Environmental health disparities: a framework integrating psychosocial and environmental concepts

Socioeconomic area deprivation and its relationship with dementia, Parkinson's Disease and all-cause mortality among UK older adults: a multistate modeling approach

The study analyzed the association of area-level socioeconomic status (SES) with the risk of all-cause dementia, Parkinson's Disease (PD), and all-cause mortality using a multistate approach. Data from the UK Biobank were used (N = 363,663 50+y individuals, ≤15y follow-up), and Cox proportional hazards and multistate parametric models including Weibull regression were conducted, while cardiovascular health was tested as a potential mediator. In multistate models, socioeconomic area-level deprivation, measured by the Townsend Deprivation Index (TDI) z-score, was positively associated with the hazard of going from healthy into the 3 states of PD, dementia, and all-cause mortality (i.e. transitions 1: HR = 1.06, 95 % CI:1.02-1.10, P = 0.005, 2: HR = 1.19, 95 % CI: 1.16-1.22, P < 0.001 and 3: HR = 1.19, 95 % CI: 1.18-1.21, P < 0.001), with no association detected for transitions 4 (PD→Dementia), 5 (PD→Death), or 6 (Dementia→Death). Cardiovascular health did not mediate these associations. Socioeconomic area-level deprivation was directly associated with reduced survival rates from Healthy into Dementia, PD and Death.

A Prospective Ultrasound Study of Whole Blood Metals and Incidence of Uterine Leiomyomata

BACKGROUND

Uterine leiomyomata (UL), hormone-dependent neoplasms, are a major source of gynecologic morbidity. Metals are hypothesized to influence UL risk through endocrine disruption, and their effects may vary by vitamin D status.

OBJECTIVE

We estimated associations of a metal mixture with incident UL, overall and by vitamin D status.

METHODS

We analyzed data from the Study of Environment, Lifestyle and Fibroids, a Detroit-area prospective cohort study of 1,693 black women 23-35 years of age. We measured concentrations of 17 metals/metalloids in whole blood and 25-hydroxyvitamin D [25(OH)D] in serum collected at baseline (2010-2012). Participants underwent ultrasonography at baseline and after 20 months to detect UL. We used Bayesian kernel machine regression to estimate adjusted associations (β ) of the metal mixture with probit of incident UL. We also ran Cox regression models with interaction terms to estimate incidence rate ratios (IRR) by vitamin D status.

RESULTS

Among 1,132 UL-free participants at baseline, 832 (73%) had vitamin D deficiency [25(OH)D < 20  ng / mL ] and 117 (10%) developed UL within 20 months. Increasing all metals from their 50th to 75th percentiles was weakly positively associated with UL overall [β = 0.06 ; 95% credible interval (CrI): - 0.03 , 0.16] and among vitamin D-deficient participants (β = 0.13 ; 95% CrI: 0.01, 0.24), driven by cadmium (overall and vitamin D-deficient) and mercury (vitamin D-deficient only). Increasing cadmium from its 25th to 75th percentile was positively associated with UL overall (β = 0.03 ; 95% CrI: - 0.05 , 0.11) and among vitamin D-deficient participants (β = 0.13 , 95% CrI: 0.02, 0.24). In Cox models, cadmium [IRR = 1.55 ; 95% confidence interval (CI): 1.07, 2.24, per 1-unit increase in standardized concentration] and mercury (IRR = 1.38 ; 95% CI: 0.99, 1.92) were positively associated with UL among vitamin D-deficient participants.

DISCUSSION

The metal mixture was positively associated with incident UL, but the association was weak and imprecise. We observed a stronger association among vitamin D-deficient participants that was driven by cadmium and mercury. https://doi.org/10.1289/EHP15218.

Health Capital and its Significance for Health Justice

This paper outlines a novel framing of the normative significance of health by considering the idea of 'health capital'. Health capital is a set of health-related assets of individuals that enable them to pursue their interests and to collaborate with others. The specific contribution of this paper is to establish the notion of health capital beyond a metaphorical idea and to initially explore the repercussions of it for theories of health justice. We propose a sufficientarian approach to health capital justice. Our theory claims that social justice requires enabling people to achieve enough health capital to meet threats to health. This is a dynamic ideal, establishing claims of justice over time. The overarching goal is to avoid disadvantageous tipping points of health depletion.

Racial-Ethnic Residential Segregation and Sleep Health among US Adults: Associations by Race and Ethnicity, Sex/Gender, and Neighborhood-Level Poverty

INTRODUCTION

Although racial-ethnic residential segregation (RRS) is hypothesized to contribute to sleep disparities by concentrating poverty and impairing sleep among minoritized racial-ethnic groups, feelings of belonging within relatively homogenous neighborhoods may be protective against poor sleep. Yet, empirical studies are sparse.

METHODS

To investigate RRS-sleep health associations and determine potential modifiers among US adults, we linked National Health Interview Survey data (2011-2017) to 2012 and 2017 American Community Survey census tract-level data. We used the local Getis-Ord Gi* statistic to categorize RRS (high, medium, low [reference]). Using survey-weighted, Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for self-reported sleep health measures. We also performed Wald tests for interactions by race-ethnicity, sex/gender, race-ethnicity-by-sex/gender intersectional category, and neighborhood-level poverty.

RESULTS

Among 126,539 participants (mean age ± SE = 46 ± 0.1 years), high RRS was most common among non-Hispanic (NH)-Black (38%), followed by NH-Asian and non-Mexican Latine (34%), Mexican Latine (30%), and NH-White adults (17%). Across races-ethnicities and sexes/genders (both p-interaction > 0.05), high vs. low RRS was associated with a 6% lower prevalence of short sleep duration (< 7-h: PR = 0.94 [95% CI:0.91-0.97]), an 11% lower prevalence of long sleep duration (> 9-h: PR = 0.89 [0.80-0.99]), and a 2% higher prevalence of restorative sleep (PR = 1.02 [1.01-1.04]). Associations with a lower prevalence of trouble falling asleep were stronger among men vs. women. Race-ethnicity-by-sex/gender group membership and neighborhood-level poverty modified associations with sleep duration and quality without consistent patterns.

CONCLUSION

RRS was associated with more favorable sleep health among US adults with variation by key modifiers (e.g., sex). Strategies that leverage potentially protective social factors while promoting equitable resources across diverse neighborhoods may help address sleep health disparities.

Psychological and cultural correlates of illness conception and menopausal symptoms: a cross-sectional and longitudinal comparative study of Mosuo, Yi, and Han women

Objective

This study explores the differences in menopausal symptoms, illness conception, and health-seeking behaviors among Mosuo, Yi, and Han women in China, analyzes the key factors behind these differences, and conducts a longitudinal comparison.

Methods

This study collected data from Mosuo, Yi, and Han women in Yongning Township, Ninglang County, Yunnan Province, through a questionnaire survey. The instruments included the Kupperman Menopause Index (KMI), Depression-Anxiety-Stress Scale (DASS), Self-Rating Scale of Illness Conception and Health Seeking Behavior (SSICHSB) and General Self-Efficacy Scale (GSES). First, descriptive statistical analysis was conducted on the demographic characteristics and various indicators of the sample. Chi-square tests and one-way ANOVA were used to examine the differences in KMI and SSICHSB among the different ethnic groups. The KMI was used to assess menopausal symptoms, and multiple linear regression analysis was employed to identify the main factors influencing menopausal symptoms. A longitudinal comparison of data from 2012 and 2020 was performed to analyze the dynamic changes in KMI and SSICHSB of Mosuo and Han women.

Results

The regression analysis identified stress, anxiety, and dysmenorrhea experience as risk factors, while self-efficacy served as a protective factor influencing menopausal symptoms. Both the menopausal symptoms and the scores for concerns and fears about illness among Mosuo women significantly decreased in 2020 compared to 2012 (p = 0.040, p = 0.010).

Conclusion

The results provide an important basis for the development of culturally sensitive health interventions. Future public health strategies should consider cultural, social, and physiological factors to provide more effective health support and interventions for women from different ethnic groups.

Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women

This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

Greater BMI across the lifespan is associated with better midlife cognition: The Bogalusa Heart Study

Studies of adiposity and cognition's relationship have been highly mixed, depending on points in the lifespan when adiposity and cognition were measured, primarily with low Black American representation. Therefore, we examined the association between adiposity (from early to mid-life) and mid-life cognition in an Black American (BA) and White American longitudinal cohort to address these literature gaps. The Bogalusa Heart Study has followed participants from childhood to adulthood since 1973. Adiposity was measured via body mass index (BMI) at roughly biannual visits from 1973-2016 and cognition was measured in 1295 participants between 2013- 2016. Cognition included Logical Memory I, II and II Recognition, Digit Spans Forward and Backward, Trail Making Tests A and B, and a global composite. BMI was averaged within age epochs (childhood/adolescence; early adulthood (EA); midlife (M)) with childhood/adolescence BMI as percentiles. Separate linear regression models were run for each cognitive measure (outcome), BMI within one epoch, and sex, race, and education (predictors). All analyses included the 1292 individuals who provided complete data across all epochs. Greater BMI within EA and M was associated with better global cognition (EA: Est. 0.139 S.D./BMI p = 0.000; M: Est. 0.094 S.D./BMI p = 0.022), and Logical Memory I (EA: Est. 0.036 S.D./BMI p = 0.000; M: Est. 0.022 S.D./BMI p = 0.000), II (EA: Est. 0.036 S.D./BMI p = 0.000; M: Est. 0.020 S.D./BMI p = 0.022) and II Recognition (EA: Est. 0.029 S.D./BMI p = 0.000; M: Est. 0.022 S.D./BMI p = 0.000) among men. Among BA, greater BMI within EA and M was associated with better Logical Memory I (EA: Est. 0.022 S.D./BMI p = 0.000; M: Est. 0.019 S.D./BMI p = 0.000) and II (EA: Est. 0.018 S.D./BMI p = 0.042; M: Est. 0.017 S.D./BMI p = 0.000). Greater adiposity from early adulthood to midlife was associated with better memory performance in midlife (associations strongest among men and Black Americans). More anatomically precise measurements of adiposity (e.g., subcutaneous vs. visceral fat) could help clarify the complex adiposity cognition relationship across the lifespan.

Breaking research silos to achieve equitable precision medicine in rheumatology

Health disparities in rheumatic disease are well established and urgently need addressing. Obstacles to precision medicine equity span both the clinical and the research domains, with a focus placed on structural barriers limiting equitable health care access and inclusivity in research. Less articulated factors include the use of inaccurate population descriptors and the existence of research silos in rheumatology research, which creates a knowledge gap that precludes addressing the health disparities and fulfilling the goals of precision medicine to understand the 'full patient'. The biopsychosocial model is a research framework that intertwines layers of biological and environmental effects to understand disease. However, very limited rheumatology research bridges across molecular and epidemiological studies of environmental exposures, such as physical and social determinants of health. In this Review, we discuss clinical obstacles to health care equity, including access to health care and the use of inaccurate language when labelling population groups. We explore the goals and data needed for research under the biopsychosocial model. We describe results from a rheumatic disease literature search that highlights the paucity of studies investigating the molecular influences of systemic exposures. We conclude with a list of considerations and recommendations to help achieve equitable precision medicine.

The Impact of the Ukraine Conflict on the Quality of Life of the Young Population in Romania from a Societal Security Perspective

BACKGROUND/OBJECTIVES

This study examines the perception of young Romanians (aged 18-35) regarding the Ukraine conflict's impact on Romania's national security and quality of life. It focuses on societal security dimensions, analyzing the conflict's regional and international implications, alongside sentiments toward global support for Ukraine.

METHODS

Data were collected via structured questionnaires administered to 848 participants in 2024 and 747 in 2022. Respondents' perceptions of the Ukraine conflict, its influence on national security, and the direct consequences for quality of life were evaluated using the WHOQOL-BREF instrument. Statistical analyses (descriptive, bivariate, multivariate) were employed to explore variations across socio-demographic factors.

RESULTS

The findings indicate that young Romanians appreciate international solidarity with Ukraine but remain cautious about military escalation. While the conflict heightened perceptions of personal and national insecurity, WHOQOL-BREF assessments revealed significant declines in psychological, social, and environmental quality of life indicators from 2022 to 2024. Variations were observed based on age, gender, education level, and residence, with young rural women and those with lower educational attainment experiencing the most pronounced impacts.

CONCLUSIONS

The study underscores the dual challenges of maintaining regional stability and addressing the socio-psychological fallout of conflicts. Despite resilience mechanisms tempering subjective perceptions, objective measures indicate deteriorations in the quality of life among Romania's young population. These findings emphasize the need for targeted policies to support vulnerable groups through mental health initiatives, social support systems, and equitable access to resources.

Socioeconomic Disparities in Exposures to PFAS and Other Unregulated Industrial Drinking Water Contaminants in US Public Water Systems

BACKGROUND

Unregulated contaminants in drinking water, such as per- and polyfluoroalkyl substances (PFAS), can contribute to cumulative health risks, particularly in overburdened and less-advantaged communities. To our knowledge, there has been no nationwide assessment of socioeconomic disparities in exposures to unregulated contaminants in drinking water.

OBJECTIVE

The goals of this study were to identify determinants of unregulated contaminant detection among US public water systems (PWSs) and evaluate disparities related to race, ethnicity, and socioeconomic status.

METHODS

We gathered data from the US Environmental Protection Agency's (US EPA's) Third Unregulated Contaminant Monitoring Rule (2013-2015), PWS characteristics, sociodemographic data, and suspected pollution sources from regulatory databases. We included four target contaminants (or classes) with industrial sources: PFAS, 1,4-dioxane, 1,1-dichloroethane, and chlorodifluoromethane (HCFC-22). Associations were evaluated with pairwise comparison tests and generalized logistic mixed-effects regression models for six dichotomous outcomes: detection of each of four target contaminants, detection of ≥ 1 target contaminant, and PWS exceedance of ≥ 1 US EPA health reference level that was in effect in 2017.

RESULTS

More than 97 million US residents were served by a PWS with detectable levels of 1,4-dioxane (22% of PWSs), HCFC-22 (5.8%), 1,1-dichloroethane (4.7%), and/or PFAS (4.0%). Unregulated contaminant detection was more frequent among large systems, urban systems, and systems using groundwater or a combination of groundwater and surface water. In comparison with PWSs with no detectable levels of these unregulated contaminants, PWSs with detectable levels served counties with higher proportions of Hispanic residents (17% vs. 13%), as did PWSs that exceeded EPA health reference levels in comparison with PWSs with no exceedances (18% vs. 14%). There were persistent positive associations between proportions of Hispanic residents and detections of target contaminants, even after accounting for pollution sources.

DISCUSSION

Previously, inequities in exposures to drinking water contaminants were underestimated because prior studies have focused on regulated contaminants. PWSs serving counties with more Hispanic residents, non-Hispanic Black residents, and urban households may benefit from additional resources to proactively mitigate unregulated chemical contamination. Future studies should evaluate factors underlying these disparities to promote actions that protect water quality for all residents. https://doi.org/10.1289/EHP14721.

Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality

The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathologic or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood. Social determinants of health, such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes. Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse social determinants of health that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes. Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

Contribution of county-level socioeconomic indicators to racial or ethnic differences in neonatal anthropometry in the USA: a prospective cohort study

Introduction

Racial and ethnic differences in fetal growth and birth size in the USA have not been adequately explained by individual-level socioeconomic status (SES) factors. We explored whether differences may be partially explained by county-level indicators of SES.

Methods

We linked participant zip codes from the National Institute of Child Health and Human Development Fetal Growth Studies (2009-2013; n=1614) to county-level US census data to calculate a neighbourhood deprivation index, education isolation index and two indices of segregation: racial isolation and evenness. Using causal mediation methods, we evaluated the extent to which racial/ethnic differences in neonatal anthropometrics could be eliminated in a hypothetical setting where everyone lived in counties with high resource availability and racial/ethnic integration.

Results

Setting racial evenness to levels consistent with the highest diversity eliminated 79.9% of the difference in birth weight between non-Hispanic White and non-Hispanic Black and all the difference (106.3%) in birth weight between Hispanic and non-Hispanic White individuals. Setting racial evenness, racial isolation and education isolation to levels consistent with higher diversity and education was also associated with similar reductions in differences for other anthropometric measures.

Conclusions

Our findings suggest that, in a hypothetical scenario where everyone lived in counties with low deprivation or segregation, race/ethnic differences in neonatal anthropometry may substantially decrease or be eliminated. Our results also highlight the importance of considering community-level and structural factors in analyses of race/ethnic health disparities.

Neighborhood Stressors and Epigenetic Age Acceleration Among Older Americans

OBJECTIVES

Exposure to stressful neighborhood environments is a well-established risk factor for health deterioration and premature death. However, the biological underpinnings are not fully understood. Epigenetic aging may function as a key molecular pathway to adverse health outcomes among residents of high-stress neighborhoods. This study examines the associations between neighborhood social stressors (socioeconomic deprivation, observed and perceived disorder, and low social cohesion) and epigenetic age (DunedinPACE and Principal component adjusted [PC] PCHorvath, PCHannum, PCPhenoAge, PCGrimAge). Further, we identify subpopulations most vulnerable to neighborhood stressors.

METHODS

Respondent data are from the 2016 Health and Retirement Study (HRS) DNA methylation subsample. Neighborhood data come from respondent reports (2014/2016) and the census (2012-2016 ACS). The analytic sample included 3,146 adults ages 56 and older (mean age = 68.8), of whom 54.9% were women and 19.3% were non-White.

RESULTS

In multilevel regression models adjusting for sociodemographic covariates, all neighborhood stressors were associated with faster DunedinPACE (B = 0.008 to 0.017). Neighborhood deprivation, perceived disorder, and low cohesion were associated with PCPhenoAge (B = 0.27 to 0.40) or PCGrimAge acceleration (B = 0.23). Health behaviors explained these associations to some degree. However, no significant associations were found with PCHorvath and PCHannum. In interaction analyses, adverse associations with deprivation, observed disorder, and low cohesion were more pronounced for women. No consistent interactions were found for race/ethnic and education groups.

DISCUSSION

Our findings indicate that neighborhood stressors can accelerate epigenetic aging, with older women particularly vulnerable to their effects. These findings provide insights into the biological foundations of health disparities rooted in neighborhood environments.

New York State Climate Impacts Assessment Chapter 07: Human Health and Safety

New Yorkers face a multitude of health and safety risks that are exacerbated by a changing climate. These risks include direct impacts from extreme weather events and other climate hazards, as well as indirect impacts occurring through a chain of interactions. Physical safety, physical health, and mental health are all part of the equation-as are the many nonclimate factors that interact with climate change to influence health outcomes. This chapter provides an updated assessment of all these topics at the intersection of climate change, public health and safety, and equity in the state of New York. Key findings are presented below.

The Need for Social and Environmental Determinants of Health Research to Understand and Intervene on Racial/Ethnic Disparities in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA), a sleep-disordered breathing (SDB) disorder, affects at least 25 million adults in the United States and is associated with increased risk for hypertension, diabetes, and cardiovascular disease (CVD). Racial/ethnic minorities have a disproportionate burden of OSA along with the health sequelae associated with this condition. Despite supporting evidence of racial/ethnic disparities, few studies have investigated SDB including OSA among minoritized racial/ethnic groups. In this scoping review of the literature, the authors summarize current findings related to racial/ethnic disparities in OSA, identified social and environmental determinants of health, treatment inequities, and promising evidence-based interventions and conclude with future research directions.

Improving the Health and Environmental Health Literacy of Professionals: Evaluating the Effect of a Virtual Intervention on Phthalate Environmental Health Literacy

The American College of Obstetricians and Gynecologists provided updated guidance in 2021, recommending that reproductive health professionals should include discussion of environmental exposures with their patients. However, environmental health is seldom included in medical training, with endocrine-disrupting chemicals, such as phthalates-linked to adverse pregnancy outcomes-being among the least discussed. We developed a one-hour virtual educational intervention to train reproductive health professionals on the routes of phthalate exposure, potential associated health impacts, and suggestions on how to discuss exposure reduction with patients. The intervention was designed to include perspectives from patients, scientists, and clinicians. Using a pre/post/post design, we evaluated the impact of the intervention on reproductive health professionals' phthalate-related reproductive health literacy via a validated environmental health literacy (EHL) scale, their confidence in discussing phthalates, and the frequency of discussions about phthalates with patients. All materials, including the study questionnaires and intervention materials, were administered virtually to reproductive health professionals (n = 203) currently seeing patients working in the United States. After completing the intervention, reproductive health professionals' average EHL increased (pre-course: 22.3, post-course: 23.7, 2 months post-course: 24.0), as did their confidence in discussing phthalates with their patients (pre-course: 1% (2/203) reported being quite confident, post-course: 64% (131/203) reported being quite confident, and 2 months post course: 86% (174/203) reported being quite confident). Additionally, the reported frequency of discussions about phthalates with patients rose substantially (pre-course: 0% (0/203) reported usually discussing phthalates with patients, and 2 months post-course: 86% (175/203) reported usually discussing phthalates with patients): In line with the recommendations of the American College of Obstetricians and Gynecologists, this online phthalate educational intervention tool increased EHL among reproductive health professionals and shifted clinical care to include discussion about phthalates, a reproductive toxicant.

Air pollution mixture exposure during pregnancy and postpartum psychological functioning: racial/ethnic- and fetal sex-specific associations

BACKGROUND

Prenatal air pollution (AP) exposure has been linked to postpartum psychological functioning, impacting health outcomes in both women and children. Extant studies primarily focused on individual pollutants.

OBJECTIVE

To assess the association between prenatal exposure to a mixture of seven AP components and postpartum psychological functioning using daily exposure data and data-driven statistical methods.

METHODS

Analyses included 981 women recruited at 24.0 ± 9.9 weeks gestation and followed longitudinally. We estimated prenatal daily exposure levels for constituents of fine particles [elemental carbon (EC), organic carbon (OC), nitrate (NO3-), sulfate (SO42-), ammonium (NH4+)], nitrogen dioxide (NO2), and ozone (O3) using validated global 3-D chemical-transport models and satellite-based hybrid models based on residential addresses. Edinburgh Postnatal Depression Scale (EPDS) was administered to participants to derive a total EPDS score and the subconstruct scores for anhedonia and depressive symptoms. A distributed lag model (DLM) was employed within Bayesian Kernel Machine Regression (BKMR) to develop time-weighted exposure profile for each pollutant. These exposures were then input into a Weighted Quantile Sum (WQS) regression to estimate an overall mixture effect, adjusted for maternal age, education, race/ethnicity, season of delivery, and delivery year. Effect modification by race/ethnicity and fetal sex was also examined.

RESULTS

Women were primarily Hispanic (51%) and Black (32%) reporting ≤12 years of education (58%). Prenatal exposure to an AP mixture was significantly associated with increased anhedonia subscale z-scores, particularly in Hispanics (β = 0.07, 95%CI = 0.004-0.13, per unit increase in WQS index). It was also borderline associated with increased total EPDS (β = 0.11, 95%CI = 0.00-0.22) and depressive symptom subscale (β = 0.09, 95%CI = -0.02 to 0.19) z-scores, particularly among Hispanic women who gave birth to a male infant. Sulfate (SO42-), O3 and OC were major contributors to these associations.

IMPACT

This study utilizes an advanced data-driven approach to examine the temporally- and mixture-weighted effects of prenatal air pollution exposure on postpartum psychological functioning. We found that exposure to a prenatal air pollution mixture predicted poorer postpartum psychological functioning, particularly anhedonia symptoms in Hispanic women. Findings underscore the importance of considering both exposure mixtures as well as potential modifying factors to better help identify particular pollutants that drive effects and susceptible populations, which can inform more effective intervention strategies.

Environmental Phenols and Growth in Infancy: The Infant Feeding and Early Development Study

CONTEXT

Higher mean and rapid increases in body mass index (BMI) during infancy are associated with subsequent obesity and may be influenced by exposure to endocrine-disrupting chemicals such as phenols.

OBJECTIVE

In a prospective US-based cohort conducted 2010-2014, we investigated associations between environmental phenol exposures and BMI in 199 infants.

METHODS

We measured 7 urinary phenols at ages 6-8 and 12 weeks and assessed BMI z-score at up to 12 study visits between birth and 36 weeks. We examined individual and joint associations of averaged early infancy phenols with level of BMI z-score using mean differences (β [95% CI]) and with BMI z-score trajectories using relative risk ratios (RR [95% CI]).

RESULTS

Benzophenone-3, methyl and propyl paraben, and all phenols jointly were positively associated with higher mean BMI z-score (0.07 [-0.05, 0.18], 0.10 [-0.08, 0.27], 0.08 [-0.09, 0.25], 0.17 [-0.08, 0.43], respectively). Relative to a stable trajectory, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol, and all phenols jointly were positively associated with risk of a rapid increase trajectory (1.46 [0.89, 2.39], 1.33 [0.88, 2.01], 1.66 [1.03, 2.68], 1.41 [0.71, 2.84], respectively).

CONCLUSION

Early phenol exposure was associated with a higher mean and rapid increase in BMI z-score across infancy, signaling potential long-term cardiometabolic consequences of exposure.

Multidimensional structural racism and estimated cancer risk from traffic-related air pollution

BACKGROUND

Traffic-related air pollutants have been associated with a variety of adverse human health impacts, including cancers. In the United States, numerous studies have documented racial inequities in neighborhood exposures to traffic-related air pollution. Emerging evidence suggests that structural racism may influence neighborhood exposures to air pollutants. However, existing research has largely focused on residential racial segregation, one indicator of structural racism. This study developed a multidimensional measure of structural racism to examine the relationship between structural racism and estimated cancer risk from air pollutants in Georgia.

METHODS

Carcinogenic air toxics data were obtained from the US Environmental Protection Agency's 2019 Air Toxics Screening Assessment and sociodemographic data from the American Community Survey. Guided by stakeholder input, county-level data on residential segregation, education, employment, incarceration, economic status, political participation, and homeownership were used to create a multidimensional county-level structural racism index. Relative risks (RRs) were estimated for associations between structural racism and elevated (top 10% in Georgia) estimated cancer risk from air toxics.

RESULTS

Multilevel analyses revealed a significant association between multidimensional structural racism and exposure to carcinogenic traffic-related air pollutants. Neighborhoods in the highest quartile of structural racism exhibited an elevated cancer risk from traffic-related air pollutants (RR, 7.84; 95% CI, 5.11-12.05) compared to neighborhoods with lower levels of structural racism.

CONCLUSIONS

Multidimensional structural racism was associated with estimated cancer risk from traffic-related air pollution in Georgia. Findings can inform future studies and policy interventions that address racial inequalities in exposure to traffic-related air pollution.

Long-term exposure to ozone and sleep disorders in children: A multicity study in China

Evidence regarding the link between long-term ambient ozone (O3) exposure and childhood sleep disorders is little. This study aims to examine the associations between long-term exposure to O3 and sleep disorders in children. We conducted a population-based cross-sectional survey, including 185,428 children aged 6-18 years in 173 schools across 14 Chinese cities during 2012 and 2018. Parents or guardians completed a checklist using Sleep Disturbance Scale for Children, and O3 exposure at residential and school addresses was estimated using a satellite-based spatiotemporal model. We used generalized linear mixed models to test the associations with adjustment for factors including socio-demographic variables, lifestyle, meteorology and multiple pollutants. Mean concentrations of O3, particulate matter with diameters ≤2.5 mm (PM2.5) and nitrogen dioxide (NO2) were 89.0 μg/m3, 42.5 μg/m3 and 34.4 μg/m3, respectively. O3 and NO2 concentrations were similar among provinces, while PM2.5 concentration varied significantly among provinces. Overall, 19.4% of children had at least one sleep disorder. Long-term exposure to O3 was positively associated with odds of sleep disorders for all subtypes. For example, each interquartile increment in home-school O3 concentrations was associated with a higher odds ratio for global sleep disorder, at 1.22 (95% confidence interval: 1.18, 1.26). Similar associations were observed for sleep disorder subtypes. The associations remained similar after adjustment for PM2.5 and NO2. Moreover, these associations were heterogeneous regionally, with more prominent associations among children residing in southeast region than in northeast and northwest regions in China. We concluded that long-term exposure to O3 is positively associated with risks of childhood sleep disorders. These associations varied by geographical region of China.

Asking Why Is Necessary to Address Health Disparities: A Critical Approach for Solution-Oriented Environmental Epidemiological Research

BACKGROUND

In environmental epidemiology, we use an array of tools from various, related disciplines to answer key questions about environmental exposures in relation to health outcomes. Typically, we ask questions related to what, who, where, when, and how. We value these questions because they contribute to novel scientific discovery and our understanding of disease etiology linked to environmental exposures. In addition, these questions help us better understand who might be at highest risk of exposure and subsequent risk of disease. Although necessary for the goals of environmental epidemiology, these questions are insufficient for addressing environmental health disparities. Specifically, these questions may be able to help us describe exposure-health outcome associations but are limited in their ability to move beyond identification to intervening on observed disparities to achieve environmental health equity.

OBJECTIVES

We sought to emphasize the need to value and routinely add the key question of "Why?" in environmental epidemiological studies. In asking this additional critical question, we can identify and incorporate the structural determinants and drivers of environmental exposure disparities and determine whether these factors are linked to existing and historically recalcitrant health disparities. Further, we can design effective studies that build on existing frameworks to address the fundamental causes of environmental health disparities.

DISCUSSION

This commentary underscores the need to routinely incorporate "why" questions in the practice of environmental epidemiology. By asking and addressing "Why?" we can employ better, more solution-oriented study designs, improve data collection, and enhance our ability to collaborate with diverse study populations through trust-building and community-engaged research. Incorporating these approaches will move environmental epidemiology forward from mostly documenting to actively addressing environmental health disparities. https://doi.org/10.1289/EHP14513.

Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

In February 2022, a fertilizer plant fire burned for four days and displaced thousands of residents, who were mainly low-income and Black or Latino, from their homes in Winston Salem, NC. In partnership with Black and Latino residents and nonprofit organizations, we sought to understand Black and Latino resident perceptions of the chronic and acute health risks, as well as the emotional and financial effects that resulted from the fire, which included the release of nitrous dioxide. We used the Environmental Health Disparities Framework to guide this community-engaged research study, capturing through semi-structured interviews: 1) how residents perceived their community before and after the fire, 2) how the fire impacted physical and mental health, and 3) how individuals coped with stress. We used thematic analysis to analyze the data and identified seven major themes. Participants: 1) perceived their neighborhood positively, 2) were unaware of the potential dangers of the fertilizer plant before the fire, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city's response to the fire, and 7) provided recommendations for future city response.

The association of short-term increases in ambient PM2.5 and temperature exposures with stillbirth: racial/ethnic disparities among Medicaid recipients

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code-level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10 μg m-3 increase in PM2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, -0.04% to 1.40%) and lag 2 (0.52%; 95% CI, -0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, -0.81 to 6.45). An association between daily PM2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6 days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM2.5 exposure. This article is part of a Special Collection on Environmental Epidemiology.

Residential proximity to toxic metal-emitting industrial sites and toenail metal concentrations in a United States-wide prospective cohort

BACKGROUND

Industrial facilities across the United States (US) release millions of pounds of toxic chemicals, including metals. Exposure to toxic metals has been associated with adverse health outcomes, but there is limited evidence on the association between living near metal-releasing facilities and the body burden of emitted compounds.

OBJECTIVE

To investigate the association between residential proximity to toxic metal-emitting industrial facilities and toenail metal concentrations and to evaluate whether associations differed by race.

METHODS

In a sample of 1556 non-Hispanic Black (32.5%) and non-Hispanic White (67.5%) women from the Sister Study, we used the US Environmental Protection Agency Toxics Release Inventory to identify metal-emitting facilities within 3, 5, and 10 km of participants' baseline residences. We measured toenail concentrations (μg/g) of arsenic, cadmium, cobalt, chromium, and lead. Using multivariable linear regression, we examined associations between residential proximity to and emissions from metal-emitting facilities and toenail metal concentrations, stratifying by race. We explored modification of race-stratified associations by neighborhood deprivation, using the Area Deprivation Index (ADI).

RESULTS

Black participants were more likely to reside within 3 km of chromium-releasing facilities and 5 and 10 km of all observed metal-emitting sites. Living near metal-releasing facilities was not associated with higher toenail metal concentrations overall. Among Black women, higher chromium emissions exposure was associated with higher toenail chromium levels (βTertile3vs.non-exposed = 2.36 μg/g, 95% CI = 0.63, 4.10). An association with lead was observed among Black women residing in the most deprived areas (≥75th ADI percentile: β = 3.08 μg/g, 95% CI = 1.46, 4.71). No associations were observed for White participants.

CONCLUSIONS

Despite low exposure prevalence, our findings suggest that living near chromium- and lead-releasing facilities, especially at shorter distances, may be associated with higher corresponding toenail metal levels among Black women, particularly those residing in the most disadvantaged areas.

Inequities in air pollution on stroke mortality among Older Americans: a U.S. nationwide analysis

Background

Air pollution is a known risk factor for cardiovascular diseases, including stroke. This study examines the impact of county-level air pollution on ischemic and hemorrhagic stroke mortality among U.S. individuals aged 65 and older, emphasizing racial and socioeconomic disparities.

Methods

Using data from the Center for Disease Control (CDC) Interactive Atlas of Heart Disease and Stroke, we analyzed county-level ischemic stroke mortality rates for older residents between 2016 and 2020. The data on air pollution at the county level, specifically particulate matter (PM2.5) levels, were obtained from the CDC. We applied multivariable linear and logistic regression models to examine the association between PM2.5 levels and stroke mortality, as well as the probability of meeting the Environmental Protection Agency (EPA) air quality standards.

Results

County-level analysis revealed a significant correlation (R = 0.68, R2 = 0.48, p < 0.001) between PM2.5 levels and overall stroke mortality. For every 1 μg/m3 increase in PM2.5, there was an increase of 1.89 ischemic stroke deaths per 100,000 residents. Racial and socioeconomic disparities were evident. Counties with predominantly Black populations exhibited a stark disparity, with each 1 μg/m3 increase in PM2.5 correlating with a significant rise in mortality, amounting to 5.81 additional deaths per 100,000 residents. Persistently poor counties displayed vulnerability, experiencing a 4.05 increase in ischemic stroke deaths per 100,000 residents for every 1 μg/m3 increase in PM2.5 levels. Conversely, in counties with a White majority and counties without a persistent state of poverty, the associated increases in stroke mortality per 100,000 residents for every 1 μg/m3 rise in county-level PM2.5 were 1.85 and 1.60, respectively. Counties with a majority of Black residents were over twice as likely to be non-compliant with EPA air quality standards compared to predominantly White counties (aOR 2.36 95% CI: 1.27-4.38, p = 0.006).

Conclusion

This study underscores the significant impact of county-level air pollution, particularly PM2.5, on ischemic stroke mortality among older U.S. residents. Our findings indicate that counties with predominantly Black populations and those experiencing persistent poverty not only suffer from higher mortality rates but also are more likely to be non-compliant with EPA air quality standards. Targeted interventions and policies are urgently needed to reduce air pollution in these vulnerable communities and promote equitable public health outcomes.

A validation study for measuring Asian- and Hispanic-serving sociocultural institutions in neighborhoods using business listing data and potential implications for health

Ethnic enclaves influence the health of Asian American and Hispanic or Latinx/a/o populations, likely via neighborhood social, economic, and built environments. To facilitate studies aiming to disentangle these specific neighborhood mechanisms, we describe the creation and validation of two novel measures-Asian-serving and Hispanic-serving sociocultural institutions (SCIs)-to estimate the social, cultural, and economic character of ethnic enclaves in California. Business listing data were used to identify SCIs or businesses that promote cultural and social identity, including arts, civic, historical, religious, social service, and membership organizations. Keyword searches of business names were used to identify potential Asian- or Hispanic-serving SCIs. An online audit of 1,627 businesses within 12 cities confirmed the validity of using keyword searches to assess whether census tracts were high or low in Asian- or Hispanic-serving SCIs (sensitivity: 63%-100%, specificity: 86%-95%; positive predictive value: 63%-89%). In exploratory regression analyses, high presence of SCIs (compared to low presence) may be associated with neighborhood-level health indicators, including greater percentages of residents who had an annual checkup in majority Asian census tracts and lower percentages of residents who were current smokers in majority Asian and Hispanic census tracts. This approach advances methodology in measurement of neighborhood sociocultural environments.

Community-Engaged Research and the Use of Open Access ToxVal/ToxRef In Vivo Databases and New Approach Methodologies (NAM) to Address Human Health Risks From Environmental Contaminants

BACKGROUND

The paper analyzes opportunities for integrating Open access resources (Abstract Sifter, US EPA and NTP Toxicity Value and Toxicity Reference [ToxVal/ToxRefDB]) and New Approach Methodologies (NAM) integration into Community Engaged Research (CEnR).

METHODS

CompTox Chemicals Dashboard and Integrated Chemical Environment with in vivo ToxVal/ToxRef and NAMs (in vitro) databases are presented in three case studies to show how these resources could be used in Pilot Projects involving Community Engaged Research (CEnR) from the University of California, Davis, Environmental Health Sciences Center.

RESULTS

Case #1 developed a novel assay methodology for testing pesticide toxicity. Case #2 involved detection of water contaminants from wildfire ash and Case #3 involved contaminants on Tribal Lands. Abstract Sifter/ToxVal/ToxRefDB regulatory data and NAMs could be used to screen/prioritize risks from exposure to metals, PAHs and PFAS from wildfire ash leached into water and to investigate activities of environmental toxins (e.g., pesticides) on Tribal lands. Open access NAMs and computational tools can apply to detection of sensitive biological activities in potential or known adverse outcome pathways to predict points of departure (POD) for comparison with regulatory values for hazard identification. Open access Systematic Empirical Evaluation of Models or biomonitoring exposures are available for human subpopulations and can be used to determine bioactivity (POD) to exposure ratio to facilitate mitigation.

CONCLUSIONS

These resources help prioritize chemical toxicity and facilitate regulatory decisions and health protective policies that can aid stakeholders in deciding on needed research. Insights into exposure risks can aid environmental justice and health equity advocates.

Addressing the research gap: access to care hinders genetic discovery in systemic lupus erythematosus patients throughout the African diaspora

Systemic lupus erythematosus (SLE) is a complex autoimmune condition that disproportionately impacts non-White ethnic and racial groups, particularly individuals in the African diaspora who experience heightened incidence, prevalence, and adverse outcomes. Genetic and epigenetic factors play significant roles in SLE risk, however these factors neither explain the whole of SLE risk nor the stark racial disparities we observe. Moreover, our understanding of genetic risk factors within African ancestry populations is limited due to social and environmental influences on research participation, disease presentation, and healthcare access. Globally, the African diaspora faces barriers in accessing essential SLE diagnostic tools, therapeutics, healthcare practitioners, and high-quality clinical and translational research studies. Here, we provide insights into the current state of genetic studies within African ancestry populations and highlight the unique challenges encountered in SLE care and research across countries of varying income levels. We also identify opportunities to address these disparities and promote scientific equity for individuals affected by SLE within the global African diaspora.

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

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

Effects of Community Assets on Major Health Conditions in England: A Data Analytic Approach

INTRODUCTION

The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide.

METHODS

This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model.

RESULTS

The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty.

CONCLUSIONS

The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.

Exposures to particulate matters and childhood sleep disorders-A large study in three provinces in China

OBJECTIVES

Evidence on the link between long-term ambient particulate matter (PM) exposures and childhood sleep disorders were scarce. We examined the associations between long-term exposures to PM2.5 and PM1 (PM with an aerodynamic equivalent diameter <2.5 μm and <1 μm, respectively) with sleep disorders in children.

METHODS

We performed a population-based cross-sectional survey in 177,263 children aged 6 to 18 years in 14 Chinese cities during 2012-2018. A satellite-based spatiotemporal model was employed to estimate four-year annual average PM2.5 and PM1 exposures at residential and school addresses. Parents or guardians completed a checklist using the Sleep Disturbance Scale for Children. We estimated the associations using generalized linear mixed models with adjustment for characteristics of children, parents, and indoor environments.

RESULTS

Long-term PM2.5 and PM1 exposures were positively associated with odds of sleep disorders for almost all domains. For example, increments in PM2.5 and PM1 per 10 μg/m3 were associated with odds ratios of global sleep disorder of 1.24 (95 % confidence interval [CI]: 1.14, 1.35) and 1.31 (95 %CI: 1.18, 1.46), respectively. Similar results were observed for subtypes of sleep disorder. These associations were heterogeneous regionally, with stronger associations among children residing in southeast region than in northeast and northwest regions. Moreover, larger estimates of PM1 were found than that of PM2.5 in southeast region.

CONCLUSION

Long-term PM2.5 and PM1 exposures are independently associated with higher risks of childhood sleep disorders, and these associations vary by geographical region.

The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use

Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related emergency department (ED) visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to the within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. Methods: An administrative database was used to define census tract population-based incidence rates of asthma-related ED visits. We estimate the associations between census tract incidence rates and 1) average fine and coarse particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and 2) racial and ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We also examine for the attenuation of incidence risk ratios (IRRs) associated with race/ethnicity when controlling for air pollution exposure. Measurements and Main Results: Fine and coarse particulate matter and SO2 are all associated with census tract-level incidence rates of asthma-related ED visits, and multipollutant models show evidence of independent risk associated with coarse particulate matter and SO2. The association between census tract incidence rate and Black resident share (IRR, 1.51 [credible interval (CI), 1.48-1.54]) is attenuated by 24% when accounting for air pollution (IRR, 1.39 [CI, 1.35-1.42]), and the association with Latinx resident share (IRR, 1.11 [CI, 1.09-1.13]) is attenuated by 32% (IRR, 1.08 [CI, 1.06-1.10]). Conclusions: Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.

Industry of employment and occupational class in relation to cardiovascular health by race/ethnicity, sex/gender, age and income among adults in the USA: a cross-sectional study

Background

Racially minoritised groups tend to have poorer cardiovascular health (CVH) than non-Hispanic (NH)-White adults and are generally more likely to work in labourer or support service positions where job strain-associated with cardiovascular disease-is often high. Yet, few studies have included racially/ethnically diverse samples.

Methods

Using 2004-2018 National Health Interview Survey cross-sectional data, we investigated standardised occupational classifications in relation to 'ideal' CVH using a modified 'ideal' CVH (mICVH) metric among US adults (n=230 196) by race/ethnicity, sex/gender, age, and income. mICVH was defined as a report of 'yes' to the following: never smoked/former smoker; body mass index (≥18.5-25 kg/m2); physical activity (≥150-300 min/week moderate or ≥75-150 min/week vigorous); sleep duration (7-9 hours/night); and no prior diagnosis of dyslipidaemia, hypertension, or diabetes/pre-diabetes. Adjusting for sociodemographic, clinical factors, and health behaviour confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% CIs of mICVH overall and by race/ethnicity and performed Wald tests for interaction.

Results

Latinx (53%) and NH-Black (37%) adults were more likely than NH-White adults (29%) to report labourer positions and had the lowest prevalence of mICVH (5.2% (Latinx) and 3.9% (NH-Black)). Labourer versus professional/management occupational class positions were associated with a lower mICVH prevalence among NH-Asian (PR=0.60 (0.46-0.79)), NH-White (PR=0.80 (0.74-0.87)) and NH-Black (PR=0.77 (0.58-1.01)), but with no evidence of an association among Latinx (PR=0.94 (0.78-1.14) adults; p interaction <0.001).

Conclusions

In conclusion, working in labourer versus professional/management positions was associated with lower mICVH, except among Latinx adults. Given the higher likelihood of labourer occupations and lower prevalence of mICVH among minoritised racial/ethnic groups, social determinants related to occupational class should be considered in future studies of racial and ethnic disparities in CVH.

Epigenetic Responses to Nonchemical Stressors: Potential Molecular Links to Perinatal Health Outcomes

PURPOSE OF REVIEW

We summarize the recent literature investigating exposure to four nonchemical stressors (financial stress, racism, psychosocial stress, and trauma) and DNA methylation, miRNA expression, and mRNA expression. We also highlight the relationships between these epigenetic changes and six critical perinatal outcomes (preterm birth, low birth weight, preeclampsia, gestational diabetes, childhood allergic disease, and childhood neurocognition).

RECENT FINDINGS

Multiple studies have found financial stress, psychosocial stress, and trauma to be associated with DNA methylation and/or miRNA and mRNA expression. Fewer studies have investigated the effects of racism. The majority of studies assessed epigenetic or genomic changes in maternal blood, cord blood, or placenta. Several studies included multi-OMIC assessments in which DNA methylation and/or miRNA expression were associated with gene expression. There is strong evidence for the role of epigenetics in driving the health outcomes considered. A total of 22 biomarkers, including numerous HPA axis genes, were identified to be epigenetically altered by both stressors and outcomes. Epigenetic changes related to inflammation, the immune and endocrine systems, and cell growth and survival were highlighted across numerous studies. Maternal exposure to nonchemical stressors is associated with epigenetic and/or genomic changes in a tissue-specific manner among inflammatory, immune, endocrine, and cell growth-related pathways, which may act as mediating pathways to perinatal health outcomes. Future research can test the mediating role of the specific biomarkers identified as linked with both stressors and outcomes. Understanding underlying epigenetic mechanisms altered by nonchemical stressors can provide a better understanding of how chemical and nonchemical exposures interact.

Associations Between Early-Life Adversity, Ambient Air Pollution, and Telomere Length in Children

OBJECTIVE

Examine the independent associations and interaction between early-life adversity and residential ambient air pollution exposure on relative buccal telomere length (rBTL).

METHODS

Experiences of abuse, neglect, household challenges, and related life events were identified in a cross-sectional sample of children aged 1 to 11 years ( n = 197) using the 17-item Pediatric ACEs and Related Life Event Screener (PEARLS) tool. The PEARLS tool was analyzed both as a total score and across established domains (Maltreatment, Household Challenges, and Social Context). Ground-level fine particulate matter (PM 2.5 ) concentrations were matched to residential locations for the 1 and 12 months before biospecimen collection. We used multivariable linear regression models to examine for independent associations between continuous PM 2.5 exposure and PEARLS score/domains with rBTL. In addition, effect modification by PEARLS scores and domains on associations between PM 2.5 exposure and rBTL was examined.

RESULTS

Study participants were 47% girls, with mean (standard deviation) age of 5.9 (3.4) years, median reported PEARLS score of 2 (interquartile range [IQR], 4), median 12-month prior PM 2.5 concentrations of 11.8 μg/m 3 (IQR, 2.7 μg/m 3 ), median 1-month prior PM 2.5 concentrations of 10.9 μg/m 3 (IQR, 5.8 μg/m 3 ), and rBTL of 0.1 (IQR, 0.03). Mean 12-month prior PM 2.5 exposure was inversely associated with rBTL ( β = -0.02, 95% confidence interval = -0.04 to -0.01). Although reported PEARLS scores and domains were not independently associated with rBTL, we observed a greater decrement in rBTL with increment of average annual PM 2.5 as reported Social Context domain items increased ( p -interaction < .05).

CONCLUSIONS

Our results suggest that adverse Social Context factors may accelerate the association between chronic PM 2.5 exposure on telomere shortening during childhood.

Screening of Environmental Chemicals to Characterize Exposures in Participants With Systemic Lupus Erythematosus

OBJECTIVE

There is a need to characterize exposures associated with the pathogenesis of systemic lupus erythematosus (SLE). In this pilot study, we explore a hypothesis-free approach that can measure thousands of exogenous chemicals in blood ("exposome") in patients with SLE and unaffected controls.

METHODS

This cross-sectional study analyzed a cohort of patients with prevalent SLE (n = 285) and controls (n = 106). Plasma was analyzed by liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). Mass spectrometry features present in at least 25% of all samples were selected for association analysis (n = 2,737). Features were matched to potential chemicals using available databases. Association analysis of abundances of features with SLE status was performed, adjusting for age and sex. We also explored features associated with SLE phenotypes, sociodemographic factors, and current medication use.

RESULTS

We found 30 features significantly associated with SLE status (Bonferroni P < 0.05). Of these, seven matched chemical names based on databases. These seven features included phthalate metabolites, a formetanate metabolite, and eugenol. The abundance of acid pesticides differed between patients with SLE and controls (Bonferroni P < 0.05). Two unmatched features were associated with a history of lupus nephritis, and one with anti-double-stranded DNA antibody production (Bonferroni P < 0.05). Seventeen features varied by self-reported race and ethnicity, including a polyfluoroalkyl substance (analysis of variance P < 1.69 × 10-5). Eleven features correlated with antimalarials, 6 with mycophenolate mofetil, and 29 with prednisone use.

CONCLUSION

This proof-of-concept study demonstrates that LC-QTOF/MS is a powerful tool that agnostically detects circulating exogenous compounds. These analyses can generate hypotheses of disease-related exposures for future prospective, longitudinal studies.

Food security status and cardiometabolic health by sex/gender and race/ethnicity among adults in the United States

BACKGROUND

Minoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are projected to widen due to the worsening climate crisis that is straining the agricultural system including food supplies. Nonetheless, studies have not investigated the relationship between food security status and 'ideal' CVH in a large, nationally-representative and racially/ethnically diverse US sample.

METHODS AND RESULTS

We investigated household food security status in relation to 'ideal' CVH among US adults (N = 157,001) using 2014-2018/2020 National Health Interview Survey data. Food security status was defined as very low, low, marginal, or high. A summed score of 4 health behaviors and 3 clinical factors totaling 7 different measures was dichotomized (yes/no) to assess modified 'ideal' CVH (mICVH). Using Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% CIs of mICVH by household food security status. We stratified models by sex/gender and race/ethnicity. Very low food security prevalence was higher among non-Hispanic (NH)-Black (8.0%) compared to Hispanic/Latinx (5.1%), NH-White (3.1%) and NH-Asian (1.7%) adults. The association between very low versus high food security and mICVH was stronger among women (PR = 0.23 [95% CI: 0.17-0.31]) than men (PR = 0.48 [95% CI: 0.35-0.66]). Compared to NH-White adults with high food security, racially/ethnically minoritized groups with very low to high food security were generally less likely (range: [PRvery low = 0.25[95% CI: 0.14-0.44] - [PRhigh = 0.88 [95% CI: 0.79-0.97]) to meet mICVH criteria.

CONCLUSIONS

Food insecurity was associated with lower mICVH prevalence and racially/ethnically minoritized groups were disproportionately burdened.

Where I'm Livin' and How I'm Feelin': Associations among community stress, gender, and mental-emotional health among Black Americans

RATIONALE

Structural racism is a primary avenue for the perpetuation of racial health disparities. For Black Americans, both historically and contemporarily, the neighborhood context serves as one of the most striking examples of structural racism, with stressful neighborhood contexts contributing to the well-documented inequalities in psychological functioning among this population.

OBJECTIVE

Thus, in this study, we adapted an intersectional-ecological framework to investigate the links between community stress and multiple dimensions of mental-emotional health for Black men and women.

METHODS

Drawing on cross-sectional data from 842 Black Americans from the Milwaukee area, we tested both objective (Area Deprivation Index; ADI) and subjective (perceived neighborhood disadvantage; PND) indicators of community stress as simultaneous predictors of negative and positive affect and the odds of psychological disorder (depression, anxiety) in multilevel models, examining gender differences in these linkages.

RESULTS

Results showed greater objective community stress was related to lower levels of negative affect for both men and women and lower odds of psychological disorder for women specifically. Greater subjective community stress was related to higher levels of negative affect and lower levels of positive affect for both men and women and to higher odds of psychological disorder for women specifically.

CONCLUSIONS

Findings highlight the complex intersectional nature of the links between community stress and Black Americans' mental-emotional health. Specifically, findings demonstrate the pernicious psychological effects of perceived community stress and allude to Black Americans', particularly women's, active resistance and resilience to objective disadvantage, potentially through investing in social relationships in their neighborhoods.

Association between urinary BTEX metabolites and dyslexic odds among school-aged children

Benzene, toluene, ethylbenzene, and xylene (BTEX) are ubiquitous in the environment, and all of them can cause neurotoxicity. However, the association between BTEX exposure and dyslexia, a disorder with language network-related regions in left hemisphere affected, remains unclear. We aimed to assess the relationship between BTEX exposure and dyslexic odds among school-aged children. A case-control study, including 355 dyslexics and 390 controls from three cities in China, was conducted. Six BTEX metabolites were measured in their urine samples. Logistic regression model was used to explore the association between the BTEX metabolites and the dyslexic odds. Urinary trans,trans-muconic acid (MU: a metabolite of benzene) was significantly associated with an increased dyslexic odds [odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.01, 1.50], and the adjusted OR of the dyslexic odds in the third tertile was 1.72 (95% CI: 1.06, 2.77) compared to that in the lowest tertile regarding urinary MU concentration. Furthermore, the association between urinary MU level and the dyslexic odds was more pronounced among children from low-income families based on stratified analyses. Urinary metabolite levels of toluene, ethylbenzene, and xylene were not found to be associated with the dyslexic odds. In summary, elevated MU concentrations may be associated with an increased dyslexic odds. We should take measures to reduce MU related exposure among children, particularly those with low family income.

Mapping Cumulative Risk in Delaware: Approach and Implications for Health Equity

BACKGROUND

Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware.

METHODS

This cross-sectional study used choropleth maps to visualize the distribution of environmental, social, and cumulative risks and Moran's I statistics to assess spatial clustering of cumulative risk across the county and among individual block groups.

RESULTS

Findings indicate that environmental risk rarely occurs without social risk and that environmental and social risks co-occur in distinct areas, resulting in large-scale clustering of cumulative risk. Areas of higher cumulative risk had more Black residents and people of lower socioeconomic status.

CONCLUSIONS

Replicable measures of cumulative risk can show how environmental and social risks are inequitably distributed by race and socioeconomic status, as seen here in New Castle County. Such measures can support upstream approaches to reduce health disparities resulting from histories of environmental racism.

Urban densification in the Netherlands and its impact on mental health: An expert-based causal loop diagram

Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals' mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.

Wildfires and climate justice: future wildfire events predicted to disproportionally impact socioeconomically vulnerable communities in North Carolina

Wildfire events are becoming increasingly common across many areas of the United States, including North Carolina (NC). Wildfires can cause immediate damage to properties, and wildfire smoke conditions can harm the overall health of exposed communities. It is critical to identify communities at increased risk of wildfire events, particularly in areas with that have sociodemographic disparities and low socioeconomic status (SES) that may exacerbate incurred impacts of wildfire events. This study set out to: (1) characterize the distribution of wildfire risk across NC; (2) implement integrative cluster analyses to identify regions that contain communities with increased vulnerability to the impacts of wildfire events due to sociodemographic characteristics; (3) provide summary-level statistics of populations with highest wildfire risk, highlighting SES and housing cost factors; and (4) disseminate wildfire risk information via our online web application, ENVIROSCAN. Wildfire hazard potential (WHP) indices were organized at the census tract-level, and distributions were analyzed for spatial autocorrelation via global and local Moran's tests. Sociodemographic characteristics were analyzed via k-means analysis to identify clusters with distinct SES patterns to characterize regions of similar sociodemographic/socioeconomic disparities. These SES groupings were overlayed with housing and wildfire risk profiles to establish patterns of risk across NC. Resulting geospatial analyses identified areas largely in Southeastern NC with high risk of wildfires that were significantly correlated with neighboring regions with high WHP, highlighting adjacent regions of high risk for future wildfire events. Cluster-based analysis of SES factors resulted in three groups of regions categorized through distinct SES profiling; two of these clusters (Clusters 2 and 3) contained indicators of high SES vulnerability. Cluster 2 contained a higher percentage of younger (<5 years), non-white, Hispanic and/or Latino residents; while Cluster 3 had the highest mean WHP and was characterized by a higher percentage of non-white residents, poverty, and less than a high school education. Counties of particular SES and WHP-combined vulnerability include those with majority non-white residents, tribal communities, and below poverty level households largely located in Southeastern NC. WHP values per census tract were dispersed to the public via the ENVIROSCAN application, alongside other environmentally-relevant data.

All-cause, cardiovascular disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980-2018)

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018.

METHODS

The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20-84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater.

RESULTS

During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107-109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer.

CONCLUSIONS

For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

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

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

Role of intrinsic apoptosis in environmental exposure health outcomes

Environmental exposures are linked to diseases of high public health concern, including cancer, neurodegenerative disorders, and autoimmunity. These diseases are caused by excessive or insufficient cell death, prompting investigation of mechanistic links between environmental toxicants and dysregulation of cell death pathways, including apoptosis. This review describes how legacy and emerging environmental exposures target the intrinsic apoptosis pathway to potentially drive pathogenesis. Recent discoveries reveal that dynamic regulation of apoptosis may heighten the vulnerability of healthy tissues to exposures in children, and that apoptotic signaling can guide immune responses, tissue repair, and tumorigenesis. Understanding how environmental toxicants dysregulate apoptosis will uncover opportunities to deploy apoptosis-modulating agents for the treatment or prevention of exposure-linked diseases.

Environmental justice burden and Black-White disparities in spontaneous preterm birth in Harris County, Texas

Introduction

Given limited evidence of previous studies, we evaluated the role of environmental justice (EJ) burden (i.e., a neighborhood characterized by both increased environmental burden and socioeconomic deprivation) in Black-White disparities in spontaneous preterm birth (sPTB) in Harris County, Texas and compared results that evaluated neighborhood-level socioeconomic deprivation alone.

Methods

We conducted a retrospective analysis using PeriBank, a database and biospecimen repository of gravidae giving birth at two hospitals in the Texas Medical Center. We included 3,703 non-Hispanic Black and 5,475 non-Hispanic white gravidae who were U.S.-born, delivered from August 2011-December 2020, and resided in Harris County, TX. We used data from the U.S. EPA EJScreen to characterize the EJ burden of participant's zip code of residence from fine particulate matter (PM2.5), ozone, and proximity to National Priorities List (NPL) sites and calculated zip-code level Area Deprivation Index (ADI). We assessed the contribution of neighborhood-level variables to the Black-White disparity in sPTB by evaluating attenuation of the odds ratio (OR) representing the effect of race in multivariable logistic regression models, controlling for individual-level characteristics. We also conducted race-stratified analyses between each neighborhood variable and sPTB. Exposure indices were treated as continuous variables; in stratified models, ORs and 95% Confidence Intervals (CIs) are presented per 10-unit increase in the neighborhood variable.

Results

Accounting for individual-level variables, Black gravidae had 79% higher odds of sPTB than white gravidae (OR = 1.79, 95%CI = 1.32, 2.44); the disparity was moderately attenuated when accounting for EJ burden or ADI (ORs ranged from 1.58 to 1.69). Though we observed no association between any of the EJ burden indices and sPTB among white gravidae, we found increased risks among Black gravidae, with ORs of similar magnitude for each EJ variable. For example, Black gravidae experienced 17% increased odds of sPTB associated with a 10-unit increase in the EJ burden index for PM2.5 (OR = 1.17, 95%CI = 0.97, 1.40). No racial differences were observed in the association of ADI with sPTB.

Discussion

Though we observed limited evidence of the contribution of living in EJ neighborhoods to the Black-White disparity in sPTB, our study suggests living in an EJ neighborhood may differentially impact Black and white gravidae.

California's zero-emission vehicle adoption brings air quality benefits yet equity gaps persist

Zero-emission vehicle (ZEV) adoption is a key climate mitigation tool, but its environmental justice implications remain unclear. Here, we quantify ZEV adoption at the census tract level in California from 2015 to 2020 and project it to 2035 when all new passenger vehicles sold are expected to be ZEVs. We then apply an integrated traffic model together with a dispersion model to simulate air quality changes near roads in the Greater Los Angeles. We found that per capita ZEV ownership in non-disadvantaged communities (non-DACs) as defined by the state of California is 3.8 times of that in DACs. Racial and ethnic minorities owned fewer ZEVs regardless of DAC designation. While DAC residents receive 40% more pollutant reduction than non-DACs due to intercommunity ZEV trips in 2020, they remain disproportionately exposed to higher levels of traffic-related air pollution. With more ZEVs in 2035, the exposure disparity narrows. However, to further reduce disparities, the focus must include trucks, emphasizing the need for targeted ZEV policies that address persistent pollution burdens among DAC and racial and ethnic minority residents.

Racial disparities affect the association between gestational urinary phthalate mixtures and infant genital measures

Background

Phthalates are ubiquitous anti-androgenic endocrine disrupting chemicals found in personal care products, medications, and many plastics. Studies have shown a racial disparity in phthalates exposure among U.S. women, which may also impact fetal development.

Methods

We conducted a prospective cohort study of gestational exposure to a phthalates mixture in a racially-diverse population to determine their association with genital development. Mid-gestation (18-22 weeks) urine was collected from 152 women who self-identified as non-Hispanic Black and 158 women who self-identified as non-Hispanic White in Charleston, South Carolina between 2011 and 2014. We measured eight phthalate monoester metabolites in urine using liquid chromatography tandem-mass spectrometry. Mid-gestational penile dimensions were measured using ultrasound and anogenital distances were measured postnatally. We used Bayesian kernel machine regression to estimate the associations among the mixture of phthalate metabolites and mid-gestation penile dimensions and postnatal anogenital distance measures among singleton male (n = 179) and female (n = 131) infants, adjusted for urinary specific gravity, maternal age, body mass index, education level, cigarette smoking, and gestational age at enrollment or birth weight z-score.

Results

We found a stronger association between greater phthalates and decreased anopenile distance among infants born to women who self-identified as Black. Mono (2-ethylhexyl) phthalate (MEHP) was the driving mixture component among Black women, and monobutyl phthalate (MBP) and monoethyl phthalate (MEP) were drivers among White women. We also identified a non-linear association between phthalates and lesser ultrasound penile volume among women who self-identified as Black with monoisobutyl phthalate (MiBP) and MBP being most important. We also found an association between greater phthalates and shorter anoclitoral distance among infants born to women who self-identified as Black, with MEP and monobenzyl phthalate (MBzP) contributing most to this association.

Conclusion

Our results suggest a disparity in the association between gestational exposure to a mixture of phthalates and fetal genital development among women who self-identified as Black compared to White.

Analysis of social determinants of health and individual factors found in health equity frameworks: Applications to injury research

INTRODUCTION

This research evaluated existing health equity frameworks as they relate to social determinants of health (SDOHs) and individual factors that may impact injury outcomes and identify gaps in coverage using the Healthy People (HP) 2030 key domains.

METHODS

The study used a list of health equity frameworks sourced from previous literature. SDOHs and individual factors from each framework were identified and categorized into the Healthy People 2030 domains. Five injury topic areas were used as examples for how SDOHs and individual factors can be compared to injury topic-specific health disparities to identify health equity frameworks to apply to injury research.

RESULTS

The study identified 59 SDOHs and individual factors from the list of 33 health equity frameworks. The number of SDOHs and individual factors identified varied by Healthy People 2030 domain: Neighborhood and Built Environment contained 16 (27.1%) SDOHs and individual actors, Social and Community Context contained 22 (37.3%), Economic Stability contained 10 (16.9%), Healthcare Access and Quality contained 10 (16.9%), and Education Access and Quality contained one (1.7%). Twenty-three (39.0%) SDOHs/individual factors related to traumatic brain injury, thirteen (22.0%) related to motor vehicle crashes and suicide, 11 (18.6%) related to drowning and older adult falls. Eight frameworks (24.2%) covered all HP 2030 key domains and may be applicable to injury topics.

CONCLUSIONS

Incorporating health equity into research is critical. Health equity frameworks can provide a way to systematically incorporate health equity into research. The findings from this study may be useful to health equity research by providing a resource to injury and other public health fields.

PRACTICAL APPLICATIONS

Health equity frameworks are a practical tool to guide injury research, translation, evaluation, and program implementation. The findings from this study can be used to guide the application of health equity frameworks in injury research for specific topic areas.