Volume 12, Issue 4 - Special issue: Break the cycle: environmental hazards and children / Editors: Isadore Leslie Rubin, Robert J. Geller, Janice Nodvin, Michele Marcus, Maeve Howett and Joav Merrick

In 2008, there were an estimated 963 million undernourished people. Today, the prevalence of child malnutrition continues to be alarmingly high in some parts of the world. Malnutrition has the greatest impact on children under the age of 2 years, who are particularly vulnerable to the long-term, deleterious impacts of inadequate nutrition. Children need access to adequate food in terms of quality and quantity, to prevent micronutrient deficiencies, stunting, and diminished brain development. Food aid can provide an essential safety net. At present, the United States is the largest provider of food aid through a variety of programs, the largest being Title II, which is administered by the U.S. Agency for International Development. However, traditional food aid staples, such as corn-soy blend, do not fully address the nutritional needs of children. For this reason, the nutritional standards for food aid products should be improved. Improving the content of food aid is one way to enhance the Title II programming, but larger U.S. policy reforms are needed to help achieve lasting solutions to hunger and malnutrition. Such policies include reducing strict domestic preferencing requirements in order to create greater flexibility in procuring food through a combination of local, regional, and domestic sources.

Background: “Food desert” is a term used to describe low-income communities without access to healthy, fresh food within a one-mile radius of their residence. The limited access to healthy foods in urban African-American communities may be a critical factor in the development of nutritional disorders and associated chronic disease in this vulnerable population. Research has shown that community gardens are a promising intervention for addressing food quality and access issues. This study aimed to assess whether improving the local food environment through community gardens can increase accessibility to healthy foods in Metropolitan Atlanta communities assumed to be food deserts. Methods: A systematic literature review was conducted to identify best practices of community garden projects in order to address food deserts in metropolitan cities. Next, a windshield survey was conducted in the Adamsville community in metropolitan Atlanta, Georgia to determine if a food desert was present, and to provide an analysis of the local food environment. Results: Twenty-nine articles were reviewed and eight best practices were identified as effective strategies in metropolitan cities. We found that community gardens had only minimal impact on food access issues in urban communities due to seasonal accessibility and low yield. The windshield survey revealed that the Adamsville community was not a food desert because it had access to healthy foods within a half-mile radius. Conclusion: While the literature review revealed that community gardens had a minimal impact on food access in urban communities, food policy advocacy and supermarket tax incentives were identified as effective ways to promote healthy community development.

Chronic arsenic exposure in developing children is associated with cognitive delays, reduced IQ, poor memory, and a range of negative health outcomes later in life. In this study, we examined demographic and socioeconomic disparities in arsenic exposure among children and adolescents in the U.S. Subjects aged 6–19 years were selected from the 2005–2006 and 2007–2008 cycles of the National Health and Nutrition Examination Survey. Exposure to arsenic was determined based on the urinary concentrations of total arsenic (tAs) and speciated arsenic. Multivariate logistic regression analysis was performed using SAS 9.3 to assess the association of demographic and socioeconomic variables with arsenic exposure. A statistically significant increase in urinary levels of tAs and dimethylarsinic acid was found in both African-American children and other races, as compared with Whites, as well as in those who recently consumed fish and shellfish. The racial disparity in arsenic exposure observed in this study may be related to genetic factors governing arsenic metabolism and excretion patterns in urine, as well as to socioeconomic status, dietary options, or residential proximity to industry. Further studies are needed to identify factors that contribute to such racial disparities in arsenic exposure.

Background: Grandparents Raising and Nurturing Dependents with Disabilities (Project GRANDD) is a support program for grandparents who are the primary caregivers of grandchildren with developmental disabilities, chronic illness, and behavior or learning difficulties. A critical problem contributing to diminished quality of life for the family is the grandparents’ own poor health, as well as the lack of access to available resources. This project pairs nursing students from the local university with grandparents participating in the GRANDD support program to improve the caregiving grandparents’ health. Methods: A total of 12 nurse practitioner (NP) students were paired with six grandparents. Students performed home visits and assessments, health histories, environmental assessments, and windshield surveys over the course of several weeks. Follow-up visits for medication reconciliation, referral to resources, or for patient health education were conducted in person or via phone. Results: The grandparents’ demographic characteristics were as follows: African American females, on fixed incomes on or near poverty level, had multiple co-morbidities, and showed reluctance in seeking help because of their role as primary caretaker. Nursing students demonstrated increased awareness of the cycle of disability and disadvantage, and improved skills that enable them to aid vulnerable individuals in accessing community resources. Conclusions: This pilot program had a positive impact on students and grandparents. Much is needed regarding outcome measurement and standardization of methods, but the initial results demonstrated a beneficial relationship between NP students and Project GRANDD participants, thus contributing to the ongoing effort to break the cycle of disadvantage and disability in this vulnerable population.

Communities living next to petrochemical facilities, refineries, and other industries producing hazardous air pollution have used inexpensive air sampling technology, known as “Buckets”, to test the air quality of their homes and neighborhoods. These samples have mobilized the communities around environmental justice issues, attracted media attention to their plight, and generated political responses; however they have not been used as part of a litigation strategy. This paper addresses the issue of whether or not these samples could be admissible to advance Clean Air Act claims in favor of these communities. The paper also sets out normative arguments that address whether environmental justice communities should focus their time, efforts, and financial resources to achieve this goal.

Background: Preterm birth results in considerable morbidity and mortality among children in the USA. The risk of preterm birth is not fully explained by individual maternal risk factors, although there is some evidence that adverse environmental factors, such as living in a high crime neighborhood, may contribute to an increased risk of preterm birth. Methods: We used multilevel logistic regression to investigate the association between census block group violent crime rate and the probability of preterm birth, controlling for potential individual and neighborhood level confounders. We restricted our analysis to births within the City of Atlanta, GA in the years 1998–2006. Results: Preterm births comprised 13.1% of 50,665 births in Atlanta. Violent crime rates at the block group level showed significant interaction with maternal age. The odds of preterm birth among women in the highest two violent crime quartiles were increased compared with women in the lowest violent crime quartile among women 30 years and older; there was no association between living in the highest block group crime quartiles and preterm birth compared with living in the lowest crime quartile among women younger than 30 years. Conclusions: There is evidence of an association between living in a high crime area and an increased risk of preterm birth for women over 30 years of age, when considering violent crime rate at the block group scale.

Background: Urban, low income minority adolescents are disproportionately affected by numerous preventable morbidities, including poor school performance, obesity, and teen pregnancy. Owing to the complex interplay of social, cultural, and economic factors that contribute to the morbidities, no single intervention has shown consistent success in categorically improving outcomes. Recent research suggests a common root problem is lack of empowerment. Effective positive youth development (PYD) initiatives can prevent many morbidities by fostering empowerment in at-risk youths. However, little is published on how to implement and sustain such interventions. Methods: Cyclopedia is an annual summer curriculum of mentored bicycle rides consisting of educational lessons, local exploration, and creative self-expression (photography and writing). It is structured on a PYD model and is supported by a core partnership between a medical institution and a community based organization (CBO). Results: Cyclopedia has completed two full seasons with expansion from 18 boys to 50 boys and girls. The cost per trip has dropped from approximately $400 per rider to $100 per rider. The number of rides increased from 13 to 20, and total mileage increased from 740 to 870 miles per year. However, miles per rider dropped from 41 to 17, and writings per rider dropped from 2.6 to 0.5. Conclusions: Cyclopedia, supported by a core partnership between a medical institution and a CBO, shows significant promise in cost-effectively reaching large numbers of at-risk children with PYD programming. Ongoing curriculum adjustments aim to address decrements in individual participation.

Past studies have shown that traffic-related air pollution may increase pediatric asthma prevalence. We analyzed the relationship between distance of a child’s home to roadways and asthma prevalence in Durham County, North Carolina (NC). Data for children aged 5–12 years and with permanent addresses in Durham County were taken from the Decision Support Repository, an electronic warehouse of all patient records in the Duke University Hospital System. Records were analyzed using logistic regression analysis. Controlling for child race, age, sex, and household median income at the block group level, children who lived <75 m away from a local road were 20% less likely to be diagnosed with asthma. Our model did not show a relationship between the distance of a home to roadways and pediatric asthma prevalence for homes located at farther distances from local roads, or at any distance from NC State highways, US highways, or interstates. Our results indicate that traffic-related air pollution is not a major determinant for pediatric asthma prevalence in Durham County. As a generally low pollution area, the effects of traffic-related pollution may be less pronounced in Durham than in higher pollution areas. However, limitations in our modeling methods may have hindered our ability to detect a relationship. As the best strategy for decreasing the effects of traffic-related air pollution is to reduce other risk factors, Durham County can now take steps to break the cycle of disadvantage and disability of pediatric asthma, no matter the effect of traffic-related air pollution.

The benefits of screening potential school sites for environmental hazards and the special vulnerability of children to environmental pollutants and toxins are well understood. Less apparent, and less widely discussed until recently, are other health concerns associated with school location, such as ready access to healthy food options and opportunities for safe walking and bicycling. In recent years, a variety of stakeholders interested in children’s wellness in school settings have expressed concerns about the trend to place larger schools further away from the communities they serve. In some cases, this trend can worsen environmental health risks, such as air pollution, and reduce opportunities for physical activity, with disproportionate impacts on communities already burdened with multiple stressors. This paper describes a project in Georgia that helps school system decision makers more fully integrate children’s environmental health and wellness concerns into all aspects of school siting planning, through a training curriculum based on the US Environmental Protection Agency’s 2011 School Siting Guidelines. Two training modules have been developed. Preliminary feedback indicates that the process itself – convening a diverse set of stakeholders with different expertise related to children’s environmental health, community planning, and school system planning – results in new partnerships and the consideration of other perspectives. Better integration of municipal and school planning and improved understanding of environmental health considerations can improve public health outcomes for the entire community.