Abstract
Background
Recent advancements in drilling technology led to a rapid increase in natural gas development (NGD). Air pollution may be elevated in these areas and may vary by drilling type ...(conventional and unconventional), production volume and gas flaring. Impacts of NGD on paediatric asthma are largely unknown. This study quantifies associations between specific NGD activities and paediatric asthma hospitalizations in Texas.
Methods
We leveraged a database of Texas inpatient hospitalizations between 2000 and 2010 at the zip code level by quarter to examine associations between NGD and paediatric asthma hospitalizations, where our primary outcome is 0 vs ≥1 hospitalization. We used quarterly production reports to assess additional drilling-specific exposures at the zip code-level including drilling type, production and gas flaring. We developed logistic regression models to assess paediatric asthma hospitalizations by zip code-quarter-year observations, thus capturing spatiotemporal exposure patterns.
Results
We observed increased odds of ≥1 paediatric asthma hospitalization in a zip code per quarter associated with increasing tertiles of NGD exposure and show that spatiotemporal variation impacts results. Conventional drilling, compared with no drilling, is associated with odds ratios up to 1.23 95% confidence interval (CI): 1.13, 1.34, whereas unconventional drilling is associated with odds ratios up to 1.59 (95% CI: 1.46, 1.73). Increasing production volumes are associated with increased paediatric asthma hospitalizations in an exposure–response relationship, whereas associations with flaring volumes are inconsistent.
Conclusions
We found evidence of associations between paediatric asthma hospitalizations and NGD, regardless of drilling type. Practices related to production volume may be driving these positive associations.
•Early childhood is a critical period for telomere biology.•Prior studies of urinary As and telomere length in children have had mixed findings.•We examined urinary As and telomere length in 5–7 year ...old Bangladeshi children.•Urinary As was associated with significant decreases in relative telomere length.•Arsenic exposure may be related to telomere shortening in early to mid-childhood.
Telomere length has been associated with the occurrence and progression of common chronic and age-related diseases, and in younger populations, may represent a biomarker of disease susceptibility. Early childhood is a critical period for telomere biology as this period is characterized by a rapid decline in telomere length due to a large turnover of highly proliferative cells and may represent a period of unique sensitivity to environmental insults. Arsenic (As) exposure has been associated with both telomere lengthening and shortening in adults and children and some evidence suggests the effects may differ by level and timing of exposure.
Given the lack of clarity across studies, we investigated the association between urinary As and leukocyte telomere length among 476 five- to seven-year-old children enrolled in the Bangladesh Environmental Research in Children's Health (BiRCH) cohort.
In a series of multivariable models, adjusted for key covariates, we examined associations between urinary As and relative telomere length (RTL) of whole blood DNA.
We observed small but consistent, negative associations between urinary As and RTL, such that a doubling of urinary As was associated with a −0.017 (95% CI: −0.030, −0.005; p = 0.0056) decrease in RTL, in fully adjusted models. We also observed a somewhat stronger inverse relationship between urinary As concentration and RTL among children born to fathers ≥ 30 years of age at the time of birth, than those < 30 years; however, we did not observe a statistically significant interaction.
Our study suggests that As influences RTL, with detectable associations in early to mid-childhood. Further studies are needed to confirm our findings and investigate the potential long-term impacts of telomere shortening in childhood on later life health outcomes. Additional studies exploring how dose and timing of exposure may relate to RTL are critical to understanding As’s relationship to telomere length.
Although the Flint, Michigan, water crisis renewed concerns about lead (Pb) in city drinking water, little attention has been paid to Pb in private wells, which provide drinking water for 13% of the ...US population. This study evaluates the risk of Pb exposure in children in households relying on private wells. It is based on a curated dataset of blood Pb records from 59,483 North Carolina children matched with household water source information. We analyze the dataset for statistical associations between children’s blood Pb and household drinking water source. The analysis shows that children in homes relying on private wells have 25% increased odds (95% CI 6.2 to 48%, P < 0.01) of elevated blood Pb, compared with children in houses served by a community water system that is regulated under the Safe Drinking Water Act. This increased Pb exposure is likely a result of corrosion of household plumbing and well components, because homes relying on private wells rarely treat their water to prevent corrosion. In contrast, corrosion control is required in regulated community water systems. These findings highlight the need for targeted outreach to prevent Pb exposure for the 42.5 million Americans depending on private wells for their drinking water.
BACKGROUND:Research on spending persistence has not focused on Medicaid and the Children’s Health Insurance Program (Medicaid/CHIP), which includes a complex and growing population.
OBJECTIVE OF THE ...STUDY:The objective of the study was to describe patterns of expenditure persistence, mortality, and disenrollment among nondually eligible Medicaid/CHIP enrollees and identify factors predicting these outcomes.
RESEARCH DESIGN:The study is based on New Jersey Medicaid/CHIP claims data from 2011 to 2014. Descriptive and multinomial regression methods were used to characterize persistently extreme spenders, defined as those appearing in the top 1% of statewide spending every year, according to demographics, Medicaid/CHIP eligibility, nursing facility residence, patient risk scores, and clinical diagnostic categories measured in 2011. Similar analyses were done for persistently high spenders (ie, always in the top 10% but not always top 1%) as well as decedents, disenrollees, and moderate spenders (ie, at least 1 year outside of the top 10%).
SUBJECTS:Nondually eligible NJ Medicaid/CHIP enrollees in 2011.
RESULTS:One fourth of extreme spenders in 2011 remained in that category throughout 2011–2014. Almost all (89.3%) of the persistently extreme spenders were aged, blind, or disabled. Within the aged, blind, or disabled population, the strongest predictors of persistently extreme spending were diagnoses involving developmental disability, HIV/AIDS, central nervous system conditions, psychiatric disorders, type 1 diabetes, and renal conditions. Individuals in nursing facilities and those with very high risk scores were more likely to die or have persistently high spending than to have persistently extreme spending.
CONCLUSIONS:The study highlights unique features of spending persistence within Medicaid/CHIP and provides methodological contributions to the broader persistence literature.
In order to enhance childhood vaccination uptake and the health consequences for the whole society, there is a need to study predictors that might help in understanding parents' behaviour in relation ...to childhood vaccination schemes. The aim of this paper is to assess whether parental education has an influence on their children's public health-care use in terms of visits for vaccinations, and thus evaluate whether more educated parents use public health resources more frequently in childhood immunization schedules.
The setting was the region of Catalonia in the north-east of Spain. Three different databases, containing information about 11,415 individuals corresponding to 79,905 observations, were merged and linked: 1) observational and longitudinal administrative data for adults and children in Catalonia; 2) a database containing information on the vaccination of children in relation to the public health programme called the "Healthy Child Programme"; and 3) the governmental vaccination registration. The presence of an education gradient was explored using a logistic regression. Children's health-care use was modelled using a logistic procedure.
The greater the mothers' educational attainment level, the higher the probability of being vaccinated in this immunization programme. The presence of an age profile for vaccinations showed that less educated parents visit their GPs more frequently for immunizations when their children are below the age of six, but that pattern is completely the opposite after that age. Hence, for children aged between six and 16, more educated parents are more likely to ensure their children are immunized. Likewise, systematic vaccinations are more likely for those parents with a lower educational attainment level.
This paper evidenced the presence of an education gradient for specific preventive care through the public health system and visits to the GP without any particular disease or advice for specific vaccinations.
The relationship between rainfall and primary-school-age children's school attendance, school absence, work and health in rural Ethiopia is investigated. The focus is on how these relationships may ...differ by children's gender. An increase in rainfall relative to longer-term average rainfall is associated with increased school attendance by girls and decreased school attendance by boys. An increase in rainfall is associated with increased probability of working by boys and decreased probability of working by girls; no significant change in weekly hours worked by boys and decreased work hours by girls. The implication for boys is that more of them work when there is more rainfall, but those already working work fewer hours. An increase in rainfall frees girls' time, so they can potentially devote more attention to their schooling. An increase in rainfall is associated with lower school enrolment by boys but fewer hours of work for those already working. In terms of human capital acquisition, these two forces work in opposite ways for boys. An implication of these findings is that policies that offset income shocks arising from reduced rainfall are expected to result in increase in girls' human capital and potentially reduce future gender economic disparities.
Early-life exposure to the endocrine disruptor bisphenol A (BPA) may contribute to the development of obesity. Prospective evidence in humans on this topic is limited.
We examined prenatal and ...early-childhood BPA exposures in relation to childhood measures of adiposity in the Columbia Center for Children's Environmental Health (CCCEH) New York City birth cohort.
BPA concentrations were measured in prenatal (n = 375) and child ages 3 (n = 408) and 5 years (n = 518) spot urine samples. Childhood anthropometric and bioelectrical impedance outcomes included body mass index z-scores (BMIZ) at 5 and 7 years, and fat mass index (FMI), percent body fat (%BF), and waist circumference (WC) at 7 years. Associations were evaluated using multiple linear regression with continuous and tertile BPA concentrations.
Prenatal urinary BPA concentrations were positively associated with child age 7 FMI (β = 0.31 kg/m2; 95% CI: 0.01, 0.60, p = 0.04), %BF (β = 0.79; 95% CI: 0.03, 1.55, p = 0.04), and WC (β = 1.29 cm; 95% CI: 0.29, 2.30, p = 0.01), but not BMIZ, or change in BMIZ between ages 5 and 7 years (all p-values > 0.1). FMI results were sex-specific. Child urinary BPA concentrations were not associated with child anthropometric outcomes (all p-values > 0.05).
Analyses of the CCCEH longitudinal birth cohort found associations between prenatal urinary BPA concentrations and FMI, %BF, and WC. Our results suggest that prenatal BPA exposure may contribute to developmental origins of adiposity. These findings are consistent with several prior studies, raising concern about the pervasiveness of BPA.
Hoepner LA, Whyatt RM, Widen EM, Hassoun A, Oberfield SE, Mueller NT, Diaz D, Calafat AM, Perera FP, Rundle AG. 2016. Bisphenol A and adiposity in an inner-city birth cohort. Environ Health Perspect 124:1644-1650; http://dx.doi.org/10.1289/EHP205.
Personal care products are a source of exposure to potentially endocrine-disrupting chemicals such as phthalates, parabens, triclosan, and benzophenone-3 (BP-3) for adolescent girls.
We enrolled 100 ...Latina girls in a youth-led, community-based participatory research intervention study to determine whether using personal care products whose labels stated they did not contain these chemicals for 3 days could lower urinary concentrations. Pre- and postintervention urine samples were analyzed for phthalate metabolites, parabens, triclosan, and BP-3 using high-performance liquid chromatography/tandem mass spectrometry.
Urinary concentrations of mono-ethyl phthalate (MEP) decreased by 27.4% (95% CI: -39.3, -13.2) on average over the 3-day intervention; no significant changes were seen in urinary concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP). Methyl and propyl paraben concentrations decreased by 43.9% (95% CI: -61.3, -18.8) and 45.4% (95% CI: -63.7, -17.9), respectively. Unexpectedly, concentrations of ethyl and butyl paraben concentrations increased, although concentrations were low overall and not detected in almost half the samples. Triclosan concentrations decreased by 35.7% (95% CI: -53.3, -11.6), and BP-3 concentrations decreased by 36.0% (95% CI: -51.0, -16.4).
This study demonstrates that techniques available to consumers, such as choosing personal care products that are labeled to be free of phthalates, parabens, triclosan, and BP-3, can reduce personal exposure to possible endocrine-disrupting chemicals. Involving youth in the design and implementation of the study was key to recruitment, retention, compliance, and acceptability of the intervention.
Harley KG, Kogut K, Madrigal DS, Cardenas M, Vera IA, Meza-Alfaro G, She J, Gavin Q, Zahedi R, Bradman A, Eskenazi B, Parra KL. 2016. Reducing phthalate, paraben, and phenol exposure from personal care products in adolescent girls: findings from the HERMOSA Intervention Study. Environ Health Perspect 124:1600-1607; http://dx.doi.org/10.1289/ehp.1510514.
To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use.
A cross-sectional, observational study was conducted using data from the ...2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors.
We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 95% CI, 1.10-1.59 and OR, 1.31 95% CI, 1.20-1.43, respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use.
Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.
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