Social Disparities in the Duration of Power and Piped Water Outages in Texas After Winter Storm Uri.

We assessed sociodemographic disparities in basic service disruptions caused by Winter Storm Uri in Texas. We collected data through a bilingual telephone survey conducted in July 2021 (n = 753). Being Black, having children, and renting one's residence were associated with longer power outage durations; being Black was also associated with longer water outages. Our findings highlight the need to plan for and ameliorate inequitable service outages and their attendant health risks in climate change-related extreme weather events such as Uri. (Am J Public Health. 2023;113(1):30-34. https://doi.org/10.2105/AJPH.2022.307110).

Trimester-specific ambient PM2.5 exposures and risk of intellectual disability in Utah.

Prenatal fine particulate matter (PM2.5) exposure is an understudied risk factor for neurodevelopmental outcomes, including intellectual disability (ID). Associations among prenatal exposures and neurodevelopmental outcomes may vary depending on the timing of exposure. Limited numbers of studies examining PM2.5 and neurodevelopmental outcomes have considered exposures occurring during the preconception period. To address these gaps, we conducted a case-control study of children born in Utah between 2002 and 2008 (n = 1032). Cases were identified using methods developed by the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network and matched with controls on birth year, sex, and birth county. We estimated the daily average PM2.5 concentration during a period spanning 12 weeks before the estimated conception date, as well as during each of the three trimesters at the maternal residential address listed on the child's birth certificate. In a multivariable model, the third (OR: 2.119, CI: 1.123-3.998, p = .021) and fourth (OR: 2.631, CI: 1.750-3.956, p < .001) quartiles for preconception average PM2.5 demonstrated significantly increased risk of ID relative to the first quartile. Second quartile preconception exposure was also associated with increased risk, though it did not reach significance (OR: 1.385, CI: 0.979-1.959, p = .07). The fourth quartile of first trimester average PM2.5 was positive and significant (OR: 2.278, CI: 1.522-3.411, p < .001); the third quartile was positive, but not significant (OR: 1.159, CI: 0.870-1.544, p = .312). Quartiles of second and third trimester were not associated with higher risk of ID. These findings from Utah, which were robust to a variety of sensitivity analyses, provide initial evidence that preconception and prenatal PM2.5 exposure may be associated with ID. Future studies are needed across other geographic locations and populations.

Exploring the distributional environmental justice implications of an air quality monitoring network in Los Angeles County.

Non-governmental air quality monitoring networks include low-cost, networked air pollution sensors hosted at homes and schools that display real-time pollutant concentration estimates on publicly accessible websites. Such networks can empower people to take health-protective actions, but their unplanned organization may produce an uneven spatial distribution of sensors. Barriers to acquiring sensors may disenfranchise particular social groups. To test this directly, we quantitatively examine if there are social inequalities in the distribution of sensors in a non-governmental air quality monitoring network (PurpleAir) in Los Angeles County, California. We paired sociodemographic data from the American Community Survey and estimates of PM2.5 concentrations from the USEPA's Downscaler model at the census tract level (n = 2203) with a sensors per capita (SPC) variable, which is based on population proximity to PurpleAir sensors (n = 696) in Los Angeles County. Findings from multivariable generalized estimating equations (GEEs) controlling for clustering by housing age and value reveal patterns of environmental injustice in the distribution of PurpleAir sensors across Los Angeles County census tracts. Tracts with higher percentages of Hispanic/Latino/a and Black residents and lower median household income had decreased SPC. There was a curvilinear (concave) relationship between the percentage of renter-occupants and SPC. Sensors were concentrated in tracts with greater percentages of adults and seniors (vs. children), higher occupied housing density, and higher PM2.5 pollution. Results reveal social inequalities in the self-organizing PurpleAir network, suggesting another layer of environmental injustice such that residents of low-income and minority neighborhoods have reduced access to information about local air pollution.

Communities of color are disproportionately exposed to long-term and short-term PM2.5 in metropolitan America.

We conducted a novel investigation of neighborhood-level racial/ethnic exposure disparities employing measures aligned with long-term and short-term PM2.5 air pollution benchmarks across metropolitan contexts of the contiguous United States, 2012-2016. We used multivariable generalized estimating equations (GEE) to quantify PM2.5 exposure disparities based on the census tract composition of people of color (POC) and POC groups (Hispanic/Latina/x/o, Black, Asian). We examined eight census tract-level measures of longer-to-shorter term exposures derived from data on modeled daily ambient PM2.5 concentrations. We found associations between increased POC composition and greater exposure to all PM2.5 measures, with associations strengthening across measures of longer-to-shorter term exposures. In a GEE with a negative binomial distribution, a standard deviation increase in POC composition predicted a 0.6% increase (incidence rate ratio (IRR): 1.006, 95% confidence interval (CI): 1.005-1.008) in the number of days PM2.5 concentrations were ≥5 µg/m3 (longest-term benchmark). In a GEE with an inverse Gaussian distribution, a standard deviation increase in POC composition predicted a 0.110 µg/m3 (1.0%) increase (B: 0.110, 95% CI: 0.076-0.143) in mean PM2.5 concentration. In GEEs with a negative binomial distribution, the effect of a standard deviation increase in POC composition on exposure strengthened to 2.6% (IRR:1.026, 95% CI:1.017-1.035), 3.4% (IRR:1.034, 95% CI:1.022-1.047), 4.2% (IRR:1.042, 95% CI:1.025-1.058), 16.2% (IRR:1.162, 95% CI:1.117-1.210), 22.7% (IRR:1.227, 95% CI:1.137-1.325) and 28.3% (IRR:1.283, 95% CI:1.144-1.439) with respect to the number of days PM2.5 concentrations were ≥10, 12, 15, 25, 35 and 55.5 µg/m3. POC group models indicated exposure disparities based on greater Hispanic/Latina/x/o, Asian, and Black composition. Evidence for stronger POC associations with shorter-term (higher concentration) PM2.5 exceedances suggests that reducing PM2.5 would attenuate racial/ethnic exposure disparities.

Social disparities in neighborhood heat in the Northeast United States.

Upward trends in ground-level warming are expected to intensify, affecting the health of human populations. Specific to the United States, the Northeast (NE) region is one of the most vulnerable to these warming trends. Previous research has found social disparities in the distribution of heat, while recent studies have examined associations between metropolitan racial/ethnic segregation and heat exposures. We advance upon previous research by including a novel measure of neighborhood-level racial/ethnic diversity in our examination of social inequalities in heat for NE neighborhoods (census tracts). We paired data derived from the United States Geological Survey on mean land surface temperature (LST) for the summer months of 2013-2017 with sociodemographic data from the American Community Survey (5-year estimates, 2013-2017). We use multivariable generalized estimating equations (GEEs) that adjust for geographic clustering. Findings reveal heat exposure disparities across NE neighborhoods. Neighborhoods with higher proportions of racial/ethnic minorities, people of lower socioeconomic status, households without access to an automobile, and greater diversity experience higher temperatures. Diversity was more strongly related to increased heat in neighborhoods with lower Latinx and lower Black composition suggesting that neighborhood homogeneity confers a differentially greater cooling effect based on higher White composition. The social groups that carry the unequal thermal burdens are also those who are most vulnerable. Interventions to reduce heat risks in the NE should therefore prioritize reducing the burden on historically disadvantaged communities.

Headache Disorders: Does Pain Affect Blood Pressure?

PURPOSE OF REVIEW: The perspective that pain corresponds to elevated blood pressure is overly simplistic. Our objective is to investigate and debunk misconceptions regarding the effect of pain on blood pressure. RECENT FINDINGS: While pain can increase blood pressure in the acute setting, prolonged pain and migraine's effect on blood pressure varies and can result in lower-than-expected blood pressure. Therefore, attributing pain as a sole source of elevation of blood pressure may lead to delays in diagnosing hypertension. Based on limited studies available, comorbid pain and chronic hypertension have a higher concurrence than in the general population. We will review current literature to investigate the effect of pain on blood pressure and prevalence of hypertension in chronic pain sufferers. A better understanding of pain's effect on blood pressure will help practitioners appropriately diagnose and counsel patients without disproportionately attributing high blood pressure to pain.

Geographic and Specialty Access Disparities in US Pediatric Leukodystrophy Diagnosis.

OBJECTIVE: To examine disparities in the diagnosis of leukodystrophies including geographic factors and access to specialty centers. STUDY DESIGN: Retrospective cohort study of pediatric patients admitted to Pediatric Health Information System hospitals. Patients with leukodystrophy were identified with International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic codes for any of 4 leukodystrophies (X-linked adrenoleukodystrophy, Hurler disease, Krabbe disease, and metachromatic leukodystrophy). We used 3-level hierarchical generalized logistic modeling to predict diagnosis of a leukodystrophy based on distance traveled for hospital, neighborhood composition, urban/rural context, and access to specialty center. RESULTS: We identified 501 patients with leukodystrophy. Patients seen at a leukodystrophy center of excellence hospital were 1.73 times more likely to be diagnosed than patients at non-center of excellence hospitals. Patients who traveled farther were more likely to be diagnosed than those who traveled shorter. Patients living in a Health Professionals Shortage Area zip code were 0.86 times less likely to be diagnosed than those living in a non-Health Professionals Shortage Area zip code. CONCLUSIONS: Geographic factors affect the diagnosis of leukodystrophies in pediatric patients, particularly in regard to access to a center with expertise in leukodystrophies. Our findings suggest a need for improving access to pediatric specialists and possibly deploying specialists or diagnostic testing more broadly.

Stabilization of Black Phosphorus by Sonication-Assisted Simultaneous Exfoliation and Functionalization.

Black phosphorus (BP) has extraordinary properties, but its ambient instability remains a critical challenge. Functionalization has been employed to overcome the sensitivity of BP to ambient conditions while preserving its properties. Herein, a simultaneous exfoliation-functionalization process is reported that functionalizes BP flakes during exfoliation and thus provides increased protection, which can be attributed to minimal exposure of the flakes to ambient oxygen and water. A tetrabutylammonium salt was employed for intercalation of BP, resulting in the formation of flakes with large lateral dimensions. The addition of an aryl iodide or an aryl iodonium salt to the exfoliation solvent creates a scalable strategy for the production of functionalized few-layer BP flakes. The ambient stability of functionalized BP was prolonged to a period of one week, as revealed by STEM, AFM, and X-ray photoelectron spectroscopy.

Mass Testing for SARS-CoV-2 in 16 Prisons and Jails - Six Jurisdictions, United States, April-May 2020.

Preventing coronavirus disease 2019 (COVID-19) in correctional and detention facilities* can be challenging because of population-dense housing, varied access to hygiene facilities and supplies, and limited space for isolation and quarantine (1). Incarcerated and detained populations have a high prevalence of chronic diseases, increasing their risk for severe COVID-19-associated illness and making early detection critical (2,3). Correctional and detention facilities are not closed systems; SARS-CoV-2, the virus that causes COVID-19, can be transmitted to and from the surrounding community through staff member and visitor movements as well as entry, transfer, and release of incarcerated and detained persons (1). To better understand SARS-CoV-2 prevalence in these settings, CDC requested data from 15 jurisdictions describing results of mass testing events among incarcerated and detained persons and cases identified through earlier symptom-based testing. Six jurisdictions reported SARS-CoV-2 prevalence of 0%-86.8% (median = 29.3%) from mass testing events in 16 adult facilities. Before mass testing, 15 of the 16 facilities had identified at least one COVID-19 case among incarcerated or detained persons using symptom-based testing, and mass testing increased the total number of known cases from 642 to 8,239. Case surveillance from symptom-based testing has likely underestimated SARS-CoV-2 prevalence in correctional and detention facilities. Broad-based testing can provide a more accurate assessment of prevalence and generate data to help control transmission (4).

Hazardous air pollutants are associated with worse performance in reading, math, and science among US primary schoolchildren.

Emerging evidence demonstrates that chronic exposure to air pollution may negatively impact children's cognitive processing and memory. Little is currently known about how air pollution impacts individual children's academic performance through time. Academic performance is practically important, given its linkage to children's future life course trajectories. Individual-level, longitudinal data from 16,000 US primary school students are combined with a tract-level hazardous air pollutant (HAP) measure to assess how kindergarten exposures are associated with competencies in reading, math and science through third grade. We employed linear mixed models with repeated measures within children (e.g., five math tests across four years), clustering within census tracts, and random effects specified at the child- and census tract-levels. Controlling for a comprehensive list of time variant and time invariant covariates, we found statistically significant associations between higher levels of HAPs and lower reading (b = -0.02; p < 0.05), math (b = -0.02; p < 0.001), and science (b = -0.05; p < 0.001) scores. These negative effects of pollution on academic competency in the early primary school years add to the weight of evidence that air pollution harms children's academic potential.

Light pollution inequities in the continental United States: A distributive environmental justice analysis.

Excessive exposure to ambient light at night is a well-documented hazard to human health, yet analysts have not examined it from an environmental justice (EJ) perspective. We conducted the first EJ study of exposure to light pollution by testing for socially disparate patterns across the continental United States (US). We first calculated population-weighted mean exposures to examine whether ambient light pollution in the US differed between racial/ethnic groups. We then used multivariable generalized estimating equations (GEEs) that adjust for geographic clustering to examine whether light pollution was distributed inequitably based on racial/ethnic composition and socioeconomic status across US neighborhoods (census tracts). Finally, we conducted a stratified analysis of metropolitan core, suburban, and small city-rural tracts to determine whether patterns of inequity varied based on urban-rural context. We found evidence of disparities in exposures to light pollution based on racial/ethnic minority and low-to-mid socioeconomic statuses. Americans of Asian, Hispanic or Black race/ethnicity had population-weighted mean exposures to light pollution in their neighborhoods that were approximately two times that of White Americans. GEEs indicated that neighborhoods composed of higher proportions of Blacks, Hispanics, Asians, or renter-occupants experienced greater exposures to ambient light at night. Stratified analyses indicated that those patterns of inequity did not substantially vary based on urban-rural context. Findings have implications for understanding environmental influences on health disparities, raise concerns about the potential for a multiple environmental jeopardy situation, and highlight the need for policy actions to address light pollution.

Patterns of distributive environmental inequity under different PM2.5 air pollution scenarios for Salt Lake County public schools.

Previous studies have cataloged social disparities in air pollution exposure in US public schools with respect to race/ethnicity and socioeconomic status. These studies rely upon chronic, averaged measures of air pollution, which fosters a static conception of exposure disparities. This paper examines PM2.5 exposure disparities in Salt Lake County (SLC), Utah public schools under three different PM2.5 scenarios-relatively clean air, a moderate winter persistent cold air pool (PCAP), and a major winter PCAP-with respect to race/ethnicity, economic deprivation, student age, and school type. We pair demographic data for SLC schools (n = 174) with modelled PM2.5 values, obtained from a distributed network of sensors placed through a community-university partnership. Results from generalized estimating equations controlling for school district clustering and other covariates reveal that patterns of social inequality vary under different PM2.5 pollution scenarios. Charter schools and schools serving economically deprived students experienced disproportionate exposure during relatively clean air and moderate PM2.5 PCAP conditions, but those inequalities attenuated under major PCAP conditions. Schools with higher proportions of racial/ethnic minority students were unequally exposed under all PM2.5 pollution scenarios, reflecting the robustness of racial/ethnic disparities in exposure. The findings speak to the need for policy changes to protect school-aged children from environmental harm in SLC and elsewhere.

Hurricane Harvey and Greater Houston households: comparing pre-event preparedness with post-event health effects, event exposures, and recovery.

Most disaster studies rely on convenience sampling and 'after-only' designs to assess impacts. This paper, focusing on Hurricane Harvey (2017) and leveraging a pre-/post-event sample of Greater Houston households (n=71) in the United States, establishes baselines for disaster preparedness and home structure flood hazard mitigation, explores household-level ramifications, and examines how preparedness and mitigation relate to health effects, event exposures, and recovery. Between 70 and 80 per cent of participants instituted preparedness measures. Mitigation actions varied: six per cent had interior drainage systems and 83 per cent had elevated indoor heating/cooling components. Sixty per cent reported home damage. One-half highlighted allergies and two-thirds indicated some level of post-traumatic stress (PTS). Three-quarters worried about family members/friends. The results of generalised linear models revealed that greater pre- event mitigation was associated with fewer physical health problems and adverse experiences, lower PTS, and faster recovery. The study design exposed the broad benefits of home structure flood hazard mitigation for households after Harvey.

Evaluating the Surface Chemistry of Black Phosphorus during Ambient Degradation.

Black phosphorus (BP) is emerging as a promising candidate for electronic, optical, and energy storage applications. However, its poor ambient stability remains a critical challenge. Evaluation of few-layer liquid-exfoliated BP during ambient exposure using X-ray photoelectron spectroscopy and attenuated total reflectance Fourier transform infrared spectroscopy allows its surface chemistry to be investigated. Oxidation of liquid-exfoliated few-layer BP initially occurs through nonbridging oxide species, which convert to bridging oxide species after ambient exposure. We demonstrate the instability of these bridging oxide species, which undergo hydrolysis to form volatile phosphorus oxides and evaporate from the BP surface. FTIR spectroscopy, scanning transmission electron microscopy, and atomic force microscopy were used to confirm the formation of liquid oxides through a continuous oxidation cycle that results in the decomposition of BP. Furthermore, we show that the instability of few-layer BP originates from the formation of bridging oxide species.

Exploring the Environmental Justice Implications of Hurricane Harvey Flooding in Greater Houston, Texas.

OBJECTIVES: To assess the environmental justice implications of flooding from Hurricane Harvey in Greater Houston, Texas, we analyzed whether the areal extent of flooding was distributed inequitably with respect to race, ethnicity, and socioeconomic status, after controlling for relevant explanatory factors. METHODS: Our study integrated cartographic information from Harvey's Inundation Footprint, developed by the US Federal Emergency Management Agency, with sociodemographic data from the 2012-2016 American Community Survey. Statistical analyses were based on bivariate correlations and multivariate generalized estimating equations. RESULTS: The areal extent of Harvey-induced flooding was significantly greater in neighborhoods with a higher proportion of non-Hispanic Black and socioeconomically deprived residents after we controlled for contextual factors and clustering. CONCLUSIONS: Results provide evidence of racial/ethnic and socioeconomic injustices in the distribution of flooding and represent an important starting point for more detailed investigation of disproportionate impacts associated with Hurricane Harvey. Public Health Implications. Our findings highlight the need to prepare for and address the unequal social consequences of climate change-related disasters, which are expected to increase in frequency and severity.

Social disparities in exposure to noise at public schools in the contiguous United States.

Children are vulnerable to environmental hazards and spend significant portions of their days at school. However, just one national-level study has examined school-level environmental inequalities (in air pollution exposures), and none have examined disparate exposures to noise pollution, even though noise impacts children's health and development. We integrated data from 2014-2015 on the locations and socio-demographics of each public school in the contiguous US (n=94,432) with road and aviation transportation noise estimates. Using bivariate and multivariate statistics, we tested for disparities in road and aviation noise exposure across schools. Among the 49,697,890 children attending contiguous US public schools, we found that those attending schools most highly exposed to road noise or aviation noise were significantly more likely to be eligible for free/reduced price meals (economically deprived), and to be Hispanic, black, or Asian/Pacific Islander (API). They were less likely to be white or of another race. In multivariate generalized estimating equations (GEEs) controlling for school district effects, we found that schools with greater proportions of Hispanic, black or API students, schools with higher enrollment, and schools serving the youngest students had significantly more road noise and greater odds of aviation noise exposure. In the GEEs, a higher proportion of economically-deprived students in schools was associated with greater road noise, but not aviation noise. Overall, our analyses indicate that America's racial/ethnic minority children bear the brunt of transportation noise exposures at school, which may unequally impact their academic performance, health, and future potential.

Environmental injustice and Hurricane Harvey: A household-level study of socially disparate flood exposures in Greater Houston, Texas, USA.

Environmental justice research on flooding has relied heavily on analyses of aggregated geographic areal units and assessing exposure to 'pre-flood' risks (e.g., residence in 100-year flood zones) rather than actual flood events. To address these limitations, we examined disproportionate exposure to flooding caused by Hurricane Harvey in 2017 in Greater Houston (Texas). Using primary survey data collected from 377 representative households before Harvey and spatial data on Harvey-induced inundation developed by the US Federal Emergency Management Agency, we found that the areal extent of flooding around residents' home sites was distributed inequitably with respect to race/ethnicity and socioeconomic status (SES). Hispanic, black and other racial/ethnic minority households experienced more extensive flooding than white households, and lower SES households faced more extensive flooding than higher SES households. Findings align with prior flood risk research in Greater Houston and provide cause for concern, as social inequities in flood exposure may have influenced social disparities in flood impacts and post-disaster needs. Since flood events in Greater Houston are expected to increase in frequency and magnitude due to climate change, socially disparate impacts are likely to become an increasingly salient public policy issue. Thus, proactive approaches for reducing flood risks and ameliorating disparities should be implemented.

The Role of Parents' Nativity in Shaping Differential Risks of Food Insecurity Among US First Graders.

Objectives Food insecurity remains a problem in the US, especially for children in immigrant families. We developed a novel measure of parental nativity and incorporated school effects to advance knowledge from prior studies. Methods Using hierarchical logistic models and data from the Early Childhood Longitudinal Study-2011 Kindergarten Cohort, we examined how parental nativity and race/ethnicity, and school characteristics influence household food insecurity among a nationally representative sample of US first-graders in 2012. Results After adjusting for potential confounders, children without any US-born parents had a higher likelihood of household food insecurity than children with two US-born parents or one foreign-born/one US-born parent. Attending a Title 1 school was associated with food insecurity independent of household socioeconomic status. Conclusions for Practice Results suggest that providers should take special care to screen for food insecurity among children with only immigrant parents and that Title 1 schools have a potentially important role to play in reducing food insecurity.

The burden of carcinogenic air toxics among Asian Americans in four US metro areas.

This study investigated disparities in residential exposure to carcinogenic air pollutants among Asian Americans, including Asian ancestry subgroups, in four US metro areas with high proportions of Asians, i.e., Honolulu, Los Angeles, San Francisco Bay Area, and Seattle. Generalized estimating equations adjusting for socioeconomic status, population density and clustering show that a greater proportion of Asian Americans in census tracts was associated with significantly greater health risk in all four metro areas. Intracategorical disparities were uncovered for Asian ancestry. A greater proportion Korean was positively associated with risk in four metro areas; greater proportion Chinese and Filipino were positively associated with risk in three of the four metro areas. While Asian Americans are infrequently examined in environmental justice research, these results demonstrate that Asian Americans experience substantial distributional environmental injustices in these four metro areas and that ancestry is an important dimension of intracategorical complexity.

Geographic and social disparities in exposure to air neurotoxicants at U.S. public schools.

Children are especially vulnerable to the health and developmental impacts of environmental hazards and they spend significant portions of their days at school. Yet there are no national-level studies examining school-level environmental inequalities and few have examined disparate exposure to neurological air toxicants, even though chronic exposure to air pollution impacts children's brain functioning. We paired information about the geographic locations and demographics of each public school in the US with air neurotoxicant exposure estimates pertaining to 24 known neurotoxicants included in the US Environmental Protection Agency's National Air Toxics Assessment. Using bivariate and multivariate statistics, we tested for environmental injustices in air neurotoxicant exposure at 84,969 US public schools. Metropolitan New York City (EPA Region 2) is the geographic region most burdened by air neurotoxicant exposures at schools since one-third of all schools in that region are in the top 10% (at "high risk") for ambient neurotoxicant exposure among all schools nationwide. Students attending "high risk" public schools nationwide are significantly more likely to be eligible for free/reduced price meals, and to be Hispanic, black, or Asian/Pacific Islander (API). They are significantly less likely to be white or of another race. In a multivariate generalized estimating equation controlling for school district effects, schools with greater proportions of Hispanic, black, and API students, schools with higher enrollment, and schools located in more urban (vs. rural) counties face greater risks. Schools serving the youngest students (e.g., pre-kindergarten) have greater levels of risk than schools serving older students. Across all analyses, this study shows that racial/ethnic minority children are bearing the brunt of air neurotoxicant exposures at school, which may be unequally impacting their school performance and future potential.