• Subject Name : Nursing

Human Health Impact Exposure to Traffic-Related Air Pollution (TRAP)

Table of Contents


1.1 Research Background.

1.2 Research aim and objectives.

1.3 Research Question.

1.4 Research rationale.

1.5 Research Scope.

Literature review..

Research methodology.

3.1 Data collection.

3.2 Data analysis.

Research schedule.


1. Introduction to Neurotoxicity of Traffic-Related Air Pollution

1.1 Research Background

The urban areas are mostly affected by major sources of air pollution. There is a mixture of secondary pollutants, vehicle exhausts, non-combustion emissions, evaporative emissions from vehicles, and is collectively known as traffic-related air pollution. These gases and other mixture exposed from the vehicles is related to various health effects that also lead to adverse birth outcomes such as dementia (Sunyer, Esnaola & Alvarez-Pedrerol et al., 2015). There is a significant relationship between health effects and exposure of pollution from vehicles such as they lead to a person suffering from incident asthma, reduced lung functioning, exacerbation of asthma, cardiovascular mortality, cardiorespiratory effects, reduced lung function, and the progression of atherosclerosis (Mannucci & Franchini, 2017). The effects of traffic-related air pollution are increasing day-by-day. There are several types of research done by the government to conduct a review so that air pollutants such as nitrous oxide and diesel exhaust have been examined and some strategies and programs are designed to improve the quality of air pollution (Tong, Chen & Malkawi et al., 2016). Health effects related to traffic-related air pollution is investigated to relate to the importance of environmental health issue and the contribution of traffic as a source of air pollution. Australia is estimated to spend 4-7% of the time in microenvironment influences caused by heavy and moderate traffic because traveling is counted in active transportation (Hystad, Villeneuve & Goldberg et al., 2015). This proposal aims to investigate the view of the health of Australians by developing evidence associate with traffic-related air pollution. To have a complete picture of traffic-related air pollution in Australia here, a systematic literature review is done by incorporating inclusion and exclusion criteria based on health effects. This will provide a review on the topic by efficiently identifying, prioritizing, and selecting areas for in-depth assessment and review.

1.2 Research Aim and Objectives

The research aims to conduct a systematic review of the literature to do further study on human health effects exposure to transportation-related air pollution. This will help in characterizing the available studies based on adverse health outcomes and study design. The gaps from the literature will be identified so that further analysis is conducted on the evaluation of health-related outcomes after air pollution.

1.3 Research Question

The research question for this review will be as follows:

What is the existing literature presenting the association between air pollution and adverse related health effects (that includes effects in various body systems: cardiovascular, immunological, respiratory, nervous, reproductive/ developmental, nervous, and other related to mortality and cancer)?

The sub-questions will identify the health effects caused by transportation-related air pollution having exposure concerning:

  1. Susceptible population (that is a person having diseases like COPD, diabetes, asthma, and heart disease)?
  2. Gender-based analysis (males affected or females or both)?
  3. Different life stages (that are infants less than one year, children and adults ranging from one to eighteen years, adults ranging from eighteen to fifty-five years, and seniors with the age fifty-five and above)?
  4. The ambient exposure-based studies that are general population and occupational exposure-based studies that are population limited to taxi drivers, traffic wardens, and bus drivers?
  5. Types of article studies such as systematic reviews, primary research studies, meta-analyses, and critical reviews?

1.4 Research Rationale

The review will help in identifying the strengths and weaknesses of the evidence so that the effects and characteristics are quantified to know the effects of traffic generated pollution on the population. The interventions done so far will be evaluated based upon the benefits drawn from them. The points on causal relationships and the limitations from previous knowledge will be evaluated between population exposures, transport emissions, and adverse effects on health (Ritz, Lee & Hansen et al., 2016). The contribution of authors and articles will give a good deal of attention to find an indicator of the composition of air pollution-related problems to health. The articles will provide valuable various stages of causal relationships and health impact assessments. Hence, an indicator will be found that adequately covers all relevant aspects of transportation-related air pollution impacts.

1.5 Research Scope

The literature review analysis will provide relationships between transportation-related air pollution affecting public health. The policymakers and experts of the field will get evidence-based data to finalize the reports to make use of existing evidence-based on peer-reviewed published material to have a meaningful interpretation and synthesis of evidence. The need for development will be emphasized after realizing the health effects. Thus, this review and proposal will be of great significance and scope to provide a better understanding of transportation-related air pollution health impacts that will help in the reformation of policies. Besides, it will help other researchers to perform further research on the same subject or area.

2. Literature Review of Neurotoxicity of Traffic-Related Air Pollution

In recent years, improvements toward air pollution and control have seen a considerable hazard to the health of human beings. In the developing countries, the concentrations of air quality have been found that it has exceeded the limit (Costa, Cole & Coburn et al., 2017). The incidence rates of multiple diseases have been found increasing due to multiple diseases such as lung cancer, cardiovascular diseases, asthma, poor birth outcomes, negative effects on pregnancy, and other respiratory problems (Ghorani-Azam, Riahi-Zanjani & Balali-Mood, 2016). The influence of air-related problems and its exposure is largely debated. In the studies, some causal relationships have been found and thus have indicated that there is an increase in outdoor air exposure that affects people's health effects that contribute both directly and indirectly (Kim, Kabir & Kabir, 2015). The present literature states that there is a great influence on air pollution about human health outcomes.

From the recent articles, it was found that there is a strong relationship between air pollution due to transport emissions and public health effects (Ritz, Lee & Hansen et al., 2016). The health effects have been described by the transport sector also showing great concern and posing a question for the government to work on the policies. The measures earlier followed in the articles have adverse effects on public health-related to transport emissions (Hystad, Villeneuve & Goldberg et al., 2015). The measures include the use of quality control, engine technology, reduced level of Sulphur in diesel fuel, use of unleaded petrol, and traffic monitoring. The economic analysis states that health effects are seen with transport externalities that impact direct users of the transport department. There is a need for great importance that it states morbidity costs and premature mortality that are caused due to transportation in assessing the efficacy of new and existing transport (Mannucci & Franchini, 2017).

Mostly discussed in the articles are the public health effects of air pollution due to transport emissions. The examples of externalities for air pollution are transportation costs, accessibility, community livability, land use, equity, safety, and economic development (Sunyer, Esnaola & Alvarez-Pedrerol et al., 2015). The most common factor related to this is found to be the commercial bodies, urban life, and motor vehicle used by individuals including public costs for crash risk, parking facilities, road facilities, environmental damage, and traffic congestion.

The extensive research on health effects was found to be characterized by different pollutant mixes, differing air quality, available civic amenities, climate, and socioeconomic status of the population. The studies observed that air pollution has an association with morbidity effects and mortality on the exposed population. The quantitative analysis done by the World Health Organization provided the analysis that transportation has adverse effects on health (Abdel-Shafy & Mansour, 2016). The epidemiological studies reflect that air pollutants include outcomes associated with respiratory disease, cardiovascular diseases including hospitalization for urgent care visits, chronic bronchitis, school absenteeism, acute problems, work loss, decreased lung function, restrictions in activity, and respiratory symptoms. The quantification of health effects is a very good tool in guiding the policymakers on the effects of the intervention on public health (Mannucci, Harari & Martinelli et al., 2015).

Other impacts that have been identified in the research articles are global warming and the health impacts that transport users are experiencing have other air pollution impacts. The impacts are such as lower property and land value, exacerbation of environment, and livability for residents, visitors, and tourists that lead to lower-income from tourism and discouragement of new investment. The decrease in visual intrusion has been felt that affected the aesthetic value of urban landscape and scenic view. Acid rain is the result of air pollution caused by industries and factories, which are directly contributing to the damage of vegetation and structures. However, the health costs are found to be inducing that remains grey due to the separation and identification of air pollutants and their health effects. The research of 2019 and 2020 has presented the issues describing that the largest transportation share is causing total emission causing health effects (Goldizen, Sly & Knibbs, 2016). The second point presented in the articles is the estimating value of statistical life (VOSL), quantification of acute health effects, quantification of chronic health effects, estimation of health costs of indoor air pollution, and valuing children's health effects. Few studies found that children are mostly affected by air pollution and the exposure is causing damage to the development stage of physiology and immature metabolism. Childhood asthma is found with a confirmed association between coughing in children under the age of two and traffic-related problems (Bowatte, Lodge & Lowe et al., 2015).

In the research studies, it was found that the traditional approach was used to synthesize the knowledge by qualitative and quantitative data both from the studies relevant to the topic. This data was used by the policymakers and strategists at all levels to identify and characterize the relations between air pollution and its side-effects (Thurston, Kipen & Annesi-Maesanon et al., 2017).

The synthesis of approach has been found and it has been found that there has been a variety of health issues related to traffic-related air pollution. The approaches have been compared with other methods such as evidence gap map and review, it is essentially affecting evidence-based decision-making as the scope of the topic (Tong, Chen & Malkawi et al., 2016).

3. Research Methodology

3.1 Data Collection

Search strategy

The present research would be done based on secondary and qualitative data analysis. The articles will be selected from software like EMBASE, Medline, Psych Info, and CINAHL. The search will be conducted based on the reference lists of identified review studies. The search would be limited to 2015 to 2020 and the language preferred will be English. Publications would be considered that they do not overlap any article. Moreover, the major consideration will be towards the topic that the articles that will be selected represent the topic such as human health impact Exposure to Traffic-related Air Pollution (TRAP).

Study selection

The duplication of articles will be taken into consideration while searching on databases like EMBASE, Medline, Psych Info, and CINAHL to search out online literature presented by many authors on this topic. The reviewer will independently screen the articles based on abstracts and titles of databases for eligibility. The next step will include the evaluation of articles collected based on the identification of a review article and a primary research study. The exposure assessment criteria will be taken into consideration for evaluating primary research articles. Transportation-related air pollution studies will be highly preferred to match the article review. The PRISMA flow diagram will be formed to conduct the screening of articles and hence identification of articles will be easy to include for research.

Charting the data

Data extraction forms in the PRISMA flow chart will be used for data collection from the evidence studies to map the evidence. The research articles will be selected by study design parameters and health effect endpoints. To do this study, the points that data collector will keep into consideration will be stud participants (all ages including infants, children, youth, adolescents, adults, and senior citizens), type of exposure (occupational-based or ambient air), the gender of the participants (male, female, or both), health complications of study participants (healthy or people suffering from diseases such as heart disease, asthma, diabetes, and chronic obstructive pulmonary disease). The studies will also be included that will be discussing respiratory effects, immunological disorders, mortality, cardiological effects, cancer, neurological, genotoxicity, reproductive and developmental effects, and other health-related effects. All the health categories have sub-groups that will be included to provide additional details on health effects in each study. The review article will be classified and charted into different types of studies such as meta-analysis, systematic review, critical review, and scoping review.

The data collection will include quality control and quality assurance by following all the steps to verify accurateness and completeness in the process. This will help in reviewing by conducting all the steps of data collection.

Collating, summarizing, and reporting the results

The study table will be developed to summarize the number of articles based on primary study and review that presents the data on different health effects. The broad category that would be considered will be respiratory health effects and sub-groupings will be done by classifying the data into respiratory mortality, lung functioning, and asthma. The cross-tabulation of health effects will be done by including study design parameters like populations, life stages, and many more. The tabular form will help in identifying the characteristics and literature-rich subject areas. The traffic-related air pollution will be used in summarizing the results to identify evaluation and future reviews from selected articles.

Quality assessment

The review will be used to identify the available resources by finding out the association between traffic-related air pollution and health effects on the public. The bias risk will not be assessed by keeping into view the guidelines to proceed with this project.

3.2 Data Analysis

The review aims to epidemiologically do the literature review of health effects exposure to transportation-related health effects on air pollution. This will include evidence-based on adverse health outcomes and study design to identify the gaps in the literature. The evidence maps generate selection and facilitation of subject areas to identify the knowledge gaps for future research. The data analysis would be done using different sources and statistician to produce evidence-based results.

4. Research Schedule

The research will commence in the first week of October 2020 and will end in December 2020. The Gantt chart for the current research is illustrated below:


October 2020

November 2020

December 2020


Week 1 - 2

Week 2

Week 3

Week 4

Week 1

Week 2

Week 3

Week 4

Week 1

Week 2

Week 3

Week 4

Chapter 1: Introduction


Chapter 2: A literature review


Chapter 3: Research methodology


Chapter 4: Findings and data analysis


Chapter 5: Conclusion and recommendations


 5. References for Neurotoxicity of Traffic-Related Air Pollution

Abdel-Shafy, H. I., & Mansour, M. S. (2016). A review on polycyclic aromatic hydrocarbons: source, environmental impact, the effect on human health, and remediation. Egyptian Journal of Petroleum25(1), 107-123. https://doi.org/10.1016/j.ejpe.2015.03.011

Bowater, G., Lodge, C., Lowe, A. J., Erbas, B., Perret, J., Abramson, M. J., ... & Dharmage, S. C. (2015). The influence of childhood traffic‐related air pollution exposure on asthma, allergy, and sensitization: A systematic review and a meta‐analysis of birth cohort studies. Allergy70(3), 245-256. https://doi.org/10.1111/all.12561

Costa, L. G., Cole, T. B., Coburn, J., Chang, Y. C., Dao, K., & Roqué, P. J. (2017). Neurotoxicity of traffic-related air pollution. Neurotoxicology59, 133-139. https://doi.org/10.1016/j.neuro.2015.11.008

Ghorani-Azam, A., Riahi-Zanjani, B., & Balali-Mood, M. (2016). Effects of air pollution on human health and practical measures for prevention in Iran. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences21. https://dx.doi.org/10.4103%2F1735-1995.189646

Goldizen, F. C., Sly, P. D., & Knibbs, L. D. (2016). Respiratory effects of air pollution on children. Pediatric Pulmonology51(1), 94-108. https://doi.org/10.1002/ppul.23262

Hystad, P., Villeneuve, P. J., Goldberg, M. S., Crouse, D. L., Johnson, K., & Canadian Cancer Registries Epidemiology Research Group. (2015). Exposure to traffic-related air pollution and the risk of developing breast cancer among women in eight Canadian provinces: A case-control study. Environment International74, 240-248. https://doi.org/10.1016/j.envint.2014.09.004

Kim, K. H., Kabir, E., & Kabir, S. (2015). A review of the human health impact of airborne particulate matter. Environment International74, 136-143. https://doi.org/10.1016/j.envint.2014.10.005

Kurt, O. K., Zhang, J., & Pinkerton, K. E. (2016). Pulmonary health effects of air pollution. Current Opinion in Pulmonary Medicine22(2), 138. https://dx.doi.org/10.1097%2FMCP.0000000000000248

Mannucci, P. M., & Franchini, M. (2017). Health effects of ambient air pollution in developing countries. International Journal of Environmental Research and Public Health14(9), 1048. https://doi.org/10.3390/ijerph14091048

Mannucci, P. M., Harari, S., Martinelli, I., & Franchini, M. (2015). Effects on health of air pollution: A narrative review. Internal and Emergency Medicine10(6), 657-662. https://link.springer.com/article/10.1007/s11739-015-1276-7

Ritz, B., Lee, P. C., Hansen, J., Lassen, C. F., Ketzel, M., Sørensen, M., & Raaschou-Nielsen, O. (2016). Traffic-related air pollution and Parkinson's disease in Denmark: A case-control study. Environmental Health Perspectives124(3), 351-356. https://doi.org/10.1289/ehp.1409313

Sunyer, J., Esnaola, M., Alvarez-Pedrerol, M., Forns, J., Rivas, I., López-Vicente, M., ... & Viana, M. (2015). Association between traffic-related air pollution in schools and cognitive development in primary school children: A prospective cohort study. PLoS Medicine12(3), e1001792. https://doi.org/10.1371/journal.pmed.1001792

Thurston, G. D., Kipen, H., Annesi-Maesano, I., Balmes, J., Brook, R. D., Cromar, K., ... & Grigg, J. (2017). A joint ERS/ATS policy statement: What constitutes an adverse health effect of air pollution? An analytical framework. European Respiratory Journal49(1). 10.1183/13993003.00419-2016

Tong, Z., Chen, Y., Malkawi, A., Adamkiewicz, G., & Spengler, J. D. (2016). Quantifying the impact of traffic-related air pollution on the indoor air quality of a naturally ventilated building. Environment International89, 138-146. https://doi.org/10.1016/j.envint.2016.01.016

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