Elaine L. Hill

School Food Environments and Policies in US Public Schools

OBJECTIVE. The purpose of this study was to describe school food environments and policies in US public schools and how they vary according to school characteristics. METHODS. We analyzed cross-sectional data from the third School Nutrition and Dietary Assessment study by using a nationally representative sample of 395 US public schools in 129 school districts in 38 states. These 2005 data included school reports of foods and beverages offered in the National School Lunch Program and on-site observations, in a subsample of schools, of competitive foods and beverages (those sold in vending machines and a la carte and that are not part of the National School Lunch Program). Seventeen factors were used to characterize school lunches, competitive foods, and other food-related policies and practices. These factors were used to compute the food environment summary score (0 [least healthy] to 17 [most healthy]) of each school. RESULTS. There were vending machines in 17%, 82%, and 97% of elementary, middle, and high schools, respectively, and a la carte items were sold in 71%, 92%, and 93% of schools, respectively. Among secondary schools with vending and a la carte sales, these sources were free of low-nutrient energy-dense foods or beverages in 15% and 21% of middle and high schools, respectively. The food environment summary score was significantly higher (healthier) in the lower grade levels. The summary score was not associated with the percentage of students that was certified for free or reduced-price lunches or the percentage of students that was a racial/ethnic minority. CONCLUSIONS. As children move to higher grade levels, their school food environments become less healthy. The great majority of US secondary schools sell items a la carte in the cafeteria and through vending machines, and these 2 sources often contain low-nutrient, energy-dense foods and beverages, commonly referred to as junk food.

Shale gas development and infant health: Evidence from Pennsylvania

This research exploits the introduction of shale gas wells in Pennsylvania in response to growing controversy around the drilling method of hydraulic fracturing. Using detailed location data on maternal addresses and GIS coordinates of gas wells, this study examines singleton births to mothers residing close to a shale gas well from 2003 to 2010 in Pennsylvania. The introduction of drilling increased low birth weight and decreased term birth weight on average among mothers living within 2.5 km of a well compared to mothers living within 2.5 km of a permitted well. Adverse effects were also detected using measures such as small for gestational age and APGAR scores, while no effects on gestation periods were found. In the intensive margin, an additional well is associated with a 7 percent increase in low birth weight, a 5 g reduction in term birth weight and a 3 percent increase in premature birth. These results are robust to other measures of infant health, many changes in specification and falsification tests. These findings suggest that shale gas development poses significant risks to human health.

Environmental and Economic Impacts of Localizing Food Systems: The Case of Dairy Supply Chains in the Northeastern United States

We developed and evaluated an empirical model of the U.S. dairy supply chain with a high degree of spatial and product disaggregation to assess the impacts of increasing localization of the northeast regions fluid milk supply on food miles, supply chain costs, greenhouse gas and criteria pollutant emissions, economic activity, and employment. Evaluation included comparison to regional production values and sensitivity analysis of demand and unit cost assumptions. Our analysis compares a baseline to two localization scenarios based on state boundaries and multiple-state subregions. Localization scenarios increased total distances fluid milk traveled by 7-15%, overall supply chain costs by 1-2%, and emissions of greenhouse gases (CO2 equivalent) criteria pollutants such as oxides of nitrogen and particulate matter smaller than 2.5 μm associated with fluid milk transportation by 7-15% per month. The impacts of localization on employment and economic activity are positive, but changes are small on a percentage basis. Our analyses indicate that the definition used for localization has an impact on outcomes and that efforts to localize food systems may benefit from a more systems-oriented approach.

Labour Migration and Health of Left-Behind Children in China

Abstract With rapid urbanisation, millions of people from rural areas have migrated to major cities for employment, leaving their young children at home. This labour migration creates substantial mental and physical challenges for these left-behind children. This study establishes two empirical models for comparing the health status of left-behind children with that of children in rural areas without migrant parents and with that of migrant children in urban areas. Our empirical findings reveal that parental migration negatively affects the height and weight indices of left-behind children. The effects are particularly prominent for younger children, when both parents migrate or when parents migrate out of province.

Shale Gas Development and Drinking Water Quality

Recent studies have linked shale gas development (SGD) to ground water contamination. The extent of these environmental externalities, to date, remains uncertain. To address this gap, we examine whether shale gas development systematically affects drinking water quality by creating a novel dataset that relates SGD to public drinking water samples in Pennsylvania. Our difference-in-differences strategy finds evidence that additional well pads drilled within 1 kilometer of a community water system intake increases shale gas-related contaminants in drinking water. These results are striking considering that our data are based on water sampling measurements taken after municipal treatment.

Patient Education for Consumer-Mediated HIE. A Pilot Randomized Controlled Trial of the Department of Veterans Affairs Blue Button.

OBJECTIVES Consumer-mediated health information exchange (HIE) is one of the three types of HIE designated by the Office of the National Coordinator. HIE is intended to improve the quality of care while reducing cost, yet empirical support for this claim is mixed. Future research should identify the contexts whereby HIE is most effective. METHODS This study was conducted as a pilot two-arm randomized controlled trial. In the intervention arm, 27 veterans were taught how to generate a Continuity of Care Document (CCD) within the Blue Button feature of their VA patient portal and were then asked to share it with their community non-VA provider. In the attention control condition, 25 Veterans were taught how to look up health information on the Internet. The impact of this training on the next non-VA medical visit was examined. RESULTS Nineteen (90%) veterans in the intervention arm shared their CCD with their non-VA provider as compared with 2 (17%) in the attention control arm (p<0.001). Both veterans and non-VA providers indicated high satisfaction with the CCD. Comparison of medical records between the VA and non-VA providers did not indicate improved medication reconciliation (p=0.72). If veterans shared their CCD prior to their non-VA providers ordering laboratory tests, the number of duplicate laboratories was significantly reduced (p=0.02). CONCLUSIONS In this pilot randomized controlled trial, training 52 veterans to share their CCD was feasible and accepted by both patients and providers. Sharing this document appeared to reduce duplicate laboratory draws, but did not have an impact on documented medication list concordance.

Unconventional natural gas development and pediatric asthma hospitalizations in Pennsylvania

Background: Pediatric asthma is a common chronic condition that can be exacerbated by environmental exposures, and unconventional natural gas development (UNGD) has been associated with decreased community air quality. This study aims to quantify the association between UNGD and pediatric asthma hospitalizations. Methods: We compare pediatric asthma hospitalizations among zip codes with and without exposure to UNGD between 2003 and 2014 using a difference‐in‐differences panel analysis. Our UNGD exposure metrics include cumulative and contemporaneous drilling as well as reported air emissions by site. Results: We observed consistently elevated odds of hospitalizations in the top tertile of pediatric patients exposed to unconventional drilling compared with their unexposed peers. During the same quarter a well was drilled, we find a 25% increase (95% CI: 1.07, 1.47) in the odds of being hospitalized for asthma. Ever‐establishment of an UNGD well within a zip code was associated with a 1.19 (95% CI: 1.04, 1.36) increased odds of a pediatric asthma hospitalization. Our results further demonstrate that increasing specific air emissions from UNGD sites are associated with increased risks of pediatric asthma hospitalizations (e.g. 2,2,4‐trimethylpentane, formaldehyde, x‐hexane). These results hold across multiple age groups and sensitivity analyses. Conclusions: Community‐level UNGD exposure metrics were associated with increased odds of pediatric asthma‐related hospitalization among young children and adolescents. This study provides evidence that additional regulations may be necessary to protect childrens respiratory health from UNGD activities. HighlightsUnconventional natural gas development may be linked to pediatric asthma.Specific air pollutants from drilling emissions may be driving these associations.Associations remain for up to eight years after drilling begins in a community.

The Economic and Health Effects of the 2014 Chemical Spill in the Elk River, West Virginia

&NA; In January 2014, Freedom Industries spilled 4‐methylcyclohexylmethanol, a chemical foaming agent used in coal processing, from a storage facility into the Elk River in West Virginia. This chemical spill, one of the most significant in U.S. history, adversely affected the drinking water supply of over 300,000 individuals in the Charleston, West Virginia Metropolitan area. We use synthetic control methods to estimate the casual effects on macro‐economic growth and infant health outcomes from this water crisis. We find a significant decrease in 5‐minute Apgar Scores, a measure of how babies fare in the birthing process and outside of the womb, after the chemical spill. We do not find significant effects for infant birthweight or gestational age. We find a statistically insignificant decrease of per capita GDP in the Charlestown, West Virginia area compared to the synthetic control of 3% two years after the chemical spill.

Birth Spacing and Educational Outcomes

Virtually all parents want their children to succeed academically. How to achieve this goal, though, is far from clear. Specifically, the temporal spacing between adjacent births has been shown to affect educational outcomes. While many of these studies have produced substantial and statistically significant results, these results have been relatively narrow in their application due to data limitations. Using Colorado birth certificates matched to schooling outcomes, we investigate the relationship between birth spacing and educational attainment. We instrument birth spacing with a previous pregnancy that did not result in a live birth. We find no overall effect of spacing on either the first or second children’s grade 3-10 test scores. Stratifying by the sexes of the children, we find that when the first child is a boy and the second a girl, an extra year of spacing increases the first child’s math, reading, and writing test scores by 0.07-0.08 SD, while there is no impact on the second child. This is the first study to do such an analysis using matched large scale birth and elementary to high school administrative data, and to leverage a very large data set to stratify our results by the sexes of the children. .