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24 pages, 1346 KiB

Open AccessArticle

Connecting Air Pollution Exposure to Socioeconomic Status: A Cross-Sectional Study on Environmental Injustice among Pregnant Women in Scania, Sweden

by Erin Flanagan, Emilie Stroh, Anna Oudin and Ebba Malmqvist

Int. J. Environ. Res. Public Health 2019, 16(24), 5116; https://doi.org/10.3390/ijerph16245116 - 14 Dec 2019

Cited by 10 | Viewed by 3927

Abstract

Environmental injustice, characterized by lower socioeconomic status (SES) persons being subjected to higher air pollution concentrations, was explored among pregnant women in Scania, Sweden. Understanding if the general reduction of air pollution recorded is enjoyed by all SES groups could illuminate existing inequalities [...] Read more.

Environmental injustice, characterized by lower socioeconomic status (SES) persons being subjected to higher air pollution concentrations, was explored among pregnant women in Scania, Sweden. Understanding if the general reduction of air pollution recorded is enjoyed by all SES groups could illuminate existing inequalities and inform policy development. “Maternal Air Pollution in Southern Sweden”, an epidemiological database, contains data for 48,777 pregnancies in Scanian hospital catchment areas and includes births from 1999–2009. SES predictors considered included education level, household disposable income, and birth country. A Gaussian dispersion model was used to model women’s average NO_X and PM_2.5 exposure at home residence over the pregnancy period. Total concentrations were dichotomized into emission levels below/above respective Swedish Environmental Protection Agency (EPA) Clean Air objectives. The data were analyzed using binary logistic regression. A sensitivity analysis facilitated the investigation of associations’ variation over time. Lower-SES women born outside Sweden were disproportionately exposed to higher pollutant concentrations. Odds of exposure to NO_X above Swedish EPA objectives reduced over time, especially for low-SES persons. Environmental injustice exists in Scania, but it lessened with declining overall air pollution levels, implying that continued air quality improvement could help protect vulnerable populations and further reduce environmental inequalities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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11 pages, 768 KiB

Open AccessArticle

Pesticide Application Practices and Knowledge among Small-Scale Local Rice Growers and Communities in Rwanda: A Cross-Sectional Study

by Benjamin Ndayambaje, Hellen Amuguni, Jeanne Coffin-Schmitt, Nancy Sibo, Martin Ntawubizi and Elizabeth VanWormer

Int. J. Environ. Res. Public Health 2019, 16(23), 4770; https://doi.org/10.3390/ijerph16234770 - 28 Nov 2019

Cited by 39 | Viewed by 6737

Abstract

Background: Agriculture contributes a third of Rwanda’s GDP and is the main source of income for rural households, with 80% of the total population involved in crop and/or livestock production. The Government of Rwanda established the Muvumba rice project in 2011 amidst a [...] Read more.

Background: Agriculture contributes a third of Rwanda’s GDP and is the main source of income for rural households, with 80% of the total population involved in crop and/or livestock production. The Government of Rwanda established the Muvumba rice project in 2011 amidst a policy shift towards rice as a national staple crop. However, the indiscriminate use of pesticides by local, low-income rice growers has raised concerns about potential human, animal and ecosystem health impacts as pesticide distribution and application are not strictly regulated. Although pesticide use can directly influence farmer health and ecosystems, little is known about small-scale farmers’ pesticide application practices and knowledge. We aimed to assess local application practices and understanding of pesticides to identify gaps in farmers’ knowledge on safe pesticide use and deviations from established standards and recommended practices. Methods: We conducted a cross-sectional study consisting of observations of pesticide practices and interviews with 206 small-scale rice growers in Nyagatare District, Rwanda, in March 2017. Descriptive statistical analyses (sample means, standard deviation and range) were performed, and we evaluated the association between farmers’ personal protective equipment (PPE) use and their education level and literacy status. Results: Over 95% of observed farmers did not comply with minimum standards for safe pesticide use, and 80% of respondents reported that they stored pesticides in their homes without personal protection measures. Education and literacy level were not significantly associated with PPE use. Additionally, 90% of respondents had experienced adverse health effects after using pesticides including intense headache, dizziness, stomach cramps, skin pain and itching, and respiratory distress. All respondents also reported animals in and around the rice scheme (cattle, birds, and fish) behaving abnormally or with signs consistent with pesticide exposure in the six months preceding the study, which may be linked to pesticide-contaminated water. Conclusions: Our study demonstrates potential for high exposure to pesticides for farmers, their families, and animals sharing rice-growing or downstream environments and points to the need for training on safe and effective pesticide use. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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25 pages, 2649 KiB

Open AccessArticle

Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida

by Evah W. Odoi, Nicholas Nagle, Chris DuClos and Kristina W. Kintziger

Int. J. Environ. Res. Public Health 2019, 16(23), 4734; https://doi.org/10.3390/ijerph16234734 - 27 Nov 2019

Cited by 5 | Viewed by 2827

Abstract

Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and [...] Read more.

Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff’s circular and Tango’s flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%–21% in high-risk clusters and by 9%–28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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16 pages, 332 KiB

Open AccessArticle

‘There You Enjoy Life, Here You Work’: Brazilian and Dominican Immigrants’ Views on Work and Health in the U.S.

by Cristina Araujo Brinkerhoff, C. Eduardo Siqueira, Rosalyn Negrón, Natalicia Tracy, Magalis Troncoso Lama and Linda Sprague Martinez

Int. J. Environ. Res. Public Health 2019, 16(20), 4025; https://doi.org/10.3390/ijerph16204025 - 21 Oct 2019

Cited by 9 | Viewed by 3973

Abstract

Structural inequalities in the U.S. work environment place most immigrants in low paying, high-risk jobs. Understanding how work experiences and influence the health of different immigrant populations is essential to address disparities. This article explores how Brazilian and Dominican immigrants feel about their [...] Read more.

Structural inequalities in the U.S. work environment place most immigrants in low paying, high-risk jobs. Understanding how work experiences and influence the health of different immigrant populations is essential to address disparities. This article explores how Brazilian and Dominican immigrants feel about their experiences working in the U.S. and how the relationship between work and culture might impact their health. In partnership with the Dominican Development Center and the Brazilian Worker Center, we held five cultural conversations (CCs) with Brazilians (n = 48) and five with Dominicans (n = 40). CCs are participatory, unstructured groups facilitated by representatives from or embedded in the community. Brazilian immigrants focused on physical health and the American Dream while Dominicans immigrants emphasized concerns about the influence of work on mental health. Dominicans’ longer tenure in the U.S. and differences in how Brazilians and Dominicans are racialized in the region might account for the variation in perspectives between groups. Future studies should further investigate the relationship between health and how immigrants’ work lives are shaped by culture, race and immigrant status. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

24 pages, 1228 KiB

Open AccessArticle

Racialized Structural Vulnerability: Neighborhood Racial Composition, Concentrated Disadvantage, and Fine Particulate Matter in California

by Raoul S. Liévanos

Int. J. Environ. Res. Public Health 2019, 16(17), 3196; https://doi.org/10.3390/ijerph16173196 - 1 Sep 2019

Cited by 19 | Viewed by 4577

Abstract

This study contributes to previous research by advancing a “racialized structural vulnerability” framework and presenting a new empirical analysis of the relationship between neighborhood Asian, Black, and Latinx composition; extrinsic and intrinsic vulnerability; and PM_2.5 exposures in California with secondary data from [...] Read more.

This study contributes to previous research by advancing a “racialized structural vulnerability” framework and presenting a new empirical analysis of the relationship between neighborhood Asian, Black, and Latinx composition; extrinsic and intrinsic vulnerability; and PM_2.5 exposures in California with secondary data from 2004–2014. Principal component analyses revealed that tract Latinx composition was highly correlated with extrinsic vulnerability (economic disadvantage and limited English-speaking ability), and that tract Black composition was highly correlated with intrinsic vulnerability (elevated prevalence of asthma-related emergency department visits and low birth weight). Spatial lag regression models tested hypotheses regarding the association between Asian, Black, and Latinx population vulnerability factors and the 2009–2011 annual average PM_2.5 percentile rankings, net of emissions and spatial covariates. Results indicated that the percent Latinx population, followed by the regional clustering of PM_2.5, and the percent of non-Latinx Black and non-Latinx Asian population were the strongest positive multivariable correlates of PM_2.5 percentile rankings, net of other factors. Additional analyses suggested that despite shifting demographic and spatial correlates of 2012–2014 PM_2.5 exposures, the tracts’ Black and Latinx composition and location in the San Joaquin Valley remain important vulnerability factors with implications for future research and policy. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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22 pages, 3962 KiB

Open AccessArticle

The Impact of Social Disparities on Microbiological Quality of Drinking Water Supply in Ugu District Municipality of Kwazulu-Natal Province, South Africa

by C. M. N. Khabo-Mmekoa and M. N. B. Momba

Int. J. Environ. Res. Public Health 2019, 16(16), 2972; https://doi.org/10.3390/ijerph16162972 - 18 Aug 2019

Cited by 5 | Viewed by 5179

Abstract

This study was undertaken to highlight the social disparity between rural and urban areas in terms of housing patterns, provision of safe drinking water, access to sanitation facilities, education, employment rate and health-related to diarrhoeal episodes in Ugu District Municipality of KwaZulu-Natal Province [...] Read more.

This study was undertaken to highlight the social disparity between rural and urban areas in terms of housing patterns, provision of safe drinking water, access to sanitation facilities, education, employment rate and health-related to diarrhoeal episodes in Ugu District Municipality of KwaZulu-Natal Province of South Africa. To achieve this aim, a survey was conducted using a structured questionnaire. Drinking water samples were collected from the point of supply and the storage containers to assess the microbiological quality of drinking water in both rural and urban areas. Results of this study revealed prominent residential segregation between rural and urban communities, whereby the houses in the rural areas were generally constructed with corrugated iron sheets, or mud brick and mortar whereas conventional brick-and-mortar construction was used to build those in the urban areas. All of the urban households had flush toilets in their houses (100%), while 98.2% of the rural households were relying on pit latrines and 1.8% were reported to defecate in an open field. The District unemployment rate was at 58.1% in rural areas and none among the urban community. Results also showed that only 13.6% of the rural dwellers completed their secondary education compared to 70.4% of the urban areas. The diarrhoeal episodes were high in rural areas (34.1%) while none of these episodes was reported in urban areas. Great disparity in the water supply persists between rural and urban communities. For the former, the standpipes located outside their homes (90.9%) remain the sole mode of access to drinking water, while in the urban area, all households had pipes/taps inside their houses. Assessment of the drinking water quality revealed only the stored drinking water used by the rural community of Ugu District was contaminated. High prevalence of E. coli ranging from 63.3 % to 66.7% was recorded only in stored water after the sequencing of 16S rRNA genes. Species-specific PCR primers exposed the presence of enteropathogenic Escherichia coli at a rate ranging between 1.4% and 3.7% in this water Overall, this study has been able to highlight the disparity left by the legacy of racial segregation in the Ugu Municipality District. Therefore, the local government must intervene in educating homeowners on safe water storage practices. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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12 pages, 313 KiB

Open AccessArticle

Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen

by Emanuel Alcala, Paul Brown, John A. Capitman, Mariaelena Gonzalez and Ricardo Cisneros

Int. J. Environ. Res. Public Health 2019, 16(15), 2683; https://doi.org/10.3390/ijerph16152683 - 27 Jul 2019

Cited by 26 | Viewed by 4878

Abstract

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the [...] Read more.

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

10 pages, 313 KiB

Open AccessArticle

Environmental Health Knowledge, Attitudes, and Practices of French Prenatal Professionals Working with a Socially Underprivileged Population: A Qualitative Study

by Marion Albouy-Llaty, Steeve Rouillon, Houria El Ouazzani, Group DisProSE, Sylvie Rabouan and Virginie Migeot

Int. J. Environ. Res. Public Health 2019, 16(14), 2544; https://doi.org/10.3390/ijerph16142544 - 16 Jul 2019

Cited by 11 | Viewed by 2749

Abstract

Introduction: As environmental health knowledge of population is associated with social economic status, the objective of this study was to determine environmental health knowledge, attitudes, and practices of French prenatal professionals working with a socially underprivileged population. Material and methods: A focus group [...] Read more.

Introduction: As environmental health knowledge of population is associated with social economic status, the objective of this study was to determine environmental health knowledge, attitudes, and practices of French prenatal professionals working with a socially underprivileged population. Material and methods: A focus group with eleven prenatal professionals working with socially underprivileged population was carried out in France in 2015. Content analysis of verbatim explanation was conducted with choice-of-subject categories carried out according to the triangulation principle, and topic trees were generated and applied. Results: The professionals have non-specialized experimental knowledge of emergent risks and were essentially preoccupied by infectious biological risks. In practice, however, they became increasingly cognizant of emergent risks. Their educational practices take cultural context into account but educational tools with imagination and affectivity have to be developed in order to reach socially underprivileged population. Discussion: Professionals are often sensitized to the field of environmental health in their apprehension of polluted biological environments, which they associate with social contexts and behavioral factors. In this study, we recommend adapted training programs and updated professional guidelines in view of reducing prenatal emergent risk exposures and social inequalities of health. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

14 pages, 1372 KiB

Open AccessArticle

Impacts of Road Traffic Network and Socioeconomic Factors on the Diffusion of 2009 Pandemic Influenza A (H1N1) in Mainland China

by Bo Xu, Huaiyu Tian, Clive Eric Sabel and Bing Xu

Int. J. Environ. Res. Public Health 2019, 16(7), 1223; https://doi.org/10.3390/ijerph16071223 - 5 Apr 2019

Cited by 37 | Viewed by 5836

Abstract

The 2009 pandemic influenza virus caused the majority of the influenza A virus infections in China in 2009. It arrived in several Chinese cities from imported cases and then spread as people travelled domestically by all means of transportation, among which road traffic [...] Read more.

The 2009 pandemic influenza virus caused the majority of the influenza A virus infections in China in 2009. It arrived in several Chinese cities from imported cases and then spread as people travelled domestically by all means of transportation, among which road traffic was the most commonly used for daily commuting. Spatial variation in socioeconomic status not only accelerates migration across regions but also partly induces the differences in epidemic processes and in responses to epidemics across regions. However, the roles of both road travel and socioeconomic factors have not received the attention they deserve. Here, we constructed a national highway network for and between 333 cities in mainland China and extracted epidemiological variables and socioeconomic factors for each city. We calculated classic centrality measures for each city in the network and proposed two new measures (SumRatio and Multicenter Distance). We evaluated the correlation between the centrality measures and epidemiological features and conducted a spatial autoregression to quantify the impacts of road network and socioeconomic factors during the outbreak. The results showed that epidemics had more significant relationships with both our new measures than the classic ones. Higher population density, higher per person income, larger SumRatio and Multicenter Distance, more hospitals and college students, and lower per person GDP were associated with higher cumulative incidence. Higher population density and number of slaughtered pigs were found to advance epidemic arrival time. Higher population density, more colleges and slaughtered pigs, and lower Multicenter Distance were associated with longer epidemic duration. In conclusion, road transport and socioeconomic status had significant impacts and should be considered for the prevention and control of future pandemics. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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12 pages, 719 KiB

Open AccessArticle

Determining the Enablers and Barriers for the Adoption of Clean Cookstoves in the Middle Belt of Ghana—A Qualitative Study

by Francis Agbokey, Rebecca Dwommoh, Theresa Tawiah, Kenneth Ayuurebobi Ae-Ngibise, Mohammed Nuhu Mujtaba, Daniel Carrion, Martha Ali Abdulai, Samuel Afari-Asiedu, Seth Owusu-Agyei, Kwaku Poku Asante and Darby W. Jack

Int. J. Environ. Res. Public Health 2019, 16(7), 1207; https://doi.org/10.3390/ijerph16071207 - 4 Apr 2019

Cited by 25 | Viewed by 4856

Abstract

Despite its benefits and espousal in developed counties, the adoption of clean cookstoves is reportedly low in less developed countries, especially in Sub–Saharan Africa. This qualitative study aimed at exploring and documenting the enablers and barriers for adoption of clean cookstove in the [...] Read more.

Despite its benefits and espousal in developed counties, the adoption of clean cookstoves is reportedly low in less developed countries, especially in Sub–Saharan Africa. This qualitative study aimed at exploring and documenting the enablers and barriers for adoption of clean cookstove in the middle belt of Ghana. The findings showed convenience of clean cookstove use, reduced firewood usage, less smoke emission and associated health problems resulting from indoor air pollution and time for firewood gathering and cooking, good smell and taste of food as enabling factors for clean cookstove adoption. Factors such as safety, financial constraint (cost), non-availability of spare parts on the open market to replace faulty stove accessories, stove size and household size were the potential barriers to clean cookstove adoption. These findings help us to understand the factors promoting and inhibiting the adoption of clean cook stoves, especially in rural settings. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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18 pages, 2106 KiB

Open AccessArticle

Metagenomic Profiling of Microbial Pathogens in the Little Bighorn River, Montana

by Steve Hamner, Bonnie L. Brown, Nur A. Hasan, Michael J. Franklin, John Doyle, Margaret J. Eggers, Rita R. Colwell and Timothy E. Ford

Int. J. Environ. Res. Public Health 2019, 16(7), 1097; https://doi.org/10.3390/ijerph16071097 - 27 Mar 2019

Cited by 47 | Viewed by 8590

Abstract

The Little Bighorn River is the primary source of water for water treatment plants serving the local Crow Agency population, and has special significance in the spiritual and ceremonial life of the Crow tribe. Unfortunately, the watershed suffers from impaired water quality, with [...] Read more.

The Little Bighorn River is the primary source of water for water treatment plants serving the local Crow Agency population, and has special significance in the spiritual and ceremonial life of the Crow tribe. Unfortunately, the watershed suffers from impaired water quality, with high counts of fecal coliform bacteria routinely measured during run-off events. A metagenomic analysis was carried out to identify potential pathogens in the river water. The Oxford Nanopore MinION platform was used to sequence DNA in near real time to identify both uncultured and a coliform-enriched culture of microbes collected from a popular summer swimming area of the Little Bighorn River. Sequences were analyzed using CosmosID bioinformatics and, in agreement with previous studies, enterohemorrhagic and enteropathogenic Escherichia coli and other E. coli pathotypes were identified. Noteworthy was detection and identification of enteroaggregative E. coli O104:H4 and Vibrio cholerae serotype O1 El Tor, however, cholera toxin genes were not identified. Other pathogenic microbes, as well as virulence genes and antimicrobial resistance markers, were also identified and characterized by metagenomic analyses. It is concluded that metagenomics provides a useful and potentially routine tool for identifying in an in-depth manner microbial contamination of waterways and, thereby, protecting public health. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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17 pages, 1555 KiB

Open AccessArticle

Mortality from Homicides in Slums in the City of Belo Horizonte, Brazil: An Evaluation of the Impact of a Re-Urbanization Project

by Maria Angélica De Salles Dias, Amélia Augusta De Lima Friche, Sueli Aparecida Mingoti, Dário Alves Da Silva Costa, Amanda Cristina De Souza Andrade, Fernando Márcio Freire, Veneza Berenice De Oliveira and Waleska Teixeira Caiaffa

Int. J. Environ. Res. Public Health 2019, 16(1), 154; https://doi.org/10.3390/ijerph16010154 - 8 Jan 2019

Cited by 4 | Viewed by 7148

Abstract

Background: Homicide rates in Brazil are among the highest worldwide. Although not exclusive to large Brazilian cities, homicides find their most important determinants in cities’ slums. In the last decade, an urban renewal process has been initiated in the city of Belo [...] Read more.

Background: Homicide rates in Brazil are among the highest worldwide. Although not exclusive to large Brazilian cities, homicides find their most important determinants in cities’ slums. In the last decade, an urban renewal process has been initiated in the city of Belo Horizonte, in Brazil. Named Vila Viva project, it includes structuring urban interventions such as urban renewal, social development actions and land regularization in the slums of the city. This study evaluates the project’s effect on homicide rates according to time and interventions. Methods: Homicide rates were analyzed comparing five slums with interventions (S1–S5) to five grouped non-intervened slums (S0), with similar socioeconomic characteristics from 2002 to 2012. Poisson regression model estimates the effect of time of observation and the effect of time of exposure (in years) to a completed intervention, besides the overall risk ratio (RR). Results: Using the time of observation in years, homicide rates decreased in the studied period and even more if considered cumulative time of exposure to a completed intervention for S1, S2, S3 and S4, but not for S5. Conclusions: Although the results of the effect of the interventions are not repeated in all slums, a downward trend in homicide rates has been found, which is connected to the interventions. New approaches could be necessary in order to verify the nexus between slum renewal projects and the reduction of homicide rates. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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22 pages, 5530 KiB

Open AccessArticle

Cardiovascular Disease Hospitalizations in Louisiana Parishes’ Elderly before, during and after Hurricane Katrina

by Ninon A. Becquart, Elena N. Naumova, Gitanjali Singh and Kenneth K. H. Chui

Int. J. Environ. Res. Public Health 2019, 16(1), 74; https://doi.org/10.3390/ijerph16010074 - 28 Dec 2018

Cited by 41 | Viewed by 10969

Abstract

The research on how health and health care disparities impact response to and recovery from a disaster, especially among diverse and underserved populations is in great need for a thorough evaluation. The time series analysis utilizing most complete national databases of medical records [...] Read more.

The research on how health and health care disparities impact response to and recovery from a disaster, especially among diverse and underserved populations is in great need for a thorough evaluation. The time series analysis utilizing most complete national databases of medical records is an indispensable tool in assessing the destruction and health toll brought about by natural disasters. In this study, we demonstrated such an application by evaluating the impact of Hurricane Katrina in 2005 on cardiovascular disease (CVD), a primary cause of mortality among older adults that can be aggravated by natural disasters. We compared CVD hospitalizations before, during and after Katrina between white and black residents of three most populated parishes in Louisiana: Orleans and Jefferson, which were severely affected by the landfall and subsequent floods, and East Baton Rouge, which hosted many of the evacuees. We abstracted 383,552 CVD hospitalization records for Louisiana’s patients aged 65+ in 2005–2006 from the database maintained by the Center of Medicare & Medicaid Services. Daily time series of CVD-related hospitalization rates at each study parish were compiled, and the changes were characterized using segmented regression. In Orleans Parish, directly affected by the hurricane, hospitalization rates peaked on the 6th day after landfall with an increase (mean ± SD) from 7.25 ± 2.4 to 18.5 ± 17.3 cases/day per 10,000 adults aged 65+ (p < 0.001) and returned to pre-landfall level after ~2 months. Disparities in CVD rates between black and white older adults were exacerbated during and following landfall. In Orleans Parish, a week after landfall, the CVD rates increased to 26.3 ± 23.7 and 16.6 ± 11.7 cases/day per 10,000 people (p < 0.001) for black and white patients, respectively. The abrupt increase in CVDs is likely due to psychosocial and post-traumatic stress caused by the disaster and inadequate response. Inequities in resource allocation and access have to be addressed in disaster preparation and mitigation. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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17 pages, 944 KiB

Open AccessArticle

Socio-Economic Status and Health: Evaluation of Human Biomonitored Chemical Exposure to Per- and Polyfluorinated Substances across Status

by Jurgen Buekers, Ann Colles, Christa Cornelis, Bert Morrens, Eva Govarts and Greet Schoeters

Int. J. Environ. Res. Public Health 2018, 15(12), 2818; https://doi.org/10.3390/ijerph15122818 - 11 Dec 2018

Cited by 55 | Viewed by 7187

Abstract

Research on the environment, health, and well-being nexus (EHWB) is shifting from a silo toward a systemic approach that includes the socio-economic context. To disentangle further the complex interplay between the socio-exposome and internal chemical exposure, we performed a meta-analysis of human biomonitoring [...] Read more.

Research on the environment, health, and well-being nexus (EHWB) is shifting from a silo toward a systemic approach that includes the socio-economic context. To disentangle further the complex interplay between the socio-exposome and internal chemical exposure, we performed a meta-analysis of human biomonitoring (HBM) studies with internal exposure data on per-and polyfluoroalkyl substances (PFASs) and detailed information on risk factors, including descriptors of socio-economic status (SES) of the study population. PFASs are persistent in nature, and some have endocrine-disrupting properties. Individual studies have shown that HBM biomarker concentrations of PFASs generally increase with SES indicators, e.g., for income. Based on a meta-analysis (five studies) of the associations between PFASs and SES indicators, the magnitude of the association could be estimated. For the SES indicator income, changes in income were expressed by a factor change, which was corrected by the Gini coefficient to take into account the differences in income categories between studies, and the income range between countries. For the SES indicator education, we had to conclude that descriptors (<college, x years of study, etc.) differed too widely between studies to perform a meta-analysis. Therefore, the use of the uniform ISCED (International Standard Classification of Education) is recommended in future studies. The meta-analysis showed that a higher income is associated with a higher internal exposure to PFASs (PFOS or perfluorooctanesulfonic acid, PFOA or perfluorooctanoic acid, PFNA or perfluorononanoic acid, PFHxS or perfluorohexane sulfonate). This is opposite to the environmental justice hypothesis, referring to an inequitable distribution of detrimental environmental effects toward poor and minority communities by a practice or policy. With a doubling of the income, internal exposure increased on average by 10%–14%. Possible explanations for this difference are given, e.g., underlying differences in diet. However, other sources can also contribute, and the exact causes of SES-related differences in PFAS concentrations remain unclear. Studies are needed that include social descriptors together with lifestyle and dietary information as explanatory variables for internal chemical exposure levels. This will help clarify the underlying factors that link SES with inequity to environmental exposures, and will raise awareness and knowledge to strengthen the capacities of people and communities to advocate chemical exposure reduction in order to reduce this health inequity. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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20 pages, 15948 KiB

Open AccessArticle

Characterization of Environmental Health Inequalities Due to Polyaromatic Hydrocarbon Exposure in France

by Despoina Ioannidou, Laure Malherbe, Maxime Beauchamp, Nicolas P.A. Saby, Roseline Bonnard and Julien Caudeville

Int. J. Environ. Res. Public Health 2018, 15(12), 2680; https://doi.org/10.3390/ijerph15122680 - 28 Nov 2018

Cited by 6 | Viewed by 4455

Abstract

Reducing environmental health inequalities has become a major focus of public health efforts in France, as evidenced by the French action plans for health and the environment. To evaluate environmental inequalities, routine monitoring networks provide a valuable source of data on environmental contamination, [...] Read more.

Reducing environmental health inequalities has become a major focus of public health efforts in France, as evidenced by the French action plans for health and the environment. To evaluate environmental inequalities, routine monitoring networks provide a valuable source of data on environmental contamination, which can be used in integrated assessments, to identify overexposed populations and prioritize actions. However, available databases generally do not meet sufficient spatial representativeness to characterize population exposure, as they are usually not assembled for this specific purpose. The aim of this study was to develop geoprocessing procedures and statistical methods to build spatial environmental variables (water, air, soil, and food pollutant concentrations) at a fine resolution, and provide appropriate input for the exposure modelling. Those methods were designed to combine in situ monitoring data with correlated auxiliary information (for example, atmospheric emissions, population, and altitude), in order to better represent the variability of the environmental compartment quality. The MODUL’ERS multimedia exposure model developed by INERIS (French Institute for industrial Environment and Risks) was then used to assess the transfer of substances from the environment to humans, through inhalation and ingestion pathway characterization. We applied the methodology to a carcinogenic Polycyclic Aromatic Hydrocarbon substance, benzo[a]pyrene(B[a]P), to map spatialized exposure indicators, at the national scale. The largest environmental contribution corresponded to the ingestion pathway. Data processing algorithms and calculation of exposure will be integrated into the French coordinated integrated environment and health platform PLAINE (PLteforme intégrée d’Analyse des INégalités Environnementales) which has been developed to map and analyze environmental health inequalities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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14 pages, 3619 KiB

Open AccessArticle

Variation in Cold-Related Mortality in England Since the Introduction of the Cold Weather Plan: Which Areas Have the Greatest Unmet Needs?

by Peninah Murage, Shakoor Hajat and Angie Bone

Int. J. Environ. Res. Public Health 2018, 15(11), 2588; https://doi.org/10.3390/ijerph15112588 - 19 Nov 2018

Cited by 9 | Viewed by 4167

Abstract

The Cold Weather Plan (CWP) in England was introduced to prevent the adverse health effects of cold weather; however, its impact is currently unknown. This study characterizes cold-related mortality and fuel poverty at STP (Sustainability and Transformation Partnership) level, and assesses changes in [...] Read more.

The Cold Weather Plan (CWP) in England was introduced to prevent the adverse health effects of cold weather; however, its impact is currently unknown. This study characterizes cold-related mortality and fuel poverty at STP (Sustainability and Transformation Partnership) level, and assesses changes in cold risk since the introduction of the CWP. Time series regression was used to estimate mortality risk for up to 28 days following exposure. Area level fuel poverty was used to indicate mitigation against cold exposure and mapped alongside area level risk. We found STP variations in mortality risk, ranging from 1.74, 1.44–2.09 (relative risk (RR), 95% CI) in Somerset, to 1.19, 1.01–1.40 in Cambridge and Peterborough. Following the introduction of the CWP, national-level mortality risk declined significantly in those aged 0–64 (1.34, 1.23–1.45, to 1.09, 1.00–1.19), but increased significantly among those aged 75+ (1.36, 1.28–1.44, to 1.58, 1.47–1.70) and for respiratory conditions (1.78, 1.56–2.02, to 2.4, 2.10–2.79). We show how spatial variation in cold mortality risk has increased since the introduction of the CWP, which may reflect differences in implementation of the plan. Combining risk with fuel poverty information identifies 14 STPs with the greatest need to address the cold effect, and that would gain most from enhanced CWP activity or additional intervention measures. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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16 pages, 1236 KiB

Open AccessArticle

Health Risk in Urbanizing Regions: Examining the Nexus of Infrastructure, Hygiene and Health in Tashkent Province, Uzbekistan

by Saravanan Veluswami Subramanian, Min Jung Cho and Fotima Mukhitdinova

Int. J. Environ. Res. Public Health 2018, 15(11), 2578; https://doi.org/10.3390/ijerph15112578 - 18 Nov 2018

Cited by 2 | Viewed by 4849

Abstract

Worldwide, development agencies have increased their investments in water supply and sanitation as a “powerful preventive medicine” to address infectious diseases. These interventions have focused on on-site technical interventions or social engineering approaches, emulating the result-based targets of the development goals. Against this [...] Read more.

Worldwide, development agencies have increased their investments in water supply and sanitation as a “powerful preventive medicine” to address infectious diseases. These interventions have focused on on-site technical interventions or social engineering approaches, emulating the result-based targets of the development goals. Against this backdrop, the study examines the following research question: What is the role of socio-cultural backgrounds, housing characteristics, and environmental hygiene practices in addressing water-transmitted diseases in the Tashkent province of Uzbekistan. In a country where public statistics and official maps are rarely accessible, and research is restrictive, the study carried out a household survey using open data kit (ODK) between July and October 2015 in Olmalik, an industrial district, and the Kibray urbanizing district in the province. The findings reveal that demographic factors, poor sanitation practices, housing characteristics, and social behaviors are key predictors of water-transmitted diseases in the two districts. In the industrial township, poor housing, larger household size, and poor excreta disposal habits increased the occurrence of diseases, while in urbanizing districts, higher household size, frequently eating out, and access to public taps significantly increased the occurrence of water-transmitted diseases. The study, which was carried out in a challenging institutional environment, highlights the need for Uzbekistan to focus their policies on environmental hygiene, demographic factors and social behavior as key interventions rather than merely on on-site drinking water and sanitation interventions. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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13 pages, 2356 KiB

Open AccessArticle

A Spatio-Temporal Pattern and Socio-Economic Factors Analysis of Improved Sanitation in China, 2006–2015

by Qing Luo, Mengjie Zhang, Wei Yao, Yanfen Fu, Haichun Wei, Yong Tao, Jianjun Liu and Hongyan Yao

Int. J. Environ. Res. Public Health 2018, 15(11), 2510; https://doi.org/10.3390/ijerph15112510 - 9 Nov 2018

Cited by 12 | Viewed by 3755

Abstract

Ensuring an adequate and safe access to sanitation is essential to prevent diseases. Using provincial spatial panel data reported in the China Health Statistical Yearbook and the China Statistical Yearbook, this paper analyzed the spatio-temporal characteristics of improved rural sanitation in 30 Chinese [...] Read more.

Ensuring an adequate and safe access to sanitation is essential to prevent diseases. Using provincial spatial panel data reported in the China Health Statistical Yearbook and the China Statistical Yearbook, this paper analyzed the spatio-temporal characteristics of improved rural sanitation in 30 Chinese provinces during the period 2006–2015, and analyzed factors that may affect improved sanitation rates in rural China. Spatial autocorrelations of improved sanitation rates were computed via Global and Local Moran’s I firstly, and then, inter-provincial disparities of improved sanitation were assessed by using the Theil index estimator; finally, the spatial panel model was employed to examine the potential socio-economic factors. Spatial autocorrelations results suggested that the provincial improved sanitation rates changes affect both the provinces themselves and the adjacent regions; Analysis of the spatial panel model revealed that factors such as GDP per capita, investment proportion ratio, centralized water supply, rural residents’ expenditure were positively associated with improved sanitation rates, and illiteracy rate of people older than 15 was negatively related with improved sanitation rates. Socio-economic factors had affected the improved sanitation rates in 30 provinces in rural China. Thus, a series of policies, socio-economic measures and personal latrine literacy education should be given to improve the status of improved sanitation rates in rural China. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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15 pages, 1139 KiB

Open AccessArticle

Health Effects of Air Pollution in China

by Wenling Liu, Ziping Xu and Tianan Yang

Int. J. Environ. Res. Public Health 2018, 15(7), 1471; https://doi.org/10.3390/ijerph15071471 - 12 Jul 2018

Cited by 79 | Viewed by 15131

Abstract

Background Rapid economic and social development in China has resulted in severe air pollution and consequent adverse impacts on society. The health effects of air pollution have been widely studied. Methods Using information from the China Health and Retirement Longitudinal Study (CHARLS) database, [...] Read more.

Background Rapid economic and social development in China has resulted in severe air pollution and consequent adverse impacts on society. The health effects of air pollution have been widely studied. Methods Using information from the China Health and Retirement Longitudinal Study (CHARLS) database, we established a hierarchical linear model combining pollution and socioeconomic and psychosocial variables to examine the effects of air pollution on public health in China. Local air pollution was characterized in multiple dimensions. Results The relationship of health to its determinants greatly differed between Eastern and Central/Western China. Higher education, higher income level, better life satisfaction, and long-term marriage were significantly associated with better health status among Chinese. In addition, regional healthcare resources were positively associated with the health of residents. As indicated by the hierarchical model with health as dependent variable, in Central/Western China, longest duration of good air quality in spring/summer was positively associated with health (estimated coefficient = 0.067, standard error = 0.026), while the mean Air Quality Index (AQI) in autumn/winter was inversely associated with health (estimated coefficient = −0.082, standard error = 0.031). Good air quality in the current study is defined as daily average AQI less than 35. Conclusions Duration (in days) of acceptable air quality was particularly important for improving public health. Future policies should target increased duration of good air quality while managing air pollution by controlling or decreasing severe air pollution. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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15 pages, 1979 KiB

Open AccessFeature PaperArticle

Independent and Joint Contributions of Fine Particulate Matter Exposure and Population Vulnerability to Mortality in the Detroit Metropolitan Area

by Amy J. Schulz, Graciela B. Mentz, Natalie Sampson, Melanie Ward, J. Timothy Dvonch, Ricardo De Majo, Barbara A. Israel, Angela G. Reyes and Donele Wilkins

Int. J. Environ. Res. Public Health 2018, 15(6), 1209; https://doi.org/10.3390/ijerph15061209 - 8 Jun 2018

Cited by 8 | Viewed by 5060

Abstract

Fine particulate matter is associated with adverse health outcomes. Exposure to fine particulate matter may disproportionately affect urban communities with larger numbers of vulnerable residents. We used multilevel logistic regression models to estimate the joint effects of fine particulate matter (PM_2.5) [...] Read more.

Fine particulate matter is associated with adverse health outcomes. Exposure to fine particulate matter may disproportionately affect urban communities with larger numbers of vulnerable residents. We used multilevel logistic regression models to estimate the joint effects of fine particulate matter (PM_2.5) and population vulnerabilities on cardiopulmonary mortality (CPM). We estimated the health benefits of reductions in PM_2.5 across census tracts in the Detroit metropolitan area with varying levels of population vulnerability, using cluster-specific odds ratios scaled to reflect PM_2.5-attributable cardiopulmonary risk. PM_2.5 and population vulnerability were independently associated with odds of CPM. Odds of CPM and the number of deaths attributable to PM_2.5 were greatest in census tracts with both high PM_2.5 exposures and population vulnerability. Reducing PM_2.5 in census tracts with high PM_2.5 would lead to an estimated 18% annual reduction in PM_2.5-attributable CPM. Between 78–79% of those reductions in CPM would occur within census tracts with high population vulnerabilities. These health benefits of reductions in PM_2.5 occurred at levels below current U.S. reference concentrations. Focusing efforts to reduce PM_2.5 in the Detroit metropolitan area in census tracts with currently high levels would also lead to greater benefits for residents of census tracts with high population vulnerabilities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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21 pages, 1855 KiB

Open AccessArticle

Impacts of Haze on Housing Prices: An Empirical Analysis Based on Data from Chengdu (China)

by Runqiu Liu, Chao Yu, Canmian Liu, Jian Jiang and Jing Xu

Int. J. Environ. Res. Public Health 2018, 15(6), 1161; https://doi.org/10.3390/ijerph15061161 - 2 Jun 2018

Cited by 35 | Viewed by 6162

Abstract

Based on cross-section data of 20 districts in Chengdu, this article reviews the relationships between haze and housing prices with the combined application of Spatial Error Model (SEM) and Spatial Lag Model (SLM). The results illustrate that haze significantly have negative impacts on [...] Read more.

Based on cross-section data of 20 districts in Chengdu, this article reviews the relationships between haze and housing prices with the combined application of Spatial Error Model (SEM) and Spatial Lag Model (SLM). The results illustrate that haze significantly have negative impacts on both the selling and rental prices of houses. Controlling other variables, if the air quality index rises by 0.1, the housing selling prices and rental prices will drop by 3.97% and 4.01%, respectively. Interestingly, housing rental prices have a more significant response to the air quality than housing sale prices. Residents are willing to pay a premium for better air quality and the influence of air quality is partially reflected in housing prices, which indicates that better air quality has been becoming a scarce resource with the improvement of people’s living standard. Furthermore, the impacts of haze on housing prices are also expected to lead to a “crowding out effect” in different regions. This would be detrimental for human capital accumulation and will accelerate the regional divergence in the internal economy and population structure, thus forming a region “fence” within cities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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8 pages, 269 KiB

Open AccessArticle

Perspectives on Biological Monitoring in Environmental Health Research: A Focus Group Study in a Native American Community

by Melissa Gonzales, Elanda King, Jeanette Bobelu, Donica M. Ghahate, Teresa Madrid, Sheri Lesansee and Vallabh Shah

Int. J. Environ. Res. Public Health 2018, 15(6), 1129; https://doi.org/10.3390/ijerph15061129 - 31 May 2018

Cited by 4 | Viewed by 4510

Abstract

Background: Reliance on natural resources brings Native American communities into frequent contact with environmental media, which, if contaminated, represents an exposure route for environmental pollutants. Native American communities vary in their perspectives on research and relatively little is known about the range of [...] Read more.

Background: Reliance on natural resources brings Native American communities into frequent contact with environmental media, which, if contaminated, represents an exposure route for environmental pollutants. Native American communities vary in their perspectives on research and relatively little is known about the range of perspectives regarding the use of biological samples for environmental exposure assessment. Methods: Thirty-one members of Zuni Pueblo (median age = 40.0 years, range = 26–59 years) participated a series of four focus groups. Qualitative themes emerging from the focus group discussion transcripts were identified by content analysis. Results: Emergent themes included adequate informed consent, traditional beliefs, and personal choice. Conclusions: The discussions reinforced the central role of traditional values in the decision to participate in research involving biological samples for environmental exposure assessment. Decision-making required a balance between the perceived value of the proposed project and its purpose, with cultural perspectives surrounding the biological sample requested. We examine the potential for study bias and include recommendations to aid in the collaborative identification and control of unintended risks posed by the use of biological samples in environmental health studies in native communities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

14 pages, 332 KiB

Open AccessArticle

Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990–2014

by Nicole Kravitz-Wirtz, Samantha Teixeira, Anjum Hajat, Bongki Woo, Kyle Crowder and David Takeuchi

Int. J. Environ. Res. Public Health 2018, 15(6), 1114; https://doi.org/10.3390/ijerph15061114 - 30 May 2018

Cited by 63 | Viewed by 10245

Abstract

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of [...] Read more.

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO₂), a marker of traffic-related pollution, and fine particulate matter (PM_2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10–1.41 and OR = 1.25, 95% CI = 1.06–1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO₂ IQR = 8.51 ppb and PM_2.5 IQR = 4.43 µ/m³)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

20 pages, 1520 KiB

Open AccessArticle

Advice and Frequently Asked Questions (FAQs) for Citizen-Science Environmental Health Assessments

by Timothy M. Barzyk, Hongtai Huang, Ronald Williams, Amanda Kaufman and Jonathan Essoka

Int. J. Environ. Res. Public Health 2018, 15(5), 960; https://doi.org/10.3390/ijerph15050960 - 11 May 2018

Cited by 15 | Viewed by 6143

Abstract

Citizen science provides quantitative results to support environmental health assessments (EHAs), but standardized approaches do not currently exist to translate findings into actionable solutions. The emergence of low-cost portable sensor technologies and proliferation of publicly available datasets provides unparalleled access to supporting evidence; [...] Read more.

Citizen science provides quantitative results to support environmental health assessments (EHAs), but standardized approaches do not currently exist to translate findings into actionable solutions. The emergence of low-cost portable sensor technologies and proliferation of publicly available datasets provides unparalleled access to supporting evidence; yet data collection, analysis, interpretation, visualization, and communication are subjective approaches that must be tailored to a decision-making audience capable of improving environmental health. A decade of collaborative efforts and two citizen science projects contributed to three lessons learned and a set of frequently asked questions (FAQs) that address the complexities of environmental health and interpersonal relations often encountered in citizen science EHAs. Each project followed a structured step-by-step process in order to compare and contrast methods and approaches. These lessons and FAQs provide advice to translate citizen science research into actionable solutions in the context of a diverse range of environmental health issues and local stakeholders. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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26 pages, 6853 KiB

Open AccessArticle

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

by Raoul S. Liévanos

Int. J. Environ. Res. Public Health 2018, 15(4), 762; https://doi.org/10.3390/ijerph15040762 - 16 Apr 2018

Cited by 38 | Viewed by 8730

Abstract

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor [...] Read more.

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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13 pages, 344 KiB

Open AccessCommunication

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA

by John T. Doyle, Larry Kindness, James Realbird, Margaret J. Eggers and Anne K. Camper

Int. J. Environ. Res. Public Health 2018, 15(4), 567; https://doi.org/10.3390/ijerph15040567 - 21 Mar 2018

Cited by 22 | Viewed by 7541

Abstract

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with [...] Read more.

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps—especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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12 pages, 4000 KiB

Open AccessArticle

Comparing Classic and Interval Analytical Hierarchy Process Methodologies for Measuring Area-Level Deprivation to Analyze Health Inequalities

by Pablo Cabrera-Barona and Omid Ghorbanzadeh

Int. J. Environ. Res. Public Health 2018, 15(1), 140; https://doi.org/10.3390/ijerph15010140 - 16 Jan 2018

Cited by 30 | Viewed by 5249

Abstract

Deprivation indices are useful measures to study health inequalities. Different techniques are commonly applied to construct deprivation indices, including multi-criteria decision methods such as the analytical hierarchy process (AHP). The multi-criteria deprivation index for the city of Quito is an index in which [...] Read more.

Deprivation indices are useful measures to study health inequalities. Different techniques are commonly applied to construct deprivation indices, including multi-criteria decision methods such as the analytical hierarchy process (AHP). The multi-criteria deprivation index for the city of Quito is an index in which indicators are weighted by applying the AHP. In this research, a variation of this index is introduced that is calculated using interval AHP methodology. Both indices are compared by applying logistic generalized linear models and multilevel models, considering self-reported health as the dependent variable and deprivation and self-reported quality of life as the independent variables. The obtained results show that the multi-criteria deprivation index for the city of Quito is a meaningful measure to assess neighborhood effects on self-reported health and that the alternative deprivation index using the interval AHP methodology more thoroughly represents the local knowledge of experts and stakeholders. These differences could support decision makers in improving health planning and in tackling health inequalities in more deprived areas. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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34 pages, 3418 KiB

Open AccessFeature PaperArticle

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

by Margaret J. Eggers, John T. Doyle, Myra J. Lefthand, Sara L. Young, Anita L. Moore-Nall, Larry Kindness, Roberta Other Medicine, Timothy E. Ford, Eric Dietrich, Albert E. Parker, Joseph H. Hoover and Anne K. Camper

Int. J. Environ. Res. Public Health 2018, 15(1), 76; https://doi.org/10.3390/ijerph15010076 - 5 Jan 2018

Cited by 40 | Viewed by 9761

Abstract

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on [...] Read more.

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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933 KiB

Open AccessArticle

Race, Ethnicity, Income Concentration and 10-Year Change in Urban Greenness in the United States

by Joan A. Casey, Peter James, Lara Cushing, Bill M. Jesdale and Rachel Morello-Frosch

Int. J. Environ. Res. Public Health 2017, 14(12), 1546; https://doi.org/10.3390/ijerph14121546 - 10 Dec 2017

Cited by 96 | Viewed by 10751

Abstract

Background: Cross-sectional studies suggest urban greenness is unequally distributed by neighborhood demographics. However, the extent to which inequalities in greenness have changed over time remains unknown. Methods: We estimated 2001 and 2011 greenness using Moderate-resolution Imaging Spectroradiometer (MODIS) satellite-derived normalized difference vegetative index [...] Read more.

Background: Cross-sectional studies suggest urban greenness is unequally distributed by neighborhood demographics. However, the extent to which inequalities in greenness have changed over time remains unknown. Methods: We estimated 2001 and 2011 greenness using Moderate-resolution Imaging Spectroradiometer (MODIS) satellite-derived normalized difference vegetative index (NDVI) in 59,483 urban census tracts in the contiguous U.S. We fit spatial error models to estimate the association between baseline census tract demographic composition in 2000 and (1) 2001 greenness and (2) change in greenness between 2001 and 2011. Results: In models adjusted for population density, climatic factors, housing tenure, and Index of Concentration at the Extremes for income (ICE), an SD increase in percent White residents (a 30% increase) in 2000 was associated with 0.021 (95% CI: 0.018, 0.023) higher 2001 NDVI. We observed a stepwise reduction in 2001 NDVI with increased concentration of poverty. Tracts with a higher proportion of Hispanic residents in 2000 lost a small, statistically significant amount of greenness between 2001 and 2011 while tracts with higher proportions of Whites experienced a small, statistically significant increase in greenness over the same period. Conclusions: Census tracts with a higher proportion of racial/ethnic minorities, compared to a higher proportion of White residents, had less greenness in 2001 and lost more greenness between 2001 and 2011. Policies are needed to increase greenness, a health-promoting neighborhood asset, in disadvantaged communities. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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1884 KiB

Open AccessArticle

Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents

by Anna Oudin, Lennart Bråbäck, Daniel Oudin Åström and Bertil Forsberg

Int. J. Environ. Res. Public Health 2017, 14(11), 1392; https://doi.org/10.3390/ijerph14111392 - 16 Nov 2017

Cited by 10 | Viewed by 6218

Abstract

It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health [...] Read more.

It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO₂ from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01–1.03) for asthma associated with a 10 µg·m⁻³ increase in NO₂. The association only seemed to be present in areas where NO₂ was higher than 15 µg·m⁻³ with an OR of 1.09 (95% CI: 1.07–1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02–1.09) and OR = 1.04 (95% CI: 1.01–1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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Open AccessArticle

Socioeconomic Inequalities in Green Space Quality and Accessibility—Evidence from a Southern European City

by Elaine Hoffimann, Henrique Barros and Ana Isabel Ribeiro

Int. J. Environ. Res. Public Health 2017, 14(8), 916; https://doi.org/10.3390/ijerph14080916 - 15 Aug 2017

Cited by 189 | Viewed by 16815

Abstract

Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in [...] Read more.

Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods: Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall’s tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results: Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions: Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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Review

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17 pages, 638 KiB

Open AccessReview

Sex/Gender Differences in the Association between Residential Green Space and Self-Rated Health—A Sex/Gender-Focused Systematic Review

by Gabriele Bolte, Sarah Nanninga and Lisa Dandolo

Int. J. Environ. Res. Public Health 2019, 16(23), 4818; https://doi.org/10.3390/ijerph16234818 - 30 Nov 2019

Cited by 45 | Viewed by 5420

Abstract

Though sex/gender is an important social determinant of health, sex/gender inequalities have not been considered comprehensively in environmental health research thus far. The aim of this systematic review was to clarify whether sex/gender theoretical concepts were addressed in studies on the impact of [...] Read more.

Though sex/gender is an important social determinant of health, sex/gender inequalities have not been considered comprehensively in environmental health research thus far. The aim of this systematic review was to clarify whether sex/gender theoretical concepts were addressed in studies on the impact of residential green space on self-rated health and whether effect modification by sex/gender was observed. Three electronic databases were searched to identify epidemiological studies on perceived or objective residential green/blue space and self-rated health. Necessary for study inclusion was mentioning at least one keyword for sex/gender in title or abstract, adult study participants and data on self-rated health and on availability and/or use of green/blue spaces. Decisive for study inclusion was consideration of sex/gender differences in the impact of perceived or objective residential green/blue spaces on self-rated health in the analysis and presentation of results. Seven studies were included. They presented an overall positive impact of green space on self-rated health. No consistent sex/gender differences in the impact of green space on self-rated health were found in these studies. However, all studies used a binary operationalization male/female without further theoretical foundation. Research quality could be enhanced by integrating sex/gender-theoretical concepts into study design and interpretation of results. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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19 pages, 693 KiB

Open AccessReview

Social Inequalities in Exposure to Ambient Air Pollution: A Systematic Review in the WHO European Region

by Jonathan Fairburn, Steffen Andreas Schüle, Stefanie Dreger, Lisa Karla Hilz and Gabriele Bolte

Int. J. Environ. Res. Public Health 2019, 16(17), 3127; https://doi.org/10.3390/ijerph16173127 - 28 Aug 2019

Cited by 93 | Viewed by 18733

Abstract

Ambient air pollution is a long-standing and significant public health issue. The aim of this review is to systematically examine the peer-reviewed evidence on social inequalities and ambient air pollution in the World Health Organization European Region. Articles published between 2010 and 2017 [...] Read more.

Ambient air pollution is a long-standing and significant public health issue. The aim of this review is to systematically examine the peer-reviewed evidence on social inequalities and ambient air pollution in the World Health Organization European Region. Articles published between 2010 and 2017 were analyzed in the review. In total 31 articles were included in the review. There is good evidence from ecological studies that higher deprivation indices and low economic position are usually linked with higher levels of pollutants such as particulate matter (particulate matter under 2.5 and 10 microns in diameter, PM_2.5, PM₁₀) and oxides of nitrogen (e.g., NO₂, and NO_x). There is also evidence that ethnic minorities experience a mixed exposure in comparison to the majority population being sometimes higher and sometimes lower depending on the ethnic minority under consideration. The studies using data at the individual level in this review are mainly focused on pregnant women or new mothers, in these studies deprivation and ethnicity are more likely to be linked to higher exposures of poor air quality. Therefore, there is evidence in this review that the burden of higher pollutants falls disproportionally on different social groups. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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21 pages, 707 KiB

Open AccessReview

Systematic Literature Review of Health Impact Assessments in Low and Middle-Income Countries

by Meelan Thondoo, David Rojas-Rueda, Joyeeta Gupta, Daniel H. de Vries and Mark J. Nieuwenhuijsen

Int. J. Environ. Res. Public Health 2019, 16(11), 2018; https://doi.org/10.3390/ijerph16112018 - 6 Jun 2019

Cited by 33 | Viewed by 5745

Abstract

Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor [...] Read more.

Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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15 pages, 639 KiB

Open AccessReview

Social Inequalities in Environmental Resources of Green and Blue Spaces: A Review of Evidence in the WHO European Region

by Steffen Andreas Schüle, Lisa Karla Hilz, Stefanie Dreger and Gabriele Bolte

Int. J. Environ. Res. Public Health 2019, 16(7), 1216; https://doi.org/10.3390/ijerph16071216 - 4 Apr 2019

Cited by 87 | Viewed by 8583

Abstract

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental [...] Read more.

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental inequalities, focusing on availability and accessibility measures of green and blue spaces. Studies in the World Health Organisation (WHO) European Region published between 2010 and 2017 were considered for the review. In total, 14 studies were identified, where most of them (n = 12) analysed inequalities of green spaces. The majority had an ecological study design that mostly applied deprivation indices on the small area level, whereas cross-sectional studies on the individual level mostly applied single social measures. Ecological studies consistently showed that deprived areas had lower green space availability than more affluent areas, whereas mixed associations were found for single social dimensions in cross-sectional studies on the individual level. In order to gain more insights into how various social dimensions are linked to the distribution of environmental resources within the WHO European Region, more studies are needed that apply comparable methods and study designs for analysing social inequalities in environmental resources. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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15 pages, 652 KiB

Open AccessReview

Social Inequalities in Environmental Noise Exposure: A Review of Evidence in the WHO European Region

by Stefanie Dreger, Steffen Andreas Schüle, Lisa Karla Hilz and Gabriele Bolte

Int. J. Environ. Res. Public Health 2019, 16(6), 1011; https://doi.org/10.3390/ijerph16061011 - 20 Mar 2019

Cited by 70 | Viewed by 6186

Abstract

Environmental noise is an important public health problem, being among the top environmental risks to health. The burden of noise exposure seems to be unequally distributed in societies. Up to now there is fragmentary evidence regarding which social groups are most affected. The [...] Read more.

Environmental noise is an important public health problem, being among the top environmental risks to health. The burden of noise exposure seems to be unequally distributed in societies. Up to now there is fragmentary evidence regarding which social groups are most affected. The aim of this review was to systematically assess published evidence on social inequalities in environmental noise exposure in the WHO European Region, taking different sociodemographic and socioeconomic dimensions as well as subjective and objective measures of environmental noise exposure into account. Articles published in English in a peer reviewed journal between 2010 and 2017 were included in the review. Eight studies were finally included in the review, four of them analysed aggregated data and four analysed individual data. Though results of social inequalities in noise exposures were mixed between and within studies, there was a trend that studies using indicators of material deprivation and deprivation indices showed higher environmental noise exposures in groups with lower socioeconomic position. More research on the social distribution of environmental noise exposure on a small spatial scale is needed, taking into account aspects of vulnerability and procedural justice. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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20 pages, 560 KiB

Open AccessReview

Environmental Justice in Industrially Contaminated Sites. A Review of Scientific Evidence in the WHO European Region

by Roberto Pasetto, Benedetta Mattioli and Daniela Marsili

Int. J. Environ. Res. Public Health 2019, 16(6), 998; https://doi.org/10.3390/ijerph16060998 - 19 Mar 2019

Cited by 52 | Viewed by 6144

Abstract

In the WHO European Region the topic of contaminated sites is considered a priority among environment and health themes. Communities living in or close to contaminated sites tend to be characterized by a high prevalence of ethnic minorities and by an unfavorable socioeconomic [...] Read more.

In the WHO European Region the topic of contaminated sites is considered a priority among environment and health themes. Communities living in or close to contaminated sites tend to be characterized by a high prevalence of ethnic minorities and by an unfavorable socioeconomic status so rising issues of environmental justice. A structured review was undertaken to describe the contents of original scientific studies analyzing distributive and procedural justice in industrially contaminated sites carried out in the WHO European Region in the period 2010–2017. A systematic search of the literature was performed. In total, 14 articles were identified. Wherever assessments on environmental inequalities were carried out, an overburden of socioeconomic deprivation or vulnerability, with very few exemptions, was observed. The combined effects of environmental and socioeconomic pressures on health were rarely addressed. Results show that the studies on environmental and health inequalities and mechanisms of their generation in areas affected by industrially contaminated sites in the WHO European Region are in their early stages, with exemption of UK. Future efforts should be directed to improve study strategies with national and local assessments in order to provide evidence for equity-oriented interventions to reduce environmental exposure and related health risks caused by industrial contamination. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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22 pages, 525 KiB

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Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region

by Mathilde Sengoelge, Merel Leithaus, Matthias Braubach and Lucie Laflamme

Int. J. Environ. Res. Public Health 2019, 16(4), 653; https://doi.org/10.3390/ijerph16040653 - 22 Feb 2019

Cited by 17 | Viewed by 3697

Abstract

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim [...] Read more.

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones—alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region. Full article

(This article belongs to the Special Issue Achieving Environmental Health Equity: Great Expectations)

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