Housing and health: intersection of poverty and environmental exposures

Air quality improvements from a transport modal change in the São Paulo megacity

Air quality and urban mobility are complex socioenvironmental issues faced by megacities, particularly those in the Global South. Investments in efficient and inclusive public transport networks, as well as encouraging active transport modals, can mitigate both traffic congestion and air pollution, leading to improved quality of life. Few studies have integrated the potential effects of a well-developed rail network in influencing modal choice - from motorised to active transport - and their impacts on pollutant emission and air quality through dynamic air quality models. In the megacity of São Paulo, the expansion of the subway system has not achieved the planned targets, as intended by state government plans. This induces the question "What would have happened to air pollution if planned stations had been properly implemented?" which this paper aims to answer, through the increased adoption of cycling or walking to and from railway stations. We applied the WRF-Chem air quality model to model the effects of railway development in a megacity, focusing on criteria pollutants. Results show that the more investments there are in public transport, by expanding the metro system, the more expressive are the decreases in air pollution, and the farther these benefits spread out spatially. More intense reductions in pollutant concentrations are predicted to occur near the new stations' buffers, but citizens living far from the metro stations will also benefit from these improvements. Additionally, modal change from car to walking/cycling and subway in all trips within a radius of 1.3 km centered in existing and planned stations is expected to result in a decrease of 11.7 % in CO2eq vehicular emissions. Therefore, improvements in public transportation could help improving environmental and social justice, leading to better air quality and transport accessibility, decreasing public health problems and costs, while helping cities reach their GEE emissions reduction targets.

Neighborhood Socioeconomic Context Predicts Pediatric Asthma Exacerbation

Causes of asthma exacerbation in children have been studied extensively at the individual level, but contributions of neighborhood-level factors are less explored. We test which distinctive residential characteristics produce variation in uncontrolled asthma among pediatric patients. We extracted electronic medical record data from pediatric patients living in Southern California and used multilevel modeling techniques to isolate which neighborhood characteristics drive inequitable asthma control. Above and beyond the individual-level factors known to predict inadequate disease control, neighborhoods with greater concentration of non-Hispanic black residents (odds ratios [OR] = 1.02; 95% confidence interval [CI]: 0.99-1.03; P < .05), higher proportions of female-headed households (OR = 1.01; 95% CI: 0.99-1.01; P < .05), and higher levels of ambient air pollution (OR = 1.05; 95% CI: 1.01-1.10; P < .001) associate with greater odds of asthma exacerbation. The interplay between community characteristics and asthma management during childhood is complex, and place-based initiatives are needed to narrow the gap in asthma exacerbation.

Tweeting environmental pollution: Analyzing twitter language to uncover its correlation with county-level obesity rates in the United States

BACKGROUND

Environmental pollution has been linked to obesogenic tendencies. Using environmental-related posts from Twitter (now known as X) from U.S. counties, we aim to uncover the association between Twitter linguistic data and U.S. county-level obesity rates.

METHODS

Analyzing nearly 300 thousand tweets from January 2020 to December 2020 across 207 U.S. counties, using an innovative Differential Language Analysis technique and drawing county-level obesity data from the 2020 Food Environment Atlas to identify distinct linguistic features in Twitter relating to environmental-related posts correlated with socioeconomic status (SES) index indicators, obesity rates, and obesity rates controlled for SES index indicators. We also employed predictive modeling to estimate Twitter language's predictive capacity for obesity rates.

RESULTS

Results revealed a negative correlation between environmental-related tweets and obesity rates, both before and after adjusting for SES. Contrarily, non-environmental-related tweets showed a positive association with higher county-level obesity rates, indicating that individuals living in counties with lower obesity rates tend to tweet environmental-related language more frequently than those living in counties with higher obesity rates. The findings suggest that linguistic patterns and expressions employed in discussing environmental-related themes on Twitter can offer unique insights into the prevailing cross-sectional patterns of obesity rates.

CONCLUSIONS

Although Twitter users are a subset of the general population, incorporating environmental-related tweets and county-level obesity rates and using a novel language analysis technique make this study unique. Our results indicated that Twitter users engaging in more active dialog about environmental concerns might exhibit healthier lifestyle practices, contributing to reduced obesity rates.

Race, historical redlining, and contemporary transportation noise disparities in the United States

BACKGROUND

Legacies of discriminatory federal housing practices-e.g., racialized property appraisal by the Home Owners' Loan Corporation (HOLC) and institutionalized redlining by the Federal Housing Administration-include disparate present-day environmental health outcomes. Noise pollution is health-harming, but just one study has associated contemporary noise with redlining in some HOLC-mapped United States (US) cities, while two national studies found associations between greater neighborhood-level people of color composition and increased noise. No studies have examined noise pollution exposure disparities across all HOLC-mapped cities or based on the intersection of race/ethnicity and redlining.

OBJECTIVE

We address three objectives: (1) Assess disparities in fine-scale, per person transportation noise exposures by historical redlining status across all HOLC-mapped cities. (2) Quantify disparities in noise exposures by race/ethnicity nationwide. (3) Explore interactions between redlining status and race/ethnicity in noise exposures.

METHODS

We analyzed three data sources: (1) complete digital HOLC maps of ordered investment risk grades (A-D), (2) fine-scale (30 m) estimates of transportation noise levels (year-2020), and (3) sociodemographic characteristics of individuals in year-2020 census blocks.

RESULTS

We find an approximately monotonic association for excess transportation noise with HOLC grade, marked by a pronounced exposure increase (17.4 dBA or 3× loudness) between contemporary residents of grade A (highest-graded) and D (lowest-graded) neighborhoods, a pattern consistent across HOLC-mapped cities. People of color experience ~7 dBA greater (2× louder) excess transportation noise exposures than White people nationwide, a pattern consistent across US counties. Noise exposure disparities are larger by HOLC grade than by race/ethnicity. However, contemporary racial/ethnic noise exposure disparities persist within each HOLC grade at levels approximating those disparities existing in ungraded areas, indicating that historical redlining is one of multiple discriminatory practices shaping contemporary national soundscape injustices.

SIGNIFICANCE

Findings illustrate how historical redlining and broader racialized inequalities in US society have shaped environmental injustices nationwide.

IMPACT STATEMENT

Excessive noise exposures harm human health. Communities of color in the United States experience disparate noise exposures, although previous studies are limited by reliance upon aggregated data. They are also disproportionately concentrated in historically redlined areas. Legacies of redlining include persistent racial and economic inequalities and environmental health disparities. Here, we conduct the first complete national examination of contemporary noise pollution disparities with respect to historical redlining and race/ethnicity. Findings advance understanding of the historical roots and enduring salience of race-based disparities in noise pollution exposures and can inform efforts to address these disparities through noise pollution policy-making.

Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study

BACKGROUND

For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap.

METHODS

Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status.

CONCLUSIONS

Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.

The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery

INTRODUCTION

We sought to evaluate the association of county-level poverty duration and cardiac surgical outcomes.

METHODS

Patients who underwent coronary artery bypass graft, surgical aortic valve replacement, and mitral valve repair and replacement between 2016 and 2020 were identified using the Medicare Standard Analytical Files Database. County-level poverty data were acquired from the American Community Survey and US Department of Agriculture (1980-2015). High poverty was defined as ≥19.5% of residents in poverty. Patients were stratified into never-high poverty (NHP), intermittent low poverty, intermittent high poverty, and persistent poverty (PP). A mixed-effect hierarchical generalized linear model and Cox regression models that adjusted for patient-level covariates were used to evaluate outcomes.

RESULTS

Among 237,230 patients, 190,659 lived in NHP counties, while 10,273 resided in PP counties. Compared with NHP patients, PP patients were more likely to present at a younger median age (NHP: 75 y versus PP: 74 y), be non-Hispanic Black (5388, 2.9% versus PP: 1030, 10.1%), and live in the south (NHP: 66,012, 34.6% versus PP: 87,815, 76.1%) (all P < 0.001). PP patients also had more nonelective surgical operations (NHP: 58,490, 30.8% versus 3645, 35.6%, P < 0.001). Notably, PP patients had increased odds of 30-d mortality (odds ratio 1.13, 95% confidence interval [CI] 1.02-1.26), 90-d mortality (odds ratio 1.14, 95% CI 1.05-1.24), and risk of long-term mortality (hazard ratio 1.13, 95% CI 1.09-1.19) compared with patients in NHP counties (all P < 0.05).

CONCLUSIONS

County-level poverty was associated with a greater risk of short- and long-term mortality among cardiac surgical patients.

The Exposome and Nutritional Pharmacology and Toxicology: A New Application for Metabolomics

The exposome refers to all of the internal and external life-long exposures that an individual experiences. These exposures, either acute or chronic, are associated with changes in metabolism that will positively or negatively influence the health and well-being of individuals. Nutrients and other dietary compounds modulate similar biochemical processes and have the potential in some cases to counteract the negative effects of exposures or enhance their beneficial effects. We present herein the concept of Nutritional Pharmacology/Toxicology which uses high-information metabolomics workflows to identify metabolic targets associated with exposures. Using this information, nutritional interventions can be designed toward those targets to mitigate adverse effects or enhance positive effects. We also discuss the potential for this approach in precision nutrition where nutrients/diet can be used to target gene-environment interactions and other subpopulation characteristics. Deriving these "nutrient cocktails" presents an opportunity to modify the effects of exposures for more beneficial outcomes in public health.

Shaping the healthy subject in gentrified spaces: Two case studies in Barcelona (Spain)

Several studies have analysed the impact of gentrification on health. However, a more in-depth examination of the constitutive role of health discourses in shaping spaces is required. This article explores the links between the gentrification process and the subjectification of healthy subjects through a critical discourse analysis of 35 walking interviews and a visual semiotic analysis of 140 shopfronts. Health is put forth as a super value to justify market interference in the configuration of urban space and class privilege based on the health products and healthy practices that have undergone a process of elitisation.

Structural and Social Determinants of Inequitable Environmental Exposures in the United States

American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.

Geographical Patterns and Risk Factor Association of Cardio-Oncology Mortality in the United States

Cardio-oncology mortality (COM) is a complex issue that is compounded by multiple factors that transcend a depth of socioeconomic, demographic, and environmental exposures. Although metrics and indexes of vulnerability have been associated with COM, advanced methods are required to account for the intricate intertwining of associations. This cross-sectional study utilized a novel approach that combined machine learning and epidemiology to identify high-risk sociodemographic and environmental factors linked to COM in United States counties. The study consisted of 987,009 decedents from 2,717 counties, and the Classification and Regression Trees model identified 9 county socio-environmental clusters that were closely associated with COM, with a 64.1% relative increase across the spectrum. The most important variables that emerged from this study were teen birth, pre-1960 housing (lead paint indicator), area deprivation index, median household income, number of hospitals, and exposure to particulate matter air pollution. In conclusion, this study provides novel insights into the socio-environmental drivers of COM and highlights the importance of utilizing machine learning approaches to identify high-risk populations and inform targeted interventions for reducing disparities in COM.

Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas

BACKGROUND

Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level.

OBJECTIVE

We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY.

METHODS

We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area.

RESULTS

Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain.

CONCLUSION

Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.

Household conditions, COVID-19, and equity: Insight from two nationally representative surveys

Background

With people across the United States spending increased time at home since the emergence of COVID-19, housing characteristics may have an even greater impact on health. Therefore, we assessed associations between household conditions and COVID-19 experiences.

Methods

We used data from two nationally representative surveys: the Tufts Equity Study (TES; n = 1449 in 2021; n = 1831 in 2022) and the Household Pulse Survey (HPS; n = 147,380 in 2021; n = 62,826 in 2022). In the TES, housing conditions were characterized by heating/cooling methods; smoking inside the home; visible water damage/mold; age of housing unit; and self-reported concern about various environmental factors. In TES and HPS, household size was assessed. Accounting for sampling weights, we examined associations between each housing exposure and COVID-19 outcomes (diagnosis, vaccination) using separate logistic regression models with covariates selected based on an evidence-based directed acyclic graph.

Results

Having had COVID-19 was more likely among people who reported poor physical housing condition (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.17-4.59; 2021), visible water damage or mold/musty smells (OR = 1.50; 95% CI = 1.10-2.03; 2022), and larger household size (5+ versus 1-2 people; OR = 1.53, 95% CI = 1.34-1.75, HPS 2022). COVID-19 vaccination was less likely among participants who reported smoke exposure inside the home (OR = 0.53; 95% CI = 0.31-0.90; 2022), poor water quality (OR = 0.42; 95% CI = 0.21-0.85; 2021), noise from industrial activity/construction (OR = 0.44; 95% CI = 0.19-0.99; 2022), and larger household size (OR = 0.57; 95% CI = 0.46-0.71; HPS 2022). Vaccination was also positively associated with poor indoor air quality (OR = 1.96; 95% CI = 1.02-3.72; 2022) and poor physical housing condition (OR = 2.27; 95% CI = 1.01-5.13; 2022). Certain heating/cooling sources were associated with COVID-19 outcomes.

Conclusions

Our study found poor housing conditions associated with increased COVID-19 burden, which may be driven by systemic disparities in housing, healthcare, and financial access to resources during the COVID-19 pandemic.

Microbial assessment of water, sanitation, and hygiene (WaSH) in temporary and permanent settlements two years after Nepal 2015 earthquake

Disaster-induced displacement often causes people to live in temporary settlements that have limited infrastructure and access to water, sanitation, and hygiene (WaSH). Reducing the risk of diarrheal diseases in such situations requires knowing how housing influences the presence of pathogens in water and the interaction between human settlements and exposure to pathogens. A cross-sectional study was conducted in May 2017 in two communities hard-hit by the Nepal 2015 earthquake: one recovered with newly reconstructed houses, and one recovered with residents still living in sheet metal temporary shelters constructed after the earthquake. We collected 60 water (30 drinking water and 30 cleaning water), 30 hand rinse, and 90 environmental swab samples (30 toilet handles, 30 utensils, and 30 water vessels) from selected households in each location and quantified 22 bacterial pathogens using microfluidic quantitative polymerase chain reaction (mfqPCR). A total of 59 samples were randomly selected for amplicon-based sequencing of the 16S rRNA, and it identified bacterial community profiles between these two settlements and their association with target genes of pathogenic bacteria. Target genes like uidA of Escherichia coli and the mip gene of Legionella pnuemophila showed significantly high frequency in specific sample types in temporary settlements than in permanent settlements. A significantly high concentration was observed in temporary settlements for Enterococcus spp. and S. typhimurium, specifically in swab samples. There was a sharp distinction of microbial community profiles between water and hand rinse samples with environmental swab samples, with a large abundance of potentially pathogenic bacteria in swab samples in both settlements. This observation highlighted that fomite could be an important transmission route for pathogens in rural settings and designing key interventions to target different stages of transmission pathways is essential. Overall findings from this study suggest that the recovered settlement with higher quality housing may be less impacted by fecal contamination than recovering settlements and that interventions should be designed to disrupt multiple transmission pathways to reduce pathogen exposure.

Prevalence and factors associated with multidimensional child deprivation: Findings from the Future of Families and Child Well-Being Study

Despite the growing importance of the multidimensional methods of assessing child poverty, few studies in the U.S. have applied a rights-based approach to examining child deprivation. This study examines multidimensional child deprivation using eight dimensions and twelve indicators based on the Convention on the Rights of the Child (CRC). Using a sample of children at age nine from the fifth wave of the Future of Families and Child Well-being Study, this study applied the multiple overlapping deprivation analysis (MODA), a comprehensive analytic method to assess the multidimensionality of child deprivation and to provide a detailed picture of material and social forms of deprivation among the U.S. children. This study found that the overall child deprivation rate was 8.89%; environmental safety (20.36%), information (15.94%), and housing security (14.23%) dimensions contributed the highest to the overall child deprivation; the overlap between deprivation and income poverty was 12.83%. Results suggest that understanding multifaceted and interrelated contexts of child deprivation is crucial to promote child rights.

The development of youth antisocial behavior across time and context: A systematic review and integration of person-centered and variable-centered research

BACKGROUND

Trajectories of youth antisocial behavior (ASB) are characterized by continuity and change. Although numerous longitudinal studies have examined ASB, findings from person-centered and variable-centered research have not yet been integrated. The present paper integrates findings across statistical methods for a more comprehensive understanding of the development of ASB. Neighborhood disadvantage is considered as a core moderator.

METHODS

The study protocol was registered in the PROSPERO database of systematic reviews (registration number CRD42021255820). The PsycINFO and PubMed databases were examined (September 2022) to identify longitudinal studies of youth aggression and/or rule-breaking. Results from person-centered and variable-centered studies were integrated via narrative synthesis, and a systematic quality assessment was conducted.

RESULTS

Of 8227 studies identified, 136 met inclusion criteria. Our review indicated that rule-breaking trajectories were largely distinguished by differences in rate of change (i.e., slope), whereas aggression trajectories differed more by baseline level (i.e., intercept), particularly in childhood. For adolescents in disadvantaged neighborhoods, however, aggression trajectories differed by both intercept and slope.

CONCLUSIONS

The respective importance of the intercept and slope differed across dimensions of ASB, developmental stage, and neighborhood residence. Neighborhood disadvantage was associated with trajectories of aggression, consistent with developmental theories emphasizing the role of person-environment interactions.

Environmental exposures are important risk factors for advanced liver fibrosis in African American adults

Background & Aims

The prevalence and aetiology of liver fibrosis vary over time and impact racial/ethnic groups unevenly. This study measured time trends and identified factors associated with advanced liver fibrosis in the United States.

Methods

Standardised methods were used to analyse data on 47,422 participants (≥20 years old) in the National Health and Nutrition Examination Survey (1999-2018). Advanced liver fibrosis was defined as Fibrosis-4 ≥2.67 and/or Forns index ≥6.9 and elevated alanine aminotransferase.

Results

The estimated number of people with advanced liver fibrosis increased from 1.3 million (95% CI 0.8-1.9) to 3.5 million (95% CI 2.8-4.2), a nearly threefold increase. Prevalence was higher in non-Hispanic Black and Mexican American persons than in non-Hispanic White persons. In multivariable logistic regression analysis, cadmium was an independent risk factor in all racial/ethnic groups. Smoking and current excessive alcohol use were risk factors in most. Importantly, compared with non-Hispanic White persons, non-Hispanic Black persons had a distinctive set of risk factors that included poverty (odds ratio [OR] 2.09; 95% CI 1.44-3.03) and susceptibility to lead exposure (OR 3.25; 95% CI 1.95-5.43) but did not include diabetes (OR 0.88; 95% CI 0.61-1.27; p =0.52). Non-Hispanic Black persons were more likely to have high exposure to lead, cadmium, polychlorinated biphenyls, and poverty than non-Hispanic White persons.

Conclusions

The number of people with advanced liver fibrosis has increased, creating a need to expand the liver care workforce. The risk factors for advanced fibrosis vary by race/ethnicity. These differences provide useful information for designing screening programmes. Poverty and toxic exposures were associated with the high prevalence of advanced liver fibrosis in non-Hispanic Black persons and need to be addressed.

Impact and Implications

Because liver disease often produces few warning signs, simple and inexpensive screening tests that can be performed by non-specialists are needed to allow timely diagnosis and linkage to care. This study shows that non-Hispanic Black persons have a distinctive set of risk factors that need to be taken into account when designing liver disease screening programs. Exposure to exogenous toxins may be especially important risk factors for advanced liver fibrosis in non-Hispanic Black persons.

Adverse Childhood Experiences (ACEs) and Environmental Exposures on Neurocognitive Outcomes in Children: Empirical Evidence, Potential Mechanisms, and Implications

The purpose of this article is to examine the current literature regarding the relationship between adverse childhood experiences (ACEs) and environmental exposures. Specifically, the paper will focus on how this relationship between ACEs and physical environmental factors impacts the neurocognitive development of children. With a comprehensive literary search focusing on ACEs, inclusive of socioeconomic status (SES), and environmental toxins common in urban environments, the paper explores how these factors contribute to cognitive outcomes that are associated with the environment and childhood nurturing. The relationship between ACEs and environmental exposures reveals adverse outcomes in children's neurocognitive development. These cognitive outcomes include learning disabilities, lowered IQ, memory and attention problems, and overall poor educational outcomes. Additionally, potential mechanisms of environmental exposures and children's neurocognitive outcomes are explored, referencing data from animal studies and evidence from brain imaging studies. This study further analyzes the current gaps in the literature, such as the lack of data focusing on exposure to environmental toxicants resulting from experiencing ACEs and discusses the research and social policy implications of ACEs and environmental exposure in the neurocognitive development of children.

The association between housing stability and perceived quality of life among emerging adults with a history of homelessness

Many cities across the United States are experiencing homelessness at crisis levels, including rises in the numbers of unhoused emerging adults (18-25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semi-structured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment n=19 were stably housed and n=11 were unstably housed. Two coders analyzed these data inductively and deductively, using pre-identified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: 1) Housing quality (neighborhood safety, convenience, housing unit characteristics); 2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and 3) Changes in QOL after stable housing (same subthemes as for pre-housing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regards to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge, but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness.

The mediation effect of indoor air quality on health: A comparison of homeowners and renters

This research aims to explore whether there is a health disparity between homeowners and renters affected by the indoor air quality of their dwellings. By proxying the presence of mold and smoke as conjoint facilitators of poor indoor air quality, we design a mediation model that previously has not been explored empirically. The structural path model in this study shows that there is indeed a disparity in health between homeowners and renters by demography, socioeconomic status, and dwelling condition. Our study argues that renters whose living conditions are generally worse off than homeowners are also unequal in their health status due to exacerbating effects from poor indoor air quality, which is endogenous to the state of the renter. The originality of this study is that it is the first study that empirically tests the mediation effect of poor indoor air quality of homeowners and renters using a structural equation path model.

Low income and schizophrenia risk: a narrative review

Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.

Indoor Household Exposures and Associated Morbidity and Mortality Outcomes in Children and Adults in South Africa

Human exposure to indoor pollution is one of the most well-established ways that housing affects health. We conducted a review to document evidence on the morbidity and mortality outcomes associated with indoor household exposures in children and adults in South Africa. The authors conducted a scientific review of the publicly available literature up to April 2022 using different search engines (PubMed, ProQuest, Science Direct, Scopus and Google Scholar) to identify the literature that assessed the link between indoor household exposures and morbidity and mortality outcomes in children and adults. A total of 16 studies with 16,920 participants were included. Bioaerosols, allergens, dampness, tobacco smoking, household cooking and heating fuels, particulate matter, gaseous pollutants and indoor spray residue play a significant role in different morbidity outcomes. These health outcomes include dental caries, asthma, tuberculosis, severe airway inflammation, airway blockage, wheeze, rhinitis, bronchial hyperresponsiveness, phlegm on the chest, current rhinoconjunctivitis, hay fever, poor early life immune function, hypertensive disorders of pregnancy, gestational hypertension, and increased incidence of nasopharyngeal bacteria, which may predispose people to lower respiratory tract infections. The findings of this research highlight the need for more initiatives, programs, strategies, and policies to better reduce the negative consequences of indoor household exposures.

Economic and Cardiometabolic Risk Factors Are Predictors of Lower Thyroid Stimulating Hormone (TSH) Levels in Hispanic/Latinx Adults with Euthyroidism-A Community-Based Study

Thyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM), and within the euthyroid range they may also impact other outcomes, such as mood disorders. This study aimed to observationally examine the relationship between TSH and social determinants of health and clinical measures in a euthyroid Hispanic/Latinx patient sample with a diagnosis of anxiety and/or depression disorders from a community health clinic. A needs assessment was completed using a random sample of 100 de-identified medical records of individuals who received free medical care, including mental health, at a community-based clinic. Those with low normal TSH (<2 mIU/L) compared with high normal TSH (≥2 mIU/L) had a greater odds of food insecurity (p = 0.016) and being at 100% of the federal poverty level (p = 0.015). The low normal TSH group had significantly higher fasting glucose (p = 0.046), hemoglobin A1c (p = 0.018), and total cholesterol (p = 0.034) compared with the high normal TSH group. In those with T2DM, individuals with low normal TSH had six-times greater odds of having high fasting glucose (p = 0.022) and high hemoglobin A1c (p = 0.029). These relationships warrant further study, to inform future public health policies and follow-up care for underserved and vulnerable communities.

Childhood Maltreatment, Blood Lead Levels, and Crime and Violence: A Prospective Examination

BACKGROUND

Research has shown that maltreated children are at increased risk for subsequent crime and violence and are more likely to reside in neighborhoods with a high likelihood of lead exposure. Other literature has reported associations between childhood lead exposure and antisocial and criminal behavior. Little is known about the relationships among childhood maltreatment, adult lead exposure, and crime and violence.

METHODS

As part of a prospective longitudinal study of the long-term consequences of childhood maltreatment, children with documented histories of abuse and neglect and demographically matched control children (ages 0-11 years) were followed into adulthood and interviewed. Participants included 556 individuals who had valid blood lead level (BLL) measures at a mean age of 41.2 years. Participants had a mean age of 50.5 (SD = 3.53) years at the time of the last criminal history check used to determine the number of arrests.

RESULTS

Childhood maltreatment predicted a higher number of arrests for any crime and any violence after the blood was collected but not higher BLLs in adulthood. There were significant paths from adult BLLs to arrests after the blood was collected, despite controlling for age, sex, race, and IQ and the inclusion of individual- and neighborhood-level socioeconomic status, and paths from neighborhood socioeconomic status to higher BLLs in models predicting any arrest and any violent arrest after the blood was collected.

CONCLUSIONS

These findings demonstrate how environmental toxins such as lead can affect outcomes in adulthood, including crime, and provide evidence that links neighborhood disadvantage to higher BLLs in adulthood.

The Effect of Neighborhood-level Resources on Children's Physical Development: Trajectories of Body Mass Index and Pubertal Development and the Influence of Child Biological Sex

Growing research substantiates the role of neighborhood disadvantage in contributing to early pubertal maturation and higher body mass index; however, previous studies in this area have design limitations. Specifically, many studies have been cross-sectional, have used singular indicators of neighborhood disadvantage (e.g., poverty), and have provided mixed findings about the role of biological sex. The present study addresses these gaps by examining how neighborhood resources (spanning educational, health/environmental, and social/economic domains) predict trajectories of pubertal maturation and body mass index using longitudinal multi-wave data. Furthermore, multigroup analyses assessed how these associations may differ by child biological sex. Participants in this study (n = 505; 54% male) were assessed every 3 years at age 9 (M = 9.17, SD = 0.39), age 12 (M = 12.63, SD = 0.43), and age 15 (M = 15.23, SD = 0.37). Approximately 12% of the sample identified as Hispanic, and 11% as non-White. Using multigroup latent growth analyses, the study examined how neighborhood resources predicted trajectories of pubertal maturation and body mass index using multi-wave data across middle childhood through mid-adolescence. The findings suggested that greater neighborhood resources were cross-sectionally associated with lower pubertal development and predicted slower trajectories across time. Although all girls in the study eventually progressed through pubertal development, girls in lower resourced neighborhoods experienced a much earlier onset of puberty. Additionally, greater neighborhood resources predicted lower BMI both cross sectionally and longitudinally. Specifically, higher resourced neighborhoods were protective against obesity risk for both boys and girls across mid-childhood through mid-adolescence. In sum, the study highlights the role of broader neighborhood factors on early maturity risk for female children, and obesity risk for children regardless of biological sex.

Assessing impacts of redeveloping public housing communities on obesity in low-income minority residents: Rationale, study design, and baseline data from the Watts Neighborhood Health Study

Introduction

Obesogenic built- and social-environments in low-income and minority communities are often blamed for the higher rates of obesity in this population, but existing evidence is based largely on observational studies. This study leverages a natural experiment created by the redevelopment of a public housing community to examine the impact of major improvements to the housing, built, and social environments on obesity among residents.

Methods/design

The study design is a natural experiment where residents from the redeveloped community (treatment group) will be compared to those from a similar community (control group) in terms of their pre/post changes in primary outcomes using annual longitudinal data on a cohort of residents. Quasi-experimental variation in the timing of exposure to various redevelopment components within the treated community will be further leveraged within a stepped-wedge research design to assess the impact of the redevelopment components. Primary outcome measures include body mass index, overweight, and obese status.

Results

A cohort of 868 adults and 704 children (ages 2–17 years) was recruited during 2018–2019 with up to two waves of baseline data. At baseline, the prevalence of obesity (overweight or obesity) was 57.2% (81.3%) in adults and 33.1% (52.4%) among children, with no significant differences by treatment status. No differential trends in primary outcomes were observed by treatment status during the two years of baseline.

Discussion

This natural experiment study offers a unique opportunity to assess whether improvements to housing, built, and social environment in low-income minority communities can lead to reductions in obesity.

Multi-Level Socioenvironmental Contributors to Childhood Asthma in New York City: a Cluster Analysis

Childhood asthma exacerbation remains the leading cause of pediatric emergency department visits and hospitalizations and disproportionately affects Latinx and Black children, compared to non-Latinx White children in NYC. Environmental exposures and socioeconomic factors may jointly contribute to childhood asthma exacerbations; however, they are often studied separately. To better investigate the multiple contributors to disparities in childhood asthma, we compiled data on various individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism, from the NYC Department of Health's KIDS 2017 survey and the US Census' American Community Survey. We applied cluster analysis and logistic regression to first identify the predominant patterns of social and environmental factors experienced by children in NYC and then estimate whether children experiencing specific patterns are more likely to experience asthma exacerbations. We found that housing and built environment characteristics, such as density and age of buildings, were the predominant features to differentiate the socio-environmental patterns observed in New York City. Children living in neighborhoods with greater proportions of rental housing, high-density buildings, and older buildings were more likely to experience asthma exacerbations than other children. These findings add to the literature about childhood asthma in urban environments, and can assist efforts to target actionable policies and practices that promote health equity related to childhood asthma.

Housing and asthma disparities

The burden of asthma disproportionately affects minority and low-income communities, resulting in racial and socioeconomic disparities in asthma prevalence, asthma exacerbations, and asthma-related death. Social determinants of health are increasingly implicated as root causes of disparities, and healthy housing is perhaps the most critical social determinant in asthma health disparities. In many minority communities, poor housing conditions and value are a legacy of historical policies and practices imbued with structural racism, including redlining, displacement, and exclusionary zoning. As a result, poor-quality, substandard housing is a characteristic feature of many underrepresented minority communities. Consequently, structurally deficient housing stock cultivates home environments rife with indoor asthma triggers. In this review we consider the historical context of urban housing policies and practices and how these policies and practices have contributed to the substandard housing conditions for many minoritized children in the present day. We describe the impact of poor housing quality on asthma and interventions that have attempted to mitigate its influence on asthma symptoms and health care utilization. We discuss the need to promote asthma health equity by reinvesting in these neighborhoods and communities to provide healthy housing.

The Influence of Living Conditions on Self-Rated Health: Evidence from China

Despite growing attention to living conditions as a social determinant of health, few studies have focused on its diverse impacts on self-rated health. Using data from the China Family Panel Study in 2018, this study used logistic regression analysis to examine how living conditions affect self-rated health in China, finding that people cooking with sanitary water and clean fuel were more likely to report good health, and that homeownership was associated with higher self-rated health. The self-rated health of people living in high-quality housing was lower than that of people living in ordinary housing, and people living in tidy homes were more likely to report good health. The findings suggest that the link between multiple living conditions and self-rated health is dynamic. Public health policies and housing subsidy programs should therefore be designed based on a comprehensive account of not only housing grade or income status, but also whole dwelling conditions.

Association between housing type and accelerated biological aging in different sexes: moderating effects of health behaviors

Introduction: Despite associated with multiple geriatric disorders, whether housing type, an indicator of socioeconomic status (SES) and environmental factors, is associated with accelerated biological aging is unknown. Furthermore, although individuals with low-SES have higher body mass index (BMI) and are more likely to smoke, whether BMI and smoking status moderate the association between SES and biological aging is unclear. We examined these questions in urbanized low-SES older community-dwelling adults.

Methods: First, we analyzed complete blood count data using the cox proportional hazards model and derived measures for biological age (BA) and biological age acceleration (BAA, the higher the more accelerated aging) (N = 376). Subsequently, BAA was regressed on housing type, controlling for covariates, including four other SES indicators. Interaction terms between housing type and BMI/smoking status were separately added to examine their moderating effects. Total sample and sex-stratified analyses were performed.

Results: There were significant differences between men and women in housing type and BAA. Compared to residents in ≥3 room public or private housing, older adults resided in 1–2 room public housing had a higher BAA. Furthermore, BMI attenuated the association between housing type and BAA. In sex-stratified analyses, the main and interaction effects were only significant in women. In men, smoking status instead aggravated the association between housing type and BAA.

Conclusion: Controlling for other SES indicators, housing type is an independent socio-environmental determinant of BA and BAA in a low-SES urbanized population. There were also sex differences in the moderating effects of health behaviors on biological aging.

Neurodevelopmental profiles of preschool-age children in Flint, Michigan: a latent profile analysis

OBJECTIVE

Children in Flint, Michigan, have experienced myriad sociodemographic adversities exacerbated by the Flint water crisis. To help inform child-focused prevention and intervention efforts, we aimed to describe patterns of neurodevelopmental outcomes among preschoolers who experienced the Flint water crisis before age 2 years.

METHOD

Participants were 170 preschoolers who completed a comprehensive neurodevelopmental assessment battery, including directly administered measures of cognitive and executive functioning and maternal-report of adaptive skills and behavioral problems. We used latent profile analysis to derive subgroups. Multivariate multinomial logistic regression was conducted to examine the predictors of profile memberships, including child sex and maternal/family-level factors selected from an array of measured exposures using least absolute shrinkage and selection operator regression.

RESULTS

Three latent profiles were identified: Profile 1-relative weakness in all domains (50%); Profile 2-normative functioning in all domains (34.1%); and Profile 3-relative strengths in executive function and behavior (15.9%). Profile 1 showed lower scores across cognitive and behavioral domains. Profile 2 demonstrated abilities within the normal range across domains. Profile 3 showed relative strength in executive functioning with few behavior problems, despite lower cognitive performance. Children across all profiles showed adaptive behavior in the adequate range. Child sex and maternal IQ were significant predictors of profile membership.

CONCLUSIONS

Children in Flint demonstrated diverse patterns of development in the face of sociodemographic and environmental adversities. Comprehensive screening and neurodevelopmental profiling of children in this at-risk population are needed to identify areas of needs and inform appropriate service delivery.

The Benefits of Rental Assistance for Children's Health and School Attendance in the United States

Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

Inequalities in Exposure to Ambient Air Neurotoxicants and Disparities in Markers of Neurodevelopment in Children by Maternal Nativity Status

Exposure levels to environmental pollutants vary significantly among different populations. These inequities in exposure to hazardous air pollutants (HAP) among different populations can contribute to disparities in neurodevelopmental outcomes. The aim of this study was to determine if exposure to HAP varies by maternal nativity status, a demographic marker often overlooked in the study of health disparities. We also assessed if those inequalities in exposure levels are associated with neurodevelopmental measures in young children. To do this, we obtained data from the Early Childhood Longitudinal Study-Birth cohort (ECLS-B), a nationally representative sample of children born in the U.S. in the year 2001 (n = 4750). Bayley’s Short Form-Research Edition (BSF-R) was used to measure cognitive development at 2 years of age. Using residential location at nine months of age, participants were assigned exposures to ten HAPs identified as potentially neurotoxic. Linear regression models were used to assess the joint effect of maternal nativity status and HAP exposure on neurodevelopment. Results showed inequities in exposure levels to ten different HAPs among the populations, as approximately 32% of children of foreign-born mothers were exposed to high levels of HAPs, compared to 21% of children born to U.S.-born mothers. Adjusting for socioeconomic factors, both isophorone exposure (a marker of industrial pollution) (−0.04, 95% CI, −0.12, 0.04) and maternal nativity status (−0.17, 95% CI, −0.27, −0.06) were independently associated with lower standardized BSF-R mental scores in children. Interaction between nativity status and isophorone was not statistically significant, but the change in mental scores associated with isophorone exposure was greater in children of foreign-born mothers compared to children of U.S.-born mothers (−0.12, vs. −0.03, p = 0.2). In conclusion, exposure to HAPs within the highest quartile was more commonly found among children of foreign-born mothers as compared to children of US-born mothers, indicating inequities in pollutant exposure by nativity status within urban populations. Exposures associated with nativity status may negatively contribute to children’s neurodevelopment.

Healthly Urban Environmental Features for Poverty Resilience: The Case of Detroit, USA

Within the existing relationship among urban environment, health, and poverty, it is necessary to clarify and characterize the influence that the physical environment has on community socioeconomic outcomes. Given that Detroit has one of the highest poverty rates among large metropolitan areas in the United States, this study aims to identify environmental and urban features that have influenced poverty in this city by assessing whether changes in household income are associated with characteristics of the built environment. The difference of median household income (DMHI) between 2017 and 2013 and 27 environmental and urban variables were investigated using both geographic distribution mapping and statistical correlation analysis. Results suggest that proximity of housing to job opportunity areas, as well as to certain educational and health-related facilities, were positively related to increasing household incomes. These findings outline a healthy urban design that may benefit community socioeconomic outcomes-specifically a design with dense and mixed-use areas, good accessibility, high presence of urban facilities, and features that promote a healthy lifestyle (involving physical activity and a healthy diet). In this sense, urban planning and public health may be important allies for poverty resilience.

Pyrethroid exposure among children residing in green versus non-green multi-family, low-income housing

BACKGROUND

There is growing concern about children's chronic low-level pesticide exposure and its impact on health. Green building practices (e.g., reducing leakage of the thermal and pressure barrier that surrounds the structure, integrated pest management, improved ventilation) have the potential to reduce pesticide exposure. However, the potential impact of living in green housing on children's pesticide exposure is unknown.

OBJECTIVE

To address this question, a longitudinal study of pyrethroid metabolites (3-phenoxybenzoic acid [3-PBA], 4-fluoro-3-phenoxybenzoic acid [4-F-3-PBA], trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid [trans-DCCA]) in first morning void urine, collected from 68 children from New Orleans, Louisiana residing in green and non-green housing was conducted.

METHODS

Children were followed for 1 year with three repeated measures of pesticide exposure. Generalized estimating equations examined associations between housing type (green vs. non-green) and urinary pyrethroid metabolite concentrations adjusting for demographic and household factors over the year.

RESULTS

Ninety-five percent of samples had detectable concentrations of 3-PBA (limit of detection [LOD]: 0.1 μg/L); 8% of 4-F-3-PBA (LOD: 0.1 μg/L), and 12% of trans-DCCA (LOD: 0.6 μg/L). In adjusted models, green housing was not associated with statistically significant differences in children's 3-PBA urinary concentrations compared to non-green housing.

Measuring Neighborhood Landscapes: Associations between a Neighborhood's Landscape Characteristics and Colon Cancer Survival

Landscape characteristics have been shown to influence health outcomes, but few studies have examined their relationship with cancer survival. We used data from the National Land Cover Database to examine associations between regional-stage colon cancer survival and 27 different landscape metrics. The study population included all adult New Jersey residents diagnosed between 2006 and 2011. Cases were followed until 31 December 2016 (N = 3949). Patient data were derived from the New Jersey State Cancer Registry and were linked to LexisNexis to obtain residential histories. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI95) for the different landscape metrics. An increasing proportion of high-intensity developed lands with 80–100% impervious surfaces per cell/pixel was significantly associated with the risk of colon cancer death (HR = 1.006; CI95 = 1.002–1.01) after controlling for neighborhood poverty and other individual-level factors. In contrast, an increase in the aggregation and connectivity of vegetation-dominated low-intensity developed lands with 20–<40% impervious surfaces per cell/pixel was significantly associated with the decrease in risk of death from colon cancer (HR = 0.996; CI95 = 0.992–0.999). Reducing impervious surfaces in residential areas may increase the aesthetic value and provide conditions more advantageous to a healthy lifestyle, such as walking. Further research is needed to understand how these landscape characteristics impact survival.

Housing Risk Factors Associated with Respiratory Disease: A Systematic Review

Cold, damp and mouldy housing arises from the degradation of the housing stock over time due to weathering and a lack of maintenance. Living in such houses is associated with many adverse impacts on human health, especially for those with existing health issues. This paper presents a systematic review, using the PRISMA protocol, consisting of an exploratory analysis of housing-related risk factors associated with respiratory disease. The review consisted of 360 studies investigating 19 risk factors associated with respiratory conditions. Each fall into one of four categories, namely, (1) outdoor environment-related factors; (2) indoor air pollution-related factors; (3) housing non-structure-related factors; or (4) housing structure-related factors. The results show that effects of poor housing conditions on occupants’ respiratory health is a growing research field, where poor indoor air quality, mainly due to a lack of adequate ventilation, was found to be the most influential risk factor. Usage of solid fuel and living in an urban area without a pollutant-free air filtration system are the main risk factors related to inadequate ventilation. Therefore, an adequate and reliable ventilation system with air-infiltration was considered to be the main mitigation solution to improve indoor air quality. It is suggested that government organisations and health practitioners could use the identified risk factors to measure the healthiness of existing dwellings and take measures to improve existing conditions and develop regulations for new housing construction to promote the healthy home concept. Further research is needed for risk mitigation strategies to reduce the respiratory health burden attributed to housing.

A distributed geospatial approach to describe community characteristics for multisite studies

Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.

Genes, Environments, and Time: The Biology of Adversity and Resilience

Exposures to adverse environments, both psychosocial and physicochemical, are prevalent and consequential across a broad range of childhood populations. Such adversity, especially early in life, conveys measurable risk to learning and behavior and to the foundations of both mental and physical health. Using an interactive gene-environment-time (GET) framework, we survey the independent and interactive roles of genetic variation, environmental context, and developmental timing in light of advances in the biology of adversity and resilience, as well as new discoveries in biomedical research. Drawing on this rich evidence base, we identify 4 core concepts that provide a powerful catalyst for fresh thinking about primary health care for young children: (1) all biological systems are inextricably integrated, continuously "reading" and adapting to the environment and "talking back" to the brain and each other through highly regulated channels of cross-system communication; (2) adverse environmental exposures induce alterations in developmental trajectories that can lead to persistent disruptions of organ function and structure; (3) children vary in their sensitivity to context, and this variation is influenced by interactions among genetic factors, family and community environments, and developmental timing; and (4) critical or sensitive periods provide unmatched windows of opportunity for both positive and negative influences on multiple biological systems. These rapidly moving frontiers of investigation provide a powerful framework for new, science-informed thinking about health promotion and disease prevention in the early childhood period.

Real-time indoor PM2.5 monitoring in an urban cohort: Implications for exposure disparities and source control

Fine particulate matter (PM2.5) concentrations are highly variable indoors, with evidence for exposure disparities. Real-time monitoring coupled with novel statistical approaches can better characterize drivers of elevated PM2.5 indoors. We collected real-time PM2.5 data in 71 homes in an urban community of Greater Boston, Massachusetts using Alphasense OPC-N2 monitors. We estimated indoor PM2.5 concentrations of non-ambient origin using mass balance principles, and investigated their associations with indoor source activities at the 0.50 to 0.95 exposure quantiles using mixed effects quantile regressions, overall and by homeownership. On average, the majority of indoor PM2.5 concentrations were of non-ambient origin (≥77%), with a higher proportion at increasing quantiles of the exposure distribution. Major source predictors of non-ambient PM2.5 concentrations at the upper quantile (0.95) were cooking (1.4-23 μg/m3) and smoking (15 μg/m3, only among renters), with concentrations also increasing with range hood use (3.6 μg/m3) and during the heating season (5.6 μg/m3). Across quantiles, renters in multifamily housing experienced a higher proportion of PM2.5 concentrations from non-ambient sources than homeowners in single- and multifamily housing. Renters also more frequently reported cooking, smoking, spray air freshener use, and second-hand smoke exposure, and lived in units with higher air exchange rate and building density. Accounting for these factors explained observed PM2.5 exposure disparities by homeownership, particularly in the upper exposure quantiles. Our results suggest that renters in multifamily housing may experience higher PM2.5 exposures due to a combination of behavioral and building factors that are amenable to intervention.

Racial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States

OBJECTIVE

We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU.

DESIGN

A retrospective multicenter analysis was conducted using Virtual Pediatric Systems data from reporting centers. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were analyzed using mixed-effects logistic regression modeling to assess for differences in mortality.

SETTING

One hundred thirty-five PICUs in the United States.

PATIENTS

Pediatric patients with cancer admitted to PICUs in the United States.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p < 0.05) compared with Caucasian children (6.3%). Regional analysis showed Hispanic patients to have higher mortality in the West in the United States, whereas African American patients in the South in the United States had higher mortality. A pulmonary disease diagnosis in Hispanics increased odds of mortality (odds ratio, 1.39; 95% CI, 1.13-1.70), whereas a diagnosis of shock/sepsis increased risk for mortality in African Americans (odds ratio, 1.56; 95% CI, 1.11-2.20) compared with Caucasians. There were no differences between races/ethnic groups in the rates of limitations of care. After controlling for Pediatric Risk of Mortality III, PICU length of stay, stem cell transplant status, readmissions, cancer type (solid, brain, hematologic), mechanical ventilation days, and sex, Hispanic (odds ratio, 1.24; 95% CI, 1.05-1.47) and African Americans (odds ratio, 1.37; 95% CI, 1.14-1.66) had significantly higher odds of mortality compared with Caucasians.

CONCLUSIONS

The results show that after controlling for severity and cancer type, a child's race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer.

Environmental Quality and Invasive Breast Cancer

Background: Breast cancer is a complex and multifactorial disease, and environmental factors have been suggested to increase its risk. However, prior research has largely focused on studying exposures to one factor/contaminant at a time, which does not reflect the real-world environment.Methods: Herein, we investigate associations between breast cancer and the environmental quality index (EQI), a comprehensive assessment of five domains of environmental quality (air, water, land, sociodemographic, and built environments) at the county level. Breast cancer diagnoses for North Carolina women were obtained from the North Carolina Central Cancer Registry (2009-2014) and the county of residence at the time of diagnosis was linked with the EQI. We evaluated the odds of localized, regional, or distant metastatic breast cancer in categories of environmental quality using women with carcinoma in situ as registry-based controls.Results: Overall environmental quality was generally not associated with invasive breast cancer; however, all breast cancer types tended to be inversely associated with land quality, particularly in more rural communities [distant metastatic breast cancer was 5%-8% more likely (OR, 1.08; 95% confidence interval, 1.02-1.14; P = 0.02) compared with carcinoma in situ].Conclusions: Cumulatively, our results suggest that some broad measures of environmental quality are associated with invasive breast cancer but that associations vary by environmental domain, cancer stage, subtype, and urbanicity.Impact: Our findings suggest that components of land quality (e.g., pesticide applications and animal facilities) warrant additional investigation in relation to invasive breast cancer.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

The Grass Is Always Greener on My Side: A Field Experiment Examining the Home Halo Effect

Wood-burning pollution is a severe problem in southern Chile, where every winter, people are exposed to unhealthy ambient fine particulate matter (PM2.5) concentrations. Urban air quality is a major concern for health officials, but public awareness campaigns tend to focus on outdoor hazards. Our understanding of how residents are exposed and perceive air pollution risks in their homes remains incomplete. This study explores the ability of participants to perceive indoor air quality. We collected data on 81 households, combining perceptions of air quality with objective measurements of PM2.5. Residents’ evaluations of air quality were systematically compared to inspectors’ evaluations in order to examine the home halo effect. We found that residents tended to overestimate air quality in their homes. We discuss how our data supported the existence of a home halo effect, but also point out the possibility that individuals’ ability to perceive air quality in indoor spaces is limited by other factors.

Asbestos-containing materials in abandoned residential dwellings in Detroit

OBJECTIVE

The efforts of many municipalities to demolish abandoned residential dwellings (ARDs) are hampered by the presence of asbestos-containing materials (ACMs) in these structures. However, the extent of such materials is unknown. Our study sought to characterize ACMs present in ARDs demolished in Detroit.

METHODS

Working with the City of Detroit, we obtained information on all ARDs demolished from 2014 to 2017. We randomly sampled 605 ARDs and analyzed the presence, type, and amount of ACM present, and the associated abatement and demolition costs.

RESULTS

Asbestos was present in about 95% of the sampled ARDs. The most common types of ACMs were flooring, roofing, siding, and duct insulation. The material containing the greatest fraction of asbestos was duct insulation. The type of asbestos generally present was chrysotile. Only eight (1%) ARDs contained commercial amphibole asbestos; another 36 contained vermiculite. The total cost of demolition averaged $13,645 per home, of which 20.1% was asbestos abatement.

CONCLUSIONS

The majority of the ACM in the ARDs was nonfriable and consisted of chrysotile. This study contributes information about the nature and extent of ACM in ARDs, which can provide part of the foundation for making an assessment of possible asbestos-containing air emissions during the demolitions of ARDs, and the nature or extent of pre-demolition abatement that may be needed (if any) to protect the public's health.

Home visits for pediatric asthma - A strategy for comprehensive asthma management through prevention and reduction of environmental asthma triggers in the home

Families often struggle to manage their child's asthma. Clinicians caring for children with asthma struggle too as they are tasked with balancing the limited time available in clinic and the need to provide comprehensive care. As a direct consequence, critical gaps in asthma care remain with respect to asthma education and the identification and reduction of environmental asthma triggers in the home. A home visit model that augments clinic-based care is a viable way to fill gaps in understanding, address incomplete adherence patterns, improve disease control by shifting the focus of asthma management to reduction of environmental asthma triggers, and bring cost savings to the health care system.

Housing as a determinant of health equity: A conceptual model

Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.

Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study

Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.