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VoPham T, White AJ, Jones RR. Geospatial Science for the Environmental Epidemiology of Cancer in the Exposome Era. Cancer Epidemiol Biomarkers Prev 2024; 33:451-460. [PMID: 38566558 PMCID: PMC10996842 DOI: 10.1158/1055-9965.epi-23-1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
Geospatial science is the science of location or place that harnesses geospatial tools, such as geographic information systems (GIS), to understand the features of the environment according to their locations. Geospatial science has been transformative for cancer epidemiologic studies through enabling large-scale environmental exposure assessments. As the research paradigm for the exposome, or the totality of environmental exposures across the life course, continues to evolve, geospatial science will serve a critical role in determining optimal practices for how to measure the environment as part of the external exposome. The objectives of this article are to provide a summary of key concepts, present a conceptual framework that illustrates how geospatial science is applied to environmental epidemiology in practice and through the lens of the exposome, and discuss the following opportunities for advancing geospatial science in cancer epidemiologic research: enhancing spatial and temporal resolutions and extents for geospatial data; geospatial methodologies to measure climate change factors; approaches facilitating the use of patient addresses in epidemiologic studies; combining internal exposome data and geospatial exposure models of the external exposome to provide insights into biological pathways for environment-disease relationships; and incorporation of geospatial data into personalized cancer screening policies and clinical decision making.
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Affiliation(s)
- Trang VoPham
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Alexandra J. White
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Rena R. Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, NIH, Department of Health and Human Services, Bethesda, Maryland
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Chan SL, Ho CZH, Khaing NEE, Ho E, Pong C, Guan JS, Chua C, Li Z, Lim T, Lam SSW, Low LL, How CH. Frameworks for measuring population health: A scoping review. PLoS One 2024; 19:e0278434. [PMID: 38349894 PMCID: PMC10863900 DOI: 10.1371/journal.pone.0278434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/03/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Many regions in the world are using the population health approach and require a means to measure the health of their population of interest. Population health frameworks provide a theoretical grounding for conceptualization of population health and therefore a logical basis for selection of indicators. The aim of this scoping review was to provide an overview and summary of the characteristics of existing population health frameworks that have been used to conceptualize the measurement of population health. METHODS We used the Population, Concept and Context (PCC) framework to define eligibility criteria of frameworks. We were interested in frameworks applicable for general populations, that contained components of measurement of health with or without its antecedents and applied at the population level or used a population health approach. Eligible reports of eligible frameworks should include at least domains and subdomains, purpose, or indicators. We searched 5 databases (Pubmed, EMBASE, Web of Science, NYAM Grey Literature Report, and OpenGrey), governmental and organizational sites on Google and websites of selected organizations using keywords from the PCC framework. Characteristics of the frameworks were summarized descriptively and narratively. RESULTS Fifty-seven frameworks were included. The majority originated from the US (46%), Europe (23%) and Canada (19%). Apart from 1 framework developed for rural populations and 2 for indigenous populations, the rest were for general urban populations. The numbers of domains, subdomains and indicators were highly variable. Health status and social determinants of health were the most common domains across all frameworks. Different frameworks had different priorities and therefore focus on different domains. CONCLUSION Key domains common across frameworks other than health status were social determinants of health, health behaviours and healthcare system performance. The results in this review serve as a useful resource for governments and healthcare organizations for informing their population health measurement efforts.
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Clement Zhong Hao Ho
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Nang Ei Ei Khaing
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Ezra Ho
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Candelyn Pong
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jia Sheng Guan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Calida Chua
- Care and Health Integration, Changi General Hospital, Singapore, Singapore
| | - Zongbin Li
- Preventive Medicine Residency, National University Health System, Singapore, Singapore
| | - Trudi Lim
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Sean Shao Wei Lam
- Health Services Research Centre, SingHealth, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | - Choon How How
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- SingHealth Office of Regional Health, Changi General Hospital, Singapore, Singapore
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Lloyd D, House JS, Akhtari FS, Schmitt CP, Fargo DC, Scholl EH, Phillips J, Choksi S, Shah R, Hall JE, Motsinger-Reif AA. Questionnaire-based exposome-wide association studies for common diseases in the Personalized Environment and Genes Study. EXPOSOME 2024; 4:osae002. [PMID: 38450326 PMCID: PMC10914401 DOI: 10.1093/exposome/osae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024]
Abstract
The exposome collectively refers to all exposures, beginning in utero and continuing throughout life, and comprises not only standard environmental exposures such as point source pollution and ozone levels but also exposures from diet, medication, lifestyle factors, stress, and occupation. The exposome interacts with individual genetic and epigenetic characteristics to affect human health and disease, but large-scale studies that characterize the exposome and its relationships with human disease are limited. To address this gap, we used extensive questionnaire data from the diverse North Carolina-based Personalized Environment and Genes Study (PEGS, n = 9, 429) to evaluate exposure associations in relation to common diseases. We performed an exposome-wide association study (ExWAS) to examine single exposure models and their associations with 11 common complex diseases, namely allergic rhinitis, asthma, bone loss, fibroids, high cholesterol, hypertension, iron-deficient anemia, ovarian cysts, lower GI polyps, migraines, and type 2 diabetes. Across diseases, we found associations with lifestyle factors and socioeconomic status as well as asbestos, various dust types, biohazardous material, and textile-related exposures. We also found disease-specific associations such as fishing with lead weights and migraines. To differentiate between a replicated result and a novel finding, we used an AI-based literature search and database tool that allowed us to examine the current literature. We found both replicated findings, especially for lifestyle factors such as sleep and smoking across diseases, and novel findings, especially for occupational exposures and multiple diseases.
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Affiliation(s)
- Dillon Lloyd
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - John S House
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Farida S Akhtari
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Charles P Schmitt
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - David C Fargo
- Office of the Director, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | | | | | | | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Alison A Motsinger-Reif
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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Tulve NS, Geller AM, Hagerthey S, Julius SH, Lavoie ET, Mazur SL, Paul SJ, Frey HC. Challenges and opportunities for research supporting cumulative impact assessments at the United States environmental protection agency's office of research and development. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100666. [PMID: 38292929 PMCID: PMC10825320 DOI: 10.1016/j.lana.2023.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Nicolle S. Tulve
- United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, USA
| | - Andrew M. Geller
- United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, USA
| | - Scot Hagerthey
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
| | - Susan H. Julius
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
| | - Emma T. Lavoie
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
| | - Sarah L. Mazur
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
| | - Sean J. Paul
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
| | - H. Christopher Frey
- United States Environmental Protection Agency, Office of Research and Development, Washington, DC, USA
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Smarr MM, Avakian M, Lopez AR, Onyango B, Amolegbe S, Boyles A, Fenton SE, Harmon QE, Jirles B, Lasko D, Moody R, Schelp J, Sutherland V, Thomas L, Williams CJ, Dixon D. Broadening the Environmental Lens to Include Social and Structural Determinants of Women's Health Disparities. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:15002. [PMID: 38227347 PMCID: PMC10790815 DOI: 10.1289/ehp12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Due to the physical, metabolic, and hormonal changes before, during, and after pregnancy, women-defined here as people assigned female at birth-are particularly susceptible to environmental insults. Racism, a driving force of social determinants of health, exacerbates this susceptibility by affecting exposure to both chemical and nonchemical stressors to create women's health disparities. OBJECTIVES To better understand and address social and structural determinants of women's health disparities, the National Institute of Environmental Health Sciences (NIEHS) hosted a workshop focused on the environmental impacts on women's health disparities and reproductive health in April 2022. This commentary summarizes foundational research and unique insights shared by workshop participants, who emphasized the need to broaden the definition of the environment to include upstream social and structural determinants of health. We also summarize current challenges and recommendations, as discussed by workshop participants, to address women's environmental and reproductive health disparities. DISCUSSION The challenges related to women's health equity, as identified by workshop attendees, included developing research approaches to better capture the social and structural environment in both human and animal studies, integrating environmental health principles into clinical care, and implementing more inclusive publishing and funding approaches. Workshop participants discussed recommendations in each of these areas that encourage interdisciplinary collaboration among researchers, clinicians, funders, publishers, and community members. https://doi.org/10.1289/EHP12996.
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Affiliation(s)
- Melissa M. Smarr
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | | | | | | | - Sara Amolegbe
- Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Abee Boyles
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Suzanne E. Fenton
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Quaker E. Harmon
- Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Bill Jirles
- Office of the Director, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Denise Lasko
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Rosemary Moody
- Division of Extramural Research, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - John Schelp
- Office of the Director, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Vicki Sutherland
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Laura Thomas
- Division of Translational Research, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Carmen J. Williams
- Division of Intramural Research, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Darlene Dixon
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
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Juarez PD. Economic Determinants of Health Disparities and the Role of the Primary Care Provider. Prim Care 2023; 50:561-577. [PMID: 37866831 DOI: 10.1016/j.pop.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The economic determinants of adverse personal health outcomes and population level disparities pose a daunting challenge for primary care providers in promoting health for persons experiencing poverty and neighborhood deprivation. Until they are addressed, however, the health and economic well-being of persons experiencing neighborhood deprivation is not likely to be improved. There is growing evidence of effective interventions that primary care providers can adopt to address social and economic determinants of health. Primary care providers can participate in clinic and community-based approaches that target individual, neighborhood and social level drives of health and disparities.
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Affiliation(s)
- Paul D Juarez
- Department of Family & Community Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Boulevard, Nashville, TN 37208, USA.
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Ramesh A, Halpern LR, Southerland JH, Adunyah SE, Gangula PR. Saliva as a diagnostic tool to measure polycyclic aromatic hydrocarbon exposure in dental patients exposed to intimate partner violence (IPV). Biomed J 2023; 46:100586. [PMID: 36804615 PMCID: PMC10774449 DOI: 10.1016/j.bj.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Social habits such as tobacco use, alcohol consumption, and chemically contaminated diet contribute to poor oral health. Intimate Partner Violence (IPV) is a global public health epidemic which can exacerbate the prevalence of health conditions affecting a victim's lifespan. This study investigates using saliva as a biomarker for detecting levels of benzo(a)pyrene [B(a)P]; a toxicant present in cigarette smoke and barbecued meat in a population of IPV + female patients. METHODS A cross-sectional IRB-approved study utilized 63 female participants (37 African Americans [AA], and 26 non-African Americans [NAA]), who provided consent for the study. Participants submitted samples of saliva, as well as questionnaires about demographics, health history, and a well-validated (IPV) screen. RESULTS The prevalence of IPV was greater in AA compared to NAA. While the concentrations of PAHs/B(a)P detected in saliva of IPV samples in NAA were generally within the range of B(a)P reported for saliva from elsewhere, the concentrations were high in some IPV positive samples. Among the B(a)P metabolites, the concentrations of B(a)P 7,8-diol, B(a)P 3,6- and 6,12-dione metabolites were greater than the other metabolite in both AA and non-AA groups who were positive. CONCLUSION Our study supports the use of saliva as a potential "diagnostic rheostat" to identify toxicants that may exacerbate/precipitate systemic disease in female victims of IPV. In addition, our study is the first to report that IPV may precipitate the accumulation of B(a)P in oral cavity that can alter inflammatory cascades and increase risk of poor health outcomes in this population of patients.
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Affiliation(s)
- Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, School of Medicine, Meharry Medical College, Nashville, TN, USA.
| | - Leslie R Halpern
- Department of Dental Medicine, New York Medical College/ NYCHHC, Metropolitan Hospital, New York, USA
| | - Janet H Southerland
- Departments of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Samuel E Adunyah
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, School of Medicine, Meharry Medical College, Nashville, TN, USA
| | - Pandu R Gangula
- Department of Oral Diagnostic Sciences & Research, School of Dentistry, Meharry Medical College, Nashville, TN, USA
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Grady SK, Dojcsak L, Harville EW, Wallace ME, Vilda D, Donneyong MM, Hood DB, Valdez RB, Ramesh A, Im W, Matthews-Juarez P, Juarez PD, Langston MA. Seminar: Scalable Preprocessing Tools for Exposomic Data Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:124201. [PMID: 38109119 PMCID: PMC10727037 DOI: 10.1289/ehp12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The exposome serves as a popular framework in which to study exposures from chemical and nonchemical stressors across the life course and the differing roles that these exposures can play in human health. As a result, data relevant to the exposome have been used as a resource in the quest to untangle complicated health trajectories and help connect the dots from exposures to adverse outcome pathways. OBJECTIVES The primary aim of this methods seminar is to clarify and review preprocessing techniques critical for accurate and effective external exposomic data analysis. Scalability is emphasized through an application of highly innovative combinatorial techniques coupled with more traditional statistical strategies. The Public Health Exposome is used as an archetypical model. The novelty and innovation of this seminar's focus stem from its methodical, comprehensive treatment of preprocessing and its demonstration of the positive effects preprocessing can have on downstream analytics. DISCUSSION State-of-the-art technologies are described for data harmonization and to mitigate noise, which can stymie downstream interpretation, and to select key exposomic features, without which analytics may lose focus. A main task is the reduction of multicollinearity, a particularly formidable problem that frequently arises from repeated measurements of similar events taken at various times and from multiple sources. Empirical results highlight the effectiveness of a carefully planned preprocessing workflow as demonstrated in the context of more highly concentrated variable lists, improved correlational distributions, and enhanced downstream analytics for latent relationship discovery. The nascent field of exposome science can be characterized by the need to analyze and interpret a complex confluence of highly inhomogeneous spatial and temporal data, which may present formidable challenges to even the most powerful analytical tools. A systematic approach to preprocessing can therefore provide an essential first step in the application of modern computer and data science methods. https://doi.org/10.1289/EHP12901.
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Affiliation(s)
- Stephen K. Grady
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, Tennessee, USA
| | - Levente Dojcsak
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee, USA
| | - Emily W. Harville
- Department Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve E. Wallace
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Dovile Vilda
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Darryl B. Hood
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, Ohio, USA
| | - R. Burciaga Valdez
- Department of Economics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | | | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
- Institute on Health Disparities, Equity, and the Exposome, Meharry Medical College, Nashville, Tennessee, USA
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee, USA
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Rushing BR, Thessen AE, Soliman GA, Ramesh A, Sumner SCJ. The Exposome and Nutritional Pharmacology and Toxicology: A New Application for Metabolomics. EXPOSOME 2023; 3:osad008. [PMID: 38766521 PMCID: PMC11101153 DOI: 10.1093/exposome/osad008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
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.
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Affiliation(s)
- Blake R. Rushing
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne E Thessen
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ghada A. Soliman
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York-Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Susan CJ Sumner
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chauhan R, Archibong AE, Ramesh A. Imprinting and Reproductive Health: A Toxicological Perspective. Int J Mol Sci 2023; 24:16559. [PMID: 38068882 PMCID: PMC10706004 DOI: 10.3390/ijms242316559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
This overview discusses the role of imprinting in the development of an organism, and how exposure to environmental chemicals during fetal development leads to the physiological and biochemical changes that can have adverse lifelong effects on the health of the offspring. There has been a recent upsurge in the use of chemical products in everyday life. These chemicals include industrial byproducts, pesticides, dietary supplements, and pharmaceutical products. They mimic the natural estrogens and bind to estradiol receptors. Consequently, they reduce the number of receptors available for ligand binding. This leads to a faulty signaling in the neuroendocrine system during the critical developmental process of 'imprinting'. Imprinting causes structural and organizational differentiation in male and female reproductive organs, sexual behavior, bone mineral density, and the metabolism of exogenous and endogenous chemical substances. Several studies conducted on animal models and epidemiological studies provide profound evidence that altered imprinting causes various developmental and reproductive abnormalities and other diseases in humans. Altered metabolism can be measured by various endpoints such as the profile of cytochrome P-450 enzymes (CYP450's), xenobiotic metabolite levels, and DNA adducts. The importance of imprinting in the potentiation or attenuation of toxic chemicals is discussed.
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Affiliation(s)
- Ritu Chauhan
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Anthony E. Archibong
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
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Stingone JA, Geller AM, Hood DB, Makris KC, Mouton CP, States JC, Sumner SJ, Wu KL, Rajasekar AK. Community-level exposomics: a population-centered approach to address public health concerns. EXPOSOME 2023; 3:osad009. [PMID: 38550543 PMCID: PMC10976977 DOI: 10.1093/exposome/osad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.
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Affiliation(s)
- Jeanette A. Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrew M. Geller
- Office of Research and Development, Environmental Protection Agency, RTP, NC, USA
| | - Darryl B. Hood
- Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, USA
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Charles P. Mouton
- Department of Family Medicine, University of Texas Medical Branch Galveston, TX, USA
| | - J. Christopher States
- Center for Integrative Environmental Health Sciences, Department of Pharmacology and Toxicology University of Louisville School of Medicine, Louisville, KY, USA
| | - Susan J. Sumner
- Department of Nutrition, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - K. Lily Wu
- California Environmental Protection Agency—Office of Environmental Health Hazard Assessment, Sacramento, CA, USA
| | - Arcot K Rajasekar
- School of Information and Library Science, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Gudi-Mindermann H, White M, Roczen J, Riedel N, Dreger S, Bolte G. Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome. ENVIRONMENTAL RESEARCH 2023; 233:116485. [PMID: 37352954 DOI: 10.1016/j.envres.2023.116485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.
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Affiliation(s)
- Helene Gudi-Mindermann
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany.
| | - Maddie White
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Jana Roczen
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Natalie Riedel
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Stefanie Dreger
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
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Sandifer PA. Linking coastal environmental and health observations for human wellbeing. Front Public Health 2023; 11:1202118. [PMID: 37780424 PMCID: PMC10540068 DOI: 10.3389/fpubh.2023.1202118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.
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Affiliation(s)
- Paul A. Sandifer
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
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Meltzer GY, Merdjanoff AA, Xu S, Gershon R, Emrich CT, Abramson DM. Examining the effects of cumulative environmental stressors on Gulf Coast child and adolescent health. POPULATION AND ENVIRONMENT 2023; 45:21. [PMID: 38681821 PMCID: PMC11052576 DOI: 10.1007/s11111-023-00436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 05/01/2024]
Abstract
This study examines how community-level cumulative environmental stress affects child and adolescent emotional distress and chronic health conditions both directly and indirectly through stressors at the household, family, and individual levels. Data comes from the Women and their Children's Health (WaTCH) Study, which sought to understand the health implications of exposure to the 2010 Deepwater Horizon oil spill (DHOS) among a cohort of 596 mothers with children ages 10 to 17 in southeastern Louisiana. Community-level environmental stress was measured using a newly developed geospatial index. Household-level stressors included previous hurricane impacts, impacts of DHOS, degree of financial difficulty, and degree of housing physical decay. Family stressors included maternal depression, self-rated physical health, and degree of parenting stress. Child stress was based on perceived stress; child mental health was based on serious emotional disturbance; and child physical health was based on diagnosis of chronic illness. Structural equation modeling used weighted least squares means and variance and theta parameterization. Results showed a significant negative direct path between community-level cumulative environmental stress and child/adolescent serious emotional disturbance and chronic illness. However, the indirect relationship through household, family, and individual-level stressors was significant and positive for both child/adolescent serious emotional disturbance and chronic illness. These findings point to the centrality of the household and family in determining child and adolescent physical and mental health outcomes in communities exposed to frequent disasters and ongoing environmental stressors.
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Affiliation(s)
- Gabriella Y. Meltzer
- Departments of Epidemiology and Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alexis A. Merdjanoff
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Shu Xu
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Robyn Gershon
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Christopher T. Emrich
- School of Public Administration & National Center for Integrated Coastal Research, University of Central Florida, Orlando, FL, USA
| | - David M. Abramson
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
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John DH, Andress L, Aytur S, Dodge T, Gustat J, Schuchardt-Vogt CE, Lee RE. Scoping Conceptions of Equity: Reviewing a Decade of Physical Activity Research. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2023; 3:7-18. [PMID: 37794922 PMCID: PMC10546938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Lee and Cubbin's (2009) call for a "socially just" Ecological Model of Physical Activity (EMPA) prompted an inquiry into physical activity (PA), active living (AL) research that advances social justice framed as a set of equity-centered principles for research. In response to the call, we conducted a scoping review to explore how PAAL research has operationalized equity to advance a socially-just EMPA. We searched for original research, published between 2010 and 2020, using key terms for 'physical activity' and 'equity' that produced 5,152 non-duplicated records. Title-abstract screening for exclusion/inclusion criteria disqualified 4,392 records. A review protocol and coding guide was developed, piloted, and revised by team members. The remaining 760 abstracts were reviewed and consensus coded for PA Variable (dependent or independent) and Factor (individual outcome or contextual exposure), Equity (population demographic or social-environmental determinant), and Social Ecological Milieu (SEM) (PAAL-specific or SEM-general policy, system, or environment (PSE) operations. Of the 463 studies selected, PA codified as an individual outcome (67%) more often than as a contextual-exposure (33%) factor. Equity codified more frequently as a population demographic (69%) rather than as a social-environmental determinant (31%). The SEM codified as PAAL-specific (44%) or as SEM-general (56%) PSE factors. Based on multistep study abstract reviews, the selected studies more often missed the opportunity to center equity in PAAL research by examining social, environmental, political, and systemic factors as institutionalized inequities at the root of PAAL disparities. We will not achieve a socially-just EMPA without shared conceptualizations of equity followed by intentional action.
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Affiliation(s)
| | - Lauri Andress
- University of New Mexico, College of Population Health,
U.S.A.
| | - Semra Aytur
- University of New Hampshire, Department of Health Management & Policy,
U.S.A.
| | - Tina Dodge
- Oregon State University, College of Health,
U.S.A.
| | - Jeanette Gustat
- Tulane University, School of Public Health & Tropical Medicine,
U.S.A.
| | - Clare E. Schuchardt-Vogt
- Arizona State University, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation,
U.S.A.
| | - Rebecca E. Lee
- Arizona State University, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation,
U.S.A.
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Giusti M, Samuelsson K. Evaluation of a smartphone-based methodology that integrates long-term tracking of mobility, place experiences, heart rate variability, and subjective well-being. Heliyon 2023; 9:e15751. [PMID: 37206049 PMCID: PMC10189173 DOI: 10.1016/j.heliyon.2023.e15751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
This study presents MyGävle, a smartphone application that merge long-term tracking of mobility data, heart rate variability and subjective and objective well-being records. Developed to address the challenges faced in researching healthy and sustainable lifestyles, this app serves as a pioneering implementation of Real-life Long-term Methodology (ReaLM). After eight months' use by 257 participants from Gävle (Sweden), we evaluate the completeness, accuracy, validity, and consistency of all data collected. MyGävle produced remarkable results as a ReaLM method. On average, it precisely tracked participants daily locations for approximately 8 h and accurately collected heart-rate variability values throughout the day (12 h) and night (6 h). Participants reported 5115 subjective place experiences (ranging from 160 to 120 per week) and seasonal participation, although declining, is accurate. Our findings indicate that the amount of data collected through smartphone sensors, fitness wristbands and in-app questionnaires is consistent enough to be leveraged for integrated assessments of habits, environmental exposure, and subjective and physiological well-being. Yet, considerable variation exists across individuals; thus diagnostic analysis must precede use of these datasets in any particular research endeavors. By doing so we can maximise the potential of ReaLM research to delve into real life conditions conducive to healthy living habits while also considering broader sustainability goals.
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Folorunso OM, Bocca B, Ruggieri F, Frazzoli C, Chijioke-Nwauche I, Orisakwe OE. Heavy metals and inflammatory, oxidative/antioxidant and DNA damage biomarkers among people living with HIV/AIDS (PLWHA) in Niger Delta, Nigeria. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2023; 58:295-313. [PMID: 36876887 DOI: 10.1080/10934529.2023.2185004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This study evaluated the association of heavy metals (HMs) and effect biomarkers (inflammation, oxidative stress/antioxidant capacity and DNA damage) among people living with HIV/AIDS (PHWHA) in Niger Delta area, Nigeria. Blood levels of lead (BPb), cadmium (BCd), copper (BCu), zinc (BZn), iron (BFe), C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Interferon-γ (IFN-γ), Malondialdehyde (MDA), Glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdG) were determined in a total of 185 participants, 104 HIV-positive and 81 HIV-negative sampled in both Niger Delta and non-Niger Delta regions. BCd (p < 0.001) and BPb (p = 0.139) were higher in HIV-positive subjects compared to HIV-negative controls; on the contrary, BCu, BZn and BFe levels were lower (p < 0.001) in HIV-positive subjects compared to HIV-negative controls. The Niger Delta population had higher levels of heavy metals (p < 0.01) compared to non-Niger Delta residents. CRP and 8-OHdG were higher (p < 0.001) in HIV-positive than in HIV-negative subjects and in Niger-Delta than in non-Niger Delta residents. BCu had significant positive dose-response relationship with CRP (61.9%, p = 0.063) and GSH (1.64%, p = 0.035) levels in HIV-positive subjects, and negative response with MDA levels (26.6%, p < 0.001). Periodic assessment of HMs levels among PLWHA is recommended.
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Affiliation(s)
- Opeyemi M Folorunso
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt, Rivers State, Nigeria
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Ruggieri
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseas, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Ifeyinwa Chijioke-Nwauche
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Orish E Orisakwe
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt, Rivers State, Nigeria
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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Tu B, Patel R, Pitalua M, Khan H, Gittner LS. Building effective intervention models utilizing big data to prevent the obesity epidemic. Obes Res Clin Pract 2023; 17:108-115. [PMID: 36870867 DOI: 10.1016/j.orcp.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The exposome consists of factors an individual is exposed to across the life course. The exposome is dynamic, meaning the factors are constantly changing, affecting each other and individuals in different ways. Our exposome dataset includes social determinants of health as well as policy, climate, environment, and economic factors that could impact obesity development. The objective was to translate spatial exposure to these factors with the presence of obesity into actionable population-based constructs that could be further explored. METHODS Our dataset was constructed from a combination of public-use datasets and the Center of Disease Control's Compressed Mortality File. Spatial Statistics using Queens First Order Analysis was performed to identify hot- and cold-spots of obesity prevalence; followed by Graph Analysis, Relational Analysis, and Exploratory Factor Analysis to model the multifactorial spatial connections. RESULTS Areas of high and low presence of obesity had different factors associated with obesity. Factors associated with obesity in areas of high obesity propensity were: poverty / unemployment; workload, comorbid conditions (diabetes, CVD) and physical activity. Conversely, factors associated in areas where obesity was rare were: smoking, lower education, poorer mental health, lower elevations, and heat. DISCUSSION The spatial methods described within the paper are scalable to large numbers of variables without issues of multiple comparisons lowering resolution. These types of spatial structural methods provide insights into novel variable associations or factor interactions that can then be studied further at the population or policy levels.
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Affiliation(s)
- Brittany Tu
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Radha Patel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mario Pitalua
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Hafiz Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Lisaann S Gittner
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Moccia C, Pizzi C, Moirano G, Popovic M, Zugna D, d'Errico A, Isaevska E, Fossati S, Nieuwenhuijsen MJ, Fariselli P, Sanavia T, Richiardi L, Maule M. Modelling socioeconomic position as a driver of the exposome in the first 18 months of life of the NINFEA birth cohort children. ENVIRONMENT INTERNATIONAL 2023; 173:107864. [PMID: 36913779 DOI: 10.1016/j.envint.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The exposome drivers are less studied than its consequences but may be crucial in identifying population subgroups with unfavourable exposures. OBJECTIVES We used three approaches to study the socioeconomic position (SEP) as a driver of the early-life exposome in Turin children of the NINFEA cohort (Italy). METHODS Forty-two environmental exposures, collected at 18 months of age (N = 1989), were classified in 5 groups (lifestyle, diet, meteoclimatic, traffic-related, built environment). We performed cluster analysis to identify subjects sharing similar exposures, and intra-exposome-group Principal Component Analysis (PCA) to reduce the dimensionality. SEP at childbirth was measured through the Equivalised Household Income Indicator. SEP-exposome association was evaluated using: 1) an Exposome Wide Association Study (ExWAS), a one-exposure (SEP) one-outcome (exposome) approach; 2) multinomial regression of cluster membership on SEP; 3) regressions of each intra-exposome-group PC on SEP. RESULTS In the ExWAS, medium/low SEP children were more exposed to greenness, pet ownership, passive smoking, TV screen and sugar; less exposed to NO2, NOX, PM25abs, humidity, built environment, traffic load, unhealthy food facilities, fruit, vegetables, eggs, grain products, and childcare than high SEP children. Medium/low SEP children were more likely to belong to a cluster with poor diet, less air pollution, and to live in the suburbs than high SEP children. Medium/low SEP children were more exposed to lifestyle PC1 (unhealthy lifestyle) and diet PC2 (unhealthy diet), and less exposed to PC1s of the built environment (urbanization factors), diet (mixed diet), and traffic (air pollution) than high SEP children. CONCLUSIONS The three approaches provided consistent and complementary results, suggesting that children with lower SEP are less exposed to urbanization factors and more exposed to unhealthy lifestyles and diet. The simplest method, the ExWAS, conveys most of the information and is more replicable in other populations. Clustering and PCA may facilitate results interpretation and communication.
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Affiliation(s)
- Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy.
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Antonio d'Errico
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Serena Fossati
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain
| | | | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tiziana Sanavia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
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Jeanjean M, Dron J, Allen BL, Gramaglia C, Austruy A, Lees J, Ferrier Y, Periot M, Dotson MP, Chamaret P, Cohen AK. Participatory environmental health research: A tool to explore the socio-exposome in a major european industrial zone. ENVIRONMENTAL RESEARCH 2023; 218:114865. [PMID: 36435495 DOI: 10.1016/j.envres.2022.114865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES We show that participatory research approaches can be a useful tool across disciplines and data collection methods to explore the socio-exposome near one of the largest industrial harbors in Europe. We analyzed resident involvement in each project and their capacity to affect structural changes. METHODS Longitudinal participatory environmental monitoring studies on lichens, petunias, aquatic systems and groundwater were conducted under the program VOCE (Volunteers for the Citizens' Observation of the Environment), which mobilized nearly 100 volunteers to collect and report data. A community-based participatory health survey, Fos EPSEAL was also carried out during the same period. We describe citizens' involvement in each study following Davis and Ramirez-Andreotta's (2021) 'best practice' grid. We also use residents' insights to refine understanding of the socio-exposome. RESULTS The region is significantly impacted by industrial pollution and fenceline communities are disproportionately exposed. The community-based participatory health survey documented negative health outcomes among the residents, including a higher prevalence of chronic symptoms and diabetes (e.g., 11.9%) in the Fos-Berre Lagoon region than in other communities. This methodology shows the benefits of the co-production of knowledge in environmental health: not only does it enable epistemological transformations favorable to the vulnerable population, but it also triggered public action (i.e., media and public authorities' attention leading to official expertise reports, filing of collective complaints before the courts). CONCLUSION This body of multiple participatory research studies over time is a useful approach to better understand the socio-exposome and health issues in an industrial zone.
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Affiliation(s)
- Maxime Jeanjean
- Institut Ecocitoyen pour La Connaissance des Pollutions - Centre de Vie La Fossette, RD 268, Fos-sur-Mer, 13270, France.
| | - Julien Dron
- Institut Ecocitoyen pour La Connaissance des Pollutions - Centre de Vie La Fossette, RD 268, Fos-sur-Mer, 13270, France
| | - Barbara L Allen
- Department of Science, Technology and Society, Virginia Polytechnic & State University-National Capital Region, Falls Church, VA, USA
| | - Christelle Gramaglia
- UMR-GEAU INRAE, 361 Rue J.-F. Breton BP 5095 34196 Montpellier, Languedoc-Roussillon, France
| | - Annabelle Austruy
- Institut Ecocitoyen pour La Connaissance des Pollutions - Centre de Vie La Fossette, RD 268, Fos-sur-Mer, 13270, France
| | - Johanna Lees
- Centre Norbert Elias (UMR 85 62), La Vieille Charité, 2 Rue de La Charité, 13002, Marseille, France; Laboratoire de Sciences Sociales Appliquées, 17 Cr Franklin Roosevelt, 13001, Marseille, France
| | - Yolaine Ferrier
- Laboratoire de Sciences Sociales Appliquées, 17 Cr Franklin Roosevelt, 13001, Marseille, France
| | - Marine Periot
- Institut Ecocitoyen pour La Connaissance des Pollutions - Centre de Vie La Fossette, RD 268, Fos-sur-Mer, 13270, France
| | - Miranda P Dotson
- Northeastern University, Department of Sociology and Anthropology, 360 Huntington Avenue, Boston, MA, USA, 02115
| | - Philippe Chamaret
- Institut Ecocitoyen pour La Connaissance des Pollutions - Centre de Vie La Fossette, RD 268, Fos-sur-Mer, 13270, France
| | - Alison K Cohen
- University of California San Francisco, Department of Epidemiology & Biostatistics, 550 16th Street, 2nd Floor, San Francisco, CA, USA, 94158
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Van Horne YO, Alcala CS, Peltier RE, Quintana PJE, Seto E, Gonzales M, Johnston JE, Montoya LD, Quirós-Alcalá L, Beamer PI. An applied environmental justice framework for exposure science. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:1-11. [PMID: 35260805 PMCID: PMC8902490 DOI: 10.1038/s41370-022-00422-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/28/2023]
Abstract
On the 30th anniversary of the Principles of Environmental Justice established at the First National People of Color Environmental Leadership Summit in 1991 (Principles of Environmental Justice), we continue to call for these principles to be more widely adopted. We propose an environmental justice framework for exposure science to be implemented by all researchers. This framework should be the standard and not an afterthought or trend dismissed by those who believe that science should not be politicized. Most notably, this framework should be centered on the community it seeks to serve. Researchers should meet with community members and stakeholders to learn more about the community, involve them in the research process, collectively determine the environmental exposure issues of highest concern for the community, and develop sustainable interventions and implementation strategies to address them. Incorporating community "funds of knowledge" will also inform the study design by incorporating the knowledge about the issue that community members have based on their lived experiences. Institutional and funding agency funds should also be directed to supporting community needs both during the "active" research phase and at the conclusion of the research, such as mechanisms for dissemination, capacity building, and engagement with policymakers. This multidirectional framework for exposure science will increase the sustainability of the research and its impact for long-term success.
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Affiliation(s)
- Yoshira Ornelas Van Horne
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.
| | - Cecilia S Alcala
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102 Street, New York, NY, 10029, USA
| | - Richard E Peltier
- School of Public Health & Health Sciences, University of Massachusetts Amherst, 686 North Pleasant Street, Room 175, Amherst, MA, 01003, USA
| | - Penelope J E Quintana
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Edmund Seto
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Roosevelt One Building, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Melissa Gonzales
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10 5550 Epidemiology, Albuquerque, NM, 87111, USA
| | - Jill E Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | | | - Lesliam Quirós-Alcalá
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Paloma I Beamer
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Ave., Tucson, AZ, 85724, USA
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Ives C, Pan H, Edwards SW, Nelms M, Covert H, Lichtveld MY, Harville EW, Wickliffe JK, Zijlmans W, Hamilton CM. Linking complex disease and exposure data-insights from an environmental and occupational health study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:12-16. [PMID: 35347232 PMCID: PMC9515242 DOI: 10.1038/s41370-022-00428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
The disparate measurement protocols used to collect study data are an intrinsic barrier to combining information from environmental health studies. Using standardized measurement protocols and data standards for environmental exposures addresses this gap by improving data collection quality and consistency. To assess the prevalence of environmental exposures in National Institutes of Health (NIH) public data repositories and resources and to assess the commonality of the data elements, we analyzed clinical measures and exposure assays by comparing the Caribbean Consortium for Research in Environmental and Occupational Health study with selected NIH environmental health resources and studies. Our assessment revealed that (1) environmental assessments are widely collected in these resources, (2) biological assessments are less prevalent, and (3) NIH resources can help identify common data for meta-analysis. We highlight resources to help link environmental exposure data across studies to support data sharing. Including NIH data standards in environmental health research facilitates comparing and combining study data, and the use of NIH resources and adoption of standard measures will allow integration of multiple studies and increase the scientific impact of individual studies.
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Affiliation(s)
- Cataia Ives
- RTI International, Research Triangle Park, NC, USA.
| | - Huaqin Pan
- RTI International, Research Triangle Park, NC, USA
| | | | - Mark Nelms
- RTI International, Research Triangle Park, NC, USA
| | - Hannah Covert
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Emily W Harville
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jeffrey K Wickliffe
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wilco Zijlmans
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
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23
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Bucher ML, Anderson FL, Lai Y, Dicent J, Miller GW, Zota AR. Exposomics as a tool to investigate differences in health and disease by sex and gender. EXPOSOME 2023; 3:osad003. [PMID: 37122372 PMCID: PMC10125831 DOI: 10.1093/exposome/osad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023]
Abstract
The health and disease of an individual is mediated by their genetics, a lifetime of environmental exposures, and interactions between the two. Genetic or biological sex, including chromosome composition and hormone expression, may influence both the types and frequency of environmental exposures an individual experiences, as well as the biological responses an individual has to those exposures. Gender identity, which can be associated with social behaviors such as expressions of self, may also mediate the types and frequency of exposures an individual experiences. Recent advances in exposome-level analysis have progressed our understanding of how environmental factors affect health outcomes; however, the relationship between environmental exposures and sex- and gender-specific health remains underexplored. The comprehensive, non-targeted, and unbiased nature of exposomic research provides a unique opportunity to systematically evaluate how environmental exposures interact with biological sex and gender identity to influence health. In this forward-looking narrative review, we provide examples of how biological sex and gender identity influence environmental exposures, discuss how environmental factors may interact with biological processes, and highlight how an intersectional approach to exposomics can provide critical insights for sex- and gender-specific health sciences.
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Affiliation(s)
| | - Faith L Anderson
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Yunjia Lai
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Jocelyn Dicent
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Gary W Miller
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Ami R Zota
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
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24
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Wei X, Huang Z, Jiang L, Li Y, Zhang X, Leng Y, Jiang C. Charting the landscape of the environmental exposome. IMETA 2022; 1:e50. [PMID: 38867899 PMCID: PMC10989948 DOI: 10.1002/imt2.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 06/14/2024]
Abstract
The exposome depicts the total exposures in the lifetime of an organism. Human exposome comprises exposures from environmental and humanistic sources. Biological, chemical, and physical environmental exposures pose potential health threats, especially to susceptible populations. Although still in its nascent stage, we are beginning to recognize the vast and dynamic nature of the exposome. In this review, we systematically summarize the biological and chemical environmental exposomes in three broad environmental matrices-air, soil, and water; each contains several distinct subcategories, along with a brief introduction to the physical exposome. Disease-related environmental exposures are highlighted, and humans are also a major source of disease-related biological exposures. We further discuss the interactions between biological, chemical, and physical exposomes. Finally, we propose a list of outstanding challenges under the exposome research framework that need to be addressed to move the field forward. Taken together, we present a detailed landscape of environmental exposome to prime researchers to join this exciting new field.
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Affiliation(s)
- Xin Wei
- Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences InstituteZhejiang UniversityHangzhouZhejiangChina
| | - Zinuo Huang
- Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences InstituteZhejiang UniversityHangzhouZhejiangChina
| | - Liuyiqi Jiang
- Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences InstituteZhejiang UniversityHangzhouZhejiangChina
| | - Yueer Li
- Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences InstituteZhejiang UniversityHangzhouZhejiangChina
| | - Xinyue Zhang
- Department of GeneticsStanford UniversityStanfordCaliforniaUSA
| | - Yuxin Leng
- Department of Intensive Care UnitPeking University Third HospitalBeijingChina
| | - Chao Jiang
- Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences InstituteZhejiang UniversityHangzhouZhejiangChina
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, First Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
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25
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Harville EW, Grady SK, Langston MA, Juarez PJ, Vilda D, Wallace ME. The public health exposome and pregnancy-related mortality in the United States: a high-dimensional computational analysis. BMC Public Health 2022; 22:2097. [PMID: 36384521 PMCID: PMC9670647 DOI: 10.1186/s12889-022-14397-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Racial inequities in maternal mortality in the U.S. continue to be stark. METHODS The 2015-2018, 4-year total population, county-level, pregnancy-related mortality ratio (PRM; deaths per 100,000 live births; National Center for Health Statistics (NCHS), restricted use mortality file) was linked with the Public Health Exposome (PHE). Using data reduction techniques, 1591 variables were extracted from over 62,000 variables for use in this analysis, providing information on the relationships between PRM and the social, health and health care, natural, and built environments. Graph theoretical algorithms and Bayesian analysis were applied to PHE/PRM linked data to identify latent networks. RESULTS PHE variables most strongly correlated with total population PRM were years of potential life lost and overall life expectancy. Population-level indicators of PRM were overall poverty, smoking, lack of exercise, heat, and lack of adequate access to food. CONCLUSIONS In this high-dimensional analysis, overall life expectancy, poverty indicators, and health behaviors were found to be the strongest predictors of pregnancy-related mortality. This provides strong evidence that maternal death is part of a broader constellation of both similar and unique health behaviors, social determinants and environmental exposures as other causes of death.
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Affiliation(s)
- E W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - S K Grady
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN, USA
| | - M A Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN, USA
| | - P J Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - D Vilda
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - M E Wallace
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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26
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Samon SM, Hammel SC, Stapleton HM, Anderson KA. Silicone wristbands as personal passive sampling devices: Current knowledge, recommendations for use, and future directions. ENVIRONMENT INTERNATIONAL 2022; 169:107339. [PMID: 36116363 PMCID: PMC9713950 DOI: 10.1016/j.envint.2022.107339] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 05/13/2023]
Abstract
Personal chemical exposure assessment is necessary to determine the frequency and magnitude of individual chemical exposures, especially since chemicals present in everyday environments may lead to adverse health outcomes. In the last decade, silicone wristbands have emerged as a new chemical exposure assessment tool and have since been utilized for assessing personal exposure to a wide range of chemicals in a variety of populations. Silicone wristbands can be powerful tools for quantifying personal exposure to chemical mixtures in a single sample, associating exposure with health outcomes, and potentially overcoming some of the challenges associated with quantifying the chemical exposome. However, as their popularity grows, it is crucial that they are used in the appropriate context and within the limits of the technology. This review serves as a guide for researchers interested in utilizing silicone wristbands as a personal exposure assessment tool. Along with briefly discussing the passive sampling theory behind silicone wristbands, this review performs an in-depth comparison of wristbands to other common exposure assessment tools, including biomarkers of exposure measured in biospecimens, and evaluates their utility in exposure assessments and epidemiological studies. Finally, this review includes recommendations for utilizing silicone wristbands to evaluate personal chemical exposure and provides suggestions on what research is needed to recognize silicone wristbands as a premier chemical exposure assessment tool.
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Affiliation(s)
- Samantha M Samon
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR, United States
| | - Stephanie C Hammel
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Heather M Stapleton
- Nicholas School of the Environment, Duke University, Durham, NC, United States
| | - Kim A Anderson
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR, United States.
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27
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Neufcourt L, Castagné R, Mabile L, Khalatbari-Soltani S, Delpierre C, Kelly-Irving M. Assessing How Social Exposures Are Integrated in Exposome Research: A Scoping Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:116001. [PMID: 36350665 PMCID: PMC9645433 DOI: 10.1289/ehp11015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exposome research aims to describe and understand the extent to which all the exposures in human environments may affect our health over the lifetime. However, the way in which humans interact with their environment is socially patterned. Failing to account for social factors in research exploring the exposome may underestimate the magnitude of the effect of exposures or mask inequalities in the distribution of both exposures and outcomes. OBJECTIVES We aimed to describe the extent to which social factors appear in the exposome literature, the manner in which they are used in empirical analyses and statistical modeling, and the way in which they are considered in the overall scientific approach. METHODS We conducted a scoping review of the literature using three databases (PubMed, Embase, and Web of Science) up to January 2022. We grouped studies based on the way in which the social variables were used in the analyses and quantified the type and frequency of social variables mentioned in the articles. We also qualitatively described the scientific approach used by authors to integrate social variables. RESULTS We screened 1,001 records, and 73 studies were included in the analysis. Fifty-five (∼75%) used social variables as exposures or confounders or both, and a wide array of social variables were represented in the articles. Individual-level social variables were more often found, especially education and race/ethnicity, as well as neighborhood-level deprivation indices. Half of the studies used a hypothesis-free approach and the other half, a hypothesis-driven approach. However, in the latter group, of 35 studies, only 8 reported and discussed at least one possible social mechanism underlying the relationship observed between the social variable and the outcome. DISCUSSION Social factors in exposome research should be considered in a more systematic way, considering their role in structuring both the specific external and the internal exposome. Doing so could help to understand the mechanisms of construction and, potentially, alleviate social inequalities in health and mitigate the emergence of new ones. https://doi.org/10.1289/EHP11015.
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Affiliation(s)
- Lola Neufcourt
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations CERPOP-UMR1295, Inserm–Université Toulouse III Paul Sabatier, Toulouse, France
| | - Raphaële Castagné
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations CERPOP-UMR1295, Inserm–Université Toulouse III Paul Sabatier, Toulouse, France
| | - Laurence Mabile
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations CERPOP-UMR1295, Inserm–Université Toulouse III Paul Sabatier, Toulouse, France
| | - Saman Khalatbari-Soltani
- Faculty of Medicine and Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
| | - Cyrille Delpierre
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations CERPOP-UMR1295, Inserm–Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations CERPOP-UMR1295, Inserm–Université Toulouse III Paul Sabatier, Toulouse, France
- Interdisciplinary Federal Research Institute on Health and Society (IFERISS-Fed 4241), Université Toulouse III Paul Sabatier, Toulouse, France
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28
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Lochotzki H, Williams KP, Colen CG, Adetona O, Tavares CB, Ginn GM, Haynes R, Im W, Bils T, Hood DB. A Framework for Interfacing and Partnering with Environmental Justice Communities as a Prelude to Human Health and Hazard Identification in the Vulnerable Census Tracts of Columbus, Ohio. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13846. [PMID: 36360728 PMCID: PMC9654058 DOI: 10.3390/ijerph192113846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Columbus, Ohio is one of the more prosperous, well-educated, and progressive cities in the United States. However, it ranks as the second worst life expectancy at birth, has a census tract wealth gap (27-year disparity), and one of the higher infant mortality rates in the country. These data suggest that there are likely several high-risk, vulnerable neighborhoods in Columbus with residents experiencing disparate and adverse outcomes. Illustrative of this fact are studies that have examined the social processes and mechanisms through which neighborhood contexts are at the forefront, including exposures to chemical stressors such as particulate matter (PM2.5) as well as non-chemical stressors including violence, social determinants of health, zoning, and land use policies. It is documented that disparate and adverse outcomes are magnified in the vulnerable neighborhoods on the Near East Side as compared to Columbus city proper, Franklin County and/or the state of Ohio. As such, we developed a nuanced community engagement framework to identify potential environmental hazards associated with adverse pregnancy outcomes in those census tracts. The refined framework uses a blended version of traditional community-based participatory research (CBPR) models and is referred to as E6, Enhancing Environmental Endeavors via e-Equity, Education, and Empowerment.
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Affiliation(s)
- Heather Lochotzki
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - Cynthia G. Colen
- Department of Sociology, The Ohio State University, Columbus, OH 43210, USA
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
| | | | - Georgina M. Ginn
- Columbus Early Learning Centers, 1611 Old Leonard Avenue, Columbus, OH 43219, USA
| | - Rejeana Haynes
- St. Vincent Family Services, 1490 East Main Street, Columbus, OH 43205, USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Tanya Bils
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
| | - Darryl B. Hood
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
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Cifuentes MP, Suarez CM, Cifuentes R, Malod-Dognin N, Windels S, Valderrama JF, Juarez PD, Valdez RB, Colen C, Phillips C, Ramesh A, Im W, Lichtveld M, Mouton C, Pržulj N, Hood DB. Big Data to Knowledge Analytics Reveals the Zika Virus Epidemic as Only One of Multiple Factors Contributing to a Year-Over-Year 28-Fold Increase in Microcephaly Incidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159051. [PMID: 35897436 PMCID: PMC9331749 DOI: 10.3390/ijerph19159051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023]
Abstract
During the 2015-2016 Zika Virus (ZIKV) epidemic in Brazil, the geographical distributions of ZIKV infection and microcephaly outbreaks did not align. This raised doubts about the virus as the single cause of the microcephaly outbreak and led to research hypotheses of alternative explanatory factors, such as environmental variables and factors, agrochemical use, or immunizations. We investigated context and the intermediate and structural determinants of health inequalities, as well as social environment factors, to determine their interaction with ZIKV-positive- and ZIKV-negative-related microcephaly. The results revealed the identification of 382 associations among 382 nonredundant variables of Zika surveillance, including multiple determinants of environmental public health factors and variables obtained from 5565 municipalities in Brazil. This study compared those factors and variables directly associated with microcephaly incidence positive to ZIKV and those associated with microcephaly incidence negative to ZIKV, respectively, and mapped them in case and control subnetworks. The subnetworks of factors and variables associated with low birth weight and birthweight where birth incidence served as an additional control were also mapped. Non-significant differences in factors and variables were observed, as were weights of associations between microcephaly incidence, both positive and negative to ZIKV, which revealed diagnostic inaccuracies that translated to the underestimation of the scope of the ZIKV outbreak. A detailed analysis of the patterns of association does not support a finding that vaccinations contributed to microcephaly, but it does raise concerns about the use of agrochemicals as a potential factor in the observed neurotoxicity arising from the presence of heavy metals in the environment and microcephaly not associated with ZIKV. Summary: A comparative network inferential analysis of the patterns of variables and factors associated with Zika virus infections in Brazil during 2015-2016 coinciding with a microcephaly epidemic identified multiple contributing determinants. This study advances our understanding of the cumulative interactive effects of exposures to chemical and non-chemical stressors in the built, natural, physical, and social environments on adverse pregnancy and health outcomes in vulnerable populations.
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Affiliation(s)
- Myriam Patricia Cifuentes
- Department of Mathematics, College of Sciences, Antonio Nariño University, Bogotá 111321, Colombia;
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
| | | | - Ricardo Cifuentes
- School of Medicine and Health Sciences, Universidad Militar Nueva Granada, Bogotá 110111, Colombia;
| | - Noel Malod-Dognin
- Department of Computer Science, University College London, London WC1E 6BT, UK; (N.M.-D.); (S.W.); (N.P.)
| | - Sam Windels
- Department of Computer Science, University College London, London WC1E 6BT, UK; (N.M.-D.); (S.W.); (N.P.)
| | - Jose Fernando Valderrama
- Subdirectorate of Transmissible Diseases, Ministry of Health and Social Protection, Bogotá 110311, Colombia;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - R. Burciaga Valdez
- Department of Family & Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87106, USA;
| | - Cynthia Colen
- Department of Sociology, College of Arts and Sciences, Ohio State University, Columbus, OH 43210, USA;
| | - Charles Phillips
- Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - Maureen Lichtveld
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Charles Mouton
- Department of Family Medicine, College of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Nataša Pržulj
- Department of Computer Science, University College London, London WC1E 6BT, UK; (N.M.-D.); (S.W.); (N.P.)
| | - Darryl B. Hood
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA
- Correspondence:
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30
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Ferrante G, Fasola S, Cilluffo G, Piacentini G, Viegi G, La Grutta S. Addressing Exposome: An Innovative Approach to Environmental Determinants in Pediatric Respiratory Health. Front Public Health 2022; 10:871140. [PMID: 35774568 PMCID: PMC9237327 DOI: 10.3389/fpubh.2022.871140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022] Open
Abstract
Developmental age is particularly vulnerable to impacts of environmental exposures. Until recent years, the field of environment and child health has predominantly relied on the study of single exposure-health effect relationships. The exposome is an emerging concept in epidemiology, encompassing the totality of the exposures experienced by an individual throughout life and their changes over time. This innovative approach provides a risk profile instead of individual predictors. Exposome research may contribute to better understand the complex relationships between environmental exposures and childhood respiratory health, in order to implement prevention strategies and mitigate adverse health outcomes across the life span. Indeed, an accurate assessment of the exposome needs several measurements as well as different technologies. High-throughput "omics" technologies may be promising tools to integrate a wide range of exposures. However, analyzing large and complex datasets requires the development of advanced statistical tools. This narrative review summarizes the current knowledge on exposome-based approaches in pediatric respiratory health. Further, it explores practical implementation, associated evidence gaps, research limitations and future research perspectives.
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Affiliation(s)
- Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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31
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Lebow-Skelley E, Young L, Noibi Y, Blaginin K, Hooker M, Williamson D, Tomlinson MS, Kegler MC, Pearson MA. Defining the Exposome Using Popular Education and Concept Mapping With Communities in Atlanta, Georgia. Front Public Health 2022; 10:842539. [PMID: 35493396 PMCID: PMC9039048 DOI: 10.3389/fpubh.2022.842539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction The exposome concept provides a framework to better incorporate the environment into the study of health and disease and has been defined by academics to encompass all lifetime exposures including toxicants, diet, and lifestyle choices. However, initial applications of the exposome concept have been less apt at measuring social determinants of health, focusing primarily on conventional environmental exposures and lifestyle choices that do not reflect the complex lived experience of many communities. To bring community voice into the exposome concept, the HERCULES Exposome Research Center and its Stakeholder Advisory Board co-developed the Exposome Roadshow. We present and discuss the resulting community-exposome definition to inform and improve exposome research. Materials and Methods Four communities from distinct areas across metro-Atlanta participated in separate 2-day Exposome Roadshow workshops with concept mapping. Aligned with a popular education approach in which community knowledge is used to work collectively for change, concept mapping provided a systematic method to collect and visualize community members' knowledge and create a shared understanding to take action. Community members brainstormed, sorted, and rated their responses to the prompt: "What in your environment is affecting your and your community's health?" Responses were analyzed and visually depicted by concept maps consisting of separate but interrelated clusters of ideas. Community members discussed and validated the maps, selecting a final map illustrating their community's exposome. Results A total of 118 community members completed concept mapping. On average communities identified 7 clusters to define their exposome. The resulting concept maps offer a community definition of the exposome. Five major themes arose across all four communities: conventional environmental concerns, built environment, social relationships, crime and safety, and individual health and behaviors. Discussion The resulting community-exposome definition demonstrates the importance of expanding the scope of exposures beyond traditional environmental influences to include the lived experience of individuals and communities. While newer exposome definitions align more closely with this community definition, traditional exposome methods do not routinely include these factors. To truly capture the totality of lifetime exposures and improve human health, researchers should incorporate community perspectives into exposome research.
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Affiliation(s)
- Erin Lebow-Skelley
- HERCULES Exposome Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States,*Correspondence: Erin Lebow-Skelley
| | - Lynne Young
- HERCULES Stakeholder Advisory Board, Atlanta, GA, United States,Pathways to Sustainability, Duluth, GA, United States
| | - Yomi Noibi
- HERCULES Stakeholder Advisory Board, Atlanta, GA, United States,Environmental Community Action (ECO-Action), Atlanta, GA, United States
| | - Karla Blaginin
- HERCULES Stakeholder Advisory Board, Atlanta, GA, United States,Dichos de la Casa, Norcross, GA, United States
| | - Margaret Hooker
- HERCULES Stakeholder Advisory Board, Atlanta, GA, United States
| | - Dana Williamson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Martha Scott Tomlinson
- HERCULES Exposome Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michelle C. Kegler
- Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Melanie A. Pearson
- HERCULES Exposome Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Abstract
Global human health threats, such as the ongoing COVID-19 pandemic, necessitate coordinated responses at multiple levels. Public health professionals and other experts broadly agree about actions needed to address such threats, but implementation of this advice is stymied by systemic factors such as prejudice, resource deficits, and high inequality. In these cases, crises like epidemics may be viewed as opportunities to spark structural changes that will improve future prevention efforts. However, crises can also weaken governance and reinforce systemic failures. In this paper, we use the concept of the governance treadmill to demonstrate cross-level dynamics that help or hinder the alignment of capacities toward prevention during public health crises. We find that variation in capacities and responses across local, national, and international levels contributes to the complex evolution of global and local health governance. Where capacities are misaligned, effective local prevention of global pandemic impacts tends to be elusive in the short term, and multiple cycles of crisis and response may be required before capacities align toward healthy governance. We demonstrate that this transition requires broader societal adaptation, particularly towards social justice and participatory democracy.
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Malecki KMC, Andersen JK, Geller AM, Harry GJ, Jackson CL, James KA, Miller GW, Ottinger MA. Integrating Environment and Aging Research: Opportunities for Synergy and Acceleration. Front Aging Neurosci 2022; 14:824921. [PMID: 35264945 PMCID: PMC8901047 DOI: 10.3389/fnagi.2022.824921] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/12/2022] [Indexed: 12/25/2022] Open
Abstract
Despite significant overlaps in mission, the fields of environmental health sciences and aging biology are just beginning to intersect. It is increasingly clear that genetics alone does not predict an individual’s neurological aging and sensitivity to disease. Accordingly, aging neuroscience is a growing area of mutual interest within environmental health sciences. The impetus for this review came from a workshop hosted by the National Academies of Sciences, Engineering, and Medicine in June of 2020, which focused on integrating the science of aging and environmental health research. It is critical to bridge disciplines with multidisciplinary collaborations across toxicology, comparative biology, epidemiology to understand the impacts of environmental toxicant exposures and age-related outcomes. This scoping review aims to highlight overlaps and gaps in existing knowledge and identify essential research initiatives. It begins with an overview of aging biology and biomarkers, followed by examples of synergy with environmental health sciences. New areas for synergistic research and policy development are also discussed. Technological advances including next-generation sequencing and other-omics tools now offer new opportunities, including exposomic research, to integrate aging biomarkers into environmental health assessments and bridge disciplinary gaps. This is necessary to advance a more complete mechanistic understanding of how life-time exposures to toxicants and other physical and social stressors alter biological aging. New cumulative risk frameworks in environmental health sciences acknowledge that exposures and other external stressors can accumulate across the life course and the advancement of new biomarkers of exposure and response grounded in aging biology can support increased understanding of population vulnerability. Identifying the role of environmental stressors, broadly defined, on aging biology and neuroscience can similarly advance opportunities for intervention and translational research. Several areas of growing research interest include expanding exposomics and use of multi-omics, the microbiome as a mediator of environmental stressors, toxicant mixtures and neurobiology, and the role of structural and historical marginalization and racism in shaping persistent disparities in population aging and outcomes. Integrated foundational and translational aging biology research in environmental health sciences is needed to improve policy, reduce disparities, and enhance the quality of life for older individuals.
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Affiliation(s)
- Kristen M. C. Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Kristen M. C. Malecki,
| | | | - Andrew M. Geller
- United States Environmental Protection Agency, Office of Research and Development, Durham, NC, United States
| | - G. Jean Harry
- Division of National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, United States
| | - Chandra L. Jackson
- Division of Intramural Research, Department of Health and Human Services, Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
- Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Denver, CO, United States
| | - Gary W. Miller
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Mary Ann Ottinger
- Department of Biology and Biochemistry, University of Houston, Houston, TX, United States
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Price EJ, Vitale CM, Miller GW, David A, Barouki R, Audouze K, Walker DI, Antignac JP, Coumoul X, Bessonneau V, Klánová J. Merging the exposome into an integrated framework for “omics” sciences. iScience 2022; 25:103976. [PMID: 35310334 PMCID: PMC8924626 DOI: 10.1016/j.isci.2022.103976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The exposome concept encourages holistic consideration of the non-genetic factors (environmental exposures including lifestyle) that influence an individual’s health over their life course. However, disconnect between the concept and practical application has promoted divergent interpretations of the exposome across disciplines and reinforced separation of the environmental (emphasizing exposures) and biological (emphasizing responses) research communities. In particular, while knowledge of biological responses can help to distinguish actual (i.e. experienced) from potential exposures, the inclusion of endogenous processes has generated confusion about the position of the exposome in a multi-omics systems biology context. We propose a reattribution of “exposome” to exclusively represent the totality of contact with external factors that a biological entity experiences, and introduce the term “functional exposomics” to denote the systematic study of exposure-phenotype interaction. This reoriented definition of the exposome allows a more readily integrable dataset for multi-omics and systems biology research. Reattribution of exposome concept to exclusively represent environmental exposures Generalized the exposome concept for all levels of biological organization Functional exposome presented as the totality of exposure-phenotype interaction
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Thyroid Cancer Diagnostics Related to Occupational and Environmental Risk Factors: An Integrated Risk Assessment Approach. Diagnostics (Basel) 2022; 12:diagnostics12020318. [PMID: 35204408 PMCID: PMC8870864 DOI: 10.3390/diagnostics12020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
There are still many questions remaining about the etiopathogenesis of thyroid cancer, the most common type of endocrine neoplasia. Numerous occupational and environmental exposures have been shown to represent important risk factors that increase its incidence. Updated information about thyroid cancer diagnostics related to occupational and environmental risk factors is reviewed here, considering an integrated risk assessment approach; new data concerning thyroid cancer etiology and pathogenesis mechanisms, diagnostic biomarkers and methodologies, and risk factors involved in its pathogenesis are presented. A special emphasis is dedicated to specific occupational risk factors and to the association between environmental risk agents and thyroid cancer development. The occupational environment is taken into consideration, i.e., the current workplace and previous jobs, as well as data regarding risk factors, e.g., age, gender, family history, lifestyle, use of chemicals, or radiation exposure outside the workplace. Finally, an integrative approach is presented, underlying the need for an accurate Risk Assessment Matrix based on a systematic questionnaire. We propose a complex experimental design that contains different inclusion and exclusion criteria for patient groups, detailed working protocols for achieving coherent and sustainable, well-defined research stages from sample collection to the identification of biomarkers, with correlations between specific oncometabolites integrated into the Risk Assessment Matrix.
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Yang J, Ma S, Song Y, Li F, Zhou J. Rethinking of Environmental Health Risks: A Systematic Approach of Physical-Social Health Vulnerability Assessment on Heavy-Metal Exposure through Soil and Vegetables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413379. [PMID: 34948988 PMCID: PMC8702039 DOI: 10.3390/ijerph182413379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
In the field of environmental health risk assessment and management research, heavy metals in soil are a constant focus, largely because of mining and metallurgical activities, and other manufacturing or producing. However, systematic vulnerability, and combined research of social and physical vulnerability of the crowd, have received less attention in the research literature of environmental health risk assessment. For this reason, tentative design modelling for comprehensive environmental health vulnerability, which includes the index of physical and social vulnerability, was conducted here. On the basis of experimental data of heavy-metal pollution in soil and vegetables, and population and societal survey data in Daye, China, the physical, social, and comprehensive environmental health vulnerabilities of the area were analyzed, with each village as an evaluation unit. First, the polluted and reference areas were selected. Random sampling sites were distributed in the farmland of the villages in these two areas, with two sampling sites per village. Then, 204 vegetable samples were directly collected from the farmland from which the soil samples had been collected, composed of seven kinds of vegetables: cowpea, water spinach, amaranth, sweet potato leaves, tomato, eggplant, and pepper. Moreover, 400 questionnaires were given to the local residents in these corresponding villages, and 389 valid responses were obtained. The results indicated that (1) the average physical vulnerability values of the population in the polluted and reference areas were 3.99 and 1.00, respectively; (2) the village of Weiwang (WW) had the highest physical vulnerability of 8.55; (3) vegetable intake is exposure that should be paid more attention, as it contributes more than 90% to physical vulnerability among the exposure pathways; (4) arsenic and cadmium should be the priority pollutants, with average physical vulnerability value contributions of 63.9% and 17.0%, respectively; (5) according to the social vulnerability assessment, the village of Luoqiao (LQ) had the highest social vulnerability (0.77); (6) for comprehensive environmental health vulnerability, five villages near mining activities and two villages far from mine-affected area had high physical and social vulnerability, and are the urgent areas for environmental risk management. In order to promote environmental risk management, it is necessary to prioritize identifying vulnerable populations in the village-scale dimension as an innovative discovery.
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Affiliation(s)
- Jun Yang
- Research Center for Environment and Health, Zhongnan University of Economic and Law, Wuhan 430073, China; (J.Y.); (Y.S.); (F.L.)
| | - Silu Ma
- Wuhan Planning and Design Company, Wuhan 430014, China;
| | - Yongwei Song
- Research Center for Environment and Health, Zhongnan University of Economic and Law, Wuhan 430073, China; (J.Y.); (Y.S.); (F.L.)
| | - Fei Li
- Research Center for Environment and Health, Zhongnan University of Economic and Law, Wuhan 430073, China; (J.Y.); (Y.S.); (F.L.)
| | - Jingcheng Zhou
- Research Center for Environment and Health, Zhongnan University of Economic and Law, Wuhan 430073, China; (J.Y.); (Y.S.); (F.L.)
- Correspondence: ; Tel.: +86-027-8838-5413
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Chen CHS, Kuo TC, Kuo HC, Tseng YJ, Kuo CH, Yuan TH, Chan CC. Lipidomics of children and adolescents exposed to multiple industrial pollutants. ENVIRONMENTAL RESEARCH 2021; 201:111448. [PMID: 34119529 DOI: 10.1016/j.envres.2021.111448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are limited studies on the lipidomics of children and adolescents exposed to multiple industrial pollutants. OBJECTIVES In this study, we aimed to investigate lipid profile perturbations in 99 children and adolescents (aged 9-15) who lived in a polluted area surrounding the largest petrochemical complex in Taiwan. Previous studies have reported increased risks of acute and chronic diseases including liver dysfunctions and chronic kidney disease (CKD) in residents living in this area. METHODS We measured urinary concentrations of 11 metals and metalloids and polycyclic aromatic hydrocarbons (PAHs) metabolite 1-hydroxypyrene (1-OHP) as exposure biomarkers, and urinary oxidative stress biomarkers and serum acylcarnitines as early health effect biomarkers. The association between individual exposure biomarkers and early health effect biomarkers were analyzed using linear regression, while association of combined exposure biomarkers with four oxidative stress biomarkers and acylcarnitines were analyzed using weighted quantile sum (WQS) regression. Lipid profiles were analyzed using an untargeted liquid chromatography mass spectrometry-based technique. "Meet-in-the-middle" approach was applied to identify potential lipid features that linked multiple industrial pollutants exposure with early health effects. RESULTS We identified 15 potential lipid features that linked elevated multiple industrial pollutants exposure with three increased oxidative stress biomarkers and eight deregulated serum acylcarnitines, including one lysophosphatidylcholines (LPCs), four phosphatidylcholines (PCs), and two sphingomyelins (SMs) that were up-regulated in high exposure group compared to low exposure group, and two LPCs, four PCs, and two phosphatidylinositols (PIs) down-regulated in high exposure group compared to low exposure group. CONCLUSION Our findings could provide information for understanding the health effects, including early indicators and biological mechanism identification, of children and adolescents exposed to multiple industrial pollutants during critical stages of development.
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Affiliation(s)
- Chi-Hsin S Chen
- Master of Public Health Program, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan
| | - Tien-Chueh Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Yufeng J Tseng
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Department of Computer Science and Information Engineering, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University. No. 33, Linsen S. Road, Taipei, 10055, Taiwan
| | - Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan. No.101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, 11153, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan.
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Exploring the Potential Risk of Heavy Metal Pollution of Edible Cultivated Plants in Urban Gardening Contexts Using a Citizen Science Approach in the Project “Heavy Metal City-Zen”. SUSTAINABILITY 2021. [DOI: 10.3390/su13158626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Urban gardening has become increasingly popular, creating green oases in cities; however, many of these activities are undertaken in areas of high traffic density or on ex-brown field sites. As a consequence, there are still some barriers to the adoption of these urban gardening practices for food production. One of the public concerns is the transfer of urban pollutants such as heavy metals into the consumer’s food chain, however, city-wide data is often difficult and expensive to collect. In the citizen science project described herein, we conducted simple citizen-led common collaborative experiments in urban community gardens. These data provided information on the potential risk of heavy metal contaminants and ways in which to mitigate those risks in an urban gardening context. Generally, values were below guideline thresholds, however, at a few garden sites, soil trace metal concentrations (Pb, Cd, Zn) exceeded Austrian recommended limits. Moreover, only at two sites were plant trace metal concentrations shown to be above European food standards limits. Given the citizen’s positive response to the project, we suggest expanding this study to the whole of Vienna, giving newly established gardens a chance to predetermine the risks posed by their local soils.
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Kane NJ, Wang X, Gerkovich MM, Breitkreutz M, Rivera B, Kunchithapatham H, Hoffman MA. The Envirome Web Service: Patient context at the point of care. J Biomed Inform 2021; 119:103817. [PMID: 34020026 DOI: 10.1016/j.jbi.2021.103817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/27/2022]
Abstract
Patient context - the "envirome" - can have a significant impact on patient health. While envirome indicators are available through large scale public data sources, they are not provided in a format that can be easily accessed and interpreted at the point of care by healthcare providers with limited time during a patient encounter. We developed a clinical decision support tool to bring envirome indicators to the point of care in a large pediatric hospital system in the Kansas City region. The Envirome Web Service (EWS) securely geocodes patient addresses in real time to link their records with publicly available context data. End-users guided the design of the EWS, which presents summaries of patient context data in the electronic health record (EHR) without disrupting the provider workflow. Through surveys, focus groups, and a formal review by hospital staff, the EWS was deployed into production use, integrating publicly available data on food access with the hospital EHR. Evaluation of EWS usage during the 2020 calendar year shows that 1,034 providers viewed the EWS, with a total of 29,165 sessions. This suggests that the EWS was successfully integrated with the EHR and is highly visible. The results also indicate that 63 (6.1%) of the providers are regular users that opt to maintain the EWS in their custom workflows, logging more than 100 EWS sessions during the year. The vendor agnostic design of the EWS supports interoperability and makes it accessible to health systems with disparate EHR vendors.
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Affiliation(s)
- N J Kane
- Children's Mercy Hospital, Kansas City, MO, United States
| | - X Wang
- University of Missouri-Kansas City, United States
| | | | - M Breitkreutz
- Children's Mercy Hospital, Kansas City, MO, United States
| | - B Rivera
- Children's Mercy Hospital, Kansas City, MO, United States
| | | | - M A Hoffman
- Children's Mercy Hospital, Kansas City, MO, United States; University of Missouri-Kansas City, United States.
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Caudeville J, Regrain C, Tognet F, Bonnard R, Guedda M, Brochot C, Beauchamp M, Letinois L, Malherbe L, Marliere F, Lestremau F, Chardon K, Bach V, Zeman FA. Characterizing environmental geographic inequalities using an integrated exposure assessment. Environ Health 2021; 20:58. [PMID: 33980260 PMCID: PMC8117491 DOI: 10.1186/s12940-021-00736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/25/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND At a regional or continental scale, the characterization of environmental health inequities (EHI) expresses the idea that populations are not equal in the face of pollution. It implies an analysis be conducted in order to identify and manage the areas at risk of overexposure where an increasing risk to human health is suspected. The development of methods is a prerequisite for implementing public health activities aimed at protecting populations. METHODS This paper presents the methodological framework developed by INERIS (French National Institute for Industrial Environment and Risks) to identify a common framework for a structured and operationalized assessment of human exposure. An integrated exposure assessment approach has been developed to integrate the multiplicity of exposure pathways from various sources, through a series of models enabling the final exposure of a population to be defined. RESULTS Measured data from environmental networks reflecting the actual contamination of the environment are used to gauge the population's exposure. Sophisticated methods of spatial analysis are applied to include additional information and take benefit of spatial and inter-variable correlation to improve data representativeness and characterize the associated uncertainty. Integrated approaches bring together all the information available for assessing the source-to-human-dose continuum using a Geographic Information System, multimedia exposure and toxicokinetic model. DISCUSSION One of the objectives of the integrated approach was to demonstrate the feasibility of building complex realistic exposure scenarios satisfying the needs of stakeholders and the accuracy of the modelling predictions at a fine spatial-temporal resolution. A case study is presented to provide a specific application of the proposed framework and how the results could be used to identify an overexposed population. CONCLUSION This framework could be used for many purposes, such as mapping EHI, identifying vulnerable populations and providing determinants of exposure to manage and plan remedial actions and to assess the spatial relationships between health and the environment to identify factors that influence the variability of disease patterns.
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Affiliation(s)
- Julien Caudeville
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France.
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France.
| | - Corentin Regrain
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
- LAMFA, UMR CNRS 7352, Université de Picardie Jules Verne, 33 rue Saint-Leu, 80039, Amiens, France
| | - Frederic Tognet
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Roseline Bonnard
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Mohammed Guedda
- LAMFA, UMR CNRS 7352, Université de Picardie Jules Verne, 33 rue Saint-Leu, 80039, Amiens, France
| | - Celine Brochot
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Maxime Beauchamp
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Laurent Letinois
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Laure Malherbe
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Fabrice Marliere
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Francois Lestremau
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Karen Chardon
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Veronique Bach
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Florence Anna Zeman
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
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Minas TZ, Kiely M, Ajao A, Ambs S. An overview of cancer health disparities: new approaches and insights and why they matter. Carcinogenesis 2021; 42:2-13. [PMID: 33185680 PMCID: PMC7717137 DOI: 10.1093/carcin/bgaa121] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer health disparities remain stubbornly entrenched in the US health care system. The Affordable Care Act was legislation to target these disparities in health outcomes. Expanded access to health care, reduction in tobacco use, uptake of other preventive measures and cancer screening, and improved cancer therapies greatly reduced cancer mortality among women and men and underserved communities in this country. Yet, disparities in cancer outcomes remain. Underserved populations continue to experience an excessive cancer burden. This burden is largely explained by health care disparities, lifestyle factors, cultural barriers, and disparate exposures to carcinogens and pathogens, as exemplified by the COVID-19 epidemic. However, research also shows that comorbidities, social stress, ancestral and immunobiological factors, and the microbiome, may contribute to health disparities in cancer risk and survival. Recent studies revealed that comorbid conditions can induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. In this review, we will discuss unanswered questions and new opportunities in cancer health disparity research related to comorbid chronic diseases, stress signaling, the immune response, and the microbiome, and what contribution these factors may have as causes of cancer health disparities.
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Affiliation(s)
- Tsion Zewdu Minas
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maeve Kiely
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anuoluwapo Ajao
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Aytur SA, Ray KL, Meier SK, Campbell J, Gendron B, Waller N, Robin DA. Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach. Front Hum Neurosci 2021; 15:587018. [PMID: 33613207 PMCID: PMC7892587 DOI: 10.3389/fnhum.2021.587018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560-$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.
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Affiliation(s)
- Semra A. Aytur
- Department of Health Management and Policy, University of New Hampshire, Durham, NH, United States
| | - Kimberly L. Ray
- Department of Psychology, University of Texas at Austin, Austin, TX, United States
| | - Sarah K. Meier
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Jenna Campbell
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Barry Gendron
- Wentworth Health Partners Seacoast Physiatry, Somersworth, NH, United States
| | - Noah Waller
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Donald A. Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
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Zota AR, VanNoy BN. Integrating Intersectionality Into the Exposome Paradigm: A Novel Approach to Racial Inequities in Uterine Fibroids. Am J Public Health 2020; 111:104-109. [PMID: 33211578 DOI: 10.2105/ajph.2020.305979] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Intersectionality is a critical theoretical framework that emphasizes the influence of intersecting systems of oppression on the lived experiences of people marginalized by inequity. Although applications of intersectionality are increasing in public health, this framework is absent in environmental health, which has instead focused on the exposome, a paradigm that considers the totality of an individual's environmental exposures across the life course.Despite advancements in the biological complexity of exposome models, they continue to fall short in addressing health inequities. Therefore, we highlight the need for integrating intersectionality into the exposome. We introduce key concepts and tools for environmental health scientists interested in operationalizing intersectionality in exposome studies and discuss examples of this innovative approach from our work on racial inequities in uterine fibroids.Our case studies illustrate how interlocking systems of racism and sexism may affect Black women's exposure to environmental chemicals, their epigenetic regulation of uterine fibroids, and their clinical care. Because health relies on biological and social-structural determinants and varies across different intersectional positions, our proposed framework may be a promising approach for understanding environmental health inequities and furthering social justice.
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Affiliation(s)
- Ami R Zota
- Ami R. Zota and Brianna N. VanNoy are affiliated with the Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Brianna N VanNoy
- Ami R. Zota and Brianna N. VanNoy are affiliated with the Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Sandifer P, Knapp L, Lichtveld M, Manley R, Abramson D, Caffey R, Cochran D, Collier T, Ebi K, Engel L, Farrington J, Finucane M, Hale C, Halpern D, Harville E, Hart L, Hswen Y, Kirkpatrick B, McEwen B, Morris G, Orbach R, Palinkas L, Partyka M, Porter D, Prather AA, Rowles T, Scott G, Seeman T, Solo-Gabriele H, Svendsen E, Tincher T, Trtanj J, Walker AH, Yehuda R, Yip F, Yoskowitz D, Singer B. Framework for a Community Health Observing System for the Gulf of Mexico Region: Preparing for Future Disasters. Front Public Health 2020; 8:578463. [PMID: 33178663 PMCID: PMC7593336 DOI: 10.3389/fpubh.2020.578463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023] Open
Abstract
The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop.
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Affiliation(s)
- Paul Sandifer
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
| | - Landon Knapp
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
| | - Maureen Lichtveld
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ruth Manley
- Master's Program in Environmental and Sustainability Studies, College of Charleston, Charleston, SC, United States
| | - David Abramson
- School of Global Public Health, New York University, New York, NY, United States
| | - Rex Caffey
- Department of Agricultural Economics and Agribusiness, Louisiana State University, Baton Rouge, LA, United States
| | - David Cochran
- School of Biological, Environmental, and Earth Sciences, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Tracy Collier
- Huxley College of the Environment, Western Washington University, Bellingham, WA, United States
| | - Kristie Ebi
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lawrence Engel
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - John Farrington
- Woods Hole Oceanographic Institution, Woods Hole, MA, United States
| | | | - Christine Hale
- Harte Research Institute, Texas A&M University-Corpus Christi, Corpus Christi, TX, United States
| | - David Halpern
- Scripps Institution of Oceanography, La Jolla, CA, United States
| | - Emily Harville
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Leslie Hart
- Department of Health and Human Performance, College of Charleston, Charleston, SC, United States
| | - Yulin Hswen
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Barbara Kirkpatrick
- Gulf of Mexico Coastal Ocean Observing System, Texas A&M University, College Station TX, United States
| | - Bruce McEwen
- Laboratory of Neuroendocrinology, Rockefeller University, New York, NY, United States
| | - Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Raymond Orbach
- Department of Mechanical Engineering, University of Texas, Austin, TX, United States
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Melissa Partyka
- Mississippi-Alabama Sea Grant Consortium, Mobile, AL, United States
| | - Dwayne Porter
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Teresa Rowles
- National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Silver Spring, MD, United States
| | - Geoffrey Scott
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Teresa Seeman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Helena Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL, United States
| | - Erik Svendsen
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terry Tincher
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Juli Trtanj
- Office of Oceanic and Atmospheric Research, National Oceanic and Atmospheric Administration, Silver Spring, MD, United States
| | | | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Bronx, NY, United States
| | - Fuyuen Yip
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David Yoskowitz
- Harte Research Institute, Texas A&M University-Corpus Christi, Corpus Christi, TX, United States
| | - Burton Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
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Vineis P, Robinson O, Chadeau-Hyam M, Dehghan A, Mudway I, Dagnino S. What is new in the exposome? ENVIRONMENT INTERNATIONAL 2020; 143:105887. [PMID: 32619912 DOI: 10.1016/j.envint.2020.105887] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 05/02/2023]
Abstract
The exposome concept refers to the totality of exposures from a variety of external and internal sources including chemical agents, biological agents, or radiation, from conception onward, over a complete lifetime. It encompasses also "psychosocial components" including the impact of social relations and socio-economic position on health. In this review we provide examples of recent contributions from exposome research, where we believe their application will be of the greatest value for moving forward. So far, environmental epidemiology has mainly focused on hard outcomes, such as mortality, disease exacerbation and hospitalizations. However, there are many subtle outcomes that can be related to environmental exposures, and investigations can be facilitated by an improved understanding of internal biomarkers of exposure and response, through the application of omic technologies. Second, though we have a wealth of studies on environmental pollutants, the assessment of causality is often difficult because of confounding, reverse causation and other uncertainties. Biomarkers and omic technologies may allow better causal attribution, for example using instrumental variables in triangulation, as we discuss here. Even more complex is the understanding of how social relationships (in particular socio-economic differences) influence health and imprint on the fundamental biology of the individual. The identification of molecular changes that are intermediate between social determinants and disease status is a way to fill the gap. Another field in which biomarkers and omics are relevant is the study of mixtures. Epidemiology often deals with complex mixtures (e.g. ambient air pollution, food, smoking) without fully disentangling the compositional complexity of the mixture, or with rudimentary approaches to reflect the overall effect of multiple exposures or components. From the point of view of disease mechanisms, most models hypothesize that several stages need to be transitioned through health to the induction of disease, but very little is known about the characteristics and temporal sequence of such stages. Exposome models reinforce the idea of a biography-to-biology transition, in that everyone's disease is the product of the individual history of exposures, superimposed on their underlying genetic susceptibilities. Finally, exposome research is facilitated by technological developments that complement traditional epidemiological study designs. We describe in depth one such new tools, adductomics. In general, the development of high-resolution and high-throughput technologies interrogating multiple -omics (such as epigenomics, transcriptomics, proteomics, adductomics and metabolomics) yields an unprecedented perspective into the impact of the environment in its widest sense on disease. The world of the exposome is rapidly evolving, though a huge gap still needs to be filled between the original expectations and the concrete achievements. Perhaps the most urgent need is for the establishment of a new generation of cohort studies with appropriately specified biosample collection, improved questionnaire data (including social variables), and the deployment of novel technologies that allow better characterization of individual environmental exposures, ranging from personal monitoring to satellite based observations.
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Affiliation(s)
- Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK; Italian Institute of Technology, Genova, Italy.
| | - Oliver Robinson
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK
| | - Marc Chadeau-Hyam
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK
| | - Abbas Dehghan
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK; UK Dementia Research Institute, Imperial College London, London, UK
| | - Ian Mudway
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK; MRC Centre for Environment and Health, King's College London, London, UK
| | - Sonia Dagnino
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2 1PG London, UK
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Donneyong MM, Chang TJ, Jackson JW, Langston MA, Juarez PD, Sealy-Jefferson S, Lu B, Im W, Valdez RB, Way BM, Colen C, Fischer MA, Salsberry P, Bridges JF, Hood DB. Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186684. [PMID: 32937852 PMCID: PMC7557537 DOI: 10.3390/ijerph17186684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022]
Abstract
Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R2 = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.
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Affiliation(s)
- Macarius M. Donneyong
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
- Correspondence: ; Tel.: +1-614-292-0075
| | - Teng-Jen Chang
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - John W. Jackson
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - Shawnita Sealy-Jefferson
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Bo Lu
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - R. Burciaga Valdez
- Family & Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Baldwin M. Way
- Department of Psychology, Ohio State University, Columbus, OH 43210, USA;
| | - Cynthia Colen
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Michael A. Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women’s Hospital, Boston, MA 02115, USA;
| | - Pamela Salsberry
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - John F.P. Bridges
- Department of Biomedical Informatics, Ohio State University, Columbus, OH 43210, USA;
| | - Darryl B. Hood
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
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Chrisinger BW. The Quantified Self-in-Place: Opportunities and Challenges for Place-Based N-of-1 Datasets. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Ogojiaku CN, Allen JC, Anson-Dwamena R, Barnett KS, Adetona O, Im W, Hood DB. The Health Opportunity Index: Understanding the Input to Disparate Health Outcomes in Vulnerable and High-Risk Census Tracts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5767. [PMID: 32785046 PMCID: PMC7459470 DOI: 10.3390/ijerph17165767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.
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Affiliation(s)
- Chinonso N. Ogojiaku
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
| | - JC Allen
- Office of Health Equity, Ohio Department of Health, Columbus, OH 43215, USA;
| | | | - Kierra S. Barnett
- The Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH 43201, USA;
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
| | - Wansoo Im
- Division of Public Health, Meharry Medical College, Nashville, TN 37208, USA;
| | - Darryl B. Hood
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
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Trentacosta CJ, Mulligan DJ. New directions in understanding the role of environmental contaminants in child development: Four themes. New Dir Child Adolesc Dev 2020; 2020:39-51. [PMID: 32920950 PMCID: PMC8189654 DOI: 10.1002/cad.20363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Environmental contaminants, which include several heavy metals, persistent organic pollutants, and other harmful chemicals, impair several domains of child development. This article describes four themes from recent research on the impact of environmental contaminants on child development. The first theme, disparities in exposure, focuses on how marginalized communities are disproportionately exposed to harmful environmental contaminants. The second theme, complexity of exposures, encapsulates recent emphases on timing of exposures and mixtures of multiple exposures. The third theme, mechanisms that link exposures to outcomes, focuses on processes that elucidate how contaminants impact outcomes. The fourth theme, mitigating risks associated with exposures, sheds light on potential protective factors that could ameliorate many of the harmful effects of contaminant exposures. Developmental scientists are well positioned to contribute to interdisciplinary research that addresses these themes, which could foster additional conceptual and empirical innovations and inform policies and practices to mitigate risks and improve children's well-being.
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Sherman M, Covert H, Brown L, Langhinrichsen-Rohling J, Hansel T, Rehner T, Buckner A, Lichtveld M. Enterprise Evaluation: A New Opportunity for Public Health Policy. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:479-489. [PMID: 31348163 PMCID: PMC6716577 DOI: 10.1097/phh.0000000000000862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standard evaluation practice in public health remains limited to evaluative measures linked to individual projects, even if multiple interrelated projects are working toward a common impact. Enterprise evaluation seeks to fill this policy gap by focusing on cross-sector coordination and ongoing reflection in evaluation. We provide an overview of the enterprise evaluation framework and its 3 stages: collective creation, individual data collection, and collective analysis. We illustrate the application of enterprise evaluation to the Gulf Region Health Outreach Program, 4 integrated projects that aimed to strengthen health care in Louisiana, Mississippi, Alabama, and the Florida Panhandle after the Deepwater Horizon oil spill. Shared commitment to sustainability and strong leadership were critical to Gulf Region Health Outreach Program's success in enterprise evaluation. Enterprise evaluation provides an important opportunity for funding agencies and public health initiatives to evaluate the impact of interrelated projects in a more holistic and multiscalar manner than traditional siloed approaches to evaluation.
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Affiliation(s)
- Mya Sherman
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Hannah Covert
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Lisanne Brown
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Jennifer Langhinrichsen-Rohling
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Tonya Hansel
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Timothy Rehner
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Ayanna Buckner
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
| | - Maureen Lichtveld
- Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives (Ms Sherman and Dr Covert) and Department of Global Environmental Health Sciences (Dr Lichtveld), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Evaluation and Research, Louisiana Public Health Institute, New Orleans, Louisiana (Dr Brown); Gulf Coast Behavioral Health Resiliency Center, University of South Alabama, Mobile, Alabama (Dr Langhinrichsen-Rohling); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr Hansel); School of Social Work, The University of Southern Mississippi, Hattiesburg, Mississippi (Dr Rehner); and Community Health Cooperative, Atlanta, Georgia (Dr Buckner)
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