Identifying environmental health priorities in underserved populations: a study of rural versus urban communities

Questionnaire-based exposome-wide association studies for common diseases in the Personalized Environment and Genes Study

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.

Informing environmental health and risk priorities through local outreach and extension

Our society is currently facing an unprecedented number of environmental and societal challenges. Stakeholder and community engagement can help identify priority issues and needs at local levels. One approach to engage stakeholders and communities in the contexts of environmental, health, and societal challenges is to leverage outreach and extension programs. Within this context, and to help identify priority issues to focus subsequent research and extension programs in North Carolina (NC), a survey was conducted with extension agents to identify priority issues as they relate to environmental health and risks and related needs. Based on responses from 66 study participants that represented half of the 100 NC counties, we found that Water pollution, Flooding, Natural resources management, and Engaging stakeholders were top priority issues across all environmental health and risk topics. Participants also identified that practices of Engaging stakeholders as well as Assessing, Managing, and Communicating risks were increasingly important. Participants indicated they needed a moderate-to-significant amount of guidance across a range of areas related to assessing, managing, communicating, and making decisions regarding environmental health and risk topics, as well as engaging with local communities. Outcomes from this work can not only help inform subsequent research and outreach efforts at local scales, but this work demonstrates a simple, low-cost approach to elicit perspectives and priorities can be leveraged in other states and regions with established stakeholder and community outreach programs more broadly.

Assessment of the environmental perceptions, attitudes, and awareness of city dwellers regarding sustainable urban environmental management: a case study of Dhaka, Bangladesh

Environmental problems are very concerning, particularly in many cities of developing countries, because they obstruct the creation of a sustainable urban environment. Dhaka, Bangladesh was chosen as the research area of this study, as Bangladesh is a developing country with pollution; moreover, the level of residents' environmental perception was assessed, and their environmental attitudes and awareness were examined in relation to their demographic characteristics. A face-to-face questionnaire survey involving 400 respondents was conducted across various zones of the study area. The mean score, standard deviation, and p value of each respondent's answer were calculated separately using a one-way analysis of variance (ANOVA). Then, a grand mean, average standard deviation, and combined p values for environmental perception and attitude themes were computed theme-wise. Descriptive statistics were produced to illustrate the respondents' level of environmental awareness. The study results revealed that the respondents had a moderate to high level of perceived knowledge about the causes and effects of environmental pollution. They also had an intention to reduce the environmental pollution in their surroundings. The score differences (p < .05) across the age groups, education levels, occupation types, and income groups were nearly all significant, except for those pertaining to the gender of the respondents. Surprisingly, only 18% of the respondents were aware of their home's and neighborhood's garbage management procedures. It is urgent to influence citizens' environmental behaviors to ensure the city's long-term sustainability. This study's findings can be used in decision-making processes regarding sustainable urban environments worldwide.

A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities

Background

Focus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019.

Methods

Six focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019.

Results

Consistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019.

Conclusions

Applying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11799-1.

Association between perceived environmental pollution and health among urban and rural residents-a Chinese national study

BACKGROUND

China's economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts' attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents.

METHODS

Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected.

RESULTS

Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents' good health (B = - 0.14, p < 0.05; B = -0.23, p < 0.001). Perceived garbage pollution had a positive effect on urban residents' poor health (B = 0.33, p < 0.01). Perceived water pollution had no significant effect on urban residents' health. The four types of perceived environmental pollution all had insignificant effects on rural residents' health.

CONCLUSIONS

Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.

Potential for city parks to reduce exposure to BTEX in air

Benzene, toluene, ethylbenzene, and xylenes (BTEX) are hazardous air pollutants commonly found in outdoor air. Several studies have explored the potential of vegetation to mitigate BTEX in outdoor air, but they are limited to a northern temperate climate and their results lack consensus. To investigate this subject in a subtropical climate, we deployed passive air samplers for two weeks in parks and outside nearby residences at four locations: three in an urban area and one in a rural area in Alabama, USA. All BTEX concentrations were below health-based guidelines and were comparable to those found in several other studies in populated settings. Concentrations of TEX, but not benzene, were 3-39% lower in parks than at nearby residences, and the differences were significant. Site type (park vs. residential) was a significant predictor of TEX concentrations, while distance to the nearest major road was a significant predictor of BTX concentrations. In and around two of the parks, toluene : benzene ratios fell outside the range expected for vehicular emissions (p < 0.01), suggesting that there were additional, industrial sources of benzene near these two locations. The ratio of m-,p-xylene : ethylbenzene was high at all locations except one residential area, indicating that BTEX were freshly emitted. Concentrations of individual BTEX compounds were highly correlated with each other in most cases, except for locations that may have been impacted by nearby industrial sources of benzene. Results of this study suggest that parks can help reduce exposure to TEX by a modest amount in some situations.

Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities

Previous research has suggested differences between public and professional understanding of the field of environmental health (EH) and the role of EH services within urban and rural communities. This study investigated EH priority differences between 1) rural and urban residents and 2) residents and EH professionals, and presents quantitative and qualitative methods for establishing locality-specific EH priorities. Residents (N = 588) and EH professionals (N = 63) in Alabama identified EH priorities via a phone or online survey. We categorized rurality of participant residences by rural-urban commuting area codes and population density, and tested whether or not EH priorities were different between urban and rural residents. Built environment issues, particularly abandoned houses, and air pollution were high priorities for urban residents-whereas, water and sanitation issues, and paper mill-related pollution were high priorities in rural communities. EH professionals ranked food safety and water and sanitation issues as higher priorities than residents did. Results highlight the importance of urbanicity on environmental risk perception and the utility of simple and inexpensive engagement methods for understanding these differences. Differences between residents and EH professionals suggest improving stakeholder participation in local-level EH decision making might lead to greater awareness of EH services, which might in turn improve support and effectiveness of those services.

Check the score: Field validation of Street Smart Walk Score in Alberta, Canada

Walk Score® is a proprietary walkability metric that ranks locations by proximity to destinations, with emerging health promotion applications for increasing walking as physical activity. Currently, field validations of Walk Score® have only occurred in metropolitan regions of the United States; moreover, many studies employ an earlier Walk Score® version utilizing straight line distance. To address this gap, we conducted a field validation of the newest, network-based metric for three municipal types along a rural-urban continuum in Alberta, Canada. In 2015, using street-level systematic observations collected in Bonnyville, Medicine Hat, and North Central Edmonton in 2008 (part of the Community Health and the Built Environment (CHBE) project), we reverse engineered 2181 scores with the network Walk Score® algorithm. We computed means, 95% confidence intervals, and t-tests (α = 0.05) for both sets of scores. Applying the Clifford-Richardson adjustment for spatial autocorrelation, we calculated Spearman's Rank Correlation Coefficients (rho, rs) and adjusted p-values to measure the strength of association between the derived scores and original network scores provided by Walk Score®. Spearman's rho for scores were very high for Bonnyville (rs = 0.950, adjusted p < 0.001), and high for Medicine Hat (rs = 0.790, adjusted p < 0.001) and North Central Edmonton (rs = 0.763, adjusted p < 0.001). High to very high correlations between derived scores and Walk Scores® field validated this metric across small, medium, and large population centres in Alberta, Canada. However, we suggest caution in interpreting Walk Score® for planning and evaluating health promotion interventions, since the strength of association between destinations and walking may vary across different municipal types.

Subjective health of adolescents from families in receipt of social assistance

OBJECTIVE

To compare the subjective health of adolescents from families in receipt and not in receipt of social assistance.

STUDY DESIGN

Nationwide cross-sectional study of 1812 pupils aged 13-18 years in Poland in 2010-2011.

METHODS

The analysis focused on two dimensions of the Child Health and Illness Profile - Adolescent Edition questionnaire: discomfort and satisfaction with health. Age, sex and seven socio-economic factors were considered as determinants.

RESULTS

Overall, 10.8% of the respondents reported that their families were in receipt of social welfare benefits. Among the families of low socio-economic status and living in poor regions, the percentage in receipt of social welfare benefits increased to 22.1%; however, this figure was lower (4.4%) if both parents had a higher level of education. After adjustment for six sociodemographic variables, the standardized regression coefficient of the social welfare benefits variable amounted to 0.072 (P = 0.004) in the discomfort model and -0.044 (P = 0.079) in the satisfaction model. A significant three-level interaction was found (P = 0.007) between residential location, neighbourhood affluence and being in receipt of social welfare benefits as predicators of discomfort score (general linear model).

CONCLUSIONS

Being in receipt of social welfare benefits has a stronger impact on experiencing discomfort than diminishing satisfaction with one's health. It also has a stronger effect on physical problems than on emotional problems. The item 'on social assistance' is recommended as it helps to identify families particularly exposed to the health consequences of poverty.