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PubMed1989

Difference in rural and urban mortality: implications for health education and promotion.

Rural health care delivery is often inferior to that of urban areas. Although health services do not have to be identical in the two settings, quality services appropriate for the needs of rural communities are imperative. Moreover, health education and promotion should be seen as an immediate and viable strategy for (a) reducing risk factors and health care needs, and (b) increasing the cost effectiveness of existing services. The appropriateness and prioritization of health care services and health education/promotion can only be realized if health professionals are aware of rural versus urban needs. To facilitate our knowledge of such differences, the mortality rates of the 10 leading causes of death were compared for each county in Ohio and differences between rural and urban mortality were analyzed. Counties were categorized according to "density" (persons per square mile) and "percent urban" (percent of county area classified as urban). The analysis demonstrated that there were no significant differences between rural and urban counties in mortality due to cancer, pulmonary disease, diabetes mellitus, atherosclerosis, and suicide. Mortality related to cardiovascular disease, cerebrovascular disease, accidents, and influenza/pneumonia was significantly higher in rural counties, while deaths due to chronic liver disease were significantly greater in urban counties.

Demography↗
PubMed1992

Cancer in rural versus urban populations: a review.

Rural-urban comparisons have identified higher age-, race-, and sex-adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts. This paper summarizes rural-urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural-urban differences in utilization of health care services; questions the appropriateness of using rural-urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents.

Cancer Care Facilities↗
PubMed1995

Changes in health insurance coverage within rural and urban environments--1977 to 1987.

This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987.

Adolescent↗
PubMed2003

Rural-urban differences in health care benefits of a community-based sample of at-risk drinkers.

CONTEXT: Different types of health plan cost-containment strategies (eg, gatekeeping, selective contracting, and cost-sharing) may affect the utilization of behavioral health services differently in urban and rural areas. PURPOSE: This research compares the cost-containment strategies used by the health plans of insured at-risk drinkers residing in rural and urban areas. METHODS: A screening instrument for at-risk drinking was administered by phone to approximately 12,000 residents of 6 southern states; 442 at-risk drinkers completed 4 interviews over a 2-year period and consented to release insurance and medical records. Two thirds of the sample (n=294) were insured during the last 6 months of the study. In 1998, health plan characteristics were successfully collected for 217 (72.3%) of the insured at-risk drinkers, representing 113 different health plans and 206 different policies. FINDINGS: Compared with urban at-risk drinkers, rural at-risk drinkers were significantly less likely to be enrolled in a health plan with gatekeeping policies for both behavioral health (P = .001), and physical health (P = .031). Compared with urban enrollees, rural enrollees were significantly more likely to pay deductibles (P = .042), to pay coinsurance for physical health services (P = .002), and to have limits placed on physical health services use (P = .067), but they were less likely to pay copayments for physical health (P = .046). Rural enrollees were less likely to face higher copayments (P = .007) and higher coinsurance (P = .076) for mental health than for physical health, compared to urban enrollees. CONCLUSIONS: Because rural residents were more likely to be enrolled in indemnity plans and less likely to be enrolled in health maintenance organizations, rural at-risk drinkers were enrolled in plans that relied less on supply-side cost-containment strategies and more on demand-side cost-containment strategies targeting physical health service use, compared with their urban counterparts. Rural at-risk drinkers were less likely to be enrolled in health plans with greater cost-sharing for mental health than for physical health compared to urban at-risk drinkers.

Actuarial Analysis↗
PubMed2004

Organization of care for acute myocardial infarction in rural and urban hospitals in Kansas.

CONTEXT: One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined. METHODS: Using a nominal group process, key elements within hospitals that might influence quality of AMI care were identified, including personnel, equipment, organizational systems, and quality improvement activities. These elements were included in a survey of 45 rural and 12 urban Kansas hospitals. FINDINGS: Though emergency 911 systems were widely available in both urban and rural communities, paramedics and advanced cardiac life support were less likely to be available in rural communities. Few rural hospitals were capable of emergent catheterization, angioplasty, or coronary artery bypass surgery; cardiologists, though readily available by phone, were rarely available on-site. Nevertheless, most rural ambulances could not bypass local hospitals. Most rural hospitals transferred the vast majority of their patients to urban medical centers within an average distance of 78 miles. Standardized protocols were used for emergent AMI care in 67% of urban and 62% of rural hospitals. Hospitals included aspirin in 53% and beta-blockers in 28% of either protocols or standing orders. CONCLUSIONS: Although faced with more limited resources, some rural hospitals, like their urban counterparts, have implemented protocols to address emergent care of AMI patients. Nevertheless, many of these protocols omit crucial aspects of AMI care. Rural and urban hospitals should jointly develop systems that assure consistent, rapid delivery of AMI care.

Cardiology Service, Hospital↗
PubMed2005

Urban, rural, and regional variations in physical activity.

PURPOSE: There is some speculation about geographic differences in physical activity (PA) levels. We examined the prevalence of physical inactivity (PIA) and whether U.S. citizens met the recommended levels of PA across the United States. In addition, the association between PIA/PA and degree of urbanization in the 4 main U.S. regions (Northeast, Midwest, South, and West) was determined. METHODS: Participants were 178,161 respondents to the 2000 Behavioral Risk Factor Surveillance System (BRFSS). Data from 49 states and the District of Columbia were included (excluding Alaska). States were categorized by urban status according to the U.S. Department of Agriculture. Physical activity variables were those commonly used in national surveillance systems (PIA = no leisure-time PA; and PA = meeting a PA recommendation). RESULTS: Nationally, PA levels were higher in urban areas than in rural areas; correspondingly, PIA levels were higher in rural areas than in urban areas. Regionally, the urban-rural differences were most striking in the South and were, in fact, often absent in other regions. Demographic factors appeared to modify the association. CONCLUSION: The association between PA and degree of urbanization is evident and robust in the South but cannot be generalized to all regions of the United States. For the most part, the Midwest and the Northeast do not experience any relationship between PA and urbanization, whereas, in the West, the trend appears to be opposite of that observed in the South.

Activities of Daily Living↗
PubMed2006

Rural-urban disparities in health-related quality of life within disease categories of Veterans.

CONTEXT: Compared to their urban counterparts, rural veterans have been found to have lower health-related quality of life. PURPOSE: To determine whether these disparities persist when examining disease categories of rural and urban veterans. METHODS: We obtained survey data on 748,216 veterans who were current or anticipated Veterans Health Administration patients. Using International Classification of Diseases (ICD)-9CM codes, we determined whether these veterans had diagnoses that fell into any of 30 physical health disease categories, and we used ZIP codes to determine whether veterans lived in rural or urban settings. We compared rural to urban prevalence of disease categories as well as urban to rural health-related quality-of-life physical health component summary scores (PCS) and mental health component summary scores (MCS) for each disease category. FINDINGS: Physical diagnoses were significantly more prevalent in the rural veteran population for most disease categories examined. For every disease category examined, PCS were significantly lower for veterans who lived in rural, compared to urban, settings (P < .001 for all); rural veterans also experienced lower MCS for all disease categories although differences were modest. Differences persisted after controlling for sociodemographic factors. CONCLUSIONS: Compared to the urban veteran population, within disease categories, the rural veteran population experiences higher disease prevalence and lower physical and mental quality-of-life scores. Policymakers should anticipate greater health care demands from the rural veteran population and work to meet that demand.

Aged↗
PubMed2005

Does living in urban or rural settings affect aspects of physical fitness in children? An allometric approach.

OBJECTIVE: The aim of this study was to investigate physical fitness in relation to fatness in urban and rural Greek children by means of allometric scaling. METHODS: The sample consisted of 360 (189 urban and 171 rural; age 12.3+/-0.42 years) boys and 247 (125 urban and 122 rural; age 12.3+/-0.43 years) girls. The sample was highly representative (32-64%) of all 12 year old children registered in the prefecture of Trikala, Greece. All volunteers were assessed for BMI and % body fat, as well as sit and reach, basketball throw (BT), vertical jump (VJ), handgrip strength (HG), 40 m sprint, agility run, and 20 m shuttle run. To correct for possible associations between fatness and fitness, a single cause allometric scaling was employed using the natural logarithms (ln) of fitness parameters that were significantly correlated with the ln body fat. RESULTS: Independent-samples t tests revealed that VJ (p<0.05) was significantly higher in boys living in urban settings compared to their rural counterparts. Similarly, BT was found to be significantly better (p<0.05) in urban girls, whereas HG was significantly higher (p<0.05) in rural girls. CONCLUSION: Considering that (a) only three out of the 14 possible cases (seven fitness parameters for boys and seven for girls) were significantly different between urban and rural children, and (b) these differences were not uniformly distributed in children living in either urban or rural environments, it is concluded that the place of residence has no clear impact on physical fitness as studied herein.

Anthropometry↗
PubMed1995

Ischaemic heart disease mortality among men in Norway: reversal of urban-rural difference between 1966 and 1989.

OBJECTIVE: This study aimed to examine regional urban-rural differences in mortality from ischaemic heart disease, including sudden death of unknown cause (IHD/SUD) in Norway from 1966-89, for men and women aged 30-69 years. DESIGN: Analysis was based on vital statistics. Regional mortality rates were obtained by aggregating the 443 municipalities in Norway into urban, rural, and intermediate municipalities. SETTINGS AND SUBJECTS: Norway. RESULTS: In 1966-70 the age adjusted IHD/SUD mortality in the age group 30-69 years was higher in urban than in rural areas; for men by 31% (95% CI 27%, 36%) and for women by 28% (95% CI 19%, 36%). In 1986-89 the IHD/SUD mortality for men showed a reversed urban-rural gradient: it was 8% (95% CI 2%, 13%) higher in rural than in urban areas. The mortality rates for women were equal for both these aggregates. For men the results indicate that IHD/SUD mortality peaked first in urban municipalities and then, but at a lower level, in rural areas. For women there was a substantial decline in IHD/SUD mortality between 1966 and 1989, but an actual peak could not be demonstrated in any of the three aggregates during the period. The decline in IHD/SUD mortality among women was steepest in urban municipalities and least noticeable in rural municipalities, but the decline tapered off towards the end of the study period. CONCLUSION: The results confirm a phase-shifted peak in IHD/SUD mortality, which began in towns and ended in rural areas, and provides clues to the main underlying factors in the IHD epidemic at the population level.

Adult↗
PubMed2000

Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States.

STUDY OBJECTIVE: Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA. DESIGN: A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques. PARTICIPANTS: Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study. MAIN RESULTS: Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09). CONCLUSIONS: Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

Adult↗
PubMedDate not supplied

Relations of body habitus, fitness level, and cardiovascular risk factors including lipoproteins and apolipoproteins in a rural and urban Costa Rican population.

Increased general and abdominal obesity has been independently associated with diabetes, increased risk of stroke, and coronary artery disease (CAD). It is more prevalent in developed countries and in urban areas of nonindustrialized nations than in less developed and rural areas. To evaluate the associations between general and abdominal obesity (as determined by total body fat, waist to hip ratio, umbilical to triceps ratio, and umbilical to subscapular ratio) with glucose, plasma lipoproteins, apolipoprotein (apo) A-I and B concentrations, and low density lipoprotein (LDL) particle size (LDL 1-7), we randomly selected 222 men and 243 women from rural and urban areas of Puriscal, Costa Rica. Abdominal obesity, as assessed by the waist to hip ratio, was independently and significantly associated with higher triglyceride levels (p less than 0.01) and with lower high density lipoprotein cholesterol levels (p less than 0.05) in men and women and with higher glucose levels (p less than 0.05) and smaller LDL particle size (p less than 0.01) in women. Abdominal obesity, as assessed by the umbilical to subscapular ratio, was independently and significantly associated with higher total cholesterol (p less than 0.005) and apo B (p less than 0.01) levels. Umbilical to triceps ratio was positively associated with blood pressure in men. Urban men had increased general and abdominal obesity (p less than 0.0001), number of cigarettes smoked per day (p less than 0.0001), and diastolic blood pressure (p less than 0.05) and had a decreased fitness level (p less than 0.0001) as well as higher (p less than 0.05) plasma glucose, triglyceride, and total cholesterol concentrations and lower (p less than 0.05) apo A-I and HDL cholesterol levels compared with rural men. The differences between rural and urban women were not as striking. Urban women had increased general and abdominal obesity, glucose, and apo B levels (p less than 0.05) and a decreased fitness level (p less than 0.0001). Our data indicate that general and abdominal obesity, increased cigarette smoking, diastolic blood pressure, and decreased fitness level are more prevalent in an urban than in a rural area in Costa Rica, particularly in men. The higher prevalence of such risk factors in the urban area is associated with a more atherogenic plasma lipoprotein profile.

Adult↗
PubMed1994

Left ventricular mass and subsequent blood pressure changes among middle-aged men in rural and urban Japanese populations.

BACKGROUND: It has been suggested that echocardiographically determined left ventricular mass (LVM) is useful in the prediction of hypertension. To examine the relation between LVM and subsequent blood pressure (BP) change, a 6- to 8-year follow-up was conducted in adult Japanese men. METHODS AND RESULTS: LVM was determined by M-mode echocardiography using the American Society of Echocardiography formula among 354 normotensive men aged 30 to 59 years from a rural community (n = 193) and from urban companies (n = 161) in Japan between 1979 and 1983. BP was remeasured 6 to 8 years after baseline in 148 rural men (77%) and 127 urban men (79%). For men whose BP was remeasured, the mean +/- SD LVM index (LVM/body surface area [g/m2]) at baseline was 117 +/- 22 in rural men and 99 +/- 15 in urban men (the difference, P < .001). For both populations, LVM index was positively associated with age and physical activity but not with body mass index. Associations of LVM index with usual alcohol intake and initial BPs were generally weak. According to linear regression analyses after controlling for these covariates at baseline, a 20-g/m2 greater LVM index at baseline was associated with a 5 mm Hg increase in systolic and a 4 mm Hg increase in diastolic BP during the subsequent 6 to 8 years for urban men. A 1-mm greater average ventricular wall thickness was associated with a similar BP increase. For rural men, positive associations of LVM index with BP increase existed but were weak. The weaker association between LVM index and BP increase in rural compared with urban men was probably the result of effects of higher physical activity, leading to a larger left ventricular internal dimension. The increase in systolic and diastolic BPs over the 6 to 8 years of observation was significantly related to baseline LVM index in rural and urban men with a smaller internal dimension (rural men, < or = 49 mm; urban men, < or = 47 mm) but not in those with larger dimensions. CONCLUSIONS: An increased LVM index predicts subsequent BP increase in middle-aged normotensive men in the presence of a normal or small internal dimension.

Adult↗
PubMed2000

Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence.

The Child Health Supplement to the 1988 National Health Interview Survey was used to examine parent-reported current asthma among a nationally representative sample of 17,110 children zero to 17 yr of age. Numerous demographic variables were analyzed for independent associations with asthma using modified stepwise logistic regression, with models including specific combinations of risk factors. Black children had higher rates of asthma than did white children in unadjusted analyses, but after controlling for multiple factors, black race was not a significant correlate of asthma (adjusted odds ratio = 0.87, 95% CI = 0.63 to 1.21). Compared with nonurban white children, urban children, both black and white, were at significantly increased risk of asthma: urban and black (adjusted OR = 1.45, 95% CI = 1.14 to 1.86), urban and white (adjusted OR = 1.22, 95% CI = 1.01 to 1.48), whereas nonurban black children were not: nonurban and black (adjusted OR = 1.15, 95% CI = 0.83 to 1.61). Similarly, compared with nonurban, nonpoor children, urban and poor (adjusted OR = 1.44, 95% CI = 1.05 to 1.95), urban and nonpoor (adjusted OR = 1.22, 95% CI = 1.004 to 1.48), urban children, both poor and nonpoor, were at significantly increased risk of asthma, whereas nonurban poor children were not: nonurban and poor (adjusted OR = 1.03, 95% CI = 0.72 to 1.48). These results suggest that the higher prevalence of asthma among black children is not due to race or to low income per se, and that all children living in an urban setting are at increased risk for asthma.

Adolescent↗
PubMed2005

Race, urban community stressors, and behavioral and emotional problems of children with special health care needs.

OBJECTIVES: This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs. METHODS: The authors interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems. RESULTS: Urban community stressors, race, and child's health status were significantly associated with behavioral and emotional problems among children with special health care needs. The association between urban stress and total behavioral problems did not differ by race. CONCLUSIONS: When caring for children with special health care needs, especially those with emotional or behavioral problems, primary care providers may be better able to identify important aggravating factors if they also assess urban stress. Systems of care are needed that can assist in addressing urban community-level stressors.

Analysis of Variance↗
PubMed2003

Breakfast food patterns among urban and rural Croatian schoolchildren.

The aim of this study was to report breakfast food patterns among the rural and urban Croatian schoolchildren in the post-war socioeconomic changes. A quantitative Food Frequency Questionnaire was used. Subjects were 7-18 year old schoolchildren (815 from urban and 375 from rural areas). The average energy intake was 27.5 and 23.0% of the Recommended Dietary Allowance (RDA) in the urban and rural area respectively. Urban subjects tend to choose healthier options when older, while the rural subjects displayed the opposite (significantly correlated age with energy intake (% RDA) and dietary fibre intake (% of 'age + 5' rule). The same applied to age versus iron intake (urban positive, rural negative correlation). Breakfasts providing 20-30% RDA for energy and more than 300 mg of calcium were consumed by 20.7 and 32.4% of the urban and rural subjects respectively. Cereal products and milk and dairy products were the major breakfast constituents everywhere. Meat and its products, and eggs seem to be uncommon breakfast foods. The urban subjects had a more adequate energy intake at breakfast, but better food choices were observed among rural subjects.

Adolescent↗
PubMedDate not supplied

Lung cancer mortality patterns in women resident in different urbanization areas in central Italy from 1987-2002.

AIMS AND BACKGROUND: The aim of the study was to evaluate mortality lung cancer trends, as an indicator of female smoking trends, in women resident in different urbanization areas. METHODS AND STUDY DESIGN: Data on the 5782 female lung cancer deaths that occurred in Tuscany, Italy, during the period 1987-2002 were analyzed, using age-period-cohort models by areas at different urbanization levels. Trends were examined with a log-linear regression model, calculating the yearly estimated percent change. Empirical bayesian estimators of the ratios between observed and expected deaths by municipality were calculated for the most recent period and mapped. RESULTS: The age-adjusted lung cancer mortality rates increased from 1987 to 2002: estimated percentage change values were equal to 24.5% in the urban areas (P < 0.001) and 17.2% in the rural areas (P = 0.023). The age-period-cohort model analyses showed a statistically significant drift and non-linear cohort effects. The higher risk was observed for the birth cohort of women born around 1955 (RR, 5.25; 95% CI, 2.83-9.72). In the rural areas, no significant effects were observed, and the age model showed the best fit. In recent years, the risk appeared concentrated in 9 Tuscan municipalities, accounting more than 35% of the female urban population. CONCLUSIONS: The observed significant cohort effect in the age-period-cohort analyses for the urban areas reflects the social impact of living in these areas to induce smoking-related disease like lung cancer in women. The risk appeared particularly relevant in more recent and urbanized generations (women born around 1955), thereby suggesting urgent effective campaigns against smoking, gender dedicated, especially in urban areas.

Adult↗
PubMed2001

A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective.

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral--126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar--almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 Pounds for those in urban areas and 59.93 Pounds per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was 47.13 Pounds for urban patients and 48.77 Pounds for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Adolescent↗
PubMed2001

Personal and outdoor nitrogen dioxide concentrations in relation to degree of urbanization and traffic density.

To assess differences in exposure to air pollution from traffic in relation to degree of urbanization and traffic density, we measured personal and home outdoor nitrogen dioxide (NO(2)) concentrations for 241 children from six different primary schools in the Netherlands. Three schools were situated in areas with varying degrees of urbanization (very urban, fairly urban, and nonurban) and three other schools were located near highways with varying traffic density (very busy, fairly busy, and not busy). Weekly averaged measurements were conducted during four different seasons. Simultaneously, indoor and outdoor measurements were conducted at the schools. Personal and outdoor NO(2) concentrations differed significantly among children attending schools in areas with different degrees of urbanization and among children attending schools in areas close to highways with different traffic densities. For the children living near highways, personal and outdoor NO(2) concentrations also significantly decreased with increasing distance of the home address to the highway. Differences in personal exposures between children from the different schools remained present and significant after adjusting for indoor sources of NO(2). This study has shown that personal and outdoor NO(2) concentrations are influenced significantly by the degree of urbanization of the city district and by the traffic density of and distance to a nearby highway. Because NO(2) can be considered a marker for air pollution from traffic, the more easily measured variables degree of urbanization, traffic density, and distance to a nearby highway can all be used to estimate exposure to traffic-related air pollution.

Air Pollution↗