title: The effects of outdoor air pollution on the respiratory health of Canadian children: A systematic review of epidemiological studies.
abstract: BACKGROUND
  Outdoor air pollution is a global problem with serious effects on human health, and children are considered to be highly susceptible to the effects of air pollution.
  
  
  OBJECTIVE
  To conduct a comprehensive and updated systematic review of the literature reporting the effects of outdoor air pollution on the respiratory health of children in Canada.
  
  
  METHODS
  Searches of four electronic databases between January 2004 and November 2014 were conducted to identify epidemiological studies evaluating the effect of exposure to outdoor air pollutants on respiratory symptoms, lung function measurements and the use of health services due to respiratory conditions in Canadian children. The selection process and quality assessment, using the Newcastle-Ottawa Scale, were conducted independently by two reviewers.
  
  
  RESULTS
  Twenty-seven studies that were heterogeneous with regard to study design, population, respiratory outcome and air pollution exposure were identified. Overall, the included studies reported adverse effects of outdoor air pollution at concentrations that were below Canadian and United States standards. Heterogeneous effects of air pollutants were reported according to city, sex, socioeconomic status and seasonality. The present review also describes trends in research related to the effect of air pollution on Canadian children over the past 25 years.
  
  
  CONCLUSIONS
  The present study reconfirms the adverse effects of outdoor air pollution on the respiratory health of children in Canada. It will help researchers, clinicians and environmental health authorities identify the available evidence of the adverse effect of outdoor air pollution, research gaps and the limitations for further research.
authors.forename: Laura Andrea
authors.initials: LA
authors.lastname: Rodriguez-Villamizar
authors.forename: Adam
authors.initials: A
authors.lastname: Magico
authors.forename: Alvaro
authors.initials: A
authors.lastname: Osornio-Vargas
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D002648:Child; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000393:Air Pollutants