Residential proximity to environmental hazards and adverse health outcomes

Place-based estimates of cigarette butt litter raise environmental justice concerns in the United States

Littering of cigarette butts is a major environmental challenge. In 2022, ~124 billion cigarette butts were littered in the United States. This litter may pose an environmental justice concern by disproportionately affecting human and environmental health in communities of color or communities of low socioeconomic status. However, the lack of data on the distribution and magnitude of cigarette butt littering prevents an environmental justice analysis and limits the ability to tackle this environmental challenge. We conducted an environmental justice assessment of tobacco product waste, specifically cigarette butts, through spatially-explicit, place-based estimates across the contiguous U.S. We built a bottom-up model by synthesizing census tract-level population and smoking prevalence, state-level cigarette consumption, and published littering data to assess the spatial pattern of cigarette consumption and littering, and its implications for environmental injustice in >71,600 U.S. census tracts. Further, we compared the model output to urbanicity (rural-urban commuting area) and Social-Environmental Risk (SER; CDC Environmental Justice Index). Cigarette butt density was not uniformly distributed across the U.S. and ranged from 0-45.5 butts/m2, with an area-weighted average of 0.019 ± 0.0005 butts/m2. Cigarette butt density was 96 times higher in metropolitan vs. rural areas. Cigarette butt density increased significantly with SER, with 5.6 times more littered cigarette butts, and a steeper response to population density, in census tracts with the highest SER vs. the lowest SER. These results demonstrate the relative influences of location, smoking prevalence, and population density, and show that cigarette butt littering is a potential environmental justice concern in the U.S. This study provides information that may help devise targeted strategies to reduce cigarette butt pollution and prevent disproportionate impacts. The spatial data layer with place-based cigarette consumption and butt density is a tool that can support municipal, state, and federal level policy work and future studies on associations among cigarette butt pollution and environmental health outcomes.

The relationship between neighborhood economic deprivation and community-acquired pneumonia related admissions in Maryland

Introduction

Community-acquired pneumonia (CAP) is a major health concern in the United States (US), with its incidence, severity, and outcomes influenced by social determinants of health, including socioeconomic status. The impact of neighborhood socioeconomic status, as measured by the Distressed Communities Index (DCI), on CAP-related admissions remains understudied in the literature.

Objective

To determine the independent association between DCI and CAP-related admissions in Maryland.

Methods

We conducted a retrospective study using the Maryland State Inpatient Database (SID) to collate data on CAP-related admissions from January 2018 to December 2020. The study included adults aged 18-85 years. We explored the independent association between community-level economic deprivation based on DCI quintiles and CAP-related admissions, adjusting for significant covariates.

Results

In the study period, 61,467 cases of CAP-related admissions were identified. The patients were predominantly White (49.7%) and female (52.4%), with 48.6% being over 65 years old. A substantive association was found between the DCI and CAP-related admissions. Compared to prosperous neighborhoods, patients living in economically deprived communities had 43% increased odds of CAP-related admissions.

Conclusion

Residents of the poorest neighborhoods in Maryland have the highest risk of CAP-related admissions, emphasizing the need to develop effective public health strategies beneficial to the at-risk patient population.

Assessing environmental injustice in Kansas City by linking paediatric asthma to local sources of pollution: a cross-sectional study

OBJECTIVE

A grassroots environmental-justice organisation in Kansas City has been examining the disproportionate exposure to air pollution experienced by residents living fenceline to the largest classification railyard in the USA. Prior analyses showed limited increased risk for asthma exacerbation for patients with asthma living closer to toxic release inventory (TRI) facilities and railyards. In this study, we assessed geographical asthma and environmental disparities, to further explore community-level disparities.

DESIGN

This is a cross-sectional study of population-level asthma rates, which included rates for all asthma encounters and acute asthma encounters (urgent care, emergency department, inpatient admission). Distances from census-tract centroids to nearest TRI facilities, railyards and highways were calculated. The association between asthma rates and distances was examined using Kendall's τ correlation and multivariable Poisson regression models.

SETTING

We used electronic medical record data from the regional paediatric hospital, census and Environmental Protection Agency (EPA) air monitoring data.

PARTICIPANTS

Patients with 2+ asthma encounters during the EPA study timeframe were identified.

RESULTS

Residential distance from railyards exhibited a significant negative correlation with overall (-0.36 (CI -0.41 to -0.32)) and acute (-0.27 (CI -0.32 to -0.22)) asthma rates. Asthma rates were elevated among tracts north of the closest railyard (incident rate ratio: 1.38; CI 1.35 to 1.41) when compared with southern directionality. An increased distance from the nearest railyard of 3 km was associated with a decrease in overall asthma rates of 26%.

CONCLUSION

Significant negative associations between proximity to all pollution source types and asthma rates were observed. This community-level research has served as a tool for community engagement and will be used to support proposed local policy. Environmental justice work addresses local concerns involving small, limited datasets, if the data exist at all. The academic epidemiological platform may reconsider acceptable approaches to small population research in order to better serve communities with the most need.

Validating self-reported Toxic Release Inventory data using Benford's Law: investigating toxic chemical release hazards in floodplains

Introduction

Acute and long-term health impacts from flooding related toxic chemical releases are a significant local health concern and can disproportionately impact communities with vulnerable populations; reliable release data are needed to quantify this hazard.

Methods

In this paper, we analyze US Federal Emergency Management Agency designated floodplain data and US Environmental Protection Agency Toxic Release Inventory (TRI) data to determine if geographically manipulated databases adhere to Benford's Law.

Results

We investigated multiple variants and discovered pollution releases adhere to Benford's Law and tests which thereby validates the self-reported toxic release dataset.

Discussion

We find that Benford's Law applies to self-reported toxic chemical release and disposal data, indicating a lack of widespread data errors or manipulation.

Feminist perspectives on environmental justice and health in Jamaica

Jamaica is an island nation with a history that is informed by Taino settlement, European colonisation, chattel slavery, disinvestment, and continued extractivism. This perspective paper leverages a historical analysis to explore environmental injustices affecting the health and quality of life of Jamaicans living in Jamaica. This article hopes to contribute to a growing but limited body of scholarly research that contends with environmental and climate justice in the context of the Caribbean. In discussing a lack of critical environmental infrastructure, such as reliable solid waste management, and the impacts of extractive industries, such as bauxite mining, the paper intends to highlight the environmental, public health, and social harms that are produced. Employing an intersectional approach grounded in Black feminist epistemology put forward by Patricia Hill Collins, the authors use their lived experiences as a source of knowledge. The paper analyses how these environmental injustices harm Jamaican communities at large but underscores the compounded challenges faced by Jamaican women who experience marginalisation on the basis of gender, urban/rural residency, and class. The paper concludes by urging researchers, policymakers, regulatory bodies, and other stakeholders to conduct further research and create sustainable and equitable environmental standards that have considerations for environmental injustice in Jamaica.

Short-Term Increases in NO2 and O3 Concentrations during Pregnancy and Stillbirth Risk in the U.S.: A Time-Stratified Case-Crossover Study

Associations between gaseous pollutant exposure and stillbirth have focused on exposures averaged over trimesters or gestation. We investigated the association between short-term increases in nitrogen dioxide (NO2) and ozone (O3) concentrations and stillbirth risk among a national sample of 116 788 Medicaid enrollees from 2000 to 2014. A time-stratified case-crossover design was used to estimate distributed (lag 0-lag 6) and cumulative lag effects, which were adjusted for PM2.5 concentration and temperature. Effect modification by race/ethnicity and proximity to hydraulic fracturing (fracking) wells was assessed. Short-term increases in the NO2 and O3 concentrations were not associated with stillbirth in the overall sample. Among American Indian individuals (n = 1694), a 10 ppb increase in NO2 concentrations was associated with increased stillbirth odds at lag 0 (5.66%, 95%CI: [0.57%, 11.01%], p = 0.03) and lag 1 (4.08%, 95%CI: [0.22%, 8.09%], p = 0.04) but not lag 0-6 (7.12%, 95%CI: [-9.83%, 27.27%], p = 0.43). Among participants living in zip codes within 15 km of active fracking wells (n = 9486), a 10 ppb increase in NO2 concentration was associated with increased stillbirth odds in single-day lags (2.42%, 95%CI: [0.37%, 4.52%], p = 0.02 for lag 0 and 1.83%, 95%CI: [0.25%, 3.43%], p = 0.03 for lag 1) but not the cumulative lag (lag 0-6) (4.62%, 95%CI: [-2.75%, 12.55%], p = 0.22). Odds ratios were close to the null in zip codes distant from fracking wells. Future studies should investigate the role of air pollutants emitted from fracking and potential racial disparities in the relationship between short-term increases in NO2 concentrations and stillbirth.

Environmental exposure disparities in ultrafine particles and PM2.5 by urbanicity and socio-demographics in New York state, 2013-2020

BACKGROUND

The spatiotemporal and demographic disparities in exposure to ultrafine particles (UFP; number concentrations of particulate matter (PM) with diameter ≤0.1 μm), a key subcomponent of fine aerosols (PM2.5; mass concentrations of PM ≤ 2.5 μm), have not been well studied.

OBJECTIVE

To quantify and compare the aerosol pollutant exposure disparities for UFP and PM2.5 by socio-demographic factors in New York State (NYS).

METHODS

Ambient atmospheric UFP and PM2.5 were quantified using a global three-dimensional model of chemical transport with state-of-the-science aerosol microphysical processes validated extensively with observations. We matched these to U.S. census demographic data for varied spatial scales (state, county, county subdivision) and derived population-weighted aerosol exposure estimates. Aerosol exposure disparities for each demographic and socioeconomic (SES) indicator, with a focus on race-ethnicity and income, were quantified for the period 2013-2020.

RESULTS

The average NYS resident was exposed to 4451 #·cm-3 UFP and 7.87 μg·m-3 PM2.5 in 2013-2020, but minority race-ethnicity groups were invariably exposed to greater daily aerosol pollution (UFP: +75.0% & PM2.5: +16.2%). UFP has increased since 2017 and is temporally and seasonally out-of-phase with PM2.5. Race-ethnicity exposure disparities for PM2.5 have declined over time; by -6% from 2013 to 2017 and plateaued thereafter despite its decreasing concentrations. In contrast, these disparities have increased (+12.5-13.5%) for UFP. The aerosol pollution exposure disparities were the highest for low-income minorities and were more amplified for UFP than PM2.5. DISCUSSION: We identified large disparities in aerosol pollution exposure by urbanization level and socio-demographics in NYS residents. Jurisdictions with higher proportions of race-ethnicity minorities, low-income residents, and greater urbanization were disproportionately exposed to higher concentrations of UFP and PM2.5 than other NYS residents. These race-ethnicity exposure disparities were much larger, more disproportionate, and unabating over time for UFP compared to PM2.5 across various income strata and levels of urbanicity.

Pesticide exposure and risk of Central Nervous System tumors in children: a systematic review with meta-analysis

Central Nervous System (CNS) tumors represent more than half of all childhood malignant neoplasms. The aim of this study was to determine the relationship between environmental exposure to pesticides and the development of CNS tumors in children. We conducted a systematic review of the literature in the PubMed/MEDILINE, Embase, Web of Science, Scopus, and CINAHL databases. The inclusion criteria were cohort and case-control studies investigating the association between exposure to pesticides and CNS tumors (all histological types included in group III of the WHO Classification of Childhood Cancer) in children aged 0-14 years. The meta-analysis was performed using a random effects model and the Mantel-Haenszel method. Strength of association was measured using odds ratios (OR). The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42021209354. The search identified 1,158 studies, 14 of which were included in the review. There was evidence of an association between the development of astrocytomas and exposure to all classes of pesticides (OR 1.50; 95%CI 1.15-1.96; p=0.03). The synthesis of the evidence pointed to a relationship between exposure to pesticides and some histological types of CNS tumors in childhood.

Residential proximity to metal emitting industries and toenail metal concentration in the US Gulf States

Objective

The US Gulf region is heavily reliant on metal-emitting petrochemical and manufacturing industries. We characterized the effect of residential proximity to metal-emitting sites and metal body burden in Gulf states residents with particular attention to potential differential exposure burden by race.

Methods

We measured toenail concentrations of arsenic, chromium, lead, manganese, mercury, and selenium using inductively coupled plasma mass spectrometry in 413 non-smoking men from the Gulf Long-term Follow-Up Study. Point sources of industrial metal emissions were identified using the US EPA's National Emissions Inventory (NEI) database and geocoded to participant residential addresses. For each metal, we assessed associations of toenail metal concentrations with the inverse-distance weighted number of emissions sites and volume of air-metal emissions within 30 km radial buffers of participant residences using multivariable linear regression. Results were stratified by race.

Results

Compared to self-identified Non-Hispanic (NH) White participants, NH Black participants lived closer to NEI sites but had 23-70% lower toenail metal concentrations adjusting for other personal/behavioral factors. Residential proximity to lead-emitting NEI sites was positively associated with toenail Pb concentration while proximity to mercury-emitting NEI sites was inversely associated with toenail Hg concentration. Findings for lead were significantly attenuated after adjustment for neighborhood-level socioeconomic factors.

Conclusion

Residential proximity to lead-emitting NEI sites in the US Gulf region is associated with a higher body burden of lead. However, this relationship may be driven in part by non-NEI factors related to residence in industry-adjacent neighborhoods.

Multi-Hazard property buyouts: Making a case for the acquisition of flood and contaminant-prone residential properties in Galena Park, TX

The aftermath of extreme flood events can be particularly devastating for residential communities in proximity to flood-prone petrochemical facilities, as they are likely to experience multiple impacts from a single flood event. Hazard impacts could be from flood inundation to their properties, and floodwaters carrying contaminants from nearby facilities into their homes. While property acquisition or buyouts have been effectively used as a flood mitigation strategy, current buyout selection processes only factor in flood exposure, thereby ignoring other hazards such as exposure of properties to potential chemical substance transfer. In this paper, we identify properties that are eligible for flood buyouts but are also at a high risk of contaminant transferal during extreme flood events. We apply a benefit-cost analysis methodology to assess the economic viability of buyouts and proximity metrics to prioritize buyouts of contaminant-prone properties in Galena Park, Texas. Results indicate that, in selected flood-only property acquisition scenarios, cumulative avoided flood losses exceed the cost of property acquisition. However, although with lower cost-benefit values, a selection criterion that factors a combination of flood and contaminant-prone properties as buyouts results in multiple properties being removed from harm's way. Our findings emphasize the potential economic benefits of applying a multi-hazard selection criterion in dealing with flood property buyouts, especially in socially vulnerable communities with high exposure to both flooding and contaminant transfer.

Exploring the association of Brownfield remediation status with socioeconomic conditions in Wayne County, MI

Urban neighborhoods with locations of environmental contamination, known as brownfields, impact entire neighborhoods, but corrective environmental remedial action on brownfields is often tracked on an individual property basis, neglecting the larger neighborhood-level impact. This study addresses this impact by examining spatial differences between brownfields with unmitigated environmental concerns (open site) and sites that are considered fully mitigated or closed in urban neighborhoods (closed site) on the US census tract scale in Wayne County, MI. Michigan's Department of Environment, Great Lakes, and Energy's leaking underground storage tank (LUST) database provided brownfield information for Wayne County. Local indicators of spatial association (LISA) produced maps of spatial clustering and outliers. A McNemar's test demonstrated significant discordances in LISA categories between LUST open and closed sites (p < 0.001). Geographically weighted regressions (GWR) evaluated the association between open and closed site spatial density (open-closed) with socioeconomic variables (population density, proportion of White or Black residents, proportion of college educated populations, the percentage of owner-occupied units, vacant units, rented units, and median household value). Final multivariate GWR showed that population density, being Black, college education, vacant units, and renter occupied units were significantly associated (p < 0.05) with open-closed, and that those associations varied across Wayne County. Increases in Black population was associated with increased open-closed. Increases in vacant units, renter-occupied units, and college education were associated with decreased open-closed. These results provide input for environmental justice research to identify inequalities and discover the distribution of environmental hazards among urban neighborhoods.

Evaluation of a water arsenic filter in a participatory intervention to reduce arsenic exposure in American Indian communities: The Strong Heart Water Study

Many rural populations, including American Indian communities, that use private wells from groundwater for their source of drinking and cooking water are disproportionately exposed to elevated levels of arsenic. However, programs aimed at reducing arsenic in American Indian communities are limited. The Strong Heart Water Study (SHWS) is a randomized controlled trial aimed at reducing arsenic exposure among private well users in American Indian Northern Great Plains communities. The community-led SHWS program installed point-of-use (POU) arsenic filters in the kitchen sink of households, and health promoters delivered arsenic health communication programs. In this study we evaluated the efficacy of these POU arsenic filters in removing arsenic during the two-year installation period. Participants were randomized into two arms. In the first arm households received a POU arsenic filter, and 3 calls promoting filter use (SHWS mobile health (mHealth) & filter arm). The second arm received the same filter and phone calls, and 3 in-person home visits and 3 Facebook messages (SHWS intensive arm) for program delivery. Temporal variability in water arsenic concentrations from the main kitchen faucet was also evaluated. A total of 283 water samples were collected from 50 households with private wells from groundwater (139 filter and 144 kitchen faucet samples). Ninety-three percent of households followed after baseline had filter faucet water arsenic concentrations below the arsenic maximum contaminant level of 10 μg/L at the final visit during our 2 year study period with no difference between study arms (98 % in the intensive arm vs. 94 % in the mHealth & filter arm). No significant temporal variation in kitchen arsenic concentration was observed over the study period (intraclass correlation coefficient = 0.99). This study demonstrates that POU arsenic filters installed for the community participatory SHWS program were effective in reducing water arsenic concentration in study households in both arms, even with delivery of the POU arsenic filter and mHealth program only. Furthermore, we observed limited temporal variability of water arsenic concentrations from kitchen faucet samples collected over time from private wells in our study setting.

Ambient air pollution and the risk of neurological diseases in residential areas near multi-purposed industrial complexes of korea: A population-based cohort study

Emerging evidence suggest that long-term exposure to air pollution may induce adverse effects on the central nervous system. However, no study explored the associations in large industrial complex (IC) areas which are one of the major contributors to air pollution. Therefore, we aimed to investigate the pollution status and the association between residential proximity and incidence of neurological diseases near two major ICs characterized as multi-purposed ICs in Korea. A retrospective cohort of residents near the ICs was constructed using Korea's health insurance data and monitored from 2008 to 2019. Emission amounts of the ICs and the air pollution status in the nearby (exposed) and remote (control) area were evaluated using data from national regulatory networks, and hazard ratios (HRs) and 95% confidence intervals (CIs) for neurological diseases of the exposed group compared to the control group were calculated using Cox proportional regression models. Overall, the complexes emitted large amounts of VOCs, CO, NOx, and PM10, and annual levels of ambient PM (2.5, 10), gaseous substances (NO₂, SO₂), VOCs and PAHs were higher in the exposed area compared to the control and/or the national average. The risk of inflammatory disease of the CNS (G00-09) and extrapyramidal and movement disorders (G20-26) were higher in the exposed area with a HR (95% CI) of 1.36 (1.10-1.68) and 1.33 (1.27-1.39) respectively. Among the subclasses, other extrapyramidal and movement disorders (G25) and epilepsy (G40) were associated with higher risks in the exposed area (HR (95%CI): 1.11 (1.04-1.18), 1.08 (1.00-1.16)) after adjusting for potential confounders. These results suggest that people living near ICs are more likely to be exposed to higher air pollution levels and have higher risks of developing several neurological disorders. However, further epidemiological studies in these industrial areas supplemented with other indicators of environmental exposure and control of other diverse factors are warranted.

Gene-environment interactions and their impact on human health

The molecular processes underlying human health and disease are highly complex. Often, genetic and environmental factors contribute to a given disease or phenotype in a non-additive manner, yielding a gene-environment (G × E) interaction. In this work, we broadly review current knowledge on the impact of gene-environment interactions on human health. We first explain the independent impact of genetic variation and the environment. We next detail well-established G × E interactions that impact human health involving environmental toxicants, pollution, viruses, and sex chromosome composition. We conclude with possibilities and challenges for studying G × E interactions.

Comparing Equilibrium Concentrations of Polychlorinated Biphenyls Based on Passive Sampling and Bioaccumulation in Water Column Deployments

Biomonitoring at contaminated sites undergoing cleanup, including Superfund sites, often uses bioaccumulation of anthropogenic contaminants by field-deployed organisms as a metric of remedial effectiveness. Bioaccumulation studies are unable to assess the equilibrium status of the organisms relative to the contaminants to which they are exposed. Establishing equilibrium provides a reproducible benchmark on which scientific and management decisions can be based (e.g., comparison with human dietary consumption criteria). Unlike bioaccumulating organisms, passive samplers can be assessed for their equilibrium status. In our study, over a 3-year period, we compared the bioaccumulation of selected polychlorinated biphenyls (PCBs) by mussels in water column deployments at the New Bedford Harbor Superfund site (New Bedford, MA, USA) to codeployed passive samplers. Based on comparisons to the calculated passive sampler equilibrium concentrations, the mussels were not at equilibrium, and the subsequent analysis focused on evaluating approaches for estimating equilibrium bioaccumulation. In addition, a limited evaluation of metal bioaccumulation by the exposed mussels and a metal passive sampler was performed. In general, mussel and passive sampler accumulation of PCBs was significantly correlated; however, surprisingly, agreement on the magnitude of accumulation was optimal when bioaccumulation and passive sampler uptake were not corrected for nonequilibrium conditions. A subsequent comparison of four approaches for estimating equilibrium mussel bioaccumulation using octanol-water partition coefficients (KOW ), triolein-water partition coefficients (KTW ), and two types of polymer-lipid partition coefficients demonstrated that field-deployed mussels were not at equilibrium with many PCBs. A range of estimated equilibrium mussel bioaccumulation concentrations were calculated, with the magnitude of the KOW -based values being the smallest and the polymer-lipid partition coefficient-based values being the largest. These analyses are intended to assist environmental scientists and managers to interpret field deployment data when transitioning from biomonitoring to passive sampling. Environ Toxicol Chem 2023;42:317-332. Published 2022. This article is a U.S. Government work and is in the public domain in the USA.

Genotoxicity and Reproductive Risk in Workers Exposed to Pesticides in Rural Areas of Curicó, Chile: A Pilot Study

Significant risks to human health have been associated with chronic exposure to low doses of pesticides, a situation which may be frequent among agricultural workers. In this context, and regarding the agricultural-based economy of central Chile, we aimed to explore the genotoxic damage in agricultural workers and reproductive risk among women in rural and urban areas of Curicó, a traditional agricultural district in Chile. Hence, we sampled a group of rural agricultural workers associated with pesticide management (n = 30) and an urban unexposed group (n = 30). Our results showed that the agricultural workers had higher micronuclei frequencies (MN: β = 13.27; 95% CI _low = 11.08, CI _high = 15.47) and women had a 40-fold higher risk of reproductive problems (OR = 40.32; 95% CI _low = 2.60, CI _high = 624.31) than the unexposed group. The factor analysis of mixed data (FAMD) showed that neither the sex nor smoking habits appear to define the ordination of the data. Nevertheless, the exposure level did segregate them in the multidimensional space (explained variance: 35.38% dim-1; 18.63% dim-2). This pilot study highlights the higher risks of biological conditions negatively associated with the health of agricultural workers.

Health inequities start early in life, even before birth: Why race-specific fetal and neonatal growth references disadvantage Black infants

Clinicians and researchers use published standards to assess and classify the size and growth of the fetus and newborn infant. Fetal growth is slower on average in Black fetuses as compared with White fetuses, and existing standards differ in whether they are race-specific or not. Here, we apply a health equity lens to the topic of fetal and newborn growth assessment by critically appraising two widely available growth standards. We conclude that using race-based standards is not well-justified and could perpetuate or even worsen inequities in perinatal health outcomes. We therefore recommend that neonatal and perinatal providers remove race from the assessment of fetal and newborn size.

Disparities in Air Pollutants Across Racial, Ethnic, and Poverty Groups at US Public Schools

We investigate socioeconomic disparities in air quality at public schools in the contiguous US using high resolution estimates of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations. We find that schools with higher proportions of people of color (POC) and students eligible for the federal free or reduced lunch program, a proxy for poverty level, are associated with higher pollutant concentrations. For example, we find that the median annual NO₂ concentration for White students, nationally, was 7.7 ppbv, compared to 9.2 ppbv for Black and African American students. Statewide and regional disparities in pollutant concentrations across racial, ethnic, and poverty groups are consistent with nationwide results, where elevated NO₂ concentrations were associated with schools with higher proportions of POC and higher levels of poverty. Similar, though smaller, differences were found in PM_2.5 across racial and ethnic groups in most states. Racial, ethnic, and economic segregation across the rural-urban divide is likely an important factor in pollution disparities at US public schools. We identify distinct regional patterns of disparities, highlighting differences between California, New York, and Florida. Finally, we highlight that disparities exist not only across urban and non-urban lines but also within urban environments.

Environmental Health: A Position Paper From the American College of Physicians

Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment.

The Structural Analysis: Incorporating Structurally Competent Clinical Reasoning into Case-Based Presentations

Structural and social determinants of health account for the health disparities we see along social hierarchies, and their impact has been made more evident by the recent COVID-19 pandemic. There have been increasing calls to incorporate structural competency into medical education. The structural and social context, however, has yet to be fully integrated into everyday clinical practice and little has been published on how to concretely imbed structural competency into clinical reasoning. The authors provide a framework for structural analysis, which incorporates four key steps: (1) developing a prioritized clinical problem list, (2) identifying social and structural root causes for clinical problems, (3) constructing and documenting a prioritized structural problem list, and (4) brainstorming solutions to address structural barriers and social needs. They show how structural analysis can be used to operationalize structural reasoning into everyday inpatient and outpatient clinical assessments.

Roadmap to mercury-free dentistry era: Are we prepared?

From the perspectives of longevity, mechanical performance, and economics, amalgam has long been considered the material of choice, especially for certain types of restorations in posterior teeth, including replacement therapy for existing amalgam fillings. In spite of numerous advantages over other filling materials, its use has been decreasing in recent years and the alternative tooth-colored filling materials are increasingly used. There is a trend towards minimal interventional, adhesive, techniques in dentistry, which are based on adhesion to tooth structure by chemical interaction and/or micromechanical retention. At the same time, the quality and durability of alternative materials have improved. Mercury is the metallic element of concern used in dental amalgam. Mercury is a well-documented toxicant, with reasonably well-defined characteristics for the major forms of exposure, involving elemental mercury as well as organic and inorganic mercury compounds. Looking into the kind of practice and its popularity among dentists and the patients in India, even we have to comply with the use of amalgam by implementing the best possible ways to minimize the extent of damage to nature.

The Changing Climate and Pregnancy Health

PURPOSE OF REVIEW

Climate change is the biggest public health threat of the twenty-first century but its impact on the perinatal period has only recently received attention. This review summarizes recent literature regarding the impacts of climate change and related environmental disasters on pregnancy health and provides recommendations to inform future adaptation and mitigation efforts.

RECENT FINDINGS

Accumulating evidence suggests that the changing climate affects pregnancy health directly via discrete environmental disasters (i.e., wildfire, extreme heat, hurricane, flood, and drought), and indirectly through changes in the natural and social environment. Although studies vary greatly in design, analytic methods, and assessment strategies, they generally converge to suggest that climate-related disasters are associated with increased risk of gestational complication, pregnancy loss, restricted fetal growth, low birthweight, preterm birth, and selected delivery/newborn complications. Window(s) of exposure with the highest sensitivity are not clear, but both acute and chronic exposures appear important. Furthermore, socioeconomically disadvantaged populations may be more vulnerable. Policy, clinical, and research strategies for adaptation and mitigation should be continued, strengthened, and expanded with cross-disciplinary efforts. Top priorities should include (a) reinforcing and expanding policies to further reduce emission, (b) increasing awareness and education resources for healthcare providers and the public, (c) facilitating access to quality population-based data in low-resource areas, and (d) research efforts to better understand mechanisms of effects, identify susceptible populations and windows of exposure, explore interactive impacts of multiple exposures, and develop novel methods to better quantify pregnancy health impacts.

An Exploratory Investigation of Government Air Monitoring Data after Hurricane Harvey

Southeast Texas is home to some of the largest refineries in the United States. During Hurricane Harvey, emergency shutdowns took place. In this exploratory investigation, we examine how government air monitors performed in measuring air quality in Beaumont, Texas during and in the months following Hurricane Harvey. Texas Commission on Environmental Quality (TCEQ) data from two active air monitors in Beaumont, Texas were analyzed during the year 2017–2018. Concentrations of sulfur dioxide (SO₂), nitric oxide (NO), oxides of nitrogen (NOx), ozone, benzene, and hydrogen sulfide (H₂S) were investigated. The number of hours and days no data were reported by air monitors were also investigated. Yearly maximum values (MAX, all in parts per billion (ppb)) in 2017 for SO₂, NO, and NOx (53.7, 113.4, 134, respectively) and their respective standard deviations (SD: 1.3, 3.4, and 14) were higher as compared to 2018 (MAX, all in ppb and (SD) = 40.9, (1.4); 103.9, (3.3); 123.8, (14), respectively). The data capture rate for these chemicals were between 88 and 97% in both years. During the months following Hurricane Harvey (August–December 2017) there was an increase in most maximum values. The yearly averages for H₂S were 0.68 ppb (SD 1.02) in 2017 and 0.53 ppb (SD 1.07) in 2018. Missing days were observed for both the H₂S and NOx air monitors, with the highest number observed in 2017 (213 missing days) for the air monitor measuring H₂S. We identified that residents of Beaumont, Texas are exposed daily to low-level concentrations of air pollutants. H₂S is released each day at a level high enough to be smelled. Data capture rates for air monitors are not always above 90%. Improved air quality data and disaster preparations are needed in Beaumont, Texas.

Mapping supply of and demand for ecosystem services to assess environmental justice in New York City

Livability, resilience, and justice in cities are challenged by climate change and the historical legacies that together create disproportionate impacts on human communities. Urban green infrastructure has emerged as an important tool for climate change adaptation and resilience given their capacity to provide ecosystem services such as local temperature regulation, stormwater mitigation, and air purification. However, realizing the benefits of ecosystem services for climate adaptation depend on where they are locally supplied. Few studies have examined the potential spatial mismatches in supply and demand of urban ecosystem services, and even fewer have examined supply-demand mismatches as a potential environmental justice issue, such as when supply-demand mismatches disproportionately overlap with certain socio-demographic groups. We spatially analyzed demand for ecosystem services relevant for climate change adaptation and combined results with recent analysis of the supply of ecosystem services in New York City (NYC). By quantifying the relative mismatch between supply and demand of ecosystem services across the city we were able to identify spatial hot- and coldspots of supply-demand mismatch. Hotspots are spatial clusters of census blocks with a higher mismatch and coldspots are clusters with lower mismatch values than their surrounding blocks. The distribution of mismatch hot- and coldspots was then compared to the spatial distribution of socio-demographic groups. Results reveal distributional environmental injustice of access to the climate-regulating benefits of ecosystem services provided by urban green infrastructure in NYC. Analyses show that areas with lower supply-demand mismatch tend to be populated by a larger proportion of white residents with higher median incomes, and areas with high mismatch values have lower incomes and a higher proportion of people of color. We suggest that urban policy and planning should ensure that investments in "nature-based" solutions such as through urban green infrastructure for climate change adaptation do not reinforce or exacerbate potentially existing environmental injustices.

Invisible and unequal: Unincorporated community status as a structural determinant of health

Despite increasing awareness of the importance of political determinants of health, place-based research has not interrogated one of the most common political statuses: the impact of living in a community without municipal incorporation. In 2010 an estimated 37% of the U.S. population lived in an unincorporated area; despite their ubiquity, unincorporated communities are largely absent from the public health literature. Residents of unincorporated areas typically do not have their own local (e.g., city or municipal) government. This lack of representation leads to political exclusion and diminished access to resources, especially for low-income communities of color, Furthermore, by not disaggregating health data to unincorporated communities, residents are subsumed into county or census tract data that may not be reflective of their community's composition or context. Without jurisdictional distinction in research, there is no accountability for the manufacturing of health inequities in unincorporated communities . In the absence of empirical research on unincorporated communities, this paper uses the Commission on Social Determinants of Health (CSDH) Framework of the World Health Organization to argue that lack of municipal status is a structural determinant of health responsible for social conditions which generate cumulative health risks for residents. This includes using existing evidence on social conditions typical of unincorporated communities to describe patterns of residential segregation, neighborhood disadvantage, and environmental hazards that may increase residents' exposure to unhealthy environments in unincorporated communities. Finally, we provide an agenda for future public health research that can begin to address this health and racial equity gap for low-income unincorporated communities of color who have, until now, been absent in health equity discourse.

Dhaka landfill waste practices: addressing urban pollution and health hazards

Two Dhaka, Bangladesh, landfills are explored to understand how management practices impact environmental quality and public health in the surrounding areas. A combination of research methods is used, such as geospatial buffer zone analysis, semi-structured observation checklist and qualitative interviews, to gain an understanding of the waste transportation, leachate percolation, and adverse health and environmental effects. A multi-ring buffer zone and ground truth method were applied through ArcMap for the spatial distribution of landfill-adjacent environmental features. Qualitative interviews were conducted with landfill officials and nearby residents. Findings reveal that landfills are situated very close to residential areas, water bodies and agricultural lands, exposing them to various health and environmental hazards. Improper solid waste management practices of the landfills cause adverse environmental effects by leachate percolation, waste incineration and vector breeding. Adjacent dwellers suffer from bronchial diseases, pneumonia, diarrhoea, itching problems, headache and appetite loss. The existing solid waste management system requires managerial and technical modifications to reduce the associated environmental pollution and health hazards.

The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic

During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect pre-existing structural inequities. Structural racism is racial discrimination rooted in history, perpetuated through policies, and manifested in disparities in healthcare, housing, education, employment, and wealth. Although these disparities exert greater impacts on health outcomes than do genetics or behavior, scientists, and policy makers are only beginning to name structural racism as a key determinant of population health and take the necessary steps to dismantle it. In radiology, structural racism impacts how imaging services are utilized. Here we review the history and policies that contribute to structural racism and predispose minority and disadvantaged communities to inferior outcomes during the COVID-19 pandemic in order to identify policy changes that could promote more equitable access to radiologic services.

Investigating correlations between illness and defensive behaviour approach: A case of twin cities of Pakistan

Municipal solid waste (MSW) management has emerged as a major problem for modern societies in recent decades. An optimal waste management system is essential to prevent the pollution burden and associated health related issues. This study carries out an empirical evaluation of the illness caused by inadequate solid waste management in the metropolitan of Rawalpindi-Islamabad. The model is based on utility-maximizing consumer behavior and predicted probability of disease in the household is estimated by employing “seemingly uncorrelated bivariate probit model”. Primary data obtained through multistage random sampling that comprises of 849 respondents. The findings show that irregular waste disposal sites in the vicinity of residences cause illness. The key findings indicate that distance from dumpsites and use of contaminated water adversely affect the health outcomes. Furthermore, the results show that respondents were unable to engage in defensive activities due to a lack of awareness. Oft-times, the waste is dumped in illegal sites that is burnt thus causing excessive air and ground water pollution. The results shed light on the respondents' understanding of the negative consequences of excessive waste disposal and study suggests measures that motivate households to engage in defensive activities through effective campaigns and capacity building programmes that ensure sustainable solid waste management.

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An overview of the household solid waste generation and management practices.

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Construct households' illness function regarding improper waste disposal practices.

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Construct households' defensive behaviour regarding illness function.

Cumulative Impacts and COVID-19: Implications for Low-Income, Minoritized, and Health-Compromised Communities in King County, WA

Few studies have assessed how the intersection of social determinants of health and environmental hazards contributes to racial disparities in COVID-19. The aim of our study was to compare COVID-19 disparities in testing and positivity to cumulative environmental health impacts, and to assess how unique social and environmental determinants of health relate to COVID-19 positivity in Seattle, King County, WA, at the census tract level. Publicly available data (n = 397 census tracts) were obtained from Public Health–Seattle & King County, 2018 ACS 5-year estimates, and the Washington Tracking Network. COVID-19 testing and positive case rates as of July 12, 2020, were mapped and compared to Washington State Environmental Health Disparities (EHD) Map cumulative impact rankings. We calculated odds ratios from a series of univariable and multivariable logistic regression analyses using cumulative impact rankings, and community-level socioeconomic, health, and environmental factors as predictors and having ≥ 10% or < 10% census tract positivity as the binary outcome variable. We found a remarkable overlap between Washington EHD cumulative impact rankings and COVID-19 positivity in King County. Census tracts with ≥ 10 % COVID-19 positivity had significantly lower COVID-19 testing rates and higher proportions of people of color and faced a combination of low socioeconomic status–related outcomes, poor community health outcomes, and significantly higher concentrations of fine particulate matter (PM_2.5). King County communities experiencing high rates of COVID-19 face a disproportionate cumulative burden of environmental and social inequities. Cumulative environmental health impacts should therefore systematically be considered when assessing for risk of exposure to and health complications resulting from COVID-19.

Adapting the environmental risk transition theory for urban health inequities: An observational study examining complex environmental riskscapes in seven neighborhoods in Global North cities

Theories of epidemiologic transition analyze the shift in causes of mortality due to changes in risk factors over time, and through processes of urbanization and development by comparing risk factors between countries or over time. These theories do not account for health inequities such as those resulting from environmental injustice, in which minority and lower income residents are more likely to be exposed to environmental hazards or have less access to environmental goods. Neighborhoods with histories of environmental injustice are also at risk for gentrification as they undergo environmental improvements and new greening projects. We aimed to understand how environmental injustice, urban renewal and green gentrification could inform the understanding of epidemiologic risk transitions. We examined 7 case neighborhoods in cities in the United States and Western Europe which were representative in terms of city region and type, which 1) had experienced a history of environmental injustice and 2) exhibited evidence of recent processes of urban renewal and/or gentrification. In each city, we conducted semi-structured qualitative interviews (n = 172) with city representatives, activists, non-profits, developers and residents. Respondents reported health implications of traditional (heavy pollutants, poor social conditions), transitional (decontamination, new amenities), new (gentrification, access to amenities), and emerging (displacement, climate-related risks, re-emergence of traditional exposures) exposures. Respondents reported renewed, complexified and overlapping exposures leading to poor mental and physical health and to new patterns of health inequity. Our findings point to the need for theories of environmental and epidemiologic risk transitions to incorporate analysis of trends 1) on a city-scale, acknowledging that segregation and patterns of environmental injustice have created unequal conditions within cities and 2) over a shorter and more recent time period, taking into account worsening patterns of social inequity in cities.

The self-reported behaviour of Iiyiyiu Aschii Cree and the worry about pollution from industrial and hydroelectric development in northern Quebec, Canada

Worry is influenced by environmental pollution and affects individual health and well-being; however, little is known about this association in Indigenous communities. Using logistic regression models, we examined self-reported responses among Cree adults to the question "Are you worried about the pollution of the environment (land, water or air) in Iiyiyiu Aschii?" to assess if increased worry was associated with proximity to industrial and hydroelectric development, whether increased worry was associated with self-reported behavioural changes of water consumption type in the community or bush, and days spent on-the-land. Proximity to multiple industrial and hydroelectric development sites was associated with increased worry about pollution. Notably, the decreased consumption of tap water in the community was significantly associated with increased worry, but time-on-the land was not. Overall, our study provides new findings concerning development in a Cree territory in northern Quebec, Canada, and the worry about pollution's association with self-reported behavioural changes.

PM2.5 polluters disproportionately and systemically affect people of color in the United States

Racial-ethnic minorities in the United States are exposed to disproportionately high levels of ambient fine particulate air pollution (PM_2.5), the largest environmental cause of human mortality. However, it is unknown which emission sources drive this disparity and whether differences exist by emission sector, geography, or demographics. Quantifying the PM_2.5 exposure caused by each emitter type, we show that nearly all major emission categories-consistently across states, urban and rural areas, income levels, and exposure levels-contribute to the systemic PM_2.5 exposure disparity experienced by people of color. We identify the most inequitable emission source types by state and city, thereby highlighting potential opportunities for addressing this persistent environmental inequity.

Breaking Down and Building Up: Gentrification, Its drivers, and Urban Health Inequality

Purpose of Review

Many neighborhoods which have been unjustly impacted by histories of uneven urban development, resulting in socioeconomic and racial segregation, are now at risk for gentrification. As urban renewal projects lead to improvements in the long-neglected built environments of such neighborhoods, accompanying gentrification processes may lead to the displacement of or exclusion of underprivileged residents from benefiting from new amenities and improvements. In addition, gentrification processes may be instigated by various drivers. We aimed to discuss the implications of specific types of gentrification, by driver, for health equity.

Recent Findings

Several recent articles find differential effects of gentrification on the health of underprivileged residents of gentrifying neighborhoods compared to those with greater privilege (where sociodemographic dimensions such as race or socioeconomic status are used as a proxy for privilege). Generally, studies show that gentrification may be beneficial for the health of more privileged residents while harming or not benefiting the health of underprivileged residents. Very recent articles have begun to test hypothesized pathways by which urban renewal indicators, gentrification, and health equity are linked. Few public health articles to date are designed to detect distinct impacts of specific drivers of gentrification.

Summary

Using a case example, we hypothesize how distinct drivers of gentrification—specifically, retail gentrification, environmental gentrification, climate gentrification, studentification, tourism gentrification, and health care gentrification—may imply specific pathways toward reduced health equity. Finally, we discuss the challenges faced by researchers in assessing the health impacts of gentrification.

A New Integrated Approach for Municipal Landfill Siting Based on Urban Physical Growth Prediction: A Case Study Mashhad Metropolis in Iran

Due to irregular and uncontrolled expansion of cities in developing countries, currently operational landfill sites cannot be used in the long-term, as people will be living in proximity to these sites and be exposed to unhygienic circumstances. Hence, this study aims at proposing an integrated approach for determining suitable locations for landfills while considering their physical expansion. The proposed approach utilizes the fuzzy analytical hierarchy process (FAHP) to weigh the sets of identified landfill location criteria. Furthermore, the weighted linear combination (WLC) approach was applied for the elicitation of the proper primary locations. Finally, the support vector machine (SVM) and cellular automation-based Markov chain method were used to predict urban growth. To demonstrate the applicability of the developed approach, it was applied to a case study, namely the city of Mashhad in Iran, where suitable sites for landfills were identified considering the urban growth in different geographical directions for this city by 2048. The proposed approach could be of use for policymakers, urban planners, and other decision-makers to minimize uncertainty arising from long-term resource allocation.

Chemical Exposure: European Citizens' Perspectives, Trust, and Concerns on Human Biomonitoring Initiatives, Information Needs, and Scientific Results

Over the last few decades, citizen awareness and perception of chemical products has been a topic of interest, particularly concerning national and international policy decision makers, expert/scientific platforms, and the European Union itself. To date, few qualitative studies on human biomonitoring have analysed communication materials, made recommendations in terms of biomonitoring surveillance, or asked for feedback in terms of specific biomonitoring methods. This paper provides in-depth insight on citizens' perceptions of knowledge of biomonitoring, impact of chemical exposure on daily life, and claims on how results of research should be used. Four semi-structured focus groups were held in Austria, Portugal, Ireland, and the United Kingdom (UK). The cross-sectional observational qualitative design of this study allows for better understanding of public concern regarding chemicals, application, and use of human biomonitoring. The main findings of this study include citizens' clear articulation on pathways of exposure, the demand on stakeholders for transparent decision-making, and sensitivity in communication of results to the public. Validated and trustful communication is perceived as key to empowering citizens to take action. The results can be used to facilitate decision-making and policy development, and feeds into the awareness needs of similar and future projects in human biomonitoring. Furthermore, it also brings to light ideas and concepts of citizens' in shaping collaborative knowledge between citizens', experts, scientists, and policy makers on equal terms.

Convergence of COVID-19 and chronic air pollution risks: Racial/ethnic and socioeconomic inequities in the U.S

Recent research suggests greater COVID-19 prevalence in areas burdened with higher exposure to chronic air pollution, but previous studies have not examined if socially disadvantaged populations are more likely to reside in communities located at the convergence of both COVID-19 and air pollution health risks. This article presents a national scale U.S. study that investigates whether racial/ethnic minorities, socioeconomically deprived residents, and other vulnerable groups are significantly overrepresented in counties where significantly higher COVID-19 incidence spatially coincides with higher respiratory health risks from outdoor exposure to hazardous air pollutants (HAPs). COVID-19 data from the Johns Hopkins Center for Systems Science and Engineering database are linked to respiratory risk estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment and variables from the 2018 American Community Survey. Bivariate local measures of spatial association are implemented to identify county clusters representing relationships between COVID-19 incidence rate and respiratory risk from HAP exposure. Socio-demographic characteristics of these clusters are compared using bivariate statistical tests and multivariable generalized estimating equations. Counties where greater COVID-19 incidence coincides significantly with higher HAP respiratory risk contain disproportionately higher percentages of non-Hispanic Black, socioeconomically deprived, and uninsured residents than all other U.S. counties, after controlling for spatial clustering, population density, older age, and other contextual factors. These significant socio-demographic inequities represent an important starting point for more detailed investigations of places facing the double burden of elevated COVID-19 prevalence and air pollution exposure, and also emphasize the urgent need to develop mitigation strategies for addressing both COVID-19 and chronic air pollution in socially vulnerable communities.

The Neonatal Environment and Health Outcomes (NEHO) Birth Cohort Study: Behavioral and Socioeconomic Characteristics and Drop-Out Rate from a Longitudinal Birth Cohort in Three Industrially Contaminated Sites in Southern Italy

Pregnant women living in industrially contaminated sites (ICSs) are exposed to environmental contaminants through different pathways, and thus children’s health may be affected by pollutants. We created the Neonatal Environment and Health Outcomes (NEHO) longitudinal birth cohort in three ICSs in the Mediterranean area of southern Italy, collecting comprehensive information on personal data and lifestyles by questionnaire. Through multiple correspondence analysis, we identified possible clusters of enrolled women, and a neural network classifier analysis (NNCA) was performed to identify variables capable of predicting the attrition rate of the study. NEHO recruited 845 mother–child pairs over two years. The mothers’ mean age was 31.1 ± 5.2 SD years. We found significant differences in socioeconomic status (SES) among the three evaluated ICS, and an overall 11.1% prevalence of mothers who actively smoked during pregnancy. Active smoking during pregnancy was strongly associated with the lowest socioeconomic level (p < 0.0001). By means of the NNCA, we found that smoking during pregnancy and the lowest education level characterized the cluster with the highest attrition rate (p < 0.001). Our results demonstrate that reason for public health concern still exists regarding smoking during pregnancy and that SES influences both lifestyles, producing negative pregnancy outcomes and a higher survey attrition rate.

Perinatal Factors Associated with Autism Spectrum Disorder in Jamaican Children

Mode of delivery, preterm birth, and low birth weight (LBW) are hypothesized to be associated with autism spectrum disorder (ASD) in the offspring. Using data from 343 ASD cases (2-8 years) and their age- and sex-matched typically developing controls in Jamaica we investigated these hypotheses. Our statistical analyses revealed that the parish of residence could modify the association between cesarean delivery and ASD, with a difference found in this relationship in Kingston parish [matched odds ratio (MOR) (95% confidence interval (CI)) 2.30 (1.17-4.53)] and other parishes [MOR (95% CI) 0.87 (0.48-1.59)]. Although the associations of LBW and preterm birth with ASD were not significant, we observed a significant interaction between LBW and the household socioeconomic status. These findings require replication.

Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

COVID-19 Interconnectedness: Health Inequity, the Climate Crisis, and Collective Trauma

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.

Reproductive toxicity assessment of Olusosun municipal landfill leachate in Mus musculus using abnormal sperm morphology and dominant lethal mutation assays

Mixture of xenobiotics in Olusosun landfill leachates (OSL) induced somatic and germ cell genotoxicity in eukaryotic cells. However, whether the DNA-damaged germ cells can increase reproductive failure, embryotoxicity and/or teratogenicity during fertilization remained unclear. The study herein investigated reproductive toxicity and embryotoxic effects of OSL in mice using abnormal sperm morphology and dominant lethal mutation assays. Six mice per group were exposed to 0.5 mL of 5, 10, 25, and 50% OSL (v/v, leachate/distilled water) for 5 consecutive days. Similar treatment was giving to distilled water and cyclophosphamide (20 mg/kg body weight), as negative and positive control groups, respectively. At 35 day post-treatment, the mice were sacrificed and examined for cauda epididymal abnormal sperm morphology, testicular weight change and histopathological lesions. Male mice were mated to untreated nulliparous females (1 treated male per 2 untreated females) until vaginal plugs were observed. Pregnant females were sacrificed on 14th day post-mating and uterine content examined for number of implants per female, resorptions, and live and dead fetuses. OSL significantly increased teratozoospermia by 31.02% with amorphous sperm head having the highest frequency and sperm with two heads, the least. Histology of the testes revealed congestion of the interstitial blood vessels, spermatid retention and disorganization of the germinal epithelium from the basal compartment. OSL insignificantly increased absolute and relative testes weights but reduced body weight of exposed mice. There was insignificant induction of dominant lethal mutation, although low fertility was observed in the treated mice. The analyzed physico-chemical parameters and heavy metals/metalloids in OSL were higher than permissible limits. The metals, physico-chemical parameters and other unanalyzed substances in OSL induced abnormal sperm morphology, altered testes pathology, but did not significantly induce dominant lethal mutation in mice. Constituents of OSL are toxic to the male reproductive organs in mice and suggests harmful impact on public health. Indiscriminate disposal of solid wastes in the environment should be prevented.

Birth Cohorts in Highly Contaminated Sites: A Tool for Monitoring the Relationships Between Environmental Pollutants and Children's Health

Industrial areas are characterized by the dispersion of environmental stressors that could possibly have long-term detrimental effects on both human health and the environment. Environmental contamination has been indicated to be one of the major risks for reproductive health. In this context, the effects of environmental pollution on pregnant women living in heavily polluted areas is of special interest. In fact, fetal development is a crucial phase due to the dynamic interaction between the maternal/external environments and the developing organs and tissues. Moreover, following Barker's postulate of the intrauterine origin of health and disease, the events occurring in this time window could affect future health. Birth cohorts provide the most suitable design for assessing the association between early-life and possible long-term health outcomes in highly contaminated sites. By providing an assessment of the early life environment throughout the collection of biological samples, birth cohorts offer the opportunity to study in-depth several possible confounders and outcomes by means of questionnaires and follow-ups based on clinical evaluations and bio-specimen samplings. The exposome comprises the totality of exposures from conception onwards; the birth cohort approach allows the integration of the exposures as a whole, including those related to socioeconomic status, with "omics" data from biological samples collected at birth and throughout life. In the characterization of the "fetal exposome," the placenta represents a highly informative and scarcely considered organ. For this purpose, the "Neonatal Environment and Health Outcomes" (NEHO) birth cohort has been established by enrolling pregnant women residing in contaminated sites and in surrounding areas.

Influence of air pollutants on pneumonia hospitalizations among children in a town in the Brazilian Legal Amazon region: a time series study

BACKGROUND

Exposure to particulate material produced as a result of increased agricultural activity may increase the number of pneumonia hospitalizations among children. We hope to contribute to the knowledge base through highlighting the environmental mechanisms involved in this outcome and optimizing pollutant control policies.

OBJECTIVES

To investigate the association between pneumonia hospitalizations among children and presence of environmental pollutants in a town in the Brazilian Legal Amazon region.

DESIGN AND SETTING

Time series study conducted in the town of Tangará da Serra, Mato Grosso (MT), Brazil.

METHODS

A total of 158 children aged 0 to 10 years participated in the study. Data on environmental variables and pollutants were extracted daily through the Coupled Chemistry-Aerosol-Tracer Transport model coupled to Brazilian Regional Atmospheric Modeling System (CCATT-BRAMS). Meteorological data were provided by the Weather Forecasting and Climate Studies Center (CPTEC).

RESULTS

There was greater frequency of pneumonia hospitalizations in the months of transition between the rainy and dry seasons, with a prevalence ratio 2.4 times higher than in other periods. For environmental pollutants, there was a significant positive correlation between particulate matter (PM2.5) and pneumonia hospitalizations (correlation 0.11), with more admissions on the days when PM2.5 levels were highest (averages of 6.6 µg/m3 when there were no admissions and 13.11 µg/m3 on days with two or more admissions).

CONCLUSIONS

The higher the PM2.5 level was, the greater the frequency of hospitalizations also was. Children living in peripheral areas had higher prevalence of pneumonia hospitalizations in the dry period than those who were living in the town center.

Residential exposure to petrochemical industrial complexes and the risk of leukemia: A systematic review and exposure-response meta-analysis

Exposure to chemicals produced by petrochemical industrial complexes (PICs), such as benzene, ionizing radiation, and particulate matters, may contribute to the development of leukemia. However, epidemiological studies showed controversial results. This systematic review and meta-analysis aimed to summarize the association between residential exposure to PICs and the risk of leukemia incidence, focusing on exposure-response effects. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for studies published before September 1st, 2019. Observational studies investigating residential exposure to PICs and the risk of leukemia were included. The outcome of interest was the incidence of leukemia comparing to reference groups. Relative risk (RR) was used as the summary effect measure, synthesized by characteristics of populations, distance to PICs, and calendar time in meta-regression. We identified 7 observational studies, including 2322 leukemia cases and substantial reference groups, in this meta-analysis. Residential exposure to PICs within a maximal 8-km distance had a 36% increased risk of leukemia (pooled RR = 1.36, 95% CI = 1.14-1.62) compared to controls, regardless of sex and age. In terms of leukemia subtypes, residential exposure to PICs was associated with the risks of acute myeloid leukemia (AML, pooled RR = 1.61, 95% CI = 1.12-2.31) and chronic lymphocytic leukemia (CLL, pooled RR = 1.85, 95% CI = 1.11-6.42). In meta-regression, the positive association occurred after 10 years of follow-up with a pooled RRs of 1.21 (95% CI = 1.02-1.44) and then slightly increased to 1.77 (95% CI = 1.35-2.33) at 30 years after follow-up. No effect modification was found by sex, age, and geographic locations.

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

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

Toxic Site Identification Program in Azerbaijan

The need to protect communities from hazardous waste is an important agenda for any nation. Although pollutant management and policy development are attempted in many developing countries, it is not always successful due to limited funds, project resources, and access to trained experts to conduct toxic site identification projects. For this reason, Pure Earth created the Toxic Site Identification Program (TSIP). The goal of the TSIP program is to provide reliable information and data that identifies location of toxic sites and the level of toxic severity. TSIP is significant because it provides developing countries a database of ranked toxic sites identified as hazardous risk to human health. For example, Azerbaijan is one of the most polluted post-Soviet nations, but has limited resources to address and manage its polluted sites. The Azerbaijani TSIP database is the first reliable data source that identifies hazardous pollutants in the country. Our study is significant because it discusses how the TSIP labels and ranks the level of toxic severity to human health. It is also the first data source in Azerbaijan that identifies which Soviet legacy toxic sites are affecting local communities. Although our study is specific to Azerbaijan, the TSIP method can be applied to nations with similar data limitations and the need for a database that identifies country specific environmental and hazardous locations. The data sampling method and results are mapped and accompanied by tables of the collected pollutant types to identify communities at greatest health-risk to legacy toxic sites.

Estimated time-varying exposures to air emissions from animal feeding operations and childhood asthma

BACKGROUND/AIM

Industrial-scale animal feeding operations (AFOs) have adverse impacts on regional air quality. Air emissions include endotoxins and other pro-inflammatory components, and exposure may cause airway inflammation and respiratory effects in susceptible individuals residing nearby. We aimed to develop and validate metrics for estimating time-varying exposure to AFO air pollution in surrounding communities and, secondly, to determine whether exposure is associated with health effects in children with asthma.

METHODS

We conducted a longitudinal panel study of N = 58 children with asthma in an agricultural region of Washington State with a high density of dairy AFOs. Children were followed for up to 26 months with repeated measures of respiratory health (N = 2023 interviews; N = 3853 lung function measurements); urine was collected in a subcohort (N = 16) at six-day intervals over three months and analyzed for leukotriene E4 (LTE4), a biomarker of systemic inflammation (N = 138 measurements). We developed an approach to estimate daily exposure to AFO airborne emissions based on distance to AFOs, AFO size, and daily wind speed and direction, and validated the estimates against direct measurements of ammonia, a chemical marker of AFO emissions, measured biweekly at 18 sites across the region for 14 months. Short-term relationships between AFO pollutant exposure and outcomes were assessed using regression models accounting for within-participant correlation and several potential confounders.

RESULTS

Estimates of daily AFO air pollution correlated moderately well with outdoor ammonia measurements (N = 842; r = 0.62). Forced expiratory volume in 1 s (FEV₁) as percent of predicted was 2.0% (95% CI: 0.5, 3.5) lower with each interquartile increase in previous day exposure, but no associations with asthma symptoms were observed. There was suggestive evidence that LTE4 concentrations were higher following days of elevated exposure to AFO emissions (p = 0.06).

CONCLUSIONS

A simple metric of time-varying exposure to AFO emissions was correlated with daily outdoor ammonia levels. Children with asthma may be adversely affected by exposure to AFO emissions.