Environmental Epidemiology

Main objective:

To know the role of Environmental Epidemiology as a methodological tool to approach the main public health issues related to the environment. To learn to identify community health problems and to assess their diverse dimensions (biomedical, environmental, social) through the application of methodological methods. To propose epidemiological designs adapted to each environmental context and to establish the adoption of ideal preventive measures, recognizing and assessing the relationship between environmental factors and community health.

Specific objectives:
• To know the applications of different epidemiological designs to study environmental risks for the population through actual examples.
• To know the main aspects of epidemiological analysis of environmental research and their accurate interpretation.
• To review the most current evidence in the various areas of environmental health and the most appropriate preventive and corrective measures.
• To provide the students with the necessary tools to critically analyze environmental situations entailing health hazards.
• To provide the knowledge to solve actual environmental problems and to evaluate its impact on population health.

Part 1. Introduction to Environmental Epidemiology
Environmental risk. Risk evaluation.
Exposure and effect.
Environmental surveillance.
Practical application of environmental epidemiology to specific problems.
Design of an environmental study in the field of environmental epidemiology.

Part 2. Environmental Tobacco Smoke
Assessment of health effects on the population.
Assessment of exposure to Environmental Tobacco Smoke.
Key epidemiological studies on Environmental Tobacco Smoke.

Part 3. Ionizing radiation and radon gas
Ionizing radiation as an example of an unknown environmental hazard.
Radon gas exposure assessment.
Key epidemiological studies on occupational and residential exposure to radon.
Prevention tools: from citizen science to health surveillance protocols for workers exposed to radon.

Part 4. Ambient air pollution
Ambient air pollution exposure assessment.
Study design and methodology to estimate short and long-term health effects.
Epidemiologic studies on ambient air pollution and key results.

Part 5. Pollution from environmental disasters
Ambient air pollution from environmental disasters and special situations.
Exposure assessment and study of health effects on the population.
Methodology to study the effects of disasters on health. An example of volcanic eruptions. The ASHES Study.

REFERENCES

• Sánchez-Villegas A et al. “Salud ambiental. Medio ambiente físico. Contaminación atmosférica.” En: Martínez González MA Ed: Conceptos de Salud Pública y estrategias preventivas. Un manual para ciencias de la salud. Pp277-282. Ed. Elsevier.Barcelona, 2013.
• García García AM, García Benavides F. Causalidad en salud laboral: El caso Ardystil.Gac San.1995; 51(9): 371-79.
• Norell S. Diseño de estudios epidemiológicos.1ª de. Siglo XXI de España Eds. Madrid, 1994.
• World Health Organization. WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide [Internet]. 2021. Available from: https://www.who.int/publications/i/item/9789240034228
• Stewart C, Damby DE, Horwell CJ, Elias T, Ilyinskaya E, Tomašek I, et al. Volcanic air pollution and human health: recent advances and future directions. Bulletin of Volcanology 2021 84:1. 2021;84(1):1–25.
• Ruano-Ravina A, Acosta O, Díaz Pérez D, Casanova C, Velasco V, Peces-Barba G, et al. A longitudinal and multidesign epidemiological study to analyze the effect of the volcanic eruption of Tajogaite volcano (La Palma, Canary Islands). The ASHES study protocol. Environmental Research. 2023;216:114486.
• Arcos González Pedro Ignacio, Castro Delgado Rafael, Busto Prado Francisco del. Desastres y salud pública: Un abordaje desde el marco teórico de la epidemiología. Rev. Esp. Salud Publica [Internet]. 2002 ; 76( 2 ): 121-132. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-5727200….
• van Oldenborgh GJ, van der Wiel K, Kew S, Philip S, Otto F, Vautard R, et al. Pathways and pitfalls in extreme event attribution. Clim Change. 2021;166(1–2):13.
• Global Burden of Disease Study 2015. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. The Lancet. 2017;10082:1907-1918. https://doi.org/10.1016/S0140-6736(17)30505-6
• Thurston GD, Kipen H, Annesi-Maesano I, et al. A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework. Eur Resp J. 2017; 49: 1600419. https://doi.org/10.1183/13993003.00419-2016
• Brauer M. How Much, How Long, What, and Where: Air Pollution Exposure Assessment for Epidemiologic Studies of Respiratory Disease. Proc Am Thor Soc. 2010; 7: 111-115. doi:10.1513/pats.200908-093RM
• Hoek G. Methods for Assessing Long-Term Exposures to Outdoor Air Pollutants. Curr Envir Health Rpt. 2017: 4; 450-462. https://doi.org/10.1007/s40572-017-0169-5
• Basagaña X, Aguilera I, Rivera M, et al. Measurement Error in Epidemiologic Studies of Air Pollution Based on Land-Use Regression Models. Am J Epidemiol. 2013;178(8):1342–1346. https://doi.org/10.1093/aje/kwt127
• Dominici F, Zigler C. Best practices for Gauging Evidence of Causality in Air Pollution Epidemiology. Am J Epidemiol. 2017; 186(12): 1303-1309. https://doi.org/10.1093/aje/kwx307
• Jaakkola, JJK. Case-crossover design in air pollution epidemiology. Eur Resp J. 2003; 21: Suppl. 40, 81s–85s. https://doi.org/10.1183/09031936.03.00402703
• Strak M, Weinmayr G, Rodopoulou S, et al. Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis. BMJ. 2021; 374: n1904. https://doi.org/10.1136/bmj.n1904
• Sociedad Española de Epidemiología, Evaluación de las Políticas de Control de Tabaquismo en España. Consultar en: https://www.seepidemiologia.es/documents/dummy/V9.0%20-%20Libro%20Tabaq…
• Blanco-Ferreiro A, et al. Assessment of exposure to secondhand tobacco smoke in Spain: A scoping review. Tob Induc Dis. 2024 Oct 11;22. doi: 10.18332/tid/192118.
• Blanco-Ferreiro A, et al. La valoración de la exposición al humo ambiental de tabaco en las encuestas de salud de España . Gac Sanit. 2024;38:102413. doi: 10.1016/j.gaceta.2024.102413.
• Rey-Brandariz J, et al. Mortality attributable to secondhand smoke exposure in the autonomous communities of Spain. Rev Esp Cardiol (Engl Ed). 2024 Nov;77(11):912-918. doi: 10.1016/j.rec.2024.02.019.
• López-Medina DC, et al. Evolution and characteristics of studies estimating attributable mortality to second-hand smoke: a systematic review. Eur J Public Health. 2024 Jun7;34(3):557-565. doi: 10.1093/eurpub/ckae049.
• Mourino N, et al. Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review. PLoS One. 2022 May 5;17(5):e0267319. doi:10.1371/journal.pone.0267319.
• Manual de la OMS sobre el radón en interiores. Una perspectiva de salud pública. 2009. Organización Mundial de la Salud. Disponible: https://www.who.int/es/publications/i/item/9789241547673
• Ruano-Ravina A, Martín-Gisbert L. Radon and Disease—It Is Time for More Case-Control Studies. JAMA Netw Open. 2025;8(1):e2454327doi:10.1001/jamanetworkopen.2024.54327
• Environmental epidemiology Study Methods And Application. https://doi.org/10.1093/oso/9780198527923.001.0001 Online ISBN: 9781383024616 Print ISBN: 9780198527923 Publisher: Oxford University Press. 2023.

Students will be capable of identifying environmental problems and providing the most appropriate answers to each situation.
Students will be capable of evaluating the impact of such problems through the understanding of its effect using the population attributable fraction or specific effects regarding excess risk.
In case-specific studies, the students will be capable of assessing the benefit-risk ratio of specific exposures, such as ionizing radiation.
To assess the importance of adequate measurement of exposure and factors that may exert confusion in epidemiologic studies.

Specific competences of the course
To be able to design epidemiologic studies in an environmental framework and to interpret their results.
To understand the different magnitude of environmental risks and the importance of analyzing specific subpopulations.
To be able to assess the importance of different epidemiologic studies (cross-sectional, longitudinal, and case control) in the analysis of environmental risks effects on health.

The teaching is developed mainly through the virtual campus, where the faculty will provide students with the necessary materials to understand and respond to the teaching objectives, and to solve the assignments and exercises that will be used for the final evaluation.
Each part of the syllabus will include content specifically adapted to its subject and will be available on the virtual campus. The contents will be based on texts in PDF format, highlighting the most relevant and updated bibliography. Key scientific papers, documents and articles from each part of the syllabus will also be available.
The faculty will encourage critical thinking and active learning through reflection-oriented questions and readings. Part of the learning is focused on design thinking and collaborative learning. To this end, several discussion forums will be held on a specific and current topic related to environmental epidemiology. Students will have to answer the questions raised by the faculty, thus collaborating in collective learning by being able to read and discuss the contributions of other students. In addition, throughout the course, each of the faculty members can propose the critical reading of a scientific study related to a specific topic within environmental epidemiology. Furthermore, the faculty will convene short online meeting sessions of voluntary attendance, to explain parts of the theory or to comment on the answers provided in the forums. The faculty will be available to students through the virtual campus and USC’s institutional email.

60% of the overall grade corresponds to the continuous assessment, which considers the participation in forums and the completion of the exercises proposed by the faculty, which will measure the knowledge acquired. The remaining 40% will be reserved for the final test. Students must take an individual test, consisting of the design of a research work applied to environmental epidemiology, or of the argued critique of a scientific article in the environmental field.

Each student should dedicate two or three hours of work per week to the reading of the materials, to the continuous assessment (resolution and elaboration of answers to periodic exercises) and to the final test.

Online participation through e-mail and the virtual campus. Submission of exercises from continuous assessment.