title: A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework.
abstract: The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.
authors.affiliation: Depts of Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Thurston
authors.affiliation: Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Kipen
authors.affiliation: Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Université Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France.
authors.forename: Isabella
authors.initials: I
authors.lastname: Annesi-Maesano
authors.affiliation: Dept of Medicine, University of California, San Francisco, CA, USA.|School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Balmes
authors.affiliation: Dept of Cardiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.affiliation: Marron Institute of Urban Management, New York University, New York, NY, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cromar
authors.affiliation: Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: De Matteis
authors.affiliation: Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.affiliation: Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.affiliation: Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Frampton
authors.affiliation: Centre for Genomics and Child Health, Queen Mary University of London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grigg
authors.affiliation: Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.affiliation: National Institute for Health Research Health Protection Unit: Health Impact of Environmental Hazards, King's College London, London, UK.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Kelly
authors.affiliation: Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Nino
authors.initials: N
authors.lastname: Kuenzli
authors.affiliation: Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Laumbach
authors.affiliation: Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt Institute of Epidemiology II, Neuherberg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Sanjay T
authors.initials: ST
authors.lastname: Rajagopalan
authors.affiliation: Depts of Public Health Sciences and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rich
authors.affiliation: Center for Occupational and Environmental Health, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
authors.affiliation: Dept of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Samet
authors.affiliation: Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sandstrom
authors.affiliation: University of Aarhus, Institute of Public Health, Aarhus, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: CREAL (Center for Research on Environmental Epidemiology, Barcelona), Pompeu Fabra University, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands b.brunekreef@uu.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000009:adverse effects*; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
chemical_list: D000393:Air Pollutants; D015415:Biomarkers