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Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma. The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV). Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years. Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication. Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.

As populations increase and air quality continues to decline in many cities around the world, there is growing recognition that human dependency on car based transport is a serious pollution issue. The potential exists to change this aspect of human behaviour using environmental education to develop more sustainable transport practices. The application of education strategies to achieve behaviour change in transport mode choice may benefit from an interdisciplinary approach. This research examined the effectiveness of three different educational strategies in a workplace situation in achieving a shift in transport mode away from the single occupant vehicle. This research aimed to determine if workplace based education interventions that stimulate a deeper level of learning, and encourage self-regulated learning and reflective practice, are more likely to achieve positive behaviour change than interventions based on more superficial learning. A secondary aim was to determine if the characteristics or type of workplace influence the effectiveness of particular education strategies. The research focuses specifically on people’s perceptions of transport behaviour and air pollution. The research examined the effectiveness of three workplace based interventions which aimed at reducing the use of single occupant vehicles (SOV) for commuting to work resulting in an increase in the use of green transport (alternatives to the SOV). The primary goal of the three educational interventions was to achieve an increased awareness, development of positive attitudes and increased empowerment regarding sustainable transport choices. Based on a combination of environmental education and self-regulation of learning theory it was theorized that achieving the three afore mentioned educational outcomes would be highly likely to result in a change in behaviour. The three interventions differ in level of participant involvement, while the information and structure of each intervention was controlled as much as is possible in a naturalistic study. The intervention designs were based on educational theories including cognitivist information processing, Vygotskian/social constructivism, and self-regulation of learning. The first intervention provided information to participants impersonally with no additional support. The second intervention incorporated a volunteer to model pro-environmental behaviour, facilitate discussion of issues, and aid in planning commute trips using alternatives to the single occupant vehicle. The third intervention included the formation of a green transport planning group within the workplace which aimed to identify and address barriers to using alternative transport in the workplace through the development of a green transport plan. In the naturalistic workplace setting, mixed methodologies(qualitative and quantitative) were employed to examine the relative effectiveness of the three interventions in terms of participants knowledge about, attitudes towards and behaviour (action) in regard to transport, as well as changes at an organizational level. Multiple case studies and surveys were used to collect data about employee transport behaviour, attitudes, and knowledge in 13 workplaces situated in the central area of Perth, the capital city of Western Australia, before and after a period of intervention. To allow comparability between workplaces in terms of organisational structure and function six of the 13 workplaces were selected to examine in detail,one government and one engineering organization in each of the three intervention groups. It was found that the level of knowledge about car use and air quality was increased in all three intervention groups, suggesting increased involvement does not improve the chance of increasing knowledge. In contrast, significantly more positive attitudes to car use and air quality issues were developed in only the two most involving interventions, suggesting information distribution alone is unlikely to influence attitude. There were no changes in the general environmental attitudes across the intervention groups. Single occupant vehicle trips were significantly reduced in the second intervention group only. An overall significant increase was reported for self efficacy (as a measure of empowerment) but no significant change was reported for any particular intervention group. At an organizational level the third intervention resulted in the greatest organizational change, and it is likely that the measures implemented as a result of the green transport planning process will have an ongoing impact on employee transport behaviour in the participant workplaces. The effectiveness of each intervention type also varied between workplaces. Structural factors such as design of the work environment, internal mail and email systems, and work hours influenced the delivery of the interventions in some workplaces and qualitative data indicates this may have influenced success. There was also an indication that management involvement and workplace culture were major factors influencing participant perceptions of effectiveness of particular education strategies. Overall it is concluded that while the second intervention involving leadership (but without participant ownership) achieved the greatest reduction in use of the single occupant vehicle, the third intervention achieved the greatest long-term impact on participants and organizations. As a result the definition of effectiveness is complicated and is dependant on whether preferred outcomes have a short-term or a long-term focus. These findings have implications for the way in which achieving sustainable transport in metropolitan areas is approached, as well as other environmentally sustainable behaviours.

Thesis (Ph. D.)--University of Missouri--Rolla, 2007. / Vita. The entire thesis text is included in file. Title from title screen of thesis/dissertation PDF file (viewed February 6, 2008) Includes bibliographical references (p. 140-144).

Thesis (Ph. D.)--University of Washington, 2008. / Vita. Includes bibliographical references (leaves 115-183).

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1993. / Vita. Abstract. Includes bibliographical references. Also available via the Internet.