Pinus and Eucalyptus species established since the 1970s. These plantations were disproportionally burnt (44% of the burned area) in 2017, and associated with the highest fire severities, as part of an increasing trend of fire extent in plantations over the past three decades. Smoke from the fires exposed over 9.5 million people to increased concentrations of particulate air pollution, causing an estimated 76 premature deaths and 209 additional admissions to hospital for respiratory and cardiovascular conditions. This study highlights that Mediterranean biogeographic regions with expansive Pinus and Eucalyptus plantations and associated rural depopulation are vulnerable to intense wildfires with wide ranging social, economic, and environmental impacts, which are likely to become more frequent due to longer and more extreme wildfire seasons.

Air pollution and mortality in Latin America: the role of education.

BACKGROUND: People with less education in Europe, Asia, and the United States are at higher risk of mortality associated with daily and longer-term air pollution exposure. We examined whether educational level modified associations between mortality and ambient particulate pollution (PM10) in Latin America, using several timescales. METHODS: The study population included people who died during 1998-2002 in Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. We fit city-specific robust Poisson regressions to daily deaths for nonexternal-cause mortality, and then stratified by age, sex, and educational attainment among adults older than age 21 years (none, some primary, some secondary, and high school degree or more). Predictor variables included a natural spline for temporal trend, linear PM10 and apparent temperature at matching lags, and day-of-week indicators. We evaluated PM10 for lags 0 and 1 day, and fit an unconstrained distributed lag model for cumulative 6-day effects. RESULTS: The effects of a 10-microg/m increment in lag 1 PM10 on all nonexternal-cause adult mortality were for Mexico City 0.39% (95% confidence interval = 0.13%-0.65%); São Paulo 1.04% (0.71%-1.38%); and for Santiago 0.61% (0.40%-0.83%). We found cumulative 6-day effects for adult mortality in Santiago (0.86% [0.48%-1.23%]) and São Paulo (1.38% [0.85%-1.91%]), but no consistent gradients by educational status. CONCLUSIONS: PM10 had important short- and intermediate-term effects on mortality in these Latin American cities, but associations did not differ consistently by educational level.

Ancillary human health benefits of improved air quality resulting from climate change mitigation.

BACKGROUND: Greenhouse gas (GHG) mitigation policies can provide ancillary benefits in terms of short-term improvements in air quality and associated health benefits. Several studies have analyzed the ancillary impacts of GHG policies for a variety of locations, pollutants, and policies. In this paper we review the existing evidence on ancillary health benefits relating to air pollution from various GHG strategies and provide a framework for such analysis. METHODS: We evaluate techniques used in different stages of such research for estimation of: (1) changes in air pollutant concentrations; (2) avoided adverse health endpoints; and (3) economic valuation of health consequences. The limitations and merits of various methods are examined. Finally, we conclude with recommendations for ancillary benefits analysis and related research gaps in the relevant disciplines. RESULTS: We found that to date most assessments have focused their analysis more heavily on one aspect of the framework (e.g., economic analysis). While a wide range of methods was applied to various policies and regions, results from multiple studies provide strong evidence that the short-term public health and economic benefits of ancillary benefits related to GHG mitigation strategies are substantial. Further, results of these analyses are likely to be underestimates because there are a number of important unquantified health and economic endpoints. CONCLUSION: Remaining challenges include integrating the understanding of the relative toxicity of particulate matter by components or sources, developing better estimates of public health and environmental impacts on selected sub-populations, and devising new methods for evaluating heretofore unquantified and non-monetized benefits.

Sensitivity of bacterioplankton nitrogen metabolism to eutrophication in sub-tropical coastal waters of Key West, Florida.

Expression of intracellular ammonium assimilation enzymes were used to assess the response of nitrogen (N) metabolism in bacterioplankton to N-loading of sub-tropical coastal waters of Key West, Florida. Specific activities of glutamine synthetase (GS) and total glutamate dehydrogenase (GDHT) were measured on the bacterial size fraction (<0.8 microm) to assess N-deplete versus N-replete metabolic states, respectively. Enzyme results were compared to concentrations of dissolved organic matter and nutrients and to the biomass and production of phytoplankton and bacteria. Concentrations of dissolved inorganic N (DIN), dissolved organic N (DON), and dissolved organic carbon (DOC) positively correlated with specific activities of GDHT and negatively correlated with that of GS. Total dissolved N (TDN) concentration explained 81% of variance in bacterioplankton GDHT:GS activity ratio. The GDHT:GS ratio, TDN, DOC, and bacterial parameters decreased in magnitude along a tidally dynamic trophic gradient from north of Key West to south at the reef tract, which is consistent with the combined effects of localized coastal eutrophication and tidal exchange of seawater from the Southwest Florida Shelf and Florida Strait. The N-replete bacterioplankton north of Key West can regenerate ammonium which sustains primary production transported south to the reef. The range in GDHT:GS ratios was 5-30 times greater than that for commonly used indicators of planktonic eutrophication, which emphasizes the sensitivity of bacterioplankton N-metabolism to changes in N-bioavailability caused by nutrient pollution in sub-tropical coastal waters and utility of GDHT:GS ratio as an bioindicator of N-replete conditions.

La amenaza del cambio climático a la salud de la población y la necesidad urgente de actuar

Climate change is associated with negative health outcomes, such as cardiovascular and respiratory diseases. This article analyses the threat of climate change on population health and the urgent need to implement measures to avoid this damage. Heat vulnerability, heatwave exposures, and wildfire exposure to forest fires have increased in Chile. In 2018, the annual mean concentration of fine particulate matter (PM2.5) exceeded the safe level proposed by the World Health Organization, increasing the risk of negative health outcomes. Thus, multidisciplinary and intersectoral mitigation and adaptation policies are needed. Among other elements, mental health impacts of climate change, health education provided by health workers to reduce negative health impacts of climate change, greater engagement of academia to generate evidence useful for policy-making processes and a better articulation between central and local governments should be considered. Finally, achieving a healthy population should be the aim of all these policies and efforts.

Vulnerability to heat-related mortality in Latin America: a case-crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City, Mexico.

BACKGROUND: Factors affecting vulnerability to heat-related mortality are not well understood. Identifying susceptible populations is of particular importance given anticipated rising temperatures from climatic change. METHODS: We investigated heat-related mortality for three Latin American cities (Mexico City, Mexico; São Paulo, Brazil; Santiago, Chile) using a case-crossover approach for 754 291 deaths from 1998 to 2002. We considered lagged exposures, confounding by air pollution, cause of death and susceptibilities by educational attainment, age and sex. RESULTS: Same and previous day apparent temperature were most strongly associated with mortality risk. Effect estimates remained positive though lowered after adjustment for ozone or PM(10). Susceptibility increased with age in all cities. The increase in mortality risk for those >or=65 comparing the 95th and 75th percentiles of same-day apparent temperature was 2.69% (95% CI: -2.06 to 7.88%) for Santiago, 6.51% (95% CI: 3.57-9.52%) for São Paulo and 3.22% (95% CI: 0.93-5.57%) for Mexico City. Patterns of vulnerability by education and sex differed across communities. Effect estimates were higher for women than men in Mexico City, and higher for men elsewhere, although results by sex were not appreciably different for any city. In São Paulo, those with less education were more susceptible, whereas no distinct patterns by education were observed in the other cities. CONCLUSIONS: Elevated temperatures are associated with mortality risk in these Latin American cities, with the strongest associations in São Paulo, the hottest city. The elderly are an important population for targeted prevention measures, but vulnerability by sex and education differed by city.

The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City.

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.

Risk perception in a developing country: the case of Chile.

In this work we characterize risk perception in Chile, based on the psychometric paradigm, exploring the difference between perceived social and personal risk. For this purpose, we conducted a survey including 54 hazards, 16 risk attributes, and 3 risk constructs. The survey, divided into four parts, was administered to 508 residents of Santiago, Chile. Using factor analysis, three main factors, which accounted for 80% of the sample's variance, were identified: factor 1, commonly called "Dread Risk" in the literature, explained 37% of variance; factor 2, "Unknown Risk," explained 28%; and factor 3, which we called "Personal Effect," explained 15% of the variance. On average, individuals perceived themselves as less exposed to risk and with more control and knowledge about them than the general population. OLS regression models were used to test the association of perceived risk with the three main factors. For social risk, factor 1 had the greatest explanatory power, while factor 2 had a negative sign. For personal risk, only factors 2 and 3 were significant, with factor 3 having the greatest explanatory power. Risk denial (defined as the difference between perceived personal and social risk) was associated with factors 1 and 2 only, with factor 2 having a negative sign. The difference between desired and actual regulation levels proved positive for all hazards, thus indicating that Chileans are dissatisfied with the current regulation level for all the hazards analyzed. The comparison of data at the aggregate and at the individual subject's level suggests that while the aggregate analysis overestimates the magnitude of the correlations it still reflects the tendency of the individual responses.

Anaerobic methane oxidation in a landfill-leachate plume.

The alluvial aquifer adjacent to Norman Landfill, OK, provides an excellent natural laboratory for the study of anaerobic processes impacting landfill-leachate contaminated aquifers. We collected groundwaters from a transect of seven multilevel wells ranging in depth from 1.3 to 11 m that were oriented parallel to the flow path. The center of the leachate plume was characterized by (1) high alkalinity and elevated concentrations of total dissolved organic carbon, reduced iron, and methane, and (2) negligible oxygen, nitrate, and sulfate concentrations. Methane concentrations and stable carbon isotope (delta13C) values suggest anaerobic methane oxidation was occurring within the plume and at its margins. Methane delta13C values increased from about -54 per thousand near the source to > -10 per thousand downgradient and at the plume margins. The isotopic fractionation associated with this methane oxidation was -13.6+/-1.0 per thousand. Methane 13C enrichment indicated that 80-90% of the original landfill methane was oxidized over the 210-m transect. First-order rate constants ranged from 0.06 to 0.23 per year, and oxidation rates ranged from 18 to 230 microM/y. Overall, hydrochemical data suggest that a sulfate reducer-methanogen consortium may mediate this methane oxidation. These results demonstrate that natural attenuation through anaerobic methane oxidation can be an important sink for landfill methane in aquifer systems.