Research Article: Exposure to air pollution and self-reported effects on Chinese students: A case study of 13 megacities

Date Published: March 16, 2018

Publisher: Public Library of Science

Author(s): Sohail Ahmed Rajper, Sana Ullah, Zhongqiu Li, Qinghua Sun.


Air pollution causes severe physical and psychological health complications. Considering China’s continuously-deteriorating air quality, this study aimed to assess the self-reported effects of air pollution on the behavior and physical health of the students of 13 densely populated cities, and their awareness, practices, and perception of air pollution and its associated public health risks. A detailed, closed-ended questionnaire was administered to 2100 students from 54 universities and schools across China. The questionnaire, which had 24 questions, was categorized into four sections. The first two sections were focused on air pollution-associated behavior and psychology, and physical effects; while the final two sections focused on the subjects’ awareness and perceptions, and practices and concerns about air pollution. The respondents reported that long-term exposure to air pollution had significantly affected their psychology and behavior, as well as their physical health. The respondents were aware of the different adverse impacts of air pollution (respiratory infections, allergies, and cardiovascular problems), and hence had adopted different preventive measures, such as the use of respiratory masks and glasses or goggles, regularly drinking water, and consuming rich foods. It was concluded that air pollution and haze had negative physical and psychological effects on the respondents, which led to severe changes in behavior. Proper management, future planning, and implementing strict environmental laws are suggested before this problem worsens and becomes life-threatening.

Partial Text

Air pollution is of serious concern across the globe, and is fueled by rapid population growth, continuous urbanization, increases in industrialization, continuous rises in energy demand, deforestation, and increases in car density, especially in major cities [1, 2]. Various anthropogenic activities lead to atmospheric degradation, such as emissions from vehicles, especially those that are older or poorly maintained; coal-powered industrial activities; construction, which produces dust; foundries and smelters; tobacco use; combustion that produces enormous heat; metal-based industries; mining; and excessive pesticide and chemical use [3–7]. This bleak scenario is further worsened through poor environmental management and regulation, use of inefficient technologies (with low production and high environmental deterioration), construction of congested roads, and the inability to strictly implement environmental regulations and laws, as well as a lack of awareness among the population about the serious health and psychological outcomes of pollution. This issue is even more prominent in underdeveloped and developing countries, where it is a serious concern as it adversely affects public health, alters the quality of life, and impacts the economy (by affecting agricultural production, for example) [8, 9].

The study was conducted according to the Ethics Review Committee of Nanjing University (No. 2009–116). The Questionnaires were administered to the students following informed verbal consent. All participants were thoroughly informed of the purposes and contents of the project. All participants had the right to answer all or part of the questionnaire, and the right to stop participating at any time-point. They were requested to complete the questionnaires, then and there. Using questionnaire for data/information acquisition, the committee approves informed verbal consent, and hence it was considered to lessen time spent by the students or/and trouble to the students.

The study included a total of 2048 subjects, who were recruited from 54 universities and schools across China. The largest number of individuals was recruited from Nanjing (21.2%), followed by Beijing (12.5%) and Changsha (11.2%). It was ensured that participants from different age groups were included. Of the total respondents, 47.3% were 16–25 years old. The study considered both genders; 55.2% of the subjects were female, while 44.8% were male. Table 1 presents the demographics of the respondents that took part in this study. Table 2 shows the average of air quality pollutants for the sampled cities. Table B in S2 File shows the interquartile ranges for the air pollutants across the samples cities (Oct 2015—March 2016).

China is currently facing prominent and complex issue of air pollution due to a rapid increase in urbanization and economic growth caused by heavy industrialization [43, 63, 64]. Environmental degradation could become more severe if proper management, environmental safety, and planning are not assured by environmental protection agencies, and the current scenario continues [11]. Over the past two decades, the infrastructure of almost all major Chinese cities has improved considerably, with extensive reconstruction in urban areas and modernization of industries [49]. In China’s major cities, subway systems are under development, along with other governmental and non-governmental infrastructures. The construction and expansion of these other infrastructures have attracted large numbers of workers from the countryside, elevating the population density of these cities. They have also resulted in an increase in urban air pollution, increasing the vulnerability of residents to adverse health effects [11, 65]. The ill-effects of long-term exposure to air pollution on human health, such as weakening/damaging the immune system, respiratory problems, low birth weight, and increased head circumference of children at birth, have been well-document [66–73]. Air pollution can cause mortality if different pollutants are present and exceed their permissible limits, for example, from continuous exposure to air containing 0.001% CO [74]. According to a report by the World Health Organization, urban air pollution (indoor and outdoor) contributes to over 2 million premature deaths per year [75]. According to the Global Burden of Disease study [26], of the 15 countries, China ranked first for premature mortalities (over 1.3 million premature deaths), which were attributed to ambient air pollution, while the preventable death rate was higher for Chinese megacities, including Beijing, Shanghai, Chengdu, and Tianjin [76].

In conclusion, the recruited respondents have suffered from different, adverse physical effects, such as respiratory infections or problems (lung cancer, asthma), and different types of ENT illnesses, due to haze and air pollution. Owing to the current air pollution scenario, almost all of the recruited subjects used face/respiratory masks, some used eyeglasses/goggles to prevent the negative impacts of haze and air pollution, and many ensured that they drank enough water to avoid dehydration and remove toxins. The most severe responses to air pollution were psychologically-associated behavioral problems, indicating a serious threat to mental health, and behavioral vulnerability and variations induced by stress, depression, anxiety, shortened tempers, mood swings, and unpleasant moods. The respondents were aware of major air pollutants, their sources, and the adverse effects of haze and air pollution. Televisions, cell phones, and the internet were the primary sources of knowledge about air pollution and its associated health effects.