Weaver AK, Keeney N, Head JR
… +14 more, Heaney AK, Camponuri SK, Collender P, Bhattachan A, Okin GS, Eisen EA, Sondermeyer-Cooksey G, Yu A, Vugia DJ, Jain S, Balmes J, Taylor J, Remais JV, Strickland MJ
Environ Health Perspect
· 2025 Jan · PMID 39804964
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BACKGROUND: Coccidioidomycosis, caused by inhalation of spp. spores, is an emerging infectious disease that is increasing in incidence throughout the southwestern US. The pathogen is soil-dwelling, and spore dispersal a...BACKGROUND: Coccidioidomycosis, caused by inhalation of spp. spores, is an emerging infectious disease that is increasing in incidence throughout the southwestern US. The pathogen is soil-dwelling, and spore dispersal and human exposure are thought to co-occur with airborne mineral dust exposures, yet fundamental exposure-response relationships have not been conclusively estimated. OBJECTIVES: We estimated associations between fine mineral dust concentration and coccidioidomycosis incidence in California from 2000 to 2017 at the census tract level, spatiotemporal heterogeneity in exposure-response, and effect modification by antecedent climate conditions. METHODS: We acquired monthly census tract-level coccidioidomycosis incidence data and modeled fine mineral dust concentrations from 2000 to 2017. We fitted zero-inflated distributed-lag nonlinear models to estimate overall exposure-lag-response relationships and identified factors contributing to heterogeneity in exposure-responses. Using a random-effects meta-analysis approach, we estimated county-specific and pooled exposure-responses for cumulative exposures. RESULTS: We found a positive exposure-response relationship between cumulative fine mineral dust exposure in the 1-3 months before estimated disease onset and coccidioidomycosis incidence across the study region [incidence rate ratio (IRR) for an increase from 0.1 to ; 95% CI: 1.46, 1.74]. Positive, supralinear associations were observed between incidence and modeled fine mineral dust exposures 1 [ (95% CI: 1.10, 1.17)], 2 [ (95% CI: 1.09, 1.20)] and 3 [ (95% CI: 1.04, 1.12)] months before estimated disease onset, with the highest exposures being particularly associated. The cumulative exposure-response relationship varied significantly by county [lowest IRR, western Tulare: 1.05 (95% CI: 0.54, 2.07); highest IRR, San Luis Obispo: 3.01 (95% CI: 2.05, 4.42)]. Season of exposure and prior wet winter were modest effect modifiers. DISCUSSION: Lagged exposures to fine mineral dust were strongly associated with coccidioidomycosis incidence in the endemic regions of California from 2000 to 2017. https://doi.org/10.1289/EHP13875.
Ding R, Wang Y, Yu Y
… +9 more, Meng X, Gong Q, Tang Y, Wang J, Mu X, Li H, Zhou H, Wang S, Liu P
Environ Health Perspect
· 2025 Jan · PMID 39772873
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BACKGROUND: Occupational heat-related illness (OHI) is a health threat to workers that can be fatal in severe cases. Effective and feasible measures are urgently needed to prevent OHI. OBJECTIVES: We evaluated the effect...BACKGROUND: Occupational heat-related illness (OHI) is a health threat to workers that can be fatal in severe cases. Effective and feasible measures are urgently needed to prevent OHI. OBJECTIVES: We evaluated the effectiveness of a multifaceted intervention, TEMP, in reducing the OHI risk among outdoor workers in the power grid industry. METHODS: A cluster randomized controlled trial was conducted with power grid outdoor workers in Southern China from 4 July 2022 to 28 August 2022. Work groups were randomly allocated (1:1) to the intervention or control groups. The multifaceted intervention TEMP comprised mobile application (app)-based education training (T), personal protective equipment [PPE (E)], OHI risk monitoring (M), and educational posters (P). Four follow-ups were conducted every 2 wk after the trial began. The primary outcome was the OHI incidence, and the secondary outcome was PPE usage. The app usage was considered as the compliance of intervention in the intervention group. The primary analysis used was intention-to-treat analysis. Multilevel analyses using random effects logistic regression models were performed to compare the odds of OHI between the two groups, adjusted for individual-level (education and work position) and work-related (including water intake when feeling thirsty, cooling measures, and poor sleep before work) covariates. RESULTS: Of 528 participants, 422 (79.92%) were males, and the age was y. The primary outcome, OHI incidence, was 1.80% in the intervention group and 4.82% in the control group at the end of the whole follow-up. OHI mainly occurred between 1100 and 1500 hours, with nausea, significantly increased heart rate, and oliguria being the top three reported OHI symptoms. Compared with the control group, the adjusted odds ratios between the intervention group and control group were 0.73 [95% confidence interval (CI): 0.30, 1.76] in the first follow-up wave, with 0.38 (95% CI: 0.15, 0.97), 0.29 (95% CI: 0.08, 1.05), and 0.39 (95% CI: 0.13, 1.19) in the following three follow-up waves, respectively. The intervention also significantly improved PPE usage in the intervention group. DISCUSSIONS: This multifaceted intervention reduced the OHI risk among outdoor workers in the power grid industry. However, further research is needed to design a more flexible intervention strategy and evaluate its effectiveness in a larger population. https://doi.org/10.1289/EHP14172.
Hilz EN, Gillette R, Thompson LM
… +2 more, Crews D, Gore AC
Environ Health Perspect
· 2024 Dec · PMID 39739410
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BACKGROUND: Increasing evidence supports an association of endocrine-disrupting chemical (EDC) exposures with adverse biological effects in humans and wildlife. Recent studies reveal that health consequences of environme...BACKGROUND: Increasing evidence supports an association of endocrine-disrupting chemical (EDC) exposures with adverse biological effects in humans and wildlife. Recent studies reveal that health consequences of environmental exposures may persist or emerge across generations. This creates a dual conundrum: that we are exposed to contemporary environmental chemicals overlaid upon the inheritance of our ancestors' exposure profiles. Even when legacy EDCs are phased out, they may remain relevant due to persistence in the environment together with intergenerational inheritance of their adverse biological effects. Thus, we all possess a body burden of legacy contaminants, and we are also increasingly exposed to new generations of EDCs. OBJECTIVES: We assessed the effects of direct and ancestral exposures to EDCs across six generations on anxiety-like behaviors in male rats using our "two hits, three generations apart" multigenerational EDC exposure experimental model. We investigated two classes of EDCs with distinct hormonal actions and historical use-the weakly estrogenic polychlorinated biphenyl (PCB) mixture Aroclor 1221 (A1221) and the anti-androgenic fungicide vinclozolin (VIN)-in both the maternal and paternal line. We also determined if a hormonal mechanism drives these effects across generations. METHODS: Rats were gestationally exposed to A1221, VIN, or vehicle [dimethyl sulfoxide (DMSO)] in the F1 generation. Three generations later, the F4 generation was given the same or a different exposure. Anxiety-like behavior was measured in the open field test, light:dark box, and elevated plus maze across generations. Serum was collected at the end of the experiment, and concentrations of estradiol and corticosterone were analyzed. RESULTS: Although direct exposure did not affect behavior in F1 males, ancestral exposure to VIN decreased anxiety-like behavior in the F3 paternal line compared to vehicle. In the F4 paternal line, ancestral A1221 followed by direct exposure to VIN increased anxiety-like behavior compared to controls. In the F6 maternal line, relative to vehicle, the double ancestral hits of A1221/VIN decreased anxiety-like behavior. Serum hormones weakly predicted behavioral changes in the F4 paternal line and were modestly affected in the F4 and F6 maternal lines. DISCUSSION: Our data suggest that anxiety-like behavioral phenotypes emerge transgenerationally in male rats in response to EDC exposure and that multiple hits of either the same or a different EDC can increase the impact in a lineage-specific manner. https://doi.org/10.1289/EHP15684.
Hilz EN, Gillette R, Thompson LM
… +5 more, Ton L, Pham T, Kunkel MN, Crews D, Gore AC
Environ Health Perspect
· 2024 Dec · PMID 39739409
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BACKGROUND: Endocrine-disrupting chemicals (EDCs) are exogenous chemical compounds that interfere with the normal function of the endocrine system and are linked to direct and inherited adverse effects in both humans and...BACKGROUND: Endocrine-disrupting chemicals (EDCs) are exogenous chemical compounds that interfere with the normal function of the endocrine system and are linked to direct and inherited adverse effects in both humans and wildlife. Legacy EDCs such as polychlorinated biphenyls (PCBs) are no longer used yet remain detectable in biological specimens around the world; concurrently, we are exposed to newer EDCs like the fungicide vinclozolin (VIN). This combination of individuals' direct environmental chemical exposures and any heritable changes caused by their ancestors' chemical exposures leads to a layered pattern of both direct and ancestrally inherited exposures that might have cumulative effects over generations. OBJECTIVES: We assessed consequences of both direct and ancestral exposure to EDCs over six generations, examining anxiety-like behaviors in maternal and paternal lines of female rats. We used the "two hits, three generations apart" multigenerational exposure model to explore how two distinct EDCs-the weakly estrogenic PCB mixture Aroclor 1221 (A1221) and the antiandrogenic VIN-interact on behavior across generations. We also explored serum hormones as a potential mechanism. METHODS: Rats were prenatally exposed to A1221, VIN, or vehicle (DMSO) in the F1 generation, and a second exposure (same or different) was administered to the F4 generation. Anxiety-like behavior was measured in the Open Field test, Light:Dark box, and Elevated Plus Maze in the F1, F3, F4, and F6 generations. Serum concentrations of estradiol and corticosterone were analyzed. RESULTS: Behavioral effects were not detectable in the F1 generation but emerged and became more robust across generations. Rats with ancestral VIN exposure demonstrated less anxiety-like behavior in the F3 paternal line in comparison with controls. Rats exposed to ancestral then prenatal A1221/VIN and VIN/A1221 had more anxiety-like behavior in the F4 maternal line, and those with two ancestral hits of VIN/VIN had more anxiety in the F6 paternal line, in comparison with controls. DISCUSSION: Our findings suggest that anxiety-like behavioral phenotypes can manifest in rats following germline exposure to EDCs and that subsequent exposures across generations can intensify these effects in a lineage-dependent manner. https://doi.org/10.1289/EHP15621.
Environ Health Perspect
· 2024 Dec · PMID 39729358
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BACKGROUND: Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse ga...BACKGROUND: Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse gas emissions. OBJECTIVES: This study used a systematic search and screening process to review the carbon footprint of hospital services and care pathways, exploring key contributing factors and outlining the rationale for chosen services and care pathways in the studies. METHODS: This state-of-the-science review searched the MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), GreenFILE (EBSCOhost), Web of Science, Scopus, and the HealthcareLCA databases for literature published between 1 January 2000 and 1 January 2024. Gray literature was considered up to 1 January 2024. Inclusion criteria comprised original research reporting on the carbon footprint of hospital services or care pathways. Quality of evidence was assessed according to the guidelines for critical review of product life cycle assessment (LCA). PROSPERO registration number: CRD42023398527. RESULTS: Of 5,415 records, 76 studies were included, encompassing 151 hospital services and care pathways across multiple medical specialties. Reported carbon footprints varied widely, from carbon dioxide () equivalents () for an hour of intravenously administered anesthesia to 10,200 for a year of hemodialysis treatment. Travel, facilities, and consumables were key contributors to carbon footprints, whereas waste disposal had a smaller contribution. Relative importance of carbon hotspots differed per service, pathway, medical specialty, and setting. Studies employed diverse methodologies, including different LCA techniques, functional units, and system boundaries. A quarter of the studies lacked sufficient quality. DISCUSSION: Hospital services and care pathways have a large climate impact. Quantifying the carbon footprint and identifying hotspots enables targeted and prioritized mitigation efforts. Even for similar services, the carbon footprint varies considerably between settings, underscoring the necessity of localized studies. The emerging field of health care sustainability research faces substantial methodological heterogeneity, compromising the validity and reproducibility of study results. This review informs future carbon footprint studies by highlighting understudied areas in hospital care and providing guidance for selecting specific services and pathways. https://doi.org/10.1289/EHP14754.
Environ Health Perspect
· 2024 Dec · PMID 39718546
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BACKGROUND: Large prospective cohort studies have been fruitful for identifying exposure-disease associations. In a cohort where biospecimens (e.g., blood, urine) were collected at enrollment, analysts can exploit a case...BACKGROUND: Large prospective cohort studies have been fruitful for identifying exposure-disease associations. In a cohort where biospecimens (e.g., blood, urine) were collected at enrollment, analysts can exploit a case-cohort approach: Biospecimens from a random sample of cohort participants, called the "subcohort," plus a sample of incident cases that were not part of the subcohort are assayed. Reusing subcohort data for multiple disease outcomes can reduce costs and conserve specimen archives. Pooling biospecimen samples before assay could both save money and reduce depletion of the archive but has not been studied for cohort studies. OBJECTIVES: We develop and evaluate a biospecimen pooling strategy for case-cohort analyses that relate an exposure to risk of a rare disease. METHODS: Our approach involves constructing pooling sets for cases not in the subcohort after grouping them according to time of diagnosis (e.g., age). In contrast, members of the subcohort are grouped by age at entry before constructing pooling sets. The analyst then fits a logistic regression model that jointly stratifies by age at risk and pooling set size and adjusts for confounders. We used simulations (288 sampling scenarios with 1,000 simulated datasets each) to evaluate the performance of this approach for several sizes of pooling sets and illustrated its application to environmental epidemiologic studies by reanalyzing Sister Study data. RESULTS: Parameter estimates were nearly unbiased, and 95% confidence intervals constructed using a bootstrap estimate of the standard error performed well. In statistical tests also based on the bootstrap standard error, pooling up to 8 specimens per pool caused only modest loss of power. Assigning more cohort members to the subcohort and commensurately increasing the number of specimens per pool improved power and precision substantially while reducing the number of assays. DISCUSSION: When using case-cohort analysis to study disease outcomes in relation to exposures assessed using biospecimens in a cohort study, epidemiologists should consider biospecimen pooling as a way to improve statistical power, conserve irreplaceable archives, and save money. https://doi.org/10.1289/EHP14476.
Brouwer AF, Zahid MH, Eisenberg MC
… +11 more, Arnold BF, Ashraf S, Benjamin-Chung J, Colford JM, Ercumen A, Luby SP, Pickering AJ, Rahman M, Kraay ANM, Eisenberg JNS, Freeman MC
Environ Health Perspect
· 2024 Dec · PMID 39705040
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BACKGROUND: While water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-b...BACKGROUND: While water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to improve interventions and remove barriers to diarrheal disease reduction. OBJECTIVES: We aimed to estimate how sensitive WASH intervention effectiveness was to underlying contextual and intervention factors in the WASH Benefits (WASH-B) Bangladesh cluster-randomized controlled trial. METHODS: The investigators measured diarrheal prevalence in children enrolled in the WASH-B trial at three time points approximately 1 year apart ( observations). We developed a susceptible-infectious-susceptible model with transmission across multiple environmental pathways and evaluated each of four interventions [water (W), sanitation (S), hygiene (H), and nutrition (N) applied individually and in combination], compliance with interventions, and the impact of individuals not enrolled in the study. Leveraging a set of mechanistic parameter combinations fit to the WASH-B Bangladesh trial using a hybrid Bayesian sampling-importance resampling and maximum-likelihood estimation approach, we simulated trial outcomes under counterfactual scenarios to estimate how changes in six WASH factors (preexisting WASH conditions, disease transmission potential, intervention compliance, intervenable fraction of transmission, intervention efficacy, and community coverage) impacted intervention effectiveness. RESULTS: Increasing community coverage had the greatest impact on intervention effectiveness (e.g., median increases in effectiveness of 34.0 and 45.5 percentage points in the WSH and WSHN intervention arms when increasing coverage to 20%). The effect of community coverage on effectiveness depended on how much transmission was along pathways not modified by the interventions. Intervention effectiveness was reduced by lower levels of preexisting WASH conditions or increased baseline disease burden. Individual interventions had complementary but not synergistic effects when combined. DISCUSSION: To realize the expected health gains, future WASH interventions must address community coverage and transmission along pathways not traditionally covered by WASH. The effectiveness of individual-level WASH improvements is reduced more the further the community is from achieving the coverage needed for herd protection. https://doi.org/10.1289/EHP15200.
Environ Health Perspect
· 2024 Dec · PMID 39688694
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Levels of certain chemicals listed under California's law have declined in biosamples from people across the nation.Levels of certain chemicals listed under California's law have declined in biosamples from people across the nation.
Environ Health Perspect
· 2024 Dec · PMID 39666390
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Racial and ethnic differences in exposures to phthalates and their replacements through use of soaps, lotions, etc. appear to begin in childhood.Racial and ethnic differences in exposures to phthalates and their replacements through use of soaps, lotions, etc. appear to begin in childhood.
Vineis P, Mangone L, Belesova K
… +7 more, Tonne C, Alfano R, Strapasson A, Millett C, Jennings N, Woods J, Mwabonje O
Environ Health Perspect
· 2024 Dec · PMID 39661413
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BACKGROUND: The Global Calculator is an open-source model of the world's energy, land, and food systems. It is a pioneering online calculator to project the impact of interventions to mitigate climate change on global te...BACKGROUND: The Global Calculator is an open-source model of the world's energy, land, and food systems. It is a pioneering online calculator to project the impact of interventions to mitigate climate change on global temperature. A few studies have been conducted to evaluate the health co-benefits of climate change mitigation, though they are still fragmentary. OBJECTIVES: Our objectives are to identify which sectors could yield the greatest results in terms of climate change mitigation and suggest whether existing evidence could be used to weight mitigation actions based on their ancillary impacts on human health or health co-benefits. METHODS: Using the International Energy Agency (IEA) 4DS scenario as a referent (i.e., the "4-degree Celsius increase scenario"), we simulated changes in different policy "levers" (encompassing 43 potential technological and behavioral interventions, grouped by 14 sectors) and assessed the relative importance of each lever in terms of changes in annual greenhouse gas emissions in 2050 and cumulative emissions by 2100. In addition, we examined existing estimates for the health co-benefits associated with different interventions, using evidence from the Lancet Pathfinder and four other tools. DISCUSSION: Our simulations suggest that-after accounting for demographic change-transition from fossil fuels to renewables and changes in agriculture, forestry, land use, and food production are key sectors for climate change mitigation. The role of interventions in other sectors, like carbon capture and storage (CCS) or nuclear power, is more modest. Our work also identifies mitigation actions that are likely to have large health co-benefits, including shifts to renewable energy and changes in land use as well as dietary and travel behaviors. In conclusion, some of the sectors/interventions which have been at the center of policy debate (e.g., CCS or nuclear power) are likely to be far less important than changes in areas such as dietary habits or forestry practices by 2050. https://doi.org/10.1289/EHP14906.
Environ Health Perspect
· 2024 Dec · PMID 39641999
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Higher exposure was associated with increased risk of ovarian cancer. Results hinted that age at exposure might matter.Higher exposure was associated with increased risk of ovarian cancer. Results hinted that age at exposure might matter.
Andrews RM, Adar SD, Szpiro AA
… +8 more, Kaufman JD, Christopher CN, Beck TL, Dhana K, Wilson RS, Rajan KB, Evans D, Weuve J
Environ Health Perspect
· 2024 Dec · PMID 39641998
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BACKGROUND: Evidence suggests that long-term exposure to air pollution may increase the risk of dementia and related cognitive outcomes. A major source of air pollution is automotive traffic, which is modifiable by techn...BACKGROUND: Evidence suggests that long-term exposure to air pollution may increase the risk of dementia and related cognitive outcomes. A major source of air pollution is automotive traffic, which is modifiable by technological and regulatory interventions. OBJECTIVES: We examined associations of four traffic-related air pollutants with rates of cognitive decline in a cohort of older adults. METHODS: We analyzed data from the Chicago Health and Aging Project (CHAP), a longitudinal (1993-2012) community-based cohort study of older adults that included repeated assessments of participants' cognitive performance. Leveraging previously developed air pollution models, we predicted participant-level exposures to the tailpipe pollutants oxides of nitrogen () and nitrogen dioxide (), plus the nontailpipe pollutants copper and zinc found in coarse particulate matter [PM with aerodynamic diameter to () and , respectively], over the 3 y prior to each participant's baseline assessment. Using generalized estimating equations, we estimated covariate-adjusted associations of each pollutant with rates of cognitive decline. We probed the robustness of our results via several sensitivity analyses, including alterations to the length of the exposure assessment window and exploring the influence of pre- and post-baseline selection bias. RESULTS: Using data from 6,061 participants, estimated associations of these pollutant exposures with cognitive decline were largely inconsistent with large adverse effects. For example, a standard deviation () increment in corresponded to a slightly slower rate of cognitive decline [e.g., mean difference in change in global score, 0.010 standard unit/5 y, 95% confidence interval (CI): , 0.036]. The results of most of our sensitivity analyses were in generally similar to those of our main analyses, but our prebaseline selection bias results suggest that our analytic results may have been influenced by differential survivorship into our study sample. DISCUSSION: In this large prospective cohort study, we did not observe compelling evidence that long-term TRAP exposure is associated with cognitive decline. https://doi.org/10.1289/EHP14585.
Environ Health Perspect
· 2024 Dec · PMID 39630532
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BACKGROUND: Residential greenness is linked to birth outcomes. However, the role of greenspace morphology remains poorly understood. Additionally, evidence is lacking regarding whether these relationships vary by subpopu...BACKGROUND: Residential greenness is linked to birth outcomes. However, the role of greenspace morphology remains poorly understood. Additionally, evidence is lacking regarding whether these relationships vary by subpopulation. OBJECTIVE: We examined the association between preterm birth and residential greenspace morphology, including percentage, shape, connectedness, aggregation, closeness, and fragmentation. METHODS: We analyzed 2,063,444 singleton live births between 2001 to 2016 in Georgia, USA. Thirty-meter resolution landcover data from National Land Cover Databased (2001-2016) were obtained to calculate greenspace morphology metrics for 1,953 census tracts in Georgia. A two-stage logistic regression examined associations between each greenspace morphology metric and preterm birth at individual level. Stratified analysis was conducted by maternal race, ethnicity, education, urbanicity, poverty rate, and greenspace percentage. RESULTS: Higher greenspace percentage, aggregation, closeness, shape complexity, connectedness, and lower fragmentation were linked to a lower risk of preterm birth. After adjusting for poverty rate, associations with morphology attenuated, except for fragmentation [odds ratio (OR) = 1.014; 95% confidence interval (CI): 1.0001, 1.026] across the entire population. Strongest associations were found among black mothers and in high-poverty areas. Specifically, the odds of preterm birth in the highest quartile of greenspace percentage were 0.962 (95% CI: 0.933, 0.991) times the odds in the lowest quartile. Additionally, a lower risk of preterm birth was associated with higher greenspace aggregation (OR = 0.969; 95% CI: 0.947, 0.992), and a higher risk of preterm birth was associated with higher fragmentation (OR = 1.028; 95% CI: 1.009, 1.047), both in the black mothers group. In tracts with a high poverty rate, a lower risk of preterm birth associate with higher greenspace percentage (OR = 0.953; 95% CI: 0.910, 0.999), aggregation (OR = 0.976; 95% CI: 0.955, 0.997), and lower fragmentation (OR = 0.976; 95% CI: 0.958, 0.994). The association with greenspace morphology was most pronounced in census tracts with a medium level of greenspace percentage. DISCUSSION: Our study complements other studies by showing the importance and protective effects of greenspace morphology. The observed effects are particularly prominent in census tracts characterized by a moderate level of greenspace percentage, high poverty rates, and among black women. Our findings suggest the need for tailored greenspace planning strategies based on varying levels of greenness in different areas. For locations with low greenness, increasing the greenspace percentage may be prioritized. In areas with a medium level of greenness, strategic enhancement of greenspace morphology is recommended. For areas with high greenness, the focus should be on improving spatial closeness of greenspace. https://doi.org/10.1289/EHP14571.
Wan W, Peters S, Portengen L
… +4 more, Babigumira R, Stenehjem JS, Richardson D, Vermeulen R
Environ Health Perspect
· 2024 Dec · PMID 39630531
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BACKGROUND: Benzene is classified as carcinogenic to humans based on evidence that benzene causes acute myeloid leukemia. However, there is limited evidence that benzene causes lung cancer. OBJECTIVES: We performed a sys...BACKGROUND: Benzene is classified as carcinogenic to humans based on evidence that benzene causes acute myeloid leukemia. However, there is limited evidence that benzene causes lung cancer. OBJECTIVES: We performed a systematic review, quality assessment, and meta-analysis of published cohort and case-control studies on the association between occupational benzene exposure and lung cancer risk. METHODS: We reviewed the relevant human epidemiological studies from PubMed and Embase databases to 19 August 2024. Data extraction included study characteristics, effect estimates, and exposure assessment details. Two investigators independently evaluated study quality using the Newcastle-Ottawa scale (NOS) framework and exposure assessment quality based on criteria. Six risk of bias (ROB) domains were constructed from the NOS criteria to identify and quantify possible biases and their impacts on parameter estimates. Meta-analysis relative risk (pooled RR) and associated confidence intervals were calculated using random-effects models, and a flexible exposure-response meta-regression was fitted to assess the shape of the association. Subgroup analyses were conducted to explore the consistency of results. RESULTS: Of 252 articles identified, 13 studies covering 366,975 participants (17,030 lung cancer cases) were included in our analysis. The meta-analysis of ever occupational benzene exposure showed an elevated risk of lung cancer (pooled ; 95% CI: 1.03, 1.27; ). Subgroup analyses revealed that larger pooled RRs in studies based on highly exposed groups had higher overall quality and better exposure assessments and included both males and females (as opposed to only males). A positive linear trend was observed in the exposure-response meta-analysis. DISCUSSION: Our meta-analysis supports an association between occupational benzene exposure and an increased risk of lung cancer. https://doi.org/10.1289/EHP15086.
Crocker J, Ogutu E, Snyder JS
… +11 more, Kome A, Tidwell B, Rosenboom JW, Shapiro J, Mahongo JS, Alexander KT, Gnilo ME, Gautam OP, Hoffman S, Neou S, Freeman MC
Environ Health Perspect
· 2024 Nov · PMID 39607683
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INTRODUCTION: Accurate information on context and implementation of public health interventions is necessary to replicate, adapt, and scale effective interventions and to interpret evaluations. Reporting the context and...INTRODUCTION: Accurate information on context and implementation of public health interventions is necessary to replicate, adapt, and scale effective interventions and to interpret evaluations. Reporting the context and implementation of water, sanitation, and hygiene (WASH) interventions has been inconsistent and incomplete. METHODS: To improve the reporting of WASH interventions, we developed the Template for Intervention Description and Replication for WASH (TIDieR-WASH) checklist and guide, by adapting and expanding the original TIDieR guide. We performed a scoping review of existing implementation reporting guidelines, and of current implementation reporting in WASH evaluations, to develop a list of candidate items to include in this checklist. We then used a 4-stages of review by international experts to reach consensus. RESULTS: The resulting 14-item checklist comprises: ) name, ) theory of change, ) prior evidence, ) location and setting, ) context, ) suitability, ) implementers, ) recipients, ) targeting, ) activities, ) intervention dose, ) fidelity, ) costs, and ) materials. Definitions, explanations, examples, and instructions for use are reported in this article. DISCUSSION: The checklist can be applied to all types of evaluations of WASH interventions, including direct service provision, behavior change, and systems strengthening interventions. We deliberately developed this guidance document to be accessible and relevant to practitioners and researchers. Adoption of this checklist will support transparent reporting of WASH implementation for research and practice. As with other sectors that have used TIDieR checklists, clear implementation reporting can assist with evidence synthesis, adaptation, and policy guidance. https://doi.org/10.1289/EHP14780.