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Environmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this "double...
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Context 1
... the univariate regression model, all SOD mea- sures were statistically significantly associated with distance to TRI facilities (Table 3). Across the state of MD, census tracts with a higher percentage of non-white residents demonstrated resistance to decaying distance between adjacent TRI facilities (Beta coefficient = -0.011; ...
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Citations
... Environmental health research has long documented disproportionate pollution exposures among black, indigenous, other people of color, and low income people in the U.S. (e.g. [1][2][3][4][5][6][7][8][9][10][11]). Numerous studies have identified corresponding burdens of cancer, respiratory disease, or premature death (e.g. ...
Previous studies indicate that pollution exposure can increase risks of adverse birth outcomes, but Black communities are underrepresented in this research, and the potential moderating role of neighborhood context has not been explored. These issues are especially relevant in Louisiana, which has a high proportion of Black residents, an entrenched history of structural racism, the most pounds of toxic industrial emissions annually, and among the nation’s highest rates of low birthweight (LBW), preterm birth (PTB), and infant mortality. We investigated whether air pollution and social polarization by race and income (measured via the index of concentration at the extremes [ICE]) were associated with LBW and PTB among Louisiana census tracts (n = 1,101) using spatial lag models. Data sources included 2011-2020 birth records, U.S. Census Bureau 2017 demographic data, and 2017 Respiratory Hazard (RH) from the U.S. Environmental Protection Agency. Both RH and ICE were associated with LBW (z = 4.4, P < 0.0001; z = -27.0, P < 0.0001) and PTB (z = 2.3, P = 0.019; z = -16.7, P < 0.0001), with no interaction. Severely polluted tracts had 25% higher and 36% higher risks of LBW and PTB, respectively, versus unpolluted tracts. On average, 2,166 low birthweight and 3,583 preterm births annually were attributable to pollution exposure. Tracts with concentrated social deprivation (i.e. low ICE scores) had 53% higher and 34% higher risks of LBW and PTB, respectively, versus intermediate or mixed tracts. On average, 1,171 low birthweight and 1,739 preterm births annually were attributable to concentrated deprivation. Our ecological study found that a majority of adverse birth outcomes in Louisiana (i.e. 67% of LBW and PTB combined) are linked to air pollution exposure or disadvantage resulting from social polarization. These findings can inform research, policy, and advocacy to improve health equity in marginalized communities.
... Cancer disparities are well documented among African American, American Indian, Alaskan Native, Asian, Pacific Islander, and Hispanic and Latino population groups, and those with low socioeconomic status (SES; i.e., below the poverty line) [1,2]. In the United States (U.S.), people from these groups experience a disproportionate burden of exposure to environmental pollution, including criteria (e.g., particulate matter, ozone) and hazardous (e.g., acetaldehyde, formaldehyde) air pollutants from traffic, industry, and other sources [3][4][5][6][7][8][9][10]. Industrial facilities are known sources of carcinogenic air pollutants, and similar patterns of unequal exposure burden have been shown among populations that live in proximity to these facilities [11][12][13][14][15][16][17][18] but very few studies have evaluated specific chemicals emitted from industrial sources. Numerous national studies have illustrated racial, ethnic, and socioeconomic inequities in exposure to industrial pollution generally [19][20][21][22][23][24], most often using an aggregated air pollution estimate of burden, toxicity, or risk to reflect exposure. ...
Background
Industrial facilities are not located uniformly across U.S. communities, but how the burden of exposure to carcinogenic air emissions may vary across population characteristics is unclear. We evaluated differences in carcinogenic industrial pollution among major sociodemographic groups in the U.S. and Puerto Rico.
Methods
We evaluated cross-sectional associations of population characteristics including race and ethnicity, educational attainment, and poverty at the census tract level with point-source industrial emissions of 21 known human carcinogens using regulatory data from the U.S. Environmental Protection Agency. Odds ratios (ORs) and 95% confidence intervals (CIs) comparing the highest emissions (tertile or quintile) to the referent group (zero emissions/non-exposed) for all sociodemographic characteristics were estimated using multinomial, population density-adjusted logistic regression models.
Results
In 2018, approximately 7.4 million people lived in Census tracts with nearly 12 million pounds of carcinogenic air releases. The odds of tracts having the greatest burden of benzene, 1,3-butadiene, ethylene oxide, formaldehyde, trichloroethylene, and nickel emissions compared to non-exposed were 10%-20% higher for African Americans, whereas White populations were up to 18% less likely to live in tracts with the highest emissions. Among Hispanics and Latinos, odds were 16%-21% higher for benzene, 1,3-butadiene, and ethylene oxide. Populations experiencing poverty or with less than high school education were associated with up to 51% higher burden, irrespective of race and ethnicity.
Conclusions
Carcinogenic industrial emissions disproportionately impact African Americans, Hispanics and Latinos, and people with limited education or experiencing poverty, thus representing a source of pollution that may contribute to observed cancer disparities.
... discharged 453.4 million pounds of lead or lead compounds into air, water or other releases in 2020 alone, which imposed a continual peril to the environment and public health [21]. Furthermore, while the environmental injustice literature has long suggested that low-income and communities of color often live near polluting facilities and are therefore disproportionately exposed to releases of toxic pollutants [22][23][24][25][26][27][28][29][30], limited research has speci cally examined the uneven distribution of different demographic groups in relation to lead-releasing industrial facilities and how the disadvantaged communities bear unfair burden of exposure to lead emissions [9,17,23,31]. ...
... Existing studies have used different distance buffers as proxies for proximity to environmental hazards to examine evidence of environmental injustice [30,[45][46][47]. For example, J Crowley [48] applied a 5-mile distance radius to estimate whether socioeconomically vulnerable residents were more likely to reside in proximity to coal-red power plants and AE Janitz, HD Dao, JE Campbell, JA Stoner and JD Peck [49] used three distance thresholds (i.e., 2-, 5-, and 10-mile) to investigate the health effects of nearness to natural gas drilling facilities. ...
... Such differences in lead exposure were consistent across all NCHS urban-rural locales that further corroborated our observations of racial and economic inequalities measured by proximity. Our results are generally supportive of increasing evidence from empirical studies that documented environment injustice between marginalized populations (i.e., low-income and minorities) and their more a uent and white counterparts [27,30,[58][59][60][61]. ...
Background: Exposure to harmful lead is a critical public health concern due to its toxic nature and widespread distribution in the environment. Given the fact that policy solutions in the past several decades have significantly decreased the risks of environmental lead exposure, a remaining threat is toxic lead emissions from industrial facilities. This study examined the racial and economic disparities in proximity to lead-releasing industrial facilities and the concomitant lead exposure in Kentucky in the U.S.
Methods: We applied unique geospatial analysis methods including distance buffer, location quotients, and population-weighted exposures to analyze the spatial patterns of lead-releasing industrial facilities and lead exposure concerning environmental injustice between blacks and whites and between the below-poverty and above-poverty populations. Pearson’s linear correlation and paired samples t-test were performed to examine the statistical significance of racial and economic inequalities measured by distance to polluting facilities, lead concentration, and population-weighted exposure to lead.
Results: We identified a negative correlation between percent of the population that was black and distance to Toxic Release Inventory (TRI) sites (r = -0.240, p <0.001) and opposite results were observed for whites (r = 0.284, p <0.001). Likewise, median household income was positively associated with distance to TRI facilities (r = 0.197, p < 0.001) while poverty rate was inversely related to distance to TRI facilities (p = -0.189, p <0.001). Moreover, blacks and the below-poverty group had larger mean population-weighted lead exposures than whites and the above-poverty group respectively although the mean differences for each pair was statistically insignificant.
Conclusions: Results of this study provide new evidence supporting the environmental injustice proposition that assets low-income and ethnic minorities are more likely to reside in the vicinity of toxic-releasing industrial facilities and are therefore disproportionately exposed to airborne lead. Findings can help promote the need for reduced national ambient air quality standards for lead releases and mitigate environmental injustice.
... Although this study did not evaluate environmental hazards associated with living close to brownfields [84,85] or U.S. Environmental Protection Agency Toxic Release Inventory facilities [83], several published studies have described the environmental contamination from manufacturing efforts in Maryland that have included U.S. Environmental Protection Agency Toxic Release Inventory facilities in the state [86][87][88][89] and brownfields in south Baltimore [84,85]. Perlin, Sexton, and Wong [87] found that there were 122 Toxic Release Inventory sites in Maryland. ...
... About half of the Toxic Release Inventory facilities were in Baltimore city, Howard, Anne Arundel, and Baltimore counties. Maryland residents near a Toxic Release Inventory site were medically underserved [89]. South Baltimore brownfields have higher respiratory and heart disease mortality rates among White working-class residents than the rest of Baltimore city and state [84]. ...
Optimal use of Hierarchical Bayesian Model (HBM)-assembled aerosol optical depth (AOD)-PM2.5 fused surfaces in epidemiologic studies requires homogeneous temporal and spatial fused surfaces. No analytical method is available to evaluate spatial heterogeneity. The temporal case-crossover design was modified to assess the spatial association between four experimental AOD-PM2.5 fused surfaces and four respiratory–cardiovascular hospital events in 12 km2 grids. The maximum number of adjacent lag grids with significant odds ratios (ORs) identified homogeneous spatial areas (HOSAs). The largest HOSA included five grids (lag grids 04; 720 km2) and the smallest HOSA contained two grids (lag grids 01; 288 km2). Emergency department asthma and inpatient asthma, myocardial infarction, and heart failure ORs were significantly higher in rural grids without air monitors than in urban grids with air monitors at lag grids 0, 1, and 01. Rural grids had higher AOD-PM2.5 concentration levels, population density, and poverty percentages than urban grids. Warm season ORs were significantly higher than cold season ORs for all health outcomes at lag grids 0, 1, 01, and 04. The possibility of elevated fine and ultrafine PM and other demographic and environmental risk factors synergistically contributing to elevated respiratory–cardiovascular chronic diseases in persons residing in rural areas was discussed.
... Although this study did not evaluate environmental hazards associated with living close to brownfields [84][85] or EPA TRI facilities [83], several published studies have described the environmental contamination from manufacturing efforts in Maryland that have included EPA TRI facilities in the State [86][87][88][89], and brownfields in South Baltimore [84][85]. Perlin, Sexton, and Wong [87] found that there were 122 TRI sites in Maryland. ...
... About half of the TRI facilities were in Baltimore City, Howard, Anne Arundel, and Baltimore Counties. Maryland residents near a TRI site were medically underserved [89]. South Baltimore brownfields have higher respiratory and heart disease mortality rates among White working-class residents than the rest of Baltimore City and State [84]. ...
Optimal use of Hierarchical Bayesian Model (HBM) assembled aerosol optical depth (AOD)-PM2.5 fused surfaces in epidemiologic studies requires homogeneous temporal and spatial fused surfaces. No analytical method is available to evaluate spatial heterogeneity. The temporal case-crossover design was modified to assess the spatial association between four experimental AOD-PM2.5 fused surfaces and four respiratory-cardiovascular hospital events in 12 km2 grids. The maximum number of adjacent lag grids with significant odds ratios (ORs) identified homogeneous spatial areas (HOSAs). The largest HOSA included 5 grids (lag grids 04; 720 km2) and the smallest HOSA contained 2 grids (lag grids 01; 288 km2). Emergency department asthma and inpatient asthma, myocardial infarction, and heart failure ORs were significantly higher in rural grids without air monitors than in urban grids with air monitors at lag grids 0, 1, and 01. Rural grids had higher AOD-PM2.5 concentration levels, population density, and poverty percent than urban grids. Warm season ORs were significantly higher than cold season ORs for all health outcomes at lag grids 0, 1, 01, and 04. The possibility of elevated fine and ultrafine PM and other demographic and environmental risk factors synergistically contributing to elevated respiratory-cardiovascular chronic diseases in persons residing in rural areas was discussed
... Although this study did not evaluate the environmental hazard associated with living close to brownfields [132,133] or EPA-designated Toxic Release Inventory (TRI) facilities [131], several published studies have described the environmental contamination from manufacturing efforts in Maryland that have included the EPA TRI facilities in the State [134][135][136][137] and brownfields in South Baltimore [132,133]. Perlin, Sexton, and Wong [135] found that there were 122 TRI sites in Maryland. ...
... About half of the TRI facilities were in Baltimore City, Howard, Anne Arundel, and Baltimore Counties. Maryland residents near a TRI site were medically underserved [137]. South Baltimore brownfields have higher respiratory and heart disease mortality rates among White working-class residents than the rest of the City and State [132]. ...
Optimal use of aerosol optical depth (AOD)-PM2.5 fused surfaces in epidemiologic studies requires homogeneous temporal and spatial fused surfaces. No analytic method is currently available to evaluate the spatial dimension. The temporal case-crossover design was modified to assess the association between Community Multiscale Air Quality (CMAQ) lag grids and four respiratory-cardiovascular hospital events. The maximum number of adjacent lag grids with the expo-sure-health outcome association determined the size of the homogeneous spatial area. The largest homogeneous spatial area included 5 grids (720 km2) and the smallest 2 grids (288 km2). PMC and PMCK analyses of ED asthma, IP asthma, IP MI, and IP HF were significantly higher in rural grids without air monitors than in urban with air monitors at lag grids 0, 1, and 01. Grids without air monitors had higher AOD-PM2.5 concentration levels, poverty percent, population density, and environmental hazards than grids with air monitors. ED asthma, IP MI, and HF PMCK ORs were significantly higher during the warm season than during the cold season at lag grids 0, 1, 01, and 04. The possibility of elevated fine PM and other demographic and environmental risk factors contributing to elevated respiratory-cardiovascular diseases in persons residing in rural areas was discussed.
... Empirical research indicates that physicians serving Black communities are often less effective at cancer education and cancer screening compared to physicians serving White communities [58,59]. Ultimately, Black communities in Louisiana, like elsewhere in the US, are faced with a 'double disparity' , in which they are overburdened by environmental pollution and medically underserved [60]. As an additional or alternative explanation, our dataset may have been inadequate to detect a link between air toxics and cancer incidence among affluent/White communities, perhaps because of their relatively greater geographic mobility [61]. ...
Despite longstanding concerns about environmental injustice in Louisiana’s industrialized communities, including the area known as Cancer Alley, there is a lack of environmental health research in this state. This research gap has direct consequences for residents of industrialized neighborhoods because state regulators have cited a lack of evidence for adverse health outcomes when making industrial permitting decisions. We investigated how cancer incidence relates to cancer risk from toxic air pollution, race, poverty, and occupation across Louisiana census tracts, while controlling for parish-level smoking and obesity rates, using linear regression and Akaike information criterion model selection. We used the most recent cancer data from the Louisiana Tumor Registry (2008–2017), estimates of race, poverty, and occupation from the US Census Bureau’s American Community Survey (2011–2015), and estimated cancer risk due to point sources from the US Environmental Protection Agency’s 2005 National Air Toxics Assessment (accounting for cancer latency). Because race and poverty were strongly correlated ( r = 0.69, P < 0.0001), we included them in separate, analogous models. Results indicated that higher estimated cancer risk from air toxics was associated with higher cancer incidence through an interaction with poverty or race. Further analysis revealed that the tracts with the highest (i.e. top quartile) proportions of impoverished residents (or Black residents) were driving the association between toxic air pollution and cancer incidence. These findings may be explained by well-established disparities that result in greater exposure/susceptibility to air toxics in Black or impoverished neighborhoods. Regardless, our analysis provides evidence of a statewide link between cancer rates and carcinogenic air pollution in marginalized communities and suggests that toxic air pollution is a contributing factor to Louisiana’s cancer burden. These findings are consistent with the firsthand knowledge of Louisiana residents from predominantly Black, impoverished, and industrialized neighborhoods who have long maintained that their communities are overburdened with cancer.
... Exposures to environmental stressors modify aspects of gene expression in the epigenome that may cause individuals to deviate from a life course trajectory of optimal health [6]. Differentially burdened populations of color and economically marginalized groups are particularly vulnerable to epigenetic modifications since they often experience the greatest exposure to environmental hazards in their neighborhoods [7][8][9][10][11] and may lack health-promoting infrastructure or resiliency buffers that are necessary to offset negative exposures. Without these safeguards in place, communities of color and low-income groups overburdened by EJ issues (i.e., heavily trafficked roadways, Toxic Release Inventory [TRI] facilities, crime) may be more likely to have higher mortality rates of stroke, hypertension, cancer, diabetes, and heart disease when compared to their White and more affluent counterparts [12,13]. ...
... Studies have further demonstrated an association between increased primary care availability and better health outcomes [11,147], as well as the necessity of these services in counteracting the negative impacts that lower socioeconomic conditions may have on health [148]. Since mental health is so intricately linked with physical health, access to these services may have important implications in improving physical health and wellbeing [149]. ...
While structural factors may drive health inequities, certain health-promoting attributes of one’s “place” known as salutogens may further moderate the cumulative impacts of exposures to socio-environmental stressors that behave as pathogens. Understanding the synergistic relationship between socio-environmental stressors and resilience factors is a critical component in reducing health inequities; however, the catalyst for this concept relies on community-engaged research approaches to ultimately strengthen resiliency and promote health. Furthermore, this concept has not been fully integrated into environmental justice and cumulative risk assessment screening tools designed to identify geospatial variability in environmental factors that may be associated with health inequities. As a result, we propose a hybrid resiliency-stressor conceptual framework to inform the development of environmental justice and cumulative risk assessment screening tools that can detect environmental inequities and opportunities for resilience in vulnerable populations. We explore the relationship between actual exposures to socio-environmental stressors, perceptions of stressors, and one’s physiological and psychological stress response to environmental stimuli, which collectively may perpetuate health inequities by increasing allostatic load and initiating disease onset. This comprehensive framework expands the scope of existing screening tools to inform action-based solutions that rely on community-engaged research efforts to increase resiliency and promote positive health outcomes.
... A diagnosis of cancer may be particularly disruptive for racial/ ethnic minority YAs given culturally specific beliefs about cancer including negative beliefs about surgery, fatalism, and medical mistrust, which have been shown to contribute to cultural differences in the cancer experiences of patients from racial/ethnic minority groups [18][19][20][21]. The literature on adult cancer survivors has shown differences in patient experiences by race/ethnicity related to interpretations of care, differences in expectations, actual provision of care, and the "same care (as non-minority peers), worse experiences" phenomenon [19][20][21][22][23]. In addition, higher likelihood of facing socioeconomic disadvantage may further add stress and contribute to poor health outcomes among minority cancer survivors [15][16][17][18][19][20][21][22][23]. ...
... The literature on adult cancer survivors has shown differences in patient experiences by race/ethnicity related to interpretations of care, differences in expectations, actual provision of care, and the "same care (as non-minority peers), worse experiences" phenomenon [19][20][21][22][23]. In addition, higher likelihood of facing socioeconomic disadvantage may further add stress and contribute to poor health outcomes among minority cancer survivors [15][16][17][18][19][20][21][22][23]. Nonetheless, other studies have documented certain protective factors related to racial/ethnic minority status derived from health-fostering beliefs, values and practices, and strong family and social networks [17,18,21]. ...
... Racial/ethnic minority YA cancer survivors face a unique set of conditions that can be considered a "double disparity" [23], wherein they face the challenges of young age and racial/ethnic minority status (e.g., advanced stage at diagnosis, less access to timely treatments, poor quality of care, and poor decision-making supports) [1,2,5,20]. Few studies have examined cancer survivors from both of these underserved groups [1,2,16,19], despite the potential benefits of better understanding this subgroup's experiences [1,2,[13][14][15][16][17][18][19]. ...
Purpose:
Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18-39) experience significant disparities in health outcomes and survivorship compared to non-minorities of the same age. However, little is known about the survivorship experiences of this population. The purpose of this study is to explore the cancer experiences and health-related quality of life (HRQOL) among YA racial/ethnic minorities in an urban US city.
Methods:
Racial and ethnic minority YA cancer survivors (0 to 5 years posttreatment) were recruited from a comprehensive cancer center using a purposive sampling approach. Participants (n = 31) completed semi-structured interviews, the FACT-G (physical, emotional, social well-being) and the FACIT-Sp (spiritual well-being). Mixed methods data were evaluated using thematic analysis and analysis of covariance (ANCOVA).
Results:
The majority of survivors were women (65 %), single (52 %), and Hispanic (42 %). Across interviews, the most common themes were the following: "changes in perspective," "emotional impacts," "received support," and "no psychosocial changes." Other themes varied by racial/ethnic subgroups, including "treatment effects" (Hispanics), "behavior changes" (Blacks), and "appreciation for life" (Asians). ANCOVAs (controlling for gender and ECOG performance status scores) revealed that race/ethnicity had a significant main effect on emotional (P = 0.05), but not physical, social, or spiritual HRQOL (P > 0.05).
Conclusions:
Our findings suggest that minority YA cancer survivors report complex positive and negative experiences. In spite of poor health outcomes, survivors report experiencing growth and positive change due to cancer. Variations in experiences and HRQOL highlight the importance of assessing cultural background to tailor survivorship care among YA racial and ethnic minorities.
... This would be unfortunate, as economically marginalized communities without access to healthcare also typically bear the heaviest burden of toxic exposure. This double jeopardy makes it especially unlikely that minority communities will benefit from the highly anticipated wave of "precision medicine initiatives" (Wilson et al. 2014). ...
We propose the socio-exposome as a conceptual framework for integrative environmental health research. Environmental scientists coined the term ‘exposome’ with the goal of inventorying and quantifying environmental exposures as precisely as scientists measure genes and gene expression. To date, the exposome’s proponents have not thoroughly engaged social, scientific, theoretical, and methodological expertise, although the exclusion of sociological expertise risks molecularizing complex social phenomena and limiting the possibility of collective action to improve environmental conditions. As a corrective, and to demonstrate how ‘omic’ technologies could be made more relevant to public health, our socio-exposome framework blends insights from sociological and public health research with insights from environmental justice scholarship and activism. We argue that environmental health science requires more comprehensive data on more and different kinds of environmental exposures, but also must consider the sociopolitical conditions and inequalities that allow hazards to continue unchecked. We propose a multidimensional framework oriented around three axes: individual, local, and global, and suggest some sociomarkers and data sources that could identify exposures at each level. This framework could also guide policy, by creating a predictive framework that helps communities understand the repercussions of corporate and regulatory practices for public health and social justice.
