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Limiting global-mean temperature increase to 1.5–2°C could reduce the incidence and spatial spread of dengue fever in Latin America
Abstract and Figures
Significance
This study is a multigeneral circulation model, multiscenario modeling exercise developed to quantify the dengue-related health benefits of limiting global warming to 1.5–2.0 °C above preindustrial levels in Latin America and the Caribbean. We estimate the impact of future climate change and population growth on the additional number of dengue cases and provide insights about the regions and periods most likely affected by changes in the length of the transmission season. Here, we show that future climate change may amplify dengue transmission and that significant impacts could be avoided by constraining global warming to 1.5 °C above preindustrial levels. Our work could be a starting point for future risk assessments incorporating other important drivers of disease such as urbanization and international traveling.
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... Precipitation modulates the creation of breeding sites 7 , though droughts may also lead to the creation of breeding sites by increasing water storage behaviours 8 . Several previous studies have fitted models to dengue data based solely on temperature and precipitation, then used these to suggest that projected future increases in these variables will lead to geographic expansion, longer transmission seasons, and more intense transmission 5,[9][10][11] Global urbanisation trends and increasing human mobility are often suggested as drivers of dengue expansion 12,13 , but rarely quantitatively analysed. Urbanisation and increases in human population density create new habitat for dengue's primary mosquito vector, Aedes aegypti, which preferentially lays eggs in artificial water holding containers in close proximity to humans that form the primary food source for adult females 1 . ...
... Our findings indicate that both dengue burden and dengue incidence will peak sometime this century in Southeast Asia, before declining to historical levels or below depending on the prevailing climatic and socioeconomic conditions. These effects will vary considerably between countries and across varying levels of population density, in agreement with previous research 5,9,17,18 . Research examining climate change impacts on future dengue risk often neglects the effects of social, environmental, and economic factors that determine the level of risk in observed past and present dengue case count trends 5,9,11 . ...
... These effects will vary considerably between countries and across varying levels of population density, in agreement with previous research 5,9,17,18 . Research examining climate change impacts on future dengue risk often neglects the effects of social, environmental, and economic factors that determine the level of risk in observed past and present dengue case count trends 5,9,11 . Evidence of a link between economic factors and dengue risk has been growing since the initial observation of substantially differing levels of dengue virus exposure either side of the US-Mexico border. ...
The recent global expansion of dengue has been facilitated by changes in urbanisation, mobility, and climate. In this work, we project future changes in dengue incidence and case burden to 2099 under the latest climate change scenarios. We fit a statistical model to province-level monthly dengue case counts from eight countries across Southeast Asia, one of the worst affected regions. We project that dengue incidence will peak this century before declining to lower levels with large variations between and within countries. Our findings reveal that northern Thailand and Cambodia will show the biggest decreases and equatorial areas will show the biggest increases. The impact of climate change will be counterbalanced by income growth, with population growth having the biggest influence on increasing burden. These findings can be used for formulating mitigation and adaptation interventions to reduce the immediate growing impact of dengue virus in the region.
... Southeast Asia, the Pacific Islands, the Indian subcontinent, the Americas, and Africa are the most common regions in which dengue fever is found. Because Aedes mosquitoes are more prevalent in metropolitan settings with a higher people density, the illness is more prevalent in these settings [6]. Dengue fever is known to follow seasonal patterns, often reaching its peak during the wet season when mosquito numbers are at their highest. ...
... Dengue fever is known to follow seasonal patterns, often reaching its peak during the wet season when mosquito numbers are at their highest. Because all four serotypes of dengue virus cocirculate in distinct places, the risk of severe dengue due to cross-immunity and antibody-dependent enhancement is significantly increased [6]. ...
The article analyzes the connection between the rising number of cases of dengue fever and the warming of the planet’s atmosphere. We underline the significant role that Aedes mosquitoes play in the development of dengue fever by undertaking an in-depth examination of the factors that lead to the disease, how it is transmitted, and how it may be treated. Following that, the study explores the epidemiology of dengue fever and investigates the patterns and trends that the sickness demonstrates in different parts of the globe. We also evaluate the impact that a changing climate has had on the prevalence of dengue fever by relying on data from a wide variety of sources. Preventive measures to battle dengue fever, future patterns in dengue sickness, and the ramifications of those patterns are also discussed.
... This situation poses a real threat to public health at the regional and global levels. The impacts of GW on MBD have caught a great deal of attention worldwide [20]. Furthermore, Ligsay et al. reported that the largest economic burden of disease in humans was borne by African and Asian countries [21]. ...
... For example, a recent study reported that reducing GW to 1.5°C might avoid about 3.3 mln. Dengue fever cases per year in Latin America compared to no intervention (+3.7°C) [20]. The experience of the spread of SARS-CoV-2 infection has taught us that no community can, whatever they do, live in isolation. ...
Human activity has a direct influence on the climate on our planet. In recent decades, the greater part of the scientific community has united around the concept of Global Warming (GW). This process highly impacts the geographical distribution of mosquitoes and Mosquito-Borne Diseases (MBD). The examined scientific publications show that Africa, especially Sub-Saharan countries were and still hot spot of MBD globally. The economic, social, and environmental conditions prevailing in most African countries have effectively contributed to the spread of MBD. The current situation is very worrying, and it will get even more complicated as GW gets worse. In this regard, health systems in developing countries will have serious difficulties in health policies and public health activities to control the spread on MBD. Therefore, the governments of African countries should do more to combat MBD. However, a part of the responsibility lies with the international community, especially countries that contribute to GW. In conclusion, the analysis of the scientific literature showed that with increasing importance of GW leads to an increase in the prevalence of MBD. - How to cite this article: Khezzani B, Baymakova M, Khechekhouche EA, Tsachev I. Global warming and mosquito-borne diseases in Africa: A narrative review. Pan Afr Med J. 2023; 44: 70.
... Moreover, the outcomes have broad applicability in tropical and subtropical zones across the world where dengue is prevalent. At present, approaching half of the world's population lives in these regions, so are potentially at risk of infection [18]. ...
Transmitted primarily by Aedes aegypti (Ae. aegypti) and Aedes albopictus (Ae. albopictus), arboviral diseases pose a major global public health threat. Dengue, chikungunya, and Zika are increasingly prevalent in Southeast Asia. Among other arboviruses, dengue and Zika are becoming more common in Central and South America. Given human encroachment into previously uninhabited, often deforested areas, to provide new housing in regions of population expansion, conceptualizing built urban environments in a novel way is urgently needed to safeguard against the growing climate change-driven threat of vector-borne diseases. By understanding the spread from a One Health perspective, enhanced control and prevention can be achieved. This is particularly important considering that climate change is likely to significantly impact the persistence of ponded water where mosquitoes breed due to increasing temperature and shifting rainfall patterns with regard to magnitude, duration, frequency, and season. Models can incorporate aquatic mosquito stages and adult spatial dynamics when habitats are heterogeneously available, thereby including dispersal and susceptible-exposed-infected-recovered (SEIR) epidemiology. Coupled with human population distribution (density, locations), atmospheric conditions (air temperature, precipitation), and hydrological conditions (soil moisture distribution, ponding persistence in topographic depressions), modeling has improved predictive ability for infection rates. However, it has not informed interventional approaches from an urban environment perspective which considers the role of ponds/lakes that support green spaces, the density of population that enables rapid spread of disease, and varying micro-habitats for various mosquito stages under climate change. Here, for an example of dengue in Vietnam, a preventive and predictive approach to design resilient urban environments is proposed, which uses data from rapidly expanding metropolitan communities to learn continually. This protocol deploys computational approaches including simulation and machine learning/artificial intelligence, underpinned by surveillance and medical data for validation and adaptive learning. Its application may best inform urban planning in low-middle income countries in tropical zones where arboviral pathogens are prevalent.
... Likewise, the epidemic belt of dengue has also been projected to move northwards in the northern USA and central northern Europe (Colón-González et al., 2021). Studies show if the increase in the mean global temperature could be managed below 2 o C then the world population can be protected, to some extent, from these public health issues (Colón-González et al., 2018). ...
Mosquitoes have always been a source of threat to human health because of their ability to transmit deadly diseases. Despite several efforts to curb their population, they have managed to survive and spread havoc. Urbanization has emerged to be one of the major contributors to their reproductive success followed by climate change. Urbanization has stimulated opportunistic breeding behaviour in mosquitoes by generating a vast array of temporary breeding habitats. The effect has been compounded by climate change allowing the mosquitoes to breed throughout the year and spread to regions which were previously inhospitable to them. Further, a study of mosquito breeding behaviour shows that gravid females follow several visual and olfactory cues to select their breeding habitats to ensure the well-being of their young ones. Thus, study of mosquito breeding habitats in urban areas helps to identify their markers to be used in mosquito larval source management. Similar problems can be largely overcome in the future by taking a more inclusive approach during town planning.
... Se ha demostrado que el cambio climático es el responsable de que el mosquito vector del virus del dengue y otras arbovirosis tenga una amplia distribución en las regiones tropicales y subtropicales del planeta, favoreciendo la transmisión de la enfermedad (Colón et. al. 2018). Cambios en la temperatura y en los patrones de las precipitaciones vienen acompañados con un aumento e intensidad de eventos climáticos extremos tales como: ciclones, huracanes, tifones, inundaciones, lluvias muy fuertes, incremento del nivel de los océanos, tsunami entre otros eventos climáticos que influyen en la distribución de las ...
... Se ha demostrado que el cambio climático es el responsable de que el mosquito vector del virus del dengue y otras arbovirosis tenga una amplia distribución en las regiones tropicales y subtropicales del planeta, favoreciendo la transmisión de la enfermedad (Colón et. al. 2018). Cambios en la temperatura y en los patrones de las precipitaciones vienen acompañados con un aumento e intensidad de eventos climáticos extremos tales como: ciclones, huracanes, tifones, inundaciones, lluvias muy fuertes, incremento del nivel de los océanos, tsunami entre otros eventos climáticos que influyen en la distribución de las ...
... La literatura latinoamericana concuerda con estudios en otras latitudes que destacan que el dengue es altamente sensible a las condiciones climáticas, por lo que se hace menester determinar el real impacto de estos cambios climáticos en la frecuencia de la enfermedad en cada país, dado que el contexto climático, social y económico no es igual en el mundo (200,224). Dado el aumento en la presencia del dengue en esta región (218), los esfuerzos investigativos en la relación del cambio climáticodengue, indican que la variabilidad climática es un agente determinante en el aumento de las enfermedades transmitidas por vectores, situación que se ha visto en Colombia, Argentina y Bolivia entre los años 2008-2009 (50,173,259). ...
RESUMEN DEL PROYECTO
Una de las enfermedades con mayor extensión en cuanto al número de casos en los últimos años el mundo es el dengue, siendo catalogada como una de las patologías transmisibles con mayor magnitud e importancia a nivel mundial tanto por la carga en salud como por su impacto económico (1). Esta enfermedad presenta un estimado de infecciones de aproximadamente 390 millones de personas al año; de los 194 países que hay actualmente en el mundo, 128 son catalogados como lugares endémicos de la enfermedad (2). La literatura actual habla del efecto de diversas vulnerabilidades sociales, climáticas y gubernamentales en la dinámica del dengue, exacerbando la presencia de la enfermedad en muchos territorios a nivel mundial (3–6).
El presente estudio tiene como objetivo evaluar el posible impacto de estos factores en el territorio colombiano en la frecuencia de esta enfermedad, todo desde un marco de vulnerabilidades presentes en la población colombiana, con fines de exponer el comportamiento complejo del dengue y proponer herramientas que permitan un manejo del dengue más particularizado, especifico y efectivo.
Diseño y objetivo
El siguiente estudio tiene como objetivo principal establecer la influencia de las vulnerabilidades sociales, climáticas, gubernamentales y de equidad a nivel departamental y municipal la evolución del dengue en el periodo de enero de 2015 a diciembre de 2020. Con esto se busca exponer la influencia de estas vulnerabilidades y establecer cuáles de estas son modificables con fines de reducir la frecuencia de dengue en el país.
Metodología
Estudio observacional, de medidas repetidas basado en los datos recolectados de manera mensual en todo el territorio a lo largo del periodo de análisis establecido, analítico, de tipo multinivel basado en la recolección de información de distintas fuentes nacionales.
El análisis principal se centrará en el número de casos de dengue presentados en el país en el periodo de enero de 2015 a diciembre de 2020. Se estimará la correlación espacial del número de casos de dengue presentados. Por otro lado se realizará un Gráfico Acíclico Dirigido (DAG por sus siglas en inglés) con fines de estudiar las interrelaciones de las distintas vulnerabilidades estudiadas con la presencia de dengue en el país y se estimará el posible impacto de dichos factores de vulnerabilidad con el número de casos de dengue por medio de un Modelo Aditivo Generalizado de tipo Poisson multinivel.
Por otro lado, se tiene presupuestado realiza un Análisis de Componentes Principales con fines de construir un índice multidimensional de vulnerabilidad que permita cuantificar el nivel de propensión a nivel municipal en cuanto al número de casos de dengue en el país.
Resultados esperados
De acuerdo con la información que se obtenga de los análisis propuestos, se espera describir el impacto de distintas vulnerabilidades objeto del estudio, así como las tendencias tanto temporales como espaciales del fenómeno del dengue, con el propósito de conocer más sobre la afectación de estas vulnerabilidades en la frecuencia de dengue en el periodo establecido con fines de ofrecer mejor información sobre los probables resultados obtenidos con este tratamiento.
... Regarding the second question, researchers have studied multiple aspects beyond temperature, such as air quality, 7 ocean life, 8 heat-related mortality, 9 sea-level rise, 10 insects, 11 and dengue fever. 12 Because of the important contribution of the land sector in achieving climate ambitions, 3 researchers have also investigated the spatially explicit responses of land use/cover to multiple socioeconomic and/or emission scenarios. These investigations were performed through the projections of land change using both bottom-up and top-down paradigms. ...
The UN Climate Change Conference in Glasgow spawned the enhancement and updating of many nations' climate pledges. Previous research has investigated the effects of these pledges on limiting planetary warming, but their spatially explicit effects on land use/cover are unknown. Here, we linked the Glasgow pledges and the spatially explicit responses of the Tibetan Plateau's land systems. We found that while fulfilling global climate pledges may not significantly affect the global shares of forestland, grassland/pasture, shrubland, and cropland, it needs a 9.4% increase in the forest area of the Tibetan Plateau. This need is an area 11.4 times the increase of the plateau's forest in the 2010s, or greater than the size of Belgium. The new forest comes mainly from the medium-density grassland in the Yangtze River basin, calling for more proactive environmental management for the headwaters area of this longest river in Asia.
Dengue is expanding globally, but how dengue emergence is shaped locally by interactions between climatic and socio-environmental factors is not well understood. Here, we investigate the drivers of dengue incidence and emergence in Vietnam, through analyzing 23-years of monthly district-level case data spanning a period of significant socioeconomic change (1998-2020). We show that urban infrastructure factors (sanitation, water supply and long-term urban growth) predict local spatial patterns of dengue incidence, while human mobility is a more influential driver in subtropical northern regions than the endemic south. Temperature is the dominant factor shaping dengue's geographical distribution and dynamics, and using long-term reanalysis temperature data we show that recent warming (since 1950) has generally expanded transmission risk throughout Vietnam, and most strongly in current dengue emergence hotspots (e.g. southern central regions and Ha Noi). In contrast, effects of hydrometeorology are complex, multi-scalar and dependent on local context: risk increases under both short-term precipitation excess and long-term drought, but improvements in water supply largely mitigate drought-associated risks except under extreme conditions. Our findings challenge the assumption that dengue is an urban disease, instead suggesting that incidence peaks in transitional landscapes with intermediate infrastructure provision, and provide evidence that interactions between recent climate change and mobility have contributed to dengue's ongoing expansion throughout Vietnam.
Dengue infection plays a central role in our society, since it is the most prevalent vectorborne viral disease affecting humans. We statistically investigated patterns concerning the spatial spreading of dengue epidemics in Brazil, as well as their temporal evolution in all Brazilian municipalities for a period of 12 years. We showed that the distributions of cases in municipalities follow power laws persistent in time and that the infection scales linearly with the population of the municipalities. We also found that the average number of dengue cases does not have a clear dependence on the longitudinal position of municipalities. On the other hand, we found that the average distribution of cases varies with the latitudinal position of municipalities, displaying an almost constant growth from high latitudes until reaching the Tropic of Capricorn leveling to a plateau closer to the Equator. We also characterized the spatial correlation of the number of dengue cases between pairs of municipalities, where our results showed that the spatial correlation function decays with the increase of distance between municipalities, following a power-law with an exponential cut-off. This regime leads to a typical dengue traveling distance. Finally, we considered modeling this last behaviour within the framework of a Edwards-Wilkinson equation with a fractional derivative on space. © 2017 Antonio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Zika virus was discovered in Uganda in 1947 and is transmitted by Aedes mosquitoes, which also act as vectors for dengue and chikungunya viruses throughout much of the tropical world. In 2007, an outbreak in the Federated States of Micronesia sparked public health concern. In 2013, the virus began to spread across other parts of Oceania and in 2015, a large outbreak in Latin America began in Brazil. Possible associations with microcephaly and Guillain-Barré syndrome observed in this outbreak have raised concerns about continued global spread of Zika virus, prompting its declaration as a Public Health Emergency of International Concern by the World Health Organization. We conducted species distribution modelling to map environmental suitability for Zika. We show a large portion of tropical and sub-tropical regions globally have suitable environmental conditions with over 2.17 billion people inhabiting these areas.
Dengue is the world's most important arboviral disease in terms of number of people affected. Over the past 50 years, incidence increased 30-fold: there were approximately 390 million infections in 2010. Globalization, trade, travel, demographic trends, and warming temperatures are associated with the recent spread of the primary vectors Aedes aegypti and Aedes albopictus and of dengue. Overall, models project that new geographic areas along the fringe of current geographic ranges for Aedes will become environmentally suitable for the mosquito's lifecycle, and for dengue transmission. Many endemic countries where dengue is likely to spread further have underdeveloped health systems, increasing the substantial challenges of disease prevention and control. Control focuses on management of Aedes, although these efforts have typically had limited effectiveness in preventing outbreaks. New prevention and control efforts are needed to counter the potential consequences of climate change on the geographic range and incidence of dengue, including novel methods of vector control and dengue vaccines.
The projected size and spatial distribution of the future population are important drivers of global change and key determinants of exposure and vulnerability to hazards. Spatial demographic projections are widely used as inputs to spatial projections of land use, energy use, and emissions, as well as to assessments of the impacts of extreme events, sea level rise, and other climate-related outcomes. To date, however, there are very few global-scale, spatially explicit population projections, and those that do exist are often based on simple scaling or trend extrapolation. Here we present a new set of global, spatially explicit population scenarios that are consistent with the new Shared Socioeconomic Pathways (SSPs) developed to facilitate global change research. We use a parameterized gravity-based downscaling model to produce projections of spatial population change that are quantitatively consistent with national population and urbanization projections for the SSPs and qualitatively consistent with assumptions in the SSP narratives regarding spatial development patterns. We show that the five SSPs lead to substantially different spatial population outcomes at the continental, national, and sub-national scale. In general, grid cell-level outcomes are most influenced by national-level population change, second by urbanization rate, and third by assumptions about the spatial style of development. However, the relative importance of these factors is a function of the magnitude of the projected change in total population and urbanization for each country and across SSPs. We also demonstrate variation in outcomes considering the example of population existing in a low-elevation coastal zone under alternative scenarios.
Robust appraisals of climate impacts at different levels of global-mean
temperature increase are vital to guide assessments of dangerous
anthropogenic interference with the climate system. The 2015 Paris Agreement
includes a two-headed temperature goal: "holding the increase in the global average temperature to well below
2 °C above pre-industrial levels and pursuing efforts to limit the
temperature increase to 1.5 °C".
Despite the prominence of these two
temperature limits, a comprehensive overview of the differences in climate
impacts at these levels is still missing. Here we provide an assessment of
key impacts of climate change at warming levels of 1.5 °C and 2 °C,
including extreme weather events, water availability, agricultural yields,
sea-level rise and risk of coral reef loss. Our results reveal substantial
differences in impacts between a 1.5 °C and 2 °C warming that are highly
relevant for the assessment of dangerous anthropogenic interference with the
climate system. For heat-related extremes, the additional 0.5 °C
increase in global-mean temperature marks the difference between events at
the upper limit of present-day natural variability and a new climate regime,
particularly in tropical regions. Similarly, this warming difference is
likely to be decisive for the future of tropical coral reefs. In a scenario
with an end-of-century warming of 2 °C, virtually all tropical coral
reefs are projected to be at risk of severe degradation due to temperature-induced bleaching from 2050 onwards. This fraction is reduced to about 90 %
in 2050 and projected to decline to 70 % by 2100 for a 1.5 °C
scenario. Analyses of precipitation-related impacts reveal distinct regional
differences and hot-spots of change emerge. Regional reduction in median
water availability for the Mediterranean is found to nearly double from 9 %
to 17 % between 1.5 °C and 2 °C, and the projected lengthening of
regional dry spells increases from 7 to 11 %. Projections for agricultural
yields differ between crop types as well as world regions. While some (in
particular high-latitude) regions may benefit, tropical regions like West
Africa, South-East Asia, as well as Central and northern South America are
projected to face substantial local yield reductions, particularly for wheat
and maize. Best estimate sea-level rise projections based on two illustrative
scenarios indicate a 50 cm rise by 2100 relative to year 2000-levels for a
2 °C scenario, and about 10 cm lower levels for a 1.5 °C
scenario. In a 1.5 °C scenario, the rate of sea-level rise in 2100
would be reduced by about 30 % compared to a 2 °C scenario. Our
findings highlight the importance of regional differentiation to assess both
future climate risks and different vulnerabilities to incremental increases
in global-mean temperature. The article provides a consistent and
comprehensive assessment of existing projections and a good basis for future
work on refining our understanding of the difference between impacts at
1.5 °C and 2 °C warming.
Significance
This study quantifies the impact of climate variability on Zika virus (ZIKV) transmission by two mosquito vectors with distinct characteristics: Aedes aegypti and Aedes albopictus . Observed climate data were used to dynamically drive a two vectors–one host R 0 epidemiological model. Our modeling results indicate that temperature conditions related to the 2015 El Niño climate phenomenon were exceptionally conducive for mosquito-borne transmission of ZIKV over South America. The virus is believed to have entered the continent earlier in 2013. This finding implicates that such a large ZIKV outbreak occurred not solely because of the introduction of ZIKV in a naive population, but because the climatic conditions were optimal for mosquito-borne transmission of ZIKV over South America in 2015.
Tetravalent, live-attenuated, dengue vaccine (Dengvaxia®; CYD-TDV) is the first vaccine approved for the prevention of dengue disease caused by dengue virus (DENV) serotypes 1–4 in individuals aged 9–45 or 9–60 years living in high dengue endemic areas. This narrative review discusses the immunogenicity, protective efficacy, reactogenicity and safety of CYD-TDV in the prevention of dengue disease. In Latin American and Asian phase 3 trials in children and adolescents (n > 30,000), the recommended three-dose CYD-TDV regimen was efficacious in preventing virologically-confirmed dengue (VCD) during the period from 28 days after the last dose (month 13) to month 25, meeting the primary endpoint criteria. Protective efficacy against VCD in the respective individual trials was 60.8 and 56.5 % (primary analysis). During the 25-month active surveillance phase, CYD-TDV also provided protective efficacy against VCD, severe dengue, any grade of dengue haemorrhagic fever and VCD-related hospitalization in children aged 9 years and older. CYD-TDV was generally well tolerated, with no safety concerns identified after up to 4 years’ follow-up (i.e. from post dose 1) in ongoing long-term studies. Based on evidence from the dengue clinical trial program, the WHO SAGE recommended that countries with high dengue endemicity consider introducing CYD-TDV as part of an integrated disease prevention strategy to lower disease burden. Pharmacoeconomic considerations will be pivotal to implementing dengue vaccination prevention strategies in these countries. The availability of a dengue vaccine is considered essential if the 2012 WHO global strategy targets for reducing the burden of dengue disease by 2020 are to be attained. Hence, CYD-TDV represents a major advance for the prevention of dengue disease in high dengue endemic regions.
The first edition of this book has established itself as one of the leading references on generalized additive models (GAMs), and the only book on the topic to be introductory in nature with a wealth of practical examples and software implementation. It is self-contained, providing the necessary background in linear models, linear mixed models, and generalized linear models (GLMs), before presenting a balanced treatment of the theory and applications of GAMs and related models. The author bases his approach on a framework of penalized regression splines, and while firmly focused on the practical aspects of GAMs, discussions include fairly full explanations of the theory underlying the methods. Use of R software helps explain the theory and illustrates the practical application of the methodology. Each chapter contains an extensive set of exercises, with solutions in an appendix or in the book’s R data package gamair, to enable use as a course text or for self-study.