Examining the association between safe drinking water act violations and adverse birth outcomes in Virginia.

In 1974, the United States established the Safe Drinking Water Act (SDWA) to protect consumers from potential exposure to drinking water contaminants associated with health risks. Each contaminant is assigned a health-based standard meant to reflect the maximum level at which an adverse human health outcome is unlikely; measurements beyond that level have greater potential to result in adverse health outcomes. Although there is extensive research on human health implications following water contaminant exposure, few studies have specifically examined associations between fetal health and municipal drinking water violations. Therefore, the objective of this study is to assess whether SDWA drinking water violations are associated with fetal health outcomes, including preterm birth (PTB), low birth weight (LBW), and term-low birth weight (tLBW), in the Commonwealth of Virginia. Singleton births (n = 665,984) occurring between 2007 and 2015 in Virginia were geocoded and assigned to a corresponding estimated water service area. Health-based (HB) and monitoring and reporting (MR) violations for 12 contaminants were acquired from the US EPA Safe Drinking Water Information System, with exposure defined at the approximate service area level to limit exposure misclassification. A logistic regression model for each birth outcome assessed potential relationships with SDWA violations. When examining the association between individual MR violations and birth outcomes, Nitrate-Nitrite (OR = 1.10; 95% CI = 1.02, 1.18, P = 0.01) was positively associated with PTB and the total coliform rule was negatively associated with tLBW (OR = 0.93; 95% CI = 0.87, 1.00, P = 0.04). These findings indicate that a lack of regular monitoring and reporting by water providers (resulting in monitoring and reporting violations) may be concealing health-based violations as these health concerns cannot be revealed without testing, suggesting a need for additional technical, managerial, and financial support to enable often-underfunded water systems to adhere to monitoring and reporting requirements meant to protect public health.

Climate change and physical activity: ambient temperature and urban trail use in Texas.

Individuals in the USA are insufficiently active, increasing their chronic disease risk. Extreme temperatures may reduce physical activity due to thermal discomfort. Cooler climate studies have suggested climate change may have a net positive effect on physical activity, yet research gaps remain for warmer climates and within-day physical activity patterns. We determined the association between ambient temperatures (contemporary and projected) and urban trail use in a humid subtropical climate. At a trail in Austin, TX, five electronic counters recorded hourly pedestrian and cyclist counts in 2019. Weather data were acquired from World Weather Online. Generalized additive models estimated the association between temperature and trail counts. We then combined the estimated exposure-response relation with weather projections from climate models for intermediate (RCP4.5) and high (RCP8.5) emissions scenarios by NASA NEX-GDDP. From summer to autumn to spring to winter, hourly trail counts shifted from bimodal (mid-morning and early-evening peaks) to one mid-day peak. Pedestrians were more likely to use the trail between 7 and 27 °C (45-81°F) with peak use at 17 °C (63°F) and cyclists between 15 and 33 °C (59-91°F) with peak use at 27 °C (81°F) than at temperature extremes. A net decrease in trail use was estimated by 2041-2060 (RCP4.5: pedestrians = - 4.5%, cyclists = - 1.1%; RCP8.5: pedestrians = - 6.6%, cyclists = - 1.6%) and 2081-2100 (RCP4.5: pedestrians = - 7.5%, cyclists = - 1.9%; RCP8.5: pedestrians = - 16%, cyclists = - 4.5%). Results suggest climate change may reduce trail use. We recommend interventions for thermal comfort at settings for physical activity.

Heat-Health Behavior Change During Summer 2020 in African American Alabama Residents.

To investigate how heat-health behaviors changed in summer 2020 compared with previous summers, our community-academic partnership conducted telephone surveys to collect data on cooling behaviors, safety concerns, and preferences for cooling alternatives for 101 participants living in Alabama. Participants indicating they would visit cooling centers declined from 23% in previous summers to 10% in summer 2020. The use of cooling centers and other public spaces may be less effective in reducing heat-related illness because of safety concerns amid the COVID-19 pandemic and police brutality.

A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities.

BACKGROUND: Focus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019. METHODS: Six focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019. RESULTS: Consistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019. CONCLUSIONS: Applying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

Bayesian auxiliary variable model for birth records data with qualitative and quantitative responses.

Many applications involve data with qualitative and quantitative responses. When there is an association between the two responses, a joint model will produce improved results than fitting them separately. In this paper, a Bayesian method is proposed to jointly model such data. The joint model links the qualitative and quantitative responses and can assess their dependency strength via a latent variable. The posterior distributions of parameters are obtained through an efficient MCMC sampling algorithm. The simulation is conducted to show that the proposed method improves the prediction capacity for both responses. Further, the proposed joint model is applied to the birth records data acquired by the Virginia Department of Health for studying the mutual dependence between preterm birth of infants and their birth weights.

The effect of time spent outdoors during summer on daily blood glucose and steps in women with type 2 diabetes.

This study investigated changes in glycemic control following a small increase in time spent outdoors. Women participants with type 2 diabetes (N = 46) wore an iBUTTON temperature monitor and a pedometer for 1 week and recorded their morning fasting blood glucose (FBG) daily. They went about their normal activities for 2 days (baseline) and were asked to add 30 min of time outdoors during Days 3-7 (intervention). Linear mixed effects models were used to test whether morning FBG values were different on days following intervention versus baseline days, and whether steps and/or heat exposure changed. Results were stratified by indicators of good versus poor glycemic control prior to initiation of the study. On average, blood glucose was reduced by 6.1 mg/dL (95% CI - 11.5, - 0.6) on mornings after intervention days after adjusting for age, BMI, and ambient weather conditions. Participants in the poor glycemic control group (n = 16) experienced a 15.8 mg/dL decrease (95% CI - 27.1, - 4.5) in morning FBG on days following the intervention compared to a 1.6 mg/dL decrease (95%CI - 7.7, 4.5) for participants in the good glycemic control group (n = 30). Including daily steps or heat exposure did not attenuate the association between intervention and morning FBG. The present study suggests spending an additional 30 min outdoors may improve glycemic control; however, further examination with a larger sample over a longer duration and determination of mediators of this relationship is warranted.

Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities.

Previous research has suggested differences between public and professional understanding of the field of environmental health (EH) and the role of EH services within urban and rural communities. This study investigated EH priority differences between 1) rural and urban residents and 2) residents and EH professionals, and presents quantitative and qualitative methods for establishing locality-specific EH priorities. Residents (N = 588) and EH professionals (N = 63) in Alabama identified EH priorities via a phone or online survey. We categorized rurality of participant residences by rural-urban commuting area codes and population density, and tested whether or not EH priorities were different between urban and rural residents. Built environment issues, particularly abandoned houses, and air pollution were high priorities for urban residents-whereas, water and sanitation issues, and paper mill-related pollution were high priorities in rural communities. EH professionals ranked food safety and water and sanitation issues as higher priorities than residents did. Results highlight the importance of urbanicity on environmental risk perception and the utility of simple and inexpensive engagement methods for understanding these differences. Differences between residents and EH professionals suggest improving stakeholder participation in local-level EH decision making might lead to greater awareness of EH services, which might in turn improve support and effectiveness of those services.

Measuring personal heat exposure in an urban and rural environment.

Previous studies have linked heat waves to adverse health outcomes using ambient temperature as a proxy for estimating exposure. The goal of the present study was to test a method for determining personal heat exposure. An occupationally exposed group (urban groundskeepers in Birmingham, AL, USA N=21), as well as urban and rural community members from Birmingham, AL (N=30) or west central AL (N=30) wore data logging temperature and light monitors clipped to the shoe for 7 days during the summer of 2012. We found that a temperature monitor clipped to the shoe provided a comfortable and feasible method for recording personal heat exposure. Ambient temperature (°C) recorded at the nearest weather station was significantly associated with personal heat exposure [ß 0.37, 95%CI (0.35, 0.39)], particularly in groundskeepers who spent more of their total time outdoors [ß 0.42, 95%CI (0.39, 0.46)]. Factors significantly associated with lower personal heat exposure include reported time indoors [ß -2.02, 95%CI (-2.15, -1.89)], reported income>20K [ß -1.05, 95%CI (-1.79, -0.30)], and measured % body fat [ß -0.07, 95%CI (-0.12, -0.02)]. There were significant associations between income and % body fat with lower indoor and nighttime exposures, but not with outdoor heat exposure, suggesting modifications of the home thermal environment play an important role in determining overall heat exposure. Further delineation of the effect of personal characteristics on heat exposure may help to develop targeted strategies for preventing heat-related illness.

Contaminant levels in Gulf of Mexico reef fish after the Deepwater Horizon oil spill as measured by a fishermen-led testing program.

The BP oil disaster posed a significant threat to the U.S. seafood industry. Invertebrates (shrimp, oyster, crab) and other nearshore species comprised the majority of postspill testing by federal and state agencies. Deeper water finfish were sampled less frequently, despite population ranges that overlapped with affected waters. We report on a voluntary testing program with Gulf of Mexico commercial fishermen to ensure the safety of their catch. Seven species of reef fish were tested for polycyclic aromatic hydrocarbons, several metals, and a constituent of Corexit 9500A and 9527A dispersants. Only two of 92 samples had detectable levels of benzo(a)pyrene-equivalents (a combined measure of carcinogenic potency across 7 different PAHs), which were still below federal safety thresholds. PAH ratios for these samples suggest pyrogenic (not petrogenic) contamination - indicating potential sources other than Deepwater Horizon. Metals were largely absent (cadmium, lead) or consistent with levels previously reported (mercury, arsenic). One notable exception was tilefish, which showed mercury concentrations lower than expected. We did not detect dispersant in any of our samples, indicating that it was not present in these species during the study period. Our findings suggest minimal risk to public health from these seafoods as a result of the disaster; however, the most contaminated areas were not sampled through this program.

Spatiotemporal association between birth outcomes and coke production and steel making facilities in Alabama, USA: a cross-sectional study.

BACKGROUND: Previous research has shown exposure to air pollution increases the risk of adverse birth outcomes, although the effects of residential proximity to significant industrial point sources are less defined. The objective of the current study was to determine whether yearly reported releases from major industrial point sources are associated with adverse birth outcomes. METHODS: Maternal residence from geocoded Alabama birth records between 1991 and 2010 were used to calculate distances from coke and steel production industries reporting emissions to the U.S. Environmental Protection Agency. Logistic regression models were built to determine associations between distance or yearly fugitive emissions (volatile organic compounds, polycyclic aromatic compounds, and metals) from reporting facilities and preterm birth or low birth weight, adjusting for covariates including maternal age, race, payment method, education level, year and parity. RESULTS: A small but significant association between preterm birth and residential proximity (≤5.0 km) to coke and steel production facilities remained after adjustment for covariates (OR 1.05 95% CI: 1.01,1.09). Above average emissions from these facilities of volatile organic compounds during the year of birth were associated with low birth weight (OR 1.17 95% CI: 1.06, 1.29), whereas metals emissions were associated with preterm birth (OR 1.07 95% CI: 1.01, 1.14). CONCLUSIONS: The present investigation suggests fugitive emissions from industrial point sources may increase the risk of adverse birth outcomes in surrounding neighborhoods. Further research teasing apart the relationship between exposure to emissions and area-level deprivation in neighborhoods surrounding industrial facilities and their combined effects on birth outcomes is needed.

Incorporating occupational risk in heat stress vulnerability mapping.

Both obesity and strenuous outdoor work are known risk factors for heat-related illness (HRI). These risk factors may be compounded by more and longer periods of extreme heat in the southeastern U.S. To quantify occupational risk and investigate the possible predictive value of a GIS-based tool, a weighted occupation-based metabolic equivalent (MET) index was created. The correlation between current MET-weighted employment rates or obesity rates and 2012 HRI report rates in Alabama were then determined. With the current dataset, results indicate occupational and obesity rates may explain some of the geographical variation seen in HRI report rates, although results are not statistically significant with this limited dataset. Mapping occupational and physiological risk factors with HRI rates may be useful for environmental and occupational health professionals to identify "hotspots" that may require special attention.

Adverse Health Impacts of Outdoor Air Pollution, Including from Wildland Fires, in the United States: "Health of the Air," 2018-2020.

Rationale: Adverse health impacts from outdoor air pollution occur across the United States, but the magnitude of these impacts varies widely by geographic region. Ambient pollutant concentrations, emission sources, baseline health conditions, and population sizes and distributions are all important factors that need to be taken into account to quantify local health burdens. Objectives: To determine health impacts from ambient air pollution concentrations in the United States that exceed the levels recommended by the American Thoracic Society. Methods: Using a methodology that has been well established in previous "Health of the Air" reports, this study provides policy-relevant estimates for every monitored county and city in the United States for the adverse health impacts of outdoor pollution concentrations using U.S. Environmental Protection Agency design values for years 2018-2020. Additionally, for the first time, the report includes adverse birth outcomes as well as estimates of health impacts specifically attributable to wildland fires using an exposure dataset generated through Community Multiscale Air Quality simulations. Results: The adverse health burdens attributable to air pollution occur across the entire age spectrum, including adverse birth outcomes (10,660 preterm and/or low-weight births; 95% confidence interval [CI], 3,180-18,330), in addition to mortality impacts (21,300 avoidable deaths; 95% CI, 16,180-26,200), lung cancer incidence (3,000 new cases; 95% CI, 1,550-4,390), multiple types of cardiovascular and respiratory morbidity (748,660 events; 95% CI, 326,050-1,057,080), and adversely impacted days (52.4 million days; 95% CI, 7.9-92.4 million days). Two different estimates of mortality impacts from wildland fires were created based on assumptions regarding the underlying toxicity of particles from wildland fires (low estimate of 4,080 deaths, 95% CI, 240-7,890; middle estimate of 28,000 deaths, 95% CI, 27,300-28,700). Conclusions: This year's report identified sizable health benefits that would be expected to occur across the United States with compliance with more health-protective air quality standards such as those recommended by the American Thoracic Society. This study also indicates that a large number of excess deaths are attributable to emissions from wildland fires; air quality management strategies outside what is required by the Clean Air Act will be needed to best address this important source of air pollution and its associated health risks.

Association between summertime emergency department visits and maximum daily heat index in rural and non-rural areas of Virginia (2015-2022).

There is growing evidence that high ambient temperatures are associated with a range of adverse health outcomes. Further evidence suggests differences in rural versus non-rural populations' vulnerability to heat-related adverse health outcomes. The current project aims to 1) refine estimated associations between maximum daily heat index (HI) and emergency department (ED) visits in regions of Virginia, and 2) compare associations between maximum daily HI and ED visits in rural versus non-rural areas of Virginia and within those areas, for persons 65 years of age and older versus those younger than 65 years. Our study utilized 16,873,213 healthcare visits from Virginia facilities reporting to the Virginia Department of Health syndromic surveillance system between May and September 2015-2022. Federal Office of Rural Health Policy defined rural areas were assigned to patient home ZIP code. The estimated daily maximum HI at which ED visits begin to rise varies between 25 °C and 33 °C across climate zones and regions of Virginia. Across all regions, estimated ED visits attributable to days with maximum HI above 25.7 °C were higher in rural areas (3.7%, 95% CI: 3.5%, 3.9%) versus in non-rural areas (3.1%, 95% CIs: 3.0%, 3.2%). Patients aged 0-64 years had a higher estimated heat attributable fraction of ED visits (4.2%, 95% CI: 4.0%, 4.3%) than patients 65 years and older (3.1%, 95% CI: 2.9%, 3.4%). Rural patients older than 65 have a higher estimated fraction of heat attributable ED visits (2.7%, 95% CI: 2.2%, 3.1%) compared to non-rural patients 65 years and older (1.5%, 95% CI: 1.3%, 1.8%). State-level syndromic surveillance data can be used to optimize heat warning messaging based on expected changes in healthcare visits given a set of meteorological variables, and can be further refined based on climate, rurality and age.

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

BACKGROUND: Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. METHODS: Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. RESULTS: Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. CONCLUSIONS: Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

Environmental risks from consumer products: Acceptable drinking water quality can produce unacceptable indoor air quality with ultrasonic humidifier use.

The commonly used consumer product of an ultrasonic humidifier (e.g., cool mist humidifier) emits fine particles containing metals from tap water used to fill the humidifier. The objectives are: 1) predict emitted indoor air inhalable metal concentrations produced by an ultrasonic humidifier filled with tap-water containing As, Cd, Cr, Cu, Mn, and Pb in 33 m3 or 72 m3 rooms with varying air exchange rates; 2) calculate daily ingestion and 8-h inhalation average daily dose (ADD) and hazard quotient (HQ) for adults and children (aged 0.25-6 yr); and 3) quantify deposition in respiratory tract via multi-path particle dosimetry (MPPD) model. Mass concentrations of indoor air metals increase proportionally with aqueous metal concentrations in fill water, and are inversely related to ventilation. Inhalation-ADDs are 2 magnitudes lower than ingestion-ADDs, using identical water quality for ingestion and fill-water. However, in the 33 m3, low 0.2/h ventilated room, inhalation-HQs are >1 for children and adults, except for Pb. HQ inhalation risks exceed ingestion risks at drinking water regulated levels for As, Cd, Cr, and Mn. MPPD shows greater dose deposits in lungs of children than adults, and 3 times greater deposited doses in a 33 m3 vs 72 m3 room. Rethinking health effects of drinking water and consumer products to broaden consideration of multiple exposure routes is needed.

Cross-sectional measurement of adherence to a proposed sustainable and healthy dietary pattern among United States adults using the newly developed Planetary Health Diet Index for the United States.

BACKGROUND: Dietary choices are an important avenue for improving food system sustainability. The Planetary Health Diet was proposed by the EAT-Lancet Commission as a reference healthy and sustainable dietary pattern. OBJECTIVES: To assess adherence to the Planetary Health Diet among United States adults, this study developed and evaluated the Planetary Health Diet Index for the United States (PHDI-US), adapted from the original PHDI validated in the Brazilian population. METHODS: The PHDI-US has 16 components with scores ranging between 0 and 150, and higher scores indicate better adherence to the Planetary Health Diet. Cross-sectional dietary data from 4741 participants of the National Health and Nutrition Examination Survey 2017-2018 were used to assess the validity and reliability of the PHDI-US. RESULTS: Validity and reliability tests were acceptable overall: principal component analysis identified 6 components; total PHDI-US and Healthy Eating Index-2015 scores were positively associated (ß = 0.67, standard error = 0.03, P <0.0001; R2 = 0.39); concurrent-criterion validity analyses identified significantly lower scores among males, everyday smokers, and younger adults; and the Cronbach's α value was 0.54. The average PHDI-US score was 46.7 out of 150, indicating that the diets of United States adults were far from meeting Planetary Health Diet recommendations. Based on component PHDI-US scores, many United States adults may be able to enhance the quality and sustainability of their diets by increasing intake of plant-based foods, including whole grains, nuts and peanuts, legumes, fruits, and vegetables, and reducing intake of animal-based foods, including red and processed meats. CONCLUSIONS: The PHDI-US is a new tool that can assess adherence to the Planetary Health Diet and identify key aspects of United States adults' diets that could be altered to potentially improve dietary sustainability and quality.

Adverse Health Outcomes Following Hurricane Harvey: A Comparison of Remotely-Sensed and Self-Reported Flood Exposure Estimates.

Remotely sensed inundation may help to rapidly identify areas in need of aid during and following floods. Here we evaluate the utility of daily remotely sensed flood inundation measures and estimate their congruence with self-reported home flooding and health outcomes collected via the Texas Flood Registry (TFR) following Hurricane Harvey. Daily flood inundation for 14 days following the landfall of Hurricane Harvey was acquired from FloodScan. Flood exposure, including number of days flooded and flood depth was assigned to geocoded home addresses of TFR respondents (N = 18,920 from 47 counties). Discordance between remotely-sensed flooding and self-reported home flooding was measured. Modified Poisson regression models were implemented to estimate risk ratios (RRs) for adverse health outcomes following flood exposure, controlling for potential individual level confounders. Respondents whose home was in a flooded area based on remotely-sensed data were more likely to report injury (RR = 1.5, 95% CI: 1.27-1.77), concentration problems (1.36, 95% CI: 1.25-1.49), skin rash (1.31, 95% CI: 1.15-1.48), illness (1.29, 95% CI: 1.17-1.43), headaches (1.09, 95% CI: 1.03-1.16), and runny nose (1.07, 95% CI: 1.03-1.11) compared to respondents whose home was not flooded. Effect sizes were larger when exposure was estimated using respondent-reported home flooding. Near-real time remote sensing-based flood products may help to prioritize areas in need of assistance when on the ground measures are not accessible.

State-of-the-Science Data and Methods Need to Guide Place-Based Efforts to Reduce Air Pollution Inequity.

BACKGROUND: Recently enacted environmental justice policies in the United States at the state and federal level emphasize addressing place-based inequities, including persistent disparities in air pollution exposure and associated health impacts. Advances in air quality measurement, models, and analytic methods have demonstrated the importance of finer-scale data and analysis in accurately quantifying the extent of inequity in intraurban pollution exposure, although the necessary degree of spatial resolution remains a complex and context-dependent question. OBJECTIVE: The objectives of this commentary were to a) discuss ways to maximize and evaluate the effectiveness of efforts to reduce air pollution disparities, and b) argue that environmental regulators must employ improved methods to project, measure, and track the distributional impacts of new policies at finer geographic and temporal scales. DISCUSSION: The historic federal investments from the Inflation Reduction Act, the Infrastructure Investment and Jobs Act, and the Biden Administration's commitment to Justice40 present an unprecedented opportunity to advance climate and energy policies that deliver real reductions in pollution-related health inequities. In our opinion, scientists, advocates, policymakers, and implementing agencies must work together to harness critical advances in air quality measurements, models, and analytic methods to ensure success. https://doi.org/10.1289/EHP13063.

Poultry Concentrated Animal-Feeding Operations on the Eastern Shore, Virginia, and Geospatial Associations with Adverse Birth Outcomes.

Concentrated animal-feeding operations (CAFOs) emit pollution into surrounding areas, and previous research has found associations with poor health outcomes. The objective of this study was to investigate if home proximity to poultry CAFOs during pregnancy is associated with adverse birth outcomes, including preterm birth (PTB) and low birth weight (LBW). This study includes births occurring on the Eastern Shore, Virginia, from 2002 to 2015 (N = 5768). A buffer model considering CAFOs within 1 km, 2 km, and 5 km of the maternal residence and an inverse distance weighted (IDW) approach were used to estimate proximity to CAFOs. Associations between proximity to poultry CAFOs and adverse birth outcomes were determined by using regression models, adjusting for available covariates. We found a -52.8 g (-95.8, -9.8) change in birthweight and a -1.51 (-2.78, -0.25) change in gestational days for the highest tertile of inverse distance to CAFOs. Infants born with a maternal residence with at least one CAFO within a 5 km buffer weighed -47 g (-94.1, -1.7) less than infants with no CAFOs within a 5 km buffer of the maternal address. More specific measures of exposure pathways via air and water should be used in future studies to refine mediators of the association found in the present study.

Identifying exposure pathways mediating adverse birth outcomes near active surface mines in Central Appalachia.

Background: Previous work has determined an association between proximity to active surface mining within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW). Multiple potential exposure pathways may exist; however, including inhalation of particulate matter (airshed exposure), or exposure to impacted surface waters (watershed exposure). We hypothesize that this relationship is mediated by exposure to contaminants along one or both of these pathways. Methods: We geolocated 194,084 birth records through health departments in WV, KY, VA, and TN between 1990 and 2015. We performed a mediation analysis, iteratively including within our models: (a) the percent of active surface mining within 5 km of maternal residence during gestation; (b) the cumulative surface mining airshed trajectories experienced during gestation; and (c) the percent of active surface mining occurring within the watershed of residency during gestation. Results: Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05-1.13) and LBW (1.06, 1.02-1.11), controlling for individual-level predictors. When mediators were added to the baseline model, the association between active mining and birth outcomes became nonsignificant (PTB: 0.48, 0.14-1.58; LBW 0.78, 0.19-3.00), whereas the association between PTB and LBW remained significant by airshed exposure (PTB: 1.14, 1.11-1.18; LBW: 1.06, 1.03-1.10). Conclusions: Our results found that surface mining airsheds at least partially explained the association between active mining and adverse birth outcomes, consistent with a hypothesis of mediation, while mediation via the watershed pathway was less evident.