1
|
Evans CR, Borrell LN, Bell A, Holman D, Subramanian SV, Leckie G. Clarifications on the intersectional MAIHDA approach: A conceptual guide and response to Wilkes and Karimi (2024). Soc Sci Med 2024; 350:116898. [PMID: 38705077 DOI: 10.1016/j.socscimed.2024.116898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) has been welcomed as a new gold standard for quantitative evaluation of intersectional inequalities, and it is being rapidly adopted across the health and social sciences. In their commentary "What does the MAIHDA method explain?", Wilkes and Karimi (2024) raise methodological concerns with this approach, leading them to advocate for the continued use of conventional single-level linear regression models with fixed-effects interaction parameters for quantitative intersectional analysis. In this response, we systematically address these concerns, and ultimately find them to be unfounded, arising from a series of subtle but important misunderstandings of the MAIHDA approach and literature. Since readers new to MAIHDA may share confusion on these points, we take this opportunity to provide clarifications. Our response is organized around four important clarifications: (1) At what level are the additive main effect variables defined in intersectional MAIHDA models? (2) Do MAIHDA models have problems with collinearity? (3) Why does the Variance Partitioning Coefficient (VPC) tend to be small, and the Proportional Change in Variance (PCV) tend to be large in MAIHDA? and (4) What are the goals of MAIHDA analysis?
Collapse
Affiliation(s)
- Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA.
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, UK
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - George Leckie
- Centre for Multilevel Modelling and School of Education, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Evans CR, Leckie G, Subramanian S, Bell A, Merlo J. A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). SSM Popul Health 2024; 26:101664. [PMID: 38690117 PMCID: PMC11059336 DOI: 10.1016/j.ssmph.2024.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and other outcomes. I-MAIHDA and related MAIHDA approaches have conceptual and methodological advantages over conventional single-level regression analysis. By enabling the study of inequalities produced by numerous interlocking systems of marginalization and oppression, and by addressing many of the limitations of studying interactions in conventional analyses, intersectional MAIHDA provides a valuable analytical tool in social epidemiology, health psychology, precision medicine and public health, environmental justice, and beyond. The approach allows for estimation of average differences between intersectional strata (stratum inequalities), in-depth exploration of interaction effects, as well as decomposition of the total individual variation (heterogeneity) in individual outcomes within and between strata. Specific advice for conducting and interpreting MAIHDA models has been scattered across a burgeoning literature. We consolidate this knowledge into an accessible conceptual and applied tutorial for studying both continuous and binary individual outcomes. We emphasize I-MAIHDA in our illustration, however this tutorial is also informative for understanding related approaches, such as multicategorical MAIHDA, which has been proposed for use in clinical research and beyond. The tutorial will support readers who wish to perform their own analyses and those interested in expanding their understanding of the approach. To demonstrate the methodology, we provide step-by-step analytical advice and present an illustrative health application using simulated data. We provide the data and syntax to replicate all our analyses.
Collapse
Affiliation(s)
- Clare R. Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA
| | - George Leckie
- Centre for Multilevel Modelling and School of Education, University of Bristol, UK
| | - S.V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, UK
| | - Juan Merlo
- Research Unit of Social Epidemiology, Faculty of Medicine, University of Lund, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| |
Collapse
|
3
|
Bell A, Evans C, Holman D, Leckie G. Extending intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to study individual longitudinal trajectories, with application to mental health in the UK. Soc Sci Med 2024; 351:116955. [PMID: 38762996 DOI: 10.1016/j.socscimed.2024.116955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
The intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach is gaining prominence in health sciences and beyond, as a robust quantitative method for identifying intersectional inequalities in a range of individual outcomes. However, it has so far not been applied to longitudinal data, despite the availability of such data, and growing recognition that intersectional social processes and determinants are not static, unchanging phenomena. Drawing on intersectionality and life course theories, we develop a longitudinal version of the intersectional MAIHDA approach, allowing the analysis not just of intersectional inequalities in static individual differences, but also of life course trajectories. We discuss the conceptualization of intersectional groups in this context: how they are changeable over the life course, appropriate treatment of generational differences, and relevance of the age-period-cohort identification problem. We illustrate the approach with a study of mental health using United Kingdom Household Longitudinal Study data (2009-2021). The results reveal important differences in trajectories between generations and intersectional strata, and show that trajectories are partly multiplicative but mostly additive in their intersectional inequalities. This article provides an important and much needed methodological contribution, enabling rigorous quantitative, longitudinal, intersectional analyses in social epidemiology and beyond.
Collapse
Affiliation(s)
- Andrew Bell
- Sheffield Methods Institute, University of Sheffield, UK.
| | - Clare Evans
- Department of Sociology, University of Oregon, USA
| | - Dan Holman
- Department of Sociology, University of Sheffield, UK
| | - George Leckie
- Centre for Multilevel Modelling, School of Education, University of Bristol, UK
| |
Collapse
|
4
|
Huijie Z, Haojun J, Zhiping Z, Zhaoyu Y. Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle. Front Public Health 2024; 12:1338079. [PMID: 38699418 PMCID: PMC11063323 DOI: 10.3389/fpubh.2024.1338079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/13/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle. Methods This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle. Results Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants. Discussion This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.
Collapse
Affiliation(s)
- Zhu Huijie
- College of Humanities and Social Development, Nanjing Agricultural University, Nanjing, China
- Center for Social Research, Nanjing Agricultural University, Nanjing, China
- Jin Shanbao Institute for Agricultural and Rural Development Research Institute, Nanjing, China
| | - Jiang Haojun
- Tourism and Social Management College, Nanjing Xiaozhuang University, Nanjing, China
| | - Zhu Zhiping
- College of Humanities and Social Development, Nanjing Agricultural University, Nanjing, China
| | - Yao Zhaoyu
- College of Humanities and Social Development, Nanjing Agricultural University, Nanjing, China
- Jin Shanbao Institute for Agricultural and Rural Development Research Institute, Nanjing, China
| |
Collapse
|
5
|
Mattsson H, Gustafsson J, Prada S, Jaramillo-Otoya L, Leckie G, Merlo J, Rodriguez-Lopez M. Mapping socio-geographical disparities in the occurrence of teenage maternity in Colombia using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Int J Equity Health 2024; 23:36. [PMID: 38388886 PMCID: PMC10885464 DOI: 10.1186/s12939-024-02123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The prevalence of teenage pregnancy in Colombia is higher than the worldwide average. The identification of socio-geographical disparities might help to prioritize public health interventions. AIM To describe variation in the probability of teenage maternity across geopolitical departments and socio-geographical intersectional strata in Colombia. METHODS A cross-sectional study based on live birth certificates in Colombia. Teenage maternity was defined as a woman giving birth aged 19 or younger. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied using multilevel Poisson and logistic regression. Two different approaches were used: (1) intersectional: using strata defined by the combination of health insurance, region, area of residency, and ethnicity as the second level (2) geographical: using geopolitical departments as the second level. Null, partial, and full models were obtained. General contextual effect (GCE) based on the variance partition coefficient (VPC) was considered as the measure of disparity. Proportional change in variance (PCV) was used to identify the contribution of each variable to the between-strata variation and to identify whether this variation, if any, was due to additive or interaction effects. Residuals were used to identify strata with potential higher-order interactions. RESULTS The prevalence of teenage mothers in Colombia was 18.30% (95% CI 18.20-18.40). The highest prevalence was observed in Vichada, 25.65% (95% CI: 23.71-27.78), and in the stratum containing mothers with Subsidized/Unaffiliated healthcare insurance, Mestizo, Rural area in the Caribbean region, 29.08% (95% CI 28.55-29.61). The VPC from the null model was 1.70% and 9.16% using the geographical and socio-geographical intersectional approaches, respectively. The higher PCV for the intersectional model was attributed to health insurance. Positive and negative interactions of effects were observed. CONCLUSION Disparities were observed between intersectional socio-geographical strata but not between geo-political departments. Our results indicate that if resources for prevention are limited, using an intersectional socio-geographical approach would be more effective than focusing on geopolitical departments especially when focusing resources on those groups which show the highest prevalence. MAIHDA could potentially be applied to many other health outcomes where resource decisions must be made.
Collapse
Affiliation(s)
- Hedda Mattsson
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Johanna Gustafsson
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Sergio Prada
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
- Universidad Icesi, Centro PROESA, Cali, Colombia
| | | | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, Bristol, UK
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Merida Rodriguez-Lopez
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
- Faculty of Health Science, Universidad Icesi, Calle 18 No. 122 -135, Cali, Colombia.
| |
Collapse
|
6
|
Chang HH, Zhang H, Latimore AD, Murray BP, D'Souza RR, Scovronick N, Gribble MO, Ebelt ST. Associations between short-term ambient temperature exposure and emergency department visits for amphetamine, cocaine, and opioid use in California from 2005 to 2019. ENVIRONMENT INTERNATIONAL 2023; 181:108233. [PMID: 37897873 PMCID: PMC10712015 DOI: 10.1016/j.envint.2023.108233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023]
Abstract
Substance use disorder is a growing public health challenge in the United States. People who use drugs may be more vulnerable to ambient heat due to the effects of drugs on thermoregulation and their risk environment. There have been limited population-based studies of ambient temperature and drug-related morbidity. We examined short-term associations between daily ambient temperature and emergency department (ED) visits for use or overdose of amphetamine, cocaine and opioids in California during the period 2005 to 2019. Daily ZIP code-level maximum, mean, and minimum temperature exposures were derived from 1-km data Daymet products. A time-stratified case-crossover design was used to estimate cumulative non-linear associations of daily temperature for lag days 0 to 3. Stratified analyses by patient sex, race, and ethnicity were also conducted. The study included over 3.4 million drug-related ED visits. We found positive associations between daily temperature and ED visits for all outcomes examined. An increase in daily mean temperature from the 50th to the 95th percentile was associated with ED visits for amphetamine use (OR = 1.072, 95% CI: 1.058, 1.086), cocaine use (OR = 1.044, 95% CI: 1.021, 1.068 and opioid use (OR = 1.041, 95% CI: 1.025, 1.057). Stronger positive associations were also observed for overdose: amphetamine overdose (OR = 1.150, 95% CI: 1.085, 1.218), cocaine overdose (OR = 1.159, 95% CI: 1.053, 1.276), and opioid overdose (OR = 1.079, 95% CI: 1.054, 1.106). In summary, people who use stimulants and opioids may be a subpopulation sensitive to short-term higher ambient temperature. Mitigating heat exposure can be considered in harm reduction strategies in response to the substance use epidemic and global climate change.
Collapse
Affiliation(s)
- Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA.
| | - Haisu Zhang
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Amanda D Latimore
- Center for Addiction Research and Effective Solutions, American Institutes for Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian P Murray
- Emergency Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Matthew O Gribble
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
O'Kelley L, Swanson B, Bishop-Royse JC. Integrative literature review: Ethylene oxide exposure signs and symptoms. Public Health Nurs 2023; 40:790-809. [PMID: 37254592 DOI: 10.1111/phn.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although ethylene oxide (EtO) gas is designated as a human carcinogen, extant literature reports mixed findings on the health effects of exposure. The disparate findings may reflect industry bias as many studies were funded by a large chemical industry lobby. OBJECTIVE To conduct an integrative review of studies free from industry bias to facilitate compilation of a comprehensive list of reported signs and symptoms of EtO exposure. METHODS We reviewed 1887 papers of which 42 articles met inclusion criteria. The authors conducted this review in accordance with PRISMA guidelines. The presence of bias was assessed using Joanna Briggs Institute checklists. RESULTS Non-industry biased literature confirmed serious adverse health effects associated with EtO exposure at the occupational, hospital, and community level. EtO represents a carcinogen, neurotoxin, and respiratory irritant. CONCLUSION After removal of industry-biased studies, EtO was unequivocally found to pose a threat to human health. There remains a gap in the number of studies examining community-level exposure, which is essential to understanding the impact of EtO. Given that EtO-emitting facilities are concentrated in diverse and disadvantaged communities, further study of EtO exposure health effects is warranted to inform public policy on toxic air emissions.
Collapse
Affiliation(s)
- Linda O'Kelley
- The College of Nursing, Rush University, Chicago, Illinois
| | | | | |
Collapse
|
8
|
Shah SH, Harris LM, Menghwani V, Stoler J, Brewis A, Miller JD, Workman CL, Adams EA, Pearson AL, Hagaman A, Wutich A, Young SL. Variations in household water affordability and water insecurity: An intersectional perspective from 18 low- and middle-income countries. ENVIRONMENT AND PLANNING. F, PHILOSOPHY, THEORY, MODELS, METHODS AND PRACTICE 2023; 2:369-398. [PMID: 38707600 PMCID: PMC11065962 DOI: 10.1177/26349825231156900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study's value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity.
Collapse
Affiliation(s)
- Sameer H Shah
- University of Washington, USA; The University of British Columbia, Canada
| | | | - Vikas Menghwani
- The University of British Columbia, Canada; University of Saskatchewan, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Evans CR, Nieves CI, Erickson N, Borrell LN. Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012-2018 New York City birth data. Soc Sci Med 2023; 331:116063. [PMID: 37467517 DOI: 10.1016/j.socscimed.2023.116063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Birthweight is a widely-used biomarker of infant health, with inequities patterned intersectionally by maternal age, race/ethnicity, nativity/immigration status, and socioeconomic status in the United States. However, studies of birthweight inequities almost exclusively focus on singleton births, neglecting high-risk twin births. We address this gap using a large sample (N = 753,180) of birth records, obtained from the 2012-2018 New York City (NYC) Department of Health and Mental Hygiene, Bureau of Vital Statistics, representing 99% of all births registered in NYC, and a novel random coefficients intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) model. Our results show evidence of intersectional inequities in birthweight outcomes for both twin and singleton births by maternal age, race/ethnicity, education, and nativity status. Twins have considerably lower predicted birthweights than singletons overall (-930 g on average), and this is especially true for babies born to mothers who are younger (11-19 years), older (40+), racial/ethnic minoritized, foreign-born, and have lower education. However, the magnitude of this birthweight 'gap' between twins and singletons varies considerably across social identity strata, ranging between 830.8 g (observed among 40+ year old Black foreign-born mothers with high school degrees) and 1013.7 g (observed among 30-39 year old Hispanic/Latina foreign-born mothers with less than high school degrees). This study underscored the needs of a high-risk population and the need for aggressive social policies to address health inequities and dismantle intersectional systems of marginalization, oppression, and socioeconomic inequality. In addition to our substantive contributions, we add to the growing methods literature on intersectional quantitative analysis by demonstrating how to apply intersectional MAIHDA with random coefficients and random slopes. We conclude with a discussion of the significant potential for this methodological extension in future research on inequities.
Collapse
Affiliation(s)
- Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA.
| | - Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | | | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| |
Collapse
|
10
|
Larsen K, Rydz E, Peters CE. Inequalities in Environmental Cancer Risk and Carcinogen Exposures: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095718. [PMID: 37174236 PMCID: PMC10178444 DOI: 10.3390/ijerph20095718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Background: Cancer is the leading cause of death in Canada and a major cause of death worldwide. Environmental exposure to carcinogens and environments that may relate to health behaviors are important to examine as they can be modified to lower cancer risks. Built environments include aspects such as transit infrastructure, greenspace, food and tobacco environments, or land use, which may impact how people move, exercise, eat, and live. While environments may play a role in overall cancer risk, exposure to carcinogens or healthier environments is not equitably spread across space. Exposures to carcinogens commonly concentrate among socially and/or economically disadvantaged populations. While many studies have examined inequalities in exposure or cancer risk, this has commonly been for one exposure. Methods: This scoping review collected and synthesized research that examines inequities in carcinogenic environments and exposures. Results: This scoping review found that neighborhoods with higher proportions of low-income residents, racialized people, or same-sex couples had higher exposures to carcinogens and environments that may influence cancer risk. There are currently four main themes in research studying inequitable exposures: air pollution and hazardous substances, tobacco access, food access, and other aspects of the built environment, with most research still focusing on air pollution. Conclusions: More work is needed to understand how exposures to these four areas intersect with other factors to reduce inequities in exposures to support longer-term goals toward cancer prevention.
Collapse
Affiliation(s)
- Kristian Larsen
- Health Canada, Office of Environmental Health, Healthy Environments and Consumer Safety Branch, Environmental and Radiation Health Science Directorate, Ottawa, ON K1A 0K9, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Geography and Planning, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Ela Rydz
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Cheryl E Peters
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Prevention, Screening and Hereditary Cancer, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Population and Public Health, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| |
Collapse
|
11
|
Kamai EM, Calderon A, Van Horne YO, Bastain TM, Breton CV, Johnston JE. Perceptions and experiences of environmental health and risks among Latina mothers in urban Los Angeles, California, USA. Environ Health 2023; 22:8. [PMID: 36641468 PMCID: PMC9840262 DOI: 10.1186/s12940-023-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Environmental exposures during pregnancy and early childhood can have acute and chronic adverse health impacts. As minoritized populations are more likely to reside in areas with greater pollution, it is important to understand their views and lived experiences to inform action. The purpose of this community-driven qualitative research study was to understand how urban Latina mothers in Los Angeles County, California perceived environmental health and risks. METHODS We conducted semi-structured individual interviews with Latina pregnant women and mothers of young children, recruited through existing collaborations with community organizations. Interviews conducted in either English or Spanish and were coded inductively according to a modified grounded theory approach. RESULTS Thirty-six Latina mothers completed interviews between August-October 2016. Participants lived primarily in low-income communities of South-Central Los Angeles and East Los Angeles. We identified three major themes based on the participants' responses during interviews: Defining the Environment, Environment & Health Risks, and Social & Political Responsibility. Women defined their environment in terms of both "nature" and "hazards." They consistently identified foul odors, dirtiness, noise, trash, bugs, smoke, and other visible blights as indicators of household and neighborhood environmental hazards. They expressed fear and uncertainty about how their environment could affect their health and that of their children, as well as specific concerns about respiratory health, asthma, allergies, cancer, and adverse pregnancy outcomes. Mothers often changed individual behaviors around diet and cleaning during pregnancy but were frustrated by power imbalances that left them unable to change their home or neighborhood environments, despite their desire to do so. DISCUSSION Our study is among the first to describe how urban Latina mothers perceive and experience environmental health risks during pregnancy and early childhood. Our research suggests additional attention is needed by public health professionals and researchers to address the environmental health risks that matter most to urban Latina mothers. They also highlight the tension that many urban Latina mothers feel between wanting to protect their families' health and well-being and feeling powerless to change their environment. Broad policy changes, rather than additional individual recommendations, are needed to address the concerns of this vulnerable population.
Collapse
Affiliation(s)
- Elizabeth M Kamai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Andrea Calderon
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yoshira Ornelas Van Horne
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jill E Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
12
|
Huang J, Li X, Zhang Y, Zhai S, Wang W, Zhang T, Yin F, Ma Y. Socio-demographic characteristics and inequality in exposure to PM 2.5: A case study in the Sichuan basin, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120630. [PMID: 36375581 DOI: 10.1016/j.envpol.2022.120630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
The Chengyu Metropolitan Area (CYMA), located in the Sichuan Basin, is an unevenly developed region with high PM2.5 concentrations and a population of approximately 100 million. Although exposure inequality in air pollution has received increasing concern, no related research has been carried out in the CYMA to date. In this work, we used the concentration index to assess inequality of PM2.5 population-weighted exposure in the CYMA among different subgroups, including age, education, gender, occupation and GDP per capita in the city of residence. Our findings revealed that the non-disadvantaged subgroups (people aged 15-64, people with senior and higher education, people with high-income occupations and residents of cities with high GDP per capita) had a higher PM2.5 exposure in the CYMA, with the concentration indices of -0.03 (95% CI: 0.064, -0.001), -0.14 (95% CI: 0.221, -0.059), -0.15 (95% CI: 0.238, -0.056) and -0.27 (95% CI: 0.556, 0.012), opposite to previous studies in developed countries such as the United States and France. In addition, exposure differences among cities were much larger than those among populations in the CYMA. These findings may benefit the government in identifying disproportionately exposed subgroups in developing regions, and suggest that related measures should initially be carried out for cities exposed to high PM2.5 concentrations rather than for populations exposed to high PM2.5 concentrations.
Collapse
Affiliation(s)
- Jingfei Huang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelin Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siwei Zhai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, China.
| |
Collapse
|
13
|
Van Horne YO, Alcala CS, Peltier RE, Quintana PJE, Seto E, Gonzales M, Johnston JE, Montoya LD, Quirós-Alcalá L, Beamer PI. An applied environmental justice framework for exposure science. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:1-11. [PMID: 35260805 PMCID: PMC8902490 DOI: 10.1038/s41370-022-00422-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/28/2023]
Abstract
On the 30th anniversary of the Principles of Environmental Justice established at the First National People of Color Environmental Leadership Summit in 1991 (Principles of Environmental Justice), we continue to call for these principles to be more widely adopted. We propose an environmental justice framework for exposure science to be implemented by all researchers. This framework should be the standard and not an afterthought or trend dismissed by those who believe that science should not be politicized. Most notably, this framework should be centered on the community it seeks to serve. Researchers should meet with community members and stakeholders to learn more about the community, involve them in the research process, collectively determine the environmental exposure issues of highest concern for the community, and develop sustainable interventions and implementation strategies to address them. Incorporating community "funds of knowledge" will also inform the study design by incorporating the knowledge about the issue that community members have based on their lived experiences. Institutional and funding agency funds should also be directed to supporting community needs both during the "active" research phase and at the conclusion of the research, such as mechanisms for dissemination, capacity building, and engagement with policymakers. This multidirectional framework for exposure science will increase the sustainability of the research and its impact for long-term success.
Collapse
Affiliation(s)
- Yoshira Ornelas Van Horne
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.
| | - Cecilia S Alcala
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102 Street, New York, NY, 10029, USA
| | - Richard E Peltier
- School of Public Health & Health Sciences, University of Massachusetts Amherst, 686 North Pleasant Street, Room 175, Amherst, MA, 01003, USA
| | - Penelope J E Quintana
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Edmund Seto
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Roosevelt One Building, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Melissa Gonzales
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10 5550 Epidemiology, Albuquerque, NM, 87111, USA
| | - Jill E Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | | | - Lesliam Quirós-Alcalá
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Paloma I Beamer
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Ave., Tucson, AZ, 85724, USA
| |
Collapse
|
14
|
Alvarez CH. Structural Racism as an Environmental Justice Issue: A Multilevel Analysis of the State Racism Index and Environmental Health Risk from Air Toxics. J Racial Ethn Health Disparities 2023; 10:244-258. [PMID: 34993918 PMCID: PMC9810559 DOI: 10.1007/s40615-021-01215-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
Communities of color and poor neighborhoods are disproportionately exposed to more air pollution-a pattern known as environmental injustices. Environmental injustices increase susceptibility to negative health outcomes among residents in affected communities. The structural mechanisms distributing environmental injustices in the USA are understudied. Bridging the literatures on the social determinants of health and environmental justice highlights the importance of the environmental conditions for health inequalities and sheds light on the institutional mechanisms driving environmental health inequalities. Employing a critical quantitative methods approach, we use data from an innovative state racism index to argue that systematic racialized inequalities in areas from housing to employment increase outdoor airborne environmental health risks in neighborhoods. Results of a multilevel analysis in over 65,000 census tracts demonstrate that tracts in states with higher levels of state-level Black-white gaps report greater environmental health risk exposure to outdoor air pollution. The state racism index explains four-to-ten percent of county- and state-level variation in carcinogenic risk and noncarcinogenic respiratory system risks from outdoor air toxics. The findings suggest that the disproportional exposure across communities is tied to systematic inequalities in environmental regulation and other structural elements such as housing and incarceration. Structural racism is an environmental justice issue.
Collapse
Affiliation(s)
- Camila H. Alvarez
- grid.266096.d0000 0001 0049 1282Department of Sociology, University of California–Merced, 5200 N. Lake Rd., CA 95343 Merced, USA
| |
Collapse
|
15
|
Alvarez CH, Calasanti A, Evans CR, Ard K. Intersectional inequalities in industrial air toxics exposure in the United States. Health Place 2022; 77:102886. [PMID: 36001937 DOI: 10.1016/j.healthplace.2022.102886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
Abstract
Environmental justice and health research demonstrate unequal exposure to environmental hazards at the neighborhood-level. We use an innovative method-eco-intersectional multilevel (EIM) modeling-to assess intersectional inequalities in industrial air toxics exposure across US census tracts in 2014. Results reveal stark inequalities in exposure across analytic strata, with a 45-fold difference in average exposure between most and least exposed. Low SES, multiply marginalized (high % Black, high % female-headed households) urban communities experienced highest risk. These inequalities were not described by additive effects alone, necessitating the use of interaction terms. We advance a critical intersectional approach to evaluating environmental injustices.
Collapse
Affiliation(s)
- Camila H Alvarez
- Department of Sociology, University of California-Merced, 5200 N. Lake Rd., Merced, CA, 95343, USA.
| | - Anna Calasanti
- Keough School of Global Affairs, University of Notre Dame, 1010 Jenkins Nanovic Halls, Notre Dame, IN, 46556-5677, USA.
| | - Clare Rosenfeld Evans
- Department of Sociology, University of Oregon, 1291 University of Oregon, Eugene, OR, 97403-1291, USA
| | - Kerry Ard
- School of Environment and Natural Resources, Ohio State University, 134 Williams Hall, 1680 Madison Avenue, Wooster, OH, 44691, USA
| |
Collapse
|
16
|
Calderón-Villarreal A, Terry B, Friedman J, González-Olachea SA, Chavez A, Díaz López M, Pacheco Bufanda L, Martinez C, Medina Ponce SE, Cázares-Adame R, Rochin Bochm PF, Kayser G, Strathdee SA, Muñoz Meléndez G, Holmes SM, Bojorquez I, Los Huertos M, Bourgois P. Deported, homeless, and into the canal: Environmental structural violence in the binational Tijuana River. Soc Sci Med 2022; 305:115044. [PMID: 35633600 PMCID: PMC9585906 DOI: 10.1016/j.socscimed.2022.115044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Abstract
Introduction: The US deports more Mexicans to Tijuana than any other borderland city. Returning involuntarily as members of a stigmatized underclass, many find themselves homeless and de-facto stateless. Subject to routinized police victimization, many take refuge in the Tijuana River Canal (El Bordo). Previous reports suggest Tijuana River water may be contaminated but prior studies have not accessed the health effects or contamination of the water closest to the river residents. Methods: A binational, transdisciplinary team undertook a socio-environmental, mixed methods assessment to simultaneously characterize Tijuana River water quality with chemical testing, assess the frequency of El Bordo residents’ water-related diseases, and trace water contacts with epidemiological survey methods (n = 85 adults, 18+) in 2019, and ethnographic methods in 2019–2021. Our analysis brings the structural violence framework into conversation with an environmental injustice perspective to documented how social forces drive poor health outcomes enacted through the environment. Results: The Tijuana River water most proximate to its human inhabitants fails numerous water-quality standards, posing acute health risks. Escherichia coli values were ∼40,000 times the Mexican regulatory standard for directly contacted water. Skin infections (47%), dehydration (40%) and diarrhea (28%) were commonly reported among El Bordo residents. Residents are aware the water is contaminated and strive to minimize harm to their health by differentially using local water sources. Their numerous survival constraints, however, are exacerbated by routine police violence which propels residents and other people who inject drugs into involuntary contact with contaminated water. Discussion: Human rights to drinking water, sanitation and hygiene are routinely violated among El Bordo in-habitants. This is exacerbated by violent policing practices that force unhoused deportees to seek refuge in waterways, and drive water contacts. Furthermore, US-Mexico ‘free-trade’ agreements drive rapid growth in Tijuana, restrict Mexican environmental regulation enforcement, and drive underinvestment in sewage systems and infrastructure.
Collapse
Affiliation(s)
- Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California, San Diego (UCSD), San Diego, CA, USA; Graduate School of Public Health, San Diego State University (SDSU), San Diego, CA, USA.
| | - Brendan Terry
- Pomona College, Claremont, CA, USA; Epigenetics Programme, Babraham Institute, Cambridge, UK.
| | - Joseph Friedman
- University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | | | | | | | | | - Carlos Martinez
- University of California, Berkeley (UC Berkeley), Berkeley, CA, USA; University of California, San Francisco (UCSF), San Francisco, USA.
| | | | | | | | - Georgia Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, CA, USA.
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UCSD, San Diego, CA, USA.
| | | | | | - Ietza Bojorquez
- El Colegio de La Frontera Norte (El COLEF), Tijuana, Mexico.
| | | | | |
Collapse
|
17
|
Bambra C. Placing intersectional inequalities in health. Health Place 2022; 75:102761. [PMID: 35397319 DOI: 10.1016/j.healthplace.2022.102761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
Research into geographical inequalities in health has focused almost exclusively on examining the effects of area-level deprivation and has been largely framed through a compositional-contextual lens, their inter-relationship and the influence of vertical macro-economic and political/policy drivers. However, in the broader health inequalities field, intersectionality has recently emerged as a critical theoretical and methodical approach which examines the concurrent and interacting influences on health of multiple axes of inequality (such as socio-economic status, gender, race/ethnicity and sexuality or gender-identity). Simultaneously, social geography has been explicitly using intersectionality to analyse how mutually constitutive forms of social oppression interact and interrelate with place. This paper exploits the analytical space opened up by this 'intersectional turn' by outlining the benefits for research into geographical inequalities in health that can be achieved by taking a more explicit approach to intersectional inequalities. It argues that: (1) geographical research into health inequalities should more explicitly and widely apply an intersectional lens; and relatedly that, in turn, (2) place needs to be considered as an aspect of intersectionality and integrated into the wider intersectional inequalities in health literature. The paper summarises the evolution of theories of place and health inequalities and outlines intersectional theory and the work to date that has been undertaken to integrate this perspective into our understanding of health inequalities. Drawing on the social geography literature into place and intersectionality, the paper explores how this perspective is being used to enhance our understanding of place effects more generally - and how place itself can be considered as an element of intersectional inequalities. Drawing these different bodies of work together, the paper concludes by considering the implications for theories of geographical inequalities in health.
Collapse
Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
| |
Collapse
|
18
|
Measuring Environmental Justice in Real Time: A Pilot Study Using Digital Participatory Method in the Global South, Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084752. [PMID: 35457618 PMCID: PMC9024717 DOI: 10.3390/ijerph19084752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Individuals' perceived fairness or justice beliefs are related to health in numerous ways. However, environment justice research to date has given little attention to perceived fairness of environmental exposures as experienced by individuals. This study explored the feasibility of a bottom-up digital participatory (via mobile phones) approach using ecological momentary assessment (EMA) to capture individuals' subjective experience of environmental exposures and the subjective evaluation of fairness by those affected in the context of Nepal. In total, 22 individuals participated in the study for 28 days. The results show high rates of study retention and adherence. Individuals' justice perception was found to vary within and between individuals, but also substantially depending on the types of environmental exposures. Nevertheless, the study indicates that uncertainties are inevitable as study design and timing may conflict participants' daily lives and priorities. The method allows us to consider multiple geographic contexts of individuals' everyday lives beyond residential environment. This pilot study proved the possibility to assess perceptions of environmental justice issues and demonstrated the necessary steps to using digital participatory method for assessing subjective perception of fairness of individuals.
Collapse
|
19
|
Uche UI, Evans S, Rundquist S, Campbell C, Naidenko OV. Community-Level Analysis of Drinking Water Data Highlights the Importance of Drinking Water Metrics for the State, Federal Environmental Health Justice Priorities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910401. [PMID: 34639699 PMCID: PMC8507655 DOI: 10.3390/ijerph181910401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
Research studies analyzing the geospatial distribution of air pollution and other types of environmental contamination documented the persistence of environmental health disparities between communities. Due to the shortage of publicly available data, only limited research has been published on the geospatial distribution of drinking water pollution. Here we present a framework for the joint consideration of community-level drinking water data and demographic data. Our analysis builds on a comprehensive data set of drinking water contaminant occurrence for the United States for 2014–2019 and the American Community Survey 5-year estimates (2015–2019) from the U.S. Census Bureau. Focusing on the U.S. states of California and Texas for which geospatial data on community water system service boundaries are publicly available, we examine cumulative cancer risk for water served by community water systems of different sizes relative to demographic characteristics for the populations served by these water systems. In both California and Texas, greater cumulative cancer risk was observed for water systems serving communities with a higher percentage of Hispanic/Latino and Black/African American community members. This investigation demonstrates that it is both practical and essential to incorporate and expand the drinking water data metrics in the analysis of environmental pollution and environmental health. The framework presented here can support the development of public policies to advance environmental health justice priorities on state and federal levels in the U.S.
Collapse
Affiliation(s)
- Uloma Igara Uche
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC 20005, USA; (C.C.); (O.V.N.)
- Correspondence: (U.I.U.); (S.E.)
| | - Sydney Evans
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC 20005, USA; (C.C.); (O.V.N.)
- Correspondence: (U.I.U.); (S.E.)
| | - Soren Rundquist
- Environmental Working Group, 111 Third Avenue South, Suite 240, Minneapolis, MN 55401, USA;
| | - Chris Campbell
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC 20005, USA; (C.C.); (O.V.N.)
| | - Olga V. Naidenko
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC 20005, USA; (C.C.); (O.V.N.)
| |
Collapse
|
20
|
Sochas L. Challenging categorical thinking: A mixed methods approach to explaining health inequalities. Soc Sci Med 2021; 283:114192. [PMID: 34274782 DOI: 10.1016/j.socscimed.2021.114192] [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: 12/22/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
"Categorical thinking" in social science research has been widely criticised by feminist scholars for conceptualising social categories as natural, de-contextualised, and internally homogeneous. This paper develops and applies a mixed-methods approach to the study of health inequalities, using social categories meaningfully in order to challenge categorical thinking. The approach is demonstrated through a case study of socio-economic (SES) inequalities in maternal healthcare access in Zambia. This paper's approach responds to the research agenda set by intersectional social epidemiologists by considering potential heterogeneity within categories, but also by exploring the context-specific meaning of categories, examining explanations at multiple levels, and interpreting results according to mutually constitutive social processes. The study finds that meso-level institutions, "health service environments", explain a large share of SES inequalities in maternal healthcare access. Women's work, marital status, and levels of "autonomy" have heterogeneous implications for healthcare access across SES categories. Disadvantaged categories and their reproductive behaviours are stigmatised as 'backwards', in contrast to advantaged categories and their behaviours, which are associated with 'modernity' and 'development'. Challenging categorical thinking has important implications for social justice and health, by rejecting framings of a specific category as problematic or non-compliant, highlighting the possibility of change, and emphasising the political and structural nature of progress.
Collapse
Affiliation(s)
- Laura Sochas
- Department of Social Policy and Intervention, University of Oxford, UK; International Inequalities Institute, London School of Economics and Political Science, UK.
| |
Collapse
|