title: Establishing integrated rural-urban cohorts to assess air pollution-related health effects in pregnant women, children and adults in Southern India: an overview of objectives, design and methods in the Tamil Nadu Air Pollution and Health Effects (TAPHE) study.
abstract: BACKGROUND
  In rapidly developing countries such as India, the ubiquity of air pollution sources in urban and rural communities often results in ambient and household exposures significantly in excess of health-based air quality guidelines. Few efforts, however, have been directed at establishing quantitative exposure-response relationships in such settings. We describe study protocols for The Tamil Nadu Air Pollution and Health Effects (TAPHE) study, which aims to examine the association between fine particulate matter (PM2.5) exposures and select maternal, child and adult health outcomes in integrated rural-urban cohorts.
  
  
  METHODS
  The TAPHE study is organised into five component studies with participants drawn from a pregnant mother-child cohort and an adult cohort (n=1200 participants in each cohort). Exposures are assessed through serial measurements of 24-48 h PM2.5 area concentrations in household microenvironments together with ambient measurements and time-activity recalls, allowing exposure reconstructions. Generalised additive models will be developed to examine the association between PM2.5 exposures, maternal (birth weight), child (acute respiratory infections) and adult (chronic respiratory symptoms and lung function) health outcomes while adjusting for multiple covariates. In addition, exposure models are being developed to predict PM2.5 exposures in relation to household and community level variables as well as to explore inter-relationships between household concentrations of PM2.5 and air toxics. Finally, a bio-repository of peripheral and cord blood samples is being created to explore the role of gene-environment interactions in follow-up studies.
  
  
  BACKGROUND
  The study protocols have been approved by the Institutional Ethics Committee of Sri Ramachandra University, the host institution for the investigators in this study. Study results will be widely disseminated through peer-reviewed publications and scientific presentations. In addition, policy-relevant recommendations are also being planned to inform ongoing national air quality action plans concerning ambient and household air pollution.
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Sankar
authors.initials: S
authors.lastname: Sambandam
authors.affiliation: Department of Physiology, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Padmavathi
authors.initials: P
authors.lastname: Ramaswamy
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Santu
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Human Genetics, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Vettriselvi
authors.initials: V
authors.lastname: Venkatesan
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Gurusamy
authors.initials: G
authors.lastname: Thangavel
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Krishnendu
authors.initials: K
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Physiology, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Department of Human Genetics, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Solomon
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Puttaswamy
authors.affiliation: Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, Delhi, India.
authors.forename: Rupinder S
authors.initials: RS
authors.lastname: Dhaliwal
authors.affiliation: Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, Delhi, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Shukla
mesh_terms: D000293:Adolescent; D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis / Q000331:legislation & jurisprudence; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects* / Q000331:legislation & jurisprudence / Q000517:prevention & control; D004784:Environmental Monitoring; D005260:Female; D005500:Follow-Up Studies; D059647:Gene-Environment Interaction; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000009:adverse effects* / Q000032:analysis; D011050:Policy Making; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000517:prevention & control; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012129:Respiratory Function Tests; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: India; air pollution; air toxics; cohorts; exposure-response; particulate matter