The past twenty years of research that has associated air pollution with health outcomes has brought remarkable advance in statistical techniques that effectively tease out the intricacies of the relationship. However, while statistical techniques progressed, an assumption based on seminal work in the field persisted: that concentrations of particulate matter (PM) air pollution are spatially homogeneous within urban areas, and consequently, that personal exposures could be based on central monitoring site data alone. Although this assumption went unaddressed for years, it has now come to researchers' attention that it may be flawed and that the assumption may induce exposure misclassification error under certain conditions. This thesis explores intraurban spatial variability in PM through a systematic review of the literature, experimental field testing, modelling, and new methodological approaches. The key outcomes of the thesis are as follows: (i) the publication of the first systematic review of the intraurban particulate literature, challenging the widely-held assumption that PM concentrations are spatially uniform; (ii) an experimental test was conducted in Christchurch, New Zealand, revealing that the homogenous assumption was false for a city with high wintertime particulate matter concentrations; (iii) an integrated meteorological-emission model was evaluated for the first time at the intraurban level for PM and a new study design was suggested; and (iv) the spatial modification effect of social and ecological confounders was analysed with respect to respiratory hospital admissions and PM. Collectively, these outcomes provide a new body of knowledge informing researchers focused on assessing the relationship between air pollution and health in applications ranging from small-area exposure assessment to the wider field of environmental epidemiology.

The past twenty years of research that has associated air pollution with health outcomes has brought remarkable advance in statistical techniques that effectively tease out the intricacies of the relationship. However, while statistical techniques progressed, an assumption based on seminal work in the field persisted: that concentrations of particulate matter (PM) air pollution are spatially homogeneous within urban areas, and consequently, that personal exposures could be based on central monitoring site data alone. Although this assumption went unaddressed for years, it has now come to researchers' attention that it may be flawed and that the assumption may induce exposure misclassification error under certain conditions. This thesis explores intraurban spatial variability in PM through a systematic review of the literature, experimental field testing, modelling, and new methodological approaches. The key outcomes of the thesis are as follows: (i) the publication of the first systematic review of the intraurban particulate literature, challenging the widely-held assumption that PM concentrations are spatially uniform; (ii) an experimental test was conducted in Christchurch, New Zealand, revealing that the homogenous assumption was false for a city with high wintertime particulate matter concentrations; (iii) an integrated meteorological-emission model was evaluated for the first time at the intraurban level for PM and a new study design was suggested; and (iv) the spatial modification effect of social and ecological confounders was analysed with respect to respiratory hospital admissions and PM. Collectively, these outcomes provide a new body of knowledge informing researchers focused on assessing the relationship between air pollution and health in applications ranging from small-area exposure assessment to the wider field of environmental epidemiology.

Maternal residency in Central Appalachian coalfields has been associated with low birth weight at the county-level. To refine the relationship between proximity and adverse birth outcomes, this study employs finer spatial scales of exposure. Spatiotemporal characterizations of surface mining boundaries in Central Appalachia between 1986-2015 were developed using Landsat data. The maternal address field on births records from VA, WV, KY, and TN were geocoded and assigned amount of surface mining within a 5km radius of residence (street-level). Births were also assigned exposures based on the amount of surface mining within residential ZIP code tabulation area (ZCTA) (ZIP code-level). Using linear and logistic regression, associations between surface mining activities during gestation and birth weight, preterm birth, low birth weight, and term low birth weight were determined, adjusting for available demographic factors. An increase in surface mining activities was negatively associated with birth weight at the street-level (β = −8.93g; (95% CI = -12.69 -5.7, P= <0.001) and ZIP code-level (β = −4.41g ; 95% CI = -6.30, -2.52, P= <0.001). Small, statistically significant associations were also found between preterm birth and mining within 5km of residence (OR = 1.003; 95% CI = 1.001, 1.005, P= 0.003) and within maternal ZCTA (OR = 1.002; 95% CI = 1.001, 1.003, P=0.001). Relationships were also found between amount of mining within 5km of residence and low birth weight and term low birth weight outcomes. This study found subtle, but significant associations between proximity to active surface mining during gestation and adverse birth outcomes. / M.S. / Central Appalachian surface mining produces air, water, and noise pollution, all of which have been associated with increased risk of adverse birth outcomes. Previous studies examining associations between surface mining and adverse birth outcomes rely upon relatively coarse county-level data. This research compares outcomes from hundreds of thousands of individual birth records and proximity of maternal home address to surface mines for a fine-scale, epidemiological study. Surface mining boundaries between 1986-2015 were developed using satellite imagery. Birth records from VA, WV, KY, and TN were geocoded and assigned the amount of surface mining within a 5km radius of residence. Births were also assigned exposures based on the amount of surface mining within residential ZIP code since geocoding led to a considerable loss of records. Associations between proximity to surface mining during gestation and birth weight, preterm birth (PTB), low birth weight (LBW), and term low birth weight (tLBW) were determined by linear and logistic regression, adjusting for available demographic factors. Results demonstrate significantly decreased birth weights were found near active mining operations. Mothers living near active surface mining also saw a slight increase in the odds of their birth being PTB, LBW or tLBW. These results suggest there is a subtle, but significant relationship between proximity to surface mining and adverse birth outcomes.

Influenza aviaire est une maladie infectieuse contagieuse, due à des virus de la famille des Orthomyxoviridae, les virus Influenza A, touchant les oiseaux et susceptible d'entraîner une mortalité extrêmement élevée, notamment chez les volailles. Les souches hautement pathogènes des virus influenza aviaire provoquent une maladie sévère et mortelle chez les volailles et constituent un risque pour la santé publique. En février 2006, la France a été touchée par une épizootie d'influenza aviaire H5N1 hautement pathogène, qui s'est répandu dans l'avifaune sauvage de la zone humide la Dombes. La Dombes est une zone humide, mosaïque de plus de mille étangs, et une zone d'importance ornithologique internationale, abritant des milliers d'oiseaux d'eau. C'est une zone à risque pour la propagation de l'influenza aviaire de part à la fois la présence des populations d'oiseaux sauvages sur les étangs et de la proximité de ces populations aux élevages de volailles qui parsèment la région. L'objectif principal de ce travail est la modélisation du risque influenza aviaire dans la région de la Dombes. Ce travail est axé sur l'avifaune sauvage et sur le risque d'infection et de transmission de l'infection par les oiseaux sauvages. Nous avons, dans un premier temps, identifié les caractéristiques particulières à la Dombes, pouvant influer sur l'épidémiologie de l'influenza aviaire dans la région. Les trois acteurs principaux de l'écosystème de la Dombes sont les étangs, les populations d'oiseaux sauvages et les élevages de volailles. Ensuite, le risque influenza aviaire dans la Dombes a été décliné à deux niveaux : 1) dans l'écosystème d'un seul étang ; et 2) au sein d'un réseau d'étangs comme caractérisés en 1), où la propagation de l'infection peut se faire d'étang à étang. Au niveau étang, le risque influenza aviaire est modélisé, d'une part, par le temps de persistance des virus influenza aviaire dans l'eau de l'étang, et d'autre part, par la dynamique de l'infection au sein des populations d'oiseaux sauvages par transmission directe entre oiseaux et indirecte via l'eau de l'étang. Au niveau réseau d'étangs, l'analyse du risque permet d'identifier des groupements spatiaux d'étangs à risque élevé d'infection aux virus influenza aviaire. Quant au risque d'exposition des élevages aux virus influenza aviaire d'origine de l'avifaune sauvage, il est calculé en tenant compte à la fois de la proximité des élevages aux étangs susceptibles d'être infectés et de la probabilité de ces étangs à être infectés en cas d'épizootie. / Avian influenza is a contagious infectious disease caused by viruses of the family Orthomyxoviridae, influenza A viruses, affecting birds and known to cause extremely high mortality, especially in poultry. Highly pathogenic strains of avian influenza viruses cause severe and fatal disease in poultry and pose a risk to public health. In February 2006, France was hit by a highly pathogenic H5N1 avian influenza outbreak, affecting aquatic wildfowl in Dombes wetland. The Dombes is a wetland mosaic of more than a thousand ponds and an area of international ornithological importance, home to thousands of waterfowl. This is an area at risk for the spread of avian influenza viruses due to both the presence of wild birds on the ponds and the proximity of these populations to poultry farms that are present in the area. The main objective of this work is the modeling of the avian influenza risk in the Dombes region. This work is focused on the wildfowl and the risk of infection and transmission of infection by wild birds. As a first step, we have identified the specific characteristics of the Dombes area, which may affect the epidemiology of avian influenza in the region. The three main players in the Dombes ecosystem are the ponds, the wildfowl populations and the poultry farms. Secondly, the avian influenza risk in the Dombes was declined at two levels: 1) in the ecosystem of a single pond; and 2) within a network of ponds as characterized by 1), where the infection is spread from pond to pond. At the pond level, the avian influenza risk is modeled, on the one hand, by the persistence time of avian influenza viruses in the water of the pond, and, on the other hand, by the infection dynamics within wild bird populations by direct transmission between birds and indirectly through the water of the pond. At the ponds network, the risk analysis identifies spatial clusters of ponds at high risk of infection with avian influenza viruses. Concerning the risk of exposure of poultry farms to avian influenza viruses of wildfowl origin, it is calculated taking into account both the proximity of the farms to ponds likely to be infected and the probability of these ponds to become infected during an outbreak.

Systematic review is a type of review that identifies, assesses, and combines all the published empirical evidence on a specific topic by using explicit, systematic methods. This type of reviews often includes a meta-analysis, a statistical tool used to combine the collected data into a quantitative summary estimate. Guidance documents such as the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) were developed to improve the reporting of systematic reviews of randomized controlled trials. Systematic reviews are commonly used in the field of healthcare research and are increasingly being employed in the field of environmental epidemiology. Environmental epidemiology studies examine exposures in populations and their associations with health outcomes. This field contains several unique considerations that require a careful and critical assessment to ensure the validity of results and to make the data or information more useful for the readers. However, to our knowledge, there is currently no guidance document for conducting systematic reviews that comprehensively addresses the specific issues in this field. Therefore, the objectives of this proposal are twofold: (1) to conduct a systematic review of the currently published epidemiology systematic reviews on a specific topic (mercury exposure and children autism spectrum disorder) to identify analytical issues encountered, and (2) use the experience and other potential solution identified in the literature to develop a guidance or recommendation document for conducting systematic reviews of environmental epidemiology studies. Akin to reporting guidelines for randomized controlled trials, a reporting guideline for environmental epidemiology is anticipated to increase the clarity and transparency of publications and enhance the usefulness of systematic reviews for knowledge synthesis.

ANTECEDENTS: La natació té beneficis per la salut, però l’assistència a piscines comporta l’exposició a subproductes de la cloració (SPC). Els banyistes podrien tenir cert risc de patir efectes respiratoris, com l’asma, però l’evidència és inconsistent. L’objectiu principal és determinar si l’assistència a piscines s’associa a efectes respiratoris aguts i crònics, especialment l’asma infantil. MÈTODES: Per avaluar efectes aguts es mesura funció pulmonar i diferents biomarcadors respiratoris a 48 adults sans abans i després de nedar en una piscina clorada. Per avaluar efectes crònics: estudi transversal a Sabadell (9-12 anys; N=3.223) i estudi longitudinal en una cohort de naixement (ALSPAC, Regne Unit; 7-10 anys; N=5.738). Informació sobre assistència a piscines durant la infància i símptomes d’asma i al lèrgia recollida amb qüestionari i espirometria. RESULTATS: L’únic efecte agut detectat és un lleuger augment de la permeabilitat pulmonar, estimada amb la concentració de CC16 en sang, correlacionat amb l’exposició a SPC i l’exercici físic. L’assistència a piscines no s’associa a un augment del risc d’asma, tampoc entre els nens atòpics, però s’associa a una menor prevalença d’alguns símptomes respiratoris i millor funció pulmonar. Els nens asmàtics que havien anat a la piscina tenen menys símptomes d’asma. CONCLUSIÓ: Es detecta un lleuger efecte agut sobre la permeabilitat de l’epitel li pulmonar dels banyistes, però actualment se’n desconeix la rellevància clínica. Aquest treball no dóna suport a la hipòtesi que l’assistència a piscines durant la infància augmenta el risc d’asma. Al contrari, la natació s’associa lleugerament a menys símptomes d’asma entre els 7 i 12 anys d’edat. / BACKGROUND: Swimming is a healthy activity, but swimming pool attendance enhances the exposure to disinfection by-products (DBP). Swimming pool attendants may have a higher risk of suffering from respiratory conditions, such as asthma, but the evidence is unconsistent. The aim is determine if swimming pool attendance is associated with acute and chronic respiratory effects, especially childhood asthma. METHODS: To evaluate acute effects lung function and several respiratory biomarkers were measured in 48 healthy adults before and alter swimming in a chlorinated pool. To evaluate chronic effects: crosssectional study in Sabadell (9-12 years; N=3,223) and longitudinal study in a birth cohort (ALSPAC, UK; 7- 10 years; N=5,738). Information on swimming pool attendance and asthma and allergic symptoms was collected by questionnaire and spirometry. RESULTS: The only acute effect detected was an slight increase in the lung epithelium permeability, estimated by serum CC16 concentration, correlated with DBP exposure and physical activity. Swimming pool attendance was not associated to an increased asthma risk, neither in atopic children, but was associated with a lower prevalence of some respiratory symptoms and higher lung function. Asthmatic children who attended swimming pools had less asthma symptoms. CONCLUSION: An slight acute effect on the lung epithelium permeability was detected among swimmers, but the clinical relevance is currently not understood. This work do not support the hypothesis that swimming pool attendance during childhood increases the asthma risk. On the contrary, swimming is associated to slightly lower prevalence of asthma symptoms in children 7 to 12 years old.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Diversos estudos em epidemiologia têm investigado a influência do ambiente urbano na saúde da população. Os benefícios dos espaços verdes têm sido um dos aspectos estudados recentemente. Uma das principais vias apontadas é através da promoção da prática de atividades físicas. Outros benefícios incluem a melhoria das condições psicossociais e da qualidade do ar. Esses fatores, por sua vez, têm comprovada associação com a saúde cardiovascular. Nesse sentido, o objetivo deste trabalho é investigar a associação entre espaços verdes e mortalidade por doenças isquêmicas do coração (DIC) e doenças cerebrovasculares (DCBV) no município do Rio de Janeiro, entre os anos de 2010 e 2012. Foi realizado um estudo do tipo ecológico, tendo os setores censitários como unidade de análise. Como variável desfecho foi calculada a razão de mortalidade padronizada (RMP) por sexo e idade, pelo método indireto. Como medidas de exposição às áreas verdes foram utilizadas a média e a variabilidade do Índice de Vegetação por Diferença Normalizada ou NDVI (sigla em inglês) médio referente ao período de estudo, em buffers de 100 metros das bordas dos setores censitários. Os dados foram analisados por um modelo linear condicional autorregressivo, que considera também a estrutura de dependência espacial. Foram incluídas no modelo as covariáveis Índice de Desenvolvimento Social (IDS); densidade de vias de tráfego veicular, divididas entre vias coletoras e locais e vias estruturais primárias e secundárias, utilizadas como proxy de poluição em buffers de 100 metros dos setores; e o indicador de setores censitários litorâneos. Após o ajuste do modelo controlando os possíveis fatores de confusão, foi verificada a redução de 4,5% (CI95%: 7,3%, 1,6%) da mortalidade nas áreas com exposição referente ao intervalo interquartílico mais alto da média do NDVI; e de 3,4% (IC95%: 6,2%; 0,7%) nas áreas referentes ao intervalo interquartílico mais alto da variabilidade, ambos em comparação com o intervalo mais baixo. Esse resultado indica a associação inversa entre a exposição aos espaços verdes e a mortalidade por DIC e DCBV no município do Rio de Janeiro. Além disso, o aumento da mortalidade está associado a piores condições de vida e à poluição do ar.

Contexte : Les phtalates et les phénols sont des perturbateurs endocriniens. Les données concernant leurs effets sur la croissance fœtale et durant l'enfance sont limitées et suggèrent un effet dépendant du sexe de certains phénols sur le poids de naissance. Une des limites de ces études est l'estimation de l'exposition, basée sur la mesure de leurs concentrations dans un petit nombre d'échantillons d'urine maternelle. En raison de la faible persistance de ces composés chimiques dans l'organisme, les concentrations urinaires varient dans le temps. Les concentrations dosées dans d'autres matrices comme le liquide amniotique pourraient être pertinentes pour estimer l'exposition fœtale.Objectifs : Les objectifs de la thèse étaient : 1) d'étudier les impacts potentiels de l'exposition prénatale aux phénols et aux phtalates sur la croissance du fœtus et de l'enfant ; 2) de caractériser la variabilité des concentrations urinaires de phénols au long de la grossesse et de comparer les concentrations de phénols dosées dans le liquide amniotique et l'urine maternelle recueillis le même jour ; 3) de caractériser le biais et l'impact sur la puissance statistique de l'utilisation d'un faible nombre d'échantillons urinaires pour estimer les expositions. Méthodes : Les associations entre les phénols, les phtalates et la croissance ont été étudiées parmi un sous-effectif de la cohorte mère-enfant EDEN ayant accouché de garçons (n =520). La croissance fœtale a été estimée à l'aide d'échographies réalisées pendant la grossesse et de mesures à la naissance. La croissance postnatale a été modélisée à partir de mesures répétées normalisées, réalisées entre la naissance et 3 ans. Les biomarqueurs d'exposition aux phtalates et phénols ont été dosés dans les urines maternelles recueillies une fois pendant la grossesse. La variabilité des concentrations urinaires de phénols et la correspondance avec les concentrations mesurées dans le liquide amniotique ont été étudiées chez 71 femmes enceintes recevant une amniocentèse au centre médical Mount Sinaï (NY, États-Unis). Un échantillon d'urine maternelle a été recueilli le jour de l'amniocentèse, et à deux autres reprises pendant la grossesse. L'étude concernant les biais est basée sur des données simulées. Résultats : Les concentrations de triclosan étaient négativement associées à tous les paramètres de croissance mesurés à la troisième échographie (p ≤ 0,16) et avec la périmètre crânien à la naissance (β = - 1,4 mm, IC 95%; -2.8; 0.0). Les parabènes étaient associés positivement avec le poids à la naissance (p < 0,05). Le méthyle et propyle parabènes étaient aussi positivement associés au poids et à la circonférence abdominale à 3 ans (p-valeurs comprises entre 0,02 et 0,14). En ce qui concerne la variabilité des concentrations urinaires pendant la grossesse, les coefficients de corrélation intra-classe (ICC) variaient entre 0,48 et 0,62 pour l'ensemble des phénols sauf le bisphénol A (ICC = 0,11). Seuls la benzophénone-3 et le propyle parabène ont été détectés dans au moins 50 % des échantillons de liquide amniotique. Pour ces composés les concentrations dosées dans l'urine maternelle et le liquide amniotique, recueillis le même jour, étaient positivement associés. Dans le cadre d'une simulation, nous avons estimé que 5 échantillons d’urine étaient nécessaires pour estimer correctement l’exposition aux produits chimiques ayant un ICC de 0,6, tandis que pour des produits chimiques avec un ICC de 0,15, environ 25 échantillons étaient nécessaires.Conclusion : Un seul échantillon d'urine était disponible pour évaluer les expositions des femmes de la cohorte EDEN et nos résultats peuvent être affectés d'un biais résultant d'erreurs de classification des expositions, notamment pour le bisphenol A pour lequel nous avons observé une variabilité importante des concentrations. Néanmoins, notre étude suggérait un effet de l'exposition prénatale à certains phénols sur la croissance pré- et post-natale. / Background: Phthalates and phenols belong to the family of short half-life endocrine disruptors. Data regarding their effects on fetal and early post-natal growth in Human are sparse and suggest a sex-specific effect of some phenols on birth weight. One of the limitations of these studies is exposure assessment usually based on the measurement of their concentrations in a small number of maternal urine samples collected during pregnancy. Because of their low persistence in the organisms and the likely episodic nature of the exposures, urinary concentrations of these chemicals are likely to vary. Chemical concentrations measured in alternative matrix, such as amniotic fluid, might be a relevant dosimeter of fetal exposure.Objectives: Objectives of the thesis were: to study the potential effects of prenatal exposures to phenols and phthalates on pre- and early post-natal growth; to characterize variability in maternal urine concentrations of phenols throughout pregnancy and to compare phenol concentrations in amniotic fluid to those measured in maternal urine collected same day; to characterize the impact of increasing the number of measurements to estimate exposure on bias and statistical power of epidemiological studies.Methods: Associations between phenols, phthalates and growth were studied among a subsample of pregnant women of the French EDEN cohort delivered boys (n =520). We measured fetal growth with ultrasound (three times during pregnancy) and birth measurements. We used standardized measures acquired between birth and 3 years of age to model postnatal growth. We measured biomarkers of phthalates and phenols in maternal urines collected once during pregnancy: 191 women were assessed in 2008 and 410 other women in 2012 (ntot = 601). Variability in phenol urine concentrations and relationship between concentrations measured in amniotic fluid and maternal urine collected on the same day were studied among 71 pregnant women presenting for an amniocentesis at the Mount Sinai Medical Center (NY, USA). Maternal urine was collected at the time of the amniocentesis appointment, and on two subsequent occasions. Urine and amniotic fluid were analyzed for nine phenols.The study aiming at characterizing bias was based on simulated data. Results: Among the subsample of 191 pregnant women from the EDEN cohort, we observed a negative association between dichlorophenols and birth weight and a positive association between benzophenone-3 and birth weight. The associations with dichlorophenols were not replicated in the larger subsample of the EDEN cohort (n = 520). Triclosan concentration was negatively associated with all of the growth parameters measured at the third ultrasound examination (p ≤ 0.16) and with head circumference measured at birth (β = - 1.4 mm, 95% CI; -2.8; 0.0). All of the parabens were positively associated with weight at birth (p < 0.05). These associations remained in childhood for methyl- and propyl-parabens. Regarding the variability in phenol urinary concentrations during pregnancy, the intraclass correlation coefficients (ICC) ranged between 0.48 and 0.62 for all phenols except bisphenol A (ICC = 0.11). Only benzophenone-3 and propylparaben were detectable in at least half of the amniotic fluid samples; for these phenols, concentrations in maternal urine and amniotic fluid were positively associated. In a simulation study, we estimated that 5 samples will be needed to correctly estimate exposure to chemicals with ICC of 0.6, while for chemicals with ICC of 0.15 around 25 samples would be needed.Conclusion: We only had spot urine sample to assess exposure in the EDEN cohort and findings may be affected by exposure misclassification, especially for bisphenol A for which we observed high variability in urine concentrations. Nevertheless, our study lends support to a potential effect of prenatal exposure to some phenols on pre- and early post-natal growth.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Diversos estudos em epidemiologia têm investigado a influência do ambiente urbano na saúde da população. Os benefícios dos espaços verdes têm sido um dos aspectos estudados recentemente. Uma das principais vias apontadas é através da promoção da prática de atividades físicas. Outros benefícios incluem a melhoria das condições psicossociais e da qualidade do ar. Esses fatores, por sua vez, têm comprovada associação com a saúde cardiovascular. Nesse sentido, o objetivo deste trabalho é investigar a associação entre espaços verdes e mortalidade por doenças isquêmicas do coração (DIC) e doenças cerebrovasculares (DCBV) no município do Rio de Janeiro, entre os anos de 2010 e 2012. Foi realizado um estudo do tipo ecológico, tendo os setores censitários como unidade de análise. Como variável desfecho foi calculada a razão de mortalidade padronizada (RMP) por sexo e idade, pelo método indireto. Como medidas de exposição às áreas verdes foram utilizadas a média e a variabilidade do Índice de Vegetação por Diferença Normalizada ou NDVI (sigla em inglês) médio referente ao período de estudo, em buffers de 100 metros das bordas dos setores censitários. Os dados foram analisados por um modelo linear condicional autorregressivo, que considera também a estrutura de dependência espacial. Foram incluídas no modelo as covariáveis Índice de Desenvolvimento Social (IDS); densidade de vias de tráfego veicular, divididas entre vias coletoras e locais e vias estruturais primárias e secundárias, utilizadas como proxy de poluição em buffers de 100 metros dos setores; e o indicador de setores censitários litorâneos. Após o ajuste do modelo controlando os possíveis fatores de confusão, foi verificada a redução de 4,5% (CI95%: 7,3%, 1,6%) da mortalidade nas áreas com exposição referente ao intervalo interquartílico mais alto da média do NDVI; e de 3,4% (IC95%: 6,2%; 0,7%) nas áreas referentes ao intervalo interquartílico mais alto da variabilidade, ambos em comparação com o intervalo mais baixo. Esse resultado indica a associação inversa entre a exposição aos espaços verdes e a mortalidade por DIC e DCBV no município do Rio de Janeiro. Além disso, o aumento da mortalidade está associado a piores condições de vida e à poluição do ar.

This chapter defines and describes hazardous wastes and their adverse health effects. Historical evolution of the management and public understanding of waste issues is traced. Other parts of the chapter describe hazardous waste management, including disposal landfills, land farming, incineration, and toxics use reduction. Various regulatory measures are described as well as nonregulatory measures for prevention and control of adverse health effects from hazardous wastes. Approaches to evaluating human health effects at hazardous waste sites are described, emphasizing special challenges and opportunities in environmental epidemiology. Social aspects of community involvement are noted. Steps of the Superfund clean-up process are delineated. Governmental contingency plans for coordination in emergency response situations are reviewed. In addition, a section describes pollution prevention and toxics use reduction.