Development of a Pilot Literacy Scale to Assess Knowledge, Attitudes, and Behaviors towards Climate Change and Infectious Disease Dynamics in Suriname.

Prior research has shown that climate literacy is sparse among low- and middle-income countries. Additionally, no standardized questionnaire exists for researchers to measure climate literacy among general populations, particularly with regards to climate change effects on vector-borne diseases (VBDs). We developed a comprehensive literacy scale to assess current knowledge, attitudes, and behaviors towards climate change and VBD dynamics among women enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort in Suriname. Items were generated by our research team and reviewed by a group of six external climate and health experts. After the expert review, a total of 31 climate change and 21 infectious disease items were retained. We estimated our sample size at a 10:1 ratio of participants to items for each scale. In total, 301 women were surveyed. We validated our scales through exploratory (n = 180) and confirmatory factor analyses (n = 121). An exploratory factor analysis for our general Climate Change Scale provided a four-construct solution of 11 items. Our chi-squared value (X2 = 74.32; p = 0.136) indicated that four factors were sufficient. A confirmatory factor analysis reinforced our findings, providing a good model fit (X2 = 39.03; p = 0.23; RMSEA = 0.015). Our Infectious Disease Scale gave a four-construct solution of nine items (X2 = 153.86; p = 0.094). A confirmatory factor analysis confirmed these results, with a chi-squared value of 19.16 (p = 0.575) and an RMSEA of 0.00. This research is vitally important for furthering climate and health education, especially with increases in VBDs spread by Aedes mosquitoes in the Caribbean, South America, and parts of the southern United States.

Climate change impacts on respiratory health: exposure, vulnerability, and risk.

Anthropogenic climate change adversely impacts human health. In this perspective, we examine the impact of climate change on respiratory health risk. We describe five respiratory health threats-heat, wildfires, pollen, extreme weather events, and viruses-and discuss their impact on health outcomes in a warming climate. The risk of experiencing an adverse health outcome occurs at the intersection of exposure and vulnerability, consisting of sensitivity and adaptive capacity. Exposed individuals and communities most at risk are those with high sensitivity and low adaptive capacity, as influenced by the social determinants of health. We call for the implementation of a transdisciplinary strategy for accelerating respiratory health research, practice, and policy in the context of climate change.

Geographic differences in exposures to metals and essential elements in pregnant women living in Suriname.

BACKGROUND: In Suriname, 20% of pregnancies end in adverse birth outcomes. While prenatal exposure to metals may lead to adverse health outcomes, exposure assessments in Suriname are scant. Environmental contamination from mercury (Hg) used in artisanal goldmining in the Amazonian Interior, and the uncontrolled use of pesticides in suburban regions are of particular concern. OBJECTIVE: This study assessed geographic differences in exposures to metals and essential elements in pregnant Surinamese women. METHODS: This study is a subset (n = 400) of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort study. Sector-field inductively-coupled plasma mass spectrometry was used to determine concentrations of lead (Pb), Hg, selenium (Se), cadmium (Cd), manganese (Mn) and tin (Sn) in whole blood of the pregnant women. High vs. low exposures to Pb and Hg were determined and were based respectively on CDC (3.5 ug/dL) and USEPA (3.5 ug/L) action levels. Differences in geographic exposures were tested with the Mann-Whitney U-test, and differences between blood elemental concentrations and action levels for Pb and Hg with the Wilcoxon signed rank test. The association between demographics and high exposures of Pb and Hg was examined with multivariate logistic regression models. RESULTS: The median concentrations of Pb, Hg and Se (5.08 µg/dL, 7.87 µg/L, and 228.26 µg/L respectively) in Interior women, were higher than the Urban and Suburban regions (p < 0.001), and higher than internationally accepted action levels (p < 0.001). The median concentrations of Mn and Sn found in Suburban women (17.55 and 0.97 ug/L respectively) were higher than Urban and Interior regions (p < 0.02). SIGNIFICANCE: Pregnant women living in Suriname's Amazonian Interior are exposed to Hg and Pb at levels of public health concern. Urgently needed is a comprehensive source characterization assessment and the development, implementation and monitoring of environmental health policies, specifically addressing the chemicals of concern. IMPACT: In a subset of participants enrolled in the CCREOH environmental epidemiology cohort study elevated levels of Hg and Pb were identified. This is the first comprehensive exposure assessment in the Surinamese population. Health concerns include adverse birth- and neurodevelopmental outcomes. Geographic differences require a tailored approach to health intervention and comprehensive source characterization. Future research should ascertain the role of Se as a potential protective factor. Environmental policy development, implementation and monitoring is pivotal to mitigate exposures to these neurotoxicants.

The Single and Combined Effects of Prenatal Nonchemical Stressors and Lead Exposure on Neurodevelopmental Outcomes in Toddlers: Results from the CCREOH Environmental Epidemiologic Study in Suriname.

The primary aim of this prospective study was to examine the single and combined effect of prenatal exposure to perceived stress, probable depression, and lead on toddlers' neurodevelopment using the Bayley Scales of Infant and Toddler Development, third edition. Data from 363 mother-toddler pairs enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health prospective cohort study were analyzed. A prenatal lead exposure of ≥3.5 µg/dL was associated with significantly lower receptive (p = 0.008) and expressive (p = 0.006) communication scaled scores. Moderate and severe maternal prenatal probable depression scores were associated with significantly lower fine (p = 0.009) and gross (p = 0.009) motor scaled scores. However, a maternal report of prenatal stress was not associated with neurodevelopmental outcomes. After adjusting for maternal demographics, prenatal stress and lead exposure, prenatal probable depression remained predictive of the toddlers' gross motor scaled scores (ß -0.13, 95% CI [-0.24--0.02]). Similarly, when adjusting for demographics, prenatal stress and probable depression, prenatal lead exposure remained a significant predictor of their receptive communication scaled scores (ß -0.26, 95% CI [-0.49--0.02]). An analysis testing combined exposure to perceived stress, probable depression, and lead exposure, measured using a cumulative risk index, significantly predicted the child fine motor scaled scores after adjusting for other covariates (ß -0.74, 95% CI: [-1.41--0.01]).

Linking complex disease and exposure data-insights from an environmental and occupational health study.

The disparate measurement protocols used to collect study data are an intrinsic barrier to combining information from environmental health studies. Using standardized measurement protocols and data standards for environmental exposures addresses this gap by improving data collection quality and consistency. To assess the prevalence of environmental exposures in National Institutes of Health (NIH) public data repositories and resources and to assess the commonality of the data elements, we analyzed clinical measures and exposure assays by comparing the Caribbean Consortium for Research in Environmental and Occupational Health study with selected NIH environmental health resources and studies. Our assessment revealed that (1) environmental assessments are widely collected in these resources, (2) biological assessments are less prevalent, and (3) NIH resources can help identify common data for meta-analysis. We highlight resources to help link environmental exposure data across studies to support data sharing. Including NIH data standards in environmental health research facilitates comparing and combining study data, and the use of NIH resources and adoption of standard measures will allow integration of multiple studies and increase the scientific impact of individual studies.

Characterization of Urinary Pesticide Metabolite Concentrations of Pregnant Women in Suriname.

Prenatal exposure to pesticides and the association with adverse health outcomes have been examined in several studies. However, the characterization of pesticide exposure among Surinamese women during pregnancy has not been assessed. As part of the Caribbean Consortium of Research in Environmental and Occupational Health research program, 214 urine samples were collected from pregnant women living in three regions in Suriname with different agricultural practices: capital Paramaribo, the rice producing district Nickerie, and the tropical rainforest, the Interior. We used isotope dilution tandem mass spectrometry to quantify urinary concentrations of biomarkers of three pesticide classes, including phenoxy acid herbicides and organophosphate and pyrethroid insecticides, all of which are commonly used in agricultural and residential settings in Suriname. We observed that participants residing in Nickerie had the highest urinary metabolite concentrations of 2,4-dichlorophenoxyacetic acid and pyrethroids compared to those from Paramaribo or the Interior. Paramaribo had the highest concentrations of organophosphate metabolites, specifically dialkyl phosphate metabolites. Para-nitrophenol was detected in samples from Paramaribo and the Interior. Samples from Nickerie had higher median urinary pesticide concentrations of 2,4-dichlorophenoxyacetic acid (1.06 µg/L), and the following metabolites, 3,5,6-trichloro-2-pyridinol (1.26 µg/L), 2-isopropyl-4-methyl-6-hydroxypyrimidine (0.60 µg/L), and 3-phenoxybenzoic acid (1.34 µg/L), possibly due to residential use and heavy rice production.

The Association between Mercury and Lead Exposure and Liver and Kidney Function in Pregnant Surinamese Women Enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Environmental Epidemiologic Cohort Study.

Exposure to mercury (Hg) and lead (Pb) may have an effect on pregnant women. We assessed the effect of exposure to mercury and lead on liver and kidney functions in a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)­Meki Tamara, study. From 400 women aged 16−46 living in rural, urban, and interior regions of Suriname, we measured blood mercury and blood lead levels. Creatinine, urea, and cystatin C were measured to assess kidney function, and aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT) were measured to assess liver function. Education, region, and ethnicity showed significant differences for both blood mercury and lead levels, which all had p-values < 0.001. Creatinine and urea were elevated with higher mercury blood levels. Our findings also suggest a relationship between high mercury blood levels and potential harmful effects on liver and kidney function.

Sociodemographic Influences on Perceived Stress during Pregnancy: Results from the CCREOH Environmental Epidemiologic Study, Suriname.

Screening for prenatal stress is not routine in Suriname, despite its significant impact on maternal and newborn health. This study assessed the prevalence of high perceived prenatal stress and its sociodemographic predictors in three geographic areas in Suriname. In this cross-sectional study, data from 1190 participants of the Caribbean Consortium for Research in Environmental and Occupational Health cohort study were analyzed. Cohen's Perceived Stress Scale was completed during pregnancy to ascertain high perceived stress (cut-off score 20). The association between maternal sociodemographic factors and high perceived stress was examined using the chi-square test and logistic regression models; 27.5% of all participants had high perceived stress with statistically significant lower rates in Nickerie (18.8%) compared with Paramaribo (29.8%; p = 0.001) and the Interior (28.6%; p = 0.019). Maternal sociodemographic factors moderated the difference between the Interior and Nickerie. Participants from Paramaribo had statistically significant higher odds of high perceived stress compared to those from Nickerie, independent of their age and educational level (adjusted OR = 1.94; 95% confidence interval 1.32-2.86). Perceived stress during pregnancy is predicted by sociodemographic factors. These findings identified target groups for interventions in Suriname. Policy makers should consider integrating perceived stress assessment as a routine part of prenatal care.

Priorities for Bolstering Public Health Resilience in the Context of Climate Change in Dominica and Puerto Rico.

Caribbean small island developing states are highly exposed to climate change impacts. Incorporating weather and climate information into public health decisions can promote resilience to climate change's adverse health effects, but regionally it is not common practice. We implemented a project to enhance dialogue between climate and public health specialists in Puerto Rico and Dominica. First, we conducted environmental scans of public health vulnerability in the context of weather and climate for both islands. Then, we convened stakeholders to discuss the scan results and identify priorities for climate and health. A shared priority was increasing climate and health knowledge; thus, we developed several educational initiatives. In this viewpoint, we discuss our process for conducting environmental scans, building capacity and partnerships, and translating knowledge-to-action around climate and health.

"The More We Know, the More We're Able to Help": Participatory Development of an Evaluation Framework for Community Health Worker Programs.

CONTEXT: It is critical to evaluate community health worker (CHW) programs to maximize effectiveness. However, there is little consensus, and structure, for how to evaluate such programs. OBJECTIVE: The purpose of this study was to develop a flexible framework for evaluating components of CHW programs in community and clinical settings. DESIGN: Semistructured interviews were conducted with CHWs and their supervisors to determine evaluation categories for the framework. A survey was then administered to pilot the framework at federally qualified health centers and community-based organizations with existing CHW programs. SETTING: Eighteen federally qualified health centers and community-based organizations in Louisiana, Mississippi, Alabama, and Florida. PARTICIPANTS: Participants consisted of 23 CHWs and 19 CHW supervisors. RESULTS: Interview participants directly informed the development of an evaluation framework for CHW programs. The framework consists of 7 evaluation categories: client relations, intraorganizational relations, interorganizational relations, capacity development, program effectiveness, cost-efficiency, and sustainability. Survey respondents specified best practices for program implementation for each evaluation category. Recommendations for CHW program evaluation include tailoring evaluation efforts and data collection methods to program context, using mixed-methods approaches for collecting evaluation data, and streamlining evaluation efforts with an organization's existing evaluation systems. CONCLUSIONS: The evaluation framework is a flexible and practical model for collecting information needed for monitoring and evaluating CHW programs. By relying on practitioners' perspectives, this study contributes to an evidence base for implementing and evaluating CHW programs.

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children.

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10-33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37-0.74, p < 0.001; OR 0.55; 95%CI: 0.39-0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study.

BACKGROUND: Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS: Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS: The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS: Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Depression during pregnancy may lead to adverse health effects in mothers and children. While one in five pregnancies resulted in an adverse birth outcome in Suriname, and perceived stress and depression are important risk factors for birth outcomes, data on depression and its risk factors are lacking. This study aimed to determine the association between perceived stress and prenatal depression in Surinamese pregnant women participating in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara study.A total of 1143 pregnant women were included in the study. Using questionnaires, data was collected on demographic factors, perceived stress, social support (including resilience), and probable depression.Perceived stress was somewhat higher during the first two trimesters (27.2%), than the third trimester (24.7%). This was also the case for probable depression; higher during the first two trimesters (22.4%) than during the third trimester (17.6%). The study found a statistically significant association of high perceived stress, low perceived individual resilience, lower education and older maternal age with probable depression during pregnancy.Early detection and effective management of perceived stress and depression during pregnancy are very important. There is a need for prenatal clinics in Suriname to routinely screen for symptoms of perceived stress and depression to minimize the potential impact on mother and child. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname.

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname's interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson's χ2-test and the Mann-Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70-7.63) and PTB (OR = 3.43; 95% CI 1.48-7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

The Cumulative Risk of Prenatal Exposures to Chemical and Non-Chemical Stressors on Birth Outcomes in Suriname.

The cumulative exposure to chemical and non-chemical stressors may have an impact on birth outcomes. The aim of this study is to examine the cumulative exposure of a mixture of chemicals (mercury, lead, selenium and tin) and non-chemical stressors (social support, perceived stress, probable depression and BMI) on birth outcomes (birthweight, gestational age at birth, and Apgar score at 5 min). The study population is a subset (n = 384) of the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between the latent chemical construct, non-chemical stressors and birth outcomes were assessed using path models. The results showed a significant direct relationship between perceived stress and birthweight (ß = -0.17), however even though the relationship between perceived stress and depression was significant in all three path models (ß = 0.61), the association between depression and birth outcomes was not significant. Perceived stress was significantly associated with community engagement (ß = -0.12) and individual resilience (ß = -0.12). BMI (ß = 0.12) was also significantly directly associated with birthweight. The latent chemical construct did not show an association with the birth outcomes. Our data indicate the need for the development of a support system for pregnant women by involving them in prenatal care programs to reduce maternal stress, which may also influence depression and (in)directly improve the birth outcomes. Interventions regarding weight management for women of childbearing age are necessary to halt obesity and its negative effects on birth outcomes.

Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Cohort Study: influences of complex environmental exposures on maternal and child health in Suriname.

PURPOSE: The Caribbean Consortium for Research in Environmental and Occupational Health prospective environmental epidemiologic cohort study addresses the impact of chemical and non-chemical environmental exposures on mother/child dyads in Suriname. The study determines associations between levels of environmental elements and toxicants in pregnant women, and birth outcomes and neurodevelopment in their children. PARTICIPANTS: Pregnant women (N=1143) were enrolled from December 2016 to July 2019 from three regions of Suriname: Paramaribo (N=738), Nickerie (N=204) and the tropical rainforest interior (N=201). Infants (N=992) were enrolled at birth. Follow-up will take place until children are 48 months old. FINDINGS TO DATE: Biospecimens and questionnaire data on physiological and psychosocial health in pregnant women have been analysed. 39.1% had hair mercury (Hg) levels exceeding values considered safe by international standards. Median hair Hg concentrations in women from Paramaribo (N=522) were 0.64 µg/g hair (IQRs 0.36-1.09; range 0.00-7.12), from Nickerie (N=176) 0.73 µg/g (IQR 0.45-1.05; range 0.00-5.79) and the interior (N=178) 3.48 µg/g (IQR 1.92-7.39; range 0.38-18.20). 96.1% of women ate fish, respective consumption of the three most consumed carnivorous species, Hoplias aimara, Serrasalmus rhombeus and Cichla ocellaris, known to have high Hg levels, was 44.4%, 19.3% and 26.3%, respectively, and was greater among the interior subcohort. 89% frequently consumed the vegetable tannia, samples of which showed presence of worldwide banned pesticides. 24.9% of pregnant women had Edinburgh Depression Scale scores indicative of probable depression. FUTURE PLANS: Fish consumption advisories are in development, especially relevant to interior women for whom fish consumption is likely to be the primary source of Hg exposure. Effects of potentially beneficial neuroprotective factors in fish that may counter neurotoxic effects of Hg are being examined. A pesticide literacy assessment in pregnant women is in progress. Neurodevelopmental assessments and telomere length measurements of the children to evaluate long-term effects of prenatal exposures to toxicant mixtures are ongoing.

A Community-Based Participatory Research Approach to Hurricane Katrina: When Disasters, Environmental Health Threats, and Disparities Collide.

In 2005, Hurricane Katrina resulted in long-term flooding of 80% of New Orleans, Louisiana. Mold-infested homes gave rise to concerns about increased childhood asthma. To address these concerns, a diverse community-academic partnership used a community-based participatory research (CBPR) approach to implement the Head-off Environmental Asthma in Louisiana (HEAL) study in 2007.The study examined the relationship between post-Katrina mold and other environmental exposures and asthma morbidity, while testing an asthma counselor (AC) intervention. Both the AC intervention and the CBPR approach were effectively implemented in the postdisaster setting. However, homes had lower levels of mold and other allergens than expected, possibly because of the timing of environmental sampling. Also, HEAL illustrated the vulnerability of the study community, especially to the interconnected threats of health disparities, environmental health stressors, and disasters.We examine the implications of these threats for public health science, policy, and practice, not only through the lens of Hurricane Katrina but also for future disasters faced by communities in the Gulf Coast and nationally.

Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study.

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 µg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen's Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05-5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03-46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

Prenatal Mercury Exposure in Pregnant Women from Suriname's Interior and Its Effects on Birth Outcomes.

Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health's environmental epidemiologic prospective cohort study of pregnant women living in Suriname's interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher's exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 µg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 µg/g, was associated with LBW (OR = 7.2; 95% CI 1.5-35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92-13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.

Environmental health risk relationships, responsibility, and sources of information among Vietnamese Americans in coastal Mississippi.

Coastal communities along the U.S. Gulf of Mexico have been profoundly shaped by environmental health (EH) threats, reflecting the region's history of natural and technological disasters, as well as ongoing issues of environmental degradation and pollution. The Vietnamese American community in the state of Mississippi is vulnerable to EH threats, but there is limited research on their risk perceptions. Understanding perceptions of risk and responsibility is important to manage EH risks and promote community resilience. This community-based participatory research study characterizes Vietnamese American perceptions of EH risks, sources of information, and responsibility in coastal Mississippi. Five focus groups were conducted in 2016 and 2017 in Biloxi, Mississippi with Vietnamese Americans working in the seafood industry (n=24) and mothers of children under the age of 18 (n=25). Findings related to participants' concerns with air quality, drinking water quality, and the 2010 Deepwater Horizon oil spill are interpreted using Boholm's relational theory of risk. Unreliable access to healthcare and limited English proficiency constrain participants from acting on their environmental health risk relationships. A community-based organization in Biloxi that works with Vietnamese Americans plays an important role in addressing risk in this population.