Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort

Author:

Martenies Sheena E.1ORCID,Zhang Mingyu2ORCID,Corrigan Anne E.2,Kvit Anton2,Shields Timothy2,Wheaton William3,Around Him Deana4ORCID,Aschner Judy56,Talavera-Barber Maria M.7ORCID,Barrett Emily S.8,Bastain Theresa M.9,Bendixsen Casper10ORCID,Breton Carrie V.9,Bush Nicole R.1112,Cacho Ferdinand13,Camargo Carlos A.14,Carroll Kecia N.15,Carter Brian S.16ORCID,Cassidy-Bushrow Andrea E.17,Cowell Whitney18,Croen Lisa A.19,Dabelea Dana20,Duarte Cristiane S.21,Dunlop Anne L.22ORCID,Everson Todd M.23,Habre Rima9ORCID,Hartert Tina V.24ORCID,Helderman Jennifer B.25,Hipwell Alison E.26,Karagas Margaret R.27ORCID,Lester Barry M.28,LeWinn Kaja Z.11,Magzamen Sheryl29,Morello-Frosch Rachel30ORCID,O’Connor Thomas G.31,Padula Amy M.32ORCID,Petriello Michael33ORCID,Sathyanarayana Sheela3435,Stanford Joseph B.36,Woodruff Tracey J.32,Wright Rosalind J.15ORCID,Kress Amii M.2

Affiliation:

1. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA

2. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA

3. Research Triangle Institute, Research Triangle Park, NC 27709, USA

4. Child Trends, Bethesda, MD 20814, USA

5. Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA

6. Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA

7. Avera Research Institute, Sioux Falls, SD 57105, USA

8. Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA

9. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA

10. Marshfield Clinic Research Institute, Marshfield, WI 54449, USA

11. Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA

12. Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA

13. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA

14. Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

15. Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

16. Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA

17. Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA

18. Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA

19. Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA

20. Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA

21. New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA

22. Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA 30322, USA

23. Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA

24. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203, USA

25. Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA

26. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA

27. Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH 03756, USA

28. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA

29. Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA

30. Department of Environmental Science, Policy and Management and School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA

31. Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 41642, USA

32. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94158, USA

33. Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI 48202, USA

34. Seattle Children’s Research Institute, Seattle, WA 98105, USA

35. Department of Pediatrics, University of Washington, Seattle, WA 98195, USA

36. Department of Pediatrics, Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA

Abstract

Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0–1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a “high” exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.

Funder

Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health

Publisher

MDPI AG

Subject

Health, Toxicology and Mutagenesis,Public Health, Environmental and Occupational Health

Reference83 articles.

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2. (2021, December 17). US Environmental Protection Agency EJSCREEN Technical Documentation, Available online: https://www.epa.gov/ejscreen/technical-information-about-ejscreen.

3. August, L., Bangia, K., Plummer, L., Prasad, S., Ranjbar, K., Slocombe, A., and Wieland, W. (2021, December 17). CalEnviroScreen 4.0, Available online: https://oehha.ca.gov/calenviroscreen/report/calenviroscreen-40.

4. (2017, February 14). Agency for Toxic Substances and Disease Registry [ATSDR] The Social Vulnerability Index (SVI): Data and Tools Download, Available online: https://svi.cdc.gov/SVIDataToolsDownload.html.

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