Accepted Manuscript Effect of Poverty on the Relationship between Personal Exposures and Ambient Concentrations of air pollutants in Ho Chi Minh City Sumi Mehta, Hind Sbihi, Tuan Nguyen Dinh, Dan Vu Xuan, Loan Le Thi Thanh, Canh Truong Thanh, Giang Le Truong, Aaron Cohen, Michael Brauer PII: S1352-2310(14)00532-9 DOI: 10.1016/j.atmosenv.2014.07.011 Reference: AEA 13097 To appear in: Atmospheric Environment Received Date: 15 April 2014 Revised Date: 30 June 2014 Accepted Date: July 2014 Please cite this article as: Mehta, S., Sbihi, H., Dinh, T.N., Xuan, D.V., Le Thi Thanh, L., Thanh, C.T., Le Truong, G., Cohen, A., Brauer, M., Effect of Poverty on the Relationship between Personal Exposures and Ambient Concentrations of air pollutants in Ho Chi Minh City, Atmospheric Environment (2014), doi: 10.1016/j.atmosenv.2014.07.011 This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain ACCEPTED MANUSCRIPT Effect of Poverty on the Relationship between Personal Exposures and Ambient Concentrations of air pollutants in Ho Chi Minh City RI PT Sumi Mehta1, Hind Sbihi2, Tuan Nguyen Dinh3, Dan Vu Xuan4 , Loan Le Thi Thanh5, Canh Truong Thanh6 , Giang Le Truong7, Aaron Cohen1, Michael Brauer2 Health Effects Institute, Boston.MA, USA School of Population and Public Health, University of British Columbia, Vancouver M AN U Canada SC Ho Chi Minh City Environmental Protection Agency (HEPA); Institute for Environment and Resources (IER) The National University Of Ho Chi Minh City, Vietnam Center for Occupational and Environmental Health, Vietnam Ho Chi Minh City Bureau of Statistics, Vietnam Ho Chi Minh City University of Science, Vietnam EP TE D Department of Public Health, Vietnam AC C Corresponding Author: Hind Sbihi School of Population and Public Health, 2206 East Mall Vancouver, BC V6T 1Z2 Canada hind.sbihi@ubc.ca ACCEPTED MANUSCRIPT Abstract: Socioeconomic factors often affect the distribution of exposure to air pollution The relationships between health, air pollution, and poverty potentially have important public health and policy implications, especially in areas of Asia where air pollution levels are high and income disparity is large The objective of the study was to characterize the levels, determinants of exposure, and relationships between children personal exposures and ambient concentrations of multiple air pollutants amongst different socioeconomic segments of the population of Ho Chi Minh City, Vietnam Using repeated (N=9) measures personal exposure monitoring and determinants of exposure modeling, we compared daily average PM2.5, PM10, PM2.5 absorbance and NO2 concentrations measured at ambient monitoring sites to measures of personal exposures for (N=64) caregivers of young children from high RI PT and low socioeconomic groups in two districts (urban and peri-urban), across two seasons Personal 11 exposures for both PM sizes were significantly higher among the poor compared to non-poor participants 12 in each district Absolute levels of personal exposures were under-represented by ambient monitors with 13 median individual longitudinal correlations between personal exposures and ambient concentrations of 14 0.4 for NO2, 0.6 for PM2.5 and PM10 and 0.7 for absorbance Exposures of the non-poor were more highly 15 correlated with ambient concentrations for both PM size fractions and absorbance while those for NO2 16 were not significantly affected by socioeconomic position Determinants of exposure modeling indicated 17 the importance of ventilation quality, time spent in the kitchen, air conditioner use and season as 18 important determinant of exposure that are not fully captured by the differences in socioeconomic 19 position Our results underscore the need to evaluate how socioeconomic position affects exposure to air 20 pollution Here, differential exposure to major sources of pollution, further influenced by characteristics 21 of Ho Chi Minh City’s rapidly urbanizing landscape, resulted in systematically higher PM exposures 22 among the poor M AN U TE D EP AC C 23 SC 10 ACCEPTED MANUSCRIPT 24 Introduction Asia is undergoing significant economic development, population growth, and urbanization with 26 subsequent industrialization and growth in vehicle fleets leading to increased emissions of air pollutants 27 and shifts in environmental risks (HEI International Scientific 2010) As a result, large populations in 28 rapidly developing economies of Asia are exposed to high concentrations of air pollution These 29 exposures, coupled with ageing populations and increasing burden of chronic diseases, have led to 30 substantial population health impacts from air pollution The recent Global Burden of Disease estimated 31 over 2.1 million premature deaths and 52 million years of healthy life lost in Asia from ambient fine 32 particle air pollution in 2010, 2/3 of the worldwide burden In Southeast Asia, the region which includes 33 Vietnam, outdoor air pollution was estimated to contribute to 712,000 deaths in 2010 (Lim et al 2012; 34 Wang et al 2012) SC RI PT 25 M AN U 35 The public health and social policy implications of the relationships between health, air pollution, and 37 socioeconomic position are likely to be important in Asia, where air pollution levels are high and many 38 still live in poverty Despite what appears to be a similar magnitude of population risk for a given level of 39 exposure to air pollution (Wong et al 2010, 2008) there is still a lack of evidence about exposure sources 40 and determinants in urban Asia compared to North American and Europe Economic deprivation has been 41 shown to increase the rates of morbidity and mortality related to air pollution in Europe and North 42 America (Finkelstein et al 2005; Laurent et al 2007) , and socioeconomic status dictates the vulnerability 43 of population to environmental risks via factors such as nutritional status and access to medical services 44 In Asia where large income disparities are more prevalent than in many high-income countries, results of 45 Western studies cannot merely be extrapolated Variation in socioeconomic status within Asian 46 populations could impact exposures differently than in developed countries, particularly for determinants 47 related to urban planning (residential location, proximity to traffic and small-scale industries), as well as 48 lifestyle and time activity patterns Exposure to indoor combustion sources in the Asian context (for 49 example from incense use and cooking) also differ from those in the European and North American 50 settings (HEI International Scientific 2010; Le et al 2012; Smith et al 2000) EP AC C 51 TE D 36 52 Studies of personal exposure conducted in developed countries indicate that for time series studies of the 53 effect of daily change in air pollution levels, central monitoring sites are adequate surrogates for 54 longitudinal changes in exposures (Janssen et al 1998, 2005; Sarnat et al 2000) To date no studies of 55 this type have been conducted in many of the poorer Southeast Asian countries, such as Laos, Cambodia, ACCEPTED MANUSCRIPT 56 and Vietnam While it is possible to apply existing studies from developed countries to help tailor air 57 quality management strategies, there is a need to assess the extent to which localized sources, time 58 activity patterns, and socioeconomic position may contribute to exposure estimation in the Asian context RI PT 59 Under an initiative of the Asian Development Bank, an interdisciplinary collaboration between local and 61 international experts launched assessed the health effect of air pollution and the role of poverty in Ho Chi 62 Minh City (HCMC), Vietnam An epidemiologic study was conducted to evaluate the impact of air 63 pollution on childhood respiratory infections (children