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A considerable body of research exists outlining ecological impacts of surface coal mining, but less work has explicitly focused on human health, and few studies have examined potential links between health and surface coal mining at fine spatial scales. In particular, relationships between individual birth outcomes and exposure to air contaminants from coal mining activities has received little attention. Central Appalachia (portions of Virginia, West Virginia, Kentucky, and Tennessee, USA), our study area, has a history of resource extraction, and epidemiologic research notes that the region experiences a greater level of adverse health outcomes compared to the rest of the country that are not fully explained by socioeconomic and behavioral factors. The purpose of this study is to examine associations between surface mining and birth outcomes at four spatial scales: individual, Census tract, county, and across county-sized grid cells. Notably, this study is among the first to examine these associations at the individual scale, providing a more direct measure of exposure and outcome. Airsheds were constructed for surface mines using an atmospheric trajectory model. We then implemented linear (birthweight) and logistic (preterm birth [PTB]) regression models to examine associations between airsheds and birth outcomes, which were geocoded to home address for individual analyses and then aggregated for areal unit analyses, while controlling for a number of demographic variables. This study found that surface mining airsheds are significantly associated with PTB and decreased birthweight at all four spatial scales, suggesting that surface coal mining activities impact birth outcomes via airborne contaminants.

To investigate how heat-health behaviors changed in summer 2020 compared with previous summers, our community–academic partnership conducted telephone surveys to collect data on cooling behaviors, safety concerns, and preferences for cooling alternatives for 101 participants living in Alabama. Participants indicating they would visit cooling centers declined from 23% in previous summers to 10% in summer 2020. The use of cooling centers and other public spaces may be less effective in reducing heat-related illness because of safety concerns amid the COVID-19 pandemic and police brutality.

Background Flooding following heavy rains precipitated by hurricanes has been shown to impact the health of people. Earth observations can be used to identify inundation extents for subsequent analysis of health risks associated with flooding at a fine spatio-temporal scale. Objective To evaluate emergency department (ED) visits before, during, and following flooding caused by Hurricane Harvey in 2017 in Texas. Methods A controlled before and after design was employed using 2016-2018 ED visits from flooded and non-flooded census tracts. ED visits between landfall of the hurricane and receding of flood waters were considered within the flood period and post-flood periods extending up to 4 months were also evaluated. Modified Poisson regression models were used to estimate adjusted rate ratios for total and cause specific ED visits. Results Flooding was associated with increased ED visits for carbon monoxide poisoning, insect bite, dehydration, hypothermia, intestinal infectious diseases, and pregnancy complications. During the month following the flood period, the risk for pregnancy complications and insect bite was still elevated in the flooded tracts. Significance Earth observations coupled with ED visits increase our understanding of the short-term health risks during and following flooding, which can be used to inform preparedness measures to mitigate adverse health outcomes and identify localities with increased health risks during and following flooding events.

Rationale: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. Objectives: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. Methods: Regionally resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. Results: Effect estimates and associated uncertainties varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1% to 1.1% per 1 degrees C) were estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel and included the following: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socioeconomic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. Conclusions: This work provides an example of how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates. U.S. Environmental Protection Agency; National Institute of Environmental Health Sciences; Centers for Disease Control and Prevention Published version Supported by the U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, and National Institute of Environmental Health Sciences. The views expressed in this manuscript are solely those of the authors and do not necessarily represent those of their employers, including the U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, and Health Canada, and no official endorsement should be inferred.

Heatwave warning systems rely on forecasts made for fixed-point weather stations (WS), which do not reflect variation in temperature and humidity experienced by individuals moving through indoor and outdoor locations. We examined whether neighborhood measurement improved the prediction of individually experienced heat index in addition to nearest WS in an urban and rural location. Participants (residents of Birmingham, Alabama [N = 89] and Wilcox County, Alabama [N = 88]) wore thermometers clipped to their shoe for 7 days. Shielded thermometers/hygrometers were placed outdoors within participant’s neighborhoods (N = 43). Nearest WS and neighborhood thermometers were matched to participant’s home address. Heat index (HI) was estimated from participant thermometer temperature and WS humidity per person-hour (HI[individual]), or WS temperature and humidity, or neighborhood temperature and humidity. We found that neighborhood HI improved the prediction of individually experienced HI in addition to WS HI in the rural location, and neighborhood heat index alone served as a better predictor in the urban location, after accounting for individual-level factors. Overall, a 1 °C increase in HI[neighborhood] was associated with 0.20 °C [95% CI (0.19, 0.21)] increase in HI[individual]. After adjusting for ambient condition differences, we found higher HI[individual] in the rural location, and increased HI[individual] during non-rest time (5 a.m. to midnight) and on weekdays.

In 1974, the United States established the Safe Drinking Water Act (SDWA) to protect consumers from potential exposure to drinking water contaminants associated with health risks. Each contaminant is assigned a health-based standard meant to reflect the maximum level at which an adverse human health outcome is unlikely; measurements beyond that level have greater potential to result in adverse health outcomes. Although there is extensive research on human health implications following water contaminant exposure, few studies have specifically examined associations between fetal health and municipal drinking water violations. Therefore, the objective of this study is to assess whether SDWA drinking water violations are associated with fetal health outcomes, including preterm birth (PTB), low birth weight (LBW), and term-low birth weight (tLBW), in the Commonwealth of Virginia. Singleton births (n = 665,984) occurring between 2007 and 2015 in Virginia were geocoded and assigned to a corresponding estimated water service area. Health-based (HB) and monitoring and reporting (MR) violations for 12 contaminants were acquired from the US EPA Safe Drinking Water Information System, with exposure defined at the approximate service area level to limit exposure misclassification. A logistic regression model for each birth outcome assessed potential relationships with SDWA violations. When examining the association between individual MR violations and birth outcomes, Nitrate-Nitrite (OR = 1.10; 95% CI = 1.02, 1.18, P = 0.01) was positively associated with PTB and the total coliform rule was negatively associated with tLBW (OR = 0.93; 95% CI = 0.87, 1.00, P = 0.04). These findings indicate that a lack of regular monitoring and reporting by water providers (resulting in monitoring and reporting violations) may be concealing health-based violations as these health concerns cannot be revealed without testing, suggesting a need for additional technical, managerial, and financial support to enable often-underfunded water systems to adhere to monitoring and reporting requirements meant to protect public health.

With advancing global climate change, heat-related illnesses and injuries are anticipated to become more prevalent for humans and other species. Canine hyperthermia is already considered an important seasonal emergency. Studies have been performed on the risk factors for heat stroke in canine athletes and military working dogs; however there is limited knowledge on environmental risk factors for the average pet dog. This observational study explores variation in individually experienced environmental temperatures of pet dogs (N = 30) in rural and urban environments in central Alabama. Temperature data from dogs and their owners was collected using wearable personal thermometers. Demographic data on the dogs was collected using a brief survey instrument completed by their owners. Dogs included in the study varied in signalment, activity level, and home environment. Linear mixed effects regression models were used to analyze repeated measure temperature and heat index values from canine thermometers to explore the effect of environmental factors on the overall heat exposure risk of canine pets. Specifically, the heat exposures of dogs were modeled considering their owner's experienced temperatures, as well as neighborhood and local weather station measurements, to identify factors that contribute to the heat exposure of individual dogs, and therefore potentially contribute to heat stress in the average pet dog. Results show hourly averaged temperatures for dogs followed a diurnal pattern consistent with both owner and ambient temperature measurements, except for indoor dogs whose recordings remained stable throughout the day. Heat index calculations showed that owners, in general, had more hours categorized into the National Weather Station safe category compared to their dogs, and that indoor dogs had a greater proportion of hours categorized as safe compared to outdoor dogs. Our results suggest that the risk of the average pet dog to high environmental heat exposure may be greater than traditional measures indicate, emphasizing that more localized considerations of temperature are important when assessing a dog's environmental risk for heat-related injury or illness. National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01ES023029]; Virginia-Maryland College of Veterinary Medicine Summer Veterinary Student Research Program; Boehringer Ingelheim Veterinary Scholar programBoehringer Ingelheim Published version This work was supported by the National Institutes of Health [Grant number R01ES023029 (PI: JG)], the Virginia-Maryland College of Veterinary Medicine Summer Veterinary Student Research Program, and the Boehringer Ingelheim Veterinary Scholar program. These funding sources were not involved in study design, collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Background Previous work has determined an association between proximity to active surface mining in coal producing counties within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW); however, the relative importance of specific exposure pathways explaining this association remains poorly understood. Multiple potential exposure pathways to surface mining activities exist during gestation, including inhalation of particulate matter (airshed exposure), or via exposure to impacted surface waters (watershed exposure). Here, we perform a mediation analysis to explore these pathways and the odds of adverse birth outcomes. Methods We obtained birth records acquired through health departments in WV, KY, VA and TN between 1990 and 2015. Surface mine extents for each year were identified through remotely sensed Landsat imagery. Corresponding airsheds were estimated using the HYSPLIT4 atmospheric trajectory model, while watersheds were assigned using United States Geological Survey’s Watershed Boundary Dataset boundaries. We performed logistic regression to determine associations between exposure and the odds of preterm birth, low birthweight, and term low birthweight, and iteratively included within our models: a) the percent of active surface mining landcover within a 5 km buffer of maternal residence; b) the cumulative potential exposure to air pollutants via the airshed experienced at the maternal residence, and; c) the percent of land experiencing surface mining within the watershed of residency. Results Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05 – 1.13) and LBW (1.06, 1.02 – 1.11), while controlling for significant predictors. When mediators were added to the base model, the association between active mining and birth outcomes was reduced (PTB: 1.04, 0.99 – 1.09; LBW 1.04, 0.99 – 1.10), while the odds of PTB and LBW increased with airshed exposure (PTB: 1.14, 1.11 – 1.18; LBW: 1.06, 1.03 – 1.10). Conclusions Results were consistent with a hypothesis of mediation via airshed, but suggested mediation via watershed was less likely. These results suggest that air pollution resulting from surface mining activities may be the primary exposure pathway explaining the association between maternal residence proximity to active surface mining and PTB and LBW.

Background Focus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019. Methods Six focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019. Results Consistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019. Conclusions Applying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

Benzene, toluene, ethylbenzene, and xylenes (BTEX) are hazardous air pollutants commonly found in outdoor air. Several studies have explored the potential of vegetation to mitigate BTEX in outdoor air, but they are limited to a northern temperate climate and their results lack consensus. To investigate this subject in a subtropical climate, we deployed passive air samplers for two weeks in parks and outside nearby residences at four locations: three in an urban area and one in a rural area in Alabama, USA. All BTEX concentrations were below health-based guidelines and were comparable to those found in several other studies in populated settings. Concentrations of TEX, but not benzene, were 3–39% lower in parks than at nearby residences, and the differences were significant. Site type (park vs. residential) was a significant predictor of TEX concentrations, while distance to the nearest major road was a significant predictor of BTX concentrations. In and around two of the parks, toluene : benzene ratios fell outside the range expected for vehicular emissions (p < 0.01), suggesting that there were additional, industrial sources of benzene near these two locations. The ratio of m-,p-xylene : ethylbenzene was high at all locations except one residential area, indicating that BTEX were freshly emitted. Concentrations of individual BTEX compounds were highly correlated with each other in most cases, except for locations that may have been impacted by nearby industrial sources of benzene. Results of this study suggest that parks can help reduce exposure to TEX by a modest amount in some situations.

Purpose:Flooding following heavy rains precipitated by hurricanes/tropical storms has previously been shown to increase fecal-oral diseases, vector-borne disease transmission and pregnancy complica...

Heat stress is a significant health concern that can lead to illness, injury, and mortality. The wet bulb globe temperature (WBGT) index is one method for monitoring environmental heat risk. Generally, WBGT is estimated using a heat stress monitor that includes sensors capable of measuring ambient, wet bulb, and black globe temperature, and these measurements are combined to calculate WBGT. However, this method can be expensive, time consuming, and requires careful attention to ensure accurate and repeatable data. Therefore, researchers have attempted to use standard meteorological measurements, using single data sources as an input (e.g., weather stations) to calculate WBGT. Building on these efforts, we apply data from a variety of sources to calculate WBGT, understand the accuracy of our estimated equation, and compare the performance of different sources of input data. To do this, WBGT measurements were collected from Kestrel 5400 Heat Stress Trackers installed in three locations in Alabama. Data were also drawn from local weather stations, North American Land Data Assimilation System (NLDAS), and low cost iButton hygrometers. We applied previously published equations for estimating natural wet bulb temperature, globe temperature, and WBGT to these diverse data sources. Correlation results showed that WBGT estimates derived from all proxy data sources—weather station, weather station/iButton, NLDAS, NLDAS/iButton—were statistically indistinguishable from each other, or from the Kestrel measurements, at two of the three sites. However, at the same two sites, the addition of iButtons significantly reduced root mean square error and bias compared to other methods., Key Points A variety of proxy methods offered reasonable estimates of wet bulb globe temperature (WBGT) in downtown and suburban Birmingham, ALEstimating WBGT from easily accessible measurements could be a powerful tool for studies and interventions related to heat stress

This article describes a collaboration among a group of university faculty, undergraduate students, local governments, local residents, and U.S. Army staff to address long-standing concerns about the environmental health effects of an Army ammunition plant. The authors describe community-responsive scientific pilot studies that examined potential environmental contamination and a related undergraduate research course that documented residents&rsquo, concerns, contextualized those concerns, and developed recommendations. We make a case for the value of resource-intensive university&ndash, community partnerships that promote the production of knowledge through collaborations across disciplinary paradigms (natural/physical sciences, social sciences, health sciences, and humanities) in response to questions raised by local residents. Our experience also suggests that enacting this type of research through a university class may help promote researchers&rsquo, adoption of &ldquo, epistemological pluralism&rdquo, and thereby facilitate the movement of a study from being &ldquo, multidisciplinary&rdquo, to &ldquo, transdisciplinary&rdquo

Many applications involve data with qualitative and quantitative responses. When there is an association between the two responses, a joint model will provide improved results than modeling them separately. In this paper, we propose a Bayesian method to jointly model such data. The joint model links the qualitative and quantitative responses and can assess their dependency strength via a latent variable. The posterior distributions of parameters are obtained through an efficient MCMC sampling algorithm. The simulation shows that the proposed method can improve the prediction capacity for both responses. We apply the proposed joint model to the birth records data acquired by the Virginia Department of Health and study the mutual dependence between preterm birth of infants and their birth weights., Comment: 27 pages, 3 figures. 3 tables

Objective It was hypothesized that exposure to mild temperatures above the human thermoneutral zone would decrease caloric intake in a sedentary office environment. Methods Women (n = 25) were randomized in a crossover design to perform seated office work for 7 hours in a thermoneutral condition (control, 19°C-20°C) and a condition above the thermoneutral zone (warm, 26°C-27°C). Food intake was estimated by weight and bomb calorimetry, peripheral temperature by thermal imaging, and thermal comfort and productivity by questionnaires. Mixed effects models were used to examine the effects of thermal condition on caloric intake. Results Participants ate, on average, 357 kcal less in the warm condition, adjusting for BMI and peripheral temperature (P = 0.0219). According to the survey results at midday (after 3.5 hours of exposure), 96% of the participants in the warm condition reported being comfortable (n = 24) compared with 32% in the control condition (n = 8). More participants reported being as productive or more productive than usual in the warm condition (n = 22, 88%) than in the control condition (n = 12, 48%). Conclusions This line of research is worthy of further exploration. Untightening climate control toward warmer conditions during summer to increase comfort and productivity while decreasing caloric intake may prove both effective and comfortable.

OBJECTIVE This study investigated whether using thermometers clipped on workers' shoes would result in different heat exposure estimation and work-rest schedules compared with using area-level meteorological data alone. METHODS Alabama workers (n = 51) were individually monitored using thermometers on shoes. Wet bulb globe temperature (WBGT) was estimated using thermometer temperatures (WBGT [personal]) or nearby weather station temperatures (WBGT [WS]). Work-rest schedules were determined from WBGT, clothing, and hourly metabolic rates estimated from self-reported tasks and bodyweight. RESULTS The percent of hours exceeding the threshold limit value (TLV, ACGIH, Cincinnati, OH) were estimated at 47.8% using WBGT (personal) versus 42.1% using WBGT (WS). For work-rest recommendations, more hours fell into the most protective schedule (0 to 15 min work/45 to 60 min rest) using WBGT (personal) versus WBGT (WS) (17.4% vs 14.4%). CONCLUSIONS Temperatures from wearable thermometers, together with meteorological data, can serve as an additional method to identify occupational heat stress exposure and recommend work-rest schedules.

This study investigated changes in glycemic control following a small increase in time spent outdoors. Women participants with type 2 diabetes (N = 46) wore an iBUTTON temperature monitor and a pedometer for 1 week and recorded their morning fasting blood glucose (FBG) daily. They went about their normal activities for 2 days (baseline) and were asked to add 30 min of time outdoors during Days 3–7 (intervention). Linear mixed effects models were used to test whether morning FBG values were different on days following intervention versus baseline days, and whether steps and/or heat exposure changed. Results were stratified by indicators of good versus poor glycemic control prior to initiation of the study. On average, blood glucose was reduced by 6.1 mg/dL (95% CI − 11.5, − 0.6) on mornings after intervention days after adjusting for age, BMI, and ambient weather conditions. Participants in the poor glycemic control group (n = 16) experienced a 15.8 mg/dL decrease (95% CI − 27.1, − 4.5) in morning FBG on days following the intervention compared to a 1.6 mg/dL decrease (95%CI − 7.7, 4.5) for participants in the good glycemic control group (n = 30). Including daily steps or heat exposure did not attenuate the association between intervention and morning FBG. The present study suggests spending an additional 30 min outdoors may improve glycemic control; however, further examination with a larger sample over a longer duration and determination of mediators of this relationship is warranted.

BACKGROUND: Area-level estimates of temperature may lead to exposure misclassification in studies examining associations between heat waves and health outcomes. Our study compared the association between heat waves and preterm birth (PTB) or non-accidental death (NAD) using exposure metrics at varying levels of spatial resolution: ZIP codes, 12.5 km, and 1 km. METHOD: Using geocoded residential addresses on birth (1990–2010) and death (1997–2010) records from Alabama, USA, we implemented a time-stratified case-crossover design to examine the association between heat waves and PTB or NAD. ZIP code- and 12.5 km heat wave indices (HIs) were derived using air temperatures from Phase 2 of the North American Land Data Assimilation System (NLDAS-2). We downscaled NLDAS-2 data, using land surface temperatures (LST) from the Moderate Resolution Imaging Spectroradiometer (MODIS) product, to estimate fine spatial resolution HIs (1 km). RESULTS: The association between heat waves and PTB or NAD was significant and positive using ZIP code-, 12.5 km, and 1 km exposure metrics. Moreover, results show that these three-exposure metric analyses produced similar effect estimates. Urban heat islands were evident with the 1 km metric. When analyses were stratified by rurality, we found associations in urban areas were more positive than in rural areas. CONCLUSIONS: Comparing results of models with a varying spatial resolution of the exposure metric allows for examination of potential bias associated with exposure misclassification.

Supplemental Digital Content is available in the text., Background: Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure. Methods: We developed characterizations of annual surface mining boundaries in Central Appalachia between 1986 and 2015 using Landsat data. Maternal address on birth records was geocoded and assigned amount of surface mining within a 5 km radius of residence (street-level). Births were also assigned the amount of surface mining within residential ZIP code tabulation area (ZCTA). Associations between exposure to active mining during gestation year and birth weight, LBW, preterm birth (PTB), and term low birth weight (tLBW) were determined, adjusting for outcome rates before active mining and available covariates. Results: The percent of land actively mined within a 5 km buffer of residence (or ZCTA) was negatively associated with birth weight (5 km: β = –14.07 g; 95% confidence interval [CI] = –19.35, –8.79, P = 1.79 × 10–7; ZCTA: β = –9.93 g; 95% CI = –12.54, –7.33, P = 7.94 × 10–14). We also found positive associations between PTB and active mining within 5 km (odds ratio [OR] = 1.06; 95% CI = 1.03, 1.09, P = 1.43 × 10–4) and within ZCTA (OR = 1.04; 95% CI = 1.03, 1.06, P = 9.21 × 10–8). Positive relationships were also found between amount of active mining within 5 km or ZIP code of residence and LBW and tLBW outcomes. Conclusions: Maternal residency near active surface mining during gestation may increase risk of PTB and LBW.

Spending time outdoors is associated with increased physical activity, however, high ambient temperature/humidity, together with built environment features in urban versus rural environments, may influence physical activity. We conducted an intervention trial with 89 urban and 88 rural participants performing normal activities on Days 1&ndash, 2 (baseline) and spending an additional 30 min outdoors on Days 3&ndash, 7 (intervention) in the summer. Participants wore a pedometer with real-time visual feedback to track daily steps taken and a thermometer clipped to their shoe to track temperatures experienced individually. Hygrometer&ndash, thermometers were deployed in participants&rsquo, neighborhoods to collect finer resolution ambient heat indexes in addition to regional weather station measurements. Using linear mixed effects models and adjusting for ambient conditions and individual-level factors, participants on average walked 637 (95%CI (83, 1192)) more steps and had a 0.59 &deg, C (95%CI (0.30, 0.88)) lower daily mean individually experienced heat index during intervention days compared to baseline days. The intervention benefit of increased physical activity was greater in rural residents who were less active at baseline, compared to urban residents. Our results suggest adding a small amount of additional time outdoors may improve physical activity without increasing participants&rsquo, heat exposure, even during summer in a humid subtropical climate.

At first glance, the nine articles in this issue of Journal of Health and Pollution seem to address disparate environmental health issues specific to different communities across several continents. Upon closer examination, links between the topics explored in these articles are evident when one considers principles of life cycle analysis (LCA), a method for quantifying the total environmental impact of a product from ‘cradle to grave’.1, 2 LCA methods are used to compare products and production processes, with the intent to minimize resource use and increase economic efficiency,3 and the field has matured to incorporate human health effects.4 Typically an LCA starts with an inventory of inputs and outputs for the lifecycle of a product, including all of the materials and energy used in the product manufacture, distribution, use and disposal. This is followed by an impact analysis of all inputs and outputs defined in the inventory. Life Cycle Analysis and Global Environmental Health Issues

Coastal communities are increasingly exposed to more intense and frequent hurricanes, accelerated sea-level rise, and prolonged tidal inundation, yet they are often a preferred retirement destination for older adults vulnerable to flooding and extreme weather events. The unique physical and psychosocial challenges of older population age 65 and over may affect their level of preparedness, capacity to cope with, and ability to respond and recover from a hazard event. Despite the clear vulnerabilities of older residents living in high-risk areas when compared to younger coastal populations, there is a lack of empirical research on the integrated flood risks to this population group in the coastal context. This paper provides a holistic assessment of this emerging problem along the U.S. East Coast by measuring the exposure of older population to sea level rise and storm surge in coastal counties. It further evaluates how age-related vulnerabilities differ between rural and urban settings using the case study approach and geospatial and statistical analysis the paper also conducts a review of scientific literature to identify gaps in the current understanding of health and well-being risks to aging populations in coastal communities. The results show that older populations are unevenly distributed along the U.S. East Coast with some states and counties having significantly higher percent of residents age 65 and older living along the shoreline. Many places with larger older populations have other attributes that further shape the vulnerability of this age group such as older housing stock, disabilities, and lower income and that often differ between rural and urban settings. Lastly, our study found that vast majority of research on aging in high-risk coastal locations has been conducted in relation to major disasters and almost none on the recurrent nuisance flooding that is already affecting many coastal communities.

Background A better understanding of how heat waves affect fatal traffic crashes will be useful to promote awareness of drivers’ vulnerability during an extreme heat event. Objective and Methods We applied a time-stratified case-crossover design to examine associations between heat waves and fatal traffic crashes during May-September of 2001–2011 in the continental United States (US). Heat waves, defined as the daily mean temperature >95% threshold for ≥2 consecutive days, were derived using gridded 12.5 km2 air temperatures from Phase 2 of the North American Land Data Assimilation System (NLDAS-2). Dates and locations of fatal traffic crash records were acquired from the National Highway Traffic Safety Administration (NHTSA). Results Results show a significant positive association between fatal traffic crashes and heat waves with a 3.4% (95% CI: 0.9, 5.9%) increase in fatal traffic crashes on heat wave days versus non-heat wave days. The association was more positive for 56–65 years old drivers [8.2% (0.3, 16.7%)] and driving on rural roadways [6.1% (2.8, 9.6%)]. Moreover, a positive association was only present when the heat wave days were characterized by no precipitation [10.9% (7.3%, 14.6%)] and medium or high solar radiation [24.6% (19.9%, 29.5%) and 19.9% (15.6%, 24.4%), respectively]. Conclusions These findings are relevant for developing targeted interventions for these driver groups and driving situations to efficiently reduce the negative effects of heat waves on fatal traffic crashes.

OBJECTIVE: We hypothesized that exposure to mild temperatures above the human thermoneutral zone would decrease caloric intake in a sedentary office environment. METHODS: Women (n = 25) were randomized in a crossover design to perform seated office work for 7 hours in a thermoneutral condition (control; 19–20°C) and a condition above the thermoneutral zone (warm; 26–27°C). Food intake was estimated by weight and bomb calorimetry, peripheral temperature by thermal imaging, and thermal comfort and productivity by questionnaires. Mixed effects models were used to examine the effects of thermal condition on caloric intake. RESULTS: Participants ate on average 357 kcal less in the warm condition, adjusting for body mass index and peripheral temperature (p=0.0219). According to the survey results at midday (after 3.5 hours of exposure), 96% of the participants in the warm condition reported being comfortable (n=24) compared with 32% in the control condition (n=8). More participants reported being as productive or more productive than usual in the warm condition (n=22, 88%) than in the control condition (n=12, 48%). CONCLUSIONS: This line of research is worthy of further exploration. Untightening climate control towards warmer conditions during summer to increase comfort and productivity while decreasing caloric intake may prove both effective and comfortable.

Health disparities that cannot be fully explained by socio-behavioral factors persist in the Central Appalachian region of the United States. A review of available studies of environmental impacts on Appalachian health and analysis of recent public data indicates that while disparities exist, most studies of local environmental quality focus on the preservation of nonhuman biodiversity rather than on effects on human health. The limited public health studies available focus primarily on the impacts of coal mining and do not measure personal exposure, constraining the ability to identify causal relationships between environmental conditions and public health. Future efforts must engage community members in examining all potential sources of environmental health disparities to identify effective potential interventions. Research funding: Funding for this research was provided by the Virginia Tech Institute for Society, Culture, and Environment; the Virginia Tech Global Change Center; and the Institute for Critical Technology and Applied Science at Virginia Tech. Conflict of interest: Authors state no conflict of interest. Informed consent: Informed consent is not applicable. Ethical approval: The conducted research is not related to either human or animals use.

Background: Environmental heat exposure is a public health concern. The impacts of environmental heat on mortality and morbidity at the population scale are well documented, but little is known abo...

Nairobi, Kenya exhibits a wide variety of micro-climates and heterogeneous surfaces. Paved roads and high-rise buildings interspersed with low vegetation typify the central business district, while large neighborhoods of informal settlements or "slums" are characterized by dense, tin housing, little vegetation, and limited access to public utilities and services. To investigate how heat varies within Nairobi, we deployed a high density observation network in 2015/2016 to examine summertime temperature and humidity. We show how temperature, humidity and heat index differ in several informal settlements, including in Kibera, the largest slum neighborhood in Africa, and find that temperature and a thermal comfort index known colloquially as the heat index regularly exceed measurements at the Dagoretti observation station by several degrees Celsius. These temperatures are within the range of temperatures previously associated with mortality increases of several percent in youth and elderly populations in informal settlements. We relate these changes to surface properties such as satellite-derived albedo, vegetation indices, and elevation.

Background. Fish advisories have been established by some nations to protect the public from the potentially harmful health effects linked to eating contaminated fish. Advisories are based on estimations of the health risks associated with concentrations of contaminating chemicals found in fish, and the average levels of consumption of fish in the population. Fish is an important source of nutrition in Ghana; however, little is known about the possible health effects associated with metal concentrations found in fish. Objective. The overall aim of the present study was to estimate metal concentrations in fishery resources so as to inform guidelines on fish consumption. Methods. We collated previously published data on levels of metals in fish in Ghana. We also estimated the potential for adverse health effects by calculating a hazard quotient (HQ) based on the reported levels of mercury in fish and either the United States Environmental Protection Agency (USEPA) Reference Dose (RfD) or the FAO/WHO Expert Committee on Food Additives Provisional Tolerable Weekly Intake (PTWI). Both are estimates of methylmercury exposure that is considered safe (0.0001 mg/kg body weight (bw) per day and 0.0016 mg/kg bw/week, respectively). We also compared HQ estimates across different fish species and water bodies in Ghana. Results. Mercury was the only metal for which there was sufficient data to estimate the possible adverse health effects from eating fish caught in Ghana. The mean concentration of mercury was 0.10 mg/kg (± 0.15) wet weight (N= 63 fish samples). This concentration was associated with a HQ of less than 1 when using the Joint FAO/WHO PTWI, but above 1 when using the USEPA RfD. Higher concentrations of mercury (Hg) were detected in fish collected from rivers in gold mining areas of Ghana (0.25 mg/kg ww ±0.23) versus fish collected from lakes/reservoirs (0.04 mg/kg w.w ±0.04) and marine areas (0.06 mg/kg w.w ±0.04). Conclusions. These results suggest regular monitoring of fish collected from water bodies in gold mining regions is warranted. Results also suggest that regulatory bodies may want to consider the development of guidelines for fish consumption advisories when warranted, and remediation of primary sources of mercury contamination to optimize the health benefits of fish consumption. Competing Interests. The authors declare no competing financial interests.

Background: A deeper understanding of how heat wave definition affects the relationship between heat exposure and health, especially as a function of rurality, will be useful in developing effective heat wave warning systems. Objective: We compared the relationships between different heat wave index (HI) definitions and preterm birth (PTB) and nonaccidental death (NAD) across urban and rural areas. Methods: We used a time-stratified case-crossover design to estimate associations of PTB and NAD with heat wave days (defined using 15 HIs) relative to non–heat wave control days in Alabama, USA (1990–2010). ZIP code–level HIs were derived using data from the North American Land Data Assimilation System. Associations with heat wave days defined using different HIs were compared by bootstrapping. We also examined interactions with rurality. Results: Associations varied depending on the HI used to define heat wave days. Heat waves defined as having at least 2 consecutive days with mean daily temperatures above the 98th percentile were associated with 32.4% (95% CI: 3.7, 69.1%) higher PTB, and heat waves defined as at least 2 consecutive days with mean daily temperatures above the 90th percentile were associated with 3.7% (95% CI: 1.1, 6.3%) higher NAD. Results suggest that significant positive associations were more common when relative—compared with absolute—HIs were used to define exposure. Both positive and negative associations were found in each rurality stratum. However, all stratum-specific significant associations were positive, and NAD associations with heat waves were consistently positive in urban strata but not in middle or rural strata. Conclusions: Based on our findings, we conclude that a relative mean-temperature-only heat wave definition may be the most effective metric for heat wave warning systems in Alabama. Citation: Kent ST, McClure LA, Zaitchik BF, Smith TT, Gohlke JM. 2014. Heat waves and health outcomes in Alabama (USA): the importance of heat wave definition. Environ Health Perspect 122:151–158; http://dx.doi.org/10.1289/ehp.1307262

High temperatures and heat waves are related but not synonymous concepts. Heat waves, generally understood to be acute periods of extreme warmth, are relevant to a wide range of stakeholders because of the impacts that these events have on human health and activities and on natural environments. Perhaps because of the diversity of communities engaged in heat wave monitoring and research, there is no single, standard definition of a heat wave. Experts differ in which threshold values (absolute versus relative), duration and ancillary variables to incorporate into heat wave definitions. While there is value in this diversity of perspectives, the lack of a unified index can cause confusion when discussing patterns, trends, and impacts. Here, we use data from the North American Land Data Assimilation System to examine patterns and trends in 15 previously published heat wave indices for the period 1979–2011 across the Continental United States. Over this period the Southeast region saw the highest number of heat wave days for the majority of indices considered. Positive trends (increases in number of heat wave days per year) were greatest in the Southeast and Great Plains regions, where more than 12 % of the land area experienced significant increases in the number of heat wave days per year for the majority of heat wave indices. Significant negative trends were relatively rare, but were found in portions of the Southwest, Northwest, and Great Plains.

Background: The Deepwater Horizon (DH) blowout resulted in fisheries closings across the Gulf of Mexico. Federal agencies, in collaboration with impacted Gulf states, developed a protocol to determine when it is safe to reopen fisheries based on sensory and chemical analyses of seafood. All federal waters have been reopened, yet concerns have been raised regarding the robustness of the protocol to identify all potential harmful exposures and protect the most sensitive populations. Objectives: We aimed to assess this protocol based on comparisons with previous oil spills, published testing results, and current knowledge regarding chemicals released during the DH oil spill. Methods: We performed a comprehensive review of relevant scientific journal articles and government documents concerning seafood contamination and oil spills and consulted with academic and government experts. Results: Protocols to evaluate seafood safety before reopening fisheries have relied on risk assessment of health impacts from polycyclic aromatic hydrocarbon (PAH) exposures, but metal contamination may also be a concern. Assumptions used to determine levels of concern (LOCs) after oil spills have not been consistent across risk assessments performed after oil spills. Chemical testing results after the DH oil spill suggest PAH levels are at or below levels reported after previous oil spills, and well below LOCs, even when more conservative parameters are used to estimate risk. Conclusions: We recommend use of a range of plausible risk parameters to set bounds around LOCs, comparisons of post-spill measurements with baseline levels, and the development and implementation of long-term monitoring strategies for metals as well as PAHs and dispersant components. In addition, the methods, results, and uncertainties associated with estimating seafood safety after oil spills should be communicated in a transparent and timely manner, and stakeholders should be actively involved in developing a long-term monitoring strategy.

Background: The growing health risks associated with greenhouse gas emissions highlight the need for new energy policies that emphasize efficiency and low-carbon energy intensity. Objectives: We assessed the relationships among electricity use, coal consumption, and health outcomes. Methods: Using time-series data sets from 41 countries with varying development trajectories between 1965 and 2005, we developed an autoregressive model of life expectancy (LE) and infant mortality (IM) based on electricity consumption, coal consumption, and previous year’s LE or IM. Prediction of health impacts from the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) integrated air pollution emissions health impact model for coal-fired power plants was compared with the time-series model results. Results: The time-series model predicted that increased electricity consumption was associated with reduced IM for countries that started with relatively high IM (> 100/1,000 live births) and low LE (< 57 years) in 1965, whereas LE was not significantly associated with electricity consumption regardless of IM and LE in 1965. Increasing coal consumption was associated with increased IM and reduced LE after accounting for electricity consumption. These results are consistent with results based on the GAINS model and previously published estimates of disease burdens attributable to energy-related environmental factors, including indoor and outdoor air pollution and water and sanitation. Conclusions: Increased electricity consumption in countries with IM < 100/1,000 live births does not lead to greater health benefits, whereas coal consumption has significant detrimental health impacts.

Experimental studies on energetics and aging often remove two major factors that in part regulate the energy budget in a normal healthy individual: reproduction and fluctuating environmental conditions that challenge homeostasis. Here we use the cyclical parthenogenetic Daphnia pulex to evaluate the role of a fluctuating thermal environment on both reproduction and lifespan across six food concentrations. We test the hypotheses that (1) caloric restriction extends lifespan; (2) maximal reproduction will come with a cost of shortened lifespan; and (3) at a given food concentration, relative to a metabolically equivalent constant temperature environment a diel fluctuating thermal environment will alter the allocation of energy to reproduction and lifespan to maintain homeostasis. We did not identify a level of food concentration that extended lifespan in response to caloric restriction, and we found no cost of reproduction in terms of lifespan. Rather, the individuals at the highest food levels generally had the highest reproductive output and the longest lifespans, the individuals at the intermediate food level decreased reproduction and maintained lifespan, and the individuals at the three lower food concentrations had a decrease in reproduction and lifespan as would be predicted with increasing levels of starvation. Fluctuating temperature had no effect on lifespan at any food concentration, but delayed time to reproductive maturity and decreased early reproductive output at all food concentrations. This suggests that a fluctuating temperature regimen activates molecular pathways that alter energy allocation. The costs of fluctuating temperature on reproduction were not consistent across the lifespan. Statistical interactions for age of peak reproduction and lifetime fecundity suggest that senescence of the reproductive system may vary between temperature regimens at the different food concentrations.

A growing body of evidence has found that mortality rates are positively correlated with social inequalities, air pollution, elevated ambient temperature, availability of medical care and other factors. This study develops a model to predict the mortality rates for different diseases by county across the US. The model is applied to predict changes in mortality caused by changing environmental factors. A total of 3,110 counties in the US, excluding Alaska and Hawaii, were studied. A subset of 519 counties from the 3,110 counties was chosen by using systematic random sampling and these samples were used to validate the model. Step-wise and linear regression analyses were used to estimate the ability of environmental pollutants, socio-economic factors and other factors to explain variations in county-specific mortality rates for cardiovascular diseases, cancers, chronic obstructive pulmonary disease (COPD), all causes combined and lifespan across five population density groups. The estimated models fit adequately for all mortality outcomes for all population density groups and, adequately predicted risks for the 519 validation counties. This study suggests that, at local county levels, average ozone (0.07 ppm) is the most important environmental predictor of mortality. The analysis also illustrates the complex inter-relationships of multiple factors that influence mortality and lifespan, and suggests the need for a better understanding of the pathways through which these factors, mortality, and lifespan are related at the community level.

Investigations into the potential mechanisms for ethanol-induced developmental toxicity have been ongoing for over 30 years since Fetal Alcohol Syndrome (FAS) was first described. Neurodevelopmental endpoints are particularly sensitive to in utero exposure to alcohol as suggested by the more prevalent alcohol-related neurodevelopmental disorder (ARND). The inhibition of proliferation during neurogenesis and the induction of apoptosis during the period of synaptogenesis have been identified as potentially important mechanisms for ARND. However, it is unclear how these two mechanisms quantitatively relate to the dose and timing of exposure. We have extended our model of neocortical neurogenesis to evaluate apoptosis during synaptogenesis. This model construct allows quantitative evaluation of the relative impacts on neuronal proliferation versus apoptosis during neocortical development. Ethanol-induced lengthening of the cell cycle of neural progenitor cells during rat neocortical neurogenesis (G13-G19) is used to compute the number of neurons lost after exposure during neurogenesis. Ethanol-induced dose-dependent increases in cell death rates are applied to our apoptosis model during rat synaptogenesis (P0-P14), when programmed cell death plays a major role in shaping the future neocortex. At a human blood ethanol concentration that occurs after 3-5 drinks ( approximately 150 mg/dl), our model predicts a 20-30% neuronal deficit due to inhibition of proliferation during neurogenesis, while a similar exposure during synaptogenesis suggests a 7-9% neuronal loss through induction of cell death. Experimental in vitro and in vivo dose-response research and stereological research on long-term neuronal loss after developmental exposure to ethanol is compared to our model predictions. Our computational model allows for quantitative, systems-level comparisons of mechanistic hypotheses for perturbations during specific neurodevelopmental periods.

Background Previous research has shown exposure to air pollution increases the risk of adverse birth outcomes, although the effects of residential proximity to significant industrial point sources are less defined. The objective of the current study was to determine whether yearly reported releases from major industrial point sources are associated with adverse birth outcomes. Methods Maternal residence from geocoded Alabama birth records between 1991 and 2010 were used to calculate distances from coke and steel production industries reporting emissions to the U.S. Environmental Protection Agency. Logistic regression models were built to determine associations between distance or yearly fugitive emissions (volatile organic compounds, polycyclic aromatic compounds, and metals) from reporting facilities and preterm birth or low birth weight, adjusting for covariates including maternal age, race, payment method, education level, year and parity. Results A small but significant association between preterm birth and residential proximity (≤5.0 km) to coke and steel production facilities remained after adjustment for covariates (OR 1.05 95% CI: 1.01,1.09). Above average emissions from these facilities of volatile organic compounds during the year of birth were associated with low birth weight (OR 1.17 95% CI: 1.06, 1.29), whereas metals emissions were associated with preterm birth (OR 1.07 95% CI: 1.01, 1.14). Conclusions The present investigation suggests fugitive emissions from industrial point sources may increase the risk of adverse birth outcomes in surrounding neighborhoods. Further research teasing apart the relationship between exposure to emissions and area-level deprivation in neighborhoods surrounding industrial facilities and their combined effects on birth outcomes is needed. Electronic supplementary material The online version of this article (doi:10.1186/1476-069X-13-85) contains supplementary material, which is available to authorized users.

Background: As part of a coordinated effort to expand our research activity at the interface of Aging and Energetics a team of investigators at The University of Alabama at Birmingham systematically assayed and catalogued the top research priorities identified in leading publications in that domain, believing the result would be useful to the scientific community at large.Objective: To identify research priorities and opportunities in the domain of aging and energetics as advocated in the 40 most cited papers related to aging and energetics in the last 4 years.Design: The investigators conducted a search for papers on aging and energetics in Scopus, ranked the resulting papers by number of times they were cited, and selected the ten most-cited papers in each of the four years that include 2010 to 2013, inclusive.Results: Ten research categories were identified from the 40 papers. These included: (1) Calorie restriction (CR) longevity response, (2) role of mTOR (mechanistic target of Rapamycin) and related factors in lifespan extension, (3) nutrient effects beyond energy (especially resveratrol, omega-3 fatty acids, and selected amino acids), 4) autophagy and increased longevity and health, (5) aging-associated predictors of chronic disease, (6) use and effects of mesenchymal stem cells (MSCs), (7) telomeres relative to aging and energetics, (8) accretion and effects of body fat, (9) the aging heart, and (10) mitochondria, reactive oxygen species, and cellular energetics.Conclusion: The field is rich with exciting opportunities to build upon our existing knowledge about the relations among aspects of aging and aspects of energetics and to better understand the mechanisms which connect them.

Background: As part of a coordinated effort to expand our research activity at the interface of Aging and Energetics a team of investigators at The University of Alabama at Birmingham systematically assayed and catalogued the top research priorities identified in leading publications in that domain, believing the result would be useful to the scientific community at large. Objective: To identify research priorities and opportunities in the domain of aging and energetics as advocated in the 40 most cited papers related to aging and energetics in the last 4 years. Design: The investigators conducted a search for papers on aging and energetics in Scopus, ranked the resulting papers by number of times they were cited, and selected the ten most-cited papers in each of the four years that include 2010 to 2013, inclusive. Results: Ten research categories were identified from the 40 papers. These included: (1) Calorie restriction (CR) longevity response, (2) role of mTOR (mechanistic target of Rapamycin) and related factors in lifespan extension, (3) nutrient effects beyond energy (especially resveratrol, omega-3 fatty acids, and selected amino acids), 4) autophagy and increased longevity and health, (5) aging-associated predictors of chronic disease, (6) use and effects of mesenchymal stem cells (MSCs), (7) telomeres relative to aging and energetics, (8) accretion and effects of body fat, (9) the aging heart, and (10) mitochondria, reactive oxygen species, and cellular energetics. Conclusion: The field is rich with exciting opportunities to build upon our existing knowledge about the relations among aspects of aging and aspects of energetics and to better understand the mechanisms which connect them.

Previous studies have linked heat waves to adverse health outcomes using ambient temperature as a proxy for estimating exposure. The goal of the present study was to test a method for determining personal heat exposure. An occupationally exposed group (urban groundskeepers in Birmingham, AL, USA N=21), as well as urban and rural community members from Birmingham, AL (N=30) or west central AL (N=30) wore data logging temperature and light monitors clipped to the shoe for 7 days during the summer of 2012. We found that a temperature monitor clipped to the shoe provided a comfortable and feasible method for recording personal heat exposure. Ambient temperature (°C) recorded at the nearest weather station was significantly associated with personal heat exposure [β 0.37, 95%CI (0.35, 0.39)], particularly in groundskeepers who spent more of their total time outdoors [β 0.42, 95%CI (0.39, 0.46)]. Factors significantly associated with lower personal heat exposure include reported time indoors [β −2.02, 95%CI (−2.15, −1.89)], reported income > 20K [β −1.05, 95%CI (−1.79, −0.30)], and measured % body fat [β −0.07, 95%CI (−0.12, −0.02)]. There were significant associations between income and % body fat with lower indoor and nighttime exposures, but not with outdoor heat exposure, suggesting modifications of the home thermal environment play an important role in determining overall heat exposure. Further delineation of the effect of personal characteristics on heat exposure may help to develop targeted strategies for preventing heat-related illness.

As a well-known eco-toxicological model organism, Daphnia pulex may also offer advantages in human health research for assessing long-term effects of early life exposures to coupled stressors. Here, we examine consequences of early life exposure to methylmercury (MeHg) under standard and reduced food ration. We exposed Daphnia for 24 h in early life to varying concentrations of methylmercury(II) chloride (0, 200, 400, 800 and 1600 ng/L) and thereafter kept Daphnia on either a standard or a reduced food ration. The data suggests an additive effect of MeHg concentration and food ration on decreasing lifespan, although MeHg concentration does not affect survival linearly. Food ration and MeHg concentration were predictive of reduced reproduction, and there is some evidence of an interaction (p = 0.048). Multi-stressor work in alternative model systems may be useful for prioritizing research, taking into account potential antagonistic, additive or synergistic effects that nutritional status may have on chemical toxicity.

We explore the relationship between current research directions in human health and environmental and public health policy. Specifically, we suggest there is a link between the continuing emphasis in biomedical research on individualized, therapeutic solutions to human disease and the increased reliance on individual choice in response to environmental and/or public health threats. We suggest that continued research emphasis on these traditional approaches to the exclusion of other approaches will impede the discovery of important breakthroughs in human health research necessary to understand the emerging diseases of today. We recommend redirecting research programs to interdisciplinary and population-focused research that would support a systems approach to fully identifying the environmental factors that contribute to disease burden. Such an approach would be able to address the interactions between the social, ecological, and physical aspects of our environment and explicitly include these in the evaluation and management of health risks from environmental exposures.

Important stages during neurodevelopment include the generation of new nerve cells (i.e., neurogenesis), differentiation and migration of these cells to their final location in the brain, formation of connections with neighboring cells (i.e., synaptogenesis), and cell death of neurons that fail to form the appropriate connections. Research found that alcohol exposure during fetal development can interfere with all of these processes. A systems biology approach using computational models of brain development in different species has been used to determine the relative contributions of alcohol-induced impairment of neurogenesis and synaptogenesis to alcohol-related neurodevelopmental deficits in mice, rats, rhesus monkeys, and humans. The results obtained with these models suggest that alcohol’s impact on cell division during neurogenesis results in greater deficits in neuron numbers in the adult than the alcohol-induced increase in cell death during synaptogenesis. In primates, the accelerated development of susceptible brain regions may convey increased sensitivity to alcohol-induced neurodevelopmental deficits. Systems-based approaches, such as the computational models described here, can help to translate research findings obtained at a molecular or cellular level in different species into assessment of risk associated with alcohol exposure during human development.