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Alcock I, White MP, Wheeler BW, Fleming LE, Depledge MH. Longitudinal effects on mental health of moving to greener and less green urban areas. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2014; 48:1247-55. [PMID: 24320055 DOI: 10.1021/es403688w] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Despite growing evidence of public health benefits from urban green space there has been little longitudinal analysis. This study used panel data to explore three different hypotheses about how moving to greener or less green areas may affect mental health over time. The samples were participants in the British Household Panel Survey with mental health data (General Health Questionnaire scores) for five consecutive years, and who relocated to a different residential area between the second and third years (n = 1064; observations = 5320). Fixed-effects analyses controlled for time-invariant individual level heterogeneity and other area and individual level effects. Compared to premove mental health scores, individuals who moved to greener areas (n = 594) had significantly better mental health in all three postmove years (P = .015; P = .016; P = .008), supporting a "shifting baseline" hypothesis. Individuals who moved to less green areas (n = 470) showed significantly worse mental health in the year preceding the move (P = .031) but returned to baseline in the postmove years. Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits.
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Reis S, Morris G, Fleming LE, Beck S, Taylor T, White M, Depledge MH, Steinle S, Sabel CE, Cowie H, Hurley F, Dick JM, Smith RI, Austen M. Integrating health and environmental impact analysis. Public Health 2013; 129:1383-9. [PMID: 24099716 DOI: 10.1016/j.puhe.2013.07.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/09/2013] [Accepted: 07/11/2013] [Indexed: 11/26/2022]
Abstract
Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.
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Depledge MH, Harvey AJ, Brownlee C, Frost M, Moore MN, Fleming LE. Changing views of the interconnections between the oceans and human health in Europe. MICROBIAL ECOLOGY 2013; 65:852-9. [PMID: 23325465 DOI: 10.1007/s00248-012-0173-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 12/25/2012] [Indexed: 05/06/2023]
Abstract
Early steps in the emergence of the discipline of "Oceans and Human Health" are charted in the USA and discussed in relation to past and present marine environment and human health research activities in Europe. Differences in terminology are considered, as well as differences in circumstances related to the various seas of Europe and the intensity of human coastal activity and impact. Opportunities to progress interdisciplinary research are described, and the value of horizon scanning for the early identification of emerging issues is highlighted. The challenges facing researchers and policymakers addressing oceans and human health issues are outlined and some suggestions offered regarding how further progress in research and training into both the risks and benefits of Oceans and Human Health might be made on both sides of the Atlantic.
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Plano LRW, Shibata T, Garza AC, Kish J, Fleisher JM, Sinigalliano CD, Gidley ML, Withum K, Elmir SM, Hower S, Jackson CR, Barrett JB, Cleary T, Davidson M, Davis J, Mukherjee S, Fleming LE, Solo-Gabriele HM. Human-associated methicillin-resistant Staphylococcus aureus from a subtropical recreational marine beach. MICROBIAL ECOLOGY 2013; 65:1039-1051. [PMID: 23553001 DOI: 10.1007/s00248-013-0216-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/11/2013] [Indexed: 06/02/2023]
Abstract
Reports of Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) detected in marine environments have occurred since the early 1990 s. This investigation sought to isolate and characterize S. aureus from marine waters and sand at a subtropical recreational beach, with and without bathers present, in order to investigate possible sources and to identify the risks to bathers of exposure to these organisms. During 40 days over 17 months, 1,001 water and 36 intertidal sand samples were collected by either bathers or investigators at a subtropical recreational beach. Methicillin-sensitive S. aureus (MSSA) and MRSA were isolated and identified using selective growth media and an organism-specific molecular marker. Antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, pulsed-field gel electrophoresis (PFGE) pattern, multi-locus sequence type (MLST), and staphylococcal protein A (spa) type were characterized for all MRSA. S. aureus was isolated from 248 (37 %) bather nearby water samples at a concentration range of <2-780 colony forming units per ml, 102 (31 %) ambient water samples at a concentration range of <2-260 colony forming units per ml, and 9 (25 %) sand samples. Within the sand environment, S. aureus was isolated more often from above the intertidal zone than from intermittently wet or inundated sand. A total of 1334 MSSA were isolated from 37 sampling days and 22 MRSA were isolated from ten sampling days. Seventeen of the 22 MRSA were identified by PFGE as the community-associated MRSA USA300. MRSA isolates were all SCCmec type IVa, encompassed five spa types (t008, t064, t622, t688, and t723), two MLST types (ST8 and ST5), and 21 of 22 isolates carried the genes for Panton-Valentine leukocidin. There was a correlation (r = 0.45; p = 0.05) between the daily average number of bathers and S. aureus in the water; however, no association between exposure to S. aureus in these waters and reported illness was found. This report supports the concept that humans are a potential direct source for S. aureus in marine waters.
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McClure LA, Fernandez CA, Clarke TC, Leblanc WG, Arheart KL, Fleming LE, Lee DJ. Risky drinking in the older population: a comparison of Florida to the rest of the US. Addict Behav 2013; 38:1894-7. [PMID: 23380494 DOI: 10.1016/j.addbeh.2012.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 11/20/2012] [Accepted: 12/27/2012] [Indexed: 12/26/2022]
Abstract
INTRODUCTION While alcohol use has traditionally been thought to decrease with age, several recent studies have shown an increase in heavy drinking among retirees. Florida's unique population distribution that includes a higher proportion of elderly residents warrants an in-depth look at the drinking patterns in the elderly and how they may differ from those in other areas of the country. However, state-level comparisons of excessive alcohol consumption are limited. METHODS We compared risky drinking (defined as ten or more drinks/week in men and seven or more drinks/week in women; or five or more drinks at one sitting, one or more times/year for both men and women) in Florida to the rest of the US. We used pooled data from the 1997-2010 National Health Interview Survey (NHIS). RESULTS The prevalence of risky drinking for those aged ≥65 in Florida and the rest of the US was 24.1%, and 21.8%, respectively, compared to 31.9% and 37.4% for all ages in Florida and the rest of the US, respectively. In multivariable analyses of those aged ≥65 years, risky drinking was significantly associated with male gender, younger age, non-Hispanic White race/ethnicity, more than a high school education, unemployment (including retirement), lower BMI, and current or former smoking. Floridians aged ≥65 were significantly more likely to report risky drinking than their counterparts in the rest of the US (Odds ratio=1.13; 95% CI: 1.04-1.21), in contrast to analyses of all ages where Floridians were less likely to report risky drinking compared to the rest of the US (0.77; 0.67-0.86). DISCUSSION Excessive alcohol consumption is an important modifiable risk factor for cancer, cardiovascular disease, and liver disease; a reduction among the elderly has great potential to reduce disease burden. Although Floridians overall were less likely to be risky drinkers than the rest of the US, almost a third of the Florida population reported this behavior. It is, therefore, an important public health concern, particularly in Florida's older population who are more likely to engage in this behavior than their counterparts in the rest of the US.
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Liu-Mares W, Mackinnon JA, Sherman R, Fleming LE, Rocha-Lima C, Hu JJ, Lee DJ. Pancreatic cancer clusters and arsenic-contaminated drinking water wells in Florida. BMC Cancer 2013; 13:111. [PMID: 23510413 PMCID: PMC3600048 DOI: 10.1186/1471-2407-13-111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/25/2013] [Indexed: 12/03/2022] Open
Abstract
Background We sought to identify high-risk areas of pancreatic cancer incidence, and determine if clusters of persons diagnosed with pancreatic cancer were more likely to be located near arsenic-contaminated drinking water wells. Methods A total of 5,707 arsenic samples were collected from December 2000 to May 2008 by the Florida Department of Health, representing more than 5,000 individual privately owned wells. During that period, 0.010 ppm (10 ppb) or greater arsenic levels in private well water were considered as the threshold based on standard of United States Environmental Protection Agency (EPA). Spatial modeling was applied to pancreatic cancer cases diagnosed between 1998–2002 in Florida (n = 11,405). Multivariable logistic regression was used to determine if sociodemographic indicators, smoking history, and proximity to arsenic-contaminated well sites were associated with residence at the time of pancreatic cancer diagnosis occurring within versus outside a cluster. Results Spatial modeling identified 16 clusters in which 22.6% of all pancreatic cancer cases were located. Cases living within 1 mile of known arsenic-contaminated wells were significantly more likely to be diagnosed within a cluster of pancreatic cancers relative to cases living more than 3 miles from known sites (odds ratio = 2.1 [95% CI = 1.9, 2.4]). Conclusions Exposure to arsenic-contaminated drinking water wells may be associated with an increased risk of pancreatic cancer. However, case–control studies are needed in order to confirm the findings of this ecological analysis. These cluster areas may be appropriate to evaluate pancreatic cancer risk factors, and to perform targeted screening and prevention studies.
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Depledge MH, Tyrrell J, Fleming LE, Holgate ST. Are marine environmental pollutants influencing global patterns of human disease? MARINE ENVIRONMENTAL RESEARCH 2013; 83:93-95. [PMID: 23140902 DOI: 10.1016/j.marenvres.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/11/2012] [Accepted: 10/17/2012] [Indexed: 06/01/2023]
Abstract
Thousands of toxic chemicals, many of which pollute marine ecosystems, potentially cause diseases, but building a consensus view of the significance of human body burdens of environmental chemicals is proving difficult. Causative mechanisms are often lacking. Older members of the population, of which there are increasing numbers worldwide, accumulate higher body burdens than the young, and may be especially at risk. It also remains unclear when crucially sensitive periods for chemical exposures occur across the life course. Very early exposures may lead to diseases much later on. The current lack of robust science upon which to base high quality expert advice is hampering effective policymaking that leads to further reductions in marine pollution, greater protection of marine life and lowering of risks to human health.
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Pollard AS, Taylor TJ, Fleming LE, Stahl-Timmins W, Depledge MH, Osborne NJ. Mainstreaming carbon management in healthcare systems: a bottom-up modeling approach. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:678-686. [PMID: 23244244 DOI: 10.1021/es303776g] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Increasing greenhouse gas emissions threaten human health and the environment. In response, healthcare managers face significant challenges in balancing operational decisions about patient care with carbon mitigation targets. We explore a bottom-up modeling framework to aid in the decision-making for both carbon and cost in healthcare, using data from a case study in Cornwall, UK. A model was built and run for secondary healthcare, specifically outpatient clinics, theater lists, beds, and diagnostic facilities. Five scenarios were tested: business-as-usual; service expansion; site closure; water temperature reduction; and theater optimization. The estimated emissions from secondary healthcare in Cornwall ran to 5787 T CO(2)eq with patient travel adding 2215 T CO(2)eq. Closing selected sites would have reduced this by 4% (261 T CO(2)eq), a reduction less than the resulting increases in patient transport emissions. Reducing hot water temperatures by 5 °C and improving theater usage would lower the footprint by 0.7% (44 T CO(2)eq) and 0.08% (5 T CO(2)eq), respectively. We consider bottom-up models important tools in the process of estimating and modeling the carbon footprint of healthcare. For the carbon reduction targets of the healthcare sector to be met, the use of these bottom-up models in decision making and forward planning is pivotal.
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Redshaw CH, Stahl-Timmins WM, Fleming LE, Davidson I, Depledge MH. Potential changes in disease patterns and pharmaceutical use in response to climate change. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2013; 16:285-320. [PMID: 23909463 PMCID: PMC3756629 DOI: 10.1080/10937404.2013.802265] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
As climate change alters environmental conditions, the incidence and global patterns of human diseases are changing. These modifications to disease profiles and the effects upon human pharmaceutical usage are discussed. Climate-related environmental changes are associated with a rise in the incidence of chronic diseases already prevalent in the Northern Hemisphere, for example, cardiovascular disease and mental illness, leading to greater use of associated heavily used Western medications. Sufferers of respiratory diseases may exhibit exacerbated symptoms due to altered environmental conditions (e.g., pollen). Respiratory, water-borne, and food-borne toxicants and infections, including those that are vector borne, may become more common in Western countries, central and eastern Asia, and across North America. As new disease threats emerge, substantially higher pharmaceutical use appears inevitable, especially of pharmaceuticals not commonly employed at present (e.g., antiprotozoals). The use of medications for the treatment of general symptoms (e.g., analgesics) will also rise. These developments need to be viewed in the context of other major environmental changes (e.g., industrial chemical pollution, biodiversity loss, reduced water and food security) as well as marked shifts in human demographics, including aging of the population. To identify, prevent, mitigate, and adapt to potential threats, one needs to be aware of the major factors underlying changes in the use of pharmaceuticals and their subsequent release, deliberately or unintentionally, into the environment. This review explores the likely consequences of climate change upon the use of medical pharmaceuticals in the Northern Hemisphere.
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Clarke TC, Soler-Vila H, Fleming LE, Christ SL, Lee DJ, Arheart KL. Trends in Adherence to Recommended Cancer Screening: The US Population and Working Cancer Survivors. Front Oncol 2012; 2:190. [PMID: 23293767 PMCID: PMC3530735 DOI: 10.3389/fonc.2012.00190] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/20/2012] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Over the past decade the United States (US) has seen a decrease in advanced cancer diagnoses. There has also been an increase in the number of cancer survivors returning to work. Cancer screening behaviors among survivors may play an important role in their return-to-work process. Adherence to a post-treatment cancer screening protocol increases early detection of secondary tumors and reduces potentially limiting side-effects. We compared screening trends among all cancer survivors, working survivors, and the general population over the last decade. MATERIALS AND METHODS Trends in adherence to recommended screening were analyzed by site-specific cancer. We used the Healthy People goals as a measure of desired adherence. We selected participants 18+ years from 1997 to 2010 National Health Interview Survey for years where detailed cancer screening information was available. Using the recommendations of the American Cancer Society as a guide, we assessed adherence to cancer screening across the decade. There were 174,393 participants. Analyses included 7,528 working cancer survivors representing 3.8 million US workers, and 119,374 adults representing more than 100 million working Americans with no cancer history. RESULTS The US population met the Healthy People 2010 goal for colorectal screening, but declined in all other recommended cancer screening. Cancer survivors met and maintained the HP2010 goal for all, except cervical cancer screening. Survivors had higher screening rates than the general population. Among survivors, white-collar and service occupations had higher screening rates than blue-collar survivors. CONCLUSION Cancer survivors report higher screening rates than the general population. Nevertheless, national screening rates are lower than desired, and disparities exist by cancer history and occupation. Understanding existing disparities, and the impact of cancer screening on survivors is crucial as the number of working survivors increases.
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Hernandez MN, Sussman DA, Lee DJ, Mackinnon JA, Fleming LE. Trends in colorectal cancer among hispanics by stage and subsite location: 1989-2006. Clin Transl Gastroenterol 2012; 3:e21. [PMID: 23238348 PMCID: PMC3464804 DOI: 10.1038/ctg.2012.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES: Hispanic colorectal cancer (CRC) rates historically have been lower than for non-Hispanic Whites in the United States and in Florida. The aim of this study is to understand CRC trends in Florida Hispanics and non-Hispanic Whites. METHODS: Using a cross-sectional study design, all invasive CRCs diagnosed among Florida residents between 1989 and 2006 were accessed from the Florida Cancer Data System (FCDS). These cases were analyzed by Hispanic and non-Hispanic White ethnic identification. The Hispanic Origin Identification Algorithm was applied to the FCDS data to identify Hispanic subjects. Primary cancer site and histology data were organized according to SEER (Surveillance Epidemiology and End Results) categories. Joinpoint regression was used to generate incidence trends by stage and subsite location. RESULTS: Rates of CRC incidence were higher for Florida Hispanics compared with non-Hispanic Whites since the mid 1990s. There was a consistent significant increase in the incidence of distant stage CRC in Hispanics (annual percent change (APC) of 1.26 and 0.90 in males and females), whereas rates in non-Hispanics decreased significantly during the same time period (APC −1.36 and −1.28, respectively). Similar trends were found in distant-stage right-sided CRC. Among right-sided CRCs, local stage incidence rate increased for both non-Hispanic Whites and Hispanics, whereas the incidence rate for regional stage decreased for both racial/ethnic groups. CONCLUSIONS: Trends for distant-stage CRC are increasing among Florida Hispanics. This is a particular public health concern given that CRC is a cancer for which screening modalities exist and could imply a concomitant increase in CRC-related mortality among Florida Hispanics. Lower rates of CRC screening in Hispanics are documented at the state level, relative to non-Hispanic Whites. Screening programs targeting the Florida Hispanic population are warranted.
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Christ SL, Fleming LE, Lee DJ, Muntaner C, Muennig PA, Caban-Martinez AJ. The effects of a psychosocial dimension of socioeconomic position on survival: occupational prestige and mortality among US working adults. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:1103-17. [PMID: 22443309 PMCID: PMC4991360 DOI: 10.1111/j.1467-9566.2012.01456.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The association between education or income and mortality has been explored in great detail. These measures capture both the effects of material disadvantage on health and the psychosocial impacts of a low socioeconomic position on health. When explored independently of educational attainment and income, occupational prestige - a purely perceptual measure - serves as a measure of the impact of a psychosocial phenomenon on health. For instance, a fire-fighter, academician or schoolteacher may carry the social benefits of a higher social status without actually having the income (in all cases) or the educational credentials (in the case of the fire-fighter) to match. We explored the independent influence of occupational prestige on mortality. We applied Cox proportional hazards models to a nationally representative sample of over 380,000 US workers who had worked at any time between 1986 and 1994 with mortality follow up through 2002. We found that occupational prestige is associated with a decrease in the risk of all-cause, cancer, cardiovascular and respiratory-related mortality after controlling for household income and educational attainment. We further investigated the question of whether the effects of prestige are moderated by sex and broader occupational groupings. Prestige effects operate in white-collar occupations for men only and within service occupations for all workers.
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Clark JD, Serdar B, Lee DJ, Arheart K, Wilkinson JD, Fleming LE. Exposure to polycyclic aromatic hydrocarbons and serum inflammatory markers of cardiovascular disease. ENVIRONMENTAL RESEARCH 2012; 117:132-7. [PMID: 22626472 PMCID: PMC3444300 DOI: 10.1016/j.envres.2012.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 04/21/2012] [Accepted: 04/23/2012] [Indexed: 05/03/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are environmental and occupational carcinogens produced by the incomplete combustion of organic materials, such as coal and petroleum product combustion, tobacco smoking, and food cooking, that may be significant contributors to the burden of cardiovascular disease in human populations. The purpose of this study was to investigate associations between ten monohydroxy urinary metabolites of four PAHs and three serum biomarkers of cardiovascular disease (fibrinogen, homocysteine, and white blood cell count). Using data on 3219 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 dataset, the associations between PAH metabolites and serum inflammatory markers were analyzed using the Spearman correlations and multiple linear regression modeling. The PAH metabolites of naphthalene, fluorene, phenanthrene, and pyrene each showed both positive and negative correlations with homocysteine, fibrinogen, and white blood cell count (correlation coefficient range: -0.077-0.143) in nonsmoking participants. Using multiple linear regression models adjusted for age, gender, race/ethnicity, and body mass index, estimates of weighted geometric means of inflammatory marker levels were not significantly different between high and low levels (75th vs. 25th percentiles) for all PAH metabolites in nonsmoking subjects. The results of this study do not provide evidence for a relationship between PAH exposure (as measured by urinary levels of PAH metabolites) and serum biomarkers of cardiovascular disease after controlling for tobacco use.
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Caban-Martinez AJ, Halder GE, Tellechea L, Fajardo M, Kaltman J, Anand J, Prendes S, Penyak V, Koganti D, Chavoustie S, Fleming LE. Health status and behaviors among adults residing in rural Dominican Republic. Rural Remote Health 2012; 12:1956. [PMID: 22591172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The rapidly increasing burden of chronic diseases linked to adequacy of healthcare services and individual health behaviors is a key determinant of global public health. Given demographic aging and the accompanying health transition, chronic diseases in low and middle income communities of the Dominican Republic are likely to increase significantly. The objective of this article was to report on efforts in surveillance of health conditions and behaviors in underserved rural Dominican communities. METHODS A modified 30 item, language-sensitive health survey was randomly administered to 117 adult participants (18 years and older) during a health fair held at three rural villages from March to April 2009 in the rural San Cristobál region of the Dominican Republic. Descriptive analyses of select health conditions and behavior variables from all completed surveys were tabulated. RESULTS Adult participant ages ranged from 18 to 79 years (mean ± standard deviation; 34.0 ± 2.1), height from 1.4 to 2.0 m (1.7 ± 0.1), weight from 41.8 to 100.0 kg (66.2 ± 1.7) and BMI from 15.2 to 46.2 (24.2 ± 0.7). Overall, 69.2% of the sample self-reported their general health status to be fair to poor. The top three chronic diseases included: high blood pressure (35.8%), diabetes (15.0%), and asthma (14.2%). In all, 33.4% reported current smoker status and 61.7% were classified as heavy alcohol drinkers. CONCLUSION Considerable variation was found in the self-report of health conditions and behavioral characteristics among those individuals that attended the health fair. Documenting these important health indicators in the rural communities has the potential to inform the development of surveillance activities and prevention efforts for future health education interventions.
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Enns AA, Vogel LJ, Abdelzaher AM, Gabriele HMS, Plano LR, Gidley ML, Phillips MC, Klaus JS, Piggot AM, Feng Z, Reniers AJ, Haus BK, Elmir SM, Zhang Y, Jimenez NH, Mottaleb NA, Schoor ME, Brown A, Khan SQ, Dameron AS, Salazar NC, Fleming LE. Spatial and temporal variation in indicator microbe sampling is influential in beach management decisions. WATER RESEARCH 2012; 46:2237-46. [PMID: 22365370 PMCID: PMC3304019 DOI: 10.1016/j.watres.2012.01.040] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/26/2011] [Accepted: 01/28/2012] [Indexed: 05/06/2023]
Abstract
Fecal indicator microbes, such as enterococci, are often used to assess potential health risks caused by pathogens at recreational beaches. Microbe levels often vary based on collection time and sampling location. The primary goal of this study was to assess how spatial and temporal variations in sample collection, which are driven by environmental parameters, impact enterococci measurements and beach management decisions. A secondary goal was to assess whether enterococci levels can be predictive of the presence of Staphylococcus aureus, a skin pathogen. Over a ten-day period, hydrometeorologic data, hydrodynamic data, bather densities, enterococci levels, and S. aureus levels including methicillin-resistant S. aureus (MRSA) were measured in both water and sand. Samples were collected hourly for both water and sediment at knee-depth, and every 6 h for water at waist-depth, supratidal sand, intertidal sand, and waterline sand. Results showed that solar radiation, tides, and rainfall events were major environmental factors that impacted enterococci levels. S. aureus levels were associated with bathing load, but did not correlate with enterococci levels or any other measured parameters. The results imply that frequencies of advisories depend heavily upon sample collection policies due to spatial and temporal variation of enterococci levels in response to environmental parameters. Thus, sampling at different times of the day and at different depths can significantly impact beach management decisions. Additionally, the lack of correlation between S. aureus and enterococci suggests that use of fecal indicators may not accurately assess risk for some pathogens.
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Kachan D, Fleming LE, LeBlanc WG, Goodman E, Arheart KL, Caban-Martinez AJ, Clarke TC, Ocasio MA, Christ S, Lee DJ. Worker populations at risk for work-related injuries across the life course. Am J Ind Med 2012; 55:361-6. [PMID: 22170632 PMCID: PMC3322113 DOI: 10.1002/ajim.21994] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Workplace injuries can have a substantial economic impact. Rates of workplace injuries differ across age groups, yet occupations/industry sectors at highest risk within age groups have not been identified. We examined workplace injury risk across industry sectors for three age groups using nationally representative U.S. data. METHODS Data from 1997 to 2009 National Health Interview Survey (NHIS) were pooled for employed adults by age groups: (1) 18-25 (n = 22,261); (2) 26-54 (n = 121,559); and (3) 55+ (n = 24,851). Workplace injury risk comparisons were made using logistic regression, with the Services sector as the referent and adjustment for sample design, gender, education, race/ethnicity, age, and income-to-poverty ratio. RESULTS Overall 3-month injury prevalence was 0.88%. Highest risk sectors for workers aged 18-25 included: Agriculture/forestry/fisheries (odds ratio = 4.80; 95% confidence interval 2.23-10.32), Healthcare/social assistance (2.71; 1.50-4.91), Construction (2.66; 1.56-4.53), Manufacturing (2.66; 1.54-4.61); for workers 26-54: Construction (2.30; 1.76-3.0), Agriculture/forestry/fisheries (1.91; 1.16-3.15), and Manufacturing (1.58; 1.28-1.96); for workers 55+: Agriculture/forestry/fisheries (3.01; 1.16-7.81), Transportation/communication/other public utilities (2.55; 1.44-4.49), and Construction (2.25; 1.09-4.67). CONCLUSIONS Agriculture/forestry/fisheries and Construction were among the sectors with highest workplace injury risk for workers across all age groups. Differences in highest risk industries were identified between the youngest and oldest industry groups. Our results indicate a need for age-specific interventions in some industries, and a need for more comprehensive measures in others.
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Lee DJ, Fleming LE, LeBlanc WG, Arheart KL, Ferraro KF, Pitt-Catsouphes M, Muntaner C, Fernandez CA, Caban-Martinez AJ, Davila EP, Bandiera FC, Lewis JE, Kachan D. Health status and risk indicator trends of the aging US health care workforce. J Occup Environ Med 2012; 54:497-503. [PMID: 22446575 PMCID: PMC3323772 DOI: 10.1097/jom.0b013e318247a379] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the health status and risk indicator trends in a representative sample of US health care workers aged 45 years and older. METHODS Using pooled data from the 1997 to 2009 National Health Interview Survey, logistic regression analyses were performed to determine whether age-group specific morbidity risks differed within occupational subgroups of the health care workforce (N = 6509). Health and morbidity trends were examined via complex survey adjusted and weighted chi-squared tests. RESULTS Rates of functional limitation and hypertension increased among diagnosing/assessing health care workers. The prevalence of hearing impairment, cancer, and hypertension was two to three times greater in health-diagnosing/assessing workers aged 60 years and older than in younger workers. Health care service workers were up to 19 times more likely to be obese than workers who diagnose/assess health. CONCLUSIONS Healthier workplaces and targeted interventions are needed to optimize the ability to meet health care demands of this aging workforce.
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Kachan D, Lewis JE, Davila EP, Arheart KL, LeBlanc WG, Fleming LE, Cabán-Martinez AJ, Lee DJ. Nutrient intake and adherence to dietary recommendations among US workers. J Occup Environ Med 2012; 54:101-5. [PMID: 22193114 PMCID: PMC3258352 DOI: 10.1097/jom.0b013e31823ccafa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess nutrient intake according to dietary guidelines among US worker groups. METHODS Participants of 1999 to 2004 National Health and Nutrition Examination Survey completed two 24-hour recall dietary interviews to assess daily intake of protein, carbohydrate, fat, cholesterol, calcium, sodium, and fiber. Employed participants (n = 8987) were classified as (1) white collar, (2) service worker, (3) farmer, and (4) blue collar. RESULTS Nutrient intake varied by occupational group, particularly for fiber, sodium, calories, and percentage of calories from protein, saturated fat, and carbohydrate. Adherence to recommendations was noted for saturated fat and cholesterol, but workers were poorly adherent to recommendations for all other nutrients, particularly fiber. CONCLUSIONS Workers display differences in nutrient intake across occupational groups with poor eating behaviors evident across all groups. Fiber is particularly poorly consumed, with less than 5% of all US workers meeting the recommendations.
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Skinner MP, Brewer TD, Johnstone R, Fleming LE, Lewis RJ. Ciguatera fish poisoning in the Pacific Islands (1998 to 2008). PLoS Negl Trop Dis 2011; 5:e1416. [PMID: 22180797 PMCID: PMC3236724 DOI: 10.1371/journal.pntd.0001416] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/22/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Ciguatera is a type of fish poisoning that occurs throughout the tropics, particularly in vulnerable island communities such as the developing Pacific Island Countries and Territories (PICTs). After consuming ciguatoxin-contaminated fish, people report a range of acute neurologic, gastrointestinal, and cardiac symptoms, with some experiencing chronic neurologic symptoms lasting weeks to months. Unfortunately, the true extent of illness and its impact on human communities and ecosystem health are still poorly understood. METHODS A questionnaire was emailed to the Health and Fisheries Authorities of the PICTs to quantify the extent of ciguatera. The data were analyzed using t-test, incidence rate ratios, ranked correlation, and regression analysis. RESULTS There were 39,677 reported cases from 17 PICTs, with a mean annual incidence of 194 cases per 100,000 people across the region from 1998-2008 compared to the reported annual incidence of 104/100,000 from 1973-1983. There has been a 60% increase in the annual incidence of ciguatera between the two time periods based on PICTs that reported for both time periods. Taking into account under-reporting, in the last 35 years an estimated 500,000 Pacific islanders might have suffered from ciguatera. CONCLUSIONS This level of incidence exceeds prior ciguatera estimates locally and globally, and raises the status of ciguatera to an acute and chronic illness with major public health significance. To address this significant public health problem, which is expected to increase in parallel with environmental change, well-funded multidisciplinary research teams are needed to translate research advances into practical management solutions.
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Koru-Sengul T, Clark JD, Ocasio MA, Wanner A, Fleming LE, Lee DJ. Utilization of the National Health and Nutrition Examination (NHANES) Survey for Symptoms, Tests, and Diagnosis of Chronic Respiratory Diseases and Assessment of Second hand Smoke Exposure. ACTA ACUST UNITED AC 2011; 1. [PMID: 26052473 DOI: 10.4172/2161-1165.1000104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Respiratory diseases encompass a number of complex disorders that constitute a major cause of both morbidity and mortality worldwide with a major burden to the afflicted as well as the health care systems that care for them. Although the prevalence of chronic respiratory diseases (CRDs) has been decreasing in industrialized countries due to a decreasing number of smokers and stricter laws aimed at reducing exposure to secondhand smoke (SHS), the burden of CRDs in developing world populations is expected to worsen due to communicable disease prevention programs, aging populations, environmental air pollution, and continued tobacco smoke exposure. Although tobacco smoking has been shown to be significantly associated with many CRDs, evidence linking SHS exposure to different CRDs is mixed, especially with low levels of SHS exposure. METHODS The National Health and Nutrition Examination Survey (NHANES) is a series of studies designed to assess the health and nutritional status of non-institutionalized adults and children in the United States (U.S.). In addition to being used to monitor the health of the U.S. population, NHANES data allow for research into prevalent health problems and their risk factors in the population, such with CRDs and SHS exposure. NHANES data can be utilized to explore a variety of issues related to the assessment of SHS exposure and its association to respiratory symptoms and illnesses. RESULTS First, we provide a brief review of NHANES including its strengths and limitations. We then provide a summary of the variables and publically available population based data that can be used to study associations between SHS exposure and CRD symptoms, testing and diagnoses. CONCLUSION Rich and cost effective, NHANES data provide a unique opportunity for research into the risk factors for CRDs in the U.S. population, particularly into the possible health effects of low levels of SHS exposure.
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Caban-Martinez AJ, Davila EP, McCollister KE, Fleming LE, Zheng DD, Lam BL, Dubovy SR, Lee DJ. Age-related macular degeneration and smoking cessation advice by eye care providers: a pilot study. Prev Chronic Dis 2011; 8:A147. [PMID: 22005640 PMCID: PMC3221586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.
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Koru-Sengul T, Clark JD, Fleming LE, Lee DJ. Toward improved statistical methods for analyzing Cotinine-Biomarker health association data. Tob Induc Dis 2011; 9:11. [PMID: 21968135 PMCID: PMC3192654 DOI: 10.1186/1617-9625-9-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 10/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serum cotinine, a metabolite of nicotine, is frequently used in research as a biomarker of recent tobacco smoke exposure. Historically, secondhand smoke (SHS) research uses suboptimal statistical methods due to censored serum cotinine values, meaning a measurement below the limit of detection (LOD). METHODS We compared commonly used methods for analyzing censored serum cotinine data using parametric and non-parametric techniques employing data from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES). To illustrate the differences in associations obtained by various analytic methods, we compared parameter estimates for the association between cotinine and the inflammatory marker homocysteine using complete case analysis, single and multiple imputation, "reverse" Kaplan-Meier, and logistic regression models. RESULTS Parameter estimates and statistical significance varied according to the statistical method used with censored serum cotinine values. Single imputation of censored values with either 0, LOD or LOD/√2 yielded similar estimates and significance; multiple imputation method yielded smaller estimates than the other methods and without statistical significance. Multiple regression modelling using the "reverse" Kaplan-Meier method yielded statistically significant estimates that were larger than those from parametric methods. CONCLUSIONS Analyses of serum cotinine data with values below the LOD require special attention. "Reverse" Kaplan-Meier was the only method inherently able to deal with censored data with multiple LODs, and may be the most accurate since it avoids data manipulation needed for use with other commonly used statistical methods. Additional research is needed into the identification of optimal statistical methods for analysis of SHS biomarkers subject to a LOD.
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Clarke TC, Soler-Vila H, Lee DJ, Arheart KL, Ocasio MA, Leblanc WG, Fleming LE. Working with cancer: health and disability disparities among employed cancer survivors in the U.S. Prev Med 2011; 53:331-4. [PMID: 21884724 PMCID: PMC3208802 DOI: 10.1016/j.ypmed.2011.07.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 07/12/2011] [Accepted: 07/29/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer. METHODS Cross-sectional data pooled from the 1997-2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors. RESULTS Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor-fair health (0.25; 0.24-0.26) and (2.06; 1.96-2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35-0.38) and (1.72; 1.64-1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers. CONCLUSION Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.
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Arheart KL, Fleming LE, Lee DJ, Leblanc WG, Caban-Martinez AJ, Ocasio MA, McCollister KE, Christ SL, Clarke T, Kachan D, Davila EP, Fernandez CA. Occupational vs. industry sector classification of the US workforce: which approach is more strongly associated with worker health outcomes? Am J Ind Med 2011; 54:748-57. [PMID: 21671459 PMCID: PMC3168588 DOI: 10.1002/ajim.20973] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Through use of a nationally representative database, we examined the variability in both self-rated health and overall mortality risk within occupations across the National Occupational Research Agenda (NORA) Industry Sectors, as well as between the occupations within the NORA Industry sectors. METHODS Using multiple waves of the National Health Interview Survey (NHIS) representing an estimated 119,343,749 US workers per year from 1986 to 2004, age-adjusted self-rated health and overall mortality rates were examined by occupation and by NORA Industry Sector. RESULTS There was considerable variability in the prevalence rate of age-adjusted self-rated poor/fair health and overall mortality rates for all US workers. The variability was greatest when examining these data by the Industry Sectors. In addition, we identified an overall pattern of increased poor/fair self-reported health and increased mortality rates concentrated among particular occupations and particular Industry Sectors. CONCLUSIONS This study suggests that using occupational categories within and across Industry Sectors would improve the characterization of the health status and health disparities of many subpopulations of workers within these Industry Sectors.
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Stewart JR, Fleming LE, Fleisher JM, Abdelzaher AM, Maille Lyons M. Waterborne Pathogens. MARINE POLLUTION AND HUMAN HEALTH 2011. [DOI: 10.1039/9781849732871-00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A variety of microorganisms occur in the marine environment which are capable of infecting humans. This chapter, focused on waterborne pathogens, summarizes the types of pathogens that are a threat to human health, as well as the fecal indicator bacteria that are commonly used as surrogates for pathogens in regulatory and research applications. Limitations and alternatives to traditional fecal indicator bacteria are explored, highlighting challenges and policy implications for protecting public health. Methodological advances and challenges are also reviewed, with an emphasis on research designed to fill gaps and provide scientific support for management of marine resources, particularly bathing beaches. Accordingly, recent and previous epidemiology studies linking microbial measures of water quality to health outcomes are discussed in detail. As an alternative to the measurement of individual water samples, modeling of pathogens in marine waters is introduced. Overall, this chapter provides an overview of the pathogens, microbial measures and policy implications important for protecting humans from exposure to pathogens in marine waters.
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