Integrating environmental and human health databases in the great lakes basin: themes, challenges and future directions.

Many government, academic and research institutions collect environmental data that are relevant to understanding the relationship between environmental exposures and human health. Integrating these data with health outcome data presents new challenges that are important to consider to improve our effective use of environmental health information. Our objective was to identify the common themes related to the integration of environmental and health data, and suggest ways to address the challenges and make progress toward more effective use of data already collected, to further our understanding of environmental health associations in the Great Lakes region. Environmental and human health databases were identified and reviewed using literature searches and a series of one-on-one and group expert consultations. Databases identified were predominantly environmental stressors databases, with fewer found for health outcomes and human exposure. Nine themes or factors that impact integration were identified: data availability, accessibility, harmonization, stakeholder collaboration, policy and strategic alignment, resource adequacy, environmental health indicators, and data exchange networks. The use and cost effectiveness of data currently collected could be improved by strategic changes to data collection and access systems to provide better opportunities to identify and study environmental exposures that may impact human health.

Public health, the APHA, and urban renewal.

Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.

The urban elderly in the United States: health status and the environment.

A large number of elderly persons live in United States metropolitan areas and center cities. Although the urban environment can be supportive of health, the urban elderly face issues of decrease in organ function and reserves; impaired chemical clearance and detoxification; vulnerability to medication-environment adverse interactions (heat/psychotropic drugs); legacy of past occupational and environmental cumulative exposures to persistent agents; overall poorer health status; decreased ability to respond to disasters, emergencies, and extreme conditions; decreased ability to access good and services outside their homes; and increased sensitivity to environmental conditions. Planning for these challenges can create a supportive environment and improve the health of the urban elderly.

The Boston schoolyard initiative: a public-private partnership for rebuilding urban play spaces.

The Boston Schoolyard Initiative (BSI) is a policy effort to rebuild school yards in Boston through innovative citywide public-private partnerships. At the center of the initiative is a commitment to engage multiple stakeholders and utilize a bottom-up planning process to encourage meaningful change. Based on a case study of BSI, this article develops a framework to understand and analyze how different school and neighborhood sectors can partner to benefit neighborhood communities and utilize the built environment to encourage more active living and active learning. The article contributes to a literature that focuses on the effects of school yards and the role of physically active environments on learning. It expands on this literature by looking at the school-yard initiative as a way to build and expand relationships between teachers, parents, and the community at large. Finally, the study shows that even older schools in inner-city neighborhoods, previously considered blights, can be turned into community, educational, and political assets.

Is obesity contagious?

Evaluation of: Christakis N, Fowler J. The spread of obesity in a large social network over 32 years. N. Engl. J. Med. 357(4), 370-379 (2007). A recent article using longitudinal data from the Framingham Heart Study found that weight gain was similar between friends. The influence of friends was found to be stronger than that of siblings or spouses. If this association reflects an underlying relationship, it implies that social norms, shared experiences and similar environments might be more important in weight gain than underlying strict biologic or genetic factors. It may also imply that new intervention strategies that use social marketing or peer-group efforts to reduce obesity might lead to successful weight control. A goal should be to enlist the help of friends to assist people to keep from gaining weight. Given the high prevalence of obesity in the USA and elsewhere, this study provides an interesting alternative foundation for addressing this important public health concern.

Neighborhood risk factors for obesity.

OBJECTIVE: The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area. RESEARCH METHODS AND PROCEDURES: This was a multi-level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI >30), and independent variables assessed included individual level variables (age, education, income, smoking status, sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets). RESULTS: After controlling for individual level factors, median household income [relative risk (RR) = 0.992; 95% confidence interval (CI) = 0.990, 0.994], population density (RR = 0.98; 95% CI = 0.972, 0.990), employment density (RR = 1.004; 95% CI = 1.001, 1.009), establishment density (RR = 0.981 95% CI = 0.964, 0.999), and the presence of a supermarket (RR = 0.893; 95% CI = 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk. DISCUSSION: Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.

The riskscape and the color line: examining the role of segregation in environmental health disparities.

Environmental health researchers, sociologists, policy-makers, and activists concerned about environmental justice argue that communities of color who are segregated in neighborhoods with high levels of poverty and material deprivation are also disproportionately exposed to physical environments that adversely affect their health and well-being. Examining these issues through the lens of racial residential segregation can offer new insights into the junctures of the political economy of social inequality with discrimination, environmental degradation, and health. More importantly, this line of inquiry may highlight whether observed pollution--health outcome relationships are modified by segregation and whether segregation patterns impact diverse communities differently. This paper examines theoretical and methodological questions related to racial residential segregation and environmental health disparities. We begin with an overview of race-based segregation in the United States and propose a framework for understanding its implications for environmental health disparities. We then discuss applications of segregation measures for assessing disparities in ambient air pollution burdens across racial groups and go on to discuss the applicability of these methods for other environmental exposures and health outcomes. We conclude with a discussion of the research and policy implications of understanding how racial residential segregation impacts environmental health disparities.

Black-white residential segregation and physical activity.

This multilevel study explores the potential relationship between Black-White residential segregation and physical activity. It combines data on physical activity from the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a national telephone survey of adults overseen by the Centers for Disease Control and Prevention (CDC), with a measure of racial segregation. Using hierarchical linear modeling, it controlled for age, sex, Black race, Hispanic ethnicity, education, income, and amount of urban sprawl. For each one-point increase in the Black-White Dissimilarity Index (on a 0-100 scale), the modeled risk of being physically inactive increased by .7% (odds ratio [OR] = 1.007, 95% confidence interval [CI] = 1.003, 1.011). The relationship between segregation and physical activity was similar for Blacks and Whites, though not statistically significant for the Black-only analysis. This finding may imply that the pathway between segregation and ill health includes physical inactivity.

Income inequality and self-rated health in US metropolitan areas: a multi-level analysis.

Income inequality has been found to affect health in a number of international and cross-national studies. Using data from a telephone survey of adults in the United States, this study analyzed the effect of metropolitan level income inequality on self-rated health. It combined individual data from the 2000 Behavioral Risk Factor Surveillance System with metropolitan level income data from the 2000 Census. After controlling for smoking, age, education, Black race, Hispanic ethnicity, sex, household income, and metropolitan area per capita income, this study found that for each 1 point rise in the GINI index (on a hundred point scale) the risk of reporting Fair or Poor self-rated health increased by 4.0% (95% confidence interval 1.6-6.5%). Given that self-rated health is a good predictor of morbidity and mortality, this suggests that metropolitan area income inequality is affecting the health of US adults.

Urban sprawl and risk for being overweight or obese.

OBJECTIVES: I examined the association between urban sprawl and the risk for being overweight or obese among US adults. METHODS: A measure of urban sprawl in metropolitan areas was derived from the 2000 US Census; individual-level data were obtained from the Behavioral Risk Factor Surveillance System. I used multilevel analysis to assess the association between urban sprawl and obesity. RESULTS: After I controlled for gender, age, race/ethnicity, income, and education, for each 1-point rise in the urban sprawl index (0-100 scale), the risk for being overweight increased by 0.2% and the risk for being obese increased by 0.5%. CONCLUSIONS: The current obesity epidemic has many causes, but there is an association between urban sprawl and obesity.

SPRAWL IN THE 1990S Measurement, Distribution, and Trends.

Although sprawl is a growing national debate, there have been few efforts to measure or monitor changes in degree of sprawl over time. By using a methodology that employs census data, this sprawl index allows computation of levels of sprawl and examination of temporal and geographic changes. The results show that sprawl has increased over the past decade in many metropolitan areas. There are important geographic variations in sprawl, implying that it is neither inevitable nor universal.

Segregation and black/white differences in exposure to air toxics in 1990.

I examined non-Hispanic Black and non-Hispanic White differences in exposure to noncriteria air pollutants in 44 U.S. Census Bureau-defined metropolitan areas with populations greater than one million, using data on air toxics concentrations prepared for the U.S. Environmental Protection Agency as part of its Cumulative Exposure Project combined with U.S. census data. I measured differences in exposure to air toxics through the calculation of a net difference score, which is a statistical measure used in income inequality analysis to measure inequality over the whole range of exposures. The scores ranged from 11.52 to 83.60. In every metropolitan area, non-Hispanic Blacks are more likely than non-Hispanic Whites to be living in tracts with higher total modeled air toxics concentrations. To assess potential reasons for such a wide variation in exposure differences, I performed a multiple regression analysis with the net difference score as the dependent variable. Independent variables initially included were as follows: the dissimilarity index (to measure segregation), Black poverty/White poverty (to control for Black/White economic differences), population density and percentage of persons traveling to work who drive to work (alone and in car pools), and percentage of workforce employed in manufacturing (factors affecting air quality). After an initial analysis I eliminated from the model the measures of density and the persons driving to work because they were statistically insignificant, they did not add to the predictive power of the model, and their deletion did not affect the other variables. The final model had an R(2) of 0.56. Increased segregation is associated with increased disparity in potential exposure to air pollution.