Retirements of Coal and Oil Power Plants in California: Association With Reduced Preterm Birth Among Populations Nearby

Climate change and human health: a primer on what women's health physicians can do on behalf of their patients and communities

PURPOSE OF REVIEW

To describe the current state of knowledge on the impact on climate change on women's health and to highlight opportunities for healthcare providers to serve as advocates and subject matter experts.

RECENT FINDINGS

Healthcare providers are a uniquely respected voice in society but have not used this advantage to advocate for their communities and participate in mitigation, adaptation, and resiliency efforts on behalf of their patients and communities.

SUMMARY

Healthcare providers feel that climate change is real, is human caused, and is currently or will shortly negatively impact their patients. They feel unprepared to serve as leaders and advocates due to time limitations and a knowledge gap. Resources in the current climate movement can help close this gap.

Roadway construction as a natural experiment to examine air pollution impacts on infant health

Traffic-related air pollution (TRAP) poses a significant public health risk that is associated with adverse birth outcomes. Large roadway infrastructure projects present a natural experiment to examine how resulting congestion change is associated with adverse birth outcomes for nearby populations. This study is designed to examine the influence of living close to a roadway before, during, and after a construction project using a difference-in-differences design. We integrated data on all large roadway construction projects (defined as widening of existing roads, building new roads, improving bridges, installing intelligent transportation systems, improving intersections, and installing or upgrading traffic signals) in Texas from 2007 to 2016 with Vital Statistic data for all births with residential addresses within 1 km of construction projects. Our outcomes included term low birth weight, term birth weight, preterm birth, and very preterm birth. Using a difference-in-differences design, we included births within 3 years of construction start and 2 years of construction end. In our main model, the exposed group is limited to pregnant individuals residing within 300 m of a construction project, and the control group includes those living within 300-1000 m from a project. We used regression models to estimate the influence of construction on infant health. We included 1,360 large roadway construction projects linked to 408,979 births. During construction, we found that the odds of term low birth weight increased by 19% (95% CI: 1.05, 1.36). However, we saw little evidence of an association for other birth outcomes. Contrary to our hypothesis of decreased TRAP after construction ends, we did not observe consistent improvements post-construction for pregnant individuals living within 300 m. Continued consideration of the influence of traffic congestion programs on birth outcomes is necessary to inform future policy decisions.

Ethics of Predicting and Preventing Preterm Birth

Preterm birth (PTB) occurs disproportionately among women who are minoritized and who live and work in poverty. This disadvantage occurs as a result of societal norms and policies that affect how people are treated and determine their access to a broad range of resources. Research that takes social context into account offers the best opportunity for identifying approaches to prevent PTB. The experience and knowledge of women from groups experiencing high rates of PTB can provide important insights for research design and for determining the feasibility and acceptability of potential interventions.

Reproductive and Social Policies, Sociopolitical Stress, and Implications for Maternal and Child Health Equity

PURPOSE OF REVIEW

Although many environmental exposures (e.g., air pollution) are geographically patterned and persist as a result of historic economic policies (e.g., redlining), the impact of reproductive and social policies on maternal and child health remains incompletely understood. Reproductive and social policies are increasingly important for maternal and child health equity, particularly following the 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization ("Dobbs decision"), which restricted access to abortion. Here, we summarize the literature from original research studies examining influences of reproductive and social policy on maternal and child health, focusing on impacts on adverse birth outcomes and policies as sources of stress.

RECENT FINDINGS

Several studies suggest that those most impacted by the Dobbs decision are younger, non-white, socioeconomically disadvantaged, and living in states with less access to government safety net programs, all of which are compounded by environmental injustices. Further, studies conducted in the wake of the Dobbs decision find elevated stress levels among women of reproductive age. This may represent one pathway leading to adverse birth outcomes, as epidemiologic studies demonstrate that preterm birth rates increased following the 2016 election, a period of heightened stress. Reproductive and social policies are understudied contributors to adverse outcomes for reproductive-aged women and their children. This has important implications for maternal and child health equity, as those who will be the most impacted by reproductive and social policies already experience the highest rates of adverse birth outcomes and environmental toxicant exposure.

A population-based cohort study of electronic tolling, traffic congestion, and adverse birth outcomes

BACKGROUND

Although traffic-related air pollution is largely regulated at the federal level, congestion reduction projects may reduce local traffic and air pollution to levels that create positive co-benefits for population health. In recent years, many urban areas have implemented electronic tolling systems to improve traffic conditions.

OBJECTIVE

Quantify associations between implementing electronic tolling and local changes in traffic and infant health.

METHODS

Using a population-based birth cohort (Texas, 1999-2016), we calculated residential proximity to the nearest tolled road segment within 5 km (n = 625,279) and examined changes in local traffic before and after toll implementation. Using a difference-in-differences design, we compared four markers of adverse birth outcomes (term birth weight, term low birth weight, preterm birth, very preterm birth) among infants from pregnant people residing < 0.5 km from a road segment before and after the tolls were implemented and compared them to a contemporaneous population of pregnant people residing at 2-5 km.

RESULTS

We observed minimal changes in local traffic after the implementation of tolling. Among births within 500 m of a tolled road, we found little evidence of an association between the implementation of tolling and adverse birth outcomes (term birth weight [β: -4.5, 95 % CI: -11.7, 2.6], term low birth weight [OR: 1.00, 95 % CI: 0.89, 1.13], preterm birth [OR: 0.99, 95 % CI: 0.92, 1.05], very preterm birth [OR: 1.00, 95 % CI: 0.84, 1.18]), compared to the contemporaneous control group of births at 2-5 km. In sub-analyses, we found some evidence of a reduced association between toll booth removal and preterm birth (OR: 0.84, 95 % CI: 0.70, 1.01) but not for other outcomes or tolling types.

DISCUSSION

In this large population-based retrospective cohort study of births in Texas, we found little evidence that the implementation of tolling was consistently associated with improvements in local infant health outcomes.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

A Long Way from Steubenville: Environmental Epidemiology in a Rapidly Changing World

This commentary focuses on research that has long been at the core of environmental epidemiology: studies of the health effects of air pollution. It highlights publications in the American Journal of Epidemiology going back more than 50 years that have contributed to the debate about the validity of this research and its meaning for public policy. Technological advances have greatly expanded the toolbox of environmental epidemiologists in terms of measuring and analyzing complex exposures in large populations. Yet, discussions about biases in estimating air pollution health effects have always been and remain intense. Epidemiologists have brought new methodologies and concepts to this research, alleviating some but not all concerns. Here, the focus is on seminal epidemiologic work that established valid links between air pollution exposures and health outcomes and generated data for environmental policies and prevention. With this commentary, I hope to inspire epidemiologists to address many more of the burning environmental health questions-wildfires included-with a similar scientific doggedness. The rapidly changing conditions of our planet are challenging us to innovate and offer solutions, albeit perhaps a little bit faster this time around.

Traffic-related air pollution is associated with spontaneous extremely preterm birth and other adverse perinatal outcomes

BACKGROUND

Although there is growing awareness of the relationship between air pollution and preterm birth, limited data exist regarding the relationship with spontaneous preterm birth and severe neonatal outcomes.

OBJECTIVE

This study aimed to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, neonatal intensive care unit admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation.

STUDY DESIGN

This was a retrospective cohort study of singleton pregnancies of patients residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to nitrogen dioxide was estimated for individual patients' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated vs spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes mellitus, body mass index, registered Health Equity Index, and nitrogen dioxide monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average nitrogen dioxide exposure.

RESULTS

Between January 1, 2013 and December 31, 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured nitrogen dioxide exposure during the pregnancy from a nearby monitoring station. Higher average nitrogen dioxide exposure throughout pregnancy was significantly associated with preterm birth (adjusted odds ratio, 1.94; 95% confidence interval, 1.77-2.12) and an increase in neonatal intensive care unit admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients and spontaneous preterm birth, and had a greater association with earlier preterm birth.

CONCLUSION

In a metropolitan area, increased exposure to the air pollutant nitrogen dioxide in pregnancy was associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with neonatal intensive care unit admissions, low-birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.

Methods in Public Health Environmental Justice Research: a Scoping Review from 2018 to 2021

PURPOSE OF REVIEW

The volume of public health environmental justice (EJ) research produced by academic institutions increased through 2022. However, the methods used for evaluating EJ in exposure science and epidemiologic studies have not been catalogued. Here, we completed a scoping review of EJ studies published in 19 environmental science and epidemiologic journals from 2018 to 2021 to summarize research types, frameworks, and methods.

RECENT FINDINGS

We identified 402 articles that included populations with health disparities as a part of EJ research question and met other inclusion criteria. Most studies (60%) evaluated EJ questions related to socioeconomic status (SES) or race/ethnicity. EJ studies took place in 69 countries, led by the US (n = 246 [61%]). Only 50% of studies explicitly described a theoretical EJ framework in the background, methods, or discussion and just 10% explicitly stated a framework in all three sections. Among exposure studies, the most common area-level exposure was air pollution (40%), whereas chemicals predominated personal exposure studies (35%). Overall, the most common method used for exposure-only EJ analyses was main effect regression modeling (50%); for epidemiologic studies the most common method was effect modification (58%), where an analysis evaluated a health disparity variable as an effect modifier. Based on the results of this scoping review, current methods in public health EJ studies could be bolstered by integrating expertise from other fields (e.g., sociology), conducting community-based participatory research and intervention studies, and using more rigorous, theory-based, and solution-oriented statistical research methods.

Comparing Two-way Fixed Effects and New Estimators for Difference-in-Differences: A Simulation Study and Empirical Example

BACKGROUND

Two-way fixed effects methods have been used to estimate effects of policies adopted in different places over time, but they can provide misleading results when effects are heterogeneous or dynamic, and alternate methods have been proposed.

METHODS

We compared methods for estimating the average treatment effect on the treated (ATT) under staggered adoption of policies, including two-way fixed effects, group-time ATT, cohort ATT, and target-trial approaches. We applied each method to assess the impact of Medicaid expansion on preterm birth using the National Center for Health Statistics' birth records. We compared each estimator's performance in a simulation parameterized to mimic the empirical example. We generated constant, heterogeneous, and dynamic effects and calculated bias, mean squared error, and confidence interval coverage of each estimator across 1000 iterations.

RESULTS

Two-way fixed effects estimated that Medicaid expansion increased the risk of preterm birth (risk difference [RD], 0.12; 95% CI = 0.02, 0.22), while the group-time ATT, cohort ATT, and target-trial approaches estimated protective or null effects (group-time RD, -0.16; 95% CI = -0.58, 0.26; cohort RD, -0.02; 95% CI = -0.46, 0.41; target trial RD, -0.16; 95% CI = -0.59, 0.26). In simulations, two-way fixed effects performed well when treatment effects were constant and less well under heterogeneous and dynamic effects.

CONCLUSIONS

We demonstrated why new approaches perform better than two-way fixed effects when treatment effects are heterogeneous or dynamic under a staggered policy adoption design, and created simulation and analysis code to promote understanding and wider use of these methods in the epidemiologic literature.

The local impacts of coal and oil power plant retirements on air pollution and cardiorespiratory health in California: An application of generalized synthetic control method

BACKGROUND

This study capitalized on coal and oil facility retirements to quantify their potential effects on fine particulate matter (PM2.5) concentrations and cardiorespiratory hospitalizations in affected areas using a generalized synthetic control method.

METHODS

We identified 11 coal and oil facilities in California that retired between 2006 and 2013. We classified zip code tabulation areas (ZCTA) as exposed or unexposed to a facility retirement using emissions information, distance, and a dispersion model. We calculated weekly ZCTA-specific PM2.5 concentrations based on previously estimated daily time-series PM2.5 concentrations from an ensemble model, and weekly cardiorespiratory hospitalization rates based on hospitalization data collected by the California Department of Health Care Access and Information. We estimated the average differences in weekly average PM2.5 concentrations and cardiorespiratory hospitalization rates in four weeks after each facility retirement between the exposed ZCTAs and the synthetic control using all unexposed ZCTAs (i.e., the average treatment effect among the treated [ATT]) and pooled ATTs using meta-analysis. We conducted sensitivity analyses to consider different classification schemes to distinguish exposed from unexposed ZCTAs, including aggregating outcomes with different time intervals and including a subset of facilities with reported retirement date confirmed via emission record.

RESULTS

The pooled ATTs were 0.02 μg/m3 (95% confidence interval (CI): -0.25 to 0.29 μg/m3) and 0.34 per 10,000 person-weeks (95%CI: -0.08 to 0.75 per 10,000 person-weeks) following the facility closure for weekly PM2.5 and cardiorespiratory hospitalization rates, respectively. Our inferences remained the same after conducting sensitivity analyses.

CONCLUSIONS

We demonstrated a novel approach to study the potential benefits associated with industrial facility retirements. The declining contribution of industrial emissions to ambient air pollution in California may explain our null findings. We encourage future research to replicate this work in regions with different industrial activities.

Climate Change and Pregnancy: Risks, Mitigation, Adaptation, and Resilience

Importance

Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health.

Evidence and Results

There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change. Pregnant people are especially vulnerable to the health harms resulting from climate change, namely, preterm birth, small for gestational age, hypertensive disorders of pregnancy, and other adverse reproductive health and birth outcomes. Strategies to minimize these harms include mitigation and adaptation.

Conclusions and Relevance

Physicians are in a unique position to protect the health of pregnant persons and children by advocating for policy changes that address climate change and providing clinical recommendations for patients to protect themselves from the health impacts of climate hazards.

Sulfur dioxide reduction at coal-fired power plants in North Carolina and associations with preterm birth among surrounding residents

Coal-fired power plants (CFPP) are major contributors of air pollution, including the majority of anthropogenic sulfur dioxide (SO2) emissions, which have been associated with preterm birth (PTB). To address a 2002 North Carolina (NC) policy, 14 of the largest NC CFPPs either installed desulfurization equipment (scrubbers) or retired coal units, resulting in substantial reductions of SO2 air emissions. We investigated whether SO2 air emission reduction strategies at CFPPs in NC were associated with changes in prevalence of PTB in nearby communities.

Methods

We used US EPA Air Markets Program Data to track SO2 emissions and determine the implementation dates of intervention at CFPPs and geocoded 2003-2015 NC singleton live births. We conducted a difference-in-difference analysis to estimate change in PTB associated with change in SO2 reduction strategies for populations living 0-<4 and 4-<10 miles from CFPPs pre- and postintervention, with a comparison of those living 10-<15 miles from CFPPs.

Results

With the spatial-temporal exposure restrictions applied, 42,231 and 41,218 births were within 15 miles of CFPP-scrubbers and CFPP-retired groups, respectively. For residents within 4-<10 miles from a CFPP, we estimated that the absolute prevalence of PTB decreased by -1.5% [95% confidence interval (CI): -2.6, -0.4] associated with scrubber installation and -0.5% (95% CI: -1.6, 0.6) associated with the retirement of coal units at CFPPs. Our findings were imprecise and generally null-to-positive among those living within 0-<4 miles regardless of the intervention type.

Conclusions

Results suggest a reduction of PTB among residents 4-<10 miles of the CFPPs that installed scrubbers.

The Black-White Disparity in Preterm Birth: Race or Racism?

Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.

It's electric! An environmental equity perspective on the lifecycle of our energy sources

Energy policy decisions are driven primarily by economic and reliability considerations, with limited consideration given to public health, environmental justice, and climate change. Moreover, epidemiologic studies relevant for public policy typically focus on immediate public health implications of activities related to energy procurement and generation, considering less so health equity or the longer-term health consequences of climate change attributable to an energy source. A more integrated, collective consideration of these three domains can provide more robust guidance to policymakers, communities, and individuals. Here, we illustrate how these domains can be evaluated with respect to natural gas as an energy source. Our process began with a detailed overview of all relevant steps in the process of extracting, producing, and consuming natural gas. We synthesized existing epidemiologic and complementary evidence of how these processes impact public health, environmental justice, and climate change. We conclude that, in certain domains, natural gas looks beneficial (e.g., economically for some), but when considered more expansively, through the life cycle of natural gas and joint lenses of public health, environmental justice, and climate change, natural gas is rendered an undesirable energy source in the United States. A holistic climate health equity framework can inform how we value and deploy different energy sources in the service of public health.

Estimating Causal Effects of Interventions on Early-life Environmental Exposures Using Observational Data

PURPOSE OF REVIEW

We discuss how epidemiologic studies have used observational data to estimate the effects of potential interventions on early-life environmental exposures. We summarize the value of posing questions about interventions, how a group of techniques known as "g-methods" can provide advantages for estimating intervention effects, and how investigators have grappled with the strong assumptions required for causal inference.

RECENT FINDINGS

We identified nine studies that estimated health effects of hypothetical interventions on early-life environmental exposures. Of these, six examined air pollution. Interventions evaluated by these studies included setting exposure levels at a specific value, shifting exposure distributions, and limiting exposure levels to less than a threshold value. Only one study linked exposure contrasts to a specific intervention on an exposure source, however. There is growing interest in estimating intervention effects of early-life environmental exposures, in part because intervention effects are directly related to possible public health actions. Future studies can build on existing work by linking research questions to specific hypothetical interventions that could reduce exposure levels. We discuss how framing questions around interventions can help overcome some of the barriers to causal inference and how advances related to machine learning may strengthen studies by sidestepping the overly restrictive assumptions of parametric regression models. By leveraging advancements in causal inference and exposure science, an intervention framework for environmental epidemiology can guide actionable solutions to improve children's environmental health.

Associations between prenatal exposure to power plants and birth outcomes across the United States

OBJECTIVES

Although there is growing evidence that in utero exposure to power plants increases the risk of adverse birth outcomes, studies have focused on coal-fired plants and single US locations, limiting generalizability. We used birth certificate data from 50 states and DC to examine the associations between prenatal exposure to power plants and birth outcomes overall and by race/ethnicity.

METHODS

We linked 2009-2018 county-level microdata natality files on 34,674,911 singleton births from 50 states and DC with 9-month county-level averages of power plant fuel consumption based on month/year of birth. We estimated linear regression models for birth weight and gestational age and probit models for the dichotomous outcomes of low birth weight, small for gestational age (SGA), and preterm birth. We subsequently examined interactions between plant fuel consumption and race/ethnicity.

RESULTS

Overall, 69.1% of counties had any power plant fuel consumption. Although we found no overall effects of prenatal exposure to power plants on birth weight or SGA, a significant interaction (both P < 0.01) revealed that a 10% increase in fuel consumption was associated with infants born to White women having slightly lower birth weights (1.76 g; 95% confidence interval = -2.87, -0.65) and higher risk of being born SGA (0.0002; 95% confidence interval = 0.0002, 0.0002).

CONCLUSION

Power plants have negative effects on infant health, which exist independent of locality.

Multiple exposure pathways and health risk assessment of potentially harmful elements for children and adults living in a coal region in Brazil

Energy generated by coal can contaminate the environment by releasing toxic elements, including metals. The human health risk assessment (HHRA) associated with geographic information system (GIS) tools can assist the management of contaminated areas, such as coal mining areas. The objective of the study was to carry out the assessment and spatialization of the risk to human health of potentially hazards elements (PHEs) in the soil for children and adults, from multiple exposure routes (oral, inhalation and dermal) in the Candiota mines, largest coal mining region of Brazil. The non-carcinogenic risks (HQ) of PHEs (Cu, Pb, Zn, Ni, Cr, Fe, Mn, Cd, As and Se) and carcinogenic risks of As were estimated and spatialized. The results revealed a risk for children exposure to Mn, with greatest contribution through dermal route. Mn (HQ_derm 72.41-96.09% and HQ_inh 40.84-82.52%) and Fe (HQ_o 43.90-81.44%) were the metals with greatest contribution to human health risk among studied population. As did not present carinogenic risk to adults. The spatial distribution of non-carcinogenic risk showed that Cr, As, Fe, Pb, Ni, Zn and Cu have higher HInc close to the coal mining areas, while Mn, Se and Cd have the highest HInc values in surrounding municipalities (Pinheiro Machado; Pedras Altas and Hulha Negra). The use of HHRA associated with GIS tools provides important elements for decision-making in the management of contaminated sites, indicating chemical elements, locations, routes of exposure and priority target populations.

Sources of ambient PM2.5 exposure in 96 global cities

To improve air quality, knowledge of the sources and locations of air pollutant emissions is critical. However, for many global cities, no previous estimates exist of how much exposure to fine particulate matter (PM_2.5), the largest environmental cause of mortality, is caused by emissions within the city vs. outside its boundaries. We use the Intervention Model for Air Pollution (InMAP) global-through-urban reduced complexity air quality model with a high-resolution, global inventory of pollutant emissions to quantify the contribution of emissions by source type and location for 96 global cities. Among these cities, we find that the fraction of PM_2.5 exposure caused by within-city emissions varies widely (μ = 37%; σ = 22%) and is not well-explained by surrounding population density. The list of most-important sources also varies by city. Compared to a more mechanistically detailed model, InMAP predicts urban measured concentrations with lower bias and error but also lower correlation. Predictive accuracy in urban areas is not particularly high with either model, suggesting an opportunity for improving global urban air emission inventories. We expect the results herein can be useful as a screening tool for policy options and, in the absence of available resources for further analysis, to inform policy action to improve public health.

Gestational and Neonatal Outcomes in Cities in the Largest Coal Mining Region in Brazil

Brazil has one of the largest mineral coal reserves in the world. More than 40% of this ore is in the Candiota Mine, in the extreme south of Brazil, which was previously identified as a hotspot of environmental pollution. In addition, an important part of Brazil's population suffers from socioeconomic vulnerability. Since there is no information on unfavorable gestational and neonatal outcomes associated with these problems, we conducted a cross-sectional study with 1950 mother-child binomials, aiming to evaluate the association between these outcomes and air pollution as well as socioeconomic, demographic and health variables in seven cities in the region. Of the total births, 11.6% were preterm and 9.5% of neonates had low birth weight (<2500 g). These conditions were also associated with skin color, previous abortions, birth type and prenatal care, as well as exposure to higher levels of coarse particulate matter (PM₁₀) during the first trimester of pregnancy. Regarding air pollutants, although the daily limits for PM₁₀ were exceeded on less than 5% of days, the annual average overtook the values proposed by WHO. Thus, we concluded that prematurity and low birth weight in this region are related to air pollution, and to socioeconomic variables and health care.

Perinatal Health Inequalities in the Industrial Region of Estonia: A Birth Registry-Based Study

Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004-2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM_2.5) air pollution, mother's ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother's ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country's unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS.

Industrial Air Pollution Leads to Adverse Birth Outcomes: A Systematized Review of Different Exposure Metrics and Health Effects in Newborns

Objectives: To review the evidence of associations between adverse birth outcomes (ABO) and industrial air pollution.

Methods: Searches were conducted in PubMed, and Scopus databases, and additional articles were found from snowball search techniques. The included studies feature a study population of mothers with live-born babies exposed to industrial air pollutants, and they examine the effects of industrial pollutants on adverse birth outcomes—namely, low birth weight, term low birth weight, preterm birth, and small for gestational age.

Results: Altogether, 45 studies were included in this review. Exposure to PM2.5, PAHs, benzene, cadmium, and mixtures of industrial air pollutants and living near an industrial area affect birth outcomes.

Conclusion: This study concludes that industrial air pollution is an important risk factor for ABO, especially low birth weight and preterm birth. The strongest evidence is associations between ABO and air pollution from power plants and petrochemical industries. Understanding of specific chemicals that are critical to birth outcomes is still vague. However, the evidence is strongest for more specific air pollutants from the industry, such as PAH, benzene, BTEX, and cadmium.

"Advances in Preterm Delivery"-How Can We Advance Further?

Preterm delivery (PTD: <37 gestational weeks) complicates 5−13% of deliveries worldwide [...]

Protective Places: the Relationship between Neighborhood Quality and Preterm Births to Black Women in Oakland, California (2007-2011)

Black women have the highest incidence of preterm birth (PTB). Upstream factors, including neighborhood context, may be key drivers of this increased risk. This study assessed the relationship between neighborhood quality, defined by the Healthy Places Index, and PTB among Black women who lived in Oakland, California, and gave birth between 2007 and 2011 (N = 5418 women, N = 107 census tracts). We found that, compared with those living in lower quality neighborhoods, women living in higher quality neighborhoods had 20-38% lower risk of PTB, independent of confounders. Findings have implications for place-based research and interventions to address racial inequities in PTB.

Residential particulate matter, proximity to major roads, traffic density and traffic volume as risk factors for preterm birth in California

BACKGROUND

While pollution from vehicle sources is an established risk factor for preterm birth, it is unclear whether distance of residence to the nearest major road or related measures like major road density represent useful measures for characterising risk.

OBJECTIVE

To determine whether major road proximity measures (including distance to major road, major road density and traffic volume) are more useful risk factors for preterm birth than other established vehicle-related measures (including particulate matter <2.5 μm in diameter (PM_2.5 ) and diesel particulate matter (diesel PM)).

METHODS

This retrospective cohort study included 2.7 million births across the state of California from 2011-2017; each address at delivery was geocoded. Geocoding was used to calculate distance to the nearest major road, major road density within a 500 m radius and major road density weighted by truck volume. We measured associations with preterm birth using risk ratios adjusted for target demographic, clinical, socioeconomic and environmental covariates (aRRs). We compared these to the associations between preterm birth and PM_2.5 and diesel PM by census tract of residence.

RESULTS

Findings showed that whereas higher mean levels of PM_2.5 and diesel PM by census tract were associated with a higher risk of preterm birth, living closer to roads or living in higher traffic density areas was not associated with higher risk. Residence in a census tract with a mean PM_2.5 in the top quartile compared with the lowest quartile was associated with the highest observed risk of preterm birth (aRR 1.04, 95% CI 1.04, 1.05).

CONCLUSIONS

Over a large geographical region with a diverse population, PM2.5 and diesel PM were associated with preterm birth, while measures of distance to major road were not, suggesting that these distance measures do not serve as a proxy for measures of particulate matter in the context of preterm birth.

Invited Commentary: The Promise and Pitfalls of Causal Inference With Multivariate Environmental Exposures

The accompanying article by Keil et al. (Am J Epidemiol. 2021;190(12):2647-2657) deploys Bayesian g-computation to investigate the causal effect of 6 airborne metal exposures linked to power-plant emissions on birth weight. In so doing, it articulates the potential value of framing the analysis of environmental mixtures as an explicit contrast between exposure distributions that might arise in response to a well-defined intervention-here, the decommissioning of coal plants. Framing the mixture analysis as that of an approximate "target trial" is an important approach that deserves incorporation into the already rich literature on the analysis of environmental mixtures. However, its deployment in the power plant example highlights challenges that can arise when the target trial is at odds with the exposure distribution observed in the data, a discordance that seems particularly difficult in studies of environmental mixtures. Bayesian methodology such as model averaging and informative priors can help, but they are ultimately limited for overcoming this salient challenge.

Bayesian G-Computation for Estimating Impacts of Interventions on Exposure Mixtures: Demonstration With Metals From Coal-Fired Power Plants and Birth Weight

The importance of studying the health impacts of exposure mixtures is increasingly being recognized, but such research presents many methodological and interpretation difficulties. We used Bayesian g-computation to estimate effects of a simulated public health action on exposure mixtures and birth weights in Milwaukee, Wisconsin, in 2011-2013. We linked data from birth records with census-tract-level air toxics data from the Environmental Protection Agency's National Air Toxics Assessment model. We estimated the difference between observed and expected birth weights that theoretically would have followed a hypothetical intervention to reduce exposure to 6 airborne metals by decommissioning 3 coal-fired power plants in Milwaukee County prior to 2010. Using Bayesian g-computation, we estimated a 68-g (95% credible interval: 25, 135) increase in birth weight following this hypothetical intervention. This example demonstrates the utility of our approach for using observational data to evaluate and contrast possible public health actions. Additionally, Bayesian g-computation offers a flexible strategy for estimating the effects of highly correlated exposures, addressing statistical issues such as variance inflation, and addressing conceptual issues such as the lack of interpretability of independent effects.

Climate change, women's health, and the role of obstetricians and gynecologists in leadership

Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

Human health risk assessment of metals and anions in surface water from a mineral coal region in Brazil

Coal mining releases high concentration elements to the environment, which can be deposited in surface water, causing several human health problems. Candiota mine in the south of Brazil is the largest coal reserves in the country, representing approximately 40% of total national coal reserves. Therefore, the present study aimed to estimate the chronic daily dose and the non-carcinogenic risk index for metals and anions in surface waters of Candiota Region, using the USEPA protocols for Human Health Risk Assessment. A total of eight water samples were collected over a distance of up to 15 km from the emission sources of the thermal power generation companies, then the Chronic Daily Intake (CDI), Hazard Quotient (HQ), Hazard Index (HI), and sum of Hazard Index (ΣHI) were calculated. All the elements and anions evaluated showed natural concentrations for continental fresh waters according to Brazilian legislation, except Pb. Individually, none of the metals Pb, As, Cd, Ni, and Se or anions F^- and NO₃^- showed an HI value greater than 1. However, the sum of HI (ΣHI) (five metals and two anions) by sample point showed values close to 1, for one of the eight points analyzed. Pb and Fe were the elements that most contribute to the risk values in the sample points of the study area. Although, there is no human health risk in this scenario, this investigation highlight priority elements to future investigations in coal mine areas. In the current region, Pb and F^- as priority elements for future studies.

Environmental impact on reproductive health and risk mitigating strategies

PURPOSE OF REVIEW

The purpose of this review is to increase awareness among reproductive health professionals and trainees about the impact of environmental toxicants and climate change on women's health and mitigation strategies at the individual, professional and governmental levels.

RECENT FINDINGS

Global health indicators reveal a meteoric rise of noncommunicable diseases over the past 50 years, which threaten reproductive health directly and indirectly. Evolutionary genetic mutations as contributors are unlikely in this timeframe, and environmental causes have been invoked. Notably, the past 75 years have witnessed marked increases in industrial chemical production, and global warming has rendered a 'climate crisis' with extreme temperatures and compromised food, water, and air quality. There is now strong experimental and epidemiologic evidence for endocrine disrupting chemicals and particulate matter and chemical components of air pollution in the pathophysiology of human reproductive disorders during development and across the lifespan, especially among vulnerable populations.

SUMMARY

Environmental impacts on fertility, pregnancy outcomes, childhood neurodevelopment, and reproductive tract development are significant, not widely appreciated, and may be preventable. In light of the evidence, education and advocating economical mitigations of toxic environmental chemicals and alternative energy strategies are imperatives to assure quality reproductive health for this and future generations.

Residential Proximity to Biorefinery Sources of Air Pollution and Respiratory Diseases in New York State

Understanding potential health risks associated with biofuel production is critical to sustainably combating energy insecurity and climate change. However, the specific health impacts associated with biorefinery-related emissions are not yet well characterized. We evaluated the relationship between respiratory emergency department (ED) visits (2011-2015) and residential exposure to biorefineries by comparing 15 biorefinery sites to 15 control areas across New York (NY) State. We further examined these associations by biorefinery types (e.g., corn, wood, or soybean), seasons, and lower respiratory disease subtypes. We measured biorefinery exposure using residential proximity in a cross-sectional study and estimation of biorefinery emission via AERMOD-simulated modeling. After controlling for multiple confounders, we consistently found that respiratory ED visit rates among residents living within 10 km of biorefineries were significantly higher (rate ratios (RRs) range from 1.03 to 3.64) than those in control areas across our two types of exposure indices. This relationship held across biorefinery types (higher in corn and soybean biorefineries), seasons (higher in spring and winter), air pollutant types (highest for NO₂), and respiratory subtypes (highest for emphysema). Further research is needed to confirm our findings.

Reducing Prenatal Exposure to Toxic Environmental Agents: ACOG Committee Opinion, Number 832

ABSTRACT

There is emerging evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes. Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birth weight, neurodevelopmental delay such as autism and attention deficit hyperactivity disorder, and adult and childhood cancer. Although there is substantial overlap in the type of exposure and the associated health outcomes, for the purposes of this document, exposures generally can be grouped into the following categories: toxic chemicals, air pollution, and climate change-related exposures. Obstetric care clinicians do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists, if needed, when a hazardous exposure is identified. It is important for obstetrician-gynecologists and other obstetric care clinicians to become knowledgeable about toxic environmental exposures that are endemic to their specific geographic areas, such as local water safety advisories (eg, lead-contaminated water), local air quality levels, and patients' proximity to power plants and fracking sites. Although exposure to toxic environmental agents is widespread across populations, many environmental factors that are harmful to reproductive health disproportionately affect underserved populations and are subsumed in issues of environmental justice. Clinical encounters offer an opportunity to screen and counsel patients during the prepregnancy and prenatal periods-particularly individuals most disproportionately affected-about opportunities to reduce toxic environmental health exposures. This Committee Opinion is revised to integrate more recent literature regarding reducing prepregnancy and prenatal toxic environmental exposures.

Effects of Environmental Crude Oil Pollution on Newborn Birth Outcomes: A Retrospective Cohort Study

BACKGROUND

The World Health Organization encourages countries to improve birth outcomes to reduce rates of neonatal mortality and morbidity.

PURPOSE

This study was designed to examine the effect of environmental crude oil pollution on newborn birth outcomes in Rivers State, Nigeria.

METHODS

A retrospective cohort design was used to examine the effects of exposure to oil pollution on birth outcomes using facility-based records. K-Dere (an oil-polluted community) served as the exposure group, whereas birth records from Iriebe served as the comparison group. A sample size of 338 systematically selected birth records was examined (169 records for each arm of the study). A data extraction sheet was used for data collection. Data were analyzed using descriptive and inferential statistics at p < .05.

RESULTS

The risk of preterm birth was significantly higher in the exposed group (16% vs. 7.7%, relative risk = 2.08, 95% CI [1.11, 3.89], p = .018). At 6 weeks after birth, newborns in the exposed group weighed significantly less (4.64 ± 0.82 vs. 4.85 ± 0.92 kg, p = .032) and reported significantly higher incidence of morbidity compared with the newborns in the comparison group (relative risk = 3.03, 95% CI [2.20, 4.19], p < .001).

CONCLUSIONS

The oil-polluted area examined in this study was found to have a higher risk of preterm birth, a slower rate of newborn growth, and a higher rate of newborn morbidity than the non-oil-polluted area at 6 weeks after birth. Stakeholders should sustain efforts to remediate the environment in polluted regions and prevent oil pollution. Future research should investigate the mechanisms of the observed toxicological effects and the targeted protection of vulnerable groups in oil-polluted communities.

The Impact of Oil Price on Transition toward Renewable Energy Consumption? Evidence from Russia

This research investigates the impact of oil price, income and carbon dioxide emissions on renewable energy consumption in Russia for the data period from 1990 to 2015, using the Vector Error Correction Models and the Canonical Cointegrating Regression method. This article is the only study conducting individual time-series analysis that emphasizes the effect of oil price on renewable energy consumption in the case of Russia. The results of empirical analysis conclude that oil price affects renewable energy consumption negatively. The negative oil price effects on renewable energy use can be interpreted as a sign of issue that stems from higher oil prices and slows the transition from conventional to renewable energy sources. Additionally, we found that there is a positive and statistically significant influence of real GDP per capita as a proxy of income on renewable energy consumption, whereas the carbon dioxide emissions have a negative and statistically insignificant influence on renewable energy consumption. Considering these empirical results, Russia, which has a significant share in energy production in the world, should focus on the use of renewable energy in order to maintain this superiority and its sustainability. The findings of this paper may be useful to policymakers and may help to contribute to existing literature for future research in the case of oil-exporting countries.

Source-specific contributions of particulate matter to asthma-related pediatric emergency department utilization

Ambient particulate matter smaller than 2.5 μm (PM_2.5) is associated with different chronic diseases. It is crucial to identify the sources of ambient particulate matter to reduce the impact on health. Still, only a few studies have been linked with specific ambient particulate matter sources. In this study, we estimated the contributions of sources of PM_2.5 and examined their association with daily asthma hospital utilization in Cincinnati, Ohio, USA. We used a model-based clustering method to group days with similar source-specific contributions into six distinct clusters. Specifically, elevated PM_2.5 concentrations occurring on days characterized by low coal combustion contributions showed a significantly reduced risk of hospital utilization for asthma (rate ratio: 0.86, 95% CI: [0.77, 0.95]) compared to other clusters. Reducing coal combustion contribution to PM_2.5 levels could be an effective intervention for lowering asthma-related hospital utilization.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13755-021-00141-z.

Association between county-level coal-fired power plant pollution and racial disparities in preterm births from 2000 to 2018

Coal has historically been a primary energy source in the United States. The byproducts of coal combustion, such as fine particulate matter (PM_2.5), have increasingly been associated with adverse birth outcomes. The goal of this study was to leverage the current progressive transition away from coal in the United States (U.S.) to assess whether coal PM_2.5 is associated with preterm birth rates and whether this association differs by maternal Black/White race/ethnicity. Using a novel dispersion modeling approach, we estimated PM_2.5 pollution from coal-fired power plants nationwide at the county-level during the study period (2000-2018). We also obtained county-level preterm birth rates for non-Hispanic White and non-Hispanic Black mothers. We used a generalized additive mixed model to estimate the relationship between coal PM_2.5 and preterm birth rates, overall and stratified by maternal race. We included a natural spline to allow for non-linearity in the concentration-response curve. We observed a positive non-linear relationship between coal PM_2.5 and preterm birth rate, which plateaued at higher levels of pollution. We also observed differential associations by maternal race; the association was stronger for White women, especially at higher levels of coal PM_2.5 (> 2.0 μg/m³). Our findings suggest that the transition away from coal may reduce preterm birth rates in the U.S.

Multiple exposure pathways and health risk assessment of selenium for children in a coal mining area

Selenium (Se) presents a dual role to human body, harmful or beneficial, depending on its concentration. The exposure to this element has been associated to coal mining. Health risk assessment allows estimating and evaluating the risks that environmental hazards pose to vulnerable groups of populations. The present study aimed to analyze the risk of exposure to Se through multiple exposure pathways in children living in Candiota city, where the largest coal reserve of Brazil is located. Data from previous environmental (air, soil, drinking water, and food) and population parameters (age, weight, and food intake) were used to assess the health risk, which was calculated with real values (extracted from the population) and fixed reference values, based on the USEPA recommendation. Most of the children had low health risk (HQ < 1); however, in the most conservative scenarios (higher Se values in the different matrices), there was a high health risk in both scenarios, using population data or the USEPA parameters. The mean HQ using reference values was twice higher than using real values. Se content in air, soil, and drinking water did not represent important average daily dose in both scenarios. While, food intake was a main source of Se exposure, contributing with 96.9% of total Se intake. The findings of this study reinforce the importance of food intake for exposure to Se and the difference between HQs using population measures and fixed parameters of the USEPA highlights the need for adaptations to local scenarios for a better dimensioning of toxicological risk management actions.

Effects of dibenzothiophene, a sulfur-containing heterocyclic aromatic hydrocarbon, and its alkylated congener, 2,4,7-trimethyldibenzothiophene, on placental trophoblast cell function

Worldwide demand for petroleum products has resulted in increased oil and gas activities in many countries. Conventional and unconventional oil and gas extraction, production, and transport lead to increased levels of petroleum-derived polycyclic aromatic hydrocarbons (PAHs) in the environment. PAH exposure has profound effects on reproduction by affecting pathways involved in placental trophoblast cell function and impairing normal placental development and function-key contributors to reproductive success. However, other components found in petroleum and wastewaters from oil and gas extraction, including the sulfur-containing heterocyclic aromatic compounds such as dibenzothiophene (DBT) and its alkylated derivatives, may also impact reproductive success. The goal of this study was to examine the effect of exposure to DBT, a compound commonly detected in the environment, and one of its alkylated analogues, 2,4,7-trimethyldibenzothiophene (2,4,7-DBT), on steroidogenic and angiogenic pathways critical for mammalian development in placental trophoblast cells (HTR-8/SVneo cells). 2,4,7-DBT but not DBT increased estradiol output in association with increased tube-like formation (surrogate for angiogenesis). These changes in angiogenesis did not appear to be related to altered expression of the key placental angiogenic gene targets (ANGPTL4, VEGFA, and PGF). Neither compound showed a concentration related effect on progesterone synthesis or its receptor expression. Our results suggest that 2,4,7-DBT can disrupt key pathways important for placental trophoblast function and highlight the importance of determining the impact of exposure to both parent and alkylated compounds. Further, these data suggest that exposure to sulfur-containing heterocyclic aromatic compounds may lead to placental dysfunction and impact reproductive success at environmentally relevant levels.

The Effects of Fine Dust, Ozone, and Nitrogen Dioxide on Health

BACKGROUND

Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 μg/m3 for fine dust particles smaller than 2.5 μm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany.

METHODS

This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS).

RESULTS

Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mor- tality rises approximately 7% for every incremental long-term exposure to 5 μg/m3 PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m3 of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits.

CONCLUSION

It is very important for public health that the current EU standards for rkedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.

Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review

IMPORTANCE

Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country.

OBJECTIVE

To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth.

EVIDENCE REVIEW

This systematic review involved a comprehensive search for primary literature in Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, PubMed, ClinicalTrials.gov website, and MEDLINE. Qualifying primary research studies included human participants in US populations that were published in English between January 1, 2007, and April 30, 2019. Included articles analyzed the associations between air pollutants or heat and obstetrical outcomes. Comparative observational cohort studies and cross-sectional studies with comparators were included, without minimum sample size. Additional articles found through reference review were also considered. Articles analyzing other obstetrical outcomes, non-US populations, and reviews were excluded. Two reviewers independently determined study eligibility. The Arskey and O'Malley scoping review framework was used. Data extraction was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

FINDINGS

Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The subpopulations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality.

CONCLUSIONS AND RELEVANCE

This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.

Towards a fuller assessment of the economic benefits of reducing air pollution from fossil fuel combustion: Per-case monetary estimates for children's health outcomes

BACKGROUND

Impacts on children's health are under-represented in benefits assessments of policies related to ambient air quality and climate change. To complement our previous compilation of concentration-response (C-R) functions for a number of children's health outcomes associated with air pollution, we provide per-case monetary estimates of the same health outcomes.

OBJECTIVES

Our goal was to establish per-case monetary estimates for a suite of prevalent children's health outcomes (preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction) that can be incorporated into benefits assessments of air pollution regulations and climate change mitigation policies.

METHODS

We conducted a systematic review of the literature published between January 1, 2000 and June 30, 2018 to identify relevant economic costs for these six adverse health outcomes in children. We restricted our literature search to studies published in the U.S., with a supplemental consideration of studies from the U.K. and prioritized literature reviews with summary cost estimates and papers that provided lifetime cost of illness estimates.

RESULTS

Our literature search and evaluation process reviewed 1065 papers and identified 12 most relevant papers on per-case monetary estimates for preterm birth, low birth weight, asthma, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Details are presented in full. We separately identified estimates of the lost lifetime earnings associated with the loss of a single IQ point. The final per-case cost estimates for each outcome were selected based on the most robust evidence. These estimates range from $23,573 for childhood asthma not persisting into adulthood to $3,109,096 for a case of autism with a concurrent intellectual disability.

CONCLUSION

To our knowledge, this is the first time that the child-specific health outcomes of preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction have been systematically valued and presented in one place. This is an important addition to the body of health-related valuation literature as these outcomes have substantial economic costs that are not considered in most assessments of the benefits of air pollution and climate mitigation policies. In general, however, the available per-case estimates presented here did not incorporate the broad societal and long-term costs and are likely underestimates. Although our context has been air pollution and climate policies, the per-case monetary estimates presented here can be applied to other environmental exposures. Fuller assessments of health benefits to children and their corresponding economic gains will improve decision-making on environmental policy.

Chemical Exposures, Health, and Environmental Justice in Communities Living on the Fenceline of Industry

PURPOSE OF REVIEW

Polluting industries are more likely to be located in low-income communities of color who also experience greater social stressors that may make them more vulnerable than others to the health impacts of toxic chemical exposures. We describe recent developments in assessing pollutant exposures and health threats posed by industrial facilities using or releasing synthetic chemicals to nearby communities in the U.S.

RECENT FINDINGS

More people are living near oil and gas development due to the expansion of unconventional extraction techniques as well as near industrial animal operations, both with suggestive evidence of increased exposure to hazardous pollutants and adverse health effects. Legacy contamination continues to adversely impact a new generation of residents in fenceline communities, with recent studies documenting exposures to toxic metals and poly- and perfluoroalkyl substances (PFASs). Researchers are also giving consideration to acute exposures resulting from inadvertent industrial chemical releases, including those resulting from extreme weather events linked to climate change. Natural experiments of industrial closures or cleanups provide compelling evidence that exposures from industry harm the health of nearby residents. New and legacy industries, coupled with climate change, present unique health risks to communities living near industry due to the release of toxic chemicals. Cumulative impacts from multiple stressors faced by environmental justice communities may amplify these adverse effects.

Impacts of Coal Use on Health

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

The promise and pitfalls of precision medicine to resolve black-white racial disparities in preterm birth

Differences in preterm birth rates between black and white women are the largest contributor to racial disparities in infant mortality. In today's age of precision medicine, analysis of the genome, epigenome, metabolome, and microbiome has generated interest in determining whether these biomarkers can help explain racial disparities. We propose that there are pitfalls as well as opportunities when using precision medicine analyses to interrogate disparities in health. To conclude that racial disparities in complex conditions are genetic in origin ignores robust evidence that social and environmental factors that track with race are major contributors to disparities. Biomarkers measured in omic assays that may be more environmentally responsive than genomics, such as the epigenome or metabolome, may be on the causal pathway of race and preterm birth, but omic observational studies suffer from the same limitations as traditional cohort studies. Confounding can lead to false conclusions about the causal relationship between omics and preterm birth. Methodological strategies (including stratification and causal mediation analyses) may help to ensure that associations between biomarkers and exposures, as well as between biomarkers and outcomes, are valid signals. These epidemiologic strategies present opportunities to assess whether precision medicine biomarkers can uncover biology underlying perinatal health disparities.

Racial disparities in preterm birth in USA: a biosensor of physical and social environmental exposures

Race is a social construct that involves a person’s self-assigned, and externally-perceived, group membership. Group membership can determine much about Americans’ lives and health. Complex health disorders such as cardiovascular disease, asthma, and obesity disproportionately affect Non-Hispanic black Americans. An individual’s risk of any of these disorders encompasses both genetic predisposition and environmental stimuli. We propose that environmental stressors may be large contributors to differences in preterm birth rates in the United States between racial groups. Environmental exposures differ by race due to ongoing residential, educational and economic racial segregation as well as discrimination. Characterizing and mitigating environmental factors that contribute to differential preterm risk could identify women at risk, prevent some preterm births, and reduce perinatal health disparities.