ICREH - Impact of climate change on respiratory health over four decades

Follow-up survey

In ICREH project we will conduct a follow-up survey for Espoo Cohort Study (ECS, 40-year follow-up), Finnish Environment and Asthma Study (FEAS, 26-28-year follow-up) and Northern Finnish Asthma Study (NoFAS, 13-year follow-up) to better understand the impact of climate change-related exposures, such as air pollution, temperature, changes in land use, and loss of green spaces, on the risk of onset and progression of respiratory diseases, such as asthma and allergies. The study protocol was approved by the Ethics committee of the Wellbeing Services County of North Ostrobothnia. All phases of the study followed the Ethical Principles for Medical Research Involving Human Subjects expressed in the Declaration of Helsinki. Consent forms will be distributed to all individuals who previously participated in three prospective Finnish population-based cohorts and those who agree (signed informed consent) to participate will be included in the follow-up survey.

Study population

Data from three prospective Finnish population-based cohorts will be used:

1. Espoo Cohort Study (ECS), which included 2568 children delivered between 1984 and 1990 who were living in 1990 in the city of Espoo in Southern Finland, and who had been followed regularly since the birth (1991-2011). A random sample of children, who were living in Espoo in 1991, was taken from the roster of Statistics Finland. The baseline data collection was conducted in 1991 and the 6- and 20-year follow-ups were conducted in 1997 and 2010-11, respectively).
2. Finnish Environment and Asthma Study (FEAS), a population-based case-control study for adult-onset asthma in 1997-2000 (521 cases and 932 controls). The study population included adults 21–63 years old who were living in Pirkanmaa Hospital District, Southern Finland, during the recruitment period.
3. Northern Finnish Asthma Study (NoFAS), a population-based cross-sectional study of 1995 adults (40% participation rate) 17-73 years old, who had received reimbursement for asthma medication according to KELA and who lived in The Oulu University Hospital District (The Northern Ostrobothnia Hospital District) in 2012.

Information for the participants

By participating in ICREH project, the participants will provide valuable information to better understand the mechanisms that link lifetime environmental exposures (lifetime exposure and exposure at different life stages, including late-stage exposure) and the development of allergic diseases and asthma.

Assessment of health information

Health data will be collected using questionnaires and health registry data. The participants will be asked to fill out a questionnaire which is divided into 6 different sections: (1) background information (e.g., education, occupation); (2) health data (e.g., asthma and allergies, respiratory infections and symptoms, and medication); (3) health-related quality of life; (4) lifestyle (e.g., diet, and physical activity); (5) home and work exposures; and (6) climate change, biodiversity, and exposure to natural environments.

Assessment of environmental exposure

This project will consider various data sources that will allow a deep characterization of the environmental exposures. To evaluate the effects of climate change-related exposures we will consider changes in the exposure to air pollution, pollen and temperature levels, and land-cover in ECS, FEAS and NoFAS covering different life stages.

The data from questionnaires, health registry data, and the data on environmental exposure will be combined to assess the impact of climate change-related exposures (air pollution, changes in temperature, and pollen levels) and loss of biodiversity on the risk of onset and progression of respiratory diseases (asthma and allergies). The data collected in this follow-up will also be combined with the data already collected in previous surveys.

Participant’s rights and Ethical consideration

The research team will ensure that this study is conducted in full conformity with the principles set forth in the Declaration of Helsinki. The study protocol was approved by the Ethics committee of the Wellbeing Services County of North Ostrobothnia. This follow-up survey includes adults evaluated in the previous surveys. Participation in the follow-up is voluntary, and participants can withdraw at any time without providing explanations. In the event of study’s discontinuation, subjects will not be affected. They can ask questions and will receive understandable answers before taking any decision. Participants will be informed about their personal data protection rights and the risks, burdens, and benefits of their participation. All personal data processing within the project must comply with applicable law. All data management activities will be conducted in full compliance with applicable national and EU legislation and will follow the General Data Protection Regulation (GDPR), EU 2016/679. Considering current information, participation in the study is not expected to cause any particular harm to participants and their wellbeing. Participants will receive online/on paper letter with general recommendations related to environmental exposures at the end of the study. This project and follow-up survey will be essential to better understand (1) on how changes in weather patterns, air pollution levels, extreme weather events, and loss of biodiversity may affect asthma and allergies, guiding adaptation and prevention strategies; and (2) of how lifetime or time-specific cumulative exposure contribute to the lifetime development of allergic diseases and asthma, supporting better prevention, treatment, and public health policies.

News

Approval from the ethics committee: All the documents, including the research protocol, consent form, information to the participant, questionnaire, statement on research ethics (Selvitys tutkimuksen eettisyydestä), description of the procedure for obtaining consent (Selvitys suostumuksen saamiseksi noudatettavasta menettelystä), and information related to the project and research team, have been submitted to the Ethics committee of the Wellbeing Services County of North Ostrobothnia at the end of 2025. The study protocol was approved by the Ethics committee of the Wellbeing Services County of North Ostrobothnia in January 2026.

Validation of the questionnaire on climate change and nature exposure: The English versions of the Nature Exposure Scale-II (NES‑II) and ClimateMind50+ questionnaire were translated and validated to be used among Finnish adult population. The validation process consisted of two rounds and took place in winter and spring 2026. A total of 283 Finnish-speaking students and personnel from the University of Oulu, Finland, completed the first validation round. Participants were recruited via email and announcements on the university intranet. Permission for recruitment was obtained from the University of Oulu. The questionnaires were administered to the participants using REDCap data capture tool hosted at the University of Oulu. The Finnish versions of the Nature Exposure II scale (NES-II-FI) and ClimateMind50+ (ClimateMind50+-FI) demonstrated good internal consistency and construct validity. NES-II-FI appears to be a valid and reliable instrument for assessing nature exposure in everyday environments, outside everyday environments, and during physical activity among Finnish adults. Similarly, ClimateMind50+-FI is a valid and reliable tool for assessing climate change knowledge, concerns, preparedness, adaptive behaviors, and involvement among Finnish adults, and is applicable not only to individuals aged 50 years and above, but also to younger adult populations.