Racial/Ethnic Disparities in Cumulative Environmental Health Impacts in California: Evidence From a Statewide Environmental Justice Screening Tool (CalEnviroScreen 1.1)

Objectives. We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities.Methods. CalEnviroScreen 1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty.Results. The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal.Conclusions. Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action.Communities of color in the United States often reside in neighborhoods with worse air quality,1 more environmental hazards,2 and fewer health-promoting environmental amenities such as parks.3 This unequal distribution of exposures may contribute to racial/ethnic health disparities in environmentally sensitive diseases such as cancer and asthma.4 Research has shown that communities of color in California experience higher cancer risk from toxic air contaminants5 and higher average levels of nitrate contamination in their drinking water6 and that they live closer to hazardous waste sites7 and traffic.8 However, less is known about the extent to which communities of color are simultaneously exposed to multiple potential sources of pollution and the implications of such coexposures for health.There is, thus, an increasing need for analytic frameworks and decision-making tools that account for exposures to multiple environmental hazards through a variety of routes. Such frameworks should also consider differential vulnerability to the health effects of those exposures, which can vary across the population because of both individual and community-level factors.9–11 For example, age and health status, including suffering from preexisting cardiovascular disease or asthma, have been shown to increase susceptibility to the adverse health effects of air pollution.12–14Several studies suggest that an individual’s educational attainment modifies the health effects of air pollution: greater effects are observed among the less educated.15,16 Poverty can hinder access to adequate nutrition and medical care to prevent and manage the health impacts of pollution. At the community level, the concentration of poverty in disadvantaged neighborhoods can lead to conditions that increase levels of chronic psychosocial stress that weaken the body’s ability to defend against external challenges.17 A cumulative impact approach that considers differential vulnerability and environmental stressors is particularly important for assessing racial/ethnic environmental health disparities because communities of color in the United States experience lower average levels of education18 and wealth19 and, for some groups, higher rates of chronic health conditions20 that increase susceptibility to environmental health hazards.Although the field is still in its infancy, several proposed methods are used to better reflect the cumulative impacts of environmental exposures and population vulnerabilities and provide assessments that can support the incorporation of equity and environmental justice goals into policymaking.21–24 The California Environmental Protection Agency first released such a method—the California Communities Environmental Health Screening Tool, or CalEnviroScreen—in April 2013, and an updated version, CalEnviroScreen 1.1, was published in September 2013.25 CalEnviroScreen is a screening tool that considers both pollution burden and population vulnerability in assessing the potential for cumulative impacts across California zip codes. It was developed following consultation with government, academic, business, and nongovernmental organizations and 12 public workshops in 7 regions of the state that resulted in more than 1000 oral and written comments on 2 preliminary drafts.26 The tool employs a model that can be adapted to different applications and as new information becomes available. For example, subsequent iterations have been developed using a finer geographic resolution and the addition of new indicators.27 It purposefully relies on publicly available data sets for transparency and relatively simple methods so that it can be understood by a general audience.We used CalEnviroScreen 1.1 to assess the extent of geographic and racial/ethnic disparities in the potential for cumulative environmental health impacts from multiple environmental hazards in California. We employed a concentration index to examine which environmental hazards are most inequitably distributed, and we considered variations to CalEnviroScreen to evaluate the sensitivity of our findings to the structure of the model.     

Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis

AIDS and Behavior - We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study...     

Nephrotisches Syndrom bei einem 33-jährigen Mann

Ohne Zusammenfassung     

Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes

To examine the associations between maternal hepatitis B (HBV) and hepatitis C (HCV) infection status and selected infant neurological outcomes diagnosed at birth, we conducted a population‐based, retrospective cohort study on singleton live births in Florida from 1998 to 2009. Primary exposures included maternal HBV and HCV monoinfection. The neurological outcomes included brachial plexus injury, cephalhematoma, foetal distress, feeding difficulties, intraventricular h aemorrhage and neonatal seizures. Multivariable logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) that were adjusted for socio‐demographic characteristics, risky behaviours, pregnancy complications and pre‐existing medical conditions, and timing of delivery. The risk of an adverse neurological outcome was higher in infants born to mothers with hepatitis viral infection (7.2% for HCV, 5.0% for HBV), compared with infants of hepatitis virus‐free mothers (4.2%). After adjusting for potential confounders, women with HBV were twice as likely to have infants who suffered from brachial plexus injury (OR = 2.04, 95% CI = 1.15–3.60), while those with HCV had an elevated odds of having an infant with feeding difficulties (OR: 1.32, 95% CI = 1.06–1.64) and a borderline increased likelihood for neonatal seizures (OR = 1.74, 95% CI = 0.98–3.10). Additionally, HCV+ mothers had a 22% increased odds of having an infant with some type of adverse neurological outcome (OR: 1.22, 95% CI = 1.03–1.44). Our findings add to current understanding of the association between maternal HBV/HCV infections and infant neurological outcomes. Further research evaluating the role of maternal HBV and HCV infections (including viraemia, treatment) on pregnancy outcomes is warranted.