Addressing tobacco industry influence in tobacco-growing countries.

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobacco-growing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.

Éviter que l'élaboration de politiques soit influencée par l'industrie du tabac est essentiel pour assurer une gestion efficace de la lutte antitabac. L'inclusion d'acteurs de l'industrie comme parties prenantes des processus législatifs demeure l'un des principaux leviers employés par les sociétés. Cette influence est renforcée par l'idée que l'industrie du tabac constitue un partenaire légitime du gouvernement dans le domaine de la gouvernance réglementaire. Pour lutter contre l'ingérence du secteur, il faut se concentrer sur les institutions gouvernementales qui officialisent les relations entre l'industrie et les responsables politiques. L'implication de l'industrie dans les institutions publiques est surtout observée dans les pays producteurs de tabac, où certains niveaux de gouvernement soutiennent activement le tabac en tant que bien économique. Dans le présent document, nous abordons le fait qu'une lutte contre l'influence de l'industrie du tabac requiert une attention particulière dans les pays producteurs, où un large éventail d'entreprises encouragent la production de tabac: approvisionnement en semences, équipements et produits chimiques, mais aussi transport, achat des feuilles, transformation et fabrication. La variété des entreprises œuvrant dans de tels contextes est spécifique, tout comme leur engagement au sein des organes politiques. Pour les gouvernements qui souhaitent privilégier les alternatives à la production de tabac (selon l'article 17 de la Convention-cadre pour la lutte antitabac), nous montrons à quel point l'application de l'article 5.3, qui vise à protéger les politiques de lutte antitabac contre l'ingérence de l'industrie, est fondamentale dans ces pays. Intégrer l'article 5.3 dans l'article 17 permettra (i) de renforcer la cohérence des politiques en vigueur, afin que les politiques relatives à des activités de remplacement ne soient pas contrecarrées par l'industrie du tabac; (ii) de favoriser la collaboration entre les secteurs pour lutter contre l'influence de l'industrie tout en développant des moyens de subsistance; et enfin, (iii) d'accroître la responsabilisation et la transparence dans les efforts menés dans la lutte antitabac.

Proteger la formulación de políticas contra la influencia de la industria tabacalera es fundamental para una gobernanza eficaz del control del tabaco. La inclusión de los actores de la industria como partes interesadas en los procesos políticos sigue siendo una vía crucial para la influencia corporativa. Esta influencia se ve reforzada por la idea de que la industria tabacalera es un asociado legítimo del gobierno en la gobernanza reglamentaria. La lucha contra la influencia de la industria tabacalera exige centrarse en las instituciones gubernamentales que formalizan las relaciones entre la industria y los responsables de formular políticas. La participación de la industria en las instituciones gubernamentales es especialmente relevante en los países productores de tabaco, donde algunos sectores del gobierno apoyan activamente el tabaco como un bien económico. En este documento, se analiza cómo el control de la influencia de la industria tabacalera requiere una consideración especial en los países productores de tabaco. En estos países, existe una gran variedad de empresas que apoyan la producción de tabaco, incluidos los proveedores de semillas, equipos y productos químicos, así como las empresas de transporte, de compra de hojas y de procesamiento y fabricación. La variedad de empresas que operan en estos contextos es particular y también lo es su compromiso dentro de las instituciones políticas. Para los gobiernos que desean apoyar alternativas al cultivo de tabaco (es decir, el artículo 17 del Convenio Marco para el Control del Tabaco), se ilustra cómo la aplicación del artículo 5.3, destinado a proteger las políticas de control del tabaco de la interferencia del tabaco, es fundamental en estos países. La integración del artículo 5.3 con el artículo 17 (i) reforzará la coherencia política, asegurando que las políticas de medios de vida alternativos no se vean perjudicadas por la interferencia de la industria tabacalera; (ii) fomentará la colaboración intersectorial al abordar tanto la interferencia de la industria tabacalera como el desarrollo de los medios de vida; y (iii) mejorará la rendición de cuentas y la transparencia en los esfuerzos de control del tabaco.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.

BACKGROUND: The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. METHODS: Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. FINDINGS: 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. INTERPRETATION: Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

Safety and health in the petrochemical industry in Map Ta Phut, Thailand.

BACKGROUND: Petrochemical industries are known as sources of many toxic chemicals. Safety and health risks of the petrochemical workers employed at Map Ta Phut Industrial Estate, located in Rayong, Thailand, are potentially high. METHODS: The research materials consisted of documents emanating from statutory reports on safety in working with toxic chemicals and the results of interviews by questionnaire among 457 petrochemical workers regarding occupational health and safety issues. RESULTS: Most of workers who were working with toxic chemicals had knowledge and awareness of health risks and chemical hazards at work. We found that safe behavior at work through read the safety information among operational workers less than non-operational workers around 10%. Most of workers had perceived occupational health and safety management in their companies. Some companies revealed that they had not been performing biological monitoring of blood or urine for their health examination reports and that workplace exposure monitoring had not correlated well with health examination of workers. CONCLUSIONS: Our study suggested that occupational health and safety for petrochemical industries requires standards and guidelines for workers' health surveillance aimed at protection of workers.

Health impact of climate change on occupational health and productivity in Thailand.

BACKGROUND: The rise in global temperature is well documented. Changes in temperature lead to increases in heat exposure, which may impact health ranging from mild heat rashes to deadly heat stroke. Heat exposure can also aggravate several chronic diseases including cardiovascular and respiratory disease. OBJECTIVE: This study examined the relationship between climate condition and health status and productivity in two main categories of the occupational setting - where one setting involves heat generated from the industry and the other with heat in a natural setting. DESIGN: This cross-sectional study included four industrial sites (pottery industry, power plant, knife industry, and construction site) and one agricultural site in the Pathumthani and Ayutthaya provinces. Exposure data were comprised of meteorological data and heat exposure including relative humidity (RH) measured by Wet Bulb Globe Temperature (WBGT) monitor. Heat index was calculated to measure the effects of heat exposure on the study population, which consisted of 21 workers at five worksites; a questionnaire was also used to collect data on workers. RESULTS: Among the five workplaces, the outdoor WBGT was found to be highest at 34.6°C during 12:00 and 1:00 PM at the agricultural site. It was found that four out of five study sites had heat indices in the 'extreme caution,' where heat cramp and exhaustion may be possible and one site showed a value of 41°C that falls into the category of 'danger,' where sunstroke and heat exhaustion are likely and prolonged exposure may lead to heatstroke. Productivity as perceived by the workers revealed that only the construction and pottery industry workers had a loss of productivity ranged from 10 to 60 %. CONCLUSIONS: Climate conditions in Thailand potentially affect both the health and productivity in occupational settings.

A pilot use of team-based learning in graduate public health education.

This pilot study was undertaken to determine the impact of team-based learning (TBL) on graduate students of public health in a Thai context. The pilot project adopted Michaelsen's approach with the aim of improving learning among Thai graduate students enrolled in public health ethics. This TBL approach attempted to motivate students to do pre-class reading and be active "in-class" learners. Pre-class preparation allowed teachers to address and concentrate on learning gaps, while team work promoted peer interaction and active learning. TBL was found to be useful in fostering student preparedness and to transform "passive" into "active" learning, which especially benefited students "academically at risk" through peer teaching opportunities. With TBL, students valued the relevance of the course content and learning materials. They had positive opinions regarding the effect of TBL on individual and group learning. TBL was perceived to be instrumental in translating conceptual into applicable knowledge, and stimulated individual efforts as well as accountability. This study should be useful to those considering using TBL for public health education.

Factors related to short-term memory dysfunction in children residing near a Petrochemical Industrial Estate.

The purpose of the present study was to investigate the factors that affect short-term memory dysfunction among children, 6 to 13 years of age, residing near the Petrochemical Industrial Estate, Map Ta Phut sub-district, Rayong province. A population-based cross-sectional study was employed for collecting data on neurobehavioral effects using the Digit Span Test. The present study found one-third of 2,158 children presented with short-term memory dysfunction. It was found an inverse association between short-term memory dysfunction with 2 out of 25 communities; Islam (adjusted OR 0.382) and Taladmabtaput (adjusted OR 0.297). In addition, short-term memory dysfunction was also found an inverse association with distance from residential areas to the industrial park (adjusted OR 0.871). It was also found that an association between short-term memory dysfunction and length of living period in study areas was not clear The finding on short-term memory dysfunction indicated that children with short-term memory dysfunction were affected by the distance from residential areas to source of pollution and community.

Short-term association between sulfur dioxide and daily mortality: the Public Health and Air Pollution in Asia (PAPA) study.

Sulfur dioxide (SO(2)) has been associated with increased mortality and morbidity, but only few studies were conducted in Asian countries. Previous studies suggest that SO(2) may have adverse health effects independent of other pollutants. In the Public Health and Air Pollution in Asia (PAPA) project, the short-term associations between ambient sulfur dioxide (SO(2)) and daily mortality were examined in Bangkok, Thailand, and three Chinese cities: Hong Kong, Shanghai, and Wuhan. Poisson regression models incorporating natural spline smoothing functions were used to adjust for seasonality and other time-varying covariates. Effect estimates were obtained for each city and then for the cities combined. The impact of alternative model specifications, such as lag structure of pollutants and degree of freedom (df) for time trend, on the estimated effects of SO(2) were also examined. In both individual-city and combined analysis, significant effects of SO(2) on total non-accidental and cardiopulmonary mortality were observed. An increase of 10 microg/m(3) of 2-day moving average concentrations of SO(2) corresponded to 1.00% [95% confidence interval (CI), 0.75-1.24], 1.09% (95% CI, 0.71-1.47), and 1.47% (95% CI, 0.85-2.08) increase of total, cardiovascular and respiratory mortality, respectively, in the combined analysis. Sensitivity analyzes suggested that these findings were generally insensitive to alternative model specifications. After adjustment for PM(10) or O(3), the effect of SO(2) remained significant in three Chinese cities. However, adjustment for NO(2) diminished the associations and rendered them statistically insignificant in all four cities. In conclusion, ambient SO(2) concentration was associated with daily mortality in these four Asian cities. These associations may be attributable to SO(2) serving as a surrogate of other substances. Our findings suggest that the role of outdoor exposure to SO(2) should be investigated further in this region.

Part 3. Estimating the effects of air pollution on mortality in Bangkok, Thailand.

While the effects of particulate matter (PM*) on mortality have been well documented in North America and Western Europe, considerably less is known about its effects in developing countries in Asia. Existing air pollution data in Bangkok, Thailand, indicate that airborne concentrations of PM < or = 10 pm in aerodynamic diameter (PM10) are as high or higher than those experienced in most cities in North America and Western Europe. At the same time, the demographics, activity patterns, and background health status of the population, as well as the chemical composition of PM, are different in Bangkok. It is important, therefore, to determine whether the effects of PM10 on mortality occurring in this large metropolitan area are similar to those in Western cities. The quality and completeness of Bangkok mortality data have been recently enhanced by the completion of a few mortality studies and through input from monitors currently measuring daily PM10 in Bangkok. In this analysis, we examined the effects of PM10 and several gaseous pollutants on daily mortality for the years 1999 through 2003. Our results suggest strong associations between several different mortality outcomes and levels of PM10 and several of the gaseous pollutants, including nitrogen dioxide (NO2), nitric oxide (NO), and ozone (O3). In many cases, the effect estimates were higher than the approximately 6% per 10 microg/m3 typically reported in Western industrialized nations-based on reviews by the U.S. Environmental Protection Agency (U.S. EPA) and the World Health Organization (WHO) (Anderson et al. 2004). For example, the excess risk (ER) for mortality due to all natural causes was 1.3% (95% confidence interval [CI], 0.8 to 1.7), with higher ERs for cardiovascular and respiratory mortality of 1.9% (95% CI, 0.8 to 3.0) and 1.0% (95% CI, -0.4 to 2.4), respectively. Of particular note, for this warm, tropical city of approximately 6 to 10 million people, is that there is no covariation between pollution and cold weather, with its associated adverse health problems. Multiday averages of PM10 generated even higher effect estimates. Our analysis of age- and disease-specific mortality indicated elevated ERs for young children, especially infants with respiratory illnesses, children less than 5 years of age with lower respiratory infections (LRIs), and people with asthma. Age-restricted analyses showed that the associations between mortality due to all natural causes and PM10 concentration increased with age, with the strongest effects among people aged 75 years and older. However, associations between increases in PM10 concentration and mortality were observed for all of the other age groups. With a few exceptions, relatively similar results were observed for several of the other pollutants-sulfur dioxide (SO2), NO2, O3, and NO, which were highly correlated with PM10. However, many of the effects from gaseous pollutants were attenuated in multipollutant models, while effects from PM10 appeared to be most consistent. In addition, there was some evidence of an independent effect of O3 for certain health outcomes. We conducted substantial sensitivity analyses to examine whether our results were robust. The results indicated that our core model was generally robust to the choice of model specification, spline model, degrees of freedom (df) of time-smoothing functions, lags for temperature, adjustment for autocorrelation, adjustment for epidemics, and adjustment for missing values using centered data (see the description of the centering method used in the Common Protocol found at the end of this volume). Finally, the concentration-response functions for most of the pollutants appear to be linear. Thus, our sensitivity analyses results suggest an impact of pollution on mortality in Bangkok that is fairly consistent. They also provide support for the extrapolation of results from health effects studies conducted in North America and Western Europe to other parts of the world, including developing countries in Asia.

The Public Health and Air Pollution in Asia (PAPA) Project: estimating the mortality effects of particulate matter in Bangkok, Thailand.

BACKGROUND: Air pollution data in Bangkok, Thailand, indicate that levels of particulate matter with aerodynamic diameter < or = 10 microm (PM(10)) are significantly higher than in most cities in North America and Western Europe, where the health effects of PM(10) are well documented. However, the pollution mix, seasonality, and demographics are different from those in developed Western countries. It is important, therefore, to determine whether the large metropolitan area of Bangkok is subject to similar effects of PM(10). OBJECTIVES: This study was designed to investigate the mortality risk from air pollution in Bangkok, Thailand. METHODS: The study period extended from 1999 to 2003, for which the Ministry of Public Health provided the mortality data. Measures of air pollution were derived from air monitoring stations, and information on temperature and relative humidity was obtained from the weather station in central Bangkok. The statistical analysis followed the common protocol for the multicity PAPA (Public Health and Air Pollution Project in Asia) project in using a natural cubic spline model with smooths of time and weather. RESULTS: The excess risk for non-accidental mortality was 1.3% [95% confidence interval (CI), 0.8-1.7] per 10 microg/m(3) of PM(10), with higher excess risks for cardiovascular and above age 65 mortality of 1.9% (95% CI, 0.8-3.0) and 1.5% (95% CI, 0.9-2.1), respectively. In addition, the effects from PM(10) appear to be consistent in multipollutant models. CONCLUSIONS: The results suggest strong associations between several different mortality outcomes and PM(10). In many cases, the effect estimates were higher than those typically reported in Western industrialized nations.

Public Health and Air Pollution in Asia (PAPA): a multicity study of short-term effects of air pollution on mortality.

BACKGROUND AND OBJECTIVES: Although the deleterious effects of air pollution from fossil fuel combustion have been demonstrated in many Western nations, fewer studies have been conducted in Asia. The Public Health and Air Pollution in Asia (PAPA) project assessed the effects of short-term exposure to air pollution on daily mortality in Bangkok, Thailand, and in three cities in China: Hong Kong, Shanghai, and Wuhan. METHODS: Poisson regression models incorporating natural spline smoothing functions were used to adjust for seasonality and other time-varying covariates that might confound the association between air pollution and mortality. Effect estimates were determined for each city and then for the cities combined using a random effects method. RESULTS: In individual cities, associations were detected between most of the pollutants [nitrogen dioxide, sulfur dioxide, particulate matter < or = 10 microm in aerodynamic diameter (PM(10)), and ozone] and most health outcomes under study (i.e., all natural-cause, cardiovascular, and respiratory mortality). The city-combined effects of the four pollutants tended to be equal or greater than those identified in studies conducted in Western industrial nations. In addition, residents of Asian cities are likely to have higher exposures to air pollution than those in Western industrial nations because they spend more time outdoors and less time in air conditioning. CONCLUSIONS: Although the social and environmental conditions may be quite different, it is reasonable to apply estimates derived from previous health effect of air pollution studies in the West to Asia.

Factors affecting decision making of low-income young women with unplanned pregnancies in Bangkok, Thailand.

Unplanned pregnancy is one of the most difficult life experiences for young women. Women are often confused and seek help and support. When the problem occurs, a woman has three choices: parenting the baby, planning for adoption, or terminating the pregnancy. Choosing one of these three options is often difficult. This study aimed to identify the factors (variables) influencing women's decision making when choosing the options available to them. The study was conducted in five shelters and low-income communities in the Bangkok area. Data were collected for five months, November 2003 to March 2004. Young women, age 13-24, who experienced an unplanned pregnancy at least once, or currently experiencing an unplanned pregnancy, were recruited into the study. One hundred and twenty volunteer cases were recruited. Discriminant analysis was used to determine the factors that affecting the choices of young women with unplanned pregnancies. There were 6 potential influencing variables, in three broad categories of factors that influenced their choices. In this study, the influencing factors from the personal history variables were, age of the most recent unplanned pregnancy. The individual psychosocial variables were: attitude towards unplanned pregnancy, attitude towards contraception, and making a decision without consultation. The relationship variables were: relationship with partner, and consulting partner when having a problem. The results from discriminant analysis yielded 68.3% predictive accuracy. This result was satisfactory compared with a 33% chance of accuracy (classified as chance alone would yield a 33% accuracy). Knowing the influencing factors for the choices of young women with unplanned pregnancies allows us to understand the women's decisions and their utilization of services with some degree of confidence. The program managers or implementers should do as much as possible to support the decision making process in these young women in order to provide better information and services to reduce the impact, both physical and mental, of the selected choice.

Heterogeneity of daily pulmonary function in response to air pollution among asthmatic children.

Several epidemiological studies have demonstrated the association of short-term exposure to air pollution with transient declines in pulmonary function. Although the magnitudes of declines in pulmonary function found in these studies are relatively small, the effects vary among children. This study examined whether the variation is evidence of biological heterogeneity or due to random variation by analyzing data from a panel study of 83 asthmatic school children exposed to SO2 and PM10 in the Mae Moh district of Thailand. Daily pulmonary function testing was performed on the children for 61 days. General linear mixed models were used to examine and test for the null hypothesis of no variation in the subject-specific slopes of pulmonary functions in response to the air pollutants. The individual daily pulmonary functions measured were FVC, FEV1, PEFR, and FEF(25-75%). These were used as an outcome to compare with air pollutant concentrations as random effects, adjusting for height, gender, time, and temperature. The results indicate evidence of inter-individual variation for subject-specific changes in FVC, FEV1, and PEFR due to the effects of SO2 and PM10 on children. In conclusion, even at low concentrations of daily SO2 and PM10 in the study area, there is evidence of a heterogeneous response to short-term exposure to SO2 and PM10 in children.

Acute effect of sulphur dioxide from a power plant on pulmonary function of children, Thailand.

BACKGROUND: Epidemiological studies have shown reversible declines of lung function in response to air pollution, but research on the independent effect of short-term exposure to ambient sulphur dioxide (SO2) on pulmonary function is limited. This study evaluated the association of short-term exposure to increased ambient SO2 and daily pulmonary function changes among children with and without asthma. METHODS: The associations of daily exposure to SO2 and particulate matter 10 microm in diameter (PM10) with pulmonary function were examined in 175 asthmatic and non-asthmatic children aged 6-14 years who resided near a coal-fired power plant in Thailand. Each child performed daily pulmonary function tests during the 61-day study period. General linear mixed models were used to estimate the association of air pollution and pulmonary function controlling for time, temperature, co-pollutants, and autocorrelation. RESULTS: In the asthmatic children, a daily increase in SO2 was associated with negligible declines in pulmonary function, but a small negative association was found between PM10 and pulmonary function. A 10-microg/m(3) increment was associated with changes in the highest forced vital capacity (FVC) (-6.3 ml, 95% CI: -9.8, -2.8), forced expiratory volume at 1 second (FEV(1)) (-6.0 ml, 95% CI: -9.2, 2.7), peak expiratory flow rate (PEFR) (-18.9 ml.sec(-1), 95% CI: -28.5, -9.3) and forced expiratory flow 25 to 75% of the FVC (FEF(25-75%)) (-3.7 ml.sec(-1), 95% CI: -10.9, 3.5). No consistent associations between air pollution and pulmonary function were found for non-asthmatic children. CONCLUSION: Declines in pulmonary function among asthmatic children were associated with increases in particulate air pollution, rather than with increases in SO2.

Acute effects of SO2 and particles from a power plant on respiratory symptoms of children, Thailand.

Epidemiological studies to evaluate the acute effects of ambient SO2 on the respiratory health of children provide inconclusive results. A panel study to examine the association of short-term exposure to ambient SO2 and respiratory symptoms of 196 children for a period of 107 days was conducted in Thailand. Generalized Estimating Equations were used to examine the association of daily variation of air pollution with daily respiratory symptoms. During the study period, SO2 was not associated with respiratory symptoms in either asthmatics or non-asthmatics, whereas a 10 microg/m3 increase in PM10 was modestly associated with increases of lower respiratory symptom incidence (OR=1.03, 95%CI=0.98, 1.09) and cough (OR=1.04, 95% CI=1.00, 1.08) in asthmatics. At the low ambient air pollution concentrations observed, particulate matter rather than SO2 was associated on a microg/m3 basis with acute daily respiratory symptoms.

The Impact of Particulate Matter on Daily Mortality in Bangkok, Thailand.

Several studies conducted in U.S. cities report an association between acute exposures to particulate matter (PM), usually measured as PM10, and mortality. Evidence of high concentrations of PM10 in Eastern Europe and in large metropolitan areas outside of the United States, such as Mexico City and Bangkok, underscores the need to determine whether these same associations occur outside of the United States. In addition, conducting studies of mortality and air pollution in regions that have distinctly different seasonal patterns than those of the United States provides an effective opportunity to assess the potentially confounding aspects of seasonality. Over the last few years, daily measures of ambient PM10 have been collected in Bangkok, a tropical city of over 6 million people. In this metropolitan area, PM10 consists largely of fine particles generated from diesel- and gasoline-powered automobiles, and from two-stroke motorcycle engines. Our analysis involved the examination of the relationship between PM10 and daily mortality for 1992 through 1995. In addition to counts of daily natural mortality (total mortality net of accidents, homicides, and suicides), the data were compiled to assess both cardiovascular and respiratory mortality, and natural mortality by age group. A multivariate Poisson regression model was used to explain daily mortality while controlling for several covariates including temperature, humidity, day of the week, season, and time. The analysis indicated a statistically significant association between PM10 and all of the alternative measures of mortality. The results suggest a 10-µg/m3 change in daily PM10 is associated with a 1-2% increase in natural mortality, a 1-2% increase in cardiovascular mortality, and a 3-6% increase in respiratory mortality. These relative risks are generally consistent with or greater than those reported in most studies undertaken in the United States.