Heatwave frequency and disability status: Thermal inequities in the U.S. South.

BACKGROUND: Although extreme heat has been found to be disproportionately distributed with respect to socially disadvantaged and marginalized groups, persons with disabilities have received limited attention in previous research on heat exposure disparities. OBJECTIVE: This gap is addressed by analyzing the relationship between local heatwave frequency and the percentages of people with a disability and specific disability types in the U.S. South-a region characterized by extremely high summer temperatures and greater disability prevalence. METHODS: Census tract level values of heatwave annualized frequency from the U.S. Federal Emergency Management Agency's National Risk Index are linked to relevant disability variables from the latest American Community Survey five-year estimates. Statistical analyses are based on bivariate correlations and multivariable generalized estimating equations that consider spatial clustering of tracts based on climate zone and county. RESULTS: The overall percentage of civilian noninstitutionalized persons with a disability and more than one disability are significantly greater (p < 0.001) in census tracts with higher heatwave frequency, after controlling for clustering, race/ethnicity, socioeconomic status, older age, population density, and metropolitan status. Heatwave frequency is also positively and significantly associated (p < 0.01) with the percentages of people with hearing, vision, cognitive, ambulatory, self-care, and independent living difficulties. CONCLUSIONS: These heat-related distributive injustices in the U.S. South demonstrate an urgent need to: (1) include disability status in future research on social disparities in heatwave exposure; (2) conduct more detailed investigations in other regions, states, and nations; and (3) develop disability-inclusive policies and interventions that provide equitable protection during extreme weather events.

Advancing disability-inclusive climate research and action, climate justice, and climate-resilient development.

Globally, more than 1 billion people with disabilities are disproportionately and differentially at risk from the climate crisis. Yet there is a notable absence of climate policy, programming, and research at the intersection of disability and climate change. Advancing climate justice urgently requires accelerated disability-inclusive climate action. We present pivotal research recommendations and guidance to advance disability-inclusive climate research and responses identified by a global interdisciplinary group of experts in disability, climate change, sustainable development, public health, environmental justice, humanitarianism, gender, Indigeneity, mental health, law, and planetary health. Climate-resilient development is a framework for enabling universal sustainable development. Advancing inclusive climate-resilient development requires a disability human rights approach that deepens understanding of how societal choices and actions-characterised by meaningful participation, inclusion, knowledge diversity in decision making, and co-design by and with people with disabilities and their representative organisations-build collective climate resilience benefiting disability communities and society at large while advancing planetary health.

Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities.

BACKGROUND: Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020. OBJECTIVE: Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013. METHODS: We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis. RESULTS: The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat's impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs. IMPACT STATEMENT: Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.

Social Inequities in Exposure to Traffic-Related Air and Noise Pollution at Public Schools in Texas.

Although children are particularly vulnerable to the adverse impacts of vehicular pollution and spend significant portions of their time at school, previous studies have not examined or compared school-level social inequities in exposure to both traffic-related air and noise pollution in the same study area. We addressed this gap through a case study in Texas-the second-largest US state based on total population and number of children. Vehicular pollution exposure was measured using: (1) outdoor concentrations of nitrogen dioxide (NO2), a widely used proxy for traffic-related air pollution; and (2) road noise estimates from the US Department of Transportation's National Transportation Noise Mapping Tool. These variables were linked to data on locations and sociodemographic characteristics of children enrolled in Texas public schools. We found children attending schools with the highest exposure to both NO2 and road noise (top 25%) were significantly more likely to be Black, Hispanic, and eligible for free/reduced lunches (socioeconomically deprived). Results from multivariable generalized estimating equations that control for spatial clustering and other relevant factors revealed that schools with greater NO2 exposure were significantly more likely to serve racial/ethnic minority and younger students, while schools with greater exposure to road noise were significantly more likely to serve socioeconomically deprived and older students. These findings underscore the urgent need to reduce both air pollution and noise exposure at school locations, especially in schools attended by higher proportions of socially disadvantaged children that are often additionally burdened with other challenges.

Disability and subsidized housing residency: The adverse impacts of Winter Storm Uri in metropolitan Texas.

BACKGROUND: While natural disasters have been found to affect both disabled and subsidized rental housing residents negatively and disproportionately, previous studies have not examined if adverse disaster impacts experienced by disabled individuals in subsidized housing developments differ from those living in other housing. OBJECTIVE: We focused on Winter Storm Uri in Texas, USA, which lasted from February 10-20, 2021. We sought to: (1) compare differences in adverse impacts suffered by households with and without disabled persons; and (2) examine how residency in US Department of Housing and Urban Development (HUD)-assisted rental housing influences the severity of impacts for households with disabled persons. METHODS: We collected data from 790 randomly selected households in eight Texas metropolitan areas through a bilingual phone survey. Bivariate and multivariable statistical methods were utilized to compare adverse impacts suffered by households, based on both disability status and HUD-assisted housing residency. RESULTS: Households with disabled persons were more severely impacted by Uri than households without disabled persons, in terms of service disruptions, colder temperatures, slower recovery, and adverse experiences that have important health implications. Households with disabled persons residing in HUD-assisted housing were more negatively impacted and suffered more adverse experiences than those living in other housing. CONCLUSIONS: Residency in federally-assisted rental housing can worsen severity of adverse impacts and amplify disaster vulnerability for disabled individuals. These disparities based on disability and subsidized housing status emphasize the need for additional research to understand the impacts of disasters on disabled residents and formulate interventions that provide equitable protections.

Assessing the Relationship Between Emergency Food Assistance and Social Vulnerability During the COVID-19 Pandemic.

Food insecurity is a major public health challenge that is associated with negative health outcomes in wealthy countries. In US urban areas, food banks and pantries played an expanded role in providing emergency food assistance and addressing food insecurity during the COVID-19 pandemic. This study seeks to determine if socially vulnerable neighborhoods are more likely to receive emergency food assistance during this pandemic, after controlling for distance to emergency food distribution sites and spatial clustering. The study area is El Paso County, Texas-an urban area on the US-Mexico border. Dependent variables represent both coverage and intensity of emergency food transfers (EFTs) from local food banks and pantries during November 2020, at the census tract level. Independent variables are derived from the widely used Social Vulnerability Index (SVI) developed by the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry. Our statistical analyses are based on multivariable generalized estimating equations that account for spatial clustering and proximity to emergency food distribution sites. Results indicate that both coverage and intensity of EFTs are significantly greater in neighborhoods with higher social vulnerability and proximity to emergency food distribution sites, but lower in neighborhoods that are more vulnerable in terms of housing and transportation. Our findings highlight the significance of neighborhood-level social factors in influencing access to the emergency food network during a public health crisis and have important implications for government agencies and nonprofit organizations associated with public health and emergency preparedness in US urban areas.

Social Disparities in the Duration of Power and Piped Water Outages in Texas After Winter Storm Uri.

We assessed sociodemographic disparities in basic service disruptions caused by Winter Storm Uri in Texas. We collected data through a bilingual telephone survey conducted in July 2021 (n = 753). Being Black, having children, and renting one's residence were associated with longer power outage durations; being Black was also associated with longer water outages. Our findings highlight the need to plan for and ameliorate inequitable service outages and their attendant health risks in climate change-related extreme weather events such as Uri. (Am J Public Health. 2023;113(1):30-34. https://doi.org/10.2105/AJPH.2022.307110).

Cascading disasters and mental health inequities: Winter Storm Uri, COVID-19 and post-traumatic stress in Texas.

Previous research on health effects of extreme weather has emphasized heat events even though cold-attributable mortality exceeds heat-attributable mortality worldwide. Little is known about the mental health effects of cold weather events, which often cascade to produce secondary impacts like power outages, leaving a knowledge gap in context of a changing climate. We address that gap by taking a novel "cascading disaster health inequities" approach to examine winter storm-associated post-traumatic stress (PTS) using survey data (n = 790) collected in eight Texas metro areas following Winter Storm Uri in 2021, which occurred against the backdrop of COVID-19. The incidence of storm-related PTS was 18%. Being Black (odds ratio [OR]: 6.6), Hispanic (OR: 3.5), or of another non-White race (OR: 4.2) was associated with greater odds of PTS compared to being White, which indicates substantial racial/ethnic inequities in mental health impacts (all p < 0.05). Having a disability also increased odds of PTS (OR: 4.4) (p < 0.05). Having piped water outages (OR: 1.9) and being highly impacted by COVID-19 (OR: 3.3) increased odds of PTS (both p < 0.05). When modelling how COVID-19 and outages cascaded, we compared householders to those with no outages and low COVID-19 impacts. PTS was more likely (p < 0.05) if householders had a water or power outage and high COVID-19 impacts (OR: 4.4) and if they had water and power outages and high COVID-19 impacts (OR: 7.7). Findings provide novel evidence of racial/ethnic inequities and cascading effects with regard to extreme cold events amid the COVID-19 pandemic.

Disparities in exposure to fine particulate air pollution for people with disabilities in the US.

Although chronic air pollution has been found to be disproportionately distributed with respect to race/ethnicity and socioeconomic status in the US, previous research on social disparities in air pollution exposure has not focused on persons with disabilities (PwDs). This gap is addressed here by conducting the first national-scale study of the relationship between outdoor exposure to fine particulate matter (PM2.5) and disability status in the continental US. Census tract-level data on average annual PM2.5 concentrations (2011-2015) were linked with relevant variables from the 2015 American Community Survey five-year estimates. Statistical analyses were based on bivariate and multivariable generalized estimating equations that account for spatial clustering of tracts within counties. Results indicated that the overall percentage of civilian noninstitutionalized persons with a disability and multiple types of disability are higher in neighborhoods with greater PM2.5 exposure, after controlling for race/ethnicity, poverty, renter occupancy, older age, population density, and metropolitan status. The percentages of PwDs with cognitive and independent living difficulties indicated stronger positive associations with PM2.5 exposure, compared to those with other types of difficulties. These findings represent an important starting point for more detailed research investigations and policy interventions that seek to mitigate disproportionate air pollution exposure for this vulnerable group.

Air pollution exposure disparities in US public housing developments.

Fine particulate matter 2.5 microns or less in diameter (PM2.5) is widely recognized to be a major public health concern. While ethnic/racial minority and lower socioeconomic status individuals in the US experience higher PM2.5 exposure, previous research on social disparities in PM2.5 exposure has not examined residents of federally-assisted public housing developments (PHDs). Here we present the first national-scale analysis of the relationship between outdoor PM2.5 exposure and PHD residency in the US, as well as exposure disparities within the population of households residing in PHDs. We integrated data on average annual PM2.5 concentrations (2011-2015) with US Department of Housing and Urban Development data on PHDs (2015), and socio-demographic information from the 2011-2015 American Community Survey. Results from multivariable generalized estimating equations indicated that PHD locations, units, and residents are significantly overrepresented in neighborhoods with greater PM2.5 exposure, after accounting for clustering, urbanization, and other socio-demographic factors. Additionally, significantly higher percentages of Black, Hispanic, disabled, and extremely low-income households reside in PHDs with greater PM2.5 exposure. Findings represent an important starting point for future research and emphasize the urgent need to identify gaps in environmental, public health, and housing policies that contribute to disproportionate air pollution exposures among PHD residents.

Children's exposure to vehicular pollution: Environmental injustice in Texas, USA.

Distributive environmental justice research on children's exposure to vehicular pollution is underdeveloped and few empirical studies have been conducted in the US. This study seeks to address this gap by examining if socially disadvantaged children are disproportionately located in public school districts burdened by higher vehicular pollution in Texas-the second largest US state based on population size. Vehicular pollution exposure is measured using two variables: (1) an index developed by the US Environmental Protection Agency that combines traffic proximity and volume; and (2) outdoor concentrations of nitrogen dioxide (NO2), a widely used proxy for traffic-related air pollution. These variables are linked to school district level data on socio-demographic characteristics of children obtained from the latest American Community Survey. Statistical analysis is based on multivariable generalized estimating equations that account for spatial clustering of school districts. Results reveal significantly greater traffic proximity and NO2 exposure in Texas school districts with higher percentages of children, after controlling for clustering, population density, and other socio-demographic factors. Districts exposed to higher levels of traffic proximity and NO2 exposure also contain significantly greater proportions of racial/ethnic minority, foreign-born, disabled, and socioeconomically vulnerable children. These findings highlight the urgent need to develop mitigation strategies for reducing vehicular pollution exposure, especially in districts with higher proportions of socially disadvantaged students that could be additionally burdened with limited resources. School districts represent a policy relevant analytic unit since school district boards can act as advocates for the environmental health of children and implement mitigation strategies for reducing pollution exposure.

Social Inequities in Urban Heat and Greenspace: Analyzing Climate Justice in Delhi, India.

Climate change and rapid urbanization currently pose major challenges for equitable development in megacities of the Global South, such as Delhi, India. This study considers how urban social inequities are distributed in terms of burdens and benefits by quantifying exposure through an urban heat risk index (UHRI), and proximity to greenspace through the normalized difference vegetation index (NDVI), at the ward level in Delhi. Landsat derived remote sensing imagery for May and September 2011 is used in a sensitivity analysis of varying seasonal exposure. Multivariable models based on generalized estimating equations (GEEs) reveal significant statistical associations (p < 0.05) between UHRI/NDVI and several indicators of social vulnerability. For example, the proportions of children (ß = 0.922, p = 0.024) and agricultural workers (ß = 0.394, p = 0.016) are positively associated with the May UHRI, while the proportions of households with assets (ß = -1.978, p = 0.017) and households with electricity (ß = -0.605, p = 0.010) are negatively associated with the May UHRI. In contrast, the proportions of children (ß = 0.001, p = 0.633) and agricultural workers (ß = 0.002, p = 0.356) are not significantly associated with the May NDVI, while the proportions of households with assets (ß = 0.013, p = 0.010) and those with electricity (ß = 0.008, p = 0.006) are positively associated with the May NDVI. Our findings emphasize the need for future research and policies to consider how socially vulnerable groups are inequitably exposed to the impact of climate change-related urban heat without the mitigating effects of greenspace.

Air Quality and Environmental Injustice in India: Connecting Particulate Pollution to Social Disadvantages.

While air pollution levels in India are amongst the highest in the world, the link between exposure to air pollution and social disadvantages has not been systematically examined. Using a distributive environmental justice framework, this study connects fine particulate matter (PM2.5) concentration data derived from satellite observations, a global chemical transport model, and ground-based measurements to district level socio-demographic information from the 2011 Census of India. The research objectives are to determine if annual average PM2.5 concentrations (2010) and recent increases in average PM2.5 concentrations (2010-2016) are unequally distributed with respect to socially disadvantaged population and household groups, after controlling for relevant contextual factors and spatial clustering. Overall, more than 85% of people and households in India reside in districts where international air quality standards for PM2.5 are exceeded. Although PM2.5 concentration levels are significantly higher in more urbanized districts located predominantly in northern India, recent increases have occurred in less urbanized areas located mainly in southern and central India. Multivariable statistical analysis indicated: (1) higher PM2.5 concentration in districts with higher percentages of Scheduled Castes (SCs), young children, and households in poor condition residence and without toilets; and (2) higher PM2.5 increases in less urbanized districts with higher percentages of SCs, females, children, people with disabilities, and households with no toilets. These findings thus highlight the need to consider the role of air pollution in exacerbating the consequences of social disadvantages in India.

Convergence of COVID-19 and chronic air pollution risks: Racial/ethnic and socioeconomic inequities in the U.S.

Recent research suggests greater COVID-19 prevalence in areas burdened with higher exposure to chronic air pollution, but previous studies have not examined if socially disadvantaged populations are more likely to reside in communities located at the convergence of both COVID-19 and air pollution health risks. This article presents a national scale U.S. study that investigates whether racial/ethnic minorities, socioeconomically deprived residents, and other vulnerable groups are significantly overrepresented in counties where significantly higher COVID-19 incidence spatially coincides with higher respiratory health risks from outdoor exposure to hazardous air pollutants (HAPs). COVID-19 data from the Johns Hopkins Center for Systems Science and Engineering database are linked to respiratory risk estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment and variables from the 2018 American Community Survey. Bivariate local measures of spatial association are implemented to identify county clusters representing relationships between COVID-19 incidence rate and respiratory risk from HAP exposure. Socio-demographic characteristics of these clusters are compared using bivariate statistical tests and multivariable generalized estimating equations. Counties where greater COVID-19 incidence coincides significantly with higher HAP respiratory risk contain disproportionately higher percentages of non-Hispanic Black, socioeconomically deprived, and uninsured residents than all other U.S. counties, after controlling for spatial clustering, population density, older age, and other contextual factors. These significant socio-demographic inequities represent an important starting point for more detailed investigations of places facing the double burden of elevated COVID-19 prevalence and air pollution exposure, and also emphasize the urgent need to develop mitigation strategies for addressing both COVID-19 and chronic air pollution in socially vulnerable communities.

Social inequities in the distribution of COVID-19: An intra-categorical analysis of people with disabilities in the U.S.

BACKGROUND: While recent reports suggest that people with disabilities (PwDs) are likely to be adversely impacted by COVID-19 and face multiple challenges, previous research has not examined if COVID-19 burdens are unequally distributed with respect to the disability characteristics of the U.S. OBJECTIVE: This article presents the first national scale study of the relationship between COVID-19 incidence and disability characteristics in the U.S. The objective is to determine whether COVID-19 incidence is significantly greater in counties containing higher percentages of socio-demographically disadvantaged PwDs, based on race, ethnicity, poverty status, age, and biological sex. METHODS: This study integrates county-level data on confirmed COVID-19 cases from the Johns Hopkins Center for Systems Science and Engineering database with multiple disability variables from the 2018 American Community Survey. Statistical analyses are based on bivariate correlations and multivariate generalized estimating equations that consider spatial clustering in the data. RESULTS: Greater COVID-19 incidence rate is significantly associated with: (1) higher percentages of PwDs who are Black, Asian, Hispanic, Native American, below poverty, under 18 years of age, and female; and (2) lower percentages of PwDs who are non-Hispanic White, above poverty, aged 65 or more years, and male, after controlling for spatial clustering. CONCLUSIONS: Socio-demographically disadvantaged PwDs are significantly overrepresented in counties with higher COVID-19 incidence compared to other PwDs. These findings represent an important starting point for more detailed investigation of the disproportionate impacts of COVID-19 on PwDs and highlight the urgent need for COVID-19 data collection systems to incorporate disability information.

Disparities in Health Effects and Access to Health Care Among Houston Area Residents After Hurricane Harvey.

OBJECTIVES: Although research shows that public health is substantially affected during and after disasters, few studies have examined the health effects of Hurricane Harvey, which made landfall on the Texas coast in August 2017. We assessed disparities in physical health, mental health, and health care access after Hurricane Harvey among residents of the Houston-The Woodlands-Sugar Land, Texas, metropolitan statistical area (ie, Houston MSA). METHODS: We used structured survey data collected through telephone and online surveys from a population-based random sample of Houston MSA residents (n = 403) collected from November 29, 2017, through January 6, 2018. We used descriptive statistics to describe the prevalence of physical health/mental health and health care access outcomes and multivariable generalized linear models to assess disparities (eg, based on race/ethnicity, socioeconomic status, disability) in health outcomes. RESULTS: Physical health problems disproportionately affected persons who did not evacuate (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87). Non-Hispanic black persons were more likely than non-Hispanic white persons to have posttraumatic stress (OR = 5.03; 95% CI, 1.90-13.10), as were persons in households that experienced job loss post-Harvey (vs did not experience job loss post-Harvey; OR = 2.89; 95% CI, 1.14-7.32) and older persons (OR = 1.04; 95% CI, 1.01-1.06). Health care access was constrained for persons whose households lost jobs post-Harvey (vs did not lose jobs post-Harvey; OR = 2.73; 95% CI, 1.29-5.78) and for persons with disabilities (vs without disabilities; OR = 3.19; 95% CI, 1.37-7.45). CONCLUSIONS: Our findings underscore the need to plan for and ameliorate public health disparities resulting from climate change-related disasters, which are expected to occur with increased frequency and magnitude.

Hurricane Harvey and Greater Houston households: comparing pre-event preparedness with post-event health effects, event exposures, and recovery.

Most disaster studies rely on convenience sampling and 'after-only' designs to assess impacts. This paper, focusing on Hurricane Harvey (2017) and leveraging a pre-/post-event sample of Greater Houston households (n=71) in the United States, establishes baselines for disaster preparedness and home structure flood hazard mitigation, explores household-level ramifications, and examines how preparedness and mitigation relate to health effects, event exposures, and recovery. Between 70 and 80 per cent of participants instituted preparedness measures. Mitigation actions varied: six per cent had interior drainage systems and 83 per cent had elevated indoor heating/cooling components. Sixty per cent reported home damage. One-half highlighted allergies and two-thirds indicated some level of post-traumatic stress (PTS). Three-quarters worried about family members/friends. The results of generalised linear models revealed that greater pre- event mitigation was associated with fewer physical health problems and adverse experiences, lower PTS, and faster recovery. The study design exposed the broad benefits of home structure flood hazard mitigation for households after Harvey.

Environmental injustice and Hurricane Harvey: A household-level study of socially disparate flood exposures in Greater Houston, Texas, USA.

Environmental justice research on flooding has relied heavily on analyses of aggregated geographic areal units and assessing exposure to 'pre-flood' risks (e.g., residence in 100-year flood zones) rather than actual flood events. To address these limitations, we examined disproportionate exposure to flooding caused by Hurricane Harvey in 2017 in Greater Houston (Texas). Using primary survey data collected from 377 representative households before Harvey and spatial data on Harvey-induced inundation developed by the US Federal Emergency Management Agency, we found that the areal extent of flooding around residents' home sites was distributed inequitably with respect to race/ethnicity and socioeconomic status (SES). Hispanic, black and other racial/ethnic minority households experienced more extensive flooding than white households, and lower SES households faced more extensive flooding than higher SES households. Findings align with prior flood risk research in Greater Houston and provide cause for concern, as social inequities in flood exposure may have influenced social disparities in flood impacts and post-disaster needs. Since flood events in Greater Houston are expected to increase in frequency and magnitude due to climate change, socially disparate impacts are likely to become an increasingly salient public policy issue. Thus, proactive approaches for reducing flood risks and ameliorating disparities should be implemented.

Vehicular Air Pollution in Houston, Texas: An Intra-Categorical Analysis of Environmental Injustice.

This article contributes to distributive environmental justice (EJ) research on air pollution by analyzing racial/ethnic and related intra-categorical disparities in health risk from exposure to on-road hazardous air pollutants (HAPs) in Harris County, Texas. Previous studies in this urban area have not examined intra-ethnic heterogeneity in EJ outcomes or disproportionate exposure to vehicular pollutants. Our goal was to determine how the EJ implications of cancer risk from exposure to on-road HAP sources differ across and within each major racial/ethnic group (Hispanics, non-Hispanic Blacks, and non-Hispanic Whites), based on data from the Environmental Protection Agency's National-Scale Air Toxics Assessment (2011) and American Community Survey (2009-2013). Statistical analyses are based on generalized estimating equations which account for clustering of analytic units. Results indicated that Hispanics and non-Hispanic Blacks are exposed to significantly higher cancer risk than non-Hispanic Whites. When each racial/ethnic group was disaggregated based on contextually relevant characteristics, individuals who are in poverty, foreign-born, renters, and have limited English proficiency are found to be disproportionately located in areas exposed to significantly higher cancer risk, regardless of their major racial/ethnic designation. Our findings underscore the need to conduct intra-categorical EJ analysis for uncovering inequalities that get concealed when broadly defined racial/ethnic categories are used.

Hurricane Harvey and people with disabilities: Disproportionate exposure to flooding in Houston, Texas.

While numerous environmental justice (EJ) studies have found socially disadvantaged groups such as racial/ethnic minorities and low-income individuals to be disproportionately affected by environmental hazards, previous EJ research has not examined whether disabled individuals are disproportionately exposed to natural hazards. Our article addresses this gap by conducting the first distributive EJ study of the relationship between flooding caused by Hurricane Harvey and locations of people with disabilities in Harris County, the most populous county in Texas that was severely impacted by this disaster. Our objective is to determine whether the areal extent of flooding at the neighborhood (census tract) level is disproportionately distributed with respect to people with any disability and with specific types of disabilities, after controlling for relevant socio-demographic factors. Our study integrates cartographic information from Harvey's Inundation Footprint developed by the U.S. Federal Emergency Management Agency with data on disability and socio-demographic characteristics from the 2012-2016 American Community Survey. Statistical analyses are based on bivariate correlations and multivariate generalized estimating equations, a modeling technique appropriate for clustered data. Results indicate that the areal extent of Harvey-induced flooding is significantly greater in neighborhoods with a higher proportion of disabled residents, after controlling for race/ethnicity, socioeconomic factors, and clustering. Disabled individuals with cognitive and ambulatory difficulties are more likely to reside in neighborhoods with a higher proportion of flooded area, compared to those facing other types of difficulties. These results represent an important starting point for more detailed investigation on the disproportionate impacts associated with Hurricane Harvey for people with disabilities. Our findings also highlight the growing need to consider individuals with physical and mental disabilities in future EJ research, as well as planning and management of natural disasters.