Asthma, environmental risk factors, and hypertension among Arab Americans in metro Detroit

The journey of F1000Research since inception: through bibliometric analysis

Background: Bibliometric analysis is an approach adopted by researchers to understand the various analytics such as year-wise publications, their citations, most impactful authors and their contributions, identification of emerging keywords, multiple themes (niche, motor, basic, and emerging or declining) etc. F1000Research is one of the Q1 category journals that publishes articles in various domains, but a detailed journal analysis is yet to be done. Methods: This study is an effort to extract the F1000Research journey information through bibliometric analysis using VOS-viewer and Biblioshiny (R-studio) interface. The F1000Research journal started its journey in 2012; since then, 5767 articles have been published until the end of 2022. Most of the published articles are from medical science, covering Biochemistry, Genetics & Molecular Biology, Immunology & Pharmacology, Toxicology & Pharmaceutics. To understand the research journey, various analyses such as publication & citation trends, leading authors, institutions, countries, most frequent keywords, bibliographic coupling between authors, countries and documents, emerging research themes, and trending keywords were performed. Results: The United States is the biggest contributor, and COVID-19 is the most commonly occurred keyword. Conclusions: The present study may help future researchers to understand the emerging medical science domain. It will also help the editors and journal to focus more on developing or emerging areas and to understand their importance towards society. Future researchers can contribute their quality research studies, focusing on emerging themes. These authors' research can guide future researchers to develop their research area around the most impacted articles. They can collaborate with them to bring that emerging theme forward.

Hypertension and diabetes mellitus as risk factors for asthma in Korean adults: the Sixth Korea National Health and Nutrition Examination Survey

Background

Asthma is a chronic inflammatory disease that may associate with other chronic diseases such as hypertension and diabetes. We observed the effects of blood pressure (BP), fasting blood glucose (FBG), haemoglobin A1c (HbA1c) and insulin on asthma in Korean adults.

Methods

Data from 5045 adults were taken from the 2015 Sixth Korea National Health and Nutrition Examination Survey and analysed using a multiple logistic regression model.

Results

By age, the probability of asthma occurrence was 1.02 times higher (adjusted odds ratio [aOR] 1.02 [95% CI 1.01 to 1.03]). Specifically, asthma occurrence was increased in individuals >66 years of age (aOR 2.40 [95% CI 1.22 to 4.72]). The probability of asthma occurrence in females was higher than in males (aOR 1.73 [95% CI 1.02 to 2.84]). Hypertension and systolic blood pressure (SBP) were found to increase the probability of asthma occurrence by 1.43- and 1.03-fold, respectively. Diabetes mellitus (DM) was another factor that increased with the occurrence of asthma (aOR 1.75 [95% CI 1.06 to 3.02]). The probability of asthma occurrence was not increased with the FBG level, whereas HbA1c (aOR 1.38 [95% CI 1.03 to 1.84]) and insulin levels (aOR 1.02 [95% CI 1.01 to 1.04]) were shown to increase the occurrence of asthma.

Conclusions

Age, sex, hypertension, SBP, DM, HbA1c and insulin levels are all factors that may influence the occurrence of asthma in Korean adults. In particular, hypertension and diabetes emerge from the present study as potential associated factors for the development of asthma.

Prevalence of Arterial Hypertension and Characteristics of Nocturnal Blood Pressure Profile of Asthma Patients According to Therapy and Severity of the Disease: The BADA Study

BACKGROUND

several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects.

METHODS

The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of asthma patients) study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. The main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ambulatory blood pressure monitoring (ABPM).

RESULTS

The overall percentage of asthmatics having also hypertension was 75% (30 patients) vs. 45% (18 patients) of the control group (p: 0.012). Reduced level of FEV₁ (but not inhaled steroid therapy) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24 h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). The regression analysis performed taking into account sex, age, diabetes, fasting glucose, and body mass index confirms the independent role played by asthma: odds ratio (OR): 3.66 (CI: 1.29-11.1).

CONCLUSIONS

hypertension is highly prevalent in asthma; the use of ABPM has allowed the detection of a considerable number of unrecognized hypertensives.

Ancestry-based intracategorical injustices in carcinogenic air pollution exposures in the United States

Previous studies of US environmental inequalities have focused on racial/ethnic differences in air pollutant exposure. Few have applied an intracategorical framework, which enables the identification of within-group differences through the examination of subgroups. We applied this framework to examine exposure disparities between 26 ancestry/ethnic origin groups within five US racial/ethnic categories. Data come from the US Census, American Community Survey, and National Air Toxics Assessment. We calculated national population-weighted lifetime cancer risk (LCR) scores from residential exposure to hazardous air pollutants. Results showed that Americans of Dominican, Ethiopian, and Somalian descent have the highest total LCR scores at 53.1, 49.2, and 48.3 estimated excess cases of cancer per one million people, respectively. Use of the intracategorical framework enabled characterization of disparate risks that would be overlooked based on the conventional assumption that racial/ethnic environmental inequalities conform to broad, homogenous categories. Intracategorical studies can inform interventions by identifying environmentally-disadvantaged socio-demographic groups.

Collins T, Rubio R. Distributional Environmental Injustices for a Minority Group without Minority Status: Arab Americans and Residential Exposure to Carcinogenic Air Pollution in the US

Distributional environmental injustices in residential exposure to air pollution in Arab American enclaves have not been examined. We conducted our investigation at the census tract-level across the continental United States using a set of socio-demographic variables to predict cancer risk from hazardous air pollutant (HAP) exposure. Arab enclaves had a mean cancer risk score of 44.08, as compared to 40.02 in non-enclave tracts. In terms of the specific origin groups, Moroccan enclaves had the highest cancer risk score (46.93), followed by Egyptian (45.33), Iraqi (43.13), Jordanian (41.67), and Lebanese (40.65). In generalized estimating equations controlling for geographic clustering and other covariates, Arab enclaves had significantly higher cancer risks due to HAPs (p < 0.001) than non-enclaves. When looking at specific ethnic origins, Iraqi, Palestinian, and Lebanese enclaves had significantly higher cancer risks due to HAPs (all p < 0.01) than non-enclaves. Results reveal significant environmental injustices for Arab American enclaves that should be examined in future studies. Results suggest that environmental injustice may be another way in which Arab Americans are disadvantaged as a racialized minority group without minority status.

Maternal asthma and the risk of hypertensive disorders of pregnancy: a systematic review and meta-analysis of cohort studies

Objective: The aim of this study was to demonstrate the association between maternal asthma and the risk of hypertensive disorders of pregnancy.Methods: A systematic search of seven databases was conducted. A meta-analysis was performed to calculate risk ratios and 95% CI using random-effects models.Results: Asthma was associated with an increased risk of pregnancy-induced hypertension (RR 1.45, 95%CI 1.29-1.63), transient hypertension of pregnancy (RR 2.00, 95%CI 1.52-2.63), preeclampsia or eclampsia (RR 1.28, 95%CI 1.25-1.32), preeclampsia (RR 1.43, 95%CI 1.31-1.57) and eclampsia (RR 1.56, 95%CI 1.13-2.15).Conclusion: The meta-analysis illustrated that asthma was significantly increased risk of hypertension during pregnancy.

Comorbidity of asthma and hypertension may be mediated by shared genetic dysregulation and drug side effects

Asthma and hypertension are complex diseases coinciding more frequently than expected by chance. Unraveling the mechanisms of comorbidity of asthma and hypertension is necessary for choosing the most appropriate treatment plan for patients with this comorbidity. Since both diseases have a strong genetic component in this article we aimed to find and study genes simultaneously associated with asthma and hypertension. We identified 330 shared genes and found that they form six modules on the interaction network. A strong overlap between genes associated with asthma and hypertension was found on the level of eQTL regulated genes and between targets of drugs relevant for asthma and hypertension. This suggests that the phenomenon of comorbidity of asthma and hypertension may be explained by altered genetic regulation or result from drug side effects. In this work we also demonstrate that not only drug indications but also contraindications provide an important source of molecular evidence helpful to uncover disease mechanisms. These findings give a clue to the possible mechanisms of comorbidity and highlight the direction for future research.

Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma

Objective: The study investigated the associations between fine particulate matter (PM_2.5; <2.5 μm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM_2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM_2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m³ during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM_2.5 was related to shortness of breath (SHOB; standardized β = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; β = 0.28, p = 0.02). However, PM_2.5 did not predict lung function (FEV₁% predicted and FEV₁/FVC). However, PM_2.5 was related to use of asthma controller drugs (β = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (β = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.

Molecular Relationships between Bronchial Asthma and Hypertension as Comorbid Diseases

Comorbidity, a co-incidence of several disorders in an individual, is a common phenomenon. Their development is governed by multiple factors, including genetic variation. The current study was set up to look at associations between isolated and comorbid diseases of bronchial asthma and hypertension, on one hand, and single nucleotide polymorphisms associated with regulation of gene expression (eQTL), on the other hand. A total of 96 eQTL SNPs were genotyped in 587 Russian individuals. Bronchial asthma alone was found to be associated with rs1927914 (TLR4), rs1928298 (intergenic variant), and rs1980616 (SERPINA1); hypertension alone was found to be associated with rs11065987 (intergenic variant); rs2284033 (IL2RB), rs11191582 (NT5C2), and rs11669386 (CARD8); comorbidity between asthma and hypertension was found to be associated with rs1010461 (ANG/RNASE4), rs7038716, rs7026297 (LOC105376244), rs7025144 (intergenic variant), and rs2022318 (intergenic variant). The results suggest that genetic background of comorbidity of asthma and hypertension is different from genetic backgrounds of both diseases manifesting isolated.

The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review

Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.

Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).

Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.

Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.

Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health

PURPOSE OF REVIEW

The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.

RECENT FINDINGS

Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations. Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.

Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms

Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes.

Disparities in Chronic Disease Prevalence Among Non-Hispanic Whites: Heterogeneity Among Foreign-Born Arab and European Americans

We estimated and compared the sex- and age-adjusted prevalence of chronic diseases (diagnosis only and comorbidity) among US- and foreign-born whites from Europe and the Arab Nations and examined associations between region of birth and chronic disease. We evaluated 213,644 adults using restricted data from the National Health Interview Survey (2000-2011) by (1) chronic disease diagnosis only (heart disease, asthma, cancer, diabetes, ulcer, or obesity) and (2) comorbidity (none, diagnosis only, comorbid). We used logistic regression to examine associations between region of birth and chronic disease while controlling for confounders. Foreign-born whites from the Arab Nations had a higher prevalence of being diagnosed with ulcer (4 %) compared to US- and European-born whites (2 %). Foreign-born whites from the Arab Nations had a lower prevalence of comorbid cancer (1 %) and ulcer (3 %) yet had higher estimates of comorbid heart disease (18 %), asthma (5 %), and obesity (13 %) when compared to European-born whites (all ps < 0.05). Arab Americans had the highest prevalence of comorbid diabetes (8 %) compared to both European- (5 %) and US-born whites (6 %). In multivariate logistic regression models, Arab Americans had a lower odds of reporting cancer, heart disease, and asthma before and after controlling for covariates. Our study builds on existing literature for Arab Americans as the first study evaluating chronic disease prevalence among foreign-born whites from countries in the Arab League of Nations geographically located in the Middle East. Methodologically robust studies are needed to better understand the influence of acculturation, country of origin, and other characteristics influencing health among foreign-born whites.

Hypertension and Asthma: A Comorbid Relationship

BACKGROUND

An increased prevalence of hypertension has been described in adult asthmatic patients. However, there is no information regarding the interaction of hypertension as a comorbidity with asthma severity.

OBJECTIVE

The objective of this study was to investigate whether a concomitant diagnosis of hypertension had any impact on markers of asthma severity in adult asthmatic patients.

METHODS

A total of 117,922 asthmatic subjects 18 years or older were identified in the Kaiser Permanente database. Case-control studies were conducted with cases defined by short-acting β-agonist canister dispensing greater than 6 (SABA > 6), history of emergency department visits or hospitalizations (EDHO), and corticosteroid dispensings (CCS), respectively. Controls were matched by age and sex. Univariate and multivariate conditional logistic regression was applied to estimate the odds ratios (OR) and 95% confidence intervals (CI) for SABA > 6, EDHO, and CCS associated with the diagnosis of hypertension.

RESULTS

Hypertension was associated with an increased odds of SABA > 6 (OR 1.19, CI 1.13-1.26, n = 15,855 cases and 76,060 controls), EDHO (OR 1.11, CI 1.03-1.19, n = 9,307 cases and 46,535 controls), and CCS (OR 1.15, CI 1.10-1.19, n = 53,690 cases and 53,690 controls) after adjusting for potential confounders.

CONCLUSIONS

Asthmatic subjects with comorbid hypertension display evidence of enhanced of asthma morbidity.

Association between psoriasis and asthma: a population-based retrospective cohort analysis

BACKGROUND

Both psoriasis and asthma are chronic immune-mediated inflammatory diseases.

OBJECTIVES

To evaluate the risk of developing asthma in patients with psoriasis compared with controls.

METHODS

This cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients with psoriasis (n = 10,288) and matched comparison patients without psoriasis (n = 41,152) were evaluated. A Cox proportional hazard regression analysis was used to determine the risk of asthma in patients with and without psoriasis.

RESULTS

The risk of asthma was 1·38-fold higher [95% confidence interval (CI) 1·23-1·54] in the cohort with psoriasis than in the reference cohort, after adjusting for age, sex and comorbidities. The incidence of asthma in men and women with psoriasis exhibited nonsignificant differences. Among all patients aged > 50 years, psoriasis was associated with a higher risk of asthma compared with not having psoriasis [adjusted hazard ratio (HR) 1·49; 95% CI 1·18-1·88 (in patients aged 50-64 years); adjusted HR 1·63; 95% CI 1·34-1·99 (in patients aged > 65 years)].

CONCLUSIONS

Our results indicate that patients with psoriasis are associated with a increased risk of developing asthma.

Bronchial asthma and chronic obstructive pulmonary disease: research activity in Arab countries

BACKGROUND

Chronic respiratory diseases, like bronchial asthma and chronic obstructive pulmonary disease (COPD), are a worldwide health problem. Quantitative and qualitative assessment of asthma and COPD-related research from Arab countries has not been explored and there are few internationally published reports on such field. The main objectives of this study were to analyze research output originating from Arab countries in the field of bronchial asthma and COPD.

METHODS

Original scientific articles or reviews published from the 22 Arab countries were screened using specific words pertaining to asthma and COPD using Scopus database and search engine. Research productivity was evaluated based on: (a) total and trends of contribution of each Arab country to asthma and COPD research and (b) journals in which researchers from Arab countries published their research.

RESULTS

The total number of original research and review articles published globally about bronchial asthma and COPD was 163,964. The leading country in bronchial asthma and COPD research was United States of America (38,632; 23.56%). Worldwide, Turkey ranked 19th while Israel and Iran ranked 25th and 29th respectively. Among Arab countries, Egypt and Kingdom of Saudi Arabia came on positions 39th and 43rd, respectively. A total of 1,304 documents about bronchial asthma and COPD were published from Arab countries which represents 0.8% of the global research output. Research in bronchial asthma was almost double that in COPD. Research from Arab countries was low and showed a significant increase after 2000. Approximately 12% of research activity in asthma and COPD from Arab countries was published in Saudi Medical Journal, Annals of Saudi Medicine, Eastern Mediterranean Health Journal and Tunisie Medicale. Kingdom of Saudi Arabia, with a total publication of 353 (27.07%) ranked first among the Arab countries while University of Kuwait was the most productive institution with a total of 123 (9.43%) documents.

CONCLUSIONS

The present data showed relatively low research productivity about bronchial asthma and COPD in Arab countries. Research output can be improved by investing more in international and national collaborative research projects in the field of asthma and COPD.

Heterogeneity in ragweed pollen exposure is determined by plant composition at small spatial scales

Pollen allergies are one of the most common health problems in the United States and over 20% of Americans are sensitized to the pollen produced by common ragweed (Ambrosia artemisiifolia L.). Despite the importance of allergenic pollen to public health, no research has linked land use and plant populations to spatial heterogeneity in airborne pollen concentrations. In order to quantify these relationships and elucidate the processes which lead to pollen exposure, we surveyed ragweed stem density in Detroit (Michigan, USA) as a function of land use. We then deployed 34 pollen collectors throughout the city and recorded ragweed cover in the immediate vicinity of each pollen collector. We found that ragweed populations were highest in vacant lots, a common land cover type in Detroit. Because ragweed population density was so strongly correlated to vacant lots, for which spatially explicit data were available, we were able to investigate whether observed ragweed pollen concentrations were a function of land use at the spatial scales of 10 m and 1 km. Both relationships were significant, and the combination of these two variables predicts a large portion of airborne ragweed pollen concentrations (R(2)=0.48). These results emphasize the important role of pollen production within the urban environment and show that management of allergenic pollen producing plants must be considered at multiple spatial scales. Our findings also demonstrate that there is too much spatial heterogeneity for a pollen collector at any given site to portray the allergenic pollen load experienced by different individuals within the same city. Finally, we discuss how spatial correlations between socio-economic status, vacant lots, and ragweed could help to explain the disproportionate amount of allergies and ragweed sensitization experienced by low income and minority populations in Detroit.

Bronchial asthma is associated with increased risk of chronic kidney disease

Background

Bronchial asthma influences some chronic diseases such as coronary heart disease, diabetes mellitus, and hypertension, but the impact of asthma on vital diseases such as chronic kidney disease is not yet verified. This study aims to clarify the association between bronchial asthma and the risk of developing chronic kidney disease.

Methods

The National Health Research Institute provided a database of one million random subjects for the study. A random sample of 141 064 patients aged ≥18 years without a history of kidney disease was obtained from the database. Among them, there were 35 086 with bronchial asthma and 105 258 without asthma matched for sex and age for a ration of 1:3. After adjusting for confounding risk factors, a Cox proportional hazards model was used to compare the risk of developing chronic kidney disease during a three-year follow-up period.

Results

Of the subjects with asthma, 2 196 (6.26%) developed chronic kidney disease compared to 4 120 (3.91%) of the control subjects. Cox proportional hazards regression analysis revealed that subjects with asthma were more likely to develop chronic kidney disease (hazard ratio [HR]: 1.56; 95% CI: 1.48-1.64; p < 0.001). After adjusting for sex, age, monthly income, urbanization level, geographic region, diabetes mellitus, hypertension, hyperlipidemia, and steroid use, the HR for asthma patients was 1.40 (95% CI: 1.33-1.48; p = 0.040). There was decreased HRs in steroid use (HR: 0.56; 95% CI: 0.62-0.61; p < 0.001) in the development of chronic kidney disease. Expectorants, bronchodilators, anti-muscarinic agents, airway smooth muscle relaxants, and leukotriene receptor antagonists may also be beneficial in attenuating the risk of chronic kidney disease.

Conclusions

Patients with bronchial asthma may have increased risk of developing chronic kidney disease. The use of steroids or non-steroidal drugs in the treatment of asthma may attenuate this risk.

A rating scale for housing-based health hazards

OBJECTIVES

This study investigated the validity and responsiveness of a rating scale designed to assess the housing-based hazards and their relationships to burden of disease symptoms in the building occupants.

STUDY DESIGN

A population-based cross-sectional survey.

METHODS

Random-digit dialing with computer-assisted phone interviews was conducted to obtain information from 642 households in the City of Saginaw, Michigan about 71 housing-based hazards, symptoms of 43 diseases often associated with environmental exposures and demographic characteristics. The housing-based hazard index (HHI) was calculated from scores of hazards across the following eight dimensions: structural scale (18 items); moisture/mold scale (8 items), electrical scale (7 items), ventilation and combustion appliances scale (6 items); pest scale (6 items); pets scale (4 items), fire scale (6 items) and lifestyle-associated factors scale (12 items). Each item was assigned a relative score based on the likelihood that the housing occupants would be exposed to the hazard, the potential for serious health impacts, and the reported strength of its association with childhood lead poisoning and respiratory diseases. The psychometric properties of HHI and individual domains (scales) were assessed along with the associations between these indicators and the inventory of disease symptoms.

RESULTS

The reliability of HHI was demonstrated by assessments of its dimensionality and internal consistency. Analysis of the predictive validity and responsiveness indicates that HHI and scores for most of the individual scales can discriminate between households in relation to the burden of reported disease symptoms.

CONCLUSIONS

The HHI represents a valid, reasonably reliable, and parsimonious measure of hazards that are congruent with the burden of symptoms generally associated with housing-related diseases.

Lead poisoning among Arab American and African American children in the Detroit metropolitan area, Michigan

This study explored the hypothesis that acculturation is a risk factor for childhood lead poisoning in the Detroit area of Michigan. Blood lead levels (BLLs) were determined in 429 Arab American and African American children, aged 6 months to 15 years, who were receiving well-child examination in three Women, Infant, and Children (WIC) clinics in the city. Mean BLL was 3.8 ± 2.3 μg/dL (range: 1-18 μg/dL) and 3.3% of the children tested had blood lead values above the 10 μg/dL level of concern. Neither the age of the dwelling units nor ethnicity of the child was significantly associated with the BLL. Multivariable analyses instead identified a number of acculturation-related factors that are associated with elevation in blood lead including paternal education, language spoken at home (English only, English and Arabic, or Arabic only), home ownership, smoking in the home, and exposure of child to home health remedies. The difference in blood lead between Arab American children from families where Arabic only versus Arabic and English is spoken at home was found to be statistically significant. This study provides information showing that immigrant children are at heightened risk of being poisoned by lead which can be useful in identifying groups at risk of atypical exposures.