title: Improved air quality in reunified Germany and decreases in respiratory symptoms.
abstract: BACKGROUND
  Previous research on air pollution effects has found associations with chronic adverse health effects even at the relatively low levels of ambient particulates currently measured in most urban areas.
  
  
  METHODS
  We assessed the impact of declines of total suspended particulates and sulfur dioxide in eastern Germany after reunification on the prevalence of nonallergic respiratory disorders in children. In the 1990s, particle mass (total suspended particulates) and sulfur dioxide declined, whereas number concentrations of nucleation-mode particles (10-30 nm) increased. In three study areas, questionnaires for 7,632 children between 5 and 14 years of age were collected in three phases: 1992-1993, 1995-1996, and 1998-1999.
  
  
  RESULTS
  Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for a 50-microg/m3 increment in total suspended particulates were 3.0 (CI = 1.7-5.3) for bronchitis, 2.6 (CI = 1.0-6.6) for sinusitis, and 1.9 (CI = 1.2-3.1) for frequent colds. The effect sizes for a 100-microg/m3 increment in sulfur dioxide were similar. The effect estimates for ambient total suspended particulates and sulfur dioxide were stronger among children not exposed to gas stove emissions, visible molds or dampness, cats, or environmental tobacco smoke.
  
  
  CONCLUSIONS
  The decreasing prevalence of nonallergic respiratory symptoms, along with improvements in ambient particle mass and sulfur dioxide (but not in nucleation-mode particles), indicates the reversibility of adverse health effects in children. This adds further evidence of a causal association between combustion-related air pollutants and childhood respiratory symptoms.
authors.affiliation: GSF, National Research Center for Environment and Health Institute for Epidemiology, PO Box 1129, D-85758 Oberschleissheim, Germany. Joachim.Heinrich@gsf.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoelscher
authors.forename: Christian
authors.initials: C
authors.lastname: Frye
authors.forename: Ines
authors.initials: I
authors.lastname: Meyer
authors.forename: Mike
authors.initials: M
authors.lastname: Pitz
authors.forename: Josef
authors.initials: J
authors.lastname: Cyrys
authors.forename: Matthias
authors.initials: M
authors.lastname: Wjst
authors.forename: Lucas
authors.initials: L
authors.lastname: Neas
authors.forename: H-Erich
authors.initials: HE
authors.lastname: Wichmann
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D010316:Particle Size; D011056:Political Systems; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology*; D013458:Sulfur Dioxide / Q000009:adverse effects* / Q000032:analysis; D011795:Surveys and Questionnaires; D014504:Urban Health
chemical_list: D000393:Air Pollutants; D013458:Sulfur Dioxide