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Beenackers MA, Kruize H, Barsties L, Acda A, Bakker I, Droomers M, Kamphuis CBM, Koomen E, Nijkamp JE, Vaandrager L, Völker B, Luijben G, Ruijsbroek A. Urban densification in the Netherlands and its impact on mental health: An expert-based causal loop diagram. Health Place 2024; 87:103218. [PMID: 38564990 DOI: 10.1016/j.healthplace.2024.103218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals' mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.
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Affiliation(s)
- Mariëlle A Beenackers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Hanneke Kruize
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Lisa Barsties
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annelies Acda
- Annelies Acda Advies - public health, policy and the built environment, Bussum, the Netherlands.
| | - Ingrid Bakker
- Department of Urban Innovation, Research Centre of Social Innovations Flevoland, Windesheim University of Applied Sciences, Almere, the Netherlands.
| | - Mariël Droomers
- Department of Public Health, City of Utrecht, Utrecht, the Netherlands.
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.
| | - Eric Koomen
- Department of Spatial Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jeannette E Nijkamp
- Department of Healthy Cities, Research Centre for Built Environment NoorderRuimte, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands.
| | - Lenneke Vaandrager
- Health and Society, Wageningen University and Research, Wageningen, the Netherlands.
| | - Beate Völker
- Department Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands; Netherlands Centre for the Study of Crime and Law Enforcement (NSCR), Amsterdam, the Netherlands.
| | - Guus Luijben
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annemarie Ruijsbroek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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Liu J, Marshall JD. Spatial Decomposition of Air Pollution Concentrations Highlights Historical Causes for Current Exposure Disparities in the United States. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2023; 10:280-286. [PMID: 36938149 PMCID: PMC10019334 DOI: 10.1021/acs.estlett.2c00826] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Racial-ethnic disparities in exposure to air pollution in the United States (US) are well documented. Studies on the causes of these disparities highlight unequal systems of power and longstanding systemic racism-for example, redlining, white flight, and racial covenants-which reinforced racial segregation and wealth gaps and which concentrated polluting land uses in communities of color. Our analysis is based on empirical estimates of ambient concentrations for two important pollutants (NO2 and PM2.5). We show that spatially decomposed concentrations can be used to infer and quantify types of root causes for local- to national-scale disparities. Urban-scale segregation is important yet reflects less than half of the overall national disparities. Other historical causes of national exposure disparities include those that led current populations of Black, Asian, and Hispanic Americans to live in larger cities; those outcomes are consistent with, for example, greater economic opportunity in large cities, land-takings from non-White farmers, and racism in homesteading and between-state migration. Our results suggest that contemporary national exposure disparities in the US reflect a broad set of historical local- to national-scale mechanisms-including racist laws and actions that include, but also extend beyond, urban-scale aspects-and offer a first attempt to quantify their relative importance.
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Affiliation(s)
- Jiawen Liu
- Department
of Civil and Environmental Engineering, University of Washington, Seattle, Washington 98125, United States
| | - Julian D. Marshall
- Department
of Civil and Environmental Engineering, University of Washington, Seattle, Washington 98125, United States
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Zheng J, Tisdale RL, Heidenreich PA, Sandhu AT. Disparities in Hospital Length of Stay Across Race and Ethnicity Among Patients With Heart Failure. Circ Heart Fail 2022; 15:e009362. [PMID: 36378760 PMCID: PMC9673157 DOI: 10.1161/circheartfailure.121.009362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reducing hospital length of stay (LOS) has been identified as an important lever for minimizing the burden of heart failure hospitalization, yet the impact of social and structural determinants of health on LOS has received little attention. We investigated disparities in LOS across race/ethnicity and their possible drivers. METHODS We analyzed patients hospitalized for heart failure from 2017 to 2020 using the Get With The Guidelines-Heart Failure registry. We characterized LOS differences across race/ethnicity by insurance and disposition, adjusting for demographics, comorbidities, and clinical severity. Effects of hospital-level clustering on LOS across race/ethnicity were assessed using hierarchical mixed-effects models. We evaluated the association between LOS and discharge rates of guideline-directed medical therapy. RESULTS Three thousand three seven hundred thirty patients hospitalized for heart failure were identified. After excluding inpatient deaths, the adjusted LOS for Black (5.72 days [95% CI, 5.62-5.82]), Hispanic (5.94 days [95% CI, 5.79-6.08]), and Indigenous American/Pacific Islander (6.06 days [95% CI, 5.85-6.27]) patients remained significantly longer compared with non-Hispanic White patients (5.32 days [95% CI, 5.25-5.39]). This pattern was driven by LOS differences among patients discharged to hospice or nursing facilities. After accounting for variability between hospitals, associations of race/ethnicity with LOS either were attenuated or reversed in direction. Guideline-directed medical therapy rates on discharge did not differ significantly across race/ethnicity despite longer LOS for Black, Hispanic, and Indigenous American/Pacific Islander patients. CONCLUSIONS Differences between hospitals drive LOS disparities across race/ethnicity. Longer LOS among Black, Hispanic, and Indigenous American/Pacific Islander patients was not associated with improved quality of care.
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Affiliation(s)
| | - Rebecca L Tisdale
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Paul A Heidenreich
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA
| | - Alexander T Sandhu
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA
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Liwin LK. Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis. BMC Public Health 2022; 22:1004. [PMID: 35585591 PMCID: PMC9115941 DOI: 10.1186/s12889-022-13379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country. Methods Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts). Results In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men. Conclusion Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13379-3.
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Affiliation(s)
- Lilipramawanty Kewok Liwin
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia.
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Marshall AT, McConnell R, Lanphear BP, Thompson WK, Herting MM, Sowell ER. Risk of lead exposure, subcortical brain structure, and cognition in a large cohort of 9- to 10-year-old children. PLoS One 2021; 16:e0258469. [PMID: 34648580 PMCID: PMC8516269 DOI: 10.1371/journal.pone.0258469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Lead, a toxic metal, affects cognitive development at the lowest measurable concentrations found in children, but little is known about its direct impact on brain development. Recently, we reported widespread decreases in cortical surface area and volume with increased risks of lead exposure, primarily in children of low-income families. METHODS AND FINDINGS We examined associations of neighborhood-level risk of lead exposure with cognitive test performance and subcortical brain volumes. We also examined whether subcortical structure mediated associations between lead risk and cognitive performance. Our analyses employed a cross-sectional analysis of baseline data from the observational Adolescent Brain Cognitive Development (ABCD) Study. The multi-center ABCD Study used school-based enrollment to recruit a demographically diverse cohort of almost 11,900 9- and 10-year-old children from an initial 22 study sites. The analyzed sample included data from 8,524 typically developing child participants and their parents or caregivers. The primary outcomes and measures were subcortical brain structure, cognitive performance using the National Institutes of Health Toolbox, and geocoded risk of lead exposure. Children who lived in neighborhoods with greater risks of environmental lead exposure exhibited smaller volumes of the mid-anterior (partial correlation coefficient [rp] = -0.040), central (rp = -0.038), and mid-posterior corpus callosum (rp = -0.035). Smaller volumes of these three callosal regions were associated with poorer performance on cognitive tests measuring language and processing speed. The association of lead exposure risk with cognitive performance was partially mediated through callosal volume, particularly the mid-posterior corpus callosum. In contrast, neighborhood-level indicators of disadvantage were not associated with smaller volumes of these brain structures. CONCLUSIONS Environmental factors related to the risk of lead exposure may be associated with certain aspects of cognitive functioning via diminished subcortical brain structure, including the anterior splenium (i.e., mid-posterior corpus callosum).
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Affiliation(s)
- Andrew T. Marshall
- Children’s Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, California, United States of America
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wesley K. Thompson
- Department of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, United States of America
| | - Megan M. Herting
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Elizabeth R. Sowell
- Children’s Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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Rane MS, Halloran ME. Estimating population-level effects of the acellular pertussis vaccine using routinely collected immunization data. Clin Infect Dis 2021; 73:2101-2107. [PMID: 33881527 DOI: 10.1093/cid/ciab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measuring and reporting the different population-level effects of the acellular pertussis vaccine on pertussis disease in addition to direct effects can increase the cost-effectiveness of a vaccine. METHODS We conducted a retrospective cohort study of children born between January 1, 2008, and December 31, 2017, in King County, Washington, who were enrolled in the Washington State Immunization Information System. Diphtheria-Tetanus-acellular-Pertussis (DTaP) vaccination data from WA-IIS was linked with pertussis case data from Public Health Seattle and King County. Census-level vaccination coverage was estimated as proportion of age-appropriately vaccinated children residing in it. Direct vaccine effectiveness was estimated by comparing pertussis risk in fully-vaccinated and under-vaccinated children. Population-level vaccine effects were estimated by comparing pertussis risk in census tracts in the highest vaccination coverage quartile to that in the lowest vaccination coverage quartile. RESULTS For direct protection, estimated vaccine effectiveness was 76% (95% CI: 63% - 84%) in low vaccination coverage clusters and it decreased to 47% (95% CI: 13% - 68%) in high vaccination coverage clusters, after adjusting for potential confounders. The estimated indirect effect was 45.0% (95% CI: 1%, 70%), total effect was 93.9% (95% CI: 91%, 96%), and overall effect was 42.2% (95% CI: 19%, 60%). CONCLUSION Our findings suggest that DTaP vaccination provided direct as well as indirect protection in the highly immunized King County, WA. Routine DTaP vaccination programs may have the potential to provide not only protection for vaccinated individuals but also for the under-vaccinated individuals living in the same area.
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Affiliation(s)
- Madhura S Rane
- Department of Epidemiology, University of Washington, Seattle USA
| | - M Elizabeth Halloran
- Department of Epidemiology, University of Washington, Seattle USA.,Department of Biostatistics University of Washington, Seattle USA.,Biostatistics, Bioinformatics, and Epidemiology Program, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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Heo S, Bell ML. The influence of green space on the short-term effects of particulate matter on hospitalization in the U.S. for 2000-2013. ENVIRONMENTAL RESEARCH 2019; 174:61-68. [PMID: 31039514 PMCID: PMC6550459 DOI: 10.1016/j.envres.2019.04.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 05/20/2023]
Abstract
Although a few studies have identified positive association between green space and reduced mortality rate, the effect modification of green space for the impact of air pollution on health outcomes is under studied. We quantified whether green space modifies associations between short-term exposure to particulate matter (PM10, PM2.5) and hospitalization across 364 urban U.S. counties for 2000-2013. Green space was measured by normalized difference vegetation index (NDVI). Daily number of hospital admissions for cardiovascular or respiratory diseases from Medicare enrollees (≥65yrs) and air quality monitoring data for each county were used to assess risks, as percent change in hospitalization related to 10μg/m3 increase in particulate matter. We computed an absolute change in county-specific relative risks explained by difference in county-level NDVI. The study results found that the association between air pollution and health was less in areas with more green space. We estimated that an interquartile range increase in NDVI corresponds to a 1.68% (95% CI: 0.43, 2.91) decrease in the association between PM10 and cardiovascular hospitalization and 10.40% (95% CI: 7.34, 13.34) decrease in the PM10-hospitalization association of acute myocardial infarction. For hospitalization associated with PM2.5, a 0.18% (95% CI: -0.39, 0.73) absolute decrease in relative risk was found for cardiovascular hospitalizations. In results stratified by age, younger age groups (65-74, 75-84yrs) had larger reductions for the PM10-hospitalization association with increase in NDVI than older populations (≥85yrs) but not for the PM2.5-hospitalization association. These findings add evidence for health benefits of green space in diminishing the health impacts of particulate matters on hospitalizations for older populations in the U.S.
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Affiliation(s)
- Seulkee Heo
- School of Forestry and Environmental Studies, Yale University, New Haven, United States.
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, United States
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Remote Sensing in Environmental Justice Research—A Review. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2019. [DOI: 10.3390/ijgi8010020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Human health is known to be affected by the physical environment. Various environmental influences have been identified to benefit or challenge people’s physical condition. Their heterogeneous distribution in space results in unequal burdens depending on the place of living. In addition, since societal groups tend to also show patterns of segregation, this leads to unequal exposures depending on social status. In this context, environmental justice research examines how certain social groups are more affected by such exposures. Yet, analyses of this per se spatial phenomenon are oftentimes criticized for using “essentially aspatial” data or methods which neglect local spatial patterns by aggregating environmental conditions over large areas. Recent technological and methodological developments in satellite remote sensing have proven to provide highly detailed information on environmental conditions. This narrative review therefore discusses known influences of the urban environment on human health and presents spatial data and applications for analyzing these influences. Furthermore, it is discussed how geographic data are used in general and in the interdisciplinary research field of environmental justice in particular. These considerations include the modifiable areal unit problem and ecological fallacy. In this review we argue that modern earth observation data can represent an important data source for research on environmental justice and health. Especially due to their high level of spatial detail and the provided large-area coverage, they allow for spatially continuous description of environmental characteristics. As a future perspective, ongoing earth observation missions, as well as processing architectures, ensure data availability and applicability of ’big earth data’ for future environmental justice analyses.
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Schmidt S, Sparks PJ. Disparities in injury morbidity among young adults in the USA: individual and contextual determinants. J Epidemiol Community Health 2018; 72:458-464. [PMID: 29439190 PMCID: PMC6152816 DOI: 10.1136/jech-2017-210259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Injuries have been recognised as important public health concerns, particularly among adolescents and young adults. Few studies have examined injuries using a multilevel perspective that addresses individual socioeconomic status (SES) and health behaviours and local socioeconomic conditions in early adolescence. We offer a conceptual framework incorporating these various components. METHODS We test our conceptual framework using population data from the National Longitudinal Study of Adolescent Health Wave 4 when respondents were young adults and linked them to contextual level data from when they were middle-schoolers. We use logistic and multilevel regression models to examine self-reported injury risk in young adults by sex (n=14 356). RESULTS Logistic regression models showed that men were more likely to experience serious injuries than women (OR 1.75, P<0.0001), but SES and health behaviours operated differently by sex. In stratified models, men with lower education had consistently higher injury risk, while only women with some college had increased injury risk (OR 1.40, P=0.0089) than college graduates. Low household income (OR 1.54, P=0.0011) and unemployment (OR 1.50, P=0.0008) increased female injury risk, but was non-significant for men. Alcohol consumption increased injury risk for both sexes, while only female smokers had elevated injury risk (OR 1.38, P=0.0154). In multilevel models, significant county-level variation was only observed for women. Women living in disadvantaged neighbourhoods during adolescence had increased injury risk (OR 1.001, P<0.0001). CONCLUSIONS These findings highlight the importance of investigating mechanisms that link early-life contextual conditions to early adult SES and health behaviours and their linkage to injury risk, particularly for women.
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Affiliation(s)
- Susanne Schmidt
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - P Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, Texas, USA
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Parnia A, Chakravartty D, Wiseman CLS, Archbold J, Copes R, Zawar N, Chen SX, Cole DC. Environmental factors associated with blood lead among newcomer women from South and East Asia in the Greater Toronto Area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 624:558-566. [PMID: 29268227 DOI: 10.1016/j.scitotenv.2017.11.336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Newcomers bring with them histories of environmental exposure in their home countries and may have different sources of lead (Pb) exposure compared to other residents of their adopted country. AIMS To describe past and current factors associated with Pb exposure and blood Pb among South and East Asian newcomer women of reproductive age in the Greater Toronto Area (GTA), Ontario, Canada. METHODS In collaboration with public health units and community organizations a community-based research model was utilized by recruiting peer researchers to assist in all aspects of the study. Blood samples were taken and phone interviews were conducted. Canadian Health Measures Survey (CHMS) cycles 1, 2, and 3 data was used to contextualize the distribution blood Pb levels. Multiple regression was applied to log-transformed blood lead measurements, using a hierarchical model building process. RESULTS In total, 211 participants were recruited from Bangladesh, China, India, Pakistan and Sri Lanka. The distribution of the blood Pb varied by country of origin, and higher blood Pb values were found above 75th percentile compared to the CHMS. Distal factors significantly influencing blood Pb concentrations related to life history, such as duration of stay in Canada (RR=0.91; 95% CI 0.86-0.97), living near agricultural fields (RR=0.78; 95% CI 0.62-0.93), and country of origin. Proximal factors with significant contribution were use of cosmetics, traditional remedies, and smoking cigarettes. RECOMMENDATIONS Different past and current exposures may be important in various newcomer populations, informing international stakeholders, public health agencies, and primary care practitioners to adapt health education and exposure reduction programs to consider pre- and post-migration factors.
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Affiliation(s)
- Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Dolon Chakravartty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Clare L S Wiseman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
| | | | - Ray Copes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Noureen Zawar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shirley X Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
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Eggers MJ, Doyle JT, Lefthand MJ, Young SL, Moore-Nall AL, Kindness L, Medicine RO, Ford TE, Dietrich E, Parker AE, Hoover JH, Camper AK. Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E76. [PMID: 29304032 PMCID: PMC5800175 DOI: 10.3390/ijerph15010076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 12/19/2022]
Abstract
An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families' financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.
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Affiliation(s)
- Margaret J Eggers
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - John T Doyle
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- Crow Water Quality Project, P.O. Box 370, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Myra J Lefthand
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Sara L Young
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Anita L Moore-Nall
- Department of Earth Sciences, Montana State University, P.O. Box 173480, Bozeman, MT 59717, USA.
| | - Larry Kindness
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Roberta Other Medicine
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- Environmental Health Department, Crow/Northern Cheyenne Indian Health Service Hospital,Crow Agency, MT 59022, USA.
| | - Timothy E Ford
- School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant Street,Amherst, MA 01003, USA.
| | - Eric Dietrich
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
| | - Albert E Parker
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Department of Mathematical Sciences, Montana State University, P.O. Box 173980,Bozeman, MT 59717, USA.
| | - Joseph H Hoover
- Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Anne K Camper
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- College of Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
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Perla ME, Rue T, Cheadle A, Krieger J, Karr CJ, Karr CK. Population-based comparison of biomarker concentrations for chemicals of concern among Latino-American and non-Hispanic white children. J Immigr Minor Health 2016; 17:802-19. [PMID: 24668388 DOI: 10.1007/s10903-014-0002-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Differences in cultural and economic status may place ethnic subgroups of children at higher risk for exposure, leading to heightened health risks, and health inequities. Although Latino-Americans represent 22% of all children in the United States, few studies have explored within-group differences in their exposure to toxicants. Using socio-demographic and biomarker data from the National Health and Nutrition Examination Survey from 1999 to 2008, we characterized determinants of health and estimated geometric means of environmental contaminant biomarkers (blood concentrations of lead and mercury, serum concentrations of dichlorodiphenyldichloroethylene [p,p'-DDE] and cotinine, and urinary metabolites of organophosphate [OP] pesticides and polycyclic aromatic hydrocarbons [PAHs]) among 4,257 Mexican American (MA), 677 Other Latino-American (OL), and 3,370 Non-Hispanic White (NHW) children. MAs had the lowest levels of health insurance coverage and regular access to health care, and largest household size compared to NHWs and OLs. MAs had higher levels of p,p'-DDE, lead, and cadmium while OLs had higher estimates of mercury relative to other groups. MAs had higher urinary metabolite concentrations of 2-hydroxynaphthalene; otherwise MAs and OLs had lower concentrations of PAHs. NHWs had higher levels of cotinine and dimethylthiophosphate. For other OP metabolites, differences among groups were less clear. Lead and p,p'-DDE exposure differences likely reflect later and less regulatory control of these chemicals in Latin America. Additionally, poor quality housing with lead paint is more common in economically disadvantaged subpopulations. Dietary habits are possible sources of differential cadmium, mercury, and organophosphate exposure. Cotinine exposure differences by income and U.S.- vs. foreign-born may represent increased acculturation. These results, coupled with additional research on exposure sources may contribute to refinement of environmental health promotion programs for the fast-growing Latino-American population.
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Affiliation(s)
- M E Perla
- Department of Health Services, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA,
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Chi GC, Hajat A, Bird CE, Cullen MR, Griffin BA, Miller KA, Shih RA, Stefanick ML, Vedal S, Whitsel EA, Kaufman JD. Individual and Neighborhood Socioeconomic Status and the Association between Air Pollution and Cardiovascular Disease. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1840-1847. [PMID: 27138533 PMCID: PMC5132637 DOI: 10.1289/ehp199] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/03/2015] [Accepted: 04/19/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Long-term fine particulate matter (PM2.5) exposure is linked with cardiovascular disease, and disadvantaged status may increase susceptibility to air pollution-related health effects. In addition, there are concerns that this association may be partially explained by confounding by socioeconomic status (SES). OBJECTIVES We examined the roles that individual- and neighborhood-level SES (NSES) play in the association between PM2.5 exposure and cardiovascular disease. METHODS The study population comprised 51,754 postmenopausal women from the Women's Health Initiative Observational Study. PM2.5 concentrations were predicted at participant residences using fine-scale regionalized universal kriging models. We assessed individual-level SES and NSES (Census-tract level) across several SES domains including education, occupation, and income/wealth, as well as through an NSES score, which captures several important dimensions of SES. Cox proportional-hazards regression adjusted for SES factors and other covariates to determine the risk of a first cardiovascular event. RESULTS A 5 μg/m3 higher exposure to PM2.5 was associated with a 13% increased risk of cardiovascular event [hazard ratio (HR) 1.13; 95% confidence interval (CI): 1.02, 1.26]. Adjustment for SES factors did not meaningfully affect the risk estimate. Higher risk estimates were observed among participants living in low-SES neighborhoods. The most and least disadvantaged quartiles of the NSES score had HRs of 1.39 (95% CI: 1.21, 1.61) and 0.90 (95% CI: 0.72, 1.07), respectively. CONCLUSIONS Women with lower NSES may be more susceptible to air pollution-related health effects. The association between air pollution and cardiovascular disease was not explained by confounding from individual-level SES or NSES. Citation: Chi GC, Hajat A, Bird CE, Cullen MR, Griffin BA, Miller KA, Shih RA, Stefanick ML, Vedal S, Whitsel EA, Kaufman JD. 2016. Individual and neighborhood socioeconomic status and the association between air pollution and cardiovascular disease. Environ Health Perspect 124:1840-1847; http://dx.doi.org/10.1289/EHP199.
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Affiliation(s)
- Gloria C. Chi
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Address correspondence to G.C. Chi, 1959 NE Pacific St., Box 357236, Seattle, WA 98195 USA. Telephone: (626) 872-3007. E-mail:
| | - Anjum Hajat
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Mark R. Cullen
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Kristin A. Miller
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Marcia L. Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Eric A. Whitsel
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joel D. Kaufman
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
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Grabich SC, Rappazzo KM, Gray CL, Jagai JS, Jian Y, Messer LC, Lobdell DT. Additive Interaction between Heterogeneous Environmental Quality Domains (Air, Water, Land, Sociodemographic, and Built Environment) on Preterm Birth. Front Public Health 2016; 4:232. [PMID: 27822465 PMCID: PMC5076290 DOI: 10.3389/fpubh.2016.00232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Environmental exposures often occur in tandem; however, epidemiological research often focuses on singular exposures. Statistical interactions among broad, well-characterized environmental domains have not yet been evaluated in association with health. We address this gap by conducting a county-level cross-sectional analysis of interactions between Environmental Quality Index (EQI) domain indices on preterm birth in the Unites States from 2000 to 2005. METHODS The EQI, a county-level index constructed for the 2000-2005 time period, was constructed from five domain-specific indices (air, water, land, built, and sociodemographic) using principal component analyses. County-level preterm birth rates (n = 3141) were estimated using live births from the National Center for Health Statistics. Linear regression was used to estimate prevalence differences (PDs) and 95% confidence intervals (CIs) comparing worse environmental quality to the better quality for each model for (a) each individual domain main effect, (b) the interaction contrast, and (c) the two main effects plus interaction effect (i.e., the "net effect") to show departure from additivity for the all U.S. counties. Analyses were also performed for subgroupings by four urban/rural strata. RESULTS We found the suggestion of antagonistic interactions but no synergism, along with several purely additive (i.e., no interaction) associations. In the non-stratified model, we observed antagonistic interactions, between the sociodemographic/air domains [net effect (i.e., the association, including main effects and interaction effects) PD: -0.004 (95% CI: -0.007, 0.000), interaction contrast: -0.013 (95% CI: -0.020, -0.007)] and built/air domains [net effect PD: 0.008 (95% CI 0.004, 0.011), interaction contrast: -0.008 (95% CI: -0.015, -0.002)]. Most interactions were between the air domain and other respective domains. Interactions differed by urbanicity, with more interactions observed in non-metropolitan regions. CONCLUSION Observed antagonistic associations may indicate that those living in areas with multiple detrimental domains may have other interfering factors reducing the burden of environmental exposure. This study is the first to explore interactions across different environmental domains and demonstrates the utility of the EQI to examine the relationship between environmental domain interactions and human health. While we did observe some departures from additivity, many observed effects were additive. This study demonstrated that interactions between environmental domains should be considered in future analyses.
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Affiliation(s)
- Shannon C Grabich
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
| | - Kristen M Rappazzo
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
| | - Christine L Gray
- National Health and Environmental Effects Research Laboratory, Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago , Chicago, IL , USA
| | - Yun Jian
- National Health and Environmental Effects Research Laboratory, Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency , Chapel Hill, NC , USA
| | - Lynne C Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University , Portland, OR , USA
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
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Kravitz-Wirtz N, Crowder K, Hajat A, Sass V. THE LONG-TERM DYNAMICS OF RACIAL/ETHNIC INEQUALITY IN NEIGHBORHOOD AIR POLLUTION EXPOSURE, 1990-2009. DU BOIS REVIEW : SOCIAL SCIENCE RESEARCH ON RACE 2016; 13:237-259. [PMID: 28989341 PMCID: PMC5628744 DOI: 10.1017/s1742058x16000205] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Research examining racial/ethnic disparities in pollution exposure often relies on cross-sectional data. These analyses are largely insensitive to exposure trends and rarely account for broader contextual dynamics. To provide a more comprehensive assessment of racial-environmental inequality over time, we combine the 1990 to 2009 waves of the Panel Study of Income Dynamics (PSID) with spatially- and temporally-resolved measures of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) in respondents' neighborhoods, as well as census data on the characteristics of respondents' metropolitan areas. Results based on multilevel repeated measures models indicate that Blacks and Latinos are, on average, more likely to be exposed to higher levels of NO2, PM2.5, and PM10 than Whites. Despite nationwide declines in levels of pollution over time, racial and ethnic disparities persist and cannot be fully explained by individual-, household-, or metropolitan-level factors.
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Affiliation(s)
| | - Kyle Crowder
- Department of Sociology, University of Washington
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington
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Abstract
The existing reviews and meta-analyses addressing unequal exposure of environmental hazards on certain populations have focused on several environmental pollutants or on the siting of hazardous facilities. This review updates and contributes to the environmental inequality literature by focusing on ambient criteria air pollutants (including NOx), by evaluating studies related to inequality by socioeconomic status (as opposed to race/ethnicity) and by providing a more global perspective. Overall, most North American studies have shown that areas where low-socioeconomic-status (SES) communities dwell experience higher concentrations of criteria air pollutants, while European research has been mixed. Research from Asia, Africa, and other parts of the world has shown a general trend similar to that of North America, but research in these parts of the world is limited.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
| | - Charlene Hsia
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
| | - Marie S O'Neill
- Departments of Environmental Health Sciences and Epidemiology, University of Michigan, 6623 SPH Tower 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
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Rappazzo KM, Messer LC, Jagai JS, Gray CL, Grabich SC, Lobdell DT. The associations between environmental quality and preterm birth in the United States, 2000-2005: a cross-sectional analysis. Environ Health 2015; 14:50. [PMID: 26051702 PMCID: PMC4464856 DOI: 10.1186/s12940-015-0038-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/29/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Many environmental factors have been independently associated with preterm birth (PTB). However, exposure is not isolated to a single environmental factor, but rather to many positive and negative factors that co-occur. The environmental quality index (EQI), a measure of cumulative environmental exposure across all US counties from 2000-2005, was used to investigate associations between ambient environment and PTB. METHODS With 2000-2005 birth data from the National Center for Health Statistics for the United States (n = 24,483,348), we estimated the association between increasing quintiles of the EQI and county-level and individual-level PTB; we also considered environmental domain-specific (air, water, land, sociodemographic and built environment) and urban-rural stratifications. RESULTS Effect estimates for the relationship between environmental quality and PTB varied by domain and by urban-rural strata but were consistent across county- and individual-level analyses. The county-level prevalence difference (PD (95% confidence interval) for the non-stratified EQI comparing the highest quintile (poorest environmental quality) to the lowest quintile (best environmental quality) was -0.0166 (-0.0198, -0.0134). The air and sociodemographic domains had the strongest associations with PTB; PDs were 0.0196 (0.0162, 0.0229) and -0.0262 (-0.0300, -0.0224) for the air and sociodemographic domain indices, respectively. Within the most urban strata, the PD for the sociodemographic domain index was 0.0256 (0.0205, 0.0307). Odds ratios (OR) for the individual-level analysis were congruent with PDs. CONCLUSION We observed both strong positive and negative associations between measures of broad environmental quality and preterm birth. Associations differed by rural-urban stratum and by the five environmental domains. Our study demonstrates the use of a large scale composite environment exposure metric with preterm birth, an important indicator of population health and shows potential for future research.
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Affiliation(s)
- Kristen M Rappazzo
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Lynne C Messer
- School of Community Health; College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Chicago, IL, USA.
| | - Christine L Gray
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
| | - Shannon C Grabich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
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18
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Messer LC, Boone-Heinonen J, Mponwane L, Wallack L, Thornburg KL. Developmental Programming: Priming Disease Susceptibility for Subsequent Generations. CURR EPIDEMIOL REP 2015; 2:37-51. [PMID: 26366336 PMCID: PMC4563822 DOI: 10.1007/s40471-014-0033-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Racial and/or ethnic minorities carry the highest burden of many adverse health outcomes intergenerationally We propose a paradigm in which developmental programming exacerbates the effects of racial patterning of adverse environmental conditions, thereby contributing to health disparity persistence. Evidence that developmental programming induces a heightened response to adverse exposures ("second hits") encountered later in life is considered. We evaluated the evidence for the second hit phenomenon reported in animal and human studies from three domains (air, stress, nutrition). Original research including a gestational exposure and a childhood or adulthood second hit exposure was reviewed. Evidence from animal studies suggest that prenatal exposure to air pollutants is associated with an exaggerated reaction to postnatal air pollution exposure, which results in worse health outcomes. It also indicates offspring exposed to prenatal maternal stress produce an exaggerated response to subsequent stressors, including anxiety and hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. Similarly, prenatal and postnatal Western-style diets induce synergistic effects on weight gain, metabolic dysfunction, and atherosclerotic risk. Cross-domain second hits (e.g., gestational air pollution followed by childhood stressor) were also considered. Suboptimal gestational environments induce exaggerated offspring responses to subsequent environmental and social exposures. These developmental programming effects may result in enhanced sensitivity of ongoing, racially patterned, adverse exposures in race/ethnic minorities, thereby exacerbating health disparities from one generation to the next. Empirical assessment of the hypothesized role of priming processes in the propagation of health disparities is needed. Future social epidemiology research must explicitly consider synergistic relationships among social environmental conditions to which gestating females are exposed and offspring exposures when assessing causes for persistent health disparities.
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Affiliation(s)
- L. C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - J. Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L. Mponwane
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - L. Wallack
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - K. L. Thornburg
- Moore Institute, Oregon Health & Science University, Portland, OR, USA
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Hillemeier MM, Landale NS, Oropesa RS. Asthma in US Mexican-Origin Children in Early Childhood: Differences in Risk and Protective Factors by Parental Nativity. Acad Pediatr 2015; 15:421-9. [PMID: 25613912 PMCID: PMC4492835 DOI: 10.1016/j.acap.2014.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/10/2014] [Accepted: 11/24/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Over 900,000 Mexican-origin children in the United States have asthma, but little is known about the extent to which development of this condition reflects early childhood exposure to social and environmental risks. The objectives of this research are to demonstrate the roles of risk and protective factors in the prevalence and severity of asthma in this population and provide comparisons with other racial/ethnic groups. METHODS Nationally representative data from the Early Childhood Longitudinal Study, Birth Cohort (n = 6900), with county-level ozone data appended to this file were analyzed using descriptive and multivariate regression methods. RESULTS The odds of asthma diagnosis by 60 months are approximately 50% higher among Mexican-origin children than for non-Hispanic whites (P < .05) in multivariate analyses. Compared to those with foreign-born parents, Mexican-origin children with native-born parents have a lower likelihood of being breast-fed and greater chances of having risks including a family history of asthma, having respiratory illnesses and allergies, living with a smoker, and attending center-based child care. Mexican-origin children live in counties with over 3 times more elevated ozone days annually than non-Hispanic whites. CONCLUSIONS Mexican-origin children experience a constellation of risk and protective factors, but those with US-born parents have elevated asthma risks compared to those with foreign-born parents. Asthma incidence and severity will likely increase as this population becomes increasingly integrated into US society.
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Affiliation(s)
| | | | - R. S. Oropesa
- Department of Sociology, The Pennsylvania State University
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20
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Clougherty JE, Shmool JLC, Kubzansky LD. The Role of Non-Chemical Stressors in Mediating Socioeconomic Susceptibility to Environmental Chemicals. Curr Environ Health Rep 2014. [DOI: 10.1007/s40572-014-0031-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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21
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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Kruize H, Droomers M, van Kamp I, Ruijsbroek A. What causes environmental inequalities and related health effects? An analysis of evolving concepts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5807-27. [PMID: 24886752 PMCID: PMC4078549 DOI: 10.3390/ijerph110605807] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 11/16/2022]
Abstract
Early environmental justice studies were exposure-oriented, lacked an integrated approach, and did not address the health impact of environmental inequalities. A coherent conceptual framework, needed to understand and tackle environmental inequalities and the related health effects, was lacking. We analyzed the more recent environmental justice literature to find out how conceptual insights have evolved. The conceptual framework of the WHO Commission on Social Determinants of Health (CSDH) was analyzed for additional explanations for environmental inequalities and the related health effects. This paper points out that recent environmental justice studies have broadened their scope by incorporating a broader set of physical and social environmental indicators, and by focusing on different geographic levels and on health impacts of environmental inequalities. The CSDH framework provided additional elements such as the role of structural determinants, the role of health-related behavior in relation to the physical and social environment, access to health care, as well as the life course perspective. Incorporating elements of the CSDH framework into existing environmental justice concepts, and performing more empirical research on the interactions between the different determinants at different geographical levels would further improve our understanding of environmental inequalities and their health effects and offer new opportunities for policy action.
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Affiliation(s)
- Hanneke Kruize
- Centre for Sustainability, Environment and Health (DMG), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands.
| | - Mariël Droomers
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands.
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health (DMG), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands.
| | - Annemarie Ruijsbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands.
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Balazs CL, Ray I. The drinking water disparities framework: on the origins and persistence of inequities in exposure. Am J Public Health 2014; 104:603-11. [PMID: 24524500 DOI: 10.2105/ajph.2013.301664] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With this article, we develop the Drinking Water Disparities Framework to explain environmental injustice in the context of drinking water in the United States. The framework builds on the social epidemiology and environmental justice literatures, and is populated with 5 years of field data (2005-2010) from California's San Joaquin Valley. We trace the mechanisms through which natural, built, and sociopolitical factors work through state, county, community, and household actors to constrain access to safe water and to financial resources for communities. These constraints and regulatory failures produce social disparities in exposure to drinking water contaminants. Water system and household coping capacities lead, at best, to partial protection against exposure. This composite burden explains the origins and persistence of social disparities in exposure to drinking water contaminants.
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Affiliation(s)
- Carolina L Balazs
- At the time of research, both authors were with Energy and Resources Group, University of California, Berkeley
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Prochaska JD, Nolen AB, Kelley H, Sexton K, Linder SH, Sullivan J. Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health. HUMAN AND ECOLOGICAL RISK ASSESSMENT : HERA 2014; 20:980-994. [PMID: 24771993 PMCID: PMC3995452 DOI: 10.1080/10807039.2013.805957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society.
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Affiliation(s)
- John D Prochaska
- The University of Texas Medical Branch, Center to Eliminate Health Disparities, Galveston, TX, USA
| | - Alexandra B Nolen
- The University of Texas Medical Branch, Center to Eliminate Health Disparities, Galveston, TX, USA
| | - Hilton Kelley
- Community In-Power and Development Association, Inc., Port Arthur, TX, USA
| | - Ken Sexton
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Stephen H Linder
- Institute for Health Policy, University of Texas School of Public Health, Houston, TX, USA
| | - John Sullivan
- NIEHS Center in Environmental Toxicology, University of Texas Medical Branch, Galveston, TX, USA
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Beck AF, Moncrief T, Huang B, Simmons JM, Sauers H, Chen C, Kahn RS. Inequalities in neighborhood child asthma admission rates and underlying community characteristics in one US county. J Pediatr 2013; 163:574-80. [PMID: 23522864 PMCID: PMC3746008 DOI: 10.1016/j.jpeds.2013.01.064] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/11/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To characterize variation and inequalities in neighborhood child asthma admission rates and to identify associated community factors within one US county. STUDY DESIGN This population-based prospective, observational cohort study consisted of 862 sequential child asthma admissions among 167 653 eligible children ages 1-16 years in Hamilton County, Ohio. Admissions occurred at a tertiary-care pediatric hospital and accounted for nearly 95% of in-county asthma admissions. Neighborhood admission rates were assessed by geocoding addresses to city- and county-defined neighborhoods. The 2010 US Census provided denominator data. Neighborhood admission distribution inequality was assessed by the use of Gini and Robin Hood indices. Associations between neighborhood rates and socioeconomic and environmental factors were assessed using ANOVA and linear regression. RESULTS The county admission rate was 5.1 per 1000 children. Neighborhood rates varied significantly by quintile: 17.6, 7.7, 4.9, 2.2, and 0.2 admissions per 1000 children (P < .0001). Fifteen neighborhoods containing 8% of the population had zero admissions. The Gini index of 0.52 and Robin Hood index of 0.38 indicated significant inequality. Neighborhood-level educational attainment, car access, and population density best explained variation in neighborhood admission rates (R(2) = 0.55). CONCLUSION In a single year, asthma admission rates varied 88-fold across neighborhood quintiles in one county; a reduction of the county-wide admission rate to that of the bottom quintile would decrease annual admissions from 862 to 34. A rate of zero was present in 15 neighborhoods, which is evidence of what may be attainable.
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Affiliation(s)
- Andrew F. Beck
- Divisions of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
,Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Terri Moncrief
- Allergy and Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Bin Huang
- Department of Epidemiology and Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jeffrey M. Simmons
- Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Hadley Sauers
- Divisions of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chen Chen
- Department of Epidemiology and Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Robert S. Kahn
- Divisions of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Chen J, Chen S, Landry PF. Migration, environmental hazards, and health outcomes in China. Soc Sci Med 2013; 80:85-95. [DOI: 10.1016/j.socscimed.2012.12.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/15/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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Boone-Heinonen J, Gordon-Larsen P. Obesogenic environments in youth: concepts and methods from a longitudinal national sample. Am J Prev Med 2012; 42:e37-46. [PMID: 22516502 PMCID: PMC3382037 DOI: 10.1016/j.amepre.2012.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/02/2012] [Accepted: 02/15/2012] [Indexed: 11/26/2022]
Abstract
To effectively prevent and reduce childhood obesity through healthy community design, it is essential to understand which neighborhood environment features influence weight gain in various age groups. However, most neighborhood environment research is cross-sectional, focuses on adults, and is often carried out in small, nongeneralizable geographic areas. Thus, there is a great need for longitudinal neighborhood environment research in diverse populations across the life cycle. This paper describes (1) insights and challenges of longitudinal neighborhood environment research and (2) advancements and remaining gaps in measurement and study design that examine individuals and neighborhoods within the context of the broader community. Literature-based research and findings from the Obesity and Neighborhood Environment Database (ONEdata), a unique longitudinal GIS that is spatially and temporally linked to data in the National Longitudinal Study of Adolescent Health (N=20,745), provide examples of current limitations in this area of research. Findings suggest a need for longitudinal methodologic advancements to better control for dynamic sources of bias, investigate and capture appropriate temporal frameworks, and address complex residential location processes within families. Development of improved neighborhood environment measures that capture relevant geographic areas within complex communities and investigation of differences across urbanicity and sociodemographic composition are needed. Further longitudinal research is needed to identify, refine, and evaluate national and local policies to most effectively reduce childhood obesity.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, USA
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Sexton K, Linder SH. Cumulative risk assessment for combined health effects from chemical and nonchemical stressors. Am J Public Health 2011; 101 Suppl 1:S81-8. [PMID: 21551386 PMCID: PMC3222498 DOI: 10.2105/ajph.2011.300118] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 12/13/2022]
Abstract
Cumulative risk assessment is a science policy tool for organizing and analyzing information to examine, characterize, and possibly quantify combined threats from multiple environmental stressors. We briefly survey the state of the art regarding cumulative risk assessment, emphasizing challenges and complexities of moving beyond the current focus on chemical mixtures to incorporate nonchemical stressors, such as poverty and discrimination, into the assessment paradigm. Theoretical frameworks for integrating nonchemical stressors into cumulative risk assessments are discussed, the impact of geospatial issues on interpreting results of statistical analyses is described, and four assessment methods are used to illustrate the diversity of current approaches. Prospects for future progress depend on adequate research support as well as development and verification of appropriate analytic frameworks.
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Affiliation(s)
- Ken Sexton
- Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, TX 78520, USA.
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Ford PB, Dzewaltowski DA. Limited supermarket availability is not associated with obesity risk among participants in the Kansas WIC Program. Obesity (Silver Spring) 2010; 18:1944-51. [PMID: 20057363 DOI: 10.1038/oby.2009.487] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Socioecological theory and a growing body of research suggests that geographic, racial, ethnic, and socioeconomic disparities in the prevalence of obesity are linked to disparities in the availability of food retail outlets that provide healthy food options. We examined the availability of food stores for low-income women in Kansas and tested whether food store availability was associated with obesity using cross-sectional, geocoded data from women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 21,166) in Kansas. The availability and density of food stores within a 1, 3, and 5 mile radius of residence was determined, and multivariate logistic regression was used to examine the association of food store availability with obesity. The availability of convenience, grocery stores, and supermarkets varied across the urban-rural continuum, but the majority of WIC recipients lived within a 1 mile radius of a small grocery store. WIC participants in micropolitan areas had the greatest availability of food stores within a 1 mile radius of residence. Availability and density of food stores was not associated with obesity in metropolitan and rural areas, but availability and density of any type of food store was associated with an increased risk of obesity among WIC recipients in micropolitan areas. These results suggest that limited spatial availability of grocery stores and supermarkets does not contribute to obesity risk among low-income WIC recipients in Kansas, and that urban influence moderates the contribution of food environments to obesity.
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Affiliation(s)
- Paula B Ford
- Department of Public Health Sciences, University of Texas at El Paso, El Paso, Texas, USA.
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Boone-Heinonen J, Popkin BM, Song Y, Gordon-Larsen P. What neighborhood area captures built environment features related to adolescent physical activity? Health Place 2010; 16:1280-6. [PMID: 20650673 DOI: 10.1016/j.healthplace.2010.06.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 06/11/2010] [Accepted: 06/24/2010] [Indexed: 11/19/2022]
Abstract
In research investigating built environment (BE) influences on physical activity (PA), inconsistent neighborhood definitions may contribute to inconsistent findings. Using data from the National Longitudinal Study of Adolescent Health (Wave I; 1994-95), we compared associations between moderate-vigorous PA (MVPA) and PA facility counts and street connectivity measures (intersection density and link:node ratio) within 1, 3, 5, and 8.05 km of each respondent's residence (Euclidean neighborhood buffers). BE-MVPA associations varied by BE characteristic, urbanicity, and sex. PA facilities within 3 km buffers and intersection density within 1 km buffers exhibited the most consistent associations with MVPA. Policy recommendations and corresponding research should address potential differences in relevant neighborhood areas across environment feature and population subgroup.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA
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Urrutia MT, Cianelli R. Disparidad en Salud: Un Fenómeno Multidimensional. HISPANIC HEALTH CARE INTERNATIONAL 2010; 8:23-35. [PMID: 22581053 DOI: 10.1891/1540-4153.8.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
La Disparidad en Salud (DS) ha llamado la atención pública desde el siglo pasado, ha sido analizada desde diversas perspectivas y enfoques incluso variados términos han sido utilizados como sinónimos pudiendo llevar a confusión e inequidades al momento de su operacionalización. Sin embargo es importante señalar que las publicaciones coinciden en que la DS es uno de las determinantes esenciales a considerar al momento de definir polĺticas públicas. El propósito de esta publicación es analizar la disparidad en salud incorporando; a) los aspectos claves de su conceptualización, b) la evolución histórica del concepto, c) las estrategias que se han generado para enfrentarla, d) los factores considerados determinantes, y e) los aspectos éticos y la contribución de la investigación en la disminución de la DS.Health Disparities (HD) have been at the center of public attention for the past century. They have been analyzed from diverse perspectives utilizing various terms as synonyms that can lead to confusion and inequality at the moment of operationalization. Despite this, it is important to indicate that publications agree that HD are essential determinants that must be considered in the definition of public policy. The objective of this publication is to analyze health disparities incorporating; (a) key aspects in their conceptualization, (b) the historic evolution of the concept, (c) strategies that have been generated to confront them, (d) determining factors, and (e) ethical aspects and the contribution of research in decreasing HD.
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Affiliation(s)
- Maria-Teresa Urrutia
- Pontificia Universidad Católica de Chile, Escuela de Enfermerĺa, and University of Miami School of Nursing and Health Studies
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Spiegel SJ. Occupational health, mercury exposure, and environmental justice: learning from experiences in Tanzania. Am J Public Health 2009; 99 Suppl 3:S550-8. [PMID: 19890157 DOI: 10.2105/ajph.2008.148940] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Mercury is a potent neurotoxin that is used by poverty-driven miners to extract gold in more than 50 countries. This article examines efforts of the United Nations to address occupational health and environmental justice amid these challenges, focusing on a 3-year campaign in one of the fastest-growing mining communities in Tanzania. By providing an integrative analysis of environmental health risks, labor practices, public health policies, and drivers of social inequity and marginalization, this study highlights the need for interdisciplinary public health approaches that support community development by strengthening local capacities. It illustrates why, to ensure that the needs of vulnerable populations are met, environmental justice and public health paradigms have to expand beyond the conventionally narrow attention paid to toxic exposure and emissions issues.
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Affiliation(s)
- Samuel J Spiegel
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
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Scribner RA, Theall KP, Simonsen NR, Mason KE, Yu Q. Misspecification of the effect of race in fixed effects models of health inequalities. Soc Sci Med 2009; 69:1584-91. [PMID: 19800158 DOI: 10.1016/j.socscimed.2009.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Indexed: 10/20/2022]
Abstract
The purpose of this study is to characterize the different results obtained when analyzing health inequalities data in which individuals are nested within their neighborhoods and a single level model is used to characterize risk rather than a multilevel model. The inability of single level models to characterize between neighborhood variance in risk may affect the level of risk attributed to black race if blacks are differentially distributed in high risk neighborhoods. The research replicates in Los Angeles an approach applied by a different group of researchers in Massachusetts (Subramanian, Chen, Rehkopf, Waterman, & Krieger, 2005). Single level and multilevel models were used to analyze Los Angeles County, California, US all-cause mortality data for the years 1989-1991, modeled as 29,936 cells (deaths and population denominators cross-tabulated by age, gender, and race/ethnicity) nested within 1552 census tracts. Overall blacks had 1.27 times the risk of mortality compared to whites. However, multilevel models demonstrated considerable between census tract variance in mortality for both blacks and whites which was partially explained by neighborhood poverty. Comparing the results of equivalent single level and multilevel models, the mortality odds ratio for blacks compared to the white reference group reversed itself, indicating greater risk for blacks in the single level model and lower risk in the multilevel model. Adding an area based socioeconomic measure (ABSM) to the single level model reduced but did not remove the discrepancy. Predictions of mortality risk for the interaction of race and age group demonstrate that all single level models exaggerated the mortality risk associated with black race. We conclude that characterizing health inequalities in mortality for blacks using single level models, which do not account for the cross level interaction created by the greater likelihood of black residence in neighborhoods where the risk of mortality is greater regardless of race, can exaggerate the risk of mortality attributable to the individual level effects of black race.
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Affiliation(s)
- Richard Allen Scribner
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA 70112, United States.
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Bellinger DC. Lead neurotoxicity in children: decomposing the variability in dose-effect relationships. Am J Ind Med 2007; 50:720-8. [PMID: 17290364 DOI: 10.1002/ajim.20438] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Enormous progress has been made in recent decades in our understanding of lead neurotoxicology in children, but an important obstacle to additional progress is the striking variability that is evident in any plot of a lead biomarker versus a health endpoint. METHODS In this article, three potential sources of variability are identified: (1) errors or imprecision in characterizing dose (and/or outcome); (2) incomplete characterization of endpoint variance attributable to factors other than lead; and (3) inter-individual differences in susceptibility to lead neurotoxicity. RESULTS Strategies are suggested for reducing the variability contributed by these sources, including the development of validated PBPK models and biomarkers of early biological effects; the development of more comprehensive models of outcome variance and, specifically, the application of multi-level models that incorporate supra-individual and supra-family risk factors; and the use of study designs that permit assessments of the effect modifying influence of contextual factors on the form and severity of neurotoxicity. CONCLUSION Decomposing the variability in the distribution of observed scores around the best-fit lines that describe the dose-effect relationships for lead neurotoxicity in children is a major research need.
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Affiliation(s)
- David C Bellinger
- Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
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Payne-Sturges D, Zenick H, Wells C, Sanders W. We cannot do it alone: Building a multi-systems approach for assessing and eliminating environmental health disparities. ENVIRONMENTAL RESEARCH 2006; 102:141-5. [PMID: 16545364 DOI: 10.1016/j.envres.2006.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 01/24/2006] [Accepted: 01/26/2006] [Indexed: 05/07/2023]
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