Modeling the relationship between SARS-CoV-2 RNA in wastewater or sludge and COVID-19 cases in three New England regions.

BACKGROUND: We aimed to compare statistical techniques estimating the association between SARS-CoV-2 RNA in untreated wastewater and sludge and reported coronavirus disease 2019 (COVID-19) cases. METHODS: SARS-CoV-2 RNA concentrations (copies/mL) were measured from 24-h composite samples of wastewater in Massachusetts (MA) (daily; 8/19/2020-1/19/2021) and Maine (ME) (weekly; 9/1/2020-3/2/2021) and sludge samples in Connecticut (CT) (daily; 3/1/2020-6/1/2020). We fit linear, generalized additive with a cubic regression spline (GAM), Poisson, and negative binomial models to estimate the association between SARS-CoV-2 RNA concentration and reported COVID-19 cases. RESULTS: The models that fit the data best were linear [adjusted R2=0.85 (MA), 0.16 (CT), 0.63 (ME); root-mean-square error (RMSE)=0.41 (MA), 1.14 (CT), 0.99 (ME)), GAM (adjusted R2=0.86 (MA), 0.16 (CT) 0.65 (ME); RMSE=0.39 (MA), 1.14 (CT), 0.97 (ME)], and Poisson [pseudo R2=0.84 (MA), 0.21 (CT), 0.52 (ME); RMSE=0.39 (MA), 0.67 (CT), 0.79 (ME)]. CONCLUSIONS: Linear, GAM, and Poisson models outperformed negative binomial models when relating SARS-CoV-2 RNA in wastewater or sludge to reported COVID-19 cases.

Climate stress and anxiety, environmental context, and civic engagement: A nationally representative study.

There is increasing recognition that people are experiencing stress and anxiety around climate change, and that this climate stress/anxiety may be associated with more pro-environmental behavior. However, less is known about whether people's own environmental exposures affect climate stress/anxiety or the relationship between climate stress/anxiety and civic engagement. Using three waves of survey data (2020-2022) from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study of US adults (n = 1071), we assessed relationships among environmental exposures (county-level air pollution, greenness, number of toxic release inventory sites, and heatwaves), self-reported climate stress/anxiety, and civic engagement measures (canvasing behavior, collaborating to solve community problems, personal efficacy to solve community problems, group efficacy to solve community problems, voting behavior). Most participants reported experiencing climate stress/anxiety (61%). In general, the environmental exposures we assessed were not significantly associated with climate stress/anxiety or civic engagement metrics, but climate stress/anxiety was positively associated with most of the civic engagement outcomes (canvassing, personal efficacy, group efficacy, voter preference). Our results support the growing literature that climate stress/anxiety may spur constructive civic action, though do not suggest a consistent relationship between adverse environmental exposures and either climate stress/anxiety or civic engagement. Future research and action addressing the climate crisis should promote climate justice by ensuring mental health support for those who experience climate stress anxiety and by promoting pro-environmental civic engagement efforts.

Nickel in ambient particulate matter and respiratory or cardiovascular outcomes: A critical review.

Exposure to ambient particulate matter (PM) has been associated with respiratory and cardiovascular outcomes, and nickel has been more frequently associated with these outcomes than other metal constituents of ambient PM. Because of this, we evaluated whether the evidence to date supports causal relationships between exposure to nickel in ambient PM and respiratory or cardiovascular outcomes. We critically reviewed 38 studies in human populations published between 2012 and 2022. Although a large variety of respiratory and cardiovascular outcomes were examined, data were sparse for many. As a result, we focused our evaluation on seven respiratory outcomes and three cardiovascular outcomes that were each examined in ≥3 studies. Of these health outcomes, exposure to nickel in ambient PM has been statistically significantly associated with respiratory mortality, respiratory emergency hospital visits, asthma, lung function (i.e., forced expiratory volume in 1 s, forced vital capacity), cardiovascular mortality, and ischemic heart disease mortality. Studies of the health outcomes of focus are subject to multiple methodological limitations, primarily ecological fallacy (short-term exposure studies), exposure measurement error, confounding, model misspecification, and multiple comparisons issue. While some statistically significant associations were reported, they were not strong, precise, or consistent. Statistically significant findings for long-term exposure to nickel in PM were largely reported in studies that could not establish temporality, despite their cohort study design. Statistically significant findings for short-term exposure to nickel in PM were largely reported in studies that could establish temporality, although this cannot inform causal inference at the individual level due to the aggregate level data used. The biological plausibility of the associations is only supported at high concentrations not relevant to ambient exposures. Overall, the literature to date does not provide adequate support for a causal relationship between nickel in ambient PM and respiratory or cardiovascular outcomes.

The role of study quality in aspartame and cancer epidemiology study reviews.

Toews et al. [1] and the World Health Organization (WHO) [2] reviewed observational epidemiology studies of non-sugar sweeteners (NSSs) and various health effects. The former used the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool and the latter used both the ROBINS-I tool and the Newcastle-Ottawa Scale to evaluate study quality. Both reviews concluded that there were no associations between NSS or aspartame consumption and cancer (except possibly between saccharin and bladder cancer) but indicated that the certainty of the evidence for all cancer types was "very low." While we agree with this conclusion, the support for the confidence in the evidence generally was not transparently documented, as the results of the study quality assessment were only provided in scores or ratings. An examination of illustrative case studies shows that some important aspects of study quality domains specific for NSSs generally or aspartame specifically (i.e., issues with the exposure and outcome assessments, the consideration of confounding/covariates, and selection bias) may have been overlooked or not given appropriate consideration, while other aspects that were less likely to have a large impact on overall study quality dominated the results in the two assessments. Our review of other studies published after the WHO [2] review further demonstrates this point. While this may not seem important given the overall lack of associations, it impacts the degree to which evidence supports a lack of effects as opposed to not being adequate to evaluate associations. In the future, aspartame and cancer outcome reviews should focus on those study quality domains that are most likely to impact the interpretation of results and discuss them in a transparent, systematic manner. If there is very low certainty in the evidence as a result of low study quality, reviewers should conclude the evidence is inadequate for making a causal determination.

Household conditions, COVID-19, and equity: Insight from two nationally representative surveys.

Background: With people across the United States spending increased time at home since the emergence of COVID-19, housing characteristics may have an even greater impact on health. Therefore, we assessed associations between household conditions and COVID-19 experiences. Methods: We used data from two nationally representative surveys: the Tufts Equity Study (TES; n = 1449 in 2021; n = 1831 in 2022) and the Household Pulse Survey (HPS; n = 147,380 in 2021; n = 62,826 in 2022). In the TES, housing conditions were characterized by heating/cooling methods; smoking inside the home; visible water damage/mold; age of housing unit; and self-reported concern about various environmental factors. In TES and HPS, household size was assessed. Accounting for sampling weights, we examined associations between each housing exposure and COVID-19 outcomes (diagnosis, vaccination) using separate logistic regression models with covariates selected based on an evidence-based directed acyclic graph. Results: Having had COVID-19 was more likely among people who reported poor physical housing condition (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.17-4.59; 2021), visible water damage or mold/musty smells (OR = 1.50; 95% CI = 1.10-2.03; 2022), and larger household size (5+ versus 1-2 people; OR = 1.53, 95% CI = 1.34-1.75, HPS 2022). COVID-19 vaccination was less likely among participants who reported smoke exposure inside the home (OR = 0.53; 95% CI = 0.31-0.90; 2022), poor water quality (OR = 0.42; 95% CI = 0.21-0.85; 2021), noise from industrial activity/construction (OR = 0.44; 95% CI = 0.19-0.99; 2022), and larger household size (OR = 0.57; 95% CI = 0.46-0.71; HPS 2022). Vaccination was also positively associated with poor indoor air quality (OR = 1.96; 95% CI = 1.02-3.72; 2022) and poor physical housing condition (OR = 2.27; 95% CI = 1.01-5.13; 2022). Certain heating/cooling sources were associated with COVID-19 outcomes. Conclusions: Our study found poor housing conditions associated with increased COVID-19 burden, which may be driven by systemic disparities in housing, healthcare, and financial access to resources during the COVID-19 pandemic.

Gas cooking and respiratory outcomes in children: A systematic review.

The most recent meta-analysis of gas cooking and respiratory outcomes in children was conducted by Lin et al. [93] in 2013. Since then, a number of epidemiology studies have been published on this topic. We conducted the first systematic review of this epidemiology literature that includes an in-depth evaluation of study heterogeneity and study quality, neither of which was systematically evaluated in earlier reviews. We reviewed a total of 66 relevant studies, including those in the Lin et al. [93] meta-analysis. Most of the studies are cross-sectional by design, precluding causal inference. Only a few are cohort studies that could establish temporality and they have largely reported null results. There is large variability across studies in terms of study region, age of children, gas cooking exposure definition, and asthma or wheeze outcome definition, precluding clear interpretations of meta-analysis estimates such as those reported in Lin et al. [93]. Further, our systematic study quality evaluation reveals that a large proportion of the studies to date are subject to multiple sources of bias and inaccuracy, primarily due to self-reported gas cooking exposure or respiratory outcomes, insufficient adjustment for key confounders (e.g., environmental tobacco smoke, family history of asthma or allergies, socioeconomic status or home environment), and unestablished temporality. We conclude that the epidemiology literature is limited by high heterogeneity and low study quality and, therefore, it does not provide sufficient evidence regarding causal relationships between gas cooking or indoor NO2 and asthma or wheeze. We caution against over-interpreting the quantitative evidence synthesis estimates from meta-analyses of these studies.

Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022.

Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per µg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.

Disparities in national and state estimates of COVID-19 vaccination receipt and intent to vaccinate by race/ethnicity, income, and age group among adults ≥ 18 years, United States.

INTRODUCTION: COVID-19 morbidity and mortality has disproportionately affected vulnerable populations such as minority racial/ethnic groups. Understanding disparities in vaccine intentions and reasons for vaccine hesitancy are important for developing effective strategies for ameliorating racial/ethnic COVID-19 inequities. METHODS: Using six waves of the large, nationally representative Census Bureau's Household Pulse Survey data from January 6-March 29, 2021 (n = 459,235), we examined national and state estimates for vaccination intent, defined as receipt of ≥ 1 dose of the COVID-19 vaccine or definite intent to be vaccinated, by race/ethnicity with stratification by household income and age group. In separate logistic regression models, we also examined the interaction between race/ethnicity and household income, and race/ethnicity and age group, and its association with vaccination intent. Lastly, we examined reasons for not vaccinating by race/ethnicity. RESULTS: Vaccination intent differed by racial/ethnic group, household income, and age group nationally and by Health and Human Services (HHS) region and state. A significant interaction was observed between race/ethnicity and household income (F(8,72) = 4.50, p < 0.001), and race/ethnicity and age group (F(8,72) = 15.66, p < 0.001). Non-Hispanic Black adults with lower income (<$35,000) and younger age (18-49 years) were least likely to intend to vaccinate. Similar disparities across racial/ethnic groups were seen across most HHS regions and states. Concerns about possible side effects and effectiveness were significantly higher among all minority groups compared to non-Hispanic White adults. CONCLUSION: Disparities in vaccination intent by racial/ethnic groups underscore the need for interventions and recommendations designed to improve vaccination coverage and confidence in underserved communities, such as younger and lower income racial/ethnic minority groups. Efforts to reduce disparities and barriers to vaccination are needed to achieve equity in vaccination coverage, and ultimately, to curb COVID-19 transmission.