State of gaseous air pollutants and resulting health effects in Karachi, Pakistan.

Karachi, Pakistan, is a priority site for air pollution research due to high emissions of air pollutants from vehicular traffic, industrial activities, and biomass burning, as well as rapid growth in population. The objectives of this study were to investigate the levels of gaseous pollutants (NO, NO2, O3, HNO3, and SO2) in Karachi, to determine temporal and seasonal variations, to compare Karachi's air quality with other urban centers, to identify relationships with meteorological conditions, to identify source characterization, and to perform a backward-in-time trajectory analysis and a health impact assessment. Daily samples of gaseous pollutants were collected for six consecutive weeks in each of the four seasons for a year. Daily maximum concentrations of NO (90 parts per billion by volume (ppbv)), NO2 (28.1 ppbv), O3 (57.8 ppbv), and SO2 (331 ppbv) were recorded in fall, while HNO3 (9129 parts per trillion by volume (pptv)) was recorded in spring. Seasonal average concentrations were high in winter for NO (9.47 ± 7.82 ppbv), NO2 (4.84 ± 3.35 ppbv), and O3 (8.92 ± 7.65 ppbv), while HNO3 (629 ± 1316 pptv) and SO2 (20.2 ± 39.4 ppbv) were high in spring and fall, respectively. The observed SO2 seasonal average concentration in fall (20.2 ± 39.4) was 5 times higher than that in summer (3.97 ± 2.77) with the fall 24-h average (120 ppbv) exceeding the WHO daily guideline (7.64 ppbv) by a factor of about 15.7. A health impact assessment estimated an increase of 1200 and 569 deaths due to short-term exposure to SO2 in fall and spring, respectively. Chronic daily intake estimated risk per 1000 was 0.99, 0.47, 0.45, and 0.26 for SO2 in fall, NO in winter, O3 in winter, and NO2 in spring, respectively. This study confirms the effect of poor urban air quality on public health and demonstrated the influence of photochemical reactions as well as unfavorable meteorological conditions on the formation of secondary pollutants.

Measuring students' exposure to particulate matter (PM) pollution across microenvironments and seasons using personal air monitors.

Particulate matter (PM) pollution is a significant concern in public health, yet children's exposure is not adequately characterized. This study evaluated PM exposures among primary school-aged children in NYS across different microenvironments. This study helps fill existing knowledge gaps by characterizing PM exposure among this population across seasons and microenvironments. Sixty students were recruited from randomly selected public primary schools representing various socioeconomic statuses. Individual real-time exposure to PM2.5 was measured continuously using AirBeam personal monitors for 48 h. Children were consistently exposed to higher PM2.5 concentrations in the fall (median: fall = 2.84, spring = 2.31, winter = 0.90 µg/m3). At school, 2.19% of PM2.5 measurements exceeded the EPA annual fine particle standard, 12 µg/m3 (winter = 7.38%, fall = 2.39%, spring = 1.38%). In classrooms, PM1-4 concentrations were higher in spring and overnight, while PM7-10 concentrations were higher in fall and school hours. At home, 37.2% of fall measurements exceeded EPA standards (spring = 10.39%, winter = 4.37%). Overall, PM2.5 levels in classrooms and during transportation never rose above the EPA standard for any significant length of time. However, PM2.5 levels routinely exceeded these standards at home, in the fall, and the evening. More extensive studies are needed to confirm these results.

Residential Proximity to Biorefinery Sources of Air Pollution and Respiratory Diseases in New York State.

Understanding potential health risks associated with biofuel production is critical to sustainably combating energy insecurity and climate change. However, the specific health impacts associated with biorefinery-related emissions are not yet well characterized. We evaluated the relationship between respiratory emergency department (ED) visits (2011-2015) and residential exposure to biorefineries by comparing 15 biorefinery sites to 15 control areas across New York (NY) State. We further examined these associations by biorefinery types (e.g., corn, wood, or soybean), seasons, and lower respiratory disease subtypes. We measured biorefinery exposure using residential proximity in a cross-sectional study and estimation of biorefinery emission via AERMOD-simulated modeling. After controlling for multiple confounders, we consistently found that respiratory ED visit rates among residents living within 10 km of biorefineries were significantly higher (rate ratios (RRs) range from 1.03 to 3.64) than those in control areas across our two types of exposure indices. This relationship held across biorefinery types (higher in corn and soybean biorefineries), seasons (higher in spring and winter), air pollutant types (highest for NO2), and respiratory subtypes (highest for emphysema). Further research is needed to confirm our findings.

Multipathways human health risk assessment of trihalomethane exposure through drinking water.

Life-time human health risk of cancer attributed to trihalomethanes in drinking water in an urban-industrialized area of Karachi (Pakistan) was conducted through multiple pathways of exposure. The extent of cancer risk was compared with USEPA guidelines. Human health cancer risk for total trihalomethanes (TTHMs) through ingestion and dermal routes were estimated in "acceptable-low risk" (≥1.0E-06; ≤5.10E-05), whereas through inhalation route it was estimated under "acceptable-high risk" (≥5.10E-05; ≤1.0E-04) category. However, at some industrial-urban areas cancer risk for CHCl3 were estimated under "unacceptable risk" (≥1.0E-04) through inhalation route.

Air quality in Mecca and surrounding holy places in Saudi Arabia during Hajj: initial survey.

The Arabian Peninsula experiences severe air pollution, the extent and sources of which are poorly documented. Each year in Saudi Arabia this situation is intensified during Hajj, the Holy Pilgrimage of Islam that draws millions of pilgrims to Mecca. An initial study of air quality in Mecca and surrounding holy sites during the 2012 Hajj (October 24-27) revealed strongly elevated levels of the combustion tracer carbon monoxide (CO, up to 57 ppmv) and volatile organic compounds (VOCs) along the pilgrimage route-especially in the tunnels of Mecca-that are a concern for human health. The most abundant VOC was the gasoline evaporation tracer i-pentane, which exceeded 1200 ppbv in the tunnels. Even though VOC concentrations were generally lower during a follow-up non-Hajj sampling period (April 2013), many were still comparable to other large cities suffering from poor air quality. Major VOC sources during the 2012 Hajj study included vehicular exhaust, gasoline evaporation, liquefied petroleum gas, and air conditioners. Of the measured compounds, reactive alkenes and CO showed the strongest potential to form ground-level ozone. Because the number of pilgrims is expected to increase in the future, we present emission reduction strategies to target both combustive and evaporative fossil fuel sources.

Air pollution we breathe: Assessing the air quality and human health impact in a megacity of Southeast Asia.

With 24 million inhabitants and 6.6 million vehicles on the roads, Karachi, Pakistan ranks among the world's most polluted cities due to high levels of fine particulate matter (PM2.5). This study aims to investigate PM2.5 mass, seasonal and temporal variability, chemical characterization, source apportionment, and health risk assessment at two urban sites in Karachi. Samples were analyzed using ion chromatography and dual-wavelength optical transmissometer for various inorganic components (anions, cations, and trace elements) and black carbon (BC). Several PM2.5 pollution episodes were frequently observed, with annual mean concentrations at Kemari (140 ± 179 µg/m3) and Malir (95 ± 40.9 µg/m3) being significantly above the World Health Organization's guidelines of 5 µg/m3. Chemical composition at both sites exhibited seasonal variability, with higher pollution levels in winter and fall and lower concentrations in summer. The annual average BC concentrations were 4.86 ± 5.29 µg/m3 and 4.52 ± 3.68 µg/m3, respectively. A Positive Matrix Factorization (PMF) analysis identified 5 factors, crustal, sea salt, vehicular exhaust, fossil-fuel combustion, and industrial emission. The health risk assessment indicated a higher number of deaths in colder seasons (fall and winter) at the Kemari (328,794 and 287,814) and Malir (228,406 and 165,737) sites and potential non-carcinogenic and carcinogenic risks to children from metals. The non-carcinogenic risk of PM2.5 bound Pb, Fe, Zn, Mn, Cr, Cu and Ni via inhalation exposure were within the acceptable level (<1) for adults. However, potential non-carcinogenic and carcinogenic health risk posed by Pb and Cr through inhalation were observed for children. The findings exhibit critical levels of air pollution that exceed the safe limits in Karachi, posing significant health risks to children and sensitive groups. Our study underscores the urgent need for effective emission control strategies and policy interventions to mitigate these air pollution risks.

Beyond the outdoors: indoor air quality guidelines and standards - challenges, inequalities, and the path forward.

In the last few decades, indoor air quality (IAQ) has become a major threat to public health. It is the fifth leading cause of premature death globally. It has been estimated that people spend ∼90 % of their time in an indoor environment. Consequently, IAQ has significant health effects. Although IAQ-related standards and guidelines, policies, and monitoring plans have been developed in a few countries, there remain several global inequalities and challenges. This review paper aims to comprehensively synthesize the current status of widely accepted IAQ guidelines and standards. It analyzes their global implementation and effectiveness to offer insights into challenges and disparities in IAQ policies and practices. However, the complexity of domestic environments and the diversity of international standards impede effective implementation. This manuscript evaluates international, national, and regional IAQ guidelines, emphasizing similarities and differences. In addition, it highlights knowledge gaps and challenges, urging the international scientific community, policymakers, and stakeholders to collaborate to advance IAQ standards and guidelines. The analysis evaluates the efficacy of guidelines, identifies deficiencies, and offers recommendations for the future of domestic air quality standards.

Fine particulate matter and its chemical constituents' levels: A troubling environmental and human health situation in Karachi, Pakistan.

Like many urban centers in developing countries, the effect of air pollution in Karachi is understudied. The goal of this study was to determine the chemical characterization, temporal and seasonal variability, sources, and health impacts of fine particulate matter (PM2.5) in Karachi, Pakistan. Daily samples of PM2.5 were collected using a low-volume air sampler at two different sites (Makro and Karachi University) over the four seasons between October 2009 and August 2010. Samples were analyzed for black carbon (BC), trace metals, and water-soluble ions. Results showed that the annual average concentrations of PM2.5 at Makro and Karachi University were 114 ± 115 and 71.7 ± 56.4 µg m-3, respectively, about 22.8 and 14.3-fold higher than the World Health Organization annual guideline of 5 µg m-3. BC concentrations were 3.39 ± 1.97 and 2.70 ± 2.06 µg m-3, respectively. The concentrations of PM2.5, BC, trace metals, and ions at the two sites showed clear seasonal trends, with higher concentrations in winter and lower concentrations in summer. The trace metals and ionic species with the highest concentrations were Pb, S, Zn, Ca, Si, Cl, Fe, and SO42-. The air quality index in the fall and winter at both sites was about 68 %, which is "unhealthy" for the general population. Positive Matrix Factorization revealed the overall contribution to PM2.5 at the Makro site came from three major sources - industrial emissions (13.3 %), vehicular emissions (59.1 %), and oil combustion (23.3 %). The estimates of expected number of deaths due to short-term exposure to PM2.5 were high in the fall and winter at both sites, with an annual mean estimate of 3592 expected number of deaths at the Makro site. Attention should be paid to the reduction of inorganic pollutants from industrial facilities, vehicular traffic, and fossil fuel combustion, due to their extremely high contribution to PM2.5 mass and health risks.

Per- and polyfluoroalkyl substances in the atmospheric total suspended particles in Karachi, Pakistan: Profiles, potential sources, and daily intake estimates.

Per- and polyfluoroalkyl substances (PFAS) have received continuous attention; however, there is limited understanding of their sources in the atmosphere and related human exposure risks. This study measured PFAS in the atmospheric total suspended particles collected from Karachi, Pakistan, during the winter. Among the quantified PFAS, perfluorobutanoic acid (PFBA) showed the highest average concentration (3.11 ± 2.64 pg/m3), accounting for 32% of the total PFAS. Wind speed was positively correlated with perfluorohexanoic acid (PFHxA) and N-ethyl perfluorooctanesulfonamide (N-EtFOSA), while relative humidity was negatively correlated with perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA). Weighted potential source contribution function (WPSCF) and concentration weighted trajectory (WCWT) analyses suggested that northwestern Pakistan and western Afghanistan areas were highly associated with the long-range atmospheric transport of PFAS. We also calculated the daily intake of PFAS via inhalation, which were in the range of 0.07-3.98 and 0.01-0.33 pg/kg bw/d for children and adults, respectively. The calculated hazard quotient (HQ) of PFOS and PFOA was significantly lower than 1, indicating less or unlikely to cause non-carcinogenic effect via inhalation exposure. Overall, this study contributes to the understanding of geographic origins and human inhalation risks of airborne PFAS on a regional scale.

Application of data science methods to identify school and home risk factors for asthma and allergy-related symptoms among children in New York.

OBJECTIVES: Few studies have comprehensively assessed multiple environmental exposures affecting children's health. This study applied machine-learning methods to evaluate how indoor environmental conditions at home and school contribute to asthma and allergy-related symptoms. METHODS: We randomly selected 10 public schools representing different socioeconomic statuses in New York State (2017-2019) and distributed questionnaires to students to collect health status and home-and school-environmental exposures. Indoor air quality was measured at school, and ambient particle exposures (PM2.5 and components) were measured using real-time personal monitors for 48 h. We used random forest model to identify the most important risk factors for asthma and allergy-related symptoms, and decision tree for visualizing the inter-relationships among the multiple risk factors with the health outcomes. RESULTS: The top contributing factors identified for asthma were family rhinitis history (relative importance: 10.40%), plant pollen trigger (5.48%); bedroom carpet (3.58%); environmental tobacco smoke (ETS) trigger symptom (2.98%); and ETS exposure (2.56%). For allergy-related symptoms, plant pollen trigger (10.88%), higher paternal education (7.33%), bedroom carpet (5.28%), family rhinitis history (4.78%), and higher maternal education (4.25%) were the strongest contributing factors. Conversely, primary heating with hot water radiator was negatively (-6.86%) associated with asthma symptoms. Younger children (<9 years old) with family history of rhinitis and carpeting in the bedroom were the prominent combined risk factors for asthma. Children jointly exposed to pollen, solvents, and carpeting in their home tended to have greater risks of allergy-related symptoms, even without family history of rhinitis. CONCLUSION: Family rhinitis history, bedroom carpet, and pollen triggers were the most important risk factors for both asthma and allergy-related symptoms. Our new findings included that hot-water radiator was related to reduced asthma symptoms, and the combination of young age, rhinitis history, and bedroom carpeting was related to increased asthma symptoms. Further studies are needed to confirm our findings.

Identifying and evaluating school environmental health indicators.

Children's health, attendance, and academic performance may be affected by school environmental hazards. While prior studies evaluated home environment and health, few have evaluated indicators of school in-/outdoor environment and health. This study addresses this knowledge gap by systematically reviewing and evaluating outdoor and indoor indicators of school environment and student's health and performance in New York State (NYS). We also evaluate statistical methodologies to address highly correlated indicators and integrate multiple exposures. Multiple school environmental indicators were identified from various existing NYS datasets. We summarized data sources, completeness, geographic and temporal coverage, and data quality for each indicator. Each indicator was evaluated by scientific basis/relevance, analytic soundness/feasibility, and interpretation/utility, and validated using objective NYS data. Finally, advanced variable selection methods were described and discussed. We have identified and evaluated multiple school environmental health indicators. It was found that mold and moisture problems, ventilation problems, ambient ozone, and PM2.5 levels are among the top priorities of school environmental issues/indicators in NYS, which were also consistent while using NYS data. Choice of best variable selection method should be made based on the research questions and data characteristics. The school environmental health indicators identified, and variable selection methods evaluated, in this study could be used by other researchers to help school officials and policy makers initiate prevention programs.

Projecting life-cycle environmental impacts of corn production in the U.S. Midwest under future climate scenarios using a machine learning approach.

Climate change is exacerbating environmental pollution from crop production. Spatially and temporally explicit estimates of life-cycle environmental impacts are therefore needed for suggesting location and time relevant environmental mitigations strategies. Emission factors and process-based mechanism models are popular approaches used to estimate life-cycle environmental impacts. However, emission factors are often incapable of describing spatial and temporal heterogeneity of agricultural emissions, whereas process-based mechanistic models, capable of capturing the heterogeneity, tend to be very complicated and time-consuming. Efficient prediction of life-cycle environmental impacts from agricultural production is lacking. This study develops a rapid predictive model to quantify life-cycle global warming (GW) and eutrophication (EU) impacts of corn production using a novel machine learning approach. We used the boosted regression tree (BRT) model to estimate future life-cycle environmental impacts of corn production in U.S. Midwest counties under four emissions scenarios for years 2022-2100. Results from BRT models indicate that the cross-validation (R2) for predicting life cycle GW and EU impacts ranged from 0.78 to 0.82, respectively. Furthermore, results show that future life-cycle GW and EU impacts of corn production will increase in magnitude under all four emissions scenarios, with the highest environmental impacts shown under the high-emissions scenario. Moreover, this study found that changes in precipitation and temperature played a significant role in influencing the spatial heterogeneity in all life-cycle impacts across Midwest counties. The BRT model results indicate that machine learning can be a useful tool for predicting spatially and temporally explicit future life-cycle environmental impacts associated with corn production under different climate scenarios.

Fine particles exposure and cardiopulmonary morbidity in Jeddah: A time-series analysis.

Health effects linked to PM2.5, have been extensively studied in developed countries of Europe and N. America. However, little has been done in Saudi Arabia and the Middle East. This study evaluated the morbidity risk for cardiovascular (CVD) and respiratory (RD) diseases, associated with PM2.5 exposure in Jeddah, Saudi Arabia. 24-h PM2.5 sampling was conducted at 3 sites for 6 weeks quarterly from Apr 8th, 2013-Feb 18th, 2014 with simultaneous hospital data collection. The relative risks (RRs) for cardiopulmonary morbidity at different moving averages (MAs) of lagged exposures were estimated using a generalized linear time-series model. Elevated risks for RD were associated with recent PM2.5 exposures (0-2 days). RD prevalence was highest in children 0-14 years. Overall, RD morbidity risk ranged from 1.081 (CI: 1.005-1.162) to 1.096 (CI: 1.023-1.173) at MAs_2-4; male, 1.081 (CI: 1.019-1.146) to 1.087 (CI: 1.020-1.159) at MAs_2-3, and female, 1.086 (CI: 1.007-1.172) to 1.093 (CI: 1.017-1.175) at MAs_2-4. Generally, females 0-14 years were the most at risk for RDs with RR = 1.097 (CI: 1.025-1.174) to 1.148 (CI: 1.049-1.257). CVD morbidity risk was highest in ER visits with overall RR = 1.057 (CI: 1.005-1.111) to 1.137 (CI: 1.065-1.213) across all MAs; male, 1.060 (CI: 1.007-1.204) to 1.131 (CI: 1.060-1.208); female, 1.065 (CI: 1.008-1.125) to 1.116 (CI: 1.045-1.192). PM2.5 exposure showed significantly increased cardiopulmonary morbidity risk, accentuating the severe health effects associated with elevated PM2.5 in Jeddah. Overall, females (0-14 years) were more at risk for RD morbidity than males. CVD morbidity risk was relatively higher in males than females, with highest risk observed in age-groups above 40 years.

Assessing the association between fine particulate matter (PM2.5) constituents and cardiovascular diseases in a mega-city of Pakistan.

Concerning PM2.5 concentrations, rapid industrialization, along with increase in cardiovascular disease (CVD) were recorded in Pakistan, especially in urban areas. The degree to which air pollution contributes to the increase in the burden of CVD in Pakistan has not been assessed due to lack of data. This study aims to describe the characteristics of PM2.5 constituents and investigate the impact of individual PM2.5 constituent on cardiovascular morbidity in Karachi, a mega city in Pakistan. Daily levels of twenty-one constituents of PM2.5 were analyzed using samples collected at two sites from fall 2008 to summer 2009 in Karachi. Hospital admission and emergency room visits due to CVD were collected from two large hospitals. Negative Binominal Regression was used to estimate associations between pollutants and the risk of CVD. All PM2.5 constituents were assessed in single-pollutant models and selected constituents were assessed in multi-pollutant models adjusting for PM2.5 mass and gaseous pollutants. The most common CVD subtypes among our participants were ischemic heart disease, hypertension, heart failure, and cardiomyopathy. Extremely high levels of PM2.5 constituents from fossil-fuels combustion and industrial emissions were observed, with notable peaks in winter. The most consistent associations were found between exposure to nickel (5-14% increase per interquartile range) and cardiovascular hospital admissions. Suggestive evidence was also observed for associations between cardiovascular hospital admissions and Al, Fe, Ti, and nitrate. Our findings suggested that PM2.5 generated from fossil-fuels combustion and road dust resuspension were associated with the increased risk of CVD in Pakistan.

Carbonyls and non-methane hydrocarbons at a rural mountain site in northeastern United States.

Measurements of carbonyls and C(2)-C(6) non-methane hydrocarbons (NMHCs) were made in ambient air at a rural site at the summit of Whiteface Mountain (WFM) in New York State. Alkanes dominated in the samples, with ethane and propane making up about 55% of the total on a carbon-atom basis. Ethane, the longest-lived of the NMHCs, showed a mixing ratio in the range of 0.86-2.1 ppbv. Photochemical ageing analysis indicated an anthropogenic influence on the NMHC levels. The photochemical reactivity of the hydrocarbons, calculated in terms of propylene-equivalent concentration, was dominated by alkenes (propene and ethene), which accounted for 74% of the total NMHC sum. Air mass back-trajectories have been used to investigate the origin of the observed NMHCs and carbonyls. Higher concentrations were found when air masses arrived from the midwestern US corridor. Acetone was the most abundant species, comprising from 31% to 53% of the total detected carbonyls, followed by MEK (15-53%), HCHO (7-39%), and CH(3)CHO (7-19%). Average concentrations were determined to be 1.61 ppbv for CH(3)C(O)CH(3), 1.40 ppbv for MEK, 1.16 ppbv for HCHO, and 0.49 ppbv for CH(3)CHO. The variations in carbonyl concentrations were observed to follow patterns similar to variations in O(3) concentrations, typical of secondary products. Correlations and statistical analysis of the carbonyls and NMHCs were performed, and showed that most of the compounds derived from mixing and photochemical transformation of long-range transported pollutants from the major source areas. Ranking of the carbonyls with respect to removal of the OH radical showed HCHO to be the most important species, followed by CH(3)CHO, MEK, and CH(3)C(O)CH(3).

Ambient air quality in the holy city of Makkah: A source apportionment with elemental enrichment factors (EFs) and factor analysis (PMF).

Air pollution remains a major global public health and environmental issue. We assessed the levels of PM2.5 and delineated the major sources in Makkah, Saudi Arabia. Fine particulate matter (PM2.5) sampling was performed from February 26, 2014-January 27, 2015 in four cycles/seasons. Samples were analyzed for black carbon (BC) and trace elements (TEs). PM2.5 source apportionment was performed by computing enrichment factors (EFs) and positive matrix factorization (PMF). Backward-in time trajectories were used to assess the long-range transport. Significant seasonal variations in PM2.5 were observed, Spring: 113 ±â€¯67.1, Summer: 88.3 ±â€¯36.4, Fall: 67.8 ±â€¯24, and Winter: 67.6 ±â€¯36.9 µg m-3. The 24-h PM2.5 exceeded the WHO (25 µg m-3) and Saudi Arabia's (35 µg m-3) guidelines, with an air quality index (AQI) of "unhealthy to hazardous" to human health. Most delta-C computations were below zero, indicating minor contributions from bio-mass burning. TEs were primarily Si, Ca, Fe, Al, S, K and Mg, suggesting major contributions from soil (Si, Ca, Fe, Al, Mg), and industrial and vehicular emissions (S, Ca, Al, Fe, K). EF defined two broad categories of TEs as: anthropogenic (Cu, Zn, Eu, Cl, Pb, S, Br and Lu), and earth-crust derived (Al, Si, Na, Mg, Rb, K, Zr, Ti, Fe, Mn, Sr, Y, Cr, Ga, Ca, Ni and Ce). Notably, all the anthropogenic TEs can be linked to industrial and vehicular emissions. PMF analysis defined four major sources as: vehicular emissions, 30.1%; industrial-mixed dust, 28.9%; soil/earth-crust, 24.7%; and fossil-fuels/oil combustion, 16.3%. Plots of wind trajectories indicated wind direction and regional transport as major influences on air pollution levels in Makkah. In collusion, anthropogenic emissions contributed >75% of the observed air pollution in Makkah. Developing strategies for reducing anthropogenic emissions are paramount to controlling particulate air pollution in this region.

Association of fine particulate air pollution with cardiopulmonary morbidity in Western Coast of Saudi Arabia.

OBJECTIVES: To assess cardiopulmonary morbidity associated with daily exposures to PM2.5 in Western Coast of Saudi Arabia. Methods: We monitored 24-h PM2.5 and its constituents including black carbon (BC), particulate sulfate (p-SO42-), nitrate (p-NO3-), ammonium (p-NH4+) and trace elements (TEs) at a site in Rabigh, Saudi Arabia from May to June 2013 with simultaneous collection of hospital data (N=2513). Cardiopulmonary morbidity risk was determined in a generalized linear time-series model.  Results: Exposure to PM2.5 was associated with a 7.6% (p=0.056) increase in risk of respiratory disease (RD) in females. Black carbon increased RD morbidity risk by 68.1% (p=0.056) in females. Exposure to p-SO42- increased the cardiovascular disease (CVD) risk by up to 5.3% (p=0.048) in males; and RD by 2.9% (p=0.037) in females and 2.5% (p=0.022) in males. The p-NH4+ increased CVD risk by up to 20.3% (p=0.033) in males; and RD by 10.7% (p=0.014) in females and 8% (p=0.031) in males. No statistically significant association was observed for p-NO3- and TEs exposure. Conclusion: Overall, results show an increased risk for cardiopulmonary morbidity following exposure to air pollution.

Road Traffic Injury as a Major Public Health Issue in the Kingdom of Saudi Arabia: A Review.

Injury was the largest single cause of disability-adjusted life years and death in the Kingdom of Saudi Arabia in 2013. The vast majority of injury-related fatalities are deaths caused by road traffic. Measures to control this serious public health issue, which has significant consequences for both Saudi families and the Saudi economy as a whole, have been underway for years but with little success. Most attempts at intervening revolve around attempts for enforcing stricter traffic laws and by installing automated traffic monitoring systems that will catch law breakers on camera and issue tickets and fines. While there has been much research on various factors that play a role in the high rate of road traffic injury in The Kingdom (e.g., driver behavior, animal collisions, disobeying traffic and pedestrian signals, environmental elements), virtually no attention has been given to examining why Saudi drivers behave the way that they do. This review provides a thorough account of the present situation in Saudi Arabia and discusses how health behavior theory can be used to gain a better understanding of driver behavior.

Climate Change and Water Scarcity: The Case of Saudi Arabia.

BACKGROUND: Climate change is expected to bring increases in average global temperatures (1.4°C-5.8°C [34.52°F-42.44°F] by 2100) and precipitation levels to varying degrees around the globe. The availability and quality of water will be severely affected, and public health threats from the lack of this valuable resource will be great unless water-scarce nations are able to adapt. Saudi Arabia provides a good example of how the climate and unsustainable human activity go hand in hand in creating stress on and depleting water resources, and an example for adaptation and mitigation. METHOD: A search of the English literature addressing climate change, water scarcity, human health, and related topics was conducted using online resources and databases accessed through the University at Albany, State University of New York library web page. RESULTS: Water scarcity, which encompasses both water availability and water quality, is an important indicator of health. Beyond drinking, water supply is intimately linked to food security, sanitation, and hygiene, which are primary contributors to the global burden of disease. Poor and disadvantaged populations are the ones who will suffer most from the negative effects of climate change on water supply and associated human health issues. Examples of adaptation and mitigation measures that can help reduce the strain on conventional water resources (surface waters and fossil aquifers or groundwater) include desalination, wastewater recycling and reuse, and outsourcing food items or "virtual water trade." These are strategies being used by Saudi Arabia, a country that is water poor primarily due to decades of irresponsible irrigation practices. The human and environmental health risks associated with these adaptation measures are examined. Finally, strategies to protect human health through international collaboration and the importance of these efforts are discussed. CONCLUSION: International, multidisciplinary cooperation and collaboration will be needed to promote global water security and to protect human health, particularly in low-income countries that do not have the resources necessary to adapt on their own.

Obesity and public health in the Kingdom of Saudi Arabia.

Overweight and obesity are now a global epidemic, with more than one in five people qualifying as obese worldwide. These conditions are accompanied by excessive rates of non-communicable diseases (NCDs) related to overweight, like type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Saudi Arabia, which has become increasingly westernized over the past few decades now has one of the highest prevalence rates of overweight and obesity, even in children. This puts the population at great risk for increased rates of NCD mortality. Competing cultures is partly to blame, as the combination of persisting traditional Saudi cultural practices, modern cultural changes, and economic prosperity has created an obesogenic environment that promotes unhealthy eating, sedentary lifestyles, and weight gain. Overweight and obesity are more prevalent in Saudi women than in Saudi men. Interventions targeting the environment are needed in order to promote greater health through healthy eating decisions and increased physical activity or exercise (especially for women).