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Mustansar T, van den Brekel L, Timmermans EJ, Agyemang C, Vaartjes I. Air pollution exposure disparities among ethnic groups in high-income countries: A scoping review. ENVIRONMENTAL RESEARCH 2025; 267:120647. [PMID: 39725138 DOI: 10.1016/j.envres.2024.120647] [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: 12/19/2023] [Revised: 09/25/2024] [Accepted: 12/15/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND The adverse health effects of air pollution are well-established. Previous reviews have highlighted disparities in air pollution exposure between minoritized ethnic groups and majoritized ethnic groups. However, these reviews primarily focused on proximity to pollution sources rather than objectively measured concentrations. This scoping review aims to provide an overview of the extent of inequalities in objectively measured air pollution exposure among ethnic groups in high-income countries. METHODS We systematically searched PubMed, Scopus, Web of Science, and Google Scholar for studies published in English, that reported on objectively measured air pollution exposure stratified by ethnic groups in high-income countries. Data on study characteristics and air pollution exposure were extracted. RESULTS The majority of all 55 included studies were conducted in North America (n = 46), followed by Europe (n = 8), and Oceania (n = 1). Across studies, 25 ethnic groups were identified, with African American, Hispanic, Latino, and Asian populations being the most studied minoritized ethnic groups. PM2.5 was the most studied (n = 38) air pollutant. Eighteen studies statistically tested differences in exposure across ethnic groups. Thirteen studies reported significantly higher air pollution exposure among minoritized ethnic populations compared to the majoritized ethnic population, and five studies showed mixed evidence. CONCLUSIONS This review highlights the extent of disparities in air pollution exposure among ethnic groups in high-income countries. It underscores the need for further research to understand the contributing factors and potential interventions to address these disparities.
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Affiliation(s)
- Tehreem Mustansar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Lieke van den Brekel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Iqbal S, Iqbal H, Kagan C. Intergenerational differences in healthy eating beliefs among British Pakistanis with type 2 diabetes. Diabet Med 2024; 41:e15222. [PMID: 37690127 DOI: 10.1111/dme.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION There are growing concerns on how to prevent, slow down and induce remission of type 2 diabetes mellitus (T2DM). Recent evidence has found diet and lifestyle interventions can cause remission of T2DM, however, there are challenges for diverse groups such as British Pakistanis who are four times more at risk of T2DM. There is a need to understand the food behaviours of different generational groups to develop culturally appropriate strategies to support diabetes prevention programmes. AIMS This study explores beliefs about healthy eating and food practices related to T2DM among British Pakistanis to understand the challenges they face in implementing healthy diets. METHOD We carried out 26 semi-structured qualitative interviews via telephone and face-to-face. The sample included T2DM British Pakistanis living in Bradford (UK), aged between 18 and 71 with a mean age of 50 (SD = 17.04). Among the participants, 14 were women (54%) and 12 were men (46%), with interviews conducted in both English (76%) and Urdu (24%). Participants were grouped under three generation groups based on age (first generation 65+; second generation 40-64; younger generation 18-39 years). There was no biological link between the generational groups, and they were not part of the same family. Data were analysed using qualitative reflexive thematic analysis. RESULTS Findings were categorised into three themes: knowledge and awareness of diabetes symptoms; social and family context of food practices and making sense of healthy eating. The family was the fundamental unit of understanding food-related health behaviours. Eating traditional food was perceived as healthy and deemed practical for first generations who were the initial members of their family to settle in the UK as well as the second generations who had parents born in Pakistan. Younger British Pakistanis were born in the UK and reported that they struggled to eat alternative foods within the home and manage their T2DM. CONCLUSION These findings improve our understanding of how three generations of British Pakistanis with T2DM negotiate healthy diets. There is a need for culturally tailored diet modifications and interventions, where different generational needs can be specifically targeted to adopt healthier diets which should be shared and encouraged.
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Affiliation(s)
- Syka Iqbal
- Department of Psychology, Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, UK
| | - Halima Iqbal
- Department of Public Health, Faculty of Health, University of Bradford, Bradford, UK
| | - Carolyn Kagan
- Research institute of Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Wu X, Zhang T, Tu Y, Deng X, Sigen A, Li Y, Jing X, Wei L, Huang N, Cheng Y, Deng L, Jia S, Li J, Jiang N, Dong B. Multidomain interventions for non-pharmacological enhancement (MINE) program in Chinese older adults with mild cognitive impairment: a multicenter randomized controlled trial protocol. BMC Neurol 2023; 23:341. [PMID: 37759178 PMCID: PMC10537159 DOI: 10.1186/s12883-023-03390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Dementia is characterized by progressive neurodegeneration and therefore early intervention could have the best chance of preserving brain health. There are significant differences in health awareness, living customs, and daily behaviors among Chinese older adults compared to Europeans and Americans. Because the synergistic benefits of multidomain non-pharmacological interventions are consistent with the multifactorial pathogenicity of MCI, such interventions are more appealing, easier to adhere to, and more relevant to daily life than single-mode interventions. One of the aims of this study is to verify the effect of multidomain intervention strategies for MCI patients based on Chinese population characteristics, and the other is to establish a biobank and image database to investigate the pathogenesis and pathways of cognitive impairment. METHODS Our study was designed as a national multicenter, community-based randomized controlled trial (RCT). Twelve medical institutions in ten Chinese cities will participate in our study from 2020 to 2024, and 1080 community residents aged 50 and above will be enrolled as participants. Each sub-center will be responsible for 90 participants (30 people per community) across three communities (non-contact control group, health education group, and multidomain intervention group). The community will be the basic unit of the present study, and all participants in each community will receive the same intervention/control measure. Three working groups are set up in each sub-center to manage the three communities independently to minimize interference at the implementation level between the groups. The multidomain intervention group will receive integrated interventions including exercise, nutrition, sleep, health education and mindfulness meditation. All data generated by the research will be analyzed and processed by statistical software (such as SPSS 21.0, Python 3.0, etc.), and part of the research data will be displayed in the form of graphs and tables. DISCUSSION In order to achieve a high-quality community intervention study, it is crucial to have a well-designed experimental protocol that follows rigorous scientific methodology. In addition, effective management of quality control measures and monitoring compliance throughout the study process are essential components. This study provides a detailed discussion of stakeholder compliance, research quality control, potential harm and mitigation, auditing, and future plans in order to better address research issues. TRIAL REGISTRATION ChiCTR2000035012 (July 27, 2020).
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Affiliation(s)
- Xiaochu Wu
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Tianyao Zhang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yanhao Tu
- Strength and Conditioning Center, Chengdu Sport University, Chengdu, China
| | - Xueling Deng
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - A Sigen
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yuxiao Li
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaofan Jing
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Lixuan Wei
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ning Huang
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Cheng
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Linghui Deng
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Shuli Jia
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jun Li
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ning Jiang
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
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Khanam R, Applegate J, Nisar I, Dutta A, Rahman S, Nizar A, Ali SM, Chowdhury NH, Begum F, Dhingra U, Tofail F, Mehmood U, Deb S, Ahmed S, Muhammad S, Das S, Ahmed S, Mittal H, Minckas N, Yoshida S, Bahl R, Jehan F, Sazawal S, Baqui AH. Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia: A population-based cohort study. PLoS One 2022; 17:e0263091. [PMID: 35130270 PMCID: PMC8820649 DOI: 10.1371/journal.pone.0263091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Women experience high rates of depression, particularly during pregnancy and the postpartum periods. Using population-based data from Bangladesh and Pakistan, we estimated the burden of antenatal depression, its risk factors, and its effect on preterm birth. METHODS The study uses the following data: maternal depression measured between 24 and 28 weeks of gestation using the 9-question Patient Health Questionnaire (PHQ-9); data on pregnancy including an ultrasound before 19 weeks of gestation; data on pregnancy outcomes; and data on woman's age, education, parity, weight, height, history of previous illness, prior miscarriage, stillbirth, husband's education, and household socioeconomic data collected during early pregnancy. Using PHQ-9 cutoff score of ≥12, women were categorized into none to mild depression or moderate to moderately severe depression. Using ultrasound data, preterm birth was defined as babies born <37 weeks of gestation. To identify risk ratios (RR) for antenatal depression, unadjusted and adjusted RR and 95% confidence intervals (CI) were calculated using log- binomial model. Log-binomial models were also used for determining the effect of antenatal depression on preterm birth adjusting for potential confounders. Data were analyzed using Stata version 16 (StataCorp LP). RESULTS About 6% of the women reported moderate to moderately severe depressive symptoms during the antenatal period. A parity of ≥2 and the highest household wealth status were associated with an increased risk of depression. The overall incidence of preterm birth was 13.4%. Maternal antenatal depression was significantly associated with the risk of preterm birth (ARR, 95% CI: 1.34, 1.02-1.74). CONCLUSION The increased risk of preterm birth in women with antenatal depression in conjunction with other significant risk factors suggests that depression likely occurs within a constellation of other risk factors. Thus, to effectively address the burden of preterm birth, programs require developing and providing integrated care addressing multiple risk factors.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer Applegate
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Imran Nisar
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Arup Dutta
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Sayedur Rahman
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Ambreen Nizar
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | | | | | - Farzana Begum
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Usha Dhingra
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Usma Mehmood
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Saikat Deb
- Center for Public Health Kinetics, Global Division, New Delhi, India
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Sajid Muhammad
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Sayan Das
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Harshita Mittal
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Nicole Minckas
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | | | - Rajiv Bahl
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | - Fyezah Jehan
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Sunil Sazawal
- Center for Public Health Kinetics, Global Division, New Delhi, India
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Abstract
INTRODUCTION There have been recent mounting concerns regarding multiple reports stating a significantly elevated relative-risk of COVID-19 mortality amongst the Black and Minority Ethnic (BAME) population. An urgent national enquiry investigating the possible reasons for this phenomenon has been issued in the UK. Inflammation is at the forefront of COVID-19 research as disease severity appears to correlate with pro-inflammatory cytokine dysregulation. This narrative review aims to shed light on the novel, pathophysiological role of inflammation in contributing towards the increased COVID-19 mortality risk amongst the BAME population. METHODS Searches in PubMed, Medline, Scopus, medRxiv and Google Scholar were performed to identify articles published in English from inception to 18th June 2020. These databases were searched using keywords including: 'COVID-19' or 'Black and Minority Ethnic' or 'Inflammation'. A narrative review was synthesized using these included articles. RESULTS We suggest a novel pathophysiological mechanism by which acute inflammation from COVID-19 may augment existing chronic inflammation, in order to potentiate a 'cytokine storm' and thus the more severe disease phenotype observed in the BAME population. Obesity, insulin resistance, cardiovascular disease, psychological stress, chronic infections and genetic predispositions are all relevant factors which may be contributing to elevated chronic systemic inflammation amongst the BAME population. CONCLUSION Overall, this review provides early insights and directions for ongoing research regarding the pathophysiological mechanisms that may explain the severe COVID-19 disease phenotype observed amongst the BAME population. We suggest 'personalization' of chronic disease management, which can be used with other interventions, in order to tackle this.
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Affiliation(s)
- Abhinav Vepa
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK.
| | - Joseph P Bae
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
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