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Traffic-related Air Pollution and Attention in Primary School Children: Short-term Association

Sunyer, Jordi; Suades-González, Elisabet; García-Esteban, Raquel; Rivas, Ioar; Pujol, Jesús; Alvarez-Pedrerol, Mar; Forns, Joan; Querol, Xavier; Basagaña, Xavier

doi: 10.1097/EDE.0000000000000603
Air Pollution

Background: Although air pollution’s short-term effects are well understood to be marked and preventable, its acute neuropsychological effects have, to our knowledge, not yet been studied. We aim to examine the association between daily variation in traffic-related air pollution and attention.

Methods: We conducted a follow-up study from January 2012 to March 2013 in 2,687 school children from 265 classrooms in 39 schools in Barcelona (Catalonia, Spain). We assessed four domains of children’s attention processes every 3 months over four repeated visits providing a total of 10,002 computerized tests on 177 different days using the child Attention Network test (ANT). Ambient daily levels of nitrogen dioxide (NO2) and elemental carbon (EC) in particulate matter <2.5 µm (PM2.5) filters were measured at a fixed air quality background monitoring station and in schools.

Results: Daily ambient levels of both NO2 and EC were negatively associated with all attention processes (e.g., children in the bottom quartile of daily exposure to ambient NO2 levels had a 14.8 msecond [95% confidence interval, 11.2, 18.4] faster response time than those in the top quartile, which was equivalent to a 1.1-month [0.84, 1.37] retardation in the natural developmental improvement in response speed with age). Similar findings were observed after adjusting for the average indoor (classroom) levels of pollutants. Associations for EC were similar to those for NO2 and robust to several sensitivity analyses.

Conclusions: The short-term association of traffic-related air pollutants with fluctuations in attention adds to the evidence that air pollution may have potential harmful effects on neurodevelopment. See video abstract at,

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From the aISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain; bPompeu Fabra University, Barcelona, Catalonia, Spain; cConsortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; dInstitut Hospital del Mar d’Investigacions Mèdiques–Parc de Salut Mar, Barcelona, Catalonia, Spain; eLearning Disabilities Unit (UTAE), Neuropediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Catalonia, Spain; fInstitute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain; and gMRI Research Unit, CRC Mar, Hospital del Mar, Barcelona, Spain.

Submitted 21 January 2016; accepted 22 November 2016.

Funded by European Research Council (ERC Grant Agreement number 268479—the BREATHE project).

The authors report no conflicts of interest.

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Correspondence: Jordi Sunyer, Doctor Aiguader, 88, 08003 Barcelona, Catalonia, Spain. E-mail:

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