Gender Differences in Respiratory Health of School Children Exposed to Rail Yard-Generated Air Pollution: The ENRRICH Study.

Studies about environmental burdens often explore overall community risk. Increasing evidence suggests, however, differential burdens by gender and age. The purpose of the authors' research was to determine if gender-related difference exists among children in a region plagued with poor air quality and if increased exposure to pollutants from a major goods movement rail yard influences the relationship. Using a cross-sectional study design, the authors provided respiratory screening for children at two elementary schools. Compared to females, males were at significantly greater odds of exhibiting elevated fractional exhaled nitric oxide (FeNO) but less likely to exhibit reduced lung volume. Even in an area of overall poor air quality, the authors found that male children were a vulnerable subpopulation for greater elevated FeNO, while females were at increased risk for reduced lung capacity. Understanding differential burdens in vulnerable subpopulations is critical to providing timely and responsive strategies targeted towards health-based prevention and intervention activities.

Respiratory Health Risks for Children Living Near a Major Railyard.

Inland southern California is a region of public health concern, especially for children, given the area's perennially poor air quality and increasing sources of local pollution. One elementary school specifically is located only a few hundred yards from the San Bernardino Railyard, one of the busiest goods movement facilities in California, potentially increasing respiratory problems. Through ENRRICH (Environmental Railyard Research Impacting Community Health) Project, we assessed association of proximity to a major freight railyard on adverse respiratory health in schoolchildren. Respiratory screening was provided for children at two elementary schools: one near the railyard and a socio-demographically matched comparison school 7 miles away. Screening included testing for airway inflammation (FE NO), lung function (peak expiratory flow, PEF) and parent reported respiratory symptoms. Parental questionnaires collected additional information. Log-binomial and linear regression assessed associations. Children attending school near the railyard were more likely to exhibit airway obstruction with higher prevalence of abnormal PEF (<80%): prevalence ratio (PR) = 1.59 (95% CI 1.19-2.12). The association with inflammation was less clear. Children at the exposure school, who had lived 6 months or longer at their current address (vs. all children at that school) were more likely to have values suggesting inflammation (FE NO > 20 ppb) (PR = 1.44, 95% CI 1.02-2.02) and present with a trend for increased adverse respiratory symptoms. Children attending school near the railyard were significantly more likely to display respiratory health challenges. Ideally these low-income, low resource communities should be supported to implement sustainable intervention strategies to promote an environment where children can live healthier and thrive.

Environmental exposures, lung function, and respiratory health in rural Lao PDR.

Although the individual contributions of smoked tobacco and indoor air pollution have been identified, there are very few studies that have characterized and measured the effects of inhaled particles from a wide range of personal, household, and community practices common in rural Asia. The objective of our study was to examine the association between environmental inhaled exposures and lung function among rural males of Lao PDR. In a sample of 92 males from rural Lao PDR, study subjects completed a survey on household exposures, a physical exam, and the following measures of lung function: FEV1, FVC, and the ratio of FEV1/FVC. Our findings were as follows: a) > 80% of the subjects were exposed to indoor cooking fires (wood fuel), animal handling, dust and dirt; b) 57.6% of subjects were in the impaired range (FEV1/FVC < 0.7); and c) animal handling was negatively associated (p < 0.03) with FEV1 and FVC. Among males in rural Lao PDR, we found a high prevalence of chronic exposure to inhaled particles (animal handling, dust/dirt, smoke) and a high prevalence of impaired lung function. Findings from this pilot study indicate that associations between exposure to multiple sources of particulate matter common in rural areas and lung function need further investigation.

Experiences of a rail yard community: life is hard.

Community groups and local air pollution control agencies have identified the San Bernardino Railyard (SBR) as a significant public health and environmental justice issue. In response, the authors conducted a comprehensive study with community members living in close proximity to the rail yard. The purpose of this article is to share the community's perceptions about the rail yard and ideas on sustainable change. A qualitative study using key informant interviews and focus group discussions was conducted and resulted in four emerging themes. Themes emerged as follows: "health as an unattainable value," "air quality challenges," "rail yard pros and cons," and "violence and unemployment ripple effect." Community participants expressed concern for poor air quality, but other challenges took priority. The authors' findings suggest that future mitigation work to reduce air pollution exposure should not only focus on reducing risk from air pollution but address significant co-occurring community challenges. A "Health in All Policies" approach is warranted in addressing impacted communities in close proximity to the goods movement industry.

Ambient air pollutants and risk of fatal coronary heart disease among kidney transplant recipients.

BACKGROUND: There is increasing evidence that specific ambient air pollutants are associated with coronary heart disease (CHD) morbidity and mortality. Because kidney transplant recipients have prevalent traditional and nontraditional risk factors, they may constitute a sensitive subgroup. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: This study includes 32,239 nonsmoking adult kidney transplant recipients who underwent transplant in 1997-2003, identified through the US Renal Data System and living in the United States within 50 km of an air pollution monitoring station. PREDICTOR: Long-term ambient pollutant ozone and particulate matter ≤10 µm (PM(10)), assessed from monthly concentrations of ozone and PM(10) calculated from ambient monitoring data by the US Environmental Protection Agency Air Quality System and interpolated to zip code centroids according to patients' residence. OUTCOMES: Outcomes of interest were death from CHD and natural-cause mortality. RESULTS: For the entire transplant cohort, average pollutant levels for ozone and PM(10) were 25.5 ± 4.4 parts per billion (ppb) and 25.3 ± 6.4 µg/m(3), respectively. Correlation between ozone and PM(10) values was low, but statistically significant (P < 0.001). There were deaths from CHD (n = 267) and natural causes (n = 2,076) during the 7-year study period. For each 10-ppb increase in ozone, the risk of fatal CHD increased by 35% (RR, 1.35; 95% CI, 1.04-1.77) in the single-pollutant model and 34% (RR, 1.34; 95% CI, 1.03-1.76) in the 2-pollutant model. No independent association was found between CHD and PM(10). No significant association was identified for PM(10) or ozone level and natural-cause mortality (RR, 1.09; 95% CI, 0.99-1.21). LIMITATIONS: Exposure assignment based on only residential location. CONCLUSIONS: For kidney transplant recipients, ambient ozone levels potentially are associated with higher risk of fatal CHD. These findings may have implications for regulations governing air pollution and the development of individual CHD risk-reduction strategies.

Strategic Partnerships for Change in an Environmental Justice Community: The ENRRICH Study.

BACKGROUND: San Bernardino, California, is home to the San Bernardino Railyard (SBR), a major commerce hub with high associated air-pollution, identified as an environmental justice (EJ) issue by local community and air quality agencies. Alarmingly, one elementary school is located only a few hundred yards from SBR. METHODS: The school, university researchers, and a local community-based organization (CBO) established a partnership to assess potential adverse health impacts in the children and develop interventions and mitigation plans. RESULTS: Study results comparing target school with a demographically matched school verified community concerns finding significantly poorer respiratory health in children attending school near the railyard. Partners are working with local and state collaboratives, the school board, and funding agencies to address the resulting needs of children through education, mitigation, and prevention in an environment where necessary systems changes involving the railyard are elusive. CONCLUSIONS: This paper shares lessons learned in moving toward change when addressing an EJ community's health challenges.

Quantification of the environmental impact of different dietary protein choices.

Quantitative environmental evaluations of meat, fresh vegetables, and processed protein based on soybeans suggest that the environmental burden of vegetarian foods is usually relatively low when production and processing are considered. The environmental comparison of cheese varieties made from cow milk and directly from lupine and the evaluation of energy inputs in fish protein and vegetable protein also suggest an environmental advantage for vegetarian food. In the evaluation of processed protein food based on soybeans and meat protein, a variety of environmental impacts associated with primary production and processing are a factor 4.4-> 100 to the disadvantage of meat. The comparison of cheese varieties gives differences in specific environmental impacts ranging between a factor 5 and 21. And energy use for fish protein may be up to a factor 14 more than for protein of vegetable origin. Assessment suggests that on average the complete life cycle environmental impact of nonvegetarian meals may be roughly a factor 1.5-2 higher than the effect of vegetarian meals in which meat has been replaced by vegetable protein. Although on average vegetarian diets may well have an environmental advantage, exceptions may also occur. Long-distance air transport, deep-freezing, and some horticultural practices may lead to environmental burdens for vegetarian foods exceeding those for locally produced organic meat.

Sustainability of plant-based diets: back to the future.

Plant-based diets in comparison to diets rich in animal products are more sustainable because they use many fewer natural resources and are less taxing on the environment. Given the global population explosion and increase in wealth, there is an increased demand for foods of animal origin. Environmental data are rapidly accumulating on the unsustainability of current worldwide food consumption practices that are high in meat and dairy products. Natural nonrenewable resources are becoming scarce, and environmental degradation is rapidly increasing. At the current trends of food consumption and environmental changes, food security and food sustainability are on a collision course. Changing course (to avoid the collision) will require extreme downward shifts in meat and dairy consumption by large segments of the world's population. Other approaches such as food waste reduction and precision agriculture and/or other technological advances have to be simultaneously pursued; however, they are insufficient to make the global food system sustainable. For millennia, meatless diets have been advocated on the basis of values, and large segments of the world population have thrived on plant-based diets. "Going back" to plant-based diets worldwide seems to be a reasonable alternative for a sustainable future. Policies in favor of the global adoption of plant-based diets will simultaneously optimize the food supply, health, environmental, and social justice outcomes for the world's population. Implementing such nutrition policy is perhaps one of the most rational and moral paths for a sustainable future of the human race and other living creatures of the biosphere that we share.

Making human subject protection training community responsive: experiences delivering on the community-based participatory research promise.

BACKGROUND: A community-based participatory research (CBPR) approach was used by the California-based Environmental Railyard Research (ENRRICH) Study, a partnership between scientists from Loma Linda University (LLU) and a local community organization, with the aim of assessing the health effects of exposure to emissions from a rail yard on a community. METHODS/RESULTS: To allow meaningful community participation in all study activities and comply with institutional review board (IRB) requirements, all participants involved needed to be properly trained and certified in the ethical conduct of human subjects (HS) research. Existing IRB training materials and the conventional certification methods designed for university scientists are not well-suited for community members who often face educational as well as language barriers. CONCLUSION: The purpose of this article is to share experiences in developing and implementing a customized human subject research curriculum, which was community responsive and addressed IRB requirements.

A spatial needs assessment of indigent acute psychiatric discharges in California.

State and local mental health agencies have responsibility for the psychiatric care of Medicaid beneficiaries and indigents meeting pre-defined criteria. A significant uninsured caseload may prove draining to agencies and hospitals mandated to provide emergency services, resulting in limited access. A spatial needs assessment was conducted to find areas having a greater relative proportion of indigent psychiatric hospitalizations. Robust descriptive and inferential spatial techniques were applied to California 1999-2003 public-use Zip-Code-level hospital discharge data to create maps. These maps reveal a more stable view of spatial variation in the proportion of indigent discharges compared to all psychiatric discharges. Synthetic estimation techniques were also applied to U.S. Census data to estimate the proportion of severe mental illness among households at less than 200% poverty level compared to estimated mental illness among all households. Visually comparing these maps suggests areas of potential mismatch. These results and methods may inform public decision-making.