vvEPA
United States                              March 2008
|ng™mental Protection	EPA/600/R-07/093bB
            Annexes for the
            Integrated Science Assessment
            for Oxides of Nitrogen -
            Health Criteria
            (Second External Review Draft)

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                                               EPA/600/R-07/093bB
                                                    March 2008
              Annexes for the
     Integrated Science Assessment
for Oxides of Nitrogen - Health Criteria
     National Center for Environmental Assessment-RTF Division
            Office of Research and Development
            U.S. Environmental Protection Agency
               Research Triangle Park, NC

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                                   DISCLAIMER
       This document is a first external review draft being released for review purposes only and
does not constitute U.S. Environmental Protection Agency (EPA) policy. Mention of trade
names or commercial products does not constitute endorsement or recommendation for use.
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          Annexes for the Integrated Science Assessment
              for Oxides of Nitrogen - Health Criteria
                       ANNEX CHAPTERS
AXl.   CHAPTER 1 ANNEX - FRAMEWORK FOR REVIEW	AX1-1
AX2.   CHAPTER 2 ANNEX - ATMOSPHERIC CHEMISTRY OF NITROGEN
      AND SULFUR OXIDES	AX2-1
AX3.   CHAPTER 3 ANNEX - AMBIENT CONCENTRATIONS AND
      EXPOSURES	AX3-1
AX4.   CHAPTER 4 ANNEX - TOXICOLOGICAL EFFECTS OF NITROGEN
      DIOXIDE AND RELATED OXIDES OF NITROGEN	AX4-1
AX5.   CHAPTER 5 ANNEX - CONTROLLED HUMAN EXPOSURE STUDIES
      OF NITROGEN OXIDES	AX5-1
AX6.   CHAPTER 6 ANNEX - EPIDEMIOLOGICAL STUDIES OF HUMAN
      HEALTH EFFECTS ASSOCIATED WITH AMBIENT OXIDES OF
      NITROGEN EXPOSURE	AX6-1
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                           Annex Table of Contents
AX1.   CHAPTER 1 ANNEX - FRAMEWORK FOR REVIEW	AX1-1
        AX1.1   LEGISLATIVE REQUIREMENTS	AX1-2
        AX1.2   HISTORY OF REVIEWS OF THE PRIMARY NAAQS FORNO2.... AX1-4
        AX1.3   LITERATURE SELECTION	AX1-5
        AX1.4   EVALUATION GUIDELINES	AX1-9
               AX1.4.1   Background on Causality Decision Framework	AX1-9
               AX1.4.2   Approaches to the Determination of Causality	AX1-11
        AX1.5   REFERENCES	AX1-47

AX2.   CHAPTER 2 ANNEX - ATMOSPHERIC CHEMISTRY OF NITROGEN
       AND SULFUR OXIDES	AX2-1
        AX2.1   INTRODUCTION	AX2-1
        AX2.2   CHEMISTRY OF NITROGEN OXIDES IN THE TROPOSPHERE.. AX2-2
               AX2.2.1   Basic Chemistry	AX2-2
               AX2.2.2   Nonlinear Relations between Nitrogen Oxide
                        Concentrations and Ozone Formation	AX2-9
               AX2.2.3   Multiphase Chemistry Involving NOX	AX2-13
        AX2.3   CHEMISTRY OF SULFUR OXIDES IN THE TROPOSPHERE	AX2-24
        AX2.4   MECHANISMS FOR THE AQUEOUS PHASE FORMATION
               OF SULFATE AND NITRATE	AX2-28
        AX2.5   TRANSPORT OF NITROGEN AND SULFUR OXIDES IN
               THE ATMOSPHERE	AX2-31
        AX2.6   SOURCES AND EMISSIONS OF NITROGEN OXIDES,
               AMMONIA, AND SULFUR DIOXIDE	AX2-35
               AX2.6.1   Interactions of Nitrogen Oxides with the Biosphere	AX2-35
               AX2.6.2   Emissions of NOX, NH3, and SO2	AX2-49
               AX2.6.3   Field Studies Evaluating Emissions Inventories	AX2-56
        AX2.7   METHODS USED TO CALCULATE CONCENTRATIONS OF
               NITROGEN OXIDES AND THEIR CHEMICAL INTERACTIONS
               IN THE ATMOSPHERE	AX2-58
               AX2.7.1   Chemistry-Transport Models	AX2-59
               AX2.7.2   CTM Evaluation	AX2-74
        AX2.8   SAMPLING AND ANALYSIS OF NITROGEN AND
               SULFUR OXIDES	AX2-87
               AX2.8.1   Availability and Accuracy of Ambient Measurements
                        forNOY	AX2-87
               AX2.8.2   Measurements of HNO3	AX2-94
               AX2.8.3   Techniques for Measuring Other NOy Species	AX2-96
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                            Annex Table of Contents
                                   (cont'd)
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                AX2.8.4  Remote Sensing of Tropospheric NO2 Columns for
                         Surface NOx Emissions and Surface NO2
                         Concentrations	AX2-96
                AX2.8.5  SAMPLING AND ANALYSIS FOR SO2	AX2-98
                AX2.8.6  Sampling and Analysis for Sulfate, Nitrate, and
                         Ammonium	AX2-102
        AX2.9   POLICY RELEVANT BACKGROUND CONCENTRATIONS
                OF NITROGEN AND SULFUR OXIDES	AX2-110
        AX2.10  REFERENCES	AX2-127

AX3.   CHAPTER 3 ANNEX - AMBIENT CONCENTRATIONS
       AND EXPOSURES	AX3-1
        AX3.1   INTRODUCTION	AX3-1
        AX3.2   AMBIENT CONCENTRATIONS OF NITROGEN OXIDES
                AND RELATED SPECIES	AX3-2
                AX3.2.1  Spatial and Temporal Variability in Ambient
                         Concentrations of NO2 and Related Species in
                         Urban Areas	AX3-4
                AX3.2.2  Temporal Variability in Nitrogen Oxides	AX3-7
                AX3.2.4  Relationships between NO2 and Other Pollutants	AX3-20
                AX3.2.5  Abundance of NOY Species	AX3-23
        AX3.3   METHODS FOR MEASURING PERSONAL AND INDOOR
                NO2 CONCENTRATIONS	AX3-30
                AX3.3.1  Issues in Measuring Personal/Indoor NO2	AX3-30
        AX3.4   NITROGEN OXIDES IN INDOOR AIR	AX3-40
                AX3.4.1  Indoor Sources and Concentrations of Nitrogen
                         Oxides	AX3-40
                AX3.4.2  Reactions of NO2 in Indoor Air	AX3-47
                AX3.4.3  Contributions from Outdoor NO2	AX3-53
        AX3.5   PERSONAL EXPOSURE	AX3-55
                AX3.5.1  Personal Exposures and Ambient (Outdoor)
                         Concentrations	AX3-57
                AX3.5.2  Personal Exposure in Microenvironments	AX3-67
                AX3.5.3  Exposure Indicators	AX3-83
        AX3.6   CONFOUNDING AND SURROGATE IS SUES	AX3-85
        AX3.7   A FRAMEWORK FOR MODELING HUMAN EXPOSURES
                TO NO2 AND RELATED PHOTOCHEMICAL AIR
                POLLUTANTS	AX3-94
                AX3.7.1  Introduction: Concepts, Terminology, and Overall
                         Summary	AX3-94
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                            Annex Table of Contents
                                    (cont'd)
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                AX3.7.2  Population Exposure Models: Their Evolution and
                         Current Status	AX3-100
                AX3.7.3  Characterization of Ambient Concentrations of NO2
                         and Related Air Pollutants	AX3-103
                AX3.7.4  Characterization of Microenvironmental
                         Concentrations	AX3-106
                AX3.7.5  Concluding Comments	AX3-114
        AX3.8   EXPOSURE ERROR	AX3-115
        AX3.9   REFERENCES	AX3-170

AX4.    CHAPTER 4 ANNEX - TOXICOLOGICAL EFFECTS OF NITROGEN
        DIOXIDE AND RELATED OXIDES OF NITROGEN	AX4-1
        AX4.1   PULMONARY EFFECTS OF NITROGEN DIOXIDE AND
                RELATED OXIDES OF NITROGEN	AX4-1
                AX4.1.1  Effects of Nitrogen Dioxide on Antioxidant and
                         Antioxidant Metabolism	AX4-1
                AX4.1.2  Lipid Metabolism and Content of the Lung	AX4-3
                AX4.1.3  Emphysema Following Nitrogen Dioxide Exposure	AX4-5
                AX4.1.4  Nitrates (NO3 )	AX4-6
        AX4.2   DOSIMETRY OF INHALED NITROGEN OXIDES	AX4-7
                AX4.2.1  Mechanisms of NO2 Absorption	AX4-8
                AX4.2.2  Regional and Total Respiratory Absorption of NO2	AX4-11
        AX4.3   EXPERIMENTAL STUDIES OF NO2 UPTAKE	AX4-13
                AX4.3.1  Upper Respiratory Tract Absorption	AX4-14
                AX4.3.2  Lower Respiratory Tract Absorption	AX4-14
                AX4.3.3  Total Respiratory  Tract Absorption	AX4-15
        AX4.4   METABOLISM, DISTRIBUTION AND ELIMINATION OF
                NO2 PRODUCTS	AX4-15
        AX4.5   EXTRA-PULMONARY EFFECTS OF NO2 AND NO	AX4-17
                AX4.5.1  Body Weight, Hepatic, and Renal Effects	AX4-17
                AX4.5.2  Brain Effects	AX4-18
                AX4.5.3  NO	AX4-18
        AX4.6   EFFECTS OF MIXTURES CONTAINING NO2	AX4-19
                AX4.6.1  Simple Mixtures Containing NO2	AX4-19
                AX4.6.2  Complex Mixtures Containing NO2	AX4-21
        AX4.7   REFERENCES	AX4-68

AX5.    CHAPTER 5 ANNEX - CONTROLLED HUMAN EXPOSURE STUDIES
        OF NITROGEN OXIDES	AX5-1
        AX5.1   INTRODUCTION	AX5-1
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                            Annex Table of Contents
                                   (cont'd)
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                AX5.1.1   Considerations in Controlled Human Exposure Studies	AX5-2
        AX5.2   EFFECTS OF NITROGEN DIOXIDE IN HEALTHY SUBJECTS .... AX5-4
        AX5.3   THE EFFECTS OF NITROGEN OXIDE EXPOSURE IN
                SENSITIVE SUBJECTS	AX5-4
        AX5.4   EFFECTS OF MIXTURES CONTAINING NITROGEN OXIDES .... AX5-5
        AX5.5   REFERENCES	AX5-16

AX6.   CHAPTER 6 ANNEX - EPIDEMIOLOGICAL STUDIES OF HUMAN
       HEALTH EFFECTS ASSOCIATED WITH AMBIENT OXIDES OF
       NITROGEN EXPOSURE	AX6-1
        AX6.1   CONSIDERATIONS IN THE INTERPRETATION OF
                EPIDEMIOLOGIC STUDIES OF OXIDES OF NITROGEN
                HEALTH EFFECTS	AX6-1
                AX6.1.1   Exposure Assessment and Measurement Error in
                         Epidemiologic Studies and Related Surrogate
                         Discussion	AX6-2
                AX6.1.2   NO2 Exposure Indices Used	AX6-7
                AX6.1.3   Lag Time: Period between NO2 Exposure and
                         Observed Health Effect	AX6-8
                AX6.1.4   Model Specification to Adjust for Temporal Trends
                         and Meteorological Effects	AX6-9
                AX6.1.5   Confounding Effects of Copollutants	AX6-10
                AX6.1.6   Generalized Estimating Equations (GEE)	AX6-11
                AX6.1.7   Hypothesis Testing and Model Selection in NO2
                         Epidemiologic Studies	AX6-11
                AX6.1.8   Impact of Generalized Additive Models Convergence
                         Issue onNO2 Risk Estimates	AX6-12
        AX6.2   CARDIOVASCULAR EFFECTS ASSOCIATED WITH
                SHORT-TERM NO2 EXPOSURE	AX6-13
                AX6.2.1   Studies Hospital Admissions and ED Visits for
                         Cardiovascular Disease (CVD)	AX6-13
                AX6.2.2   Heart Rate Variability, Repolarization, Arrhythmia,
                         and Other Measures Cardiovascular Function
                         Associated with Short-Term NO2 Exposure	AX6-22
        AX6.4   REFERENCES	AX6-194
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                                 Annex List of Figures
Number
AX1.3-1.     Selection process for studies included in ISA	AX1-6
AX1.4-1.     Focusing on unmeasured confounders/covariates, or other
             sources of spurious association from bias	AX1-21
AX1.4-2.     Example posterior distribution for the determination of Sufficient	AX1 -21
AX1.4-3.     Example posterior distribution for the determination of Equipoise
             and Above	AX1-22
AX1.4-4.     Example posterior distribution for the determination of Against	AX1 -23
AX2.2-1.     Schematic diagram of the cycle of reactive nitrogen species
             in the atmosphere	AX2-3
AX2.2-2.     Measured values of O3 and NOZ (NOY - NOX) during the afternoon
             at rural sites in the eastern United States (gray circles) and in urban
             areas and urban plumes associated with Nashville, TN (gray dashes),
             Paris, FR (black diamonds) and Los Angeles, CA (X's)	AX2-12
AX2.2-3.     Structures of nitro-polycyclic aromatic hydrocarbons	AX2-16
AX2.2-4.     Formation of 2-nitropyrene (2NP) from the reaction of OH with
             gaseous pyrene (PY)	AX2-17
AX2.3-1.     Transformations of sulfur compounds in the atmosphere	AX2-26
AX2.4-1.     Comparison of aqueous-phase oxidation paths	AX2-30
AX2.6-1.     Diel cycles of median concentrations (upper panels) and fluxes
             (lower panels) for the Northwest clean sector,  left panels) and
             Southwest (polluted sector, right panels) wind sectors at Harvard
             Forest, April-November, 2000, for NO, NO2, and O3/10. NO and
             O3 were sampled at a height of 29 m, andNO2 at 22m	AX2-43
AX2.6-2.     Simple NOX photochemical canopy model outputs	AX2-44
AX2.6-3.     Hourly (dots) and median nightly (pluses) NO2 flux vs. concentration,
             with results of least-squares fit on the hourly data (curve)	AX2-45
AX2.6-4.     Averaged profiles at Harvard Forest give some evidence of some
             NO2 input near the canopy top from light-mediated ambient reactions,
             or emission from open stomates	AX2-46
AX2.6-5.     Summer (June-August) 2000 median concentrations (upper panels),
             fractions of NOy (middle  panels), and fluxes (lower panels) of NOy
             and component species separated by wind direction (Northwest on the
             left and Southwest on the right)	AX2-48
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                                Annex List of Figures
                                       (cont'd)
Number
                                                                                  age
AX2.7-1.     Scatter plot of total nitrate (HNO3 plus aerosol nitrate) wet deposition
             (mg(N)m2yr~1) of the mean model versus measurements for the North
             American Deposition Program (NADP) network	AX2-71
AX2.7-2.     Same as Figure AX2.7-1 but for sulfate wet deposition
             (mg^m'V1)	AX2-72
AX2.7-3a,b.  Impact of model uncertainty on control strategy predictions for O3 for
             two days (August lOa and lib, 1992) in Atlanta, GA	AX2-77
AX2.7-4.     Ozone isopleths (ppb) as a function of the average emission rate for
             NOx and VOC (1012 molec. cm"2 s"1) in zero dimensional box model
             calculation	AX2-78
AX2.7-5a.    Time series for measured gas-phase species in comparison with
             results from a photochemical model	AX2-79
AX2.7-5b.    Time series for measured gas-phase species in comparison with
             results from a photochemical model	AX2-80
AX2.7-6.     Correlations for O3 versus NOz (NOy-NOx) in ppb from chemical
             transport models for the northeast corridor,  Lake Michigan, Nashville,
             the San Joaquin Valley, and Los Angeles	AX2-82
AX.7-7a,b.   Evaluation of model versus measured O3 versus NOy for two model
             scenarios for Atlanta	AX2-83
AX2.7-8a,b.  Evaluation of model versus: (a) measured O3  versus NOz and
             (b) O3 versus the sum 2H2O2 + NOZ for Nashville, TN	AX2-85
AX2.7-9.     Time series of concentrations of RO2, HO2, and OH radicals, local
             O3 photochemical production rate and concentrations of NOx from
             measurements made during BERLIOZ	AX2-86
AX2.8-1.     Tropospheric NO2 columns (molecules NO2/ cm2) retrieved from the
             SCIAMACHY satellite instrument for 2004-2005	AX2-97
AX2.9-1.     Annual mean  concentrations of NO2 (ppbv) in surface air over the
             United States  in the present-day (upper panel) and policy relevant
             background (middle panel) MOZART-2 simulations	AX2-112
AX2.9-2.     Same as Figure AX2.9-1 but for SO2 concentrations	AX2-113
AX2.9-3.     Same as for Figure AX2.9-1 but for wet and dry deposition of
             HNO3, NH4NO3, NOX, HO2NO2, and organic  nitrates
             (mgNm'V1)	AX2-114
AX2.9-4.     Same as Figure AX2.9-1 but for SOX deposition (SO2 + SO4)
              mSnr1	AX2-115
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                                 Annex List of Figures
                                       (cont'd)

Number                                                                          Page

AX2.9-5.     July mean soil NO emissions (upper panels; 1 x 10 9 molecules
             cm"2 s1) and surface PRB NOx concentrations (lower panels; pptv)
             over the United States from MOZART-2 (left) and GEOS-Chem
             (right) model simulations in which anthropogenic Os precursor
             emissions were  set to zero in North America	AX2-116
AX3.2-1.     Location of ambient NO2 monitors in the United States	AX3-3
AX3.2-2.     NC>2 concentrations measured at 4 m (Van) and  at 15 m at NY
             Department of Environmental Conservation sites (DEC709406
             and DEC709407)	AX3-7
AX3.2-4a-e.  Time  series of 24-h average NO2 concentrations at
             individual sites in New York City from 2003 through 2006	AX3-10
AX3.2-5a-e.  Time  series of 24-h average NO2 concentrations at individual sites
             in Atlanta, GA from 2003 through 2005	AX3-11
AX3.2-6a-g.  Time  series of 24-h average NC>2 concentrations at individual sites
             in Chicago, IL from 2003 through 2005	AX3-12
AX3.2-7a-b.  Time  series of 24-h average NC>2 concentrations at individual sites
             in Baton Rouge, LA from 2003 through 2005	AX3-13
AX3.2-8a-g.  Time  series of 24-h average NC>2 concentrations at individual sites
             in Houston, TX from 2003 through 2005	AX3-14
AX3.2-9a-h.  Time  series of 24-h average NC>2 concentrations at individual sites in
             Los Angeles, CAfrom 2003 through 2005	AX3-15
AX3.2-9i-n.  Time  series of 24-h average NC>2 concentrations at individual sites in
             Los Angeles, CA from 2003 through 2006	AX3-16
AX3.2-10a-d. Time  series of 24-h average NC>2 concentrations at individual sites in
             Riverside, CA from 2003 through 2006	AX3-17
AX3.2-10e-i. Time  series of 24-h average NC>2 concentrations at individual sites in
             Riverside, CA from 2003 through 2006	AX3-18
AX3.2-11.    Nationwide trends in annual meanNO2 concentrations	AX3-19
AX3.2-12.    Trends in annual meanNO2 concentrations by site type	AX3-19
AX3.2-13a-d. Correlations of NC>2 to 63 vs. correlations of NC>2 to CO for
             Los Angeles, CA (2001-2005)	AX3-22
AX3.2-14.    Relationship between 63, NO, and NO2 as a function of NOx
             concentration	AX3-23
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                                 Annex List of Figures
                                        (cont'd)

Number                                                                            Page


AX3.2-15.    Variation of odd oxygen (= O3 + NO2) with NOX	AX3-24
AX3.2-16a-d. Measured Os (ppbv) versus PAN (pptv) in Tennessee, including
             (a) aircraft measurements, and (b, c, and d) suburban sites
             near Nashville	AX3-26
AX3.2-17.    Relationship between benzene and NOy at a measurement site in
             Boulder, CO	AX3-27
AX3.2-18.    Ratios of PAN to NO2 observed at Silwood Park, Ascot, Berkshire,
             U.K. from July 24 to August 12 1999	AX3-28
AX3.2-20.    Concentrations of particulate nitrate measures as part of the
             Environmental Protection Agency PA's speciation network	AX3-30
AX3.4-1.     Percentage of time people spend in different environments	AX3-42
AX3.5-1.     Average residential outdoor concentration versus concentration
             during commuting forNO2	AX3-77
AX3.7-1.     Schematic description of a general framework identifying the processes
             (steps or components) involved in assessing inhalation exposures
             and doses for individuals and populations	AX3-97
AX3.8-1.     Errors associated with components of the continuum from ambient air
             pollution to adverse health outcome	AX3-116
AX3.8-2.     A systematic approach to evaluate whether NO2 itself is causing
             the observed adverse health outcome orNO2 is acting as a surrogate
             for other pollutants	AX3-120
AX6.2-1.     Relative risks (95% CI) for associations of 24-h NO2 (per 20 ppb) and
             daily 1 hour maximum NO2* with hospitalizations or emergency
             department visits for all cardiovascular diseases (CVD)	AX6-14
AX6.2-2.     Relative risks (95% CI) for associations of 24-h NO2 (per 20 ppb) and
             daily 1 hour maximum NO2* (per 30 ppb) with hospitalizations for
             Ischemic Heart Disease (MD)	AX6-15
AX6.2-3.     Relative risks (95% CI) for associations between 24-h NO2 (per 20 ppb)
             and hospitalizations for myocardial infarction (MI)	AX6-17
AX6.2-4.     Relative risks (95% CI) for associations of 24-h NO2 (per 20 ppb) and
             1-hour maximum NO2* with hospitalizations for congestive heart
             failure (CHF). Primary author and year of publication, city, stratification
             variable(s), and lag are listed.  Results for lags 0 or 1 are presented
             as available	AX6-18
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                                Annex List of Figures
                                       (cont'd)

Number                                                                         Page

AX6.2-5.     Relative risks (95% CI) for associations of 24-h NO2 exposure (per
             20 ppb) and daily 1-hour maximum NO2* (per 30 ppb) with
             hospitalizations or emergency department visits for CVD:  Studies with
             2 pollutant model results	AX6-20
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                                 Annex List of Tables
Number

AX1.3-1.     Literature Search Strategy for Epidemiologic Studies:
             Examples of Keywords	AX1-46
AX1.3-2.     Literature Search Strategy for The Atmospheric Sciences	AX1-46
AX2.3-1.     Atmospheric Lifetimes of Sulfur Dioxide and Reduced Sulfur
             Species with Respect to Reaction With OH, NO3, and Cl Radicals	AX2-120
AX2.4-la.    Relative Contributions of Various Reactions to the Total S(IV)
             Oxidation Rate within a Sunlit Cloud, 10 Minutes after
             Cloud Formation	AX2-120
AX2.4-lb.    Relative Contributions of Various Gas and Aqueous Phase Reactions
             to Aqueous Nitrate Formation within a Sunlit Cloud, 10 Minutes after
             Cloud Formation	AX2-121
AX2.6-1.     Emissions of Nitrogen Oxides, Ammonia, and Sulfur Dioxide in the
             United States in 2002	AX2-122
AX2.8-1.     Satellite Instruments Used to Retrieve Tropospheric NO2 Columns	AX2-126
AX3.2-1.     Summary of Percentiles of NO2  Data Pooled Across Monitoring
             Sites (2003-2005) Concentrations are in ppm	AX3-121
AX3.2-2.     Spatial Variability of NO2 in Selected United states Urban Areas	AX3-122
AX3.2-3.     NOX and NOY Concentrations at Regional Background Sites in the
             Eastern United States. Concentrations are GIVEN in ppb	AX3-122
AX3.2-4.     Range of Pearson Correlation Coefficients Between NO2 and O3,
             COandPM2.5	AX3-123
AX3.3-1.     Passive Samplers Used inNO2 Measurements	AX3-124
AX3.3-2.     The Performance of Sampler/Sampling Method for NO2
             Measurements in the Air	AX3-125
AX3.4-1.     NO2 Concentrations (ppb) in Homes in Latrobe Valley, Victoria,
             Australia	AX3-126
AX3.4-2.     NO2 Concentrations (ppb) in Homes in Connecticut	AX3-126
AX3.4-3.     NO2 Concentrations Near Indoor Sources - Short-Term Averages	AX3-127
AX3.4-4.     NO2 Concentrations Near Indoor Sources - Long-Term Averages	AX3-128
AX3.5-1.     Summary of Regression Models of Personal Exposure to
             Ambient/Outdoor NO2	AX3-129
AX3.5-2.     Average Ambient and Nonambient Contributions to
             Population Exposure	AX3-130
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                                 Annex List of Tables
                                       (cont'd)
Number                                                                          Page

AX3.5-3.     The Association Between Personal Exposures and Ambient
             Concentrations	AX3-131
AX3.5-4.     Indoor/Outdoor Ratio and the Indoor vs. Outdoor Regression Slope	AX3-134
AX3.5-5.     NO2 Concentrations (ppb) in Different Rooms	AX3-141
AX3.5-6.     Indoor and Outdoor Contributions to Indoor Concentrations	AX3-143
AX3.5-7.     The Association Between Indoor, Outdoor, and Personal NO2	AX3-145
AX3.5-9.     Personal NO2 Levels Stratified by Demographic and Socioeconomic
             Factors (Concentrations are in ppb and Slopes are Dimensionless)	AX3-164
AX3.6-1.     Correlations (Pearson Correlation Coefficient) Between Ambient NO2
             and Ambient Copollutants	AX3-165
AX3.6-2.     Correlations (Pearson Correlation Coefficient) Between Personal NO2
             and Personal Copollutants	AX3-166
AX3.6-3.     Correlations (Pearson Correlation Coefficient) Between Personal NO2
             and Ambient Copollutants	AX3-167
AX3.6-4.     Correlations (Pearson Correlation Coefficient) Between Ambient NO2
             and Personal Copollutants	AX3-168
AX3.7-1.     The Essential Attributes of the pNEM, HAPEM, APEX, SHEDS, and
             MENTOR-1A	AX3-169
AX4.1.       Effects of Nitrogen Dioxide on Oxidant and Antioxidant Homeostasis	AX4-22
AX4.2.       Effects of Nitrogen Dioxide on Lung Amino Acids, Proteins,
             Lipids, and Enzymes	AX4-25
AX4.3.       Effects of Nitrogen Dioxide on Alveolar Macrophages and
             Lung Host Defense	AX4-31
AX4.4.       Effects of Nitrogen Dioxide on Lung Permeability and Inflammation	AX4-38
AX4.5.       Effects of Nitrogen Dioxide on Immune Responses	AX4-43
AX4.6.       Effect of Nitrogen Dioxide  on Susceptibility to Infectious Agents	AX4-49
AX4.7.       Effects of Nitrogen Dioxide on Lung Structure	AX4-56
AX4.8.       Effects of Nitrogen Dioxide on Pulmonary Function	AX4-62
AX4.9.       Effect of Nitrogen Dioxide  on Hematological Parameters	AX4-63
AX4.10.      Effects of Nitric Oxide on Iron, Enzymes, and Nucleic Acids	AX4-65
AX4.11 A.    Genotoxicity of Nitrogen Dioxide In Vitro and In Plants	AX4-66
March 2008
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                                 Annex List of Tables
                                       (cont'd)
Number
                                                                                   age
AX4.11B.    Genoticity of Nitrogen Dioxide In Vivo	AX4-67
AX4.11C.    Genotoxicity of Nitric Oxide	AX4-67
AX5.2-1.     Clinical Studies of NO2 Exposure in Healthy Subjects	AX5-6
AX5.3-1.     Effects of NO2 Exposure in Subjects with Respiratory Disease
             (see Table AX5.3-2 for Studies with Allergen Challenge)	AX5-11
AX5.3-2.     Effects of NO2 Exposure on Response to Inhaled Allergen	AX5-12
AX5.4-1.     Effects of Exposure to NO2 with Other Pollutants	AX5-14
AX6.3-1.     Studies Examining Exposure to Indoor NO2 and Respiratory Symptoms... AX6-29
AX6.3-2.     Studies Examining Exposure to Ambient NO2 and Acute Respiratory
             Symptoms Using Generalized Estimating Equations (GEE) in the
             Analysis Method	AX6-32
AX6.3-3.     Respiratory Health Effects of Oxides of Nitrogen: Hospital Admissions.. AX6-35
AX6.3-4.     Respiratory Health Effects of Oxides of Nitrogen: Emergency
             Department Visits	AX6-81
AX6.3-5.     Respiratory Health Effects of Oxides of Nitrogen: General
             Practitioner/Clinic Visits	AX6-104
AX6.3-6.     Human Health Effects of Oxides of Nitrogen: CVD Hospital
             Admissions and Visits: United States and Canada	AX6-110
AX6.3-7.     Human Health Effects of Oxides of Nitrogen: CVD Hospital
             Admissions and Visits: Australia and New Zealand	AX6-125
AX6.3-8.     Human Health Effects of Oxides of Nitrogen: CVD Hospital
             Admissions and Visits: Europe	AX6-130
AX6.3-9.     Human Health Effects of Oxides of Nitrogen: CVD Hospital
             Admissions and Visits: Asia	AX6-141
AX6.3-10.    Studies Examining Exposure to Ambient NO2 and Heart Rate
             Variability as Measured by Standard Deviation of Normal-to-Normal
             Intervals (SDNN)	AX6-147
AX6.3-11.    Studies Examining Exposure to Ambient NO2 and Heart Rate Variability
             as Measured by Variables Recorded on Implantable Cardioverter
             Defibrillators (ICDs)	AX6-148
AX6.3-12.    Birth Weight and Long-Term NO2 Exposure Studies	AX6-149
AX6.3-13.    Preterm Delivery and Long-Term NO2 Exposure Studies	AX6-153
AX6.3-14.    Fetal Growth and Long-Term NO2 Exposure Studies	AX6-155
March 2008
                                          xv
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Number

AX6.3-15.
AX6.3-16.
AX6.3-17.
AX6.3-18.
AX6.3-19.

AX6.3-20.
                                Annex List of Tables
                                     (cont'd)
                                                                  age
Lung Function and Long-Term NO2 Exposure	AX6-156
Asthma and Long-Term NO2 Exposure	AX6-158
Respiratory Symptoms and Long-Term NO2 Exposure	AX6-162
Lung Cancer	AX6-169
Effects of Acute NOX Exposure on Mortality. Risk Estimates are
Standardized for per 20 ppb 24-h AVG NO2 Increment	AX6-170
NO2 Exposure Affects Asthmatics	AX6-192
March 2008
                                        xvi
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                     Authors, Contributors, and Reviewers
Authors

Dr. Dennis J. Kotchmar (NOx Team Leader)—National Center for Environmental Assessment
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Mary Ross (Branch Chief)—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Kathleen Belanger, Yale University, Epidemiology and Public Health, 60 College Street,
New Haven, CT 06510-3210

Dr. James S. Brown—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Douglas Bryant—Cantox Environmental Inc., 1900 Minnesota Court, Mississauga, Ontario
L8S IPS

Dr. Ila Cote—National Center for Environmental Assessment (B243-01), U.S. Environmental
Protection Agency, Research Triangle Park, NC 27711

Dr. Mark Frampton—Strong Memorial Hospital, 601 Elmwood Ave., Box 692, Rochester, NY
14642-8692

Dr. Janneane Gent—Yale University, CPPEE, One Church Street, 6th Floor, New Haven, CT
06510

Dr. Vic Hasselblad—Duke University, 29 Autumn Woods Drive, Durham, NC 27713

Dr. Kazuhiko Ito—New York University School of Medicine, 57 Old Forge Road, Tuxedo, NY
10987

Dr. Jee Young Kim—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Ellen Kirrane—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Thomas Long—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Thomas Luben—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
March 2008                              xvii        DRAFT-DO NOT QUOTE OR CITE

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                     Authors, Contributors, and Reviewers
                                       (cont'd)
Authors
(cont'd)

Dr. Andrew Maier—Toxicology Excellence for Risk Assessment, 2300 Montana Avenue,
Suite 409, Cincinnati, OH 45211

Dr. Qingyu Meng—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Joseph Pinto—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Paul Reinhart—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. David Svendsgaard—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Lori White—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
Contributors

Dr. Dale Allen, University of Maryland, College Park, MD

Dr. Jeffrey Arnold—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Barbara Buckley—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Louise Camalier, U.S. EPA, OAQPS, Research Triangle Park, NC

Ms. Rebecca Daniels, MSPH—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Russell Dickerson, University of Maryland, College Park, MD

Dr. Tina Fan, EOHSI/UMDNJ, Piscataway, NJ

Dr. Arlene Fiore, NOAA/GFDL, Princeton, NJ
March 2008                              xviii       DRAFT-DO NOT QUOTE OR CITE

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                      Authors, Contributors, and Reviewers
                                       (cont'd)
Contributors
(cont'd)

Dr. Panos Georgopoulos, EOHSI/UMDNJ, Piscataway, NJ

Dr. Larry Horowitz, NOAA/GFDL, Princeton, NJ

Dr. William Keene, University of Virginia, Charlottesville, VA

Dr. Randall Martin, Dalhousie University, Halifax, Nova Scotia

Dr. Maria Morandi, University of Texas, Houston, TX

Dr. William Munger, Harvard University, Cambridge, MA

Mr. Charles Piety, University of Maryland, College Park, MD

Dr. Jason Sacks—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Sandy Sillman, University of Michigan, Ann Arbor, MI

Dr. Jeffrey Stehr, University of Maryland, College Park, MD

Dr. Helen Suh, Harvard University, Boston, MA

Ms. Debra Walsh—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Charles Wechsler, EOHSI/UMDNJ, Piscataway, NJ

Dr. Clifford Weisel, EOHSI/UMDNJ, Piscataway, NJ

Dr. Jim Zhang, EOHSI/UMDNJ, Piscataway, NJ


Reviewers

Dr. Tina Bahadori—American Chemistry Council,  1300 Wilson Boulevard, Arlington, VA
22209
March 2008                               xix         DRAFT-DO NOT QUOTE OR CITE

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                      Authors, Contributors, and Reviewers
                                       (cont'd)
Reviewers
(cont'd)

Dr. Tim Benner—Office of Science Policy, Office of Research and Development, Washington,
DC 20004

Dr. Daniel Costa—National Program Director for Air, Office of Research and Development,
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Robert Devlin—National Health and Environmental Effects Research Laboratory, Office of
Research and Development, U.S. Environmental Protection Agency, Chapel Hill, NC

Dr. Judy Graham—American Chemistry Council, LRI, 1300 Wilson Boulevard, Arlington, VA
22209

Dr. Stephen Graham—Office of Air and Radiation, U.S. Environmental Protection Agency,
Research Triangle Park, NC 27711

Ms. Beth Hassett-Sipple—U.S. Environmental Protection Agency (C504-06), Research Triangle
Park, NC 27711

Dr. Gary Hatch—National Health and Environmental Effects Research Laboratory, Office of
Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC
27711

Dr. Scott Jenkins—Office of Air Quality Planning and Standards, U.S. Environmental Protection
Agency (C504-02), Research Triangle Park, NC 27711

Dr. David Kryak—National Exposure Research Laboratory, Office of Research and
Development, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Mr. John Langstaff—U.S. Environmental Protection Agency  (C504-06), Research Triangle Park,
NC27711

Dr. Morton Lippmann—NYU School of Medicine, 57 Old Forge Road, Tuxedo, NY 10987

Dr. Thomas Long—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Karen Martin—Office of Air and Radiation, U.S. Environmental Protection Agency
(C504-06), Research Triangle Park, NC 27711
March 2008                               xx         DRAFT-DO NOT QUOTE OR CITE

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                     Authors, Contributors, and Reviewers
                                       (cont'd)
Reviewers
(cont'd)

Dr. William McDonnell—William F. McDonnell Consulting, 1207 Hillview Road, Chapel Hill,
NC27514

Dr. Dave McKee—Office of Air and Radiation/Office of Air Quality Planning and Standards,
U.S. Environmental Protection Agency (C504-06), Research Triangle Park, NC 27711

Dr. Lucas Neas—National Health and Environmental Effects Research Laboratory, Office of
Research and Development, U.S. Environmental Protection Agency, Chapel Hill, NC 27711

Dr. Russell Owen—National Health and Environmental Effects Research Laboratory, Office of
Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC
27711

Dr. Haluk Ozkaynak—National Exposure Research Laboratory, Office of Research and
Development, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Jennifer Peel—Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523-
1681

Mr. Harvey Richmond—Office of Air Quality Planning and Standards/Health and
Environmental Impacts Division, U.S. Environmental Protection Agency (C504-06), Research
Triangle Park, NC 27711

Mr. Joseph Somers—Office of Transportation and Air Quality, U.S. Environmental Protection
Agency, 2000 Traverwood Boulevard, Ann Arbor, MI 48105

Ms. Susan Stone—U.S. Environmental Protection Agency (C504-06), Research Triangle Park,
NC27711

Dr. John Vandenberg—National Center for Environmental Assessment (B243-01), Office of
Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC
27711

Dr. Alan Vette—National Exposure Research Laboratory, Office of Research and Development,
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Mr. Ron Williams—National Exposure Research Laboratory, Office of Research and
Development, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
March 2008                               xxi        DRAFT-DO NOT QUOTE OR CITE

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                     Authors, Contributors, and Reviewers
                                     (cont'd)
Reviewers
(cont'd)

Dr. William Wilson—Office of Research and Development, National Center for Environmental
Assessment (B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC
27711
March 2008                             xxii       DRAFT-DO NOT QUOTE OR CITE

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             U.S. Environmental Protection Agency Project Team
              for Development of Integrated Scientific Assessment
                              for Oxides of Nitrogen
Executive Direction

Dr. Ila Cote (Acting Director)—National Center for Environmental Assessment-RTF Division,
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Debra Walsh (Deputy Director)—National Center for Environmental Assessment-RTF
Division, (B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
Scientific Staff

Dr. Dennis Kotchmar (NOX Team Leader)—National Center for Environmental Assessment
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Jeff Arnold—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. James S. Brown—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Barbara Buckley—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Rebecca Daniels—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Jee Young Kim—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Ellen Kirrane—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Tom Long—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Thomas Luben—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Qingyu Meng—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
March 2008                              xxiii        DRAFT-DO NOT QUOTE OR CITE

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              U.S. Environmental Protection Agency Project Team
              for Development of Integrated Scientific Assessment
                              for Oxides of Nitrogen
                                      (cont'd)
Scientific Staff
(cont'd)

Dr. Joseph Pinto—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Paul Reinhart—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Mary Ross—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Jason Sacks—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. David Svendsgaard—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. Lori White—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Dr. William Wilson—National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
Technical Support Staff

Ms. Ella King—Executive Secretary, National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Emily R. Lee—Management Analyst, National Center for Environmental Assessment
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Ellen F. Lorang—Information Manager, National Center for Environmental Assessment
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711

Ms. Christine Searles—Management Analyst, National Center for Environmental Assessment
(B243-01), U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
March 2008                              xxiv       DRAFT-DO NOT QUOTE OR CITE

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              U.S. Environmental Protection Agency Project Team
              for Development of Integrated Scientific Assessment
                              for Oxides of Nitrogen
                                       (cont'd)
Technical Support Staff
(cont'd)

Mr. Richard Wilson—Clerk, National Center for Environmental Assessment (B243-01),
U.S. Environmental Protection Agency, Research Triangle Park, NC 27711
Document Production Staff

Ms. Barbra H. Schwartz—Task Order Manager, Computer Sciences Corporation,
2803 Slater Road, Suite 220, Morrisville, NC 27560

Mr. John A. Bennett—Technical Information Specialist, Library Associates of Maryland,
11820 Parklawn Drive, Suite 400, Rockville, MD 20852

Mr. David Casson—Publication/Graphics Specialist, TekSystems, 1201 Edwards Mill Road,
Suite 201, Raleigh, NC 27607

Mrs. Melissa Cesar—Publication/Graphics Specialist, Computer Sciences Corporation,
2803 Slater Road, Suite 220, Morrisville, NC 27560

Mr. Eric Ellis—Records Management Technician, InfoPro, Inc., 8200 Greensboro Drive, Suite
1450, McLean, VA 22102

Ms. Kristin Hamilton—Publication/Graphics Specialist, TekSystems, 1201 Edwards Mill Road,
Suite 201, Raleigh, NC 27607

Ms. Stephanie Harper—Publication/Graphics Specialist, TekSystems, 1201 Edwards Mill Road,
Suite 201, Raleigh, NC 27607

Ms. Sandra L. Hughey—Technical Information Specialist, Library Associates of Maryland,
11820 Parklawn Drive, Suite 400, Rockville, MD 20852

Dr. Barbara Liljequist—Technical Editor, Computer Sciences Corporation, 2803 Slater Road,
Suite 220, Morrisville, NC 27560

Ms. Molly Windsor—Graphic Artist, Computer Sciences Corporation, 2803 Slater Road,
Suite 220, Morrisville, NC 27560
March 2008                              xxv       DRAFT-DO NOT QUOTE OR CITE

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                     U.S. Environmental Protection Agency
                         Science Advisory Board (SAB)
        Staff Office Clean Air Scientific Advisory Committee (CASAC)
             CASAC NOX and SOX Primary NAAQS Review Panel
Chair
Dr. Rogene Henderson*, Scientist Emeritus, Lovelace Respiratory Research Institute,
Albuquerque, NM

Members

Mr. Ed Avol, Professor, Preventive Medicine, Keck School of Medicine, University of Southern
California, Los Angeles, CA

Dr. John R. Balmes, Professor, Department of Medicine, Division of Occupational and
Environmental Medicine, University of California, San Francisco, CA

Dr. Ellis Cowling*, University Distinguished Professor At-Large, North Carolina State
University, Colleges of Natural Resources and Agriculture and Life Sciences, North Carolina
State University, Raleigh, NC

Dr. James D. Crapo [M.D.]*, Professor, Department of Medicine, National Jewish Medical and
Research Center, Denver, CO

Dr. Douglas Crawford-Brown*, Director, Carolina Environmental Program; Professor,
Environmental Sciences and Engineering;  and Professor, Public Policy, Department of
Environmental Sciences and Engineering,  University of North Carolina at Chapel Hill, Chapel
Hill, NC

Dr. Terry Gordon, Professor, Environmental Medicine, NYU School of Medicine, Tuxedo, NY

Dr. Dale Hattis, Research Professor, Center for Technology, Environment, and Development,
George Perkins Marsh Institute, Clark University, Worcester, MA

Dr. Patrick Kinney, Associate Professor,  Department of Environmental Health Sciences,
Mailman School of Public Health, Columbia University, New York, NY

Dr. Steven Kleeberger, Professor, Laboratory Chief, Laboratory of Respiratory Biology,
NIH/NIEHS, Research Triangle Park, NC

Dr Timothy Larson, Professor, Department of Civil and Environmental Engineering, University
of Washington, Seattle, WA
March 2008                              xxvi        DRAFT-DO NOT QUOTE OR CITE

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                     U.S. Environmental Protection Agency
                         Science Advisory Board (SAB)
        Staff Office Clean Air Scientific Advisory Committee (CASAC)
             CASAC NOX and SOX Primary NAAQS Review Panel
                                      (cont'd)

Members
(cont'd)

Dr. Kent Pinkerton, Professor, Regents of the University of California, Center for Health and
the Environment, University of California, Davis, CA

Mr. Richard L. Poirot*, Environmental Analyst, Air Pollution Control Division, Department of
Environmental Conservation, Vermont Agency of Natural Resources, Waterbury, VT

Dr. Edward Postlethwait, Professor and Chair, Department of Environmental Health Sciences,
School of Public Health, University of Alabama at Birmingham, Birmingham, AL

Dr. Armistead (Ted) Russell*, Georgia Power Distinguished Professor of Environmental
Engineering, Environmental Engineering Group, School of Civil and Environmental
Engineering, Georgia Institute  of Technology, Atlanta, GA

Dr. Richard Schlesinger, Associate Dean, Department of Biology, Dyson College, Pace
University, New York, NY

Dr. Christian Seigneur, Vice  President, Atmospheric and Environmental Research, Inc., San
Ramon, CA

Dr. Elizabeth A. (Lianne) Sheppard, Research Professor, Biostatistics and Environmental &
Occupational Health Sciences, Public Health and Community Medicine, University of
Washington, Seattle, WA

Dr. Frank Speizer [M.D.]*, Edward Kass Professor of Medicine, Channing Laboratory,
Harvard Medical School, Boston, MA

Dr. George Thurston, Associate Professor, Environmental Medicine, NYU School of Medicine,
New York University, Tuxedo, NY

Dr. James Ultman, Professor, Chemical Engineering, Bioengineering Program, Pennsylvania
State University, University Park, PA

Dr. Ronald Wyzga, Technical Executive, Air Quality Health and Risk, Electric Power Research
Institute, P.O. Box 10412, Palo Alto, CA
March 2008                             xxvii        DRAFT-DO NOT QUOTE OR CITE

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                    U.S. Environmental Protection Agency
                        Science Advisory Board (SAB)
        Staff Office Clean Air Scientific Advisory Committee (CASAC)
             CASAC NOX and SOX Primary NAAQS Review Panel
                                    (cont'd)


SCIENCE ADVISORY BOARD STAFF

Dr. Angela Nugent, CASAC Designated Federal Officer, 1200 Pennsylvania Avenue, N.W.,
Washington, DC, 20460, Phone: 202-343-9981, Fax: 202-233-0643 (nugent.angela@epa.gov)
(Physical/Courier/FedEx Address: Angela Nugent, Ph.D, EPA Science Advisory Board Staff
Office (Mail Code 1400F), Woodies Building, 1025 F Street, N.W., Room 3614, Washington,
DC 20004, Telephone: 202-343-9981)

* Members of the statutory Clean Air Scientific Advisory Committee (CASAC) appointed by the EPA
 Administrator
March 2008                           xxviii      DRAFT-DO NOT QUOTE OR CITE

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                       Annex Abbreviations and Acronyms
 a

 ACS
 ADP
 a;
 AIRE
 AM
 APEX
 APHEA
 AQCD
 AQS
 ATS
 BAL
 BALF
 BHPN
 BHR
 Br
 Cx T
 Ca++
 CAA
 CALINE4
 CAMP
 CAPS
 CAPs
 CARS
 CASAC
 CC16
 CDC
 CHAD
 CHF
 CHS
 CI
 CMAQ
 CO
 C02
 COD
brackets signifying concentration(s)
alpha; the ratio of a person's exposure to a pollutant of ambient
origin to the pollutant's ambient concentration
American Cancer Society
adenosine dinucleotide phosphate
air exchange rate for microenvironment /'
Asma Infantile Ricerca (Italian study)
alveolar macrophage
Air Pollution Exposure (model)
Air Pollution on Health: a European Approach (study)
Air Quality Criteria Document
Air Quality System (database)
American Thoracic Society
bronchoalveolar lavage
bronchoalveolar lavage fluid
7V-bis(2-hydroxyl-propyl)nitrosamine
bronchial hyperresponsiveness
bromine
concentration x time; concentration times duration of exposure
calcium ion
Clean Air Act
California line  source dispersion (model)
Childhood Asthma Management Program
cavity attenuated phase shift (monitor)
concentrated ambient particles
California Air Resources Board
Clean Air Scientific Advisory Committee
Clara cell 16-kDa protein
Centers for Disease Control and Prevention
Consolidated Human Activity Database
congestive heart failure
Children's Health Study
confidence interval
Community Multiscale Air Quality (model)
carbon monoxide
carbon dioxide
coefficient of divergence
March 2008
                                        XXIX
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 CoH
 COPD
 CRP
 CTM
 CVD
 DEPcCBP
 DHHS
 DMA
 DMN
 DNA
 DOAS
 Ea
 EC
 ECP
 ED
 ELF
 Ena
 EPA
 EPO
 ER
 ETS
 FEF25
 FEF75
 F£NO
 FEVo.s
 FEVi
 Finfi
 FRM
 FVC
 GAM
 GEE
 GEOS-CHEM

 GIS
 GM-CSF
 GSH
 GST
 H+
 HCHO
 HDL
coefficient of haze
chronic obstructive pulmonary disease
C-reactive protein
Chemistry-transport model
cardiovascular disease
diesel exhaust particulates extract-coated carbon black particles
U.S. Department of Health and Human Services
dimethylamine
dimethylnitrosamine
deoxyribonucleic acid
differential optical absorption spectroscopy
a person's exposure to pollutants of ambient origin
elemental carbon
eosinophil cationic protein
emergency department
epithelial lining fluid
a person's exposure to pollutants that are not of ambient origin
U.S. Environmental Protection Agency
eosinophil peroxidase
emergency room
environmental tobacco smoke
forced expiratory flow at 25% of vital capacity
forced expiratory flow at 25 to 75% of vital capacity
forced expiratory flow at 75% of vital capacity
fractional exhaled nitric oxide
forced expiratory volume in 0.5 second
forced expiratory volume in 1 second
the infiltration factor for microenvironment /'
Federal Reference Method
forced vital capacity
Generalized Additive Model(s)
generalized estimating equation(s)
three-dimensional, global model of atmospheric chemistry driven by
assimilated Goddard Earth Orbiting System observations
Geographic Information System
granulocyte-macrophage colony stimulating factor
glutathione
glutathione S-transferase (e.g., GSTM1, GSTP1, GSTT1)
hydrogen ion
formaldehyde
high-density  lipoprotein cholesterol
March 2008
                                         XXX
                            DRAFT-DO NOT QUOTE OR CITE

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 HNO3
 HNO4
 HONO
 HR
 HRV
 HS
 H2SO4
 hv
 ICAM-1
 ICD, ICD9
 id
 Ig
 fflD
 IIASA
 IL
 He
 IN
 IOM
 IQR
 IS
 ISA
 ISAAC
 ki
 LDH
 LIF
 LOESS
 LRD
 LT
 MEF25
 MEF50
 MEF75
 MENTOR
 MI
 MMEF
 MoOx
 MOZART
 MPO
 MPP
 MSA
 N
 n
nitric acid
pernitric acid
nitrous acid
heart rate
heart rate variability
hemorrhagic stroke
sulfuric acid
solar ultraviolet proton
intercellular adhesion molecule-1
International Classification of Diseases, Ninth Revision
identification
immunoglobulin (e.g., IgA, IgE, IgG)
ischemic heart disease
International Institute for Applied Systems Analysis
interleukin (e.g., IL-6, IL-8)
isoleucine
inorganic particulate species
Institute of Medicine
interquartile range
ischemic stroke
Integrated Science Assessment
International Study of Asthma and Allergies in Children
pollutant specific decay rate in microenvironment /'
lactate dehydrogenase
laser-induced fluorescence
locally estimated smoothing splines
lower respiratory disease
leukotriene (e.g., LTB4, LTC4, LTD4, LTE4)
maximal expiratory flow at 25%
maximal expiratory flow at 50%
maximal expiratory flow at 75%
Modeling Environment for Total Risk
myocardial infarction
maximal midexpiratory flow
molybdenum oxide
Model for Ozone and Related Chemical Tracers
myeloperoxidase
multiphase processes
metropolitan statistical area
nitrogen
number of observations
March 2008
                                         XXXI
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 Na+
 NAAQS
 NaAsO2
 NAL
 NAMS
 NAS
 NCo.oi-o.io

 NCHS
 NCICAS
 NDMA
 NEI
 NERL
 2NF
 NHAPS
 NHIS
 NHX
 NK
 NLCS
 NMMAPS
 NMOR
 NN
 NO
 NO2
 NO2
 NO3
 NO3
 NOX
 NOY
 NOZ

 NOAANCEP

 1NP
 2NP
 NR,N/R
 NRC
 NSA
 03
 oc
 OH
sodium ion
National Ambient Air Quality Standards
sodium arsenite
nasal lavage
National Air Monitoring Stations
National Academy of Sciences
particle number concentration for particle aerodynamic diameter
between 10 and 100 nm
National Center for Health Statistics
National Cooperative Inner-City Asthma Study
7V-nitrosodimethylamine
National Emissions Inventory
National Exposure Research Laboratory
2-nitrofluoranthene
National Human Activity Pattern Survey
National Health Interview Survey
reduced nitrogen compounds (NH3, NH4+)
natural killer (lymphocytes)
the Netherlands Cohort Study on Diet and Cancer
National Morbidity, Mortality, and Air Pollution Study
7V-nitrosomorpholine
nitronapthalene
nitric oxide
nitrogen dioxide
nitrite ion
nitrate radical
nitrate ion
sum of NO and NO2
sum of NOX and NOZ, total oxidized nitrogen
sum of all  inorganic and organic reaction products of NOX (HONO,
HNO3, HNO4, organic nitrates, particulate nitrate, nitro-PAHS, etc.)
U.S. National Oceanic and Atmospheric Administration's National
Center for Environmental Prediction
1-nitropyrene
2-nitropyrene
not reported
National Research Council
nitrosating agent
ozone
organic carbon
hydroxyl radical
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 OR
 OVA
 P,P
 P90
 PAARC
 PAF
 PAHs
 PAMS
 PAN
 PANs
 PaO2
 Pb
 PD20-FEVi
 PD100
 PEACE
 PEF
 PEFR
 Pi
 PIH
 PM
 PMiQ-2.5
 PM2.5
 PMN
 pN03
 POM
 ppb
 ppm
 ppt
 PRB
 PT
 PUFA
 R
 r
 R2
 RAPS
 RCS
 RONO2
odds ratio
ovalbumin
probability value
90th percentile
French air pollution and chronic respiratory diseases study
paroxysmal atrial fibrillation
polycyclic aromatic hydrocarbons
Photochemical Aerometric Monitoring System
peroxyacetyl nitrate
peroxyacyl nitrates
pressure of arterial  oxygen
lead
provocative dose that produces a 20% decrease in FEVi
provocative dose that produces a 100% increase in SRaw
Pollution Effects on Asthmatic Children in Europe (study)
peak expiratory flow
peak expiratory flow rate
pollutant specific penetration coefficient for microenvironment /
primary intracerebral  hemorrhage
particulate matter
particulate matter with an aerodynamic diameter of < lOjim
coarse particulate matter
fine particulate matter
polymorphonuclear leukocytes
particulate nitrate
particulate organic  matter
parts per billion (by volume)
parts per million (by volume)
parts per trillion (by volume)
Policy Relevant Background
prothombin time
polyunsaturated fatty  acids
intraclass correlation coefficient; organic radical
correlation coefficient
coefficient of determination
Pearson's correlation  coefficient
Spearman's rank correlation coefficient
Regional Air Pollution Study
random component superposition
organic nitrates
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 ROS
 RR
 RSV
 S
 SAPALDIA
 SAR
 SCE
 SD
 SE
 SEP
 SES
 SGA
 SHEDS
 SIDS
 SLAMS
 SO2
 SO42"
 SRaw
 STN
 T
 TEA
 Th2
 TNF
 TSP
 TVOCs
 TX
 UFP
 URI
 V
 Val
 VOCs
 VWF
 WBC
 Yi
reactive oxygen species
relative risk
respiratory syncytial virus
microenvironmental source strength
Study of Air Pollution and Lung Diseases in Adults
Site Audit Report
sister chromatid exchange
standard deviation
standard error
social-economic position
social-economic status
small for gestational age
Simulation of Human Exposure and Dose System
sudden infant death syndrome
State and Local Air Monitoring Stations
sulfur dioxide
sulfate ion
specific airways resistance
Speciation Trends Network
tau; atmospheric lifetime
triethanolamine
T-derived helper 2 lymphocyte
tumor necrosis factor (e.g., TNF-a)
total suspended particulates
total volatile organic compounds
thromboxane (e.g., TXA2, TXB2)
ultrafine particles; <0.1 jim diameter
upper respiratory infections
volume of the microenvironment
valine
volatile organic compounds
von Willibrand Factor
white blood cell
the fraction of time people spend in microenvironment /
the fraction of time people spend outdoors
Fisher's transform of the correlation coefficient
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 i         AX1.  CHAPTER 1 ANNEX - FRAMEWORK FOR
 2                                        REVIEW
 o
 4          The Integrated Science Assessment (ISA) presents a concise synthesis of the most policy-
 5    relevant science to form the scientific foundation for the review of the primary (health-based)
 6    National Ambient Air Quality Standards (NAAQS) for nitrogen dioxide (NO2) (U.S.
 7    Environmental Protection Agency, 2007).  The Annexes: (1) provide more details of the most
 8    pertinent scientific literature relative to the review of the NO2 NAAQS in the areas of
 9    atmospheric sciences, air quality analyses, exposure assessment, dosimetry, controlled human
10    exposure studies, toxicology, and epidemiology; and (2) focus on the  key policy relevant
11    questions and studies published since the last EPA review.
12          Annex 1 provides the legislative background and history of previous reviews of the
13    NAAQS for oxides of nitrogen. Annex 1 also includes more detailed information on the
14    methods used to identify and select studies, and on frameworks for evaluating scientific evidence
15    relative to causality determination. The overarching framework for evaluation of evidence for
16    causality used in the draft ISA is outlined in the introduction to that document, and this Annex
17    provides supporting information for that framework, including excerpts from decision
18    frameworks or criteria developed by other organizations.
19          Annex 2 presents evidence related to the physical and chemical processes controlling the
20    production, destruction, and levels of reactive nitrogen compounds in the atmosphere, including
21    both oxidized and reduced species.  Annex 3 presents information on  environmental
22    concentrations, patterns, and human exposure to ambient oxides of nitrogen; however, most
23    information relates to NO2. Annex 4 presents results from toxicological studies as well as
24    information on dosimetry of oxides of nitrogen. Annex 5 discusses results from controlled
25    human exposure studies, and Annex 6 presents evidence from epidemiologic studies. Finally,
26    Annex 7 is comprised of tables of the findings of epidemiologic studies of respiratory health
27    outcomes that also include descriptive statistics (e.g., mean, maximum) on the NO2 air quality
28    data used in the studies. These Annexes include more detailed information on health or exposure
29    studies that is summarized in tabular form, as well as more extensive discussion of atmospheric
30    chemistry,  source, exposure, and dosimetry information. Annex tables for health studies are
31    generally organized to include information about (1) concentrations of oxides of nitrogen levels

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 1    or doses and exposure times, (2) description of study methods employed, (3) results and
 2    comments, and (4) quantitative outcomes for oxides of nitrogen measures.
 3
 4
 5    AX1.1    LEGISLATIVE REQUIREMENTS
 6           Two sections of the Clean Air Act (CAA) govern the establishment and revision of the
 7    national ambient air quality standards (NAAQS). Section 108 (U.S. Code, 2003a) directs the
 8    Administrator to identify and list "air pollutants" that "in his judgment, may reasonably be
 9    anticipated to endanger public health and welfare" and whose "presence in the ambient air results
10    from numerous or diverse mobile or stationary sources" and to issue air quality criteria for those
11    that are listed. Air quality criteria are intended to "accurately reflect the latest scientific
12    knowledge useful in indicating the kind and extent of identifiable effects on public health or
13    welfare which may  be expected from the presence of [a] pollutant in ambient air."
14           Section 109 (U.S. Code, 2003b) directs the Administrator to propose and promulgate
15    "primary" and "secondary" NAAQS for pollutants listed under Section 108.  Section 109(b)(l)
16    defines a primary standard as one "the attainment and maintenance of which in the judgment of
17    the Administrator, based on  such criteria and allowing an adequate margin of safety, are requisite
18    to protect the public health."1  A secondary standard, as defined in Section 109(b)(2), must
19    "specify a level of air quality the attainment and maintenance of which, in the judgment of the
20    Administrator, based on such criteria, is required to protect the public welfare from any known
21    or anticipated adverse effects associated with the presence of [the] pollutant in the ambient air."2
22           The requirement that primary standards include an adequate margin of safety was
23    intended to address uncertainties associated with inconclusive scientific and technical
24    information available at the time of standard setting.  It was also intended to provide a reasonable
25    degree of protection against hazards that research has not yet identified. See Lead Industries
26    Association v. EPA, 647 F.2d 1130, 1154  (D.C.  Cir 1980), cert, denied, 449 U.S. 1042 (1980);
      1 The legislative history of Section 109 indicates that a primary standard is to be set at "the maximum permissible
       ambient air level ... which will protect the health of any [sensitive] group of the population" and that, for this
       purpose, "reference should be made to a representative sample of persons comprising the sensitive group rather
       than to a single person in such a group" [U.S.  Senate (1970)].
      2 Welfare effects as defined in Section 302(h) [U.S. Code, (2005)] include, but are not limited to, "effects on soils,
       water, crops, vegetation, man-made materials, animals, wildlife, weather, visibility and climate, damage to and
       deterioration of property, and hazards to transportation, as well as effects on economic values and on personal
       comfort and well-being."
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 1    American Petroleum Institute v. Costle, 665 F.2d 1176, 1186 (D.C. Cir. 1981), cert, denied, 455
 2    U.S. 1034(1982). Both kinds of uncertainties are components of the risk associated with
 3    pollution at levels below those at which human health effects can be said to occur with
 4    reasonable scientific certainty. Thus, in selecting primary standards that include an adequate
 5    margin of safety, the Administrator is seeking not only to prevent pollution levels that have been
 6    demonstrated to be harmful but also to prevent lower pollutant levels that may pose an
 7    unacceptable risk of harm, even if the risk is not precisely identified as to  nature or degree.
 8           In selecting a margin of safety, the U.S. Environmental Protection Agency  (EPA)
 9    considers such factors as the nature and severity of the health effects involved, the size of
10    sensitive population(s) at risk, and the kind and degree of the uncertainties that must be
11    addressed.  The  selection of any particular approach to providing an adequate margin of safety is
12    a policy choice left specifically to the Administrator's judgment. See Lead Industries
13    Association v. EPA,  supra, 647 F.2d at 1161-62.
14           In setting standards that are "requisite" to protect public health and welfare, as provided
15    in Section 109(b), EPA's task is to establish standards that are neither more nor less stringent
16    than necessary for these purposes.  In so doing, EPA may not consider the costs of implementing
17    the standards. See generally Whitman v. American Trucking Associations, 531 U.S. 457,  465-
18    472, and 475-76 (U.S. Supreme Court, 2001).
19           Section 109(d)(l) requires that "not later than December 31, 1980, and at 5-year intervals
20    thereafter, the Administrator shall complete a thorough review of the criteria published under
21    Section 108 and the national ambient air quality standards and shall make such revisions in such
22    criteria and standards and promulgate such new standards as may be appropriate ...."  Section
23    109(d)(2) requires that an independent scientific review committee "shall  complete a review of
24    the criteria  ... and the national primary and secondary ambient air quality standards ... and shall
25    recommend to the Administrator any new standards and revisions of existing criteria and
26    standards as may be appropriate ...." Since the early 1980s, this independent review function
27    has been performed by the Clean Air Scientific Advisory Committee (CAS AC) of EPA's
28    Science Advisory Board.
29
30
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 1   AX1.2   HISTORY OF REVIEWS OF THE PRIMARY NAAQS FOR NO2
 2          On April 30, 1971, EPA promulgated identical primary and secondary NAAQS for
 3   nitrogen dioxide (NO2), under Section 109 of the Act, set at 0.053 parts per million (ppm),
 4   annual average (Federal Register, 1971). In 1982, EPA published Air Quality Criteria for
 5   Oxides of Nitrogen (1982 NOX AQCD) (U.S. Environmental Protection Agency, 1982), which
 6   updated the scientific criteria upon which the initial NO2 standards were based.  On February 23,
 7   1984, EPA proposed to retain these standards (Federal Register, 1984).  After taking into account
 8   public comments, EPA published the final decision to retain these standards on June 19, 1985
 9   (Federal Register, 1985).
10          On July 22, 1987, EPA announced that it was undertaking plans to revise the 1982 NOx
11   air quality criteria (Federal Register, 1987).  In November 1991, EPA released an updated draft
12   air quality criteria document (AQCD) for CAS AC and public review and comment (Federal
13   Register, 1991). The draft document provided a comprehensive assessment of the available
14   scientific and technical information on heath and welfare effects associated with NO2 and other
15   oxides of nitrogen. The CAS AC reviewed the document at a meeting held on July 1, 1993, and
16   concluded in a closure letter to the Administrator that the document "provides a scientifically
17   balanced and defensible summary of current knowledge of the effects of this pollutant and
18   provides an adequate basis for EPA to make a decision as to the appropriate NAAQS for MV
19   (Wolff, 1993).
20          The EPA also prepared a draft Staff Paper that summarized and  integrated the key studies
21   and scientific evidence contained in the revised AQCD and identified the critical elements to be
22   considered in the review of the NO2 NAAQS. The Staff Paper received external review at a
23   December 12, 1994 CAS AC meeting. CAS AC comments and recommendations were reviewed
24   by EPA staff and incorporated into the final  draft of the Staff Paper as appropriate.  CAS AC
25   reviewed the final draft of the  Staff Paper in June 1995 and responded by written closure letter
26   (Wolff, 1996). In September of 1995, EPA finalized the document entitled, "Review of the
27   National Ambient Air Quality  Standards for Nitrogen Dioxide Assessment of Scientific and
28   Technical  Information" (U.S. Environmental Protection Agency, 1995).
29          Based on that review, the Administrator announced her proposed decision not to revise
30   either the primary or the secondary NAAQS for NO2 (Federal Register, 1995). The decision not
31   to revise the NO2 NAAQS was finalized after careful evaluation of the comments received on the

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 1    proposal. The level for both the existing primary and secondary NAAQS for NC>2 is 0.053 ppm
 2    annual arithmetic average, calculated as the arithmetic mean of the 1-h NC>2 concentrations.
 3
 4
 5    AX1.3    LITERATURE SELECTION
 6          Literature searches are conducted routinely, on a quarterly or monthly basis, to identify
 7    studies published since the last review; the review includes publications from 1-2 years prior to
 8    the publication of 1993 AQCD for Oxides of Nitrogen (U.S. Environmental Protection Agency,
 9    1993). Examples of strategies used for literature searches are presented below.  The search
10    strategies are periodically reexamined and modified in an effort to optimize the identification of
11    pertinent published papers. Additional papers are  identified for inclusion in several ways. These
12    include the review of pre-publication tables of contents for journals in which relevant papers may
13    be published independent identification of relevant literature by expert authors.  In addition,
14    publications that may be pertinent are identified by both the public and CAS AC during the
15    external review process.  Generally, only information that has undergone scientific peer review
16    and that has been published (or accepted for publication) in the open literature is considered.
17    The following sections briefly summarize criteria for selection of studies for this draft ISA.
18          Figure AX1.3-1 depicts the selection process for studies included in the ISA, and two
19    tables are included below that offer examples of the keywords and strategies used  to search the
20    literature.  Table AX1.3-1 lists examples of the keywords used for identifying epidemiologic
21    studies on oxides of nitrogen for this review. The  search strategy for atmospheric  science and
22    exposure studies is  outlined in Table AX1.3-2.
23          The studies  identified through  literature searches are further evaluated by EPA staff and
24    outside experts to determine if the studies merit inclusion in the ISA and/or its Annexes.  The
25    criteria used for study selection are summarized below.
26
27    General Criteria for Study Selection
28          In assessing the scientific quality and relevance of epidemiological and human or animal
29    toxicological studies, the following considerations have been taken into account.
30          •  To what extent are the aerometric data, exposure, or dose metrics of adequate quality
31              and sufficiently representative to serve as indicators of exposure to ambient NOx?
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                             Identification of Studies for Inclusion in the ISA
                 Continuous,
                 comprehensive
                 literature review
                 of peer-reviewed
                 journal articles
                                               Studies added
                                               to the docket
                                               during public
                                               comment period.
                 Informative studies
                   are identified.
        Studies identified
        during EPA
        sponsored kickoff
        meeting (including
        studies in
        preparation).
     Studies that do
     not address
     exposure and/or
     effects of air
     pollutant(s) under
     review are
     excluded.
Selection of
studies
discussed and
additional studies
identified during
CASACpeer
review of draft
document.
          INFORMATIVE studies are well-designed,
          properly implemented, thoroughly
          described.

          HIGHLY INFORMATIVE studies reduce
          uncertainty on critical issues, may include
          analyses of confounding or effect
          modification by copollutants or other
          variables, analyses of concentration-
          response or dose-response relationships,
          analyses related to time between
          exposure and response, and offer
          innovation in method or design.

          POLICY-RELEVANT studies may include
          those conducted at or near ambient
          concentrations and studies conducted in
        .U.S. and Canadian airsheds.
         >w_                                  -~*
                         tudies are
                       evaluated for
                    inclusion in the ISA
                       and included
                          in the
                         Annex
Studies
summarized
in figures are
included
because they are
sufficiently
comparable
to be displayed
together. A study
highlighted in the
text may not
appear in a
summary figure.
A figure from a
highlighted study
maybe
reproduced
in its entirely.
Studies
REFERENCED
in the text include
those that provide
a basis for or
describe
the association
between the
criteria pollutant
and effects. In
addition, policy
relevant
and highly
informative
studies
are discussed
in the text.
Figure AX1.3-1.       Selection process for studies included in ISA.
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 1           •   Were the study populations adequately selected and are they sufficiently well defined
 2              to allow for meaningful comparisons between study groups?
 3           •   Are the statistical analyses appropriate, properly performed, and properly interpreted?
 4           •   Are likely covariates (i.e., potential confounders or effect modifiers) adequately
 5              controlled or taken into account in the study design and statistical analysis?
 6           •   Are the reported findings internally consistent, biologically plausible, and coherent in
 7              terms of consistency with other known facts?
 8    Consideration of these issues informs our judgments on the relative quality of individual studies
 9    and allows us to focus the assessment on the most pertinent studies.
10
11    Criteria for Selecting Epidemiological Studies
12           In selecting epidemiological  studies for this assessment, EPA considered whether a given
13    study contains information on (1) associations with measured oxides of nitrogen concentrations
14    using short- or long-term exposures at or near ambient levels of oxides of nitrogen, (2) health
15    effects of specific oxides of nitrogen species or indicators related to  oxides of nitrogen sources
16    (e.g., motor vehicle emissions, combustion-related particles), (3) health endpoints and
17    populations not previously extensively researched, (4) multiple pollutant analyses and other
18    approaches to address issues related  to potential confounding and modification of effects, and/or
19    (5) important methodological issues  (e.g., lag of effects, model specifications, thresholds,
20    mortality displacement) related to interpretation of the health evidence. Among the
21    epidemiological studies, particular emphasis has been placed on those most relevant to reviews
22    of the NAAQS. Specifically, studies conducted in the United States or Canada may be discussed
23    in more detail than those from other  geographic regions.  Particular emphasis has been placed on:
24    (A) new multicity studies that employ standardized methodological analyses for evaluating
25    effects of oxides of nitrogen and that provide overall estimates for effects based on combined
26    analyses of information pooled across multiple cities, (B) new studies that provide quantitative
27    effect estimates for populations of interest, and (C) studies that consider oxides of nitrogen as a
28    component of a complex mixture of  air pollutants.
29           Not all studies are accorded equal weight in the overall interpretive assessment of
30    evidence regarding NO2-associated health effects. Among well-conducted studies with adequate
31    control for confounding, increasing scientific weight is accorded in proportion to the precision of


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 1    their effect estimates. Small-scale studies without a wide range of exposures generally produce
 2    less precise estimates compared to larger studies with a broad exposure gradient. For time-series
 3    studies, the size of the study, as indicated by the length of the study period and total number of
 4    events, and the variability of NO2 exposures are important components that help to determine the
 5    precision of the health effect estimates. In evaluating the epidemiologic evidence in this chapter,
 6    more weight is accorded to estimates from studies with narrow confidence bands.
 7          The goal is to perform a balanced and objective evaluation that summarizes, interprets,
 8    and synthesizes the most important studies and issues in the epidemiologic database pertaining to
 9    oxides of nitrogen exposure, illustrated using newly created or previously published summary
10    tables and figures. For each study presented, the quality  of the exposure and outcome data as
11    well as the quality of the statistical analysis methodology are discussed. The discussion
12    incorporates the magnitude and statistical strengths of observed associations between NO2
13    exposure and health outcomes.
14
15    Criteria for Selecting Animal and Human Toxicological Studies
16          Criteria for the selection of research evaluating animal toxicological or controlled human
17    exposure studies include a focus on those studies conducted at levels within about an order of a
18    magnitude of ambient NC>2 concentrations and those studies that approximate expected human
19    exposure conditions in terms of concentration and duration.  Studies that elucidate mechanisms
20    of action and/or susceptibility, particularly if the studies were conducted under atmospherically
21    relevant conditions, are  emphasized whenever possible.
22          The selection of research evaluating controlled human exposures to oxides of nitrogen  is
23    mainly limited to studies in which subjects were exposed to <5 ppm NC>2.  For these controlled
24    human exposures, emphasis is placed on studies that (1) investigate potentially susceptible
25    populations such as asthmatics, particularly studies that compare responses in susceptible
26    individuals with those in age-matched healthy controls; (2) address issues such as concentration-
27    response or time-course of responses; (3) investigate exposure to NC>2 separately and in
28    combination with other pollutants such as 63 and 862; (4) include control exposures to filtered
29    air;  and (5) have sufficient statistical  power to assess findings.
30
31
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 1    AX1.4   EVALUATION GUIDELINES
 2
 3    AX1.4.1   Background on Causality Decision Framework
 4           The critical assessment of health evidence presented in the ISA is conceptually based
 5    upon consideration of salient aspects of the evidence so as to reach fundamental judgments as to
 6    the likely causal significance of the observed associations.  In so doing, it is appropriate to draw
 7    from those aspects initially presented in Hill's classic monograph (Hill, 1965) and widely used
 8    by the scientific community in conducting such evidence-based reviews. A number of these
 9    aspects are judged to be particularly salient in evaluating the body of evidence available in this
10    review, including the aspects described by Hill as strength, experiment, consistency, plausibility,
11    and coherence. Other aspects identified by Hill, including temporality and biological gradient,
12    are also relevant and considered here (e.g., in characterizing lag structures and concentration-
13    response relationships), but are more directly addressed in the design and analyses of the
14    individual epidemiologic studies included in this assessment.  (As noted below, Hill's remaining
15    aspects of specificity and analogy are not considered to be particularly salient in this
16    assessment.) As discussed below, these salient aspects are interrelated and considered
17    throughout the evaluation of the evidence presented in this chapter, and are more generally
18    reflected in the ISA.
19           In the following sections, the general evaluation of the strength of the epidemiological
20    evidence reflects consideration not only of the magnitude of reported oxides of nitrogen effects
21    estimates and their statistical significance, but also of the precision of the effects estimates and
22    the robustness of the effects associations.  Consideration of the robustness of the associations
23    takes into account a number of factors, including in particular the impact of alternative models
24    and model  specifications and potential confounding by copollutants, as well issues related to the
25    consequences of measurement error.  Another aspect that is related to the strength of the
26    evidence in this assessment is the availability of evidence from "found experiments", or so-called
27    intervention studies, which have the potential to  provide particularly strong support for making
28    causal inferences.
29           Consideration of the consistency of the effects associations, as discussed in the following
30    sections, involves  looking across the results of multi- and single-city studies conducted by
31    different investigators in different places and times. In this assessment of ambient oxides of
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 1    nitrogen—health effects associations, it is important to consider the aspect of consistency.  Other
 2    relevant factors are also known to exhibit much variation across studies.  These include, for
 3    example, the presence and levels of copollutants, the relationships between central measures of
 4    oxides of nitrogen and exposure-related factors, relevant demographic factors related to sensitive
 5    subpopulations, as well  as climatic and meteorological conditions. Thus, in this case,
 6    consideration of consistency, and the related heterogeneity of effects issue, is appropriately
 7    understood as an evaluation of the similarity or general concordance of results, rather than  an
 8    expectation of finding quantitative results within  a very narrow range. Particular weight is given
 9    in this assessment, consistent with Hill's views, to the presence of "similar results reached  in
10    quite different ways, e.g.,  prospectively and retrospectively" (Hill, 1965). On the other hand, in
11    light of complexities of exposure and surrogate issues and its spatial and temporal variations,
12    Hill's specificity of effects and analogy aspects are not viewed as being particularly salient here.
13           Looking beyond the epidemiological evidence, evaluation of the biological plausibility  of
14    the oxides of nitrogen—health effect associations observed in epidemiologic studies reflects
15    consideration of both exposure-related factors and dosimetric/toxicologic evidence relevant to
16    identification of potential  biological  mechanisms. Similarly, consideration of the coherence of
17    health effects associations reported in the epidemiologic literature reflects broad consideration  of
18    information pertaining to the nature of the various respiratory- and cardiac-related mortality and
19    morbidity effects and biological markers evaluated in toxicologic and epidemiologic studies.
20           In identifying these aspects as being particularly salient in this assessment, it is also
21    important to recognize that no one aspect is either necessary or sufficient for drawing inferences
22    of causality. As Hill (1965) emphasized:
23                  "None of my nine viewpoints can bring indisputable evidence for or against the
24                  cause-and-effect hypothesis and none can be required as a sine qua non. What
25                  they can do, with greater or less strength, is to help us to make up our minds on
26                  the fundamental question — is there any  other way of explaining the set of facts
27                  before us, is there any other answer equally, or more, likely than cause and
28                  effect?"
29           Thus, while these aspects frame considerations weighed in assessing the  epidemiologic
30    evidence, they do not lend themselves to being considered in terms of simple formulas or hard-
31    and-fast rules of evidence leading to answers about causality  (Hill, 1965).  One,  for example,
32    cannot simply count up  the numbers of studies reporting statistically significant results for  oxides
33    of nitrogen and health endpoints evaluated in this assessment and reach credible conclusions

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 1    about the relative strength of the evidence and the likelihood of causality. Rather, these
 2    important considerations are taken into account throughout this assessment with a goal of
 3    producing an objective appraisal of the evidence (informed by peer and public comment and
 4    advice), which includes the weighing of alternative views on controversial issues.
 5
 6    AX1.4.2   Approaches to the Determination of Causality
 7           The following sections include excerpts from several reports that have documented
 8    approaches for the determination of causality, or related decision-making processes. These
 9    sections provide supplementary documentation of approaches that are similar in nature to EPA's
10    framework for evaluation of health evidence.
11
12    AX1.4.2.1  Surgeon General's Report:  The Health Consequences of Smoking (CDC, 2004)
13           The Surgeon General's Report (CDC,  2004) evaluates the health effects of smoking; it
14    builds upon the first Surgeon General's report published in 1964 (USDEHW, 1964). It also
15    updates the methodology for evaluating evidence that was first presented in the 1964 report. The
16    2004 report acknowledges the effectiveness of the previous methodology, but attempts to
17    standardize the language surrounding causality of associations.
18           The Surgeon General's Reports on Smoking play a central role in the translation of
19    scientific evidence into policy.  As such, it is important that scientific evidence is presented in a
20    manner that conveys most succinctly the link between smoking and a health effect.  Specifically,
21    the report states:
22                 The statement that an exposure "causes" a disease in humans represents a
23                 serious claim, but one that carries with it the possibility of prevention. Causal
24                 determinations may also carry substantial economic implications for society and
25                 for those who might be held responsible for the exposure  or for achieving its
26                 prevention.
27           To address the issue of identifying causality, the 2004 report provides the following
28    summary of the earlier 1964 report:
29                 When a relationship or an association between smoking... and some condition in
3 0                 the host was noted, the significance of the association was assessed.
31                 The characterization of the assessment called for a specific term. ... The word
32                 cause is the one in general usage in connection with matters considered in this
3 3                 study, and it is capable of conveying the notion of a significant, effectual
34                 relationship between an agent and an associated disorder or disease in the host.

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  1                    No member was so naive as to insist upon mono-etiology in pathological
  2                    processes or in vital phenomena. All were thoroughly aware... that the end
  3                    results are the net effect of many actions and counteractions.

  4                    Granted that these complexities were recognized, it is to be noted clearly that the
  5                    Committee's considered decision to use the words  "a cause," or "a major cause,"
  6                    or "a significant cause," or "a causal association" in certain conclusions  about
  7                    smoking and health affirms their conviction (USDHEW, 1964, p. 21).

  8     This 2004 report creates uniformly labeled conclusions that are used throughout the document.

  9     The following excerpts from the  report include a description of the methodology and the

10     judgments used to reach a conclusion:


11                    Terminology of Conclusions and Causal Claims
12                    The first step in introducing this revised approach is to outline the language that
13                    will be used for summary conclusions regarding causality, which follows
14                    hierarchical language used by Institute of Medicine committees (Institute of
15                    Medicine, 1999) to couch causal conclusions, and by IARC to classify
16                    carcinogenic substances (IARC, 1986). These entities use a four-level hierarchy
17                    for classifying the strength of causal inferences based on available evidence as
18                    follows:

19                         A.  Evidence is sufficient to infer a causal relationship.

20                         B.  Evidence is suggestive but not sufficient to infer a causal relationship.

21                         C.  Evidence is inadequate to infer the presence or absence of a causal
22                            relationship  (which encompasses evidence that is sparse, of poor
23                            quality, or conflicting).

24                         D.  Evidence is suggestive of no causal relationship.

25                    For this report, the summary conclusions regarding causality are expressed in
26                    this four-level classification. Use of these classifications should not constrain
27                    the process of causal inference, but rather bring consistency across chapters and
28                    reports, and greater clarity as to what the final conclusions are actually saying.
29                    As shown in Table 1.1 [see original document], without a uniform classification
30                    the precise nature of the final judgment may not always be obvious, particularly
31                    when the judgment is that the evidence falls below the "sufficient" category.
32                    Experience has shown that the "suggestive" category is often an uncomfortable
33                    one for scientists, since scientific culture is such that any evidence that falls
34                    short of causal proof is typically deemed inadequate to make a causal
3 5                    determination.  However, it  is very useful to distinguish between evidence that is
3 6                    truly inadequate versus that  which just falls short of sufficiency.

37                    There is no category beyond "suggestive of no causal relationship" as it  is
3 8                    extraordinarily difficult to prove the complete absence of a causal association.
39                    At best, "negative" evidence is suggestive, either strongly or weakly.  In
40                    instances where this category is used, the strength of evidence for no
41                    relationship will be indicated in the body of the text.  In this new framework,
42                    conclusions regarding causality will be followed by a section on implications.
43                    This section will separate the issue of causal inference from recommendations
44                    for research, policies, or other actions that might arise from the causal
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  1                     conclusions. This section will assume a public health perspective, focusing on
  2                     the population consequences of using or not using tobacco and also a scientific
  3                     perspective, proposing further research directions.  The proportion of cases in
  4                     the population as a result of exposure (the population attributable risk), along
  5                     with the total prevalence and seriousness of a disease, are more relevant for
  6                     deciding on actions than the relative risk estimates typically used for etiologic
  7                     determinations. In past reports, the failure to  sharply separate issues of
  8                     inference from policy issues resulted in inferential statements that were
  9                     sometimes qualified with terms for action.  For example, based on the evidence
10                     available in 1964, the first Surgeon General's report on smoking and health
11                     contained the following statement about the relationship between cardiovascular
12                     diseases and smoking:

13                             It is established that male cigarette smokers have a higher death rate
14                             from coronary artery disease than non-smoking males.  Although the
15                             causative role of cigarette smoking in deaths from coronary disease is
16                             not proven, the Committee considers it more prudent from the public
17                             health viewpoint to assume that the established association has
18                             causative meaning, than to suspend judgment until no uncertainty
19                             remains (USDHEW, 1964, p. 32).

20                     Using this framework, this conclusion would  now be expressed differently,
21                     probably placing it in the "suggestive" category and making it clear that
22                     although it falls short of proving causation,  this evidence still makes causation
23                     more likely than not. The original statement makes it clear that the 1964
24                     committee judged that the evidence fell short of proving causality but was
25                     sufficient to justify public health action. In this report, the rationale and
26                     recommendations for action will be placed in the implications section, separate
27                     from the causal conclusions.  This separation  of inferential from action-related
28                     statements clarifies the degree to which policy recommendations are driven by
29                     the strength of the evidence and by the public health consequences acting to
30                     reduce exposure. In addition, this separation appropriately reflects the
31                     differences between the processes and goals of causal inference and decision
32                     making.

33                     Judgment in Causal Inference
34                     Making causal inferences from observational  data can be a challenging task,
3 5                     requiring expert judgment as to the likely sources and magnitude of
3 6                     confounding, together with judgments about how well the existing constellation
37                     of study designs, results, and analyses addresses this potential threat to
3 8                     inferential validity. To aid this judgment, criteria for the determination of a
3 9                     cause have been proposed by many philosophers and scientists over the
40                     centuries.  The most widely cited criteria in epidemiology and public health
41                     more generally were set forth by Sir Austin Bradford Hill in 1965 (Weed, 2000).
42                     Five of the nine criteria he listed were also put forward in the 1964 Surgeon
43                     General's report as the criteria for causal judgment: consistency, strength,
44                     specificity, temporality, and coherence of an observed association. Hill also
45                     listed biologic  gradient (dose-response), plausibility, experiment (or natural
46                     experiment), and analogy.  Many of these criteria have been cited in earlier
47                     epidemiologic  writings (Lilienfeld, 1959; Yerushalmy and Palmer, 1959;
48                     Sartwell, 1960), and Susser has extensively refined them by exploring their
49                     justification, merits, and interpretations (Susser, 1973, 1977; Kaufman and
50                     Poole,  2000).

51
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  1             Hill (1965) clearly stated that these criteria were not intended to serve as a checklist:


  2                     Here are then nine different viewpoints from all of which we should study
  3                     association before we cry causation. What I do not believe... is that we can
  4                     usefully lay down some hard-and-fast rules of evidence that must be obeyed
  5                     before we accept cause and effect. None of my nine viewpoints can bring
  6                     indisputable evidence for or against the cause-and-effect hypothesis and none
  7                     can be required as a sine qua non. What they can do, with greater or less
  8                     strength, is to help us to make up our minds on the fundamental question—is
  9                     there any other way of explaining the facts before us, is there any other answer
10                     equally, or more, likely than cause and effect? (Hill, 1965, p. 299)

11                     All of these criteria were meant to be applied to an already established statistical
12                     association; if no association has been observed, then these criteria are not
13                     relevant. Hill explained how, if a given criterion were satisfied, it strengthened a
14                     causal claim. Each of these nine criteria served one of two purposes: either as
15                     evidence against competing noncausal explanations or as evidence supporting
16                     causal ones. Noncausal explanations for associations include chance;  residual or
17                     unmeasured confounding; model misspecification; selection bias; errors in
18                     measurement of exposure, confounders, or outcome; and issues regarding
19                     missing data (which can also include missing studies, e.g., publication bias).
20                     The criteria are briefly discussed below.

21                     Consistency
22                     This criterion refers to the persistent finding of an association between exposure
23                     and outcome in multiple studies of adequate power, and in different persons,
24                     places,  circumstances, and times. Consistency can serve two purposes. The first
25                     purpose, which was discussed previously, is to make unmeasured confounding
26                     an unlikely alternative explanation for an observed association. Such
27                     confounding would have to persist across diverse populations, exposure
28                     opportunities, and measurement methods.  The confounding is still possible if
29                     the exposure (in this case smoking) were very strongly tied to an alternative
3 0                     cause, as was claimed in the form of the "constitutional hypothesis" put forward
31                     in the early days of the smoking-disease debate (USDHEW, 1964).  This
32                     hypothesis held that there was a constitutional (i.e., genetic) factor that made
33                     people  more likely to both smoke and develop cancer. So consistency serves
34                     mainly to rule out the hypothesis that the association is produced by an ancillary
3 5                     factor that differs across studies, but not one factor that is common to all or most
36                     of them (Rothman and Greenland, 1998).

3 7                     The second purpose of the consistency criterion is to make the hypothesis of a
3 8                     chance effect unlikely by increasing the statistical strength of a finding through
3 9                     the accumulation of a larger body of data.  It does not include the qualitative
40                     strength of such studies, which Susser subsumes under his subsidiary concept of
41                     "survivability," relating to the rigor and severity of tests of association (Susser,
42                     1991).

43                     Strength of Association
44                     This criterion includes two dimensions of strength: the magnitude of the
45                     association and its statistical strength. An association strong in both aspects
46                     makes the  alternative explanations of chance and confounding unlikely. The
47                     larger the measured effect, the less likely that an unmeasured or poorly
48                     controlled confounder could account for it completely.  Associations that have a
49                     small magnitude or a weak statistical strength are more likely to reflect chance,
50                     modest bias, or unmeasured weak confounding. However, the magnitude of
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  1                     association is reflective of underlying biologic processes and should be
  2                     consistent with understanding the role of smoking in these processes.

  3                     Specificity
  4                     Specificity has been interpreted to mean both a single (or few) effect(s) of one
  5                     cause, or no more than one possible cause for one effect. In addition to specific
  6                     infectious diseases that are caused by specific infectious agents, some other
  7                     examples include asbestos exposure and mesothelioma and thalidomide
  8                     exposure during gestation and the resulting unusual constellation of birth
  9                     defects. This criterion is rarely used as it was originally proposed, having been
10                     derived primarily from the Koch Postulates for infectious causes of disease
11                     (Evans, 1993). When specificity exists, it can strengthen a causal claim, but its
12                     absence does not weaken it (Sartwell, 1960).  For example, most cancers are
13                     known to have multifactorial etiologies, many cancer-causing agents can cause
14                     several types of cancer, and these agents can also have noncancerous effects.
15                     Similarly, there are multiple causes of cardiovascular disease.

16                     In considering specificity in relation to the smoking-lung cancer association, the
17                     1964 Surgeon General's report (USDHEW, 1964) provides a rich discussion of
18                     this criterion. The committee recognized the linkage between this criterion and
19                     strength of association and offered a symmetric formulation of specificity in the
20                     relationship between exposure and disease; that is, a particular exposure always
21                     results in a particular disease and the disease always results from the exposure.
22                     The committee acknowledged that smoking does not always result in lung
23                     cancer and that lung cancer has other causes.  The report notes the extremely
24                     high relative risk for lung cancer in smokers and the high attributable risk, and
25                     concludes that the association between smoking and lung cancer has "a high
26                     degree of specificity."

27                     Temporality
28                     Temporality refers to the occurrence of a cause before its purported effect.
29                     Temporality is the sine qua non of causality, as a cause clearly cannot occur
30                     after its purported effect.  Failure to establish temporal sequence seriously
31                     weakens  a causal  claim, but establishing temporal precedence is by itself not
3 2                     very strong evidence in favor of causality.

33                     Coherence, Plausibility, and Analogy
34                     Although the original definitions of these criteria were subtly different, in
3 5                     practice they have been treated essentially as one idea: that a proposed causal
3 6                     relationship not violate known scientific principles, and that it be consistent with
37                     experimentally demonstrated biologic mechanisms and other relevant data, such
38                     as ecologic patterns of disease (Rothman and Greenland, 1998). In addition, if
3 9                     biologic understanding can be used to set aside explanations other than a causal
40                     association, it offers further support for causality.  Together, these criteria can
41                     serve both to support a causal claim (by supporting the proposed mechanism) or
42                     refute it (by showing that the proposed mechanism is unlikely).

43                     Biologic  understanding, of course, is always evolving as scientific advances
44                     make possible an ever deeper exploration of disease pathogenesis. For example,
45                     in 1964 the Surgeon General's committee found a causal association of smoking
46                     with lung cancer to be biologically plausible.  Nearly 40 years later, this
47                     association remains biologically plausible, but that determination rests not only
48                     on the earlier evidence but on more recent findings that address the genetic and
49                     molecular basis of carcinogenesis.
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 1                   Biologic Gradient (Dose-Response)
 2                   The finding of an increment in effect with an increase in the strength of the
 3                   possible cause provides strong support in favor of a causal hypothesis. This is
 4                   not just because such an observation is predicted by many cause-effect models
 5                   and biologic processes, but more importantly, because it makes most noncausal
 6                   explanations very unlikely. One would have to posit that some unmeasured
 7                   factor was changing in the same manner as the exposure of interest if that factor,
 8                   rather than the factor of interest, is to explain the gradient. Except for
 9                   confounders that are very closely related to a causal factor,  it is very difficult for
10                   such a pattern to be created by virtually any of the noncausal explanations for an
11                   association listed  earlier. The finding of a dose-response relationship has long
12                   been a mainstay of causal arguments in smoking investigations; virtually all
13                   health outcomes causally linked to smoking have shown an increase in risk
14                   and/or severity with an increase in the lifetime smoking history, generally
15                   number of cigarettes smoked per day, duration of smoking, or a cumulative
16                   measure of consumption. This criterion is not based on any specific shape of the
17                   dose-response relationship.

18                   Experiment
19                   This criterion refers to situations where natural conditions might plausibly be
20                   thought to imitate conditions of a randomized experiment, producing a "natural
21                   experiment" whose results might have the force of a true experiment.  An
22                   experiment is typically a situation in which a scientist controls who is exposed
23                   in a way that does not depend on any of the  subject's characteristics.  Sometimes
24                   nature produces similar exposure patterns. The reduction in risk after smoking
25                   cessation serves as one such situation that approximates an experiment; an
26                   alternative noncausal explanation would have to posit that an unmeasured causal
27                   factor of that health outcome was more frequent among those who did not stop
28                   smoking than among those who did. The causal interpretation is further
29                   strengthened if risk continues to decline in former smokers  with increasing
30                   length of time since quitting.  Similar to the dose-response criteria, observations
31                   of risk reduction after quitting smoking have the dual effects of making most
32                   noncausal explanations unlikely, and supporting the biologic model that
33                   underlies the causal claim.

34
35    AX1.4.2.2   The EPA Guidelines for  Carcinogen Risk Assessment

36            The EPA Guidelines for Carcinogen Risk Assessment, published in 2005 (U.S.

37    Environmental Protection Agency, 2005), is an update to the previous risk assessment document

38    published in  1986. This document serves to guide EPA staff and public about the Agency's risk

39    assessment development and methodology.  In the 1986 Guidelines, a step-wise approach was

40    used to evaluate the scientific findings.  However, this newer  document is similar to the Surgeon

41    General's Report on Smoking in that it uses single integrative step after assessing all of the

42    individual lines of evidence. Five standard descriptors are used to evaluate the weight of

43    evidence:

44            •   Carcinogenic to Humans

45            •   Likely to Be Carcinogenic to Humans
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  1            •   Suggestive Evidence of Carcinogenic Potential

 2            •   Inadequate Information to Assess Carcinogenic Potential

 3            •   Not Likely to Be Carcinogenic to Humans.

 4    The 2005 Guidelines recommend that a separate narrative be prepared on the weight of evidence

 5    and the descriptor.  The Guidelines further recommend that the descriptors should only be used

 6    in the context of a weight-of-evidence discussion.

 7            The following excerpt describes how a weight of evidence narrative should be developed

 8    and a how a descriptor should be selected (U.S.  Environmental Protection Agency, 2005):


 9                    The weight of the evidence should be presented as a narrative laying out the
10                    complexity of information that is essential to understanding the hazard and its
11                    dependence on the quality, quantity, and type(s) of data available, as well as the
12                    circumstances of exposure or the  traits of an exposed population that may be
13                    required for expression of cancer. For example, the narrative can clearly state to
14                    what extent the determination was based on data from human exposure, from
15                    animal experiments, from some combination of the two, or from other data.
16                    Similarly, information on mode of action can specify  to what extent the data are
17                    from in vivo or in vitro exposures or based on  similarities to other chemicals.
18                    The extent to  which an agent's mode of action occurs only on reaching a
19                    minimum dose or a minimum duration should also be presented.  A hazard
20                    might also be expressed disproportionately in individuals possessing a specific
21                    gene; such characterizations may follow from  a better understanding of the
22                    human genome. Furthermore, route of exposure should be used to qualify a
23                    hazard if, for  example, an agent is not absorbed by some routes.  Similarly, a
24                    hazard can be attributable to exposures during a susceptible lifestage on the
25                    basis of our understanding of human development.

26                    The weight of evidence-of-evidence narrative  should  highlight:
27                       •  the quality and quantity  of the data;
28                       •  all key decisions and the basis for these major decisions; and
29                       •  any data, analyses, or assumptions that are unusual for or new to EPA.

30                    To capture this complexity, a weight of evidence narrative generally includes
31                       •  conclusions about human carcinogenic potential (choice of
32                           descriptor(s), described below)
33                       •  a summary of the key  evidence supporting these conclusions (for each
34                           descriptor used), including information on the type(s) of data (human
3 5                           and/or animal, in vivo and/or in vitro) used to support the conclusion(s)
36                       •  available information on the epidemiologic or experimental conditions
37                           that characterize expression of carcinogenicity (e.g., if carcinogenicity
38                           is possible only by one exposure route or only above a certain human
39                           exposure level),
40                       •  a summary of potential modes of action and  how they reinforce the
41                           conclusions,
42                       •  indications of any susceptible populations or lifestages, when available,
43                           and
44                       •  a summary of the key  default options invoked when the  available
45                           information is inconclusive.
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  1                     To provide some measure of clarity and consistency in an otherwise free-form
  2                     narrative, the weight of evidence descriptors are included in the first sentence of
  3                     the narrative. Choosing a descriptor is a matter of judgment and cannot be
  4                     reduced to a formula. Each descriptor may be applicable to a wide variety of
  5                     potential data sets and weights of evidence. These descriptors and narratives are
  6                     intended to permit sufficient flexibility to accommodate new scientific
  7                     understanding and new testing methods as they are developed and accepted by
  8                     the scientific community and the public. Descriptors represent points along a
  9                     continuum of evidence; consequently, there are gradations and borderline cases
10                     that are clarified by the full narrative. Descriptors, as well as  an introductory
11                     paragraph, are a short summary of the complete narrative that preserves the
12                     complexity that is an essential part of the hazard characterization.  Users of
13                     these cancer guidelines  and of the risk assessments that result from the use
14                     of these cancer guidelines should consider the entire range of information
15                     included in the narrative rather than focusing simply on the descriptor.

16                     In borderline cases, the narrative explains the case for choosing one descriptor
17                     and discusses the arguments for considering but not choosing another. For
18                     example, between "suggestive" and "likely" or between "suggestive" and
19                     "inadequate," the explanation clearly communicates the information needed to
20                     consider appropriately the agent's carcinogenic potential in subsequent
21                     decisions.

22                     Multiple descriptors can be used for a single agent, for example, when
23                     carcinogenesis is dose- or route-dependent. For example, if an agent causes
24                     point-of-contact tumors by one  exposure route but adequate testing is negative
25                     by another route, then the agent could be described as likely to be carcinogenic
26                     by the first route but not likely to be carcinogenic by the second.  Another
27                     example is when the mode of action is sufficiently understood to conclude that a
28                     key event in tumor development would not occur below a certain dose range. In
29                     this case, the agent could be described as likely to be carcinogenic above a
30                     certain dose  range but not likely to be carcinogenic below that range.

31                     Descriptors can be selected for an agent that has not been tested in a cancer
32                     bioassay if sufficient other information, e.g., toxicokinetic and mode of action
33                     information, is available  to make a strong, convincing, and logical case through
34                     scientific inference.  For  example, if an agent is one of a well-defined class of
3 5                     agents that are understood to operate through a common mode of action and if
3 6                     that agent has the same mode of action, then in the narrative the untested agent
37                     would have the same descriptor as the class. Another example is when an
3 8                     untested agent's effects are understood to be caused by a human metabolite, in
3 9                     which case in the narrative the untested agent could have the same descriptor as
40                     the metabolite. As new testing methods are developed and used, assessments
41                     may increasingly be based on inferences from toxicokinetic and mode of action
42                     information in the absence of tumor studies in animals or humans.

43                     When a well-studied agent produces tumors only at a point of initial contact, the
44                     descriptor generally applies only to the exposure route producing tumors unless
45                     the mode of action is relevant to other routes.  The rationale for this conclusion
46                     would be explained in the narrative.

47                     When tumors occur at a site other than the point of initial contact, the descriptor
48                     generally applies to all exposure routes that have not been adequately tested at
49                     sufficient doses.  An exception  occurs when there is convincing information,
50                     e.g., toxicokinetic data that absorption does not occur by another route.
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 1                   When the response differs qualitatively as well as quantitatively with dose, this
 2                   information should be part of the characterization of the hazard. In some cases
 3                   reaching a certain dose range can be a precondition for effects to occur, as when
 4                   cancer is secondary to another toxic effect that appears only above a certain
 5                   dose. In other cases exposure duration can be a precondition for hazard if
 6                   effects occur only after exposure is sustained for a certain duration. These
 7                   considerations differ from the issues of relative absorption or potency at
 8                   different dose levels because they may represent a discontinuity in a dose-
 9                   response function.

10                   When multiple bioassays are inconclusive, mode of action data are likely to hold
11                   the key to resolution of the more appropriate descriptor. When bioassays are
12                   few, further bioassays to replicate a study' s results or to investigate the potential
13                   for effects in another sex, strain, or species may be useful.

14                   When there are few pertinent data, the descriptor makes a statement about the
15                   database, for example, "Inadequate Information to Assess Carcinogenic
16                   Potential," or a database that provides "Suggestive Evidence of Carcinogenic
17                   Potential." With more information, the descriptor expresses a conclusion about
18                   the agent's carcinogenic potential to humans.  If the conclusion is positive, the
19                   agent could be described as "Likely to Be Carcinogenic to Humans" or, with
20                   strong evidence, "Carcinogenic to Humans." If the conclusion is negative, the
21                   agent could be described as "Not Likely to Be Carcinogenic to Humans."

22                   Although the term "likely" can have a probabilistic connotation in other
23                   contexts, its use as a weight of evidence descriptor does not correspond to a
24                   quantifiable probability of whether the chemical is carcinogenic. This is
25                   because the data that support cancer assessments generally are not suitable  for
26                   numerical calculations of the probability that an agent is a carcinogen.  Other
27                   health agencies have expressed a comparable weight of evidence using terms
28                   such as "Reasonably Anticipated to Be a Human Carcinogen" (NTP) or
29                   "Probably  Carcinogenic to Humans" (International Agency for Research on
30                   Cancer).

31    AX1.4.2.3  Improving the Presumptive Disability Decision-Making Process for Veterans

32            A recent publication by the Institute of Medicine (IOM) also provides foundation for the

33    causality framework adapted in this ISA (IOM, 2007). The Committee on Evaluation of the

34    Presumptive Disability Decision-Making Process for Veterans was charged by the Veterans

35    Association to describe  how presumptive decisions are made for veterans with health conditions

36    arising from military service currently, as  well as recommendations for how such decisions could

37    made in the future. The committee proposes a multiple-element approach that includes a

38    quantification of the extent of disease attributable to an exposure.  This process involves a review

39    of all relevant data to  decide the strength of evidence for causation, using one of four categories:

40            •   Sufficient:  the evidence is sufficient to conclude that a causal relationship exists.
41            •   Equipoise  and Above: the evidence is sufficient to conclude that a causal relationship
42                is at least as likely as not, but not sufficient to conclude that a causal relationship
43                exists.
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  1             •   Below Equipoise: the evidence is not sufficient to conclude that a causal relationship
  2                is at least as likely as not, or is not sufficient to make a scientifically informed
  3                judgment.
  4             •   Against:  the evidence suggests the lack of a causal relationship.
  5
  6     The following is an excerpt from this report and describes these four categories in detail:


  7                    In light of the categorizations used by other health organizations and agencies as
  8                    well as considering the particular challenges of the  presumptive disability
  9                    decision-making process, we propose a four-level categorization of the strength
10                    of the overall evidence for or against a causal relationship from exposure to
11                    disease.

12                    We use the term "equipoise" to refer to the point at which the evidence is in
13                    balance between favoring and not favoring causation. The term "equipoise" is
14                    widely used in the biomedical literature, is a concept familiar to those concerned
15                    with evidence-based decision-making and is used in VA processes for rating
16                    purposes as well as being a familiar term in the veterans' community.

17                    Below we elaborate on the four-level categorization which the Committee
18                    recommends.

19                    Sufficient
20                    If the overall evidence for a causal relationship is categorized as Sufficient, then
21                    it should be scientifically compelling.  It might include:
22                        •    replicated and consistent evidence of a causal association: that is,
23                             evidence of an association from several high-quality epidemiologic
24                             studies that cannot be explained by plausible noncausal alternatives
25                             (e.g., chance, bias, or confounding)
26                        •    evidence of causation from animal studies and mechanistic knowledge
27                        •    compelling evidence from animal studies and strong mechanistic
28                             evidence from studies in exposed humans, consistent with (i.e., not
29                             contradicted by) the epidemiologic evidence.

3 0                    Using the Bayesian framework to illustrate the evidential support and the
31                    resulting state of communal  scientific opinion needed for reaching the Sufficient
32                    category (and the lower categories that follow), consider again the causal
33                    diagram in [Figure AX1.4-1]. In this model, used to help  clarify matters
34                    conceptually, the observed association between exposure and health is the result
35                    of: (1) measured confounding, parameterized by a; (2) the causal relation,
36                    parameterized by (3; and (3) other, unmeasured sources such as bias or
3 7                    unmeasured confounding, parameterized by y. The belief of interest, after all
3 8                    the evidence has been weighed, is in the size of the causal parameter (3.  Thus,
39                    for decision making, what matters is how strongly the evidence supports the
40                    proposition that (3 is above 0. As it is extremely unlikely that the types of
41                    exposures considered for presumptions reduce the risk of developing disease, we
42                    exclude values of (3 below 0.  If we consider the evidence  as supporting degrees
43                    of belief about the size of (3,  and we have a posterior distribution over the
44                    possible size of (3, then a posterior like [Figure AX1.4-2] illustrates a belief state
45                    that might result when the evidence for causation is considered Sufficient.
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                                                     Measured
                                               Confounders/Covariates
                                                I
                                          Exposure
                                        to Substance
                                            I
                                           Health
                                          Outcome
                                                         1
                                        Unmeasured Confounders/Covariates, or
                                      Other Sources of Spurious Association from Bias
      Figure AX1.4-1.
        Focusing on unmeasured confounders/covariates, or other sources of
        spurious association from bias.
                                                                        Posterior Mass
                                                                        Over an Effect
                                           Size of the Causal Effect 6
      Figure AX1.4-2.     Example posterior distribution for the determination of Sufficient.
      Source: IOM(2007).
 1
 2
 3
 4
 5
 6

 7
 8
 9
10
11
As the "mass" over a positive effect (the area under the curve to the right of the
zero) vastly "outweighs" the small mass over no effect (zero), the evidence is
considered sufficient to conclude that the association is causal. Put another way,
even though the scientific community might be uncertain as to the size of (3,
after weighing all the evidence, it is highly confident that the probability that (3
is greater than zero is substantial; that is, that exposure causes disease.

Equipoise and Above
To be categorized as Equipoise and Above, the scientific community should
categorize the overall evidence as making it more confident in the existence of a
causal relationship than in the non-existence of a causal relationship, but not
sufficient to conclude causation.
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  1
  2
  3
  4
  5
  6
  7
  8
  9
10

11
12
13
For example, if there are several high-quality epidemiologic studies, the
preponderance of which show evidence of an association that cannot readily be
explained by plausible noncausal alternatives (e.g., chance, bias, or
confounding), and the causal relationship is consistent with the animal evidence
and biological knowledge, then the overall evidence might be categorized as
Equipoise and Above. Alternatively, if there is strong evidence from animal
studies or mechanistic evidence, not contradicted by human or other evidence,
then the overall evidence might be categorized as Equipoise and Above.
Equipoise is a common  term employed by VA and the courts in deciding
disability claims (see Appendix D).

Again, using the Bayesian model to illustrate the idea of Equipoise and Above,
[Figure AX 1.4-3] shows a posterior probability distribution that is an example of
belief compatible with the category Equipoise and Above.
                                                                          Posterior Mass
                                                                          Over an Effect
                                            Size of the Causa! Effect 6
       Figure AX1.4-3.     Example posterior distribution for the determination of Equipoise and
                              Above.
       Source: IOM(2007).
14
15
16
17
18
19

20
21
22
23

24
25
26
27
28
In this figure, unlike the one for evidence classified as Sufficient, there is
considerable mass over zero, which means that the scientific community has
considerable uncertainty as to whether exposure causes disease at all; that is,
whether (3 is greater than zero.  At least half of the mass is to the right of the
zero, however, so the community judges causation to be at least as likely as not,
after they have seen and combined all the evidence available.

Below Equipoise
To be categorized as Below Equipoise, the overall evidence for a causal
relationship should either be judged not to make causation at least as likely as
not, or not sufficient to make a scientifically informed judgment.

This might occur:
    •   when the human evidence is consistent in showing an association, but
        the evidence is limited by the inability to rule out chance, bias, or
        confounding with confidence, and animal or mechanistic evidence is
        weak
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 1
 2
 3
 4
 5
 6

 7
 8
 9
10
11
12
13
14
15
    •   when animal evidence suggests a causal relationship, but human and
        mechanistic
    •   evidence is weak or inconsistent
    •   when mechanistic evidence is suggestive but animal and human
        evidence is weak or inconsistent
    •   when the evidence base is very thin.

Against
To be categorized as Against, the overall evidence should favor belief that there
is no causal relationship from exposure to disease. For example, if there is
human evidence from multiple studies covering the full range of exposures
encountered by humans that are consistent in showing no causal association, or
there are is animal or mechanistic evidence supporting the lack of a causal
relationship, and combining all of the evidence results in a posterior resembling
[Figure AX 1.4-4]  then the scientific community should categorize the evidence
as, Against causation.
22
23
24
25
26
27
28
                                                                       Posterior Over p
                                           Size of the Causal Effect
      Figure AX1.4-4.      Example posterior distribution for the determination of Against.


      Source:  IOM(2007).



16    AX1.4.2.4   Guidelines for Formulation of Scientific Findings to be Used for Policy
17                  Purposes

18            The following guidelines in the form of checklist questions were developed and

19    published in 1991 by the NAPAP Oversight Review Board for the National Acid Precipitation

20    Assessment Program to  assist scientists in formulating presentations of research results to be

21    used in policy decision processes.
   1.   IS THE STATEMENT SOUND ? Have the central issues been clearly
      identified? Does each statement contain the distilled essence of present
      scientific and technical understanding of the phenomenon or process to
      which it applies? Is the statement consistent with all relevant evidence -
      evidence developed either through NAPAP research or through analysis
      of research conducted outside of NAPAP? Is the statement contradicted
      by any important evidence developed through research inside or outside
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 1                         of NAPAP? Have apparent contradictions or interpretations of available
 2                         evidence been considered in formulating the statement of principal
 3                         findings?

 4                      2  IS THE STATEMENT DIRECTIONAL AND, WHERE
 5                         APPROPRIATE, QUANTITATIVE? Does the statement correctly
 6                         quantify both the direction and magnitude of trends and relationships in
 7                         the phenomenon or process to which the statement is relevant? When
 8                         possible, is a range of uncertainty given for each quantitative result?
 9                         Have various sources of uncertainty been identified and quantified, for
10                         example, does the statement include or acknowledge errors in actual
11                         measurements, standard errors of estimate, possible biases in the
12                         availability of data, extrapolation of results beyond the mathematical,
13                         geographical, or temporal relevancy of available information, etc. In
14                         short, are there numbers in the statement?  Are the numbers correct? Are
15                         the numbers relevant to the general meaning of the statement?

16                      3  IS THE DEGREE OF CERTAINTY OR UNCERTAINTY OF THE
17                         STATEMENT INDICATED CLEARLY?  Have appropriate statistical
18                         tests been applied to the data used in drawing the conclusion set forth in
19                         the statement? If the statement is based on a mathematical or novel
20                         conceptual model, has the model or concept been validated? Does the
21                         statement describe the model or concept on which it is based and the
22                         degree of validity  of that model or concept?

23                      4  IS THE STATEMENT CORRECT WITHOUT QUALIFICATION?
24                         Are there limitations of time, space, or other special circumstances in
25                         which the statement is true? If the statement is true only in some
26                         circumstances, are these limitations described adequately and briefly?

27                      5  IS THE STATEMENT CLEAR AND UNAMBIGUOUS? Are the
28                         words and phrases used in the statement understandable by the decision
29                         makers of our society?  Is the statement free of specialized jargon?  Will
30                         too many people misunderstand its meaning?

31                      6  IS THE STATEMENT AS CONCISE AS IT CAN BE MADE
32                         WITHOUT RISK OF MISUNDERSTANDING? Are there any excess
3 3                         words, phrases, or ideas in the statement which are not necessary to
34                         communicate the meaning of the statement? Are there so many caveats
35                         in the statement that the statement itself is trivial, confusing, or
36                         ambiguous?

37                      7  IS THE STATEMENT FREE OF SCIENTIFIC OR OTHER
3 8                         BIASES OR IMPLICATIONS OF SOCIETAL VALUE
3 9                         JUDGMENTS?  Is the statement free of influence by specific schools of
40                         scientific thought? Is the statement also free of words, phrases, or
41                         concepts that have political, economic,  ideological, religious, moral, or
42                         other personal-, agency-, or organization-specific values, overtones, or
43                         implications?  Does the choice of how the statement is expressed rather
44                         than its specific words suggest underlying biases or value judgments? Is
45                         the tone impartial and free of special pleading? If societal value
46                         judgments have been discussed, have these judgments been identified as
47                         such and described both clearly  and objectively?

48                      8  HAVE SOCIETAL IMPLICATIONS BEEN DESCRIBED
49                         OBJECTIVELY? Consideration of alternative courses of action and
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 1                         their consequences inherently involves judgments of their feasibility and
 2                         the importance of effects.  For this reason, it is important to ask if a
 3                         reasonable range of alternative policies or courses of action have been
 4                         evaluated? Have societal implications of alternative courses of action
 5                         been stated in the following general form?:

 6                      9.  "If this [particular option] were adopted then that [particular outcome]
 7                         would be expected."

 8                     10  HAVE THE PROFESSIONAL BIASES OF AUTHORS AND
 9                         REVIEWERS BEEN DESCRIBED OPENLY?  Acknowledgment of
10                         potential sources of bias is important so that readers can judge for
11                         themselves the credibility of reports and assessments.

12
13    AX1.4.2.5 International Agency for Research on Cancer  Guidelines for Scientific Review
14                and Evaluation

15            The following is excerpted from the International Agency for Research on Cancer

16    (IARC) Monographs on the evaluation of carcinogenic  risks to humans (LARC, 2006).


17                   The available studies are summarized by the Working Group, with particular
18                   regard to the qualitative aspects discussed below. In general, numerical findings
19                   are indicated as they appear in the original report; units are converted when
20                   necessary for easier comparison.  The Working Group may conduct additional
21                   analyses of the published data and use them in their assessment of the evidence;
22                   the results of such supplementary analyses are given in  square brackets. When
23                   an important aspect of a study that directly impinges on its interpretation should
24                   be brought to the  attention of the reader, a Working Group comment is given in
25                   square brackets.

26                   The scope of the IARC Monographs programme has expanded beyond
27                   chemicals to include complex mixtures, occupational exposures, physical and
28                   biological agents, lifestyle factors and other potentially  carcinogenic exposures.
29                   Over time, the structure of a Monograph has evolved to include the following
30                   sections:

31                   1. Exposure data

32                   2. Studies of cancer in humans

33                   3. Studies of cancer in experimental  animals

34                   4. Mechanistic and other relevant data

35                   5. Summary

36                   6. Evaluation and rationale

37                   In addition, a section of General Remarks at the  front of the volume discusses
3 8                   the reasons the agents were scheduled for evaluation and some key issues the
39                   Working Group encountered during  the meeting.
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  1                     This part of the Preamble discusses the types of evidence considered and
  2                     summarized in each section of a Monograph, followed by the scientific criteria
  3                     that guide the evaluations.

  4                     1. Exposure data

  5                     Each Monograph includes general information on the agent: this information
  6                     may vary substantially between agents and must be adapted accordingly. Also
  7                     included is information on production and use (when appropriate), methods of
  8                     analysis and detection, occurrence, and sources and routes of human
  9                     occupational and environmental exposures.  Depending on the agent, regulations
10                     and guidelines for use may be presented.

11                     (a) General information on the agent

12                     For chemical agents, sections on chemical and physical data are included: the
13                     Chemical Abstracts Service Registry Number, the latest primary name and the
14                     IUPAC systematic name are recorded; other synonyms are given, but the list is
15                     not necessarily comprehensive.  Information on chemical and physical
16                     properties that are relevant to identification,  occurrence and biological activity is
17                     included. A description of technical products of chemicals includes trade
18                     names, relevant specifications and available  information on composition and
19                     impurities. Some of the trade names given may be those of mixtures in which
20                     the agent being evaluated is only one  of the ingredients.

21                     For biological agents, taxonomy, structure and biology are described, and the
22                     degree of variability is indicated. Mode of replication, life cycle, target cells,
23                     persistence, latency, host response and clinical disease other than cancer are also
24                     presented.

25                     For physical agents that are forms of radiation, energy and range of the radiation
26                     are included. For foreign bodies, fibres and  respirable particles, size range and
27                     relative dimensions are indicated.

28                     For agents such as mixtures, drugs or lifestyle factors, a description of the agent,
29                     including its composition, is given.

30                     Whenever appropriate, other information, such as historical perspectives or the
31                     description of an industry or habit, may be included.

32                     (b) Analysis and detection

33                     An overview of methods of analysis and detection of the agent is presented,
34                     including their sensitivity, specificity  and reproducibility. Methods widely used
3 5                     for regulatory purposes are emphasized.  Methods for monitoring human
3 6                     exposure are also given. No critical evaluation or recommendation of any
3 7                     method is meant or implied.

3 8                     (c) Production and use

3 9                     The dates of first synthesis and of first commercial production of a chemical,
40                     mixture or other agent are provided when available; for agents that do not occur
41                     naturally, this information may allow  a reasonable estimate to be made of the
42                     date before which no human exposure to the agent could have  occurred.  The
43                     dates of first reported occurrence of an exposure are also provided when
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  1                     available.  In addition, methods of synthesis used in past and present commercial
  2                     production and different methods of production, which may give rise to different
  3                     impurities, are described.

  4                     The countries where companies report production of the agent, and the number
  5                     of companies  in each country, are identified. Available data on production,
  6                     international trade and uses are obtained for representative regions. It should
  7                     not, however, be inferred that thoseareas or nations are necessarily the sole or
  8                     major sources or users of the agent.  Some identified uses may not be current or
  9                     major applications, and the coverage is not necessarily comprehensive.  In the
10                     case of drugs, mention of their therapeutic uses does not necessarily represent
11                     current practice nor does it imply judgement as to their therapeutic efficacy.

12                     (d) Occurrence and exposure

13                     Information on the occurrence of an agent in the environment is obtained from
14                     data derived from the monitoring and surveillance of levels in occupational
15                     environments, air, water, soil, plants, foods and animal and human tissues.
16                     When available, data on the generation, persistence and bioaccumulation of the
17                     agent are also included. Such data may be available from national databases.

18                     Data that indicate the extent of past and present human exposure, the sources of
19                     exposure, the  people most likely to be exposed and the factors that contribute to
20                     the exposure are reported. Information is presented on the range of human
21                     exposure, including occupational and environmental exposures. This includes
22                     relevant findings from both developed and developing countries. Some of these
23                     data are not distributed widely and may be available from government reports
24                     and other sources.  In the case of mixtures, industries,  occupations or processes,
25                     information is given about all agents known to be present.  For processes,
26                     industries and occupations, a historical description is also given, noting
27                     variations  in chemical composition, physical properties and levels of
28                     occupational exposure with date and place. For biological agents, the
29                     epidemiology of infection is described.

30                     (e) Regulations and guidelines

31                     Statements concerning regulations and guidelines (e.g. occupational exposure
32                     limits, maximal levels permitted in foods and water, pesticide registrations) are
33                     included, but they may not reflect the most recent situation, since such limits are
34                     continuously reviewed and modified. The absence of information on regulatory
3 5                     status for a country should not be taken to imply that that country does not have
3 6                     regulations with regard to the exposure.  For biological agents, legislation and
3 7                     control, including vaccination and therapy, are described.

38                     2. Studies of cancer in humans

39                     This section includes all pertinent epidemiological studies  (see Part A, Section
40                     4).  Studies of biomarkers are included when they are  relevant to an evaluation
41                     of carcinogenicity to humans.

42                     (a) Types  of study considered

43                     Several types  of epidemiological study contribute to the assessment of
44                     carcinogenicity in humans — cohort studies, case-control  studies, correlation
45                     (or ecological) studies and intervention studies.  Rarely, results from randomized
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  1                     trials may be available.  Case reports and case series of cancer in humans may
  2                     also be reviewed.

  3                     Cohort and case-control studies relate individual exposures under study to the
  4                     occurrence of cancer in individuals and provide an estimate of effect (such as
  5                     relative risk) as the main measure of association. Intervention studies may
  6                     provide strong evidence for making causal inferences, as exemplified by
  7                     cessation of smoking and the subsequent decrease in risk for lung cancer.

  8                     In correlation studies, the units of investigation are usually whole populations
  9                     (e.g. in particular geographical areas or at particular times), and cancer
10                     frequency is related to asummary measure of the exposure of the population to
11                     the agent under study.  In correlation studies, individual exposure is not
12                     documented, which renders this kind of study more prone to confounding. In
13                     some circumstances, however, correlation studies may be more informative than
14                     analytical study designs (see, for example, the Monograph on arsenic in
15                     drinking-water; IARC, 2004).

16                     In some instances, case reports and case series have provided important
17                     information about the carcinogenicity of an agent.  These types of study
18                     generally arise from a suspicion, based on clinical experience, that the
19                     concurrence of two events — that is, a particular exposure and occurrence of a
20                     cancer — has happened rather more frequently than would be expected by
21                     chance. Case reports and case series usually lack complete ascertainment of
22                     cases in any population, definition or enumeration of the population at risk and
23                     estimation of the expected number of cases in the absence of exposure.

24                     The uncertainties that surround the  interpretation of case reports, case series and
25                     correlation studies make them inadequate, except in rare instances, to form the
26                     sole basis for inferring a causal relationship.  When taken together with case-
27                     control and cohort studies, however, these types of study may add materially to
28                     the judgement that a causal relationship exists.

29                     Epidemiological studies of benign neoplasms, presumed preneoplastic lesions
30                     and other end-points thought to be relevant to cancer are also reviewed.  They
31                     may, in some instances, strengthen inferences drawn from studies of cancer
32                     itself.

3 3                     (b) Quality of studies considered

34                     It is necessary to take into account the possible roles of bias, confounding and
3 5                     chance in the interpretation of epidemiological studies. Bias is the effect of
3 6                     factors in study design or execution that lead erroneously to a stronger or weaker
3 7                     association than in fact exists between an  agent and disease. Confounding is a
3 8                     form of bias that occurs when the relationship with disease is made to appear
3 9                     stronger or weaker than it truly is as a result of an association between the
40                     apparent causal factor and another factor that is associated with either an
41                     increase or decrease in the incidence of the disease. The role of chance is
42                     related to biological variability and the influence of sample size on the precision
43                     of estimates of effect.

44                     In evaluating the extent to which these factors have been minimized in an
45                     individual study, consideration is given to a number of aspects of design and
46                     analysis as described in the report of the study. For example, when suspicion of
47                     carcinogenicity arises largely from  a single small study, careful consideration is
48                     given when interpreting subsequent studies that included these data in an


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  1                     enlarged population.  Most of these considerations apply equally to case-
  2                     control, cohort and correlation studies. Lack of clarity of any of these aspects in
  3                     the reporting of a study can decrease its credibility and the weight given to it in
  4                     the final evaluation of the exposure.

  5                     Firstly, the study population, disease (or diseases) and exposure should have
  6                     been well defined by the authors. Cases of disease in the study population
  7                     should have been identified in a way that was independent of the exposure of
  8                     interest, and exposure should have been assessed in a way that was not related to
  9                     disease status.

10                     Secondly, the authors should have taken into account — in the study design and
11                     analysis — other variables that can influence the risk of disease and may have
12                     been related to the exposure of interest. Potential confounding by such variables
13                     should have been dealt with either in the design of the study, such as by
14                     matching, or in the analysis, by statistical adjustment. In cohort studies,
15                     comparisons with local rates of disease may or may not bemore appropriate than
16                     those with national rates.  Internal comparisons of frequency of disease among
17                     individuals at different levels of exposure are  also desirable  in cohort studies,
18                     since they minimize the potential for confounding related to the difference in
19                     risk factors between an external reference group and the  study population.

20                     Thirdly, the authors should have reported the basic data on which the
21                     conclusions are founded, even if sophisticated statistical  analyses were
22                     employed.  At the very  least, they should have given the  numbers of exposed
23                     and unexposed cases and controls in a case-control study and the numbers of
24                     cases observed and expected in a cohort study. Further tabulations by time since
25                     exposure began and other temporal factors are also important. In a cohort study,
26                     data on all cancer sites and all causes of death should have been given, to reveal
27                     the possibility of reporting bias. In a case-control study, the effects of
28                     investigated factors other than the exposure of interest should have been
29                     reported.

30                     Finally, the statistical methods used to obtain  estimates of relative risk, absolute
31                     rates of cancer, confidence intervals and significance tests, and to adjust for
32                     confounding should have been clearly stated by the authors. These methods
33                     have been reviewed for case-control studies (Breslow & Day,  1980) and for
34                     cohort studies (Breslow & Day, 1987).

3 5                     (c) Meta-analyses  and pooled analyses

36                     Independent epidemiological studies of the same agent may lead to results  that
37                     are difficult to interpret. Combined analyses of data from multiple studies  are a
3 8                     means of resolving this ambiguity, and well-conducted analyses can be
39                     considered.  There are two types of combined analysis.  The first involves
40                     combining summary statistics such as relative risks from individual studies
41                     (meta-analy sis) and the second involves a pooled analysis of the raw data from
42                     the individual studies (pooled analysis) (Greenland, 1998).

43                     The advantages of combined analyses are increased precision due to increased
44                     sample size and the opportunity to explore potential confounders, interactions
45                     and modifying effects that may explain heterogeneity among studies in more
46                     detail. A disadvantage of combined analyses is the possible lack of compatibility
47                     of data from various studies due to differences in subject recruitment,
48                     procedures of data collection, methods of measurement and effects of
49                     unmeasured co-variates that may  differ among studies. Despite these


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  1                     limitations, well-conducted combined analyses may provide a firmer basis than
  2                     individual studies for drawing conclusions about the potential carcinogenicity of
  3                     agents.

  4                     IARC may commission a meta-analysis or pooled analysis that is pertinent to a
  5                     particular Monograph (see Part A, Section 4). Additionally, as a means of
  6                     gaining insight from the results of multiple individual studies, ad-hoc
  7                     calculations that combine data from different studies may be conducted by the
  8                     Working Group during the course of a Monograph meeting. The results of such
  9                     original calculations, which would be specified in the text by presentation in
10                     square brackets, might involve updates of previously conducted analyses that
11                     incorporate the results of more recent studies or de-novo analyses. Irrespective
12                     of the source of data for the meta-analyses and pooled analyses, it is important
13                     that the same criteria for data quality be applied as those that would be applied
14                     to individual studies and to ensure also that sources of heterogeneity between
15                     studies be  taken into account.

16                     (d) Temporal effects

17                     Detailed analyses of both relative and absolute risks in relation to temporal
18                     variables, such as age at first exposure, time since first exposure, duration of
19                     exposure, cumulative exposure, peak exposure (when appropriate) and time
20                     since cessation of exposure, are reviewed and summarized when available.
21                     Analyses of temporal relationships may be usefulin making causal inferences.
22                     In addition, such analyses may suggest whether a carcinogen acts early or late in
23                     the process of carcinogenesis, although, at best, they allow only indirect
24                     inferences about mechanisms of carcinogenesis.

25                     (e) Use of biomarkers in epidemiological studies

26                     Biomarkers indicate molecular, cellular or other biological changes and are
27                     increasingly used in epidemiological studies for various purposes (IARC, 1991;
28                     Vainio et al., 1992; Toniolo et al., 1997; Vineis et al., 1999; Buffler et al.,
29                     2004). These may include evidence of exposure, of early effects, of cellular,
3 0                     tissue or organism responses, of individual susceptibility or host responses, and
31                     inference of a mechanism (see Part B, Section 4b).  This is a rapidly evolving
32                     field that encompasses developments in genomics, epigenomics and other
33                     emerging technologies.

34                     Molecular epidemiological data that identify associations between genetic
3 5                     polymorphisms and interindividual differences in susceptibility to the agent(s)
3 6                     being evaluated may contribute to the identification of carcinogenic hazards to
3 7                     humans. If the polymorphism has been demonstrated experimentally to modify
38                     the functional activity of the gene product in a manner that is consistent with
39                     increased susceptibility, these data may be useful in making causal inferences.
40                     Similarly,  molecular epidemiological studies that measure cell functions,
41                     enzymes or metabolites that are thought to be  the basis of susceptibility may
42                     provide evidence that reinforces biological plausibility. It should be noted,
43                     however, that when data on genetic susceptibility originate from multiple
44                     comparisons that arise from subgroup analyses, this can generate false-positive
45                     results and inconsistencies across studies, and such data therefore require careful
46                     evaluation. If the known phenotype of a genetic polymorphism can explain the
47                     carcinogenic mechanism of the  agent being evaluated, data on this phenotype
48                     may be useful in making causal inferences.
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  1                     (f) Criteria for causality

  2                     After the quality of individual epidemiological studies of cancer has been
  3                     summarized and assessed, a judgement is made concerning the strength of
  4                     evidence that the agent in question is carcinogenic to humans. In making its
  5                     judgement, the Working Group considers several criteria for causality (Hill,
  6                     1965).  A strong association (e.g. a large relative risk) is more likely to indicate
  7                     causality than a weak association, although it is recognized that estimates of
  8                     effect of small magnitude do not imply lack of causality and may be important if
  9                     the disease or exposure is common. Associations  that are replicated in several
10                     studies of the same design or that use different epidemiological approaches or
11                     under different circumstances of exposure are more likely to represent a causal
12                     relationship than isolated observations from single studies. If there are
13                     inconsistent results among investigations, possible reasons are sought (such as
14                     differences in exposure), and results of studies that are judged to be of high
15                     quality are given more weight than those of studies that are judged to be
16                     methodologically less sound.

17                     If the risk increases with the exposure, this is considered to be a strong
18                     indication of causality, although the absence of a graded response is not
19                     necessarily evidence against a causal relationship. The demonstration of a
20                     decline in risk after cessation of or reduction in exposure in individuals or in
21                     whole populations also supports a causal interpretation of the findings.

22                     A number of scenarios may increase confidence in a causal relationship.  On the
23                     one hand, an agent may be specific in causing tumours at one site or of one
24                     morphological type. On the other, carcinogenicity may be evident through the
25                     causation of multiple tumour typesTemporality, precision of estimates of effect,
26                     biological plausibility and coherence of the overall database are considered.
27                     Data on biomarkers may be employed in an assessment of the biological
28                     plausibility of epidemiological observations.

29                     Although rarely available, results from randomized trials that show different
3 0                     rates of cancer among exposed and unexposed individuals provide particularly
31                     strong evidence for causality.

32                     When several epidemiological studies show little or no indication of an
33                     association between an exposure and cancer, a judgement may be made that, in
34                     the aggregate, they show evidence of lack of carcinogenicity.  Such a judgement
3 5                     requires firstly that the studies meet, to a sufficient degree, the standards of
36                     design and analysis described above.  Specifically, the possibility that bias,
3 7                     confounding or misclassification of exposure or outcome could explain the
3 8                     observed results should be considered and excluded with reasonable certainty.
39                     In addition, all studies that are judged to be methodologically sound should (a)
40                     be consistent with an estimate of effect of unity for any observed level of
41                     exposure, (b) when considered together, provide a pooled estimate of relative
42                     risk that is at or near to unity, and (c) have a narrow confidence interval, due to
43                     sufficient population size. Moreover,  no individual study nor the pooled results
44                     of all the studies should show any consistent tendency that the relative risk of
45                     cancer increases with increasing level of exposure. It is important to note that
46                     evidence of lack of carcinogenicity obtained from several epidemiological
47                     studies can apply only to the type(s) of cancer studied, to the dose levels
48                     reported, and to the intervals between first exposure and disease onset observed
49                     in these studies.  Experience with human cancer indicates that the period from
50                     first exposure to the development of clinical cancer is sometimes longer than 20
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  1                     years; latent periods substantially shorter than 30 years cannot provide evidence
  2                     for lack of carcinogenicity.

  3                     3. Studies of cancer in experimental animals

  4                     All known human carcinogens that have been studied adequately for
  5                     carcinogenicity in experimental animals have produced positive results in one or
  6                     more animal species (Wilbourn et al., 1986; Tomatis et al., 1989).  For several
  7                     agents (e.g. aflatoxins, diethylstilbestrol, solar radiation, vinyl chloride),
  8                     carcinogenicity in experimental animals was established or highly suspected
  9                     before epidemiological studies confirmed their carcinogenicity in humans
10                     (Vainio et al., 1995).  Although this association cannot establish that all agents
11                     that cause cancer in experimental animals also cause cancer in humans, it is
12                     biologically plausible that agents for which there is sufficient evidence of
13                     carcinogenicity in experimental animals (see Part B, Section 6b) also present a
14                     carcinogenic hazard to humans. Accordingly, in the absence of additional
15                     scientific information, these agents are considered to pose a carcinogenic hazard
16                     to humans.  Examples of additional scientific information are data that
17                     demonstrate that a given agent causes cancer in animals through a species-
18                     specific mechanism that does not operate in humans or data that demonstrate
19                     that the mechanism in experimental animals also operates in humans (see Part B,
20                     Section 6).

21                     Consideration is given to all available long-term studies of cancer in
22                     experimental animals with the agent under review (see Part A, Section 4). In all
23                     experimental settings, the nature and extent of impurities or contaminants
24                     present in the agent being evaluated are given when available. Animal species,
25                     strain (including genetic background where applicable), sex, numbers per group,
26                     age  at start of treatment, route of exposure, dose levels, duration of exposure,
27                     survival and information on tumours (incidence, latency, severity or multiplicity
28                     of neoplasms or preneoplastic lesions) are reported.  Those studies in
29                     experimental animals that are judged to be irrelevant to the evaluation or judged
30                     to be inadequate (e.g. too short aduration, too few animals, poor survival; see
31                     below) may be omitted. Guidelines for conducting long-term carcinogenicity
32                     experiments have been published (e.g. OECD, 2002).

3 3                     Other studies considered may include: experiments in which the agent was
34                     administered in the  presence of factors that modify carcinogenic effects (e.g.
3 5                     initiation-promotion studies, co-carcinogenicity studies and studies in
3 6                     genetically modified animals); studies in which the end-point was not cancer but
37                     a defined precancerous lesion; experiments on the carcinogenicity of known
3 8                     metabolites and derivatives; and studies of cancer in non-laboratory animals
39                     (e.g. livestock and companion animals) exposed to the agent.

40                     For studies of mixtures, consideration is given to the possibility that changes in
41                     the phy sicochemical properties of the individual substances may occur during
42                     collection, storage,  extraction, concentration and delivery. Another
43                     consideration is that chemical and toxicological interactions of components in a
44                     mixture may alter dose-response relationships.  The relevance to human
45                     exposure of the test mixture administered in the animal experiment is  also
46                     assessed. This may involve consideration of the following aspects of the
47                     mixture tested: (i) physical  and chemical characteristics, (ii) identified
48                     constituents that may indicate the presence of a class of substances and (iii) the
49                     results of genetic toxicity and related tests.
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  1                     The relevance of results obtained with an agent that is analogous (e.g. similar in
  2                     structure or of a similar virus genus) to that being evaluated is also considered.
  3                     Such results may provide biological and mechanistic information that is relevant
  4                     to the understanding of the process of carcinogenesis in humans and may
  5                     strengthen the biological plausibility that the agent being evaluated is
  6                     carcinogenic to humans (see Part B, Section 2f).

  7                     (a) Qualitative aspects

  8                     An assessment of carcinogenicity involves several considerations of qualitative
  9                     importance, including (i) the experimental conditions under which the test was
10                     performed, including route, schedule  and duration of exposure, species, strain
11                     (including genetic background where applicable), sex, age and duration of
12                     follow-up; (ii) the consistency  of the results, for example, across species and
13                     target organ(s); (iii) the spectrum of neoplastic response, from preneoplastic
14                     lesions and benign tumours to malignant neoplasms; and (iv) the possible role of
15                     modifying factors.

16                     Considerations of importance in the interpretation and evaluation of a particular
17                     study include: (i) how clearly the agent was defined and, in the case of mixtures,
18                     how adequately the sample characterization was reported; (ii) whether the dose
19                     was monitored adequately, particularly in inhalation experiments; (iii) whether
20                     the doses, duration of treatment and route of exposure were appropriate; (iv)
21                     whether the survival of treated animals was similar to that of controls; (v)
22                     whether there were adequate numbers of animals per group; (vi) whether both
23                     male and female animals were  used; (vii) whether animals were allocated
24                     randomly to groups; (viii) whether the duration of observation was adequate;
25                     and (ix) whether the data were reported and analysed adequately.

26                     When benign tumours (a)  occur together with and originate from the same cell
27                     type as malignant tumours in an organ or tissue in a particular study and (b)
28                     appear to represent a stage in the progression to malignancy, they are usually
29                     combined in the assessment of tumour incidence (Huff., 1989). The occurrence
30                     of lesions presumed  to be  preneoplastic may in certain instances aid in assessing
31                     the biological plausibility  of any neoplastic response observed. If an agent
32                     induces only benign neoplasms that appear to be end-points that do not readily
33                     undergo transition to malignancy, the agent should nevertheless be suspected of
34                     being carcinogenic and requires further investigation.

3 5                     (b) Quantitative aspects

36                     The probability that tumours will occur may depend on the species, sex, strain,
3 7                     genetic background and age of the animal, and on the dose, route, timing and
3 8                     duration of the exposure.  Evidence of an increased incidence of neoplasms with
3 9                     increasing levels of exposure strengthens the inference of a causal association
40                     between the exposure and the development of neoplasms.

41                     The form of the dose-response relationship can vary widely, depending on the
42                     particular agent under study and the target organ.  Mechanisms such as
43                     induction of DNA damage or inhibition of repair, altered cell division and cell
44                     death rates and changes in intercellular communication are important
45                     determinants of dose-response relationships for some carcinogens.  Since many
46                     chemicals require metabolic activation before being converted to their reactive
47                     intermediates, both metabolic and toxicokinetic aspects are important in
48                     determining the dose-response pattern. Saturation of steps such as absorption,
49                     activation, inactivation and elimination may produce non-linearity in the dose-


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  1                     response relationship (Hoel et al., 1983; Gart et al., 1986), as could saturation of
  2                     processes such as DNA repair. The dose-response relationship can also be
  3                     affected by differences in survival among the treatment groups.

  4                     (c) Statistical analyses

  5                     Factors considered include the adequacy of the information given for each
  6                     treatment group: (i) number of animals studied and number examined
  7                     histologically, (ii) number of animals with a given tumour type and (iii) length
  8                     of survival. The statistical methods used should be clearly stated and should be
  9                     the generally accepted techniques refined for this purpose (Peto et al., 1980;
10                     Gart et al, 1986; Portier & Bailer,  1989; Bieler & Williams, 1993).  The  choice
11                     of the most appropriate  statistical method requires  consideration of whether or
12                     not there are differences in survival among the treatment groups;  for example,
13                     reduced survival because of non-tumour-related mortality can preclude the
14                     occurrence of tumours later in life.  When detailed information on survival is not
15                     available, comparisons of the proportions of tumour-bearing animals among the
16                     effective number of animals (alive  at the time the first tumour was discovered)
17                     can be useful when significant differences in survival occur before tumours
18                     appear. The lethality of the tumour also requires consideration: for rapidly fatal
19                     tumours, the time of death provides an indication of the time of tumour onset
20                     and can be assessed using life-table methods; non-fatal or incidental tumours
21                     that do not affect survival can be assessed using methods such as the Mantel-
22                     Haenzel test for changes in tumour prevalence. Because tumour lethality is
23                     often difficult to determine, methods such as the Poly-K test that  do not require
24                     such information can also be used.  When results are available on the number
25                     and size of tumours seen in experimental animals (e.g. papillomas on mouse
26                     skin, liver tumours observed through nuclear magnetic resonance tomography),
27                     other more complicated statistical procedures  may  be needed (Sherman et al.,
28                     1994;  Dunson et al, 2003).

29                     Formal statistical methods have been developed to incorporate historical  control
3 0                     data into the analysis of data from a given experiment. These methods assign an
31                     appropriate weight to historical and concurrent controls on the basis of the
32                     extent of between-study and within-study variability: less weight is given to
33                     historical controls when they show a high degree of variability, and greater
34                     weight when they  show little variability. It is  generally not appropriate to
3 5                     discount a tumour response that is significantly increased compared with
3 6                     concurrent controls by arguing that it falls within the range of historical controls,
3 7                     particularly when historical controls show high between-study variability and
3 8                     are, thus, of little relevance to the current experiment. In analysing results for
39                     uncommon tumours, however, the analysis may be improved by considering
40                     historical control data, particularly  when between-study  variability is low.
41                     Historical controls should be selected to resemble the concurrent  controls as
42                     closely as possible with respect to species, gender and strain, as well as other
43                     factors such as basal diet and general laboratory environment, which may affect
44                     tumour-response rates in control animals (Haseman et al,  1984; Fung et al,
45                     1996;Greime/a/., 2003).

46                     Although meta-analyses and combined analyses are conducted less frequently
47                     for animal experiments than for epidemiological studies due to differences in
48                     animal strains,  they can be useful aids in interpreting animal data when the
49                     experimental protocols are sufficiently similar.
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  1                    4. Mechanistic and other relevant data

  2                    Mechanistic and other relevant data may provide evidence of carcinogenicity
  3                    and also help in assessing the relevance and importance of findings of cancer in
  4                    animals and in humans. The nature of the mechanistic and other relevant data
  5                    depends on the biological activity of the agent being considered. The Working
  6                    Group considers representative studies to give a concise description of the
  7                    relevant data and issues that they consider to be important; thus, not every
  8                    available study  is cited. Relevant topics may include toxicokinetics,
  9                    mechanisms of carcinogenesis, susceptible individuals, populations and life-
10                    stages, other relevant data and other adverse effects.  When data on biomarkers
11                    are informative about the mechanisms of carcinogenesis, they are included in
12                    this section.

13                    These topics are not mutually exclusive; thus, the same studies may be discussed
14                    in more than one subsection. For example, a mutation in a gene that codes for
15                    an enzyme that metabolizes the agent under study could be discussed in the
16                    subsections on toxicokinetics, mechanisms and individual susceptibility if it also
17                    exists as an inherited polymorphism.

18                    (a) Toxicokinetic data

19                    Toxicokinetics refers to the absorption, distribution, metabolism and elimination
20                    of agents in humans, experimental animals and, where relevant, cellular systems.
21                    Examples of kinetic factors that may affect dose-response relationships include
22                    uptake, deposition, biopersistence and half-life in tissues, protein binding,
23                    metabolic activation and detoxification.  Studies that indicate the metabolic fate
24                    of the agent in humans and in experimental animals are summarized briefly, and
25                    comparisons of data from humans and animals are made when possible.
26                    Comparative information on the relationship between exposure and the dose that
27                    reaches the target site may be important for the extrapolation of hazards between
28                    species and in clarifying the role of in-vitro findings.

29                    (b) Data on mechanisms of carcinogenesis

30                    To provide focus, the Working Group attempts to identify the possible
31                    mechanisms by which the agent may increase the risk of cancer. For each
32                    possible mechanism, a representative selection of key data from humans and
33                    experimental systems is summarized. Attention is given to gaps in the data and
34                    to data that suggests that more than one mechanism may be operating. The
3 5                    relevance of the mechanism to humans is discussed, in particular, when
3 6                    mechanistic data are derived from experimental model systems. Changes in the
37                    affected organs, tissues or cells can be divided into three non-exclusive levels as
3 8                    described below, (i) Changes in physiology

3 9                    Physiological changes refer to exposure-related modifications to the physiology
40                    and/or response of cells, tissues and organs. Examples of potentially adverse
41                    physiological changes include mitogenesis, compensatory cell division, escape
42                    from apoptosis and/or senescence, presence of inflammation, hyperplasia,
43                    metaplasia and/or preneoplasia, angiogenesis, alterations in cellular adhesion,
44                    changes in steroidal hormones and changes in immune surveillance.
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  1                     (ii) Functional changes at the cellular level

  2                     Functional changes refer to exposure-related alterations in the signalling
  3                     pathways used by cells to  manage critical processes that are related to increased
  4                     risk for cancer. Examples of functional changes include modified activities of
  5                     enzymes involved in the metabolism of xenobiotics, alterations in the expression
  6                     of key genes that regulate DNA repair, alterations in cyclin-dependent kinases
  7                     that govern cell cycle progression, changes in the patterns of post-translational
  8                     modifications of proteins, changes in regulatory factors that alter apoptotic rates,
  9                     changes in the secretion of factors related to the stimulation of DNA replication
10                     and transcription and changes in gap-junction-mediated intercellular
11                     communication.

12                     (iii) Changes at the molecular level

13                     Molecular changes refer to exposure-related changes in key cellular structures at
14                     the molecular level, including, in particular, genotoxicity. Examples  of
15                     molecular changes include formation of DNA adducts and DNA strand breaks,
16                     mutations in genes, chromosomal aberrations, aneuploidy and changes in DNA
17                     methylation patterns. Greater emphasis is given to irreversible effects.

18                     The use of mechanistic data in the identification of a carcinogenic hazard is
19                     specific to the mechanism being addressed and is not readily described for every
20                     possible level and mechanism discussed above.

21                     Genotoxicity data are discussed here to illustrate the key issues involved in the
22                     evaluation of mechanistic data.

23                     Tests for genetic and related effects are described in view of the relevance  of
24                     gene mutation and chromosomal aberration/aneuploidy to carcinogenesis
25                     (Vainio et al., 1992; McGregor et al.,  1999). The adequacy of the reporting of
26                     sample characterization is considered and, when necessary, commented upon;
27                     with regard to complex mixtures, such comments are similar to those described
28                     for animal carcinogenicity tests.  The available data are interpreted critically
29                     according to the end-points detected, which may include DNA damage, gene
30                     mutation, sister chromatid exchange, micronucleus formation, chromosomal
31                     aberrations and aneuploidy. The concentrations employed are given, and
3 2                     mention is made of whether the use of an exogenous metabolic system in vitro
3 3                     affected the test result.  These data are listed  in tabular form by phylogenetic
34                     classification.

3 5                     Positive results in tests using prokaryotes, lower eukaryotes, insects, plants and
3 6                     cultured mammalian cells suggest that genetic and related effects could occur in
37                     mammals. Results from such tests may also  give information on the types of
3 8                     genetic effect produced and on the involvement of metabolic  activation. Some
39                     end-points described are clearly genetic in nature (e.g. gene mutations), while
40                     others are associated with genetic effects (e.g. unscheduled DNA synthesis). In-
41                     vitro tests formay be sensitive to changes that are not necessarily the result of
42                     genetic alterations but that may have specific relevance to the process of
43                     carcinogenesis. Critical appraisals of these tests have been published
44                     (Montesano et al., 1986; McGregor et al.,  1999).

45                     Genetic or other activity manifest in humans and experimental mammals is
46                     regarded to be of greater relevance than that in other organisms.  The
47                     demonstration that an agent can induce gene  and chromosomal mutations in
48                     mammals in vivo indicates that it may have carcinogenic activity. Negative


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  1                     results in tests for mutagenicity in selected tissues from animals treated in vivo
  2                     provide less weight, partly because they do not exclude the possibility of an
  3                     effect in tissues other than those examined. Moreover, negative results in short-
  4                     term tests with genetic end-points cannot be considered to provide evidence that
  5                     rules out the carcinogenicity of agents that act through other mechanisms (e.g.
  6                     receptor-mediated effects, cellular toxicity with regenerative cell division,
  7                     peroxisome proliferation) (Vainio et al., 1992). Factors that may give
  8                     misleading results in short-term tests have been discussed in detail elsewhere
  9                     (Montesano et al, 1986; McGregor et al, 1999).

10                     When there is evidence that an agent acts by a specific mechanism that does not
11                     involve genotoxicity (e.g. hormonal dysregulation, immune suppression, and
12                     formation of calculi and other deposits that cause chronic irritation), that
13                     evidence is presented and reviewed critically in the context of rigorous criteria
14                     forthe operation of that mechanism in carcinogenesis (e.g. Capenet al., 1999).

15                     For biological agents such as viruses, bacteria and parasites, other data relevant
16                     to carcinogenicity may include descriptions of the pathology of infection,
17                     integration and expression of viruses, and genetic alterations seen in human
18                     tumours. Other observations that might comprise cellular and tissue responses
19                     to infection, immune response and the presence of tumour markers are also
20                     considered.

21                     For physical agents that are forms of radiation, other data relevant to
22                     carcinogenicity may include descriptions of damaging effects at the
23                     physiological, cellular and molecular level, as for chemical agents, and
24                     descriptions of how these effects occur. 'Physical agents' may also be
25                     considered to comprise foreign bodies, such as surgical implants of various
26                     kinds, and poorly soluble fibres, dusts and particles of various sizes, the
27                     pathogenic effects of which are a result of their physical presence in tissues or
28                     body cavities. Other relevant data for such materials may  include
29                     characterization of cellular, tissue and physiological reactions to these materials
3 0                     and descriptions of pathological conditions other than neoplasia with which they
31                     may be associated.

32                     (c) Other data relevant to mechanisms

33                     A description is provided of any structure-activity  relationships that may be
34                     relevant to an evaluation of the carcinogenicity of an agent, the lexicological
3 5                     implications of the physical and chemical properties, and  any other data relevant
36                     to the evaluation that are not included elsewhere.

3 7                     High-output data, such as those derived from gene  expression microarrays, and
3 8                     high-throughput data, such as those that result from testing hundreds of agents
39                     for a single end-point, pose a unique problem for the use of mechanistic data in
40                     the evaluation of a carcinogenic hazard. In the case of high-output data, there  is
41                     the possibility to overinterpret changes in individual end-points (e.g. changes in
42                     expression in one gene) without considering the consistency of that finding in
43                     the broader context of the other end-points (e.g. other geneswith linked
44                     transcriptional control).  High-output data can be used in assessing mechanisms,
45                     but all end-points measured in a single experiment  need to be considered in the
46                     proper context.  For high-throughput data, where the number of observations far
47                     exceeds the number of end-points measured, their utility for identifying common
48                     mechanisms across multiple agents is enhanced. These data can be used to
49                     identify mechanisms that not only seem plausible, but also have a consistent
50                     pattern of carcinogenic response across entire classes of related compounds.


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  1                     (d) Susceptibility data

  2                     Individuals, populations and life-stages may have greater or lesser susceptibility
  3                     to an agent, based on toxicokinetics, mechanisms of carcinogenesis and other
  4                     factors. Examples of host and genetic factors that affect individual susceptibility
  5                     include sex, genetic polymorphisms of genes involved in the metabolism of the
  6                     agent under evaluation, differences in metabolic capacity due to life-stage or the
  7                     presence of disease, differences in DNA repair capacity, competition for or
  8                     alteration of metabolic capacity by medications or other chemical exposures,
  9                     pre-existing hormonal imbalance that is exacerbated by a chemical exposure, a
10                     suppressed immune system, periods of higher-than-usual tissue growth or
11                     regeneration and genetic polymorphisms that lead to differences in behaviour
12                     (e.g. addiction). Such data can substantially increase the strength of the evidence
13                     from epidemiological data and enhance the linkage of in-vivo and in-vitro
14                     laboratory studies to humans.

15                     (e) Data on other adverse effects

16                     Data on acute, subchronic and chronic adverse effects relevant to the cancer
17                     evaluation are summarized.  Adverse effects that confirm distribution and
18                     biological effects at the sites of tumour development, or alterations in
19                     physiology that could lead to tumour development, are emphasized. Effects on
20                     reproduction, embryonic and fetal survival and development are summarized
21                     briefly. The adequacy of epidemiological studies of reproductive outcome and
22                     genetic and related effects in humans is judged by the same criteria as those
23                     applied to epidemiological studies of cancer, but fewer details are given.

24                     5. Summary

25                     This section is a summary of data presented in the preceding sections.
26                     Summaries can be found on the Monographs programme website
27                     (http://monographs.iarc.fr).

28                     (a) Exposure data

29                     Data are summarized, as appropriate, on the basis of elements such as
30                     production, use, occurrence  and exposure levels  in the workplace and
31                     environment and measurements in human tissues and body fluids. Quantitative
32                     data and time trends are given to compare exposures in different occupations
33                     and environmental settings.  Exposure to biological agents is described in terms
34                     of transmission, prevalence  and persistence of infection.

3 5                     (b) Cancer in humans

3 6                     Results of epidemiological studies pertinent to an assessment of human
37                     carcinogenicity are summarized. When relevant, case reports and correlation
3 8                     studies are also summarized. The target organ(s) or tissue(s) in which an
39                     increase in cancer was observed is identified. Dose-response and other
40                     quantitative data may be summarized when available.

41                     (c) Cancer in experimental animals

42                     Data relevant to an evaluation of carcinogenicity in animals are summarized.
43                     For each animal species, study design and route  of administration, it is stated
44                     whether an increased incidence, reduced latency, or increased severity or
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  1                     multiplicity of neoplasms or preneoplastic lesions were observed, and the
  2                     tumour sites are indicated. If the agent produced tumours after prenatal
  3                     exposure or in single-dose experiments, this is also mentioned. Negative
  4                     findings, inverse relationships, dose-response and other quantitative data are
  5                     also summarized.

  6                     (d) Mechanistic and other relevant data

  7                     Data relevant to the toxicokinetics (absorption, distribution, metabolism,
  8                     elimination) and the possible mechanism(s) of carcinogenesis (e.g. genetic
  9                     toxicity, epigenetic effects) are summarized. In addition, information on
10                     susceptible individuals, populations and life-stages is summarized.  This section
11                     also reports on other toxic effects, including reproductive and developmental
12                     effects, as well as additional relevant data that are considered to be important.

13                     6. Evaluation and rationale

14                     Evaluations of the strength of the evidence for carcinogenicity arising from
15                     human and experimental animal data are made, using standard terms. The
16                     strength of the mechanistic evidence is also characterized.

17                     It is recognized that the criteria for these evaluations, described below, cannot
18                     encompass all of the factors that may be relevant to an evaluation of
19                     carcinogenicity.  In considering all of the relevant scientific data, the Working
20                     Group may assign the agent to a higher or lower category than a strict
21                     interpretation of these criteria would indicate.

22                     These categories refer only to the strength of the evidence that an exposure is
23                     carcinogenic and not to the extent of its carcinogenic activity (potency). A
24                     classification may change as new information becomes available.

25                     An evaluation of the degree of evidence is limited to the materials tested, as
26                     defined physically, chemically or biologically. When the agents evaluated are
27                     considered by the Working Group to be sufficiently closely related, they may be
28                     grouped together for the purpose of a single evaluation of the degree of
29                     evidence.

30                     (a) Carcinogenicity in humans

31                     The evidence relevant to carcinogenicity from studies in humans is classified
32                     into one of the following categories:

33                     Sufficient evidence of carcinogenicity. The Working Group considers that a
34                     causal relationship has been established between exposure to the agent and
3 5                     human cancer. That is, a positive relationship has been observed between the
3 6                     exposure and cancer in studies in which chance, bias and confounding could be
37                     ruled out with reasonable confidence.  A statement that there is sufficient
3 8                     evidence is followed by a separate sentence that identifies the target organ(s) or
3 9                     tissue(s) where an increased risk of cancer was observed in humans.
40                     Identification of a specific target organ or tissue does not preclude the possibility
41                     that the agent may cause cancer at other sites.

42                     Limited evidence of carcinogenicity. A positive association has been observed
43                     between exposure to the agent and cancer for which a causal interpretation is
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  1                     considered by the Working Group to be credible, but chance, bias or
  2                     confounding could not be ruled out with reasonable confidence.

  3                     Inadequate evidence of carcinogenicity. The available studies are of
  4                     insufficient quality, consistency or statistical power to permit a conclusion
  5                     regarding the presence or absence of a causal association between exposure and
  6                     cancer, or no data on cancer in humans are available.

  7                     Evidence suggesting lack of carcinogenicity. There are several adequate
  8                     studies covering the full range of levels of exposure that humans are known to
  9                     encounter, which are mutually consistent in not showing a positive association
10                     between exposure to the agent and any studied cancer at any observed level of
11                     exposure.  The results from these studies alone or combined should have narrow
12                     confidence intervals with an upper limit close to the null value (e.g. a relative
13                     risk of 1.0). Bias and confounding should be ruled out with reasonable
14                     confidence, and the studies should have an adequate length of follow-up. A
15                     conclusion of evidence suggesting lack of carcinogenicity is inevitably limited to
16                     the cancer sites, conditions and levels of exposure, and length of observation
17                     covered by the available studies.  In addition, the possibility of a very small risk
18                     at the levels of exposure studied can never be excluded.

19                     In some instances, the above categories may be used to classify the degree of
20                     evidence related to carcinogenicity in specific organs or tissues.

21                     When the available epidemiological studies pertain to a mixture, process,
22                     occupation or industry, the Working Group seeks to identify the specific agent
23                     considered most likely to be responsible for any excess risk. The evaluation is
24                     focused as narrowly as the available data on exposure and other aspects permit.

25                     (b) Carcinogenicity in experimental animals

26                     Carcinogenicity in experimental animals can be evaluated using conventional
27                     bioassays, bioassays that employ genetically modified animals, and other in-
28                     vivo bioassays that focus on one or more of the critical stages of carcinogenesis.
29                     In the absence of data from conventional long-term bioassays or from assays
30                     with neoplasia as the end-point, consistently positive results in several models
31                     that address several stages in the multistage process of carcinogenesis should be
32                     considered in evaluating the degree of evidence of carcinogenicity in
33                     experimental animals.

34                     The evidence relevant to carcinogenicity in experimental animals is classified
3 5                     into one of the  following categories:

36                     Sufficient evidence of carcinogenicity.  The Working Group considers that a
3 7                     causal relationship has been established between the agent and an increased
3 8                     incidence of malignant neoplasms or of an appropriate combination of benign
39                     and malignant neoplasms in (a) two or more species of animals or (b) two or
40                     more independent studies in one species carried out at different times or in
41                     different laboratories or under different protocols. An increased incidence of
42                     tumours in both sexes of a single species in a well-conducted study, ideally
43                     conducted under Good Laboratory Practices, can also provide sufficient
44                     evidence.

45                     A single study  in one species and sex might be considered to provide sufficient
46                     evidence of carcinogenicity when malignant neoplasms occur to an unusual
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  1                     degree with regard to incidence, site, type of tumour or age at onset, or when
  2                     there are strong findings of tumours at multiple sites.

  3                     Limited evidence of carcinogenicity.  The data suggest a carcinogenic effect but
  4                     are limited for making a definitive evaluation because, e.g. (a) the evidence of
  5                     carcinogenicity is restricted to a single experiment; (b) there are unresolved
  6                     questions regarding the adequacy of the design, conduct or interpretation of the
  7                     studies; (c) the agent increases the incidence only of benign neoplasms or
  8                     lesions of uncertain neoplastic potential; or (d) the evidence of carcinogenicity is
  9                     restricted to studies that demonstrate only promoting activity in a narrow range
10                     of tissues or organs.

11                     Inadequate evidence of carcinogenicity. The  studies cannot be interpreted as
12                     showing either the presence or absence of a carcinogenic effect because of major
13                     qualitative or quantitative limitations, or no data on cancer in experimental
14                     animals are available.

15                     Evidence suggesting lack of carcinogenicity: Adequate studies involving at
16                     least two  species are available which show that, within the limits of the tests
17                     used, the  agent is not carcinogenic. A conclusion of evidence suggesting lack of
18                     carcinogenicity is inevitably limited to the species, tumour sites, age at
19                     exposure, and conditions and levels of exposure studied.

20                     (c) Mechanistic and other relevant data

21                     Mechanistic and other evidence judged to be relevant to an evaluation of
22                     carcinogenicity and of sufficient importance to affect the overall evaluation is
23                     highlighted. This may include data on preneoplastic lesions, tumour pathology,
24                     genetic and related effects, structure-activity relationships, metabolism and
25                     toxicokinetics, physicochemical parameters and analogous biological agents.

26                     The strength of the evidence that any carcinogenic effect observed is due to a
27                     particular mechanism is evaluated, using terms such as 'weak', 'moderate' or
28                     'strong'.  The Working Group then assesses whether that particular mechanism
29                     is likely to be operative in humans. The strongest indications that a particular
3 0                     mechanism operates in humans derive from data on humans or biological
31                     specimens obtained from exposed humans.  The data may be considered to be
32                     especially relevant if they show that the agent in question has caused changes in
33                     exposed humans that are on the causal pathway to carcinogenesis. Such data
34                     may, however, never become available, because it is at least conceivable that
3 5                     certain compounds may be kept from human use solely on the basis of evidence
36                     of their toxicity and/or carcinogenicity in experimental systems.

3 7                     The conclusion that a mechanism operates in experimental animals is
3 8                     strengthened by findings of consistent results in different experimental systems,
39                     by the demonstration of biological plausibility  and by coherence of the overall
40                     database. Strong support can be obtained from studies that challenge the
41                     hypothesized mechanism experimentally, by demonstrating that the suppression
42                     of key mechanistic processes leads to the suppression of tumour development.
43                     The Working Group considers whether multiple mechanisms might contribute to
44                     tumour development, whether different  mechanisms might operate in different
45                     dose ranges, whether separate mechanisms  might operate in humans and
46                     experimental animals and whether a unique mechanism might operate in a
47                     susceptible group.  The possible contribution of alternative mechanisms must be
48                     considered before concluding that tumours observed in experimental animals are
49                     not relevant to humans.  An uneven level of experimental support for different


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  1                     mechanisms may reflect that disproportionate resources have been focused on
  2                     investigating a favoured mechanism.

  3                     For complex exposures, including occupational and industrial exposures, the
  4                     chemical composition and the potential contribution of carcinogens known to be
  5                     present are considered by the Working Group in its overall evaluation of human
  6                     carcinogenicity. The Working Group also determines the extent to which the
  7                     materials tested in experimental systems are related to those to which humans
  8                     are exposed.

  9                     (d) Overall evaluation

10                     Finally, the body of evidence is considered as a whole, in order to reach an
11                     overall evaluation of the carcinogenicity of the agent to humans.

12                     An evaluation may be made for a group of agents that have been evaluated by
13                     the Working  Group. In addition, when supporting data indicate that other related
14                     agents, for which there is no  direct evidence of their capacity to induce cancer in
15                     humans or in animals, may also be carcinogenic, a statement describing the
16                     rationale for this conclusion is added to the evaluation narrative; an additional
17                     evaluation may be made for this broader group of agents if the strength of the
18                     evidence warrants it.

19                     The agent is described according to the wording of one of the following
20                     categories, and the designated group is given. The  categorization of an agent is
21                     a matter of scientific judgement that reflects the strength of the evidence derived
22                     from studies in humans and in experimental animals and from  mechanistic and
23                     other relevant data.

24                     Group 1: The agent is carcinogenic to humans.

25                     This category is used when there is sufficient evidence of carcinogenicity in
26                     humans. Exceptionally, an agent may be placed in this category when evidence
27                     of carcinogenicity in humans is less than sufficient but there is  sufficient
28                     evidence of carcinogenicity in experimental animals and strong evidence in
29                     exposed humans that the agent acts through a relevant mechanism of
3 0                     carcinogenicity.

31                     Group 2.

32                     This category includes agents for which, at one extreme, the degree of evidence
33                     of carcinogenicity in humans is almost sufficient, as well as those  for which, at
34                     the other extreme, there are no human data but for which there is evidence of
3 5                     carcinogenicity in experimental animals.  Agents are assigned to either Group
36                     2A (probably carcinogenic to humans) or Group 2B (possibly carcinogenic to
3 7                     humans) on the basis of epidemiological and experimental evidence of
3 8                     carcinogenicity and mechanistic and other relevant data. The terms probably
39                     carcinogenic and possibly carcinogenic have no quantitative significance and
40                     are used simply as descriptors of different levels of evidence of human
41                     carcinogenicity, with probably carcinogenic signifying a higher level of
42                     evidence than possibly carcinogenic.
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  1                     Group 2A: The agent improbably carcinogenic to humans.

  2                     This category is used when there is limited evidence of carcinogenicity in
  3                     humans and sufficient evidence of carcinogenicity in experimental animals.  In
  4                     some cases, an agent may be classified in this category when there is inadequate
  5                     evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity
  6                     in experimental animals and strong evidence that the carcinogenesis is mediated
  7                     by a mechanism that also operates in humans. Exceptionally, an agent may be
  8                     classified in this category solely on the basis of limited evidence of
  9                     carcinogenicity in humans. An agent may be assigned to this category if it
10                     clearly belongs, based on mechanistic considerations, to a class of agents for
11                     which one or more members  have been classified in Group 1 or Group 2A.

12                     Group 2B: The agent is possibly carcinogenic to humans.

13                     This category is used for agents for which there  is limited evidence of
14                     carcinogenicity in humans and less than sufficient evidence of carcinogenicity in
15                     experimental animals. It may also be used when there is inadequate evidence of
16                     carcinogenicity in humans but there is sufficient evidence of carcinogenicity in
17                     experimental animals. In some instances, an agent for which there is inadequate
18                     evidence of carcinogenicity in humans and less than sufficient evidence of
19                     carcinogenicity in experimental animals together with supporting evidence from
20                     mechanistic and other relevant data may be placed in this group. An agent may
21                     be classified in this category  solely on the basis  of strong evidence from
22                     mechanistic and other relevant data.

23                     Group 3: The agent is not classifiable as to its carcinogenicity to humans.

24                     This category is used most commonly for agents for which the evidence of
25                     carcinogenicity is inadequate in humans and inadequate or limited in
26                     experimental animals.

27                     Exceptionally, agents for which the evidence of carcinogenicity is inadequate in
28                     humans but sufficient in experimental animals may be placed in this category
29                     when there is strong evidence that the mechanism of carcinogenicity in
3 0                     experimental animals does not operate in humans.

31                     Agents that do not fall into any other group are also placed in this category.

32                     An evaluation in Group  3 is not a determination of non-carcinogenicity or
33                     overall safety. It often means that further research is needed, especially when
34                     exposures are widespread or the cancer data are  consistent with differing
3 5                     interpretations.

36                     Group 4: The agent improbably not carcinogenic to humans.

3 7                     This category is used for agents for which there  is evidence suggesting lack of
3 8                     carcinogenicity in humans and in experimental animals. In some instances,
3 9                     agents for which there is inadequate evidence of carcinogenicity in humans but
40                     evidence suggesting lack of carcinogenicity in experimental animals,
41                     consistently and strongly supported by a broad range of mechanistic and other
42                     relevant data, may be classified in this group.
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  1                    (e) Rationale

  2                    The reasoning that the Working Group used to reach its evaluation is presented
  3                    and discussed. This section integrates the major findings from studies of cancer
  4                    in humans, studies of cancer in experimental animals, and mechanistic and other
  5                    relevant data. It includes concise statements of the principal line(s) of argument
  6                    that emerged, the conclusions of the Working Group on the strength of the
  7                    evidence for each group of studies, citations to indicate which studies were
  8                    pivotal to these conclusions, and an explanation of the reasoning of the Working
  9                    Group in weighing data and making evaluations. When there are significant
10                    differences of scientific interpretation among Working Group Members, a brief
11                    summary of the alternative interpretations is provided, together with their
12                    scientific rationale and an indication of the relative degree of support for each
13                    alternative.

14
15     AX1.4.2.6  National Toxicology Program Criteria

16
17            The criteria for listing  an agent, substance, mixture, or exposure circumstance in the

18     National Toxicology Program's Report on Carcinogens (NTP, 2005) are as follows:


19                    Known To Be Human Carcinogen:

20                    There is sufficient evidence of carcinogenicity from studies in humans*, which
21                    indicates a causal  relationship between exposure to the agent, substance, or
22                    mixture, and human cancer.

23                    Reasonably Anticipated To Be Human Carcinogen:

24                    There is limited evidence of carcinogenicity from studies in humans*, which
25                    indicates that causal interpretation is credible, but that alternative explanations,
26                    such as chance, bias, or confounding factors, could not adequately be excluded,
27
33
                      or
28                    there is sufficient evidence of carcinogenicity from studies in experimental
29                    animals, which indicates there is an increased incidence of malignant and/or a
3 0                    combination of malignant and benign tumors (1) in multiple species or at
31                    multiple tissue sites, or (2) by multiple routes of exposure, or (3) to an unusual
32                    degree with regard to incidence, site, or type of tumor, or age at onset,
                      or
34                    there is less than sufficient evidence of carcinogenicity in humans or laboratory
3 5                    animals; however, the agent, substance, or mixture belongs to a well-defined,
3 6                    structurally related class of substances whose members are listed in a previous
3 7                    Report on Carcinogens as either known to be a human carcinogen or reasonably
3 8                    anticipated to be a human carcinogen, or there is convincing relevant
3 9                    information that the agent acts through mechanisms indicating it would likely
40                    cause cancer in humans.

41                    Conclusions regarding carcinogenicity in humans or experimental animals are
42                    based on scientific judgment, with consideration given to all relevant
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 1                    information. Relevant information includes, but is not limited to, dose response,
 2                    route of exposure, chemical structure, metabolism, pharmacokinetics, sensitive
 3                    sub-populations, genetic effects, or other data relating to mechanism of action or
 4                    factors that may be unique to a given substance. For example, there may be
 5                    substances for which there is evidence of carcinogenicity in laboratory animals,
 6                    but there are compelling data indicating that the agent acts through mechanisms
 7                    which do not operate in humans and would therefore not reasonably be
 8                    anticipated to cause cancer in humans.

 9                    This evidence  can include traditional cancer epidemiology studies, data from
10                    clinical studies, and/or data derived from the study of tissues or cells from
11                    humans exposed to the substance in question that can be useful for evaluating
12                    whether a relevant cancer mechanism is operating in people.
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    TABLE AX1.3-1.  LITERATURE SEARCH STRATEGY FOR EPIDEMIOLOGIC
	STUDIES: EXAMPLES OF KEYWORDS	
                         Search engines used include: MEDLINE, BIOSYS,...
 Search Key Word Examples:
 Nitrogen Oxides or Nitric Acid or Nitrous Oxide or Nitrogen Dioxide or Nitrogen Tetroxide or Nitrogen Trioxide
 or NOX or NO2 or HNO3 or Peroxyacetyl Nitrate or HNO4 or NO3 or N2O5 or Pan or Ch3COOONO2 or HNO2 or
 HONO or Organic Nitrate or Peroxynitric Acid or Nitrogen Pentoxide or Nitrous Acid

 Mortality or Epidemiologic Studies or Hospitals

 Asthma or Bronchial Hyperactivity or Lung Diseases, Obstructive or Respiratory Hypersensitivity and
 Immunology, Respiratory Tract Diseases or Respiratory Tract Infections, Lung Infection or Respiratory Disease
 or Respiratory System

 Neoplasm or Neoplastic or Cancer or Carcinogen, Mutation or Chromosome Aberrations or Mutagenicity Tests

 Pregnancy Complication or Prenatal Exposure or Delayed Effects or Teratogens	
            TABLE AX1.3-2.  LITERATURE SEARCH STRATEGY FOR THE
	ATMOSPHERIC SCIENCES	

                                 Search Engine:  Web of Knowledge
 Search Key Words:
 Exposure and (NO2 or NO or Nitrogen Dioxide or Nitrogen Oxide(s) or Nitrous Oxide or Oxide(s) of Nitrogen or
 HNO3 or HONO or Nitric Acid or Nitrous Acid or PAN(s) or Nitro-PAH(s) or NO3 Radical)

 Indoor and (NO2 or NO or Nitrogen Dioxide or Nitrogen Oxide(s) or Nitrous Oxide or Oxide(s) of Nitrogen or
 HNO3 or HONO or Nitric Acid or Nitrous Acid or PAN(s) or Nitro-PAH(s) or NO3 Radical)

 (Source Apportionment or Source(s) or PMF or CMB or Receptor Model) and (NO2 or NO or Nitrogen Dioxide
 or Nitrogen Oxide(s) or Nitrous Oxide or Oxide(s) of Nitrogen or HNO3 or HONO or Nitric Acid or Nitrous Acid
 or PAN(s) or Nitro-PAH(s) or NO3 Radical)

 (Traffic or Street Canyon) and (NO2 or NO or Nitrogen Dioxide or Nitrogen Oxide(s) or Nitrous Oxide or
 Oxide(s) of Nitrogen or HNO3 or HONO or Nitric Acid or Nitrous Acid or PAN(s) or Nitro-PAH(s) or NO3
 Radical)

 Sampler and (NO2 or NO or Nitrogen Dioxide or Nitrogen Oxide(s) or Nitrous Oxide or Oxide(s) of Nitrogen or
 HNO3 or HONO or Nitric Acid or Nitrous Acid or PAN(s) or Nitro-PAH(s) or NO3 Radical)
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26          Washington, DC: U.S. Environmental Protection Agency, Clean Air Scientific Advisory
27          Committee; EPA-SAB-CASAC-LTR-96-008; June 13.
28   Yerushalmy, J.; Palmer, C. E. (1959) On the methodology of investigations of etiologic factors
29          in chronic diseases. J. Chronic Dis. 10: 27-40.
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 i            AX2.  CHAPTER 2 ANNEX-ATMOSPHERIC
 2       CHEMISTRY OF NITROGEN AND SULFUR OXIDES
 o
 4
 5   AX2.1    INTRODUCTION
 6          Nitrogen oxides (NOX) along with volatile organic compounds (VOCs) including
 7   anthropogenic and biogenic hydrocarbons, aldehydes, etc. and carbon monoxide (CO) serve as
 8   precursors in the formation of ozone (O3) and other elements of photochemical smog. Nitrogen
 9   oxides are defined here as nitric oxide (NO) and nitrogen dioxide (NO2), the latter of which is a
10   U.S. EPA Air Pollutant; similarly, oxides of sulfur (SOx) are defined here to be sulfur monoxide
11   (SO), sulfur dioxide (802), the largest component of SOx and also a U.S. EPA Criteria Air
12   Pollutant, and sulfur trioxide (SO3).  SO3 rapidly reacts with water vapor to form H2SO4, and
13   only SO2 is present in the atmosphere at detectable levels.
14          Nitrogen dioxide is an oxidant and can further react to form other photochemical
15   oxidants, in particular the organic nitrates, including peroxy acetyl nitrates (PAN) and higher
16   PAN analogues. It can also react with toxic compounds such as poly cyclic aromatic
17   hydrocarbons (PAHs) to form nitro-PAHs, which may be even more toxic than the precursors.
18   Nitrogen dioxide together with sulfur dioxide (802), another U.S. EPA criteria air pollutant, can
19   be oxidized to the strong mineral acids, nitric acid (HNO3) and sulfuric acid (H2SO4), which
20   contribute to the acidity of cloud, fog, and rainwater,  and can form ambient particles.
21          The role of NOx in O3 formation was reviewed in Chapter 2 (Section 2.2) of the latest
22   AQCD for Ozone and Other Photochemical Oxidants (U.S. Environmental Protection Agency,
23   2006 CD06), and in numerous texts (e.g., Seinfeld and Pandis, 1998; Jacob, 2000; Jacobson,
24   2002). Mechanisms for transporting O3 precursors, the factors controlling the efficiency of O3
25   production from NOx, methods for calculating O3 from its precursors, and methods for
26   measuring NOx were all reviewed in Section 2.6 of CD06. The main points from those
27   discussions in CD06 and updates, based on new materials will be presented here. Ammonia
28   (NH3) is included here because its oxidation can be a source of NOx, and it is a precursor for
29   ammonium ions (NH4+), which play a key role in neutralizing acidity in ambient particles and in
30   cloud, fog, and rain water. Ammonia is also involved in the ternary nucleation of new particles,
31   and it reacts with gaseous HNO3 to form ammonium nitrate (NH4NO3), which is a major
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 1    constituent of ambient Parti culate Matter (PM) in many areas.  Ammonia is also involved in over
 2    nitrification of aqueous and terrestrial ecosystems and participates in the N cascade (Galloway
 3    et al., 2003)
 4          The atmospheric chemistry of NOx is discussed in Section AX2.2, and of SC>2 in Section
 5    AX2.3. Mechanisms for the formation of aqueous-phase sulfate (SC>42 ) and nitrate (NOs ) are
 6    reviewed in Section AX2.4. Sources and emissions of NOx, NHa, and SC>2 are discussed in
 7    Section AX2.5. Modeling methods used to calculate the atmospheric chemistry, transport, and
 8    fate of NOx and SO2 and their oxidation products are presented in Section AX2.6. Measurement
 9    techniques for the nitrogen-containing compounds and for SO2, nitrates, sulfates, and ammonium
10    ion are discussed in Section AX2.8. Estimates of policy-relevant background concentrations of
1 1    NOx and SOx are given in Section AX2.9. An overall review of key points in this chapter is
12    given in Section AX2. 1 1 .
13          The overall chemistry of reactive nitrogen compounds in the atmosphere is summarized
14    in Figure AX2.2-1 and is described in greater detail in the following sections. Nitrogen oxides
15    are emitted primarily as NO with smaller quantities of NO2.  Emissions of NOx are spatially
16    distributed vertically with some occurring at or near ground level and others aloft as indicated  in
17    Figure AX2.2-1. Because  of atmospheric chemical reactions, the relative abundance of different
18    compounds contributed by different sources varies with location. Both anthropogenic and
19    natural (biogenic) processes emit NOX.  In addition to gas phase reactions, multiphase processes
20    are important for forming aerosol-phase pollutants, including aerosol
21
22
23   AX2.2     CHEMISTRY OF NITROGEN OXIDES IN THE TROPOSPHERE
24
25   AX2.2.1    Basic Chemistry
26          There is a rapid photochemical cycle in the troposphere that involves photolysis of NO2
27   by solar UV-A radiation to yield NO and a ground-state oxygen atom, O(3P)
28                                                                                 (AX2M)
29    This ground-state oxygen atom can then combine with molecular oxygen (©2) to form Os; and,
30    colliding with any molecule from the surrounding air (M = N2, 62, etc.), the newly formed Os
3 1    molecule, transfers excess energy and is stabilized

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                                                   Long range transport to remote
                                                   regions at low  temperatures


                                                           ; PAH__^ nitro.pAHs
                                                                  R-C=C R
                                                                         >• RONO.
                                                                nitrosamines,
                                                                nitro-phenols, etc.
                                                                >-RONO,
                                                                    deposition
                                              emissions
Figure AX2.2-1.
                        Schematic diagram of the cycle of reactive nitrogen species in the
                        atmosphere. MPP refers to multi-phase process; hv to a photon of
                        solar energy.
                                                                           (AX2.2-2)
5
6
7
8
9
where M = N2, 62. Reaction AX2.2-2 is the only significant reaction forming Oj in the
troposphere.
      NO and 63 react to reform
                                                                           (AX2.2-3)
                               NO + O3 -> M?2 + O2

Reaction AX2.2-3 is responsible for O3 decreases and NO2 increases found near sources of NO
(e.g., highways), especially at night when the actinic flux is 0.  Oxidation of reactive VOCs leads
to the formation of reactive radical species that allow the conversion of NO to NO2 without the
participation of Os (as in Reaction AX2.2-3)
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                                      „„  HO,,RO,
                                      N°     ~    •
 1                                                                               (AX2.2-4)
 2          Ozone, therefore, can accumulate as NO2 photolyzes as in Reaction AX2.2-1, followed
 3   by Reaction AX2.2-2.  Specific mechanisms for the oxidation of a number of VOCs were
 4   discussed in the Os AQCD (U.S. Environmental Protection Agency, 2006).
 5          It is often convenient to speak about families of chemical species defined in terms of
 6   members that interconvert rapidly among themselves on time scales that are shorter than those
 7   for formation or destruction of the family as a whole. For example, an "odd oxygen" (Ox)
 8   family can be defined as
 9                            Ox = I(0(-lP) + 0('D) + 03 + N02)                 (AX2.2-5)
10   In much the same way, NOX is sometimes referred to as "odd nitrogen".  Hence, we see that
1 1   production of Ox occurs by the schematic Reaction AX2.2-4, and that the sequence of reactions
12   given by reactions AX2.2-1 through AX2.2-3 represents no net production of Ox.  Definitions of
13   species families and methods for constructing families are discussed in Jacobson (1999) and
14   references therein.  Other families that include nitrogen-containing species (and which will be
1 5   referred to later in this chapter) include:
                                                                                 (AX22_6)
17   One can then see that production of Ox occurs by the schematic Reaction AX2.2-4, and that the
18   sequence of reactions given by reactions AX2.2-1 through AX2.2-3 represents no net production
19   of Ox. Definitions of species families and methods for constructing families are discussed in
20   Jacobson (1999) and references therein. Other families that include nitrogen-containing species,
21   and which will be referred to later in this chapter, are: (which is the sum of the products of the
22   oxidation of NOX)

        NOZ = X HNO3 + HNO4  + NO3 + 2NO2O5 + PAN(CH3CHO - OO - NO2) + other
23      organic nitrates + halogen nitrates + paniculate nitrate)
                                  NOY = NOX + NO2 + HONO;
24                                 and NHX = NH3 + NH4 +                     (AX2.2-7)
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            The reaction of NO2 with O3 leads to the formation of N(V radical
 3    However, because the NOs radical photolyzes rapidly (lifetime of ~5 s during the
 4    photochemically most active period of the day around local solar noon (Atkinson et al., 1992),
                                                                                  (AX2.2-9a)

 6                                      "^ '  ^v ' '(yuyf°)                        (AX2.2-9b)
 7    its concentration remains low during daylight hours, but can increase after sunset to nighttime
 8    concentrations of <5 x 107 to 1 x 1010 molecules cm"3 (<2 to 430 parts per trillion (ppt)) over
 9    continental areas influenced by anthropogenic emissions of NOx (Atkinson et al., 1986). At
10    night, NOs, rather than the hydroxyl radical (OH), is the primary oxidant in the system.
11    Nitrate radicals can combine with NO2 to form dinitrogen pentoxide (N2Os)
                                                    M  . « r /-i
12                                     ~*     ^2        '";~:>                    (AX2.2-10)
13    and N2Os both photolyzes and thermally decomposes back to NO2 and NOs during the day;
14    however, N2Os concentrations ([N2Os]) can accumulate during the night to parts per billion (ppb)
15    levels in polluted urban atmospheres.
16          The tropospheric chemical removal processes for NOx include reaction of NO2 with the
17    OH radical and hydrolysis of N2Os in aqueous aerosol solutions if there is no organic coating.
18    Both of these reactions produce
19                                            23                    (AX22_n)
20                                      25
21          The gas-phase reaction of the OH radical with NO2 (Reaction AX2.2-1 1) initiates one of
22    the major and ultimate removal processes for NOx in the troposphere. This reaction removes
23    OH and NO2 radicals and competes with hydrocarbons for OH radicals in areas characterized by
24    high NOx concentrations, such as urban centers (see Section AX2.2.2). The timescale (T) for
25    conversion of NOX to HNO3 in the planetary boundary layer at 40 N latitude ranges from about

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 1    4 hours in July to about 16 hours in January. The corresponding range in T at 25 N latitude is
 2    between 4 and 5 hours, while at 50 N latitude, HNOs T ranges from about 4 to 20 hours (Martin
 3    et al., 2003).  In addition to gas-phase HNO3, Golden and Smith (2000) have shown on the basis
 4    of theoretical studies that pernitrous acid (HOONO) is also produced by the reaction of NC>2 and
 5    OH radicals.  However, this channel of production most likely represents a minor yield
 6    (approximately 15% at the surface) (Jet Propulsion Laboratory, 2003). Pernitrous acid will also
 7    thermally decompose and can photolyze. Gas-phase HNOs formed from Reaction AX2.2-1 1
 8    undergoes wet and dry deposition to the surface, and uptake by ambient aerosol particles.
 9    Reaction AX2.2-1 1 limits NOx T to a range of hours to days.
10          In addition to the uptake of HNOs on particles and in cloud drops, it photolyzes and
1 1    reacts with OH radicals via
12
13    and
14                                 HN03 + OH^ N03 + H20                    (AX2.2-14)
15    The lifetime of HNOs with respect to these two reactions is long enough for HNOs to act as a
16    reservoir species for NOx during long-range transport, contributing in this way to NO2 levels and
17    to Os formation in areas remote from the source region of the NOx that formed this HNOs.
1 8          Geyer and Platt (2002) concluded that Reaction AX2 .2- 1 2 constituted about 1 0% of the
19    removal of NOx at a site near Berlin, Germany during spring and summer.  However, other
20    studies found a larger contribution to HNOs production from Reaction AX2.2-12. Dentener and
21    Crutzen (1993) estimated 20% in summer and 80% of HNOs production in winter is from
22    Reaction AX2.2-12.  Tonnesen and Dennis (2000) found between 16 to 3 1% of summer HNO3
23    production was from Reaction AX2.2-12. The contribution of Reaction AX2.2-12 to HNO3
24    formation is highly uncertain during both winter and summer. The importance of Reaction
25    AX2.2-12 could be much higher during winter than during summer because of the much lower
26    concentration of OH radicals and the enhanced stability of ^Os due to lower temperatures and
27    less sunlight. Note that Reaction AX2. 2-12 proceeds as a heterogeneous reaction. Recent work
28    in the northeastern United States indicates that this reaction is proceeds at a faster rate in power
29    plant plumes than in urban plumes (Brown et al., 2006a,b; Frost et al., 2006).

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 1          OH radicals also can react with NO to produce nitrous acid (HONO or HNO2)
 2                                                                                (AX22.15)
 3    In the daytime, HNO2 is rapidly photolyzed back to the original reactants
 5          Reaction AX2.2-15 is, however, a negligible source of HONO, which is formed mainly
 6    by multiphase processes (see Section AX2.2.3). At night, heterogeneous reactions of NO2 in
 7    aerosols or at the earth's surface result in accumulation of HONO (Lammel and Cape, 1996;
 8    Jacob, 2000; Sakamaki et al., 1983; Pitts et al., 1984; Svensson et al., 1987; Jenkin et al., 1988;
 9    Lammel and Perner, 1988; Notholt et al., 1992a,b). Harris et al. (1982) (e.g.) suggested that
10    photolysis of this HNO2 at sunrise could provide an important early-morning source of OH
1 1    radicals to drive Os formation.
12          Hydroperoxy (HO2) radicals can react with NO2 to produce pernitric acid (HNO4)

13                                HO 2 + NO2 + M^> HNO4 + M                      2 2

14    which then can thermally decompose and photolyze back to its original reactants. The acids
15    formed in these gas-phase reactions are all water soluble.  Hence, they can be incorporated into
16    cloud drops and in the aqueous phase of particles.
17          Although the lifetimes of HNO4 and N2O5  are short (minutes to hours) during typical
18    summer conditions, they can be much longer at the lower temperatures and darkness found
19    during the polar night.  Under these conditions, species such as PAN, HNOs, HNO/t,  and ^Os
20    serve as NOx reservoirs that can liberate NO2 upon the return of sunlight during the polar spring.
21    A broad range of organic nitrogen compounds can be directly emitted by combustion sources or
22    formed in the atmosphere from NOx emissions. Organic nitrogen compounds include the PANs,
23    nitrosamines, nitro-PAHs, and the more recently identified nitrated organics in the quinone
24    family. Oxidation of VOCs produces organic peroxy radicals (RO2), as discussed in the latest
25    AQCD for Ozone and Other Photochemical Oxidants (U.S. Environmental Protection Agency,
26    2006). Reaction of RO2 radicals with NO and NO2 produces organic nitrates (RONO2) and
27    peroxynitrates (RO2NO2)
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                                                                              (AX2.2-18)
 2                               R02 + N02    M   »R02N02                  (AX2

 3          Reaction (AX2.2-18) is a minor branch for the reaction of RO2 with NO. The major
 4   branch produces RO and NO2, as discussed in the next section; however, the organic nitrate yield
 5   increases with carbon number (Atkinson, 2000).
 6          The most important of these organic nitrates is PAN, the dominant member of the
 7   broader family of peroxyacylnitrates which includes peroxypropionyl nitrate (PPN) of
 8   anthropogenic origin and peroxymethacrylic nitrate (MPAN) produced from isoprene oxidation.
 9   The PANs are formed by the combination reaction of acetyl peroxy radicals with NO2

1Q                        CH3C(0)-00 + N02 -> CH3C(0)OON02            (AX2.2-20)
11   where the acetyl peroxy radicals are formed mainly during the oxidation of ethane (^He).
12   Acetaldehyde (CHsCHO) is formed as an intermediate species during the  oxidation of ethane.
13   Acetaldehyde can be photolyzed or react with OH radicals to yield acetyl  radicals

14                           CH3-C(0)H + hv -> CH3-C(0) + H              (AX2.2-21)
15                         CH3-C(0)H +OH^> CH3-C(0) + H2O            (AX2.2-22)
16   Acetyl radicals then react with O2 to yield acetyl peroxy radicals

1?                        CH3-C(0) + 02 + M^ CH3C(0}-00 + M

18   However, acetyl peroxy radicals will react with NO in areas of high NO concentrations

                          CH3(CO)-00 + NO -> C//5(C0)-0 + N02
                                                                              (AX2.2-24)
20   and the acetyl-oxy radicals will then decompose

21                               CH3(CO)-0 -> CH3 + C02                  (AX2.2-25)
22   Thus, the formation of PAN is favored at conditions of high ratios of NO2 to NO, which are most
23   typically found under low NOx conditions.  The PANs both thermally decompose and photolyze

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 1   back to their reactants on timescales of a few hours during warm sunlit conditions, with lifetimes
 2   with respect to thermal decomposition ranging from ~1 hour at 298 K to -2.5 days at 273 K, up
 3   to several weeks at 250 K.  Thus, they can provide an effective sink of NOX at cold temperatures
 4   and high solar zenith angles, allowing release of NC>2 as air masses warm, in particular by
 5   subsidence. The PANs are also removed by uptake to vegetation (Sparks et al., 2003;
 6   Teklemariam and Sparks, 2004).
 7          The organic nitrates may react further, depending on the functionality of the R group, but
 8   they will typically not return NOx and can therefore be viewed mainly as a permanent sink for
 9   NOx, as alkyl nitrates are sparingly soluble and will photolyze. This sink is usually small
10   compared to HNOs formation, but the formation of isoprene nitrates may be a significant sink for
11   NOX in the United States in summer (Liang et al., 1998).
12          The peroxynitrates produced by AX2.2-19 are thermally unstable and most have very
13   short lifetimes (less than a few minutes) owing to thermal decomposition back to the original
14   reactants. They are thus not effective sinks of NOx.
15
16   AX2.2.2   Nonlinear Relations between Nitrogen Oxide Concentrations and
17               Ozone Formation
18          Ozone is unlike some other species whose rates of formation vary directly with the
19   emissions of their precursors in that Os production (P(Os)) changes nonlinearly with the
20   concentrations of its precursors.  At the low NOx concentrations found in most environments,
21   ranging from remote continental areas to rural and suburban areas downwind of urban centers,
22   the net production of Os  increases with increasing NOx. At the high NOx concentrations found
23   in downtown metropolitan  areas, especially near busy streets and roadways, and in power plant
24   plumes, there is net destruction of O3 by (titration) reaction with NO.  Between these two
25   regimes is a transition stage in which O3 shows only  a weak dependence on NOx concentrations.
26   In the high NOx regime, NO2 scavenges OH  radicals which would otherwise oxidize VOCs to
27   produce peroxy radicals, which in turn would oxidize NO to NO2.  In the low NOx regime, VOV
28   (VOC) oxidation generates, or at least does not consume, free radicals, and O3 production varies
29   directly with NOx. Sometimes the terms ' VOC-limited' and 'NOx-limited' are used to describe
30   these two regimes. However, there are difficulties with this usage  because:  (l)VOC
31   measurements are not as abundant as they are for NOx, (2) rate coefficients for reaction of
32   individual VOCs with free  radicals vary over an extremely wide range, and (3) consideration is

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 1    not given to CO nor to reactions that can produce free radicals without invoking VOCs. The
 2    terms NOx-limited and NOx-saturated (used by, e.g., Jaegle et al., 2001) will be used wherever
 3    possible to describe these two regimes more adequately. However, the terminology used in
 4    original articles will also be kept.  The chemistry of OH radicals, which are responsible for
 5    initiating the oxidation of hydrocarbons, shows behavior similar to that for Os with respect to
 6    NOx concentrations (Hameed et al., 1979; Pinto et al., 1993; Poppe et al., 1993; Zimmerman and
 7    Poppe, 1993).  These considerations introduce a high degree of uncertainty into attempts to relate
 8    changes in Os concentrations to emissions of precursors. It should also be noted at the outset that
 9    in a NOx-limited (or NOx-sensitive) regime, Os formation is not insensitive to radical production
10    or the  flux of solar UV photons, just that Os formation is more sensitive to NOx.  For example,
11    global tropospheric O3 is sensitive to the concentration of CH4 even though the troposphere is
12    predominantly NOx-limited.
13          Various analytical techniques have been proposed that use ambient NOx and VOC
14    measurements to derive information about Os production and Os-NOx-VOC sensitivity.
15    Previously (e.g., National Research Council, 1991), it was suggested that Os formation in
16    individual urban areas could be understood in terms of measurements of ambient NOx and VOC
17    concentrations during the early morning. In this approach, the ratio of summed (unweighted by
18    chemical reactivity) VOC to NOx concentrations is used to determine whether conditions are
19    NOx-sensitive or VOC sensitive. This technique is inadequate to characterize  Os formation
20    because it omits many factors recognized as important for P(O3), including: the effect of
21    biogenic VOCs (which are not present in urban centers during early morning); important
22    individual differences in the ability of VOCs to generate free radicals, rather than just from total
23    VOC concentration and other differences in Os-forming potential for individual VOCs (Carter,
24    1995); the effect of multiday transport; and general changes in photochemistry as air moves
25    downwind from urban areas (Milford et al., 1994).
26          Jacob et al. (1995) used a combination of field measurements and a chemical transport
27    model (CTM) to show that the formation of Os changed from NOx-limited to NOx-saturated as
28    the season changed from summer to fall at a monitoring site in Shenandoah National Park, VA.
29    Photochemical production of Os generally occurs together with production of various other
30    species including HNOs, organic nitrates, and hydrogen peroxide (^02). The relative rates of
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           and the production of other species varies depending on photochemical conditions, and can
 2    be used to provide information about (Vprecursor sensitivity.
 3          There are no hard and fast rules governing the levels of NOx at which the transition from
 4    NOx-limited to NOx-saturated conditions occurs. The transition between these two regimes is
 5    highly spatially and temporally dependent. In the upper troposphere, responses to NOx additions
 6    from commercial aircraft have been found which are very similar to these in the lower
 7    troposphere (Briihl et al., 2000).  Briihl et al. (2000) found that the NOX levels for O3 production
 8    versus loss are highly sensitive to the radical sources included in model calculations. They found
 9    that inclusion of only CH4 and CO oxidation leads to a decrease in net O3 production in the
10    North Atlantic flight corridor due to NO emissions from aircraft. However, the additional
11    inclusion of acetone photolysis was found to shift the maximum in O3 production to higher NOX
12    mixing ratios, thereby reducing or eliminating areas in which  O3 production rates decreased due
13    to aircraft emissions.
14          Trainer et al. (1993) suggested that the slope of the regression line between O3 and
15    summed NOx oxidation products (NOz, equal to the difference between measured total reactive
16    nitrogen, NOy, and NOx) can be used to estimate the rate of P(O3) per NOx (also known as the
17    O3 production efficiency, or OPE).  Ryerson et al. (1998, 2001) used measured correlations
18    between O3 and NOz to identify different rates of O3 production in plumes from large point
19    sources.
20          Sillman (1995)  and Sillman and He (2002) identified several secondary reaction products
21    that show different correlation patterns for NOx-limited  conditions and NOx-saturated
22    conditions. The most important correlations are for O3 versus NOy, O3 versus NOz, O3 versus
23    HNO3, and H2O2 versus HNO3. The correlations between O3  and NOy, and O3 and NOz are
24    especially important because measurements of NOy and NOx are widely available.  Measured O3
25    versus NOz (Figure AX2.2-2) shows distinctly different patterns in different locations.  In rural
26    areas and in urban areas such as Nashville, TN, O3 shows a strong correlation with NOz and a
27    relatively steep slope to the regression line. By contrast, in Los Angeles  O3 also increases with
28    NOZ, but the rate of increase of O3 with NOZ is lower and the O3 concentrations for a given NOZ
29    value are generally lower.
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     Figure AX2.2-2.
                                                  x
                                                               X
                                                               X
                                                       X  X
                                                                   X
                                      10
                          20
                      NOZ (ppb)
       30
                                                                           x
40
Measured values of Os and NOz (NOy - NOx) during the afternoon at
rural sites in the eastern United States (gray circles) and in urban
areas and urban plumes associated with Nashville, TN (gray dashes),
Paris, FR (black diamonds) and Los Angeles, CA (X's)
 1          The difference between NOx-limited and NOx-saturated regimes is also reflected in
 2   measurements of H2O2. Formation of H2O2 takes place by self-reaction of photochemically
 3   generated HC>2 radicals, so that there is large seasonal variation of H2O2 concentrations, and
 4   values in excess of 1 ppb are mainly limited to the summer months when photochemistry is more
 5   active (Kleinman, 1991). Hydrogen peroxide is produced in abundance only when 63 is
 6   produced under NOx-limited conditions. When the photochemistry is NOx-saturated, much less
 7   H2O2 is produced. In addition, increasing NOx tends to slow the formation of H2O2 under NOx-
 8   limited conditions. Differences between these two regimes are also related to the preferential
 9   formation of sulfate during summer and to the inhibition of sulfate and hydrogen peroxide during
10   winter (Stein and Lamb, 2003).  Measurements in the rural eastern United States (Jacob et al.,
11   1995), at Nashville (Sillman et al., 1998), and at Los Angeles (Sakugawa and Kaplan, 1989)
12   show large differences in H2O2 concentrations likely due to differences in NOx availability at
13   these locations.
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 1    AX2.2.3    Multiphase Chemistry Involving NOX
 2          Recent laboratory studies on sulfate and organic aerosols indicate that the reaction
 3    probability yN2O5 is in the range of 0.01 to 0.05 (Kane et al., 2001; Hallquist et al., 2003;
 4    Thornton et al., 2003).  Tie et al. (2003) found that a value of 0.04 in their global model gave the
 5    best simulation of observed NOx concentrations over the Arctic in winter.
 6          Using aircraft measurements over the northeastern United States, Brown et al. (2006b)
 7    found that the uptake coefficient for N2Os, yN2Os, on the surfaces of particles depends strongly
 8    on their sulfate content.  They found that yN2Os was highest (0.017) in regions where the aerosol
 9    sulfate concentration was highest and lower elsewhere (<0.0016). This result contrasts with that
10    of Dentener and Crutzen (1993) who concluded that yN2Os would be independent of aerosol
11    composition, based on a value for yN2Os of 0.1, implying that the heterogeneous hydrolysis of
12    N2O5 would be saturated for typical ambient aerosol surface areas. The importance of this
13    reaction to tropospheric chemistry depends on the value of yN2Os. If it is 0.01 or lower, there
14    may be difficulty in explaining the loss of NOy and the formation of aerosol nitrate, especially
15    during winter. A decrease in N2Os slows down the removal of NOx by leaving more NO2
16    available for reaction and thus increases Os production. Based on the consistency between
17    measurements of NOy partitioning and gas-phase models, Jacob (2000) considers it unlikely that
18    HNOs is recycled to NOx in the lower troposphere in significant concentrations.  However, only
19    one of the reviewed studies (Schultz et al., 2000) was conducted in the marine troposphere and
20    none was conducted in the MBL. An investigation over the equatorial Pacific reported
21    discrepancies between observations and theory (Singh et al., 1996) which might be explained by
22    HNOs recycling. It is important to recognize that both Schultz et al. (2000) and Singh et al.
23    (1996) involved aircraft sampling at altitude which, in the MBL, can significantly under-
24    represent sea salt aerosols and thus most total NOs (defined to be HNOs + NOs ) and large
25    fractions of NOy in marine air (e.g., Huebert et al., 1996). Consequently, some caution is
26    warranted when interpreting constituent ratios and NOy budgets based on such  data.
27          Recent work in the Arctic has  quantified significant photochemical recycling of NOs to
28    NOX and attendant perturbations of OH chemistry in snow (Honrath et al.,  2000; Dibb et al.,
29    2002; Domine and Shepson, 2002) which suggest the possibility that similar multiphase
30    pathways could occur in aerosols. As mentioned above, NOs  is photolytically reduced to NO2
31    (Zafiriou and True,  1979) in acidic sea salt solutions (Anastasio et al., 1999). Further photolytic

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 1    reduction of NO2 to NO (Zafiriou and True, 1979) could provide a possible mechanism for
 2    HNOs recycling.  Early experiments reported production of NOx during the irradiation of
 3    artificial seawater concentrates containing NOs (Petriconi and Papee, 1972). Based on the
 4    above, HNOs recycling in sea salt aerosols is potentially important and warrants further
 5    investigation. Other possible recycling pathways involving highly acidic aerosol solutions and
 6    soot are reviewed by Jacob (2000).
 7           Stemmler et al. (2006) studied the photosensitized reduction of NO2 to HONO on humic
 8    acid films using radiation in the UV-A through the visible spectral regions. They also found
 9    evidence for reduction occurring in the dark, reactions which may occur involving surfaces
10    containing partly  oxidized aromatic structures. For example, Simpson et al. (2006) found that
11    aromatic compounds constituted -20% of organic films coating windows in downtown Toronto.
12    They calculated production rates of HONO that are compatible with observations of high HONO
13    levels in a variety of environments. The photolysis of HONO formed this way could account for
14    up to 60% of the integrated source of OH radicals in the inner planetary boundary layer. A
15    combination of high NO2 levels and surfaces of soil and buildings and other man-made structures
16    exposed to diesel exhaust would then be conducive to HONO formation and, hence, to high
17    [OH].
18           Ammann  et al. (1998) reported the efficient conversion of NO2 to HONO on fresh soot
19    particles in the presence of water.  They suggest that interaction between NO2 and soot particles
20    may account for high mixing ratios of HONO observed in urban environments.  Conversion of
21    NO2 to HONO and  subsequent photolysis and HONO to NO + OH would constitute a NOX"
22    catalyzed Os sink involving snow. High concentrations of HONO can lead to the rapid growth in
23    OH concentrations shortly after sunrise, giving a "jump start" to photochemical smog formation.
24    Prolonged exposure to ambient oxidizing agents appears to deactivate this process.  Broske et al.
25    (2003)  studied the interaction of NO2 on secondary organic aerosols and concluded that the
26    uptake  coefficients were too low for this reaction to be an important source of HONO in the
27    troposphere.
28           Choi and Leu (1998) evaluated the interactions of HNOs on model black carbon soot
29    (FW2), graphite, hexane, and kerosene soot.  They found that HNOs decomposed to NO2 and
30    H2O at higher HNOs surface coverages, i.e., P(HNO3) > 10~4 Torr.  None of the soot models used
31    were reactive at low HNOs coverages, at P(HNO3) =  5 x 10~7 Torr or at temperatures below 220

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 1    K.  They conclude that it is unlikely that aircraft soot in the upper troposphere/lower stratosphere
 2    reduces HNO3.
 3          Heterogeneous production on soot at night is believed to be the mechanism by which
 4    HONO accumulates to provide an early morning source of HOx in high NOx environments
 5    (Harrison et al., 1996; Jacob, 2000). HONO has been frequently observed to accumulate to
 6    levels of several ppb overnight, and this has been attributed to soot chemistry (Harris et al., 1982;
 7    Calvert et al., 1994; Jacob, 2000).
 8          Longfellow et al. (1999) observed the formation of HONO when methane, propane,
 9    hexane, and kerosene soots were exposed to NO2. They suggested that this reaction may account
10    for some part of the unexplained high levels of HONO observed in urban areas.  They comment
11    that without details about the surface area, porosity, and amount of soot available for this
12    reaction, reactive uptake values cannot be estimated reliably. They comment that soot and NO2
13    are produced in close proximity during combustion, and that large quantities of HONO have
14    been  observed in aircraft plumes.
15          Saathoff et al. (2001) studied the heterogeneous loss of NO2, HNO3, NO3/N2O5,
16    HO2/HO2NO2 on soot aerosol using a large aerosol chamber. Reaction periods of up to several
17    days were monitored and results used to fit a detailed model. Saathoff et al. derived  reaction
18    probabilities at 294 K and 50% RH for NO2, NO3, HO2, and HO2NO2 deposition to soot; HNO3
19    reduction to NO2; and ^Os hydrolysis. When these probabilities were included in
20    photochemical box model calculations of a 4-day smog event, the only noteworthy influence of
21    soot was a 10% reduction in the second day O3 maximum, for a soot loading of 20 jig nT3, i.e.,
22    roughly a factor of 10 times observed black carbon loadings seen in U.S. urban areas, even
23    during air pollution episodes.
24          Mufioz and Rossi (2002) conducted Knudsen cell studies of HNO3 uptake on black and
25    grey decane soot produced in lean and rich flames, respectively. They observed HONO as the
26    main species released following HNO3 uptake on grey soot,  and NO and traces of NO2 from
27    black soot. They conclude that these reactions would only have relevance in special  situations in
28    urban settings where soot and HNO3 are present in high concentrations simultaneously.
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 1   Formation ofNitro PAHs
 2          Nitro-polycyclic aromatic hydrocarbons (nitro-PAHs) (see Figure AX2.2-3 for some
 3   example nitro-PAHs) are generated from incomplete combustion processes through electrophilic
 4   reactions of polycyclic aromatic hydrocarbons (PAHs) in the presence of NC>2 (International
 5   Agency for Research on Cancer [IARC], 1989; World Health Organization [WHO], 2003).
 6   Among combustion sources, diesel emissions have been identified as the major source of nitro-
 7   PAHs in ambient air (Bezabeh et al., 2003; Gibson, 1983; Schuetzle, 1983; Tokiwa and Ohnishi,
 8   1986). Direct emissions of NPAHs in PM vary with type of fuel, vehicle maintenance, and
 9   ambient conditions (Zielinska et al., 2004).
         2-nitronaphthalene   9-nitroanthracene    2-nitrofluoranthene   6-nitrobenzo(a)pyrene
      Figure AX2.2-3.     Structures of nitro-polycyclic aromatic hydrocarbons.
10          In addition to being directly emitted, nitro-PAHs can also be formed from both gaseous
11    and heterogeneous reactions of PAHs with gaseous nitrogenous pollutants in the atmosphere
12    (Arey et al., 1986, 1989, Arey, 1998; Perrini, 2005; Pitts, 1987; Sasaki et al., 1997; Zielinska
13    et al., 1989).  Different isomers of nitro-PAHs are formed through different formation processes.
14    For example, the most abundant nitro-PAH in diesel particles is 1-nitropyene (1NP), followed by
15    3-nitrofluoranthene (3NF) and 8-nitrofluoranthene (8NF) (Bezabeh et al., 2003; Gibson, 1983;
16    Schuetzle, 1983; Tokiwa and Ohnishi, 1986).  However, in ambient particulate organic matter
17    (POM), 2-nitrofluoranthene (2NF) is the dominant compound, followed by 1NP and 2-
18    nitropyrene (2NP) (Arey et al., 1989; Bamford et al., 2003; Reisen and Arey, 2005; Zielinska
19    et al., 1989), although 2NF and 2NP are not directly emitted from primary combustion
20    emissions. The reaction mechanisms for the different nitro-PAH formation processes have been
21    well documented  and are presented in Figure AX2.2-3.
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 1          The dominant process for the formation of nitro-PAHs in the atmosphere is gas-phase
 2   reaction of PAHs with OH radicals in the presence of NOx (Arey et al., 1986, Arey, 1998;
 3   Atkinson and Arey, 1994; Ramdahl et al., 1986; Sasaki et al., 1997). Hydroxyl radicals can be
 4   generated photochemically or at night through ozone-alkene reactions, (Finlayson-Pitts and Pitts,
 5   2000). The postulated reaction mechanism of OH with PAHs involves the addition of OH at the
 6   site of highest electron density of the aromatic ring, for example, the 1-position for pyrene (PY)
 7   and the 3-position for fluoranthene (FL). This reaction is followed by the addition of NO2 to the
 8   OH-PAH adduct and elimination of water to form the nitroarenes (Figure AX2.2-4) (Arey et al.,
 9   1986; Atkinson et al., 1990; Pitts, 1987). After formation, nitro-PAHs with low vapor pressures
10   (such as 2NF and 2NP) immediately migrate to particles under ambient conditions (Fan et al.,
11   1995; Feilberg et al., 1999). The second order rate-constants for the reactions of OH with most
12   PAHs range from 10~10 to 10~12 cm3molecule~y * at 298 K with the yields ranging from -0.06 to
13   -5% (Atkinson and Arey, 1994). 2NF and 2NP have been found as the most abundant nitro-
14   PAHs formed via reactions of OH with gaseous PY and FL, respectively in ambient air.
     Figure AX2.2-4.
                                             OH
                                                             Hv  OH
                                                          4NO;
                                                             H,  OH
                              2NP
Formation of 2-nitropyrene (2NP) from the reaction of OH with
gaseous pyrene (PY).
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 1          The second important process for the formation of nitro-PAHs in the atmosphere is the
 2    nitration of PAHs by NOs  in the presence of NOx at night (Atkinson et al., 1990; Atkinson and
 3    Arey, 1994; Sasaki et al., 1997). Nitrate radicals can be generated by reaction of ozone (O3) with
 4    NC>2 in the atmosphere by Reaction AX2.2-26
 5                                     3
 6          Similar to the mechanism of OH reactions with PAHs, NOs initially adds to the PAH ring
 7    to form an NOs-PAH adduct, followed by loss of HNOs to form nitro-PAHs (Atkinson et al.,
 8    1990; Atkinson and Arey, 1994; Sasaki et al., 1997). For example, in the mixture of naphthalene
 9    and ^Os-NOs-NCh, the major products formed through the NOs reaction are 1- and 2-nitro-
10    naphthalene (INN and 2NN) (Atkinson et al., 1990; Feilberg et al., 1999; Sasaki et al., 1997).
1 1    2NF and 4NP were reported as the primary products of the gas-phase reactions of FL and PY
12    with NOs radical, respectively (Atkinson et al., 1990; Atkinson and Arey, 1994).
13          The reaction with NOs is of minor importance in the daytime because NOs radical is not
14    stable in sunlight. In addition, given the rapid reactions of NO with NOs and with Os in the
15    atmosphere (Finlayson-Pitts and Pitts 2000), concentrations of NOs at ground level are low
16    during daytime.  However, at night, concentrations of NOs radicals formed in polluted ambient
17    air are expected to increase. According to Atkinson (1991), the average NOs concentration is
18    about 20 ppt in the lower troposphere at night and can be as high as 430 ppt. It is also worth
19    noting that significant NOs radical concentrations are found at elevated altitudes where Os  is
20    high but NO is low (Reissell and Arey, 2001; Stutz et al., 2004a).  When NO3 reaches high
21    concentrations, the formation of nitro-PAHs  by the reaction of gaseous PAHs with NOs may be
22    of environmental significance.  At 10~17 - 10~18 cm3 molecule  V1, the rate constants of NOs
23    with most PAHs are several orders of magnitude lower than those of OH with the same PAHs;
24    however, the yields of nitro-PAHs from NOs reactions are generally much higher than those of
25    OH reactions. For example, the yields of 1-NN and 2NF are 0.3% and 3%, respectively from
26    OH reactions, but the yields are 17% and 24% for these two compounds generated from the NO3
27    radical reactions (Atkinson and Arey, 1994).  Therefore, formation of nitro-PAHs via reactions
28    of NOs at nighttime under certain circumstances can be significant.
29          The third process of nitro-PAH formation in the atmosphere is nitration of PAHs by
30    NO2/N2Os in the presence of trace amounts of HNOs (HNOs) in both gas and particle phases.
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 1    This mechanism could be operative throughout the day and night (Pitts, 1983, 1985a,b; Grosjean
 2    et al., 1983; Ramdahl et al., 1984; Kamens et al., 1990).  The formation of nitro-fluoranthenes
 3    was observed when adsorbed FL was exposed to gaseous N2O5, and the distribution of product
 4    NF isomers was 3- > 8- > 7- > 1- NF (Pitts et al., 1985a,b). The proposed mechanism for this
 5    reaction was an ionic electrophilic nitration by nitronium ion (NC>2+).  It was speculated that
 6    N2Os became ionized prior to the reaction with FL (Zielinska et al., 1986). Only 1NP was
 7    observed for the reaction of PY with ^Os on filters (Pitts et al., 1985b). Compared to the
 8    reactions of OH and NOs, nitration of PAHs by NO2/N2Os is less important.
 9          Measurements of nitro-PAHs in ambient air provide evidence for the proposed reaction
10    mechanism, i.e. the reactions of OH and NOs radicals with PAHs are  the major sources of
11    nitro-PAHs (Bamford and Baker, 2003; Reisen and Arey, 2005; and references therein).  2NF is
12    a ubiquitous component of ambient POM, much higher than 1NP, itself a marker of combustion
13    sources. Nitro-PAH isomer ratios show strong seasonality. For instance, the mean ratios of
14    2NF/1NP were higher in summer than in winter (Bamford et al., 2003; Reisen and Arey,  2005),
15    indicating that reactions of OH and NOs with FL are the  major sources of nitro-PAHs in  ambient
16    air in summer.  The ratio of 2NF/1NP was lower in winter than in summer because of lower OH
17    concentrations and, therefore, less production of 2NF via atmospheric reactions.  A ratio  of
18    1NP/2NF greater than 1 was observed in locations with major contributions from vehicle
19    emissions (Dimashki et al., 2000; Feilberg et al., 2001).  In addition, the ratio of 2NF/2NP was
20    also used to evaluate the contribution of OH and NO3 initiated reactions to the ambient nitro-
21    PAHs (Bamford et al., 2003; Reisen and Arey, 2005).
22          The concentrations for most  nitro-PAHs found in ambient air  are much lower than
23    1 pg/m3, except NNs, 1NP, and 2NF, which can be present at several  pg/m3. These levels are
24    much lower (~2 to -1000 times lower) than their parent PAHs.  However, nitro-PAHs are much
25    more toxic than PAHs (Durant et al., 1996; Grosovsky et al., 1999; Salmeen et al., 1982;  Tokiwa
26    et al., 1998; Tokiwa and Ohnishi, 1986). Moreover, most nitro-PAHs are present in particles
27    with a mass median diameter <0.1 |im.
28          Esteve et al. (2006) examined the reaction of gas-phase NO2 and OH radicals with
29    various PAHs adsorbed onto model diesel particulate matter (SRM 1650a, NIST). Using pseudo
30    second order rate coefficients, they derived lifetimes for  conversion of the particle-bound PAHs
31    to nitro-PAHs of a few days (for typical urban NO2 levels of 20 ppb). They also found that the

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 1    rates of reaction of OH with the PAHs were about four orders of magnitude larger than for the
 2    reactions involving NC>2.  However, since the concentrations of NC>2 used above are more than
 3    four orders of magnitude larger than those for OH (106-107/cm3), they concluded that the
 4    pathway involving NO2 is expected to be favored over that involving OH radicals. Consistent
 5    with the importance of the gas-phase formation of NPAHS, both the mutagenic potency of PM
 6    and the content of NPAHs in PM vary by particle size, and are higher in the submicron size
 7    range (Xu and Lee, 2000; Kawanaka et al., 2004).
 8          The major loss process of nitro-PAHs is photodecomposition (Fan et al., 1996; Feilberg
 9    et al., 1999; Feilberg and Nielsen, 2001), with lifetimes on the order of hours.  However, lacking
10    direct UV light sources indoors, nitro-PAHs are expected have a longer lifetimes (days) indoors
11    than outdoors; and may therefore pose increased health risks. Many nitro-PAHs are semi- or
12    nonvolatile organic compounds. As stated above, indoor environments have much greater
13    surface areas than outdoors. Thus, it is expected that gas/particle distribution of nitro-PAHs
14    indoors will be different from those in ambient air. A significant portion of nitro-PAHs will
15    probably be adsorbed by indoor surfaces, such as carpets, leading to different potential  exposure
16    pathways to nitro-PAHs in indoor environments. The special characteristics of indoor
17    environments, which can  affect the indoor chemistry and potential exposure pathways
18    significantly, should be taken  into consideration when conducting exposure studies of nitro-
19    PAHs.
20          Reaction with OH and NO3 radicals is a major mechanism for removing gas-phase PAHs,
21    with OH radical initiated reactions predominating depending on season (Vione et al., 2004;
22    Bamford et al., 2003). Particle-bound PAH reactions occur but tend to be slower.
23    Nitronaphthalenes tend to remain in the vapor phase, but because phase partitioning depends on
24    ambient temperature, in very cold regions these species can condense (Castells et al., 2003)
25    while the higher molecular weight PAHs such as the nitroanthracenes, nitrophenantrenes and
26    nitrofluoranthenes condense in and on PM (Ciganek et al., 2004; Cecinato, 2003).
27
28    Multiphase Chemical Processes Involving Nitrogen Oxides and Halogens
29          Four decades of observational data on Os in the troposphere have revealed numerous
30    anomalies not easily explained by gas-phase HOX-NOX photochemistry. The best-known
31    example is the dramatic depletion of ground-level Os during polar sunrise due to multiphase
32    catalytic cycles involving inorganic Br and Cl radicals (Barrie et al., 1988; Martinez et  al., 1999;

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 1   Foster et al., 2001). Other examples of anomalies in tropospheric 63 at lower latitudes include
 2   low levels of 63 (<10 ppbv) in the marine boundary layer (MBL) and overlying free troposphere
 3   (FT) at times over large portions of the tropical Pacific (Kley et al., 1996), as well as post-sunrise
 4   Os depletions over the western subtropical Pacific Ocean (Nagao et al., 1999), the temperate
 5   Southern Ocean (Galbally et al., 2000), and the tropical Indian Ocean (Dickerson et al., 1999).
 6   The observed Os depletions in near-surface marine air are generally consistent with the model-
 7   predicted volatilization of Br2, BrCl, and C^ from sea salt aerosols through autocatalytic halogen
 8   "activation" mechanisms (e.g., Vogt et al., 1996; Von Glasow et al., 2002a) involving these
 9   aqueous phase reactions.

1Q                              HOBr + Br- + H- -> Br2 + H2O

1 1                            HOCL +  Bf + H+  -» BrCl + H2O                (AX2.2-28)

12                              HOCl + Cr + H+^C!2+H20                (AX22-29)
13   In polluted marine regions at night, the heterogeneous reaction
14                               N20S + CI-->CIN02 + NOS-

15    may also be important (Finlayson-Pitts et al., 1989; Behnke et al.,  1997; Erickson et al., 1999).
16    Diatomic bromine, BrCl, Cb, and C1NO2 volatilize and photolyze  in sunlight to produce atomic
17    Br and Cl.  The acidification of sea salt aerosol via incorporation of HNOs (and other acids)
18    leads to the volatilization of HC1 (Erickson et al., 1999), e.g.
19                               — ~., ,  ~,    ,  ,,v^   ~v.f                  (AX2.2-31)
20    and the corresponding shift in phase partitioning can accelerate the deposition flux to the surface
21    of total NO3 (Russell et al., 2003; Fischer et al., 2006).  However, Pryor and Sorensen (2000)
22    have shown that the dominant form of nitrate deposition is a complex function of wind speed.  In
23    polluted coastal regions where HC1 from Reaction 35 often exceeds 1 ppbv, significant
24    additional atomic Cl~ is produced via
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 ,                                 we/ + o» -                                (AX22.32)
 2    (Singh and Kasting, 1988; Keene et al., 2007).  Following production, Br and Cl atoms
 3    catalytically destroy Os via
                                                                                 (AX2.2-33)
 7   where (X = Br and Cl).
 8   Formation  of Br and Cl nitrates via
 9                                                                               (AX2M6)
10    and the subsequent reaction of XNO3 with sea salt and sulfate aerosols via

1 1                             XN03 + H20 -» HOX + H+ + NOf

12    and
13                                  ""-,,               ,,Vj                    (AX2.2-38)
14    (where Y = Cl, Br, or I) accelerates the conversion of NOX to particulate NO3  and thereby
15    contributes indirectly to net O3 destruction (Sander et al., 1999; Vogt et al., 1999, Pszenny et al.,
16    2004). Most XNO3 reacts via Reaction AX2.2-38 on sea salt whereas reaction 33 is more
17    important on sulfate aerosols.  Partitioning of HC1 on sulfate aerosols following Henry's Law
18    provides Cl" for Reaction AX2.2-38 to form BrCl. Product NO3  from both Reactions AX2.2-37
19    and AX2.2-38 partitions with the gas-phase HNO3 following Henry's Law. Because most
20    aerosol size fractions in the MBL are near equilibrium with respect to HNO3 (Erickson et al.,
21    1999; Keene et al., 2004), both sulfate and sea salt aerosol can sustain the catalytic removal of
22    NOx and re-activation of Cl and Br with no detectable change in composition.  The photolytic
23    reduction of NO3  in sea salt aerosol solutions recycles NOx to the gas phase (Pszenny et al.,
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 1    2004).  Halogen chemistry also impacts 63 indirectly by altering OH/HO2 ratios (XO + HC>2 —»•
 2    HOX + O2 -> OH + X) (e.g., Stutz et al., 1999; Bloss et al., 2005).
 3           In addition to O3 destruction via Reaction AX2.3-3, atomic Cl oxidizes hydrocarbons
 4    (HCs) primarily via hydrogen abstraction to form HC1 vapor and organz products (Jobson et al.,
 5    1994; Pszenny et al., 2006).  The enhanced supply of odd-H radicals from HC oxidation leads to
 6    net Os production in the presence of sufficient NOx (Pszenny et al., 1993). Available evidence
 7    suggests that Cl~ radical chemistry may be a significant net source for 63 in polluted
 8    coastal/urban air (e.g., Tanaka et al., 2003; Finley and Saltzman, 2006).
 9           An analogous autocatalyic 63 destruction cycle involving multiphase iodine chemistry
10    also operates in the marine atmosphere (Alicke et al., 1999, Vogt et al.,  1999; McFiggans et al.,
11    2000; Ashworth et al., 2002). In this case, the primary source of I is believed to be either
12    photolysis of CH^, other I-containing gases (Carpenter et al., 1999; Carpenter, 2003), and/or
13    perhaps I2 (McFiggans et al., 2004; Saiz-Lopez and Plane, 2004; McFiggans, 2005) emitted by
14    micro-and macro flora.  Sea salt and sulfate aerosols provide substrates  for multiphase reactions
15    that sustain the catalytic I-IO cycle.  The IO radical has been measured by long-path (LP) and/or
16    multi axis (MAX) differential optical absorption spectroscopy (DOAS)  at Mace Head, Ireland;
17    Tenerife, Canary Islands; Cape Grim, Tasmania; and coastal New England, USA; having
18    average daytime levels of about 1 ppt with maxima up to 7 ppt (e.g., Allan et al., 2000; Pikelnaya
19    et al., 2006). Modeling suggests that up to 13% per day of O3 in marine air may be destroyed via
20    multiphase iodine chemistry (McFiggans et al., 2000). The reaction of IO with NO2 followed by
21    uptake of INOs into aerosols (analogous to Reactions AX2.2-12 through AX2.2-14) accelerates
22    the conversion of NOx to particulate MV and thereby contributes to net Os destruction.  The
23    reaction IO + NO —»• I + NO2 also influences NOX cycling.
24           Most of the above  studies have focused  on halogen-radical chemistry and related
25    influences on NOx cycling in coastal and urban air. However, available evidence suggests that
26    similar chemical transformations proceed in other halogen-rich tropospheric regimes. For
27    example, Cl, Br, and/or I oxides have been measured at significant concentrations in near-surface
28    air over the Dead Sea, Israel, the Great Salt Lake, Utah (e.g., Hebestreit et al., 1999; Stutz et al.,
29    1999, 2002; Zingler and Platt, 2005), and the Salar de Uyuni salt pan in the Andes mountains
30    (U. Platt, unpublished data, 2006); high column densities of halogenated compounds have also
31    been observed from satellites over the northern Caspian  Sea (Wagner et al., 2001; Hollwedel

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 1    et al., 2004).  The primary source of reactive halogens in these regions is thought to be from
 2    activation along the lives of that in Reactions AX2.2-27 through AX2.2-29 involving
 3    concentrated salt deposits on surface evaporite pans.  High concentrations of BrO have also been
 4    measured in volcanic plumes (Bobrowski et al., 2003, Gerlach, 2004). Although virtually
 5    unexplored, the substantial emissions of inorganic halogens during biomass burning (Lobert
 6    et al., 1999; Keene et al., 2006) and in association with crustal dust (Keene et al., 1999; Sander
 7    et al., 2003) may also support active halogen-radical chemistry and related transformations
 8    involving NOx downwind of sources.  Finally, observations from satellites,  balloons, and aircraft
 9    indicate that BrO is present in the free troposphere at levels sufficient to significantly influence
10    photochemistry (e.g., Von Glasow  et al., 2004).
11
12
13    AX2.3     CHEMISTRY OF SULFUR OXIDES IN THE TROPOSPHERE
14          The four known monomeric sulfur oxides are sulfur monoxide (SO), sulfur dioxide
15    (802), sulfur tri oxide (SOs), and disulfur monoxide (82©). SO can be formed by photolysis of
16    SO2 at wavelengths less than 220 nm, and so could only be found in the middle and upper
17    stratosphere (Pinto et al., 1989). SOs can be emitted from the stacks of power plants and
18    factories however, it reacts extremely rapidly with H2O in the stacks or immediately after release
19    into the atmosphere to form H^SO/t. Of the four species, only SO2 is present at concentrations
20    significant for atmospheric chemistry and human exposures.
21    Sulfur dioxide can be oxidized either in the gas phase, or, because it is soluble, in the aqueous
22    phase in cloud drops. The gas-phase oxidation of SO2 proceeds through the reaction
23                                SO 2 + OH+M^ HSO3 + M                        2 3
24   followed by

25
26                                   ^ + H20 -> H2S04                       (AX2.3-3)
27    Since H2SO4 is extremely soluble, it will be removed rapidly by transfer to the aqueous phase of
28    aerosol particles and cloud drops. Rate coefficients for reaction of SO2 with HO2 or NO3 are too
29    low to be significant (JPL, 2003).
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 1          SO2 is chiefly but not exclusively primary in origin; it is also produced by the
 2    photochemical oxidation of reduced sulfur compounds such as dimethyl sulfide (CH3-S-CH3),
 3    hydrogen sulfide (H2S), carbon disulfide (CS2), carbonyl sulfide (OCS), methyl mercaptan
 4    (CH3-S-H), and dimethyl disulfide (CH3-S-S-CH3) which are all mainly biogenic in origin.
 5    Their sources are discussed in Section AX2.5. Table AX2.3-1 lists the atmospheric lifetimes of
 6    reduced sulfur species with respect to reaction with various oxidants. Except for OCS, which is
 7    lost mainly by photolysis (x~6 months), all of these species are lost mainly by reaction with OH
 8    and NO3 radicals. Because OCS is relatively long-lived in the troposphere, it can be transported
 9    upwards into the stratosphere. Crutzen (1976) proposed that its oxidation serves as the major
10    source of sulfate in the stratospheric aerosol layer sometimes referred to the "Junge layer,"
11    (Junge et al., 1961) during periods when volcanic plumes do not reach the stratosphere.
12    However, the flux of OCS into the stratosphere is probably not sufficient to maintain this
13    stratospheric aerosol layer.  Myhre et al. (2004) propose instead that SO2 transported upwards
14    from the troposphere is the most likely source, have become the upward flux of OCS is too small
15    to sustain observed sulfate loadings in the Junge layer. In addition, insitu measurements of the
16    isotopic composition of sulfur do not match those of OCS (Leung et al., 2002).  Reaction with
17    NO3 radicals at night most likely represents the major loss process for dimethyl sulfide and
18    methyl mercaptan. The mechanisms for the oxidation of DMS are still not completely
19    understood. Initial attack by NO3 and OH radicals involves H atom abstraction, with a smaller
20    branch leading to OH addition to the S atom. The OH addition branch increases in importance as
21    temperatures decrease and becoming the major pathway below temperatures of 285 K
22    (Ravishankara, 1997).  The adduct may either decompose to form methane sulfonic acid (MSA),
23    or undergo further reactions in the main pathway, to yield dimethyl  sulfoxide (Barnes et al.,
24    1991). Following H atom abstraction from DMS, the main reaction products include MSA and
25    SO2.  The ratio of MSA to SO2 is strongly temperature dependent, varying from about 0.1 in
26    tropical waters to about 0.4 in Antarctic waters (Seinfeld and Pandis, 1998). Excess sulfate (over
27    that expected from the sulfate in seawater) in marine aerosol is related mainly to the production
28    of SO2 from the oxidation of DMS. Transformations among atmospheric sulfur compounds  are
29    summarized in Figure AX2.3-1.
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       DCS
                       Av, O
 so
           OH
                      Tropopause
    Figure AX2.3-1.     Transformations of sulfur compounds in the atmosphere.
    Source: Adapted from Berresheim et al. (1995).
1   Multiphase Chemical Processes Involving Sulfur Oxides and Halogens
2          Chemical transformations involving inorganic halogenated compounds effect changes in
3   the multiphase cycling of sulfur oxides in ways analogous to their effects on NOx.  Oxidation of
4   dimethylsulfide (CH3)2S by BrO produces dimethyl sulfoxide (CH3)2SO (Barnes et al.,  1991;
5   Toumi, 1994), and oxidation by atomic chloride leads to formation of SO2 (Keene et al., 1996).
6   (CH3)2SO and SO2 are precursors for methanesulfonic acid (CH3SO3H) and H2SO4. In the MBL,
7   virtually all H2SO4 and CHsSOsH vapor condenses onto existing aerosols or cloud droplet, which
8   subsequently evaporate, thereby contributing to aerosol growth and acidification. Unlike
9   CHsSOsH, H2SO4 also has the potential to produce new particles (Korhonen et al.,  1999;
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 1    Kulmala et al., 2000), which in marine regions is thought to occur primarily in the free
 2    troposphere.  Saiz-Lopez et al. (2004) estimated that observed levels of BrO at Mace Head
 3    would oxidize (CH3)2S about six times faster than OH and thereby substantially increase
 4    production rates of H2SO4 and other condensible S species in the MBL. Sulfur dioxide is also
 5    scavenged by deliquesced aerosols and oxidized to H2SO4 in the aqueous phase by several
 6    strongly pH-dependent pathways (Chameides and Stelson, 1992; Vogt et al., 1996; Keene et al.,
 7    1998).  Model calculations indicate that oxidation of S(IV) by O3 dominates in fresh, alkaline sea
 8    salt aerosols, whereas oxidation by hypohalous acids (primarily HOC1) dominates in moderately
 9    acidic solutions. Additional paniculate non-sea salt (nss) SO42  is generated by SO2 oxidation in
10    cloud droplets (Clegg and Toumi, 1998).  Ion-balance calculations indicate that most nss SC>42
11    in short-lived (two to 48 hours) sea salt size fractions accumulates in acidic aerosol solutions
12    and/or in acidic aerosols processed through clouds (e.g., Keene et al., 2004). The production,
13    cycling, and associated radiative effects of S-containing aerosols in marine and coastal air are
14    regulated in part by chemical transformations involving inorganic halogens (Von Glasow et al.,
15    2002b). These transformations include:  dry-deposition fluxes of nss SC>42 in marine air
16    dominated, naturally, by the sea salt size fractions (Huebert et al., 1996; Turekian et al., 2001);
17    HC1 phase partitioning that regulates sea salt pH and associated pH-dependent pathways for
18    S(IV) oxidation (Keene et al., 2002; Pszenny et al., 2004); and potentially important oxidative
19    reactions with reactive halogens for (CH3)2S and S(IV). However, both the absolute magnitudes
20    and relative importance of these processes in MBL S cycling are poorly understood.
21           Iodine chemistry has been linked to ultrafme particle bursts at Mace Head (O'Dowd
22    et al., 1999, 2002).  Observed bursts coincide with the elevated concentrations of IO and are
23    characterized by particle concentrations increasing from background levels to up to
24    300,000 cm"3 on a time scale of seconds to minutes.  This newly identified source of marine
25    aerosol would provide additional aerosol surface area for condensation of sulfur oxides and
26    thereby presumably diminish the potential for nucleation pathways involving H2SO4.  However,
27    a subsequent investigation in polluted air along the New England, USA coast found no
28    correlation between periods of nanoparticle growth and corresponding concentrations of I oxides
29    (Russell et al., 2006). The potential importance of I chemistry in aerosol nucleation and its
30    associated influence on sulfur cycling remain highly uncertain.
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 1   AX2.4    MECHANISMS FOR THE AQUEOUS PHASE FORMATION OF
 2              SULFATE AND NITRATE
 3          The major species containing sulfur in clouds are HSCV and SOs2 , which are derived
 4   from the dissolution of 862 in water and are referred to as S(IV); and HSCV and SC>42 , which
 5   are referred to as S(VI). The major species capable of oxidizing S(IV) to S(VI) in cloud water
 6   are 63, peroxides (either H2O2 or organic peroxides), OH radicals, and ions of transition metals
 7   such as Fe and Cu that can catalyze the oxidation of S(IV) to S(VI) by 62.
 8          The basic mechanism of the aqueous phase oxidation of SO2 has long been studied and
 9   can be found in numerous texts on atmospheric chemistry, e.g., Seinfeld and Pandis (1998),
10   Jacob (2000), and Jacobson (2002). The steps involved in the aqueous phase oxidation of SC>2
1 1   can be summarized as follows (Jacobson, 2002):
12          Dissolution of SO2

13                                     S°2(g)^S02(aq}                          (AX2.4-1)
14          The formation and dissociation of H2SO3
15                       aq}(aq                                           (AX2.4-2)
16   In the pH range commonly found in rainwater (2 to 6), the most important reaction converting
17   S(IV) to S(VI) is
18
19   as SOs2 is much less abundant than
                                                       +H20+2H+              (AX2.4-3)
20          Major pathways for the aqueous phase oxidation of S(IV) to S(VI) as a function of pH are
21   shown in Figure AX2.4-1 .  For pH up to about 5.3, H2O2 is seen to be the dominant oxidant;
22   above 5.3, Os, followed by Fe(III) becomes dominant. Higher pHs are expected to be found
23   mainly in marine aerosols.  However, in marine aerosols, the chloride-catalyzed oxidation of
24   S(IV) may be more important (Zhang and Millero, 1991; Hoppel and Caffrey, 2005). Because
25   NH4+ is so effective in controlling acidity, it affects the rate of oxidation of S(IV) to S(VI) and
26   the rate of dissolution of 862 in particles and cloud drops.
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 1          Nitrogen dioxide is also taken up in cloud drops and can be oxidized to NO3 , although it
 2    is much less soluble than 862 and this pathway is of minor importance. Instead, the uptake of
 3    more highly soluble nitrogen-containing acids initiates aqueous-phase chemistry of NO3
 4    formation.
 5          Warneck (1999) constructed a box model describing the chemistry of the oxidation of
 6    SC>2 and NO2 including the interactions of N and S species and minor processes in sunlit cumulus
 7    clouds. The relative contributions of different reactions to the oxidation of S(IV) species to
 8    S(VI) and NC>2 to NO3  10 minutes after cloud formation are given in Tables AX2.4-la and
 9    AX2.4-lb. The two columns show the relative contributions with and without transition metal
10    ions. As can be seen from Table AX2.4-la, 862 within a cloud (gas + cloud drops) is oxidized
11    mainly by H2O2 in the aqueous phase, while and the gas-phase oxidation by OH radicals is small
12    by comparison. A much smaller contribution in the aqueous phase is made by methyl
13    hydroperoxide (CH3OOH) because it is formed mainly in the gas phase and its Henry's Law
14    constant is several orders of magnitude smaller that of H2O2.  After H2O2, HNO4 is the major
15    contributor to  S(IV) oxidation.  The contribution from the gas phase oxidation of SC>2 to be small
16    by comparison to the aqueous -phase reactions given above.
17          In contrast to the oxidation of 862, Table AX2.4-lb shows that the oxidation of NC>2
18    occurs mainly in the gas phase within clouds, implying that the gas phase oxidation of NC>2 by
19    OH  radicals predominates. Clouds occupy about 15%, on average, of the volume of the
20    troposphere.
21          The values shown in Tables AX2.4-la and AX2.4-lb indicate that only about 20% of
22    SO2 is oxidized in the gas phase, but about 90% of NO2 is oxidized in the gas phase.  Thus, SO2
23    is oxidized mainly by aqueous-phase reactions, but NO2 is oxidized mainly by gas phase
24    reactions.
25
26    Multiphase Chemical Processes Involving Sulfur Oxides and Ammonia
27          The phase partitioning of NH3 with deliquesced aerosol solutions is controlled primarily
28    by the thermodynamic properties of the system expressed  as follows:
9Q                                jg   I    _KK/J   L""4 J   w'if*  j                 TAX2 4-4^
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    Figure AX2.4-1.
                             10'6
                         T)   1Q-10
                         s
                         s"
                         zz   io-12

                             io-14
                             10
                              ,-16
                             10
                              ,-18
                                                           I      I
                           J	I
       I
        0123456
                           PH
Comparison of aqueous-phase oxidation paths.  The rate of
conversion of S(IV) to S(VI) is shown as a function of pH.  Conditions
assumed are:  [SO2(g)] = 5 ppb; [NO2(g)] = 1 ppb; [H2O2(g)] = 1 ppb;
[03(g)] = 50 ppb; [Fe(III)(aq)] = 0.3 uM; [Mn(II)(aq)] = 0.3 uM.
     Source: Seinfeld and Pandis (1998).
1   where KH and Kb are the temperature-dependent Henry's Law and dissociation constants
2   (62 M atnT1) (1.8 x 1CT5 M), respectively, for NH3, and Kw is the ion product of water (1.0 x
3   10~14 M) (Chameides, 1984).  It is evident that for a given amount of NHX (NHs + particulate
4   NH4+) in the system, increasing aqueous concentrations of particulate H+ will shift the
5   partitioning of NH3 towards the condensed phase. Consequently, under the more polluted
6   conditions characterized by higher concentrations of acidic sulfate aerosol, ratios of gaseous
7   to particulate NH4+ decrease (Smith et al., 2007). It also follows that in marine air, where
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 1    aerosol acidity varies substantially as a function of particle size, NH3 partitions preferentially to
 2    the more acidic sub-jam size fractions (e.g., Keene et al., 2004; Smith et al., 2007).
 3          Because the dry-deposition velocity of gaseous NH3 to the surface is substantially greater
 4    than that for the sub-|im, sulfate aerosol size factions with which most particulate NH4+ is
 5    associated, dry-deposition fluxes of total NH3 are dominated by the gas phase fraction (Russell
 6    et al., 2003; Smith et al., 2007). Consequently, partitioning with highly acidic sulfate aerosols
 7    effectively increases the atmospheric lifetime of total NH3 against dry deposition. This shift has
 8    important consequences for NH3 cycling and potential ecological effects.  In coastal New
 9    England during summer, air transported from rural eastern Canada contains relatively low
10    concentrations of particulate non-sea salt (nss) SC>42  and total NH3 (Smith et al., 2007).  Under
11    these conditions, the roughly equal partitioning of total NH3 between the gas and particulate
12    phases sustains substantial dry-deposition fluxes of total NH3 to the coastal ocean (median of
13    10.7 (imol nT2 day l).  In contrast, heavily polluted air transported from the industrialized
14    midwestern United States contains concentrations of nss SC>42 and total NH3 that are, about a
15    factory of 3 greater, based on median values. Under these conditions, most total NH3 (>85%)
16    partitions to the highly acidic sulfate aerosol size  fractions and, consequently, the median dry-
17    deposition flux of total NH3 is  30% lower than that under the cleaner northerly flow regime. The
18    relatively longer atmospheric lifetime of total NH3 against dry deposition under more polluted
19    conditions implies that, on average, total NH3 would accumulate to higher atmospheric
20    concentrations under these conditions and also be subject to atmospheric transport over longer
21    distances. Consequently, the importance NHx of removal via wet deposition would also
22    increase.  Because of the inherently sporadic character of precipitation, we might expect by
23    greater heterogeneity in NH3 deposition fields and any potential responses by sensitive
24    ecosystems downwind of major S-emission regions.
25
26
27    AX2.5    TRANSPORT OF NITROGEN AND  SULFUR OXIDES IN
28               THE ATMOSPHERE
29          Major episodes of high O3 concentrations  in the eastern United Sates and in Europe are
30    associated with slow moving high-pressure systems. High-pressure systems during the warmer
31    seasons are associated with subsidence, resulting  in warm, generally cloudless conditions with
32    light winds. The subsidence results in stable conditions near the surface, which inhibit or reduce

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 1    the vertical mixing of 63 precursors (NOx, VOCs, and CO).  Photochemical activity is enhanced
 2    because of higher temperatures and the availability of sunlight. However, it is becoming
 3    increasingly apparent that transport of O3 and NOX and VOC from distant sources can provide
 4    significant contributions to local [Os] even in areas where there is substantial photochemical
 5    production.  There are a number of transport phenomena occurring either in the upper boundary
 6    layer or in the free troposphere which can contribute to high  Os values at the surface. These
 7    phenomena include stratospheric-tropospheric exchange (STE), deep and shallow convection,
 8    low-level jets, and the so-called "conveyor belts" that serve to characterize flows around frontal
 9    systems.
10
11    Convective Transport
12           Crutzen and Gidel (1983), Gidel (1983), and Chatfield and Crutzen (1984) hypothesized
13    that convective clouds played an important role in rapid atmospheric vertical transport of trace
14    species and first tested simple parameterizations of convective transport in atmospheric chemical
15    models. At nearly the same time,  evidence was shown of venting the boundary layer by shallow,
16    fair weather cumulus clouds (e.g., Greenhut et al., 1984; Greenhut, 1986). Field experiments
17    were conducted in 1985 which resulted in verification of the  hypothesis that deep convective
18    clouds are instrumental in atmospheric transport of trace constituents (Dickerson et al.,  1987).
19    Once pollutants are lofted to the middle and upper troposphere, they typically have a much
20    longer chemical lifetime and with the generally stronger winds at these altitudes, they can be
21    transported large distances from their source regions.  Transport of NOx from the boundary layer
22    to the upper troposphere by convection tends to dilute the higher in the boundary layer
23    concentrations and extend the NOx lifetime from less than 24 hours to several days.
24    Photochemical reactions occur during this long-range transport.  Pickering et al. (1990)
25    demonstrated that venting of boundary layer NOx by convective clouds (both shallow and deep)
26    causes enhanced Os production in the free troposphere. The  dilution of NOx at the surface can
27    often increase Os production efficiency.  Therefore, convection aids in the transformation of
28    local pollution into a contribution to global atmospheric pollution. Downdrafts within
29    thunderstorms tend to bring air with less NOx from the middle troposphere into the boundary
30    layer. Lightning produces NO which is directly injected chiefly into the middle and upper
31    troposphere.  The total global production of NO by lightning remains uncertain, but is on the
3 2    order of 10% of the total.

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 1    Observations of the Effects ofConvective Transport
 2          The first unequivocal observations of deep convective transport of boundary layer
 3    pollutants to the upper troposphere were documented by Dickerson et al. (1987).
 4    Instrumentation aboard three research aircraft measured CO, Os, NO, NOx, NOy, and
 5    hydrocarbons in the vicinity of an active mesoscale convective system near the
 6    Oklahoma/Arkansas border during the 1985 PRE-STORM experiment. Anvil penetrations about
 7    two hours after maturity found greatly enhanced mixing ratios inside the cloud of all of the
 8    aforementioned species compared with outside it.  Nitric oxide mixing ratios in the anvil
 9    averaged 3 to 4 ppbv, with individual 3-min observations reaching 6 ppbv; boundary layer NOx
10    was typically 1.5 ppbv or less outside the cloud. Therefore, the anvil observations represent a
11    mixture of boundary layer NOx and NOx contributed by lightning.  Luke et al. (1992)
12    summarized the air chemistry data from all 18 flights during PRE-STORM by categorizing each
13    case according to synoptic flow patterns.  Storms in the maritime tropical flow regime
14    transported large amounts of CO, Os, and NOy into the upper troposphere with the
15    midtroposphere remaining relatively clean. During frontal passages a combination of stratiform
16    and convective clouds mixed pollutants more uniformly into the middle and upper levels.
17          Prather and Jacob (1997) and Jaegle et al. (1997) noted that precursors of HOx are also
18    transported to the upper troposphere by deep convection, in addition to primary pollutants (e.g.,
19    NOX, CO, VOCs).  The HOX precursors of most importance are water vapor, HCHO, H2O2,
20    CHaOOH,  and acetone.  The hydroperoxyl radical is critical for oxidizing NO to NO2 in the Os
21    production process as described above.
22          Over remote marine areas, the effects of deep convection on trace gas distributions differ
23    from those over moderately polluted continental regions. Chemical measurements taken by the
24    NASA ER-2 aircraft during the Stratosphere-Troposphere Exchange Project (STEP) off the
25    northern coast of Australia show the influence of very deep convective events. Between 14.5
26    and 16.5 km on the February 2-3, 1987 flight, chemical profiles that included pronounced
27    maxima in CO, water vapor,  and CCN, and minima of NOY, and O3 (Pickering et al., 1993).
28    Trajectory analysis showed that these air parcels likely were transported from convective cells
29    800-900 km upstream.  Very low marine boundary layer mixing ratios of NOy and Os in this
30    remote region were apparently transported upward in the convection. A similar result was noted
31    in Central Equatorial Pacific Experiment (CEPEX) (Kley et al., 1996) and in Indian Ocean

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 1    Experiment (INDOEX) (DeLaat et al., 1999) where a series of ozonesonde ascents showed very
 2    low upper tropospheric 63 following deep convection. It is likely that similar transport oflow-
 3    ozone tropical marine boundary layer air to the upper troposphere occurs in thunderstorms along
 4    the east coast of Florida.  Deep convection occurs frequently over the tropical Pacific.  Low-
 5    ozone and low-NOx convective outflow likely will descend in the subsidence region of the
 6    subtropical eastern Pacific, leading to some of the cleanest air that arrives at the west coast of the
 7    United States.
 8          The discussion above relates to the effects of specific convective events. Observations
 9    have  also been conducted by NASA aircraft in survey mode, in which the regional effects of
10    many convective events can be measured. The Subsonic Assessment Ozone and Nitrogen
11    Oxides Experiment (SONEX) field program in 1997 conducted primarily upper tropospheric
12    measurements over the North Atlantic. The regional effects of convection over North America
13    and the Western Atlantic on upper tropospheric NOx were pronounced (Crawford et al., 2000;
14    Allen et al., 2000).  A discussion of the results of model  calculations of convection and its effects
15    can be found in Section AX2.7.
16
17    Effects on Photolysis Rates and Wet Scavenging
18          Thunderstorm clouds are optically very thick, and, therefore, have major effects on
19    radiative fluxes and photolysis rates. Madronich (1987)  provided modeling estimates of the
20    effects of clouds of various optical depths on photolysis rates. In the upper portion of a
21    thunderstorm anvil, photolysis is likely to be enhanced by a factor of 2 or more due to multiple
22    reflections off the ice crystals.  In the lower portion and beneath the cloud, photolysis is
23    substantially decreased. With enhanced photolysis rates, the NO/NO2 ratio in the upper
24    troposphere is driven to larger values than under clear-sky conditions.
25          Thunderstorm updraft regions, which contain copious amounts of water, are regions
26    where efficient scavenging of soluble species can occur (Balkanski et al., 1993). Nitrogen
27    dioxide itself is not very soluble and therefore wet scavenging is not a major removal process for
28    it.  However, a major NOx reservoir species, HNOs is extremely soluble. Very few direct field
29    measurements of the amounts of specific trace gases that are scavenged in storms are available.
30    Pickering et al. (2001) used a combination of model estimates of soluble species that did not
31    include wet scavenging and observations of these species from the upper tropospheric outflow
32    region of a major line of convection observed near Fiji. Over 90% of the and in the outflow air

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 1   appeared to have been removed by the storm. About 50% of CH3OOH and about 80% of HCHO
 2   had been lost.
 3          Convective processes and small-scale turbulence transport pollutants both upward and
 4   downward throughout the planetary boundary layer and the free troposphere. Ozone and its
 5   precursors (NOx, CO, and VOCs) can be transported vertically by convection into upper part of
 6   the mixed layer on one day, then transported overnight as a layer of elevated mixing ratios,
 7   perhaps by a nocturnal low-level jet, and then entrained into a growing convective boundary
 8   layer downwind and brought back to the surface.
 9          Because NO  and NO2 are only slightly soluble, they can be transported over longer
10   distances in the gas phase than can more soluble species which can be depleted by deposition to
11   moist surfaces, or taken up more readily on aqueous surfaces of particles. During transport, they
12   can be transformed into reservoir species such as HNOs, PANs, and ^Os. These species can
13   then contribute to local NOx concentrations in remote areas.  For  example, it is now well
14   established that PAN decomposition provides a major source of NOx in the remote troposphere
15   (Staudt et al., 2003). PAN decomposition in subsiding air masses from Asia over the eastern
16   Pacific could make an important contribution to Os and NOx enhancement in the United States
17   (Kotchenruther et al., 2001; Hudman et al., 2004).  Further details about mechanisms for
18   transporting ozone and its precursors were described at length in CD06.
19
20
21   AX2.6    SOURCES AND EMISSIONS OF NITROGEN OXIDES,
22              AMMONIA, AND SULFUR DIOXIDE
23          All three of the species listed in the title to this section have both natural and
24   anthropogenic sources. In Section AX2.6.1, interactions of NOx with the terrestrial biosphere
25   are discussed. Because of the tight coupling between processes linking emissions and
26   deposition, they are discussed together.  In Section AX2.6.2, emissions of NOx, NHa, and SO2
27   are discussed. Field studies evaluating emissions inventories are discussed in Section AX2.6.3.
28
29   AX2.6.1   Interactions of Nitrogen Oxides with the Biosphere
30          Nitrogen oxides affect vegetated ecosystems, and in turn the atmospheric chemistry of
31   NOx is influenced by vegetation. Extensive research on nitrogen inputs from the atmosphere to
32   forests was conducted in the 1980s as part of the Integrated Forest Study,  and is summarized by

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 1    Johnson and Lindberg (1992). The following sections discuss sources of NOx from soil,
 2    deposition of NOx to foliage, reactions with biogenic hydrocarbons, and ecological effects of
 3    nitrogen deposition.
 4
 5    NOx Sources
 6
 1    Soil NO
 8          Nitric oxide NO from soil metabolism is the dominant, but not exclusive, source of
 9    nitrogen oxides from the biosphere to the atmosphere. As noted below, our understanding of
10    NO2 exchange with vegetation suggests that there should be emission of NO2 from foliage when
11    ambient concentrations are less than about 1 ppb. However, Lerdau et al. (2000) have pointed
12    out that present understanding of the  global distribution of NOx is not consistent with a large
13    source that would be expected in remote forests if NO2 emission was important when
14    atmospheric concentrations were below the compensation point.
15          The pathways for nitrification and denitrification include two gas-phase intermediates,
16    NO and N2O,  some of which can escape.  While N2O is of interest for its greenhouse gas
17    potential and role in stratospheric chemistry it is not considered among the reactive nitrogen
18    oxides important for urban and regional air quality and will not be discussed further.
19    Temperature and soil moisture are critical factors that control the rates of reaction  and
20    importantly the partitioning between  NO and N2O which depend on oxygen levels: in flooded
21    soils where oxygen levels are low, N2O is the dominant soil nitrogen gas; as soil dries, allowing
22    more O2 to diffuse, NO emissions increase. In very dry soils microbial activity is inhibited and
23    emissions of both N2O and NO decrease.  Nitrogen metabolism in soil is strongly dependent on
24    the substrate concentrations.  Where nitrogen is limiting, nitrogen is efficiently retained and little
25    gaseous nitrogen is released.  Where  nitrogen is in excess of demand, gaseous nitrogen emissions
26    increase; consequently, soil NO emissions are highest in fertilized agriculture  and tropical soils
27    (Davidson and Kingerlee, 1997; Williams et al., 1992).
28
29    Sinks
30          Several reactive nitrogen are species are deposited to vegetation,  among them,
31    NO2, PAN, and organic nitrates.
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 1   HNO3
 2          Deposition of HNO3 appears to be relatively simple.  Field observations based on
 3   concentration gradients and recently using eddy covariance demonstrate rapid deposition that
 4   approaches the aerodynamic limit (as constrained by atmospheric turbulence) in the Wesely
 5   (1989) formulation based on analogy to resistance.  Surface resistance for HNOs uptake by
 6   vegetation is negligible. Deposition rates are independent of leaf area or stomatal conductance,
 7   implying that deposition occurs to branches, soil, and leaf cuticle as well as internal leaf surfaces.
 8          Deposition velocities (Vd) typically exceed 1 cm s^and exhibit a daily pattern controlled
 9   by turbulence characteristics: midday maximum and lower values at night when there is stable
10   boundary layer.
11
12   Deposition of NO 2
13          Nitrogen dioxide interaction with vegetation is more  complex. Application of 15N-
14   labeled Nitrogen Dioxide demonstrates that Nitrogen Dioxide is absorbed and metabolized by
15   foliage (Siegwolf et al., 2001; Mocker et al., 1998; Segschneider et al., 1995; Weber, et al.,
16    1995). Exposure to NC>2 induces nitrate reductase (Weber et al., 1995, 1998), a necessary
17   enzyme for assimilating oxidized nitrogen. Understanding of NC>2 interactions with foliage is
18   largely based on leaf cuvette and growth chamber studies, which expose foliage or whole plants
19   to controlled levels of NO2 and measure the fraction of NO2  removed from the chamber air. A
20   key finding is that the fit of NO2 flux to NO2 concentration, has a non-zero intercept, implying a
21   compensation point or internal concentration.  In studies at very low NC>2 concentrations
22   emission from foliage is observed (Teklemariam and Sparks, 2006). Evidence for a
23   compensation point is not solely based on the fitted intercept. Nitrogen dioxide uptake rate to
24   foliage is clearly related to stomatal conductance. Internal resistance is  variable, and may be
25   associated with concentrations of reactive species such as ascorbate in the plant tissue that react
26   with NC>2 (Teklemariam and Sparks, 2006). Foliar NC>2 emissions show some dependence on
27   nitrogen content (Teklemariam and Sparks, 2006). Internal NC>2 appears to derive from plant
28   nitrogen metabolism.
29          Two approaches to modeling NO2 uptake by vegetation are the resistance-in-series
30   analogy which  considers flux (F) as the product of concentration (C) and Vd, where is related to
31   the sum of aerodynamic, boundary layer, and internal resistances (Ra, Rb, and RC; positive fluxes
32   are from atmosphere to foliage)

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                                                                                    (AX2.6-1)

 2                                      'a  v"a-»6  »t-y                           (AX2.6-2)
 3          Ra and Rb and controlled by turbulence in the mixed layer; RC is dependent on
 4    characteristics of the foliage and other elements of the soil, and may be viewed as 2 combination
 5    of resistance internal to the foliage and external on the cuticle, soils, and bark.  This approach is
 6    amenable to predicting deposition in regional air quality models (Wesely, 1989).  Typically, the
 7    NO2, Vd is less than that for Os, due to the surface's generally higher resistance to NO2 uptake,
 8    consistent with N(Vs lower reactivity.
 9          Alternatively, NO2 exchange with foliage can be modeled from a physiological viewpoint
10    where the flux from the leaf is related to the stomatal conductance and a concentration gradient
11    between the ambient air and interstitial air in the leaf. This approach best describes results for
12    exchange with individual foliage elements, and is expressed per unit leaf (needle) area. While
13    this approach provides linkage to leaf physiology, it is not straightforward to scale up from the
14    leaf to ecosystem scale

15                                         J=Ss(Ca-Ci)                            (AX2.6-3)
16          This model implicitly associates the compensation point with a finite internal
17    concentration.  Typically observed compensation points are around 1 ppb. Finite values of
18    internal NO2 concentration are consistent with metabolic pathways that include oxides of
19    nitrogen. In this formulation, the uptake will be linear with NO2 concentration, which is
20    typically observed with foliar chamber studies.
21          Several studies have shown the UV dependence of NO2 emission, which implies some
22    photo-induced surface reactions that release NO2. Rather than model this as a UV-dependent
23    internal concentration, it would be more realistic to add an additional term to account for
24    emission that is dependent on light levels and other surface characteristics
25                                            a-
26          The mechanisms for surface emission are discussed below.  Measurement of NC>2 flux is
27    confounded by the rapid interconversion of NO, NC>2, and Os (Gao et al., 1991).
      March 2008                              AX2-3 8       DRAFT-DO NOT QUOTE OR CITE

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 1   PAN Deposition
 2          Peroxyacetyl nitrate is phytotoxic, so clearly it is absorbed at the leaf. Observations
 3   based on inference from concentration gradients and rates of decline at night (Shepson et al.,
 4    1992; Schrimpf et al., 1996) and leaf chamber studies (Teklemariam and Sparks, 2004) have
 5   indicated that PAN uptake is slower than that of Os; however, recent work in coniferous canopy
 6   with direct eddy covariance PAN flux measurements indicated a Vd more similar to that of O^.
 1   Uptake of PAN is under stomatal control, has a non-zero deposition at night, and is influenced by
 8   leaf wetness (Turnipseed et al., 2006). On the other hand, flux measurements determined by
 9   gradient methods over a grass surface showed a Vd closer to 0.1 cm s'1, with large uncertainty
10   (Doskey et al.,  2004). A factor of 10 uncertainty remains in Vd 0.1-1  cm s'1 giving a range.
11   Whether the discrepancies are methodological or indicate intrinsic differences between different
12   vegetation is unknown.  Uptake of PAN is smaller than its thermal decomposition in all cases.
13
14   Organic Nitrates
15          The biosphere also interacts with NOx through hydrocarbon emissions and their
16   subsequent reactions to form multi-functional organic nitrates. Isoprene nitrates are an important
17   class of these.  Isoprene reacts with OH to form a radical that adds NO2 to form a hydroxyalkyl
18   nitrate.  The combination of hydroxyl and nitrate functional group makes these compounds
19   especially soluble with low vapor pressures; they likely deposit rapidly (Shepson et al., 1996;
20   Treves et al., 2000).  Many other unsaturated hydrocarbons react by analogous routes.
21   Observations at Harvard Forest show a substantial fraction of total NOy not accounted for by
22   NO, NO2 and PAN, which is attributed to the organic nitrates (Horii et al., 2006, Munger et al.,
23    1998). Furthermore, the total NOY flux exceeds the sum of HNO3, NOX, and PAN, which
24   implies that the organic nitrates are a substantial fraction of nitrogen deposition.  Other
25   observations that show evidence of hydoxyalkyl nitrates include those of Grossenbacher et al.
26   (2001) and Day et al. (2003).
27          Formation of the hydroxyalkyl nitrates occurs after VOC + OH reaction.  In some sense,
28   this mechanism is just an alternate pathway for OH to react with NOX to form a rapidly
29   depositing species.  If VOC were not present, OH would be available to react with NO2 when it
30   is present instead to form
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 1   HONO
 2          Nitrous acid formation on vegetative surfaces at night has long been observed based on
 3   measurements of positive gradients (Harrison and Kitto, 1994). Surface reactions of NO2
 4   enhanced by moisture were proposed to explain these results.  Production was evident at sites
 5   with high ambient NO2; at low concentration, uptake of HONO exceeded the source.
 6   Daytime observations of HONO when rapid photolysis is expected to deplete ambient
 7   concentrations to very low levels implies a substantial source of photo-induced HONO formation
 8   at a variety of forested sites where measurements have been made. Estimated source strengths
 9   are 200-1800 pptv hr"1 in the surface layer (Zhou et al., 2002a, 2003), which is about 20 times
10   faster than all nighttime sources. Nitrous acid sources could be important to OH/HO2 budgets as
11   HONO is rapidly photolyzed by sunlight to OH and NO.  Additional evidence of light-dependent
12   reactions to produce HONO comes from discovery of a HONO artifact in pyrex sample inlet
13   lines exposed to ambient light. Either covering the inlet or washing it eliminated the HONO
14   formation (Zhou et al., 2002b). Similar reactions might serve to explain observations of UV-
15   dependent production of NOx in empty foliar cuvettes that had been exposed to ambient air (Hari
16   et al., 2003; Raivonen et al., 2003).
17          Production of HONO in the dark is currently believed to occur via a heterogeneous
18   reaction involving NO2 on wet surfaces (Jenkin et al., 1988; Pitts et al., 1984; He et al., 2006;
19   Sakamaki et al., 1983), and it is proposed that the mechanism has first-order dependence in both
20   NO2 and H2O (Kleffmann et al., 1998; Svensson et al., 1987) despite the stoichiometry.
21   However, the molecular pathway of the mechanism is still under debate. Jenkin et al. (1988)
22   postulated a H2O-NO2 water complex reacting with gas phase NO2 to produce HONO, which is
23   inconsistent with the formation of an N2O4 intermediate leading to HONO as proposed by
24   Finlayson-Pitts et al. (2003). Another uncertainty is whether the reaction forming HONO is
25   dependent on water vapor (Svensson et al., 1987; Stutz et al., 2004b) or water adsorbed on
26   surfaces  (Kleffmann et al., 1998).  Furthermore, the composition of the surface and the available
27   amount of surface or surface-to-volume ratio can significantly influence the HONO production
28   rates (Kaiser and Wu, 1977; Kleffmann et al., 1998; Svensson et al.,  1987), which may explain
29   the difference in the rates observed between laboratory and atmospheric measurements.
30          There is no consensus on a chemical mechanism for photo-induced HONO production.
31   Photolysis of HNOs or MV absorbed on ice or in surface water films has been proposed

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 1    (Honrath et al., 2002; Ramazan et al., 2004; Zhou et al., 2001, 2003). Alternative pathways
 2    include NO2 interaction with organic surfaces such as humic substances (George et al., 2005;
 3    Stemmler et al., 2006). Note that either NOs  photolysis or heterogeneous reaction of NO2 are
 4    routes for recycling deposited nitrogen oxides back to the atmosphere in an active form.  Nitrate
 5    photolysis would return nitrogen that heretofore was considered irreversibly deposited, surface
 6    reactions between NO2 and water films or organic molecules would decrease the effectiveness of
 7    observed NO2 deposition if the HONO were re-emitted.
 8
 9    Fast Homogeneous Reactions
10          Inferences from observations at Blodgett Forest (Cohen et al. in prep) suggest that
11    radicals from Os + VOC react with NOx in the canopy to produce HNOs and organic nitrates
12    among other species. This mechanism would contribute to canopy retention of soil NO emission
13    in forests with high VOC possibly more effectively than the NO to NO2 conversion and foliar
14    uptake of NO2 that has been proposed to reduce the amount of soil NO that escapes to the supra-
15    canopy atmosphere (Jacob and Bakwin, 1991).
16
17    Some NO 2 and HNOs Flux Data from Harvard Forest
18
19    Observations from TDL Measurements of NO 2
20          Harvard Forest is a rural site in central Massachusetts, where ambient NOx, NOy, and
21    other pollutant concentrations and fluxes of total NOy have been measured since 1990 (Munger
22    et al., 1996).  An intensive study in 2000 utilized a Tunable Diode Laser Absorption
23    Spectrometer (TDLAS) to measure NO2 and HNOs. TDLAS has an inherently fast response, and
24    for species such as NO2 and HNOs with well-characterized spectra it provides  an absolute and
25    specific measurement.  Absolute concentrations of HNO3 were measured, and  the flux inferred
26    based on the dry deposition inferential method that uses momentum flux measurements to
27    compute a deposition velocity and derives an inferred flux (Wesely and Hicks, 1977; Hicks et al.,
28    1987). Direct eddy covariance calculations for HNOs were not possible because the atmospheric
29    variations were attenuated by interaction with the inlet walls despite very short residence time
30    and use of fluorinated silane coatings to make the inlet walls more hydrophobic.  Nitrogen Oxide
31    response was adequate to allow both concentration and eddy covariance flux determination.
32    Simultaneously, NO and NOy eddy covariance fluxes were determined with two separate Os

      March 2008                             AX2-41      DRAFT-DO NOT  QUOTE  OR CITE

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 1    chemiluminescence detectors, one equipped with a H2-gold catalyst at the inlet to convert all
 2    reactive nitrogen compounds to NO.  Additionally, the measurements include concentration
 3    gradients for NO, NO2, and O3 over several annual cycles to examine their vertical profiles in the
 4    forest canopy.
 5           Overall, the results show typical NO2 concentrations of 1 ppb under clean-air conditions
 6    and mean concentrations up to 3 ppb  at night and 1 ppb during daytime for polluted conditions.
 7    Net positive fluxes (emission) of NO2 were evident in the daytime and negative fluxes
 8    (deposition) were observed at night (Figure AX2.6-1). Nitric oxide fluxes were negative during
 9    the daytime and near zero at night.
10           In part the opposite NO and NO2 fluxes are simply consequences of variable NO/NO2
11    distributions responding to vertical gradients in light intensity and O3 concentration, which
12    resulted in no net flux of NOx (Gao et al., 1993). In the Harvard Forest situation, the NO and
13    NO2 measurements were not at the same height above the canopy, and the resulting
14    differences derive at least in part from the gradient in flux magnitude between the two inlets
15    (Figure AX2.6-2).
16           At night, when NO concentrations are near 0 due to titration by ambient O3 there is not a
17    flux of NO to offset NO2 fluxes. Nighttime data consistently show NO2 deposition (Figure
18    AX2.6-3), which increases with increasing NO2 concentrations. Concentrations above 10 ppb
19    were rare at this site, but the few high NO2 observations suggest a nonlinear dependence on
20    concentration. The data fit a model with Vd of-0.08 plus an enhancement term that was second
21    order in NO2 concentration.  The second order term implies that NO2 deposition rates to
22    vegetation in polluted urban sites would be considerably larger than what was observed at this
23    rural site.
24           After accounting for the NO-NO2 null cycle the net NOx flux could be derived. Overall,
25    there was a net deposition of NOx during the night and essentially zero flux  in the day, with large
26    variability in the magnitude and sign  of individual flux observations.  For the periods with [NO2]
27    > 2 ppb, deposition was always observed. These canopy-scale field observations are consistent
28    with a finite compensation point for NO2 in the canopy that offsets foliar uptake or even reverses
29    it when concentrations are especially  low.  At concentrations above the compensation point, NOx
30    is absorbed by the canopy.  Examination of concentration profiles corroborates the flux
31    measurements (Figure AX2.6-4). During daytime for low-NOx conditions, there is a local

      March 2008                              AX2-42       DRAFT-DO NOT QUOTE OR CITE

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                            NW
                                                              SW
, 	 . 8-
^
"o
6-
"o
1 -
o
§ 2
o
0-
Z~~ 4
1 2
O n
1
•*-" -2
X
3
E -4


[NO] 	 • 	
[Ncy -— ^ —
. [U^J/IO
*^*fi- ^i^^^^it^M
1 1-i
1! |U-^,
, , . .* 1 a
r-.-.^.l.T -. - - ---i'f -. i*,:.»*
\ ' /" < '
F NO 	 • 	 '*••-. ..
- FNO, ^*^-
FO /10 ------ 	 -
i i i i I t i i i «i i i * i i ii
0 6 12 18
Hours









*rv*s..- "
[*fn7rT , *-*' -v
[-.* *%• : 1-
i*4* *
"i i ' • i 7 t i i i i i i t~\~r~»~i~tm
/'•"-*-*-*
,4
i-i-^*-K , "r * >^*-4^f
V_--''
1 1 1 1 i i • I I 1 1 1 1 ( 1 1 1 • 1
0 6 12 18
Hours
    Figure AX2.6-1.
                   Diel cycles of median concentrations (upper panels) and fluxes (lower
                   panels) for the Northwest clean sector, left panels) and Southwest
                   (polluted sector, right panels) wind sectors at Harvard Forest, April-
                   November, 2000, for NO, NO2, and O3/10. NO and O3 were sampled
                   at a height of 29 m, and NOi at 22 m.  Vertical bars indicate 25th and
                   27th quartiles for NO and NOi measurements. NOi concentration
                   and nighttime deposition are enhanced under southwesterly
                   conditions, as are O3 and the morning NO maximum.
    Source: Horn et al. (2004).
4

5
maximum in the concentration profile near the top of the canopy where Oj has a local minimum,

which is consistent with foliar emission or light-dependent production of NOx in the upper

canopy. Depletion is evident for both NOx and Os near the forest floor. Air reaching the ground

has passed through the canopy where uptake is efficient and the vertical exchange rates near the

ground are slow.  At night, the profiles generally decrease with decreasing height above the
    March 2008
                                       AX2-43
DRAFT-DO NOT QUOTE OR CITE

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                                  Simple Model
    100
      80
 ,,   60
 O)
 "0
      40
      20
       0
NO,
NO,
                                        NO
         0.0    0.2   0.4    0.6   0.8    1.0-2-1      0       1       2
            Concentration (nmol mol"1)          Flux (nmol mol"1 cm s"1)
Figure AX2.6-2.
      Simple NOx photochemical canopy model outputs.  Left panel,
      concentrations of NO (dashed) and NO2 (solid); right, fluxes of NO
      (dashed) and NO2 (solid). Symbols indicate measurement heights for
      NO (29m) and NO2 (22m) at Harvard Forest. The model solves the
      continuity equation for NO concentration at 200 levels, d/dz(-
      Kc(dNO/dz)) = PNO - LNO, where PNO = [NO]/tl, LNO = [NO]/t2,
      and zero net deposition or emission of NOx is allowed. NOx (NO +
      NO2) is normalized to Ippb. tl = 70s in this example. Due to the
      measurement height difference, observed upward NO2 flux due to
      photochemical cycling alone should be substantially larger than
      observed downward NO flux attributable to the same process.
Source: Horn (2002).
March 2008
                        AX2-44
          DRAFT-DO NOT QUOTE OR CITE

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                      FNO2 (night) = F0 + V0 [NO2] + a [NO2]2
       5-
      -5 —
U)

u

"o
E
"o
 J  -10
 u_
  CM
 O
     -15-
     -20-
                                                     Hourly Data (fitted)  *
                                                     Nightly Medians    +
             F0=0
            V0= -0.08 ±0.03 (ems'1)
            a = -0.013 ± 0.001 (nmo!"1 mol cm s"1)

            R2=0.63
            0
10        15       20
    [N02] (nmol mol'1)
                                                              25
                          30
Figure AX2.6-3.
                 Hourly (dots) and median nightly (pluses) NOi flux vs. concentration,
                 with results of least-squares fit on the hourly data (curve).  The flux is
                 expressed in units of concentration times velocity (nmol mol'1 cm s'1)
                 in order to simplify the interpretation of the coefficients in  the least-
                 squares fit.  Pressure and temperature corrections have been taken
                 into account in the conversion from density to mixing ratio.
Source: Horn et al. (2004).
March 2008
                                   AX2-45
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                                         N(X PROFILES
   Canopy
    Top *""l
             30- '
             25- -
             20- -
          .S>
          "3
          -C
             10
                             xo
                             xo
                          xo
                         xo
                    NO2 //NO,
                       xo
                      xo
                                 Night Low NOx   o

                                                 30"
                                                 25
                                                 20"
                                                 15"
                                                 10"
                                                                      Night High NOx  <>
                                                                   . >-
               O.TO  0.75  0.80   0.85  15   20   25    30      34   3.8   4.2   4,814  16 18  20 22 24
   Canopy
    Top  ~~
             30
             25- -
             20"

             10"
             o -•
                  N02     NO
                 x      o

                  X    O
                                 Day Low NOx    o


                                                 20 •'
                                                 15"
                                                 10--
                                                                     Day High NOx    o
               0,60  0.65 0.70 0,75 0,80 28  30  32  34  36    4,2  4,4  4.6 4,8  5,0 22 23 24 25 26 27  28

                 Concentration (nmol mol'1)        Concentration (nrnol mo!*1)
Figure AX2.6-4.
                    Averaged profiles at Harvard Forest give some evidence of some
                    input near the canopy top from light-mediated ambient reactions, or
                    emission from open stomates.
Source: Horn et al. (2004).
March 2008
                                        AX2-46      DRAFT-DO NOT QUOTE OR CITE

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 1    ground, showing only uptake.  At higher concentrations, the daytime NOx concentrations are
 2    nearly constant through the canopy; no emission is evident from the sunlit leaves.
 3          Figure AX2.6-5 compares observed fluxes of all the observed species. The measured
 4    NOx and estimated PAN fluxes are small relative to the observed total NOy flux. In clean air,
 5    HNOs accounts for nearly all the NOy flux and the sum of all measured species is about equal to
 6    the NOy concentration. However, in polluted conditions, unmeasured species are up to 25% of
 7    the NOy, and HNOs fluxes cannot account for all the total NOy flux observed. Likely these
 8    unmeasured NOy species are hydroxyalkyl nitrates and similar compounds and are rapidly
 9    deposited.  Although NC>2 uptake may be important to the plant, because it is an input directly to
10    the interior of foliage that can be used immediately in plant metabolism, it is evidently not a
11    significant part of overall nitrogen deposition to rural sites. The deposition of HNO3 and
12    multifunctional organic nitrates are the largest elements of the nitrogen dry deposition budget.
13    Two key areas of remaining uncertainty are the production of HONO over vegetation and the
14    role of very reactive biogenic VOCs. HONO is important because its photolysis is a source of
15    OH radicals, and its formation may represent an unrecognized mechanism to regenerate
16    photochemically active NOx from nitrate that had been considered terminally removed from the
17    atmosphere.
18
19    Ecosystem Effects
20          In addition to the contribution to precipitation acidity, atmospheric nitrogen oxides have
21    ecological  effects.  Total loading by both and wet and dry deposition is the relevant metric for
22    considering ecosystem impacts.  At low inputs, nitrogen deposition adds essential nutrients to
23    terrestrial ecosystems.  Most temperate forests are nitrogen limited; thus the inputs stimulate
24    growth.  Anthropogenic nitrogen may influence some plant species different and alter the
25    distribution of plant species (cf. Wedin and Tilman, 1996). At high nitrogen loading, where
26    nitrogen inputs exceed nutrient requirements, deleterious effects including forest decline
27    associated with 'nitrogen saturation'  are seen (Aber at al., 1998; Driscoll et al., 2003).  In aquatic
28    ecosystems, however, nitrogen is may or may not be limiting, but in brackish waters  atmospheric
29    deposition of anthropogenic nitrogen is suspected of contributing to eutrophication of some
30    coastal waters and lakes (see Bergstrom and Jansson, 2006; Castro and Driscoll, 2002).
      March 2008                              AX2-47       DRAFT-DO NOT QUOTE OR CITE

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                                  Summer 2000
                       NW
                                         sw
-» 12
o 10
E
_ 8

E 6
c
4 •
0
0 2
•
""^ 1 2
0


^•^
"5 0.8
c
0
o 0.4
2
IL
0.0
^= -5
CM
E
"5
1 -15

X
3
ul
-25



NOxV+HNO3+PAN 	
"NO +HNO,

NOx=NO+NO2
NO

- *^<^^?*^^- ...^-- :-- - -
- ' 	 S ' ' 	 •
L \ -N / y 	
\ '/ 	 --, _ 	 . ,- "* •--.


VA / '-/ \ ~ . /
V ' — ' v-,v-'/
, ^ \/
- ' \ 	 •- ^ '
V \ '

^ ^- ^ — "*
, - ' ' 	 	
" [E m O i ' / " C 1
FPAN (est.) X
- FNO (param.) T
FNO2 (param.) A
_FHNO3(DDIM) o
FNOy (e.c.) n
- I I I I I I ill LJJLLJL
0 5 10 15 20
He
*

•

1 ~~~~^^^^\ y\ -
'^- \/** — ~^\_— ^—/
">'x\\1— ^ _"^«— "" N .^ - ^
S____ 	 ^ 	 ^^^
1 1 1 1 1)11 1 1 1 1 1 1 1 1 1 1 *
.






/•'"_ Vx'7/ ••X\'x/%v^'~^ 	 '^,^- ", ~- "*'• 	
• /' Vv_x ^^^ ~~" --"-"; — •
/ - -.^ 	 	 _ . *
.. — 	 - 	
. S | ' ff) _ r^-^' J^ /
\ /f\ a. o ,^- /
'[1^ J, n 1 c> | ° °' '\ / ° I
i( F n'
^ M\ -[I-[]'[I
[] []'


1
0 5 10 15 20
•ur
Figure AX2.6-5.
Summer (June-August) 2000 median concentrations (upper panels),
fractions of NOY (middle panels), and fluxes (lower panels) of NOY
and component species separated by wind direction (Northwest on the
left and Southwest on the right). Vertical lines in the flux panels show
25th and 75th quartiles of F(NOY) and F(HNO3); negative fluxes
represent deposition; F(NOX) is derived from eddy covariance F(NO)
and F(NOi) measurements (corrected for photochemical cycling),
F(HNOs) is inferred, and F(NOy) was measured by eddy covariance.
The sum of NOx, HNOs, and PAN accounts for all of the NOy
concentration and flux for Northwesterly (unpolluted background)
flows, whereas up to 50% of NOy and F(NOy) under Southwesterly
flows are in the form of reactive nitrogen species whose fluxes are not
measured or estimated here.
Source: Horn et al. (2006).
March 2008
                  AX2-48
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 1   AX2.6.2    Emissions of NOX, NH3, and SO2
 2
 3   Emissions ofNOx
 4          Estimated annual emissions of NOx, NHa, and SC>2 for 2002 (U.S. Environmental
 5   Protection Agency, 2006) are shown in Table AX2.6-1 .  Methods for estimating emissions of
 6   criteria pollutants, quality assurance procedures, and examples of emissions calculated by using
 7   data are given in U.S. Environmental Protection Agency (1999). Discussions of uncertainties in
 8   current emissions inventories and strategies for improving them can be found in NARSTO
 9   (2005).
10          As can be seen from the table, combustion by stationary sources, such as electrical
1 1   utilities and various industries, accounts for roughly half of total anthropogenic emissions of
12   NOx.  Mobile sources account for the other half, with highway vehicles representing the major
13   mobile source component. Approximately half the mobile source emissions are contributed by
14   diesel  engines, the remainder are emitted by gasoline-fueled vehicles and other sources.
15          Emissions of NOx associated with combustion arise from contributions from both fuel
16   nitrogen and atmospheric nitrogen.  Combustion zone temperatures greater than about  1300 K
17   are required to fix atmospheric N2
18                                                                                (AX26.5)
19    Otherwise, NO can be formed from fuel N according to this reaction
20                        CaHhOcNd +  02 -> xC02 + yH20 + zNO           (AX2.6-6)
21          In addition to NO formation by the schematic reactions given above, some NO2 and CO
22    are also formed depending on temperatures, concentrations of OH and HO2 radicals and O2
23    levels. Fuel nitrogen is highly variable in fossil fuels, ranging from 0.5 to 2.0 percent by weight
24    (wt %) in coal to 0.05% in light distillates (e.g., diesel fuel), to 1 .5 wt % in heavy fuel oils (UK
25    AQEG, 2004).  The ratio of NO2 to NOx in primary emissions ranges from  3 to 5 % from
26    gasoline engines,  5 to 12% from heavy-duty diesel trucks, 5 to 10% from vehicles fueled by
27    compressed natural gas and from 5 to 10% from stationary sources. In addition to NOx, motor
28    vehicles also emit HONO, with ratios of HONO to NOX ranging from 0.3% in the Caldecott
29    Tunnel, San Francisco Bay (Kirchstetter and Harley, 1996) to 0.5 to 1.0% in studies in the

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 1    United Kingdom (UK AQEG, 2004). The NC>2 to NOx ratios in emissions from turbine jet
 2    engines are as high as 32 to 35 % during taxi and takeoff (CD93). Sawyer et al. (2000) have
 3    reviewed the factors associated with NOX emissions by mobile sources. Marine transport
 4    represents  a minor source of NOx, but it constitutes a larger source in the EU where it is
 5    expected to represent about two-thirds of land-based sources (UK AQEG, 2004).
 6
 7    NOx Emissions from Natural Sources (Soil,  Wild Fires, and Lightning)
 8
 9    Soil
10          Emission rates of NO from cultivated soil depend mainly on fertilization levels and soil
11    temperature. About 60% of the total NOx emitted by soils occurs in the central corn belt of the
12    United States. The oxidation of NH3, emitted mainly by livestock and soils, leads to the
13    formation of NO, also NH4+ and NO3 fertilizers lead to NO emissions from soils.  Estimates of
14    emissions from natural sources are less  certain than those from anthropogenic sources. On a
15    global scale, the contribution of soil emissions to the oxidized nitrogen budget is on the order of
16    10% (Van  Aardenne et al., 2001; Finlayson-Pitts and Pitts, 2000; Seinfeld and Pandis, 1998), but
17    NOx emissions from fertilized fields are highly variable. Soil NO emissions can be estimated
18    from the fraction of the applied fertilizer nitrogen emitted as NOx, but the flux varies strongly
19    with land use and temperature. Estimated globally averaged fractional applied nitrogen loss as
20    NO varies  from  0.3% (Skiba et al., 1997) to 2.5% (Yienger and Levy, 1995). Variability within
21    biomes to which fertilizer is applied, such as shortgrass versus tallgrass prairie, accounts for a
22    factor of three in uncertainty (Williams  et al., 1992; Yienger and Levy,  1995; Davidson and
23    Kingerlee, 1997).
24          The local contribution can be much greater than the global average, particularly in
25    summer and especially where corn is grown extensively.  Williams et al. (1992) estimated that
26    contributions to  NO budgets from soils  in Illinois are about 26% of the emissions from industrial
27    and commercial processes in that State.   In Iowa, Kansas, Minnesota, Nebraska, and South
28    Dakota, all states with smaller human populations, soil emissions may dominate the NO budget.
29    Conversion of NH3 to NO3 (nitrification) in aerobic soils appears to be the dominant pathway to
30    NO. The mass and chemical  form of nitrogen (reduced or oxidized) applied to soils, the
31    vegetative cover, temperature, soil moisture, and agricultural practices such as tillage all
32    influence the amount of fertilizer nitrogen released as NO.

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 1          Emissions of NO from soils peak in summer when Os formation is also at a maximum.
 2    An NRC panel report (NRC, 2002) outlined the role of agriculture in emissions of air pollutants
 3    including NO and NH3.  That report recommends immediate implementation of best
 4    management practices to control these emissions, and further research to quantify the magnitude
 5    of emissions and the impact of agriculture on air quality. Civerolo and Dickerson (1998) report
 6    that use of the no-till cultivation technique on a fertilized cornfield in Maryland reduced NO
 7    emissions by a factor of seven.
 8
 9    NOxfrom Biomass Burning
10          During biomass burning, nitrogen is derived mainly from fuel nitrogen and not from
11    atmospheric N2, since temperatures required to fix atmospheric N2 are likely to be found only in
12    the flaming  crowns of the most intense boreal forest fires. Nitrogen is present mainly in plants as
13    amino (NH2) groups in amino acids.  During combustion, nitrogen is released mainly in
14    unidentified forms,  presumably as N2, with very little remaining in fuel ash. Apart from N2, the
15    most abundant species in biomass burning plumes is NO.  Emissions of NO account for only
16    about 10 to 20% relative to fuel N (Lobert et al., 1991). Other species such as NO2, nitriles,
17    ammonia, and other nitrogen compounds account for a similar amount. Emissions of NOx are
18    about 0.2 to 0.3% relative to total biomass burned (e.g., Andreae,  1991; Radke et al., 1991).
19    Westerling et al. (2006) have noted that the frequency and intensity of wildfires in the western
20    United States have increased substantially since 1970.
21
22    Lightning Production of NO
23          Annual global production of NO by lightning is the most uncertain source of reactive
24    nitrogen.  In the last decade, literature values of the global average production rate range from
25    2 to 20 Tg N per year. However, the most likely range is from 3 to 8 Tg N per year, because the
26    majority of the recent estimates fall in this range. The large uncertainty stems from several
27    factors: (1) a large range of NO production rates per meter of flash length (as much as two
28    orders of magnitude); (2) the open question of whether cloud-to-ground (CG) flashes and
29    intracloud flashes (1C) produce substantially different amounts of NO; (3) the global flash rate;
30    and (4) the ratio of the number of 1C flashes to the number of CG flashes. Estimates of the
31    amount of NO produced per flash have been made based on theoretical considerations (e.g.,
32    Price et al.,  1997), laboratory experiments (e.g., Wang et al., 1998); field experiments (e.g., Stith

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 1    et al., 1999; Huntrieser et al., 2002, 2007) and through a combination of cloud-resolving model
 2    simulations, observed lightning flash rates, and anvil measurements of NO (e.g., DeCaria et al.,
 3    2000, 2005; Ott et al., 2007). The latter method was also used by Pickering et al. (1998), who
 4    showed that only ~5 to 20% of the total NO produced by lightning in a given storms exists in the
 5    boundary layer at the end of a thunderstorm. Therefore, the direct contribution to boundary layer
 6    Os production by lightning NO is thought to be small.  However, lightning NO production can
 7    contribute substantially to Os production in the middle and upper troposphere. DeCaria et al.
 8    (2005) estimated that up to 10 ppbv of ozone was produced in the upper troposphere in the first
 9    24 hours following a Colorado thunderstorm due to the injection of lightning NO. A series of
10    midlatitude and subtropical thunderstorm events have been simulated with the model of DeCaria
11    et al. (2005), and the derived NO production per CG flash averaged 500 moles/flash while
12    average production per 1C flash was 425 moles/flash (Ott et al., 2006).
13          A major uncertainty in mesoscale and global chemical transport models is the
14    parameterization of lightning flash rates. Model variables such as cloud top height, convective
15    precipitation rate, and upward cloud mass flux have been used to estimate flash rates.  Allen and
16    Pickering (2002) have evaluated these methods against observed flash rates from satellite, and
17    examined the effects on ozone production using each method.
18
19    Uses of Satellite Data to Derive Emissions
20          Satellite data have been shown to be useful for optimizing estimates of emissions of NO2.
21    (Leue et al., 2001; Martin et al., 2003; Jaegle et al., 2005).  Satellite-borne instruments such as
22    Global Ozone Monitoring Experiment (GOME) (Martin et al., 2003; and references therein) and
23    Scanning Imaging Absorption Spectrometer for Atmospheric Chartography (SCIAMACHY)
24    (Bovensmann et al., 1999) retrieve tropospheric columns of NO2, which can then be combined
25    with model-derived chemical lifetimes of NOx to yield emissions of NOx.
26          Top-down inference of NOx emission inventory from the satellite observations of NO2
27    columns by mass balance requires at minimum three pieces of information: the retrieved
28    tropospheric NO2 column, the ratio of tropospheric NOx to NO2 columns, and the NOx lifetime
29    against loss to stable reservoirs.  A photochemical model has been used to provide information
30    on the latter two pieces of information.  The method is generally applied exclusively to land
31    surface emissions, excluding lightning.  Tropospheric NO2 columns are insensitive to lightning
32    NOx emissions since most of the lightning NOx in the upper troposphere is present as NO at the

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 1    local time of the satellite measurements (Ridley et al., 1996), owing to the slower reactions of
 2    NO with O3 there.
 3          Jaegle et al. (2005) applied additional information on the spatial distribution of emissions
 4    and on fire activity to partition NOx emissions into sources from fossil fuel combustion, soils,
 5    and biomass burning. Global a posteriori estimates of soil NOx emissions are 68% larger than
 6    the a priori estimates. Large increases are found for the agricultural region of the western United
 7    States during summer, increasing total U.S. soil NOx emissions by a factor of 2 to 0.9 Tg N yr'1.
 8    Bertram et al. (2005) found clear signals in the SCIAMACHY observations of short intense NOx
 9    pulses following springtime fertilizer application and subsequent precipitation over agricultural
10    regions of the western United States. For the agricultural region in North-Central Montana, they
11    calculate a yearly SCIAMACHY top-down estimate that is 60% higher than a commonly used
12    model of soil NOx emissions by Yienger and Levy (1995).
13          Martin et al. (2006) retrieved tropospheric nitrogen dioxide (NO2) columns for
14    May 2004 to April 2005 from the SCIAMACHY satellite instrument to derive top-down NOX
15    emissions estimates via inverse modeling with a global chemical transport model (GEOS-Chem).
16    The top-down emissions were combined with a priori information from a bottom-up emission
17    inventory with error weighting to achieve an improved a posteriori estimate of the global
18    distribution of surface NOx emissions. Their a posteriori inventory improves the GEOS-Chem
19    simulation of NOX, PAN, and HNO3 with respect to airborne in situ measurements over and
20    downwind of New York City. Their a posteriori inventory shows lower NOx emissions from the
21    Ohio River valley during summer than during winter, reflecting recent controls on NOx
22    emissions from electric utilities. Their a posteriori inventory is highly consistent (R2 = 0.82,
23    bias = 3%) with the NEI99 inventory for the United States. In contrast, their a posteriori
24    inventory is 68% larger than a recent inventory by Streets et al. (2003) for East Asia for the
25    year 2000.
26
27    Emissions ofNHs
28          Emissions of NH3 show a strikingly different pattern from those of NOx.  Three-way
29    catalysts used in motor vehicles emit small amounts of NH3 as a byproduct during the reduction
30    of NOX. Stationary combustion sources make  only a small contribution to emissions of NH3
31    because efficient combustion favors formation of NOx and, NH3 from combustion is produced
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 1    mainly by inefficient, low temperature fuel combustion. For these reasons, most emissions of
 2    NHs arise from fertilized soils and from livestock.
 3          The initial step in the oxidation of atmospheric NH3 to NO is by reaction with OH
 4    radicals. However, the lifetime of NH? from this pathway is  sufficiently long (-1-2 months
 5    using typical OH values 1-2 x 106/cm3) that it is a small sink compared to uptake of NH? by
 6    cloud drops, dry deposition, and aerosol particles. Thus, the  gas-phase oxidation of NH? makes a
 7    very small contribution as a source of NO.  Holland et al. (2005) estimated wet and dry
 8    deposition of NHX, based on measurements over the continental United States, and found that
 9    emissions of NH3 in the National Emissions Inventory are perhaps underestimated by about a
10    factor of two to three. Reasons for this imbalance include under-representation of deposition
11    monitoring sites in populated areas and the neglect of off-shore transport in their estimate.  The
12    use of fixed deposition velocities that do not reflect local conditions at the time of measurement
13    introduces additional uncertainty into their estimates of dry deposition.
14
15    Emissions of SO2
16          As  can be seen from Table AX2.6-1, emissions of SO2 are due mainly to the combustion
17    of fossil fuels by electrical utilities  and industry. Transportation related sources make only a
18    minor contribution. As a result, most SO2 emissions originate from point sources.  Since sulfur
19    is a volatile component of fuels, it is almost quantitatively released during combustion and
20    emissions can be calculated on the basis of the sulfur content of fuels to greater accuracy than for
21    other pollutants such as NOx  or primary PM.
22          The major natural sources of SO2 are volcanoes and biomass burning and DMS oxidation
23    over the oceans. SO2 constitutes a relatively minor fraction (0.005% by volume) of volcanic
24    emissions (Holland, 1978).  The ratio of H2S to SO2 is highly variable in volcanic gases. It is
25    typically much less than one,  as in the Mt. Saint Helen's eruption (Turco et al., 1983). However,
26    in addition to being degassed from  magma, H2S can be produced if ground waters,  especially
27    those containing organic matter, come into contact with volcanic gases. In this case, the ratio of
28    H2S to SO2 can be greater than one. H2S produced this way would more likely be emitted
29    through side vents than through eruption columns (Pinto et al., 1989).  Primary particulate sulfate
30    is a component of marine aerosol and is also produced by wind erosion of surface soils.
31          Volcanic sources of SO2 are limited to the Pacific Northwest, Alaska, and Hawaii. Since
32    1980, the Mount St. Helens volcano in the Washington Cascade Range (46.20 N, 122.18 W,

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 1    summit 2549 m asl) has been a variable source of 862.  Its major effects came in the explosive
 2    eruptions of 1980, which primarily affected the northern part of the mountainous western half of
 3    the United States. The Augustine volcano near the mouth of the Cook Inlet in southwestern
 4    Alaska (59.363 N, 153.43 W, summit 1252 m asl) has had variable SC>2 emission since its last
 5    major eruptions in 1986.  Volcanoes in the Kamchatka peninsula of eastern region of Siberian
 6    Russia do not significantly effect surface SO2 concentrations in northwestern North America.
 7    The most serious effects in the United States from volcanic SC>2 occurs on the island of Hawaii.
 8    Nearly continuous venting of 862 from Mauna Loa and Kilauea produces 862 in such large
 9    amounts that >100 km downwind of the island SC>2 concentrations can exceed 30 ppbv
10    (Thornton and Bandy, 1993). Depending on wind direction, the west coast of Hawaii (Kona
11    region) has had significant deleterious effects from SO2 and acidic sulfate aerosols for the past
12    decade.
13          Emissions of SC>2 from burning vegetation are generally in the range of 1 to 2% of the
14    biomass burned (see e.g., Levine et al., 1999).  Sulfur is bound in amino acids in vegetation.
15    This organically bound sulfur is released during combustion. However, unlike nitrogen, about
16    half of the sulfur initially present in vegetation is found in the ash (Delmas, 1982).  Gaseous
17    emissions are mainly in the form of SC>2 with much smaller amounts of H2S and OCS.  The ratio
18    of gaseous nitrogen to sulfur emissions is about 14, very close to their ratio in plant tissue
19    (Andreae, 1991). The ratio of reduced nitrogen and sulfur species such as NH3 and H2S to their
20    more oxidized forms, such as NO and SO2, increases from flaming to smoldering phases of
21    combustion, as emissions of reduced species are favored by lower temperatures and C>2 reduced
22    availability.
23          Emissions of reduced sulfur species are associated typically with marine organisms living
24    either in pelagic or coastal zones and with anaerobic bacteria in marshes and estuaries.
25    Mechanisms for their oxidation were discussed in Section AX2.2.  Emissions of dimethyl sulfide
26    (DMS) from marine plankton represent the largest single source of reduced sulfur species to the
27    atmosphere (e.g., Berresheim et al., 1995). Other sources such as wetlands and terrestrial plants
28    and soils probably account for less than 5% of the DMS  global flux, with most of this coming
29    from wetlands.
30          The coastal and wetland sources of DMS have a dormant period in the fall/winter from
31    senescence of plant growth.  Marshes die back in fall and winter, so dimethyl sulfide emissions

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 1    from them are lower, reduced light levels in winter at mid to high latitudes reduce cut
 2    phytoplankton growth which also tends to reduce DMS emissions. Western coasts at mid to high
 3    latitudes have reduced levels of the light that drive photochemical production and oxidation of
 4    DMS.  Freezing at mid and high latitudes affects the release of biogenic sulfur gases, particularly
 5    in the nutrient-rich regions around Alaska. Transport of SC>2 from regions of biomass burning
 6    seems to be limited by heterogeneous losses that accompany convective processes that ventilate
 7    the surface layer and the lower boundary layer (Thornton et al., 1996, TRACE-P data archive).
 8          However, it should be noted that reduced sulfur species are also produced by industry.
 9    For example, DMS is used in petroleum refining and in petrochemical production processes to
10    control the formation of coke and carbon monoxide. In addition, it is used to control dusting in
11    steel mills. It is also used in a range of organic syntheses. It also has a use as a food flavoring
12    component. It can also be oxidized by natural or artificial means to dimethyl sulfoxide (DMSO),
13    which has several important solvent properties.
14
15    AX2.6.3    Field Studies Evaluating Emissions Inventories
16          Comparisons of emissions model predictions with observations have been performed in a
17    number of environments. A number of studies of ratios of concentrations of CO to NOx and
18    NMOC to NOx during the early 1990s in tunnels and ambient air (summarized in Air Quality
19    Criteria for Carbon Monoxide (U.S. Environmental Protection Agency, 2000)) indicated that
20    emissions of CO and NMOC were systematically underestimated in emissions inventories.
21    However, the results of more recent studies have been mixed in this regard, with many studies
22    showing agreement to within ±50% (U.S. Environmental Protection Agency, 2000).
23    Improvements in many areas have resulted from the process of emissions model  development,
24    evaluation, and further refinement.  It should be remembered that the conclusions from these
25    reconciliation studies depend on the assumption that NOx emissions are predicted correctly by
26    emissions factor models.  Roadside remote sensing data indicate that over 50% of NMHC and
27    CO emissions are produced by less than about 10% of the vehicles (Stedman et al., 1991).  These
28    "super-emitters" are typically poorly maintained vehicles. Vehicles of any  age engaged in  off-
29    cycle operations (e.g., rapid accelerations) emit much more than if operated in normal driving
30    modes.  Bishop and Stedman (1996) found that the most important variables governing CO
31    emissions are fleet age and owner maintenance.
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 1          Emissions inventories for North America can be evaluated by comparison to measured
 2   long-term trends and or ratios of pollutants in ambient air.  A decadal field study of ambient CO
 3   at a rural site in the eastern United States (Hallock-Waters et al., 1999) indicates a downward
 4   trend consistent with the downward trend in estimated emissions over the period 1988 to 1999
 5   (U.S. Environmental Protection Agency, 1997), even when a global downward trend is
 6   accounted for. Measurements at two urban areas in the United States confirmed the decrease in
 7   CO emissions (Parrish et al., 2002). That study also indicated that the ratio of CO to NOx
 8   emissions decreased by almost a factor of three over  12 years (such a downward trend was noted
 9   in AQCD 96). Emissions estimates (U.S. Environmental Protection Agency, 1997) indicate a
10   much smaller decrease in this ratio, suggesting that NOx emissions from mobile sources may be
11   underestimated and/or increasing. Parrish et al. (2002) conclude that O3 photochemistry in U.S.
12   urban areas may have become more NOx-limited over the past decade.
13          Pokharel et al. (2002) employed remotely sensed emissions from on-road vehicles and
14   fuel use data to estimate emissions in Denver.  Their  calculations indicate a continual decrease in
15   CO, HC, and NO emissions from mobile sources over the 6-year study period.  Inventories based
16   on the ambient data  were 30 to 70% lower for CO, 40% higher for HC, and 40 to 80% lower for
17   NO than those predicted by the MOBILE6 model.
18          Stehr et al. (2000) reported simultaneous measurements of CO, SO2, and NOy at an East
19   Coast site. By taking advantage of the nature of mobile sources (they emit NOx and  CO but
20   little SO2) and power plants (they emit NOX and SO2 but little CO), the authors evaluated
21   emissions estimates  for the eastern United States.  Results indicated that coal combustion
22   contributes 25 to 35% of the total NOx emissions in rough agreement with emissions inventories
23   (U.S. Environmental Protection Agency, 1997).
24          Parrish et al. (1998) and Parrish and Fehsenfeld (2000) proposed methods to derive
25   emission rates by examining measured ambient ratios among individual VOC, NOx and NOy.
26   There is typically a strong correlation among measured values for these species because emission
27   sources are geographically collocated, even when individual sources are different. Correlations
28   can be used to derive emissions ratios between species, including adjustments for the impact of
29   photochemical aging. Investigations of this type include correlations between CO and NOy (e.g.,
30   Parrish et al., 1991), between individual VOC species and NOY (Goldan et al., 1995, 1997, 2000)
31   and between various individual VOC (Goldan et al., 1995, 1997; McKeen and Liu, 1993;

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 1    McKeen et al., 1996). Buhr et al. (1992) derived emission estimates from principal component
 2    analysis (PC A) and other statistical methods.  Many of these studies are summarized in Trainer
 3    et al. (2000), Parrish et al. (1998), and Parrish and Fehsenfeld (2000).  Goldstein and Schade
 4    (2000) also used species correlations to identify the relative impacts of anthropogenic and
 5    biogenic emissions. Chang et al. (1996, 1997) and Mendoza-Dominguez and Russell (2000,
 6    2001) used the more quantative technique of inverse modeling to derive emission rates, in
 7    conjunction with results from chemistry-transport models.
 8
 9
10    AX2.7    METHODS USED TO CALCULATE CONCENTRATIONS OF
11               NITROGEN  OXIDES AND THEIR CHEMICAL
12               INTERACTIONS IN THE ATMOSPHERE
13          Atmospheric chemistry and transport models are the major tools used to calculate the
14    relations among Os, other oxidants, and their precursors,  the transport and transformation of air
15    toxics, the production of secondary organic aerosol, the evolution of the particle size distribution,
16    and the production and deposition of pollutants affecting ecosystems.  Chemical transport
17    models are driven by emissions inventories for primary species such as the precursors for 63 and
18    PM and by meterological fields produced by other numerical models.  Emissions of precursor
19    compounds  can be divided into anthropogenic and natural source categories. Natural sources can
20    be further divided into biotic (vegetation, microbes, animals) and abiotic (biomass burning,
21    lightning) categories.  However, the distinction between natural sources and anthropogenic
22    sources is often difficult to make as human  activities affect directly, or indirectly, emissions from
23    what would have been considered natural sources during the preindustrial era.  Emissions from
24    plants and animals used in agriculture have been referred to as anthropogenic or natural in
25    different applications. Wildfire emissions may be considered to be natural, except that forest
26    management practices may have led to the buildup of fuels on the forest floor, thereby altering
27    the frequency and severity of forest fires. Needed meteorological quantities such as winds and
28    temperatures are taken from operational analyses, reanalyses, or circulation models. In most
29    cases, these are off-line analyses, i.e., they are not modified by radiatively active species such as
30    Os and particles generated by the model.
31          A brief overview of atmospheric chemistry-transport models is given in Section AX2.7.1.
32    A discussion of emissions inventories of precursors used by these models is given in Section

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 1    AX2.7.2. Uncertainties in emissions estimates have also been discussed in Air Quality Criteria
 2    for Particulate Matter (U.S. Environmental Protection Agency, 2004).  Chemistry-transport
 3    model evaluation and an evaluation of the reliability of emissions inventories are presented in
 4    Section AX2.7.4.
 5
 6    AX2.7.1    Chemistry-Transport Models
 7          Atmospheric CTMs have been developed for application over a wide range of spatial
 8    scales ranging from neighborhood to global.  Regional scale CTMs are used: (1)  to obtain better
 9    understanding of the processes controlling the formation, transport, and destruction of gas-and
10    particle-phase criteria and hazardous air pollutants; (2) to understand the relations between Os
11    concentrations and concentrations of its precursors such as NOx and VOCs, the factors leading to
12    acid deposition, and hence to possible damage to ecosystems; and (3)  to understand relations
13    among the concentration patterns of various pollutants that may exert adverse health effects.
14    Chemistry Transport Models are also used for determining control strategies for 63 precursors.
15    However, this application has met with varying degrees of success because of the highly
16    nonlinear relations between Os and emissions of its precursors, and uncertainties in emissions,
17    parameterizations of transport, and chemical production and loss terms. Uncertainties in
18    meteorological variables and emissions can be large enough to lead to significant errors in
19    developing control strategies (e.g., Russell and Dennis, 2000; Sillman  et al., 1995).
20          Global scale CTMs are used to address issues associated with climate change,
21    stratospheric ozone depletion, and to provide boundary conditions for regional scale models.
22    CTMs include mathematical (and often simplified) descriptions of atmospheric transport, the
23    transfer of solar radiation through the atmosphere, chemical reactions, and removal to the surface
24    by turbulent motions and precipitation for pollutants emitted into the model domain.  Their upper
25    boundaries extend anywhere from the top of the mixing layer to the mesopause (about 80 km in
26    height), to obtain more realistic boundary conditions for problems involving stratospheric
27    dynamics.  There is a trade-off between the size of the modeling domain and the grid resolution
28    used in the CTM that is imposed by computational resources.
29          There are two major formulations of CTMs in current use. In the first approach, grid-
30    based, or Eulerian, air quality models, the region to be modeled (the modeling domain) is
31    subdivided into a three-dimensional array of grid cells.  Spatial derivatives in the species
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 1    continuity equations are cast in finite-difference there are also some finite-element models, but
 2    not many applications form over this grid, and a system of equations for the concentrations of all
 3    the chemical species in the model are solved numerically at each grid point. Time dependent
 4    continuity (mass conservation) equations are solved for each species including terms for
 5    transport, chemical production and destruction, and emissions and deposition (if relevant), in
 6    each cell. Chemical processes are simulated with ordinary differential equations, and transport
 7    processes are simulated with partial differential equations. Because of a number of factors such
 8    as the different time scales inherent in different processes, the coupled, nonlinear nature of the
 9    chemical process terms, and computer storage limitations, all of the terms in the equations are
10    not solved simultaneously in three dimensions. Instead, operator splitting, in which terms in the
11    continuity equation involving individual processes are solved sequentially,  is used. In the second
12    CTM formulation, trajectory or Lagrangian models, a large number of hypothetical air parcels
13    are specified as following wind trajectories.  In these models, the original system of partial
14    differential equations is transformed into a system of ordinary differential equations.
15          A less common approach is to use a hybrid Lagrangian/Eulerian model, in which certain
16    aspects of atmospheric chemistry and transport are treated with a Lagrangian approach and
17    others are treaded in an Eulerian manner (e.g., Stein et al., 2000). Each approach has its
18    advantages and disadvantages. The Eulerian approach is more general in that it includes
19    processes that mix air parcels and allows integrations to be carried out for long periods during
20    which individual  air parcels lose their identity.  There are, however, techniques for including the
21    effects of mixing in Lagrangian models such as FLEXPART (e.g., Zanis et al., 2003), ATTILA
22    (Reithmeier and Sausen, 2002), and CLaMS (McKenna et al., 2002).
23
24    Regional Scale Chemistry Transport Models
25          Major modeling efforts within the U.S. Environmental Protection Agency  center on the
26    Community Multiscale Air Quality modeling system (CMAQ) (Byun and Ching, 1999; Byun
27    and Schere, 2006).  A number of other modeling platforms using Lagrangian and Eulerian
28    frameworks have been reviewed in the 96 AQCD for Os (U.S. Environmental Protection
29    Agency, 1997), and in Russell and Dennis (2000). The capabilities of a number of CTMs
30    designed to study local- and regional-scale air pollution problems are summarized by Russell and
31    Dennis (2000).  Evaluations of the performance of CMAQ are given in Arnold et al. (2003), Eder
32    and Yu (2005), Appel et al. (2005), and Fuentes and Raftery (2005). The domain  of CMAQ can

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 1    extend from several hundred km to the hemispherical scale.  In addition, both of these classes of
 2    models allow the resolution of the calculations over specified areas to vary.  CMAQ is most
 3    often driven by the MM5 mesoscale meteorological model (Seaman, 2000), though it may be
 4    driven by other meteorological models (e.g., RAMS). Simulations of Os episodes over regional
 5    domains have been performed with a horizontal resolution as low as 1 km, and smaller
 6    calculations over limited domains have been accomplished at even finer scales. However,
 7    simulations at such high resolutions require better parameterizations of meteorological processes
 8    such as boundary layer fluxes, deep convection and clouds (Seaman, 2000), and finer-scale
 9    emissions. Finer spatial resolution is necessary to resolve features such as urban heat island
10    circulations; sea, bay, and land breezes; mountain and valley breezes, and the nocturnal low-level
11    jet.
12          The most common approach to setting up the horizontal domain is to nest a finer grid
13    within a larger domain of coarser resolution. However, there are other strategies such as the
14    stretched grid (e.g., Fox-Rabinovitz et al., 2002) and the adaptive grid. In a stretched grid, the
15    grid's resolution continuously varies throughout the domain, thereby eliminating any potential
16    problems with the sudden  change from one resolution to another at the boundary. Caution
17    should be exercised in using such a formulation, because certain parameterizations that are valid
18    on a relatively coarse grid scale (such as convection) may not be valid on finer scales. Adaptive
19    grids are not fixed at the start of the simulation, but instead adapt to the needs of the simulation
20    as it evolves (e.g., Hansen et al., 1994). They have the advantage that they can resolve processes
21    at relevant spatial scales. However, they can be very slow if the situation to be modeled is
22    complex. Additionally, if adaptive grids are used for separate meteorological, emissions, and
23    photochemical models, there is no reason a priori why the resolution of each grid should match,
24    and the gains realized from increased resolution in one model will be wasted in the transition to
25    another model.  The use of finer horizontal resolution in CTMs will necessitate finer-scale
26    inventories of land use and better knowledge of the exact paths of roads, locations of factories,
27    and, in general, better methods for locating sources and estimating their emissions.
28          The vertical resolution of these CTMs is variable, and usually configured to have higher
29    resolution near the surface and decreasing aloft.  Because the height of the boundary layer is of
30    critical importance in simulations of air quality, improved resolution of the boundary layer height
31    would likely improve air quality simulations.  Additionally, current CTMs do not adequately

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 1    resolve fine scale features such as the nocturnal low-level jet in part because little is known about
 2    the nighttime boundary layer.
 3          CTMs require time-dependent, three-dimensional wind fields for the period of
 4    simulation. The winds may be either generated by a model using initial fields alone or with four-
 5    dimensional data assimilation to improve the model's performance, fields (i.e., model equations
 6    can be updated periodically or "nudged", to bring results into agreement with observations.
 7    Modeling efforts typically focus on simulations of several days' duration, the typical time scale
 8    for individual 63 episodes, but there have been several attempts at modeling longer periods. For
 9    example, Kasibhatla and Chameides (2000) simulated a  four-month period from May to
10    September of 1995 using MAQSIP. The current trend in modeling applications is towards
11    annual simulations.  This trend is driven in part by the need to better understand observations of
12    periods of high wintertime PM (e.g., Blanchard et al., 2002) and the need to simulate Os episodes
13    occurring outside of summer.
14          Chemical kinetics mechanisms (a set of chemical reactions) representing the important
15    reactions occurring in the atmosphere are used in CTMs to estimate the rates of chemical
16    formation and destruction of each pollutant simulated as a function of time. Unfortunately,
17    chemical mechanisms that explicitly treat the reactions of each individual reactive species are too
18    computationally demanding to be incorporated into CTMs. For example, a master chemical
19    mechanism includes approximately 10,500 reactions involving 3603 chemical species (Derwent
20    et al., 2001).  Instead, "lumped" mechanisms, that group compounds of similar chemistry
21    together, are used.  The chemical mechanisms used in existing photochemical Os models contain
22    significant uncertainties that may limit the accuracy of their predictions; the accuracy of each of
23    these mechanisms is also limited by missing chemistry.  Because of different approaches to the
24    lumping of organic compounds into surrogate groups, chemical mechanisms can produce
25    somewhat different results under similar conditions. The CB-IV chemical mechanism  (Gery
26    et al., 1989), the RADMII mechanism (Stockwell et al., 1990), the SAPRC (e.g., Wang et al.,
27    2000a,b; Carter, 1990) and the RACM mechanisms can be used in CMAQ. Jimenez et al. (2003)
28    provide brief descriptions of the features of the main mechanisms in use and they compared
29    concentrations of several key species predicted by seven chemical mechanisms in a box model
30    simulation over 24 h. The average deviation from the average of all mechanism predictions for
31    Os and NO over the daylight period was less than 20%, and was 10% for NC>2 for all

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 1    mechanisms. However, much larger deviations were found for HNOs, PAN, HC>2, H2O2, C2H4,
 2    and CsH8 (isoprene). An analysis for OH radicals was not presented. The large deviations
 3    shown for most species imply differences between the calculated lifetimes of atmospheric
 4    species and the assignment of model simulations to either NOx-limited or radical quantity
 5    limited regimes between mechanisms.  Gross and  Stockwell (2003) found small differences
 6    between mechanisms for clean conditions, with differences becoming more  significant for
 7    polluted conditions, especially for NC>2 and organic peroxy radicals.  They caution modelers to
 8    consider carefully the mechanisms they are using. Faraji et al. (2005) found differences of 40%
 9    in peak  1 h 63 in the Houston-Galveston-Brazoria area between simulations using SAPRAC and
10    CB4. They attributed differences in predicted 63 concentrations to differences in the
11    mechanisms of oxidation of aromatic hydrocarbons.
12           CMAQ and other CTMs (e.g., PM-CAMx) incorporate processes and interactions of
13    aerosol-phase chemistry (Mebust et al., 2003).  There have also been several attempts to study
14    the feedbacks of chemistry on atmospheric dynamics using meteorological models, like MM5
15    (e.g., Grell et al., 2000; Liu et al., 2001a; Lu et al., 1997; Park et al., 2001).  This coupling is
16    necessary to simulate accurately feedbacks such as may be caused by the heavy aerosol loading
17    found in forest fire plumes (Lu et al., 1997; Park et al., 2001), or in heavily polluted areas.
18    Photolysis rates in  CMAQ can now be calculated interactively with model produced 63, NO2,
19    and aerosol fields (Binkowski et al., 2007).
20           Spatial and temporal characterizations of anthropogenic and biogenic precursor emissions
21    must be specified as inputs to a CTM. Emissions inventories have been compiled on grids of
22    varying resolution  for many hydrocarbons, aldehydes,  ketones, CO, NH?,  and NOx. Emissions
23    inventories for many species require the application of some algorithm for calculating the
24    dependence of emissions on physical variables such as temperature and to convert the
25    inventories into formatted emission files required by a CTM. For example, preprocessing of
26    emissions data for  CMAQ is done by the Spare-Matrix Operator Kernel Emissions (SMOKE)
27    system.  For many  species, information concerning the temporal variability of emissions is
28    lacking, so long-term (e.g., annual or O3-season) averages are used in short-term, episodic
29    simulations.  Annual emissions estimates are often modified by the emissions model to produce
30    emissions more characteristic of the time of day and season. Significant errors in emissions can
31    occur if an inappropriate time dependence or a default profile is used. Additional complexity

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 1    arises in model calculations because different chemical mechanisms are based on different
 2    species, and inventories constructed for use with another mechanism must be adjusted to reflect
 3    these differences.  This problem also complicates comparisons of the outputs of these models
 4    because one chemical mechanism may produce some species not present in another mechanism
 5    yet neither may agree with the measurements.
 6           In addition to wet deposition, dry deposition (the removal of chemical species from the
 7    atmosphere by interaction with ground-level  surfaces) is an important removal process for
 8    pollutants on both urban and regional scales and must be included in CTMs.  The general
 9    approach used in most models is the resistance in series method, in which where dry deposition
10    is parameterized with a Vd, which is represented as Vd = (ra + rb + r^1 where ra, rt,, and rc
11    represent the resistance due to atmospheric turbulence, transport in the fluid sublayer very near
12    the elements of surface such as leaves or soil, and the resistance to uptake of the surface itself.
13    This approach works for a range of substances, although it is inappropriate for species with
14    substantial emissions from the surface or for  species whose deposition to the surface depends on
15    its concentration at the surface itself. The approach is also modified somewhat for aerosols: the
16    terms it, and rc are replaced with a surface Vd to account for gravitational settling. In their
17    review, Wesely and Hicks (2000) point out several shortcomings of current knowledge of dry
18    deposition.  Among those shortcomings are difficulties in representing dry deposition over
19    varying terrain where horizontal advection plays a significant role in determining the magnitude
20    of ra and difficulties in adequately determining a Vd for extremely stable conditions such as
21    those occurring at night (e.g., Mahrt, 1998).  Under the best of conditions, when a model is
22    exercised over a relatively small area where dry deposition measurements have been made,
23    models still commonly show uncertainties at least  as large as ±30% (e.g., Massman et al., 1994;
24    Brook et al.,  1996; Padro, 1996).  Wesely and Hicks (2000) state that an important result of these
25    comparisons is that the current level of sophistication of most dry deposition models is relatively
26    low, and that deposition estimates therefore must rely heavily on empirical data.  Still larger
27    uncertainties exist when the surface features in the built environment are not well known or
28    when the surface comprises a patchwork of different surface types, as is common in the  eastern
29    United States.
30           The initial  conditions, i.e., the concentration fields of all species computed by a model,
31    and the boundary conditions, i.e., the concentrations of species along the horizontal and  upper

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 1    boundaries of the model domain throughout the simulation must be specified at the beginning of
 2    the simulation. It would be best to specify initial and boundary conditions according to
 3    observations.  However, data for vertical profiles of most species of interest are sparse. The
 4    results of model simulations over larger, preferably global, domains can also be used. As may be
 5    expected, the influence of boundary conditions depends on the lifetime of the species under
 6    consideration and the time scales for transport from the boundaries to the interior of the model
 7    domain (Liu et al., 2001 b).
 8          Each of the model components described above has an associated uncertainty, and the
 9    relative importance of these uncertainties varies with the modeling application. The largest
10    errors in photochemical modeling are still thought to arise from the meteorological and
11    emissions inputs to the model (Russell and Dennis, 2000). Within the model itself, horizontal
12    advection algorithms are  still thought to be significant source of uncertainty (e.g., Chock and
13    Winkler, 1994), though more recently, those errors are thought to have been reduced (e.g.,
14    Odman and Ingram,  1996). There are also indications that problems with mass conservation
15    continue to be present in photochemical and meteorological models (e.g., Odman and Russell,
16    1999); these can result in significant simulation errors. The effects of errors in initial conditions
17    can be minimized by including several days "spin-up" time in a simulation to allow the model to
18    be driven by emitted species before the simulation of the period of interest begins.
19          While the effects of poorly  specified boundary conditions propagate through the model's
20    domain, the effects of these errors remain undetermined. Because many meteorological
21    processes occur on spatial scales which are smaller than the model grid spacing (either
22    horizontally or vertically) and thus are not calculated explicitly, parameterizations of these
23    processes must be used and these introduce additional uncertainty.
24          Uncertainty also arises in modeling the chemistry of Os formation because it is highly
25    nonlinear with respect to NOx concentrations.  Thus, the volume of the grid cell into which
26    emissions are injected is important because the nature of 63 chemistry (i.e., 63 production or
27    titration) depends in a complicated way on the concentrations of the precursors and the OH
28    radical as noted earlier. The use of ever-finer grid spacing allows  regions of O3 titration to be
29    more clearly separated from regions of Os production.  The use of grid spacing fine enough to
30    resolve the chemistry in individual power-plant plumes is too demanding of computer resources
31    for this to be attempted in most simulations. Instead, parameterizations of the effects of sub-

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 1    grid-scale processes such as these must be developed; otherwise serious errors can result if
 2    emissions are allowed to mix through an excessively large grid volume before the chemistry step
 3    in a model calculation is performed. In light of the significant differences between atmospheric
 4    chemistry taking place inside and outside of a power plant plume (e.g., Ryerson et al., 1998 and
 5    Sillman, 2000), inclusion of a separate, meteorological module for treating large, tight plumes is
 6    necessary. Because the photochemistry of Os and many other atmospheric species is nonlinear,
 7    emissions correctly modeled in a tight plume may be incorrectly modeled in a more dilute plume.
 8    Fortunately, it appears that the chemical mechanism used to follow a plume's development need
 9    not be as detailed as that used to simulate the rest of the domain, as the inorganic reactions are
10    the most important in the plume see (e.g., Kumar and Russell, 1996). The need to include
11    explicitly plume-in-grid chemistry only down to the level of the smallest grid disappears if one
12    uses the adaptive grid approach mentioned previously, though such grids are more
13    computationally intensive.  The differences  in simulations are significant because they can lead
14    to significant differences in the calculated sensitivity of Os to its precursors (e.g., Sillman et al.,
15    1995).
16          Because the chemical production and loss terms in the continuity equations for individual
17    species are coupled, the chemical  calculations must be performed iteratively until calculated
18    concentrations converge to within some preset criterion. The number of iterations and the
19    convergence criteria chosen also can introduce error.
20
21    Intra-urban Scale Dispersion Modeling
22          The grid spacing in regional chemistry transport models is typically too coarse to resolve
23    spatial variations on the neighborhood scale. CTM grid spacing is typically 4 km at best,
24    although there are efforts to increase the horizontal resolution to 1 km. The interface between
25    regional scale models and models of personal exposure described in Annex 3,  Section 3.7 is
26    provided by smaller scale dispersion models.  AERMOD is a steady-state plume model that was
27    formulated as a replacement to the ISC3 dispersion model. In the stable boundary layer (SBL), it
28    assumes the concentration distribution to be Gaussian in both the vertical and horizontal. In the
29    convective boundary layer (CBL), the horizontal distribution  is also assumed to be Gaussian, but
30    the vertical distribution is described with a bi-Gaussian probability density function (pdf).
31    AERMOD has provisions to be applied to flat and complex terrain, and multiple source types
32    (including, point, area and volume sources)  in both urban and rural areas.  It incorporates air

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 1    dispersion based on planetary boundary layer turbulence structure and scaling concepts, and it is
 2    meant to treat both surface and elevated sources, and both simple and complex terrain in both
 3    rural and urban areas. The dispersion of emissions from line sources, such as highways is treated
 4    as the  sum of emissions from a number of point sources placed side by side.  However,
 5    emissions are usually not in steady state and there are different functional relationships between
 6    buoyant plume rise in point and line sources. In contrast, there are models that are non-steady
 7    state and can incorporate plume rise explicitly from different types of sources.  For example,
 8    CALPUFF (http://www.src.com/calpuff/calpuffl .htm) is a non-steady-state puff dispersion
 9    model that simulates the effects of time- and space-varying meteorological conditions on
10    pollution transport, transformation, and removal and has provisions for calculating dispersion
11    from surface sources.
12
13    Global Scale CTMs
14          The importance of global transport of Os and Os precursors and their contribution to
15    regional Os levels in the United States is slowly becoming apparent. There are presently on the
16    order of 20 three-dimensional global models that have been developed by various groups to
17    address problems in tropospheric chemistry. These models resolve synoptic meteorology,
18    (VNOx-CO-hydrocarbon photochemistry, have parameterizations for wet and dry deposition,
19    and parameterize sub-grid scale vertical mixing processes such as convection.  Global models
20    have proven useful for testing and advancing scientific understanding beyond what is possible
21    with observations alone.  For example, they can calculate quantities of interest that cannot be
22    measured directly, such as the export of pollution from one continent to the global atmosphere or
23    the response of the atmosphere to future perturbations to anthropogenic emissions.
24          Global simulations are typically conducted at a horizontal resolution  of about 200 km2.
25    Simulations of the effects of transport from long-range transport link multiple horizontal
26    resolutions from the global to the local scale. Finer resolution will only improve scientific
27    understanding to the extent that the governing processes are more accurately described at that
28    scale.  Consequently, there is a critical need for observations at the appropriate scales to evaluate
29    the scientific understanding represented by the models.
30          During the recent IPCC-AR4 tropospheric chemistry study coordinated by the European
31    Union project Atmospheric Composition Change:  the European Network of excellence
32    (ACCENT), 26 atmospheric CTMs were used to estimate the impacts of three emissions

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 1    scenarios on global atmospheric composition, climate, and air quality in 2030 (Dentener et al.,
 2    2006a).  All models were required to use anthropogenic emissions developed at IIASA (Dentener
 3    et al., 2005) and GFED version 1 biomass burning emissions (Van der Werf et al., 2003) as
 4    described in Stevenson et al. (2006). The base simulations from these models were evaluated
 5    against a suite of present-day observations. Most relevant to this assessment report are the
 6    evaluations with ozone and NC>2, and for nitrogen and sulfur deposition (Stevenson et al., 2006;
 7    Van Noije et al., 2006; Dentener et al., 2006a), which are summarized briefly below.
 8          An analysis of the standard deviation of zonal mean and tropospheric column 63 reveals
 9    large inter-model variability in the tropopause region and throughout the polar troposphere,
10    likely reflecting differences in model tropopause levels and the associated stratospheric injection
11    of O3 to the troposphere (Stevenson et  al., 2006).  Ozone distributions in the tropics also exhibit
12    large standard deviations (-30%), particularly as compared to the mid-latitudes (-20%),
13    indicating larger uncertainties in the processes that influence ozone in the tropics:  deep tropical
14    convection, lightning NOx, isoprene emissions and chemistry, and biomass burning emissions
15    (Stevenson et al., 2006).
16          Stevenson et  al., (2006) found that the model ensemble mean (MEM) typically captures
17    the observed seasonal cycles to within  one standard deviation. The largest discrepancies
18    between the MEM and observations include:  (1) an underestimate of the amplitude of the
19    seasonal cycle at 30°-90°N with a 10 ppbv overestimate of winter ozone, possibly due to the lack
20    of a seasonal cycle in anthropogenic emissions or to shortcomings in the stratospheric influx of
21    Os, and (2) an overestimate of Os throughout the northern tropics.  However, the MEM  was
22    found to capture the  observed seasonal cycles in the southern hemisphere, suggesting that the
23    models adequately represent biomass burning and natural emissions.
24          The mean present-day global ozone budget across the current generation of CTMs differs
25    substantially from that reported in the IPCC TAR, with a  50% increase in the mean chemical
26    production (to 5100 Tg O3 yr"1), a 30% increase in the chemical and deposition loss terms (to
27    4650 and 1000 Tg  Oj yr'1, respectively) and a 30% decrease in the mean stratospheric input flux
28    (to 550 Tg Oj yr"1) (Stevenson et al., 2006). The larger chemical terms as compared to  the IPCC
29    TAR are attributed mainly to higher NOx (as well as an equatorward shift in distribution) and
30    isoprene emissions, although more detailed NMHC schemes and/or improved representations of
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 1    photolysis, convection, and stratospheric-tropospheric exchange may also contribute (Stevenson
 2    et al., 2006).
 3          A subset of 17 of the 26 models used in the Stevenson et al. (2006) study was used to
 4    compare with three retrievals of NO2 columns from the GOME instrument (van Noije et al.,
 5    2006) for the year 2000. The higher resolution models  reproduce the observed patterns better,
 6    and the correlation among simulated and retrieved columns improved for all models when
 7    simulated values are smoothed to a 5° x 5° grid, implying that the models do not accurately
 8    reproduce the small-scale features of NO2 (Van Noije et al., 2006). Van Noije et al.  (2006)
 9    suggest that variability in simulated NO2 columns may reflect a model differences in OH
10    distributions and the resulting NOx lifetimes, as well as differences in vertical mixing which
11    strongly affect partitioning between NO and NO2. Overall, the models tend to underestimate
12    concentrations in the retrievals in industrial regions (including the eastern United States) and
13    overestimate them in biomass burning regions (Van Noije et al., 2006).
14          Over the eastern United States,  and industrial regions more generally, the spread in
15    absolute column abundances is generally larger among the retrievals than among the models,
16    with the discrepancy among the retrievals particularly pronounced in winter (Van Noije et al.,
17    2006), suggesting that the models are biased low, or that the European retrievals may be biased
18    high as the Dalhousie/SAO retrieval is  closer to the model  estimates.   The lack of seasonal
19    variability in fossil fuel combustion emissions may contribute to a wintertime model
20    underestimate (Van Noije et al., 2006) that is manifested most strongly over Asia.  In biomass
21    burning regions, the models generally reproduce the timing of the seasonal cycle of the
22    retrievals, but tend to overestimate the seasonal cycle amplitude, partly due to lower values in the
23    wet season, which may reflect an underestimate in wet season soil NO emissions (Van Noije
24    et al., 2006, Jaegle et al., 2004, 2005).
25
26    Deposition in Global CTMs
27          Both wet and dry deposition are highly parameterized in global CTMs. While all current
28    models implement resistance schemes for dry deposition, the generated Vd generated from
29    different models can vary highly across terrains (Stevenson et al., 2006). The accuracy of wet
30    deposition in global CTMs is tied to spatial and temporal distribution of model precipitation and
31    the treatment of chemical scavenging.  Dentener et al. (2006b) compared wet deposition across
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 1    23 models with available measurements around the globe. Figures AX2.7-1 and AX2.7-2 below
 2    extract the results of a comparison of the 23-model mean versus observations from Dentener
 3    et al. (2006b) over the eastern United States for nitrate and sulfate deposition, respectively.  The
 4    mean model results are strongly correlated with the observations (r > 0.8), and usually capture
 5    the magnitude of wet deposition to within a factor of 2 over the eastern United States (Dentener
 6    et al., 2006b).  Dentener et al. (2006b) conclude that 60-70% of the participating models capture
 7    the measurements to within 50% in regions with quality controlled observations. This study then
 8    identified world regions receiving >1000 mg (N) nT2 yr"1 (the "critical load") and found that
 9    20% of the natural vegetation (non-agricultural) in the United States is exposed to nitrogen
10    deposition in excess of the critical load threshold (Dentener et al., 2006b).
11
12    Modeling the Effects of Convection
13          The effects of deep convection can be simulated using cloud-resolving models, or in
14    regional or global models in which the convection is parameterized. The Goddard  Cumulus
15    Ensemble (GCE) model (Tao and Simpson, 1993) has been used by Pickering et al. (1991,
16    1992a,b, 1993, 1996),  Scala et al. (1990), and Stenchikov et al. (1996) in the analysis of
17    convective transport of trace gases. The cloud model is nonhydrostatic and contains a detailed
18    representation of cloud microphysical processes.  Two- and three-dimensional versions of the
19    model have been applied in transport analyses. The initial conditions for the model are usually
20    from a sounding of temperature, water vapor and winds representative of the region of storm
21    development.  Model-generated wind fields can be used to perform air parcel trajectory analyses
22    and tracer advection calculations.
23          Such methods were used by Pickering et al. (1992b) to examine transport of urban
24    plumes by deep convection.  Transport of an Oklahoma City plume by the 10-11 June 1985
25    PRE-STORM squall line was simulated with the 2-D GCE model.  This major squall line passed
26    over the Oklahoma  City metropolitan area, as well as more rural  areas to the north. Chemical
27    observations ahead of the squall line were conducted by the PRE-STORM aircraft. In this event,
28    forward trajectories from the boundary layer at the leading edge of the storm showed that almost
29    75% of the low level inflow was transported to altitudes exceeding 8 km. Over 35% of the air
30    parcels reached altitudes over 12 km. Tracer transport calculations were performed for CO,
31    NOx, Os, and hydrocarbons. Rural boundary layer NOx was only 0.9 ppbv, whereas the urban
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                   600
                   400
               o
               T3
               O
                   200
                      0
                                           '/     -. '1  .    x?  '•
                                          /   '*.     .*/
                                                Ave- model: 227 Ave. Mea. 195 r: 0.82 n = 226
                                                2 param. fit: y = 51.1 + 0.90.x
                                                1 param. fit: y = 1.08x
                                                Percentage within ± 50%: 74.8
                       0
                200              400
                     Measurement
                    600
    Figure AX2.7-1.
Scatter plot of total nitrate (HNOs plus aerosol nitrate) wet deposition
(mg(N)m2yr~1) of the mean model versus measurements for the North
American Deposition Program (NADP) network. Dashed lines
indicate factor of 2.  The gray line  is the result of a linear regression
fitting through 0.
    Source: Dentener et al. (2006b).


1   plume contained about 3 ppbv.  In the rural case, mixing ratios of 0.6 ppbv were transported up
2   to 11 km.  Cleaner air descended at the rear of the storm lowering NOx at the surface from 0.9 to
3   0.5 ppbv.  In the urban plume, mixing ratios in the updraft core reached 1 ppbv between 14 and
4   15 km. At the surface, the main downdraft lowered the NOx mixing ratios from 3 to 0.7 ppbv.
5          Regional chemical transport models have been used for applications such as simulations
6   of photochemical Os production, acid deposition, and fine PM. Walcek et al. (1990) included a
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                  1000
                   800 -
                   600 -
               TJ
               O
                                                                t
                                                              5   f
                   400 -
                   200
                                                  Ave, model: 383 Ave. Meas: 322 r; 0.87 n = 226
                                                  2 param fit: y = 114.0 + 0.77x
                                                  1 param fit: y ™ 1.00x
                                                  percentage within t 50%; 66,0
200
                                           400       600
                                             Measurement
                     800
                  1000
                                                                                     2   J
    Figure AX2.7-2.     Same as Figure AX2.7-1 but for sulfate wet deposition (mg(S)m  yr
     Source: Dentener et al. (2006b).

1    parameterization of cloud-scale aqueous chemistry, scavenging, and vertical mixing in the
2    chemistry model of Chang et al. (1987). The vertical distribution of cloud microphysical
3    properties and the amount of sub-cloud-layer air lifted to each cloud layer are determined using a
4    simple entrainment hypothesis (Walcek and Taylor, 1986).  Vertically integrated O3 formation
5    rates over the northeast U. S. were enhanced by -50% when the in-cloud vertical motions were
6    included in the model.
7          Wang et al. (1996) simulated the 10-11 June 1985 PRE-STORM squall line with the
8    NCAR/Penn State Mesoscale Model (MM5) (Grell et al., 1994; Dudhia, 1993).  Convection was
9    parameterized as a sub-grid-scale process in MM5 using the Kain and Fritsch (1993) scheme.
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 1   Mass fluxes and detrainment profiles from the convective parameterization were used along with
 2   the 3-D wind fields in CO tracer transport calculations for this convective event.
 3          Convective transport in global chemistry and transport models is treated as a sub-grid-
 4   scale process that is parameterized typically using cloud mass flux information from a general
 5   circulation model or global data assimilation system.  While GCMs can provide data only for a
 6   "typical" year, data assimilation systems can provide "real" day-by-day meteorological
 7   conditions, such that CTM output can be compared directly with observations of trace gases.
 8   The NASA Goddard Earth Observing System Data Assimilation System (GEOS-1 DAS and
 9   successor systems; Schubert et al., 1993; Bloom et al., 1996; Bloom et al., 2005) provides
10   archived global data sets for the period 1980 to present, at 2° x 2.5° or better resolution with
11   20 layers or more in the vertical. Deep convection is parameterized with the Relaxed
12   Arakawa-Schubert scheme (Moorthi and Suarez, 1992) in GEOS-1 and GEOS-3 and with the
13   Zhang and McFarlane (1995) scheme in GEOS-4. Pickering et al. (1995) showed that the cloud
14   mass fluxes from GEOS-1 DAS are reasonable for the 10-11 June 1985 PRE-STORM squall line
15   based on comparisons with the GCE model (cloud-resolving model) simulations of the same
16   storm. In addition, the GEOS-1 DAS cloud mass fluxes compared favorably with the regional
17   estimates of convective transport for the central United States presented by Thompson et al.
18   (1994). However, Allen et al. (1997) have shown that the GEOS-1 DAS  overestimates the
19   amount and frequency of convection in the tropics and underestimates the convective activity
20   over midlatitude marine storm tracks.
21          Global models with parameterized convection and lightning have been run to examine
22   the roles of these processes over North America. Lightning contributed 23% of upper
23   tropospheric NOy over the SONEX region according to the UMD-CTM modeling analysis  of
24   Allen et al. (2000). During the summer of 2004 the NASA Intercontinental Chemical Transport
25   Experiment - North America (INTEX-NA) was conducted primarily over the eastern two-thirds
26   of the United States, as a part of the International Consortium for Atmospheric Research  on
27   Transport and Transformation (ICARTT). Deep convection was prevalent  over this  region
28   during the experimental period. Cooper et al. (2006) used a particle dispersion model simulation
29   for NOx to show that 69-84% of the upper tropospheric Os  enhancement  over the region  in
30   Summer 2004 was due to lightning NOx.  The remainder of the enhancement was due to
31   convective transport of Os from the boundary layer or other sources of NOx. Hudman et al.

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 1    (2007) used a GEOS-Chem model simulation to show that lightning was the dominant source of
 2    upper tropospheric NOx over this region during this period.  Approximately 15% of North
 3    American boundary layer NOx emissions were shown to have been vented to the free
 4    troposphere over this region based on both the observations and the model.
 5
 6    AX2.7.2    CTM Evaluation
 7          The comparison of model predictions with ambient measurements represents a critical
 8    task for establishing the accuracy of photochemical models and evaluating their ability to serve
 9    as the basis for making effective control strategy decisions. The evaluation of a model's
10    performance, or its adequacy to perform the tasks for which it was designed can only be
11    conducted within the context of measurement errors and artifacts.  Not only are there analytical
12    problems, but there are also problems in assessing the representativeness of monitors at ground
13    level for comparison with model values which represent typically an average over the volume of
14    a grid box.
15          Evaluations of CMAQ are given in Arnold et al. (2003) and Fuentes and Raftery (2005).
16    Discrepancies between model predictions and observations can be used to point out gaps in
17    current understanding of atmospheric chemistry and to spur improvements in parameterizations
18    of atmospheric chemical and physical processes.  Model evaluation does not merely involve a
19    straightforward comparison between model predictions and the concentration field of the
20    pollutant of interest.  Such comparisons may not be meaningful because it is difficult to
21    determine if agreement between model predictions and observations truly represents an accurate
22    treatment of physical and chemical processes in the CTM or the effects of compensating errors in
23    complex model routines.  Ideally, each of the model components (emissions inventories,
24    chemical mechanism, meteorological driver) should be evaluated individually. However, this is
25    rarely done in practice.
26          Chemical transport models for Os formation at the urban/regional scale have traditionally
27    been evaluated based on their ability to simulate correctly 03. A series of performance statistics
28    that measure the success of individual model simulations to represent the observed distribution
29    of ambient 63, as represented by a network of surface measurements at the urban scale were
30    recommended by the EPA (U.S. Environmental Protection Agency,  1991; see also Russell and
31    Dennis, 2000).  These statistics consist of the following:
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 1          •   Unpaired peak 63 concentration within a metropolitan region (typically for a
 2              single day).
 3          •   Normalized bias equal to the summed difference between model and measured hourly
 4              concentrations divided by the sum of measured hourly concentrations.
 5          •   Normalized gross error, equal to the summed unsigned (absolute value) difference
 6              between model and measured hourly concentrations divided by the sum of measured
 7              hourly concentrations.
 8    Unpaired peak prediction accuracy, Au
                                 =
                                         C (x* t')
 9                                       ^o<-*"lSmax                             (AX2.7-1)
10   Normalized bias, D;

                                 /  N  {Cn(Xi,t)-Cn(Xj,t)}
                           D = — y    f  '       °  '      tt = 1,24.
11                              N i=1        Co(*i.n                              (AX2.7-2)
12   Gross error, Ed (for hourly observed values of Os >60 ppb)

                            Ed  =-Lj[ I  Cp(Xi,t)-C0(Xi,t)  \  f=l 24
13                                ^;W         Co(*/.0                             (AX2.7-3)
14          The following performance criteria for regulatory models were recommended in U.S.
15   Environmental Protection Agency (1991): unpaired peak Oj to within ±15% or ±20%;
16   normalized bias within ± 5% to ± 15%; and normalized gross error less than 30% to 35%, but
17   only when Os the concentration >60 ppb.  This can lead to difficulties in evaluating model
18   performance since nighttime and diurnal cycles are ignored. A major problem with this method
19   of model evaluation is that it does not provide any information about the accuracy of Os-
20   precursor relations predicted by the model. The process of Os formation is sufficiently complex
21   that models can predict 63 correctly without necessarily representing the 63 formation process
22   properly.  If the 63 formation process is incorrect, then the modeled source-receptor relations
23   will also be incorrect.
24          Studies by Sillman et al. (1995, 2003), Reynolds et al. (1996), and Pierce et al. (1998)
25   have identified instances in which different model scenarios can be created with very different

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 1    (Vprecursor sensitivity, but without significant differences in the predicted 63 fields.
 2    Figures AX2.7-3a,b provide an example. Referring to the (VNOx-VOC isopleth plot (Figure
 3    AX2.7-4), it can be seen that similar O3 concentrations can be found for photochemical
 4    conditions that have very different sensitivity to NOx and VOCs.
 5          Global-scale CTMs have generally been evaluated by comparison with measurements for
 6    a wide array of species, rather than just for Os (e.g., Wang et al., 1998; Emmons et al., 2000; Bey
 7    et al., 2001; Hess, 2001; Fiore et al., 2002).  These have included evaluation of major primary
 8    species (NOx, CO, and selected VOCs) and  an array of secondary species (HNOs, PAN, H2O2)
 9    that are often formed concurrently with Os.  Models for urban and regional Os have also been
10    evaluated against a broader ensemble of measurements in a few cases, often associated with
11    measurement intensives (e.g., Jacobson et al.,  1996; Lu et al.,  1997; Sillman et al., 1998). The
12    results of a comparison between observed and computed concentrations from Jacobson et al.
13    (1996) for the Los Angeles Basin  are shown in Figures AX2.7-5a,b.
14          The highest concentrations of primary  species usually  occur in close proximity to
15    emission sources (typically in urban centers) and at times when dispersion rates are low. The
16    diurnal cycle includes high concentrations at night, with maxima during the morning rush hour,
17    and low concentrations during the afternoon (Figure AX2.7-5a).  The afternoon minima are
18    driven by the much greater rate of vertical mixing at that time. Primary species also show a
19    seasonal maximum during winter, and are often high during fog episodes in winter when vertical
20    mixing, is suppressed.  By contrast, secondary species such as O3 are typically highest during the
21    afternoon (the time of greatest photochemical  activity), on sunny days and during summer.
22          During these conditions, concentrations of primary species may be relatively low. Strong
23    correlations between primary and  secondary species are generally observed only in downwind
24    rural areas where all anthropogenic species are simultaneously elevated.  The difference  in the
25    diurnal cycles of primary species (CO, NOx and ethane) and secondary species (Os, PAN, and
26    HCHO) is evident in Figure AX2.7-5b.
27          Models for urban and regional chemistry have been  evaluated less extensively than
28    global-scale models in part because the urban/regional context presents a number of difficult
29    challenges.  Global-scale models typically represent continental-scale events and can be
30    evaluated effectively against a sparse network of measurements.  By contrast, urban/regional
      March 2008                              AX2-76      DRAFT-DO NOT QUOTE OR CITE

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            .Q
            Q.
            Q.
                25
                20
            ~  10
            o
            3
            "O   5
            tt
            O
0
                -5
                  100      120       140      160
                                     Ozone (ppb)
                                        180
                                                      200
            O
                35
                30
                25

                20
                15
0}  10
 CO   r-
o   5
     0
                                x   x
                                              X
                                          XX
                                        X
                                            X
                                                     X
                                 X
                  100       120       140      160
                                     Ozone (ppb)
                                        180
                                                      200
Figure AX2.7-3a,b.  Impact of model uncertainty on control strategy predictions for Os for
                   two days (August lOa and lib, 1992) in Atlanta, GA.  The figures
                   show the predicted reduction in peak Os resulting from 35%
                   reductions in anthropogenic VOC emissions (crosses) and from 35%
                   reductions in NOx (solid circles) in a series of model scenarios with
                   varying base case emissions, wind fields, and mixed layer heights.
Source: Results are plotted from tabulated values published in Sillman et al. (1995, 1997).
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                    AX2-77
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                   ~   10.00
                    E
                    o
                    c
                    o
                   LU
                    x
                   O
    Figure AX2.7-4.
                          3.16
                    o
                   es
                   O
                   C,      1.0
                    0)
                   •+•»
                    (0
                        0.316
                           0.1
                                                   a.
                                                   a.
                                                   CO
                                                   o
      1.0      3.16       10.0      31.6      100.0
   VOC Emission Rate (1012 molec. cm-2 s-1)
Ozone isopleths (ppb) as a function of the average emission rate for
NOx and VOC (1012 molec. cm"2 s"1) in zero dimensional box model
calculations.  The isopleths (solid lines) represent conditions during
the afternoon following 3-day calculations with a constant emission
rate, at the hour corresponding to maximum Os. The ridge line
(shown by solid circles) lies in the transition from NOx-saturated to
NOx-limited conditions.
1   models are critically dependent on the accuracy of local emission inventories and event-specific
2   meteorology, and must be evaluated separately for each urban area that is represented.
3          The evaluation of urban/regional models is also limited by the availability of data.
4   Measured NOx and speciated VOC concentrations are widely available through the EPA PAMs
5   network, but questions have been raised about the accuracy of those measurements and the data
6   have not yet been analyzed thoroughly.  Evaluation of urban/regional models versus
7   measurements has generally relied on results from a limited number of field studies in the United
8   States. Short-term, research-grade measurements for species relevant to  Os formation, including
    March 2008
                   AX2-78
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E
Q.
a
_o
+!
m
en
c
'x
i
               E
               a
               a.
               03
               a:
               en
               .E
               'x
               E
               Q.
               a.
               a
               IT
               en
               c
0.30

0.25

0.20

0.15

0.10

0.05

0.00


0.30

0.25

0.20

0.15

0.10

0.05

0.00


  6

  5

  4

  3

  2

  1

  0
                          Reseda
                          O3(g)
                          	 Predicted
                          	Observed
                           8    16   24   32   40    48    56   64   72
                                  Hour After First Midnight
Reseda
NOX (g)
                                     	  Predicted
                                     	Observed
                                16   24   32   40    48    56   64   72
                                  Hour After First Midnight
Riverside
C0(g)
                                      	  Predicted
                                      	Observed
                                16   24   32   40    48    56   64   72
                                  Hour After First Midnight
Figure AX2.7-5a.
 Time series for measured gas-phase species in comparison with results
 from a photochemical model. The dashed lines represent
 measurements, and solid lines represent model predictions (in parts
 per million, ppmv) for August 26-28,1988 at sites in southern
 California. The horizontal axis represents hours past midnight,
 August 25. Results represent Os and NOx at Reseda, and CO at
 Riverside.
Source: Jacobsonetal. (1996).
March 2008
                    AX2-79
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    0.060

|  0.050
Q.
S  0.040
O
'•JS  0.030
IT
0>  0.020

g  0.010

    0.000
                  0.030

               |  0.025
               Q.
              3:  0.020
               O
              "•   0.015
               TO  0.010
               c.
              ~  0.005
    0.000


    0.020

£  0.016
Q.

^O  0.012
'^
re
**  0.008
O)

1  0.004
s
    0.000
                              Claremont
                              Ethane (g)
                                  	  Predicted
                                   O    Observed
                                 I
                   I
                                  I
I
I
                                 16    24    32   40   48   56
                                  Hour After First Midnight
                                            64   72
       Claremont
       Formaldehyde (g)
                                       	  Predicted
                                        O   Observed
                                 I
                   I
                             I
I
I
                                 16    24    32   40   48   56
                                  Hour After First Midnight
                                            64   72
                           Los Angeles
                           PAN (g)
                                 	  Predicted
                                 	Observed
                                JL
                                 16    24    32   40   48   56
                                  Hour After First Midnight
                                            64   72
Figure AX2.7-5b.
Time series for measured gas-phase species in comparison with results
from a photochemical model. The circles represent measurements,
and solid lines represent model predictions (in parts per million,
ppmv) for August 26-28,1988 at sites in southern California.  The
horizontal axis represents hours past midnight, August 25. Results
represent ethane and formaldehyde at Claremont, and PAN at Los
Angeles.
Source: Jacobsonetal. (1996).
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 1    VOCs, NOx, PAN, HNOs, and H2O2 are also available at selected rural and remote sites (e.g.,
 2    Daum et al., 1990, 1996; Martin et al., 1997; Young et al., 1997; Thompson et al., 2000; Hoell
 3    et al.,  1997, 1999; Fehsenfeld et al.,  1996; Emmons et al., 2000; Hess, 2001; Carroll et al., 2001).
 4    The equivalent measurements are available for some polluted rural sites in the eastern United
 5    States, but only at a few urban locations (Meagher et al., 1998; Hiibler et al., 1998; Kleinman
 6    et al., 2000, 2001; Fast et al., 2002; new SCAQS-need reference). Extensive measurements have
 7    also been made in Vancouver (Steyn et al., 1997) and in several European cities (Staffelbach
 8    et al.,  1997; Prevot et al., 1997, Dommen et al., 1999;  Geyer et al., 2001; Thielman et al., 2001;
 9    Martilli et al., 2002; Vautard et al., 2002).
10          The results of straightforward comparisons between observed and predicted
11    concentrations of O3 can be misleading because of compensating  errors, although this possibility
12    is diminished when a number of species are compared. Ideally, each of the main modules of a
13    CTM system (for example, the meteorological model and the chemistry and radiative transfer
14    routines) should be evaluated separately. However, this is rarely done in practice. To better
15    indicate how well  physical and chemical processes are being represented in the model,
16    comparisons of relations between concentrations measured in the field and concentrations
17    predicted by the model can be made. These comparisons could involve ratios and correlations
18    between species. For example, correlation coefficients could be calculated between primary
19    species as a means of evaluating the accuracy of emission inventories or between secondary
20    species as a means of evaluating the treatment of photochemistry  in the model. In addition,
21    spatial relations involving individual species (correlations, gradients) can also be used as a means
22    of evaluating the accuracy of transport parameterizations.  Sillman and He (2002) examined
23    differences in correlation patterns between O3 and NOz in Los Angeles, CA, Nashville, TN, and
24    various sites in the rural United States. Model calculations (Figure AX2.7-6) show differences in
25    correlation patterns associated with differences in the sensitivity of O3 to NOx and VOCs.
26    Primarily NOx-sensitive (NOx-limited) areas in models show a strong correlation between O3
27    and NOz with a relatively steep slope, while primarily VOC-sensitive (NOx-saturated) areas in
28    models show lower O3 for a given NOZ and a lower O3-NOZ slope.  They found that differences
29    found in measured data ensembles were matched by predictions from chemical transport models.
30    Measurements in rural  areas in the eastern United States show differences in the pattern of
31    correlations for O3 versus NOz between summer and autumn (Jacob et al., 1995;  Hirsch et al.,

      March 2008                             AX2-81       DRAFT-DO NOT QUOTE OR CITE

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            250
               0
    Figure AX2.7-6.
                                                   20
                                               NOZ (ppb)
Correlations for Os versus NOz (NOy-NOx) in ppb from chemical
transport models for the northeast corridor, Lake Michigan,
Nashville, the San Joaquin Valley, and Los Angeles. Each location is
classified as NOx-limited or NOx-sensitive (circles), NOx-saturated or
VOC-sensitive (crosses), mixed or with near-zero sensitivity (squares),
and dominated by NOX titration (asterisks) based on the model
response to reduced NOx and VOC.
    Source: Sillman and He (2002).

1   1996), corresponding to the transition from NOx-limited to NOx-saturated patterns, a feature
2   which is also matched by CTMs.
3          The difference in correlations between secondary species in NOx-limited to NOx-
4   saturated environments can also be used to evaluate the accuracy of model predictions in
5   individual applications.  Figures AX2.7-7a and AX2.7-7b show results for two different model
6   scenarios for Atlanta. As shown in the figures, the first model scenario predicts an urban plume
7   with high NOy and Os formation apparently suppressed by high NOy.  Measurements show
8   much lower NOy in the Atlanta plume. This error was especially significant because the model
    March 2008
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                  0
             200
            10           20
                    NOy (Ppb)
       30
Figure AX.7-7a,b.
Evaluation of model versus measured Os versus NOy for two model
scenarios for Atlanta.  The model values are classified as NOx-limited
(circles), NOx-saturated (crosses), or mixed or with low sensitivity to
NOx (squares). Diamonds represent aircraft measurements.
Source: Sillmanetal. (1997).
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                   AX2-83
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 1   locations sensitive to NOx. The second model scenario (with primarily NOx-sensitive
 2   conditions) shows much better agreement with measured values. Figure AX2.7-8a,b shows
 3   model-measurement comparisons for secondary species in Nashville, showing better agreement
 4   with measured with conditions. Greater confidence in the predictions made by CTMs will be
 5   gained by the application of techniques such as these on a more routine basis.
 6          The ability of chemical mechanisms to calculate the concentrations of free radicals under
 7   atmospheric conditions was tested in the Berlin Ozone Experiment, BERLIOZ (Volz-Thomas
 8   et al., 2003) during July and early August at a site located about 50 km NW of Berlin. (This
 9   location was chosen because Os episodes in central Europe are often associated with SE winds.)
10          Concentrations of major compounds such as Os, hydrocarbons, etc., were fixed at
11   observed values.  In this regard, the protocol used in this evaluation is an example of an
12   observationally high NOy were not sensitive to NOx, while locations with lower NOy were
13   primarily based method. Figure AX2.7-9 compares the concentrations of RO2, HO2, and OH
14   radicals predicted by RACM and MCM with observations made by the laser-induced
15   fluorescence (LIF) technique and by matrix isolation ESR spectroscopy (MTESR).  Also shown
16   are the production rates of Os calculated using radical concentrations predicted by the
17   mechanisms and those obtained by measurements, and measurements of NOx concentrations.
18   As can be seen, there is good agreement between measurements of RO2, HO2, OH, radicals with
19   values predicted by both mechanisms at high concentrations of NOx (>10 ppb).  However, at
20   lower NOX concentrations, both mechanisms substantially overestimate OH concentrations and
21   moderately overestimate HO2 concentrations.  Agreement between models and measurements is
22   generally better for organic peroxy radicals, although the MCM appears to overestimate their
23   concentrations somewhat. In general, the mechanisms reproduced the HO2 to OH and RO2 to
24   OH ratios better than the individual measurements.  The production of O?, was found to increase
25   linearly with NO (for NO < 0.3 ppb) and to decrease with NO (for NO > 0.5 ppb).
26          OH and HO2 concentrations measured during the PM2.s Technology Assessment and
27   Characterization Study  conducted at Queens College in New York City in the summer of 2001
28   were also compared with those predicted by RACM (Ren et al., 2003).  The ratio of observed to
29   predicted HO2 concentrations over a diurnal cycle was 1.24 and the ratio of observed to predicted
30   OH concentrations was about 1.10 during the day, but the mechanism significantly
31   underestimated OH concentrations during the night.

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              160
              140
                0
              160

              140
                              10
     20
 NOZ (ppb)
     30
40
                              10          20          30
                                  2H2O2 + NOZ (ppb)
Figure AX2.7-8a,b.  Evaluation of model versus: (a) measured Os versus NOz and (b) Os
                   versus the sum 2H2O2 + NOz for Nashville, TN. The model values are
                   classified as NOx-limited (gray circles), NOx-saturated (X's), mixed or
                   near-zero sensitivity (squares), or dominated by NOX titration (filled
                   circles).  Diamonds represent aircraft measurements.
Source: Sillmanetal. (1998).
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     0

«?"   6

I   4
O
£.   2
 CM
O
x   0
           |   10
           CD
           I   5

           O    0
           £•   10
           B
           a.
           =    5
           CO
           O

           r    o
           t 20
           Q.
           5 10
                0
                     O   LIF
                     •   MiESR
                                   VVV
                                                  J(d1D)*106(s-1)
                       8
                      10        12        14

                           UT 20.7.98
              16
Figure AX2.7-9.
        Time series of concentrations of ROi, HOi, and OH radicals, local Os
        photochemical production rate and concentrations of NOX from
        measurements made during BERLIOZ. Also shown are comparisons
        with results of photochemical box model calculations using the RACM
        and MCM chemical mechanisms.
Source: Volz-Thomas et al. (2003).
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 1   AX2.8    SAMPLING AND ANALYSIS OF NITROGEN AND
 2              SULFUR OXIDES
 o
 4   AX2.8.1   Availability and Accuracy of Ambient Measurements for NOy
 5          Section AX2.8.1-AX2.8.4 focus on current methods and on promising new technologies,
 6   but no attempt is made here to cover the extensive development of these methods or of methods
 7   such as wet chemical techniques, no longer in widespread use.  More detailed discussions of
 8   these methods may be found elsewhere (U.S. Environmental Protection Agency, 1993, 1996).
 9   McClenny (2000), Parrish and Fehsenfeld (2000), and Clemitshaw (2004) reviewed methods for
10   measuring NOx and NOy compounds. Discussions in Sections 2.8.1-2.8.4 center on
11   chemiluminescence and optical Federal Reference and Equivalent Methods (FRM and FEM,
12   respectively).
13          The use of methods such as observationally based methods or source apportionment
14   models, either as stand-alone methods or as a basis for evaluating chemical transport models, is
15   often limited by the availability and accuracy of measurements.  Measured NOx and speciated
16   VOC concentrations are widely available in the United States through the PAMS network.
17   However, challenges have been raised about both the accuracy of the measurements and their
18   applicability.
19          The PAMs network currently includes measured NO and NOx. However, Cardelino and
20   Chameides (2000) reported that measured NO during the afternoon was frequently at or below
21   the detection limit of the instruments (1 ppb), even in large metropolitan regions (Washington,
22   DC; Houston, TX; New York, NY). Nitric dioxide measurements are made with commercial
23   chemilluminescent detectors with hot molybdenum converters. However, these measurements
24   typically include a wide variety of other reactive N species, such as organic nitrates in addition to
25   NOx, and cannot be interpreted as a "pure" NOx measurement (see summary in Parrish and
26   Fehsenfeld, 2000). Detection of these species can be considered an interference or a cross
27   sensitivity useful for understanding the chemistry of the air.
28          Total reactive nitrogen (NOy) is included in the PAMS network only at a few sites. The
29   possible expansion of PAMS to include more widespread NOY measurements has been
30   suggested (McClenny, 2000).  NOy measurements are also planned for inclusion in the NCore
31   network (U.S. Environmental Protection Agency, 2005). A major issue to be considered when
32   measuring NOx and NOy is the possibility that HNOs, a major component of NOy, is sometimes

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 1    lost in inlet tubes and not measured (Luke et al., 1998; Parrish and Fehsenfeld, 2000). This
 2    problem is especially critical if measured NOy is used to identify NOx-limited versus NOx-
 3    saturated conditions. The problem is substantially alleviated although not necessarily completely
 4    solved by using much shorter inlets on NOy monitors than on NOx monitors and by the use of
 5    surfaces less likely to take up HNOs. The correlation between Os and NOy differs for NOx-
 6    limited versus NOx-saturated locations, but this difference is driven primarily by differences in
 7    the ratio of Os to HNOs.  If HNOs were omitted from the NOy measurements, then the
 8    measurements would represent a biased estimate and their use would be problematic.
 9
10    AX2.8.1.1 Calibration Standards
11           Calibration gas standards of NO, in N2 (certified at concentrations of approximately 5 to
12    40 ppm) are obtainable from the Standard Reference Material (SRM) Program of the National
13    Institute of Standards and Technology (NIST), formerly the National Bureau of Standards
14    (NBS), in Gaithersburg, MD. These SRMs are supplied as compressed gas mixtures at about
15    135 bar (1900 psi) in high-pressure aluminum cylinders containing 800 L of gas at standard
16    temperature and pressure, dry (STPD) National Bureau of Standards, 1975; Guenther et al.,
17    1996).  Each cylinder is supplied with a certificate stating concentration and uncertainty.  The
18    concentrations are certified to be accurate to ±1 percent relative to the stated values.  Because of
19    the resources required for their certification, SRMs are not intended for use as daily working
20    standards, but rather as primary standards against which transfer standards can be calibrated.
21           Transfer stand-alone calibration gas standards of NO in N2 (at the concentrations
22    indicated above) are obtainable from specialty gas companies. Information as to whether a
23    company supplies such mixtures is obtainable from the company, or from the SRM Program of
24    NIST.  These NIST Traceable Reference Materials (NTRMs) are purchased directly from
25    industry and are supplied as compressed gas mixtures at approximately 135 bar (1900 psi) in
26    high-pressure aluminum cylinders containing 4,000 L of gas at STPD. Each cylinder is supplied
27    with a certificate stating concentration and uncertainty.  The concentrations are certified to be
28    accurate to within ±1 percent of the stated values (Guenther et al., 1996).  Additional details can
29    be found in the previous AQCD for Os (U.S. Environmental Protection Agency, 1996).
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 1    AX2.8.1.2 Measurement of Nitric Oxide
 2
 3    Gas-phase Chemiluminescence (CL) Methods
 4          Nitric oxide can be measured reliably using the principle of gas-phase
 5    chemiluminescence induced by the reaction of NO with Os at low pressure. Modern commercial
 6    NOx analyzers have sufficient  sensitivity and specificity for adequate measurement in urban and
 7    many rural locations (U.S. Environmental Protection Agency, 1993,  1996, 2006).  Research
 8    grade CL instruments have been compared under realistic field conditions to spectroscopic
 9    instruments, and the results indicate that both methods are reliable (at concentrations relevant to
10    smog studies) to better than 15 percent with 95 percent confidence. Response times are on the
11    order of 1 minute. For measurements meaningful for understanding  Os formation, emissions
12    modeling, and N deposition, special care must be taken to zero and calibrate the instrument
13    frequently. A chemical zero, obtained by reacting the NO up-stream and out of view  of the
14    photomultiplier tube, is preferred because it accounts for interferences such as light emitting
15    reactions with unsaturated hydrocarbons.  Calibration should be performed with NTRM-of
16    compressed NO in N2. Standard additions of NO at the inlet will account for NO loss or
17    conversion to NO2 in the lines. In summary, CL methods, when operated carefully in an
18    appropriate manner, can be suitable for measuring or monitoring NO (e.g., Crosley, 1996).
19
20    Spectroscopic Methods for Nitric Oxide
21          Nitric oxide has also been successfully measured in ambient air with direct spectroscopic
22    methods; these include two-photon laser-induced fluorescence (TPLIF), tunable diode laser
23    absorption spectroscopy (TDLAS), and two-tone frequency-modulated spectroscopy (TTFMS).
24    These were reviewed thoroughly in the previous AQCD and will be only briefly summarized
25    here. The spectroscopic methods demonstrate excellent sensitivity and selectivity for NO with
26    detection limits on the order of 10 ppt for integration times of 1 min. Spectroscopic methods
27    compare well with the CL method for NO in controlled laboratory air, ambient air, and heavily
28    polluted air (e.g., Walega et al., 1984; Gregory et al., 1990; Kireev et al., 1999). These
29    spectroscopic methods remain  in the research arena  due to their complexity, size, and cost, but
30    are essential for demonstrating that CL methods are reliable for monitoring NO concentrations
31    involved in O3 formation—from around 20 ppt to several hundred of ppb.
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 1          Atmospheric pressure laser ionization followed by mass spectroscopy has also been
 2    deployed for detection of NO and NC>2.  Garnica et al. (2000) describe a technique involving
 3    selective excitation at one wavelength followed by ionization at a second wavelength. They
 4    report good selectivity and detection limits well below 1 ppb. The practicality of the instrument
 5    for ambient monitoring, however, has yet to be demonstrated.
 6
 7    AX2.8.1.3 Measurements of Nitrogen Dioxide
 8
 9    Gas-Phase Chemiluminescence Methods
10          Reduction of NC>2 to NO, on the surface of a heated (to 300 to 400 °C) molybdenum
11    oxide substrate followed by detection of the chemiluminescence produced during the reaction of
12    NO with Os at low pressure as described earlier for measurement of NO serves as the basis of the
13    FRM for measurement of ambient NO2. However, the substrate used in the reduction of NO2 to
14    NO is not specific to NO2;  hence the chemiluminescence analyzers are subject to interference
15    nitrogen oxides other than NO2 produced by  oxidized NOY  compounds, or NOZ. Thus, this
16    technique will overestimate NO2 concentrations particularly in areas downwind of sources of NO
17    and NO2 as NOx is oxidized to NOz in the form of PANs and other organic nitrates, and HNOs
18    and HNO4.  Many of these compounds are reduced at the catalyst with nearly the same efficiency
19    as NO2.  Interferences have also been found from a wide range of other compounds as described
20    in the latest AQCD for NO2.
21
22    Other Methods
23          Nitrogen dioxide can be selectively converted to NO by photolysis. For example,
24    (Ryerson et al., 2000) developed a gas-phase chemiluminescence method using a photolytic
25    converter based on a Hg lamp with increased radiant intensity in the region of peak NO2
26    photolysis (350 to 400 nm) and producing conversion efficiencies of 70% or more in less than
27    1 s. Metal halide lamps with conversion efficiency of about 50% and accuracy on the order of
28    20% (Nakamura, et al., 2003) have been used.  Because the converter produces little radiation  at
29    wavelengths less than 350 nm, interferences from HNOs and PAN are minimal. Alternative
30    methods to photolytic reduction followed by CL are desirable to test the reliability of this widely
31    used technique. Any method based on a conversion to measured species presents potential for
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 1    interference a problem.  Several atmospheric species, PAN and HO2NO2 for example, dissociate
 2    to NO2 at higher temperatures.
 3          Laser induced fluorescence for NO2 detection involves excitation of atmospheric NO2
 4    with laser light emitted at wavelengths too long to induce photolysis.  The resulting excited
 5    molecules relax in a photoemissive mode and the fluorescing photons are counted. Because
 6    collisions would rapidly quench the electronically excited NO2, the reactions are conducted at
 7    low pressure. Matsumi et al. (2001) describe a comparison of LIF with a photofragmentation
 8    chemiluminescence instrument. The LIF system involves excitation at 440 nm with a multiple
 9    laser system. They report sensitivity of 30 ppt in 10 s and good agreement between the two
10    methods under  laboratory conditions at mixing ratios up to 1.0 ppb. This high-sensitivity LIF
11    system has yet to undergo long-term field tests. Cleary et al. (2002) describe field tests of a
12    system that uses continuous, supersonic expansion followed by excitation at 640 nm with a
13    commercial cw external-cavity tunable diode laser. More recently, LIF has been successfully
14    used to detect NO2 with accuracy of about 15% and detections limits well below 1 ppb. When
15    coupled with thermal dissociation, the technique also measures peroxy nitrates such as PAN,
16    alkyl nitrates, HNO4 and HNO3 (Cohen, 1999; Day et al., 2002; Farmer et al., 2006; Perez et al.,
17    2007; Thornton et al., 2003).  This instrument can have very fast sampling rates be fast (>1 Hz)
18    and shows good correlation with chemiluminescent techniques, but remains a research-grade
19    device.
20          Nitrogen dioxide can be detected by differential optical absorption spectroscopy (DOAS)
21    in an open, long-path system by measuring narrow band absorption features over a background
22    of broad band extinction (e.g., Stutz  et al., 2000; Kim and Kim, 2001). A DOAS system
23    manufactured by OPSIS is designated as a Federal Equivalent Method for measuring NO2.
24    DOAS systems can also be configured to measure NO, HONO, and NO3 radicals.  Typical
25    detection limits are 0.2 to 0.3  ppbv for NO, 0.05 to 0.1 ppbv for NO2,  0.05 to 0.1 ppbv for
26    HONO, and 0.001 to 0.002 ppbv for NO3, at path lengths of 0.2, 5, 5,  and 10 km, respectively.
27    The obvious advantage compared to fixed point measurements is that concentrations relevant to
28    a much larger area are obtained, especially if multiple targets are used. At the same time, any
29    microenvironmental artifacts are minimized over the long path integration.  A major limitation in
30    this technique had involved inadequate knowledge of absorption cross sections. Harder et al.
31    (1997) conducted an experiment in rural Colorado involving simultaneous measurements of NO2

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 1    by DOAS and by photolysis followed by chemiluminescence.  They found differences of as
 2    much as 110% in clean air from the west, but for NO2 mixing ratios in excess of 300 ppt, the two
 3    methods agreed to better than 10%. Stutz et al. (2000) cites two intercomparisons of note.  Nitric
 4    oxide was measured by DOAS, by photolysis of NO2 followed by chemiluminescence, and by
 5    LIF during July 1999 as part of the SOS in Nashville, TN.  On average, the three methods agreed
 6    to within 2%, with some larger differences likely caused by spatial variability over the DOAS
 7    path. In another study in Europe, and a multi-reflection set-up over a 15 km path, negated  the
 8    problem of spatial averaging here agreement with the chemiluminescence detector following
 9    photolytic conversion was excellent (slope = 1.006 ± 0.005; intercept = 0.036 ± 0.019; r = 0.99)
10    over a concentration range from about 0.2 to 20 ppbv.
11          Nitric oxide can also be detected from space with DOAS-like UV spectroscopy
12    techniques (Kim et al., 2006; Ma et al., 2006).  These measurements appear to track well with
13    emissions estimates and can be a useful indicator of column content as well as for identifying hot
14    spots in sources. See also Richter et al., 2005.  Leigh (2006) report on a DOAS method that uses
15    the sun as a light source and compares well with an in situ chemiluminescence detector in an
16    urban environment.
17          Chemiluminescence on the surface of liquid Luminol has also been used for measurement
18    of NO2 (Gaffney et al.,  1998; Kelly et al., 1990; Marley et al., 2004; Nikitas et al.,  1997; Wendel
19    etal., 1983).  This technique is sensitive and linear, and more specific than hot MoOx. Luminol
20    does not emit light when exposed to NHOs  or alkyl nitrates, but does react with PAN.  This
21    interference can be removed by chromatographic separation prior to detection and the resulting
22    measurement compares well with more specific techniques for moderate to high (> 1 ppb) mixing
23    ratios of NO2.
24          Several tunable diode laser spectroscopy techniques have been used successfully for NO2
25    detection (Eisele et al., 2003; Osthoff et al., 2006). These devices remain research grade
26    instruments, not yet practical for urban monitoring.
27
28    Measurements of Total Oxidized Nitrogen Species, NOy
29          Gold catalyzed CO, or H2 reduction or as conversion on hot molybdenum oxide catalyst
30    have been used to reduce NOY to NO before then detection by chemiluminescence (Fehsenfeld
31    et al., 1987; Crosley,  1996). Both techniques offer generally reliable measurements, with
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 1    response times on the order of 60 s and a linear dynamic range demonstrated in field
 2    intercomparisons from about 10 ppt to 10s of ppb. Under certain conditions, HCN, NH3, RNO2,
 3    and CH3CN can be converted to NO, but at normal concentrations and humidity these are minor
 4    interferences. Thermal decomposition followed by LIF has also been used for NOy detection, as
 5    described above. In field comparisons, instruments based on these two principles generally
 6    showed good agreement (Day et al., 2002). The experimental uncertainty is estimated to be of
 7    15-30%.
 8
 9    AX2.8.1.4 Monitoring for NOi Compliance Versus Monitoring for Ozone Formation
10          Regulatory measurements of NC>2 have been focused on demonstrating compliance with
11    the NAAQS for NC>2. Today, few locations violate that standard, but NO2 and related NOy
12    compounds remain among the most important atmospheric trace gases to measure and
13    understand. Commercial instruments for NO/NOX detection are generally constructed with an
14    internal converter for reduction of NC>2 to NO, and generate a signal referred to as NOx.  These
15    converters, generally constructed of molybdenum oxides  (MoOx), reduce not only NO2 but also
16    most other NOy species.  Unfortunately, with an internal  converter, the instruments may not give
17    a faithful indication of NOy either—reactive species such as HNOs will adhere to the walls of
18    the inlet system. Most recently, commercial vendors such as Thermo Environmental (Franklin,
19    MA) have offered NO/NOy detectors with external Mo converters. If such instruments are
20    calibrated through the inlet with a reactive nitrogen species such as propyl nitrate, they give
21    accurate measurements of total NOy, suitable for evaluation of photochemical models. (Crosley,
22    1996; Fehsenfeld et al., 1987; Nunnermacker et al., 1998; Rodgers and Davis, 1989).  Under
23    conditions of fresh emissions, such as in urban areas during the rush hour, NOy ~ NOx and these
24    monitors can be used for testing emissions inventories (Dickerson, et al.,  1995; Parrish, 2006).
25    The state of Maryland for example is making these true NOy measurements at the Piney Run  site
26    in the western part of the state.  These data produced at this site can be more reliably compared
27    to the output of CMAQ and other chemical transport models.
28
29    Summary of Methods for Measuring NO 2
30          A variety of techniques exist for reliable monitoring of atmospheric NO2 and related
31    reactive nitrogen species. For demonstration of compliance with the NAAQS for NO2,
32    commercial chemiluminescence instruments are adequate. For certain conditions, luminol

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 1    chemiluminescence is adequate.  Precise measurements of NO2 can be made with research grade
 2    instruments such as LIF and TDLS. For path-integrated concentration determinations UV
 3    spectroscopic methods provide useful information.  Commercial NOX instruments are sensitive
 4    to other NOy species, but do not measure NOy quantitatatively. NOy instruments with external
 5    converters offer measurements more useful for comparison to chemical transport model
 6    calculations.
 7
 8    AX2.8.2   Measurements  of HNO3
 9           Accurate measurement of HNOs, has presented a long-standing analytical challenge to
10    the atmospheric chemistry community. In this context, it is useful to consider the major factors
11    that control HNOs partitioning between the gas and deliquesced-particulate phases in ambient
12    air.  In equation form,

                                       Kll           Ka
13                                  •*£   L      -'tw3rj   L   J   L    -'                  (AX2.8-1)
14    where KH is the Henry's Law constant in M ataf * and Ka is the acid dissociation constant in M.
15           Thus, the primary controls on HNOs phase partitioning are its thermodynamic properties
16    (KH, Ka, and associated temperature corrections), aerosol liquid water content (LWC), solution
17    pH, and kinetics. Aerosol LWC and pH are controlled by the relative mix of different acids and
18    bases in the system, hygroscopic properties of condensed compounds, and meteorological
19    conditions (RH, temperature, and pressure).  It is evident from relationship AX2.8-1  that, in the
20    presence of chemically distinct aerosols of varying acidities (e.g., super-jam predominantly sea
21    salt and sub-jam predominantly S aerosol), HNOs will partition preferentially with the less-acidic
22    particles; and this is consistent with observations (e.g., Huebert et al., 1996; Keene and Savoie,
23    1998; Keene et al., 2002). Kinetics are controlled by atmospheric concentrations of HNOs vapor
24    and particulate MV and the size distribution and corresponding atmospheric lifetimes of
25    particles against deposition. Sub-jam diameter aerosols typically equilibrate with the gas phase
26    in seconds to minutes while super-um aerosols require hours to a day or more (e.g., Meng and
27    Seinfeld,  1996; Erickson et al., 1999). Consequently, smaller aerosol size fractions are typically
28    close to thermodynamic equilibrium with respect to HNOs whereas larger size fractions (for
29    which atmospheric lifetimes against deposition range from hours to a few days) are often
30    undersaturated (e.g., Erickson et al., 1999;  Keene and Savioe, 1998).

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 1          Many sampling techniques for HNOs (e.g., annular denuder, standard filterpack and mist-
 2    chamber samplers) employ upstream prefilters to remove particulate species from sample air.
 3    However, when chemically distinct aerosols with different pHs (e.g., sea salt and S aerosols) mix
 4    together on a bulk filter, the acidity of the bulk mixture will be greater than that of the less acidic
 5    aerosols with which most NOs is associated. This change in pH may cause the bulk mix to be
 6    supersaturated with respect to HNOs leading to volatilization and, thus, positive measurement
 7    bias in HNOs sampled downstream.  Alternatively, when undersaturated super-Jim size fractions
 8    (e.g., sea salt) accumulate on a bulk  filter and chemically interact over time with HNOs in the
 9    sample air stream, scavenging may lead to negative bias in HNOs sampled downstream.
10    Because the magnitude of both effects will vary as functions of the overall composition and
11    thermodynamic state of the multiphase system, the combined influence can cause net positive or
12    net negative measurement bias in resulting data.  Pressure drops across particle filters can also
13    lead to artifact volatilization and  associated positive bias in HNOs measured downstream.
14          Widely  used methods for measuring HNOs include standard filterpacks configured with
15    nylon or alkaline-impregnated filters (e.g., Goldan et al., 1983; Bardwell et al., 1990), annular
16    denuders (EPA Method IP-9), and standard mist chambers (Talbot et al., 1990). Samples from
17    these instruments are typically analyzed by ion chromatography.  Intercomparisons of these
18    measurement techniques (e.g., Hering et al.,  1988;  Tanner et al., 1989; Talbot et al.,  1990) report
19    differences on the order of a factor of two or more.
20          More recently, sensitive HNOs measurements based on the principle of Chemical
21    lonization Mass Spectroscopy (CIMS) have  been reported (e.g., Huey et al., 1998; Mauldin
22    et al., 1998; Furutani and Akimoto, 2002; Neuman et al., 2002). CIMS relies on selective
23    formation of ions such as SiFs  -HNOs or HSC>4 -HNOs followed by detection via mass
24    spectroscopy.  Two CIMS techniques and a filter pack technique were intercompared in Boulder,
25    CO (Fehsenfeld et al., 1998).  Results indicated agreement to within 15% between the two CIMS
26    instruments and between the CIMS and filterpack methods under relatively clean conditions with
27    HNO3 mixing ratios between 50 and 400 pptv. In more polluted air, the filterpack technique
28    generally yielded higher values than the CIMS suggesting that interactions between chemically
29    distinct particles on bulk filters is a more important source of bias in polluted continental air.
30    Differences were also greater at lower temperature when particulate NOs corresponded to
31    relatively greater fractions of total N(V.

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 1   AX2.8.3    Techniques for Measuring Other NOY Species
 2          Methods for sampling and analysis of alkyl nitrates in the atmosphere have been
 3   reviewed by Parrish and Fehsenfeld (2000).  Peroxyacetylnitrate, PPN, and MPAN are typically
 4   measured using a chromatograph followed by electron capture detectors or GC/ECD (e.g.,
 5   Gaffney et al., 1998), although other techniques such as FTIR could also be used.  Field
 6   measurements are made using GC/ECD with a total uncertainty of ± 5 pptv + 15% (Roberts
 7   etal., 1998).
 8          In the IMPROVE network and in the EPA's speciation network, particulate nitrate in the
 9   PM2.5 size range is typically collected on nylon filters downstream of annular denuders coated
10   with a basic solution capable of removing acidic gases such as HNOs, HNO2, and  862. Filter
11   extracts are then analyzed by ion chromatography (1C) for nitrate, sulfate,  and chloride. Nitrite
12   ions are also measured by this technique but their concentrations are almost always beneath
13   detection limits. However, both of these networks measure nitrate only in the PM2.5 fraction.
14   Because of interactions with more highly acidic components on filter surfaces, there could be
15   volatilization of nitrate in PMio samples. These effects are minimized if separate aerosol size
16   fractions are collected, i.e., the more acidic PM2.s and the more alkaline PMi0-2.5 as in a
17   dichotomous sampler or multistage impactor.
18
19   AX2.8.4    Remote Sensing of Tropospheric NOi Columns for Surface NOx
20                Emissions and Surface NOi Concentrations
21          Table AX2.8-1 contains an overview of the three satellite instruments that  are used
22   retrieve tropospheric NC>2 columns from measurements of solar backscatter. All three
23   instruments are in polar sun-synchronous orbits with global measurements in the late morning
24   and early afternoon. The spatial resolution of the measurement from  SCIAMACHY is 7 times
25   better than that from Ozone Monitoring Instrument (GOME), and that from Ozone Monitoring
26   Instrument (OMI) is 40 times better than that from GOME.
27          Figure AX2.8-1 shows tropospheric NO2 columns retrieved from SCIAMACHY.
28   Pronounced enhancements are evident over major urban and industrial emissions.  The high
29   degree of spatial heterogeneity over the southwestern United States provides empirical evidence
30   that most of the tropospheric NO2 column is concentrated in the lower troposphere.
31   Tropospheric NO2 columns are more sensitive to NOx in the lower troposphere than in the upper
32   troposphere (Martin et al., 2002). This sensitivity to NOx in the lower troposphere is due to the

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     Figure AX2.8-1.
                                                                                       u
                              SCIAMACHYTropospheric N0 (10 15 moleccm  2)
Tropospheric NOi columns (molecules NOi/ cm ) retrieved from the
SCIAMACHY satellite instrument for 2004-2005.
     Source: Martin et al. (2006).

 1   factor of 25 decrease in the NO2/NO ratio from the surface to the upper troposphere (Bradshaw
 2   et al., 1999) that is driven by the temperature dependence of the NO + Os reaction.  Martin et al.
 3   (2004a) integrated in situ airborne measurements of NO2 and found that during summer the
 4   lower mixed layer contains 75% of the tropospheric NO2 column over Houston and Nashville.
 5   However, it should be noted that these measurements are also sensitive to surface albedo and
 6   aerosol loading.
 7          The retrieval involves three steps: (1) determining total NO2 line-of-sight (slant) columns
 8   by spectral fitting of solar backscatter measurements, (2) removing the stratospheric columns by
 9   using data from remote regions where the tropospheric contribution to the column is small, and
10   (3) applying an air mass factor (AMF) for the scattering atmosphere to convert tropospheric  slant
11   columns into vertical columns. The retrieval uncertainty is determined by (1) and (2) over
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 1   remote regions where there is little tropospheric NO2, and by (3) over regions in regions of
 2   elevated tropospheric NO2 (Martin et al., 2002; Boersma et al., 2004).
 3          The paucity of in situ NO2 measurements motivates the inference of surface NO2
 4   concentrations from satellite measurements of tropospheric NO2 columns.  This prospect would
 5   take advantage of the greater sensitivity of tropospheric NO2 columns to NOx in the lower
 6   troposphere than in the upper troposphere as discussed earlier. Tropospheric NO2 columns show
 7   a strong correlation with in situ NO2 measurements in northern Italy (Ordonez et al., 2006).
 8          Quantitative calculation of surface NO2 concentrations from a tropospheric NO2 column
 9   would require information on the relative vertical profile. Comparison of vertical profiles of
10   NO2 in a chemical transport model (GEOS-Chem) versus in situ measurements over and
11   downwind of North America shows a high degree of consistency (Martin et al., 2004b, 2006),
12   suggesting that chemical transport models could be used to infer the relationship between surface
13   NO2 concentrations and satellite observations of the tropospheric NO2 column.
14          However, the satellites carrying the spectrometer (GOME/SCIAMACHY/OMI) are in
15   near polar, sun-synchronous orbits. As a result, these measurements are made only once per day,
16   typically between about 10:00 to 11:00 a.m. or 1 p.m. local time, during a brief overflight.  Thus
17   the utility of these measurements is limited as they would likely miss short-term features.
18
19   AX2.8.5    SAMPLING AND ANALYSIS FOR SO2
20          Currently, ambient SO2 is measured using instruments based on pulsed fluorescence.  The
21   UV fluorescence monitoring method for atmospheric SO2 was developed to improve upon the
22   flame photometric detection (FPD) method for SO2, which in turn had displaced the
23   pararosaniline wet chemical method for SO2 measurement. The  pararosaniline method is still the
24   FRM for atmospheric SO2, but is rarely used because of its complexity and slow response, even
25   in its automated forms.  Both the UV fluorescence and FPD methods are designated as FEMs by
26   the EPA, but UV fluorescence has largely supplanted the FPD approach because of the UV
27   method's inherent linearity, sensitivity, and the absence of consumables, such as the hydrogen
28   gas needed for the FPD method.
29          Basically, SO2 molecules absorb ultraviolet (UV) light at one wavelength and emit UV
30   light at longer wavelengths.  This  process is known as fluorescence, and involves the excitation
31   of the SO2 molecule to a higher energy (singlet) electronic state.  Once excited, the molecule
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 1    decays non-radiatively to a lower energy electronic state from which it then decays to the
 2    original, or ground, electronic state by emitting a photon of light at a longer wavelength (i.e.,
 3    lower energy) than the original, incident photon.  The process can be summarized by the
 4    following equations
                                                                                      (2.8-2)
 ,                                    S02*^>S02+hv2                             ,._.,
 6                                                                                    (2.Q-3)
 7   where SO 2* represents the excited state of SO2, h v/, and h V2 represent the energy of the
 8   excitation and fluorescence photons, respectively, and hv2
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 1    positive interference.  To remove this source of interference, the high sensitivity 862 analyzers,
 2    such as those to be used in the NCore network (U.S. Environmental Protection Agency, 2005),
 3    have hydrocarbon scrubbers to remove these compounds from the sample stream before the
 4    sample air enters the optical chamber.
 5           Another potential source of positive interference is nitric oxide (NO). NO fluoresces in a
 6    spectral region that is close to the SO2 fluorescence. However, in high sensitivity SO2 analyzers,
 7    the bandpass filter in front of the PMT is designed to prevent NO fluorescence from reaching the
 8    PMT and being detected. Care must be exercised when using multicomponent calibration gases
 9    containing both NO and SO2 that the NO rejection ratio of the SO2 analyzer is sufficient to
10    prevent NO interference. The most common source of positive bias (as constrasted with positive
11    spectral interference) in high-sensitivity SO2 monitoring is stray light reaching the optical
12    chamber. Since SO2 can be electronically excited by a broad range of UV wavelengths, any
13    stray light with an appropriate wavelength that enters the optical chamber can excite SO2 in the
14    sample and increase the fluorescence signal.
15           Furthermore, stray light at the wavelength of the SO2 fluorescence that enters the optical
16    chamber may impinge on the PMT and increase the fluorescence signal.  Several design features
17    are incorporated to minimize the stray light that enters the chamber.  These features include the
18    use of light filters, dark surfaces, and opaque tubing to prevent light from entering the chamber.
19           Luke (1997) reported the positive artifacts of a modified pulsed fluorescence detector
20    generated by the co-existence of NO, CS2, and a number of highly fluorescent aromatic
21    hydrocarbons such as benzene, toluene, o-xylene, m-xylene, p-xylene, m-ethyltoluene,
22    ethylbenzene, and 1,2,4-trimethylbenzene.  The positive artifacts could be reduced by using a
23    hydrocarbon "kicker" membrane.  At a flow rate of 300 standard cc min"1 and a pressure drop of
24    645 torr across the kicker, the interference from ppm levels of many aromatic hydrocarbons was
25    eliminated entirely.
26           Nicks and Benner (2001) described a sensitive SO2 chemiluminescence  detector, which
27    was based on a differential  measurement where response from ambient SO2 is determined by the
28    difference between air containing SO2 and air scrubbed of SO2 where both air samples contain
29    other detectable sulfur species, and the positive artifact could also be reduced through this way.
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 1    Sources of Negative Interference
 2          Nonradiative deactivation (quenching) of excited SO2 molecules can occur from
 3    collisions with common molecules in air, including nitrogen, oxygen, and water.  During
 4    collisional quenching, the excited  SC>2 molecule transfers energy, kinetically allowing the SC>2
 5    molecule to return to the original lower energy state without emitting a photon. Collisional
 6    quenching results in a decrease in the SC>2 fluorescence and results in the underestimation of SC>2
 7    concentration in the air sample.  The concentrations of nitrogen and oxygen are constant in the
 8    ambient air, so quenching from those species at a surface site is also constant, but the water
 9    vapor content of air can vary. Luke (1997) reported that the response of the detector could be
10    reduced by about 7% and 15% at water vapor mixing ratios of 1  and 1.5 mole percent (RH = 35
11    to 50% at 20-25 °C and 1 atm for a modified pulsed fluorescence detector (Thermo
12    Environmental Instruments, Model 43s). Condensation of water vapor in sampling lines must be
13    avoided, as it can absorb SC>2 from the sample air. The simplest approach to avoid condensation
14    is to heat sampling lines to a temperature above the expected dew point, and within a few
15    degrees of the controlled optical bench temperature. At very high 862  concentrations, reactions
16    between electronically excited 862 and ground state 862 to form 863 and SO might occur
17    (Calvert et al., 1978).  However, this possibility has not been examined.
18
19    Other Techniques for Measuring SO 2
20          A more sensitive SO2 measurement method than the UV-fluorescence method was
21    reported by  Thornton et al. (2002). Thornton et al (2002) reported an atmospheric pressure
22    ionization mass  spectrometer. The high measurement precision  and instrument sensitivity were
23    achieved by adding isotopically labeled SC>2 (34S16C>2) continuously to the manifold as an internal
24    standard.  Field studies showed that the method precision was better than 10% and the limit of
25    detection was less than 1 pptv for a sampling interval of Is.
26          Sulfur Dioxide can be measured by LIF at around 220 nm (Matsumi et al. (2005).
27    Because the laser wavelength is alternately tuned to an 862 absorption  peak at 220.6 and bottom
28    at 220.2 nm, and the difference signal at the two wavelengths is used to extract the 862
29    concentration, the technique eliminates interference from either absorption or fluorescence by
30    other species and has high sensitivity (5 pptv in 60 sec).  Sulfur Dioxide can also be measured by
31    the same DOAS instrument that can measure NC>2.
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 1          Photoacoutsic techniques have been employed for SO2 detection, but they generally have
 2    detection limits suitable only for source monitoring (Gondal, 1997; Gondal and Mastromarino,
 3    2001).
 4          Chemical lonization Mass Spectroscopy (CIMS) utilizes ionization via chemical
 5    reactions in the gas phase to determine an unknown sample's mass spectrum and identity. High
 6    sensitivity (10 ppt or better) has been achieved with uncertainty of-15% when a charcoal
 7    scrubber is used for zeroing and the sensitivity is measured with isotopically labeled 34SO2
 8    (Hanke et al., 2003; Huey et al., 2004; Hennigan et al., 2006).
 9
10    AX2.8.6    Sampling and Analysis for Sulfate, Nitrate, and Ammonium
11
12    Sampling Artifacts
13          Sulfate, nitrate,  and ammonium are commonly present in PM2 5. Most PM2 5 samplers
14    have a size-separation device to separate particles so that only those particles approximately
15    2.5 |im or less are collected on the sample filter. Air is drawn through the sample filter at a
16    controlled flow rate by  a pump located downstream of the  sample filter.  The systems have two
17    critical flow rate components for the capture of fine paniculate: (1) the flow of air through the
18    sampler must be at a flow rate that ensures that the size cut at 2.5 jim occurs; and (2) the flow
19    rate must be optimized  to capture the desired amount of particulate loading with respect to the
20    analytical method detection limits.
21          When using the system described above to collect sulfate, nitrate and parti culate
22    ammonium, sampling artifacts can occur because of: (1) positive sampling artifact for sulfate,
23    nitrate, and particulate ammonium due to chemical reaction; and (2) negative sampling artifact
24    for nitrate and ammonium due to the decomposition and evaporation.
25
26    Sampling and Analysis Techniques
27
28    Denuder-Filter Based Sampling and Analysis Techniques for Sulfate, Nitrate, and Ammonium
29          There are two major PM speciation ambient air-monitoring networks in the United States:
30    the Speciation Trend Network (STN), and the Interagency Monitoring of Protected Visual
31    Environments (IMPROVE) network. The current STN samplers include three filters: (1) Teflon
32    for equilibrated mass and elemental analysis including elemental sulfur; (2) a HNOs denuded
33    nylon filter for ion analysis including NOs and SO/t, (3) a quartz-fiber filter for elemental and

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 1    organic carbon.  The IMPROVE sampler, which collects two 24-h samples per week,
 2    simultaneously collects one sample of PMio on a Teflon filter,  and three samples of PM2.5 on
 3    Teflon, nylon, and quartz filters. PM2 5 mass concentrations are determined gravimetrically from
 4    the PM2.5 Teflon filter sample.  The PM2.5 Teflon filter sample is also used to determine
 5    concentrations of selected elements. The PM2.5  nylon filter sample, which is preceded by a
 6    denuder to remove acidic gases, is analyzed to determine nitrate and sulfate aerosol
 7    concentrations.  Finally, the PM2 5 quartz filter sample is analyzed for OC and EC using the
 8    thermal-optical reflectance (TOR) method.  The STN and the IMPROVE networks represent a
 9    major advance in the measurement of nitrate, because the combination of a denuder (coated with
10    either Na2COs or MgO) to remove HNOs vapor and a Nylon filter to adsorb HNOs vapor
11    volatilizing from the collected ammonium nitrate particles overcomes the loss of nitrate from
12    Teflon filters.
13          The extent to which sampling artifacts for particulate NH3+ have been adequately
14    addressed in the current networks is not clear. Recently, new denuder-filter sampling systems
15    have been developed to measure sulfate, nitrate, and ammonium with an adequate correction of
16    ammonium sampling artifacts.  The denuder-filter system, Chembcomb Model 3500 speciation
17    sampling cartridge developed by Rupprecht & Patashnick Co, Inc. could be used to collect
18    nitrate,  sulfate,  and ammonium simultaneously.  The sampling system contains a single-nozzle
19    size-selective inlet, two honeycomb denuders, the  aerosol filter and two backup filters (Keck and
20    Wittmaack, 2005). The first denuder in the system is coated with 0.5% sodium carbonate and
21    1% glycerol and collects acid gases such as HCL,  SO2, HONO, and HNOs.  The second denuder
22    is coated with 0.5% phosphoric acid in methanol for collecting NHa. Backup filters collect the
23    gases behind denuded filters. The backup filters are coated with the same solutions as the
24    denuders. A similar system based on the same principle was applied by Possanzini et al. (1999).
25    The system contains two NaCl-coated annular denuders followed by other two denuders coated
26    with NaCOs/glycerol and citric acid, respectively.  This configuration was adopted to remove
27    HNOs quantitatively on the first NaCl denuder.  The third and forth denuder remove SO2 and
28    NH3, respectively. A polyethylene cyclone and a two-stage filter holder containing three filters
29    is placed downstream of the denuders. Aerosol  fine particles are collected on a Teflon
30    membrane. A backup nylon filter and a subsequent citric acid impregnated filter paper collect
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 1    dissociation products (HNOs and NH3) of ammonium nitrate evaporated from the filtered
 2    particulate matter.
 3          Several traditional and new methods could be used to quantify elemental S collected on
 4    filters: energy dispersive X-ray fluorescence, synchrotron induced X-ray fluorescence, proton
 5    induced X-ray emission (PIXE), total reflection X-ray fluorescence, and scanning electron
 6    microscopy.  Energy dispersive X-ray fluorescence (EDXRF) (Method IO-3.3, U.S.
 7    Environmental Protection Agency, 1997; see 2004 PM CD for details) and PIXE are the most
 8    commonly used methods.  Since sample filters often contain very small amounts of particle
 9    deposits, preference is given to methods that can accommodate small sample sizes and require
10    little or no sample preparation or operator time after the samples are placed into the analyzer. X-
11    ray fluorescence (XRF) meets these needs and leaves the sample intact after analysis so it can be
12    submitted for additional examinations by other methods as needed.  To obtain the greatest
13    efficiency and sensitivity, XRF typically places the filters in a vacuum which may cause volatile
14    compounds (nitrates and organics) to evaporate.  As a result, species that can volatilize such as
15    ammonium nitrate and certain organic compounds can be lost during the analysis.  The effects of
16    this volatilization are important if the PTFE filter is to be subjected to subsequent analyses of
17    volatile species.
18          Polyatomic ions such as sulfate, nitrate, and ammonium are quantified by methods such
19    as ion chromatography (1C) (an alternative  method commonly used for ammonium analysis is
20    automated colorimetry). All ion analysis methods require a fraction of the filter to be extracted
21    in deionized distilled water for sulfate and NaCOs/NaHCOs solution for nitrate and then filtered
22    to remove insoluble residues prior to analysis.  The extraction volume should be as small as
23    possible to avoid over-diluting the solution and inhibiting the detection of the desired
24    constituents at levels typical of those found in ambient PM2 5 samples. During analysis, the
25    sample extract passes through an ion-exchange column which separates the ions in time for
26    individual quantification, usually by an electroconductivity detector. The ions are identified by
27    their elution/retention times and are quantified by the conductivity peak area or peak height.
28          In a side-by-side comparison of two of the major aerosol monitoring techniques (Hains
29    et al., 2007), PM2.5 mass and major contributing species were well correlated among the different
30    methods with r-values in excess of 0.8. Agreement for mass, sulfate, OC, TC, and ammonium
31    was good while that for nitrate and BC was weaker.  Based on reported uncertainties, however,

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 1    even daily concentrations of PM2.5 mass and major contributing species were often significantly
 2    different at the 95% confidence level.  Greater values of PM2.5 mass and individual species were
 3    generally reported from Speciation Trends Network methods than from the Desert Research
 4    Institute Sequential Filter Samplers. These differences can only be partially accounted for by
 5    known random errors.  The authors concluded that the current uncertainty estimates used in the
 6    STN network may underestimate the actual uncertainty.
 7
 8    Positive Sampling Artifacts
 9          The reaction of SO2 (and other acid gases) with basic sites on glass fiber filters or with
10    basic coarse particles on the filter leads to the formation of sulfate (or other nonvolatile salts,
11    e.g., nitrate, chloride).  These positive artifacts lead to the overestimation of total mass, and
12    sulfate, and probably also nitrate concentrations.  These problems were largely overcome by
13    changing to quartz fiber or Teflon filters and by the separate collection of PM2.5. However, the
14    possible reaction of acidic gases with basic coarse particles remains a possibility, especially with
15    PMio and PMio-2.s measurements. These positive artifacts could be effectively eliminated by
16    removing acidic gases in the sampling line with denuders coated with NaCl or Na2CO3.
17          Positive sampling artifacts also occur during measurement of particulate NH4. The
18    reaction of NH3 with acidic particles (e.g. 2NH3 + H2SO4 ^ (NH4)2SO4), either during sampling
19    or during transportation, storage, and equilibration could lead to an overestimation of parti culate
20    NH4 concentrations. Techniques have been developed to overcome this problem: using a
21    denuder to remove NH3 during sampling and to protect the collected PM from NH3 (Suh et al.,
22    1992, 1994; Brauer et al., 1991; Koutrakis et al., 1988a,b; Keck and Wittmaack, 2006;
23    Possanzini et al., 1999; Winberry et al., 1999). Hydrogen fluoride, citric acid, and phosphorous
24    acids have been used as coating materials for the NH3 denuder. Positive artifacts for particulate
25    NH4 can also be observed during sample handling due to contamination. No chemical analysis
26    method, no matter how accurate or precise, can adequately represent atmospheric concentrations
27    if the filters to which these methods are applied are improperly handled. Ammonia is emitted
28    directly from human sweat, breath and smoking.  It can then react with acidic aerosols on the
29    filter to form ammonium sulfate, ammonium bisulfate and ammonium nitrate if the filter was not
30    properly handled (Sutton el al., 2000). Therefore, it is important to keep filters away from
31    ammonia sources, such as human breath, to minimize neutralization of the acidic compounds.
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 1    Also, when filters are handled, preferably in a glove box, the analyst should wear gloves that are
 2    antistatic and powder-free to act as an effective contamination barrier.
 3
 4    Negative Sampling Artifact
 5          Although sulfate is relatively stable on a Teflon filter, it is now well known that
 6    volatilization losses of particulate nitrates occur during sampling.
 7          For nitrate, the effect on the accuracy of atmospheric parti culate measurements from
 8    these volatilization losses is more significant for PM2.5 than for PMio. The FRM for PM2.5 will
 9    likely suffer a loss of nitrates similar to that experienced with other simple filter collection
10    systems. Sampling artifacts resulting from the loss of parti culate nitrates represents a significant
11    problem in areas such as southern California that experience high loadings of nitrates.  Hering
12    and Cass (1999) discussed errors in PM2.5 mass measurements due to the volatilization of
13    parti culate nitrate. They examined data from two field measurement campaigns that were
14    conducted  in southern California: (1) the Southern California Air Quality Study  (SCAQS)
15    (Lawson, 1990) and (2) the 1986 CalTech study (Solomon et al., 1992). In both these studies,
16    side-by-side sampling of PM2.5 was conducted.  One sampler collected particles directly onto a
17    Teflon filter. The second sampler consisted of a denuder to remove gaseous HMOs followed by
18    a nylon filter that absorbed the HNOs as it evaporated from NITXNOs. In both studies, the
19    denuder consisted of MgO-coated glass tubes (Appel et al.,  1981).  Fine particulate nitrate
20    collected on the Teflon filter was compared to fine particulate nitrate collected on the denuded
21    nylon filter. In both studies, the PM2.5 mass lost because of ammonium nitrate volatilization
22    represented a significant fraction of the total PM2.5 mass. The fraction of mass lost was higher
23    during summer than during fall (17% versus 9% during the SCAQS study, and 21% versus 13%
24    during the  CalTech study). In regard to percentage loss of nitrate, as opposed to percentage loss
25    of mass discussed above, Hering and Cass (1999) found that the amount of nitrate remaining on
26    the Teflon  filter samples was on average 28% lower than that on the denuded nylon filters.
27          Hering and Cass (1999) also analyzed these data by extending the evaporative model
28    developed  by Zhang and McMurry (1987). The extended model used by Hering and Cass (1999)
29    takes into account the dissociation of collected particulate ammonium nitrate on Teflon filters
30    into HNOs and NH3 via three mechanisms: (1) the scrubbing of HNOs and NH3 in the sampler
31    inlet (John et al. (1988) showed that clean PMio inlet surfaces serve as an effective denuder for
32    HNOs); (2) the heating of the filter substrate above ambient temperature by sampling; and (3) the

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 1    pressure drop across the Teflon filter. For the sampling systems modeled, the flow-induced
 2    pressure drop was measured to be less than 0.02 atm, and the corresponding change in vapor
 3    pressure was 2%, so losses driven by pressure drop were not considered to be significant in this
 4    work.  Losses from  Teflon filters were found to be higher during the summer than during the
 5    winter, higher during the day compared to night, and reasonably consistent with modeled
 6    predictions.
 7          Finally, during the SCAQS (Lawson, 1990) study, particulate samples also were collected
 8    using a Berner impactor and greased Tedlar substrates in size ranges from 0.05 to 10 jim in
 9    aerodynamic diameter.  The Berner impactor PM2.5 nitrate values were much closer to those
10    from the denuded nylon filter than those from the Teflon filter, the impactor nitrate values being
11    -2% lower than the nylon filter nitrate for the fall measurements and -7% lower for the summer
12    measurements.  When the impactor collection was compared to the Teflon filter collection for a
13    nonvolatile species (sulfate), the results were in agreement. Chang et al. (2000) discuss reasons
14    for reduced loss of nitrate from impactors.
15          Brook and Dann (1999) observed much higher nitrate losses during a study in which they
16    measured parti culate nitrate in Windsor and Hamilton, Ontario, Canada, by three techniques:
17    (1) a single Teflon filter in a dichotomous sampler, (2) the Teflon filter in an annular denuder
18    system (ADS),  and (3) total nitrate including both the Teflon filter and the nylon back-up filter
19    from the ADS.  The Teflon filter from the dichotomous  sampler averaged only 13% of the total
20    nitrate, whereas the  Teflon filter from the ADS averaged 46% of the total nitrate. The authors
21    concluded that considerable nitrate was lost from the dichotomous sampler filters during
22    handling, which included weighing and X-ray fluorescence (XRF) measurement in a vacuum.
23          Kim et al. (1999) also examined nitrate sampling artifacts by comparing denuded and
24    non-denuded quartz and nylon filters during the PMi0 Technical Enhancement Program (PTEP)
25    in the South Coast Air Basin of California. They observed negative nitrate artifacts (losses) for
26    most measurements; however, for a significant number of measurements, they observed positive
27    nitrate artifacts. Kim et al. (1999) pointed out that random measurement errors make it difficult
28    to measure true amounts of nitrate loss.
29          Diffusion denuder samplers, developed primarily to measure particle strong acidity
30    (Koutrakis et al., 1988b, 1992), also can be used to study nitrate volatilization. Such techniques
31    were used to measure loss of parti culate nitrate from Teflon filters in seven U.S. cities (Babich

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 1    et al., 2000). Measurements were made with two versions of the Harvard-EPA Annular Denuder
 2    System (HEADS).  HNOs vapor was removed by a Na2CC>3-coated denuder.  Paniculate nitrate
 3    was the sum of nonvolatile nitrate collected on a Teflon filter and volatized nitrate collected on a
 4    Na2CO3-coated filter downstream of the Teflon filter (full HEADS) or on a Nylon filter
 5    downstream of the Teflon filter (Nylon HEADS).  It was found that the full HEADS (using a
 6    Na2COs filter) consistently underestimated the total particulate nitrate by approximately 20%
 7    compared to the nylon HEADS. Babich et al. (2000) found significant nitrate losses in
 8    Riverside, CA; Philadelphia, PA; and Boston, MA, but not in Bakersfield, CA;  Chicago, IL;
 9    Dallas, TX; or Phoenix, AZ, where measurements were made only during the winter.  Tsai and
10    Huang (1995) used a diffusion denuder to study the positive and negative artifacts on glass and
11    quartz filters. They found positive artifacts attributed to SO2 and HNO3 reaction with basic sites
12    on glass fibers and basic particles  and negative artifacts attributed to loss of HNOs and HC1 due
13    to volatilization  of NH4NO3 and NH4C1 and reaction of these species with acid  sulfates.
14          Volatile compounds can also leave the filter after sampling and prior to  filter weighing or
15    chemical analysis. Losses of NOs, NH4, and Cl from glass and quartz-fiber filters that were
16    stored in unsealed containers at ambient air temperatures for 2 to 4 weeks prior to analysis
17    exceeded 50 percent (Witz et al., 1990). Storing filters in sealed containers and under
18    refrigeration will minimize these losses.
19          Negative sampling artifacts due to decomposition and volatilization are  also significant
20    for particulate ammonium. Ammonium particulates, especially NH4 N3 nitrate  NH4 Cl are very
21    sensitive to some environmental factors, such as temperature, relative humidity, acidity of
22    aerosols, as well as to filter type (Spurny, 1999; Keck and Wittmaack, 2005). Any change in
23    these parameters during the sampling period influences the position of the equilibrium between
24    the particle phase and the gas phase.  Keck and Wittmaack (2005) observed that at temperatures
25    below 0 °C, acetate-nitrate, quartz fiber, and Teflon filters could properly collect particulate NH4
26    NET? and Cl. At temperature above 0 °C, the salts were lost from quartz fiber and Teflon filters,
27    more so the higher the temperature and with no significant difference between quartz fiber and
28    Teflon filters. The salts were lost completely from denuded quartz fiber filters  above about
29    20 °C, and from  non-undenuded quartz fiber and Teflon filters above about 25 °C. It is
30    anticipated that current sampling techniques underestimate NH4 concentrations  due to the
31    volatilization of NH4, but fine particle mass contains many acidic compounds and consequently,

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 1    a fraction of volatilized NH4 (in the form of NHa) can be retained on a PTFE filter by reaction
 2    with the acid compounds.  Therefore, it is reasonable to assume that NH4 loss will be less than
 3    the nitrate loss. Techniques have been applied to paniculate ammonium sampling to correct
 4    particulate ammonium concentrations due to evaporation: a backup filter coated with
 5    hydrofluoric acids, citric acid, or phosphorous acids, is usually introduced to absorb the
 6    evaporated ammonium (as ammonia); the total ammonium concentration is the sum of the
 7    particle phase ammonium collected on the Teflon filter and the ammonia concentration collected
 8    on the backup filter.
 9
10    Other Measurement Techniques
11
12    Nitrate
13          An integrated collection and vaporization cell was developed by Stolzenburg and Hering
14    (2000) that provides automated, 10-min resolution monitoring of fine-particulate nitrate.  In this
15    system, particles are collected by a humidified impaction process and analyzed in place by flash
16    vaporization and chemiluminescent detection of the evolved NOx. In field tests in which the
17    system was collocated with two FRM samplers, the automated nitrate sampler results followed
18    the results from the FRM, but were offset lower. The system also was collocated with a HEADS
19    and a SASS speciation sampler (MetOne Instruments).  In all these tests, the automated sampler
20    was well correlated to other samplers with slopes near 1 (ranging from 0.95 for the FRM to 1.06
21    for the HEADS) and correlation coefficients ranging from 0.94 to 0.996. During the Northern
22    Front Range Air Quality Study in Colorado (Watson et al., 1998), the automated nitrate monitor
23    captured the 12-min variability in fine-particle nitrate concentrations with a precision of
24    approximately ± 0.5 |ig/m3 (Chow et al., 1998).  A comparison with denuded filter
25    measurements followed by ion chromatographic (1C) analysis (Chow and Watson, 1999) showed
26    agreement within ± 0.6 |ig/m3 for most of the measurements, but exhibited a discrepancy of a
27    factor of two for the elevated nitrate periods.  More recent intercomparisons took place during
28    the 1997 Southern California Ozone Study (SCOS97) in Riverside, CA. Comparisons with
29    14 days of 24-h denuder-filter sampling gave a correlation  coefficient of R2 = 0.87 and showed
30    no significant bias (i.e., the regression  slope is not significantly different from 1).  As currently
31    configured, the system has a detection limit of 0.7 |ig/m3 and a precision of 0.2 |ig/m3.
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 1   Sulfate
 2          Continuous methods for the quantification of aerosol sulfur compounds first remove
 3   gaseous sulfur (e.g., SO2, H^S) from the sample stream by a diffusion tube denuder followed by
 4   the analysis of particulate sulfur (Cobourn et al., 1978; Durham et al., 1978; Huntzicker et al.,
 5   1978; Mueller and Collins, 1980; Tanner et al.,  1980). Another approach is to measure total
 6   sulfur and gaseous sulfur separately by alternately removing particles from the sample stream.
 7   Particulate sulfur is obtained as the difference between the total and gaseous sulfur (Kittelson
 8   et al., 1978).  The total sulfur content is measured by a flame photometric detector (FPD) by
 9   introducing the sampling stream into a fuel-rich, hydrogen-air flame (e.g., Stevens et al., 1969;
10   Farwell and Rasmussen, 1976) that reduces sulfur compounds and measures the intensity of the
11   chemiluminescence from electronically excited  sulfur molecules (S2*).  Because the formation
12   of S2* requires two sulfur atoms, the intensity of the chemiluminescence is theoretically
13   proportional to the square of the concentration of molecules that contain a single sulfur atom.
14   In practice, the exponent is between 1 and 2 and depends on the sulfur compound being analyzed
15   (Dagnall et al., 1967; Stevens et al., 1971). Calibrations are performed using both particles and
16   gases as standards. The FPD can also be replaced by a chemiluminescent reaction with ozone
17   that minimizes the potential for interference and provides a faster response time (Benner and
18   Stedman, 1989, 1990).  Capabilities added to the basic system include in situ thermal analysis
19   and sulfuric acid speciation (Cobourn et al., 1978; Huntzicker et al., 1978; Tanner et al., 1980;
20   Cobourn and Husar, 1982).  Sensitivities for particulate sulfur as low as 0.1 |ig/m3, with time
21   resolution ranging from 1 to 30 min, have been reported. Continuous measurements of
22   particulate sulfur content have also been obtained by on-line XRF analysis with resolution of
23   30 min or less (Jaklevic et al., 1981). During a field-intercomparison study of five different
24   sulfur instruments, Camp et al. (1982) reported four out of five FPD systems agreed to within
25   ± 5% during a 1-week sampling period.
26
27
28   AX2.9    POLICY RELEVANT BACKGROUND CONCENTRATIONS OF
29              NITROGEN AND SULFUR OXIDES
30          Background concentrations of nitrogen and sulfur oxides used for purposes of informing
31   decisions about NAAQS are referred to as Policy Relevant Background (PRB) concentrations.
32   Policy Relevant Background concentrations are those concentrations that would occur in the

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 1    United States in the absence of anthropogenic emissions in continental North America (defined
 2    here as the United States, Canada, and Mexico). Policy Relevant Background concentrations
 3    include contributions from natural sources everywhere in the world and from anthropogenic
 4    sources outside these three countries. Background levels so defined facilitate separation of
 5    pollution levels that can be controlled by U.S. regulations (or through international agreements
 6    with neighboring countries) from levels that are generally uncontrollable by the United States.
 7    EPA assesses risks to human health and environmental effects from NC>2 and SC>2 levels in
 8    excess of PRB concentrations.
 9          Contributions to PRB concentrations include natural emissions of NC>2, 862, and
10    photochemical reactions involving natural emissions of reduced nitrogen and sulfur compounds,
11    as well as their long-range transport from outside North America.  Natural sources of NO2 and its
12    precursors include biogenic emissions, wildfires, lightning, and the stratosphere. Natural sources
13    of reduced nitrogen compounds, mainly NHa, include  biogenic emissions and wildfires.  Natural
14    sources of reduced sulfur species include anaerobic microbial activity in wetlands and volcanic
15    activity.  Volcanos and biomass burning are the major natural source of SC>2. Biogenic
16    emissions from agricultural activities are not considered in the formation of PRB concentrations.
17    Discussions of the sources and estimates of emissions are given  in Section AX2.6.2.
18
19    Analysis of PRB Contribution to Nitrogen and Sulfur oxide Concentrations and Deposition
20                 over the United States
21          The MOZART-2 global model of tropospheric chemistry (Horowitz et al., 2003) is used
22    to diagnose the PRB contribution to nitrogen and sulfur oxide concentrations, as well as to total
23    (wet plus dry) deposition. The model setup for the present-day simulation has been published in
24    a series of papers from a recent model  intercomparison (Dentener et al., 2006a,b; Shindell et al.,
25    2006;  Stevenson et al., 2006; Van Noije et al., 2006).  MOZART-2 is driven by National Center
26    for Environmental Prediction meteorological fields and IIASA 2000 emissions at a resolution of
27    1.9° x 1.9° with 28 sigma levels in the vertical,  and it  includes gas- and aerosol  phase chemistry.
28    Results shown in Figures AX2.9-1 to AX2.9-5 are for the meteorological year 2001. Note that
29    color images are available on the web. An additional  "policy relevant background" simulation
30    was conducted in which continental North American anthropogenic emissions were set to zero.
31          We first examine the role of PRB in contributing to NC>2 and SC>2 concentrations in
32    surface air. Figure AX2.9-1 shows the annual mean NC>2 concentrations in surface air in the base

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                                         Total
                          12D°W
                                       100°W
                                 290
                                         530
       770
       1010
       1250
                                       Background
                          120°W
                                       10Q°W
                          25
                                 45
65
85
105
125
                              Percent Background Contribution
                          iaa°w
                                       100°W
                                  14
                                         23
       32
        41
        50
Figure AX2.9-1.
                    Annual mean concentrations of NOi (ppbv) in surface air over the
                    United States in the present-day (upper panel) and policy relevant
                    background (middle panel) MOZART-2 simulations. The bottom
                    panel shows the percentage contribution of the background to the
                    present-day concentrations. Please see text for details.
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                                         Total
                                                       so°w
                    <   D.D1
            1.21
2.41
3.BO     4.80
B.OO
ppb
                                       Background
                                       100°W
                                   oo°w
<  0.001     0.006    0.011    0.015    0.020    0.025
                                                                          ppb
                             Percent Background Contribution
                                        ioo°w
                                   so°w
                                         10
                              15
                 20
 25
Figure AX2.9-2.     Same as Figure AX2.9-1 but for SO2 concentrations.
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                                        Total
                        12Q°W
       100°W
              ao°w
                        50
290
530
770     1010
       1250
                                     Background
                        25
45
B5
105
                125
                             Percent Background Contribution
                                                     so°w
                                14
        23
        32
41
                 50
Figure AX2.9-3.     Same as for Figure AX2.9-1 but for wet and dry deposition of HNO3,
                                                                     -2  -K
                   NH4NO3, NOX, HO2NO2, and organic nitrates (mg N m" y  ).
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                                       Total
                                     10Q°W
                     ao°w
                   <   100     800    1500    2200    2900    3BOO
                       10
                                     Background
                                     ioo°w
                     so°w
16
22
34
40
                            Percent Background Contribution
                               10
        20
        30
40
50
Figure AX2.9-4.     Same as Figure AX2.9-1 but for SOX deposition (SO2 + SO4)
                   (mg S m-y1).
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                     W.OZART-2 SOIL WO
                                                            GEOS-Cam SOIL UD.
                   -.  n  a   ii  *fl  22  2B
                   MOZAHT-2 SL*rac* MO JUL
                                                           GEQS-ChWfi Surface NO
                  -:  SD  150 2»  S'JB 450
                                                          »  EH)  190 23O 3SD 490 33O
    Figure AX2.9-5.
July mean soil NO emissions (upper panels; 1 x 10 9 molecules cm 2 s1)
and surface PRB NOx concentrations (lower panels; pptv) over the
United States from MOZART-2 (left) and GEOS-Chem (right) model
simulations in which anthropogenic Os precursor emissions were set
to zero in North America.
1   case simulation (top panel) and the PRB simulation (middle panel), along with the percentage
2   contribution of the background to the total base case NO2 (bottom panel). Maximum
3   concentrations in the base case simulation occur along the Ohio River Valley and in the
4   Los Angeles basin. While present-day concentrations are often above 5 ppbv, PRB is less than
5   300 pptv over most of the continental United States, and less than 100 pptv in the eastern United
6   States. The distribution of PRB (middle panel of Figure AX2.9-1) largely reflects the
7   distribution of soil NO emissions, with some local enhancements due to biomass burning such as
8   is seen in western Montana. In the northeastern United States, where present-day
9   concentrations are highest, PRB contributes <1% to the total.
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 1          The spatial pattern of present-day 862 concentrations over the United States is similar to
 2   that of NO2, with highest concentrations (>5 ppbv) along the Ohio River valley (upper panel
 3   Figure AX2.9-2). Background SO2 concentrations are orders of magnitude smaller, below 10
 4   pptv over much of the United States (middle panel of Figure AX2.9-2).  Maximum PRB
 5   concentrations of SC>2 are 30 ppt. In the Northwest where there are geothermal sources of SO2,
 6   the contribution of PRB to total SC>2 is 70 to 80%. However, with the exception of the West
 7   Coast where volcanic SC>2 emissions enhance PRB concentrations, the PRB contributes <1% to
 8   present-day 862 concentrations in surface air (bottom panel Figure AX2.9-2).
 9          The spatial pattern of NOY (defined here as HNO3, NH4NO3, NOX, HO2NO2, and organic
10   nitrates) wet and dry deposition is shown in Figure AX2.9-3. Figure AX2.9-3 (upper panel)
11   shows that highest values are found in the eastern United States in and downwind of the Ohio
12   River Valley. The pattern of nitrogen deposition in the PRB simulation (Figure AX2.9-3, middle
13   panel), however, shows maximum deposition centered over Texas and in the Gulf Coast region,
14   reflecting a combination of nitrogen emissions from lightning in the Gulf region, biomass
15   burning in the Southeast, and from microbial activity in soils (maximum in central Texas and
16   Oklahoma).  The bottom panel of Figure AX2.9-3 shows that the PRB contribution to nitrogen
17   deposition is less than 20% over the eastern United States, and typically less than 50% in the
18   western United States where NOy deposition is low (25-50 mg N nT2  yr"1).
19          Present-day SOx (SO2 + SO4 ~) deposition is largest in the Ohio River Valley, likely due
20   to coal-burning power plants in that region, while background deposition is typically at least an
21   order of magnitude smaller (Figure AX2.9-4). Over the eastern United States, the background
22   contribution to SOx deposition is <10%, and it is even smaller (<1%) where present-day SOx
23   deposition is highest. The contribution of PRB to sulfate deposition is highest in the western
24   United States (>20%) because of geothermal sources of SO2 and oxidation of dimethyl sulfide in
25   the surface of the eastern Pacific.
26          Thus far, the discussion has focused on results from the MOZART-2 tropospheric
27   chemistry model. In Figure AX2.9-5, results from MOZART-2 are compared with those from
28   another tropospheric chemistry model, GEOS-Chem (Bey et al., 2001), which was previously
29   used to diagnose PRB O3 (Fiore et al., 2003; U.S. Environmental Protection Agency, 2006).  In
30   both models, the surface PRB NOx  concentrations tend to mirror the distribution of soil NO
31   emissions, which are highest in the Midwest.  The higher soil NO emissions in GEOS-Chem (by

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 1   nearly a factor of 2) as compared to MOZART-2 reflect different assumptions regarding the
 2   contribution to soil NO emissions largely through fertilizer, since GEOS-Chem total soil NO
 3   emissions are actually higher than MOZART-2 (0.07 versus 0.11 Tg N) over the United States in
 4   July.  Even with the larger PRB soil NO emissions, surface NOx concentrations in GEOS-Chem
 5   are typically below 500 pptv.
 6          It is instructive to also consider measurements of SO2 at relatively remote monitoring
 7   sites, i.e., site located in sparsely populate areas not subject to obvious local sources of pollution.
 8   Berresheim et al. (1993) used a type of atmospheric pressure ionization mass spectrometer
 9   (APIMS) at Cheeka Peak, WA (48.30N 124.62W, 480 m asl), in April 1991 during a field study
10   for DMS oxidation products. Sulfur Dioxide concentrations ranged between 20 and 40 pptv.
11   Thornton et al. (2002) have also used an APIMS with an isotopically labeled internal standard to
12   determine background SO2 levels.  SO2 concentrations of 25 to 40 pptv were observed in
13   northwestern Nebraska in October 1999 at 150m above ground using the NCAR C-130
14   (Thornton, unpublished data). These data are comparable to remote central south Pacific
15   convective boundary layer SO2 (Thornton et al., 1999).
16          Volcanic sources of SO2 in the United States are limited to the Pacific Northwest, Alaska,
17   and Hawaii. Since 1980 the Mt. St. Helens volcano in Washington Cascade Range (46.20 N,
18   122.18 W, summit 2549 m asl) has been a variable source of SO2. Its major impact came in the
19   explosive eruptions of 1980, which primarily affected the northern part of the mountain west of
20   the United States. The Augustine volcano  near the mouth of the Cook Inlet in southwestern
21   Alaska (59.363 N, 153.43 W, summit 1252 m asl) has had  SO2 emissions of varying extents
22   since its last major eruptions in 1986.  Volcanoes in the Kamchatka peninsula of eastern region
23   of Siberian Russia do not particularly impact the surface concentrations in the northwestern NA.
24   The most serious impact in the United States from volcanic SO2 occurs on the island of Hawaii.
25   Nearly continuous venting of SO2 from Mauna Loa and Kilauea produce SO2 in such large
26   amounts so that >100 km downwind of the island SO2 concentrations can exceed 30 ppbv
27   (Thornton and Bandy, 1993). Depending on the wind direction the west coast of Hawaii (Kona
28   region) has had significant impacts from SO2 and acidic sulfate aerosols for the past decade.
29   Indeed, SO2 levels in Volcanoes National Park, HI exceeded the 3-h and the 24-h NAAQS in
30   2004 -2005. The area's design value is 0.6 ppm for the 3-h, and 0.19 ppm for the 24-h NAAQS
31   (U.S. Environmental Protection Agency, 2006).

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1          Overall, the background contribution to nitrogen and sulfur oxides over the United States
2   is relatively small, except for 862 in areas where there is volcanic activity.
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      TABLE AX2.3-1. ATMOSPHERIC LIFETIMES OF SULFUR DIOXIDE AND
   REDUCED SULFUR SPECIES WITH RESPECT TO REACTION WITH OH, NO3,
                                   AND CL RADICALS
Compound
S02
CH3-S-CH3
H2S
CS2
DCS
CH3-S-H
CH3-S-S-CH3
OH
k x 1012
1.6
5.0
4.7
1.2
0.0019
33
230
T
7.2d
2.3d
2.2 d
9.6 d
17 y
8.4 h
1.2 h
N03
k x 1012
NA
1.0
NA
0.0004
0.0001
0.89
0.53
T

l.lh

>116d
>1.3y
1.2 h
2.1 h
Cl
k x 1012
NA
400
74
0.004
0.0001
200
NA
T

29 d
157 d
NR
NR
58 d

 Notes:
 NA = Reaction rate coefficient not available. NR = Rate coefficient too low to be relevant as an atmospheric loss mechanism. Rate
 coefficients were calculated at 298 K and 1 atmosphere.
 y = year, d = day. h = hour. OH = 1 x 106/cm3; NO3 = 2.5 x 108/cm3; Cl = 1 x 103/cm3.
 'Rate coefficients were taken from JPL Chemical Kinetics Evaluation No. 14 (JPL, 2003).

Source: Seinfeld and Pandis (1998).
   TABLE AX2.4-la.  RELATIVE CONTRIBUTIONS OF VARIOUS REACTIONS TO
   THE TOTAL S(IV) OXIDATION RATE WITHIN A SUNLIT CLOUD, 10 MINUTES
                              AFTER CLOUD FORMATION
Reaction
Gas Phase
OH + SO2
Aqueous Phase
O3 + HSCV
O3 + SO32~
H2O2 + SCV
CH3OOH + HSCV
HNO4 + HSCV
HOONO + HSCV
HSCV + HSCV
SCV + SO32~
HSCV + Fe2+
% of Total3

3.5

0.6
7.0
78.4
0.1
9.0
O.I
1.2
0.1

% of Total b

3.1

0.7
8.2
82.1
0.1
4.4
O.I
O.I
0.1
0.6
 aln the absence of transition metals.
 bln the presence of iron and copper ions.


Source: Adapted from Warneck (1999).
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      TABLE AX2.4-lb. RELATIVE CONTRIBUTIONS OF VARIOUS GAS AND
  AQUEOUS PHASE REACTIONS TO AQUEOUS NITRATE FORMATION WITHIN
          A SUNLIT CLOUD, 10 MINUTES AFTER CLOUD FORMATION
Reaction
Gas Phase
OH + NO2 + M
Aqueous Phase
N2O5g + H2O
NO3 + cr
NO3 + HSO3~
NO3 + HCOCT
HNO4 + HSO3~
HOONO+NCV
O3 + NO2
% of Total3

57.7

8.1
0.1
0.7
0.6
31.9
0.8
O.I
% of Total b

67.4

11.2
0.1
1.0
0.8
20.5
0.1
O.I
 a In the absence of transition metals.
 b In the presence of iron and copper ions.


Source: Adapted from Warneck (1999).
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 TABLE AX2.6-1. EMISSIONS OF NITROGEN OXIDES, AMMONIA, AND SULFUR
                 DIOXIDE IN THE UNITED STATES IN 2002
2002 Emissions (Tg/yr)
Source Category
TOTAL ALL SOURCES
FUEL COMBUSTION TOTAL
FUEL COMB. ELEC. UTIL
Coal
Bituminous
Subbituminous
anthracite & lignite
Other
Oil
Residual
Distillate
Gas
Natural
Process
Other
Internal Combustion
FUEL COMBUSTION INDUSTRIAL
Coal
Bituminous
Subbituminous
Anthracite & Lignite
Other
Oil
Residual
Distillate
Other
Gas
Natural
Process
Other
Other
wood/bark waste
liquid waste
Other
Internal Combustion
FUEL COMB. OTHER
Commercial/Institutional Coal
Commercial/Institutional Oil
Commercial/Institutional Gas
Misc. Fuel Comb. (Except Residential)
Residential Wood
NOx1

23.19
9.11
5.16
4.50
2.90
1.42
0.18
<0.01
0.14
0.13
0.01
0.30
0.29
0.01
0.05
0.17
3.15
0.49
0.25
0.07
0.04
0.13
0.19
0.09
0.09
0.01
1.16
0.92
0.24
0.01
0.16
0.11
0.01
0.04
1.15
0.80
0.04
0.08
0.25
0.03
0.03
NH3

4.08
0.02
0.01
0.01




O.01


0.01


O.01
O.01
O.01
O.01




0.01



O.01



0.01



0.01
0.01
0.01
0.01
O.01
O.01

S02

16.87
14.47
11.31
10.70
8.04
2.14
0.51

0.38
0.36
0.01
0.01


0.21
0.01
2.53
1.26
0.70
0.10
0.13
0.33
0.59
0.40
0.16
0.02
0.52



0.15



0.01
0.63
0.16
0.28
0.02
0.01
O.01
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  TABLE AX2.6-1 (cont'd). EMISSIONS OF NITROGEN OXIDES, AMMONIA, AND
              SULFUR DIOXIDE IN THE UNITED STATES IN 2002
2002 Emissions (Tg/yr)
Residential Other
distillate oil
bituminous/subbituminous
Other
INDUSTRIAL PROCESS TOTAL
CHEMICAL & ALLIED PRODUCT
MFC
Organic Chemical Mfg
Inorganic Chemical Mfg
Sulfur compounds
Other
Polymer & Resin Mfg
Agricultural Chemical Mfg
ammonium nitrate/urea mfg.
Other
Paint, Varnish, Lacquer, Enamel Mfg
Pharmaceutical Mfg
Other Chemical Mfg
METALS PROCESSING
Non-Ferrous Metals Processing
Copper
Lead
Zinc
Other
Ferrous Metals Processing
Metals Processing
PETROLEUM & RELATED
INDUSTRIES
Oil & Gas Production
natural gas
Other
Petroleum Refineries & Related
Industries
fluid catalytic cracking units
Other
Asphalt Manufacturing
OTHER INDUSTRIAL PROCESSES
Agriculture, Food, & Kindred Products
Textiles, Leather, & Apparel Products
Wood, Pulp & Paper, & Publishing
Products
NOx1
0.36
0.06
0.26
0.04
1.10
0.12

0.02
0.01


<0.01
0.05


0.00
0.00
0.03
0.09
0.01




0.07
0.01
0.16

0.07


0.05



0.04
0.54
0.01
<0.01
0.09

NH3




0.21
0.02

0.01
O.01


O.01
0.02
0.01
0.02


O.01
O.01
O.01




0.01
O.01
O.01

O.01


0.01

0.01
0.01

0.05
O.01
O.01
0.01

S02
0.16
0.15
0.01
0.01
1.54
0.36

0.01
0.18
0.17
0.02
O.01
0.05


0.00
0.00
0.12
0.30
0.17
0.04
0.07
0.01
0.01
0.11
0.02
0.38

0.11
0.11
0.01
0.26

0.16
0.07
0.01
0.46
0.01
O.01
0.10

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  TABLE AX2.6-1 (cont'd). EMISSIONS OF NITROGEN OXIDES, AMMONIA, AND
              SULFUR DIOXIDE IN THE UNITED STATES IN 2002
2002 Emissions (Tg/yr)
Rubber & Miscellaneous Plastic
Products
Mineral Products
cement mfg
glass mfg
Other
Machinery Products
Electronic Equipment
Transportation Equipment
Miscellaneous Industrial Processes
SOLVENT UTILIZATION
Degreasing
Graphic Arts
Dry Cleaning
Surface Coating
Other Industrial
Nonindustrial
Solvent Utilization NEC
STORAGE & TRANSPORT
Bulk Terminals & Plants
Petroleum & Petroleum Product Storage
Petroleum & Petroleum Product
Transport
Service Stations: Stage II
Organic Chemical Storage
Organic Chemical Transport
Inorganic Chemical Storage
Inorganic Chemical Transport
Bulk Materials Storage
WASTE DISPOSAL & RECYCLING
Incineration
Industrial
Other
Open Burning
Industrial
Land clearing debris
Other
Public Operating Treatment Works
Industrial Waste Water
Treatment, Storage, and Disposal
Facility
Landfills
Industrial
NOx1
O.01

0.42
0.24
0.01
0.10
0.01
0.01
O.01
0.01
0.01
O.01
0.01
0.01
0.01
0.01
O.01
O.01
O.01
O.01
0.01
0.01

0.01
0.01
0.01
O.01
O.01
0.01
0.17
0.06


0.10



O.01
0.01
0.01

0.01

NH3
O.01

O.01



0.01
0.01

0.05
O.01
O.01
0.01
0.01
0.01
0.01


O.01
O.01
0.01
0.01


0.01

O.01

O.01
0.14
O.01


0.01



0.14
0.01
0.01

0.01

S02
O.01

0.33
0.19

0.09
0.01
0.01
O.01
0.02
O.01
O.01
0.01
0.01
0.01
0.01


0.01
O.01
0.01
0.01

0.01
0.01
0.01
O.01
O.01
O.01
0.03
0.02

0.01
0.01
0.01

O.01
O.01
0.01
0.01

0.01
0.01
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  TABLE AX2.6-1 (cont'd). EMISSIONS OF NITROGEN OXIDES, AMMONIA, AND
              SULFUR DIOXIDE IN THE UNITED STATES IN 2002
2002 Emissions (Tg/yr)
Other
Other
TRANSPORTATION TOTAL
HIGHWAY VEHICLES
Light-Duty Gas Vehicles & Motorcycles
light-duty gas vehicles
Motorcycles
Light-Duty Gas Trucks
light-duty gas trucks 1
light-duty gas trucks 2
Heavy-Duty Gas Vehicles
Diesels
heavy-duty diesel vehicles
light-duty diesel trucks
light-duty diesel vehicles
OFF-HIGHWAY
Non-Road Gasoline
Recreational
Construction
Industrial
lawn & garden
Farm
light commercial
Logging
airport service
railway maintenance
recreational marine vessels
Non-Road Diesel
Recreational
Construction
Industrial
lawn & garden
Farm
light commercial
Logging
airport service
railway maintenance
recreational marine vessels
Aircraft
Marine Vessels
Diesel
residual oil
Other
NOX 1 NH3

<0.01 <0.01
12.58 0.32
8.09 0.32
2.38 0.20
2.36
0.02
1.54 0.10
1.07
0.47
0.44 <0.01
3.73 0.01
3.71
0.01
0.01
4.49 O.01
0.23 O.01
0.01
0.01
0.01
0.10
0.01
0.04
0.01
O.01
O.01
0.05
1.76 O.01
0.00
0.84
0.15
0.05
0.57
0.08
0.02
0.01
0.01
0.03
0.09
1.11
1.11


S02
O.01
O.01
0.76
0.30
0.10
0.10
0.00
0.07
0.05
0.02
0.01
0.12



0.46
0.01










0.22










0.01
0.18



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   TABLE AX2.6-1 (cont'd).  EMISSIONS OF NITROGEN OXIDES, AMMONIA, AND
                  SULFUR DIOXIDE IN THE UNITED STATES IN 2002
2002 Emissions (Tg/yr)
Railroads
Other
liquefied petroleum gas
compressed natural gas
MISCELLANEOUS
Agriculture & Forestry
agricultural crops
agricultural livestock
Other Combustion
Health Services
Cooling Towers
Fugitive Dust
Other
Natural Sources
NOx1
0.98
0.32
0.29
0.04
0.39
0.01







3.10
NH3

O.01


3.53
3.45
O.01
2.66
0.08




0.03
S02
0.05
0.00


0.10
0.01


0.10





 1 Emissions are expressed in terms of NO2.
  Emissions based on Guenther et al. (2000).
Source: U.S. Environmental Protection Agency (2006).
         TABLE AX2.8-1. SATELLITE INSTRUMENTS USED TO RETRIEVE
                            TROPOSPHERIC NO2 COLUMNS.
Instrument
GOME

SCIAMACHY

OMI

Coverage
1995-2002

2002-

2004-

Typical U.S.
Measurement Time
10:30-11:30 AM

10:00-11:00 AM

12:45-1:45 PM

Typical
Resolution
(km)
320 x 40

30x60

13 x24

Return
Time
(days)1
3

6

1

Instrument
Overview
Burrows et al.
(1999)
Bovensmann
etal. (1999)
Levelt et al.
(2006)
 1 Return time is reported here for cloud free conditions. Note that due to precession of the satellite's orbit, return
 measurements are close to but not made over the same location. In practice, clouds decrease observation frequency by a
 factor of 2.
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 1    Arey, J.; Atkinson, R.; Zielinska, B.; McElroy, P. A. (1989) Diurnal concentrations of volatile
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 4   World Health Organization (WHO). (2003) Nitrogenated polycyclic aromatic hydrocarbons.
 5          Geneva, Switzerland: World Health Organization. (Environmental Health Criteria 229).
 6   Xu, J. H.; Lee, F. S. C. (2000) Quantification of nitrated polynuclear aromatic hydrocarbons in
 7          atmospheric parti culate matter. Anal. Chim. Acta 416: 111-115.
 8   Yienger, J. J.; Levy, H., II. (1995) Empirical model of global soil-biogenic NOX emissions. J.
 9          Geophys. Res. [Atmos.] 100: 11,447-11,464.
10   Young, V. L.; Kieser, B. N.; Chen, S. P.; Niki, H. (1997) Seasonal trends and local influences on
11          nonmethane hydrocarbon  concentrations in the Canadian boreal forest. J. Geophys. Res.
12          [Atmos.] 102: 5913-5918.
13   Zafiriou, O. C.; True, M. B. (1979) Nitrate photolysis in seawater by sunlight. Mar. Chem. 8: 33-
14          42.
15   Zanis, P.; Trickl, T.; Stohl, A.; Wernli, H.; Cooper, O.; Zerefos, C.; Gaeggeler, H.; Schnabel, C.;
16          Tobler, L.; Kubik, P. W.; Priller, A.; Scheel, H. E.; Kanter, H. J.; Cristofanelli, P.;
17          Forster, C.; James, P.; Gerasopoulos, E.; Delcloo, A.; Papayannis, A.; Claude, H. (2003)
18          Forecast, observation and  modelling of a deep stratospheric intrusion event over Europe.
19          Atmos. Chem. Phys. 3: 763-777.
20   Zhang, G. J.; McFarlane, N. A. (1995) Sensitivity of climate simulations to the parameterization
21          of cumulus convection in the Canadian Climate Centre general circulation model. Atmos.
22          Ocean 33: 407-446.
23   Zhang, X. Q.; McMurry, P. H. (1987) Theoretical analysis of evaporative losses from impactor
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25   Zhang, J.-Z.; Millero, F. J. (1991) The rate of sulfite oxidation in seawater. Geochim.
26          Cosmochim. Acta 55: 677-685.
27   Zhou, X.; Beine, H. J.; Honrath, R. E.; Fuentes, J. D.; Simpson, W.; Shepson, P. B.; Bottenheim,
28          J. W. (2001) Snowpack photochemical production of HONO:  a major source of OH in
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30   Zhou, X.; Civerolo, K.; Dai, H. (2002a)  Summertime nitrous acid chemistry in the atmospheric
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32          10.1029/2001JD001539.
33   Zhou, X. L.; He, Y.; Huang, G; Thornberry, T. D.; Carroll, M. A.; Bertman, S. B. (2002b)
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 8          gas phase chemistry. J. Atmos. Chem. 17: 141-155.
 9   Zingler, J.; Platt, U. (2005) Iodine oxide in the Dead Sea Valley: evidence for inorganic sources
10          of boundary layer IO. J. Geophys. Res. [Atmos.]  110(D07307): 10.1029/2004JD004993.
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 i                AX3.  CHAPTER 3 ANNEX-AMBIENT
 2                CONCENTRATIONS AND EXPOSURES
 o
 4
 5   AX3.1    INTRODUCTION
 6          Topics discussed in this chapter include the characterization of ambient air quality for
 7   nitrogen dioxide (NO2), the uses of these data in assessing human exposures to NO2;
 8   concentrations and sources of NC>2 in different microenvironments, and personal exposures to
 9   NC>2.  The NC>2 data contained in this chapter are taken mainly from the U.S. Environmental
10   Protection Agency's Air Quality System (AQS) database (formerly the AIRS database) (U.S.
11   Environmental Protection Agency, 2007).
12
13   Characterizing Ambient NO2 Concentrations
14          The "concentration" of a specific air pollutant is typically defined as the amount (mass)
15   of that material per unit volume of air. However, most of the data presented in this chapter are
16   expressed as "mixing ratios" in terms of a volume-to-volume ratio (e.g., parts per million [ppm]
17   or parts per billion [ppb]. Data expressed this way are often referred to as concentrations, both in
18   the literature and in the text, following common usage. Human exposures are expressed in units
19   of mixing ratio times time.
20
21   Relationship to the 1993 Air Quality Criteria Document for Nitrogen Oxides
22          The 1993 AQCD for Oxides of Nitrogen emphasized NC>2 indoor sources (gas stoves)
23   and the relationship between personal total exposure and indoor or outdoor NC>2 concentrations
24   (U.S. Environmental Protection Agency, 1993). At that time, only few personal exposure studies
25   had been conducted with an emphasis on residential indoor NC>2 sources and concentrations.
26   Although the concept of microenvironment had been introduced in the document, NC>2
27   concentrations were seldom reported for microenvironments other than residences.  Exposure
28   measurements at that time relied on Palmes tubes and Yanagisawa badges; and exposure-
29   modeling techniques were limited mainly to simple linear regression. In the 1993 AQCD, NC>2
30   was treated as an independent risk factor, and confounding issues were not mentioned in the
31   human environmental exposure chapters.
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 1          The current chapter summarizes and discusses the state-of-the-science and technology
 2   regarding NC>2 human exposures since 1993. Since then, numerous human exposure studies
 3   have been conducted with new measurement and modeling techniques. Microenvironmental
 4   measurements were not limited to residential indoor environments; NC>2 concentrations were also
 5   measured in vehicles, schools and offices, and microenvironments close to traffic. More indoor
 6   sources have been identified and more NO2 formation and transformation mechanisms in the
 7   indoor environment have been reported. Both indoor and outdoor NC>2 have been treated as
 8   components of a pollutant mixture, and therefore the concepts of confounding and surrogacy
 9   have been discussed in the current chapter.
10
11
12   AX3.2    AMBIENT CONCENTRATIONS OF NITROGEN OXIDES  AND
13              RELATED SPECIES
14          As discussed in Chapter 2, most measurements of NOx are made by instruments that
15   convert NC>2 to NO, which is then measured by chemiluminescence. However, the surface
16   converters that reduce NC>2 to NO also reduce other reactive NOy species. As indicated in
17   Chapter 2, NOy compounds consist of NOx, gas phase inorganic nitrates, such as CINOs; organic
18   nitrates, such as PANs; inorganic acids, given by the formulas HNOy (Y = 2 to 4); and
19   particulate nitrate. In urban areas or in rural areas where there are large local sources, NO and
20   NO2 are expected to be the major forms of NOy. Thus, interference from PANs and other NOy
21   species near sources are expected to minor; in most rural and remote areas, interference may be
22   substantial as concentrations of other NOy species may be much larger than those for NO and
23   NO2 (National Research Council, 1991).  Examples will be presented in Section AX3.3.5.
24          Data for NOx in addition to NO2 is reported into the U.S. Environmental Protection
25   Agency's Air Quality System (AQS), but data for NO is not reported, even though measurements
26   of NO are not affected by artifacts caused by products of NO2 oxidation and therefore should be
27   the most reliable. By definition, NOx is equal to the  sum of NO and NO2, so the concentration
28   of NO can be found by subtraction.  However, measurements are obtained for NO and NOx
29   every 2 to 3 min, but hourly averages for NO2 and NOx are reported into AQS.  The locations of
30   NO2 monitoring sites are shown in Figure AX3.2-1.  As can be seen from Figure AX3.2-1, there
31   are large areas of the United States for which data for ambient NO2 are not collected. The
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                     Monitor Locator Map - Criteria Air Pollutants
                                         United States
               Monitor Location: A NO2 (n=375)
                                  Shaded states have monitors
     Figure AX3.2-1.     Location of ambient NOi monitors in the United States.


 1   percentile distribution of NC>2 concentrations in urban and nonurban areas in the U.S. for
 2   different averaging periods is shown in Table AX3.2-1.
 3          Because of their short lifetime with respect to oxidation to PANs and HNOs, NOx
 4   concentrations are highly spatially and temporally variable. Average concentrations range from
 5   tens of ppt in remote areas of the globe to tens of ppb in urban cores, i.e., by three orders of
 6   magnitude. Median NO, NOx, and NOy concentrations at the surface are typically below 0.01,
 7   0.05, and 0.3 ppb, respectively, in remote areas such as Alaska, northern Canada, and the eastern
 8   Pacific; median NOy concentrations range from about 0.7 to about 4.3 ppb at regional
 9   background sites in the eastern United States (Emmons et al., 1997). Note that the last two
10   values, especially, contain a substantial contribution from pollution. Maximum short-term
11   average (1-h) NOx concentrations near heavy traffic (e.g., in Los Angeles, CA) approach 1 ppm,
12   but these levels decrease rapidly away from sources. Even at sites where such high hourly
13   values are found, 24-h average concentrations are much lower. For example, the maximum 24-h
14   average NOx concentration at any  site in Los Angeles in 2004 was 82 ppb.
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 1          NO2 concentrations are likewise highly spatially and temporally variable.  The overall
 2    annual mean concentration of NO2 at U.S. monitoring sites is about 15 ppb. Most sites
 3    monitoring NO2 are located in populated areas and values outside of urban and suburban areas
 4    can be much lower. Perhaps the most comprehensive characterization of ambient NO2 levels has
 5    been performed by the California Air Resources Board (CARB) as part of the review of the air
 6    quality standards for California (CARB, 2007). On a statewide basis, the average NO2
 7    concentration was about 15 ppb from 2002 to 2004.  Highest average values of about 27 ppb
 8    were found in the South Coast Air Basin.  The maximum 1-h average NO2 concentration during
 9    the same period was 262 ppb, again in the South Coast Air Basin. However, maximum 1-h
10    concentrations of NO2 were about 150 ppb in Los Angeles, CA in 2004, implying that the high
11    NOx level (~lppm) cited above for Los Angeles consisted mainly of NO. It is highly unlikely
12    that NOx oxidation products constituted a significant fraction of the NOx reported.
13
14    AX3.2.1   Spatial and Temporal Variability in Ambient Concentrations of
15                NO2 and Related Species in Urban Areas
16          As noted earlier, the number of monitoring sites reporting data for NO2 is considerably
17    smaller than for other  criteria pollutants.  As a result, there are few urban areas where there exist
18    sufficient data to evaluate the spatial variability in NO2 even though most of the NO2 monitors
19    are found in urban or suburban areas.  Analyses of spatial variability in NO and NO2 are thus
20    limited to Los Angeles, CA and Chicago, IL.  Also, as noted in Chapter 2, current methods for
21    measuring NO2 are subject to interference from its oxidation products. Hence the reported
22    values represent upper limits for the true NO2 concentration.  Near highways or other NOx
23    sources, the measurements should give more accurate values, but because of variability in the
24    time needed for conversion of NOx to NOz, no firm  rules can be  applied to account for the
25    presence of NOz species such as HNOs and PANs. These considerations introduce additional
26    uncertainty into the interpretation of any metrics (e.g., correlation coefficients, concentration
27    differences) that are used to characterize spatial variability in NO2 concentrations.
28          The spatial variability in 1 h average NO2 concentrations  in New York, NY; Atlanta, GA;
29    Chicago, IL; Houston, TX; Los Angeles, CA; and Riverside, CA is characterized in this section.
30    These areas were chosen to provide analyses to help guide risk assessment and to provide a
31    general overview of the spatial variability  of NO2 in cities where health outcome studies have
32    been conducted. Statistical analyses of the human health effects  of airborne pollutants based on

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 1    aggregate population time-series data have often relied on ambient concentrations of pollutants
 2    measured at one or more central sites in a given metropolitan area. In particular, cities with low
 3    traffic densities that are located downwind of major sources of precursors are heavily influenced
 4    by long range transport and tend to show smaller spatial variability (e.g., New Haven, CT) than
 5    those source areas with high traffic densities located upwind (e.g., New York, NY).
 6          Metrics for characterizing spatial variability include the use of Pearson correlation
 7    coefficients, values of the 90th percentile (P90) of the absolute difference in concentrations, and
 8    coefficients of divergence (COD) The COD is defined as follows:
                                             ViU
                                                     •">ii ' "-it
                                                                                    (AX3.2-1)
Y--+ y
Aij ^ A-A
10    where xy- and x;k represent observed concentrations averaged over some measurement averaging
11    period (hourly, daily, etc.), for measurement period /' at site7 and site k andp is the number of
12    observations.  These methods of analysis follow those used for characterizing PM2 5 and PMi0-2.5
13    concentrations in Pinto et al. (2004) and in the latest edition of the PM AQCD (U.S.
14    Environmental Protection Agency, 2004).
15           Summary statistics for the spatial variability in several urban areas across the United
16    States are shown in Table AX3.2-2. These areas were chosen because they are the major urban
17    areas with at least five monitors operating from 2003 to 2005. Values in parentheses below the
18    city name refer to the number of sites colleting data.  The second column shows the mean 1 h
19    average concentration across all sites and the range in means at individual sites.  The third
20    column gives the range of Pearson correlation coefficients between individual site pairs in the
21    urban area.  The fourth column shows the 90th percentile absolute difference in concentrations
22    between site pairs.  The fifth column gives the coefficient of divergence (COD).
23           As can be seen from the table, mean concentrations at individual  sites vary by factors of
24    1.5 to 6 in the MS As examined. Correlations between individual site pairs range from slightly
25    negative to highly positive in a given urban area. The sites in New York City tend to be the most
26    highly correlated and show the highest mean levels, reflecting their proximity to traffic, as
27    evidenced by the highest mean concentration of all the entries.  However, correlation coefficients
28    are not sufficient for describing spatial variability as concentrations at two sites may be highly
29    correlated but show differences in levels.  Thus, the range in mean concentrations is given. Even

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 1    in New York City, the spread in mean concentrations is about 40% of the city-wide mean
 2    (12/29). The relative spread in mean concentrations is larger in the other urban areas shown in
 3    Table AX3.2-2. As might be expected, the 90th percentile concentration spreads are even larger
 4    than the spreads in the means.
 5           The same statistics shown in Table AX3.2-2 have been used to describe the spatial
 6    variability of PM2.5 (U.S. Environmental Protection Agency, 2004; Pinto et al., 2004) and 63
 7    (U.S. Environmental Protection Agency, 2006a). However, because of relative sparseness in
 8    data coverage for NO2, spatial variability in all cities that were considered for PM2.5 and 63
 9    could not be considered here.  Thus, the number of cities included below is much smaller than
10    for either 63 (24 urban areas) or PM2.5 (27 urban areas). Even in those cities where there are
11    monitors for all three pollutants, data may not have been collected at the same locations and even
12    if they were, there would be variable influence from local sources.  For example, concentrations
13    of NO2 collected near traffic will be highest in an urban area, but concentrations of Os will tend
14    to be lowest because of titration by NO forming NO2. However, some general observations can
15    still be made.  Mean concentrations of NO2 at individual monitoring sites are not as highly
16    variable as for 63 but are more highly variable than PM2.5. Lower bounds on inter-site
17    correlation coefficients for PM2.5 and for 63 tend to be much higher than NO2 in the same areas
18    shown in Table AX3.2-2.  CODs for PM2 5 are much lower than for Os, whereas CODs for NO2
19    tend to be the largest among the three pollutants. Therefore, it is apparent that there is the
20    potential for errors from the use of ambient monitors to characterize exposures either at the
21    community or personal level, and that this potential may be higher than for either Os or PM2 5.
22
23    Small Scale Vertical Variability
24          Inlets to instruments for monitoring gas phase criteria pollutants can be located from 3 to
25    15m above ground level (Code of Federal Regulations, 2002).  Depending on the pollutant,
26    either there can be positive, negative or no vertical gradient from the ground to the monitor inlet.
27    Pollutants that are formed over large areas by atmospheric photochemical reactions and are
28    destroyed by deposition to the surface or by reaction with pollutants emitted near the surface
29    show positive vertical gradients. Pollutants that are emitted by sources at or just above ground
30    level show negative vertical gradients.  Pollutants with area sources and have minimal deposition
31    velocities show little or no vertical gradient.  Restrepo et al. (2004) compared data for criteria
32    pollutants collected at fixed monitoring sites at 15 m above the surface on a school rooftop to

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 1   those measured by a van whose inlet was 4 m above the surface at monitoring sites in the South
 2   Bronx during two sampling periods in November and December 2001.  They found that CO,
 3   SO2, and NO2 showed positive vertical gradients, whereas O3 showed a negative vertical gradient
 4   and PM2.5 showed no significant vertical gradient. As shown in Figure AX3.2-2, NO2 mixing
 5   ratios obtained at 4 m (mean -74 ppb) were about a factor of 2.5 higher than at 15 m (mean -30
 6   ppb). Because tail pipe emissions occur at lower heights, NO2 values could have been much
 7   higher nearer to the surface, and the underestimation of NO2 values by monitoring at 15 m even
 8   larger. Restrepo et al.  (2004) note that the use of the NO2 data obtained by the stationary
 9   monitors would result in an underestimate of human exposures to NO2 in the South Bronx.
10   However, this issue is most likely not unique to the South Bronx and could arise in other large
11   urban areas in the United States with populations of similar demographic and socioeconomic
12   characteristics.
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 1    AX3.2.2.1   Diurnal Variability in NOi Concentrations
 2          As might be expected from a pollutant having a major traffic source, the diurnal cycle of
 3    NC>2 in typical urban areas is characterized by traffic emissions, with peaks in emissions
 4    occurring during morning and evening rush hour traffic. Motor vehicle emissions consist mainly
 5    of NO, with only about 10% of primary emissions in the form of NC>2.  The diurnal pattern of
 6    NO and NO2 concentrations is also strongly influenced by the diurnal variation in the mixing
 7    layer height.  Thus, during the morning rush hour when mixing layer heights are still low, traffic
 8    produces a peak in NO and NO2 concentrations. As the mixing layer height increases during the
 9    day, dilution of emissions occurs.  During the afternoon rush hour, mixing layer heights are at or
10    are near their daily maximum values resulting in dilution of traffic emissions through a larger
11    volume than  in the morning. Starting near sunset, the mixing layer height drops and conversion
12    of NO to NO2 occurs without photolysis of NO2 recycling NO.
13          The composite diurnal variability of NO2 in selected urban areas with multiple sites
14    (New York, NY; Atlanta, GA;  Baton Rouge,  LA; Chicago. IL; Houston, TX; Riverside, CA;
15    and Los Angeles, CA) is shown in Figure AX3.2-3.  Figure AX3.2-3 shows that lowest hourly
16    median concentrations are typically found at  around midday and that highest hourly median
17    concentrations are found either in the early morning or in mid-evening. Median values range by
18    about a factor of two from about 13 ppb to about 25 ppb.  However, individual hourly
19    concentrations can be considerably higher than  these typical median values, and hourly NO2
20    concentrations > 0.10 ppm can be found at any  time of day.
21
22    AX3.2.2.2   Seasonal Variability in NO2 Concentrations
23
24    Urban Sites
25          As might be expected from an atmospheric species that behaves essentially like a primary
26    pollutant emitted from surface  sources, there  is  strong  seasonal variability in NOx and NO2
27    concentrations.  Highest concentrations are found during winter, consistent with lowest mixing
28    layer heights found during the year.  Mean and  peak concentrations in winter can be up to a
29    factor of two larger than in the summer at several sites in Los Angeles County.
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     Figure AX3.2-3.  Composite, diurnal variability in 1-h average NO2 in urban areas. Values
                      shown are averages from 2003 through 2005. Boxes define the
                      interquartile range, and the whiskers the 5th and 95th percentile values.
                      Asterisks denote individual values above the 95th percentile.
 1          The month-to-month variability in NO2 at individual sites in selected urban areas is

 2   illustrated in Figures AX3.2-4 to AX3.2-10. Seasonal patterns can be found at some sites but not

 3   in others.  There appears to be a somewhat regular pattern for the southern cities with winter

 4   maxima and summer minima. Monthly maxima tend to be found from late winter to early spring

 5   in Chicago and New York with minima occurring from summer through the fall. However, in

 6   Los Angeles and Riverside, monthly maxima tend to occur from autumn through early winter

 7   with minima occurring from spring through early summer.

 8
 9   Regional Background Sites

10          Surface NOx and NOy data obtained in Shenandoah National Park,  VA from 1988 to

11   1989 show wintertime maxima and summertime minima (Doddridge et al.,  1991, 1992; Poulida

12   et al., 1991). NOX and NOY data collected in Harvard Forest, MA from 1990 to 1993 show a

13   similar seasonal pattern (Munger et al., 1996).  In addition the within-season variability was

14   found to be smaller in the summer than in the winter as shown in Table AX3.2-3.
     March 2008
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Figure AX3.2-4a-e.   Time series of 24-h average NOi concentrations at individual sites in
                         New York City from 2003 through 2006. A natural spline function
                         (with 9 degrees of freedom) was fit and overlaid to the data (dark
                         solid line).
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                             Sample Date (mm/dd/yyyy)
Figure AX3.2-5a-e.  Time series of 24-h average NOi concentrations at individual sites in
                    Atlanta, GA from 2003 through 2005. A natural spline function (with
                    9 degrees of freedom) was fit and overlaid to the data (dark solid line).
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      a. Chicago, IL.
                          RURAL
                                                     b. Chicago, IL.
                                                                        SUBURBAN
       007-


       006-
       001'


       DCO-
       «UA        j^-. ij=—to
       wT^^f^t        ^rjpfjj       "fTOfvm
                     Sample Date {mm/dd/yyyy}
                                                                    Sample Date (mm/dd/yyyy)
     C. Chicago, IL
                        SUBURBAN
     5.
     S 006-
     C
     O (

     2 DW:
                                                     d- Chicago, IL
                                                                        SUBURBAN
                     Sampl« Date {mm/dd,'yyyyj
                                                                     DI/QICO&*  effiflusodw  oifli^OB

                                                                     Sample Date (mm/dd/yyyy)
      e. Chicago, IL,
     .« 005-

     5
     t> O'-W"

     g Q.DJ.
     u
                         SUBURBAN
00:-


COC-

 01^1/2003  07/010003  01rfH3004  07fl)1/20M  01^31/2005


              Sample Date {mm/dd/yyyy}
                                                     f. Chicago, IL.
                                             •—•  aos-

                                             .2  0.05 4
                                             ?
                                             g
                                             2  003.

                                             O  W.

                                                aoi.
                                                            URBAN and CENTER CITY
                                                           14* J • 170310W3 po4 •
                                               01*1/2006   oirtjriaooa
                                                                     OliOlQOO*  07*l^!flOfl  Ol/Ol/SOOS

                                                                     Sample Date {mm/dd/yyyy)
                             g. Chicago, IL.    URBAN and CENTER CITY
                                      
-------
     a. Baton Rouge, LA.
                             SUBURBAN
    a
    Q.
    c
    o
    I
    O
    o
0.09:
0.08-i
0.07-i
0.06^
0.05-i
0.04 •;
0.03-j
0.02-i
0.01-j
0.00^
                 siteid=221210001 poc=1
                                                          = Natural Spline Fit w/ 9 df
         01/01/2003  07/01/2003   01/01/2004   07/01/2004   01/01/2005   07/01/2005   01/01/2006
                               Sample Date (mm/dd/yyyy)
     b. Baton Rouge, LA.
                      URBAN and CENTER CITY
    Q.
    O
    '+">
    re
    o>
    o
    c
    o
    o
0.09:
0.08-
0.07-
0.06-
0.05:
0.04:
0.03:
0.02:
0.01-
0.00-
                  site id=220330009 poc=1
                                                         I           I
         01/01/2003  07/01/2003   01/01/2004   07/01/2004   01/01/2005   07/01/2005   01/01/2006
                               Sample Date (mm/dd/yyyy)
Figure AX3.2-7a-b.  Time series of 24-h average NOi concentrations at individual sites in
                    Baton Rouge, LA from 2003 through 2005. A natural spline function
                    (with 9 degrees of freedom) was fit and overlaid to the data (dark
                    solid line).
March 2008
                                AX3-13
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     a. Houston, TX.
                       SUBURBAN
                                                  b. Houston, TX.
                                                             SUBURBAN
     ^-, oa
     £ „
               i'.L&".-:ji'.a:'t:- '
                    Sample Date (mm/dd/yyyy)
                                                     9 £4.
                                                     003-
                                                     3C2-
                                                     001-
                                                     0:0-
                                                                 Sample Date (mm/dd/yyyy)
     c. Houston, TX.
                       SUBURBAN
                                =.
       ace-
     s
     o
     o
       CO' •
       cce-
                   URBAN and CENTER CITY
Cn^OUSBJ  QTflJfEQM   01^)1W»4
             Sample Date (mm/dd/yyyy)
                                                  f, Houston, TX,
                                                               URBAN and CENTER CITY
                                                                 Sample Date (mm/dd/yyyy)
                            g. Houston. TX.    U RBAN and C ENTER CITY
                           E 0.07
                           Q.
                           S 0»<
                           c
                           o Q.K.
                           O CK
                           o
                             001


                                          Sample Date (mm/dd/yyyy)
Figure AX3.2-8a-g.  Time series of 24-h average NOi concentrations at individual sites in
                       Houston, TX from 2003 through 2005. A natural spline function (with
                       9 degrees of freedom) was fit and overlaid to the data (dark solid line).
March 2008
                                      AX3-14
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      a. Los Angeles, CA.
                        SUBURBAN
                                                    b. Los Angeles, CA.
                                                  SUBURBAN
        G1«1J2fKB  07J01/2003
                     Sample Date (mm/dd/yyyy)
                                                                   Sample Date (mm/dd/yyyy)
      c. Los Angeles, CA.
                        SUBURBAN
                                                    d. Los Angeles, CA.
                                                  SUBURBAN
        01*1^003  OT/01/2003   OMQiraOW  OWHaHXl
                     Sample Date (mm/dd/yyyy)
                                                                   Sample Date (mm/dd/yyyy)
      e. Los Angeles, CA,
                        SUBURBAN
                                                   f. Los Angeles, CA.
                                                                      SUBURBAN
OWIEOM  Q7rtJ1fflB4

Sample Date (mm/dd/yyyy)
                                                                   Sample Date (mm/dd/yyyy)
      g. Los Angeles, CA.
                        SUBURBAN
                                                   h. LOS Angeles, CA.  URBAN and CENTER CITY
                    D1/Q1/20W   {J7>D1/3XM
                     Sample Date (mm/dd/yyyy)
                                                      OTfllQOtB  07/0tia»3   01*1J20O1  07/01COM  QI/QltfQQS  07flli2006

                                                                   Sample Date (mm/dd/yyyy)
Figure AX3.2-9a-h.   Time series of 24-h average NOi concentrations at individual sites in
                        Los Angeles, CA from 2003 through 2005. A natural spline function
                        (with 9 degrees of freedom) was fit and overlaid to the data (dark
                        solid line).
March 2008
                          AX3-15
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  LOS Angeles, CA.   URBAN and CENTER CITY
                           j. LOS Angeles, CA.  URBAN and CENTER CITY
                                                    I
                                                    0.
                                                    c
                                                    01
                                                    o
                                                    c
                                                    o
                                                    o
           07/01/2003  OM31/2004  07(01/2004  01j01/2CG5


                  Sample Date (mm/dd/yyyy)
                                       07)01/2003   01*1/2004   07)0112004  01(01(2005  07/010005


                                              Sample Date (mm/dd/yyyy}
k. Los Angeles, CA.   URBAN and CENTER CITY
                            i. LOS Angeles, CA.  URBAN and CENTER CITY
                                                    a.
                                                    a.
                                                    O
                                                    o
                                                    c
                                                    o
                                                    o
                                01)01(2006  07/0112005
                                                       0110112003   07/01(2003   01101/2004   07|01I2004  QlfflteGOB  07(01(2005
                  Sample Date (mm/dd/yyyy)
                                                                      Sample Date (mm/dd/yyyy)
 n. LOS Angeles, CA.  URBAN and CENTER CITY
         •rfe d = GSQ3750Q1 poe = 1
                           n. Los Angeles, CA,  URBAN and CENTER CITY
   01(01(2003  074)10003  01/01/2004   07,01(2004   OKOIftX*  07(01/2006  01(01(200$    01(01(2003   07/01(2003   01/01(2004   07/OIG004  01(01(2005  07(01(2005  01/01(2006
                  Sample Date (mm/dd/yyyy)
                                              Sample Date (mm/dd/yyyy)
Figure AX3.2-9i-n.
Time series of 24-h average NOi concentrations at individual sites in

Los Angeles, CA from 2003 through 2006.  A natural spline function

(with 9 degrees of freedom) was fit and overlaid to the data (dark

solid line).
March 2008
                        AX3-16
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     a. Riverside, CA.
                            RURAL
                                                     b. Riverside, CA.
                                                   SUBURBAN
        MS-
        006.
        COS-
        004-
        003^
        002-
        0.01 • 1
        000- '	
        01(01(2003
                                     -~, - Nnluial Spline fe-ntl &dl
                               a
                               _a
                               B
                               o
                               2
     c. Riverside, CA.
01101(2004   07(01)2004  01)01(2005  07)01)2005   01(01(2008
Sample Date (mm/dd/yyyy)

   SUBURBAN
                                                        01(01(2003  07(01(2003  01101)2004  07)01)2004  01(01(2005  07(01(2005   01BK2006
                                                     d. Riverside, CA.
                                                                      Sample Date (mm/dd/yyyy)
                                                                         SUBURBAN
        oca
        oos
        mar
        0.06'
        005
        VM
        003
        002
        001
        ooc
        01*1)2003  07)01(2003   01(01(20M  07(010X14  OWK2005   07)01(2005  01OT200S
                      Sample Date (mm/dd/yyyy}
                               o
                               o
                                   01(01(2003  07(01(2003  01(01)2004  07)0112004   01(01(2005  07)01(2005   0101)2005
                                                Sample Date (mm/dd/yyyy)
     Figure AX3.2-10a-d. Time series of 24-h average NOi concentrations at individual sites in
                           Riverside, CA from 2003 through 2006.  A natural spline function
                           (with 9 degrees of freedom) was fit and overlaid to the data (dark
                           solid line).
1    AX3.2.2.3   Trends in NO2 Concentrations
2           Figure AX3.2-11 shows the nationwide trend in annual mean NC>2 concentrations from
3    1983 to 2002.  As can be seen from the figure, NC>2 concentrations have decreased by about 10%
4    per decade. As can be seen from Figure AX3.2-12, most monitoring sites are located in either
5    urban (49) or suburban (58) areas and comparatively few monitoring sites are located in rural
6    areas (14). Figure AX3.2-12 also shows that decreases have been at least twice as large in urban
7    and suburban areas than in rural areas and that NC>2 concentrations in urban and suburban areas
8    are roughly twice those in rural areas. Note that a land use characterization of rural does not
     March 2008
                           AX3-17
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e. Riverside, CA.
                       SUBURBAN
                                                       f. Riverside, CA.
                            SUBURBAN
                                                       a.  uu'
                                                       Q.
                                                       —  005
                                                                 a ri = 060712002 pDC = 1
    01(01/2003  07/0112003   01(01/2004   07/01(2004  01(01/2005   07/01(2005   01(01(2006
                                                           005^
                                                           004-
                                                           003-
                                                           002-
                                                           101. |
                                                           0.00-
                                                           01(01(2003   07)01/2003  01/01/2004   07/01/2KM   01/01(2005  07/OU20CS   0«)1(2006
                    Sample Date (mm/dd/yyyy)
                        Sample Date (mm/dd/yyyy)
g. Riverside, CA.
   0.09-
                       SUBURBAN
     h Riverside. CA    URBAN and CENTER CITY
    01(01/2003  07/01(2003  01(01(2004   07/01(2004   01101(2005  07/010005   Olffll/2006
                                                           000-
                                                           01(01/2003   07/0112003   0101/2004  07/01(2004   01/01(2005  07/01(2005  01(01(2006
                   Sample Date (mm/dd/yyyy)
                                                                           Sample Date (mm/dd/yyyy)
                          i.  Riverside, CA.     URBAN and CENTER CITY
                              01/01M03   07*1/2003  01/OW2OM   07)01/2004   01/01/2OS  07(01/2005   01/01.0003
                                             Sample Date (mm/dd/yyyy)
Figure AX3.2-10e-i. Time series of 24-h average NOi concentrations at individual sites in
                         Riverside, CA from 2003 through 2006. A natural spline function
                         (with 9 degrees of freedom) was fit and overlaid to the data (dark
                         solid line).
March 2008
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                         0.06
                         0.05 -
                                    sites have* concentraliens wlcw this line
                          0.0
                            83 64 85 86 87 88 83 90 91 92 93 94 95 &6 97 98 99 00 01 02
                                          1983-02:  21% decrease
                                          1993-02:  11% decrease
     Figure AX3.2-11.    Nationwide trends in annual mean NOi concentrations.
     Source: U.S. Environmental Protection Agency (2003).
                          .C'30
                          .025
                         ,03,
                        1  .015
                        I
                        §  -010
                          .COS
                          .000
19B2-2O01
Rural Sil«e 14
Suburban Sites
Urban SHes
sa
49
                             62  83 84 85 86 87 88 6S> go 01  02 93 S4 SiS 96 87 98 99 00 01
                                                   Year
     Figure AX3.2-12.    Trends in annual mean NOi concentrations by site type.
4
5
6
Source: U.S. Environmental Protection Agency (2003)

imply that a site is free of local pollution influences, as evidenced by the still relatively high
values at rural sites compared to those found in remote areas of the globe.  Rural sites can be
affected by nearby highways, power plants, and other sources.
       In addition to the downward trend in annual mean concentrations of NC>2 shown in
Figures AX3.2-11 and AX3.2-12, hourly maximum concentrations have also declined,  as
evidenced by a number of peak values above 250 ppb across the United States in 1988. In
     March 2008
                                         AX3-19
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 1    contrast only one hourly maximum concentration above 250 ppb was found in 2004 (however,
 2    this may have been a measurement artifact as it represented a one h spike that was many times
 3    the next highest concentration at this site), and all other values were less than about 150 ppb.
 4
 5    AX3.2.4   Relationships between NOi and Other Pollutants
 6          Determining the relationships between NO2 and other pollutants is important for better
 7    understanding the findings of time-series epidemological studies relating NO2 to mortality
 8    (e.g., Burnett et al., 2004). Correlations between NO2 and CO, Os, and PM2.5 were calculated for
 9    monitoring sites in Los Angeles and Riverside, CA; Chicago, IL; Washington, D.C.; and New
10    York City. Correlations were calculated using both hourly and 24-h average data with similar
11    results. The ranges of Pearson correlation coefficients between 24-h average NO2 and Os, CO
12    and PM2.5 for 2000 through 2004 at monitoring sites in a few urban areas are shown in Table
13    AX3.2-4. As can be seen from the table, correlations of NO2 with Os range from negative to
14    slightly positive;  with CO they range from  slightly negative to highly positive, and with PM2.5
15    they range from slightly to moderately positive.  However, it should be noted that these
16    correlations are based on annual data from  sites influenced by local sources. In general, there is
17    a strong seasonal  variation in the correlations, r, with lowest values of r between NO2 and Os
18    found in winter.
19          In order to understand the relations  between atmospheric species as shown in Table
20    AX3.2-4, an important distinction must be made between primary  (directly emitted) species and
21    secondary (photochemically produced) species. In general, it is more likely that primary species
22    will be more highly correlated with each other, and that secondary species will be more highly
23    correlated with each other. By contrast, primary and secondary  species are less likely to be
24    correlated with each other.  Secondary reaction products tend to correlate with each other, but
25    there is considerable variation. Some species (e.g., Os and organic nitrates) are closely related
26    photochemically  and correlate with each other strongly.
27          Although  NO2 is produced mainly by the reaction of directly emitted NO with Os with
28    a small contribution from direct emissions, in practice, it behaves like a primary species. The
29    timescale for conversion  of NO to NO2 is relatively rapid (~1 or 2  min for Os = 40 ppb and
30    ambient temperatures from 273 to 298 K), so NO and NO2 ambient concentrations  rapidly
31    approach values determined  by the photochemical steady state.  The sum of NO and NO2 (NOx)
      March 2008                              AX3-20      DRAFT-DO NOT CITE OR QUOTE

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 1    behaves like a typical primary species, while NO and NO2 reflect some additional complexity
 2    based on photochemical interconversion. Chemical interactions among O3, NO and NO2 have
 3    the effect of converting O3 to NO2 and vice versa, which can result in a significant negative
 4    correlation between O3 and NO2.
 5          Most CO in urban air is emitted from motor vehicles and so is primary in origin. O3 is a
 6    secondary pollutant.  Figures AX3.2-13a-d show seasonal plots of correlations between NO2 and
 7    Os versus correlations between NO2 and CO.  As can be seen from the figures, NO2 is positively
 8    correlated with CO during all seasons at all sites. However, the sign of the correlation of NO2
 9    with O3 varies with season, ranging from negative during winter to slightly positive during
10    summer. There are at least two main factors contributing to the observed seasonal behavior.
11    O3 and radicals correlated with it tend to be higher during the summer, thereby tending to
12    increase the NO2 to NO ratio according to the expression below (Equation AX3.2-2).

                                   _ k,(O3) + k2(HO2) + k3(RO3)
13                            N°                                                  (AX3.2-2)
14          NOz compounds formed from the oxidation of NOx are also expected to be correlated
15    with O3 and increased photochemical activity.  Because of interference of NOZ compounds with
16    the measurement of NO2 by conventional chemiluminescent monitors, they may also tend to
17    increase the correlation of NO2 with O3 during the warmer months.  However, there is not
18    enough information on the seasonal behavior in their concentrations to quantify the contribution
19    of NOz compounds.
20          Relationships between O3, NO, and NO2 are shown in Figures AX3.2-14 and AX3.2-15.
21    Figure AX3.2-14 shows daylight average concentrations based on data collected from November
22    1998 and 1999 at several sites in the United Kingdom representing a wide range of pollution
23    conditions (open symbols).  The solid lines represent calculations of photostat! onary  state values
24    subj ect to the constraint that Ox = 3 1 . 1 + 0. 1 04(NOX), where Ox = O3  + NO2.  Note that Ox is
25    defined in the UK AQG report as oxidant, as used in this document, and in the latest AQCD for
26    Ozone and other Photochemical Oxidants (U.S. Environmental Protection Agency, 2006a) it is
27    taken to refer to  "odd oxygen" as defined in  Section 2.2. The reason is that oxidants  also include
28    PANs, peroxides, and reactive oxygen species in particles etc., in addition to O3 and NO2. The
29

      March 2008                              AX3-21     DRAFT-DO NOT CITE OR QUOTE

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o
*CS|
O
^






CO
o
CM
o
Winter
0.8-
0.6-
0.4-
0.2-
-0.8 -0.6 -0.4 -0.2 (
-0.2-
-0.4 •
-0.6-
-0.8-



0.2 0.4 0.6 0.8


• #*++}
* **
NO2: CO
Spring
0.8-
0.6-
0.4-
0.2-
1 -0.8 -0.6 -0.4 -0.2



% * ++1 +
I Q^ o5 0.6 Js


O
N
o
z






CO
o
o-
Summer
0.8-
0.6-
0.4-
0.2-
1 -0.8 -0.6 -0.4 -0.2 [
-0.2-
-0.4-
-0.6-
-0.8-


/ * t
) 0.2 0.4 0.6 0.8




NO2: CO
Fall
0.8-
0.6-
0.4-
0.2-
1 -0.8 -0.6 -0.4 -0.2 (



* ** \ *
) 0.2 0.4 ^0.6 *.8
                       NO2: CO
                                                              NO,: CO
    Figure AX3.2-13a-d. Correlations of NOi to Os vs. correlations of NOi to CO for Los
                        Angeles, CA (2001-2005).
4
5
6
emissions of NC>2 (an oxidant and a component of odd oxygen) varying linearly with emissions
of NOx, especially after NO has reacted with Os to form NO2 as shown in Figure AX3.2-14.
Thus the concentration of Ox (and not Os, as is often stated) can be taken to be the sum of
regional and local contributions.
       Figure AX3.2-15 shows that primary emissions from motor vehicles are major sources of
oxidant in the form of NO2, as evidenced by the high values of Ox at elevated NOx.
    March 2008
                                       AX3-22
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               a)    100
                     80
                  Q.
                  o
                  o
                  Z
                     40
                     20
100      200       300       400
               [NOxHppb)
                                                                       500
                                                       600
     Figure AX3.2-14.
Relationship between Os, NO, and NOi as a function of NOx
concentration.  Open circles represent data collected at a number of
sites in the United Kingdom. Lines represent calculated relationships
based on photostationary state.
     Source: Clapp and Jenkin (2001).

 1   AX3.2.5   Abundance of NOY Species
 2          Data for individual NOy species are much less abundant than for either oxides of nitrogen
 3   or for total NOy. Data for NOy species are collected typically as part of research field studies,
 4   e.g., the Southern Oxidant Study (SOS), Texas Air Quality Study (TexAQS I and TexAQS II) in
 5   the United States. So this information is simply not available for a large number of areas in the
 6   United States.
 7
 8   PANs
 9          Organic nitrates consist of PAN, a number of higher-order species with photochemistry
10   similar to PAN (e.g., PPN), and species such as alkyl nitrates with somewhat different
11   photochemistry.  These species are produced by a photochemical process very similar to that of
12   Os. Photochemical production is initiated by the reaction of primary and secondary VOCs with
13   OH radicals, the resulting organic radicals  subsequently react with NO2 (producing
     March 2008
                    AX3-23
                         DRAFT-DO NOT CITE OR QUOTE

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                    100
                                                      local contribution to ox id ant
                                                           (NOx-dependent)
                                         regional contribution to oxidant
                                               (NO x-independent)
                        0        100       200      300       400       500       600
                                                [N0x](ppb)

     Figure AX3.2-15.   Variation of odd oxygen (= Os + NOi) with NOx. The figure shows
                         the "regional" and the "local" contributions. Note that Ox refers to
                         odd oxygen in the document and the latest Os AQCD.

     Source: Clapp and Jenkin (2001).

 1   PAN and analogous species) or with NO (producing alkyl nitrates). The same sequence (with
 2   organic radicals reacting with NO) leads to the formation of Os.
 3          In addition, at warm temperatures, the concentration of PAN forms a photochemical
 4   steady state with its radical precursors on a timescale of roughly 30 min.  This steady state value
 5   increases with the ambient concentration of Os (Sillman et al., 1990).  Ozone and PAN may
 6   show different seasonal cycles, because they are affected differently by temperature. Ambient
 7   Os increases with temperature, driven in part by the photochemistry of PAN (see description in
 8   Chapter 2). The atmospheric lifetime of PAN decreases rapidly with increasing temperature due
 9   to thermal decomposition.  Based on the above, the ratio of O3 to PAN is  expected to show
10   seasonal  changes, with highest ratios in summer, although there is no evidence from
11   measurements.  Measured ambient concentrations (Figures AX3.2-16a-d) show a strong
12   nonlinear association between Os and PAN, and between Os and other organic nitrates (Pippin
13   et al., 2001; Roberts et al.,  1998). Moreover, the uncertainty in the relationship between Os and
     March 2008
AX3-24
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 1   PAN grows as the level of PAN increases. Individual primary VOCs are generally highly
 2   correlated with each other and with NOx (Figure AX3.2-17).
 3          Measurements and models show that PAN in the United States includes major
 4   contributions from both anthropogenic and biogenic VOC precursors (Horowitz et al., 1998;
 5   Roberts et al., 1998). Measurements in Nashville during the 1999 summertime Southern
 6   Oxidants Study (SOS) showed PPN and MPAN amounting to 14% and 25% of PANs,
 7   respectively (Roberts et al., 2002). Measurements during the TexAQS 2000 study in Houston
 8   indicated PAN concentrations of up to 6.5 ppbv (Roberts et al., 2003). PAN measurements in
 9   southern California during the SCOS97-NARSTO study indicated peak concentrations of
10   5-10 ppbv, which can be contrasted to values of 60-70 ppbv measured back in 1960 (Grosjean,
11   2003). Vertical profiles measured from aircraft over the United States and off the Pacific coasts
12   typically show PAN concentrations above the boundary layer of only a few hundred pptv,
13   although there are significant enhancements associated with long-range transport of pollution
14   plumes from Asia (Kotchenruther et al., 2001; Roberts et al., 2004).
15          Observed ratios of PAN to NO2 as a function of NOx at a site at Silwood Park, Ascot,
16   Berkshire, UK are shown in Figure AX3.2-18 United Kingdom Air Quality Expert Group (U.K.
17   AQEG, 2004). As can be seen there is a very strong inverse relation between the ratio and the
18   NOx  concentration, indicating photochemical oxidation of NOx has occurred in aged air masses
19   and that PAN can make a significant contribution to measurements of NO2 especially at low
20   levels of NO2 (cf. Section 2-8). It should be noted that these ratios will likely differ from those
21   found in the United States because of differences in the composition of precursor emissions, the
22   higher solar zenith angles found in the UK compared to the United States., and different
23   climactic conditions.
24          Nevertheless, these results indicate the potential importance of interference from NOy
25   compounds in measurements of NO2.
26
27   HONO
28          The ratio of HONO to NO2 as a function of NOx measured at a curbside site in a street
29   canyon in London, UK is shown in Figure AX3.2-19 (U.K. AQEG, 2004).  The ratio is highly
30   variable, ranging from about 0.01 to 0.1, with a mean -0.05. As NO2 constitutes several percent
     March 2008                             AX3-25      DRAFT-DO NOT CITE OR QUOTE

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                                0  1000 2000 3000 4000  0  1000 2000 3000 4000 5000
                                               PAN (pptv)
     Figure AX3.2-16a-d.  Measured Os (ppbv) versus PAN (pptv) in Tennessee, including (a)
                           aircraft measurements, and (b, c, and d) suburban sites near
                           Nashville.
     Source: Roberts etal. (1998).
1
2
3
4
5
6
7
8
     of motor vehicle emissions of NOx, the above implies that emissions of HONO represent a few
     tenths of a percent of mobile NOx emissions.  A similar range of ratios have been observed at
     other urban sites in the United Kingdom (Lammel and Cape, 1996). The ratios of HONO to NO2
     shown in Figure AX3.2-19 indicate that HONO can make a measurable contribution to
     measurements of NO2  (cf. Section 2-8). However, similar arguments about extrapolating the
     use of UK data to the United States can be made for HONO as for PAN.
     HNO3 andNO3
 9          Elevated Os is generally accompanied by elevated HNOs, although the correlation is not
10   as strong as between Os and organic nitrates. Ozone is often associated with HNOs, because
11   they have the same precursor (NOx). However, HNOs can be produced in significant quantities
12   in winter, even when Os is low. The ratio between Os and HNOs also shows great variation in
13   air pollution events, with NOx-saturated environments having much lower ratios of Os to HNOs
14   (Ryerson et al., 2001). Aerosol nitrate is formed primarily by the combination of nitrate
15   (supplied by HNOs) with ammonia, and may be limited by the availability of either nitrate or
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                   0.0
                                20
                 40      60       80
                   NOy (ppbv)
           100     120
    Figure AX3.2-17.
Relationship between benzene and NOy at a measurement site in
Boulder, CO. Instances with SO2 >10 ppb are identified separately
(open circles), because these may reflect different emission sources.
    Source: Goldanetal. (1995).

1   ammonia. Nitrate is expected to correlate loosely with Os (see above), whereas ammonia is not
2   expected to correlate with 03. Concentrations of particulate nitrate measured as part of the
3   Environmental Protection Agency's speciation network at several locations are shown in Figure
4   AX3.2-20.  Concentrations shown are annual averages for 2003. Also shown are the estimated
5   contributions from regional and local sources. A concentration of 1 |ig/m3 corresponds to -0.40
6   ppb equivalent gas phase concentration for NOs~.
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o
EL

z*

Q_
               0.20
               0.15
               0.10 >
               0.05
               0.00
                                                 AQ
                            20
                           40        60


                            [NOX] (ppb)
80
                                                                    100
Figure AX3.2-18.   Ratios of PAN to NOi observed at Silwood Park, Ascot, Berkshire,

                   U.K. from July 24 to August 12 1999. Each data point represents a

                   measurement averaged over 30 minutes.
Source: UK AQEG (2004).
                 0.3 -1—
               CD0'2
               z
               *:£
               O
               z
               O
               I 0.1 ^
                            200
                                     400
                                              600
                                                        800
                                                                 1000
                                           (ppb)
Figure AX3.2-19.
        Ratios of HONO to NOi observed in a street canyon (Marylebone

        Road) in London, U.K. from 11 a.m. to midnight during October

        1999. Data points reflect 15-min average concentrations of HONO

        and NO2.
Source: UK AQEG (2004).
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 1    Thus, annual average particulate nitrate can account for several ppb of NOy, with the higher
 2    values in the West.  There is a strong seasonal variation, which is especially pronounced in
 3    western areas where there is extensive wood burning in the winter resulting in a larger fractional
 4    contribution of local sources. Areas in the East where there are topographic barriers might be
 5    expected to show higher fractional contributions from local sources than other eastern areas that
 6    are influenced by regionally dispersed sources.
 7           However, depending on the acidity of the particles, which in turn depends strongly on
 8    their sulfate and ammonium contents, higher nitrate concentrations could be found in coarse
 9    mode particles PMi0-2.5 than in PM2.5 samples. The average nitrate content of PM2.5 and PMio is
10    typically about a percent in the eastern United States; and 15.7% and 4.5% in the western United
11    States (U.S. Environmental Protect!on Agency, 1996).  These values suggest that most of the
12    nitrate was in the PM2.5 size fraction in the studies conducted in the western United States, but
13    nitrate in the studies in the eastern United States was mainly in the PMio-2.5 size fraction.
14
15    Nitro-PAHs
16           Nitro-PAHs (NPAHs) are widespread and found even in high altitude, relatively
17    unpolluted environments (Schauer et al., 2004) but there are differences in composition and
18    concentration profiles both  within and between sites (rural vs. urban) as well as between and
19    within urban areas (Albinet et al., 2006; Soderstrom et al., 2005; Naumova et al., 2002, 2003),
20    with some differences in relative abundances of nitro- and oxo-PAHs also reported. Source
21    attribution has remained largely qualitative with respect to concentrations  or mutagenicity (Eide
22    et al., 2002). The spatial and temporal concentration pattern for the NPAHs may differ from that
23    of the parent compounds (PAHs) because concentrations of the latter are dominated by direct
24    emission from local combustion sources.  These emissions results in higher concentrations
25    during atmospheric conditions more typical of wintertime when mixing heights tend to be low.
26    The concentrations of secondary NPAHs are elevated under conditions that favor hydroxyl and
27    nitrate radical formation, i.e., during conditions more typical of summertime,  and are enhanced
28    downwind of areas of high  emission density of parent PAHs and show diurnal variation (Fraser
29    et al., 1998; Reisen and Arey, 2005; Kameda et al., 2004). Nitro-napthalene concentrations in
30    Los Angeles, CA varied between about 0.15 to almost 0.30 ng/m3 compared to 760 to
31    1500 ng/m3 for napthalene.   Corresponding values for Riverside, CA were 0.012 to more than
32    0.30 ng/m3 for nitro-napthalene and 100 to 500 ng/m3 for napthalene.  Nitro-pyrene

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                                                  Nitrates
     Figure AX3.2-20.
                                 Fresno
                               Missoula
                            Salt Lake City
                                  Tulsa
                               St. Louis
                             Birmingham
                             Indianapolis
                                 Atlanta
                               Cleveland
                               Charlotte
                               Richmond
                               Baltimore
                            New York City
                                                             WEST
                                                             EAST
                                                         Q Regional
                                                           Contribution
                                                         • Local
                                                           Contribution
8
                                                            10
                                                                12
                                         Annual Average Concentration
                                              of Nitrates, MB'1113
                         Concentrations of particulate nitrate measures as part of the
                         Environmental Protection Agency PA's speciation network. 1 ug/m3
                         -0.45 ppb equivalent gas phase concentration for NOs".  (Note:
                         Regional concentrations are derived from the rural IMPROVE
                         monitoring network, http://vista.cira.colostate.edu/improve.
     Source: U.S. Environmental Protection Agency (2004).
 1
 2
 3
 4
 5
 6
 1
 8
 9
10
11
     concentrations in LA varied between approximately 0.020 to 0.060 ng/m3 compared to 3.3 to
     6.9 ng/m3 pyrene, whereas corresponding values for Riverside were 0.012 to 0.025 ng/m3 and 0.9
     to 2.7 ng/m3.
     AX3.3    METHODS FOR MEASURING PERSONAL AND INDOOR NO2
                CONCENTRATIONS
     AX3.3.1   Issues in Measuring Personal/Indoor
     Background
12          Nitrogen dioxide, a criteria air pollutant, has been sampled in ambient and indoor air
13   using active pumped systems both for continuous monitoring and collection onto adsorbents, and
14   by diffusive samplers of various designs, including badges and tubes. Nitrogen dioxide
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 1    concentrations in personal air have been typically measured using diffusive samplers because
 2    they are: (1) small in size and light-weight, (2) unobtrusive and thus more readily used by study
 3    participants, (3) comparatively easier to use and handle in field studies because they do not
 4    require power (e.g., battery or extra electrical sources), (4) cost-effective, and (5) usable not only
 5    for residential indoor and outdoor air sampling but also personal monitoring.  However, diffusive
 6    samplers usually have lower equivalent sampling rates than active methods and so require
 7    relatively long sampling times (24 h or longer).  Consequently, diffusive samplers including
 8    those used for NO2 monitoring provide integrated but not short-term concentration
 9    measurements.
10          Both active and passive sampling methods can collect other gas-phase nitrogen oxide
11    species.  However, semivolatile nitrogen oxide compounds require separation of the gas- and
12    particle-bound phases.  This  selective separation of gases from gas-particle matrices is
13    commonly done by means of diffusion denuders (Vogel,  2005), an approach also useful for
14    measuring other gas phase airborne contaminants such as SC>2 (Rosman et al., 2001).
15    Application of denuder sampling to personal exposure or indoor air monitoring has been
16    relatively limited.
17          Active air sampling with a pump can collect larger volumes of air and thus detect the
18    lower concentrations found in community environments within relatively short time periods.
19    Automated active sampling methods have been the  preferred method used to monitor NO2
20    continuously at ambient sites for environmental  regulation compliance purposes. However,
21    practical considerations impede the use of these continuous monitors in residential air and
22    exposure monitoring studies. Small, low flow active samplers using battery-operated pumps
23    have been used instead, however, there are only a few such studies.
24          The first passive sampling devices for NC>2 were intended for occupational exposure
25    monitoring, but were later adapted for environmental  monitoring purposes. Since this sampler,
26    the Palmes tubes (Palmes et al., 1976), was first developed, other tube, badge-type (Yanagisawa
27    and Nishimura, 1982) and radial (Cocheo et al.,  1996) diffusive samplers have been employed as
28    monitors in exposure studies worldwide.  The theories behind and applications of Palmes Tubes
29    and Yanagisawa badges have been described in the last AQCD for Oxides of Nitrogen (U.S.
30    Environmental Protection Agency, 1993). There are currently several commercially  available
31    samplers (e.g., Ogawa, 1998; Radiello®, 2006) which are modifications of the original Palmes

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 1    tube design.  Most modifications are directed at reducing effects related to meteorological
 2    conditions (e.g., insufficient or too high a wind speed, humidity, temperature), increasing the
 3    sampling uptake rate, and improving analytical sensitivity.
 4
 5    Active (Pumped) Sampling
 6          Nitrogen dioxide measurement by active pumping systems as part of continuous monitors
 7    has been widely employed for ambient air monitoring as these instruments require relatively
 8    little maintenance; however they have been used less frequently for indoor sampling. Devices
 9    needing a pump to draw air can measure average concentrations of pollutants over short time
10    periods, but are not generally suitable for measuring personal exposures because they are heavy
1 1    and large.  Some exposure studies employed this approach for active sampling with stationary
12    chemiluminescent analyzers or portable monitors to measure nitrogen dioxide levels in
13    residential indoor air (Mourgeon et al., 1997; Levesque et al., 2000; Chau et al., 2002).
14    Recently, Staimer and his colleagues (2005) evaluated a miniaturized active sampler, suitable for
15    personal exposure monitoring, to estimate the daily exposure of pediatric asthmatics to nitrogen
16    dioxide, and reported that this small active sampling system is useful for this purpose in
17    environmental exposure epidemiology studies where daily measurements are desired.
18
19    Passive (Diffusive) Sampling
20          Passive samplers are based on the well known diffusion principle described by Pick's law
21    (Krupa and Legge, 2000). A  convenient formulation of this law that can be easily related to
22    sampler design considerations is:
23                                                  arsot                        (AX3.3-1)
24    where:
25    J = flux (mg/s)
26    D = diffusion coefficient in air (cm2/s)
27    A = diffusion cross-sectional area of the sampler (cm2)
28    L = diffusion path length from the inlet to sorbent (cm),
29    Cair = concentration of analyte in air (mg/cm3)
30    Csor = concentration of analyte at the sorbent (mg/cm3)
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 1          The term D(A/L) can be related to the uptake or sampling rate (cmVs) which is
 2    conceptually analogous to the sampling rate in an active monitor.  Once the amount of analyte in
 3    the passive sampler sorbent is determined, the concentration in air (Ca;r) can be calculated as:

 4                   Concentration(mg/cm3) - M(mg)/D(A/L)(cm3/s)/t($ec)      (AX3 3-2)
 5    where:
 6          M = mass of analyte collected in the sorbent
 7          t = sampling time
 8
 9          Pick's law strictly applies only under ideal, steady state conditions assuming that the
10    sorbent is a perfect sink. However, there can be deviations between the theoretical sampling rate
1 1    for a given analyte and the actual rate depending on sampling conditions.  It is also clear that
12    sampling rate can be optimized by modifying the geometry of the diffusive sampler, either by
13    reducing L, increasing A or a suitable combination. However, the impact of deviations from
14    ideality on actual sampling rate due to geometry also poses a limit to the extent of possible
15    modifications. Thus, passive samplers, either diffusive or permeation, are prepared as tubes or
16    badges.  These two main designs are the basis for all further modifications which, as indicated
17    above, have been made in order to improve efficiency, reduce sensitivity to wind turbulence of
18    the samplers, and to simplify analyte desorption. Tube-type samplers are characterized by a
19    long, axial diffusion length, and a low cross-sectional area; this results in relatively low sampling
20    rates (Namiesnik et al., 2005).  Badge-type samplers have a shorter diffusion path length and a
21    greater cross-sectional area which results in uptake rates that are typically higher than diffusion
22    tubes (Namiesnik et al., 2005) but the sampling rate may be more variable because it is more
23    affected by turbulence. Physical characteristics of these two fundamental  passive sampler types,
24    tube-type and badge-type, are summarized and provided in Table AX3.3-1. Performance
25    characteristics are presented in Table AX3.3-2.
26          The sorbent can be either physically sorptive or chemisorptive; passive samplers for NC>2
27    are chemisorptive, that is,  a reagent coated on a support (e.g.,  metal mesh, filter) reacts with the
28    NC>2. The sorbent is extracted  and analyzed for one or more reactive derivatives; the mass of
29    NC>2 collected is derived from the concentration of the derivative(s) based on the stoichiometry
30    of the reaction. Thus, an additional approach to reducing detection limits associated with passive
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 1    samplers is to modify the chemisorptive reaction and the extraction and analysis methods to
 2    increase analytical sensitivity.  However, although chemisorption is less prone to the back
 3    diffusion phenomenon of sorptive-only methods, analyte losses could occur due to interferences
 4    from other pollutants that also react with the sorbent or the derivatives. The most commonly
 5    used NC>2 passive samplers rely on the classical reaction with triethanolamine (TEA). TEA
 6    requires hydration for quantitative NC>2 sampling (i.e., 1:1 conversion to nitrite) and the reaction
 7    products have been subject to a number of investigations and several have been reported,
 8    including TEA-nitrate and nitrite, triethanolammonium nitrate, nitrosodiethanolamine, and
 9    triethanolamine N-oxide (Glasius et al., 1999).  Known interferences include HONO, PAN, and
10    nitric acid (Gair et al., 1991.).
11          The tube-type passive samplers (Palmes tubes) require week-long sampling periods and
12    have been extensively used for residential indoor/outdoor measurements, mostly for exploring
13    the relationship between indoor and outdoor levels (Cyrys et al., 2000; Raw et al., 2004; Simoni
14    et al., 2004; Janssen et al., 2001). Passive diffusion tubes have also been widely used for
15    measurements of NC>2 in ambient air (Gonzales et al., 2005; Gauderman et al., 2005; Da Silva
16    et al., 2006; Lewne et al., 2004; Stevenson et al., 2001; Glasius et al.,  1999).  Personal exposure
17    studies have also been conducted using the Palmes tubes (Mukala et al., 1996; Kousa et al.,
18    2001).  Some of these studies evaluated passive sampler performance by collocating them with
19    chemiluminescence analyzers during at least some portion of the field studies (Gair et al.,  1991;
20    Gair and Penkett, 1995; Plaisance et al., 2004; Kirby et al., 2001).  The majority of these studies
21    indicate that these samplers have very good precision (generally within 5%) but tend to
22    overestimate NO2 by 10 to 30%. However, there has not been a methodical evaluation of
23    variables contributing to variance for the range of samplers available when used in field
24    conditions.  Thus, it is not clear if the bias is due to deviations from ideal sampling conditions
25    that can affect actual sampling rates, contributions from co-reacting contaminants or, most
26    probably, a combination of these variables.
27          A badge-type sampler was introduced by Yanagisawa and Nishimura (1982) to overcome
28    the long sampling time required by Palmes tubes.  Since then, these sensitive NO2 short path
29    length samplers (Toyo Roshi Ltd) have been optimized and evaluated for indoor air and for
30    personal monitoring (Lee et al., 1993a,b).  They have been used  extensively for personal
31    exposure studies (Ramirez-Aguilar et al., 2002; Yanagisawa et al., 1986; Berglund et al., 1994,

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 1   Lee et al., 2004) and indoor air measurements (Kodama et al., 2002; Bae et al., 2004; Algar
 2   et al., 2004; Shima and Adachi, 2000; Smedje, et al., 1997) and to a more limited amount for
 3   ambient monitoring (Tashiro and Taniyama, 2002; Levy et al., 2006; Norris and Larson, 1999).
 4   Due to the greater uptake rate resulting from the larger cross sectional area of the badges and
 5   shorter diffusion length compared to the tube-type samplers, sampling times can be decreased
 6   from one-week to one-day for typical environmental air concentrations. This makes diffusive
 7   filter-badges more suitable for shorter-term sampling while long-term ambient monitoring can
 8   still be conducted using the Palmes-tubes.
 9
10   Tube Type Samplers
11          Gradko Sampler (http://www.gradko.co.uk)
12          The Gradko sampler is based on the Palmes tube design (Gerboles et al., 2006a).
13   It collects O3 or NO2 by molecular diffusion along an inert tube by chemisorption. A stable
14   complex is formed with triethanolamine coated on a stainless steel screen in the tube. The
15   complex is spectroscopically analyzed by adding an azo die (Chao and Law, 2000).  The sampler
16   has a detection limit of 0.5 ppb for NO/NO2 and the precision of + 6% above 5 ppb levels when
17   used for two weeks (Table AX3.3-2).  This sampler has been used to measure personal
18   exposures, concentrations of residential air indoors such as in the kitchen and bedroom, and
19   concentrations of outdoor air (Chao and Law, 2000; Gallelli et al., 2002; Lai et al., 2004). It has
20   been used to measure ambient NO2 levels in Southern California as a marker of traffic-related
21   pollution in San Diego County  (Ross et al., 2006).
22
23          Passam Sampler (http://www.passam.ch)
24          This sampler is also based on the design of the Palmes tube (Palmes et al., 1976).
25   It collects NO2 by molecular diffusion along an inert polypropylene tube to an absorbent,
26   triethanolamine. The collected NO2 is determined spectrophotometrically by the well-
27   established Saltzmann method.  When used outdoors the samplers are placed in a special shelter
28   to protect them from rain and minimize wind turbulence effects. The Passam sampler is sold in
29   two different models, one for long-term and one for short-term sampling.

30          Analyst™Sampler (http://www.monitoreurope.com)
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 1          The Analyst™ sampler is also a modification of the open-Palmes-tube design and was
 2    developed by the Italian National Research Council (CNR - Institute Inquinamento
 3    Atmosferico) in 2000 (Bertoni et al., 2001).  The Analyst™ consists of a glass vessel, which
 4    contains a reactant supported on a stainless steel grid.  It is suitable for long-term monitoring
 5    (typically one month) of oxides  of nitrogen,  sulfur dioxide, and volatile organic compounds in
 6    ambient air. The target compound is analyzed by gas chromatography with minimum detection
 7    limit of 0.1 mg/m3 (-52  ppb) for a twelve-week sample duration, and has relatively high
 8    precision.  The Analyst™ method development (De Santis et al., 1997, 2002) and actual field
 9    application (De Santis et al., 2004) have been described. The primary use for Analyst™ is as a
10    reliable tool for long-term determination of concentration in indoor as well as outdoor
11    environments (Bertoni et al., 2001) and as a screening tool for ambient monitoring to identify
12    pollution "hot spots" (De Santis et al., 2004).
13
14    Badge-Types Samplers
15          Ogawa Passive Sampler (http://www.ogawausa.com)
16          This sampler is a double face badge that can monitor NO, NOx, and NC>2. The design
17    can be used also for the determination of 862, 63, and NH3 levels in air. The manufacturer-
18    reported detection limits for nitrogen oxides are 2.3 ppb and 0.32 ppb  for 24-h and 168-h
19    sampling, respectively. Reported actual sampling rates for NO2 are two to three times higher
20    than the manufacturer's values.  The normal operation ranges are 0 to  25 ppm for 24-h exposure
21    and 0 to 3.6 ppm for 168-h exposure.  The manufacturer recommends  a sampling height of
22    2.5 meters and  storage time of up to 1 year when kept frozen.  Ogawa passive samplers have
23    been extensively used for human exposure studies to measure personal air concentrations and
24    (or) indoor/outdoor levels for residents in a number of locations, including adults of Richmond,
25    Virginia (Zipprich et al., 2002),  children of Santiago, Chile (Rojas-Bracho et al., 2002), office
26    workers of Paris, France (Mosqueron et al., 2002), and cardiac compromised individuals of
27    Toronto, Canada (Kim et al., 2006).  The samplers have been used also in air monitoring
28    networks to assess traffic-related pollutant exposure (Singer et al., 2004), as well as to evaluate
29    spatial variability of nitrogen dioxide ambient concentrations in Montreal, Canada (Gilbert et al.,
30    2005).
31          IVL Sampler (http//www.ivl.se/en/business/monitoring/diffusive_samplers.asp)

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 1          The IVL method development has been described in detail by Perm and Svanberg (1998).
 2    It was developed by Swedish Environmental Research Institute in the mid of 1980s (Sjodin et al.,
 3    1996), is designed to minimize turbulent wind effects outdoors as well as "starvation effects"
 4    indoors (i.e., very low face velocities), interferences from within sampling tube chemistry,
 5    temperature and humidity effects, and artifacts and losses during post-sampling storage.
 6    Manufacturer-reported detection limits for this sampler with sampling times of ~1 month are
 7    0.1 |ig/m3 (0.05 ppb) for NO2, and 0.5 |ig/m3 (0.42 ppb) for NO,  respectively. Due to its long
 8    sampling time, this sampler has been extensively used for NO2 background monitoring in
 9    ambient air of rural or urban (Fagundez et al., 2001; Sjodin et al., 1996; Pleijel et al., 2004).
10
11          Willems Badge Sampler
12          The Willems badge, a short-term diffusion sampler, was developed at the University of
13    Wageningen, Netherlands, originally for airborne ammonia measurements and later for
14    measuring NO2 (Hagenbjork-Gustafsson et al., 1996). It consists of a cylinder of polystyrene
15    with a Whatman GF-A glass fiber filter impregnated with triethanolamine at its based held in
16    place by a 6 mm distance ring.  A Teflon filter is placed on the 6 mm polystyrene ring, which is
17    secured with a polystyrene ring of 3 mm (Hagenbjork-Gustafsson et al., 1996).  The badge is
18    closed by a polyethylene cap to limit influences by air turbulence. The diffusion length in the
19    badge is 6 mm. This sampler was evaluated for ambient air measurements in laboratory and
20    field tests (Hagenbjork-Gustafsson et al., 1999). It has a manufacturer's reported detection limit
21    of 2 |ig/m3 (~1 ppb) for 48 h sampling duration. When used for personal sampling in an
22    occupational setting with a minimum wind velocity of 0.3  m/s, detection limits of 18 (-9.4 ppb)
23    and 2 |ig/m3  (~1 ppb) for 1-h and 8-h sampling, respectively, have been reported (Hagenbjork-
24    Gustafsson et al., 2002, Glas et  al., 2004).
25
26    Radial Sampler Types
27          Radiello®  -the radial diffusive sampler (http://www.radiello.com)
28          Radiello®  samplers use radial diffusion over a microporous cylinder into an absorbing
29    inner cylinder, instead of axial diffusion, which increases the uptake rate by a factor of about
30    100 (Hertel et al., 2001).  Nitrogen dioxide is chemiadsorbed onto triethanolamine  as nitrite,
31    which is quantified by visible spectrometry. Sample collection of up to 15 days  is feasible but
32    relative humidity higher than 70% can cause interferences when used for extended periods of

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 1    more than 7 days. The manufacturer-reported typical sampling rate for nitrogen dioxide
 2    sampling is 75 + 3.72 ml/min at temperatures between -10 and 40 °C. The rate can vary with
 3    humidity in the range of 15 to 90% and wind speed between 0.1 and 10 m/s (Radiello® Manual,
 4    2006). A Danish study (S0rensen et al., 2005) recruited 30  subjects during each of four seasons
 5    in Copenhagen, and measured the subjects' personal exposures, home indoor/front door air
 6    concentrations during 2-day periods with this sampler.
 7
 8    EMD (Ecole des Mines de Douai) Sampler
 9          A new high-uptake rate diffusive sampler has been recently developed by the Ecole
10    des Mines de Douai (EMD) laboratory (Piechocki-Minguy et al., 2003) and evaluated in the
11    laboratory and field for measurement of NC>2 levels in ambient air. It is composed of a porous
12    cartridge impregnated with triethanolamine and fitted in a cylindrical protective box equipped
13    with caps at its extremities (Piechocki-Minguy et al., 2006). The large sampling area (cartridge
14    surface)  and the two circular openings provide a high uptake rate (exceeding 50 cmVmin).  The
15    sampling rate was reported to be on average 0.89 cm3/s for indoor sampling and 1.00 cm3/s for
16    outdoor sampling.  Detection limits were determined to be 11  |ig/m3 (-5.8 ppb) for 1-h
17    measurement. The sampling rate was not significantly influenced by wind at speeds higher than
18    0.3 m/s (Piechocki-Minguy et al., 2003). This sampler has been used in France to assess
19    personal exposures in a series of microenvironments (home, other indoor places, transport and
20    outdoor) for two 24-h time periods (weekday and weekend) (Piechocki-Minguy et al., 2006).
21
22    NO2 Measurements in Epidemological Studies
23          Since passive samplers are the most frequently used monitoring method in epidemiology
24    studies of NC>2 effects, their performance compared to the long established chemiluminescence
25    monitoring method is critical for determining the contribution of measurement error to exposure
26    estimates. First, most passive samplers developed and used for personal and indoor exposure
27    studies need to be employed for at least 24 h to collect sufficient NO2 to be detected. Therefore,
28    the majority of measurements of personal exposure concentrations done to date represents daily
29    or longer integrated or average  exposure and cannot be used to assess acute, peak exposure
30    concentrations. Some newer passive samplers for nitrogen  dioxide have higher uptake rates and
31    active pump samplers with traditional battery operated sampling pumps and appropriate
32    adsorbents can collect sufficient NC>2 in approximately one  h and have been used in a few studies

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 1    providing information on exposure in microenvironments and shorter term exposure
 2    concentration.  Hourly fluctuations in nitrogen dioxide concentrations may be important to the
 3    evaluation of exposure-health effects relationship, so continuous monitors, such as those used at
 4    central site monitoring stations are still the only approach for estimating short-term exposures.
 5          Second, interferences for other nitrogen oxide species can contribute to NC>2 exposure
 6    monitoring errors. Both the chemiluminescence analyzer and passive samplers experience these
 7    interferences but the kinetics and stoichiometry of interferent compound reactions have not been
 8    well established, especially for the passive samplers. As indicated earlier, TEA-based diffusive
 9    sampling methods tend to overestimate NO2 concentrations in field comparisons with
10    chemiluminescence analyzers. This could be in part the result of chemical reactions between
11    ozone and nitric oxide (NO) within the diffusion tube, leading to as much as an overestimate up
12    to 30%, or differential sensitivity to other nitrogen oxides between the passive and active
13    samplers.  Due to spatially and temporally variability of NO and NO2 concentrations, especially
14    at roadsides where nitric oxide concentrations are relatively high and when sufficient ozone is
15    present for interconversion between the species, lack of agreement between the passive sampler
16    and central continuous monitor can represent differences in sampler response (Heal et al., 1999;
17    Cox, 2003).  In the U.K., an alternative nitrogen dioxide monitoring plan using  cost-effective and
18    simpler tube-type passive sampler has been proposed and implemented  countrywide. However,
19    careful investigation of nitrogen  dioxide levels revealed an overestimation, around 30% by the
20    passive sampler (Campbell et al., 1994). Another evaluation study (Bush et al., 2001) showed
21    that the overall average NO2 concentrations calculated from diffusion tube measurements were
22    likely to be within 10%  of chemiluminescent measurement data.
23          Third, the effect of environmental conditions (e.g., temperature,  wind speed, and
24    humidity) on the performance of passive samplers is still a concern when using it for residential
25    indoor, outdoor, and personal exposure studies, because of sampling rates that deviate from ideal
26    and can vary through the sampling period. Overall, field test results of passive  sampler
27    performance are not consistent and they have not been extensively studied over a wide range of
28    concentrations, wind velocities, temperatures and relative humidities (Varshney and Singh,
29    2003). Therefore, studies directed at investigating the contributions from environmental
30    conditions to the performance of diffusive samplers in multiple locations need to be undertaken.
31

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 1   AX3.4    NITROGEN OXIDES IN INDOOR AIR
 2
 3   AX3.4.1   Indoor Sources and Concentrations of Nitrogen Oxides
 4          Penetration of outdoor NO2 and combustion in various forms are the major sources of
 5   NO2 to indoor environments. These environments include homes, schools, restaurants, theaters
 6   etc.  As might be expected, indoor concentrations of NO2 in the absence of combustion sources
 7   are determined by the infiltration of outdoor NO2 (Spengler et al., 1994; Weschler et al., 1994;
 8   Levy et al., 1998a), with a much smaller contribution from chemical reactions in indoor air.
 9   Indoor sources of nitrogen oxides have been characterized in several reviews, namely the last
10   AQCD for Oxides of Nitrogen (U.S. Environmental Protection Agency, 1993); the Review of the
11   Health Risks Associated with Nitrogen Dioxide and Sulfur Dioxide in Indoor Air for Health
12   Canada (Brauer et al., 2002); and the Staff Recommendations for revision of the NO2 Standard in
13   California (CARB, 2007). Mechanisms by which nitrogen oxides are produced in the
14   combustion zones of indoor sources were reviewed in the last AQCD for Oxides of Nitrogen
15   (U.S. Environmental Protection Agency, 1993) and will not be repeated here. Sources of
16   ambient NO2 are reviewed in Chapter 2 of this document.  It should also be noted that indoor
17   sources can affect ambient NO2 levels, particularly in areas in which atmospheric mixing is
18   limited.
19          Because most people spend most of their time indoors, personal exposure is primarily
20   determined by indoor air quality as shown in Figure AX3.4-1.  Ideally, exposure to NO2 should
21   be cumulated over all indoor environments in which an individual spends time.  These indoor
22   environments may include homes, schools, offices, restaurants, theaters, ice skating rinks, stores,
23   etc.  However, in a study by Leaderer et al. that used two-week integrated measures,
24   concentrations of NO2 inside the home accounted for  80% of the variance in total personal
25   exposure, indicating that home concentrations are a reasonable proxy for personal exposure
26   (Leaderer etal., 1986).
27
28   Homes
29   Combustion of fossil and biomass fuels produce nitrogen oxides and the importance of such
30   sources for determining human exposures  depends on how emissions are allowed to mix into
31   living areas and whether emissions are vented to the outdoors or not. Combustion of fossil fuels
32   occurs in gas-fired appliances used for cooking, heating, and drying clothes; oil furnaces;

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 1    kerosene space heaters; and coal stoves. Motor vehicles and various types of generators also
 2    contribute in structures attached to living areas. Biomass fuels include mainly wood used in
 3    fireplaces and wood stoves and tobacco.
 4
 5    Gas Cooking Appliances
 6          A large number of studies, as described in the reviews cited above, have all noted the
 7    importance of gas cooking appliances as sources of NO2 emissions. Depending on geographical
 8    location, season, other sources, length of monitoring period, and household characteristics,
 9    homes with gas cooking appliances have approximately 50% to over 400% higher NC>2
10    concentrations than homes with electric cooking appliances (Gilbert et al., 2006; Lee et al.,  2000,
11    2002; Garcia-Algar et al., 2004; Raw et al., 2004; Leaderer et al., 1986; Garcia-Algar, 2003).
12    Gas cooking appliances remain significantly associated with indoor NC>2 concentrations after
13    adjusting for several potential confounders including season, type of community, socioeconomic
14    status, use of extractor fans, household smoking, and type of heating (Garcia-Algar et al., 2004;
15    Garrett et al., 1999).
16          Gas appliances with pilot lights emit more NC>2 than gas appliances with electronic
17    ignition. Spengler et al. (1994) found that NC>2 concentrations in bedrooms of homes with a gas
18    range without a pilot light averaged 4 ppb higher than in homes with an electric range, but were
19    15 ppb higher in homes with gas ranges with pilot lights. Lee et al. (1998) found somewhat
20    larger differences in NC>2 concentrations in homes in the Boston area, with minor seasonal
21    variation. Homes with gas stoves without pilot lights averaged between 11 ppb (summer) and
22    18 ppb (fall) higher than homes with electric stoves, while  those with pilot lights averaged
23    between 19 ppb (summer) and 27 ppb (fall) higher than electric stove homes.
24          Use of extractor fans reduces NC>2 concentrations in homes with gas cooking appliances
25    (Gallelli et al., 2002; Garcia-Algar et al., 2003), although absolute NO2 levels tend to remain
26    higher than in homes with electric stoves.  In a multivariate analysis, Garcia-Algar et al. (2004)
27    found that having a gas cooker remained significantly increased NC>2 concentrations  even after
28    adjusting for extractor fan use. Raw et al. (2004) found only a small effect of extraction fan use
29    on NC>2 levels in the bedroom in gas cooker homes.  Among homes with gas cooking, geometric
30    mean bedroom NC>2 levels were 1.7 ppb lower in homes with an extractor fan than in homes
31    without one.  As expected, among homes with no fossil fuel cooking, there were no differences
32    in mean bedroom levels of NC>2 in homes with and without extractor fans.

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                 NHAPS - Nation, Percentage Time Spent
                                 Total n = 9,
           IN A RESIDENCE iMS 7",i
                                                      TOTAL TIME SPENT
                                                       IN DOORS 2.  Kodama et al. (2002) examined the associations between secondary heating sources and
1 1   NC>2 concentrations measured over a 48-h exposure period in the living rooms of homes in
12   Tokyo, Japan. They found much higher NO2 concentrations during February 1998 and January
13   1999 in homes with kerosene heaters in both southern (152.6 ppb and 139.7 ppb for 1998 and
14   1999,  respectively) and northern (102.4 and 93.1 ppb  for 1998 and 1999, respectively)  areas of
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 1    Tokyo compared to homes with electric heaters (30.8 and 31.1 for the southern and 37.2 and
 2    31.6 for northern areas, 1998 and 1999, respectively).
 3          In a study by Garrett et al. (1999) of 78 homes in Latrobe Valley, Australia, the two
 4    highest indoor NO2 levels recorded in the study were 129 ppb for the only home with an
 5    unvented gas heater and 69 ppb for a home with a vented gas heater. Levels of NO2 in the
 6    kitchens and living rooms of homes with a vented gas heater (mean = 6.9 ppb in living room,
 7    7.3 ppb in kitchen, n = 15) were comparable to homes with gas stoves (mean = 6.7 ppb in living
 8    room, 8.0 ppb in kitchen, n = 15) (Table AX3.4-1).  These concentrations include results from all
 9    seasons combined, so the levels are somewhat lower than those found by Triche et al. (2005) for
10    winter monitoring periods  only.
11          Triche et al. (2005) also found high levels of NO2 in homes with gas space heaters,
12    although information on whether the appliance was vented or unvented was not available. Data
13    from this study were analyzed in more detail and are shown in Table AX3.4-2.  The median NO2
14    concentration in the 6 homes with gas space heater use during monitoring periods with no gas
15    stove use was 15.3 ppb; a similar incremental increase in total NO2 levels was noted for homes
16    with gas space heater use during periods when  gas stoves were also used (Median = 36.6 ppb)
17    compared to homes where gas stoves were used but no secondary heating sources were present
18    (Median = 22.7 ppb) (Table AX3.4-2).
19          Shima and Adachi (1998) examined associations between household characteristics,
20    outdoor NO2, and indoor NO2 in 950 homes during the heating season (640 with unvented and
21    310 vented heaters) and 905 homes during the non-heating season in urban, suburban, and rural
22    areas of Japan.  While no information is provided on gas stove use, the authors note that nearly
23    all homes in Japan have gas stoves, though relatively few have pilot lights.  During the heating
24    season, geometric mean NO2 levels in homes with unvented heaters (66.4 ppb) are about three
25    times higher than in homes with vented heaters (20.6 ppb).  In the non-heating season, the mean
26    levels were lower at only 13.8 ppb, suggesting  a contribution from vented heaters as well.
27          In multivariate analyses, Gilbert et al. (2006) found that gas and mixed/other heating
28    systems were significantly associated with NO2 levels, adjusting  for presence of gas stoves and
29    air exchange rates in 96 homes in Quebec City, Canada during the winter/early spring period.
30    Many homes with gas space heaters also have gas stoves, and the contribution from multiple
31    sources is much higher than from any single source alone (Garrett et al., 1999). In the Garrett

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 1    et al. (1999) study, homes were classified into five categories: no indoor source (n = 15), gas
 2    stove only (n = 15), gas heater only (n = 14), smoker in the household only (n = 7),  and multiple
 3    sources (n = 29). Homes with multiple sources had much higher NO2 concentrations homes with
 4    either a gas stove only or gas heater only (Table AX3.4-3).
 5          Kerosene heaters are also important contributors to indoor NO2 levels. Leaderer et al.
 6    (1986) enrolled a cohort of kerosene heater users identified from local kerosene dealers and a
 7    cohort of controls systematically chosen from the same neighborhoods with each matched pair
 8    treated as a sampling unit (i.e., sampled at the same randomly assigned time period). A total of
 9    302 homes were monitored for at least one two-week period. While outdoor concentrations
10    never exceeded 100 |ig/m3 (53 ppb), approximately 5% of homes with either no gas but
11    1 kerosene heater or gas but no kerosene heater had levels exceeding 53 ppb. Between
12    17%-33% of homes with both gas and kerosene heater(s) exceeded this limit, while nearly one
13    quarter of homes with no gas, but two or more kerosene heaters had these levels.
14          Data from Triche et al. (2005) (Table AX3.4-2) also indicated increased levels of NO2 for
15    kerosene heater homes during monitoring periods with no gas stove use (Median =  18.9  ppb)
16    compared to homes with no sources (Median = 6.3 ppb), which is similar to levels found in
17    homes using gas space heaters (Median =15.3 ppb).  However, these NO2 concentrations are of
18    the same magnitude as those in homes with gas stove use (Median = 17.2 ppb).
19          Data are available for unvented gas hot water heaters from a number of studies conducted
20    in the Netherlands. Results summarized by Brauer et al. (2002) indicate that concentrations of
21    NO2 in homes with unvented gas hot water heaters were 10 to 21 ppb higher than in homes with
22    vented heaters, which in turn, had NO2 concentrations 7.5 to 38 ppb higher than homes without
23    gas hot water heaters.
24          The contribution from combustion of biomass fuels has not been studied as extensively as
25    that from gas. A main conclusion from the previous AQCD was that properly vented wood
26    stoves and fireplaces would make only minor contributions to indoor NO2 levels. Several studies
27    conclude that use of wood burning appliances does not increase indoor NO2 concentrations.
28    Levesque et al. (2001) examined the effects of wood-burning appliances on indoor NO2
29    concentrations in 49 homes in Quebec City, Canada.  The homes, which had no other
30    combustion source, were sampled for 24 h while the wood-burning appliance was being used.
31    No significant differences in mean NO2 levels were found in homes with (6.6 + 3.6 ppb) and

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 1    without (8.8 + 1.9 ppb) a wood-burning appliance.  Data from Triche et al. (2005) confirm these
 2    findings (Table AX3.4-2). Homes with wood burning sources had comparable NC>2
 3    concentrations to homes without other secondary heating sources, with (Median = 5.9 ppb) and
 4    without (Median = 16.7 ppb) gas stove use.
 5          Table AX3.4-3 shows short-term average (minutes to a few hours) concentrations of NC>2
 6    in homes with combustion sources. The concentrations represent those found in different rooms
 7    in houses sampled. However, concentrations are much higher in those persons directly exposed
 8    to emissions. For example, Dennekamp et al. (2001) found NCh concentrations of about 1 ppm
 9    at face level in front of a 4-burner gas range. Table AX3.4-4 shows long-term average (24-h to
10    2 week) concentrations of NC>2 in homes with combustion sources (mainly gas fired).
11          Data are available for unvented gas hot water heaters from a number of studies conducted
12    in the Netherlands. Results summarized by Brauer et al. (2002) indicate that concentrations of
13    NC>2 in homes with unvented gas hot water heaters were 10 to 21 ppb higher than in homes with
14    vented heaters, which in turn, had NC>2 concentrations 7.5 to 38 ppb higher than homes without
15    gas hot water heaters.
16          As can be seen from the tables, shorter-term average concentrations tend to be much
17    higher than longer term averages.  However, as Triche et al. (2005) point out, the 90th percentile
18    concentrations can be substantially greater than the medians, even for two week long samples.
19          This finding illustrates the high variability found among homes. This variability reflects
20    differences in ventilation of emissions from sources, air exchange rates, the size of rooms etc.
21    The concentrations for short averaging periods that are listed in Table AX3.4-3 correspond to
22    about 10 to 30 ppb on a 24-h average basis. As can be seen from inspection of Table AX3.4-4,
23    these sources would contribute significantly to the longer term averages reported there if
24    operated on a similar schedule on a daily basis. This implies that measurements made with long
25    averaging periods may not capture the nature of the diurnal pattern of indoor concentrations in
26    homes with strong indoor sources. This problem becomes more evident as ambient NC>2 levels
27    decrease due to more efficient controls on outdoor sources.
28          In 10%  of homes with fireplaces studied by Triche et al. (2005), NO2 concentrations were
29    greater than or equal to 80 ppb, or about twice the level  found in homes with no indoor
30    combustion source (see Figure AX3.30).  In a study of students living in Copenhagen, S0rensen
31    et al. (2005) found that personal exposures to NC>2 were significantly  associated with time

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 1    exposed to burning candles in addition to other sources. However, they did not provide data for
 2    concentrations in spaces in which candles were burned. Results of studies relating NO2
 3    concentrations and exposures to environmental tobacco smoke (ETS) have been mixed. Several
 4    studies found positive associations between NO2 levels and ETS (e.g., Linaker et al., 1996);
 5    Farrow et al., 1997; Aim et al., 1998; Levy et al., 1998a; Monn et al., 1998; Cyrys et al., 2000;
 6    Lee et al., 2000; Garcia-Algar et al., 2004) whereas others have not (e.g., Hackney et al., 1992;
 7    Kawamoto et al., 1993). In a study of 57 homes in Brisbane, Australia (Lee et al., 2000), levels
 8    of NC>2 were higher in homes with smokers present (14.9 + 7.7 ppb) than without smokers (9.9 +
 9    5.0 ppb).  However, these concentrations did not account for presence of a gas range (n = 18 of
10    57 homes had a gas range). Garrett et al. (1999) found that smoking in the home increased levels
11    of NC>2 in the winter, but not in the summer when windows tended to be opened.  In a study of
12    students living in Copenhagen, S0rensen et al. (2005) did not find a significant association
13    between ETS and personal exposures to NC>2. However, they found that burning candles was a
14    significant prediction of bedroom levels of NC>2.
15
16    Other Indoor Environments
17          Indoor ice skating rinks have been cited as environments containing high levels of NC>2
18    when fuel powered ice resurfacing machines are used especially without ventilation.  As part of a
19    three year study, Levy et al. (1998b) measured NC>2 concentrations at 2 locations at the outside of
20    the ice surface in 19 skating rinks in the Boston area over 3 winters. Although different passive
21    samplers were used in the first year (Palmes tubes, 7 day sampling time) and in years 2 and
22    3  (Yanagisawa badges, 1 day working hours) of the study, consistently high mean NO2
23    concentrations were associated with the use of propane fueled resurfacers (248 ppb in the first
24    year and 206 ppb in the following years) and gasoline fueled resurfacers (54 ppb in the first year
25    and 132 ppb in the following years) than with electric resurfacers (30 ppb in the first year and
26    37 ppb in the following years). During all three years of the study peak NC>2 concentrations were
27    several times higher in the rinks with propane and gasoline fueled resurfacers than the values
28    given above. A number of earlier studies have also indicated NC>2 concentrations of this order
29    and even higher (Paulozzi  et al., 1993; Berglund et al., 1994; Lee et al., 1994; Brauer et al.,
30    1997). In these studies peak averages were in the range of a few ppm.
31
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 1    AX3.4.2    Reactions of NO2 in Indoor Air
 2          Chemistry in indoor settings can be both a source and a sink for NC>2 (Weschler and
 3    Shields, 1997). NC>2 is produced by reactions of NO with ozone or peroxy radicals, while NC>2 is
 4    removed by gas phase reactions with ozone and assorted free radicals and by surface promoted
 5    hydrolysis and reduction reactions. The concentration of indoor NC>2 also affects the
 6    decomposition of peroxyacyl nitrates. Each of these processes is discussed in the following
 7    paragraphs.  They are important not only because they influence the indoor NC>2 concentrations
 8    to which humans are exposed, but also because certain products of indoor chemistry may
 9    confound attempts to examine associations between NC>2 and health.
10          Indoor NO can be oxidized to NO2 by reaction with ozone or peroxy radicals; the latter
1 1    are generated by indoor air chemistry involving Os and unsaturated hydrocarbons such as
12    terpenes found in air fresheners and other household products (Sarwar et al., 2002a,b; Nazaroff
13    and Weschler, 2004; Carslaw, 2007).  The rate coefficient for the reaction
14
15    at room temperature (298 K) is 1.9 x 1CT14 cmVmolec-sec or 4.67 x 10~4 ppb"1 s"1 (Jet
16    Propulsion Laboratory, 2006).  At an indoor Os concentration of 10 ppb and an indoor NO
17    concentration that is significantly less than that of Os, the half-life of NO is 2.5 min.  This
18    reaction is sufficiently fast to compete with even relatively fast air exchange rates.  Hence, the
19    amount of NO2 produced from NO tends to be limited by the amount of Os available.  The
20    indoor concentrations of NO and Os are negatively correlated; significant concentrations of NO
21    can only accumulate when small amounts of Os are present and vice versa (Weschler et al.,
22    1994).
23          The rapid reaction between NO and Os also means that humans, themselves, can be
24    indirect sources of NO2 in the rooms they occupy. Exhaled human breath contains NO that is
25    generated endogenously (Gustafsson et al.,  1991). For a typical adult male, the average nasal
26    NO output is 325 nL min"1 or 23.9 jig IT1 (Imada et al., 1996). If ozone is present in the indoor
27    air, some or all of these exhaled NO molecules will be oxidized to NO2.  To put this source in
28    perspective, consider the example of an adult male in a 30 m3 room ventilated at 1 air change per
29    hour (h-1) with outdoor air.  The steady-state concentration of NO in the room as a consequence
30    of NO in exhaled breath is 0.80  jig m3 or 0.65 ppb if none of the NO were to be oxidized.

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 1    However, assuming a meaningful concentration of ozone in the ventilation air (>5 ppb), most of
 2    this NO is oxidized to NO2 before it is exhausted from the room.  In this scenario, the single
 3    human occupant is indirectly a source for 0.65 ppb of NO2 in the  surrounding air. At higher
 4    occupant densities, lower air exchange rates and elevated concentrations of Os in the ventilation
 5    air, human exhaled breath could contribute as much as 5 ppb to the total concentration of indoor
 6    NO2.
 7           The reaction of NO2 with ozone produces nitrate radicals
 8                                                                                  (AX34_2)

 9    The second order rate-constant for this reaction at room temperature (298 K) is
10    3.2 x 1Q~17 cmVmolec-sec or 7.9 x 10~7 ppb"1 s"1 (Jet Propulsion Labatory, 2006). For indoor
1 1    concentrations of 20 ppb and 30 ppb for 63 and NO2, respectively, the production rate of
12    NOs radicals is 1.7 ppb h"1.  This reaction is strongly temperature dependent, an important
1 3    consideration given the variability of indoor temperatures with time of day and season. The
14    nitrate radical is photolytically unstable (Finlayson-Pitts and Pitts, 2000).  As a consequence,
15    it rapidly decomposes outdoors during daylight hours. Indoors, absent direct sunlight, nitrate
16    radical concentrations may approach those measured during nighttime hours outdoors. To date
17    there have been no indoor measurements of the concentration of nitrate radicals in indoor
18    settings. Modeling studies by Nazaroff and Cass (1986), Weschler et al. (1992), Sarwar et al.
19    (2002b), and Carslaw (2007) estimate indoor nitrate radical concentrations in the range of 0.01 to
20    5 ppt, depending on the indoor levels of 63 and NO2.
21          The nitrate radical  and NO2 are in equilibrium with dinitrogen pentoxide (N2Os):
22                                                                                  (AX34.3)
23    Dinitrogen pentoxide reacts with water to form nitric acid. The gas phase reaction with water is
24    too slow (Sverdrup et al., 1987) to compete with air exchange rates in most indoor environments.
25    Due to mass transport limits on the rate at which N2Os is transported to indoor surfaces, reactions
26    of N2Os with water sorbed to indoor surfaces are much slower than gas phase reactions between
27    nitrate radicals and commonly occurring indoor alkenes.
28          Once formed, NOs radicals can oxidize organic compounds by either adding to an
29    unsaturated carbon bond or abstracting a hydrogen atom (Wayne et al., 1991). In certain indoor

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 1    settings, the nitrate radical may be a more important indoor oxidant than either ozone or the
 2    hydroxyl radical. Table 8 in Nazaroff and Weschler (2004) illustrates this point. Assuming
 3    indoor concentrations of 20 ppb, 5 x 10~6 ppb, and 0.001 ppb for Os, OH, and NOs, respectively,
 4    the pseudo first-order rate constants for reactions of most terpenoids are larger for reactions with
 5    NOs than for reactions with either Os or OH. For example, for the stated conditions, the half-
 6    lives of d-limonene and a-pinene are roughly three times shorter as a consequence of reaction
 7    with NOs versus reaction with 03.  The products of reactions between NOs and various organic
 8    compounds include nitric acid, aldehydes, ketones, organic acids and organic nitrates; these have
 9    been summarized by Wayne et al. (1991). Nitrate radicals and the products of nitrate radical
10    chemistry may be meaningful confounders in NO2 exposure studies.
11          Reactions between NO2 and various  free radicals can be  an indoor  source of organo-
12    nitrates,  analogous to the chain-terminating reactions observed in photochemical smog
13    (Weschler and Shields, 1997). Additionally, based on laboratory measurements and
14    measurements in outdoor air (Finlayson-Pitts and Pitts, 2000), one would anticipate that NO2,
15    in the presence of trace amounts of HNOs, can react with PAHs  sorbed on indoor surfaces to
16    produce mono- and dinitro-PAHs.
17          As noted earlier in Chapter 2, HONO occurs in the atmosphere mainly via multiphase
18    processes involving NO2. HONO is observed to form on surfaces containing partially oxidized
19    aromatic structures (Stemmler et al., 2006) and on soot (Ammann et al., 1998).  Indoors, surface-
20    to-volume ratios are much larger than outdoors, and the surface mediated hydrolysis of NO2 is a
21    major indoor source of HONO (Brauer et al., 1990; Febo and Perrino, 1991;  Spicer et al., 1993;
22    Brauer et al., 1993; Spengler et al., 1993; Wainman et al., 2001;  Lee et al., 2002). Spicer et al.
23    (1993) made measurements in a test house that demonstrated HONO formation as a consequence
24    of NO2 surface reactions and postulated the following mechanism to explain their observations

25                      2NO2 + H2O/stirface -> HONO(aq) + H++NO3~

26                                   HONO(aq) o HONO(g)                      (AX3.4-5)
27    In a series of chamber studies, Brauer et  al. (1993) reported HONO formation as a consequence
28    of NO2 surface reactions and further reported that HONO production increased with increasing
29    relative humidity.  Wainman et al. (2001) confirmed Brauer's findings regarding the influence of

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 1    relative humidity.  They also found that NC>2 removal and concomitant HONO production was
 2    greater on synthetic carpet surfaces compared to Teflon surfaces, and that the affinity of a
 3    surface for water influences HONO's desorption from that surface. Lee et al. (2002) measured
 4    HONO and NO2 concentrations in 119 Southern California homes. Average indoor HONO
 5    levels were about 6 times larger than outdoors (4.6 ppb versus 0.8 ppb). Indoor HONO
 6    concentrations averaged 17% of indoor NO2 concentrations, and the two were strongly
 7    correlated. Indoor HONO levels were higher in homes with humidifiers compared to homes
 8    without humidifiers (5.9 ppb versus 2.6 ppb). This last observation is consistent with the studies
 9    of Brauer et al. (1993) and Wainman et al. (2001)  indicating that the production rate of HONO
10    from NO2/surface reactions is larger at higher relative humidities.  Based on detailed laboratory
11    studies, the hydrolysis mechanism, Equations AX3.4-4 and AX3.4-5, have been refined.
12    Finlayson-Pitts et al. (2003) hypothesize that the symmetric form of the NO2 dimer is sorbed on
13    surfaces, isomerizes to the asymmetric dimer which auto ionizes to NO^Os ; the latter then
14    reacts with water to form HONO and  surface adsorbed HNOs. FTIR-based analyses indicate that
15    the surface adsorbed HNOs exists as both undissociated nitric acid-water complexes,
16    (HNO3)x(H2O)Y, and nitrate ion-water complexes, (NO3 )x(H2O)Y (Dubowski et al., 2004,
17    Ramazan et al., 2006).  Such adsorbed species may serve as oxidizing agents for organic
18    compounds sorbed to these same surfaces (Ramazan et al., 2006).
19          HONO and much smaller amounts of HNO3 are also emitted directly by combustion by
20    gas appliances and can infiltrate from outdoors. Spicer et al.  (1993) compared the measured
21    increase in HONO in a test house resulting from direct emissions of HONO from a gas range and
22    from production by surface reactions of NO2. They found that emissions from the gas range
23    could account for about 84% of the measured increase in HONO and surface reactions for 11%
24    in an experiment that lasted several hours. An equilibrium between adsorption of HONO from
25    the gas range (or other indoor combustion sources) and HONO produced by surface reactions
26    (see Equation AX3.4-5) also determines the relative importance of these processes in producing
27    HONO in indoor air. In a study of Southern CA homes (Lee et al., 2002), indoor levels of NO2
28    and HONO were positively associated with the presence of gas ranges.
29          It is known that the photolysis of HONO (g) in the atmosphere (outdoors) is a major
30    source of the hydroxyl radical (OH).  Given high indoor HONO concentrations and the presence
31    of lighting (sun light penetrating windows, incandescent lights, fluorescent lights), the photolysis

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 1    of indoor HONO may be a meaningful source of indoor hydroxyl radical, under favorable
 2    reaction conditions.  Given the large suite of man-made chemicals present indoors at elevated
 3    concentrations, indoor free radicals (e.g., OH and NO3) can initiate and drive a complex series of
 4    indoor chemical reactions.
 5          NO2 can also be reduced on certain surfaces, forming NO. Spicer et al. (1989) found that
 6    as much as 15% of the NO2 removed on the surfaces of masonite, ceiling tile, plywood,
 7    plasterboard, bricks, polyester carpet, wool carpet, acrylic carpet and oak paneling was re-
 8    emitted as NO. Weschler and Shields (1996) found that the  amount of NO2 removed by charcoal
 9    building filters were almost equally matched by the amount of NO subsequently emitted by these
10    same filters.
11          Spicer  et al. (1993) determined the 1st order rate constants for removal of several NOY
12    components by reaction with indoor surfaces. They found lifetimes (e-folding times) of about
13    half an hour for HNOs, an hour for NO2, and hours for NO and HONO. Thus the latter two
14    components, if generated indoors are more likely to be lost to the indoor environment through
15    exchange with outside air than by removal on indoor surfaces. However, HONO is in
16    equilibrium with the nitrite ion (NO2 ) in aqueous surface films

17                                 HONO(ag) ^ H* + NOf                     (AX3 4_6)

18    Ozone oxidation of nitrite ions in such films is a potential sink for indoor HONO (Lee et al.,
19    2002).
20          Jakobi  and Fabian (1997) measured indoor and outdoor concentrations of ozone and
21    peroxyacetyl nitrate (PAN) in several offices, private residences, a classroom, a gymnasium and
22    a car. They found that indoor levels of PAN were 70% to 90% outdoor levels, and that PAN's
23    indoor half-life ranged from 0.5 to 1 h.  The primary indoor removal process is thermal
24    decomposition
25
                           CH3C(O)OONO2 <-> CH3C(O)OO + NO2
                                            *"                       ~"
26   As is indicated by Equation AX3.4-7, PAN is in equilibrium with the peroxylacetyl radical and
27   NO2. Hence, the indoor concentration of NO2 affects the thermal decomposition of PAN and,
28   analogously, other peroxyacyl nitrates. Peroxylalkyl radicals rapidly oxidize NO to NO2, so the
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 1    indoor concentration of NO also influences the thermal decomposition of PAN type species
 2    (Finlayson-Pitts and Pitts, 2000).
 3          Reactions between hydroxyl radicals and aldehydes in the presence of NO2 can lead to
 4    the formation of peroxyacyl nitrates. Weschler and Shields (1997) have speculated that such
 5    chemistry may sometimes occur indoors. For example, the requisite conditions for the formation
 6    of the highly irritating compound peroxybenzoyl nitrate may occur when ozone, certain terpenes,
 7    styrene and NO2 are present simultaneously at low air exchange rates.  This relatively common
 8    indoor mixture of pollutants produces hydroxyl radicals and benzaldehyde, which can
 9    subsequently react as noted above. In her detailed model of indoor chemistry, Carslaw (2007)
10    explores the indoor formation of PAN-type species (see Figure 2 in the cited reference).
11          Recent work indicates that indoor NO2 also can affect the formation of secondary organic
12    aerosols  (SOA) resulting from the reaction of O3 with terpenes such as d-limonene and a-pinene
13    (N0jgaard et al., 2006). At concentrations of 50 ppb for O3 and the terpenes, NO2 decreased the
14    formation of SOA compared to the levels formed in the absence of NO2.  The effect was more
15    pronounced for SOA derived from a-pinene than d-limonene, and at lower NO2 concentrations,
16    appears to be explained by the O3 loss resulting from its reaction with NO2. The resultant nitrate
17    radicals apparently are not as efficient at producing SOA as the lost O3.
18          Nitro-PAHs have been found in indoor environments (Mumford et al., 1991; Wilson
19    et al., 1991). The major indoor sources of nitro-PAHs include cooking, wood burning, and the
20    use of kerosene heater (World Health Organization (WHO), 2003). It is also likely that nitro-
21    PAHs outdoors can infiltrate indoors. One of the potential sources of nitro-PAHs indoors, which
22    has not been characterized, is reactions via indoor chemistry. The reactions of PAHs with OH
23    and NO3 may occur in indoor environments. Although no direct measurements of OH or NO3 in
24    indoor environments, OH and NO3 can be formed via indoor chemistry and may present at
25    significant levels indoors (Nazaroff and  Cass  1986, Sarwar et al., 2002a; Carslaw, 2007).
26    Concentrations of ~10~6 ppb for OH and 0.01-5 ppt of NO3 have been predicted through indoor
27    chemical reactions (Nazaroff and Cass 1986, Sarwar et al., 2002a, Carslaw, 2007), depending on
28    the indoor levels of O3, alkenes, and NO2. Observation of secondary organic aerosols (SOA)
29    formation in a simulated indoor environment also suggested that ~10~5 ppb steady-state OH
30    radicals were generated from the reactions of O3 with terpenes (Fan et al., 2003). PAHs are
31    common indoor air pollutants (Chuang et al., 1991; Naumova et al., 2002), and  the

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 1    concentrations of some PAHs indoors are often higher than outdoors (Naumova et al., 2002).
 2    Therefore, the reactions of OH and NOs with PAHs may occur at rates comparable to air
 3    exchange rates to form nitro-PAHs indoors. In addition, the reactions of NOs with PAHs may be
 4    more significant indoors than outdoors because indoor NOs is more stable due to the low uv in
 5    indoor environments.  Given the high surface areas available indoors, the formation of nitro-
 6    PAHs via surface reactions of PAHs with nitrating species may be more important compared to
 7    heterogeneous reactions outdoors.
 8          In summary, indoor chemistry can meaningfully alter the indoor concentration of NC>2.
 9    Indoor exposure to NC>2 may be accompanied by indoor exposures to nitrate radicals, organic
10    nitrates, and nitro-PAHs.
11
12    AX3.4.3   Contributions from Outdoor NO2
13          As might be expected, indoor concentrations of NC>2 in the absence of combustion
14    sources are primarily determined by outdoor NC>2 concentrations (Spengler et al., 1994;
15    Weschler et al., 1994; Levy et al., 1998a), with a much smaller contribution from chemical
16    reactions in indoor air.
17          The exchange between NC>2 in ambient air and in the indoor environment is influenced by
18    infiltration (air leakage), natural ventilation (air flow through intentional openings such as
19    windows), and mechanical ventilation (rarely used in residences) (Yang et al., 2004).
20    In temperate climates, winter is associated with lower indoor/outdoor ratios of NC>2 since
21    windows and doors are usually tightly closed and the only source of exchange is infiltration.
22    Newer homes tend to be built more tightly than older homes, so have even lower rates of
23    infiltration.  During warmer weather, air conditioner use and opening of windows increase air
24    exchange between outdoors and indoors.
25          Yang et al. (2004) used multiple integrated (7-day) NC>2 measurements indoors and
26    outdoors to calculate penetration and source strength factors in Seoul, Korea and Brisbane,
27    Australia using a mass balance model considering a residence as a single chamber (Yang et al.,
28    2004). They showed that, while penetration factors did not differ significantly between gas and
29    electric range homes, source  strength factors were much higher in homes with gas ranges in both
30    Brisbane and Seoul (5.77 ± 3.55 and 9.12 ± 4.50, respectively) than in electric range homes in
31    Brisbane (1.49 ± 1.25). Similarly, calculated NC>2 source strengths (|ig/m3/h) were
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 1    21.9 ± 21.8 and 44.7 ± 38.1 in gas homes in Brisbane and Seoul, respectively, and 6.6 ± 6.3 in
 2    electric homes in Brisbane.
 3
 4    Household Characteristics
 5          Yang et al. (2004) found that levels of indoor NO2 (in |ig/m3) were associated with house
 6    characteristics in 28 homes in Brisbane (where there were both electric and gas range homes).
 7    Homes with a gas water heater had higher levels than those without (34.5 ± 16.4 versus 22.8 ±
 8    12.1, p = 0.048), but these were unadjusted associations, and it is likely that many of the homes
 9    with gas water heaters also had gas ranges. Homes with an attached garage had higher levels of
10    NO2 (33.1 ± 18.3) compared to homes without one (21.8 ± 8.8) (p = 0.039).  Attached garages
11    were not, however, associated with NO2 levels in a study in Quebec City, Canada (Gilbert et al.,
12    2006). The authors suggested that the lack of association might be attributed to small numbers
13    (n = 18 homes with attached garages) or to the airtightness of homes in Canada compared to
14    those in Australia.
15          Location in a city center was associated with higher NO2 levels in homes in Menorca
16    (one of the Balearic Islands off the coast of Spain with rural and small town residences), after
17    adjusting for gas cooker, extractor fan use, smoking in the home, type of central heating, season,
18    and social class (Garcia-Algar et al., 2004). In the same study, levels of indoor NO2 in
19    Barcelona (a large coastal city in Spain) and Ashford (a medium-sized town in the southeast UK)
20    were significantly higher than those in Menorca
21          In a study of a random sample of 845 homes in England (Raw et al., 2004), levels  of NO2
22    were significantly associated with dwelling type and age of home, but the authors attributed
23    these effects to the geographical location of the home (e.g., inner city). Garrett et al. (1999) also
24    found that age of house was significantly associated with NO2 levels in winter and summer. In
25    the study by Shima and Adachi,  (1998), differences in concentrations of NO2 between homes
26    with and without unvented heaters in the heating season were slightly lower among homes with
27    wood compared to aluminum window frames.  Type of window frames, but not structure type,
28    was associated with NO2 concentrations in the heating  period for homes with unvented heaters
29    (76.2 ±1.4 ppb versus 55.9 ±3.9 ppb in homes with aluminum and wood windows,
30    respectively), but not in homes with vented heaters. In the non-heating season, mean NO2 levels
31    in the home varied by type of structure (steel/concrete or wood) and type of window frames
32    (aluminum or wood), with wood structures and frames indicating a less airtight dwelling.

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 1   AX3.5      PERSONAL EXPOSURE
 2
 3   Components of Personal Exposure
 4          Human exposure to NC>2 consists of contact at the air boundary layer between the human
 5   and the environment at a specific concentration for a specified period of time.  People spend
 6   various amount of time in different microenvironments with various NC>2 concentrations.  The
 7   integrated NO2 exposure is the sum of the individual NO2 exposures over all possible time
 8   intervals for all environments.  Therefore, the assessment of human exposures to NC>2 can be
 9   represented by the following equation:
10                                             i=l                                (AX3.5-1)
11   where ET is the time-weighted personal exposure concentration over a certain period of time, n is
12   the total number of environments that a person encounters,/ is the fraction of time spent in the
13   /'th environment, and C\ is the average NC>2 concentration in the rth environment during the time
14   fraction/.  Depending upon the time fraction and  environmental concentration we consider
15   during exposure assessment, the exposure a person experiences can be classified into
16   instantaneous exposure, peak exposure, averaged exposure, or integrated exposure.  These
17   distinctions are important because health effects caused by long-term low-level exposures may
18   be different from those resulting from short-term peak exposures.
19          The equation above represents the average personal exposure concentration is a linear
20   combination of the average concentration in the ambient environment and each
21   microenvironment, weighted by an individual's fraction of time spent in that environment.
22   Hence, personal exposure to NC>2 is influenced by the microenvironmental concentration and the
23   amount of time spent in each microenvironment. In theory,  a microenvironment could be any
24   three-dimensional space having a volume in which people spend a certain amount of time.
25   In practice, microenvironments typically used to determine NC>2 exposures include residential
26   indoor environment, other indoor locations, near-traffic outdoor environment, other outdoor
27   locations, and in-vehicles. In other words, total personal exposure to NO2 can be decomposed
28   into exposure to NC>2 in different environments. An individual's total exposure (Ex) can also be
29   represented by the following equation
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      ET = Ea
 2    subject to the constraint
10
15
                                                                                  ,wna
                                                                                      (AX3.5-2)
 3                                         "     /                                   (AX3.5-3)
 4   where Ea is the person's exposure to pollutants of ambient origin; Enona is the person's exposure
 5   to pollutants that are not of ambient origin; y0 is the fraction of time people spend outdoors and yi
 6   is the fraction of time they spend in microenvironment /'; F-m^ P[, a;, and k; are the infiltration
 7   factor, penetration coefficient, air exchange rate, and decay rate for microenvironment /'.
 8          In the case where microenvironmental exposures are dominated by one
 9   microenvironment, Equation AX3.5-2 may be approximated by
                           nona
                                  { v
                                         -y)[Pa/(a + k)] } Ca + Emma = aCa
                                                                               mma
1 1   where Et is the total personal exposure, Ea is the exposure to ambient generated pollutants, Enon!lg
12   is the nonambient generated pollutants, andy is the time fraction people spent outdoors.  Other
13   symbols have the same definitions in Equation AX. 5-2.  If microenvironmental concentrations
14   are considered, then Equation AX3.5-5 can be recast as
                          Cme = Ca+ Cna = [Pa /(a + k)}Ca + S/{V(a
                                                                                   (AX3.5-5)
16   where Cme is the concentration in a microenvironment; Ca and Cnona the contributions to Cme from
17   ambient and nonambient sources; S is the microenvironmental source strength; Fis the volume
18   of the microenvironment, and the symbols in brackets have the same meaning as in Equation
19   AX3.5-5. In this equation, it is assumed that microenvironments do not exchange air with each
20   other, but only with ambient air.
21          The NC>2 concentration in each microenvironment can show substantial spatial  and
22   temporal variability, which is determined by many factors, such as season, day of the week,
23   personal age, occupation, house characteristics, personal activities, source emission rate, air
24   exchange rate, and transport and removal mechanisms of NC>2. Failure to disaggregate total
25   human exposure and assess human exposure in various microenvironments may result in
26   exposure misclassification, which may obscure the true relations between ambient air pollution
27   and health outcomes.
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 1          Studies reviewed in this section were generally conducted in North America (Canada, the
 2    United States, and Mexico) and European countries. Studies conducted in other parts of the
 3    world were not the primary focus of this science review because exposure patterns may not be
 4    similar to those in the United States. However, studies which might support general conclusions
 5    (not country or cultural specific conclusions) about NC>2 exposures will be included.
 6          Either Palmes tubes or Yanagisawa badges or Ogawa samplers were used to measure
 7    personal exposures in most of the reviewed studies, and sometimes residential indoor and
 8    outdoor concentrations.  Sampling time for each cartridge varied from 8 h to two weeks, and the
 9    study design covered (1) longitudinal, in which each subject is measured for many days;
10    (2) pooled, in which each subject is measured for only one or two days, different days for
11    different subjects; and (3) daily-average, in which many subjects are measured on the same day.
12    Most studies focused primarily on children, and in some studies adults or people with respiratory
13    diseases were taken as study population.
14
15    AX3.5.1    Personal Exposures and Ambient (Outdoor) Concentrations
16          Numerous epidemiological studies have shown a positive association between ambient
17    (outdoor) NC>2 concentrations and adverse health effects. Since a causal  association requires
18    exposure, it is very important to evaluate personal exposure to ambient (outdoor) generated NC>2.
19    In this section, topics related to the total personal exposure and ambient (outdoor) generated NC>2
20    will be evaluated, such as the levels of personal exposure and ambient (outdoor) NC>2, the
21    attenuation factor of personal exposure to NC>2, the  correlation between personal and ambient
22    (outdoor) NC>2, and the factors determining the associations between personal exposure and
23    ambient (outdoor) level. Based on the science review, the following key questions will be
24    addressed: (1) When, where, how and how much are people exposed to ambient (outdoor)
25    generated NC>2?  and (2) Is ambient (outdoor) NC>2 a good surrogate  for personal total exposure
26    or personal exposure to ambient (outdoor) NC>2?
27          Personal  exposures in most of the studies  considered here were less than the
28    corresponding outdoor or ambient concentrations. In the presence of local sources (indoor or
29    local traffic sources), personal exposure levels could be higher than outdoor or ambient levels
30    (Spengler et al.,  1994; Nakai et al., 1995; Linn et al., 1996; Spengler et al., 1996; Raaschou-
31    Nielsen et al., 1997; Aim et al., 1998; Levy et al., 1998a; Monn et al., 1998; Liard et al., 1999;
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 1   Kramer et al., 2000; Linaker et al., 2000; Mukala et al., 2000; Gauvin et al., 2001; Monn, 2001;
 2   Rotko et al., 2001; Sarnat et al., 2001; Kodama et al., 2002; Mosqueron et al., 2002; Ramirez-
 3   Aguilar et al., 2002; Rojas-Bracho et al., 2002; Lai et al., 2004; Nerriere et al., 2005; Sarnat
 4   et al., 2005; S0rensen et al., 2005; Kim et al., 2006; Sarnat et al., 2006).
 5          In a probability based population exposure study in Los Angeles Basin, 48 h indoor,
 6   outdoor and personal exposures (pooled exposures) were reported for 682 participants (Spengler
 7   et al., 1994). Spengler et al. (1994) found that the median personal exposure was 35 ppb and the
 8   median outdoor level was 36 ppb.  Linn et al. (1996) reported the results of a personal exposure
 9   study for 269 school children from three Southern California communities. During this
10   longitudinal study, 24 h averaged personal exposures, as well as inside school, outside school
11   and ambient central site NO2 levels, were measured by Yanagisawa badges for one week for
12   each season from 1992 to 1994. Results showed that mean personal exposure was 22 ppb and
13   the mean central site concentration was 37 ppb.  Kim et al. (2006) conducted a longitudinal,
14   multi-pollutant exposure study in Toronto, Canada.  During the study, personal exposures (24-h
15   integrated by Ogawa sampler) to PM2 5,  NO2 and CO were measured for 28 subjects with
16   coronary artery disease one day a week for a maximum of 10 weeks, and were compared with
17   ambient  fixed site measurements. The mean NO2 personal exposure was 14.4 ppb, which was
18   lower than the ambient site concentrations (20-26 ppb).  Sarnat et al. (2001) and Sarnat et al.
19   (2005) reported multi-pollutant exposure studies in Baltimore and Boston. In the Baltimore
20   study, 24 h averaged personal  exposure and ambient PM2.5, O3, NO2, SO2, and CO were
21   measured for 56  subjects (20 older adults, 21 children and 15 individuals with COPD) in the
22   summer  of 1998 and the winter of 1999. All subjects were monitored for  12 or 8 consecutive
23   days in each of the one or two seasons. Median ambient NO2 levels were  higher than the median
24   personal levels in both seasons (about 10 ppb in difference).  During the winter, both ambient
25   and personal exposure to NO2 were higher than the summer, the difference between ambient and
26   personal exposure in winter was 1 to 2 ppb smaller than the difference in the summer. In the
27   Boston study, 24-h averaged personal and ambient PM2.5, Os, NO2, and SO2 were measured for
28   20 healthy  seniors and 23 schoolchildren. All subjects were measured for 12 consecutive  24-h
29   periods in each of the 1 or 2 seasons.  Ambient NO2 levels were on average 6 to 20 ppb higher
30   than the  personal exposure levels for seniors during all sampling sessions. For children's
31   exposure, ambient NO2 levels were 7 to 13 ppb higher than the personal exposures in 4 out of

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 1    6 sampling sessions, and in the other two sampling sessions (one in summer and one in winter)
 2    ambient levels were 1.8 to 2.6 ppb lower than personal exposures.  Sarnat et al. (2006) measured
 3    24-h averaged ambient and personal PM2.5, sulfate, elemental carbon, O3, and SO2 for 10 non-
 4    smoking seniors in Steubenville, Ohio during the summer and fall of 2000.  For each subject,
 5    two consecutive 24 h personal exposure measurements were collected during each week for
 6    23 weeks. Data were stratified by the presence of gas stoves in homes. Personal exposure was
 7    lower than the ambient level for homes without gas stoves (9.0 ppb for personal exposure versus
 8    9.5 ppb for ambient level during the summer and 9.9 ppb versus 11.3 ppb during the fall), and
 9    higher than ambient levels for homes with gas stoves (12.3 ppb for personal exposure versus
10    9.5 ppb for ambient level during the summer and 15.7 ppb versus 11.3 ppb during the fall).
11          Nerriere et al. (2005) investigated factors determining the discrepancies between personal
12    exposure and ambient levels in the Genotox ER study. During the study, forty-eight h averaged
13    PM2.5, PMio, and NO2 were collected in both summer and winter for each person in a cohort,
14    with 60 to 90 nonsmoking volunteers composed of two groups of equal size for adults and
15    children at four metropolitan areas in France (Grenoble, Paris, Rouen, and Strasbourg).  In each
16    city, subjects were selected so as to live in three different urban sectors contrasted in terms of air
17    pollution: one highly exposed to traffic emissions, one influenced by local industrial sources,
18    and a background urban environment. In each urban sector, a fixed ambient air monitoring
19    station was used to simultaneously collect the same air pollutants as personal exposure samplers.
20    Factors affecting the concentration discrepancies between personal exposure and corresponding
21    ambient monitoring site were investigated by a multiple linear regression model.  Results showed
22    that the discrepancies were season, city and land use dependent.  During the winter, city and land
23    use  can interpret 31% of the variation of the discrepancy, and during the summer 54% of the
24    variation in the discrepancy can be interpreted by those factors.  In most cases, ambient
25    concentrations were higher than the corresponding personal exposures. When using the ambient
26    site  to represent ambient levels, the largest difference between ambient and personal exposure
27    was found at the "proximity to traffic" site, while the smallest difference was found at the
28    "background" site. When using urban background site as ambient level, the largest difference
29    was observed at the "industry" site, and the smallest difference was observed at the background
30    site, which reflected the heterogeneous distribution of NO2 in an urban area. During winter,
31    differences between ambient site and personal exposure were larger than those in the summer.

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 1    Age was not found to be a significant factor interpreting the discrepancies between ambient level
 2    and personal exposure.
 3           S0rensen et al. (2005) reported that during the cold season, median personal exposure
 4    was higher than residential indoor and urban background concentrations, but lower than the
 5    residential outdoor and street station concentrations (designed to capture the close to traffic
 6    exposure). During the warm season, personal exposure was again lower than the street station
 7    concentration but higher than the residential indoor, outdoor, and urban background
 8    concentrations.  The implication of these findings is that ambient concentrations are the primary
 9    factor in determining exposures when there is no or little contribution from indoor sources and
10    that traffic is the most significant NC>2 source in this study.
11           The relative levels of ambient and personal exposure can also be expressed as ratios of
12    personal/ambient (Levy et al., 1998a; Rojas-Bracho et al., 2002; Sarnat et al., 2006). As shown
13    in Equation AX3.5-4, personal exposure is related to  ambient concentration through the
14    infiltration factor, the fraction of time people spend outdoors, indoor sources and outdoor
15    concentration. In the absence of indoor sources, the ratio of personal exposure to ambient
16    concentration is sometimes also called the attenuation factor (a), which is always less than or
17    equal to one, and it is a function of infiltration factor  (F;nf) and the fraction of time people spend
18    outdoors (y).  The attenuation factor can be derived directly from measured personal and outdoor
19    concentrations or calculated from measured or estimated values of the parameters a, k, and P
20    (see Equation AX3.5-2 and Equation AX3.5-4) and the time spent in various microenvironments
21    from activity pattern diaries (Wilson et al., 2000). Because a depends on building and lifestyle
22    factors, air exchange rate, and NC>2 decay rate, it will vary to a certain extent from region-to-
23    region, season-to-season, and by the type of indoor microenvironment.  Consequently, predicted
24    exposures based on these physical modeling concepts provide exposure distributions derived
25    conceptually as resulting from building, lifestyles, and meteorological considerations. For any
26    given population, the distribution of the coefficient a may represent substantial intra- and inter-
27    personal variability based on personal activity patterns, building and other microenvironmental
28    characteristics, and proximity to ambient and indoor sources. Distributions of a should be
29    determined using population studies in order to evaluate the uncertainty and variability
30    associated with model exposures. Unfortunately, only a few studies have reported the value and
31    distribution of the ratio of personal to ambient, and even fewer studies reported the value and

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 1    distribution of attenuation factors based on sophisticated study designs. Rojas-Bracho et al.
 2    (2002) reported the median personal/outdoor ratio was 0.64 (with an interquartile range (IQR) of
 3    0.45). Although it was less than one, the authors also reported the indoor/outdoor ratio (0.95
 4    with an IQR of 0.48) of NC>2 and based on the indoor/outdoor ratio, the authors pointed out that
 5    the high median indoor/outdoor ratio was greater than the estimated effective penetration
 6    efficiency, which supports the argument of the importance of indoor sources to indoor NC>2
 7    levels.  Therefore, the attenuation factor in this study should be smaller than the ratio of
 8    personal/ambient, which was 0.64.  Sarnat et al. (2006) reported that the ratio of
 9    personal/ambient for NC>2 was 2.05 and 1.27 for subjects with and without gas stoves in their
10    homes. The large personal/ambient ratio for the latter might be attributed to the influence of
11    indoor or local sources that were not identified and/or partly to measurement error.
12          The attenuation factor is one of the keys to evaluate personal exposure to ambient
13    generated NO2, or ambient contribution to personal exposure. However, the ratio of personal
14    exposure/ambient concentration will not  accurately reflect the attenuation factor in the presence
15    of indoor sources. As shown above, in many cases, the ratio  of personal exposure and ambient
16    concentration was above one, which is physically impossible for the attenuation factor. The
17    random component superposition (RCS)  model is an alternative way to calculate attenuation
18    factor using observed ambient and personal exposure concentrations (Ott et al., 2000).  The
19    Random Component Superposition (RCS) statistical model (shown in Equation AX3.5-4) uses
20    the slope of the regression line of personal concentration on the ambient or outdoor NO2
21    concentration to estimate the population average attenuation factor and means and distributions
22    of ambient/outdoor and nonambient contributions to personal NC>2 concentrations (the intercept
23    of the regression is the averaged nonambient contribution to personal exposure). This model
24    assumes a linear superposition of the ambient and nonambient components of exposure and lack
25    of correlation between these two components.
26          The RCS model derives a mean a across all homes (assuming the infiltration behavior
27    and time budget for all people are the same) from the linear regression of measured values of Et
28    on Ca. The product of the constant a and Ca from each home provides an estimate of the mean
29    and distribution of Ea for the population of study homes. In practice, the mean and distribution
30    of nonambient contributions (En0na) are given by the difference, Et - E&, on a home-by-home
31    basis. The RCS-predicted distribution of E& across the population of study homes is  given by the

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 1    product of the constant a and Ca from each home, and the mean of the ambient contribution is
 2    the difference between the mean total personal exposure and the intercept of the regression line.
 3    The RCS model has been widely applied to PM exposure studies PTEAM, THEES, Toronto, and
 4    RIOPA studies (Ott et al., 2000; Meng et al., 2005), but researchers have not intentionally used
 5    this model for NC>2 exposure assessments. Although many studies explored the relationship
 6    between personal exposure and ambient NC>2 concentrations using regression models, most of
 7    those studies are not useful for evaluating the attenuation factor or helping answer the question
 8    of how much personal NCh exposure comes from ambient air, either because only R2 was
 9    reported, or because log-transformed concentrations were used in the regression model, or
10    because  physically meaningless multiple linear regression models (exploratory variables were
11    not independent of each other, e.g., both indoor, outdoor, indoor sources from questionnaire
12    responses and air exchange rate were used as exploratory variables) were used to interpret
13    personal exposure variations. Only those simple linear regression models (personal versus
14    ambient  or personal versus outdoor) and physically meaningful multiple linear regression models
15    (personal versus ambient + indoor source measured or identified by questionnaire) are useful for
16    evaluating the attenuation factor, and those models are summarized in Table AX3.5-1. The
17    intercept of the regressions (i.e., the nonambient contribution to personal exposure) varies widely
18    from study to study (5 ppb to 18 ppb) and thus depends strongly on time and location.  The slope
19    of these  regression models (i.e., the population average attenuation factor)  varies between 0.3 to
20    0.6 in most of the studies.  The attenuation factor is determined by air exchange rate, penetration
21    and decay rate of NC>2 and also the fraction of time people spend outdoors.  S0rensen et al.
22    (2005) found that the attenuation factor was larger in the summer than in the winter.  However,
23    Sarnat et al. (2006) found opposing results and said the reason was unknown. Based on the
24    regression model and reported mean personal exposure values, the ambient and nonambient
25    contribution to personal exposure could be calculated using the method described above.  Since
26    most researchers did not report the mean personal exposure and the regression model at the same
27    time, ambient and nonambient contributions can only be calculated in four studies as shown in
28    Table AX3.5-2.  The ambient contribution to population exposures varies from 20% to 50% in
29    these four studies.
30          The RCS model calculates ambient contributions to indoor concentrations and personal
31    exposures based on the statistical inferences of regression analysis. However, personal-outdoor

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 1    regressions could be affected by extreme values (outliers either on the x or the y axis), such as a
 2    high nonambient exposure on a day with low ambient concentration or vice versa. For this
 3    reason outliers must be identified and their influence on the infiltration factor or attenuation
 4    factor in the RCS model must be evaluated in order to obtain a robust result. Another limitation
 5    of the RCS model is that this model is not designed to estimate ambient  and nonambient
 6    contributions for individuals, in part because the use of a single attenuation factor does not
 7    account from the large home-to home variations in actual air exchange rates, and penetration and
 8    decay rates of NC>2. As suggested by Meng  et al. (2005) the use of a fixed attenuation factor
 9    might underestimate ambient contributions to indoor concentrations and personal exposures  and
10    could also overlook some of the exposure errors and cause large uncertainties in risk estimates.
11           The estimation of the ambient and nonambient contribution to personal exposure could be
12    improved by allowing for variations in air exchange rate, penetration and decay rate of NC>2, and
13    the variations in the fraction of time people spend outdoors. The mass balance model described
14    in Equation AX3-5-4 gives more flexibility than the RCS model if the distributions of P, k, a,
15    and y are known. A comprehensive assessment of the impact of ambient sources on personal
16    exposure would require detailed consideration of the mechanisms of NO2 formation,
17    transformation, transport and decay. In the research field of NC>2 exposure assessment, no
18    published reports were found that use the mass balance model to explore the relationship of
19    personal exposures to ambient NC>2 concentrations. As mentioned in Section 3.4.2, the only
20    reported k values were 0.99 h-1 by Yamanaka (1984), and  people always assumes the
21    penetration coefficient (P) is one for NC>2, which might overestimate the ambient contribution
22    due to the chemical reactivity of NC>2 during penetration.
23           The association between personal exposure and ambient NC>2 was quantified by Pearson
24    correlation coefficient (rp),  Spearman correlation coefficient (rs), or coefficient of determination
25    (R2) in regression models (Spengler et al., 1994; Linn et al., 1996;  Spengler et al., 1996;
26    Raaschou-Nielsen et al., 1997; Aim et al., 1998; Levy et al., 1998a; Monn et al., 1998; Liard
27    et al., 1999; Kramer et al., 2000; Linaker et al., 2000; Mukala et al., 2000; Gauvin et al., 2001;
28    Monn, 2001; Rotko et al., 2001; Sarnat et al., 2001; Kodama et al., 2002; Rojas-Bracho et al.,
29    2002; Lai et al.,  2004; Sarnat et al., 2005; Kim et al., 2006; Sarnat  et al., 2006).  In Table
30    AX3.5-3, the associations between personal  exposure and ambient concentration found in these
31    studies  are summarized.

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 1          The association between personal NO2 exposure and ambient/outdoor NO2 concentration
 2    varied from poor to good as shown in Table AX3.5-3.  The strength of the correlation between
 3    personal exposure and ambient/outdoor concentration for a population is determined by the
 4    variations in indoor or other local sources, air exchange rate, penetration and decay rate of NO2
 5    in different microenvironment, and time people spend in different microenvironments with
 6    different NC>2 concentrations. The relationship is also a function of season and location
 7    (rural/urban).  Aim et al. (1998) indicated that the association between personal exposure and
 8    outdoor concentration was stronger than the correlation between personal exposure and central
 9    site concentration. However, Kim et al.  (2006) pointed out that the association was not improved
10    using the ambient  sampler closest to a home. Home ventilation is another important  factor
11    modifying the personal-ambient relationships; we expect to observe the strongest associations for
12    subjects  spending time indoors with open windows. Aim et al. (1998) and Kodama et al. (2002)
13    observed the association between personal exposure and ambient concentration became stronger
14    during the summer than the winter. However, Sarnat et al. (2006) reported that R2 decreased
15    from 0.34 for low ventilation population to 0.16 for high ventilation population in the summer,
16    and from 0.47 to 0.34 in the fall. This might be a caution that the association between personal
17    exposure and ambient concentration is complicated and is determined by many factors.
18    Exposure misclassification might happen if a single factor, such as season or ventilation status, is
19    used as an exposure indicator. Another factor affecting the personal to ambient association is the
20    subject's location, with higher correlation for subjects living in the rural areas and lower
21    correlation with subjects living in the urban areas (Rojas-Bracho et al., 2002; Aim et al., 1998).
22    Spengler et al. (1994) also observed that the relationship between personal exposure  and outdoor
23    concentration was highest in areas with lower ambient NC>2 levels (R2 = 0.47) and lowest in areas
24    with higher ambient NC>2 levels (R2 = 0.33).  This might reflect the highly heterogeneous
25    distribution, or the effect of local sources of NC>2 in an urban area, and personal activities are
26    more diverse in an urban area. However, this factor (location: urban vs. rural) might also interact
27    with indoor sources because indoor sources could explain more personal exposure when ambient
28    concentrations become lower and more homogeneously distributed.
29          The association is also affected by indoor or local sources, and the association becomes
30    stronger after those sources are controlled in the model. Raaschou-Nielsen et al. (1997) observed
31    that R2 increased from 0.15 for general population to 0.49 for a population who spent less than

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 1    2% of their time close to gas appliances and passive smoking in Copenhagen urban area, and R2
 2    increased from 0.35 to 0.45 in the rural area for the population with the same characteristics.
 3    When those who reported exposure to either gas appliances or passive smoking were excluded,
 4    R2 increased to 0.59 in urban and 0.46 in the rural districts. Spengler et al. (1994) observed that
 5    less of the variation in personal exposure was explained by outdoor concentrations for those who
 6    had gas ranges with pilot lights (R2 = 0.44) than it is for the other two groups (R2 = 0.52). When
 7    there is little or no contribution from indoor sources, ambient concentrations are the primary
 8    factor in determining exposure, but if there are continuous indoor sources, the influence of
 9    outdoor levels decrease.  In the VESTA study, Gauvin et al. (2001) reported low R2s in all three
10    cities. R2s increased for all three cities after controlling indoor air sources (e.g., gas cooking)
11    and ambient traffic densities: R2 increased from 0.01 to 0.43 for Grenoble, from 0.04 to 0.50 for
12    Toulouse,  and from 0.02 to 0.37 for Paris.  Other factors, such as cross-sectional vs. longitudinal
13    study design, and sampling duration might also affect the strength of the association.  However,
14    the current science review cannot give a clear picture of the effects by those factors due the lack
15    of key studies and data.
16          The correlation coefficient between personal exposure and ambient/outdoor concentration
17    has different meanings for different study designs.  There are three types of correlations
18    generated  from different study designs:  longitudinal, "pooled," and daily-average correlations.
19    Longitudinal correlations are calculated when data from a  study includes measurements over
20    multiple days for each subject (longitudinal study design). Longitudinal correlations describe the
21    temporal relationship between daily personal NCh exposure or microenvironment concentration
22    and daily ambient NC>2 concentration for each individual subject. The longitudinal  correlation
23    coefficient may differ for each subject. The distribution of correlations across a population could
24    be obtained with this type of data. Pooled correlations are calculated when a study  involves one
25    or only a few measurements per subject and when different subjects are studied on subsequent
26    days.  Pooled correlations combine individual subject/individual day data for the calculation of
27    correlations.  Pooled correlations describe the relationship between daily personal NO2 exposure
28    and daily ambient NO2 concentration across all subjects in the study.  Daily-average correlations
29    are calculated by averaging exposure across subjects for each day.  Daily-average correlations
30    then describe the relationship between the daily average exposure and daily ambient NO2
31    concentration.

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 1          The type of correlation analysis can have a substantial effect on the value of the resultant
 2    correlation coefficient. Mage et al. (1999) mathematically demonstrated that very low
 3    correlations between personal exposure and ambient concentrations could be obtained when
 4    people with very different nonambient exposures are pooled, even though their individual
 5    longitudinal correlations are high. Data shown in Table AX3.5-3 demonstrate that the
 6    longitudinal correlations between personal exposure and ambient NO2 concentrations were
 7    higher than the correlations obtained from a pooled data set.
 8          In conclusion, personal exposure to ambient/outdoor NC>2 is determined by many factors.
 9    Physically, the determinant factors are ambient concentration, air exchange rate, NC>2 penetration
10    and decay rate, and also the fraction of time people spend outdoors. These factors are in turn
11    determined by factors, such as season, location of home, outdoor temperature and so on.  These
12    factors all help determine the contribution of ambient/outdoor generated NO2 to personal
13    exposures. Personal activities determine when, where and how people are exposed to NC>2.  The
14    variations of these physical factors and indoor sources determine the strength of the association
15    between personal exposure and ambient concentrations both longitudinally and cross-sectionally.
16    In the absence of indoor and local sources, the personal exposure level is in between the ambient
17    level and the indoor level, but in the presence of indoor and local sources, personal exposures
18    could be much higher than both indoor and outdoor concentrations. Again, the discrepancies
19    between personal exposures and ambient levels are determined by the considerations given
20    above. Most researchers found that personal NO2 was significantly associated with ambient NO2
21    but the strength of the association ranged from poor to good.  Based on that finding, some
22    researchers concluded that ambient NC>2 is a good surrogate for personal exposure, while others
23    reminded us that caution must be exercised if ambient NC>2 is used as a surrogate for personal
24    exposure. The crude association between personal exposure  and ambient monitors could be
25    improved when indoor or other local sources are well controlled during exposure assessment.
26    The ambient contribution to personal exposure could be evaluated by the attenuation factor,
27    which is the ratio of personal exposure to ambient level in the absence of indoor sources, or the
28    slope of the RCS regression model. The attenuation factor in the studies shown in Table
29    AX3.5-1 ranged from 0.3 to 0.6.  The ambient and nonambients  contributions could also be
30    calculated from the RCS model, although  only a few studies provide enough information for us
31    to calculate them.  The accuracy and precision of the estimation  of ambient and nonambient

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 1    contributions to personal exposures could be improved if the variations for the physical factors
 2    given above were known. The mass balance model could give a more accurate and precise
 3    estimation if we knew the distributions of these key physical factors.
 4          Because people are exposed to ambient NO2 in microenvironments, and the fact that NO2
 5    is heterogeneously distributed in urban areas (as shown in Section AX3.3.2), the association of
 6    personal exposure to ambient NO2 could be modified by microenvironmental characteristics.
 7    Personal total exposure will be decomposed and further evaluated in each microenvironment in
 8    the following section.
 9
10    AX3.5.2    Personal Exposure in Microenvironments
11
1 2    Personal Exposure in the Residential Indoor Environment
13          People spend most of their daily time in a residential indoor environment (Klepeis et al.,
14    2001). NO2 found in an indoor environment originates both indoor and outdoors; and therefore,
1 5    people in an indoor environment are exposed to both indoor and outdoor generated NC>2. The
16    physical parameters, which determine personal exposure to ambient and nonambient generated
17    NC>2, have been shown in Equations AX3.5-2 to AX3.5-5. In a residential indoor environment,
18    personal exposure to NC>2 can be summarized below (notations are the same as those in
19    Equations AX3. 5-2 to AX3. 5-5)
                                     + Enona = {y + (/ - y)[Pa/(a + k)]}Ca + Eimw =
20              ^'   ^  ~ ^! ^ "?/'  a   nona                                          (AX3 5-6)
21   if people spend 100% of their time indoors, the equation above can be recast as
      Et = Ea + Enona = «Q + Enona = Finf^a + Enona
22     a    nona                                                                  (AX3.5-7)
23   In other words, in a residential indoor environment, personal exposure concentration equals the
24   residential indoor concentration (if there is no personal cloud) which can be broken down into
25   two parts: indoor generation and ambient contribution.
26          In a residential indoor environment, the relationship between personal NC>2 exposure and
27   ambient NC>2 can be modified by the indoor environment in the following ways: (1) during the
28   infiltration processes, ambient NC>2 can be lost through penetration and decay (chemical and

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 1    physical processes) in the indoor environment, and therefore, the concentration of indoor NC>2 of
 2    ambient origin is not the ambient NC>2 concentration but the product of the ambient NC>2
 3    concentration and the infiltration factor (Finf, or a if people spend 100% of their time indoors);
 4    (2) in an indoor environment, people are exposed to not only ambient generated NC>2 but also
 5    indoor generated NC>2, and therefore, the relative contribution of ambient and nonambient NC>2 to
 6    personal exposure depends not only on the ambient NC>2 concentration but also on the infiltration
 7    factor (attenuation factor) and the indoor source contribution;  (3) the strength of the association
 8    between personal exposure to NC>2  of ambient origin and ambient NC>2 concentration is
 9    determined by the temporal and spatial variation in the infiltration factor; and (4) the strength of
10    the association between personal total exposure and ambient NC>2 is determined by the variation
11    in the indoor source contribution and the variation in the infiltration factor.  Below, factors
12    affecting infiltration factor and the  indoor source contribution will be  evaluated, and the key
13    issues, such as those mentioned above, related to ambient contribution to personal NC>2 exposure
14    will be addressed.
15          Infiltration factor (F^f) of NC>2, the physical meaning of which is the fraction of ambient
16    NC>2 found in the indoor environment, is determined by the NC>2 penetration coefficient (P), air
17    exchange rate (a), and the NC>2 decay rate (&), through the equation F-mf= Pa/(a + k). Information
18    on P and k for NC>2 is sparse.  In most mass balance modeling work, researchers assume P
19    equals 1 because NC>2 is a gas, and  assume k equals 0.99 IT1, which is cited from Yamanaka
20    (1984).  Yamanaka (1984) systematically studied the decay rates of NO2 in a typical Japanese
21    living room.  The author used a chemical luminescence method to monitor the decay process of
22    indoor-originated NC>2. The author observed that the decay process of NC>2 followed
23    approximately first-order kinetics.  The author also pointed out that the NC>2 decay processes was
24    both surface type and relative humidity (RH) dependent: Under low RH (43.5-50%), the sink
25    rate of NC>2 was 0.99 ± 0.19 IT1, independent of interior surface properties;  however, the NC>2
26    decay rate increased in proportion to RH above 50%, and in that RH range, the decay rate
27    depended on the interior surface properties. Yang et al. (2004) estimated a  decay rate of 0.94 IT1
28    for Seoul and 1.05 IT1 for Brisbane. As it is well known, the decay rate is dependent on lots of
29    indoor parameters, such as indoor temperature,  relative humidity, surface properties, surface-to-
30    volume ratio, the turbulence of air flow, and co-existing pollutants,  et al. However,  in the indoor
31    air modeling studies, a decay rate of 0.99 IT1 is a widely accepted parameter (Dimitroulopoulou

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 1    et al., 2001; Kulkarni et al., 2002).  As a result, it will over- or underestimate the real NO2 decay
 2    rate. A penetration coefficient (P) of 1 is also widely accepted for NO2 (Kulkarni et al., 2002;
 3    Yang et al., 2004).  No systematic investigations have been found on NO2 penetration behaviors.
 4    As a general principle, the upper limit of the penetration coefficient is 1, and it would be less
 5    than 1 if NO2 lost during penetration due to diffusion and chemical reactions. Therefore, using a
 6    penetration coefficient of 1 gives an upper bound to the estimated infiltration coefficient.
 7    Among P, k, and a, air exchange rate (a) is the most solidly based parameter and can be obtained
 8    from a nationwide database (Pandian et al., 1998).
 9          Although specific P, k, and a were not reported by most studies, a number of studies
10    investigated factors affecting P, k, and a (or indicators of P, £, and a), and their effects on indoor
11    and personal exposures (Lee et al., 1996; Cotterill and Kingham,  1997; Monn et al., 1998;
12    Garcia-Algar et al., 2003; S0rensen et al., 2005; Zota et al.,  2005). Garcia-Algar et al. (2003)
13    observed that double-glazed windows had significant effect on indoor NO2 concentrations.
14    Homes with double-glazed windows had lower indoor concentrations (6 ppb lower) than homes
15    with single glazed windows. Cotterill and Kingham  (1997) reported that single or double glazed
16    window was a significant factor affecting NO2 concentrations in kitchen in the gas-cooker homes
17    (31.4 ppb and 39.8 ppb for homes with single and double glazed windows, respectively).  The
18    reduction of ventilation can block outdoor NO2 from coming into the indoor environment, and at
19    the same time it can also increase the accumulation of indoor generated NO2. The same effect
20    was found for homes using air conditioners. Lee et al. (2002) observed that NO2 was 9 ppb
21    higher in homes with an air conditioner than homes without. The authors also observed that the
22    use of humidifier would reduce indoor NO2 by 6 ppb. House type was another factor reported
23    affecting ventilation (Lee et al., 1996; Garcia-Algar et al., 2003).  Lee et al. (1996) reported that
24    the building type was significantly associated with air exchange rate: the air exchange rate
25    ranged from 1.04 IT1 for single dwelling unit to 2.26 IT1 for large multiple dwelling unit.  Zota
26    et al. (2005) reported that the air exchange rates were significantly lower in the heating season
27    than the non-heating season (0.49 IT1 for the heating season and 0.85 IT1 for the non-heating
28    season respectively). It should be pointed out that both P and k are functions of complicated
29    mass transfer mechanisms on the indoor surfaces, and therefore they are associated with air
30    exchange rate, which has an impact on the turbulence of air flows indoors.  However, the
31    relationship between P, k, and a has not been thoroughly investigated.  Factors mentioned above

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 1    can significantly affect P, &, and a, and thus affect the relationship between indoor and outdoor
 2    NO2 concentration, and personal exposure and outdoor NC>2 concentration.
 3          Due to the lack of specific P, &, and a for study homes or a study population, instead of
 4    using P, k, and a, alternative approaches to obtain the infiltration factor are the ratio of
 5    indoor/outdoor NC>2 and the regression based RCS model.  The basic rationale of the RCS model
 6    has been introduced in the previous section. Without indoor sources, the ratio between indoor
 7    NC>2 and outdoor NC>2 should be always less than or equal to 1.  If the indoor to outdoor ratio is
 8    larger than 1 (after adjusting for measurement error), we can surely say that indoor sources exist.
 9    However, if an indoor/outdoor ratio is less than one, we cannot exclude the effect of indoor
10    sources; otherwise, the infiltration factor would be overestimated. In order to use an
11    indoor/outdoor ratio as the infiltration factor, study designs and questionnaires must be carefully
12    read, and only the ratio for homes without identified indoor sources can be used as an indicator
13    of infiltration factor.  The population averaged infiltration factor is the slope of the regression
14    line of indoor concentration vs. outdoor concentration. The reliability of the regression slope is
15    dependent upon the sample size and how to deal with the outlier effects. Indoor/outdoor ratios
16    and the regression slopes are summarized in Table AX3.5-4. Those numbers, which can be
17    considered as an infiltration factor, are underlined and marked with bold font.  Most of the
18    infiltration factors ranges from  0.4 to 0.7.  Theoretically, infiltration factor is a function of air
19    exchange rate, which  has been indicated by season in some studies.  However, most studies do
20    not report the infiltration factor by season, and therefore, a seasonal trend of infiltration factor
21    could not be observed in Table  AX3.5-4.
22          As mentioned before, personal NC>2 exposure is not only affected by air infiltrating from
23    outdoors but also by indoor  sources.  The NC>2 residential indoor sources reported are gas
24    cooking, gas heating,  kerosene  heating, smoking and burning candles (Schwab et al., 1994;
25    Spengler et al., 1994;  Nakai et al., 1995; Lee et al., 1996; Linaker et al.,  1996; Cotterill and
26    Kingham, 1997; Farrow et al., 1997; Kawamoto et al.,  1997; Lee, 1997; Raaschou-Nielsen et al.,
27    1997; Aim et al., 1998; Levy et al., 1998a; Monn et al., 1998; Garrett et al., 1999; Chao, 2001;
28    Dennekamp et al., 2001; Dutton et al., 2001; Emenius et al., 2003; Kodama et al., 2002; Lee
29    et al., 2002; Mosqueron et al., 2002; Garcia-Algar et al.,  2003; Garcia-Algar et al., 2004; Lai
30    et al., 2004; Lee et al., 2004; Yang et al., 2004; Zota et al., 2005; S0rensen et al., 2005; Lai et al.,
31    2006).  Spengler et al. (1994) reported that personal exposures in homes with gas range with

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 1    pilot light were 15 ppb higher than those in homes with electric range, and it was 5 ppb higher in
 2    homes with gas range without pilot light than homes with electric ranges. Schwab et al. (1994)
 3    reported that homes with gas stove with pilot light had higher indoor NO2 concentrations (peak
 4    concentrations ranging from 30 to 35 ppb), followed by homes with gas stove without a pilot
 5    light (peak concentrations ranging from 15 to 20 ppb) and then homes with electric stoves (peak
 6    concentrations ranging from 5 to 10 ppb).  In an international study, Levy et al., (1998a) reported
 7    that the use of a gas stove in the home was the dominant activity influencing NO2 concentrations
 8    with a 67% increase in mean personal NO2 exposure and an increase in indoor-outdoor ratios
 9    from 0.7 to 1.2.  Smoking was found to be another significant factor elevating personal and
10    indoor NO2 exposure. Monn et al. (1998) reported that during 1-week integrated measurement,
11    smoking contributed 1 ppb more NO2 exposure. Aim et al. (1998) reported that one-week
12    integrated personal NO2 exposure for smokers and nonsmokers were 12.9 ppb and 10.7 ppb,
13    respectively.  Zota et al.  (2005) observed that smoking was not a significant indoor source.
14    However, the authors pointed out that the effect of smoking might have been overwhelmed by
15    the presence of the gas stove.  S0rensen et al. (2005) found that burning candles were
16    significantly associated with the elevation of indoor NO2 (p = 0.02). NO2 concentration in an
17    indoor environment affected by the indoor sources is not homogeneously distributed: NO2
18    concentration is usually the highest in the kitchen, lowest in the bedroom and the concentration
19    in a livingroom is in between as shown in  Table AX3.5-5.  The concentration differences
20    between a bedroom and a kitchen ranged from 1 ppb to 28 ppb, and largest difference occurred
21    in homes with gas stoves.
22          The concentration differences in indoor microenvironments reflect the differences in
23    personal exposure in those microenvironments, which is related to personal activities and
24    behaviors.  People who spend more time in a kitchen are expected to have higher NO2 exposures.
25    Also, in most exposure studies, integrated indoor and personal exposures were measured from
26    2 days to 2 weeks with passive samplers. Therefore, the peak exposure concentration could be
27    even higher.
28          Indoor source contributions to indoor and personal exposure are determined by indoor
29    source strength (S), house volume (F),  air  exchange rate (a) and the NO2 decay rate (K) in an
30    indoor environment, through the equation  Cnona = SI\V(a + k)]. Indoor source strength has been
31    summarized in a previous section (Indoor sources and concentrations of nitrogen oxides). With a

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 1    mass balance approach, Yang et al. (2004) reported that the source strength for electric range
 2    was 3.5 ppb/h, 11.5 ppb/h for gas range in Brisbane, and 23.4 ppb/h for gas range in Seoul.  The
 3    age of house and the house type are associated with ventilation, indoor sources, and house
 4    volume. As mentioned before, Lee et al. (1996) reported that the building type was significantly
 5    associated with volume of dwelling unit, and air exchange rate. Garrett et al. (1999) reported
 6    that older houses were associated with higher nitrogen dioxide levels, possibly as a result of
 7    older and less efficient appliances in older homes or due to smaller rooms.
 8          The relative contribution of indoor and outdoor NO2 to personal and indoor exposures
 9    can be easily and precisely calculated if we know the physical determinants, such as P, &, a, and
10    indoor source strength.  Probability based exposure models, such as SHEDS and APEX, could be
11    used to evaluate the personal exposure to indoor and outdoor generated NO2. Basically, those
12    exposure models incorporate the physical and chemical  processes determining indoor pollutant
13    concentrations as a function of outdoor concentration, indoor emission rates and building
14    characteristics; the combination of a  microenvironment  model and personal activity model will
15    allow researchers to evaluate the personal exposure to indoor and outdoor generated NO2. Due
16    to the lack of those parameters in publications, we are going to use a regression based RCS
17    model to evaluate the contribution of indoor and outdoor generated NO2 to personal exposure.
18    The rationale to use the RCS model to estimate indoor and outdoor contribution to indoor and
19    personal NO2 have been introduced in the previous section. In summary, the regression intercept
20    of indoor NO2 concentration vs. outdoor NO2 concentration is the population mean indoor
21    contribution to indoor NO2; and the difference between  the population mean NO2 and the
22    intercept in the population mean of outdoor contribution to indoor NO2. The RCS model results
23    are summarized in Table AX3.5-6. As shown in Table AX3.5-6, the overall ambient
24    contribution to indoor NO2 is around 70% with a wide range from 40 to 90%.  Indoor generated
25    NO2 contribution is 10-20% less for  homes with electric stoves if electric stove then indoor
26    contribution is usually zero. With the lack of indoor sources, the role of indoor environment is a
27    sink for outdoor generated NO2 due to physical and chemical losses of NO2 in the indoor
28    environment (Yamanaka, 1984; Ekberg 1996; Kraenzmer 1999; Chao, 2001).  Chao (2001)
29    reported that the average sink strength of NO2 in an indoor environment in Hong Kong was  0.42
30    mg/h.
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 1          In theory, personal exposure of ambient origin should be at least as much as the indoor
 2   NC>2 of ambient origin in that people spend time in either an indoor or an outdoor environment.
 3   However, it was shown in the previous part (Table AX3.5-2) that the ambient contribution to
 4   population exposure ranged from 20% to 50% based on four studies (Rojas-Bracho et al., 2002;
 5   Monn et al., 1998; Levy et al., 1998a; Spengler et al., 1994); and results here show that the
 6   ambient contribution to indoor NC>2 is around 70% with a wide range from 40 to 90% based on
 7   another four studies (Mosqueron et al., 2002; Yang et al., 2004; Kulkarni et al., 2002; Monn
 8   et al., 1998). It is not clear at present why the indoor NC>2 of ambient origin is larger than the
 9   personal NO2 exposure of ambient origin.
10          The strength of the indoor, outdoor and personal NC>2 associations (rp: Pearson
11   correlation coefficient; rs:  Spearman correlation coefficient; and R2:  coefficient of
12   determination) are summarized in Table AX3.5-7. The strength of the associations are
13   determined by the variation in F;nf (P, k, and a) and indoor source contributions from home to
14   home and from day to day.  In general, the correlation between indoor and outdoor NC>2 ranges
15   from poor to good (rp: 0.06 to 0.86). When we break down the correlation coefficient by season
16   and indoor sources, it is obvious that the association between indoor and outdoor NC>2 is stronger
17   during spring and summer but weaker during wintertime, and the association is stronger for
18   homes without indoor sources but weaker for homes with strong indoor sources. Mukala et al.
19   (2000) reported an rp of 0.86 for the indoor and outdoor NC>2 association during the spring and it
20   reduced to 0.54 during the winter. Spengler et al.  (1994) reported that the associations were
21   0.66 and 0.75 (rp) for homes with and without air conditioning system, respectively. Emenius
22   et al. (2003) reported that the association between indoor and outdoor NC>2 was 0.69 (rp) for
23   homes without smoker and without gas stove using, but the association was not significant for
24   homes with gas stove or smokers.  Yang et al. (2004) reported that the indoor and outdoor NC>2
25   association was 0.70 (R2) for homes with electric ranges, and was 0.57 (R2) for homes with gas
26   ranges. In other words, personal exposure to ambient NC>2 in a residential indoor environment
27   will be modified the least when  the air exchange rate is high and the indoor source contribution
28   is not significant. Considering the large spatial variation in ambient NO2 concentrations and the
29   relative sparseness of ambient NC>2 monitors, the associations between indoor and outdoor
30   concentrations are usually stronger than the associations between indoor and ambient
31   concentrations. As shown in Table AX3.5-7, a stronger personal vs. residential indoor

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 1    relationship than the personal vs. outdoor relationship has been reported by most studies (Lai
 2    et al., 2004; Monn et al., 1998, Levy et al., 1998a; Spengler et al., 1994; Kousa et al., 2001;
 3    Linaker et al., 1996), which is a reminder that personal exposure to ambient NO2 mostly happens
 4    in the residential indoor environment.  It should be pointed out that the association between
 5    indoor, outdoor and personal NO2 and the relative contributions of indoor and outdoor NO2 to
 6    indoor and personal exposures were calculated based on time integrated indoor, outdoor and
 7    personal NO2 measurement with passive samplers and an average measurement time of a couple
 8    of days to two weeks. In most studies, an equilibrium condition was assumed and the effects of
 9    dynamics on the indoor, outdoor, and personal association were not evaluated, which could result
10    in missing the peak exposure  and obscuring the real short-term outdoor contribution to indoor
11    and personal exposure. For example, the NO2 concentrations at locations close to busy streets in
12    urban environments may vary drastically with time. If the measurement is carried out during a
13    non-steady-state period, the indoor/outdoor concentration ratio may indicate either a too low
14    relative importance of indoor sources (if the outdoor concentration is in an increasing phase) or a
15    too high relative importance of indoor resources (if the outdoor concentration is in a decreasing
16    phase). The lower the air exchange rate, the greater the error due to the effects of transients
17    (Ekberg, 1996).
18
19    School and Office
20          Workplaces (schools and offices) are the places where people spend most of their time
21    after homes in an urban area.  The location, indoor sources as well as the ventilation pattern of
22    schools and offices could be different from people's homes. Therefore, personal exposure
23    patterns in schools and offices could be different from exposure patterns at  home. However,
24    NO2 concentrations in schools and offices have only been measured in only a few exposure
25    studies.
26          Most studies reported  the personal exposure levels were lower than  or equal to office
27    NO2 levels. Lai et al. (2004) reported that a cohort in Oxford spent 17.5% of their daily time in
28    offices, and mean personal total NO2 exposure was 15 ppb and 16.8 ppb for mean office
29    concentrations. Mosqueron et al. (2002) reported Paris office worker exposure levels and no
30    significant difference was found between personal total exposure (22.8 ppb) and NO2
31    concentrations in office (23.5 ppb). Personal exposures in schools were studied in Helsinki,
32    Southampton and Southern California.  Aim et al. (1998) and Mukala et al.  (2000) reported the

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 1    personal exposure levels in Helsinki for pre-school children.  They reported that median personal
 2    exposures were lower than the median NO2 concentrations measured inside the day care center
 3    (13.1 ppb for personal exposure versus 18.8 ppb for inside day-care center for downtown winter;
 4    14.7 ppb versus 24.1 ppb for downtown spring; 8.9 ppb versus 15.2 ppb for suburban winter; and
 5    8.9 ppb versus 13.1 ppb for suburban spring). Linaker et al. (1996) found that the geometric
 6    mean of school children exposures (18.8 ppb) was higher than geometric  means of the NC>2
 7    concentrations in classrooms (8.4 to 14.1 ppb) in a study of children's exposures to NC>2 in
 8    Southampton, UK. A similar exposure pattern was found by Linn et al. (1996) during the
 9    Southern  California school children exposure study. During the study, personal exposure
10    (22 ppb) was higher than the NC>2 concentration inside school (16 ppb). NC>2 concentration in
11    school/office is determined by ambient NO2 level, local traffic sources, floor height and building
12    ventilation pattern. Partti-Pellinen et al. (2000) studied the effect of ventilation and air filtration
13    systems on indoor air quality in a children's day-car center in Finland.  Without filtration, NOx
14    and PM generated by nearby motor traffic penetrated readily indoors. With chemical filtration,
15    50 to 70% of nitrogen oxides could be removed.  The authors suggested that the possible adverse
16    health effects of nitrogen oxides and particles indoors could be countered by efficient filtration.
17    Mosqueron et al. (2002) reported 24% of variations in in-office NC>2 concentrations could be
18    explained by outdoor NC>2 levels (18%), and floor height (6%) and an inverse relation was
19    observed  between in-office concentration and floor height. Aim et al. (1998) attributed the high
20    NO2 concentration in the day-care center to its close to major roads.  Obviously, the relative
21    scale of personal exposure and school concentration also depends on personal activities outside
22    schools and workplaces.
23           Significant associations between personal exposure and workplace concentrations were
24    reported by most studies. Mosqueron et al.  (2002) reported office NC>2 was a significant
25    predictor  of personal exposure and 15% of the personal exposure was explained by time
26    weighted  office NC>2 concentrations. Aim et al. (1998) reported population NC>2 exposures were
27    highly correlated with the NC>2 levels inside the day-care centers (R2 = 0.88). However, Lai et al.
28    (2004) reported a nonsignificant Pearson correlation coefficient (0.15) between personal
29    exposure  and workplace  indoor concentration and the authors suggested that the strong
30    residential indoor sources and long time indoors obscured the personal versus office relationship.
31    Personal total exposure is a function of NC>2 concentrations in different indoor and outdoor

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 1    microenvironments and how long a person stays in that microenvironment. The large variation
 2    of NC>2 exposure in some microenvironments could obscure the association between personal
 3    exposure and NC>2 concentrations in other microenvironments.
 4
 5    In Traffic
 6           On-road NC>2 concentrations could be substantially higher than ambient or residential
 7    outdoor NC>2 concentrations, especially in a street canyon, which are narrow with enclosing
 8    architecture and slow-moving traffic. As shown in Figure AX3.5-1, NC>2 in heavy traffic
 9    (-60 ppb) can be over twice the concentration in a residential outdoor level (-26 ppb) in North
10    America (Lee et al., 2000). The UK and Scandinavian data in the plot may have been obtained
11    outside homes close to traffic.  Westerdahl et al. (2005) reported on-road NC>2 concentrations in
12    Los Angeles ranging from 40 to 70 ppb on freeways, and 20  to 40 ppb on residential or arterial
13    roads. People in traffic can potentially experience such high concentrations and NO2 exposures
14    due to the high air exchange rates for vehicles.  Park et al. (1998) measured the air exchange
15    rates in three stationary automobiles under four conditions: windows closed and no mechanical
16    ventilation, windows closed with fan set  on recirculation, windows  open with no mechanical
17    ventilation, and windows closed with the fan set on fresh air.  The reported air exchange rates
18    varied from 1.0 to 3.0 IT1 with windows  closed and no mechanical ventilation to 36.2 to 47.5 IT1
19    with windows closed and the fan set on fresh air.  It implies that the NC>2 concentration inside  a
20    vehicle is at least the same as the surrounding NC>2 concentration, or in other words, "on-road"
21    NC>2 can quickly and almost completely infiltrate into the "in-vehicle" environment contribute to
22    in-vehicle personal exposures.  Although people only  spend a small fraction of their time in
23    traffic (5% to 7%), exposure while commuting could be a significant contributor to personal
24    exposure to NC>2 due to the high concentration of NC>2 in traffic. Liard et al. (1999) reported that
25    both NO and NC>2  exposure levels increased with the number of hours spent in a car.  During the
26    study, NO and NO2 concentrations were  separated into three levels  according to the distribution
27    tertiles. Personal exposure levels increased from low to high when  accordingly people spent
28    from 2.5 h in a car to 6.7 h in a car.  The  same relationship only held for one of the two sampling
29    periods, in which personal NO2 exposures increased from low to high when the time people
30    spent in a car increased from 3.5 h to 5.7 h.
31           Bell and Ashenden (1997) and Kirby et al. (1998) reported the NO2 concentration along
32    major roads and street canyons in UK, and they found that monthly mean NO2 concentrations  on

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                0                      50                   100                   150
                        Estimated NO2  Level during Commuting (ppb)
     Figure AX3.5-1.     Average residential outdoor concentration versus concentration
                         during commuting for
     Source: Lee et al. (2000).

 1   major roads were consistently higher (up to 20 ppb) than those found 250 m away from the
 2   major roads. It is important to distinguish between short-term peak exposure and chronic
 3   exposures because health effects associated with short-term peak exposures might be different
 4   from chronic exposures to ambient NC>2.
 5          Other than infiltration of ambient air, the intrusion of the vehicle's own exhaust into the
 6   passenger cabin is another NC>2 source contributing to personal  exposure while commuting.  The
 7   intrusion of a school bus's own exhaust into the bus cabin was found by Sabin et al. (2005), but
 8   the fraction of air inside the bus cabin from the bus's own exhaust was small, ranging from
 9   0.02% to 0.28%. Marshall and Behrentz (2005) also reported the intrusion of exhaust into the
10   bus cabin and indicated that average per capita inhalation of emissions from any single bus is
11   105-106 times greater for a passenger on that school bus than for a typical resident in the same
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 1    area. CARB (2007) reported that self-pollution increased with increasing age of the bus. Fuel
 2    type could be another factor affecting personal exposure while commuting.  Sonetal. (2004)
 3    found that the two-day averaged NO2 exposures for taxi drivers using LPG fueled vehicles
 4    (26.3 ppb) were significantly lower than those using diesel-fueled vehicle (38.1 ppb).  However,
 5    in another taxi driver exposure study, Lewne et al. (2006) did not find an effect on taxi driver
 6    exposures to NO2 due to fuel differences (diesel versus petrol).  Sabin et al. (2005) reported that
 7    NO2 concentrations were significantly higher inside diesel buses than inside the compressed
 8    natural gas buses.  CARB (2007) showed that the NO2 concentrations on a conventional diesel
 9    bus was 2.8 times higher than the ambient concentration (76 ppb in cabin versus 27 ppb  in
10    ambient) while windows were closed, and 3.85 times higher than the ambient concentration
11    (77 ppb in cabin versus 20 ppb in ambient) while windows were open. However, the ratio of
12    cabin NO2 to ambient NO2 was much lower for a compressed natural gas bus: 1.2 for windows
13    closed and 2.2 for windows opened.
14          While commuting, concentrations for personal exposure or in a vehicle cabin could be
15    substantially higher than corresponding residential indoor, outdoor, and ambient concentrations.
16    Sabin et al. (2005) measured concentrations of a number of pollutants (black carbon, particulate
17    PAHs and NO2 in school buses on routes in Los Angeles. Mean cabin concentrations for
18    individual runs ranged from 24 to 120 ppb. Concentrations of NO2 tended to be slightly higher
19    for open compared to closed windows on urban routes.  These concentrations were typically
20    factors of 2.3 to 3.4 higher than at ambient monitors in the area.  However, the highest ratios
21    found ranged from 3.9 to 5.3.  They concluded that children commuting in areas such as Los
22    Angeles may be exposed to much higher levels of pollutants than are obtained at ambient, central
23    site monitors. Lewne et al. (2006) reported work hour exposures to NO2 for taxi drivers
24    (25.1 ppb), bus drivers (31.4 ppb) and lorry drivers (35.6 ppb).  The ratios of in-vehicle
25    exposures to urban background were 1.8, 2.7, and 2.8 for taxi drivers, bus drivers and lorry
26    drivers, respectively. Due to the high peak exposures during commuting, total personal  exposure
27    could be underestimated if exposure in traffic are not considered; and sometimes exposure in
28    traffic can dominate personal  exposure to NO2.  In a personal exposure study in Brisbane and
29    Queensland, Australia, two-day averaged indoor, outdoor, and personal NO2 were measured by
30    Yanagisawa badges (Lee et al., 2000). Lee et al. (2000) found that estimated personal exposures
31    (22.5 ppb) significantly underestimated the measured personal exposures (28.8 ppb) if personal

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 1    exposures in traffic were not considered.  Son et al. (2004) reported two-day averaged indoor,
 2    outdoor, in vehicle and personal NC>2 concentrations measured by passive filter badges for
 3    31 taxi drivers in Korea.  Measured personal concentrations (30.3 ppb) were higher than both
 4    residential indoor (24.7 ppb) and residential outdoor concentrations (23.8 ppb). A stronger
 5    correlation was observed between personal NO2 exposures and interior vehicle NO2 levels, than
 6    for residential indoor and residential outdoor levels (rp = 0.89 for Personal versus Vehicle,
 7    rp = 0.74 for Personal versus Indoor; and rp = 0.71 for Personal versus Outdoor).
 8          Variations in traffic exposure could be attributed to time spent in traffic, type of vehicle,
 9    traffic congestion levels, encounters with other diesel vehicles, type of fuel and driving location
10    (urban/rural) (Sabin et al., 2005; Son et al., 2004; Chan  et al., 1999).
11
12    Microenvironments Close to NO2 Sources
13          As suggested previously in this chapter, both large and small-scale variations exist in
14    ambient NC>2 concentrations.  In this section, those microenvironments and associated personal
15    exposures, which are close to traffic sources and might make significant contributions to total
16    personal NC>2 exposures are analyzed. These microenvironments could be residential outdoor
17    environments and some other outdoor environments, such as parking lots and playgrounds; they
18    could also be indoor environments as well, such as homes and classrooms. Concentrations in
19    these microenvironments and personal exposure characteristics in these microenvironments will
20    be summarized below.
21          Many studies show that outdoor NC>2 levels are strongly associated with distance from
22    major roads (the closer to a major road, the higher the NO2 concentration) (Gilbert et al., 2005;
23    Roorda-Knape et al., 1998; Lai and Patil, 2001; Kodama et al., 2002; Gonzales et al., 2005;
24    Cotterill and Kingham, 1997; Nakai et al., 1995). Meteorological factors (wind direction and
25    wind speed), and traffic density are also important for interpreting measured NC>2 concentrations
26    (Gilbert et al., 2005; Roorda-Knape et al., 1998; Rotko et al., 2001; Aim et al., 1998; Singer
27    et al., 2004; Nakai et al., 1995). Gonzales et al. (2005) found an inverse correlation between
28    NO2 concentration and distance from a highway (rp = -0.81, p < 0.001) in the El Paso region.
29    Nakai et al.  (1995) reported the results of a study designed to explore the differences of indoor,
30    outdoor and personal exposure levels among residence zones located varying distances from
31    major roads with heavy traffic in Tokyo.  The authors found that outdoor NC>2 concentrations in
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 1   Zone A (0-20 m from the road) was always the highest among the three zones (Zone B was 20-
 2   150 m from the road, and Zone C was a reference zone in a suburban area). The differences of
 3   the mean levels between Zone A and Zone C ranged from 11 ppb to 39 ppb.  Kodama et al.
 4   (2002) reported NC>2 levels for indoor, outdoor and personal exposure among 150 junior high
 5   school student homes in two major traffic areas in Tokyo. Forty-eight h average NC>2
 6   concentrations were measured by Yanagisawa badge.  NO2 tended to decrease according to
 7   distance from the roadside; the difference was about 10 ppb between the roadside (0-50 m) and
 8   the site far away from the road (200 m).  Singer et al. (2004) reported results of the East Bay
 9   Children's Respiratory Health Study. The authors reported weekly integrated NC>2 and NOx
10   concentrations measured by Ogawa passive samplers placed outside ten elementary schools and
11   selected student residences during 14 weeks in spring and 8 weeks in fall 2001. The authors
12   found that NC>2 concentrations increased with decreasing downwind distance for school and
13   neighborhood sites within 350m downwind of a freeway, and schools located upwind or far
14   downwind of freeways were generally indistinguishable from one another and regional pollution
15   levels. An exponential equation was used to fit the measured concentrations to distance from the
16   freeway:  C(x) = KixK2 where C is the measured concentration and x is the distance (m) from a
17   freeway.  A high R2 was observed (R2 = 0.80, KI = 128, and K2 = -0.356 for NO2; R2 =  0.76, KI
18   = 376, and K2 = -0.468). According to this equation, NC>2 concentrations 100 m away from the
19   freeway are about 20% of those at roadside.
20          Elevated NC>2 concentrations were also observed and reported in parking lots and school
21   playgrounds.  Lee et al. (1999) reported the concentration of NC>2 at a parking lot in Hong Kong
22   was 60 ppb, and the level was about the same for NO. Colbeck (1998) reported that
23   concentrations in two parking lots in Colchester, UK were similar to those measured at the curb
24   side.  Exposure of car parking lot users to NC>2 is comparable to that arising in the vicinity  of
25   roads with moderate traffic density (-9000 vehicles per day). NC>2 concentrations in one parking
26   lot ranged from 30.4 to 47.1 ppb, while those in the payment booth ranged from 22.5 to 31.4 ppb.
27   Rundell et al. (2006) reported PMi, NO2,  SO2, CO, and O3 concentrations at four elementary
28   school playgrounds and one university soccer field in Pennsylvania. NO2 concentrations were
29   below 100 ppb. The number  concentration in the PMi size fraction decreased with distance
30   away from the highway (from 140,000 number/cm3 within 10 m of the road to 40,000
31   number/cm3 at 80 m).

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 1          Indoor environments, which are close to traffic, include buildings and houses along
 2    major, busy roads. Most studies show that indoor NC>2 is correlated with outdoor NC>2, and is
 3    also a function of distance to traffic, traffic density and meteorological parameters.  The level of
 4    indoor NC>2 in those microenvironments is also affected by indoor sources. Bae et al. (2004)
 5    reported indoor and outdoor concentrations of NC>2 in 32 shoe stalls in Seoul, which were located
 6    on busy streets. Working-hour (10 ± 2.1 h) NC>2 was measured by Yanagisawa passive filter
 7    badges. Mean indoor and outdoor NC>2 concentrations were 57.4 and 58.1 ppb with a mean
 8    indoor vs. outdoor ratio of 0.93. Maximum indoor and outdoor NC>2 concentrations were 94.1
 9    and 96.3 ppb.  In this study, outdoor traffic generated NC>2 is likely the main source of indoor
10    exposures due to the lack of indoor NC>2 sources. Outdoor and in-classroom NC>2 were measured
11    using Palmes tubes during three 2-week periods in six  city districts near motor ways in the West
12    of the Netherlands (Roorda-Knape et al., 1998). NC>2 concentrations in classrooms were
13    significantly correlated with car and total traffic density (rp = 0.68), percentage of time
14    downwind (rp  = 0.88) and distance of the school from the motorway (rp = -0.83).  Cotterill and
15    Kingham (1997) measured indoor and outdoor NC>2 in 40 homes in Huddersfield, UK, over three
16    consecutive two-week periods in late 1994 using Palmes tubes. The authors found that
17    proximity to a main road had little effect on indoor levels of nitrogen dioxide (a mean of 1 ppb
18    indoor concentration difference was found for homes close to main roads and homes close to
19    side roads). A t-test suggested that there was no difference in indoor levels of nitrogen dioxide
20    due to proximity to the main road after indoor sources  were controlled by the type of cookers.
21    In this study, meteorological parameters were measured, but meteorological parameters were not
22    controlled during data analysis.
23          Personal exposure is determined by both indoor and outdoor levels of NC>2.  Most studies
24    show significant associations between personal exposure and the traffic density.  The influence
25    of indoor sources on personal exposure was also observed in those studies. Aim et al. (1998)
26    reported the weekly personal NC>2 exposures of 246 children aged 3-6 years in Helsinki. Weekly
27    personal exposures were measured for 13 weeks in winter and spring in  1991 using Palmes
28    tubes. The 13 week geometric mean of the NC>2 exposures was higher for the children living in
29    the downtown (13.9 ppb) than in the suburban area (9.2 ppb, p = 0.0001). Rotko  et al. (2001)
30    reported the EXPOLIS-Helsinki study results and observed that the NC>2 exposure was
31    significantly associated with traffic volume near homes.  The average exposure level of

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 1    138 subjects having low or moderate traffic near their homes was 12.3 ppb, while the level was
 2    15.8 ppb for the 38 subjects having high traffic volume near home.  Gauvin et al. (2001) reported
 3    the VESTA study results.  An index of traffic density and proximity was constructed as the ratio
 4    of traffic density to distance from a roadway. The index was one of the significant interpreters of
 5    personal exposure in all three cities (p < 0.05 for Grenoble and Toulouse, and 0.05 < p < 0.15 for
 6    Paris). Kodama et al. (2002) showed that personal exposure was similar to residential home NO2
 7    concentration for residences along busy roads. The authors also observed that personal exposure
 8    levels were higher than outdoor levels during the winter, while during the summer, personal
 9    exposure levels were lower than ambient levels, due to the influence of indoor sources and low
10    ventilations in the winter.  Although the personal to outdoor relationship was dominated by
11    indoor sources, the effects of outdoor NO2 on personal exposure could still be observed after
12    controlling the indoor source effects. Nakai et al. (1995) observed that personal exposure levels
13    basically followed the ambient concentrations patterns given above; i.e., exposures in Zone A
14    (0-20 m from the road) were the highest and exposures in Zone C (the suburban background
15    area) were the lowest for residents not using an unvented heater (as defined before, Zone A was
16    0-20 m from the road; Zone B was 20-150 m from the road. The maximum difference of
17    personal exposure between Zone A and Zone C was approximately 20 ppb. The NO2 exposure
18    for a special population, athletes, was addressed by  Carlisle and Sharp (2001). The authors
19    pointed out that athletes could be a potential population at risk, if the ambient NO2 concentration
20    is high because (1) inhalation rate increases during exercise, (2) a large fraction of air is inhaled
21    through the mouth during exercise, effectively bypassing the normal nasal mechanisms for the
22    filtration of large particles and soluble vapors, and (3) the increased air flow velocity carries
23    pollutants deeper into the respiratory tract and pulmonary diffusion capacity increases during
24    exercise.  This might also be true for outdoor workers but few data  are available to perform the
25    exposure assessment.
26          Although traffic is a maj or source of ambient NO2, industrial point sources are also
27    contributors to ambient NO2.  However, no published reports were found to address the effect of
28    those sources on population exposure within the United States. Nerriere et al. (2005) measured
29    personal exposures to PM2 5, PMio, and NO2 in traffic dominated, urban background and
30    industrial settings in Paris, Grenoble, Rouen, and Strasbourg, France. They always found highest
31    ambient concentrations and personal exposures close to traffic. In some cases, urban and

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 1   background, concentrations of NC>2 were higher than in the industrial zone. However, PM levels
 2   and personal exposures tended to be higher in the industrial area than in the traffic dominated
 3   area.  It should be remembered that there can be high traffic emissions in industrial zones, such
 4   as in the Ship Channel in Houston, TX.  In rural areas where traffic is sparse, other sources could
 5   dominate. For example, Martin et al. (2003) found pulses of NC>2 release from agricultural areas
 6   following rainfall and there are contributions from wildfires and residential wood burning.
 7
 8   Exposure Reconstruction
 9          Personal exposure has been evaluated in each major microenvironment, where either the
10   NC>2 concentration is high or people spend most of their daily time. As shown in Equation
11   AX3.5-2, personal exposure could be reasonably reconstructed if we know the NO2
12   concentration in each microenvironment and the duration of personal exposure in each
13   microenvironment. Levy et al., (1998a) reconstructed personal exposures measured in an
14   international study with a time-weighted average exposure model (Equation AX3.5-1).  The
15   personal exposure was reconstructed based on the measured NC>2 concentrations in residential
16   indoor, residential outdoor, and workplace microenvironments, and the time people spent in
17   those environments.  The mean measured personal NC>2  exposure was 28.8 ppb and a mean of
18   estimated NC>2 exposure was 27.2 ppb. The Spearman correlation coefficient between personal
19   measured exposure and reconstructed exposure was 0.81. The same approach was  applied by
20   Kousa et al. (2001) to reconstruct the personal exposures in the EXPOLIS study.  A correlation
21   coefficient of 0.86 was  observed for the association between measured NC>2 exposure and
22   reconstructed NO2 exposure (data were log-transformed), and the slope and the intercept were
23   0.90 and 0.22 respectively for the reconstructed exposure vs. measured exposure. In the two
24   studies mentioned above, NC>2 exposure during commuting was not measured.  Probably that is
25   part of the reason why reconstructed NC>2 exposure was  lower than the measured NC>2 exposure.
26
27   AX3.5.3    Exposure Indicators
28          Physically, personal exposure levels are determined by those physical parameters in
29   Equations AX3.5-1 to AX3.5-5, i.e., the time people spend in each microenvironment and the
30   NC>2 concentrations in each microenvironment, which is determined by source emission strength,
31   air exchange rate, penetration coefficient, the NC>2 decay rate and the volume of the
32   microenvironment. Any factors that can influence the above physical parameters can modify the

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 1    level of personal exposure. These factors are defined as exposure indicators in this section. The
 2    indoor, outdoor and personal NO2 levels on each stratum of those factors will be summarized.
 3           Those factors can be classified in to the following categories:  (1) factors associated with
 4    environmental conditions, such as weather and season; (2) factors associated with dwelling
 5    conditions, such as the location of the house and ventilation system; (3) factors associated with
 6    indoor sources, such as the type of range and the fuel type; (4) factors associated with personal
 7    activities, such as the time spent on cooking or commuting; (5) socioeconomic status, such as the
 8    level of education  and the income level; and (6) demographic factors, such as age and gender.
 9           Most studies addressed the influences of dwelling condition and indoor sources on indoor
10    and personal exposures. A few studies explored the impacts of environmental factors and
11    personal activities on personal exposures. Indoor and personal exposures have rarely been
12    stratified by socioeconomic and demographic factors. Indoor, outdoor, and personal exposure
13    levels are presented in  Table AX3.5-8, stratified by environmental factors,  dwelling conditions,
14    indoor sources, and personal activities factors.  The effects of socioeconomic and demographic
15    factors on the indoor, outdoor, and personal levels are summarized in Table AX3.5-9.
16           Season is an environmental factor affecting both indoor and outdoor levels, and thus
17    personal NO2 levels. During the wintertime, the mixing height is usually lower than during the
18    summer, and therefore concentrations of many primary pollutants are higher than in the summer.
19    Wintertime is also a heating season,  which usually leads to higher indoor source emissions and
20    lower air exchange rates. Therefore, a higher indoor NO2 concentration can be expected during
21    the winter. For most cases, the differences of indoor or personal  NO2 exposure between the
22    heating and non-heating season are within several ppb, but sometimes the difference could be
23    close to 20 ppb (Zota et al., 2005). Other environmental factors include day of the week
24    (weekday versus weekend), and the wind direction, as shown in Table AX3.5-8.
25           The dwelling conditions are also associated with indoor, outdoor, and personal NO2
26    levels. Location of the dwelling unit is an indicator of ambient NO2 source strength. A house
27    located in an urban center or close to a major road is  expected to  have higher outdoor and indoor
28    NO2 levels, and the differences in NO2 exposures are often within 20 ppb based on passive
29    sampler monitoring. The age of the  house, house type, and window type can affect the
30    ventilation of dwelling units, and sometimes the type of heating and cooking applicances in a
31    house. Range and fuel type are the indoor source factors discussed the most in the literature. It

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 1    is common to see differences larger than 10 ppb in indoor and personal NO2 exposures between a
 2    gas range home (especially gas range with pilot light) and an electric range home. Sometimes
 3    the differences could be as high as 40 ppb. For peak short-term exposures, the difference could
 4    reach 100 ppb.
 5          The level of personal exposure is dependent upon the time a person spends in each
 6    microenvironment. Kawamoto et al. (1997), Levy et al. (1998a), and Chao and Law (2000)
 7    clearly showed that personal NO2 exposure increases with time spent cooking or commuting.
 8          The common findings are summarized above.  However, there are inconsistencies in the
 9    literature. For example, smoking is claimed to be a significant factor in some studies but not in
10    others, and the same can be  said for proximity to a major road. For another example, a higher
11    indoor NO2 level could be found in a rural home rather than in an urban home (Table AX3.5-8),
12    although most studies found the opposite.  Part of the reason is that exposure indicators function
13    together, as a multidimensional parameter space, on indoor and personal exposures.  They are
14    not independent of each other.  Unfortunately, studies have rarely been conducted to understand
15    the associations between these exposure indicators and to use the study findings to explain
16    indoor and personal NO2 exposures.
17          More effort put on exposure indicator studies should help in finding better surrogate
18    measurements for personal exposures. Although misclassifying exposures in epidemiological
19    studies is almost inevitable,  and it is unlikely that the personal exposures of all subjects will be
20    measured, a better knowledge of the effects of exposure indicators on personal exposure will
21    help reduce exposure errors in exposure and epidemiological studies and help interpret those
22    study results.
23
24
25    AX3.6    CONFOUNDING AND SURROGATE ISSUES
26          Confounding is the technical term for finding an association for the wrong reason. It is
27    associated with both the exposure and the disease being studied, but is not a consequence of the
28    exposure. The confounder does not need to be an exposure for the disease under study. The
29    confounding variable can either inflate or deflate the true relative risk.
30          Since epidemological studies of NO2 often use ambient concentrations to reflect
31    exposures, whether confounding of NO2 findings is possible can be determined by examining
32    associations among ambient concentrations and personal exposures to NO2 and its relevant

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 1    copollutants. Importantly, by examining these associations, it is also possible to evaluate
 2    whether a copollutant may act as a confounder or as a proxy of ambient NO2 concentrations.
 3          The potential for confounding of ambient NO2 health effects is discussed in terms of four
 4    relationships:  (1) ambient NO2 and ambient copollutant concentrations, (2) personal NO2 and
 5    personal copollutant exposures, (3) personal NO2 exposures and ambient copollutant
 6    concentrations, and (4) ambient NO2 concentrations and personal copollutant exposures.
 7
 8    1) Associations between Ambient NO 2 and Ambient Copollutant Concentrations
 9          Confounding of NO2 health effects is often examined at the ambient level, since ambient
10    concentrations are generally used to reflect exposures in epidemiological studies. The majority
11    of studies examining pollutant associations in the ambient environment have focused on ambient
12    NO2, PM2.5 (and its components), and CO, with fewer studies reporting the relationship between
13    ambient NO2 and ambient O3 or SO2.
14          Correlations between concentrations of ambient NO2 and other ambient pollutants, PM2 5
15    (and its components where available), CO, Os and SO2 are summarized in Table AX3.6-1. Data
16    were compiled from Environmental Protection Agency's Air Quality System and a number of
17    exposure studies. Mean values of site-wise correlations are shown.  As can be seen from the
18    table, NO2 is moderately correlated with PM2.5 (range: 0.37 to 0.78) and with CO (0.41 to 0.76)
19    in suburban and urban areas.  At rural locations, such as Riverside, CA, associations between
20    ambient NO2 and ambient CO concentrations (both largely traffic-related pollutants) are much
21    lower, likely as the result of other sources  of both CO and NO2 increasing in importance in rural
22    areas. These sources include oxidation of CH4 and other biogenic compounds, wood burning
23    and wildfires (for CO); and soil emissions, lightning, and wood burning and wildfires for NO2.
24    In urban areas, the ambient NO2-CO correlations vary widely. The strongest correlations are
25    seen between NO2 and elemental carbon.  Note that the results of Hochadel et al. (2006) for
26    PM2 5 optical absorbance have been interpreted in terms of elemental carbon (EC). Correlations
27    between ambient NO2 and ambient Os are  mainly negative, with again considerable variability in
28    the observed correlations.  Only one study (Sarnat et al., 2001) examined associations between
29    ambient NO2 and ambient SO2 concentrations, showing a negative correlation during winter.
30    The robustness of this result needs to be examined in other cities.
31          Kim et al. (2006) reported the associations between 24 h averaged NO2 and other
32    pollutions for personal  exposures and ambient concentrations in a study in Toronto, Canada from

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 1    August 1999 to November 2001. The median, mean, and standard deviation of the correlations
 2    between ambient NO2 and ambient PM2.5 were 0.52, 0.44, and 0.35 respectively; and 0.81, 0.72,
 3    and 0.22 respectively for the correlation between NO2 and CO.
 4          In an exposure study in Steubenville, Ohio, Sarnat et al. (2006) reported the associations
 5    between ambient concentrations and personal exposures for different pollutants.  Ambient NO2
 6    was significantly associated with ambient PM2.5, sulfate and EC during the fall (slope = 0.38,
 7    0.96, and 7.01; and R2 = 0.61, 0.49, and 0.68 respectively) but not during the summer
 8    (slope = -0.01, -0.17, and 3.76; and R2 = 0.0, 0.01, and 0.06 respectively).
 9          In a related study, Connell et al. (2005) reported the correlation between ambient NOx
10    and PM2.5 during a comprehensive air monitoring program in Steubenville, Ohio. Across the two
11    year study (August 2000-April 2002), the Spearman correlation coefficient (rs) between hourly
12    ambient PM2.5 and NO concentrations was 0.33, and between hourly ambient PM2.5 and NO2
13    concentrations was 0.50.  The authors suggested the importance of a common factor influencing
14    ambient concentrations of these species.
15          Kim et al. (2005) analyzed particle composition and gas phase data collected during the
16    RAPS/RAMS study on St. Louis, MO from 1975 to 1977 in terms of source contributions to
17    PM2.s. This study  examined the spatial variability of source contributions to PM2.5 at the ten
18    monitoring sites in that study.
19          Sarnat et al. (2001) and reported associations between personal exposures and ambient
20    concentration across pollutants in a study conducted in the Baltimore area. At the ambient level,
21    NO2 was significantly correlated with PM2.5 (rs = 0.37) and  CO (rs = 0.75) during the summer
22    and with CO (rs =  0.76), SO2 (rs = -0.17), PM2.5 (rs = 0.75) and O3 (rs = -0.71) during the winter.
23          Linn et al.  (1996) reported short-term air pollution exposures in Los Angeles area school
24    children.  Correlations between different pollutants were weaker: rp = 0.11 for ambient NO2 and
25    O3; rp = 0.25 for ambient NO2 and outdoor PM2.5.
26          Lee et al. (2002) found that ambient NO2 was significantly correlated with O3
27    (rp =  -0.34).
28    Foreign Studies
29          Hochadel et al. (2006) reported the results of research which is  part of a cohort study on
30    the impact of traffic-related air pollution on respiratory health, conducted at the western end of
31    the Ruhr-area in North-Rhine Westphalia, Germany. Strong correlations across the measurement

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 1    sites were observed between annual average PM2.5 absorbance and NO2 concentrations
 2    (rp = 0.93), whereas PM2.5 mass concentration was less strongly correlated with NO2 (rp = 0.41).
 3    The only major absorbing agent in PM2.5 is elemental carbon (EC) as other components (sulfate,
 4    nitrate, organic carbon) either do not absorb or at best are only weakly absorbing. Therefore,
 5    correlations between PM2 5 absorbance and NO2 may be inferred as correlations between EC
 6    and NO2.
 7           Hazenkamp-von Ark et al. (2004) reported the PM2 5 and NO2 associations across 21
 8    European study centers during ECRHS II.  The correlation between annual NO2 and PM2.5
 9    concentrations is fair (Spearman correlation coefficient rs = 0.75), but when considered as
10    monthly means, the correlation is far less consistent and varies substantially between centers.
11    The authors pointed out that NO2 is attributed to traffic emissions, a relatively constant source of
12    pollution throughout the year.  PM2 5 on the other hand, can be driven by other sources such as
13    wind-blown dust, although usually it consists predominantly of primary and secondary particles
14    from combustion processes. Sources,  such as Saharan dust in Spain,  probably cause some of the
15    observed patterns. The wide range of correlations between PM2 5 and NO2 evokes the hypothesis
16    that monthly PM2 5 mass concentrations in some centers may be driven by traffic emissions,
17    whereas in other centers, particles from other sources may be of further relevance.
18           Cyrys et al. (2003) reported the results of a source apportionment study in Erfurt,
19    Germany. Hourly NO2 was correlated with NO, CO, PM0.oi-2.5 number concentration, and
20    PM0.oi-2.5 mass concentration (rp = 0.73, 0.74, 0.55, and 0.50 respectively). Stronger correlations
21    were found daily correlation between NO2 and NO, CO, PMo.oi-2.5 number concentration, and
22    PMo.oi-2.5 mass concentration (rp = 0.87, 0.76, 0.71, and 0.66 respectively). The observed high
23    correlations between CO, NO, and NO2 indicate that direct emissions from mobile sources might
24    be the major contributors to the concentrations of these gaseous pollutants.
25           Rojas-Bracho et al. (2002) conducted a study of children's exposures in Santiago, Chile.
26    During the study, indoor, outdoor, and personal PM2.5, PMio, PMio-2.5, and NO2 were measured
27    24 h averaged for five consecutive days). Outdoor NO2 was significantly associated with all PM
28    fractions (slope = 1.82 and R2 = 0.59 for PM2.5; slope = 3.12 and R2 = 0.57 for PMi0; and slope =
29    1.11 and R2 = 0.32 for PM2.5-io).
30           Modig et al. (2004) investigated whether NO2 can be used to indicate ambient and
31    personal levels of benzene and 1, 3-butadiene in air.  The stationary measurements showed

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 1    strong relations between 1,3-butadiene, benzene and NO2 (rp = 0.70 for NO2 and benzene; and
 2    r = 0.77 for NC>2 and 1,3-butadiene).  This study supports NC>2 as a potential indicator for
 3    1,3 butadiene and benzene levels in streets or urban background air.
 4           In summary, ambient NC>2 was moderately correlated with corresponding ambient
 5    concentrations of its co- pollutants. Based on associations in the ambient environment, results
 6    suggest a possibility of confounding of ambient NC>2 health effects by ambient PM2.5 (and its
 7    components) and by ambient CO.
 8
 9    2) Associations between Personal (NO 2) and Personal Copollutant Exposures
10           For this section,  measured personal NC>2 exposures are regarded as the "true" personal
11    exposure.  The correlation between personal NC>2 exposure and personal exposure to other
12    pollutants are summarized below in Table AX3.6-2.
13           In Kim et al. (2006), the median, mean and standard deviation of the correlation between
14    NC>2 and PM2.5 personal exposures for eleven subjects were 0.43, 0.41, and 0.28 respectively;
15    and 0.16, 0.12, and 0.42 respectively  for the correlation between NO2 and CO (Kim et al., 2006).
16           Although Sarnat et al. (2001)  found that personal exposures to PM2.5 were generally not
17    significantly associated with personal exposures to gases in Baltimore, personal NO2 was
18    significantly associated with personal PM2.5 (slope = 0.18, intercept = 18.65, p < 0.01, and
19    n = 213) and personal PM2.5 of ambient origin  (slope = 0.17, intercept = 12.77, p < 0.05, and
20    n = 150) during the summer.  There was some evidence to indicate that the strength of the
21    association was driven largely by the cohort of  older adult subjects, and not by the children's or
22    COPD  patients cohorts.  They noted that gas stove usage did not significantly affect personal
23    NO2 to PM2.5 relations, but did affect relations between personal NO2 and personal PM2.5 of
24    ambient origin. They further pointed out that associations observed among pollutants in ambient
25    air may not be reflected in personal exposures and that they may not persist across seasons.
26    However, Lai et al. (2004) found that personal exposure to NO2 was slightly negatively
27    correlated with personal exposure to PM2.5 and  total VOCs in a study conducted from 1998  to
28    2000 in Oxford, UK (- 0.1 for PM2.5,  0.3 for CO, and -0.11 for TVOCs).
29           Modig et al. (2004) investigated whether NO2 can be used to indicate ambient and
30    personal levels of benzene and 1, 3-butadiene in air. The results from the personal
31    measurements showed a negligible association  of NO2 with 1,3-butadiene (rp = 0.06) as well as
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 1    with benzene (rp = 0.10), while the correlation coefficient between benzene and 1,3-butadiene
 2    was high and significant (rp = 0.67).  The weak relations found for the personal measurements do
 3    not support the use of NO2 as an indicator for personal 1,3-butadiene and benzene exposure.
 4    Although gas stove and kerosene heaters were almost absent in the study area, this study
 5    included both smokers  and non-smokers, but the data were not stratified. Smoking is a major
 6    source of both benzene and 1,3-butadiene, in addition to motor vehicles.  If smoking were the
 7    major cause of the poor association between NO2 and the  gases in the personal measurements,
 8    then this would indicate that smoking was not a major source of personal NO2. Thus, this study
 9    cannot determine whether personal NO2 is an indicator of traffic generated VOCs and so the
10    interpretation of results in this paper is problematic.
11          In the Paris office worker study, no relation was observed between personal NO2 and
12    PM2.5 exposures (rp = 0.12, n = 53, p = 0.38) (Mosqueron  et al., 2002). In addition, NO2 and
13    PM2.s concentrations were correlated neither in-home (rp = 0.06, n = 54, p = 0.69) nor in-office
14    (rp = 0.05, n = 55, p = 0.74).
15
16    Associations with HONO
17          Spicer et al. (1993) and Wainman et al. (2000) suggested the presence of a strong indoor
18    source of HONO from  heterogeneous reactions involving  NO2 and water films on indoor
19    surfaces. Hence, combustion appliances are sources for exposures to both NO2 exposure and
20    HNO2.  Epidemiological studies of NO2 health effects should consequently  consider the potential
21    confounding effects of NO2 and vice versa.
22          Jarvis et al. (2005) reported the indoor nitrous acid and lung function in adults as part of
23    European Community Respiratory Health Survey (ECRHS). Indoor HONO and indoor and
24    outdoor NO2 were measured. Indoor NO2 were correlated with HONO (rp = 0.77) but no
25    significant association of indoor NO2 with symptoms or lung function was observed.
26          Lee et al.  (2002) studied the nitrous acid, nitrogen  dioxide, and ozone concentrations in
27    residential  environments. The authors found that indoor NO2 was significantly correlated  with
28    HONO (rp  = 0.511).
29          As  shown above, very few studies showed the relationship between  personal NO2
30    exposure and other pollutant exposures. In general, personal NO2 was moderately correlated
31    with PM2.s and CO. Due to the lack of personal HONO exposure data, indoor HONO was used
32    as an indicator for personal  exposure, and current studies  showed that indoor HONO was

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 1    correlated with indoor NC>2 with high correlation coefficients, which suggested that the collect
 2    ion of HONO exposure data would help interpret adverse health outcome in the NO2 health risk
 3    assessment.
 4
 5    3) Personal (NO2) -Ambient Copollutants
 6          The relationship between personal NO2 exposure and other ambient pollutants are
 7    summarized in Table AX3.6-3.
 8          In Steubenville, Ohio, Sarnat et al. (2006) found that personal NO2 was significantly
 9    associated with ambient PM2.s and ambient sulfate during the fall (slope = 0.17 and R2 = 0.21 for
10    PM2.s; and slope = 0.34 and R2 = 0.12 for sulfate);  and was significantly associated with ambient
11    EC in both summer and fall (slope =1.81 and R2 = 0.03 for the summer; and slope = 3.71 and
12    R2 = 0.32 for the fall).
13          Kim et al. (2006) also reported correlations between personal exposure and ambient
14    measurements across pollutants. The median, mean, and standard deviation of the correlation
15    between personal NC>2 and ambient PM2.5 were 0.36, 0.30, and 0.30 respectively; and 0.17, 0.20,
16    and 0.41 respectively for the correlation between personal NC>2 and ambient CO.  The authors
17    suggested that the existing correlation between PM2.5 and NO2 for both ambient measurements
18    and personal exposures suggests that there is potential for NO2 to be a confounder of PM2.5, and
19    vice versa. Therefore, it may be appropriate for time-series epidemiological studies to control
20    for confounding by NO2 in PM2.5 risk models, and  vice versa.
21          In a study conducted in Santiago, Chile (Rojas-Bracho et al., 2002) personal NO2 was
22    moderately associated with PM2.5 (slope  = 1.99 and r2 = 0.42) and PMi0 (slope = 2.13 and
23    r2 = 0.15) but not coarse particles. At the indoor level, the same observation held (slope = 0.86
24    and r2 = 0.22 for PM2.5; slope =1.0 and R2 = 0.2 for PMio). "However, in comparing the indoor
25    and outdoor associations, we find that the latter is more highly significant and that the intercept
26    is smaller. It is likely that in outdoor environments, there are more high-temperature combustion
27    processes, which are associated with nitrogen oxide emissions.  Since nitrogen oxides are
28    precursors of secondary particles, which  partly form PM2.5, our results showed a stronger
29    association between these two pollutions outdoors."
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 1          Lee et al. (2002) studied nitrous acid, nitrogen dioxide, and ozone concentrations in
 2    residential environments.  The authors found that indoor NC>2 was significantly correlated with
 3    outdoor O3 (rp = - 0.220).
 4          These studies above show moderate correlations between personal NO2 exposure and
 5    ambient PM2.5, PMio, EC, sulfate, and CO. Based on our knowledge that, moderate to strong
 6    personal-ambient correlations exist for all the other pollutants mentioned above all of those
 7    species might serve as confounders for NC>2 exposure (detailed evaluation of the personal vs.
 8    ambient relationship for these pollutants are beyond the scope of this document).
 9
10    4) Ambient NO2-Personal Copollutant
11          Correlation between ambient NC>2 and personal exposure to copollutants are summarized
12    in Table AX3.6-4.
13          Sarnat et al. (2006) found that ambient NO2 was significantly associated with personal
14    PM2.s and personal sulfate during the fall (slope = 0.93 and R2 = 0.25 for PM2.5; and
15    slope = 0.28  and R2 = 0.27 for sulfate); and was significantly associated with personal EC during
16    both summer and fall (slope = 0.02 and R2 = 0.07 during the summer; and slope = 0.08 and
17    R2 = 0.49 during the fall) in Steubenville, OH.  Sarnat et al. (2006) suggested that for most cases,
18    ambient gas concentrations, although not suitable proxies of gas exposures are equally not
19    suitable for particle exposures in time-series health studies. Despite this, numerous
20    epidemological studies have linked 24-h ambient gas concentrations to adverse health impacts,
21    suggesting that the gases may indeed elicit biological responses alone or in combination with
22    other pollutants, or are acting as proxies for shorter-term exposures. The authors pointed out that
23    for Steubenville in the fall, a season with strong associations between ambient particle and NO2
24    concentrations, the separation of particle and NO2 health effects in daily time-series studies may
25    be difficult, and more precise exposure metrics may be needed.  The authors suggested that
26    personal-ambient relationships are greatly dependent on ambient conditions (e.g., season and
27    meteorology) and behavior (e.g., use of windows).  However, further factors such as building
28    design will also be extremely important, further exposure assessment work, particularly in
29    different geographic and climatic zones, is needed.
30          During both summer and winter in Baltimore (Sarnat et al., 2001), ambient NO2 was
31    significantly associated with personal PM2.5 (slope = 0.42, intercept = 12.38, and n = 225 during
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 1    the summer; and slope = 0.24, intercept = 13.16, and n = 487 during the winter). Also significant
 2    relationships held for ambient NC>2 and personal exposures to PM2.5 of ambient origin.  Ambient
 3    NO2 was also  significantly associated with personal EC  (slope = 0.05 and p = 0.0001), as an
 4    indicator of mobile source pollution.  In conclusion, the  authors suggested that ambient gases
 5    were acting as surrogates for personal PM2.5 exposure instead of confounding effects of personal
 6    PM2.5 exposure.
 7          Vinzents et al. (2005) found that ambient temperature and NC>2 concentrations at one of
 8    the street stations were the only significant predictors of ultra fine particle exposure during
 9    bicycling in traffic (R2 = 0.74).  Kim et al. (2006) also reported correlations between personal
10    exposure and ambient measurements across pollutants.  The median, mean, and standard
11    deviation of the correlation between ambient NC>2 and personal PM2.s were 0.24, 0.29, and 0.33
12    respectively; and 0.26, 0.22, and 0.32 respectively for the correlation between ambient NC>2 and
13    personal CO.
14          Studies above shows that ambient NC>2 is moderately correlated with personal EC and
15    ultrafme particle exposures, but only weakly to moderately correlated with personal PM2.5 mass
16    and sulfate exposures.  Since ambient NC>2 concentrations has been shown to be significant
17    proxy for corresponding personal NC>2 exposures, these  findings suggest that ambient NC>2 may
18    be acting as a  proxy not only for its own exposures but also to exposures to EC and ultrafme
19    particles. As a result, it may not be possible to separate  the health effects  of from those of other
20    pollutants, especially from the same source.
21          In the analysis of the confounding effect of exposure, we are limited by the lack of key
22    data:  (1) multipollutant exposure studies were rarely conducted and even  fewer studies reported
23    the cross-level (ambient and personal exposure) and cross-pollutant correlations; (2) most studies
24    focus on a several  copollutants (PM and its components, CO, Os, and some VOCs) with little
25    data available for other possibly important copollutants;  (3) the impact of indoor and personal
26    sources on the possibility of confounding has not yet been examined; and  (4) the impact of
27    measurement uncertainties, which can be large as mentioned in  Section AX3.4.1, on
28    confounding needs to be examined. Finally, the analysis shown above in the exposure
29    assessment should be integrated with other analysis in other parts of the risk assessment.
30
31
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 1    AX3.7     A FRAMEWORK FOR MODELING HUMAN EXPOSURES TO
 2               NO2 AND RELATED PHOTOCHEMICAL AIR POLLUTANTS
 o
 4    AX3.7.1    Introduction: Concepts, Terminology, and Overall Summary
 5          Predictive (or prognostic) exposure modeling studies1, specifically focusing on NO2,
 6    could not be identified in the literature, though, often, statistical (diagnostic) analyses have been
 7    reported using data obtained in various field exposure studies (see Section AX3.5.1). However,
 8    existing prognostic modeling systems for the assessment of inhalation exposures can in principle
 9    be directly applied to, or adapted for, NO2 studies; specifically, such systems include APEX,
10    SHEDS, and MENTOR-1 A, to be discussed in the following sections. Nevertheless, it should be
11    mentioned that such applications will be constrained by data limitations, such as the degree of
12    ambient concentration characterization (e.g., concentrations at the local level) and quantitative
13    information on indoor sources and sinks.
14          Predictive models of human exposure to ambient air pollutants such as NO2 can be
15    classified and differentiated based upon a variety of attributes. For example, exposure models
16    can be classified as:
17          •      models of potential (typically maximum) outdoor exposure versus models of
18                 actual exposures (the latter including locally modified microenvironmental
19                 exposures, both outdoor and indoor),
20          •      Population Based Exposure Models  (PBEM) versus Individual Based Exposure
21                 Models (IBEM),
22          •      deterministic versus probabilistic (or statistical) exposure models,
23          •      observation-driven versus mechanistic air quality  models (see Section AX3.7.3
24                 for discussions about the construction, uses and limitations of this class of
25                 mathematical models.
26          Some points should be made regarding terminology and essential concepts in exposure
27    modeling, before proceeding to the overview of specific developments reported in the current
28    research literature:
      1 i.e. assessments that start from emissions and demographic information and explicitly consider the physical and
       chemical processes of environmental and microenvironmental transport and fate, in conjunction with human
       activities, to estimate inhalation intake and uptake.

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 1          First, it must be understood that there is significant variation in the definitions of many of
 2    the terms used in the exposure modeling literature; indeed, the science of exposure modeling is a
 3    rapidly evolving field and the development of a standard and commonly accepted terminology is
 4    an ongoing process (see, e.g., WHO, 2004).
 5          Second, it should also be mentioned that, very often, procedures that are called exposure
 6    modeling, exposure  estimation, etc. in the scientific literature, may in fact refer to only a sub-set
 7    of the complete set of steps or components required for a comprehensive exposure assessment.
 8    For example, certain self-identified exposure modeling studies focus solely on refining the sub-
 9    regional or local spatio-temporal dynamics of pollutant concentrations (starting from raw data
10    representing monitor observations or regional grid-based model estimates). Though not
11    exposure studies per se, such efforts have value and are included in the discussion of the next
12    sub-section, as they  provide potentially useful tools that can be used in a complete exposure
13    assessment.  On the  other hand, formulations that are self-identified as exposure models but
14    actually  focus only on  ambient air quality predictions,  such as chemistry-transport models, are
15    not included in the discussion that follows.
16          Third, the process of modeling human exposures to photochemical pollutants
17    (traditionally focused on ozone) is very often identified explicitly with population-based
18    modeling, while models describing the specific mechanisms affecting the exposure of an actual
19    individual (at specific locations) to an air contaminant  (or to a group of co-occurring gas and/or
20    aerosol phase pollutants) are usually associated with studies focusing specifically on indoor air
21    chemistry modeling.
22          Finally, fourth, the concept of microenvironments, introduced in earlier sections of this
23    document, should be clarified further, as it is critical in developing procedures for exposure
24    modeling. In the past,  microenvironments have typically been defined as individual or aggregate
25    locations (and  sometimes even as activities taking place within a location) where a homogeneous
26    concentration of the pollutant is encountered.  Thus a microenvironment has often been
27    identified with an ideal (i.e.  perfectly mixed) compartment of classical compartmental modeling.
28    More recent and general definitions view the microenvironment as a control volume, either
29    indoors or outdoors, that can be fully characterized by  a set of either mechanistic or
30    phenomenological governing equations, when appropriate parameters are available,  given
31    necessary initial and boundary conditions. The boundary conditions typically would reflect

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 1    interactions with ambient air and with other microenvironments. The parameterizations of the
 2    governing equations generally include the information on attributes of sources and sinks within
 3    each microenvironment. This type of general definition allows for the concentration within  a
 4    microenvironment to be non-homogeneous (non-uniform), provided its spatial profile and
 5    mixing properties can be fully predicted or characterized. By adopting this definition, the
 6    number of microenvironments used in a study is kept manageable, but variability in
 7    concentrations in each of the microenvironments can still be taken into account.
 8    Microenvironments typically used to determine exposure include indoor residential
 9    microenvironments, other indoor locations (typically occupational microenvironments), outdoors
10    near roadways, other outdoor locations, and in-vehicles.  Outdoor locations near roadways are
11    segregated from other outdoor locations (and can be further classified into street canyons,
12    vicinities of intersections, etc.) because emissions from automobiles alter local concentrations
13    significantly compared to background outdoor levels. Indoor residential microenvironments
14    (kitchen, bedroom, living room, etc. or aggregate home microenvironment) are typically
15    separated from other indoor locations because of the time spent there and potential differences
16    between the residential environment and the  work/public environment.
17          Once the actual individual and relevant activities and locations (for Individual Based
18    Modeling), or the sample population and associated spatial (geographical) domain (for
19    Population Based Modeling) have been defined along with the temporal framework of the
20    analysis (time period and resolution), the comprehensive modeling of individual/population
21    exposure to NO2 (and related pollutants) will in general require seven steps (or components, as
22    some of them do not have to be performed in sequence) that are listed below. This list represents
23    a composite based on approaches and frameworks described in the literature over the last twenty -
24    five years (Ott, 1982; Ott, 1985; Lioy, 1990;  U.S. Environmental Protection Agency, 1992;
25    Georgopoulos and Lioy, 1994; U.S. Environmental Protection Agency, 1997; Buck  et al., 2003;
26    Price et al., 2003; Georgopoulos et al., 2005; WHO, 2005; U.S. Environmental Protection
27    Agency, 2006a; Georgopoulos and Lioy, 2006) as well on the structure of various inhalation
28    exposure models (NEM/pNEM, HAPEM, SHEDS, REHEX, EDMAS, MENTOR, ORAMUS,
29    APEX, AIRPEX, AIRQUIS, etc., to be discussed in the following section) that have been used in
30    the past or in current studies to specifically assess inhalation exposures. Figure AX3.7-1,
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r
Calculate
potential
outdoor
exposures
L
•'i,a. Emissions: NEt (NET, NTI), state; Processing with SMOKE,
EMS-HAP, MOBILE/MOVES, NONROAD, FAAED, BEIS, etc.
i.b. Meteorology: NWS, NCDC; Modeling MM5, RAMS, CALMET
i.e. Land Use/ land Cover, Topography: NLDC (USGS), etc.
*
gg Estimate background
levels of air pollutants
through
a. mutttvariate spatio-
temporal analysis of
monitor data
b. emissions-base^ air
quality modeling
{with regional,
grid -based models:
Models- 3/ CMAQ, CAMx
and REMSAD)

•. Develop database of
' individual subjects
attributes (residence &
wortc location, housing
characteristics, age,
gender, race, income, file.)
a. collect study-specific
information
b. supplement with
available relevant local,
regional, and national
demographic
information
X Study-specific survey
(also US Census,
US Housing Survey)
•*•
"+>
*
' estimate local outdoor
. pollutant levels that
characterize the ambient air of
an administrative unit (such as
census tract) or a conveniently
defined grid through
a. spatiotemporaS statistical
analysis of monitor data
t>. application of urban scale
model at high resolution
c subgrid (e.g. pfume-m-grid)
modeling
d. data/model assimilation

4 Develop activity event
(or exposure event)
sequences for each individual
of the study for the exposure
peHml
a. collect stu4y-#pedfic
information
b. supplement with ottier
available data
c, organize time-activity
database in format
compatible wtth CHAD
/ Study-specific survey
i (or defaw It from
I CMAD^ NMAF^)
; ii.a. Emissions: EMS-HAP
il.b. Local Meteorology - Local
Effects: RAMS, FLUENT
s +
•*
/*
»•#
;v; Estimate levels and
^'-~ temporal profiles of
pollutants m various
mlcroenvironments (streets,
residences, offices, restaurants,
vehicles, etc.) through
a. regression of observational
data
b. simple linear mass balance
€. lumped (nonlinear) ||E
9as/aerosol chemistry models
d. combined chemistry & CR>
(DNS, LES, RANS) models
*
i " Calculate appropriate
, initiation rates for the
members of ttie sample
population,, combining the
physiological attilbtites of the
study subjects and the
activities pursued during the
mdivMuaS exposure evem^s
	 	 	 f
IOM» and Other
WifsiologicalftHfTS
Oalabines




— -v

^>
1 1
Calculate
exposures/
intakes
_^l

[ "' Biologically
' based
target tissue
dose modeling
J



     Figure AX3.7-1.
                    Schematic description of a general framework identifying the
                    processes (steps or components) involved in assessing inhalation
                    exposures and doses for individuals and populations. In general
                    terms, existing comprehensive exposure modeling systems such as
                    SHEDS, APEX, and MENTOR-1A follow this framework.
 1

 2


 3

 4

 5
 6

 7

 8

 9

10
Source:  Figure adapted with modifications from Georgopoulos et al. (2005).


adapted from Georgopoulos et al. (2005), schematically depicts the sequence of steps involved

that are summarized here (and further discussed in the following sub-sections).


     1.     Estimation of the background or ambient levels of both NO2 and related

           photochemical pollutants. This is done through either (or a combination of):


             a.     multivariate spatio-temporal analysis of fixed monitor data, or

             b.     emissions-based, photochemical, air quality modeling (typically with a

                    regional, grid-based model such as Models-3/CMAQ or CAMx) applied in

                    a coarse resolution mode.
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 1        2.     Estimation of local outdoor pollutant levels of both NC>2 and related photochemical
 2               pollutants. These levels could typically characterize the ambient air of either an
 3               administrative unit (such as a census tract, a municipality, a county, etc.) or a
 4               conveniently defined grid cell of an urban scale air quality model.  Again, this may
 5               involve either (or a combination of):
 6
 7                 a.     spatio-temporal statistical analysis of monitor data, or
 8                 b.     application of an urban multi-scale, grid based model (such as CMAQ or
 9                        CAMx) at its highest resolution (typically around 2-4 km), or
10                 c.     correction of the estimates of the regional model using some scheme that
11                        adjusts for observations and/or for subgrid chemistry and mixing
12                        processes.
13        3.     Characterization of relevant attributes of the individuals or populations under study
14               (residence and work locations, occupation, housing data, income, education, age,
15               gender, race, weight,  and other physiological  characteristics).  For Population Based
16               Exposure Modeling (PBEM) one can either:
17
18                 a.     select a fixed-size sample population of virtual individuals in a way that
19                        statistically reproduces essential demographics (age, gender, race,
20                        occupation, income, education) of the administrative population unit used
21                        in  the assessment (e.g., a sample of 500 people is typically used to
22                        represent the demographics of a given census tract, whereas a sample of
23                        about 10,000 may be needed to represent the demographics of a county),
24                        or
25                 b.     divide the population-of interest into a set of cohorts representing selected
26                        subpopulations where the cohort is  defined by characteristics known to
27                        influence exposure.
28        4.     Development of activity event (or exposure event) sequences for each member of
29               the sample population (actual or virtual) or for each cohort for the  exposure period.
30               This could utilize:

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 1                 a.      study-specific information, if available
 2                 b.      existing databases based on composites of questionnaire information from
 3                        past studies
 4                 c.      time-activity databases, typically in a format compatible with U.S.
 5                        Environmental Protection Agency's Consolidated Human Activity
 6                        Database (CHAD - McCurdy et al., 2000)
 7
 8        5.      Estimation of levels and temporal profiles of both NC>2 and related photochemical
 9               pollutants in various outdoor and indoor microenvironments such as street canyons,
10               roadway intersections, parks, residences, offices, restaurants, vehicles, etc. This is
11               done through either:
12
13                 a.      linear regression of available observational data sets,
14                 b.      simple mass balance models (with linear transformation and sinks) over
15                        the volume (or a portion of the volume) of the microenvironment,
16                 c.      lumped (nonlinear) gas or gas/aerosol chemistry models, or
17                 d.      detailed combined chemistry and Computational Fluid Dynamics
18                        modeling.

19        6.      Calculation of appropriate inhalation rates for the members of the sample
20               population,  combining the physiological  attributes of the (actual or virtual) study
21               subjects and the activities pursued during the individual exposure events.
22        7.      Calculation of target tissue dose through  biologically based modeling estimation
23               (specifically, respiratory dosimetry modeling in the case of NC>2 and related reactive
24               photochemical  pollutants) if sufficient information is available.
25          Implementation of the above framework for comprehensive exposure modeling has
26    benefited significantly from recent advances and expanded availability of computational
27    technologies such as Relational Database Management Systems (RDBMS) and Geographic
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 1    Information Systems (GIS) (Purushothaman and Georgopoulos, 1997, 1999a,b; Georgopoulos
 2    et al., 2005).
 3          In fact, only relatively recently comprehensive, predictive, inhalation exposure modeling
 4    studies for ozone, PM, and various air toxics, have attempted to address/incorporate all the
 5    components of the general framework described here.  In practice, the majority of past exposure
 6    modeling studies have either incorporated only subsets of these components or treated some of
 7    them in a simplified manner, often focusing on the importance of specific factors affecting
 8    exposure. Of course, depending on the objective of a particular modeling study, implementation
 9    of only a limited number of steps may be necessary. For example, in a regulatory setting, when
10    comparing the relative effectiveness of emission control strategies, the focus can be on expected
11    changes  in ambient levels (corresponding to those observed at NAAQS monitors) in relation to
12    the density of nearby populations. The outdoor levels of pollutants, in conjunction with basic
13    demographic information, can thus be used to calculate upper bounds of population exposures
14    associated with ambient air (as opposed to total exposures that would include contributions from
15    indoor sources) useful in comparing alternative control strategies. Though the metrics derived
16    would not be quantitative indicators of actual human exposures, they can serve as surrogates of
17    population exposures associated with  outdoor air, and thus aid  in regulatory decision making
18    concerning pollutant standards and in  studying the efficacy of emission control strategies. This
19    approach has been used in studies performing comparative evaluations of regional and local
20    emissions reduction strategies in the eastern United States (e.g., Purushothaman and
21    Georgopoulos, 1997; Georgopoulos et al., 1997a; Foley et al., 2003).
22
23    AX3.7.2   Population Exposure Models:  Their Evolution and Current Status
24          Existing comprehensive inhalation exposure models consider the trajectories of
25    individual human subjects (actual or virtual), or of appropriately defined cohorts, in space and
26    time as sequences of exposure events. In these sequences each event is defined by time,  a
27    geographic location, a microenvironment, and the activity of the subject. U.S. Environmental
28    Protection Agency offices (OAQPS and NERL) have supported the most comprehensive efforts
29    in developing models implementing this general concept (see, e.g., Johnson, 2002), and these
30    efforts have resulted in the NEM/pNEM (National Exposure Model and Probabilistic National
31    Exposure Model - Whitfield et al., 1997), HAPEM (Hazardous Air Pollutant Exposure Model -


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 1   Rosenbaum, 2005), SHEDS (Simulation of Human Exposure and Dose System - Burke et al.,
 2   2001), APEX (Air Pollutants Exposure model - U.S. Environmental Protection Agency,
 3   2006b,c), and MENTOR (Modeling Environment for Total Risk studies - Georgopoulos et al.,
 4   2005; Georgopoulos and Lioy, 2006) families of models. European efforts have produced some
 5   formulations with similar general attributes as the above U.S. models but, generally, involving
 6   simplifications in some of their components. Examples of European models addressing
 7   exposures to photochemical oxidants (specifically ozone) include the AirPEx (Air Pollution
 8   Exposure) model (Freijer et al., 1998), which basically replicates the pNEM approach and has
 9   been applied to the Netherlands, and the AirQUIS (Air Quality Information System) model
10   (Clench-Aas et al., 1999).
11          The NEM/pNEM, SHEDS, APEX, and MENTOR-1A (MENTOR for One-Atmosphere
12   studies) families of models provide exposure estimates defined by concentration and breathing
13   rate for each individual exposure event, and then average these estimates over periods typically
14   ranging from one h to one year. These models allow simulation of certain aspects of the
15   variability and uncertainty in the principal factors affecting exposure. An alternative approach is
16   taken by the HAPEM family of models that typically provide annual average exposure estimates
17   based on the quantity of time spent per year in each combination of geographic locations and
18   microenvironments.  The NEM, SHEDS, APEX, and MENTOR-type models are therefore
19   expected to be more appropriate for pollutants with complex chemistry such as NO2, and could
20   provide useful information for enhancing related health assessments.
21
22   More specifically, regarding the consideration of population demographics and activity patterns:
23          1.    pNEM divides the population of interest into representative cohorts based on the
24               combinations of demographic characteristics (age, gender, and employment),
25               home/work district, residential cooking fuel and replicate number, and then assigns
26               activity  diary record from CHAD (Consolidated Human Activities Database) to each
27               cohort according to demographic characteristic, season, day-type
28               (weekday/weekend) and temperature.
29          2.    HAPEM6 divides the population of interest into demographic groups based on age,
30               gender and race, and then for each demographic group/day-type (weekday/weekend)
31               combination, select multiple activity patterns randomly (with replacement) from

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 1              CHAD and combine them to find the averaged annual time allocations for group
 2              members in each census tract for different day types.
 3          3.   SHEDS, APEX, and MENTOR-1A generate population demographic files, which
 4              contain a user-defined number of person records for each census tract of the
 5              population based on proportions of characteristic variables (age, gender,
 6              employment, and housing) obtained from the population of interest, and then assign
 7              a matching activity diary record from CHAD to each individual record of the
 8              population based on the characteristic variables.  It should be mentioned that, in the
 9              formulations of these models, workers may commute from one census tract to
10              another census tract for work.  So, with the specification of commuting patterns, the
11              variation of exposure concentrations due to commuting between different census
12              tracts can be captured.
13
14          The essential attributes of the pNEM, HAPEM, APEX, SHEDS, and MENTOR-1A
15   models are summarized in Table AX3.7-1.
16          The conceptual approach originated by the SHEDS models was modified and expanded
17   for use in the development of MENTOR-1 A (Modeling Environment for Total Risk - One
18   Atmosphere).  Flexibility was incorporated into this modeling system, such as the option of
19   including detailed indoor chemistry of the Os-NOx system and other relevant
20   microenvironmental processes, and providing interactive linking with CHAD for consistent
21   definition of population characteristics and activity events (Georgopoulos et al., 2005).
22          NEM/pNEM implementations have been extensively applied to ozone studies in the
23   1980s and 1990s. The historical evolution of the pNEM family of models of OAQPS started
24   with the introduction of the first NEM model in the  1980's (Biller et al., 1981).  The first such
25   implementations of pNEM/Os  in the 1980's used a regression-based relationship to estimate
26   indoor ozone concentrations from outdoor concentrations. The second generation of pNEM/Os
27   was developed in 1992 and included a simple mass balance model to estimate indoor ozone
28   concentrations. A report by Johnson et al. (2000) describes this version of pNEM/Os and
29   summarizes the results of an initial application of the model to 10 cities.  Subsequent
30   enhancements to pNEM/Os and its input databases included revisions to the methods used to
31   estimate equivalent ventilation rates, to determine commuting patterns, and to adjust ambient

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 1    ozone levels to simulate attainment of proposed NAAQS. During the mid-1990's,
 2    Environmental Protection Agency applied updated versions of pNEM/Os to three different
 3    population groups in selected cities: (1) the general population of urban residents, (2) outdoor
 4    workers, and (3) children who tend to spend more time outdoors than the average child.  This
 5    version of pNEM/Os used a revised probabilistic mass balance model to determine ozone
 6    concentrations over one-h periods in indoor and in-vehicle microenvironments (Johnson, 2001).
 7          In recent years, pNEM has been replaced by (or "evolved to") the Air Pollution Exposure
 8    Model (APEX).  APEX differs from earlier pNEM models in that the probabilistic features of the
 9    model are incorporated into a Monte Carlo framework (Langstaff, 2007; U.S. Environmental
10    Protection Agency, 2006b,c).  Like SHEDS and MENTOR-1A, instead of dividing the
11    population-of-interest into a set of cohorts, APEX generates individuals as if they were being
12    randomly sampled from the population. APEX provides each generated individual with a
13    demographic profile that specifies values  for all parameters required by the model. The values
14    are selected from distributions and databases that are specific to the age, gender, and other
15    specifications  stated in the demographic profile.  Environmental Protection Agency has applied
16    APEX to the study of exposures to ozone  and other criteria pollutants; APEX can be modified
17    and used for the  estimation of NC>2 exposures, if required.
18          Reconfiguration of APEX for use  with NC>2 or other pollutants would require significant
19    literature review, data analysis, and modeling efforts. Necessary steps include determining
20    spatial scope and resolution of the model; generating input files for activity data, air quality and
21    temperature data; and developing definitions for microenvironments and pollutant-
22    microenvironment modeling parameters (penetration and proximity factors, indoor source
23    emissions rates, decay rates, etc.) (ICF Consulting 2005). To take full advantage of the
24    probablistic capabilities of APEX, distributions of model input parameters should be used
25    wherever possible.
26
27    AX3.7.3   Characterization of Ambient Concentrations of NO2 and  Related
28               Air Pollutants
29          As mentioned earlier, background and regional outdoor concentrations of pollutants, over
30    a study domain, may be estimated either through emissions-based mechanistic modeling, through
31    ambient-data-based modeling, or through  a combination of both.  Emissions-based models
32    calculate the spatio-temporal fields of the  pollutant concentrations using precursor emissions and

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 1    meteorological conditions as inputs. The ambient-data-based models typically calculate spatial
 2    or spatio-temporal distributions of the pollutant through the use of interpolation schemes, based
 3    on either deterministic or stochastic models for allocating monitor station observations to the
 4    nodes of a virtual regular grid covering the region of interest. The geostatistical technique of
 5    kriging provides various standard procedures for generating  an interpolated spatial distribution
 6    for a given time, from data at a set of discrete points. Kriging approaches were evaluated by
 7    Georgopoulos et al. (Georgopoulos et al., 1997b) in relation  to the calculation of local ambient
 8    ozone concentrations for exposure assessment purposes, using either monitor observations or
 9    regional/urban photochemical model outputs.  It was found that kriging is severely limited by the
10    nonstationary character of the concentration patterns of reactive pollutants; so the advantages this
11    method has in other fields of geophysics do not apply here.  The above study showed that the
12    appropriate semivariograms had to be hour-specific, complicating the automated reapplication of
13    any purely spatial interpolation over an extended time period.
14           Spatio-temporal distributions of pollutant concentrations, such as ozone, PM, and various
15    air toxics have alternatively been obtained using methods of the Spatio-Temporal Random Field
16    (STRF) theory (Christakos and Vyas, 1998a,b).  The STRF approach interpolates monitor data in
17    both space and time simultaneously.  This method can thus analyze information on temporal
18    trends, which cannot be incorporated directly in purely spatial interpolation methods such as
19    standard kriging.  Furthermore, the STRF method can optimize the use of data that are not
20    uniformly sampled in either space or time.  STRF was further extended within the Bayesian
21    Maximum Entropy (BME) framework and applied to ozone  interpolation studies (Christakos and
22    Hristopulos, 1998; Christakos and Kolovos, 1999; Christakos, 2000). It should be noted that
23    these studies formulate an over-arching scheme for linking air quality with population dose and
24    health effects; however they are limited by the fact that they  do not include any
25    microenvironmental  effects. MENTOR has incorporated STRF/BME methods as one of the
26    steps for performing a comprehensive analysis of exposure to ozone and PM (Georgopoulos
27    et al., 2005).
28           Subgrid spatial variability is a major issue with respect to characterizing local
29    concentrations of NC>2.  Indeed, the fast rates of the reactions involving the Os-NOx system result
30    in significant concentration gradients in the vicinity of sources of NOx. These gradients are not
31    resolved directly by currently operational grid photochemical air quality simulation models

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 1    (PAQSMs) such as CMAQ and CAMx. However, both these models include a plume-in-grid.
 2    (PinG) option (AER, 2004; Emery and Yarwood, 2005; Gillani and Godowitch, 1999; U.S.
 3    Environmental Protection Agency, 2006d) that can be used for large point NOX sources (such as
 4    smokestacks). Nevertheless, PinG formulations typically will resolve gradients in upper
 5    atmospheric layers and thus are not necessarily relevant to human exposure calculations, which
 6    are affected by gradients caused by a multiplicity of smaller ground level or near ground level
 7    combustion sources such as motor vehicles.
 8          Currently PAQSMs are typically applied with horizontal resolutions of 36 km, 12 km,
 9    and 4 km and a surface layer thickness that is typically of the order of 30 m. Though
10    computationally it is possible to increase the resolution of these simulations, there are critical
11    limits that reflect assumptions inherent in the governing equations for both (a) the fluid
12    mechanical processes embodied in the meteorological models (e.g., typically MM5 and RAMS)
13    that provide the inputs for the PAQSMs, and (b) the dispersion processes which become more
14    complex at fine scales (see, e.g., Georgopoulos and Seinfeld, 1989) and thus cannot be described
15    by simple formulations (such as constant dispersion coefficients) when the horizontal resolutions
16    is 2 km or finer.
17          Application of PAQSMs to urban domains is further complicated by urban topography,
18    the urban heat island, etc.  It is beyond the scope, however, of the present discussion, to overview
19    the various issues relevant to urban fluid dynamics and related transport/fate processes of
20    contaminants. However, the issue of modeling subgrid atmospheric dispersion phenomena
21    within complex urban areas in a consistent manner is a very active research area.  Reviews of
22    relevant issues and of available approaches for modeling urban fluid mechanics and dispersion
23    can be found in,  e.g., Fernando et al. (2001) and Britter and Hanna (2003).
24          The issue of subgrid variability (SGV) from the perspective of interpreting and evaluating
25    the outcomes of grid-based, multiscale, PAQSMs is discussed in Ching et al. (2006), who
26    suggest a framework that can provide for qualitative judgments on model performance based on
27    comparing observations to the grid predictions and its SGV distribution. From the perspective of
28    Population Exposure Modeling, the most feasible/practical approach for treating subgrid
29    variability of local concentrations is probably through (1) the identification and proper
30    characterization  of an adequate number of outdoor microenvironments (potentially related to
31    different types of land use  within the urban area as well as to proximity to different types of

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 1    roadways) and (2) then, concentrations in these microenvironments will have to be adjusted from
 2    the corresponding local background ambient concentrations through either regression of
 3    empirical data or various types of local atmospheric dispersion/transformation models. This is
 4    discussed further in the next subsection.
 5
 6    AX3.7.4   Characterization of Microenvironmental Concentrations
 7          Once the background and local ambient spatio-temporal concentration patterns have been
 8    derived, microenvironments that can represent either outdoor or indoor settings when individuals
 9    come in contact with the contaminant of concern (e.g., NO2) must be characterized. This process
10    can involve modeling of various local sources and sinks, and interrelationships between ambient
11    and microenvironmental concentration levels. Three general approaches have been used in the
12    past to model microenvironmental concentrations:
13       •   Empirical (typically linear regression) fitting of data from studies relating ambient/local
14          and microenvironmental concentration levels to develop analytical relationships.
15       •   Parameterized mass balance modeling over, or within, the volume of the
16          microenvironment. This type of modeling has ranged from very simple formulations, i.e.
17          from models assuming ideal (homogeneous) mixing within the microenvironment (or
18          specified portions of it) and only linear physicochemical transformations (including
19          sources and sinks), to models incorporating analytical solutions of idealized dispersion
20          formulations (such as Gaussian plumes), to models that take into account aspects of
21          complex multiphase chemical and physical interactions and nonidealities in mixing.
22       •   Detailed Computational Fluid Dynamics (CFD) modeling of the outdoor or indoor
23          microenvironment, employing either a Direct Numerical Simulation (DNS) approach, a
24          Reynolds Averaged Numerical Simulation (RANS) approach,  or a Large Eddy
25          Simulation (LES)  approach, the latter typically for outdoor situations (see, e.g., Milner
26          et al., 2005; Chang and Meroney, 2003; Chang, 2006).
27
28          Parameterized mass balance modeling is the approach currently preferred for exposure
29    modeling for populations.  As discussed earlier,  the simplest microenvironmental setting
30    corresponds to a homogeneously mixed compartment, in contact with possibly both
31    outdoor/local environments as well as other microenvironments. The air quality of this idealized
32    microenvironment is affected mainly by the following processes:

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 1          a.   Transport processes: These can include advection/convection and dispersion that
 2               are affected by local processes and obstacles such as vehicle induced turbulence,
 3               street canyons, building structures, etc.
 4          b.   Sources and sinks:  These can include local outdoor emissions, indoor emissions,
 5               surface deposition,  etc.
 6          c.   Transformation processes:  These can include local outdoor as well as indoor gas
 7               and aerosol phase chemistry,  such as formation of secondary organic and inorganic
 8               aerosols.
 9
10          Examples of the above are discussed next, specifically for outdoor and for indoor
11    microenvironments.
12
13    AX3.7.4.1   Characterization of Outdoor Microenvironments
14          Empirical regression analyses have been used in some studies to relate specific outdoor
15    locations - that can be interpreted as generalized types of exposure microenvironments - to
16    spatial variability of NC>2 concentrations.  For example, Gilbert et al. (2005) in May 2003
17    measured NO2 for 14 consecutive days at  67 sites across Montreal, Canada. Concentrations
18    ranged from 4.9 to 21.2 ppb (median 11.8 ppb), and they used linear regression analysis to assess
19    the association between logarithmic values of NO2 concentrations and land-use variables via a
20    geographic information system. In univariate analyses, NC>2 was negatively associated with the
21    area of open space and positively associated with traffic count on nearest highway, the length of
22    highways within any radius from 100 to 750 m, the length of major roads within 750 m, and
23    population density within 2000 m.  Industrial land-use and the length of minor roads showed no
24    association with NC>2.  In multiple regression analyses, distance from the nearest highway, traffic
25    count on the nearest highway, length of highways and major roads within 100 m, and population
26    density showed significant associations with NC>2. The authors of that study point out the value
27    of using land-use regression modeling to assign exposures in large-scale epidemological studies.
28    Similar analyses have been performed in a predictive setting by Sahsuvaroglu et al. (2006) for
29    Hamilton, Ontario, Canada.
30          The category of parameterized mass balance models for outdoor microenvironments
31    includes various local roadway, intersection, and street canyon models.  For example, Fraigneau

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 1    et al. (1995) developed a simple model to account for fast nitrogen oxide - ozone
 2    reaction/dispersion in the vicinity of a motorway. Venegas and Mazzeo (2004) applied a
 3    combination of simple point and area source analytical plume models to characterize NO2
 4    concentration patterns in Buenos Aires, Argentina, which they used for a simplified (potential)
 5    population exposure study.  ROADWAY-2 (Rao, 2002), is another near-highway pollutant
 6    dispersion model that incorporates vehicle wake parameterizations derived from  canopy flow
 7    theory and wind tunnel measurements. The atmospheric velocity and turbulence fields are
 8    adjusted to account for velocity-deficit and turbulence production in vehicle wakes and a
 9    turbulent kinetic energy closure model of the atmospheric boundary layer is used to derive the
10    mean velocity, temperature, and turbulence profiles from input meteorological data.
11          In parameterized street canyon models, typically, concentrations of exhaust gases are
12    calculated using a combination of a plume model for the direct contribution and a box model for
13    the recirculating part of the pollutants in the street. Parameterization of flow and dispersion
14    conditions in these models is usually deduced from analysis of experimental data and model tests
15    that considered different street configurations and various meteorological conditions.
16    An example of a current model that belongs in the parameterized mass balance category is the
17    Danish Operational Street Pollution Model (OSPM) (Berkowicz, 2002), which updates earlier
18    formulations of street canyon models such as STREET of Johnson et al. (1973) and CPBM
19    (Canyon Plume-Box Model) of Yamartino and Weigand (1986). A variation of this simple
20    approach is the model of Proyou et al. (1998), which uses a three-layer photochemical box model
21    to represent a street canyon.
22          A variety of CFD based street canyon models have been developed in recent years (see,
23    e.g., the series of International Conferences on Harmonization - http://www.harmo.org),
24    employing various alternatives  for closure of the turbulent transport equations. A review and
25    intercomparison of five of these models (CHENSI, CHENSI-2, MIMO, MISKAM, TASCflow)
26    vis-a-vis field data from a street canyon in Hannover, Germany can be found in the articles by
27    Sahm et al. (2002) and by Ketzel et al.  (2002).
28          These complex localized models could be useful for improving population exposure
29    model estimates by calculating  pollutant concentrations at the microenvironmental  level. Lack
30    of input parameter data and parameter variation across the modeling domain (spatial and
31    temporal) contributes to uncertainty in microenvironmental concentrations calculated by exposre

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 1    models.  In such cases, parameterized mass balance models could provide outdoor concentration
 2    values for estimating exposure. If infiltration factors are known, these concentrations could also
 3    be used to estimate indoor exposures.
 4
 5    AX3.7.4.2   Characterization of Indoor Microenvironments
 6          Numerous indoor air quality modeling studies have been reported in the literature;
 7    however, depending on the modeling scenario, only few of them address (and typically only a
 8    limited subset of) physical and chemical processes that affect photochemical oxidants indoors
 9    (Nazaroff and Cass, 1986; Hayes, 1989,1991; Freij er and Bloemen, 2000).
10          It is beyond the scope of the present discussion to review in detail the current status of
11    indoor air modeling.  Existing indoor air concentration models indeed are available as a wide
12    range of (a) empirical regression relationships, (b) parameterized mass balance models (that can
13    be either single-zone—that is, single well-mixed room—or multi-zone models), and (c) CFD
14    formulations.  Recent overviews of this area can be found in Milner et al. (2005), who focus, in
15    particular, on the issue of entrainment from outdoor sources, and in Teshome and Haghighat,
16    (2004), who focus on different formulations of zonal models and on how they compare with
17    more complex CFD models.
18          Few indoor air models have considered detailed nonlinear chemistry, which, however,
19    can have a significant effect on the indoor air quality, especially in the presence of strong indoor
20    sources (e.g., gas stores and kerosene heaters, in the case of NCh). Indeed, the need for more
21    comprehensive models that  can take into account the complex, multiphase processes that affect
22    indoor concentrations of interacting gas phase pollutants and particulate matter has been
23    recognized and a number of formulations have appeared in recent years. For example, the
24    Exposure and Dose Modeling and Analysis System (EDMAS) (Georgopoulos et al., 1997c)
25    included an indoor model with detailed gas-phase atmospheric chemistry to estimate indoor
26    concentrations resulting from penetration and reaction of ambient pollutants. This indoor model
27    was dynamically coupled with (a) the outdoor photochemical air quality models UAM-IV and
28    UAM-V, which provided the gas-phase composition of influent air; and (b) with a
29    physiologically based uptake and dosimetry model. Subsequent work (Isukapalli et al., 1999)
30    expanded the approach of the EDMAS model to incorporate alternative representations of gas-
31    phase chemistry as well as multiphase photochemistry and gas/aerosol interactions.  The
32    microenvironmental model corresponding to this more general formulation is mathematically

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 1    represented by the following equation, when an assumption of uniform mixing is used for each
 2    component (e.g., individual room) of the indoor environment. Sarwar et al. (2001) presented a
 3    more comprehensive modeling study of the gas phase aspects of ozone indoor chemistry
 4    focusing on the impact of different factors (such as outdoor ozone, indoor emissions, ventilation
 5    rates, etc.) on the levels of indoor hydroxyl radicals (OH), which in turn are expected to control
 6    the rate of formation of secondary toxicants indoors.
                j
             V,              i                     /
                  Jj    ,— 1  J  J     .— j  j  J            . — j
 1               dt    i  i         j-i                 j-i                              (AX3.7-1)
 8    where,
 9    Vi = volume of compartment (m3)
10    C; = concentration of species in compartment (mol/m3)
11    K[j = mass transfer coefficient from compartment (m/h)
12    ay = interfacial air exchange area between compartments (m2)
13    QJ = concentration in compartment i in equilibrium with concentration in j (mol/m3)
14    Qij = volumetric flow rate from compartment i to j (m3/h)
15    R[ = rate of formation of species in compartment i (gmol/h)
16
17    and,

                        c     _ c      _ c
                     c / °/, emis °i, aepos  °i,conaens                      ;for gases
                     '(C     _C      -t-C      4-C*        4-C    4-C
ig                     ^i, emis ^i.depos  ^i.restisp ^i.condens ^i.nucl ^i.coag; Jor PM      TAX3 7-2^)

19          More recent work (S0rensen and Weschler, 2002) has coupled CFD calculations with
20    gas-phase atmospheric chemistry mechanisms to account for the impact of nonideal flow mixing
21    (and associated concentration gradients) within a room on the indoor spatial distribution of ozone
22    and  other secondary pollutants.  This work has identified potential limitations associated with the
23    assumption of uniform mixing in indoor microenvironments when calculating personal
24    exposures.
25          A recent indoor air model that specifically focuses on NC>2 (along with CO, PMio, and
26    PM2.5 is INDAIR (Dimitroulopoulou et al., 2006). The INDAIR model considers three
27    interconnected residential microenvironments: kitchen, lounge, and bedroom.  Removal

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 1    processes are lumped together and quantified via an apparent deposition velocity. Specifically, a
 2    loss rate of 0.99 ± 0.19 IT1 (Yamanaka, 1984), is used in this model corresponding to a mean
 3    deposition velocity of 1.2 x 10~4 m s~l. The sources of NC>2 considered in INDAIR are from gas
 4    stove cooking and from cigarette smoking, but only the former contributes significantly to indoor
 5    NC>2 levels, based on available model parameterizations.
 6          Estimation of NC>2 emission rates from gas cooking utilized the following empirical
 7    information: (a) NOx emission rate equal to 0.125 g kWlT1 (Wooders, 1994); (b) an assumption
 8    that NO2 represents 25% of the total NOx emissions and (c) gas consumption per household in
 9    cooking equal to 5-7 kWh day'1, assuming 1 h cooking per day. By multiplying the estimates in
10    (a), (b), and (c) together, NO2 gas cooking emission rates were calculated to be in the range 0.16
11    to 0.22 g h'1, with a uniform distribution.
12          In a range of simulations performed with INDAIR for houses in the UK, it was found that
13    the predicted maximum 1-h mean concentrations in the kitchen were increased, compared to no-
14    source simulations, by a factor of 10 for NC>2 (30 for PMi0 and 15 for PM2.5) and were higher in
15    winter than in summer.  Cooking activity in the kitchen resulted in significantly elevated 24 h
16    mean concentrations of NC>2, PMio, and PM2.5 in the lounge, as well as the kitchen, while there
17    was a  relatively small effect in the bedroom, which was not connected directly to the kitchen in
18    the model structure (i.e., the direct internal air exchange rate was zero).
19          A very wide range of predictions was derived from the  INDAIR simulations.  The 95th
20    percentile concentrations were typically 50% higher than mean concentrations during periods of
21    average concentration,  and up to 100% higher than mean concentrations during concentration
22    peaks, which were associated with cooking emissions. There was approximately a factor of
23    2 variation in concentrations, and  all modeled concentrations were below those outdoors.  The
24    effect  of cooking was to shift the distribution to the right, but the degree of variation was not
25    greatly increased. This  may reflect the fact that for the fixed emission scenarios that were used,
26    the additional variation in emission rates was small compared to that of other factors such as
27    deposition rate and air exchange rate.  In this scenario, modeled concentrations in the lounge all
28    remained below those outdoors, but a proportion of kitchens (16%) had modeled values above
29    the outdoor concentration. For the gas-cooking scenario, indoor/outdoor ratios for NC>2 ranged
30    from 0.5 to 0.8 for the bedroom, 0.7 to 1.6 for the lounge and 0.9 to 3.6 for the kitchen.
31    According to Dimitrolopoulou et al. (2006), these results  were  broadly consistent with

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 1    indoor/outdoor ratios reported for the UK.  Modeled peak concentrations associated with gas
 2    cooking, of about 300 ppb in the kitchen and 100 ppb in the lounge, were also consistent with
 3    results from UK studies.
 4
 5    AX3.7.4.3   Characterization of Activity Events
 6          An important development in inhalation exposure modeling has been the consolidation of
 7    existing information on activity event sequences in the Consolidated Human Activity Database
 8    (CHAD) (McCurdy, 2000; McCurdy et al., 2000).  Indeed, most recent exposure models are
 9    designed (or have been re-designed) to obtain such information from CHAD which incorporates
10    24-h time/activity data developed from numerous surveys. The surveys include probability -
11    based recall studies conducted by Environmental Protection Agency and the California Air
12    Resources Board, as well as real-time diary studies conducted in individual U.S. metropolitan
13    areas using both probability-based and volunteer subject panels. All ages of both genders are
14    represented in CHAD.  The data for each subject consist of one or more days of sequential
15    activities, in which each activity is defined by start time, duration, activity type (140 categories),
16    and microenvironment classification (110 categories). Activities vary from one min to one h in
17    duration, with longer activities being subdivided into clock-hour durations to facilitate exposure
18    modeling.  A distribution of values for the ratio of oxygen uptake rate to body mass (referred to
19    as metabolic equivalents or METs) is provided for each activity type listed in CHAD.  The forms
20    and parameters of these distributions were determined through an extensive review of the
21    exercise and nutrition literature.  The primary source of distributional data was Ainsworth et al.
22    (1993), a compendium developed specifically to facilitate the coding of physical activities  and to
23    promote comparability across studies.
24
25    AX3.7.4.4   Characterization of Inhalation Intake and Uptake
26          Use of the information in CHAD provides a rational way for incorporating realistic
27    intakes into exposure models by linking inhalation rates to activity information.  As mentioned
28    earlier, each cohort of the pNEM-type models, or each (virtual or actual) individual  of the
29    SHEDS, MENTOR, APEX, and HAPEM4 models, is assigned an exposure  event sequence
30    derived from activity diary data. Each exposure event is typically defined by a start time, a
31    duration, assignments to a geographic location and microenvironment, and an indication of
32    activity level.  The most recent versions of the above models have defined activity levels using

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 1    the activity classification coding scheme incorporated into CHAD.  A probabilistic module
 2    within these models converts the activity classification code of each exposure event to an energy
 3    expenditure rate, which in turn is converted into an estimate of oxygen uptake rate.  The oxygen
 4    uptake rate is then converted into an estimate of total ventilation rate (VE), expressed in liters
 5    min"1. Johnson (2001) reviewed briefly the physiological principles incorporated into the
 6    algorithms used in pNEM to convert each activity classification code to an oxygen uptake rate
 7    and describes the additional steps required to convert oxygen uptake to VE.
 8          McCurdy (1997a,b, 2000) has recommended that the ventilation rate should be estimated
 9    as a function of energy expenditure rate. The energy expended by an individual during a
10    particular activity can be expressed as EE = (MET)(RMR) in which EE is the average energy
11    expenditure rate (kcal min"1) during the activity and RMR is the resting metabolic rate of the
12    individual expressed in terms of number of energy units expended per unit of time (kcal min"1).
13    MET (the metabolic equivalent of tasks) is a ratio specific to the activity and is dimensionless. If
14    RMR is specified for an individual, then the above equation requires only an activity-specific
15    estimate of MET to produce an estimate of the energy expenditure rate for a given activity.
16    McCurdy et al. (2000) developed distributions of MET for the activity classifications appearing
17    in the CHAD database.
18          Finally, in order to relate intake to dose delivered to the lungs, it is important to take into
19    account the processes affecting uptake following inhalation intake of NO2, in a biologically
20    based dosimetry modeling framework. As a reactive gas, NO2 participates in transformation
21    reactions in the lung epithelial lining fluid, and products of these reactions are thought to be
22    responsible for toxic effects (Postlethwait et., 1991), although kinetic modeling of these reactions
23    has not been performed.  Dosimetry models indicate that deposition varies spatially within the
24    lung and that this spatial variation is dependent on ventilation rate (Miller et al., 1982; Overton
25    and Graham, 1995). Controlled exposure studies found that fractional uptake of NO2 increases
26    with exercises and ventilation rate (e.g., Bauer et al.,  1986), making activities with high MET
27    values important for quantifying total NO2 exposure.  Further discussion of NO2 dosimetry
28    modeling is provided in Section 4.2.
29
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 1   AX3.7.5    Concluding Comments
 2          An issue that should be mentioned in closing is that of evaluating comprehensive
 3   prognostic exposure modeling studies, for either individuals or populations, with field data.
 4   Although databases that would be adequate for performing a comprehensive evaluation are not
 5   expected to be available any time soon, there have been a number of studies, reviewed in earlier
 6   sections of this Chapter, that can be used to start building the necessary information base.  Some
 7   of these studies report field observations of personal, indoor, and outdoor ozone levels and have
 8   also developed simple semi-empirical personal exposure models that were parameterized using
 9   the observational data and regression techniques.
10          In conclusion, though existing inhalation exposure modeling systems have evolved
11   considerably in recent years, limitations of available modeling methods and data, in relation to
12   potential NO2 studies that include the  following, should be taken into account and be addressed
13   by future research efforts:
14       •  Ambient photochemical modeling systems are not optimized for estimating NO2 at a
15          local scale.
16       •  Subgrid scale modeling (LES,  RANS, DNS) is needed to properly characterize effects of
17          nonhomogeneous  mixing  (i.e., of spatial subgrid variability) on fast nonlinear chemical
18          transformations; the outcomes of this characterization then should be incorporated in
19          simpler models, appropriate for use  in conjunction with exposure modeling systems.
20       •  Microenvironmental modeling efforts need to balance mechanistic detail and usability by
21          developing:
22             — A simplified but adequate indoor chemistry mechanism for NO2 and related
23                 oxidants,
24             — Databases  of realistic distributions of indoor NO2 source magnitudes and
25                 activities,
26             — Flexible, multi-zonal models of indoor residential and occupational
27                 microenvironments.
28          Existing prognostic modeling systems for inhalation exposure can in principle be directly
29   applied to, or adapted for, NO2 studies; APEX, SHEDS, and MENTOR-1A are candidates.
30   However, such applications would be  constrained by data limitations such as ambient

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 1    characterization at the local scale and by lack of quantitative information for indoor sources and
 2    sinks.
 3
 4
 5    AX3.8    EXPOSURE ERROR
 6           Discussions in this section focus on the errors associated with exposure assessments and,
 7    in particular, with those that may be associated with using ambient NC>2 as a surrogate of
 8    personal NO2 exposure in epidemological time series studies. As shown in Figure AX3.8-1,
 9    exposure error is one of the errors associated with epidemological studies linking pollutant
10    concentrations in ambient air and human health responses. How exposure errors influence the
11    epidemological findings depend upon the design of the epidemological study.  In this section, the
12    exposure errors will be discussed in the context of two common environmental epidemological
13    study designs, time-series studies and chronic  studies, in which central site NC>2 concentrations
14    are used as surrogates of personal exposure.
15           In a broader sense, NO2 is an indicator of a chemical  mixture, which might be the real
16    agent(s) leading to epidemological findings. Ambient, indoor or personal NC>2 might indicate
17    different chemical mixtures because of differences in the infiltration efficiency or chemical
18    reactivity of other NOY species or in the composition of nearby sources.  When using ambient
19    NC>2  as a surrogate of personal exposure, issues of confounding and surrogate are raised.
20    Confounding issues have been discussed in Section AX3.6.  A brief summary of the confounding
21    issues and a brief discussion of the surrogate issues will be provided in this section.
22           Usually when discussing errors in the context of exposure assessments, errors resulting
23    from limitations of analytical capabilities of monitoring instruments are lumped together with
24    those caused by environmental factors such as spatial heterogeneity in ambient concentrations,
25    the lack of identification of indoor and neighborhood sources etc.  In certain instances these
26    different errors may be linked.
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EPI
                                                            __Exposure
                                                             Assignment
                                                                          I
                                                                      Error      >L
                                                                Uncertainty t?): Measurement
                                                                Variability <-): Spatial Distribution)
                                                                          f   Error   "\
                                                                          I Numerical: Convergence!
                                                                          \ModeJ1 Selection  ^/
                                                                                          EPI
                                                                                   Model
                                                                     Error
                                                                 ? . Measurement, Misclass.
                                                                 *• -" Levoi ditf. from person to
                                                                  person
                                          Health
                                        Outcome
                                       Different/able?
                                                      Error
                                                  7 ; Case Ascertainment
                                                  ^: Susceptibility
                           '
                                                                                         Study
                                                                                         Design
      Figure AX3.8-1.
                     Errors associated with components of the continuum from ambient
                     air pollution to adverse health outcome.
 1           Measurements of NO2 are subject to artifacts both at the ambient level and at the personal
 2    level. A discussion of the errors associated with ambient monitors is given in Section 2.8, and
 3    one for errors associated with personal monitors is given in Section AX3.4.  As noted earlier,
 4    measurements of ambient NC>2 are subject to variable interference caused by other NOy
 5    compounds, in particular PANs, organic nitrates, particulate nitrate and HNC>2 and HNOs. The
 6    latter is taken up on inlet walls to varying degrees and likely causes variable (positive) artifacts
 7    in NC>2 measurements.
 8           Personal monitors are subject to interference by SC>2 and HONO and it is not clear to
 9    what extent they are affected by interference by the NOy species interfering with the ambient
10    monitors.  In addition, personal monitors generally require longer sampling times (typically from
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 1    about a day to two weeks) and so will not be able to identify peak exposures occurring on time
 2    scales of a few hours or less.  As noted by Pilotto et al. (1997) these exposures would have been
 3    averaged out and associated health outcomes would not be properly attributed by monitors
 4    requiring longer sampling times. Often personal concentrations may either be below or not very
 5    much above detection limits for the most commonly used personal  samplers (see Table
 6    AX3.3-2).  Thus, associations between ambient and personal concentrations could be weakened
 7    between ambient and personal concentrations of a given pollutant.  In studies of multiple
 8    pollutants, personal concentrations of one pollutant may be more strongly associated with
 9    ambient concentrations of another pollutant if the measurements of the latter at the personal level
10    are subject to larger analytical errors than are measurements of the  former at the personal level.
11           Spatial heterogeneity in ambient concentrations helps determine how well concentrations
12    measured at ambient monitoring sites reflect exposures at the community and personal levels.
13    Correlations between different pairs of monitoring sites are not sufficient for characterizing
14    spatial variability, as there may be significant differences in concentrations among monitoring
15    sites. This point has been demonstrated in Chapter 3 the latest AQCD for PM (U.S.
16    Environmental Protection Agency, 2004) and Chapter 3 the latest AQCD for ozone and other
17    photochemical oxidants (U.S. Environmental Protection Agency, 2006a). As described earlier in
18    Section AX3.2, concentrations of NO2 are highly variable across the urban areas examined and
19    will result in exposure  characterization errors at least as significant as, if not larger, than those
20    for O3 and PM2.5.  The  problem is exacerbated for NO2 because of the sparseness of NOX
21    monitors, compared to  monitors for PM and Os.  Thus, the use of central site monitors may be
22    more problematic for NO2 than for PM2 5 (e.g.).  As a result, little relation might be found
23    between ambient central site monitors and personal exposures and/or indoor concentrations and
24    stronger associations might be found  between cross pollutants at the ambient and personal levels.
25    In this case, it may be necessary to supplement existing ambient measurements to derive ambient
26    concentrations that are  consistent with those of other pollutants, e.g., by the use of supplemental
27    'outdoor' monitors. Additional complexity arises if horizontal spatial gradients are large enough,
28    as might happen in going from urban to rural environments, as the lowest values measured might
29    be beneath quantification limits or even beneath detection.  Small scale horizontal variability
30    especially as found near roads could be large.
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 1          As noted earlier in Section AX3.2, variability in the vertical must be considered in
 2    addition to horizontal variability. NO2 emitted at or near ground level exhibits strong vertical
 3    gradients. Restrepo et al. (2004) found that NO2 measured at 15 m above the surface was a
 4    factor of higher than measurements of NO2 at 4 m.  Monitors placed at heights such as these will
 5    be found in many inner urban areas.
 6          In the framework developed by Zeger (2000) for analyzing errors in time-series
 7    epidemological studies associated with exposure measurement errors, exposure errors could be
 8    classified into three components: (1) the difference between true ambient concentration and the
 9    measured ambient concentration, (2) the difference between the measured ambient concentration
10    and the community ambient exposure, and (3) the difference between the community ambient
11    exposure and the personal ambient exposure. These differences mentioned above are determined
12    by (1) the reliability of measurement techniques, (2) the spatial and temporal variation of
13    ambient NO2 concentrations, and (3) personal activity and microenvironment characteristics.
14          In the context of chronic epidemological studies, the issue of misclassification also arises.
15    Personal exposure is composed of exposures to both ambient sources and nonambient sources. If
16    total personal NO2 exposure is assumed to be responsible for the observed health outcomes, the
17    use of ambient concentration as a surrogate for personal exposure could lead to misclassification
18    and bias the epidemological findings. The degree of the misclassification also depends on the
19    spatial and temporal variation of ambient NO2, personal activities and microenvironment
20    characteristics.
21          In the Danish children exposure study, front door NO2 as well as personal NO2
22    concentrations were measured (Raaschou-Nielsen et al., 1997).  To evaluate the extent of
23    misclassification using outdoor NO2 as an indicator of personal exposure, Raaschou-Nielsen
24    et al. (1997) reported that both the sensitivity (the proportion of correctly classified highly
25    exposure) and the specificity (the proportion of correctly classified low exposure) were 81% in
26    Copenhagen and 74% in the rural areas.  Similar results were reported by Lee, et al., (2004).
27          Exposure measurement errors could also be evaluated by comparing the within subject
28    and between subject variations of individual  exposures. The higher the ratio of within variance
29    and between variance, the more the true exposure-effect relationship is biased (Armstrong et al.,
30    1992). During the Los Angeles NO2 exposure study, Spengler et al. (1994) reported that the
31    within personal variation was 61.2 |ig/m3 and the variation between personal exposure was

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 1    608.2 |ig/m3. Aim et al. (1998) reported that within personal variation explained 59% of the total
 2    personal exposure variation and 41% of the total variation was accounted by between-subject
 3    variation.
 4          Simply speaking, two parameters could be used to evaluate the feasibility of using
 5    ambient NO2 concentrations as a surrogate for personal exposure: the correlation coefficient
 6    between personal exposure and ambient concentrations (especially in the context of longitudinal
 7    design and daily-averaged design), and the difference between personal exposure and ambient
 8    concentration. Extensive discussions of this issue have been provided in Section AX3.5, such
 9    discussions are not repeated here and only general conclusions will be provided. The correlation
10    between personal exposure and ambient concentrations range from moderate to good.  Personal
11    exposure concentrations are generally lower than ambient concentrations for homes with no
12    indoor or local sources but higher than ambient concentration for homes with indoor or local
13    sources.
14          In a broader context, NO2 serves as an indicator of a pollutant mixture whose components
15    have different physical and chemical properties that may be the real agent(s) causing the adverse
16    health effects. The components of the mixture are either primary or secondary, i.e., they either
17    come from direct emissions or form through atmospheric chemical reactions. When the ambient
18    mixture infiltrates into microenvironments, some components are lost due to absorption and
19    chemical reaction, while some new components are formed through chemical reactions in indoor
20    air.  At the same time, indoor primary sources could add more NO2 along with other pollutants in
21    the indoor environments. When evaluating the question of whether ambient NO2 is the agent
22    causing the observed adverse health effects, the two issues of confounding and surrogacy are
23    raised.
24          The definition and discussion of the confounding issue from the perspective of exposure
25    analysis could be found in Section AX3.6.  In Section AX3.6, the following five questions were
26    evaluated (the five arrows in Figure AX3.8-2):  (1) Are ambient copollutant concentrations
27    significantly associated with ambient NO2?  (2) Are personal exposures to copollutants
28    significantly associated with personal exposures to NO2?  (3) Are ambient pollutant
29    concentrations associated with their respective personal exposures? (4) Are ambient copollutants
30    surrogates for personal exposure to NO2? (5) Is ambient NO2 a surrogate for personal exposure
31    to copollutants?  Based on the fact that NO2 is correlated with other copollutants at both ambient

      March 2008                             AX3-119     DRAFT-DO NOT CITE OR QUOTE

-------
 1   level and personal exposure levels and that cross-level correlations were also observed, we
 2   concluded that caution should be exercised when dealing with the observed NO2 health effect
 3   and a more comprehensive analysis should be performed in conjunction with other components
 4   of the risk assessment.
 5          Another issue raised is the surrogate issue.  There are different meanings associated with,
 6   to use the word "surrogate".  In summary, there are three scenarios involving the concept of a
 7   surrogate and each one is associated with a question: (1) At ambient level, is ambient NC>2 a
 8   good surrogate (tracer) for some ambient chemical or chemical mixture? (2) At personal
 9   exposure levels, is personal NO2 exposure a good surrogate (tracer) for some chemical or
10   chemical mixture of personal exposure?  and (3) At health effect levels, is NO2 a good surrogate
11   for some chemical or chemical mixture causing an adverse health outcome?  The first two
12   questions could be sufficiently answered by various source apportionment approaches to
13   evaluate the co-variation of NC>2 with other pollutants.  The third question is evaluated in Figure
14   AX3.8-2 with a systematic approach considering biological plausibility and exposure
15   assessment.
                    Yes  -^PersonalNO, Exposure
                         correlated witti ambient
                            c&pofatants?
     Figure AX3.8-2.
A systematic approach to evaluate whether NOi itself is causing the
observed adverse health outcome or NOi is acting as a surrogate for
other pollutants.
     March 2008
                   AX3-120
DRAFT-DO NOT CITE OR QUOTE

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   TABLE AX3.2-1. SUMMARY OF PERCENTILES OF NO2 DATA POOLED ACROSS MONITORING SITES (2003-
o
to
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Pooled Group/ Avg
Time
1-h Max Concentrations
Monitors in CMSAs
Monitors not in
CMSAs
1-h Avg. Concentrations
Monitors in CMSAs
Monitors not in
CMSAs

Number of
Values Mean

288008 0.029
460913 0.008

6163408 0.015
460913 0.008
zuu3j ^*jr>^i^r> iK/\injr>a AKJL ir> rrwi
Percentiles
1 5 10 25 30 50 70 75 90 95 99 Max

0.003 0.007 0.010 0.017 0.019 0.027 0.036 0.038 0.048 0.055 0.072 0.201
0.001 0.001 0.001 0.002 0.003 0.005 0.009 0.010 0.019 0.026 0.040 0.189

0.001 0.003 0.003 0.006 0.007 0.012 0.019 0.022 0.033 0.040 0.053 0.201
0.001 0.001 0.001 0.002 0.003 0.005 0.009 0.010 0.019 0.026 0.040 0.189
Daily 24-h Avg. Concentrations
X
OJ
to
Monitors in CMSAs
riusAc
282810 0.015
20635 0.008
0.002 0.003 0.005 0.008 0.009 0.012 0.019 0.021 0.028 0.034 0.045 0.129
0.001 0.001 0.001 0.003 0.003 0.006 0.010 0.011 0.017 0.021 0.030 0.081
2-week Avg. Concentrations

Monitors in CMSAs     21779

Monitors not in
CMSAs              1588
0.015     0.003     0.005     0.006    0.009     0.010     0.014    0.019     0.020     0.026     0.031     0.038    0.076

0.008     0.001     0.001     0.001    0.003     0.003     0.007    0.009     0.012     0.016     0.020     0.030    0.039
H
6
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0
H
O
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W
O
o
n
Yearly Avg. Concentrations
Monitors in CMSAs 758
CMSAs 51
3-yr Avg. Concentrations
Monitors in CMSAs 247
Monitors not in
CMSAs 15

0.015 0.004 0.006 0.007 0.011 0.012 0.015 0.018 0.019 0.025 0.028 0.033 0.037
0.008 0.001 0.001 0.002 0.003 0.005 0.009 0.012 0.012 0.015 0.016 0.017 0.017

0.015 0.004 0.006 0.007 0.011 0.012 0.015 0.018 0.019 0.025 0.028 0.032 0.033

0.008 0.001 0.001 0.002 0.003 0.006 0.008 0.012 0.012 0.014 0.016 0.016 0.016

-------
 TABLE AX3.2-2. SPATIAL VARIABILITY OF NO2 IN SELECTED UNITED STATES
                              URBAN AREAS
Mean 1-h
Concentration(ppb) r P90 (ppb)
New York, NY
(5)
Atlanta, GA
(5)
Chicago, IL
(7)
Houston, TX
(7)
Los Angeles, CA
(14)
Riverside, CA
(9)
29
(25-37) 0.77-0.90 7-19
** 0.22-0.89 7-24
(5-16)
(6-230) -°05-°-83 10-39
(T-'lS) °31-°-8° 6-2°
25
(14-33) 0.01-0.90 8-32
(, 2* 0.03-0.84 10-40
COD
0.08-0.23
0.15-0.59
0.13-0.66
0.13-0.47
0.08-0.51
0.14-0.70
       TABLE AX3.2-3. NOX AND NOY CONCENTRATIONS AT REGIONAL
 BACKGROUND SITES IN THE EASTERN UNITED STATES. CONCENTRATIONS
                            ARE GIVEN IN PPB

NO
Winter
Summer
NOX
Winter
Summer
NOY
Winter
Summer
Shenandoah NP, VA

0.39-2.2 l
0.12-0.28
—
—
—
—
2.7-8.6
2.3-5.7
Harvard Forest, MA

—
—
—
1-15
0.4-1.2
—
4.4 2
2.7 2
1 Ranges represent lo limits.
2 Values represent medians.
March 2008                        AX3-122    DRAFT-DO NOT CITE OR QUOTE

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     TABLE AX3.2-4. RANGE OF PEARSON CORRELATION COEFFICIENTS
 	BETWEEN NO2 AND O3, CO AND PM2.5	
  Monitoring Sites in                          Copollutant
Selected Areas
Los Angeles, CA
Riverside, CA
03
-0.59 to 0.19
-0.26 to 0.28
CO
0.11 to 0.83
0.15 to 0.65
PM25
0.45 to 0.56
 Chicago, IL             -0.20 to-0.13         -0.10 to 0.53          0.21 to 0.49
 Washington, DC               —                  —                  —
 New York City, NY            —                  —                  —
March 2008                         AX3-123     DRAFT-DO NOT CITE OR QUOTE

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                          TABLE AX3.3-1. PASSIVE SAMPLERS USED IN NO2 MEASUREMENTS
o
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HH
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Passive Sampler
Palmes tube

Gradko sampler
Passam Short
sampler Long
Analyst™
Yanagisawa badge
Ogawa sampler
IVL sampler
Willems badge
Radiello®
EMD sampler
Dimension
(diffusion length x
cross-sectional area) Absorbent
7.1cm x 0.71cm2 Triethanolamine

7.1cm x 0.93cm2 Triethanolamine
0.74cm x 0.75cm2 Triethanolamine
2.54cm x 3.27cm2 Active charcoal
1.0cm x 20cm2 Triethanolamine
0.6cm x 0.79cm2 Triethanolamine
Potassium iodide
1.0cm x 3.14cm2 & sodium arsenite
Triethanolamine-
0 . 6cm x 5 . 3 1 cm2 acetone
1 . 8cm x 2 . Ocm2 Triethanolamine
N.A. Triethanolamine
Analytical
Method
Spectrophotometry

Spectrophotometry
Spectrophotometry
Gas
chromatography
Spectrophotometry
Spectrophotometry
Spectrophotometry
Spectrophotometry
Spectrophotometry
Ion
chromatography
Sampling Rate
Manufacturer Experiment Reference
N.A. 0.92 cnrYmin Palmes et al. (1976)
Plaisance et al.
(2004)
1.2 cnrYmin 1.212 cnrYmin Gradko (2007)
15.5 cnrYmin N.A.
0.854 cnrYmin 0.833 cnrYmin Passam (2007)
De Santis et al.
N.A. 12.3 cnrYmin (2002)
Yanagisawa and
N.A. N.R. Nishimura (1982)
Ogawa & Company
(1998a) Gerboles
N.A. 16.2 cnrYmin et al. (2006a)
Perm and Svanberg
N.A. 29 cnrYmin (1998)
Hagenbjork-
Gustafsson et al.
N.A. 46 cnrYmin (2002)
75 cnrYmin N.R. Radiello® (2006)
Piechocki-Minguy
N.A. 53.4 cnrYmin etal. (2006)
        *N.A.: not available; N.R.: notreported.
O

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O
        TABLE AX3.3-2. THE PERFORMANCE OF SAMPLER/SAMPLING METHOD FOR NO2 MEASUREMENTS
                                             IN THE AIR
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X
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1
to

O
H
6
O
0
H
O
H
W
Type Sampler
Active Impinger method
sampling
Chemiluminescence
Personal monitor
Passive Palmes tube
sampling
Gradko sampler
Passam Short
sampler
Long
Analyst™
Yanagisawa badge
Ogawa sampler
IVL sampler
Willems badge
Radiello®
EMD sampler
N.R.: not reported.


Optimal Duration of
Sampling
2-24 h
Continuous
Real-time
1-4 wks
2-4 wks
8-48 h
1-4 wks
1-3 mos
1-14 days
24-168 h
1 mo +
2-8 h& 1-7 days
1-24 h& 1-7 days
1-24 h



Concentration
Range
10 - 400 ppb
0.5 - 1000 ppb
0.1 -50ppm
10 - 100 ppb
1.0 -10,000 ppb
5 - 240 ug/m3
1 - 200 ug/m3
24 - 1,237 ug/m3
N.R.
0 - 3,600 ppb
0.1-400 ug/m3
2.0 - 150 ug/m3
1.0 -496 ppb
N.R.



Detection Limit
0.2 ppb
0.05 ppb
0.1 ppm
10 ppb
0.5 ppb
2-5 ug/m3
0.64 ug/m3
100 ug/m3
3.0 ppb
2.3 ppb
0.1 ug/m3
2 ug/m3
1.0 ppb
11 ug/m3




RSD < 5%
Accuracy ±
Precision ±
Uncertainty
Uncertainty
Accuracy ±
3%

RSD - 4%
Uncertainty
Uncertainty
Uncertainty



Comment

5%
5% above 5 ppb
-27% at 80 ug/m3
- 25% at 20-40 ug/m3
5%; Precision within

- 24%; RSD 22%
- 12%
-28%



O

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TABLE AX3.4-1. NO2 CONCENTRATIONS (PPB) IN HOMES IN LATROBE VALLEY,
                            VICTORIA, AUSTRALIA
Living Room

No source
Gas stove only
Gas heater only
Smoking only
Multiple sources
Mean ppb
3.77
6.70
6.86
6.02
14.50
Min ppb
<0.37
1.57
2.20
0.94
2.25
Max ppb
9.27
18.32
18.06
14.61
114.66
Mean ppb
3.82
8.01
7.33
6.60
10.73
Kitchen
Min ppb
<0.37
2.62
2.88
1.83
2.62

Max ppb
8.17
24.14
26.23
16.44
128.80
Source: Garrettetal. (1999).
TABLE AX3.4-2. NO2
CONCENTRATIONS (PPB) IN
No Gas Stove Used in Monitoring Period
Secondary
Heating
Source
None
Gas space
heater
Wood
burning
source
Kerosene
heater
GSH +
Wood
GSH + KH
Wood + KH
GSH +
Wood + KH

N
1018
6
200


159

3

0
73
0


10th
1.7
0.1
1.8


3.3

12.6

—
1.9
—


25th
3.5
9.2
3.6


7.1

12.6

—
8.2
—


Median
6.3
15.3
5.9


18.9

80.6

—
16.4
..


75th
12.3
68
12.2


42.7

81.9

—
35.2
—


90th
28.2
69.6
28.2


88.3

81.9

—
66.8
—

HOMES IN CONNECTICUT
Yes Gas Stove Used in Monitoring Period

N
564
6
78


14

5

1
5
1


10th
8.4
19.5
6


0

36.2

n/a
8.9
n/a


25th
14.5
34.6
9.5


9.6

44.8

n/a
12.7
n/a


Median
22.7
36.6
16.7


17.2

57.1

147.7
17.3
107.8


75th
33.8
54.8
31.4


33.6

114.
2
n/a
23.5
n/a


90th
48.1
147.2
58.6


46.1

156.6

n/a
72.9
n/a

Source: Triche et al. (2005).
March 2008
AX3-126
DRAFT-DO NOT CITE OR QUOTE

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       TABLE AX3.4-3. NO2 CONCENTRATIONS NEAR INDOOR SOURCES -
                             SHORT-TERM AVERAGES
       Average
     Concentration
         (PPb)
 Peak Concentration
        (PPb)
      Comment
    Reference
 191 kitchen
 195 living room
 184 bedroom
 400 kitchen,
 living room,
 bedroom

 90 (low setting)
 350 (med setting)
 360 (high setting)
 N/R
 N/R
 180 to 650
375 kitchen
401 living room
421 bedroom
673 bedroom
N/R1
1000
1500
N/R
Cooked full meal with
use of gas stove and
range for 2 h, 20 min;
avg cone, is time-
weighted over 7 h.
Automatic oven
cleaning of gas stove.
Avgs are over the entire
cycle.
Natural gas unvented
fireplace,2 2-h-time-
weighted avg in main
living area of house
(177m3).
Room concentration
with kerosene heater
operating for 46 min.
Room concentration
with gas heater
operating for 10 min.
Calculated steady-state
concentration from
specific unvented gas
space heaters operating
in a 1400 ft2  house,
1.0 ach.
Fortmann et al.
(2001)
Fortmann et al.
(2001)
Duttonetal. (2001)
Girman et al.
(1982)

Girman et al.
(1982)

Girman et al.
(1982)
 1 N/R = Not Reported.
 2 Unvented fireplaces are not permitted in many areas such as California.

Source: Adapted from CARB (2007).
March 2008
                AX3-127
        DRAFT-DO NOT CITE OR QUOTE

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       TABLE AX3.4-4.  NO2 CONCENTRATIONS NEAR INDOOR SOURCES -
  	LONG-TERM AVERAGES	
  Average Concentration
          (ppb)                           Comment                    Reference
 30 to 33
 22
 6 to 11
 55 (Median)
 41 (90th %-ile)
 80 (90th %-ile)
 84 (90th %-ile)
 147 (90th %-ile)
 52 (90th %-ile)
 18 bedrooms
 19 living rooms
 15 outdoors
Gas stoves with pilot lights.
Gas stoves without pilot lights.
Electric ranges. Study conducted in 517
homes in Boston, values represent 2-wk
avgs.
Gas space heaters.
No indoor combustion source.
Fireplaces.
Kerosene heater.
Gas space heaters.
Wood stove.
All values represent 2-wk avgs in living
rooms.
Almost all homes had gas stoves.  Values
represent 2-wk avgs.
                Lee etal. (1998)
                Triche et al.
                (2005)
                Zipprich et al.
                (2002)
March 2008
           AX3-128
DRAFT-DO NOT CITE OR QUOTE

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       TABLE AX3.5-1. SUMMARY OF REGRESSION MODELS OF PERSONAL EXPOSURE TO AMBIENT/OUTDOOR NO2
O

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X
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H
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O
H
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HH
H
W
Study Location
Rojas-Bracho et al. Santiago, urban
(2002)
Aim et al. (1998) Helsinki, downtown +

Monn et al.


suburban
(1998) Four urban + two rural
+ two alpine

Levy et al. (1998a) 15 cities in 18

Spengler et
(1994)
S0rensen et
(2005)


Sarnat et al.

Sarnat et al.

Sarnat et al.

countries
al. Los Angeles Basin

al. Copenhagen, urban



(2001) Baltimore

(2005) Boston

(2006) Steubenville

Season
Winter
Winter +
Spring
All


Winter

All

All
(>8 °C)
(<8 °C)
All
Summer
Winter
Summer
Winter
Summer
Fall
Model type
Personal vs. outdoor
Personal vs. central
Personal vs. outdoor
Personal (all subjects) vs. outdoor
Personal (no smokers and gas
cooking) vs. outdoor
Personal vs. outdoor

Personal vs. outdoor

Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor
Personal vs. central
Personal vs. central
Personal vs. central
Personal vs. central
Personal vs. central
Personal vs. central
Personal vs. central
Slope (SE) Intercept / ppb R2
0.33 (0.05)
0.3
0.4
0.45
0.38

0.49

0.56

0.60 (0.07)
0.68 (0.09)
0.32(0.13)
0.56 (0.09)
0.04*
-0.05*
0.19
-0.03*
0.25 (0.06)
0.49 (0.05)
7.2 0.27
5.0 0.37
4.7 0.86
7.2 0.33
7.2 0.27

14.5 —

15.8 0.51

— —
— —
— —
— —
9.5 —
18.2 —
— —
— —
— 0.14
— 0.43
       *Not significant at the 5% level.
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TABLE AX3.5-2. AVERAGE AMBIENT AND NONAMBIENT CONTRIBUTIONS TO POPULATION EXPOSURE
o
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OJ
i
o
O
H
6
o
0
H
O
H
W
O
o
o
Study
Rojas-B radio
et al. (2002)
Aim et al.
(1998)
Monn et al.
(1998)

Levy et al.
(1998a)
Spengler et al.
(1994)
** Not reported.








Slope
Model Type (SE)
Personal vs. outdoor 0.33
(0.05)
Personal vs. central 0.3
Personal vs. outdoor 0.4
Personal (all subjects) 0.45
vs. outdoor
Personal (no smokers 0.38
and gas cooking) vs.
outdoor
Personal vs. outdoor 0.49
Personal vs. outdoor 0.56









Mean of Percent Percent
Personal Total Mean Ambient Ambient Nonambient
Intercept / Exposure / Contribution / Contribution Contribution
ppb ppb Ppb °/° 0//0
7.2 36.4 7.2 19.8 80.2
5.0 — 5.0 — —
4.7 — 4.7 — —
7.2 14.1 7.2 51.1 48.9
7.2 — 7.2 — —
14.5 28.8 14.5 50.3 49.7
15.8 37.6 15.8 42.0 58.0










-------
O
                    TABLE AX3.5-3. THE ASSOCIATION BETWEEN PERSONAL EXPOSURES AND
                                       AMBIENT CONCENTRATIONS
1— '
to
o
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oo









X
OJ
1
^

o
H
6
o
2;
o
H
O
HH
H
W
O
O
O
Study


Linn et al.
(1996)

Kramer et al.
(2000)
Rojas-B radio
et al. (2002)
Raaschou-
Nielsen et al.
(1997)
Aim et al.
(1998)








Monn et al.
(1998)




Study Design


Children, Southern California, 24 h averaged, one wk
consecutive measurement for each season (fall, winter, and
spring 1992-1994) for each child.
Children, West Germany, two one-wk averaged
measurements for each child each in March and Sept 1996
Children, Santiago, 24 h averaged sample for five
consecutive days for each child, winters of 1998 and 1999
Children, Copenhagen and rural areas, one-wk averaged, 2
measurements for each child in each month (Oct 1994,
April, May, and June 1995)
Children, Helsinki, one-week averaged, 13 wks for each
child in each season (winter and spring 1991)








Adults, Switzerland, eight regions in Swiss (four
urban/suburban, two rural and two alpine regions), one-wk
averaged, one measurement each mo (the first wk of the
mo) for each subject, between Dec 1993 to Dec 1994


Association Variable


Personal vs. central


Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor

Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor
Personal vs. outdoor
Personal vs. central
Personal vs. central
Personal vs. outdoor

Personal vs. central

Personal vs. outdoor





Location


pooled


pooled
urban
urban

urban
rural
downtown
suburban
downtown
suburban
downtown
suburban
pooled

pooled

pooled





Season


pooled


pooled
pooled
winter

pooled
pooled
winter
winter
spring
spring
spring
spring
pooled

pooled

pooled





rp, rs, or R2


0.63 (rp)


0.37 (rp)
0.06 (rp)
0.27 (R2)

0.15 (R2)
0.35 (R2)
0.46 (rp)
0.49 (rp)
0.80 (rp)
0.82 (rp)
0.64 (rp)
0.78 (rp)
0.86 (R2)

0.37 (R2)

0.33 (R2)






-------
O
                  TABLE AX3.5-3 (cont'd). THE ASSOCIATION BETWEEN PERSONAL EXPOSURES AND
                                         AMBIENT CONCENTRATIONS
1— '
to
o
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oo









X
OJ
1
to
o
fj*
i-rj
H
6
o
o
^^
H
o
i — 1
H
W
O
Study
Levy et al.
(1998a)


Kodama et al.
(2002)

Liard et al.
(1999)

Gauvin et al.
(2001)




Spengler et al.
(1994)



Kousa
etal. (2001)

Study Design
Adults, 18 cities across 15 countries, two-day averaged,
one measurement for each person, all people were
measured on the same winter day in February or March
1996
Junior high school students and their family members,
Tokyo, three-day averaged, samples were simultaneously
collected on Feb 24-26, Jun 2-4, July 13-15, and Oct 14-16
in 1998 and Jan 26-28 in 1999
Adults and Children, Paris, 4-day averaged, three
measurements for each person, during each measurement
session, all subjects were measured at the same time
during May/June 1996
Children, three French metropolitan areas, 48-h averaged,
one measurement for each child, all children in the same
city were measured on the same day. The study occurred
between April-June 1998 in Grenoble, May-June 1998 in
Toulouse, and June-Oct 1998 in Paris.



Probability based population, Los Angeles Basin, 48-h
averaged, one measurement per person in one of the eight
sampling cycles (microenvironmental component of the
study), from May 1987 to May 1988

Probability based population, Helsinki, Basel, and Prague,
48-h averaged, one measurement per person, during 1996
and 1997
Association Variable Location Season
Personal vs.



Personal vs.
Personal vs.

outdoor



outdoor
outdoor

Adults vs. central
Children vs.

Personal vs.
(Grenoble)
Personal vs.
(Toulouse)
Personal vs.
(Paris)

Personal vs.




Personal vs.


central

central

central
central


outdoor




outdoor


urban



urban
urban

urban
urban

urban

urban
urban


pooled




urban


winter



summer
winter

summer
summer

pooled

pooled
pooled


pooled




pooled


rp, rs, or R2
0.57 (rs)



0.24 (rp)
0.08 (rp)

0.41 (R2)
0.17(R2)

0.01 (R2)

0.04 (R2)
0.02 (R2)


0.48 (R2)




0.40 (R2)


O

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                   TABLE AX3.5-3 (cont'd). THE ASSOCIATION BETWEEN PERSONAL EXPOSURES AND
                                         AMBIENT CONCENTRATIONS
to
o
o
oo











>
OJ
1

OJ



>
H
6
O
0
H
O
H
W
Study
Linaker et al.
(2000)





Lai et al.
(2004)
Kim et al.
(2006)

Sarnat et al.
(2005)






Sarnat et al.
(2006)
Study Design
Asthmatic children, Southampton, one-wk averaged,
13 mos for each child, until Dec 1995





Adults, Oxford, 48-h averaged, once per person, between
Dec 1998 and Feb 2000
Coronary artery adults, Toronto, 24-h averaged, one day
a wk for 10 wks for each person, from Aug 1999 to Nov
2001
Seniors and schoolchildren, Boston, 24-h averaged, 12
consecutive days in each of the 1 or 2 seasons, summer of
1999 and winter of 2000





Seniors, Steubenville, 24-h averaged, the same two
consecutive days each wk for 23 wks, summer and fall of
2000
Association Variable
Personal vs. outdoor
(Overall
measurements across
children and time)
Personal vs. outdoor
(subject-wise)

Personal vs. outdoor

Personal vs. central
(ambient)

Personal vs. central
(subject wise)






Personal vs. central

Location
pooled,
urban, no
major indoor
sources
By person


urban

urban


urban







urban

Season
pooled



pooled


pooled

pooled


summer



winter



summer
fall
rp, rs, or R2
Not
significant


-0.77 to 0.68
and median
-0.02(rp)
0.41 (rp)

0.57 (rs)


-0.25 to 0.5
(rs) with a
median of
0.3*
-0.5 to 0.9
(rs) with a
median of
0.4*
0.14(R2)
0.43 (R2)
* Values were estimated from figures in the original paper.


















O

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                 TABLE AX3.5-4.  INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
O

to
O
O
oo
      Study
        Description
   Season
Regression Format or
        Ratio
    Indoor
Characteristics
Slope/Ratio/
    Fjnf
Comments
>
X
Mosqueron et al.
(2002)
        Lee etal. (1999)
48 h residential indoor,
workplace, outdoor and
personal exposure were
measured for 62 Paris office
workers using Ogawa badges
from Dec 1999 to Sept 2000
Overall study Residential indoor vs.    Cooking
seasons      ambient and using gas
            cooking

            Office indoor vs. ambient None
            and floor height
                                            0.26
                                                                                                             0.56
                  The indoor and outdoor air   Overall study Indoor vs. outdoor
                  quality of 14 public places    seasons
                  with mechanical ventilation
                  systems in Hong Kong; from
                  Oct 1996 to March 1997;                 Indoor/outdoor ratio
                  Teflon bags were used to
                  collect indoor and outdoor
                  NO and NO2 during peak h
                                                                                   0.59
                                                                                0.53-1.03
                                                                                (mean: 0.75)
                             The overall R is 0.14,
                             and ambient NO2 and
                             indoor cooking
                             account for 0.07 each.
                             The overall R2 is 0.24,
                             partial R2 for ambient
                             and floor height were
                             0.18 and 0.06,
                             respectively.
                             R2 was 0.59. The
                             slopes for NO and
                             NOX were 1.11 and
                             1.04 respectively.
                             0.83-2.68 for NO
                             (mean: 0.99)
                             0.78-1.68 for NOX
                             (mean: 0.94)
H
6
O
2
O
H
O
HH
H
W
O

-------
   TABLE AX3.5-4 (cont'd).  INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
                                                          Regression Format or        Indoor        Slope/Ratio/
     Study             Description
O

to
O
O
oo
                             Season
                       Ratio
                         Characteristics
                       Finf
          Comments
>
X
H
6
o
2
o
H
O
HH
H
W
Monn et al.
(1997)
          Monn et al.
          (1997)
          Garcia-Algar
          et al. (2003)
During the SAPALDIA
(Spain) study, 48-72 h
indoor, outdoor, and
personal NO2 were
measured by Palmes tubes
between the winter of
1994 to the summer of
1995, and between May
and July of 1996
During the SAPALDIA
(Spain) study, 48-72 h
indoor, outdoor, and
personal NO2 were
measured by Palmes tubes
between the winter of
1994 to the summer of
1995, and between May
and July of 1996
Yanagisawa passive filter
badges were used to
measure indoor NO2
concentrations for 7~15
days for 340 homes in
Barcelona, Spain during
1996-1999. Outdoor
NO2 concentrations were
obtained from the fixed
monitoring stations by the
method of CL.
Overall study
seasons
Indoor/outdoor ratio
                                           Overall study
                                           seasons
               Indoor/outdoor ratio
With gas-cooking
                                                                                          Without gas
                                                                                          cooking
                       With gas-cooking
                                                                                 Without gas
                                                                                 cooking
> 1.2
                                                                                                       0.4-0.7
                       > 1.2
                                                            0.4-0.7
                                           Overall study
                                           seasons
               Indoor/outdoor ratio
                                             0.8-1.0
                                Including
                                both homes
                                with and
                                without
                                indoor
                                sources.
O

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           TABLE AX3.5-4 (cont'd).  INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
o
to
o
o
oo












X
UJ
1
s


o

£5
H
6
o

0
H
O
HH
H
W
Study Description Season
Lee et al. Two-wk averaged indoor Summer
(1995) (kitchen, living room, and
bedroom) and outdoor NO2
were measured by Palmes
tube for 517 homes from
November 1984 to Oct 1986
in Boston area.
Lee et al. Six-day integrated indoor and Overall
(2002) outdoor concentrations of study
NO2 in two communities in seasons
Southern California were
measured using Yanagisawa
badges for 119 homes in
April and May 1996.
Lee (1997) Indoor and outdoor air Overall
quality at two staff quarters study
in Hong Kong were measured seasons
from January to Feb of 1996
by Chemical Luminescent
method in two staff quarters
in Hong Kong (TSTE, in a
downtown area; and ST in a
suburban area).






Regression Format Indoor
or Ratio Characteristics
Indoor/outdoor Electric stove
ratio homes





Indoor/outdoor With gas range
ratio ± SD
Without gas range
With air
conditioner
Without air
conditioner
Indoor/outdoor Downtown area
ratio (Range)







Suburban area





Slope/Ratio/Finf
0.81 (kitchen)

0.81 (living room)

0.77 (bedroom)


2.27 ±1.88

1.22 ±0.52
1.07 ±0.26

3.03 ±2.01

0.78 (0.70-0.87)
forNO2

0.92(0.77-1.10)
for NO

0.86(0.78-0.95)
forNOx

0.97(0.89-1.03)
forNO2


0.92(0.77-3.14)
for NO
Comments
Homes with gas
stove and gas
stove with pilot
light have an I/O
ratio >1, but the
values were not
reported.
—

—
—

—

—














O
0.86(0.89-1.03)
   forNOx

-------
TABLE AX3.5-4 (cont'd). INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
o
to
o
o
oo











>
r*^
X
UJ
i
OJ


o

rr5
H
6
o

0
o
1 — I
H
W
O
O
^^
Study Description
Garrett et al. Four-day averaged indoor
(1999) (bedroom, living room, and
kitchen) and outdoor NO2
was monitored using
Yanagisawa passive samplers
for 80 homes in the Latrobe
Valley, Victoria, Australia, in
March-April 1994, and Jan-
Feb, 1995.
Zota et al. Two-wk integrated NO2 was
(2005) measured in 77 homes within
three Boston public housing
developments (low-income,
urban neighborhoods, where
asthma prevalence is high),
using Palmes tubes. Homes
were sampled between June
2002 and May 2003 for 2-wk
periods with up to three
sampling sessions in each
home.
Yang et al. Daily indoor and outdoor
(2004) NO2 concentrations were
measured for 30 consecutive
days in 28 house in Brisbane
(between April and May in
1999), and for 21 consecutive
days in 37 houses in Seoul
(between June and Aug in
2000) using Yanagisawa
badges.
Season
Overall
study
seasons






Overall
study
seasons









Overall
study
seasons






Regression Format or Indoor
Ratio Characteristics
Indoor/outdoor ratio No major indoor
sources (major
sources were gas
stove, vented gas
heater, and smoking)




Residential indoor vs. —
residential outdoor










Residential indoor vs. Brisbane with
residential outdoor electric range
Brisbane with gas
range
Seoul with gas range
Indoor/outdoor ratio Brisbane
Seoul


Slope/Ratio/
Finf Comments
0.8 The ratio
increased to
1.3, to 1.8 and
to 2.2 for
homes with
one, two, and
three major
indoor sources.

1.21 —











0.65 ±0.18 R2 was 0.70.

0.56 ±0.12 R2 was 0.57.

0.58 ±0.12 R2 was 0.52.
0.82 ±0.41 —
0.88 ±0.32 —



-------
          TABLE AX3.5-4 (cont'd). INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
O


to
O
O
oo
>
X
oo
H

6
O

2
O
H
O
HH
H
W
Regression Format or
Indoor
Study
Chao (2001)







Kulkarni and
Patil (2002)






Monn et al.
(1998)






Description
48-h averaged indoor
and outdoor NO, and
NO2 were measured in
ten non-smoking
residential buildings
using Ogawa passive
samplers in the summer
of 1997 in Hong Kong.
48-h averaged indoor
and outdoor NO2 were
measured using passive
filter badge sampler in
the winter (Feb 1996)
and summer of 1996
(April) for 43 residence
in Mumbai.
One-wk averaged
indoor, outdoor, and
personal NO2 were
measured for more than
500 subjects between
Dec 1993 to Dec 1994
for a SAPALDIA study
subpopulation, once per
home.

Season
Overall
study
seasons





Overall
study
seasons





Overall
study
seasons





Ratio
Indoor/outdoor ratio







Residential indoor vs.
residential outdoor






Residential indoor vs.
residential outdoor


Residential indoor vs.
residential outdoor + gas
cooking + smoking +
ventilation

Indoor/outdoor ratio
Characteristics
—







Homes using LPG
Homes using
Kerosene





All homes
Homes without
smokers and gas-
cooking
All homes


All homes
Slope/Ratio/Finf
0.79 ±0.30
(range: 0.75 -
1.36)forNO2

0.98 ±0.19
(range: 0.29 -
1.25) for NO

0.92
0.73






0.47
0.40


0.55


0.7-0.8
Comments
—







R2 was 0.80.
R2 was 0.40.






R2 was 0.37.
R2 was 0.33.


Overall R2 was
0.58, but partial
R2 cannot be
derived.

—
O

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 TABLE AX3.5-4 (cont'd). INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE

     Study            Description          Season
O
to
O
O
oo
                                    Regression Format or
                                            Ratio
                                                            Slope/Ratio
                                     Indoor Characteristics     / Finf     Comments
>
X
VO
H
6
O
2
O
H
O
HH
H
W
O
Levy et al.
(1998a);
Spengler et al.
(1996)
48-h averaged indoor,
outdoor, and personal
exposures to NO2 were
measured in 18 cities in
15 countries around the
world during a 2-day
period in Feb or March
1996.
Overall
study
seasons
Indoor/outdoor ratio
Boston, U.S.              0.6 ± 0.4
Ottawa, Canada           0.5 ± 0.2
Mexico City, Mexico       1.9 ± 1.0
London, UK              0.6 ± 0.4
Watford, UK              0.8 ± 0.4
Geneva, Switzerland       0.8 ± 0.6
Kjeller, Norway           0.7 ± 0.4
Kuopio, Finland           0.5 ± 0.5
Berlin, Germany           0.3 ± 0.2
Erfurt, Germany           0.8 ± 0.7
Homes without gas stove      0.7
Homes with gas stove         1.2
Homes without kerosene      0.85
heater
Homes with kerosene         2.27
heater
Homes without gas space     0.96
heater
Homes with gas space        1.93
heater
Homes without gas water     0.94
heater
Homes with gas water        1.07
heater
Homes without smokers      0.92
present
Homes with smokers         1.16
present

-------
O

to
O
O
oo
TABLE AX3.5-4 (cont'd). INDOOR/OUTDOOR RATIO AND THE INDOOR VS. OUTDOOR REGRESSION SLOPE
                                                     Regression Format or         Indoor         Slope/Ratio/
   Study            Description          Season             Ratio            Characteristics          Finf
                                                                          Comments
>
X
         Spengleretal.
         (1994)
         Lai et al. (2004)
               A Yanagisawa type of
               passive sample was used
               to measure the 48-h
               integrated indoor, outdoor
               and personal NO2 levels
               from the May of 1987 to
               the May of 1988.

               48-h averaged personal,
               indoor, outdoor and
               workplace NO2 levels
               were measured by passive
               filter badges for 50 adults
               in Oxford between 1998
               and 2000, once per person.
Overall study Residential indoor vs.
seasons      residential outdoor
Overall study Indoor/outdoor ratio
seasons
Gas range with pilot
light
Gas range without
pilot light
Electric stove
All homes
0.49       R2 was 0.44.

 0.4        R2 was 0.39.

 0.4        R2 was 0.41.


 0.9             —
                                                                                       Smoking homes
                                                                                       Non-smoking homes
                                                                                                      1.5
                                                                                                       1
H
6
o
2
o
H
O
HH
H
W
        Note: *Only data that are marked by underline and bold font can be considered as an infiltration factor.
O

-------
                          TABLE AX3.5-5. NO2 CONCENTRATIONS (PPB) IN DIFFERENT ROOMS
O


to
O
O
oo
>
X
H
6
o
2
o
H
O
HH
H
W
Study
Topp et al.
(2004)




Garrett et al.
(1999)






Cotterill and
Kingham(1997)








Zota et al.
(2005)




Conditions
First visit



Second visit

No identified
indoor sources
Gas stove homes
Gas heater
homes
Smoking homes
Homes with
multiple sources
Gas Stove homes
Electric cooker
homes
Gas cooker home
with single
glazing window

Gas cooker home
with double
glazing window
Overall
Heating season
Non-heating
season



Outdoor
12.4



12.5

4.7

4.7
4.7

4.7
4.7

20.9
20.9

20.9



20.9


19
21
17



Kitchen
—



—

3.8

8.0
7.3

6.6
10.7

35.6
9.9

31.4



39.8


43
50
33



Living Room
7.8



8.0

3.8

6.7
6.9

6.0
14.5

17.3
8.9

16.8



18.3


36
43
26



Bedroom
7.2



7.6

3.0

6.3
5.0

5.7
11.2

11.5
7.3

11.0



12.0


	
	
—



Comments
Indoor and outdoor NO2 concentrations for 777 residential
homes in five study areas were measured: Erfurt,
Hamburg, Zerbst, Bitterfeld and Hettstedt during two
visits (from June 1995 to May 1997, and from April 1996
to Sept 1998). In the study, one-week averaged NO2 were
measured by Palmes tube.
Garrett (1999) investigated the levels and sources of NO2
in Australian homes. During the study, four-day averaged
NO2 was monitored using Yanagisawa passive samplers in
80 homes in the Latrobe Valley, Victoria in March-April
1994, and Jan-Feb 1995.



Three consecutive two-week averaged outdoor, kitchen,
living room, and bedroom NO2 were measured using
Palmes tubes in 40 houses in Huddersfield, UK in late
1994. Half the houses were located close to a busy main
road and half on residential roads set back and parallel to
the main road. The sample was split so that half had gas
cookers and half had electric cookers. These subsets were
split again so that half had double glazing and half had
single glazed windows.

The indoor and outdoor NO2 concentrations for low-
income, urban neighborhoods were measured, where
asthma prevalence is high. NO2 was measured in 77
homes within three Boston public housing developments,
using Palmes tubes (two-wk integrated sample) placed in
the kitchen, living room, and outdoors. Air exchange rate
for each home was also measured.
O

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                             TABLE AX3.5-5 (cont'd).  NO2 CONCENTRATIONS (PPB) IN DIFFERENT ROOMS
o
1— >
to
o
o
oo











>
!x!
rS
OJ
I
to
Study
Gallelli et al.
(2002)




Linaker
etal. (1996)


Kodama
et al. (2002)






Conditions
Overall study

With vent

Without vent

Overall study



Feb 1998
June 1998
July 1998
Oct 1998
Jan 1999



Outdoor Kitchen
— 24.6

— 18.1

— 30.9

— 27.2



40,31.3 81.8
38,28 33.2
29, 26.7 24.8
40,35 23.5
49, 50 70.9



Living Room
—



—

20.9



73.5
28.8
21.9
24.7
65.8



Bedroom
13.0



—

—



55.2
24
17.4
18.2
50.7



Comments
During the study, one-wk integrated indoor (kitchen and
bedroom) and personal NO2 were measured in Genoa,
Italy, for 89 subjects with Palmes samplers. Study
volunteers included students, workers, and housewives
living in three areas of Genoa differing by street traffic and
industrial plant location.
During the study, one-wk integrated personal, indoor
(kitchen, living room), classroom, and playground NO2
were measured using Palmes tubes for school children in
Southampton.
The first number in outdoor column was the ambient
concentration in the South Area; and the second number is
the ambient concentration in the North Area. During the
study, personal, indoor (kitchen, living room, bedroom and
study room), and outdoor NO2 were measured for 150
junior high school students with Yanagisawa badges in
Tokyo. The investigation was conducted five times
seasonally, 3 days each, from February 1998 to January
1999.
H
6
o
2
o
H
O
HH
H
W
          Chao and
          Law (2000)
Overall study
37.6
51.9
28.2
26.4       Personal and indoor exposures were monitored with
          passive sampler in Hong Kong for 60 subjects. Twelve of
          the subjects were selected to conduct more detailed study
          to examine the behavioral and microenvironmental effects
          on personal exposure to NO2.
O

-------
TABLE AX3.5-6. INDOOR AND OUTDOOR CONTRIBUTIONS TO INDOOR CONCENTRATIONS
o
to
o
o
oo







X
OJ
i
OJ
o
H
6
o
0
H
O
H
W
O
o
o
Study
Mosquero
net al.
(2002)
Yang
etal.
(2004)


Monn
etal.
(1998)









Percent
Mean Indoor Mean Outdoor Outdoor
Condition Slope Intercept Concentration Concentration Contribution
Overall 0.258 — 18.4 31.5 44.2
study

Brisbane, 0.65 0.8 10.3 — 92.4
electric
range
Brisbane, 0.56 3.0 18.3 — 83.5
gas range
Seoul, gas 0.58 4.8 33.4 40.4 85.7
range
Overall 0.47 3.2 11.0 16.2 70.5
study
Homes 0.40 3.2 6.8 16.2 53.1
without
smokers
and gas
cooking








Percent Indoor
Indoor Source
Contribution Strength Comments
55.8 — —

7.6 3.5ppb/h —

16.5 11.5ppb/ —
h
14.3 23.4 ppb/ —
h
29.5 — —

46.9 — Mean indoor
was
estimated
based on the
text
description.









-------
            TABLE AX3.5-6 (cont'd). INDOOR AND OUTDOOR CONTRIBUTIONS TO INDOOR CONCENTRATIONS
o
to
o
o
oo




>
X
OJ
i
£
"^

O
H
6
o
0
H
O
H
W
Percent Percent
Mean Indoor Mean Outdoor Outdoor Indoor
Study Condition Slope Intercept Concentration Concentration Contribution Contribution
Spengler Gas range 0.49 — 30 37 60.4 39.6
etal. (1994) with pilot
light


Gas range 0.4 — 22 33 60.0 40.0
without
pilot light
Electric 0.4 — 17 33 77.6 22.4
stove



Overall 0.49 8.64 27.2 38.3 68.2 31.8




Indoor
Source
Strength Comments
— Mean indoor
and mean
outdoor are
estimated from
Figure 2 in
Spengler et al.
(1994).
— Mean indoor
and mean
outdoor are
estimated from
Figure 2 in
Spengler et al.
(1994).
— Mean indoor
and mean
outdoor are
estimated from
Figure 2 in
Spengler et al.
(1994).
— —




O

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O

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O
O
oo
                     TABLE AX3.5-7. THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
   Study
      Summary
     Condition
Indoor vs.
 Outdoor
Personal vs.
  Indoor
Personal vs.
  Outdoor
Comments
Mosqueron
et al. (2002)
Simultaneous personal,
indoor, and in-office
48-h averaged NO2
concentrations were
measured with Ogawa
badges for 62 people,
and ambient
concentrations were
provided by local air
monitoring network.
Overall study
   0.07
(partial R2)
                                  Gas cooking
                                  interpreted another
                                  7% of indoor NO2
                                  variation
>
X
H
6
O
2
O
H
O
HH
H
W
         Emenius
         et al. (2003)
             Palmes tubes were
             used to measure indoor
             (in the main living
             room) and outdoor
             (outside the window of
             this room) NO2
             concentrations during
             a four-wk period
             (mean 28 days, range
             26-31) in the first
             winter season
             following recruitment
             in the case-control
             study.
                      Without smoker and       0.69 (rp)
                      gas stove was not
                      used
                                            With gas stove and        0.13 (rp)
                                            with smoker
                      With gas stove but        0.06 (rp)
                      without smoker
                                                                       p< 0.001
                                                                                             p = 0.43
                                                                                                                   p = 0.75
O

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O

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O
O
oo
                 TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
    Study
       Summary
     Condition
Indoor vs.
 Outdoor
Personal vs.
  Indoor
Personal vs.
  Outdoor
Comments
Lee et al.       Indoor and outdoor air
(1999)         quality of 14 public places
               with mechanical
               ventilation systems in
               Hong Kong were measured
               fromOct 1996 to March
               1997.  Traffic peak h NO,
               NO2 was sampled using
               Teflon bags and then
               shipped back to the
               laboratory for further
               analysis.
                          Overall study
                       0.59 (R2)
                                           0.92 for NO and
                                           0.92 for NOX.
>
X
H
6
o
2
o
H
O
HH
H
W
Garcia-Algar
et al. (2003)
Yanagisawa passive filter
badges were used to
measure indoor NO2
concentrations for 7~15
days for 340 homes in
Barcelona, Spain during
1996-1999. Outdoor NO2
concentrations were
obtained from the fixed
monitoring stations by the
method of CL.
Overall study
 0.15(rp)
                             p = 0.007
O

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O

to
O
O
oo
>
X
H
6
o
2
o
H
O
HH
H
W
        TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
                                                              Indoor vs.     Personal vs.    Personal vs.
  Study             Summary               Condition          Outdoor        Indoor       Outdoor          Comments
Lai et al.    The study was conducted
(2006)      between 1996 and 2000 in six
           EU cities: Athens, Basel,
           Helsinki, Milan, Oxford, and
           Prague. 48 h averaged indoor
           and outdoor NO2 were
           collected each home using
           diffusion tubes for 302 homes.

Lee et al.   Six-day integrated indoor and
(2002)      outdoor concentrations of NO2
           were measured in two
           communities in Southern
           California using Yanagisawa
           badges for 119 homes in April
           and May 1996.

Mukala    The one-week averaged
et al.       indoor (day-care center),
(2000)      outdoor (outside day care
           center) and personal NO2 for
           162 children aged 3-6 years
           old nitrogen dioxide exposure
           were measured by Palmes
           tube in Helsinki, in  1991.
Overall study
0.13 (partial R")
The overall R for the
multiple linear
regression was 0.67
                                                 Overall study
                        0.60 (rp)
Spring
Winter

Spring (ambient vs.
indoor)


Winter (ambient vs.
indoor)
                                                                         0.86 (rp)
                                                                         0.54 (rp)

                                                                         0.45 (rp)
   0.36 (rp)
O

-------
O

to
O
O
oo
        TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
                                                                     Indoor vs.    Personal vs.  Personal vs.
   Study                  Summary                  Condition       Outdoor       Indoor       Outdoor       Comments
Garrett et al.   Four-day averaged NO2 was
(1999)        monitored using Yanagisawa passive
              samplers in 80 homes in the Latrobe
              Valley, Victoria, Australia in March-
              April 1994, and Jan-Feb 1995.
Overall study
0.28 (R2)
Log 10
transformed data
>
X
oo
H
6
O
2
O
H
O
HH
H
W
Cotterill and   Three consecutive two-week averaged
Kingham      outdoor, kitchen, living room, and
(1997)        bedroom NO2 were measured using
              Palme's tubes in 40 houses in
              Huddersfield, UK in late 1994.  Half
              the houses were located close to a
              busy main road and half on residential
              roads set back and parallel to the main
              road.  The sample was split so that
              half had gas cookers and half had
              electric cookers. These subsets were
              split again so that half had double
              glazing and half had single glazed
              windows.
                                                           Overall study
                    0.59 (rp)
O

-------
O

to
O
O
oo
>
X
        TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
                                                               Indoor vs.    Personal vs.    Personal vs.
   Study             Summary               Condition         Outdoor       Indoor        Outdoor          Comments
Yangetal.    Daily indoor and outdoor
(2004)       NO2 concentrations were
             measured for 30 consecutive
             days in 28 house in Brisbane
             (between April and May in
             1999), and for 21
             consecutive days in 37
             houses  in Seoul (between
             June and Aug in 2000) using
             Yanagisawa badges.
Lai et al.      During the study, 48-
(2004)       averaged personal,
             residential indoor,
             residential outdoor, and
             workplace indoor pollutants
             were measured for 50 adults
             between 1998 and 2000 in
             Oxford, once per person.
             NO2 were measured using
             passive sampling badges.
Brisbane, electric
range house
                                                 Brisbane, gas range
                                                 house
                                                 Seoul, gas range
                                                 house
                                                 Overall study
0.70 (R2)



0.57 (R2)

0.52 (R2)
                        0.29 (rp)       0.47 (rp)
                          (not        (p<0.01)
                       significant)
                             -0.41 (rp)
                             (p < 0.05)
                            Data were log
                            transformed
H
6
O
2
O
H
O
HH
H
W
O
Monn et al.   During the study, one-wk
(1998)       integrated indoor, outdoor
             and personal samples were
             collected for a
             subpopulation (n = 140) of
             SAPALDIA study using
             Pamles tube between Dec
             1993 and Dec 1994 at eight
             study centers in Switzerland.
Overall study
Homes without
smoker and without
gas-cooking
0.37 (R2)
0.34 (R2)
0.51(R2)
0.47 (R2)
0.33 (R2)
0.27 (R2)

-------
             TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
O


to
O
O
oo
>
X
H

6
O

2
O
H
O
HH
H
W
Study
Levy
etal.
(1998a)





Spengler
etal.
(1994)












Summary
48-h averaged indoor,
outdoor and personal
NO2 were measured in
18 cities in 15
countries around the
world with passive
filter badges in Feb or
March, 1996.
Probability based
population, Los
Angeles Basin, 48-h
averaged indoor,
outdoor and personal
NO2 were measured
(microenvironmental
component of the
study), from May 1987
to May 1988






Condition
Overall study







Overall study
Electric range
Gas range without
pilot light

Gas range with pilot
light
With air conditioning
Without air
conditioning
High ambient
concentration
Low ambient
concentration
Indoor vs. Personal vs.
Outdoor Indoor
— 0.75 (rs)







0.4 (R2) 0.6 (R2)
0.41 (R2) —
0.39 (R2) —


0.44 (R2) —

0.66 (rp) —
0.75 (rp) -

— —

— —

Personal vs.
Outdoor Comments
0.57 (rs) —







0.51 (R2) —
0.52 (R2) —
—


0.44 (R2) —

— —
— —

0.47 (R2) —

0.33 (R2) —

O

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             TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
O


to
O
O
oo
X
Study
Kousa
etal.
(2001)






Linaker
etal.
(1996)





Summary Condition
The indoor, outdoor, and Overall study
personal NO2 relationship in
three EXPOLIS centers
(Basel, Helsinki, and Prague)
were reported. During the
study, 48-averaged indoor, Helsinki
outdoor, and personal NO2
were measured with Palmes
tubes during 1996-1997.
During the study, one-wk Overall study
integrated personal, indoor
(kitchen, living room),
classroom and playground
NO2 were measured using
Palmes tubes for 46 school
children aged 9-11 in
Southampton, UK.
Indoor vs. Personal vs. Personal vs.
Outdoor Indoor Outdoor Comments
0.44 (R2) 0.53 (R2) 0.37 (R2) Data were log-
transformed


— 0.45 (R2) 0.40 (R2) Data were log-
transformed



— 0.53-0.76 (rp) 0.61-0.65 (rp) Data were log-
transformed






H
6
o
2
o
H
O
HH
H
W
O

-------
             TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
O


to
O
O
oo
>
X
to
H

6
O

2
O
H
O
HH
H
W
O
Study
Aim et al.
(1998)

























Summary
During the study,
weekly personal,
indoor (day care
center), outdoor (day
care center), and
ambient site NO2
exposures of 246
children aged 3-6 yrs
O J
were measured with
Palmes tubes during
13 wks in winter and
spring in 1991 in
Helsinki.















Indoor vs.
Condition Outdoor
Overall study —

Winter —

Spring —

Winter downtown 0.44 (rp)



Spring downtown 0.84 (rp)
Winter suburban 0.22 (rp)


Spring suburban 0.46 (rp)
Downtown electric —
stove
Downtown gas stove —
Downtown non- —
smoking
Downtown smoking —
Suburban electric —
stove
Suburban gas stove —
Suburban non- —
smoking
Suburban smoking —
Personal vs.
Indoor
0.88 (R2)

—

—

0.32 (rp)



0.75 (rp)
0.04 (rp)


0.75 (rp)
0.67 (rp)

0.50 (rp)
0.67 (rp)

0.47 (rp)
0.55 (rp)


0.50 (rp)

0.48 (rp)
Personal vs.
Outdoor
0.86 (R2)

0.04 (partial R2)

0.50 (partial R2)

0.46 (rp)



0.80 (rp)
0.49 (rp)


0.82 (rp)
0.55 (rp)

0.59 (rp)
0.73 (rp)

0.51(rp)
0.63 (rp)


0.59 (rp)

0.46 (rp)
Comments
0.37 (R2) for personal
vs. ambient
p = 0.01; log
transformed data
p = 0.0001; log
transformed data

Personal vs. indoor
was not significant
(day-care center, not
residential indoor).

Personal vs. indoor,
and indoor vs. outdoor
were not significant
—
—

—
—

—
—

—
—

—

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O

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O
O
oo
>
X
       TABLE AX3.5-7 (cont'd). THE ASSOCIATION BETWEEN INDOOR, OUTDOOR, AND PERSONAL NO2
                                                      Indoor vs.     Personal vs.       Personal vs.
  Study         Summary            Condition          Outdoor        Indoor          Outdoor           Comments
Kodama    During the study,
et al.       personal, indoor
(2002)      (kitchen, living room,
           bedroom, and study
           room), and outdoor
           NO2 were measured
           for 150 junior high
           school students with
           Yanagisawa badges in
           Tokyo.  The
           investigation was
           conducted five times
           seasonally, 3 days
           each, from Feb 1998 to
           Jan 1999.
Summer
                                         Winter
0.31(rp)
                                      0.57 (rp)
0.24 (rp)
                 0.08 (rp)
H
6
O
2
O
H
O
HH
H
W
O

-------
O
                 TABLE AX3.5-8. INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY
                                         EXPOSURE INDICATORS
l->*
O
O
oo











>
X
OJ
1
L/l
r\


O
>
H
1
O
O
1— J
z;
0
H
O
H
W
O
O
O
Ambient
NO2
References Factor Name Factor levels Level
Environmental conditions
Singer etal. Wind Direction Upwind of freeway 20.5
(2004) Downwind and close 26.5
to freeway
Downward and far 21
from freeway
Zotaetal. Season Heating 21
(2005) Non-Heating 17
Serensen et al. Season < 8C 14.6
(2005) > 8C 7.8
Aim et al. Season Winter downtown —
(1998) smoker
Spring downtown —
smoker
Winter downtown —
nonsmoker
Spring downtown —
nonsmoker
Winter suburban —

smoker
Spring suburban —
smoker
Winter suburban —
nonsmoker
Spring suburban —
nonsmoker


Indoor Personal
Ambient NO2 Indoor NO2 Personal
Slope Level Slope Level Slope Comments

— — — — — —
— — — — — —

— — — — — —

— 43 — — — —
— 26 — — — —
— 8.9 — 11.4 — —
— 6.6 — 9.2 — —
— — — 13.5 — —

— — — 15.4 — —

— — — 13.0 — —

— — — 14.1 — —

— — — 11.2 — —


— — — 10.7 — —

— — — 9.2 — —

— — — 8.7 — —




-------
O
>
X
                TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED
                                              EXPOSURE INDICATORS
BY
l->*
O
O
oo













References Factor Name Factor Levels
Zota et al. Heating season —
(2005)
Vukovich Day Weekday
(2000)
Lee (1997) Day Weekday





Ambient Indoor Personal
NO2 Ambient NO2 Indoor NO2 Personal
Level Slope Level Slope Level Slope Comments
— 3.87 — 17.3 — — —

— — — — — 39% more than
weekend
— — — — — — The effect of
weekday/week-
end is clear but
the paper didn't
give a value to
cite
                                   Weekend
       Dwelling conditions
01
01

o
^
H
6
o

0
H
O
H
W
O
7s


Levy et al. Window open
(1998a)
Cotterill and Window
Kingham (1997)




Partti-Pellinen Type of Filtration
et al. (2000)







With —
Without —
Single Glazing —
Double Glazing —
Single Glazing —

Double Glazing —

Mechanical filter 12.3

Mechanical intake 11.5
and mechanical filter

Mechanical intake 12.4
and mechanical and

chemical filter
— — — 30
— — — 26.7
— 9.4 — —
— 9.4 — —
— 11.0 — —

— 12.0 — —

— 9.6 — —

— 12.5 — —


— 6.5 — —



— —
— —
— —
— —
— Gas cooker
homes
— Gas cooker
homes
— —

— —


— —




-------
o
TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY
                            EXPOSURE INDICATORS
to
o
o
oo











.
X
OJ
1
01
Oi

O
^
i-rj
H
6
o
0
H
O
H
W
O
o
o
(CONCENTRATIONS ARE IN PPB AND SLOPES ARE DIMENSIONLESS)



References
Yamanaka
(1984)
Zota et al.
(2005)
Levy et al.
(1998a)
Emenius et al.
(2003)



Cotterill and
Kingham (1997)


Zota et al.
(2005)
Lee et al. (2004)


Liard et al.
(1999)









Factor Name
Surface type

Occupancy

Occupancy

Location




Location



Location

Location


Location










Factor Levels
—

—

1
2
Urban

Semi-urban
Suburban

On Main Road

50-85m from Main
Road
—

Industrial

Residential
Main Road

Side Road






Ambient Indoor Personal
NO2 Ambient NO2 Indoor NO2 Personal
Level Slope Level Slope Level Slope Comments
— — — — — Affect decay
rate
— — — 3.2 — — —

— — — — 25.9 — —
— — — — 30.8 — —
16.5 — 9.6 — — — —

11.3 — 6.4 — — — —
7.2 — 4.2 — — — —

— — 7.9 — — — Electric cooker
homes
— — 6.8 — — — Electric cooker
homes
— -0.0093 — — — — —

— — — — 34.9 — —

— — — — 27.8 — —
— — — — 28.1 — —

— — — — 24.3 — —






-------
O
               TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED
                                           EXPOSURE INDICATORS
BY
l->*
o
o
oo









X
UJ
1
^

References Factor Name Factor Levels
Nakai et al. Location < 20 m
(1995)

20-150 m


>150m


Aim et al. Location Downtown smoker
(1998) Suburban smoker
Downtown
nonsmoker
Suburban
nonsmoker
Ambient Indoor Personal
NO2 Ambient NO2 Indoor NO2
Level Slope Level Slope Level
42.4 — 43.8 — 43.1


34.9 — 38.4 — 35.9


20.3 — 36.4 — 30.1


— — — — 14.6
— — — — 10.9
— — — — 13.6
— — — — 9.0

Personal
Slope Comments
— Recalculated
based published
data
— Recalculated
based published
data
— Recalculated
based published
data
— —
— —
— —

fe
-LJ
H
1
O
o

0
H
O
HH
H
W
O
&
Lee etal. (1996) House structure Single DU
Small multi-DU

Large multi-DU
Single DU
Small multi-DU

Large multi-DU
Single DU

Small multi-DU
Large multi-DU
17
23

23.6
18.4
25.1

25.1
15.9

23.7
24.5
— 17 — —
— 28.9 — —

— 26.8 — —
— 17.8 — —
— 30.2 — —

— 25.4 — —
— 17.3 — —

— 27.8 — —
— 29.1 — —
— Winter
— Winter

— Winter
— Fall
— Fall

— Fall
— Summer

— Summer
— Summer
O

-------
O
               TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED
                                           EXPOSURE INDICATORS
BY
l->*
O
O
oo











;>
X
OJ
1
01
oo


O
[>
H
1
O
O
z;
0
H
o
1 — I
H
W
O
O
O


References
Gallelli et al.
(2002)


Zota et al.
(2005)
Mosqueron
et al. (2002)
Liard et al.
(1999)
Gallelli et al.
(2002)

Yang et al.
(2004)
Garrett et al.
(1999)
Indoor sources
Zota et al.
(2005)

Lai et al. (2004)

Levy et al.
(1998a)

Belanger et al.
(2006)





Factor Name
Heating system

Frames

Floor level

Floor level

Extractor fan over
cooker
Chimney


Attached garage

Age of house


Supplemental
Heating with stove

Smoking

Smokers present


Ranges






Factor Levels
Individual
Central
Metal
Wood
—

—

Without
With
With vent
Without vent

With
Without
—


—


Smoking
Nonsmoking
With
Without

Electric
Gas



Ambient Indoor Personal
NO2 Ambient NO2 Indoor NO2
Level Slope Level Slope Level
— — 13.7 — —
— — 12.5 — —
— — 12.6 — —
— — 15.0 — —
— 2 — — —

— — — -1.78 —

— — — — 27.5
— — — — 24.8
— — 18.1 — —
— — 30.9 — —

— — 17.3 — —
— — 11.4 — —
— — — 0.5 —


— — — 7.84 —


— — 10.9 — 10.8
— — 11.5 — 14.1
— — — — 34.8
— — — — 26.8

— — 8.6 — —
— — 25.9 — —




Personal
Slope Comments
— Bedroom data
— Bedroom data
— Bedroom data
— Bedroom data
— —

— —

— —
— —
— Kitchen data
— Kitchen data

— —
— —
— —


— —


— —
— —
— —
	 	

— —
— —




-------
O
               TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY
                                           EXPOSURE INDICATORS
l->*
o
o
oo










X
r N
OJ
L/l
VO

o
^
i-rj
H
6
o
o
H
O
H
W
O
References
Cotterill and
Kingham(1997)


Yang et al.
(2004)
Schwab et al.
(1994)


Monn et al.
(1998)




Spengler et al.
(1994)



Aim et al.
(1998)
Raaschou-
Nielsen et al.
(1997)
Factor Name
Ranges



Ranges

Ranges



Ranges





Ranges




Ranges

Near fire


Factor Levels
Gas
Electric
Gas
Electric
Gas
Not Gas
Gas with pilot light
Gas without pilot
light
Electric
Gas Geneva
Electric Geneva
Gas Basle
Electric Basle
Gas Lugano
Electric Lugano





Electric smoker




Ambient Indoor
NO2 Ambient NO2 Indoor
Level Slope Level Slope
— — 35.6 —
— — 9.9 —
— — 11.5 —
— — 7.3 —
— — 18.3 —
— — 10.3 —
— — 20.3 —
— — 11.7 —

— — 8 —
— — 20.9 —
— — 16.8 —
— — 15.2 —
— — 12.6 —
— — 18.8 —
— — 15.7 —
— — — —




— — — —

	 	 	 	


Personal
NO2
Level
—
—
—
—
—
—
—
—

—
23.6
19.9
18.3
16.2
20.9
18.3
—




13.0

	


Personal
Slope Comments
— Kitchen
— Kitchen
— Bedroom
— Bedroom
— —
— —
— Summer 1998 data
— Summer 1998 data

— Summer 1998 data
— —
— —
— —
— —
— —
— —
— Gas with pilot was
15 ppb higher than
electric; gas without
pilot was 4 ppb
higher than electric
— —

0.052 —


O

-------
O
X
ON
                  TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED
                                                  EXPOSURE INDICATORS
                              BY
l->*
o
o
oo









References
Kawamoto et al.
(1997)

Lee et al. (2004)

Liardetal. (1999)

Kodama et al.
(2002)

Factor Name
Heating time


Heating fuel

Heating appliance

Heater


Factor Levels
Oil fan heater
Kerosene heater
Clean heater
Coal briquette
Petroleum
Gas
Other
Kerosene heater

Gas stove
Ambient Indoor
NO2 Ambient NO2 Indoor
Level Slope Level Slope
— — — —
— — — —
— — — —
— — — —
— — — —
— — — —
— — — —
— — 152.6 —

— — 77.5 —
Personal
NO2
Level
—
—
—
22.2
33.1
27.9
25.2
—

—
Personal
Slope Comments
2.59 —
1.17 —
— —
— —
— —
— —
— —
— Sourth area, Feb
1998
— Sourth area, Feb
                                      Electric heater
30.8
1998
Sourth area, Feb
1998
o


O
[>
H
1
O
o

0
H
O
HH
H
W
O
O
Yang et al. (2004)

Levy et al.
(1998a)





Monn et al.
(1997)
Mosqueron et al.
(2002)
Raaschou-Nielsen
etal. (1997)
Gas water heater

Gas water heater




Gas range

Gas cooking

Gas cooking

Gas appliances at
home
With
Without
With
Without
With
Without

With
Without
With
Without




— — 18.1 — — — —
— — 11.9 — — — —
— — — — 30.5 — —
— — — — 28.2 — —
— — — — 36.4 — —
— — — — 28.5 — —

— — — — 34.8 — —
— — — — 20.5 — —
— — — — — — I/O > 1.2
— — — — — — I/O -0.4 -0.7
— — — 0.068 — — —

— — — — — 0.202 —


-------
O


to
O
O
oo
>
X
H
6
o
2
o
H
O
HH
H
W
TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY

                           EXPOSURE INDICATORS

         (CONCENTRATIONS ARE IN PPB AND SLOPES ARE DIMENSIONLESS)
References
Garrett et al.
(1999)








Button et al.
(2001)

Serensen et al.
(2005)
Liard et al.
(1999)
Raaschou-
Nielsen et al.
(1997)
Lee et al. (2004)


Liard et al.
(1999)
Factor Name
Gas and smoking









Fireplace setting


Exposure to burning
candle
Exposure to ETS

Exposure to ETS


Cooking fuel


Cooking appliance

Factor Levels
None





Gas stove
Gas heater
Smoking
Multiple
Low
Middle
High
—

With
Without



Petroleum
Gas
Coal briquette
Gas
Electric
Ambient Indoor
NO2 Ambient NO2 Indoor
Level Slope Level Slope
— — 3.0 —





— — 6.3 —
— — 5.0 —
— — 5.7 —
— — 11.2 —
— — 90 —
— — 350 —
— — 360 —
— — — —

— — — —
— — — —
— — — —


— — — —
— — — —
— — — —
— — — —
— — — —
Personal
NO2 Personal
Level Slope Comments
— — I/O ratio increase
from 0.8 to 1.3 to
1.8 to 2.2 in houses
with no, one, two,
or three major
indoors sources
— — —
— — —
— — —
— — —
— — —
— — —
— — —
— 0.031 —

25.1 — —
26.3 — —
— 0.056 —


26.1 — —
33.1 — —
20.6 — —
25.8 — —
25.5 — —
O

-------
O
               TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY
                                           EXPOSURE INDICATORS
l->*
o
o
oo









j>
X
OJ
1
ON
to


o
s>
H
6
o
0
H
O
H
W

References Factor Name Factor Levels
Dennekamp Cooking 1 ring
etal. (2001)
2 rings

3 rings

4 rings

Boil water

Stir fry
Fry bacon

Bake cake

Roast meat
Bake potatoes



Ambient Indoor Personal
NO2 Ambient NO2 Indoor NO2
Level Slope Level Slope Level
— — 437 — —

— — 310 — —

— — 584 — —

— — 996 — —

— — 184 — —

— — 92 — —
— — 104 — —

— — 230 — —

— — 296 — —
— — 373 — —



Personal
Slope Comments
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations
— The max 5 min
concentrations



O

-------
O
>
X
               TABLE AX3.5-8 (cont'd). INDOOR, OUTDOOR, AND PERSONAL NO2 LEVELS STRATIFIED BY

                                           EXPOSURE INDICATORS
References
Personal activities
Levy et al.
(1998a)

Chao and Law
(2000)






Kawamoto et al.
(1997)
Factor
Name

Commute


Commute




Cooking to
stay home h
ratio
Cooking time

Ambient Indoor
NO2 Ambient NO2
Factor Levels Level Slope Level

Commuting less than — — —
Ih
Without commuting — — —
< 1 h — — —
1-2 h — — —
2-3 h — — —
3-4 h — — —
4-6 h — — —
— — — —


— — — —

Personal
Indoor NO2 Personal
Slope Level Slope Comments

— 29.9 — —

— 27.9 — —
— 21.7 — —
— 24.7 — —
— 24.6 — —
— 20.1 — —
— 27.9 — —
— — 55.4 —


— — 1.61 —

H

6
o

2
o
H
O
HH
H
W
O

-------
       TABLE AX3.5-9. PERSONAL NO2 LEVELS STRATIFIED BY DEMOGRAPHIC AND SOCIOECONOMIC FACTORS
                       (CONCENTRATIONS ARE IN PPB AND SLOPES ARE DIMENSIONLESS)
to
o
o
oo










^
X
OJ
1
ON


DRAFT-DO I
^
0
H
O
H
W
References
Rotkoetal. (2001)
Rotkoetal. (2001)
Raaschou-Nielsen (1997)
Lee etal., (2004)
Lee etal., (2004)
Rotkoetal. (2001)
Rotkoetal. (2001)
Raaschou-Nielsen (1997)
Rotkoetal. (2001)
Rotkoetal. (2001)
Rotkoetal. (2001)
Rotkoetal. (2001)
Rotkoetal. (2001)
Rotkoetal. (2001)
Algar et al. (2004)

Algar et al. (2004)
Algar et al. (2004)




Factor Type
Demography
Demography
Demography
Demography
Demography
Demography
Demography
Demography
Socioeconomic
Socioeconomic
Socioeconomic
Socioeconomic
Socioeconomic
Socioeconomic
Socioeconomic

Socioeconomic
Socioeconomic




Factor Name
Age
Age
Age
Gender
Gender
Gender
Gender
Gender
Education years
Education years
Employment
Employment
Occupational status
Occupational status
Employment

Employment
Employment




Factor levels Personal NO2 Level Personal Slope
25-34
35-55

Female
Male
Female
Male

<14 years
> 14 years
Employed
Not employed
Non white collar
White collar
Managerial, technical and
professional (Barcelona)
Skilled (manual and non-
manual) (Barcelona)
Unskilled and partly skilled
(Barcelona)




13.1
13.1
0.056
33
29
12.9
13.4
0.267
13.8
12.8
13.3
11.5
13.4
13.0
12.2

12.3
12.1




O

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  TABLE AX3.6-1. CORRELATIONS (PEARSON CORRELATION COEFFICIENT)
         BETWEEN AMBIENT NO2 AND AMBIENT COPOLLUTANTS
Study
(ambient)
This CD
This CD
This CD
This CD
Kim et al.
(2006)
Sarnat et al.
(2006)
Sarnat et al.
(2006)
Connell et al.
(2005)
Kim et al.
(2005)
Sarnat et al.
(200 1)4
Sarnat et al.
(2001)
Hochadel et al.
(2006)
Location
Los Angeles
Riverside, CA
Chicago
New York City
Toronto
Steubenville, OH
(autumn)
Steubenville, OH
(summer)
Steubenville, OH
St. Louis (RAPS)
Baltimore, MD
(summer)
Baltimore, MD
(winter)
Ruhr area,
Germany
PM25
0.49 (u3), 0.56 (s)

0.49 (s)
0.58 (u)
0.44
0.78 (0.70 for sulfate,
0.82 for EC)
0.00
(0.1 for sulfate, 0.24
for EC)
0.50

0.37
0.75
0.41, (0.93 for EC2)
CO O3 SO2
0.59 (u), -0.29 (u),
0.64 (s) -O.ll(s)
0.43 (u), 0.045 (u),
0.41 (s), 0.10(s),
0.15 (r) -0.31 (r)
0.53 (u), -0.20 (u)
0.46 (s)
0.46(u) -0.06(u)
0.72



0.641
0.75 0.02
not significant
0.76 -0.71 -0.17

March 2008
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       TABLE AX3.6-1 (cont'd). CORRELATIONS (PEARSON CORRELATION
    COEFFICIENT) BETWEEN AMBIENT NO2 AND AMBIENT COPOLLUTANTS
     Study
   (ambient)
    Location
      PM2
CO
03
SO2
 Hazenkamp-
 von Arx et al.
 (2004)

 Cyrys et al.
 (2003)

 Mosqueron
 et al.  (2002)

 Rojas-B radio
 et al.  (2002)
21 European cities  0.75
Erfurt, Germany    0.50
                    0.74
Paris
0.69
Santiago, Chile     0.77
 'Value with respect to NOX.
 Inferred based on EC as dominant contributor to PM2 5 absorbance.
 3u: urban; s: suburban; and r: rural
 4Spearman correlation coefficient was reported
   TABLE AX3.6-2.  CORRELATIONS (PEARSON CORRELATION COEFFICIENT)
          BETWEEN PERSONAL NO2 AND PERSONAL COPOLLUTANTS
Study
Kim et al.
(2006)
Modig et al.
(2004)
Mosqueron et
al. (2002)
Jarvis et al.
(2005)
Lee et al.
(2002)
Lai et al. (2004)
Location PM2.5
Toronto 0.41
Umea
Paris 0.1 2 but not
significant
21
European
cities

Oxford -0.1
CO VOCs HONO
0.12
0.06 for 1,3-butadiene;
and 0.10 for benzene

0.77 for indoor
NO2 and indoor
HONO
0.51 for indoor
NO2 and indoor
HONO
0.3 - 0.11 for TVOCs
March 2008
                      AX3-166
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  TABLE AX3.6-3.  CORRELATIONS (PEARSON CORRELATION COEFFICIENT)
          BETWEEN PERSONAL NO2 AND AMBIENT COPOLLUTANTS

      Study         Location     PM2.5       Sulfate       EC    PMio     CO

 Sarnatetal.         Steubenville /    0.46         0.35         0.57
 (2006)             Fall

 Sarnatetal.         Steubenville/    0.00          0.1         0.17
 (2006)             Summer                 not significant

 Kim et al. (2006)    Toronto         0.30                                     0.20

 Rojas-Bracho       Santiago         0.65                             0.39
 et al. (2002)
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  TABLE AX3.6-4.  CORRELATIONS (PEARSON CORRELATION COEFFICIENT)
          BETWEEN AMBIENT NO2 AND PERSONAL COPOLLUTANTS

    Study        Location     PM2.5      Sulfate      EC     Ultrafine-particle

 Sarnatetal.    Steubenville /    0.71        0.52       0.70
 (2006)        Fall

 Sarnatetal.    Steubenville/    0.00         0.1        0.26
 (2006)        Summer                not significant

 Vinzents      Copenhagen                                 0.49 (R2) explained by
 et al. (2005)                                              ambient NO2 and ambient
                                                         temperature
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  TABLE AX3.7-1.  THE ESSENTIAL ATTRIBUTES OF THE PNEM, HAPEM, APEX,
                        SHEDS, AND MENTOR-1A

Exposure Estimate

Characterization of
the High-End
Exposures
Typical Spatial
Scale/Resolution

Temporal
Scale/Resolution

Population
Activity Patterns
Assembly

Microenvironment
Concentration
Estimation








Microenviron-
mental (ME)
Factors
Specification of
Indoor Source
Emissions
Commuting
Patterns
Exposure Routes

Potential Dose
Calculation
Physiologically
Based Dose
Variability/
Uncertainty
pNEM
Hourly averaged

Yes


Urban
areas/Census
tract level
A yr/one h


Top-down
approach


Non-steady-state
and steady-state
mass balance
equations (hard-
coded)






Random samples
from probability
distributions
Yes (gas-stove,
tobacco
smoking)
Yes

Inhalation

Yes

No

Yes

HAPEM
Annual averaged

No


Ranging from
urban to national/
Census tract level
A yr/one h


Top-down
approach


Linear
relationship
method (hard-
coded)







Random samples
from probability
distributions
Available; set to
zero in HAPEM6

Yes

Inhalation

No

No

No

APEX
Hourly averaged

Yes


Urban
area/Census tract
level
A yr/one h


Bottom-up
"person-
oriented"
approach
Non-steady-state
mass balance and
linear regression
(flexibility of
selecting
algorithms)





Random samples
from probability
distributions
Yes (multiple
sources defined
by the user)
Yes

Inhalation

Yes

No

Yes

SHEDS
Activity event
based
Yes


Urban
areas/Census
tract level
A yr/event based


Bottom-up
"person-oriented"
approach

Steady-state mass
balance equation
(residential) and
linear regression
(non-residential)
(hard-coded)





Random samples
from probability
distributions
Yes (gas-stove,
tobacco smoking,
other sources)
Yes

Inhalation

Yes

Yes

Yes

MENTOR-1A
Activity event
based
Yes


Multiscale/
Census tract level

A yr/activity
event based time
step
Bottom-up
"person-oriented"
approach

Non-steady-state
mass balance
equation with
indoor air
chemistry
module or
regression
methods
(flexibility of
selecting
algorithms)
Random samples
from probability
distributions
Yes (multiple
sources defined
by the user)
Yes

Multiple
(optional)
Yes

Yes

Yes (Various
"Tools")
March 2008
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      March 2008                             AX3-173      DRAFT-DO NOT QUOTE OR CITE

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 i          AX4.  CHAPTER 4 ANNEX - TOXICOLOGICAL
 2       EFFECTS OF NITROGEN DIOXIDE AND RELATED
 3                           OXIDES OF NITROGEN
 4
 5
 6   AX4.1   PULMONARY EFFECTS OF NITROGEN DIOXIDE AND
 7             RELATED OXIDES OF NITROGEN
 8
 9   AX4.1.1   Effects of Nitrogen Dioxide on Antioxidant and Antioxidant
10               Metabolism
11          Nitrogen dioxide is an oxidant and lipid peroxidation is believed to be a major molecular
12   event responsible for its toxicity. As a result, there has been considerable attention paid to the
13   effect of NO2 on the antioxidant defense system in the epithelial lining fluid and in pulmonary
14   cells. Repeated exposures to NO2 at concentrations ranging from 0.04 to 33 ppm have revealed
15   effects on low molecular weight antioxidants such as glutathione, vitamin E, and vitamin C, as
16   well as some enzymes involved in cell oxidant homeostasis.
17          A number of studies have investigated the hypothesis, originally proposed by Menzel
18   (1970), that antioxidants might protect the lung from NC>2 damage by inhibiting lipid
19   peroxidation (see Table AX4.1). Changes in the activity of enzymes in the lungs of NC>2-
20   exposed animals that regulate levels of glutathione (GSH) have been reported at relatively low
21   exposure concentrations.  Sagai et al. (1984) studied the effects of prolonged (9 and 18 months)
22   exposure to 0.04, 0.4, and 4.0 ppm NC>2 on rats. After either exposure duration, non-protein
23   sulfhydryl levels were increased at 0.4 ppm or greater, and exposure to 4.0 ppm decreased the
24   activity of GSH peroxidase but increased glucose-6-phosphate dehydrogenase activity.
25   Glutathione peroxidase activity was also decreased in rats exposed to 0.4 ppm NC>2 for 18
26   months. Three GSH S-transferases were also studied, two of which (aryl S-transferase and
27   aralkyl S-transferase) exhibited decreased activities after 18 months of exposure to 0.4 ppm or
28   greater NC>2. No effects were observed on the activities of 6-phosphogluconate dehydrogenase,
29   superoxide dismutase, or disulfide reductase. Effects followed a concentration- and exposure-
30   duration response function. The decreases in glutathione-related enzyme activities were
31   inversely related to the apparent formation of lipid peroxides (see lipid peroxidation subsection).
32   Shorter exposures (4 months) to NC>2 between 0.4 and 4.0 ppm also caused concentration- and

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 1    duration-dependent effects on antioxidant enzyme activities (Ichinose and Sagai, 1982). For
 2    example, glucose-6-phosphate dehydrogenase increased, reaching a peak at 1 month, and then
 3    decreased towards the control value. Shorter (2-week) exposures to 0.4 ppm NO2 caused no
 4    such effects in rats or guinea pigs (Ichinose and Sagai, 1989).
 5          The activities of GSH reductase and glucose-6-phosphate dehydrogenase were
 6    significantly increased during exposure to 6.2 ppm NO2 for 4 days; GSH peroxidase activity was
 7    not affected (Chow et al., 1974).  The possible role of edema and cellular inflammation in these
 8    findings was not examined. Since NO2 had no significant effect on lung GSH peroxidase
 9    activity in this study, but did significantly increase the activities of GSH reductase and glucose-
10    6-phosphate dehydrogenase, the authors concluded that NO2 attacks mainly GSH and NADPH.
11          Newer studies also identified effects on glutathione. Changes in glutathione status in the
12    blood and lung (bronchoalveolar lavage (BAL) fluid) occurred in rats exposed to 5 ppm and 10
13    ppm NO2 continuously for 24 h, but not for 7 days (Pagani et al., 1994).  Total glutathione - total
14    of reduced (GSH) and oxidized (GSSG) form - was significantly increased in blood but not in
15    BAL fluid; however, GSSG was elevated in BAL fluid only.  A decreased GSH/GSSG ratio was
16    observed in the blood and BAL fluid, but not in lung type II cells, in rats continuously exposed to
17    10 ppm NO2 for 3 or 20 days (Hochscheid et al., 2005). Interestingly, lipid peroxidation was
18    decreased in type II cells at 3 days, but was similar to controls at 20 days. Gene expression, as
19    measured by mRNA levels of the enzymes involved in the biosynthesis of glutathione - gamma-
20    glutamylcysteine synthetase (yGCS) and glutathione synthetase (GS), was decreased at both time
21    points, but gamma-glutamyltranspeptidase (yGT) mRNA expression was increased. No GSH
22    peroxidase activity (important for hydroperoxide reduction of complex lipids) was detected at 3
23    days, and was barely detected at 20 days.
24          Malnutrition of animals can drastically affect their response to toxicants, including NO2.
25    Experimental interest in this area has mainly focused  on dietary lipids, vitamin E and other lipid-
26    soluble antioxidants, and vitamin C and other water-soluble antioxidants. Ayaz and Csallany
27    (1978) exposed vitamin E-deficient and vitamin E-supplemented (30 or 300 mg/kg of diet)
28    weanling mice continuously for 17 months to 0.5 or 1.0 ppm NO2 and assayed blood, lung,  and
29    liver tissues for GSH peroxidase activity. Exposure to 1.0 ppm NO2 alone  or combined with
30    vitamin E deficiency decreased the enzyme activity in the blood and lungs.  Neither vitamin E
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 1    deficiency nor NC>2 exposure affected liver GSH peroxidase activity. However, in vitamin E-
 2    supplemented mice, GSH peroxidase activity increased at 0.5 ppm and 1.0 ppm NC>2.
 3
 4    AX4.1.2   Lipid Metabolism and Content of the Lung
 5          Lipid peroxidation is an important mechanism of cell damage arising from changes in
 6    cell membrane structure and function.  The ability of NC>2 exposure to induce lipid peroxidation
 7    in the respiratory tract has been well demonstrated in available studies as measured by increased
 8    ethane exhalation in the breath, as thiobarbituric acid (TEA) reactive substances in tissues, and
 9    as the content of conjugated dienes in tissue homogenates.
10          A number of studies have investigated the effects of NO2 exposure on lipid metabolism
11    and content of the lung. Lipid peroxidation induced by NC>2 exposure has been detected at
12    exposure concentrations as low as 0.04 ppm. Increased ethane exhalation was observed in rats
13    exposed to 0.04  or 0.12 ppm after 9 and 18 months of exposure (Sagai et al., 1984).  Exposure to
14    0.4 ppm NC>2 for 9 months or longer and to 4.0 ppm for 6 months resulted in increased TEA
15    reactants (Ichinose et al., 1983). NO2 exposures for shorter durations also increased lipid
16    peroxidation in rats.  For example, NC>2 concentrations of 1.2 ppm or greater for 1 week
17    (Ichinose and Sagai, 1982; Ichinose et al., 1983) increased ethane exhalation in rats, while
18    exposure of pregnant rats to 0.53 or 5.3 ppm NC>2 for 5 h/day for 21 days rats resulted in
19    increases in lung lipid peroxidation products (Balabaeva and Tabakova, 1985). These results
20    indicate at least  some degree of duration-dependence in the formation of lipid peroxidation, with
21    lower effect thresholds identified with longer durations of exposure.
22          Lipid peroxidation results in altered phospholipid composition, which in turn may  affect
23    membrane fluidity and thus, membrane function.  Significant depression of lipid content and
24    total content of saturated fatty acids such as phosphatidyl-ethanolamine, lecithin
25    (phosphatidylcholine),  phosphatidylinositol, and phosphatidylserine were found in rats exposed
26    to 2.9 ppm NC>2  for 24  h/day, 5 days/week for 9 months (Arner and Rhoades, 1973). Exposure
27    of rabbits to 1.0  ppm NC>2 for 2 weeks also caused depression of lecithin synthesis after one
28    week of exposure (Seto et al., 1975), while exposure of rats to 5.5 ppm NC>2 for 3 h/day for 7 or
29    14 days elicited  only few changes in lipid metabolism (Yokoyama et al., 1980). In beagle dogs,
30    the amount of unsaturated fatty acids in the phospholipids from the lungs was increased after
31    exposure to concentrations ranging from 5 to 16 ppm, but not to 3 ppm (Dowell et al., 1971).
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 1    Exposure of either mice or guinea pigs to an NC>2 level of 0.4 ppm for a week resulted in a
 2    decreased concentration of phosphatidylethanolamine and a relative increase in the
 3    phosphatidylcholine concentration (Sagai et al., 1987). Concentration-and exposure duration-
 4    dependent increases were reported in phospholipid components in BAL fluid, when rats were
 5    exposed to 10 ppm NO2 continuously for 1 day or 3 days (Miiller et. al., 1994).
 6          Functional studies conducted on surfactant phospholipid extracts indicated that NO2
 7    exposures of 5 ppm or greater, but not to 0.8 ppm, directly impaired surface tension, although the
 8    structure of the surfactant protein A (SP-A) was not altered by NC>2 exposure. Changes in the
 9    phospholipid composition of membranes may result in disruption of the cell membrane barrier.
10    Miiller et al. (2003) found that uptake of liposomes by type II lung cells occurred more easily
11    from animals exposed to 10 ppm NO2 for 3 to 28 days, possibly as a result of increased demand
12    of phosphatidylcholine during lung injury.
13          Lipid peroxidation can also activate phospholipases. Activation of phospholipase Al in
14    cultured endothelial cells occurred at NC>2 concentration of 5 ppm after 40 h of exposure and was
15    speculated to depend on a specific NO2-induced increase in phosphatidyl serine in the plasma
16    membranes (Sekharam et al., 1991).
17          One function of phospholipases is the release of arachidonic acid (AA), which serves as a
18    mediator of inflammatory response.  NC>2 exposure affects the release and metabolism of
19    arachidonic acid both  in vivo and in vitro.   The products of arachidonic acid metabolism, such as
20    prostaglandins, prostacyclin, thromboxanes, and leukotrienes play an important role (such as
21    recruitment of neutrophils to sights of local irritation) in modulating inflammatory response.
22    Schlesinger et al. (1990) reported elevated concentrations of thromboxane B2 (1x82) following
23    NC>2 exposures of 1.0  ppm for 2 h, depressed concentrations at 3.0 ppm, and  significant
24    depression 24 h postexposure at 10 ppm NC>2.  The same investigators also reported depressed
25    level of 6-keto-prostaglandin F1 a  at  1.0 ppm NC>2, but exposure to NC>2 did not affect
26    prostaglandins E2 and F2 and leukotriene B4 (LTB4) levels.
27          Changes in activation of arachidonate metabolism were also reported in rat alveolar
28    macrophages (AMs) when these animals were  exposed to 0.5 ppm NO2 for 0.5, 1, 5, and 10  days
29    (Robison et al., 1993). Unstimulated AM synthesis of LTB4 was  depressed after 0.5 days and
30    again after 5 days of exposure to NC>2. Alveolar macrophage production of TxB2, LTB/t, and 5-
31    hydroxyeicosatetraenoic acid (5-HETE) in response to stimulation with the calcium ionophore,

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 1   A23187, was depressed after 0.5 days of exposure and recovered to air-control values with
 2   longer exposure periods. 5-HETE levels were increased after 10 days of exposure. However,
 3   AM production of LTB4 in response to zymosan-activated rat serum was depressed only after 5
 4   days of exposure.
 5          The effects of NO2 on structural proteins of the lungs have been of concern because
 6   elastic recoil is lost after exposure. Collagen synthesis rates are increased in rats exposed to NO2
 7   concentrations as low as 5.0 ppm NC>2.  It has been assumed that increased collagen synthesis
 8   reflect increases in total lung collagen which, if sufficient, could result in pulmonary fibrosis
 9   after longer periods of exposure. Such correlation has yet to be confirmed by in vivo studies
10   involving NO2 exposure.
11          Alterations in xenobiotic metabolism pathways following NO2 exposure are also
12   summarized in Table AX4.2, in addition to changes in phase  I enzymes (such as cytochrome
13   P450s) and phase II enzymes (GST as described earlier).  While these changes are not
14   necessarily toxic manifestations of NC>2 per se, such changes may impact the metabolism and
15   toxicity of other chemicals.  Glycolytic pathways are also apparently affected. For example,
16   glycolytic metabolism was increased by NC>2 exposure, apparently  due to a concurrent increase
17   in type II cells (Mochitate et al.,  1985).
18
19   AX4.1.3    Emphysema Following Nitrogen Dioxide Exposure
20          Emphysema as a result of chronic exposure to NC>2 has been reported in animal studies.
21   The definition of emphysema has changed since the time that some of the studies  have been
22   published; thus, it is important to compare the findings of the studies with the current definition
23   of emphysema. U.S. Environmental Protection Agency (1993) evaluated the animal studies
24   reporting emphysema from chronic exposure to NC>2 based upon the most recent definition of
25   emphysema from the report of the National Heart, Lung and Blood Institute (NHLBI), Division
26   of Lung Diseases Workshop (Snider et al., 1985); see U.S. Environmental Protection Agency
27   (1993) for the definitions of emphysema.  Because the focus of this document is extrapolation of
28   NC>2 exposures to potential hazards for humans, only those studies  showing emphysema of the
29   type seen in human lungs will be discussed.
30          Emphysema was reported by Hay don et al. (1967) in rabbits exposed continuously
31   (presumably 24 h/day) for 3 to 4 months to 8.0 or 12.0 ppm NC>2.  The investigators reported
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 1    enlarged lungs that failed to collapse when the thorax was opened. When the lungs were fixed in
 2    an expanded state via the trachea using formaldehyde, there was evidence of enlarged airspaces
 3    with destructive changes in alveolar walls. Although no stereology was performed, the changes
 4    observed appear to be emphysema of the type seen in human lungs.
 5          WHO (1997) has also reported a study by Freeman et al. (1972) in which rats were
 6    exposed to 20.0 ppm NO2, which was reduced during the exposure to 15.0 ppm or to 10.0 ppm,
 7    for varying periods up to 33 months. The lungs were fixed via the trachea, and morphometric
 8    analysis of the lung and alveolar size indicated an enlargement of alveolar, reduction in alveolar
 9    surface, and alveolar destruction.  Although the investigators concluded that their study
10    demonstrated emphysema in their NO2-exposed rats, WHO (1997) noted that it was not entirely
11    clear whether the experimental groups or only the group exposed to 15.0 ppm had emphysema.
12          Although many of the papers reviewed (U.S. Environmental Protection Agency, 1993)
13    reported finding emphysema, some of these studies were reported according to previous,
14    different criteria; some reports did not fully describe the methods used; and/or the results
15    obtained were not in sufficient detail to allow independent confirmation of the presence of
16    emphysema. For example, Hyde et  al. (1978) reported no emphysema in beagle dogs exposed
17    16 h daily for 68 months to 0.64 ppm NO2 with 0.25 ppm NO or to 0.14 ppm NO2 with 1.67 ppm
18    NO. The dogs then breathed clean air  during a 32-to 36-month post-exposure period. The right
19    lungs were fixed via the trachea at 30-cm fixative pressure in a distended state.  Semiautomated
20    image analysis was used for morphometry of air spaces.  The dogs exposed to 0.64 ppm NO2
21    with 0.25 ppm NO had significantly larger lungs with enlarged air spaces and evidence of
22    destruction of alveolar walls. These effects were not observed in dogs exposed to 0.14 ppm NO2
23    with 1.67 ppm NO, implying a significant role of the NO2 in the production of the lesions. The
24    lesions in the dogs exposed to the higher NO2 concentration meet the criteria of the 1985 NHLBI
25    workshop for emphysema of the type seen in human lungs.
26
27    AX4.1.4   Nitrates (NO3~)
28          Busch et al. (1986) exposed rats and guinea pigs with either normal lungs or elastase-
29    induced emphysema to ammonium nitrate aerosols at 1 mg/m3 for 6 h/day, 5 days/week for
30    4 weeks. Using light and electron microscopy, the investigators concluded that there were no
31    significant effects of exposure on lung structure.


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 1    AX4.2     DOSIMETRY OF INHALED NITROGEN OXIDES
 2          This section provides an overview of NO2 dosimetry and updates information provided in
 3    the 1993 AQCD for Oxides of Nitrogen. Dosimetry of NO2 refers to the measurement or
 4    estimation of the amount of NO2 or its reaction products reaching and persisting at specific sites
 5    in the respiratory tract following an exposure.  Nitrogen dioxide, classified as a reactive gas,
 6    interacts with surfactants, antioxidants, and other compounds in the epithelial lining fluid (ELF).
 7    The compounds thought responsible for adverse pulmonary effects of inhaled NO2 are the
 8    reaction products themselves or the metabolites of these products in the ELF. At the time of the
 9    1993 AQCD for Oxides of Nitrogen, it was thought that inhaled NO2 probably reacted with the
10    water molecules in the ELF to form nitrous acid (FDSTO2) and nitric acid (HNOs). However,
11    some limited data suggested that the absorption of NO2 was linked to reactive substrates in the
12    ELF and subsequent nitrite production. Since then,  the reactive absorption of NO2 has been
13    examined in a number of studies (see Section 4.2.2). These studies have characterized the
14    absorption kinetics and reactive substrates for NO2 delivered to various sites in the respiratory
15    tract. Researchers have attempted to obtain a greater understanding of how these complex
16    interactions affect NO2 absorption and NO2-induced injury.
17          With respect to quantifying absolute NO2 absorption, the following were reported in the
18    1993 AQCD for Oxides of Nitrogen. The principles of Os uptake were generally assumed
19    applicable for NO2 modeling studies. The results indicated that NO2 is absorbed throughout the
20    lower respiratory tract, but the major delivery site is the centriacinar region, i.e., the junction
21    between the conducting and respiratory airways in humans and animals. Experimental studies
22    have found that the total respiratory tract uptake in humans ranges from 72 to 92% depending on
23    the study and the breathing conditions.  The percent total uptake increases with increasing
24    exercise level.  In laboratory animals, upper respiratory tract uptakes ranged from as low as 25%
25    to as high as 94% depending on the study, species, air flow rate, and mode of breathing (nasal or
26    oral). Upper respiratory tract uptake of NO2 was found to  decrease with increasing ventilation.
27    Uptake during nasal breathing was determined to be significantly greater than during oral
28    breathing.
29
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 1    AX4.2.1    Mechanisms of NO2 Absorption
 2          The ELF is the initial barrier against NO2 delivery to the underlying epithelial cells.
 3    Postlethwait and Bidani (1990) suggested that acute NO2 uptake in the lower respiratory tract
 4    was rate limited by chemical reactions of NO2 with ELF constituents rather than by gas solubility
 5    in the ELF. Subsequently, Postlethwait et al. (1991) reported that inhaled NO2 (10 ppm) does
 6    not penetrate the ELF to reach underlying sites and suggested that cytotoxicity may be due to
 7    NO2 reactants formed in the ELF. Since then, the reactive absorption of NO2 has been examined
 8    in a number studies that have sought to identify reactive substrates for NO2 and quantify the
 9    absorption kinetics of NO2 in the respiratory tract.
10          Postlethwait and Bidani (1994) concluded that the reaction between NO2 and water does
11    not significantly contribute to the absorption of inhaled NO2. Uptake is a first-order process for
12    NO2 concentrations less than 10 ppm, is aqueous substrate-dependent, and is saturable. The
13    absorption of inhaled NO2 is thought to be coupled with free radical-mediated hydrogen
14    abstraction to form FDSTO2 and an organic radical (Postlethwait and Bidani, 1989, 1994). At
15    physiologic pH, the HNO2 subsequently dissociates to H+ and nitrite (NO2 ). The concentration
16    of the resulting nitrite is thought insufficient to be toxic, so effects are thought to be due to the
17    organic radical and/or the proton load. Nitrite may enter the underlying epithelial cells and
18    blood. In the presence of red blood cells, nitrite is oxidized to nitrate (N(V) (Postlethwait and
19    Mustafa, 1981). Beyond cell susceptibility and the concentration of NO2 in the lumen,  site-
20    specific  injury was proposed to depend on rate of 'toxic'  reaction product formation and the
21    quenching of these products within the ELF. Related to the balance between reaction product
22    formation and removal, it was further suggested that cellular responses may be nonlinear with
23    greater responses being possible at low levels of NO2 uptake versus higher levels of uptake.
24    Since the ELF may vary throughout the respiratory tract, the uptake of inhaled NO2 and reaction
25    with constituents of the pulmonary ELF may be related to the heterogeneous distribution of
26    epithelial injury observed from NO2 exposure.
27
28          Postlethwait et al. (1995) sought to determine the absorption substrates for NO2 in the
29    ELF lavaged from male Sprague-Dawley rats.  Since the bronchoalveolar lavage fluid (BALF)
30    collected from the rats may be diluted up to 100-fold relative to the native ELF, the effect of
31    concentrating the BAL fluid on NO2 absorption was  investigated.  A linear association was


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 1    found between the first-order rate constant for NO2 absorption and the concentration of the
 2    BALF. This suggests that concentration of the reactive substrates in the ELF determines the rate
 3    of NO2 absorption.  The absorption due to specific ELF constituents was also examined in
 4    chemically pure solutions.  Albumin, cysteine, reduced glutathione (GSH), ascorbic acid, and
 5    uric acid were hydrophilic moieties found to be active substrates for NO2 absorption.
 6    Unsaturated fatty acids (such as oleic, linoleic, and linolenic) were also identified as active
 7    absorption substrates and thought to account for up to 20% of NO2 absorption.  Vitamins A and
 8    E exhibited the greatest reactivity of the substrates that were examined. However, the low
 9    concentrations of uric acid and vitamins A and E were thought to preclude them from being
10    appreciable substrates in vivo. The authors concluded that ascorbate and GSH were the primary
11    NO2 absorption substrates in rat ELF. Postlethwait et al.  (1995) also found that the pulmonary
12    surfactant, dipalmitoyl phosphatidylcholine, was not an effective substrate for NO2 absorption.
13    Later, Connor et al. (2001) suggested that dipalmitoyl phosphatidylcholine may actually inhibit
14    NO2 absorption.
15           In a subsequent study, Velsor and Postlethwait (1997) investigated the mechanisms of
16    acute epithelial injury from NO2  exposure.  The impetus for this work was to evaluate the
17    supposition that NO2 reaction products rather than NO2 itself cause epithelial injury.  Red blood
18    cell membranes were immobilized to the bottom of Petri dishes, covered with a variety of well
19    characterized aqueous layers, and exposed to gaseous NO2 (10 ppm for 20 min). The study
20    focused on the potential roles of  GSH and ascorbic acid reaction products in mediating cellular
21    injury.  Based on negligible membrane oxidation when covered with only an aqueous phosphate
22    buffer,  the diffusive/reactive resistance of a thin aqueous layer clearly prevented direct
23    interaction between NO2 and the underlying membrane. The presence of unsaturated fatty acids
24    was not observed to  affect NO2 absorption, but a sufficiently thin liquid layer was required for
25    membrane oxidation to occur. Interestingly, membrane oxidation was not a simple monotonic
26    function of GSH and ascorbic acid levels.  The maximal levels of membrane oxidation were
27    observed at low antioxidant levels versus null or high antioxidant levels. Glutathione and
28    ascorbic acid related membrane oxidation were superoxide and hydrogen peroxide dependent,
29    respectively. The authors suggested that at the higher antioxidant concentrations, there was
30    increased absorption of NO2, but little secondary oxidation of the membrane because the reactive
31    species (e.g., superoxide and hydrogen peroxide) generated during absorption were quenched.

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 1    At the low antioxidant concentrations, there was a lower rate of NO2 absorption, but oxidants
 2    were not quenched and so were available to interact with the cell membrane.
 3          Kelly et al. (1996a) examined the effect of a 4-h NO2 (2 ppm) exposure on antioxidant
 4    levels in bronchial lavage fluid (BLF) and BALF of 44 healthy nonsmoking adults (19-45 year,
 5    median 24 years).  Subjects were randomly assigned to three groups and lavaged at either 1.5 h
 6    (n = 15), 6 h (n = 15), or 24 h (n = 14) after the NO2 exposure.  The baseline concentrations of
 7    uric acid and ascorbic acid were strongly correlated between the BLF and BALF within
 8    individuals (r = 0.88, p < 0.001; r = 0.78, p = 0.001; respectively), whereas the concentrations of
 9    GSH in the BLF and BALF were not correlated. Uric acid levels in both lavage fractions were
10    significantly reduced at 1.5 h (p < 0.04), significantly increased at 6 h (p < 0.05), and back to
11    baseline at 24 h postexposure.  A statistically significant loss of ascorbic acid was also found in
12    both lavage fractions at 1.5 h (p < 0.05). At 6 and 24 h postexposure, the ascorbic acid levels
13    had returned to baseline. In contrast, GSH levels were significantly increased at both 1.5 h
14    (p < 0.01) and 6 h (p < 0.03) in BLF. At 24 h postexposure, the GSH levels in BLF returned to
15    baseline. Although GSH in BLF increased at 1.5 and 6 h postexposure, oxidized GSH levels
16    remained similar to baseline in both BLF and BALF. No changes in BALF levels of GSH were
17    observed at any time point.
18          The depletion of uric acid and ascorbic acid, but not GSH has also been observed with
19    ex vivo exposure of human BALF to NO2.  Kelly et al. (1996b) collected BALF from male lung
20    cancer patients (n = 16) and exposed the BALF ex vivo at 37°C to NO2 (0.05 to 2.0 ppm; 4 h) or
21    O3 (0.05 to 1.0 ppm; 4 h). Kelly and Tetley (1997) also collected BALF from lung cancer
22    patients (n = 12, 54 + 16 years) and  exposed the BALF ex vivo to NO2 (0.05 to 1.0 ppm; 4 h).
23    Both studies found that NO2 depletes uric acid and ascorbic acid, but not GSH from BALF.
24    Kelly et al. (1996b) noted a differential  consumption of the antioxidants with uric acid loss being
25    greater than that of ascorbic acid which was lost at a much greater rate than GSH. Kelly and
26    Tetley (1997) found that the rates of uric acid and ascorbic acid consumption were correlated
27    with their initial concentrations in the BAL fluid, such that higher initial antioxidant
28    concentrations were associated with a greater rate of antioxidant depletion. Illustrating the
29    complex interaction of antioxidants, these studies also suggest that GSH oxidized by NO2 may
30    be again reduced by uric acid and/or ascorbic acid.
31

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 1    AX4.2.2    Regional and Total Respiratory Absorption of NO2
 2          There has been very limited work related to the quantification of NC>2 uptake since the
 3    1993 AQCD for Oxides of Nitrogen.  As a result, there is an abbreviated discussion here of some
 4    papers that were reviewed in the 1993 AQCD for Oxides of Nitrogen.
 5
 6    AX4.2.2.1    Dosimetry Models
 7          There is a paucity of theoretical studies investigating NO2 dosimetry. Like Os, NO2 is
 8    highly reactive in ELF and is not very soluble. An Os model has been utilized to predict the
 9    uptake of NO2 in the lower respiratory tract of humans, rats, guinea pigs, and rabbits (Miller
10    et al., 1982; Overton, 1984). In this model, there was a strong distinction between uptake and
11    dose. Uptake referred to the amount of NO2 being removed from gas phase per lung surface area
12    (|ig/cm2), whereas, dose referred to the amount of NO2 per lung surface area (jig/cm2) that
13    diffused through the ELF and reached the underlying tissues. These investigators assessed NO2
14    uptake and dose on a breath by breath basis. Miller et al. (1988) provided uptake and dose rates
15    (|ig/cm2-min) for Oj, in the same species.
16          Miller et al. (1982) and subsequently Overton (1984) did not attempt to predict the
17    amount of reactants in the ELF or the transport of reactants to the tissues. Rather, they focused
18    mainly on the sensitivity of NO2 tissue dose on NO2 reaction rates in the ELF and the Henry's
19    law constant. Reaction rates of NO2 in the ELF were varied from zero, 50%, and 100% of the
20    reaction rate for Os in ELF. The Henry's law constant was varied from half to double the
21    Henry's law constant for NO2 in water at 37 °C. Effects of species, lung morphology, and tidal
22    volume (Vx) were also examined.  In general, the model  predicted that NO2 is taken up
23    throughout the lower respiratory tract.  In humans, NO2 uptake was fairly constant from the
24    trachea to the terminal bronchioles, beyond which uptake decreased with distal progression.
25    This pattern of NO2 uptake predicted for humans is very  similar to the pattern of Os uptake per
26    unit time predicted for humans, rats, rabbits, and guinea pigs by Miller et al. (1988). Thus, it is
27    reasonable to expect that the pattern NO2 uptake per unit time will also be similar between these
28    species.  The NO2 tissue dose was highly dependent on the Henry's law constant and reaction
29    rate in the ELF.  In the conducting airways, the NO2 tissue dose decreased as the Henry's law
30    constant increased (i.e., decreased gas solubility), whereas the NO2 tissue dose in the alveolar
31    region increased. The site of maximal NO2 tissue dose was fairly similar between  species,

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 1    ranging from the first generation of respiratory bronchioles in humans to the alveolar ducts in
 2    rats.  In guinea pigs and rabbits, the maximal NC>2 tissue dose was predicted to occur in the last
 3    generation of respiratory bronchioles. Based on Miller et al.  (1988), the dose rate of NO2 is also
 4    expected to be similar between species.  The simulations also showed that exercise increases the
 5    NC>2 tissue dose in the pulmonary region relative to rest.  Miller et al. (1982) also reported that
 6    increasing the NC>2 reaction rate decreased NO2 tissue dose in the conducting airways, but had no
 7    effect on the dose delivered to the pulmonary region.
 8          Simultaneously occurring diffusion and chemical reactions in the ELF have been
 9    suggested as the limiting factors in 63 (Santiago et al., 2001) and NO2 uptake (Postlethwait and
10    Bidani, 1990). Hence, Miller et al. (1982) should have found an increase in the uptake of NC>2 in
11    the conducting airways with increasing the rate of chemical reactions in the ELF. This increase
12    in NC>2 uptake in the conducting airways would then lead to a reduction in the amount of NC>2
13    reaching and taken up in the pulmonary region. The Miller et al. (1982) model considered
14    reactions of NC>2 with constituents in the ELF as protective in that these reactions reduced the
15    flux of NC>2 to the tissues.  Others have postulated that NCVreactants formed in the ELF, rather
16    than NC>2 itself, could actually cause adverse responses (Overton, 1984; Postlethwait and Bidani,
17    1994; Velsor and Postlethwait, 1997).
18          Overton and Graham (1995) examined NO2 uptake in an asymmetric anatomic model of
19    the rat lung.  The multiple path model of Overton and Graham (1995) allowed for variable path
20    lengths from the trachea to the terminal bronchioles, whereas Miller et  al. (1982) used a single or
21    typical path model of the conducting airways.  The terms dose and uptake were used
22    synonymously to describe the amount of NO2 gas lost from the gas phase in a particular lung
23    region or generation by Overton and Graham (1995). Reactions of NO2 in the ELF were not
24    explicitly considered. Their simulations were conducted for  rats breathing at 2 mL VT at a
25    frequency of 150 breaths per minute.  The mass transfer coefficients of 0.173, 0.026, and 0.137
26    cm/sec were assumed for the upper respiratory tract, the tracheobronchial airways, and the
27    pulmonary region, respectively. Uptake was predicted to decrease with distal progression into
28    the lung.  In general, the modeled NO2 dose varied among anatomically equivalent ventilatory
29    units as a function of path  length from the trachea with shorter paths showing greater dose. A
30    sudden increase in NO2 uptake was predicted in the proximal alveolar region (PAR) which was
31    due to the increase in the assumed mass transfer coefficient relative to the adjacent terminal

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 1    bronchiole. Overton et al. (1996) showed that increasing the mass transfer coefficient of the
 2    tracheobronchial airways would decrease the dose to the PAR and vice versa. Additionally, the
 3    PAR dose would also be reduced by the more realistic modeling of tracheobronchial airways
 4    expansion during inspiration versus the static condition employed by Overton and Graham
 5    (1995).
 6          More recently, two studies examined the influence of age on reactive gas dosimetry in
 7    humans (Ginsberg et al., 2005; Sarangapani et al., 2003). Both studies specifically considered
 8    the dosimetry 63 during light activity (on average) in their analysis. It is assumed here that their
 9    general findings should also be applicable to NO2. Sarangapani et al.  (2003) used a
10    physiologically based pharmacokinetic model and found that regional uptake of 63 is relatively
11    insensitive to age (range:  infants to elderly). Ozone uptake per unit surface area was 2- to 8-fold
12    higher in infants compared to adults.  However, this finding (i.e., uptake per unit surface area) is
13    a less informative expression of dose than the rate of uptake per unit surface area.  The rate of
14    uptake, obtained by multiplying by the ventilation rate, adjusts for the greater rate of gas intake
15    by adults relative to children. Ginsberg et al. (2005) utilized the U.S. EPA (1994) reference
16    concentration methodology and found no effect of age (infants vs. adults) on the uptake rate of
17    63 per unit surface area.
18          In summary, these modeling  studies predict that the net NO2 dose (NO2 flux to air-liquid
19    interface) is relatively constant from the trachea to the terminal bronchioles and then rapidly
20    decreases in the pulmonary region. The pattern of net NO2 dose rate or uptake rate is expected to
21    be similar between species and unaffected by age in humans.  The predicted tissue dose and dose
22    rate of NO2 (NO2 flux to liquid-tissue interface) is low in the trachea, increases to  a maximum in
23    the terminal bronchioles and the first generation of the pulmonary region, and then decreases
24    rapidly with distal progression.  The site of maximal NO2 tissue dose is predicted to be fairly
25    similar between species, ranging from the first generation of respiratory bronchioles in humans
26    to the alveolar ducts in rats.  The production of toxic NO2-reactants in the ELF and the
27    movement of the reactants to the tissues have not been modeled.
28
29
30    AX4.3     EXPERIMENTAL STUDIES OF NO2 UPTAKE
31
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 1   AX4.3.1   Upper Respiratory Tract Absorption
 2          The nasal uptake of NO2 has been experimentally measured in dogs, rabbits, and rats
 3   under conditions of unidirectional flow.  Yokoyama (1968) reported 42.1 + 14.9%
 4   (Mean + StDev) uptake of NO2 in the isolated nasal passages of two dogs (3.5 L/min) and three
 5   rabbits (0.75 L/min) exposed to 4 and 41 ppm NC>2. Uptake did not appear to depend on the
 6   exposure concentration and was relatively constant over a 10 to 15 min period.  Cavanagh and
 7   Morris (1987) measured uptakes of 28% and 25% uptake of NC>2 (40.4 ppm) in the noses of four
 8   naive and four previously exposed rats (0.10 L/min), respectively. Uptake was not affected by a
 9   4-h prior exposure (naive versus previously exposed rats) to 40.4 ppm NC>2 and was constant
10   over the 24-min period during which uptake was determined.
11          Kleinman and Mautz (1991) measured the penetration of NO2 through the upper airways
12   during inhalation in six tracheotomized dogs exposed to 1.0 or 5.0 ppm NC>2.  Uptake in the nasal
13   passages was significantly greater at 1.0 ppm than at 5.0 ppm, although the magnitude of this
14   difference was not reported. The mean uptake of NC>2 (1.0 ppm) in the nasal passages decreased
15   from 55% to 40% as the ventilation rate increased from about 2 to 8 L/min. During oral
16   breathing, uptake was not dependent on concentration.  The mean oral uptake of NC>2 (1.0 and
17   5.0 ppm) decreased from 65% to 30% as the ventilation rate increased from 2 to 8 L/min.
18
19   AX4.3.2   Lower Respiratory Tract Absorption
20          Postlethwait and Mustafa (1989) investigated the effect of exposure concentration and
21   breathing frequency on the uptake of NC>2 in isolated perfused rat lungs.  To evaluate the effect
22   of exposure concentration, the lungs were exposed to NC>2 (4 to 20 ppm) while ventilated at 50
23   breaths/min with a VT of 2.0 mL.  To examine the effect of breathing frequency, the lungs were
24   exposed to NC>2 (5 ppm) while ventilated at 30-90 breaths/min with a VT of 1.5  mL. All
25   exposures were for 90 min. The uptake of NC>2 ranged from 59 to 72% with an average of 65%
26   and was not affected by exposure concentration or breathing frequency. A  combined regression
27   showed a linear relationship between NC>2 uptake and total inspired dose (25 to 330 jig NO2).
28   Illustrating variability in NC>2 uptake measurements, Postlethwait and Mustafa (1989) observed
29   59% NO2 uptake in lungs ventilated at 30 breaths/min with a VT of 1.5 mL, whereas,
30   Postlethwait and Mustafa (1981) measured 35% NC>2 uptake for the same breathing condition.
31   In another study, 73% uptake of NC>2 was reported for rat lungs ventilated 50  breaths/min with a

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 1    VT of 2.3 mL (Postlethwait et al., 1992).  It should be noted that typical breathing frequencies are
 2    around 80, 100, and 160 breaths/min for rats during sleep, rest, and light exercise, respectively
 3    (Winter-Sorkina and Cassee, 2002).  Hence, the breathing frequencies at which NO2 uptake has
 4    been measured are lower than for rats breathing normally.
 5          In addition to measuring upper respiratory tract uptakes, Kleinman and Mautz (1991) also
 6    measured NO2 uptake in the dog lung. In general, there was about 90% NO2 uptake in the lungs
 7    which was independent of ventilation rates from 3 to 16 L/min.
 8
 9    AX4.3.3    Total Respiratory Tract Absorption
10          Bauer et al. (1986) measured the uptake of NO2 (0.3 ppm) in 15 adult asthmatics exposed
11    for 30 min (20 min at rest, then 10 min exercising on a bicycle ergometer) via a mouthpiece
12    during rest and exercise. There was a statistically significant increase in uptake from 72% during
13    rest to 87% during exercise.  The minute ventilation also increased from 8.1 L/min during rest to
14    30.4 L/min during exercise. Hence, exercise increased the dose rate of NO2 by 5-fold in these
15    subjects. In an earlier study of seven healthy adults in which subjects were exposed to a nitric
16    oxide (NO)/NO2 mixture containing 0.29 to 7.2 ppm NO2 for brief (but unspecified) periods,
17    Wagner (1970) reported that NO2 uptake increased from 80% during normal respiration (Vx, 0.4
18    L) to 90% during maximal respiration (Vx, 2 to 4 L).
19          Kleinman and Mautz (1991) also measured the total respiratory tract uptake of NO2 (5
20    ppm) in female beagle dogs while standing at rest or exercising on a treadmill.  The dogs
21    breathed through a small face mask.  Total respiratory tract uptake of NO2 was 78% during rest
22    and increased to 94% during exercise.  In large part, this increase in uptake may be due to the
23    increase  in Vx from 0.18 L during rest to 0.27 L during exercise. Coupled with an increase in
24    minute ventilation from 3.8 L/min during rest to 10.5 L/min during exercise, the dose rate of
25    NO2 was 3-fold greater for the dogs during exercise than rest.
26
27
28    AX4.4     METABOLISM, DISTRIBUTION AND ELIMINATION OF NO2
29               PRODUCTS
30          As stated earlier, NO2 absorption is coupled with nitrous acid (HNO2) formation, which
31    subsequently dissociates to H+ and nitrite (NO2 ).  Nitrite enters the underlying epithelial cells
32    and subsequently the blood. In the presence of red blood cells and possibly involving

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 1    oxyhemoglobin, nitrite is oxidized to nitrate (NO3 ) (Postlethwait and Mustafa, 1981). Nitrate
 2    may subsequently be excreted in the urine. There has been concern that inhaled NO2 may lead to
 3    N-nitrosamine production, many of which are carcinogenic, since NO2 can produce nitrite and
 4    nitrate (in blood). Nitrate can be converted to nitrite by bacterial reduction in saliva, the
 5    gastrointestinal tract, and the urinary bladder. Nitrite has been found to react with secondary
 6    amines to form N-nitrosamines. This remains speculative since nitrosamines are not detected in
 7    tissues of animals exposed by inhalation to NO2 unless precursors to nitrosamines and/or
 8    inhibitors of nitrosamine metabolism are co-administered. Rubenchik et al. (1995) could not
 9    detect N-nitrosodimethylamine (NDMA) in tissues of mice exposed to 4 to 4.5 ppm NO2 for 1 h.
10    NDMA was found in tissues,  however, if mice were simultaneously given oral doses of
11    amidopyrine and 4-methylpyrazole, an inhibitor of NDMA metabolism. Nevertheless, the main
12    source of NO2 in the body is formed endogenously, and food is also a contributing source of
13    nitrite from the conversion of nitrates.  Thus, the relative importance of inhaled NO2  to N-
14    nitrosamine formation has yet to be demonstrated.
15          Metabolism of inhaled NO2 may also transform other chemicals that may be present in
16    the body, in some cases into mutagens and carcinogens.  Van Stee et al. (1983) reported
17    N-nitrosomorpholine (NMOR), production in mice gavaged with 1 g of morpholine/kg body
18    weight per day and then exposed (5-6 h daily for 5 days) to 16.5 to 20.5 ppm NO2.
19    N-nitrosomorpholine is a nitrosamine that is a potent animal carcinogen.  The single site
20    containing the greatest amount of NMOR was the gastrointestinal tract. Later, Van Stee et al.
21    (1995) exposed mice to approximately 20 ppm  15NO2 and to 1 g/kg morpholine simultaneously.
22    N-nitrosomorpholine was found in  the body of the exposed mice. Ninety-eight point four
23    percent was labeled with 15N that was derived from the inhaled 15NO2 and 1.6% was derived
24    presumably from endogenous sources.
25          Miyanishi et al. (1996) co-exposed rats, mice, guinea pigs and hamsters to NO2 and
26    various polycyclic aromatic hydrocarbons (PAHs) such as pyrene, fluorene, or anthracene.  Nitro
27    derivatives of these PAHs were excreted in the  urine of co-exposed animals, which were found
28    to be highly mutagenic in the  Ames/S. typhimurium assay. Specifically, the nitrated metabolite
29    of pyrene (l-nitro-6/8-hydroxypyrene and l-nitro-3hydroxypyrene) was detected in the urine.
30    Further studies indicated that these  metabolites  are nitrated by an ionic reaction in vivo after the
31    hydroxylation of pyrene in the liver.

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 1          Inhaled NO2 may also be involved in the production of mutagenic (and carcinogenic)
 2    nitro derivatives of other co-exposed compounds, such as poly cyclic aromatic hydrocarbons
 3    (PAHs), via nitration reactions. Miyanishi et al. (1996) co-exposed rats, mice, guinea pigs and
 4    hamsters to 20 ppm NC>2 and various PAHs (pyrene, fluoranthene, fluorene, anthracene, or
 5    chrysene). Nitro derivatives of these PAHs were excreted in the urine of these animals, which
 6    were found to be highly mutagenic in the AmesA?. typhimurium assay. Specifically, the nitrated
 7    metabolite of pyrene (l-nitro-6/8-hydroxypyrene and l-nitro-3hydroxypyrene) was detected in
 8    the urine. Further studies indicated that these metabolites are nitrated by an ionic reaction in
 9    vivo after the hydroxylation of pyrene in the liver.
10
11
12    AX4.5     EXTRA-PULMONARY EFFECTS OF NO2 AND NO
13          Exposure to NC>2 produces a wide array of health effects beyond the confines of the lung.
14    Thus, NC>2 and/or some of its reactive products penetrate the lung or nasal epithelial and
15    endothelial layers to enter the blood and produce alteration in blood and various other organs.
16    Effects on the systemic immune system were discussed above and the  summary of other
17    systemic effects is quite brief because the database suggests that effects on the respiratory tract
18    and immune  response are of greatest concern. A more detailed discussion of extrapulmonary
19    responses can be found in U.S. Environmental Protection Agency (1993).
20
21    AX4.5.1    Body Weight, Hepatic, and Renal Effects
22          Conflicting results have been reported on whether NO2 affects  body weight gain in
23    experimental animals as a general indicator of toxicity (U.S. Environmental Protection  Agency,
24    1993). Newer subchronic studies show no significant effects on body weight in rats, guinea
25    pigs, and rabbits exposed up to 4 ppm NC>2 (Tepper et al., 1993; Douglas et al., 1994; Fujimaki
26    and Nohara,  1994).
27          Effects on the liver, such as changes in serum chemistry and xenobiotic metabolism, have
28    been reported by various investigators to result from exposure to NC>2  (U.S. Environmental
29    Protection Agency 1993). Drozdz et al. (1976) found decreased total liver protein and sialic
30    acid, but increased protein-bound hexoses in guinea pigs exposed to 1.05 ppm NO2, 8 h/day for
31    180 days. Liver alanine and aspartate aminotransferase activity was increased in the
32    mitochondrial fraction but decreased in the cytoplasmic fraction of the liver. Electron

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 1    micrographs of the liver showed intracellular edema and inflammatory and parenchymal
 2    degenerative changes.
 3          No new studies on liver effects were located in the literature since the 1993 AQCD for
 4    Oxides of Nitrogen.  Several older studies have shown changes in kidney function and
 5    xenobiotic metabolism in animals following NO2, although no histopathological changes were
 6    reported.
 7          Increases in urinary protein and specific gravity of the urine were reported by Sherwin
 8    and Layfield (1974) in guinea pigs exposed continuously to 0.5 ppm NO2 for 14 days.
 9    Proteinuria (albumin and alpha-, beta-, and gamma-globulins) was found in another group of
10    animals when the exposure was reduced to 0.4 ppm NO2 for 4 h/day. However, differences in
11    water consumption or in the histology of the kidney were not found. No new studies were
12    located in the literature since the  1993 AQCD for Oxides of Nitrogen.
13
14    AX4.5.2   Brain Effects
15          There are several studies suggesting that NO2 affects the brain. Decreased activity of
16    protein metabolizing enzymes, increased glycolytic enzymes, changes in neurotransmitter levels
17    (5-HT and noradrenaline), and increased lipid peroxidation, accompanied by lipid profile and
18    antioxidant changes, have been reported (Farahani  and Hasan, 1990, 1991, 1992; Sherwin et al.,
19    1986; Drozdz et al., 1975). The U.S. Environmental Protection Agency (1993) concluded that
20    "none of these effects have been replicated and all reports lack sufficient methodological rigor;
21    thus, the implications of these findings, albeit important, are not clear and require further
22    investigation".
23          A developmental neurotoxicity study by Tabacova et al.(1985) suggest that in utero
24    exposure  to NO2 may result in postnatal neurobehavioral development changes as described in
25    the section on reproductive and developmental toxicology.

26    AX4.5.3   NO
27          The genotoxicity of NO has been studied both in vitro and in vivo (Arroyo et al., 1992;
28    Nguyen et al., 1992) (see Table AX4.8). Overall, the synthesis of these older studies suggests
29    that NO has some genotoxic potential;  however, the effect is slight and to a lesser extent when
30    compared to NO2.
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 1    AX4.6      EFFECTS OF MIXTURES CONTAINING NO2
 2          Humans are generally exposed to NO2 in a mixture with other air pollutants. A limitation
 3    of animal toxicity studies is the extrapolation of dose-response data from controlled exposures to
 4    NO2 alone to air pollutant mixtures that are typically found in the environment. It is difficult to
 5    predict the effects of NO2 in a mixture based on the effects of NO2 alone.  In order to understand
 6    how NO2 is affected by mixtures of other air pollutants, studies are typically conducted with
 7    mixtures containing NO2 and one or two other air pollutants, such as Os and/or H2SC>4. The
 8    result of exposure to two or more pollutants may be simply the sum  of the responses to
 9    individual pollutants (additivity),  may be greater than the sum of the individual responses,
10    suggesting some type of interaction or augmentation of the response (synergism) or may be less
11    than additive (antagonism).
12          Animal toxicity studies have shown an array of interactions,  including no interaction,
13    additivity or synergism.  Because no clear understanding of NO2 interactions has yet emerged
14    from this database, only a brief overview is provided here.  A more substantive review can be
15    found in U.S. Environmental Protection Agency (1993). There are animal studies, which have
16    studied the effects of ambient air mixtures containing NO2 or gasoline or diesel combustion
17    exhausts containing NOx. Generally these studies provide useful information on the mixtures,
18    but lack NO2-only groups, making it impossible to discern the influence of NO2.  Therefore, this
19    class of research is not described here, but is reviewed elsewhere (U.S. Environmental Protection
20    Agency, 1993).
21
22    AX4.6.1   Simple Mixtures Containing NO2
23          Most of the interaction  studies have involved NO2  and 63. After subchronic exposure,
24    lung morphology studies did not show any interaction of NO2 with O3 (Freeman et al., 1974) or
25    with SO2 (Azoulay et al., 1980).  Some biochemical responses to NO2 plus Os  display no
26    positive interaction or synergism. For example, Mustafa et al.  (1984) found synergism for some
27    endpoints (e.g., increased activities of O2 consumption and antioxidant enzymes), but no
28    interaction for others (e.g., DNA or protein content) in rats exposed for 7 days. Ichinose and
29    Sagai (1989) observed a species dependence in regard to the interaction of 63 (0.4 ppm) and NO2
30    (0.4 ppm) after 2 weeks of exposure. Guinea pigs, but not rats, had a synergistic increase in lung
31    lipid peroxides.  Rats, but not guinea pigs, had synergistic increases  in antioxidant factors (e.g.,


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 1    non-protein thiols, vitamin C, glucose-6-phosphate dehydrogenase, GSH peroxidase). Duration
 2    of exposure can have an impact.  Schlesinger et al. (1990) observed a synergistic increase in
 3    prostaglandin E2 and F2a in the lung lavage of rabbits exposed acutely for 2 h to 3.0 ppm NO2
 4    plus 0.3 ppm Os; the response appeared to have been driven by Os. However, with 7 or 14 days
 5    of repeated 2-h exposures, only prostaglandin E2 was decreased and appeared to have been
 6    driven by NO2; there was no synergism (Schlesinger et al., 1991).
 7          Using an infectivity model, Ehrlich et al. (1977) found additivity after acute exposure to
 8    mixtures of NO2 and 63 and synergism after subchronic exposures. Exposure scenarios
 9    involving NO2 and 63 have also been performed using a continuous baseline exposure to one
10    concentration or mixture, with superimposed short-term peaks to a higher level (Ehrlich et al.,
11    1979; Gardner, 1980, 1982; Graham et al., 1987).  Differences in the pattern and concentrations
12    of the exposure are responsible for the increased susceptibility to pulmonary infection, without
13    indicating clearly the mechanism controlling the interaction.
14          Some aerosols may potentiate response to NO2 by producing local changes in the lungs
15    that enhance the toxic action of co-inhaled NO2. The impacts of NO2 and H2SC>4 on lung host
16    defenses have been examined by Schlesinger and Gearhart (1987) and Schlesinger (1987). In the
17    former study, rabbits were exposed for 2 h/day for 14 days to either 0.3 ppm or 1.0 ppm NO2, or
18    500 |ig/m3 H2SC>4 alone, or to mixtures of the low and high NO2 concentrations with H2SC>4.
19    Exposure to either concentration of NO2 accelerated alveolar clearance, whereas H2SC>4 alone
20    retarded clearance. Exposure to either concentration of NO2 with H2SO4 resulted in retardation
21    of clearance in a similar manner to that seen with H2SC>4 alone.  Using a similar exposure design
22    but different endpoints, exposure of rabbits to 1.0 ppm NO2 increased the numbers of PMNs in
23    lavage fluid at all time points (not seen with either pollutant alone), and increased phagocytic
24    capacity of AMs after two or six exposures (Schlesinger et al., 1987). Exposure to 0.3 ppm NO2
25    with acid, however, resulted in depressed phagocytic capacity and mobility. The NO2/H2SO4
26    mixture was generally either additive or synergistic, depending on the specific cellular endpoint
27    being examined.
28          Exposure to high levels of NO2 (<5.0 ppm) with very high concentrations of H2SC>4
29    (1 mg/m3) caused a synergistic increase in collagen synthesis rate and protein content of the
30    lavage fluid of rats (Last and Warren, 1987; Last, 1989).
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 1   AX4.6.2    Complex Mixtures Containing NO2
 2          Although many studies have examined the response to NC>2 with only one additional
 3   pollutant, the atmosphere in most environments is a complex mixture of more than two materials.
 4   A number of studies have attempted to examine the effects of multi-component atmospheres
 5   containing NO2, but as mentioned before, in many cases the exact role of NC>2 in the observed
 6   responses is not always clear. One study by Stara et al. (1980) deserves mention because
 7   pulmonary function changes appeared to progress after exposure ceased.
 8          In the study by Stara et al. (1980), dogs were exposed for 68 months (16 h/day) to raw or
 9   photochemically reactive vehicle exhaust which included mixtures of NOx:  one with a high NC>2
10   level and a low NO level (0.64 ppm, NO2; 0.25 ppm, NO), and one with a low NO2 level and a
11   high NO level (0.14 ppm, NO2; 1.67 ppm, NO). At the end of exposure, the animals were
12   maintained for about 3 years in normal indoor air. Numerous pulmonary functions,
13   hematological and histological endpoints were examined at various times during and after
14   exposure. The lack of an NO2-only or NO-only group precludes determination of the nature of
15   the interaction. Nevertheless, the main findings are of interest.  Pulmonary function changes
16   appeared to progress after exposure ceased.  Dogs in the high NO2 group had morphological
17   changes considered to be analogous to human centrilobular emphysema. Because these
18   morphological measurements were made after a 2.5- to 3-year holding period in clean air, it
19   cannot be determined with certainty whether these disease processes abated or progressed during
20   this time. This study suggests progression of damage after exposure ends.
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TABLE AX4.1. EFFECTS OF NITROGEN DIOXIDE ON OXIDANT AND ANTIOXIDANT HOMEOSTASIS
O
to
O
O
oo












>
^
to
to


O
>
Tj
H
6
O

0
H
/O
r*^x
O
H
W
O
O
HH
H
W
ppm
0.04
0.4
4.0




0.4

0.4
1.2
4.0

0.4-0.5

0.5
1.0

1.0

1.0
2.3
6.2


1.2
1.8

2.0
10.0







Exposure Gender Age
Continuous, M 8 wks
9 and 18 mos





2 wks NS NS

Continuous, M 13 wks
4 mos


Continuous, F NS
1.5yrs
Continuous, F 4 wks
17 mos

4 h/day, NS NS
6 days
Continuous, M 8 wks
4 days



Continuous, M 12 wks
3 days

3 days M/F 5->60
days







Species (Strain)
Rat (Wistar)






Rat
Guinea Pig
Rat (Wistar)



Mouse
(NS)
Mouse (C57B1/6J)


Rat (Sprague-Dawley)

Rat
(Sprague-Dawley)



Rat (Sprague-Dawley)


Rat (Wistar) Guinea pig
(Dunkin Hartley)







Effects
NPSHs increased at >0.4 ppm after 9 or 18 mos;
GSH peroxidase activity increased after a 9-mo
exposure to 4.0 ppm; G-6-P dehydrogenase was
increased after a 9- and 18-mo exposure to 4.0 ppm;
no effects on 6-P-G dehydrogenase , SOD disulfide
reductase; some GSH S-transferase had decreased
activities after 18-mo exposure to >0.4 ppm.
No effect on TEA reactants, antioxidants, or
antioxidant enzyme activities.
Duration dependent pattern for increase in activities
of antioxidant enzymes; increase, peaking at wk 4
and then decreasing. Concentration-dependent
effects.
Growth reduced; Vitamin E (30 or 300 mg/kg diet)
improved growth.
At 1 ppm, GSH-peroxidase activity decreased in
vitamin E-deficient mice and increased in Vitamin
E- supplemented mice.
Vitamin E-supplement reduced lipid peroxidation.

Activities of GSH reductase and G-6-P
dehydrogenase increased at 6.2 ppm proportional to
duration of exposure; plasma lysozyme and GSH
peroxidase not affected at 6.2 ppm; no effects at 1.0
or 2.3 ppm.
Increases in G-6-P dehydrogenase, isocitrate
dehydrogenase, disulfide reductase, and NADPH
cytochrome c reductase activities at 1.8 ppm only.
Decreased SOD activity in 21 -day -old animals.








References
Sagai etal. (1984)
Ichinose etal. (1983)





Ichinose and Sagai
(1989)
Ichinose and Sagai
(1982)


Csallany (1975)

Ayaz and Csallany
(1978)

Thomas etal. (1967)

Chow etal. (1974)




Lee etal. (1989, 1990)


Azoulay-Dupuis et al.
(1983)








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            TABLE AX4.1 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON OXIDANT AND ANTIOXIDANT HOMEOSTASIS
o Ppm
5 2.0
8 4.0
00 10.0
3.0

9.5


3.0
Exposure
14 days
10 days
7 days
7 days

7 h/day,
5 days/wks,
6 mos
4 days
Gender Age
M

M/F

M


M
12-24 wks

1 day to
>8wks
In utero
and 6 mos

NS
Species (Strain)
Rat (Wistar)

Rat (Sprague-Dawley)

Rat (Fischer 344)


Rat (Sprague-Dawley)
Effects
G-6-P dehydrogenase increased at >2 ppm; at
2 ppm, 14 days of exposure needed

Increased lipid peroxidation (TBA-reactive
substances) with vitamin E deficiency.
Increase in GSH reductase activity in younger rats
and SDH peroxidase activity in older rats.

No effects on parameters tested.
References
Mochitate et al.
(1985)

Sevanian et al. (1982)

Mauderly et al. (1987)


Mustafa etal. (1979)
             7.0
4 days
Increase in lung weight, G-6-P dehydrogenase,
GSH reductase, and GSH peroxidase activities.

Increased lung weight, G-6-P dehydrogenase; and
GSH reductase activities.
to
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
              10      4 days
              15       1-7 days
             4.0       3h
              M/F      21-33yrs    Human
             5.0     Continuous,   M         NS
             10.0     24 h 7 days
                                    Rats (CD Cobs)
                                                           Increase in lung weight, DNA content, G-6-P
                                                           dehydrogenase, 6-P-G dehydrogenase, GSH
                                                           reductase, disulfide reductase, GSH peroxidase,
                                                           disulfide reductase, succinate oxidase, and
                                                           cytochrome oxidase activities; no effect on lung
                                                           protein
Decreased elastase inhibitory capacity and
increased lipid peroxidation products in B AL of
subjects not administered supplement of vitamin C
and E prior to NO2 exposure.
Changes in the GSH levels in blood and lung
occurred in rats exposed for 24 h, but returned to
normal after 7 days.
Mohsenin(1991)
Paganietal. (1994)

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O
to
O
O
oo
to
             TABLE AX4.1 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON OXIDANT AND ANTIOXIDANT HOMEOSTASIS
             ppm      Exposure     Gender     Age       Species (Strain)                         Effects                             References
              6.0
              15
              28
              9.5
             10.0
4 h/day,
30 days

7 days

7 h/day,
5 days/wk,
24 mos
Continuous
3 days,
20 days
NS
Mouse
(NS)
                                    M
                                    NS
18 wks     Rat (Fischer 344)
NS        Rat (Fischer 344)
             14.0
                       NS
             NS
NS
Human
Increase in GSH reductase and G-6-P
dehydrogenase activities.

Increase in GSH levels, G-6-P dehydrogenase, and
GSH peroxidase activities.
Increase in GSH reductase activity in BAL.
Decreased GSH/GSSG ratio in blood and BAL
fluid, but not in lung type II cells.  Lipid
peroxidation was decreased in type II cells at
3 days, but was similar to controls at 20 days.
mRNA expression of the enzymes involved in the
biosynthesis (yGCS and GS) was decreased at
both time points.  yGT (redox of GSH) mRNA
expression was increased.
Rapid depletion of vitamin C, glutathione and
vitamin E
Csallany (1975)
                                                                        Mauderlyetal., (1990)
                                                                        Hochscheid et al. (2005)
Halliwelletal. (1992)
H
6
o
o
H
O
O
H
W
O
O
HH
H
W
          M = Male
          NPSHs = Nonprotein sulfhydryls
          G-6-P dehydrogenase = Glucose-6-phosphate dehydrogenase
          G6-P-G dehydrogenase = 6-phosphosgluconate dehydrogenase
          SOD = superoxide dismutase
          F = Female
          NS = Not started
          NADP = Nicotinamide-adenine dinucleotide phosphate (reduced form)
          TEA = Thiobarbituric acid
          BAL = Bronchoalveolar lavage
          GR = Glutathione reductase
          GS = Glutathione synthetase
          GSH = Reduced glutathione
          GSSG = Oxidized glutathione
          y-GCS - y-Glutamyl-cystein synthetase
          y-GT - y-Glutamyltranspeptidase

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O

to
O
O
oo
ppm
                         TABLE AX4.2. EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS, PROTEINS,
                        	LIPIDS, AND ENZYMES	
                       Exposure    Gender      Age      Species (Strain)
                                                                                   Effects
                                                                                       References
to
H
6
o

o
H
O
O
H
W
O
O
HH
H
W
0.4
1.0
3.0
5.0

5.0

0.4

0.4

0.4
1.2
4.0
             0.5
             1.0
             1.0
             7.5
             15
             25
             30
         72 h         M        NS         Guinea Pig         No effect at 0.4 ppm; increase in BAL protein in vitamin
                                            (Hartley)          C-depleted, but not normal, animals at 1.0 ppm and
                                                              above.
                                                                                                                              Selgradeetal. (1981)
                     3h

                     Continuous,
                     Iwk
                     Continuous,  M
                     Iwk
                     1-14 wks     M
                                NS
                                                         Guinea Pig
                                22-24 wks   Rat (Wistar)
         6 h/day,
         5 days/wk,
         4 wks
                                   M
NS
                                           Rat (Fischer 344)
         6 h/day,
         2 days
Increased BAL protein in vitamin C-depleted guinea
pigs 15 h postexposure.

No effect on BAL protein.
Increased protein content of BAL from
vitamin-C-deficient guinea-pigs.
Complex concentration and duration dependence of
effects. Example: at 0.4 ppm, cytochrome P-450 levels
decreased at 2 wks, returned to control level by 5 wks.
At 1.2 ppm, cytochrome P-450 levels decreased initially,
increased at 5 wks, and decreased at 10 wks.  Effects on
succinate-cytochrome c reductase also.
0.5 ppm; increase in urinary hydroxylysine output
starting during wk 1; BAL  hydroxylysine level,
angiotensin-converting enzyme level, and BAL protein
content unchanged.
1.0 ppm: gradual increase in urinary hydoxylysine
output, becoming significant the week after exposure
ended; BAL hydroxylysine level lower following
exposure and 4 wks postexposure; andiotensin-
converting enzyme level increased.

Concentration dependent increase in urinary
hydroxylysine output and BAL hydroxyxlysine content,
but only significant at >7.5 ppm and 15 ppm,
respectively; angiotensin-converting enzyme levels and
BAL protein increased in highest-exposed groups.	
                                                                                 Sherwin and Carlson
                                                                                 (1973)
                                                                                 Takahashietal. (1986)
Evans etal. (1989)

-------
TABLE AX4.2 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS, PROTEINS,
                               LIPIDS, AND ENZYMES
to
O
O
oo









X
•^
Oi


O
i
H
6
O
0
H
O
O
H
W
O
O
HH
H
W
ppm
1.0
5.0

1.2
1.2
4.0
2.0

0.8
5
10



2.0
4.0
10
3.0



3.6
7.2
10.8
14.4






Exposure
7 h/day,
5 days/wk,
up to 15 wks
7 days


1, 2, or 3 wks

1 or 3 days





14 days
10 days
7 days
7 days



24 h
12 h
8h
6h






Gender Age Species (Strain)
M/F 14-16 wks Rat (Fischer 344)


M 10 wks Rat (Wistar)


M NS Guinea pig

M NS Rat
(Sprague-Dawley)




M 12-24 wks Rats (Wistar)


M/F 8 wks Rat
(Sprague-Dawley)


M 10-12 wks Rat
(Sprague-Dawley)








Effects
Change in BAL and tissue levels of enzymes early in
exposure, resolved by 15 wks.

Decrease in levels of cytochrome P-450 at 1.2 ppm.


Increased lactate dehydrogenase (LDH) content of
the lower lobes of the lung.
BAL protein content significantly increased in a
concentration- and exposure duration-dependent
manner, with the change becoming significant at
5 ppm for 3 days and at 10 ppm for > 1 day of
exposure.

Increase activity of lung glycolytic enzymes.


Various changes in lung homogenate protein and
DNA content and enzyme activities, changes more
severe in vitamin E-deficient rats.

Increased BAL protein >7.2 ppm.









References
Gregory etal. (1983)


Mochitate et al. (1984)


Sherwin and Carlson
(1973)
Muller etal. (1994)





Mochitate et al. (1985)


Elsayed and Mustafa
(1982)


Gelzleichter etal. (1992)










-------
TABLE AX4.2 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS,
                    PROTEINS, LIPIDS, AND ENZYMES
to
O
O
oo




1


DRAFT-DO
^
0
H
O
O
H
W
O
O
HH
H
W
ppm
4.0
10
4.0
10
25

4.5
4.8
4.8
5.0

5.0
5.0
5.0-25.0



Exposure
10 days
7 days
6 h/day
5 days/wk,
7, 14, and
21 days
16hrs
3h
8 h/day,
7 days
14-72 h

2 wks
6 h/day,
6 days
Continuous,
7 days



Gender Age Species (Strain)
M 2 1-24 wks Rat(Wistar)
M NS Rat (Wistar)

M/F NS Guinea pig
(Hartley)
M
M 8 wks Mouse (Swiss
Webster)
F NS Mouse (NS)

M 5 wks Rat
(Fischer 344)
NS NS Mice
M 10- 11 wks Rat(Sprague-
Dawley)



Effects
Initial decrease in lung protein content followed by an
increase; changes on microsomal enzyme activities.
Increased gamma-glutamyl transferase on days 14 and
21; no consistent effect on alkaline phosphatase, LDH,
or total protein.

Increased lung wet weight, alterations in lung
antioxidant levels in Vitamin C- deficient animals.
Increased lung lavage fluid protein content in vitamin C-
deficient animals.
No significant changes in lung homogenate parameters.
Increase in lung protein (14 to 58 h) by radioactive label
incorporation.
Increased amounts of the tryptophan metabolites and
xanthurenic and kynurenic acids excreted in urine during
wk 2 of exposure, but had returned to normal levels by
wk4.
Modest increase in albumin in BAL; no effect on LDH
or lysosomal enzyme peroxidase.
Concentration-related increase in collagen synthesis rate;
125% increase in rats exposed to 5.0 ppm.



References
Mochitate et al. (1984)
Hooftman etal. (1988)

Hatch etal. (1986)

Mustafa etal. (1984)
Csallany (1975)

Suzuki etal. (1988)
Rose etal. (1989)
Last etal. (1983)




-------
TABLE AX4.2 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS,
                    PROTEINS, LIPIDS, AND ENZYMES
to
o
o
oo









X
r
oo




>
H
1
O
o
o
H
O
o
H
W
O
O
HH
H
W
ppm
5.0
20.0
50.0
5.0


8.0

9.5



9.5


10






10

10
20
30
40






Exposure
3h


Continuous,
1, 3, or 7 days

Continuous,
14 days
7 h/day,
5 days/wk,
6 mos

7 h/day, 5
days/wk,
24 mos
24 h or 7 days






Continuous,
14 days
4h









Gender Age Species (Strain)
NS NS Rabbit
(New Zealand)

M NS Rat
(Sprague-
Dawley)
F NS Mouse (NS)

M In utero Rat
and (Fischer 344)
6 mos

M 18 wks Rat
(Fischer 344)

M NS Rat (CD cobs)






M 8 wks Rat (Wistar)

M NS Rat
(Long Evans)








Effects
Benzo [a] pyrene hydroxylase activity of tracheal
mucosa not affected.

Increased BAL protein at 3 days (day 7 not measured);
increased (120% collagen synthesis at 7 days (not
measured other days).
Increase in lung protein.

Increase in BAL alkaline phosphatase, acid
phosphatase, and LDH in older rats only.


Increase in BAL levels of LDH and alkaline
phosphatase activities and in collagenous peptides.

Protein content of BALF increased significantly in rats
after only 24 h. BALF elastase activity was not
affected. Concentration-dependent increase in a-
1 proteinase inhibitor content after 24 h of exposure,
but not with longer exposures.


Changes in several enzymes in whole lung
homogenates.
Increased activities of various enzymes, sialic acid, and
BAL protein; attenuation by high dietary levels of
vitamin E.







References
Palmer etal. (1972)


Last & Warren (1987)


Csallany (1975)

Mauderly etal. (1987)



Mauderly etal. (1990)


Pagani etal. (1994)






Sagai etal. (1982)

Guth and Mavis
(1985, 1986)









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O
O
oo
                            TABLE AX4.2 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS,
                           	PROTEINS, LIPIDS, AND ENZYMES	
ppm
          Exposure
          Duration
 Gender    Age     Species (Strain)
                                                     Effects
                                                                                Reference
            10
       24 h/day,
       0 (control),
       3 days or
       20 days
NS
NS
Rat (Fischer 344)
LPO decreased in type II pneumocytes after 3 days compared
to controls but remained comparable to controls after 20 days.
Authors stated that LPO is a very early reaction during
oxidative stress and that the decrease after 3-day exposure
suggests an adaptation mechanism.

Exposure duration-dependent, statistically significant increase
in GPX and GR enzyme activities after 3 and 20 days over
control values. Changes in mRNA expression of GSH
synthesizing enzymes in type II pneumocytes were also
observed.
Hochscheid et al.
(2005)
to
VO
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
            10    24 h/day, for 0,
                  3,20, or 28 days
                        M        NS      Rat (Sprague-        Uptake of surfactant-like liposomes by type II pneumocytes in
                                           Dawley)            the presence or absence of SP-A was faster and significantly
                                                               higher in cells from all NO2 exposed groups than in control
                                                               cells. No difference in the uptake kinetics between cells from
                                                               exposed groups of different duration.  Increase in liposome
                                                               uptake suggests NO2 exposure likely disrupted cell membranes
                                                               to allow liposomes to enter the cells easily. Lipid uptake
                                                               associated with duration-dependent increase in internalization
                                                               of label found in PC fraction. Suggests increased demand of
                                                               PC in lung injury.
                                                                                                Muller et al. (2003)

-------
O

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O
O
oo
                             TABLE AX4.2 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG AMINO ACIDS,
                            	PROTEINS, LIPIDS, AND ENZYMES	
 ppm
           Exposure
           Duration
Gender     Age
Species
(Strain)
Effects
Reference
            0.8    Presumably       M         NS       Rat           Phospholipid component in BAL increased in a concentration- and
            5.0    continuous,                           (Sprague-     exposure duration-dependent manner, with significance only at
            10    1 day or 3 days                        Dawley)       10 ppm, but not at 5 ppm or below, for > 1 day of exposure. PC
                                                                      content in BAL of exposed animal did not change significantly
                                                                      compared to controls. At 10 ppm, but not at 5 ppm or below,
                                                                      percentage of saturated PC decreased and that of unsaturated PC
                                                                      increased statistically significant, while significant decreases in
                                                                      palmitic acid (16:0) and increases in arachidonic acid (20:4)
                                                                      contained in PC were observed. Sphingomyelin - as a marker for an
                                                                      influx of serum into the alveolar airspace - was also not changed by
                                                                      NO2 exposure.
                                                                                                                            Mulleretal. (1994)
                                                                       Functional studies on surfactant phospholipid extracts indicated
                                                                       increased values for the surface tension at equilibrium, and for the
                                                                       maximal and minimal surface tension of animals exposed to > 5 ppm,
                                                                       but not to 0.8 ppm. Suggests NO2 directly impaired surface tension
                                                                       at > 5 ppm. Structure of the SP-A not altered by NO2 exposure.
                                                                       Authors suggested exposure to NO2 impaired surfactant components
                                                                       may be used as markers of altered surfactant metabolism.
H
6
o

o
H
O
O
H
W
O
O
HH
H
W
  5     24 h or 24 h/day   M
  10    for 7 days
          NS      Rat (CD       Concentration-dependent increase in a-1 PI content. Exposure to 5
                   Cobs)         and 10 ppm NO2 significantly increased
                                  a-1 PI content only after 24 h and returned to control values after 7
                                  days at each exposure concentration. Since blood GSH content was
                                  also increased together with
                                  a-1 PI content at 24 h, authors suggested the increase in these
                                  parameters can be considered a prompt protective response resulting
                                  in no further increase of a-1 PI.
                                                                                                                                      Pagani et al. (1994)
LPO = Lipid peroxidation
PC = Phosphatidylcholine
SP-A = Surfactant protein-AGPx = Glutathione peroxidase
GPX = Glutathione peroxidase
                                               GR = Glutathione reductase
                                               GSH = Glutathione
                                               a-1 PI = a-1 proteinase inhibitor

-------
O

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O
O
oo
                        TABLE AX4.3.  EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                                                               LUNG HOST DEFENSE
   ppm
   Exposure
                               Gender
                                                      Age
             Species (Strain)
                                    Effects
                                                Reference
0.05 base +
 2.0 peaks

   0.6
3 h base + three
15-minpeaks
                                       NS
NS
Human
No effects at 0.05 ppm NO2 with peaks; trend
(p < 0.07) towards AMs losing ability to
inactivate influenza virus at 0.6 ppm.
Framptonetal. (1989)
              0.1
              1.0
              5.0
              20
            Ih
                NS
                                                    NS         Rat
                                                               (Sprague-Dawley)
                                                               (in vitro)
                              At 5.0 ppm: increase in LTB4; concentration-
                              related decrease in SOD production in AMs at
                              > 1.0 ppm; increase in LDH in AMS at 5.0 and
                              20 ppm
                                                              Robinson etal. (1990)
>
              0.2
              0.5
              2.0
                             Gestation   Rat (Brown-        Reactive oxygen species generation from
                             12 wks     Norway)           alveolar macrophages was significantly
                                                           suppressed in NO2 exposed weanling animals;
                                                           no changes in reactive oxygen generating
                                                           capability in the embryonic exposed animals.
                                                                                                                  Kumae and Arakawa
                                                                                                                  (2006)
              0.5
            Continuous,
            24wks
                NS
                                                    NS
           Mouse
                   No effects on AM morphology at 0.5 ppm
                   continuous or 0.1 ppm base + peak.
                                           Aranyietal. (1976)
H
6
O

O
H
O
O
H
W
O

O
HH
H
W
           0.1 base +
           1.0 peak

              2.0
           0.5 base +
           2.0 peak
            Continuous
            base + 3-h peak,
            5 days/wk,
            24wks

            Continuous,
            33wks

            Continuous
            base + 1-hpeak,
            5 days/wk,
            33wks
                                                           After 21 wks of exposure to 2.0 ppm
                                                           continuous or 0.5 ppm base + peak,
                                                           morphological changes were identified, such a
                                                           loss of surface processes, appearance of
                                                           fenestrae, bleb formation, and denuded surface
                                                           areas.

-------
                   TABLE AX4.3 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                                                               LUNG HOST DEFENSE
to
o
o
oo





ppm
0.3
1.0





Exposure
2h/day
2, 6, 13 days





Gender Age Species (Strain)
M NS Rabbit
(New Zealand)





Effects
Decreased phagocytic ability of AMs at
0.3 ppm after 2 days of exposure;
increased at 1.0 ppm after 2 days of
exposure; no effect on cell number or
viability; random mobility reduced at
0.3 ppm only; no effects after 6 days of
exposure.
Reference
Schlesinger (1987)






              0.3
              1.0
         2 h/day up to 14 days   M
             NS
             Rabbit
             (New Zealand)
                 Increase in alveolar clearance.
Schlesinger and
Gearhart (1987)
to
0.3
1.0
3.0
10

1.0
10
                      2h
M
NS
                      2 h/day, 14 days
Rabbit           Concentration-related acceleration in
(New Zealand)    clearance of particles from lung with the
                 greatest increase at two lowest
                 concentrations, effects from repeated
                 exposures similar to those seen after acute
                 exposures to same concentrations.
Vollmuthetal. (1986)
              0.5      0.5, 1, 5 and 10 days
                      exposure
                              NS
             NS
             Rat (NS)         Superoxide production in alveolar
                             macrophages from B ALF, stimulated by
                             phorbol myrisate acetate (PMA), was
                                                       Robinson etal. (1993)
H
6
o
0
— ]
o

o
H
W
O
o
HH
H
W


0.5 base +
1.5 peak
2.0 base
+6.0 peak








Base 22 h/day, M
7 days/wk + two 1-h
peaks, 5 days/wk,
6 wks






continued to be depressed after 1,5, and
10 days.
1 day and Rat (Fischer Trend towards increase in number of Crapo et al. (1984)
6 wks 344) AMs and cell volume in younger animals; Chang etal. (1986)
increase in number of AMs and cell
volume in older rats.







-------
TABLE AX4.3 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                                  LUNG HOST DEFENSE
to
O
O
oo



i

ppm
0.5
1.3
2.7
1.0
2.0
4.0
1.0
5.0
15
1.0
2.0
4.0
1.0 +
0.9 ppm No
Exposure Gender Age
Continuous, 28 days M 6 wks

24 h/day, 12 wks
6 h/day, 2 days NS 4-6 wks
24 h/day, 12 wks
7 h/day, 5 days/wks NS NS
for 1 1 or 22 exposures
Species (Strain)
Rat (Wistar)

Guinea pig (NS)
Rat (NS)
Mouse (CD1)
Guinea pig (NS)
Rat (NS)
Rat (Long Evans)
Effects
Increase in AMs in highest exposed group; no
effects noted in 2 lowest exposure groups.

IgE-mediated histamine release from lung
mast cells was enhanced in guinea pigs, but
not rats exposed to 4.0 ppm. No effect
observed at lower concentrations.
Exposure-related decrease in AM
phagocytosis from 1.0-5.0 ppm, decrease was
not further affected by 15 ppm.
IgE-mediated histamine release from lung
mast cells was enhanced in guinea pigs, but
not rats exposed to 4.0 ppm. No effect
observed at lower concentrations.
Stimulated clearance of particles from lung at
lowest concentration, but decreased clearance
Reference
Rombout etal. (1986)

Fujimaki and Nohara
(1994)
Rose etal. (1989)
Fujimaki and Nohara,
(1994)
Ferin and Leach
(1977)
15
24
                                                   rate at two highest concentrations.
H
6
o
o
^^
H
O
O
H
W
o

O
HH
H
W

1.0
5.0

base +
5.0 peaks


1.3-17





7 h/day, 5 days/wks M/F

Base 7 h/day,
5 days/wks;
two 1.5-h peaks/day;
15 wks

NS ("acute") F





14-16 wks Rat (Fischer 344) Accumulation of AMs. Superimposed peak
exposures produced changes that may persist
with continued exposures.




NS Rat (Sprague-Dawley) Decreased production of superoxide anion
radical.




Gregory etal. (1983)






Amorusoetal. (1981)





-------
TABLE AX4.3 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                              LUNG HOST DEFENSE
to
O
O
oo








X

£

M
%•/
>
H
1
O
O
n
\~s
H
O
O
H
W
O
O
HH
H
W
ppm
2.0
10


2.0

2.0

2.7
3-6

3.6
12.1

4
10
25



4.0










Exposure Gender Age Species (Strain)
3 days M/F 5,10,21, Guinea pig (Dunkin
45, 55, 60, Hartley)
and Rat (Wistar)
>60 days
8 h/day, 5 days/wk, M/F 3-4 yrs Baboon
6 mo
4h NS NS Human

24 h M 6wks Rat (Wistar)
3 h NS NS Dog (Beagle)

Ih F NS Rat (Sprague-Dawley)
2h (in vitro)

6 h/day, 7, 14, or M NS Rat (Wistar)
21 days




10 days 19-23 wks










Effects
Newborns were less affected than adults
when AMs were tested for SOD levels.


Impaired AM responsiveness to migration
inhibitory factor.
Decreased phagocytosis and superoxide
anion release.
Increase in number of AMs.
Enhanced swelling of AMs.

Enhanced macrophage agglutination with
concanavalin A at both concentrations
tested.
Changes in morphology at all
concentrations; increase in number of AMs
at > 10 ppm; phagocytic capacity reduced
after 14 and 21 days of exposure to 25 ppm.


Increase in number of AMs; no increase in
PMNs; increased metabolic activity, protein,
and DNA synthesis; all responses peaked on
day 4 and returned to normal on day 10.







Reference
Azoulay-Dupuis et al.
(1983)


Green and Schneider
(1978)
Devlin etal. (1992)

Romboutetal. (1986)
Dowell etal. (1971)

Goldstein etal. (1977)


Hooftman etal. (1988)





Mochitate et al. (1986)











-------
O

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O
O
oo
ppm
                    TABLE AX4.3 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                                                               LUNG HOST DEFENSE
    Exposure
                              Gender
              Age     Species (Strain)
                                             Effects
                                                                Reference
 4.0
 8.0
Up to 10 days
NS
NS
Rat (Fischer 344)
Increase in number of AMs at both
concentrations, reaching a peak on day 3 and
5; no increase in number of PMNs; decrease
in AM viability throughout exposure period.
Suppression of phagocytic activity after 7
days of exposure to 4 ppm and after 5 days
of exposure to 8 ppm; returned to normal
value at 10 days. Decrease in superoxide
radical production, but at 4 ppm, the effect
became significant on days  3,5, and  10; at 8
ppm, the effect was significant at all time
periods tested.
Suzuki etal. (1986)
              5.0
         7 days
                                                           No effect on phagocytic activity.
                                                                                 Lefkowitzetal. (1986)
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
5
15
5
10
15
5-60
7.0
9.5
3 h after infection
with parainfluenza
3 virus
3h
3h
24 h
7 h/day; 5 days/wk;
18-22 mo
NS
M
Fb
NS
NS
M
NS
NS
NS
NS
18wks
Rabbit (New
Zealand)
Humans (in vitro
exposure)
Rabbit (New
Zealand)
Rabbit
Rat (Fischer 344)
AMs lost resistance to challenge with rabbit
pox virus after exposure to 15 ppm.
No change in cell viability, release of
neutrophil chemotactic factor, or
interleukin-1.
Inhibition of phagocytic activity.
Increased rosette formation in AMs treated
with lipase.
No effect on long-term clearance of
radiolabeled tracer particles.
Acton and Myrvik (1972)
Pinkston et al. (1988)
Gardner etal. (1969)
Acton and Myrvik (1972)
Hadley etal. (1977)
Mauderly etal. (1990)

-------
TABLE AX4.3 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                              LUNG HOST DEFENSE
to
o
o
oo









X
£
ON


O
§
H
6
o
0
H
O
O
H
W
O
O
HH
H
W
ppm Exposure Gender Age Species (Strain) Effects
10 Continuous 7 days NS NS Rat(NS) High influx of PMNsinthe lung(BALF)
after 24 h of exposure, reversed for
macrophages; no change in the lymphocyte
population.
10 35 days NS NS Guinea pig 63% increase in epithelial cells positive for
macrophage congregation.
10 4 h F NS Mouse (Swiss) Increase in total pulmonary cells in animals
infected with some species of bacteria.
10 24 h M 12-13 Rat(Sprague- Decreased phagocytosis at 25 ppm only.
25 wks Dawley)
ppm Exposure Gender Age Species (Strain) Effects
Clearance
3 6 h/day, 6 days/wk, F NS Guinea Pig Significant, dose -dependent decrease in
9 for 2 wks ciliary activity, significant at 3 ppm (12%)
and 9 ppm (30%), and increase in
eosinophil accumulation on epithelium and
submucosal layer.
10 14 h/day, for 15 M NS Mouse (C57BL/5) 20 ppm NO2 induced an increased mucus
20 days, 20 or 25 days production due to goblet cell hyperplasia in
the central airways.










Reference
Paganietal. (1994)



Sherwinetal. (1968)

Jakab (1988)

Katz and Laskin( 1976)

Reference

Ohashietal. (1994)




Wegman and Herz (2002)













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O

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O
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                    TABLE AX4.3 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON ALVEOLAR MACROPHAGES AND
                                                                LUNG HOST DEFENSE
ppm     Exposure
  Gender
    Age
   Species
   (Strain)
Effects
Reference
          Alveolar Macrophage Endpoints
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
            0.5
        8 h/day,
        5 days/wk,
        for 0.5, 1,5,
        or 10 days
M
NS
            0.2
            0.5
            2.0
        Continuous,
        presumably
        7 days/wk, up
        to 12 wks
             Neonates or
             5 wks old
Rat (Sprague-  Acute depression of pulmonary arachidonate metabolism observed.  Robinson et al.
Dawley)       Unstimulated AM synthesis of LTB4 depressed within 1 day and    (1993)
              also on day 5 of exposure. Acute depression of AM synthesis of
              TxB2, LBT4, and 5-HETE on stimulation by the calcium
              ionophore, A23187, within 1 day of exposure but not with longer
              exposure, while 5-HETE increased significantly at 10 days of
              exposure only.  Suggests rapid depression of cyclooxygenase and
              5-lipoxygenase activities. ZAS-stimulated LTB4 production
              delayed until 5 days and remained lower at 10 days.  AM
              superoxide production stimulated by PMA was rapidly and
              continuously depressed throughout the study. BAL fluid levels of
              LTB4 and TxB2 paralleled ex vivo depression of AM production.
Rat (Brown-   Animals were exposed during embryonic or weanling (5-wks old)    Kumae and
Norway)       period. ROS generation was significantly suppressed at 0.5 and     Arakawa
              2.0 ppm NO2 in animals exposed during the weanling period.        (2006)
              Cytokine level measurement in AM culture mediums indicated that
              inflammatory reactions (significant increases in TFNa and IFNy)
              were initiated at 8 wks and terminated at 12 wks in animals
              exposed during the  embryonic period while inflammatory reactions
              (significantly increased TFNa level) were not initiated at 8 wks but
              take place at 12 wks in animals exposed as weanlings.  Results
              suggest that NO2 exposure from the weanling period has stronger
              effects on AM  activity.

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O
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                  TABLE AX4.4.  EFFECTS OF NITROGEN DIOXIDE ON LUNG PERMEABILITY AND INFLAMMATION
ppm
0.8
5
10
Exposure
Presumably
continuous,
1 day or 3 days
Gender
M
Age
NS
Species
(Strain)
Rat
(Sprague-
Dawley)
Effects
BAL protein content significantly increased in a concentration- and
exposure duration-dependent manner, with the change becoming significant
at 5 ppm for 3 days and 10 ppm for > 1 day of exposure.
Reference
Muller et al.
(1994)
oo
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
 5      24hor          M        NS     Rat (CD       Exposure induced inflammatory response in the lungs. At 10 ppm, influx    Paganietal.
10     24 h/day for                        Cobs)         of PMN, maximal at 24 h, but no influx observed after 7 days of exposure,    (1994)
       7 days                                           a trend that was also observed with protein content in BAL fluid. In
                                                        contrast, no influx of macrophages was observed, but the influx was
                                                        maximal after 7 days of exposure. No significant changes in lymphocyte
                                                        counts at any exposure concentration and protein content in BAL fluid not
                                                        significantly affected at 5 ppm.
                                                        Protein content of BAL fluid increased significantly only after 24 h of
                                                        exposure to 10 ppm NO2.

 5      6 h/day for 1, 3,   NS        NS     Mouse        Exposure to 5 ppm NO2 did not cause any lung inflammation or injury.       Poynteretal.
25     or 5 days                          (C57BL/6)    Exposure to 25 ppm NO2 induced acute lung injury (characterized by        (2006)
                                                        increases in protein, LDH, macrophages, and neutrophils recovered by
                                                        BAL) that peaked after 3 days, lesions within terminal bronchioles, and
                                                        AHR.  OVA-sensitized animals exposed to 25 ppm, but not 5 ppm, NO2
                                                        showed augmentation of eosinophilic inflammation and terminal
                                                        bronchiolar lesions, which extended significantly into the alveoli.  No
                                                        increased expression of mucus cell-associated gene products in non-
                                                        sensitized or OVA-sensitized animals exposed at any concentration.

 5      3 h              M        NS     Mouse        Exposure of OVA-challenged animals to 20 ppm produced BHR and        Proust et al.
20                                        (BALB/c)     caused significant increase in neutrophils and fibronectin concentration,      (2002)
                                                        significant reduction in eosinophil count, and exudation and release of IL-5
                                                        in BAL fluid  24 h and/or 72 h after exposure. Exposure to 5 ppm did not
                                                        modify BHR, but significantly reduced pulmonary eosiniphilic
                                                        inflammation (reduced esinophilic count and eosinophil peroxidase
                                                        activity) and the production of IL-5 in the BAL fluid.  Exposure to NO2 did
                                                        not cause any significant changes in IgE anti-OVA antibody in exposed
                                                        animals, while IgGl liters were significantly increased in animals exposed
                                                        only lo 5 ppm NO2, compared lo controls. There was no development of
                                                        mucosal melaplasia in any NO2 exposed group compared lo controls.

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  TABLE AX4.4 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG PERMEABILITY AND INFLAMMATION
                                               Species
ppm      Exposure     Gender    Age       (Strain)
Effects
Reference
             5      24 h/day, for     M        NS      Rat (Sprague-   Exposure to NO2 exhibited concentration- and exposure duration-
             10     3 or 25 days                         Dawley)       dependent, and tissue localization-specific differences in Clara cell
             20                                                       proliferation. Increased proliferation (measured as BrdU-LI) in both
                                                                      bronchial and bronchiolar epithelium of all exposed groups, with
                                                                      significance starting at exposure to 5 ppm for 3 or 25 days. Exposure to 5
                                                                      and 10 ppm NO2 for 3 days showed significantly higher proliferative
                                                                      activity in bronchiolar epithelium than in the bronchial epithelium for
                                                                      corresponding exposure groups, while the difference in proliferation
                                                                      between proximal and distal airways diminished after 25 days of exposure.
                                                                      Clara cell proliferation was not accompanied by a change in Clara cell
                                                                      numbers in any of exposure groups, a finding the authors explained by the
                                                                      assumption that the process of proliferation takes place at the same rate as
                                                                      Clara cell differentiates into other cells, a transition that leads to the loss of
                                                                      phenotypic Clara properties in differentiating cells.
                                                                                                                               Earth and
                                                                                                                               Muller (1999)
VO
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
1.2

10
20




3.6
7.2
10.8
14.4


24 h/day, for M
3 days
14 h/day, for M
15 days, 20 or
25 days



24 h, 12h, 8h, M
and 6 h,
respectively,
for 3 days,
giving a C x T
of 86.4ppm-h
NS Rat (Sprague-
Dawley)
NS Mouse
(C57BL/5)




NS Rat (Sprague-
Dawley)




No significant differences in cell viability and percentages of pulmonary
AMs or PMNs between animals exposed to 1.2 ppm NO2 and controls.
Exposure to 10 ppm for 15 days - the only exposure duration used for this
concentration - did not significantly affect influx of inflammatory cells
(leukocyte subpopulations and macrophages). 20 ppm NO2 induced
airway and parenchymal inflammation - dominated by a significant influx
of macrophages and neutrophils -, peaking at 15 days of exposure and
declining at day 25.
Significant cell proliferation (increased labeling index) in peripheral
airways compared to controls, regardless of concentration or exposure
duration. Suggests Haber's law (c x t = k) was not followed over the
concentration ranges studied. No proliferative response was observed in
alveolar epithelium.

Bermudez
(2001)
Wegman and
Herz (2002)




Rajini et al.
(1993)





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              TABLE AX4.4 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG PERMEABILITY AND INFLAMMATION
                                                        Species
             ppm      Exposure    Gender   Age      (Strain)
O

to
O
O
oo
Effects
Reference
              0.5      8 h/day,        M       NS    Rat(Sprague-    No effect on weight gain. No effects on neutrophil, lymphocyte
                      5 days/wk, for                   Dawley)        macrophage/monocyte levels or cell population percentages in BAL.
                      0.5, 1, 5, or                                     Suggests no significant influx of inflammatory cells into lung airways and
                      10 days                                        alveolar spaces.
                                       Robinson et al.
                                       (1993)
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
              5      24 h/day, for   M        NS    Rat (Sprague-   Compared to controls, proliferative activity significantly increased, but
              10      3 or 25 days                     Dawley)        with no concentration-dependence in respiratory bronchiolar epithelium at
              20                                                     5 ppm and above after 3-day exposure, but increase was concentration-
                                                                    dependent, with significance at > 10 ppm following 25-day exposure.
                                                                    Proliferative activity increased in a concentration-dependent manner in
                                                                    bronchial epithelium, with significance only at 20 ppm after 3 days of
                                                                    exposure and at > 10 ppm following 25 days of exposure.
                                                                    Concentration-dependent thickening of alveolar septa and bronchiolar
                                                                    walls, significant only at > 10 ppm after 3- and 25-day exposure, but 5 ppm
                                                                    caused significant thickening only in bronchiolar walls after 25 days, but
                                                                    not after 3 days, of exposure compared to controls.
                                                                    Statistically significant reduction in alveoli surface density at > 10 ppm
                                                                    after 25 days of exposure and at 20 ppm only after 3 days of exposure,
                                                                    while alveolar circumference increased statistically significantly at
                                                                    > 10 ppm after 25 days of exposure and at 20 ppm following 3 days of
                                                                    exposure. 5 ppm did not significantly affect these endpoints after 3 or 25
                                                                    days of exposure compared to controls. Data suggest concentration- and
                                                                    exposure duration-dependent development of emphysema, significant only
                                                                    at > 10 ppm, but not at 5 ppm, after 3  or 25 days of exposure. Alveolar
                                                                    duct length increased significantly at > 10 ppm after 25 days and at 20 ppm
                                                                    after 3 days of exposure; no effect at 5 ppm.

                                                                    Radial alveolar count values decreased significantly at 20 ppm after 3 and
                                                                    25 days and at 10 ppm after 25 days exposure; no effect at 5 ppm.
                                                                    Increase in avg medial thickness at 10 ppm with significance only after 25
                                                                    days of exposure and at 20 ppm with significance after 3 and 25 days of
                                                                    exposure. In contrast, 5 ppm caused significant increase at both 3 and 25
                                                                    days of exposure. Authors suggested effect at 5 ppm was due a reduction
                                                                    of pulmonary arterial mass and not as a result of vasodilation induced by
                                                                    nitrogen oxide.
                                                                                                                                          Earth et al.
                                                                                                                                          (1994b)

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O
O
oo
             TABLE AX4.4 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON LUNG PERMEABILITY AND INFLAMMATION
            ppm
Exposure    Gender    Age
            Species
            (Strain)
                                                                                                 Effects
                                                                  Reference
>

-k
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
            0, 1.0,
           2.0, 4.0
                     24 h/day,
                     for 12 wks
            M
10 wks   Rat (Wistar)
No change in body weight or absolute lung weight in any exposed
group compared to controls, but relative lung weight was significantly
increased in animals exposed to 4.0 ppm NO2. Number of lung cells
from animals exposed to >2.0 ppm significantly reduced (but extent of
reduction at 4.0 ppm < 2.0 ppm), whereas number of mast cells not
significantly different in exposed animals  compared to controls. IgE-
mediated histamine release from lung mast cells significantly reduced
at 2.0 ppm NO2 but not at 4.0 ppm or 1.0 ppm, but no difference
observed in A23187-stimulated histamine release in lung mast cells in
any exposed group compared to controls.  Results from histamine
release suggest that NO2 exposure to rat lung mast cells did not induce
histamine-releasing activity.
                                                      Guinea Pig      NO change in body weight or absolute or relative lung weight in any
                                                      (Hartley)        exposed group compared to controls. Number of lung cells or mast
                                                                      cells was not significantly different in exposed animals compared to
                                                                      controls. Increasing trend observed in IgE-mediated histamine release
                                                                      from lung mast cells, the change becoming significant only at 4.0
                                                                      ppm. No significant change in ionophore A2318-stimulated histamine
                                                                      release in exposed groups compared to controls.  Data suggest NO2
                                                                      exposure in guinea pigs enhanced histamine-releasing activity in lung
                                                                      mast cells.
Fujimaki and
Nohara (1994)

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 TABLE AX4.4 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG PERMEABILITY AND INFLAMMATION
                                                   Species
ppm        Exposure      Gender      Age         (Strain)
O

to
O
O
oo
                                                                                Effects
                                                                                            Reference
to
 0.2
 0.5
  2
Continuous,
presumably
7 days/wk, up
to 12 wks
Neonates    Rat (Brown-    Rats were exposed from embryonic or weanlings (5-wks old)
or 5 wks    Norway)        period up to 12 wks of age.  Significantly decreased levels of AM +
old                        Mo in weanling animals exposed to 0.5 and 2.0 ppm, and
                           significantly increased levels of neutrophils in animals exposed to
                           2.0 ppm at 12 wks.  Levels of AM + Mo significantly increased in
                           animals exposed to 0.5 ppm during embryonic period while levels
                           of neutrophil population significantly decreased, compared to
                           controls, at 12 wks. [Changes in cell populations in BAL fluid not
                           investigated in animals exposed to 2.0 ppm during the embryonic
                           period due to loss of sample.] Mean level of lymphocytes
                           significantly increased in the embryonic group exposed to 0.2 ppm
                           and in the weanling group exposed to 0.5 and 2.0 ppm, but increase
                           not concentration-dependent in the weanling group. Except for
                           exposure to 0.2 ppm, NO2 exposure appeared to improve allergic
                           conditions in the BAL fluid of the embryonic group, but caused
                           inflammatory changes in the BAL fluid of the weanling group.
                           Data suggest NO2 exposure from the weanling period has stronger
                           effects on AM activity.
Kumae and
Arakawa (2006)
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
           AHR = Airway hyperresponsiveness
           AM = Alveolar macrophage
           BAL = Bronchoalveolar lavage
           BHR = Bronchopulmonary hyperreactivity
           BrdU-LI = Bromodeoxyuridine-laebling index
           IgE = Immunoglobulin E
                                                                      IgG = Immunoglobulin G
                                                                      IL-5 = Interleukin-5
                                                                      LDH = Lactate dehydrogenase
                                                                      Mo =  Monocytes
                                                                      OVA  = Ovalbumin
                                                                      PMN  = Polynorphonuclear neutrophil

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O

to
O
O
oo

ppm
0.5

0.1 base +
0.25,0.5,
or 1.0
peak
0.25

TABLE
Exposure
Continuous

Continuous base +
3 h/day, 5 days/wk
peak for 1, 3, 6, 9,
12 mos
7 h/day,
5 days/wk, 7wks
AX4.5.
Gender
NS





F

EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
Age
NS





6 wks

Species
(Strain)
Mouse





Mouse
(AKR/cum)
Effects
Suppression of splenic T and B cell responsiveness to
mitogens variable and not related to concentration or
duration, except for the 940 ug/m3 continuous group, which
had a linear decrease in PHA-induced mitogenesis with
NO2 duration.

Reduced percentage of total T-cell population and trend
towards reduced percentage of certain T-cell
References
Maigetter et al. (1978)





Richters and Damji
(1988)
                                                                            subpopulations; no reduction of mature T cells or natural
                                                                            killer cells.
H
6
o

o
H
O
O
H
W
O
O
HH
H
W
             0.25     7 h/day,              F          5 wks
                      5 days/ wk, 36 wks

             0.35     7 h/day,              M         6 wks
                      5 days/ wk, 12 wks

              0.4      24 h/day             M         7 wks
              1.6      4 wks

          0.5 base +   22 h/day, 7 days/wk   M
           1.5 peak    base+ 6 h/day,
                      5 days/wk peak for
                      1,3, 13, 52, 78 wks

          0.5 base +   24 h/day, 5 days/wk   M         6 wks
           2.0 peak    base + 1 h/day,
                      5 days/wk peak for
                      3 mos
         Mouse       Reduced percentage of total T-cell population and
         (AKR/cum)   percentages of T helper/inducer cells on days 3 7 and 181.
         Mouse
         (C57BL/6J)

         Mouse
         (BALB/c)
10 wks   Rat
         (Fischer
         344)
         Mouse
         (CD-I)
                                                        Richters and Damji
                                                        (1990)

                                                        Richters and Damji
                                                        (1988)
Trend towards suppression in total percentage of T-cells.
No effects on percentages of other T-cell subpopulations.

Decrease in primary PFC response at >752 ug/m3.  Increase   Fujimaki et al. (1982)
in secondary PFC response at 3010 ug/m3.
No effect on splenic or circulatory B or T cell response to
mitogens. After 3 weeks of exposure only, decrease in
splenic natural killer cell activity. No histological changes
in lymphoid tissues.

Vaccination with influenza A2/Taiwan virus after exposure.
Decrease in serum neutralizing antibody; hemagglutination
inhibition antibody liters unchanged. Before virus
challenge, NO2 exposure decreased serum IgA and
increased IgGl, IgM, and IgG2; after virus, serum IgA
unchanged and IgM increased.
                                                        Selgrade et al. (1991)
                                                        Ehrlichetal. (1975)

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                             TABLE AX4.5 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
O

to
O
O
oo
ppm
Exposure
                           Gender
            Age
Species
(Strain)
Effects
Reference
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
 0.5    8 h/day, 5 days/wk,
       for 0.5, 1,5, or
       10 days
            5    3h
M         NS       Rat(Sprague-     Levels of TxB2, LTB4, and PGE2 in BAL fluid were depressed
                    Dawley)          within 4 h of exposure. Suggests acute depression of pulmonary
                                     arachidonate metabolism observed in BAL fluid.  Unstimulated AM
                                     synthesis of LTB4 was depressed within 1 day and also on day 5 of
                                     exposure. The AM synthesis of TxB2, LTB4, and 5-HETE on
                                     stimulation by the calcium ionophore, A23187, was acutely depressed
                                     within 1 day of exposure but not with longer exposure, while 5-HETE
                                     was significantly increased at 10 days.  Suggests rapid depression of
                                     cyclooxygenase and 5-lipoxygenase activities. Z AS-stimulated LTB4
                                     production was delayed until 5 days and remained lower at 10 days.
                                     BAL fluid levels of LTB4 and TxB2 paralleled ex vivo depression of
                                     AM production. AM superoxide production stimulated by PMA was
                                     rapidly and continuously depressed throughout the study.

F          7 wks    Rat (Brown-      Rats were immunized intraperitoneally and challenged intratracheally
                    Norway)          with house mite dust. Animals were exposed to NO2 after
                                     sensitization or challenge or after sensitization and challenge (double
                                     exposure). A single exposure after sensitization or challenge caused a
                                     significant decrease in antigen-specific IgG in BAL fluid, single
                                     exposure after sensitization caused significant increase in serum IgE,
                                     while exposure only after challenge caused significant decrease in
                                     antigen-specific IgA levels in BAL fluid. Double NO2 exposure
                                     caused significantly higher levels of antigen-specific serum IgE and
                                     local IgA, IgG, and IgE antibody, and significant increase in
                                     lymphocyte responsiveness to antigen in the spleen and mediastinal
                                     lymph nodes.  Double exposure also significantly increased the ratio
                                     of inflammatory cells to alveolar macrophages without affecting the
                                     total number of lavageable cells.
                                     Data suggest a 3-h exposure to 5 ppm NO2 after intraperitoneal
                                     sensitization and pulmonary challenge with house dust mite allergen
                                     was necessary to enhance specific immune responses to the allergen
                                     and increased the number of inflammatory cells in the lungs.
                                     Additionally, data suggest an upregulation of specific immune
                                     responses and subsequent immune-mediated pulmonary inflammation.
                                                                                                                     Robinson et al.
                                                                                                                     (1993)
                                                                                                                               Gilmour et al.
                                                                                                                               (1996)

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                            TABLE AX4.5 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
O

to
O
O
oo
ppm    Exposure     Gender
                                    Age
Species
(Strain)
Effects
Reference
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
 5     3 h          M           NS          Mouse          Animals were sensitized and challenged with the antigen OVA
 20                                          (BALB/c)       to generate airway inflammation before being exposed to NO2.
                                                             Exposure of OVA-challenged animals to 20 ppm produced
                                                             BHR and caused significant increase in neutrophils and
                                                             fibronectin concentration, significant reduction in eosinophil
                                                             count, and exudation and release of IL-5 in broncholaveolar
                                                             fluid 24 h and/or 72 h after exposure. Exposure to 5 ppm did
                                                             not modify BHR, but significantly reduced pulmonary
                                                             eosiniphilic inflammation (reduced esinophilic count and
                                                             eosinophil peroxidase activity) and the production of IL-5 in the
                                                             B AL fluid. Authors suggested that potentiation of BHR by 20
                                                             ppm NO2 in allergic mice may be accounted for by an increased
                                                             vascular/epithelial permeability, facilitating the allergen
                                                             availability and accelerating the inflammatory process.
                                                             Exposure to NO2 did not cause any significant changes in IgE
                                                             anti-OVA antibody in exposed animals, while IgGl liters were
                                                             significantly increased in animals exposed only lo 5 ppm NO2,
                                                             compared lo controls.  There was no developmenl of mucosal
                                                             melaplasia in any NO2 exposed group compared lo controls.

       2 h/day       M and F      From birth   Rabbil (NZW)   No effecl on mortality, heallh, behavior, body weighl, or basal
                                 until 3 mos                   pulmonary function (lung resistance, dynamic compliance,
                                 of age                       respiration rales, tidal volume,  and minule volumes) in animals
                                                             immunized againsl house mile  dusl compared lo lillermales
	exposed lo air. Immune parameters were nol evaluated.	
                                                                                                                        Proust et al. (2002)
                                                                                                                                   Douglas et al.
                                                                                                                                   (1994)

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O
O
oo
                             TABLE AX4.5 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
ppm
Exposure
                             Gender
  Age
Species
(Strain)
Effects
Reference
4.76   4 h/day, 5 days/wk,
       for 6 wks
       (30 exposures, total)
                M
NS      Guinea Pig         Animals were intraperitoneally sensitized twice and then
         (Hartley)           challenged pulmonarily with C. albicans. Animals were
                            exposed, from the first day of sensitization, and
                            throughout the study period.  Exposure to NO2 resulted in
                            significantly increased respiratory rate (tachypnea)
                            (2.3-2.7 times/s) 15 h after antigen challenge compared to
                            controls, but did not significantly affect the
                            expiration/inspiration ratio. Authors indicated that
                            delayed-type dyspneic  symptoms in this study were
                            increased by exposure to NO2.
                                                                   Kitabatakeetal. (1995)
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
           0.06
           0.5
            1
            2
            4
       24 h/day, for 6 or
       12 wks
                M
NS      Guinea Pig         Concentration- and exposure duration-dependent
         (Hartley)           increases in airway responsiveness to inhaled histamine
                            aerosol, significant at 1.0 ppm and above in animals
                            exposed for 12 wks and at 2 ppm and above in those
                            exposed for 6 wks. No significant increase in specific
                            airway resistance (SRawo) values at any NO2
                            concentration at 6 wks of exposure, but there was a
                            concentration-dependent increase in this parameter at
                            12 wks of exposure, with significance at 2.0 ppm and
                            above. Authors concluded NO2 could be a potent risk
                            factor for alteration of pulmonary function and airway
                            responsiveness.
                                                                   Kobayashi and Miura
                                                                   (1995)

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O
O
oo
                            TABLE AX4.5 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
ppm     Exposure
  Gender
   Age
Species
(Strain)
Effects
Reference
       24 h/day, for 12
       wks
M
10 wks       Rat (Wistar)       No change in body weight or absolute lung weight in any
                              exposed group compared to controls, but relative lung
                              weight significantly increased in animals exposed to 4.0
                              ppm NO2.  Number of lung cells from animals exposed to
                              >2.0 ppm significantly reduced (but extent of reduction at
                              4.0 ppm < 2.0 ppm), but number of mast cells not
                              significantly different in exposed animals compared to
                              controls. IgE-mediated histamine release from lung mast
                              cells significantly reduced at 2.0 ppm NO2 but not at 4.0
                              ppm or 1.0 ppm, but no difference observed in A23 187-
                              stimulated histamine release in lung mast cells in any
                              exposed group compared to controls. Results from
                              histamine release suggest that NO2 exposure to rat lung
                              mast cells did not induce histamine-releasing activity in
                              rats.
                                                                   Fujimaki and Nohara
                                                                   (1994)
                                  M
H
6
o

o
H
O
O
H
W
O

O
HH
H
W
                                     10 wks       Guinea Pig       No change in body weight or absolute or relative lung
                                                 (Hartley)         weight in any exposed group compared to controls.
                                                                  Number of lung cells or mast cells not significantly
                                                                  different in exposed animals compared to controls.
                                                                  Increasing trend observed in IgE-mediated histamine
                                                                  release from lung mast cells, the change becoming
                                                                  significant only at 4.0 ppm.  No significant change in
                                                                  ionophore A2318-stimulated histamine release in exposed
                                                                  groups compared to controls. Data suggest NO2 exposure
                                                                  in guinea pigs enhanced histamine-releasing activity in
                                                                  lung mast cells. Thus, species differences exist between
                                                                  the rat and guinea pig in response to induction of
                                    _ histamine-releasing activity following NO2 exposure.

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O
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O
O
oo
                             TABLE AX4.5 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON IMMUNE RESPONSES
ppm      Exposure
  Gender
  Age
Species
(Strain)
Effects
Reference
  5    6 h/day for 1, 3,
 25    or 5 days
NS
NS        Mouse         Exposure to 25 ppm, but not 5 ppm, NO2 induced acute lung
           (C57BL/6)     injury (characterized by increases in protein, LDH,
                          macrophages, and neutrophils recovered by bronchoalveolar
                          lavage) that peaked after 3 days, lesions within terminal
                          bronchioles, and AHR.  OVA-sensitized animals exposed to
                          25 ppm, but not 5 ppm, NO2 showed augmentation of
                          eosinophilic inflammation and terminal bronchiolar lesions,
                          which extended significantly into the alveoli. There was no
                          increased expression of mucus cell-associated gene products
                          in non-sensitized or OVA-sensitized animals exposed at any
                          concentration.
                                                                       Poynter et al. (2006)
oo
5-HETE = 5-Hydroxyeicosatrtraenoate
AM = Alveolar macrophage
AHR = AHR = Airway hyperresponsiveness
BAL = Bronchoalveolar lavage
BHR = Bronchopulmonary hyperreactivity
IFNy = Interferon y
IgA = Immunoglobulin A
IgE = Immunoglobulin E
IgG = Immunoglobulin G
IL-5 = Interleukin-5
                   LDH = Lactate dehydrogenase
                   LTB4 = Leukotriene B4
                   OVA = Ovalbumin
                   PGE2 = Prostaglandin E2
                   PMA = Phorbol myristate acetate
                   ROS = Reactive oxygen species
                   SRawo = Specific airway resistance
                   TNFa = Tumor necrosis factor a
                   TxB2 = Thromboxane B2
                   ZAS = Zymosan-activated rat serum
H
6
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o
H
O
O
H
W
O
O
HH
H
W

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                         TABLE AX4.6. EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO

                                                INFECTIOUS AGENTS
to
O
O
oo
ppm
0.05 base +
0.1 peak
Exposure
Continuous, base +
twice/day 1 h peaks,
5 days/wk for 15 days
Gender
F
Age
NS
Species
(Strain)
Mouse
(CD-I)
Infective Agent Effects
Streptococcus sp. No effect.
References
Gardner (1980, 1982)
Graham etal. (1987)
           0.5

           +

          peak
Increased mortality.
H

6
o


o
H

O


O
H
W

O


O
HH
H
W
1.2 base +
2.5 peak
0.2 base + 23 h/day, 7 days/wk F
0.8 peak base+ twice daily 1 h
peaks, 5 days/wk for
lyr
0.3-0.5 Continuous, 3 mos F





Continuous, 6 mos


Increased mortality.
6-8 Mouse Streptococcus sp. Peak plus baseline caused
wks (CD-I) significantly greater mortality
than baseline.

4 wks Mouse A/PR/8 virus High incidence of
(ICR:JCL) adenomatous proliferation
peripheral and bronchial
epithelial cells; NO2 alone
and virus alone caused less
severe alterations.
No enhancement of effect of
NO2 and virus.


Miller etal. (1987)



Motomiya et al. (1973)








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                    TABLE AX4.6 (cont'd). EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO

                                            INFECTIOUS AGENTS
H

6
O


O
H

O


O
H
W

O


O
HH
H
W
ppm
0.5

0.5-1.0
10

0.5-28

0.5
0.5
1.0
1.5
5.0
Exposure
Intermittent, 6 or
18 h/day, up to
12 mos
Continuous,
90 days
Continuous,
39 days
2 h/day, 1, 3, and
5 days
Varied

3 h/day, 3 mos
24 h/day,
7 days/wk,
3 mos
3 days
Species
Gender Age (Strain) Infective Agent Effects
F NS Mouse (Swiss) K. pneumoniae Increased mortality after 6 mos
intermittent exposure or after 3, 6,
9, or 12 mos continuous exposure,
increased mortality was
significant only in continuously
exposed mice.
F NS Mouse (ICR, A/PR/8 Increased susceptibility to
dd) virus infection.


F NS Mouse (CD-I) Streptococcus sp. Increase mortality with increased
time and concentration;
concentrations is more important
than time.
F 6-8 Mouse (CD2 Streptococcus sp. Increase in mortality with
wks F!, CD-I) reduction in mean survival time.
F NS Mouse (CF-1) K. pneumoniae Significant increase in mortality
after 3-day exposure to 5.0 ppm;
no effect at other concentrations,
but control mortality very high.

References
Ehrlich and Henry
(1968)

Ito (1971)


Gardner et al.
(1977 a,b)
Coffin etal. (1977)
Ehrlich etal. (1979)
McGrath and
Oyervides (1985)


-------
TABLE AX4.6 (cont'd). EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO
                        INFECTIOUS AGENTS
to
o
o
oo










>
£
i
(^



o
>
H
6
o
0
H
O
O
H
W
O
O
HH
H
W

ppm
0.5
1.0
2.0
5.0
1.0
2.3
6.6


1.0
2.5
5.0
10.0


1.0



1.0
3.0












Species
Exposure Gender Age (Strain) Infective Agent Effects
4h M/F 8-10 wks Mouse Mycoplasma Decrease in intrapulmonary killing only
(C57BL/6N) pulmonis at 5.0 ppm.


17 h M NS Mouse (Swiss) S. aureus after No difference in number of bacteria
exposure deposited, but at the two highest
concentrations, there was a decrease in
pulmonary bactericidal activity of 6 and
35%, respectively; no effect at 1.0 ppm
4h F NS Mouse (Swiss) S. aureus Injection with corticosteroids increased
NO2-induced impairment of bactericidal
activity at >2.5 ppm.



48 h M NS Mouse (Swiss Streptococcus sp. Increased proliferation of Streptococcus
Webster) S. aureus in lung of exposed mice but no effect
withX aureus.

3h F 5-6 wks Mouse (CD-I) Streptococcus sp. Exercise on continuously moving
wheels during exposure increased
mortality at 3.0 ppm.












References
Davis et al.
(1991, 1992)


Goldstein et al.
(1974)



Jakab (1988)





Sherwood et al.
(1981)


Illingetal. (1980)














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to
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O

O
H
                           TABLE AX4.6 (cont'd).  EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO
                                                              INFECTIOUS AGENTS
to
o
o
oo




ppm
1.0
2.5
5.0
1.5-
50

1.5
Species
Exposure Gender Age (Strain)
6 h/day, 6 days NS 4-6 wks Mouse
(CD-I)

2h NS NS Mouse (NS)
Hamster (NS)
Monkey
(Squirrel)
Continuous or F NS Mouse
intermittent, 7 h/day, (CD-I)
Infective Agent
Cytomegalovirus

K. pneumoniae

Streptococcus sp.
Effects
Increase in virus susceptibility at
5.0 ppm only.

Increased mortality in mice,
hamsters, and monkeys at >3.5,
>35, and 50 ppm NO2, respectively

After 1 wk, mortality with
continuous exposure was greater
References
Rose etal. (1988,
1989)

Ehrlich(1980)

Gardner etal. (1979)
Coffin etal. (1977)
                     7 days/wk, up to
                     15 days
             5.5
than that for intermittent after 2
wks, no significant difference
between continuous and
intermittent exposure.

Increased mortality with increased
duration of exposure; no significant
difference between continuous and
intermittent exposure; with data
adjusted for total difference in
C x T, mortality essentially the
same.
o
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O
^
O
HH
H
W

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                           TABLE AX4.6 (cont'd). EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO
                                                             INFECTIOUS AGENTS
            ppm
            Exposure
                                        Gender
  Age
  Species
  (Strain)
Infective Agent
                                                                                            Effects
References
1.5 base +   Continuous 64 h,
4.5 peak    then peak for 1,
           3.5, or 7 h, then
           continuous 18 h
           base
                                                  NS
                                               Mouse
                                               (CD-I)
                      Streptococcus sp.
                               Mortality increased with 3.5- and
                               7 h single peak when bacterial
                               challenge was after an 18 h
                               baseline exposure.
                                                Gardner (1980)
                                                Gardner (1982)
                                                Graham etal. (1987)
                    1,3.5, or 7 h
>
1.5      7 h/day, 4, 5, and 7   NS
        days
NS
Mouse (NS)  Streptococcus sp.
                 Mortality proportional to duration
                 when bacterial challenge was
                 immediate, but not 18 h
                 postexposure.

                 Elevated temperature (32°C)
                 increased mortality after 7 days.
                                                                                                               Gardner (1982)
wv


O
E>
CTJ
H
1
O
o

0
H
O
o
H
W
O
O
HH
H
W
1.9 4h
3.8
7.0
9.2
14.8



1.5- 3h
5.0










M NS Mouse (NS) S. aureus Physical removal of bacteria
unchanged by exposure.
Bactericidal activity decreased by
7, 14, and 50%, respectively, in
three highest NO2-exposed
groups.


F 6-10 wks Mouse (CF- Streptococcus sp. Increased mortality in mice
1, CD2F!) exposed to >2.0 ppm










Goldstein etal. (1973)







Ehrlich etal. (1977)
Ehrlich(1980)











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                TABLE AX4.6 (cont'd).  EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO
                                                     INFECTIOUS AGENTS
to
O
O
oo






ppm Exposure
1.5 2h
2.5
3.5
5.0
10
15

Species
Gender Age (Strain)
NS 6-8 wks Mouse
(Swiss
Webster)




Infective Agent Effects
K. pneumoniae No effect at 1.5 or 2.5 ppm; increased
mortality at 3.5 ppm and above. Increase
in mortality when K. pneumoniae
challenge 1 and 6 h after 5 or 10 pm NO2
exposure; when K. pneumoniae challenge
27 h following NO2 exposure, effect only
at 15 ppm.
References
Purvis and Ehrlich
(1963)
Ehrlich (1979)




2.0
        1.5 h/day,
        5 days/wk for
        1, 2, and 3 wks
                                    NS
                             2 wks
                                       Hamster
                                       (Golden
                                       Syrian)
                                       (in vitro)
              A/PR/8/34
              influenza virus
                  Peak virus production in tracheal explants  Schiff (1977)
                  occurred earlier.
H
6
O

O
H
O
O
H
W
O

O
HH
H
W
2.5
4.0
5.0
10
15
5.0
        4h
                                                 NS
10
Continuous,
2 mos
                                    M
                            NS
Continuous,
1 mo
                                       Mouse
                                       (Swiss)
Monkey
(Squirrel)
              S. aureus,
              Proteus mirabilis,
              Pasteurella
              pneumotropica
K. pneumoniae or
A/PR/8 influenza
virus
Concentration-related decrease in
bactericidal activity at >4.0 ppm with S.
aureus when NO2 exposure after bacterial
challenge; when NO2 exposure was
before challenge, effect at 10 ppm; NO2
concentrations >5.0 ppm required to
affect bactericidal activity for other tested
microorganisms.
Increased viral-induced mortality (1/3).
Increase in Klebsiella-induced mortality
(2/7); no control deaths.
                                                                               Increased virus-induced mortality (6/6)
                                                                               within 2-3 days after infection; no control
                                                                               deaths. Increase in Klebsiella-mduced
                                                                               mortality (1/4), no control deaths.
                                                                                                              Jakab (1987, 1988)
                                                                                                                      Henry etal. (1970)

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                           TABLE AX4.6 (cont'd). EFFECT OF NITROGEN DIOXIDE ON SUSCEPTIBILITY TO
                                                             INFECTIOUS AGENTS
ppm
   Exposure
 Gender    Age    Species (Strain)     Infective Agent
                                                                                          Effects
                                                                                  References
 5.0
 10
4h
M/F
6-10
wks
Mouse
(C57BL6N,
C3H/HeN)
Mycoplasma
pulmonis
NO2 increased incidence and severity    Parker et al. (1989)
of pneumonia lesions and decreased
the number of organisms needed to
induce pneumonia; no effect on
physical clearance; decreased
mycoplasmal killing and increased
growth; no effect on specific IgM in
serum; C57B1/6N mice generally
more sensitive than C3H/HeN mice.
At 10 ppm, one strain (C57B1/6N) of
mice had increased mortality.
10 2h
15
35
50
5 NS


M/F NS Monkey
(Squirrel)


NS NS Mice (NS)


K. pneumoniae



Parainfluenza
(murine sendei
virus)
Clearance of bacteria from lungs of
10-, 15-, and 35-ppm groups delayed
or prevented. All three animals in
highest exposed group died.
Altered the severity but not the course
of the infection

Henry etal. (1969)



Jakab (1988)


         Source: Modified from U.S. Environmental Protection Agency (1993).
H
6
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o
H
O
O
H
W
O

O
HH
H
W

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                                  TABLE AX4.7.  EFFECTS OF NITROGEN DIOXIDE ON LUNG STRUCTURE
O

to
O
O
oo
            ppm
  Exposure     Gender
              Age
             Species (Strain)
                                                                                                    Effects
                                                                           Reference
6 h/day,
6 days/wk, for
2 wks
           NS
             Guinea Pig         Morphological changes observed at both
                               concentrations. Ciliated cells displayed pathological
                               changes such as cytoplasmic vacuolation and protrusion
                               at 3 ppm, but eosinophils displayed normal
                               morphology. Minor to major changes in epithelial cells
                               (decreased number of specific granules, cytoplasmic
                               vacuolization, and morpholigcal changes in specific
                               granules) and ciliated cells showed compound cilia,
                               cytoplasmic vacuolization, and sloughing) at 9 ppm.
                                                                     Ohashietal. (1994)
              5
             25
6 h/day for 1,
3, or 5 days
NS
NS
Mouse            No lung inflammation or injury observed at 5 ppm at
(C57BL/6)         any time, compared to controls. 25 ppm NO2 induced
                  acute lung injury (characterized by increases in protein,
                  LDH, macrophages, and neutrophils recovered by
                  BAL) at 25 ppm that peaked after 3 days, lesions within
                  terminal bronchioles, and AHR. Another group of mice
                  exposed for 5 days to 25 ppm and allowed to recover in
                  room air for 20 days demonstrated resolution of the
                  pattern of acute  lung injury in these animals.
                                                                                                                                  Poynter et al. (2006)
H
6
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o
H
O
O
H
W
O

O
HH
H
W
              5
              10
              20
              5
              10
              20
24 h/day, for
3 days
24 h/day, for
25 days
M
NS
M
NS
Rat (Sprague-      Significant alteration in morphology of Clara cells (loss
Dawley)           of apical intra-luminal projects and damaged epithelium
                  covered by a layer of CClO-reactive material) at
                  > 5 ppm.

Rat (Sprague-      No significant alteration of morphology of Clara cells
Dawley)           compared to controls.
                                                                     Earth and Muller
                                                                     (1999)
                                                                     Earth and Muller
                                                                     (1999)

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                              TABLE AX4.7 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG STRUCTURE
            ppm
                      Exposure    Gender      Age     Species (Strain)
                                                                                                   Effects
    Reference
              5      24 h/day,      M        NS         Rat (Sprague-     Exposure to 5 ppm showed no significant qualitative changes of
              10     for 25 days                          Dawley)          the lung tissue, but animals exhibited slight fibrosis of the
              20                                                          centroacinar alveolar septa, respiratory bronchioli, and
                                                                          interstitium, and irregularly shaped alveolar spaces at > 10 ppm.
                                                                          Morphometric analysis showed significantly diminished alveolar
                                                                          surface density at > 10 ppm. Suggests development of
                                                                          emphysema at > 10 ppm. The avg medial thickness of the
                                                                          pulmonary artery was significantly increased at > 10 ppm, but at
                                                                          5 ppm, this parameter was significantly decreased, compared to
                                                                          controls.  Authors reported negative correlation between avg
                                                                          medial thickness and alveolar surface density.
Earth etal. (1995)
H
6
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o
H
O
O
H
W
O

O
HH
H
W
              5      24 h/day,     M         NS          Rat (Sprague-     Histopathology revealed structural alterations extending from
             10      for 3 days                            Dawley)          slight interstitial edema after exposure to 5 ppm, to epithelial
             20                                                           necrosis and interstitial inflammatory infiltration after exposure
                                                                          to 10 ppm, and an additional intra-alveolar edema after 20 ppm.
                                                                          Light microscopic examination did not confirm the qualitative
                                                                          histological changes, particularly muscularization of intra-acinar
                                                                          vessels. Exposure to > 10 ppm for 25 days caused emphysema
                                                                          and slight centrilobular interstitial fibrosis.
                                                                          Morphometric analysis showed significantly diminished alveolar
                                                                          surface density at 10 ppm after 25 days of exposure and at 20
                                                                          ppm after 3 and 25 days of exposure.  Avg medial thickness of
                                                                          the pulmonary artery significantly increased at > 10 ppm, but at
                                                                          5 ppm, this parameter was significantly decreased both during
                                                                          after 3-day and 25-day exposures, compared to controls.
                                                                          Authors regarded the decrease in the medial thickness at 5 ppm
                                                                          as reflecting a reduction of pulmonary arterial mass and not as a
                                                                          result of vasodilation. Avg medial thickness and alveolar
                                                                          surface density were negatively correlated. Study indicates
                                                                          exposures to as low as 5 ppm is not likely to induce structural
                                                                          changes in the lung of rats. Effect on the morphometry of the
                                                                          alveolar region appeared to be time-dependent, since significant
                                                                          changes were seen at 10 ppm after 25 days, but only at 20 ppm
                                                                          in the 3-day exposure study.
                                                                                                                                      Earth etal. (1995)

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                              TABLE AX4.7 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG STRUCTURE
            ppm
  Exposure     Gender
               Age
               Species
               (Strain)
                                                                                                 Effects
     Reference
             10
             20
14h/day,for
15 days, 20 or
25 days
M
NS
Mouse         Initial dose response experiment identified 20 ppm NO2 as
(C57/BL/5)     concentration causing lung injury and air inflammation
               (marked influx of inflammatory cells in the airways,
               predominated by macrophages and neutrophils and to a
               lesser extent by lymphocytes) for exposure that lasted 15
               days, whereas 10 ppm did not induce significant increase in
               leukocyte amount in BAL fluid. Actual study using 20 ppm
               NO2 observed induction of air space enlargement
               (evidenced by a significant increase in mass-specific lung
               volume and volume-weighted alveolar volume). No
               significant changes in total alveolar surface area.
Wegman and Herz
(2002)
oo
H
6
O

O
H
O
O
H
W
O

O
HH
H
W
            0.8
             5
             10
                    24 h/day, for 1
                    or 3 days
               M
            NS
            Rat (Sprague-    Significant increase in Type II cell proliferation (evidenced
            Dawley)        by increases in AgNOR-number and BrdU-LI) after
                            exposure to 5 ppm NO2 for 3 days and 10 ppm for 1 and
                            3 days.  Significant increase in bronchiolar epithelial
                            proliferation (increases in AgNOR-number and BrdU-LI) at
                            >0.8 ppm for 1 and 3 days. In the bronchial epithelium,
                            statistically significant increase in proliferation as increase
                            in AgNOR-number at 10 ppm only after 3 days of exposure
                            and as increase in BrdU-LI after exposure to 5 and  10 ppm
                            for > 1 day. Results showed highest rate of epithelial
                            proliferation in the bronchiolar epithelium compared to
                            bronchial epithelium and Type II cells.  Study indicates cell
                            proliferation changes beginning at concentrations as low
           	0.8 ppm NO2 following a single day of exposure.	
Earth etal. (1994a)

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                              TABLE AX4.7 (cont'd). EFFECTS OF NITROGEN DIOXIDE ON LUNG STRUCTURE
O

to
O
O
oo
            ppm
         Exposure      Gender
Age
            Species
            (Strain)
                                                                                                 Effects
Reference
H
6
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o
H
O
O
H
W
O
O
HH
H
W
 5      24 h/day, for 3  M
10     or 25 days
20
NS       Rat          Compared to controls, proliferative activity (evidenced by increase
          (Sprague-     in AgNOR-number) significantly increased, but with no
          Dawley)      concentration-dependence in respiratory bronchiolar epithelium at
                       5 ppm and above after 3-day exposure, but the increase was
                       concentration-dependent, with significance  at > 10 ppm following
                       25-day exposure. Activity was increased in a concentration-
                       dependent manner in bronchial epithelium with significance only at
                       20 ppm after 3 days of exposure and at > 10 ppm following 25 days
                       of exposure.

                       Concentration-dependent thickening of alveolar septa and
                       bronchiolar walls, significant only at > 10 ppm after 3- and 25-day
                       exposure, but 5 ppm caused significant thickening only in
                       bronchiolar walls after 25 days, but not 3 days, of exposure
                       compared to controls.

                       Statistically significant reduction in alveoli  surface density at > 10
                       ppm after 25  days of exposure and at 20 ppm only after 3 days of
                       exposure, while alveolar circumference increased statistically
                       significantly at > 10 ppm after 25 days of exposure and at 20 ppm
                       following 3 days of exposure. 5 ppm did not significantly affect
                       these endpoints after 3 or 25 days of exposure compared to controls.
                       Data suggest concentration- and exposure duration-dependent
                       development of emphysema, significant only at > 10 ppm, but not at
                       5 ppm, after 3 or 25 days of exposure.
                       Alveolar duct length increased significantly at > 10 ppm after 25 days
                       and at 20 ppm after 3 days of exposure; no effect at 5 ppm.
                       Radial alveolar count values decreased significantly at 20 ppm after
                       3 and 25 days and at 10 ppm after 25 days exposure; no effect at
                       5 ppm.
                       Increase in avg medial thickness at 10 ppm  with significance only
                       after 25 days of exposure and at 20 ppm with significance after 3 and
                       25 days of exposure. However, 5 ppm caused significant decrease at
                       both 3 and 25 days of exposure. Authors suggested effect at 5 ppm
                       was due to vasodilation induced by nitrogen oxide.
                                                                                     Earth etal. (1994b)

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                             TABLE AX4.7 (cont'd).  EFFECTS OF NITROGEN DIOXIDE ON LUNG STRUCTURE
O

to
O
O
oo
ppm
   Exposure     Gender    Age
           Species
           (Strain)
                                                                                    Effects
   Reference
 25
 50
              75
              100
              150
              200
              250
5, 15, or 30 min   M
          2,5, 15, or
          30 min
          2, 5, or 15 min
NS      Rat          Animals exposed to >200 ppm NO2 for 30 min died within 24 h
         (Fischer-     after exposure.
         344)         NO2 exposure induced proportional increases in LWW, indicative
                      of pulmonary edematous responses, over the same exposure period
                      after the 15-min exposures. Animals exposed to 25 ppm NO2 did
                      not produce observable lung injury (i.e., occurrence  of alveolar
                      fibrin and Type II cell hyperplasia) on exposure for 5 min.
                      Animals exposed to all exposure concentrations for 15 min showed
                      alveolar fibrin, while Type II hyperplasia occurred at 50 ppm and
                      its level of expression correlated with exposure concentration.
                      After 30 min of exposure, the occurrence of fibrin increased as a
                      function of exposure concentration, while over a concentration
                      range of 25-150  ppmNO2, the Type II cell hyperplastic response
                      increased with increasing exposure concentration. Data suggest
                      exposure concentration was evidently more important than
                      exposure time in terms of causing lung injury when high
                      concentrations of NO2 are inhaled.
Lehnert et al.
(1994)



o
>
H
1
O
o
0
H
O
o
H
W
O
O
HH
H
W
3.6 24 h, 12 h, 8 h, M NS Rat Short-term exposure was not sufficient to produce significant type Rajinietal.
7.2 and6h, (Sprague- I alveolar cell necrosis or a significant migration of inflammatory (1993)
10.8 respectively, Dawley) cells across the interstitium and alveolar epithelium.
14 4 for 3 days,
giving a C x T
of 86.4 ppm h















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 O
 to
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 oo
TABLE AX4.7 (cont'd).
ppm Exposure Gender Age
0.5 base + Base M 7 wks
1.5 peak presumably
continuous, two
1-h peaks/day,
for 9 wks






EFFECTS
Species
(Strain)
Rat
(Fischer-
344)








OF NITROGEN DIOXIDE ON LUNG STRUCTURE
Effects
No significant differences in thickness of the alveolar septal
components, between controls and exposed group.
Analysis of parenchymal cell populations showed no significant
differences in the avg volumes of different cell types or in their
surface areas. Total number of fenestrae in the lungs of
NO2~exposed animals occurred at a greater frequency than in
controls, but no significant alterations were found in the connective
tissue matrix or interstitial cell population, suggesting that
connective tissue matrix and interstitial cells of the lung
parenchyma did not undergo significant degeneration on exposure
to the low level of NO2 used in this study.

Reference
Mercer et al.
(1995)









             AgNOR = Silver-stainable nucleolar organizer regions
             AHR = Airway hyperresponsiveness
             BAL = Bronchoalveolar lavage
             BrdU-LI = Bromodeoxyuridine-laebling index
             LDH = Lactate dehydrogenase
             LWW = Lung wet weight
 H
 6
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 H
O
 O
 H
 W
 O
 O
 HH
 H
 W

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                                TABLE AX4.8. EFFECTS OF NITROGEN DIOXIDE ON PULMONARY FUNCTION
O

to
O
O
oo
Species
ppm Exposure Gender Age (Strain)
0.5 0.5 ppm background M 67 days Rat(Fischer-
1.5 level for 16 h, a 6-h 344)
exposure spike, and
a 2-h downtime;
profile was run each
day for 1, 3, 13, 52
or 78 wks
Effects
No NO2 related-effects on body weight or pulmonary function
(total lung capacity, vital capacity, residual volume (difference
between total lung capacity and vital capacity), respiratory system
compliance, single-breath diffusing capacity of carbon monoxide,
slope of nitrogen wash-out curve, and end-expiratory volume)
observed following 13-, 52-, or 78-wk exposure. NO2~related
effects on small airway function [FVC, peak flow, flow at 50%
(FEF 50%), 25% (FEF 25%) and 10% (FEF 10%) of FVC]
evaluated at 52- or 78-wk exposure or at 26- and 17-wks
postexposure were not significantly different from controls.
However, breathing patterns and mechanics (tidal volume,
expiratory resistance, inspiratory and expiratory time) were
generally greater and FOB was significantly slower in
NO2~exposed animals compared to controls at all of the time
points evaluated.
Reference
Tepper et al.
(1993)
to
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o
H
O
O
H
W
O
O
HH
H
W
Base presumably      M
continuous, two 1-h
peaks/day, for 9 wks
0.5 base +   Base presumably      M         7 wks     Rat (Fischer-    No significant differences in lung volume, total air volume of the    Mercer etal.
1.5 peak     continuous, two 1-h                         344)            lungs, total lung tissue volume, surface area, body weight, or       (1995)
                                                                      thickness of the alveolar septal components, between controls and
                                                                      exposed group.
                                                                      Analysis of parenchymal cell populations showed no significant
                                                                      differences in the avg volumes of different cell types or in their
                                                                      surface areas. Total number of fenestrae in the lungs of
                                                                      NO2~exposed animals occurred at a greater frequency than in
                                                                      baseline controls, but no significant alterations were found in the
                                                                      connective tissue matrix or interstitial cell population, suggesting
                                                                      that connective tissue matrix and interstitial cells of the lung
                                                                      parenchyma did not undergo significant degeneration on exposure
                                                                      to the low level of NO2 used in this study.

                                            NS        Mouse          20 ppm NO2 induced development of progressive airflow           Wegmanand
                                                      (C57/BL/6)      obstruction (evidenced by decreases in midexpiratory airflow,       Herz (2002)
                                                                      breathing frequency and tidal volume, with statistical significance
                                                                      only at day 25 of exposure).
FVC = Forced vital capacity
FOB = Frequency of breathing
              10
              20
14 h/day, for 15
days, 20 or 25 days
M

-------
TABLE AX4.9. EFFECT OF NITROGEN DIOXIDE ON HEMATOLOGICAL PARAMETERS
o
to
o
o
oo




>
OJ
O
H
6
o
0
H
O
o
H
W
O
O
HH
H
W
ppm Exposure Gender Age
0.05 Continuous NS NS
90 days
0.36 Iwk NS NS
0.5-0.8 + Continuous 1 to M/F 4 wks
1.5 mos
0.8 Continuous, 5 days M 7 wks
1.0 Continuous, M NS
16 mos
1.0 Continuous, M NS
5.0 18 mos
1-30 18 h NS NS
1.3-3.0 2h/day, 15 and NS NS
17 wks
2.0 Continuous, M/F NS
14 mos
M




Species (Strain)
Rat
Guinea Pig
Mouse (ICR:JCL)
Mouse (ICR)
Monkey (Squirrel)
Dog (Mongrel)
Mouse (NS)
Rabbit
(NS)
Monkey (Macaca
speciosa)
Rat
(Sprague-Dawley)




Effects
No effect on blood hemoglobin or RBCs.
Increase of red blood cell D-2,3-diphosphoglycerate
Addition of 50 ppm CO to NO2 failed to affect
carboxy hemoglobin.
No effect on methemoglobin.
No effect on hematocrit or hemoglobin with NO2
and influenza exposure.
No changes in hemoglobin or hematocrit.
Concentration-related increase in methemoglobin
and nitrosylhemoglobin
Decreased RBCs.
With or without NaCl (330 ug/m3): polycythemia
with reduced mean corpuscular volume and normal
mean corpuscular hemoglobin.





References
Shalamberidze (1969)
Mersch etal. (1973)
Nakajima and
Kusumoto (1970)
Nakajima and
Kusumoto (1968)
Fenters etal. (1973)
Wagner etal. (1965)
Case et al. (1979)
Mitina (1962)
Furiosi etal. (1973)






-------
                   TABLE AX4.9 (cont'd). EFFECT OF NITROGEN DIOXIDE ON HEMATOLOGICAL PARAMETERS
O
to
O
O
oo


ppm
2.0
4.0

Exposure
Continuous, up to
6 wks
1-10 days

Gender
M
NS

Age
8 wks
NS

Species (Strain)
Rat
(Wistar)
Rat
(NS)
Effects
No effect on hemoglobin, hematocrit or RBC count;
no methemoglobin was observed.
Increase in RBC sialic acid.

References
Azoulayetal. (1978)
Kunimoto et al. (1984)

H
6
o

o
H
O
O
H
W
O

O
HH
H
W
            4.0
NS
NS
NS      NS
Decrease in RBCs.
Mochitate and Miura
(1984)
            5-40
Ih
          4 mos    Mouse (JCL:ICR)
No increase in methemoglobin. Increased nitrite      Oda et al. (1981)
and especially nitrate.
             10     2 h/day, 5 days/wk,  F
            	up to 30 wks	
                            6-8      Mouse (BALB/c)
                            wks
                                    Small decrease in hemoglobin and mean corpuscular  Holt et al. (1979)
                                    hemoglobin concentration.
         Source:  Modified from U.S. Environmental Protection Agency (1993).

-------
     TABLE AX4.10. EFFECTS OF NITRIC OXIDE ON IRON, ENZYMES, AND
                                  NUCLEIC ACIDS
                         Effect
                            Reference
 Sodium nitroprusside (NO donor) mobilizes iron from ferritin   Reif and Simmons (1990)

 Modulation of arachidonic acid metabolism via interference     Kanner et al. (1991, 1992)
 with iron
Inhibition of aconitase (an enzyme in the Krebs cycle, and
also complex 1 and 2 of the respiratory chain)

Permanent modification of hemoglobin, possibly via
deamination

Deamination of DNA

DNA strand breaks

Inhibition of DNA polymerase and ribonucleotide reductase

Antimitogenic; inhibition of T cell proliferation in rat spleen
cells

Inhibition of DNA synthesis, cell proliferation, and
mitogenesis in vascular tissue

Inhibition of mitogenesis and cell proliferation (vascular
smooth muscle cells)

Adenosine diphosphate ribosylation is stimulated by NO-
generating agents
                   Hibbsetal. (1988)
                   Perssonetal. (1990)
                   Stadleretal. (1991)
                   Moriguchi et al. (1992)
                   Wink etal. (1991)

                   Nguyenetal. (1992)

                   Lepoivre et al. (1991)
                   Kwon etal. (1991)
                   Fu & Blankenhorn (1992)
                   Nakaki etal. (1990)


                   Garg and Hassid (1989)


                   Nakaki etal. (1990)
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              TABLE AX4.11 A.  GENOTOXICITY OF NITROGEN DIOXIDE IN VITRO AND IN PLANTS
o
to
o
o
oo
  Test Organism
   End Point
Exposure
                                                                                   Comments
                                                                                                Results
                                                                         Reference
Salmonella TA 100
Salmonella TA 100

Salmonella TA 100
and TA 102
                    Mutations
                    Mutations

                    Mutations
SalmonellaTAlOO    SOS repair
E. coll, WP2

E. coll

Bacillus sub tills
spores
V79 hamster cells
Mutations

SOS repair

Mutations
6-10 ppm, 40 mins
10-15 ppm, 6h

Bubbling of 10-90 ppm
through bact. susp., 30 mins
as above
Bubbling of 10-90 ppm
through bact. susp., 30 mins

Bubbling of 10-90 ppm
through bact. susp., 30 mins
Bubbling of 10-90 ppm
through bact. susp., 30 mins
500 ppm, 2-3 h
                                             Concentrations >10 ppm were
                                             bacteriotoxic
                                             Effect not considered solely
                                             attributed to nitrite in suspension.
                                             No effect seen with NO gas.
Chromatid-type     10-100 ppm, 10 mins
aberrations, SCE
                   Effect shown not to be solely due
                   to nitric acid or nitrite. No effect
                   if cells not washed with Hank's
                   salt solution prior to exposure
                                                           Isomuraetal. (1984)
                                                           Victorin and
                                                           Stahlberg (1988)
                                                           Kosakaetal. (1985)
                                                     +     Kosakaetal. (1985)
                                                                                                                  Kosakaetal. (1986,
                                                                                                                  1987)
                                                                                                                  Kosakaetal. (1986,
                                                                                                                  1987)
                                                                                                                  Sasaki etal. (1980)

                                                                                                                  Tsudaetal. (1981)
O
>
H
6
o
0
H

O
H
W
O
O
HH
H
W
V79 hamster cells

Don hamster cells

V79 hamster cells

Tradescantia

Tradescantia


Source: Victorin (1994).


SCE

Mutations (8-
G resistance)
DNA single-
strand breaks
Micronuclei in
pollen
Mutations in
stamen hair




2-3 ppm, 10 mins

2-3 ppm, 10 mins

10 ppm, 20 mins

5 ppm, 24 h

50 ppm, 6 h





+ Shiraishi and
Bandow (1985)
Slight response - Isomuraetal. (1984)

Effect not due to formation of + Gorsdorf et al.
nitrite (1990)
+ Ma etal. (1982)

+ Schairer etal. (1979)






-------
                          TABLE AX4.11B.  GENOTICITY OF NITROGEN DIOXIDE IN VIVO
fa
O
to
O
O
oo





Test Organism
Drosophila
Drosophila
Rats
Rats
Mice

Mice
End Point
Recessive lethals
Somatic mutations (wing spot test)
Mutations in lung cells (oubain res.)
Chromosome aberrations in lung cells
Chromosome aberrations in lymphocytes and
spermatocytes
Micronuclei in bone marrow
Exposure
500-7000 ppm, 1 h
50-280 ppm, 2 days
50-560 ppm, >12 days
27 ppm, 3 h
0. 1-10 ppm, 6 h

20 ppm, 23 h
Result Reference
Inoueetal. (1981)
Victorinetal. (1990)
+ Isomuraetal. (1984)
+ Isomuraetal. (1984)
Goochetal. (1977)

Victorinetal. (1990)
Source: Victorin (1994).
                                TABLE AX4.11C. GENOTOXICITY OF NITRIC OXIDE
  Test Organism
 Salmonella TA100
 Salmonella
 Don hamster cells
 V79 hamster cells
 TK 6 human cells
                 End Point
Mutations
SOS repair
Mutations (8-AG resistance)
DNA single-strand breaks
Mutations, DNA single-strand breaks
        Exposure
25-30 ppm, 40 min
Bubbling of 10-90 ppm
2-3 ppm, 10 min
500 ppm, 30 min
Injection of 0.12-0.38 ml NO
gas/ml of culture medium, 1 h
Result        Reference
  +     Isomuraetal. (1984)
        Kosakaetal. (1985)
  +     Isomuraetal. (1984)
        Gorsdorfetal. (1990)
  +     Nguyenetal. (1992)
H
6
o
2
0
H
O
c
o
H
W
O
V
O
HH
H
W
Salmonella Mutations
TA1535
Rats Mutations in lung cells (oubain res.)
Source: Victorin (1994); Arroyo et al. (1992) added.
30 min to 5-90 ppm + Arroyo et al. (1992)
27 ppm, 3 h - Isomura et al. (1984)


-------
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 i      AX5.  CHAPTER 5 ANNEX - CONTROLLED HUMAN

 2           EXPOSURE STUDIES OF NITROGEN OXIDES
 o
 4
 5   AX5.1   INTRODUCTION
 6          This annex summarizes the effects of nitrogen oxides (NOx) on human volunteers

 7   exposed under controlled conditions. The goal is to review the scientific literature on human

 8   clinical studies of NOx exposure published since the 1993 Air Quality Criteria Document

 9   (AQCD) for Oxides of Nitrogen (U.S. Environmental Protection Agency, 1993).  Summary

10   findings from the 1993 AQCD are provided below. The primary focus will be on nitrogen

11   dioxide because it is the most abundant NOx species in the atmosphere and there are few human

12   studies of exposure to other NOx species.

13          The following are the conclusions drawn from the review of clinical studies of nitrogen

14   oxide exposure in the 1993 criteria document.

15          1.     Nitrogen dioxide causes decrements in lung function, particularly increased
16                airway resistance in healthy subjects at concentrations exceeding 2.0 ppm for
17                2 hours.
18          2.     Nitrogen dioxide exposure results in increased airway responsiveness in healthy,
19                nonsmoking subjects exposed to concentrations exceeding 1.0 ppm for exposure
20                durations of 1 hour or longer.
21          3.     Nitrogen dioxide exposure at levels above 1.5 ppm may alter numbers and types
22                of inflammatory cells in the distal airways or alveoli, but these responses depend
23                upon exposure concentration, duration, and frequency. Nitrogen dioxide may
24                alter function of cells within the lung and production of mediators that may be
25                important in lung host defenses.
26          4.     Nitrogen dioxide exposure of asthmatics causes, in some subjects, increased
27                airway responsiveness to a variety of provocative mediators, including cholinergic
28                and histaminergic chemicals, SO2 and cold air.  However, the presence of these
29                responses appears to be influenced by the exposure protocol, particularly whether
30                or not the exposure includes exercise.
31          5.     Modest decrements in spirometric measures of lung function (3 to 8%) may occur
32                in some asthmatics and COPD patients under certain NO2 exposure conditions.
33          6.     Nitric acid levels in the range of 50 to 200 ppb may cause some pulmonary
34                function responses in adolescent asthmatics, but not in healthy  adults. Other
35                commonly occurring NOx species do not appear to cause any pulmonary function
36                responses at concentrations expected in the ambient environment, even at higher
37                levels than in worst-case scenarios. However, not all nitrogen oxides acid species
38                have been studied sufficiently.


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 1          7.     No association between lung function responses and respiratory symptom
 2                 responses were observed.  Furthermore, there is little evidence of a concentration-
 3                 response relationship for changes in lung function, airway responsiveness, or
 4                 symptoms at the NO2 levels that are reviewed here.
 5
 6          In the summary and integration chapter of the 1993 NOX criteria document, one of the
 7    key health effects of most concern at near ambient concentrations of NO2 was increases in
 8    airway responsiveness of asthmatic individuals after short-term exposures. The 1993 AQCD
 9    notes the absence of a concentration-response relationship for NO2 exposure and airways
10    responsiveness in asthmatics. For example, most responses to NO2 that had been observed in
11    asthmatics occurred at concentrations between 0.2 and 0.5 ppm.  However, other studies showed
12    an absence of effects on airways responsiveness at much higher concentrations, up to 4 ppm.
13    Since 1993, additional studies suggest that exposure to low concentrations of NO2, either alone
14    or in combination with other pollutants such as SO2, may enhance allergen responsiveness in
15    asthmatic subjects.
16          In the years since the preparation  of the 1993 AQCD, many studies from a variety of
17    disciplines have convincingly demonstrated that exposure to particulate air pollution increases
18    the risk for cardiovascular events.  In  addition, a number of epidemiological studies have shown
19    associations between ambient NO2 levels and adverse cardiovascular outcomes, at concentrations
20    well below those shown to cause respiratory effects. However, to date there remain very few
21    clinical studies of NO2 that include endpoints relevant to cardiovascular disease.
22
23    AX5.1.1    Considerations in Controlled Human Exposure Studies
24
25    Strengths and Limitations of Controlled Human Studies
26          The database for air pollution  risk assessment arises from four investigative approaches:
27    epidemiology, animal toxicology, in vitro studies, and human inhalation studies. Each possesses
28    advantages but also carries significant limitations. For example, the epidemiological
29    investigation examines exposures in the "real world" but struggles with the realities of
30    conducting research in the community, where cigarette smoking, socioeconomic status,
31    occupational exposures, meteorological variability, and exposure characterization are important
32    confounders. Outcomes are often evaluated from available health or mortality records or from
33    administered questionnaires, all of which have inherent limitations. Sophisticated measures of

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 1    physiological responses are often not practical in studies involving large populations, although
 2    they may be used in panel studies. In contrast, inhalation studies in animals allow precision in
 3    quantifying exposure duration and concentration, measurement of a wide variety of physiologic,
 4    biochemical, and histological endpoints, and examination of extremes of the exposure-response
 5    relationship. Often, however, interpretation of these studies is constrained by difficulty in
 6    extrapolating findings from animals to humans, especially when exposure concentrations are
 7    unrealistically high.
 8           Controlled, quantitative studies of exposed humans offer a third approach (Frampton
 9    et al., 2006). Human clinical studies attempt to engineer laboratory atmospheric conditions
10    relevant to ambient pollutant atmospheres, with careful control of concentrations, duration,
11    timing, and other conditions which may impact responses. These studies provide the opportunity
12    to measure symptoms and physiological markers of health effects that result from breathing the
13    atmospheres.  The carefully controlled environment allows investigators to identify responses to
14    individual pollutants, to characterize exposure-response relationships, to examine interactions
15    among pollutants, and to study the effects of other variables such as exercise, humidity, or
16    temperature.  Susceptible populations can participate, including individuals with acute and
17    chronic respiratory and cardiovascular diseases, with appropriate limitations based on subject
18    comfort and protection from risk.  Endpoint assessment traditionally has included symptoms and
19    pulmonary function, but more recently a variety of markers of pulmonary, systemic, and
20    cardiovascular function have been used to assess pollutant effects.
21           Human clinical studies have limitations. For practical and ethical reasons, studies must
22    be limited to relatively small  groups, to short durations of exposure, and to pollutant
23    concentrations that are expected to produce only mild and transient responses. Findings from the
24    short-term exposures in clinical studies may provide limited insight into the health  effects of
25    chronic or repeated exposures.
26           Specific issues of protocol design in human clinical studies have been reviewed
27    (Frampton et al., 2006), and will not be considered further here, except in the context of specific
28    studies of NC>2 exposure described in the following pages.
29
30    Assessing the Findings from Controlled Human Studies
31           In clinical studies, humans are the species of interest, so findings have particular
32    relevance in risk assessment.  However, the utility of clinical studies in risk assessment is

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 1   tempered by the obvious need to avoid adverse health effects of the study itself.  This usually
 2   means selecting subjects that are not the most susceptible to the pollutant being studied.
 3   Furthermore, clinical studies depend on outcome markers with variable relevance or validation
 4   as markers of true health effects. The statement from the American Thoracic Society, "What
 5   constitutes an adverse health effect?" (American Thoracic Society, 2000) addresses issues
 6   relevant to selection and interpretation of outcome markers in clinical studies.
 7          The 1993 NC>2 AQCD included a description of key outcome measures that had been in
 8   use to that date. These included primarily respiratory outcomes, including pulmonary function
 9   tests such as spirometry, lung volumes, and airways resistance, and tests of pulmonary clearance
10   of inhaled aerosols.  A brief description of bronchoalveolar lavage was also included, which had
11   come into use prior to 1993 to assess airway inflammation and changes in the epithelial lining
12   fluid in response to NC>2 exposure.
13
14
15   AX5.2    EFFECTS OF NITROGEN DIOXIDE IN HEALTHY SUBJECTS
16          Table AX5.2-1 summarizes the key clinical studies of NC>2 exposure in healthy subjects
17   since 1993, with a few key studies included prior to that  date.
18
19
20   AX5.3    THE EFFECTS OF NITROGEN OXIDE EXPOSURE IN
21              SENSITIVE SUBJECTS
22          Table AX5.3-1 summarizes studies of potentially sensitive subjects.  The potential for
23   NC>2 exposure to enhance responsiveness to allergen challenge in asthmatics deserves special
24   mention.  Several recent studies, summarized in Table AX5.3-2, have reported that low-level
25   exposures to NC>2, both at rest and with exercise, enhance the response to specific allergen
26   challenge in mild asthmatics.
27          These recent studies  involving allergen challenge suggest that NC>2 may enhance the
28   sensitivity to allergen-induced decrements in lung function, and increase the allergen-induced
29   airway inflammatory response.
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1   AX5.4   EFFECTS OF MIXTURES CONTAINING NITROGEN OXIDES
2         Table AX5.4-1 summarizes human clinical studies of NO2-containing mixtures or
3   sequential exposures that are most relevant to ambient exposure scenarios.
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                             TABLE AX5.2-1. CLINICAL STUDIES OF NO2 EXPOSURE IN HEALTHY SUBJECTS
Reference
Avissar et al.
(2000)
Location
Rochester,
NY, USA
Participants
21 healthy
nonsmokers
Approach & Methods
Measurements of extracellular
glutathione peroxidase (eGPx)
activity and protein levels in
epithelial lining fluid from NO2
exposure study described in
Frampton et al. (2002) (see
below).
Findings
No effects of NO2 exposure on eGPx
activity and protein concentrations.
(Ozone exposure decreased eGPx activity
and protein concentrations.)
Comments
NO2 up to 1.5 ppm for
3 h did not deplete this
mode of antioxidant
defense in the epithelial
lining fluid.
Azadniv et al.
(1998)
Rochester,
NY, USA
2 studies,
12 healthy
nonsmokers in
each
                                                       Air vs. 2 ppm NO2 for 6 h with
                                                       intermittent exercise.
                                                       Phase 1: BAL 18 h after
                                                       exposure;
                                                       Phase 2: BAL immediately after
                                                       exposure.
                                                            Increased BAL neutrophils, decreased
                                                            blood CD8+ and null T lymphocytes 18 h
                                                            after exposure. No effects on symptoms
                                                            or lung function.
                                                                                      2 ppm NO2 for 6 h
                                                                                      caused mild
                                                                                      inflammation.
X
          Blomberg et al.    Sweden      30 healthy      Air vs. 2 ppm NO2 for 4 h, with
          (1997)                         nonsmokers     intermittent exercise.
                                                            Increased neutrophils and interleukin-8 in
                                                            bronchial wash. Increases in specific
                                                            lymphocyte subsets in BAL fluid.
                                                            Symptoms/lung function not reported.
                                                                                      2 ppm NO2 for 4 h
                                                                                      caused airway
                                                                                      inflammation.
H
6
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HH
H
W
          Blomberg et al.
          (1999)
Sweden
          Devlin et al.
          (1999)
Chapel Hill,
NC, USA
12 healthy
nonsmokers
8 healthy
nonsmokers
Air vs. 2 ppm NO2 for 4 h on
4 days, with intermittent
exercise.
Air and 2.0 ppm NO2 for 4 h
with intermittent exercise.
After 4 days of NO2, increased
neutrophils in bronchial wash but
decreased neutrophils in bronchial biopsy.
2% decrease in FEVi after first exposure
to NO2, attenuated with repeated
exposure.  Symptoms not reported.

Increased bronchial lavage neutrophils,
IL-6, IL-8, alphai-antitrypsin, and tissue
plasminogen activator.  Decreased
alveolar macrophage phagocytosis and
superoxide production.  No effects on
pulmonary function. Symptoms not
reported.
Decreased lung function,
not confirmed in other
studies at this
concentration.
Conflicting information
on airway inflammation.

2 ppm NO2 for 4 h
caused airway
inflammation.

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                         TABLE AX5.2-1 (cont'd).  CLINICAL STUDIES OF NO2 EXPOSURE IN HEALTHY SUBJECTS
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  Reference      Location      Participants
                                   Approach & Methods
                                                               Findings
                                             Comments
Drechsler-
Parks (1995)
Santa
Barbara,
CA, USA
          Frampton et al.  Rochester,
          (1991)          NY, USA
8 older healthy     4 2-h exposures with intermittent
nonsmokers        exercise: air, 0.60 ppm NO2,
                  0.45 ppm O3, and 0.60 ppm NO2
                  + 0.45 ppm O3.
                             39 healthy          3 protocols, all for 3 h with
                             nonsmokers        control air exposure:
                                               (1) continuous 0.06 ppm NO2,
                                               (2) baseline 0.05 ppm NO2 with
                                               peaks of 2.0 ppm, and
                                               (3) continuous 1.5 ppmNO2.
Significant reduction in cardiac output
during exercise, estimated using
noninvasive impedance cardiography,
with NO2 + O3. Symptoms and
pulmonary function not reported.

No symptoms or direct effects on
pulmonary function. Increased airways
responsiveness to carbachol after
1.5ppmNO2.
Suggests cardiac effects of
NO2 + O3. Small number
of subjects limits  statistical
power, has not been
replicated.

Evidence for increased
nonspecific airways
responsiveness with NO2 as
low as 1.5 ppm for 3 h.
X
          Frampton et al.  Rochester,    21 healthy
          (2002)          NY, USA    nonsmokers
                                               Exposure to air, 0.6, 1.5 ppm
                                               NO2 for 3 h with intermittent
                                               exercise.
                                                              Dose-related decrease in hematocrit,
                                                              hemoglobin, blood lymphocytes, and T
                                                              lymphocytes. Mild increase in
                                                              neutrophils recovered in bronchial
                                                              portion of B AL fluid.  In vitro viral
                                                              challenge of bronchial epithelial cells
                                                              showed increased cytotoxicity after
                                                              1.5 ppm NO2. No effects on symptoms
                                                              or pulmonary function.
                                                                                       Indicates NO2 causes
                                                                                       airway inflammation below
                                                                                       1.5 ppm for 3 h. Suggest
                                                                                       subtle effects on red blood
                                                                                       cells, possibly RBC
                                                                                       destruction (hemolysis).
H
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o
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O
O
H
W
O

O
HH
H
W
          Gong et al.
          (2005)
          Helleday et al.
          (1994)
                Downey,
                CA, USA
                Sweden
             6 healthy
             nonsmokers and
             18 ex-smokers
             with COPD
             8 healthy
             smokers, 8
             healthy
             nonsmokers
                  2 h exposures with intermittent
                  exercise to:
                  (1) air,
                  (2)0.4ppmNO2,
                  (3) 200 ug/m3 concentrated
                  ambient paniculate matter
                  (CAPs), (4) NO2 + CAPs.

                  3.5 ppm NO2 for 20 min with
                  15 min exercise. BAL 24 h after
                  exposure compared with non-
                  exposure control BAL.
Reduced maximum mid-expiratory flow
rate and oxygen saturation with CAPs
exposures; no effects of NO2 alone or
additive effect with CAPs.
Different inflammatory cell increases in
smokers and nonsmokers. No effects on
symptoms.  Pulmonary function not
reported.
Exposures not fully
randomized.  Small number
of healthy subjects limits
interpretation for healthy
group.
Lack of control air
exposure with exercise is
problematic.

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               TABLE AX5.2-1 (cont'd).  CLINICAL STUDIES OF NO2 EXPOSURE IN HEALTHY SUBJECTS
  Reference
 Location
   Participants
    Approach & Methods
                                                                                                     Findings
        Comments
Helleday et al.
(1995)
Sweden
24 healthy
nonsmokers, 8 in
each of 3 groups
Bronchoscopic assessment of
mucociliary activity:
(1) 45 min after 1.5 ppm NO2
for 20 min,
(2) 45 min after 3.5 ppm NO2
for 20 min, and
(3) 24 h after 3.5 ppm NO2 for
4h.
                                                                                        Complete abolition of mucociliary
                                                                                        activity 20 min after NO2; increased
                                                                                        activity 24 h after NO2.  Symptoms/
                                                                                        pulmonary function not reported.
No true air control
exposure, order of
procedures not randomized,
subjects not blinded.
X

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                       TABLE AX5.2-1 (cont'd).  CLINICAL STUDIES OF NO2 EXPOSURE IN HEALTHY SUBJECTS
 Reference    Location
  Participants
      Approach & Methods
             Findings
                                                                                                                                 Comments
Posin et al.    Downey,      10 healthy          3 daily exposures for 2.5 h.
(1978)        CA, USA     nonsmokers        1st day: air;
                                            2nd and 3rd days: 1 or 2 ppm NO2.
                                            Intermittent exercise.  Subsequent
                                            control series of 3 daily air
                                            exposures.
                                                   Reduced hemoglobin and hematocrit,
                                                   and red blood cell acetyl
                                                   cholinesterase.
                                                                     Suggests red blood cell
                                                                     effects of NO2(see
                                                                     Frampton et al., 2002).
                                                                     Exposures not randomized.
          Rasmussen
          etal. (1992)
             Denmark
14 healthy
nonsmokers
Air vs. 2.3 ppm NO2 for 5 h.
Small increases in FVC
Reduced lung permeability and blood
glutathione peroxidase after exposure.
                                                                                                                           Only 1 wk between
                                                                                                                           exposures may have
                                                                                                                           confounded results.
X
          Rigas et al.
          (1997)
          Sandstrom    Sweden
          etal. (1990)
                          12 healthy         2 h of 0.36 ppm NO2, 0.75 ppm
                          nonsmokers       NO2, 0.36 ppm SO2, or 0.36 ppm
                                           O3. Boluses of O3 every 30 min to
                                           measure O3 absorption.

                          32 healthy         4 ppm NO2 for 20 min with 15 min
                          nonsmokers,       exercise. BAL 4, 8, 24, 72 h after
                          4 groups of        exposure, compared with non-
                          8 subjects         exposure control BAL.
                                                   NO2 and SO2 increased O3 absorption
                                                   by increasing biochemical substrates.
                                                   Increase in BAL mast cells and
                                                   lymphocytes 4-24 h after exposure.
                                                                     Suggests breathing
                                                                     mixtures of NO2 and O3
                                                                     would increase O3 dose to
                                                                     airways.

                                                                     Study weakened by lack of
                                                                     control air exposure.
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          Sandstrom    Sweden
          etal. (1991)
          Sandstrom    Sweden
          etal.
          (1992a)
          Sandstrom    Sweden
          etal.
          (1992b)
                          18 healthy
                          nonsmokers
                          10 healthy
                          nonsmoking men
                          8 healthy
                          nonsmokers
                  2.25, 4.0, 5.5 ppm NO2 for 20 min
                  with light exercise. BAL 24 h after
                  exposure, compared with non-
                  exposure control BAL.

                  4 daily exposures to 4 ppm NO2 for
                  20 min with 15 min exercise. BAL
                  24 h after exposure, compared with
                  non-exposure control BAL.

                  1.5 ppm NO2 for 20 min with
                  15 min exercise, every 2nd day x 6.
                  BAL 24 h after exposure compared
                  with non-exposure control BAL.
                                 Increase in BAL mast cells (all
                                 concentrations) and lymphocytes
                                 (4.0 and 5.5 ppm).
                                 Reduction in alveolar macrophages,
                                 NK cells, and CDS lymphocytes in
                                 BAL; reduction in total lymphocytes
                                 in blood.

                                 Reduced CD8+ T lymphocytes and NK
                                 cells in BAL fluid.
                                    Study weakened by lack of
                                    control air exposure.
                                    Study weakened by lack of
                                    control air exposure.
                                    Study weakened by lack of
                                    control air exposure.

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I       	TABLE AX5.2-1 (cont'd).  CLINICAL STUDIES OF NO2 EXPOSURE IN HEALTHY SUBJECTS	


^j         Reference     Location      Participants          Approach & Methods                     Findings                     Comments

o        Solomon     San          15 healthy         Air or 2.0 ppm NC>2 with intermittent   Increased neutrophils in bronchial       Airway inflammation with

          etal. (2000)  Francisco,    nonsmokers       exercise, for 4 h daily x 4.            lavage decreased CD4+T lymphocytes   2 ppm NO2 for 4 daily 4 h

                      CA, USA                      BAL18 hours after exposure.         in BAL.  No changes in blood.          exposures.



          Vagaggini    Italy         7 healthy          Air vs. 0.3 ppm NO2 for 1 h with      Mild increase in symptoms. No         Small number of subjects

          et al. (1996)               nonsmokers       intermittent exercise.                 effects on lung function, nasal lavage,    limits statistical power.

                                                                                      or induced sputum.
X
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                        TABLE AX5.3-1. EFFECTS OF NO2 EXPOSURE IN SUBJECTS WITH RESPIRATORY DISEASE
                       	(SEE TABLE AX5.3-2 FOR STUDIES WITH ALLERGEN CHALLENGE)	
  Reference
  Location
   Participants
     Approach & Methods
              Findings
                                                                                                                                             Comments
Gong et al.
(2005)
Downey,
CA, USA
6 healthy
nonsmokers and
18 ex-smokers with
COPD
2 h exposures with intermittent
exercise to: (1) air,
(2) 0.4 ppm NO2,
(3) 200 ug/m3 concentrated
ambient participate matter (CAPs),
(4) NO2 + CAPs.
Reduced maximum mid-expiratory flow
rate and oxygen saturation with CAPs
exposures; no effects of NO2 alone or
additive effect with CAPs.
                                                                                                                                  Exposures not fully randomized.
                                                                                                                                  Small number of subjects limits
                                                                                                                                  interpretation for healthy group.
           Hackney et al.
           (1992)
               Downey,
               CA, USA
              26 smokers with
              symptoms and
              reduced FEV]
                    Personal monitoring and chamber
                    exposure to air and 0.3 ppm NO2
                    for 4 h with intermittent exercise.
                                No significant effects on lung function.
>
X
           Jorres and
           Magnussen
           (1991)
           Jorres et al.
           (1995)
               Germany
               Germany
              11 mild asthmatics
              8 healthy
              nonsmokers &
              12 mild asthmatics
                    Air vs. 0.25 ppm NO2 for 30 min
                    with 10 min exercise.

                    Air or 1 ppm NO2 exposure for 3 h
                    with intermittent exercise.
                                No effects on lung function or airways
                                responsiveness to methacholine.

                                In asthmatics, 2.5% decrease FEVj after
                                NO2 vs. 1.3% decrease after air, p = 0.01.
                                FEV! decreased 20% in 1 subject after
                                NO2. No significant lung function effect
                                in healthy subjects. Changes in
                                eicosanoids (more pronounced in
                                asthmatics), but not inflammatory cells,
                                in BAL fluid.
                                      Lung function effects consistent
                                      with other studies, suggesting
                                      some asthmatics susceptible.
                                      Evidence for mild airway
                                      inflammation.  Small number of
                                      healthy subjects limits statistical
                                      power.
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O
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O
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           Morrow et al.
           (1992)

           Strand et al.
           (1996)
           Vagaggini
           etal. (1996)
               Rochester,
               NY, USA

               Sweden
               Italy
              20 COPD,
              20 healthy elderly

              19 mild asthmatics
              8 mild asthmatics,
              7 COPD
                    Air vs. 0.3 ppm NO2 for 4 h with
                    intermittent exercise.

                    Air vs. 0.26 ppm NO2 for 30 min
                    with intermittent exercise.
                    Air vs. 0.3 ppm NO2 for 1 h with
                    intermittent exercise.
                                Equivocal reduction in FVC with COPD
                                patients, but not healthy subjects.

                                Increased airway responsiveness to
                                histamine 5 h after exposure. No effects
                                on lung function.
                                Mild decrease in FEV] in COPD subjects
                                in comparison with air exposure, but not
                                with baseline. No effects on nasal lavage
                                or induced sputum.
                                      Suggests increased nonspecific
                                      airways responsiveness at much
                                      lower concentration than healthy
                                      subjects. Differs from findings in
                                      Jorres and Magnussen (1991).

                                      No convincing effect of NO2 in
                                      this study.  Small number of
                                      subjects limits statistical power.

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                            TABLE AX5.3-2.  EFFECTS OF NO2 EXPOSURE ON RESPONSE TO INHALED ALLERGEN
             Reference
                 Location     Participants
Approach & Methods
                                                                                                              Findings
Comments
Barck et al.      Sweden      13 mild         30 min exposures to air and 0.26 ppm
(2002)                       asthmatics,      NO2 (at rest?), allergen challenge 4 h and
                             4 ex-smokers    BAL 19 h after exposure. Randomized,
                                             crossover, double blind.
                               Increased PMN in bronchial wash and
                               BAL fluid, increased eosinophil cationic
                               protein in bronchial wash, and reduced
                               cell viability and BAL volume with NO2
                               + allergen. No effects on lung function
                               response to allergen.
                                                                                                                                      Key study suggesting that NO2
                                                                                                                                      enhances inflammatory response
                                                                                                                                      to allergen in mild asthmatics.
           Barck etal.      Sweden      18 mild         Day 1: 15 min exposures,
           (2005a)                      asthmatics,      Day 2:215-min exposures to air and
                                        4 ex-smokers     0.26 ppm NO2 separated by 1 h, at rest.
                                                        Allergen challenge 4 h after exposure on
                                                        day 1 and 3 h after exposure on day 2.
                                                        Sputum induction before exposure on
                                                        days 1 & 2, and morning of day 3.
                                                        Randomized, crossover, single blind.
                                                                                    Increased eosinophilic cationic protein in
                                                                                    sputum and blood, and increased
                                                                                    myeloperoxidase in blood with NO2 +
                                                                                    allergen. No differences in lung function
                                                                                    or sputum cells.
                                                                      Provides supporting evidence that
                                                                      NO2 enhances the airway
                                                                      inflammatory response to allergen.
X
(Si
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Barck etal.      Sweden      16 mild         30 min exposures to air and 0.26 ppm
(2005b)                      asthmatics       NO2 at rest, nasal allergen challenge 4 h
                             with rhinitis      after exposure.  Nasal lavage before and
                                             at intervals after exposure and challenge.

Devaliaetal.     United       8 mild          6 h exposures to combination of 0.4 ppm
(1994)          Kingdom     asthmatics       NO2 and 0.2 ppm SO2.
                                                                                               No significant differences between air
                                                                                               and NO2 exposure.
                                                                                               Increased allergen responsiveness 10 min
                                                                                               after exposure to combination of NO2 and
                                                                                               SO2, but not to individual gases.
                                                                      0.26 ppm NO2 did not enhance
                                                                      nasal inflammatory response to
                                                                      allergen challenge.
                                                                      Small number of subjects limits
                                                                      statistical power.
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           Jenkinsetal.     United       llmild         (1) 6-h exposures to air, 0.1 ppm ozone,
           (1999)          Kingdom     asthmatics       0.2 ppm NO2, and combination followed
                                                        by allergen challenge;
                                                        (2) 3-h exposures to air, 0.2 ppm ozone,
                                                        0.4 ppm NO2, and combination;
                                                        All exposures with intermittent exercise.
                                                                                    All of the second exposure scenarios
                                                                                    (ozone, NO2, and combination), but none
                                                                                    of the first exposure scenarios, resulted in
                                                                                    reduced concentration of allergen causing
                                                                                    a 20% decline in FEVj. Authors
                                                                                    conclude that concentration more
                                                                                    important than total inhaled pollutant.
                                                                      Suggests 0.4 ppm for 3 h with
                                                                      intermittent exercise increases
                                                                      allergen responsiveness.

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 	TABLE AX5.3-2 (cont'd). EFFECTS OF NO2 EXPOSURE ON RESPONSE TO INHALED ALLERGEN
  Reference     Location          Participants              Approach & Methods                       Findings                          Comments
Rusznak et al.
(1996)
United
Kingdom
13 mild asthmatics
6 h exposures to combination of
0.4 ppm NO2 and 0.2 ppm SO2
Increased allergen responsiveness to
combination of NO2 and SO2, 10 min, 24,
and 48 h after exposure.
Confirms findings of Devalia
et al. (1994), thatNO2 + SO2
for 6 h increases allergen
responsiveness.
            Strand et al.      Sweden      18 patients with mild
            (1997)                        asthma, age 18-50 yrs
                                                      Exposure to 0.26 ppm NO2 for
                                                      30 min at rest, allergen challenge 4 h
                                                      after exposure.
                                                                         Late phase, but not early phase, response
                                                                         to allergen enhanced by NO2.
                                                                                                   Suggests 0.26 ppm NO2 for
                                                                                                   30 min at rest increases late
                                                                                                   response.
            Strand et al.      Sweden      16 patients with mild to
            (1998)                        moderate asthma, age
                                         21-52 yrs
                                                      4 daily repeated exposures to
                                                      0.26 ppm NO2 for 30 min at rest.
                                                                         Significant increases in both early and
                                                                         late phase response to allergen after 4th
                                                                         day of exposure.
                                                                                                   Suggests repeated 0.26 ppm
                                                                                                   NO2 at rest increases allergen
                                                                                                   response.
 X
            Tunnicliffe       United       10 nonsmoking mild
            etal. (1994)      Kingdom     asthmatics age
                                         16-60 yrs.
                                         8 subjects completed.
            Wang et al.       United       2 groups of 8 subjects
            (1995a,b)        Kingdom     with allergic rhinitis
                                                      Exposure to air, 0.1 ppm, and
                                                      0.4 ppm NO2 for 1 h at rest,
                                                      separated by at least 1 wk, followed
                                                      by allergen challenge.
                                                      Exposure to 0.4 ppm NO2 (at rest?)
                                                      for 6 h followed by nasal allergen
                                                      challenge and nasal lavage.
                                                                         Post-challenge reduction in FEV! after
                                                                         0.4 ppm NO2 was greater than after air,
                                                                         for both the early (p < 0.009) and late
                                                                         (p< 0.02) responses. No difference in
                                                                         nonspecific airway responsiveness.

                                                                         Increase in myeloperoxidase and
                                                                         eosinophil cationic protein in nasal
                                                                         lavage fluid following allergen challenge.
                                                                                                   Suggests threshold for
                                                                                                   allergen responsiveness effect
                                                                                                   is between 0.1 and 0.4 ppm
                                                                                                   for 1 h resting exposure.
                                                                                                   Suggests enhanced nasal
                                                                                                   inflammatory response to
                                                                                                   allergen with 0.4 ppm.
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            Wang et al.       United       16 subjects with allergic
            (1999)           Kingdom     rhinitis
                                                      Treatment with nasal fluticasone or
                                                      placebo for 4 wks followed by
                                                      exposure to 0.4 ppm NO2 for 6 h,
                                                      allergen challenge, and nasal lavage.
                                                                         Fluticasone suppressed the NO2 and
                                                                         allergen-induced increase in eosinophil
                                                                         cationic protein in nasal lavage fluid.
                                                                                                   Confirms earlier findings of
                                                                                                   this group that 0.4 ppm NO2
                                                                                                   enhances nasal allergen
                                                                                                   response.

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                              TABLE AX5.4-1. EFFECTS OF EXPOSURE TO NO2 WITH OTHER POLLUTANTS
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 Reference     Location     Participants
                        Approach & Methods
                                                                                          Findings
                                         Comments
Devalia et al.   United      8 mild asthmatics   6 h exposures to combination of
(1994)        Kingdom                      0.4 ppm NO2 and 0.2 ppm SO2.
                                                     Increased allergen responsiveness
                                                     10 min after exposure to combination
                                                     of NO2 and SO2, but not to individual
                                                     gases.
                                                                                                                 Small number of subjects
                                                                                                                 limits statistical power.
Drechsler-     Santa       8 older healthy
Parks (1995)   Barbara,     nonsmokers
              CA, USA
                                                     4 2-h exposures with intermittent
                                                     exercise: air, 0.60 ppm NO2,
                                                     0.45 ppm O3, and 0.60 ppm NO2 +
                                                     0.45 ppmO3.
                                                     Significant reduction in cardiac
                                                     output during exercise, estimated
                                                     using noninvasive impedance
                                                     cardiography, with NO2 + O3.
                                                     Symptoms and pulmonary function
                                                     not reported.
                                                                                                                 Suggests cardiac effects of
                                                                                                                 NO2 + O3.  Small number
                                                                                                                 of subjects limits statistical
                                                                                                                 power, has not been
                                                                                                                 replicated.
X
Gong et al.     Downey,    6 healthy
(2005)         CA, USA    nonsmokers and
                          18 ex-smokers
                          with COPD
                                            2 h exposures with intermittent
                                            exercise to:
                                            (1) air,
                                            (2)0.4ppmNO2,
                                            (3) 200 ug/m3 concentrated ambient
                                            paniculate matter (CAPs),
                                            (4) NO2 + CAPs.
                                                                                        Reduced maximum mid-expiratory
                                                                                        flow rate and oxygen saturation with
                                                                                        CAPs exposures; no effects of NO2
                                                                                        alone or additive effect with CAPs.
                                                                                       Exposures not fully
                                                                                       randomized. Small
                                                                                       number of healthy subjects
                                                                                       limits interpretation for
                                                                                       healthy group.
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          Hazucha
          etal. (1994)
          Torres and
          Magnussen
          (1990)
              Chapel
              Hill, NC,
              USA
              Germany
21 healthy female
nonsmokers
14 nonsmoking
mild asthmatics
                                            2 h exposure to air or 0.6 ppm NO2
                                            followed 3 h later by exposure to
                                            0.3 ppm O3, with intermittent
                                            exercise.
NO2 enhanced spirometric responses
and airways responsiveness
following subsequent O3 exposure.
                                            30 min exposures to air, 0.25 ppm     NO2 but not SO2 increased airways
                                            NO2, or 0.5 ppm SO2 at rest followed  responsiveness to SO2 challenge.
                                            15 min later by 0.75 ppm SO2
                                            hyperventilation challenge.
                                                                                                                           0.6 ppm NO2 enhanced
                                                                                                                           ozone responses.
                                   Findings contrast with
                                   Rubenstein et al. (1990).

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                          TABLE AX5.4-1 (cont'd).  EFFECTS OF EXPOSURE TO NO2 WITH OTHER POLLUTANTS
 Reference    Location     Participants
      Approach & Methods
          Findings
         Comments
Koenig et al.   Seattle,     28 asthmatic
(1994)        WA, USA   adolescents; 6
                          subjects did not
                          complete.
Exposure for 90 min with
intermittent exercise to:
(1) 0.12 ppm ozone + 0.3 ppm NO2
(2) 0.12 ppm ozone + 0.3 ppm NO2
68 ug/m3 H2SO4, or
(3) 0.12 ppm ozone + 0.3 ppm NO2
0.05 ppm nitric acid.
No effects on pulmonary
function.
Absence of lung function
effects of 0.3 ppmNO2
consistent with other studies;
no effects of mixtures.
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          Rubenstein     San        9 stable           30 min exposures to air or 0.3 ppm
          etal. (1990)    Francisco,   asthmatics         NO2 with 20 min exercise, followed
                         CA, USA                     1 h later by SO2 inhalation challenge.
                                                                               No effects on pulmonary
                                                                               function or SO2 responsiveness.
                                                                  Findings contrast with Torres
                                                                  and Magnussen et al. (1990).
X
Rudell et al.    Sweden     10 healthy         Air and diesel exhaust for 1 h, with
(1999)                    nonsmokers        and without particle trap. NO2
                                            concentration 1.2-1.3 ppm.  BAL
                                            24 h after exposures.

Rusznak       United      13 mild           6 h exposures to combination of
et al. (1996)    Kingdom    asthmatics         0.4 ppm NO2 and 0.2 ppm SO2.
                                                                                          Increased neutrophils in BAL
                                                                                          fluid, no significant reduction in
                                                                                          effect with particle trap.
                                                                                         Increased allergen
                                                                                         responsiveness to combination
                                                                                         of NO2 and SO2, 10 min, 24, and
                                                                                         48 h after exposure.
                                                                  Filter only partially trapped
                                                                  particles. Unable to draw
                                                                  conclusions about role of NO2
                                                                  in causing effects.

                                                                  Confirms findings of Devalia
                                                                  et al. (1994), that NO2 + SO2
                                                                  for 6 h increases allergen
                                                                  responsiveness.

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35    Frampton, M. W.; Boscia, J.; Roberts, N. J., Jr.; Azadniv, M.; Torres, A.; Cox,  C.; Morrow, P.
36          E.; Nichols, J.; Chalupa, D.; Frasier, L. M.; Gibb, F. R.; Speers, D. M.;  Tsai, Y.; Utell, M.
37          J. (2002) Nitrogen dioxide exposure: effects on airway and blood cells.  Am. J. Physiol.
38          282:L155-L165.
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 1    Frampton, M. W.; Pietropaoli, A. P.; Morrow, P. E.; Utell, M. J. (2006) Human clinical studies
 2          of airborne pollutants. In: Gardner, D. E. Toxicology of the lung. Boca Raton, FL: CRC
 3          Press; pp. 29-82. (Target organ toxicology series).
 4    Gong, H., Jr., Linn, W. S.; Clark, K. W.; Anderson, K. R.; Geller, M. D.; Sioutas, C. (2005)
 5          Respiratory responses to exposures with fine particulates and nitrogen dioxide in the
 6          elderly with and without COPD. Inhalation Toxicol. 17: 123-132.
 7    Hackney, J. D.; Linn, W. S.; Avol, E. L.; Shamoo, D. A.; Anderson, K. R.; Solomon, J. C.;
 8          Little, D. E.; Peng, R.-C. (1992) Exposures of older adults with chronic respiratory illness
 9          to nitrogen dioxide: a combined laboratory and field study. Am. Rev. Respir. Dis. 146:
10          1480-1486.
11    Hazucha, M. J.; Folinsbee, L. J.; Seal, E.; Bromberg, P. A. (1994) Lung function response of
12          healthy women after sequential exposures to NO2 and O^. Am. J. Respir. Crit. Care Med.
13          150: 642-647.
14    Helleday, R.; Sandstrom, T.; Stjernberg, N. (1994) Differences in bronchoalveolar cell  response
15          to nitrogen dioxide exposure between smokers and nonsmokers. Eur. Respir. J.  7: 1213-
16          1220.
17    Helleday, R.; Huberman, D.; Blomberg, A.;  Stjernberg, N.; Sandstrom, T. (1995) Nitrogen
18          dioxide exposure impairs the frequency of the mucociliary activity in healthy subjects.
19          Eur. Respir. J. 8: 1664-1668.
20    Jenkins, H. S.; Devalia, J. L.; Mister, R. L.; Bevan, A. M.; Rusznak, C.; Davies, R. J. (1999) The
21          effect of exposure to ozone and nitrogen dioxide on the airway response of atopic
22          asthmatics to inhaled allergen: dose- and time-dependent effects. Am. J. Respir. Crit.
23          Care Med. 160:33-39.
24    Jorres, R.; Magnussen, H. (1990) Airways response of asthmatics after a 30 min exposure, at
25          resting ventilation, to 0.25 ppm NO2 or 0.5 ppm SO2. Eur. Respir. J. 3: 132-137.
26    Jorres, R.; Magnussen, H. (1991) Effect of 0.25 ppm nitrogen dioxide on the airway response to
27          methacholine in asymptomatic asthmatic patients.  Lung 169: 77-85.
28    Jorres, R.; Nowak, D.;  Grimminger, F.; Seeger, W.; Oldigs, M.; Magnussen, H. (1995) The
29          effect of 1 ppm nitrogen dioxide on bronchoalveolar lavage cells and inflammatory
30          mediators in normal and asthmatic subjects. Eur. Respir. J. 8: 416-424.
31    Kim, S. U.; Koenig, J. Q.; Pierson, W. E.; Hanley, Q. S. (1991) Acute pulmonary effects of
32          nitrogen dioxide exposure during exercise in competitive athletes. Chest 99: 815-819.
33    Koenig, J. Q.; Covert, D. S.; Pierson, W. E.; Hanley, Q. S.; Rebolledo, V.; Dumler, K.;
34          McKinney, S. E. (1994) Oxidant and acid aerosol exposure in healthy subjects and
35          subjects with asthma. Part I: effects of oxidants, combined with sulfuric or nitric acid, on
36          the pulmonary function of adolescents with asthma. Cambridge, MA: Health Effects
37          Institute; pp. 1-36; research report no. 70.
38    Morrow, P. E.; Utell, M. J.; Bauer, M. A.; Smeglin, A. M.; Frampton, M. W.; Cox, C.;  Speers,
39          D. M.; Gibb, F. R. (1992) Pulmonary performance of elderly normal subjects and
40          subjects with chronic obstructive pulmonary disease exposed to 0.3 ppm nitrogen
41          dioxide. Am. Rev. Respir. Dis. 145: 291-300.
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 1    Pathmanathan, S.; Krishna, M. T.; Blomberg, A.; Helleday, R.; Kelly, F. J.; Sandstrom, T.;
 2          Holgate,  S. T.; Wilson, S. J.; Frew, A. J. (2003) Repeated daily exposure to 2 ppm
 3          nitrogen dioxide upregulates the expression of IL-5, IL-10, IL-13, and ICAM-1 in the
 4          bronchial epithelium of healthy human airways. Occup. Environ. Med. 60: 892-896.
 5    Posin, C.; Clark, K.; Jones, M. P.; Patterson, J. V.; Buckley, R. D.; Hackney, J. D. (1978)
 6          Nitrogen dioxide inhalation and human blood biochemistry. Arch. Environ. Health 33:
 7          318-324.
 8    Rasmussen, T. R.; Kjaergaard, S. K.; Tarp, U.; Pedersen, O. F. (1992) Delayed effects of NO2
 9          exposure on alveolar permeability and glutathione peroxidase in healthy humans. Am.
10          Rev. Respir. Dis. 146: 654-659.
11    Rigas, M. L.; Ben-Jebria, A.; Ultman, J. S. (1997) Longitudinal distribution of ozone absorption
12          in the lung: effects of nitrogen dioxide, sulfur dioxide, and ozone exposures. Arch.
13          Environ.  Health 52: 173-178.
14    Rubenstein, I; Bigby, B. G.; Reiss, T. F.; Boushey, H. A., Jr. (1990) Short-term exposure to 0.3
15          ppm nitrogen dioxide does not potentiate airway responsiveness to sulfur dioxide in
16          asthmatic subjects. Am. Rev. Respir. Dis. 141: 381-385.
17    Rudell, B.; Blomberg, A.; Helleday, R.; Ledin, M.-C.; Lundback, B.; Stjernberg, N.; Horstedt,
18          P.; Sandstrom, T. (1999) Bronchoalveolar inflammation after exposure to diesel exhaust:
19          comparison between unfiltered and particle trap filtered exhaust. Occup. Environ. Med.
20          56: 527-534.
21    Rusznak, C.; Devalia, J. L.; Davies, R. J. (1996) Airway response of asthmatic subjects to
22          inhaled allergen after exposure to pollutants. Thorax 51: 1105-1108.
23    Sandstrom, T.; Andersson, M. C.; Kolmodin-Hedman, B.; Stjernberg, N.; Angstrom, T. (1990)
24          Bronchoalveolar mastocytosis and lymphocytosis  after nitrogen dioxide exposure in man:
25          a time-kinetic study. Eur. Respir. J. 3: 138-143.
26    Sandstrom, T.; Stjernberg, N.; Eklund, A.; Ledin, M.-C.; Bjermer, L.; Kolmodin-Hedman, B.;
27          Lindstrom, K.; Rosenhall, L.; Angstrom, T.  (1991) Inflammatory cell response in
28          bronchoalveolar lavage fluid after nitrogen dioxide exposure of healthy subjects: a dose-
29          response study. Eur. Respir. J. 4: 332-339.
30    Sandstrom, T.; Helleday, R.; Bjermer, L.; Stjernberg, N. (1992a) Effects of repeated exposure to
31          4 ppm nitrogen dioxide on bronchoalveolar lymphocyte subsets and macrophages in
32          healthy men. Eur.  Respir. J. 5: 1092-1096.
33    Sandstrom, T.; Ledin, M.-C.; Thomasson, L.; Helleday, R.; Stjernberg, N. (1992b) Reductions in
34          lymphocyte subpopulations after repeated exposure to 1.5 ppm nitrogen dioxide. Br. J.
35          Ind. Med. 49: 850-854.
36    Solomon, C.; Christian, D. L.; Chen, L. L.; Welch, B. S.; Kleinman, M. T.; Dunham, E.; Erie, D.
37          J.; Balmes, J. R. (2000) Effect of serial-day exposure to nitrogen dioxide on  airway and
38          blood leukocytes and lymphocyte subsets. Eur. Respir. J. 15: 922-928.
39    Strand, V.; Salomonsson, P.; Lundahl, J.; Bylin, G.  (1996) Immediate and delayed effects of
40          nitrogen dioxide exposure  at an ambient level on bronchial responsiveness to histamine in
41          subjects with asthma. Eur.  Respir. J. 9: 733-740.
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 1    Strand, V.; Rak, S.; Svartengren, M.; Bylin, G. (1997) Nitrogen dioxide exposure enhances
 2           asthmatic reaction to inhaled allergen in subjects with asthma. Am. J. Respir. Crit. Care
 3           Med. 155: 881-887.
 4    Strand, V.; Svartengren, M.; Rak, S.; Barck, C.; Bylin, G. (1998) Repeated exposure to an
 5           ambient level of NO2 enhances asthmatic response to nonsymptomatic allergen dose. Eur.
 6           Respir. J. 12: 6-12.
 7    Tunnicliffe, W. S.; Burge, P. S.; Ayres, J. G. (1994) Effect of domestic concentrations of
 8           nitrogen dioxide on airway responses to inhaled allergen in asthmatic patients.  Lancet
 9           344:1733-1736.
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14    Vagaggini, B.; Paggiaro, P. L.; Giannini, D.; Franco, A. D.; Cianchetti, S.; Carnevali, S.;
15           Taccola, M.; Bacci, E.; Bancalari, L.; Dente, F. L.; Giuntini, C. (1996) Effect of short-
16           term NO2 exposure on induced sputum in normal, asthmatic and COPD  subjects. Eur.
17           Respir. J. 9: 1852-1857.
18    Wang, J. H.; Devalia, J. L.; Duddle,  J. M.; Hamilton, S. A.;  Davies, R. J. (1995a) Effect of six-
19           hour exposure to nitrogen dioxide on early-phase nasal  response to allergen challenge in
20           patients with a history of seasonal allergic rhinitis. J. Allergy Clin. Immunol. 96: 669-
21           676.
22    Wang, J. H.; Duddle, J.; Devalia, J. L.; Davies, R. J. (1995b) Nitrogen dioxide increases
23           eosinophil activation in the early-phase response to nasal allergen provocation. Int. Arch.
24           Allergy Immunol. 107: 103-105.
25    Wang, J. H.; Devalia, J. L.; Rusznak, C.; Bagnall, A.; Sapsford, R. J.; Davies, R. J. (1999) Effect
26           of fluticasone propionate aqueous nasal spray on allergen-induced inflammatory changes
27           in the nasal airways of allergic rhinitics following exposure to nitrogen dioxide. Clin.
28           Exp. Allergy 29: 234-240.
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 i        AX6.  CHAPTER 6 ANNEX - EPIDEMIOLOGICAL
 2    STUDIES OF HUMAN HEALTH EFFECTS ASSOCIATED
 3     WITH AMBIENT OXIDES OF NITROGEN EXPOSURE
 4
 5
 6         This annex provides supplemental information on various epidemiologic methods and
 7   studies that are referenced in the oxides of nitrogen integrated science assessment.  The first
 8   section describes considerations in the interpretation of epidemiologic studies.  This is followed
 9   by a section on cardiovascular effects that are associated with short-term exposure to nitrogen
10   dioxide (NO2). This topic is discussed in the Integrated Science Assessment (ISA), but more
11   detail is provided in this annex due to inconsistency with supporting studies. The second section
12   of this annex presents tables detailing the epidemiologic studies presented in the ISA.  In general,
13   these tables are divided into sections based on the endpoint of concern. Tables AX6.1 through
14   AX6.4 cover respiratory endpoints, while tables in section AX6.5 address cardiovascular disease.
15   The two tables in AX6.6 cover heart rate variability, section AX6.7 addresses birth weight, AX
16   6.7 looks at lung function, AX6.9 focuses on lung cancer, and lastly, table AX6.10 covers
17   mortality.
18
19
20   AX6.1     CONSIDERATIONS IN THE INTERPRETATION OF
21              EPIDEMIOLOGIC STUDIES OF OXIDES OF NITROGEN
22              HEALTH EFFECTS
23         Issues and questions arising from the study designs and analysis methods used in the
24   assessment of NC>2 effect estimates will be presented briefly in this section. Study design can
25   restrict the health effect parameters that can be estimated. Separate considerations need to be
26   made for acute versus chronic effect studies, as well as individual- versus aggregate-level
27   analyses.  Time-series studies and panel studies are most frequently conducted in air pollution
28   epidemiologic research. Aggregate-level exposure data are often used in these types of studies.
29   Time series studies also use aggregate level health outcome data while panel studies collect
30   individual level data on health outcomes.  Analyses using administrative health outcome data
31   (e.g., numbers of deaths and emergency hospital admissions) have inherent limitations as well as
32   strengths (Virnig and McBean, 2001). The impact of study design or the loss of information due
33   to aggregation depends on the source of exposure (Sheppard et al., 2005).

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 1          This section mainly focuses on the topics of exposure assessment and model specification
 2    in air pollution epidemiologic studies. Potential biases that may result from NC>2 exposure
 3    measurement error and from the choice of exposure index and lag period are discussed first.
 4    Model specification issues and potential confounding by temporal factors, meteorological
 5    effects, seasonal trends, and copollutants are then discussed.
 6
 7    AX6.1.1   Exposure Assessment and Measurement Error in Epidemiologic
 8               Studies and Related Surrogate Discussion
 9          In many air pollution epidemiologic studies, especially time-series studies with
10    administrative data on mortality and hospitalization outcomes, data from central ambient
11    monitoring sites generally are used as the estimate of exposure. Personal exposures of individual
12    study subjects generally are not directly measured in epidemiologic studies. The relation
13    between NO2 concentrations from ambient monitors and personal NC>2 exposures was discussed
14    previously (Chapter 2). Routinely collected ambient monitor data, though readily available and
15    convenient,  may not represent true personal exposure, which includes both ambient and
16    nonambient (i.e., indoor)  source exposures. Also, personal exposure measurements may or may
17    not be subject to the same artifacts as the ambient measurements.  Therefore, they may not be
18    measuring the same quantities.
19          Zeka and Schwartz (2004) state that each pollutant, as measured  at a central site in each
20    city, is a surrogate for exposure to the same pollutant. However, Sarnat  et al. (2001) have
21    proposed that ambient concentration of gaseous air pollutants may be serving as a surrogate not
22    for exposure to the gas itself, but for exposure to ambient PM from sources where NO2 is
23    primarily a surrogate for particles from traffic.  These data are specific to the data in the  Sarnat
24    et al. (2001) study.  Studies in other cities provide different results. In Boston, Sarnat et al.
25    (2005) noted seasonal differences in the relationship and stronger associations between ambient
26    NC>2 and personal NC>2. Another aspect is noted by Gilbert et al. (2005)  who report regression
27    models including traffic and land-use variables to provide exposure estimates for epidemiologic
28    studies that they state may be more representative than the fixed monitors.
29          Studies evaluating exposure to NC>2 that recorded indoor environment measurements
30    report air exchange rates (AERs) of 0.49/h versus 0.85/h for heating versus non-heating  season
31    noting significant univariate predictors of indoor concentrations to include outdoor NC>2  levels
32    and AERs. Indoor sources of NC>2 include gas cooking and heating.  Outdoor NC>2 levels are

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 1    impacted by combustion sources and vehicular traffic emissions and related to distance to
 2    major highways.
 3          In considering exposure error, it should be noted that total personal  exposure can be
 4    partitioned into two types of sources, ambient and nonambient.  Sheppard (2005) notes that
 5    nonambient source exposures typically vary across individuals, but the community averages do
 6    not vary across communities. In addition, nonambient exposures are not likely to have strong
 7    temporal correlations. In contrast, ambient concentrations across individuals should be highly
 8    correlated, as they tend to vary over time similarly for everyone because of changes in source
 9    generation, weather, and season. The independence of ambient and non-ambient exposure
10    sources has important implications.  Sheppard et al. (2005) observe that when ambient and
11    nonambient sources are independent, exposure variation due to nonambient source exposures
12    behaves like Berkson measurement error and does not bias the effect estimates.
13          A simulation study by Sheppard et al. (2005)  also considered attenuation of the risk based
14    on personal behavior, their microenvironment, and the qualities of the pollutant in time-series
15    studies.  Of particular interest is their finding that significant variation in nonambient exposure or
16    in ambient source exposure that is independent of ambient concentration does not further bias the
17    effect estimate. In other words, risk estimates were not further attenuated in time-series studies
18    even when the correlations between personal exposures and ambient concentrations were weak.
19          In the case of NO2, there are nonambient indoor sources; thus, the nonambient source
20    exposures may be independent from ambient source exposures depending on the exchange rate.
21    However, unlike PM, NC>2 is a reactive pollutant, while less so than Os. In applying these
22    conclusions to NC>2, an additional assumption needs to be made, i.e., that its chemical reactivity
23    does not introduce strong temporal correlations.
24          Other complications for NO2 in the relationship between personal exposures and ambient
25    concentrations include expected strong seasonal variation of personal behaviors and building
26    ventilation practices that can modify exposure. Also, there may be potential differential errors
27    based on different measurement techniques for ambient and personal measurement. In addition,
28    the relationship may be  affected by temperature (e.g., high temperature may increase air
29    conditioning use, which may reduce NO2 penetration indoors), further complicating the role of
30    temperature as a confounder of NO2 health effects. It should be noted that the pattern of
31    exposure misclassification error and influence of confounders may differ across the outcomes of

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 1    interest as well as in susceptible populations and by study design. For example, those who may
 2    be suffering from chronic cardiovascular or respiratory conditions may be in a more protective
 3    environment (i.e., with less exposure to both NO2 and its confounders, such as temperature and
 4    PM) than those who are healthy.
 5          As discussed thoroughly in the 2004 PM AQCD (Section 8.4.5), the resulting exposure
 6    measurement error and its effect on the estimates of relative risk must be considered. In theory,
 7    there are three components  to exposure measurement error in time-series studies as described by
 8    Zeger et al. (2000):  (1) the use of average population rather than individual exposure data;
 9    (2) the difference between average personal ambient exposure and ambient concentrations at
10    central monitoring sites; and (3) the difference between true and measured ambient
11    concentrations. The first error component, having aggregate rather than individual exposure
12    data,  is a Berksonian measurement error, which in a simple linear model increases the standard
13    error, but does not bias the risk estimate. The second error component resulting from the
14    difference between average personal ambient exposure and outdoor ambient concentration level
15    has the greatest potential to introduce bias. If the error is of a fixed  amount (i.e., absolute
16    differences do not change with increasing concentrations), there is no bias.  However, if the error
17    is not a fixed difference, this error will likely attenuate the NO2 risk estimate as personal NO2
18    exposures are generally lower than ambient NO2 concentrations in homes without sources, while
19    they are higher in homes with sources. The third error component, the instrument measurement
20    error in the ambient levels, is referred to as nondifferential measurement error and while unlikely
21    to cause substantial bias, can lead to a bias toward the null.
22          The impact of exposure measurement error on NO2 effect estimates was  demonstrated in
23    a study by Kim et al. (2006) that is a longitudinal study investigating personal exposures to NO2,
24    PM2 5, and CO for cardiac compromised individuals in Toronto, Canada.  The mean (SD)
25    personal exposure for NO2 was 14 ppb (6). NO2 personal exposures were less than central-fixed-
26    site ambient measurements.  Ambient NO2 was correlated with the personal NO2 (median
27    Spearman's correlation coefficient of 0.57). Personal exposures to PM2.5 were correlated with
28    the personal exposure to NO2 (median Spearman's correlation coefficient of 0.43). This study
29    suggests that central-fixed-site measurements of PM2 5 and NO2 may be treated as surrogates for
30    both exposure to PM2 5 and NO2 in time-series epidemiology studies and that NO2 is a potential
31    confounder of PM2 5 and vice versa.  Nerriere et al. (2005) proved more data from European

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 1    cities, noting some differences by city and impact of indoor sources and activity patterns and
 2    recommend a site-specific analysis for a specific study.
 3          Zidek (1997) noted that a statistical analysis must balance bias and imprecision (error
 4    variance).  Ignoring measurement error in air pollution epidemiologic studies often results in
 5    underestimated risk estimates and standard errors.
 6          In addition to overestimation of exposure and the resulting underestimation of effects, the
 7    use of ambient NO2 concentrations may obscure the presence of thresholds in epidemiologic
 8    studies at the population level. Using PM2.5 as an example, Brauer et al. (2002) examined the
 9    relationship between ambient concentrations and mortality risk in a simulated population with
10    specified common individual threshold levels. They found that no  population threshold was
11    detectable when a low threshold level was specified. Even at high-specified individual threshold
12    levels, the apparent threshold at the population level was much lower than specified. Brauer
13    et al. (2002) concluded that surrogate measures of exposure (i.e., those from centrally-located
14    ambient monitors) that were not highly correlated with personal exposures obscured the presence
15    of thresholds in epidemiologic studies at the population level, even if a common threshold exists
16    for individuals within the population.
17          As discussed in Chapter 3, NO2 concentrations measured at central ambient monitors
18    may explain, at least partially, the variance of individual personal exposures; however, this
19    relationship is influenced by factors such as air exchange rates in housing and time spent
20    outdoors, which may vary by city.  Other studies conducted in various cities observed that the
21    daily averaged personal NO2 exposures from the population were well correlated with monitored
22    ambient NO2 concentrations, although substantial variability existed among the personal
23    measurements. Thus, there is supportive evidence that ambient NO2 concentrations from central
24    monitors may serve as valid surrogate measures for mean personal  NO2 exposures experienced
25    by the population, which is of most relevance to time-series studies (See Chapter 3). Respiratory
26    hospital  visit and admission studies are influenced by the visits and admission of asthmatics. In
27    children, for whom asthma is more prevalent, ambient monitors may correlate to some extent
28    with personal exposure to NO2 of ambient origin because children spend more time outdoors in
29    the warm season and have an increased potential for exposure due to traffic. However, of some
30    concern  for mortality and hospitalization time-series studies is the extent to which ambient NO2
31    concentrations are representative of personal NO2 exposures in another particularly susceptible

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 1    group of individuals, the debilitated elderly, as the correlation between the two measurements
 2    has not been examined in this population.  A better understanding of the relationship between
 3    ambient concentrations and personal exposures, as well as of the factors that affect the
 4    relationship will improve the interpretation of ambient concentration-population health response
 5    associations observed.
 6           Existing epidemiologic models may not fully take into consideration all the biologically
 7    relevant exposure history or reflect the complexities of all the underlying biological processes.
 8    Using ambient concentrations to determine exposure may overestimate true personal NO2
 9    exposures (depending on indoor sources), resulting in biased descriptions of underlying
10    concentration-response relationships (i.e., in attenuated risk estimates). The implication is that
11    the effects being estimated occur at exposures that are uncertain and the potency of NO2 is
12    different than these effect estimates indicate.  As very few studies evaluating NO2 health effects
13    with personal NO2 exposure measurements exist in the literature, effect estimates determined
14    from ambient NO2 concentrations must be evaluated and used with caution to assess the health
15    risks of NO2.  Ambient NO2 levels are regulated  and can consist of exposure to NO2 in the
16    ambient air and NO2 exposure to NO2 of ambient origin in vehicles or indoors as opposed to
17    personal NO2 levels.
18           The question of what the NO2 measurements made at ambient monitoring sites represent
19    impacts the interpretation of epidemiology studies where the exposure estimate is derived from
20    such data. Time-series studies for hospitalization and mortality that show a relationship with
21    such measurements must be interpreted with this question in mind.  For example, if the NO2
22    measurement is a surrogate for some other pollutant such as particles or, more generally, a
23    traffic-related mix, what interpretations are possible? Further, if not related to NO2 levels but for
24    some unmeasured mixture, how is this quantified? Additionally, the discussion and data related
25    to surrogates for NO2 in the literature are not quantitative or extensively researched, but do
26    provide a hypothesis for the relationships observed.  Obviously, other data from clinical studies
27    and animal toxicology became important in interpreting the meaning of the relationship. Also,
28    epidemiology studies that use personal exposure  measurements related to health outcomes
29    providing direct evidence of an association between exposure to NO2 and respiratory health
30    unconfounded by surrogate issues or copollutants are very informative in this evaluation.
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 1          The ultimate goal of the NO2 NAAQS is to set a standard for the ambient level, not
 2    personal exposure level, of NC>2. Confidence in the use of ambient concentrations in
 3    epidemiologic studies is greatly strengthened if they are shown to be associated with personal
 4    exposures. However, until more data on personal NO2 exposure become available, the use of
 5    routinely monitored ambient NC>2 concentrations as a surrogate for personal exposures is not
 6    generally expected to change the principal conclusions from NC>2 epidemiologic studies. An
 7    issue to be addressed is if estimates of NC>2 exposure are a surrogate for another pollutant and/or
 8    a surrogate for NC>2. Evidence related to this will be presented in this chapter. More discussion
 9    evaluating this will be presented in the ISA.  Therefore, population health risk estimates derived
10    using ambient NC>2 levels from currently available observational studies (with appropriate
11    caveats taking into account personal exposure considerations) remain useful. These conclusions
12    must be evaluated to better determine associated uncertainties.
13
14    AX6.1.2   NOi Exposure Indices Used
15          The NO2 related effect estimates for mortality and morbidity health outcomes are usually
16    presented in this document as a  relative risk,  i.e., the risk rate relative to a baseline mortality or
17    morbidity rate. Relative risks are based on an incremental change in exposure. To enhance
18    comparability between studies, presenting these relative risks by a uniform exposure increment is
19    needed.  However, determining a standard increment is complicated by the use of different NC>2
20    exposure indices in the existing health studies.  The daily NC>2 exposure indices that most often
21    appear in the literature are the maximum 1-h average within a 24-h period (1-h max) and 24-h
22    average (24-h avg) concentrations. As levels are lower and less variable for the longer averaging
23    times, relative risks of adverse health outcomes for a specific numeric concentration range are
24    not directly comparable across metrics.  Using the nationwide distributional data for NC>2
25    monitors in U.S. Metropolitan Statistical Areas, increments representative of a low-to-high
26    change in NC>2 concentrations were approximated on the basis of annual mean to 95th percentile
27    differences (Langstaff, 2006), as follows:
                     Daily Exposure Index
                     l-havgNO2            30
                     24-h avg NO2           20
                     2-wk avg NO2	2p_
Exposure Increment (ppb)
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 1          In the following chapter sections, efforts were made to standardize the NO2 risk estimates
 2    using these increments, except as noted.  The specified incremental change for each daily NO2
 3    exposure index ensures that risk estimates are comparable across the different metrics.  The
 4    different increments for each NC>2 exposure index do not represent inconsistencies; rather, they
 5    are appropriately scaled to facilitate comparisons between the various studies that used different
 6    indices. Note that in the Chapter 6 Annex Tables (see Annex Section AX6.1), effect estimates
 7    are not standardized; there, the results are presented in the tables as reported in the published
 8    papers.
 9
10    AX6.1.3   Lag Time:  Period between NO2 Exposure and Observed Health
11               Effect
12          Exposure lags may reflect the distribution of effects across time in a population and the
13    potential mechanisms of effects.  The choice of lag days for the relationship between exposure
14    and health effects depends on the hypothesis being tested and the mechanism involved in the
15    expression of the outcome. Effects can occur acutely with exposure on the same or previous day,
16    cumulatively over several days, or after a delayed period of a few days. With knowledge of the
17    mechanism of effect, the choice of lag days can be determined prior to analysis.  As one
18    example, one could expect cough to occur acutely after  exposure with a lag of 0 or 1  day, given
19    that NO2 can act as a short-term irritant.  However, an NCVrelated inflammatory response may
20    not lead to asthma exacerbation until several days later.  An asthmatic may be impacted by NO2
21    on the first day  of exposure, have further effects triggered on the second day, and then report to
22    the emergency room for an asthmatic attack three days after exposure.  Further, within a
23    population of asthmatics, exacerbation of asthma symptoms may be observed over a period of
24    several days, since each asthmatic may have varying individual aspects of the disease and may
25    be affected by the exposure differently depending on his/her sensitivity and disease severity.
26    The results from controlled human studies may be useful in assessing the adequacy of lags for
27    some respiratory health outcomes.
28          The concepts of lags are well discussed in the O3 AQCD (2006) and are only briefly
29    reviewed here, as the concept for Os pertains to NC>2 as  well.  Selection of lag periods should
30    depend on the hypothesis of the study and the potential  mechanism of the effect. When the
31    mechanism of the health effect is unknown, investigating the association between outcome and
32    exposure using  cumulative distributed lag models may be informative.  Analyzing a large

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 1    number of lags and simply choosing the largest and most significant results may bias the air
 2    pollution risk estimates away from the null. Most studies have shown that NC>2 has a fairly
 3    consistent, immediate effect on health outcomes, including respiratory hospitalizations and
 4    mortality. Several studies also observed significant NO2 effects over longer cumulative lag
 5    periods,  suggesting that in addition to single-day lags, multiday lags should be investigated to
 6    fully capture a delayed NO2 effect on health outcomes. In this document, discussion largely
 7    focuses on effect estimates from 0- and 1-day lags, with some consideration of cumulative,
 8    multiday lag effects. It is not straightforward to compare and contrast results from single-day
 9    versus multiday lag models, because the parameters estimated from these models are not the
10    same.  These complications need to be taken into consideration when interpreting results from
11    various lag models.
12
13    AX6.1.4   Model Specification to Adjust for Temporal Trends and
14               Meteorological Effects
15          Several challenges are encountered with respect to designing and interpreting time-series
16    studies.  The principal challenge facing the analyst in the daily time-series context is avoiding
17    bias due to confounding by short-term temporal factors operating over time scales from days to
18    seasons, thus adjusting for long-term trends in the evaluation of acute or short-term associations.
19    In the current regression models used to estimate short-term effects of air pollution, two major
20    potential confounders generally need to be considered: (1) seasonal trend and other "long-wave"
21    temporal trends; and (2) weather effects. Both of these variables tend to predict a significant
22    fraction  of fluctuations in time-series.
23          Current weather models used in time-series analyses can be classified by their use of:
24    (1) quantile (e.g., quartile, quintile) indicators; (2) parametric functional forms such as V- or
25    U-shape functions; and (3) parametric (e.g., natural splines) or nonparametric (e.g., locally
26    estimated smoothing splines [LOESS]) smoothing functions.  More recent studies tend to use
27    smoothing functions.  While these methods provide flexible ways to fit health outcomes as a
28    function of temperature and other weather variables, there are two major issues that need further
29    examination to enable more meaningful interpretation of NC>2 morbidity and mortality effects.
30          The  first issue is the interpretation of weather or temperature effects.  Most researchers
31    agree about the morbidity and mortality effects of extreme temperatures (i.e., heat waves or cold
32    spells). However, as extreme hot  or cold temperatures, by definition, happen rarely, much of the

      March 2008                             AX6-9      DRAFT-DO NOT QUOTE OR CITE

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 1    health effects occur in the mild or moderate temperature range. Given the significant correlation
 2    between NO2 and temperature, ascribing the association between temperature and health
 3    outcomes solely to temperature effects may underestimate the effect of NO2.  The second issue is
 4    that weather model specifications are fitted for year-round data in most studies.  Such models
 5    will ignore the correlation structure that can change across seasons, resulting in inefficiency and
 6    model mis-specification. This is particularly important for NC>2, which appears to change its
 7    relationship with temperature as well as with other pollutants across seasons.
 8           This changing relationship between NC>2 and temperature, as well as between NO2 and
 9    other pollutants across seasons, and its potential implications for health effects modeling have
10    not been examined thoroughly in the time-series literature.  Even the flexible smoother-based
11    adjustments for seasonal and other time-varying variables cannot fully take into account these
12    complex relationships. One obvious way to alleviate or avoid this complication is to analyze
13    data by season. While this practice reduces sample size, its extent would not be as serious as for
14    PM (which is collected only every sixth day in most locations) because NC>2 is collected daily.
15    An alternative approach is to include separate NC>2 concentration variables for each season (by
16    multiplying NC>2  concentrations by a season indicator variable).  However, this approach
17    assumes that all effects in the model that are not indicated to be season-specific do not vary
18    seasonally.
19           In locations where seasonal variability may be a factor, NC>2 effect estimates calculated
20    using year-round data can be misleading, as the changing relationship between NO2,
21    temperature, and other pollutants across seasons may have a significant influence on the
22    estimates.  Analyses have indicated that confounding from seasonal variability may be controlled
23    effectively by stratifying the data by season.
24
25    AX6.1.5   Confounding Effects of Copollutants
26           Extensive discussion of issues related to confounding effects among air pollutants in
27    time-series studies are provided in Section 8.4.3 of the 2004 PM AQCD (U.S. Environmental
28    Protection Agency, 2004).  Since the general issues discussed there are applicable to all
29    pollutants, such discussions are not repeated here.
      March 2008                             AX6-10      DRAFT-DO NOT QUOTE OR CITE

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 1    AX6.1.6  Generalized Estimating Equations (GEE)
 2           Since the publication of the 1993 NC>2 AQCD (U.S. Environmental Protection Agency,
 3    1993), methods have been improved to analyze panel and longitudinal studies.  The general
 4    mixed model method of Stiratelli et al. (1984) was an improvement over the method of Korn and
 5    Whittemore (1979) in that all the data could be used, including that from subjects with
 6    insufficient data to permit fitting of a separate logistical regression model.  Generalized
 7    Estimating Equations, Liang and Zeger (1986) is an extension of generalized linear models. The
 8    joint distribution of the subject's observations does not have to be specified to derive the
 9    estimating equations. This is avoided by assuming a marginal distribution at each time.
10    However, a covariate that is constant for a subject cannot be included in this model. Besides
11    Gaussian outcome variables, the method can also be used for binomial or Poisson variables.
12
13    AX6.1.7  Hypothesis Testing and Model Selection in NO2 Epidemiologic
14               Studies
15           Epidemiologic studies investigated the association between various measures of NO2
16    (e.g., multiple lags, different metrics, etc.) and various health  outcomes using different model
17    specifications.  Statistically testing a null hypothesis (i.e., there is no effect of NCh) requires one
18    to calculate the value of a test statistic (i.e., the t-value).  If the observed test statistic exceeds a
19    critical value (oftentimes the 95th percentile) or  is outside a range of values, the null hypothesis
20    is rejected. However, when multiple testing is done using a critical value determined for a single
21    test, the chance that at least one of the hypotheses is significant may be greater than the specified
22    error rate.  Procedures are available to ensure that the rejection error rate does not exceed the
23    expected error rate (usually 5%) when conducting multiple hypothesis testing. However, often
24    the multiple hypotheses being tested are not statistically independent, thus  some corrections,
25    such as the Bonferroni adjustment, may be overly conservative.
26           Multiple hypothesis testing and model selection also contribute to publication bias.
27    Publication bias is the tendency of investigators  to submit and/or editors to accept manuscripts
28    for publication based on the strength  of the study findings.  Although publication bias commonly
29    exists for many topics of research, it may be present to a  lesser degree in the air pollution
30    literature.  Several air pollutants often are examined in a  single study, leading to the publication
31    of significant, as well as nonsignificant, individual pollutant results. For example, many air
32    pollution papers with a focus on PM health effects also published NO2 results. NO2 was largely

      March 2008                              AX6-11       DRAFT-DO NOT QUOTE OR CITE

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 1    considered a potentially confounding copollutant of PM; thus, NC>2 effect estimates were often
 2    presented regardless of the statistical significance of the results.  Another aspect of publication
 3    bias is only selecting the largest or statistically strongest effect estimate to report and not the
 4    array of models evaluated. See a full discussion in the Os AQCD (U.S. Environmental
 5    Protection Agency, 2006).
 6          The summary of health effects in this chapter is vulnerable to the errors of publication
 7    bias and multiple testing. Efforts have been made to reduce the impact of multiple testing errors
 8    on the conclusions in this document. To address multiple hypothesis testing, emphasis will be
 9    placed in this chapter on a priori hypotheses. As identifying a priori hypotheses is difficult in the
10    majority of the studies, the most common hypotheses will be considered.  For example, although
11    many studies examined multiple single-day lag models, priority would be given to effects
12    observed at 0- or 1-day lags rather than at longer lags.  Both single- and multiple-pollutant
13    models that include NC>2 will be considered and examined for robustness of results. Analyses of
14    multiple model specifications for adjustment of temporal or meteorological trends will be
15    considered sensitivity analyses. Sensitivity analyses shall not be granted the same inferential
16    weight as the original hypothesis-driven analysis; however, these analyses will be discussed in
17    this chapter as appropriate given their valuable insights that may lead scientific knowledge in
18    new directions.
19
20    AX6.1.8   Impact of Generalized Additive Models Convergence Issue on NO2
21               Risk Estimates
22          Generalized Additive Models (GAM) have been widely utilized for epidemiologic
23    analysis of the health effects attributable to air pollution.  The impact of the GAM convergence
24    issue was thoroughly discussed in Section 8.4.2 of the 2004 PM AQCD. Reports have indicated
25    that using the default convergence criteria in the Splus software package for the GAM function
26    can lead to biased regression estimates for PM and an underestimation of the standard error of
27    the effect estimate (Dominici et al., 2002; Ramsay et al., 2003).  The GAM default convergence
28    criterion in the Splus software package is 10 and a maximum number of 10 iterations.  The user
29    can specify convergence criteria, that is orders of magnitude smaller than the default value and
30    can also allow for many more iterations before terminating the program. The use of the default
31    convergence criterion was found to be a problem when the estimated relative risks were small
32    and two or more nonparametric smoothing curves were included in the GAM (Dominici et al.,

      March 2008                             AX6-12       DRAFT-DO NOT QUOTE OR CITE

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 1   2002). The magnitude and direction of the bias depend in part on the concurvity of the
 2   independent variables in the GAM and the magnitude of the risk estimate. Recent focus has
 3   been on the influence of the GAM function on effect estimates for PM.
 4          The GAM convergence problem appears to vary depending on data sets, and likely
 5   depends upon the intercorrelation among covariates and the magnitude of the risk estimate; thus,
 6   its impact on the results of individual studies cannot be known without a reanalysis. Consistent
 7   with the approach used in the 2004 PM AQCD, the results from studies that analyzed data using
 8   GAM with the default convergence criterion and at least two nonparametric smoothing terms are
 9   generally not considered in this chapter, with some exceptions as noted.
10
11
12   AX6.2   CARDIOVASCULAR EFFECTS ASSOCIATED WITH  SHORT-
13             TERM NO2  EXPOSURE
14
15   AX6.2.1  Studies Hospital Admissions and ED Visits for Cardiovascular
16              Disease (CVD)
17
18   AX6.2.1.1  All  CVD (ICD9 390-459)
19          Results of studies of short-term NC>2 exposure and hospitalization or ED visits for CVD
20   are summarized in Figure AX6.2-1. Studies of both 1-h maximum NC>2 level and 24-h average
21   NC>2 level are included.  With the exception of lag  1 results reported by Jalaludin et al. 2006,
22   most point estimates are positive with confidence limits excluding the null value. Jalaludin et al.
23   report a lag 0 cool season relative risk (not pictured) of 1.09 (95%CI: 1.05, 1.13) per 30 ppb
24   increase in 1 hour maximum NC>2 level (Jalaludin et al., 2006).  (Note that the IQR reported by
25   Jalaludin et al. is 9.3 ppb so the 30-ppp increase into which the results were standardized may be
26   unlikely in Sydney, where the study was conducted.) Although results for cardiovascular
27   diseases were not tabulated for a reanalysis of GAM impacted study of Los Angeles and Cook
28   County hospital admissions, authors note that they  observed an association of NC>2 with CVD
29   hospital admissions in the  reanalyses (Moolgavkar, 2003.  The association was diminished with
30   the use of increasingly stringent convergence criteria, however (Moolgavkar, 2003).
     March 2008                            AX6-13      DRAFT-DO NOT QUOTE OR CITE

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      Reference
      Linn et al. (2000)
      Metzger et al. (2004)*
      Tolbertetal.(2007)*
      Baliesteretal. (2006)
      Andersen et al. (2007a)
      Andersen et al. (2007b)
      Atkinson etal. (1999a)*
      Atkinson et a!. (1999a)*
      Baliesteretal. (2001)*
      Poloniecki etal. (1997)
      Barnett etal. (2006)
      Barnett et al. (2006)
      Hinwood et al. (2006)
      Hinwood et al. (2006)
      Jalaludinetal. (2006)*
      Jalaludin et al. (2006)*
      Jalaludin et al (2006)*
      Chang et al. (2005)
      Chang et al. (2005)
      Wong etal. (1999)
      Wong etal. (1999)
      Yang et al. (2004a)
      Yang et al. (2004a)
                                                                         Relative risk

     Figure AX6.2-1.     Relative risks (95% CI) for associations of 24-h NO2 (per 20 ppb) and
                           daily 1 hour maximum NOi* with hospitalizations or emergency
                           department visits for all cardiovascular diseases (CVD). Primary
                           author and year of publication, city, stratification variable(s), and lag
                           are listed.  Results for lags 0 or 1 are presented, as available.
Location Season
Metro LA
Atlanta
Atlanta
Spain
Copenhagen
Copenhagen
London
London
Valencia
London
Australia Multicity
Australia Multicity
Perth
Perth
Sydney
Sydney
Sydney
Taipei Warm
Taipei Cold
Hong Kong
Hong Kong
Kaohsiung Warm
Kaohsiung Cool


Age Lag
All ages 0
All ages 3d av .
All ages 0-2
All ages 0-1
65 + 0-3
65 + 0-3 .
0-64 0
65+ 0
All ages 0
All ages 1
65+ 0-1
15-64 0-1
65+ 1
All ages 1
65+ 0
65+ 1
65+ 0-1
All ages 0-2
All ages 0-2
5-64 0-1
65+ 0-1 .
All ages 0-2
All ages 0-2

1
1
ff
1
4L
4-
|

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1
ll
Hh
^_
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_!_
	 , 	
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1 1 1 1 1 1 1
.9 1.1 1.3 1.5 1.7 1.9 2.1 2.32.52.72
1    AX6.2.1.2  Ischemic Heart Disease (IHD) ICD9 410-414
2           Studies that further narrow the cardiac disease grouping to evaluate Ischemic Heart
3    Diseases (IHD) are summarized in Figure AX6.2-2. Several US studies examined the
4    association of ambient NO2 level with IHD (Ito, 2004; Mann et al. 2002; Metzger et al. 2004;
     March 2008
AX6-14
DRAFT-DO NOT QUOTE OR CITE

-------
     Reference
     Lippmannet al. (2000)
     !to (2004)
     Mann et al. (2002)
     Mann et al. (2002)
     Mann et al. (2002)
     Mann et al. (2002)
     Metzgeretai. (2004)*
     Peel et al. (2007)*
     Peel et al. (2007)*
     Atkinson etal.(1999a)*
     Atkinson etal. (1999a)*
     Poloniecki et al. (1997)
     Barnett et a!. (2006)
     Barnett et al. (2006)
     Simpson et al. (2005a,b)*
     Simpson et al. (2005a,b)*
     Jalaludin et al. (2006)*
     Jalaludinetal. (2006)*
     Jalaludin etal. (2006)*
     Wong etal. (1999)
Location
Ontario
Ontario
South Coast Air Basin
South Coast Air Basin
South Coast Air Basin
South Coast Air Basin
Atlanta
Atlanta
Atlanta
London
London
London
Australia, NZ
Australia, NZ
Australia, Multicity
Australia, Multicity
Sydney
Sydney
Sydney
Hong Kong
Disease Age
All Ages
All Ages
All Ages
All Ages
Arrhythmia All Ages
CHF All Ages
No Secondary All Ages
AIIIHD All Ages
All Ages
Hypertension 0-64
Diabetes 65+
All Ages
65+
15-64
All Ages
65+
65+
65+
65+
All Ages
Lag
1.01
0.98 .
1.02
1.02 .
1.03 .
1.02
1.03 .
1.04
1.00 .
1.02 .
1.03 .
1.00
1.03 .
1.01 .
1.00 .
1.00 .
1.02
1.01 .
1.02 .
1.01 .





H






-1-
i
tt
+
1


I—






	

I I
9 1.1
     Figure AX6.2-2.
                                                                       Relative risk

                      Relative risks (95% CI) for associations of 24-h NOi (per 20 ppb) and
                      daily 1 hour maximum NO2* (per 30 ppb) with hospitalizations for
                      Ischemic Heart Disease (IHD). Primary author and year of
                      publication, city, stratification variable(s), and lag are listed. Results
                      for lags 0 or 1 are presented, as available.
4
5
6
Peel et al. 2007). Ito (2004) reports a null association of 24-h average NO2 level with IHD
admissions in Ontario where the mean ambient level was 21.3 ppb.  Mann et al. (2002) examined
the association of 24-h average NO2 level with IHD and secondary diagnoses of arrhythmia, IHD
and secondary diagnosis of CHF, IHD and no secondary diagnosis, and all IHD regardless of
secondary diagnosis in single pollutant models.  The authors note that the strongest effect
observed (IHD with secondary diagnosis of CHF) may have been driven  by the MI primary
     March 2008
                                           AX6-15
DRAFT-DO NOT QUOTE OR CITE

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 1    diagnoses. The 24-h average NO2 level in the South Coast Air Basin of California, where this
 2    study was conducted was approximately 37 ppb.  This study was novel in that exposure level
 3    was assigned based on the zip code of the health insurance participant and proximity to the
 4    monitoring station (Mann et al., 2002).  A non-significant increased risk of ED visit for IHD was
 5    observed in single pollutant models, among those with hypertension but not diabetes in a study
 6    conducted in Atlanta where the daily 1-h maximum NC>2 level is approximately 46 ppb (Peel
 7    et al., 2007).
 8          Two studies of IHD and hospital admissions conducted in Europe have produced
 9    conflicting results (Atkinson et al., 1999a; Poloniecki et al., 1997).  Atkinson et al. (1999a)
10    reports a significant increase in IHD admission in a study in London.  A study conducted in
11    Helsinki reports an association of NO with both hospitalization and ED visits for IHD while no
12    association with NC>2 was observed (Ponka and Virtanen,  1996). In addition, Several Australian
13    studies, including two multicity studies, support an association of hospital admissions and
14    emergency visits for IHD and ambient NC>2 level among older adults in single pollutant models
15    (Jalaludin et al., 2006; Barnett et al., 2006; Simpson et al., 2005a,b). One study conducted in
16    Hong Kong reports slightly elevated non-significant association of IHD with 24-h average NO2
17    level (Wong et al., 1999).  In addition, Lee et al. (2003a) report an increase in IHD admissions
18    associated with 24-h NO2 level at lag 5.
19
20    AX6.2.1.3  Hospital Admissions for Myocardial Infarction (MI) (ICD9 410)
21          Studies of hospital admissions for MI are summarized in Figure AX6.2-3. In the United
22    States, positive single pollutant associations for emergency admissions for MI and increases in
23    ambient NO2 level were reported in Boston (Zanobetti and Schwartz, 2006) and California (Linn
24    et al., 2000; Mann et al., 2002).
25          Pooled results from two European multicity studies are inconsistent. Von Klot et al.
26    (2005) report an increase in MI readmissions at lag 0 while Lanki et al. (2006) report a null
27    effect at lag 1.  The NO2 levels were similar in the cities studied with Lanki et al. (2006)
28    reporting the 24 h average level of 23 ppb and Von Klot et al. (2005) reporting a range in 24-h
29    average  across the cities studied of 12-37 ppb. A single-city study in Italy (D'Ippoliti et al.,
30    2003) found positive significant associations between 24-h average NO2 level  and admission for
31    the first  episode of MI. The 24-h average NO2 level reported by D'Ippoliti was approximately
32    45 ppb.  A study conducted in London reports a positive association of ED visit for MI with 24-h

      March 2008                              AX6-16       DRAFT-DO NOT QUOTE OR CITE

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       Reference
       Linn et al. (2000)
       Mann et al. (2002)
                      Location
                      Metropolitan LA  All ages
                      So Coast Air Basin All Ages
       Zanobetti and Schwartz (2006) Boston
       Zanobetti and Schwartz (2006) Boston
       Lanki et al. (2006)
       Von Klot et al. (2005)
       D'lppoliti et al. (2003)
       D'lppoliti et al. (2003)
       Barnettetal. (2006)
       Barnettetal.(2006)
       Poloniecki et al. (1997)
      Figure AX6.2-3.
                      Europe
                      Europe
                      Italy
                      Italy
                      Australia, NZ
                      Australia, NZ
                      London
                                   65+
                                   65+
65+
je
ages
Ages
+
+
ages
Survivors 35+
ages
ages
+
-64
ages

Lis
0 .
0
0
0-1
0
n
0
0-2
0-1
0-1
1 .













-H
_|_








fi
I I I
.9 1.1 1.3
                                                                    Relative risk
                     Relative risks (95% CI) for associations between 24-h NOi (per 20
                     ppb) and hospitalizations for myocardial infarction (MI).  Primary
                     author and year of publication, city, stratification variable(s), and lag
                     are listed.  Results for lags 0 or 1 are presented as available.
 4
 5
 6
 1
 8
 9
10
average NC>2 where the 24-h average reported was approximately 35 ppb. Finally, positive
associations are reported for MI in a multicity study conducted in Australia and New Zealand
among older adults and adults from 15 to 64 years old (Barnett et al., 2006).  The 24-h average
NC>2 level ranged from approximately 7-12 ppb in the Australian cities studied (Barnett et al.,
2006).

AX6.2.1.4  Arrhythmia (ICD9 427) and Congestive Heart Failure (CHF) (ICD9 428)
       Hospital or ED admissions for arrhythmia were inconsistently associated with increases
in ambient NC>2 level. Some studies report positive associations (Rich et al.,  2006a; Mann et al.,
2002; Barnett et al., 2006) while others report null associations (Metzger et al., 2004; Lippmann
      March 2008
                                           AX6-17
                      DRAFT-DO NOT QUOTE OR CITE

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1   et al., 2000; reanalysis Ito, 2003, 2004). Single pollutant models of hospital admissions and ED

2   visits for CHF have also produced mixed results (Figure AX6.2-4). A seven city study
Reference Location
Morris et al. (1995) US, multeity
Morris et al. (1995) US, multeity
Morris et al. (1995) US, multeity
Morris et al. (1995) US, multeity
Morris et al. (1995) US, multeity
Morris et al. (1995) US, multeity
Morris etal. (1995) US, multeity
Linn et al. (2000) Metro LA
Ito etal. (2004) Ontario
Ito et al. (2004) Ontario
Metzger etal. (2004) Atlanta
Peel et al. (2007) Atlanta
Peel et al. (2007) Atlanta
Wellenius e! al. (2005a) Pittsburg
Poloniecki et al. (1997) London
Barnett et a!. (2006) Australia, HZ
Barnett et al. (2006) Australia, NZ
Wong et al . ( 1 999) Hong Kong


Other Age Lag
LA 65+0
Chicago 65+ 0
Philadelphia 65+ 0
New York 65+ 0
Detroit 65+ 0
Houston 65+ 0
Milwaukee 65+ 0
All Ages 0
All Ages 0
All Ages 1
All Ages 3 d moving .
Hypertension All Ages 0-2
Diabetes All Ages 0-2
65+ 0
All Ages 1
65+ 0-1
15-64 0-1
All Ages 0-3










-










}

-1—
Ir-
-i —
-I —
+

L


1
-t-

—
I I I I I I I
.7 .9 1.1 1.3 1.5 1.7 1.9
Relative risk
    Figure AX6.2-4.
Relative risks (95% CI) for associations of 24-h NO2 (per 20 ppb) and
1-hour maximum NOi* with hospitalizations for congestive heart
failure (CHF). Primary author and year of publication, city,
stratification variable(s), and lag are listed. Results for lags 0 or 1 are
presented as available.
    March 2008
                    AX6-18
DRAFT-DO NOT QUOTE OR CITE

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 1    conducted in the U.S. among the elderly found positive associations in Los Angeles (RR: =1.52
 2    [1.35, 1.71]), Chicago (RR:  = 1.60 [1.24, 2.07]) and New York (RR: = 1.23 [1.05, 1.43]) per
 3    30-ppb increase in NO2 (Morris et al., 1995).  Estimates were close to the null value in
 4    Philadelphia, Detroit, Houston, and Milwaukee and only the estimate for New York remained
 5    significant in multi-pollutant models (Morris et al., 1995). The 1 h maximum NO2 level in the
 6    cities studied ranged from 40 ppb in Milwaukee to 77 ppb in Los Angeles (Morris et al. 1995).
 7    Ito et al. 2004 report null associations for CHF and NO2 in Ontario where the 24 h average NO2
 8    level is approximately 21 ppb (Ito et al., 2004). Elevated but non-significant associations were
 9    reported in Atlanta (Metzger et al. 2004; Peel et al. 2007) and elevated significant associations
10    were reported in Pittsburgh (Wellenius et al., 2005a). Null associations were reported in London
11    (Poloniecki et al., 1997) while positive significant associations were reported in a multicity study
12    in Australia and New Zealand (Barnett et al. 2006) and in Hong Kong (Wong et al., 1999).
13
14    Cerebrovascular Disease (ICD9 430-448)
15
16    AX6.2.1.5  Vaso-occlusion in Sickle Cell
17           A recent study evaluated the association of pain in Sickle Cell patients, which is thought
18    to be caused by vaso-occlusion, with air pollution (Yallop et al., 2007). A time series analysis
19    was performed to link daily hospital admissions for acute pain among sickle  cell patients with
20    daily air pollution levels in London using the cross correlation function.  No  association was
21    reported for NO2.  However, Yallop et al. observed an association (CCF = -0.063, lag 0) for NO,
22    CO, and O3.
23
24    AX6.2.1.6  Multipollutant Modeling Results
25           As noted in Annex ISA 3B, multipollutant models may have limited utility to distinguish
26    the independent effects  of specific pollutants if model assumptions are not met. However, these
27    models are widely used in air pollution research and results for CVD hospital admissions and ED
28    visits are summarized in Figure AX6.2-5. This figure includes only those studies that present
29    two pollutant results in tabular form. Studies with qualitative descriptions or figures
30    summarizing two pollutant results are discussed in the text that follows (Linn et al., 2000; Mann
31    et al., 2002; Metzger et  al., 2004; Tolbert et al., 2007; Zanobetti and Schwartz, 2006; Jalaludin
32    et al., 2006; Von Klot et al.,  2005; Ballester et al., 2006; Wong et al., 1999).  In addition, we

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                                                               Relative risk
   Reference    Location   Season Age
   Yang et al,
   (2004a)
           Kaohsiung, Warm  All
           Taiwan
    Lag  Polluants °-5
    0-2  NO,
                       Cool
                                 N02PM10
                                 N02S010
                                 N02CO
                                 N0203
                                 N02
                                 N02 PM!0
                                 N02 S02
                                 N02CO
                                 N0203
Andersen et al.
(2007a)
Andersen et al.
(2007a)
Simpson et ai.
(2005a,b)
Barnett et al.
(2006)*
Chang et al.
(2005)
Copenhagen
Copenhagen
4 Cities, All
Australia year
7 Cities,
Australia
andNZ
Taipei, Warm
Taiwan
65+
65+
All
65+

                                 0-3 NO,
                                    N02PM
                                 0-3 NO,
                                    N0
                                    N02 BSP
                                    N0203
                                 0-1 NO,
                                    NOZCO
                                0-2  NO,
   Poloniecki et al. London
   (1997)
                       Cool
                                    N02PM10
                                    N02 S02
                                    N02CO
                                 N02
                                 N02 PM10
                                 N02 S02
                                 N02CO
                                 N020j
Wellenius et al.  Allegheny  All
(2005a)      Co PA    year
                             65+  0  NO
                                    N02PM,0
                                    N02CO
                                    N0203
                                    N02 S02
                   Cool
All   0-1   NO,
                                    N02 S02
                                    N02CO
                                    N02BS
                                    N0203
                                                 1.0     1.5    2.0     2.5    3.0    3.5
                                                    	I	i	i	i	
Cardiovascular Disease
                                                                         Congestive heart failure
Figure AX6.2-5.     Relative risks (95% CI) for associations of 24-h NOi exposure (per 20
                      ppb) and daily 1-hour maximum NOi* (per 30 ppb) with
                      hospitalizations or emergency department visits for CVD: Studies
                      with 2 pollutant model results.  Primary author and year  of
                      publication, city, stratification variable(s), and lag are listed.  Results
                      for lags 0 or 1 are presented as  available.
March 2008
                                        AX6-20
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 1    include text discussion of studies that simultaneous adjust for several pollutants (Morris et al.,
 2    1995; Llorca et al., 2005) and several cerebrovascular disease studies that report multipollutant
 3    results (Ballester et al., 2001; Villeneuve et al., 2006; Tsai et al., 2003a; Chan et al., 2006).
 4          A U.S. study shows a diminishment of the relative risk for CHF in two pollutant models
 5    (Wellenius et al., 2005a). Morris et al. (1995) also observes a similar diminishment of the CHF
 6    association in multipollutant models containing SO2, CO and Ozone (Morris et al., 1995). The
 7    association of cardiac disease admissions with NO2 in several non-U.S. studies was not robust in
 8    two pollutant models (Simpson et al., 2005a,b; Poloniecki et al., 1997; Barnett et al., 2006;
 9    Ballester et al., 2006).  Llorca et al. (2005) reports a similar lack of robustness in models
10    containing NO2, TSP, H2S, NO and SO2. Estimates from studies conducted in Taiwan reporting
11    relatively high associations of NO2 with CVD in single pollutant models remained robust in 2-
12    pollutant models during the cool (Yang et al., 2004a) or warm (Chang et al., 2005) seasons only.
13    In an Australian study of the older adults (65+ years), the effect estimate for NO2 was robust to
14    simultaneous adjustment for Os and particles (Morgan et al., 1998a).
15          In two additional U.S. studies, investigators provide text descriptions of multi-pollutant
16    model results and indicate that their analyses were unable to distinguish the effects of NO2 from
17    PM, CO and other traffic pollutants (Linn et al. 2000; Mann et al. 2002.) In both studies, CO
18    was more highly correlated with NO2 than PM. In a Canadian study in which default GAM
19    procedures were used, the significant association of NO2 with ED visits for cardiac disease was
20    reduced and non-significant in multipollutant models (Stieb et al., 2000).  Further, in a study of
21    emergency department visits to Atlanta hospitals, Metzger et al. 2004, who present results via
22    figure, observed a diminishment of the effect of NO2 on visits for cardiovascular disease when
23    CO was modeled with NO2, while the effect of CO remained robust (Metzger et al., 2004).  This
24    finding was repeated in an analysis that included several additional years of data (Tolbert et al.,
25    2007).  In this paper, Tolbert et al. discuss the limitations of multipollutant models in detail and
26    conclude that these models may help researchers identify the strongest predictor of disease but
27    may not isolate the independent effect of each pollutant (Tolbert et al., 2007). In an Australia
28    study (Jalaludin et al., 2006) and a Spanish multicity study (Ballester et al., 2006) presenting
29    multipollutant results in figures, the association of NO2 with cardiac disease was not robust to
30    adjustment for other pollutants (CO, SO2, particles).  However, in a European multicity study
      March 2008                              AX6-21      DRAFT-DO NOT QUOTE OR CITE

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 1    investigators report that the effect of NO2 on cardiac readmissions among MI survivors was not
 2    diminished in multipollutant models (Von Klot et al., 2005).
 3          Burnett et al. (1997a) reported robust estimates for cardiac disease hospital admissions
 4    and NO2, whereas the observed association for cardiac hospitalizations and PM were explained
 5    by gaseous pollutants. In another multicity study conducted in the same area, associations of
 6    NC>2 with cardiac disease were not attenuated when CO, SO2, and PM variables were included in
 7    the models (Burnett et al., 1999).
 8          The association of NC>2 with stroke was not robust to adjustment for CO in a Canadian
 9    study (Villeneuve et al., 2006). The association of NO2 with all cerebrovascular disease was not
10    robust to adjustment for BS and  SO2 in a Spanish single city study (Ballester et al., 2001).
11    Although results from a Taiwanese study indicate the effect of NO2 on stroke admissions is not
12    diminished in 2 pollutant models, the authors note that the association of NO2 with stroke may
13    not be causal if NO2 is a surrogate other components of the air pollution mixture
14    (Tsai et al., 2003a).
15          Studies using alternative  methods to investigate the influence of co-pollutants on
16    observed associations of NO2 with cardiovascular disease are few in number. In an study of
17    emergency admissions for MI and ambient pollution in Boston investigators attempt to
18    distinguish traffic from non-traffic related pollutants through their definition of an exposure
19    metric for non-traffic PM (residuals in model of PM2.s regressed against BC) but found NO2,
20    PM2.s and non-traffic PM each may trigger MI during the warm season (Zanobetti and Schwartz,
21    2006). In a study conducted in Hong Kong, investigators looked at the association of NO2 with
22    CVD during high PMio and high ozone days (Wong et al., 1999).  An interaction between NO2
23    and Ozone was observed (in the  single pollutant model NO2 associated with heart failure,
24    RR: 1.1895%CI: 1.10, 1.26 per 20 ppb, lag 0-3).
25
26    AX6.2.2  Heart Rate Variability, Repolarization, Arrhythmia, and Other
27              Measures Cardiovascular Function Associated with Short-Term
28              NO2 Exposure
29
30    AX6.2.2.1  Heart Rate Variability
31          Liao et al. (2004) investigated short-term associations between ambient pollutants and
32    cardiac autonomic control from the fourth cohort examination (1996 to 1998) of the population-

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 1    based Atherosclerosis Risk in Communities (ARIC) Study.  PMio, NO2, and other gaseous air
 2    pollutants were examined in this study.  PMio (24-h average) and NO2 (24-h average) 1 day prior
 3    to the randomly allocated examination date were used.  The mean (SD) NO2 level was 21 (8)
 4    ppb.  PMio concentrations measured 1 day prior to the HRV measurements were inversely
 5    associated with both frequency- and time-domain HRV indices.  Ambient NO2 concentrations
 6    were inversely associated with high-frequency power and SDNN. In single-pollutant models, a
 7    20-ppb increase in ambient NO2 was associated with a 5% reduction (95% CI:  0.7, 9.2), in mean
 8    SDNN. Consistently more pronounced  associations were suggested between PMio and HRV
 9    among persons with a history of hypertension.
10          Various measures of HRV have  been examined in relation to daily levels of ambient air
11    pollution in other studies (Chan et al., 2005; Wheeler et al.,  2006; Holguin et al., 2003;
12    Luttmann-Gibson et al., 2006; Schwartz et al., 2005). Chan et al. (2005) recruited 83 patients
13    from the cardiology section of a hospital in Taiwan. Patients included 39 with  coronary heart
14    disease (CHD) and 44 with more than one risk factor for CHD. The authors reported finding
15    significant associations between increases in NO2 and decline in SDNN (NO2 lagged 4 to 8 h)
16    and LF (NO2 lagged 5 or 7 h) (see Annex Table AX6.5.1 for quantitative results).  There were no
17    significant associations for r-MSSD or HF and NO2. None of the other pollutants tested (PMio,
18    CO, SO2, 63) were significantly associated with any of the HRV measured. Wheeler et al.
19    (2006) examined HRV and ambient air pollution in Atlanta  in 12 patients who  had an MI from
20    3 to 12 months prior to enrollment and 18 COPD patients. The results in the two patient groups
21    were quite different: increasing concentration of NO2 in the previous 4-h significantly reduced
22    SDNN in MI patients and significantly increased SDNN in COPD patients (see Annex Table
23    AX6.10). Similar significant associations were seen with increases in 4-h ambient PM2.s.  The
24    PM2 5 concentrations were moderately correlated with NO2 levels (r = 0.4).
25          In contrast, Holguin et al. (2003) found PM2.5 concentrations were moderately correlated
26    with NO2 levels (v = 0.04) in  34 elderly adults in Mexico City and found no significant
27    associations with increases in NO2, but did find significant effects of PM2.5 on HF, particularly
28    among hypertensive subjects.  Similarly, Luttmann-Gibson et al. (2006) also found significant
29    effects of PM2.s and SO4 on HRV  measured in a panel of 32 senior adults in Steubenville,  OH,
30    but observed no effect of increasing NO2.  Likewise, Schwartz et al. (2005) found significant
31    effects of increases in PM2 5 on measures of HRV, while no associations with NO2 were

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 1    observed. A population-based study of air pollutants and HRV was conducted in Boston, MA on
 2    497 men from the VA Normative Aging Study (NAS) (Park et al., 2005).  The mean (SD) 24-h
 3    average NO2 concentration was 22.7 (6.2) ppb. Associations with HRV outcomes were observed
 4    with a 4-h moving average of Os and PM2.5 concentrations, but not with NC>2.
 5
 6    AX6.2.2.2   Repolarization Changes
 7          A prospective panel study, conducted in East Germany, analyzed 12 repeat ECG
 8    recordings for 56 males with IHD (Henneberger et al., 2005).  Ambient air pollutants measured
 9    at fixed monitoring sites were used to assign individual exposures for 0 to 5, 5 to 11,  12 to 17, 18
10    to 23, 0 to 23 h and for 2 to 5 days prior to the EEG. Pollutants considered were ultrafme
11    particles (UFP), accumulation mode particle (ACP), PM2.5, elemental carbon (EC), organic
12    carbon (OC), 862, NC>2, NO, and CO.  Associations were observed between (1) QT duration and
13    EC and OC; (2) T-wave amplitude and UFP, ACP and PM2.s; and (3) T-wave complexity and
14    PMio, EC, and OC.  NO (r = 0.83) and  NO2 (0.76) were highly correlated with UFP but were not
15    associated with repolarization abnormalities.
16
17    AX6.2.2.3   Arrhythmias Recorded on Implanted Defibrillators
18          In a pilot study, Peters et al.  (2000a) abstracted device records for 3 years for each of 100
19    patients with ICDs.  Defibrillator discharge events were positively associated with the previous
20    day and 5-day mean NO2 concentrations: each 20-ppb increase in the previous day's NO2 level
21    was associated with an increased risk of a discharge event (OR = 1.55 [95% CI: 1.05, 2.29]) (see
22    Annex Table AX6.5.2 for the increase associated with a 20-ppb increase in NO2).
23          Three papers by the same team  of investigators examined the association between air
24    pollution and the incidence of ventricular arrhythmias (Dockery et al., 2005; Rich et al., 2005)
25    and PAF episode (Rich et al. 2006b) in Boston.  A total of 203 patients with ICDs who lived
26    within 25 miles of the ambient monitoring site were monitored. Data included a total of
27    635 person-years of follow-up or an average of 3.1 years per subject.  The median (IQR) 48-h
28    average NO2 concentration was 22.7 (7.7) ppb. In the study by Dockery et al. (2005), significant
29    positive associations were observed between ventricular arrhythmias within 3 days of a prior
30    event,  and a 2-day mean exposure to several air pollutants including PM2.s, BC, NO2, CO, and
31    SO2. Rich et al. (2005) examined associations between ambient air pollution levels less than 24
32    hours before the occurrence of a ventricular arrhythmia to make use of the precise time definition

      March 2008                             AX6-24       DRAFT-DO NOT QUOTE OR CITE

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 1    available from the implantable cardioverter defibrillator (Rich et al., 2005). In single-pollutant
 2    models, each 20-ppb increase in the mean NO2 level over the previous 2 days was associated
 3    with an increased likelihood of ventricular arrhythmia, OR = 1.54 (95% CI:  1.11,2.18). The
 4    association with NC>2 was not significant in two pollutant models with PM2.5, but remained
 5    marginally significant in models with Os (2.0-ppb increase in 24-h moving average NC>2 was
 6    associated with an OR = 1.36 [95% CI:  1.00, 1.80]).  There was a strong association between an
 7    increase of NO2 (by 20 ppb) and ventricular arrhythmia in the presence of ventricular arrhythmia
 8    within the previous 72 h (OR = 2.09 [95% CI:  1.26, 3.51]). Increased but non-significant
 9    associations were observed in this population between NO2 levels and PAF, as well as fine
10    particles and black carbon (Rich et al., 2006b).
11           A study conducted in St. Louis, which also examined the association of air pollutant level
12    within 24 hours of a ventricular arrhythmia, reports non-significant increases for NO2 and
13    elemental carbon, while SO2 was significantly associated with increased occurrence of
14    arrhythmia (Rich et al. 2006a).  Metzger et al. (2007) examined the association of ventricular
15    tachyarrhythmias with air pollutants in the largest study to  date (N =518), which was conducted
16    in Atlanta. These investigators report "suggestive" findings for course particulate but generally
17    no evidence of an association of NO2 and other pollutants with tachyarrhythmias (Metzger et al.,
18    2007).
19
20    AX6.2.2.4  Markers of Cardiovascular Disease
21
22    Epidemiological Studies
23           In a large cross-sectional study of 7,205 office workers in London, Pekkanen et al. (2000)
24    collected blood samples and analyzed the association between plasma fibrinogen, a risk factor
25    for CVD, and ambient levels of air pollution.  In models  adjusting for weather, demographic, and
26    socioeconomic factors, there was an increased likelihood of blood levels of fibrinogen >3.19 g/1
27    (90th percentile) for each 20-ppb increase in NO2 lagged by 3  days (OR =1.14 [95% CI:  1.03,
28    1.25]).  The correlation between daily NO2 and other traffic-related pollutants were high:  daily
29    levels of black smoke (r = 0.75), PMio (r = 0.76), SO2 (r = 0.62), CO (r = 0.81). The authors
30    suggest that the increased concentrations of fibrinogen, a mediator of cardiovascular morbidity
31    and mortality, may be an indicator of inflammatory reactions caused by air pollution.
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 1          Schwartz (2001) examined the association between fibrinogen, platelet count and white
 2    blood cell (WBC) count in the Third National Health and Nutrition Examination Survey
 3    (NHANES III).  In single pollutant models NO2 was associated with platelet counts and
 4    fibrinogen.  However, in a two-pollutant model with PMio these associations became negative.
 5          Pekkanen et al. (2002) enrolled a panel of 45 adults with coronary heart disease in order
 6    to examine associations between heart function as measured by risk of ST-segment depression
 7    and particulate pollution. Level of particulate and gaseous pollutants, including NO2, lagged by
 8    2 days was found to have the strongest effect on risk of ST-segment depression during mild
 9    exercise tests (OR= 14.1 [95% CI: 3.0, 65.4] for ST-segment depression of >0.1mV with a
10    20-ppb increase in NO2 lagged by 2 days).  A large (n = 863) cross-sectional study of resting
11    heart rate (HR) of adults in France found significant associations between elevated levels of NO2
12    within 8-h of measurement and resting HR of >75 beats per minute (bpm) (OR = 2.7 [95% CI:
13    1.2, 5.4] for resting HR >75 bpm for each 20-ppb increase in NO2) (Ruidavets et al., 2005).
14          In a population based study of participants in the Atherosclerosis Risk in Communities
15    (ARIC) study, Liao et al. 2005 did not observe differences in White Blood Cell (WBC) count,
16    Factor VIII C, fibrinogen, Von Willibrand Factor (VWF) or albumin depending on 24-h average
17    NO2 level lagged 1 to 3 days prior to the examination date. However, PMio was associated with
18    factor VIII-C in this cohort.  An association between PMio and serum albumin was observed
19    only among persons with a history of CVD (Liao et al. 2005).
20          Ruckerl et al. (2006) examined several markers  of inflammation, cell adhesion, and
21    coagulation among a panel of 57 male patients with CHD.  These authors primary hypothesis
22    was that C-reactive protein (CRP) would be increased with increases in air pollution.  They also
23    investigated the effect of air pollution on other markers including serum amyloid A (S AA),
24    E-selectin, von Wildebrand factor antigen, intercellular adhesion molecule 1 (ICAM-1),
25    fibrinogen, factor VII, prothrombin fragment 1+2, and D-dimer. A significant association was
26    observed for NO2 with CRP greater than the 90th percentile but the strongest effect on CRP was
27    observed for ultrafme particles.
28          Steinvil et al. investigated the association of air  pollutants with several markers of
29    inflammation (fibrinogen, CRP and WBC).  Significant decreases in fibrinogen associated with
30    increases of 13 ppb in ambient NO2 were reported among men (all lags 0-7 and 7 day average)
31    and women (lag 0, 7 day average).  The absolute change in fibrinogen ranged from 7.9 to  16.7

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 1    mg/dL (Steinvil et al., 2007). The mean NO2 level was 19.5 ppb (Steinvil et al., 2007).
 2    was significantly associated with increased fibrinogen only at day 7. No correlations with CRP
 3    and WBC were observed (Steinvil et al. 2007).
 4          Baccarelli et al. (2007) investigated the effect of ambient NO2 with prothrombin time
 5    (PT) and activated partial thromboplastin time (APTT) in 1218 normal subjects in Italy.  Both
 6    NO2 (coefficient = -0.08 95%CI:  -0.15, 0.00) and PMio (coefficient = -0.08 95% CI: -0.14,
 7    -0.01) on the same day and the average for 30 days prior to the examination were negatively
 8    correlated with PT (e.g. PT became shorter indicating hypercoagulability), while no effect on
 9    APTT was reported (Baccarelli et al., 2007).
10
11    AX6.2.2.5  Controlled Human Exposure and Animal Studies
12          Folinsbee et al. (1978) studied three groups of 5 healthy males exposed to 0.62-ppm NO2
13    for 2 h. The groups differed by duration of exercise during exposure:  15, 30, or  60 min. In
14    addition to pulmonary function, outcome measures included indirect calorimetry, cardiac output
15    using the CO2 rebreathing technique, blood pressure, HR, and diffusing capacity  of the lung for
16    carbon monoxide (DLCO).  There were no significant effects for the individual groups, or for the
17    15 subjects analyzed together. However, the small number of subjects in each group limited
18    statistical power.
19          Drechsler-Parks (1995) assessed changes in cardiac output using noninvasive impedance
20    cardiography. Eight older adults (56 to 85 years of age) were exposed to 0.60-ppm NO2,
21    0.45-ppm Os, and the combination of 0.60-ppm NO2 + 0.45-ppm Os for 2-h with intermittent
22    exercise. The exercise-induced increase in cardiac output was smaller with the NO2 + Os
23    exposures than with the filtered air or Os exposures alone. There were no significant differences
24    in minute ventilation, HR, or cardiac stroke volume, although the mean stroke volume was lower
25    for NO2 + Os than for air. The author speculated that chemical interactions between Os and NO2
26    at the level of the epithelial lining fluid led to the production of nitrite, leading to vasodilatation,
27    with reduced cardiac preload and cardiac output. This study has not been repeated.
28          Linn et al. (1985) reported small but statistically significant reductions in blood pressure
29    after exposure to 4-ppm NO2 for 75 min, a finding consistent with systemic vasodilatation in
30    response to the exposure. However, many subsequent studies at concentrations generally less
31    than 4 ppm have not reported changes in blood pressure in response to NO2 exposure.
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 1          There is also evidence that NO2 exposure may affect circulating red blood cells. Posin
 2   et al. (1978) exposed 10 healthy males to 1- or 2-ppm NO2 for 2.5- to 3.0-h daily for 2 days.
 3   Blood obtained immediately after the second exposure showed a reduced hemoglobin and
 4   hematocrit (NO2: 41.96 ± 2.75; sham exposure:  43.18 ± 2.83, p = 0.001) and reduced red blood
 5   cell acetyl cholinesterase levels. However, the control air exposures were not identical to and
 6   concurrent with the NO2 exposures, a potential flaw in the study design.
 7          In the study by Frampton et al. (2002), healthy subjects were exposed to air or 0.6- or
 8   1.5-ppm NO2 for 3-h with intermittent exercise, and blood was obtained 3.5-h after exposure.
 9   There was a significant, concentration-related reduction in hematocrit and hemoglobin in both
10   males and females, confirming the findings of Posin et al. (1978). These studies suggest that
11   NO2 exposure in the range of 1- to 2-ppm for a few hours is sufficient to alter the red blood cell
12   membrane.  The reductions in blood hemoglobin were not sufficiently large to result in health
13   effects for these healthy subjects. However, in the Frampton study, the reduction in hemoglobin
14   represented the equivalent of about 200 mL of blood loss for a 70-kg male.  This could
15   conceivably have adverse cardiovascular consequences for someone with significant underlying
16   lung disease, heart disease, or anemia.
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                TABLE AX6.3-1.  STUDIES EXAMINING EXPOSURE TO INDOOR NO2 AND RESPIRATORY SYMPTOMS
                                                                   NO2 Measurement
O

to
O
O
oo
  Author, Year,
     Location
Study Design
Exposure
  Time
Mid-Range (ppb)
Range
(ppb)
Outcome
OR or RR (95% CI)
          Pilotto et al. (2004)   Subjects: 118 asthmatic  6 h
          Australia            children

                             Analysis: negative
                             binomial

                             Monitoring Device:
                             passive diffusion badges
                                                           mean(sd)           7,38
                                                           intervention 16 (7)

                                                           mean(sd)           12,116
                                                           control 47 (27)
                                                                  daytime symptoms
                                                                  difficulty breathing      RR 2.44 (1.02, 14.29)=*
                                                                                           chest tightness

                                                                                           asthma attacks
                                                                                           difficulty breathing,
                                                                                           night
                                                                                        RR 2.22 (1.23, 4.00)*

                                                                                        RR 2.56 (1.08, 5.88)*
                                                                                        RR 3.12 (1.45, 7.14)*
X
to
VO
Pilotto et al. (1997)    Subjects:  388 children    6 h
Australia
                    Analysis:  generalized
                    linear mixed models
                    Monitoring Device:
                    passive diffusion badges
                                                                                        4, 132
                                                                  wheeze (>40 ppb)
                                                                   OR 1.41 (0.63, 3.15)
C Nitschke et al.
^ (2006)
' Australia
o
O
2|
0
H
O
O
H
W


O
HH
H
W
Subjects: 174 asthmatic 6 h mean home 20 (22)
children


Analysis: negative mean school 34 (28)
binomial
Monitoring Device:
passive diffusion badges








night symptoms



difficulty breathing

school max

home max
chest tightness
school max









RR 1.23 (1.10, 1.39)

RR 1.06 (1.02, 1.10)


RR 1.25 (1.14, 1.37)







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            TABLE AX6.3-1 (cont'd).  STUDIES EXAMINING EXPOSURE TO INDOOR NO2 AND RESPIRATORY SYMPTOMS
                                                                   NO2 Measurement
O

to
O
O
oo
Author, Year,
  Location
Study Design
Exposure Time   Mid-range (ppb)   Range (ppb)
                    Outcome
  OR or RR (95% CI)
          Garrettetal. (1998)
          Australia
                 Subjects: 148 children
                 Analysis: multiple
                 logistic regression
                 Monitoring Device:
                 passive monitors
                  4 days
                med6
plO-p90, 3, 15   chest tightness
OR 1.53 (0.45, 5.32)
X
ON
OJ
O
H
6
o
o
H
O
O
H
W
O
HH
H
W
          Smith et al. (2000)
          Australia
                 Subjects: 125
                 asthmatic
                 adults/children
                 Analysis: GEE
                 Monitoring Device:
                 passive diffusion
                 badges
                  4.5 h
                                 4, 147
               children (n = 49, 0 14)   OR 1.12 (1.07, 1.18)
               chest tightness
Belanger et al.
(2006)
Northeast U.S.






Chauhan et al.
(2003)
Southampton, U.K.





Subjects: 728 2 wks
asthmatic children
Analysis: logistic,
Poisson regression
Monitoring Device:
Palmes tubes



Subjects: 114 7d
asthmatic children
Monitoring Device:
Palmes diffusion tubes




mean (sd) gas
home 26 (18)




mean (sd) elect
home 9 (9)

Exposure tertiles:
<4; 4-7; >7






multifamily housing





wheeze

chest tightness
Increased symptom
score, comparing first
and second tertiles of
NO2 exposure
Increased symptom
score, comparing first
and third tertiles of
NO2 exposure






RR 1.33 (1.05, 1.68)

RR 1.51 (1.18, 1.91)
0.6(0.01, 1.18)



2.1(0.52,3.81)




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             TABLE AX6.3-1 (cont'd).  STUDIES EXAMINING EXPOSURE TO INDOOR NO2 AND RESPIRATORY SYMPTOMS
Author, Year,
Location
Van Strien et al.
(2004)
Northeast U.S.
Study Design
Subjects: 762 infants
Analysis: Poisson
regression
NO2 Measurement
Exposure Time Mid-range (ppb)
medlO

Range
(ppb)


Outcome
persistent cough
ORorRR(95%CI)

                                                                                                               <5.1 ppb
                                                                                                               5.1,9.9 ppb
                                                                                                               9.9, 17.4 ppb
                                                                                                               >17.4 ppb
                                                                                                               shortness of breath
                        RR1.0
                        RR 0.96 (0.69, 1.36)
                        RR 1.33 (0.94, 1.88)
                        RR 1.52 (1.00, 2.31)
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<5.1ppb
5.1,9.9 ppb
9.9, 17.4 ppb
>17.4 ppb
RR1.0
RR 1.59 (0.96, 2.62)
RR 1.95 (1.17, 3.27)
RR 2.38 (1.31, 4.34)
           Notes:
           Unless otherwise noted, results given for 20-ppb increase in NO2.
           *For purpose of comparison, RRs from Pilotto et al. (2004) are shown here as risk of symptoms given greater exposure to NO2, i.e., control (unflued gas heater) vs intervention (flued or electric
           replacement heater).
           RRs reported by Pilotto et al. (2004) as protective effects for intervention vs. control.
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TABLE AX6.3-2. STUDIES EXAMINING EXPOSURE TO AMBIENT NO2 AND ACUTE RESPIRATORY SYMPTOMS
          USING GENERALIZED ESTIMATING EQUATIONS (GEE) IN THE ANALYSIS METHOD
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Author, Year,
Location



Subjects
NO2 Measurement

Avg Copollutants &
Time Mid-range (ppb) Range (ppb) Correlations



Outcome



OR (95% CI)
Children: Multi-City Studies








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Schwartz et al.
(1994)
6 U.S. Cities

Mortimer et al.
(2002)
U.S., NCICAS
Schildcrout et al.
(2006)
North America
CAMP






1844 children



864 asthmatic
children

990 asthmatic
children








24 h medlS plO-p90, 5, 24 PM25: r=0.35
PM10: r = 0.36
O3: r=-0.28
SO2: r=0.51
4h med25 7,90 O3: r=0.27


24 h med23 minplOtomax PM10:r = 0.26,
p90, 10, 37 0.64
O3: r= 0.04, 0.47
SO2: r= 0.23, 0.68

CO: r= 0.63, 0.92




cough, incidence:
lag 1-4 mean


asthma symptoms:
lag 1-6 mean

asthma symptoms:





lagO
lagl
lag 2
3 -day moving sum
1.61(1.08,2.43)



1.48(1.02,2.16)








1.06(1.00, 1.13)
1.04(0.97,1.10)
1.09(1.03,1.15)
1.04(1.01, 1.07)
Children: Single-City Studies
Pino et al. (2004)
Chile


Ostroetal. (2001)
Southern California






504 infants



138 asthmatic
children, African
American





24 h mean (sd) 4 1(19) p5-p95, 20, 81



1 h mean (sd) 80 (4) 20, 220 PM25: r = 0.34
PM10: r = 0.63
O3: r=0.48





wheezy bronchitis:
6 day lag


cough, incidence:
Iag3

wheeze, incidence:
Iag3



1.14(1.04, 1.30)



1.07(1.00,1.14)


1.05(1.01,1.09)





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TABLE AX6.3-2 (cont'd). STUDIES EXAMINING EXPOSURE TO AMBIENT NO2 AND ACUTE RESPIRATORY
   SYMPTOMS USING GENERALIZED ESTIMATING EQUATIONS (GEE) IN THE ANALYSIS METHOD
^j NO2 Measurement

o
o Author, Year, Avg Mid-range Copollutants &
Location Subjects Time (ppb) Range (ppb) Correlations Outcome


OR (95% CI)
Children: Single-City Studies (cont'd)
Deffino et al. (2002) 22 asthmatic 8h mean (sd) 15 (7) 6,34
Southern California children
Segalaetal. (1998) 84 asthmatic 24 h mean (sd) 30 (8) 13,65
Paris children




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Just et al. (2002) 82 asthmatic 24 h mean (sd) 29 (9) 12, 59
Paris children
O

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Z; Jalaludin et al. (2004) 148 children with 15 h mean (sd) 15 (6) 3, 79
O Austrailia wheeze history
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PM10: r = 0.55 asthma symptoms:
O3: r=0.26 lagO
PM25: r = (0.61)* asthma symptoms:
PM10: r = 0.55 incidence: lagO
SO2: r=0.54
lagl
lag 4
nocturnal cough:
incidence: lag 3
lag 4

PM25: r = 0.92* nocturnal cough:
PM10: r = 0.54 incidence: lagO
O3: r=0.09
SO2: r=0.69
lag 0-2
lag 0-4


PM10: r = 0.26 Wet cough: lagO
O3: r=-0.31








1.91(1.07,

1.89(1.13,


1.36 (0.70,
1.80(1.07,
1.44 (0.99,

1.74(1.20,

2.11(1.20,



1.80 (0.89,
1.58(0.73,


1.13(1.00,









3.39)

3.17)


2.64)
3.01)
2.08)

2.52)

3.74)



3.84)
3.54)


1.26)










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            TABLE AX6.3-2 (cont'd).  STUDIES EXAMINING EXPOSURE TO AMBIENT NO2 AND ACUTE RESPIRATORY

                SYMPTOMS USING GENERALIZED ESTIMATING EQUATIONS (GEE) IN THE ANALYSIS METHOD
^j NO2 Measurement

qj
o Author, Year, Avg Copollutants &
Location Subjects Time Mid-range (ppb) Range (ppb) Correlations Outcome
OR (95% CI)
Adults:
Segala et al. (2004) 46 nonsmoking adults 24 h mean (sd) 30 (9) 12, 71
Paris
Von Klot et al. 53 asthmatic adults 24 h med 24 4, 63
(2002)
Germany




X
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PM25: r = 0.82* sore throat, cough:
PM10: r = 0.83 lag 0-4
PM10: r = 0.74 wheeze, prev:
SO2: r = 0.36 5-day mean
CO: r=0.82
phlegm, prev:
5 -day mean
cough, prev:
5 -day mean
breathing prob in
a.m. : 5-day mean
4.05 (1.20,

1.15(1.02,


1.22(1.10,

1.15(1.00,

1.25(1.10,
13.60)

1.31)


1.39)

1.31)

1.39)
         Odds ratios (OR) given for 20-ppb increase in NO2 with 24-h averaging time, or 30 ppb for 1-h averaging time. (20-ppb increases also used for times between 1 and 24 h.) *BS
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                              TABLE AX6.3-3.  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                HOSPITAL ADMISSIONS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
UNITED STATES
Moolgavkar (2000a,b,c)
Moolgavkar (2003)

Multi-city, United States:
Chicago, Los Angeles,
Maricopa County,
(Phoenix).

Period of Study:
1987-1995








Outcomes (ICD 9 codes): COPD
including asthma (490-496)
Age groups analyzed: 0-19,20-64,65+
(LA only)
Study Design: Time-series
Statistical Analyses: Poisson regression,
GAM
Covariates: Day of wk, temporal trends,
temperature, relative humidity
Lag: 0-5 days








Chicago
Median: 25 ppb
IQR: 10 ppb

Los Angeles
Median: 38 ppb
IQR: 18 ppb

Maricopa
Median: 19 ppb
IQR: 12 ppb







Chicago:
PM10;r=0.49
CO; r= 0.63
S02; r = 0.44
O3; r = 0.02

LA:
PM2.5; r = 0.73
PM10; r = 0.70
CO; r= 0.80
SO2; r = 0.74
O3;r=-0.10

Maricopa:
PM10; r = 0.22
CO; r= 0.66
S02; r = 0.02
03;r=-0.23
Increment: 10 ppb

COPD, >65 yrs
Chicago 1.7% [CI 0.36, 3.05] lag 0 - GAM default
Chicago 2.04% [t = 2.99] lag 0 - GAM-100
Los Angeles 2. 5% [CI 1.85, 3.15] lag 0 - GAM
default
Los Angeles 2.84% [t = 13.32] lag 0 - GAM - 30
Los Angeles 1 .80% [t = 9.60] lag 0 - GAM - 100
Los Angeles 1 .78% [t = 7.72] lag 0 - NS-100
Phoenix 4.4% [CI 1.07, 7.84] lag 5

Chronic Respiratory Disease
Los Angeles
0-19 yrs 4.9% [CI 4.1, 5.7] lag 2
20-64 yrs 1.7% [CI 0.9, 2.1] lag 2

Multi-pollutant model
          Moolgavkar*et al. (1997)    Outcomes (ICD 9 codes): COPD
          United States:
          Minneapolis-St. Paul

          Period of Study:
          1986-1991
including asthma (490-496), Pneumonia
(480-487)
Age groups analyzed: 65+
Study Design: Time-series
Statistical Analyses: Semi-parametric
Poisson regression, GAM
Covariates: Day of wk, season, temporal
trends, temperature
Statistical Package:  S Plus
Lag:  0-3 days
NO2 24-h avg (ppb)

16.3 ppb
IQR:  9.5 ppb
PM10;r=0.31
SO2;r = 0.09
CO; r= 0.58
NO2 andPM10: 1.72% [t = 3.18] lag 0 - GAM-100
NO2 and PM2.5:  1.51% [t = 2.07] lag 0 - GAM-100
Increment:  10 ppb

Sum of Pneumonia and COPD
2.2% [0.2, 4.2] lag 1

Pneumonia Only
3.1% [0.6, 5.6] lag 1,20 df
1.7% [-0.8, 4.2] lag 1,130 df
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                            TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
UNITED STATES (cont'd)
Neidell (2004) Outcomes (ICD 9 codes): Asthma
California Age groups analyzed: <18; 0-1; 1-3; 3-6;
N02 (ppb)
Mean: 45.947
03
CO
Increment: NR
           Period of Study:
           1992-1998
6-12; 12-18
Study Design: Time-series
Statistical Analyses: NR
Covariates:  Temperature, precipitation,
influenza epidemic
Seasons: Nov-Maronly
Lag: 0-4 days
                                                                           SD=17.171
Age 0-1
Fixed effects:  0.009(0.014)
Controlled for avoidance behavior:  0.009 (0.014)
Single pollutant: 0.001(0.011)
Adjusted for SES:  0.021(0.017)
Interaction with Low SES:  -0.017 (0.029)
Age: 1-3
Fixed effects:  0.002(0.016)
Controlled for avoidance behavior:  0.002 (0.016)
Single pollutant: 0.009 (0.013)
Adjusted for SES:  -0.001(0.020)
Interaction with Low SES:  -0.004 (0.032)
Age 3-6
Fixed effects:  0.006(0.016)
Controlled for avoidance behavior:  0.006 (0.016)
Single pollutant: 0.028 (0.013)
Adjusted for SES:  0.020 (0.020)
Interaction with Low SES:  -0.037 (0.033)
Age 6-12
Fixed effects:  0.041(0.015)
Controlled for avoidance behavior:  0.042 (0.015)
Single pollutant: 0.047(0.012)
Adjusted for SES:  0.040(0.018)
Interaction with Low SES:  -0.016 (0.031)
Age: 12-18
Fixed effects:  0.005(0.013)
Controlled for avoidance behavior:  0.005 (0.013)
Single pollutant: 0.015(0.010)
Adjusted for SES:  0.013 (0.017)
Interaction with Low SES:  -0.020 (0.026)

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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                   HOSPITAL ADMISSIONS
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
UNITED STATES (cont'd)
Karr et al. (2006) Outcomes (ICD 9 codes): Acute
Southern LA County, CA, bronchiolitis (466. 1 )
United States Age groups analyzed: 0-1 yr
1-h max NO2 (ppb)
Mean: 59 ppb
IQR: 26 ppb
CO
PM2.5
Increment: 26 ppb (IQR)
Acute bronchiolitis
           Period of Study:
           1995-2000
Study Design:  Case-crossover
N: 19,109
Statistical Analyses:  Conditional logistic
regression
Covariates: Day of wk, temperature,
humidity
Seasons: Nov-Maronly
Lag:  0-4 days
Number of Stations:  34
OR 0.96 [0.94, 0.99] lag 4
OR 0.97 [0.95, 0.99] lag 1
Stratified by Gestational Age at Birth:
37-44 wks
0.98 [0.95, 1.00] lag 1; 0.97 [0.94, 0.99] lag 4
34-36 wks
0.90 [0.84, 0.97] lag 1; 0.94 [0.88, 1.02] lag 4
29-33 wks
1.01 [0.91, 1.13] lag 1; 0.90 [0.80, 1.01] lag 4
25-28 wks
0.94 [0.78, 1.13] lag 1; 0.90 [0.73, 1.11] lag 4
Linn et al. (2000)
Los Angeles, United
States

Period of Study:
1992-1995













Outcomes (ICD 9 codes): Asthma (493),
COPD (APR-DRG 88), Pulmonary
diagnoses
(APR-DRG 75-101)
Age groups analyzed: >30
Study Design: Time-series
N: 302,600
Statistical Analyses: Poisson regression,
GAM, OLS regression
Covariates: day of wk, holiday, max
temperature, min temperature, rain days,
mean temperature, barometric pressure,
season
Seasons: Winter (Jan-Mar),
Spring (Apr-Jun), Summer (Jul-Sep),
Fall (Oct-Dec)
Statistical Package: SPSS and SAS
Lag: 0, 1 days



All concentrations are in
pphm.
Winter: 3. 4 ±1.3
Spring: 2. 8 ±0.9
Summer: 3. 4 ± 1.0
Autumn: 4.1 ± 1.4

Overall: 3. 4 ±1.3











Winter:
CO; r= 0.89
PM10;r=0.88
O3;r=-0.23

Spring:
CO; r= 0.92
PM10; r = 0.67
03;r=0.35

Summer
CO; r= 0.94
PM10;r=0.80
O3;r=0.11

Winter
CO; r= 0.84
PM10;r=0.80
03;r=-0.00

Increment: 10 ppb

All pulmonary
All seasons: 0.7% ±0.3%
Winter: 1.1% ±0.5%
Spring: 0.7% ±0.1%
Summer: 0.4% ±0.8%
Autumn: 1.2% ±0.4%
Asthma
All season: 1.4% ±0.5%
Winter: 2. 8% ±0.1%
Spring: NR
Summer: NR
Autumn: 1.9% ±0.8%
COPD
All season: 0.8% ±0.4%
Winter: NR
Spring: NR
Summer: NR
Autumn: 1.6% ±0.6%

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                TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                         HOSPITAL ADMISSIONS
    Reference, Study
   Location, & Period
        Outcomes, Design, & Methods
    Mean Levels &
  Monitoring Stations
Copollutants &   Effects: Relative Risk or Percent Change
  Correlations          & Confidence Intervals (95%)
           UNITED STATES (cont'd)
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           Magas et al. (2007)
           Oklahoma City, OK

           Period of Study: 2001-
           2003
Gwynn*et al. (2000)
Buffalo, NY
United States

Period of Study:
1988-1990

Days: 1,090
           Zanobetti and Schwartz
           (2006)
           Boston, MA, United
           States

           Period of Study:
           1995-1999
Outcomes (ICD 9 codes): Asthma (493)
Age groups analyzed: 0-14
Study Design: Time-series
N: 1,270
Statistical Analyses: negative binomial
regression
Covariates: gender, day of wk, holiday,
Lag:

Outcomes (ICD 9 codes): Respiratory
admissions: Acute bronchitis/bronchiolitis (466);
Pneumonia (480-4860); COPD and Asthma (490-
493, 496)
Age groups analyzed: 6
Study Design: Time-series
N: 24,
Statistical Analyses: Poisson regression with
GLM and GAM
Covariates: Season, day of wk, holiday,
temperature, relative humidity
Lag:  0-3 days

Outcomes (ICD 9 codes): Pneumonia (480-7)
Age groups analyzed: 65+
Special Population: Medicare patients only
Study Design: Case-crossover
N: 24,857
Statistical Analyses: Conditional logisitic
regression
Covariates: Apparent temperature, day ofwk
Seasons: Warm (Apr-Sep), Cool (Oct-Mar)
Statistical Package: SAS
Lag:  0, 1 days, 0-1 avg
                                                                     24-havg: 11.7ppb
                                                                     Number of monitors: 10
24-h avg NO2 (ppb):
Min: 4.0
25th: 15.5
Mean: 20.5
75th: 24.5
Max: 47.5
                                                                     NO2 median 23.20 ppb;
                                                                     90-10%: 20.41 ppb;
                                                                     For lag 0-12 day avg
                                                                     90-10% =16.8 ppb;
                                                                     IQR= 10.83

                                                                     Number of Stations: 5
                        03
                        PM2.5
H+; r = 0.22
SO42~;r=0.36
PM10; r = 0.44
O3;r=0.06
SO2;r = 0.36
CO; r= 0.65
COH; r = 0.72
                        PM2.5; r = 0.55
                        BC;r=0.70
                        CO; r= 0.67
                        O3;r=-0.14
                 Qualitative results: ambient concentrations
                 of NO2 increased pediatric asthma
                 hospitalizations
                                                                                                                        Increment: 27 9 ppb (Max-Mean; IQR)

                                                                                                                        NO2 alone:
                                                                                                                        Max-Mean RR 1.033 (t = 1.32) lag 1
                                                                                                                        IQRRR1.01(t= 1.32) lag 1
                 Increment:  20.41 ppb (90-10%)
                 Pneumonia
                 -0.16% [-4.73, 4.42] lag 0

                 Increment:  16.78 ppb (90-10%)
                 Pneumonia
                 2.26% [-2.55, 7.01] lag 0-1

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                  TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                             HOSPITAL ADMISSIONS
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Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants & Effects: Relative Risk or Percent Change &
Correlations Confidence Intervals (95%)
CANADA
Burnett etal. (1997a)
16 cities
Canada

Period of Study:
4/1981-12/1991

Days: 3,927




Yang et al. (2003)
Vancouver, Canada

Period of Study: 1986-
1998

Days: 4748






Outcomes (ICD 9 codes): All respiratory
admissions
(466, 480-6, 490-4, 496)
Study Design: Time-series
N: 720,519
# of hospitals: 134
Statistical Analyses: Random effects
relative risk regression model
Covariates: Long-term trend, season, day of
wk, hospital,
Statistical Package: NR
Lag: 0, 1,2 day
Outcomes (ICD 9 codes): All respiratory
admissions (460-519)
Study Design: Case-crossover
Age groups analyzed: <3, >65
Statistical Analyses: Conditional logistic
regression
Statistical Package: NR
Lag: 0-5 days





1 -h max NO2 (ppb)
Mean: 35.5
SD=16.5
25th: 25
50th: 33
75th: 43
95th: 62
99th: 87




24-h avg NO2 (ppb):
Mean: 18.74
SD = 5.66
5th: 11.35
25th: 14.88
50th: 17.80
75th: 21.45
100th: 49.00
IQR: 5.57

Number of stations: 30


O3;r=0.20 Increment: 10 ppb
CO
SO2 Single pollutant
COH NO2 and respiratory admissions, p = 0.772

Multipollutant model (adjusted for CO, O3, SO2,
COH, dew point):
RR 0.999 [0.9922, 1.0059] lag 0




CO Increment: 5. 57 ppb (IQR)
SO2
O3; r = -0.32 All Respiratory Admissions <3 yrs:
COH NO2 alone: OR 1.05 [1.02, 1.09] lag 1
NO2 + O3: OR 1.05 [1.02, 1.09] lag 1
N02 + 03 + CO + COH + S02: OR 1 .05
[0.99, 1.11] lag 1

All Respiratory Admissions >65 yrs:
NO2 alone: OR 1.05 [1.03, 1.07] lag 1
N02 + 03: OR 1.04 [1.02, 1.07] lag 1
NO2 + O3 + CO + COH + SO2: OR 1 .05
[1.01, 1.08] lag 1
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                        TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                            HOSPITAL ADMISSIONS
Reference, Study Mean Levels &
Location, & Period Outcomes, Design, & Methods Monitoring Stations
Copollutants & Effects:
Correlations
Relative Risk or Percent Change &
Confidence Intervals (95%)
CANADA (cont'd)
Fung et al. (2006) Outcomes (ICD 9 codes): All respiratory NO224-havg:
Vancouver, BC, Canada hospitalizations (460-519) Mean: 16. 83 ppb,
Age groups analyzed: 65+ SD = 4.34;
Period of Study: Study Design: (1) Time-series, (2) Case- !QR: 5.43 ppb;
6/1/95-3/31/99 crossover, (3) DM-models (Dewanji and range: 7.22,33.89
Moolgavkar 2000, 2002)
N: 40,974
Statistical Analyses: (1 ) Poisson,
(2) conditional logistic regression, (3) DM
method - analyze recurrent data in which
the occurrence of events at the individual
level over time is available
Covariates: Day of wk
Statistical Package: S-Plus and R
Lag: Current day, 3 and 5 day lag



CO; r= 0.74 Increment: 5.43 ppb. (IQR)
COH; r = 0.72
S02; r = 0.57 NO2
PM10;r=0.54 RR 1
PM2.5;r = 0.35 RR 1
PM10-2.5;r = 0.52 RR 1
O3;r=-0.32 RR 1
N02
RR1
RR1
RR1
RR1
NO2
RR1
RR1
RR1
RR1
Time-series
.018
.024
.025
.027
[1.
[1.
[1.
ro.
,003, 1
,004, 1
,000, 1
,998, 1
.034]
.044]
.050]
.058]
lag
lag
lag
las
;0
;0-3
;0-5
;0-7
Case-crossover
.028
.035
.032
.028
ri
L
[1.
[1.
[0.
,010, 1
,012,1
,006, 1
,997, 1
047]
J
.059]
.060]
.060]
las
c
lag
lag
lag
;0
;0-3
;0-5
;0-7
DM model
.012
.018
.007
.002
[0.
[1.
[0.
[0.
,997, 1
,000, 1
,988, 1
,981,1
.027]
.037]
.026]
.023]
lag
lag
lag
lag
;0
;0-3
;0-5
;0-7
                                                                                                      DM method produced slightly higher RR
                                                                                                      estimates on O3, SO2, and PM2 5 compared to
                                                                                                      Time-series and case-crossover, and slightly
                                                                                                      lower RR estimates on COH, NO2, and PM10,
                                                                                                      though the results were not significantly different
                                                                                                      from one another.
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                        TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              HOSPITAL ADMISSIONS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels & Copollutants &
Monitoring Stations Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
CANADA (cont'd)
Yang (2005)
Vancouver, BC, Canada

Period of Study:
1994-1998

Days: 1826




Outcomes (ICD 9 codes): COPD excluding
asthma (490-2, 494, 496)
Age groups analyzed: 65+
Study Design: Time-series
N: 6,027
Statistical Analyses: Poisson regression
with GAM (with more stringent criteria)
Covariates: Temperature, relative humidity,
day of wk, temporal trends, season
Statistical Package: S-Plus
Lag: 0-6 days, moving avgs
24-havg: 17.03 ppb, PM10;r=0.61
SD = 4.48; SO2;r = 0.61
IQR: 5.47 ppb; CO; r= 0.73
Range: 4.28,33.89 O3;r=-0.10

Winter: 19.20(4.86)
Spring: 15.36(3.72)
Summer: 16.33(4.57)
Fall: 17.27(3.77)

Number of Stations: 31
Increment: 5. 5 ppb (IQR)

COPD
>65 yrs, yr round
RR 1.05 [1.01, 1.09] lag 0
RR 1.04 [1.00, 1.10] lag 0-1
RR 1.07 [1.01, 1.13] lag 0-2
RR 1.08 [1.02, 1.15] lag 0-3
RR 1.10 [1.03, 1.17] lag 0-4
RR1.11 [1.04, 1.19] lag 0-5
RR1.11 [1.04, 1.20] lag 0-6
                                                                                                          Two-pollutant model
                                                                                                          PM10: RR 1.03 [0.90, 1.17] lag 0
                                                                                                          CO: RR 1.07 [0.96, 1.20] lag 0-6
                                                                                                          03: RR 1.12 [1.04, 1.20] lag 0-6

                                                                                                          Multipollutant models
                                                                                                          N02, CO, S02, 03, PM10: RR 1.01 [0.88, 1.16]
                                                                                                          N02, CO, S02, 03: RR 1.06 [0.95,1.19]

                                                                                                          NO2 was strongest predictor of hospital admission
                                                                                                          for COPD among all gaseous pollutants in single-
                                                                                                          pollutant models.
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                        TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                                             HOSPITAL ADMISSIONS
X
to
H
6
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o
H
O
O

H
W
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants & Effects: Relative Risk or Percent Change &
Correlations Confidence Intervals (95%)
CANADA (cont'd)
Lin* et al. (2004)
Vancouver, BC
Canada

Period of Study:
1987-1991












Outcomes (ICD 9 codes): Asthma (493)
Age groups analyzed: 6-12
Study Design: Time-series
N: 3,754 (2,331 male, 1,423 female)
Statistical Analyses: Semi-parametric
Poisson regression with GAM (with default
and more stringent criteria)
Covariates: Trend, day of wk,
Statistical package: S-Plus
Lag: Cumulative 1-7 day








24-h avg NO2 (ppb)
Mean: 18.65
SD = 5.59
Min: 4.28
25th: 14.82
50th: 17.75
75th: 21.36
Max: 45.36

Number of stations: 30








CO; r = 0.73 Increment: 6.54 ppb (IQR)
SO2;r = 0.67
O3;r=-0.03 Boys 6-12 yrs by SES status: Low; High
PM2.5; r = 0.37 Lag 1 RR 1.13 [1.04, 1.23]; 1.04 [0.95, 1.14]
PM10;r=0.55 Lag 2 RR 1.13 [1.02, 1.24]; 1.06 [0.95, 1.18]
Lag 3 RR 1.14 [1.02, 1.27]; 1.06 [0.94, 1.19]
Lag 4 RR 1.14 [1.02, 1.28]; 1.05 [0.92, 1.19]
Lag 5 RR 1.12 [0.99, 1.27]; 1.10 [0.96, 1.26]
Lag 6 RR 1.12 [0.98, 1.28]; 1.07 [0.93, 1.23]
Lag 7 RR 1.11 [0.97,1.28]; 1.09 [0.94, 1.27]
Girls 6-12 yrs by SES status: Low; High
Lag 1 RR 1.07 [0.96, 1.19]; 1.01 [0.90, 1.13]
Lag 2 RR 1.03 [0.91, 1.17]; 0.98 [0.85, 1.12]
Lag 3 RR 1.04 [0.91, 1.20]; 0.98 [0.84, 1.13]
Lag 4 RR 1.11 [0.95,1.29]; 1.01 [0.86,1.19]
Lag 5 RR 1.11 [0.94, 1.30]; 0.99 [0.83, 1.17]
Lag 6 RR 1.08 [0.91, 1.28]; 1.03 [0.86, 1.24]
Lag 7 RR 1.07 [0.90, 1.28]; 1.09 [0.90, 1.32]
                                                                                                         Multipollutant model (adjusted for SO2)

                                                                                                         Boys, Low SES:

                                                                                                         1.16 [1.06, 1.28] lag 1

                                                                                                         1.18 [1.03, 1.34] lag 4


                                                                                                         Results presented are default GAM, but authors

                                                                                                         state that use of natural cubic splines with a more

                                                                                                         stringent convergence rate produced similar

                                                                                                         results.
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                  TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                            HOSPITAL ADMISSIONS
X
H
6
o

o
H
O
O

H
W
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
CANADA (cont'd)
Chen etal. (2005)
Vancouver, BC
Period of Study:
6/1995-3/1999

Lin etal. (2003)
Toronto, ON

Period of Study:
1981-1993






Outcomes (ICD 9 codes): All Respiratory
(460-519)
Age groups analyzed: 65+
Study Design: Time-series
N: 12,869 overall admissions
Statistical Analyses: Poisson regression
with GLM
Covariates: Trend, day of wk, weather
Statistical package: S-Plus
Lag: 1-7
Outcomes (ICD 9 codes): Asthma (493)
Age groups analyzed: 6-12
Study Design: Bi-directional case-crossover
N: 7,319
Statistical Analyses: Conditional logistic
regression
Covariates: Daily maximum and minimum
temperatures and avg relative humidity
Lag: Cumulative lag of 1-7 days


24-havg: 16.8 (4. 3) ppb
Range: 7.2-33.9
IQR: 5.4

NO2 24-havg: 25.24 ppb,
SD = 9.04;
IQR: 11 ppb;
Range: 3.00, 82.00

Number of Stations: 4





PM10;r=0.54
PM10_2.5;r = 0.54
PM2.5; r = 0.36
CO; r= 0.74
SO2;r = 0.57
03;r=-0.32

C0;r:
SO2;r
PM10;
O3;r =
PM2.5;

= 0.55
= 0.54
r=0.52
:Q.03
r = 0.50
PM10-2.5;r = 0.38










No analyses forNO2

Increment: 11

Boys 6-12 yrs;


ppb (IQR)

Girls 6-12




yrs

LagO: OR 1.04 [0.99, 1.10]; 0.
Lag 0-1: OR1
Lag 0-2: OR 1
Lag 0-3: OR 1
Lag 0-4: OR 1
Lag 0-5: OR 1
Lag 0-6: OR 1
.07 [1.00,
.09 [1.01,
.10 [1.01,
.10 [1.00,
.12 [1.01,
.11 [1.00,
1.14];
1.17];
1.20];
1.20];
1.23];
1.24];





99 [0
1.03
1.07
1.09
1.14
1.16
1.16










.92,1.
[0.
[0.
[0.
[1.
[1.
[1.
,94,
,96,
,97,
,02,
,02,
,02,





06]
1.12]
1.18]
1.21]
1.28]
1.31]
1.32]
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                   HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           CANADA (cont'd)
X
           Burnett etal. (1997b)
           Toronto, Canada

           Period of Study:
           1992-1994
                    Outcomes (ICD 9 codes): Respiratory
                    tracheobronchitis (480-6), COPD (491-4, 496)
                    Study Design: Time-series
                    Statistical Analyses: Poisson regression, GEE,
                    GAM
                    Covariates:  Temperature, dew point
                    temperature, long-term trend, season, influenza,
                    day of wk
                    Seasons:  summers only
                    Lag: 0,1,2,3,4 days
                                   MeanNO2:  38.5 ppb

                                   IQRNO2: 5.75 ppb
                                   Range: 12, 81

                                   Number of Stations:
                                   6-11
                      PM10;r=0.61
                      CO; r= 0.25
                      H+; r = 0.25
                      SO4; r = 0.34
                      TP;r=0.61
                      FP; r = 0.45
                      CP;r=0.57
                      COH;r = 0.61
                      O3;r=0.07
                      SO2; r = 0.46
                 Increment:  5.75 ppb (IQR)

                 Respiratory - Percent increase
                 4.4% [CI 2.4, 6.4], lag 0

                 Copollutant and multipollutant models RR
                 (t-statistic):
                 N02,COH: 1.018(1.36)
                 NO2,H+: 1.037(3.61)
                 NO2, SO4: 1.033(3.05)
                 N02,PM10: 1.039(2.85)
                 NO2,PM2.5:  1.037(3.13)
                 N02, PM10-2.5:  1.037(2.96)
                 NO2, O3, SO2:  1.028(2.45)
                 N02, 03, S02, COH: 1.010(0.71)
                 N02, 03, S02, FT:  1.027(2.39)
                 NO2, O3, SO2, SO4:  1.027(2.36)
                 N02, 03, S02, PM10: 1.028 (1.77)
                 NO2, O3, SO2, PM2 5: 1.028 (2.26)
                 N02, 03, S02, PM10-2.5: 1.022(1.71)
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
                                                                                Mean Levels &
                                                                              Monitoring Stations
  Copollutants &     Effects: Relative Risk or Percent Change &
   Correlations               Confidence Intervals (95%)
           CANADA (cont'd)
X
           Burnett etal. (1999)
           Metro Toronto, Canada

           Period of Study:
           1980-1994
                     Outcomes (ICD 9 codes): Asthma (493);
                     Obstructive lung disease (490-2,496);
                     Respiratory Infection (464, 466, 480-7, 494)
                     Study Design:  Time-series
                     Statistical Analyses:  Poisson regression
                     model with stepwise analysis
                     Covariates: Long-term trends, season, day of
                     wk, daily maximum temperature, daily
                     minimum temperature, daily avg dew point
                     temperature, daily avg relative humidity
                     Statistical Package: S-Plus, SAS
                     Lag: 0,1,2 day s, cumulative
                                    24-h mean: 25.2 ppb,
                                    SD = 9.1,
                                    CV = 36;
                                    IQR = 23

                                    Number of stations: 4
COH;
PM2.5;
PM10-
PM10;
CO; r
SO2;r
O3;r=
                                                                                                         r = NR
                                                                                                          r = 0.50
                                                                                                          .5;r = 0.3
                                                                                                         r=0.52
                                                                                                         = 0.55
                                                                                                          = 0.54
                                                                                                          -0.03
Increment: 25.2 ppb (Mean)

7.72 excess daily admissions due to pollution of
all sorts. 40.4% increase; or 3 excess daily
admissions traced to NO2.

Single-pollutant model percent increase
(t statistic)
Asthma: 3.33% (2.37) lag 0
OLD 2.21% (1.07) lag 1
Respiratory infection:  6.89% (5.53), lag 2

Multipollutant model percent increase (SE)
Respiratory infection:
NO2 alone: 4.64 (SE>3)
N02 + S02 + 03 + PM2.5: 4.04 (SE >2)
NO2 + SO2 + O3 + PM10-2.5: 4.56 (SE >3)
NO2 + SO2 + O3 + PM10:  4.16(SE>3)
NO2 + O3 + PM2.5: 4.44 (SE >2)
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           Lin etal. (2005)         Outcomes (ICD 9 codes):  Respiratory
           Toronto, Canada         infections (464,466, 480-487)
                                  Age groups analyzed: 0-14
           Period of Study:         N: 6,782
           1998-2001              Study Design: Bidirectional Case-Crossover
                                  Statistical Analyses: Conditional logistic
                                  regression
                                  Covariates: temperature, dew point
                                  temperature,
                                  Statistical Package: SAS v 8.2
                                  Lag:  1-7 day exposure averages
                                                                24-h avg: 24.54
                                                                (7.56) ppb
                                                                Range: 9.2-53.75
                                                                25th:  18.75
                                                                50th:  24.00
                                                                75th:  29.33

                                                                Number of monitors: 7
                                                           CO, r = 0.20         Increment:  10.6 ppb (IQR)
                                                           SO2,r = 0.61         All children:
                                                           O3,r = 0             NO2 alone:  1.20 [1.08, 1.34] lag 0-5
                                                           PM10,r=0.54        N02 + PM2.5 + PM10-2.5: 1.13 [0.97, 1.31] lag 0-5
                                                           PM2.5, r = 0.48        Boys:
                                                           PMio-2.5, r = 0.40     NO2alone:  1.13 [0.98, 1.29] lag 0-5
                                                                               NO2 + PM2.5 + PM10-2.5: 1.00 [0.83, 1.21] lag 0-5
                                                                               Girls:
                                                                               NO2 alone:  1.28 [1.09-1.50] lag 0-5
                                                                               N02 + PM2.5 + PM10-2.5: 1.31 [1.05, 1.63] lag 0-5
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
  Reference, Study
 Location, & Period
       Outcomes, Design, & Methods
    Mean Levels &
  Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations            & Confidence Intervals (95%)
           CANADA (cont'd)
X
Oi
-k
Oi
H
6
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H
O
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H
W
           Burnett* et al. (2001)
           Toronto, Canada

           Period of Study:
           1980-1994
Fung et al. (2007)
Ontario, Canada

Period of Study:
1996-2000
Outcomes (ICD 9 codes):  Croup (464.4),
pneumonia (480-486), asthma (493), acute
bronchitis/bronchiolitis (466)
Age groups analyzed: <2 yrs
Study Design: Time-series
Statistical Analyses: Poisson regression with
GAM
Covariates: temporal trend, day of wk,
temperature, relative humidity
Statistical Package: S-Plus
Lag:  0-5 days

Outcomes (ICD 9 codes):  All respiratory
(460-519)
Age groups analyzed: 0-4, 5-14, 15-19, 20-24,
25-54, 55-64, 65-74, 75+
Study Design:
Statistical Analyses:
Covariates:
Statistical Package:
Lag:
                                                                  1-h max NO2 (ppb)
                                                                  Mean: 44.1
                                                                  CV:  33
                                                                  5th: 25
                                                                  25th: 35
                                                                  50th: 42
                                                                  75th: 52
                                                                  95th: 70
                                                                  99th: 86
                                                                  100th: 146
Number of stations:  4
London                 SO2
Mean:  18.10 ppb (7.86)    O3
Range: 0-53             CO

Windsor
Mean:  23.50 ppb (7.59)
Range: 6-50

Sarnia
Mean: 16.85 ppb (8.13)
Range: 0-52	
                        O3;r=0.52
                        SO2
                        CO
                        PM2.5
                        PMio-2.5
                  Increment: NR

                  All respiratory admissions:
                  Single-pollutant:
                  Percent increase: 20.2 (t = 3.43) lag 0-1

                  Multipollutant (adjusted for O3):
                  Percent increase: 7.1 (t = 1.09) lag 0-1
                                                                                                                        Not reported
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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change &
 Correlations             Confidence Intervals (95%)
           CANADA (cont'd)
X
           Luginaah et al. (2005)
           Windsor, ON, Canada

           Period of Study:
           4/1/95-12/31/00
                      Outcomes (ICD 9 codes):  Respiratory
                      admissions (460-519)
                      Age groups analyzed: 0-14,15-64, 65+, all
                      ages
                      Study Design: (1) Time-series and (2) case-
                      crossover
                      N: 4,214
                      # of Hospitals: 4
                      Statistical Analyses: (1) Poisson regression,
                      GAM with natural splines (stricter criteria),
                      (2) conditional logistic regression with Cox
                      proportional hazards model
                      Covariates:  Temperature, humidity, change in
                      barometric pressure, day of wk
                      Statistical Package:  S-Plus
                      Lag:  1,2,3 days
                                    NO2 mean 1-h max:
                                    38.9 ppb,
                                    SD = 12.3;
                                    IQR: 16

                                    Number of stations: 4
                      SO2; r = 0.22
                      CO; r= 0.38
                      PM10;r=0.33
                      COH;  r = 0.49
                      03; r = 0.26
                      TRS;r=0.06
                 Increment:  16 ppb (IQR)

                 Time-series, females; males
                 All ages, lag 1 1.035 [0.971, 1.104]; 0.944
                 [0.886,1.006]
                 0-14 yrs, lag 2 1.114 [0.994, 1.248]; 0.955
                 [0.866,1.004]
                 15-65 yr, lag 3 1.121 [0.978,1.285], 1.012
                 [0.841,1.216]
                 65+yr, lag  1 1.020 [0.930, 1.119]; 0.9196
                 [0.832,1.016]

                 Case-crossover, females; males
                 All ages, lag 1 1.078 [0.995, 1.168]; 0.957
                 [0.883,1.036]
                 0-14 yrs, lag 2 1.189 [1.002, 1.411]; 0.933
                 [0.810,1.074]
                 15-65 yr, lag 3 1.114 [0.915,1.356]; 0.972
                 [0.744,1.268]
                 65+yr,lag  1 1.081 [0.964, 1.212]; 0.915
                 [0.810,1.034]
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                  TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                             HOSPITAL ADMISSIONS
X
OO
H
6
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o
H
O
O

H
W
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change &
Confidence Intervals (95%)
AUSTRALIA/NEW ZEALAND
Simpson et at (2005a)
Multi-city study,
Australia (Sydney,
Melbourne, Brisbane,
Perth)

Period of Study:
1996-1999













Outcomes (ICD 9/ICD 10): All respiratory
(460-5 19/JOO-J99 excluding J95.4-J95.9,
R09.1, R09.8), asthma (493/J45, J46, J44.8),
COPD (490-492, 494-496/J40-J44, J47, J67),
pneumonia with bronchitis (466, 480-486/J12-
17, J18.0, J18.1, J18.8, J18.9, J20, J21)
Age groups analyzed: 15-64 (asthma), 65+ (all
respiratory, COPD, asthma, pneumonia with
bronchitis)
Study Design: Time-series
Statistical Analyses: Followed APHEA2
protocol: (1) Single city: (a) GAM with default
and more stringent criteria, (b) GLM with
default and more stringent criteria, (c) penalized
spline models. (2) Multicity meta analysis:
random effects meta-analysis
Covariates: Temperature, relative humidity, day
of wk, holiday, influenza epidemic,
brushfire/controlled bum
Statistical Package: S-Plus, R
Lag: 0,1, 2 days
1 h max NO2 ppb
(range)

Brisbane: 24.1
(2.1,63.3)
Sydney: 23.7
(6.5, 59.4)
Melbourne: 23.7
(4.4, 66.7)

Perth: 16.3(1.9,41.0)











Brisbane:
O3;r=0.15
BSP;r=0.50

Melbourne:
03;r=0.30
BSP; r = 0.29
Sidney ;

O3; r = 0.24
BSP; r= 0.54

Perth:
03; r = 0.28
BSP; r = 0.62






Increment: 1 ppb

Respiratory
>65 yrs 1.0027 [1.0015, 1.0039] lag 0-1
COPD and Asthma
>65 yrs 1.0020 [1.0003, 1.0037] lag 0-1
Pneumonia and Acute Bronchitis
>65 yrs 1.0030 [1.0011, 1.0048] lag 0-1

Multipollutant Model
Respiratory >65 yrs
N02 Alone: 1.0027 [1.0015,1.0039] lagO-1
NO2 + BSP: 1.0023 [1.0009, 1.0038] lag 0-1
N02 + 03: 1.0028 [1.0016, 1.0040] lag 0-1

GAM results from S-Plus and R similar to one
another, but different than results from GLM.
GAM results from S-Plus presented.



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                            TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &       Effects:  Relative Risk or Percent Change
 Correlations              & Confidence Intervals (95%)
           AUSTRALIA/NEW ZEALAND (cont'd)
X
vo
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           Barnett et al. (2005)
           Multicity, Australia/
           New Zealand;
           (Auckland, Brisbane,
           Canberra, Christchurch,
           Melbourne, Perth,
           Sydney)

           Period of Study:
           1998-2001
                      Outcomes (ICD 9/ICD 10): All respiratory
                      (460-519/JOO-J99 excluding J95.4-J95.9,
                      RO9.1, RO9.8), asthma (493/J45, J46,
                      J44.8), COPD (490-492, 494-496/J40-J44,
                      J47, J67), pneumonia with bronchitis (466,
                      480-486/J12-17, J18.0, J18.1, J18.8, J18.9,
                      J20,J21)

                      Age groups analyzed: 0, 1-4, 5-14
                      Study Design: Case-crossover
                      Statistical Analyses: Conditional logistic
                      regression, random effects meta-analysis
                      Covariates:  Temperature, current-previous
                      day temperature, relative humidity,
                      pressure, extremes of hot and cold, day of
                      wk, holiday, day after holiday
                      Season:  Cool, May-Oct; Warm, Nov-Apr
                      Statistical Package:  SAS
                      Lag:  0-1 days
                                   24-h avg (ppb) (range):
                                   Auckland 10.2
                                   (1.7,28.9)
                                   Brisbane 7.6 (1.4, 19.1)
                                   Canberra 7.0 (0, 22.5)
                                   Christchurch 7.1
                                   (0.2,24.5)
                                   Melbourne 11.7 (2, 29.5)
                                   Perth 9.0 (2, 23.3)
                                   Sydney 11.5(2.5,24.5)

                                   IQR: 5.1 ppb

                                   Daily 1-h max (range):
                                   Auckland 19.1
                                   (4.2, 86.3)
                                   Brisbane 17.3 (4, 44.1)
                                   Canberra 17.9 (0, 53.7)
                                   Christchurch 15.7
                                   (1.2,54.6)
                                   Melbourne 23.2
                                   (4.4, 62.5)
                                   Perth 21.3 (4.4,48)
                                   Sydney 22.6 (5.2, 51.4)

                                   IQR: 9.0 ppb
                      BS;r= 0.39, 0.63
                      PM2.5;r = 0.34, 0.68
                      PM10;r= 0.21,0.57
                      CO; r = 0.53, 0.73
                      SO2;r = 0.15, 0.58
                      O3;r=-0.15, 0.28
                   Increment:  5.1 ppb (24 h) or per 9 ppb (1-h
                   max).  (IQR)

                   24-h avg NO2 (5.1 ppb change)
                   Pneumonia and acute bronchitis
                   Oyrs 3.2% [-1.8, 8.4] lag 0-1
                   1-4 yrs 4.8% [-1.0, 11.0] lag 0-1
                   5-14 yrs (sample size too small)
                   Respiratory
                   Oyrs 3.1% [-1.0, 7.3] lag 0-1
                   1-4 yrs 2.4% [-0.8, 5.7] lag 0-1
                   5-14 yrs 5.8% [1.7, 10.1] lag 0-1
                   Asthma
                   0 yrs No analysis (poor diagnosis)
                   1-4 yrs 2.6% [-1.3, 6.6] lag 0-1
                   5-14 yrs 6.0% [0.2, 12.1] lag 0-1
                   1 h NO2 maximum (9.0 ppb change)
                   Pneumonia and acute bronchitis
                   Oyrs2..8% [-1.8, 7.7] lag 0-1
                   l-4yrs4.1%[-2.4,11.0]lagO-l
                   5-14 yrs (sample size too small)
                   Respiratory
                   Oyrs2.2% [-1.6, 6.1] lag 0-1
                   1-4 yrs 2.8% [0.7, 4.9] lag 0-1
                   5-14 yrs 4.7% [1.6, 7.9]  lag 0-1
                   Asthma
                   0 yrs No analysis (poor diagnosis)
                   1-4 yrs 2.5% [-0.2, 5.2] lag 0-1
                   5-14 yrs 2.6% [-2.2, 7.6] lag 0-1
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
   Reference, Study
  Location, & Period
 Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
 Copollutants &    Effects: Relative Risk or Percent Change
  Correlations            & Confidence Intervals (95%)
           AUSTRALIA/NEW ZEALAND (cont'd)
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           Erbas et al. (2005)
           Melbourne, Australia

           Period of Study :  2000-2001
Hinwood et al. (2006)
Perth, Australia

Period of Study:
1992-1998
Outcomes (ICD 10): Asthma (J45, J46)
Age groups analyzed:  1-15
Study Design: Time-series
N:  8,955
# of Hospitals: 6
Statistical Analyses: Poisson
regression, GAM and GEE
Covariates: Day of wk
Dose-response investigated?: Yes
Statistical Package: NR
Lag: 0,1,2 days
Outcomes (ICD 9): COPD (490-496,
excluding 493); Pneumonia (480-
489.99); Asthma (493)
Age groups analyzed: <15, 65+, all
ages
Study Design: Case-crossover, time-
stratified
Statistical Analyses: Conditional
logistic regression
Covariates:  Temperature, change in
temperature, maximum humidity,
holiday, day of wk
Statistical Package: NR
Lag: 0,1,2,3 days or cumulative 0-2
and
0-3 days
l-hmeanNO2: 16.80 ppb,
SD = 8.61;
Range: 2.43,63.00
24-h mean [Std. Dev]
(10th and 90th percentile)
All yr 10.3 [5.0]
(4.4,17.1)
Summer 9.6 [4.8]
(4.3, 15.7)
Winter 11.1 [5.1]
(4.8, 18.0)
Daily  1-hmax
Mean [Std. Dev]
All yr 24.8 [10.1]
(13.3,37.5)
Summer 24.9 [8.9]
(12.4, 39.2)
Winter 24.7 [11.1]
(14.4,35.7)

Number of stations: 3
                                                                                           PM10
                                                                                           03
03;r=-0.06
CO; r= 0.57
BS;r=0.39
PM10
PM2.5
Increment: 90th-1 Oth percentile

Inner Melbourne; increment = 25.54 ppb
RR 0.83 [0.68, 0.98] lag 0

Western Melbourne; increment = 28.86 ppb
RR 1.15 [1.03, 1.27] lag 2

Eastern Melbourne; increment = 17.67 ppb
RR 1.07 [0.93, 1.22] lag 0

South/Southeastern; increment =  17.74 ppb
RR 0.98 [0.79, 1.18] lag 1

Increment: 1 ppb (all values were estimated
from the graphs)

All respiratory NO2 (24 h)
>65yrsOR:  1.005 [1.001, 1.011] lag 1
All ages OR: 1.002 [0.998, 1.004] lag 1

Pneumonia NO2 (24 h)
>65 yrs OR:  1.006 [0.999, 1.014] lag 1
All ages OR: 1.002 [0.998, 1.010] lag 1

COPD N02 (24 h)
>65 yrs OR:  1.004 [0.990, 1.012] lag 2
All ages OR: 1.001 [0.995, 1.010] lag 2

Asthma NO2 (24 h)
0-14 yrs OR: 1.002 [0.998, 1.004] lag 0
>65 yrs OR:  0.996 [0.988, 1.002] lag 0
All ages OR: 1.001 [0.999, 1.003] lag 0

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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change
& Confidence Intervals (95%)
AUSTRALIA/NEW ZEALAND
           Morgan etal. (1998a)
           Sydney, Australia

           Period of Study:
           1990-1994
Outcomes (ICD 9): COPD (490-492, 494,
496); Asthma (493)
Age groups analyzed:  1-14, 15-64, 65+, all
ages
Study Design: Time-series
# of hospitals: 27
Statistical Analyses: APHEA protocol,
Poisson regression, GEE
Covariates: Long-term trend, temperature,
dew point, day of wk, holiday
Statistical Package: SAS
Lag: 0,1,2 days and cumulative
24-h daily mean:  15ppb,
SD = 6,Range: 0,52,
IQR:  11, 90-10th
percentile: 17

Mean daily 1-h max:  29 ppb,
SD = 3,
Range: 0, 139,
IQR:  15, 90-10th
percentile: 29

# of stations: 3-14, r = 0.52
                                                                                                      24-h avg NO2:

                                                                                                      PM(24h);r=0.53
                                                                                                      PM(lh);r=0.51
                                                                                                      O3;r=-0.9

                                                                                                      l-hmaxNO2:

                                                                                                      PM(24 h); r = 0.45
                                                                                                      PM(lh);r=0.44
                                                                                                      O3;r=0.13
X
Increment: 90-1 Oth percentile

24-h avg (17 ppb)
Asthma: 1-14 yrs 3.28% [-1.72, 8.54] lag 0
        15-64 yrs 2.29% [-2.97, 7.83] lag 0
COPD: >65 yrs 4.30% [-0.75, 9.61] lag 1

Daily 1-h maximum (29 ppb)
Asthma: 1-14 yrs 5.29% [1.07, 9.68] lag 0
        15-64 yrs. 3.18% [-1.53, 8.11] lag 0
COPD: 65+ yrs. 4.60% [-0.17, 9.61] lag 1

Multipollutant model (29 ppb)
Asthma: 1-14 yrs. 5.95% [1.11, 11.02] lag 0
COPD: 65+ yrs. 3.70% [-1.03, 8.66] lag 1
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           Petroeschevsky et al.
           (2001)
           Brisbane, Australia

           Period of Study:
           1987-1994
           Days:  2922
Outcomes (ICD 9): All respiratory (460-519);
Asthma (493)
Age groups analyzed: 0-4, 5-14, 15-64, 65+,
all ages
Study Design: Timeseries
N:  33,710 (13,246 = asthma)
Statistical Analyses: APHEA protocol,
Poisson regression, GEE
Covariates:  Temperature, humidity, season,
infectious disease, day of wk, holiday
Season: Summer, Autumn, Winter, Spring,
Allyr
Dose-response investigated?:  Yes
Statistical Package: SAS
Lag: Single: 1,2,3 day
Mean (range) 24-h avg:
Cumulative: 0-2,0-4
Overall: 139(12,497)
Summer: 97(20,331)
Autumn: 129(33,319)
Winter:  179(12,454)
Spring:  153(35,497)

Mean (range) 1-h max
Overall: 282 (35, 1558)
Summer: 206(35,580)
Autumn: 256(70,585)
Winter:  354(35,805)
Spring:  321 (35, 1558)

# of stations: 3,
r = 0.43, 0.53
                                                                                                      BSP
                                                                                                      03
                                                                                                      S02
Increment: 10 ppb

Respiratory (1-h max):
0-4 yrs 1.015 [0.996, 1.035] lag 3
5-14 yrs 0.985 [0.950, 1.021] lag 0
All ages 0.989 [0.977, 1.002] lag 1

Respiratory (24-h avg):
15-64 yrs 1.027 [0.984, 1.071] lag 0
>65 yrs 0.903 [0.851, 0.959] lag 5

Asthma (1-h max):
0-4 yrs 0.975 [0.947, 1.004] lagO
5-64 yrs 0.983 [0.949, 1.018] lag 1
All ages 0.962 [0.936, 0.989] lag 0-2

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                          TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                   HOSPITAL ADMISSIONS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels & Copollutants & Effects: Relative Risk or Percent Change
Monitoring Stations Correlations & Confidence Intervals (95%)
EUROPE
Anderson et al. (1997)
Multicity, Europe
(Amsterdam,
Barcelona, London,
Paris, Rotterdam)

Period of study:
1977- 1989 for
Amsterdam and
Rotterdam
1986- 1992 for
Barcelona
1987-1991 for London
1980-1989 for Milan

1987-1 992 for Paris
Outcomes (ICD 9): COPD - unspecified
bronchitis (490), chronic bronchitis (491),
emphysema (492), chronic airways
obstruction (496)
Study Design: Time-series
Statistical Analyses: APHEA protocol,
Poisson regression, meta-analysis
Covariates: Trend, season, day of wk,
holiday, influenza, temperature, humidity
Season: Cool, Oct-Mar; Warm, Apr-Sep
Statistical Package: NR
Lag: 0,1,2 days and 0-3 cumulative




24-h all yr avg: (ug/m3) SO2
Amsterdam: 50 BS
Barcelona: 53 TSP
London: 67 O3
Paris: 42
Rotterdam: 52

1-hmax:
Amsterdam: 75
Barcelona: 93
London: 67
Paris' 64
Rotterdam: 78



Increment: 50 ug/m

Meta-analytic results - Weighted mean
values from 6 cities

COPD- Warm season
24 h 1.03 [1.00, 1.06] lag 1
1 h 1.02 [1.00, 1.05] lag 1

COPD-Cool season
24 h 1.01 [0.99,1.03]
Ih 1.02 [0.99, 1.05]

COPD-A11 Year

24 hr 1.019 [1.002, 1.047] lag
o A i 	 i no,c n nn/i i n*>,cn i —












; 1
. n •?
                                                                                      cumulative
                                                                                      1 hr 1.013 [1.003, 1.022] lag 1
                                                                                      1 hr 1.014 [0.976, 1.054] lag 0-3, cumulative
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          Atkinson etal. (2001)
          Multicity, Europe
          (Barcelona,
          Birmingham, London,
          Milan, Netherlands,
          Paris, Rome,
          Stockholm)

          Period of study:
          1998-1997
Outcomes (ICD 9): Asthma (493), COPD
(490-496), All respiratory (460-519)
Study Design: Time-series
Statistical Analyses: APHEA protocol,
Poisson regression, meta-analysis
Covariates: Season, temperature, humidity,
holiday, influenza
Statistical Package: NR
Lag:  NR
1-hmax of NO2 (ug/m3)

Barcelona: 94.4
Birmingham: 75.8
London: 95.9
Milan:  147.0
Netherlands: 50.1
Paris:  87.2
Rome:  139.7
Stockholm:  35.6
S02, 03, CO, BS
PM10;r =
Barcelona: 0.48
B'gham: 0.68
London: 0.70
Milan:  0.72
Netherlands: 0.64
Paris:  0.44
Rome:  0.32
Stockholm:  0.30
Increment: 10 ug/m3 for PM10; change in
NO2 not described.

Asthma, 0 to 14 yrs:
ForPM10:  1.2% [0.2, 2.3]
ForPM10 + N02:  0.1 [-0.8,1.0]
Asthma, 15 to 64 yrs:
ForPM10:  1.1% [0.3, 1.8]
ForPM10 + NO2:  0.4 [-0.5, 1.3]
COPD + Asthma, >65 yrs
ForPM10:  1.0% [0.4, 1.5]
ForPM10 + NO2:  0.8 [-0.6, 2.1]
All Respiratory, >65 yrs of age
ForPM10:  0.9% [0.6, 1.3]
ForPM10 + NO2:  0.7 [-0.3, 1.7]

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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
            Reference, Study
            Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
           Sunyeretal. (1997)
           Multicity, Europe
           (Barcelona, Helsinki,
           Paris, London)

           Period of Study:
           1986-1992
                                Outcomes (ICD 9):  Asthma (493)
                                Age groups analyzed: <15,15-64
                                Study Design:  Time-series
                                Statistical Analyses:  APHEA protocol,
                                Poisson regression, GEE; meta-analysis
                                Covariates: Humidity, temperature, influenza,
                                soybean, long-term trend, season, day of wk
                                Season: Cool, Oct-Mar; Warm:
                                Apr-Sep
                                Statistical Package:  NR
                                Lag: 0,1,2,3 and cumulative 1-3
                                   24-h median (range) (ug/m )
                                   Barcelona:  53 (5, 142)
                                   Helsinki: 35(9,78)
                                   London: 69(27,347)
                                   Paris: 42 (12, 157)

                                   # of stations:
                                   Barcelona:  3
                                   London: 2
                                   Paris: 4
                                   Helsinki: 8
                        SO2
                        black smoke
                        03
                  Increment:  50 ug/m3 of 24-h avg for all
                  cities combined

                  Asthma
                  15-64yrs
                  1.029 [1.003, 1.055] lag 0-1
                  1.038 [1.008-1.068] lag 0-3, cumulative
                  <15 yrs
                  1.026 [1.006, 1.049] lag 2
                  1.037 [1.004, 1.067] lag 0-3, cumulative
                  1.080 [1.025,1.140] -Winteronly
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                                                                                                                        Two-pollutant models:
                                                                                                                        NO2/Black smoke
                                                                                                                        15-64 yrs
                                                                                                                        1.055 [1.005, 1.109] lag 0-1
                                                                                                                        15-64 yrs 1.088 [1.025,1.155] cumulative 0-
                                                                                                                        3
                                                                                                                        <15 yrs
                                                                                                                        1.036 [0.956,1.122]
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                                                                                                                        N02/S02
                                                                                                                        <15yrs
                                                                                                                        1.034 [0.988,1.082]
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects:  Relative Risk or Percent Change &
 Correlations            Confidence Intervals (95%)
           EUROPE (cont'd)
X
           Schouten et al.
           (1996)
           Multicity, The
           Netherlands
           (Amsterdam,
           Rotterdam)

           Period of Study:
           04/01/77-09/30/89
                    Outcomes (ICD 9): All respiratory (460-519),
                    COPD (490-2, 494, 496), Asthma (493)
                    Age groups analyzed: 15-64, 65+, all ages
                    Study Design: Time-series
                    Statistical Analyses: APHEA protocol, Poisson
                    regression
                    Covariates: Long-term trend, season, influenza,
                    day of wk, holiday, temperature, humidity
                    Season:  Cool, Nov-Apr; Warm:  May-Oct
                    Statistical Package: NR
                    Lag:  0,1,2 days; and cumulative 0-1 and 0-3
                    day lags
                                    24-h avg NO2

                                    Amsterdam
                                    Mean/Med: 50/50 ug/m3
                                    Rotterdam
                                    Mean: 54/52 ug/m3

                                    Daily max 1 h
                                    Amsterdam
                                    Mean/Med: 75/75 ug/m3
                                    Rotterdam
                                    Mean/Med: 82/78 ug/m3

                                    # of stations:  1 per city
                       SO2
                       BS
                       03
                Increment: 100 ug/m increment

                All respiratory, Amsterdam 24 h mean; 1-h max
                15-64 yrs RR 0.890 [0.783, 1.012]; 0.894
                [0.821, 0.973] lag 1
                >65 yrs RR 1.023 [0.907, 1.154]; 0.996 [0.918,
                1.080] lag 2
                All respiratory, Rotterdam 24 h mean; 1-h max
                (1985-89)
                15-64 yrs RR 0.965 [0.833, 1.118]; 1.036
                [0.951,1.129] lagl
                >65 yrs RR 1.172 [0.990, 1.387]; 1.073 [0.970,
                1.186] lag 0
                COPD, Amsterdam, 24-h mean,
                All ages RR 0.937 [0.818, 1.079] lag 1
                Asthma Amsterdam, 24-h mean,
                All ages RR 1.062 [0.887, 1.271] lag 2
                COPD, Rotterdam 24-h mean
                All ages RR 1.051 [0.903, 1.223] lag 2
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
X
           Ponce de Leon et al.
           (1996)
           London, England

           Period of Study:
           04/1987-1988;
           1991-02/1992
                    Outcomes (ICD 9): All respiratory (460-519)
                    Age groups analyzed: 0-14, 15-64, 65+, all
                    ages
                    Study Design: Timeseries
                    N: 19,901
                    Statistical Analyses: APHEA protocol, Poisson
                    regression GAM
                    Covariates: Long-term trend, season, influenza,
                    day of wk, holiday, temperature, humidity
                    Season:  Cool, Oct-Mar; Warm:
                    Apr-Sep
                    Dose-Response Investigated: Yes
                    Statistical Package: SAS
                    Lag:  0,1,2 days, 0-3 cumulative avg.
                                    NO224-havg: 37.3 ppb,
                                    Med: 35
                                    SD=13.8
                                    IQR: 14 ppb

                                    1-hmax: 57.4 ppb,
                                    Med: 51
                                    SD = 26.4
                                    IQR: 21 ppb

                                    # of stations: 2
                       SO2; r = 0.45
                       BS;r = 0.44
                       03
                  Increment:  90th-1 Oth percentile
                  (24-havg: 27 ppb)

                  Allyr
                  All ages 1.0114 [1.006, 1.0222] lag 2
                  0-14 yrs 1.0104 [0.9943, 1.0267] Iag2
                  15-64 yr 1.0113 [0.9920, 1.0309] lag 1
                  >65 yr 1.0216 [1.0049, 1.0386] lag 2

                  Warm season
                  All ages 1.0276 [1.0042,1.0515] lag 2
                  0-14 yrs 1.038 [1.0009, 1.0765] lag 2
                  15-64 yr 1.0040 [0.9651, 1.0445] lag 1
                  >65 yr 1.0326 [0.9965, 1.0699] lag 2

                  Cool  season
                  All ages 1.0060 [0.9943,10177] Iag2
                  0-14 yrs 1.0027 [0.9855, 1.0202] Iag2
                  15-64 yr 1.0136 [0.9920, 1.0357] lag 1
                  >65 yr 1.0174 [0.9994, 1.0358] lag 2
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                            TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
                                                                                                          Copollutants &    Effects: Relative Risk or Percent Change
                                                                                                           Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
X
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           Atkinson et al.
           (1999a)
           London, England

           Period of Study:
           1992 to 1994
           Days:  1096
           Spixetal. (1998)
           Multi-city (London,
           Amsterdam,
           Rotterdam, Paris),
           Europe

           Period of Study:
           1977 and 1991
                    Outcomes (ICD 9):  All respiratory (460-519),
                    Asthma (493), Asthma + COPD (490-6), Lower
                    respiratory disease (466, 480-6)
                    Age groups analyzed: 0-14, 15-64, 65+, all
                    ages
                    Study Design:  Time-series
                    N:  165,032
                    Statistical Analyses:  APHEA protocol, Poisson
                    regression
                    Covariates: Long-term trend, season, influenza,
                    day of wk, holiday, temperature, humidity
                    Season: Cool, Oct-Mar; Warm: Apr-Sep
                    Dose-Response Investigated?: Yes
                    Statistical Package: SAS
                    Lag: 0,1,2 days, 0-1, 0-2, 0-3 cum. avg.
                    Hospital Admissions
                    Outcomes (ICD 9 codes): All respiratory
                    (460-519); Asthma (493)
                    Age groups analyzed: 15-64,65+
                    Study Design: Time-series
                    # of Hospitals:
                    Statistical Analyses: Poisson regression
                    following APHEA protocol. Pooled meta-
                    analysis adjusted for heterogeneity
                    Covariates: Trend, seasonality, day of wk,
                    holiday, temperature, humidity, unusual events
                    (strikes, etc.)
                    Statistical Package:
                    Lag:  1 to 3 days
                                     NO2 1-hmean:  50.3ppb,
                                     SD = 17.0,
                                     Range:  22.0, 224.3 ppb, 10th
                                     centile:  34.3, 90th percentile:
                                     70.3

                                     # of stations:  3; r= 0.7, 0.96
                        03,
                        CO,
                        PMio
                        BS,
                        S02
                                     NO2 daily mean (ug/m )

                                     London 35
                                     Amsterdam 50
                                     Rotterdam 53
                                     Paris 42
                                                                                                                            Increment: 36 ppb (90th-10th centile)

                                                                                                                            All ages
                                                                                                                            Respiratory 1.64% [0.14, 3.15] lag 1
                                                                                                                            Asthma
                                                                                                                            1.80% [-0.77,4.44] lag 0
                                                                                                                            0-14yrs
                                                                                                                            Respiratory 1.94% [-0.39, 4.32] lag 2
                                                                                                                            Asthma
                                                                                                                            1%[-1.42, 5.77] lag 3
                                                                                                                            15-64yrs
                                                                                                                            Respiratory 1.61% [-0.82, 4.09] lag 1
                                                                                                                            Asthma
                                                                                                                            5.08% [0.81, 9.53] lag 1
                                                                                                                            65+ yrs
                                                                                                                            Respiratory 2.53% [0.58, 4.52] lag 3
                                                                                                                            Asthma 4.53% [-2.36, 11.91] lag 3
                                                                                                                            COPD 3.53% [0.64, 6.50] lag 3
                                                                                                                            Lower Resp. 3.47%  [0.08, 6.97] lag 3
                        SO2, O3, BS, TSP     Increment: 50 ug/m3.
                                            All cities, yr round
                                            15-64 yrs RR 1.010 [0.985,1.036]
                                                     Warm RR 1.00 [0.96, 1.04]
                                                     Cold RR 1.01 [0.98,1.04]
                                            >65 yrs RR 1.019 [0.982, 1.060]
                                                     Warm RR 1.02 [0.99, 1.06]
                                                     Cold RR 1.00 [0.98,1.03]

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                       TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                          HOSPITAL ADMISSIONS
X
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Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants & Effects: Relative Risk or Percent Change
Correlations & Confidence Intervals (95%)
EUROPE (cont'd)
Wong *etal. (2002)
London England and
Hong Kong

Period of Study:
London: 1992-1994
Hong Kong:
1995-1997
Days: 1,096
















Outcomes (ICD 9): All respiratory admissions
(460-5 19); asthma (493)
Age groups analyzed: 15-64, 65+, all ages
Study Design: Time-series
Statistical Analyses: APHEA protocol, Poisson
regression with GAM
Covariates: Long-term trend, season, influenza,
day of wk, holiday, temperature, humidity,
thunderstorms
Season: Cool, Oct-Mar; Warm: Apr-Sep
Dose-Response Investigated?: Yes
Statistical Package: S-Plus
Lag: 0,1,2,3,4 days, 0-1 cum. avg












24hNO2ug/m3
Hong Kong
Mean: 55.9
Warm: 48.1
Cool: 63.8
SD=19.4
Range: 15.3,151.5
10th: 31.8
50th: 53.5
90th: 81.8

London
Mean: 64.3
Warm: 62.6
Cool: 66.1
SD = 20.4
Range: 23.7,255.8
10th: 42.3
50th: 61.2
90th: 88.8

# of stations:
Hong Kong: 7; r = 0.65,
0.90
London: 3;r=0.80
Hong Kong Increment: 10 ug/m
PM10;r=0.82
SO2; r = 0.37 Asthma, 15-64 yrs
O3; r = 0.43 Hong Kong
ER -0.6 [-2. 1,1.0] lag 0-1
London ER -1.3 [-2.6, 0.1] lag 1
PM10; r= 0.68 Warm: ER -0.5 [-2.7, 1.6] lag 0-1
SO2;r=0.71 Cool: ER -0.6 [-2.8, 1.6] lag 0-1
O3;r=-0.29 London
ER1.0 [0.0, 2.1] lag 0-1
ER 1.1 [0.2,2.0] lag 2
Warm: ER 0.6 [-0.8, 2.0] lag 0-1
Cool: ER 1.3 [-0.1, 2.8] lag 0-1

Respiratory 65+ yrs
Hong Kong
ER 1.8 [1.2, 2.4] lag 0-1
ER 1.3 [0.8, 1.8] lag 0
Warm: ER 0.8 [0.1, 1.6] lag 0-1
Cool: ER 3.0 [2. 1,3. 9] lag 0-1
+03: ER 1.6 [1.0, 2.3] lag 0-1
+PM10: ER 1.7 [0.8, 2. 7] lag 0-1
+SO2: ER 1.6 [0.8, 2.4] lag 0-1

T .onHon
                                                                                                       ER-0.1 [-0.6, 0.5] lag 0-1
                                                                                                       ER 0.9 [0.5, 1.3] lag 3
                                                                                                       Warm: ER 0.6 [-0.2, 1.4] lag 0-1
                                                                                                       Cool: ER-0.7 [-1.4, 0.0] lag 0-1
                                                                                                       +O3: ER -0.1 [-0.5, 0.6] lag 0-1
                                                                                                       +PM10:  ER-0.4 [-1.2, 0.4] lag 0-1
                                                                                                       +SO2: ER-0.2 [-0.9, 0.5] lag 0-1

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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
X
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           Anderson et al.
           (1998)
           London, England

           Period of Study: Apr
           1987-February 1992

           Days: 1,782
                    Outcomes (ICD 9): Asthma (493)
                    Age groups analyzed: <15, 15-64, 65+
                    Study Design: Ti
                    N:  16
                    Statistical Analyses: APHEA protocol, Poisson
                    regression
                    Covariates:  Time trends, seasonal cycles, day
                    of wk, public holidays, influenza epidemics,
                    temperature, humidity
                    Season:  Cool (Oct-Mar); Warm (Apr-Sep)
                    Dose-Response Investigated?: Yes
                    Statistical Package: S
                    Lag: 0,1,2 days
                                    24-h avg NO2 (ppb)
                                    Mean:  37.2
                                    SD=12.3
                                    Range: 14,182
                                    5th:  22
                                    10th: 25
                                    25th: 30
                                    50th: 36
                                    75th: 42
                                    90th: 50
                                    95th: 58

                                    1 -h max NO2 (ppb)
                                    Mean:  57.2
                                    SD = 23.0
                                    Range: 21,370
                                    5th:  35
                                    10th: 38
                                    25th: 44
                                    50th: 52
                                    75th: 64
                                    90th: 81
                                    95th: 98

                                    Number of stations:  2
                       03
                       SO2
                       BS
                  Increment:  10 ppb in 24-h NO2

                  0-14 yrs
                  Whole yrRR 1.25 [0.3, 2.2] lag 2; RR1.77
                  [0.39, 3.18] lag 0-3
                  + 03     RR 1.13 [-0.10, 2.36] lag 2
                  + SO2    RR 0.97 [-0.05, 1.99] lag 2
                  + BS    RR 2.26 [0.83, 3.71] lag 2
                  Warm season RR 1.42 [-0.3, 3.17] lag 2;
                  RR 3.01 [3.8, 5.72] lag 0-3
                  Cool season RR 1.18 [0.02, 2.35] lag 2;
                  RR 1.22 [-0.48, 2.96] lag 0-3
                  15-64 yrs
                  Whole yrRR 0.95 [-0.26, 2.17] lag 0;
                  RR 0.99 [-0.36, 3.36] lag 0-1
                  Warm RR 0.46 [-1.70, 2.67] lag 0;
                  RR0.05[-2.45,2.61]lagO-l
                  Cool season RR 1.21 [-0.22, 2.5] lag  0;
                  RR1.43
                  [-0.18, 3.06]  lag 0-1
                  65+ yrs
                  Whole yrRR 2.96 [0.67, 5.31] lag 2;
                  RR3.14
                  [-0.04, 6.42]  lag 0-3
                  + 03     RR 4.51 [1.43, 7.69] lag 2
                  + SO2    RR 2.49 [-0.25, 5.31] lag 2
                  + BS    RR 1.88 [-1.49, 5.36] lag 2
                  Warm   RR 1.89 [-2.41, 6.38] lag 2;
                  RR-1.76 [-7.27, 4.07] lag 0-3
                  Cool season RR 3.52 [0.81, 6.30] lag 2;
                  RR 5.57 [1.85, 9.43] lag 0-3
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &     Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
X
          Anderson et al.
          (1998) (cont'd)
                                                                                                             + O3     RR 5.14 [0.69, 9.79] lag 2
                                                                                                             + SO2   RR 2.10 [-1.08, 5.39] lag 2
                                                                                                             + BS    RR 4.47 [-0.04, 9.19] lag 2
                                                                                                             All ages
                                                                                                             Whole yrRR 1.25 [0.49,2.02] lag 2;
                                                                                                             RR 2.05 [0.96, 3.15] lag 0-3
                                                                                                             + O3     RR 1.08 [0.12, 2.05] lag 2
                                                                                                             + S02   RR 0.99 [0.18, 1.81] lag 2
                                                                                                             + BS    RR 1.23 [0.47, 2.00] lag 2
                                                                                                             Warm   RR 1.15 [-0.25, 2.57] lag 2;
                                                                                                             RR 1.54 [-0.54, 3.67] lag 0-3
                                                                                                             Cool season RR 1.30 [0.38, 2.23] lag 2;
                                                                                                             RR 2.26 [0.94, 3.59] lag 0-3
                                                                                                             + O3     RR 0.50 [-0.79, 1.81] lag 2
                                                                                                             + SO2   RR 1.10 [0.12, 2.08] lag 2
                                                                                                             + BS    RR 1.29 [0.37, 2.22] lag 2
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          Anderson et al.
          (2001)
          West Midlands
          conurbation, United
          Kingdom

          Period of Study:
          10/1994-12/1996
                    Hospital Admissions:
                    Outcomes (ICD 9 codes): All respiratory (460-
                    519), Asthma (493), COPD (490-496,
                    excluding 493)
                    Age groups analyzed: 0-14, 15-64, 65+
                    Study Design:  Time-series
                    Statistical Analyses: Followed APHEA 2
                    protocol, GAM
                    Covariates:  Season, temperature, humidity,
                    epidemics, day of wk, holidays
                    Statistical Package:  S-Plus 4.5 Pro
                    Lag:  0,1,2,3,0-1,0-2,0-3
                                    1-h max avg: 37.2 ppb,
                                    15.1 (SD)
                                    Min: 10.7 ppb
                                    Max: 176.1 ppb
                                    10th: 22.9 ppb
                                    90th: 51.7 ppb

                                    # of monitors: 5
                       PM10; r = 0.62
                       PM2.5;r=0.61
                       PM2.5_10;r=0.25
                       BS;r = 0.65
                       SO4;r=0.30
                       SO2;r=0.52
                       O3;r=0.08
                       CO; r= 0.73
                  Increment: 25.5 ppb (90th- 10th)

                  All respiratory
                  All ages 1.7% [-0.2, 3.7] lag 0-1
                  0-14 yrs 2.3% [-0.6, 5.3] lag 0-1
                  15-64 yrs 0.0% [-3.7, 3.8] lag 0-1
                  >65 yrs 1.0% [-1.8, 3.9] lag 0-1

                  COPD with asthma
                  0-14 yrs 4.0% [-2.0, 10.2] lag 0-1
                  15-64 yrs -3.3% [-10.4, 4.4] lag 0-1
                  >65 yrs 2.5% [-2.1, 7.3] lag 0-1
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
  Reference, Study
 Location, & Period
       Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
  Copollutants &     Effects:  Relative Risk or Percent Change
   Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
           Prescott et al. (1998)
           Edinburgh, United
           Kingdom

           Period of Study:
           10/92-6/95
                     Outcomes (ICD 9): Pneumonia (480-7), COPD
                     + Asthma (490-496)
                     Age groups analyzed: <65, 65+
                     Study Design:  Time-series
                     Statistical Analyses: Poisson log linear
                     regression
                     Covariates: Trend, seasonal and wkly variation,
                     temperature, wind speed, day of wk
                     Lag:  0,1 or 3 day rolling avg
                                           NO2: 26.4 ± 7.0 ppb
                                           Min: 9 ppb
                                           Max: 58 ppb
                                           IQR: 10 ppb

                                           # of Stations: 1
                          CO
                          PM10
                          S02
                          03
                          BS
                   Increment:  10 ppb

                   Respiratory admissions
                   >65 yrs
                   3.1 [-4.6, 11.5] rolling 3-day avg
                   <65 yrs
                   -0.2% [-7.5, 7.7] rolling 3-day avg
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Thompson et al.
(2001)
Belfast, Northern
Ireland

Period of Study:
1993-1995
Outcomes: Asthma
ICD9: NR
Age groups analyzed: 0-14
Study Design: Time-series
N: 1,095
Number of hospitals:  1
Statistical Analyses: Poisson regression
Covariates:  Season, long-term trend,
temperature, day of wk, holidays
Season:  Warm (May-Oct), Cold
(Nov-Apr)
Statistical Package: Stata
Lag:  0,1,2,3 days
24-h mean:
Warm: 19.2 (7.9) ppb;
Range: 13-23
Cold:  23.3 (9.0) ppb;
Range: 18-28
S02; r = 0.82
PM10; r = 0.77
CO; r= 0.69
O3;r=-0.62
NOX; r = 0.93
log (NO); r = 0.84
log (CO); r = 0.69
Increment: 10 ppb
All seasons
RR 1.08 [1.03, 1.13] lag 0
RR1.11 [1.05, 1.17] lag 0-1
RR 1.10 [1.04, 1.17] lag 0-2
RR 1.12 [1.03, 1.02] lag 0-3
Warm season
RR 1.14 [1.04, 1.26] lag 0-1
Cold season
RR 1.10 [1.03, 1.17] lag 0-1
NO2 + Benzene
RR 0.99 [0.87, 1.13] lag 0-1
*Model made no allowance for possible
autocorrelation in the data or for extra-
Poisson variation.
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                            TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &       Effects: Relative Risk or Percent
 Correlations       Change & Confidence Intervals (95%)
           EUROPE (cont'd)
X
Oi
           Hagen et al. (2000)
           Drammen, Norway

           Period of Study:
           1994-1997
                    Outcomes (ICD 9): All respiratory admissions
                    (460-519)
                    Age groups analyzed: All ages
                    Study Design: Time-series
                    Number of hospitals:  1
                    Statistical Analyses: Poisson regression with
                    GAM (adhered to HEI phase l.B report)
                    Covariates:  Time trends, day of wk, holiday,
                    influenza, temperature, humidity
                    Lag: 0,1,2,3 days
                                    NO2 24-h avg (ng/m3):  36.15,
                                    SD=16

                                    IQR:  16.92 ng/m3

                                    # of Stations: 2
                         PM10;r=0.61      Increment: NO2:  16.92 ng/mj (IQR);
                         S02;r = 0.58       NO:  29|ig/m3 (IQR)
                         Benzene; r = 0.31
                         NO; r = 0.70       Single-pollutant model
                         O3; r = -0.47       Respiratory disease only
                         Formaldehyde;      NO2: RR 1.058 [0.994, 1.127]
                         r = 0.68            NO:  1.048 [1.013, 1.084]
                         Toluene; r = 0.65    All disease
                                           NO2: RR 1.011 [0.988,1.035]

                                           Two-pollutant model with PM10
                                           NO2: 1.044 [0.966, 1.127]
                                           NO:  1.045 [1.007, 1.084]

                                           Three-pollutant model with PM10 + Benzene
                                           N02: 1.015 [0.939, 1.097]
                                           NO:  1.031 [0.986,1.077]
           Oftedal et al. (2003)    Outcomes (ICD 10): All respiratory admissions   Mean:  33.8 |ig/m3
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           Drammen, Norway

           Period of Study:
           1994-2000
                    (JOO-J99)
                    Age groups analyzed: All ages
                    Study Design: Time-series
                    Statistical Analyses: Semi-parametric Poisson
                    regression, GAM with more stringent criteria
                    Covariates:  Temperature, humidity, influenza
                    Lag: 2,3 days
                                    SD = 16.2
                                    IQR: 20.8 |ig/m3
                         PM10
                         S02
                         03
                         Benzene
                         Formaldehyde
                         Toluene
                Increment: 20.8 ng/m3 (IQR)

                All respiratory disease

                Single-pollutant model
                RR 1.060 [1.017,1.105] lag 3

                Two-pollutant model
                Adjusted for PM10
                RR 1.063 [1.008,1.120]
                Adjusted for benzene
                RR 1.046 [1.002,1.091]
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
                                                                                                      Copollutants &    Effects: Relative Risk or Percent Change
                                                                                                       Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
X
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          Ponka(1991)         Outcomes (ICD 9 codes): Asthma (493)
          Helsinki, Finland      Age groups analyzed: 0-14; 15-64; >65 yrs
                               Study Design: Time-series
          Period of Study:       N: 4,209
          1987-1989            Statistical Analyses: Correlations and partial
                               correlations
                               Covariates: Minimum temperature
                               Statistical Package:
                               Lag: 0-1
                                                               24-havg:  38.6 (16.3) ug/m3
                                                               Range:  4.0-169.6

                                                               Number of Monitors:  4
                                                              SO2;r = 0.4516
                                                              NO; r = 0.6664
                                                              O3;r=-0.2582
                                                              TSP;r=0.1962
                                                              CO
                                           Correlations between hospital admissions
                                           (HA) for asthma and pollutants and
                                           temperature by ages.
                                           0-14 vrs
                                           HA: -0.0166
                                           Emergency HA: 0.0061
                                           15-64 vrs
                                           HA: 0.1648 p< 0.0001
                                           Emergency HA: 0.1189 p< 0.0001
                                           >65 vrs
                                           HA: 0.1501 p< 0.0001
                                           Emergency HA: 0.1392 p< 0.0001

                                           Partial correlations between admissions for
                                           asthma and SO2 were standardized for
                                           temperature.
                                           HA: 0.1830 p< 0.0001
                                           Emergency HA: 0.1137 p = 0.0004
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          Ponka and Virtanen
          (1994)

          Helsinki, Finland

          Period of Study:
          1987-1989
          Days: 1096
                    Outcomes (ICD 9): Chronic bronchitis and
                    emphysema (491-492)
                    Age groups analyzed: <65, >65
                    Study Design: Time-series
                    Statistical Analyses: Poisson regression
                    Covariates: Season, day of wk, yr, influenza,
                    humidity, temperature
                    Season:  Summer (Jun-Aug), Autumn (Sep-
                    Nov), Winter (Dec-Feb), Spring (Mar-May)
                    Lag:  0-7 days
                                    24-hmean: 39 ug/m3        SO2
                                    SD = 16.2;                 O3
                                    Range: 4, 170              TSP

                                    # of stations:  2
                                          Increment: NR

                                          Chronic bronchitis and emphysema
                                          >65 yrs
                                          RR 0.87 [0.71, 1.07] lag 0
                                          RR 1.07 [0.86, 1.33] lag 1
                                          RR 1.16 [0.93, 1.46] lag 2
                                          RR 1.08 [0.86, 1.35] lag 3
                                          RR 0.94 [0.76, 1.18] lag 4
                                          RR 0.90 [0.72, 1.12] lag 5
                                          RR1.31 [1.03, 1.66] lag 6
                                          RR 0.82 [0.67, 1.01] lag 7
                                          <65 yrs
                                          NR

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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
  Reference, Study
 Location, & Period
       Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
  Copollutants &     Effects: Relative Risk or Percent Change
   Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
           Ponka and Virtanen,
           (1996)
           Helsinki, Finland

           Period of study:
           1987-1989
                     Hospital Admissions                          24-h avg (ug/m ):
                     Outcomes (ICD 9 codes):  Asthma (493)         Winter: 38
                     Age groups analyzed: 0-14,15-64,65+          Spring: 44
                     Study Design: Time-series                    Summer: 39
                     Statistical Analyses:                          Fall: 34
                     Covariates: Long-term trend, season, epidemics,
                     day of wk, holidays, temperature, relative
                     humidity
                     Statistical Package:
                     Lag:  0-2
                                                                      SO2
                                                                      03
                                                                      TSP
                                              No results presented for NO2 because they
                                              were not statistically significant
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Rossi etal. (1993)
Oulu, Finland

Period of Study:
10/1/1985-9/30/1986
ED Visits
Outcome(s) (ICD 9):  Asthma (493)
Age groups analyzed:  15-85
Study Design: Time-series
N: 232
Statistical Analyses: Pearson's and partial
correlation coefficients and multiple regression
with stepwise discriminate analysis
Covariates:  Temperature, humidity
Statistical Package: BMDP software
Lag:  0,1,2,3
24-h mean:  13.4 ug/m
Range: 0-69
1-hrmax:
38.5 ug/m3
Range: 0-154

# of Monitoring Stations: 4
NO2; r = 0.48 TSP;    Pearson correlation coefficients
H2S
                    ED asthma visits and same day
                    SO2: r = 0.20 p< 0.001 lag 0

                    Weekly ED asthma visits and same wk SO2:
                    r = 0.42 p< 0.001
                    Weekly ED asthma visits and previous wk
                    SO2:  r = 0.58 p< 0.001

                    Multi-pollutant (NO2; TSP; H2S)
                    Regression coefficient:
                    Allyr: p = 0.209, p = 0.034
                    Winter: p = 0.201, p = 0.014
                    Summer:  p = 0.041, p = 0.714
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                    TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:  HOSPITAL
                                                                             ADMISSIONS
  Reference, Study
 Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &      Effects:  Relative Risk or Percent Change
 Correlations             & Confidence Intervals (95%)
           EUROPE (cont'd)
           Andersen et al.        Outcomes (ICD 10):  chronic bronchitis (J41-
           (2007a)              42), emphysema (J43), COPD (J44), asthma
           Copenhagen,          (J45), status asthmaticus (J46)
           Denmark             Age groups analyzed: 5-18,65+
                                Number of hospitals: 9
           Period of Study:       Study Design:  Time-series
           1999-2004            Statistical Analyses:  Poisson regression with
                                GAM
                                Covariates:  Temperature, long-term trend,
                                seasonality, influenza, day of wk, public
                                holidays, school holidays,
                                Lag:  0, 1, 2,  3, 4, 5, 0-4, 0-5 days
                                                                 24-h avg: 12 (5) ppb
                                                                 Statistical package: R
                                                                 IQR: 7
                                                                 25th: 8
                                                                 75th: 15
                                                           PM10; r = 0.42
                                                           PM10-biomass; r = 0.41
                                                           PM10-Secondary; r =
                                                           0.43
                                                           PMio-Oil; r = 0.42
                                                           PM10-Crustal; r = 0.24
                                                           PM10-Sea salt; r=-0.19
                                                           PM10-Vehicle; r = 0.65
                                                           CO; r= 0.74
                                             Increment: 7 ppb (IQR):

                                             All respiratory disease (65+):
                                             NO2: 1.040 [1.009, 1.072] lag 5 day moving
                                             avg
                                             NO2 + PM10: 1.014 [0.978, 1.051] lag 5
                                             day ma

                                             Asthma (5-18 yrs):
                                             NO2: 1.128 [1.029,1.235] lag 6 day ma
                                             N02+PM10: 1.032 [0.917-1.162] lag 6
                                             day ma
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Andersen et al.        Outcomes (ICD 10):  chronic bronchitis (J41-
(2007b)              42), emphysema (J43), COPD (J44), asthma
Copenhagen,          (J45), status asthmaticus (J46)
Denmark             Age groups analyzed: 5-18,65+
                     Number of hospitals: 9
Period of Study:       Study Design: Time-series
5/15/2001-            Statistical Analyses:  Poisson regression with
12/31/2004            GAM
                     Covariates:  Temperature, long-term trend,
                     seasonality, influenza, day of wk, public
                     holidays, school holidays,
                     Lag:  0, 1, 2,  3, 4, 5, 0-4, 0-5 days
                                     24-h avg: 11 (5) ppb
                                     Statistical package: R
                                     IQR: 6
                                     25th: 8
                                     50th: 11
                                     75th: 14
                                     99th: 28
                     PM10
                     PM2.5
                     CO
                     03
                   Increment:  6 ppb (IQR):

                   All respiratory disease (65+):
                   NO2:  1.06 [1.01, 1.12] lag 0-4 moving avg
                   N02 + NCtot:  1.06 [0.99, 1.13] lag 0-4 ma

                   Asthma (5-18 yrs):
                   N02:  1.04 [0.92, 1.18] lag 0-5 ma
                   N02+NCtot:  0.97 [0.83-1.14] lag 0-5 ma
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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
  Reference, Study
 Location, & Period
       Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
 Copollutants &    Effects: Relative Risk or Percent Change
  Correlations            & Confidence Intervals (95%)
           EUROPE (cont'd)
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           Dab* etal. (1996)
           Paris, France

           Period of Study:
           1/1/87-9/30/92
Linares et al. (2006)
Madrid, Spain

Period of Study:
1995-2000
                     Outcomes (ICD 9): All respiratory (460-519),
                     Asthma (493), COPD (490-496)
                     Age groups analyzed: All ages
                     Study Design: Time-series
                     Number of hospitals:  27
                     Statistical Analyses: Poisson regression,
                     followed APHEA protocol
                     Covariates:  Temperature, relative humidity,
                     influenza, long-term trend, season, holiday,
                     medical worker strike
                     Lag:  0,1,2 days, 0-3 cumulative
Outcomes (ICD 9): All respiratory (460-519),
bronchitis (460-496), pneumonia (480-487)
Age groups analyzed: <10
Study Design: Time-series
Number of hospitals:  1
Statistical Analyses: Poisson regression
Covariates:  Temperature, pressure, relative
humidity
Statistical Package: S Plus 2000
Lag:
                                            NO2 24-h avg: 45 ug/m3
                                            5th: 22,99th:  108.3
                                            Daily maximum 1-h
                                            concentration:  73.8 ug/m
                                            5th: 37.5,99th: 202.7
                           SO2
                           03
                           PM13
                           BS
24-h avg: 64.8 (17.1) ug/m3
Range: 23-144

Number of monitors: 24
PM10;r=0.71
03;r=-0.41
SO2;r = 0.63
Increment: 100 ug/m

All respiratory (1987-1990)
24-h avg NO2: RR 1.043 [0.997, 1.090] lag 0
l-hmaxN02: RR 1.015 [0.993, 1.037] lag 0

Asthma (1987-1992)
24-h avg: RR 1.175 [1.059, 1.304] lag 0-1
1-hmax:  RR 1.081  [1.019, 1.148] lag 0-1

COPD
24-h avg: RR 0.974 [0.898, 1.058] lag 2
1-hmax:  RR0.961  [0.919, 1.014] lag 2

Qualitative results suggest linear relationship
without threshold for NO2 concentration and
respiratory hospital admissions.
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                            TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
                                       Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &   Effects: Relative Risk or Percent Change &
 Correlations             Confidence Intervals (95%)
           EUROPE (cont'd)
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           Llorcaetal. (2005)
           Torrelavega, Spain

           Period of Study:
           1992-1995

           Days:  1,461
                    Outcomes (ICD 9):  All respiratory admissions
                    (460-519)
                    Age groups analyzed: All ages
                    Study Design:  Time-series
                    Number of hospitals:  1
                    Statistical Analyses:  Poisson regression
                    Covariates: Short and long-term trends
                    Statistical Package:  Stata
                    Lag: NR
                                                                            24-havgNO2: 21.3 ug/m3,
                                                                            SD=16.5
                                                                            24-havgNO:  12.2 ug/m3,
                                                                            SD= 15.2

                                                                            # of Stations: 3
                        SO2;r = 0.588
                        NO; r = 0.855
                        TSP;r=-0.12
                        SH2;r = 0.545
                Increment: 100 ug/m

                Single-pollutant model
                All cardio-respiratory admissions
                N02: RR 1.37 [1.26, 1.49]
                NO:  RR 1.33 [1.22, 1.46]

                Respiratory admissions
                NO2: RR 1.54 [1.34, 1.76]
                NO:  RR1.35 [1.17,1.56]

                5-pollutant model
                All cardio-respiratory admissions
                N02: RR 1.20 [1.05, 1.39]
                NO:  RR0.93 [0.79,1.09]
                Respiratory admissions
                N02: RR 1.69 [1.34, 2.13]
                NO:  RR 0.87 [0.67, 1.13]
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           Migliaretti and         Outcome(s) (ICD 9):  Asthma (493)
           Cavallo (2004)         Age groups analyzed: <4,4-15
           Turin, Italy            Study Design: Case-Control
                                Controls:  Age matched with other respiratory
           Period of Study:        disease (ICD9: 460-7, 490-2, 494-6, 500-19)
           1997-1999            N: Cases = 734,  controls = 25,523
                                Statistical Analyses: Logistic regression
                                Covariates: Seasonality, temperature, humidity,
                                solar radiation
                                Seasons: Cold: Oct-Mar; Warm: Apr-Sep
                                Statistical Package: SPSS
                                Lag:  0-3 days and cumulative
                                                                Controls:
                                                                Mean:  113.3 ug/m ,
                                                                SD=30.5

                                                                Cases:
                                                                Mean:  117.4 ug/m3,
                                                                SD = 29.7
                                                                                                        TSP
                                         Increment:  10 ug/m3

                                         <4 yrs 2.8% [0.03, 5.03] lag 1-3 cumulative
                                         4-15 yrs 2.7% [-0.01, 6.06] lag 1-3 cumulative
                                         All ages 2.8% [0.07, 4.09] lag 1-3 cumulative

                                         Two-pollutant model adjusted for TSP
                                         NO2 2.1% [-0.1, 5.6]
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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                      HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
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           Farchi et al. (2006)
           Rome, Italy

           Period of Study:
           11/94-2/95
                     Outcome(s) (ICD 9): All respiratory conditions
                     (381-382,460-466, 480-493); acute upper
                     respiratory  tract infections (380-382, 460-465);
                     lower respiratory tract conditions including
                     asthma (466,480-493)
                     Age groups analyzed: 6-7
                     Study Design:  Cohort (SIDRIA)
                     N:  2,947
                     Statistical Analyses: Cox regression models,
                     GAM
                     Covariates: Gender, paternal education,
                     paternal smoking
                     Statistical Package: STATA 8.0
                                     Mean: 46.9 ug/m3 (10.2)
                                     IQR: 17
                                     Range: 24-66
                         Traffic
                Increment:  10 ug/m

                All respiratory conditions:
                HR:  1.28 [0.98-1.68]
                1 st Quartile (24-35 ug/m3):  1.00
                2nd Quartile (35-47 ug/m3): 1.06 [0.45-2.53]
                3rd Quartile (47-52  ug/m3):  1.57 [0.59-4.13]
                4th quartile (52-66 ug/m3):  1.95 [0.81-4.71]

                Acute URT infections:
                HR:  1.56 [0.96-2.56]
                1st Quartile (24-35 ug/m3):  1.00
                2nd Quartile (35-47 ug/m3): 0.55 [0.08-3.61]
                3rd Quartile (47-52  ug/m3):  1.25 [0.25-6.24]
                4th quartile (52-66 ug/m3):  3.04 [0.67-13.79]

                Acute LRT infections and asthma:
                HR:  1.10 [0.80-1.51]
                1st Quartile (24-35 ug/m3):  1.00
                2nd Quartile (35-47 ug/m3): 1.34 [0.51-3.21]
                3rd Quartile (47-52  ug/m3):  1.58 [0.35-4.10]
                4th quartile (52-66 ug/m3):  1.24 [0.64-3.08]
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           EUROPE (cont'd)
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           Fusco* etal. (2001)
           Rome, Italy

           Period of Study:
           1/1/95-10/31/97
                    Outcomes (ICD 9): All respiratory (460-519
                    excluding 470-478), Asthma (493), COPD
                    (490-492, 494-496), Respiratory infections
                    (460-466, 480-486)
                    Age groups analyzed:  0-14, all ages
                    Study Design: Time-series
                    Statistical Analyses: Semi-parametric Poisson
                    regression with GAM
                    Covariates:  Influenza, day, temperature,
                    humidity, day of wk, holiday
                    Season:  Warm (Apr-Sep), Cold (Oct-Mar)
                    Statistical Package: S-Plus 4
                    Lag: 0-4 days
                                    NO2 24-h avg (ug/m3):  86.7,   PM10:
                                    SD=16.2                   All yr;r = 0.35
                                                                Cold; r = 0.50
                                    IQR:  22.3 ug/m3             Warm; r = 0.25
                                                                S02:
                                    # of stations:  5; r= 0.66-0.79   All yr;r = 0.33
                                                                Cold; r = 0.40
                                                                Warm; r = 0.68
                                                                CO:
                                                                All yr;r = 0.31
                                                                Cold; r= 0.41
                                                                Warm; r= 0.59
                                                                03:
                                                                All yr;r = 0.19
                                                                Cold; r= 0.19
                                                                Warm; r= 0.13
                                          Increment: 22.3 ug/m (IQR)

                                          All respiratory
                                          All ages: 2.5% [0.9, 4.2] lag 0
                                          0-14 yrs: 4.0% [0.6, 7.5] lag 0
                                          Respiratory infections
                                          All ages: 4.0% [1.6, 6.5] lag 0
                                          0-14 yrs: 4.0% [0.2, 8.0] lag 0
                                          Asthma
                                          All ages: 4.6% [-0.5,10.0] lag 0
                                          0-14 yrs: 10.7% [3.0, 19.0] lag 1
                                          COPD
                                          >65yrs: 2.2% [-0.7, 5.2] lag 0

                                          Multipollutant models
                                          All respiratory (NO2 + CO)
                                          All ages: 0.9% [-0.8,2.8] lag 0
                                          0-14 yrs: 3.3% [-0.2, 6.9] lag 0
                                          Acute infections (NO2 + CO)
                                          All ages: 3.9% [1.3, 6.7] lag 0
                                          0-14 yrs: 2.9% [-1.0, 7.0] lag 0
                                          Asthma (NO2 + CO)
                                          All ages: 1.4% [-3.9, 7.1] lag 0
                                          0-14 yrs: 8.3% [-0.1,17.4] lag 1
                                          COPD (NO2 + CO)
                                          >65yrs: -1.0%[-4.1, 2.2] lag 0
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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
  Reference, Study
 Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
                             Copollutants &    Effects: Relative Risk or Percent Change
                               Correlations          & Confidence Intervals (95%)
           EUROPE (cont'd)
           Pantazopoulou et al.
           (1995)
           Athens, Greece

           Period of Study:
           1988
                     Outcomes: All respiratory admissions
                     ICD9: NR
                     Age groups analyzed: All ages
                     Study Design: Time-series
                     N:  15,236
                     Number of hospitals: 14
                     Statistical Analyses: Multiple linear regression
                     Covariates: Season, day of wk, holiday,
                     temperature, relative humidity
                     Season:  Warm (3/22-9/21), Cold (1/1-3/21 and
                     9/22-12/31)
                     Lag: NR
                                     NO2 24-h avg
                                     Winter: 94 ug/m ,
                                     SD = 25
                                     5th: 59,50th:  93,95th: 135
                                     Summer: 111  ug/m3,
                                     SD=32
                                     5th: 65,50th:  108,95th: 173

                                     # of stations: 2
                        CO
                        BS
                                               Increment:  76 ug/m in winter and 108
                                               ug/m3 in summer (95th-5th)

                                               Respiratory disease admissions

                                               Winter: Percent increase: 24% [6.4,43.5]

                                               Summer: Percent increase:  9.3%
                                               [-14.1,24.4]
           LATIN AMERICA
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Gouveiaand          Outcomes (ICD 9): All respiratory; Pneumonia
Fletcher, (2000a)       (480-486); asthma or bronchitis (466, 490, 491,
Sao Paulo, Brazil       493)
                     Age groups analyzed:  
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent Change
& Confidence Intervals (95%)
LATIN AMERICA (cont'd)
Braga* et al. (1999) Hospital Admissions
Sao Paulo, Brazil Outcomes (ICD 9 codes): All respiratory
(466,480-486,491-492,496)
Period of Study: Age groups analyzed: <1 3 yrs
10/1992-10/1993 Study Design: Time-series
24-havg 174.84(101.38)
ug/m3
Min: 26.0
Max: 668.3
PM10;r=0.53
CO; r= 0.42
S02;r = 0.53
03;r =
Due to problems with NO2 monitors, this
pollutant could not be included in the
analysis.
N: 68,918
# of Hospitals:  112
Statistical Analyses: Multiple linear regression
models (least squares). Also used Poisson
regression techniques.  GLM and GAM using
LOESS for smoothing.
Covariates:  Season, temperature, humidity, day
ofwk,
Statistical Package:  SPSS, S-Plus
Lag:  1,2,3,4,5,6,7 moving avgs
                                                                           # of monitors: 13
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           Braga* etal. (2001)
           Sao Paulo, Brazil

           Period of Study:
           1/93-11/97
Outcomes (ICD 9): All respiratory admissions
(460-519)
Age groups analyzed: 0-19, <2, 3-5,
6-13, 14-19
Study Design: Time-series
Statistical Analyses: Poisson regression with
GAM
Covariates: Long-term trend, season,
temperature, relative humidity, day ofwk,
holiday
Statistical Package: S-Plus 4.5
Lag:  0-6 moving avg
NO2mean:  141.4 ug/m,
SD = 71.2
IQR: 80.5 ug/m3
Range: 25,652.1
# of stations: 5-6
PM10; r = 0.62
SO2;r = 0.54
CO; r= 0.58
03;r=0.34
Increment: 80.5 ug/m3 (IQR)
All Respiratory admissions
<2 yrs 9.4% [6.2, 12.6] lag 5
3-5 yrs 1.6% [-6.4, 9.6]
6-13 yrs 2.3% [-5.9, 10.4]
14-19 yrs-3.0% [-15.7, 9.7]
All ages 6.5% [3.3, 9.7]
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                   HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations          & Confidence Intervals (95%)
           LATIN AMERICA (cont'd)
           Braga*etal. (2001)
           Sao Paulo, Brazil

           Period of Study:
           1/93-11/97
                    Outcomes (ICD 9): All respiratory admissions
                    (460-519)
                    Age groups analyzed:  0-19, <2, 3-5,
                    6-13, 14-19
                    Study Design:  Time-series
                    Statistical Analyses: Poisson regression with
                    GAM
                    Covariates: Long-term trend, season,
                    temperature, relative humidity, day of wk,
                    holiday
                    Statistical Package: S-Plus 4.5
                    Lag: 0-6 moving avg
                                   NO2 mean:  141.4 ug/m ,
                                   SD = 71.2
                                   IQR:  80.5 ug/m3
                                   Range: 25,652.1
                                   # of stations: 5-6
                        PM10; r = 0.62
                        SO2;r = 0.54
                        CO; r= 0.58
                        O3;r=0.34
                 Increment:  80.5 ug/m3 (IQR)
                 All Respiratory admissions
                 <2 yrs 9.4% [6.2, 12.6] lag 5
                 3-5 yrs 1.6% [-6.4, 9.6]
                 6-13 yrs 2.3% [-5.9, 10.4]
                 14-19 yrs-3.0% [-15.7, 9.7]
                 All ages 6.5% [3.3, 9.7]
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
       Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations          & Confidence Intervals (95%)
           LATIN AMERICA (cont'd)
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           Farhat* et al. (2005)
           Sao Paulo, Brazil

           Period of Study:
           8/96-8/97

           Days: 396
Outcomes (ICD 9):
Pneumonia/bronchiopheumonia (480-6), asthma
(493), bronchiolitis (466), Obstructive disease
493,466)
Age groups analyzed: <13
Study Design: Time-series
N: 1,021
Number of hospitals:  1
Statistical Analyses: Poisson regression with
GAM
Covariates: Time, temperature, humidity, day
of wk, season
Statistical package: S-Plus
Lag:  0-7 days, 2,3,4 day moving avg
                                                               Mean:  125.3 ug/m3
                                                               SD = 5 1 .7

                                                               IQR: 65. 04 ug/m3

                                                               Range' 42 5 369 5
                        PM10;r=0.83
                        SO2;r = 0.66
                        CO; r= 0.59
                        O3; r = 0.47
                 Increment: 65.04 ug/m3 (IQR)

                 Single-pollutant models (estimated from
                 graphs)

                 Lower respiratory tract disease:
                 N02 alone: ~ 18% [ 13, 24] lag 0-3
                 NO2 + PM10 16.1% [5.4, 26.8] lag 0-2
                 N02 + S02 24.7% [18.2, 31.3] lag 0-2
                 N02 + CO 19.2% [11.8,26.6] lag 0-2
                 NO2 + O3 16.1% [9.5, 22.7] lag 0-2
                 Multipollutant model (PM10, SO2, CO, O3)
                 18.4% [3.4, 33.5] 2 day avg
                 Pneumonia:
                 NO2 alone: -17.5% [3, 32.5] lag 0-2
                 N02 + PM10 8.1% [-11.4, 27.6] lag 0-2
                 N02 + S02 13.1% [-3.4, 29.7] lag 0-2
                 NO2 + CO 14.6% [-4.9, 34.1] lag 0-2
                 NO2 + O3 12.4% [-5.6, 30.4] lag 0-2
                 Multipollutant model (PM10, SO2, CO, O3)
                 1.8% [-23.9, 27.6] 2 day avg
                 Asthma or Bronchiolitis
                 NO2 alone: 30.5% [9, 56] lag 0-1
                 NO2 + PM10 47.7% [1.15, 94.2] lag 0-2
                 N02 + S02 33.1% [5.7, 60.5] lag 0-2
                 NO2 + CO 28.8% [-0.2, 57.9] lag 0-2
                 NO2 + O3 28.0% [-1.0, 57.0] lag 0-2
                 Multipollutant model (PM10, SO2, CO, O3)
                 39.3% [-14.9, 93.5] 2 day avg
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                          TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                  HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations          & Confidence Intervals (95%)
           LATIN AMERICA (cont'd)
           Arbex et al., 2007
           Araraquara, Brazil

           Period of Study:
           3/2003-7/2004
                   Outcomes (ICD 10): asthma (J15)
                   Age groups analyzed: <13
                   Study Design: Ecological Time-series
                   N:  1,021
                   Number of hospitals:  1
                   Statistical Analyses: Poisson regression with
                   GLM
                   Covariates: Long-term trend, weather
                   Statistical package: S-Plus
                   Lag: 0-7 days, 2,3,4 day moving avg
                                   TSP (ug/m3)
                                         Increment: 10 ug/m

                                         Asthma hospital admissions:
                                         11.6% [5.4, 17.7] lag 1-5
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels &
Monitoring Stations
Copollutants &
Correlations
Effects: Relative Risk or Percent
Change & Confidence Intervals
(95%)
ASIA
Lee et al. (2006)
Hong Kong, China
Period of Study:
1997-2002
Outcomes (ICD 9): Asthma (493)
Age groups analyzed: < 18
Study Design: Time-series
N: 26,663
Statistical Analyses: Semi-parametric Poisson
NO2 24-h mean: 64.7 ug/m3,
SD = 20.9
IQR: 27.1 ug/m3
25th: 49.7,75th: 76.8
PM10;r=0.78
PM2.5; r = 0.75
SO2; r = 0.49
03;r=0.35
Increment: 27. 1 ug/m3 (IQR)
Asthma
Single-pollutant model
4.37% [2.5 1,6.271 lag 0
           Days: 2,191
           Chew etal. (1999)
           Singapore

           Period of Study:
           1990-1994
regression with GAM (similar to APHEA 2)
Covariates:  Long-term trend, temperature,
relative humidity, influenza, day of wk, holiday
Statistical package: SAS 8.02
Lag: 0-5 days
Outcome(s) (ICD 9):  Asthma (493)
Age groups analyzed: 3-12,13-21
Study Design: Time-series
N: 23,000
# of Hospitals: 2
Statistical Analyses: Linear regression, GLM
Covariates: Variables that were significantly
associated with ER visits were retained in the
model
Statistical Package: SAS/STAT, SAS/ETS 6.0
Lag:  l,2daysavgs
# of stations: 9-10, r= 0.53, 0.94,
Mean = 0.78
24-havg: 18.9 ug/m3,
SD=15.0,
Max < 40

# of Stations: 15
                                                                                                                             5.88% [4.00, 7.70] lag 1
                                                                                                                             7.19% [5.37, 9.04] lag 2
                                                                                                                             9.08% [7.26, 10.93] lag 3
                                                                                                                             7.64% [5.84, 9.48] lag 4
                                                                                                                             6.40% [4.60, 8.22] lag 5

                                                                                                                             Multipollutant model - including PM,
                                                                                                                             SO2, and O3
                                                                                                                             5.64% [3.21, 8.14] lag 3
                                                                                                                             Other lags NR

                                                                                                           SO2; r = -0.22      Categorical analysis (via ANOVA) p-
                                                                                                           O3; r = 0.17        value and Pearson correlation
                                                                                                           TSP' r = 0 23       coefficient (r) using continuous data
                                                                                                                             comparing daily air pollutant levels and
                                                                                                                             daily number of hospital admissions.
                                                                                                                            Age Group:
                                                                   3-12     13-21
                                                                                                                            LagO    r=0.13  r=0.05
                                                                                                                                     p = 0.013p<0.18
                                                                                                                            Lagl    r=0.13  r=0.02
                                                                                                                                     P = 0.02 p = 0.75
                                                                                                                            Lag 2    r=0.13  r=0.07
                                                                                                                                     p = 0.35 p = 0.012
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &    Effects: Relative Risk or Percent Change
 Correlations           & Confidence Intervals (95%)
           ASIA (cont'd)
X
           Tsai et al. (2006)
           Kaohsiung, Taiwan

           Period of Study:
           1996-2003

           Days:  2922
                    Outcomes (ICD 9):  Asthma (493)
                    Study Design:  Case-crossover
                    N:  17,682
                    Statistical Analyses: Conditional logistic
                    regression
                    Covariates:  Temperature, humidity
                    Season: Warm (>25°C); Cool (<25°C)
                    Statistical package:  SAS
                    Lag: 0-2 days cumulative
                                    NO224-hmean: 27.20 ppb
                                    IQR:  17 ppb
                                    Range:  4.83,63.40

                                    # of stations: 6
                        PM10
                        SO2
                        03
                        CO
                 Increment: 17 ppb (IQR)

                 Seasonality
                 Single-pollutant model
                 >25°C 1.259 [1.111, 1.427] lag 0-2
                 <25°C 2.119 [1.875, 2.394] lag 0-2
                 Dual-pollutant model
                 Adjusted for PM10
                 >25°C 1.082 [0.913, 1.283] lag 0-2
                 <25°C 2.105 [1.791, 2.474] lag 0-2
                 Adjusted for CO
                 >25°C 0.949 [0.792, 1.137] lag 0-2
                 <25°C 2.30 [1.915, 2.762] lag 0-2
                 Adjusted for SO2
                 >25°C 1.294 [1.128, 1.485] lag 0-2
                 <25°C 2.627 [2.256, 3.058] lag 0-2
                 Adjusted for O3
                 >25°C 1.081 [0.945, 1.238] lag 0-2
                 <25°C 2.096 [1.851, 2.373] lag 0-2
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           Chen et al. (2006)
           Taiwan

           Period of Study:
           1/1998-12/2001
                    Outcomes (ICD 9):  Asthma (493)
                    Age Groups: 0-4, 5-14, 15-44, 45-64, 65+
                    Study Design:  Time-series
                    N:  126,671
                    Statistical Analyses:  Spearman Rank
                    Correlations
                    Covariates:
                    Season:
                    Statistical package:  SPSS
                    Lag:
                                    Mean monthly NO2 averaged
                                    across 55 monitors: 37.64
                                    (4.89) ppb
                                    Minimum: 29.52
                                    25th: 33.72
                                    50th: 37.07
                                    75th: 40.63
                                    Maximum:  47.65
                        PM10; r =
                        SO2; r =
                        C0;r =
                        03;r =
                 Spearman rank correlations show that
                 seasonal variations in adult asthma
                 admissions are significantly correlated with
                 levels of NO2 (r = 0.423, p = 0.003).
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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
             Reference, Study
            Location, & Period
         Outcomes, Design, & Methods
     Mean Levels &
  Monitoring Stations
 Copollutants &       Effects: Relative Risk or Percent
  Correlations      Change & Confidence Intervals (95%)
           ASIA (cont'd)
X
Oi
-!j
Oi
           Lee* et al. (2002)
           Seoul, Korea

           Period of Study:
           12/1/97-12/31/99
           Days: 822
           Yang et al. (2007)
           Taipei, Taiwan

           Period of Study:
           1996-2003
Outcomes (ICD 10): Asthma (J45 - J46)
Age groups analyzed: <15
Study Design: Time-series
N:  6,436
Statistical Analyses: Poisson regression, log link
with GAM
Covariates:  Time, day of wk, temperature, humidity
Season:  Spring (Mar-May), Summer (Jun-Aug), Fall
(Sep-Nov), Winter (Dec-Feb)
Statistical package: NR
Lag: 0-2 days cumulative

Outcomes (ICD 9): Asthma (493)
Age groups analyzed: All
Study Design: Case-crossover
N:  25,602
Number of hospitals:  47
Statistical Analyses: Conditional logistic regression
Covariates:  Temperature, humidity
Statistical package: SAS
Lag: 0-2
24-h NO2 (ppb)
Mean:  31.5
SD=10.3
5th: 16.0
25th: 23.7
50th: 30.7
75th: 38.3
95th: 48.6

# of stations: 27


24-havg: 30.77 ppb
Range:  3.84-77.97
25th: 25.55
50th: 30.31
75th: 35.60

Number of monitors:  6
                                                                                                         SO2; r = 0.72
                                                                                                         O3;r=-0.07
                                                                                                         CO; r= 0.79
                                                                                                         PM10; r = 0.74
SO2
PM10
CO
03
                  Increment:  14.6 ppb (IQR)

                  Asthma
                  NO2:  RR 1.15 [1.10, 1.20] lag 0-2
                  N02 + PM10: RR 1.13 [1.07, 1.19] lag 0-2
                  N02 + S02: RR 1.20 [1.11,  1.29] lag 0-2
                  NO2 + O3:  RR 1.14 [1.09, 1.20] lag 0-2
                  N02 + C0:  RR 1.12 [1.03, 1.22] lag 0-2
                  NO2 + O3 + CO + PM10 + SO2: RR 1.098
                  [1.002,1.202]
Increment: 10.05 ppb (IQR)

NO2 alone:
>25C: 1.178 [1.113, 1.247] lag 0-2
<25C: 1.128, 1.076, 1.1 82] lag 0-2

N02 + PM10:
>25C: 1.328 [1.224, 1.441] lag 0-2
<25C: 1.144 [1.077, 1.215] lag 0-2
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                                                                                                                           NO2 + SO2:
                                                                                                                           >25C:  1.224 [1.140, 1.314] lag 0-2
                                                                                                                           <25C:  1.219 [1.150, 1.291] lag 0-2

                                                                                                                           NO2 + CO:
                                                                                                                           >25C:  1.084 [0.999, 1.176] lag 0-2
                                                                                                                           <25C:  1.198 [1.111, 1.291] lag 0-2

                                                                                                                           NO2 + O3:
                                                                                                                           >25C:  1.219 [1.142, 1.301] lag 0-2
                                                                                                                           <25C:  1.156 [1.102, 1.212] lag 0-2

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                           TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                    HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
Copollutants &       Effects: Relative Risk or Percent
 Correlations      Change & Confidence Intervals (95%)
           ASIA (cont'd)
X
           Yang and Chen
           (2007)
           Taipei, Taiwan

           Period of Study:
           1996-2003
                    Outcomes (ICD 9):  COPD (493)
                    Age groups analyzed:
                    Study Design:  Case-crossover
                    N: 25,602
                    Number of hospitals: 47
                    Statistical Analyses:  Conditional logistic regression
                    Covariates: Temperature, humidity
                    Statistical package:  SAS
                    Lag:  0-2
                                      24-h avg: 30.77 ppb
                                      Range:  3.84-77.97
                                      25th: 25.55
                                      50th: 30.31
                                      75th: 35.60

                                      Number of monitors: 6
                      SO2
                      PM10
                      CO
                      03
                 Increment:  10.05 ppb (IQR)

                 NO2 alone:
                 >20C:  1.193 [1.158, 1.230] lag 0-2
                 <20C:  0.972 [0.922, 1.024] lag 0-2

                 N02 + PM10:
                 >20C:  1.183 [1.137, 1.231] lag 0-2
                 <20 C:  0.920 [0.862, 0.982] lag 0-2

                 NO2 + SO2:
                 >20C:  1.302 [1.254, 1.351] lag 0-2
                 <20 C:  0.895 [0.837, 0.956] lag 0-2

                 NO2 + CO:
                 >20C:  1.154 [1.102, 1.208] lag 0-2
                 <20C:  0.972 [0.892, 1.059] lag 0-2
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                                                                                                                        NO2 + O3:
                                                                                                                         >20C:  1.163 [1.126, 1.200] lag 0-2
                                                                                                                        <20C: 0.952 [0.901, 1.006] lag 0-2
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g                       TABLE AX6.3-3 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
|       	HOSPITAL ADMISSIONS	
.j           Reference, Study            Outcomes, Design, & Methods              Mean Levels &        Copollutants &      Effects: Relative Risk or Percent
O           Location, & Period                                              Monitoring Stations       Correlations     Change & Confidence Intervals (95%)
00        ASIA (cont'd)	
          Ko et al. (2007a)          Outcomes (ICD 9):
          Hong Kong              Age groups analyzed:
          Period of Study           # of hospitals:
                                 Study Design:
                                 Statistical Analyses:
                                 Covariates:
                                 Statistical package:
                                 Lag:
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                           TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
    Reference, Study
   Location, & Period
      Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
Copollutants &       Effects:  Relative Risk or Percent
  Correlations      Change & Confidence Intervals (95%)
           ASIA (cont'd)
X
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           Lee et al. (2006)
           Hong Kong, China

           Period of Study:
           1997-2002
Lee et al. (2007)
Kaohsiung, Taiwan

Period of Study:
1996-2003
Outcomes (ICD 9): asthma (493)
Age groups analyzed: <18
N: 26,663
Study Design: Time-series
Statistical Analyses: Poisson regression with
GAM
Covariates: Temperature, humidity, influenza,
day of wk, holidays
Statistical package: SAS v 8.02
Lag:  0,1,2,3,4,5


Outcomes (ICD 9): COPD (490-492, 494,
496)
Age groups analyzed: All
# of hospitals: 63
N: 25,108
Study Design: Case-crossover
Statistical Analyses: Conditional logistic
regression
Covariates: temperature, humidity
Season:  Warm: >25 C, cool: <25 C
Statistical package: SAS v 8.2
Lag:  0-2 cumulative avg
                                                                   24-havg: 64.7 (20.9) ug/m3
                                                                   25th: 49.7
                                                                   50th: 63.5
                                                                   75th: 76.8
                                                                   IQR: 27.1

                                                                   Number of monitors: 10
24-h avg: 27.2 ppb
Range: 4.83-63.40
25th:  18.4
50th:  27.17
75th:  35.40

# of monitors: 6
                            SO2;r=0.49
                            PM10; r = 0.78
                            PM2.5; r = 0.75
                            O3;r = 0.35
SO2
PM10
CO
03
Increment: 27.1 ug/m  (IQR)

LagO: 4.37% [2.51, 6.27]
Lagl: 5.88% [4.00, 7.70]
Lag 2: 7.19% [5.37, 9.04]
Lag 3: 9.08% [7.26, 10.93]
Lag 4: 7.64% [5.84, 9.48]
Lag 5: 6.40% [4.60, 8.22]
NO2 alone:  9.08% [7.26, 10.93] lag 3
NO2 + SO2 + PM10 + PM2 5 + O3: 5.64%
[3.21, 8.14] lag 3
Increment:  17 ppb (IQR)

NO2 alone:
>25C:  1.241 [1.117, 1.379] lag 0-2
<25C:  1.975 [1.785, 2.186] lag 0-2

N02 + PM10:
>25C:  1.083 [0.939, 1.249] lag 0-2
<25C:  1.957 [1.709, 2.241] lag 0-2

NO2 + SO2:
>25C:  1.264 [1.127, 1.418] lag 0-2
<25 C:  2.378 [2.095, 2.700] lag 0-2

NO2 + CO:
>25C:  0.984 [0.848, 1.141] lag 0-2
<25 C:  2.035 [1.746, 2.373] lag 0-2

N02 + 03:
>25C:  1.076 [0.961, 1.205] lag 0-2
<25C:  1.946 [1.755, 2.157] lag 0-2

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                            TABLE AX6.3-3 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                     HOSPITAL ADMISSIONS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
                                                                                Mean Levels & Monitoring
                                                                                         Stations
Copollutants &     Effects: Relative Risk or Percent
 Correlations     Change & Confidence Intervals (95%)
           ASIA (cont'd)
           Wong etal. (1999)
           Hong Kong, China

           Period of Study:
           1994-1995
                      Outcomes (ICD 9):  All respiratory admissions
                      (460-6,471-8, 480-7, 490-6); Asthma (493),
                      COPD (490-496), Pneumonia (480-7)
                      Age groups analyzed:  0-4, 5-64, >65, all ages
                      # of hospitals:  12
                      Study Design:  Time-series
                      Statistical Analyses: Poisson regression
                      (followed APHEA protocol)
                      Covariates:  Trend, season, day of wk, holiday,
                      temperature, humidity
                      Statistical package:  SAS 8.02
                      Lag: days 0-3 cumulative
                                    Median 24-h NO2:  51.39 ug/m3
                                    Range: 16.41, 122.44
                                    25th:  39.93,75th:  66.50

                                    # of stations: 7,
                                    r = 0.68, 0.89
                                                                                                             03
                                                                                                             SO2
                                                                                                             PM10;r=0.79
                Increment =10 ug/m

                Overall increase in admissions:
                1.020 [1.013, 1.028] lag 0-3

                Respiratory Relative Risks (RR)
                0-4 yrs: 1.020 [1.010, 1.030] lag 0-3
                5-64yrs:  1.023 [1.011, 1.034] lag 0-3
                >65yrs:  1.024 [1.014, 1.035] lag 0-3
                Cold Season:  1.004 [0.988, 1.020]
                N02 + highPM10:  1.009 [0.993, 1.025]
                NO2 + highO3:  1.013 [0.999, 1.026]
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           Wong etal. (200la)
           Hong Kong, China

           Period of Study:
           1993-1994
                      Outcomes (ICD 9):  Asthma (493)
                      Age groups analyzed:  < 15
                      N:  1,217
                      # of hospitals:  1
                      Study Design:  Time-series
                      Statistical Analyses: Poisson regression
                      (followed APHEA protocol)
                      Covariates:  Season, temperature, humidity
                      Season: Summer (Jun-Aug), Autumn
                      (Sep-Nov), Winter (Dec-Feb), Spring
                      (Mar-May)
                      Lag: 0,1,2,3,4,5 days; and cumulative 0-2 and
                      0-3 days.
                                    24-h avg
                                    NO2 mean: 43.3 ug/m ,
                                    SD = 16.6
                                    Range: 9, 106 ug/m3
                                    Autumn: 51.7(17.6)
                                    Winter: 46.6(15.5)
                                    Spring: 40.7(11.8)
                                    Summer:  32.6(13.7)
                                    # of stations:  9
                                                                                                             PM10
                                                                                                             SO,
                Asthma:  1.026 [1.01, 1.042] lag 0-3
                COPD:  1.029 [1.019, 1.040] lag 0-3
                Pneumonia:  1.028 [1.015, 1.041] lag 0-3
                Increment:  10 ug/m3

                Asthma
                Allyr: 1. 08 p = 0.001
                Autumn: 1. 08 p = 0.017
                Winter:  NR
                Spring:  NR
                Summer: NR
           *Default GAM
           +Did not report correction for over-dispersion
           NR: Not Reported
           APHEA: Air Pollution and Health: A European Approach

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                                 TABLE AX6.3-4. RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant             Effects and Interpretation:
Correlations     Relative Risk & Confidence Intervals (95%)
           UNITED STATES
X
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           Jaffe et al. (2003)
           3 cities, Ohio, United
           States (Cleveland,
           Columbus, Cincinnati)

           Period of Study:
           7/91-6/96
                       Outcome (ICD-9):  Asthma (493)
                       Age Groups Analyzed:  5-34
                       Study Design: Time-series
                       N: 4,416
                       Statistical Analyses: Poisson regression
                       using a standard GAM approach
                       Covariates:  City, day of wk, wk, yr,
                       minimum temperature, overall trend,
                       dispersion parameter
                       Season:  Jun to Aug only
                       Dose-response investigated:  Yes
                       Statistical Package:  NR
                       Lag:  0-3 days
                                  Cincinnati
                                  24-havg: 50 ppb, SD = 15
                                  Cleveland
                                  24-havg: 48 ppb, SD = 16

                                  NO2 was not monitored in
                                  Columbus due to relatively
                                  low levels
                          Cincinnati:
                          PM10;r=0.36
                          SO2;r = 0.07
                          O3;r=0.60

                          Cleveland:
                          PM10; 0.34
                          SO2;r = 0.28
                          O3; r = 0.42

                          No
                          multipollutant
                          models were
                          utilized.
               Increment:  10 ppb

               Cincinnati:  6% [-1.0, 13] lag 1
               Cleveland:  4% [-1,8] lag 1
               All cities: 3% [-1.0, 7]

               Attributable risk from NO2 increment:
               Cincinnati 0.72 (RR 1.06)
               Cleveland 0.44 (RR 1.04)

               Regression diagnostics for Cincinnati showed
               significant linear trend during entire study period
               and for each wk (6/1-8/31). No trends observed
               for Cleveland.

               Regression Models assessing exposure thresholds
               showed a possible dose-response for NO2
               (percent increase after 40 ppb).  No increased risk
               until minimum concentration of 40 ppb was
               reached.
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           Norris* etal. (1999)
           Seattle, WA, United States

           Period of Study:
           1995-1996
                       Outcome (ICD-9):  Asthma (493)
                       Age groups analyzed: <18yrs
                       Study Design: Time-series
                       N: 900 ER visits
                       Statistical Analyses: Semi parametric
                       Poisson regression using GAM.
                       Covariates: day of wk, time trends,
                       temperature, dew point temperature
                       Dose-response investigated:  Yes
                       Statistical Package: NR
                       Lag:  0,2 days
                                  24 h:  20.2 ppb, SD = 7.1
                                  IQR:  9 ppb

                                  1-hmax: 34.0 ppb,
                                  SD=11.3
                                  IQR:  12 ppb
                          CO; r= 0.66
                          PM; r = 0.66
                          SO2;r = 0.25
               Increment: IQR

               24-h avg (9-ppb increment)
               RR 0.99 [0.90, 1.08] lag 2

               1-h max (12-ppb increment)
               RR 1.05 [0.99, 1.12] lag 0

               Age and hospital utilization (high and low)
               segregation (<5, 5-11, and 12-17 yrs) did not
               figure significantly in the association between
               emergency room visits and asthma.

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                           TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                            EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
           UNITED STATES (cont'd)
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           Lipsettetal. (1997)
           Santa Clara County,
           California, United States

           Period of Study:
           1988-1992
                      Outcome(s): Asthma
                      ICD-9 Code(s): NR
                      Age groups analyzed: All
                      Study Design:  Time-series
                      Statistical Analyses: Poisson
                      Regression; GEE repeated with GAM
                      Covariates: Minimum temperature,
                      day of study, precipitation, hospital,
                      day of wk, yr, overdispersion
                      parameter
                      Season:  Winters only
                      Statistical Package: SAS, S Plus,
                      Stata
                      Lag: 0-5 days
                                NO2 1-hmean: 69 ppb,
                                SD = 28
                                Range:  29, 150 ppb
                         PM10; r = 0.82
                         COH;r = 0.8
                         No multipollutant
                         model due to high
                         correlation
                         between pollutants
                Same day NO2 was associated with ER visits for
                asthma ((3 = 0.013, p = 0.024)

                Absence of association between lagged or
                multiday specifications of NO2 and asthma ER
                visits (data not shown) suggest that same day
                association may be artifact of covariation with
                PM10.
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                             TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant               Effects and Interpretation:
Correlations        Relative Risk & Confidence Intervals (95%)
           UNITED STATES (cont'd)
X
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           Peel et al. (2005)
           Atlanta, GA, United States

           Period of Study:
           1/93-8/2000
           Tolbert et al. (2000)
           Atlanta, GA, United States

           Period of Study:
           1993-1995
                      Outcome(s) (ICD-9): All respiratory
                      (460-6, 477, 480-6, 480-6, 490-3, 496);
                      Asthma (493); COPD (491-2, 496);
                      Pneumonia (480-486); Upper Respiratory
                      Infection (460-6,477)
                      Age groups analyzed: All, 2-18
                      Study Design: Time-series
                      N:  484,830
                      # of Hospitals:  31
                      Statistical Analyses:  Poisson Regression,
                      GEE, GLM, and GAM (data not shown
                      for GAM) Covariates: day of wk, hospital
                      entry/exit, holidays, time trend; season,
                      temperature, dew point temperature
                      Statistical Package:  SAS, S-Plus
                      Lag: 0 to 7 days. 3-day moving avgs.

                      Outcome(s) (ICD-9): Asthma (493),
                      wheezing (786.09), Reactive airways
                      disease (RADS) (519.1)
                      Age groups analyzed: 0-16; 2-5, 610,
                      11-16
                      Study Design: Case-Control
                      N:  5,934
                      Statistical Analyses:  Ecological GEE
                      analysis (Poisson model with logit link)
                      and logistic regression
                      Covariates: Day of wk, day of summer,
                      yr, interaction of day of summer and yr
                      Season:  Summers only
                      Statistical Package:  SAS
                      Lag:  1 day (a priori)
                                  1-hmax: 45.9ppb,
                                  SD= 17.3
                                 NOX 1-h max continuous
                                 Mean: 81.7ppb,
                                 SD = 53.8
                                 Range = 5.35, 306

                                 Number of stations: 2
                        O3; r = 0.42
                        SO2;r = 0.34
                        CO; r= 0.68
                        PM10; r = 0.46

                        Evaluated
                        multipollutant
                        models (data not
                        shown)
                        PM10; r = 0.44
                        O3;r=0.51
               Increment: 20 ppb

               All respiratory
               RR 1.016 [1.006, 1.027] lag 0-2, 3-day moving avg
               Upper Respiratory Infection (URI)
               RR 1.019 [1.006, 1.031] lag 0-2, 3-day moving avg
               Asthma
               All:  1.014 [0.997, 1.030] lag 0-2, 3-day moving avg
               2-18:  1.027 [1.005, 1.050]  lag 0-2, 3-day moving avg
               Pneumonia
               RR 1.000 [0.983, 1.019] lag 0-2, 3-day moving avg
               COPD
               RR 1.035 [1.006, 1.065] lag 0-2, 3-day moving avg
               Increment: 50 ppb

               Age 0-16:
               RR 1.012 [0.987,1.039] lag 1
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                             TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
    Outcomes, Design, & Methods
 Mean Levels of NO2 &
  Monitoring Stations
     Copollutant                Effects and Interpretation:
    Correlations        Relative Risk & Confidence Intervals (95%)
           UNITED STATES (cont'd)
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Tolbert et al. (2007)
Atlanta, GA

Period of Study:
1993-2004
Cassino* et al. (1999)
New York City, NY
United States

Period of Study:
1/1989-12/1993
Outcome(s) (ICD-9): Combined
respiratory diseases (493, 786.07, 786.09,
491, 492, 496, 460-465, 477, 480-486,
466.1,466.11,466.19)
Age groups analyzed: All
Study Design: Time-series
N:  1,072,429
Number of hospitals: 41
Statistical Analyses: Poisson regression
with GLM
Covariates: Day of wk, season, hospital,
holiday, temperature, dew point)
Statistical Package:  SASv. 9.1
Lag: 0-2 (a priori)

Outcome(s) (ICD-9): Asthma (493);
COPD (496), bronchitis (490),
emphysema (492), bronchiectasis (494)
Study Design: Time-series
N:  1,115
# of Hospitals:  11
Statistical Analyses: Time-series
regression, Poisson regression with GLM
and GAM; Linear regression, Logistic
regression with GEE
Covariates: Season, trend, day of wk,
temperature, humidity
Statistical Package:  S Plus and SAS
Lag: 0-3 days
1-hmax:  43.2ppb
Range: 1.0-181.0
10th: 22.0
25th: 31.0
50th: 41.0
75th: 54.0
90th: 66.0
24-h avg NO2:
Mean: 45.0ppb
Median: 43 ppb
10%31ppb
25% 37 ppb
75% 53 ppb
90% 63 ppb
                                                                                                   PM10;r=0.53
                                                                                                   O3; r = 0.44
                                                                                                   S02;r = 0.36
                                                                                                   CO; r= 0.70
                                                                                                   PM2.5; r = 0.47
                      Increment: 23 ppb (IQR)

                      RR 1.015 [1.004, 1.025] lag 0-2
                                                                                                      10-2.5     .
                                                                                                   PM2.5sulfate;r = 0.14
                                                                                                   PM2 5EC; r = 0.64
                                                                                                   PM2.5OC; r = 0.62
                                                                                                   OHC; r = 0.24
03
CO
S02
Increment: 15 ppb (IQR)

RR 0.97 [0.85, 1.09] lag 0
RR 1.04 [0.92, 1.18] lag 1
RR 1.06 [0.94, 1.2] lag 2
RR 0.97 [0.86, 1.09] lag 3
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                  TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                        EMERGENCY DEPARTMENT VISITS
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Reference, Study Mean Levels of NO2 & Copollutant
Location, & Period Outcomes, Design, & Methods Monitoring Stations Correlations
Effects and Interpretation:
Relative Risk & Confidence Intervals (95%)
CANADA
Bates etal. (1990) Outcome(s) (ICD 9): Asthma (493); May-Oct May-Oct.
Vancouver Region, Pneumonia (480-486); SO2l-hmax: O3;r=0.35
BC, Canada Chronic bronchitis (491,492,496); Range: 0.0337-0.0458 ppm SO2;r = 0.67
Other respiratory (466) CoH r = 0 53
Period of Study: 7/1/1984- Age groups analyzed: All; 15-60 Nov-Apr SO4;r = 0.50
10/31/1986 Study Design: Range: 0.0364-0.0455 ppm
# of Hospitals: 9 Nov-Apr
Statistical Analyses: Pearson correlation Number of stations: 11 O3;r=0.31
coefficients were calculated between §Q . r = Q g j
asthma visits and environmental variables CoR- r = 0 69
Season: Warm (May-Oct); SO''r = 049
Cool (Nov-Apr) 4'
Covariates: NR
Statistical Package: NR
Lag: 0,1,2




















Correlation Coefficients:

Warm Season (May-Oct)
Asthma (1-14 yrs)
NS lag 0
NS lag 1
NS lag 2
Respiratory (1-14)
NS lag 0
NS lag 1
NS lag 2
Total (1-14)
NS lag 0
NS lag 1
NS lag 2
Asthma (15-60 yrs)
NS lag 0
NS lag 1
NS lag 2
Respiratory (15-60 yrs)
r = 0.120 lag Op< 0.01
NS lag 1
NS lag 2
Total (15-60 yrs)
NS lag 0
NS lag 1
NS lag 2
Asthma (61+ yrs)
NS lag 0
NS lag 1
NS lag 2
Respiratory (61+ yrs)
NS lag 0
NS lag 1
NS lag 2

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                           TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                         EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant             Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
          CANADA (cont'd)
          Bates etal. (1990)
          (cont'd)
                                                                                                   Total(61+yrs)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
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                                                                                                   Cool Season (Nov - Apr)
                                                                                                   Asthma (1-14 yrs)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Respiratory (1-14)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Total (1-14)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Asthma (15-60 yrs)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Respiratory (15-60 yrs)
                                                                                                   r = 0.120 lag Op< 0.01
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Total (15-60 yrs)
                                                                                                   NS lag 0
                                                                                                   NS lag 1
                                                                                                   NS lag 2
                                                                                                   Asthma (61+yrs)
                                                                                                   NS lag 0
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                            TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
    Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
           CANADA (cont'd)
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          Bates etal. (1990)
          (cont'd)
Kestenetal. (1995)
Toronto, ON

Period of Study:
7/1/1991-6/30/1992
           Stieb etal. (1996)
           St. John, New Brunswick,
           Canada

           Period of Study: 1984-
           1992
Outcome(s): Asthma
Age groups analyzed: All
Study Design:  Time-series
N: 854
# of Hospitals:  1
Statistical analysis: autoregressive
technique
Statistical Package: SAS v 6.04
Lag:  0,1

Outcome(s): Asthma
(May-Sept only)
ICD-9 Codes:  NR
Age groups analyzed: 0-15, >15
Study Design:  Time-series
N: 1,163
# of Hospitals:  2
Statistical Analyses: SAS NLIN
(Equivalent to  Poisson GEE)
Covariates: day of wk, long-term trends,
Season:  Summers only (May-Sep)
Dose-response investigated: Yes
Statistical Package: SAS
Lag:  0-3 days
                                                                         24-h avg NO2:                SO2
                                                                         Range: 2.20-3.75 x 0.01 ppm    O3
                                                              l-hmaxNO2 (ppb)
                                                              Mean:  25.2
                                                              Range: 0, 120
                                                              95th: 60
                         O3;r=0.16
                         S02;r=-0.03
                         SO42~;r=0.16
                         TSP;r=0.15
                                                                                                             NS lag 1
                                                                                                             NS lag 2
                                                                                                             Respiratory (61+ yrs)
                                            r=0.\76\ag\p<0.00\
                                            r=Q.\78\ag2p
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                  TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:

                                        EMERGENCY DEPARTMENT VISITS
Reference, Study
Location, & Period
Mean Levels of NO2 &
Outcomes, Design, & Methods Monitoring Stations
Copollutant
Correlations
Effects and Interpretation:
Relative Risk & Confidence Intervals (95%)
CANADA (cont'd)
Stieb* et al. (2000)
Saint John, New
Brunswick, Canada

Period of Study:
Retrospective:
7/92-6/94
Prospective:
7/94-3/96








Outcome(s): Asthma; COPD; Annual mean: 8.9 ppb
Respiratory infection (bronchitis, spring/fall mean: 10.0 ppb
bronchiolitis, croup, pneumonia); Max: 82
All respiratory
ICD-9 Codes: NR
Age groups analyzed: All
Study Design: Time-series
N: 19,821
Statistical Analyses: Poisson regression,
GAM
Covariates: Day ofwk, selected weather
variables in each model
Seasons: All yr, summer only
Dose-response investigated: Yes
Statistical Package: S-Plus
Lag: all yr = 0; summer
only = 8
03;r=-0.02
SO2;r = 0.41
TRS;r=0.16
PM10;r=0.35
PM2.5;r = 0.35
11^=0.25
SO42~;r=0.33
COH; r = 0.49
Assessed
multipollutant
models






Increment: 8.9ppb(IQR)

Respiratory visits: - 3.8%, p = 0.070 lag 0
May to Sept: 11.5%, p = 0.17 lag 8

Multipollutant model (NO2, O3, SO2)
-3.6% [-7.5, 0.5] lag 0

Multipollutant model (ln(NO2), O3, SO2 COH)
May to Sept: 4.7% [0.8 to 8.6] lag 8


Non- linear effect of NO2 on summertime
respiratory visits observed and log
transformation strengthened the association.



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                           TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                            EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST
           Sunyeretal. (1997)
           Multi-city, Europe
           (Barcelona, Helsinki,
           Paris, London)

           Period of Study: 1986-
           1992
                      Outcomes (ICD-9): Asthma (493)
                      Age groups analyzed: <15,15-64
                      Study Design: Time-series
                      Statistical Analyses: APHEA protocol,
                      Poisson regression, GEE; meta-analysis
                      Covariates: Humidity, temperature,
                      influenza, soybean, long-term trend,
                      season, day of wk
                      Season:  Cool, Oct-Mar; Warm: Apr-Sep
                      Statistical Package: NR
                      Lag: 0,1,2,3 and cumulative 1-3
                                 24-h median (range)
                                 (ug/m3)
                                 Barcelona:  53 (5, 142)
                                 Helsinki: 35(9,78)
                                 London: 69(27,347)
                                 Paris: 42 (12, 157)
                                 # of stations:
                                 Barcelona:  3
                                 London: 2
                                 Paris: 4
                                 Helsinki: 8
                        SO2
                        black smoke
                        03
                Increment:  50 ug/m3 of 24-h avg for all cities
                combined

                Asthma
                15-64yrs
                1.029 [1.003, 1.055] lag 0-1
                1.038 [1.008, 1.068] lag 0-3, cumulative

                <15 yrs
                1.026 [1.006, 1.049] lag 2
                1.037 [1.004, 1.067] lag 0-3, cumulative
                1.080 [1.025, 1.140] -Winter only
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                                                                                                        NO2/Black smoke
                                                                                                        15-64 yrs 1.055 [1.005, 1.109] lag 0-1
                                                                                                        15-64 yrs 1.088 [1.025, 1.155] cumulative 0-3
                                                                                                        <15yrs  1.036 [0.956, 1.122]
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                                                                                                                     N02/S02
                                                                                                                     <15yrs  1.034 [0.988, 1.082]
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                            TABLE AX.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
                                                                            Mean Levels of NO2 &
                                                                             Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations       Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST (cont'd)
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           Atkinson et al. (1999b)
           London, United Kingdom

           Period of Study:
           1/92-1294
           Buchdahl et al. (1996)
           London, United Kingdom

           Period of Study:  3/1/92-
           2/28/93
                      Outcome(s) (ICD-9): Respiratory
                      ailments (490-496), including asthma,
                      wheezing, inhaler request, chest
                      infection, COPD, difficulty in breathing,
                      cough, croup, pleurisy, noisy breathing
                      Age groups analyzed: 0-14; 15-64; >65;
                      All ages
                      Study Design:  Time-series
                      N:  98,685
                      # of Hospitals: 12
                      Statistical Analyses:  Poisson regression,
                      APHEA protocol
                      Covariates: Long-term trend, season, day
                      of wk, influenza, temperature, humidity
                      Statistical Package: SAS
                      Lag: 0,1,0-2, and 0-3 days
                      Outcomes:  Daily acute wheezy episodes
                      ICD-9: NR
                      Age groups analyzed: > 16
                      Study Design:  Case-control
                      N:  1,025 cases, 4,285 controls
                      Number of hospitals:  1
                      Statistical Analyses:  Poisson regression
                      Covariates: Season, temperature, wind
                      speed
                      Season: Spring (Apr-Jun), Summer
                      (Jul-Sep), Autumn (Oct Dec),
                      Winter (Jan-Mar)
                      Statistical Package: Stata
                      Lag: 0-7 days
                                  1-hmax: 50.3ppb,
                                  SD = 17.0

                                  # of Stations: 3;
                                  r= 0.70, 0.96
                                                                                                    NO2, O3
                                                                                                    (8 h), SO2
                                                                                                    (24 h), CO (24 h),
                                                                                                    PM10 (24 h), BS
                                  NO2 24-h yr round mean:
                                  60 ug/m3, SD = 17

                                  IQR:  17 ug/m3

                                  Spring: 59(19)
                                  Summer:  55(18)
                                  Fall:  66(13)
                                  Winter: 61 (17)
                                                                                                    SO2 r = 0.62
                                                                                                    O3r=-0.18
                 Increment: 36 ppb in 1-hmax

                 Single-pollutant model
                 Asthma Only
                 0-14 yrs 8.97% [4.39, 13.74] lag 1
                 15-64 yrs 4.44% [0.14, 8.92] lag 1
                 All ages 4.37% [1.32, 7.52] lag 0
                 All Respiratory
                 0-14 yrs 2.17% [-0.49, 4.91] lag 1
                 15-64 yrs 1.87% [-0.69, 4.49] lag 2
                 >65 yrs 3.97% [0.51, 7.55] lag 0
                 All Ages 1.20% [-0.57, 3.00]
                 Two-pollutant model Asthma Only 0-14 yrs:
                 SO2:  5.75% [0.39, 11.40] lag 1
                 CO: 8.34% [3.61, 13.29] lag 0
                 PM10:  6.95% [1.96,12.19] lag 2
                 BS:  8.32% [3.56,  13.30] lag 2
                 03: 9.68% [5.02, 14.54] lag 0
                 Increment: 17 ug/m3 (IQR)

                 No adjustments to model
                 RR 1.07 [1.01, 1.14] lag not specified

                 Adjusted for temperature and season.
                 RR 1.02 [0.96, 1.09] lag not specified

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                           TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                            EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST (cont'd)
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           Thompson et al. (2001)
           Belfast, Northern Ireland

           Period of Study:
           1993-1995
                      Outcome(s): Asthma
                      ICD-9 Code(s):  NR
                      Age groups analyzed: Children
                      Study Design: Time-series
                      N: 1,044
                      Statistical Analyses: Followed APHEA
                      protocol, Poisson regression analysis
                      Covariates: Season, long-term trend,
                      temperature, day of wk, holiday
                      Season: Warm (May-Oct);
                      Cold (Nov-Apr)
                      Statistical Package: Stata
                      Lag:  0-3
                                 Warm Season
                                 NO2(ppb): Mean:  19.20;
                                 SD = 7.90;
                                 IQR: 13.0,23.0
                                 NOx(ppb): Mean:  35.50;
                                 SD = 25.50;
                                 IQR: 21.0,40.0
                                 NO(ppb): Mean:  16.4;
                                 SD = 19.70;
                                 IQR: 7.0,17.0

                                 Cold Season
                                 NO2(ppb): Mean:  23.30;
                                 SD = 9.00;
                                 IQR: 18.0,28.0
                                 NOx(ppb): Mean:  50.50;
                                 SD = 50.50;
                                 IQR: 26.0,56.0
                                 NO(ppb): Mean:  27.30;
                                 SD = 43.10;
                                 IQR: 9.0,28.0
                       NO2:
                       PM10; r = 0.77
                       S02;r = 0.82
                       NOX; r = 0.93
                       NO; r = 0.84
                       O3;r=-0.62
                       CO; r= 0.69
                       Benzene; r = 0.83

                       NOX:
                       PM10; r = 0.73
                       S02;r = 0.83
                       N02;r=0.92
                       NO; r = 0.97
                       O3;r=-0.73
                       CO; r= 0.74
                       Benzene; r = 0.86

                       NO:
                       PM10;r=0.65
                       SO2; r = 0.76
                       NOX; r = 0.97
                       N02;r=0.84
                       O3;r=-0.76
                       CO; r= 0.71
                       Benzene; r = 0.82
                NO2 Increment:  lOppb
                NOX Increment:  per doubling
                NO Increment: per doubling

                N02
                Lag ORR 1.08 [1.03, 1.13]
                Lag 0-1 RR 1.11  [1.05,1.17]
                Lag 0-2 RR 1.10 [1.04, 1.17]
                Lag 0-3 RR 1.12 [1.03, 1.20]
                Warm only Lag 0-1 RR 1.14 [1.04, 1.26]
                Cold only Lag 0-1 RR1.10 [1.03, 1.17]
                Adjusted for Benzene Lag 0-1 RR 0.99
                [0.87,1.13]

                NOX
                Lag ORR 1.07 [1.02, 1.12]
                Lag 0-1 RR 1.10 [1.05, 1.16]
                Lag 0-2 RR 1.10 [1.03, 1.17]
                Lag 0-3 RR 1.11  [1.04,1.20]
                Warm only Lag 0-1 RR 1.13 [1.03, 1.24]
                Cold only Lag 0-1 RR 1.09  [1.02, 1.16]
                Adjusted for Benzene Lag 0-1 RR 0.89
                [0.77, 1.03]

                NO
                Lag ORR 1.04 [1.01, 1.07]
                Lag 0-1 RR 1.07 [1.03, 1.11]
                Lag 0-2 RR 1.06 [1.02, 1.11]
                Lag 0-3 RR 1.08 [1.02, 1.14]
                Warm only Lag 0-1 RR 1.08 [1.01, 1.16]
                Cold only Lag 0-1 RR 1.06  [1.01, 1.11]
                Adjusted for Benzene Lag 0-1 RR 0.93
                [0.85, 1.01]

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                            TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              EMERGENCY DEPARTMENT VISITS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
Monitoring Stations
Copollutant
Correlations
Effects and Interpretation:
Relative Risk & Confidence Intervals (95%)
EUROPE and MIDDLE-EAST (cont'd)
Boutin-Forzano et al.
(2004)
Marseille, France
Outcome(s): Asthma
ICD-9 Code(s): NR
Age groups analyzed: 3-49
MeanNO2: 34.9 ug/m3
Range: 3.0, 85
SO2;r = 0.56
O3;r=0.58
Increment: 10 ug/m3
Increased ER visits
           Period of Study:
           4/97-3/98
                         Study Design:  Case-Crossover
                         N:  549
                         Statistical Analyses:  Logistic regression
                         Covariates: Minimal daily temperature,
                         maximum daily temperature, minimum
                         daily relative humidity, maximum daily
                         relative humidity, day of wk
                         Statistical Package: NR
                         Lag: 0-4 days
                                                                                   OR 1.0067 [0.9960, 1.0176] lag 0
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Castellsague et al. (1995)
Barcelona, Spain

Period of Study:
1986-1989
Outcome(s):  Asthma
ICD-9 Code(s): NR
Age groups analyzed:  15-64
Study Design: Time-series
# of Hospitals: 4
Statistical Analyses: Poisson regression
Covariates: long-time trend, day of wk,
temperature, relative humidity, dew point
temperature
Seasons: Winter:  Jan-Mar;
Summer:  Jul-Sep
Dose-Response investigated: Yes
Statistical Package: NR
Lag: 0, 1-5 days and cumulative.
Summer:  lag 2 days
Winter: lag 1 day
Mean NO2 (ug/m )
Summer: 104.0
Winter:  100.8

IQR (ug/m3):
Summer: 48
Winter:  37
S02; r = NR
O3; r = NR
                                                                           # of Stations:
                                                                           3 automatic
                                                                            15 manual,
Increment: 25 ug/m3

Seasonal differences
Summer:
1.071 [1.101, 1.130] lag 0-5 cumulative
1.045 [1.009, 1.081] lag 0
Winter:
1.072 [1.010, 1.137] lag 0-2 cumulative
1.056 [1.011, 1.104] lag 0

Asthma visits increased across quartiles of NO2
in summer; a positive but less consistent
increase across quartiles was observed in winter.
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                            TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                              EMERGENCY DEPARTMENT VISITS
Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
Monitoring Stations

Copollutant
Correlations
Effects and Interpretation:
Relative Risk & Confidence Intervals (95%)
EUROPE and MIDDLE-EAST (cont'd)
Tobias etal. (1999)
Barcelona, Spain
Outcome(s): Asthma
ICD-9: NR
Age groups analyzed: >14
24-h avg NO2 ug/m
Non-epidemic days: 54.7
BS
SO2
03

P x 104 (SE x 104 ) using Std Poisson
Without modeling asthma epidemics: 1 1 .25 (1 1 .79) p > 0. 1
Modeling epidemics with 1 dummy variable: 1 . 1 8 (7. 59) p
           Period of Study:
           1986-1989
           Galan et al. (2003)
           Madrid, Spain

           Period of Study:
           1995-1998
Study Design: Time-series
Statistical Analyses: Poisson
regression, followed APHEA
protocol
Covariates:  temperature, humidity,
long-term trend, season, day of wk
Statistical Package: NR
Lag: NR
Outcome(s) (ICD-9): Asthma (493)
Age groups analyzed:  All
Study Design: Time-series
N: 4,827
Statistical Analyses: Poisson
regression, (1) classic APHEA
protocol and (2) GAM with stringent
criteria
Covariates:  trend, yr, season, day of
wk, holidays, temperature, humidity,
influenza, acute respiratory
infections, pollen
Statistical Package:  NR
Lag: 0-4 days
(20.8)
Epidemic days:
58.9 (26.7)
24-h mean:  67.1 ug/m3
SD=18.0
IQR: 20.5
Max:  147.5

# of Stations:  15
                                                                                             PM10;r= 0.717
                                                                                             SO2;r= 0.610
                                                                                             03;r= -0.209
Modeling epidemics with 6 dummy variables: 13.60 (7.79)
p<0.1
Modeling each epidemic with dummy variable: 14.40
(7.44) p< 0.1

P x 104 (SE x  104) using Autoregressive Poisson
Without modeling asthma epidemics:
13.65(11.81)p>0.1
Modeling epidemics with 1 dummy variable: 3.28 (7.77) p
>0.1
Modeling epidemics with 6 dummy variables: 16.49 (8.01)
p<0.05
Modeling each epidemic with dummy variable: 18.18
(8.01)p<0.1

Increment:  10 ug/m3

Asthma:
RR 1.013 [0.991, 1.035] lag 0
RR 1.011 [0.989, 1.032] lag 1
RR 1.013 [0.992, 1.034] lag 2
RR 1.033 [1.013, 1.054] lag 3
RR 1.026 [1.006, 1.047] lag 4

Multipollutant model:
NO2/SO2 1.031 [1.004,1.059] lag 3
N02/PM10 1.001 [0.971, 1.031] lag 3
NO2/Pollen 1.024 [1.004, 1.044] lag 3
NO2/Pollen/O3 1.024 [1.005, 1.045] Poisson
N02/Pollen/03 1.022 [1.005, 1.040] GAM

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                            TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant
Correlations
        Effects and Interpretation:
Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST (cont'd)
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           Teniasetal. (1998)
           Valencia, Spain

           Period of Study:
           1993-1995

           Seasons:
           Cold: Nov-Apr
           Warm:  May-Oct
           Tenias et al. (2002)
           Valencia, Spain

           Period of Study:  1994-
           1995
                     Outcome(s): Asthma
                     ICD-9 Code(s):  NR
                     Age groups analyzed: >14
                     Study Design: Time-series
                     N: 734
                     Statistical Analyses: Poisson
                     regression, APHEA protocol
                     Covariates: seasonality,
                     temperature, humidity, long-term
                     trend, day of wk, holidays, influenza
                     Seasons: Cold:  Nov-Apr;
                     Warm:  May-Oct
                     Dose-Response Investigated: Yes
                     Statistical Package: NR
                     Lag:  0-3 days
                     Outcome(s): COPD
                     ICD-9 Code(s):  NR
                     Age groups analyzed: >14
                     Study Design: Time-series
                     N: 1,298
                     # of Hospitals: 1
                     Statistical Analyses: Poisson
                     regression, APHEA protocol; basal
                     models and GAM
                     Covariates: Seasonality, annual
                     cycles, temperature, humidity, day
                     ofwk, feast days
                     Seasons: Cold: Nov-Apr;
                     Warm:  May-Oct
                     Dose-Response Investigated: Yes
                     Statistical Package: NR
                     Lag:  0-3 days
                               24 h:
                               57.7 ug/m3
                               Cold:  55.9
                               Warm: 59.4
                               1-hmax:
                               101.1  ug/m3
                               Cold:  97.3
                               Warm: 102.8

                               # of Stations: 2
                               NO224-havg:  57.7
                               ug/m ; Range:  12, 135
                               1-hmax:  100.1 ug/m3;
                               Range: 31,305

                               # of Stations: 6 manual
                               and 5 automatic; r = 0.87
                        24 h:
                        O3;r=-0.304
                        SO2 (24 h); r = 0.265
                        S02(lh);r= 0.261

                        Ih:
                        O3;r=-0.192
                        SO2(24h);r=0.199
                        S02(lh);r= 0.201
                        BS;r = 0.246
                        SO2;r=0.194
                        CO; r= 0.180
                        O3;r=-0.192
                  Increment: 10 ug/m

                  NO2 24-h avg
                  Allyr 1.076 [1.020, 1.134] lag 0
                  Cold: 1.083 [1.022, 1.148] lag 0
                  Warm:  1.066 [0.989, 1.149] lag 0

                  NO2 1-hmax
                  Allyr 1.037 [1.008, 1.066] lag 0
                  Cold: 1.034 [1.004, 1.066] lag 0
                  Warm:  1.044 [1.002, 1.088] lag 0
                  Increment: 10 ug/m3

                  24-h avg NO2
                  All yrRR 0.979 [0.943, 1.042] lag 0
                  Cold: 24-h avg: RR 0.991 [0.953, 1.030] lag 0
                  Warm:  24-h avg:  RR 0.961 [0.900, 1.023] lag 0

                  l-hmaxNO2
                  All yrRR 0.986 [0.966, 1.007] lag 0
                  Cold: 24-h avg: RR 0.996 [0.975, 1.018] lag 0
                  Warm:  24-h avg:  RR 0.968 [0.935, 1.003] lag 0

                  Possibility of a linear relationship between pollution
                  and risk of emergency cases could not be ruled out.
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                           TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST (cont'd)
X
           Migliaretti et al. (2005)
           Turin, Italy

           Period of Study:  1997-
           1999
                      Outcome (ICD-9):  Asthma (493)
                      Age groups analyzed:
                      <15, 15-64,>64
                      Study Design: Case-Control
                      Controls: age matched with other
                      respiratory disease  (ICD-9: 460 487,
                      490-2,494-6, 500-19) or heart disease
                      (ICD-9:  390-405,410-429)
                      N:  cases = 1,401
                      controls = 201,071
                      Statistical Analyses: Logistic regression
                      Covariates:  Seasonality, temperature,
                      humidity, solar radiation, wind velocity,
                      day of wk, holiday, gender, age,
                      education level
                      Seasons: Cold: Oct-Mar; Warm: Apr-
                      Sep
                      Statistical Package: NR
                      Lag: 0-3 days and  cumulative
                                 All Participants:
                                 24-h mean: 112.7 ug/m3,
                                 SD = 30.2,               Two-pollutant
                                 Median = 107.7

                                 Cases:
                                 24-h mean:  117.1 ug/m3,
                                 SD = 30.0,
                                 Median = 113.0

                                 Controls:
                                 24-h mean:  112.7 ug/m3,
                                 SD = 30.2,
                                 Median = 107.7
                                 # of Stations:  10; r = 0.79
                        model adjusted for
                        TSP
                Increment:  10 ug/m

                Single Pollutant (NO2):
                <15yrs2.3%[0.3,4.40]
                15-64 yrs 3.10% [-0.01, 7.70]
                >64yrs 7.70% [0.20, 15.20]
                All ages 2.40% [0.5, 4.30]

                Copollutant (NO2 and TSP)
                <15 yrs 1.71% [-0.02, 5.00]
                15-64 yrs 1.20% [-0.06, 6.50]
                >64 yrs 0.91% [-0.08, 5.91]
                All ages 1.10% [-0.02, 3.82]
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                            TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
    Outcomes, Design, & Methods
  Mean Levels of NO2 &
   Monitoring Stations
                           Effects and Interpretation:
   Copollutant         Relative Risk & Confidence Intervals
   Correlations                       (95%)
           EUROPE and MIDDLE-EAST (cont'd)
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           Bedeschi et al. (2007)
           Reggio Emilia, Italy

           Period of Study:
           03/2001-03/2002
Vigotti et al. (2007)
Pisa, Italy

Period of Study: 2000
Outcome (ICD-9):  Respiratory disorders,
asthma or asthma-like disorders, other
respiratory disorders
Age groups analyzed: <15
Study Design: Time-series
N:  854 children, 1051 visits
Statistical Analyses: Poisson regression
with GAM
Covariates: Weekday, festivity day,
humidity, precipitation, temperature, flu
epidemic, pollen concentrations
Statistical Package: R software
Lag: 0-5 days and cumulative
Outcome (ICD-9):  Respiratory
complaints (493,468, 466)
Age groups analyzed: <10, >65
Study Design: Ecologic
N:  966
Number of hospitals:  1
Statistical Analyses: Robust poisson
regression in GAM model
Covariates: Day of study, temperature,
humidity, rain, influenza epidemics, day
of wk, holidays
Statistical Package: NR
Lag: up to 5  d
                                                               24-havg: NO2 (ug/mj)

                                                               Mean:  49(13.8)
                                                               Range: 21.6-107.5
                                                               Median: 47.5
                           SO2;r = 0.56
                           CO;r = 0.77
                           TSP;r=0.58
                           PM10;r=0.57
                           O3;r=-0.50
                    Increment: 10 ug/m

                    All Respiratory Disorders:
                    Italians:  9% [1.0, 17.6] lag 4
                    Foreigners: 17.6% [3.9, 33.0] lag 4
                    All: 11.0% [3.6, 18.8] lag 4
24-havg: 45.6 (11.0) ug/m3
Range: 21.3-74.0
50th:  44.8
Number of monitors: 3
PM10;r=0.58
CO; r= 0.62
Increment: 10 ug/m
Children: 1.118 [1.014, 1.233] lag 0-2
65+: 1.06 [0.967, 1.162] lag 0-2
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                             TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                               EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
Outcomes, Design, & Methods
                                       Mean Levels of NO2 &
                                        Monitoring Stations
                             Copollutant                Effects and Interpretation:
                             Correlations        Relative Risk & Confidence Intervals (95%)
           EUROPE and MIDDLE-EAST (cont'd)
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Pantazopoulou et al.
(1995)
Athens, Greece

Period of Study :  1988
Garty etal. (1998)
Tel Aviv, Israel
1993
Outcomes: All respiratory visits
ICD-9: NR
Age groups analyzed: All ages
Study Design: Time-series
N: 213,316
Number of hospitals: 14
Statistical Analyses: Multiple linear
regression
Covariates: Season, day of wk, holiday,
temperature, relative humidity
Season:  Warm (3/22-9/21), Cold (1/1-
3/2 land 9/22-12/31)
Lag: NR

Outcome(s):  Asthma
ICD-9 Code(s): NR
Age groups analyzed:  1-18
Study Design: Descriptive study with
correlations
N:  1,076
Statistical Analyses: Pearson correlation
and partial correlation coefficients
Covariates: maximum and minimum
ambient temperatures, relative humidity
and barometric pressure
Statistical Package:  Statistix
NO2 24-h avg

Winter:  94 ug/m3,
SD = 25
5th: 59,50th: 93,
95th:  135

Summer: 111 ug/m3,
SD = 32
5th: 65,50th: 108,
95th:  173

# of stations: 2

24-h mean of NOX
(estimated from
histogram): 60 ug/m3;
Range: 50,250
                                                                                                    CO
                                                                                                    BS
                                                                               Increment: 76 ug/m3 in winter and 108 ug/m3 in
                                                                               summer (95th-5th)

                                                                               Respiratory disease admissions

                                                                               Winter: Percent increase:  p = 66.8 [19.6, 113.9]

                                                                               Summer:  Percent increase: p = 21.2 [-35.1, 77.5]
                                                                               Correlation between NOX and ER visits for asthma:

                                                                               All Yr:
                                                                               Daily data r= 0.30
                                                                               Running mean for 7 days r = 0.62

                                                                               Excluding Sept:
                                                                               Daily data r= 0.37
                                                                               Running mean for 7 days r = 0.74

                                                                               38% of variance in number of ER visits explained
                                                                               by fluctuations in NOX. Increases to 55% when
                                                                               Sept. is omitted from analyses.
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                            TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
    Outcomes, Design, & Methods
 Mean Levels of NO2 &
  Monitoring Stations
   Copollutant              Effects and Interpretation:
   Correlations      Relative Risk & Confidence Intervals (95%)
           LATIN AMERICA
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           Farhat* et al. (2005)
           Sao Paulo, Brazil

           Period of Study:
           1996-1997
Martins* et al. (2002)
Sao Paulo, Brazil

Period of Study:
5/96-9/98
Outcome(s) (ICD-9): Lower Respiratory
Disease (466, 480-5)
Age groups analyzed: <13
Study Design: Time-series
N: 4,534
# of Hospitals:  1
Statistical Analyses: (l)Poisson
regression and (2) GAM-no mention of
more stringent criteria
Covariates:  Long-term trends,
seasonality, temperature, humidity
Statistical Package:  S-Plus
Lag:  0-7 days, 2,3,4 day moving avg

Outcome(s)(ICD-10): Chronic Lower
Respiratory Disease (CLRD) (J40-J47);
includes chronic bronchitis, emphysema,
other COPDs, asthma, bronchiectasia
Age groups analyzed: >64
Study Design: Time-series
N: 712
# of Hospitals:  1
Catchment area: 13,163 total ER visits
Statistical Analyses: Poisson regression
and GAM - no mention of more stringent
criteria
Covariates:  weekdays, time, minimum
temperature, relative humidity, daily
number of non-respiratory emergency
room visits made by elderly
Statistical Package:  S-Plus
Lag:  2-7 days and 3 day moving avgs
                                                               Mean: 125.3 ug/mj
                                                               SD = 51.7

                                                               IQR: 65.04 ug/m3

                                                               # of Stations: 6
                         PM10;r=0.83
                         SO2;r = 0.66
                         CO; r = 0.59
NO2 max 1-h avg (ug/m ):
117.6,
SD = 53.0,
Range: 32.1,421.6

IQR: 62.2 ug/m3

# of Stations: 4
O3; r = 0.44
SO2; r = 0.67
PM10;r=0.83
CO; r= 0.62
Increment: IQR of 65.04 ug/m

Single-pollutant models (estimated from
graphs):
LRD-17.5% [12.5, 24]

Multipollutant models:
Adjusted for:
PM10 16.1% [5.4, 26.8] 4 day avg
S02 24.7% [18.2, 31.3] 4 day avg
CO 19.2% [11.8, 26.6] 4 day avg
Multipollutant model
18.4% [3.4, 33.5] 4 day avg

Increment: IQR of 62.2 ug/m3

Percent increase: 4.5% [-6.5, 15] lag 3 day
moving avg (estimated from graph)
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                            TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
              Reference, Study
              Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
          LATIN AMERICA (cont'd)
X
          Ilabacaetal. (1999)
          Santiago, Chile

          Period of Study:
          2/1/95-8/31/96
                                    Outcome(s) (ICD-9): Upper respiratory
                                    illness (460 465, 487);
                                    Days: 578
                                    Lower respiratory illness
                                    (466, 480-486, 490-494, 496, 519.1,
                                    033.9);
                                    Pneumonia (480 486)
                                    Age groups analyzed:  <15
                                    Study Design: Time-series
                                    # of Hospitals: 1
                                    Statistical Analyses: Poisson regression
                                    Covariates: Long-term trend, season, day
                                    of wk, temperature, humidity, influenza
                                    epidemic
                                    Season:  Warm (Sep-Apr),
                                    Cool (May-Aug)
                                    Statistical Package: NR
                                    Lag: 0-3 days
                                 24-h avg NO2:
                                 Warm:
                                 Mean: 97.0
                                 Median:  91.5
                                 SD = 34.6
                                 Range: 37.2,246
                                 5th: 54.3
                                 95th:  163.0

                                 Cool:
                                 Mean: 160.2
                                 Median:  154.4
                                 SD = 59.5
                                 Range: 60.1,397.5
                                 5th: 74.4
                                 95th:  266.0
                                 # of stations: 4, r = 0.70,0.:
                         Warm:           Increment: IQR
                         SO2;r = 0.66
                         O3; r = 0.15       All respiratory
                         PM10; r = 0.71    Cool
                         PM2.5;r = 0.70    Lag 2 IQR: 56.4 RR 1.0378 [1.0211, 1.0549]
                                         Lag 3 IQR: 56.4 RR 1.0294 [1.0131, 1.0460]
                         Cool:            Lagavg7IQR: 33.84 RR 1.0161 [1.0000, 1.0325]
                         SO2; r = 0.74     Warm
                         03;r=0.22       Lag 2 IQR: 30.08 RR 1.0208 [0.9992, 1.0428]
                         PM10;r=0.82    Lag 3 IQR: 30.08 RR 1.0395 [1.0181, 1.0612]
                         PM2.5;r = 0.80    Lag avg 7 IQR: 22.56 RR 1.0251 [0.9964, 1.0548]

                                         Upper respiratory
                                         Cool
                                         Lag 2 IQR: 56.4 RR 1.0569 [1.0339, 1.0803]
                                         Lag 3 IQR: 56.4 RR 1.0318 [1.0095, 1.0545]
                                         Lag avg 7 IQR: 33.84 RR 1.0177 [0.9960, 1.0399]
                                         Warm
                                         Lag 2 IQR: 30.08 RR 1.0150 [0.9881, 1.0426]
                                         Lag 3 IQR: 30.08 RR 1.0425 [1.0157, 1.0699]
                                         Lag avg 7 IQR: 22.56 RR 0.9944 [0.9591, 1.0311]
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                                                                                                                    Pneumonia
                                                                                                                    Cool
                                                                                                                    Lag 2 IQR: 56.4 RR 1.0824 [1.0300, 1.1374]
                                                                                                                    Lag 3 IQR: 56.4 RR 1.0768 [1.0273, 1.1287]
                                                                                                                    Lag avg 7 IQR: 33.84 RR 1.0564 [1.0062, 1.1092]
                                                                                                                    Warm
                                                                                                                    Lag 2 IQR: 30.08 RR 1.1232 [1.0450, 1.2072]
                                                                                                                    Lag 3 IQR: 30.08 RR 1.0029 [0.9332, 1.0779]
                                                                                                                    Lag avg 7 IQR: 22.56 RR 1.1084 [1.0071, 1.2200]
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                            TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                             EMERGENCY DEPARTMENT VISITS
              Reference, Study
              Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant              Effects and Interpretation:
Correlations      Relative Risk & Confidence Intervals (95%)
          LATIN AMERICA (cont'd)
X
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          Lin etal. (1999)
          Sao Paulo, Brazil

          Period of Study: May
          1991 -Apr 1993

          Days: 621
                                    Outcome(s):  Respiratory disease, Upper
                                    respiratory illness, Lower respiratory
                                    illness, Wheezing
                                    ICD-9 Code(s): NR
                                    Age groups analyzed: <13
                                    Study Design: Time-series
                                    # of Hospitals:  1
                                    Statistical Analyses: Gaussian and
                                    Poisson regression
                                    Covariates:  Long-term trend,
                                    seasonality, day of wk, temperature,
                                    humidity
                                    Statistical Package: NR
                                    Lag:  5-day lagged moving avgs
                                 NO2 ug/m :
                                 Mean: 163
                                 SD = 85
                                 Range: 2,688

                                 Number of stations: 3
                         SO2;r = 0.38
                         CO; r= 0.35
                         PM10; r = 0.40
                         O3;r=0.15
                Increment: NR

                All respiratory illness
                NO2 alone: RR 1.003 [1.001, 1.005] 5-day
                moving avg
                NO2 + PM10 + O3 + SO2 + CO:  RR 0.996
                [0.994, 0.998]

                Lower respiratory illness
                NO2 alone: RR 0.999 [0.991, 1.007] 5-day
                moving avg
                NO2 + PM10 + O3 + SO2 + CO:  RR 0.990
                [0.982, 0.998]

                Upper respiratory illness
                N02 alone: RR 1.003 [0.999, 1.007] 5-day
                moving avg
                N02 + PM10 + 03 + S02 + CO:  RR 0.996
                [0.992,1.000]
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                                                                                                                       Wheezing
                                                                                                                       NO2 alone: RR 0.996 [0.990, 1.002] 5-day
                                                                                                                       moving avg
                                                                                                                       N02 + PM10 + 03 + S02 + CO: RR 0.991
                                                                                                                       [0.983,0.999]
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                              TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                                EMERGENCY DEPARTMENT VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
Copollutant             Effects and Interpretation:
Correlations     Relative Risk & Confidence Intervals (95%)
           ASIA
 X
 I
 o
 H
 6
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 H
O
 o
 H
 W
           Kim et al. (2007)
           Seoul, Korea

           Period of Study:  2002
                       Outcome(s) (ICD-10):  Asthma (J45, J46)
                       Age groups analyzed: All
                       Study Design: Case-crossover
                       N:  92,535
                       Statistical Analyses:  Conditional logistic
                       regression
                       Covariates: Time trend, weather conditions,
                       seasonality
                       Statistical Package: NR
                       Lag: 0, 1,2, 3,4, 2-4 ma
                                      24-havg:  36.0 (14.7) ppb   PM10
                                      Range:  2.3-108.0          CO
                                      50th: 34.3                SO2
                                      IQR: 20.1                O3
                                         Increment: 20.1 ppb

                                         Stratified by individual SES:
                                         Highest SES quintile:  1.06 [1.02, 1.10] lag 2-4

                                         2nd Quintile: 1.06 [1.02, 1.09] lag 2-4
                                         3rd Quintile:  1.03 [0.99, 1.06] lag 2-4
                                         4th Quintile:  1.06 [ 1.02, 1.10] lag 2-4
                                         Lowest SES quintile:  1.05 [1.00,  1.10] lag 2-4

                                         Stratified by Regional  SES:
                                         Highest SES quintile:  0.96 [0.90, 1.02] lag 2-4
                                         2nd Quintile: 1.08 [1.04, 1.13] lag 2-4
                                         3rd Quintile:  1.03 [1.00, 1.07] lag 2-4
                                         4th Quintile:  1.06 [ 1.02, 1.10] lag 2-4
                                         Lowest SES quintile:  1.06 [1.02,  1.09] lag 2-4
                                         Overall:  1.05 [1.03, 1.06]

                                         Relative  Effect Modification for Interaction
                                         Terms:
                                         Stratified by individual SES x air pollution:
                                         Highest SES quintile:  1.00 [referent]
                                         2nd Quintile: 0.99 [0.95, 1.04]
                                         3rd Quintile:  0.96 [0.92, 1.01]
                                         4th Quintile:  1.00 [0.95, 1.05]
                                         Lowest SES quintile:  0.99 [0.93,  1.05]

                                         Stratified by Regional  SES x air pollution:
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                             TABLE AX6.3-4 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                               EMERGENCY DEPARTMENT VISITS
    Reference, Study
   Location, & Period
       Outcomes, Design, & Methods
 Mean Levels of NO2 &
  Monitoring Stations
 Copollutant             Effects and Interpretation:
 Correlations     Relative Risk & Confidence Intervals (95%)
           ASIA (cont'd)
X
O
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H
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H
O
O
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W
           Kim et al. (2007)
           (cont'd)
           Sun et al. (2006)
           Central Taiwan
           Period of Study: 2004
Chew etal. (1999)
Singapore

Period of Study:
1990-1994
Outcome(s) (ICD-9): asthma (493)
Age groups analyzed:  <16,16-55
Study Design: Cross-sectional
Number of hospitals: 4
Statistical Analyses: Multiple correlation
coefficients/multiple regression analysis
Covariates:
Statistical Package:  SPSS v 12.0
Lag:

Outcome(s) (ICD-9): Asthma (493)
Age groups analyzed:  3-12,13-21
Study Design: Time-series
N: 23,000
# of Hospitals: 2
Statistical Analyses: Linear regression, GLM
Covariates: Variables that were significantly
associated with ER visits were retained in the
model
Statistical Package:  SAS/STAT, SAS/ETS 6.0
Lag:  l,2daysavgs
                                                                     Number of monitors: 11
24-havg: 18.9 ug/m3,
SD= 15.0,Max<40

# of Stations:  15
                                         Highest SES quintile:  1.00 [referent]
                                         2ndQuintile:  1.11 [1.03,1.20]
                                         3rd Quintile: 1.07 [1.00, 1.15]
                                         4th Quintile: 1.09 [1.02, 1.17]
                                         Lowest SES quintile: 1.09 [1.02, 1.16]

                          SO2            Children:
                          O3             r = 0.72, p = 0.004
                          CO             Adults:
                          PM10           r = 0.428, p = 0.083

                                         Emergency  visits for asthma increased with
                                         increased levels of NO2 for children but not for
                                         adults.
SO2; r = -0.22    Categorical analysis (via ANOVA) p-value and
O3; r = 0.17      Pearson correlation coefficient (r) using
TSP' r = 0 23     continuous data comparing daily air pollutant
                levels and daily number of ER visits

                AgeGroup:3-12    13-21
                LagO    r=0.10  r=0.09
                        p = 0.0019 p< 0.001
                Lagl    r=0.12  r=0.04
                        p < 0.001 p = 0.0014
                Lag 2    r=0.14  r=0.03
                        p < 0.001 p = 0.0066
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                            TABLE AX6.3-4 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:
                                                               EMERGENCY DEPARTMENT VISITS
               Reference, Study
              Location, & Period
Outcomes, Design, & Methods
Mean Levels of NO2 &
 Monitoring Stations
                                                                                                Copollutant             Effects and Interpretation:
                                                                                                Correlations     Relative Risk & Confidence Intervals (95%)
           ASIA (cont'd)
X
 I
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           Hwang and Chan (2002)
           Taiwan

           Period of Study:
           1998
Tanakaetal. (1998)
Kushiro, Japan

Period of Study: 1992-
1993
                                     Outcome(s) (ICD-9): Lower Respiratory
                                     Disease (LRD) (466, 480-6) including acute
                                     bronchitis, acute bronchiolits, pneumonia
                                     Age groups analyzed:  0-14, 15-64, >65, all
                                     ages
                                     Study Design: Time-series
                                     Catchment area:  Clinic records from
                                     50 communities
                                     Statistical Analyses: Linear regression,
                                     GLM
                                     Covariates: Temperature, dew point
                                     temperature, season, day of wk, holiday
                                     Statistical Package:  NR
                                     Lag: 0,1,2 days and avgs
                                     Outcome(s): Asthma
                                     ICD-9 Code(s): NR
                                     Age groups analyzed:  15-79
                                     Study Design:  Time-series
                                     N:  102
                                     # of Hospitals: 1
                                     Statistical Analyses: Poisson regression
                                     Covariates: Temperature, vapor pressure,
                                     barometric pressure, relative humidity, wind
                                     velocity, wind direction at maximal velocity
                                     Statistical Package: NR
                                    24-hr avg:  23.6 ppb,
                                    SD = 5.4, Range:  13.0,34.1
                                                                              NO2 24-h avg
                                                                              9.2 ± 4.6 ppb in fog

                                                                              11.5 ± 5.7 in fog free days

                                                                              Max NO2 24-h avg <30 ppb
                         SO2
                         PM10
                         03
                         CO
                         No correlations
                         for individual
                         pollutants.
                                                                                                                Increment: 10% change in NO2 (natural avg)
                                                                                                                which is equivalent to 2.4 ppb. NOTE: The
                                                                                                                percent change is for the rate of clinic use NOT
                                                                                                                for relative risk for adverse effect.

                                                                                                                Increased clinic visits for lower respiratory
                                                                                                                disease (LRD) by age group
                         Colinearity of     0-14yrs
                         pollutants        1.3% [1.0,1.6] lag 0
                         prevented use of  15-64 yrs
                         multipollutant     1.5% [1.3,1.8] lag 0
                         models           >65 yrs
                                          1.8% [1.4,2.2] lag 0
                                          All ages
                                          1.4% [1.2,1.6] lag 0
                                          Increment:  15 ppb
                                                               N02; r = NR
                                                               S02; r = NR
                                                               SPM (TSP);
                                                               r=0.70
                                                               O3; r = NR
                                          Nonatopic
                                          OR 0.62 [0.45, 0.84]

                                          Atopic
                                          OR 0.81 [0.67,0.97]
           * Default GAM
           +Did not report correction for over-dispersion
           NR: Not Reported
           APHEA: Air Pollution and Health: a European Approach
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                TABLE AX6.3-5. RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN: GENERAL

                                        PRACTITIONER/CLINIC VISITS
X
I

o
H
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o
H
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Reference, Study
Location, & Period
Mean Levels
Outcomes, Design, & Methods & Monitoring Stations
Copollutants
Correlations
Effects:
Relative Risk & Confidence Intervals (95%)
NORTH AMERICA
Sinclair and Tolsma
(2004)
Atlanta, GA

Period of Study:
8/1998-8/2000





Hernandez-Garduno
etal. (1997)
Mexico City, Mexico

Period of Study: May
15, 1992 -January 31,
1993







Outcome(s) (ICD9): Asthma (493), UPJ 1-h max: 51.22 (18.54) ppb
(460-466, 477), LPJ (466.1, 480-486)
Age groups analyzed: <18, >18 Monitors: 1 ARIES monitor in
Study Design: Time-series downtown Atlanta
N: 232,350
Statistical Analyses: Poisson regression
with GLM
Covariates: Season, day of wk, federal
holiday, study month, long-term trend
Statistical Package: SAS v 8.02
Lag: 0-2,3-5,6-8
Outcome(s): Respiratory illness Number of Stations: 5
ICD9: NR
Age groups analyzed: <15, 15+,
all ages (0-92)
Study Design: Time-series
N: 24,113
Number of Clinics: 5
Statistical Analyses: Cross-correlation,
linear regression and autoregressive error
model analyses
Covariates: Long-term trend, day of wk,
temperature, humidity
Statistical Package: SAS
Lag: 0-6
PM2.5,
PM10-2.5
PM10
PM2.5
components
PMuf
Polar VOCs
03
SO2


S02
03
CO
NOX










No NO2 results presented because they were not
statistically significant for any lag periods
examined.








Increment: Maximum NO2 concentration of all
days-MeanNO2 concentration of all days

<14 yrs:
NO2lagO: RR 1.29 ±0.09 (p< 0.01)
NO2lag6: RR 1.18 ± 0.09 (p> 0.05)

15+ yrs:
NO2lagO: RR 1.14 ± 0.07 (p< 0.05)
NO2lag6: RR 1.10 ± 0.06 (p> 0.05)

All ages:
NO2lagO: RR 1.43 ± 0.15 (p< 0.01)
NO2lag6: RR 1.29 ± 0.15 (p> 0.05)
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                  TABLE AX6.3-5 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:  GENERAL
                                                          PRACTITIONER/CLINIC VISITS
Reference, Study
Location, & Period Outcomes, Design, & Methods
Mean Levels
& Monitoring Stations
Copollutants
Correlations
Effects:
Relative Risk & Confidence Intervals

(95%)
NORTH AMERICA (cont'd)
Villeneuve et al. Outcome(s) (ICD9): Allergic Rhinitis
(2006) (177)
Toronto, ON, Canada Age groups analyzed: >65
Study Design: Time-series
Period of Study: N: 52,691
1995-2000 Statistical Analyses: GLM, using natural
24-h avg: 25.4 ppb,
SD = 7.7
IQR: 10.3 ppb,
Range 9.2, 71.7

Number of stations: 9
SO2
03
CO
PM2.5
PMiQ-2 5
PM10
Increment: 10.3 ppb (IQR)

All results estimated from Stick Graph:

All Yr:
Mean Increase: 1.9% [-0.2, 3.8] lag 0






          Days: 2,190
splines (more stringent criteria than
default)
Covariates: Day of wk, holiday,
temperature, relative humidity,
aero-allergens
Season: All yr; Warm, May-Oct;
Cool, Nov-Apr
Statistical Package: S-Plus
Lag: 0-6
Warm:
Mean Increase:  0.1% [-3.2, 3.8] lag 0

Cool:
Mean Increase:  1.4% [0.0, 5.9] lag 0
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                      TABLE AX6.3-5 (cont'd).  RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN: GENERAL
                                                                   PRACTITIONER/CLINIC VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
Copollutants
Correlations
                Effects:
Relative Risk & Confidence Intervals (95%)
           EUROPE
X
Oi
O
Oi
H
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H
O
O
H
W
O
HH
H
W
           Hajatetal. (1999)
           London, United
           Kingdom

           Period of Study:  1992-
           1994
                     Outcome (ICD9): Asthma (493); Lower
                     respiratory disease (464, 466,476, 480-3,
                     490-2, 485-7, 4994-6, 500, 503-5, 510-5)
                     Age groups analyzed: 0-14; 15-64; 65+;
                     all ages
                     Study Design: Time-series analysis
                     Statistical Analysis:  Poisson regression,
                     APHEA protocol
                     Covariates:  Long-term trends, seasonality,
                     day of wk, temperature, humidity
                     Seasons:  Warm, Apr-Sep; Cool, Oct-Mar;
                     Allyr
                     Dose-response investigated?: Yes
                     Statistical package:  SAS
                     Lag: 0-3 days, cumulative
                                  All yr 24-h avg: 33.6ppb,
                                  SD= 10.5

                                  Warm:  32.8(19.8)
                                  Cool: 34.5(10.1)

                                  10th-90th all yr percentile:
                                  24ppb
                         SO2;r = 0.61    Increment: 24 ppb (90th-10th percentile)
                         BS; r = 0.70     Asthma
                         CO; r = 0.72    All ages 2.1% [-0.7, 4.9] lag 0; 3.1%
                         PM10;r=0.73   [-0.4, 6.7] lag 0-1
                         O3;r= -0.10    0-14 yrs 6.1% [1.2, 11.3] lag 1;6.9%
                                        [1.7, 12.4] lag 0-1
                                        Warm: 13.2% [5.6, 21.3] lag 1
                                        Cool:  -0.1% [-6.3, 6.5] lag 1
                                        15-64 yrs 3.0% [-0.7, 6.7] lag 0; 3.1%
                                        [-1.6, 7.9] lag 0-3
                                        Warm: 3.3% [-2.0, 8.9] lag 0
                                        Cool:  2.6% [-2.3, 7.7] lag 0
                                        65+ yrs 9.9% [1.6, 18.7] lag 2; 5.3%
                                        [-3, 14.3] lag 0-3
                                        Warm: 18.6% [6.3, 32.4] lag 2
                                        Cool:  -0.5% [-9.6,11.8] lag 2
                                        Lower Respiratory disease
                                        All ages 1.3% [-0.4, 3.0] lag 1; 1.2%
                                        [-0.7, 3.1] lag 0-2
                                        0-14 yrs 4.8% [1.3, 8.3] lag 2; 4.5%
                                        [0.4, 8.7] lag 0-3
                                        Warm: 1.4% [-3.8, 6.9] lag 2
                                        Cool:  7.2% [2.8, 11.6] lag 2
                                        15-64 yrs 1.1% [-1.1, 3.4] lag 2; 0.8% [-1.8, 3.5] lag 0-2
                                        Warm: 2.3% [-1.2, 5.9] lag 2
                                        Cool:  0.2% [-2.6, 3.1] lag 2
                                        65+-1.7% [-4.3, 1.1] lag 0
                                        Warm: -1.7% [-5.9, 2.6] lag 0
                                        Cool:  -1.6% [-4.8,1.8]lagO
                                        Two-pollutant model-Asthma
                                        NO2 alone:  5.2% [0.8, 9.8]
                                        N02/03: 6.7% [2.2, 11.4]
                                        NO2/SO2:  3.9% [-1.2, 9.2]
                                        NO2/PM10:  5.3% [-0.6, 11.6]

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                      TABLE AX6.3-5 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:  GENERAL
                                                                  PRACTITIONER/CLINIC VISITS
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
Copollutants
Correlations
                Effects:
Relative Risk & Confidence Intervals (95%)
           EUROPE (cont'd)
           Hajatetal. (1999)
           (cont'd)
                                                                                                      Two-pollutant model - Lower Respiratory disease
                                                                                                      NO2 alone 4.2% [1.1, 7.3]
                                                                                                      N02/034.9%[1.8,8.2]
                                                                                                      N02/S022.5%[-1.1,6.2]
                                                                                                      N02/PM103.5%[0.1,6.9]
X
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H
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           Hajat*etal. (2001)
           London, United
           Kingdom

           Period of Study:
           1992-1994
                     Outcome (ICD9): Allergic Rhinitis (477)
                     Age groups analyzed: 0-14;  15-64; 65+;
                     all ages
                     Study Design: Time-series analysis
                     N:  4,214
                     Statistical Analysis: Poisson regression,
                     GAM
                     Covariates: long-term trends, seasonality,
                     day of wk, temperature, humidity,
                     variation in practice population, counts for
                     lagged allergic pollen measures, daily
                     number of consultations for influenza
                     Dose-response investigated?  Yes
                     Statistical package: S-Plus
                     Lag: 0-6 days, cumulative
                                  NO224-havg: 33.6ppb,
                                  SD=10.5

                                  # of Stations: 3,
                                  r= 0.7-0.96
                         SO2;r = 0.61
                         BS;r=0.70
                         CO; r= 0.72
                         PM10;r=0.73
                         O3;r=-0.10
              Increment:  24 ppb (90th-10th percentile)

              Single-pollutant model
              <\ to 14 yrs
              11.0% [3.8, 18.8] lag 4
              12.6% [4.6, 21.3] lag 0-4
              15 to 64 yrs
              5.5% [2.0, 9.1] lag 6
              11.1% [6.8, 15.6] lag 0-6
              >64 yrs - too small for analysis

              Two-pollutant models
              
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                   TABLE AX6.3-5 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN: GENERAL
                                                               PRACTITIONER/CLINIC VISITS
              Reference, Study
             Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
Copollutants
Correlations
                Effects:
Relative Risk & Confidence Intervals (95%)
           EUROPE (cont'd)
X
O
oo
           Hajat*etal. (2002)
           London, United
           Kingdom

           Period of Study:
           1992-1994
                                  Outcome (ICD9): Upper Respiratory
                                  Disease, excluding Rhinitis (460-3, 465,
                                  470-5, 478)
                                  Age groups analyzed:  0-14; 15-64; 65+;
                                  all ages
                                  Study Design: Time-series analysis
                                  Statistical Analysis: Poisson regression,
                                  GAM
                                  Covariates: Long-term trends, seasonality,
                                  day of wk, holidays, temperature,
                                  humidity, variation in practice population,
                                  counts for lagged allergic pollen measures,
                                  daily number of consultations for influenza
                                  Seasons: Warm: Apr-Sep;
                                  Cool:  Oct-Mar
                                  Dose-response investigated?: Yes
                                  Statistical package: S-Plus
                                  Lag: 0,1,2,3 days
                                  NO224-havg:  33.6ppb,
                                  SD= 10.5

                                  Warm: (Apr-Sep)
                                  Mean:  32.8ppb,
                                  SD=10.1

                                  Cool:  (Oct-Mar)
                                  Mean:  34.5 ppb,
                                  SD= 10.1

                                  # of Stations: 3
                         SO2;r = 0.61
                         BS;r=0.70
                         CO; r= 0.72
                         PM10;r=0.73
                         03;r=-0.10
               Increment (90th-10th percentile): All yr: 24 ppb;
               Warm season:  25.8 ppb;
               Cool season: 22.1 ppb

               Single-pollutant model
               Allyr
               0-14 yr 2.0% [-0.3, 4.3] lag 3
               15-64 yrs 5.1% [2.0, 8.3] lag 2
               >65 yrs 8.7% [3.8, 13.8] lag 2

               Warm
               0-14 yrs 2.5% [-0.9, 6.1] lag 3
               15-64 yrs 6.7% [3.7, 9.8] lag 2
               >65 yrs 6.6% [-1.1,14.9] lag 2
               Cool
               0-14 yrs 1.7% [-1.1, 4.6] lag 3
               15-64 yrs 1.2% [-1.3, 3.9] lag 2
               >65 yrs 9.4% [2.8, 16.4] lag 2
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                                                                                                                   Two-pollutant models
                                                                                                                   0-14 yrs
                                                                                                                   NO2&O3:  1.7% [-0.6, 3.9]
                                                                                                                   N02 & S02: 2.2% [-0.4, 5.0]
                                                                                                                   N02&PM10: 1.5% [-1.7, 4.8]
                                                                                                                   For 15-64 yrs
                                                                                                                   NO2&O3:  4.4% [2.2, 6.8]
                                                                                                                   N02&S02: 4.4% [1.6, 7.2]
                                                                                                                   NO2 & PM10: 2.7% [-0.5, 5.9]
                                                                                                                   For >65 yrs
                                                                                                                   NO2&O3:  8.1% [3.0, 13.6]
                                                                                                                   NO2&SO2: 8.6% [2.1,15.4]
                                                                                                                   NO2&PM10: 4.3% [-2.8, 11.8]

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                   TABLE AX6.3-5 (cont'd). RESPIRATORY HEALTH EFFECTS OF OXIDES OF NITROGEN:  GENERAL
                                                               PRACTITIONER/CLINIC VISITS
   Reference, Study
  Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
Copollutants
Correlations
                Effects:
Relative Risk & Confidence Intervals (95%)
           EUROPE (cont'd)
X
O
VO
           Chardon et al. (2007)
           Greater Paris, France

           Period of Study:
           2000-2003
                       Outcome (ICD9): Asthma, URD, LRD
                       Age groups analyzed:  0-14; 15-64; 65+;
                       all ages
                       Study Design:  Time-series analysis
                       Statistical Analysis: Poisson regression,
                       GAM
                       Covariates: Long-term trends, seasonality,
                       day of wk, holidays, temperature,
                       humidity, counts for lagged allergic pollen
                       measures, daily number of consultations
                       for influenza
                       Seasons: Warm: Apr-Sep;
                       Cool: Oct-Mar
                       Dose-response investigated?: Yes
                       Statistical package: R software
                       Lag: 0,1,2, 3,0-1,0-2, 0-3 days	
                                  24-h avg: 44.4 (14.92) ug/m3
                                  Median: 43.6
                                  IQR:  33.7-53.2
                                  Range:  12.3-132.8
                                  Number of monitors: 12-15
                          PM10;r = 0.68
                          PM2.5; r = 0.68
              Increment: 10 ug/m

              URD: 0.7% [-0.9,2.3] lag 0-3
              LRD: 1.1% [-0.7, 2.9], lag 0-3
              Asthma: -0.3% [-3.3, 2.7], lag 0-3
* Default GAM
+ Did not report correction for over-dispersion
NR: Not Reported
APHEA: Air Pollution and Health: a European Approach
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                 TABLE AX6.3-6. HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants    Effects: Relative Risk or Percent Change &
(Correlations)   Confidence Intervals ([95% Lower, Upper])
X
           Burnett etal. (1997a)
           Metropolitan Toronto
           (Toronto, North York,
           East York, Etobicoke,
           Scarborough, York),
           Canada

           Study period:
           1992-1994, 388 days,
           summers only
                      Outcome(s) (ICD9): IHD
                      410-414; Cardiac Dysrhythmias 427;
                      Heart failure 428. All Cardiac 410-414,
                      427,428. Obtained from hospital
                      discharge data.
                      Population:  2.6 Million residents
                      Study design:  Time-series
                      Age groups analyzed: all
                      # Hospitals: NR
                      Statistical analysis: relative risk
                      regression models, GEEs.
                      Covariates:  Adjusted for long-term
                      trends, seasonal and subseasonal
                      variation, day of the wk, temperature,
                      dew point
                      Seasons:  Summer only
                      Dose response: Figures presented
                      Statistical package: NR
                      Lag:  1-4 days
                                  NO2 daily 1 -h max (ppb):         H+ (0.25)
                                  Mean:  38.5                     SO4(0.34)
                                  CV: 29                        TP(0.61)
                                  Min: 12                        FP (0.45)
                                  25th percentile:  31               CP(0.61)
                                  50th percentile:  38               COH(0.61)
                                  75th percentile:  45               O3 (0.07)
                                  Max: 81                        SO2 (0.46)
                                                                 CO (0.25)
                                  # of Stations:  6-11

                                  (Results are reported for
                                  additional metrics including
                                  24-h avg and daytime avg (day))
                                           Results reported for RR for an IQR increment
                                           increase in NO2. T ratio in parentheses.

                                           All Cardiac Disease
                                           Single-pollutant model
                                           1.049 (3.13), daily avg over4 days, lag 0

                                           Multipollutant model
                                           1.30 (1.68), w/N02,03, S02,

                                           Objective of study was to evaluate the role of
                                           particle size and chemistry on cardio and
                                           respiratory diseases. NO2 attenuated the effect
                                           of particulate in this study.
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants    Effects: Relative Risk or Percent Change &
(Correlations)   Confidence Intervals ([95% Lower, Upper])
X
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           Burnett etal. (1999)*
           Metropolitan Toronto
           (Toronto, North York,
           East York, Etobicoke,
           Scarborough, York),
           Canada

           Study Period:
           1980-1995, 15 yr
                      Outcome(s) (ICD9): IHD
                      410-414; Cardiac Dysrhythmias 427;
                      Heart failure 428; All Cardiac 410-414,
                      427, 428; Cerebrovascular Disease
                      Obtained from hospital discharge data
                      430-438; Peripheral Circulation Disease
                      440-459.
                      Population: 2.13-2.42 million residents
                      Study Design: Time-series
                      Statistical Analysis: GAMs with LOESS
                      smoothers to remove temporal and
                      weather related trends, stepwise
                      regression used to select minimum
                      number of air pollutants in multipollutant
                      models.
                      Covariates:  Long-term trends, seasonal
                      variation, day of wk, temperature,  and
                      humidity.
                      Statistical Package:  SPLUS, SAS
                      Lag(s):  0-2 day
                                  NO2 daily avg (ppb)
                                  Mean:  25.2
                                  5th percentile:  13
                                  25th percentile:  19
                                  50th percentile:  24
                                  75th percentile:  30
                                  95th percentile:  42
                                  Max: 82

                                  Multiple day avgs used in
                                  models
                           PM2.5 (0.50)
                           PM10-2.5 (0.38)
                           PM10 (0.52)
                           CO (0.55)
                           SO2 (0.55)
                           O3(-0.04)
               Results reported for % increase in hospital
               admissions for an increment increase in NO2
               equal to the mean value.

               Single-Pollutant Models:
               Dysrhythmias: 5.33 (1.73) 3-day avg, lag 0
               Heart Failure: 9.48 (6.33), 1 day, lag 0
               IHD: 9.73 (8.4) 2-day avg, lag 0
               Cerebrovascular disease:  1.98 (1.34), 1 day,
               lagO
               Peripheral circulation: 3.57(1.78), 1-day,
               lagO

               Multipollutant Models:
               Heart failure
               6.89 (w/CO)
               6.68 (w/ CO, PM2.5)
               6.33(w/CO,PM2.5,PM10-2.5)
               6.45 (w/ CO, PM2.5, PMio-2.5, PM10)
               IHD
               8.34 (w/CO, SO2)
               7.76 (w/ CO, S02, PM2.5)
               8.41 (w/ CO, SO2, PM2 5, PM10-2.5)
               8.52 (w/ CO, SO2, PM2.5, PMio-2.5, PM10)

               In multipollutant models, gaseous pollutants
               were selected by stepwise regression. PM
               variables were then added to the model.
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                         AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants    Effects: Relative Risk or Percent Change &
(Correlations)   Confidence Intervals ([95% Lower, Upper])
           Morris etal. (1995)
           US (Chicago, Detroit,
           LA, Milwaukee, NYC,
           Philadelphia)

           Study Period:
           1986-1989, 4 yr
                      Outcome(s) (ICD9):  CHF 428.
                      Daily Medicare hospital admission
                      records.
                      Study Design:  Time-series
                      Statistical Analyses:  GLM, negative
                      binomial distribution
                      Age groups analyzed: >65 yrs
                      Covariates: Temperature, indicator
                      variables for mo to adjust for weather
                      effects and seasonal trends, day of wk, yr
                      Statistical Software:  S-PLUS
                      Lag(s):  0-7 day
                                  NO2 1 h-max (ppm)
                                  Mean: (SD)
                                  LA: 0.077(0.028)
                                  Chicago: 0.045(0.013)
                                  Philadelphia:  0.054 (0.017)
                                  New York: 0.064(0.022)
                                  Detroit: 0.041 (0.015)
                                  Houston: 0.041 (0.017)
                                  Milwaukee: 0.040(0.014)
                           SO2 1 -h max     Results reported for RR of admission for CHF
                           O3 1-h max      associated with an incremental increase in NO2
                           COl-hmax     oflOppb.

                           Correlations of   CHF:
                           N02 with other   LA:  1.15(1.10,1.19)
                           pollutants       Chicago: 1.17(1.07,1.27)
                           strong.          Philadelphia:  1.03(0.95,1.12)
                                           New York:  1.07(1.02,1.13)
                           Multipollutant   Detroit:  1.04(0.92,1.18)
                           models run.      Houston: 0.99(0.88,1.10)
                                           Milwaukee:  1.05 (0.89, 1.23)
 X
                                                                                                            RR diminished in multipollutant models
                                                                                                            (4 copollutants) for all cities with the exception
                                                                                                            of New York.
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           Dales et al (2006)
           Canada (11 largest
           cities)

           Study period: January 1,
           1986-December 31,
           2000.
                      Outcomes (ICD-9): Asphyxia (799.0),
                      respiratory failure (799.1), dyspnea and
                      respiratory abnormalities (786.0),
                      respiratory distress syndrome (769),
                      unspecificed birth asphyxia in live-born
                      infant (768.9), other respiratory problems
                      after birth (770.8) and pneumonia (486)
                      Data from: Canaidian Institutue for
                      Health Information:
                      9542 records for patients aged birth to 27
                      days
                      Study Design:  Time series
                      Statistical analysis:  Random-effects
                      regression model
                      Statitsitical Software: S-PLUS
                                  NO2 24-hour mean levels (ppb):
                                  Calgary: 25.6
                                  Edmonton: 24.6
                                  Halifax:  15.1
                                  Hamilton: 20.8
                                  London: 20.0
                                  Ottawa: 21.2
                                  Saint John: 9.2
                                  Toronto: 25.1
                                  Vancouver:  19.0
                                  Windsor:  24.9
                                  Winnipeg:  15.2
                                  Population weighted avg:  21.8
                           Range of
                           Pearson
                           pairwise
                           correlations
                           PM10: -0.26
                           to 0.69
                           O3: -0.55 to
                           0.05
                           SO2: 0.20 to
                           0.67
                           CO: 0.13 to
                           0.76
                Pooled estimate of % increase in neonatal
                resipartory hospital admissions (95% CI):

                Interquartile range: 10.0
                Single pollutant model: 2.94 (1 .93 to 3.95)
                Multi pollutant model: 2.85 (1.68 to 4.02)
                Multipollutant model restricted to days with
                PM10 measures: 2.48 (1.18 to 3.80)
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                         AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants    Effects: Relative Risk or Percent Change &
(Correlations)   Confidence Intervals ([95% Lower, Upper])
X
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           Wellenius et al. (2005b)
           Birmingham, Chicago,
           Cleveland, Detroit,
           Minneapolis, New
           Haven, Pittsburgh,
           Seattle

           Study Period:
           Jan 1986-Nov 1999
           (varies slightly
           depending on city)
                      Outcome(s) IS, primary diagnosis of
                      acute but ill-defined cerebrovascular
                      disease or occlusion of the cerebral
                      arteries; HS, primary diagnosis of
                      intracerebral hemorrhage. ICD codes not
                      provided. Hospital admissions
                      ascertained from the Centers for
                      Medicare and Medicaid Services. Cases
                      determined from discharge data were
                      admitted from the ER to the hospital.
                      NIS: 155,503
                      NHS:  19,314
                      Study Design: Time-stratified Case-
                      crossover. Control days chosen such that
                      they fell in same mo and same day of wk.
                      Design controls for seasonality, time
                      trends, chronic and other slowly varying
                      potential confounders.
                      Statistical Analysis: 2-stage hierarchical
                      model (random effects), conditional
                      logistic regression for city effects in the
                      first stage.
                      Software package: SAS
                      Covariates:
                      Lag(s):  0-2, unconstrained distributed
                      lags
                                  NO2 24-h (ppb)
                                  10th: 13.71
                                  25th: 18.05
                                  Median:  23.54
                                  75th: 29.98
                                  90th: 36.54

                                  NO2 data not available for
                                  Birmingham, Salt Lake, and
                                  Seattle.
                           PM10 (0.53)
                           CO, S02

                           Correlation
                           only provided
                           forPM
                           because study
                           hypothesis
                           involves PM
               Results reported for percent increase in stroke
               admissions for an incremental increase in NO2
               equivalent to one IQR (11.93).

               Ischemic Stroke: 2.94 (1.78, 4.12), lag 0
               Hemorrhagic Stroke: 0.38 (-2.66, 3.51), lag 0

               Multipollutant models not run.
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           TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                      AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants    Effects: Relative Risk or Percent Change &
(Correlations)    Confidence Intervals ([95% Lower, Upper])
           Fung etal. (2005)
           Windsor, Ontario,
           Canada

           Study Period:
           Apr 1995-Jan 2000
                     Outcome(s) (ICD9): CHF 428;
                     IHD 410-414; dysrhythmias 427.
                     Hospital admissions from Ontario Health
                     Insurance Plan records.
                     Study Design: Time-series
                     Statistical Analysis:  GLM
                     N:  11,632 cardiac admission, 4.4/day for
                     65+ age group
                     Age groups analyzed: 65+, <65 yr
                     Statistical Software: SPLUS
                     Lag(s): lag 0, 2, 3 day avg
                                 NO2 l-hmax(ppb):
                                 Mean(SD):  38.9(12.3)
                                 Min:  0
                                 Max:  117
                          SO2 (0.22)
                          CO (0.38)
                          O3 (0.26)
                          COH(0.39)
                          PM10 (0.33)
               Results expressed as percent change associated
               with an incremental increase in NO2 equivalent
               totheIQR(16ppb)

               Cardiac:
               <65 age group:
               0.7 (-5.5, 6.6)
               2.1 (-3.7, 8.2)
               3.7 (-2.9, 10.7)
               65+ age group:
               0.8 (-2.2, 3.9), lag 0
               0.9 (-2.7, 4.6), 2-day avg (lag 0-1)
               0.8 (-3.3, 5.0), 3-day avg (lag 0-2)
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                                                                                                       Effect for NO2 not observed in these data.
                                                                                                       Association of SO2 with cardiac admissions
                                                                                                       observed.
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            TABLE AX6.3-6 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                       AND VISITS:  UNITED STATES AND CANADA
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Reference, Study
Location, & Period
Linn et at (2000)
Metropolitan Los
Angeles, USA
Outcomes, Design, & Methods
Outcome(s): All Patient Refined
Diagnosis Related Groups (based on
medicare diagnosis related groups).
Mean Levels
& Monitoring Stations
NO2 24-h (ppm)
Winter
Copollutants
(Correlations)
CO (0.84, 0.92)
O3 (-0.23, 0.11)
PM10 (-0.67, 0.8)
Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported as increase % increase in
admission for a 10 ppb increase in NO2. SD in
parentheses.
           Study Period:
           1992-1995
CVD APR-DRG 103-144;
Cerebrovascular APR-DRG 14-17 and
22; CHF APR-DRG 127; MI APR-DRG
111, 115,121; cardiac ARR APR-DRG
138; Occlusive Stroke APR-DRG 14.
Hospital admission records used to
ascertain cases.
Study Design: Time-series
Statistical Analyses: Poisson regression,
cubic spline smooth on time, indicator
variables to adjust for temperature and
rain.
Covariates:  Day of wk, holidays, long-
term trend, seasonal variation,
temperature, humidity
Lag(s): 0-1
Seasons: Winter, Spring, Summer,
Autumn
Statistical Software: SPSS, SAS
Mean: (SD) 3.4 (1.3)
Range: 1.1,9.1
Spring
Mean(SD): 2.8(0.9)
Range: 1.1,6.1
Summer
Mean(SD): 3.4(1.0)
Range: 0.7,6.7
Autumn
Mean(SD): 4.1(1.4)
Range: 1.6,8.4
Range in correlations
depends on the season,
independent effects of
pollutants could not be
distinguished.

# Stations: 6+
CVD, lag 0
All Seasons:  1.4(0.2)
Winter:  1.6(0.4)
Spring: 0.1 (0.6)
Summer:  1.1 (0.5)
Autumn:  1.4(0.3)
Cerebrovascular, lag 0
All Seasons:  0.4(0.4)
Winter:  -1.3(0.7)
Spring: 4.2(1.2)
Summer:  0.9(1.2)
Autumn:  0.7(0.6)
MI, lag 0 (yr round)
1.1(0.5)
CHF, lag 0 (yr round)
1.0 (0.5), winter 1.9 (0.9)
Cardiac Arrhythmia, lag 0
(yr round)
0.6(0.5)
Occlusive stroke, lag 0
(yr round)
2.0 (0.5), winter 2.7 (1.0), autumn 0.1 (0.05)
Significant effects observed in fall for occlusive
stroke and winter for CHF.
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            TABLE AX6.3-6 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                        AND VISITS: UNITED STATES AND  CANADA
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Reference, Study
Location, & Period
Lippmann et al. (2000*;
reanalysis Ito, 2003,
2004)
Windsor Ontario
(near Detroit MI)

Study period:
1992- 1994 (hospital
admissions - mortality
study spanned longer
period)




Outcomes, Design, & Methods
Outcome(s): IHD 410-414; dysrhythmias
427; heart failure 428; stroke 431-437.
Study Design: Time-series
Statistical Analysis: Poisson regression
GAM. Results of reanalysis by Ito 2003,
2004 with GLM are presented.
Lag(s): 0-3 day








Mean Levels Copollutants
& Monitoring Stations (Correlations)
NO2 24-h avg (ppb)
5th %:
25th %:
50th %:
75th %:
95th %:
Mean:








11
: 16
: 21
: 26
: 36
21.3








PM10 (0.49)
PM2.5 (0.48)
PM10-2.5 (0.32)
1^(0.14)
SO4(0.35)
03(0.14)
SO2 (0.53)
CO (0.68)







Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported for RR for incremental increase
in NO2 of 5th to 95th percentile (28 ppb).

IHD
(0.94, 1.10), lag 0
0.98(0.90, 1.06), lag 1
Dysrhythmias
0.98(0.86, 1.12), lag 0
1.03(0.90, 1.06), lag 1
Heart Failure
1. 00 (0.91, 1.09), lag 0
1.07(0.98, 1.17), lag 1
Stroke
0.99(0.90, 1.09), lag 0
0.98(0.89, 1.08), lag 1
           Mann et al. (2002)
           South coast air basin of
           CA, U.S.

           Study Period:
           1988-1995, Syr
Outcome(s) IHD 410-414; or IHD with
accompanying diagnosis of CHF 428; or
Arrhythmia 426, 427; Ascertained
through health insurance records.
Study Design: Time-series
N: 54,863 IHD admissions
Age groups analyzed:  <40; 40-59; >60.
Statistical Analysis: Poisson regression,
GAM with cubic splines, results pooled
across air basins using inverse variance
weighting as no evidence of
heterogeneity was observed.
Covariates: study day, temperature,
relative humidity, day  of wk.
Lag(s): 0-2, 2-4 day moving avg
Software:  SPLUS
Seasons:  Some analyses restricted to
Apr-Oct
NO2 24-h avg (ppb):
Exposure assigned for each
air basin based on health
insurance participant's zip
code.

Mean(SD): 37.2(15.7)
Range: 3.69, 138
Median: 34.8

# Stations: 25-35
O3 8 h-max
(-0.16,0.54)
CO 8-h max
(0.64, 0.86)
PM10 24-h avg
(0.36, 0.60)

Range depends on
air basin.

No multipollutant
models run.
Traffic pollution
generally
implicated in
findings.
Results reported for percent increase in
admissions for a 10-ppb incremental increase in
NO2.

All IHD:  1.68(1.08,2.28), lag 0
MI: 1.04(1.05, 3.02), lag 0
Other acute IHD:  1.75 (0.72, 2.78), lag 0
IHD w/ secondary diagnosis of Arrhythmia:
1.81 (0.78, 2.85), lag 0
IHD w/ secondary diagnosis of CHF:
2.32(0.69, 3.98), lag 0
IHD w/ no secondary diagnosis:
0.46 (-0.81, 1.74), lag 0

Effect of secondary diagnosis strongest in the
40-59 age group.
Group with secondary CHF may be sensitive
subpopulation or their vulnerability may be due
to greater prevalence of MI as the primary
diagnosis.

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            TABLE AX6.3-6 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
X
           Metzger et al. (2004)
           Atlanta, GA

           Period of Study: Jan
           1993-Aug312000,4yr
                      Outcome(s): IHD 410-414; AMI 410;
                      Dysrhythmias 427; cardiac arrest 427.5;
                      congestive heart failure 428; peripheral
                      and cerebrovascular disease 433-437,
                      440, 443-444,451-453; atherosclerosis
                      440; stroke 436. ED visits from billing
                      records.
                      N: 4,407,535 visits, 37 CVD visits/day
                      # Hospitals:  31
                      Age groups analyzed: Adults >19,
                      elderly 56+
                      Statistical Analysis: Poisson regression,
                      GLM. Sensitivity analyses using GEE
                      and GAM (strict convergence criteria)
                      Covariates: long-term trends, mean and
                      dew point temp, relative humidity (cubic
                      splines)
                      Statistical Software:  SAS
                      Season: Warm: Apr 15-Oct 14;
                      Cool: Oct 15-Apr  14.
                      Lag(s): 0-3 day
                                  NO2 1-h max (ppb):
                                  Median: 26.3
                                  10th-90thpercentile
                                  Range: 25,68
                         PM10 24 h (0.49)
                         O3 8-h max (0.42)
                         SO2 (0.34)
                         CO Ih (0.68)

                         1998-2000 Only
                         PM2.5 (0.46)
                         Course PM (.46)
                         Ultrafme PM (.26)
                         Water-soluble
                         metals (.32)
                         Sulfates(.17)
                         OC (0.63)
                         EC (.37)
                         OHC (0.3)

                         Multipollutant
                         models used. All
                         models specified
                         a priori.
                 Results presented for RR of an incremental
                 increase in 1-h max NO2 equivalent to 20 ppb
                 (1 SD).

                 All CVD:  1.025(1.012,1.039)
                 Dysrhythmia: 1.019 (0.994, 1.044)
                 CHF: 1.010(0.981,1.040)
                 IHD:  1.029(1.005,1.053)
                 PERI:  1.041(1.013,1.069)
                 Finger wounds:  1.010(0.993,1.027)

                 Lag is 3-day moving avg for results above.

                 NO2 effect was generally attenuated in two
                 pollutant models. The attenuation was strongest
                 in the period after 1998.
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                       AND VISITS: UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants      Effects:  Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
X
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           Moolgavkar
           (2000a,b,c)*
           Cook County, IL,
           Los Angeles County,
           CA,
           Maricopa County, AZ

           1987-1995
                      Outcome(s) (ICD9):  CVD
                      390-429; Cerebrovascular disease
                      430-448. Hospital admissions from CA
                      department of health database.
                      Age groups analyzed: 20-64, 65+ yrs
                      Study Design: Time-series
                      N:  118 CVD admissions/day
                      # Hospitals:  NR
                      Statistical Analysis:  Poisson regression,
                      GAM
                      Covariates: Adjustment for day of wk,
                      long-term temporal trends, relative
                      humidity, temperature
                      Statistical Package: SPLUS
                      Lag: 0-5 days
                                  NO2 24-h avg (ppb)
                                  Cook County:
                                  Min:  7
                                  Ql:  20
                                  Median:  25
                                  Q3:  30
                                  Max: 58

                                  N02 24-h avg (ppb) LA
                                  County:
                                  Min:  10
                                  Ql:  30
                                  Median:  38
                                  Q3:  48
                                  Max: 102

                                  NO2 24-h avg (ppb)
                                  Maricopa County:
                                  Min:  2
                                  Ql:  14
                                  Median:  19
                                  Q3:  26
                                  Max: 56
                         PM10 (0.22-0.70)
                         PM2.5 (0.73)
                         (LA only)
                         CO (0.63-0.80)
                         SO2 (0.02- 0.74)
                         O3 (-0.23-0.02)

                         Two-pollutant
                         models (see results)
                 Results reported for percent change in hospital
                 admissions per 10-ppb increase in 24-h avg
                 NO2.  T statistic in parentheses.

                 CVD, 65+:
                 Cook County
                 2.9 (10.2), lag 0
                 2.3 (6.7), lag 0, two-pollutant model (PM10)
                 2.9 (8.1), lag 0, two-pollutant model (CO)
                 2.8 (8.8), lag 0, two-pollutant model (SO2)

                 LA County
                 2.3 (16.7), lag 0
                 -0.1 (-0.5), lag 0, two-pollutant model (CO)
                 1.7 (8.0), lag 0, two-pollutant model (SO2)

                 Maricopa County
                 2.9(4.1), lag 0
                 -0.3 (-0.3), lag 0, two-pollutant model (CO)
                 2.6 (3.6), lag 0, two-pollutant model (SO2)

                 Cerebrovascular Disease, 65+:
                 Cook County
                 1.6(3.6)
                 LA County
                 1.1(5.7)

                 Effect size generally diminished with increasing
                 lag time.  Increase in hospital admissions
                 (1.3 for CVD and 1.9 for Cerebrovascular) also
                 observed for the 20-64 age group.
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                       AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
    Mean Levels
& Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
X
           Moolgavkar (2003)*
           Cook County, IL,
           Los Angeles County, CA,
           Maricopa County, AZ

           1987-1995
                      Outcome(s) (ICD9):  CVD
                      390-429; Cerebrovascular disease
                      430-448 was not considered in the
                      reanalysis.  Hospital admissions from CA
                      department of health database.
                      Age groups analyzed:  20-64, 65+ yrs
                      Study Design: Time-series
                      N: 118 CVD admissions/day
                      # Hospitals: NR
                      Statistical Analysis: Poisson regression,
                      GAM with strict convergence criteria
                      (10-8), GLM using natural splines
                      Covariates: Adjustment for day of wk,
                      long-term temporal trends, relative
                      humidity, temperature
                      Statistical Package: SPLUS
                      Lag:  0-5 days
                                 NO2 24-h avg (ppb)
                                 Cook County:
                                 Min:  7
                                 Ql: 20
                                 Median:  25
                                 Q3: 30
                                 Max: 58
                                 NO2 24-h avg (ppb)
                                 LA County:
                                 Min:  10
                                 Ql: 30
                                 Median:  38
                                 Q3: 48
                                 Max: 102

                                 NO2 24-h avg (ppb)
                                 Maricopa County:
                                 Min:  2
                                 Ql: 14
                                 Median:  19
                                 Q3: 26
                                 Max: 56
                        PM10 (0.22-0.70)
                        PM2.5 (0.73)
                        (LA only)
                        CO (0.63-0.80)
                        S02 (0.02-0.74)
                        O3 (-0.23-0.02)

                        Two-pollutant
                        models (see results)
                 Results for CVD not shown but use of stringent
                 criteria in GAM did not alter results
                 substantially. However, increased smoothing of
                 temporal trends attenuated results for all gases.
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           TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                      AND VISITS:  UNITED STATES AND CANADA
Reference, Study
Location, & Period
Peel et al. (2007)
Atlanta, GA
Study Period:
Outcomes, Design, & Methods
Outcome(s) (ICD9): IHD 410-414;
dysrhythmia 427; CHF 428; peripheral
vascular and cerebrovascular disease
433-437, 440, 443, 444, 451-453.
Mean Levels
& Monitoring Stations
NO2 l-hmax(ppb):
Mean(SD): 45.9(17.3)
10th: 25.0
90th: 68.0
Copollutants
(Correlations)
PM10 24-h avg
O3 8-h max
SO2 1-hmax
CO 1-hmax
Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results expressed as OR for association of CVD
admissions with a 20-ppb incremental increase
inN02.
           Jan 1993-Aug 2000
Computerized billing records for ED
visits.
Comorbid conditions: Hypertension 401 -
405; diabetes 250; dysrhythmia 427, CHF
428; atherosclerosis 440; COPD 491,
492, 496; pneumonia 480-486; upper
respiratory infection 460-465, 466.0;
asthma 493, 786.09.
# Hospitals:  31
N: 4,407,535 visits
Study Design: Case-crossover. CVD
outcomes among susceptible groups with
Comorbid conditions.
Statistical Analyses:  Conditional logistic
regression.
Covariates:  Cubic splines for
temperature  and humidity included in
models.  Time independent variables
controlled through design.
Statistical Software:  SAS
Lag(s): 3-day avg, lagged 0-2 day
                                                                                                 Correlations not
                                                                                                 reported
Comorbid Hypertension:
IHD: 1.036(0.997,1.076)

Dysrhythmia:  1.095(1.030,1.165)
PERI: 1.031(0.987,1.076)
CHF:  1.037(0.985,1.090)

Comorbid Diabetes:
IHD: 1.003(0.95,1.059)

Dysrhythmia:  1.158 (1.046, 1.282)
PERI: 1.012(0.947,1.082)
CHF:  1.017(0.959,1.078)
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
   Reference, Study
  Location, & Period
    Outcomes, Design, & Methods
   Mean Levels &
 Monitoring Stations
  Copollutants        Effects:  Relative Risk or Percent Change &
  (Correlations)        Confidence Intervals ([95% Lower, Upper])
X
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           Schwartz, (1997)*
           Tucson, AZ

           Study Period:
           Jan 1988-Dec 1990.
Stieb et al. (2000) *
Saint John, New
Brunswick Canada

Study Period:
July 1992-Mar 1996
Outcome(s) (ICD9): CVD 390-429.
Ascertained from hospital discharge
records.
Study Design: Time-series
Statistical Analysis: Poisson regression,
GAM
Age groups analyzed:  65+
Covariates:  Long-term and seasonal
trends, day of the wk, temperature, dew
point,
Statistical Software: SPLUS

Outcome(s): Angina pectoris; MI;
dysrhythmia/conduction disturbance;
CHF; All Cardiac.  ED Visits collected
prospectively.
Study Design: Time-series
Statistical Analyses: Poisson regression,
GAM, LOESS smooth for temporal and
weather related variables
N:  19,821 ER visits
# Hospitals: 2
Lag(s): 1-8 days
                                                             NO2 24-h avg (ppb):
                                                             Mean: 19.3
                                                              10th: 9.9
                                                             25th: 13.2
                                                             50th: 19
                                                             75th: 24.6
                                                             90th: 29.8
NO2 24-h avg (ppb)
Mean(SD): 8.9(5.5)
95th:  19
Max:  35
NO2 max (ppb)
Mean(SD): 20.2
95th:  39
Max:  82
                      PM10 (0.326)
                      03 (-0.456)
                      SO2 (0.482)
                      CO (0.673)
CO (0.68)
H2S.(0.07)
03(-0.02)
S02(0.41)
PM10 (0.35)
PM2.5 (0.35)
H+(-0.25)
S04(0.33)
COH (0.49)
                  Results reported as a percent increase in admission for
                  an increment in NO2 equivalent to the IQR (11.4 ppb).

                  CVD 0.69% (-2.3, 3.8)
                  Tucson selected to minimize correlations between
                  pollutants. Since there was no association between
                  NO2 and admissions, author suggests results for CO
                  not confounded by NO2.
Results reported for percent change in admissions
based on a single-pollutant model for incremental
increase in NO2 equivalent to 1 IQR (8.9 ppb)

Cardiac visits:
-3.9, p-value = 0.136, lag 2, allyr
10.1, p-value = 0.051, lag 5, May-Sept

For specific CVD diagnoses, ARR and CHF
approached significance. NO2 was not a focus of this
paper.
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Tolbert et al. (2007)
Atlanta, GA

Study Period:
1993-2004




Outcome(s) (ICD9): All CVD including
IHD 410-414; cardiac dysrhythmias 427;
CHF 428; peripheral vascular and
cerebrovascular disease 433-437, 440
443-445,451-453. Emergency visits
primary and secondary diagnostic codes.
Study Design: Time-series
Statistical Analysis: GLM, cubic splines
with monthly knots, indicators for
season, day of wk, holiday, excluded
days with missing exposure data
Statistical Software: SAS
Lag(s): 3 day moving avg (0-2 d)
NO2 l-hmax(ppb):
Mean: 43.2
Minimum: 1.0
10th: 22
25th: 31
Median: 41
75th: 54
90th: 66
Maximum: 181



PM10 (0.53)
03 (0.44)
CO (0.70)
SO2 (0.36)
Course PM (0.70)
PM2.5 (0.47)
PM25SO4(0.14)
PM2.5 EC (0.64)
PM2.5 OC (0.62)
PM2.5 TC (0.65)
PM2 5 water sol
metals (0.32)
OHC (0.24)
Results reported for RR based on incremental increase
of NO2 equivalent to 1 IQR (23 ppb):

Single pollutant model results:
CVD 1.015 (1.004, 1.025), lag 0-2
NO2 effect diminished in multipollutant models
containing CO and PM2 5TC (shown in figure).




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            TABLE AX6.3-6 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants        Effects: Relative Risk or Percent Change &
(Correlations)        Confidence Intervals ([95% Lower, Upper])
X
to
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           Villeneuve et al. (2006)
           Edmonton, Canada

           Study Period:
           Apr 1992-Mar 2002
                      Outcome(s) (ICD9):  Acute ischemic
                      stroke 434, 436; hemorrhagic stroke 430,
                      432; transient ischemic attack (TIA) 435;
                      Other 433, 437,438. ED visits supplied
                      by Capital Health.
                      N: 12,422 Stroke Visits
                      Catchment area:  1.5 million people
                      Study Design:  Case-crossover, exposure
                      index time compared to referent time.
                      Time-independent variables controlled in
                      the design. Index and referent day
                      matched by day of wk.
                      Statistical Analysis:  Conditional logistic
                      regression, stratified by season and
                      gender.
                      Covariates: Temperature and humidity
                      Statistical Software:  SAS
                      Season: Warm: Apr-Sept;
                      Cool: Oct-Mar.
                      Lag(s):  0, 1, 3-day avg
                                 NO2 24 h ppb:
                                 Allyr
                                 Mean(SD):  24(9.8)
                                 Median: 22.0
                                 25th: 16.5
                                 75th: 30.0
                                 IQR: 13.5
                                 Summer
                                 Mean(SD):  18.6(6.4)
                                 Median:  17.5
                                 25th: 14.0
                                 75th: 22.0
                                 IQR: 8
                                 Winter
                                 Mean(SD):  29.4(9.6)
                                 Median: 28.5
                                 25th: 22.5
                                 75th: 35.5
                                 IQR: 13.0
                      O3 24-h max
                      (-0.33)
                      O3 24-h avg
                      (-0.51)
                      SO2 25-h avg
                      (0.42)
                      CO 24-h avg
                      (0.74)
                      PM10 24-h avg
                      (0.34)
                      PM2524-havg
                      (0.41)

                      All yr correlations
                      summarized.
                 Results reported for an incremental increase in NO2
                 equivalent to one IQR NO2.

                 Ischemic Stroke, Summer
                 1.17(1.05, 1.31), lag 0
                 1.18(1.05, 1.31), lag 1
                 1.26(1.09, 1.46), 3-day avg

                 Hemorrhagic stroke, Summer
                 1.16(0.99,1.37)
                 1.14(0.97,1.35)
                 1.18(0.95,1.46)

                 TIA not associated with increase in NO2. Above
                 results are strongest effects, which were observed
                 during summer.

                 Authors attribute NO2 effect to vehicular traffic since
                 NO2 and CO are highly correlated.
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            TABLE AX6.3-6 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                        AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
X
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           Wellenius et al. (2005a)
           Allegheny County, PA
           (near Pittsburgh)

           Study Period:
           Jan 1987-Nov 1999
                      Outcome(s): CHF 428. Cases are
                      Medicare patients admitted from ER with
                      discharge of CHF.
                      Study Design:  Case-crossover, control
                      exposures same mo and day of wk,
                      controlling for season by design.
                      Statistical Analysis:  Conditional logistic
                      regression
                      N: 55,019  admissions, including repeat
                      admissions, 86% admitted < 5 times
                      Age groups analyzed:  65+ yrs (Medicare
                      recipients)
                      Covariates: Temperature and pressure.
                      Effect modification by age, gender,
                      secondary diagnosis arrhythmias, atrial
                      fibrillation, COPD, hypertension, type 2
                      diabetes, AMI within 30 days, angina
                      pectoris, IHD, acute respiratory infection.
                      Statistical Software:  SAS
                      Lag(s):  0-3
                                  NO2 24-h avg (ppb):
                                  Mean(SD): 26.48(8.02)
                                  5th: 15.10
                                  25th: 20.61
                                  Median: 25.70
                                  75th: 31.30
                                  95th: 4102

                                  # Stations: 2
                        PM10 (0.64)
                        CO (0.70)
                        O3(-0.04)
                        SO2 (0.52)
                 Results reported for the percent increase in
                 admissions for an increment of NO2 equivalent
                 to one IQR (11 ppb).

                 CHF, single-pollutant model
                 4.22 (2.61, 5.85), lag 0

                 CHF, two-pollutant model
                 4.05 (1.83, 6.31), adjusted for PM10
                 -0.37 (-2.59, 1.89), adjusted for CO
                 3.73 (2.10, 5.39), adjusted for O3
                 3.79 (1.93, 5.67), adjusted for SO2

                 CHF admission was 3x higher among those
                 with history of MI.
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            TABLE AX6.3-6 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                          AND VISITS:  UNITED STATES AND CANADA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
     Mean Levels
& Monitoring Stations
                                                                                                          Copollutants      Effects:  Relative Risk or Percent Change &
                                                                                                          (Correlations)     Confidence Intervals ([95% Lower, Upper])
            Zanobetti and Schwartz     Outcome(s) (ICD9): MI 410.
            (2006)
            Boston, MA
            1995-1999
                       Admissions through the emergency room
                       from Medicare claims.
                       Age group analyzed: 65+ yrs
                       Study Design: Case-crossover, control
                       days matched yr, mos and temperature
                       Statistical Analysis: Conditional logistic
                       regression
                       N: 15,578
                       Covariates: Temperature (regression
                       spline), day of wk
                       Seasons: Hot (Apr-Sept) and cold
                       Software:  SAS
                       Lags:  0, 0-1 previous day avg
                                   NO2 24-h avg ppb
                                   5th:  12.59
                                   25th: 18.30
                                   Median:  23.20
                                   75th: 29.13
                                   95th:
                                   90th-10th:  20.41

                                   # Stations:  4
                          O3(-0.14)
                          BC (0.70)
                          CO (0.67)
                          PM2.5 (0.55)
                          PM non-traffic
                          (0.14)
                          (residuals from
                          model of PM25
                          regressed on BC)
                                                                                                                            Results reported for percent increase in
                                                                                                                            admissions for incremental increase in NO2
                                                                                                                            equivalent to the 90th-1 Oth percentiles (20.41 or
                                                                                                                            16.80 for 0-1, previous day avg).

                                                                                                                            MI
                                                                                                                            10.21(3.82, 15.61), lag 0
                                                                                                                            12.67 (5.82, 18.04), lag 0-1, previous day avg

                                                                                                                            Results suggest traffic exposure is responsible
                                                                                                                            for the observed effect.  Effects more
                                                                                                                            pronounced in the summer season.
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            *Default GAM
            AMI Acute Myocardial
            Infarction
            ARR Arrhythmia
            BC Black Carbon
            COH coefficient of haze
            CP Course Particulate
                       CVD Cardiovascular Disease
                       EC Elemental Carbon
                       FP Fine Particulate
                       HS Hemorrhagic Stroke
                       ICD9 International Classification of Disease,
                       9th Revision
                       IHD Ischemic Heart Disease
                       IS ischemic stroke
                                   MI Myocardial Infarction
                                   OC Organic Carbon
                                   OHC Oxygenated
                                   Hydrocarbons
                                   PERI Peripheral Vascular and
                                   Cerebrovascular Disease
                                   PM Particulate Matter
                          PIH primary intracerebral hemorrhage
                          PNC Particle Number Concentration
                          SHS Subarachnoid hemorrhagic stroke
                          TP Total Particulate
                          UBRE Unbiased Risk Estimator
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           TABLE AX6.3-7. HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS

                                  AND VISITS: AUSTRALIA AND NEW ZEALAND
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Reference, Study
Location, & Period
Barnett et al. (2006)
Australia and New
Zealand: Brisbane,
Canberra, Melbourne,
Perth, Sydney

Period of Study:
1998-2001


















Outcomes, Design, & Methods
Outcome(s) (ICD9): All CVD 390-459;
ARR427; Cardiac disease 390-429;
Cardiac failure 428; IHD 410-413; MI
410; Stroke 430-438.
Ages groups analyzed: 15-64 yrs, >65yrs
Study Design: Time stratified, case-
crossover, multicity study
# of Hospitals: All ER admissions from
state government health departments
Statistical Analyses: Random effects
meta analysis, heterogeneity assessed
using 12 statistic.
Covariates: Matched analysis controlling
for long-term trend, seasonal variation,
and respiratory epidemics. Temperature
(current-previous day) and relative
humidity, pressure, extremes of hot and
cold, days of wk, holidays, day after
holiday, rainfall in some models.
Matched on copollutants.
Statistical Package: SAS
Lag: 0-3






Mean Levels &
Monitoring Stations
NO2 (ppb), Mean (range)
Auckland
1-hmax: 19.1(4.2-86.3)
24-havg: 10.2(1.7-28.9)
Brisbane
1-hmax: 17.3(4-44.1)
24-havg: 7.6(1.4-19.1)
Canberra
1-hmax: 17.9(0-53.7)
24-havg: 7.0 (0-22. 5)
Christchurch
1-hmax: 15.7(1.2-54.6)
24-havg: 7.1 (0.2-24.5)
Melbourne
1-hmax: 23.2(4.4-48)
24-havg: 11.7(2-29.5)
Perth
1-hmax: 21.3(4.4-48)
24-havg: 9.0(2-23.3)
Sydney
1-hmax: 22.6(5.2-51.4)
24-havg: 11.5(2.5-24.5)
24havgIQR: 5.1
# of Stations: 1-13
depending on the city


Copollutants
(Correlations)
PM10 24 h
C024h
S02 24 h
O38h
BS24h

Matched analysis
conducted to
control for
copollutants












Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported for % change in hospital

admissions associated with one IQR increase in
24-havg NO2, lag 0-1.

Arrhythmia
>65: 0.4 (-1.8, 2.6)
15-64: 5.1(2.2,8.1)
Cardiac
>65: 3.4(1.9,4.9)
15-64: 2.2(0.9,3.4)
Cardiac failure
>65: 6.9(2.2,11.8)
15-64: 4.6(0.1,6.1)
IHD
>65: 2.5(1.0,4.1)
15-64: 0.7 (-1.0, 2.4)
MI
>65: 4.4(1.0,8.0)
15-64: 1.7 (-1.1, 2.4)
All CVD
>65: 3.0(2.1,3.9)
15-64: 1.7(0.6,2.8)





















NO2 association became smaller when matched



with CO. Authors hypothesize that NO2 is a
good surrogate for PM, which may explain
these associations.



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            TABLE AX6.3-7 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                       AND VISITS:  AUSTRALIA AND NEW ZEALAND
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
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           Simpson et al. (2005a)
           Australia (Brisbane,
           Melbourne, Perth,
           Sydney).

           Study Period:
           Jan 1996-Dec  1999
                      Outcome(s) (ICD9):  Cardiac disease 390-
                      429; IHD 410-413; stroke 430-438.
                      Study Design: Time-series.
                      Statistical analysis: APHEA2 protocol,
                      GAM (did not indicate use of stringent
                      convergence criteria), GLM with natural
                      splines, penalized splines.  Random effects
                      meta-analysis with tests for homogeneity.
                      Age groups analyzed: All, 15-64, 65+
                      Covariates: long-term trend, temperature,
                      humidity, day of wk, holidays, influenza
                      epidemics
                      Software package: SPLUS, R
                      Lag(s):  1-3 days
                                   NO l-hmax(ppb):

                                   Mean (range):
                                   Brisbane: 21.4(2.1,63.3)
                                   Sydney: 23.7(6.5,59.4)
                                   Melbourne: 23.7 (4.4, 66.7)
                                   Perth:  16.3(1.9,41.0)
                        PM10 24 h
                        PM2.5
                        BS24h
                        (0.29, 0.62)
                        03lh
                        CO8h

                        Not all correlations
                        reported. NO2
                        affect attenuated
                        slightly when
                        modeled with BS
                        but not with O3.

                        May be
                        confounding  of
                        NO2 effect by
                        particulate.
                  Single-city results reported for percent increase
                  for an increment in 1-h max NO2 equivalent to
                  one IQR.  Pooled results reported for an
                  increment of 1 ppb NO2.

                  Cardiac
                  All ages:  1.0023 (1.0016, 1.0030), lag 0-1
                  15-64: 1.0015 (1.0006,1.0025), lag 0
                  >65:  1.0018 (1.0011, 1.0025), lag 0-1
                  IHD
                  All ages:  1.0019(1.0010,1.0027)
                  >65:  1.0017(1.0007,1.0027)
                  No effect observed/reported for  stroke.

                  Multipollutant results (65+ age group):
                  Cardiac:
                  1.0032 (1.0006, 1.0022), w/BS, lag 0-1
                  1.0032 (1.0024, 1.0039), w/O3,  lag 0-1

                  Heterogeneity in CVD results among cities,
                  probably due to different pollutant mixtures,
                  may have affected the results.
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           Hinwood et al. (2006)
           Perth, Australia

           Study Period:
           1992-1998
                      Outcome(s): All CVD unscheduled
                      admissions. Obtained from discharge
                      records using ICD9 Codes.
                      Age groups analyzed: All ages, 65+
                      Study design:  Case-crossover, time-
                      stratified with 3-4 controls within same mo
                      Statistical Analysis:  conditional logistic
                      regression
                      N:  26.5 daily CVD admissions
                      Seasons: Nov-Apr, May-Oct
                                   NO2 24-h (ppb)
                                   Mean:  10.3
                                   SD = 5
                                   10th percentile: 4.4
                                   90th percentile: 17.1
                                   NO2 1-h max (ppb)
                                   Mean:  24.8
                                   SD=10.1
                                   10th percentile: 13.3
                                   90th percentile: 37.5
                        O3 1 h, 8 h (- .06)
                        CO 8 h (.57)
                        BSP24h(.39)
                  Results reported for OR per incremental
                  increase of 1 ppb NO2.

                  All CVD (estimated from graph)
                  NO2 24 h65+:  1.005 (1.001, 1.006), lag 1

                  NO2 24 h all ages:  1.003(1.001, 1.007), lag 1
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                                                                           # of Stations:  3

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         TABLE AX6.3-7 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS

                                             AND VISITS: AUSTRALIA AND NEW ZEALAND
Reference, Study
Location, & Period
Jalaludin et al. (2006)
Sydney, Australia

Period of Study:
Jan 1997-Dec 2001












Outcomes, Design, & Methods
Outcome(s) (ICD9): All CVD 390-459;
cardiac disease 390-429; IHD 410-413;
and cerebro vascular disease or stroke
430-438; Emergency room attendances
obtained from health department data.
Age groups included: 65+
Study Design: Time-series, multi-city
APHEA2 Protocol.
Statistical Analysis: GAM (with
appropriate convergence criteria) and
GLM Models. Only GLM presented.
T r\ "$
Lag: 0-3
Covariates: Daily avg temperature and
daily relative, humidity, long-term trends,
seasonality, weather, day of wk, public
school holidays, outliers and influenza
epidemics.
Dose response: Quartile analysis
Season: Separate analyses for warm
(Nov-Apr) and cool periods (May-Oct).
Mean Levels &
Monitoring Stations
NO2 daily 1-h avg
Mean: 32.2
SD = 7.4
Min: 5.2
Ql: 18.2
Median: 23
Q3: 27.5
Max: 59.4

# of Stations: 14







Copollutants
(Correlations)
BS 24-h avg (0.35)
PM10 24-h avg
(0.44)
PM2524-havg
(0.45)
CO 8-h avg (0.55)
O3 1-h avg (0.45)
SO2 24-h avg (0.56)

Two-pollutant
models to adjust for
copollutants






Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported for % change in hospital
admissions associated with one IQR increase in
l-havgNO2.

All CVD
2.32(1.45, 3.19), lag 0
0.45 (-0.52, 1.42), lag 1
1.31 (0.28, 2.35), lag 0-1

Cardiac Disease
2.00 (0.81, 3.20), lag 0
0.91 (-0.26,2.09), lag 1
1.78(0.54, 3. 04), lag 0-1

IHD
2.11 (0.34, 3. 91), lag 0
0.76 (-0.97, 2. 52), lag 1
1.73 (-0.10, 3.59), lag 0-1

                                                                                                    Stroke

                                                                                                    -1.66 (-3.80, 0.51) lag 0

                                                                                                    -1.11 (-3.19, 1.02), lag 1

                                                                                                    -1.68 (-3.90, 0.60), lag 0-1


                                                                                                    Effect of NO2 attenuated when CO was included

                                                                                                    in the model. NO2 effect most prominent

                                                                                                    during the cool season.
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            TABLE AX6.3-7 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                     AND VISITS: AUSTRALIA AND NEW ZEALAND
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects:  Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
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           Morgan etal. (1998a)
           Sydney, Australia

           Study Period:
           Jan 1990-Dec 1994
                      Outcome(s) (ICD9): Heart Disease 410,
                      413,427,428. Inpatient statistics
                      database for New South Wales Health
                      Department.
                      Study Design: Time-series
                      Statistical Analysis: Poisson regression,
                      GEE
                      # Hospitals:  27
                      Covariates: Daily mean temperature,
                      dew point temperature
                      Lag(s):  0-2 days, cumulative
                      Statistical Software: SAS
                                 NO2 24-h avg (ppb):

                                 Mean(SD):  15(6)
                                 IQR:  11 ppb
                                 10th-90th: 17

                                 NO2 l-hmax(ppb):
                                 Mean(SD): 29(3)
                                 10-90th: 29 ppb

                                 NO2 24-h max: 52
                                 NO2l-hmax: 139

                                 # Stations: 3-14
                                 (1990-1994)
                       O3 1-hmax
                       (-0.086)
                       PM (0.533, 0.506)

                       Correlations for
                       24-h avg NO2
                       concentrations

                       Multipollutant
                       models
                 Results reported as percent increase in
                 admissions associated with an incremental
                 increase in 1-h max NO2 and 24-h avg
                 equivalent to the 10th-90th percentile.

                 Heart Disease:
                 24-h avg, lag 0
                 All ages: 7.52(5.21,9.88)
                 65+: 8.39(5.41,11.46)
                 0-64:  5.81(1.63,10.17)
                 1-hmax, lag 0
                 All ages: 6.08(3.63,8.59)
                 65+: 6.71(4.25,9.23)
                 0-64:  4.79(1.18,8.53)
                 65+: 6.68(3.61, 9.84) Particulate,O3

                 Results lost precision but did not change
                 substantially when stratified by age or when
                 24-h averaging time was used.
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            TABLE AX6.3-7 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                       AND VISITS:  AUSTRALIA AND NEW ZEALAND
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Reference, Study
Location, & Period
Petroeschevsky et al.
(2001)
Brisbane, Australia

Study Period:
Jan 1987-Dec 1994,
2,922 days














Outcomes, Design, & Methods
Outcome(s) (ICD9): CVD 390-459.
Hospital admissions, non-residents
excluded.
Study Design: Time-series
Statistical Analyses: Poisson regression,
APHEA protocol, linear regression and
GEEs
Age groups analyzed: 15-64,65+
Covariates: Temperature, humidity,
rainfall. Long-term trends, season, flu,
day of wk, holidays.
Statistical Software: SAS
Lag(s): lag 0-4, 3-day avg, 5 day avg









Mean Levels &
Monitoring Stations
NO2 1-h max (pphm)

Summer
Mean: 206
Min: 0.35
Max: 5.8
Fall
Mean: 2.56
Min: 0.70
Max' 5 85
Winter
Mean: 3.54
Min: 0.35
Max: 8.05
Spring
Mean: 3.12
Min: 0.55
Max: 15.58
Overall
Mean: 2.82
Min: 0.35
Max: 15.58
Copollutants Effects: Relative Risk or Percent Change &
(Correlations) Confidence Intervals ([95% Lower, Upper])
BSP Results reported for RR for CVD emergency
O3 admissions associated with a one-unit increase
SQ2 in NO2 1 -h max.
Correlation
between pollutants CVD 1 5-64 yrs
not reported. 0.986 (0.968, 1.005), lag 3

CVD 65+ yrs
0.990(0.977,1.003)

CVD all ages
0.987(0.976,0.998)









           *Default GAM

           AMI Acute Myocardial
           Infarction
           ARR Arrhythmia
           BC Black Carbon
           COH coefficient of haze
           CP Course Particulate
CVD Cardiovascular Disease
EC Elemental Carbon
FP Fine Particulate
HS Hemorrhagic Stroke
ICD9 International Classification of Disease,
9th Revision
IHD Ischemic Heart Disease
IS ischemic stroke
MI Myocardial Infarction
OC Organic Carbon
OHC Oxygenated
Hydrocarbons
PERI Peripheral Vascular and
Cerebrovascular Disease
PM Particulate Matter
PIH primary intracerebral hemorrhage
PNC Particle Number Concentration
SHS Subarachnoid hemorrhagic stroke
TP Total Particulate
UBRE Unbiased Risk Estimator
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                 TABLE AX6.3-8. HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
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           Ballester et al. (2006)
           Multi-city, Spain:
           Barcelona, Bilbao,
           Castellon, Gijon,
           Huelva, Madrid,
           Granada, Oviedo,
           Seville, Valencia,
           Zaragoza

           Period of Study:
           1995/1996-1999,
           N= 1,096 day
                      Outcome(s) (ICD9): All CVD 390-459;
                      Heart diseases 410-414,427,428.
                      Emergency admission from hospital
                      records. Discharge data used.
                      Study Design: Time-series, meta-
                      analysis to pool cities
                      N: daily mean admissions reported by
                      city
                      Statistical Analyses: Poisson regression
                      and GAM, with stringent convergence
                      criteria, meta-analysis with fixed effect
                      model.  Tested linearity by modeling
                      pollutant in linear and non-linear way
                      (spline  smoothing).  Linear model
                      provided best results 55% of time but
                      used in all cases to facilitate
                      comparability.
                      Covariates: temperature, humidity and
                      influenza, day of wk unusual events,
                      seasonal variation and trend of the series
                      Seasons: Hot: May to Oct;
                      Cold: NovtoApr
                      Statistical Package:  SPLUS
                      Lag: 0-3
                                  NO2 24-h avg (ug/m ):
                                  Mean:  51.5
                                  10th percentile:  29.5
                                  90th percentile:  74.4

                                  # of Stations:  Depends on
                                  the city

                                  Correlation among stations:
                                  NR
                        CO 8-h max (0.58)
                        O38-h max .(0.03)
                        S02 24 h (0.46)
                        BS24h(0.48)
                        TSP 24 h (0.48)
                        PM10 24 h (0.40)

                        Two-pollutant
                        models used to
                        adjust for
                        copollutants.
                 Results reported for % change in hospital
                 admissions associated with 10 ug/m2 increase in
                 N02.

                 All CVD
                 0.38% (0.07%, 0.69%), lag 0-1
                 Heart Diseases:
                 0.86% (0.44%, 1.28%)

                 Effect of NO2 was diminished in two-pollutant
                 models.
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        TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS

                                              AND VISITS: EUROPE
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Reference, Study
Location, & Period
Lanki et al. (2006)
Europe (Augsburg,
Helsinki, Rome,
Stockholm)

Study period:
1992-2000

















Outcomes, Design, & Methods
Outcome(s) (ICD9): AMI 410.
Ascertained from discharge records or
AMI registry data depending on the city.
Study Design: Time-series
Statistical Analysis: Poisson regression,
for non-linear confounders - penalized
splines in GAM chosen to minimize
UBRE score. Random-effects model for
pooled estimates.
N: 26,854 hospitalizations
Statistical Software: R package
Covariates: Barometric pressure,
temperature, humidity.
Lag(s): 0-3 day














Mean Levels & Copollutants
Monitoring Stations (Correlations)
NO2 (|ig/m3)

Augsburg
25th: 40.2
50th: 49.2
75th: 58.9
98th: 88.7
Barcelona
25th: 34.8
50th: 45.0
75th: 60.0
98th: 86.0
Helsinki

25th: 21.8
50th: 28.7
75th: 37.6
98th: 64.7
Rome
25th: 61.9
50th: 70.6
75th: 80.4
98th: 102.5
Stockholm
25th: 16.3
50th: 22.2
75th: 28.6
98th: 45.9
PM10 (0.29, 0.64)
C0(0.43,0.75)
03 (0.17, 0.38)

Range in
correlations
depends on the city.
Two-pollutant
models for PNC
withO3 andPM10
only.















Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported as RR associated with an
incremental increase in NO2 equivalent to the
IQR (8 ng/m2).

Pooled results for 5 Cities:
First MI:
0.996(0.988, 1.015), lag 0
0.998(0.986, 1.010), lag 1
1.003(0.994, 1.011), lag 2
1.001(0.989, 1.014), lag 3
No significant results observed for analyses
stratified by age or season for lag 0/1 .















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            TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                         AND VISITS: EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants       Effects:  Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
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            Von Klot et al. (2005)
            Europe (Augsburg,
            Barcelona, Helsinki,
            Rome, Stockholm)

            Study Period:
            1992-2000
                      Outcome(s) (ICD9): Re-admission for
                      AMI 410; angina pectoris 411 and 413;
                      Cardiac diseases including AMI angina
                      pectoris, dysrhythmia (427), heart failure
                      (428).  Hospital admissions database used
                      to identify cases.
                      Population: Incident cases of MI during
                      1992-2000 among those >35 yrs old.
                      N Augsburg:  1560
                      N Barcelona:  1134
                      N Helsinki: 4026
                      NRome: 7384
                      N Stockholm:  7902
                      Study Design:  Prospective Cohort
                      Statistical Analyses: Poisson regression,
                      at risk period from the 29th day after the
                      index event until the event of interest,
                      death, migration, or loss to follow-up.
                      GLM models, penalized spline functions
                      for continuous confounders.  City results
                      pooled using random-effects model.
                      Heterogeneity assessed. Sensitivity
                      analyses conducted varying the smooth
                      functions, convergence criteria, and how
                      confounders were specified.
                      Statistical Software: R package
                      Covariates: Daily mean temperature,
                      dew point temperature, barometric
                      pressure, relative humidity, vacations or
                      holidays.
                      Lag: 0-3 days
                                   NO2 24-h avg (ug/m ):

                                   Augsburg
                                   Mean: 49.6
                                   5th: 30
                                   25th: 39.7
                                   75th: 57.2
                                   95th: 75.3

                                   Barcelona
                                   Mean: 47.7
                                   5th: 18
                                   25th: 34.0
                                   75th: 60
                                   95th: 83
                                   Helsinki
                                   Mean: 30.1
                                   5th: 13
                                   25th: 21.2
                                   75th: 36.7
                                   95th: 52.9
                                   Rome
                                   Mean: 15.8
                                   5th: 5.4
                                   25th: 10.1
                                   75th: 21.7
                                   95th: 25.9
                                   Stockholm
                                   Mean: 22.8
                                   5th: 10.3
                                   25th: 16
                                   75th: 28
                                   95th: 39.4
                        C024h
                        (0.44, 0.75)
                        038h
                        (-0.2,-0.13)
                        PM10 (.29, .66)
                        PNC (.44, .83)

                        Two-pollutant
                        models but NO2,
                        CO, and PNC not
                        modeled together
                        because they were
                        too highly
                        correlated.
                  Results reported for RR for incremental
                  increases in same day NO2 equivalent to the
                  mean of the city specific IQR's multiplied by
                  0.05 (8 ug/m ). Pooled results are below:

                  MI
                  1.028(0.997, 1.060), lag 0

                  Angina Pectoris
                  1.032(1.006, 1.058), lag 0

                  Cardiac Diseases
                  1.032(1.014, 1.051), lag 0

                  Two-pollutant models show that the effect of
                  NO2 independent of PM10 and O3. Traffic
                  exhaust may be associated with cardiac
                  re-admission.
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            TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                       AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
X
           Andersen et al. (2007a)
           Copenhagen, Denmark

           Study Period:
           1999-2004
                      Outcome(s) (ICD10): angina pectoris
                      120; acute and subsequent MI 121-22;
                      other acute IHD124; chronic IHD125;
                      pulmonary embolism 126; cardiac arrest
                      146; cardiac arrhythmias 148-49; hear
                      failure 150. Hospital admissions from
                      Danish Hospital Register.
                      # Hospitals: 9 (within 15 km of
                      monitoring station)
                      Study Population: 65 +
                      Catchment area:  1.5 million
                      Study Design: Time-series
                      Statistical Analysis:  Principal
                      components analysis for source
                      apportionment. Poisson GAM,
                      smoothing splines for weather, long-term
                      trends/seasonality, indicator variables for
                      influenza, holidays
                      Software: mgcv package, R
                      Lag(s): 0-5 d, 0-3davg
                                  24-h avg NO2 (ppb)
                                  Mean(SD): 12(5)
                                  25th: 8
                                  75th: 15
                                  IQR: 7
                        PM10 (0.45)
                        CO (0.74)
                        Source Specific
                        PM10
                        Biomass(0.41)
                        Secondary (0.43)
                        Oil (0.42)
                        Crustal (0.24)
                        Sea Salt (-0.19)
                        Vehicle (0.65)
                 Results reported for RR associated with an
                 incremental increase in NO2 equivalent to one
                 IQR (7 ppb).
                 Single pollutant
                 1.013 (0.993, 1.033), lag 0-3 avg
                 2-pollutant, NO2 with PM10
                 1.000(0.975,1.026)
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              TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
Mean Levels & Monitoring
        Stations
 Copollutants       Effects: Relative Risk or Percent Change &
(Correlations)       Confidence Intervals ([95% Lower, Upper])
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           Andersen et al. (2007b)
           Copenhagen, Denmark

           Study Period:
           2001-2004
                     Outcome(s) (ICD10): Angina pectoris
                     120; acute and subsequent MI 121-22;
                     other acute IHD124; chronic IHD125;
                     pulmonary embolism 126; cardiac arrest
                     146; cardiac arrhythmias 148-49; heart
                     failure 150.  Hospital admissions from
                     Danish Hospital Register.
                     # Hospitals: 9 (within 15 km of
                     monitoring station)
                     Study Population: 65 +
                     Catchment area: 1.5 million
                     Study Design: Time-series
                     Statistical Analysis:  Poisson GAM,
                     smoothing splines for weather, long-term
                     trends/seasonality, indicator variables for
                     influenza, holidays
                     Software: mgcv package, R
                     Lag(s): 0-5 d, 0-3 d avg
                                 24-h avg NO2 (ppb)
                                 Mean(SD): 11(5)
                                 25th:  8
                                 50th:  11
                                 75th:  14
                                 99th:  28
                                 IQR:  6

                                 24-h avg NOX (ppb)
                                 Mean(SD): 15(8)
                                 25th:  9
                                 50th:  12
                                 75th:  18
                                 99th:  46
                                 IQR:  9

                                 24-h avg NOX curbside (ppb)
                                 Mean(SD): 83(36)
                                 25th:  58
                                 50th:  76
                                 75th:  103
                                 99th:  207
                                 IQR:  45
                           NCtotw/NO2(0.68)
                           NCtotw/NOx(0.66)
                           NCa57w/N02(0.57)
                  Results reported for associations of a 6-ppb
                  increase equivalent to one IQR of NO2 with all
                  CVD.

                  One-pollutant model:
                  1.0(0.98, 1.03), lag 0-3
                  2-pollutant model with NCtot
                  1.0(0.96,1.03)
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            TABLE AX6.3-8 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
X
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           Atkinson et al. (1999b)
           London, England

           Period of Study:
           1992-1994,
           N= 1,096 day
                      Outcome(s) (ICD9):  All CVD 390-459;
                      IHD 410-414. Emergency admissions
                      obtained from the Hospital Episode
                      Statistics (HES) database.
                      Ages groups analyzed:  0-14 yr, 15-64 yr,
                      0-64 yr, 65+ yr, 65 74 yr, 75+ yr
                      Study Design:  Time-series, hospital
                      admission counts
                      N:  189, 109 CVD admissions
                      Catchment area: 7 million residing in
                      1600 Km2 area of Thames basin.
                      Statistical Analyses:  APHEA protocol,
                      Poisson regression
                      Covariates:  Adjusted long-term seasonal
                      patterns, day of wk, influenza,
                      temperature, humidity (compared
                      alternative methods for modeling
                      meteorological including linear,
                      quadratic, piece-wise, spline)
                      Seasons: Warm season Apr-Sept, cool
                      season remaining mos,  interactions
                      between season investigated
                      Dose response investigated: Yes, bubble
                      charts presented
                      Statistical Package:  SAS
                      Lag: 0-3
                                   l-hmax(ppb)
                                   Mean: 50.3
                                   SD = 17.0
                                   Min:  22.0
                                   Max: 224.3
                                   10th-90thpercentile: 36

                                   # of Stations: 3, results
                                   averaged across stations

                                   Correlation among stations:
                                   0.7-0.96
                        PM10 24 h
                        C024h
                        S02 24 h
                        O38h
                        BS24h

                        Correlations of NO2
                        with CO, SO2, O3,
                        BS ranged from
                        0.6-0.7

                        Correlation of NO2
                        with O3 negative

                        Two-pollutant
                        models used adjust
                        for copollutants
                  Results reported for % change in hospital
                  admissions associated with 10th-90th percentile
                  increase in NO2 (36 ppb)

                  All CVD
                  Ages 0-64: 1.20% (-0.62%, 3.05%), lag 0
                  Ages 65+:  1.68% (0.32%, 3.06%), lag 0

                  IHD
                  Ages 0-64: 1.53% (-1.22%, 4.37%), lag 0
                  Ages 65+:  3.03% (0.87%, 5.24), lag 0

                  NO2 was associated with increased CVD
                  admissions for all ages but this association was
                  stronger among those 65+ yrs old.  Similar
                  increase associated with IHD among those 65+
                  yrs old.

                  Monitors close to roadways were not used in the
                  study. Correlations for NO2 between urban
                  monitoring sites were high. Authors suggest
                  that the pollution levels are uniform across the
                  study area. Authors did not investigate the
                  interaction between meteorological variables
                  and air pollution.  In two-pollutant models, O3
                  had little impact on NO2. BS moderated the
                  association of NO2 with CVD among the 65+
                  age group.  Suggestion that NO2 associations
                  were non-linear.
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            TABLE AX6.3-8 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)     Confidence Intervals ([95% Lower, Upper])
X
Oi
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           Ballester et al. (2001)
           Valencia, Spain

           Period of Study:
           1992-1996
                      Outcome(s) (ICD9): All CVD 390-459;
                      heart diseases 390-459; cerebrovascular
                      diseases 430-438. Admissions from city
                      registry - discharge codes used.
                      Study Design: Time-series
                      N: 1080 CVD admissions
                      # of Hospitals: 2
                      Catchment area:  376,681 inhabitants of
                      Urban Valencia
                      Statistical Analyses: Poisson regression,
                      GAM with parametric smoothers,
                      APHEA/ Spanish EMECAM protocol.
                      Both Linear and non parametric model,
                      including a loess term was fitted,
                      departure from linearity assess by
                      comparing deviance of both models.
                      Covariates:  Long-term trend and
                      seasonality, temperature and humidity,
                      wk days, flu, special events, air pollution.
                      Seasons:  Hot season May to Oct;
                      Cold season Nov to Apr
                      Statistical Package:  SAS
                      Lag:  0-4
                                  1-hmax (ug/m2)
                                  Mean:  116.1
                                  SD = NR
                                  Min: 21.1
                                  Max:  469.0
                                  Median: 113.2
                                                                          # of Stations:
                                                                          5 automatic
                                               14 manual,
                        CO 24 h (0.03)
                        S02 24 h (0.33)
                        O38h(-0.26)
                        BS(0.33)

                        Two-pollutant
                        models used to
                        adjust for
                        copollutants.
                                                                          Correlation among stations:
                                                                          0.3-0.62 for BS, 0.46-0.78
                                                                          for gaseous pollutants
                 Results reported for RR corresponding to a
                 10 ug/m2 increase inNO2

                 All CVD
                 1.0302(1.0042,1.0568), lag 0
                 Heart Disease
                 1.0085(0.9984,1.0188), lag 2
                 Cerebrovascular Disease
                 1.0362(1.0066,1.0667), lag 4

                 Clear association of NO2 with cerebrovascular
                 disease observed. Association persisted after
                 Inclusion of BS and SO2 in two-pollutant
                 models with NO2.

                 Cases of digestive disorders served as a control
                 group - null association with NO2 observed.
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            TABLE AX6.3-8 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
   Copollutants       Effects:  Relative Risk or Percent Change &
  (Correlations)      Confidence Intervals ([95% Lower, Upper])
X
           D'Ippolitietal. (2003)
           Rome, Italy

           Study Period: Jan 1995-
           Junl997
                      Outcome(s) (ICD): AMI 410 (first
                      episode). Computerized hospital
                      admission data.
                      Study Design: Case-crossover, time-
                      stratified, control days within same mo
                      falling on the same day.
                      Statistical Analyses:  Conditional logistic
                      regression, examined homogeneity across
                      co-morbidity categories
                      N: 6531 cases
                      Age groups analyzed: 18-64yrs,
                      65-74 yrs, > 75
                      Season:  Cool: Oct-Mar;
                      Warm: Apr-Sept
                      Lag(s): 0-4 day, 0-2 day cum avg
                      Dose Response:  OR  for increasing
                      quartiles presented and p- value for trend.
NO2 24
Mean(SD):
25th:  74.9
50th:  86.0
75th:  96.9
IQR:  22

# Stations: 5
                                              86.4(15.8)
TSP 24 h (0.37)
S0224h(0.31)
CO 24 h (0.03)
No multipollutant
models
Results presented for OR associated with
incremental increase in NO2 equivalent to one
IQR.

AMI
1.026(1.002, 1.052), lag 0
1.026(0.997, 1.057), lag 0-2

Association observed for NO2 but TSP
association more consistent. Authors think that
TSP, CO, and NO2 cannot be distinguished
from traffic-related pollution in general.
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           Llorca et al. (2005)
           Torrelavega, Spain

           Study period:
           1992-1995
                      Outcome(s) (ICD): CVD (called cardiac
                      in paper) 390-459. Emergency
                      admissions, excluding non residents.
                      Obtained admissions records from
                      hospital admin office.
                      Study design:  Time-series
                      Statistical analyses:  Poisson regression,
                      APHEA protocol
                      Covariates:  rainfall, temperature, wind
                      speed direction
                      N: 1 8, 1 37 admissions
                      Statistical software:  STATA
                      Lag(s):  not reported
                                  NO2 24 h ng/m3
                                  Mean(SD): 21.3(16.5)
                           TSP (-0.12)
                           SO2 (0.588)
                           SH2 (0.545)
                           NO (0.855)

                           Multipollutant
                           models
                    Results reported for RR of hospital admissions
                    for 100 ng/m3 increase inNO2.

                    CVD admissions:
                    1.27 (1.14, 1.42), 1-pollutant model
                    1.10 (0.92, 1.32), 5-pollutant model

                    Effect of NO2 diminished in multipollutant
                    model.
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            TABLE AX6.3-8 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS:  EUROPE
   Reference, Study
  Location, & Period
    Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
   Copollutants       Effects:  Relative Risk or Percent Change &
  (Correlations)      Confidence Intervals ([95% Lower, Upper])
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           Pantazopoulou et al.
           (1995)
           Athens, Greece

           Study Period:  1988
           (Winter and Summer)
Poloniecki et al. (1997)
London, UK

Study Period:
Apr 1987-Mar 1994, 7
yrs
Outcome(s): Cardiac Disease ICD codes
not provided.  Cases ascertained from
National Center for Emergency Service
database. Cases diagnosed at time of
admission so they are ED visits and were
not necessarily admitted to the hospital.
Study design:  Time-series
Statistical Analyses: Linear regression
(not well described)
Covariates:  Dummy variables for winter
mos with Jan as referent.  Dummy
variables for summer mos with Apr as
referent.  Day of the wk, holidays,
temperature, relative humidity,
N: 25,027 cardiac admissions.
Lag(s): NR


Outcome(s): All CVD 390-459; MI 410;
Angina pectoris 413; other IHD 414;
ARR 427; congestive heart failure 428;
cerebrovascular disease 430-438.
Hospital Episode Statistics (HES) data on
emergency hospital admissions.
Study Design:  Time-series
N: 373, 556 CVD admissions
Statistical Analyses: Poisson regression,
linear and quadratic terms to adjust for
long-term trends. APHEA protocol
Covariates:  long-term trends, seasonal
variation, day of wk, influenza,
temperature and humidity.
Season:  Warm, Apr-Sept;
Cool,  Oct-Mar.
Lag:  0-1 day
                                                               NO2 l-hmax(ng/m3):
                                                               Winter
                                                               Mean(SD): 94(25)
                                                               5th: 59
                                                               50th: 93
                                                               95th: 135

                                                               Summer
                                                               Mean(SD): 111(32)
                                                               5th: 65
                                                               50th: 108
                                                               95th: 173

                                                               # Stations:  2
NO2 24 h ppb:
Min: 8
10%: 23
Median: 35
90%: 53
Max:  198
                           CO,BS
                           No correlations
                           provided
Black Smoke
C024h
S02 24 h
O38h

Correlations
between pollutants
high but not
specified.
                    Results reported for regression coefficients
                    based on an incremental increase in NO2 of
                    76 ng/m3 in winter and 108 ng/m3 in summer
                    (5th to 95th percentile).

                    Winter (regression coefficient)
                    11.2(3.3,19.2)

                    Summer (regression coefficient)
                    -0.06 (-6.6, 6.5)
Results expressed as a relative rate (RR) for an
incremental increase of NO2 equivalent to
30 ppb (10th-90th percentile).

AMI:  1.0274(1.0084,1.0479)
Angina Pectoris: 1.0212 (0.9950,1.0457)
Other IHD: 0.99(0.0067,1.0289)
Cardiac ARR:  1.0274 (1.0006, 1.0984)
Heart Failure: 0.9970(0.9769, 1.0194)
Cerebro vascular Disease: 0.9851
(0.9684,1.0045)
Other Circulatory:  1.0182 (1.0000,1.0398)
All CVD:  1.0243 (1.0054,1.0448)

No attenuation of NO2 association with MI in
two-pollutant model (cool season).
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           TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                       AND VISITS:  EUROPE
              Reference, Study
             Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
                                                                                            Copollutants      Effects: Relative Risk or Percent Change &
                                                                                            (Correlations)     Confidence Intervals ([95% Lower, Upper])
X
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           Ponka and Virtanen
           (1996)
           Helsinki, Finland

           Study Period:
           1987-1989, 3 yrs
                                    Outcome(s) (ICD9): IHD 410-414; MI
                                    410; TIA 411; Cerebrovascular diseases
                                    430-438; Cerebral ischemia due to
                                    occlusion of extracerebral vessels 433;
                                    Cerebral ischemia due to occlusion of
                                    cerebral vessels 434; Transient ischemic
                                    cerebral attack 435. Case ascertainment
                                    was for both emergency admission and
                                    hospital admissions - done via registry
                                    system.
                                    Study Design: Time-series
                                    Statistical Analyses: Poisson regression,
                                    pollutant concentrations log transformed
                                    N:  12,664 all IHD admissions; 7005 IHD
                                    ED admissions; 7232 cerebrovascular
                                    hospital admissions; 3737
                                    cerebrovascular ED admissions.
                                    Covariates: Weather, day of wk, long-
                                    term trends, influenza
                                    Lag(s): 1-7 days
                                  NO2 8 h (ug/m3)
                                  Mean(SD):  39(16.2)
                                  Range: 4, 170
                                  NO 8 h ug/m3
                                  Mean(SD):  91(61)
                                  Range: 7,467

                                  # Stations: 2
                        SO28h
                        N08h
                        TSPSh
                        O38h

                        NO2 highly
                        correlated with SO2
                        and TSP.
                                                                                                             Results reported are regression coefficients and
                                                                                                             standard errors (SE).

                                                                                                             NO2 with ED admissions for transient short
                                                                                                             term ischemic attack
                                                                                                             -0.056 (0.105), p = 0.59, lag 1
                                                                                                             NO2 with ED admissions for cerebrovascular
                                                                                                             disease
                                                                                                             -0.025 (0.057), p = 0.657, lag 1
                                                                                                             NO with IHD, all admissions
                                                                                                             0.097 (0.023), p< 0.001, lag 1
                                                                                                             NO with IHD, ED admissions
                                                                                                             0.111 (0.030), p< 0.001, lag 1

                                                                                                             Significant increase in admissions for transient
                                                                                                             short-term ischemic attack and cerebrovascular
                                                                                                             diseases for lag 6 associated with NO2 exposure.
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Prescottetal. (1998)*
Edinburgh, UK

Study period:
Oct 1992-June 1995
                                   Outcome(s) (ICD9):  Cardiac and
                                   cerebral ischemia 410-414,426-429, 434-
                                   440. Extracted from Scottish record
                                   linkage system.
                                   Study Design: Time-series
                                   Statistical Analysis: Poisson, log linear
                                   regression models
                                   Age groups analyzed: <65, 65+yrs
                                   Covariates:  Seasonal and wkday
                                   variation, temperature, and wind speed.
                                   Lag(s): 0, 1, 3 day moving avg
                                                                          NO2 24 h (ppb)
                                                                          Mean(SD): 26.4(7.0)
                                                                          Range: 9, 58
                                                                          IQR:  10 ppb
                                                             03, 24 h
                                                             PM, 24 h
                                                             SO2, 24 h
                                                             CO, 24 h

                                                             Correlations not
                                                             reported.
                                            Results reported for percent change in
                                            admissions based on an incremental increase in
                                            NO2 equivalent to the IQR of 10 ppb.

                                            <65 yrs, CVD admissions
                                            -0.05 (-5.2, 4.5), 3 day moving avg
                                            65+ yrs, CVD admissions
                                            -0.9 (-8.2, 7.0), 3 day moving avg

                                            Data for lag 1 not presented.
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            TABLE AX6.3-8 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                          AND VISITS:  EUROPE
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects: Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
 X
            Yallop et al. (2007)
            London, England

            Study Period:
            Jan. 1988-Oct. 2001,
            >1400 days
                       Outcome(s): Acute pain in Sickle Cell
                       Disease (HbSS, HbSC, HbS/pO,
                       thalassaemia, HbS/p+).  Admitted to
                       hospital for at least one night.
                       Study Design:  Time-series
                       Statistical Analyses:  Cross-correlation
                       function
                       N: 1047 admissions
                       Covariates: No adjustment made in
                       analysis, discussion includes statement
                       that the effects of weather variables and
                       copollutants are inter-related.
                       Statistical Package: SPSS
                       Lag(s): 0-2 days
                       Dose response: Quartile analysis, graphs
                       presented, ANOVA comparing means
                       across quartiles.
                                    NR
                         O3, CO, NO, NO2,
                         PM10:
                         daily avg used for
                         all copollutants

                         High O3 levels
                         correlate with low
                         NO, low CO,
                         increased wind
                         speeds and low
                         humidity and each
                         was associated with
                         admission for pain.
                         Not possible to
                         distinguish
                         associations in
                         analysis.
                  Results reported are cross-correlation
                  coefficients. NO inversely correlated with
                  admission for acute pain in SCO.
                  CFF: -0.063, lag 0
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            *Default GAM


            AMI Acute Myocardial
            Infarction
            ARR Arrhythmia
            BC Black Carbon
            COH coefficient of haze
            CP Course Particulate
                       CVD Cardiovascular Disease
                       EC Elemental Carbon
                       FP Fine Particulate
                       HS Hemorrhagic Stroke
                       ICD9 International Classification of Disease,
                       9th Revision
                       IHD Ischemic Heart Disease
                       IS ischemic stroke
                                    MI Myocardial Infarction
                                    OC Organic Carbon
                                    OHC Oxygenated
                                    Hydrocarbons
                                    PERI Peripheral Vascular and
                                    Cerebrovascular Disease
                                    PM Particulate Matter
                         PIH primary intracerebral hemorrhage
                         PNC Particle Number Concentration
                         SHS Subarachnoid hemorrhagic stroke
                         TP Total Particulate
                         UBRE Unbiased Risk Estimator
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                 TABLE AX6.3-9.  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                         AND VISITS:  ASIA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants       Effects:  Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
X
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           Chan et al. (2006)
           Taipai, Taiwan

           Period of Study:
           Apr 1997-Dec 2002,
           2090 days
                      Outcome(s) (ICD9): Cerebrovascular
                      disease 430-437; stroke 430-434;
                      hemorrhagic stroke 430-432; ischemic
                      stroke 433-434. Emergency admission
                      data collected from National Taiwan
                      University Hospital.
                      Ages groups analyzed: Age >50 included
                      in study
                      Study Design:  Time-series
                      N:  7341 Cerebrovascular admissions
                      among those >50 yrs old
                      # of Hospitals:
                      Catchment area:
                      Statistical Analyses: Poisson regression,
                      GAMs used to adjust for non-linear
                      relation between confounders and ER
                      admissions.
                      Covariates: Time-trend variables:  yr,
                      mo, and day of wk, daily temperature
                      difference, and dew point temperature.
                      Linearity: Investigated graphically by
                      using the LOESS smoother.
                      Statistical Package: NR
                      Lag:  0-3, cumulative lag up to 3 days
                                  NO224-havg  (ppb):
                                  Mean: 29.9
                                  SD = 8.4
                                  Min: 8.3
                                  Max: 77.1
                                  IQR: 9.6 ppb

                                  # of Stations:  16

                                  Correlation among
                                  stations:  NR
                       PM1024h;r=0.50
                       PM2 5 24 h; r = 0.64
                       CO 8-h avg; r = 0.77
                       SO2 24 h; r = 0.64
                       O3 1-h max; r= 0.43

                       Two-pollutant
                       models to adjust for
                       copollutants.
                  Results reported for OR for association of
                  emergency department admissions with an IQR
                  increase in NO2 (9.3 ppb)

                  Cerebrovascular:
                  1.032(0.991,1.074), lag 0
                  Stroke:
                  0.994(0.914, 1.074), lag 0
                  Ischemic stroke:
                  1.025(0.956, 1.094), lag 0
                  Hemorrhagic stroke:
                  0.963(0.884, 1.042), lag 0

                  No significant associations for NO2 reported.
                  Lag 0 shown but similar null results were
                  obtained for lags 1-3. NO2 highly correlated
                  with PM and CO.
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            TABLE AX6.3-9 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                                           AND VISITS: ASIA
   Reference, Study
  Location, & Period
    Outcomes, Design, & Methods
     Mean Levels &
   Monitoring Stations
   Copollutants      Effects: Relative Risk or Percent Change &
  (Correlations)      Confidence Intervals ([95% Lower, Upper])
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           Chang et al. (2005)
           Taipei, Taiwan

           Study Period:
           1997-2001, 5 yrs
Hosseinpoor et al.
(2005)
Tehran, Iran

Study period:
Marl996-Mar2001,5
yrs
Outcome(s) (ICD9):  CVD 410-429.
Daily clinic visits or hospital admission
from computerized records of National
Health Insurance. Discharge data.
Source Population: 2.64 Million
N: 40.8 admissions/day, 74,509/5 yrs
# Hospitals: 41
Study Design: Case-crossover, referent
day 1 wk before or after index day
Statistical Analyses:  Conditional logistic
regression.
Covariates:  Same day temperature and
humidity.
Season:  Warm/cool (stratified by
temperature cutpoint of 20 °C)
Lag(s):  0-2 days

Outcome(s) (ICD9):  Angina pectoris
413. Primary discharge diagnosis from
registry databases or records.
Study Design: Time-series
Statistical Methods: Poisson regression
# Hospitals: 25
Covariates:  Long-term trends,
seasonality, temperature, humidity,
holiday, post-holiday, day of wk.
Lag(s):  0-3
                                                               NO2 24-h avg (ppb):
                                                               Mean:  31.54
                                                               Min: 8.13
                                                               25th: 26.27
                                                               50th: 31.03
                                                               75th: 36.22
                                                               Max: 77.97

                                                               # of Stations: 6
NO2 24-h avg (ug/m3)
Mean(SD): 60.01(39.69)
Min: 0.30
25th: 29.39
Median: 47.42
75th: 84.55
Max: 324.78
                           CO 24-h avg
                           O3 24-h avg
                           SO2 24-h avg
                           PM10 24-h avg

                           Correlations not
                           reported.

                           Two-pollutant
                           models to adjust for
                           copollutants
N02 CO 03 PMi,

Correlations not
reported
                    OR for the association of CVD admissions with
                    an incremental increase in 24-h avg NO2
                    equivalent to one IQR, 9.95 ppb.

                    Warm(>20°C)
                    1.177(1.150, 1.205), lag 0-2
                    Cool (<20 °C)
                    1.112(1.058, 1.168), lag 0-2

                    NO2 effect remained in all warm season two-
                    pollutant models. Effect remained in cool
                    season two-pollutant models with the exception
                    of the model that included PM10.
Results reported for relative risk in hospital
admissions per increment of 10 ug/m3 SO2.

Angina
1.00618 (1.00261, 1.00976), lag 1

In a multipollutant model only CO (lag 1) was
significantly associated with angina pectoris
related hospital admissions.
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            TABLE AX6.3-9 (cont'd).  HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN: CVD HOSPITAL ADMISSIONS
                                                                          AND VISITS:  ASIA
   Reference, Study
  Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
                                                                     Copollutants      Effects: Relative Risk or Percent Change &
                                                                     (Correlations)      Confidence Intervals ([95% Lower, Upper])
X
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           Lee et al. (2003a)*
           Seoul, Korea

           Study period:
           Dec 1997-Dec 1999,
           822 days, 184 day sin
           summer
Tsai et al. (2003a)
Kaohsiung, Taiwan

Study period:
1997-2000
Outcome(s) (ICD10): IHD: Angina
pectoris 120; Acute or subsequent MI 121-
123; other acute IHD 124.  Electronic
medical insurance data used.
Study Design: Time-series
Statistical Methods: Poisson regression,
GAM with default convergence criteria.
Age groups analyzed: all ages, 64+
Covariates:  long-term trends LOESS
smooth, temperature, humidity, day of wk.
Season: Presented results for summer
(Jun, Jul, Aug) and entire period.
Lag(s):  0-6

Outcome(s) (ICD9): All cerebrovascular
430-438; SHS 430; PIH 431-432; IS 433-
435; Other 436-438. Ascertained from
National Health Insurance Program
computerized admissions records.
Study Design: Case-crossover
Statistical Analysis: Conditional logistic
regression.
Statistical Software: SAS
Seasons: >20°C;<20°C.
N: 23,179 stroke admissions
# Hospitals:  63
Lag(s):  0-2, cumulative lag up to 2
previous days
                                                               NO2 24 h (ppb):
                                                               5th:  16
                                                               10th: 23.7
                                                               Median: 30.7
                                                               75th: 38.3
                                                               95th: 48.6
                                                               Mean(SD):  31.5(10.3)
                                                               IQR: 14.6
                                   24-h avg NO2 (ppb)
                                   Min:  6.25
                                   25th:  19.25
                                   Median:  28.67
                                   75th:  36.33
                                   Max:  63.40
                                   Mean: 28.17
                                                             PM10;r= 0.73, 0.74
                                                             S02;r = 0.72, 0.79
                                                             O3;r= -0.07, 0.63
                                                             CO; r = 0.67, 0.79

                                                             Range depends on
                                                             summer vs. entire
                                                             period.

                                                             Two-pollutant
                                                             models
                        PM10
                        S02
                        CO
                        03
Results reported for RR of IHD hospital
admission for an incremental increase in NO2
equivalent to one IQR.

64+, entire study period:
1.08(1.03, 1.14), lag 5
64+, summer only:
1.25 (1.11, 1.41), lag 5

Results for lag 5 presented above. Lag 0 or 1
results largely null - presented graphically.
Confounding by PM10 was not observed in these
data using two-pollutant models.

Results reported as OR for the association of
admissions with an incremental increase of NO2
equivalent to the IQR of 17.1 ppb

PIH admissions
Warm: 1.56 (1.32, 1.84), lag 0-2
Cool:  0.81(0.0, 1.31), lag 0-2

IS admissions:
Warm: 1.55 (1.40, 1.71), lag 0-2
Cool:  1.16(0.81,1.68), lag 0-2
Effects persisted after adjustment for PM10,
SO2, CO, and O3.
PIH:
1.31(1.03, 1.66) N02w/PM10
1.66 (1.38, 2.00), NO2 w/ SO2
1.60(1.25,2.05)NO2w/CO
1.51(1.26, 1.80)N02w/03
IS:
1.39(1.20, 1.60) N02w/PM10
1.62(1.45, 1.81),N02w/S02
1.54(1.33, 1.79),NO2w/CO
1.53(1.37, 1.71),N02w/03

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             TABLE AX6.3-9 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                            AND VISITS: ASIA
 Reference, Study
Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants         Effects: Relative Risk or Percent Change &
(Correlations)        Confidence Intervals ([95% Lower, Upper])
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           Wong etal. (1999)
           Hong Kong, China

           Study Period:
           1994-1995
           Wong et al. (2002)*
           Hong Kong
           London

           Study Period:
           1995-1997
                      Outcome(s) (ICD9):  CVD:  410-417,
                      420-438,440-444; CHF 428; IHD 410-
                      414; Cerebrovascular Disease 430-438.
                      Hospital admissions through ER
                      departments via Hospital Authority
                      (discharge data).
                      Study Design:  Time-series
                      Statistical Analyses:  Poisson regression,
                      linear and quadradic terms for long-term
                      trends, APHEA protocol
                      # Hospitals:  12
                      Covariates: Daily temperature, relative
                      humidity day of wk, holidays, influenza,
                      long-term trends (yr and seasonality
                      variables). Interaction of pollutants with
                      cold season examined.
                      Season:  Cold (Dec-Mar)
                      Lag(s): 0-3 days
                      Outcome(s) (ICD9):  Cardiac disease
                      396-429; IHD 410-414. Admissions
                      through the emergency department,
                      general outpatient, or direct to inpatient
                      wards.
                      Study design:
                      Statistical analysis: Poisson regression,
                      GAMs, nonparametric smooth functions
                      (LOESS)
                      Covariates:
                      Statistical Software:  SPlus
                                  NO2 24-h avg (ug/m )
                                  Minimum:  16.41
                                  25th: 39.93
                                  Median:  51.39
                                  75th: 51.39
                                  Maximum:  122.44
                                  24-h avg NO2
                                  Hong Kong
                                  Mean (warm/cool): 55.9
                                  (48.1/63.8)
                                  Minimum:  15.3
                                  10th:  31.8
                                  50th:  53.5
                                  90th:  81.8
                                  Max:  151.5
                                  Hong Kong
                                  Mean (warm/cool): 64.3
                                  (62.6.1/66.1)
                                  Minimum:  23.7
                                  10th:  42.3
                                  50th:  61.2
                                  90th:  88.8
                                  Max:  255.8
                      PM10;r=0.79
                      S02
                      03

                      Range for other pollutants:
                      r = 0.68, 0.89.
                      Hong Kong
                      S02;r = 0.37
                      PM10;r=0.82
                      O3;r=0.43
                      London
                      SO2;r = 0.71
                      PM10;r=0.68
                      O3;r=-0.29
                    Results reported for RR associated with
                    incremental increase inNO2 equal to 10 ug/m .

                    CVD
                    5-64 yrs: 1.008 (0.998, 1.018), lag 0-1
                    65+yrs:  1.016 (1.009, 1.023), lag 0-1
                    All ages: 1.013(1.007, 1.020), lag 0-1

                    CHF
                    1.044(1.25, 1.063), lag 0-3
                    IHD
                    1.010(0.999,  1.020), lag 0-1
                    Cerebrovascular Disease
                    1.008(0.998,  1.018), lag 0-1

                    Interaction  of NO2 with O3 observed

                    Results reported for excess risk associated with
                    a 10 ug/m3  change in mean concentration
                    Single-pollutant model.
                    Hong Kong: 1.8 (1.2, 2.4), lag 0-1
                    London: -0.1  (-0.6, 0.5), lag 0-1
                    Multipollutant results
                    Hong Kong:
                    1.6 (1.0, 1.3),  lag 0-1, adjusted for Ozone
                    1.7 (0.8, 2.7),  lag 0-1, adjusted for PM10
                    1.6 (0.8, 2.4),  lag 0-1, adjusted for SO2
                    London:
                    0.1 (-0.5, 0.6), lag 0-1, adjusted for Ozone
                    -0.4 (-1.2, 0.4), lag  0-1, adjusted for PM10
                    -0.2 (-0.9, 0.5), lag  0-1, adjusted for SO2

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           TABLE AX6.3-9 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                        AND VISITS: ASIA
              Reference, Study
             Location, & Period
Outcomes, Design, & Methods
  Mean Levels &
Monitoring Stations
 Copollutants      Effects:  Relative Risk or Percent Change &
(Correlations)      Confidence Intervals ([95% Lower, Upper])
X
           Yang et al. (2004b)
           Kaohsiung, Taiwan

           Period of Study:
           1997-2000
                                   Outcome(s) (ICD9):  All CVD: 410-429
                                   "(All CVD typically defined to include
                                   ICD9 codes 390-459)
                                   N: 29,661
                                   Study Design:  Case-crossover
                                   Statistical Analysis:  Poisson time-series
                                   regression models, APHEA protocol
                                   # of Hospitals: 63
                                   Seasons: Authors indicate not considered
                                   because the Taiwanese climate is tropical
                                   with no apparent seasonal cycle
                                   Covariates: Stratified by warm (>25°)
                                   and cold (<25°) days, temperature and
                                   humidity measurements included in the
                                   model
                                   Statistical Package: SAS
                                   Lag:  0-2 days
                                 24-h avg (ppb)
                                 Min:  6.25
                                 25%:  19.25
                                 50%:  28.67
                                 75%:  36.33
                                 Max:  63.40
                                 Mean: 28.17

                                 # of Stations: 6
                                 Correlation among stations:
                                 NR
                       PM10
                       CO
                       S02
                       O38

                       Two-pollutant
                       models used to
                       adjust for
                       copollutants

                       Correlations NR
                 OR's for the association of one IQR (17.08 ppb)
                 increase in NO2 with daily counts of CVD
                 hospital admissions are reported.

                 All CVD (ICD9: 410-429), one-pollutant model
                 >25°: 1.380(1.246,1.508)
                 <25°: 2.215(2.014,2.437)

                 All CVD (ICD9: 410-429), two-pollutant
                 models
                 Adjusted for PM10:
                 >25°: 1.380(1.246,1.508)
                 <25°: 2.215(2.014,2.437)
                 Adjusted for SO2:
                 >25°: 1.149(1.017,1.299)
                 <25°: 2.362(2.081,2.682)
                 Adjusted for CO:
                 >25°: 1.039(0.919,1.176)
                 <25°: 2.472(2.138,2.858)
                 Adjusted for O3:
                 >25°: 1.159(1.051,1.277)
                 <25°: 2.243(2.037,2.471)
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                                                                                                                      Association of CVD admissions with NO2
                                                                                                                      attenuated on warm days after adjustment for
                                                                                                                      copollutants.  Association persisted on cool
                                                                                                                      days. Kaohsiung is the center of Taiwan's
                                                                                                                      heavy industry.
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            TABLE AX6.3-9 (cont'd). HUMAN HEALTH EFFECTS OF OXIDES OF NITROGEN:  CVD HOSPITAL ADMISSIONS
                                                                             AND VISITS:  ASIA
Reference, Study
Location, & Period
Yeetal. (2001)
Tokyo, Japan

Study Period:
Jul-Aug,
1980-1995







Outcomes, Design, & Methods
Outcome(s): Angina 4 13; Cardiac
insufficiency 428; Hypertension 401-405;
MI 4 10. Diagnosis made by attending
physician for hospital emergency
transports.
Age groups analyzed: 65+ yrs male and
female
Statistical analysis: GLM
Covariates: Maximum temperature,
confounding by season minimal since
only 2 summer mos included in analysis
Statistical Software: SAS
Lag(s): 1-4 days
Mean Levels &
Monitoring Stations
NO2 24-h avg (ppb)
Min: 5.3
Max: 72.2
Mean(SD): 25.4(11.4)









Copollutants
(Correlations)
O3;r= 0.183
PM10; r = 0.643
S02;r = 0.333
CO; r= 0.759









Effects: Relative Risk or Percent Change &
Confidence Intervals ([95% Lower, Upper])
Results reported for model coefficient and
95% CI.

Angina:
0.007 (0.004, 0.009)
Cardiac insufficiency:
0.006(0.003,0.01)
MI:
0.006(0.003,0.01)




* Default GAM
AMI Acute Myocardial
Infarction
ARR Arrhythmia
BC Black Carbon
COH coefficient of haze
CP Course Particulate
CVD Cardiovascular Disease
EC Elemental Carbon
FP Fine Particulate
HS Hemorrhagic Stroke
ICD9 International Classification of Disease,
9th Revision
IHD Ischemic Heart Disease
IS ischemic stroke
MI Myocardial Infarction
OC Organic Carbon
OHC Oxygenated
Hydrocarbons
PERI Peripheral Vascular and
Cerebrovascular Disease
PM Particulate Matter
PIH primary intracerebral hemorrhage
PNC Particle Number Concentration
SHS Subarachnoid hemorrhagic stroke
TP Total Particulate
UBRE Unbiased Risk Estimator
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TABLE AX6.3-10. STUDIES EXAMINING EXPOSURE TO AMBIENT NO2 AND HEART RATE VARIABILITY AS
        MEASURED BY STANDARD DEVIATION OF NORMAL-TO-NORMAL INTERVALS (SDNN)
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Author, Year,
Location
Liao et al.
(2004)
US, ARIC study

Chan et al.
(2005)
Taiwan


Wheeler et al.
(2006)
Atlanta


Luttmann-
Gibson et al.
(2006)
Steubenville



Schwartz et al.
(2005)
Boston







Avg
Study Design Time
Subjects: 4,390 adults
Analysis Method: multivariable
linear regression 24 h
Subjects: 83 adults recruited from
cardiology
Analysis Method: linear mixed
effects regression 1 h

Subjects: 30 adults (12 MI + 22
COPD)
Analysis Method: linear mixed
models 4 h




Subjects: 32 adults (>50 yrs)
Analysis Method: mixed models 24 h


Subjects:
28 elderly adults
Analysis Method: hierarchical
models 24 h






NO2 Cone (ppb)
Copollutant
Mean (sd) Range Correlation Outcome % Change (95% CI)


21(8) none lag 1 -5.0% (-9.2, -7)
PM10: 0.4
03: -0.4
SO2: 0.5
33(15) 1,110 CO: 0.7 4-hlag -4.5% (-8.1, -30)
8-hlag -6.9% (-12.0, -1.8)

MI patients
18 (no sd plO-p20, PM25: 0.4 [N = 12]
given) 7,30 CO: 0.5 4-hlag -26.0% (-42.1, -8.6)
COPD patients
[N = 22] 4-h lag 16.6% (0.2, 34.3)
PM25: 0.4
O3: -0.3
10(nosd p25-p75, SO2: 0.3
given) 6,13 lag 1 0.3% (-6.0, 6.6)



PM25: :0.3
p25-p75, 03: 0.02
medlS 14,23 CO: 0.6 lag 1 -1.6% (-7.8, 5.1)







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TABLE AX6.3-11. STUDIES EXAMINING EXPOSURE TO AMBIENT NO2 AND HEART RATE VARIABILITY AS
 MEASURED BY VARIABLES RECORDED ON IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICDS)
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Author, Year,
Location


Peters et al. (2000a)
Eastern MA


Rich et al. (2005)
Boston





Dockery etal. (2005)
Boston
Pekkanen et al. (2002)
Finland
Ruidavets et al. (2005)
France
NO2 Cone (ppb)
Subjects Analysis Method Mean (sd) Range


100 cardiac logistic regression, 23 (no sd
outpatients fixed effects given) 11,65


203 cardiac p25-max,
outpatients case-crossover med22 18,62





307 cardiac p25-p95,
outpatients logistic regression, GEE med23 19,34
45 cardiac p25-max,
patients linear regression, GAM med 16 12,36
polytomous logistic
863 adults regression 16(6) 2,48
Copollutant
Correlation Outcome
PM2.5: 0.6
Os: -0.3 RiskoflCD-recorded
SO2: 0.3 ventricular
CO: 0.7 arrhythmias
lagl
lag 0-4

all patients lag 0-1
patients with recent
arrhythmia
(<3 days) lag 0-1
PM2.5 > 0.4
O3 < - 0.4 patients with recent
SO2 > 0.4 arrhythmia
CO: 0.6 (<3 days) lag 0-1
PM2.5: 0.4
CO: 0.3 lag 2
03: -0.3
S02: 0.7 lagSh

OR (95% CI)




1.55(1.05,2.29)
1.88(1.01,3.49)

1.54(1.11,2.18)


2.09(1.26,3.51)



2.14(1.14,4.03)

14.1 (3.0,65.4)

2.7(1.2,5.4)
All results given for 20-ppb increase in NO2 with 24-h averaging time.













































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TABLE AX6.3-12. BIRTH WEIGHT AND LONG-TERM NO2 EXPOSURE STUDIES
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Cone Range (ppb) Correlation
Author, Year, Mid- with Other
Location Study Details Low range High Pollutants Outcomes
Lin et al. (2004) Subjects: 92,288 birth cert <26.1 26.1,32.9 >32.9 Pregnancy
Taiwan Years: 1995-1997
Group: Term LEW
Analysis method: Logistic regression
Distance 3 km
Medium NO2
HighN02
<24.3 24.3,34.7 >34.7 Trimester 1
Medium NO2
HighN02
<24.0 24.0,34.4 >34.4 Trimester 2
Medium NO2
HighNO2
<23.8 23.8,34.2 >34.2 Trimester 3
Medium NO2
HighNO2

Lee et al. (2003b) Subjects: 388,105 birth cert 25 31.4 39.7 PM10: 0.66 Pregnancy
Seoul, Korea Years: 1996-1998 SO2: 0.75
Group: Term LEW model (GAM) , Interquartile CO: 0.77
Averaging time: 24h
Analysis method: Generalized additive
PM10: 0.81 Trimester 1
S02: 0.77
CO: 0.78
PM10: 0.8 Trimester 2
S02: 0.76
CO: 0.82
Trimester 3




Odds Ratio





1.06(0.93,1
1.06(0.89,1

1.10(0.96,1
1.09(0.89,1

0.87 (0.76, 1
0.93 (0.77, 1

1.01 (0.88, 1
0.86(0.71,1

1.04(1.00,1




1.02(0.99,1


1.03(1.01,1


0.98 (0.96, 1




(95% CI)





.22)
.26)

.27)
.32)

.00)
.12)

.16)
.03)

.08)




.04)


.06)


.00)



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                  TABLE AX6.3-12 (cont'd). BIRTH WEIGHT AND LONG-TERM NO2 EXPOSURE STUDIES
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Cone Range (ppb)
Author, Year, Mid- Correlation with
Location Study Details Low range High Other Pollutants Outcomes
Bobak M. (2000) Subjects: 69,935 birth cert SO2: 0.53 Trimester 1
Czech Year: 1991
Group: LEW adjusted for GA
Averaging time: 24 h
Analysis method: Logistic regression, 50 jig
increase 12.2 20 31.1
SO2: 0.62 Trimester 2
SO2: 0.63 Trimesters
Gouveia et al. (2004) Subjects: 179,460 live births First Trimester
Sao Paulo city, Brazil Group: Ministry of Health, Brazil
Year: 1997
Analysis method: GAM models 43.5 117.9 399.6
1Q
2Q
3Q
4Q
Second
Trimester
1Q
2Q
3Q
4Q
Third trimester
1Q
2Q
3Q
4Q
Odds Ratio (95% CI)
0.
0.
0.
1
1.
1.
1.


1
0.
1.
1.

1
0.
1.
1.
,98(0.81,1.18)
,99(0.80,1.23)
,97(0.80,1.18)

,060
,197
126



,986
,008
,034


,992
,041
,046

(0
(0.
(0.



(0.
(0.
(0.


(0.
(0.
(0.

.971-1.157)
885-1.619)
812-1.560)



902-1.076)
871-1.167
861-1.243)


913-1.078)
927-1.169
889-1.231)
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                  TABLE AX6.3-12 (cont'd). BIRTH WEIGHT AND LONG-TERM NO2 EXPOSURE STUDIES
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Author, Year,
Location
Maroziene and
Grazuleviciene (2002)
Kaunas, Lithuania







Liu etal. (2003)
Vancouver





Salam et al. (2005)
Southern CA







Study Details
Subjects: 3,988 birth cert
Group: LEW adjusted for GA
Year: 1998
Analysis method: Logistic regression,
10 jig increase





Subjects: 229,085 birth cert
Years: 1986-1998
Group: LEW adjusted for GA
Averaging time: 24 h
Analysis method: Logistic regression,
10 ppb increase

Subjects: 3,901 birth cert
Group Term LEW, CHS:
Years: 1975-1987
Analysis method: Logistic regression
Distance: 5 km or 3 within 50 km, within
county



Cone Range (ppb)
Mid- Correlation with
Low range High Other Pollutants Outcome
Pregnancy




6.2(5.7) Medium NO2
HighNO2
Trimester 1
Trimester 2
Trimester 3
O3: -0.25 First mo
SO2: 0.61
CO: 0.72


15.1 18.1 22.3
Last mo
PM10: 0.55 Pregnancy
03: -0.1
CO: 0.41

36.1
(15.4)
IQR 25 Trimester 1
Trimester 2
Trimester 3
Odds Ratio (95%
CI)
1.28(0.97,1.68)




0.96(0.47,1.96)
1.54(0.80,2.96)
0.91(0.53,1.56)
0.93(0.61,1.41)
1.34(0.94,1.92)
0.98(0.90,1.07)





0.94(0.85,1.04)
0.8(0.4,1.4)





0.9(0.5,1.5)
1.0(0.6,1.6)
0.6(0.4,1.1)
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                   TABLE AX6.3-12 (cont'd). BIRTH WEIGHT AND LONG-TERM NO2 EXPOSURE STUDIES
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Author, Year,
Location
Bell et al. (2007)
CT and MA







Slama et al.
(2007)
Munich





Study Details
Subjects: 358,504 birth cert
Group: LEW adjusted for GA
Years: 1999-2002
Analysis method: logistic regression,
interquartile linear regression, difference in
gms per IQR



Subj ects : 1016 non-premature births
Group: LISA
Analysis method: Poisson Regression





Cone Range (ppb)
Mid- Correlation with
Low range High Other Pollutants
PM2.5: 0.64
PM10: 0.55


17.4
(5.0)

IQR 4.8



0.52 0.75 0.90





Outcome
pregnancy





black mothers

white mothers
Adjusted 1Q


Adjusted 2Q
Adjusted 3Q
Adjusted 4Q
Continuous
coding
Odds Ratio (95%
CI)
1.027(1.002,1.051)





-12.7 (-18.0, -7.5)

-8.3 (-10.4, -6.3)
1


0.80(0.52-1.28)
1.32(0.86-2.09)
1.16(0.71-1.71)
1.21(0.86-1.68)

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                  TABLE AX6.3-13. PRETERM DELIVERY AND LONG-TERM NO2 EXPOSURE STUDIES
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Author, Year,
Location
Bobak (2000)
Czech






Liu S. et al. (2003)
Vancouver





Maroziene and
Grazuleviciene R.
(2002)
Kaunas, Lithuania





Rite et al. (2000)
Southern CA






Study Details
Subjects: 69,935 birth cert
Group: Preterm
Years: 1991
Avg time: 24 h
Analysis Method: Logistic regression, 50 jig
increase


Subjects: 229,085 birth cert
Group: Preterm
Years: 1986-1998
Avg time: 24 h
Distance: 13 monitors
Analysis Method: 10 ppb increase

Subjects: 3,988 birth cert
Group: Preterm
Analysis Method: Logistic regression






Subjects: 97,158 birth cert
Group: Preterm
Years: 1989-1993
Avg time: 24 h
Analysis Method: Logistic regression
Distance: Zip code within 2 miles


Cone Range (ppb)
Mid- Correlation with
Low range High Other Pollutants Outcome
12.2 20 31.1 SO2: 0.62 trimester 1





trimester 2
trimester 3
15.1 18.1 22.3 O3: -0.25 first mo
S02: 0.61
CO: 0.72



last mo
pregnancy



6.2(5.7) medium NO2
highNO2
trimester 1
trimester 2
trimester 3
32 40.9 50.4 PM10: 0.74 first mo
O3: -0.12
CO: 0.64



6 wks before
birth
Odds Ratio
(95% CI)
1.10(1.00,1.21)





1.08(0.98,1.19)
1.11(1.00,1.23)
1.01(0.94,1.07)





1.08(0.99,1.17)
1.25(1.07,1.46)



1.14(0.77,1.68)
1.68(1.15,2.46)
1.67(1.28,2.18)
1.13(0.90,1.40)
1.19(0.96,1.47)
No effects for
any preg period




No effects for
any preg period

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   	TABLE AX6.3-13 (cont'd). PRETERM DELIVERY AND LONG-TERM NO2 EXPOSURE STUDIES	
                                                                      Cone Range (ppb)
    Author, Year,                                                            Mid-                Correlation with                      Odds Ratio
      Location                       Study Details                   Low      range      High      Other Pollutants       Outcome         (95% CI)
           Leem et al. (2006)
           Inchon, Korea
                      Subjects: 52,113 birth cert
                      Group: Preterm
                      Years: 2001-2002
                      Analysis Method: Log binomial regression
                                            15.78
22.93
29.9
PM10: 0.37
SO2: 0.54
CO:  0.63
Trimester 1 Q2    1.13(0.99,1.27)
                                                                                                                            Trimester 1 Q3
                                                                                                                            Trimester 1 Q4

                                                                                                                            Trimester 3 Q2

                                                                                                                            Trimester 3 Q3

                                                                                                                            Trimester 3 Q4
                                                                                                                                  1.07(0.94,1.21)
                                                                                                                                  1.24(1.09,1.41)
                                                                                                                                  Trend .02
                                                                                                                                  1.06(0.93,1.20)

                                                                                                                                  1.14(1.01,1.29)

                                                                                                                                  1.21(1.07,1.37)
                                                                                                                                  Trend <.001
X
Hansen et al. (2006)
Brisbane
Subjects: 28,200 birth cert
Group: Preterm
Years: 2000-2003
Avg time: 24 h
Analysis Method:  Logistic regression
                   PM10: 0.32
                   O3: 0.13
                                                                                                                            trimester 1
                                                                                                                            90 days before
                                                                                                                            birth
                                            0.93(0.78,1.12)
                                                                                                                                  1.03 (0.86, 1.23)
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                               TABLE AX6.3-14. FETAL GROWTH AND LONG-TERM NO2 EXPOSURE STUDIES
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Author, Year,
Location
Salam et al. (2005)
Southern CA, CHS







Study Details
Subjects: 3,901 birth cert
Group: Term SGA, <1 5% of data
Years: 1975-1987
Avg time: 24 h
Analysis Methods: Linear mixed model, IQR = 25
Distance: 5 km or 3 monitors within 50 km



Cone Range (ppb) Correlation
Mid- with Other
Low range High Pollutants
36.1 PM10: 0.55
(15.4) Q3: -0.1
CO: 0.69






Outcome
Pregnancy





Trimester 1
Trimester 2
Trimester 3
Odds Ratio
(95% CI)
1.1(0.9,1.3)





1.2(1.0,1.4)
1.0(0.8,1.2)
1.0(0.8,1.2)
X
          Marines et al. (2005)
          Sydney
Subjects:  51,460 birth cert
Group: SGA, >2sd below national data
Years:  1998-2000
Avg time: 1-hmax
Analysis Methods:  Logistic regression, 1 ppb
Distance:  5 km
                                                                                    18
23
27.5
                                                                                            23.2
                                                                                            (7.4)
PM2.5: 0.66
PM10: 0.47
03:  0.29
CO:  0.57
Trimester 1
                                                                                               Trimester 2

                                                                                               Trimester 3
                                                                                               1 mo before
                                                                                               birth
1.06(0.99,1.14)
                                                                                                                                               1.14(1.07,1.22)

                                                                                                                                               1.13(1.05,1.21)
                                                                                                                                               1.07(1.00,1.14)
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          Liu et al. (2003)        Subjects:  229,085 birth cert
          Vancouver             Group: Term SGA, < 10% national
                                Years:  1986-1998
                                Avg time: 24 h
                                Analysis Methods:  Logistic regression, 10 ppb
                                Distance:  13 monitors Avg
                                                   15.1
                                                                                             18.1
          22.3
        SO2: 0.61
        O3: -0.25
        CO:  0.72
                Trimester 1
                                                                                                                               Trimester 2
                                                                                                                               Trimester 3
                                                                                                                               First mo
                                                                                                                               Last mo
               1.03(0.98,1.10)
                                                                                                              0.94(0.88,1.00)
                                                                                                              0.98(0.92,1.06)
                                                                                                              1.05(1.01,1.10)
                                                                                                              0.98(0.92,1.03)
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                         TABLE AX6.3-15. LUNG FUNCTION AND LONG-TERM NO2 EXPOSURE
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Author, Year
Gauderman
(2004)
Southern CA





Moseler et al.
(1994)
Frieberg,
Germany










Ackermann-
Liebrich et al.
(1997)
Switzerland




Study Details
Subjects: 1757 children age 10-18, CHS
Group: Lung function, Longitudinal
Avg Time: 24-h annual
Anlaysis Method: 2-stage linear Regression, 34.6 ppb
Distance: Study monitors in 12 towns



Subjects: 467 children age 9-16
Group: Lung function
Avg Time: Median wkly
Anlaysis Method: Linear regression, Parameter estimates










Subjects: 3,1 15 adults, 3-yr residents, nonsmokers,
SAPALDIA
Group: Lung function
Avg Time: 24-h annual
Anlaysis Method: 2-stage linear Regression
Distance: Monitors in 8 Study areas


Cone Range (ppb) Correlation
with Other
Low Mid-range High Pollutants Outcome
PM25: 0.79 Difference
PM10: 0.67 in lung
O3: -0.11 growth


FVC
FEVj
MMEF
2 1 .28 with asthma
threshold symp


FEVj
lnMEF75%
lnMEF50%
lnMEF25%
no asthma
symp
FEVj
lnMEF75%
lnMEF50%
lnMEF25%
18.9(8.5) PM10: 0.91 FVC
O3: -0.78
SO2: 0.86



FEVj

Odds Ratio (95% CI)





-95 (-183.4, -0.6)
-101.4 (-164. 5, -38.4)
-211 (-377.6, -44.4)




0.437
-0.011
-0.022
-0.029


-0.049
0.003
0.004
0.003
-0.0123 (-0.0152,
-0.0094)




-0.0070 (-0.0099,
-0.0041)
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                      TABLE AX6.3-15 (cont'd). LUNG FUNCTION AND LONG-TERM NO2 EXPOSURE
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Author, Year,
Location
Schindler et al.
(1998)
Switzerland



Peters et al.
(1999a)
Southern CA







Tager et al.
(2005)
Southern &
Northern CA

Cone Range (ppb)
Analysis Mid-
Study Details Method LOW range High
Subjects: 560 adults, 3-yr residents, SAPALDIA
Group: Lung function
Avg Time: Wkly avg
Anlaysis Method: Linear regression
Distance: Personal and Home monitors



Subjects: 3,293 children, CHS
Group: Lung function
Avg Time: 24 h
Anlaysis Method: Linear regression
Distance: Study monitors in 12 towns







Subjects: 255 students UC Berkeley
Group: Lung function
Avg Time:
Anlaysis Method: Linear regression (men): 22 30 40
(women): 21 27 40
Correlation
with Other
Pollutants Outcome
FVC home
FVC personal
FEV home
FEV personal
FVC all: 1986-
1990
FVC girls:
1986-1990
FEViall: 1986-
1990
FEVi girls:
1986-1990
FVC all: 1994
FVC girls: 1994
FEViall: 1994
FEV! girls:
1994
lnFEF75 men
03: 0.57
lnFEF75 women
Odds Ratio (95% CI)
% change- 0.59 (-1)



-42.6(13.5)
-58.5(15.4)
-23.2(12.5)
-39.9(13.9)
-46.2(16.0)
-56.7(19.8)
-22.3(14.8)
-44.1(16.1)
-0.029 (0.003)
-0.032 (0.002)
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                                           TABLE AX6.3-16  ASTHMA AND LONG-TERM NO2 EXPOSURE
Author, Year,
Location Study Design
Garrett et al. (1 999) Subjects: 148 children ages 7-14
Latrobe Valley, Years: 1994-1995
Australia Distance: In home
Study Group: Asthma, Monash Q








Correlation Conc Ran§e (PPb)
with Other LOW Mid- High Odds Ratio
Analysis Method Pollutants range Study Factor (95% CI)
Logistic regression 6

10 ug

Bedroom NO2 1.01
(0.75,1.37)
Indoor mean 1 .00
(.075,1.31)
winter 0.99
(0.84,1.16)
summer 2.52
(0.99, 6.42)
Hirschetal. (1999)
Dresden, Germany
Subjects:  5,421 children ages 5-7, 9-11
Years:  1995-1996, 12 mo residence
Distance:  4 monitors within 1 km
Study Group: Asthma, ISAAC
Logistic regression

10 ug
                                                                                                     29.3
                                                                                                                       37.8
                                                                                                                              Home address      1.16
                                                                                                                                               (0.94,1.42)
                                                                                                                              Home & school    1.14
                                                                                                                                               (0.86,1.51)
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          Peters etal. (1999b)
          Southern CA, CHS
                    Subjects:  3,676 children Age 9-16
                    Years:  1994
                    Avg time: 24 h
                    Distance:  Study monitors in 12 towns
                    Study Groups: Asthma, Questionnaire
                                     Logistic regression

                                     IQR = 25 ppb
                                           21.5
                                          mean
all children

boys

girls

1.21
(0.850,1.71)
1.25
(0.90,1.75)
1.07
(0.57,2.02)

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                          TABLE AX6.3-16 (cont'd). ASTHMA AND LONG-TERM NO2 EXPOSURE
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Author, Year
Millstein et al. (2004)
Southern CA, CHS






Penard-Morand et al.
(2005)
France 6 towns





Studnicka et al.
(1997)
8 communities,
Lower Austria










Correlation
with Other
Study Design Analysis Method Pollutants
Subjects: 2,034 children age 9-11 Mixed effects PM2.5: 0.28
Years: 1995 model PM10: 0.39
Distance: Study monitors in 12 towns
Study Groups: Asthma, Medication use IQR = 5.74 ppb




Subjects: 4,901 children Age 9-11 Logistic regression PMi0: 0.46
Years: 1999-2000, 3 yr residence O3: 0.76
Avgtime: 3 yrs 10 ug SO2: 0.35
Distance: monitoring sites, school
address
Study Groups: Asthma, ISAAC


Subjects: 843 children Logistic regression
Distance: monitor in each community
Avg time: 3 yrs <.05
Study Group: A sthma, ISAAC










Cone Range (ppb)
Mid-
Low range High Study Factor
annual



Mar-August

Sept-Feb

8.7, 16.1, lifetime asthma
16.0 25.7




current asthma

8.0, 11.7, 14.7, Ever asthma low
8.7 13.3 17.0


Ever asthma
medium
Ever asthma
high
Current asthma
low
Currrent asthma
medium
Current asthma
high
Odds Ratio
(95% CI)
0.94
(0.71,


0.96
(0.68,
0.90
(0.66,
0.94
(0.83,




0.92
(0.77,
1.28



2.14

5.81

1.7

1.47

8.78


1.22)



1.37)

1.24)

1.07)





1.10)














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                          TABLE AX6.3-16 (cont'd). ASTHMA AND LONG-TERM NO2 EXPOSURE
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Author, Year
Wang etal. (1999)
Taiwan


Ramadour et al.
(2000)
7 communities,
France

Shima and Adachi
et al. (2000)
7 communities, Japan
















Study Design
Subjects: 1 17,080 students age 11-16
Distance: 24 district monitors
Study Group: Asthma

Subjects: 2,445 children
Years: 3-yr residence
age 13-14
Distance: Monitors in each community
Study Group: Asthma, ISAAC
Subjects: 905 children age 9-10
Distance: In home measurements
Monitors near schools
Study Groups: Asthma, Prevalence,
Incidence














Correlation Conc Ran§e (PPb)
with Other Mid-
Analysis Method Pollutants LOW range High Study Factor
Logistic regression 28 Current
median asthma
Above/below
median
Logisitic regression 11-27
mean



Logistic regression 20-29 30-39 >40 Outdoor 4th
grade girls
10-ppb increase 7-25
mean
Outdoors
Outdoor 5th
grade girls
Outdoor 6th
grade girls
Indoor 4th
grade girls
Indoor 5th
grade girls
Indoor 6th
grade girls
Outdoor

Indoor

Odds Ratio
(95% CI)
1.08
(1.04,1.13)


Nonsignificant
Results



1.14
(0.65,2.09)



1.14
(0.63,2.13)
0.95
(0.45,2.05)
1.63
(1.06,2.54)
1.67
(1.06,2.66)
1.18
(0.62,2.18)
2.10
(1.10,4.75)
0.87
(0.51,1.43)
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                          TABLE AX6.3-16 (cont'd). ASTHMA AND LONG-TERM NO2 EXPOSURE
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Author, Year
Kim et al. (2004a)
San Francisco Bay
area















Gauderman et al.
(2005)
Southern CA CHS



Hwang et al. (2005)
Taiwan,
National study



Study Subjects
Subjects: 1,109 children Age 9-11
Distance: 10 school sites
Study Group: Asthma















Subjects: 208 children
Avg time: 4 wk
Distance: Outside home
Study Group: Asthma


Subjects: 32,672 children
Distance: Schools within
1 km of monitors
Study Group: Asthma, ISAAC


Correlation Conc Ran§e (PPb)
with Other Mid-
Analysis Method Pollutants LOW range High Study Factor
2-stage Hierarchical PM25: "low" 24 mean All children
model O3: "low"
IQR = 3.6N02
IQR = 14.9 NOX
All 1 yr
residents
1 yr resident
girls
1 yr resident
boys
All children

All 1 yr
residents
1 yr resident
girls
1 yr resident
boys
Logistic regression 13-51 Lifetime
asthma
IQR =5. 7

Asthma med
use
2-stage Hierarchical PM10: 0.34 21.5 29.6 33.1 Parental atopy
model O3: -0.39
SO2: 0.5
lOppbNOx
No parental
atopy
Odds Ratio
(95% CI)
1.02
(0.97, 1.07)


1.04
(0.98,1.10)
1.09
(1.03,1.15)
1.00
(0.94, 1.07)
1.04
(0.97,1.11)
1.07
(1.00,1.14)
1.17
(1.06,1.29)
1.02
(0.93,1.11)
1.83
(1.04,3.21)


2.19
(1.20,4.01)
0.99
(0.92, 1.07)


1.02
(0.95,1.10)

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                      TABLE AX6.3-17. RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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Cone Range (ppb) Correlation
Author, Year

Karr et al.
(2006)

Karr et al.
(2006)
Garrett et al.
(1999)
wheeze
cough
short of breath
chest tightness
any symptoms
any symptoms
any symptoms
Hirsch et al.
(1999)
wheeze home
wheeze school
cough home
cough school
cough non-
atopic child

Peters et al.
(1999b)
wheeze
cough
wheeze boys
wheeze girls
Study
Location

Southern
California

Southern
California
Latrobe
Valley
Australia







Dresden
Germany







Southern CA
CHS



Study Group Study Subjects
18,595 cases;
Infant 169,472 controls
Bronchiolitis ages 3 wks to 1 yr
18,595 cases;
Infant 169,472 controls
Bronchiolitis ages 3 wks to 1 yr

Symptoms 148 children
MonashQ Age 7- 14
1994-1995






Symptoms 5,421 children
ISAAC Age 5-7, 9 1 1
1995-1996
12 mo residence





Symptoms 3,676 children
Questionnaire Age 9- 16
1994


Odds Ration
(95% CI)

1.03 [0.99, 1.07]
per 16 ppb

1.04 [1.00, 1.08]
per 15 ppb


1.15(0.85, 1.54)
1.47(0.99,2.18)
1.23 (0.92, 1.64)
1.12(0.81, 1.56)
1.24(0.91, 1.68)
1.12(0.93, 1.35)
2.71(1.11,6.59)


1.13(0.93, 1.37)
0.95 (0.72, 1.26)
1.22(1.94, 1.44)
1.21 (0.96, 1.52)

1.42(1.10, 1.84)



1.12(0.86, 1.45)
1.14(0.94, 1.39)
1.54(1.04,2.29)
0.86(0.57, 1.29)
Analysis Mid- with Other
Method Unit of Averaging Time LOW range High Pollutants Distance
Conditional
logistic Chronic (lifetime avg of
regression 1-h daily max) (ppb) 12 58 204
Conditional Subchronic (avg of 1-h
logistic daily max 1 mo prior to
regression hospitalization) (ppb) 12 57 152
Logistic
regression 6

10 ug


10 ug mean
10 ug winter
10 ug summer
Logistic
regression 29.3 33.8 37.8

10 ug





Logistic 21.5
regression 24 h mean

IQR = 25 ppb




34 monitors

34 monitors
in home






4 monitors



Within 1 km






Study
monitors
in 12 towns




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TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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^
X
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ON
OJ

M
\^
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Author, Year Study Location
Millstein et al.
(2004) Southern CA
wheeze CHS
wheeze
Mar-Aug
wheeze
Sept-Feb
Penard-
Morand et al.
(2005) France 6 towns


wheeze past
12mos.



Wageningen and
Roemer et al. Bennekom,
(1993) Netherlands
Mukala et al. Helsinki
(1999)
cough Finland

cough
nasal symp
winter
nasal symp
winter
nasal symp
spring
nasal symp
spring








Study Group Study Subjects

Symptoms 2,034 children
Age 9- 11

1995




Symptoms 4,901 children
IS SAC Age 9- 11


1999-2000
3-yr residence

73 children
grades 3-8
Symptoms Dec 1990-
Questionnaire Mar 1991
Symptoms 163 children

Age 3-6

1991















Odds Ration
(95% CI)


0.93(0.77, 1.12)

0.79(0.40, 1.53)

0.85(0.64, 1.14)






0.87(0.75, 1.01)





No associations


1.23 (0.89, 1.70)

1.52(1.00,2.31)
0.99(0.58, 1.68)

0.89(0.44. 1.82)

0.76(0.56, 1.02)

0.68(0.46, 1.01)







Unit of Conc Ran§e (PPb)
Averaging Mid-
Analysis Method Time Low range High
Mixed effects
model Moly


IQR = 5.74ppb




Logistic regression 3 yrs


8.7, 16.1,
10 ug 16.0 25.7



Time series using
Yule-Walker
estimation method 24 hr avg 127
GEE WklyAvg <8.6 8.6, >14.5
14.5
2nd tertile

3rd tertile
2nd tertile

3rd tertile

2nd tertile

3rd tertile







Correlation
with Other
Pollutants Distance
PM25: 0.28 Study monitors
PMi0: 0.39 in 12 towns





29 monitoring
sites,
school address

03: 0.76
SO2: 0.35
PMi0: 0.46


National Air
PM10: 0.57 Quality
SO2: 0.26 Monitoring
BS: 0.65 Network
Palmes tubes

On outer
garment















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                  TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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Study
Author, Year Location
Pikhart et al. Prague
(2000)
wheeze Czech
wheeze
wheeze
Setiani, (1996) 6 cities in
Japan
Lacrimacy
Eye itch
Runny nose
Sore throat
Cough
Plegm
SOB
Sum of cough
with phlegm and
SOB
Van Strien
(2004) CT and MA
wheeze
wheeze
wheeze
cough
cough
cough
short of breath
short of breath
short of breath
Odds Ration
Study Group Study Subjects (95% CI)
Symptoms 3,045 children
SAVIAH Age 7-10 1.16(0.95,1.42)
1993-1994 1.07(0.86,1.33)
1.08(0.86, 1.36)
Hiroshima 13,836 adult non- Logistic regression
Community smoking women coefficient
Health Study aged 40-59 (standard error)
0.047 (0.046)
0.036 (0.046
-0.018(0.076)
0.059 (0.042)
-0.046(0.044)
-0.088(0.049)
-0.056(0.058)
-0.035 (0.030)

Symptoms 849 children
Agel2mos 1.15(0.79,1.67)
1.03 (0.69, 1.53)
1.45 (0.92, 2.27)
0.96(0.69, 1.36)
1.33 (0.94, 1.88)
1.52(1.00,2.31)
1.59(0.96,2.62)
1.95(1.17.3.27)
2.38(1.31,4.34)
Unit of Conc Ran§e (PPb> Correlation
Averaging Mid- with Other
Analysis Method Time Low range High Pollutants Distance
Multi-level model 14.8 19 24.1
Individual covariates
Ecological covariates
Both covariates
Individual multiple 24 h graph graph graph SPM: 0.606
linear regression ox: -0.337
analysis









Poisson regression 10-14 day 5.1 9.9 17.4 In home
Q2 Avg
Q3
Q4
Q2
Q3
Q4
Q2
Q3
Q4
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                  TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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:x!
rN
ON
i
Study Study
Author, Year Location Group
Nitschke et al.
(2006) Adelaide Symptoms

Wheeze school Australia
Wheeze home
Cough school
Cough home
Difficult breath
school
Difficult breath
home
Chest tight
school
Chest tight home

Hoek and
Brukekreef Wageningen, Primary
(1993) Netherlands school
Study Odds Ration
Subjects (95% CI)

174 asthmatic
Children, age
5-13 0.99(0.93,1.06)
2000 1.00(0.90,1.11)
1.01 (0.98, 1.04)
0.99(0.96, 1.02)

1.11 (1.05, 1.18)

1.03(1.01, 1.05)

1.12(1.07, 1.17)
1.02(0.95, 1.09)


1 12 children
grades 4-7 No association
Unit of Conc Ran§e (PPb)
Averaging Mid-
Analysis Method Time Low range High
School 117
Zero-inflated negative 34 (28) max
Home 147
binomial regression 20 (22) max

10-ppb increase








Individual linear
regression analysis and
distribution of individual
regression slopes 24-h 127
Correlation
with Other
Pollutants Distance

9 days in class

3 days at home











PMi»: 0.55
S02: 0.28
BS: 0.65
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                   TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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Study Study
Author, Year Location Group
Delfmo et al. Southern Asthmatic
(2006) California children

Personal NO2
Not taking anti-
inflammatory
meds
Taking anti-
inflammatory
meds
Inhaled
corticosteroids
Antileukotrienes
± inhaled
corticosteroes
Central site NO2
Not taking anti-
inflammatory
meds
Taking anti-
inflammatory
meds
Inhaled
corticosteroids
Antileukotrienes
± inhaled
corticosteroes
Study Odds Ration
Subjects (95% CI) Analysis Method
Linear mixed effects
45 children models (Verbeke and
ages 9- 1 8 Molenberghs 200 1 )


0.80 (-3.01 to 4.61)

1.67 (0.55 to 2.79)

1.22 (0.04 to 2.40


1.73 (-0.70 to 4.16)

0.96 (-1.34 to 3.26)

1.48 (0.47 to 2.50)

1.32 (0.33 to 2.32)


-7.5 (-2.83 to 1.32)
Unit of Cone Range (ppb) Correlation
Averaging Mid- with Other
Time Low range High Pollutants
Personal NO2,
personal PM2.5:
24-h 0.33
Central NO2,
personal PM25:
0.22
Central NO2,
central PM25:
0.25
















Distance
Backpack monitor,
active sampling system,
central site exposure



















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                 TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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Study
Author, Year Study Location Group
Salome et al.
(1996) Australia asthmatic
Day of exposure-
room air
Change in
symptom score:
adult
Change in
symptom score:
Child
Week following
exposure- room air
Severity score:
adult
Severity score:
child
Russia, Austria,
Pattenden et al. Italy, Switzerland,
(2006) Netherlands PATY

Wheeze
Asthma
Bronchitis
Phlegm
Nocturnal cough
Morning cough
Sensitivity to
inhaled allergens
Hay fever
Itchy rash
Woken by wheeze
Allergy to pets



Unit of Conc Ran§e (PPb) Correlation
Odds Ration Averaging Mid- with Other
Study Subjects (95% CI) Analysis Method Time Low range High Pollutants Distance
20 (9 adults and 0.02 1.12
11 children) ANOVA ppm ppm




0.01 (0.38)


-0.02(0.26)



4.38(1.5)

4.20(1.3)

23,955 children Logistic regression,
ages 6-12 Cochran y? 12.45 50.00 variable
1993-1999
1.01(0.93-1.10)
1.02(0.94-1.09)
0.99(0.88-1.12)
1.05(0.95-1.17)
1.13(0.94-1.35)
1.15(1.01-1.30)
1.13(1.01-1.26)

1.04(0.98-1.11)
1.05(0.98-1.12)
1.06(0.89-1.26)
1.14(0.99-1.31)


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                  TABLE AX6.3-17 (cont'd). RESPIRATORY SYMPTOMS AND LONG-TERM NO2 EXPOSURE
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Author, Year
Chen etal. (1999)
Day average
1 day lag- FVC
1 day lag- FEVio
2 day lag- FVC
2 day lag FEVio
7 day lag- FVC
7 day lag- FEV10
Daytime Peak
1 day lag- FVC
1 day lag- FEVio
2 day lag- FVC
2 day lag FEVio
7 day lag- FVC
7 day lag- FEVio
Unit of Conc RanSe (PPb> Correlation
Study Study Odds Ration Analysis Averaging Mid- with Other
Location Study Group Subjects (95% CI) Method Time Low range High Pollutants Distance
Taiwan Study on Air 941 children Coefficient models 9.2 141.6
Pollution and Health ages 8-13 (standard error)

-2.66(1.23)
-0.46(1.16)
-3.32(1.53)
-0.93(1.45)
1.39(1.71)
2.52(1.61)

-0.59(0.40)
-0.16(0.37)
-1.33(0.72)
-0.36(0.68)
-0.13(0.87)
0.43 (0.82
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                                              TABLE AX6.3-18. LUNG CANCER
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Cone Range (ppb)
Mid-
Author, Year, Location Exposure Study Subjects Low range High Analysis
Nyberg et al. (2000) From addresses 1 ,042 cases, 2,364 controls
Stockholm, Sweeden and traffic men age 40-75 8.1 10.6 13.3 logistic regression
30-yr estimated exposure
10 ng
Q2
Q3
Q4
10-yr estimated exposure
10 jig
Q2
Q3
Q4
90th percentile
Nafstad (2004) Home address 1 6,209 men age 40-49 at
Norway 1972-1974 entry followed 1972-1998 5.32 10.6 16 Cox proportional
lung cancer incidence
10 ng
Q2
Q3
Q4
non-lung cancer
10 jig
Q2
Q3
Q4
Odds Ratio (95% CI)


1
1
0
1

1
1
1
1
1



1
0
1
1

1
0
1
1


.05 (0.
.18(0.
.90 (0.
.05 (0.

.10(0.
.15(0.
.01 (0.
.07 (0.
.44(1.



.08(1.
.90 (0.
.06 (0.
.36(1.

.02 (0.
.98 (0.
.05 (0.
.04 (0.


,93,
,93,
,71,
,79,

,97,
,91,
,79,
,81,
,05,



,02,
,70,
,81,
,01,

,99,
,88,
,94,
,91,


1.18)
1.49)
1.14)
1.40)

1.23)
1.46)
1.29)
1.42)
1.99)



1.15)
1.15)
1.38)
1.83)

1.06
1.08)
1.18)
1.18)
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                 TABLE AX6.3-19. EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                                    STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome
Measure
Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported
Method/Design
Effect Estimates
META ANALYSIS
Stieb et al. (2002),
re-analysis (2003)
meta-analysis of
estimates from
multiple countries.
All cause
24-h avg ranged from
13 ppb (Brisbane,
Australia) to 38 ppb
(Santiago, Chile).
"Representative"
concentration: 24 ppb
PMio, O3, SO2, CO
The lags and
multiday
averaging used in
these estimates
varied
Meta-analysis of
Time-series study
results
Single-pollutant model (11
estimates): 0.8%(95%CI:
0.2,1.5);
Multipollutant model
estimates (3 estimates):
0.4%(95%CI: -0.2,1.1)
UNITED STATES
Samet et al. (2000a,b)
(reanalysis Dominici
et al., 2003) 90 U.S.
All cause;
cardiopulmonary
Ranged from 9 ppb
(Kansas City) to 39
ppb (Los Angeles),
PMio, O3, SO2,
CO; two-pollutant
models
0,1,2
Poisson GAM,
reanalyzed with
stringent convergence
24-h avg NO2 (per 20 ppb):
Posterior means:
All cause:
cities (58 U.S. cities

with NO2 data)

1987-1994
                                         24-h avg
criteria; Poisson GLM.

Time-series study.
Lagl: 0.50% (0.09, 0.90)

Lag 1 with PM10 and SO2:

0.48% (-0.54, 1.51)
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Kinney and Ozkaynak
(1991)
Los Angeles County,
CA
1970-1979
Kelsalletal. (1997)
Philadelphia, PA,
1974-1988


All cause; 69 ppb, 24-h avg
respiratory;
circulatory


All cause; 39.6 ppb, 24-h avg
respiratory;
cardiovascular,


KM (particle optical 1
reflectance), NO2,
S02, CO;
multipollutant models

TSP, CO, SO2, O3 0 (AIC presented
for 0 through 5)



OLS (ordinary least
squares) on high-pass
filtered variables.
Time-series study.

Poisson GAM




All cause:
Exhaustive multipollutant
model: 0.5% (-0.1, 1.2);
Two pollutant with Ox:
0.7% (0.5, 1.0)
All cause:
Single pollutant: 0.3%
(-0.6,1.1);
With TSP: -1.2%
(-2.2, -0.2)
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          TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                             STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
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Reference, Study
Location, and Period
Outcome
Measure
Copollutants
Mean NO2 Levels Considered
Lag Structure
Reported Method/Design
Effect Estimates
UNITED STATES (cont'd)
Ostro et al. (2000)
Coachella Valley, CA
1989-1998
Fairley (1999;
reanalysis
Fairley, 2003)
Santa Clara County,
CA
1989-1996
Gamble (1998)
Dallas, TX
1990-1994
Dockeryetal. (1992)
St. Louis, MO and
Eastern Tennessee
1985-1986
All cause;
respiratory;
cardiovascular;
cancer; other
All cause;
respiratory;
circulatory
All cause;
cardiopulmonary
All cause
20 ppb, 24-h avg PM10, PM2.5,
PM10-2.5, O3, CO
28 ppb, 24-h avg PM10, PM2.5,
PM10-2.5, S042\
coefficient of
haze, NQ3, O3,
S02;
1 5 ppb, 24-h avg PM10, O3, SO2,
CO; two-pollutant
models
St. Louis: 20 ppb; PM10, PM2.5, SO4,
Eastern Tennessee: LT", O3, SO2
12.6 ppb, 24-h avg
0-4 Poisson GAM with
default convergence
criteria. Time-series
study.
0, 1 Poisson GAM,
reanalyzed with
stringent convergence
criteria; Poisson GLM.
Time-series study.
Avg 4-5 Poisson GLM. Time-
series study.
Lag 1 Poisson with GEE.
Time-series study.
Lag 0 day:
All cause: 5. 5% (1.0, 10.3)
Respiratory: 1.8%(-10.3, 15.5)
Cardiovascular: 3.7% (- 1 .7, 9.3)
Lagl:
All cause: 1.9% (0.2, 3.7);
Cardiovascular: 1 .4% (- 1 .7, 4.5);
Respiratory: 4. 8% (-0.3, 10.2)
All cause: 4.4% (0.0, 9.0)
Cardiovascular: 1.9% (-4.6, 9.0)
Respiratory: 13. 7% (-2.0, 32.0)
All cause:
St. Louis,MO: 0.7% (-3.5, 5.1)
Eastern Tennessee: 3. 9% (-8.7, 18.2)
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               TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                                           STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period Outcome Measur
UNITED STATES (cont'd)
Moolgavkar (2003) All cause;
Cook County, IL and cardiovascular
Los Angeles County,
CA, 1987 1995
e Mean NO2 Levels

Cook County: 25 ppb;
Los Angeles: 38 ppb,
24-h avg
Copollutants Lag Structure
Considered Reported

PM2 5, PMio, O3, 0,1,2,3,4,5
SO2, CO; two
pollutant models
Method/Design

Poisson GAM with
default convergence
criteria. Time-series
study.
Effect Estimates

All cause:
Lagl:
Cook County:
Single pollutant:
Moolgavkar
(2000a,b,c);
re-analysis (2003).
Cook County, IL; Los
Angeles County, CA,
and Maricopa County,
AZ,
1987-1995
                                Cardiovascular;
                                cerebro vascular;
                                COPD
Cook County: 25 ppb;
Los Angeles:  38 ppb;
Maricopa County:  19
ppb, 24-h avg
PM2.5, PMio, 03,
SO2, CO; two- and
three-pollutant
models
0,1,2,3,4,5
Poisson GAM with
default convergence
criteria in the original
Moolgavkar (2000);
GAM with stringent
convergence criteria
and GLM with natural
splines in the 2003
re-analysis. The 2000
analysis presented
total death risk
estimates only in
figures.
2.2% (1.3, 3.1); with
PM10: 1.8% (0.7,
3.0);
Los Angeles: Single
pollutant:  2.0% (1.6,
2.5); with PM25:
1.8% (0.1, 3.6).
GAM, Lagl:
Cardiovascular:
Cook County: 1.1%
(-0.5,2.8); Los
Angeles: 2.8% (2.0,
3.6); Maricopa Co.:
4.6% (0.5, 9.0);
Re-analysis, GLM:
Total deaths: 2.5%
(1.5,3.6)
Lippmann et al.
(2000); reanalysis Ito,
(2003, 2004)
Detroit, MI
1985-1990
1992-1994



All cause;
respiratory;
circulatory;
cause-specific





1985-1990: 23.3 ppb,
24-h avg
1992-1994: 21.3 ppb,
24-h avg





PM10,PM2.5, 0,1,2,3,0-1,
PMio-2.5, S042\ Lf, 0-2, 0-3
03, S02, CO;
two-pollutant
models




Poisson GAM,
reanalyzed with
stringent convergence
criteria; Poisson GLM.
Numerical NO2 risk
estimates were not
presented in the re-
analysis. Time-series
study.
Poisson GAM:
All cause:
Lagl:
1985-1990:
0.9% (-1.2, 3.0)
1992-1994:
1.3% (-1.5, 4.2)



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           TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                             STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
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Reference, Study
Location, and Period
Outcome Measure Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported Method/Design
Effect Estimates
UNITED STATES (cont'd)
Lipfert et al. (2000)
Seven counties in
Philadelphia, PA area
1991-1995




Chock et al. (2000)
Pittsburgh, PA
1989-1991

De Leon etal. (2003)
New York City, NY
1985-1994


Klemm and Mason
(2000); Klemm et al.
(2004)
Atlanta, GA
Aug 1998-M2000



All cause; 20.4 ppb, 24-h avg
respiratory;
cardiovascular;
all ages; age
65+ yrs; age
<65 yrs; various
subregional
boundaries
All cause; age Not reported.
<74 yrs;
age 75+ yrs

Circulatory and 40.6 ppb, 24-h avg
cancer with and
without contributing
respiratory causes

All cause; 51.3 ppb, max 1-h.
respiratory;
cardiovascular;
cancer; other; age
<65 yrs; age
65+ yrs


PMio, PM2.5,
PM10_2.5, S04
O3, other PM
indices, NO2, SO2,
CO; two-pollutant
models


PMio, NO2, SO2,
CO; two-, live-,
and six-pollutant
models
PMio, O3, SO2,
CO; two-pollutant
models


PM2.5, PMio-2.5,
EC, OC, 03,
SO42~,
N03, S02, CO




0-1 Linear with 1 9-day
weighted avg
Shumway filters.
Time-series study.
Numerous results.



0, plus minus 3 days. Poisson GLM. Time-
series study.
Numerous results

0 or 1 Poisson GAM with
stringent convergence
criteria; Poisson GLM.
Time-series study.

0-1 Poisson GLM using
quarterly, moly, or
biweekly knots for
temporal smoothing.
Time-series study.



All-cause, avg of 0- and
1-day lags,
Philadelphia:
2.2% (p > 0.05)




All cause, lag 0, age
0-74: 0.5% (-2.4, 3.5);
age 75+: 1.0% (-1.9, 4.0)

Gaseous pollutants results
were given only in
figures. Circulatory:
Age < 75: -1%
Age 75+: -2%
All cause, age 65+ yrs:
avg 0-1 days
Quarterly knots:
1.0% (-4.2,6.6);
Moly knots:
3.1% (-3.0, 9.7);
Bi-wkly knots:
0.9% (-5.9, 8.2)
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              TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                                        STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome Measure
Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported Method/Design
Effect Estimates
UNITED STATES (cont'd)
Gwynn et al. (2000)
Buffalo, NY
Time-series study.
All cause;
respiratory;
circulatory
24-h avg 21 ppb
PMio, CoH, O3, SO2,
CO, If, SO42~
Poisson GAM with
Default convergence
criteria.
All cause (lag 3):
2.1% (-0.3, 4.6);
Circulatory (lag 2):
1.3% (-2. 9, 5.6);
Respiratory (lag 1):
6.4% (-2. 5, 16.2)
CANADA
Burnett et al. (2004)
12 Canadian cities
1981-1999
All cause
24-h avg ranged from
10 (Saint John) to 26
(Calgary) ppb.
PM25,PM10-25, O3,
S02, CO
1,0-2 Poisson GLM. Time-
series study.
Lag 0-2, single
pollutant: 2.0%
(1.1, 2.9); with O3:
1.8% (0.9, 2.7)
          Burnett et al. (2000);
          re-analysis (2003)
          8 Canadian cities
          1986-1996
All cause
24-h avg ranged from
15 (Winnipeg) to 26
(Calgary) ppb.
PM2.5,PM10,
PM2.5_10, S02,
03,CO
0, 1, 0-2
Poisson GAM with
default convergence
criteria. Time-series
study.  The 2003 re-
analysis did not
consider gaseous
pollutants.
Days when PM indices
available, lag 1, single
pollutant:  2.4% (0.7,
4.1);withPM25: 3.1%
(1.2,5.1)
Days when PM indices
available, lag 1, single
pollutant:  3.6%
(1.6, 5.7); with PM25:
2.8% (0.5, 5.2)
Burnett et al. (1 998a), All cause
1 1 Canadian cities
1980-1991
24-h avg ranged from SO2, O3, CO
14 (Winnipeg) to 28
(Calgary) ppb.
0,1,2,0-1,0-2
examined but the
best lag/averaging
for each city
chosen
Poisson GAM with
default convergence
criteria. Time-series
study.
Single pollutant: 4.5%
(3.0, 6.0); with all
gaseous pollutants:
3. 5% (1.7, 5.3)

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             TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                                      STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period Outcome Measure Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported
Method/Design
Effect Estimates
CANADA (cont'd)
         Burnett etal. (1998b),

         Toronto,

         1980-1994
All cause
24-h avg 25 ppb.
SO2, O3, CO, TSP,

COH, estimated PM10,
estimated PM2 s
0,1,0-1
Poisson GAM with

default convergence

criteria. Time-series

study.
Single pollutant (lag

0): 1.7% (0.7, 2.7);

with CO: 0.4%

(-0.6,1.5)
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Vedal et al. (2003)
Vancouver, British
Columbia, Canada
1994-1996

Villeneuve et al.
(2003)
Vancouver, British
Columbia, Canada
1986-1999





Goldberg et al. (2003)
Montreal, Quebec,
Canada
1984-1993




All cause; 17 ppb, 24-h avg
respiratory;
cardiovascular


All cause; 1 9 ppb, 24-h avg
respiratory;
cardiovascular;
cancer;
socioeconomic
status




Congestive heart 22 ppb, 24-h avg
Failure (CHF) as
underlying cause of
death vs. those
classified as having
congestive heart
failure 1 yr prior to
death
PMio, O3, SO2, 0,1,2
CO



PM2.5,PM10, 0,1,0-2
PMio-2.5, TSP,
coefficient of
haze, SO42~, SO2,
O3, CO





PM2.5, coefficient 0,1,0-2
of haze, SO42~,
S02, 03, CO





Poisson GAM with
stringent convergence
criteria. Time-series
study. By season.

Poisson GLM with
natural splines.
Time-series study.







Poisson GLM with
natural splines.
Time-series study.





Results presented in
figures only. NO2
showed associations
in winter but not in
summer.
All yr:
All cause
Lag 1: 4.0%
(0.9, 7.2)
Respiratory:
LagO: 2.1%
(-3.0,7.4)
Cardiovascular:
LagO: 4.3%
(-4.2, 13.4)
CHF as underlying
cause of death:
Lag 1: 1.0%
(-5.1,7.5)
Having CHF 1 yr
prior to death:
Lag 1: 3.4%
(0.9,6.0)
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          TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                            STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
X
Oi
Oi
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Reference, Study
Location, and Period Outcome Measure
Copollutants
Mean NO2 Levels Considered
Lag Structure
Reported Method/Design
Effect Estimates
EUROPE
Samoli et al. (2006) All cause,
30 APHEA2 cities. respiratory;
Study periods vary cardiovascular
by city, ranging from
1990 to 1997






Samoli et al. (2005) All-cause
9 APHEA2 cities.
Period not reported.



Touloumi et al. (1997) All cause
Six European cities:
London, Paris, Lyon,
Barcelona, Athens,
Koln.
Study periods vary by
city, ranging from
1977 to 1992
1-h max ranged from BS, PM10, SO2, O3
24 (Wroclaw) to 81
(Milan) ppb








The selected cities had None
1 -h max medians
above 58 ppb and the
third quartiles above
68.

Ranged from 37 BS, O3; two-pollutant
(Paris) to 70 (Athens) models
ppb, 1-h max





01 Poisson model with
penalized splines.









0 1 Poisson model with
either non-parametric
or cubic spline smooth
function in each city,
and combined across
cities.
0,1,2,3,0-1,0-2, Poisson
0-3 (best lag autoregressive. Time-
selected for each series study.
city)




All-cause: single:
1.8% (1.3, 2.2); with
SO2: 1.5% (1.0, 2.0)
Cardiovascular: single:
2.3%
(1.7, 3.0); with SO2:
1.9% (1.1, 2.7)
Respiratory: single:
2.2% (1.0, 3.4); with
SO2: 1.1%
(-0.4,2.6)
No numeric estimate
presented. The
concentration-response
was approximately
linear.

All-cause: Single-
pollutant model:
1.0% (0.6, 1.3);
WithBS:
0.5% (0.0, 0.9).



Zmirouetal. (1998)
Four European cities:
London, Paris, Lyon,
Barcelona
Study periods vary by
city, ranging from
1985-1992
Respiratory;
cardiovascular





Ranged from 24 BS, TSP, SO2, O3
(Paris) to 37 (Athens)
ppb in cold season and
23 (Paris) to 37
(Athens) ppb in warm
season, 24-h avg

0,1,2,3,0-1,0-2,
0-3 (best lag
selected for each
city)



Poisson GLM. Time-
series study.





Western Europe:
Respiratory:
0.0% (-1.1, 1.1)
Cardiovascular:
0.8% (0.0, 1.5)



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              TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                                         STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome Measure
Mean NO2 Levels
Copollutants Lag Structure
Considered Reported
Method/Design
Effect Estimates
EUROPE (cont'd)
Biggeri et al. (2005)
8 Italian cities,
Period variable
between
1990-1999

Anderson etal. (1996)
London, England
1987-1992



All cause;
respiratory;
cardiovascular



All cause;
respiratory;
cardiovascular



24-h avg ranged from
30 (Verona) to 51
(Rome) ppb



37 ppb, 24-h avg





Only single-pollutant 0-1
models; O3, SO2, CO,
PM10



BS, O3, SO2; 0, 1
two-pollutant models




Poisson GLM. Time-
series study.




Poisson GLM. Time-
series study.




All cause:
3. 6% (2.3, 5.0);
Respiratory:
5. 6% (0.2, 11.2)
Cardiovascular:
5.1% (3.0, 7.3)
All cause (Lag 1 ):
0.6% (-0.1, 1.2);
Respiratory (lag 1):
-0.7% (-2.3, 1.0)
Cardiovascular:
0.5% (-0.4, 1.4)
          Bremneretal. (1999)
          London, England
          1992-1994
All cause;
respiratory;
cardiovascular; all
cancer; all others; all
ages; age specific
(0-64, 65+, 65-74,
75+ yrs)
34 ppb, 24-h avg
BS, PMio, 03, S02,
CO; two-pollutant
models
Selected best from
0, 1,2, 3, (all cause);
0,1,2,3,0-1,0-2,
0-3 (respiratory,
cardiovascular)
Poisson GLM. Time-  All cause (lag 1):
series study.          0.9% (0.0, 1.9)
                   Respiratory (lag 3):
                   1.9% (-0.3, 4.2)
                   Cardiovascular (lag 1):
                   1.9% (0.6, 3.2)
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Anderson etal. (2001)
West Midlands region,
England
1994-1996


All cause; 37 ppb, 1-hmax
respiratory;
cardiovascular.


PMio, PM2.5, 0-1
PM25_10,BS, SO42~,
03, S02, CO


Poisson GAM with
default convergence
criteria. Time-series
study.


All cause:
1.7% (-0.5, 3.8)
Respiratory:
3. 3% (-1.9, 8.8)
Cardiovascular:
3.1% (-0.2, 6.4)
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         TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                           STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
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Reference, Study
Location, and Period
Outcome Measure
Copollutants
Mean NO2 Levels Considered
Lag Structure
Reported Method/Design
Effect Estimates
EUROPE (cont'd)
Prescottetal. (1998)
Edinburgh, Scotland
1992-1995



Le Tertre et al. (2002)
Le Havre, Lyon, Paris,
Rouen, Strasbourg, and
Toulouse, France
Study periods vary by
city, ranging from
1990-1995

Zeghnoun et al. (2001)
Rouen and Le Havre,
France 1990-1995


Dab etal. (1996)
Paris, France
1987-1992
All cause;
respiratory;
cardiovascular; all
ages; age <65 yrs;
age >65 yrs

All cause;
respiratory;
cardiovascular





All cause;
respiratory;
cardiovascular


Respiratory


26 ppb, 24-h avg BS, PM10, O3, SO2,
CO; two-pollutant
models



Ranged from BS, O3, SO2
1 5 (Toulouse) to
28 (Paris) ppb,
24-h avg




24-h avg 1 8 ppb in SO2, BS, PM13, O3
Rouen; 20 ppb in
Le Havre


24 ppb, 24-h avg BS, PM13, O3, SO2,
CO

0 Poisson GLM.
Time-series study.




0-1 Poisson GAM with
default convergence
criteria. Time-series
study.




0, 1 , 2, 3, 0-3, Poisson GAM with
default convergence
criteria. Time-series
study.

0 Poisson
autoregressive.
Time-series study.
Results presented as
figures only.
Essentially no
associations in all
categories. Very wide
confidence intervals.
Six-city pooled
estimates:
All cause:
2. 9% (1.6, 4.2)
Respiratory:
3.1% (-1.7, 8.0)
Cardiovascular:
3. 5% (1.1, 5. 9)
All cause in Rouen
(lag 1): 5.5%
(0.2, 11.1); in
Le Havre (lag 1):
2.4% (-3.4, 8.5)
Lagl:
2.1% (3. 1,7.7)

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         TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                           STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome Measure
Mean NO2 Levels
Copollutants Lag Structure
Considered Reported Method/Design
Effect Estimates
EUROPE (cont'd)
Zmirouetal. (1996)
Lyon, France
1985-1990


Sartor etal. (1995)
Belgium
Summer 1994




All cause;
respiratory;
cardiovascular;
digestive


All cause; age <65
yrs; age 65+ yrs




37 ppb, 24-h avg


24-h avg NO2:
Geometric mean:
During heat wave
(42 day period): 17 ppb
Before heat wave
(43 day period): 15 ppb
After heat wave
(39 day period): 13 ppb
PM13, SO2, 03 Selected best Poisson GLM.
from Time-series study.
0,1,2,3


TSP, NO, 03, S02 0,1,2 Log-linear
regression for O3
and temperature.
Time-series study.




All cause (lag 1 ):
1.5% (-1.5, 4.6)
Respiratory (lag 2):
-2. 3% (-15. 6, 13.0)
Cardiovascular (lag 1):
0.8% (-2.7, 4. 3)
Only correlation coefficients
presented for NO2. Unlike
O3, NO2 was not particularly
elevated during the heat
wave.




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              TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                                         STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome Measure Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported Method/Design
Effect Estimates
EUROPE (cont'd)
Hoek et al. (2000);
reanalysis Hoek,
(2003)
The Netherlands:
entire country, four
urban areas
1986-1994




All cause; COPD; 24-h avg median: 17 ppb
pneumonia; in the Netherlands; 24 ppb
cardiovascular in the four major cities








PMio, BS, S042\
N(V, 03, S02,
CO; two-pollutant
models







1,0-6 PoissonGAM,
reanalyzed with
stringent
convergence
criteria; Poisson
GLM. Time-series
study.




Poisson GLM:
All cause:
Lag 1: 1.9% (1.2, 2.7)
Lag 0-6: 2.6% (1.2, 4.0);
withBS: 1.3% (-0.9, 3.5);
Cardiovascular (lag 0 6):
2.7% (0.7, 4.7).
COPD (lag 0-6):
10.4% (4.5, 16.7).
Pneumonia (lag 0-6):
19.9% (11. 5, 29.0).
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Hoek etal. (2001);
reanalysis Hoek,
(2003)
The Netherlands
1986-1994
Total
cardiovascular;
myocardial
infarction;
arrhythmia; heart
failure;
cerebro vascular;
thrombosis-related
24-h avg median: 17 ppb    PM10,
in the Netherlands; 24 ppb   CO
in the four major cities
                                                                               03, S02,
Poisson GAM,
reanalyzed with
stringent
convergence
criteria; Poisson
GLM. Time-series
study.
Poisson GLM:

Total cardiovascular:
2.7% (0.7,4.7)
Myocardial infarction:
0.3% (-2.6, 3.2)
Arrhythmia:
1.7% (-6.6, 10.6)
Heart failure:
7.6% (1.4,14.2)
Cerebro vascular:
5.1% (0.9, 9.6)
Thrombosis-related:
-1.2% (-9.6, 8.1)
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              TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY.  RISK ESTIMATES ARE
                                        STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period Outcome Measure
Mean NO2 Levels
Copollutants Lag Structure
Considered Reported Method/Design
Effect Estimates
EUROPE (cont'd)
Roemer and van All cause
Wijinen(2001)
Amsterdam, The
Netherlands
1987-1998



Verhoeff et al. (1996) All cause; all ages;
Amsterdam, The age 65+ yrs
Netherlands
24-h avg:

Background sites:
24 ppb

Traffic sites:
34 ppb

l-hmaxO3:
43 ug/m
Maximum 301
BS, PMio, O3, SO2, 1 , 2, 0-6 Poisson GAM with
CO default convergence
criteria (only one
smoother). Time-
series study.



PMio, O3, CO; 0,1,2 Poisson. Time-
multipollutant models series study.

Total population using
background sites: Lag 1 :
3. 8% (1.7, 5.9);
Traffic pop. using background
sites: Lag 1: 5.7% (0.6, 11.0);
Total pop. using traffic sites:
Lagl:
1.7% (0.4, 3.0)
1-h max O3 (per 100 ug/m )

All ages:
          1986-1992
                                      NO NO,!!!
                                                                                         LagO: 1.8% (-3.8, 7.8)
                                                                                         Lagl: 0.1% (-4.7, 5.1)
                                                                                         Lag 2: 4.9% (0.1, 10.0)
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         Fischer et al. (2003)
         The Netherlands,
         1986-1994
All-cause,
cardiovascular,
COPD, and
pneumonia in age
groups <45, 45-64,
65-74, 75+
24-h avg median
17 ppb
   o, BS, O3, SO2,
                                                                                       0-6
CO
Poisson GAM with
default convergence
criteria. Time-
series study.
Cardiovascular:
Age<45: -1.3% (-13.0, 12.1):
age 45-64: -0.4% (-4.8,4.3);
age 65 74: 4.4% (0.8, 8.0); age
75 and up: 3.5% (1.4, 5.6)
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          TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                            STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
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Reference, Study
Location, and Period
EUROPE (cont'd)
Spix and Wichman
(1 996) Koln, Germany
1977-1985
Peters et al. (2000b)
NE Bavaria, Germany
1982-1994
Coal basin in Czech
Republic
1993-1994


Michelozzi et al.
(1998) Rome, Italy
1992-1995



Ponkaetal. (1998)
Helsinki, Finland
1987-1993


Saez et al. (2002)
Seven Spanish cities,
variable study periods
between 1991 and
1996.



Outcome Measure

All-cause


All cause;
respiratory;
cardiovascular;
cancer




All-cause





All cause;
cardiovascular; age
<65 yrs, age 65+ yrs


All cause;
respiratory;
cardiovascular





Copollutants
Mean NO2 Levels Considered

24-h avg 24 ppb; TSP, PM7, SO2
l-hmax38ppb

24-h avg: TSP, PM10, O3, SO2,
Czech Republic: CO
17.6 ppb
Bavaria, Germany:
13. 2 ppb



24-h avg 52 ppb PM13, SO2, O3, CO





24-h avg: TSP, PM10, O3, SO2
Median 20 ppb



24-h avg mean ranged O3, PM, SO2, CO
from 17 ppb in Huelva
to 35 ppb in Valencia.





Lag Structure
Reported Method/Design

0,1,0-1 PoissonGLM.
Time-series study.

0,1,2,3 PoissonGLM.
Time-series study.






0,1,2,3,4 Poisson GAM with
default convergence
criteria. Time-series
study.


0,1,2,3,4,5, PoissonGLM.
6, 7 Time-series study.



0-3 Poisson GAM with
default convergence
criteria. Time-series
study.




Effect Estimates

Lag 1: 0.4%
(-0.4, 1.2)

Czech Republic:
All cause:
Lag 1: 2.1%
(-1.7,6.1)
Bavaria, Germany:
All cause:
Lag 1: -0.1%
(-3.6,3.6)
Lag 2: all-yr: 1.6%
(0.4,2.9);
Cold season 0.3%
(-1.2,1.8);
Warm season: 4.2%
(1.8, -6.6)
No risk estimate presented
forN02.
PM10 and O3 were reported
to have stronger
associations.
All cause:
2.6% (1.6, 3.6);
with all other poll:
1.7% (0.0, 3.3);
Respiratory:
7.1% (-14.0, 33.5)
Cardiovascular:
4.4% (-0.2, 9.2)

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                TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY.  RISK ESTIMATES ARE
               	STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT	
  Reference, Study
Location, and Period
Outcome Measure     Mean NO2 Levels
Copollutants
 Considered
Lag Structure
  Reported
Method/Design
                                                                                                                                       Effect Estimates
          EUROPE (cont'd)
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          Garcia-Ay merich et al.
          (2000)
          Barcelona, Spain
          1985-1989
                    All cause;
                    respiratory;
                    cardiovascular;
                    general population;
                    patients with COPD
                  Levels not reported.     BS, O3, SO2
                 Selected best avg lag    Poisson GLM.
                                     Time-series study.
                                   All cause:
                                   General population:
                                   Lag 0-3: 3.3% (0.8, 5.8)
                                   COPD patients:
                                   Lag 0-2: 10.9% (0.4,22.6)

                                   Respiratory:
                                   General population:
                                   Lag 0-1: 3.3% (-2.3, 9.2)
                                   COPD patients:
                                   Lag 0-2: 12.1% (-4.3, 31.4)

                                   Cardiovascular:
                                   General population:
                                   Lag 0-3: 2.4% (-0.9, 5.8)
                                   COPD patients:
                                   Lag 0-2: 4.3% (-13.6, 25.8)
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          Saezetal. (1999)
          Barcelona, Spain
          1986-1989
                    Asthma mortality;
                    age 2-45 yrs
                  Levels not reported.     BS, O3, SO2
                 0-2
                 Poisson with GEE.
                 Time-series study.
                 RR = 4.1(0.5, 35.0)
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                TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
               	STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT	
              Reference, Study
            Location, and Period
 Outcome Measure
  Mean NO2 Levels
Copollutants
 Considered
Lag Structure
  Reported
Method/Design
Effect Estimates
          EUROPE (cont'd)
           Sunyeretal. (1996)
           Barcelona, Spain
           1985-1991
                                  All cause; respiratory;
                                  cardiovascular; all
                                  ages; age 70+ yrs
                     1-hmax:
                     Median:
                     Summer:  51 ppb
                     Winter: 46 ppb
                     BS, SO2, O3
                Selected best single-
                day lag
                  Autoregressive        All yr, all ages:
                  Poisson.  Time-series   All cause:
                  study.                Lagl:  1.9% (0.8, 3.1)

                                      Respiratory:
                                      LagO:  1.5% (-1.9, 5.0)
                                                                                                                                        Cardiovascular:
                                                                                                                                        Lagl:  2.2% (0.5, 3.9)
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           Sunyer and Basagana
           (2001)
           Barcelona, Spain
           1990-1995
           Sunyer et al. (2002)
           Barcelona, Spain
           1986-1995
Mortality in a cohort
of patients with
COPD
Mean not reported
IQR8.9ppb24-havg
                                  All cause, respiratory,   1-hmax: median
                                  and cardiovascular      47 ppb;
                                  mortality in a cohort    24-h avg median
                                  of patients with severe   27 ppb
                                  asthma
                                                                                o, 03, CO
                0-2
                                           PMio, BS, S02, 03,   0-2
                                           CO, pollen
                  Conditional logistic
                  (case-crossover)
                                                             Conditional logistic
                                                             (case-crossover)
                                                                                                                                        Summer risk estimates
                                                                                                                                        larger than winter risk
                                                                                                                                        estimates.
                  7.8% (-2.0, 18.6) with
                  PM10:
                  3.9% (-12.0,22.5)

                  Odds Ratio:
                  Patients with 1 asthma
                  admission:
                  All cause:
                  1.10(0.80,1.51)
                  Cardiovascular:
                  1.70(0.96,2.99)

                  Patients with more than
                  1 asthma admission:
                  All cause:
                  2.14(1.10,4.14)
                  Cardiovascular:
                  1.53(0.46,5.07)

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           TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                              STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and
Period
Outcome Measure
Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported
Method/Design
Effect Estimates
EUROPE (cont'd)
Diaz etal. (1999)
Madrid, Spain
1990-1992
All cause; respiratory;
cardiovascular
24-h avg
Levels not reported.
TSP, 03, S02, CO
1,4,10
Autoregressive linear.
Time-series study.
Only significant risk estimates were
shown. For NO2, only respiratory
mortality was significantly
(p < 0.05) associated with an excess
percent risk 8.5%.
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LATIN AMERICA
Borja-Aburto et al.
(1997)
Mexico City
1990-1992






Borja-Aburto et al.
(1998)
SW Mexico City
1993-1995
All cause; respiratory; 1 -h max O3: TSP, SO2, CO;
cardiovascular; all Median 155 ppb two-pollutant
ages; age <5 yrs; age models
>65yrs 8-hmax03:
Median 94 ppb
10-havgO3
(8 a.m.-6 p.m.):
Median 87 ppb
24-h avg O3:
Median 54 ppb
All cause; respiratory; 37.7 ppb, 24-h avg PM2.5, O3, SO2;
cardiovascular; other; two-pollutant
all ages; age >65 yrs models
0, 1 , 2 Poisson iteratively
weighted and filtered
least-squares method.
Time-series study.






0, 1 , 2, 3, 4, 5, Poisson GAM with
and multiday default convergence
avg criteria (only one
smoother). Time-
series study.
1-h max O3 (per 100 ppb):
All ages:






Lag 1-5:
All cause: 2.3% (-1.0, 5.6);
Cardiovascular: 2. 8% (-3.2, 9.2);
Respiratory: 4.7% (-5.1, 15.5).
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          TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                             STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
X
Oi
OO
Oi
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O
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Reference, Study
Location, and
Period
Outcome Measure
Copollutants Lag Structure
Mean NO2 Levels Considered Reported Method/Design
Effect Estimates
LATIN AMERICA (cont'd)
Loomisetal. (1999)
Mexico City
1993-1995

Gouveia and Fletcher
(2000b)
Sao Paulo, Brazil
1991-1993





Pereiraetal. (1998)
Sao Paulo, Brazil
1991-1992

Saldivaetal. (1994)
Sao Paulo, Brazil
1990-1991
Saldivaetal. (1995)
Sao Paulo, Brazil
1990-1991
Infant mortality



All ages (all cause);
age <5 yrs (all
cause, respiratory,
pneumonia); age
65+ yrs (all cause,
respiratory,
cardiovascular)



Intrauterine
mortality


Respiratory; age
<5yrs

All cause; age
65+ yrs

24-h avg 38 ppb PM2.5, O3 0, 1 , 2, 3, 4, 5, 3-5 Poisson GAM with
default convergence
criteria. Time-series
study.
1-hmax: 84 ppb PM10, 03, SO2, CO 0,1,2 Poisson GLM.
Time-series study.







24-h avg 82 ppb PM10, 03, SO2, CO 0-4 Poisson GLM.
Time-series study.


24-h avg NOX 127 ppb PM10, O3, SO2, CO; 0-2 OLSofrawor
multipollutant transformed data.
models Time-series study.
24-h avg NOX 127 ppb PM10, O3, SO2, CO; 0-1 OLS; Poisson with
two-pollutant GEE. Time-series
models study.
Lag 3-5:
11.4% (2.2, 21.4);
withPM25:
2. 9% (-10.2, 17.8)
All ages:
All cause:
LagO: -0.1% (-0.7, 0.4)
Age 65+:
All cause:
Lagl: 0.4% (-0.2, 1.1)
Respiratory:
Lag 2: 1.0% (-0.6, 2.5)
Cardiovascular:
Lagl: -0.5% (-0.4, 1.3)
Single-pollutant model: 5.1%
(2.8, 7.5);
With other pollutants: 4.7%
(1.6,7.9)
NOX slope estimate:
0.007197 deaths/day/ppb
(SE 0.003214), p = 0.025
NOX slope estimate:
0.0341 deaths/day/ppb
(SE 0.0105)

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TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                  STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
X
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Reference, Study
Location, and
Period


Outcome Measure


Mean NO2 Levels

Copollutants Lag Structure
Considered Reported Method/Design


Effect Estimates
LATIN AMERICA (cont'd)
Cifuentes et al.
(2000) Santiago,
Chile
1988-1966


Ostroetal. (1996)
Santiago, Chile
1989-1991
All cause





All cause


8-havg41 ppb





l-hmax56ppb


PM2 5, PM10 25, 0, 1 , 2, 3, 4, 5, Poisson GAM with
CO, SO2, O3 1-2, 1 3, 1-4, 1-5 default convergence
criteria; Poisson GLM.
Time-series study.


PMio, O3, SO2; two 1 OLS, Poisson.
pollutant models Time-series study.

GLM model, lag 1-2:
Single-pollutant: 1.7% (0.7,
2.7); with other pollutants:
1.5%
(0.3,2.7)
(per 25ppb 8-h avg)
Poisson,lag 1: -0.5%(-1.1, 0)


AUSTRALIA
Simpson et al.
(2005a,b)
Brisbane, Sydney,
Melbourne, and
Perth, Australia
1996-1999
Simpson et al. (2000)
Brisbane, Australia
1991-1996


Morgan etal. (1998b)
Sydney, Australia
1989-1993


All cause,
respiratory, and
cardiovascular in all
ages; cardiovascular
in age 65+ yrs

All cause,
respiratory, and
cardiovascular in all
ages; cardiovascular
in age 65+ yrs
All cause;
respiratory;
cardiovascular


1-h max ranged from
16 to 24 ppb




24-havg: whole yr:
12 ppb; cool season:
1 3 ppb; warm season
9 ppb

24-h avg 13 ppb; 1-h
max 26 ppb



PMio, PM2.5, BSP 0, 1, 2, 3, 0-1 Poisson GLM, GAM
(nephelometer), O3, with stringent
CO convergence criteria.
Time-series study.


PMio, PM2.5, BSP, 0, 1 , 2, 3, 0-1 Poisson, GAM with
O3, CO default convergence
criteria. Time-series
study.

BSP, O3 0-1 Poisson with GEE.
Time-series study.



Lag 0-1, GAM, all-cause,
Single pollutant: 3.4% (1.1,
5.7); with BSP: 3.1% (0.3,
5.9); cardiovascular: 4.3% (0.9,
7.8); respiratory: 1 1 .4% (3.5,
19.9)
All-cause (lag 1): 9.7% (4.7,
14.8); respiratory: 18. 8% (1.2,
39.6)


Lag 0-1, single pollutant, all-
cause: 3.0% (0.1, 6.0);
cardiovascular: 2.2% (-1.7,
6.4); respiratory: 8.6% (-0.4,
18.4)

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          TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                            STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
X
OO
oo
H
6
o

o
H
O
O

H
W
Reference, Study
Location, and
Period Outcome Measure


Mean NO2 Levels

Copollutants Lag Structure
Considered Reported Method/Design


Effect Estimates
AUSTRALIA (cont'd)
Simpson et al. (1 997) All cause;
Brisbane, Australia respiratory;
1987-1993 cardiovascular

24-h avg 14 ppb;
l-hmax28 ppb


PMio, TSP, O3, 0 Autoregressive
SO2, CO Poisson with GEE.
Time-series study.

Lag 0-1, single pollutant, all-
cause, all-yr: -1.0% (-5.2,
3.4); summer: -3.6%(-11.2,
4.7); winter: - 1 .2% (-4.0, 6.9)
ASIA
Kim et al. (2004b) All cause
Seoul, Korea
1995-1999





Lee et al. (1 999) All cause
Seoul and Ulsan,
Korea
1991-1995






24-h avg 33 ppb.





1-hmax O3:

Seoul:
32.4 ppb
10th%-90th%
14-55
Ulsan:
26.0 ppb
10th%-90th%
16-39
PMio, O3, SO2, CO; 1 Poisson GAM with
two-pollutant stringent convergence
models criteria (linear model);
GLM with cubic
natural spline; GLM
with B mode spline
(threshold model).
Time-series study.
TSP, SO2 0 Poisson with GEE.
Time-series study.








Risk estimates for NO2 not
reported.





1-h max O3 (per 50 ppb):

Seoul:
1.5% (0.5, 2. 5)
Ulsan:
2.0%(-11. 1,17.0)




O
HH
H
W

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to
O
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oo
           TABLE AX6.3-19 (cont'd). EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE

                             STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
X
OO

VO
H
6
o

o
H
O
O

H
W
O
HH
H
W
Reference, Study
Location, and Period
Outcome Measure Mean NO2 Levels
Copollutants Lag Structure
Considered Reported Method/Design
Effect Estimates
ASIA (cont'd)
Lee and Schwartz (1999)
Seoul, Korea
1991-1995
Kwonetal. (2001)
Seoul, Korea
1994-1998



Ha et al. (2003)
Seoul, Korea
1995-1999
Hong et al. (2002)
Seoul, Korea
1995-1998

Tsai et al. (2003b)
Kaohsiung, Taiwan
1994-2000


All cause 1 -h max O3:
Seoul:
32.4 ppb
10th%-90th%
14-55
Mortality in a cohort 24-h avg 32 ppb
of patients with
congestive heart
failure



All cause; respiratory; 24-h avg 33 ppb
postneonatal (1 mo to
1 yr); age 2 64 yrs;
age 65+
Acute stroke mortality 24-h avg 33 ppb


All cause; respiratory; 24-h avg 29 ppb
cardiovascular;
tropical area


TSP, SO2 0 Conditional
logistic
regression.
Case-crossover
with
bidirectional
control sampling.
PMm, O3, SO2, CO 0 Poisson GAM
with default
convergence
criteria; case-
crossover
analysis using
conditional
logistic
regression.
PMm, O3, SO2, CO 0 Poisson GAM
with default
convergence
criteria. Time-
series study.
PMm, O3, SO2, CO 2 Poisson GAM
with default
convergence
criteria. Time-
series study.
PMm, SO2, 03, CO 0-2 Conditional
logistic
regression.
Case-crossover
analysis.


1-hmax O3
(per 50 ppb):
Two controls ± 1 wk:
1.5% (-1.2, 4.2)
Four controls ± 2 wks:
2.3% (-0.1, 4.8)
Odds ratio in general population:
1.1% (-0.3, 2. 5)
Congestive heart failure cohort:
15. 8% (1.8, 31.7)



All cause for postneonates: 0.8%
(-5.7, 7.7); age 65+: 3. 8% (3. 7, 3.9)
4. 3% (1.6, 7.0)


Odds ratios:
All cause:
0.1% (-5. 9, 6.6);
Respiratory:
-1.0% (-22.2, 25. 9);
Cardiovascular:
-1.8%(- 14.0, 12.1)

-------
O

to
O
O
oo
X
H
6
o

o
H
O
O
H
W
                TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                                          STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT
Reference, Study
Location, and Period
Outcome Measure
Mean NO2 Levels
Copollutants
Considered
Lag Structure
Reported
Method/Design
Effect Estimates
ASIA (cont'd)
Yang et al. (2004b)
Taipei, Taiwan
1994-1998
All cause; respiratory;
cardiovascular;
subtropical area
24-h avg 3 1 ppb
PMio, SO2, O3, CO
0-2
Conditional logistic
regression. Case-
crossover analysis.
Odds ratios:
All cause: 0.6% (-3. 9, 5.2);
Respiratory: 2. 5% (-13.1, 20.8);
          Wong et al. (200 Ib)
          Hong Kong
          1995-1997
All cause; respiratory;
cardiovascular
24-h avg 25 ppb in
warm season; 33 ppb
in cold season
PMio, O3, SO2;
two-pollutant
models
0,1,2
                                                                                                                        Cardiovascular:
                                                                                                                        -1.1% (-9.5, 8.0)
Poisson GAM with    All cause (lag 1):
               default convergence
               criteria. Time-series
               study.
                                                                                         2.6% (0.9, 4.4);
                                                                                         Respiratory (lag 0):
                                                                                         6.1% (-1.8, 10.5);
                                                                                         Cardiovascular (lag 2):
                                                                                         5.2% (1.8, 8.7)
Wong et al. (2002)
Hong Kong
1995-1998
Respiratory; 24-h avg 29 ppb
cardiovascular;
COPD; pneumonia
and influenza;
ischemic heart dis.;
cerebrovascular
PMio, O3, SO2; two 0,1,2,0-1,0-2
pollutant models
Poisson GLM. Time-
series study.
Respiratory (0-1):
5.1% (1.6, 8.7);
Cardiovascular (lag 0-2):
3.1% (-0.2, 6.5)
O
HH
H
W

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to
O
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oo
                  TABLE AX6.3-19 (cont'd).  EFFECTS OF ACUTE NOX EXPOSURE ON MORTALITY. RISK ESTIMATES ARE
                 	STANDARDIZED FOR PER 20 ppb 24-h AVG NO2 INCREMENT	
Reference, Study
 Location, and
     Period
Outcome Measure
Mean NO2 Levels
Copollutants
 Considered
Lag Structure
  Reported
Method/Design
Effect Estimates
           ASIA (cont'd)
           Hedley et al. (2002)
           Hong Kong
           1985-1995
           Intervention Jul 1990
           (switch to low sulfur-
           content fuel)
                   All cause; cardiovascular;
                   respiratory; neoplasms and
                   other causes; all ages; age
                   15-64 yrs; age 65+ yrs
                      Avg moly NO2:

                      Baseline:  29 ppb

                      1 yr after intervention:
                      25 ppb
                                                        2-5 yrs after
                                                        intervention: 28 ppb
                    SO2 (main pollutant
                    of interest, 45%
                    reduction observed
                    5 yrs after
                    intervention), PM10,
                    SO42~,NO2
                Moly avgs
                considered
                without lags
                Poisson regression of
                moly avgs to estimate
                changes in the
                increase in deaths
                from warm to cool
                season. Annual
                proportional change
                in death rate before
                and after the
                intervention was also
                examined.
                   Declines observed in all cause
                   (2.1%, p = 0.001), respiratory
                   (3.9%, p = 0.001), and
                   cardiovascular
                   (2.0%, p = 0.020) mortality after
                   the intervention.

                   As NO2 levels did not change
                   before and after the intervention,
                   NO2 likely did not play a role in
                   the decline in observed
                   mortality.
X
H
6
o
o
H
O
O
H
W
Yang et al. (2004b)
Taipei, Taiwan
1994-1998




All cause; respiratory; 24-h avg 31 ppb PM10, SO2, O3, CO 0-2
cardiovascular; subtropical
area




Conditional logistic
regression. Case-
crossover analysis.




Odds ratios:
All cause:
0.6% (-3.9, 5.2);
Respiratory:
2.5%(-13.1,20.8);
Cardiovascular:
-1.1% (-9.5, 8.0)
O
HH
H
W

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	TABLE AX6.3-20. NO2 EXPOSURE AFFECTS ASTHMATICS	
 An intervention study (Pilotto et al., 2004) of respiratory symptoms of asthmatic children in
 Australia resulted in reductions in several symptoms (difficulty in breathing during the day and
 at night, chest tightness during the day and at night, and asthma attacks during the day) related
 to reduction in NO2 exposure from in-class heaters. Information on other heater emissions,
 such as ultrafme particles, was not reported.

 Birth cohort studies in the United Sates (Belanger et al., 2006; Van Strein et al., 2004) and
 Europe (Brauer et al., 2007) relate NO2 concentrations to increased respiratory symptoms,
 infections, and asthma in the very young.

 In England, Chauhan et al. (2003) and Linaker et al. (2000) studied personal NO2 exposure and
 found NO2 exposure in the week before an upper respiratory infection was associated with
 either increased severity of lower-respiratory-tract symptoms, or reduction of PEF for all virus
 types together, and for two of the common viruses, RSV and a picorna virus, individually.

 Nitschke et al.  (2006) reported difficulty breathing and chest tightness associated with 10 ppb
 increases in NO2 measured in school classrooms. Lung function tests were performed at the
 beginning and  at the end of the study period, and the authors observed personal NO2 exposures
 related in a dose-response manner for reported symptoms in asthmatics.

 United States multeity studies of ambient NO2 exposure examined respiratory symptoms in
 asthmatics (Mortimer et al., 2002; Schildcrout et al., 2006). In the NCICAS (Mortimer et al.,
 2002) the greatest effect was seen for morning symptoms (cough, wheeze, shortness of breath)
 for a 6-day-morning average.  In multi-pollutant models, the NO2 effect was attenuated though
 remained positive, for Os, SO2, and combined coarse and fine particulate matter (PMio). In the
 CAMP study (Schildcrout et al., 2006), the strongest association  between NO2 and increased
 risk of cough and increased use of rescue medication was found for a 2-day lag, which was not
 attenuated, in two-pollutant models for CO, PMio, or SO2.  Single city panel studies in the
 Los Angeles area are supportive of these associations for asthmatics (Ostro et al., 2001; Delfino
 et al., 2002, 2003a,b).  Segala et al. (1998) and Just et al. (2002), in Paris both found positive
 relationships to NO2 exposure and symptoms in asthmatics.

 Few studies of the impact of NO2 on respiratory symptoms of adult asthmatics are available.
 These find positive associations for NO2 exposure and respiratory symptoms in European
 studies (Hiltermann et al., 1998; Von Klot et al., 2002; and Forsberg et al., 1998).

 The associations between ambient concentrations of NO2 and ER visits for asthma in the United
 States are positive (Jaffe et al., 2003; Peel et al., 2005; Tolbert et al., 2000). Studies conducted
 outside the United States (Castlellsague et al., 1995;  Sunyer et al., 1997; Atkinson et al.,
 1999a,b; Tenias et al., 1998; Erbas et al., 2005) found similar results. A concentration response
 for NO2 and asthma ER visits is indicated in these studies (Jaffe et al., 2003; Tenias et al.,  1998;
 Castellsague et al., 1995).
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	TABLE AX6.3-20 (cont'd). NO2 EXPOSURE AFFECTS ASTHMATICS	

 In relation to long-term exposure, Moseler (1994) examined a cohort in Germany and reported
 decrements in lung function parameters related to NC>2 exposure measures in a group of
 physician-diagnosed asthmatic children.

 The relationship between long-term NC>2 exposure and asthma prevalence and incidence has
 been examined in several studies. In the  CHS, Gauderman et al. (2005) report a positive
 relationship. A marginally significant positive relationship was seen for NC>2 exposure with
 new onset asthma, while significant associations for PM were observed (Islam et al. 2007). In
 a separate cohort in the Netherlands, Brauer et al. (2007) provide confirming evidence for
 this relationship.

 Acute mortality related to asthma was examined in Barcelona, Spain (Saez et al., 1999; Sunyer
 et al., 2002). In the study by Sunyer et al. (2002), severe asthmatics with more than one
 asthma emergency visit were found to have the strongest mortality associations with NC>2.
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