2012 Progress Report: Health Effects Institute (2010-2015)

EPA Grant Number: R834677
Center: Health Effects Institute (2005 — 2010)
Center Director: Greenbaum, Daniel S.
Title: Health Effects Institute (2010-2015)
Investigators: Greenbaum, Daniel S.
Institution: Health Effects Institute
Current Institution: Health Effects Institute (HEI)
EPA Project Officer: Hunt, Sherri
Project Period: April 1, 2010 through March 31, 2015
Project Period Covered by this Report: April 1, 2012 through March 31,2013
Project Amount: $25,000,000
RFA: Health Effects Institute (2010) RFA Text |  Recipients Lists
Research Category: Health Effects , Air Quality and Air Toxics , Air



For 32 years, the Health Effects Institute has fostered sound, credible science that answers important questions about the health effects of pollution. Through its efforts, HEI has helped create an environment of trust between government and industry and has helped decision makers agree to changes in regulations and technology that have improved air quality and health worldwide.

The HEI model is like no other. The Institute provides government regulators, industry experts, and environmental stakeholders with trustworthy science without advocating positions or taking sides on policies. HEI achieves its impartial stance through independent governance and balanced funding between government agencies and industry. HEI’s Health Research and Health Review Committees work independently of each other to provide checks and balances that encourage rigorous studies and objective reports.

HEI’s unique model ensures that HEI science is dependable and reliable. As a result, HEI has been part of many significant advances that have contributed to today’s environment of cleaner air and better health.

A Model for Better Health Research

By working with government, industry, the environmental community, and scientists, HEI has contributed to research that has helped change the nature and tone of the debate about the science of the health effects of emissions. With scientific results in hand, regulators and all stakeholders can move beyond debate about the nature of the problem. Instead of asking, “What does the science say?” they instead can ask, “What should we do, given the science?”

Such action-oriented and science-based discussion has yielded several key changes in regulations and technology that have improved health. The clearest example is the significant education in emissions from gasoline and diesel engines. The process began in the 1980s when questions arose about tailpipe emissions standards for carbon monoxide. HEI launched a series of studies that confirmed the adverse health effects of low levels of carbon monoxide in the air. The research influenced the U.S. Environmental Protection Agency (EPA) in deciding to retain its carbon monoxide standards. In turn, the motor vehicle industry developed innovative tailpipe control technologies that reduce carbon monoxide emissions.

Similarly, when the U.S. Congress was considering asbestos removal from all buildings to reduce the risk of lung disease, regulators tapped HEI to answer key scientific questions about the safety of asbestos removal. The finding that some asbestos is better left in place helped Congress shift its attention to the buildings with the highest exposure risks.

On several occasions, when questions have been raised about studies relevant to decisions on whether or not to tighten the National Ambient Air Quality Standards (NAA QS), HEI has been asked to step in to independently reanalyze research data and determine whether results stand up to scrutiny. In the late 1990s, HEI did just this, examining the results of two major studies

of the long-term effects of air pollution (the Harvard Six Cities Study and the American Cancer Society Study). These reanalyses formed the basis for health benefit studies that led to the 2001 U.S. EPA rules calling for a greater than 90% reduction in emissions from heavy-duty highway diesel vehicles by 2007.

A Model for Tomorrow

Even today, HEI is being held up as a model for other groups to follow as they navigate complex decisions about energy, health, and the environment. For instance, to help move debate about gas drilling forward, Andrew Revkin of the New York Times Dot Earth blog wrote:

I encourage leadership...to consider the structure of the 32-year-old Health Effects Institute, which was created to conduct independent studies of health impacts of air pollution and is co-funded by the Environmental Protection Agency and the worldwide motor vehicle industry. The institute, even with (transparent) industry support, has developed and sustained a reputation for independent and authoritative research.

In February 2012, the Subcommittee on Energy and the Environment of the U.S. House Committee on Science, Space, and Technology met in  ashington, D.C., to discuss the quality of scientific research that the U.S. EPA uses to inform regulatory policy. HEI President Dan Greenbaum was there.

Invited by both parties, Greenbaum highlighted several of HEI’s guiding principles for producing balanced science. HEI engages independent, objective scientists and subjects all research results to intense peer review. It also conducts and reports science with full transparency.

Greenbaum also served, along with HEI Research Committee Chair David Eaton, on a recent committee of the National Research Council on Science for EPA’s Future that assessed how well the U.S. EPA develops, obtains, and uses scientific information to meet modern environmental challenges.

While air quality in the United States is demonstrably better than it was when HEI got its start three decades ago, today’s environmental and health challenges are complex. The scientific problems cross disciplines, and the solutions may involve multiple industries and governing agencies. Solving problems of this complexity—and securing a sustainable future that protects human health—will require exactly the kind of sound, credible science HEI delivers.

Progress Summary:


HEI’s research programs are specifically designed to inform regulatory decisions and to evalute changes in technology and other actions intended to improve air quality and health. But such design is easier said than done. Several areas of study require thoughtful experimental structure and novel approaches to research and analysis.

Multipollutants and Health

Most air quality management in the United States focuses on individual air pollutants. But in reality, the air we breathe is a complex mix of many pollutants that may interact with one another and with climate variations. A piecemeal approach that examines pollutants one at a time may not provide the most scientifically sound evidence pointing to strategies to protect human health.

To begin to tackle the challenge of understanding the health effects of multipollutants, HEI and the U.S. EPA cosponsored a major workshop in 2011 aimed at helping the EPA address questions surrounding a multipollutant approach to managing air quality in the near and longer term. HEI also funded three teams of investigators to develop and test new statistical methods. Brent Coull of Harvard University, John Molitor of Oregon State University, and Eun Sug Park of Texas A&M University are leading studies that will develop novel statistical techniques to further the understanding of how pollutants occur together, to compare the potential influence of such combinations on health with effects attributed to individual pollutants within a mixture, and to test these new methods in real-world databases.

In addition, HEI is beginning to report on research efforts launched as part of its National Particle Component Toxicity (NPACT ) initiative, a five-year program featuring the first comprehensive epidemiologic and toxicologic analysis of the short- and long-term effects of individual particulate matter (PM) components, as well as a variety of particle sizes and gaseous pollutants. The NPACT program is designed to inform future decisions about U.S. National Ambient Air Quality Standards.

In 2012 HEI published the first of three NPACT -funded reports. Conducted by Michelle Bell of Yale University, this study analyzed fluctuation of chemical components of fine PM over time, region, and season. Bell found that chemical composition of PM only partially explains regional and seasonal differences in health effects associated with total PM mass. 

Two other studies slated to be published in 2013, led by Morton Lippmann at New York University and by Sverre Vedal of the University of Washington (in collaboration with the Lovelace Respiratory Research Institute), are making inroads into connecting components and sources of air pollution to health effects.

Final summary results of these NPACT initiatives will be reported early in 2013 and presented at forums in the United States and at a workshop planned by HEI with the European Commission and the World Health Organization on the state of scientific research on air pollution and health to inform the European Union’s plans for making 2013 the “Year of Air.”

Hot Spots

In industrial and high-traffic areas, there is a potential for elevated human exposure to air toxics compared with nearby areas. Identifying these hot spots and understanding their health risks require careful investigation.

Last year HEI published two hot spot studies. One, led by Paul Lioy of the Environmental and Occupational Health Sciences Institute in Piscataway, New Jersey, reported on two neighborhoods in Camden, New Jersey. One was a suspected hot spot, the other not. Lioy and his team discovered that, when the two were compared, the first neighborhood was indeed a more polluted spot. But compared with the rest of the country, both were hot spots, illustrating the challenges of defining local hot spots.

Another study, led by John Spengler of the Harvard School of Public Health, investigated a potential hot spot at the U.S. border crossing in Buffalo, New York, where approximately 4000 trucks cross daily. Elevated levels of air toxics were found downwind of the site as compared with upwind. But contrasted with other sites in the United States, the levels were not elevated. On many days, winds blew away from the neighborhood, making it difficult to conclude the site constituted a hot spot. Nevertheless, Spengler’s report will help with future hot spot studies involving pollutants in a particular neighborhood.

Getting Exposure Right

In 2010 the HEI Panel on the Health Effects of Traffic-Related Air Pollution identified an exposure zone of up to 300 to 500 meters from major roadways as the area most highly affected by traffic emissions. The panel estimated that 30% to 45% of people living in major North American cities live in such zones.

Given the number of people who live near major roads and the potential for long-term exposures and adverse health effects, there is a clear need for epidemiologic research to understand how such exposure links to possible health effects. The Panel’s 2010 extensive review of existing research (Traffic- Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects), however, showed that standard measures that characterize exposure to traffic, such as “distance from the road,” are oversimplifications. Traffic pollution may fluctuate depending on land-use, weather, and traffic patterns, and it is difficult to discern its source.

To begin the work of developing new research methods to improve assessment of exposure to traffic-related pollution, HEI held a workshop in April 2012. Based on the discussion at this workshop, HEI is issuing a Request for Applications for research that will focus on the relations among traffic emissions, near-road concentrations, and human exposures.


Diesel engines are powerful and reliable and are used everywhere, for transport, mining, construction, and electricity generation. Emissions from these engines are complex, including a variety of potentially harmful compounds and particles, but new technologies, documented by HEI, are making a big difference.

Over the past two decades—guided by evidence from HEI-funded scientific research and HEI’s unbiased scrutiny of those independent studies—tighter emissions standards for on-road vehicles in North America and Europe have triggered advances in diesel technology that have lowered emissions of particulate matter, nitrogen oxides, and hydrocarbons substantially.

In 2006, in collaboration with government agencies, industry, and the Coordinating Research Council, HEI launched the Advanced Collaborative Emissions Study (ACES). The goal was to characterize the emissions of heavy-duty diesel engine systems that use new technology to reduce emissions and examine any health effects due to exposure.

New Diesel Engines

In 2012, ACES scientists published their findings on the health effects of short-term exposure to the emissions from heavy-duty diesel engines compliant with the 2007 U.S. EPA regulations. An earlier ACES study had found that the 2007-compliant engines have reduced concentrations of PM by more than 90% compared with older technologies.

To examine the health effects associated with exposure to the 2007-compliant diesel exhaust, the 2012 study exposed rats and mice to emissions from these engines for up to 12 months and collected data on biologic and genotoxic endpoints. Even though the animals were exposed for 16 hours per day, 5 days a week, to an intense cycle of diesel emissions, they showed only mild biologic effects and no genotoxic effects after a few months. The study will continue exposing animals for their lifetimes (up to 30 months), with results due out in 2014.

An HEI-funded report on the effects of diesel exhaust particles on people with asthma and allergies was also published this year. Marc Riedl of the University of California–Los Angeles and colleagues set out to determine whether exposure to diesel exhaust from 1999-model engines enhanced inflammatory and allergic responses in the lungs and blood of asthmatic and allergic individuals. The team found few associations between exposure and these specific adverse health effects.

Assessing Diesel and Cancer

In June 2012, the International Agency for Research on Cancer (IARC ), part of the World Health Organization, convened an expert panel to review whether diesel and gasoline exhaust are carcinogens. HEI President Dan Greenbaum attended the meeting as an observer, and HEI Principal Scientist Aaron Cohen served as an invited specialist. IARC committee members reviewed a wide range of HEI and other scientific studies predominantly focused on older engine technologies, as well as the ACES study recently published by HEI for its findings on the reduction of PM in emissions from the newer engines. Based on its review of the evidence from older engines, the IARC panel concluded that diesel exhaust is a known human carcinogen, a reclassification from the 1989 designation of diesel exhaust as a probable carcinogen.

The IARC monograph, now being finalized, also notes that regulations in North America, Europe, and elsewhere have implemented successively tighter emissions standards and, consequently, have dramatically improved vehicle exhaust control technologies. However in less-developed countries, regulatory measures are not as stringent, and the cleaner fuels needed for control are not available. The determination by IARC that the older technology, which is still in widespread use in many locations, can cause cancer could encourage adoption of newer fuels and technologies in more countries.


Once new regulations and technologies are in place, HEI’s work is not done. A question remains: Do these advances actually improve human health? HEI’s Health Outcomes (Accountability) Research Program aims to answer this by funding studies that evaluate a wide range of short- and longterm interventions to see if they reduce pollution levels, lower human exposure to air pollutants, and improve health. Results are coming in.

New Wood Stoves, Better Health in Montana

In the rural mountain community of Libby, Montana, many families use wood stoves to heat their homes. But old stoves tend to be smoky, and many children in the region suffer from symptoms of respiratory distress. Curtis Noonan of the University of Montana– Missoula and colleagues evaluated a program to swap 1200 older-model stoves for newer, less-polluting stoves. The stove upgrade not only improved indoor and ambient air quality, but also reduced respiratory symptoms in local children. The work made headlines in Billings and across the country.

Cleaner Air in Beijing

Before and during the 2008 Beijing Olympics, the Chinese government mandated actions to improve ambient air quality in the city. To examine the health impact of these interventions, which aimed to reduce concentrations of PM and other pollutants from industry and traffic, Junfeng (Jim) Zhang of the University of Medicine and Dentistry in New Jersey launched a study in Beijing to look at changes in biomarkers of pulmonary and systemic inflammation and blood coagulation in local residents before and after the Games. While the HEI report is slated for publication in 2013, early data suggest that the interventions resulted in reduced air pollution and that those reductions were associated with an acute improvement in several biologic measures that signal cardiorespiratory disease among a group of nonsmoking adults. Effects of Dublin Coal Ban

Black smoke and high levels of other air pollutants plagued Dublin, Ireland, in the 1980s. At the time, many families burned coal in household stoves. Beginning in 1990, Dublin and other cities banned the sale of coal. A group led by Douglas Dockery and colleagues of the Harvard School of Public Health had previously found that black smoke and sulfur dioxide levels dropped after the Dublin ban, and health seemed to improve. Now, the group has completed an HEI-funded study (scheduled for publication in 2013) to determine the effectiveness of the bans in Dublin and several other Irish cities in reducing air pollution and improving public health. Results suggest that the bans improved air quality and reduced respiratory deaths in all cities, confirming earlier published analyses in Dublin alone. However, the improvements in cardiovascular and total mortality orginally reported in Dublin were not in evidence in Dublin or in other Irish cities after taking into account the general decreasing trend in cardiovascular mortality due to other factors. The study also illustrated how multiple simultaneous changes in the way people live can affect the same health indicators and complicate the study of public health outcomes.

Effective Emissions-Control Technology for Power Plants

In 1990, the U.S. Congress amended the Clean Air Act to curb the growing problem of acid rain. In response, electric power plants drastically reduced emissions of sulfur dioxide and nitrogen oxides, which are implicated in acid rain formation. Richard Morgenstern and his colleagues at Resources for the Future and Yale University analyzed these reductions in coal-fired power plant emissions and found that they were associated with lowered concentrations of fine PM in the eastern United States between 1999 and 2005. Morgenstern’s group not only showed that the Clean Air Act had made progress toward reducing emissions associated with acid rain, but also developed potentially useful methods for verifying air quality changes after interventions are put in place.

New Health Outcomes Studies

HEI is continuing its commitment to health outcomes research. The Institute has solicited proposals for studies on the effectiveness of complex, longer-term regulatory actions, with a special interest in regulations affecting major ports.

In 2012, HEI approved four studies that focus on long-term changes. In one, Frank Gilliland and colleagues at the University of Southern California will evaluate the relation between long-term changes in air pollution and lung development and chronic respiratory symptoms in children with asthma, using data spanning from 1993 through 2012. They will also examine whether long-term air quality improvements can be linked to regulations implemented in southern California during the study period.

In another new study, Armistead Russell at the Georgia Institute of Technology and collaborators at Emory University will study changes in air quality and health outcomes in the southeastern United States from 1993 to 2012, with a focus on regulations that reduce emissions from stationary and mobile sources, such as the Clean Air Interstate Rule and national regulations affecting light- and heavy-duty gasoline and diesel vehicles.

A third study, led by Corwin Zigler and Francesca Dominici at the Harvard School of Public Health, will develop statistical methods to study long-term regulatory actions, applying a newly developed “causal interference” approach. They plan to use these methods to compare changes in air quality and health outcomes among U.S. counties deemed to be either in or out of compliance with the National Ambient Air Quality Standards.

A fourth study, by Ying-Ying Meng and colleagues at the University of California–Los Angeles with collaborators at the University of California–Berkeley, will evaluate the impact of the 2006 Emission Reduction Plan for Ports and Goods Movement on long-standing air quality issues at large ports in California. Meng’s team will first evaluate air quality before and after the Goods Movement plan went into effect. If they detect air quality improvements in goods movement corridors, they will follow up with a study of health outcomes within and outside of these corridors.

Journal Articles: 5 Displayed | Download in RIS Format

Other center views: All 69 publications 62 publications in selected types All 5 journal articles
Type Citation Sub Project Document Sources
Journal Article Greenbaum D, Shaikh R. First steps toward multipollutant science for air quality decisions. Epidemiology 2010;21(2):195-197. R834677 (Final)
  • Abstract from PubMed
  • Full-text: LWW-Full Text HTML
  • Other: LWW-Full Text PDF
  • Journal Article Meng Q, Hackfeld LC, Hodge RP, Walker VE. Comparison of mutagenicity of stereochemical forms of 1,2,3,4-diepoxybutane at HPRT and TK loci in human cells. Environmental and Molecular Mutagenesis 2003;41(36 Supplement):77. R834677C150 (Final)
    not available
    Journal Article Meng Q, Redetzke DL, Hackfeld LC, Hodge RP, Walker DM, Walker VE. Mutagenicity of stereochemical configurations of 1,2-epoxybutene and 1,2:3,4-diepoxybutane in human lymphoblastoid cells. Chemico-Biological Interactions 2007;166(1-3):207-218. R834677C150 (Final)
  • Abstract from PubMed
  • Abstract: ScienceDirect-Abstract
  • Journal Article van Erp AM, Kelly FJ, Demerjian KL, Pope III CA, Cohen AJ. Progress in research to assess the effectiveness of air quality interventions towards improving public health. Air Quality, Atmosphere & Health 2012;5(2):217-230. R834677 (Final)
  • Abstract: Springer-Abstract
  • Journal Article van Erp AM, Cohen AJ, Shaikh R, O’Keefe R. Recent progress and challenges in assessing the effectiveness of air quality interventions toward improving public health: the HEI experience. EM Magazine 2012;10:22-28. R834677 (Final)
  • Full-text: EM Magazine-Full Text PDF
  • Relevant Websites:

    HEI 2012 Annual Report (PDF) (20 pp, 3.21 MB) Exit EPA Disclaimer

    Progress and Final Reports:

    Original Abstract
    2010 Progress Report
    2011 Progress Report
    2013 Progress Report
    Final Report

    Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R834677C149 Development and Application of a Sensitive Method to Determine Concentrations of Acrolein and Other Carbonyls in Ambient Air
    R834677C150 Mutagenicity of Stereochemical Configurations of 1,3-Butadiene Epoxy Metabolites in Human Cells
    R834677C151 Biologic Effects of Inhaled Diesel Exhaust in Young and Old Mice: A Pilot Project
    R834677C152 Evaluating Heterogeneity in Indoor and Outdoor Air Pollution Using Land-Use Regression and Constrained Factor Analysis
    R834677C153 Improved Source Apportionment and Speciation of Low-Volume Particulate Matter Samples
    R834677C155 The Impact of the Congestion Charging Scheme on Air Quality in London
    R834677C156 Concentrations of Air Toxics in Motor Vehicle-Dominated Environments
    R834677C158 Air Toxics Exposure from Vehicle Emissions at a U.S. Border Crossing: Buffalo Peace Bridge Study
    R834677C159 Role of Neprilysin in Airway Inflammation Induced by Diesel Exhaust Emissions
    R834677C160 Personal and Ambient Exposures to Air Toxics in Camden, New Jersey
    R834677C162 Assessing the Impact of a Wood Stove Replacement Program on Air Quality and Children’s Health
    R834677C163 The London Low Emission Zone Baseline Study
    R834677C165 Effects of Controlled Exposure to Diesel Exhaust in Allergic Asthmatic Individuals
    R834677C168 Evaluating the Effects of Title IV of the 1990 Clean Air Act Amendments on Air Quality
    R834677C172 Potential Air Toxics Hot Spots in Truck Terminals and Cabs
    R834677C173 Detection and Characterization of Nanoparticles from Motor Vehicles
    R834677C174 Cardiorespiratory Biomarker Responses in Healthy Young Adults to Drastic Air Quality Changes Surrounding the 2008 Beijing Olympics