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Your Environment. Your Health.

School buses, diesel emissions, and respiratory health

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost-benefit analysis (CBA)
Beatty TK and Shimshack JP
Journal of Health Economics
This study estimated the benefits of the clean school bus program in Washington state, and determined that school bus retrofits induced statistically significant reductions in bronchitis, asthma, and pneumonia incidence for children and adults with chronic conditions. These results suggested that policies targeting localized air pollution may be particularly cost effective relative to ambient air pollution policies.
At-risk populations with chronic respiratory conditions (children and adults)

Health Outcomes

  • Respiratory outcomes (bronchitis, asthma, pneumonia, pleurisy)

Environmental Agents

List of Environmental Agents:

  • Air pollutants

Source of Environmental Agents:

  • Diesel emissions

Economic Evaluation / Methods and Source


  • Cost-benefit analysis (CBA)

Cost Measured:

  • Healthcare costs per inpatient episode of bronchitis, asthma, and pneumonia
  • CCV retrofit costs (including parts, labor, and testing) per adopter school district

Potential Cost Measures:

  • Indirect costs of school absences, pain and suffering, communicable disease transmission, and long-term welfare effects
  • Costs related to non-respiratory illnesses, long-term health effects, and health impacts on adults with chronic respiratory conditions

Benefits Measures:

  • Reduced and/or avoided healthcare cost

Potential Benefits:

  • Benefits calculations related to reduction in costs for non-respiratory illnesses, long-term health effects, suffering considerations, and impacts on adults with chronic respiratory conditions


  • Puget Sound region, Washington

Models Used: (Not available)

Methods Used:

  • The authors examined the impact of school bus emissions reductions programs on health outcomes. The authors — 1) performed a large-scale empirical assessment of the health outcomes stemming from school bus retrofit programs for Washington state districts; 2) used standard two-period difference-in-difference approach to examine differential trends in health outcomes for adopter districts and non-adopter districts over time using a regression model; and 3) combined empirical point estimates with cost-of-treatment health valuation estimates and observed retrofit costs to compute benefit-cost assessment of school bus retrofits.

Sources Used:

  • Washington State Comprehensive Hospital Abstract Reporting System (CHARS); US Historical Climatology Network; Washington State Department of Ecology; Puget Sound Clean Air Agency; Washington State Department of Health; National Center of Educational Statistics; additional sources cited in publication

Economic Evaluation / Methods and Source


  • Beatty TK and Shimshack JP. 2011. School buses, diesel emissions, and respiratory health. Journal of Health Economics.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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