Air Pollution and Health Outcomes in the Eastern Mediterranean Region: Knowledge and Research Gaps and Need

  • Yousef Saleh KhaderEmail author
Living reference work entry


Although air pollution is recognized as an emerging public health problem in the EMR countries, it is difficult to construct evidence on the effect of air pollution on health in the EMR countries for several reasons, in part because the impact of air pollution on health is not recognized as a priority area by health researchers, health professionals, and policy makers in the EMR countries. Although the burden of diseases from air pollution is expected to be high in the EMR, a limited number of studies in a few areas of the EMR countries have assessed the association between various air pollution exposures and health outcomes. For the majority of reviewed studies, limitations do exist – even in well-conducted ones. The limitations and shortcomings arise from inappropriate study designs, poor assessment of exposure and outcomes, questionable sources of data, lack of standardized methods, poor adjustment of confounders, limited geographical area studies, small sample sizes, poor statistical modeling, and not testing for possible interactions between exposures.

Tobacco smoking increases the risk of some types of cancers. Nitrogen dioxide increases the risk of lung and breast cancer incidence. Outdoor and indoor pollution, using fuel for heating, and living near an electric generator are associated with an increased risk of lung cancer. Air pollution is associated with cardiovascular morbidity, especially in high-risk groups. Moreover, exposure to poor ambient air quality and particulate matter increases blood pressure in schoolchildren. The few studies in the EMR that have examined the effect of air pollution on pregnancy outcomes show that prenatal secondhand smoke, carbon monoxide, and exposure to wood fuel smoke have harmful effects on the weight of newborn babies and increase the risk of spontaneous abortion. Other ambient air pollutants have no significant association with the mean birth weight and do not affect preterm birth.

In conclusion, it is difficult to gauge the evidence on the effects of air pollution on health in the EMR countries based on the limited number of published material and the poor qualities of many of the studies. Policy makers should use the best available evidence to make recommendations. Standardized reliable assessments on national levels for various air pollutants in different countries should be implemented and made publicly available for research purposes. Advancing and utilizing epidemiological designs is of key importance. Best epidemiological designs should be used to yield information on rare chronic health outcomes. In addition, well-designed case-control studies should be used to study the health effects of airborne toxins and pollutants. Accurate exposure levels, detailed outcome assessments, and incorporating appropriate confounders should be considered in future studies, which should also consider exposures to pollutants that are emitted together, or as individual pollutants, to better understand the mechanisms of the health outcomes of environmental pollutants.


Air pollution Health outcomes Research gaps Epidemiology 


  1. Abbey DE, Nishino N, McDonnell WF et al (1999) Long-term inhalable particles and other air pollutants related to mortality in nonsmokers. Am J Respir Crit Care Med 159:373–382PubMedCrossRefPubMedCentralGoogle Scholar
  2. Abdel Rasoul GM, Al-Batanony MA, Mahrous OA, Abo-Salem ME, Gabr HM (2012) Environmental lead exposure among primary school children in Shebin El-Kom District, Menoufiya Governorate, Egypt. Int J Occup Environ Med 3(4):186–194PubMedPubMedCentralGoogle Scholar
  3. Abdul Wahab A, Mostafa OA (2007) Arabian incense exposure among Qatari asthmatic children. A possible risk factor. Saudi Med J 28(3):476–478PubMedPubMedCentralGoogle Scholar
  4. Abou-Khadra MK (2013) Association between PM10 exposure and sleep of Egyptian school children. Sleep Breath 17(2):653–657PubMedCrossRefPubMedCentralGoogle Scholar
  5. Abu Sham'a F, Skogstad M, Nijem K, Bjertness E, Kristensen P (2010) Lung function and respiratory symptoms in male Palestinian farmers. Arch Environ Occup Health 65(4):191–200PubMedCrossRefPubMedCentralGoogle Scholar
  6. Abusalah A, Gavana M, Haidich AB, Smyrnakis E, Papadakis N, Papanikolaou A, Benos A (2012) Low birth weight and prenatal exposure to indoor pollution from tobacco smoke and wood fuel smoke: a matched case-control study in Gaza Strip. Matern Child Health J 16(8):1718–1727PubMedCrossRefPubMedCentralGoogle Scholar
  7. Akhtar T, Ullah Z, Khan MH, Nazli R (2007) Chronic bronchitis in women using solid biomass fuel in rural Peshawar, Pakistan. Chest 132(5):1472–1475PubMedCrossRefPubMedCentralGoogle Scholar
  8. Al Kaabi JM, Wheatley AD, Barss P, Al Shamsi M, Lababidi A, Mushtaq A (2011) Carbon monoxide poisoning in the United Arab Emirates. Int J Occup Environ Health 17(3):202–209PubMedCrossRefPubMedCentralGoogle Scholar
  9. Al-Ahmadi K, Al-Zahrani A (2013) NO(2) and cancer incidence in Saudi Arabia. Int J Environ Res Public Health 10(11):5844–5862PubMedPubMedCentralCrossRefGoogle Scholar
  10. Al-Mousawi MS, Lovel H, Behbehani N, Arifhodzic N, Woodcock A, Custovic A (2004) Asthma and sensitization in a community with low indoor allergen levels and low pet-keeping frequency. J Allergy Clin Immunol 114(6):1389–1394PubMedCrossRefPubMedCentralGoogle Scholar
  11. Al-Rawas OA, Al-Maniri AA, Al-Riyami BM (2009) Home exposure to Arabian incense (bakhour) and asthma symptoms in children: a community survey in two regions in Oman. BMC Pulm Med 9:23PubMedPubMedCentralCrossRefGoogle Scholar
  12. Al-Taiar A, Thalib L (2014) Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait. Int J Biometeorol 58(1):69–77PubMedCrossRefPubMedCentralGoogle Scholar
  13. American Thoracic Society (2000) What constitutes an adverse health effect of air pollution? Am J Respir Crit Care Med 161:665–673CrossRefGoogle Scholar
  14. Anderson HR, Ponce DL, Bland JM, Bower JS, Emberlin J, Strachan DP (1998) Air pollution, pollens, and daily admissions for asthma in London 1987–92. Thorax 53:842–848PubMedPubMedCentralCrossRefGoogle Scholar
  15. Aoun J, Saleh N, Waked M, Salamé J, Salameh P (2013a) Lung cancer correlates in Lebanese adults: a pilot case – control study. J Epidemiol Glob Health 3(4):235–244PubMedCrossRefPubMedCentralGoogle Scholar
  16. Aoun J, Saleh N, Waked M, Salamé J, Salameh P (2013b) Lung cancer correlates in Lebanese adults: a pilot case – control study. J Epidemiol Glob Health 3(4):235–244PubMedCrossRefPubMedCentralGoogle Scholar
  17. Araban M, Kariman N, Tavafian SS, Motesaddi S, Alavimajd H, Shokravi F (2012) Air pollution and low birth weight: a historical cohort study from Tehran. East Mediterr Health J 18(6):556–560PubMedCrossRefPubMedCentralGoogle Scholar
  18. Awadalla NJ, Hegazy A, Elmetwally RA, Wahby I (2012) Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Egypt: a multicenter case-control study. Int J Occup Environ Med 3(3):107–116PubMedPubMedCentralGoogle Scholar
  19. Battah AH, Al-Farras MI, Abdallat IM, Hadidi MS (2009) Trends of carbon monoxide fatalities in Jordan. Saudi Med J 30(6):853–854PubMedPubMedCentralGoogle Scholar
  20. Bener A, Dogan M, Ehlayel MS, Shanks NJ, Sabbah A (2009) The impact of air pollution on hospital admission for respiratory and cardiovascular diseases in an oil and gas-rich country. Eur Ann Allergy Clin Immunol 41(3):80–84PubMedPubMedCentralGoogle Scholar
  21. Braun-Fahrlander C, Vuille JC, Sennhauser FH et al (1997) Respiratory health and long-term exposure to air pollutants in Swiss schoolchildren. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen. Am J Respir Crit Care Med 155:1042–1049PubMedCrossRefPubMedCentralGoogle Scholar
  22. Bruce N, Perez-Padilla R, Albalak R (2002) The health effects of indoor air pollution exposure in developing countries, vol 11. World Health Organization, GenevaGoogle Scholar
  23. Chen Z, Salam MT, Eckel SP, Breton CV, Gilliland FD (2015) Chronic effects of air pollution on respiratory health in Southern California children: findings from the Southern California Children’s Health Study. J Thorac Dis 1:46–58Google Scholar
  24. Chen Y, Mi BB, Zhao YL, Yang JM, Tao YL, Yan H (2016) Prenatal exposure to outdoor air pollution and preterm birth: a meta-analysis. Zhonghua Liu Xing Bing Xue Za Zhi 37(6):880–885PubMedPubMedCentralGoogle Scholar
  25. Dehghani M, Anushiravani A, Hashemi H, Shamsedini N (2014) Survey on air pollution and cardiopulmonary mortality in shiraz from 2011 to 2012: an analytical-descriptive study. Int J Prev Med 5(6):734–740PubMedPubMedCentralGoogle Scholar
  26. DeVries R, Kriebel D, Sama S (2017) Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD 14(1):113–121PubMedCrossRefPubMedCentralGoogle Scholar
  27. Dianat I, Nazari J (2011) Characteristics of unintentional carbon monoxide poisoning in Northwest Iran – Tabriz. Int J Inj Control Saf Promot 18(4):313–320CrossRefGoogle Scholar
  28. Dockery DW, Pope AC III, Xu X et al (1993) An association between air pollution and mortality in six U.S. cities. N Engl J Med 329:1753–1759PubMedCrossRefPubMedCentralGoogle Scholar
  29. EcoMENA. Air quality in Arab countries: an overview. Available at:
  30. Edraki M, Rambod M (2011) Parental smoking and risk of childhood cancer: hospital-based case-control study in Shiraz. East Mediterr Health J 17(4):303–308PubMedCrossRefPubMedCentralGoogle Scholar
  31. El Sayed MJ, Tamim H (2014) Carbon monoxide poisoning in Beirut, Lebanon: patient’s characteristics and exposure sources. J Emerg Trauma Shock 7(4):280–284PubMedPubMedCentralCrossRefGoogle Scholar
  32. El-Ghitany EM, Abd El-Salam MM (2012) Environmental intervention for house dust mite control in childhood bronchial asthma. Environ Health Prev Med 17(5):377–384PubMedPubMedCentralCrossRefGoogle Scholar
  33. El-Hodhod MA, Hamdy AM, Ahmed MB, Youssef SR, Aly SM (2011) Effect of passive smoking on blood lymphocyte apoptosis in children. Eur J Clin Investig 41(4):387–392CrossRefGoogle Scholar
  34. Elshabrawy WO, Ismail HA, Hassanein KM (2014) The impact of environmental and agricultural pollutants on the prevalence of allergic diseases in people from Qassim, KSA. Int J Health Sci (Qassim) 8(1):21–31CrossRefGoogle Scholar
  35. Emami-Razavi SH, Ghajarzadeh M, Aziz S, Keyvan A, Mirjafari SA, Sodagari F (2014) Are Iranians aware of carbon monoxide poisoning: symptoms and its prevention strategies? Acta Med Iran 52(12):931–934PubMedPubMedCentralGoogle Scholar
  36. Eze IC, Hemkens LG, Bucher HC, Hoffmann B, Schindler C, Künzli N, Schikowski T, Probst-Hensch NM (2015) Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. Environ Health Perspect 123(5):381–389PubMedPubMedCentralCrossRefGoogle Scholar
  37. Fahim AE, El-Prince M (2013) Pulmonary function impairment and airway allergy among workers in traditional bakeries. Int J Occup Med Environ Health 26(2):214–219PubMedCrossRefPubMedCentralGoogle Scholar
  38. Fatmi Z, Coggon D, Kazi A, Naeem I, Kadir MM, Sathiakumar N (2014) Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study. Public Health 128(1):77–82PubMedCrossRefGoogle Scholar
  39. Feng BJ, Khyatti M, Ben-Ayoub W, Dahmoul S, Ayad M, Maachi F, Bedadra W, Abdoun M, Mesli S, Bakkali H, Jalbout M, Hamdi-Cherif M, Boualga K, Bouaouina N, Chouchane L, Benider A, Ben-Ayed F, Goldgar DE, Corbex M (2009) Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa. Br J Cancer 101(7):1207–1212PubMedPubMedCentralCrossRefGoogle Scholar
  40. Filippini T, Heck JE, Malagoli C, Del Giovane C, Vinceti M (2015) A review and meta-analysis of outdoor air pollution and risk of childhood leukemia. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 33(1):36–66PubMedPubMedCentralCrossRefGoogle Scholar
  41. Forbes LJ, Patel MD, Rudnicka AR, Cook DG, Bush T, Stedman JR, Whincup PH, Strachan DP, Anderson HR (2009) Chronic exposure to outdoor air pollution and diagnosed cardiovascular disease: meta-analysis of three large cross-sectional surveys. Environ Health 8:30PubMedPubMedCentralCrossRefGoogle Scholar
  42. Gholampour A, Nabizadeh R, Naseri S, Yunesian M, Taghipour H, Rastkari N, Nazmara S, Faridi S, Mahvi AH (2014) Exposure and health impacts of outdoor particulate matter in two urban and industrialized area of Tabriz, Iran. J Environ Health Sci Eng 12(1):27PubMedPubMedCentralCrossRefGoogle Scholar
  43. Ghozikali MG, Mosaferi M, Safari GH, Jaafari J (2015) Effect of exposure to O3, NO2, and SO2 on chronic obstructive pulmonary disease hospitalizations in Tabriz, Iran. Environ Sci Pollut Res Int 22(4):2817–2823PubMedCrossRefPubMedCentralGoogle Scholar
  44. Hamadeh RR, Al-Roomi KA (2014) Air quality and seasonal variations in consultations for respiratory, allergic, dermatological and gastrointestinal diseases in Bahrain, 2007. East Mediterr Health J 20(5):309–316PubMedCrossRefPubMedCentralGoogle Scholar
  45. Hammad M, Atta K, Manzoor M, Tariq M, Saeed Z, Masood Z, Saleem K, Raza M, Malik GM, Alam AY (2010) Association of passive smoking with respiratory symptoms and clinical correlates, among married women, in a rural community in Islamabad. J Pak Med Assoc 60(7):601–604PubMedPubMedCentralGoogle Scholar
  46. Hamra GB, Laden F, Cohen AJ, Raaschou-Nielsen O, Brauer M, Loomis D (2015) Lung cancer and exposure to nitrogen dioxide and traffic: a systematic review and meta-analysis. Environ Health Perspect 123(11):1107–1112PubMedPubMedCentralCrossRefGoogle Scholar
  47. Hasnain SM, Akhter T, Waqar MA (2012) Airborne and allergenic fungal spores of the Karachi environment and their correlation with meteorological factors. J Environ Monit 14(3):1006–1013PubMedCrossRefPubMedCentralGoogle Scholar
  48. HEI (2004) Special report 15, Health effects of outdoor air pollution in developing countries of Asia: a literature review. Health Effects InstituteGoogle Scholar
  49. Heydarpour P, Amini H, Khoshkish S, Seidkhani H, Sahraian MA, Yunesian M (2014) Potential impact of air pollution on multiple sclerosis in Tehran, Iran. Neuroepidemiology 43(3–4):233–238PubMedCrossRefPubMedCentralGoogle Scholar
  50. Hosseinpanah F, Pour SH, Heibatollahi M, Moghbel N, Asefzade S, Azizi F (2010) The effects of air pollution on vitamin D status in healthy women: a cross sectional study. BMC Public Health 10:519PubMedPubMedCentralCrossRefGoogle Scholar
  51. Hosseinpoor AR, Forouzanfar MH, Yunesian M, Asghari F, Naieni KH, Farhood D (2005) Air pollution and hospitalization due to angina pectoris in Tehran, Iran: a time-series study. Environ Res 99(1):126–131PubMedCrossRefPubMedCentralGoogle Scholar
  52. Houssaini AS, Messaouri H, Nasri I, Roth MP, Nejjari C, Benchekroun MN (2007) Air pollution as a determinant of asthma among schoolchildren in Mohammedia, Morocco. Int J Environ Health Res 17(4):243–257PubMedCrossRefPubMedCentralGoogle Scholar
  53. Janghorbani M, Piraei E (2010) Association between air pollution and preterm birth among neonates born in Isfahan, Iran. J Res Med Sci 18(10):875–881Google Scholar
  54. Kelishadi R, Hashemi M, Javanmard SH, Mansourian M, Afshani M, Poursafa P, Sadeghian B, Fakhri M (2014) Effect of particulate air pollution and passive smoking on surrogate biomarkers of endothelial dysfunction in healthy children. Paediatr Int Child Health 34(3):165–169PubMedCrossRefPubMedCentralGoogle Scholar
  55. Khader YS, Al-Akour N, Alzubi IM, Lataifeh I (2011) The association between second hand smoke and low birth weight and preterm delivery. Matern Child Health J 15(4):453–459PubMedCrossRefPubMedCentralGoogle Scholar
  56. Khanjani N, Bahrampour A (2013) Temperature and cardiovascular and respiratory mortality in desert climate. A case study of Kerman, Iran. Iranian J Environ Health Sci Eng 10(1):11PubMedPubMedCentralCrossRefGoogle Scholar
  57. Kheirandish-Gozal L, Ghalebandi M, Salehi M, Salarifar MH, Gozal D (2014) Neighbourhood air quality and snoring in school-aged children. Eur Respir J 43(3):824–832PubMedCrossRefPubMedCentralGoogle Scholar
  58. Kobrossi R, Nuwayhid I, Sibai AM, El-Fadel M, Khogali M (2002) Respiratory health effects of industrial air pollution on children in North Lebanon. Int J Environ Health Res 12(3):205–220PubMedCrossRefPubMedCentralGoogle Scholar
  59. Leski TA, Malanoski AP, Gregory MJ, Lin B, Stenger DA (2011) Application of a broad-range resequencing array for detection of pathogens in desert dust samples from Kuwait and Iraq. Appl Environ Microbiol 77(13):4285–4292PubMedPubMedCentralCrossRefGoogle Scholar
  60. Li Y, Gibson JM, Jat P, Puggioni G, Hasan M, West JJ, Vizuete W, Sexton K, Serre M (2010) Burden of disease attributed to anthropogenic air pollution in the United Arab Emirates: estimates based on observed air quality data. Sci Total Environ 408(23):5784–5793PubMedCrossRefPubMedCentralGoogle Scholar
  61. Li G, Xue M, Zeng Q, Cai Y, Pan X, Meng Q (2017) Association between fine ambient particulate matter and daily total mortality: an analysis from 160 communities of China. Sci Total Environ 599–600:108–113PubMedCrossRefPubMedCentralGoogle Scholar
  62. Luqman M, Javed MM, Daud S, Raheem N, Ahmad J, Khan AU (2014) Risk factors for lung cancer in the Pakistani population. Asian Pac J Cancer Prev 15(7):3035–3039PubMedCrossRefPubMedCentralGoogle Scholar
  63. Mahboub B, Al-Hammadi S, Prakash VP, Sulaiman N, Blaiss MS, Redha AA, Vats DM (2014) Prevalence and triggers of allergic rhinitis in the United Arab Emirates. World Allergy Organ J 7(1):19PubMedPubMedCentralCrossRefGoogle Scholar
  64. Mansourian M, Javanmard SH, Poursafa P, Kelishadi R (2010) Air pollution and hospitalization for respiratory diseases among children in Isfahan, Iran. Ghana Med J 44(4):138–143PubMedPubMedCentralGoogle Scholar
  65. Masjedi MR, Jamaati HR, Dokouhaki P, Ahmadzadeh Z, Taheri SA, Bigdeli M, Izadi S, Rostamian A, Aagin K, Ghavam SM (2003) The effects of air pollution on acute respiratory conditions. Respirology 8(2):213–230PubMedCrossRefPubMedCentralGoogle Scholar
  66. Maziak W, Ward KD, Rastam S, Mzayek F, Eissenberg T (2005) Extent of exposure to environmental tobacco smoke (ETS) and its dose-response relation to respiratory health among adults. Respir Res 6:13PubMedPubMedCentralCrossRefGoogle Scholar
  67. Meo SA, Al-Kheraiji MF, Alfaraj ZF, Alwehaibi NA, Aldereihim AA (2013) Respiratory and general health complaints in subjects exposed to sandstorm at Riyadh, Saudi Arabia. Pak J Med Sci 29(2):642–646PubMedCrossRefPubMedCentralGoogle Scholar
  68. Merétei T, Bite PZ, Báthory C, Bolla Z (2017) Particulate matter and heavy metal air pollution in the Middle East region. Mater Sci Eng 42(1):86–93. HU ISSN 2063-6792Google Scholar
  69. Merghani TH, Saeed AM (2013) The relationship between regular second-hand smoke exposure at home and indicators of lung function in healthy school boys in Khartoum. Tob Control 22(5):315–318PubMedCrossRefPubMedCentralGoogle Scholar
  70. Merghani T, Saeed A, Alawad A (2012) Changes in plasma IL4, TNFá and CRP in response to regular passive smoking at home among healthy school children in Khartoum, Sudan. Afr Health Sci 12(1):41–47PubMedPubMedCentralGoogle Scholar
  71. Mohammad Y, Shaaban R, Hassan M, Yassine F, Mohammad S, Tessier JF, Ellwood P (2014) Respiratory effects in children from passive smoking of cigarettes and narghile: ISAAC phase three in Syria. Int J Tuberc Lung Dis 18(11):1279–1284PubMedCrossRefPubMedCentralGoogle Scholar
  72. Moridi M, Ziaei S, Kazemnejad A (2014) Exposure to ambient air pollutants and spontaneous abortion. J Obstet Gynaecol Res 40(3):743–748PubMedCrossRefPubMedCentralGoogle Scholar
  73. Nabavi SM, Jafari B, Jalali MS, Nedjat S, Ashrafi K, Salahesh A (2012) Environmental air pollution and acute cerebrovascular complications: an ecologic study in Tehran, Iran. Int J Prev Med 3(10):723–729PubMedPubMedCentralGoogle Scholar
  74. Nahidi F, Gholami R, Rashidi Y, Alavi MH (2013) Relationship between air pollution and preeclampsia in pregnant women: a case–control study. East Mediterr Health J 19:S60–S66Google Scholar
  75. Nazari J, Dianat I, Stedmon A (2010) Unintentional carbon monoxide poisoning in Northwest Iran: a 5-year study. J Forensic Legal Med 17(7):388–391CrossRefGoogle Scholar
  76. Poursafa P, Mansourian M, Motlagh ME, Ardalan G, Kelishadi R (2014) Is air quality index associated with cardiometabolic risk factors in adolescents? The CASPIAN-III Study. Environ Res 134:105–109PubMedCrossRefPubMedCentralGoogle Scholar
  77. Qasem JA, Nasrallah H, Al-Khalaf BN, Al-Sharifi F, Al-Sherayfee A, Almathkouri SA, Al-Saraf H (2008) Meteorological factors, aeroallergens and asthma-related visits in Kuwait: a 12-month retrospective study. Ann Saudi Med 28(6):435–441PubMedPubMedCentralGoogle Scholar
  78. Qorbani M, Yunesian M, Fotouhi A, Zeraati H, Sadeghian S (2012) Effect of air pollution on onset of acute coronary syndrome in susceptible subgroups. East Mediterr Health J 18(6):550–555PubMedCrossRefPubMedCentralGoogle Scholar
  79. Qorbani M, Yunesian M, Baradaran HR (2014) Indoor smoke exposure and risk of anthracosis. Iran J Med Sci 39(6):571–576PubMedPubMedCentralGoogle Scholar
  80. Raaschou-Nielsen O, Pedersen M, Stafoggia M, Weinmayr G, Andersen ZJ, Galassi C, Sommar J, Forsberg B et al (2017) Outdoor air pollution and risk for kidney parenchyma cancer in 14 European cohorts. Int J Cancer 140(7):1528–1537PubMedCrossRefPubMedCentralGoogle Scholar
  81. Sasco AJ, Merrill RM, Dari I, Benhaïm-Luzon V, Carriot F, Cann CI, Bartal M (2002a) A case-control study of lung cancer in Casablanca, Morocco. Cancer Causes Control 13(7):609–616PubMedCrossRefPubMedCentralGoogle Scholar
  82. Sasco AJ, Merrill RM, Dari I, Benhaïm-Luzon V, Carriot F, Cann CI, Bartal M (2002b) A case-control study of lung cancer in Casablanca, Morocco. Cancer Causes Control 13(7):609–616PubMedCrossRefPubMedCentralGoogle Scholar
  83. Schwartz J (1994) PM10, ozone, and hospital admissions for the elderly in Minneapolis-St. Paul, Minnesota. Arch Environ Health 49:366–374PubMedCrossRefPubMedCentralGoogle Scholar
  84. Senevirathne SRDA (2003) Air pollution: a case study of environmental pollution. J Coll Commun Phys Sri Lanka 8(1):1–9Google Scholar
  85. Sheikhazadi A, Saberi Anary SH, Ghadyani MH (2010) Nonfire carbon monoxide-related deaths: a survey in Tehran, Iran (2002–2006). Am J Forensic Med Pathol 31(4):359–363PubMedCrossRefPubMedCentralGoogle Scholar
  86. Shiva F, Nasiri M, Sadeghi B, Padyab M (2003) Effects of passive smoking on common respiratory symptoms in young children. Acta Paediatr 92(12):1394–1397PubMedCrossRefPubMedCentralGoogle Scholar
  87. Siddiqui AR, Gold EB, Yang X, Lee K, Brown KH, Bhutta ZA (2008) Prenatal exposure to wood fuel smoke and low birth weight. Environ Health Perspect 116(4):543–549PubMedPubMedCentralCrossRefGoogle Scholar
  88. Simoni M, Baldacci S, Maio S, Cerrai S, Sarno G, Viegi G (2015) Adverse effects of outdoor pollution in the elderly. J Thorac Dis 1:34–45Google Scholar
  89. Stieb DM, Chen L, Eshoul M, Judek S (2012) Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis. Environ Res 117:100–111PubMedCrossRefPubMedCentralGoogle Scholar
  90. Sughis M, Nawrot T, Ihsan-ul-Haque S, Amjad A, Nemery B (2012) Blood pressure and particulate air pollution in schoolchildren of Lahore, Pakistan. BMC Public Health 12:378–386PubMedPubMedCentralCrossRefGoogle Scholar
  91. Talaat HS, Metwaly MA, Khafagy AH, Abdelraouf HR (2014) Dose passive smoking induce sensorineural hearing loss in children? Int J Pediatr Otorhinolaryngol 78(1):46–49PubMedCrossRefPubMedCentralGoogle Scholar
  92. Thalib L, Al-Taiar A (2012) Dust storms and the risk of asthma admissions to hospitals in Kuwait. Sci Total Environ 433:347–351PubMedCrossRefPubMedCentralGoogle Scholar
  93. Vigeh M, Yunesian M, Shariat M, Niroomanesh S, Ramezanzadeh F (2011) Environmental carbon monoxide related to pregnancy hypertension. Women Health 51(8):724–738PubMedCrossRefPubMedCentralGoogle Scholar
  94. Wadi MA, Al-Sharbatti SS (2011) Relationship between birth weight and domestic maternal passive smoking exposure. East Mediterr Health J 17(4):290–296PubMedCrossRefPubMedCentralGoogle Scholar
  95. Wahabi H, Mandil A, Alzeidan R, Bahnassy A, Fayed A (2013a) The independent effects of second hand smoke exposure and maternal body mass index on the anthropometric measurements of the newborn. BMC Public Health 13:1058PubMedPubMedCentralCrossRefGoogle Scholar
  96. Wahabi H, Alzeidan R, Fayed A, Mandil A, Al-Shaikh G, Esmaeil SA (2013b) Effects of secondhand smoke on the birth weight of term infants and the demographic profile of Saudi exposed women. BMC Public Health 13:341PubMedPubMedCentralCrossRefGoogle Scholar
  97. Waked M, Salame J, Khayat G, Salameh P (2012) Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study. Int J Chron Obstruct Pulmon Dis 7:577–585PubMedPubMedCentralCrossRefGoogle Scholar
  98. Wheatley A, Sadhra S (2010) Carcinogenic risk assessment for emissions from clinical waste incineration and road traffic. Int J Environ Health Res 20(5):313–327PubMedCrossRefPubMedCentralGoogle Scholar
  99. WHO (2004) Health aspects of air pollution: results from the WHO project “systematic review of health aspects of air pollution in Europe”. Copenhagen: WHO Regional Office for Europe.
  100. World Atlas. Cities with the worst air quality in the Middle East. Available at:
  101. World Health Organisation. Quantifying environmental health impacts.
  102. World Health Organization (2000) Air quality guidelines for Europe. WHO Regional Office for Europe. WHO Regional Publications, European series. No. 91. World Health Organization, CopenhagenGoogle Scholar
  103. Yeatts KB, El-Sadig M, Leith D, Kalsbeek W, Al-Maskari F, Couper D, Funk WE, Zoubeidi T, Chan RL, Trent CB, Davidson CA, Boundy MG, Kassab MM, Hasan MY, Rusyn I, Gibson JM, Olshan AF (2012) Indoor air pollutants and health in the United Arab Emirates. Environ Health Perspect 120(5):687–694PubMedPubMedCentralCrossRefGoogle Scholar
  104. Zeidan RK, Rachidi S, Awada S, El Hajje A, El Bawab W, Salamé J, Bejjany R, Salameh P (2014) Carbon monoxide and respiratory symptoms in young adult passive smokers: a pilot study comparing waterpipe to cigarette. Int J Occup Med Environ Health 27(4):571–582. Epub 2014 Jul 7
  105. Zhang Z, Wang J, Lu W (2018) Exposure to nitrogen dioxide and chronic obstructive pulmonary disease (COPD) in adults: a systematic review and meta-analysis. Environ Sci Pollut Res Int 25(15):15133–15145PubMedCrossRefPubMedCentralGoogle Scholar
  106. Zhao R, Chen S, Wang W, Huang J, Wang K, Liu L, Wei S (2017) The impact of short-term exposure to air pollutants on the onset of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Int J Cardiol 226:110–117PubMedCrossRefPubMedCentralGoogle Scholar
  107. Zheng YL, Amr S, Saleh DA, Dash C, Ezzat S, Mikhail NN, Gouda I, Loay I, Hifnawy T, Abdel-Hamid M, Khaled H, Wolpert B, Abdel-Aziz MA, Loffredo CA (2012) Urinary bladder cancer risk factors in Egypt: a multicenter case-control study. Cancer Epidemiol Biomark Prev 21(3):537–546CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Community Medicine, Public Health and Family Medicine, Faculty of MedicineJordan University of Science & TechnologyIrbidJordan

Section editors and affiliations

  • Yousef Khader
    • 1
    • 2
  1. 1.Department of Community Medicine, Public Health and Family Medicine, Faculty of MedicineJordan University of Science and TechnologyIrbidJordan
  2. 2.Global Health Development (GHD)/The Eastern Mediterranean Public Health Network (EMPHNET)AmmanJordan

Personalised recommendations