Devon Payne-Sturges

Environmental health disparities : A framework integrating psychosocial and environmental concepts

Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure–disease paradigm has long suggested that differential “vulnerability” may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.

Project TENDR: Targeting Environmental Neuro-Developmental Risks The TENDR Consensus Statement.

Summary: Children in America today are at an unacceptably high risk of developing neurodevelopmental disorders that affect the brain and nervous system including autism, attention deficit hyperactivity disorder, intellectual disabilities, and other learning and behavioral disabilities. These are complex disorders with multiple causes—genetic, social, and environmental. The contribution of toxic chemicals to these disorders can be prevented. Approach: Leading scientific and medical experts, along with children’s health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children’s brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children’s risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects. Conclusion: Based on these findings, we assert that the current system in the United States for evaluating scientific evidence and making health-based decisions about environmental chemicals is fundamentally broken. To help reduce the unacceptably high prevalence of neurodevelopmental disorders in our children, we must eliminate or significantly reduce exposures to chemicals that contribute to these conditions. We must adopt a new framework for assessing chemicals that have the potential to disrupt brain development and prevent the use of those that may pose a risk. This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential.

Use of point-of-sale data to track usage patterns of residential pesticides: methodology development

BackgroundResidential-use pesticides have been shown to be a major source of pesticide exposure to people in the United States. However, little is understood about the exposures to household pesticides and the resultant health effects. One reason that little is known about home-use pesticide exposure is the lack of comprehensive data on exposures to pesticides in the home. One method to help ascertain the amount of pesticides present in the home is use of point-of-sale data collected from marketing companies that track product sales to obtain the volume of pesticides sold for home-use. This provides a measure of volume of home-use pesticide.MethodsWe have constructed a searchable database containing sales data for home-use permethrin-containing pesticides sold by retail stores in the United States from January 1997 through December 2002 in an attempt to develop a tracking method for pesticide. This pilot project was conducted to determine if point-of-sale data would be effective in helping track the purchase of home-use permethrin containing pesticides and if it would stand as a good model for tracking sales of other home-use pesticides.ResultsThere are several limitations associated with this tracking method, including the availability of sales data, market coverage, and geographic resolution. As a result, a fraction of sales data potentially available for reporting is represented in this database. However, the database is sensitive to the number and type of merchants reporting permethrin sales. Further, analysis of the sale of individual products included in the database indicates that year to year variability has a greater impact on reported permethrin sales than the amount sold by each type of merchant.ConclusionWe conclude that, while nothing could completely replace a detailed exposure assessment to estimate exposures to home-use pesticides, a point-of-sale database is a useful tool in tracking the purchase of these types of pesticides to 1) detect anomalous trends in regional and seasonal pesticide sales warranting further investigation into the potential causes of the trends; 2) determine the most commonly purchased application types; and 3) compare relative trends in sales between indoor and outdoor use products as well as compare trends in sales between different active ingredients.

Evaluating Cumulative Organophosphorus Pesticide Body Burden of Children: A National Case Study

Biomonitoring is a valuable tool for identifying exposures to chemicals that pose potential harm to human health. However, to date there has been little published on ways to evaluate the relative public health significance of biomonitoring data for different chemicals and even less on cumulative assessment of multiple chemicals. The objectives of our study are to develop a methodology for a health risk interpretation of biomonitoring data and to apply it using NHANES 1999-2002 body burden data fororganophosphorus (OP) pesticides. OP pesticides present a particularly challenging case given the nonspecificity of manymetabolites monitored through NHANES. We back-calculate OP pesticide exposures from urinary metabolite data and compare cumulative dose estimates with available toxicity information for a common mechanism of action (brain cholinesterase inhibition) using data from U.S. EPA. Our results suggest that approximately 40% of children in the United States may have had insufficient margins of exposure (MOEs) for neurological impacts from cumulative exposures to OP pesticides (MOE less than 1000). Limitations include uncertainty related to assumptions about likely precursor pesticide compounds of the urinary metabolites, sources of exposure, and intraindividual and temporal variability.

The Struggle Is Real: A Systematic Review of Food Insecurity on Postsecondary Education Campuses

BACKGROUND Numerous international studies have examined cross-sectional correlates of food insecurity (FI) among postsecondary education students. Research is needed to synthesize the findings of this work to support vulnerable students. OBJECTIVE To systematically review peer-reviewed and gray literature to assess the prevalence of FI on postsecondary education institutions, as well as factors related to FI among students and suggested/practiced solutions. DESIGN Systematic literature review. Medline, Web of Science, and PsycINFO databases were searched for peer-reviewed literature for FI research; a Google search (Google Inc) was conducted to obtain gray literature on FI among postsecondary education students. PARTICIPANTS/SETTING Undergraduate and graduate students at postsecondary institutions of higher education. MAIN OUTCOME MEASURES Measures included prevalence of FI; sociodemographic, health, and academic factors related to FI; and solutions to address FI on postsecondary institutions. RESULTS Seventeen peer-reviewed studies and 41 sources of gray literature were identified (out of 11,476 titles). All studies were cross-sectional. Rates of FI were high among students, with average rates across the gray and peer-reviewed literature of 35% and 42%, respectively. FI was consistently associated with financial independence, poor health, and adverse academic outcomes. Suggested solutions to address food security among postsecondary institutions addressed all areas of the socioecologic model, but the solutions most practiced included those in the intrapersonal, interpersonal, and institutional levels. CONCLUSIONS FI is a major public health problem among postsecondary education students. Studies are needed to assess the long-term influence of FI among this vulnerable population. More research is needed on the effectiveness of FI interventions.

Using Inequality Measures to Incorporate Environmental Justice into Regulatory Analyses

Formally evaluating how specific policy measures influence environmental justice is challenging, especially in the context of regulatory analyses in which quantitative comparisons are the norm. However, there is a large literature on developing and applying quantitative measures of health inequality in other settings, and these measures may be applicable to environmental regulatory analyses. In this paper, we provide information to assist policy decision makers in determining the viability of using measures of health inequality in the context of environmental regulatory analyses. We conclude that quantification of the distribution of inequalities in health outcomes across social groups of concern, considering both within-group and between-group comparisons, would be consistent with both the structure of regulatory analysis and the core definition of environmental justice. Appropriate application of inequality indicators requires thorough characterization of the baseline distribution of exposures and risks, leveraging data generally available within regulatory analyses. Multiple inequality indicators may be applicable to regulatory analyses, and the choice among indicators should be based on explicit value judgments regarding the dimensions of environmental justice of greatest interest.

Hazard Ranking Methodology for Assessing Health Impacts of Unconventional Natural Gas Development and Production: The Maryland Case Study

The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.

U.S. EPA Authority to Use Cumulative Risk Assessments in Environmental Decision-Making

Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA’s general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself.

Student Hunger on Campus: Food Insecurity Among College Students and Implications for Academic Institutions.

Purpose: To estimate the prevalence of food insecurity among students at a large mid-Atlantic publicly funded university; examine the association between food insecurity, demographic characteristics, potential financial risk factors, and self-reported physical and mental health and academic performance; and identify possible risk factors for food insecurity. Design: Cross-sectional survey. Setting: Large, public mid-Atlantic university. Participants: Two hundred thirty-seven undergraduate students. Measures: US Department of Agriculture (USDA) 18-item Household Food Security Survey Module (HFSSM) and questions on demographics, student status, economic factors, housing stability, living arrangements, academic performance, and self-rated physical health and depression symptoms. Analysis: Multivariate logistic regression analysis. Results: Among students surveyed, 15% were food insecure; an additional 16% were at risk of food insecurity. Students who were African American, other race/ethnicity, receiving multiple forms of financial aid, or experiencing housing problems were more likely to be food insecure or at the risk of food insecurity (Adjusted Odds Ratio [AOR] = 4.00, 95% confidence interval [CI] = 1.83-8.71, P value < .0001; AOR = 5.26, 95% CI = 1.85-14.98, P value = .002; AOR = 3.43, 95% CI = 1.85-6.37, P value <.001; AOR = 8.00, 95% CI = 3.57-17.93, P value < .0001, respectively). Food secure students were less likely to report depression symptoms than at-risk or food insecure students. Conclusion: Food insecurity among college students is an important public health concern that might have implications for academic performance, retention, and graduation rates. Universities that measure food insecurity among their students will be better positioned to advocate for policy changes at state and federal levels regarding college affordability and student financial assistance.

A Systematic Review of Community Engagement in the US Environmental Protection Agency’s Extramural Research Solicitations: Implications for Research Funders

OBJECTIVES We systematically reviewed the Environmental Protection Agency, National Center for Environmental Researchs (NCERs) requests for applications (RFAs) and identified strategies that NCER and other funders can take to bolster community engagement. METHODS We queried NCERs publically available online archive of funding opportunities from fiscal years 1997 to 2013. From an initial list of 211 RFAs that met our inclusion criteria, 33 discussed or incorporated elements of community engagement. We examined these RFAs along 6 dimensions and the degree of alignments between them. RESULTS We found changes over time in the number of RFAs that included community engagement, variations in how community engagement is defined and expected, inconsistencies between application requirements and peer review criteria, and the inclusion of mechanisms supporting community engagement in research. CONCLUSIONS The results inform a systematic approach to developing RFAs that support community engagement in research.