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Grunwell JR, Mutic AD, Ezhuthachan ID, Mason C, Tidwell M, Caldwell C, Norwood J, Zack S, Jordan N, Fitzpatrick AM. Environmental Injustice Is Associated With Poorer Asthma Outcomes in School-Age Children With Asthma in Metropolitan Atlanta, Georgia. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1263-1272.e1. [PMID: 38378096 PMCID: PMC11081836 DOI: 10.1016/j.jaip.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Environmental justice mandates that no person suffers disproportionately from environmental exposures. The Environmental Justice Index (EJI) provides an estimate of the environmental burden for each census tract but has not yet been used in asthma populations. OBJECTIVE We hypothesized that children from census tracts with high environmental injustice determined by the EJI would have a greater burden of asthma exacerbations, poorer asthma control, and poorer lung function over 12 months. METHODS Children aged 6 to 18 years with asthma (N = 575) from metropolitan Atlanta, Georgia, completed a baseline research visit. Participant addresses were geocoded to obtain the EJI Social-Environmental Ranking for each participant's census tract, which was divided into tertiles. Medical records were reviewed for 12 months for asthma exacerbations. A subset of participants completed a second research visit involving spirometry and questionnaires. RESULTS Census tracts with the greatest environmental injustice had more racial and ethnic minorities, lower socioeconomic status, more hazardous exposures (particularly to airborne pollutants), and greater proximity to railroads and heavily trafficked roadways. Children with asthma residing in high injustice census tracts had a longer duration of asthma, greater historical asthma-related health care utilization, poorer asthma symptom control and quality of life, and more impaired lung function. By 12 months, children from high injustice census tracts also had more asthma exacerbations with a shorter time to exacerbation and persistently more symptoms, poorer asthma control, and reduced lung function. CONCLUSIONS Disparities in environmental justice are present in metropolitan Atlanta that may contribute to asthma outcomes in children. These findings require an additional study and action to improve health equity.
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Affiliation(s)
- Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - Idil D Ezhuthachan
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Allergy and Immunology, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Carrie Mason
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Mallory Tidwell
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Cherish Caldwell
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jalicae Norwood
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Sydney Zack
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Natalie Jordan
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Ga.
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Bakshi A, Apantaku E, Marquette T, Jacob C, Dumas SA, Friedman K, Aubin K, Soileau S, Kemmerly S. The Utility of Virtual Home Visits to Reduce Asthma Burden in Low-Income Black Communities in Louisiana During the COVID-19 Pandemic. Public Health Rep 2024:333549241236090. [PMID: 38511560 DOI: 10.1177/00333549241236090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The Louisiana Department of Health identified a need for greater outreach in low-income Black communities that addressed environmental asthma triggers. We piloted an asthma virtual home visit (VHV) program and evaluated its reach and ability to promote asthma self-management strategies in communities with a high prevalence of poorly controlled asthma. METHODS Participants from Louisiana were continuously recruited into the VHV program starting in March 2021 and provided with asthma education materials. Participants reporting poorly controlled asthma and environmental triggers were also offered 3 VHVs with a respiratory therapist. All participants were asked to complete a preintervention and postintervention knowledge test, an Asthma Control Test (ACT) (maximum score = 25; scores ≤19 indicate poorly controlled asthma), and a final survey that assessed perceptions about asthma management and reduction of environmental triggers. RESULTS As of October 2022, 147 participants were enrolled in the program, and 52 had consented to and received ≥1 VHV. Forty VHV recipients (77%) were aged <18 years, 40 (77%) were Black people, and 46 (88%) were from families with extremely low or low incomes. Asthma symptoms improved across all participants, with a median increase of 2.4 points on the ACT. Knowledge tests revealed that 86% of participants learned about ≥1 new asthma trigger; a larger percentage of VHV recipients than nonrecipients (68% vs 36%) had an improved knowledge test score postintervention. Compared with preintervention, about three-quarters of participants reported feeling more empowered to self-manage their asthma and a significant improvement in their quality of life postintervention. CONCLUSIONS The program provided virtual asthma education to communities with a high burden of asthma and improved asthma outcomes for participants. Similar virtual models can be used to promote health equity, especially in areas with limited access to health care.
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Affiliation(s)
- Arundhati Bakshi
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
- Immunization Program, Louisiana Department of Health, New Orleans, LA, USA
| | - Elora Apantaku
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
| | - Tracy Marquette
- Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | - Colette Jacob
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
| | - S Amanda Dumas
- Bureau of Health Services Financing (Medicaid), Louisiana Department of Health, New Orleans, LA, USA
| | - Kate Friedman
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
| | - Kathleen Aubin
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
| | - Shannon Soileau
- Section of Environmental Epidemiology & Toxicology, Louisiana Department of Health, New Orleans, LA, USA
| | - Shaun Kemmerly
- Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
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Monthé-Drèze C, Aris IM, Rifas-Shiman SL, Shivappa N, Hebert JR, Oken E, Sen S. The Role of Prenatal Psychosocial Stress in the Associations of a Proinflammatory Diet in Pregnancy With Child Adiposity and Growth Trajectories. JAMA Netw Open 2023; 6:e2251367. [PMID: 36662527 PMCID: PMC9860526 DOI: 10.1001/jamanetworkopen.2022.51367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/23/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Prenatal psychosocial stress and nutrition may each program offspring adiposity, an important predictor of lifelong cardiometabolic health. Although increased stress and poor nutrition have been found to co-occur in pregnancy, little is known about their combined longitudinal associations in the offspring. Objective To investigate whether the associations of the Dietary Inflammatory Index (DII) with offspring adiposity differ by prenatal stress levels and whether these associations change with age. Design, Setting, and Participants Project Viva, a prospective prebirth cohort study of mother-child dyads in Massachusetts, included singleton children of mothers enrolled between April 1999 and July 2002, with follow-up visits at early childhood, midchildhood, and early adolescence. Data analysis was performed from October 31, 2020, to October 31, 2022. Exposures Food frequency-derived DII score in pregnancy was the exposure. Effect modifiers included stress-related measures in pregnancy; depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS), dichotomized at scores greater than or equal to 13 vs less than 13; and census tract-level social vulnerability (overall Social Vulnerability Index and its 4 main subindices), dichotomized at the 75th percentile. Main Outcomes and Measures Overall adiposity, comprising sex- and age-standardized body mass index (BMI z), sum of subscapular and triceps skinfolds, fat mass index (FMI), and body fat percentage estimated using bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA); and central adiposity, comprising waist circumference, ratio of subscapular to triceps skinfolds, and DXA-derived trunk FMI. Results Among 1060 mother-child dyads, mean (SD) maternal age was 32.6 (4.6) years, and 811 (77%) mothers were non-Hispanic White. Mean (SD) DII score was -2.7 (1.3) units, Social Vulnerability Index level was 38th (27th) percentile, and 8% of mothers had depressive symptoms. Mean (SD) age of the children was 3.3 (0.3) years at the early childhood visit, 7.9 (0.8) years at the midchildhood visit, and 13.2 (0.9) years at the early adolescence visit. In adjusted analyses, children born to mothers in the highest (vs lowest) quartile of DII had slower decrease in BMI z scores (β, 0.03 SD units/y; 95% CI, 0.01-0.05 SD units/y), and faster adiposity gain (eg, BIA total FMI β, 0.11 kg/m2/y; 95% CI, 0.03-0.19 kg/m2/y) over time. Associations of prenatal DII quartiles with childhood adiposity were stronger (eg, BIA total FMI quartile 4 vs quartile 1 change in β, 1.40 kg/m2; 95% CI, 0.21-2.59 kg/m2) among children of mothers with high vs low EPDS scores in pregnancy, although EPDS scores did not modify the change over time. Associations of prenatal DII with adiposity change over time, however, were greater among children whose mothers lived in neighborhoods with a high (BIA percentage body fat: β, 0.55% per year; 95% CI, 0.04%-1.07% per year) vs low (β, 0.13% per year; 95% CI, -0.20 to 0.46% per year), percentage of racial and ethnic minorities, and residents with limited English-language proficiency. Conclusions and Relevance The findings of this cohort study suggest that it may be useful to simultaneously evaluate prenatal diet and psychosocial stress in women as targets for interventions intended to prevent excess childhood adiposity.
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Affiliation(s)
- Carmen Monthé-Drèze
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Nitin Shivappa
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina
| | - James R. Hebert
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Sagrera CE, Magner J, Temple J, Lawrence R, Magner TJ, Avila-Quintero VJ, McPherson P, Alderman LL, Bhuiyan MAN, Patterson JC, Murnane KS. Social media use and body image issues among adolescents in a vulnerable Louisiana community. Front Psychiatry 2022; 13:1001336. [PMID: 36405904 PMCID: PMC9669337 DOI: 10.3389/fpsyt.2022.1001336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Widespread concern has been expressed regarding unrealistic body image and adolescent eating disorder promoting content on social media (SM) platforms. Numerous research studies have examined the impact of SM on body image as well as social vulnerability on negative mental health outcomes. Despite this, few previous studies have examined the impact of SM on body image specifically in vulnerable, underserved, or predominantly minority communities. This study examines the impact of SM on body image issues (BII) in adolescents in a public school system where greater than 50% of the students live in impoverished households. In late 2019, high school student leaders in Northwest Louisiana developed a survey alongside Step Forward, a collective impact initiative. Questions investigated adolescent SM use and mental health in Caddo Parish, namely BII. Teachers within Caddo Parish Public School System administered the survey. Out of the 11,248 total high school students in the school system, nearly 50% were sampled for a sample size of 5,070. Hypotheses included: (1) females were more likely to use SM than males, (2) increasing time spent on SM would correlate with females reporting BII, with males remaining largely unaffected, and (3) highly visual social media (HVSM) platforms would be associated with greater reports of BII than non-HVSM platforms. Results showed females were more likely to use SM (p < 0.001) and report BII (p < 0.001) compared to males, while both sexes reported BII with increasing time spent on SM (p < 0.001). A diversity of platforms were associated with increased BII among SM users compared to non-users (p < 0.001): Pinterest, Reddit, Snapchat, TikTok, Twitter, and YouTube. This conclusion is tempered by the omission of race as a variable in the study design, the use of self-report, and the use of an unvalidated instrument. These findings suggest that the harmful association between SM use and BII may transcend culture and socioeconomic status for a broadly deleterious effect on adolescent mental wellbeing.
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Affiliation(s)
- Caroline E. Sagrera
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
| | - Johnette Magner
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
- School of Communication and Media Studies, Louisiana Tech University, Ruston, LA, United States
| | - Jazzlynn Temple
- Caddo Parish Magnet High School, Shreveport, LA, United States
| | - Robert Lawrence
- Caddo Parish Magnet High School, Shreveport, LA, United States
| | | | | | - Pamela McPherson
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
| | - Laura Lane Alderman
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
| | - Mohammad Alfrad Nobel Bhuiyan
- Division of Clinical Informatics, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - James C. Patterson
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
- Department of Pharmacology, Toxicology and Neuroscience, School of Graduate Studies, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Kevin S. Murnane
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
- Department of Pharmacology, Toxicology and Neuroscience, School of Graduate Studies, Louisiana State University Health Shreveport, Shreveport, LA, United States
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Cui W, Chen J, Shen H, Zhang Y, Liu S, Zhou Y. Evaluation of the vulnerability to public health events in the Guangdong-Hong Kong-Macao Greater Bay Area. Front Public Health 2022; 10:946015. [PMID: 36159289 PMCID: PMC9500186 DOI: 10.3389/fpubh.2022.946015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023] Open
Abstract
With the continuous improvement in the integration of urban agglomeration, a multi-functional, socialized, and complex dynamic system, effective prevention and control of emergent public health events have become increasingly important. Based on the Public-Health Vulnerability-Assessment-System of Urban Agglomeration (PVUA), the temporal and spatial differentiation characteristics of vulnerability in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) for the period of 2015-2019 are explored, and the vulnerable cities to public health events are identified in this area. The results can be summarized as follows: (1) The overall vulnerability to public health events in GBA decreases in the investigated period. (2) In the temporal dimension, accompanied by social and economic development, the sensitivity to public health events increases in GBA, and the coping capacity change from stable fluctuation to rapid improvement. (3) From the spatial dimension, the sensitivity level in GBA is low in the west, relatively high in the middle, and high in the southeast; the coping capacity is high in the southeast and low in the northwest; the collaborative governance capacity presents a spatial pattern of being low in the south and high in the north. (4) In the period of study, the vulnerability to public health events in Guangzhou and Jiangmen is stable at the lowest level, while that in Zhaoqing, Foshan, and Hong Kong SAR (Special Administrative Region) gradually reduces; the vulnerability in Shenzhen, Zhuhai, and Dongguan is fluctuating, and that in Huizhou, Zhongshan, and Macao SAR is continually maintained at a higher and the highest level.
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Affiliation(s)
- Wenjing Cui
- College of Geosciences and Tourism Management, Hanshan Normal University, Chaozhou, China,China Center for Special Economic Zone Research Shenzhen University, Shenzhen, China
| | - Jing Chen
- College of Geosciences and Tourism Management, Hanshan Normal University, Chaozhou, China,*Correspondence: Jing Chen
| | - Huawen Shen
- Faculty of International Tourism and Management, City University of Macau, Macau SAR, China
| | - Yating Zhang
- Faculty of International Tourism and Management, City University of Macau, Macau SAR, China
| | - Shuting Liu
- The NO.1 Middle School of Suixi County, Zhanjiang, China
| | - Yiting Zhou
- School of management, Guangzhou College of Commerce, Guangzhou, China
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