Many factors may have contributed to this increase: poor hygiene and socioeconomic conditions, lack of medical training, and probably some resistance to pediculicide preparations in the lice. The stigma attached to the disease may prevent people from coming forward.

While air quality is usually an environmental condition patients can little do about, there are a few options and decisions that modify the personal exposure and risk. Location - in particular the residence - time and activity are the key determinants of personal exposure. Traffic-related primary pollutants such as ultrafine particles or diesel soot are highly concentrated along busy roads but reach urban background concentrations already some 100 - 200 meters off. Morbidity and mortality follow this spatial pattern, which is usually attributed to these pollutants. Depending on ventilation systems, indoor exposure can be substantially lower. Studies done in China confirm that the use of face masks in extremely polluted cities can reduce exposure, resulting in lower inflammatory and cardiovascular responses. A diet rich in antioxidants appears to also reduce some of the oxidative and inflammatory effects of air pollution and treatments such as leucotrien receptor antagonists or statins pay interfere with some of the adverse effects of pollution. However, the benefits, if any, are unlikely to be large. A quantitative comparison of the various pollution related health effects - namely from smoking, passive smoking and air pollution - reveal a typical paradox to be well understood: the individual risks related to air pollution and that one may reduce through personal decisions are rather small. However, given the large number of people exposed (i. e. in essence the entire population), the overall air pollution related health burden is rather substantial. This underscores that sustained clean air policies are indeed the most important and efficient solution to reduce the air pollution related health effects.

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