EBPH FINAL PAPER

Flood, Spring 2016

The Effects of Air Pollution on Chinese Residents from the Coal IndustryAndrea Flood

University at Albany SUNY

Flood, Spring 2016 2

Executive Summary

China is a country that relies heavily on industry. China’s rapid economic expansion was

due to this increased use of industry and its use of coal burning to fuel it

(Coal Industry Advisory Board, 1999). The burning of coal results in emissions of chemicals into

the air. Some of the chemicals released are sulfur dioxide, nitrogen dioxide, particulate matter 10

and particulate matter 2.5 (Guo et al., 2016). Linfen, China is reported to have the worst air

quality in the country, with an air quality index of 215 (World Air Quality Index, 2016). Air

Pollution in China contributes to 1.6 million deaths per year with the leading cause of death from

cancer due to lung cancer specifically (Wanqing Chen et al., 2015). The evaluation of these

pollutants and their risk for lung cancer was assessed. Yuming Guo et al., found that particulate

2.5 resulted in an increased risk for developing lung cancer because the relative risk for lung

cancer incidence related to 10ug/m^3 increase in PM2.5 were 1.055, which falls within the 95%

confidence interval (Guo et al., 2015). Pope III et al., examined the relationship of long term

exposure to fine particulate pollution and lung cancer and concluded the exposure to fine

particulate and sulfur dioxide related pollution is associated with all-cause, lung cancer, and

cardiopulmonary mortality. Each 10ug/m^3 elevation of fine particulate air pollution was

associated with an 8% increased risk for developing lung cancer (Pope III et al., 2002). A two-

pronged one-year pilot study intervention is being proposed. The first part will be to target the

individual to educate residents of Linfen, China on protective measure they can take to limit their

exposure to air pollution along with dissemination of protective materials. The second part is to

develop a policy to propose to the government to provide strict regulations and surveillance

measures. These will be evaluated through pre and post surveys along with feedback from the

government on the proposal.

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IntroductionThe air is very important for human health because humans need it to survive. In recent

years, several countries suffer from air pollution such as India, China, Egypt, Japan, Afghanistan

and Pakistan and this can be a result of the emissions of the coal industry, emissions from

nuclear plants, and burning of household fuels (Muller, Rhode, 2015). Among the list of

countries mentioned China is reported to have one of the worst cases of air pollution

(Muller, Rhode, 2015). Linfen, China is one of the largest coal industry cities in China and it is

home to the Linfen Power Station, a two-unit coal burning plant (Worst Polluted, 2007). China’s

rapid economic expansion was due to the increased use of industry, especially led by the burning

of coal. The coal industry is of key importance to China’s industry and accounts for 75% of their

commercial primary energy consumption (Coal Industry Advisory Board, 1999). The World

Bank stated that in the top 20 worst polluted cities in the world China holds 16 of those spots

while also the State Environmental Agency Administration (SEPA) has reported Linfen as

having the worst air quality in China (Worst Polluted, 2007).

The air quality in Linfen is currently rated to be at 215, which is considered to be very

unhealthy by the real-time air quality index (World Air Quality Index, 2016). Some of the major

emissions from the coal industry that result in air pollution are particulate matter 10, particulate

matter 2.5, nitrogen dioxide, and sulfur dioxide (Wanqing Chen et al., 2015). Exposure through

inhalation to these pollutants are risk factors for developing respiratory infections, asthma and

lung cancer (Olzem Kar Kurt et al., 2016). In Wanqing Chen et al., (2015) Chinese men were

evaluated to have a higher incidence rate of developing lung cancer compared with Chinese

women at 70.39 compared to 33.78 (Wanqing Chen et al., 2015). The leading cause of death

from cancer in China in 2010 was lung cancer with the mortality rate of 50.04 compared with all

other cancers in China (Wanqing Chen et al., 2015). Consequentially, air pollution in China

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contributes to 1.6 million deaths in China every year (Muller, Rhode, 2015). Hence, the risk of

lung cancer among men above age 40 of Linfen, China is indicated by the high levels of air

pollution PM2.5, PM10, NO2, and SO2 and results from the coal industry. The exposure is the

air pollutants PM2.5, PM10, NO2, and SO2 with the outcome being lung cancer.

Priority Population

Air pollution in China contributes to 1.6 million deaths in China every year

(Muller, Rhode, 2015). Risk of lung cancer among Chinese men above age 40 of Linfen, China

is indicated by the high levels of air pollution particulate matter 2.5, particulate matter 10,

nitrogen dioxide, and sulfur dioxide and results from the coal industry. The air quality in Linfen

is currently rated to be at 215, which is considered to be very unhealthy by the real-time air

quality index. (World Air Quality Index, 2016). Pollutants such as PM10, PM2.5, NO2 and SO2

are some air pollutants that are very abundant in China because of their heavy industry

(Guo et al., 2016). The World Bank stated that in the top 20 worst polluted cities in the world

China holds 16 of those spots while also the State Environmental Agency Administration

(SEPA) has reported Linfen as having the worst air quality in China (Worst Polluted, 2007).

Exposure- Air Pollution: specifically PM2.5, PM10, SO2 and NO2

Rhode and Muller examined hourly air pollution data from over 1,500 areas in China.

The air pollutants PM10, PM2.5, SO2, NO2 and O3 were examined. These pollutants were

mainly results from sources including electric power plants, coal factories, burning of fossil fuels

and automobiles (Rhode, Muller, 2015). To map the sources of the air pollutants they used the

data that is made available from the Chinese government. After examining the data the major

areas where the exposure is worst is in the east but significant levels are also across central and

northern China (Rhode, Muller, 2015). The results showed that 92% of China is experiencing

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more than 120 hours of unhealthy air (Rhode, Muller, 2015). This goes beyond the US

Environmental Protection Agencies standard (EPA, 2016). They then calculated the amount of

air exposure to the average Chinese citizen and this was calculated to contribute to 1.6 million

deaths a year in China which converts to 17% of all deaths (Rhode, Muller, 2016). This study

concluded that the highest particulate concentrations are south of Beijing while extensive levels

extent to the interior since PM can remain airborne for weeks and travel thousands of kilometers

(Rhode, Muller, 2015).

Falcon-Rodriguez et al., examined the pollutants SO2, NO2 and particulate matter. China

is a very industry heavy country and this is why their air is so polluted. When it comes to

particulate matter the size and composition associates to the different toxicity levels

(Falcon-Rodriguez et al., 2016). The smaller the PM the more dangerous it is because it can

reach its way into human lungs easier (Falcon-Rodriguez et al., 2016). The particles focused on

are secondary aerosols, which are formed by gases such as sulfates, nitrates and organic

compounds. The pollutants can be released from the burning of fossil fuels, coal and mining

activities (Falcon-Rodriguez et al., 2016). The analysis concluded that these pollutants are strong

mutagenic and carcinogenesis agents, which can be associated with genetic damage associated

with cancer (Falcon-Rodriguez et al., 2016).

Song et al., examined the pollutants released from a coal burning industry plant in

Pingdinshan, China. In the study of the coal burning plant the sulfur in coal is released into the

air mainly as SO2 and partly NO2 through the coal combustion in the plants (Song et al., 2014).

The average PM10 mass concentrations in the city were much higher in the winter v. in the

summer due to the increased use of coal in the winter. The average mass concentrations of PM10

were 190 in the winter and 187 in the summer (Song et al., 2016). Both of these numbers surpass

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the 24h Chinese limit of 150. The major sources of PM10 in Pingdinshan City were from sources

of coalmine waste dumps and coal ash from power plants. These pollutants are inhalable once

the coal is burned and present high risk to human health. (Song et al., 2014).

Outcome- Lung Cancer

Zheng et al. assessed the leading types of cancers in China, which can be seen in figure 3

in the appendix below. The study assessed 235 cancer registries in China. The study found that

lung cancer had the highest incidence rate in China and was the leading cause of death from

cancer in China (Zheng et al., 2015). The study also compared men v. women and urban v. rural

areas as shown in figure 4 in the appendix below. Lung cancer incidence rates from the coal

industry are 47.14 in rural areas and 49.44 in urban areas (Zheng et al., 2015). This study shows

that there is no difference between the two types of areas. There is however seen to be a

difference in the incidence rates of lung cancer in men v. females. Men have a rate of 63.90

where as women have an incidence rate much lower of 31.93 (Zheng et al., 2015). The mortality

rates from lung cancer in China follow a similar trend. As the age increases to 40+ the mortality

rate jumps up. The study also controlled for smoking status (Zheng et al., 2015).

Kurt, et. Al reviewed the current literature on how air pollution is associated with

pulmonary morbidity and mortality. The study showed that air pollution poses a greater harm to

children, the elderly and those of lower socio-economic status worldwide (Kurt et al., 2016). The

study showed that air pollution and related PM were a class I human carcinogen based on the

data (Kurt et al., 2016). The study also reviewed data from exposure to coal combustion and

found that exposure to this increased risk for developing asthma and lung cancer. The study

reviewed epidemiological data that indicated a positive correlation between air pollutants and

lung cancer (Kurt et al., 2016). The study also controlled for smoker status to eliminate any

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confounding variables. The study concluded that developing countries such as China that still use

coal burning as fuel are at a greater risk of developing various pulmonary health effects

(Kurt et al., 2016).

Wanqing Chen et al., collected epidemiological data from National Central Cancer

Registry. In 2010 there were 605,956 new lung cancer diagnoses in China (Chen et al., 2014).

Lung cancer is a problem in China that seems to be increasing. Of the new cases in 2010,

roughly 57% came from urban areas while 43% came from rural areas (Chen et al., 2014). This

data shows that there is no significant difference between incidences in rural v. urban China.

Lung cancer incidence rates were seen to be heavier in males than female with a rate of 68.16 v.

29.54 (Chen et al., 2014). Information from this literature demonstrates that lung cancer

incidence is still a heavy concern for Chinese citizens especially those who are male.

Particulate matter in air pollution and its risk for lung cancer was examined

(O. Raaschou-Nielsen et al., 2015). Fourteen different cohorts were examined all from European

areas surrounding suburban or rural areas (O. Raaschou-Nielsen et al., 2015). The air pollutants

of interest were PM10, PM2.5, sulfur dioxide and oxides of nitrogen. Baseline air pollution

concentrations were estimated using the Land Use Regression models

(O. Raaschou-Nielsen et al., 2015). The air pollution was monitored from October 2008 until

May 2011. Variables such as age, gender, calendar time and smoker status were controlled for in

this study to reduce confounding. The results concluded that out of the 245,782 participants

1,878 lung-cancer cases were diagnoses during follow-up (O. Raaschou-Nielsen et al., 2015).

Exposure to all elements is associated with a greater risk for developing lung cancer

(O. Raaschou-Nielsen et al., 2015).

Connection between Exposure and Outcome

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Pope III et al., assessed the relationship of long-term exposure to fine particulate air

pollution and lung cancer and cardiopulmonary mortality (Pope III et al., 2002). Vital statistics

and all death data were collected from the American Cancer Society from the Cancer Prevention

II study. The study controlled for individual risk factor data such as race, age, sex, smoking

history, diet and occupational exposure (Pope III et al., 2002). The study concluded the exposure

to fine particulate and sulfur dioxide related pollution is associated with all-cause, lung cancer,

and cardiopulmonary mortality. Each 10ug/m^3 elevation of fine particulate air pollution was

associated with an 8% increased risk for lung cancer (Pope III et al., 2002).

Yuming Guo et al., provides information on particulate matter 2.5 and ozone with its

association to lung cancer incidence. The study obtained information on lung cancer incidence

from the National Cancer Registration of China and computed a spatial age-period cohort model

to assess the relative risk of lung cancer incidence with the exposure to PM2.5 and ozone

(Guo et al., 2015). The relative risk for lung cancer incidence related to 10ug/m^3 increase in

PM2.5 were 1.055, which falls within the 95% confidence interval (Guo et al., 2015). The results

of the study give evidence that there is an increased risk for developing lung cancer when

exposed to PM2.5 and ozone.

The world’s largest coal fired power plant; the Taichung power plant in Taiwan’s

emissions were collected to determine the loss of life expectancy and the lifetime risks for PM2.5

health-related mortalities (Kuo et al., 2014). In the study they took into account five different

scenarios of areas around the plant. The mean Loss of Life Expectancy (LLE) for residents of

Taiwan was calculated to be 83.9 days (Kuo et al., 2014). The study also concluded that in

scenarios 3, 4, and 5 indicates that moving the plant to a leeward side of Taiwan can reduce the

LLE significantly (Kuo et al., 2014). The study also found that reducing the fuel source from

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coal to natural gas reduces the exposure concentration from the plant to about one-third.

Although the article also recognized that this is not realistic because of the expensive costs of

using natural gas (Kuo et al., 2014).

Discussion

Limitations: Problems with some of the literature was that it did not include some

possible confounding variables. It is concerning that some studies did not mention controlling for

smoker status. The information incidence rates for lung cancer did not specify if occupational

history status was controlled for. This could be a problem because men could be more likely to

be exposed to the pollutants than woman because they are more likely to work in the plants.

Also, some studies that were done in European countries may not be generalizable to the city

Linfen or even China in general because of the difference in demographics and population

density and the fact that China is a developing country.

Past interventions: Since 2012 China has adopted an Ambient Air Quality Standard

(Rhode, Muller, 2015). They have also begun to develop a national air reporting system that

includes over 190 cities (Rhode, Muller, 2015). This is useful because it sets standards of what is

acceptable and not and there is a program set up to analyze air quality and to recognize the

amounts of air pollutants in the atmosphere (Rhode, Muller, 2015). Also, transitioning to the

usage of natural gas in plants reduces the amount of exposure of air pollutants (Kuo et al., 2014).

The clean air act of 1970 in the United States developed by the Environmental Protection

Agency developed policies in the U.S. to limit the usage of coal as an energy source and

developed a monitoring system of air pollutants (Environmental Protection Agency, 2015). The

goal of this act was to achieve National Ambient Air Quality Standards to protect the public’s

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health and welfare along with regulating the chemicals that are being admitted into the air

(Environmental Protection Agency, 2015).

Intervention Proposal

The principle investigator and research team will be proposing a two-pronged

intervention. The levels of the ecological model that will be used are at the individual and policy

levels. This intervention will be a pilot study of one year. The first part of the intervention will

target individuals of Linfen, China. Residents will be given educational pamphlets and

prevention resources in order to limit their exposure to the pollutants. The second part of the

intervention will be developing a written document policy to propose at the end of the 1-year

mark to change the air quality in the future. The outcome objective is to increase cleaner air

intake by 10% for Linfen, China residents by implementing policy change through the

development of a full policy proposal by 2030. The impact objective is going to be for

community members of Linfen, China to limit their exposure to polluted air by 15% from

adopting and implementing all protective measures within 6 months after implementation.

The first part of the intervention will be to educate Linfen community members of the

health risks the pollutants in the air have on them and to educate on how to limit exposure to

these. Pamphlets will be handed out with all the education information in them along with

surgical masks, suggested curfews and desk fans. The N95 surgical masks are meant to filter out

the specific air pollutants we are targeting. The suggested curfew will be from 9pm-5am and

windows to be shut at night due to the air quality decreasing at nighttime. The N95 surgical

masks are meant to wear when out in the open air and the fan is meant for at night so the

windows can be kept shut. Everyone who goes to the local markets will have the opportunity to

take a pamphlet along with a surgical mask but the first 500 will only receive a desk fan. In order

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to get all of this everyone will have to fill out a pre-survey that has questions about SES,

occupational status, number of hours spent outside, and how often they experience dry eyes,

nasal congestion, tiredness and occasional minor headaches. As noted in the timeline, posters

will be hung up a month in advance to promote the events location and times. There will also be

a post survey a year after asking how often the various preventative measures were used and how

often they experience dry eyes, nasal congestion, tiredness and occasional minor headaches.

Lastly the principle investigator will evaluate the pre and post surveys to see any health and

behavioral/education change. Refer to the timeline in figure 2 to evaluate the time frame of each

activity.

The second part of the intervention is to form a policy to propose to the government to

regulate the emissions from coal burning factories and this will be called “Take off the Black

Hat.” This will be developed by the environmental lawyer hired with the oversight of the

principle investigator. This would include making it mandatory to use natural gas instead of coal

to power the plants with the government providing resources to pay for this due to the fact that it

is very expensive. The policy will set limits to what air pollutant levels should not exceed. The

levels of the hazardous pollutants will be measured on a weekly basis. The major goal of this

proposal will be to reduce the emissions of hazardous pollutants, specifically NO2, SO2, PM2.5

and PM10. At the end of the year the policy proposal will be complete to submit to the Chinese

government. Refer to figure 1 in the appendix below to evaluate all of the resources, activities,

inputs and outputs needed for the intervention to be successful.

The N95 surgical masks have been effective to filter the air and protect people from

inhaling hazardous pollutants such as PM2.5 (Greenpeace, 2012). We will also be suggesting the

use of fans at night and closing windows because the air quality is worse during the night time

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hours, usually between 9pm and 5am (World Air Quality Index, 2016). Because of this we are

also suggesting a curfew to stay indoors to avoid the outdoor air quality during these times. We

are asking the participants on the pre and post survey to document their experience of dry eyes,

nasal congestion, tiredness and occasional minor headaches because these are some of the short-

term health effects exposure to these pollutants can cause (Hoffmann, 2016). The policy proposal

is partially being modeled similarly after the Clean Air Act of 1970. This act put restrictions on

the use of burning coal and continually monitored the levels of air pollutants in the air and this

helped towards the increase in quality air in the United States (EPA, 2015). For example since

the Clean Air Act the amount of sulfur dioxide has been down 75% (Face the Facts USA, 2015).

Evaluation Plan

Goal: Improve community member’s knowledge on protective measures against air pollution along with the formation of air quality policy proposal.

Study Questions MeasuresData Collection Methods

Data Sources Data Collector(s)

Timeframe

Impact Evaluation•To what extend was there a decrease in exposure to SO2, NO2, PM2.5 and PM10?

•To what extend was there an increased use of protective measures?

•To what extend were the experience of dry eyes, nasal congestion, tiredness and occasional minor headaches decreased?

•To what extent was the policy proposal approved?

Participants• Number of residents who completed pre/ post surveys.

•Post-Survey results- the number and percent of people whocarry out protective measures.

•Number of members whose acute affects decreased.

•Feedback results on what needs improving before government can take action.

•Pre and Post surveys

•Feedback from government on policy proposal

•Volunteers & Project Director

• Principle Investigator & Environmental Lawyer

Post intervention

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References:

1. Chen, Wanqing, Rongshou Zheng, Hongmei Zeng, and Siwei Zhang. "Epidemiology of Lung Cancer in China." Thoracic Cancer 6, no. 2 (2015): 209-15. Accessed February 23, 2016. PubMed.

2. Cyr, R. S. (2013). Do Pollution Masks Really Work? Retrieved March 22, 2016, from http://www.myhealthbeijing.com/china-public-health/n95-air-pollution-masks-proof/

3. Environmental Protection Agency. (2015). Summary of the Clean Air Act. Retrieved April 11, 2016, from https://www.epa.gov/laws-regulations/summary-clean-air-act

4. Environmental Protection Agency. (2016, February 23). Cleaner Power Plants. Retrieved March 22, 2016, from https://www3.epa.gov/airquality/powerplanttoxics/powerplants.html

5. Falcon-Rodriguez, C. I., Osornio-Vargas, A. R., Sada-Ovalle, I., & Segura-Medina, P. (2016). Aeroparticles, Composition, and Lung Diseases. Front. Immunol. Frontiers in Immunology, 7.

6. George Washington University. (2013). Breathing easier: Clean Air Act gets results. Retrieved April 11, 2016, from http://www.facethefactsusa.org/facts/breathing-easier-clean-air-act-gets-results

7. Green Peace. (2012). The coal hard truth of air pollution. Retrieved April 11, 2016, from http://www.greenpeace.org/eastasia/campaigns/air-pollution/problems/coal-hard-truth-air-pollution/

8. Guo, Y., Zeng, H., Zheng, R., Li, S., Barnett, A. G., Zhang, S., . . . Williams, G. (2016). The association between lung cancer incidence and ambient air pollution in China: A spatiotemporal analysis. Environmental Research, 144, 60-65. Retrieved February, 2016.

9. Hoffmann, M. (2016). Pollution in China. Retrieved April 11, 2016, from http://www.china-family-adventure.com/pollution-in-china.html

10. Kuo, P., Tsuang, B., Chen, C., Hu, S., Chiang, C., Tsai, J., . . . Ku, K. (2014). Risk assessment of mortality for all-cause, ischemic heart disease, cardiopulmonary disease, and lung cancer due to the operation of the world's largest coal-fired power plant. Atmospheric Environment, 96, 117-124. Retrieved February, 2016.

11. Kurt, O. K., Zhang, J., & Pinkerton, K. E. (2016). Pulmonary health effects of air pollution. Current Opinion in Pulmonary Medicine, 22(2), 138-143. Retrieved February, 2016.

12. Linfen Air Pollution: Real-time PM2.5 Air Quality Index (AQI). (2016, February). Retrieved February 25, 2016, from http://aqicn.org/city/linfen/

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13. "Linfen, China." WorstPolluted Projects Reports. 2007. Accessed February 25, 2016. http://www.worstpolluted.org/projects_reports/display/22.

14. Pope III, C. A., Burnette, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., & Thurston, G. D. (2002). Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution. Jama, 287(9), 1132. Retrieved February, 2016.

15. Priddle, Robert. "Coal in the Energy Supply of China." Coal Industry Advisory Board. 1999. Accessed February 2016. https://www.iea.org/ciab/papers/coalchina99.pdf.

16. Raaschou-Nielsen, O., Beelen, R., Wang, M., Hoek, G., Andersen, Z., Hoffmann, B., . . . Vineis, P. (2016). Particulate matter air pollution components and risk for lung cancer. Environment International, 87, 66-73. Retrieved February, 2016.

17. Rohde, R. A., & Muller, R. A. (2015). Air Pollution in China: Mapping of Concentrations and Sources. PLOS ONE PLoS ONE, 10(8). Retrieved February, 2016.

18. Song, X., Longyi, S., Shushen, Y., Riying, S., Limei, S., & Shihong, C. (2015). Trace elements pollution and toxicity of airborne PM10 in a coal industrial city. Atmospheric Pollution Research, 6(3), 469-475.

19. Ventura County Air Pollution Control District. (n.d.). 50 Simple Ways to Reduce Air Pollution. Retrieved April 9, 2016, from http://www.vcapcd.org/pubs/Factsheets/50WaysfactSheet.pdf

20. Zheng, R., Zeng, H., Zuo, T., Zhang, S., Qiao, Y., Zhou, Q., & Chen, W. (2015). Lung cancer incidence and mortality in China, 2011. Thoracic Cancer, 7(1), 94-99. Retrieved February 2016.

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Appendix

Figure 1Logic Model:Program: Air Pollution Information Outreach Program & Formation of Policy Regulations on Air Quality (Two-pronged)Goal: Improve community member’s knowledge on protective measures against air pollution along with the formation of air quality policy proposal

Resources Activities Outputs Short/Medium Outcomes

Long term Outcomes

• Environmental health professionals•Money in donation for fans, payment of lawyer, environmental health professional, and development of posters and pamphlets.•Hospital to kindly donate 500 surgical masks.•Volunteers to help disseminate the flyers and pamphlets with the masks along with the fans later on.•Office supplies to make pamphlets and posters (computers, printer, etc.)•Public policy professional or lawyer to develop policy proposal.•Fan distributer to donate or sell in bulk discount.•1 year time

•Develop and disseminate 500 flyers and pamphlets along with surgical masks.•Recruit volunteers•Go to hospital to pick up surgical masks.•Volunteers post posters and give out pamphlets and masks at market.•Give away 500 fans to residents returning at market after they have read the pamphlet.• Give out pre and post surveys to examine behavioral change.•Consult with lawyer and Environmental Health professional on forming a policy proposal.

•# of residents that use fans instead of windows.•# of residents that use AC instead of windows.•# of residents that follow suggested curfew.• # of residents that wear surgical masks when outdoors.• # of completed parts of our policy proposal.

•15% of Linfen residents will be knowledgeable about the benefits of closing windows at night and using AC or fans.•15% of Linfen residents will be knowledgeable of the benefits of staying inside after 8pm until 5am.•The environmental lawyer and principle investigator will complete full policy proposal to include all 3 sections and propose to the Chinese Government at the end of the 1-year.•15% of Linfen residents will be able to identify at least two protective measures they can use to limit exposure to air pollution.•Community members of Linfen, China will limit their exposure to polluted air by 15% from adopting and implementing all protective measures within 6 months after implementation.

• The Coal Industry and Linfen community will align with implemented policy change to increase cleaner air intake by 10% for Linfen, China by 2030.

Assumptions: Everyone living in the area wants to breath clean air. Everyone wants to see change in the air quality. Most people go to the market often. Most people want to learn how to improve their health.External Factors: Low SES, not everyone goes to the market, access to air conditioning, environmental health values, occupational status, and daily work schedule.

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Figure 2Timeline:Linfen, China residents: Exposure to air pollution and protective measures along with Public Policy

Tasks – Year One Person Responsible

June 2015

July 2015

Aug. 2015

Sept. 2015

Oct. 2015

Nov. 2015

Dec. 2015

Jan. 2016

Feb. 2016

Mar. 2016

April 2016

May 2016

Raise money for program

Project Director

X X

Recruit and hire a lawyer or environmental health professional

Principle Investigator

X

Meet with hospital to discuss free masks

Principal Investigator

X

Meet with fan distributer to discuss bulk discounting or donating fans

Principal Investigator

X

Creation of pamphlet and posters along with pre and post surveys

Principal Investigator

X

Recruit volunteersPrincipal Investigator and Project Director

X

Pick up masks from hospital

Project Director

X

Pick up fans from distributer

Project Director

X

Form policy proposal Principal Investigator and Environmental Lawyer

X X X X X X X

Volunteers post posters about event date, time, location etc.

Project Director and volunteers

X

Handout pamphlet, pre-survey and surgical masks

Project Director and volunteers

X

When survey handed in give out fans to returners

Project director and volunteers

X

Post-survey Project director and volunteers

X

Propose policy to government

Principal Investigator and environmental lawyer

X

Feedback on proposal Principal Investigator and Environmental Lawyer

X

Evaluation of the survey results

Principal Investigator

X

Dissemination of findings to stakeholders

Principal Investigator

X X

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Figure 3

Figure 4