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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.

The commonly used consumer product of an ultrasonic humidifier (e.g., cool mist humidifier) emits fine particles containing metals from tap water used to fill the humidifier. The objectives are: 1) predict emitted indoor air inhalable metal concentrations produced by an ultrasonic humidifier filled with tap-water containing As, Cd, Cr, Cu, Mn, and Pb in 33 m

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.

International audience; In February–March, 2021, a Working Group of 11 scientists from eight countries met remotely at the invitation of the International Agency for Research on Cancer (IARC) to finalise their evaluation of the carcinogenicity of five agents used as dyes and reagents, and for their antibacterial and antifungal properties.

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

Satellite observations following flooding coupled with electronic health data collected through syndromic surveillance systems (SyS) may be useful in efficiently characterizing and responding to health risks associated with flooding.There was a 10% (95% Confidence Interval (CI): 1%-19%) increase in asthma related ED visits and 22% (95% CI: 5%-41%) increase in insect bite related ED visits in the flooded ZCTAs compared to non-flooded ZCTAs during the flood period. One month following the floods, diarrhea related ED visits were increased by 15% (95% CI: 4%-27%) for flooded ZCTAs and children and adolescents from flooded ZCTAs had elevated risk for dehydration related ED visits. During the protracted period (2-3 months after the flood period), the risk for asthma, insect bite, and diarrhea related ED visits were elevated among the flooded ZCTAs. Effect modification by reported age, ethnicity and race was observed.Combining satellite observations with SyS data can be helpful in characterizing the location and timing of environmentally mediated adverse health outcomes, which may be useful for refining disaster resilience measures to mitigate health outcomes following flooding.

Room-sized ultrasonic humidifiers are exposure pathways to aerosolized metals, with dose positively associated with increased concentrations of metals in fill water. This study innovatively quantifies water ingestion along with inhalation doses from humidifiers for 10–1000 μg/L dissolved lead (Pb) in tap water. The subsequent indoor air Pb concentrations, average daily doses, and inhalation deposited respiratory fractions were predicted under four room scenarios for 3-mo, 12-mo, 28-mo, and 6-yr children and adults. Elevated blood Pb levels (BLLs) in children were modeled using USEPA's Integrated Exposure Uptake Biokinetic (IEUBK) model. Indoor air Pb exceeds the USEPA ambient air standard of 0.15 μg/m3 when humidifier fill water contains 33 μg/L Pb in the small room of 33.5 m3 and 0.2 h−1 air exchange rate (AER). For this room, ~40–46% inhaled Pb-containing humidifier particles deposit in children's respiratory tracts; inhaling humidifier particles from ≥500 μg/L Pb water results in >1 μg/dL BLL in 2–7 yr children. For adults, ~23% of particles deposit in the respiratory tract; 8-h inhalation exposure with ≥17 μg/L Pb water exceeds the California EPA reproductive toxicity guideline of 0.5 μg/day. Larger rooms and higher AER decrease Pb inhalation exposure under the same water Pb concentration.

OBJECTIVE The aim of this study was to characterize environmental exposure from Deepwater Horizon oil spill among pre-K to fourth-grade children from six schools in Mobile County, Alabama. METHODS A mail-in survey administered 11 months post-oil spill to children's parents/caregivers elicited information on exposure-related activities. Descriptive and multivariable analyses were performed. RESULTS Overall, 180 children (coastal schools, 90; inland schools, 90) completed the survey. During the post-oil spill period, children in coastal schools were less likely to reduce their exposure-related activities, including fishing; eating and selling caught fish; visiting beaches; and parental participation in cleanup activities, than children in inland schools. Particularly, fishing and eating caught fish were significantly associated with the coastal group (odds ratio = 2.28; 95% confidence interval = 1.54 to 3.36). CONCLUSION Proximity to the shoreline may serve as an indicator for potential exposure in oil spills among vulnerable populations including children.

The goal of the study was to characterize risk pertaining to seafood consumption patterns following the Deepwater Horizon oil spill, among school children (K to 4th grade) residing in close proximity to the Gulf of Mexico in Mobile County, Alabama.Responses on seafood consumption pattern including the type of seafood and intake rate during the pre and post oil spill periods, from parents of 55 school children from three schools located20mile radius from the Gulf of Mexico shoreline (coastal group) were compared with those from parents of 55 children from three schools located ≥20miles away from the shoreline (inland group). We also estimated levels of concern (LOCs) in seafood for selected chemicals found in crude oil including heavy metals, and polycyclic aromatic hydrocarbons (PAH), and dioctyl sodium sulfosuccinate (DOSS), the primary compound in dispersants.The coastal group ate more seafood consisting primarily of crustaceans (62% vs. 42%, p=0.04) and fin fish (78% vs. 58%, p=0.02) from the Gulf of Mexico compared to the inland group, while the inland group ate more fin fish not found in the Gulf of Mexico (62% vs. 33%, p0.01). In the post-oil spill time period, both groups substantially reduced their consumption of sea food. On average, the coastal group ate ≥2 seafood meals per week, while the inland group ate ≤1 meal per week; these frequency patterns persisted in the post oil-spill period. Comparison of the estimated LOCs with contaminant levels detected in the seafood tested by the Food and Drug Administration and National Oceanic and Atmospheric Administration, post-oil spill, found that the levels of PAHs, arsenic, and DOSS in seafood were 1-2 orders of magnitude below the LOCs calculated in our study. Levels of methyl mercury (MeHg) in the seafood tested pre- and post- oil spill were higher than the estimated LOCs suggesting presence of higher levels of MeHg in seafood independent of the oil spill.In sum, the study found higher than average seafood consumption among children along the Mobile coastal area when compared to the inland children and the National Health and Nutrition Examination Survey (NHANES) estimates. Risk characterization based on the LOCs indicated no increase in risk of exposure despite higher seafood consumption rates among the study population compared to the general population.

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.

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.

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: 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

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.

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.

We have developed a computational model that allows for the evaluation of normal and perturbed neurodevelopmental processes. This mathematical construct is used to test the hypothesis that reduced neuronal production is the critical mechanism behind fetal alcohol syndrome. Model predictions of normal neurodevelopment match independent stereological measures but challenge estimates generated using a previously published model of normal neocortical neuronogenesis. Evaluation of data showing an increased cell cycle length after prenatal exposure to ethanol during neocortical neuronogenesis yields predictions of cellular deficits that can account for the permanent neocortical neuronal loss seen in rodents exposed to ethanol concentrations of public health relevance.

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.

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.

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.

Objectives Understanding and effectively addressing persistent health disparities in minority communities requires a clear picture of members' concerns and priorities. This study was intended to engage residents in urban and rural communities in order to identify environmental health priorities. Specific emphasis was placed on how the communities: defined the term environment; their perceptions of environmental exposures as affecting their health; specific priorities in their communities; and differences in urban versus rural populations. Study design A community-engaged approach was used to develop and implement focus groups and compare environmental health priorities in urban versus rural communities. Methods A total of eight focus groups were conducted: four in rural and four in urban communities. Topics included: defining the term environment; how the environment may affect health; and environmental priorities within their communities, using both open discussion and a predefined list. Data were analysed both qualitatively and quantitatively to identify patterns and trends. Results There were important areas of overlap in priorities between urban and rural communities; both emphasized the importance of the social environment and shared a concern over air pollution from industrial sources. In contrast, for urban focus groups, abandoned houses and their social and physical sequelae were a high priority while concerns about adequate sewer and water services and road maintenance were high priorities in rural communities. Conclusions This study was able to identify environmental health priorities in urban versus rural minority communities. In contrast to some previous risk perception research, the results of this study suggest prioritization of tangible, known risks in everyday life instead of rare, disaster-related events, even in communities that have recently experienced devastating damage from tornadoes. The findings can help inform future efforts to study, understand and effectively address environmental issues, and are particularly relevant to developing effective community-based strategies in vulnerable populations.

Background Pathogenesis of complex diseases involves the integration of genetic and environmental factors over time, making it particularly difficult to tease apart relationships between phenotype, genotype, and environmental factors using traditional experimental approaches. Results Using gene-centered databases, we have developed a network of complex diseases and environmental factors through the identification of key molecular pathways associated with both genetic and environmental contributions. Comparison with known chemical disease relationships and analysis of transcriptional regulation from gene expression datasets for several environmental factors and phenotypes clustered in a metabolic syndrome and neuropsychiatric subnetwork supports our network hypotheses. This analysis identifies natural and synthetic retinoids, antipsychotic medications, Omega 3 fatty acids, and pyrethroid pesticides as potential environmental modulators of metabolic syndrome phenotypes through PPAR and adipocytokine signaling and organophosphate pesticides as potential environmental modulators of neuropsychiatric phenotypes. Conclusion Identification of key regulatory pathways that integrate genetic and environmental modulators define disease associated targets that will allow for efficient screening of large numbers of environmental factors, screening that could set priorities for further research and guide public health decisions.

Computational, systems-based approaches can provide a quantitative construct for evaluating risk in the context of mechanistic data. Previously, we developed computational models for the rat, mouse, rhesus monkey, and human, describing the acquisition of adult neuron number in the neocortex during the key neurodevelopmental processes of neurogenesis and synaptogenesis. Here we apply mechanistic data from the rat describing ethanol-induced toxicity in the developing neocortex to evaluate the utility of these models for analyzing neurodevelopmental toxicity across species. Our model can explain long-term neocortical neuronal loss in the rodent model after in utero exposure to ethanol based on inhibition of proliferation during neurogenesis. Our human model predicts a significant neuronal deficit after daily peak BECs reaching 10-20 mg/dl, which is the approximate BEC reached after drinking one standard drink within one hour. In contrast, peak daily BECs of 100 mg/dl are necessary to predict similar deficits in the rat. Our model prediction of increased sensitivity of primate species to ethanol-induced inhibition of proliferation is based on application of in vivo experimental data from primates showing a prolonged rapid growth period in the primate versus rodent neuronal progenitor population. To place our predictions into a broader context, we evaluate the evidence for functional low-dose effects across rats, monkeys, and humans. Results from this critical evaluation suggest subtle effects are evident at doses causing peak BECs of approximately 20 mg/dl daily, corroborating our model predictions. Our example highlights the utility of a systems-based modeling approach in risk assessment.

This paper presents a computational model allowing quantitative simulations of acquisition of neocortical neuronal number across mammalian species. When extrapolating scientific findings from rodents to humans, it is particularly pertinent to acknowledge the importance of the accelerated enlargement of the neocortex during human evolution. Neocortex development is marked by discrete stages of neural progenitor cell proliferation and death, neuronal differentiation, and neuronal programmed cell death. We have developed computational models of human and rhesus monkey neocortical neuronal cell acquisition based on experimentally derived parameters of cell cycle length, commitment to cell cycle exit, and cell death. Our model results agree with independent stereological studies estimating neocortical neuron number in adult and developing rhesus monkey and human. Comparisons of our primate models with previously developed rodent models suggest correlations between the lengthening of the duration of the neuronogenesis period and a lengthening of the cellular processes of cell cycle progression and death can account for the vast increase in size of the primate neocortex. Furthermore, when compared with rodents, we predict that cell death may play a larger role in shaping the primate neocortex. Our mathematical models of the development and evolution of the neocortex provide a quantitative, biologically based construct for extrapolation between rodent and humans. These models can assist in focusing future experimental research on the differing mechanisms of rodent versus human neocortical development.

Benefit-cost analyses of environmental regulations are increasingly mandated in the United States. Evaluations of criteria air pollutants have focused on benefits and costs associated with adverse health effects. Children are significantly affected by the health benefits of improved air quality, yet key environmental health policy analyses have not previously focused specifically on children's effects. In this article we present a "meta-analysis" approach to child-specific health impacts derived from the U.S. Clean Air Act (CAA). On the basis of data from existing studies, reductions in criteria air pollutants predicted to occur by 2010 because of CAA regulations are estimated to produce the following impacts: 200 fewer expected cases of postneonatal mortality; 10,000 fewer asthma hospitalizations in children 1-16 years old, with estimated benefits ranging from 20 million U.S. dollars to 46 million U.S. dollars (1990 U.S. dollars); 40,000 fewer emergency department visits in children 1-16 years old, with estimated benefits ranging from 1.3 million U.S. dollars to 5.8 million U.S. dollars; 20 million school absences avoided by children 6-11 years old, with estimated benefits of 0.7-1.8 billion U.S. dollars; and 10,000 fewer infants of low birth weight, with estimated benefits of 230 million U.S. dollars. Inclusion of limited child-specific data on hospitalizations, emergency department visits, school absences, and low birth weight could be expected to add 1-2 billion U.S. dollars (1990 U.S. dollars) to the 8 billion U.S. dollars in health benefits currently estimated to result from decreased morbidity, and 600 million U.S. dollars to the 100 billion U.S. dollars estimated to result from decreased mortality. These estimates highlight the need for increased consideration of children's health effects. Key needs for environmental health policy analyses include improved information for children's health effects, additional life-stage-specific information, and improved health economics information specific for children.

Background Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status. Methods Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Results Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Conclusions Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

A method is proposed that finds enriched pathways relevant to a studied condition, using molecular and network data., A method is proposed that finds enriched pathways relevant to a studied condition using the measured molecular data and also the structural information of the pathway viewed as a network of nodes and edges. Tests are performed using simulated data and genomic data sets and the method is compared to two existing approaches. The analysis provided demonstrates the method proposed is very competitive with the current approaches and also provides biologically relevant results.