Environmental Health[JOURNAL]
Sun
200 papers
Occupation and urinary phthalate metabolite concentrations in a national survey of adults in Canada.
Hinton P, Yeo RE, Kim J … +4 more , Middleton DRS, Pullella K, Arrandale V, DeBono NL
Environ Health · 2026 Apr · PMID 42032672 · Full text
BACKGROUND: Phthalates are synthetic chemicals with widespread exposure linked to adverse health effects. Occupational determinants remain understudied despite the potential for substantially elevated workplace exposure...
BACKGROUND: Phthalates are synthetic chemicals with widespread exposure linked to adverse health effects. Occupational determinants remain understudied despite the potential for substantially elevated workplace exposure levels. This study aimed to investigate the associations between occupation and urinary phthalate metabolite concentrations in a national sample of Canadian adults. METHODS: We analyzed data from 4,259 adults, aged 20–79 years, from four cycles (2007–2019) of the cross-sectional Canadian Health Measures Survey, which quantified 11 urinary phthalate metabolites. We compared creatinine-corrected concentrations of individual metabolites and four summary measures of phthalates across occupation (10 broad- and 40 major-level groups) and industry (19 sectors). Multivariable linear regression models estimated geometric mean ratios (GMRs) and 95% confidence intervals (CIs). For four metabolites with low detection frequencies, multivariable logistic regression estimated odds ratios of detection. Models were adjusted for sociodemographic, lifestyle, and dietary confounders. Sensitivity analyses compared results using specific gravity-corrected concentrations. RESULTS: Non-occupational factors, including female sex, Asian and Black ethnicity, and higher fruit and vegetable consumption, were associated with elevated phthalate concentrations. Workers in natural resources, agriculture, and related production had elevated concentrations of most metabolites, including mono(3-carboxypropyl) phthalate (MCPP) (GMR = 1.64, 95% CI: 1.15, 2.33) and monobenzyl phthalate (MBzP) (GMR = 1.41, 95% CI: 0.97, 2.03). Workers in trades, transport, and equipment operation also exhibited modestly increased exposures, particularly trades helpers and construction labourers for mono-n-butyl phthalate (MBP) (GMR = 1.41, 95% CI: 1.05, 1.89) and MCPP (GMR = 1.80, 95% CI: 1.22, 2.67). Elevated concentrations were also observed among workers in service support and other service occupations, with precise increases across several metabolites. Elevated concentrations in construction and industrial trades were largely driven by males, while females were the primary drivers of elevated di(2-ethylhexyl) phthalate (DEHP) metabolites in natural resources and agriculture, and of increases more broadly in service support occupations. CONCLUSION: This study identifies significantly elevated phthalate exposures among Canadian workers in agriculture, construction, and trades, as well as in service support roles. These findings highlight novel at-risk occupational groups beyond traditional manufacturing settings providing critical evidence for targeting exposure reduction and disease prevention strategies.
Sex and adrenal hormone alteration in Ecuadorian adolescents with home and school proximity to floriculture crop area.
Kayser GL, Zhang J, Baghdad A … +7 more , Wei J, Chronister BNC, Calderón-Villarreal A, Brouwer KC, Suarez-Torres J, De La Cruz F, Suarez-Lopez JR
Environ Health · 2026 Apr · PMID 42032596 · Full text
BACKGROUND: Pesticides frequently used in agriculture, including organophosphates, glyphosate, and 2,4-D, have endocrine disrupting potential. We previously found that residential proximity to floriculture crops can incr...
BACKGROUND: Pesticides frequently used in agriculture, including organophosphates, glyphosate, and 2,4-D, have endocrine disrupting potential. We previously found that residential proximity to floriculture crops can increase the potential for pesticide exposure of children and adolescents. Little is known about whether residential or school proximity to crops can affect their hormone levels. METHODS: We examined 507 adolescents (12–17 years, 51% female, ESPINA cohort) living in agricultural communities in Ecuador. Salivary dehydroepiandrosterone (DHEA), testosterone, estradiol, and cortisol were measured. Using linear regression, we analyzed the association of hormones with residential distance to floricultural crops and crop areas near homes and schools within various radii (150 m, 200 m, 300 m, and 500 m). RESULTS: The median (25th-75th percentile) residential proximity to floricultural crops was 312.6 m (112.3, 653.2), and 49% of adolescent participants lived within 300 m. Among these, the median (25th-75th percentile) crop area within 300 m was 8000m2. Within 150 m of children’s homes, doubling crop area was associated with lower concentrations of testosterone in boys (-9.14% (95% CI: -15.08%, -2.79%)). Doubling crop area within 300 m of homes was associated with greater cortisol concentrations in boys (8.05% (95% CI: 0.45%, 16.23%)). Doubling crop area within 500 m of homes was associated with lower estradiol in boys (-4.82% (95% CI: -9.26%, -0.17%)). Doubling crop area within 100 m of children’s schools was associated with lower estradiol in boys (-6.70% (95% CI: -11.78%, -1.34%)). CONCLUSIONS: We found greater crop area near homes was associated with testosterone, estradiol, and cortisol alterations in boys but not girls. Greater crop area near schools was associated with estradiol alterations in boys. This research suggests home and school proximity to pesticide spray site pose a risk to the developing endocrine systems of children.
Mitochondrial dysfunction as a potential pathway linking DL-PCB exposure to intrauterine growth retardation.
Yao H, Jiang C, Zhang H … +3 more , Si S, Li X, Zhang Y
Environ Health · 2026 Apr · PMID 42021317 · Full text
BACKGRAOUND: Dioxin-like polychlorinated biphenyls (DL-PCBs) are persistent organic pollutants with known endocrine-disrupting and developmental toxicity. Increasing evidence suggests that prenatal exposure to DL-PCBs ma...
BACKGRAOUND: Dioxin-like polychlorinated biphenyls (DL-PCBs) are persistent organic pollutants with known endocrine-disrupting and developmental toxicity. Increasing evidence suggests that prenatal exposure to DL-PCBs may adversely affect fetal growth; however, few studies have examined congener-specific and mixture-level effects, and the underlying biological mechanisms remain unclear. This study aimed to assess the relationship between umbilical cord DL-PCB concentrations and key fetal growth indicators including birth weight (BW), birth length (BL), and head circumference (HC), and to explore whether mitochondrial dysfunction mediates these effects. METHODS: A total of 5421 mother-infant pairs were recruited between 2022 and 2024 from a multicenter birth cohort in China. Twelve WHO-designated DL-PCB congeners were quantified in umbilical cord blood using gas chromatography-mass spectrometry (GC-MS). We employed multivariable linear regression, sex-stratified models, Bayesian kernel machine regression, generalized weighted quantile sum (gWQS), quantile g-computation (g-comp), and mediation analysis to evaluate individual and mixture effects. RESULTS: Eight DL-PCBs, particularly PCB-77 and PCB-126, were significantly associated with reduced BW (ranging from - 26.52 g to - 80.05 g per IQR increase). PCB-77 and PCB-126 were also negatively associated with HC, while no DL-PCBs showed significant associations with BL. Although inverse associations appeared stronger in boys, sex interactions were not statistically significant. Mediation analysis revealed that mitochondrial DNA content partially mediated the relationship between several DL-PCBs (e.g., PCB-77, PCB-81, PCB-118, PCB-126) and BW, with up to 10.76% of the total effect explained. Mixture models confirmed negative associations with BW and HC, with g-comp estimating a 161.95 g BW reduction per cumulative exposure unit. Bayesian kernel machine regression further identified PCB-77 and PCB-126 as dominant contributors. CONCLUSION: These findings suggest that mitochondrial dysfunction may be a mechanistic pathway linking prenatal DL-PCB exposure to intrauterine growth restriction, especially reduced birth weight, highlighting potential developmental risks from environmental contamination.
Spatial variation of asthma rates in Los Angeles County by environmental and socioeconomic indicators.
Khawari P, Bartell SM, Odegaard A … +1 more , Vieira VM
Environ Health · 2026 Apr · PMID 42021302 · Full text
BACKGROUND: Asthma is a chronic lung disease affecting nearly 1.2 million people in Los Angeles (LA) County. Asthma can be triggered and worsened by environmental pollutants. Exposure to oil/gas well operations, environm...
BACKGROUND: Asthma is a chronic lung disease affecting nearly 1.2 million people in Los Angeles (LA) County. Asthma can be triggered and worsened by environmental pollutants. Exposure to oil/gas well operations, environmental contamination, and other forms of environmental degradation have been linked with poorer respiratory outcomes. METHODS: We used Generalized Additive Models (GAMs) with a bivariate smooth of location and Quasipoisson framework to examine the relationship between location and asthma emergency department visitation (EDV) rates for census tracts in LA County (n = 2106). Using CalEnviroScreen scores, we predicted and mapped the rates after adjustment for environmental exposures and socioeconomic factors to determine if observed spatial patterns in asthma EDV could be explained by these known characteristics. Permutation tests were conducted to identify areas of elevated asthma EDV rates. We also calculated rate ratios (RR) and 95% confidence intervals for the indicators. RESULTS: The rate of asthma EDVs was highest to the north of the major shipping ports in the county. Per interquartile range increase, poverty (RR: 1.29 [1.26–1.32]), percent of the population unemployed (RR: 1.02 [1.00–1.03], and solid waste site scores (RR: 1.01 [1.00–1.02]), were associated with higher asthma EDV rates. Poverty contributed the most to the observed spatial variation in asthma EDV. CONCLUSION: These findings can motivate future research to investigate spatial variation in asthma using higher resolution individual-level data, especially in the identified areas of elevated risk in LA County. Solid waste exposure indicators, poverty level, and unemployment explained some of the spatial variation of asthma EDV rates. Closer investigations in these geographic areas can help us better understand the disparities in exposure and risk.
The potential role of dietary patterns in modifying the association between ambient PM exposure and mortality in elderly Hong Kong Chinese.
Li SY, Leung J, Lu ZH … +4 more , Ho KF, Su Y, Yu B, Kwok T
Environ Health · 2026 Apr · PMID 41998705 · Full text
BACKGROUND: The potential of dietary patterns to modify the associations between long-term ambient fine particulate matter (PM2.5) exposure and all-cause, respiratory, and circulatory mortality remains unclear. METHODS:...
BACKGROUND: The potential of dietary patterns to modify the associations between long-term ambient fine particulate matter (PM2.5) exposure and all-cause, respiratory, and circulatory mortality remains unclear. METHODS: A total of 3,937 older adults (≥ 65 years) living in the community were enrolled in a prospective cohort study from 2001 to 2003 in Hong Kong. Assessment of the Diet Quality Index-International (DQI-I), Dietary Inflammatory Index (DII), the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet was carried out utilizing a 280-item food frequency questionnaire. Annual PM2.5 concentrations were estimated via land use regression models. Mortality outcomes were sourced from official death registry. Time-varying Cox proportional hazards models were applied to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs). RESULTS: During a median of 16.8 years follow-up, 1,856 deaths were recorded. PM2.5 exposure significantly increased the risks of all-cause mortality, respiratory and circulatory mortality. The MIND diet interacted with PM2.5 exposure on all-cause (p-interaction = 0.008) and respiratory mortality (p-interaction = 0.022). Higher MIND diet scores (≥ median) attenuated the adverse PM2.5 exposure-mortality association, showing lower risks for all-cause (HR: 1.18, 95% CI: 1.06–1.32) and respiratory mortality (HR: 1.14, 95% CI: 0.91–1.41). In contrast, those with lower MIND scores (< median) had elevated mortality risks, with HRs of 1.45 (95% CI: 1.27–1.65) for all-cause mortality and 1.60 (95% CI: 1.24–2.06) for respiratory mortality. No significant interaction was observed for circulatory mortality. Besides, no interaction was found between PM2.5 exposure with DQI-I or DII in relation to mortality. CONCLUSIONS: Adherence to MIND diet may mitigate the detrimental effects of long-term exposure to PM2.5 on all-cause and respiratory mortality in older adults, whereas overall diet quality or an anti-inflammatory diet showed no protective effects.
Activation of anti-inflammatory pathways by polyunsaturated fatty acid signaling may protect neurodevelopment in children prenatally exposed to methylmercury.
Bartra C, Llop S, Kuligowski J … +11 more , Albiach-Delgado A, Suñol C, Rodríguez-Farré E, Ballester F, Soler-Blasco R, Jora B, Jarné-Ferrer J, Griñán-Ferré C, Vázquez S, Pallàs M, Sanfeliu C
Environ Health · 2026 Apr · PMID 41987264 · Full text
BACKGROUND: Mercury is ubiquitous in the environment. Substantial levels of its organic form, methylmercury, pose a risk to fetal neurodevelopment through the maternal diet. Conversely, nutrients such as the polyunsatura...
BACKGROUND: Mercury is ubiquitous in the environment. Substantial levels of its organic form, methylmercury, pose a risk to fetal neurodevelopment through the maternal diet. Conversely, nutrients such as the polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and arachidonic acid (AA) promote neurodevelopment. We aimed to elucidate the neuroprotective role of PUFA signaling against prenatal methylmercury exposure in a Mediterranean fish-consuming area, addressing a critical gap in understanding nutritional modulation of neurotoxicity. METHODS: Associations between levels of oxidized PUFA metabolites (oxylipins) in placental tissue ( = 12) or cord blood plasma ( = 39) and postnatal neurodevelopment in children were evaluated at two levels of prenatal mercury exposure. Low and moderate exposure groups were defined by total mercury concentrations in whole cord blood of 1.4–6.6 µg/L and 20–66 µg/L, respectively. Oxylipins were measured using liquid chromatography mass spectrometry. Neurodevelopment was assessed at 14 months and 5 years using Bayley and McCarthy scales, respectively. Oxylipins were also analyzed in mouse brain tissue after treatment with a soluble epoxide hydrolase inhibitor to increase AA epoxide levels. RESULTS: Under low mercury exposure, EPA-, DHA- and AA-derived placental oxylipins showed positive Spearman correlations with 14-month scores. In cord blood plasma, AA epoxides correlated positively with cognitive parameters at both ages under moderate exposure. Multivariate linear regression revealed positive associations between anti-inflammatory AA-derived epoxides and neurodevelopmental scores across tissues and ages, and between a DHA oxylipin in cord blood plasma and 14-month scores. No neurodevelopmental delays were observed in the moderate exposure group compared to the low exposure group. Oxylipin levels exhibited a more anti-inflammatory profile in samples from the moderate exposure group. Additionally, the brain oxylipin profile of mice treated with an AA epoxide enhancer indicated reduced inflammation. CONCLUSIONS: PUFA signaling dynamics revealed potential protective pathways against methylmercury-induced neurodevelopmental toxicity. Differential oxylipin modulation, together with the absence of neurodevelopmental delays, underscores the importance of a maternal diet rich in anti-inflammatory PUFAs for children at risk of cognitive impairment due to prenatal methylmercury exposure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12940-026-01270-2.
Serum cotinine-assessed tobacco exposure, cadmium co-exposure, and childhood obesity: a cross-sectional study.
Guo F, Ding C, Gu S … +14 more , Shi W, Zhang X, Qu Y, Xu P, Mo Z, Wang X, Yan S, Sun P, Zhao F, Zhu Y, Lv Y, Chen Z, Shi X, Lou X
Environ Health · 2026 Apr · PMID 41987245 · Full text
BACKGROUND: The association between tobacco exposure and obesity remains controversial, with the potential modifying role of cadmium (Cd) unclear. Childhood population provide a critical window to assess low-dose tobacco...
BACKGROUND: The association between tobacco exposure and obesity remains controversial, with the potential modifying role of cadmium (Cd) unclear. Childhood population provide a critical window to assess low-dose tobacco effects. This study aimed to investigate the association between serum cotinine-assessed tobacco exposure and childhood obesity, and further evaluate whether Cd exposure acts as a potential effect modifier in this association. METHODS: This nationwide cross-sectional study investigated 5,595 school-aged children from 2017 to 2018 China National Human Biomonitoring. Serum cotinine levels were measured to assess tobacco exposure. General obesity was determined using BMI Z-score, and central obesity was assessed via waist circumference, waist-to-height ratio, and body roundness index. Weighted regression and restricted cubic splines (RCS) assessed associations between cotinine and obesity, with interaction analyses for Cd exposure. RESULTS: Compared to the lowest cotinine tertile, individuals with the highest tertile had higher odds of general obesity (OR = 1.485; 95% CI: 1.096, 2.011) and central obesity (OR = 1.333; 95% CI: 1.030, 1.723). RCS models indicated linear and positive associations. Cd exposure significantly attenuated the association between cotinine levels and general obesity (Pinteraction = 0.002), with stronger effects observed in low Cd subgroups (OR = 1.279; 95% CI: 1.133, 1.444). CONCLUSIONS: These results indicate positive associations of tobacco exposure with general and central obesity among nonsmoking children, and Cd acted as an effect modifier. This study suggested that environmental tobacco reduction and considering Cd co-exposure could have implications for obesity in children and adolescents.
Experiences of clinicians engaged in report-back of individual chemical exposures in two pregnancy cohorts.
McIntyre AM, Franz K, Powderly C … +8 more , Otero NH, Boronow KE, Brody JG, Brown P, Vega CMV, James-Todd T, Quinn MR, Ohayon JL
Environ Health · 2026 Apr · PMID 41928229 · Full text
Reporting individualized chemical exposure results increases environmental health literacy, empowers study participants to reduce harmful exposures, and supports researchers in identifying and addressing exposure sources...
Reporting individualized chemical exposure results increases environmental health literacy, empowers study participants to reduce harmful exposures, and supports researchers in identifying and addressing exposure sources. Despite recommendations to increase clinicians’ roles in environmental health promotion, clinician-involvement in environmental health report-back remains limited. This study investigates clinician-facilitated environmental health report-back as a promising approach to results dissemination. We partnered with two pregnancy cohort studies to implement report-back of individual chemical results delivered by clinicians. Nine clinicians provided individualized exposure results to 87 participants across the two cohort studies. Following report-back sessions, we conducted semi-structured interviews to assess clinician experiences, perceived facilitators and barriers to report-back, and shifts in environmental health knowledge. Clinician-facilitated report-back was described as a rewarding process that enhanced clinicians’ ability to not only guide study participants through their individual chemical results but also expand their ability to provide environmental health information to other patients. Clinicians reported increased environmental health knowledge and adoption of personal exposure reduction habits. Clinicians from both cohorts discussed the challenge of communicating scientific uncertainty surrounding specific chemical exposures and related health outcomes. To address this, clinicians relied on structured training and materials developed by the study team to provide practical and actionable exposure reduction recommendations. Expanding training opportunities, embedding environmental health information into medical curricula and clinical practice, and developing guidance for clinician participation could advance communication of environmental exposure results.
Mapping the global health burden of climate-sensitive exposures: a systematic scoping review.
Corvetto JF, Simion R, Boutros P … +5 more , Kassem N, Belesova K, Bärnighausen T, Sauerborn R, Barteit S
Environ Health · 2026 Apr · PMID 41928226 · Full text
BACKGROUND: Climate change is an increasing determinant of morbidity and mortality worldwide. However, the health burden attributable to climate-sensitive exposures remains poorly quantified and inconsistently reported a...
BACKGROUND: Climate change is an increasing determinant of morbidity and mortality worldwide. However, the health burden attributable to climate-sensitive exposures remains poorly quantified and inconsistently reported across the existing literature. This lack of systematic evidence limits the ability of policymakers and health systems to allocate resources efficiently, design targeted interventions, and implement effective adaptation strategies. METHODS: We conducted a systematic scoping review following the PRISMA-ScR guidelines to map and synthesize available global evidence on the health impacts of climate-sensitive hazards, including heat, temperature variability, extreme weather events, and air pollution. Peer-reviewed studies published up to November 2024 were identified through searches in Scopus, PubMed, Embase, and Web of Science. Eligible studies were charted by exposure type, health outcome, study design, and geographic region. The review protocol was pre-registered in PROSPERO (CRD42023421873). RESULTS: Of the 15,538 records screened, 199 studies met the inclusion criteria. Evidence was most consistent for heat exposure, which showed strong associations with all-cause, cardiovascular, and respiratory mortality. Across 15 disease categories—including mental health, infectious, endocrine, and neurological disorders—exposures sensitive to climate change were associated with increased morbidity and mortality risks. However, the available evidence base was heavily skewed toward high- and upper-middle-income countries, with over half of the studies conducted in China. Evidence gaps were identified for undernutrition, injuries, disabilities, and non-fatal outcomes, particularly in low- and middle-income countries. Heterogeneity in exposure definitions, outcome, and regional data availability limited comparability across studies. A selective meta-analysis of comparable studies yielded pooled attributable fractions of 1.18% (95% CI: 1.01–1.37) for all-cause, 2.15% (1.54–2.88) for cardiovascular, 3.08% (2.17–4.15) for respiratory, and 2.71% (1.85–3.73) for stroke-related mortality due to heat. Additional climate-sensitive exposures and outcomes were not comparable and therefore could not be pooled. CONCLUSIONS: Climate-sensitive exposures are associated with a substantial health burden as reflected in the available global literature, with the strongest evidence originating from high-resource settings. Findings from this scoping review highlight the urgent need to enhance climate health surveillance systems in underrepresented regions, harmonize exposure and outcome metrics, and strengthen the integration of health evidence into national adaptation strategies and climate finance mechanisms. Addressing these evidence and infrastructure gaps is critical for informing equitable, data-driven adaptation planning, public health preparedness, and downstream loss-and-damage policy discussions.
Climate change and tuberculosis: enhancing impact through an implementation science informed agenda.
Christian C, Mukondwa R, Webb KA … +1 more , Shete PB
Environ Health · 2026 Mar · PMID 41888782 · Full text
Climate change increasingly threatens progress in tuberculosis (TB) control by exacerbating food insecurity, disrupting health systems, and driving population displacement, particularly in resource-constrained settings....
Climate change increasingly threatens progress in tuberculosis (TB) control by exacerbating food insecurity, disrupting health systems, and driving population displacement, particularly in resource-constrained settings. Although a growing body of literature links climate stressors to adverse TB outcomes, most existing research remains descriptive and provides limited guidance on how TB programs can adapt service delivery under worsening environmental conditions. This review examines how implementation science can address this evidence-to-practice gap and advance a climate-adaptive TB agenda. Drawing on the recently published World Health Organization's Climate Change and Tuberculosis Analytical Framework, we synthesize evidence on key climate-related pathways affecting TB vulnerability and highlight persistent gaps in data on the feasibility, acceptability, and effectiveness of adaptive interventions. We describe how implementation science frameworks and methods, including stakeholder-engaged approaches, mixed methods research, and evaluation of implementation outcomes, can guide the design, evaluation, and scale-up of climate-adaptive strategies. We conclude that embedding implementation science within climate-TB research is essential to move beyond documenting climate impacts toward actionable, equitable, and sustainable public health solutions, and to support resilient TB programs in the context of accelerating climate change.
Projecting tick-borne encephalitis risk in Sweden under climate change scenarios: a high-resolution spatio-temporal modeling approach.
Sewe MO, Wallin J, Rocklöv J … +3 more , Wang S, Koenigk T, Semenza JC
Environ Health · 2026 Mar · PMID 41872906 · Full text
BACKGROUND: Tick-borne encephalitis (TBE) is a serious vector-borne neurological disease in Europe, with a complex transmission cycle involving ticks of genus Ixodes, animal hosts, environmental and climatic determinants...
BACKGROUND: Tick-borne encephalitis (TBE) is a serious vector-borne neurological disease in Europe, with a complex transmission cycle involving ticks of genus Ixodes, animal hosts, environmental and climatic determinants. METHODS: We modelled annual Geocoded Swedish TBE case data for the period 2005–2023 as a log-Gaussian Cox process in relation to population, environmental and climate data, and wildlife citizen science reports at high spatial resolution. We used the computationally efficient Integrated Nested Laplace Approximation (INLA) and projected the future TBE incidence using fifteen regional climate models. RESULTS: The covariates significantly associated with TBE incidence in Sweden, ranked based on predictive capacity, were mean temperature, population density, habitat richness, forest cover, precipitation, relative humidity and roe deer density. Specifically, mean temperature above 12° C degrees in the third quarter of the previous year, habitat richness, precipitation in the third quarter, and higher roe deer density were associated with increased TBE risk. The model performed well on testing data, excluded from model building, demonstrating high predictive accuracy in TBE-endemic areas compared to observed data. Our projections indicate TBE cases will increase by 69% under low emissions (RCP2.6) and 121% under high emissions (RCP8.5) by the 2090s, relative to 2014–2023. CONCLUSION: The TBE incidence is projected to rise substantially, even under lower emission scenarios. Our findings highlight the growing influence of climate change on TBE transmission in Sweden and provide actionable evidence to inform surveillance, vaccination strategies, and long-term public health planning. Citizen science initiatives and risk maps can help focus resources on areas most vulnerable to transmission. More broadly, the integration of climate models with high-resolution epidemiological data, offers a template for anticipating climate-sensitive vector-borne diseases. Proactive, evidence-based interventions are essential to mitigate the growing health burden posed by TBE in Sweden and beyond.
Association between charcoal cooking fuel and cardiovascular disease prevalence in Haiti: a cross-sectional analysis.
Yan LD, Sufra R, St Sauveur R … +20 more , Celestin K, Rouzier V, Apollon A, Forestal G, Marcelin SE, Auguste S, Pierre J, Hilaire E, Fénélus JL, Ogyu A, Bennett C, Rasul R, Underhill LJ, Huffman MD, Davila-Roman VG, Peel JL, Kwan GF, Deschamps MM, Pape JW, McNairy ML
Environ Health · 2026 Mar · PMID 41872838 · Full text
BACKGROUND: There is little evidence on the association between cooking with polluting fuels, particularly charcoal, and heart disease from low- and middle-income countries, which have the highest burdens of polluting fu...
BACKGROUND: There is little evidence on the association between cooking with polluting fuels, particularly charcoal, and heart disease from low- and middle-income countries, which have the highest burdens of polluting fuels and cardiovascular disease (CVD). We sought to assess the relationship between self-reported primary home cooking with charcoal and prevalent cardiovascular disease in the low-income country Haiti. METHODS: Demographic and clinical data were collected from 3,005 adults in the Haiti Cardiovascular Disease Cohort, recruited from Port-au-Prince using multistage random sampling from 2019 to 2021. Primary cooking fuel was self-reported in the household: charcoal orliquified petroleum gas (LPG). Prevalent CVD (heart failure, stroke, myocardial infarction) was physician-adjudicated using epidemiological criteria similar to international cohorts. Multivariable generalized estimating equations with a Poisson distribution estimated prevalence ratios of prevalent CVD by polluting charcoal vs. LPG. RESULTS: Among 2,865 adults in the analytic sample, median age was 41 years (IQR 28–55), 57.9% female, and 88.4% reported using charcoal cooking fuel. Age-adjusted prevalence of any CVD was 13.7% (95% CI 12.2%, 15.4%) with the most common subtype being heart failure. Cooking with charcoal versus LPG was associated with higher prevalence of heart failure (1.63 prevalence ratio; 95% confidence interval 1.09, 2.44) after multivariable adjustment, lower prevalence of stroke, and not significantly associated with myocardial infarction or any CVD. CONCLUSION: Most urban Haitian adults cook with charcoal, an uncommon primary cooking fuel in other countries, and charcoal is associated with higher prevalence of heart failure compared to LPG. Polluting charcoal cooking fuel is a potentially modifiable risk factor for heart failure in low-income settings that needs remediation and intervention. TRIAL REGISTRATION: Registry: clinicaltrials.gov.
Mapping heat-related morbidity burden attributable to human-induced climate change across 460 communities of Victoria, Australia.
Xing Y, Xu R, Xu Z … +7 more , Li Z, Yang Z, Zhang Y, Huang W, Yu P, Li S, Guo Y
Environ Health · 2026 Mar · PMID 41862912 · Full text
BACKGROUND: With the continued rise in global temperature, the health risks associated with heat have become increasingly prominent. This study aims to assess and map the risk and cost of hospital admissions and emergenc...
BACKGROUND: With the continued rise in global temperature, the health risks associated with heat have become increasingly prominent. This study aims to assess and map the risk and cost of hospital admissions and emergency department (ED) visits attributable to heat exposure across local communities in Victoria, Australia, and quantify the impact of human-induced climate change. METHODS: We collected daily hospital admissions and ED visits during the hot seasons from 2014 to 2019 in Victoria, Australia. Using a standard time-series Poisson model and a random-effects meta-analysis, we estimated the heat-attributable burden of hospital admissions as well as ED visits at both the community and statewide levels, and further quantified the excess heat-related burden attributable to human-induced climate change. RESULTS: This study included 6,301,710 all-cause hospital admissions and 3,812,690 all-cause ED visits across 460 communities. From 2014 to 2019, heat exposure was responsible for 4574 (95% confidence interval [CI]: 4486, 4628) hospital admissions and 10,920 (95%CI: 10,789, 11,016) ED visits per year in Victoria, resulting in healthcare costs of AU$ 23.30 (95%CI: 22.86, 23.58) million and AU$ 7.03 (95%CI: 6.94, 7.09) million, respectively. Notably, the heat-related burden was particularly pronounced in women, rural areas, and northern communities. Human-induced climate change increased heat-related hospitalizations by 27.25% and ED visits by 16.46%. Urban areas were more sensitive to human-induced climate change than rural areas, with human-induced climate change contributing to 31.28% of heat-related hospitalizations and 21.14% of heat-related ED visits. CONCLUSION: Heat exposure was associated with increased risks of hospital admissions and ED visits in Victoria, particularly in women, rural areas, and northern communities, contributing to approximately AU$30 million in healthcare costs annually. Human-induced climate change had further intensified these heat-related burdens, with urban areas exhibiting greater sensitivity to human-induced climate change than rural areas.
Environmental stress, water inequality, and environmental justice in Palestinian urban areas: a GIS-based assessment of sanitation and infrastructure disparities in the southern West Bank.
Nassar N, Al Zabadi H, Chabaane Z
Environ Health · 2026 Mar · PMID 41840667 · Full text
This study examines environmental justice disparities in the southern West Bank by assessing groundwater quality, wastewater management, and water supply infrastructure in Dura City, Fawwar Refugee Camp, and the Israeli...
This study examines environmental justice disparities in the southern West Bank by assessing groundwater quality, wastewater management, and water supply infrastructure in Dura City, Fawwar Refugee Camp, and the Israeli settlement of Nahal Negohot. A mixed-methods approach combined field-based water sampling (71 points) with socio-demographic data (2014–2024) and GIS-based spatial analyses to generate composite indices, including the Environmental Stress Index (ESI) and Pollution Risk Index (PRI).Results indicate pronounced spatial inequities. Nitrate (NO₃⁻) concentrations in Dura City ranged from near zero to extreme peaks of 1,667.5 mg/L, exceeding WHO standards by up to 34 times, while Fawwar Camp exhibited moderate exceedances (51.5–147.1 mg/L). Nahal Negohot maintained low nitrate levels (<50 mg/L) due to centralized treatment and secure water supply. Total dissolved solids (TDS) reached 2,100 mg/L in Dura, 724 mg/L in Fawwar, and remained below 250 mg/L in Nahal Negohot. Electrical conductivity (EC) followed similar patterns, with values exceeding 2,600 µS/cm in Dura, 1,500 µS/cm in Fawwar, and <500 µS/cm in Nahal Negohot. The PRI highlighted high pollution risk in Dura (4.05), moderate risk in Fawwar (2.0–3.5), and low risk in Nahal Negohot (1.35–2.0).Water allocation in 2024 revealed stark inequities: Dura and Fawwar received only 13.5% and 7.2% of total supply, respectively, corresponding to 64.6 and 53 L/person/day, while Nahal Negohot received 79.3%, equivalent to 650 L/person/day. The ESI indicated high environmental stress in Dura, moderate stress in Fawwar, and low stress in Nahal Negohot, reflecting cumulative pressures from poor infrastructure, unregulated wastewater, illegal water extraction, network losses, and administrative deficiencies in Palestinian areas.These findings indicate that groundwater contamination and unequal water distribution are intertwined with structural and administrative constraints, resulting in environmental injustice. The study emphasizes the urgent need to enhance the capacity for integrated water and wastewater management, strengthen monitoring, and implement governance reforms to promote equitable and sustainable access to resources in the study area.
A systematic review of human studies assessing the health effects of unburned kerosene-based jet fuels and products across diverse populations and settings.
Carvajal V, Ng B, Rosendaal N … +1 more , Pirkle CM
Environ Health · 2026 Mar · PMID 41840653 · Full text
OBJECTIVE: Petroleum hydrocarbons are significant environmental health concerns globally, due to their extensive use and environmental release, including water contamination events such as the 2021 Red Hill jet fuel spil...
OBJECTIVE: Petroleum hydrocarbons are significant environmental health concerns globally, due to their extensive use and environmental release, including water contamination events such as the 2021 Red Hill jet fuel spill. Research on kerosene and kerosene-based jet fuels is limited, with prior reviews often focused on occupational and post-combustion exposures. No previous systematic review has focused specifically on pre-combustion exposures. Thus, we systematically reviewed evidence of human health impacts associated with these raw fuels across all exposure settings and population groups. MATERIALS AND METHODS: Search strategies and eligibility criteria were developed and executed following PRISMA reporting guidelines and informed by OHAT procedures for systematic reviews. PubMed and Web of Science databases were searched (2017–2024) for eligible literature. Data extraction, analyses, quality assessment and risk of bias appraisals were conducted. Four reviewers participated in these processes. RESULTS: A total of 28 articles were included. Respiratory outcomes were frequently observed following acute kerosene ingestion, whereas neurological outcomes were common with chronic occupational, dermal and inhalation exposure to jet fuel. Evidence of gastrointestinal and dermal outcomes were also documented. Current literature did not allow outcomes with long latency to be assessed. Limited analytical studies and data heterogeneity challenge the ability to establish robust conclusions. CONCLUSION: Considering the global health implications of kerosene and kerosene-based jet fuel, and recent water contamination events, this review is novel and timely in its focus on unburned fuel. Current evidence on the human health consequences of these fuels is limited. We thus provide recommendations for future studies, including exposure assessment methods, study designs, and prioritization of underrepresented populations.
Occupational characteristics are missing from heat vulnerability indices: a study in New York and New Jersey.
Laskaris Z, Baron S, Markowitz SB
Environ Health · 2026 Mar · PMID 41826969 · Full text
BACKGROUND: Heat vulnerability indices and maps are widely used by government agencies to guide heat-prevention strategies and prioritize resources for at-risk communities. However, these tools typically exclude the occu...
BACKGROUND: Heat vulnerability indices and maps are widely used by government agencies to guide heat-prevention strategies and prioritize resources for at-risk communities. However, these tools typically exclude the occupational characteristics of the population, a salient source of heat exposure. METHODS: To examine how occupation might enrich these tools, we developed a method to generate Census tract-level estimates of occupational heat exposure risk for employed residents using publicly available data from the U.S. Bureau of Labor Statistics Occupational Information Network (O*NET) and the U.S. Census American Community Survey Public Use Microdata Sample (2018–2022) and applied it to New York State (NYS) and New Jersey (NJ). We calculated the proportion of residents in occupations with elevated indoor or outdoor heat exposure. We then examined correlations and spatial alignment between occupational heat risk and social, health, and environmental vulnerability indicators. RESULTS: Approximately 1.3 million residents in NYS (13.6% of total employment) and 698,000 in NJ (15.1%) were employed in occupations with elevated indoor or outdoor heat exposure risk. Occupational heat exposure correlated most strongly with health vulnerability, followed by social vulnerability, while environmental vulnerability showed weak or negative correlations. Geographic overlap of tracts in the highest quintiles of occupational risk and other vulnerability domains was modest overall: occupational and health vulnerabilities aligned in less urban areas, whereas occupational, social, and environmental vulnerabilities clustered in and around urban centers. CONCLUSIONS: Integrating occupation into climate and social vulnerability indices is important, because it is an essential human activity, a social determinant of health, and a salient source of heat exposure that is not fully captured by existing social, health, and environmental data. These findings provide a replicable method for mapping occupational heat exposure, highlighting populations at elevated risk, informing future research, and supporting targeted interventions in community and workplace settings, especially where enforceable workplace protections against extreme heat are limited.
Exposure limits to radiofrequency EMF do not account for cancer risk or reproductive toxicity assessed from data in experimental animals.
Melnick RL, Moskowitz JM, International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF)
Environ Health · 2026 Mar · PMID 41826931 · Full text
BACKGROUND: Recent WHO-commissioned systematic reviews have concluded with “high certainty” that exposure to radiofrequency electromagnetic fields (RF-EMF) increases cancer risk and reduces male fertility in experimental...
BACKGROUND: Recent WHO-commissioned systematic reviews have concluded with “high certainty” that exposure to radiofrequency electromagnetic fields (RF-EMF) increases cancer risk and reduces male fertility in experimental animals. METHODS: We performed benchmark dose (BMD) analyses on experimental cancer data to estimate exposure levels associated with cancer risk of 1 × 10–5 (1 in 100,000). Due to the lack of an established non-linear mode of action for RF-EMF-induced tumor responses, we utilized linear low-dose extrapolation from 1% BMD values. In addition, we applied traditional uncertainty factors to the reported linear potency value of 0.03 per W/kg for male reproductive toxicity to derive health-protective exposure limits. RESULTS: The derived dose per hour (expressed as the specific absorption rate, SAR) at 1 × 10–5 cancer risk ranges from about 0.8 to 5 mW/kg. It should be noted that cancer risk increases with increasing time of exposure to RF-EMF. For protection of male fertility due to exposure to RF-EMF, the estimated SAR exposure limit was 3.3 to 10 mW/kg. These health protective whole-body exposure values are significantly lower than the current whole-body exposure limit value of 0.08 W/kg (80 mW/kg) established by ICNIRP and the FCC for the general public. CONCLUSIONS: For the general public, current regulatory limits to RF-EMF are 15- to 900-fold higher than our estimates of exposure levels associated with cancer risk of 1 × 10–5 (depending on the duration of daily exposure), and 8- to 24-fold higher than levels that are protective of male reproductive health. Thus, we strongly recommend an independent re-evaluation of RF-EMF exposure limits, integrating scientific data accumulated over the past 30 years and applying rigorous health-protective methodologies.
PFAS endocrine disruption affecting pubertal development: exposure-response is steeper below median PFAS serum concentrations.
van Larebeke N, Voorspoels S, Den Hond E … +2 more , Leermakers M, Schoeters G
Environ Health · 2026 Mar · PMID 41814302 · Full text
BACKGROUND: We have recently published (van Larebeke, Environ Health 24:34, 2025) consistent and biologically relevant associations of PFAS serum concentrations with sex hormone levels in male adolescents and with a sign...
BACKGROUND: We have recently published (van Larebeke, Environ Health 24:34, 2025) consistent and biologically relevant associations of PFAS serum concentrations with sex hormone levels in male adolescents and with a significant delay in physiological processes occurring during puberty in girls and boys. Associations with thyroid hormones differed significantly by sex with only for boys significant positive associations of FT3 with PFOA, PFHxS and PFNA. Here we report a follow-up analysis to test a work hypothesis stating that, as can be expected for receptor mediated effects, the observed associations would be stronger at lower PFAS serum concentrations (e.g. below the median) than at higher PFAS serum concentrations. MAIN BODY: To allow for a comparison between associations of biological/health effects with PFAS concentrations below or above median values, PFAS concentrations without log transformation were used in linear multiple regression with continuous effect parameters, logistic models with binary effect parameters, and Ordinal Multinomial Probit models with ordinal effect parameters. Regression coefficients and other statistical parameters were calculated with the Statistica 14.0 program. Significance of the difference between a regression coefficient observed for an association with a certain PFAS below the median serum concentration compared to above the median was assessed using a two‑tailed Wald test. The median PFAS serum values observed in our study were below present health based guidance values. Consistent with our working hypothesis, the lower exposed subpopulations (with serum concentrations below the median) had a greater change in outcome per unit increase in PFAS exposure (a stronger regression coefficient) than the higher exposed subpopulations concerning 72 of the 84 significant associations described previously and this was most pronounced for PFHxS, and to a lesser extent for PFOS(branched), PFOA and sum parameters. Continuous piecewise linear models, models with a quadratic term and, in the range of PFAS concentrations where sufficient data were present, also weighted least square graphs, yielded results supporting stronger regression coefficients below median PFAS serum concentrations. CONCLUSION: Our observations suggest that an important part of the endocrine disrupting effect of PFAS on adolescents occurs at serum levels below present health based guidance values.
Associations of urinary bisphenol A and its emerging substitutes with subfecundity in preconception couples: a prospective nested case-control study.
Yin A, Tse LA, Chen A … +9 more , Cheng L, Chen Y, Zhang S, Lin Z, Li X, Zhu Z, Zhang H, Li J, Jiang H
Environ Health · 2026 Mar · PMID 41781991 · Full text
BACKGROUND: Global infertility rates have noticeably increased in recent decades. The effects of environmental exposures on human fertility have been well-noted. However, Evidence on couple-based preconception exposure t...
BACKGROUND: Global infertility rates have noticeably increased in recent decades. The effects of environmental exposures on human fertility have been well-noted. However, Evidence on couple-based preconception exposure to bisphenols (BPs), particularly emerging substitutes, and fecundity remains limited. This study aimed to investigate the exposure profiles of 14 classic and emerging BPs in the preconception period as well as their impacts on couple fecundity, to assess both the individual effects of specific compounds and the combined effects of mixtures in males and females, and to evaluate the health risks induced by BPs exposure after tolerable daily intake (TDI) value was tightened in 2023. METHODS: This nested case-control study involved 1934 preconception individuals in two research sites of China, from October 2016 to May 2025. The case and control groups were comprised of 318 and 649 couples with time to pregnancy (TTP) > 12 and ≤ 12 menstrual cycles, respectively. BPs were quantified in preconception urine samples using ultra-performance liquid chromatography-tandem mass spectrometry, including novel substitutes that had not been measured and reported in human beings, such as 2,2’-diallyl bisphenol A (DBA) and 4-hydroxy-4’-isopropoxydiphenylsulfone (D8). Generalized linear, weighted quantile sum and Bayesian kernel machine regression models were employed to assess individual and mixture effects of BPs on subfecundity. RESULTS: The positive associations of BPs and subfecundity risks were observed in both females and males. Mixed BPs were positively correlated with subfecundity in females (OR = 2.84, 95% CI: 2.23–3.61), males (OR = 4.21, 95% CI: 3.24–5.47), and couples (OR = 6.73, 95% CI: 4.81–9.41), with DBA and bisphenol AF (BPAF) identified as major contributors. Health risk assessment indicated that although few participants had an estimated daily intake (EDI) exceeding the 2015 TDI (4000 ng/kg bw/day), most (81.8%-100%) surpassed the 2023 TDI (0.2 ng/kg bw/day). CONCLUSIONS: This study provides the first evidence linking novel bisphenols, BPAF and DBA, to increased subfecundity risk and highlights significant health risks in a population with an intention to conceive, underscoring the urgency to regulate a broader range of bisphenols to protect reproductive health.
Strategies to facilitate the report-back of research results: a systematic review of methods and evaluations.
Germano F, Vogel T, Tamayo-Ortiz M … +6 more , Hersbtman J, Barton M, Waters KM, Bramer LM, Khanna S, Rohlman D
Environ Health · 2026 Mar · PMID 41772658 · Full text
BACKGROUND: Reporting back of research results (RBRR) is becoming a recognized component of ethical community-engaged and human subjects research. Scholars emphasize the importance of involving participants in developing...
BACKGROUND: Reporting back of research results (RBRR) is becoming a recognized component of ethical community-engaged and human subjects research. Scholars emphasize the importance of involving participants in developing reports and methods of report-back, arguing that RBRR enhances comprehension, trust, and engagement with findings. Yet, despite growing recognition, standardized guidelines for ethical RBRR remain limited. To address this gap, we conducted a systematic literature review of peer-reviewed studies- primarily in genomics, environmental health, and biomonitoring- to identify RBRR development strategies. Secondarily, we assessed how these strategies may align with the bioethical principles of autonomy, beneficence, nonmaleficence, and justice to inform future RBRR design. METHODS: A systematic search of Web of Science, PubMed, and Google Scholar yielded 2,164 records; after removing 748 duplicates, 1,416 unique studies were screened, and 32 met the inclusion criteria (peer-reviewed, published 2016–2024, written in English). Studies were required to include primary report-back (e.g., direct return of results to participants) or detailed descriptions of RBRR methods or recommendations. The review followed a PE/IO (Population, Exposure, Intervention, Outcome) framework and adhered to PRISMA guidelines. Risk of bias was assessed using the STROBE cohort study checklist and GRADE criteria. RESULTS: Across studies, RBRR was framed as an ethical obligation, and an opportunity to improve understanding of environmental influences on health. Most emphasized plain-language communication (n = 8), multimodal dissemination (n = 10), and culturally responsive design (n = 4). However, only three studies applied formal communication or evaluation frameworks, and only one-third described how materials were developed. Common evaluation methods included post-report surveys (n = 22), interviews (n = 18), and focus groups (n = 14), however, we noted a lack of consistency in evaluation methods. Collectively, these 32 studies underscored the importance of tailoring materials to population characteristics, providing multiple formats, and experimenting with visual and digital tools to enhance comprehension. Although none cited a bioethical framework, the core principles were reflected in practice: respect for autonomy through participants’ right to know their results; beneficence through the development of accessible, actionable materials; nonmaleficence through anticipating and mitigating anxiety or confusion; and justice through culturally and linguistically appropriate design. Yet, gaps remain, with inconsistent characterization of RBRR methods and limited evaluation of RBRR. This study was limited by the risk of bias in participant selection, as many studies included participants with prior interest in the field of environmental health or emotional investment in the studies. CONCLUSION: Ethical RBRR supports both individual and collective knowledge and action when paired with ongoing community engagement. Developing consistent, evidence-based best practices that balance feasibility with contextual relevance could strengthen trust, comprehension, and the translation of scientific findings into meaningful public-health action.
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