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Chu MT, Fenelon A, Adamkiewicz G, Zota AR. Federal Housing Assistance and Blood Lead Levels in a Nationally Representative US Sample Age 6 and Older: NHANES, 1999-2018. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:37004. [PMID: 38477610 DOI: 10.1289/ehp12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Federal housing assistance is an important policy tool to ensure housing security for low-income households. Less is known about its impact on residential environmental exposures, particularly lead. OBJECTIVES We conducted a quasi-experimental study to investigate the association between federal housing assistance and blood lead levels (BLLs) in a nationally representative US sample age 6 y and older eligible for housing assistance. METHODS We used the 1999-2018 National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development (HUD) administrative records to assess BLLs of NHANES participants with concurrent HUD housing assistance (i.e., current recipients, n = 3 , 0 71 ) and those receiving assistance within 2 y after the survey (i.e., pseudo-waitlist recipients, n = 1,235 ). We estimated BLL least squares geometric means (LSGMs), odds ratio (OR) for BLL ≥ 3.5 μ g / dL , and percent differences in LSGMs by HUD housing assistance status adjusting for age, sex, family income-to-poverty ratio, education, country of birth, race/ethnicity, region, and survey year. We also examined effect modification using interaction terms and stratified analyses by program type [i.e., public housing, multifamily, housing choice vouchers (HCV)], and race/ethnicity. RESULTS Current HUD recipients had a significantly lower LSGM [1.07 μ g / dL ; 95% confidence interval (CI): 1.02, 1.12] than pseudo-waitlist recipients (1.21 μ g / dL ; 95% CI: 1.14, 1.28), with an adjusted OR of 0.60 (95% CI: 0.42, 0.87) for BLL ≥ 3.5 μ g / dL . Some effect modification were observed: The protective association of HUD assistance on BLL was strongest among public housing (- 19.5 % LSGM; 95% CI: - 27.5 % , - 1 0 . 7 % ), multifamily (- 12.5 % LSGM; 95% CI: - 2 0 . 7 % , - 3.5 % ), and non-Hispanic White (- 2 0 . 6 % LSGM; 95% CI: - 29.8 % , - 1 0 . 3 % ) recipients. It was weaker to null among HCV (- 5.7 % LSGM; 95% CI: - 12.7 , 1.7%), non-Hispanic Black (- 1.6 % LSGM; 95% CI: - 8.1 % , 5.4%), and Mexican American (-12.5% LSGM; 95% CI: - 31.9 % , 12.5 % ) recipients. DISCUSSION Our research underscores the importance of social-structural determinants like federal housing assistance in providing affordable, stable, and healthy housing to very low-income households. More attention is needed to ensure housing quality and racial equity across HUD's three major housing assistance programs. https://doi.org/10.1289/EHP12645.
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Affiliation(s)
- MyDzung T Chu
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Andrew Fenelon
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ami R Zota
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Mallach G, Sun L(S, McKay M, Kovesi T, Lawlor G, Kulka R, Miller JD. Indoor air quality in remote first nations communities in Ontario, Canada. PLoS One 2023; 18:e0294040. [PMID: 37992001 PMCID: PMC10664901 DOI: 10.1371/journal.pone.0294040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023] Open
Abstract
A recent study of the health of Indigenous children in four First Nations Communities in remote northwestern Ontario found that 21% of children had been admitted to hospital for respiratory infections before age 2 years. Here we report a detailed analysis of the housing conditions in these communities. We employed a variety of statistical methods, including linear regression, mixed models, and logistic regression, to assess the correlations between housing conditions and loadings of biocontaminants (dust mite allergens, fungal glucan, and endotoxin) and indoor concentrations of PM2.5, CO2, benzene, and formaldehyde. The houses (n = 101) were crowded with an average of approximately 7 people. Approximately 27% of the homes had sustained CO2 concentrations above 1500 ppm. Most homes had more than one smoker. Commercial tobacco smoking and the use of non-electric heating (e.g., wood, oil) were associated with increased fine particle concentrations. Over 90% of the homes lacked working Heat Recovery Ventilators (HRVs), which was associated with increased fine particle concentrations and higher CO2. Of the 101 homes, 12 had mold damage sufficient to increase the relative risk of respiratory disease. This resulted from roof leaks, through walls or around the windows due to construction defects or lack of maintenance. A similar percentage had mold resulting from condensation on windows. Endotoxin loadings were much higher than any previous study in Canada. This work provides evidence for the need for more effort to repair existing houses and to ensure the HRVs are properly installed and maintained.
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Affiliation(s)
- Gary Mallach
- Water and Air Quality Bureau, Health Canada, Ottawa, Canada
| | | | | | - Thomas Kovesi
- Department of Pediatrics, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Canada
| | | | - Ryan Kulka
- Water and Air Quality Bureau, Health Canada, Ottawa, Canada
| | - J. David Miller
- Department of Chemistry, Carleton University, Ottawa, Canada
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Miller JD. Fungal bioaerosols as an occupational hazard. Curr Opin Allergy Clin Immunol 2023; 23:92-97. [PMID: 36752376 DOI: 10.1097/aci.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW Over the past 40 years, the circumstances where fungal bioaerosols are major issues have shifted because of changes in the industrial sector from mainly agriculture to operations, including composting, cannabis production and forestry in hot humid conditions. Changes in the design and operation of nonindustrial workplaces meant that mould and dampness became major issues that are just being reduced. This review attempts to frame that history offers a perspective on the current thinking on mechanisms and provide potentially useful sources of information for physicians and their patients. RECENT FINDINGS The major impact of fungal exposures is not only from their allergens but also from an array of Danger-Associated Molecular Pattern molecules, possibly the most important of which is the type of glucan found in moulds that grow in damp buildings, wood chips and crops, that is beta 1, 3 D glucan in triple helical form. Located in lung epithelia, the dectin receptor is exquisitely sensitive to this compound. Except in some agricultural workplaces, low molecular weight secondary metabolites often mischaracterized as mycotoxins play little, if any, role on population health. SUMMARY There has been a convergence in thinking between the allergy and industrial hygiene communities as well as government agencies on mould and occupational health. This has led to some useful strategies for better managing these issues as well as increasing consumer awareness.
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Affiliation(s)
- J David Miller
- Department of Chemistry, Carleton University, Ottawa, Ontario, Canada
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Denary W, Fenelon A, Whittaker S, Esserman D, Lipska KJ, Keene DE. Rental assistance improves food security and nutrition: An analysis of National Survey Data. Prev Med 2023; 169:107453. [PMID: 36813247 PMCID: PMC10037672 DOI: 10.1016/j.ypmed.2023.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
The U.S. is experiencing a severe housing affordability crisis, resulting in households having to make difficult trade-offs between paying for a place to live and basic health necessities such as food. Rental assistance may mitigate these strains, improving food security and nutrition. However, only one in five eligible individuals receive assistance, with an average wait time of two years. Existing waitlists create a comparable control group, allowing us to examine the causal impact of improved housing access on health and well-being. This national quasi-experimental study utilizes linked NHANES-HUD data (1999-2016) to investigate the impacts of rental assistance on food security and nutrition using cross-sectional regression. Tenants with project-based assistance were less likely to experience food insecurity (B = -0.18, p = 0.02) and rent-assisted individuals consumed 0.23 more cups of daily fruits and vegetables compared the pseudo-waitlist group. These findings suggest that the current unmet need for rental assistance and resulting long waitlists have adverse health implications, including decreased food security and fruit and vegetable consumption.
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Affiliation(s)
- Whitney Denary
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Andrew Fenelon
- School of Public Policy and Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Kasia J Lipska
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Gaines B, Kloog I, Zucker I, Ifergane G, Novack V, Libruder C, Hershkovitz Y, Sheffield PE, Yitshak-Sade M. Particulate Air Pollution Exposure and Stroke among Adults in Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1482. [PMID: 36674236 PMCID: PMC9860673 DOI: 10.3390/ijerph20021482] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 05/13/2023]
Abstract
Stroke is the second most common cause of death and disability in the world. Many studies have found fine particulate matter (PM2.5) exposure to be associated with an increased risk of atherosclerotic cardiovascular disease, mostly focusing on ischemic heart disease and acute myocardial infarction. In a national analysis conducted in Israel-an area with unique climate conditions and high air pollution levels, we estimated the association between short-term PM2.5 exposure and ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attacks (TIA). Using the Israeli National Stroke Registry, we obtained information on all stroke cases across Israel in 2014-2018. We obtained daily PM2.5 exposures from spatiotemporally resolved exposure models. We restricted the analytical data to days in which PM2.5 levels did not exceed the Israeli 24 h standard (37.5 µg/m3). We repeated the analysis with a stratification by sociodemographic characteristics and comorbidities. For all outcomes, the exposure-response curves were nonlinear. PM2.5 exposure was associated with a higher ischemic stroke risk, with larger effect estimates at higher exposure levels. Although nonsignificant, the exposure-response curve for TIA was similar. The associations with ICH were nonsignificant throughout the PM2.5 exposure distribution. The associations with ischemic stroke/TIA were larger among women, non-Jewish individuals, older adults, and individuals with diabetes, hypertension, and ischemic heart disease. In conclusion, short-term PM2.5 exposure is associated with a higher risk for ischemic stroke and possibly TIA, even when PM2.5 concentrations do not exceed the Israeli air quality guideline threshold. Vulnerability to the air pollution effects differed by age, sex, ethnicity, and comorbidities.
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Affiliation(s)
- Britney Gaines
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben Gurion University, Beer Sheva 8410501, Israel
| | | | - Gal Ifergane
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Neurology Department, Soroka University Medical Center, Beer Sheva 8410101, Israel
| | - Victor Novack
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Clinical Research Center, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | | | | | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Park SS. Racial/ethnic inequalities in the indoor home environment among households with people with disabilities. Disabil Health J 2023; 16:101440. [PMID: 36754775 DOI: 10.1016/j.dhjo.2023.101440] [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: 07/26/2022] [Revised: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND The indoor home environment (IHE) is an important determinant of health. However, there is limited information about variation in the IHE by race/ethnicity among the population with disabilities. OBJECTIVE This study summarizes the IHE among households with any person with a disability (HWDs) and describes differences by race/ethnicity. The study evaluates whether these racial/ethnic differences are accounted for by demographic, socioeconomic, and geographic characteristics. METHODS Using a nationally representative, cross-sectional survey, descriptive and multivariate analyses were conducted to examine racial/ethnic differences across eight inadequate conditions of the IHE and the total number of inadequate conditions of the IHE. RESULTS Some IHE conditions are common, such as low indoor air quality. Large racial/ethnic differences in exposure persist, net of controls. Black, Hispanic, and Mixed Race/Ethnicity HWDs have greater exposure to low indoor temperatures, injury hazards, and lead than White HWDs. Black and Hispanic HWDs reside in dwellings with lower indoor air quality and pests/allergens than White HWDs. Mixed Race/Ethnicity HWDs are the only racial/ethnic minority group with greater barriers to water and sanitation than White HWDs. Asian households have comparable exposure to White households for all IHE conditions. Black, Hispanic, and Mixed Race/Ethnicity HWDs have about 23%, 17%, and 15% more inadequate conditions of the IHE than White HWDs, net of controls. CONCLUSION There is heterogeneity in exposure to inadequate conditions of the IHE, with Black, Hispanic, and Mixed Race/Ethnicity HWDs at a disadvantage compared to their White counterparts. It is critical to examine racial/ethnic variation when studying health inequalities in the IHE among HWDs.
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Affiliation(s)
- Sung S Park
- Office of Population Research, Wallace Hall, Princeton University, NJ, 08540, USA.
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Fasolino T, O'Hara S. Assessing SPACES in Patients with Chronic Obstructive Pulmonary Disease Helps Identify Unmet Needs. J Palliat Med 2023; 26:149-152. [PMID: 35930241 DOI: 10.1089/jpm.2022.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Environmental factors contribute to the symptom burden for patients with chronic obstructive pulmonary disease, particularly in the Appalachian region where prevalence of the disease is higher. These regions are especially vulnerable because of poor air quality, exposure to organic toxic dust, and higher percentage of smokers. Using an innovative approach to assess the home environmental impact, SPACES (Spend, Primary Place, Assessment, Changes, Equipment, and Synergy), palliative care providers may uncover factors contributing to the symptom burden that might otherwise be missed. We present a case of a 68-year-old woman living in Appalachia with several environmental factors that contributed to her symptom burden while reducing the healing home environment.
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Affiliation(s)
- Tracy Fasolino
- Clemson University, School of Nursing, Clemson, South Carolina, USA
| | - Susan O'Hara
- The Ohio State University, College of Nursing, Center for Healthcare Innovation and Leadership, Columbus, Ohio, USA
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Mahabee-Gittens EM, Han G, Merianos AL. Child Tobacco Smoke Exposure, Indoor Home Characteristics, and Housing Stability among a National Sample of U.S. Children. TOXICS 2022; 10:639. [PMID: 36355931 PMCID: PMC9695748 DOI: 10.3390/toxics10110639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
(1) Objectives: To examine the associations of child tobacco smoke exposure (TSE) with home quality and housing instability. (2) Methods. A secondary analysis of 32,066 U.S. 0-11-year-old children from the 2018-2019 National Survey of Children's Health was conducted. Child home TSE status was defined as: no TSE: child lived with no smokers; thirdhand smoke (THS) exposure only: child lived with a smoker(s) who did not smoke indoors; and secondhand smoke (SHS) and THS exposure: child lived with a smoker(s) who smoked indoors. Home quality was assessed by the presence of mold or pesticide use and housing instability was assessed by home ownership, frequency of moves, and number of household members. We conducted weighted multivariable logistic regression and linear regression models while adjusting for important child covariates. (3) Results: In total, 12.3% had home THS exposure only and 1.6% had home SHS and THS exposure. Compared to children with no home TSE, children with home SHS and THS exposure were 2.60 times more likely (95%CI = 1.73, 3.92) to have mold inside their homes; 1.57 times more likely (95%CI = 1.09, 2.26) to live in homes where pesticides were used ≥1 time during the past 12-months; and more likely to have more frequent moves (β = 1.06, 95%CI = 0.62, 1.50). (4) Conclusions: Children with home TSE have higher rates of mold, pesticide use, frequent moves, and household members compared to children with no home TSE. Children with TSE should also be screened for home quality and housing instability and provided with appropriate interventions and resources.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA
| | - Gang Han
- Department of Epidemiology and Biostatistics, Texas A&M University School of Public Health, College Station, TX 77843, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA
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