Meeting the Water and Sanitation Challenges of Underbounded Communities in the U.S.

Water and sanitation (wastewater) infrastructure in the United States is aging and deteriorating, with massive underinvestment over the past several decades. For many years, lack of attention to water and sanitation infrastructure has combined with racial segregation and discrimination to produce uneven access to water and wastewater services resulting in growing threats to human and environmental health. In many metropolitan areas in the U.S., those that often suffer disproportionately are residents of low-income, minority communities located in urban disadvantaged unincorporated areas on the margins of major cities. Through the process of underbounding (the selective expansion of city boundaries to exclude certain neighborhoods often based on racial demographics or economics), residents of these communities are disallowed municipal citizenship and live without piped water, sewage lines, and adequate drainage or flood control. This Perspective identifies the range of water and sanitation challenges faced by residents in these communities. We argue that future investment in water and sanitation should prioritize these communities and that interventions need to be culturally context sensitive. As such, approaches to address these problems must not only be technical but also social and give attention to the unique geographic and political setting of local infrastructures.

Review of methods to determine hand surface area of children less than six years old: a case study.

Various methods exist to determine the surface area of hands. The consistency of these methods is essential given that risk assessments utilize hand surface area (HSA) to quantify exposure to environmental contaminants. HSA is also utilized in the clinical setting to estimate size of burns, and to determine specific treatments and medication dosages. A reliable method of surface area measurement is important to guide these decisions, especially in children who are vulnerable to environmental contaminants and medication side effects. Despite this, fewer HSA-determining studies have been performed for children compared to adults. In this study, 122 children completed hand tracings, and the tracings were digitized using an ImageJ program to determine HSA. Six previously published methods of determining HSA were utilized based on the child's height, weight, and length and width of hand. Children were analyzed by age group including 0-2, 3-4, and 5-6 years. The HSA measurements determined by five of the six methods were statistically different from HSA determined using direct hand tracings/Image J methodology (p < 0.001). The single remaining study that did not differ significantly from the hand tracing method provided a uniform hand to total body surface area (TBSA) ratio for children of all ages. Based on these results, we propose a novel age-group-specific ratio utilizing the HSA results from hand tracings and TBSA calculations. The percentages of TBSA that reflect HSA for children aged 0-2, 3-4 and 5-6 years were 0.91%, 0.90% and 0.87%, respectively. These percentages should be considered for use in risk assessments and the clinical setting to guide treatment and prognosis.

Towards integrated modeling of the long-term impacts of oil spills.

Although great progress has been made to advance the scientific understanding of oil spills, tools for integrated assessment modeling of the long-term impacts on ecosystems, socioeconomics and human health are lacking. The objective of this study was to develop a conceptual framework that could be used to answer stakeholder questions about oil spill impacts and to identify knowledge gaps and future integration priorities. The framework was initially separated into four knowledge domains (ocean environment, biological ecosystems, socioeconomics, and human health) whose interactions were explored by gathering stakeholder questions through public engagement, assimilating expert input about existing models, and consolidating information through a system dynamics approach. This synthesis resulted in a causal loop diagram from which the interconnectivity of the system could be visualized. Results of this analysis indicate that the system naturally separates into two tiers, ocean environment and biological ecosystems versus socioeconomics and human health. As a result, ocean environment and ecosystem models could be used to provide input to explore human health and socioeconomic variables in hypothetical scenarios. At decadal-plus time scales, the analysis emphasized that human domains influence the natural domains through changes in oil-spill related laws and regulations. Although data gaps were identified in all four model domains, the socioeconomics and human health domains are the least established. Considerable future work is needed to address research gaps and to create fully coupled quantitative integrative assessment models that can be used in strategic decision-making that will optimize recoveries from future large oil spills.

Overweight and Obesity Among School Bus Drivers in Rural Arkansas.

INTRODUCTION: Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined. METHODS: We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m2) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers' perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 "ride-alongs" and an environmental scan. RESULTS: Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage. CONCLUSION: Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers' body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers' health.

Assessing the health of homes in the Central Little Rock Neighborhood of Arkansas.

The quality of the indoor air has received greater consideration in the last decade as Americans spend more time indoors and researchers become more aware of the influence of poor indoor air quality on adverse health outcomes. This paper presents the assessment of 10 homes in the Central Little Rock Neighborhood of Arkansas, using survey tools adapted from The Healthy Homes Initiative (HHI) and other health agencies. Mold, ventilation related deficiencies, and high levels of air particulates relative to the outdoors were the predominant findings in the ten homes.

Recommendations for implementing an Arkansas state-wide healthy homes program.

Relative housing condition has been shown to correlate to the health of its occupants. While unhealthy homes affect those from all income levels, geographical areas and cultures or ethnic groups, studies frequently link poorer quality housing to low socioeconomic status. Several factors seem to justify the creation of a State Healthy Homes program. These include the significant health and economic cost of home hazards, the value of an integrated approach, federal actions to support such programs and existing examples from other states. This paper discusses such factors and proposes a healthy homes program approach for Arkansas.

Methodologies for the collection of parameters to estimate dust/soil ingestion for young children.

Background: Heavy metals, pesticides and a host of contaminants found in dust and soil pose a health risk to young children through ingestion. Dust/soil ingestion rates for young children can be estimated using micro-level activity time series (MLATS) as model inputs. MLATS allow for the generation of frequency and duration of children's contact activities, along with sequential contact patterns. Models using MLATS consider contact types, and transfer dynamics to assign mechanisms of contact and appropriate exposure factors for cumulative estimates of ingestion rates. Objective: The objective of this study is to describe field implementation, data needs, advanced field collection, laboratory methodologies, and challenges for integrating into and updating a previously validated physical-stochastic MLATS-based model framework called the Child-Specific Aggregate Cumulative Human Exposure and Dose (CACHED) model. The manuscript focuses on describing the methods implemented in the current study. Methods: This current multidisciplinary study (Dust Ingestion childRen sTudy [DIRT]) was implemented across three US regions: Tucson, Arizona; Miami, Florida and Greensboro, North Carolina. Four hundred and fifty participants were recruited between August 2021 to June 2023 to complete a 4-part household survey, of which 100 also participated in a field study. Discussion: The field study focused on videotaping children's natural play using advanced unattended 360° cameras mounted for participants' tracking and ultimately conversion to MLATS. Additionally, children's hand rinses were collected before and after recording, along with indoor dust and outdoor soil, followed by advanced mass analysis. The gathered data will be used to quantify dust/soil ingestion by region, sociodemographic variables, age groups (from 6 months to 6 years), and other variables for indoor/outdoor settings within an adapted version of the CACHED model framework. Significance: New innovative approaches for the estimation of dust/soil ingestion rates can potentially improve modeling and quantification of children's risks to contaminants from dust exposure.

Correction: Ferguson et al. Soil, Hand, and Body Adherence Measures across Four Beach Areas: Potential Influence on Exposure to Oil Spill Chemicals. Int. J. Environ. Res. Public Health 2020, 17, 4196.

In the original publication [...].

Integrating microbial source tracking with quantitative microbial risk assessment to evaluate site specific risk based thresholds at two South Florida beaches.

Quantitative microbial risk assessment (QMRA) can be used to evaluate health risks associated with recreational beach use. This study developed a site-specific risk assessment using a novel approach that combined quantitative PCR-based measurement of microbial source tracking (MST) genetic markers (human, dog, and gull fecal bacteria) with a QMRA analysis of potential pathogen risk. Water samples (n = 24) from two recreational beaches were collected and analyzed for MST markers as part of a broader Beach Exposure And Child Health Study that examined child behavior interactions with the beach environment. We report here the measurements of fecal bacteria MST markers in the environmental DNA extracts of those samples and a QMRA analysis of potential health risks utilizing the results from the MST measurements in the water samples. Human-specific Bacteroides was enumerated by the HF183 Taqman qPCR assay, gull-specific Catellicoccus was enumerated by the Gull2 qPCR assay, and dog-specific Bacteroides was enumerated by the DogBact qPCR assay. Derived reference pathogen doses, calculated from the MST marker concentrations detected in recreational waters, were used to estimate the risk of gastrointestinal illness for both children and adults. Dose-response equations were used to estimate the probability of the risk of infection (Pinf) per a swimming exposure event. Based on the QMRA simulations presented in this study, the GI risk from swimming or playing in water containing a mixture of human and non-human fecal sources appear to be primarily driven by the human fecal source. However, the estimated median GI health risk for both beaches never exceeded the U.S. EPA risk threshold of 32 illnesses per 1,000 recreation events. Our research suggests that utilizing QMRA together with MST can further extend our understanding of potential recreational bather risk by identifying the source contributing the greatest risk in a particular location, therefore informing beach management responses and decision-making.

An education initiative concerning lead in an Arkansas community: results from pre- and post-surveys.

The Arkansas People Participating in Lead Education (APPLE) Program is a collaborative effort between six Arkansas state, national and community organizations to provide lead awareness, training, and municipal legislation to needy communities in Arkansas. Under this program, APPLE organized and hosted well-designed, hands-on, and effective "call to action" lead awareness workshops for parents and community members in 10 needy communities over a 2 year period. Pre- and post-surveys were given to community members to access knowledge, attitudes and effectiveness of lead workshop activities, with demographic and another 13 and 11 questions on pre- and post-surveys, respectively. There were 709 adult attendees across the 10 workshop (Many children also attended.), with 460 completing pre-surveys, and 199 completed post-survey. Post-surveys were limited to four cities. The majority of those who completed surveys were African-American, reported as 78% on pre-surveys, with the majority also being parents (61%) and females. Although, 71% reported knowing that lead paint was bad for their health, more than 60% reported knowing little about lead exposure, and another 25% did not know the age of their residence. On the post-surveys, the majority of respondents found the workshop to be pleasant and informative (98%), while 45% had changed something in their lives to prevent lead exposure for a child and another 53% planned to make a change to prevent lead exposure for a child.

Computer controlled chamber measurements for clay adherence relevant for potential dioxin exposure through skin.

A computer-controlled mechanical chamber was used to control the contact between aluminum sheet samples laden with clay, and cotton sheet samples for the measurement of mass transfer. The contact parameters of pressure (20 to 60 kPa) and time (10 to 70 sec) were varied for 160 multiple experiments of mass soil transfer. Before log transformation the average transfer for 'First Transfer' of clay particles was 34.4 ± 6.3 mg/8.97 cm(2) while that for 'Total Transfer' was 36.1 ± 6.8 mg/8.97 cm(2). Second contact, therefore, resulted in an average transfer of 1.70 ± 0.76 mg/8.97 cm(2). These values are well above adherence values measured for potting soil and sand as reported for previous experiments using the same methodologies. Based on the univariate analysis and the multiple regression analysis we were able to see some effect of parameters on the clay adherence values. The effect of pressure increases was significant for the higher levels of 50 and 60 kPa. In addition, we observed that increases in temperature were significant for 'First Transfer,' and less so for 'Total Transfer'. Past experiments using potting soil and play sand show high adherence values to human cadaver skin over cotton sample; the same scenario would be expected for clay. This data set can be used to improve estimates of dermal exposure to dioxins found in ball clays often used by artisans in the making of pottery.

PAH depletion in weathered oil slicks estimated from modeled age-at-sea during the Deepwater Horizon oil spill.

During time-periods oil slicks are in the marine environment (age-at-sea), weathering causes significant changes in composition and mass loss (depletion) of oil spill chemicals including the more toxic polycyclic aromatic hydrocarbons (PAHs). The goal of this study was to estimate the age-at-sea of weathered oil slicks using the oil spill module of the Connectivity Modeling System and to use this age to interpret PAH concentration measurements. Percent depletion (PD) for each measurement was computed as the percentage difference between the original and measured PAH concentration in the crude oil and weathered oil slicks, normalized upon the mass losses relative to hopane. Mean PD increased with estimated age-at-sea for all PAHs. Less PD was observed for alkylated than for parent PAHs, likely due to decreasing vapor pressure with increasing degree of alkylation. We conclude that estimated age-at-sea can be used to explain PAH depletion in weathered oil slicks. We propose PAH vapor pressure can be coupled with the model to expand capacity for predicting concentration distributions of individual parent and alkylated PAHs in weathered oil along the coastline. This new module will advance the science supporting oil spill response by providing more certain estimates of health risks from oil spills.

Using satellite-based AOD and ground-based measurements to evaluate the impact of the DWH oil spill on coastal air quality.

The 2010 DWH disaster generated atmospheric pollutants of health concern which reached the Gulf Coast. This study evaluated whether changes in coastal air quality due to the disaster were captured by aerosol optical depth (AOD) estimated using satellite data and by ground-based monitoring of air pollution, including fine particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5), benzene and naphthalene. Mean monthly AOD levels were higher in May 2010 [during oil spill time], (mean AOD = 0.355), than for the prior (mean AOD = 0.258) and following years (mean AOD = 0.252) (p < 0.05). PM2.5 concentrations and AOD were significantly correlated (R2 = 0.59, p < 0.05), for one study area. Elevated PM2.5, benzene, and naphthalene concentrations coincided with downwind directions from the location of the oil slicks. A fully-coupled oil fate and transport atmospheric transport model of oil spill emissions, integrated with AOD and more extensive ground-based measurements, is recommended to predict coastal population exposures during oil spills.

Arkansas People Participating in Lead Education (APPLE): results of a lead-safe training program.

Lead is still seen as one of the most harmful environmental toxins for young children, with the predominant source being deteriorating lead-based paint. Those at continued risk include those living in homes built before 1978, renovators and remodelers, and especially those with limited access to proper healthcare and diets. Proper training on lead-safe work practices focused on preventing and reducing the spread of lead dust can help reduce lead exposure. Presented in this paper are experiences in delivering lead-safe work practices training in six Arkansas cities, and results from pre- and post- surveys delivered before and immediately after the training. Pre- and post-surveys assess strong and weak areas of training. Participants demonstrated positive shifts in attitude and behavior towards lead-safe work practices following training. However, our research found that more emphasis should be focused on clarifying current lead exposure sources and routes for children.

Combined Effect of Lead Exposure and Allostatic Load on Cardiovascular Disease Mortality-A Preliminary Study.

This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008 linked to 1999-2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

Quantified Activity Patterns for Young Children in Beach Environments Relevant for Exposure to Contaminants.

In a study to evaluate beach play activities, 120 children were videotaped to observe and quantify factors that could influence their exposure to contaminants in the beach environment. Children aged 1 to 6 years were followed by researchers with video cameras at beaches (two in Miami, Florida and two in Galveston, Texas) for approximately one hour each. Factors evaluated included time spent in various beach locations, various activities engaged in, and various surfaces contacted (including contacts by hand and mouth). Activities recorded in the videos were transcribed to text files to allow for quantitative analyses. Across all sexes, age groups, and beaches, Wading was the most common activity and Seawater was the most common location where children played. The left hand was found to not be in contact with objects most of the time, while the right hand, considered the most dominant hand in most cases, contacted Plastic-Toys the most. Although activity patterns collection through videotaping and videotranslation can be labor-intensive, once collected, they can be widely useful for estimates of exposures to all contaminants in the beach environment (e.g., microorganisms and chemicals) as well as UV exposure, with considerations for whether the contaminants are found in water, sand or both. These activity patterns were collected to potentially look at exposures following the Deepwater Horizon 2010 Spill.

A novel method to evaluate chemical concentrations in muddy and sandy coastal regions before and after oil exposures.

Oil spills can result in changes in chemical concentrations along coastlines. In prior work, these concentration changes were used to evaluate the date sediment was impacted by oil (i.e., oil exposure date). The objective of the current study was to build upon prior work by using the oil exposure date to compute oil spill chemical (OSC) concentrations in shoreline sediments before and after exposure. The new method was applied to OSC concentration measures collected during the Deepwater Horizon oil spill with an emphasis on evaluating before and after concentrations in muddy versus sandy regions. The procedure defined a grid that overlaid coastal areas with chemical concentration measurement locations. These grids were then aggregated into clusters to allow the assignment of chemical concentration measurements to a uniform coastal type. Performance of the method was illustrated for ten chemicals individually by cluster, and collectively for all chemicals and all clusters. Results show statistically significant differences between chemical concentrations before and after the calculated oil exposure dates (p < 0.04 for each of the 10 chemicals within the identified clusters). When aggregating all chemical measures collectively across all clusters, chemical concentrations were lower before oil exposure in comparison to after (p < 0.0001). Sandy coastlines exhibited lower chemical concentrations relative to muddy coastlines (p < 0.0001). Overall, the method developed is a useful first step for establishing baseline chemical concentrations and for assessing the impacts of disasters on sediment quality within different coastline types. Results may be also useful for assessing added ecological and human health risks associated with oil spills.

Soil-skin adherence measures from hand press trials in a Gulf study of exposures.

Marine oil spills and the resulting environmental contamination is common along coastal areas; however, information is lacking about the safety of impacted beaches for public use, especially for the most vulnerable population: children. One route of exposure for children at oil impacted beaches is through contact with sands. The purpose of this study was to evaluate beach sand skin adherence for children under the age of seven. Each of 122 children participated in a hand press trial conducted at one of four different U.S. beaches (two in Miami, FL, and two in Galveston, TX USA). During the hand press trials, hand conditions of the children were randomized (dry, wet, or with sunscreen), and soil adherence (mass of sand per palmar surface area of the hand) and the maximum pressure applied (force applied per area of hand) was measured and calculated. Each child was instructed to press their hands on a soil laden tray for 5 s and pressure of contact was measured using a scale. Results (n = 98) showed that the average soil adherence for both palmar hands across the four beaches ranged from 0.200 to 234 mg/cm2 with an average of 35.7 mg/cm2, with boys (40.4 mg/cm2) showing slightly higher means than girls (31.7 mg/cm2), but these differences were not significant even after adjusting for age. Among the three conditions evaluated, the highest loading was measured for children with wet hands (mean 65.3 mg/cm2), followed by dry hands (mean 24.5 mg/cm2). Sunscreen hands (mean 23.2 mg/cm2) had the lowest loadings. The pressure of contact ranged from 0.180 to 1.69 psi and varied by age groups and by height and weight, where pressure of contact did not have a significant influence on soil adherence. The average adhered sand grain size and average ambient sand grain size both had a statistically significant impact on hand soil adherence. Overall results from this study can be utilized in exposure and risk assessment models to evaluate the possible health impacts from contaminants found in beach sands.

Assessment for oil spill chemicals: Current knowledge, data gaps, and uncertainties addressing human physical health risk.

Limited models are available to estimate human physical health risks (e.g., probability of outcomes such as lung disease, cancer, skin disease) from exposure to chemicals resulting from oil spills that may occur offshore and later impact coastline spills. An approach is presented to assess physical health risks from oil spills that involves establishing a platform capable of assessing aggregate health risk (via inhalation, ingestion, and dermal exposure routes). Gaps include the need to develop models reflecting oil spill concentration distributions given the influence from environmental, physical, biological and chemical factors. Human activities need to be quantified for different populations including emergency response workers, fishermen, shellfish consumers, and children who play at beaches that may be impacted by oil spills. Work is also needed in developing comprehensive toxicological profiles for the majority of chemicals - including dispersants found in oil spills - and to estimate toxicity from mixtures.

Categorization of nearshore sampling data using oil slick trajectory predictions.

Oil Spill Chemicals (OSCs) represent a risk to the environment and human health, especially in nearshore environments used for recreational purposes. Importantly, the starting point for human health risk assessment is to define the concentration of OSCs at nearshore locations. The objective of this study was to evaluate nearshore sampling data of OSC concentrations in different environmental matrices within time-space specific categories. The categories correspond to OSC concentration values for samples collected prior to nearshore oiling, post nearshore oiling and at no time impacted by oil as predicted by historic oil spill trajectories generated by an Oil Spill Trajectory Model. In general, concentration values for the post category were higher than prior which were higher than unimpacted. Results show differences in PAH concentration patterns within each matrix and for each category. Concentration frequency distributions for most chemicals in each category were log-normally distributed.