Zika Virus Infection Knowledge and Communication Preferences Among Women of Reproductive Age in Central Brooklyn, New York: A Thematic Analysis.

The 2016 outbreak of Zika virus (ZIKV) infected millions and resulted in thousands of infants born with malformations. Though the clusters of severe birth defects resulting from this outbreak have subsided, ZIKV continues to be a concern throughout much of Latin America and the Caribbean. Travel and sexual intercourse remain the dominant transmission risk factors for women of reproductive age and their partners. This is particularly true for communities in Brooklyn, New York, that comprise large immigrant and foreign-born populations. Practitioners of public health understand little about how women at risk for ZIKV are most likely to receive information about the virus or who they trust most to provide that information. In the context of five focus group discussions, this study explored the knowledge and communication preferences of 20 women of reproductive age in Central Brooklyn. Results derived from a thematic analysis suggest that while most women are familiar with mosquitos as ZIKV vectors, knowledge of sexual transmission is considerably lower. Many respondents believe that only women who are pregnant or trying to become pregnant are at risk, and public health agencies, such as the U.S. Centers for Disease Control and Prevention, remain the most trusted sources of information. These findings can support more effective communication about the risks of ZIKV infection and other vector-borne diseases to women in New York City and similar urban communities.

Knowledge, Attitudes and Practices About Zika Virus Infection Among Women of Reproductive Age in Central Brooklyn, New York City, USA.

Zika virus (ZIKV) is spread by mosquitos, sexual intercourse and vertically during pregnancy. The 2015-2016 ZIKV epidemic infected millions in the Americas and resulted in thousands of infants born with malformations. Though the clusters of severe birth defects have subsided since 2017, ZIKV transmission remains a concern throughout Latin America and the Caribbean. Travel-associated and sexually-transmitted Zika, therefore, remain potential routes of transmission for women of reproductive age and their partners. This is particularly true for communities with high immigrant and foreign-born populations in Central Brooklyn, New York. Limited information has been collected on the perception by this population of ZIKV and how high-risk women engage in preventive practices. Using a survey adapted from the WHO, we assessed engagement in mosquito-related preventive practices while traveling. Data from 483 respondents on knowledge and perceived ZIKV concern, along with demographics as correlates of engagement in preventive practices were collected using a convenience sample between September 2020 and January 2021. Data were collected via a multipronged approach using social media in REDCap. Our findings show that being white/not Hispanic, pregnant, knowledgeable and concerned about ZIKV, and having enough information about ZIKV were all significantly associated with an increased likelihood of engaging in preventive practices while traveling. Multivariable logistic modeling revealed that knowledge was significantly associated with an increased likelihood of engaging in preventive practices while traveling (AOR = 1.90, 95% CI [1.28-2.83]). These findings underscore the importance of directing tailored health education efforts to vulnerable populations.

Ambient and household air pollution on early-life determinants of stunting-a systematic review and meta-analysis.

Stunting is an important risk factor for early growth and health implications throughout the life course, yet until recently, studies have rarely focused on populations exposed to high levels of particulate matter pollution or on developing countries most vulnerable to stunting and its associated health and developmental impacts. We systematically searched for epidemiologic studies published up to 15 August 2020 that examined the association between ambient and household particulate exposure and postnatal stunting (height-for-age z-score) and prenatal determinants (small for gestational age or SGA, or equivalent) of stunting. We conducted the literature search in PUBMED, MEDLINE, EMBASE, and Web of Science databases in August 2020, using keywords including, but not limited to, "particulate matter," "indoor/household air pollution," and "adverse birth outcomes," to identify relevant articles. Forty-five studies conducted in 29 countries met our inclusion criteria for meta-analysis. We found significant positive associations between SGA and a 10 µg/m3 increase in fine particulate matter (PM2.5) exposure over the entire pregnancy [OR = 1.08; 95% confidence interval (CI): 1.03-1.13], with similar SGA impact during the second and third trimesters, and from high exposure quartile of PM2.5 exposure during the entire pregnancy. A 19% increased risk of postnatal stunting (95% CI: 1.10, 1.29) was also associated with postnatal exposure to household air pollution. Our analysis shows consistent, significant, and noteworthy evidence of elevated risk of stunting-related health outcomes with ambient PM2.5 and household air pollution exposure. This evidence reinforces the importance of promoting clean air as part of an integrated approach to preventing stunting.

A meta-analysis of blood lead levels in India and the attributable burden of disease.

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 µg/dL (95% CI: 4.38-9.35) in children and 7.52 µg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Burden of disease resulting from lead exposure at toxic waste sites in Argentina, Mexico and Uruguay.

BACKGROUND: Though lead contaminated waste sites have been widely researched in many high-income countries, their prevalence and associated health outcomes have not been well documented in low- and middle-income countries. METHODS: Using the well-established health metric disability-adjusted life year (DALY) and an exposure assessment method developed by Chatham-Stephens et al., we estimated the burden of disease resulting from exposure to lead at toxic waste sites in three Latin American countries in 2012: Argentina, Mexico and Uruguay. Toxic waste sites identified through Pure Earth's Toxic Sites Identification Program (TSIP) were screened for lead in both biological and environmental sample media. Estimates of cardiovascular disease incidence and other outcomes resulting from exposure to lead were utilized to estimate DALYs for each population at risk. RESULTS: Approximately 316,703 persons in three countries were at risk of exposure to pollutants at 129 unique sites identified through the TSIP database. Exposure to lead was estimated to result in between 51,432 and 115,042 DALYs, depending on the weighting factor used. The estimated burden of disease caused by exposure to lead in this analysis is comparable to that estimated for Parkinson's disease and bladder cancer in these countries. CONCLUSIONS: Lead continues to pose a significant public health risk in Argentina, Mexico, and Uruguay. The burden of disease in these three countries is comparable with other widely recognized public health challenges. Knowledge of the relatively high number of DALYs associated with lead exposure may be used to generate support and funding for the remediation of toxic waste sites in these countries and others.

The prevalence of toxic hotspots in former Soviet countries.

Using a global database of contaminated sites, toxic hotspots in eight former Soviet countries were analyzed to identify the prevalence, types and sources of toxic pollution, as well as their associated potential public health impacts. For this analysis, polluted sites in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Ukraine, and Uzbekistan were compiled and analyzed. The levels of contamination of seven key pollutants were assessed in each country. 424 contaminated sites were identified using data from Blacksmith Institute. Pesticides, lead (Pb), radioactive metals, arsenic (As), mercury (Hg), chromium (Cr), and cadmium (Cd) were the most commonly identified key pollutants. Collectively, these sites pose health risks to an estimated 6.2 million residents. The existing data on toxic hotspots in former Soviet countries likely captures only a small percentage of actual contaminated sites, but suggests potentially severe public health consequences. Additional assessments are needed to understand the risks posed by toxic pollution in the region.

Estimating the Prevalence of Toxic Waste Sites in Low- and Middle-Income Countries.

BACKGROUND: Exposure to heavy metals at contaminated industrial and mining sites, known also as hot spots, is a significant source of toxic exposure and adverse health outcomes in countries around the world. The Toxic Sites Identification Program (TSIP) developed by Pure Earth, a New York-based nongovernmental organization, is the only systematic effort to catalogue contaminated sites globally. To date, TSIP has identified and catalogued 3282 sites in low- and middle-income countries. The TSIP methodology is not designed to survey all contaminated sites in a country. Rather sites are prioritized based on their perceived impact on human health, and only a limited number of the most highly hazardous sites are surveyed. The total number of contaminated sites globally and the fraction of contaminated sites captured by TSIP is not known. OBJECTIVE: To determine the TSIP site capture rate, the fraction of contaminated sites in a country catalogued by TSIP. METHODS: Ghana was selected for this analysis because it is a rapidly industrializing lower middle income country with a heterogeneous industrial base, a highly urban population (51%), and good public records systems. To develop an estimate of the fraction of sites in Ghana captured by TSIP, assessors targeted randomly selected geographic quadrats for comprehensive assessment using area and population statistics from the Ghana Statistical Service. Investigators physically walked all accessible streets in each quadrat to visually identify all sites. Visual identification was supplemented by field-based confirmation with portable x-ray fluorescence instruments to test soils for metals. To extrapolate from survey findings to develop a range of estimates for the entire country, the investigators used 2 methodologies: a "bottom-up" approach that first estimated the number of waste sites in each region and then summed these regional subtotals to develop a total national estimate; and a "top-down" method that estimated the total number of sites in Ghana and then allocated these sites to each region. Both methods used cluster random sampling principles. FINDINGS: The investigators identified 72 sites in the sampled quadrats. Extrapolating from these findings to the entire country, the first methodology estimated that there are 1561 sites contaminated by heavy metals in Ghana (confidence interval [CI]: 1134-1987), whereas the second estimated 1944 sites (CI: 812-3075). The estimated total number of contaminated sites in Ghana is thus 7-9 times the number of sites captured through TSIP. On a population basis, it was estimated that there are between 31 and 115 contaminated sites per million inhabitants in Ghana. CONCLUSIONS: The findings of this study indicate that the TSIP methodology provides a sound statistical basis for policy formulation. The statistical approaches used in this study can be replicated in other countries to improve estimates of the prevalence of contaminated sites. This information provides important input to calculations of the global burden of disease attributable to hazardous exposures at contaminated sites.

Spatial Associations Between Contaminated Land and Socio Demographics in Ghana.

Associations between contaminated land and socio demographics are well documented in high-income countries. In low- and middle-income countries, however, little is known about the extent of contaminated land and possible demographic correlations. This is an important yet sparsely researched topic with potentially significant public health implications as exposure to pollution remains a leading source of morbidity and mortality in low-income countries. In this study, we review the associations between several socio demographic factors (population, population density, unemployment, education, and literacy) and contaminated sites in Ghana. Within this context, both correlation and association intend to show the relationship between two variables, namely contaminated sites and socio demographics. Aggregated district level 2010 census data from Ghana Statistical Service and contaminated site location data from Pure Earth's Toxic Sites Identification Program (TSIP) were spatially evaluated using the number of sites per kilometer squared within districts as the unit of measurement. We found a low to medium positive correlation (ρ range: 0.285 to 0.478) between contaminated sites and the following socio demographics: higher population density, higher unemployment, greater education, and higher literacy rate. These results support previous studies and suggest that several socio demographic factors may be reasonably accurate predictors of contaminated site locations. More research and targeted data collection is needed to better understand these associations with the ultimate goal of developing a predictive model.

Blood lead levels in Mexico and pediatric burden of disease implications.

BACKGROUND: Although there has been success in reducing lead exposure with the phase-out of leaded gasoline, exposure to lead in Mexico continues to threaten the health of millions, much of which is from lead-based glazes used in pottery that leaches into food. OBJECTIVES: An extensive historical review and analysis of available data on blood lead levels in Mexican populations was conducted. We used a calculated geometric mean to evaluate the effect of lead on the pediatric burden of disease. METHODS: An extensive bibliographic search identified 83 published articles from 1978 to 2010 with blood lead level (BLL) data in Mexican populations representing 150 data points from more than 50,000 study participants. Values from these publications were categorized into various groupings. We then calculated the incidence of disease and disability-adjusted life-years resulting from these BLLs using the World Health Organization's burden of disease spreadsheets for mild mental retardation. RESULTS: Reviewing all relevant studies, the geometric means of Mexican BLLs in urban and rural areas were found to be 8.85 and 22.24 ug/dL, respectively. Since the phase-out of leaded gasoline, the mean in urban areas was found to be 5.36 ug/dL and the average in rural areas is expected to be much higher. The U.S. Centers for Disease Control and Prevention's (CDC) upper limit of blood lead in children under the age of 6 years is 5 ug/dL and the current U.S. average is 1.2 ug/dL. Our results indicate that more than 15% of the population will experience a decrement of more than 5 IQ points from lead exposure. The analysis also leads us to believe that lead is responsible for 820,000 disability-adjusted life-years for lead-induced mild mental retardation for children aged 0 to 4 years. CONCLUSION: Lead continues to threaten the health of millions and remains a significant cause of disability in Mexico. Additional interventions in reducing or managing lead-based ceramic glazes are necessary to protect the public health.

A simplified risk-ranking system for prioritizing toxic pollution sites in low- and middle-income countries.

BACKGROUND: In low- and middle-income countries (LMICs), chemical exposures in the environment due to hazardous waste sites and toxic pollutants are typically poorly documented and their health impacts insufficiently quantified. Furthermore, there often is only limited understanding of the health and environmental consequences of point source pollution problems, and little consensus on how to assess and rank them. The contributions of toxic environmental exposures to the global burden of disease are not well characterized. OBJECTIVES: The aim of this study was to describe the simple but effective approach taken by Blacksmith Institute's Toxic Sites Identification Program to quantify and rank toxic exposures in LMICs. This system is already in use at more than 3000 sites in 48 countries such as India, Indonesia, China, Ghana, Kenya, Tanzania, Peru, Bolivia, Argentina, Uruguay, Armenia, Azerbaijan, and Ukraine. METHODS: A hazard ranking system formula, the Blacksmith Index (BI), takes into account important factors such as the scale of the pollution source, the size of the population possibly affected, and the exposure pathways, and is designed for use reliably in low-resource settings by local personnel provided with limited training. FINDINGS: Four representative case studies are presented, with varying locations, populations, pollutants, and exposure pathways. The BI was successfully applied to assess the extent and severity of environmental pollution problems at these sites. CONCLUSIONS: The BI is a risk-ranking tool that provides direct and straightforward characterization, quantification, and prioritization of toxic pollution sites in settings where time, money, or resources are limited. It will be an important and useful tool for addressing toxic pollution problems in LMICs. Although the BI does not have the sophistication of the US Environmental Protection Agency's Hazard Ranking System, the case studies presented here document the effectiveness of the BI in the field, especially in low-resource settings. Understanding of the risks posed by toxic pollution sites helps assure better use of resources to manage sites and mitigate risks to public health. Quantification of these hazards is an important input to assessments of the global burden of disease.

A cross-sectional study of differences in 6-min walk distance in healthy adults residing at high altitude versus sea level.

BACKGROUND: We sought to determine if adult residents living at high altitude have developed sufficient adaptation to a hypoxic environment to match the functional capacity of a similar population at sea level. To test this hypothesis, we compared the 6-min walk test distance (6MWD) in 334 residents living at sea level vs. at high altitude. METHODS: We enrolled 168 healthy adults aged ≥35 years residing at sea level in Lima and 166 individuals residing at 3,825 m above sea level in Puno, Peru. Participants completed a 6-min walk test, answered a sociodemographics and clinical questionnaire, underwent spirometry, and a blood test. RESULTS: Average age was 54.0 vs. 53.8 years, 48% vs. 43% were male, average height was 155 vs. 158 cm, average blood oxygen saturation was 98% vs. 90%, and average resting heart rate was 67 vs. 72 beats/min in Lima vs. Puno. In multivariable regression, participants in Puno walked 47.6 m less (95% CI -81.7 to -13.6 m; p < 0.01) than those in Lima. Other variables besides age and height that were associated with 6MWD include change in heart rate (4.0 m per beats/min increase above resting heart rate; p < 0.001) and percent body fat (-1.4 m per % increase; p = 0.02). CONCLUSIONS: The 6-min walk test predicted a lowered functional capacity among Andean high altitude vs. sea level natives at their altitude of residence, which could be explained by an incomplete adaptation or a protective mechanism favoring neuro- and cardioprotection over psychomotor activity.