Smog, Cognition and Real-World Decision-Making

Document Type : Perspective


1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA

2 Yale Department of Economics, New Haven, CT, USA


Cognitive functioning is critical as in our daily life a host of real-world complex decisions in high-stakes markets have to be made. The decision-making process can be vulnerable to environmental stressors. Summarizing the growing economic and epidemiologic evidence linking air pollution, cognition performance and real-world decision-making, we first illustrate key physiological and psychological pathways between air pollution and cognition. We then document the main patterns of air pollution affecting cognitive test performance by type of cognitive tests, gender, window of exposure, age profile, and educational attainment. We further extend to a review of real-world decision-making that has been found to be affected by air pollution and the resulting cognitive impairments. Finally, rich implications on environmental health policies are drawn based on existing evaluations of social costs of air pollution.


Main Subjects

  1. World Health Organization. WHO releases country estimates on air pollution exposure and health impact.  Accessed July 12, 2018. Published 2016.
  2. American Lung Association. Key Findings: The State of the Air 2018.   Accessed September 15, 2018. Published 2018.
  3. The Economist Magazine. Air Pollution: Choking on it.  Accessed September 12, 2018. Published 2015.
  4. Ebenstein A, Lavy V, Roth S. The long-run economic consequences of high-stakes examinations: Evidence from transitory variation in pollution. Am Econ J Appl Econ. 2016;8(4):36-65. doi:10.1257/app.20150213
  5. Chang T, Graff Zivin J, Gross T, Neidell M. The effect of pollution on worker productivity: Evidence from call-center workers in China. American Economic Journal: Applied Economics; Forthcoming.
  6. Block ML, Calderon-Garciduenas L. Air pollution: mechanisms of neuroinflammation and CNS disease. Trends Neurosci. 2009;32(9):506-516. doi:10.1016/j.tins.2009.05.009
  7. Branis M, Rezacova P, Domasova M. The effect of outdoor air and indoor human activity on mass concentrations of PM(10), PM(2.5), and PM(1) in a classroom. Environ Res. 2005;99(2):143-149. doi:10.1016/j.envres.2004.12.001
  8. Wilker EH, Preis SR, Beiser AS, et al. Long-term exposure to fine particulate matter, residential proximity to major roads and measures of brain structure. Stroke. 2015;46(5):1161-1166. doi:10.1161/strokeaha.114.008348
  9. Calderon-Garciduenas L, Reed W, Maronpot RR, et al. Brain inflammation and Alzheimer's-like pathology in individuals exposed to severe air pollution. Toxicol Pathol. 2004;32(6):650-658. doi:10.1080/01926230490520232
  10. Levesque S, Surace MJ, McDonald J, Block ML. Air pollution & the brain: Subchronic diesel exhaust exposure causes neuroinflammation and elevates early markers of neurodegenerative disease. J Neuroinflammation. 2011;8:105. doi:10.1186/1742-2094-8-105
  11. Weuve J, Puett RC, Schwartz J, Yanosky JD, Laden F, Grodstein F. Exposure to particulate air pollution and cognitive decline in older women. Arch Intern Med. 2012;172(3):219-227. doi:10.1001/archinternmed.2011.683
  12. Wu YC, Lin YC, Yu HL, et al. Association between air pollutants and dementia risk in the elderly. Alzheimers Dement (Amst). 2015;1(2):220-228. doi:10.1016/j.dadm.2014.11.015
  13. Chen H, Kwong JC, Copes R, et al. Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study. Lancet. 2017;389(10070):718-726. doi:10.1016/s0140-6736(16)32399-6
  14. Calderon-Garciduenas L, Franco-Lira M, D'Angiulli A, et al. Mexico City normal weight children exposed to high concentrations of ambient PM2.5 show high blood leptin and endothelin-1, vitamin D deficiency, and food reward hormone dysregulation versus low pollution controls. Relevance for obesity and Alzheimer disease. Environ Res. 2015;140:579-592. doi:10.1016/j.envres.2015.05.012
  15. Cacciottolo M, Wang X, Driscoll I, et al. Particulate air pollutants, APOE alleles and their contributions to cognitive impairment in older women and to amyloidogenesis in experimental models. Transl Psychiatry. 2017;7(1):e1022. doi:10.1038/tp.2016.280
  16. Justin BN, Turek M, Hakim AM. Heart disease as a risk factor for dementia. Clin Epidemiol. 2013;5:135-145. doi:10.2147/clep.s30621
  17. Amitai Y, Zlotogorski Z, Golan-Katzav V, Wexler A, Gross D. Neuropsychological impairment from acute low-level exposure to carbon monoxide. Arch Neurol. 1998;55(6):845-848.
  18. Perera FP, Li Z, Whyatt R, et al. Prenatal airborne polycyclic aromatic hydrocarbon exposure and child IQ at age 5 years. Pediatrics. 2009;124(2):e195-202. doi:10.1542/peds.2008-3506
  19. Sanders NJ. What doesn’t kill you makes you weaker: prenatal pollution exposure and educational outcomes. J Hum Resour. 2012;47(3):826-850. doi:10.1353/jhr.2012.0018
  20. Isen A, Rossin-Slater M, Walker WR. Every breath you take—every dollar you'll make: The long-term consequences of the clean air act of 1970. J Polit Econ. 2017;125(3):848-902. doi:10.1086/691465
  21. Nattero G, Enrico A. Outdoor pollution and headache. Headache. 1996;36(4):243-245.
  22. Rotton J, Frey J. Psychological costs of air pollution: Atmospheric conditions, seasonal trends, and psychiatric emergencies. Popul Environ. 1984;7(1):3-16. doi:10.1007/bf01257469
  23. Levinson A. Valuing public goods using happiness data: The case of air quality. J Public Econ. 2012;96(9):869-880. doi:10.1016/j.jpubeco.2012.06.007
  24. Szyszkowicz M. Air pollution and emergency department visits for depression in Edmonton, Canada. Int J Occup Med Environ Health. 2007;20(3):241-245. doi:10.2478/v10001-007-0024-2
  25. Zhang X, Zhang X, Chen X. Happiness in the Air: How Does a Dirty Sky Affect Mental Health and Subjective Well-being? J Environ Econ Manage. 2017;85:81-94. doi:10.1016/j.jeem.2017.04.001
  26. Zhang X, Chen X, Zhang XB. Environment and Subjective Well-being. Handbook of Well-being, Happiness and the Environment. 2018.
  27. University of California, Irvine. Intelligence in men and women is a gray and white matter. Science Daily. 2005.    Accessed July 16, 2018.
  28. Calderon-Garciduenas L, Mora-Tiscareno A, Ontiveros E, et al. Air pollution, cognitive deficits and brain abnormalities: a pilot study with children and dogs. Brain Cogn. 2008;68(2):117-127. doi:10.1016/j.bandc.2008.04.008
  29. Calderon-Garciduenas L, Engle R, Mora-Tiscareno A, et al. Exposure to severe urban air pollution influences cognitive outcomes, brain volume and systemic inflammation in clinically healthy children. Brain Cogn. 2011;77(3):345-355. doi:10.1016/j.bandc.2011.09.006
  30. Chen X, Zhang X, Zhang X. Smog in our brains: Gender differences in the impact of exposure to air pollution on cognitive performance. IZA Discussion Paper No. 10628. 2017.
  31. Haier RJ, Jung RE, Yeo RA, Head K, Alkire MT. The neuroanatomy of general intelligence: sex matters. Neuroimage. 2005;25(1):320-327. doi:10.1016/j.neuroimage.2004.11.019
  32. Zhang X, Chen X, Zhang X. The impact of exposure to air pollution on cognitive performance. Proc Natl Acad Sci. 2018; 115(37):9193-9197. doi:10.1073/pnas.1809474115
  33. Agarwal S, Driscoll JC, Gabaix X, Laibson D. The age of reason: Financial decisions over the life cycle and implications for regulation. Brookings Papers on Economic Activity. 2009;40(2):51-117. doi:10.1353/eca.0.0067
  34. Keane MP, Ketcham JD, Kuminoff NV, Neal T. Evaluating Consumers’ Choices of Medicare Part D Plans. Working Paper. 2017.
  35. Bishop K, Ketcham J, Kuminoff N, Powers C. Hazed and Confused: Air Pollution, Cognitive Functioning, and Financial Decision Making among the Elderly. Arizona State University; 2017.
  36. Keane MP, Thorp S. Complex decision making: the roles of cognitive limitations, cognitive decline, and aging. In: Piggott J, Woodland A, eds. Handbook of the Economics of Population Aging. North-Holland: Elsevier; 2016:661-709.
  37. Huffman D, Maurer R, Mitchell OS. Time Discounting and Economic Decision-Making among the Elderly. NBER Working paper #22438. 2016.
  38. Heyes A, Neidell M, Saberian S. The Effect of Air Pollution on Investor Behavior: Evidence from the S&P 500. NBER Working Paper No. 22753. 2016.
  39. Chew SH, Huang W, Li X. Haze and Decision Making: A Natural Laboratory Experiment. National University of Singapore; 2017.
  40. Herrnstadt E, Muehlegger E. Air pollution and criminal activity: Evidence from Chicago microdata. NBER Working Paper No. 21787. 2016.
  41. Fang H, Keane M, Khwaja A, Salm M, Silverman D. Testing the mechanisms of structural models: The case of the mickey mantle effect. Am Econ Rev. 2007;97(2):53-59. doi:10.1257/aer.97.2.53
  42. Finkelstein A, Luttmer EFP, Notowidigdo MJ. What good is wealth without health? The effect of health on the marginal utility of consumption. J Eur Econ Assoc. 2013;11(s1):221-258. doi:10.1111/j.1542-4774.2012.01101.x
  43. Zhang X, Zhang X, Chen X. Valuing air quality using happiness data: the case of China. Ecol Econ. 2017;137:29-36. doi:10.1016/j.ecolecon.2017.02.020
  44. World Health Organization. WHO Global Urban Ambient Air Pollution Database.  Accessed September 6, 2018. Published 2016.
  45. Plumer B. How Big a Deal Is Trump’s Fuel Economy Rollback? For the Climate, Maybe the Biggest Yet. The New York Times. 2018.  Accessed September 14, 2018.
  46. U.S. Environmental Protection Agency. Regulatory Impact Analysis for the Proposed Emission Guidelines for Greenhouse Gas Emissions from Existing Electric Utility Generating Units; Revisions to Emission Guideline Implementing Regulations; Revisions to New Source Review Program.  Accessed September 2, 2018. Published 2018.
Volume 8, Issue 2
February 2019
Pages 76-80
  • Receive Date: 19 March 2018
  • Revise Date: 18 October 2018
  • Accept Date: 20 October 2018
  • First Publish Date: 01 February 2019