Volume 26, Issue 3 - Special issue on breaking the cycle of environmental health disparities in vulnerable children

No abstract available

No abstract available

Children living in poverty are disproportionately at risk from and affected by environmental hazards. According to the National Center for Children in Poverty, 13 million children in America live in poverty. Thus, not only are millions of children living in poverty but are also living in environments that are hazardous to their health. Impoverished children are more likely to live in environments with heavily polluting industries, hazardous waste sites, contaminated water and soil, in old housing with deteriorating lead-based paint, in areas with limited access to healthy food, and more. Poor children residing in these toxic environments are either at risk or suffer from a myriad of health disparities, such as asthma, cancer, lead poisoning, obesity, and hyperactivity. This unfortunate reality is better known as environmental injustice. Environmental injustice recognizes that economically disadvantaged groups are adversely affected by environmental hazards more than other groups. To remedy this dilemma, environmental justice seeks to address these unfair burdens of environmental health hazards on poor communities. The purpose of this article is to (a) examine the environmental living conditions of children living in poverty, (b) examine the environmental health disparities of children living in poverty, (c) discuss environmental justice legislation, (d) describe government initiatives to improve environmental health, and (e) propose recommendations that executes measures to protect the health of children.

Substandard housing conditions have been linked to widespread childhood environmental health ailments, including two of the leading causes of childhood morbidity: lead poisoning and asthma. In 2009, the United States Surgeon General called for action around healthy homes. Improving home health environments can alleviate the cycle of childhood morbidity and mortality. The North Carolina (NC) Department of Environment and Natural Resources Children’s Environmen­tal Health Branch is working to build capacity at the State level to expand the childhood lead poisoning prevention program to respond to additional in-home environmental health issues. To achieve this objective, North Carolina must consider recommendations for assessment, management, and evaluation. This paper will situate healthy homes on the national public health agenda; discuss ways that healthy homes programs address children’s environmental health disparities; introduce the NC Healthy Homes Initiative; explore current healthy housing efforts in North Carolina through an examination of the Guilford County Healthy Homes Initiative; and provide recommendations for the NC Healthy Homes Initiative to address children’s environmental health disparities.

Childhood overweight and obesity have reached epidemic proportions, with nearly one of every three children in the USA being affected. That factors in the built environment are closely correlated to childhood obesity has become increasingly evident. Negative built environment factors disproportionately affect poor and minority children. This paper examines the current research on the state of childhood overweight and obesity and surveys the built environment factors that have been linked to the problem. Analyzing the built environment from a legal perspective, this paper identifies how zoning, legislation, public/private partnerships, and contracts are being used at the local, state, and federal levels to combat the epidemic of childhood obesity. Using these tools, local, state, and federal government agencies are increasing access to healthy food, decreasing the density of unhealthy food sources, and increasing physical activity resources for children. Whereas some of the programs are geared toward minority and low-income children, many apply to children across the socioeconomic and demographic spectrum.

The role of physical school environment on student health and education is becoming better understood. A growing body of literature indicates that improved physical environments in schools (e.g., indoor air quality, lighting, and acoustic conditions) can enhance student health outcomes. In parallel, the green building movement centers around designing buildings, including schools, that are more sustainable to decrease energy consumption, minimize environmental impact, and create healthier spaces for occupants. This paper synthesizes the findings from both green design studies and school outcomes studies to provide a systematic evaluation of the potential impacts of green school design features on student health outcomes. Three inter-related topics are covered in detail: (i) overview of the “green” concept, including existing guidelines for “greening” schools, attitudes toward green schools, and condition of the physical environments in non-green schools; (ii) potential effects of the physical environment on school children, including documentation of national statistics and summary of findings from school research studies; (iii) synthesis of findings, including a discussion of the knowledge gaps in the field of green school research and conclusions.

A growing body of research has broadened the study of the relationship between the built environment and health from individual housing conditions, to include the larger neighborhood environment and its subsequent effects on the health outcomes of its residents. Research has connected measures of neighborhood quality to changes in health outcomes for residents, yet little work has been done to develop measures that capture and quantify the physical features of the neighborhood’s manmade surroundings, also known as the built environment. This paper investigates the current literature detailing the relationship between the built environment and low birthweight and suggests potential interventions. Interventions developed at the county, neighborhood, and individual levels could aid community leaders and policymakers in breaking the cycle of low birthweight.

Background: Second hand smoke (SHS) exposure has long been correlated with many adverse disease processes, particularly in children. For children growing up with socioeconomic disadvantages and increased exposure to SHS, exposure can have far-reaching consequences. Objective: The purpose of this review was to examine the literature assessing the effects of SHS exposure in children, as well as the perspectives of both parents and providers regarding current practices in cessation counseling. The review also sought out recommendations on ways to increase the influence of pediatricians on parental smoking. Study group: Children under the age of 18 years. Methods: PubMed and MEDLINE were searched systematically. A narrative approach was used because the studies differed in methods and data. Results: The studies showed correlations between SHS exposure and sudden infant death syndrome (SIDS), asthma, altered respiratory function, infection, cardiovascular effects, behavior problems, sleep difficulties, increased cancer risk, and a higher likelihood of smoking initiation. Questionnaires of both parents and pediatricians showed that pediatricians are not consistently carrying out the recommended smoking cessation interventions, with lack of training as a primary barrier. Nevertheless, interventions targeting improved cessation training for both residents and practicing pediatricians have been studied and show promising results. Conclusions: SHS exposure has many detrimental effects on children’s health, particularly for those in low socioeconomic circumstances, for which factors in the built environment accentuated a higher baseline risk. By counseling parents, expanding residency education, and continuing advocacy work, pediatricians can have a significant positive impact on children’s health as related to SHS exposure.

Duval County (Jacksonville, FL, USA) has a long history of environmental health hazards, especially prevalent within its urban core, referred to as Health Zone 1. In 2009, the Duval County Health Department conducted a survey of awareness of and actual exposure to methylmercury among women in the county. The survey found that women with more education or higher incomes had a higher awareness of potential mercury exposures. Furthermore, women in the urban core were less aware and had higher exposure than those in more affluent areas. This study assesses the mercury-exposure awareness and education by healthcare providers serving women of child-bearing age. We surveyed 28 women’s health clinic offices. Sixty-one percent (17/28) indicated that they provide mercury exposure education to female patients, either written or verbal. Of these, only half (8/17) provide written education materials. Ninety-three percent of the providers indicated that a benefit to providing education on mercury exposure, is having “healthier developing fetuses and young children in the community”. Two barriers identified by providers to offering information on mercury exposure and risk were (a) a lack of interest among patients, and (b) a lack of clear, understandable educational materials. The long-term goal of our * -8project is to develop and distribute culturally effective, low literacy materials for distribution by health clinics, to document the increased awareness of mercury exposure risks, and to lessen the adverse health outcomes that may result from mercury exposure among vulnerable population groups in Duval County.

Background: Recent studies suggest that exposure to mold in damp buildings is an important environmental risk factor for childhood respiratory illness. One potential source of a damp home, is crawl space construction. A poorly constructed crawl space not only presents the possibility of contributing to a ‘damp’ home but can also become a reservoir for fungal growth. Objectives: Fungal levels in the livable indoor environment have been characterized in other studies, but little has been done to assess the potential for mold growth in the crawl space. This study examines the potential for mold growth and subsequent transmission from the crawl space into the home environment. Methods: In this study, we assessed mold contamination levels within crawl spaces from 238 study homes in North Carolina. We determined whether air leakage from the heating, ventilation, and air conditioning (HVAC) system and associated ductwork, transmitted viable mold spores from the crawl space into the living spaces within the home. Results: The results indicate that 19% of the homes demonstrated transmission of mold spores from the crawl space into the indoor environment, 45% of the homes displayed no transmission, and 36% of the homes were indeterminate. Conclusions: The results support the hypothesis that the HVAC system can serve as a conduit for the transmission of mold spores from the crawl space to the indoor environment of a home. This transmission likely affects children’s health, given the significant amount of time they spend in the home environment. For low-income families, the HVAC system may contribute an additional source of childhood exposure and highlights the importance of the assessment of indoor environmental hazards.

Background: Increasing prevalence of childhood obesity has been seen in the United States and other parts of the world. Environmental chemical exposures might play a role in the worldwide obesity epidemic. Objective: This study was conducted to assess the association of exposure to environmental pesticides with childhood obesity. Methods: A total of 6770 subjects aged 6–19 years were selected from the 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey (NHANES). Exposure to environmental pesticides was determined based on the concentrations of pesticide residues in urine. Multivariate logistic regression was performed using SAS 9.1.3 to assess the association between pesticide levels in urine and childhood obesity with the adjustment of potential confounders, including age, gender, race, income, and total fat intake. Results: A dose-dependent increase in prevalence of obesity was observed in the groups with inter-quartile urinary concentrations of 2,5-dichlorophenol (2,5-DCP). Logistic regression revealed a significant association between adjusted third (Q3) (AOR: 1.47; 95% CI: 1.09, 1.97) and fourth (Q4) (AOR: 1.44; 95% CI: 1.06, 1.95) inter-quartile urinary 2,5-DCP levels and childhood obesity. However, urinary concentrations of 2,4-dichlorophenol were not shown to be significantly associated with childhood obesity. Conclusion: This study suggests a possible relationship between exposure to 2,5-DCP and obesity in children.

Background: Studies of small for gestational age (SGA) birth and subsequent childhood cognitive outcomes are inconsistent. Few studies have assessed whether effects varied by socioeconomic status (SES). Objective: To assess child cognitive and behavioral outcomes according to SGA and severe SGA (<10th and <5th percentiles) and SES. Methods: We followed 474 infants initially selected for a case-control study assessing SGA vs. appropriate-for-gestational age (AGA). The infants were born at two hospitals: a public hospital serving a low-income, African-American population and a private hospital serving a predominantly white, middle-class population. At age 54 months, a psychologist administered the Differential Abilities Scales (DAS), and Vineland Adaptive Behavior Scales (VABS). The mother completed the Child Behavior Checklist (CBCL). Associations were analyzed using multiple linear regression. Results: Among AGA children, the mean DAS score was >1 standard deviation lower for children born at the public vs. the private hospital (75.2 vs. 95.7 among boys; 76.3 vs. 101.8 among girls). Being SGA had a weaker effect on DAS scores, overall. Severe SGA had a significant effect on DAS scores of children born at the private hospital (average reduction 8.0±2.5 points), but not on children born at the public hospital (average reduction 1.1±2.2 points). In the latter group, severe SGA was associated with a lower VABS score (average reduction 9.2±2.5 points). Conclusions: Poor fetal growth influences neurodevelopment, but this influence is modified by postnatal environment. Adverse effects associated with low SES might mask or attenuate associations between prenatal exposures and developmental outcomes in some populations.