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Numerous epidemiologic studies have documented environmental health disparities according to race/ethnicity (R/E) to inform targeted interventions aimed at reducing these disparities. Yet, the use of R/E under the potential outcomes framework implies numerous underlying assumptions for epidemiologic studies that are often not carefully considered in environmental health research. In this commentary, we describe the current state of thinking about the interpretation of R/E variables in etiologic studies. We then discuss how such variables are commonly used in environmental epidemiology. We observed three main uses for R/E: i) as a confounder, ii) as an effect measure modifier and iii) as the main exposure of interest either through descriptive analysis or under a causal framework. We identified some common methodological concerns in each case and provided some practical solutions. The use of R/E in observational studies requires particular cautions in terms of formal interpretation and this commentary aims at providing a practical resource for future studies assessing racial/ethnic health disparities in environmental research.

Numerous epidemiologic studies have documented environmental health disparities according to race/ethnicity (R/E) to inform targeted interventions aimed at reducing these disparities. Yet, the use of R/E under the potential outcomes framework implies numerous underlying assumptions for epidemiologic studies that are often not carefully considered in environmental health research. In this commentary, we describe the current state of thinking about the interpretation of R/E variables in etiologic studies. We then discuss how such variables are commonly used in environmental epidemiology. We observed three main uses for R/E: i) as a confounder, ii) as an effect measure modifier and iii) as the main exposure of interest either through descriptive analysis or under a causal framework. We identified some common methodological concerns in each case and provided some practical solutions. The use of R/E in observational studies requires particular cautions in terms of formal interpretation and this commentary aims at providing a practical resource for future studies assessing racial/ethnic health disparities in environmental research.

The coronavirus disease 2019 (COVID-19) pandemic revealed and exacerbated existing social and economic health disparities, and actionable epidemiologic evidence is needed to identify potential vulnerability factors to help inform targeted responses. In this commentary, methodological challenges and opportunities regarding the links between air pollution and COVID-19 are discussed with a focus on 2 factors: 1) the role of differential exposure to air pollution across populations as an explanation for spatiotemporal variability of the epidemic spread and resultant mortality; and 2) the indirect impacts of interventions to control COVID-19 person-to-person spread treated as natural experiments on air pollution and population health. I first discuss the potential mechanisms between exposure to air pollution and COVID-19 and the opportunity to clearly formulate causal questions of interest through the target trial framework. Then, I discuss challenges regarding the use of quasiexperimental designs that capitalize on the differential timing of COVID-19 policies including the selection of control groups and potential violations of the common shock assumption. Finally, I discuss environmental justice implications of this many-headed beast of a crisis.

The coronavirus disease 2019 (COVID-19) pandemic revealed and exacerbated existing social and economic health disparities, and actionable epidemiologic evidence is needed to identify potential vulnerability factors to help inform targeted responses. In this commentary, methodological challenges and opportunities regarding the links between air pollution and COVID-19 are discussed with a focus on 2 factors: 1) the role of differential exposure to air pollution across populations as an explanation for spatiotemporal variability of the epidemic spread and resultant mortality; and 2) the indirect impacts of interventions to control COVID-19 person-to-person spread treated as natural experiments on air pollution and population health. I first discuss the potential mechanisms between exposure to air pollution and COVID-19 and the opportunity to clearly formulate causal questions of interest through the target trial framework. Then, I discuss challenges regarding the use of quasiexperimental designs that capitalize on the differential timing of COVID-19 policies including the selection of control groups and potential violations of the common shock assumption. Finally, I discuss environmental justice implications of this many-headed beast of a crisis.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Le présent ouvrage pose un regard pluridisciplinaire sur les enjeux épistémologiques, éthiques et politiques de la mise en forme des problèmes sociaux contemporains à travers l’expérimentation. À partir de réflexions et d’études de cas venant de disciplines comme l’éthique, la philosophie, la sociologie, l’épidémiologie, la criminologie et l’histoire, ce livre définit l’expérimentation comme une modalité de production des savoirs transformant les sujets et les objets qu’elle met en relation. Plus particulièrement, il propose une réflexion sur le concept de « sociétés de l’expérimentation » envisagé à partir d’une série de tensions entre les preuves et les valeurs, l’émancipation et l’assujettissement, l’objectivation scientifique et la participation sociale. Le livre est constitué de trois parties : 1) une mise en perspective historique et épistémologique de l’expérimentation ; 2) un questionnement issu d’études de cas ; 3) une réflexion sur la force politique de l’expérimentation ainsi que des points de vue philosophiques et sociologiques sur l’inclusion et la participation sociales. L’ouvrage s’adresse particulièrement aux étudiants et étudiantes en sciences sociales et en sciences de la santé. La perspective proposée est aussi susceptible d’intéresser un public plus large cherchant à mieux comprendre les fondements historiques et épistémologiques de l’expérimentation, ainsi que ses dynamiques au sein des sociétés d’aujourd’hui.

Many smokers believe that electronic nicotine delivery systems (ENDS) and pharmaceutical cessation aids can help them quit smoking or reduce cigarette consumption, but the evidence for e-cigarettes to aid quitting is limited. Examining 3,093 quit attempters in the nationally representative US Population Assessment of Tobacco and Health (PATH) Study, using data from 2013-2015, we evaluated the influence of ENDS and pharmaceutical cessation aids on persistent abstinence (≥30 days) from cigarettes and reduced cigarette consumption, using propensity score matching to balance comparison groups on potential confounders and multiple imputation to handle missing data. At PATH Wave 2, 25.2% of quit attempters reported using ENDS to quit during the previous year, making it the most popular cessation aid in 2014-2015. More quit attempters were persistently cigarette abstinent than were persistently tobacco abstinent (15.5% (standard error, 0.8) vs. 9.6% (standard error, 0.6)). Using ENDS to quit cigarettes increased the probability of persistent cigarette abstinence at Wave 2 (risk difference (RD) = 6%, 95% confidence interval (CI): 2, 10), but using approved pharmaceutical aids did not (for varenicline, RD = 2%, 95% CI: -6, 13; for bupropion, RD = 4%, 95% CI: -6, 17; for nicotine replacement therapy, RD = -3%, 95% CI: -8, 2). Among quit attempters who relapsed, ENDS did not reduce the average daily cigarette consumption (cigarettes per day, -0.18, 95% CI: -1.87, 1.51).

The epidemiological evidence demonstrating the effect of disinfection by-products (DBPs) from drinking water on colon and rectal cancers is well documented. However, no systematic assessment has been conducted to assess the potential effect measure modification (EMM) in the relationship between DBPs and cancer. The objective of this paper is to conduct a systematic literature review to determine the extent to which EMM has been assessed in the relationship between DBPs in drinking water in past epidemiological studies. Selected articles (n = 19) were reviewed, and effect estimates and covariates that could have been used in an EMM assessment were gathered. Approximately half of the studies assess EMM (n = 10), but the majority of studies only estimate it relative to sex subgroups (n = 6 for bladder cancer and n = 2 both for rectal and colon cancers). Although EMM is rarely assessed, several variables that could have a potential modification effect are routinely collected in these studies, such as socioeconomic status or age. The role of environmental exposures through drinking water can play an important role and contribute to cancer disparities. We encourage a systematic use of subgroup analysis to understand which populations or territories are more vulnerable to the health impacts of DBPs.

Many smokers believe that electronic nicotine delivery systems (ENDS) and pharmaceutical cessation aids can help them quit smoking or reduce cigarette consumption, but the evidence for e-cigarettes to aid quitting is limited. Examining 3,093 quit attempters in the nationally representative US Population Assessment of Tobacco and Health (PATH) Study, using data from 2013-2015, we evaluated the influence of ENDS and pharmaceutical cessation aids on persistent abstinence (≥30 days) from cigarettes and reduced cigarette consumption, using propensity score matching to balance comparison groups on potential confounders and multiple imputation to handle missing data. At PATH Wave 2, 25.2% of quit attempters reported using ENDS to quit during the previous year, making it the most popular cessation aid in 2014-2015. More quit attempters were persistently cigarette abstinent than were persistently tobacco abstinent (15.5% (standard error, 0.8) vs. 9.6% (standard error, 0.6)). Using ENDS to quit cigarettes increased the probability of persistent cigarette abstinence at Wave 2 (risk difference (RD) = 6%, 95% confidence interval (CI): 2, 10), but using approved pharmaceutical aids did not (for varenicline, RD = 2%, 95% CI: -6, 13; for bupropion, RD = 4%, 95% CI: -6, 17; for nicotine replacement therapy, RD = -3%, 95% CI: -8, 2). Among quit attempters who relapsed, ENDS did not reduce the average daily cigarette consumption (cigarettes per day, -0.18, 95% CI: -1.87, 1.51).

The epidemiological evidence demonstrating the effect of disinfection by-products (DBPs) from drinking water on colon and rectal cancers is well documented. However, no systematic assessment has been conducted to assess the potential effect measure modification (EMM) in the relationship between DBPs and cancer. The objective of this paper is to conduct a systematic literature review to determine the extent to which EMM has been assessed in the relationship between DBPs in drinking water in past epidemiological studies. Selected articles (n = 19) were reviewed, and effect estimates and covariates that could have been used in an EMM assessment were gathered. Approximately half of the studies assess EMM (n = 10), but the majority of studies only estimate it relative to sex subgroups (n = 6 for bladder cancer and n = 2 both for rectal and colon cancers). Although EMM is rarely assessed, several variables that could have a potential modification effect are routinely collected in these studies, such as socioeconomic status or age. The role of environmental exposures through drinking water can play an important role and contribute to cancer disparities. We encourage a systematic use of subgroup analysis to understand which populations or territories are more vulnerable to the health impacts of DBPs.

BackgroundRacial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes.ObjectivesTo apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution.MethodsWe used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less (PM2.5) and nitrogen dioxide (NO2)] predictors, we conducted a nonlinear extension of the Blinder-Oaxaca method to decompose racial/ethnic disparities in PTB.ResultsThe predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black-white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black-white difference in birth outcomes than air pollution (5.7% for PTB).ConclusionsOur results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black-white differences in birth outcomes, the individual contribution of PM2.5 is comparable in magnitude to any single individual- or neighborhood-level factor. https://doi.org/10.1289/EHP490.

ObjectivesIn Quebec, various actors fund activities aimed at increasing physical activity, improving eating habits and reducing smoking. The objective was to evaluate how effective does the healthy lifestyle habits promotion (HLHP) strategy need to be to make to offset its costs.MethodsFirst, we built the logic model of the HLHP strategy. We then assessed the strategy's total cost as well as the direct health care expenditures associated with lifestyle-related risk factors (smoking, physical inactivity, insufficient intake of fruits and vegetables, obesity and overweight). Finally, we estimated the break-even point beyond which the economic benefits of the HLHP strategy would outweigh its costs.ResultsThe HLHP strategy cost for 2010-2011 was estimated at $110 million. Direct healthcare expenditures associated with lifestyle-related risk factors were estimated at $4.161 billion. We estimated that 47 % of these expenditures were attributable to these risk factors.ConclusionsWe concluded that the HLHP strategy cost corresponded to 5.6 % of the annual healthcare expenditures attributable to these risk factors. This study compared the economic value of HLHP activities against healthcare expenditures associated with targeted risk factors.

BACKGROUND:Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. METHODS:We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. RESULTS:WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. CONCLUSION:In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to

BackgroundRacial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes.ObjectivesTo apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution.MethodsWe used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less (PM2.5) and nitrogen dioxide (NO2)] predictors, we conducted a nonlinear extension of the Blinder-Oaxaca method to decompose racial/ethnic disparities in PTB.ResultsThe predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black-white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black-white difference in birth outcomes than air pollution (5.7% for PTB).ConclusionsOur results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black-white differences in birth outcomes, the individual contribution of PM2.5 is comparable in magnitude to any single individual- or neighborhood-level factor. https://doi.org/10.1289/EHP490.

BACKGROUND:Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. METHODS:We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. RESULTS:WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. CONCLUSION:In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to

ObjectivesIn Quebec, various actors fund activities aimed at increasing physical activity, improving eating habits and reducing smoking. The objective was to evaluate how effective does the healthy lifestyle habits promotion (HLHP) strategy need to be to make to offset its costs.MethodsFirst, we built the logic model of the HLHP strategy. We then assessed the strategy's total cost as well as the direct health care expenditures associated with lifestyle-related risk factors (smoking, physical inactivity, insufficient intake of fruits and vegetables, obesity and overweight). Finally, we estimated the break-even point beyond which the economic benefits of the HLHP strategy would outweigh its costs.ResultsThe HLHP strategy cost for 2010-2011 was estimated at $110 million. Direct healthcare expenditures associated with lifestyle-related risk factors were estimated at $4.161 billion. We estimated that 47 % of these expenditures were attributable to these risk factors.ConclusionsWe concluded that the HLHP strategy cost corresponded to 5.6 % of the annual healthcare expenditures attributable to these risk factors. This study compared the economic value of HLHP activities against healthcare expenditures associated with targeted risk factors.

BackgroundThe impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.ObjectivesWe developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.MethodsA difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000-2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.ResultsWe found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.ConclusionThese findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached. Citation: Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J. 2016. A difference-in-differences approach to assess the effect of a heat action plan on heat-related mortality, and differences in effectiveness according to sex, age, and socioeconomic status (Montreal, Quebec). Environ Health Perspect 124:1694-1699; http://dx.doi.org/10.1289/EHP203.

BackgroundThe impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.ObjectivesWe developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.MethodsA difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000-2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.ResultsWe found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.ConclusionThese findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached. Citation: Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J. 2016. A difference-in-differences approach to assess the effect of a heat action plan on heat-related mortality, and differences in effectiveness according to sex, age, and socioeconomic status (Montreal, Quebec). Environ Health Perspect 124:1694-1699; http://dx.doi.org/10.1289/EHP203.

ObjectivesWe propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris.MethodsWe used historical data from the summers of 1990 through 2007 for Montreal and from 2004 through 2009 for Paris to estimate daily years of life lost social disparities (DYLLD), summarizing social inequalities across groups. We used Generalized Linear Models to separately estimate relative risks (RR) for DYLLD in association with daily mean temperatures in both cities. We used 30 climate scenarios of daily mean temperature to estimate future temperature distributions (2021-2050). We performed random effect meta-analyses to assess the impact of climate change by climate scenario for each city and compared the impact of climate change for the two cities using a meta-regression analysis.ResultsWe show that an increase in ambient temperature leads to an increase in social disparities in daily years of life lost. The impact of climate change on DYLLD attributable to temperature was of 2.06 (95% CI: 1.90, 2.25) in Montreal and 1.77 (95% CI: 1.61, 1.94) in Paris. The city explained a difference of 0.31 (95% CI: 0.14, 0.49) on the impact of climate change.ConclusionWe propose a new analytical approach for estimating vulnerability in the relationship between heat and health. Our results suggest that in Paris and Montreal, health disparities related to heat impacts exist today and will increase in the future.

ObjectivesWe propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris.MethodsWe used historical data from the summers of 1990 through 2007 for Montreal and from 2004 through 2009 for Paris to estimate daily years of life lost social disparities (DYLLD), summarizing social inequalities across groups. We used Generalized Linear Models to separately estimate relative risks (RR) for DYLLD in association with daily mean temperatures in both cities. We used 30 climate scenarios of daily mean temperature to estimate future temperature distributions (2021-2050). We performed random effect meta-analyses to assess the impact of climate change by climate scenario for each city and compared the impact of climate change for the two cities using a meta-regression analysis.ResultsWe show that an increase in ambient temperature leads to an increase in social disparities in daily years of life lost. The impact of climate change on DYLLD attributable to temperature was of 2.06 (95% CI: 1.90, 2.25) in Montreal and 1.77 (95% CI: 1.61, 1.94) in Paris. The city explained a difference of 0.31 (95% CI: 0.14, 0.49) on the impact of climate change.ConclusionWe propose a new analytical approach for estimating vulnerability in the relationship between heat and health. Our results suggest that in Paris and Montreal, health disparities related to heat impacts exist today and will increase in the future.

BackgroundHeat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored.MethodsWe used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated.ResultsWe found that chronic air pollution exposure and social deprivation are effect modifiers of the association between daily temperature and mortality. We found a potential interactive effect between social deprivation and chronic exposure with regards to air pollution in the mortality-temperature relationship.ConclusionOur results may have implications in considering chronically polluted areas as vulnerable in heat action plans and in the long-term measures to reduce the burden of heat stress especially in the context of climate change.

BackgroundMost studies that have assessed impacts on mortality of future temperature increases have relied on a small number of simulations and have not addressed the variability and sources of uncertainty in their mortality projections.ObjectivesWe assessed the variability of temperature projections and dependent future mortality distributions, using a large panel of temperature simulations based on different climate models and emission scenarios.MethodsWe used historical data from 1990 through 2007 for Montreal, Quebec, Canada, and Poisson regression models to estimate relative risks (RR) for daily nonaccidental mortality in association with three different daily temperature metrics (mean, minimum, and maximum temperature) during June through August. To estimate future numbers of deaths attributable to ambient temperatures and the uncertainty of the estimates, we used 32 different simulations of daily temperatures for June-August 2020-2037 derived from three global climate models (GCMs) and a Canadian regional climate model with three sets of RRs (one based on the observed historical data, and two on bootstrap samples that generated the 95% CI of the attributable number (AN) of deaths). We then used analysis of covariance to evaluate the influence of the simulation, the projected year, and the sets of RRs used to derive the attributable numbers of deaths.ResultsWe found that < 1% of the variability in the distributions of simulated temperature for June-August of 2020-2037 was explained by differences among the simulations. Estimated ANs for 2020-2037 ranged from 34 to 174 per summer (i.e., June-August). Most of the variability in mortality projections (38%) was related to the temperature-mortality RR used to estimate the ANs.ConclusionsThe choice of the RR estimate for the association between temperature and mortality may be important to reduce uncertainty in mortality projections.

BackgroundMost studies that have assessed impacts on mortality of future temperature increases have relied on a small number of simulations and have not addressed the variability and sources of uncertainty in their mortality projections.ObjectivesWe assessed the variability of temperature projections and dependent future mortality distributions, using a large panel of temperature simulations based on different climate models and emission scenarios.MethodsWe used historical data from 1990 through 2007 for Montreal, Quebec, Canada, and Poisson regression models to estimate relative risks (RR) for daily nonaccidental mortality in association with three different daily temperature metrics (mean, minimum, and maximum temperature) during June through August. To estimate future numbers of deaths attributable to ambient temperatures and the uncertainty of the estimates, we used 32 different simulations of daily temperatures for June-August 2020-2037 derived from three global climate models (GCMs) and a Canadian regional climate model with three sets of RRs (one based on the observed historical data, and two on bootstrap samples that generated the 95% CI of the attributable number (AN) of deaths). We then used analysis of covariance to evaluate the influence of the simulation, the projected year, and the sets of RRs used to derive the attributable numbers of deaths.ResultsWe found that < 1% of the variability in the distributions of simulated temperature for June-August of 2020-2037 was explained by differences among the simulations. Estimated ANs for 2020-2037 ranged from 34 to 174 per summer (i.e., June-August). Most of the variability in mortality projections (38%) was related to the temperature-mortality RR used to estimate the ANs.ConclusionsThe choice of the RR estimate for the association between temperature and mortality may be important to reduce uncertainty in mortality projections.

BackgroundHeat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored.MethodsWe used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated.ResultsWe found that chronic air pollution exposure and social deprivation are effect modifiers of the association between daily temperature and mortality. We found a potential interactive effect between social deprivation and chronic exposure with regards to air pollution in the mortality-temperature relationship.ConclusionOur results may have implications in considering chronically polluted areas as vulnerable in heat action plans and in the long-term measures to reduce the burden of heat stress especially in the context of climate change.