Rural and Urban Differences in Air Quality, 2008-2012, and Community Drinking Water Quality, 2010-2015 - United States

Exposure to Environmental Toxins: Potential Implications for Stroke Risk via the Gut- and Lung-Brain Axis

Recent evidence indicates that exposure to environmental toxins, both short-term and long-term, can increase the risk of developing neurological disorders, including neurodegenerative diseases (i.e., Alzheimer's disease and other dementias) and acute brain injury (i.e., stroke). For stroke, the latest systematic analysis revealed that exposure to ambient particulate matter is the second most frequent stroke risk after high blood pressure. However, preclinical and clinical stroke investigations on the deleterious consequences of environmental pollutants are scarce. This review examines recent evidence of how environmental toxins, absorbed along the digestive tract or inhaled through the lungs, affect the host cellular response. We particularly address the consequences of environmental toxins on the immune response and the microbiome at the gut and lung barrier sites. Additionally, this review highlights findings showing the potential contribution of environmental toxins to an increased risk of stroke. A better understanding of the biological mechanisms underlying exposure to environmental toxins has the potential to mitigate stroke risk and other neurological disorders.

An exploratory analysis of PM 2.5 /PM 10 ratio during spring 2016-2018 in Metropolitan Lima

Aerosols (PM2.5 and PM10 ) represent one of the most critical pollutants due to their negative effects on human health. This research analyzed the relationship of PM and its PM2.5 /PM10 ratios with climatic variables in the austral spring (2016-2018) in Metropolitan Lima. Overall, there was an average PM2.5 /PM10 ratio of 0.33 with fluctuations from 0.30 to 0.35. However, there have also been high point values that reached ratios greater than one. This situation indicates a moderate condition of contamination by particulate matter with a predominance of coarse aerosols in spring, with an increasing trend over the years. The locations Ate and Villa Maria del Triunfo, especially Ate, presented poor quality conditions. Thursdays showed outstanding pollution peaks by PM10 , and a decrease is visible on Sundays. On the other hand, the PM2.5 showed a similar pattern every day, including Sundays. The maximum peaks occurred in the morning and night hours. The increase in anthropogenic emissions associated with the formation of secondary aerosols has been evident, being the case of the location Campo de Marte, the one that had a significant increase in ratios PM2.5 /PM10 , which confirms a greater intensity of secondary formations of carbonaceous particles from industrial oil sources, vehicle exhaust, as well as aerosols from metal smelting and biomass burning. There were negative correlations of the ratios with PM10 , temperature, wind speed, and direction, and positive correlations with PM2.5 and relative humidity. Contour lines were successfully developed that demonstrated the interaction of climate with PM2.5 /PM10 ratios. This will deepen the exploration of emission sources and modeling, which allows for optimizing air quality indices to control emissions and adequately manage air quality in Metropolitan Lima.

Nickel in ambient particulate matter and respiratory or cardiovascular outcomes: A critical review

Exposure to ambient particulate matter (PM) has been associated with respiratory and cardiovascular outcomes, and nickel has been more frequently associated with these outcomes than other metal constituents of ambient PM. Because of this, we evaluated whether the evidence to date supports causal relationships between exposure to nickel in ambient PM and respiratory or cardiovascular outcomes. We critically reviewed 38 studies in human populations published between 2012 and 2022. Although a large variety of respiratory and cardiovascular outcomes were examined, data were sparse for many. As a result, we focused our evaluation on seven respiratory outcomes and three cardiovascular outcomes that were each examined in ≥3 studies. Of these health outcomes, exposure to nickel in ambient PM has been statistically significantly associated with respiratory mortality, respiratory emergency hospital visits, asthma, lung function (i.e., forced expiratory volume in 1 s, forced vital capacity), cardiovascular mortality, and ischemic heart disease mortality. Studies of the health outcomes of focus are subject to multiple methodological limitations, primarily ecological fallacy (short-term exposure studies), exposure measurement error, confounding, model misspecification, and multiple comparisons issue. While some statistically significant associations were reported, they were not strong, precise, or consistent. Statistically significant findings for long-term exposure to nickel in PM were largely reported in studies that could not establish temporality, despite their cohort study design. Statistically significant findings for short-term exposure to nickel in PM were largely reported in studies that could establish temporality, although this cannot inform causal inference at the individual level due to the aggregate level data used. The biological plausibility of the associations is only supported at high concentrations not relevant to ambient exposures. Overall, the literature to date does not provide adequate support for a causal relationship between nickel in ambient PM and respiratory or cardiovascular outcomes.

Incidence of histologic chorioamnionitis in a rural community hospital

BACKGROUND

Histological chorioamnionitis (HCA) is a pathological condition defined as an acute inflammation of the amniochorionic membranes which has been linked to a wide range of adverse neonatal events.

AIM

The purpose of this study is to identify the incidence of HCA in the rural population and evaluate whether there are significant differences in these incidences within the different clinical parameters of delivery method, gravidity, gestational age, previous cesarean section, reason for cesarean section and body mass index (BMI).

METHODS

A retrospective chart review was conducted on 462 consecutive deliveries that occurred in a rural hospital during a four-year period. Data collected was analyzed using independent sample T-tests, chi-squared tests, and descriptive statistics, with a p-value of < 0.05.

RESULTS

Overall incidence of HCA was 15.9% (73/459), with a term incidence of 16.2% (68/421) and preterm incidence of 13.2% (5/38). The incidence of HCA was significantly higher in vaginal deliveries (18.8%; n = 54/288) than C-section deliveries (11.1%; n = 19/171) (p = 0.03). Incidence of clinical chorioamnionitis was 0.43% (2/462), with 2.74% (2/73) of HCA manifesting clinically.

CONCLUSIONS

Evaluation of the incidence of HCA and associated clinical parameters in this study showed a marked decrease in the incidence of HCA when compared to other studies. Strategies to reduce the incidence of HCA include reducing the length of labor via active labor management. We hypothesize that these findings are due to the consistent use of active labor management and our rural study population, but further investigation is required to confirm this.

Social and Behavior Factors of Alzheimer's Disease and Related Dementias: A National Study in the U.S

INTRODUCTION

Considerable research has linked many risk factors to Alzheimer's Disease and Related Dementias (ADRD). Without a clear etiology of ADRD, it is advantageous to rank the known risk factors by their importance and determine if disparities exist. Statistical-based ranking can provide insight into which risk factors should be further evaluated.

METHODS

This observational, population-based study assessed 50 county-level measures and estimates related to ADRD in 3,155 counties in the U.S. using data from 2010 to 2021. Statistical analysis was performed in 2022-2023. The machine learning method, eXtreme Gradient Boosting, was utilized to rank the importance of these variables by their relative contribution to the model performance. Stratified ranking was also performed based on a county's level of disadvantage. Shapley Additive exPlanations (SHAP) provided marginal contributions for each variable.

RESULTS

The top three ranked predictors at the county level were insufficient sleep, consuming less than one serving of fruits/vegetables per day among adults, and having less than a high school diploma. In both disadvantaged and non-disadvantaged counties, demographic variables such as sex and race were important in predicting ADRD. Lifestyle factors ranked highly in non-disadvantaged counties compared to more environmental factors in disadvantaged counties.

CONCLUSIONS

This ranked list of factors can provide a guided approach to ADRD primary prevention strategies in the U.S., as the effects of sleep, diet, and education on ADRD can be further developed. While sleep, diet, and education are important nationally, differing prevention strategies could be employed based on a county's level of disadvantage.

Pressures of the urban environment on the endocrine system: Adverse effects and adaptation

With an increasing collective awareness of the rapid environmental changes, questions and theories regarding the adaptability of organisms are emerging. Global warming as well as chemical and non-chemical pollution have been identified as triggers of these adaptative changes, but can we link different kinds of stressors to certain phenotypic traits? The physiological adaptation, and particularly endocrine system adaptation, of living beings to urban environments is a fascinating way of studying urban endocrinology, which has emerged as a research field in 2007. In this paper, we stress how endocrine disruption in humans and environment can be studied in the urban environment by measuring the levels of pollution, endocrine activities or adversity. We broaden the focus to include not only exposure to the chemicals that have invaded our private spheres and their effects on wild and domestic species but also non-chemical effectors such as light, noise and climate change. We argue that taking into account the various urban stress factors and their effects on the endocrine system would enable the adoption of new approaches to protect living organisms.

County Rurality and Incidence and Prevalence of Diagnosed Diabetes in the United States

OBJECTIVE

To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality.

PATIENTS AND METHODS

This observational, cross-sectional study used US Centers for Disease Control and Prevention data from 2004 through 2019 for county estimates of incidence and prevalence of diagnosed diabetes. County rurality was based on 6 levels (large central metro counties [most urban] to noncore counties [most rural]). Weighted least squares regression was used to relate rurality with diabetes incidence rates (IRs; per 1000 adults) and prevalence (percentage) in adults aged 20 years or older after adjusting for county-level sociodemographic factors (eg, food environment, health care professionals, inactivity, obesity).

RESULTS

Overall, in 3148 counties and county equivalents, the crude IR and prevalence of diabetes were highest in noncore counties. In age and sex ratio-adjusted models, the IR of diabetes increased monotonically with increasing rurality (P<.001), whereas prevalence had a weak, nonmonotonic but statistically significant increase (P=.002). Further adjustment for sociodemographic factors including food environment, health care professionals, inactivity, and obesity attenuated differences in incidence across rurality levels, and reversed the pattern for prevalence (prevalence ratios [vs large central metro] ranged from 0.98 [95% CI, 0.97 to 0.99] for large fringe metro to 0.94 [95% CI, 0.93 to 0.96] for noncore). In region-stratified analyses adjusted for sociodemographic factors including inactivity and obesity, increasing rurality was inversely associated with incidence in the Midwest and West only and inversely associated with prevalence in all regions.

CONCLUSION

The crude incidence and prevalence of diagnosed diabetes increased with increasing county rurality. After accounting for sociodemographic factors including food environment, health care professionals, inactivity, and obesity, county rurality showed no association with incidence and an inverse association with prevalence. Therefore, interventions targeting modifiable sociodemographic factors may reduce diabetes disparities by region and rurality.

Nature-Inspired Regenerative Fine-Dust-Catching Coatings to Improve Air Quality

Increased particulate matter (PM) concentrations in our ambient air are the cause of various life-threatening diseases and consequently need to be reduced to nonhazardous levels. The natural PM removal capabilities of leaves inspired the development of a low-cost coating technology that exploits natural weather phenomena for its PM catching and removal processes. The herein presented coating is based on microparticle-filled silicone with optimized chemical and physical surface properties. Its surface roughness was tuned using differently sized spray-dried particles, and its surface contact angle was adjusted through silicone tensides, polar ether groups incorporated in the silicon backbone, and the used amount of spray-dried particles. In such a way, optimized silicone coatings showed in laboratory experiments improved catching abilities (>300% relative to glass surfaces), a full retention of adsorbed PM during wind events, and the formation of large PM aggregates. Upon (simulated) rain events, these coatings were regenerated, and the content of harmful PM of various sizes dispersed in water was reduced between ∼73 and 100%. Furthermore, an outdoor test over 100 days showed the functioning of the coating under real-world conditions. These regenerative coatings are readily applicable on diverse surfaces and do not require any further technical infrastructure. Thus, they present an extension of the toolbox for PM reduction technologies.

Rural-urban differences in personality traits and well-being in adulthood

OBJECTIVE

One large focus of personality psychology is to understand the biopsychosocial factors responsible for adult personality development and well-being change. However, little is known about how macro-level contextual factors, such as rurality-urbanicity, are related to personality development and well-being change.

METHOD

The present study uses data from two large longitudinal studies of U.S. Americans (MIDUS, HRS) to examine whether there are rural-urban differences in levels and changes in the Big Five personality traits and well-being (i.e., psychological well-being, and life satisfaction) in adulthood.

RESULTS

Multilevel models showed that Americans who lived in more rural areas tended to have lower levels of openness, conscientiousness, and psychological well-being, and higher levels of neuroticism. With the exception of psychological well-being (which replicated across MIDUS and HRS), rural-urban differences in personality traits were only evident in the HRS sample. The effect of neuroticism was fully robust to the inclusion of socio-demographic and social network covariates, but other effects were partially robust (i.e., conscientiousness and openness) or were not robust at all (i.e., psychological well-being). In both samples, there were no rural-urban differences in Big Five or well-being change.

CONCLUSIONS

We discuss the implications of these findings for personality and rural health research.

Air Pollutants and Risk of Parkinson's Disease among Women in the Sister Study

BACKGROUND

Air pollutants may contribute to the development of Parkinson's disease (PD), but empirical evidence is limited and inconsistent.

OBJECTIVES

This study aimed to prospectively investigate the associations of PD with ambient exposures to fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and nitrogen dioxide (NO 2 ).

METHODS

We analyzed data from 47,108 US women from the Sister Study, enrolled from 2003-2009 (35-80 years of age) and followed through 2018. Exposures of interest included address-level ambient PM 2.5 and NO 2 in 2009 and their cumulative averages from 2009 to PD diagnosis with varying lag-years. The primary outcome was PD diagnosis between 2009 and 2018 (n = 163 ). We used multivariable Cox proportional hazards and time-varying Cox models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

NO 2 exposure in 2009 was associated with PD risk in a dose-response manner. The HR and 95% CI were 1.22 (95% CI: 1.03, 1.46) for one interquartile [4.8 parts per billion (ppb)] increment in NO 2 , adjusting for age, race and ethnicity, education, smoking status, alcohol drinking, caffeine intake, body mass index, physical activity, census region, residential area type, area deprivation index (ADI), and self-reported health status. The association was confirmed in secondary analyses with time-varying averaged cumulative exposures. For example, the multivariable adjusted HR for PD per 4.8   ppb increment in NO 2 was 1.25 (95% CI: 1.05, 1.50) in the 2-year lag analysis using cumulative average exposure. Post hoc subgroup analyses overall confirmed the association. However, statistical interaction analyses found that the positive association of NO 2 with PD risk was limited to women in urban, rural, and small town areas and women with ≥ 50 th percentile ADI but not among women from suburban areas or areas with < 50 th percentile ADI. In contrast, PM 2.5 exposure was not associated with PD risk with the possible exception for women from the Midwest region of the US (HR interquartile -range = 2.49 , 95% CI: 1.20, 5.14) but not in other census regions.

DISCUSSION

In this nationwide cohort of US women, higher level exposure to ambient NO 2 is associated with a greater risk of PD. This finding needs to be independently confirmed and the underlying mechanisms warrant further investigation. https://doi.org/10.1289/EHP13009.

Long-term exposure to ambient ozone at workplace is positively and non-linearly associated with incident hypertension and blood pressure: longitudinal evidence from the Beijing-Tianjin-Hebei medical examination cohort

BACKGROUND

There is limited longitudinal evidence on the hypertensive effects of long-term exposure to ambient O3. We investigated the association between long-term O3 exposure at workplace and incident hypertension, diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), and mean arterial pressure (MAP) in general working adults.

METHODS

We conducted a cohort study by recruiting over 30,000 medical examination attendees through multistage stratified cluster sampling. Participants completed a standard questionnaire and comprehensive medical examination. Three-year ambient O3 concentrations at each employed participant's workplace were estimated using a two-stage machine learning model. Mixed-effects Cox proportional hazards models and linear mixed-effects models were used to examine the effect of O3 concentrations on incident hypertension and blood pressure parameters, respectively. Generalized additive mixed models were used to explore non-linear concentration-response relationships.

RESULTS

A total of 16,630 hypertension-free working participants at baseline finished the follow-up. The mean (SD) O3 exposure was 45.26 (2.70) ppb. The cumulative incidence of hypertension was 7.11 (95% CI: 6.76, 7.47) per 100 person-years. Long-term O3 exposure was independently, positively and non-linearly associated with incident hypertension (Hazard ratios (95% CI) for Q2, Q3, and Q4 were 1.77 (1.34, 2.36), 2.06 (1.42, 3.00) and 3.43 (2.46, 4.79), respectively, as compared with the first quartile (Q1)), DBP (β (95% CI) was 0.65 (0.01, 1.30) for Q2, as compared to Q1), SBP (β (95% CI) was 2.88 (2.00, 3.77), 2.49 (1.36, 3.61) and 2.61 (1.64, 3.58) for Q2, Q3, and Q4, respectively), PP (β (95% CI) was 2.12 (1.36, 2.87), 2.03 (1.18, 2.87) and 2.14 (1.38, 2.90) for Q2, Q3, and Q4, respectively), and MAP (β (95% CI) was 1.39 (0.76, 2.02), 1.04 (0.24, 1.84) and 1.12 (0.43, 1.82) for Q2, Q3, and Q4, respectively). The associations were robust across sex, age, BMI, and when considering PM2.5 and NO2.

CONCLUSIONS

To our knowledge, this is the first cohort study in the general population that demonstrates the non-linear hypertensive effects of long-term O3 exposure. The findings are particularly relevant for policymakers and researchers involved in ambient pollution and public health, supporting the integration of reduction of ambient O3 into public health interventions.

Identifying groups of children's social mobility opportunity for public health applications using k-means clustering

Background

The Opportunity Atlas project is a pioneering effort to trace social mobility and adulthood socioeconomic outcomes back to childhood residence. Half of the variation in adulthood socioeconomic outcomes was explainable by neighborhood-level socioeconomic characteristics during childhood. Clustering census tracts by Opportunity Atlas characteristics would allow for further exploration of variance in social mobility. Our objectives here are to identify and describe spatial clustering trends within Opportunity Atlas outcomes.

Methods

We utilized a k-means clustering machine learning approach with four outcome variables (individual income, incarceration rate, employment, and percent of residents living in a neighborhood with low levels of poverty) each given at five parental income levels (1st, 25th, 50th, 75th, and 100th percentiles of the national distribution) to create clusters of census tracts across the contiguous United States (US) and within each Environmental Protection Agency region.

Results

At the national level, the algorithm identified seven distinct clusters; the highest opportunity clusters occurred in the Northern Midwest and Northeast, and the lowest opportunity clusters occurred in rural areas of the Southwest and Southeast. For regional analyses, we identified between five to nine clusters within each region. PCA loadings fluctuate across parental income levels; income and low poverty neighborhood residence explain a substantial amount of variance across all variables, but there are differences in contributions across parental income levels for many components.

Conclusions

Using data from the Opportunity Atlas, we have taken four social mobility opportunity outcome variables each stratified at five parental income levels and created nationwide and EPA region-specific clusters that group together census tracts with similar opportunity profiles. The development of clusters that can serve as a combined index of social mobility opportunity is an important contribution of this work, and this in turn can be employed in future investigations of factors associated with children's social mobility.

Ambient Air Pollutants and Olfaction among Women 50-79 Years of Age from the Sister Study

BACKGROUND

Poor olfaction is common in older adults and may have profound adverse implications on their health. However, little is known about the potential environmental contributors to poor olfaction.

OBJECTIVE

We investigated ambient fine particulate matter [PM ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 )] and nitrogen dioxide (NO 2 ) in relation to poor olfaction in middle-aged to older women.

METHODS

The Sister Study is a nationwide cohort of 50,884 women in the United States with annual average air pollutant exposures estimated based on participants' residences from enrollment (2003-2009) through 2017. This analysis was limited to 3,345 women, 50-79 years of age as of January 2018, who completed the Brief Smell Identification Test (B-SIT) in 2018-2019. Poor olfaction was defined as a B-SIT score of ≤ 9 in the primary analysis. We conducted multivariable logistic regressions, accounting for covariates and study sampling design.

RESULTS

Overall, we found little evidence for associations of air pollutants with poor olfaction. The odds ratio (OR) and 95% confidence interval (CI) of poor olfaction for each interquartile range (IQR) increment of air pollutants in 2006 were 1.03 (95% CI: 0.91, 1.17) for PM 2.5 (per 3.3   μ g / m 3 ) and 1.08 (95% CI: 0.96, 1.22) for NO 2 (per 5.7  ppb ). Results were similar in the analyses using the most recent (2017) or the cumulative average (2006-2017) air pollutant exposure data. Secondary analyses suggested potential association in certain subgroups. The OR per IQR was 1.35 (95% CI: 1.11, 1.65) for PM 2.5 among younger participants (< 54.2 years of age) and 1.87 (95% CI: 1.29, 2.71) for NO 2 among current smokers.

DISCUSSION

This study did not find convincing evidence that air pollutants have lasting detrimental effects on the sense of smell of women 50-79 years of age. The subgroup analyses are exploratory, and the findings need independent confirmation. https://doi.org/10.1289/EHP12066.

Agrimonia: a dataset on livestock, meteorology and air quality in the Lombardy region, Italy

The air in the Lombardy region, Italy, is one of the most polluted in Europe because of limited air circulation and high emission levels. There is a large scientific consensus that the agricultural sector has a significant impact on air quality. To support studies quantifying the role of the agricultural and livestock sectors on the Lombardy air quality, this paper presents a harmonised dataset containing daily values of air quality, weather, emissions, livestock, and land and soil use in the years 2016-2021, for the Lombardy region. The daily scale is obtained by averaging hourly data and interpolating other variables. In fact, the pollutant data come from the European Environmental Agency and the Lombardy Regional Environment Protection Agency, weather and emissions data from the European Copernicus programme, livestock data from the Italian zootechnical registry, and land and soil use data from the CORINE Land Cover project. The resulting dataset is designed to be used as is by those using air quality data for research.

Patterns of Emergency Room Visits for Respiratory Diseases in New York State in Relation to Air Pollution, Poverty and Smoking

We have explored differences in rates of emergency room (ER) visits for respiratory diseases in the counties of New York State (NYS) in relation to levels of air pollution, poverty, and smoking. Air pollution information was derived from the National Emissions Inventory, which provides information on road, non-road, point, and non-point sources of 12 different air pollutants. This information is only available at the county level. Four types of respiratory diseases were considered: asthma, chronic obstructive pulmonary disease (COPD), acute lower respiratory diseases, and acute upper respiratory diseases. Asthma ER visits were elevated in counties with greater total air pollution. All forms of respiratory diseases were elevated in counties with a greater rate of poverty, although this may reflect the fact that poor people often use ERs for routine care. There was a very strong association between rates of smoking for COPD and acute lower respiratory diseases. There was an apparent negative association between smoking and asthma ER visits, but this must reflect the fact that smoking was much more common in upstate counties while asthma was more common in the New York City area, where air pollution is high. Air pollution was much greater in urban than in rural areas. Our evidence indicates that air pollution is the greatest risk factor for asthma attacks, whereas smoking is the greatest risk factor for chronic obstructive pulmonary disease (COPD) and lower respiratory disease. Poor people are more vulnerable to all forms of respiratory diseases.

Factors associated with nonsyndromic anotia and microtia, Texas, 1999-2014

BACKGROUND

Few risk factors have been identified for nonsyndromic anotia/microtia (A/M).

METHODS

We obtained data on cases and a reference population of all livebirths in Texas for 1999-2014 from the Texas Birth Defects Registry (TBDR) and Texas vital records. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for A/M (any, isolated, nonisolated, unilateral, and bilateral) using Poisson regression. We evaluated trends in prevalence rates using Joinpoint regression.

RESULTS

We identified 1,322 cases, of whom 982 (74.3%) had isolated and 1,175 (88.9%) had unilateral A/M. Prevalence was increased among males (PR: 1.3, 95% CI: 1.2-1.4), offspring of women with less than high school education (PR: 1.3, 95% CI: 1.1-1.5), diabetes (PR: 2.0, 95% CI: 1.6-2.4), or age 30-39 versus 20-29 years (PR: 1.2, 95% CI: 1.0-1.3). The prevalence was decreased among offspring of non-Hispanic Black versus White women (PR: 0.6, 95% CI: 0.4-0.8) but increased among offspring of Hispanic women (PR: 2.9, 95% CI: 2.5-3.4) and non-Hispanic women of other races (PR: 1.7, 95% CI: 1.3-2.3). We observed similar results among cases with isolated and unilateral A/M. Sex disparities were not evident for nonisolated or bilateral phenotypes, nor did birth prevalence differ between offspring of non-Hispanic Black and non-Hispanic White women. Maternal diabetes was more strongly associated with nonisolated (PR: 4.5, 95% CI: 3.2-6.4) and bilateral A/M (PR: 5.0, 95% CI: 3.3-7.7). Crude prevalence rates increased throughout the study period (annual percent change: 1.82).

CONCLUSION

We identified differences in the prevalence of nonsyndromic A/M by maternal race/ethnicity, education, and age, which may be indicators of unidentified social/environmental risk factors.

Worldwide Surveillance Actions and Initiatives of Drinking Water Quality: A Scoping Review

This study identified and mapped worldwide surveillance actions and initiatives of drinking water quality implemented by government agencies and public health services. The scoping review was conducted between July 2021 and August 2022 based on the Joanna Briggs Institute method. The search was performed in relevant databases and gray literature; 49 studies were retrieved. Quantitative variables were presented as absolute and relative frequencies, while qualitative variables were analyzed using the IRaMuTeQ software. The actions developed worldwide and their impacts and results generated four thematic classes: (1) assessment of coverage, accessibility, quantity, and drinking water quality in routine and emergency situations; (2) analysis of physical-chemical and microbiological parameters in public supply networks or alternative water supply solutions; (3) identification of household water contamination, communication, and education with the community; (4) and investigation of water-borne disease outbreaks. Preliminary results were shared with stakeholders to favor knowledge dissemination.

Assessment of the exposure to PM2.5 in different Lebanese microenvironments at different temporal scales

The weak potential of using the sole outdoor concentrations to represent personal exposure to PM_2.5 is confirmed by the literature; therefore, it is important to account for a person's movements over time when estimating the short-term personal air pollution exposure within different microenvironments (MEs). This study is an example of applying an assessment method of the exposure to PM_2.5 in different microenvironments at different temporal scales. A low-cost particle counter (the Dylos 1700) was used; its performance was validated in comparison with equivalent instruments such the SidePak AM520 Personal Aerosol Monitor (R² = 0.89). This validation also provided a function to convert measured particle number concentrations (PNCs) into calculated particle mass concentrations. The 150 profiles that was collected on a minute-by-minute basis regarding PM_2.5 concentration from December 2018 to May 2021 highlight the influence of individual activities and contextual factors on the air quality, so that Lebanon's annual PM_2.5 mean (24.2 µg⁄m³) is 142% higher than the World Health Organization (WHO) annual mean guideline (10 µg⁄m³). Winter is the most polluted period due to the increased application of space heating devices. Additionally, the occurrence of dusty winds during the spring period leads to the elevated levels of dispersed PM_2.5. Simultaneously, the rural zones are more polluted than urban ones due to the usage of more traditional heating equipment, in addition to the usage of chemical products like pesticides and fertilizers in agricultural activities in such areas. Furthermore, the (outdoor-indoor-transport) MEs indicate that the transport and indoor MEs have similar levels of suspended fine particulates, while outdoor MEs are less polluted. Studies based on the personal exposure to PM_2.5 were generally applied on specific and limited places such as schools, workplaces, or residences. The study aims to shed light on the modern method in an attempt to estimate the personal exposure to PM_2.5 and to inspire similar studies to achieve the maximum efficiency.

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

BACKGROUND

Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation.

METHODS

We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation.

RESULTS

From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels.

CONCLUSIONS

During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

Environmental exposures and lymphoma risk: a nested case-control study using the Golden Retriever Lifetime Study cohort

Lymphoma is the second most common cancer affecting Golden Retrievers and is hypothesized to arise through a complex interaction of genetic and environmental factors. The aim of this nested case–control study was to investigate the association between potential environmental pollutant sources and lymphoma risk among Golden Retrievers participating in the Golden Retriever Lifetime Study. Forty-nine Golden Retrievers with non-cutaneous lymphoma and 98 Golden Retrievers without a history of cancer matched by age, sex and neuter status were selected from the Golden Retriever Lifetime Study cohort. Geographic proximity between each dog’s primary residence and nine potential sources of environmental pollution was determined. In addition, the average annual ozone and airborne fine particulate matter levels for each dog’s county of residence and owner-reported secondhand smoke exposure were evaluated. Environmental pollution sources of interest included chemical plants, municipal dumps, manufacturing plants, incineration plants, railroad embankment tracks, landfills, coal plants, high-voltage transmission lines, and nuclear power plants. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each exposure of interest. Subgroup analyses were conducted to evaluate whether associations differed among 1) dogs with multicentric lymphoma, 2) dogs with B-cell lymphoma, and 3) dogs with T-cell lymphoma. No variables reached statistical significance when evaluating all cases together. However, cumulative exposure burden (household proximity to 3 or more pollution sources) approached significance within the multicentric lymphoma subgroup (OR = 2.60, 95%CI 0.99–6.86, p-value = 0.053). Patterns emerged among B- and T-cell subgroups, but none reached statistical significance. Ongoing research is warranted to discern if different environmental mechanisms may be driving B- and T-cell lymphoma immunophenotypes, consistent with previously reported regional differences in subtype prevalence.

Lymphoma is a common cancer affecting dogs, particularly Golden Retrievers. By identifying risk factors for lymphoma, work can be done to reduce harmful exposures or increase monitoring among dogs at a higher risk of disease. Using a subset of dogs from the Golden Retriever Lifetime Study, we sought to investigate whether dogs with lymphoma were more likely to live near certain environmental pollutant sources than dogs without lymphoma.

Forty-nine Golden Retrievers with non-cutaneous lymphoma and 98 Golden Retrievers without a history of cancer were selected from the Golden Retriever Lifetime Study Cohort. We evaluated how close each dog lived to nine environmental pollutant sources: chemical plants, municipal dumps, manufacturing plants, incineration plants, railroad embankment tracks, landfills, coal plants, high-voltage transmission lines, and nuclear power plants. Additionally, we evaluated individual exposure to secondhand smoke, and average annual ozone and particulate matter exposure (as surrogate measures for air pollution) for each dog’s county of residence.

None of the exposures examined were associated with an increased lymphoma risk in this population. More research is needed, including direct biomonitoring, to determine whether specific environmental exposures are associated with lymphoma in the Golden Retriever breed.

Cumulative human exposure and environmental occurrence of phthalate esters: A global perspective

In the current investigation, the distribution and extent of human exposure of phthalate esters (PAEs) have been reported on global extent based on computed indices. The proposed indices were calculated based on environmental concentrations, toxicity, occurrence, environmental fate, and transport of PAEs. The cumulative phthalate exposure index (PEI) based on the phthalate pollution index (PPI) was mapped on a global scale based on the existing data reported in the literature. The results revealed that the PAEs are heterogeneously distributed globally, and about 30% of total environmental PAEs are ultimately exposed to the average human being. The comparative distribution of PAEs in various environmental compartments including urban-rural, indoor-outdoor, home-dormitory-classroom, and their exposure likelihood were studied based on indices. More than 90% of total human exposure of PAEs was observed to be from indoor environmental compartments. Significantly high exposure was observed in the urban population as compared to the rural population. About 70% of the total phthalate pollution sub-index of dust was observed from home followed by a classroom of ∼15% and then a dormitory of ∼10%. In addition, the indices were equated with the current human development index (HDI), gross national income (GNI), and exposure of particulate matter of each country. Based on current findings, the population living in the areas where >20 μg/m³ of particulate matter has been reported are possibly exposed with higher PAEs. The indices were highly diversified at high HDI (0.9) values and between 40,000 and 50,000 $ per capita income due to different usage of phthalate-containing products, disposal, and extensive monitoring work carried out by the developed and developing countries.

Air pollution, social engagement and subjective well-being: evidence from the Gallup World Poll

The link between air pollution and individual happiness is widely documented. However, the role of social engagement in pollution reduction is seldom considered in the nexus. As such, using large individual-level data from the Gallup World Poll of 151 countries for 2005-2018, this study applies a pooled cross-sectional data approach (controlling for country and year fixed effects) to examine the impact of air pollution on individual happiness and the role of social engagement in shaping the pollution-happiness relationship. The key findings of this study reveal that better air quality raises personal subjective well-being, given that the coefficient of individuals' perceived air quality is positive and statistically significant. More importantly, social engagement in pollution reduction is found to play an important moderating role in shaping the pollution-happiness relationship. Moreover, using a series of robustness checks, such as applying an alternative measure of happiness, an alternative measure of air quality (objective air quality), and using an instrumental variable estimation approach, confirms the positive effect of air quality (perceived or objective) on improving individuals' happiness and the moderating role of social engagement. Furthermore, this study reveals that different demographic characteristics (i.e., age, sex, income, marital status, and urban/rural residence) respond differently to the adverse effects of air pollution and the moderating role of social engagement in pollution reduction. Thus, some policies can be revised and proposed in light of the novel findings of social engagement. In particular, the government should take an active role in combating air pollution and improving air quality by increasing financial input and strengthening environmental protection publicity. The limitations of the study and directions for future research are discussed.

Where Is Air Quality Improving, and Who Benefits? A Study of PM2.5 and Ozone Over 15 Years

In the United States, concentrations of criteria air pollutants have declined in recent decades. Questions remain regarding whether improvements in air quality are equitably distributed across subpopulations. We assessed spatial variability and temporal trends in concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and ozone (O3) across North Carolina from 2002-2016, and associations with community characteristics. Estimated daily PM2.5 and O3 concentrations at 2010 Census tracts were obtained from the Fused Air Quality Surface Using Downscaling archive and averaged to create tract-level annual PM2.5 and O3 estimates. We calculated tract-level measures of: racial isolation of non-Hispanic Black individuals, educational isolation of non-college educated individuals, the neighborhood deprivation index (NDI), and percentage of the population in urban areas. We fitted hierarchical Bayesian space-time models to estimate baseline concentrations of and time trends in PM2.5 and O3 for each tract, accounting for spatial between-tract correlation. Concentrations of PM2.5 and O3 declined by 6.4 μg/m3 and 13.5 ppb, respectively. Tracts with lower educational isolation and higher urbanicity had higher PM2.5 and more pronounced declines in PM2.5. Racial isolation was associated with higher PM2.5 but not with the rate of decline in PM2.5. Despite declines in pollutant concentrations, over time, disparities in exposure increased for racially and educationally isolated communities.

Understanding Farmworker Fluid Intake Using Intersectionality Theory

In the United States, Latino farmworkers are disproportionately at risk for death from heat-related illnesses. To elicit Latino farmworker perceptions on their fluid intake and heat stress, a qualitative descriptive, community-informed research study was conducted in eastern North Carolina. A total of 28 Mexican farmworkers participated in one of 4 focus groups. Using content analysis and guided by Intersectionality theory, themes and subthemes were identified. The first theme was Absence of Protection, represented by 2 subthemes: (1a) Intense Climate Considerations; and (1b) Workplace Exploitation. The second theme, Freedom to Drink, included 2 subthemes: (2a) Distance and Distaste; and (2b) Culture of Farm Work. Farmworkers perceived extreme outdoor temperatures as the greatest workplace barrier to staying hydrated and reported water accessibility and quality issues. Farmworker fluid intake was influenced by interlocking social categories and power systems. Policy recommendations that prevent farmworker heat-related illness and promote hydration are discussed.

Urban-rural residence and birth defects prevalence in Texas: a phenome-wide association study

BACKGROUND

Some assessments indicate the prevalence of certain birth defects varies by urban-rural status. We evaluated associations between urban-rural residence and a spectrum of birth defects, using a phenome-wide association study approach in Texas, a state with large urban centers and expansive rural areas.

METHODS

Data for birth defects and livebirths during 1999-2015 were obtained from the Texas Birth Defects Registry and the Center for Health Statistics. Maternal residence was classified as urban or rural, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated for any defect and 140 specific defects by Poisson regression.

RESULTS

Overall, birth defects were less frequent in rural compared to urban counties (PR = 0.88, 95% CI: 0.87-0.89). Twelve specific defects were less prevalent in rural counties, including ventricular septal defects (VSDs; PR = 0.76, 95% CI: 0.73-0.79) and hypospadias (PR = 0.86, 95% CI: 0.82-0.89). For some birth defects, including VSDs, there was evidence of decreasing prevalence with decreasing population size.

CONCLUSIONS

In our large population-based assessment, we demonstrated that several birth defects were less prevalent in rural counties, suggesting that characteristics of urban settings may be relevant to their etiologies, diagnosis, or surveillance. Further research is needed to identify specific exposures underlying these associations.

IMPACT

There are few studies of birth defects prevalence in urban versus rural settings. To address this, we investigated a comprehensive range of birth defects, including several rare defects that have not been previously studied, in a large and diverse population. We identified 12 structural birth defects that were less prevalent in rural areas. Findings suggest possible differential exposures among urban and rural women, and/or possible underdiagnosis of certain birth defects in rural areas. Findings highlight the need for further study of geographically referenced risk factors for birth defects, and of the completeness of birth defects ascertainment in rural areas.

Long-Term Exposure to Air Pollution Associates the Risk of Benign Brain Tumor: A Nationwide, Population-Based, Cohort Study in Taiwan

Air pollutants as risk factors for benign brain tumor (BBT) remain unclear. Therefore, we conducted a nationwide retrospective cohort study by integrating the patients’ clinical data and daily air quality data to assess the environmental risk factors of BBT in Taiwan.Daily air quality data were categorized into quartiles (Q1 to Q4). The adjusted hazard ratio (aHR) was evaluated by comparing the BBT incidence rate of the subjects in Q2–Q4 with that of the subjects in Q1 (the lowest concentration of air pollutants). A total of 161,213 subjects were enrolled in the study. Among the air pollutants tested, the aHR of BBT was significantly higher in the subjects who were exposed to the highest level (Q4) of CO (aHR 1.37, 95% CI 1.08–1.74), NO2 (aHR 1.40, 95% CI 1.09–1.78), and PM2.5 (aHR 1.30, 95% CI 1.02–1.65) than that in the subjects who were exposed to the lowest level (Q1). No significant risk association of BBT with SO2 and PM10 exposure was observed. The results revealed that long-term exposure to air pollutants, particularly CO, NO2, and PM2.5, is associated with the risk of BBT.

Health Effects of Long-Term Exposure to Ambient PM2.5 in Asia-Pacific: a Systematic Review of Cohort Studies

Abstract

Purpose of Review

Health effects of long-term exposure to ambient PM_2.5 vary with regions, and 75% of the deaths attributable to PM_2.5 were estimated in Asia-Pacific in 2017. This systematic review aims to summarize the existing evidence from cohort studies on health effects of long-term exposure to ambient PM_2.5 in Asia-Pacific.

Recent Findings

In Asia-Pacific, 60 cohort studies were conducted in Australia, Mainland China, Hong Kong, Taiwan, and South Korea. They consistently supported associations of long-term exposure to PM_2.5 with increased all-cause/non-accidental and cardiovascular mortality as well as with incidence of cardiovascular diseases, type 2 diabetes mellitus, kidney diseases, and chronic obstructive pulmonary disease. Evidence for other health effects was limited. Inequalities were identified in PM_2.5-health associations.

Summary

To optimize air pollution control and public health prevention, further studies need to assess the health effects of long-term PM_2.5 exposure in understudied regions, the health effects of long-term PM_2.5 exposure on mortality and risk of type 2 diabetes mellitus, renal diseases, dementia and lung cancer, and inequalities in PM_2.5-health associations. Study design, especially exposure assessment methods, should be improved.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40572-022-00344-w.

Anthropogenic contamination leads to changes in mineral composition of soil- and tree-growing mushroom species: A case study of urban vs. rural environments and dietary implications

Because wild-growing edible mushroom species are frequently consumed, a knowledge of their mineral composition is essential. The content of elements in mushrooms and their possible beneficial or harmful effect may be influenced by the human-impacted environment. Thus, the aim of the study was to analyse the mineral composition of the soil, trees, and especially soil- and tree-growing mushroom species collected from within a city and from rural areas. Due to potentially higher pollution in urban areas, we assumed that mushrooms from a city environment will contain higher levels of mineral elements than those from rural areas and that the high content will be attributed to greater contamination of city soils. Significantly higher concentrations of several elements in soils (Ca, Ba, Bi, Hg, Pb, Sb, Sr, W and Zr) and trees (Ag, Bi, Ce, Co, Mn, Mo, Nd, Pr, Ta, Tm and W) were observed from the samples collected in the city. Additionally, significantly higher contents of Ag, Fe, Hg, Mn, Mo, Sr, Y and Zn in soil-growing, and Al, As, Ba, Cr, Fe, Hg, Ni, Pb, Sr, Ta and Zn in tree-growing mushroom species were recorded from the urban area. These differences formed the basis for the observation that the content of elements in urban mushrooms is generally higher than in those from rural areas. However, a higher content of several soil elements does not necessarily mean that there will be a significantly higher content in fruit bodies. There was also no real risk of consuming soil-growing mushroom species collected in recent years from the city, suggesting that this practice may still be continued.

Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.

Poor Air Quality in Urban Settings: A Comparison of Perceptual Indicators, Causes and Management in Two Cities

Poor air quality (PAQ) is a global concern, especially in urban areas, and is often seen as an important element of social sustainability given its negative impact on health and quality of life. However, little research has been undertaken in cities of the developing world to explore how residents perceive poor air quality, its main causes, what control measures should be used to address PAQ and where the main responsibility rests for implementing control measures. The research described in this paper sought to address these points, using a questionnaire-based survey (n = 262) in Nigeria’s federal capital city of Abuja (n = 137) and the state-capital city of Enugu (n = 125). The survey took place during the COVID-19 pandemic (October 2020 to March 2021), and was stratified to ensure representation across a number of demographic groups such as gender, age, education and income. The results were analysed using the Kruskal–Wallis non-parametric test and Hochberg’s post hoc test available in SPSS version 28. The study found that the ranking of perceptual indicators and the main causes of PAQ had much agreement between respondents from both cities and between demographic groups. Smoke, odour and dust particles were perceived to be the most important indicators of PAQ, while the main sources of PAQ were waste and bush burning, vehicle use and power generators. The two most preferred control measures were proper waste management and the avoidance of bush burning. However, there was a significant difference between the two cities in terms of the main organisations responsible for addressing PAQ, with respondents from Abuja citing the federal government, while those from Enugu cited the state government. Interestingly, younger people in Enugu noted that the government should take more responsibility in controlling PAQ than did the older demographic in that city, but this difference was not seen in Abuja. Overall, this study reveals that residents in these two Nigerian cities clearly recognise their exposure to PAQ and it suggests that these perceptual indicators, and views on sources and interventions should be central to designing policies to control this important issue.

Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States

Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this manuscript, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Atmospheric black carbon in urban and traffic areas in Shanghai: Temporal variations, source characteristics, and population exposure

Black carbon (BC) measurements were performed at Pudong (PD) urban supersite and Gonghexin (GH) roadside station from December 1, 2017 to August 10, 2020 to investigate the variations, source characteristics, and population exposure levels of BC in traffic and urban areas in Shanghai, China. The BC median concentration at GH was more than two-fold that at PD. Absorption Ångström exponent (AAE) values were 1.27 ± 0.17 and 1.31 ± 0.17 at PD and GH, respectively, suggesting the dominance of liquid fossil fuel combustion sources (i.e., traffic exhaust) at these stations. The higher BC and AAE values in winter at PD indicated the relatively increasing contribution of solid fuels (i.e., biomass burning) to BC concentration in urban Shanghai. The diurnal variation in BC showed similar twin-peak patterns at PD and GH, implying that traffic emission mainly contributed to ambient BC concentration in urban Shanghai. The estimated daily intakes (EDIs) of BC were generally higher in males than in females at both PD and GH. The highest BC EDIs at PD were found in age subgroups 1-<2 and 2-<3 years. In contrast, the BC EDIs at GH were observed in age subgroups 6-<9, 12-<15, and 15-<18 years, which were higher than those determined at PD, indicating that more attention must be paid to BC exposure of the population in these age subgroups. These results provide scientific insights into variations, source characteristics, and population exposure levels of BC in urban and traffic areas and could help in the development of BC control strategies in Shanghai.

Association of Socio-Demographic and Climatic Factors with the Duration of Hospital Stay of Under-Five Children with Severe Pneumonia in Urban Bangladesh: An Observational Study

Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005–1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029–1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008–1.019), p < 0.001). There was also a significant negative association with LoS for children’s age (β: 0.996, 95% Cl: 0.994–0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881–0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973–0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.

The Evolutionarily Mismatched Impact of Urbanization on Insomnia Symptoms: a Short Review of the Recent Literature

PURPOSE OF REVIEW

For the most part of human existence, individuals have been living a rural lifestyle in a rural setting. However, such sleep-conducive conditions have largely been transformed dramatically by urbanization within a relatively short span of time in recent history, and the resulting evolved mechanisms-environment mismatch is theorized to bring about an increased risk for insomnia symptoms. This brief review of the recent literature is designed to evaluate the veracity of this proposition.

RECENT FINDINGS

The majority of recent findings have suggested that most proposed evolutionarily mismatched urban factors are indeed related to the presence of insomnia symptoms. However, there is a general paucity of longitudinal evidence (and for some other factors, a lack of enough evidence of any kind). Although there is a preponderance of recent findings indicating a link between evolutionarily mismatched urban phenomena and insomnia symptoms, more longitudinal data are needed before any causative conclusion can be drawn.

Iranian population exposures to heavy metals, PAHs, and pesticides and their intake routes: a study protocol of a national population health survey

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water.

Natural compounds protect the skin from airborne particulate matter by attenuating oxidative stress

Particulate matter (PM) is a common indirect indicator of air pollution and threatens public health upon prolonged exposure, leading to oxidative stress, increasing the risk of develop respiratory and cardiovascular, as well as several autoimmune diseases and cancer. Nowadays, as a first line defense against PM, skin health attracted much attention. Our review summarized the skin damage mechanism induced by PM, including damage skin barrier directly, reactive oxygen species (ROS) accumulation, autophagy, and two canonical signaling pathways. Furthermore, ROS and oxidative stress have been considered pathogenesis centers, with essential skin damage roles. Extracts from plants and natural compounds which present high antioxidant capacity could be used to treat or protect against air pollution-related skin damage. We conclude the extracts reported in recent studies with protective effects on PM-mediated skin damage. Besides, the mechanism of extracts' positive effects has been revealed partially.

Cytotoxicity and inflammatory effects in human bronchial epithelial cells induced by polycyclic aromatic hydrocarbons mixture

Polycyclic aromatic hydrocarbons (PAHs) are the most common contaminants in the air pollutants. Inhalation exposure to PAHs could increase the risk of respiratory disease, cardiovascular disease and even cancer. However, the biotoxicity of multi-component PAHs from atmospheric pollutants has been poorly studies. The main topic of this study was to investigate the PAHs mixture, which derived from atmospheric pollutants, induced toxic effects and inflammatory effects on human bronchial epithelial cells in vitro. The results showed that PAHs mixture could decrease the cell viability, increase the apoptosis rate, and induce cell cycle arrest at S-phase. Furthermore, the expression of inflammatory factors IL-1β and IL-6 were increased and NF-κB signaling pathway was activated in PAHs mixture-treated cells. The findings of this study indicate that PAHs mixture-induced cytotoxicity and inflammation may be related to intracellular ROS generation and to the activated NF-κB signaling pathway.

An Examination of National Cancer Risk Based on Monitored Hazardous Air Pollutants

BACKGROUND

Hazardous air pollutants, or air toxics, are pollutants known to cause cancer or other serious health effects. Nationwide cancer risk from these pollutants is estimated by the U.S. EPA National Air Toxics Assessment. However, these model estimates are limited to the totality of the emissions inventory used as inputs, and further, they cannot be used to examine spatial and temporal trends in cancer risk from hazardous air pollutants.

OBJECTIVES

To complement model estimates of nationwide cancer risk, we examined trends in cancer risk using monitoring data from 2013 to 2017 across the 27 U.S. National Air Toxics Trends Stations.

METHODS

For each monitoring site, we estimated cancer risk by multiplying the annual concentration for each monitored pollutant by its corresponding unit risk estimate. We examined the 5-y average (2013-2017) cancer risk across sites and the population levels and demographics within 1-mi of the monitors, as well as changes in estimated cancer risk over time. Finally, we examined changes in individual pollutant concentrations and their patterns of covariance.

RESULTS

We found that the total estimated cancer risk is higher for urban vs. rural sites, with the risk at seven urban sites (of 21) above 75 in 1 million. Furthermore, while most pollutant concentrations have not changed over the time period explored, we found 38 site-pollutant combinations that significantly declined and 12 that significantly increased between 2013 and 2017. We also identified a positive correlation between estimated cancer risk and percent of the population within 1-mi of a monitor that is low income.

DISCUSSION

Long-term trends show that annual mean concentrations of most measured air toxics have declined. Our evaluation of a more recent snapshot in time finds that most pollutant concentrations have not changed from 2013 to 2017. This analysis of cancer risk based on monitored values provides an important complement to modeled nationwide cancer risk estimates and can further inform future approaches to mitigate risk from exposure to hazardous air pollutants. https://doi.org/10.1289/EHP8044.

China's drinking water sanitation from 2007 to 2018: A systematic review

Regular monitoring of drinking water in China is carried out by the Centers for Disease Control and Prevention at all levels and some articles were published for the public to understand the status of drinking water. However, these published articles were limited to small areas and reported almost exclusively in Chinese. In order to give the public a comprehensive understanding of the situation of drinking water sanitation in China and provide specific directions for ensuring drinking water safety in the future, we review the sanitation status of drinking water in different regions of China from 2007 to 2018, the changes over time and the factors affecting drinking water quality by means of systematic review for the first time. Our results show that the quality of drinking water in China has shown an upward trend from 2007 to 2018. The qualification rate of urban drinking water (85.51%) was much higher than that of rural drinking water (51.12%), and the dry season (56.93%) was higher than the wet season (50.54%), and the terminal tap water (59.88%) was higher than the outlet water of waterworks (55.87%). In addition, the regions with low qualification rate of water quality in China were mainly distributed in several southern provinces, such as Yunnan, Guizhou, Hainan, etc. What's more, the qualified rate of the three microbiological indicators was the lowest, all below 85%. All the results indicate that the sanitation status of drinking water in China is unsatisfactory, and the biggest risk affecting water safety is microbial pollution. The central and local governments should work hard to improve people's drinking water quality and continue to strengthen the treatment and supervision of drinking water, especially in rural areas and undeveloped southern areas.

Toward a bioarchaeology of urbanization: Demography, health, and behavior in cities in the past

Urbanization is one of the most important settlement shifts in human history and has been the focus of research within bioarchaeology for decades. However, there have been limited attempts to synthesize the results of these studies in order to gain a broader perspective on whether or how urbanization affects the biology, demography, and behavior of humans, and how these potential effects are embodied in the human skeleton. This paper outlines how bioarchaeology is well-suited to examine urbanization in the past, and we provide an overview and examples of three main ways in which urbanization is studied in bioarchaeological research: comparison of (often contemporaneous) urban and rural sites, synchronic studies of the variation that exists within and between urban sites, and investigations of changes that occur within urban sites over time. Studies of urbanization, both within bioarchaeology and in other fields of study, face a number of limitations, including a lack of a consensus regarding what urban and urbanization mean, the assumed dichotomous nature of urban versus rural settlements, the supposition that urbanization is universally bad for people, and the assumption (at least in practice) of homogeneity within urban and rural populations. Bioarchaeologists can address these limitations by utilizing a wide array of data and methods, and the studies described here collectively demonstrate the complex, nuanced, and highly variable effects of urbanization.

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

Air pollution and its economic impacts at household level: willingness to pay for environmental services in Pakistan

Air pollution has become a major global problem. Thus, the goal of this study was to find out the economic impacts (treatment cost) of air pollution on households as well as the principal factors inducing an individual's willingness to pay for better air quality. District Faisalabad was purposively selected for sampling, as it is a major industrial hub in Pakistan. The required information was collected from 120 sampled respondents through a structured questionnaire. The ordinary least squares method was used for assessing the impact of various factors on the treatment cost of the most recent episode of ailment related to air pollution. The ordered logit model was used to assess the impacts of factors affecting the willingness to pay for programs aimed at the provision of better environmental services. The results revealed that high air pollution in the urban area resulted in more lost workdays and higher health costs. The findings also showed that people were willing to pay for better air quality in urban areas than in rural areas. Based on the findings, it is suggested that the incentive schemes may be designed for the promotion of cleaner services in rural and urban areas.

The urban lead (Pb) burden in humans, animals and the natural environment

Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980's, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead's neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.

Set of stress biomarkers as a practical tool in the assessment of multistress effect using honeybees from urban and rural areas as a model organism: a pilot study

A decrease among honey bee populations (Apis mellifera) in the traditional apiaries has been observed in recent years. In light of this negative phenomenon, urban beekeeping seems to be an appropriate alternative solution for the bee population in reducing the toxic effects of a large number of pesticides that are commonly used in agricultural ecosystems. Despite the rapid development of urban beekeeping, there is little information regarding the different aspects of the defense effectiveness of bees from the urban and rural areas. The study was aimed to show whether honey bees from these two locations differ in the level of the valuable biomarkers of stress exposure helpful in establishing which bees, from urban or rural areas, are under greater environmental pressure. For this purpose, foragers from an urban rooftop apiary and a traditional rural apiary were collected. The chosen biomarkers were measured in various tissues of bees. The activity of glutathione S-transferase and acetylcholinesterase, the level of total antioxidant capacity, heat shock protein 70 (Hsp70), and defensin were selected for the analyses. In our opinion, the Hsp70 and defensin levels seemed to be important in the indication of urban multistress factors. The higher level of heat shock proteins and defensins in tissues/organs of bees from the urban apiary-in the gut (an increase, respectively, 92% and 7.3%) and fat body (an increase, respectively, 130% and 7.8%), known as targets of environmental toxins, pointed out the urban environment as highly stressful at both the individual and colony levels. In turn, high total antioxidant capacity was measured in the guts of honey bees from rural area (an increase 107%). Such a situation suggests a different mechanism of defense and specificity of rural and urban environmental stressors and also honey bees foraging activity.

Geographic information system-based health risk assessment of rural drinking water in Central China: a case study of You County, Hunan

This study assessed potential human health hazards posed by drinking water from centralized water supply systems in rural You County, along with its spatial distribution. While most previous studies have focused on source water or urban drinking water, this study evaluated the health risk posed by 20 common pollutants (arsenic, cadmium, chromium(VI), lead, mercury, selenium, cyanide, fluoride, nitrate nitrogen, trichloromethane, tetrachloromethane, chlorite, aluminum, iron, manganese, copper, zinc, ammonia nitrogen, chlorine dioxide, and volatile phenols) in rural terminal tap water. The assessment adopted the model recommended by the US Environmental Protection Agency (EPA) and was combined with the geographic information system (GIS) analysis to explore the spatial distribution of risk factors. Water samples were collected from 13 townships in You County across four quarters of 2019. The results indicated that the average carcinogenic risk of the rural drinking water was 2.45 × 10^-5, ranging from 1.80 × 10^-5 to 3.89 × 10^-5, which never exceeded the maximum acceptable range recommended by the US EPA (1.0 × 10^-4 ~ 1.0 × 10^-6). The average hazard index (HI), which reflects noncarcinogenic risk levels, was 0.75 and ranged from 0.34 to 1.74. Throughout the year, some townships presented HI > 1, indicating a non-carcinogenic risk. The GIS analysis indicated that noncarcinogenic risks were mainly distributed in the north, followed by the east and west. This is generally consistent with the spatial distribution of chlorite concentrations, which contribute most strongly to noncarcinogenic risk levels. The northern You County should therefore be prioritized for health risk control, followed by the eastern and western regions. Chlorite is the priority pollutant for control.

Ambient air quality of a less industrialized region of India (Kerala) during the COVID-19 lockdown

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Air quality of major cities of Kerala State (India) during the COVID-19 lockdown.

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Substantial reduction of NO₂ (-48 %) NO_x (-53 % to -90 %) and CO (-24 % to -67 %).

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Significant decrease in PM_2.5 (-24 % to -47 %) and PM₁₀ (-17 % to -20 %) levels.

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Increase of O₃ levels in Northern Kerala during lockdown period.

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Indications of multiple sources (other than traffic and industry) of air pollution.

This study assesses the effect of lockdown, due to the coronavirus disease (COVID-19) pandemic, on the concentration of different air pollutants and overall air quality of a less industrialized region (Kerala) of India. We analysed data from four ambient air quality stations over three years (January to May, 2018–2020) with pairwise comparisons, trend analysis, etc. Results indicated unprecedented reduction in the concentration of the air pollutants: nitrogen dioxide, NO₂ (-48 %), oxides of nitrogen, NO_x (-53 % to -90 %), carbon monoxide, CO (-24 % to -67 %) and the particulate matter (-24 % to -47 % for particulate matter with a diameter of less than 2.5 μm, PM_2.5; -17 % to -20 % for particulate matter with a diameter of less than 10 μm, PM₁₀), as well as the reduction of the National Air Quality Index (NAQI). These reductions indicate an overall improvement of the ambient air quality due to restrictions on transportation, construction, and the industrial sectors during lockdown, even in an area considered less industrial. Despite the general decreasing trend of the concentration of various air pollutants from January to May, suggesting seasonal influences, the trend was intensified in the year 2020 due to the added effect of the lockdown measures. Comparison of the results with those from larger and more industrialized cities suggests that the effects of lockdown are more variable, and focused on the levels of gaseous pollutants. Findings from this study demonstrate the far-reaching effects and implications of the COVID-19 lockdown on ambient air quality, even on less industrialized and less urbanized regions.

Selecting Indicators to Monitor and Assess Environmental Health in a Portuguese Urban Setting: A Participatory Approach

Environmental health (EH) is influenced by complex interactions between health and the built and natural environments, there being little research on its specificities in urban settings. The use of suitable indicators to monitor and assess EH is fundamental in informing evidence-based interventions at the local level. A participatory approach to selecting indicators to inform the monitoring and assessment of EH in Lisbon is herein considered. Evidence derived from a systematic review of literature and data from Lisbon and Portuguese databases were analyzed by 12 Portuguese experts in individual semi-structured interviews. The interviews aimed at identifying relevant indicators and important emerging issues in the Lisbon urban setting. The outputs from the interviews were validated by a two-round Web-Delphi process in which panelists (22 experts) from different areas of expertise expressed their views regarding the relevance of the indicators for the analysis of EH in urban settings. Seventeen indicators were validated in the Web-Delphi process. High participation achieved along this process supports the view that this participatory approach was useful for validation. Results from the adopted participatory approach point out gaps in the collection of noise and mobility indicators data and raise emerging issues on housing indicators that require further research. The results also suggest the need for local action to improve indicators and tools in order to help the monitorization of EH in urban contexts. The adopted participatory approach can be replicated for other Portuguese and European urban settings.

Environmental determinants of cardiovascular disease: lessons learned from air pollution

Air pollution is well recognized as a major risk factor for chronic non-communicable diseases and has been estimated to contribute more to global morbidity and mortality than all other known environmental risk factors combined. Although air pollution contains a heterogeneous mixture of gases, the most robust evidence for detrimental effects on health is for fine particulate matter (particles ≤2.5 µm in diameter (PM2.5)) and ozone gas and, therefore, these species have been the main focus of environmental health research and regulatory standards. The evidence to date supports a strong link between the risk of cardiovascular events and all-cause mortality with PM2.5 across a range of exposure levels, including to levels below current regulatory standards, with no 'safe' lower exposure levels at the population level. In this comprehensive Review, the empirical evidence supporting the effects of air pollution on cardiovascular health are examined, potential mechanisms that lead to increased cardiovascular risk are described, and measures to reduce this risk and identify key gaps in our knowledge that could help address the increasing cardiovascular morbidity and mortality associated with air pollution are discussed.