STATEMENT OF W. Gerald Teague, M.D.

Professor and Vice Chairman of Clinical Affairs,

Director, Division of Pulmonary Medicine,

Department of Pediatrics,

Emory University School of Medicine

2040 Ridgewood Dr, NE

Atlanta, GA 30322

Telephone: 404-727-4788

Impact of Changes in Transportation and Commuting Behaviors during the 1996 Summer Olympic Games in Atlanta on Air Quality and Childhood Asthma

United States Senate Committee on the Environment and Public Works

Subcommittee on Clean Air, Climate Change, and Nuclear Safety

Table of Contents

I Biosketch: W. Gerald Teague, M.D. …….................................................   3

II Study Abstract …………………………………………………………... 4

III Written Testimony………………………………………………………  5

IV Media Guide …………………………………………………………… 9

V References……………………………………………………………….. 11

Biosketch

W. Gerald Teague, M.D.                                                                              

W. Gerald Teague is Professor and Vice Chairman of Pediatrics, and Director, Division of Pediatric Pulmonary Medicine, at Emory University.  He is the Medical Director of the Emory Asthma Center, and the Emory University Cystic Fibrosis Center. Dr. Teague also directs the American Lung Association’s Asthma Clinical Research Center at Emory University.  As a clinician-scientist, Dr. Teague is on the Steering Committee of the National Institutes of Health Severe Asthma Research Program, and is principal investigator for the Centers for Disease Control and Prevention to study the role of respiratory viruses in exacerbations of asthma. Dr. Teague is past recipient of the Edward Livingston Trudeau Research Scholarship of the American Lung Association, and is the author of peer-reviewed papers appearing in JAMA, The American Journal of Physiology, The Journal of Applied Physiology, The American Journal of Respiratory and Critical Care Medicine, The Journal of Pediatrics, and Pediatric Research. He is involved in community advocacy activities as a co-investigator in the Southeastern Pediatric Environmental Health Specialty Unit at Emory. He is a member of the American Thoracic Society, and the Georgia Chapter of the American Academy of Pediatrics.  Dr. Teague graduated from the Medical College of Georgia where he was elected to Alpha Omega Alpha. He completed an internship, residency, and a year as chief resident in pediatrics at the University of Virginia Health Sciences Center, and completed one year of post-graduate training in pediatric pulmonary medicine at the University of Virginia. Dr. Teague completed fellowships in pediatric pulmonary medicine and neonatology at the Cardiovascular Research Institute, University of California, San Francisco.  He is board-certified in general pediatrics and pediatric pulmonary medicine. 

Study Abstract

THE IMPACT OF CHANGES IN TRANSPORTATION AND COMMUTING BEHAVIORS DURING THE 1996 SUMMER OLYMPIC GAMES IN ATLANTA ON AIR QUALITY AND CHILDHOOD ASTHMA.  Michael S. Friedman, Kenneth E. Powell, Lori Hutwagner, Leroy E. Graham, William G. Teague.    

Background:  Vehicle exhaust is a major source of ozone and other air pollutants.  Although high ground-level ozone pollution is associated with transient increases in asthma morbidity, the impact of citywide transportation changes on air quality and childhood asthma has not been studied.  The alternative transportation strategy implemented during the 1996 Summer Olympic Games in Atlanta, GA, provided such an opportunity.  

Methods:  We measured acute care visits for asthma, all-cause acute care visits, mean air pollution concentrations, meteorological variables, traffic counts, public transportation use, and monthly statewide gasoline sales during the 17 days of the Olympics.  This was compared to a baseline period consisting of the 4 weeks before and after the Olympics.  

Results:  During the Olympics, acute asthma events decreased 42% (4.2 vs. 2.5 daily events) in the Georgia Medicaid Claims file, 44% (1.4 vs. 0.8 daily events) in a health maintenance organization, 11% (4.8 vs. 4.2 daily events) in 2 pediatric emergency rooms, and 19% (2.0 vs. 1.65 daily hospitalizations) in the Georgia Hospital Discharge database.  Acute non-asthma events changed –3.1%, +1.3%, -2.1%, and +1.0%, respectively.  In multivariate regression analysis, only the reduction in asthma events among Medicaid children was significant (relative risk = 0.48; 95% confidence interval = 0.44-0.86).  Peak daily ozone concentrations decreased 28%, from 81.3 ppb during the baseline period to 58.6 ppb during the Olympics.  Peak weekday a.m. traffic counts dropped 22.5%.  Traffic counts were significantly correlated with that day’s peak ozone concentration (average r = 0.36 for all 4 roads examined).  Meteorological conditions during the Olympics did not differ substantially from the baseline period.

Conclusions:  Efforts to reduce downtown traffic congestion in Atlanta during the Olympics resulted in decreased automobile use, especially during the critical morning period.  This was associated with a prolonged period of low ozone pollution and a significantly lower rate of childhood asthma events.  These data provide support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.

For full study articles, see JAMA (February 21, 2001 issue) ;285:897-905.

Written Testimony

The Impact of Changes in Transportation and Commuting Behaviors during the 1996 Summer Olympic Games in Atlanta on Air Quality and Childhood Asthma

W. Gerald Teague, M.D.

Good morning.  I am Dr. Gerald Teague, Professor of Pediatrics at the Emory University School of Medicine in Atlanta. I would like to thank Senators Voinovich and Carper and the Senate committee on the Environment and Public Works for inviting me here today.

Health Effects of Urban Air Pollution

As many of us in this room already know, outdoor air quality is known to affect respiratory health.  Studies done over ten years ago in children seen at Grady Hospital, an inner city hospital that serves primarily minorities, established a clear relationship between exposure to unhealthy levels of ozone and increased symptoms of asthma (White et al). Other studies done in Atlanta showed that airborne particles, apart from ozone, can also increase respiratory symptoms in children (Tolbert et al). As a pediatrician who practices in Atlanta, a city which has not met U.S. air quality standards, I regularly care for children with asthma attacks caused by air pollution episodes.

The evidence that air quality significantly impacts health is not limited to breathing problems like asthma.  The link between particulate pollution and increased deaths due to heart attacks and arrhythmias in adults is clearly established (Samet et al).  Evidence is also mounting that air quality is directly linked to the risk of lung cancer, childhood leukemia, complications of pregnancy like low birth weight, prematurity, and possibly congenital heart defects.

Importance of Traffic Congestion

Since the 1950s, we have known that vehicle exhaust fumes play a major role in the deterioration of air quality in urban areas (CMAQ).  The Clean Air Act, passed in 1970, authorized the EPA to cap pollutants emitted from a wide range of sources to meet air quality standards and preserve human health.  As a result of this legislation, the air is much cleaner today than it was in 1970. However, the prevalence of asthma in urban areas has increased significantly, and an estimated 62 million Americans live in areas where the air quality does not meet the health-based standards. Furthermore, the U.S. has experienced a staggering increase in traffic congestion (CMAQ).  From 1982 to 1997, traffic congestion increased by 45% in metropolitan Atlanta.

Introduction to the Atlanta Olympics Study

All of this leads me to the questions we face today. What happens when a city makes a well-organized, highly-collaborative, and aggressive attempt to decrease automobile traffic congestion?  Can such a strategy work in terms of decreasing traffic volumes and traffic congestion, and increasing traffic flow?  If it does, what impact would this have on the air quality of that city?  And what impact would this improvement in air quality, in turn, have on the health of the residents of that city?

The 1996 Summer Olympic Games in Atlanta provided an opportunity to answer these questions.  To set the stage, Atlanta was preparing to be host to an additional 1 million visitors during the 17 days of the Olympic Games.  These visitors would be concentrated in the downtown area, where traffic congestion was already a very serious problem. 

Methods to Reduce Traffic Congestion during the 1996 Atlanta Olympic Games

In response, the city of Atlanta, the Department of Transportation, and the Atlanta Committee of the Olympic Games along with local business leaders came together to develop and enact a comprehensive traffic mitigation strategy which included the following key components:

• Expand and encourage use of public transportation – 24 hour bus and rapid rail services, additional buses

• Promote alternative commuting practices to shift travel away from rush hour periods – telecommuting, flex hours, etc.

• Media warnings of particularly severe traffic congestion

• Highway improvements – additional lanes, widened lanes

• Traffic restrictions around the venue

Study Methods

To do this study, we measured acute care visits for asthma, mean air pollution concentrations, weather variables, traffic counts, public transportation use, and monthly gasoline sales during the 17 days of the Olympics. This was compared to a baseline period consisting of the 4 weeks before and after the Olympics.

Results

During the Olympics, acute asthma events decreased 42% in the Georgia Medicaid Claims file, 44% in a health maintenance organization, 11% in 2 pediatric emergency rooms, and 19% in the Georgia Hospital Discharge database (see figure above).

Peak daily ozone concentrations decreased 28% from 81.3 ppb during the baseline period to 58.6 ppb during the Olympics (see figure above).

 

Peak weekday AM traffic counts decreased 22.5% (figure above).

Conclusions

Efforts to reduce downtown traffic congestion in Atlanta during the Olympics resulted in decreased automobile use, especially during the critical morning rush hours. These changes were associated with a prolonged period of low ozone pollution and significantly lower rates of childhood asthma events. This study provides evidence in support of efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.

Olympic Asthma Study Media Fact Sheet

Friedman MS, Powell KE, Hutwagner L, Graham LM, Teague, WG. Impact of changes in transportation and commuting behaviors during the 1996 Summer Olympic Games in on air quality and childhood asthma. JAMA 2001; 285(7): 897-905.

Contact Information:

W. Gerald Teague, M.D.

Professor and Vice Chairman of Pediatrics,

Emory University School of Medicine

2040 Ridgewood Dr. NE

Atlanta, GA 30322

Telephone: 404-727-4788

Email: wteague@emory.edu

1.               Our study showed that decreased city-wide use of automobiles in Atlanta during the Olympics led to improved air quality and a large decrease in childhood asthma events.

2.               Automobile use decreased most dramatically during the weekday morning rush hour period, which we believe is a critical time period for the build-up of ozone pollution latter in the day.

3.               Dramatic increases in public transportation use and the widespread implementation of alternative downtown commuting schedules resulted in the observed decrease in automobile use.  Strategies to decrease rush hour commuting included closure of the downtown area to car traffic, flextime, carpooling, telecommuting, and promotion of commuting alternatives through the media.  Cooperation between city government, ACOG, local businesses, the local media, and residents of Atlanta ensured the success of these strategies.

4.               Our findings are consistent with other studies linking poor air quality to increased asthma events and decreased lung function in children.

5.               Our study is important because:  1) it provides evidence that decreasing automobile use can reduce the burden of asthma in our cities.  2)  City-wide efforts to reduce rush hour automobile traffic through the use of public transportation and altered work schedules is possible in America.

6.               Atlanta’s inner-city children on Medicaid seemed to benefit the most from this Olympic experiment in city transportation planning.

7.               While some Atlantans may have left the city during the Olympics, we found that overall emergency medical visits did not change while emergency asthma visits did, suggesting this was a real decrease.

8.               The decrease in automobile use was driven by the Olympics; the question is whether there can be such a dramatic change in car usage under more routine and sustainable conditions.

9.               We believe that sustainable transportation changes are possible if city governments, businesses, and city residents have a strong desire to reduce automobile pollution, and work together in innovative ways to accomplish this.

10.            We hope that this study spurs interest in the development and use of near emission-free cars in our cities.  The technology and practical application of such cars already exist.  Efforts now need to focus on how to encourage and promote their use over the next 5 years.

11.            Asthma is a very complicated disease with many possible causes. Air pollution and automobile congestion is only one factor in why a person’s asthma may flare up.  Efforts to decrease automobile emissions and improve air quality will not help everyone’s asthma.  But as our study shows, it may have a significant impact on the burden of asthma, especially in our inner-cities.

References

1. Friedman MS, Powell KE, Hutwagner L, Graham LM, Teague, WG. Impact of changes in transportation and commuting behaviors during the 1996 Summer Olympic Games in on air quality and childhood asthma. JAMA 2001; 285(7): 897-905.

2. White MC, Etzel RA, Wilcox WD, Lloyd C. Exacerbations of childhood asthma and ozone pollution in Atlanta. Environ Res 1994; 65:56-68.

3. Tolbert P, Mulholland JA, MacIntosh DL, et al. Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia. Am J Epidemiol 2000; 151: 798-810.

4. U.S. Department of Transportation/Federal Highway Administration. The congestion mitigation and air quality improvement program. Publication No. FHWA-EP-00-020.

5. Samet JM, Dominici F, Curriero FC, Coursac I, Zeger SL. Fine particulate air pollution and mortality in 20 U.S. cities 1987-1994. N Engl J Med 2000; 343: 1742-1749.