Disparities in Toxic Chemical Exposures and Associated Neurodevelopmental Outcomes: A Scoping Review and Systematic Evidence Map of the Epidemiological Literature.

BACKGROUND: Children are routinely exposed to chemicals known or suspected of harming brain development. Targeting Environmental Neuro-Development Risks (Project TENDR), an alliance of >50 leading scientists, health professionals, and advocates, is working to protect children from these toxic chemicals and pollutants, especially the disproportionate exposures experienced by children from families with low incomes and families of color. OBJECTIVE: This scoping review was initiated to map existing literature on disparities in neurodevelopmental outcomes for U.S. children from population groups who have been historically economically/socially marginalized and exposed to seven exemplar neurotoxicants: combustion-related air pollution (AP), lead (Pb), mercury (Hg), organophosphate pesticides (OPs), phthalates (Phth), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs). METHODS: Systematic literature searches for the seven exemplar chemicals, informed by the Population, Exposure, Comparator, Outcome (PECO) framework, were conducted through 18 November 2022, using PubMed, CINAHL Plus (EBSCO), GreenFILE (EBSCO), and Web of Science sources. We examined these studies regarding authors' conceptualization and operationalization of race, ethnicity, and other indicators of sociodemographic and socioeconomic disadvantage; whether studies presented data on exposure and outcome disparities and the patterns of those disparities; and the evidence of effect modification by or interaction with race and ethnicity. RESULTS: Two hundred twelve individual studies met the search criteria and were reviewed, resulting in 218 studies or investigations being included in this review. AP and Pb were the most commonly studied exposures. The most frequently identified neurodevelopmental outcomes were cognitive and behavioral/psychological. Approximately a third (74 studies) reported investigations of interactions or effect modification with 69% (51 of 74 studies) reporting the presence of interactions or effect modification. However, less than half of the studies presented data on disparities in the outcome or the exposure, and fewer conducted formal tests of heterogeneity. Ninety-two percent of the 165 articles that examined race and ethnicity did not provide an explanation of their constructs for these variables, creating an incomplete picture. DISCUSSION: As a whole, the studies we reviewed indicated a complex story about how racial and ethnic minority and low-income children may be disproportionately harmed by exposures to neurotoxicants, and this has implications for targeting interventions, policy change, and other necessary investments to eliminate these health disparities. We provide recommendations on improving environmental epidemiological studies on environmental health disparities. To achieve environmental justice and health equity, we recommend concomitant strategies to eradicate both neurotoxic chemical exposures and systems that perpetuate social inequities. https://doi.org/10.1289/EHP11750.

Assessment and Prevention of Lead Poisoning in Refugee Populations.

Lead is a neurotoxin, and there are no safe blood lead levels identified for children. Even low levels of lead in blood have been shown to permanently harm the brain, affecting a child's development, intelligence, and academic achievement. In the U.S., refugee children are at an increased risk for lead poisoning. Preventing lead exposure can reduce damage to children's health. It is imperative that clinicians conduct an exposure assessment and offer anticipatory guidance to prevent exposure to lead, especially with sources such as cosmetics, ceramics, herbs, and toys.

Sustaining a nurse-led community partnership to promote environmental justice.

The Westlawn Partnership for a Healthier Environment (WPHE) is a longstanding group of community stakeholders that was formed over a decade ago to identify, prioritize, and address environmental health (EH) concerns in a low-income, predominantly African American, urban neighborhood, which faces a disproportionate burden of EH risks, particularly asthma. Launched by the University of Wisconsin-Milwaukee College of Nursing, which established a nurse-managed health center within the community 30 years ago, WPHE utilized the Protocol of Assessing Community Excellence in Environment Health methodology to develop, implement, and sustain the partnership. WPHE implemented programs for Healthy Homes, Healthy Day Cares, and bicycling, and made system and infrastructure changes within the community to address the top identified EH concerns: indoor and outdoor air pollution, mold exposure, access to safe and healthy food, and pesticide exposure. WPHE's efforts have resulted in significant local, state, and national policy impacts to promote environmental justice. This brief report shares how the partnership was formed, its priorities, major activities and accomplishments, and insights into sustaining a community-based EH partnership, including recommendations for the key role that public health nurses can play to promote environmental justice.

Exposures to per-and polyfluoroalkyl substances (PFAS): Potential risks to reproductive and children's health.

As the science on the human health effects of per-and polyfluoroalkyl substances (PFAS) emerges, there are growing concerns about the potential health impacts on children and reproductive health. PFAS exposure may affect growth, learning, and behavior of infants and older children; lower a woman's chance of getting pregnant; increase cholesterol levels; affect the immune system; and induce vaccine-reduced immune protection in children. Without existing regulation or established standards for testing and treatment, prevention is key. PFAS exposure can occur through a wide range of consumer products and a contaminated drinking water supply. Military bases and surrounding communities have been especially impacted by PFAS in drinking water from the use of firefighting foam for decades.

Moving Upstream From the Individual to the Community: Addressing Social Determinants of Health.

School nurses are often the primary health professional promoting children's health-and address not just individuals, but communities. This article, featuring the key principle of community/public health, is the first in a series focusing on The Framework for 21st Century School Nursing Practice™ and presents a case study on asthma and air quality issues comparing the more traditional individual approaches to health (labeled downstream and midstream) with population-level approaches (labeled upstream). Through collaboration with key community stakeholders, school nurses can successfully implement policies and programs to address social determinants of health and, in turn, improve the health of the entire community. As we look to advance school nursing and support best practices, concentrating on population-level, upstream approaches align with recommendations outlined in the Framework for 21st Century School Nursing Practice™.

Climate changes reproductive and children's health: a review of risks, exposures, and impacts.

Our climate has significantly changed, exceeding what the world has experienced over the last 650,000 years, and has been cited as the most significant health threat of the twenty-first century. Climate change is impacting health in unprecedented ways. While everyone is vulnerable to the health impacts associated with climate change, children are disproportionately affected because of their physical and cognitive immaturity. Climate change impacts that include rising temperatures, extreme weather, rising sea levels, and increasing carbon dioxide levels are associated with a wide range of health issues in children such as asthma, allergies, vector-borne diseases, malnutrition, low birth weight, and post-traumatic stress disorder. Pediatric health providers play a critical role in advancing the science and translating findings to improve public understanding about the link between climate changes and children's health, and establishing strategies to address these issues. This review will provide an overview of research exploring the impact of climate change on children's health impacts, as well as provide recommendations for pediatric research moving forward.

Climate Change and Schools: Implications for Children's Health and Safety.

The predicted impacts of climate change are fast becoming a reality and are already adversely affecting human health and health systems. Events such as flooding, hurricanes, tornadoes, and wildfires are challenging communities to re-evaluate whether their schools provide a safe, healthy environment. Among the populations most vulnerable to the impacts of our changing climate are our children. Nurses are key to supporting mitigation and adaptation efforts to promote more resilient school environments, using approaches based on values of the common good and social justice.

Healthy Air, Healthy Brains: Advancing Air Pollution Policy to Protect Children's Health.

Evidence is growing on the adverse neurodevelopmental effects of exposure to combustion-related air pollution. Project TENDR (Targeting Environmental Neurodevelopmental Risks), a unique collaboration of leading scientists, health professionals, and children's and environmental health advocates, has identified combustion-related air pollutants as critical targets for action to protect healthy brain development. We present policy recommendations for maintaining and strengthening federal environmental health protections, advancing state and local actions, and supporting scientific research to inform effective strategies for reducing children's exposures to combustion-related air pollution. Such actions not only would improve children's neurological development but also would have the important co-benefit of climate change mitigation and further improvements in other health conditions.

Neighborhood Environment and Asthma Exacerbation in Washington, DC.

Approximately one in eight people in the United States have been diagnosed with asthma. Asthma is associated with significant medical expenditure and has been implicated as a leading reason for chronic school absences. Environmental risk factors such as access to green space and exposure to poor air quality are patterned such that some vulnerable populations may be at higher risk. Using data from DC Health, the Washington, DC, department of public health, this study investigated associations between neighborhood social, built, and natural environments and rates of asthma-related healthcare encounters by ZIP code between 2014 and 2017. We found that significant differences in rates exist between ZIP codes and for different subpopulations. Black boys had the highest overall rate, with 58.49 visits per 1,000 population, ranging by ZIP code from 0 to 88.56 visits. We found that the ZIP code Social Vulnerability Index was consistently associated with rates of healthcare encounters, but not access to green/open space or exposure to high traffic. However, we discuss how the ZIP code level may not be an appropriate level at which to investigate such built/natural environment features because of the proportion of variability that is found within rather than between ZIP codes. We end with a short discussion of ways that nurses, in particular school nurses, could help to address neighborhood environmental risk factors.

Per- and Polyfluoroalkyl Substances: An Emerging Contaminant of Concern.

Concerns about the health impacts from per- and polyfluoroalkyl substances (PFAS) continue to grow as the science continues to emerge associating this chemical family with a wide range of health impacts. PFAS exposure may affect growth, learning, and behavior of infants and older children, and also impact reproductive health, cardiovascular health, and the immune system. PFAS exposure is widespread, with communities surrounding military bases at potentially greater risk of exposure from the use of fire fighting foam that may have entered the drinking water. As trusted health professionals, nurses have been in the frontlines communicating risks regarding PFAS to impacted communities. This chapter describes a large number of PFAS studies in blood and harmful health effects in people. The chapter discusses primary sources of exposure and risk reduction. It explains health advisory levels, minimal risk levels. The chapter provides medical testing and medical management.

Project TENDR.

: Chemicals are ubiquitous in the food we eat, the water we drink, the air we breathe, and the products we use at work and in our personal lives. Toxic chemicals increase the risk of cognitive, behavioral, and neurodevelopmental disorders throughout the life span. The Toxic Substances Control Act of 1976 was intended to allow for the collection of data on and regulation of these chemicals but has been criticized for its significant limitations in protecting the public's health. In recognition of the scientific evidence demonstrating the connection between toxic environmental chemicals and neurodevelopmental disorders, Project TENDR (Targeting Environmental Neuro-Developmental Risks)-a collaborative initiative of scientists, health professionals, and children's health advocates-produced a call to action last July with the aim of reducing exposure to chemicals and pollutants that contribute to the development of these disorders.

Climate Change and Mental Health.

: Climate change is an enormous challenge for our communities, our country, and our world. Recently much attention has been paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. However, much less attention has been paid to the psychological impacts. This article examines the likely psychological impacts of climate change, including anxiety, stress, and depression; increases in violence and aggression; and loss of community identity. Nurses can play a vital role in local and regional climate strategies by preparing their patients, health care facilities, and communities to effectively address the anticipated mental health impacts of climate change.

Identifying populations at risk: interdisciplinary environmental climate change tracking.

BACKGROUND: Climate change, experienced as extreme weather events such as heat waves can lead to poorer air quality and underscores the critical need to consider the consequences of these environmental changes on health. Changes are occurring at a rate that exceeds what the world has experienced over the last 650,000 years, yet little attention has been focused on the potentially catastrophic public health effects of climate change. METHODS: This study instituted a two-phase approach. In building capacity for an Environmental Public Health Tracking Network, the District of Columbia Department of Health first examined the availability of climate change and health data. These data were then used to assess vulnerabilities and disease burden associated with heat, air quality, and hospitalizations for asthma (N = 5,921) and acute myocardial infarction (AMI) (N = 2,773) during 2007-2010. A Poisson regression analysis was applied to the time series of daily counts for hospitalizations for selected age, race, and gender groups. RESULTS: Although no significant associations were found for PM2.5, PM10, or ozone with asthma-related or AMI-related hospitalizations with seasonal changes, surveillance data found disparities in hospitalizations particularly in female, African American residents for both asthma and AMI. CONCLUSIONS: Tracking Networks are critical for assessing community environmental health vulnerabilities.