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Marie S. O'Neill,¹ Michael Jerrett,² Ichiro Kawachi,¹ Jonathan I. Levy,¹ Aaron J. Cohen,³ Nelson Gouveia,⁴ Paul Wilkinson,⁵ Tony Fletcher,⁵ Luis Cifuentes,⁶ and Joel Schwartz,¹ with input from participants of the Workshop on Air Pollution and Socioeconomic Conditions*

¹Harvard School of Public Health, Boston, Massachusetts, USA; ²McMaster University, Hamilton, Ontario, Canada; ³Health Effects Institute, Boston, Massachusetts, USA; ⁴Universidade de São Paulo, São Paulo, Brazil; ⁵London School of Hygiene and Tropical Medicine, London, England; ⁶Pontificia Universidad Cátolica de Chile, Santiago, Chile

Abstract
The effects of both ambient air pollution and socioeconomic position (SEP) on health are well documented. A limited number of recent studies suggest that SEP may itself play a role in the epidemiology of disease and death associated with exposure to air pollution. Together with evidence that poor and working-class communities are often more exposed to air pollution, these studies have stimulated discussion among scientists, policy makers, and the public about the differential distribution of the health impacts from air pollution. Science and public policy would benefit from additional research that integrates the theory and practice from both air pollution and social epidemiologies to gain a better understanding of this issue. In this article we aim to promote such research by introducing readers to methodologic and conceptual approaches in the fields of air pollution and social epidemiology ; by proposing theories and hypotheses about how air pollution and socioeconomic factors may interact to influence health, drawing on studies conducted worldwide ; by discussing methodologic issues in the design and analysis of studies to determine whether health effects of exposure to ambient air pollution are modified by SEP ; and by proposing specific steps that will advance knowledge in this field, fill information gaps, and apply research results to improve public health in collaboration with affected communities. Key words: air pollution, environmental justice, epidemiology, exposure assessment, socioeconomic factors. Environ Health Perspect 111:1861-1870 (2003) . doi:10.1289/ehp.6334 available via http://dx.doi.org/ [Online 2 September 2003]

Address correspondence to M.S. O'Neill, Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Suite 415M, Boston, MA 02215 USA. Telephone: (617) 384-8753. Fax: (617) 384-8745. E-mail: moneill@hsph.harvard.edu

*Participants of the Workshop on Air Pollution and Socioeconomic Conditions held 13 March 2002 at the Harvard School of Public Health, Boston, Massachusetts: Thomas F. Bateson, Cristina Cann, Douglas Dockery, Diane Gold, Francine Laden, Stephanie London, Dana Loomis, Frank Speizer, Stephen Van den Eeden, Antonella Zanobetti.

We thank C. Grundy for help in preparing the maps in Figure 2.

Funding was provided by the Health Effects Institute, a training grant from the National Institute for Environmental Health Sciences, 5 T32 ES07069-22, NIEHS ES00002, and EPAR827353.

The views expressed in this article are those of the authors and do not necessarily reflect those of the Health Effects Institute or its sponsors.

The authors declare they have no competing financial interests.

Received 13 March 2003 ; accepted 2 September 2003.