{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:32:25Z","timestamp":1790652745677,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T00:00:00Z","timestamp":1567728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007040","name":"Singapore University of Technology and Design","doi-asserted-by":"publisher","award":["SRG SCI 2019 142"],"award-info":[{"award-number":["SRG SCI 2019 142"]}],"id":[{"id":"10.13039\/501100007040","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Air pollution has emerged as one of the world\u2019s largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from \u201cslash-and-burn\u201d farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.<\/jats:p>","DOI":"10.3390\/ijerph16183286","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T04:12:40Z","timestamp":1568002360000},"page":"3286","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Acute Health Impacts of the Southeast Asian Transboundary Haze Problem\u2014A Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4475-5451","authenticated-orcid":false,"given":"Kang Hao","family":"Cheong","sequence":"first","affiliation":[{"name":"Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3339-7281","authenticated-orcid":false,"given":"Nicholas Jinghao","family":"Ngiam","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey G.","family":"Morgan","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pin Pin","family":"Pek","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore"},{"name":"Health Services &amp; Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Yong-Qiang","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5619-2051","authenticated-orcid":false,"given":"Joel Weijia","family":"Lai","sequence":"additional","affiliation":[{"name":"Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Ming","family":"Koh","sequence":"additional","affiliation":[{"name":"Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Eng Hock","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore"},{"name":"Health Services &amp; Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4338-3876","authenticated-orcid":false,"given":"Andrew Fu Wah","family":"Ho","sequence":"additional","affiliation":[{"name":"SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore"},{"name":"National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore"},{"name":"Cardiovascular &amp; Metabolic Disorders Programme, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"ref_1","unstructured":"The United Nations Economic Commission for Europe (2019, May 30). Air pollution and health. Available online: https:\/\/www.unece.org\/environmental-policy\/conventions\/envlrtapwelcome\/cross-sectoral-linkages\/air-pollution-and-health.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","article-title":"A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lim","year":"2012","journal-title":"Lancet (London, England)"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.envres.2014.10.015","article-title":"A systematic review of the physical health impacts from non-occupational exposure to wildfire smoke","volume":"136","author":"Liu","year":"2015","journal-title":"Environ. Res."},{"key":"ref_4","unstructured":"World Health Organization (2019, May 01). Burden of disease from ambient air pollution for 2016. Available online: https:\/\/www.who.int\/airpollution\/data\/AAP_BoD_results_May2018_final.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4327","DOI":"10.1021\/es405533d","article-title":"2013 Southeast Asian Smoke Haze: Fractionation of Particulate-Bound Elements and Associated Health Risk","volume":"48","author":"Betha","year":"2014","journal-title":"Environ. Sci. Technol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1353\/dem.2002.0009","article-title":"Forest Fires, Air Pollution, and Mortality in Southeast Asia","volume":"39","author":"Sastry","year":"2002","journal-title":"Demography"},{"key":"ref_7","unstructured":"Sunchindah, A. (2019, May 01). Transboundary haze pollution problem in Southeast Asia: Reframing ASEAN\u2019s response (no. DP-2015-82). Available online: http:\/\/www.eria.org\/ERIA-DP-2015-82.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/nclimate1658","article-title":"El Ni\u00f1o and health risks from landscape fire emissions in Southeast Asia","volume":"3","author":"Marlier","year":"2013","journal-title":"Nat. Clim. Chang."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/1467-9493.00092","article-title":"Haze and Health in Brunei Darussalam: The Case of the 1997-98 Episodes","volume":"22","author":"Odihi","year":"2001","journal-title":"Singap. J. Trop. Geogr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"094006","DOI":"10.1088\/1748-9326\/9\/9\/094006","article-title":"V Contribution of vegetation and peat fires to particulate air pollution in Southeast Asia","volume":"9","author":"Reddington","year":"2014","journal-title":"Environ. Res. Lett."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1007\/s11356-017-0860-y","article-title":"Haze and health impacts in ASEAN countries: A systematic review","volume":"25","author":"Ramakreshnan","year":"2018","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"094023","DOI":"10.1088\/1748-9326\/11\/9\/094023","article-title":"Public health impacts of the severe haze in Equatorial Asia in September\u2013October 2015: Demonstration of a new framework for informing fire management strategies to reduce downwind smoke exposure","volume":"11","author":"Koplitz","year":"2016","journal-title":"Environ. Res. Lett."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1007\/s11356-012-1157-9","article-title":"Physicochemical and toxicological characteristics of urban aerosols during a recent Indonesian biomass burning episode","volume":"20","author":"Pavagadhi","year":"2013","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_14","first-page":"418","article-title":"Factors Influencing the Emissions of Gases and Particulate Matter from Biomass Burning","volume":"Volume 84","author":"Goldammer","year":"1990","journal-title":"Fire in the Tropical Biota. Ecological Studies (Analysis and Synthesis)"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5194\/acp-16-597-2016","article-title":"Fine particulate matter in the tropical environment: Monsoonal effects, source apportionment, and health risk assessment","volume":"16","author":"Khan","year":"2016","journal-title":"Atmos. Chem. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/09603123.2011.613112","article-title":"Fine aerosol and PAH carcinogenicity estimation in outdoor environment of Mumbai City, India","volume":"22","author":"Abba","year":"2012","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1289\/ehp.1409277","article-title":"Critical Review of Health Impacts of Wildfire Smoke Exposure","volume":"124","author":"Reid","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_18","first-page":"1448","article-title":"Clinical Experience and Impact of a Community-Led Volunteer Atmospheric Haze Clinic in Singapore","volume":"45","author":"Yeo","year":"2014","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1164\/ajrccm.161.4.9904084","article-title":"The Human Bone Marrow Response to Acute Air Pollution Caused by Forest Fires","volume":"161","author":"TAN","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ho, R.C., Zhang, M.W., Ho, C.S., Pan, F., Lu, Y., and Sharma, V.K. (2014). Impact of 2013 south Asian haze crisis: Study of physical and psychological symptoms and perceived dangerousness of pollution level. BMC Psychiatry, 14.","DOI":"10.1186\/1471-244X-14-81"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Tan, B.Y., Leong, A.Z., Leow, A.S., Ngiam, N.J., Ng, B.S., Sharma, M., Yeo, L.L., Seow, P.A., Hong, C.S., and Chee, Y.H. (2019). Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0208724"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1046\/j.1440-1843.2000.00247.x","article-title":"Impact to lung health of haze from forest fires: The Singapore experience","volume":"5","author":"Emmanuel","year":"2000","journal-title":"Respirology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1353\/dem.2005.0004","article-title":"Health Consequences of Forest Fires in Indonesia","volume":"42","author":"Frankenberg","year":"2005","journal-title":"Demography"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ijheh.2005.01.018","article-title":"Cardiorespiratory hospitalizations associated with smoke exposure during the 1997 Southeast Asian forest fires","volume":"208","author":"Mott","year":"2005","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/S0140-6736(95)92443-4","article-title":"Singapore\u2019s haze and acute asthma in children","volume":"346","author":"Chew","year":"1995","journal-title":"Lancet (London, England)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/00001648-199807001-00330","article-title":"Respiratory function of elementary school children exposed to the 1997 Kuala Lumpur Haze","volume":"9","author":"Hashim","year":"1998","journal-title":"Epidemiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1161\/STROKEAHA.111.629246","article-title":"Stroke and Long-Term Exposure to Outdoor Air Pollution from Nitrogen Dioxide","volume":"43","author":"Andersen","year":"2012","journal-title":"Stroke"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Xiang, H., Mertz, K.J., Arena, V.C., Brink, L.L., Xu, X., Bi, Y., and Talbott, E.O. (2013). Estimation of Short-Term Effects of Air Pollution on Stroke Hospital Admissions in Wuhan, China. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0061168"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ajem.2008.03.013","article-title":"Air pollution and daily ED visits for migraine and headache in Edmonton, Canada","volume":"27","author":"Szyszkowicz","year":"2009","journal-title":"Am. J. Emerg. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2478\/v10001-009-0024-5","article-title":"Emergency department visits for migraine and headache: A multi-city study","volume":"22","author":"Szyszkowicz","year":"2009","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4697","DOI":"10.3390\/ijerph120504697","article-title":"Association between Fine Particulate Air Pollution and Daily Clinic Visits for Migraine in a Subtropical City: Taipei, Taiwan","volume":"12","author":"Chen","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1080\/15287394.2015.1010465","article-title":"Fine particulate air pollution and outpatient department visits for headache in Taipei, Taiwan","volume":"78","author":"Chang","year":"2015","journal-title":"J. Toxicol. Environ. Health. A"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.annemergmed.2018.06.037","article-title":"The Relationship Between Ambient Air Pollution and Acute Ischemic Stroke: A Time-Stratified Case-Crossover Study in a City-State with Seasonal Exposure to the Southeast Asian Haze Problem","volume":"72","author":"Ho","year":"2018","journal-title":"Ann. Emerg. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S0140-6736(10)61507-3","article-title":"Health and health-care systems in southeast Asia: Diversity and transitions","volume":"377","author":"Chongsuvivatwong","year":"2011","journal-title":"Lancet"},{"key":"ref_35","first-page":"E8","article-title":"Air particulate matter and cardiovascular disease: The epidemiological, biomedical and clinical evidence","volume":"8","author":"Du","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/S0735-1097(19)30856-3","article-title":"Significant Association between Transboundary Air Pollution and Acute Myocardial Infarction","volume":"73","author":"Cheong","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e011272","DOI":"10.1161\/JAHA.118.011272","article-title":"Time-Stratified Case Crossover Study of the Association of Outdoor Ambient Air Pollution With the Risk of Acute Myocardial Infarction in the Context of Seasonal Exposure to the Southeast Asian Haze Problem","volume":"8","author":"Ho","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12940-019-0476-4","article-title":"Particulate air pollution on cardiovascular mortality in the tropics: impact on the elderly","volume":"18","author":"Yap","year":"2019","journal-title":"Environ. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00420-011-0707-7","article-title":"A time-stratified case-crossover study of fine particulate matter air pollution and mortality in Guangzhou, China","volume":"85","author":"Yang","year":"2012","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.atmosenv.2014.07.043","article-title":"A case-crossover analysis of forest fire haze events and mortality in Malaysia","volume":"96","author":"Sahani","year":"2014","journal-title":"Atmos. Environ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ejim.2013.04.001","article-title":"Air particulate matter and cardiovascular disease: A narrative review","volume":"24","author":"Martinelli","year":"2013","journal-title":"Eur. J. Intern. Med."},{"key":"ref_42","first-page":"A12831","article-title":"Effects of Air Pollution and Other Environmental Parameters on All-Cause Mortality in Singapore","volume":"138","author":"Ho","year":"2018","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.atmosenv.2014.11.050","article-title":"Artificial intelligence based approach to forecast PM2.5 during haze episodes: A case study of Delhi, India","volume":"102","author":"Mishra","year":"2015","journal-title":"Atmos. Environ."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s40808-018-0530-1","article-title":"Seasonal prediction of particulate matter over the steel city of India using neural network models","volume":"5","author":"Gogikar","year":"2019","journal-title":"Modeling Earth Syst. Environ."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/18\/3286\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:17:24Z","timestamp":1760188644000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/18\/3286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,6]]},"references-count":44,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["ijerph16183286"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16183286","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,6]]}}}