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Eliminating Health Disparities to Achieve Health Equity

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 January 2015) | Viewed by 166241

Special Issue Editors

Prof. Dr. Stephen B. Thomas

E-Mail Website
Guest Editor
Department of Health Services Administration, School of Public Health and Maryland Center for Health Equity, University of Maryland, College Park, MD 20742, USA
Interests: race, ethnicity and health disparities research
Special Issues, Collections and Topics in MDPI journals
Dr. Devon C. Payne-Sturges

E-Mail Website
Guest Editor
Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
Interests: environmental health policy; health disparities; environmental health equity; children's environmental health; environmental health of minority populations; social determinants of health; cumulative risk assessment; biomonitoring; health impact assessment; exposure assessment; risk assessment; environmental regulatory decision making; population vulnerability and susceptibility; pesticides; air pollution; toxic chemicals in consumer products; indoor air; community-based participatory research; environmental public health indicators
Special Issues, Collections and Topics in MDPI journals
Dr. Christiane Bunge

E-Mail Website
Guest Editor
Unit "General Aspects of Environment and Health" Federal Environment Agency Corrensplatz 1 14195 Berlin, Germany
Interests: environmental justice; social inequality in environmental health; health promotion and migration; sustainable urban development and health
Dr. Kenneth Olden

E-Mail
Guest Editor
Office of Research and Development National Center for Environmental Assessment 1200 Pennsylvania Ave, Washington, DC 20460, USA

Special Issue Information

Dear Colleagues,

The purpose of this special issue is to highlight the latest interdisciplinary and innovative research, tools, methods and approaches to assess, reduce and prevent environmentally driven social, racial and ethnic health disparities. We welcome manuscripts that link environmental, health and these factors including, but not limited to, spatial dimensions of health disparities, community capacity building for environmental justice and community based participatory research. Additionally, .we also encourage submissions on policy analysis/policy decision making that address social determinants of environmental health, and on analytical approaches that inform decision making for policy and program development/implementation to reduce/prevent environmental health disparities. Our aim is to advance health disparity research into the arena of environmental health and help accelerate efforts designed to improve access to healthy environments for vulnerable populations.

Dr. Stephen B. Thomas
Dr. Devon C. Payne-Sturges
Dr. Christiane Bunge
Dr. Kenneth Olden
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (19 papers)

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4167 KiB  
Article
State-Issued Identification Cards Reveal Patterns in Adult Weight Status
by Daniel S. Morris, Eric C. Main, Jenine K. Harris, Abraham Moland and Curtis Cude
Int. J. Environ. Res. Public Health 2015, 12(6), 6388-6402; https://doi.org/10.3390/ijerph120606388 - 08 Jun 2015
Cited by 1 | Viewed by 5390
Abstract
Background: State-issued identification cards are a promising data source for neighborhood-level obesity estimates. Methods: We used information from three million Oregon state-issued identification cards to compute age-adjusted estimates of average adult body mass index (BMI) for each census tract in the state. We [...] Read more.
Background: State-issued identification cards are a promising data source for neighborhood-level obesity estimates. Methods: We used information from three million Oregon state-issued identification cards to compute age-adjusted estimates of average adult body mass index (BMI) for each census tract in the state. We used multivariate linear regression to identify associations between weight status and population characteristics, food access, commuting behavior, and geography. Results: Together, home values, education, race, ethnicity, car commuting, and rural-urban commuting area (RUCA) explained 86% of the variation in BMI among tracts. BMI was lower in areas with higher home values and greater educational attainment, and higher in areas with more workers commuting by car. Discussion: Our findings are consistent with other research on socioeconomic disparities in obesity. This demonstrates state-issued identification cards are a promising data source for BMI surveillance and may offer new insight into the association between weight status and economic and environmental factors. Public health agencies should explore options for developing their own obesity estimates from identification card data. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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1037 KiB  
Article
Disparities in Children’s Blood Lead and Mercury Levels According to Community and Individual Socioeconomic Positions
by Sinye Lim, Mina Ha, Seung-Sik Hwang, Mia Son and Ho-Jang Kwon
Int. J. Environ. Res. Public Health 2015, 12(6), 6232-6248; https://doi.org/10.3390/ijerph120606232 - 29 May 2015
Cited by 21 | Viewed by 5060
Abstract
We aimed to examine the associations between blood lead and mercury levels and individual and community level socioeconomic positions (SEPs) in school-aged children. A longitudinal cohort study was performed in 33 elementary schools in 10 cities in Korea. Among a total of 6094 [...] Read more.
We aimed to examine the associations between blood lead and mercury levels and individual and community level socioeconomic positions (SEPs) in school-aged children. A longitudinal cohort study was performed in 33 elementary schools in 10 cities in Korea. Among a total of 6094 children included at baseline, the final study population, 2281 children followed-up biennially, were analyzed. The geometric mean (GM) levels of blood lead were 1.73 μg/dL (range 0.02–9.26) and 1.56 μg/dL (range 0.02–6.83) for male and female children, respectively. The blood lead levels were significantly higher in males, children living in rural areas, and those with lower individual SEP. The GM levels of blood mercury were 2.07 μg/L (range 0.09–12.67) and 2.06 μg/L (range 0.03–11.74) for males and females, respectively. Increased blood mercury levels were significantly associated with urban areas, higher individual SEP, and more deprived communities. The risk of high blood lead level was significantly higher for the lower individual SEP (odds ratio (OR) 2.18, 95% confidence interval (CI) 1.36–3.50 in the lowest educational attainment of the father), with a significant dose-response relationship observed after adjusting for the community SEP. The association between high blood lead levels and lower individual SEP was much stronger in the more deprived communities (OR 2.88, 95% CI 1.27–6.53) than in the less deprived communities (OR 1.40, 95% CI 0.76–2.59), and showed a significant decreasing trend during the follow-up only in the less deprived communities. The risk of high blood mercury levels was higher in higher individual SEP (OR 0.64, 95% CI 0.40–1.03 in the lowest educational attainment of the father), with a significant dose-response relationship noted. Significant decreasing trends were observed during the follow-up both in the less and more deprived communities. From a public health point-of-view, community level intervention with different approaches for different metals is warranted to protect children from environmental exposure. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration
by Timothy M. Barzyk, Sacoby Wilson and Anthony Wilson
Int. J. Environ. Res. Public Health 2015, 12(5), 4546-4571; https://doi.org/10.3390/ijerph120504546 - 24 Apr 2015
Cited by 9 | Viewed by 6393
Abstract
Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific methodology, including partnership formation and solution [...] Read more.
Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific methodology, including partnership formation and solution development as necessary practices. Community, state, and federal examples were described and then summarized based on their adherence to CRA principles of: (1) planning, scoping, and problem formulation; (2) risk analysis and ranking, and (3) risk characterization, interpretation, and management. While each application shared the common goal of protecting human health and the environment, they adopted different approaches to achieve this. For a specific project-level analysis of a particular place or instance, this may be acceptable, but to ensure long-term applicability and transferability to other projects, recommendations for developing a consistent approach to CRA are provided. This approach would draw from best practices, risk assessment and decision analysis sciences, and historical lessons learned to provide results in an understandable and accepted manner by all entities. This approach is intended to provide a common ground around which to develop CRA methods and approaches that can be followed at all levels. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
Community-Based Research as a Mechanism to Reduce Environmental Health Disparities in American Indian and Alaska Native Communities
by Cynthia Agumanu McOliver, Anne K. Camper, John T. Doyle, Margaret J. Eggers, Tim E. Ford, Mary Ann Lila, James Berner, Larry Campbell and Jamie Donatuto
Int. J. Environ. Res. Public Health 2015, 12(4), 4076-4100; https://doi.org/10.3390/ijerph120404076 - 13 Apr 2015
Cited by 38 | Viewed by 13747
Abstract
Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural [...] Read more.
Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural impacts. As a result, both quantity and quality of culturally important subsistence resources are diminished, contributing to poor nutrition and obesity, and overall reductions in quality of life and life expectancy. Climate change is adding to these impacts on Native American communities, variably causing drought, increased flooding and forced relocation affecting tribal water resources, traditional foods, forests and forest resources, and tribal health. This article will highlight several extramural research projects supported by the United States Environmental Protection Agency (USEPA) Science to Achieve Results (STAR) tribal environmental research grants as a mechanism to address the environmental health inequities and disparities faced by tribal communities. The tribal research portfolio has focused on addressing tribal environmental health risks through community based participatory research. Specifically, the STAR research program was developed under the premise that tribal populations may be at an increased risk for environmentally-induced diseases as a result of unique subsistence and traditional practices of the tribes and Alaska Native villages, community activities, occupations and customs, and/or environmental releases that significantly and disproportionately impact tribal lands. Through a series of case studies, this article will demonstrate how grantees—tribal community leaders and members and academic collaborators—have been addressing these complex environmental concerns by developing capacity, expertise and tools through community-engaged research. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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734 KiB  
Article
Ensuring Healthy American Indian Generations for Tomorrow through Safe and Healthy Indoor Environments
by Joseph A. Pacheco, Christina M. Pacheco, Charley Lewis, Chandler Williams, Charles Barnes, Lanny Rosenwasser, Won S. Choi and Christine M. Daley
Int. J. Environ. Res. Public Health 2015, 12(3), 2810-2822; https://doi.org/10.3390/ijerph120302810 - 04 Mar 2015
Cited by 1 | Viewed by 5327
Abstract
American Indians (AI) have the highest rate of severe physical housing problems in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes. The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a [...] Read more.
American Indians (AI) have the highest rate of severe physical housing problems in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes. The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, highlight major successes, and propose recommendations for future indoor environmental health studies. The Center for American Indian Community Health (CAICH) and Children’s Mercy Hospital’s Center for Environmental Health and Allergy and Immunology Research Lab collaborated to provide educational sessions and healthy home assessments for AI. Through educational trainings, more than 240 AI were trained on the primary causes of health problems in homes. A total of 72 homes and places of employment were assessed by AI environmental health specialists. The top three categories with the most concerns observed in the homes/places of employment were allergens/dust (98%), safety/injury (89%) and chemical exposure (82%). While some information on smoking inside the home was collected, these numbers may have been underreported due to stigma. This was CAICH’s first endeavor in environmental health and although challenges arose, many more successes were achieved. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
School Locations and Traffic Emissions — Environmental (In)Justice Findings Using a New Screening Method
by Philine Gaffron and Deb Niemeier
Int. J. Environ. Res. Public Health 2015, 12(2), 2009-2025; https://doi.org/10.3390/ijerph120202009 - 11 Feb 2015
Cited by 41 | Viewed by 8712
Abstract
It has been shown that the location of schools near heavily trafficked roads can have detrimental effects on the health of children attending those schools. It is therefore desirable to screen both existing school locations and potential new school sites to assess either [...] Read more.
It has been shown that the location of schools near heavily trafficked roads can have detrimental effects on the health of children attending those schools. It is therefore desirable to screen both existing school locations and potential new school sites to assess either the need for remedial measures or suitability for the intended use. Current screening tools and public guidance on school siting are either too coarse in their spatial resolution for assessing individual sites or are highly resource intensive in their execution (e.g., through dispersion modeling). We propose a new method to help bridge the gap between these two approaches. Using this method, we also examine the public K-12 schools in the Sacramento Area Council of Governments Region, California (USA) from an environmental justice perspective. We find that PM2.5 emissions from road traffic affecting a school site are significantly positively correlated with the following metrics: percent share of Black, Hispanic and multi-ethnic students, percent share of students eligible for subsidized meals. The emissions metric correlates negatively with the schools’ Academic Performance Index, the share of White students and average parental education levels. Our PM2.5 metric also correlates with the traffic related, census tract level screening indicators from the California Communities Environmental Health Screening Tool and the tool’s tract level rate of asthma related emergency department visits. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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448 KiB  
Article
Approaching Environmental Health Disparities and Green Spaces: An Ecosystem Services Perspective
by Viniece Jennings and Cassandra Johnson Gaither
Int. J. Environ. Res. Public Health 2015, 12(2), 1952-1968; https://doi.org/10.3390/ijerph120201952 - 10 Feb 2015
Cited by 100 | Viewed by 17951
Abstract
Health disparities occur when adverse health conditions are unequal across populations due in part to gaps in wealth. These disparities continue to plague global health. Decades of research suggests that the natural environment can play a key role in sustaining the health of [...] Read more.
Health disparities occur when adverse health conditions are unequal across populations due in part to gaps in wealth. These disparities continue to plague global health. Decades of research suggests that the natural environment can play a key role in sustaining the health of the public. However, the influence of the natural environment on health disparities is not well-articulated. Green spaces provide ecosystem services that are vital to public health. This paper discusses the link between green spaces and some of the nation’s leading health issues such as obesity, cardiovascular health, heat-related illness, and psychological health. These associations are discussed in terms of key demographic variables—race, ethnicity, and income. The authors also identify research gaps and recommendations for future research. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
705 KiB  
Article
Difference in Health Inequity between Two Population Groups due to a Social Determinant of Health
by Ramal Moonesinghe, Karen Bouye and Ana Penman-Aguilar
Int. J. Environ. Res. Public Health 2014, 11(12), 13074-13083; https://doi.org/10.3390/ijerph111213074 - 16 Dec 2014
Cited by 6 | Viewed by 8259
Abstract
The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems” that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we [...] Read more.
The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems” that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we consider social determinants of health such as the distribution of income, wealth, influence and power as risk factors for risk of disease. We operationally define health inequity in a disease within a population due to a risk factor that is unfair and avoidable as the difference between the disease outcome with and without the risk factor in the population. We derive expressions for difference in health inequity between two populations due to a risk factor that is unfair and avoidable for a given disease. The difference in heath inequity between two population groups due to a risk factor increases with increasing difference in relative risks and the difference in prevalence of the risk factor in the two populations. The difference in health inequity could be larger than the difference in health outcomes between the two populations in some situations. Compared to health disparities which are typically measured and monitored using absolute or relative disparities of health outcomes, the methods presented in this manuscript provide a different, yet complementary, picture because they parse out the contributions of unfair and avoidable risk factors. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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718 KiB  
Article
Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors
by Anika L. Hines, Roxanne M. Andrews, Ernest Moy, Marguerite L. Barrett and Rosanna M. Coffey
Int. J. Environ. Res. Public Health 2014, 11(12), 13017-13034; https://doi.org/10.3390/ijerph111213017 - 12 Dec 2014
Cited by 30 | Viewed by 8266
Abstract
Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific [...] Read more.
Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2009 State Inpatient Databases for California. There were 3,757,218 records. Speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality; the exception was significantly higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients. Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients. The influence of language on obstetric trauma and the potential effects of interpretation services on inpatient care are discussed. The broader context of policy implications for collection and reporting of language data is also presented. Results from other countries with and without English as a primary language are needed for the broadest interpretation and generalization of outcomes. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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866 KiB  
Article
Exploration of Preterm Birth Rates Using the Public Health Exposome Database and Computational Analysis Methods
by Anne D. Kershenbaum, Michael A. Langston, Robert S. Levine, Arnold M. Saxton, Tonny J. Oyana, Barbara J. Kilbourne, Gary L. Rogers, Lisaann S. Gittner, Suzanne H. Baktash, Patricia Matthews-Juarez and Paul D. Juarez
Int. J. Environ. Res. Public Health 2014, 11(12), 12346-12366; https://doi.org/10.3390/ijerph111212346 - 28 Nov 2014
Cited by 21 | Viewed by 7449
Abstract
Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and [...] Read more.
Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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714 KiB  
Article
A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research
by Duk Won Bang, Sheila M. Manemann, Yariv Gerber, Veronique L. Roger, Christine M. Lohse, Jennifer Rand-Weaver, Elizabeth Krusemark, Barbara P. Yawn and Young J. Juhn
Int. J. Environ. Res. Public Health 2014, 11(11), 11597-11615; https://doi.org/10.3390/ijerph111111597 - 12 Nov 2014
Cited by 26 | Viewed by 5546
Abstract
Background: To assess whether the individual housing-based socioeconomic status (SES) measure termed HOUSES was associated with post-myocardial infarction (MI) mortality. Methods: The study was designed as a population-based cohort study, which compared post-MI mortality among Olmsted County, Minnesota, USA, residents with [...] Read more.
Background: To assess whether the individual housing-based socioeconomic status (SES) measure termed HOUSES was associated with post-myocardial infarction (MI) mortality. Methods: The study was designed as a population-based cohort study, which compared post-MI mortality among Olmsted County, Minnesota, USA, residents with different SES as measured by HOUSES using Cox proportional hazards models. Subjects’ addresses at index date of MI were geocoded to real property data to formulate HOUSES (a z-score for housing value, square footage, and numbers of bedrooms and bathrooms). Educational levels were used as a comparison for the HOUSES index. Results: 637 of the 696 eligible patients with MI (92%) were successfully geocoded to real property data. Post-MI survival rates were 60% (50–72), 78% (71–85), 72% (60–87), and 87% (81–93) at 2 years for patients in the first (the lowest SES), second, third, and fourth quartiles of HOUSES, respectively (p < 0.001). HOUSES was associated with post-MI all-cause mortality, controlling for all variables except age and comorbidity (p = 0.036) but was not significant after adjusting for age and comorbidity (p = 0.24). Conclusions: Although HOUSES is associated with post-MI mortality, the differential mortality rates by HOUSES were primarily accounted for by age and comorbid conditions. HOUSES may be useful for health disparities research concerning cardiovascular outcomes, especially in overcoming the paucity of conventional SES measures in commonly used datasets. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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392 KiB  
Article
Beginning a Partnership with PhotoVoice to Explore Environmental Health and Health Inequities in Minority Communities
by Melinda Butsch Kovacic, Sara Stigler, Angela Smith, Alexis Kidd and Lisa M. Vaughn
Int. J. Environ. Res. Public Health 2014, 11(11), 11132-11151; https://doi.org/10.3390/ijerph111111132 - 27 Oct 2014
Cited by 22 | Viewed by 7170
Abstract
Research informs action, but the challenge is its translation into practice. The 2012–2017 National Institute of Environmental Health Sciences Strategic Plan emphasizes partnership with community stakeholders to capture critical missing information about the effects of environment on health and to improve translation of [...] Read more.
Research informs action, but the challenge is its translation into practice. The 2012–2017 National Institute of Environmental Health Sciences Strategic Plan emphasizes partnership with community stakeholders to capture critical missing information about the effects of environment on health and to improve translation of study results, a daunting task for many traditionally-trained researchers. To better understand economic and neighborhood context consistent with these goals as well as existing inequities, we needed access to a highly affected community to inform and participate in our research. Our team therefore undertook a PhotoVoice project as a first step in establishing a participatory partnership and to appreciate the lived experiences of and build trust with youth visiting an urban community center in a high-risk, low-income, African American neighborhood located along a busy, polluted interstate. Ten 8–13 years-olds represented their community’s perspectives through photographs over 14-weeks using structured questioning. Five themes emerged: poor eating habits/inadequate nutrition; safety/violence; family/friends/community support; future hopes/dreams; and garbage/environment. Public viewings of the photos/captions facilitated engagement of other community agencies and multidisciplinary academic faculties to work together to build a sustainable “community collaboratory” that will promote health at the center by providing families knowledge/skills to prevent/minimize environmental exposures via diet/lifestyle changes using community-engaged, citizen scientist and systems thinking approaches. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
Scalable Combinatorial Tools for Health Disparities Research
by Michael A. Langston, Robert S. Levine, Barbara J. Kilbourne, Gary L. Rogers, Jr., Anne D. Kershenbaum, Suzanne H. Baktash, Steven S. Coughlin, Arnold M. Saxton, Vincent K. Agboto, Darryl B. Hood, Maureen Y. Litchveld, Tonny J. Oyana, Patricia Matthews-Juarez and Paul D. Juarez
Int. J. Environ. Res. Public Health 2014, 11(10), 10419-10443; https://doi.org/10.3390/ijerph111010419 - 10 Oct 2014
Cited by 21 | Viewed by 7621
Abstract
Despite staggering investments made in unraveling the human genome, current estimates suggest that as much as 90% of the variance in cancer and chronic diseases can be attributed to factors outside an individual’s genetic endowment, particularly to environmental exposures experienced across his or [...] Read more.
Despite staggering investments made in unraveling the human genome, current estimates suggest that as much as 90% of the variance in cancer and chronic diseases can be attributed to factors outside an individual’s genetic endowment, particularly to environmental exposures experienced across his or her life course. New analytical approaches are clearly required as investigators turn to complicated systems theory and ecological, place-based and life-history perspectives in order to understand more clearly the relationships between social determinants, environmental exposures and health disparities. While traditional data analysis techniques remain foundational to health disparities research, they are easily overwhelmed by the ever-increasing size and heterogeneity of available data needed to illuminate latent gene x environment interactions. This has prompted the adaptation and application of scalable combinatorial methods, many from genome science research, to the study of population health. Most of these powerful tools are algorithmically sophisticated, highly automated and mathematically abstract. Their utility motivates the main theme of this paper, which is to describe real applications of innovative transdisciplinary models and analyses in an effort to help move the research community closer toward identifying the causal mechanisms and associated environmental contexts underlying health disparities. The public health exposome is used as a contemporary focus for addressing the complex nature of this subject. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
Concurrent Fetal Exposure to Multiple Environmental Chemicals along the U.S.—Mexico Border: An Exploratory Study in Brownsville, Texas
by Ken Sexton and Jennifer J. Salinas
Int. J. Environ. Res. Public Health 2014, 11(10), 10165-10181; https://doi.org/10.3390/ijerph111010165 - 29 Sep 2014
Cited by 8 | Viewed by 5900
Abstract
There is mounting concern that cumulative exposure to diverse chemicals in the environment may contribute to observed adverse health outcomes in the Lower Rio Grande Valley of Texas. To investigate this situation, biomarker concentrations of organochlorine (OC) pesticides/metabolites, polychlorinated biphenyls (PCBs), and polycyclic [...] Read more.
There is mounting concern that cumulative exposure to diverse chemicals in the environment may contribute to observed adverse health outcomes in the Lower Rio Grande Valley of Texas. To investigate this situation, biomarker concentrations of organochlorine (OC) pesticides/metabolites, polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons (PAHs) were measured in maternal and umbilical cord blood from pregnant Hispanic women in Brownsville, TX. Results show that both mothers and fetuses were exposed concurrently to a variety of relatively low-level, hazardous environmental chemicals. Approximately 10% of the blood specimens had comparatively high concentrations of specific OC pesticides, PCBs and PAHs. Because many pregnant women in Brownsville live in socioeconomically-disadvantaged and environmentally-challenging circumstances, there is appropriate concern that exposure to these exogenous substances, either individually or in combination, may contribute to endemic health problems in this population, including cardiovascular disease, obesity, and diabetes. The challenge is to identify individuals at highest comparative risk and then implement effective programs to either prevent or reduce cumulative exposures that pose significant health-related threats. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Article
Relationship of Racial Composition and Cancer Risks from Air Toxics Exposure in Memphis, Tennessee, U.S.A.
by Chunrong Jia, Wesley James and Satish Kedia
Int. J. Environ. Res. Public Health 2014, 11(8), 7713-7724; https://doi.org/10.3390/ijerph110807713 - 31 Jul 2014
Cited by 19 | Viewed by 8508
Abstract
African Americans in the U.S. often live in poverty and segregated urban neighborhoods, many of which have dense industrial facilities resulting in high exposure to harmful air toxics. This study aims to explore the relationship between racial composition and cancer risks from air [...] Read more.
African Americans in the U.S. often live in poverty and segregated urban neighborhoods, many of which have dense industrial facilities resulting in high exposure to harmful air toxics. This study aims to explore the relationship between racial composition and cancer risks from air toxics exposure in Memphis/Shelby County, Tennessee, U.S.A. Air toxics data were obtained from 2005 National Air Toxics Assessment (NATA), and the demographic data, including racial composition, were extracted from the 2000 United States Census. The association was examined using multivariable geographically weighted regression (GWR) analysis. The risk difference between African American and White concentrated areas was defined as the absolute disparity, and the percent difference as the relative disparity. GWR analyses show that cancer risks increase with respect to increasing percent of African Americans at the census tract level. Individuals in African American concentrated tracts bear 6% more cancer risk burden than in White concentrated tracts. The distribution of major roads causes the largest absolute disparity and the distribution of industrial facilities causes the largest relative disparity. Effective strategies for reduction in environmental disparity should especially target sources of large absolute disparities. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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550 KiB  
Article
Use of Segregation Indices, Townsend Index, and Air Toxics Data to Assess Lifetime Cancer Risk Disparities in Metropolitan Charleston, South Carolina, USA
by LaShanta J. Rice, Chengsheng Jiang, Sacoby M. Wilson, Kristen Burwell-Naney, Ashok Samantapudi and Hongmei Zhang
Int. J. Environ. Res. Public Health 2014, 11(5), 5510-5526; https://doi.org/10.3390/ijerph110505510 - 21 May 2014
Cited by 35 | Viewed by 9084
Abstract
Background: Studies have demonstrated a relationship between segregation and level of education, occupational opportunities, and risk behaviors, yet a paucity of research has elucidated the association between racial residential segregation, socioeconomic deprivation, and lifetime cancer risk. Objectives: We examined estimated lifetime [...] Read more.
Background: Studies have demonstrated a relationship between segregation and level of education, occupational opportunities, and risk behaviors, yet a paucity of research has elucidated the association between racial residential segregation, socioeconomic deprivation, and lifetime cancer risk. Objectives: We examined estimated lifetime cancer risk from air toxics by racial composition, segregation, and deprivation in census tracts in Metropolitan Charleston. Methods: Segregation indices were used to measure the distribution of groups of people from different races within neighborhoods. The Townsend Index was used to measure economic deprivation in the study area. Poisson multivariate regressions were applied to assess the association of lifetime cancer risk with segregation indices and Townsend Index along with several sociodemographic measures. Results: Lifetime cancer risk from all pollution sources was 28 persons/million for half of the census tracts in Metropolitan Charleston. Isolation Index and Townsend Index both showed significant correlation with lifetime cancer risk from different sources. This significance still holds after adjusting for other sociodemographic measures in a Poisson regression, and these two indices have stronger effect on lifetime cancer risk compared to the effects of sociodemographic measures. Conclusions: We found that material deprivation, measured by the Townsend Index and segregation measured by the Isolation index, introduced high impact on lifetime cancer risk by air toxics at the census tract level. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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239 KiB  
Article
Social Disparities in Children’s Respiratory Health in El Paso, Texas
by Sara E. Grineski, Timothy W. Collins, Paola Chavez-Payan, Anthony M. Jimenez, Stephanie Clark-Reyna, Marie Gaines and Young-an Kim
Int. J. Environ. Res. Public Health 2014, 11(3), 2941-2957; https://doi.org/10.3390/ijerph110302941 - 11 Mar 2014
Cited by 12 | Viewed by 7521
Abstract
The objectives of this study were to assess prevalence of children’s respiratory health conditions and to measure and describe social disparities in children’s respiratory problems and access to health resources for asthma/wheezing management. Data were collected through a cross-sectional, observational mail survey of [...] Read more.
The objectives of this study were to assess prevalence of children’s respiratory health conditions and to measure and describe social disparities in children’s respiratory problems and access to health resources for asthma/wheezing management. Data were collected through a cross-sectional, observational mail survey of all primary caretakers of 4th and 5th grade children in El Paso Independent School District (El Paso, TX, USA). 6295 primary caretakers received surveys at their home address and 1904 surveys were completed and returned for a 30% response rate. El Paso children have high rates of asthma (17%) and allergies (51%). In terms of social disparities, children that are male, not poor, obese, Hispanic, born in El Paso, have a US-born caretaker, and have a caretaker who has lower levels Spanish proficiency have increased odds of respiratory problems. Among children with asthma and wheezing, disparities exist in access to care; those that are poor, with a Spanish-speaking caretaker, or with a foreign-born caretaker had increased odds of seeking care in urgent care center, emergency rooms and hospitals. Results have scholarly and practical implications for broader trends in terms of increasing prevalence of respiratory health problems across multiple scales (from El Paso to the US context to worldwide) and health disparities experienced within the rapidly growing US Hispanic population. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

Review

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694 KiB  
Review
A Critical Review of an Authentic and Transformative Environmental Justice and Health Community — University Partnership
by Sacoby Wilson, Dayna Campbell, Laura Dalemarre, Herb Fraser-Rahim and Edith Williams
Int. J. Environ. Res. Public Health 2014, 11(12), 12817-12834; https://doi.org/10.3390/ijerph111212817 - 11 Dec 2014
Cited by 20 | Viewed by 8216
Abstract
Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case [...] Read more.
Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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Other

Jump to: Research, Review

1777 KiB  
Concept Paper
The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research
by Paul D. Juarez, Patricia Matthews-Juarez, Darryl B. Hood, Wansoo Im, Robert S. Levine, Barbara J. Kilbourne, Michael A. Langston, Mohammad Z. Al-Hamdan, William L. Crosson, Maurice G. Estes, Sue M. Estes, Vincent K. Agboto, Paul Robinson, Sacoby Wilson and Maureen Y. Lichtveld
Int. J. Environ. Res. Public Health 2014, 11(12), 12866-12895; https://doi.org/10.3390/ijerph111212866 - 11 Dec 2014
Cited by 120 | Viewed by 18353
Abstract
The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level [...] Read more.
The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures “get under the skin”. The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training. Full article
(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)
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