Environmental justice and the health of children

Nucleic acid aptamers protect against lead (Pb(II)) toxicity

Lead (Pb(II)) is a pervasive heavy metal toxin with many well-established negative effects on human health. Lead toxicity arises from cumulative, repeated environmental exposures. Thus, prophylactic strategies to protect against the bioaccumulation of lead could reduce lead-associated human pathologies. Here we show that DNA and RNA aptamers protect C. elegans from toxic phenotypes caused by lead. Reproductive toxicity, as measured by brood size assays, is prevented by co-feeding of animals with DNA or RNA aptamers. Similarly, lead-induced neurotoxicity, measured by behavioral assays, are also normalized by aptamer feeding. Further, cultured human HEK293 and primary murine osteoblasts are protected from lead toxicity by transfection with DNA aptamers. The osteogenic development, which is decreased by lead exposure, is maintained by prior transfection of lead-binding DNA aptamers. Aptamers may be an effective strategy for the protection of human health in the face of increasing environmental toxicants.

Communities Disproportionately Affected by Carbon Monoxide Exposure After Winter Storm Uri

Extreme cold in February 2021 precipitated prolonged power failure in Texas. In Houston, many patients presented for carbon monoxide exposure from neighborhoods with lower per capita income, higher rates of limited English proficiency, and greater median Social Vulnerability Indices than Greater Houston. Weather-related disasters disproportionately affect socially vulnerable communities.

Advancing Understanding of Chemical Exposures and Maternal-child Health Through the U.S. Environmental Influences on Child Health Outcomes (ECHO) Program: A Scoping Review

PURPOSE OF REVIEW

Environmental chemical exposures may disrupt child development, with long-lasting health impacts. To date, U.S. studies of early environmental exposures have been limited in size and diversity, hindering power and generalizability. With harmonized data from over 60,000 participants representing 69 pregnancy cohorts, the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) Program is the largest study of U.S. children's health. Here, we: (1) review ECHO-wide studies of chemical exposures and maternal-child health; and (2) outline opportunities for future research using ECHO data.

RECENT FINDINGS

As of early 2024, in addition to over 200 single-cohort (or award) papers on chemical exposures supported by ECHO, ten collaborative multi-cohort papers have been made possible by ECHO data harmonization and new data collection. Multi-cohort papers have examined prenatal exposure to per- and polyfluoroalkyl substances (PFAS), phthalates, phenols and parabens, organophosphate esters (OPEs), metals, melamine and aromatic amines, and emerging contaminants. They have primarily focused on describing patterns of maternal exposure or examining associations with maternal and infant outcomes; fewer studies have examined later child outcomes (e.g., autism) although follow up of enrolled ECHO children continues. The NICHD's Data and Specimen Hub (DASH) database houses extensive ECHO data including over 470,000 chemical assay results and complementary data on priority outcome areas (pre, peri-, and postnatal, airway, obesity, neurodevelopment, and positive health), making it a rich resource for future analyses. ECHO's extensive data repository, including biomarkers of chemical exposures, can be used to advance our understanding of environmental influences on children's health. Although few published studies have capitalized on these unique harmonized data to date, many analyses are underway with data now widely available.

Lead brownfields and birth defects in North Carolina 2003-2015: A cross-sectional case-control study

BACKGROUND

Brownfields consist of abandoned and disused sites, spanning many former purposes. Brownfields represent a heterogenous yet ubiquitous exposure for many Americans, which may contain hazardous wastes and represent urban blight. Neonates and pregnant individuals are often sensitive to subtle environmental exposures. We evaluate if residential exposure to lead (Pb) brownfields is associated with birth defects.

METHODS

Using North Carolina birth records from 2003 to 2015, we sampled 169,499 births within 10 km of a Pb brownfield with 3255 cardiovascular, central nervous, or external defects identified. Exposure was classified by binary specification of residing within 3 km of a Pb brownfield. We utilized multivariable logistic regression models adjusted for demographic covariates available from birth records and 2010 Census to estimate odds ratios (OR) and 95% confidence intervals (CI). Effect measure modification was assessed by inclusion of interaction terms and stratification for the potential modifiers of race/ethnicity and diabetes status.

RESULTS

We observed positive associations between cardiovascular birth defects and residential proximity to Pb brownfields, OR (95%CI): 1.15 (1.04, 1.26), with suggestive positive associations for central nervous 1.16 (0.91, 1.47) and external defects 1.19 (0.88, 1.59). We did observe evidence of effect measure modification via likelihood ratio tests (LRT) for race/ethnicity for central nervous and external defect groups (LRT p values 0.08 and 0.02). We did observe modification by diabetes status for the cardiovascular group (LRT p value 0.08).

CONCLUSIONS

Our results from this analysis indicate that residential proximity to Pb brownfields is associated with cardiovascular birth defects with suggestive associations for central nervous and external defects. In-depth analyses of individual defects and other contaminants or brownfield site functions may reveal additional novel associations.

Promotion of environmental public health and environmental justice in communities affected by large and long lasting industrial contamination: methods applied and lessons learned from the case study of Porto Torres (Italy)

Introduction

Communities affected by large scale and long lasting industrial contamination are often keen to understand whether their health has been impaired by such contamination. This requires answers that integrate environmental public health and environmental justice perspectives. At these sites, exposure scenarios from environmental contamination over time by multiple chemicals, often involving different environmental matrices, are complex and challenging to reconstruct.

Methods

An approach for describing the health of such communities in association with environmental contamination is presented, with the methods applied across the three domains of environmental contamination, population exposure and toxicology, environmental and social epidemiology, and environmental public health communication. The approach is described with examples from its application to the case study of Porto Torres, a town with a substantial industrially conditioned evolution.

Results

Activities in the field of environmental contamination, population exposure and toxicology focus on the collection and systematization of available contamination data, the identification of priority pollutants based on their toxicological profiles, the qualitative assessment of the likelihood of exposure for the population to priority pollutants and their known health effects. Environmental and social epidemiology methods are applied to describe the health profiles and socioeconomic conditions of the local population, taking into account multiple health outcomes from local information systems and considering specific diseases based on exposure and toxicological assessments. The environmental public health communication methods are directed to produce a communication plan and for its implementation through interaction with local institutional and social actors. The interpretation of health profiles benefits from a transdisciplinary analysis of the results.

Discussion

The proposed approach combines the needs of environmental public health and environmental justice allowing the integration of multidisciplinary knowledge to define recommendations for reducing and/or preventing hazardous environmental exposures and adverse health effects, stimulating the interactions between stakeholders, and making the study results more accessible to citizens.

Associations of long-term exposure to air pollution and noise with body composition in children and adults: Results from the LEAD general population study

BACKGROUND

While long-term air pollution and noise exposure has been linked to increasing cardiometabolic disease risk, potential effects on body composition remains unclear. This study aimed to investigate the associations of long-term air pollution, noise and body composition.

METHODS

We used repeated data from the LEAD (Lung, hEart, sociAl, boDy) study conducted in Vienna, Austria. Body mass index (BMI; kg/m2), fat mass index (FMI; z-score), and lean mass index (LMI; z-score) were measured using dual-energy x-ray absorptiometry at the first (t0; 2011-ongoing) and second (t1; 2017-ongoing) examinations. Annual particulate matter (PM10) and nitrogen dioxide (NO2) concentrations were estimated with the GRAMM/GRAL model (2015-2021). Day-evening-night (Lden) and night-time (Lnight) noise levels from transportation were modeled for 2017 following the European Union Directive 2002/49/EC. Exposures were assigned to residential addresses. We performed analyses separately in children/adolescents and adults, using linear mixed-effects models with random participant intercepts and linear regression models for cross-sectional and longitudinal associations, respectively. Models were adjusted for co-exposure, lifestyle and sociodemographics.

RESULTS

A total of 19,202 observations (nt0 = 12,717, nt1 = 6,485) from participants aged 6-86 years (mean age at t0 = 41.0 years; 52.9 % female; mean PM10 = 21 µg/m3; mean follow-up time = 4.1 years) were analyzed. Among children and adolescents (age ≤ 18 years at first visit), higher PM10exposure was cross-sectionally associated with higher FMI z-scores (0.09 [95 % Confidence Interval (CI): 0.03, 0.16]) and lower LMI z-scores (-0.05 [95 % CI: -0.10, -0.002]) per 1.8 µg/m3. Adults showed similar trends in cross-sectional associations as children, though not reaching statistical significance. We observed no associations for noise exposures. Longitudinal analyses on body composition changes over time yielded positive associations for PM10, but not for other exposures.

CONCLUSION

Air pollution exposure, mainly PM10, was cross-sectionally and longitudinally associated with body composition in children/adolescents and adults. Railway/road-traffic noise exposures showed no associations in both cross-sectional and longitudinal analyses.

Validating self-reported Toxic Release Inventory data using Benford's Law: investigating toxic chemical release hazards in floodplains

Introduction

Acute and long-term health impacts from flooding related toxic chemical releases are a significant local health concern and can disproportionately impact communities with vulnerable populations; reliable release data are needed to quantify this hazard.

Methods

In this paper, we analyze US Federal Emergency Management Agency designated floodplain data and US Environmental Protection Agency Toxic Release Inventory (TRI) data to determine if geographically manipulated databases adhere to Benford's Law.

Results

We investigated multiple variants and discovered pollution releases adhere to Benford's Law and tests which thereby validates the self-reported toxic release dataset.

Discussion

We find that Benford's Law applies to self-reported toxic chemical release and disposal data, indicating a lack of widespread data errors or manipulation.

Clustering by chemicals: A novel examination of chemical pollutants and social vulnerability in children and adolescents

BACKGROUND

Inhaled air pollutants are environmental determinants of health with negative impacts on human health. Air pollution has been linked to the incidence and progression of disease, with its effects unequally distributed across the population. Children compared to adults are a highly vulnerable group and suffer disproportionately from systemic environmental inequities exacerbated by social determinants.

OBJECTIVE

To explore air pollution cluster patterns among 6- to 19-year-olds from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) and examine chemical cluster associations with social vulnerability.

METHODS

NHANES data was extracted for 697 children and adolescents. Social vulnerability characteristics from questionnaires were assembled to construct a modified social vulnerability index (SVI). Thirty-four air pollutant exposure chemicals were measured in urine and available from the laboratory sub-sample A data. K-means clustering classified the sample into three groups: low, medium, and high chemical exposure groups. Logistic regression was used to examine associations between high chemical group membership and SVI after adjusting for age, biological sex, and BMI. Complex survey analysis was conducted using SAS v9.4 to reflect population effects.

RESULTS

Air pollution clusters revealed significant differences in mean concentrations between groups for 31 analytes with minimal distinction in mixture profiles. SVI scores differed significantly between the three groups (P = .002), and with each point increase in their SVI, the odds of a child being assigned to the highest-chemical exposure group increased by 11.55% (95% CI: 1.02-1.31), after adjustment.

CONCLUSION

Unsupervised clustering of environmental sub-sample specimens from NHANES provides an innovative, multi-pollutant model that can be used to explore exposure patterns in this population. Utilizing the modified SVI allows for the identification of children that may be highly susceptible to air pollution. It is imperative to interpret the research findings in light of historical structural and discriminatory inequalities to develop beneficial and sustainable solutions.

Accelerated aging and altered subclinical response to ozone exposure in young, healthy adults

Ozone exposure induces a myriad of adverse cardiopulmonary outcomes in humans. Although advanced age and chronic disease are factors that may exacerbate a person's negative response to ozone exposure, there are no molecular biomarkers of susceptibility. Here, we examine whether epigenetic age acceleration (EAA) is associated with responsiveness to short-term ozone exposure. Using data from a crossover-controlled exposure study (n = 17), we examined whether EAA, as measured in lung epithelial cells collected 24 h after clean air exposure, modifies the observed effect of ozone on autonomic function, cardiac electrophysiology, hemostasis, pulmonary function, and inflammation. EAA was assessed in lung epithelial cells extracted from bronchoalveolar lavage fluids, using the pan-tissue aging clock. We used two analytic approaches: (i) median regression to estimate the association between EAA and the estimated risk difference for subclinical responses to ozone and (ii) a block randomization approach to estimate EAA's effect modification of subclinical responses. For both approaches, we calculated Fisher-exact P-values, allowing us to bypass large sample size assumptions. In median regression analyses, accelerated epigenetic age modified associations between ozone and heart rate-corrected QT interval (QTc) ([Formula: see text]= 0.12, P-value = 0.007) and between ozone and C-reactive protein ([Formula: see text] = -0.18, P = 0.069). During block randomization, the directions of association remained consistent for QTc and C-reactive protein; however, the P-values weakened. Block randomization also revealed that responsiveness of plasminogen activator inhibitor-1 (PAI-1) to ozone exposure was modified by accelerated epigenetic aging (PAI-1 difference between accelerated aging-defined block groups = -0.54, P-value = 0.039). In conclusion, EAA is a potential biomarker for individuals with increased susceptibility to ozone exposure even among young, healthy adults.

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

INTRODUCTION

Heat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities.

METHODS

Live-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014-2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May-October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated.

RESULTS

Infants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05-1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education.

DISCUSSION

This study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.

Nucleic Acid Aptamers Protect Against Lead (Pb(II)) Toxicity

Lead (Pb(II)) is a pervasive heavy metal toxin with many well-established negative effects on human health. Lead toxicity arises from cumulative, repeated environmental exposures. Thus, prophylactic strategies to protect against the bioaccumulation of lead could reduce lead-associated human pathologies. Here we show that DNA and RNA aptamers protect C. elegans from toxic phenotypes caused by lead. Reproductive toxicity, as measured by brood size assays, is prevented by co-feeding of animals with DNA or RNA aptamers. Similarly, lead-induced behavioral anomalies are also normalized by aptamer feeding. Further, cultured human HEK293 and primary murine osteoblasts are protected from lead toxicity by transfection with DNA aptamers. The osteogenic development, which is decreased by lead exposure, is maintained by prior transfection of lead-binding DNA aptamers. Aptamers may be an effective strategy for the protection of human health in the face of increasing environmental toxicants.

Ambient air pollution is associated with graft failure/death in pediatric liver transplant recipients

Children exposed to disproportionately higher levels of air pollution experience worse health outcomes. In this population-based, observational registry study, we examine the association between air pollution and graft failure/death in children following liver transplantation (LT) in the US. We modeled the associations between air pollution (PM2.5) levels localized to the patient's ZIP code at the time of transplant and graft failure or death using Cox proportional-hazards models in pediatric LT recipients aged <19 years in the US from 2005-2015. In univariable analysis, high neighborhood PM2.5 was associated with a 56% increased hazard of graft failure/death (HR: 1.56; 95% CI: 1.32, 1.83; P < .001). In multivariable analysis, high neighborhood PM2.5 was associated with a 54% increased risk of graft failure/death (HR: 1.54; 95% CI: 1.29, 1.83; P < .001) after adjusting for race as a proxy for racism, insurance status, rurality, and neighborhood socioeconomic deprivation. Children living in high air pollution neighborhoods have an increased risk of graft failure and death posttransplant, even after controlling for sociodemographic variables. Our findings add further evidence that air pollution contributes to adverse health outcomes for children posttransplant and lay the groundwork for future studies to evaluate underlying mechanisms linking PM2.5 to adverse LT outcomes.

The interplay between air pollution, built environment, and physical activity: Perceptions of children and youth in rural and urban India

The role of physical inactivity as a contributor to non-communicable disease risk in children and youth is widely recognized. Air pollution and the built environment can limit participation in physical activity and exacerbate non-communicable disease risk; however, the relationships between perceptions of air pollution, built environment, and health behaviours are not fully understood, particularly among children and youth in low and middle-income countries. Currently, there are no studies capturing how child and youth perceptions of air pollution and built environment are associated with physical activity in India, thus, this study investigated the association between perceived air pollution and built environment on moderate-to-vigorous physical activity (MVPA) levels of Indian children and youth. Online surveys captured MVPA, perception of air pollution as a problem, built environment factors, as well as relevant sociodemographic characteristics from parents and children aged 5-17 years in partnership with 41 schools across 28 urban and rural locations during the Coronavirus disease lockdowns in 2021. After adjusting for age, gender, and location, a significant association was found between the perception of air pollution as a problem and MVPA levels (β = -18.365, p < 0.001). Similarly, the perception of a high crime rate was associated with lower MVPA levels (β = -23.383, p = 0.002). Reporting the presence of zebra crossings, pedestrian signals, or attractive natural sightings were associated with higher MVPA levels; however, this association varied across sociodemographic groups. These findings emphasize the importance of addressing air pollution and improving the built environment to facilitate outdoor active living, including active transportation, among children and youth - solutions that are particularly relevant not only for preventing non-communicable disease risk but also for climate change mitigation.

Unseen Risk: Mapping Contamination Hazards to Enhance Risk Perception in Galena Park, Texas

As extreme weather events have become more frequently observed in recent decades, concerns about exposure to potential flood risk have increased, especially in underserved and socially vulnerable communities. Galena Park, Texas, is a socially vulnerable community that also confronts escalated physical vulnerabilities due to existing flood risks from Buffalo Bayou and the Houston Ship Channel as well as proximity to industrial facilities that emit chemical pollution. To better understand the underlying risks that Galena Park is facing, this research assesses and visualizes the existing contamination hazards associated with the chemical facilities within Galena Park. Through this process, we (1) compute the environmental, health, and physical hazards associated with industrial facilities, (2) spatially geocode the points of contamination sources and flood exposure, and (3) increase awareness of existing risk by visualizing and distributing related information using an ArcGIS Dashboard. The results indicate that there are 169 points of location from 127 industrial facilities, and 24 points were inducing potential chemicals. In total, 126 chemicals have potential physical, health, and environmental hazards. On average, each facility has 2.4 chemicals that could cause potential hazards with a range of zero to 57 chemicals. When examining the specific physical, health, and environmental risks associated with the chemicals, on average each facility has 14.6 types of risks associated with it. This includes, on average, 9.8 types of health hazards, 1.53 physical hazards, and 2.3 environmental hazards per facility. When analyzing the spatial relationship between the chemical exposure and the current flood risk using the Dashboard, it is noticeable that most of the industrial facilities are located in the south of Galena Park, near Buffalo Bayou, where a variety of industrial facilities are clustered. Through this study, we spatially mapped the existing risks in Galena Park that are not readily available to the community and risks that are not currently tangible or visible. The utility of ArcGIS Dashboards affords the opportunity to translate massive databases into digestible knowledge that can be shared and utilized within the community. This study also takes another step toward building community resilience by providing knowledge that can be used to prepare for and respond to disasters. Visualizing unseen risks and promoting awareness can enhance risk perception when supported by scientific knowledge. Further investigation is necessary to enhance preparedness behaviors, identify proper evacuation techniques and routes, and build community networks to comprehensively promote resilience to multi-hazard circumstances.

Social Inequities in Exposure to Traffic-Related Air and Noise Pollution at Public Schools in Texas

Although children are particularly vulnerable to the adverse impacts of vehicular pollution and spend significant portions of their time at school, previous studies have not examined or compared school-level social inequities in exposure to both traffic-related air and noise pollution in the same study area. We addressed this gap through a case study in Texas-the second-largest US state based on total population and number of children. Vehicular pollution exposure was measured using: (1) outdoor concentrations of nitrogen dioxide (NO₂), a widely used proxy for traffic-related air pollution; and (2) road noise estimates from the US Department of Transportation's National Transportation Noise Mapping Tool. These variables were linked to data on locations and sociodemographic characteristics of children enrolled in Texas public schools. We found children attending schools with the highest exposure to both NO₂ and road noise (top 25%) were significantly more likely to be Black, Hispanic, and eligible for free/reduced lunches (socioeconomically deprived). Results from multivariable generalized estimating equations that control for spatial clustering and other relevant factors revealed that schools with greater NO₂ exposure were significantly more likely to serve racial/ethnic minority and younger students, while schools with greater exposure to road noise were significantly more likely to serve socioeconomically deprived and older students. These findings underscore the urgent need to reduce both air pollution and noise exposure at school locations, especially in schools attended by higher proportions of socially disadvantaged children that are often additionally burdened with other challenges.

The Minderoo-Monaco Commission on Plastics and Human Health

Background

Plastics have conveyed great benefits to humanity and made possible some of the most significant advances of modern civilization in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that plastics are also responsible for significant harms to human health, the economy, and the earth's environment. These harms occur at every stage of the plastic life cycle, from extraction of the coal, oil, and gas that are its main feedstocks through to ultimate disposal into the environment. The extent of these harms not been systematically assessed, their magnitude not fully quantified, and their economic costs not comprehensively counted.

Goals

The goals of this Minderoo-Monaco Commission on Plastics and Human Health are to comprehensively examine plastics' impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations-the poor, minorities, and the world's children. On the basis of this examination, the Commission offers science-based recommendations designed to support development of a Global Plastics Treaty, protect human health, and save lives.

Report Structure

This Commission report contains seven Sections. Following an Introduction, Section 2 presents a narrative review of the processes involved in plastic production, use, and disposal and notes the hazards to human health and the environment associated with each of these stages. Section 3 describes plastics' impacts on the ocean and notes the potential for plastic in the ocean to enter the marine food web and result in human exposure. Section 4 details plastics' impacts on human health. Section 5 presents a first-order estimate of plastics' health-related economic costs. Section 6 examines the intersection between plastic, social inequity, and environmental injustice. Section 7 presents the Commission's findings and recommendations.

Plastics

Plastics are complex, highly heterogeneous, synthetic chemical materials. Over 98% of plastics are produced from fossil carbon- coal, oil and gas. Plastics are comprised of a carbon-based polymer backbone and thousands of additional chemicals that are incorporated into polymers to convey specific properties such as color, flexibility, stability, water repellence, flame retardation, and ultraviolet resistance. Many of these added chemicals are highly toxic. They include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, per- and poly-fluoroalkyl substances (PFAS), brominated flame retardants, and organophosphate flame retardants. They are integral components of plastic and are responsible for many of plastics' harms to human health and the environment.Global plastic production has increased almost exponentially since World War II, and in this time more than 8,300 megatons (Mt) of plastic have been manufactured. Annual production volume has grown from under 2 Mt in 1950 to 460 Mt in 2019, a 230-fold increase, and is on track to triple by 2060. More than half of all plastic ever made has been produced since 2002. Single-use plastics account for 35-40% of current plastic production and represent the most rapidly growing segment of plastic manufacture.Explosive recent growth in plastics production reflects a deliberate pivot by the integrated multinational fossil-carbon corporations that produce coal, oil and gas and that also manufacture plastics. These corporations are reducing their production of fossil fuels and increasing plastics manufacture. The two principal factors responsible for this pivot are decreasing global demand for carbon-based fuels due to increases in 'green' energy, and massive expansion of oil and gas production due to fracking.Plastic manufacture is energy-intensive and contributes significantly to climate change. At present, plastic production is responsible for an estimated 3.7% of global greenhouse gas emissions, more than the contribution of Brazil. This fraction is projected to increase to 4.5% by 2060 if current trends continue unchecked.

Plastic Life Cycle

The plastic life cycle has three phases: production, use, and disposal. In production, carbon feedstocks-coal, gas, and oil-are transformed through energy-intensive, catalytic processes into a vast array of products. Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastic. Single-use plastics constitute the largest portion of current use, followed by synthetic fibers and construction.Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. The result is that an estimated 22 Mt of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950. Strategies for disposal of plastic waste include controlled and uncontrolled landfilling, open burning, thermal conversion, and export. Vast quantities of plastic waste are exported each year from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health-environmental injustice on a global scale. Plastic-laden e-waste is particularly problematic.

Environmental Findings

Plastics and plastic-associated chemicals are responsible for widespread pollution. They contaminate aquatic (marine and freshwater), terrestrial, and atmospheric environments globally. The ocean is the ultimate destination for much plastic, and plastics are found throughout the ocean, including coastal regions, the sea surface, the deep sea, and polar sea ice. Many plastics appear to resist breakdown in the ocean and could persist in the global environment for decades. Macro- and micro-plastic particles have been identified in hundreds of marine species in all major taxa, including species consumed by humans. Trophic transfer of microplastic particles and the chemicals within them has been demonstrated. Although microplastic particles themselves (>10 µm) appear not to undergo biomagnification, hydrophobic plastic-associated chemicals bioaccumulate in marine animals and biomagnify in marine food webs. The amounts and fates of smaller microplastic and nanoplastic particles (MNPs <10 µm) in aquatic environments are poorly understood, but the potential for harm is worrying given their mobility in biological systems. Adverse environmental impacts of plastic pollution occur at multiple levels from molecular and biochemical to population and ecosystem. MNP contamination of seafood results in direct, though not well quantified, human exposure to plastics and plastic-associated chemicals. Marine plastic pollution endangers the ocean ecosystems upon which all humanity depends for food, oxygen, livelihood, and well-being.

Human Health Findings

Coal miners, oil workers and gas field workers who extract fossil carbon feedstocks for plastic production suffer increased mortality from traumatic injury, coal workers' pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. Plastic production workers are at increased risk of leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast cancer, mesothelioma, neurotoxic injury, and decreased fertility. Workers producing plastic textiles die of bladder cancer, lung cancer, mesothelioma, and interstitial lung disease at increased rates. Plastic recycling workers have increased rates of cardiovascular disease, toxic metal poisoning, neuropathy, and lung cancer. Residents of "fenceline" communities adjacent to plastic production and waste disposal sites experience increased risks of premature birth, low birth weight, asthma, childhood leukemia, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.During use and also in disposal, plastics release toxic chemicals including additives and residual monomers into the environment and into people. National biomonitoring surveys in the USA document population-wide exposures to these chemicals. Plastic additives disrupt endocrine function and increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancers. Chemical-laden MNPs formed through the environmental degradation of plastic waste can enter living organisms, including humans. Emerging, albeit still incomplete evidence indicates that MNPs may cause toxicity due to their physical and toxicological effects as well as by acting as vectors that transport toxic chemicals and bacterial pathogens into tissues and cells.Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children's unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.

Economic Findings

Plastic's harms to human health result in significant economic costs. We estimate that in 2015 the health-related costs of plastic production exceeded $250 billion (2015 Int$) globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion (2015 Int$). Plastic production results in greenhouse gas (GHG) emissions equivalent to 1.96 gigatons of carbon dioxide (CO2e) annually. Using the US Environmental Protection Agency's (EPA) social cost of carbon metric, we estimate the annual costs of these GHG emissions to be $341 billion (2015 Int$).These costs, large as they are, almost certainly underestimate the full economic losses resulting from plastics' negative impacts on human health and the global environment. All of plastics' economic costs-and also its social costs-are externalized by the petrochemical and plastic manufacturing industry and are borne by citizens, taxpayers, and governments in countries around the world without compensation.

Social Justice Findings

The adverse effects of plastics and plastic pollution on human health, the economy and the environment are not evenly distributed. They disproportionately affect poor, disempowered, and marginalized populations such as workers, racial and ethnic minorities, "fenceline" communities, Indigenous groups, women, and children, all of whom had little to do with creating the current plastics crisis and lack the political influence or the resources to address it. Plastics' harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North. Social and environmental justice (SEJ) principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics' negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs.

Conclusions

It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices.The main driver of these worsening harms is an almost exponential and still accelerating increase in global plastic production. Plastics' harms are further magnified by low rates of recovery and recycling and by the long persistence of plastic waste in the environment.The thousands of chemicals in plastics-monomers, additives, processing agents, and non-intentionally added substances-include amongst their number known human carcinogens, endocrine disruptors, neurotoxicants, and persistent organic pollutants. These chemicals are responsible for many of plastics' known harms to human and planetary health. The chemicals leach out of plastics, enter the environment, cause pollution, and result in human exposure and disease. All efforts to reduce plastics' hazards must address the hazards of plastic-associated chemicals.

Recommendations

To protect human and planetary health, especially the health of vulnerable and at-risk populations, and put the world on track to end plastic pollution by 2040, this Commission supports urgent adoption by the world's nations of a strong and comprehensive Global Plastics Treaty in accord with the mandate set forth in the March 2022 resolution of the United Nations Environment Assembly (UNEA).International measures such as a Global Plastics Treaty are needed to curb plastic production and pollution, because the harms to human health and the environment caused by plastics, plastic-associated chemicals and plastic waste transcend national boundaries, are planetary in their scale, and have disproportionate impacts on the health and well-being of people in the world's poorest nations. Effective implementation of the Global Plastics Treaty will require that international action be coordinated and complemented by interventions at the national, regional, and local levels.This Commission urges that a cap on global plastic production with targets, timetables, and national contributions be a central provision of the Global Plastics Treaty. We recommend inclusion of the following additional provisions:The Treaty needs to extend beyond microplastics and marine litter to include all of the many thousands of chemicals incorporated into plastics.The Treaty needs to include a provision banning or severely restricting manufacture and use of unnecessary, avoidable, and problematic plastic items, especially single-use items such as manufactured plastic microbeads.The Treaty needs to include requirements on extended producer responsibility (EPR) that make fossil carbon producers, plastic producers, and the manufacturers of plastic products legally and financially responsible for the safety and end-of-life management of all the materials they produce and sell.The Treaty needs to mandate reductions in the chemical complexity of plastic products; health-protective standards for plastics and plastic additives; a requirement for use of sustainable non-toxic materials; full disclosure of all components; and traceability of components. International cooperation will be essential to implementing and enforcing these standards.The Treaty needs to include SEJ remedies at each stage of the plastic life cycle designed to fill gaps in community knowledge and advance both distributional and procedural equity.This Commission encourages inclusion in the Global Plastic Treaty of a provision calling for exploration of listing at least some plastic polymers as persistent organic pollutants (POPs) under the Stockholm Convention.This Commission encourages a strong interface between the Global Plastics Treaty and the Basel and London Conventions to enhance management of hazardous plastic waste and slow current massive exports of plastic waste into the world's least-developed countries.This Commission recommends the creation of a Permanent Science Policy Advisory Body to guide the Treaty's implementation. The main priorities of this Body would be to guide Member States and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste. This Body could also assess trade-offs among these solutions and evaluate safer alternatives to current plastics. It could monitor the transnational export of plastic waste. It could coordinate robust oceanic-, land-, and air-based MNP monitoring programs.This Commission recommends urgent investment by national governments in research into solutions to the global plastic crisis. This research will need to determine which solutions are most effective and cost-effective in the context of particular countries and assess the risks and benefits of proposed solutions. Oceanographic and environmental research is needed to better measure concentrations and impacts of plastics <10 µm and understand their distribution and fate in the global environment. Biomedical research is needed to elucidate the human health impacts of plastics, especially MNPs.

Summary

This Commission finds that plastics are both a boon to humanity and a stealth threat to human and planetary health. Plastics convey enormous benefits, but current linear patterns of plastic production, use, and disposal that pay little attention to sustainable design or safe materials and a near absence of recovery, reuse, and recycling are responsible for grave harms to health, widespread environmental damage, great economic costs, and deep societal injustices. These harms are rapidly worsening.While there remain gaps in knowledge about plastics' harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these impacts are great and that they will increase in severity in the absence of urgent and effective intervention at global scale. Manufacture and use of essential plastics may continue. However, reckless increases in plastic production, and especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, need to be curbed.Global intervention against the plastic crisis is needed now because the costs of failure to act will be immense.

Making the invisible visible: Using a qualitative system dynamics model to map disparities in cumulative environmental stressors and children's neurodevelopment

BACKGROUND

The combined effects of multiple environmental toxicants and social stressor exposures are widely recognized as important public health problems, likely contributing to health inequities. However, US policy makers at state and federal levels typically focus on one stressor exposure at a time and have failed to develop comprehensive strategies to reduce multiple co-occurring exposures, mitigate cumulative risks and prevent harm. This research aimed to move from considering disparate environmental stressors in isolation to mapping the links between environmental, economic, social and health outcomes as a dynamic complex system using children's exposure to neurodevelopmental toxicants as an illustrative example. Such a model can be used to support a broad range of child developmental and environmental health policy stakeholders in improving their understanding of cumulative effects of multiple chemical, physical, biological and social environmental stressors as a complex system through a collaborative learning process.

METHODS

We used system dynamics (SD) group model building to develop a qualitative causal theory linking multiple interacting streams of social stressors and environmental neurotoxicants impacting children's neurodevelopment. A 2 1/2-day interactive system dynamics workshop involving experts across multiple disciplines was convened to develop the model followed by qualitative survey on system insights.

RESULTS

The SD causal map covered seven interconnected themes: environmental exposures, social environment, health status, education, employment, housing and advocacy. Potential high leverage intervention points for reducing disparities in children's cumulative neurotoxicant exposures and effects were identified. Workshop participants developed deeper level of understanding about the complexity of cumulative environmental health risks, increased their agreement about underlying causes, and enhanced their capabilities for integrating diverse forms of knowledge about the complex multi-level problem of cumulative chemical and non-chemical exposures.

CONCLUSION

Group model building using SD can lead to important insights to into the sociological, policy, and institutional mechanisms through which disparities in cumulative impacts are transmitted, resisted, and understood.

National-Scale Assessment of Environmental Justice Trends in Public School Proximity to Industrial Lead Sources

BACKGROUND

Lead poisoning can severely affect neurological development in small children. Communities with environmental justice concerns often face higher levels of lead exposure via multiple routes of exposure. School-aged children can be exposed to lead at their schools through the deposition of lead emissions onto soil over time.

METHOD

Public school students' demographics in 'proximate schools;' those within 1.5 km of facilities with lead emissions were compared to other schools in their area. The average proximate emissions per student were calculated for different demographic groups in various geographic areas.

RESULTS

Schools in combined statistical areas within 1.5 km of lead facilities were found to be composed of significantly more Black (22%) and Hispanic (30%) students than other schools in the area (17% and 26% respectively). Meanwhile, schools close to lead sources tended to have smaller proportions of white students (37% in 'proximate schools', but 47% overall. When average emissions around students were calculated for a handful of combined statistical areas, inequality in lead exposure could be seen in almost every geographic area, across income and racial lines.

DISCUSSION

Students of color consistently faced the highest emissions in every area, though amounts, inequities, and at-risk populations differed throughout the different geographic areas.

CONCLUSION

The unique history of each location regarding immigration, discrimination, zoning laws, urban sprawl, and industrial past can contribute to this variety in inequities. These findings are not only consistent with environmental justice trends but also highlight other vulnerabilities for students like age and food security.

The Assessment of Organophosphate Pesticide Exposure among School Children in Four Regions of Thailand: Analysis of Dialkyl Phosphate Metabolites in Students' Urine and Organophosphate Pesticide Residues in Vegetables for School Lunch

In Thailand, pesticides containing organophosphates (OP) are frequently applied to crops to suppress insects. School children can be exposed to OPs on a daily basis, from food consumption to breathing and touching pesticides drifted near classrooms. Living in an agricultural area can also be one of the causes. As a result, it is important to monitor OPs residues in the food chain and biomarkers of exposure. The Gas Chromatography-Flame Photometric Detector method was employed to examine the relationship between OPs residue and DAPs (Diakly phosphate) in four targeted locations in Thailand, as well as to examine the residues of OPs in vegetable samples and DAPs in 395 school children's urine samples. Vegetables were found to contain at least one OP, with chlorpyrifos being the most prevalent. The OPs detected frequencies for Sakon Nakhon, Chiang Mai, Phang Nga, and Pathum Thani are 96.1%, 94%, 91.7%, and 83.3%, respectively. The overall centration level of OPs showed 0.3261 mg/kg, 0.0636 mg/kg, 0.0023 mg/kg, 0.0150 mg/kg, 0.2003 mg/kg, 0.0295 mg/kg, and 0.0034 mg/kg for diazinon, dimethoate, pirimiphos-methyl, chlorpyrifos, profenofos, ethion, and triazophos, respectively. Nearly 98% of school children were detected with at least one DAP. The overall level of dimethyl phosphate metabolites (5.258 µmole/mole creatinine) in urine samples is higher than diethyl phosphate metabolites (2.884 µmole/mole creatinine), especially in the case of Pathum Thani. Our findings show a consistent relationship between OPs in vegetables from wet markets and DAPs in urine samples of school children in various parts of Thailand.

A Generalizable Evaluated Approach, Applying Advanced Geospatial Statistical Methods, to Identify High Lead Exposure Locations at Census Tract Scale: Michigan Case Study

BACKGROUND

Despite great progress in reducing environmental lead (Pb) levels, many children in the United States are still being exposed.

OBJECTIVE

Our aim was to develop a generalizable approach for systematically identifying, verifying, and analyzing locations with high prevalence of children's elevated blood Pb levels (EBLLs) and to assess available Pb models/indices as surrogates, using a Michigan case study.

METHODS

We obtained ∼1.9 million BLL test results of children <6 years of age in Michigan from 2006-2016; we then evaluated them for data representativeness by comparing two percentage EBLL (%EBLL) rates (number of children tested with EBLL divided by both number of children tested and total population). We analyzed %EBLLs across census tracts over three time periods and between two EBLL reference values (≥5 vs. ≥10μg/dL) to evaluate consistency. Locations with high %EBLLs were identified by a top 20 percentile method and a Getis-Ord Gi* geospatial cluster "hotspot" analysis. For the locations identified, we analyzed convergences with three available Pb exposure models/indices based on old housing and sociodemographics.

RESULTS

Analyses of 2014-2016 %EBLL data identified 11 Michigan locations via cluster analysis and 80 additional locations via the top 20 percentile method and their associated census tracts. Data representativeness and consistency were supported by a 0.93 correlation coefficient between the two EBLL rates over 11 y, and a Kappa score of ∼0.8 of %EBLL hotspots across the time periods (2014-2016) and reference values. Many EBLL hotspot locations converge with current Pb exposure models/indices; others diverge, suggesting additional Pb sources for targeted interventions.

DISCUSSION

This analysis confirmed known Pb hotspot locations and revealed new ones at a finer geographic resolution than previously available, using advanced geospatial statistical methods and mapping/visualization. It also assessed the utility of surrogates in the absence of blood Pb data. This approach could be applied to other states to inform Pb mitigation and prevention efforts. https://doi.org/10.1289/EHP9705.

Children's exposure to vehicular pollution: Environmental injustice in Texas, USA

Distributive environmental justice research on children's exposure to vehicular pollution is underdeveloped and few empirical studies have been conducted in the US. This study seeks to address this gap by examining if socially disadvantaged children are disproportionately located in public school districts burdened by higher vehicular pollution in Texas-the second largest US state based on population size. Vehicular pollution exposure is measured using two variables: (1) an index developed by the US Environmental Protection Agency that combines traffic proximity and volume; and (2) outdoor concentrations of nitrogen dioxide (NO₂), a widely used proxy for traffic-related air pollution. These variables are linked to school district level data on socio-demographic characteristics of children obtained from the latest American Community Survey. Statistical analysis is based on multivariable generalized estimating equations that account for spatial clustering of school districts. Results reveal significantly greater traffic proximity and NO₂ exposure in Texas school districts with higher percentages of children, after controlling for clustering, population density, and other socio-demographic factors. Districts exposed to higher levels of traffic proximity and NO₂ exposure also contain significantly greater proportions of racial/ethnic minority, foreign-born, disabled, and socioeconomically vulnerable children. These findings highlight the urgent need to develop mitigation strategies for reducing vehicular pollution exposure, especially in districts with higher proportions of socially disadvantaged students that could be additionally burdened with limited resources. School districts represent a policy relevant analytic unit since school district boards can act as advocates for the environmental health of children and implement mitigation strategies for reducing pollution exposure.

A cross-sectional study of brownfields and birth defects

BACKGROUND

Brownfields are a multitude of abandoned and disused sites, spanning many former purposes. Brownfields represent a heterogenous yet ubiquitous exposure for many Americans, which may contain hazardous wastes and represent urban blight. Neonates and pregnant individuals are often sensitive to subtle environmental exposures. We evaluate whether residential brownfield exposure is associated with birth defects.

METHODS

Using North Carolina birth records from 2003 to 2015, we sampled 753,195 births with 39,495 defects identified. We examined defect groups and 30 distinct phenotypes. Number of brownfields within 2,000 m of the residential address at birth was summed. We utilized mixed effects multivariable logistic regression models adjusted for demographic and environmental covariates available from birth records, 2010 Census, and EPA's Environmental Quality Index to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

We observed positive associations between cardiovascular and external defect groups (OR [95% CI]: 1.07 [1.02-1.13] and 1.17 [1.01-1.35], respectively) and any brownfield exposure. We also observed positive associations with atrial septal and ventricular septal defects (1.08 [1.01-1.16] and 1.15 [1.03-1.28], respectively), congenital cataracts (1.38 [0.98-1.96]), and an inverse association with gastroschisis (0.74 [0.58-0.94]). Effect estimates for several additional defects were positive, though we observed null associations for most group and individual defects. Additional analyses indicated an exposure-response relationship for several defects across levels of brownfield exposure.

CONCLUSIONS

Our results indicate that residential proximity to brownfields is associated with birth defects, especially cardiovascular and external defects. In-depth analyses of individual defects and specific contaminants or brownfield sites may reveal additional novel associations.

Microplastic occurrence in settled indoor dust in schools

This study examines for the first time the characteristics and human exposure of microplastics (MPs) in settled indoor dust in schools. An average of 195 MPs·g^-1 of dust were detected in settled indoor composite dust samples from 28 schools in Shiraz. White-transparent microfibres with lengths 500-1000 μm were the most abundant type of MP found among the samples examined. Polyethylene terephthalate and polypropylene MPs were dominant across all types of MP found including microfibres. MPs had generally smooth morphology with sharp or regular edges which could have been released to the environment as primary MPs. Among all sampling sites, higher concentrations of MPs were found in the south and centre of the city. These were areas affected by high population density, high traffic load and high presence of industrial units and workshops. Principal Component Analysis (PCA) showed a positive strong correlation between sampling sites and MP physical characteristics. The PCA plots revealed that MP sheets and fragments were prevalent in sites in the North of Shiraz, whereas microfibres were mainly associated with sites in the South. The levels of MPs in the South of Shiraz were greater than in the rest of the country and the wind direction and topography were found to be important factors affecting the MP distribution observed. Compared to other population groups, elementary school students had relatively high exposure risk to MPs. This study reveals that microfibres are widespread in Shiraz' schools and pose a high exposure risk to MPs for young students.

Culturally Sensitive Interventions in Pediatric Primary Care Settings: A Systematic Review

CONTEXT

Culturally sensitive interventions in the pediatric primary care setting may help reduce health disparities. Less is known on the development of these interventions, their target groups, and their feasibility, acceptability, and impact on health outcomes.

OBJECTIVE

We conducted a systematic review to describe culturally sensitive interventions developed for the pediatric primary care setting.

DATA SOURCES

PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (January 2000 to July 2020).

STUDY SELECTION

Studies were eligible for inclusion if they were (1) original research on an intervention with an evaluation, (2) within a pediatric primary care setting, (3) not limited to education for providers, (4) not limited to interpreter use, and (5) based in the United States.

DATA EXTRACTION

The following were extracted: study topic, study design, intervention, cultural sensitivity strategies and terminology, setting, target group, sample size, feasibility, acceptability, and health outcomes.

RESULTS

Twenty-five studies described 23 interventions targeting a variety of health topics. Multiple cultural sensitivity strategies were used, most commonly sociocultural (83%). Most interventions (57%) were focused on Hispanic/Latino families. Interventions were generally reported as being feasible and acceptable; some also changed health outcomes.

LIMITATIONS

Small samples and heterogenous methods subject to bias were used. Relevant articles may have been missed because of the variety of terms used to describe cultural sensitivity.

CONCLUSIONS

The included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.

Uncovering Evidence: Associations between Environmental Contaminants and Disparities in Women's Health

Over the years, industrial accidents and military actions have led to unintentional, large-scale, high-dose human exposure to environmental contaminants with endocrine-disrupting action. These historical events, in addition to laboratory studies, suggest that exposure to toxicants such as dioxins and polychlorinated biphenyls negatively impact the reproductive system and likely influence the development of gynecologic diseases. Although high-level exposure to a single toxicant is rare, humans living in industrialized countries are continuously exposed to a complex mixture of manmade and naturally produced endocrine disruptors, including persistent organic pollutants and heavy metals. Since minorities are more likely to live in areas with known environmental contamination; herein, we conducted a literature review to identify potential associations between toxicant exposure and racial disparities in women's health. Evidence within the literature suggests that the body burden of environmental contaminants, especially in combination with inherent genetic variations, likely contributes to previously observed racial disparities in women's health conditions such as breast cancer, endometriosis, polycystic ovarian syndrome, uterine fibroids, and premature birth.

Racial/Ethnic Disparities in Longitudinal Emotional-Behavioral Functioning Among Youth Born to Women Living With HIV

BACKGROUND

Youth with perinatal HIV exposure have demonstrated high rates of emotional-behavioral problems. Few studies have longitudinally examined racial/ethnic disparities in such functioning across adolescence, a critical time for targeting prevention/intervention efforts.

SETTING

The Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol is one of the largest US-based cohort studies of youth with perinatal HIV (YPHIV) infection or HIV exposed but uninfected (YPHEU).

METHODS

Youth and caregivers individually completed the Behavior Assessment System for Children, second edition, every 2 years between ages 7 and 19 years. We used adjusted mixed-effects models to evaluate whether mean youth-reported emotional concerns and caregiver-reported behavioral concerns differed by race/ethnicity. We used group-based trajectory models to identify groups having similar emotional-behavioral trajectories, followed by multinomial models to determine which factors predicted group membership.

RESULTS

Three hundred ninety-one YPHIV and 209 YPHEU (7% White non-Hispanic, 21% White Hispanic, 66% Black non-Hispanic, and 6% Black Hispanic) completed a median of 4 assessments over follow-up. Adjusted models showed more caregiver-reported behavioral concerns for Black non-Hispanic YPHEU than for Black non-Hispanic YPHIV, White Hispanic YPHIV, and White Hispanic YPHEU, particularly later in adolescence. Race/ethnicity did not predict membership in subgroups of youth-reported emotional or caregiver-reported behavioral functioning identified using group-based trajectory models. However, factors predicting membership in vulnerable youth-reported emotional and caregiver-reported behavioral groups included experiencing a stressful life event and living with a caregiver who was married or screened positive for a psychiatric condition.

CONCLUSIONS

Our study revealed that Black non-Hispanic YPHEU are a vulnerable subgroup. Contributing factors that could inform interventions include the caregiver's health, household characteristics, and psychiatric status.

Long-term analysis of the relationships between indoor and outdoor fine particulate pollution: A case study using research grade sensors

The growing concern of air quality and its associated health-related impacts has led to increased awareness of pollutant exposure. Most human populations spend the majority of their time indoors and the COVID-19 pandemic has likely exacerbated this behavior. While significant amounts of research have focused on outdoor air quality, to date there have been no studies that examined simultaneous long-term trends on indoor and outdoor air quality on a site using research-grade sensors. We measured fine particulate matter (PM_2.5) for a year using sensors located on the rooftop, air handling room, and indoor office space in a building and captured the impacts of three types of regularly occurring elevated pollution events: wintertime atmospheric inversions, wildfires, and fireworks. The events had different magnitudes and durations, and infiltration rates varied for each event leading to dissimilar indoor air pollution levels. The building's air handling unit and different environmental conditions (lower indoor humidity and temperature during the winter) combined to reduce indoor pollution from inversion events however, particulate matter from wildfires and fireworks infiltrated at higher rates. Together, this suggests possible intervention strategies, such as ventilation rates and filter upgrades, that could be used to mitigate contaminant intrusion during elevated pollution events. This year-long study illustrates an array of ways that elevated pollution events interact with the protective effects that buildings have against air pollution for its occupants. Furthermore, we show that outdoor air pollution is an important variable to consider when studying indoor air quality as contaminant infiltration is strongly dependent on the specific pollution source.

Air pollution and neurological development in children

Pregnancy and early childhood are periods with high plasticity in neurological development. Environmental perturbations during these sensitive windows can have lifelong developmental consequences. This review summarizes key findings relevant to the effects of air pollution on neurological development. Mounting evidence suggests that exposure to air pollution, both during pregnancy and childhood, is associated with childhood developmental outcomes ranging from changes in brain structures to subclinical deficits in developmental test scores, and, ultimately, developmental disorders such as attention-deficit/hyperactivity disorders or autism spectrum disorders. Although the biological mechanisms of effects remain to be elucidated, multiple pathways are probably involved and include oxidative stress, inflammation, and/or endocrine disruption. Given the alarming global increase in developmental disorders in recent years, and increased human exposures to pollution, it is critical to reduce personal and community-level exposures through tight collaboration of interdisciplinary and multi-level bodies including community partners, physicians, industry partners, policy makers, public health practitioners, and researchers. WHAT THIS PAPER ADDS: Exposure to air pollution is associated with a range of childhood developmental complications. Biological mechanisms may include oxidative stress, inflammation, and endocrine disruption.

Cultural competence learning of the health care students using simulation pedagogy: An integrative review

The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.

Defining and Intervening on Cumulative Environmental Neurodevelopmental Risks: Introducing a Complex Systems Approach

BACKGROUND

The combined effects of multiple environmental toxicants and social stressor exposures are widely recognized as important public health problems contributing to health inequities. However cumulative environmental health risks and impacts have received little attention from U.S. policy makers at state and federal levels to develop comprehensive strategies to reduce these exposures, mitigate cumulative risks, and prevent harm. An area for which the inherent limitations of current approaches to cumulative environmental health risks are well illustrated is children's neurodevelopment, which exhibits dynamic complexity of multiple interdependent and causally linked factors and intergenerational effects.

OBJECTIVES

We delineate how a complex systems approach, specifically system dynamics, can address shortcomings in environmental health risk assessment regarding exposures to multiple chemical and nonchemical stressors and reshape associated public policies.

DISCUSSION

Systems modeling assists in the goal of solving problems by improving the "mental models" we use to make decisions, including regulatory and policy decisions. In the context of disparities in children's cumulative exposure to neurodevelopmental stressors, we describe potential policy insights about the structure and behavior of the system and the types of system dynamics modeling that would be appropriate, from visual depiction (i.e., informal maps) to formal quantitative simulation models. A systems dynamics framework provides not only a language but also a set of methodological tools that can more easily operationalize existing multidisciplinary scientific evidence and conceptual frameworks on cumulative risks. Thus, we can arrive at more accurate diagnostic tools for children's' environmental health inequities that take into consideration the broader social and economic environment in which children live, grow, play, and learn. https://doi.org/10.1289/EHP7333.

Biomonitoring of Lead Exposure in Children from Two Fishing Communities at Northern Colombia

Lead (Pb) exposure is a growing concern in developing countries, especially in vulnerable children. The objective of this study was to evaluate blood lead levels (BLL) in children from two fishing populations at Northern Colombia, Loma de Arena and Tierrabomba, as well as their association with morphometric parameters, markers of hematological status, liver function, and mRNA expression of genes related to Pb toxicity. A total of 198 blood samples were collected from participants aged 5-16 years old. The mean (± standard error) BLL for the studied sample was 3.6 ± 0.3 μg/dL, and the 97.5th percentile was 21.0 μg/dL. The participants of Loma de Arena and Tierrabomba presented BLL of 3.9 ± 0.5 and 2.9 ± 0.3 μg/dL, respectively. Children born preterm had greater BLL than those born at full term. Boys had greater BLL than girls, which also occurred for participants between 12 and 16 years old, compared with those aged 5-11 years old. The BLL were negatively correlated with body mass index in children from Loma de Arena, but an opposite behavior was observed for Tierrabomba. In Loma de Arena, the mRNA expression of interferon gamma, a pro-inflammatory cytokine, increased with the BLL, but that of δ-aminolevulinic acid dehydrogenase, a sensor for Pb poisoning, decreased. In Tierrabomba, gene expression did not change with BLL. These results show that in fishing communities, lead exposure promotes different health impacts depending on age, sex, and other site-specific factors. In any case, appropriate educational and intervention programs should be carried out to minimize Pb exposure in children.

The urban lead (Pb) burden in humans, animals and the natural environment

Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980's, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead's neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.

Impact of Environmental Injustice on Children's Health-Interaction between Air Pollution and Socioeconomic Status

Air pollution disproportionately affects marginalized populations of lower socioeconomic status. There is little literature on how socioeconomic status affects the risk of exposure to air pollution and associated health outcomes, particularly for children’s health. The objective of this article was to review the existing literature on air pollution and children’s health and discern how socioeconomic status affects this association. The concept of environmental injustice recognizes how underserved communities often suffer from higher air pollution concentrations in addition to other underlying risk factors for impaired health. This exposure then exerts larger effects on their health than it does in the average population, affecting the whole body, including the lungs and the brain. Children, whose organs and mind are still developing and who do not have the means of protecting themselves or creating change, are the most vulnerable to the detrimental effects of air pollution and environmental injustice. The adverse health effects of air pollution and environmental injustice can harm children well into adulthood and may even have transgenerational effects. There is an urgent need for action in order to ensure the health and safety of future generations, as social disparities are continuously increasing, due to social discrimination and climate change.

The COVID-19 Pandemic and Children's Environmental Health

The coronavirus disease 2019 pandemic has dramatically altered the health and well-being of children, particularly as they have been isolated indoors and in their homes as a result of social distancing measures. In this article, we describe several of the environmental threats that are affecting the health of children during the pandemic. These include increased exposure to household cleaning products, chemicals and lead in dust, indoor air pollutants, screen time, family stress, and firearms, as well as decreased availability of food, social supports, and routine childhood screenings. Importantly, many of these threats disproportionately affect children of racial or ethnic minorities or who have low socioeconomic status. Pediatric health care providers will need to screen and treat children and counsel their parents and/or other caregivers during well-child visits with an eye for these new or worsened environmental threats. [Pediatr Ann. 2020;49(12):e537-e542.].

Impact of low-level fine particulate matter and ozone exposure on absences in K-12 students and economic consequences

High air pollution levels are associated with school absences. However, low level pollution impacts on individual school absences are under-studied. Understanding the variability of pollution at individual schools within an urban region could improve school recess decisions, better identify local pollution sources, and improve local economic impact assessments by providing granular information relevant to specific schools. We modelled PM_2.5 and ozone concentrations at 36 schools from July 2015 to June 2018 using data from a dense, research grade regulatory sensor network. We determined exposures and daily absences at each school. We used a generalized estimating equations model to retrospectively estimate rate ratios for association between outdoor pollutant concentrations and school absences. We estimated lost school revenue, productivity, and family economic burden. PM_2.5 and ozone concentrations and absence rates vary across the School District. Pollution exposure was associated with a rate ratio as high as 1.02 absences per μg m^-3 and 1.01 per ppb increase for PM_2.5 and ozone, respectively. Significantly, even PM_2.5 and ozone exposure below the air quality index breakpoints for good air quality (<12.1 μg m^-3 and <55 ppb, respectively) was associated with positive rate ratios of absences: 1.04 per μg m^-3 and 1.01 per ppb increase, respectively. Granular local measurements enabled demonstration of air pollution impacts that varied between schools and were undetectable with averaged pollution levels. Reducing pollution by 50% would save $426000 per year districtwide. Pollution reduction benefits would be greatest in schools located in socioeconomically disadvantaged areas. Heterogeneity in exposure, disproportionately affecting socioeconomically disadvantaged schools, points to the need for fine resolution exposure estimation. The economic cost of absences associated with air pollution is substantial even excluding indirect costs such as hospital visits and medication. These findings may help elucidate the differential burden on individual schools and inform local decisions about recess and regulatory considerations for localized pollution sources.

Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

Development of Vulnerability Assessment Framework for Disaster Risk Reduction at Three Levels of Geopolitical Units in the Philippines

This study developed a comprehensive framework for vulnerability assessment as a tool to measure vulnerability at three levels of geopolitical units in the Philippines. This is a comprehensive multi-disaster framework that can provide information to a decentralized type of government system like the Philippines. The vulnerability assessment framework (VAF) that has been developed was anchored upon the IPCC model and used the integration of community-based monitoring system (CBMS) data, expert inputs, and a series of community-based activities such as consultative fora, focus group discussions, workshops, and risk reduction immersion activities. The developed VAF for the assessment of vulnerability indices (VIs) is a system framework composed of a vulnerability scoping diagram (VSD) and an expanded vulnerability assessment model (VAM). The VSD is composed of three dimensions (e.g., exposure, sensitivity, resiliency), seven identified hazards, with 26, 27, and 29 sub-indicators for household, barangay, and municipal levels, respectively. Measuring vulnerability can be an effective strategy for assessing the potential impact/s of natural disasters on society. The continuous occurrence of natural disasters in the Philippines requires enhancement of public understanding of vulnerability. This would provide transparent understanding and enhance community competency leading to the development of methodologies and tools to assess various factors and indicators of vulnerability. The information extracted from using the VAF and VSD are helpful to the local government units, especially in preparing budgets, strategies, and programs for disaster risk reduction.

Patterns of distributive environmental inequity under different PM2.5 air pollution scenarios for Salt Lake County public schools

Previous studies have cataloged social disparities in air pollution exposure in US public schools with respect to race/ethnicity and socioeconomic status. These studies rely upon chronic, averaged measures of air pollution, which fosters a static conception of exposure disparities. This paper examines PM_2.5 exposure disparities in Salt Lake County (SLC), Utah public schools under three different PM_2.5 scenarios-relatively clean air, a moderate winter persistent cold air pool (PCAP), and a major winter PCAP-with respect to race/ethnicity, economic deprivation, student age, and school type. We pair demographic data for SLC schools (n = 174) with modelled PM_2.5 values, obtained from a distributed network of sensors placed through a community-university partnership. Results from generalized estimating equations controlling for school district clustering and other covariates reveal that patterns of social inequality vary under different PM_2.5 pollution scenarios. Charter schools and schools serving economically deprived students experienced disproportionate exposure during relatively clean air and moderate PM_2.5 PCAP conditions, but those inequalities attenuated under major PCAP conditions. Schools with higher proportions of racial/ethnic minority students were unequally exposed under all PM_2.5 pollution scenarios, reflecting the robustness of racial/ethnic disparities in exposure. The findings speak to the need for policy changes to protect school-aged children from environmental harm in SLC and elsewhere.

A Framework to Classify Environmental Inequity in Absolute and Relative Terms, and Its Application in Beijing

Although reducing environmental inequities is widely recognized as an essential step towards sustainable cities, decision-makers frequently lack the tools to identify inequity distribution patterns and designing effective intervention policies. This study seeks to present a framework that can help decision-making processes by classifying environmental inequity districts in multiple perspectives, especially in absolute and relative terms. This framework includes four steps: (A) variable selection, (B) data normalization, (C) ranking indicators, (D) summarizing inequity classification, which then assign results to selected areas. The framework aims to classify and compare environmental inequities in multiple perspectives, and can be applied in various environmental problems, with advantages such as high acceptability and clear comprehensibility. To show the potential use of this framework, a case application in Beijing, China, was conducted to evaluate the environmental inequity of air pollution. The results suggest that decision-makers should focus on the central urban area and some southern regions of Beijing to implement various improvement policies. Based on the results from Beijing, how the framework can be used to help decision-makers, the future roles of this framework with the government and the public, as well as the framework’s limitations are further discussed.

Combined neurodevelopmental exposure to deltamethrin and corticosterone is associated with Nr3c1 hypermethylation in the midbrain of male mice

Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders and manifests inattention, hyperactivity, and impulsivity symptoms in childhood that can last throughout life. Genetic and environmental studies implicate the dopamine system in ADHD pathogenesis. Work from our group and that of others indicates that deltamethrin insecticide and stress exposure during neurodevelopment leads to alterations in dopamine function, and we hypothesized that exposure to both of these factors together would lead to synergistic effects on DNA methylation of key genes within the midbrain, a highly dopaminergic region, that could contribute to these findings. Through targeted next-generation sequencing of a panel of cortisol and dopamine pathway genes, we observed hypermethylation of the glucocorticoid receptor gene, Nr3c1, in the midbrain of C57/BL6N males in response to dual deltamethrin and corticosterone exposures during development. This is the first description of DNA methylation studies of Nr3c1 and key dopaminergic genes within the midbrain in response to a pyrethroid insecticide, corticosterone, and these two exposures together. Our results provide possible connections between environmental exposures that impact the dopamine system and the hypothalamic-pituitary-adrenal axis via changes in DNA methylation and provides new information about the presence of epigenetic effects in adulthood after exposure during neurodevelopment.

A comprehensive analysis of racial disparities in chemical biomarker concentrations in United States women, 1999-2014

BACKGROUND

Stark racial disparities in disease incidence among American women remain a persistent public health challenge. These disparities likely result from complex interactions between genetic, social, lifestyle, and environmental risk factors. The influence of environmental risk factors, such as chemical exposure, however, may be substantial and is poorly understood.

OBJECTIVES

We quantitatively evaluated chemical-exposure disparities by race/ethnicity, life stage, and time in United States (US) women (n = 38,080) by using biomarker data for 143 chemicals from the National Health and Nutrition Examination Survey (NHANES) 1999-2014.

METHODS

We applied a series of survey-weighted, generalized linear models using data from the entire NHANES women population along with cycle and age-group stratified subpopulations. The outcome was chemical biomarker concentration, and the main predictor was race/ethnicity with adjustment for age, socioeconomic status, smoking habits, and NHANES cycle.

RESULTS

Compared to non-Hispanic White women, the highest disparities were observed for non-Hispanic Black, Mexican American, Other Hispanic, and Other Race/Multi-Racial women with higher levels of pesticides and their metabolites, including 2,5-dichlorophenol, o,p'-DDE, beta-hexachlorocyclohexane, and 2,4-dichlorophenol, along with personal care and consumer product compounds, including parabens and monoethyl phthalate, as well as several metals, such as mercury and arsenic. Moreover, for Mexican American, Other Hispanic, and non-Hispanic black women, there were several exposure disparities that persisted across age groups, such as higher 2,4- and 2,5-dichlorophenol concentrations. Exposure levels for methyl and propyl parabens, however, were the highest in non-Hispanic black compared to non-Hispanic white children with average differences exceeding 4-fold. Exposure disparities for methyl and propyl parabens are increasing over time in Other Race/Multi-Racial women while fluctuating for non-Hispanic Black, Mexican American, and Other Hispanic. Cotinine levels are among the highest in Non-Hispanic White women compared to Mexican American and Other Hispanic women with disparities plateauing and increasing, respectively.

DISCUSSION

We systematically evaluated differences in chemical exposures across women of various race/ethnic groups and across age groups and time. Our findings could help inform chemical prioritization in designing epidemiological and toxicological studies. In addition, they could help guide public health interventions to reduce environmental and health disparities across populations.

Environmental Tobacco Smoke Exposure in Relation to Family Characteristics, Stressors and Chemical Co-Exposures in California Girls

Childhood environmental tobacco smoke (ETS) exposure is a risk factor for adverse health outcomes and may disproportionately burden lower socioeconomic status groups, exacerbating health disparities. We explored associations of demographic factors, stressful life events, and chemical co-exposures, with cotinine levels, among girls in the CYGNET Study. Data were collected from families of girls aged 6–8 years old in Northern California, through clinic exams, questionnaires and biospecimens (n = 421). Linear regression and factor analysis were conducted to explore predictors of urinary cotinine and co-exposure body burdens, respectively. In unadjusted models, geometric mean cotinine concentrations were higher among Black (0.59 ug/g creatinine) than non-Hispanic white (0.27), Asian (0.32), or Hispanic (0.34) participants. Following adjustment, living in a rented home, lower primary caregiver education, and lack of two biologic parents in the home were associated with higher cotinine concentrations. Girls who experienced parental separation or unemployment in the family had higher unadjusted cotinine concentrations. Higher cotinine was also associated with higher polybrominated diphenyl ether and metals concentrations. Our findings have environmental justice implications as Black and socio-economically disadvantaged young girls experienced higher ETS exposure, also associated with higher exposure to other chemicals. Efforts to reduce ETS and co-exposures should account for other disparity-related factors.

Housing as a determinant of health equity: A conceptual model

Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.

Lifetime cancer risks from hazardous air pollutants in US public school districts

Background

Children are sensitive to the health impacts of environmental contaminants, but research assessing outdoor environmental exposures for children and schools is underdeveloped. There are no national-level studies examining geographical and social disparities in air pollution exposure for children in school districts. Focusing on school districts is important because they are meaningful decision-making entities for schools.

Methods

Using data from the National Air Toxics Assessment, we spatially reallocated lifetime cancer risk (LCR) from hazardous air pollutants (HAPs) within US school district boundaries, and paired those estimates with school district level sociodemographic measures obtained through the Integrated Public Use Microdata Series National Historic Geographic Information System. We employed local Moran’s I to identify district-level hotpots and generalised estimating equations (GEEs) to quantify risk disparities.

Results

We identified hotspots of elevated LCR from all sources of HAPs (called ‘total’). A regional hotspot extends throughout the southeastern USA and smaller regional hotspots are present in southern Arizona, southern California and in California’s central valley. School districts with higher proportions of children, children with disabilities, foreign-born children, black children and multiracial/other race children, and lower proportions of Native American children, had greater total LCR (p<0.001). The effect of poverty on total LCR (p<0.001) was nonlinear; the lowest and highest poverty districts had lower total LCR.

Conclusions

Geographical and social disparities in LCR across US school districts may be affecting children’s health and future potential. This new knowledge can inform policy changes, as school districts can advocate for the environmental health of children.

A Neurodevelopmental Model of Combined Pyrethroid and Chronic Stress Exposure

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and previous studies indicate the dopamine system plays a major role in ADHD pathogenesis. Two environmental exposures independently associated with dopaminergic dysfunction and ADHD risk include exposure to deltamethrin, a pyrethroid insecticide, and chronic stress. We hypothesized that combined neurodevelopmental exposure to both deltamethrin and corticosterone (CORT), the major stress hormone in rodents, would result in additive changes within the dopamine system. To study this, we developed a novel dual exposure paradigm and exposed pregnant C57BL/6 dams to 3 mg/kg deltamethrin through gestation and weaning, and their offspring to 25 μg/mL CORT dissolved in the drinking water through adulthood. Midbrain RNA expression as well as striatal and cortical protein expression of key dopaminergic components were investigated, in addition to ADHD-like behavioral tasks and electrochemical dopamine dynamics via fast-scan cyclic voltammetry. Given the well-described sexual dimorphism of ADHD, males and females were assessed separately. Males exposed to deltamethrin had significantly decreased midbrain Pitx3 expression, decreased cortical tyrosine hydroxylase (TH) expression, increased activity in the Y maze, and increased dopamine uptake rate in the dorsal striatum. These effects did not occur in males exposed to CORT only, or in males exposed to both deltamethrin and CORT, suggesting that CORT may attenuate these effects. Additionally, deltamethrin- and CORT-exposed females did not display these dopaminergic features, which indicates these changes are sex-specific. Our results show dopaminergic changes from the RNA through the functional level. Moreover, these data illustrate the importance of testing multiple environmental exposures together to better understand how combined exposures that occur in certain vulnerable populations could affect similar neurodevelopmental systems, as well as the importance of studying sex differences of these alterations.

Healthy Air, Healthy Brains: Advancing Air Pollution Policy to Protect Children's Health

Evidence is growing on the adverse neurodevelopmental effects of exposure to combustion-related air pollution. Project TENDR (Targeting Environmental Neurodevelopmental Risks), a unique collaboration of leading scientists, health professionals, and children's and environmental health advocates, has identified combustion-related air pollutants as critical targets for action to protect healthy brain development. We present policy recommendations for maintaining and strengthening federal environmental health protections, advancing state and local actions, and supporting scientific research to inform effective strategies for reducing children's exposures to combustion-related air pollution. Such actions not only would improve children's neurological development but also would have the important co-benefit of climate change mitigation and further improvements in other health conditions.

Environmental justice screening tools: Implications for nursing

Environmental justice (EJ) means socially and economically disadvantaged communities and citizens are entitled to an equally clean environment and resources to enjoy. EJ communities are mostly located close to polluters such as Superfund sites, coal-fired power plants and landfills and are more likely to be exposed to higher levels of environmental hazards than the U.S. population on average. It is often a difficult task to identify EJ communities and the environmental hazards in the communities without using specific EJ screening tools. Therefore, the goal of this manuscript is to introduce public health nurses to map-based EJ screening tools. This will help public health nurses to identify EJ communities and take appropriate actions. Public Health Nurses can also use other relevant web sites, such as the U.S. Environmental Protection Agency (EPA), National Institute of Environmental Health Sciences (NIEHS) and Toxicology Data Network (TOXNET) as resources concerning potential health effects of pollutants. Using the provided tools in this paper, nurses should be able to identify EJ communities and be united to recognize barriers of EJ communities and become promoters for EJ advocacy in practice, leadership and education.

Working with an environmental justice community: Nurse observation, assessment, and intervention

Environmental justice (EJ) is the concept that all people and communities, regardless of their race and socioeconomic status, are entitled to enjoy an equally clean environment and resources. Communities where residents face environmental injustice and a higher risk of being exposed to environmental hazards due to their race, ethnicity, and socioeconomic status are called EJ communities. The purpose of this manuscript is to provide an example of nurses' involvement in observation, assessment, and intervention of an EJ community using a community-based participatory research (CBPR) model. Utilizing a multistage CBPR approach along with a mixed methods design, the project was carried out in three stages. Within the three stages, we conducted a thorough observation of the community, identified possible environmental issues, and collected health data and drinking water samples. Citizens' complaints included coal ash, failed sewer system, health issues, including kidney disorders and neuropathy. Drinking water samples (n = 59) showed lead levels higher than the health limits in 10.4% of samples. We intervened based on our short-term goal, reducing citizens' exposure to lead by education, and our long-term goal, reducing disparities, and exposures. We recommend that nurses increase their knowledge about EJ communities and environmental exposures and their health effects and be advocates for EJ communities.

Geographic and social disparities in exposure to air neurotoxicants at U.S. public schools

Children are especially vulnerable to the health and developmental impacts of environmental hazards and they spend significant portions of their days at school. Yet there are no national-level studies examining school-level environmental inequalities and few have examined disparate exposure to neurological air toxicants, even though chronic exposure to air pollution impacts children's brain functioning. We paired information about the geographic locations and demographics of each public school in the US with air neurotoxicant exposure estimates pertaining to 24 known neurotoxicants included in the US Environmental Protection Agency's National Air Toxics Assessment. Using bivariate and multivariate statistics, we tested for environmental injustices in air neurotoxicant exposure at 84,969 US public schools. Metropolitan New York City (EPA Region 2) is the geographic region most burdened by air neurotoxicant exposures at schools since one-third of all schools in that region are in the top 10% (at "high risk") for ambient neurotoxicant exposure among all schools nationwide. Students attending "high risk" public schools nationwide are significantly more likely to be eligible for free/reduced price meals, and to be Hispanic, black, or Asian/Pacific Islander (API). They are significantly less likely to be white or of another race. In a multivariate generalized estimating equation controlling for school district effects, schools with greater proportions of Hispanic, black, and API students, schools with higher enrollment, and schools located in more urban (vs. rural) counties face greater risks. Schools serving the youngest students (e.g., pre-kindergarten) have greater levels of risk than schools serving older students. Across all analyses, this study shows that racial/ethnic minority children are bearing the brunt of air neurotoxicant exposures at school, which may be unequally impacting their school performance and future potential.