Residential proximity to environmental hazards and adverse health outcomes

Estimated time-varying exposures to air emissions from animal feeding operations and childhood asthma

BACKGROUND/AIM

Industrial-scale animal feeding operations (AFOs) have adverse impacts on regional air quality. Air emissions include endotoxins and other pro-inflammatory components, and exposure may cause airway inflammation and respiratory effects in susceptible individuals residing nearby. We aimed to develop and validate metrics for estimating time-varying exposure to AFO air pollution in surrounding communities and, secondly, to determine whether exposure is associated with health effects in children with asthma.

METHODS

We conducted a longitudinal panel study of N = 58 children with asthma in an agricultural region of Washington State with a high density of dairy AFOs. Children were followed for up to 26 months with repeated measures of respiratory health (N = 2023 interviews; N = 3853 lung function measurements); urine was collected in a subcohort (N = 16) at six-day intervals over three months and analyzed for leukotriene E4 (LTE4), a biomarker of systemic inflammation (N = 138 measurements). We developed an approach to estimate daily exposure to AFO airborne emissions based on distance to AFOs, AFO size, and daily wind speed and direction, and validated the estimates against direct measurements of ammonia, a chemical marker of AFO emissions, measured biweekly at 18 sites across the region for 14 months. Short-term relationships between AFO pollutant exposure and outcomes were assessed using regression models accounting for within-participant correlation and several potential confounders.

RESULTS

Estimates of daily AFO air pollution correlated moderately well with outdoor ammonia measurements (N = 842; r = 0.62). Forced expiratory volume in 1 s (FEV₁) as percent of predicted was 2.0% (95% CI: 0.5, 3.5) lower with each interquartile increase in previous day exposure, but no associations with asthma symptoms were observed. There was suggestive evidence that LTE4 concentrations were higher following days of elevated exposure to AFO emissions (p = 0.06).

CONCLUSIONS

A simple metric of time-varying exposure to AFO emissions was correlated with daily outdoor ammonia levels. Children with asthma may be adversely affected by exposure to AFO emissions.

Health and Environmental Risks of Residents Living Close to a Landfill: A Case Study of Thohoyandou Landfill, Limpopo Province, South Africa

The by-products of solid waste deposited in a landfill has adverse effects on the surrounding environment and humans living closer to landfill sites. This study sought to test the hypothesis that the deposition of waste on landfill has an impact on the surrounding environment and residents living closer to it. This was achieved by evaluating the perception of the respondents drawn from people living close (100-500 m) and far (1-2 km) from the landfill site, concerning environmental issues, health problems, and life satisfaction. Results from the study showed that 78% of participants living closer to the landfill site indicated serious contamination of air quality evident from bad odours linked to the landfill site. Illnesses such as flu, eye irritation and weakness of the body were frequently reported by participants living closer to the landfill than those living far from the landfill. More than half of the participants (56%) living closer to the landfill indicated fear of their health in the future. Thus, the participants living closer to the landfill site were less satisfied with the location of their community with respect to the landfill, than those living far from the landfill site. Therefore, the need for a landfill gas (LFG) utilisation system, proper daily covering of waste and odour diluting agents are necessary to reduce the problems of the residents living closer to the landfill site.

Mercury Contamination from Dental Amalgam

BACKGROUND

Mercury in dental amalgam is a hidden source of global mercury pollution, resulting from the illegal diversion of dental mercury into the artisanal and small-scale gold mining sector, to crematoria emissions from the deceased and sewage sludge that is sold to farmers. These significant mercury sources result in air, water, and food contamination that consequently have a negative impact on human health.

OBJECTIVES

The aim of the present study was to investigate and report on all of the various pathways mercury in dental amalgam can enter the environment.

METHODS

The present study searched the electronic data bases of PubMed and Google Scholar. Peer reviewed journals and references of studies included for full-text review were examined for potentially relevant studies. Articles published between 2000 to 2018 were searched and specifically screened for articles that referenced "Dental Amalgam," and the following key words in various combinations: "Minamata Convention on Mercury Treaty," "Sewage Sludge," "Cremation," and "Artisanal and Small-Scale Gold Mining." Data were included on the most populous countries of China, India, the United States, Brazil, and the European Union collectively. We also included data on cremation statistics and current global trends, looking at populations where cremation is a common practice, such as Japan and India.

DISCUSSION

Dental amalgam represents a significant, but understudied area of global mercury pollution that includes cremation, sewage sludge, burial, and small-scale gold mining.

CONCLUSIONS

Mercury used in products and processes, including dental amalgams, is a global pollutant. Even after the last mercury dental amalgam is placed, its toxic legacy will continue for decades, because of its pervasive bioaccumulation in the environment. Government regulatory agencies should make it mandatory to utilize available technologies, not only in developing countries, but also in developed countries, to reduce mercury contamination.

COMPETING INTERESTS

The authors declare no competing financial interests.

Methodological approaches to the study of cancer risk in the vicinity of pollution sources: the experience of a population-based case-control study of childhood cancer

Background

Environmental exposures are related to the risk of some types of cancer, and children are the most vulnerable group of people. This study seeks to present the methodological approaches used in the papers of our group about risk of childhood cancers in the vicinity of pollution sources (industrial and urban sites). A population-based case–control study of incident childhood cancers in Spain and their relationship with residential proximity to industrial and urban areas was designed. Two methodological approaches using mixed multiple unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) were developed: (a) “near vs. far” analysis, where possible excess risks of cancers in children living near (“near”) versus those living far (“far”) from industrial and urban areas were assessed; and (b) “risk gradient” analysis, where the risk gradient in the vicinity of industries was assessed. For each one of the two approaches, three strategies of analysis were implemented: “joint”, “stratified”, and “individualized” analysis. Incident cases were obtained from the Spanish Registry of Childhood Cancer (between 1996 and 2011).

Results

Applying this methodology, associations between proximity (≤ 2 km) to specific industrial and urban zones and risk (OR; 95% CI) of leukemias (1.31; 1.04–1.65 for industrial areas, and 1.28; 1.00–1.53 for urban areas), neuroblastoma (2.12; 1.18–3.83 for both industrial and urban areas), and renal (2.02; 1.16–3.52 for industrial areas) and bone (4.02; 1.73–9.34 for urban areas) tumors have been suggested.

Conclusions

The two methodological approaches were used as a very useful and flexible tool to analyze the excess risk of childhood cancers in the vicinity of industrial and urban areas, which can be extrapolated and generalized to other cancers and chronic diseases, and adapted to other types of pollution sources.

Socioeconomic factors increase the adverse effects of air pollution and temperature on mortality

OBJECTIVE

To verify the effects of PM2.5 and temperature on mortality due to cardiovascular diseases according to socioeconomic status and traffic proximity.

METHOD

Time series were used, using the generalized additive models with the Poisson regression option, at 5% significance level. Interactionbetween proximity of traffic and socioeconomic status was analyzed through stratification. The proximity to the traffic was divided into distances up to 150m or over 150m. Socioeconomic status in the residential environment was categorized as high and low based on the median (3.9%). The relative risk percentage (%RR) of cardiovascular disease deaths was calculated for each linear increase of 10 µg/m3 at PM2.5 and 1ºC at the maximum temperature.

RESULTS

Mortality due to cardiovascular diseases presented %RR 1.64 (95%CI -0.03; 3.33), related to the maximum temperature and %RR 4.60 (95%CI 0.78; 8.56) related to PM2.5, in areas with high traffic exposure. In areas with poor living conditions, %RR 1.34 (95%CI -0.31; 3.01) was observed, related to maximum temperature and RR% 3.95 (95%CI -0.27; 8.34) associated with PM2.5.

CONCLUSION

Areas with poor living conditions and high-exposure to vehicular traffic had an increased risk of cardiovascular disease mortality related to high temperature and PM2.5.

Characterization of leachates from waste landfill sites in a religious camp along Lagos-Ibadan expressway, Nigeria and its hepatotoxicity in rats

Landfill sites near human settlements are known to have adverse health effects. Here, we investigated the effect of different concentrations of leachates from the Redemption Camp landfill (RCLL, 10%, 30%, 50%) on the liver of adult female rats after 21 days of exposure in their drinking water. The physicochemical and metal analyses showed that biochemical oxygen and chemical oxygen demand, zinc and magnesium levels were significantly high, whereas copper level was low in RCLL when compared to water samples from residential areas close to the landfill site, and were higher than the acceptable limits (p < 0.05). The predominant bacteria isolates recovered from the leachate and drinking water samples were Escherichia coli, Salmonella spp and Shigella spp. At the end of the 21-day exposure, RCLL increased the weight of the liver. Malondialdehyde concentrations were increased and glutathione levels were decreased significantly in the liver of treated animals at all concentrations of leachates tested. Furthermore, the activities of serum alanine amino transferase, aspartate amino transferase, gamma glutamyl transferase and cholesterol concentrations were increased whereas bilirubin and albumin levels were decreased dose-dependently. Histological examination of the liver was characterized by accumulation of inflammatory cells around hepatocytes, and extended sinusoids. The histo-pathological alterations and oxidative damage observed in the liver of treated rats and occurrence of pathogenic species and metals in the RCLL may suggest possible impaired hepatic health in subjects with occupational or environmental exposure.

Utilization of the Maryland Environmental Justice Screening Tool: A Bladensburg, Maryland Case Study

Maryland residents' knowledge of environmental hazards and their health effects is limited, partly due to the absence of tools to map and visualize distribution of risk factors across sociodemographic groups. This study discusses the development of the Maryland EJSCREEN (MD EJSCREEN) tool by the National Center for Smart Growth in partnership with faculty at the University of Maryland School of Public Health. The tool assesses environmental justice risks similarly to the U.S. Environmental Protection Agency's (USEPA) EJSCREEN tool and California's tool, CalEnviroScreen 3.0. We discuss the architecture and functionality of the tool, indicators of importance, and how it compares to USEPA's EJSCREEN and CalEnviroScreen. We demonstrate the use of MD EJSCREEN through a case study on Bladensburg, Maryland, a town in Prince George's County (PG) with several environmental justice concerns including air pollution from traffic and a concrete plant. Comparison reveals that environmental and demographic indicators in MD EJSCREEN most closely resemble those in EPA EJSCREEN, while the scoring is most similar to CalEnviroScreen. Case study results show that Bladensburg has a Prince George's environmental justice score of 0.99, and that National Air Toxics Assessment (NATA) air toxics cancer risk is concentrated in communities of color.

Remote Sensing in Environmental Justice Research—A Review

Human health is known to be affected by the physical environment. Various environmental influences have been identified to benefit or challenge people’s physical condition. Their heterogeneous distribution in space results in unequal burdens depending on the place of living. In addition, since societal groups tend to also show patterns of segregation, this leads to unequal exposures depending on social status. In this context, environmental justice research examines how certain social groups are more affected by such exposures. Yet, analyses of this per se spatial phenomenon are oftentimes criticized for using “essentially aspatial” data or methods which neglect local spatial patterns by aggregating environmental conditions over large areas. Recent technological and methodological developments in satellite remote sensing have proven to provide highly detailed information on environmental conditions. This narrative review therefore discusses known influences of the urban environment on human health and presents spatial data and applications for analyzing these influences. Furthermore, it is discussed how geographic data are used in general and in the interdisciplinary research field of environmental justice in particular. These considerations include the modifiable areal unit problem and ecological fallacy. In this review we argue that modern earth observation data can represent an important data source for research on environmental justice and health. Especially due to their high level of spatial detail and the provided large-area coverage, they allow for spatially continuous description of environmental characteristics. As a future perspective, ongoing earth observation missions, as well as processing architectures, ensure data availability and applicability of ’big earth data’ for future environmental justice analyses.

Sociodemographic predictors of residents worry about contaminated sites

The management and remediation of contaminated environments increasingly involves engagement with affected local residents. Of late, risk communication tools and guidelines have drawn attention to the stress and concern of residents as a result of heightened awareness of localised contamination and the need to address these less visible impacts of contamination when engaging with affected communities. Despite this emerging focus, there is an absence of research exploring the factors that predict resident worry about neighbourhood contamination. This paper aims to address this shortcoming by drawing on data from a cross-sectional survey of 2009 adult residents in neighbourhoods near 13 contaminated sites across Australia. Analyses used ordered logistic regression to determine the sociodemographic, environmental, and knowledge-based factors that influence residents' degree of worry. The findings suggest age, gender and income significantly affect residents' degree of worry. Being knowledgeable about the contaminant was associated with lower degrees of worry. Conversely, having a stronger sense of place within a neighbourhood predicted higher degrees of worry. Type of contaminant also impacted resident worry, with residents being less likely to worry about hydrocarbon, asbestos and waste than other types of contaminants. Our analyses suggest resident worry can be reduced through improving access to accurate information and the development of specific risk reduction strategies tailored to each neighbourhood and aimed at the heterogeneous distribution of worry amongst residential populations.

Health risk assessment of volatile organic compounds exposure near Daegu dyeing industrial complex in South Korea

BACKGROUND

Studying human health in areas with industrial contamination is a serious and complex issue. In recent years, attention has increasingly focused on the health implications of large industrial complexes. A variety of potential toxic chemicals have been produced during manufacturing processes and activities in industrial complexes in South Korea. A large number of dyeing industries gathered together in Daegu dyeing industrial complex. The residents near the industrial complex could be often exposed to volatile organic compounds. This study aimed to evaluate VOCs levels in the ambient air of DDIC, to assess the impact on human health risks, and to find more convincing evidences to prove these VOCs emitted from DDIC.

METHODS

According to deterministic risk assessment, inhalation was the most important route. Residential indoor, outdoor and personal exposure air VOCs were measured by passive samplers in exposed area and controlled area in different seasons. Satisfaction with ambient environments and self-reported diseases were also obtained by questionnaire survey. The VOCs concentrations in exposed area and controlled area was compared by t-test. The relationships among every VOC were tested by correlation. The values of hazard quotient (HQ) and life cancer risk were estimated.

RESULTS

The concentrations of measured VOCs were presented, moreover, the variety of concentrations according the distances from the residential settings to the industrial complex site in exposed area. The residential indoor, outdoor, and personal exposure concentrations of toluene, DMF and chloroform in exposed area were significantly higher than the corresponding concentrations in controlled area both in summer and autumn. Toluene, DMF, chloroform and MEK had significantly positive correlations with each other in indoor and outdoor, and even in personal exposure. The HQ for DMF exceeded 1, and the life cancer risk of chloroform was greater than 10^- 4 in exposed area. The prevalence of respiratory diseases, anaphylactic diseases and cardiovascular diseases in exposed area were significantly higher than in controlled area.

CONCLUSIONS

This study showed that adverse cancer and non-cancer health effects may occur by VOCs emitted from DDIC, and some risk managements are needed. Moreover, this study provides a convenient preliminarily method for pollutants source characteristics.

Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status

OBJECTIVES

To quantify nationwide disparities in the location of particulate matter (PM)-emitting facilities by the characteristics of the surrounding residential population and to illustrate various spatial scales at which to consider such disparities.

METHODS

We assigned facilities emitting PM in the 2011 National Emissions Inventory to nearby block groups across the 2009 to 2013 American Community Survey population. We calculated the burden from these emissions for racial/ethnic groups and by poverty status. We quantified disparities nationally and for each state and county in the country.

RESULTS

For PM of 2.5 micrometers in diameter or less, those in poverty had 1.35 times higher burden than did the overall population, and non-Whites had 1.28 times higher burden. Blacks, specifically, had 1.54 times higher burden than did the overall population. These patterns were relatively unaffected by sensitivity analyses, and disparities held not only nationally but within most states and counties as well.

CONCLUSIONS

Disparities in burden from PM-emitting facilities exist at multiple geographic scales. Disparities for Blacks are more pronounced than are disparities on the basis of poverty status. Strictly socioeconomic considerations may be insufficient to reduce PM burdens equitably across populations.

Sociocultural Considerations in Juvenile Arthritis: A Review

PROBLEM

Juvenile Arthritis (JA) is one of the most common autoimmune diseases in children. A variety of sociocultural factors that influence health outcomes in children with JA have been examined in previous research. However, clinical guidelines to guide the care of these children lack support because this research has not been systematically examined and synthesized.

ELIGIBILITY CRITERIA

Primary research articles from five internet databases were included if they were peer-reviewed articles in English of studies conducted in the U.S. or Canada and referenced one or more determinants of health, quality of life, socioeconomic status, or health disparities in children with JA.

SAMPLE

The final sample included 16 articles representing 2139 children and 939 parents.

RESULTS

Topics covered in the studies included medication compliance, electronic medical records, environmental risk factors, economic hardship, parental coping, leisure activities, and their effects on patient outcomes including disability and quality of life. Patients with Medicaid experienced more severe outcomes than patients with private insurance despite equivalent levels of healthcare utilization. Other important topics, such as effects of the physical environment and alcohol use, were missing from the literature.

CONCLUSIONS

Five categories of health determinants were found to influence outcomes: biology, individual behaviors, social environment, physical environment, and health services. Disparities continue to exist for racial and ethnic minority children with JA and those of low socioeconomic status.

IMPLICATIONS

Sociocultural factors should be taken into consideration when developing care plans, research studies, and policies in order to remove barriers and promote the best outcomes for this vulnerable population.

Disease and Health Inequalities Attributable to Air Pollutant Exposure in Detroit, Michigan

The environmental burden of disease is the mortality and morbidity attributable to exposures of air pollution and other stressors. The inequality metrics used in cumulative impact and environmental justice studies can be incorporated into environmental burden studies to better understand the health disparities of ambient air pollutant exposures. This study examines the diseases and health disparities attributable to air pollutants for the Detroit urban area. We apportion this burden to various groups of emission sources and pollutants, and show how the burden is distributed among demographic and socioeconomic subgroups. The analysis uses spatially-resolved estimates of exposures, baseline health rates, age-stratified populations, and demographic characteristics that serve as proxies for increased vulnerability, e.g., race/ethnicity and income. Based on current levels, exposures to fine particulate matter (PM_2.5), ozone (O₃), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂) are responsible for more than 10,000 disability-adjusted life years (DALYs) per year, causing an annual monetized health impact of $6.5 billion. This burden is mainly driven by PM_2.5 and O₃ exposures, which cause 660 premature deaths each year among the 945,000 individuals in the study area. NO₂ exposures, largely from traffic, are important for respiratory outcomes among older adults and children with asthma, e.g., 46% of air-pollution related asthma hospitalizations are due to NO₂ exposures. Based on quantitative inequality metrics, the greatest inequality of health burdens results from industrial and traffic emissions. These metrics also show disproportionate burdens among Hispanic/Latino populations due to industrial emissions, and among low income populations due to traffic emissions. Attributable health burdens are a function of exposures, susceptibility and vulnerability (e.g., baseline incidence rates), and population density. Because of these dependencies, inequality metrics should be calculated using the attributable health burden when feasible to avoid potentially underestimating inequality. Quantitative health impact and inequality analyses can inform health and environmental justice evaluations, providing important information to decision makers for prioritizing strategies to address exposures at the local level.

Children and youth's biopsychosocial wellbeing in the context of energy resource activities

BACKGROUND

Children and youth emerge as key populations that are impacted by energy resource activities, in part because of their developmental vulnerabilities, as well as the compounding effects of energy systems on their families, communities, and physical environments. While there is a larger literature focused on fossil fuel emissions and children, the impacts of many aspects of energy systems on children and youth remain under examined and scattered throughout the health, social science, and environmental science literatures.

OBJECTIVES

This systematic interdisciplinary review examines the biological, psychosocial, and economic impacts of energy systems identified through social science research - specifically focused on household and industrial extraction and emissions - on children and youth functioning.

METHODS

A critical interpretive search of interdisciplinary and international social sciences literature was conducted using an adaptive protocol focusing on the biopsychosocial and economic impacts of energy systems on children and youth. The initial results were complemented with a purposeful search to extend the breadth and depth of the final collection of articles.

DISCUSSION

Although relatively few studies have specifically focused on children and youth in this context, the majority of this research uncovers a range of negative health impacts that are directly and indirectly related to the development and ongoing operations of natural resource production, particularly oil and gas, coal, and nuclear energy. Psychosocial and cultural effects, however, remain largely unexamined and provide a rich avenue for further research.

CONCLUSIONS

This synthesis identifies an array of adverse biopsychosocial health outcomes on children and youth of energy resource extraction and emissions, and identifies gaps that will drive future research in this area.

Fatores de risco para mortalidade por doenças cardiovasculares associados à alta exposição ao tráfego veicular

RESUMO: Objetivo: Identificar áreas e fatores de risco para a mortalidade causada por doenças cardiovasculares (DC) associados à poluição do ar proveniente da alta exposição ao tráfego. Métodos: Estudo transversal da mortalidade por DC em 2.617 indivíduos de 45 a 85 anos residentes na zona urbana de Cuiabá e Várzea Grande, Mato Grosso, entre 2009 e 2011. Utilizou-se a proximidade residencial de até 150 metros de uma via de grande fluxo de veículos como proxy da alta exposição à poluição atmosférica proveniente do tráfego. A associação entre idade, sexo, renda e intensidade do trânsito com a exposição ao tráfego foi avaliada por meio de regressão logística múltipla. Foram realizadas análises estratificadas para observar a influência das estações do ano e dos grupos de causas. Utilizou-se modelo espacial de probabilidade de Bernoulli para identificação de áreas de risco. Resultados: Os principais fatores de risco para mortalidade por DC associados à alta exposição ao tráfego foram: residir em setores censitários com renda muito desigual (OR = 1,78; IC95% 1,36 - 2,33), trânsito intenso (OR = 1,20; IC95% 1,01 - 1,43) e sexo feminino (OR = 1,18; IC95% 1,01 - 1,38). O risco de mortalidade por DC aumenta cerca de 10% no período de seca. Foram identificadas nove áreas de risco. Conclusão: A alta exposição ao tráfego está associada à mortalidade por DC em Cuiabá e Várzea Grande. A desigualdade de renda, a intensidade do trânsito e o sexo feminino apresentaram-se como os principais determinantes dessa exposição, além da estação seca potencializá-la.

Hazard Characteristics and Patterns of Environmental Injustice: Household-Level Determinants of Environmental Risk in Miami, Florida

Limited systematic comparative knowledge exists about patterns of environmental injustices in exposure to varied natural and technological hazards. To address this gap, we examine how hazard characteristics (i.e., punctuated event/suddenness of onset, frequency/magnitude, and divisibility) influence relationships between race/ethnicity, nativity, socioeconomic status (SES), older age, housing tenure, and residential hazard exposure. Sociodemographic data come from a random sample survey of 602 residents of the tricounty Miami Metropolitan Statistical Area (Florida). Hazard exposure was measured using spatial data from the Federal Emergency Management Agency, the National Air Toxics Assessment, and the Emergency Response Notification System. We specified generalized estimating equations (GEEs)-which account for sociospatial clustering-predicting 100-year flood risk, acute chemical accidental releases, and chronic cancer risk from air toxics from all and on-road mobile sources. We found that for punctuated, sudden onset events, some socially advantaged people were significantly at risk. Racial/ethnic minority variables were significant predictors of greater exposure to the three technological hazards, while higher SES was associated with 100-year flood risk exposure. Black and foreign-born Hispanic residents, and white and U.S.-born Hispanic residents, shared nearly identical risk profiles. Results demonstrate the complexities found in human-hazard associations and the roles of hazard characteristics in shaping disparate risk patterns.

Systematic literature review of reproductive outcome associated with residential proximity to polluted sites

This study aims to assess the evidence on adverse pregnancy outcome associated with living close to polluted industrial sites, and identify the strengths and weaknesses of published epidemiological studies. A systematic literature search has been performed on all epidemiological studies published in developed countries since 1990, on the association between residential proximity to industrial sites (hazardous waste sites, industrial facilities and landfill sites) and adverse pregnancy outcome (low birth weight, preterm birth, small for gestational age, intrauterine growth retardation, infant mortality, congenital malformation). Based on 41 papers, our review reveals an excess risk of reproductive morbidity. However, no studies show significant excess risk of mortality including fetal death, neonatal or infant mortality and stillbirth. All published studies tend to show an increased risk of congenital abnormalities, yet not all are statistically significant. All but two of these studies revealed an excess risk of low birth weight. Results for preterm birth, small for gestational age and intrauterine growth retardation show the same pattern. There is suggestive evidence from the post-1990 literature that residential proximity to polluted sites (including landfills, hazardous waste sites and industrial facilities) might contribute to adverse reproductive outcomes, especially congenital malformations and low birth weight-though not mortality. This body of evidence has limitations that impede the formulation of firm conclusions, and new, well-focused studies are called for. The review findings suggest that continued strengthening of rules governing industrial emissions as well as industrial waste management and improved land use planning are needed.

Risk factors for central nervous system tumors in children: New findings from a case-control study

Background

Central nervous system tumors (CNS) are the most frequent solid tumor in children. Causes of CNS tumors are mainly unknown and only 5% of the cases can be explained by genetic predisposition. We studied the effects of environmental exposure on the incidence of CNS tumors in children by subtype, according to exposure to industrial and/or urban environment, exposure to crops and according to socio-economic status of the child.

Methods

We carried out a population-based case-control study of CNS tumors in Spain, covering 714 incident cases collected from the Spanish Registry of Childhood Tumors (period 1996–2011) and 4284 controls, individually matched by year of birth, sex, and autonomous region of residence. We built a covariate to approximate the exposure to industrial and/or urban environment and a covariate for the exposure to crops (GCI) using the coordinates of the home addresses of the children. We used the 2001 Census to obtain information about socio-economic status (SES). We fitted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs).

Results

The results for all CNS tumors showed an excess risk (OR = 1.37; 95%CI = 1.09–1.73) for SES, i.e., children living in the least deprived areas had 37% more risk of CNS tumor than children living in the most deprived areas. For GCI, an increase of 10% in crop surface in the 1-km buffer around the residence implied an increase of 22% in the OR (OR = 1.22; 95%CI = 1.15–1.29). Children living in the intersection of industrial and urban areas could have a greater risk of CNS tumors than children who live outside these areas (OR = 1.20; 95%CI = 0.82–1.77). Living in urban areas (OR = 0.90; 95%CI = 0.65–1.24) or industrial areas (OR = 0.96; 95%CI = 0.81–1.77) did not seem to increase the risk for all CNS tumors together. By subtype, Astrocytomas, Intracranial and intraspinal embryonal tumors, and other gliomas showed similar results.

Conclusion

Our results suggest that higher socioeconomic status and exposure to crops could increase the risk of CNS tumors in children.

Foundations Invest In Environmental Health

Nearly one in four deaths globally are due to environmental hazards such as air and water pollution, according to the World Health Organization. However, knowledge about how the environment affects health and health equity outcomes has not been well integrated into decisions that shape the conditions in which people live, work, and play. To address this challenge, US foundations have invested millions of dollars to make it easier to incorporate environmental health information into decisions ranging from family purchases and governmental policy making to business, medical, and other professional practices. This article summarizes grant making aimed at improving environmental conditions to improve health and health equity outcomes. We provide examples of environmental health grants that focus on tools that the public, policy makers, and professionals can use in making decisions. We found that the investment in and attention to environmental factors, including in work addressing social determinants of health, have been insufficient to realize the potential for reducing negative environmental impacts on health and health disparities. We argue that the grant making highlighted here has increased knowledge that could enable more widespread consideration of environmental health in many decisions, with positive effects on health and health equity.

Improving the health of African Americans in the USA: an overdue opportunity for social justice

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis

Cancer is the second most important non-communicable disease worldwide and disproportionately impacts low- to middle-income countries. Diet in combination with other lifestyle habits seems to modify the risk for some cancers but little is known about South Americans. Food habits of Argentinean men pre- and post-diagnosis of prostate cancer (n = 326) were assessed along with other lifestyle factors. We studied whether any of the behaviors and risk factors for prostate cancer were found in men with other cancers (n = 394), compared with control subjects (n = 629). Before diagnosis, both cases reported a greater mean consumption of meats and fats and lower intakes of fruits, green vegetables, cruciferous vegetables, legumes, nuts, seeds, and whole grains than the controls (all p < 0.001). After diagnosis, cases significantly reduced the intake of meats and fats, and reported other dietary modifications with increased consumption of fish, fruits (including red fruits in prostate cancer), cruciferous vegetables, legumes, nuts, and black tea (all p < 0.001). Additional lifestyle aspects significantly predominant in cases included a reduced quality of sleep, emotional stress, low physical activity, tobacco smoking, alcohol consumption, living in rural areas, and being exposed to environmental contaminants. Argentinian men were predisposed to modify their unhealthy dietary habits and other lifestyle factors after cancer diagnosis.

Chronic dietary exposure to pesticide residues and associated risk in the French ELFE cohort of pregnant women

Dietary exposure to pesticide residues may present a risk to public health, especially for sensitive populations such as pregnant women. To characterize this risk, this study assessed chronic dietary exposure to pesticide residues based on the French ELFE cohort. A self-administered food frequency questionnaire (FFQ) about the last three months of pregnancy filled in by pregnant women in 2011 was used in combination with occurrence data from French Total Diet Studies completed by the results of national monitoring programs on pesticide residues in food. The dietary intake of pesticides (μg/kg of body weight/day) was estimated for 14,099 pregnant women with a complete FFQ, for 317 substances under two occurrence scenarios to handle left-censored data: a lower-bound scenario (LB), where undetected results were set to zero, and an upper-bound scenario (UB), where undetected results were set to the detection limit if the substance was expected to be found in food and zero if it was not. The risk was assessed for 284 substances with a toxicological reference value (TRV) and a good coverage level of the diet potentially contributing to pesticide intake. The cumulative risk was also assessed for seven effects on nervous and thyroid systems using the hazard index and the Cumulative Assessment Groups defined by EFSA. Substances with the highest exposure levels under the LB scenario were, in decreasing order, imazalil, piperonyl butoxide, chlorpropham, thiabendazole, iprodione and propargite. Under the LB scenario, only for lindane did women have a statistically significant probability of exceeding the TRV (2.4%). Under the UB scenario, risk could not be excluded for nine other substances. A better management of left-censored data and more sensitive analyses of the main food contributors might help to refine the UB exposure and risk assessments. A statistically significant cumulative risk was found for neurochemical effects related to high intake levels of three organophosphate insecticides (chlorpyrifos, pirimiphos-methyl and dimethoate) mainly detected in fruits and cereals.

Wastewater Disposal Wells, Fracking, and Environmental Injustice in Southern Texas

OBJECTIVES

To investigate race and poverty in areas where oil and gas wastewater disposal wells, which are used to permanently inject wastewater from hydraulic fracturing (fracking) operations, are permitted.

METHODS

With location data of oil and gas disposal wells permitted between 2007 and 2014 in the Eagle Ford area, a region of intensive fracking in southern Texas, we analyzed the racial composition of residents living less than 5 kilometers from a disposal well and those farther away, adjusting for rurality and poverty, using a Poisson regression.

RESULTS

The proportion of people of color living less than 5 kilometers from a disposal well was 1.3 times higher than was the proportion of non-Hispanic Whites. Adjusting for rurality, disposal wells were 2.04 times (95% confidence interval = 2.02, 2.06) as common in areas with 80% people of color or more than in majority White areas. Disposal wells are also disproportionately sited in high-poverty areas.

CONCLUSIONS

Wastewater disposal wells in southern Texas are disproportionately permitted in areas with higher proportions of people of color and residents living in poverty, a pattern known as "environmental injustice."

Application of space-time disease clustering by administrative databases in Italy: Adverse Reproductive Outcomes (AROs) and residential exposure

BACKGROUND

The aims of this study were to estimate the existence of clusters of AROs in the municipalities of the Marches Region (Central Italy) after complaints from residents living near an abandoned landfill site.

METHODS

Cases of AROs (i.e., congenital malformation, chromosomal abnormalities, and low birth weight) were retrieved from hospital discharge data. SaTScan and GeoDa were used to check for the presence of clusters at a regional and a small area level. Moreover, at a small area/neighborhood level, smoothed rates were calculated, and a case-control approach was used to assess the residence in proximity to the abandoned landfill as an independent risk factor for AROs.

RESULTS

AROs were associated with the price per square meter of the accommodations in the area of residence (OR 2.53, 95 % CI 2.06-3.10). On the other hand, residence within one kilometer of the landfill (OR 0.04, 95 % CI 0.01-0.23) and maternal age greater than 35 years (OR 0.96, 95 % CI 0.92-0.99) were protective.

CONCLUSIONS

Residency in proximity to the abandoned landfill was not a risk factor for the occurrence of AROs. The results show that basic information, such as the price of accommodations in different neighborhoods, could be of interest in order to target training programs for women living in difficult conditions and highlights the potential role of the building environment in perinatal health. However, we note that aside from the data provided by Geographic Information Systems in public health, collection of the patient's residential address was unreliable for selected conditions. Future efforts should emphasize the patient's residential address as information important for evaluating the health of individuals instead of being merely administrative data.

Application of Citizen Science Risk Communication Tools in a Vulnerable Urban Community

A public participatory geographical information systems (PPGIS) demographic, environmental, socioeconomic, health status portal was developed for the Stambaugh-Elwood (SE) community in Columbus, OH. We hypothesized that soil at SE residences would have metal concentrations above natural background levels. Three aims were developed that allowed testing of this hypothesis. Aim 1 focused on establishing partnerships between academia, state agencies and communities to assist in the development of a community voice. Aim 2 was to design and conduct soil sampling for residents of the SE community. Aim 3 was to utilize our interactive, customized portal as a risk communication tool by allowing residents to educate themselves as to the potential risks from industrial sources in close proximity to their community. Multiple comparisons of means were used to determine differences in soil element concentration by sampling location at p < 0.05. The results demonstrated that eight metals (As, Cd, Cu, Pb, Mo, Se, Tl, Zn) occurred at statistically-significantly greater levels than natural background levels, but most were below risk-based residential soil screening levels. Results were conveyed to residents via an educational, risk-communication informational card. This study demonstrates that community-led coalitions in collaboration with academic teams and state agencies can effectively address environmental concerns.

Engaging Communities in Research on Cumulative Risk and Social Stress-Environment Interactions: Lessons Learned from EPA's STAR Program

Studies have documented cumulative health effects of chemical and nonchemical exposures, particularly chronic environmental and social stressors. Environmental justice groups have advocated for community participation in research that assesses how these interactions contribute to health disparities experienced by low-income and communities of color. In 2009, the U.S. Environmental Protection Agency issued a request for research applications (RFA), "Understanding the Role of Nonchemical Stressors and Developing Analytic Methods for Cumulative Risk Assessments." Seven research projects were funded to help address this knowledge gap. Each engaged with communities in different ways. We describe the community engagement approaches of the seven research projects, which ranged from outreach through shared leadership/participatory. We then assess the experiences of these programs with respect to the community engagement goals of the RFA. We present insights from these community engagement efforts, including how the grants helped to build or enhance the capacity of community organizations in addition to contributing to the research projects. Our analysis of project proposals, annual grantee reports, and participant observation of these seven projects suggests guidelines for the development of future funding mechanisms and for conducting community-engaged research on cumulative risk involving environmental and social stressors including: 1) providing for flexibility in the mode of community engagement; 2) addressing conflict between research timing and engagement needs, 3) developing approaches for communicating about the uniquely sensitive issues of nonchemical stressors and social risks; and 4) encouraging the evaluation of community engagement efforts.

Autism spectrum disorder prevalence and proximity to industrial facilities releasing arsenic, lead or mercury

Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outcomes in offspring and may contribute to prevalence of autism spectrum disorder (ASD). For this ecologic study, we evaluated the association between ASD prevalence, at the census tract level, and proximity of tract centroids to the closest industrial facilities releasing arsenic, lead or mercury during the 1990s. We used 2000 to 2008 surveillance data from five sites of the Autism and Developmental Disabilities Monitoring (ADDM) network and 2000 census data to estimate prevalence. Multi-level negative binomial regression models were used to test associations between ASD prevalence and proximity to industrial facilities in existence from 1991 to 1999 according to the US Environmental Protection Agency Toxics Release Inventory (USEPA-TRI). Data for 2489 census tracts showed that after adjustment for demographic and socio-economic area-based characteristics, ASD prevalence was higher in census tracts located in the closest 10th percentile compared of distance to those in the furthest 50th percentile (adjusted RR=1.27, 95% CI: (1.00, 1.61), P=0.049). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.

Lung function and fractional exhaled nitric oxide among petroleum refinery workers

Background

Occupational and environmental exposure to petroleum refinery products poses a great threat to human health. This study aimed to assess the lung function and Fractional Exhaled Nitric Oxide (FeNO) among petroleum refinery workers.

Methods

In this cross-sectional study, 112 participants (56 petroleum refinery workers with mean age 35.20 ± 1.62 years, and 56 age, weight, height, ethnicity and socioeconomically matched control subjects with mean age 30.02 ± 1.76 years) were recruited. A comprehensive clinical history and examination was conducted to decide whether to include in the study or not. Ventilatory lung function test parameters were recorded by using a Spirometer and Fractional Exhaled Nitric Oxide (FeNO) was measured by Niox Mino.

Results

A significant decline in lung function parameters FEV1 (p = 0.0001), FEV1/FVC Ratio (p = 0.01), PEF (p = 0.0001), FEF 25 % (p = 0.0001), FEF-50 % (p = 0.012) was observed among oil refinery workers compared to their matched controls. However, there was no difference in the mean values of FeNO between the groups.

Conclusion

Subjects working in the petroleum refinery have significantly impaired lung functions. However, there was no change in the values of FENO between the groups. The lung function impairment pattern provide evidence in the favor of an obstructive lung disease.

Racial/Ethnic Disparities in Cumulative Environmental Health Impacts in California: Evidence From a Statewide Environmental Justice Screening Tool (CalEnviroScreen 1.1)

OBJECTIVES

We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities.

METHODS

CalEnviroScreen 1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty.

RESULTS

The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal.

CONCLUSIONS

Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action.

Identifying potential exposure reduction priorities using regional rankings based on emissions of known and suspected carcinogens to outdoor air in Canada

BACKGROUND

Emissions inventories aid in understanding the sources of hazardous air pollutants and how these vary regionally, supporting targeted reduction actions. Integrating information on the relative toxicity of emitted pollutants with respect to cancer in humans helps to further refine reduction actions or recommendations, but few national programs exist in North America that use emissions estimates in this way. The CAREX Canada Emissions Mapping Project provides key regional indicators of emissions (total annual and total annual toxic equivalent, circa 2011) of 21 selected known and suspected carcinogens.

METHODS

The indicators were calculated from industrial emissions reported to the National Pollutant Release Inventory (NPRI) and estimates of emissions from transportation (airports, trains, and car and truck traffic) and residential heating (oil, gas and wood), in conjunction with human toxicity potential factors. We also include substance-specific annual emissions in toxic equivalent kilograms and annual emissions in kilograms, to allow for ranking substances within any region.

RESULTS

For provinces and territories in Canada, the indicators suggest the top five substances contributing to the total toxic equivalent emissions in any region could be prioritized for further investigation. Residents of Quebec and New Brunswick may be more at risk of exposure to industrial emissions than those in other regions, suggesting that a more detailed study of exposure to industrial emissions in these provinces is warranted. Residential wood smoke may be an important emission to control, particularly in the north and eastern regions of Canada. Residential oil and gas heating, along with rail emissions contribute little to regional emissions and therefore may not be an immediate regional priority.

CONCLUSIONS

The developed indicators support the identification of pollutants and sources for additional investigation when planning exposure reduction actions among Canadian provinces and territories, but have important limitations similar to other emissions inventory-based tools. Additional research is required to evaluate how the Emissions Mapping Project is used by different groups and organizations with respect to informing actions aimed at reducing Canadians' potential exposure to harmful air pollutants.

Using Geographic Information Science to Explore Associations between Air Pollution, Environmental Amenities, and Preterm Births

The study uses geographic information science (GIS) and statistics to find out if there are statistical differences between full term and preterm births to non-Hispanic white, non-Hispanic Black, and Hispanic mothers in their exposure to air pollution and access to environmental amenities (green space and vendors of healthy food) in the second largest city in New England, Worcester, Massachusetts. Proximity to a Toxic Release Inventory site has a statistically significant effect on preterm birth regardless of race. The air-pollution hazard score from the Risk Screening Environmental Indicators Model is also a statistically significant factor when preterm births are categorized into three groups based on the degree of prematurity. Proximity to green space and to a healthy food vendor did not have an effect on preterm births. The study also used cluster analysis and found statistically significant spatial clusters of high preterm birth volume for non-Hispanic white, non-Hispanic Black, and Hispanic mothers.

Childhood leukemia and residential proximity to industrial and urban sites

BACKGROUND

Few risk factors for the childhood leukemia are well established. While a small fraction of cases of childhood leukemia might be partially attributable to some diseases or ionizing radiation exposure, the role of industrial and urban pollution also needs to be assessed.

OBJECTIVES

To ascertain the possible effect of residential proximity to both industrial and urban areas on childhood leukemia, taking into account industrial groups and toxic substances released.

METHODS

We conducted a population-based case-control study of childhood leukemia in Spain, covering 638 incident cases gathered from the Spanish Registry of Childhood Tumors and for those Autonomous Regions with 100% coverage (period 1990-2011), and 13,188 controls, individually matched by year of birth, sex, and autonomous region of residence. Distances were computed from the respective subject's residences to the 1068 industries and the 157 urban areas with ≥10,000 inhabitants, located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to industrial and urban pollution sources were calculated, with adjustment for matching variables.

RESULTS

Excess risk of childhood leukemia was observed for children living near (≤2.5 km) industries (OR=1.31; 95%CI=1.03-1.67) - particularly glass and mineral fibers (OR=2.42; 95%CI=1.49-3.92), surface treatment using organic solvents (OR=1.87; 95%CI=1.24-2.83), galvanization (OR=1.86; 95%CI=1.07-3.21), production and processing of metals (OR=1.69; 95%CI=1.22-2.34), and surface treatment of metals (OR=1.62; 95%CI=1.22-2.15) - , and urban areas (OR=1.36; 95%CI=1.02-1.80).

CONCLUSIONS

Our study furnishes some evidence that living in the proximity of industrial and urban sites may be a risk factor for childhood leukemia.

Data analysis techniques: a tool for cumulative exposure assessment

Everyone is subject to environmental exposures from various sources, with negative health impacts (air, water and soil contamination, noise, etc.or with positive effects (e.g. green space). Studies considering such complex environmental settings in a global manner are rare. We propose to use statistical factor and cluster analyses to create a composite exposure index with a data-driven approach, in view to assess the environmental burden experienced by populations. We illustrate this approach in a large French metropolitan area. The study was carried out in the Great Lyon area (France, 1.2 M inhabitants) at the census Block Group (BG) scale. We used as environmental indicators ambient air NO2 annual concentrations, noise levels and proximity to green spaces, to industrial plants, to polluted sites and to road traffic. They were synthesized using Multiple Factor Analysis (MFA), a data-driven technique without a priori modeling, followed by a Hierarchical Clustering to create BG classes. The first components of the MFA explained, respectively, 30, 14, 11 and 9% of the total variance. Clustering in five classes group: (1) a particular type of large BGs without population; (2) BGs of green residential areas, with less negative exposures than average; (3) BGs of residential areas near midtown; (4) BGs close to industries; and (5) midtown urban BGs, with higher negative exposures than average and less green spaces. Other numbers of classes were tested in order to assess a variety of clustering. We present an approach using statistical factor and cluster analyses techniques, which seem overlooked to assess cumulative exposure in complex environmental settings. Although it cannot be applied directly for risk or health effect assessment, the resulting index can help to identify hot spots of cumulative exposure, to prioritize urban policies or to compare the environmental burden across study areas in an epidemiological framework.

Validity of geographically modeled environmental exposure estimates

Geographic modeling is increasingly being used to estimate long-term environmental exposures in epidemiologic studies of chronic disease outcomes. However, without validation against measured environmental concentrations, personal exposure levels, or biologic doses, these models cannot be assumed a priori to be accurate. This article discusses three examples of epidemiologic associations involving exposures estimated using geographic modeling, and identifies important issues that affect geographically modeled exposure assessment in these areas. In air pollution epidemiology, geographic models of fine particulate matter levels have frequently been validated against measured environmental levels, but comparisons between ambient and personal exposure levels have shown only moderate correlations. Estimating exposure to magnetic fields by using geographically modeled distances is problematic because the error is larger at short distances, where field levels can vary substantially. Geographic models of environmental exposure to pesticides, including paraquat, have seldom been validated against environmental or personal levels, and validation studies have yielded inconsistent and typically modest results. In general, the exposure misclassification resulting from geographic models of environmental exposures can be differential and can result in bias away from the null even if non-differential. Therefore, geographic exposure models must be rigorously constructed and validated if they are to be relied upon to produce credible scientific results to inform epidemiologic research. To our knowledge, such models have not yet successfully predicted an association between an environmental exposure and a chronic disease outcome that has eventually been established as causal, and may not be capable of doing so in the absence of thorough validation.

Asthma, respiratory symptoms and lung function in children living near a petrochemical site

Residential proximity to environmental hazards has been related to adverse health outcomes. Respiratory health and allergies in children living near petrochemical sites have not been extensively studied. We evaluated the association between residential proximity to the petrochemical site of Tarragona (Catalonia, Spain) and the prevalence of asthma, respiratory symptoms and lung function in children. Children aged 6-7 (n=2672) and adolescents aged 13-14 (n=2524) residing near two large petrochemical sites and those living in a city with medium vehicular traffic were cross-sectionally compared with children from an area with low vehicular traffic and without industry. The prevalence of symptoms was measured using the International Study of Asthma and Allergies in Childhood written and video questionnaires. Lung function measurements were done in a subsample of 959 adolescents in the four areas. Multivariable analyses were done to estimate the effects of the residential area on symptoms and lung function adjusted for potential confounders. Crude prevalence of symptoms was similar across the studied areas. After adjustment, children and adolescents living near a petrochemical site had a statistically significant higher prevalence of respiratory hospitalizations in the previous year (Prevalence Ratio (PR)=1.49; 95%CI, 1.06-2.09) and of nocturnal cough (PR=1.29; 95%CI 1.05-1.57), respectively. Reduced lung function values among adolescents residing near the petrochemical areas were not observed. Although a higher prevalence of asthma in children and adolescents living near the petrochemical sites could not be demonstrated, as described in other studies, respiratory hospitalizations and nocturnal cough could be related to short-term exposures to pollutants. Other clinical and sub-clinical respiratory health effects in the petrochemical industry areas should be investigated.

Disaster-related environmental health hazards: former lead smelting plants in the United States

OBJECTIVE

Natural disasters exacerbate risks of hazardous environmental exposures and adverse health consequences. The present study determined the proportion of previously identified lead industrial sites in urban locations that are at high risk for dispersal of toxic chemicals by natural disasters.

METHODS

Geographic analysis from publicly available data identified former lead smelting plants that coincide with populated urban areas and with high-risk locations for natural disasters.

RESULTS

From a total of 229 urban smelting sites, 66 (29%) were in relatively high-risk areas for natural disasters: flood (39), earthquake (29), tornado (3), and hurricane (2). States with urban sites at relatively high risk for natural disaster included California (15); Pennsylvania (14); New York (7); Missouri (6); Illinois (5); New Jersey (4); Kentucky (3); Florida, Oregon, and Ohio (2 each); and Indiana, Massachusetts, Rhode Island, Texas, Utah, and Washington (1 each). Incomplete historical records showed at least 10 smelting site locations were affected by natural disaster.

CONCLUSIONS

Forgotten environmental hazards may remain hazardous in any community. Uncertainty about risks in disasters causes disruptive public anxiety that increases difficulties in community responses and recovery. Our professional and public responsibility is to seek a better understanding of the risks of latent environmental hazards.

Evidence of high rates of undiagnosed asthma in central Ohio elementary schoolchildren

BACKGROUND

In Ohio, 14.5% of 5- to 9-year-olds and 17.3% of 10- to 17-year-olds have asthma. Moreover, there is concern that these numbers may underestimate the true disease burden. We sought to evaluate variability in asthma rates and respiratory symptoms among central Ohio fourth graders as a means to assess potential undiagnosed and undertreated asthma and its determinants.

METHODS

We recruited 13 central Ohio elementary schools representing a broad range of nonurban settings and surveyed fourth graders to estimate school-level physician-diagnosed asthma (PDA), respiratory morbidity, and home exposures to smoking and pets. We used generalized linear mixed models with random intercept for school to examine relationships among exposures, respiratory symptoms, and PDA.

RESULTS

Across the 13 schools, 94% of students participated in the survey, and the estimated asthma prevalence rate was 10.2% (N = 101 of 987). An additional 41% reported not having PDA but then went on to report symptoms consistent with asthma potentially suggestive of undiagnosed asthma. Of students with PDA, 21% reported symptoms suggestive of poorly controlled asthma. High levels of secondhand smoke (SHS) exposure were associated both with PDA (p = .05) and with respiratory symptoms (p < .0001). Students who owned a cat or a bird were more likely to report respiratory symptoms (p = .02 and p = .04, respectively).

CONCLUSIONS

We provide evidence that the already high childhood asthma public health burden in central Ohio may be underreported. Schools may be an ideal location to conduct screenings and implement environmental interventions oriented toward SHS and household pets that will yield respiratory morbidity benefits.

Spatial disparity in the distribution of superfund sites in South Carolina: an ecological study

BACKGROUND

According to the US Environmental Protection Agency (EPA), Superfund is a federal government program implemented to clean up uncontrolled hazardous waste sites. Twenty-six sites in South Carolina (SC) have been included on the National Priorities List (NPL), which has serious human health and environmental implications. The purpose of this study was to assess spatial disparities in the distribution of Superfund sites in SC.

METHODS

The 2000 US census tract and block level data were used to generate population characteristics, which included race/ethnicity, socioeconomic status (SES), education, home ownership, and home built before 1950. Geographic Information Systems (GIS) were used to map Superfund facilities and develop choropleth maps based on the aforementioned sociodemographic variables. Spatial methods, including mean and median distance analysis, buffer analysis, and spatial approximation were employed to characterize burden disparities. Regression analysis was performed to assess the relationship between the number of Superfund facilities and population characteristics.

RESULTS

Spatial coincidence results showed that of the 29.5% of Blacks living in SC, 55.9% live in Superfund host census tracts. Among all populations in SC living below poverty (14.2%), 57.2% were located in Superfund host census tracts. Buffer analyses results (0.5mi, 1.0mi, 5.0mi, 0.5km, 1.0km, and 5.0km) showed a higher percentage of Whites compared to Blacks hosting a Superfund facility. Conversely, a slightly higher percentage of Blacks hosted (30.2%) a Superfund facility than those not hosting (28.8%) while their White counterparts had more equivalent values (66.7% and 67.8%, respectively). Regression analyses in the reduced model (Adj. R2 = 0.038) only explained a small percentage of the variance. In addition, the mean distance for percent of Blacks in the 90th percentile for Superfund facilities was 0.48mi.

CONCLUSION

Burden disparities exist in the distribution of Superfund facilities in SC at the block and census tract levels across varying levels of demographic composition for race/ethnicity and SES.

Leaking Underground Storage Tanks and Environmental Injustice: Is There a Hidden and Unequal Threat to Public Health in South Carolina?

There are approximately 590,000 underground storage tanks (USTs) nationwide that store petroleum or hazardous substances. Many of these tanks are leaking, which may increase the risk of exposure to contaminants that promote health problems in host neighborhoods. Within this study, we assessed disparities in the spatial distribution of leaking underground storage tanks (LUSTs) based on socioeconomic status (SES) and race/ethnicity in South Carolina (SC). Chi-square tests were used to evaluate the difference in the proportion of populations who host a LUST compared to those not hosting a LUST for all sociodemographic factors. Linear regression models were applied to examine the association of distance to the nearest LUST with relevant sociodemographic measures. As percent black increased, the distance (both in kilometers and miles) to the nearest LUST decreased. Similar results were observed for percent poverty, unemployment, persons with less than a high school education, blacks in poverty, and whites in poverty. Furthermore, chi-square tests indicated that blacks or non-whites or people with low SES were more likely to live in LUST host areas than in non-host areas. As buffer distance increased, percent black and non-white decreased. SES variables demonstrated a similar inverse relationship. Overall, burden disparities exist in the distribution of LUSTs based on race/ethnicity and SES in SC.

Adverse birth outcomes in the vicinity of industrial installations in Spain 2004-2008

Industrial activity is one of the main sources of ambient pollution in developed countries. However, research analyzing its effect on birth outcomes is inconclusive. We analyzed the association between proximity of mother's municipality of residence to industries from 24 different activity groups and risk of very (VPTB) and moderate (MPTB) preterm birth, very (VLBW) and moderate (MLBW) low birth weight, and small for gestational age (SGA) in Spain, 2004-2008. An ecological study was defined, and a "near vs. far" analysis (3.5 km threshold) was carried out using Hierarchical Bayesian models implemented via Integrated Nested Laplace Approximation. VPTB risk was higher for mothers living near pharmaceutical companies. Proximity to galvanization and hazardous waste management industries increased the risk of MPTB. Risk of VLBW was higher for mothers residing near pharmaceutical and non-hazardous or animal waste management industries. For MLBW many associations were found, being notable the proximity to mining, biocides and animal waste management plants. The strongest association for SGA was found with proximity to management animal waste plants. These results highlight the importance of further research on the relationship between proximity to industrial sites and the occurrence of adverse birth outcomes especially for the case of pharmaceutical and animal waste management activities.

U.S. EPA authority to use cumulative risk assessments in environmental decision-making

Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA's general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself.

Symposium on integrating the science of environmental justice into decision-making at the Environmental Protection Agency: an overview

In March 2010, the Environmental Protection Agency (EPA) collaborated with government and nongovernmental organizations to host a groundbreaking symposium, "Strengthening Environmental Justice Research and Decision Making: A Symposium on the Science of Disproportionate Environmental Health Impacts." The symposium provided a forum for discourse on the state of scientific knowledge about factors identified by EPA that may contribute to higher burdens of environmental exposure or risk in racial/ethnic minorities and low-income populations. Also featured were discussions on how environmental justice considerations may be integrated into EPA's analytical and decision-making frameworks and on research needs for advancing the integration of environmental justice into environmental policymaking. We summarize key discussions and conclusions from the symposium and briefly introduce the articles in this issue.